ifSW '..«^,^'-.' vx<-:^'. fev< \py v m. P + OUTLINES :fr..-V:-i • COURSE OF LECJUEES MATERIA MEDICA, *.>•. DESIGNED FOR THE USE OF STUDENTS, DELIVERED AT THE JJMitai &tt\U$t 0f t\t Slah 0f S0«tt-(S8r0li»a; HENRY R. FROST^^-M,^-- ' —v- ITT* . - -r* 1" .L: 1 .!'> .' V-ti. FIFTH EDITION. :5{jRGtCNGeN.tRAi:S OFFICE v.---.'-.:- ;,.• CHARLESTON, S. C. JAMES AND WILLIAMS, PRINTERS, 16 STATE-STREET. 18 5 8. 's v.-\\ QV 1858 f./n. NO. 6 if 7, /uo.2 Entered according to Act of Congress, in llie year 1851, by HENRY R. FROST, M.D , In the Clerk's Office of the District Court of the District of South-Carolina. 1 SYLLABUS. INTRODUCTORY LECTURE. Responsibilities of a Lecturer on.the subject of medicine, and the reasons why these feelings should 'be entertained— Responsibilities of the student—No profession, except the Clerical, the duties of which are so arduous, and the results, issuing in life, or death, are more important—Student excited by the honors and rewards of the profession. The prelimi- nary and collateral studies of the physician are of the most engaging character. His active duties attended with enjoy- ments of a still higher order—moral, benevolent, and reli- gious feelings encouraged. Qualifications and duties of medical students—Importance of education. Of qualifications preparatory to professional education—of the study of Languages—English—Latin—Greek. These last selected for the formation of the various compound terms employed in science—illustrated by furnishing a few words with their derivatives. French and German should be studied by every one desirous of excelling in professional literature. Other branches of knowledge—as Geography, History, Natu- ral Philosophy, Mathematics, a liberal course of reading. Qualifications during the student's medical education—The study of anatomy, with physiology, forming the ground-work of his medical course—the cultivation of organic science, wi microscopic observation—organic chemistry. To healthy anatomy, the study of morbid anatomy should succeed. Chemistry—applied to pathology and therapeu- tics—to the Materia Medica—vegetable analysis—value of the Materia Medica to the student and general practitioner— Of other branches of study. Duties of the student—To study and qualify for the pro- fession selected—force of perseverance—striving for the mastery in all undertakings—not on accidental circumstan- 1 6 GENERAL VIEW OF THE MATERIA MEDICA. cos, but on the character as students, that success as practi- tioners will mainly depend. To study and correct conduct, to be added humility—Improvement of leisure moments- - The results to which it has led—Sir Astley Cooper's advice— Conclusion—General aim of the Lecturer to be as practical as the limits will admit. GENERAL VIEW OF THE MATERIA MEDICA. Its connections with other branches of Science—Natural History—Pharmacy—Chemistry—Physiology, and the prac- tice of Physic. The natural substances employed as medi- cines are extremely numerous, and derived from the three kingdoms of nature—vegetable, mineral, animal. From the first obtained in the largest number—Remarks upon each of these divisions. Vegetables, though varied in their effects, and exercising an influence of the most opposite character, yet in their ultimate elementary arrangement exhibit a very similar composition ;—oxygen, hydrogen, carbon, and some- times nitrogen, enter into the structure of all vegetable sub- stances. Though these elements exist in all vegetables, yet they are in different proportions. It is this diversity which gives rise to the great variety of vegetable productions, and places us in possession of remedies different in powers and in action, and adapted to every state of disease. The active principles of plants being influenced by a vari- ety of circumstances, particular attention should be paid to whatever relates to their growth and preservation. It is im- portant when we wish to avail ourselves of their medicinal properties, that we should regard the period of their maturity, since to each period of their growth, there corresponds most commonly a chemical composition peculiar to that stage. Remarks upon the general economy of plants, with direc- tions for gathering and preserving them. The choice of plants—the period for gathering the leaves, roots and seeds. The means by which the medicinal properties of plants may be discovered. 1. The sensible qualities of plants, color, taste and smell considered, as determining their properties—remarks upon each. They will not admit of very extensive, or accurate application. 2. Botanical affinities. By these affinities is meant that MODUS OPERANDI OP MEDICINE. 7 plants agreeing in their general structure, habits and appear- ance, have also a similarity in their elfects upon the system. Examples of plants allied to each other by affinities, also agreeing in their operation—the graminas, or grasses—the labiated plants—the umbilliferous—the euphorbiaceous—the coniferae—the amentaciae—Exceptions to these examples. These exceptions do invalidate the general principle, but are not sufficient to set it aside—since we must take into con- sideration the important influence of cultivation upon the properties of plants—being no less remarkable in the vege- table than the animal kingdom. 3. Chemical analysis. 4. Experiments or experience—not alwaj^s conclusive— sources of error. From the animal kingdom we derive but few medicines. In what condition does nature present us with remedies in the vegetable kingdom ? Medicines are not simple substances, but will vary in their action according to the principles they contain—The effects which follow their application to the organized body. Remarks upon the importance of the Study of Botany to the physician—the study enforced from several considera- tions. MODUS OPERANDI OF MEDICINES. The subject intricate and obscure—the operations of me- dicines dependent upon the vital actions with which the body is endowed—Remarks upon life and its effects—division into animal and organic. The various parts or organs to which medicines are ap- plied. 1. The stomach and alimentary canal the most important.— They become so from their seat and connexions. The two properties of the stomach upon which the impression of me- dicines are made—its sensibility and irritability—The nature of the impression made upon these organs. I. An increase of the vital energies of the part. 2. A change of action. The proofs of an increase of action—The impression not the same in all cases. It varies with the quality of the article. It is modified according to constitution, habit, the situation of the part, the state of disease. That a change of action takes place, we may soon be con- MODUS OPERANDI OP MEDICINE. vinced, if we administer a substance which produces a strong impression—illustrated bv examples from Emetics, Cathar- tics. Stimulants, hus Fever, blood-letting is employed to prevent, cere- bral symptoms. The cause of the fatality in most cases ; used not only to relieve symptoms, but to prevent this symp- tom ; objections may be made to it from the debility which exists. This is a reason for abstracting a small quantity at once, a few ounces, but not to reject it; other debilitating remedies are employed, as leeches, blisters, purgatives, anti- monials. What is weakness, or debility, to delirium, or coma ? De- bility alone, a small consideration in comparison to either. Those cases of typhus go on most smoothly, which require to be fed all through the disease, in which weakness has been from first to last a prominent symptom. In inflammatory diseases, a remedy much to be depended upon. In these cases, the time, the quantity, and the sud- denness with which it is drawn, are all-important. The quantity to be drawn will depend upon the state of * Vide American Journal Medical Science. ON BLOOD-LETTING. 17 the pulse ; the degree and seat of the inflammation ; but the effect of the impression may always be increased, by bleed- ing from a large orifice ; or by placing the patient in an up- right position. This practice may very properly be pur- sued with delicate constitutions laboring under high arterial excitement; or Avhere it is desirable to secure the conse- quences of free depletion, without its exhausting operation. In practising blood-letting, the effect to be obtained, or the impression made, to be the measure of what is drawn, rather than the apparent quantity. _ The system readily accommodates itself to large abstrac- tions. Instances related of large quantities of blood being lost in disease, in surgical operations, on the field of battle, in parturition, in improper situations of the placenta ; prov- ing that when judiciously managed for the cure of diseases, blood-letting may be extensively employed. In Iiiflanr.iiatory diseases will be found a powerful curative remedy ; and when an organ is inflamed, it may be employed unhesitatingly. In PiivLininia afra Pleurisy, may be freely employed. The general directions given should be attended to. The quan- tity drawn should be influenced by the degree of inflamma- tion present, the age, habit and constitution of the patient; carried to the extent of relieving pain, or tendency to syn- cope. In Dysentery.—In the cases requiring this treatment, it will be found useful by lessening excessive pain and tormina, removing mucous, and bloody discharges, substituting for them feculent matter ; laxative medicines operate with best effects after bleeding ; a further proof of the good effects of blood-letting, when required in this disease, is the relief which is obtained by a natural haemorrhage from the bowels; other remedies also required in acute cases. In Inflammation of the Brain, or Arachnitis, Encephalitis, or Cerebritis—the advantage of this mode of depletion, or rather its superiority over other means, is very conspicuous. Other means are useful, but blood-letting has decided advantages. Not unusual to observe every exacerbation in the progress of such case, denoted by restlessness, delirium, increased fre- quency of pulse, of 10, 15 or 20 pulsations, subside after the loss of a few ounces. Fainting or syncope in this inflamma- tion not readily induced ; for the excited condition of the brain keeps up* a constant determination to that organ, and prevents syncope. In Ophthalmia.--T\\o great utility of this species of deple- tion must be apparent. From this disease we will take the opportunity of illustrating the utility of venaesection upon 18 BLOOD-LETTING. an important system of vessels, the capillaries—constituting the seat of inflammation ; the capillaries being inflamed and distended with blood, no remedy more important to relieve this distension, and to lessen the impetus of the advancing column. An inflamed eye, which is red as scarlet before bleeding, in a few moments is essentially improved in its ap- pearance, and a repetition will frequently remove it. In Acute Puerperal Peritonitis, or Puerperal Fever.—The treatment must be antiphlogistic ; one direction should be particularly enforced, that it be drawn early and freely ; un- safe to resort to this evacuation after the disease has been established thirty hours. Many authorities adduced as to its utility in this disease ; Dis. Alexander Gordon, La Gouais, Meigs, Lee. The state of the pulse should not deter from the use of the remedy ; often small and contracted, but be- comes fuller and stronger during the time the blood has been flowing, or soon after. Pain • a safer guide than the pulse. The great mortality which has taken place in this and other varieties of uterine inflammation, certainly cannot be attributed to the abuse of blood-letting, for it is observed that few of those bled early and copiously, died ; while those terminated fatally which either were not bled at all, or very late and sparingly, and took stimulants. Blood-letting not recommended in febrile inflammatory dis- eases, to the exclusion of other active remedies ; other valu- able auxiliaries. Objections to the use of the lancet considered and an- swered. 1. Dropsies and anasarcous swellings the frequent conse- quences of its employment. 2. Increasing the debility which exists in febrile diseases. 3. Rendering its habitual employment necessary. Conclude by noticing the immediate effects of this remedy on patients laboring under disease. A reduction of the force and frequency of the pulse. The sudden removal of pain. Reducing the temperature of the surface. Promoting the operation of cathartic medicines. Tendency to induce sleep. Morbid effects of blood-letting. LOCAL BLOOD-LETTTNG, 19 LOCAL BLOOD-LETTING. Comprehends Leeching and Cupping ; natural history of the Hirudo Medicinalis, or Lcecli. It is characterized by an oblong body, very contractile, having each extremity capable of being expanded into a fleshy disc, by which it adheres to the body, with a kind of suction similar to a cupping glass ; a triangular mouth situ- ated under the anterior extremity, armed with three very sharp, strong, teeth, and a sucker at the bottom, bvthe assis- tance of which it draws blood from the wound it inflicts. Utility in various inflammatory affections. In these cases they are frequently of considerable service, but it is an auxi- liary, rather than primary remedy. In all acute cases, particularly'of important viscera, gene- ral bleeding should be used to break the force of the disease, and after sufficient reduction, local measures are resorted to, to prevent a further expenditure of the vital powers ; and to act with peculiar advantage at this time on the part dis- eased. In Inflammatory affections about the throat, in the abdo- men, thorax, or cranium, or in the limbs and more superficial situations, the benefit derived from the application of Leech- es, can often be obtained by no other means. To particular- ize some of these examples : In Cynanche Trachealis, or Croup—the application of leech- es will very properly precede the employment of blisters, and in Quinsy, they have been known to afford great relief. In Inflammation of the Pulmonary organs, local blood-letting is often employed with great advantage, and applied to the thorax, may be considered as acting locally on the lungs. They exercise beneficial effects, not only by the depletion which follows, but also by revulsion. In Inflammation of the Trachea and in Bronchitis. In the painful, irritating cough of the latter affection, ap- plied above the sternum ; in the pit formed by the interme- diate space between the sterno cleido-mastoidei muscles, they will be found very serviceable. In Pneumonia occurring in children, they are a remedy of the utmost importance, and their utility should be held in recollection ; applied to the part affected as indicated by the stethoscope, and at a proper period of the disease, they will contribute very much to shorten its duration. Other modes of evacuation useful, but blood-letting, general or local, high- 20 LOCAL BLOOD-LETTING. ly important. Not omitted in a disease of such fatal charac- ter ; more so than croup, bronchitis, or hooping-cough. In Inflammedion of the Stomach and Intestines. The floAV of blood promoted by washing Avith Avarm Avater, or by cupping glasses, or by Avarm fomentations, or poultices, removing them as they became cold. In all Local Inflammations. In cases of Extravasated Blood, Ecchymoses and Contusions. In Local Plethora, or Congestions about the head and heart, threatening or producing apoplexy, a useful preventive check. In Phlegmonous Inflammation of superficial parts. In Erysipelatous Inflammation.—In the latter not much em- ployed in this country, but in France much resorted to. The practice in using them. When the disease spreads ex- tensively, they must be applied directly over the inflamed membrane; they should be scattered over the surface. From the External surfaces, their use has been extended to the Internal. In Ophthalmia they have been applied to the conjunctiva of the eye, lining the tarsus. The reports in favor of this practice are very encouraging, but I have employed it with effects not equal to expectations. Manner of applying them to the Conjunctiva. Leeches haA~e been applied to Inflamed Tonsils, to the Nostrils, to the Uterus, and Rectum. Manner of usinq them.—As they are very sensitive to strong odors, the part to which they are applied, should be first washed Avith soap and Avater, so as to remoA'e the matter of perspiration, and the skin should be Aviped dry ; the leeches should be applied one by one Avith the fingers, or placed in a glass covered all over, except one edge. The leeches should generally be suffered to fall off the spot spontaneous- ly. If forcibly separated, the teeth Avhich penetrate the skin, and Avhich swell Avhen inserted, are apt to be torn off. They may be made to drop off by sprinkling with salt or snuff. The leech drops off Avhen it is gorged, by falling into a state of asphyxia from want of respiration. The number to be applied will vary Avith the age. The quantity of blood draAvn by each leech, will depend upon the quality. To the blood draAvn by the leech, must be added that discharged by the punctures. The discharge from this source is often very considerable, and occasionally very diffi- cult to check. Means to be resorted to : use of collodion in arresting haemorrhage from these punctures recommended. Leech Fishery. CUPPING. 21 CUPPING. Resorted to, when besides the loss of blood, it is also de- sirable to excite much irritation on the skin, being revulsive and depletive—employed for the same general purposes as Leeches. The diseases to which this remedy is adapted aa ill correspond Avith those Avhich have been already mentioned under the head of leeching. They arc applied to various parts of the body ; the temples, scalp, back of the neck, along the spine, to the chest and other places. The manner in Avhich the operation is performed. Dry cupping, and Avith the scarificator. The former a very prompt and efficacious method of producing counter irrita- tion in acute pains ; it may with much advantage be resorted to in spasmodic affections of the bowels ; in Cholera ; in Cramps ; small tumblers may be employed for this purpose. Two or three applied to the abdomen are sufficient for this purpose ; a valuable auxiliary applied to the back of the neck in Epistaxis. Cupping glasses to Poisoned wounds—Avith a view to prevent the absorption of venomous matter ; experiments which were performed to illustrate their utility. Strychnia, or hy- drocyanic acid, introduced into wounds made in the thighs and back of full grown rabbits ; cupping glass applied, and reneAved as often as it fell off, no symptoms of poisoning oc- curring ; but when removed, convulsions brought on. Other poisonous articles employed, and Avith similar results. Dr. Barry's explanation of the modus operandi ; that of Drs. Pen- nock and Rodrigues. Treatment of poisoned wounds recommended.—-The applica- tion of a ligature above the affected part, and the employ- ment of suction by the mouth. This method I would recom- mend in cases of poisoning, or suspected poisoning from animals, as more prompt, more effectual, and more safe. In- asmuch as it can be speedily practised, it is superior to ex- cision or caustic. If there are no ulcers in the mouth, no apprehension need be entertained ; for should a portion of the saliva impregnated with the poisonous matter be SAval- loAved, no injury would result, since, from the experiments of Orfila, the poison of the viper may be introduced into the stomach \vith perfect safety—not ahvays successful; pursued in the case of Dr. Wainright, of NeAv York, but with fatal termination. oo MATERIA MEDICA. MATERIA MEDICA. Having considered all the subjects introductory to our subject, we Avill now proceed to those which are particularly to engage our attention. The Materia Medica is commonly divided into aliments and medicines. Though not always followed by systematic Avri- ters, it is certainly correct, and productive of much practical utility. Every practitioner should be acquainted with the kind of diet which will suit different disorders, and more par- ticularly how to direct the regimen of his patients in such a manner, as not to be unmindful of their comfort, and of the very essential aid which is to be furnished to the medical treat- ment from this source. Definition of the Materia Medica, more properly Materies Medic-e ; the department of medical science which teaches the knowledge of remedies, or the substances employed in the cure of diseases. The subject diffuses itself very extensively, comprehend- ing the natural and chemical history of the different articles ; the method of preparing them for use ; the application of these articles to diseases ; their doses and best modes of ad- ministering them. Previous to the consideration of these points, it Avill be proper to treat of the Classification of so extensive and mul- tifarious a list of remedies as this branch comprises ; impor- tance of a good arrangement in facilitating the acquirement of knowledge ; a good system in science being like a fine building in architecture, Avhere, from the skill of the architect, the various rough and heterogeneous substances Avhich enter into its composition, are so ordered, each in its proper place, as to present to the eye a uniform and harmonious whole ; so in the Materia Medica, the confusion Avhich would arise from a large number of articles being irregularly treated, yields at once to the simplicity, order, and ready comprehen- sion afforded by a judicious classification. No branch of science affords a more manifest foundation for associations, than that which treats of the different arti- cles employed in the cure of diseases. Distribution of me- dicines into classes of very ancient date ; during a period so extensive as that in which medicine has been practised, many different distributions have been formed, and a variety of general terms introduced for expressing them. MATERIA MEDICA. 23 Brief account of the various plans of arrangement Avhich have been pursued. First, in point of time and simplicity, is the alphabetical arrangement. From this, Ave can derive no information with regard to the specific virtues of various substances admitted into the catalogue of the Materia Medica. Another mode Avas founded on the class of bodies or king- doms, to Avhich the different substances belonged. Thus Ave had three general divisions, animal, vegetable, and mineral. Another upon an investigation of the sensible and most obvious qualities of the medicinal substances. These divisions are too general, indiscriminating and unin- structive. For example,'some substances have no discrimi- nating sensible qualities ; others possess several so nearly similar, that it is difficult to refer them to one class, in pre- ference to another ; and others again resemble one another in their sensible qualities, and yet are very different in their effects upon the human frame. Another upon the medicinal operation of the article upon the system. This arrangement must be considered the best for classification, as Avell as to present to our vieAv the pre- dominant characters of such a variety of articles as the Ma- teria Medica comprises. Medicines ought to furnish the characters which serve to unite, or to separate them ; and Avhat characters can be preferable to the effects, physiological and practical, Avhich they excite ? Dr. Cullen has arranged the articles as their operation is exerted upon the solids and fluids of the body, and has distributed the various substances in tAventy-three classes; Dr. DarAvin, comprehends them all under seven classes. A fifth into classes, according to the systems of the body upon which their action is exerted. The folloAving is the arrangement Avhich will be pursued in these Lectures : 1. To treat of those medicines which irritate the stomach and duodenum. This division comprises Emetics. 2. Those which irritate the internal surface of the intes- tines. This division comprises Cathartics. 3. Those Avhich increase the natural operations of the in- testines without exciting irritation. Laxatives comprised under this division. 4. Those which destroy, or counteract offending substances lodged in the alimentary canal. Under this division is comprised Anthelmintics and Anta- cids. 24 MATERIA MEDICA. 5. Medicines which promote particular secretions. a Of the skin—Diaphoretics. b Of the kidneys—Diuretics. c Of the uterus—Emmenagogues. d Of the salivary glands—Sialagogues. e Of the bronchial passages—Expectorants. 6. Medicines which strengthen the organized structures ; Tonics. 7. Medicines which in strengthening, also restrain exces- sive discharges ; Astringents. 8. Medicines which lessen the energy of the nervous and muscular systems ; Narcotics and Antispasmodics. 9. Medicines incertae sedis ; those Avhose action is not Avell determined, and which cannot Avith propriety be arranged under any of the foregoing divisions. In this proposed distribution, there are as many classes of medicines as are sufficiently determined by their characters, and by the phenomena which are proper to them. Each division represents a particular medical property, Avhich is discoverable in all the natural substances compre- hended under it. This property not the same in all the dif- ferent substances ; they have not the same energy, but it is sufficient to justify the alliance which is made, that each ex- erts the same organic phenomena, and that the substances of each class produce an action bearing a considerable re- semblance to each other. Objections Avhich may be made to the proposed arrange- ment. Every article treated gf more particularly under that head in Avhich its powers are most conspicuous ; when, from a difference in its preparation or its exhibition, other proper- ties are discovered, it must again be considered under such other divisions as correspond with the virtue specified. The medicines of these Classes do not act in any of these modes uniformly and invariably. From the states and con- ditions of the organs attacked, the same remedies exhibit often the most opposite effects ; a cathartic Avill often prove emetic, or the reverse ; a febrifuge increase fever, &c. Nothing absolute ; the operations of medicines modified by the condition of the organs or system ; in prescribing an ar- ticle, it is important that the condition of the part, or sys- tem, be accurately knoAvn ; that the nature of the impression made by each article, as Avell as the force of that impression, be also knoAvn ; the modifications that are to be pursued, as relates to age, sex, idiosyncrasy, climate, season ; that the preparation be such as to furnish all the results that may reasonably be expected after all the foregoing knowledge has MATERIA MEDICA. 25 been obtained ; and lastly, in Avhat shape, or what states of combination, the medicinal agent produces the most poAver- ful and beneficial effects. Upon some, or all of these sub- jects, it Avill be my duty to enlarge, and as much as in my power, to afford you just, reasonable, and proper vicavs upon the action of medicines, so that without extolling them un- duly on the one hand, or depressing them unnecessarily on the other, present you such changes either in the body to be acted upon, or the agent, as will secure or defeat the inten- tions Ave may have in view. In commencing any of the divisions, the following is an abstract of the leading objects which will be considered : 1. A definition of the class. 2. Direct effects of the class, and the changes induced in the system by these direct effects. 3. Effects of the class in the cure of diseases, and practical remarks upon its use in particular diseases. 4. Directions to be observed in the use of the class. The history of particular artichs. 1. The Natural History. Under this head Avill be considered its natural Family, sen- sible qualities, chemical analysis. 2. The medical History. The preparation of the article. 1. For a convenient form. 2. For preservation. 3. For external uses. Combinations of the Article. 1. For augmenting its virtues. 2. For correcting its active powers. Lastly, the adulterations. Pursuing the arrangement proposed, I shall consider under the first division. Division 1. Medidnes which irritate the Stomach and Duodenum. This comprises the articles termed Emetics. Definition of an Emetic ; many substances may act as Emetics, but we understand by them, such as act by a specific impression upon the stomach. 3 26 IMMEDIATE EFFECTS OF EMETICS. The importance of this class of remedies ; their usefulness apparent by controlling the operations of so essential an or- gan. , Objections have been made to this class of remedies, and some prejudices have existed against them. These considered and removed. Another objection to emetics, is, that they are Aveakenmg remedies, and exhaust the patient too much ; this objection Avill also appear equally unfounded—for the weakness Avhich occurs in the early stages of disease, does not arise from real exhausted strength, but from the nervous system being depressed, in consequence of the action of morbid substances on the stomach, and which is extended over the system. Any de- gree of languor, or weakness, produced by an emetic, cannot be so mischievous, as suffering the morbid cause to continue in action ; Avhatever therefore will evacuate it from the sys- tem, so far from Aveakehing, Avill restore strength, and this fact most of us have experienced, either as relates to Emetics or Cathartics* The immediate effects of Emetics, and the Physiological pheno- mena following their employment. The operation of Emetics upon the mucous coat of the stomach is irritating ; the effects of this irritation are an in- crease of all the vita] actions of the mucous membrane, the blood penetrates it, the capillary net Avork existing upon its surface, is more red, and more sensible ; these effects are ex- tended to the duodenum, and the same organic phenomena excited; this increase of the vital energies of the stomach and duodenum is only of short duration ; if it Avas of long continuance, it would cease to belong to those operations which are considered sanitory ; it would partake of the action of disease. The impression is soon effaced, without leaving any traces of its effects, within a very short time after they are admin- istered. To these effects of an Emetic of a proper character, others quickly succeed. The secretions are increased in a considerable degree. 1. The serous exhalation. 2. The secretion from the mucous follicles is augmented 3. The secretions of the large glands opening into the duodenum are increased. a. The Liver ; it is not probable that the quantity of bile frequently rejected, could have existed in the stomach or IMMEDIATE EFFECTS OF EMETICS. 27 duodenum previous to the taking of the Emetic ; the secre- tion of the fluid is often excited by the medicine taken, and is the result of irritation upon the surface of the duodenum extended by means of the Ductus Communis Coledochus to the liver ; particles of the emetic substance may also be ab- sorbed by branches of the vena portaj and carried to the liver, adding another irritant to this organ. To these sources furnishing an increased supply of bile, mustbe added the com- pression of the gall bladder. The secretory operation of another gland is promoted. The Pancreas partakes also of the irritating operation of emetic articles—its secretory action increased. The effects of this irritation do not cease here ; the muscu- lar coat of the stomach and duodenum feels the influence of this new irritation ; by its contraction, the contents of this organ are expelled, and we have all seen hoAv violent and severe it is in many cases, being so complete as to reject the smallest quantity of fluid which has been swalloAved. Another effect still produced ; a change takes place in the regular and accustomed operations of this coat; its action is inverted, and the contractions proceed from the pylorus to the cardia. How is this inverted action explained. Is the evacuation of the stomach the result of an active operation of the organ? Magendio maintains that the stom- ach is passive ; and that vomiting is occasioned by the pres- sure of the abdominal muscles and diaphragm upon it; this opinion at variance with the received opinions of Physiolo- gists. The experiments of Magendie have been repeated ; and while the importance of the action of the diaphragm and abdominal muscles has been acknowledged, the contractions of the stomach were also considered necessary, to effect the expulsion of its contents : such Avould be our conclusion, from the uniformity which takes place in this operation ; the diaphragm becoming contracted and fixed, the ribs drawn down, the abdominal muscles draAvn imvards, so that the stomach is pressed on all sides by voluntary muscles, its own contraction is all that is required to expel its contents. The local operation of Emetics is not alone of interest to us ; it is the actions it excites in various parts of the body ; it is the changes Avhich are produced in the exercise of its functions, Avhich are important to be known. 28 GENERAL EFFECTS OF EMETICS. The general effects of Emetics. 1. Upon the Brain and nervous system. 2. Upon the Circulation. The secretions are excited. 1. Expectoration is promoted ; the contraction of the diaphragm and abdominal muscles, Avith their alternate re- laxation, variously agitates the motion of the air in the lungs and bronchia?, and thereby promotes expectoration. 2. Diaphoresis is promoted. 3. The action of the absorbents is increased. 4. The secretion of the kidneys is more abundant. Rules to be observed in their administration : 1. Where there is plethora of the system, or the habit dis- poses to plethora, general bleeding should precede the ad- ministration of the emetic ; lest from the strong determina- tion of blood to the head,- apoplexy be induced, or a rupture of the vessels of the brain. 2. When the necessity is urgent and a quick operation is desired, a large dose of the most active Emetic must be given. 3. In ordinary cases it is best to give them in divided doses. 4. If the operation of the Emetic is too violent, the best means of checking it is fomentations to the stomach, and if necessary to the feet—anodynes in large doses. During the existence of pain, it is necessary to administer them in large doses ; pain so modifies the action of opium upon the nervous system, that large doses can be taken Avith impunity. If these means fail, an anodyne enema should be adminis- tered ; the warm bath may be required ; or the abstraction of a feAv ounces of blood ; counter agents may be required to neutralize the emetic salt which has been taken. If the Tar- tarised Antimony and Potash, an infusion of green tea or other astringents ; if the Sulphate of Copper, or other salt of this metal, albumen diluted Avith water, or sugar and Avater drunk freely. In irritable conditions of the stomach, whether brought on by Emetics, or other causes, it is important to admmister medicines and drinks, in the smallest possible quantity • it is the custom to give drinks freely in these cases, and the thirst is also urgent; but from the condition of the stomach it is rejected as soon as taken ; a mouthful, or a tablespo'onful will be sufficient to moisten the throat; more will be rejected' Sometimes entire abstinence is best. APPLICATION OF EMETICS TO DISEASES. 29 5. Do notalloAv the apparently inactive state of the stomach to induce you to augment the dose of an emetic to a prepos- terous extent. When the stomach is insensible to the opera- tion of one emetic carried to a reasonable extent, the best practice Avould be, to have recourse to another, as sensibility may exist to the stimulus of one article, Avhen it refuses to respond to another. Dr. Paris observes, that although the stomach be unable to void its contents by vomiting, it may, nevertheless, retain its sensibility, and therefore be liable to inflammation. A case is related of a practitioner attempting to excite emesis in an epileptic patient by a large dose of the Sulphate of Zinc, Avhich produced inflammation of the stomach, and a fatal termination. APPLICATION OF EMETICS TO DISEASES. They are adapted to a great diversity of cases ; this at- tributable to the extensive surface Avhich the stomach and intestinal canal presents, to the variety of irritating matters which are daily introduced into them, from the combined sources of extraneous articles of food, and the occasional morbidity of their natural secretions. There is also a con- siderable affinity between the surface of the body and the intestinal canal, so that Avhen perspiration is checked, as by the application of cold, the natural secretions into that canal are increased, which becoming acrid and irritating, add to the original exciting causes. Their beneficial operation may be arranged under the fol- loAving heads : 1. As Evacuants—In Febrile diseases they will often be found highly beneficial; these diseases generally accompanied Avith symptoms which mark a deranged condition of the secretions, and a departure from healthy action. The symptoms are, impaired appetite for food ; weight at the precordia ; abdominal distension ; with nausea, thirst, and furred tongue. Under these circumstances, the propri- ety of their employment must be manifest. They should, generally, be of an active character, not only to evacuate and reneAV secretions, but to make such an impression upon the general system through their influence upon the nervous, as to alter and subdue the existing diseased actions. I have not occasion to employ them in every case of fever. The cases requiring their employment: when the fever has 30 APPLICATION OF EMETICS TO DISEASES. been preceded bv a meal which oppresses the stomach ; when nausea distresses the patient ; when an unpleasant taste is complained of; Avhen headache exists. In most cases, headache will be found connected Avith the disordered condition of the stomach, and of its secretions. II bile is not present, there will often be acidity in excess, and patients will state to you, that it is of such a character, as to place the teeth on edge ; it is then a good general rule to evacuate the stomach. Cases of Febrile disease, where they are contra-indicated ; Avhen there is determination to the stomach and intestines— this determination is indicated Avhen the stomach is irritable, Avith occasional vomiting of thin fluids ; or frequent retching; when the tongue is red ; when pain and soreness exist in the epigastric region upon pressure being made. In the Bilious Remittent and Intermittent Fevers of our coun- try they are often indicated. In Intermittents their operation is sometimes remarkable, not unfrequently putting a stop to the disease. In Fevers of a Typhoid character ; in Eruptive diseases ; no one remedy can be beneficial in all cases, and at all times. Emectics Avere condemned by Broussais, a very popular writer and practitioner, under the impression that they pro- duce such a degree of irritation as to produce a Gastritis ; and that if the patient labored under fever, it Avould be con- verted from a mild form, to one of a more violent character ; and under these apprehensions of their use, he restricts their employment to a very feAV occasions. The objections an- swered, and an appeal made to experience for a full refuta- tion of them. The author's testimony in favor of their utility, and the beneficial effects derived from them ; not confined to the early state of disease, but may with safety be given, in the middle and advanced stages ; may even be useful in some of the mild forms of Gastritis itself, by changing the condition of the organ, and substituting an impression fol- lowed by critical evacuations, and of a different nature, from that constituting the disease. 2. Emetics useful as Diaphoretics.—They operate beneficially in Febrile diseases, not only as evacuants, but by promoting the secretions, particularly by the skin. In these diseases, this secretion is checked from the high arterial excitement' and from a morbid stricture of the vessels of the skin. The perspiration being checked, the heat of the body is increased with the general uneasiness of the system. Emetics operate by diminishing action, and inducing gene- ral relaxation. In Dysentery and Diarrhma—They are useful not only for APPLICATION OF EMETICS TO DISEASES. 31 their evacuant operation, but also from their diaphoretic ; intimate connection between the skin and alimentary canal ; in the disease of the latter, Ave attempt revulsion by reneAving the secretions by the surface—utility of this practice con- firmed by many authorities. In Dyspepsia, they are useful by removing the morbid con- tents of the stomach, and changing the character of its secre- tions ; they are more useful in removing the burning pain in the epigastrium, and freeing the stomach of its acid secre- tions, than all the antacids which can be employed ; some caution should be observed in their use. 3. Emetics emulge the Biliary ducts, and promote the Biliary secretion. They become useful in obstinate Constipedion of the boAvels, unattended Avith inflammation ; they promote the biliary secretion, by Avhich the boAvels are stimulated to the discharge of their contents ; Avhile by their febrifuge and relaxing operation, they remove the Fever, and the constriction, Avhich constitute the most dangerous, as Avell as distressing symp- toms of the disease. Several cases related of persons subject to attacks of obstinate constipation being relieved by this course, after mercurials and other remedies had been employ- ed Avithout success ; not to be used indiscriminately ; consti' pation of the boAvels attendant upon Intestinal Inflammation, and very difficult to overcome—the causes of this extreme difficulty. Emetics act as Expectorant and Revulsive remedies. In Pneumonia Notha.—When the congestive state of the lungs exists in a high degree, Emetics in repeated, but small doses, are more useful than any remedies we can employ. They equalize the circulation. To such a degree does this congestion exist, that Dr. Rush has called it an apoplexy of the lungs. In Typhus Pneumonia. In Asthma, given before the formation of the paroxysm they very often suspend the attack ; after the disease is formed, full and free vomiting does much to effect the solu- tion, and bestoAv relief. Phenomena attendant on this dis- ease ; emetics appear to exert a centrifugal poAver ; the con- cussion the system undergoes by the action of vomiting drives the blood into the remoter parts of the body ; by the nausea they produce, spasm is relaxed, and expectoration,by the rapid * passage of the air in the lungs through the bronchiaa, is promoted. In Pertussis or hooping cough, they are effectual remedies in all stages of the disease ; it mitigates one paroxysm, and suspends another ; the emetics preferred. 32 APPLICATION OF EMETICS TO DISEASES. In Cunanche Trachealis or Croup, emetics are indispensa- ble, and equally successful in the Inflammatory and spasmo- dic forms ; they afford much relief to the symptoms, and they maybe repeated during the Avhole course of the disease, Avhenever from increased excitement, or an increase of the secretion of the larynx and bronchia, any aggravation of the symptoms is experienced ; the stomach not always susceptible to their action ; by Avhat means it is made so. In the Anginose affections; sore throat; of great utility ; Avell adapted to the commencement of these diseases ; more benefit from their use than from any other species of evacu- ant; these diseases intimately connected Avith the disordered condition of the stomach ; other diseases having a similar connection. In Cynanche Maligna. * In Cynanche Laryngcea—C. Suffocativa—Pseudo-membra- nous Laryngitis. One of the most distressing forms of Anginose disease, which you will ever witness, not only from the sufferings of the patient, but the great mortality which attends it ; emetics are highly beneficial ; the sufferings of the patient compared to a pack thread around the trachea, and this gradually tightened, until suffocation takes place—Dr. Armstrong's tes- timony in favor of their utility. Such the sufferings and the mortality of these cases, that the propriety of an artificial opening into the trachea strenuously recommended by some practitioners. Emetics in the Diseases of the Head havebeen thought beneficial. The sick headaches of the studious and sedentary. In an anomalous species of headache, occurring after blows upon the head, they afford much relief. A case related of a severe blow upon the head in a rencon- tre, Avith the effects, and the relief afforded by emetics. The brain supports the operation of emetics under certain circum- stances Avithout injury. In the Apoplectic state of intoxica- tion, they effect much in restoring the patient to his senses ; also in the excited state Avhich precedes collapse. In Apoplexy—used with caution. In Idiopathic Apoplexy depending upon general fulness of the system, of the vessels of the brain, or rupture of its blood vessels, they are forbidden ; but Avhen dependent upon the condition of the stomach, resorted to with advantage ; when it succeeds a debauch or a full meal, they are useful • but to be preceded by venesection—apoplexy frequently ari- sing from the latter causes. APPLICATION OF EMETICS TO DISEASES. 33 In Epilepsy—of great utility when connected Avith the de- rangement of the stomach and boAvels. This connection rendered probable by the circumstances of its recurrence—it being observed to make its attacks in epileptics, upon any irregularity in diet; to occur among children who are much indulged ; and that its attacks are seldom renewed without either an habitual indulgence in eating, or a neglect of neces- sary exercise ; utility of emetics before the recurrence of the paroxysm, Avhen this is indicated by symptoms. In the Convulsive diseases of Children—-Partake of the char- acter of epilepsy—these affections always alarming, and par- ticularly in those of tender years—the causes various—den- tition—a consequence of Febrile excitement—worms—irrita- ting substances in the stomach and intestines—evacuants highly necessary when originating in the latter causes—-eme- tics of a mild character, folloAved by liberal doses of castor oil. The practice usually pursued in these cases, much to be deprecated. The practice recommended : In Mania—In acute states of the disease as indicated by great loquaciousness, flushed cheeks—wild and inflamed eyes —emetics by increasing the determination to the brain, pro- hibited. In Chronic Mania, and in Melancholia—employed as a chro- nic remedy. The stomach generally torpid, and requiring active doses. In Mania a Potu—Utility of these evacuants from the gas- tric origin of the disease—this inferred from the nature of the substances ejected from the stomach—the appearances on dissection, and the effects which follow their operation. The subjects of this disease : The treatment Avhich has at different times been pursued— generally stimulating—but the cure tedious and protracted. The late Dr. Klapp, from observing the effects of accidental vomiting, was induced to make trial of emetics, and much success folloAved their use—patients speedily tranquillized under this practice. Effects of vomiting—the removal of thick, viscid, and glairy matter, a remoAral of the usual tremor, the pulse becoming fuller and less frequent, and the patient falling into a sound sleep, from which he commonly awoke, restored to reason and himself—stimulants necessary to confirm the cure. The stomach in this disease loses its susceptibility to the action of medicines, insomuch that large doses of an active charac- ter are required. In constitutions much impaired by long indulgence, they would be prostrated under this practice, and it must not be 4 34 INDIVIDUAL EMETICS. resorted to in all cases. When, however, the strength of the pulse, and the vigor of the constitution Avill admit of it, its effects Avill be found extremely satisfactory. In Haemorrhages—Emetics have been employed. In Hemoptysis, the practice cannot be considered safe—and haemorrhages from other organs, are more effectually checked by other remedies. In some local diseases—The state of nausea, Avith the dimin- ished action of the heart and arteries, and the muscular re- laxation Avhich precedes the operation of emetics, Avould en- title them to some consideration in obstinate dislocations. The practice to be pursued in these cases. They haAre also been employed in Hernia Humoralis, and in the suppurative stage of bubo. They should be used with caution during the latter months of pregnancy, and Avhen prolapsus uteri exists. PARTICULAR EMETICS. The class divided into Vegetable and Mineral—Vegeta- ble substances will be first considered, and they will be ar- ranged according to the natural system in families. This arrangement holds out many advantages over the Linnean or Artificial—since it informs the medical inquirer not only of the botanical affinities of the plants, but also supplies him with a knoAvledge of their properties and qualities. This acquaintance Avith the properties of even one plant of any order, enables him to form some idea of the remedial value of all the other plants in the same order, and if needful, to substitute upon fixed principles, any one of them, for that which is most usually employed. The first article of Avhich I shall treat, is from The Family Rubiacea3--Calycocca Ipecacuanha —Natural History.—For a long time the natural history of this plant was involved m much doubt and obscurity. The characters were undetermined 150 years after its properties were known They were not satisfactorily ascertained, until Prof. Brotero read a Monograph on this subject, before the Linnean Soci- ety, in 1801, accompanied with an engraving of the plant__ Several distinguished botanists having fallen into much error on this subject—then ascertained to be the root of the above INDIVIDUAL EMETICS. 35 Botanical description. Root is perennial—length, 2 to 4 inches ; breadth, 2 to 3 lines. Color broAvn Avithout, white within, marked by numerous prominent unequal rings. Taste acrid and bitter. Smell feeble. Stem shrubby and creeping, giving out roots at the joints. Leaves, 4 to 8—situated near the summit of the stem, op- posite—length, 3 to 4 inches ; breadth, 1 to 2—color, deep green. Flowers, aggregate, in a solitary head—peduncles terminal and rather drooping. Habitat—moist and shady places—in the Avoods of Peru, Pernambuco, Brazil. Several varieties of the roots to be observed in the shops— the ash, or grey, and the brown. These varieties are furnished from the same plant—the differences depending upon the soil in which it groAvs—season e; . of the year in which it is collected. ?,iiCft The root is composed of a cortical and medullary portion; the former being most active. ~ Medical History.—Although the properties of this article £ were Avell known to the inhabitants of South America, it was not introduced into Europe until about the middle of the 16th century, Avhen Helvetius, under the patronage of Louis XIV., brought it into notice, and was rewarded handsomely for the benefits conferred by its employment. C/iemical History.—From analysis, it contains— Gum. Starch. Extractive matter. Oily matter, highly acrimonious, of a penetrating odor, and pungent taste, Avhich does not occasion vomiting. Emetine or the emetic principle—when first prepared it is in ttie form of scales, of a reddish, broAvn color. Sensible properties—Odor moderate—taste slightly bitter, acrid, not nauseous. -^plvents of Emetine. Water and Acetic Acid. Analysis of Emetine. Carbon, Oxygen, Hydrogen and Nitrogen—Obtained in the largest quantity from the cortical portion of the root. 36 APPLICATION OF IPECACUANHA TO DISEASES. Preparation of Emetine. The poAvdered Ipecac is treated with ether, in order to dissolve the fatty, odorous matter of the Ipecac—and Avhen the solvent has ceased to act, the powdered substance is it- self exhausted by means of alcohol. The alcoholic tincture is then evaporated in a sand bath, and the extract dissolved in cold Avater, when it abandons some Avax and a little re- maining fatty matter. It remains iioav only to macerate it Avith some carbonate of magnesia, Avhich deprives it of the gallic acid, and then to re-dissolve in alcohol, and evaporate to dryness. Operation of Emetine—More active than Ipecac, and pos- sesses fewer disagreeable qualities—proposed as a substitute on account of its more pleasant taste, its small bulk, and ready solubility. In the human subject, 4 grs. in two doses, gi\"en at an interval of 15 minutes, produces full vomiting, followed by a marked disposition to sleep—not much employed, as its operation on the stomach is apt to be more violent and con- tinued than Ipecac itself. The application of Emetine the same as Ipecac, given in divided doses. Solvents of Ipecac.—They are numerous—water, vinegar, wine, alcohol—dissolve its active matter—active matter of a . volatile nature, and by boiling it is driven off. With Avine is formed the vinous tincture of the shops, of much value in the diseases of children. The strength of the powder is much impaired by exposure to light and air. Application of Ipecacuanha to Diseases. Most important of the vegetable emetics—being mild, prompt, and efficacious in its operation—not so active as the tartarised antimony, nor so speedy as the sulphate of zinc. Adapted to a great variety of cases, and produces'effects not obtained by other emetics. Its operation in general confined to the stomach, Avithout having its action extended to the duodenum—cleanses the stomach of impurities Avith- out debilitating the patient. To the diseases of children it is well adapted. The activity of this article is proportioned to the dose, though in a less degree than other emetics- being bulky and partially insojuble, much of the poAvder is rejected with the contents of the stomach—admits of accu- mulation without having its action increased. Powers increased by combination with tartarised antimony APPLICATION OF IPECACUANHA TO DISEASES. 37 and Avith calomel—Avhen very active emetics are required, we must have recourse to the mineral. What changes does Ipecac undergo in the stomach by Avhich its emetic operation is promoted ? It is decomposed in the stomach, its alimentary matters digested, and its medi- cinal principles set free. Not only as an emetic is it used with advantage, but em- ployed in a variety of diseases. As a sudorific, has been employed in the diseases of the "alimentary canal, and A\Tas originally introduced in the treat- ment of Dysentery—has not lost reputation by time. In 1686, introduced into practice in France, by Helvetius, under the patronage of Louis XIV., Avho proved its efficacy in the person of the Dauphin, and some of the gentlemen of the court. In this disease after the contents of the stomach and bow- els have been evacuated, it almost always produces good effects in small doses, either alone, or in combination with opium. It has been said to be particularly adapted to those cases where there is a great discharge of blood—but it is useful in every form, especially if there is much pain and tenesmus. Of its modus operandi—it acts favorably by its diaphoretic,, y operation, by Avhich the fluids are determined to the surface^ —effects of Ipecac, in combination Avith opium. In Diarrhoea equally efficacious, employed in the same man- ner, Avith proper attention to regimen. In Dyspepsia, highly recommended—in what manner given ? In such doses as will not excite any painful sensations of nausea, but to produce a slight action upon the stomach, by which its viscid contents are separated and discharged. Thus given, acts as an alterative and gentle evacuant—improving the gastric and other secretions of the body. Doses of the powder, \ to \ gr. ; or Tincture, viii. to x. m. two or three times a day, in a little water. In Haemorrhages, this article has been employed. In Hcemoptysis in nauseating doses, taking care that vomit- ing be not excited, otherwise bad consequences Avould be likely to ensue. In Uterine HcemorrJiage, also exhibits good effects—its modus operandi—exciting nausea—diminishing the action of the heart and arteries, lessening the impetus of the blood—to this may we add, equalizing the circulation, and exciting a discharge from the cutaneous vessels—given in small doses. In Catarrhal and Pmum^nic disorders—Useful by the action it exerts upon the mucous membrane of the bronchia and 38 APPLICATION OF IPECACUANHA TO DISEASES. fauces—its action in these cases diversified, and seemingly of an opposite nature—'promoting expectoration in cases Avhero the mucous membrane is inflamed and dry, and likewise serving to restrain the secretion when it is inordinate and excessiA'e. In the samediseases occuringin children.—No diseases so much benefitted by frequent vomiting, and no article so efficacious and so innocent—their use not limited to a single emetic, or to the beginning of the disease. They must be repeated frequently t\ATo or three times a day until relief is afforded— small doses very efficacious for this purpose. When a deci- ded impression is made upon the disease, as evinced by the greater freedom in breathing, the improved countenance, the developed pulse, and the increased discharges from the sur- face, the doses are lessened, or the intervals increased. In Asthma, given to the extent of vomiting, it affords relief —relief is afforded by the mechanical operation of vomiting, expelling the mucous collected in the bronchia and trachea —thereby promoting expectoration—removing the conges- tion of the lungs—enlarging the capacity of the thorax. Ipecac, given in doses of v. grs. every morning in the in- tervals of the paroxysm, to effect a permanent cure. The author has pursued this practice in smaller doses night and morning, with the effect of moderating the paroxysms, and enabling the patient to resume laborious duties. Combinations of Ipecac, with opium and a portion of the sulphate of potash, forms the compound, termed Dover's poAvder. United Avith purgative medicines in small doses, gives to them greater activity. Combined Avith calomel in many cases with great advan- tage. Incompatible substances—All vegetable astringents—as in- fusions of galls, green tea, vegetable acids, as the acetic. Action of gallic acid upon Emetine—contracts Avith it an intimate union, and takes from it its emetic property. Forms of Exhibition.—-Powder, tincture, infusion—the poAv- der the most energetic—x. to xxx. grs. as an emetic ; i. to ii. grs. as diaphoretic ; £ to £ gr. as alterative and expectorant. Tinctures—x. m. to 3 i. as a dose. Infusion—#. Powdered Ipecac. 3 ss. Boiling Avater, | iv.—dose 3 ii. to f ss. Repeated as often as required, until the emetic operation takes place—much used in this form for children, and is com- monly termed hippo tea. Useful as a counter-irritant. Applied in the form of liniment, it produces an eruption of ADULTERATIONS OF MEDICINES. 39 minute vesicles, on an inflamed base, in from 36 to 48 hours, which fade aAvay in 3 or 4 days—prepared as folloAvs : $. Ipecacuanha in fine poAvder, - f ss. Lard.......3 ii. Olive oil,.....f iss. m. A fourth to be rubbed Avell into the part it is desired to ir- ritate, 3 or 4 times a day. GENERAL REMARKS UPON THE DOSES OF MEDI- CINES. That large and small doses of medicines are merely rela- tive terms, and should never be understood as denoting ab- solute quantities—for Avhat Avould pro\Te a large dose in one person, might prove trifling in another. The general rule of conduct ought to be derived from the sensible effect of our practice. Every dose of medicine, however large, is too small, if it stop short of the usual sensible operation on the consti- tution. This is to be the rule in the use of medicines—the system must be placed fully under their influence, and Avhen this has been done Avithout effect, the remedies must be changed for others. Were this general rule more attended to, Ave should not so often complain of the inertness of our means, or the obstinacy of diseases. Disease and debility are kept up by Avhat is called cautious practice—practice which is regulated rather by the quantity of the prescribed medicines, than by the effects produced. Adulterations of Medicines. Practised to a considerable extent, and it will be my duty to expose them on all occasions—feAV articles more frequent- ly than the present—of the various substances Avhich have been sold for Ipecac, I shall merely mention a few. The roots of the Gillenia Trifoliata, or Indian physic, the Euphorbia Ipecacuanha, or Ipecacuanha sponge—and the Phytolacca Decandria, or Pokeberry root, have all been sold for this article. The roots of Sarsaparilla have been poAv- dered, and combined with Tartarised Antimony in imitation of Ipecac. 40 INDIGENOUS EMETICS. From the frequency of adulterations, it is not advisablo to purchase a large quantity of any medicinal substance in pow- der—and as frauds are committed in a manner to elude de- tection, Avould advise, Avhen practicable, to procure as many of your medicines in the root as is possible. When this is not practicable, to seek out a responsible apothecary, and to pav the best prices for your medicines. Of adulterations of other articles, I shall give details when they come under consideration. Physicians cannot be too sedulous on this subject—for Avithout it, their honest endeavors will be thwarted by the substitution of some adulterated compound, in the place of the pure article which alone can amend and heal. Will on all occasions point out the frauds committed with medicines, and by presenting the best specimens, so familiar- ize you Avith their sensible properties, as to enable you to discover these impositions. INDIGENOUS EMETICS, SUBSTITUTES FOR IPECA- CUANHA. Family Rosacece—Spircea Trifoliata, vel Gillenia T.—Indian physic—grows plentifully in every section of the United States—the root, the part used, though the stem and leaves may be employed. Description of the plant and root. Root composed of a cortex or bark, and a ligneous portion ■—the former is most active, though the ligneous portion is not without activity. Root administered in the form of powder, when it will prove a certain and manageable emetic, at the same time safe in its operation—in mild cases requiring the employment of Ipecacuanha, it may with advantage be substituted for it —employed in the same diseases. The dose of the Gillenia is xxx. to xl. grs., which gives to Ipecac, a decided superiority, the bulk being a great incon- venience—this objection obviated by combining Avith it one or tAvo grs. of Tartarised Antimony—used in the adulteration of Ipecacuanha. Family Euphorbiaceaz— Euphorbia Ipecacuanha — Ipecac. Spurge. INDIGENOUS EMETICS. 41 Found in most parts of our country—the root the part used, and was supposed to furnish the officinal Ipecacuanha. The general character of the Euphorbia}—all remarkable for their activity, and abounding with a milky juice. Description of the Euphorbia Ipecac. The root an active emetic, the most active of the vegeta- ble emetics enumerated, differing from them in having its action extended to the bowels, and operating as a cathartic with considerable energy. The testimony of Drs. Barton and Bigelow in its favor. It differs from Ipecac, in not ad- mitting of a frequent repetition of the doses, nor of accumu- lation, as violent effects might ensue. Dose 3i. to 3 ss. Euphorbia Corollata.—Description of the plant and root. m The root employed, and is in its operation and effects al- lied to the preceding, often exerting a cathartic action. Dose 3i. to 3 ss. In smaller doses, as ii. to iii. grs., it acts as a diaphoretic, combined Avith opium, or the antimonials. In concluding these articles, I Avould recommend them to physicians practising in the country, little doubting that they would be found valuable, and good substitutes for Ipeca- cuanha. There are a variety of other plants that may be used as emetics. Their enumeration will be sufficient, and their fur- ther acquaintance can be extended hereafter. They are as folloAvs—Sanguinaria Canadensis, or blood root; Aralia Spinosa, or Prickly Ash ; Eupatorium Perfoliatum, or Thor- ouglnvort; Stylingia Sylvatica, Queen's delight ; Erythro- nium, or snake leaf; Phytolacca Decandra, Poke Root ; Lo- belia Inflata, Indian Tobacco. Upon this last, as much has been said of its virtues, a few remarks may be made. Family Campanulaceai—Lobelia Inflata—Description of the plant. It is a biennial, and found growing in most parts of the United States. Its properties are various—being Emetic, Diaphoretic, Expectorant, and in some degree Narcotic. Sensible properties—to the taste it is acrid and pungent, folloAved by a sensation of roughness in the throat. This impression being stimulating, excites a copious secretion of salivary and mucous fluids, with haAvking and expectoration 5 42 INDIGENOUS EMETICS. —effect upon tho stomach—nausea produced, and in large doses, vomiting. Character as an emetic—no peculiarity of operation, ex- cept being pungent and irritating—violent effects sometimes follow its use—becomes, therefore, exceptionable, and other articles preferred. Very useful in Asthmatic affections from its expectorant and emetic operation—much pleased Avith its effects after a variety of other remedies had been unavailingly employed-— employed in combination with other expectorants, as in the following formula : £fc. Tinct. Lobelia, ) Compound Syrup of Squills, V Equal parts. Simple Syrup of Squills— j 3 ii. to 3 iii. given every ten minutes during the paroxysm with a little water, until relief is afforded—and in the inter- vals of the paroxysms, two or three times a day. In other diseases of the thorax—as Catarrh, Pertussis, Cynanche Trachealis, and other pectoral diseases. Forms of exhibition—powder—dose from 3i. to 3 i. as an emetic. Tincture—dose 3 i. tof ss. as an emetic, repeated every 10 or 15 minutes until it operates—for its expectorant opera- tion every hour or tAvo. TJie infusion is rarely employed—with sugar or treacle, a syrup may be formed, which may be advantageously employ- ed "1 the catarrhal affections of children, and in threat- ens' croup. This preparation will be found more active than squills, and more readily taken. Family Solanece—Nicotiana Tabacum, or Tobacco—natural- ized. Description of the plant. Natural History—was not knoAvn in Europe until after the discovery of America, and Avas first imported about the year 1560, as some say, by Sir F. Drake. Chemical analysis— Besides several principles, it contains a peculiar proximate one, upon Avhich the properties of the plant depend. This is.the volatile oil of tobacco, or nicotin. Properties—taste acrid, smell peculiar to tobacco—color- less— in it resides the active principle of tobacco—it is of a volatile nature, and obtained by distillation from the leaves- poisonous—experiments of Mr. Brodie. Medicinal properties—very diversified—being narcotic INDIGENOUS EMETICS. 43 errhine, sialagogue, purgative, as well as emetic. The latter very decided, and has been known to produce vomiting, after other articles had failed. Useful to evacuate the stomach after poisons had been taken, and has been employed exter- nally for this purpose—and in Cynanche Trachealis after other emetics had been unavailing. -—"Ta < Employed in the form of, Enema in obstinate constipation :*f-^-: of th<3 bowels, and in strangulated hernia—employed also in the same manner in the treatment of Tetanus. Dr. O'Bierne's practice—a strong infusion injected by means of a flexible tube into the colon. This practice adopted in • 20 cases, eleven of Avhich recovered. The smoke of tobacco " employed in the same manner. United with cerate in fine powder, has been employed for its relaxating operation in Spasmodic diseases—as Cynanche Trachealis, applied in the form of plaster to the sternum. Poisonous effects more likely to occur in the form of ene- ma, than as an emetic—Gallic acid, a counter agent, unites Avith the nicotina, and renders it inert. To obtain this acid, prepare an infusion of galls, green tea, or other astringent. Family Liliaccw—Scilla Maritima, or Squills—Naturalized. Description of the plant—root bulbous, and increases much in size—composed of lamina? or scales, the external being broAvn, internal Avhite. Sensible properties—no odor—taste bitter and acrid—by drying looses much of its acrimony, but still a very active medicine. Analysis of Squills— Scillatinthe essentially active principle—properties—acrid and bitter—white, transparent, of a resinous fracture, deli- quescent—soluble.---——-"*- Medical uses.—The root of squill has been long knoAvn in medicine under the mystic name of Eye of Typhon—its pro- perties numerous and diversified, being emetic and purgative —expectorant, DiureticY"^ / Employed in children for its emetic and expectorant ope- . — ration, and for their diseases it is much and advantageously resorted to. Given to relieve in them troublesome chronic cough—to promote expectoration in hooping cough—in croup. Usefully combined in adults with other articles in the treat- ment of chronic coughs, colds, &c, as in the following formula : #. Gum Opium, gr. £ PoAvdered Ipecac, gr. £ Powdered Squills, gr. ii. 44 MINERAL EMETICS. Svrup as much as is sufficient—make a pill. To be repeated every 3 or 4 hours, or oftener, if neces- sary. Squills yields its active properties to several menstrua— the preparations are, therefore, numerous. They are— Tincture of Squills, Syrup of Squills, Vinegar of Squills, Compound Syrup of Squills, Oxymel of Squills, Infusion of Squills. Dose of the powder, 8 to 10 grs. as an emetic. Tinctures—3 i. to f ss. In smaller doses of poAvder, its diuretic properties are ob- tained—referred to under the head of Diuretics. Family Cruciferce, Semina Sinapi—Mustard seed. The ground mustard given in the form of a Aveak infusion in the proportion of 3 ii. of the flour, or fresh ground seed, in a half pint of water, acts promptly as an emetic. It Avas much employed as an emetic in the early treatment of Asiatic cholera, and often Avith advantage. It has the ad- vantage of leaving the stomach and system in a less depressed condition, than it is after the use of other emetics. MINERAL EMETICS. The most valuable are among the Preparations of An- timony. Natural History of Antimony.—It exists in nature as a Sul- phuret of Antimony, and is of a bluish color—a shining sur- face, and a striated texture—obtained from mines in Hungary, Germany, &c—Tradition respecting the early use of this ar- ticle—Medical History—introduced into the practice of me- dicine Avith great difficulty. Uses of this article revived by Paracelsus, and it was em- ployed by him as a powerful and efficacious remedy—alter- nately received and rejected—finally established in regular practice, by the labors of Hoffman, Cullen and Fordyce. Antimony, in its natural state, is not active, unless it meets with an acid in the stomach. To become active, it is submit- ted to a variety of processes by the chemist. These prepara- tions, though greatly multiplied, are characterised by an uni- formity of operation. I will only glance at the most impor- tant of these preparations. The means used to give activity to the Sulphuret of Anti- mony, are— (a.) By trituration and the action of heat and air. ANTIMONIAL PREPARATIONS. 45 None of these preparations retained in practice. By the action of the alkalies. 1. Kermes Mineral, or Sulphuretted Hydroguret of Anti- mony, or sub-Hydro-sulphate of Antimony of the French- preparation. 2. Golden Sulphur of Antimony, or Sulphuretted sub-Hy- dro-sulphate of Antimony—preparation. These preparations coincide nearly in their action on the system—the only difference, the latter containing more sul- phur, is less acti\^e. Medical properties and uses—their action is upon the coats of the stomach, producing nausea, and promoting the secre- tions of the skin, lungs and trachea. Their action extended to the bowels, producing Catharsis. Useful in all Inflammatory affections of the lungs—-in pneu- monia—catarrhs, acute and chronic. . ^eJ ?an De recommended in these cases, and are useful by diminishing excitement, determining to the surface, allaying thereby the irritation Avhich excites and provokes coughing^ These preparations are also useful in Febrile affections, and may very well be substituted for the Pulvis Antimonialis, being not only more uniform in their operation, but decided- ly more energetic. Dose as an emetic..................vi. to x. grs. As a Diaphoretic,..............ii. to iii. grs., or used in the form of Pectoral mixture. #. Kermes Mineral...................3 ss. to 3ii. Mucilage Gum A.rab.,...............^ vii., mix. Dose—f ss. every second or third hour. The nausea excited diminishes action and excites perspi- ration—while the pulmonary exhalation being increased, ex- pectoration is promoted. Treat all pulmonary affections, even mild ones, as impor- tant, and you will less seldom err from too much than too little caution, Recollect that most diseases commence with irritation of function, when they are curable ; and pass often rapidly into derangement of structure, when they are incu- rable. 3. By the action of Nitrate of Potash upon Antimony— none of these preparations are retained—in their place we have the Pulvis Antimonialis. Preparation—it is prepared by exposing the sulphuret of antimony, and hartshorn shavings, to a white heat for a cer- tain time—the animal matter and the sulphur are driven off, leaving an oxyde antimony with phosphate of lime, which, combined together, form the Pulvis Antimonialis of the shops or the proto-oxyde of antimony with phosphate of lime. 46 ANTIMONIAL PREPARATIONS. These are the principal preparations with the Sulphuret of AntimouA*. With the oxydes of antimony united with acids, so as to form salts, there have been many preparations in use—but few are employed at the present time. The most important is the Emetic Tartar—a compound of protoxyd of antimony, tartaric acid and potash. Preparation—it is obtained by boiling bi-tartrate of potash with protoxyd of antimony, in a glass vessel, for a quarter of an hour, ana* setting the liquor by to cool. In this process the excess of tartaric acid, in the bi-tartrate, is saturated by the protoxyd of antimony, and by evaporation, and crystali- zation, a triple salt, Tartrate of antimony and potash, is ob- tained. Sensible properties. Color Avhite. Taste styptic and metallic Soluble in Avater—requisite dose small. Character as an Emetic— Prompt, certain, and energetic. Excites the stomach into forcible and long continued ef- forts to discharge its contents—this action extended to the duodenum—the operation of antimony is extended to the alimentary canal, and hence itproves considerably purgative. This effect taking place, either when the dose has been great- er than necessary, merely to produce vomiting, or when the stomach has escaped the action of this powerful medicine— antimony appears to promote almost all the excretions, and to quicken and stimulate the action of the absorbent vessels. From this extended action upon the system, it is often pre- ferred to other emetics—and by this extended operation, does much to break up the morbid associations Avhich are formed in disease. Employed in the commencement of the continued fevers of our climate, and does much to effect a crisis at the onset. In Intermittent, Remittent, and Bilious remittents of our climate, it is often properly resorted to in the early stages. The object of the practioner Avhen called in the early stages of fever, is to arrest the febrile paroxysm in its commence- ment. This is done by the use of such means as produce a considerable commotion or shock in the system—and among these means emetics have held a high rank. They possess this advantage, that they may be employed at any period of the paroxysm. If during the chin,, free vomiting is excited, the cold fit is often speedily terminated, and a general glow, accompanied with a degree of perspiration, is produced. TARTARISED ANTIMONY. 47 If delayed until the hot fit has commenced, its operation is frequently followed by free perspiration, and relief to many of the concomitant symptoms. Should it fail in bringing about a solution of the fever, the antimonial may be continued during its progress, in minute doses. It has been a question, Avhether they should be carried to the degree of producing nausea. By some physicians it is contended, that it should be carried to this extent. While by others this practice has been condemned, and it has been said to produce the most decided advantages, Avhen it produces the least sensible effects upon the stomach. The sensation of nausea cannot be long supported, and if the antimonials produce good effects Avithout being carried to this extent, it will be removing one of the strongest objec- tions to their use. Their favorable operation in Febrile and Inflammatory diseases seems to depend upon their poAver to moderate the action of the heart and arteries, and upon the exercise of this power, their good effects seem to depend. To such an extent is it exercised, that the term sedative and febrifuge has been applied to them. Upon this principle has this medicine been employed in other diseases, particularly the Phlegmasia?. In Pneumonia, after proper depletion, given in small doses, it will be found efficacious in relieving pain, increasing the freedom of respiration, exciting perspiration, and subduing the remaining inflammatory symptoms, more effectually than venajsection, or the usual depleting remedies. In Catarrhs—chronic coughs, employed at a proper period, no article exercises a more salutary influence. By it an impression is made upon the disease, infinitely to be preferred to the mucilaginous drinks, cough mixtures, anodynes, as follows ! #. Calcined Magnesia, 3i. Water, ?i. Tincture of Assafcetida, gtt> lx. Laudanum, gtt. xx> The dose is twenty drops—if not relieved, to be repeated in an hour or two. Magnesia is employed in the treatment of Calculous com- plaints Avith great benefit—Of its use in these cases, I shall speak on a future occasion. The dose for a Cathartic operation is 3 ss. to 3 ii., given in water or milk. The habitual, or long continued use of magnesia, has some- times occasioned distressing symptoms from its retention in the bowels—It is found accumulated in the colon. Useful as a counter poison Avhere the mineral acids have been taken in large quantity, either by accident or design. It combines with the acid, deprives it of its acrimonious pro- perties, and is converted into a saline substance by no means deleterious. NEUTRAL SALTS. They hold an intermediate station in their operation, between Laxatives and Purgatives. They are employed for evacuating the contents of the bowels, This is done by exciting the exhalents of the intestines to pour forth a large secretion, by which the system is depleted—Hence their use in excited states of the system, reducing action and lessening inflammation, and from this operation they are called "cooling medicines/ Sulphate of Soda, Glauber's Salt. It is procured from the residuum of several chemical pro* cesses, particularly after distilling muriatic or hydrochloric acid, from the chloride of sodium by sulphuric acid. It is a very common and useful cathartic. It contains much water of crystallization, which evaporates upon exposure to the air—hence it is termed an efflorescent salt. When the water is evaporated, half of the usual dose is sufficient. This salt is more nauseous than the other saline prepara- tions, but it is also more active—No method of disguising its NEUTRAL SALTS, 95 taste, but it is less disagreeable by being taken in a small quantity of fluid—It is also less active—The energy of saline substances seems to depend upon their being dissolved in a large quantity of fluid—Hence the activity of Seidlitz pow- ders, of sea water, of mineral Avaters generally. Formula for the administration of this salt : #. Glauber's Salts, |ii. Antimony Tart,, grs. i. Lemon Juice, or Vinegar, |i. Water, fviii.—mix — dose f ss. to f i., every two hours until it operates. Sulphate of Magnesia. Found native—and obtained by evaporating waters which hold it in solution, as Epsom springs in England—hence the name applied to the salt—also from sea water, and from a mineral called Dolomite. This article is mild in its operation, and agrees well with the stomach. Sulphate of Soda sometimes substituted for it— The fraud readily detected. Enters into the formation of the black draught. #. Sulphate of Magnesia, f ss. Infusion of Senna C, fiss. Tincture of Senna, 3 i. Syrup of Ginger, 3 i. m. as a purgative draught. Phosphate of Soda has lately been introduced, and is less unpleasant to the taste than the other salts, being a good substitute for them—particularly when there is any tendency to nausea. It possesses no particular advantages—Prepara- tion. Tartrate of Potash and Soda, or Rochelle Salt—Preparation —Most agreeable of the saline preparations, but less active, requiring a larger dose. Sulphate of Potash—Sal Polychrest—Vitriolated Tartar— Preparation—Not very Soluble, and is seldom employed, but in combination with other cathartics, as Jalap, Rhubarb, the operation of which it promotes, as already mentioned. To the taste it is rather bitter, and acts as a gentle cathartic in the dose of 3 ii. Of other Neutral Salts—the Bi-Tartrate of Potash, the Nitrate of Potash, &c, I shall speak under other heads, where they can more properly be introduced. 96 MINERAL WATERS. MINERAL WATERS. Those particularly noticed, remarkable for the saline im- pregnations, being an agreeable form of administering purgative medicines. They have been known to mankind from great antiquity, and were employed externally and internally for the preven- tion and cure of diseases. Homer speaks of tepid and cold springs—the Asclepiadeae erected their temples in the neigh- borhood of Mineral Waters. Hippocrates speaks of them, and Pliny notices their medicinal properties. General observations upon the composition of Mineral Waters. The small quantity of active ingredients they contain— their number—their extensive dilution. The gaseous substances which are combined in a mineral water, are deserving of much consideration. The precise operation of these agents is not well known, but the effects of a gaseous Avater are more powerful, in proportion to the suddenness of the expulsion of the air, and therefore to the looseness of its adhesion to the water, with which it is com- bined. The Mineral Waters alone brought to notice, remarkable for their saline impregnations, and of which imitations are made, or rather attempted. Seidlitz Salt—the product of a spring near Seidlitz, in Bohe- mia—the water was long neglected by the inhabitants, until it was brought into notice by Hoffman. The taste of the water is very saline and bitter, but not acidulous or brisk. From analysis, its principal active ingredient is Sulphate of Magnesia, and to this is owing its bitter, saline taste, and purgative property. The quality of the water is similar to that of the Epsom spring in England, as ascertained by Hoffman. The effect of this water is in a high degree purgative, greater than might be supposed from the quantity of active ingredients. The salt is obtained at the spring by evaporation and crystallization, and sold as the Seidlitz salt. The popular draught from the Seidlitz powders, made in imitation, has no property at all to be compared. It is com- posed of two different powders—one contained in the white paper, consists of MINERAL WATERS. 97 Tartrate of Potash and Soda, or Rochelle Salt, 3 ii. Bi-Carbonate of Soda, 3ii.—make a powder. That in the blue paper, of Tartaric Acid, grs. xxxv. They are dissolved in separate vessels containing small portions of water, one Avhich has been sweetened, and drunk during the effervescence. Sea Water is the strongest in saline matter, of all the natural waters. It contains by analysis, several distinct salts, as follows: Chloride of Sodium. Chloride of Magnesium. Sulphate of Magnesia. Chloride of Calcium. Iodine, and Bromine. These proportions will vary somewhat, according to situa- tion. A pint is a dose, and it will, in general, remain upon the stomach, unless it is very irritable, and prove purgative. It can be persevered in a considerable time without debili- tating the stomach and intestines, or impairing the digestive powers. When used for its purgative operation, it should be brought several miles from the shore, from the sea. It is not so much employed internally, as in the form of baths, &c, in weak habits, and in scrofulous constitutions. Its poAvers in this respect have been long extolled by Dr. Russell, and others, and it is the common practice in England to resort to various watering places on the sea shore, to enjoy the benefits of sea bathing, and the internal use of the water. The efficacy of sea bathing has of late attracted the atten- tion of our community, and it is considered a very important therapeutical agent in many chronic diseases, particularly Avhen the digestive organs are concerned. It may be used according to the strength of the patient, in the form of cold or warm bathing, and in either manner employed, has been found very efficacious in restoring the tone of the digestive organs, and promoting the healthy operations of the system. The stimulus of the salt bath on the skin, will be much aided by the flesh brush. Another mineral water which furnishes us with a purgative salt, is Cheltenham water, though it possesses also chalybeate properties. It contains the following principles : Sulphated Soda. 12 98 MINERAL WATERS. Sulphated Magnesia. Chloride of Sodium. Muriated and Carbonated Magnesia. Selenite. Oxyd of Iron. Carbonic acid gas, a large quantity. From this analysis, it is decidedly saline. It is also chabybeate. Contains much carbonic acid. Cheltenham water will not keep Avell, the active principles being precipitated. The Avater is evaporated at the springs, and the salt is obtained by crystallizing. A moderate dose operates effectually as a cathartic, and also in a very gentle manner. It is imitated by the apothecaries, and a factitious powder prepared, composed of the Sulphate of Soda. Sulphate of Magnesia. Chloride of Sodium. Sulphate of Iron. This compound is inferior to the imported article, but still active in a small dose, from the mixture of salts. This water, as drank at the spring, is useful in persons laboring under hepatic derangements from long residence in hot climates, also in scorbutic affections of the skin. In the United States, the principal mineral Avaters, are those of Saratoga and Ballston, in the State of NeAV-York, Ballston Spring Avater— Carbonic Acid Gas. Chloride of Sodium, Chloride of Calcium. Chloride of Magnesium, Carbonate of Lime. Carbonate of Magnesia. Carbonate of Iron, Congress water contains— Carbonic Acid Gas. Chloride of Sodium. Hydriodate of Soda. Bi-Carbonate of Soda. Carbonate of Lime. Carbonate of Magnesia. Carbonate of Iron. Hydro-bromate of Potash. The Carbonic Acid Gas is a very important principle, to which many of the properties of the water are owing. It holds the Iron and Salts in solution—gives to the water ENEMATA-. 99 its agreeable, pungent, and subacid taste—excites exhiliration of spirits, &c To the Chloride of Sodium, or common salt, its purgative properties are OAving. That a substance with which Ave are so familiar, should be so powerful a cathartic as the Saratoga water is knoAvn to be, Avoilld appear surprising. The activity of the AVater much augmented by the combination of salts. The Iron is another important ingredient. These Avaters are adapted to diseases which proceed from a disordered state of the alimentary canal, from obstructions of any of the viscera—of the biliary organs. ENEMATA. Substitutes for purging, and serve some important pur- poses. They are useful to evacuate the rectum, but principally to promote the operation of cathartic medicines. They cannot pass higher up than the valve of the colon, and consequently they can only act upon the large intestines —cannot supply the place of purgatives by the mouth. Their preparation—Instruments described. In purchasing a syringe, let it be large, the walls of the cylinder unyielding, and Avith a good leather valve. Self-injecting Syringe—With this syringe the bowels can be distended Avith any quantity of fluid, so that by simple distension alone, any obstruction may be overcome. The advantages attending its use—can be admininistered by the person himself. The pipe can be introduced under the bed clothes, and thus any exposure prevented. The same instrument used for evacuating the stomach of poisonous substances* Other instruments—the Irrigateur of the French, one of the best for the purpose—the same explained. When more powerful enemata required—Tobacco, in the form of infusion, or smoke—or a suppository of tobacco, or a cigar. Cold or iced Avater, used to overcome obstinate costiveness Avalking over a hearth barefoot, or throwing cold water over the thighs, and legs, have been productive of the same effect. Enemata employed for other purposes—to allay irritation of the system* and of the Pelvic viscera—and through this channel often with great advantage. The enemata used for this purpose, are of an anodyne character—Preparation—Employed in irritable conditions of 100 suppositories. the bladder or it* neck—in the painful and spasmodic diseases of the Uterus—in the tenesmus of Dysentery. In irritable conditions of the Stomach. Enemata employed as vermifuges, when the Avorms are lodged in the lower intestines. Enemata of Tobacco in Strangulated Hernia. In Uterine and Intestinal Haemorrhage, astringent glysters, and particularly iced water, are sometimes of poAverful use, in checking these alarming accidents. A solution of Assafcetida, or other anti-spasmodics, are often resorted to in Hysteria, and other complaints for Avhich this class of remedies is employed. Nutritive enemata are sometimes had recourse to, Avhen from obstructions in the (Esophagus, nourishment cannot be conveyed into the stomach. In cases of sudden collapse in Fevers, or other cases, Avhere poAverful remedies are required, and the powers of deglutition fail, there is no part to Avhich stimulants may be more effect- ually applied, than to the rectum. They may be prepared Avith turpentine, or brandy and water, equal parts, Avith the greatest advantage. SUPPOSITORIES. Useful in relieving costiveness in infants, and in adults— They may be prepared with a piece of paper rolled up and oiled, or of hard soap cut into a cylindrical shape, and intro- duced into the rectum. Or they may be formed of opium, or a pill of opium, for the purpose of acting upon the diseases of the rectum, or of the neighboring organs—Will be employed by patients to whom the use of enemata is disagreeable, or excites pain. Division 3. Embraces those means by which ive destroy or counteract morbid substances lodged in the Alimentary Canal. ANTHELMINTICS. It is Avell knoAvn to physicians, that in the human body there are found occasionally different species of Avorms. I shall treat of them as they differ in their habits, character and structure. They are divided into two general divisions—the round and flat worms. ANTHELMINTICS. 101 Under the first, are included— 1. The Ascaris Lumbricoides—the long round Avorm. 2. Ascaris Vermicularis—the maw or thread worm. 3. Trichuris Vulgaris—the long thread worm. The Ascaris Lumbricoides, are of a round form, in length ten to twelve inches, and in circumference equal to a goose quill. They infest the small intestines, but more frequently the course of the jejunum and ilium. Sometimes they are known to ascend through the duodenum into the stomach, and they have been seen to creep out of the mouth and nostrils. It is not often they are found in the large intestines, and then only after the exhibition of vermifuges. They are sometimes found in considerable numbers. The sexes of the Lumbrici are distinct, and they are ovipa- rous, the ovula being discovered in the mucous surrounding them in the intestines. All the intestinal worms are oviparous, and they produce a considerable number of eggs. If all these eggs came to maturity, the diseases from this source would be exceedingly numerous, as well as dangerous. Several occurrences take place calculated to prevent their development. In short, it has been remarked by Rosin, that it is difficult for these Avorms to be abundantly produced. This arises from the continued action of the intestinal canal, by Avhich the eggs are carried doAvmvards and expelled with the excretions. In addition, the different gases, with the substances found in the intestinal canal, suffice frequently to prevent their development, or to effect their destruction. The uterus in this species of worm is very peculiar. It branches out into two large crura, which for the space of one or two inches are continued of an uniform character. They then suddenly become diminished in size, and appear like opaque threads lying on, and embracing in a convoluted manner the intestinal tube in the middle. This convoluted apparatus is composed of very fine transparent membranes, which is distended with innumerable eggs. It is these opaque threads Avhich are visible through the transparent coverings of the worm, and Avhich, in common language, are considered as so many young Avorms. 2. Ascaris Vermicularis, Ascarides, maAV, or thread worm, are on the contrary very small, being in thickness of the size of a piece of thread, and when full grown about half an inch in length. They are most commonly situated in the rectum, and when there, frequently pass out per anum. They are also met with in the coecum and colon, and have 102 GENERAL DESCRIPTION OF WORMS. been found in the stomach, Avhence they have been called maAV Avorm. In the rectum of children or adults, they are generally in considerable numbers, but Avhen in other parts their numbers are less considerable. When discharged, they are extremely vivacious, and it is probably from this circumstance that the term Ascarides has been employed, from the Greek Avord Askarizein—to leap. The male and female are here also distinct, and not as gener- ally considered hermaphrodite. 3. Trichuris Vulgaris, or Trichocephalus dispar, or long thread Avorm. This Avorm is of rare occurrence, and it is only within the last half century that any notice has been taken of it, or any accurate description drawn. Its body, Avhen full grown, equals in breadth the sixteenth of an inch, and in length nearly two inches. From the head proceeds a kind of pro- boscis, Avhich the worm protrudes or withdraAvs at pleasure. Description of the worm. These Avorms have been found in the intestinum rectum, in the inferior part of the ilium, also in the jejunum, mixed with their contents. Of the Flat Avorm, there is 1. The Bothriocephalus Latus—the Broad Tape Avorm. It consists of a head, a chain of articulations more or less long, and a small round tail. The head varies in size and shape from the Taenia Solium. The articulations in this species are broader than they are long. It is found in the small intestines of the inhabitants of Poland, Russia, Switzerland, and some parts of France, but it is not so generally met with as the Taenia Solium. It rarely exceeds eighteen or twenty feet in length, although they have been found longer. Their color is generally a dusky Avhite. Another distinction of this worm is, that it seldom parts with its joints spontaneously. Three, four, and even more of these worms have been found in the same person, but they seem to be peculiar to the inhabitants of the countries just mentioned, and where they prevail the Taenia Solium is not to be found, at least in the same subject. 2. Taenia Solium—Common Tape worm, also called the solitary Avorm. From this circumstance a conclusion has been drawn, which seems to be established, that the smaller the Avorm, the more WORMS A CAUSE OF DISEASE. 103 numerous they are found to be, and the larger, the less numerous, hence the above term. This animal consists of a head placed at the smallest ex- tremity, and a chain of articulations more or less broad or long, which gradually enlarge as they advance, and at length terminate in a tail formed by a rounded joint. Each of these joints contain their proper viscera, and they are very easily separated from each other Avhile the animal is alive. Each joint Avhen detached has the power of retaining for a considerable time its living principle, and is called from its resemblance to the seed of the gourd, Vermis Cucurbitinus. The separated joints do not appear capable of retaining their situation for any length of time, but are soon forced doAvn the intestinal tube, and at length creep out, or are expelled per anum. It has been conceived that these Vermes Cucurbitinae have the poAver of forming fresh joints, but this opinion is not probable—the head alone having this property. Certain it is, that Avhen the Avhole is voided except the head, in a short time after fresh joints are formed, and the patient is as much troubled with the worm as before, The Taenia are always found in the jejunum and ilium, occupying their Avhole length. The small intestines would seem to be the natural residence of this Avorm and the Lumbricus Intestinalis. Should their residence be made uncomfortable, they are readily removed from the system, either by vomiting, when they creep into the stomach, or with the discharges of the bowels, when they pass the valve of the ccecum. The origin of Avorms is still buried in much obscurity. All that Ave know certainly, is, that whenever a nidus is formed favorable to their production and growth, there we see them generated and supported. There are many circumstances predisposing to their pro- duction—Climate—more abundant in moist and cold, and in moist and hot countries. Examples—Season also predisposes more common in summer and in the autumn. Diet predisposes—common in countries where fruit and pulse, or beans, are much eaten, Particular states of the alimentary canal favor their pro- duction. They occur in all habits—the feeble and the robust—in children and adults—Found chiefly in children, with weak digestive organs and feeble constitutions, a state of body favoring the production of much mucous. Are worms a primary or accessory cause of disease? They are both. They become a primary cause when their number 104 WORMS A CAUSE OF DISEASE. is increased to such a degree, as to disturb the regular opera- tions of the system, producing such a degree of irritation that the natural sympathies are aAvakened, or probably from a misplaced situation of the Avorm itself. Under these circum- stances the diseases Avill be found as numerous and diversified as are the sympathies of the intestinal canal Avith the various parts of the body. A train of nervous and convulsive diseases are excited by this cause—also dysentery, remitting fever, chronic and spasmodic cough, cynanche trachealis. Thus is exhibited a striking instance of the influence of one exciting cause in bringing into action a variety of diseases according to the predisposition of the individual. This, you observe, varies in different persons, and hence such a diver- sity in their diseases. If worms are capable of producing the disturbances in the system I have mentioned, they are capable of producing a Fever, several cases of which I have seen in practice. I would caution my hearers, that these cases are of less frequent occurrence than is commonly supposed, and that great mis- chief is sometimes clone by treating the disorders of children as Avorm cases, which are really not so. Popular prejudice is too apt to attribute to the existence of worms the diseases of children. Dr. Hunter, we are told, dissected great numbers of chil- dren, who had been supposed to die of worm fever, and Avhose complaints Avere of course treated as proceeding from worms, in Avhom, however, there appeared on dissection to be not only no worms, but evident proofs of the disorders being of a different character. Worms are capable of producing a fever I have already stated, and as it is not of very frequent occurrence, its symp- toms may be mentioned in this place. The Avorm fever of children described. Symptoms by Avhich the presence of Lumbrici may be dis- covered. These may all be referred, in a greater or less degree, to intestinal irritation—and they are pains in the abdomen, itching in the nose, vomiting, looseness of the boAvels, intermitting pulse, epileptic convulsions, &c Diseases produced from a misplaced situation of the Avorm. Examples—Cynanche Trachealis, or Croup, Spasmodic Cough, even sudden death. Besides the intestines, worms are found in other parts of the body—In the integuments—the bronchial glands—the kidneys—the fat surrounding the ovaries—the cellular tissue —in the muscles—the brain—the uterus. SPIGELIA MARYLANDICA. 105 PARTICULAR ANTHELMINTICS. The articles of the class have been differently arranged by different Avriters. By some, as their action was chemical, mechanical, or of a cathartic character. I shall arrange them according to the worm they are best calculated to remove, beginning with the articles adapted to the expulsion of the Ascaris Lumbricoides. Family Gentianeai—Spigelia Marylandica—Indian Pink- Pink root. Description of the plant. Roots fibrous and perennial. Stem herbaceous, six to twenty inches high. Leaves sessile, ovate, lanceolate, acute. Flowers, a simple secund raceme, yelloAv within, crimson without. Every part of the plant is active—the root more so than the leaves. It has long been celebrated for its Anthelmintic property, and was first recommended in the Edinburgh Physical and Literary Essays, by the late Dr. Garden, of this city. It Avell sustains its reputation. It operates by virtue of a narcotic quality, in consequence of which it exerts a poisonous and debilitating influence on the worm—so that upon the administration of* cathartic medi- cines, they are readily removed from the system. When given in large doses, it exerts a deleterious influence upon the human system, and this is exerted upon the brain and nervous system. Never known these effects produced to an alarming degree, nor when exerted, are they difficult of removal. Administration—In powder combined with calomel, or other cathartic, and thus combined its narcotic effects are seldom observed. Dose for a child, v. to x. grs. For an adult, 3SS. to ji. In infusion, it is equally efficacious, and more readily taken —Preparation of the infusion for children : R-. Root of Spigelia, 3H. Boiling water, 1 pint and a gill. Simmer until reduced to a pint—Sweeten with sugar or treacle, and drink in divided doses in twenty-four hours. To be followed by a cathartic of castor oil. In the form of syrup, prepared by adding to a strong infu- sion sugar or treacle, and reducing to a proper consistence. 13 106 MELIA AZEDARACH, OR PRIDE OF INDIA. Spigelia combined Avith the leaves of Senna and Savin, often with adA-antage. Besides the anthelmintic property, it is adapted to the Febrile diseases of children, unaccompanied with Avorms— Exercises an excellent febrifuge operation, and affords much satisfaction. Family Meliacece—Melia Azedarach—Pride of India—Poison berry tree. The tree a native of the Island of Japan, but has been naturalized in this country. It is possessed of strong anthelmintic properties—has been spoken of in high terms by different practitioners, and is much employed by the planters of our State. The root is the part employed, and it is best administered in the form of decoction. Manner of preparing—The outer covering of the root is scraped off, and about f iv. of the bark is boiled in a quart of Avater, until it acquires the color of strong coffee, or until it is reduced to a pint. The dose is f ss. to ?i., every two or three hours, until it operates, or it may be given in the quantity of a tea-cupful for several evenings, and a cathartic then exhibited. The pulp which invests the stone of the ripe berries also useful, and they may be taken in the quantity of a gill during the day, rejecting the kernels—Cases of its efficacy related. All parts of the tree vermifuge, and it is noted as being clean, or remarkably free from insects. This article, like the preceding, is also possessed of febri- fuge properties. Family Chenopodece—Chenopodium Anthelminticum—Jerusa- lem Oak. Description of the plant. Root perennial. Stem herbaceous, erect, furrowed, four to six feet high. Leaves alternate, nearly sessile, glabrous, strongly veined. FloAvers in spikes, Avhich towards the summit of the branches are densely crowded. This plant a native of South America, but has become naturalized in this country. Useful anthelmintic, all parts of the plant being active, the seeds in the highest degree. It is exhibited in the form of expressed juice of the plant, or the seeds poAvdered, and given enveloped in mucilage, or the oil separated from the seeds. Administered in any of these forms, has been useful after COWHAGE.—CAMPHOR. 107 other articles have failed—and after being employed for several days, to be suspended, and a cathartic exhibited. Dose of the expressed juice, a table-spoonful. Of the poAvdered seeds a tea-spoonful. Of the oil, v. to x. and xx., m. The objections to the oil, are its unpleasant taste and smell —if these could be corrected, would be introduced into very general practice. Formula for the administration of the oil: #. Oil of Worm-Seed, 3iss. Castor, or Olive Oil, f ii. Honey fii. Dose—a tea-spoonful for a child one or two years old, night and morning, gradually increased to three or four. Family Leguminosce — Gcqffroea Inermis—Cabbage tree bark. This tree, of Avhich the bark is used as a vermifuge, is a native of Jamaica, and the other West India Islands. It is spoken of by the physicians of those islands as an anthel- mintic of great power and efficacy, but it is little employed in this country. Family Leguminose—Dolichos Pruriens—CoAvhage. A climbing plant groAving in the West Indies. It produces pods thickly beset on the outside Avith stiff hairs, which, when applied to the skin, occasion a most intolerable itching. It has been employed in the treatment of worms, the part used being the hairy spiculae obtained by scraping them from the pods, and mixing Avith syrup. The operation is mechanical on the worm, and they inflict little injury to the mucous membrane. They have been spoken of very favorably by the practi- tioners of the West Indies, but seldom resorted to in this country. But though there are sufficient proofs of its efficacy, doubts have been entertained of its safety. These objections entirely theoretical. That their operation is mechanical, is proved from this circumstance, that they have been given in tinctifre and decoction to Avorm patients, without any sensible advantage. The dose of the CoAvhage mixed with SAjrup, to the consis- tency of an electuary, is a tea-spoonful to a child, and a table-spoonful for an adult, repeated in the morning and evening, for several successive days, followed by a purgative dose. This remedy, though interesting from its character, seldom resorted to in this country. 108 CAMPHOR.—CEDAR APPLE. Family Laurinccc—Camphor. Among the remedies for Lumbricoides, this article has been held in much estimation—Spoken of very favorably by Pro- fessor Brera, and the Italian physicians. It is administered in the form of mixture, as follows : fy. Camphor, 3SS. to 3L Mucilage Gum Arab., f viii. Dose—fss.. frequently repeated. The advantages of camphor, that it not only removes worms, but prevents the development of the ova. Cathartics have been employed for the expulsion of worms, and not being very tenacious of life, are easily destroyed and evacuated by their use. Those employed are Calomel, Jalap, Hellebore, Scammony, Aloes, Chloride of Sodium, or Common Salt. Proto-Chloride of Mercury—Calomel is administered in a large dose at bed time, and removed from the system the next morning, Avith castor oil, or other cathartic—or repeated at short intervals, in order to remove such Avorms and ova, as have been screened from the preceding dose, by the folds of the intestines, or by mucous. Combined also with Jalap—a common ingredient in all the nostrums advertised for the cure of worms, and a useful auxiliary to other vermifuges. Chloride of Sodium, or Common Salt. The use of this article is very ancient and common in some countries. The value of salt, as an anthelmintic, may be inferred from the practice in some countries, of compelling crimi- nals condemned to death, to live upon a diet without salt —Multitudes of worms being thus produced, from which death was ultimately the consequence. In his OAvn practice, Dr. Rush says, that he has adminis- tered many pounds of salt, colored Avith cochineal, with great success in destroying worms. The formula is as follows : #. Chloride of Sodium, f ii. Cochineal, _ 3 ii.—Mix for a powder. The dose 3SS. to 3L, given in the morning on an empty stomach. Family Pinacece—Cedar Apple—An excrescence from the Juniperus Virginiana, or Red Cedar, produced by the puncture of an insect of the bark, or young branches—History of its discovery. ASCARIS VERMICULARIS. 109 The modus operandi seems to be by virtue of the bitter, and probably Terebinthinate principle which it contains, proving a poison to the worms, and also by its tonic powers, overcoming that condition of the alimentary canal upon Avhich their generation is supposed to depend. Forms of administration—In powder, decoction, and in its green state, as plucked from the tree. Dose of poAvder, grs. x. to xx., three times a day, and this pursued for a week. In decoction, a tea-cupful several times a day. As plucked from the tree—an apple for every year of the person's age, and this continued for nine mornings, in succes- sion, fasting. Family Asteracem—Artemisia Santonica—The Worm-seed of Europe. It is the product of a plant groAving in Persia, Asia Minor, and other Eastern countries. The seeds, but more properly the small globular, unexpanded flowers of the plant, mixed with their broken peduncles, have been much celebrated as a vermifuge. They are given in powder and infusion. The dose in substance is x. to xxx. grs., repeated morning and evening, and followed by a cathartic They are much employed, particularly by the German population of this country. Completing the consideration of the remedies for the long round worm, Ave will proceed to those of another species of this class, viz : the Ascaris Vermicularis, or Ascarides. Their size is about half an inch in length, and their seat usually the rectum. Symptoms of their presence—An uneasiness of the part, and an intolerable itching in the anus, which usually comes on in the evening, and prevents sleep for several houi s. This is attended with swelling in the rectum, internally and externally, with tenesmus and mucous dejections. They are found in the bed-clothes, or discharged with the alvine evacuations. The general health of the patient is not much impaired by their presence ; and this species, though among the most difficult of cure, is the least dangerous of all. They are difficult of cure, in consequence of their tenacity of life, and by burying themselves in the mucous of the first passages, they resist the action of medicines. It is this Avhich preserves them unhurt, though surrounded with many other substances, Avhich would be fatal. Whatever will lessen the 110 T,EXIA OR TAPE WORM.—POLYPODIUM FILIX MAS. quantity of this mucous, will not fail to relieve the patient- Purgative medicines employed for the purpose. Those are the best Avhich operate with sufficient activity, without enfeebling the patient to such a degree, but that a repetition could be borne. Mineral waters containing much saline matter of this sort— Jalap mixed Avith sugar—Cinnabar Avith Rhubarb, of each 3SS. is useful, as it never fails to bring aAvay mucous as transpa- rent as the Avhite of an egg, and in this many Ascarides will be found. Calomel, also, with much confidence of success—Aloes, and its preparations, as its action is chiefly on the rectum. The Compound Tincture of Aloes is one of the best for this purpose, the dose being 3 b*.. to f ss., night and morning, in a little Avater—or the Hiera Picra, ?i., dissolved in a pint of spirits—the dose 3 ii. to f ss. Enemata or Glysters, also useful, and even necessary, from the tenacity of life which these worms exhibit, and from their being seated far from the mouth, medicines have little effect upon them, further than as they evacuate the contents of the rectum in common with the other viscera. The enemata most approved, are Aloes ^i. to 3 ii. dissolved in a pint of new milk—a weak infusion of Tobacco—a solu- tion of Assafoetida—Lime water—Olive oil—Camphor. This last, dissolved in Olive oil, will be found very benefi- cial in allaying the violent itching, and other painful symp- toms of the anus. It gives immediate ease, and stays all night—Discharged in the morning, and with it many dead worms. Solutions of salt—tepid milk well salted—Spirits Turpen- time, enveloped in mucilage, have been employed. With these, the rectum should be filled, but not distended, otherwise it would be expelled. The operation should be repeated for a few successive days, when it seldom fails to remove, for a time, the Ascari- des, and the symptoms they produce—Proper also to admin- ister a cathartic. A case related, detailing the symptoms connected with the Ascarides, and the treatment pursued. The Third, species of round worm—The Trichuris Vulgaris or long thread worm. This of rare occurrence, and as there is no peculiarity of symptoms attending its presence, the same treatment may be adopted, as for the Lumbricus Intestinalis. Of the Flat worms— Taenia or Tape Worm—One of the most difficult to be re- TAENIA OR TAPE WORM. Ill moved from the body. The reason of its being so difficult to expel is, that though portions are apt to break off and be discharged, it is endoAved Avith a power of reproduction, so that the patient is little or nothing better. Of the anatomy of the Taenia little is known. Symptoms of the presence of this worm, similar to the foregoing—the most characteristic are, pain in the abdomen, weight in the side, pickings or bitings in the region of the stomach, Avith the evacuation per anum of small substances resembling the seeds of the gourd—or Vermes Cucurbitini— Remedies. Family Filices—Polypodium Filix Mas—Male fern. Natural History—Native of Europe—The root the part used. Properties—mucilaginous and sweet, afterwards astringent and bitter. The root is large, firm, and covered with thick brown scales, placed in an imbricate order, and furnished with many long tough fibres. Very ancient remedy, and had fallen into neglect until the latter part of the last century—revived by Madame Nouffer —Her remedy being the root of this plant, gathered in the fall, and reduced to a very fine powder. Dose—3 iii. of the powdered root, mixed with f iv. to f vi. of water, taken in the morning—For children less. If nausea is produced by taking the medicine, endeavor to relieve it—if rejected, it must be repeated as soon as the sickness is gone off—To be followed by a cathartic of a dras- tic character. The efficacy of this practice confirmed by others. The root may be given in a form of a decoction—used also as an extract—Preparation. Dose of extract—xviii. to xx. grains given at bed-time, and the same quantity in the morning, fasting—so that on the administration of a cathartic, the parasite has been dis- charged, often in the form of a ball. Family Coniferce—Oil, or Spirits of Turpentine. One of the best remedies in the treatment of this, and other intestinal worms—The earliest mention of it. Given in large doses, from ? ss. to f i. and ? ii. and its exhi- bition is usually folloAved in a few hours by a considerable cathartic operation, and a discharge of Taenia. The principle upon Avhich its virtues depend, does not seem to be distinguished by the true cathartic character. The medicine has the power of resisting absolute decomposi 112 SPIRITS OF TURPENTINE.—POMEGRANATE. m A . tion, by the assimilating operations of the organs of digestion, passes'along the intestines in a great measure unchanged, and may be observed floating upon the surface of an evacua- tion—It comes in contact Avith the Avorm, and by a specific property deprives it of life. In large doses it is less apt to disturb the bladder than in small. The constitutional symptoms produced by its use, are —giddiness to a great degree, Avhich subsides Avith a cathar- tic operation. This medicine affords relief to the painful feelings Avhich Avere believed to originate in the presence of the worm. Cases might be cited of the beneficial effects Avhich have been exhibited by the Oil of Tupentine. Carbonate of Iron—Carbonate of the Protoxyd of Iron— Rubigo Ferri—Rust of Iron. A safe and certain remedy—Has been given from 3ii. to f ss. every morning, for three or four days, not only with safety, but success—Administered in treacle, or jelly, and taken as soon as mixed. Cathartics of a drastic character—Gamboge given in doses of xx. grs., morning and evening, mixed with a little sugar and water—repeated on the second or third day. Other remedies—as bark of the root of Pomegranate, Tin, Arsenic, Assafcetida. Family Myrtaceoz—Punica Granatum—Pomegranate. Has been recommended as a remedy for Taenia, and a number of cases stated as cured by its use. Given in the form of powder and decoction. Dose of the former viii. to xx. grs., two or three times a day—In decoc- tion, prepared as follows : Bark of the root of Pomegranate, ^ii. Water, 1 pint and a half—boil to 1 pint. Dose—?ii. every half hour until the worm is expelled. If of greater strength, it excites nausea and griping—affects the nervous system—producing vertigo, tremblings, the sen- sation of intoxication, &c In the treatment of Avorms, we must not confine our atten- tion to the mere expulsion of the worm, but endeavor to give tone to the stomach and bowels by the use of Tonics, so as to prevent their reproduction. DIAPHORETICS. 113 Division 4. ANTACIDS. Division 5. Medidnes which promote particular Secretions. (a.) Of the skin. DIAPHORETICS. Shall premise my remarks upon Diaphoretics, by a short account of the nature and importance of perspiration—It may be Insensible and Sensible—The former may be demon- strated by holding a highly polished metallic surface to the skin, Avhen a watery vapor collects upon it and clouds it. When increased, it becomes sensible, and is denominated sweat. It is the same kind of fluid as the insensible perspi- ration—very small particles are observed on the skin, and they unite in larger drops. The causes—The quantity—Not easily ascertained, but may be supposed to be very consider- able, when we consider the extent of the exhaling surface, and the rapidity of its reproduction. Sanctorius's computa- tion in the climate of Italy—Less in other climates—Dr. Lining's calculation. The ordinary quantity in twenty-four hours, in one of good health, is iii., iv., or v. pounds. The quantity determined by enclosing the body in a silk bag, rendered impermeable to moisture, by being varnished with Caoutchouc, and having only one opening for the breathing, the sides of which were carried round the mouth. The nature of the secretion—in a great measure aqueous, holding in solution several salts, the excrementitious matter of animal substances, and sometimes acids. It possesses sen- sible properties. Definition of Diaphoretics—divided by some writers into Diaphoretics and Sudorifics; but, as in the medicines arranged by authors under these titles, Ave can find no difference, but in the degree of activity, or Avhat arises from the manner of administration, Ave may comprehend the Avhole under the title of Diaphoretics. The importance of this secretion may be judged ol, from the uneasy feelings produced by its suppression, and from 14 114 DIAPHORETICS. the number of diseases Avhich originate in, or are aggravated by an interruption of the free discharge. * The action of Diaphoretics may be arranged under three heads. 1st. Those Avhich operate by exciting the action of the heart and arteries. 2nd. Those Avhich operate by producing a relaxation of the extreme vessels. 3rd. Those Avhich are local in their operation, or which are applied to the surface of the body. Under the first Division is included all the stimulating Diaphoretics—the blood by their operation being sent more forcibly into the minute vessels, and the secretory process thereby promoted. They produce their good effects in dis- ease b}r depletion and by revulsion. Every stimulant may, to a certain extent, produce these effects; but the stimulating Diaphoretics have the additional property of giving increased activity to the perspiratory vessels. But if the Cutaneous vessels are already much excited, stimulating the arterial system will not accomplish our ob- ject—hence another class of remedies is, therefore, called into requisition, viz:—Such as produce relaxation—and this class operate by their action upon the stomach, producing nausea. The sensation of nausea is accompanied by feelings of depression, languor, indisposition to motion, with dimin- ished vascular action. Diminished vascular action, by lessen- ing the excitement of the skin, removes the constriction of the surface, alloAvs perspiration—hence they are said to pro- duce relaxation. The medicines of this class are, the Antimonials, Saline Diaphoretics, small doses of Ipecacuanha, and cold Avater. The last operating by bringing down the excitement to the secreting point. External remedies.—That these means should be efficacious, we should attend to the condition of the skin. If already excited, any additional excitement will postpone the desired result—will rather impede, than promote the sudorific pro- cess. Hence, in excited states of the skin, and system, a contrary class of remedies will be required, as cool air, cold drinks, the cold affusion. These would be the proper sudor- ifics. We OAve much to Dr. Currie, and from him the prac- tice of sponging, and the cold affusion, has been introduced in Fevers. When there does not exist this excitement, warmth to the surface contributes to the free performance of the secretory process. - RULES IN THE EXHIBITION OF DIAPHORETICS. 115 We have frequently noticed the advantages which arise from medicinal combination. They are not less conspicuous here. Examples—The union of the tAvo classes, viz: a stim- ulant and relaxing Diaphoretic, more certain in their opera- tion than either class singly. The articles entering into the composition of Dover's poAvder furnishing us an instance of this union. The primary effect of the opium, being to in- crease the action of the heart and arteries, Avhile that of the Ipecacuanha, or Antimony, by its nauseating and relaxing operation, to diminish the action of the surface, or to produce relaxation. Hence, Avhile the circulation is increased, the the skin is placed in a situation for the free discharge of per- spiration. Another beneficial operation results—the sudor- ific being determined to the skin, prevents the unpleasant effects of opium on the brain, while the anodyne operation is obtained. Other instances—as the combination of Tart. Antimony, Avith Gum Guaiacum, or Glim Guaiacum, Tart. Antimony and Opium—vis unita fortior. Rules for the administration of Diaphoretics. Rule I. During the exhibition of Diaphoretic medicines, it is most beneficial that the patient be confined to bed, and in some instances it is essentially necessary. Rule II. The pulse and temperature of the skin are to be carefully Avatched. If the pulse be active, or the heat very great, Diaphoresis cannot be induced until they have been lowered by venaesection, or other depletives, Avhich should not be admitted unless contra-indicated. This rule is of the utmost importance, since Diaphoresis can never be advantageously excited, until the inflammatory action of the system has been reduced. The medicines cf this class are, let it be understood, secondary remedies, and are resorted to when more vigorous means have failed, or cannot further be persisted in to subdue disease. When employed at a proper period, they are of the utmost benefit, since they not only act as evacuants, but by determining the fluids to the capillaries, they relieve the larger vessels. The strength of their impression will be adapted to the existing action, which they may change or subdue, Avhile they will be wholly inefficient at an earlier period. Rule III. While under the operation of a Diaphoretic, diluent drinks must be employed, unless the stomach be very irritable, or unless the antimonials have been exhibited, for in either case they may induce vomiting. The tempera- ture of the drinks must depend upon that of the surface, for 116 APPLICATION OF DIAPHORETICS TO DISEASES. if the skin is very hot, cold drinks are preferable; if the skin is cold, and the system feeble, warm drinks are to be pre- ferred. Rule IV. After the perspiration has subsided, the pa- tient's linen should be changed, and he should be removed to a dry bed, or a dry part of the bed. The clothes under such circumstance becomes highly offensive, and in addition, tend much to check the perspiratory process. Rule V. Guard against a sudden suppression of perspira- tion. This rule is of great importance, whence it is often necessary to Avatch patients while asleep. I have more than once knoAvn relapses to take place from this cause, Avhich had very near proved fatal. One instance in particular, oc- curs to my mind, in Avhich a female laboring under a pulmo- nary affection, had her symptoms suddenly aggravated by the bed clothes falling off Avhen asleep, and Avhile perspiring freely. Rule VI. Avoid Cathartics during the administration of Diaphoretics, for they may suppress perspiration by a revul- sive action, and will render necessary a frequent exposure to cold. Rule VII. Avoid, during the use of Diaphoretics, those medicines which increase the secretion by the kidneys. These last directions are but little considered in ordinary practice, it being very common to hear of medicines being directed Avith a vieAV to a cathartic and diaphoretic opera- tion, or a diuretic and diaphoretic action. Physicians too often flatter themselves, that they can accomplish more than is compatible Avith the laws of the animal economy. The functions to which I have reference, are ahvays opposed to each other—Avhatever will excite one Avill diminish the other. Rule VIII. When long continued perspiration is requisite, as in chronic rheumatism, flannel should be substituted for linen, next the skin; without this, it will be impossible to keep up a uniform and constant perspiration. DISEASES IN WHICH DIAPHORETICS ARE USEFUL. In Intermittent and Remittent Fevers after proper depletion —These diseases terminate sometimes naturally by sudoresis, and these remedies seem indicated by nature to put a stop to the paroxysm. The system should be prepared for them—its excitement reduced, and the alimentary canal evacuated. APPLICATION OF DIAPHORETICS TO DISEASES. 117 When judiciously applied, they conduct the paroxysm to a close—they sometimes prevent its recurrence, and thus break the catenated motions on which the disease depends. In Continued Fevers, they are equally necessary. It was the practice at one time, to give stimulating Diaphoretics, even in the most inflammatory fevers, confining the patient to a hot room, and preventing the ingress of fresh air. In this state, sometimes a profuse sweat breaks out, but it brings no relief, and does not diminish arterial action. In this, and all inflammatory diseases, A^enaesection, and other depleting remedies, should be used before Ave have recourse to this class of remedies, and even then, the milder ones are to be resorted to. Diaphoretics have been much recommended in fevers, sup- posed to originate in contagion, as Small Pox, Measles, &c. They are, doubtless, of service in these cases—no peculiar or specific action, and their use is to be governed only by the state of the system. In the diseases of the Alimentary Canal—There exists a very intimate connection betAveen the cutaneous capillaries, and those of the internal organs—and from the general effects of Diaphoretics, they must prove salutary in these cases. They are not only useful as depleting remedies, but act by revul- sion, and thus determine from the seat of the disease. We observe, for example, Dysentery, Diarrhoea, and Inflammation of the Bowels, to ensue from the sudden suppression of per- spiration; and, on the contrary, these diseases, from Avhatever cause they may arise, are almost ahvays relieved by the Cutaneous secretion taking place. In Catarrhal affections, they are of the utmost importance, and in all acute affections of the lungs. The relief is sensible and immediate. The cough, shortness of breathing, general uneasiness and distress, seem to be commensurate with the free discharge from the surface. In Rheumatism—in acute cases preceded by venaesection, purgatives, and, in general, their efficacy is increased by be- ing combined with opium. In chronic cases more essentially necessary. The treatment pursued, is directed to a reneAval of the energies of the cutaneous vessels, by clothing in flan- nel, flannel bandages, stimulating diaphoretics, alterative medicines, bathing, general and local, the vapor bath. The warm and hot springs of Virginia, very useful in exciting the secretory functions of the skin, and in restoring health. De- scription of these springs. Diaphoretics useful in Dropsies—Treatment of these com- plaints by the Indians by means of SAveat ovens. Captain Cook relates being cured of a dropsy in the South Sea Islands, by being buried up to the neck in Avarm sand. 118 STIMULATING DIAPHORETICS.—OPIUM. STIMULATING DIAPHORETICS. Family Papaveraceo?—Pa paver Somniferum—Poppy—Opium. The Diaphoretic property of opium, intimately connected Avith the poAver of stimulating the action of the heart and arteries—Illustrations of its stimulating operation, from the custom of Eastern countries, and from its employment in the low stages of fever. As a Diaphoretic, seldom used alone, but combined Avith Ipecacuanha, the Antimonial preparations, or the Sweet Spirits of Nitre. Formula— 5L Tincture of Opium, gtt. xxv. Antimonial Wine, gtt. xxv. Or Sweet Spirits of Nitre, gtt. xl. Water, fi. To be taken as a draught. Thus combined, it is useful in all cases Avhere diaphoresis is required—as Catarrhal affec- tions, or other cases. In combination with Ipecacuanha, its best effects are ex- hibited, and applicable to many diseases. By this combina- tion, its anodyne and diaphoretic operation are obtained, without any, or very little disturbance of the functions of the brain—Hence in all chronic diseases it is resorted to, Avith safety and advantage. These enumerated—Its efficacy is improved by a union Avith the Sulphate of Potash. Its action may be purely mechanical, dividing and mixing the active particles more intimately, the success of the remedy depending much upon a minute division of the ingredients—constitutes the Dover's poAvder of the shops, in the folloAving proportions:—Ipeca- cuanha, one part; Opium, one part; Sulphate of Potash, eight parts. Can be employed in Inflammatory diseases after excite- ment has been reduced, without increasing the actions of the system. For though Opium may stimulate, the Ipecacuanha relaxes the surface, and free perspiration is induced. While these actions progress, pain and irritation are relieved. The powder should be taken at bed time, the body should be kept covered, and no drinks alloAved until perspiration commences. Combined Avith Calomel—By this combination Ave obtain not only a diaphoretic operation, but a purgative and altera- tive. Combined with Calomel, the objections Avhich have been made to the employment of Opium in Inflammatory diseases are obviated, at the same time, by operating in the several ways mentioned, an anti-inflammatory operation is exerted. By this union Ave obtain a diaphoretic, or a purga- STIMULATING DIAPHORETICS.—CAMPHOR. 119 five, or an alterative operation—We allay pain, and irrita- tion, and thus disease is removed. The practice has been adopted very generally, and with all the beneficial effects which might be expected. Examples— Administered in Pleurisy, after general bleeding, or other depletion, Avith great advantage. Administered as follows: #. Opium, gr. 1. Calomel, grs. vi. or viii. Made into a pill, and repeated every four or six hours. This combination will be found highly composing and re- freshing—promoting secretions, and removing all traces of disease. In the treatment of Inflammatory diseases, blood- letting and purgatiA-es are not alone sufficient. These reme- dies, though useful, often induce symptoms also of a very distressing character, and they have received the general title of irritation, and this irritation may sink the patient unless allayed. It is for the relief of this symptom, that opium is so com- monly employed, and Avith particular good effects if combined. Should any topical disease continue, the same combination will be found beneficial—Thus employed, the prejudices Avhich have so long existed against the use of opium in in- flammatory diseases have given way, and we find it employed in acute disease, and even in topical inflammation, after, or in company with venaesection. Family Laurineae—Laurus CampJwra—Camphor Tree. A forest tree, growing to a considerable size in the Islands of Borneo and Sumatra. The Avood has a strong camphorated smell, and is much sought after as a material for chests, &c The oldest trees are the best, and the camphor is found in perpendicular veins, near the centre of the tree, or concreted in the knots of the tree. Manner of separating the camphor from the tree. Purification of Camphor—The process consists in uniting thirty or fifty pts. of quicklime with the impure camphor, and submitting the mixture to a neAV sublimation. Obtained also from many aromatic plants, as the roots of the Cinnamon tree, of the Cassia, of the Sassafras—Various aromatic oils, as Rosemary, Mint, Sage. Camphor obtained from these sources not identical Avith that obtained from the L. Camphora, and from the Dryobaly- nops Camphora. Qualities of Camphor. White brittle substance. Unctuous to the touch. Tenacious betAveen the teeth. 120 CAMPHOR. Not easily pulverized. Odor, fragrant and penetrating. Taste, pungent and bitter. It is volatile, and dissipated at ordinary temperatures. It is dissolved by alcohol, aether, oils. Properties—There is still some difference of opinion re- specting the action of camphor on the system. _ By some it is regarded as a stimulant, Avhile others maintain that it pos- sesses considerable sedative powers. When taken into the mouth, it has an acrid, bitter taste, and Avhen sAyallowed, it excites an uneasy sensation in the stomach, Avhich may be imputed to the operation of its acrimony upon its upper orifice. In its operation upon the system, this article is somewhat peculiar. In its sensible properties it is, doubtless, stimula- ting, but it appears to exert but little action upon the pulse. It soon produces a strong tendency to perspiration, Avithout the pulse being sensibly affected in quickness—Employed in Febrile affections, with a dry, contracted skin, combined with other articles, even when the excitement would seem to forbid it, as in the folkming formula: p. Nitrate of Potash, ji. Camphor 3 i. to 3SS. Tart. Antimony, gr. i. Mix and divide into vii. or viii. powders, one of which may be given every second or third hour. Instead of Nitrate of Potash, Calomel may be added, and sometimes Opium. Opium is conjoined with Camphor, with considerable effect —a new substance being formed, different from either. The combination prevents the disagreeable effects of opium, and determines gently to the skin. The union of these tAVO arti- cles in the folloAving proportions, forms a poAverful dia- phoretic #• Camphor, grs. viii. Opium, gr. i. Make into a powder, to be repeated according to circum- stances. In all Uterine affections requiring the use of opium, the above combination is very efficacious. The German or Camphor practice, was employed with much success in the treatment of Asicdic Cholera—Employed in all the stages. In the stage of Asphyxia, it is given in doses of xv. to xxx. m., every fifteen minutes in a table-spoonful of Avater. Enemata of the same were employed. The chest and abdomen were covered with flannel, wet Avith a solution of the same. The practice continued, until CAMPHOR.—CARBONATE OF AMMONIA. 121 free perspiration was induced, and the evacuations lessened. As the symptoms became less violent, the doses Avere dimin- ished, or the intervals increased. In the Spasmodic stage, the same treatment—also in the Premonitory. This practice spoken of in high terms by some of the physicians of New-York. Effects of Camphor in a large dose—Recital of a case in which a very large dose was taken. The case interesting, as illustrating the action of camphor on the brain, being one of the sensorial stimuli—also exhibiting its strong determi- nation to the skin, the perspiration floAving freely under its operation. As camphor is of a volatile nature, and its effects transient, the dose should be repeated at short intervals. It ought to be minutely divided before it is given—This is done by rubbing it first in a mortar, Avith any dry poAvder, as sugar, or nitrate of potash, or by dropping a few drops of rectified spirit upon the camphor. Dose of Camphor as a Diaphoretic is from ii. to viii, grs. Carbonate of Ammonia, or Mild Volatile Alkali. Preparation—It is obtained in the form of a Avhite crystal- line mass, fibrous texture, efflorescent, odor pungent and peculiar. Properties—Stimulating, and employed in the low stages of disease—Antacid, also Diaphoretic, though in a less degree than the preparations made from it. The Acetate of Ammo- nia being most remarkable for its diaphoretic operation. It is prepared by pouring upon the Carbonate of Ammonia, as much acetous acid as may be sufficient to saturate the Ammonia, the carbonic acid gas escaping in the process. By this operation, Ave obtain Acetate of Ammonia, dissolved in the water of the acetous acid—To it, other diaphoretics are added, as SAveet Spirits of Nitre, or other articles. It is administered in doses of f ss. every hour or two. It may be given during the paroxysm of Fever with less apprehension than most other diaphoretics of this class, and administered'when much heat and dryness of the skin exist, Avith this great advantage, that it will be readily retained upon the stomach, Avhen most others would be rejected. This medicine may be made very readily, and extempora- neously, by adding the acetous acid to the carbonate in a phial, and by corking it, the carbonic acid is prevented from escaping—it unites with the water, and forms a much more pleasant mixture. 15 122 ASCLEPIAS DECUMBENS.—PLEURISY ROOT. INDIGENOUS DIAPHORETICS. Family Synantherece—Eupatorium Perfoliaium—Thorough- wort, Boneset, Vegetable Antimony, Arc. Found in most parts of the United States. Description of the plant. Leaves connate, perfoliate, rough, doAvny. Stem rises to the height of three and six feet. Corolla, small, AAThite. Properties—Diaphoretic, tonic, emetic The leaves and floAvers being the most active parts of the plant. Qualities—Taste bitter, flavor peculiar. Administration—In the form of infusion, taken warm, it acts as a diaphoretic Employed in the treatment of Intermittent and Remittent Fevers, and forms a very useful domestic prescription. It Avas Dr. Rush's favorite diaphoretic in the Yellow Fever, of Philadelphia, in 1.798—and such Avas its efficacy, as to cause it to be entitled the Vegetable Antimony. Employed in Typhoid Pneumonia with advantage, as a sudorific and tonic, after proper evacuations. In Catarrhal affections—In Influenza, Break-bone Fever, Avith such success as to be called " Boneset." It is also possessed of tonic properties, and employed in the treatment of Intermittent and Remittent Fevers, as a sub- stitute for Cinchona—Its Febrifuge powers overrated, and properly ranks with Chamomile and others of that class. Useful in the convalescence from acute diseases, in debili- tated conditions of the digestive organs, and in indigestion. Forms of exhibition—As a tonic, given in the form of de- coction and cold, in substance and in tincture. Dose—Substance, xx. to xxx. grs. Decoction, a tea-cupful. Infusion, as much as the stomach Avill bear. Family Apocynece—Asclepias Decumbens—Pleurisy Root, and Butterfly-weed. Description of the plant. Root tuberous, but more properly fusiform, perennial. Leaves scattered, sessile, on short foot stalks, hairy, long, lanceolate. FloAvers, bright yelloAv color. Stems numerous, ascending, and procumbent. The root has been long celebrated for its diaphoretic and expectorant properties, and has been employed in Fevers, ARISTOLOCHIA SERPENTARIA. 123 Catarrhs, and pleuritic affections. It produces its effects Avithout stimulating the system, but operates with mildness and efficacy. Dr. Parker, who employed it many years, con- siders it as possessing a specific quality of acting upon the organs of respiration, promoting suppressed expectoration, and relieving the breathing of pleuritic patients. Dr. Chapman speaks of it as possessing very decided pro- perties, and producing its effects Avithout increasing the force of the circulation, or the heat of the body. The popular opinion of its efficacy in pleurisy is not Avith- out foundation; relieving the oppression of the chest in re- cent catarrh, and promoting expectoration in protracted pneumonies. It can only be considered as an auxiliary, and may be resorted to, Avhen the force of the disease has been reduced by more active means. Forms of exhibition— In infusion, a tea-cupful every two or three hours. PoAvder, xx. to xxx. grs. several times a day. Family Aristolachice — Aristolochia Serpentaria—Virginia Snake Root. Description of the plant. Root perennial, fibrous, externally brown, internally Avhite, Stems round, slender, eight or ten inches high. Leaves feAv, entire, ovate. Flower at the base of the stem, lying on, or sometimes under the surface of the earth, of a purplish color. Qualities—Odor, aromatic. Taste bitterish, pungent, not easily concealed. It yields its active properties to Avater and alcohol. From the root, camphor in the form of fine Avhite crj^stals can be obtained by distillation. Properties—Stimulating diaphoretic—insomuch that it is not usually resorted to in diseases, until the excitement of the system has been reduced by evacuating measures—Use- ful in allaying the irregular actions attendant on great febrile debility—Employed in the advanced stages of Fevers, and those attended Avith Typhoid symptoms—May be given alone, or in combination Avith Avine Avhey, or other articles. It is also advantageously united Avith camphor, as folioavs: #. Infusion of Serpentaria, f A7ii. Camphor, grs, x. to 3 i. Sweet Spirits of Nitre, fss. White Sugar, 3 ii. m. Rub the camphor with the sugar until it is reduced to a fine poAvder—add the Spirits of Nitre, and then the infusion —strain. Dose, fss. every tAvo hours. 124 ASARUM VIRGINICUM.—ARALIA SPINOSA. Employed also in the form of Avarm infusion in the second- ary stages of Pleurisy, Ac. It is highly recommended by its agreeable taste and aro- matic odor, insomuch that it will in general remain Avell upon the stomach. The infusion is prepared as folloAvs: $. Roots of Serpentaria, 3 i. to 3 ii. Boiling water, 1 pint. Dose f ss. to f i., as often as the case requires. Of the same family—Asarum Virginicum—Heart Snake- Root. Description of the plant. Root fibrous and perennial. Leaf solitary, heart shaped. Flower nearly sessile—concealed in the ground—of a greenish color, to a purple. Qualities—Odor aromatic, agreeable in a high degree. Taste bitterish. Properties—Stimulating diaphoretic, and similar to those of the preceding article—employed in the same disease, and may be advantageously substituted for it. Same Family—Asarum Canadense—Wild Ginger. Description of the plant. Roots fibrous and perennial. Leaves radical, petiolated, kidney shaped. « Flower Solitary. Properties and applications, similar to the foregoing. Family Araliaceai—Aralia Spinosa—Prickly Ash, Description of the plant. Root perennial. Stem straight, unbranching, naked and prickly beloAV. Leaves crowded on the summit of the stem, like the palm tree. Qualities—Taste pungent and acrimonious, and there is experienced soon after swalloAving, a heat and warmth in the stomach, with a glow upon the surface. Properties—Stimulating, and pretty certain diaphoretic— Employed in Rheumatism in the form of saturated tincture of the root, and taken in as large dose as the stomach Avill bear, without exciting sickness, or vomiting. Dose of the tincture, 3 i. to ? ss., taken in a little Avater. The root is used as an ingredient in diet drinks, and in the form of an infusion made strong, is an active emetic. GUAIACUM. 125 Vegetable Alteratives^ This term sprung up amongst the Humoral pathologists, Who entertained the belief that the diseases of the human body arose from some disordered state of the fluids, and that all disorders Avere mere efforts of nature to expel the peccant humors. They considered the blood as the principal source of mischief, and they employed such medicines as might alter its state—hence they speak of purifying and sweetening the blood. The term is still employed, and the diseases in Avhich they are used are well understood. The first of this class of remedies, is the Family Rutaceai—Guaiacum Officinale—Lignum Guaiacum, &c Description of the tree. It is a native of the West IndieS) and of South America, and groAvs to a considerable size* The Wood is extremely ponderous and solid, very resinous, of a blackish yelloAV in the middle, taste heating and aromatic. The wood is possessed of properties similar to the gum- resin, though less active. It has been used as an ingredient in decoctions, which were celebrated in several diseases of the system, particularly in Syphilitic affections*. It is not as efficacious as the Gum Resin, or Extract. This Extract is obtained by wounding the bark of the above tree, from which it exudes in a considerable degree, and when a sufficient quantity has been discharged, and hardened by exposure to the sun, it is gathered and packed in small kegs for exportation. Color of the extract, greenish brown. It is easily pulverized—the poAvder which is first grey, becomes green on exposure to air and light. Of the precise nature of this substance, chemists are not agreed. It pos- sesses properties allied to gums and resins—yet distinct from either. Medical Properties of the Extract or Gum.—They are stim- ulant, diaphoretic, sometimes diuretic or purgative. The effects are, to excite the action of the heart and arte- ries, and to promote the serous exhalation of the skin. The Guaiacum was first employed by the natives of .St. Domingo, as an antidote for the Lues Venerea. The Spaniards soon acquired a knowledge of its virtues, and introduced it into Spain as early as the year 1517. It 16 126 GUAIAC. has declined in importance, but is still useful in the sequela? of the disease. This article has been much celebrated in Rheumatism, par- ticularly in the chronic forms of the disease. Given in these cases after depleting remedies, Avhen there is little fever, the pains frequently shifting their situation, with swellings of the joints, any of the preparations will be found useful. It should be given in larger doses than it is usual to employ, and it is probably from these small doses, that the article has lost reputation. The utility of medicinal combinations is manifested, in the application of this article to diseases. The following formula Avill be found useful: #. PoAvdered Gum Guaiac, 3i. Tartarised Antimony, gr. \. Gum Opium, gr. \. Mix and make into a powder. To be repeated as often as the case requires. To these articles, Calomel may be added. By this combi- nation we obtain a neAv and active compound, not afforded by the simple substance. The Tincture, combined with a small quantity of Laudanum, afforded much relief to the pains following Dengue Fever. Has been recommended in Gout—can only be resorted to during the intervals of the paroxysms. Guaiac has been much employed as an Emmenagogue— shall speak of its application under that head. In Cutaneous diseases has been recommended, and from its knoAvn tendenc)5" to pass off by the pores of the skin, may be given with considerable success. In the chronic stages, when the constitution is enfeebled and deteriorated, the general excitement produced by this article, and particularly of the cutaneous vessels, has a con- siderable tendency to remove the disease, and restore the enfeebled system. Combined Avith other articles, its efficacy much improved —for formula—vide Sarsaparilla. Mr. Pearson recommends the combination with Sulphur, Antimony, &c, in Herpes, Scabies, Porrigo, &c Preparations of Guaiac. Decoction of the wood—In its preparation, the Avood should be in the state of shavings, or raspings. It is prepared according to the following formula: #. Shavings of Guaiac Wood, f ii. Water, Ibii.—boil gently down to ibiss. ToAvard the end, add liquorice root bruised, and sassafras SMILAX SARSAPARILLA. 127 raspings—each fi.—simmer to tbi., and strain—This quantity to betaken daily. It is also given in the form of tincture and powder. Dose—Tincture 3L to ? ss., in milk or mucilage. Ammoniated Tincture—the same. Of the Powder, grs. x. to xxx. Adulterations—Sometimes Avith the common Resin and the Machineal Gum. Family Thymehce—Daphne Mezereum—Mezereon. A shrub Avhich grows in the Northern parts of Europe, and the high and Avoody parts of France and Spain. The bark of the root is chiefly employed. To the taste it is acrid, Avith an aromatic odor. Applied to the skin, it readily excites a blister, and a considerable discharge of serum. Properties—Stimulating diaphoretic, diuretic and purga- tive. It agrees with Guaiac in its general operation and effects, and is employed in the same diseases, viz:—Syphilis and cu- taneous affections. Seldom used alone, but in combination, and the formation of compound decoctions. Dose of the poAvders, grs. vi. to x. Family Smilacece—Smilax Sarsaparilla. Grows in the West Indies, and in South America. It is brought to us in long slender roots. Color—broAvn externally, white Avithin, covered with a thin coat, and having a Avrinkled appearance. Sensible qualities—odor little or none. Taste mucilaginous and slightly bitter. Properties—Diaphoretic, alterative, and sub-tonic Medical History—It Avas brought into Europe as late as the year 1530, with the character of being a specific for the Lues Venerea, in which disease it had been employed by the Indians with considerable success. It. however, lost credit, upon the discovery of the superior efficacy of mercury, and its virtues were overlooked—Again brought into notice by Dr. Wm. Hunter, and Sir George Baker. Much difference of opinion exists among practitioners re- specting the efficacy of this article. Some consider it a med- icine of no activity, and others of much efficacy. The fact that 100,000 pounds are annually sold in Great Britain, and as many more in this country, would prove that its advocates are numerous. In proceeding to speak of this article, I Avould observe that 128 SMIL AX SARSAPARILLA. the remarks made, Avill not have reference to the Sarsapa- rilla alone, but they must be understood as applying to it in various states of combination. By itself, it is highly useful, but. the good effects derived from this and other similar arti- cles, as the guaiacum, inezereon, sassafras, &c, are greatly increased by combination with each other. It is therefore of the combinations of this article, contributing as they do, to their increased activity, as well as to the greater conveni- ence of administration, that the practical remarks I shall make Avill apply. Sarsaparilla and its preparations, are admirably adapted to the secondary stages of Syphilis. The secondary forms of this disease, exhibit themseh^es in the most painful, loathe- some, and mortifying affections of the human body. Originating as these diseases do, not in single acts of folly, or the Aveakness to Avhich human nature is subjected, but in a continuance of excesses, dissipation and disease, those who are subject to them, exhibit most frequently in constitution and appearance, a body impaired in its energies, and crippled in its faculties. Mercury alone, in a constitution like the one I have described, cannot be endured. Its stimulating, or rather irritating operation, under these circumstances, aggravates all the symptoms—harrasses the patient, and superinduces the most distressing consequences. Sarsaparilla and the vegetable alteratives, combined with very minute quantities of the Perchloride of Mercury, in the manner I shall point out, forms a preparation freed from the objections just made, and a medicine well adapted to the disordered states of the constitution noAv under consideration. It Avill be found excellent in restoring the appetite, strength and flesh of the patient. It will complete the cure of ulcerations of the palate, throat and mucous membrane of the nose, skin, and other parts. It Avill relieve nocturnal pains of the limbs, painful enlarge- ments of the joints, of the bones, membranous nodes, cutane- ous ulcerations, &c. It will efface the blotches, foul spots, stains, ss. to one grain, made into a pill. Tincture, x. to xx. m., three times a day, in any aro- matic water, Infusion prepared as stated. When the Narcotic effects of the article are desired, as in Pulmonary Consumption, the poAvder or tincture is preferred. When the Diuretic, the infusion. Symptoms of the morbid operation of Digitalis. They are retardation of the pulse, palpitations, faintings, sickness, purging. There is likewise, a membranous tensive pain of the head, Avith a disturbance of the functions of the brain. When these symptoms occur, the medicine must be omitted. When the symptoms run high, and the poisonous operation of the medicine is exhibited, they must be corrected. The corrective's—an emetic if the degree of prostration does not prohibit it. Stimulants—as sether, brandy, volatile alkali, &c—-Sinapisms and blisters—Opium has been success- fully employed to counteract the deleterious agency of Di- gitalis. Family Solaneo—Nicotiana Tabacum—Tobacco. Allied to Digitalis in its structure and effects. Natural History already detailed. Its diuretic property to be considered. Tobacco was recommended as a diuretic by Dr. Fowler, who published a number of cases of Anasarca and Ascites, as relieved by it. It has been spoken of by other writers—as Ferrier, and others. Dr. Garden, a distinguished physician of this city, spoke of the great efficacy of the Alkaline Salt of Tobacco in Drop- sies, and from this hint communicated to Dr. Hope, Dr. Foav- ler was induced to make trial of this article. Upon the faith of these recommendations, I have employ- ed Tobacco in a few cases of dropsy—But it is a medicine, the effects of which it is very difficult to regulate. In small doses it is a very uncertain diuretic, and in larger doses it causes such distressing nausea, that practitioners have al- most ceased to use it—So that I may say, we have much to learn in the administration of the remedy, so as to render it certain or convenient in any cases of dropsy. These objections to the use of the article, I have obviated, by commencing with a small dose of the tincture, and in- creasing until some sensible effect was produced. Thus administered, we have been much pleased Avith its effects in the cases in Avhich it was employed. 21 166 TOBACCO. Commencing with a few drops, three times a day, the quan- tity has been increased to lx. m., three times a day, Avith ef- fects very decided upon the urinary secretion, frequently ob- serving from three to four quarts discharged during the night; and where there is no organic injury, may be considered a remedy in dropsy, as its diuretic effect is considerable. From the uncertainty which attends diuretic medicines, it is proper to make trial of a greater number than we are in the habit of employing. Forms of administration—Infusion and Tincture. Preparation of the Infusion— $. Dried leaves of Tobacco, f i. Water, f xiv. Spirits of Wine, f ii.—Digest for a week. The dose for an adult, sufficient to produce the diuretic ef- fect, is xx. m. three times a day, increasing until some sensi- ble effect is produced. It may also be given in the form of a saturated vinous tincture. The dose the same. In giving medicines, it may also be observed as a general rule, that they can less readily be retained in the morning, than at any other time. The doses should be smaller at this time of day, Avhile they may be augmented in the evening. It should also be noticed, that between constitutions which are very nervous or irritable, or those very robust, or torpid, or long accustomed to the use of Tobacco, the dose will ad- mit of great and surprising variations. From the sedative action exerted by this article upon the heart and arteries, closely allied to Digitalis, it has been em- ployed in diseases of the chest. In chronic Catarrhs, Phthisis Pulmonalis, and other chronic diseases of the Lungs, it is an article more to be relied upon, in some cases, than Digitalis. It is given in the same doses, x. or xx. drops, three times a day, in a little water. Family Calchiceos, Colchicum Autumnale—Meadow Saffron. This plant is a native of England and Germany. Root perennial, bulbous, brown coat externally, size of a tulip, fleshy, and contains a milky juice. Flower purplish, appearing in the Fall, Avithout stem or leaves—anthers yellow. Leaves appearing in the spring, twelve inches long, flatfish, dark green. Different opinions are expressed of the sensible qualities of the root. By some said to be void of taste and acrimony. COLCHICUM AUTUMNALE. 167 By others, highly acrimonious. These contradictory state- ments are readily explained by the season of the year when the roots are taken out of the ground. They are inert in au- tum, because flowering—inert in the spring, because the leaves appear—active in mid-summer, not being engaged in giving nourishment to the leaves or flowers. An Alkaline principle has been obtained from the root, and termed Colchicine—a very active substance—one-tenth of a grain given to a cat, caused such copious alvine discharges, as to occasion death. The root of this plant was introduced into practice by Baron Storck, Avho employed it in the form of an oxymel in the Hospital of Vienna, in dropsical cases. Prepared as follows: #. Recent root sliced, f i. Vinegar, Ibi.—digest with a gentle heat forty-eight hours, strain—add honey in the proportion of two parts to one of the vinegar—boil to a proper consistency. Dose, one drachm, increased to one oz. With this oxymel, cases of dropsy were cured which were considered desperate. This preparation still popular in France and Germany, but little known to us. It has been superseded by the use of the Colchicum Wine, which is prepared in the following manner: #. Fresh root of Colchicum, sliced, f iss. Sherry Wine, f xii.—digest for two or three days, and filter through paper. This is a very active preparation, more so than the oxymel, and when given in dropsical cases, seems to remove the swelling by its strong cathartic operation, very copious watery discharges being produced by it—The cure is then completed by the use of Tonics. It is given in doses of thirty or forty drops, three times a day, and thus administered it operates very actively, the cathartic operation continuing several days after its use has been suspended. It is in other diseases that it is used with more advantage. These are Gout and Rheumatism. The former disease pos- sesses a considerable connection with the state of the aliment- ary canal, and it has been very successfully treated by very free and copious evacuations. Besides a strong purgative operation, it possesses considerable sedative powers in these diseases, exercising a distinct influence over these forms of specific inflammation. By virtue of this sedative influence, there follows soon after its administration complete relief to the violent pains which existed, and sleep commonly ensues. 168 COLCHICUM AUTUMNALE. In the morning a severe purging takes place of black, foetid matter, Avith nausea, and a profuse diaphoresis. With the removal of these symptoms, the disease has completely dis- appeared. The power of Colchicum to alleviate an attack of gout is admitted by all, but some difference of opinion exists as to the extent of its power, and the propriety of employing it— It alleviates a paroxysm of gout, but that alleviation is pallia- tive, not curative—It has no poAver to prevent a recurrence of the attacks. According to Scudamore, it renders the dispo- sition to the disease stronger in the system. It came into general practice from being thought similar in composition to an empirical medicine called Eau Medicinale, employed eighty years ago by a French officer in the service of the King of France. The composition has never been dis- covered, but supposed to be a combination of drastic and narcotic substances. Most practitioners concur in the opinion that it is a vinous Tincture of Colchicum. Dr. Scudamore recommends the following draught: p. Magnesia, grs. xv. to xx. Sulphate of Magnesia, p. topi. Vinegar of Colchicum, p. to ^ii. Distilled water, as much as is sufficient. Sweetened with any pleasant syrup. The dose of the Tincture is 200 drops at bed time— xxx. to xl. m. three times a day—in these doses producing very copious Avatery discharges. It has been employed in the treatment of Rheumatism-~-in painful chronic diseases, as an alterative, and said to have been beneficial—A tincture of the seeds has been employed in Rheumatism, in preference to the wine, and is prepared as follows : p. Seeds of Colchicum Autumnale, f ii. Spanish Wine, rbi.—Digest. Dose xx. to xxx. drops, increased to i. drachm, two or three times a day. Thus employed, it has been found beneficial—relieving pain and removing the disease in a short time. The proper period to have recourse to this article is, after the Inflammatory symptoms are abated by the use of antiphlogistic remedies. Has been spoken of in very favorable terms by Dr. Arm- strong in Rheumatism, and he considers it capable of giving more speedy and decided relief, than any other single remedy he has employed. Its effects are to reduce the action of the heart and arteries, to lessen the animal heat, and abate pain. COLCHICINE AND VERATRINE. 169 The Tincture is also employed as a liniment in the same affection. It has been recommended in the treatment of Inflammatory diseases, acute and chronic—Possesses much power in overcom- ing Inflammatory action, so as to become a useful auxiliary to the lancet, and in some instances to supersede its use. The dose of the Tincture is 3 i. night and morning, in the more violent cases, and 3 ss. in those of less severe character, until|pain and fever are abated. Colchidne and Veratrine.—Upon the alkaline principle obtained from the roots of the Colchicum Autumnale, and the root of the Veratrum Album, and the seeds of the Vera- trum Sabadilla, a feAV remarks may be made. The family of the Veratrum or Hellebore tribe, has been long knoAvn in the Materia- Medica, and are remarkable for their extreme activity Avhen applied to the human system, producing, in small doses, violent vomiting and purging, hypercatharsis, with bloody stools and tenesmus. To the alkaline principle obtained from these plants, the term Veratrine has been applied, and to this principle is owing their extreme activity and dangerous character. Sensible properties— Uncrystaliizable powder. Taste acrid, Odor little, but excites sneezing. Taken internally, in small doses, it excites violent vomit- ing, purging, and all the effects of the narcotic, acrid poisons. Applied to the skin in the form of ointment, it causes a sensation of heat and tingling in the part, and somewhat simi- lar sensations in distant parts. The diseases in which it is employed—In Neuralgic Affec- tions, Tic Douloureux, Paralysis—applied externally in the form of ointment, in the proportion of A scruple of the salt, Lard, 1 ounce. The frictions are to be continued until the heat and tingling caused by the veratrine, have acquired considerable intensity. It fails in the great majority of cases, according to our expe- rience, though in some few, its effects are highly beneficial. In Rheumatism, when of the neuralgic character, it may be employed externally and internally. In Dropsy, applied endermically, it acts as a diuretic, and has afforded relief. Has been recommended in some affections of the Heart. Taken internally, and applied externally, it has produced a diminution of the frequency and force of the pulsations of the 170 INDIGENOUS DIURETICS.—BLUE FLAG. heart, and in some cases, where it has been more excited than natural, restoration of a regular circulation. Mode of administering— Given in pills, or in spirituous tincture. Pills of Veratrine— p. Veratrine, grs. ii. Powdered Liquorice Root, grs. xii. Ext. of Hyosciamus, grs. vi.—Mix and make into xii. pills, one three times a day. Tincture of Veratrine— #. Veratrine, grs. ii. Sweet Spirits of Nitre, f i.—Mix. The dose is xx. or xxv. m. in a wine-glassful of water, two or three times a day. Ointment of Veratrine— #. Veratrine, 3 i. Lard, f i.—Mix. The size of a hazel-nut to be rubbed carefully in the morning and evening, or oftener, for from five to six minutes. Diuretics varied in their action. INDIGENOUS DIURETICS. Family Irideos—Iris Versicolor, or Blue Flag. Botanical Description— Root of the plant, thick and creeping. Leaves ensiform. Flowers terminal, racemose. Found in all parts of the U. States, inhabiting swamps and meadows. The root is the part of the plant employed. To the taste it is nauseous, followed by a sense of heat and acrimony in the fauces. The effects dependent upon an acrid juice which exists in the root, and which, when expressed, has been considered a local application in several diseases. It is possessed of cathartic properties, but it is not likely to be employed for this purpose, as it is apt to occasion a dis- tressing nausea, like sea-sickness, with prostration of strength, etc. It will never be resorted to when others can be obtained. Its diuretic properties are considerable, and for this pur- pose was recommended in high terms by the late Dr. McBride, of this city. INDIGENOUS DIURETICS.—BUTTON SNAKE ROOT. 171 It is given in the form of decoction, combined with Button Snake Root, as folloAvs : R-. Take of the Root of the Iris Versicolor; of the Button Snake Root, chipped small, each, f i. Warm Water, iv. lbs.—boil to 3b ii., strain—add of Powdered Nitrate of Potash, 3 ii. Spirits, brandy, or Avhiskey, fii. Dose—a Avine-glassful three times a day for adults, increas- ing or diminishing the dose, as upon trial may be found necessary. It will sometimes at first act as an emetic, but generally as a cathartic or diuretic, particularly the latter, and ought to be given in sufficient doses to operate as freely as the patient's strength can conveniently bear. This medicine is so quick in its effects, that if it does not succeed in a few days, or in a week, in producing a very per- ceptible change, it may be discontinued. The testimony of several practitioners in favor of the utility of this article, and cases cited illustrative of its beneficial operation. Dr. Bigelow has employed a tincture of the iris, in small doses, with several persons affected with Hydrothorax and Anasarca. It was evidently, he says, of great advantage to a majority of those who took it for a certain time. ^P Family Umbelliferae—Eryngium Aquaticum, or Yuccifolium— Button Snake-Root. Description of the plant— Root tuberous and premorse, or bitten off. Stem three or four feet high. Leaves twelve to eighteen inches long, one to one and a half inches wide, sword-shaped, fringed with soft spines. Flowers capitate. This plant a native of the Southern States. The root is the part used. To the taste it is pungent, bitter, and aromatic Its medicinal properties are diaphoretic, expectorant, some- times emetic, and diuretic. It was much esteemed by the late Dr. McBride, in combi- nation with the preceding article, in the treatment of dropsi- cal cases. For formula, vide Iris Versicolor. It has also been employed in the form of Tincture, and may be resorted to advantageously when other means have failed. Dose Tincture—i. drachm, two or three times a day, in- creased. 172 INDIGENOUS DIURETICS.—WINTER GREEN. A Tincture of this article is a very popular remedy in some of the stages of Dyspepsia. Family Ericineae—Pyrola UmbeUata—Winter Green—Pip- sisseAva—Bitter Sweet. To be found growing in most parts of the United States, in shad}'- woods. Description of the plant. Root Avoody and creeping. Stems two to four inches high. Leaves in Avhorls, evergreen, coriaceous. Flowers in a small corymb. All parts of the plant are active. The taste of the plant is bitter and SAveet, combined with a moderate degree of pungency. It has been considered one of the remedies derived from the Indians, and was employed by them in all disorders Avhich they ascribe to diminished secretion of urine, or Avhich are cured by an increase of that secretion. Spoken of in high terms by Dr. Summerville, in a paper in the Medico-Chirurgical Transactions, for its diuretic ope- ration. A case is related by him of its efficacy, in which with an increase of urine, there was an augmentation of strength and improved appetite. Though the case improved much under the use of the article, yet ifffinally terminated unfa- vorably—the good effects of the Pyrola being however fully manifested. To remove the fluid, by which dropsy is characterized, is not to cure the disease, of which the fluid preternaturally accumulated is often only a symptom, or remote effect. But since that is often the only relief we can aim at, it must be acknowledged to be a useful article, since it is not only diur- etic, but tonic, and free from any deleterious qualities. Form of administration—A strong infusion of the whole plant, or decoction, prepared as follows: Roots, stalks and leaves, 1 oz. Water, 2 pints—boil until it yields a pint of strained liquor. This quantity drank daily. Also employed in diseases of the urinary organs—in Ischu- ry and Dysury, and in Nephritis Cahulosa—possessing pro- perties nearly allied to Uva Ursi. Externally used as a wash in several species of ulcers with success. Pyrola Bfaculata—Spotted Winter Green. Possesses properties similar to the foregoing, being Tonic and Diuretic. INDIGENOUS DIURETICS.—OTHER ARTICLES. 173 Family Ahidece—Aletris Farinosa—Star Grass. Botanical description— Root tuberous and perennial. Leaves radical, expanding, and in consequence of being spread out close to the ground in a radiated manner like a star, the plant has been called Star Grass. Stem, one to three feet high. FloAvers in a spike. It grows in most parts of the United States, in damp pine barrens. Properties—To its diuretic, is added considerable bitter- ness, and is used in cases of dropsy Avhere tonics are re- quired. Infused in spirits, it is employed in cases of Intermittent Fevers, attended Avith dropsical SAvellings. It is a popular remedy in Dropsy, administered* in the form of a strong infusion, or decoction, of the root and leaves, drank freely, alone, or combined with other remedies. It is not unpleasant and agrees Avell Avith the stomach. I have employed it in some cases—In these its diuretic action has been manifested, but the patients did not recover, owing to the general disease of the habit. The decoction is prepared as folloAvs: R\ Root and leaves of the Aletris Farinosa, f ss. to f i. Water, lb iss.—simmer to lb i. Dose, as much as the stomach will bear. Family —Achyranthes Repens—Fort}^ Knot. Botanical Description— Root perennial. Stem creeping, hairy, and villous at the joints. Leaves sprinkled Avith hairs, opposite, one leaf generally larger than another. GroAvs in dry soils, along fences, &c. Useful for its diuretic properties in Ischury and Dysury. These complaints of frequent occurrence in old persons, * and are caused by calculi or gravel, irritating the neck of the bladder, or lodging in the urethra. Diuretics useful under these circumstances. Useful also in Dropsy. Administered in decoction of the whole plant—a handful to a pint and half Avater, simmered to a pint, and taken freely, aided by the addition of the Saline Diuretics. There are various articles which are useful in domestic practice. They are the leaves of the 22 174 INDIGENOUS DIURETICS.—OTHHER ARTICLES. Cynara Scolymus, or Artichoke, bruised and steeped in gin. and taken in moderate doses during the day. The root of the Cochlearia Amoracia, or Horse Radish, taken in the form of a strong infusion. The Semina Sinapi, or Mustard Seed, unbruised, and taken in the dose of a tea-spoonful, tAvo or three times a day. The Aliaceos have been much employed. The expressed juice of the Garlic and Leek, has been re- commended at different times. The Apium Petrbsilinum, or Parsley—Useful in strangury—- In suppression of urine occurring in children—Employed in the form of decoction of the root, alone, or combined with the Nitrate of Potash. Water Melon Seed tea, prepared in the folloAving manner: Of the bruised seed, f ii. Boiling water, lb i. Dose, a gill every tAvo hours. General Principles— The following principles will give a very good idea of the extent of operation of this class of remedies. 1. Dropsies produced by an obstruction to the circulation, yield to bleeding and gentle diuretics, provided the cause of the obstruction is not incurable. Digitalis is useful Avhen this obstacle is hypertrophy of the heart; 2. Dropsies produced by the sympathetic influence of a chronic inflammation are rarely curable, because such inflam- mation seldom occasions drops}', till the seat of the inflamma- tion is changed in its structure. The treatment must be directed solely to the chronic inflammation, and the diuretics such as do not irritate the digestive organs. 3. Dropsies which depend upon an accidental defect in the urinary or perspiratory secretions or excretions, -will yield to the establishment of these by the proper means. Diuretics and even purgatives will cure them, but Ave must take care to remove the accompanying vascular plethora, and not to exasperate the phlogosis which may co-exist. 4. Dropsies which result from bad digestion, and assimila- tion, disappear under the influence of tonics, good air, and good aliments. 5. Dropsies resulting from haemorrhages, or other evacua- tions, are cured by tonics, good food, and active diuretics— but Ave should be cautious in such cases of too suddenly re- storing the strength. In dismissing this class of medicines, Ave are, by an inti- mate connection, led to consider the morbid conditions of the LITHONTRIPTICS AND ANTILITHICS. 175 urinary secretion, and to take a brief vieAV of those medi- cines, the object of Avhich is to correct and remove them. I shall, therefore, proceed to Lithontriptics and Antilithics. Division 7. . LITHONTRIPTICS AND ANTILITHICS. Explanation of these terms-— The consideration of the urinary secretion has enlisted much attention, on account of the very singular products which have been obtained from it, and from its intimate connection Avith many diseases. In its healthy state, it consists of many acids and salts, and it is from the predominance of a few, or their varied combi- nation, that calculi are derived. The several principles are— 1. Phosphoric Acid. 2. Phosphate of Lime. 3. Phosphate of Magnesia. 4. Carbonic Acid. 5. Carbonate of Lime. • 6. Uric Acid. 7. Albumen and Gelatine. 8. Urea. 9. Muriate of Soda. 10. Phosphate of Soda and Ammonia. 11. Muriate of Ammonia. With other salts, according to the state of health, or disease. Upon a few of these substances offer some remarks—they are Phosphorus, Uric Acid, Albumen and Gelatine, Urea—va- rious salts. Such being the nature and composition of urine, it may be supposed that Avhen the quantity of these substances is augmented beyond what can be held in solution, urinary concretions or calculi Avould be found. Particular states of the constitution, give rise to the for- mation of these ingredients, and Avhen carried to excess is called the Lithic Diathesis. This state of the system is pro- bably intimately connected Avith the deranged condition of the alimentary canal, and the first link in the chain of causes, giving rise to the production of these substances, has its ori- gin in the stomach. 176 LITHONTRIPTICS AND ANTILITHICS. The different substances which enter into the composition of urinary calculi, may be arranged under the following heads: 1. Lithic or Uric Acid. 2. Phosphate of Lime. 3. Ammoniaco Magnesian Phosphate. 4. Oxalate of Lime. 5. Cystic Oxyd. Besides others produced by the combination or admixture of these ingredients. General appearance of the Calculi in the Bladder. 1. Lithic Calculus—Of a broAvnish or faAvn color, hard and inodorous-- -soluble in solutions of the alkalies, insoluble in the acids. It is estimated by Dr. Prout, that at least two- thirds of the Avhole number of calculi originate from this acid. 2. Bone Earth Calculus, or Phosphate of Lime—Of a pale brown color, composed of laminae, Avhich separate readily from each other. It is dissolved by the acids. 3. Triple Calculus, or Ammoniaco Magnesian Phosphate— It is of a Avhite color, and less compact than the preceding. It is dissolved in most, if not all the acids. •4. Mulberry Calculus, or Oxalate of Lime—named from its resemblance to the mulberry—readily dissolved in the nitric and muriatic acids. 5. Cystic Oxyd—Of a compact structure, not laminated, appears as amass confusedly crystallized. Dissolved by acids and alkalies. 6. Fusible Calculus—Whiter and more friable than the preceding—resembles a mass of chalk, and leaves a white dust on the fingers—acquires a large size, moulding itself into the contracted cavity of the bladder. It is dissolved by the sulphuric and muriatic acids.—fide Marcet on Calculous Diseases. To that state of the constitution which favors the produc- tion of these substances, the term Lithic Diathesis has been applied. It is not knoAvn exactly in Avhat it consists, or by Avhat modification of vital chemical actions those changes are pro- duced, Avhich give rise to these concretions. It is probable that they are intimately connected Avith the deranged conditions of the alimentary canal, as calculi are ahvays accompanied Avith indications of impaired digestion, and the first link in the series of actions has its origin in the stomach. This probable connection is supported by the analogy Avith LITHONTRIPTICS AND ANTILITHICS. 177 other diseases; these concretions taking place in gout, and the Avell known connection between the attacks of gout and alimentary derangements. The importance of the connection of the lithic diathesis Avith impaired digestion cannot be too often repeated, Avhen it is considered, that in all cases of calculous diseases, it is necessary to pay particular attention to the general state of the patient's health, and along Avith medicines usually called solvents, to pursue a tonic and invigorating plan Avith re- spect to the stomach. The medicines Ave term antilithic, are more or less tonic in their operation. Dr. Prout, in his work upon Calculous Diseases, insists very strenuously upon the connection, and has pointed out very fully the symptoms Avhich precede these earthy deposits. They consist, he says, of great irritability of the system, derangement of the chylopoietic viscera in general, flatu- lence, costiveness or diarrhoea, the stools being of an unnatu- ral color. The first object then to be attended to, is to improve the condition of the digestive organs, and to incite them to a more healthy action—Hence the reason of a class of medi- cines termed Antilithics. The other class of medicines, or Lithontriptics, are em- ployed during the formation of urinary calculi, or after they are formed. To produce a beneficial effect, these medicines are taken into the circulation, the urinary secretion becomes impreg- nated Avith them, and thus a solvent operation is exerted upon the concretions which exist—That many substances pursue this course, Ave have already endeavored, on many occasions, fully to set forth, and hope to have established. But it might be questioned, Avhether they can be conveyed into the bladder of such strength as to exert a solvent ope- ration upon the concretions which exist. When these concretions attain any size, all will agree, that but very little benefit can arise from their use, and the im- possibility of effecting a solution of them. Indeed, Ave might almost as soon expect that the stones in the street Avould be dissolved by the rain, as that these substances can be re- moved by any course of internal treatment. Still they may be beneficial in relieving the symptoms, and to such an extent have they been relieved, as to induce the belief that they had been dissolved, though they have been found after death imbedded in cysts, or their surfaces smooth- ed and polished, rendering it tolerably certain that they had been acted upon by these medicines. 178 LITHONTRIPTICS. The medicines Avhich are employed for these purposes, are divided into those of an alkaline and those of an acid char- acter. That by a course of alkaline medicines the urine may be deprived of its acid qualities, I believe there will be no hesi- tation in admitting, and that it may even become decidedly alkaline, and capable of dissolving lithic acid calculi. But Avith regard to the acids, the question is not so easily settled, and particularly as the urine is decidedly an acid fluid. Mr. Brandt has, hoAvever, determined, by experiments, that they are capable of being conveyed into the bladder, and this he has more especially endeavored to ascertain by experi- ment Avith the carbonic acid. But admitting that neither of these substances are taken into the circulation, still as they correct the condition of the digestive organs, from a state of acidity or alkalescence, they thereby modify the action of the kidneys, and, of course, their secretions. The conclusions then I would support upon the action of Lithontriptic medicines, are as follows: 1. That these medicines are not entitled to be considered as solvents of stone in the bladder. 2. That in small calculi, or gravel, or the forming stage of the disease, the symptoms derived from this cause, Avith the concretions, have been relieved, and dispersed, by the proper and judicious use of alkaline or acid medicines. 3. That in advanced stages of the disease, or after stones exist in the bladder, the symptoms of irritation produced by them, have been so much relieved by the use of Lithontriptic medicines, that the patient's life has been rendered easy and comfortable, to such a degree, by changes induced from che- mical actions upon the surface of the stone, as to excite a belief that they had been dissolved, though they have been discovered in the bladder after death. 4. That even supposing these medicines incapable of exert- ing any action upon the urinary organs, yet, by correcting the morbid condition of the alimentary canal, either from a state of acidity or alkalescence, that they thereby disturb those affinities, Avhich, in the subsequent processes of assimi- lation and secretion, give rise to calculous affections. The last, and a most important question, remains to be considered. How are Ave to discover the nature of the cal- culous secretion, so as to direct a suitable remedy? This must be considered a question of primary importance, for Avithout some principles to guide us, our practice is but em- pyricism, and failing in our attempts to afford relief, we LITHONTRIPTICS. 179 decide that all is conjecture and uncertainty, that the prac- tice is based on an unstable basis, when in fact the fault is not in the medicine, but in our insufficient knoAvledge of its application. In the inquiry, hoAv are we to be directed in the employ- ment of a suitable remedy ? For this purpose Ave must examine the sediment Avhich is deposited by the recent urine, or Ave must analyze the small calculi which are passed Avith the urine. Here is presented a specimen of calculi passed from a patient Avhom Ave Avere called to visit, for Avhat was called a gravel complaint. It Avas necessary to knoAvthe composition of these concretions before a proper remedy could be admin- istered. We had them analyzed, and determined that they were lithic or uric acid. The patient Avas placed upon the use of alkaline medicines, and in a few Aveeks they Avere entirely dissolved, the urine was voided free of them, and has so continued, though several months have elapsed since he Avas first seen. To shoAv the importance of the principle, suppose that we had proceeded to administer acids, the evil would, undoubtedly, have been increased. As a general rule, the acid sediment is of a red color, and this is a circumstance which may aid us in the investigation. When this sediment makes its appearance in urine upon cool- ing, and Avhen particles are discharged with the last drops, it is an evidence that the acid qualities of the urine are in excess, and under these circumstances the alkalies are the proper remedies. We are not to use them incautiously, for by their long con- tinued use, we may not only deprive the urine of its acid qualities, but render it decidedly alkaline—and thus, in removing a deposit of an acid character, Ave may form one of an alkaline. But urine Avhich deposits a sediment of a rose, red, or brick dust color, is not always an evidence of a disposition to cal- culus—It is often a symptom of other organic derangements —It is often an evidence of impaired digestion, and it not unfrequently occurs where there is hepatic, or splenic disor- ders—So that you will be on your guard, and not pronounce every case where this occurrence manifests itself, as of a calculous character. It is only Avhen taken in connection Avith other symptoms, as frequent micturition, pain in the region of the bladder, bloody urine, with the discharge of small cal- culi, as Ave have shown you, that Ave determine upon the pre- sence of calculus. ' It might be some satisfaction to knoAv, and it may give to our medical treatment more simplicity to be informed, that, 180 ANTILITHICS. according to the opinion of Dr. Prout, tAvo thirds of the Avhole number of calculi originate from lithic acid. The next deposits most frequent, are of an Alkaline charac- ter—They consist of the Phosphate of Lime, and the Ammo- niaco Magnesian Phosphate. This sediment is usually of a Avhite color, and Avhenever it appears, it is an evidence that the acid character of the urine, by Avhich it is held in solution, is diminished. When, there- fore, this Avhite sand is noticed in connection Avith other symp- toms, Avhich are its invariably folloAving meals, and its being observed in the urine, not merely as a deposit upon cooling, but at the time the last drops are voided, Ave will find that the internal use of acids Avill, in most cases, diminish or remove it. You may, by an experiment, cause this deposit to take place, by adding a solution of Potash or Soda to recent urine, A\Then it will be throAvn doAvn. Hence, therefore, the Alkalies, as well as the acids, should be used with caution, as by too long use of them, the urine may be so changed, that the phosphates may be formed. It was at one time considered that the alkalies should only be employed in their caustic or pure state, but they cannot reach the bladder in a caustic state, combining, as they would, Avith the carbonic and other acids in their course. Expe- rience has determined that the carbonates are equally valu- able, and less likely to disagree with the stomach. The alkalies, even though they do not act as solvents, are often useful by allaying irritation of the bladder, promoting the flow of urine, and thus mitigating symptoms. ANTILITHICS. Definition.—Under this head are comprised Tonics and Astringents. From what I have said of the disordered con- ditions of the digestive organs in calculous cases, it Avould naturally be inferred, that our first object Avould be to correct their derangements. For Avhatever will improve their powers of action, will prevent the development of those principles Avhich lay the foundation of, and are very intimately con- nected Avith the production of urinary concretions. For any excess of acidity, or alkalescence, in the primae viae, may be considered as exciting causes of similar conditions in the urinary secretions. Tonics, and Avhatever promotes digestion, may be con- sidered as valuable resources. ANTILITHICS.—ARBUTUS UVA URSA.—BEAR BERRY. 181 Astringents are also useful as tonics, but, in addition, they seem to have some power to relieve the symptoms, Avhich attend the presence of calculus in the urinary passages. They have therefore, been employed, almost at all times, and by most eminent physicians. That the symptoms may be relieved, without the stone being removed, has been suffi- ciently proved, and among the medicines which operate in this manner, astringents may be mentioned. Uva Ursi, Avhich has been so long celebrated, seems to ope* rate in these cases by virtue of these principles. Dr. Cullen further supposes, that it is useful by absorbing acid in the stomach, but this operation is very improbable. Astringents are, therefore, useful by their tonic impression —they are also useful by lessening the sensibility of the blad- der, and probably lessen the acrimony of the urine. Of the Astringents employed as Antilithics— Family Ericaceae—Arbutus Uva Ursi—Bear Berry. Description of the plant— It is an evergreen creeping plant. Stems procumbent, branches trailing. LeaA'es alternate, oval, firm, deep green upper surface, paler underneath. FloAvers flesh color, in small clusters at the end of the branches. Berries red. Very common in many parts of Europe, and in the Northern parts of the United States. Sensible properties— Considerable bitterness and astringency, abounding in a large proportion of Tannin. They yield their active principles to water. The leaves of this plant have been long known in the Mate- ria Medica, and Avere employed in diseases requiring astrin- gents. They had declined very much in practice, until their use Avas revived by DeHaen, in the middle of the last century, as a useful and efficacious medicine in the treatment of nephritic and calculous affections. This physician, Avho practiced medicine in Vienna, and who had the superinten- dence of a very large hospital, speaks of it in "very high terms, as valuable in relieving the symptoms of calculous—so much so, that under its use the patients continued free from pain or inconvenience in making Avater, although the catheter showed that the calculus still continued—that others who seemed to be cured, relapsed on leaving off the medicine, and Avere again relieved upon repeating the use of it, Avhile others obtained only temporary and precarious relief. 23 182 ANTILITHICS.—HUMULUS LUPULUS—HOP. The efficacy of this article in nephritic and calculous cases has been variously represented by different writers on the Materia Medica. By some, it has been represented as merely possessed of diuretic properties, and having no effect in reliev- ing calculous, or other diseases of the bladder. The weight of authority is decidedly in its favor—The tes- timony of the late Dr. Wistar. From the testimony of vari- ous individuals, there is no doubt that it proves a palliative for calculous symptoms in many cases, and prevents their appearance. In Nephritic affections a valuable medicine, particularly in N. Podagrica, or depending upon gout. Its employment preceded by purgative and depleting medi- cines, which are to be repeated at proper intervals. In Cystitis, or Inflammation of the bladder, in Catarrhus Vesicae, in suppurations of long continuance in the kidneys, bladder, and its appendages, this medicine will be found useful. In Gonorrhoea and Gleets of long standing, useful in the form of decoction. Many other applications of this article we shall not detail. Forms of administration—Infusion and Decoction. ft. Leaves of Uva Ursi, bruised, f ss. Water, f xvi.—Boil ten minutes. 'Dose, f i. to f ii. every hour or two. Powder, 3 i. to 3 ii., three or four times a day. Family Urticeae—Humulus Lupulus, or Hop. The Hop Vine a nati\Te of most countries of Europe, also indigenous to America. The strobiles or flowers are employed. Odor, heavy and aromatic. Taste, strong bitter—tonic. A useful ingredient in malt liquors, imparting an agreeable flavor to them—and to this article we attribute the narcotic or droAvsy effects produced by their use. Lupuline is obtained in the form of small, yelloAV grains, pulverulent, of an aromatic smell and bitter taste. It covers the base of the scales of the hop, and is separated from them by a fine sieATe. Upon this article we need not dAvell long—its medicinal powers overrated—allowed to be a slight narcotic bitter. Useful in the form of infusion, to relieve an attack of Nephritis, by removing pain and quieting irritation. It is well adapted to this disease, possessing both anodyne and diuretic properties. It has been very usefully employed, ANTILITHICS.—WILD CARROT.—RED PEPPER. 183 administered in the form of infusion made strong, or hop tea prepared as follows : R\ Hops, f ss. Boiling water, Sbi.—m.—strain. Dose f i. to f ii. three or four times a day. Tincture—dose, 3 i. to 3 iv. Family Apiaceoe—Daucus Carota—Wild Carrot. This plant groAvs wild in many parts of the United States, and in the neighborhood of this city. It bears considerable resemblance to the cultivated, only possessed of more active properties, being much more acrimonious and bitter. In many of the urinary diseases, this plant is often a very useful remedy. It is given in the form of infusion of the roots and seeds, in the quantity of a pint a day. Family Solanece—Capsicum Indicum, or Red Pepper. Of this article I shall speak more particularly under the head of Stimulants. From its action upon the digestive organs, in improving their functions, and removing many of the unpleasant symptoms attendant upon imperfect digestion, we think it may with great propriety be placed among the Antilithics. We have no particular authority in making this arrangement, but our experience in a single instance. It was employed by an elderly gentleman, upwards of 70 years of age, who had for several years been distressed with gravel and small calculi. He had tried many remedies for his relief, and had consulted the best authorities upon his disease. Finding his constitution becoming every day more impaired by a painful and protracted disease, with feeling of sinking and great gastric derangements, he was induced, in order to improve his appetite, and promote the function of digestion, to make trial of this article. He employed it in the form of a salad, cutting up five or six peppers each day, and mixing them with the food eaten. The effect of this treatment, by restoring his appetite, has been to restore his strength, and Avhile promoting the func- tions of the bowels, giving to them greater regularity, it exerts also a diuretic operation. He also thinks that some change has taken place in the structure of the calculi, that they are softer, more readily broken down by the muscular action of the urethra, and expelled in a more pulverulent form. The occurrences of this case, and the beneficial effects produced from Capsicum, have contributed very much to strengthen the opinions I had formed of the Antilithic pow- ers of medicine. 184 ALLIUM SATIVUM—DIOSMA CRENATA. Family 'Liliaceae—Allium Sativum—Garlic. OAA^es its Antilithic properties to its stimulant and stomachic operation in enfeebled digestion. From its stimulus being poAverful and diffusible, it is used under the same circum- stances, and same advantage, as Capsicum. The dose is half a garlic, or half a table-spoonful of the ex- pressed juice. The Leek is said to be equally useful, and may be adminis- tered in the same Avay. Family Rutaceoe—Diosma Crenata—Barosma Crenulata, Bu- ohu, or Bucku. The leaves of seA*eral species of Diosma are knoAvn in the shops as Buchu. They are intermixed with stalks and leaves. They are smooth, shining, serrated. Their consistence coriaceous. Their color pale or yellowish green. They are oval, oblong, or obovate. Might be taken for Senna, differs only in color. Properties—Aromatic, Stimulant and Tonic. Taken in moderate doses, it promotes the appetite, relieves nausea and flatulence, and acts as a diuretic and diaphoretic. Buchu has principally been employed in chronic maladies of the urino-genital organs. Though the plant has been long knoAvn, it Avas not employ- ed in medicine until 1823, Dr. McDowell in that year giving a most favorable account of its good effects. It has since been employed by a considerable number of practitioners, and its remedial poAvers fairly tried. It seems to be principally adapted to chronic cases, attend- ed with copious secretion. In Chronic Inflammation of the mucous membrane of the blad- der attended Avith copious discharge of mucous, it frequently checks the secretion, and diminishes the irritable condition of the bladder, thereby enabling the patient to retain his urine for a longer period—but it has also failed to give re- lief. In irritable conditions of the urethra, and in gleet, it has proved serviceable. In this last disease, worthy the atten- tion of medical men. In Lithiasis, attended with increased secretion of uric acid, it has been given with considerable benefit by Dr. Carter, and others, and has appeared to check the formation of this acid. It should be given in these cases in combination Avith alkalies, Administration—In Powder, Tincture and Infusion. ALLIUM SATIVUM—DIOSMA CRENATA. 185 PoAArder—3 i. to 3 ss. Infusion—# Diosma C, f i. ; water, lb i.—macerate for two hours in a lightly covered vessel—strain. Dose—f i. to f ii. Tincture—3 i. to 3 iv. Of Diet as an Antilithic. The secretions being materially influenced by the ingesta, the remarks on this subject cannot be considered irrelevant. In experiments upon birds, it has been ascertained by Dr. Wollaston, that the proportion of Uric Acid voided Avith their dung, Avould be much influenced by the diet upon which they Avere fed—That Avhere they fed upon grass wholly, the propor- tion of Uric Acid was extremely small—That Avhen to the vege- table, a portion of animal food Avas added, the quantity of Uric Acid Avas greatly increased—That when feeding Avholly upon flesh, the proportion Avas manifestly greater, and seemed to be little more than Uric Acid. It seems, consequently, deserving of inquiry, Avhat changes might be produced in the urine of any animal by such alter- ations of diet as its constitution Avould permit —for, as far as any inference could be drawn from the above experiments, it Avould seem that persons subject to calculi, consisting of Uric Acid, as well as gouty persons, in Avhom there is ahvays an excess of the same matter, have much reason to prefer a ve- getable diet. The preceding observations will be of much use in determin- ing our practice, as to the propriety of an animal or vegetable diet for those laboring under an excess of Uric Acid. The experiments of Dr. Wollaston are so ingenious and satisfac- tory, that it Avould be hardly admissible to doubt what has been so ably proved. Independent of these experiments, a Aveek's abstinence from animal food has been known to re- lieve a fit of gravel of the Uric Acid character, when alkalies were of little avail, and in other cases, the same plan has been successfully adopted. These observations of Dr. Wollaston, of the connection of Uric Acid concretions with the nature of the ingesta, have been confirmed by others. Magendie has repeated these ex- periments on dogs, and found that by a vegetable diet, their urine could be made to contain neither Uric Acid, nor the Phosphates, that it became rather alkaline than acid. Andral, in his Pathological Anatomy, notices the changes the blood undergoes by the use of a diet containing much azote, or nitrogen, of which nature is animal food. Not only does the blood acquire an additional quantity of fibrine, (and hence these persons are much disposed to h> 186 OF DIET. flammatory diseases,) but under the same circumstances, a su- perabundant secretion of Uric Acid takes place, and gives rise to the complaint called gravel. Not only does it exist in a greater quantity in the urine, but it occurs in other parts of the system. It forms around the joints, is found in masses between the fasciculi of several muscles, in the subcutaneous cellular tissue, and even in the spongy extremities of the bones. The best way to change this superabundant secretion, is to change the diet of the person affected, and to give him food containing as little azote as possible. He should, there- fore, avoid as much as possible animal food. As a healthy state of the digestive organs is what we should have in view, it may be found detrimental to restrain persons affected Avith Calculus of the Uric Acid character, from taking a due proportion of animal, as Avell as vegetable diet. They should, particularly, abstain from all things Avhich manifestly disagree Avith them—such as heavy unfer- mented bread, hard boiled and fat puddings, salted meats, acescent fruits, and soups of every kind. In general, also malt liquors and wines, particularly of an acescent quality, Avill be injurious. Errors, therefore, in these respects, should be guarded against: But it is not only important that those articles should be avoided Avhich are unwholesome—regard should be had to the quantity of those Avhich are wholesome. Errors in this respect are probably more injurious than in quality—at least they produce the same effects. When the sediment consists of white sand, or the phosphates, Ave should adopt a general add system of diet, as far as may be compatible Avith the state and condition of the alimentary canal—to abstain from soda water and all alkalies—to take weak lemonade, and an occasional glass of cider, as ordinary drink at meals; and if accustomed to wine, to prefer Cham- pagne and Claret, to Madeira and Port, and to eat salads, and acid fruits. Exerdse is of great importance in all gravelly complaints, and flannel should be Avorn constantly. Sailors and other persons accustomed to constant laborious exercise in the open air, are very rarely affected with these complaints. Magen- die has given a striking example of the advantages to be derived from exercise and abstinence, and the mischievous effects of luxury, in the case of a merchant in one of the Hansiatic tOAvns. MINERAL ACIDS. 101 PARTICULAR LITHONTRIPTICS. The consideration of particular articles Avill correspond with the general vieAvs taken. We will consider first the solvents of the Avhite sand, or the Phosphates of Lime, and of Ammonia and Magnesia. These comprise all the acids. Carbonic Add—First employed by Dr. Saunders, as a sol- vent for the human calculus in 1775, and aftenvards by Dr. Percival, avIio speaks in the highest terms of it as a medi- cine, grateful to the palate, strengthening to the stomach, and salutary to the Avhole system—Has advantages over lime water, and the alkalies. Advantages of Carbonic Add—May be taken in union with water in the largest quantity without satiety or inconve- nience—it requires no restrictions in diet, and its medicinal virtues will be undiminished in the stomach or bowels. It has been a question Avhether it does enter the circula- tion, so as to reach the bladder in an uncombined state—Dr. Priestly decidedly of this opinion, having expelled it by means of heat from fresh made urine. Mode of administration—Impregnating water with this gas by means of a Nooth's apparatus, or procured from the dealers in artificial mineral Avaters. It may be drunk freely. Mineral Adds—Comprehending the Nitric Sulphuric, and Muriatic or Hydrochloric. They all agree in their general properties. Nitric Acid is most apt to disagree with the stomach, pro- ducing symptoms of flatulency and indigestion, though cases may be cited of its tonic operation. The Muriatic Add has been most celebrated in the treat- ment of gravel complaints. Mr. Copland has employed it in persons Avho were distressed Avith a frequent desire to make water, voiding it Avith pain, and in small quantities—accom- panied Avith obtuse pain in the region of the bladder. Upon giving it in doses of xxx. m. of the diluted acid, three times a day, a considerable discharge of sand and gravel with the urine has taken place, followed by relief of all the symptoms. Muriatic Acid is most apt to agree with the stomach, but not so Avith the boAvels, which are most commonly relaxed under its use. This circumstance often recommends it, for costiveness very frequently attends the state of the body Avhich favors the formation of the white sand—hence aperient medicines often alone useful—Cases of its efficacy related. 188 LITHONTRIPTICS.—VEGETABLE ACIDS. Muriatic Acid employed in some forms of Dyspepsia, and its employment recommended by being a constituent of healthy gastric juice, and Avhen mixed with mucus, has a sol- vent or digestive poAver in the case of various articles of food The Sulphuric Add most properly considered tonic, and admits of being persevered in a longer time. It might be supposed, from the disordered condition of the first passages, that these acids would disagree in most cases. The contrary is the case. This circumstance points out an important distinction betAAreen vegetable and mineral acids. When the use of the acids produces much irritation, they should be intermitted, or opium employed to allay the pain. Dose of the acids, from v. to xxx. m., three times a day, in plain or barley water. Vegetable acids— The Mineral Acids disagreeing Avith children, we have recourse to the vegetable. Children are equally liable with adults to an increased secretion of the Phosphates, and in Avhom prompt treatment is required to prevent the formation of stone. Tartaric acid may be used—dose v. to xx. grs. or the Bi- Tartrate of Potash—dose xx. to xl. grs. This last often ope- rates on the bowels, Avhich renders it beneficial. Remedies for the Uric Add Concretions. They are distinguished by their red color, and occur when the acids are in excess. The proper remedies are alkalies. The efficacy of the alkalies and alkaline earths being suffi- ciently proved, the question to be considered is, the kind to be preferred, and the manner of using them. Carbonates of Potash and Soda.—They Avere directed to be employed in their caustic or pure state, but in this state they are not more active than the Carbonates, and are more likely to disagree Avith the stomach. Soda is preferred to Potash, as being more mild, and less likely to disagree, and Fourcroy states as his opinion, that it is more eligible for medicinal purposes than Potash, on account of its analogy with animal substances which always contain it. Potash has dispelled symptoms Avhich had withstood the operation of the former. They should both be retained and employed. Sir G. Blane and Mr. Brand state that they had LITHONTRIPTICS.™LIME WATER.—-MAGNESIA. 189 obtained beneficial effects from the use of Potash, Avhen Soda had failed to give any relief. The explanation given for the relief afforded by Potash. Administration of Soda.—In the form of the Avell-known artificial beverage of Soda Water. The alkali being saturated with Carbonic Acid Gas, looses its caustic and disagreeable taste. In the quantity of a tumbler-ful, containing 3 ss. to 3L of the carbonated alkali, it makes a pleasant beverage, in which the offensive effects of the alkali are obviated. Or, ft. Carbonate of Potash or Soda, f ii. Water, tbxxiw And this impregnated with fixed air by a Nooth's appara- tus—of this from xii. to xxh\ ozs. may be taken daily. Or, The ordinary Soda PoAvders may be taken. Administration of Potash.—It may be given in doses of xv. to xxx. grs. at a dose, night and morning. It sometimes pro- duces much gastric distress, Avhich may be diminished by uniting Avith it mucilage of Gum Arabic, or giving it in thin broth—-Cannot be given long without producing uneasy symptoms in the stomach. To obviate this, it is given also supersaturated Avith Carbonic Acid Gas. 0r' The alkalies may be freed from the water of crystallization, and made into pills. The quantity taken being from 3 ss. to 3L daily. Cases related exhibiting the power of these medicines to prevent, or diminish, the secretion of calculous matter. The alkalies have also been much used in the state of Soap—but in this state they are often offensive to the stomach, or impair its powers, and lay the foundation of Dyspepsia. Dose, f ss. to f i. in pills daily. Aqua Calds, or Lime Water—Has been long known for its poAvers of lessening pain, and removing the symptoms of cal- culous disorders. To be effectual, it must be given in large quantity—not less than a quart or three pints daily. It is an inconvenient and ineffective form of alkaline medi- cine, and not entitled to much consideration. Magnesia.—The use of this article was suggested by Mr. Hume, upon the supposition that calculous complaints could be prevented by introducing into the stomach such substan- ces as are capable of preventing the formation of Uric Acid, 24 190 LITHONTRIPTTCS.—GRAVEL ROOT. and that this mode of treatment would have many advantages over the usual method, Avhich consists in dissolving it after it was formed. Efficacious in diminishing the quantity of Uric Acid in the urine, and sometimes effectual after the alkalies lurve failed. Also of great value Avhere the alkaline remedies are indi- cated, but in Avhich Potash and Soda have created gastric symptoms. Magnesia may be used as calcined or sub-carbonate—the latter generally preferable, except Avhere flatulence exists, Avhen the calcined should be used. The dose xv. to xx. grs., several times a day, in any conve- nient vehicle. Care should be taken that an accumulation should not take place, by the occasional administration of a mild cathartic. Magnesia, a valuable addition to the medical treatment of calculous diseases. .Being less offensive to the stomach, yet capable of removing acidity from the digestive organs, will be found preferable to the other alkalies, Avhich injure the tone of the stomach by their long-continued use. The utility of this article illustrates the pathology of these diseases, such as has been endeavored to be pointed out. Its operation being exerted upon the stomach and aliment- ary canal, correcting the morbid condition of their contents, points out the connection of urinary deposits with their deranged states, and we may say their dependence upon the condition of these organs. Since, in the results Avhich follow the administration of this article, Ave see, that as acidity of the first passages is corrected, the red sediment of the urine is diminished, and ultimately removed—thus proving, that there is a very intimate connection between the secretions of the stomach, and those of the kidneys. Family Menispermaceoe—Cissampelos Pareira—Pareira Bra- va, Velvet Leaf", Wild Vine—Gravel Root. Natural History— Root woody and branching. Stem, round, smooth. Leaves aristate at the point, covered underneath with silky pubescence, hence called velvet leaf, but not truly downy. Native of the West Indies and Spanish Main. The root, the part employed, was originally introduced into medicine as a Lithontriptic. Its poAvers in this way were at one time highly vaunted, and Helvetius went so far as to assert, that calculi of the size of an olive had disappeared under its use, and that the operation of Lithotomy was no longer necessary. EMMENAGOGUES. 191 It is now employed almost solely in discharges from the urino-genital mucous membrane. It has been used in Gonorrhoea, Leucorrhcea, and Chronic Inflammation of the bladder. In the latter disease, Sir B. Brodie states that he has seen more good from this root, than from Uva Ursi. It is given in the form of strong decoction, to which may be added a little of the Tincture of Hyosciamus, as follows : ft. Root of C. Pareira, f i. Boiling Water, ft>i — digest—strain. Dose, f i. to f ii., three or four times a day. Of the Powder, 3 ss. to 3 i. The last of the means which have been recommended for the solution of calculi is the injection of various substances into the bladder. The acids and alkalies sufficiently diluted have been employed for this purpose—But it is tedious and ineligible, and has yielded to lithotrity and lithotomy. The gastric juice of animals has also been employed. The injection of Castor Oil into the bladder has great effect in relieving the sufferings occasioned by stone in the bladder, and as the pain and irritation arising from this cause are often very great, I have, says Dr. Morris, much pleasure in recom- mending it to the notice of those who are laboring under so severe an affliction, hoping that they may find it of inestima- ble advantage. Division 8. Medidnes which promote the Catamenial Secretion. EMMENAGOGUES. General remarks upon the Catamenia—Its nature and importance—Its suppression connected Avith several forms of chronic disease, and an inquiry into the condition of the ute- rine secretions, should never be overlooked. Medical men being aware of this fact, have applied them- selves with diligence to promote this secretion—but ftom fre- quent failures of their endeavors, doubts have arisen as to the beneficial effects of medicines in these cases. The preca- riousness of this class of medicines, those Avho have had expe- rience must allow. Still we are decidedly of the impression, that we are possessed of medicines which exert an action upon the secretions of the uterus, and if failure attends their 192 STIMULATING EMMENAGOGUES. administration, it proceeds from the incorrect ideas Avhich are entertained of the nature of the Catamenia, and our inatten- tion to the state of the system. The fact is, the practice in these cases is often in a great degree empirical, and the Avant of success proceeds from neg- lect of those circumstances Avhich should influence their operation. Alibert observes, that there are few diseases which depend upon such a variety of causes, or are connected Avith such different conditions of the general system, as obstructed catamenia. Hence, its remedies are so various, and often of such contrary characters, and hence, too, the great uncertainty of our remedial measures in such cases. Many of us may have observed the great facility Avith Avhich the emmenagogue operation of a particular agent has been produced, after the system has been subjected to a process of preparation, when the same substance has proved perfectly futile Avithout it. In some cases, the suppression of the secretion is produced by the general relaxation and debility of the system, and hence, our best remedies will be such as will invigorate and restore it. Here exercise, tonics, the cold bath, and a nour- ishing diet, produce the best effects. At other times, an opposite condition of the system exists, connected with a considerable degree of rigidity of fibre, and a high degree of arterial action. In these cases, a contrary plan is to be pursued, and the best emmenagogues will be venesection, and other depleting remedies, In prescribing, therefore, for a suppression of the cata- menia, it is of the utmost importance to attend to the general state of the system, as Avithout it we shall frequently be baf- fled in our attempts, and our medicines may often increase the disease they were designed to cure. We shall divide the medicines of this class into such as increase, and such as diminish, arterial action ; and before commencing to speak of the individual articles, we cannot but state, that Ave are possessed of remedies, adapted to the vary- ing condition of the system, provided we use judgment in their selection. Such as increase Arterial Action. STIMULATING EMMENAGOGUES. Under this division is comprehended those articles which Stimulate the arterial system, and those which give Tone to the system generally. STIMULATING EMMENAGOGUES.—POLYGALA SENEKA. 193 Family Polygaleoe—Polygala Seneka—Seneka Snake Root. The Natural History and properties of this article already described. The acrid qualities are owing to the presence of an acid called Polygalic The testimony in favor of its emmenagogue operation is very considerable, and to Dr. Hartshorn, of Philadelphia, are Ave indebted for its application to the deranged condition of the secretions of the uterus. He employed it in twenty-three cases of Amenorrhea. In thirteen, the menses appeared during the use of the decoction —In two, the health improved, but the catamenia did not return. In three, no advantage whatever Avas derived from its use. In the remaining five cases, he was unable to ascer- tain the event. In the last case in wrhich it was employed, chlorotic symptoms supervened to those of the suppression, yet by perseverance in the use of the decoction for tAA'o Aveeks, the menses then appeared, and the patient has since enjoyed much better health. The testimony of Dr. Chapman can also be adduced in favor of the beneficial operation of this article, and he has related seA'eral cases illustrative of the particular state and circum- stances of this deranged function, to which it is best adapted. These cases are highly interesting, and the attention is invited to them. The particular inferences to be draAvn from these cases are highly important—shoAving the connection between the state of intellectual derangement and the uterine organs. They open a new view in the treatment of mania in females, and conclusively prove that amenorrhcea, if not a cause of insan- ity, at least, is intimately concerned in its production. They furnish an important fact, that in some cases of mania occurring in females, a cure may be effected, when other means fail, by simply producing a return of the catamenia. * To the many causes concerned in the production of Ame- norrhcea, another may be enumerated. This is the produc- tion of a membranous substance, formed within the cavity of the uterus. It Avas first noticed by Morgagni, and afterwards by Denman. It is produced by the vessels which pour out the menstrual secretion. The appearance of this substance—It is a membranous lining of the uterus, retaining the figure of the inside of that organ—In consistence resembling firmly impacted mucous— in color similar to the decidua, being twice or three times as thick. 194 STIMULATING EMMENAGOGUES.—JUNIPERUS SABINA. Its existence produces much embarrassment in the treat- ment of amenorrhoea. It exists in protracted and long con- tinued cases. The Seneka not only adapted to all the forms of amenor- rhoea, but particularly to those cases Avhere this deciduous membrane exists. It effects its expulsion by a forcible and specific impression. The habits to Avhich it is adapted, are those of a feeble and slender make, and of a temperament apparently cold and leuco-phlegmatic Forms of administration—In decoction as follows : ft. Seneka Root, bruised, f i. Water, ftii.—boil to Ibi. Dose, f ss. to f i., several times a day—In larger doses Avhen the menstrual effort is about to be made. In the intervals, it should be discontinued for a week or two. Should it produce nausea, Avhich it is apt to do, it may be prepared Avith the addition of an aromatic, such as orange peel, or cinnamon. In considering the general properties of the Seneka, little doubt exists, that it produces its good effects by promoting the various secretory discharges—the uterine, with the various other secretions. In using this article, always commence at least two weeks before the period the patient usually menstruates. Family Pinaceoe—Juniperus Sabina, or Savin. It is an evergreen tree, a native of the South of Europe. The leaves and tops employed. Sensible properties— Smell, moderately strong. Taste, hot, bitterish, acrid. Allied to Seneka in its properties, being a warm, powerful, and diffusible stimulus, increasing the secretions, and deter- mining with peculiar force to the uterus. From its strong determination to the uterus, it has been employed for the purpose of procuring abortion, and has been remarked as producing hemorrhage from the uterus. It Avas first employed by Dr. Home, of Edinburgh, Avho seems to have had much success with this article. In five cases of amenorrhoea, Avhich occurred at the Royal Infirmary, at Edinburgh, four were cured with Savin, administered in doses of 3 i. to 3 i., tAvice a day. The constitutions to Avhich it is adapted are the weak and relaxed—it is improper in plethoric habits, before previous bleeding has been practised. STIMULATING EMMENAGOGUES.—RED CEDAR. 195 It has been recommended by Burns in cases occurring in similar states of the constitution. Savin is not much used internally—but in cases of amenor- rhoea depending on, or accompanied by, a torpid condition, or deficient action in the uterine A'essels, it may be given as an active uterine stimulant. In such cases, it proves an efficient remedy, and when properly administered, no ill effects Avill arise from its employment. Forms of administration— PoAvder, but not an eligible form. The reason why, is that it is not readily pulverized without previously drying it, and as the active part is an essential oil, very readily volatilized by heat, its activity is often impaired by this process. Dose, 3 i. to 3 ii., three or four times a day. Infusion prepared as folloAvs : ft. Leaves of Savin, f i. to f ii. Boiling Water, Sbi.—simmer a short time, strain, add—Syrup, f ii. Dose, f i. to f ii., every tAvo or three hours. Besides these forms of administering Savin, the essential oil has been highly recommended, given as follows : ft. Essential Oil of Savin, vi. to x. or xii. m., taken on a lump of sugar, tAATo or three times a day. The oil in large doses occasions vomiting and purging, and other symptoms of gastro-intestinal irritation—it increases the circulation, irritates the kidneys, yet more obviously the uterus—abortion follows in some cases, in others haemorrhage from the uterus. In Chronic Rheumatism, with a languid circulation of the extreme vessels, it is spoken of in very high terms by Dr. Chapman, in his Therapeutics. External employment— The leaves are used as an escharotic, either in powder or infrxslon. Equal parts of the powder, and acetate of copper, or verdigris, form a good application for venereal warts, and other excrescences, and the infusion is used as a wash for foul ulcers, for tinea capitis, for warts, psora, etc. The Savin ointment is found effectual to dress blistered sur- faces, to keep up the discharge, as folloAvs : ft. Leaves of Savin, bruised, f ii. Wax, f i. Lard, f iv. Melt, mix the leaves, strain through a linen cloth. Same Family—Juniperus Virginiana, or Red Cedar. The largest of the Junipers, and found in all parte of the United States, but growing most luxuriantly in Virginia. It 196 EMMENAGOGUES.—TINCTURE OF CANTHARIDES. bears a considerable resemblance to Savin, insomuch that a botanical distinction is not easily draAvn. In their sensible and medicinal properties, they are nearly allied. Like Savin, it is stimulant, diuretic, and emmenagogue, and used in the diseases in Avhich that article is recommended, as a substitute for Savin. Used in the formation of cerates, for keeping up the dis- charge from blistered surfaces, by boiling the fresh leaves Avith twice their weight of lard, to Avhich a little Avax is ad- ded. Tincture of Cantharides.—An active article, and employed in suppression of the catamenia, connected with atony of the uterus. Its emmenagogue operation not the result of gene- ral increase of action, but of particular local determinations of this article, acting upon the abdominal, and more especial- ly the pelvic viscera. The effects are exnibited in the pro duction of strangury, and are not confined to the bladder, but extended to the viscera in its neighborhood—to the rectum, and to the uterus, and under its influence the uterus is often excited to pour out the menstrual secretion. The bowels, we knoAV, are much affected by the production of strangury, and patients have been heard to complain, that the passage of the faeces through the rectum excited a sensation of heat or burn- ing, similar to that Avhich attends the voiding of urine. If such be the strength of the impression produced by the pre- sence of strangury upon the alimentary canal, the uterus, Ave may suppose, is likely to partake of an equal inflammato- ry action. Several cises related in which this article was employed. In one case, from the suppression which occurred, a very unfavorable change took place in the health of the patient— symptoms of pulmonary disease being induced, with haemop- tysis, pain in the chest, a weak quick pulse, with nocturnal chills and perspiration, the family being predisposed to Phthisis. Several remedies were employed without much benefit. She was then placed upon the use of the Tincture of Can- tharides, in the dose of tAventy-five drops, three times a day. On the second day, strangury was produced—and on the third, the menses appeared. With the return of the catamenia, all the unfavorable symptoms disappeared, and, in due time, she recovered her health. Other cases of the beneficial operation of this article cited. In administering this article, regard should had to the state of the constitution, it being adapted to cases of long contin- EMMENAGOGUES.—TINCTURE OF CANTHARIDES. 197 nance and debility. It should be given in doses of xx. to xxv. drops three times a day, and carried to the extent of produc- ing stranguary, and when carried to this extent, the secretion will most frequently be excited. Connection of several chronic forms of disease with the suppression of the Catamenia exhibited—as Mania, Nympho-* mania, Epilepsy, Phthisis. We have alluded to the connection between chronic de- rangements and the suppression of the catamenia. The se- veral cases Ave have related, have been illustrative of the de- pendence of mania, nymphomania, epilepsy, and phthisis, on that cause. The connection of the first diseases with the state of the menstrual secretion is admitted; but Avith phthisis, the relation has been overlooked, or not acknoAvleclged. The present occasion is too favorable a one, not to state to you, that, in our opinion, amenorhoea is often the cause of con- sumption. The case cited, confirms this opinion; and, at all events, it is an interesting subject of inquiry, Avhether the pulmonary disease is not occasioned by the suppression, and Avhether, in certain cases, amenorrhoea does not prove a cause of phthisis in the predisposed ? Our own views are favora- ble to this connection, and in the treatment of cases of phthi- sis, as well as some other complaints, we Avould suggest di- recting the attention to the suppression, as forming the chief disease, upon the removal of Avhich all the other symptoms Avill vanish, provided the secretion can be restored before the lungs have sustained such organic injuries as to render them incapable of continuing duly to perform their proper func- tions. Certain it is, that no occurrence is more common, than the attack of cough, pain in the side, difficulty of breathing in females, soon after the obstruction of the menses, and upon its recurrence, all these symptoms going off. The connection derives much support from the knowledge, that the approach of phthisis is generally much more insidi- ous, and its progress more slow in Avomen than in men, and that this difference depends upon its being rather symptoma- tic, than idiopathic, in. females. In other cases, where it arises from some obvious occasional cause other than the ca- tamenia, and to Avhich females are subjected as well as males, its progress is equally rapid and violent. Impressed with this belief, we Avould recommend, that we keep in view the probable dependence of the pulmonary symptoms, and the other diseases mentioned upon the interrupted functions of the uterus, and direct our treatment accordingly. But you Avill inquire, hoAv are we to distinguish those cases in Avhich phthisis is of symptomatic origin, from others ? Its symptomatic origin may be ascertained, by the suppression 25 198 EMMENAGOGUES.—MADDER. preceding the appearance of the pulmonary affections—and Avhen such is the case, the disease, if not dependent, has, at least, an intimate connection w.th the state of the uterine se- cretion. Under these circumstances, ad\rantages, Ave can as- sure you, Avill result from re-establishing the discharge. - When phthisis has existed for some time, this secretion, with others, will be deficient, or suppressed, from the enfee- bled condition of the general system. So impressed is the female mind, Avith the general ill effects of this state of things, that even here, you Avill often be urged to do something, and advisers will not be wanting, avIio will press upon you the ne- cessity of so doing. Here, hoAvever, it can be of no advan- tage, and you will be obliged to resist and combat Avith much opposition. Do it in this and all other instances, Avith kind- ness and forbearance, explain your vieAvs clearly, and divest- ed of technicalities, and, from some experience, Ave are satis- fied that you Avill make your opponents your friends. Family Rubiaceoe—Rubia Tinctorum, or Madder. Native of Great Britain and Holland, Avhere it is cultivated as an article of commerce. The roots are the part employed. They are long and slender, and of the thickness of a quill. They are red throughout. Smell, weak. Taste, bitterish, astringent. It is remarkable as giving color to the bones of animals, also to the urine and milk, and from the circumstance of so large a quantity entering the circulation, has been considered deobstruent. This article has been experimented with by several indi- viduals. Dr. Home seems to have had much success with it. In nineteen cases of amenorrhoea in Avhich it Avas employed, fourteen cases were cured. It does not exert much sensible operation. Dr. Dewees speaks of it in terms nearly similar, and consi- ders among its advantages, that it may be given Avithout any reference to the pulse, or state of the system. The late Prof: B. S. Barton, spoke of it in very high terms. Respectable, hoAvever, as are these authorities, and this Aveight of evidence in its favor, it is employed by few physi- cians at the present day, and Avhatever may be its virtues, it does not possess the confidence of the profession at large, as an article adapted to restore the uterine secretions. Indeed, in our opinion, an article exhibiting so few active properties, and Avhich, from the mildness of its impression, can be em- ployed under almost any circumstances, and Avithout refer- EAIAIENAGOGUES.—ROSEMARY—PENNYROYAL—ERGOT. 199 ence to the states of the system, can belittle entitled to con- sideration in a practical point of vieAV. It is not with such instruments that disease is to be arrested, or deficient secre- tions excited. In proportion to the mischief an article is ca- pable of doing Avhen improperly administered, Avould we esti- mate the benefits to be derived from it in the hands of acau-' tious and judicious practitioner. You have heard the author- ities in favor of this article, and may form your OAvn opinions. Family Labiatoe—Rosemarinus Officinalis—Rosemary. This is a perennial plant, a native of the South of Europe, but cultivated in this countr}\ Sensible properties— Smell, fragrant. Taste, pungent and bitterish. It is much in use as a domestic remedy for suppression of the catamenia, and it Avould appear from the testimony of se- veral respectable authorities, that its powers are not inconsi- derable. It is given in the form of a strong infusion, or decoction, in doses of a tea-cupful for se\Teral successive nights, and then suspended. Its effects are aided by the pediluvium. Family Labiatoe, Mentha Pulegium—Pennyroyal. Common in all parts of our country. It is a popular reme- dy, and is given in the form of a strong infusion at bed-time. In recent cases, this practice is beneficial, and is generally re- sorted to before professional aid is called upon. The use of the pediluvium also resorted to. Secale Cornutum, or Ergot. It has received a variety of names, as Spermedia Clavus, Clavus Secalinus, Master Secale; also, Horned Rye, Ergot of Rye, Mother of Rye. Hatural History. The nature and formation of the Ergot, are subjects on which botanists are much divided in opinions. The only opinion Avhich seems to be Avell supported is, that the Clavus is a Parasitic Fungus, a species of Ustilago, like the different sorts of blight, smut, &c. Of this opinion is De- candolle. It affects most of the Cerealia, but rye seems to be most apt to take on this morbid condition, particularly when the plant grows in low damp situations, and Avhen it is exposed to heat, succeeding heavy rains. It is found in greater abun- dance on the margin of fields, than in the central parts. Description of the Ergot. 200 EMMENAGOGUES.—ERGOT. It consists of grains, varying in length from a feAv lines to an inch—breadth half a line to four. Form, cylindrical, tapering at the extremities. Odor, of a large quantity, fishy, nauseous and peculiar. Taste, Avhen cheAved for a considerable time, it produces a sense of fullness in the throat, disagreeable and slightly acrid. When taken into the stomach in moderately large doses it occasions nausea; a scruple or a drachm has occasioned vo- miting, but Avithout acting on the boAvels. The color, purplish broAvn or black. Chemical analysis— A fixed oil. A peculiar principle called Ergotin. Phosphoric acid combined Avith lime. Gum, starch, albumen. The properties of the Ergot— The most prominent effect is, its direct action upon the ute- tus, producing and increasing contractions, Avhen there is a predisposition to action in that organ, and restoring the cata- menial secretion Avhen obstructed. It must, therefore, be ranked in the M. M. as a Partus accelerator, and as an Emme- nagogue. Medical History. This article Avas knoAvn to Holland and France in the middle of the last century. From the indiscriminate manner in which it Avas employed, injurious results followed, and Ave find it prohibited in France by a legislative decree. In 1807, its use was revived by Dr. Stearns, of New York, who Avas led to make trial of it, from the powerful effects it produced in the hands of some ignorant Scotch women. My informa- tion, he says, was such, as to impress upon my mind the necessity of extreme caution in my first experiments. The continued influence of this impression upon my subsequent practice, has been a source of much consoling reflection. There can be no doubt at present, that this medicine has the power of exerting a specific action upon the uterus— that this action consists in augmenting the contractile poAver of that organ during parturition, and in lingering and pro- tracted cases, inducing forcible contractions, and expediting delivery. The concurrent opinion of most physicians is decidedly in favor of these effects. These effects are not more extraordinary than the almost instantaneous manner in which they are produced. In tAven- ty cases, says Dr. Prescott, I carefully noticed the precise time it required to produce its customary operation. In two of them, the increased strength of the pains, and the con- tinued action, commenced in seven minutes from the time ERGOT. 201 the decoction was taken. In one case, it Avas eight minutes, in seven, it was ten, in three, eleven, and in other three cases, it Avas fifteen minutes. In the employment of an agent so poAverful in its opera- tion, certain rules and directions become necessary to pre- vent any bad consequences which might arise from its use, and Avhich are more particularly proper, as the action Avhen excited is so little under control. The mles necessary in its administration, are— Rule I. That it should never be administered when nature is competent to a safe delivery. Rule II. It should never be given until the regular pains have ceased, or are ineffectual, and there is danger to be apprehended from delay. Rule III. It should never be administered until the rigidi- ty of the os uteri has been overcome, and a perfect relaxation induced. When labor has been protracted from the rigidity of the os uteri, or of the soft parts, these obstacles should be overcome by venaesection—after Avhich the Ergot may be usefully employed, and its operation will be found mild and efficacious. Rule IV. It should never be administered in the incipient stages of labor, nor until the os uteri is dilated to the size of a dollar. This rule is of the utmost importance, the success of the article being very much influenced by the time when it is employed. When given in the early stages of labor, and before the os uteri is sufficiently dilated and relaxed, it often fails of success. The pains induced under these circum- stances, often terminate before the labor is accomplished, and are of no advantage. Rule V. It should never be administered in any case of Preternatural Presentation, that will require the foetus to be turned. The necessity of this caution will be obvious, Avhen it is considered that the violent and forcible contractions induced, will add much to the difficulty and hazard of the operation. With these precautions in the use of the Ergot, it may be safely and effectually used, and the relief afforded will, from the united testimony of those who have Avritten on the sub- ject, be gratifying in the highest degree. Without a regard to these rules, the most mischievous consequences will result, and an article capable of serving many valuable purposes, Avill be neglected and abandoned. Having premised the rules Avhich are to be observed in the administration of the Ergot, I shall proceed to consider those cases in which it is necessary to have recourse to it, 202 EMMENAGOGUES.—EPCOT. 1. The Ergot is indicated in those cases, Avhere the expul- sion of the child is delayed from the action of the uterus being Aveak and ineffectual—where it has descended into the pelvis, and the soft parts are prepared for its passage. Any delay to its expulsion Avhen in this situation, Avould be at- tended with danger to the mother from pressure on the soft parts, or from the exhaustion of strength and vital energy, Avhich might ensue from haemorrhage, or other alarming symptoms. In these cases, the action of the Ergot, by re- neAving the uterine contractions to a considerable degree, speedily effects delivery. 2. When the pains are transferred from the uterus to other parts of the body, or to the Avhole muscular system, as in puerperal convulsions. In these cases, Dr. Stearns observes, that after copious blood-letting, the Ergot concentrates all these misplaced labor pains upon the uterus, Avhich it soon restores to its appropriate action, and the convulsions cease. The beneficial effects of this practice is also confirmed by Dr. Waterhouse, avIio in a case of violent puerperal convul- sions, accompanied Avith dilatation of the os uteri, succeeded by employing the Ergot, in restoring the pains to the proper organ, in a manner almost instantaneous, he says, and truly astonishing. 3. When in any of the stages of pregnancy abortion be- comes inevitable from haemorrhage. Cases complicated Avith haemorrhage, call forth all the decision and energy of the medical character. Their management is connected Avith much hazard to the mother, and to the physician, a scene of trial and difficulty. Under these circumstances, to knoAv that Ave possess a remedy, the action of which tends to re- strain the haemorrhage, must be attended Avith consolatory reflections. The indication to be fulfilled, is to excite the uterus to contract, and expel its burthen, as by this means only the haemorrhage can be arrested. The Ergot, from its action upon the uterine fibres, presents itself as a remedy suited to these purposes. It must be given to the extent of exciting contractions, and when these are produced, the flooding Avill commonly cease. 4. The Ergot is indicated in cases of labor, complicated with uterine haemorrhage. The same remarks as in the pre- ceding, are applicable here. The haemorrhage must be stopped by plugging the vagina, the use of cold applica- tions, &c, until the os uteri is dilated, when the Ergot may be tried with safety and effect. 5. Where the placenta is retained fiom the Avant of action in the uterus—We have seen several instances of the bene- ERGOT. 203 ficial application of this article in such cases, and from all that Ave knoAV of its operation, the Ergot will be well adapted to effect its expulsion. 6. The Ergot Avill be beneficial in cases Avhere haemorrhage occurs after delivery. It occasionally happens that the ute- rus, from the Avant of tone, does not contract after the de- livery of the child and secundines, in consequence of Avhich, flooding is very apt to ensue. This is Avhat has been called relaxation of the uterus, and is a state of extreme danger. It may be knoAvn by the abdomen being large and flaccid, and the uterine tumor not being perceptible above the pelvis. In these cases, the Ergot will be found very efficacious, and in a short time excites contractions of the uterus. I cannot conclude this summary of the beneficial effects of the Ergot, Avithout stating to you the opinion of Dr. Dewees on this subject. It Avould appear, he says, from all I have been able to collect, and from all I have observed, that it rarely fails, or disappoints, Avhen properly prescribed. Objections to its employments answered. Manner of exhibiting the Ergot in Parturition. It does not exert as beneficial effects when administered in powder, as in decoction. In this latter form it is prepared, by infusing 3 ss. of the bruised Ergot iii f iv. of hot water. Of this, one- third is taken as a dose. If the pains are not sufficiently severe in twenty minutes, half the remainder is given, and the last dose if necessary; but this is rarely the case. While this quantity produces its most favorable effects upon the uterus, it does not affect the stomach Avith nausea, or vomiting, which sometimes interrupts its successful operation. Besides the cases already mentioned, in Avhich Ergot may be successfully resorted to, it has been employed in profuse discharges of the Lochia, in Menorrhagia, by several persons, and by myself, with very gratifying results. Preparations of Ergot. Ergotine—Preparation—It has been recommended as a val- uable Therapeutical agent, Avithout being possessed of poison- ous properties. It has been particularly recommended in haemorrhages de- pendent upon carcinoma of the uterus. It is given in doses of ii. grs., every tAAro hours, until relief is obtained. Used also as an external ipplication to restrain haemorrh- ages from wounds. Manner of employing it—Dissolve Ergotine in ten or twelve times its Aveight of Avater—A compress of lint mois- tened, is brought in contact Avith the Avound, and while hold- ing it, let fall, drop by drop upon the lint, the solution of Ergotine. 204 EMMENAGOGUES.—ERGOT. Oil of Ergot—Preparation. It is given in the same cases as Ergot. The dose is from x. to xx. m., in Avarm tea, or Aveak spirit and water. It has the advantage of being kept for a length of time Aviihout its activity being diminished. Tincture of Ergot—A useful and convenient mode of ad- ministration. Ergot has been recommended in haemorrhage from other organs. The power possessed by Ergot, of exciting uterine contrac- tions, readily explains its efficacy in haemorrhages from the uterus. It cannot, therefore, verj^ easily be understood Iioav it restrains haemorrhages from other organs. A number of cases haA'e been published of its efficacy in restraining dis- charges of blood from the gums, thorax, abdomen, bladder— but further e\Tidence is required, before Ave can pronounce upon its anti-haemorrhagic poAvers. The Emmenagogue operation of Ergot. On this subject there exists considerable contrariety of opinion, some maintaining such a power, others denying it— Our opinion favorable to the beneficial operation of the Ergot in this particular. This opinion strengthened by the reports of cases in the various Journals of the day. Dr. Randal, of Boston, in the New-England Journal. Dr. Church, in the Nos. of the American Journal of Medi- cal Sciences. The authority of Dr. Waterhouse. It is given in poAvder, in doses of xv. or xx. grs., three times a day, or in decoction. Morbid Effects. From the experiments of Dr. Robert, of Berlin, it appears to be injurious, and even fatal to all animals, Avhich are fed for a sufficient length of time upon a moderate proportion of it, unless they escape its action by early vomiting. That dogs and cats, in consequence of discharging it by vomiting, suffer only slight symptoms of irritant poisoning—but that swine, geese, ducks, fowls, quails and sparroAvs, are sooner or later killed by it. The symptoms it causes in birds and beasts, are giddiness, dilated pupils and palsy, diarrhoea, suppurating tumors, scat- tered gangrene throughout the body, dropping off of the toes, &c. In the human subject it produces very distressing symp- toms, and the manner in which its usual distressing effects are produced, is, Avhen it has been mixed with the grain in meal, and been taken as food for a continuance of time in bread. Two distinct set of symptoms have been described. EMMENAGOGUES.—GUAIAC. 205 The one a nervous disease called by the French, Convul- sive Ergotism. The other being a depraved state of the constitution, which ends in that remarkable disorder called dry Gangrene; also, Gangrenous Ergotism, Creeping Sickness, &c, from its being preceded by general uneasiness, weakness, and a feel- ing of insects creeping over the skin, followed by numbness of the feet and toes, Avhich, in a short time, become shrivelled, dry, and drop off—and the two affections are not apt to be blended in the same individual. Guaiac, in the form of volatile Tincture, has been recom- mended in high terms in Amenorrhoea and Dysmenorrhoea, by Dr. Dewees. His success with it has been so considerable, that he has pronounced it a specific in these cases, and em- ploys it almost to the exclusion of everything else. The formula is as follows: ft. Powdered Guaiac, f viii. Powdered Pimento, f ii. Carbonate of Soda, or Potash, 3 iii. Alcohol diluted, tb ii. Mix and digest for two or three days. The dose is 3 i. three times a day, in a wine-glassful of milk. The Vol. Spirits of Ammonia is added, in the proportion of 3 i. to f iv. of the Tincture. Should it purge, a few drops of Laudanum may be given. Stimulating Injections. Under stimulating Emmenagogues, may be mentioned the employment of Aqua Ammonia, in the form of injection into the vagina. This practice was first proposed by an Italian, and he re- lates cases in which the treatment succeeded in a feAv days in producing the discharge. The proportion used was x. or xii. drops of ammonia in two tablespoonsful of warm milk, often repeated in the course of the day. It generally pro- duced in the vagina a sensation more or less painful, accord- ing to the strength of the mixture, or the sensibility of the part, but in no case was anything dangerous, or tioublesome produced. ELECTRICITY. A few remarks may be made upon Electricity, as an agent of considerable importance in removing uterine obstructions. 26 206 ELECTRICITY. From the well known influence of this agent in the pro- duction of the physical and chemical phenomena of the external world, as Avell as on the animal economy, Ave Avould expect that it should be applied to valuable purposes as a remedial agent. The effect of the Electric fluid upon the animal system, seems to be that of a general stimulant. It quickens the circulation, increases the insensible perspiration, and pro- motes the glandular secretions. Many instances are to be found in the history of our science, in which it has been employed on various occasions with considerable advantage and success. Of its utility in Amenorrhoea, there is not Avanting the Aveight of high authority, and the experience of many in this city Avho have employed and recommended it. The authority of Drs. Cullen, Cavallo, and Golding Bird, on Electricity and Galvanism, in their Physiological and Therapeutical relations, adduced in support of the efficacy of this agent. The success which has followed its use, entitles it to be considered a valuable and efficacious remedy in this disease. Besides its effects upon the general system already detail- ed, it has this great advantage, that it can be applied to any particular organ. Not reason only, and the opinions of individuals, shall we urge in support of the utility of this agent—Ave shall furnish the results of the experience of the late Dr..Shecut, of this city. Of forty-nine cases Avhich were submitted to electrical treatment, thirty-four of them were effectually cured, and the remaining fifteen relieved from their most distressing symptoms. More might have been cured, for he adds, that it is too common Avith patients Avhen they find themselves relieved, to trust to nature for the rest. In bringing before you this statement, I should observe, that such is the dread entertained by females of electrical sparks, together with the trouble of being carried to a machine, that it is seldom resorted to until medical treatment has been prac- ticed to some extent, so that I may say the usual remedies had been unsuccessfully employed. In confirmation of the utility of Electricity, two cases in- troduced Avhich fell under our notice, in Avhich this remedy was employed Avith the utmost advantage. The case of a lady, of'this city, cited, avIio for six years labored under a suppression of the menstrual secretion, in Avhom, to the ordinary distressing symptoms, Avas added such strong convulsive paroxysms, as to render the approach of EMMENAGOGUES.—CARBONATE OF IRON. 207 her monthly periods the occasion of great dread, and painful forebodings to her friends. From her situation in life, the first physicians Avere employed, and every expedient Avhich medical skill suggested, was united Avith the utmost care and assiduity in its execution. They Avere all unavailing. The paroxysms and the morbid derangements still continued, and the patient's constitution became at every period, more and more enfeebled. Her existence seemed nearly to have been extended to its utmost limit, and death, I may say, had mark- ed her for his own. In this situation electricity was pro- posed, and from the extreme feebleness Avhich existed, appre- hensions AATere entertained that the necessary shocks would be too seArere. They Avere submitted to, hoAArever, and the first application Avas found useful in abating the severity of the symptoms. A few repetitions seemed to unlock the se- cretions Avhich had so long been retained. With the dis- charge every unpleasant symptom disappeared, and to this day the lady enjoys a large share of health. So complete a triumph as Avas thus exhibited, deser\Tes not only to be re- corded, but to be remembered. Its application being con- nected with so many minute directions, which can best be exemplified upon the machine, that I must refer you to the Professor of Chemistry. Another case of spasmodic disease, closely resembling Cat- alepsy, fell under my notice, in Avhich the benefit conferred by electricity Avas conspicuously manifested. (b.) Remedies which increase arterial action by giving tone to tlie systemi Amenorrhoea is often connected with a debilitated state of the system requiring Tonics. The preparations of Iron have long been considered among the most useful and valuable remedies in these cases; and a number of facts could be cited, of their utility in diseases which proceed from atony of the general system, in cases of feeble re-action, and of languid and imperfect operations of the functions generally. They have, therefore, been em- ployed in a variety of cases, which will be more particularly considered at a future period. In the state of the system which is at present under con- sideration, few articles can be more beneficial. Not only are they of use by the impression which is made upon the animal fibre, but by being received into the circulating system, the energies of the heart are greatly increased, the pulse is ren- dered more full and sti ong, and greater energy is afforded to the animal functions, secretions are renewed, and health is 208 EMMENAGOGUES.—SULPHATE OF IRON. restored. With these changes the process of assimilation is better performed, a more healthy chyle elaborated, nutrition advances, and hence, to an increase of vascular action, is added an increase in the bulk of the body. Of the Preparations which have been most esteemed— 1st. Protoxyd, Rust, or Carbonate of Iron. Preparation—By adding a solution of an alkaline Carbonate to a solution of the Sulphate of Iron, the atmospheric air being excluded, the Carbonate of the Protoxyd of Iron is precipitated. This is one of the most valuable preparations of Iron, on account of the facility with which it dissolves in the fluids of the stomach, and becomes absorbed. Its local effects are very mild. The dose is from x. to xv. grs. It is seldom given alone, but combined with bitters and aromatics, with a view to improve their action, or lessen the distaste which arises from its uncombined administration. The following formula will be found a useful mode of exhi- biting this article : ft. Protoxyd of Iron, Powdered Ginger, each, 3 ii. Powdered Cinchona, f ss. to f i. Mix and divide into viii. or x. powders, one of which is to be taken every two or three hours, or the mass may be made into an electuary with syrup. Or, A better and more agreeable formula, is the Chalybeate Wine, prepared as follows : ft. Protoxyd of Iron, Orange Peel, Gentian Root, each, f ss. Port Wine, fbii. These ingredients are to be bruised and then put into the wine, exposed to a moderate heat, either in the rays of the sun, or near a fire—shake occasionally—decant for use. Dose, half to two-thirds of a Avine-glass, with a little water. This preparation may be recommended as pleasant, and highly beneficial in it3 operation. In the constitutions submitted to our care under this con- dition of the system, much attention is required in adapting the medicine given to the excitability, and so to compound your medicines, that exciting but little disgust, they may be persisted in until the object intended is accomplished. Sulphate of Iron, another preparation employed in the same cases. It entered into the composition of Griffith's Myrrh EMMENAGOGUES.—IODIDE OF IRON. 209 Mixture, Avhich was at one time much used, but which is little employed at the present. The following formula may be substituted for it: ft. Sulphate of Iron, 3 i. Gum Myrrh, 3 i. Sub-Carbonate of Potash, 3 i. Refined Sugar, 3 i. These are to be well rubbed together, and during the tritu- ration, add Rose Water, fviiss. Spirit of Nutmeg, 3 ss. Dose, f ss. to f i., tAvo or three times a day. This preparation will be found useful in Anemia, Chlorosis, Atonic Amenorrhoea, and hysterical affections. It is particularly useful from its ready solubility, by which it is readily digested and absorbed. The Sulphate of Iron, administered in the form of pills, as follows : ft. Sulphate of Iron, 3 ii. Ext. of Gentian, or Bark, 3 i. Mix and divide into xx. pills—a pill taken two or three times a day. Or, Combined with Myrrh to increase its Emmenagogue ope- ration. Or, United to an infusion of Quassia or Columbo. These infusions preferred, as in consequence of their con- taining little or none of the astringent principle, their color is not changed by the addition of the salts of iron. Iodide of Iron. It possesses in a useful form, the properties of both the ferruginous salts and of Iodine, and it is indicated in cases Avhere both are required for administration. As a Tonic, it is useful in cases of debility, accompanied with softness of the solids and paleness of the skin—In scrofu- lous affections of the glandular system, in which both the use of Iron and Iodine are indicated. in Tabes Mesenterica, Chlorosis, Atonic Amenorrhoea, it has been found serviceable by Dr. Thompson, and his testimony of its good effects is supported by that of others. Its opera- tion must be promoted by exercise and invigorating diet— Vide Tonics. It is given in substance and in solution. In substance, in doses of iii. to v. grs., tAvo or three times a day. In solution— ft. Iodide of Iron, grs. xxv. Distilled Water, or Syrup, fi.—m. A tea-sp6onful contains grs. iii., and is a dose. 210 EMMENAGOGUES AVHICH DIMINISH ACTION. Tincture Ferri Sesqui-chloridi, or Muriated Tincture of Iron. One of the most poAverful preparations of Iron. It is employed in any of the cases in which the other ferru- ginous compounds are administered. Dose as the folloAving. Per-Nitrate of Iron—Preparation. It resembles the solution of the Muriate of Iron in its medi- cinal properties. Dose, x. drops several times a day, increased to xx. and xxv. drops, largely diluted Avith Avater. Lactate of Iron. Citrate of Iron. Tartrate of Iron and Ammonia, Avith other preparations, which will be considered under the class of Tonics. A variety of other means are usually resorted to, to restore the tone of the system, but they can scarcely be considered Emmenagogue. It may be proper to mention them here. They are exer- cise in the open air, a very poAverful means of strengthening the system, and Avith particularly good effects, if the lower limbs can be much employed—as in walking, riding on horse- back, dancing, etc. The cold bath. Friction to the lower extremities. Lastly, a cordial and strengthening diet, Avhich, if properly directed, and caution be observed with respect to quantity, Ave would rank among the best of tonics. EMMENAGOGUES WHICH DIMINISH ACTION. The suppression of this secretion is often found occurring in full, plethoric habits, Avith much arterial excitement, flushed face, inflamed eyes, and pains in various parts of the body. Depleting remedies under these circumstances are the best Emmenagogues, and of these Venesection holds the first rank. The uterus, in habits of this description, may be considered as partaking of the same plethoric and inflammatory state, and its action to be carried to such a degree as to transcend the point of secretion. Here then venesection becomes an excellent remedy, and many instances might be adduced of its success in restoring the discharge. To this may be added other means of depletion. Cathartics may be considered as next in value. For the purposes of depletion, any of them may be employed, but of those Avhich have been most celebrated, a few"may be selected. EMMENAGOGUES,—BLACK HELLEBORE.—ALOES. 211 Family Ranunculaceoe—Helleborus Niger—Black Hellebore. Christmas rose, flowering in winter. GroAvs Avild in the mountainous parts of SAvitzerland and Austria. Root, consists of the root-stock, and the fibres which arise from it. Sensible properties— Taste of the root acrid and biting, fibres more acrimonious than the root from Avhich they issue. Odor, feeble compared to Seneka. The properties of this root are those of a drastic, irritating cathartic, having an action principally exerted upon the pelvic viscera, and thereby often proving Emmenagogue. It has been long knoAvn in the M. M., having been used by Melampus in the treatment of madness, fourteen hundred years before the Christian era. It was employed in those cases Avhere there was much torpor of the system, and in phlegmatic habits requiring strong impressions—Hence itAvas employed In the treatment of Melancholia, and in Mania depending upon black bile in the system. In cases Avhere the pelvic circulation was languid. Hence, as an Emmenagogue, it was highly recommended by Dr. Mead, and is still much valued by some practitioners. Administered in PoAvder—dose, iii. to viii. grains. In Tincture, 3 ss. to 3L Notwithstanding Avhat has been said of this medicine, it is a dangerous and drastic remedy. It has been tried in the affections spoken of, but in these less violent, and more man- ageable, and certain remedies of the same class are equally effective. Aloes, and its Preparations, have been much Used in these cases. It is seldom given alone, but is combined Avith various arti- cles, or administered in the form of Tincture. Of these preparations, the most celebrated is the Elixir Proprietatis, or Compound Tincture of Aloes. It is prepared in the following manner : ft. Powdered S. Aloes, Fine Saffron, each, f iii. Tincture of Myrrh, Bbii.—digest these a due time, press off the liquor, filter for use. The dose is f ss. This is a warm, active, and stimulating cathartic, and is much used in Catamenial obstructions. 212 SIALAGOGUES. In the state of constitution urder consideration, Ave have commonly been more successful, by administering x. or xv. grs. of Calomel at bed-time, and in the morning, folloAving up its operation with a dose of the Tincture. The practice is to be repeated tAvo or three nights, and will often be found beneficial. Preparations of Mercio-y. They are sometimes useful, not only for their evacuant operation, but to reneAv secretions. For the latter purpose, they should be employed to the extent of producing a slight salivation, which is to be kept up for two or three weeks— and this aided by the use of blisters, placed high up the inside of the thighs, has been found efficacious after other means have failed, and in very obstinate cases should, doubt- less, be resorted to. By this mode of treatment, the deranged actions of the system are counteracted and completely broken up by the operation of the Mercury, while a degree of action is communicated to the parts more immediately diseased, by the local impression of the blisters. Division 9. SIALAGOGUES. Definition—from the Greek, Sialen, saliva and ago, I expel. The term Sialagogue is objectionable, inasmuch as it is ap- plied to an effect which in most cases is incidental, and which, in many instances, is not necessary to the cure of diseases. We shall retain it as it has been done by preceding writers on the M. M., keeping in mind that the term does not em- brace the principal operation to be considered in the medi- cines arranged under this head. Of two kinds—Masticatories, or External Sialagogues. They operate by stimulating the excretories of the saliva and mucous glands, and cause a more copious secretion of sa- liva. It seems to be a salutary provision of nature, that when any acrid matter is applied to the sensible part of the tongue, and the internal surface of the mouth, a quantity of saliva and mucous should be poured out to wash it off, or to defend those parts from its irritating effects. The operation contin- ued, a considerable discharge from the vessels supplying the head may be produced. Hence it is, that these masticatories may become local evacuants, and useful in rheumatic conges- SIALAGOGUES.—MERCURY. 213 tions, and inflammatory dispositions in any part, supplied by branches of the carotid artery. They Aviil also be found, by their stimulating qualities, to be of considerable advantage in paralytic affections of the tongue. _ The substances resorted to for this purpose, are the Ange- lica, Horse Radish, Tooth-ache Bush, Polygala Senaka. Yet as they are not much employed for practical purposes, they need not be more particularly considered. Of the Internal Sialagogues, Mercury is the only one capa- ble of exciting a flow of saliva, and the only one to be de- pended upon. Mercury. Natural History—It appears like melted lead—is capable of being solidified by cold, and easily volatilized by heat. Synonymes—Quicksibver, or living silver. Hydrargyrum, or watery silver. Mercury, after the winged messenger of the gods, on account of its volatility. It is found sometimes pure, and called Virgin Mercury, most commonly combined Avith sulphur, or the metals, from which it is separated by chemical processes. It is brought from mines in Spain, Hungary, East Indies, and other places. Medical History—It urged its way into practice Avith much difficulty, being considered by the ancient Greeks as highly poisonous. Thus Diascorides ascribed pernicious effects to it as a me- dicine, and the elder Pliny declared it to have the quality of poisoning all things. The writings of Galen circulating among the Arabians, the correctness of these opinions became questioned, and we find their most distinguished physicians introducing it into medi- cine as an external application in the cure of cutaneous dis- eases. From its external employment, it began to be ventured upon internally, and it became common to give it in obstruc- tions of the aliamentary canal—its weight forcing a passage, and in difficult labors. The researches after the philosopher's stone contributed very much to enlarge our knoAvledge of the chemical history of this article, this being one of the substances to which their attention was particularly directed, and in the zeal for disco- very, its properties became better knoAvn. The practice of the Arabians was soon folloAved by some of the physicians of Europe, towards the end of the thirteenth century, but was not established, or looked upon in general 27 214 SIALAGOGUES.—MERCURY. to be safe, until about the sixteenth century, Avhen the vene- real disease making its appearance in Europe, was found to yield to mercurial preparations alone. To Paracelsus, that extraordinary adventurer in Chemis- try and Physic, we are indebted for'the early introduction of this article into medicine. He was the first to employ it for the cure of the venereal disease, Avhich made its appearance in the early part of the sixteenth century. In the treatment of this severe, and newly distinguished disease, he acquired a degree of success which none of his contemporaries could attain, Avho did not resort to its use— and he must be allowed to have conferred on mankind a sub- stantial benefit by the introduction of the use of mercury into medicine. Being found so efficacious in the venereal disease, its use began to be ventured on in other conplaints. To Dr. Chisolm of the West Indies, and the physicians of this coun- try, Ave owe its extensive use in malignant fevers, and the diseases of warm climates. Chemical History—In its crude state, it produces no per- ceptible effect on the body, and is without any sensible acri- mony, taste, or smell—yet it may be rendered active by changes in its chemical state, or additions to its substance. When rendered thus active, it seems to be a stimulus to eve- ry sensible and moving fibre of the body to Avhich it is ap- plied. The degree of its stimulant impression is modified in a very remarkable manner, by the different preparations of it which have been proposed and employed. In consequence of the changes Avhich it undergoes by its numerous preparations, it is not only a powerful stimulant, but it enters the circulation, quickens the vascular action, excites powerfully the whole glandular system, and increases all the secretions and excretions. Hence, it happens, that its various preparations produce different effects, operating some- times as stimulants to the general system, or as cathartics, emmenagogues, errhines, &c, and hence it becomes useful in a great variety of diseases, such as febrile affections, cachec- tic diseases, glandular obstructions, and cutaneous eruptions. The value of these preparations may be inferred from this circumstance, that during a period of three hundred years, experience has fully sanctioned their use; and in confirmation, I may adduce the remark of Mr. Pearson, avIio justly observes, that no one medicine besides, (opium excepted), derived from the animal, vegetable, or mineral kingdoms, has maintained its credit with men actually engaged in extensive practice, du- ring a tenth part of that period. Although it is a medicine capable of being abused, to the disappointment of the patient, and the injury of the constitution, yet, under the direction of SIALAGOGUES.—MERCURY. 215 cautious and judicious practitioners, it may be ranked as one of the most useful articles of the Materia Medica. The chemical changes Avhich have been proposed, in order to render mercury active and useful, may be reduced to oxi- dation in different degrees, and union with acids, constitu- ting mercurial salts. The Preparations of Mercury may be considered under the three folloAving heads : 1. As they are formed by Trituration. 2. As they are combined Avith Sulphur and Iodine. 3. As they are combined with acids of different kinds, form- ing salts. The Preparations by Trituration, are formed by rubbing Mercury with Saccharine, Mucilaginous, or other substances, until the globules of mercury are completely divided. By this operation, the mercury, being exposed to the atmosphere, becomes oxydized. They are more mild than the prepara- tions formed by a combination Avith the acids, but to be ef- fectual, the trituration should be complete, otherAvise the practitioner Avill experience uncertainty in their use. The first of the Preparations under this head, is the Piluloe Hydrargyri, or Blue Pill. Preparation—This is one of the best preparations of mer- cury, and may, in general, supercede most other forms of this medicine. In its preparation, the mercury is minutely divided, and converted into the black oxide. (Present a specimen of the blue mass manufactured by steam power, being in a more minute and permanent division—also of the protoxide of mer- cury as it exists in the blue mass). Blue mass can be prepared more readily by adding this oxyd to the conserve of Roses, in the proportion of an ounce to the pound. Or given alone in the dose of \ gr. at bed-time, in a little syrup. The blue pill is much employed to produce a mercurial im- pressions on the system, sometimes to act as a laxative. For these purposes it is much less active than calomel, but pos- sesses this advantage, that it may be administered to irrita- ble subjects, who are purged, or othenvise incommoded by the Proto-Chloride of Mercury. Employed in the treatment of various affections of the stomach, and chylopoietic viscera. Dose, iv. to vj. grs. One grain of mercury is contained in four grains of the mass, according to the Edinburgh formula. Do. in iij. of the London. Do. in ij. of the Dublin. The first is preferred. Adulterated by the substitution of earthy clay for the mer- 216 SIALAGOGUES.—MERCURIAL OINTMENT- cury, and a preparation examined, contained but little more than a fifth of the proper proportion of mercury. Mistura, Hydrargyri Mucilaginosa. This is the second proparation formed by trituration, in Avhich the mercury, reduced to the state of a dark gray oxide, is combined with gum or vegetable mucilage.* Called, also, Plenck's solution, from being introduced into use by Profes- sor Plenck. This is an inconvenient mode of exhibition, as the mercury does not remain sufficiently suspended-—But rarely employed. Used in the formation of gargles, collyria, injections, &c. Our experience not considerable with it, prefering other ar- cles, Unguentum Hydrargyri, or Mercurial Ointment. Two preparations in the shops, the strong and the mild. Preparation—Two drachms of the former contain one drachm of the mercury; and three drachms of the latter, con- tain one drachm of mercury. The former used chiefly for mercurial frictions—the latter as a dressing for ulcers and some cutaneous affections. Mercurial Ointment rarely found in the shops of a proper quality. This depends upon the difficulty which is found to exist in minutely dividing the globules of the mercury by the mere friction of talloAV and lard. To facilitate the operation, various expedients have been proposed. These enumerated. The addition of a little of the old ointment to the quicksil- ver, facilitates the operation. State in which mercury exists in the ointment—mechanical division—a protoxyd, and as a sebate of mercury. Medical application—Mercurial Ointment is the form of introducing mercury into the system by friction. It is the least exceptionable form, because the skin is not near so es- sential to life as the stomach, and is therefore capable, in itself, of bearing much more than the stomach. It is adapted to patients whose bowels are irritable, and will not bear the in- ternal use of mercurials, or Avho are purged, or otherwise in- commoded by the use of mercurials, or when it is desirable to make a speedy impression on the system. Employed in local affections, tumors, buboes, &c Before having recourse to this mode of employing mercury, the patient should be prepared. He should take a cathartic. Use the warm bath. Skin to be cleansed with soap and water. SIALAGOGUES.—MERCURIAL OINTMENT. 217 The patient should rub in at night from 3 ii. to 3 iii. of oint- ment, where the cuticle is thin, and the absorbents numer- ous. Before each neAV application, the grease and blackness should be washed off with soap and Avater—The friction should be performed by the patient. If an assistant is re- quired, he shduld protect his hand Avith a glove. The frictions to be continued until the gums begin to swell, or the breath to smell disagreeable, when they should be left off. When an immediate effect is desired, it should be rubbed into the axilla—mercurial socks should be Avorn. This prac- tice only to be resorted to in desperate cases—in Hydroce- phalus, Tetanus, &c. Mercurial ointment has been employed in Erysipelas. In conjunction with depleting remedies, it relieves the burning pain, heat, and Inflammation. Mercurial ointment is frequently prepared with a smaller proportion of mercury than that directed to be used in the Pharmacopoeias—and in order to communicate to it the re- quisite shade of color, Sesqui-Sulphuret of Antimony, Indigo- or Prussian blue, are added. Mercurial ointment is rarely, or never, administered inter- nally in this country, but it is used in Europe, and often Avith considerable effect. It is said thus administered to be effi- cacious in exciting speedy salivation. It is given in doses of from ii. to v. grs., in pills, to which liquorice powder is added. Hoav does mercury operate Avhen applied to the surface? That it is absorbed by the skin is stated by some, and that it is inhaled by the lungs, is contended for by others. We have already explained our views fully on this subject, and Avill refer to what was said at the commencement of the course. We have sufficient evidence that it is taken into the circu^ lation, and that it produces its good effects, by virtue of being taken into the system. That certain medicines are absorbed and carried into the circulation, we have maintained on a former occasion. That mercurial medicines may likeAvise, we knoAV, from this prac- tical fact, that infants laboring under syphilitic affections, are cured by administering mercurial preparations to their nurses. Thus it Avould appear to have been absorbed, carried into the blood-vessels, and secreted with the milk by the arteries of the breast. Some facts adduced, which prove that when mercury is combined with the atmosphere in the state of vapor, pro- 218 SIALAGOGUES.—HYDRARGYRUM CUM CRETA. duced by the partial evaporation of the metal, its effects are very active. Hydrargyrum cum Creta. Prepared by triturating mercury and prepared chalk until the globules disappear. This is a mild preparation, and well adapted* to children, particularly to the various disordered conditions of the di- gestive organs occurring in them. In these cases, the dejections exhibit considerable derange- ment in the secretions, being either of a greenish color, or clay colored, or Avhite. Consistence, thin and Avatery, or curdled, or slimy. Odor, highly offensive, or earthy. In the above condition of the secretions, this preparation will be found valuable, aiding its operation by attention to diet. Also valuable in Syphilis of infants. It is given in small doses frequently repeated, and often the beneficial effects which result are more permanent, than Avhen larger doses are employed—at the same time, they can be continued longer Avithout apprehensions of salivation. Three grains of the powder contain one grain of mercury. Half this quantity may be given at a dose, and to improve its antacid operation, combined Avith an additional portion of prepared chalk. Combination of Mercury ivith Sulphur. Black Sulphuret of Mercury- -Proto Sulphuret of Mercury, or (Ethiops Mineral. Preparation—Employed as an alterative in the glandular diseases of children, in scrofulous swellings, and cutaneous diseases. Lately recommended by Bicquerel in the Treatment of Typhoid Fever—vide New York Journal of Medicine, No. 49. It is a preparation but rarely employed, being the least active of the preparations of Mercury. Dose, v. to xxx. grs. two or three times a day. Bi-Sulphurate of Mercury—Red Sulphuret of Mercury—Fac- titious Cinnabar. Preparation—Used at one time in cutaneous and gouty affections, and with musk formed the famous Chinese reme- dy in Hydrophobia. Not much used internally, but as a fumigating agent in venereal ulcerations of the throat and nose. SIALAGOGUES.—BI-SULPHURET OF MERCURY. 219 Ulcers and excrescences about the anus and pudenda, are particularly benefitted in this manner. Mode of applying the fumes—By placing a piece of hot iron at the bottom of a night stool-pan, sprinkling upon it a small portion of the Red Sulphuret, and when volatilized, seating the patient upon the pan. Ulcers in the fauces treated also with the fumes of the Red Sulphuret—Contractions of the joints from Rheumatism. A few remarks may be made upon the subject of Fumi- gations. The practice is among the most ancient methods of affect- ing the system with mercury, and in some respects it is a very eligible mode. The advantages attending its use, are— That Ave are enabled to affect the constitution Avhen other methods fail. That these effects can be produced in a much shorter time than any other method requires. It can be employed when venereal ulcers are making great ravages. When the system refuses to take on mercurial action. And when the bowels will not bear the internal Use of mercury. Mr. Abernethy approves of this practice, and recommends it as a very poAverful and innocent means of mercurializing the s}rstem. The manner of applying the fumes is in a bath prepared as the Sulphur bath. The patient is seated within, and breathes an air foreign to the bath, the mercury being vola- tilized outside. The powder preferred by Mr. Abernethy, is the Protoxyd of Mercury, obtained by the decomposition of the Proto- Chloride of Mercury. An extension of this practice has recently been proposed, to the treatment of Febrile diseases, as YelloAv Fever, Bilious and Malignant Fevers generally, Puerperal Fever, Typhus Pneumonia, &c By this plan, it is proposed to inhale the fumes of mercury, and to take them into the lungs. The process explained. The system is placed by this practice Under the mercurial influence in a very short time, in twelve hours, and it must be a very intractable state of the body, which can hold out more than two or three days. Vide Dr. S. Jackson, of Northumberland, Pa., on this sub- ject, American Journal Medical Science. The combinations of mercury with Iodine, will be consid- ered under the head of Iodine. 220 SIALAGOGUES.—PER-CHLORIDE OF MERCURY. The third division of the mercurial preparations includes those formed Avith acids. These preparations are the most energetic. The first is Hydrargyria Nitratus Ruber, Red Predpitate, or Peroxide of Mercury. Preparation—Seldom used internally—sometimes violent in its operation, even in doses of a grain. Employed as an external application to cleanse ulcers and to stimulate them to action. As an escharotic, it is used to repress exuberant granulations, and Avith lard it forms an ointment for various purposes. Sub-Persulphate of Mercury, or Turpeth Mineral. Preparation—It is too harsh for general use, and is seldom employed. Its action is not confined to the primae viae, but it is apt to produce salivation, if a purgative is not employed soon after. The Ammonio Chloride of Mercury—White Precipitate. This article is only used externally in the form of ointment, in the proportion of 3 i. of the salt to f i. of simple ointment, and is of great value in obstinate eruptions, herpetic affec- tions, psora, &c. Adulterated with white lead, chalk, or gypsum. The combinations of mercury Avith chlorine, are the most valuable and efficacious remedies the M. M. affords. They form the Per and Proto-Chloride of Mercury. The Per-Chhi'ide of Mercury is formed by subliming a mix- ture of the Bi-Sulphate of the Peroxide of Mercury, or Tur- peth Mineral, with the Chloride of Sodium, the Per-Chloride being formed during the process. This is the most corrosive and acrid preparation of Mer- cury Avith Avhich we are acquainted. It Avas first introduced in the treatment of Syphilis by the celebrated Van Swieten, and by him recommended in the form of alcoholic solution. He was led to the employment of it, from a suspicion that salivation Avas not requisite for curing this class of diseases, and from the great abuses practiced Avith the mercurials in these cases. He commenced his experiments with it, and meeting with much success, recommended it to Maximilian Locher. He employed it at the Hospital of Vienna, betAATeen the years 1754 and 1762, and cured by it no less than 4,880 persons, Avithout inducing salivation, and testifies that no person died, or experienced the least dangerous or painful symptoms in SIALAGOGUES.—PER-CHLORIDE OF MERCURY. 221 consequence of this remedy. The cures that were effected were permanent. Its opponents state, on the other hand, that other mercu- rials are quite as effective and speedy—that the cure by Corrosive Sublimate is not permanent—and lastly, that its corrosive and irritant properties render its employment ob- jectionable. This article has been very fully tested in this country, and more particularly by the late Dr. Hosack, of New York. He is fully convinced of its anti-venereal powers. That the se- vere effects attributed to it by SAvediaur and others, upon the stomach and the intestinal canal, he has never noticed— and, on the contrary, that from its mildness in proper doses, it can be given to children, and even infants, laboring under hereditary taint. Our opinion founded on some experience is, that the Blue Pill, or Calomel, are by far the best remedies for the venereal in its first stages, but that after these have passed off, and the secondary have commenced, the Corrosive Sublimate, aided by decoctions of Sarsaparilla, or combined with the Syrup of Sarsaparilla, as already mentioned, will be found to be better than any other preparation. Forms of administration—In the form of pills, or dissolved in spirits, as follows: ft. Corrosive Sublimate, grs. iv. Alcohol, f i. The dose for an adult is xxv. drops, Avhich is equal to £ of a grain. For a child, iv. to vi. drops—repeated three or four times a day. Formula for the pills: ft. Corrosive Sublimate, grs. iv. Muriate of Ammonia, grs. xv. Distilled Water, 3 iss. To this is added as much of the crumb of bread as will make it into a mass—divide into one hundred and twenty pills. Each pill contains the | of a gr. of Mercury. The Muriate of Ammonia is added, because by it the Cor- rosive Sublimate is rendered more soluble in water. The Per-Chloride is employed in other diseases with ad- vantage. In Ulcers which have existed a long time. In Cutaneous affections. In Rheumatism. In various Chronic Inflammations it is a valuable article combined Avith the vegetable alteratives, particularly Sarsa- 28 222 SIALAGOGUES.—PER-CHLORIDE OF MERCURY. parilla, and in these cases is given in very minute doses, ns the £ or \ of a gr. in a pint daily. It is to be continued as long as it is thought necessary, taking care to watch its effects upon the mouth, and always keeping in view, that mercury given in excess, will tend to increase, rather than destroy constitutional irritation. The value of this combination may be inferred, when we state our belief, that Swaim's Panacea oAves its efficacy to the union of these substances, and Avhen you consider the numer- ous and diversified affections in which this medicine has been employed, and the beneficial effects Avhich have generally been derived. We have introduced this subject again to your notice, as much with a vieAv to bring to your recollec- tion Avhat was then said, as to inform you, that the suspicions which we expressed of the composition of the medicine, have been confirmed by conversation Avith several gentlemen. The composition had been investigated by Prof. Hare and others, and from the evidence of circumstance, there could be little doubt on this subject. So general Avas the belief, that most of the physicians of Philadelphia were in the habit of preparing it for themselves. The Per-Chloride of Mercury dissolved in a Tincture of Cinchona, in the proportion of ij. grs. to an ounce, and given in doses of x. or xv. drops, according to the age of the patient, twice a day, will be found a valuable medicine in the chronic diseases of children, and Avith particularly good effects, in those cases where there is enlargement of the mesenteric glands. Many of the empirical remedies, Avhich are boasted of as curing Syphilis without mercury, owe their efficacy to this substance. The dose being small, it is easily disguised Avith other articles Avith which it is mixed, and it is less liable than the other preparations of Mercury to excite ptyalism. Externally it is employed for various purposes. In combination with lime-water, it forms the yelloAv-wash, so much recommended in the treatment of obstinate and ill- conditioned ulcers. Poisonous operation of the Per-Chloride. Effects upon the system in large doses— It acts as a poison in these cases by virtue of its affinity for albumen, fibrin, and the other constituents of the tissues. The corrosive action exerted upon the stomach, is extended to the heart and brain, and death is the result of the suspen- sion of the functions of these tAvo organs so essentially neces- sary to life. Treatment to be pursued— SIALAGOGUES.—CALOMEL. 223 Antidotes—The best is albumen, or the white of eggs beat up with Avater, and taken in large quantity. It decomposes the corrosive sublimate, and forms a triple compound, con- sisting of albumen, muriatic acid and calomel—An ounce of the Avhite of eggs is required to neutralize 3 grs. of the cor- rosive sublimate. Along Avith the use of this article, blood-letting should be had recourse to, if the organs of the abdomen are in a state of inflammation, for it is not uncommon to find Gastritis, Enteritis, and even Peritonitis, as the consequence of this accident. Local bleeding by leeches should be added, and fomenta- tions to the abdomen. The next of the combinations of chlorine, is the Proto-Chloride of Mercury, Calomel. It is prepared by rubbing purified Quicksilver with the Per-Chloride of Mercury until the globules disappear. It is then sublimed in a glass mattrass, or Florence flask. When sublimed, it is reduced to powder, and well washed for the purpose of separating any portion of corrosive sublimate which may have been formed in the process. It is again sublimed and Avashed—corrosive sublimate being soluble in water, and calomel insoluble, this is a ready mode of separat- ing them. This is the most important, and the most extensively employed article in the whole range of the Materia Medica. It is capable of fulfilling more indications, and of being applied advantageously to a greater variety of diseases, than any other article which is furnished by the vegetable or min- eral kingdoms. It is anti-syphilitic, anti-spasmodic, alterative, deobstruent, purgative, errhine, sialagogue, and anthelmintic. General Operation of Calomel on the System.—Mercury, when rendered active by chemical changes, as in the state of an oxide, or neutral salt, seems to be a stimulus to every part of the system. When taken into the system, it manifests itself by a quickened circulation, gives the blood the disposition to take on the buffy coat when drawn, renders the pulse fre- quent and harder, increases respiration, excites the tempera- ture of the body, occasions a whitish fur on the tongue, and other symptoms of general inflammatory action. It seems, also, to be a stimulus to all the excretories of the body, of the salivary glands, of the trachea, lungs, digestive organs, the chylo-poietic viscera, and the Avhole alimentary canal. 224 SIALAGOGUES.—CALOMEL. It is slow in its operation, but Avhen accumulated in the system to a sufficient degree, its action is exhibited in the production of such excitement as to be called Morbus Mercu- rialis, during Avhich the functional operation of all the systems of the body are quickened and excited to a very great degree. —Francis1 Inaugural Dissertation. It is these various and diversified poAvers Avhich give to mercury its very great superiority, and as particular effects are produced by regulating the dose, it becomes a remedy very generally applicable to diseases. The good effects of mercury in Fevers, depend— 1. On its power of evacuating bile, faeces, and the morbid secretions of the alimentary canal. It is well known, that in malignant fevers, the intestines are loaded, not only with increased quantity, but a vitiated quality of all the secretions which are poured into them. These, by retention, not only increased in the degree of their morbid qualities, but by their accumulation become, in reality, exciting causes of disease. They have been knoAvn to possess such a degree of acrimony as to excoriate the rectum, and the skin of the neighboring parts. For the removal of these acrimonious matters, the milder cathartics, as the neutral salts, etc., have been resorted to, for fear of increasing the debility Avhich exists. But Cal- omel alone, though generally in combination, surpasses all other cathartics, not only evacuating the contents of the bowels, but by exciting the several glands which empty into them, to a free and copious discharge, changing the charac- ter of their vitiated secretions, relieving topical congestions, and by removing the causes which indirectly debilitate, the patient is strengthened. 2. The good effects of mercury in the cure of fevers, depend upon its exciting a new action in the vessels, or one different from that which constitutes the proximate cause of the dis- ease, and accordingly, we find, that as the mercurial action begins to exhibit itself, the symptoms of the original disease subside. This action commences with the approach of saliva- tion, which seems to be the test of the mercurial impression. The fact of the original disease giving way, upon the approach of the Mercurial, is so well established, that it hardly seems necessary to adduce proofs. For your satisfac- tion, Ave might detail the opinions of the most distinguished adATocates of the mercurial practice on this point, of Drs. Rush, Chisolm, Clark, Warren, and others. Application of Calomel to the Cure of Diseases. In Yellow Fever, the practice of several physicians stated— of Warren, Chisolm, Clark, and of the resident physicians of SIALAGOGUES.—CALOMEL. 225 Charleston, during the several seasons that it has appeared as an epidemic. We Avould not wish to be understood that the mercurial is the only practice which is to be pursued. We are, on the contrary, most favorable to the employment of general and local blood-letting in this fever, the use of the cold affusion, purgative and diaphoretic medicines, with blisters, and the benefits to be derived from a rigid system of abstinence, when that peculiarly irritable and inflammatory condition of the stomach takes place, Avhich precedes and accompa- nies the black vomit. With these means we have combated this severe disease, and the practice, Ave have had reason to think, Avas as successful as most of our medical brethren. In severe cases, it Avas observed, that the high excitement of the system resisted the mercurial action, and though em ployed in large doses, and repeated at proper intervals, yet it failed to produce its specific effects, and death Avas often the consequence. In other cases, Avhere this excitement was less violent, the peculiar effects of the mercury Avere pro- duced, and Avith the ptyalism a gradual subsidence of all the symptoms took place. In these cases, Ave have every reason to think, that equally beneficial effects folloAv from the prac- tice just mentioned—and on some accounts it Avas preferable, as patients in their convalescence Avere not distressed Avith the disagreeable effects of sore mouth, SAvelled tongue, etc The mildness of the particular case, as Bright and Addison observe, permitted, the usual operation of the remedy, rather than that the remedy controlled the fever. In the Bilious Remittent, or Country Fever—The beneficial operation of this medicine in these cases, may be inferred from Avhat has been said of the peculiar operation of this arti- cle, in another place, upon the alimentary canal and the chylo- poietic viscera. To the advantages arising from the use of mercurials in this form of fever, it may be added, that relapses are less likely to follow, thanAvhere the purgative and diapho- retic course is pursued. Exercising an influence so powerful as this medicine does, and in the several modes pointed out, we still think, that in the very acute diseases of our country, it is Dot alone sufficient. In this disease, as well as Yellow Fever, blood-letting at the commencement, is of the utmost importance in diminishing action, lessening undue determina- tions, reducing inflammation, and other effects, of which we have already spoken. Neither can we depend upon Calomel as a cathartic, for in these acute cases, its operation is too sIoav, and the sufferings of the patient require that prompt measures be enforced. It is proper, therefore, to alternate its use Avith the saline cathartics, and this course continued 226 SIALAGOGUES.—CALOMEL. until the disease begins to decline, or the mercurial prepara- tions to exhibit their effects upon the system, either in improved secretions, or if still further continued, in its im- pression upon the gums and salivary glands. While thus advocating the use of this article, Ave cannot too earnestly caution you in the administration of it. Saliva- tion is always painful,'and very distressing to convalescents. All that is required is a gentle mercurial impression tofne extent of producing tumefaction of the gums, and a slight • spitting. This is what most practitioners will alloAv is all that is to be desired. Yet, from a careless employment of the medicine, the sialagogue operation often takes place to a great, and even alarming degree. It is, therefore, important that you should be informed Iioav it may be obviated, and by attention to a feAV rules, you will, in most cases, succeed. Rule. I. In those cases where Mercury is employed, exa- mine the evacuations of your patient, and as soon as they are changed, either from a dark, grey, or ash color, to the color of bile—or their consistence, from being thin and watery, to a more natural appearance, Avhich will always take place when the liver pours forth a more healthy secretion, the medicine should be discontinued, or given at longer intervals. Rule II. By omitting the use of the medicine as soon as it exhibits the first indications of action upon the gums. These are redness, a peculiar faetor upon being rubbed, and a slight ulceration about the teeth. Rule III. By attending to the constitution of the patient. The sialagogue operation of mercury is very badly borne by persons of delicate habits, in whom the nervous temperament chiefly prevails. It is badly borne by persons advanced in life, Avhose constitutions have been impaired by previous attacks of sickness, and who are, therefore, weak and en- feebled. Rule. IV. The sialagogue operation of mercury should not be attempted in persons under twelve years of age. By attending to these rules, severe instances of salivation will be prevented from occurring, we will not say invariably, but in a great majority of cases. Only observe the same pre- cautions with this medicine, which are used with other active articles. We discontinue the use of opium when sleep is induced—digitalis Avhen it affects the brain and the organ of vision—arsenic when it produces intumescence of the cellular membrane, and calomel when it changes the secretions. This is sometimes difficult to be discovered, but attention is, on that account, the more necessary, particularly as its effects are more lasting and distressing. SIALAGOGUES.—CALOMEL. 227 In Typhus Fever—In the early stages it is valuable as an evacuant, to relieve the intestines of black and viscid matter, and abate the symptoms. In the advanced stage it is resorted to as a stimulant in small doses, united Avith very small doses of opium, to bring on a mercurial fever, and to sustain the actions of the system. In the PJdegmasios, and more particularly of the glandular system, is mercury used and recommended. In the acute attacks of Hepatitis, more active measures are required—but in chronic cases, no other practice than the mercurial can with safety be trusted. The secretion of healthy bile, says Johnson, the flow of saliva from the mouth, and a gentle and uniform perspiration on the skin, Avere syn- chronous effects of the medicine, and certain indications of an approaching cure. Where Inflammation of the Liver runs through its stages with rapidity, as in India, calomel must be resorted to early and vigorously, and it must be given in large doses until pty- alism is excited. It operates beneficial^ in preventing sup- puration, and other derangements of its structure, by forcing it on to an active secretion, by which its state of congestion is relieved, as congestion or undue determination is relieved in other instances, by a spontaneous active secretion, producing' resolution of the inflammation. To the many operations of mercury, a new title has of late been added, viz.: an auti-inflammatory operation. It derives this title from its efficacy in the cure of Ophthalmia—its efficacy in every symptomatic Venereal inflammation—its suc- cess over the Hepatitis of India, and its utility in other inflam- matory affections. With an anti-inflammatory intention it is employed in Pneumonia, Rheumatism, and other cases—and it seems to do good iu these cases by its poAver to equalize the circulation, and enable the capillary system of vessels to resume their secretory offices as before. Practice pursued by Dr. Hamilton in the employment of this medicine. In Inflammatory affections of the Throat. In Cynanche Trachealis, or Croup, Calomel has been recom- mended by the Scotch physicians in the highest terms. With the views Avhich have been presented of this disease, it should be treated actively in the commencement until inflammatory symptoms are abated—afterwards no medicine will be more effectual than Calomel in small doses frequently repeated, calculating that beneficial effects would arise from its equal- izing the circulation, and restoring to the capillaries their accustomed powers of secretion. 228 SIALAGOGUES.—CALOMEL. In Pneumonia, Mercury has also been recommended. The treatment should be the same, active depletion at first, and Mercurv combined to subdue the remaining excitement. In Phthisis Pulmonalis, Ave have many and contradictory reports. The reports of Dr. Rush, of the efficacy of this treatment, gave rise Avith some to sanguine expectations, that a remedy was at length discovered for this medical oppro- brium. Mercury has been tried to the extent of producing salivation, and it has been known to suspend all the symp- toms of Tubercular Phthisis, the patient not coughing during the ptyalism. But though the symptoms may be suspended, they recur as the mercurial affection abates, and the patient dies after a long course of the disease. In short, Ave never kneAv of recovery from phthisis by mercury, or any other means, where the tubercular form of the disease was charac- terized. Bronchitis, after refusing to yield to all the artillery of the antiphlogistic treatment, and after continuing a period Avhich threatened to end i» consumption, has had all the symptoms attending it, yield to small doses of calomel and James' poAAr- der, repeated several times a day. The mercurial commonly quickened the pulse a little before the gums were affected, but after a slight ptyalism Avas produced, the pulse has com- monly subsided, the patients lost their other symptoms, and were regularly convalescent from that period. In Rheumatism, after action has been sufficiently reduced, diaphoretics become useful. Their utility is much increased by the addition of Calomel, and as far as we can judge from experience, the combination of this article with opium and ipecac, Avill be found well adapted to these cases. In the Intestinal affections, mercury has been used with advantage. In Dysentery, it has been extensively used, especially in warm climates. In the milder forms of the disease, the com- mon methods of treatment will, doubtless, succeed, as vene- section, purgatives, anodynes. But in the more violent attacks of it, such as occasionally appear in our climate, and especially in the East and West Indies, it is a medicine very much relied upon. It is given in these cases in large doses, as xv. to xx. grs., until ptyalism is excited, Avhen as is asserted, upon the testimony of all writers on the subject, the disease subsides. It operates beneficially in the several Avays I have mentioned, restoring the biliary secretion, Avith the other secretions of the body. From the circumstance that it is often better retained in large doses than small, from its allaying vomiting and irrita- bility of the intestinal canal in cholera, diarrhoea, dysentery, Irregular pagination : P. 229-238 SIALAGOGUES.—CALOMEL. 239 and some other cases—its action in these large doses would seem to be sedative, and this would appear to be the opinion of physicians practicing in the East Indies. In Malignant Dysentery, it requires to be given in large doses. In Dyspepsia, Mercury is a valuable article. The principle to be kept in vieAv in the treatment of some forms of this disease, is, together Avith the use of means Avhich give vigor to the alimentary canal, Ave should also employ those which correct the morbid state of the liver. Mercury, says Wilson Philip, has a specific operation on the liver—a power not only of exciting its functions, but of correcting the various derangements of that function in a Avay which it does not possess with respect to any other organ, and Avhich no other medicine possesses Avith respect to the liver. Its use should be discontinued when the appearance of the alvine discharges indicates the return of a healthy secretion. With its improvement the skin generally becomes relaxed and of a proper temperature, the pulse more dilated^ the color and expression of the countenance better, and in particular, that expression of languor so peculiar to the advanced stages of the disease abates. In Cholera Morbus, mercury exhibits equally valuable effects. Its employment fulfills many indications;. It allays the inordinate gastric irritability, lessens the too abundant secretion of bile, and by equalizing the circulation, relieves the congestion of the vessels Avhich form the vena portae. In this disease, from the great irritability of the stomach and upper part of the intestinal canal, few evacuating medi- cines, if required, could, from their bulk, be retained. They could only add to the general distress. Calomel is, therefore, peculiarly useful in this situation—it is inodorous, insipid, and is comprised in a small compass. It is, therefore, highly probable that it will be retained in the stomach, and if a sufficient number of doses are given, it will remove the offending matters of the primae viae—It equalizes the hepatic secretion—It is Avell calculated to contend with this complaint, and we have knoAvn a single dose, or a couple, relieve all the urgent symptoms, after oil and laudanum, ene- mata, cathartic and anodyne, fomentations, and a variety of other means, have been employed to no purpose. The practice we pursue, is to administer four or five grains in a pill or poAvder, combined with one grain of opium, or alone, according to the degree of irritability, every two hours, until the disease subsides. Other means are to be employed which will be pointed out to you by the professor of the prac- tice. 29 240 SIALAGOGUES—CALOMEL. In Cholera, (Asiatic)~Dr. Griffin asserts that Calomel proved a most successful medicine in Cholera, controlling or arrest- ing its progress in eighty four cases out of one hundred, Avhen administered Avhile the pulse Avas perceptible at the Ayrist-— but, on the contrary, proved detrimental Avhen given in the- collapse. The practice Avas tested in fourteen hundred and forty-eight cases. The dose Avas from 3 i. to 3 ii. every hour or half hour. In speaking of the use of Calomel in this and other dis- eases, you must not conceive that any article is sufficient of itself to effect cures. It is only one of the means, which is often useful in conjunction Avith such other aids, as are to be derived from diet, clothing, the preparation of the system, the stage of the disease, and other circumstances, of which you must judge. In the Intestinal Derangements of Children, nothing to add. In Tetanus, relief has commonly been expected from the employment of opium, given to a large extent. Much expe- rience has convinced me of the entire inefficiency of this plan of treatment, and the necessity we are under of looking to other means for the subjugation of this distressing affection. Of those to which I would next resort, mercury promises to be most powerful. As the progress of the disease is rapid, we would employ it in doses of ten or tAventy grains, every two hours, until an impression was made on the system, em- ploying at the same time mercurial frictions. Dr. Rush cured a case of this disease by salivation, aided Avith bark and wine. The German physicians speak highly of the same practice, and my friend, Professor Dickson, has succeeded by the use of the same means. In Dropsies, the utility of mercury is well known. Com- bined with various diuretics, it promotes their operation, and increases the activity of the absorbents. When the disease is connected Avith visceral obstructions, the employment of this article is attended Avith the happiest effects. It would be easy for me to ailate upon the application of mercury to the cure of diseases, as there is scarce one in which it has not been used, and the beneficial effects of AA-hich, at one stage or the other, has not been acknoAvledged. The greatest difficulty Ave have experienced, has been, to condense the matter which is to be found relative to its application. There is one other disease in Avhich its very great import- ance should not be overlooked, viz: its use in syphilitic affec- tions. We shall conclude the account of the application of mer- cury to the cure of diseases Avith its use in Syphilis. My hearers already knoAV that mercury is the grand remedy in SIALAGOGUES—CALOMEL. 241 all complaints, unequivocally venereal. This is so much the case, that this medicine is usually regarded as a specific, and the only one to be depended upon as a cure. The origin of the venereal disease has been a subject of much debate, among most medical writers. By the greater part of them Ave are informed that it Avas brought by Colum- bus and his companions from the West Indies, between the years 1494 and 1496. The proofs, hoAvever, in favor of this origin are all equivocal, and we shall find much difficulty in ascertaining the precise period of its appearance, as Avell as of the causes Avhich gave rise to it. In Avhatever manner it arose, says Mr. Hunter, it certainly began in the human race, as we knoAV of no animal capable of being infected Avith this poison. It is probable, too, he says, that the parts of gene- ration Avere the first affected; for if it had taken place in any other part of the body, it might probably have never gone further than the person in whom it first arose. Desruelles attributes the origin of the disease to irritation, and refers its appearance among the Spaniards, on their re- turn with Columbus, to their licentious conduct Avith the Ab- origines of America, aided by the novelty of their situation, the influence of climate, diet, &c When the disease first made its appearance in Europe, its malignity was so great, that the consternation produced by it may more easily be conceived than described. The manner in which the disease was communicated—the rapidity with Avhich it passed from one order of disgusting symptoms to another—and, above all, the want of knowledge of the reme- dies which were proper to arrest its progress, furnished rea- sons sufficiently strong for regarding it as one of the most de- structive scourges which had been inflicted on mankind. We can form no idea of the disease at that period from its pre- sent appearances. There can be little doubt at present of a change of character of the Syphilitic disease, and that its symptoms are milder and more tractable. Astruc observes, more than one hundred years ago, that the disease is less vi- olent, its symptoms not so man}/, so painful, or so difficult of cure—it yields more readily to remedies properly applied, he says, and seems by little and little to approach toAvards a cure. On its first appearance in Europe, of a hundred persons in- fected, there were no fewer than ten deaths. If such was its character on its first appearance, the importance of a remedy calculated to arrest its progress, may well be conceived. In the medical history of mercury, we have ghren you an account of the manner in AA-hich this article came to be em- ployed in the treatment of Syphilis, and stated to you that it 242 SIALAGOGUES.—CALOMEL. was to the Arabian physicians Ave are indebted for its appli- cation to the purposes of medicine. Rhazes,we are told, re- commended an ointment, in Avhich quicksilver was an ingre- dient, for the cure of cutaneous diseases, and the practice Ave may suppose, soon became common, to apply it to diseases having a syphilitic origin. From its external use it began to be ventured upon internally, and we find about the year 1535, this mode of exhibition beginning to be practiced. It is not necessary to employ your time with an account of the variety of preparations which were in vogue, nor of the empyricaland barbarous practice which Avas pursued, but will at once pass over this period to the eighteenth century, Avhen this disease began to be treated on scientific principles. The doctrines of Mr. Hunter have had a greater effect in pro- ducing revolutions in the theories formed, concerning the na- ture and treatment of this disease, than any that preceded him, and even at this time, have a very great effect in regulating the practice upon this subject. Having had such extensive influence, it may not be amiss to state the leading opinions entertained by him on the subject of the venereal. He con- siders— 1. That the venereal poison being taken into the system, becomes universally diffused, and contaminates such parts as are susceptible of the venereal action, and that it is soon af- ter expelled Avith some of the excretions. 2. That the parts contaminated do not immediately go into venereal action, but that they acquire a new state or condi- tion, Avhich is termed a disposition to take on venereal action. 3. That the number of parts contaminated does not depend upon the quantity or strength of the virus absorbed. 4. That the disposition once formed in a part, necessarily goes on to action at some future period. 5. That mercury can cure the venereal action, but cannot remove the disposition which has been previously formed, and has not yet come into action. 6. That although mercury does not destroy the disposition already formed, yet that it prevents it from forming. 7. That though the disposition continues, it does not go into action during the use of mercury. 8. That the action having once taken place, goes on in- creasing Avithout wearing itself out. 9. That parts once cured never become contaminated again from the same stock of infection. 10. That the matter of the secondary ulcer is not infec- tious. 11. That the venereal matter is as soon destroyed in a large chancre, as in a small one, the mercury acting equally on every part of the sore. SIALAGOGUES.—CALOMEL. 243 Such is a summary of the views of Mr. Hunter on this subject, and the more closely they are examined, the more strictly Avill they be found to accord with the progress of the disease. Some of his positions are not clear in their expres- sion, and are ambiguous in theii meaning, particularly that which relates to the disposition of parts to take on the vene- real action. It is not my intention to enter upon a defence of Mr. Hun- ter, but to bring before you the treatment he recommended, and Avhich has a number of advocates. Mercury, he says, must be employed both externally and internally, in every case, let it be ever so slight, even when the disease has been destroyed at its commencement, as when the ulcer is touched with nitrate of silver. It must be employed during the whole time of the cure, and continued for some time after the chancres have healed. It should be carried to the extent of producing a slight sialagogue operation, when it must be discontinued, or kept up by smaller doses several days. We have already referred to the pernicious extent to Avhich pytalism has been carried. I have heard, says Dr. W. Philip, the late Dr. Munro, of Ed- inburgh, state the quantity of saliva which must be dis- charged to eradicate particular affections. A slight saliva- tion, as Ave stated, is sufficient in most cases, and it is most effectual when produced by small quantities of mercury, gra- dually introduced, than Avhen the condition of the s\ stem is suddenly changed by a large quantity. If the remedies have been applied before the venereal matter has been absorbed into the system, the disease will terminate Avith the healing of the mouth. But if matter has been absorbed, other parts of the body may acquire a disposition, as Mr. Hunter calls it, to diseased action, as the skin, the throat, the bones, and the disease will appear severally in them, and in the order in Avhich they succeed. This is the part of Mr. Hunter's doctrine which has been the subject of much controversy. It has been asked how is it possible to prove that a venereal disposition has, or has not existed, at any particular time? If after a certain course of mercury, and the consequent removal of a chancre, blotches should appear, then, says Mr. Hunter, a disposition had been formed which no quantity of mercury could have destroyed. But the critics say, may we not with at least equal probability affirm, that mercury had been insufficiently used. If, on the other hand, after such a course, no blotches should occur, the friends of the doctrine tell us, the seconda- 244 SIALACOGUES.—CALOMEL. ry order of parts had not been contaminated. But in this it may be contended by the opposite party, that the mercurial course had been judicious and efficient. Of the modus operandi of Mercury. Mr. Hunter, in speaking of the nature of the venereal matter, regards it as a poison, Avhich irritating the living parts in a manner peculiar to itself, produces an inflammation peculiar to that irritation, and from Avhich a matter is pro- duced peculiar to that inflammation. The good effects of mercury depend upon its exciting an action incompatible with that Avhich existed, counteracting the venereal irritation by producing another of a different kind. Upon the prin- ciple, then, that no tAvo morbid actions can exist at the same time in the constitution, is erected his views of the curative operation of mercury in Syphilis. The theory here advanced, though not strictly tenable, is probably the most reasonable Avhich has been delivered. That two morbid actions can exist at the same time in the constitution, is supported by the occurrence of small-pox and measles in the same individual, of hooping-cough during the eruptive stage of small-pox, small-pox combined Avith scarlatina, vaccination and measles. But it is the most plausible on these grounds, because Ave knoAV that mercury is a universal stimulus, causing great irritability of the constitution, making the heart to beat faster, and rendering the arteries more rigid, so as to produce a hard pulse. We also know that it produces a disease, or a peculiar and unnatural mode of action, changing the action of the extreme vessels, particularly the secretory vessels of the body, and it is to this double operation that its good effects may be attributed. The theory of Mr. Bell is less tenable. It proceeds upon the supposition that mercury being carried into the consti- tution, combines with and neutralizes the matter of the disease. This opinion is supported upon the experiment of the matter of lues venerea being mixed with triturated mercury, becoming inert and incapable of producing disease upon inoculation. The assumption of such an operation is altogether gratui- tous, and the venereal matter becoming inert, can be admit- ted only as a species of chemical agency upon inorganized materials, and will by no means apply to the organized ani- mal body. If the operation of mercury depended upon this principle, the successful treatment of the disease Avould de- pend upon the quantity of the medicine employed. This is SIALAGOGUES.—CALOMEL. 245 at variance with the opinion of most practical men on the subject. The operation of Corrosive Sublimate would seem to de- pend upon a very different principle. Such is a concise account of the venereal disease, and of the manner in Avhich it has been treated for the last century, and by many still at the present time. It becomes our duty to state, that within the last few years, the propriety of employing mercury to the extent Avhich has been done, in diseases of the genitals, has been questioned, it being asserted that many affections having a near resem- blance both to the primary and secondary symptoms of sy- philis, have been cured Avithout the use of mercury. The subject has excited the attention of many distinguished sur- geons, and the result has been a conviction, that the genital organs are subject to ulcerations, arising either from Avant of cleanliness, or from the acrid secretions of the parts. That these ulcerations bear a very close resemblance to syphilis, but may, in the generality of cases, be distinguished from it, the pathognomonic characters having been pointed out by Carmichael, Abernethy, and others, to Avhom we would refer you. Though a similitude exists in some cases to a great degree, there are generally, some marks by Avhich they may be dis- tinguished. They have not the character described by Mr. Hunter, but are less retorted at their edges, more shalloAv, more rapid in their progress, and pour out more abundantly an acrid dis- charge. Mercury internally seems to aggravate them, and the ulcers heal readily by the use of astringent washes and a purgative course. The practice, therefore, which has been recommended in cases which have not the decided Hunterian character, is to give up the use of mercury in the primary ulcers, treating them as if they were simple ulcerations, by cleanliness, rest, abstinence, and simple applications. But if they remain open beyond a reasonable length of time, mercury should certainly be used. The same principles are to be observed in the case of buboes and cutaneous eruptions. The efficacy of this practice has been confirmed in our at- tendance at the Marine Hospital of this city. In a very feAv cases Avas mercury employed, and then Avith a very sparing hand. The result has been very gratifying, inasmuch as the patients were restored in a comparatively short space of time, Avithout those distressing effects Avhich frequently folloAv the use of this article, or those tedious and painful complications Avhich arise from other diseases being developed by the mercurial irritation. 246 SIALAGOGUES.—CALOMEL. 1. Ulcerations of the penis have been treated as simple ulcers, by mild evacuants from the bowels, the use of astrin- gent Avashes, the lunar caustic, simple dressings, a moderate and spare diet. By this course, with an occasional variation of the remedies, the local injuries of the genital organs have been healed in the course of a few Aveeks. When they exhibited an indolence in their action, or con- tinued open longer than is thought prudent, or safe, they are then excited by the use of mercurials, externally employed, and occasionally internally exhibited. 2. Buboes, in their different stages, have been speedily re- duced by the same means. In their inflammatory state, and even after suppuration had commenced, they have yielded to blood-letting, evacuants, repeated at regular intervals every other day, or tAvice a week, rest, and a recumbent posture, the use of cold applications or blisters, and a regulated diet. The most severe cases Avere relieved in five or six Aveeks. 3. Where buboes have ulcerated before admission, or a day or two after admission, the same course Avas pursued, and with effects equally gratifying. Throughout, these affections which have so long been con- sidered as arising from a specific virus, were treated as in- flammatory affections of a simple character, and in no instance Avas failure or disappointment experienced. When improvement did not folloAv this course after it had been pursued a sufficient length of time, then the mercurials were properly resorted to. In secondary affections, a non-mercurial course, or a very sparing use of mercury, was pursued. In only one case ad- mitted during our attendance, the internal employment of mercury created much distress from the general irritability of the system, and particularly the digestive. In this opiates were necessary with the use of the vegetable alteratives, and the external employment of the mercurials as a dressing to the ulcers, until an action Avas manifested on the gums. Un- der this cautious use of mercury, combined with the vegetable alteratives, a healing action Avas established, and ulcers which would have been extremely tedious and obstinate under ano- ther course, speedily cicatrized. At this stage, let me digress a little from the subject, and state to you, that when from the proper and sparing use of the mercurials a healing action is not set up or established, we recommend that these remedies be discontinued, and other alteratives employed, and under these circumstances we would strongly recommend to your attention some of the preparations of Iodine, particularly the Iodide of Potassium, or Iodide of Iron. SIALAGOGUES,—MORBID EFFECTS OF MERCURY. 247 Secondary symptoms, from this non-mercurial practice, were not seen, or they did not occur before the patients were discharged. It should be noticed, further, that these symptoms follow in pseudo-syphilitic cases, as in true syphilis. They are said to occur more frequently, and appear at an earlier and more determinate period, than when mercury has been used, but they, in many cases^ have gone off as soon. Never, as has been supposed, proceeding from bad to worse, or from one succession of parts to another in unabated violence—On the contrary, they do not exhibit the same violent and unrelent- ing symptoms which have been observed when mercury has been used. Chances of secondary symptoms. If the primary sore be destroyed during the first six days of its existence, no secondary symptoms will follow. If six months elapse after the cure of a chancf e, (no mer- cury having been exhibited,) without the appearance of secondary symptoms, all fear of constitutional symptoms may be laid aside. The practice above detailed, seems to be such as our pre- sent knoAvledge of the disease authorizes and prudence sanc- tions. It is the practice of several English Army Surgeons, as well as of Mr. Carmichael, and Mr. Abernethy, It was observed, as we have mentioned, by Astruc, more than one hundred years ago, that the venereal disease was milder then than upon its first introduction—-the same remark may be made respecting the present appearance of the disease, and what it was in the time of Astruc Morbid effects produced from the use of Mercury.-—The first is the Erethismus Mercuriale, the Eczema Mereuriale, and Hydrargyrum, all having allusion to the same affection. The disease consists in an eruption on the skin, varying in appearance from a light rose color to a dark red, and even to a purple, accompanied with heat, itching, fever, headache, and gastric symptoms. It commences about the scrotum, the inside of the thighs, groins, and spreads over the body. Desquamation takes place on the fourth day. Varieties in the disease. That it is produced by mercury, is proved by this circum- stance—that mercury aggravates the symptoms of the com- plaint—that it will cease upon its being discontinued, and reproduced by too early a recurrence to the medicine. The causes—Sometimes dependent upon a peculiar idiosyn- crasy of constitution, obnoxious to mercurial remedies. 30 248 SIALAGOGUES.—MORBID EFFECTS OF MERCURY- A certain state of the skin, also favorable to the produc- tion of the disease. When these predisposing causes exist, a very small quanti- ty of mercury will excite it into action. Treatment-^All mercurials to be discontinued, for it is re- markable, as soon as mercury shows its morbid effects, its anti-venereal powers cease-^-remove the patient from the apartment in which they have been exhibited—-advise tepid bathing, and some gentle purgative. Salivation, another of the morbid effects of mercury, and sometimes by its violence a more distressing disease than the original complainty Salivation, though not necessary to the curative operations of mercury, is, in the opinion of most practitioners, a desira- ble effect of the mercurial practice. Those very profuse salivations Avhich were at one time thought so essential for the full attainment of its beneficial effects are now happily abandoned, and physicians in all cases would be satisfied with only a moderate sialagogue operation. This, however, cannot ahvays be obtained for the reasons stated. The only mode to prevent these effects, is to exercise great caution, to Avatch the progress of symptoms, and to observe the rules advanced upon this subject. To these rules we Avould add, that we prevent the severe effects of salivation, by attending to the constitution of pa- tients who are under our care. Mercury is improper in every system submitted to medical treatment. It is badly borne by persons of delicate habits, those in whom the ner- vous temperament prevails, and possessing much mental, as well as corporeal excitability. It is generally better borne by males, than females—by the active, than the sedentary— by the well, than the badly fed—and it is better borne by the hardy inhabitant of the country, than by those residing in cities. The Sialagogue operation of mercury is generally very severe in persons somewhat advanced in life, whose consti- tutions have been impaired by previous attacks of sickness, and who are, therefore, weak and enfeebled. The Sialagogue operation of mercury, should not be at- tempted in young persons under tAvelve years of age, for a similar inequality exists at this period of life between the strength of the impression, and the resistance which the soft parts oppose. When the disease is formed, the first object is the mitiga- tion of pain. This is done by the use of gargles, as a solu- tion of opium in Avater or milk, a strong infusion of green tea, a solution of the acetate of lead, to Avhich is added a portion of laudanum. IODINE. 249 Emetics have been considered useful in counteracting the inordinate effects of mercury. They have been said to have succeeded in arresting inordinate salivation, and the progress of gangrene. Cathartics—Sulphur—Blisters as counter-irritants, iced water, leeches, cooling applications. The use of the Chlorate of Potash internally, and as a wash for the mouth. When sloughing exists— Pyroligenous acid diluted with water—a solution of the Chloride of Soda or Lime—Spirits of Turpentine, rubbed up with mucilage—a decoction of the root of the Rhus Glabrum. The third object is to restore the tone of the parts. This is done by astringent gargles, as red rose leaves, red oak bark, a decoction of galls, with a small portion of honey and alum. To the consideration of Mercury, Iodine may properly suc- ceed, as it is allied to it so closely in its operation and effects. IODINE. The simple substance Iodine was discovered in the Soda derived from the incineration of certain marine vegetables, by Mons. Curtois, in 1813. Its properties were investigated by himself, but principally to Sir H. Davy, and Gay Lussac, do we owe much of our knowledge of the chemical habitudes of Iodine. Physical properties— It is a soft, friable, opaque substance, in the form of crystal- line scales. Color, bluish black, metallic lustre. Odor, resembles chlorine very closely. Taste, hot, acrid, pungent. Its effects upon the system— It is stimulant in its operation, and acts also upon the lym- phatic system—is alterative in its operation, and allied to mercury. When carried to a great extent, very considerable ema- ciation takes place, and the gland of the mamma undergoes a considerable diminution in its volume. It is absorbed into the system, can be detected in the blood, in the urine, in the perspiration. 250 IODINE. Operation of Iodine upon the Stomach. In moderate doses it occasions a slight sensation of heat in the mouth and throat, Avith thirst, pains in the abdomen, with diarrhoea. To these effects are added, a disturbance of the other organs, particularly of the brain. In larger doses, all the symptoms of gastritis, Avith accele- rated pulse, heat of skin, tenderness of the gums, Avith redness and separation from the teeth, with increased discharge of saliva.* In very large doses, the disease called Iodism or Iodosis. Given in proper doses, it stimulates without exciting irri- tation. They act upon the mucous surfaces, and upon the different organs. It gives activity to the circulating system. It increases the appetite, and improves the vital powers generally. Peculiarities in the operation of Iodine. It bears a general analogy to mercury in its application to tumors, enlargements of glandular bodies, thickenings of the tissues. It is better adapted to chronic and long protracted cases. It is often beneficial in these after mercury has failed, or when it cannot be persisted in. It is inadmissible in Febrile and Inflammatory complaints with vascular excitement. It exerts a less permanent influence over the secretions than mercury, and when they are defective, and are to be restored, it is less to be depended upon than mercury. In some specific diseases where mercury has ruled trium- phant, much experience with the preparations of Iodine has evinced their greater safety and efficacy. Its application to diseases— In Bronchocele. In enlargements of the lymphatic glands. To discuss Tubercles in the Lungs. In Asthma. In chronic Inflammation, induration, and enlargement of the Liver. In enlargement of the spleen. In deragements of the Uterine Secretions, as an Emmena- gogue. Antidotes—It is easily and readily rendered inert, by a solution of starch with which it unites, and is then but little soluble. To allay irritation milk 'albu- men, and a solution of gum arabic may be employed, with the use'of opium IODINE. 251 In Leucorrhcea, Gonorrhoea. In diseases of the Fibrous system, Rheumatism, and of a Syphilitic character. In the Secondary and Tertiary forms of Syphilis. In ulcerations of the skin. In Cutaneous eruptions. In Indolent Ulcers with a sloughy surface. In Ulcers occurring in scrofulous constitutions. In Cancerous Ulcerations and in Lupus. In Chilblains. In Erysipelas. As an Injection in Hydrocele. Forms of administration— 1. In Pills, rubbed up with any tenacious substance. Dose, half a grain, night and morning. 2. In Tincture— ft. Iodine, grs. xlviii. Spirits of Wine, f i. Dose, xxv. grs. for adults, two or three times a day, in sherry wine, or sugar and water. 3. In solution of Hydriodate of Potash, or more properly Iodide of Potassium. ft Iodide of Potassium, grs. xxxvi. to %i. Distilled water, ? i.—The dose as the Tincture. 4. In solution of the Induretted Hydriodate of Potash. It is formed by adding Iodine, grs/x. to the above. The dose vi to x. m., three times a day. During the administration of the Iodine, care should be taken not to combine it with substances likely to decom- pose it, and not to give it when the stomach is loaded. The use of the medicine should be occasionally suspended, on account of the supervention of unpleasant effects from it,' and a dose of magnesia, given on the day of its suspension, with the view of cleansing the primae viae. Lugol's Solution— Called also loduretted mineral water of Lugol,made by him of three different degrees of strength. No. 1. No. 2. No. 3. Iodine, gr. §. Iodine, gr. 1. Iodine, gr. 1£. Iodide of Pot.,gr, 1£. Iodide of Pot., gr. 2. Iodide of Pot., gr. 2£, Distilled water, fviii. Distil'd water, fviii. Distilled water, fviii, When sweetened it is readily taken by children, but sugar should be added at the time of administration, as in the course of a few days it effects a chemical change in the solution. From six to eight ounces may be taken daily by an adult, Iodine Ointment— 252 IODINE. Is made as follows : ft. Iodine, 3 i. Lard, f i. A scruple to be rubbed into the affected part. Or, Iodide of Potassium, 3 ss. to 3 i. Lard, ? i. The size of a small nut to be rubbed on the affected part. Iodine Liniment— Prepared by adding the Tincture of Iodine to Soap Lini- ment in the following proportions : ft. Tincture Iodine, 3 i. Soap Liniment, ?i. To be be rubbed over the tumor once or tAvice a day, in a 6mall quantity. This preparation has the advantage over the ointment, that evaporation is prevented by keeping it in a stopped phial. When practicable, our method of using Iodine externally to tumors, buboes, etc., is to apply a blister to the part—and after two or three days, when the soreness of the blister is diminished, to direct a plaster of the Iodine Ointment to be applied. It occasions much smarting and irritation, and cannot be resorted to earlier, but the effects are highly bene- ficial. Iodine Vapor— Employed in this form in Inhalations into the Lungs, in the treatment of Phthisis Pulmonalis, Chronic Bronchitis, united with Cicuta. Iodine Baths— Employed in this form for children and adults in the treat- ment of Scrofula. Combinations of Iodine with mineral substances. 1. loduret of Ammonia has been employed in cases of Lepra and Psoriasis. 2. Iodide of Barium in similar cases, and in Eliphantiasis. 3. Iodide of Sulphur, principally employed in the form of ointment in various diseases of the skin, 4. Iodide of Arsenic has been employed in Lepra, Impetigo, and diseases resembling Carcinoma. 5. Iodide of Lead has been used to reduce indolent tumors, especially enlargements of the cervical, axillary, and mesen- teric glands. It has also been used externally for the pur- pose of subduing dropsy, and has been regarded as one of the most energetic and valuable of the preparations of Iodine. 6. Protchlodide and Deutio-Iodide of Mercury.—These pre- parations have been employed in all the cases in which Iodine is useful, and even where the other combinations have been COD LIVER OIL. 253 unsuccessfully given. They are employed internally and externally, in the form of ointment, in diseases of the bones and their articulations, and in all cases of external scrofulous diseases. Iodo-Hydrargyrate of Potasdum—combining the properties of tAvo very active articles, might be considered of great value in many diseases. In Dyspepsia, diseases of the liver, enlargements of the spleen, dysmenorrhoea, glandular enlargement of a scrofulous character, dropsies, etc., it is better suited, and may be em- ployed in all cases. Iodide of Iron has been employed as a tonic and resolvent, in cases of debility, accompanied with a relaxed condition of the solids. Adulterations. COD LIVER OIL. This article may properly succeed to the consideration of Iodine, containing, as it doesj Avith this principle, Chlorine, and traces of Bromine* This remedy, which has lately acquired reputation in the treatment of Pulmonary Consumption, and diseases of scrofu- lous habits, is obtained from the livers of the codfish. Pre- paration. It should be prescribed as free from taste and smell as can be procured as it existed in the cells of the liver of the healthy fish, without contamination by any process of putre- faction, roasting, boiling, or the like. Properties—Stimulant, alterative, antacid, and nutrient, exerting an action upon the lymphatic and capillary systems —increasing the functions of secretion and excretion, and improving nutrition. It also replenishes the blood with an energetic and rich plasma, and promotes the absorption of scrofulous tumors. Uses of the Cod Liver Oil— In Pulmonary Consumption, according to the experience of Prof. Williams, of the London University, its use has been folloAved by marked and unequivocal symptoms of improve- ment—the improvement varying from a temporary retarda- tion of the progress of the disease, and mitigation of the dis- tressing symptoms, up to a more or less complete restoration to apparent health. The stage of the disease in which decided and lasting improvement has occurred, is that usually termed the second stage. 254 COD LIVER OIL. But the most striking instances of the beneficial operation of the oil in Phthisis, is to be found in cases of the third stage. The relief, though decided, has not always been per- manent, and the patients have again declined, and the disease terminated in death. The results of various trials of the cod liver oil, even as a palliative, give it a rank far above any other agent hitherto recommended. To the medicinal properties of the oil must be added, that it is a highly nutrient material. Another remarkable effect of the oil, in some cases of scro- fulous disease, with extensive suppuration, is the speedy removal of the sweats, and other symptoms of hectic fever. In its use, it rarely disturbs the stomach or boAvels, or the functions of the liver. The dose of the oil is from 3 i. to ? ss. in some pleasant fla- vored liquid, as diluted orange wine, or the infusion of orange peel, or cherry bounce, and repeated two or three times a day. In the instances which have fallen under our experience in the use of the oil, have been favorable to its action, relief having been afforded in some cases, and a removal of the cough, and other symptoms of the disease in others. In Chronic Coughs, associated with much Hepatic derange- ment, dark complexion, heat of skin, Avith disordered aliment- ary functions, relief has been afforded in a very few days to all the symptoms, and the patient much improved. In Bronchitis, similar beneficial effects have been derived— and in a case of Asthma, which fell under our notice, the most decided advantages Avere obtained, after many other remedies had failed. Useful in Tertiary Syphilis, in persons of strumous habits. In Chronic Rheumatism, it has succeeded beyond the fond- est anticipations. In various Cachectic diseases dependent upon, or connected with scrofula, it has been employed, as Rachitis—Malacosteon, caries, diseased joints, curvature of the spine, and general de- formity of the osseous system. In Cutaneous diseases, attention has been draAvn to its use. The cases are Tinea Favosa, Impetigo, Chronic Eczema— used internally, and as a topical application. In Tinea Capitis, that very obstinate disease of children, we have succeeded most happily in a case of several years continuance, by anointing the head with the oil twice a day, previously washing with soap and wator—the internal use of the article being conjoined. In Chronic Inflammation of the Eyelids, of much obstinacy, the external use of the oil has been highly beneficial. EXPECTORANTS. 255 Division 10. EXPECTORANTS. Medidnes which promote the Secretion of Hue Bronchial Passages. The organs communicating with the external air, are lined Avith a membrane of a thin and delicate structure, Avhich pours out a mucous secretion. This fluid constantly lubri- cates the whole of its surface. It is limpid, mild, and nearly insipid, or rather saltish, and of little tenacity in the natural state. It is produced in so small a quantity in a state of health, that it seems to be dissolved by the air, and thus to pass off insensibly in expiration, or to be taken up by the absorbents. Under various circumstances it is poured out much more abundantly, and is altered in color and consis- tence ; it is then expelled by the expiratory efforts Avhich constitute cough. In its natural state the membrane is white, and but few marks of vessels can be seen upon it, but in dis- ease, vessels are developed, and become perceptible, particu- larly in catarrhal affections to which this membrane is very subject. The blood is then accumulated in the capillaries, and gives to the membrane a red color. The increased secre- tion Avhich takes place is one of the terminations of inflamma- tion by resolution, being a species of depletion which the vessels undergo, and the good effects of which are familiarly illustrated in the discharges from the nostrils, Avhich follow inflammation of the schneiderian membrane. To promote this discharge from the lungs and trachea, is the object of this class of medicines. There is frequent occasion for such remedies, since the lungs and trachea are frequently irritated by mucous, which is either distressing from its quantity, or by its density and tenacity. It is not surprising then, that physicians in search of such remedies, administered many medicines Avith this intention. But it is not agreed whether any medicines possess a specific poAver of promoting the secre- tion or expectoration from the lungs. The principal object in attempting to facilitate the discharge of the contents of the bronchial vessels and cells, must consist in changing the nature of those contents, so as to render them thinner, less tena- cious, and more movable than before. Whether Ave are possessed of any medicines capable of producing such a direct effect, may admit of a question. The generality of writers on the Materia Medica, and of physicians, speak of the utility of such medi- cines as they have termed Attenuantia for this purpose, but Ave may believe with Dr. Cullen, that their hypothesis on this subject is altogether erroneous, and that no such medicines 31 256 EXPECTORANTS. exist. The only probable explanation of the action of an expectorant medicine appears to be, that by increasing the secretion from the exhalent arteries in the. lungs, the mucous may be diluted and rendered less viscid, and the passages from the cells may be more fully moistened Avith a less tena- cious fluid. We knoAV that there is a constant and consider- able exhalation of moisture from the lungs; and there are many reasons for believing that this is an excrementitious secretion, connected Avith the other excrementitious secre- tions, particularly with the perspiration from the surface of the body. If, therefore, there are medicines disposed to pass by perspiration, it may be presumed that the same are dis- posed to pass by the exhalents of the lungs ; and this exha- lation may not only be increased, but the mucous produced by the follicles may also be poured out in a less viscid form, and consequently in a state to be more easily brought up by expectoration. Such is the most reasonable explanation of the action of this class of remedies. In its application much latitude is allowed, and a variety of articles of diversified characters are employed, according to the different states of the lungs, and the circumstances Avhich promote an increase of their secretions, or their discharge. Where much inflam- mation of the membrane of the trachea and lungs exist, de- noted by a dry and irritable cough, sense of fulness of the chest, dyspnoea, all of which denote an increased determina- tion of fluids to this part—depleting remedies, by reducing action, and allowing secretion to take place, gives relief to many of these symptoms. This state of the lining membrane is familiarly illustrated in a similar affection of the membrane of the nostrils, producing Avhat is commonly called a cold in the head. Here the membrane is thickened by inflammation, and the passage of air through the nostrils impeded. The uneasy feelings thus produced are allayed, and speedily car- ried off by the discharge which takes place. Expectoration is promoted by medicines which produce an action upon the stomach. This would seem to depend upon the production of nausea, exciting as it does an increase of the cutaneous secretions, and in like manner, an increase of the thinner secretion of the lungs. For nausea, by means of that singular consent betAveen the stomach and many other part?, m&y either relax the spasm of the very minute secretory and exhaling vessels of the lungs, or excite them to more vigorous action, when the mucous becomes at once more copious and healthy, and its expectoration more easy. The same effect is produced more completely by the operation of an emetic, Avhich agitating the passage of air through the EXPECTORANTS. 257 bronchiae and its ramifications, expels much mucous which is collected in many diseases, and affords often great relief to the system. Expectoration is promoted by various stimulating sub- stances, Avhich, by irritating the fauces and upper part of the larynx, and the system generally, excite the muscles of the thorax and diaphragm to convulsive contractions, which expelling the air of the'lungs with some rapidity through the windpipe, mucous collected in it is discharged. Expecto- rants of this nature are best adapted to the chronic coughs of old people, when with the accumulation existing, there is a deficiency of muscular poAver to effect its expulsion. Under the class of expectorants is included various mild, gummy and mucilaginous substances—such as spermaceti, gum arabic, flaxseed, liquorice, tragacanth, etc. This class is most useful Avhen the mucous is too thin and acrid, and when there is a frequent and almost dry cough, with great irrita- tion of the lungs and branches of the bronchia. They are, therefore, more properly, demulcents, but since they allay irritation, and thereby allow the mucous to be collected and then expectorated, they may be comprehended under this division. There has been some dispute about the action of these substances—some suppose that they produce their good effects by being received into the blood and conveyed to the lungs, Avhile others suppose that it is only during deglutition, by lubricating the fauces and glottis, and by this means defending them from irritation, that relief follows their use. This at least is certain, that many of them so suddenly allay the cough and remove the irritation, previously very trouble- some, that it is utterly impossible that they could have reached the affected parts by the blood. But the cough be- ing allayed, and the agitation of the lungs consequent upon it being for a while composed, the mucous, which was present in the lungs and trachea, is allowed to collect and become inspissated, and the strength of the patient being in the mean- time somewhat restored, it is easily and copiously ejected with the first cough that occurs. Nothing more remarkable points out the connection of various parts of the system than the preceding circumstance^ that an impression of a soothing nature being made upon the fauces and glottis, should be suf- ficient for a time to allay irritation of the pulmonary system, and lessen coughing. The fact is such, and in the cases to which allusion Avas made, the benefit afforded by these sub- stances is very considerable. There are yet other means of exciting expectoration. Blis- ters applied to the breast, side and back, not unfrequently 258 PARTICULAR EXPECTORANTS. manifestly promote expectoration. Their operation seems to consist in lessening inflammation, relaxing spasm, and promot- ing a more equal distribution of the fluids. The steam of warm Avater inhaled into the lungs, by pro- moting the exhalation and secretion of mucous, Avhich it also dilates and attenuates, renders the expectoration more easy and prompt, and on many occasions answers valuable pur- poses. PARTICULAR EXPECTORANTS. In particularizing the articles of this class, Ave shall folloAV the order pursued in considering their general operation. Upon depleting remedies Ave need not enlarge further, as from Avhat has been said Avhen upon this subject, their opera- tion is understood, as is their great efficacy in restoring secre- tions which have been suspended. Of those Avhose action is upon the stomach, and Avhich ope- rate by increasing the pulmonary secretions. Ipecacuanha.—The natural and chemical history of this arti- cle having been fully treated of, and its application to diseases, Ave shall only observe, that in small or nauseating doses, it is often of considerable benefit as an expectorant. For this purpose it is employed in catarrhal and pulmonic disorders, and in different states of these complaints, it appears to exert a decided action in promoting expectoration, particularly where the mucous membrane is dry and inflamed. It is sel- dom employed alone, since more is gained by the co-operation of these remedies than can be obtained by the exhibition of any of them separately. The remarks Avhich have been made upon this article may be applied with equal propriety to the Tartarized Antimony, given either in the form of poAvder or vinous solution, as in the following formula, for Pertussis, or Hooping-cough : ft. Salt of Tartar, 3i. • Water, fvi. to fviii. Cochineal, grs. x. Antimonial or Ipecac, Wine, 3 ii. Paregoric, 3 ii. m. To be made palateable by the addition of sugar. Dose, 3 i. to 3 ii. several times a day. To infants, according to age. SCILLA MARITIMA. 259 Sdlla Maritima.—To the properties of this article which have been enumerated, must be added its expectorant. It is possessed of these in a considerable degree, and is perhaps more frequently resorted to than any other of this class. In the diseases of children connected with accumulation of mu- cous in the bronchial passages, and in their catarrhal affec- tions, feAv articles are more deserving of attention, since to its action in stimulating the mucous follicles, and exciting more copious excretion from the lungs, by a small augmentation of its dose, emesis speedily follows, and with it the expulsion of the viscid matter which had oppressed the pulmonary system. In asthmatic affections, dyspnoea arising from similar causes, it is much employed, and is held in general estimation. In short, in all the pulmonic affections, after action has been reduced, it is found to be a very valuable medicine. It is ren- dered more useful Avhen combined Avith the nitrate of potash, tartarized antimony, or ipecacuanha, and in asthma, or dys- pnoea Avithout fever, combined with ammoniacum, it is per- haps the best remedy we can employ. In Hydrothorax occurring in persons of an advanced age, especially when there is chronic catarrh, asthma or cough, and the bronchial tubes are loaded with large quantities of viscid phlegm, expectorated Avith much difficulty, squills will be found highly beneficial, both as an expectorant, a diuretic, and by promoting absorption. In such cases it may be gh'en in very full doses, so as to keep up nausea, Avhich is conducive, in no small degree, toAvards a free excretion from the bron- chial vessels. In Pertussis it is very useful. Of the many formula recom- mended for the treatment of this disease, the following has in our hands afforded the most relief. Syrup of Squills, Ipecacuanha Wine, Paregoric, each equal parts. Of this a tea-spoonful is a dose, taken five or six times a day. The preparations of squills used are, the oxymel, vinegar, and tincture. The two former are generally preferred, be- cause the other ingredients with which the squill is combined, seems to add to its virtues. The tincture is, hoAvever, recom- mended by many. The following forms a very useful pectoral mixture in most cases : ft. Syrup of Squills, ? ss. Honey, ? i. Elixir Paregoric, 3 ii. Antimonial Wine, 3 iii. Laudanum, 3L Water, f iv. 260 EXPECTORANTS WHICH OPERATE AS STIMULANTS. A dessert-spoonful to be taken Avith a little honey, every tAvo or three hours, or oftener if required. Or, ft. Syrup of Squills. ■ ?"• Spts. Ether Nitros, f iss. Camph. Tinct. of Opium, f ss. Comp. Syrup of Squills, 3H. mix. For an adult, 3 ss. to 3 i., four or five times a day. Syrupus Sdlloe Compositus—Hive Syrup.—A combination of Seneka Snake Root, Squills, Tartarized Antimony, boiled in water and made into a syrup. Thus combined, a preparation has been made by Dr. Coxe, of Philadelphia, and. introduced in the American Dispensatory as an officinal article. The effi- cacy of these articles is much improved by their union, and in cases of croup, and others, Avhere expectorants are re- quired, in doses so regulated, as to produce an emetic or expectorant operation. Very great benefit has been afforded in many cases, and for these purposes the preparation is Avell deserving your attention. For the manner of preparing this medfbine, we refer you to Coxe's Dispensatory. EXPECTORANTS WHICH OPERATE AS STIMULANTS. Family Umbelliferoe—Dorema Ammoniacum—Gum Ammo- niac—Is a concrete, gummy, resinous juice, which oozes from a plant of the umbelliferous kind, growing in Egypt, Turkey, and the East Indies. It is found in the shops in masses, formed of drops or tears, Avhich are white within, yellowish Avithout, easily fusible, somewhat bitter and nauseous, and of a sharp taste and smell. The white drops, or tears, are observed to change to a yellowish or brownish color, on being exposed for some time to the air. It is often met Avith in the shops, mixed with much foreign matter, as wood, small stones and sand. From them it is separated by softening or dissolv- ing it in a little boiling water, washing it Avhile hot through a strainer, and then inspissating it to its former consistence. For internal use, the larger and finer tears, unpurified are preferred to the common strained gum. The virtues of Ammoniac have been considered more va- rious than experience justifies. It has been commended for its anti-spasmodic and deobstruent properties, neither of which does it possess in any degree. As a stimulating expec- ¥ POLYGALA SENEKA. 261 torant it is better knoAvn and appreciated, and it is only in this point of view that it can be considered entitled to our attention. In various Pulmonary affections, Avhen the lungs are op- pressed by vicid phlegm, in chronic catarrhs, in asthma, par- ticularly in the pituitary or humid, in pneumonia, after action has been reduced, and in peripneumonia notha, it is often of essential service in promoting expectoration and relieving respiration. In these diseases its poAvers are very considera- ble, and its efficacy such that it deserves the first place in this division. Triturated with water it forms a milky liquor called lac ammoniac, in this state it is more active than when administered in pills. The following formula is the usual mode of administering it: ft. Lac Ammoniac, Cinnamon Water, each f ii. Syrup of Squills, f ss. Elixer Paregoric, 3 ii.—ft. mistura. The dose is a large table-spoonful, which is to be repeated until relief is obtained. Dissolved in a diluted solution of nitric acid, it is employed in cases where large accumulations of purulent or vicid mat- ter exists, with feeble and difficult expectoration. The for- mula is as follows : ft. Nitric Acid, 3 ii. Water, f viii. This is poured upon Gum Ammoniac 3 ii., and rubbed down until a solution is made—of this a small quantity is taken as often as is necessary, mixed with any mucilaginous fluid. Polygala Seneka.—Is also a very useful stimulating expec- torant. It has an unpleasant and someAvhat acrid taste. Af- ter chewing, it leaves a sensation of acrimony in the mouth, and still more in the fauces, if it has been swallowed. It is probably oAving to the particular irritation of the Seneka in the fauces, the sensation of Avhich is compared to a burning, that the discharge of mucous which takes place, is attributa- bue—since during its existence much is brought up by haAvk- ing. The poAvers of Seneka as an expectorant, are as Avell established as those of any other medicine. It has for this purpose been employed in several affections, and the reputa- tion it acquired has been Avell sustained in subsequent trials with it. Introduced as it had been upAvards of eighty years since, in the treatment of pneumonia, it is still employed Avith advantage in pneumonic affections, and most practitioners are agreed upon the decidedly good effects often following its use. The stage of the disease to which it is best adapted is t 262 EXPECTORANTS. more clearly defined, and it is noAV considered that it cannot be employed to the exclusion of other active remedies. When these, therefore, have been pursued to a proper extent, and the patient continues oppressed Avith a dry cough, or difficult expectoration, a decoction of this article may be resorted to Avith much advantage. It is also useful in croup, as a second- ary remedy, and Avhen employed, the decoction should be much stronger than is usually given. The mode of prepar- it is as folloAvs : ft. Seneka Snake-Root, coarsely poAvdered, f ss., boil it in f viii. of Avater to f iv.—of this a tea-spoonful is to be given every half hour or hour, as the urgency of the symptoms re- quire. Of this strength it is decidedly expectorant, and it may also excite emesis. The decoction is the best form of administer- ing the Seneka, though the tincture is often useful, in combi- nation Avith other articles. In ordinary cases, the strength above directed is greater than necessary—f ss. to a pint and a half of water, boiled doAvn to a pint, is sufficient—To this, such other additions may be made, according to the indica- tions, or the pai tialities of the physician. The dose is ? ss. to f i., until relief is obtained. Lobelia Inflata.—See Emetics. Family Liliacoe—Allivum Sativum—Garlic.—The virtues of Garlic are various. The whole of the plant possesses simi- lar propei ties, but the root, Avhich has a strong pungent odor, and a very acrid taste, is the only part employed in medicine. Of the many purposes for which it is recommended, we shall only speak of its Expectorant, Avhich in common with other articles of the class Aliaceae, it possesses in a considerable de- gree. Its utility, in this respect, in the several forms of Asth- ma and other affections, unattended Avith inflammation, has been long noticed. Thus, Dioscorides mentions its use in mo- derate coughs. Celsus employed it mixed Avith honey in these complaints, and Rosenstein recommends it to be boiled in milk, and a pint to be taken night and morning. It is, Iioav- ever, not so much in repute among professional men as among unprofessional, with Avhom, made into syrup Avith honey, it is much employed in Catarrhal affections of long continuance, in Tussis Senilis, and in other cases, and very frequently with advantage. We have never had occasion to administer it, but have knoAvn of its employment in several cases Avith good effects. BALSAMS. 263 A Watery Solution of Assafoetida has been recommended in pectoral affections, for its expectorant properties, and it has been much used in Pertussis, chronic coughs, &c. Its good effects rather depend upon its anti-spasmodic properties, and it is advantageously employed in all those affections of the lungs which are attended with spasm. The prescription is as folloAvs : ft. Gum Assafoetida, 3 ss. Water, f iv. The Avater is rubbed Avith the gum until a solution is made. To this is added Tincture Tolut, f ss. Laudanum, gtt. xxx., or xl. The dose is a tea-spoonful to a child every two hours, and f ss. to an adult. There are several other articles that might be mentioned under this head, but they are either so uncertain, or so seldom employed, that their enumeration is unnecessary. Of the properties attributed to Balsams, none are more an- cient and commonly prevalent than those of healing or vulne- rary. This idea appears to have arisen from the observa- tion of their use Avhen externally applied to a recent Avound. If a Avound is made on any part of the body with a clean cut- ting instrument, and the parts be brought together, and bound up Avith a rag dipped in any balsam, and left undisturbed for several days, it is a matter of common remark, that the Avound will generally heal without any suppuration, by simple union of the divided parts. The same effect would be produced by any other substance similarly employed. Without regarding the effects Avhich folloAved this approximation of parts, and the exclusion of external air, they Avere supposed to be pos- sessed of healing poAvers in a peculiar degree. From their utility thus applied externally, their use Avas extended to in- ternal affections. But scarcely a single circumstance which recommends their external application can apply to internal injuries or diseases. Tbeir good effects as external remedies, depend upon tbe degree of topical stimulus, and probably the exclusion of external air, and hence the value which is set upon balsams as internal remedies is entirely lost. A languid, indolent ulcer of the kidney might, perhaps, be assisted by local stimulating remedies, but when the remedy must enter the stomach, and pervade all the vessels, be mixed with and diluted by the common circulating fluid, the remedy is no longer local, and the irritation Avhich it produces is either counteracted during the circulation, or is equally diffused over the Avhole system. Balsams, therefore, are no longer 32 264 BALSAMS. vieAved Avith that partiality Avhich the older physicians enter- tained for them, and repeated experience has shoAvn them to be sometimes absolutely useless, and often positively injuri- ous in internal affections of different parts for which they have long been celebrated. Used with caution, they may be be- neficial in several diseases. Family Leguminosa?—Myrospermum Peruiferum et Toluife- rum—Balsams of Peru and Tolu.—From recent discoveries, it is ascertained that these balsams are obtained from the same genus, and are similar in their properties. The tree from which the balsam is derived grows in South America. It is procured by making incisions in the bark, from Avhich it ex- udes in considerable abundance during the hot season. The balsam is of a yelloAvish brown color, transparent, in consist- ence thick and tenacious. By age, it groAvs so hard and brit- tle that it may be rubbed into a powder between the finger and thumb. Its smell is extremely fragrant, someAAThat re- sembling that of lemons, its taste is warm and SAveetish, and on being cheAved it adheres to the teeth. In its composition it consists of an essential oil, a peculiar resin, and benzoic acid. It is this last principle Avhich characterizes the balsams. In common with the other balsams, it has been much celebrated for its expectorant properties. It is less heating and stimu- lating, and may, therefore, be employed Avith more safety in pectoral affections than others. The cases to Avhich it is adapt- ed are similar to those to which this division has been consi- dered best suited—only it is not often resorted to until vas- cular action has been much reduced, or Avhere but little ex- citement exists. It is a useful addition to other expectorants, to which it often imparts vigor, and is, therefore, principally employed in combination. It may be administered alone, suspended in water by means of a mucilage or the yolk of an With it is formed the medicine sold in the shops, and knoAvn as Hill's Balsam of Honey. The formula is to be seen in Pa- ris' Pharmacologia. We haA^e found it very useful in chronic coughs, and the pectoral affections of old people. Balsam Copaiva.—See Diuretics. Having considered the manner in Avhich expectoration is excited by medicines which exert their action upon the sto- mach, and by their stimulant impressions—Ave proceed to consider another division, comprehending those substances, Avhich, by sheathing the upper part of the trachea .Avith a bland and vicid fluid, allay that irritation which excites cough- BALSAMS. 265 ing and by allowing the mucous to be collected, thus appear to promote expectoration. This division Avill comprehend the mild gums and mucilaginous articles, such as gum arabic, tragacanth, sugar, linseed, liquorice, tussilago, and the like. They are most useful Avhen the mucous is of a thin and acrid quality, Avhen there is a frequent and dry cough, Avith great irritation of the lungs and bronchiae. There is some dispute about the action of these medicines. It had generally been considered by physicians, until the time of Dr. Cullen, that these substances act upon the lungs through the medium of the circulation. Thus the gum arabic, Avhich is in very com- mon use, Avas proved to extend its soothing qualities to the bronchiae, and there to allay that irritation which excites coughing. It is, hoAvever, more probable that the articles of this class produce their good effects only during deglutition, and that by besmearing the fauces and glottis, they are defended from the various irritations which, in their irritable state, Avould excite coughing. In this condition of the membrane, deprived as it often is of the mucous which lines it, the air itself is often an irritant. That it is by supplying the absence of this natural covering, that these substances allay coughing, and remove the irritation previously so troublesome, is proved by the quickness Avith which the effect folloAvs, and that in so short a period of time, as to render it impossible that the smallest quantity could have reached the affected parts through the circulation. The cough therefore being allayed, and the agitation of the lungs consequent upon being com- posed, the mucous Avhich Avas present in the lungs becomes more abundant and inspissated, and the strength of the pa- tient being in the mean time somewhat restored, it is easily and copiously ejected with the first slight cough which oc- curs. We now proceed to their particular consideration. Family Leguminosce— Glycyrrhiza Glabra—Liquorice.—This plant is "a native of the South of Europe, and is also culti- vated in Great Britain. The root is the part used in medi- cine, and it contains much saccharine matter joined with some proportion of mucilage. When boiled for a short time in water, it gives out nearly all its sAveetness—the decoction then strained and inspissated with a gentle heat, affords the extract so commonly met with in our shops. The uses of this article are so Avell known, that it is almost unnecessary to enter upon the description. It is much employed in catarrhal and other pulmonic affections, in coughs, hoarseness, etc, and from its bland and emollient properties, is well adapted to all these cases. It is not often employed alone, but combined Avith a variety of other articles for greater convenience and 266 BALSAMS. efficacy. The following formula, constituting what is called the BroAvn mixture, is very commonly employed, and is a preparation Avhich is often beneficial. ft. Extract of Liquorice, Gum Arabic, each, f ss. Hot Water, f viii.—simmer until dissolved. Antimonial Wine, 3 iii. Laudanum, xl. drops.—f ss. to be taken every two or three hours. In this formula the anodyne co-operates Avith the mucilagi- nous articles in allaying irritation, while the determination to the surface excited by the antimonial preparation, completes the intentions to be fulfilled in pectoral affections, and thus furnishes us with a very valuable mixture in the secondary stages of these diseases. In milder cases the same articles may be given in the form of lozenges, prepared in the follow- ing manner : ft. PoAvdered Gum Arabic, Powdered Extract of Liquorice, White Sugar, each, 3 ii- Powdered Opium, grs. vi. Oil of Anniseed, gtt. iv. To be divided into sixty parts. One of these may be dissolved in the mouth three or four times a day, or more frequently. This is the formula of Dr. Wistar, and which is very useful and convenient. Or, ft. Sugar, PoAvdered Gum Arabic, Extract of Liquorice, each, f iv. Powdered Opium, 3 iss. PoAvdered Ipecac, 3 iss. Tinct. of Tolut, zi. Mix and make into a mass. Divide into lozenges of six grains each. Powdered Liquorice Root is much employed in the compo- sition of pills, and for disguising the taste of unpalateable medicines, which it does more effectually than any other substance. Gum-mi Arabicum—Acada? Vera? Succus.—This valuable article is a concrete mucilage which exudes from the Mimosa Nilotica, or Acacia vera, a tree that grows abundantly on the sandy soil of Egypt and Arabia, or the rivers Senegal and Niger, near the Cape of Good Hope, and other parts of Africa. The gum exudes in a liquid state from the bark of the trunk BALSAMS. 267 and branches of the tree, in a similar manner to the gum which is often produced upon the cherry tree, etc., of this country, and by exposure to the air it soon acquires solidity and hardness. The common appearance of this gum is so Avell known as not to require any description of it ; the various figures Avhich it assumes seem to depend upon a variety of accidental circumstances attending its transudation and con- cretion. That Avhich is of a pale yelloAvish color is most esteemed ; those pieces which are of a brownish or reddish hue are found to be less pure, and are said to be produced from a different species of Mimosa. Gum Arabic is probably the most valuable of all the gums and mucilaginous substances in coughs, hoarseness, and other catarrhal affections, for the purpose of diminishing irritation, and supplying the absence of the natural mucous. On this account it is employed to allay the tickling sensation in the fauces, Avhich so often excites coughing. It is, therefore, much resorted to in the formation of pectoral mixtures, and is a very useful adjuvant. It is combined, as I have already mentioned, Avith several articles. Gum Arabic is employed to suspend in water a number of substances, Avhich would not otherwise be kept equally dif- fused in this fluid. It is also used in rendering miscible with Avater the balsams, resins, fixed oils, and similar substances, Avhereby they may be very commodiously taken in a liquid form. This article is considerably nutritious—in the coun- tries where it is native, it forms an important article of food, either by itself or mixed Avith milk, rice, etc. Hasselquist relates an instance of the travellers of a large caravan, avIio had consumed all their provisions in the middle of their jour- ney, through the deserts of Africa, preserving themselves from famine by gum arabic, which they were carrying as merchandize. Gum Tragacanth.—This is so nearly allied to Gum Arabic in its properties, that a particular description is unnecessary. Family Lineaceoe—Semen Lini—Flaxseed—Is the product of the Linum Usitatissimum, a plant which is a native of Great Britain, but is cultivated in many parts of Europe and this country. It is a plant of great utility for purposes in the arts to Avhich it is subservient. The seeds which it furnishes have an unctuous sAveetish taste, but no remarkable smell. On expression they afford a large quantity of oil—boiled in water they yield much mucilage—the mucilage residing chiefly in the cuticle of the seeds. 268 INHALATIONS. Infusions and decoctions of these seeds, like other vegeta- ble mucilages, are used in coughs, hoarseness, and pulmonary affections generally. They are of considerable benefit in many of these cases, and Avhen sweetened with honey, and acidulated Avith lime juice or vinegar, are not very unpalata- ble. They may be drunk freely, and are useful in allaying irritation. Besides the articles Ave have mentioned, there are several others which are much employed for the purposes already detailed, as almonds, spermaceti, malloAvs, the seeds of quinces, slippery elm, etc., Avhich, as they possess only mu- cilaginous properties, need not be particularized further. INHALATIONS. Hitherto I have been considering the articles Avhich have been employed, and are, doubtless, of great utility in allaying irritation—in lessening the inordinate secretion from the lin- ing membrane of the trachea and bronchiae, and promoting its expectoration. Under the head of Inhalation, we advance a step further, and will bring to your notice remedial meas- ures, Avhich Avill change the morbid action existing, and sub- stitute a new and healthier one, will promote the healing of ulceration, provided it has not extended into the parenchyma of the lungs—and by attacking the sources from Avhich the bronchial discharges have issued, diminish and finally pre- vent them. The great utility of applications in promoting the curative action of ulcers situated on the external parts of the body, has frequently been noticed, and by a parity of reasoning we Avould be led to suppose, that if they could be made to the surface of the lungs in a manner adapted to their greater degree of irritability, similar good effects Avould result. Every day's experience convinces us that the improvement which takes place in the constitution of those laboring under pectoral complaints, by changes of climate, by long voyages, arise not more from the changes Avhich are made in the cir- culation, than by the passages to the lungs being also stimu- lated, by neAv actions being excited, through their Avhole ex- tent, and ulcerations healed Avhich had long existed. From these circumstances, Ave may suppose that the dissemination of stimulating effluvia in the apartments of those laboring under pulmonary complaints, Avhen the matter expectorated indicates that the ulcers evince a depraved condition, would be highly serviceable not only to cleanse the sores, promote INHALATIONS. 269 the healing action of their surfaces, and prevent or diminish acrid secretions—but that they would facilitate the expecto- ration of such matters as lodged in the bronchiae, render the breathing oppressed and difficult. The great object in the treatment of every disease, is to change the existing action, to direct our remedies in such a manner, that by their strong impress upon the system, their operation may be substituted for the diseased, and health be finally restored. This object can often only be effected by cautious, steady and persevering exertions, and in no diseases are these directions more necessary than in those of the lungs. The period in the disease for the employment of Inhalations, Avill be after the inflammatory symptoms have passed off, and the disease begins to assume the chronic form. By such means, strenuously and judiciously maintained, the most bene- ficial effects have resulted in chronic affections of the breast. Inhalations of the mildest character consist of water in the state of vapor, either in its simple state, or containing other substances, with a view to a more stimulating action. In many cases these means are often of great benefit in promot- ing difficult expectoration, by relaxing the bronchial vessels, and occasioning thereby a more copious secretion, by which the viscid contents of the lun^s are altered, and their libera- tion more readily effected. The vapor of Avater, or vinegar and Avater, inhaled through the spout of a tea-pot, or a fun- nel inverted over a bowl, or Mudge's inhaler, (for a good model of one, see Edinburgh Medical or Surgical Journal, No. 75) may be usefully employed in cases where these objects are desired, and the relief afforded is often very considerable. The vapor of spirits has been much used in chronic ulcera- tions of the lungs with great advantage. The Tincture of Digitalis, united Avith the vapor of water, has been inhaled in the lungs, either by Mudge's Inhaler, or by the use of the sponge. iEther in which cicuta is dissolved has been long employed, where a stimulating expectorant and anti-spasmodic is re- quired. Dr. Chapman speaks of the utility of this remedy Avith some confidence in dyspnoea and in pulmonary com- plaints. Of its utility I can say nothing, having neither seen nor knoAvn of its employment. The fumes of terebinthinate substances have been employed in catarrhal affections, and in diseases of the chest more ex- tensively, and from the various reports upon the subject, Avith effects highly salutary. From their less stimulating properties, they may be employed more frequently, and the occasions in which they may be resorted to, are more com- mon than is supposed. 270 INHALATIONS. In conjunction with other remedies, the fumes of rosin are often highly beneficial in the catarrhal affections of children. They are often received with pleasure by the infant, and seem to produce an immediate improvement of the breathing. If the effect is not salutary, the patient may easily be removed beyond the influence of the fumes. The manner of administering the remedy is simply to fill a room with the smoke of rosin, and allow the patient to remain in it as long as is necessary. The fumes of tar have also been employed in the same cases, and in Pertussis. In Pulmonary Consumption this article has been employed Avith success in Petersburg, Russia, and it is confidently stated that patients have been restored after their lives had been despaired of by the most eminent physicians of that kingdom. Sir Arthur Clarke speaks of its use in three cases of consumption in St. George's House of Recovery in Dublin, and he states from the experience he has had, the tar fumigation renders the cough less trouble- some, and produces very salutary effects on the pulmonary system. The manner in Avhich the fumigation is directed to be conducted, is to put the tar in an open vessel over a lamp or hot iron, so as to produce a slow volatilization, until the air of a chamber is Avell impregnated. In this atmosphere the patient may remain one or tAvo hours together, twro or three times a day. In a similar manner it has been em- ployed in Pertussis, and its effects are spoken of in very high terms. The inhalation of the effluvia from raAv muscovado sugar, has been recommended by Dr. Chisolm in cases of Phthisis. He has knoAvn it produce a wonderfully soothing effect, which has in some instances become permanent. In the West In- dies he recommends lodging the patient hear a boiling house of a sugar plantation, or Avhere this is not practicable, a small barrel, or even a basin, filled Avith the coarsest or dampest muscovado sugar, may be placed in the corner of a room occupied by the patient. In changing the climate, a sugar- laden ship should always be preferred. Besides this mode of applying stimulating substances to the lungs, it has been proposed, and even practiced, to intro- duce into the lungs various articles in the form of poAvder. Dr. Darwin invented a box for the application of poAvders to the surface of the lungs, for the cure of ulcers, etc., and the practice has lately been revived by a practitioner in New England. The mode, however, of impregnating vapor with medicinal herbs has many advantages, and this more especial- ly, since there are few substances, the active principles of Avhich may not be dissolved and applied to the lungs through the medium of vapor. ANESTHETIC AGENTS. 271 Such are the remedies which have been commonly resorted to for the purposes of inhalation. It is a practice but little resorted to at present, much less than it deserves, and I hope that with the views which haA^e been given of its operation, it may excite more general attention. ANESTHETIC AGENTS. Derived from the Greek of a primitive, and Aisthanomai, IfeeU ^Etherization.--The following is a short account of the his- tory of this discovery : A knoAvledge of the effects of ^Etherization does not appear to have been made knoAvn by the exertions of a single indi- vidual, but to have been brought into existence by the joint operations and discoveries of many. It has been Avell known, that various gases and factitious airs could be introduced into the lungs—and, at one time, this method of treating diseases Avas much in vogue—Dr. Beddoes having, in 1779, been chiefly instrumental in bringing this practice into notice. In 1795 and 1796, Dr. Thornton recommended the inhala- tion of Ether, and it Avas employed by a patient laboring under pectoral catarrh, Avith relief from the oppression, pain, etc., in the chest—also employed in other cases, as in a pain- ful inflammatory affection of the mamma. In none of these cases Avas it carried to the extent of the abolition of pain. Sir H. Davy seems to have contemplated such a result by medicamentous inhalation, and to have put it to the test of experiment. He employed the nitrous oxyd gas for this pur- pose. He also had recourse to it for headache, and for the relief of other diseases, as spasmodic asthma, catarrh, dys- pnoea, hooping-cough ; also, to correct the unpleasant sensa- tions caused by the inhalation of chlorine gas. In 1841 and 1842, Dr. C. T. Jackson employed aether to obtain relief from the above accident, and to produce a pecu- liar sleep or unconsciousness, but a state of complete insensi- bility Avas considered one of great danger, and it had been known to produce fatal results. Dr. Jackson also suggested its use for the slighter, aud instantaneous operations of the teeth. Dr. H. Wells next claims the discovery. He had used the nitrous oxyd gas in the extraction of teeth, but his claims, as a discoverer, must yield to that of Sir H. Davy, who had sug- 33 272 ANESTHETIC AGENTS. gested the use of this agent for this very purpose, some years previous. His public experiments with the use of aether seemed to have been a failure. Dr. W. T. Morton, of Boston, must next be mentioned. He had been a student of Dr. Jackson, and a partner of Dr. Wells. He became acquainted Avith the vieAvs of Jackson, and the experiments of Wells. He finds a patient who con- sents to permit him to use the aether, and extracts a tooth without pain. Though Dr. Jackson's vieAvs Avere favorable to the expediency and safety of aether, he does not appear to have had his countenance or support. Dr. Morton follows up his first experiment, and the great truth is at last made manifest, that aether may be employed with safety, so as to produce insensibility during all surgical operations. The world is indebted to Mr. Morton for this discovery, and in its progressive steps is indebted to Dr. Jackson's scien- tific knowledge and sound advice—and but for it, would not have been made at the present time. Thus it would appear that Dr. Jackson suggested the use of aether, while Dr. Morton demonstrated by actual experiment the existence of this Avonderful property. Since the discovery has been made, anaesthetic agents have been used extensively in surgical operations and midwifery practice—also in several morbid conditions of the nervous system. Administration of the AEther.—The horizontal posture is pre- ferred, being the most favorable to aetherization, and it is most easily applied. When first administered, the tube and bottle Avere employed, but the sponge will be found most con- venient. It requires less effort to inhale it, and the atmospheric air introduced with the aether, removes the danger of asphyxia. The sponge should be of an excavated form, in order to ac- commodate the projection of the nose. The sponge previously moist, is saturated with aether of the purest quality, and applied to the nasal cavities. The volatility and combustibility of aether should be kept in mind when it is employed by candle-light. The quantity of aether employed has usually been about tAvo ounces, but Ave are to be more guided by the effects upon the patient, than by the quantity consumed. The time required is from two to five minutes, though it may be prolonged in accordance with the length of the operation, and the difficulty of accomplishing the aether- ization. ANESTHETIC AGENTS. 273 In important operations there is advantage in preliminary trials, to test the susceptibility of the patient, and to instruct him in the manner of its application. The existence of aetherization is usually recognized by the closure of the eyelids, by the non-respondence to questions, and by muscular relaxation. The pulse and respiration should be carefully watched, that when they fail, the process may be discontinued, and the face of the patient sponged with cold water—artificial respiration practiced if necessary. The stimulus of ammonia may also be employed—oxygen gas thrown into the lungs. It should be administered fasting. Uses of Ether—Dr. Warren, of Boston, is entitled to the distinction of having been the first to perform a surgical ope- ration on a patient rendered insensible to pain by the inhala- tion of the vapor of aether. He has continued to use it in his practice to the present time, and furnishes the fruits of his experience with it in two hundred cases, in a small volume which he has published. For his conclusions in the use of the article, refer to volume. The point requiring most skill and care, is to know Avhen aetherization has been carried far enough. Effects produced by the inhalation— The first symptom noticed is a short, dry cough, which im- pels the patient to remove the sponge—Avith a little persua- sion he alloAvs it to be replaced—he inspires the vaporous draught until he becomes insensible. The respiration is often audible, and sometimes apoplectic, afterwards feeble, and almost imperceptible. The pulsations of the heart are often hard and vibratory. The muscular apparatus is excited at an early period. The conjunctiva of the eye is injected with blood. The brain is sometimes singularly affected, and the most curious changes produced in the sensitive and intellectual functions. In some cases the sense of feeling is suspended, while the intellect exists. The principal symptoms disappear in half an hour—when an unfavorable influence is excited, it is exhibited in the form of asphyxia or convulsions. The treatment consists in the suspension of the aether, and the free affusion of cold Avater. Abuses in the use of Ether— For the purpose of destroying life—for the accomplishment of a criminal purpose. The following are the occasions in which aetherization may be resorted to: 274 CHLOROFORM. In Dentistry Tetanus, Amputations, Neuralgia, Extirpations, Strictures, Fractures, Lithotomy, Operations on the Bones, Cautery, Dislocations, Dysmenorrhoea, Strangulated Hernia, Midwifery. CHLOROFORM—TER-CHLORIDE OF FORMYL. It was discovered in 1832, by Soubreiran and by Liebeg. Its composition and relation to other bodies investigated by Dumas and Flouriens, in 1842 and 1847. The same year, Dr. Simpson discovered its most remark- able property as an anaesthetic agent, and applied it to various diseases. Chemical History—Refer to the Professor of Chemistry. Properties- It is a transparent, colorless fluid, of considerable density, of a peculiar, fragrant, aetherial odor, and a SAveetish taste— soluble in alcohol and aether. It is often adulterated with alcohol. Its medicinal properties are various—in large doses, a nar- cotic poison—in smaller, a stimulant, anti-spasmodic, anodyne, and anaesthetic. It is not much employed internally as a medicinal agent. When inhaled in doses of xx. to xxx. m. to 3 i. dropped on a handkerchief, it occasions— Whizzing and pulsations in the head—-a change in the ap* parent color of objects—pleasurable visions and ideas— loss of consciousness, or semi-conscious state—soft sleep,'etc. Or, Tendency to laughter and jocularity, or incoherent talking, or boisterous turbulence, resembling in its effects those of nitrous oxyd gas. In large doses, coma is rapidly produced, with relaxation of the muscles, sIoav and stertorious breathing, Avith total insensibility. Sometimes convulsive twitches about the mouth, frothing at the mouth, etc. Insensibility may begin in fifteen seconds—it is seldom postponed beyond two minutes. If too large a quantity is inhaled, the lips become blanched, spattering at the mouth as one in Epilepsy, and the person in a minute has ceased to breathe. CHLOROFORM. 275 To obviate these dangers— It should be administered in the horizontal posture, and upon an empty stomach. Whenever the stomach is not in a state of emptiness, it produces anxiety and agitation. The uses of Chloroform are numerous. It has been substituted for the inhalation of Ether, to in duce insensibility during surgical operations. Some advantages over aether. It is more rapid in its action, and more certain. It acts in a much less dose. It requires no nicer apparatus than a handkerchief. It can be employed in the cases of children, in Avhom aether often can scarcely be made available. Where there is a Avant of susceptibility to the narcotic action, after trying the use of aether, the more powerful impressions of chloroform have been exerted Avith good effect. It has been employed to subdue the sufferings of child- bearing. It produces no injurious effects upon the female. It does not interfere Avith delivery. Under its influence the uterus and abdominal muscles con- tinue to contract. The child is not affected by its use. It may usefully be resorted to in cases requiring the use of instruments, or where it is necessary to turn the child. Without being used to the extent of insensibility, in small doses it sustains the energies of the patient, and removes the despondency so often felt in these cases. But though you have been informed that Ether and Chlo- roform are Araluable anaesthetic agents, it is proper to state, that they are narcotic poisons of great power and rapid action. In small repeated doses, they produce agreeable exhilaration, and pleasing hallucinations. By merely inhaling chloroform from a bottle, the most delightful thrill over the Avhole frame is produced. They are carried by the blood into every capillary, and excite simultaneously every part of the frame. Chloroform has been employed in all the cases in Avhich Ether has been recommended, and by some preferred. It should be used with caution, as death has in some in- stances been produced by it, and several cases Avill be found recorded in the journals. In some instances, it seems to have been produced by the too free use of the article—in others, a peculiarity of the system has existed unfavorable to its em- ployment. In some cases the cause of death would seem to be conges- tion of the lungs—in others, without any obvious cause. It 276 CHLORIC ETHER. * leaves us only the nervous system, independent of vascular action, or congestion, as the seat of the sudden change pro- duced by the rapid passage of the narcotic principle to the great nervous centres. t The fatal phenomena occur suddenly. In four cases death took place within a minute. In two cases in two minutes. Thus it Avould appear that the fatal issue is not a conse- quence of the quantity inhaled, nor yet of the time, but rather the instantaneous violence of the impression. To the diseases mentioned in Avhich aether is used, in all of which chloroform may be employed, Ave may add—Typhus Fever, Mania, Delirium Tremens, Asthma, Cholera, Obstinate Costiveness, and Tetanus. Objections to Chloroform—the facility Avith which it may be abused. The highly concentrated state of the toxic principle, the convenience with Avhich the substance can be transported, the absence of the penetrating and diffusive property of Sul- phuric Ether, favor its use in an undiscoverable manner. Persons have resorted to it for tho purpose of obtaining the pleasure of a temporary delirium. The number of per- sons Avho resort to it in this manner is probably very consid- erable, and leads to the belief that those who employ it in secrecy must be very great. The habit of taking it may be thus formed, which may lead to pernicious consequences. The same objection may be made to aether, but in a less degree. Its volatility reveals its use. The quantity required is also such as to make it more difficult to conceal its employ- ment. CHLORIC ETHER. In consequence of the accidents with the use of Chloro- form, it has been recommended to be used diluted as in the above form. Chloric Ether is the product of the distillation of Alcohol Avith the Chloride of Lime, It is Chloroform diluted with Alcohol. It has been employed without any unpleasant con- sequences at the time or afterwards. It has advantages over Sulphuric Ether and Chloroform—over Ether, in being less irritating to the lungs, the inhalation being more agreeable— Never produces headache in the operator and bystanders— Its narcotic power is equal to Ether. It is more safe than Chloroform. EPISPASTICS. 277 Division 11. EPISPASTICS. The idea of applying to the surface of the body a substance, which, by producing a considerable irritation, was calculated either to displace or equalize in any manner the force of mor- bid excitement, embraces one of the most important patho- logical principles in the practice of our profession. With whom it originated is not very accurately known, but the honor is most probably due to Hippocrates, since the idea is frequently expressed in many parts of his works. When ap- plied to practice, it furnishes us with resources the most extensive in Therapeutics, and presents us with a very favor- able specimen of the state of medicine in the days of ancient Greece. The substances employed by the Greek physicians, as Epispastics, were derived from acrid and irritating vegeta- bles, from the actual cautery, and other means equally severe and pungent. It Avas not until the science was more ad- vanced, that the more common practice, that of employing Cantharides, came into vogue—their introduction into the Materia Medica being attributed to Aretaeus, a physician of judgment and learning, Avho flourished a little before the time of Galen. The method employed by him consisted in rubbing them on the part until a blister was produced. This method, I need not inform you, is noAV rejected, and the present mode of applying them did not prevail much in practice until the beginning of the sixteenth century. Disputes which existed respecting the employment of blisters in a plague which pre- vailed in Italy about the years 1575 and 1590, directed the attention of medical men more particularly to their consider- ation, and laid the foundation of a more accurate acquaint- ance Avith their virtues and operations. The term epispastic, from the Greek word epispao, to draw, signifies applications which draw the fluids more copiously into the parts to which they are applied. It may, therefore, be considered one of pretty extensive import, comprehend- ing not only blisters, properly so called, but Sinapisms, Issues, Setons, Caustics; each of these in their proper places, and in states of disease furnishing us Avith very important means in a curative point of view. Of these, however, blisters are the Epispastics most commonly employed, and they are so desig- nated, because their most sensible effect is to determine upon the skin the formation of vesicles which are filled with humor of the color of amber. The manner in which this effect takes place seems to be by stimulating the arteries to an increased 278 epispastics. secretion. This is evident from the symptoms which folloAV the application of a blister. The skin exhibits all the signs of great irritation—it becomes red and very sensible—the blood circulates Avith so much activity that it penetrates all the cutaneous capillaries, and the exhalation becomes more abundant. As the natural texture of the skin becomes alter- ed, it is no longer permeable to the fluids Avhich the exhalents carry off, the fluids therefore detach it from the cutis vera, they raise it, they accumulate under it, and form the vesicles Avhich the blister plaster covers. This local action is not the only effect Avhich the use of blisters offers to our attention. They exercise a considerable influence upon the system at large. The pulse becomes fuller and more frequent; the ani- mal heat is augmented; many of the organs exhibit the effects of a stimulant impression, and evince, by their accelerated movements, that they are stimulated and irritated. The modus operandi of blisters, in the cure of diseases, has been the subject of considerable discussion. By some it is contended that their beneficial effects are to be attributed to the local and general excitement, producing neAV determina- tions of the fluids, or altering and subduing morbid action. According to others, much of the benefits derived from blis- tering are attributed to the evacuations of serous fluids Avhich follow their application. Without embracing either of these opinions, I may be justified in stating, that there are cases in Avhich advantages are derived from all these modes of ope- rating. That from their general operation, they are capable of rousing the poAvers of life, of communicating to the system an advantageous impression, and of giving to the circulation and the other functions more energy and activity. By this topical impression they are capable of changing the afflux of fluids upon a part Avhich might become fatal, to displace a painful inflammation fixed upon an organ essential to life, and to render it superficial, exciting disease on a part of the body where it may exist Avithout danger. That advantage is de- rived from the discharge, Ave infer from the beneficial effects Avhich follow Issues and Setons, from the blistered surface be- coming, in fact an excretory organ, to Avhich not only an in- creased determination has been made, but by Avhich the over- distended and inflated vessels are enabled to relieve them- selves of their contents. " So long, therefore, as the discharge continues, so long will there be an especial demand for blood in the blistered part, and a consequent derivation of the circu- lation from the inflamed and engorged vessels of the neigh- boring organs. These different effects of blisters will be fully illustrated Avhen I shall speak of their practical application. The beneficial operations of blisters may be arranged un- der the following heads: EPISPASTICS. 279 1. Where the actions of the system threaten to become too Aveak. 2. Where they are irregular. 3. Where they are partially too strong. Under the first head their utility is manifested in the ad- vanced stages of Typhus or other Continued Fevers. In Ty- phus fevers blisters become very useful, when the poAvers of the system show a tendency to prostration, when the contrac- tions of the heart become languid, and the patient struggles under anxiety, restlessness, delirium, difficulty of breathing, &c These symptoms are the result of rapidly increasing de- bility, and strongly point out the necessity of cordial reme- dies, with stimulating applications. Blisters seem to be best adapted to these cases as rubefacients. To obtain this effect their situation should be frequently changed, and after being applied four or five hours to one part, should be re- moved to another. They may be applied successively to the legs, the thighs, upon the arms, to the back, so as to renew each time their general action. It is under these circum- stances, less the local impression Avhich we desire, than the advantageous changes produced in the state of the circula- tion, and the other functions. Of late the delirium which so commonly attends in the advanced stages of this disease, has been considered as more effectually treated by blistering the whole surface of the cranium. In this disease the brain ap- pears to be the organ which is chiefly disordered—many of the distressing symptoms which occur during its progress, having their origin either in the state of sub-acute inflamma- tion which exists, or the state of congestion. The utility of blisters in such conditions is very decided, and the nearer that the application is made to the diseased part, the greater be- nefit Avill be derived. They will be found useful in determin- ing from the part, and giving an impulse to the restorative powers of the animal economy. In Continued Fevers, blisters, judiciously managed, are of great advantage. Without proper attention to the time in which they ought to be employed, they would be productive of much distress to the patient, without any relief folloAving their application. As a general rule they are inadmissible in the commencement of these diseases, and their use should be deferred until the action of the heart and arteries has subsided. There is a state between the reduction of excite- ment, and the appearance of symptoms of prostration, in Avhich they afford the greatest benefit. Morbid action seems in this state to have fixed itself, that the uatural powers of the system are incapable of relaxing themselves from its thraldom. 34 280 EPISPASTICS. These actions, from their continuance, seem to haA'e estab- lished a kind of habit, which Avould run to exhaustion, unless their course AATas interrupted. It is in such states of Con- tinued Fevers that blisters exert a renovating impression, and by changing the existing action tend greatly to subdue it. They are applied Avith most advantage to the calves of the legs, the inside of the arms, or the back of the neck. Such parts of the body being generally preferred as the most con- venient, and from their situation and connections, those upon Avhich the most favorable impressions can be made. In Remittent Fevers, Avhen they have been of long continu- ance, and the spirits and the pulse of the patient begin to flag, they have been successfully employed. Of their utility, Dr. Lind speaks in high terms, and observes that a remission soon follows their application. Dr. Rush, in his account of the bi- lious Remittent Fever ot the year 1780, informs us that he ahvays had recourse to blisters, if the fever did not intermit after the fourth or fifth day. They seldom failed of produc- ing an intermission of the fever, the day after they were ap- plied. He thought that more immediate good effects were derived from blistering the neck and behind the ears. In some of the Eruptive Fevers the utility of blisters is par- ticularly manifested. In the Small Pox, Avhere the patient is of a lax and weak habit, when the pulse is low, feeble and depressed, and the fever insufficient for the expulsion and suppuration of the pustules, Epispastics are certainly indica- ted. Dr. Mead also observes, that whenever the maturation of the pustules does not regularly succeed their eruption, and when anxiety, inquietude, difficulty of breathing, and delirium come on, the fever should be quickened by warm cordials, and especially by the application of blisters. Many other au- thorities, as Sydenham, Morton, and others, may be adduced in favor of the good effects of blisters under such circum- stances. They are useful not only in preventing unpleasant symptoms, but are capable of relieving them Avhen present. They, as I have stated, not only promote the maturation of the pustules, but Avhen the fauces are covered Avith them, and both deglutition and respiration are impeded by the SAvelling of the throat, blisters, Avhen applied to the neck, are highly serviceable. In the advanced stages of Inflammatory Fevers, Avhen the patient becomes languid, and perhaps comatose, blisters are highly beneficial. They are found useful in relieving many of the symptoms of this state, particularly those obstinate and oppressive headaches, Avhich have resisted every previ- ous evacuation, and Avhich often continue to the last period of the disorder. EPISPASTICS. 281 These remarks sufficiently illustrate the utility of blisters in the diseases I have spoken of. The same observations are equally applicable in eArery other species of fever, Avhere such a train of symptoms occur, as have been already described. The Second Division of diseases in Avhich the use of blisters is indicated, is Avhere the actions of the system are Irregular. This division Avill comprehend a great variety of cases, in Avhich, from unequal excitement, either of the nervous or vas- cular system, symptoms diversified, according to the seat of the irritation, will be produced. It is evident that under such circumstances they will manifest very decided and effi- cacious powers, since, if Ave deny to them all other modes of operation, at least we cannot dispute their tendency to restore an equilibrium in the irregular determinations of diseases. These remarks will be better illustrated in considering the diseases Avhich arise from irregular action. Convulsive diseases most commonly have their origin in some irritation of the cerebral system. They generally proceed from undue determinations of the vascular system to this part, or such a degree of irritability as to be excited into irregular actions by the usual stimuli of life. Whatever, therefore, "will abstract from this organ, Avill seldom fail to afford relief, by lessening or destroying the sense of that irritation. Blisters, therefore, are indicatad in such cases to stimulate and excite pain in a part of the body that is sound ; for, according to the aphorism of Hippocrates, Duobus doloribus simul abortis, non in eodem loco, vehementior obscurat alterum. In Epilepsy the use of blisters is too much neglected. Their utility is recommended by Hoffman, Mead, and other more modern Avriters. Their effects are most beneficial when applied to the arms, and I have little doubt that their continued repetition Avould be of decided benefit. In Convulsions Avhich supercede the eruption of Small Pox, blisters act as powerful anti-spasmodics—but they should not on slight occasions, be employed in this state of the disease, lest by their stimulus they aggravate the fever, and increase the number of pustules. In Apoplexy, in Mania, in Hydrocephalus, their beneficia effects are Avell established, and from the peculiar obstinacy of these cases, a single application is not sufficient, but they should be applied successively until the morbid action is sub- dued. In those affections of the alimentary canal, designated by the names of Cholera Morbus, Dysentery, Colic and Diarrhoea, blisters cannot be too much commended. In no cases are the 282 EPISPASTICS. sympathetic connections stronger, than betAveen the skin and the mucous membranes. In these diseases of the internal coat of the alimentary canal, the powerful influence of blisters is Avell knoAvn. In cholera morbus and dysentery, the appli- cation of blisters should never be omitted. They considera- bly lessen the pain and spasm, however excruciating, by a dh7ersion of it to another part. In Colic, they afford quick and certain relief, and it has been observed by some Avriters, that very soon after their applica- tion, purgative medicines have more certainly produced their good effects, In Diarrhoeas, particularly of the chronic kind, they are greatly to be depended upon. I have seen the most happy effects from their use, and Dr. Rush speaks of the very es- sential benefit afforded by them in such complaints. They are most adArantageously applied to the inside of the thighs, and they should be kept discharging for a considerable time. The Third Division of diseases in Avhich blisters are useful, is where the actions of the system are partially too strong. This division will comprehend" all those cases in Avhich there exists local determinations to particular organs, and other parts of the system. The frequency of these determinations must have struck your attention in your intercourse with the sick, and it is from their consideration that the divisions of diseases are founded, and upon them that systems of nosology are established. They constitute, therefore, the very essen- tial point in the treatment of diseases, and it is to their relief that our care must be directed. The necessity of these direc- tions will be obvious, when you consider that there is no con- stitution which has not its particular weak point, upon which the violence of disease is frequently expended. The utility of blisters will, therefore, be apparent, since they so well sup- port the constitutional remedies which are employed, and lend such important aid to our means of cure. The cases Avhich are comprised under this head, will consist of diseases connected with Inflammatory action. Before proceeding further, Ave may inquire, at Avhat period in Inflammatory diseases ought Ave to have recourse to these remedies. From inattention to this circumstance, there has existed much contrariety of opinion, as to the benefit con- ferred by blistering. For applied, as they too often have been, when the system labored under much arterial excite- ment, from the general operation of blisters already pointed out, they have tended to do harm ; when applied after that action has nearly ceased, they do but little service. To be serviceable, therefore, they should not be employed until the Phlogistic diathesis has been so much reduced by depleting EPISPASTICS. 283 remedies, that the irritation produced upon the skin, will, in" stead of proving a stimulus to the complaint, rather serve to counteract the excitement existing in other parts of the sys- tem, and by giving a centrifugal direction to the fluids, save parts essential to life. It is, therefore, by common consent agreed, that blisters are improperly employed before arterial action has been sufficiently reduced, and the excitement lowered to Avhat Dr. Rush has called the blistering point. I should enlarge more upon this subject, but it is one which, from its importance, Avill be enforced upon you by the pro- fessor of practice. The diseases of high local action in Avhich they are appli- cable, are the Pulmonic Affections. In these cases our chief dependence should be upon bleeding frequently repeated, and we should avoid the early use of blisters. But Avhen the dis- ease has continued some time, when bleeding gives but little relief, the pulse becomes small, and the patient unable to bear further evacuations ; under such circumstances Epispastics Avill produce remarkably good effects. If there be no par- ticular pain, but only a general oppression, the vesicatory may be applied to the back, and afterwards, if the disease be obstinate, first to one side and then to the other. When thus applied, they will be found to relieve the chest, promote ex- pectoration, and lower the pulse. In Inflammation of the Liver, Stomach, and Intestines, one of the best remedies is a large blister applied over the part affected. They afford very great relief in such cases, and next to blood-letting, are the most valuable agents we can bring to our assistance. In Rheumatism, blisters do much service, and should always be had recourse to. They create a diversion of the diseased action, and thereby mitigate those acute sensations of pain, and that stiffness which attends this disease. They should be applied over the part complained of and be repeated as often as occasion may require. In the various Anginose affections, the utility of blisters is well established. In Sore Throat, in Croup, in Scarlatina Anginosa, and other diseases of these parts, they are confi- dently applied, and the great relief which arises from their use, entitles them to the consideration of very important means in the treatment of these cases. In the Scarlatina Am ginosa, Avhich prevailed in Philadelphia, in the years 1783 and 1784, Dr. Rush ahvays derived great advantages from their use. He applied them to the neck, or behind the ears. In Erysipelas, they are employed Avith remarkably good effects. In affections of the head and face, from this com- plaint, applied to the back of the neck, they have been highly 284 EPISPASTICS. beneficial. When attacking other parts of the body, they are applied over the affected surface, and Avhen this is very extensive, Avith a rapid extension of the disease, a strip of blister placed along the margin of the inflammation, is very efficacious in arresting its progress. In Ophthalmia, the benefits conferred by this mode of de- riving from the affected part, are Avell known. Besides these diseases, blisters may be employed advanta- geously in many others, and particularly those of a local nature. To extend the further consideration of this subject Avould take up more time than is necessary, and Ave have said sufficient to impress you Avith the importance of the remedy. We shall merely add a few remarks upon the connections of the skin with the general system, as tending to enforce the importance of vesicatories. The sensibility of no part of the system is more remarkable than that of the'skin ; this part of the body being truly said to be the theatre of various functions and phenomena, over which this extraordinary faculty presides Avithout ceasing. The abundant sensibility Avith which the skin is possessed, seems necessary to support the activity of various functions which are continually in operation—to favor the course of the fluids in the capillary vessels—to promote the secretion of a sebaceous humor—to excite into action the processes of ab- sorption and exhalation—to determine the exercise of the sense of touch, and to establish the sympathetic connections of the skin, Avith the internal parts of the body. Each of these functions Avould furnish us with ample materials for consideration, but it is only of the last that I propose to treat. The sympathy most commonly acknowledged is that which exists between the skin and the mucous membrane of the ali- mentary canal. This is obvious from the disgust, the nausea and vomiting, Avhich follows the existence of various exanthe- mous disorders, and from various cutaneous eruptions being produced by substances taken into the stomach. It is evinced by the introduction of Avarm drinks into the stomach, favoring the function of exhalation upon the skin, and the in- troduction of cold drinks suspending, in a sudden manner, the same function. Upon the same principle, a bath taken at an improper period, often interrupts the digestive process. A considerable sympathy exists between the skin and urin- ary bladder, and this connection is often taken advantage of in suppression of urine, relief being frequently afforded by causing the patient to stand upon a cold floor or marble slab. The connection betAveen the skin and lungs is exhibited in the frequent metastaesis of disease from this organ to the respiratory system. The connection between the skin and^ EPISPASTICS. 285 brain is exhibited in the delirium Avhich accompanies certain inflammatory eruptions, such as Small Pox, Measles, Scarlet Fever, etc. Lastly, there is a considerable connection be- tween the skin and the genital system. It is Avell knoAvn that persons affected Avith the itch, Avith leprosy, and other cutaneous diseases, are often troubled with priapism, and an inordinate desire for venereal pleasures,, Attention to these sympathetic connections of the skin, with all the living parts of the body, Avill render this subject doubly interesting, and Avill satisfy you that the importance of blistering has not been too much o\Terrated. It will satisfy you that it is not only the local operation which is to be considered, but that by them great and important changes are promoted in parts of the body very distant, and seemingly but little connected. It shows the harmony and order which reign throughout the animal system, and our great obligations to that Being Avho has caused the instruments of relief, and the structure of our frames so happily to agree. Of the Articles composing the Class Epispastics. The Class denominated Epispastics may be divided into three Divisions. 1. Epispastics, strictly so called, or Vesicatories. 2. Rubefacients. 3. Setons and issues. The most important article under the first head, is the Can- tharis, or Meloe Vesicatorius, or Spanish Fly. Natural History already noticed. Chemical History likeAvise. The chief use to Avhich Cantharides is applied, is in the form of Blisters. No other knoAvn substance produces the effect so certainly, so extensively, and, upon the Avhole, so easily to the patient, and hence this insect is among the most valuable articles of the Materia Medica. Preparation of the Cantharides, and the formation of Blis- tering Plaster. The choice of the place upon Avhich to apply a blister, Avill depend much upon the nature of the disease which is under treatment, and according as our object is to obtain a general or local operation. When we Avish to obtain the general effects, it is customary to apply them to the legs, upon the internal and inferior part of the calves—The advantages of this situation consist— In the facility of dressing, the plaster can be easily retained in its situation by bandages, and they are parts upon Avhich counter-irritation can be made Avith greater effect. 286 EPISPASTICS. Some practitioners prefer applying them to the thighs. The advantages—The surface more extended, and nearer to the seat of irritation. The texture less aponeurotic—less subject to tedious ulcerations. The latter we prefer Avhen a strong impression is to be made upon the system. The inside of the arms another situation favorable for the general operation of blisters. Particular situations selected for particular diseases. Affections of the chest are favorably acted on by impres- sions on the fleshy part of the arm. Diseases of the eyes and head, restrained by impressions on the neck and upper part of the back. Diseases of the abdomen and the uterine organs, by appli- cations to the inside of the thighs. When the operation is local, the nearer the blisters are ap- plied to the seat of the disease, the more beneficial they will prove. The form and shape of the blisters to be employed. The size of these topical applications proportioned to the results Ave Avish to obtain. In general, a large blister does not create more uneasiness than a small one, as from its size it is kept closely applied to the skin, and does not change its situation. The pain produced by the action of Cantharides varies greatly, according to the part to which they are applied, the thickness of the skin, and general iriitability of the constitu- tion. In some cases slight, in others, very acute. In dressing blisters. When to keep up a permanent discharge, the means to be be employed are—a milder form of Cantharides ointment, or using a watery infusion of Cantharides, with stimulating resin ointment. The Savin ointment employed for the same purpose. She pain of blisters is much connected Avith their unsteady application ; it will be proper, in applying them to children, to surround the blister with a margin of strong adhesive plas- ter. Thus it is kept steadily applied to the skin, and the pain and irritation from it greatly lessened. The effects of blisters on the constitution. The production of strangury, by the absorption of some active principle from the fly—for if the flies are steeped in boiling water, they are deprived of this poAver of thus acting upon the urinary organs, while their vesicating properties are not much impaired. The Treatment of Strangury—Much benefit will be derived from the free use of mucilaginous drinks and mild diuretics— as barley-Avater, the parsley root tea, Avatermelon seed tea, etc, opiate enema. RUBEFACIENTS. 287 Lytta Vittata—Potato Fly.—Native of the United States. Has considerable resemblance to the imported fly. From experiments made Avith these flies, they possess vesi- cating properties equal, if not superior, to the imported. Vesicatories derived from the Mineral Kingdom. Tartarised Antimony, already noticed. Nitric Add— From the promptness of its operation, and its local irrita- tion, it has been employed in diseases Avhich are rapid in their progress, and dangerous from their irregular determi- nations—Employed in Cholera Morbus—applied to the whole of the Epigastric region properly diluted, a speedy action commences, and wTith it much relief is afforded. Tavo parts of the acid are diluted with one part of Avater, and Avith 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 neutralized by Avashing the surface Avith a solution of Carbonate of Potash. The cuticle can noAv be easily detached, and the cutis vera left ra\\r. upon Avhich a common blister may be laid, to keep up the irritation. Em- ployed in other diseases in which prompt vesication is desired —to the Ioav states of fever—to the comatose affections—to mania, and other instances where the ordinary process of blis- tering is resisted. The vegetable vesicatories—as the mezereon, the ranuncu- lus bulbosus, and others, seldom employed—their considera- tion becomes unnecessary. RUBEFACIENTS. Effects produced by their application to the surface. The friction by which they are applied, promotes the in- tention Avith which they are directed. The substances are of an acrid and stimulating nature, as Spirits Turpentine, Mustard, Ammonia, Camphor, the Essen- tial Oils, etc., and the diseases which they are used to relieve, are the slighter degrees of local inflammation—Inflammation of the tonsils, slight pains of the chest, rheumatic affections, are often effectually removed by friction of the surface in the neighborhood Avith a rubefacient. Sinapis, or Mustard among the most important. In the form of Cataplasm, it is quick and energetic in its operation, and on the occasions in Avhich it is used, is a 35 288 RUBEFACIENTS. resource, the place of which, probably, no internal remedy can supply. The effects produced by its application. Employed Avhere the poAvers of the system are suddenly prostrated, or languish under a feeling of exhaustion and faintness. The pain and excitement folloAving the applica- tion reneAv the vital energies, and from the convenience Avith Avhich they are applied, they become a very essential, and even necessary article in our prescriptions. The occasions for their use must be familiar to all. Their preparation—by making a paste of the poAvdered Mustard Avith vinegar, and apply it to the skin, spread on cloth. The Rubefacient action quickly succeeds, which can- not be long supported, and it must be removed in the space of half an hour, or an hour, otherwise very painful and dis- tressing sores would be produced. A few words may be said upon the uses of Mustard Seed, (Semen Sinapi) in diseases. It has been recommended in several diseases, as in Dropsy, Rheumatism, Impaired Appetite, Indigestion, Asthma, and several others. As a popular remedy, it has been, and is still in vogue in manv parts, particularly in England. The white mustard seed is proposed, and it is directed to be taken in doses of a tea-spoonful, unbruised, in a little cold water, two or three times a day. It does occasionally prove useful as an aperient, and for this purpose may be employed advantageously in the chronic diseases mentioned. As a popular remedy ithas had a great run, but like other catholicons, it has probably nearly run its course. Oil or Spirits of Turpentine—Avaluable rubefacient. Aided Avith the friction of flannel, the skin becomes as tender and painful, as when a blister has been applied—and in affections of the chest and abdomen, may often be substituted for its more permanent impression. Seldom employed alone, but combined as follows : ft. Spirits Turpentine, Spirits of Hartshorn, Olive Oil— each equal parts, forms a very useful embrocation. There are a variety of other articles commonly employed as rubefacients—as Garlic, Horse Radish, Capsicum, Tincture of Cantharides, Aq. Ammonia, Spirits of Camphor, etc Hav- ing already spoken of their general operation, and the dis- eases to which they are applicable, it is unnecessary to treat of these articles separately. They may be employed singly, or united to the formula already furnished. SETONS AND ISSUES. 289 Where a mild preparation is required, the following may be employed : ft. Spirits of Camphor, Olive Oil, Hartshorn, each equal parts. To these the Tincture of Opium may be added, Avhere ben- efit will ensue from an anodyne operation. A still stronger embrocation is made as follows : ft. Olive Oil, f iiss. Sulphuric Acid, f ss. This preparation is well adapted to Chronic Rheumatism, and chronic pains in various parts of the body. Red Pepper, infused in spirits, forms a very good embro- cation. Granville's Lotion— ft. Spirits Camphor, f ii. Spirits Rosemary, f iv. Strong liquid ammonia, fx.—m. for a liniment. Capsicum Liniment— ft. Powdered Capsicum, f iii. Powdered Mustard seed, f iss. Camphor, f ss. PoAvdered Cantharides, 3 iii. Alcohol, 1 pint—digest and add. Spirits Turpentine, ? vi. The above recommended by Prof Geddings as a rubefacient in Cholera and in collapse of the system, used freely. Another— ft. Alcohol, ^ijss. Sulphuric Ether, ? ij. Tincture Opium, Tincture Cantharides, Aqua Ammonia, each, 3 ss. 01. Organum, 01. Rosemary, each, 3L 01. Sassafras, 31J. Camphorae, (Gum) 3 v.—mix. Apply as a Liniment in Local Rheumatism, Sprains, Bruises etc. SETONS AND ISSUES. The Third Division comprehends Setons and Issues—the manner in which they are/formed. Setons are much employed in surgery. Unless kept very clean, and dressed with much tenderness, they excite much irritation, and prove very troublesome to the patient. 290 STIMULANTS. Issues not being subject to these objections, and being upon the Avhole better adapted to the curative intentions in disease, the remarks made Avill be confined to them. Issues—refer to Prof, of Surgery for the manner in Avhich they are established. They have been in use from a very early period in medi- cine, from the time of Hippocrates to the present day. Diseases in Avhich they have been used. In Phthisis Pulmonalis—Their utility confirmed by the very beneficial effects Avhich have folloAved the spontaneous pro- duction of abscesses in the axilla in phthisical cases. They may be applied to the sternum between the breasts, and kept discharging two or three months. In Cnronic Hepatitis, and other morbid states of the Liver. The deranged conditions of the viscus are often relieved by the occurrence of a diseased state of the skin; as gutta rosa- cea, herpetic eruptions, and leprous dequamations. A caustic issue has the same effect, and it possesses the advantage of being easily applied at any time, and easily healed. The efficacy of the discharge is confirmed by the practice so common in India, of establishing these artificial drains in the neighborhood of the diseased organ. It has been noticed as a very common occurrence, that the porters Avho generally go naked to the middle, exhibit in their sides either issues in operation, or the cicatrices Avhich have been formed. The use has extended to the treatment of Dyspepsia and Hypochondriasis. In obstinate cases of Leucorrhosa, Avhich had resisted all the usual remedies. In Menorrhagia, applied on each side of the spine, above the ilium. In Scrofulous affections with advantage. In scrofula of the hip joint, or that disease called Morbus Coxarius, and in that affection of the spine known under the name of Spina Bifida. Division 12. STIMULANTS. Having completed what was necessary to be said on the articles which promote particular secretions, I shall proceed to speak of those, the action of Avhich is general and diffused over the system. The medicines of which I am noAv to treat, STIMULANTS. 291 exhibit their effects upon the several systems of the body, as the arterial, the nervous, the muscular, etc., those of Avhich I have spoken have their operation upon its parts. By the term Stimulant, is meant an agent endowed with power to increase the mobility of the system, or in other Avords, to excite sensation, motion and thought. It is not to be supposed that the articles of this Division differ only in the degree in which they are capable of producing these effects, but in each is to be observed not only a difference of power, but also in their specific operation upon the system. Thus, to some belong the property of exciting the action of the heart and arteries, of producing warmth upon the surface, and Avith these a reneAval of the vital energies. These are what I would denominate Stimulants or Incitants. Others, in addition to these general effects, manifest a particular action upon the sensorium commune, or general nervous system, as evinced by the property of producing sleep, allaying pain— these are called Narcotics. Others, besides a stimulant ope- ration, have the effect of allaying irregular muscular contrac- tion ; and to these is applied the term Anti-spasmodic To the head of Stimulants may be referred two other classes of medicines, the operation of Avhich is more slow and gradual, but their effects are equally obvious. These are Tonics and Astringents. Under this term, then, Ave have arranged five classes of medicines, each of Avhich I shall consider in their order.—Murray's M. M. First, of those called Stimulants, or medicines increasing the action of the heart and arteries. Stimulants produce their effects by an impression upon the nervous energies of the stomach, Avhich, being communicated to the sensorium, is thence diffused over the system. The operation of these substances is too rapid to admit of the sup- position of their introduction into the circulation. By the impression upon the stomach through the medium of the nerves, the ATital energies are excited, as is evinced by the activity of the mental and corporeal poAvers, the increase of the force and vigor of the pulse, by the general determination of blood to the surface of the body, producing heat, flushing, and even perspiration. From a knowledge of their effects, Ave judge of the diseases to which they are applicable Em- ployed Avith caution, they become very valuable in those cases of debility succeeding fevers, or other violent dis- eases, Avhen the morbid action ceases, and no organic disorder remains. At the present time, it is so fashionable to attribute all dis- eases to inflammation, that it might almost be questioned whether such a class as Stimulants should be retained. We 292 EPISPASTICS. confess that Ave are not so much a convert to the physiologi- cal system of medicine, as to admit of their exclusion from practice. We still, however, consider that they are less ne- cessary, and that their administration should be more cau- tiously regulated than has been usual. This is more particu- larly the case Avhen Ave reflect, that all the symptoms of pros- tration may be produced from irritation or inflammation of particular organs. Take for example typhus, and the low forms of fever generally. The symptoms most strongly cha- racteristic of these diseases, arise in lesions of the cerebral, spinal and nervous systems. Inflammation of these systems is followed by great prostration of strength, frequent pulse, excited skin, depraved secretions, stupor, coma, convulsions ; and it is for the relief of these very symptoms that stimulants are so frequently employed. There are other cases, hoAvever, Avhere typhus is strictly adynamic, and in which the free use of stimulants becomes necessary. These cases are, however, rare, compared with the acute forms of the disease. The symptoms are great prostration of the muscular and nervous energies, delirium, haemorrhage, scattered petechiae, soft, fluent pulse, heat of the skin little increased, or beloAv par. Under these circumstances it is necessary to administer Stimulants, and often to a consi- derable extent. It is obvious, therefore, that in the employment of these medicines much discrimination is required, and that until a correct diagnosis is drawn, mischief rather than benefit must arise from the use of Stimulants. The practitioner, therefore should make himself acquainted with the Pathology of dis- ease, and that he may be guided in his researches, he must have recourse to the productions of the French school. He will be much assisted by Goupil's exposition of the modern doctrines, Broussais, on Chronic Inflammation; Louis, on Gas- tro Enteritis. But though Stimulants are improper Avhile in- flammation exists, yet they become proper at its decline, to put an end to the relaxation and inaction which occur in parts that have been long stimulated. Under these circumstances the powers of the constitution languish, the circulation is fee- ble, and the digestive function is weak. The functions here, are materially assisted by a supply of gentle stimulation, and it is then that they are useful and safe. PARTICULAR STIMULANTS. 193 PARTICULAR STIMULANTS. Carbonate of Ammonia—Sesqui Carbonate of Ammonia. Preparation— The effects of this article as a Therapeutical agent are— Stimulant, excitant, or califacient. Effects upon the system— It produces a Avarmth in the mouth, throat and epigastri- um, frequently attended Avith eructations. A temporary excitement of the vascular system succeeds, this excitement being often of short duration. The heat of the skin is sometimes increased, Avith a tenden- cy to perspiration. Sometimes other secretions are excited, as the Urinary. The nervous system is also affected, and the activity of its functions is heightened, as evinced by the increased capabi- lity for muscular exertion, and the great facility Avith which all the functions are executed. It is employed, therefore, with advantage as a stimulating sudorific in Continued Fevers, Avhich ha\re existed for some time, and when the activity of their circulation is abated. The usual dose is grs. v. every second hour—but it may be given to an extent of grs. x. every hour, and even every half hour. As its effects are evanescent, perhaps more so than any other medicine, the doses ought to be small and frequently repeated. In one respect, the vol. alkali differs from any other article of the class, which is, that though it is a powerful stimulant, it excites an action Avhich approaches nearer to health than any of them. On this account it is used earlier than any other medicine in Inflammatory affections, and Avith greater safety in mixed cases than most of this class. It may be given in pills, or what is preferable, in the form of Julep, as follows: ft. Carbonate of Ammonia, 3 i. White Sugar, 3 iii. Mucilage, f vi. Spts. Lavend. Comp., 3 ii. m, Dose, f ss. every hour or two hours. In other forms of Fever it is given, , In Intermittents it has been recommended. When given before the period of accession, it either pre- vents the paroxysm, or mitigates its violence, It may also be employed during the hot stage, in the state of Spiritus 294 PARTICULAR STIMULANTS. Mindereri, with great benefit, in order to bring on perspi- ration. In Remittents it is also useful, where there is any tendency to Typhus. In some Inflammatory affections this article has been re- commended. In Pneumonia, after action has been subdued by depleting measures, Avhen the expectoration is deficient, the skin dry, and the pulse small, it has been given in combination Avith a Decoction of Seneka, Avith the effect of promoting perspira- tion, and a more free expectoration. In the form of Pneumonia called the Typhoid, this article in conjunction Avith other sudorifics, forms the most successful plan of treatment. The practice pursued in this disease. In many of the affections of the Alimentary Canal, the Car- bonate of Ammonia is employed with advantage. In Flatulent Colics, unconnected with Inflammation. In Cardialgia, depending upon acidity—and in the same affection Avhen it occurs in the early and late stages of preg- nancy, this article combined with magnesia and other sub- stances, has been found very efficacious. The folloAving is the usual formula: ft. Aqua Ammonia, Calcined Magnesia, each, 3 i. Cinnamon Water, f ii. Water, ? iv. m. Dose, f ss., whenever the uneaseness is experienced—and by taking a dose before each meal, the recurrence of the un- easiness is prevented. In Gastric affections supervening on habits of irregularity and debauch. ^rln Chronic Rheumatism, in combination with the Tincture of Guaiac, forming the Volatile Tincture. In Hoarseness, depending upon relaxed states of the throat, beneficial effects have been obtained from its use. In diseases of the class Neuroses—Not useful in any but as a palliative in Hysteria, and a Stimulant in Syncope. The Ammonia has been reported as possessing the poAver of quickly bringing an intoxicated man to his senses. The re- ports contradictory on this subject. The circumstances Avhich in our opinion render it efficient. As an application to Burns—It has been recommended by M. Guerand, and employed in the form of caustic ammonia. When the burn affects the extremities of the fingers, they are immersed in the liquid Avithout any addition of water. When the seat of the burn does not admit of such immersion, PARTICULAR STIMULANTS. 295 compresses dipped in the liquid are applied, preventing the evaporation by means of a Avater-proof covering. The pain is thus removed. As evaporation takes place, a renewal of the solution should be made. The stronger the solution, the more efficacious. When there is solution of continuity it should not be used. Lastly, in the bites of venemous reptiles it has been recom- mended. It is given internally in large doses, and the part is bathed with a solution of the same, and popular opinion is in favor of its utility. Applied externally, it may be beneficial by uniting Avith the poison, Avhich is probably of an oily nature, and thus neutralising its activity. A variety of other diseases are enumerated by writers in Avhich this article is beneficial. We are, in our opinion, in possession of remedies better adapted to them, and shall omit their enumeration. The preparations are the Concrete Carbonate of Ammonia. The water of Ammonia, pure. The Acetate of Ammonia. Camplior.—This article has been variously arranged by wri- ters on the M. M.—by some placed among the Narcotics, and by others among the Anti-spasmodics. The present situa- tion seems to be the least objectionable, as the property most strikingly exhibited is its Stimulant. Its Natural History I have already spoken of, and shall refer to what was said on that occasion—vide Diaphoretics. Application of Camphor to diseases. By some it has been considered Sedative. This opinion is somewhat remarkable Avhen its sensible qua- lities are considered, since no medicine exhibits more evident- ly stimulating properties. Its taste is acrid, and when swalloAved a degree of heat is experienced in the fauces, with some pain and uneasiness, which is probably owing to its stimulating the upper orifice of the stomach. In small doses, it produces much general excitement, andif^ pushed very far, it brings on convulsions, delirium and death.^ fc Composition—Carbon, Hydrogen, Oxygen. The operation of this article is someAvhat peculiar. From its sensible properties it is undoubtedly stimulant, yet it does not exert as much action upon the sanguiferous system as is commonly, supposed. It has an action upon the brain and nervous system in such a degree, as to be considered one of the Sensorial Stimuli, and it is probably from its action on this part of the system, that 36 296 PARTICULAR STIMULANTS. its good effects in diseases are owing. Its action upon the sensorium is different from that of the Narcotics in moderate doses, since it is not always followed by a disposition to sleep. In its action as Avell as composition, it seems to be sui ge- neris, and is better arranged under this head than any other. Camphor is absorbed as we formerly mentioned, and is throAvn out of the system by the bronchial membrane princi- pally. It has also been recognized in the perspiration. Medical uses—It Avas at one time much used in Fevers, but it has been neglected of late, and much more so than it de- serves. It has most frequently been employed in those Fevers con- sidered Typhoid, particularly Avhen attended with marks of great debility, or prostration of strength, and in these cases it is by some much preferred to the vol. alkali. Both are, no doubt, admirably adapted to meet the indications in such cases, and they may be employed alternately, in order to avoid their losing their power, by the system becoming habi- tuated to either. When employed for this purpose, the following formula will be the pleasantest mode of administering it: ft. Camphor, 3 i. Powdered Gum Arabic and White Sugar, each 3 ii. Or SAveet Almonds blanched, one or two dosen. Rectified Spirit, gtt. x. The Camphor is first to be rubbed with the Spirit to pro- mote the pulverization, and very slightly the solution of Cam- phor. Then add the sugar, powdered Gum Arabic, or Almonds, beat the whole into a pulp. Add Water, or Mint Water, sloAvly, f vi Laudanum, gtt. xx.—strain. Dose, f ss. to f i. The quantity of Camphor which remains in solution is very small, and the liquid can scarcely be said to possess more than the flavor and odor of Camphor. This is a very pleasant and useful mixture, extremely Avell bdapted to these cases, and I think preferable to the vol. Idkali. From its influence over the cerebral system, it has been frequently used in Fever to allay the nervous symptoms, as the delirium, watchings, subsultus tendinum, and often with success. In Gangrene, it is recommended by the German physicians to promote a separation of the slough, and it is employed in- ternally and externally, by sprinkling the powder on the part, or bathing it with the Tincture. PARTICULAR STIMULANTS. 297 But it is less used for this purpose since the discovery of the efficacy of Blisters, in arresting the progress of mortifica- tion. It is often necessary to support the strength of the patient, and this is best done by a combination of Bark and Camphor. In Intermittent the same combination Avill be found useful, given during the intermission, and before the expected paroxysm. In the ExantJiemata it has been long celebrated to promote the eruption, and to bring it back if it had receded—and in the confluent Small-pox it is used to promote the filling of the pustules, and to change the type of the Fever. In Inflammatory Fevers, after action has been reduced, Cam- phor, in combination with Nitrate of Potash and Tart. Anti- mony, has been held in much repute to excite perspiration, and change the action of the disease. Of this combination I have already spoken under the head of diaphoretics. In Chronic disorders it is used more freely, and with less danger. In some cases, a little opium is joined, which pre- vents the uneasiness which Camphor of itself is apt to pro- duce, at the same time increasing its operation by the skin— a compound of Camphor and Opium being one of the most poAverful Diaphoretics. In Chronic Rheumatism, or other disorders where copious perspiration is required, there are few medicines more certain than a compound of Camphor and Nitrate of Potash, about grs. v. of the former, and x. or xv. grs of the latter, to which half a gr. of Opium may be added, and the dose repeated every two or three hours. In Dysmenorrhea, or painful menstruation, nothing has been found to afford more relief than large doses of Camphor in conjunction with Opium, and of the benefit afforded, we can speak from experience, having seen it operate in many cases almost instantaneously, The proportion used is Camphor, grs. ii. to iv. Opium, grs. 1. Made into a pill and repeated every tAvo or three hours, until relief is obtained—a valuable combination. In the treatment of Spasmodic and Convulsive diseases, Camphor has been much celebrated, but it is noAv little re- sorted to. 7 7. 7 In Mania, Melancholia, and other forms of mental disorder. In these cases Camphor is taken to occasion exhilaration. In persons of a nervous temperament it is much used for this purpose. In the Inflammatory forms it ought, of course, to be avoided, until action is reduced by venesection, and other means of depletion, Avhen the employment of it with Opium, 298 PARTICULAR STIMULANTS. will be found useful in allaying irritation and procuring sleep. There is, however, savs'Dr. Chapman, a form of mania, in which Ave can resort to it at once, Avithout premising any depletion. It is in those cases in which mania is simply an affection of the mind, the system not sympathizing at all, as when it comes on from grief, or religious melancholy. Here camphor and opium, Avith blisters to the extremities, and the alternate use of the warm and cold baths, form the best mode of treat- ment. The patient is to be taken from the warm bath and plunged immediately into the cold, in order to give a sufficient shock. It is, however, more especially in that species of mania AAThich arises in intemperate and debauched habits, that cam- phor exhibits its best effects. When the system is too much reduced by long habits of indulgence in ardent spirits to sup- port blood-letting, emetics, or the cold bath, this article will be found beneficial. Given in doses of five or eight grains every hour, with lau- danum, it will subdue the distressing hallucinations of the patient, renew the sensorial functions, and excite sleep. The formula which I have commonly employed, is that already recommended, the quantity of laudanum being in- creased. Camphor is often a useful addition to opium. Persons Avho cannot procure rest, except by large doses of opium, will sometimes succeed by combining small doses Avith camphor. Camphor dissolved in Spirits of Turpentine, in the propor- tion of 3 ii. of the former to f i. of the latter, is a good application for the toothache. Kreosote of a good quality is better. In Chilblains, the Tincture of Camphor is generally con- sidered a useful article, so much so, that many practitioners would consider it heretical to employ any other remedy. As an external application, feAv articles are more extensively employed in this form. It is literally the family panacea, and the bottle containing the camphorated brandy is resorted to with much faith and confidence in its utility. It is cer- tainly an excellent article in all local pains and bruises, and is much employed by physicians as an ingredient in lini- ments, etc. Camphor is given internally in various forms. It is given in the form of mixture, by rubbing the Camphor with sugar, almonds, or thick mucilage, and adding Avater by degrees. The operation is much promoted by previously adding a feAv drops of the spirit of Avine, or other spirit, by PARTICULAR STIMULANTS. 299 which the Camphor is dissolved—or it may be suspended in milk, and this last mode of exhibiting it seems to be gene- rally preferred. The camphorated mixture of which I have spoken, is as neat a preparation as any that is prepared, and will serve for most purposes when this article is required. There is a preparation of Camphor, which from its excel- lence deserves to be noticed. It is a solution of Camphor in Avater, saturated with carbonic acid gas. It is prepared in the following manner : If pulverized Camphor is diffused in Avater in a Nooth's apparatus, or any similar contrivance, and carbonic acid gas is extricated by pouring sulphuric acid upon lime, the Avater Avill take up a considerable quantity of the gas, which also dissolves a portion of the Camphor. This is a very excellent preparation of Camphor, often of singular use in irritability of the stomach, and in incipient vomiting. Family Coniferoe— Oil or Spirits of Turpentine.—This arti- cle, from the diversified indications it is capable of fulfilling, is entitled to a conspicuous station in the M. M. Its Natural History and preparation have been already de- tailed. The Oil or Spirits of Turpentine, taken into the system, is an active and diffusible stimulus, occas oning a sense of warmth in the stomach, and commonly throughout the body. It is absorbed, circulates Avith the blood, and in this manner affects the capillary vessels. It is thrown out of the system by the different excretories, on the vessels of which it acts in its passage through them. The exhalations of the skin and the bronchial membranes, acquire a marked terebinthinate odor, while the urine obtains the smell of violets. On the Renal vessels it proves diuretic, and on the cutaneous vessels it proves sudorific. Its con- tinued use brings on irritation of the urinary organs, even strangury, bloody urine, suppression of the secretion, with fever, thirst and vomiting. It has of late been introduced very extensively into the practice of medicine, and from the success Avhich has folloAved its use in many distressing and dangerous diseases, it is enti- tled to your attentive consideration. Of the diseases in which it has been employed, the first in importance is Puerperal Fever. This disease has raged at different times, with considerable malignity, in different parts of England and this country, so that feAv of those attacked escaped. 300 PARTICULAR STIMULANTS. Though not ahvays so destructive in its progress, yet the mortality Avas still ATery considerable. The effect of the employment of this article has been, to arrest its destructive progress, in some instance, to restore the patient under the most unpromising circumstances. The nature and character of Puerperal Fever described. It is Avhen these symptoms occur, denoting the extension of the disease to the Peritoneum, that the Spirits of Turpen- tine exhibits invaluable effects. Given in doses of from 3 ii. to f ss., Avith an equal quantity of castor oil, it produces very copious discharges from the boAvels, and Avith them, a relief to all the distressing SA/mptoms I have mentioned. Peritoneal Inflammation is confessedly at all times very difficult of cure, and a variety'of remedies have been employed for its relief Avith but little advantage. Some medicine is re- quired, which Avhile it supports the strength of the patient, will excite a copious secretion from the Avhole internal mem- brane of the intestines, and thus determine morbid irritation from the Peritoneum. Such a medicine we possess in the Oil of Turpentine, Avhich, Avhile acting upon the principle of a counter-irritant, determines fluids from the intestines, and by its purgative operation, these increased secretions are car- ried out of the system. Recommended in those cases where typhoid symptoms are manifesting themselves. At other times, Avhen it occurs in Hospitals and crowded cities, it must be resorted to early. To the internal use of the article, its external should also be conjoined, as the irritation of the skin will be found to re- lieve many of the urgent symptoms of the disease. In the advanced stages of Pneumonia, particularly when of a Typhoid character, this article may be employed with the greatest advantage. When it is verging on a fatal termina- tion, there are many properties possessed by it, which render it highly deserving of attention. Entering the circulation, and stimulating the secretory and excretory vessels, it exerts an influence much more exciting and enduring, than wTould readily be conceived. It is given for these purposes in small doses frequently repeated, and has proved very efficacious after other remedies had failed to afford relief. The dose should be xx. to xxx. drops, repeated every hour or two hours, and it is most conveniently administered with the white of egg. In Epilepsy, this article has acquired no inconsiderable reputation. PARTICULAR STIMULANTS. 301 It is given in doses of from 3 i. to 3 ii., three or four times a day, and thus administered, cures have been accomplished in adults laboring for two years under this disease. Circumstances limiting the use of this medicine. When the disease depends upon organic lesions Avithin the osseous envelopes of the nervous centres, no benefit can be expected to be derived from the use of this, or any olier arti- cle. It is only when it originates in parts distant from the cerebro-spinal axis, that benefit can be derived from the use of these agents, which, Avhile it stimulates the abdominal vis- cera, operates as a Cathartic and Anthelmintic, and produces a derivative action on the head. As an Anthelmintic, its value is Avell knoAvn. In Chronic Rheumatism, highly recommended, given in small doses. In obstinate obstructions of tlie Bowels, combined Avith Castor Oil, in the proportion of 3 ii, of Spirits Turpentine to f ss. of Castor Oil, every two hours, until it operates. In Irritable conditions of the stomach, as occurs in Yellow Fever, it has been recommended and employed, but it is a remedy of very doubtful efficacy. In Chronic Affections of the Thorax, unattended Avith Fever, but Avhen pain is referred to one spot, Avith a general uneasi- ness of the respiratory system, a slight, hacking cough, op- pression, and a sense of weight about the precordia, and these symptoms occurring in a phlegmatic constitution, Turpentine given in small doses, or a Tincture of the gum, has been found beneficial. In profuse discharges from the mucous membranes, it ope- rates by a topical influence over the capillary and secerning vessels', in its passage through them. In some instances, its operation is confined to an increase of tonicity in the vessels which pour out the mucous—and in others, to a new kind of action, or irritation in the affected membranes, which super- sedes the previously existing disease. In Gonorrhoea and Gleet, it has been employed as a substi- tute for Copaiva. . . . Where relief is afforded by the use of this article, it is generally speedy, so that it is not necessary to continue its use longer than five or six days. Where it is useful, from the tendency of these diseases to recur, it should be continued some time after the symptoms have disappeared. In Fluor Albus, the Terebinthinate medicines have been employed, and sometimes with success, but they are generally ill adapted to the feeble constitutions in which this disease occurs. 302 PARTICULAR STIMULANTS. In Catarrhus Vesica', or Crystirrhoea, it occasionally acts beneficially, but it is required to be used in small doses, and Avith caution. In chronic Pulmonary Catarrh, and in chronic Diarrhoea and Dysentery, it has proved advantageous. In the hist cases, it has a decided action upon the affected part, besides acting upon the mucous surfaces after its absorption. In Tympanitis^-To relieve flatulent distension of the stom- ach, and the colic thereby induced. It should be given in full doses so as to act as a purgative, or it may be administered in the form of enema—also in Acute Tympcautis of the Puerperal state. Besides these diseases, it is a valuable Styptic in Haemor rhages. Employed externally, a dosil of lint dipped in Spirits of turpentine, and applied to the bleeding vessel, is very effi- cacious. Internally, employed in haemorrhages from the stomach, it has succeeded after other means have failed, united Avith the white of egg. In Nasal Haemorrhages, which nothing else has stopped, ten drops of Turpentine, taken every tAvo or three hours, has en- tirely arrested the bleeding in less than tAventy-four hours. Haemorrhages from other parts, particularly those called Passive, have been arrested by the same means Its virtues, as a styptic, depending upon its exerting some direct influ- ence on the contractile power of the-blood-vessels. It relieves the pain arising from the sting of bees, or other insects, rubbed over the part. The forms of administration— The best mode of taking it, is mixed with any aromatic water, or blended with mucilage or honey, or Avhite of egg, or with magnesia. Another mode, is to dissolve the Terebinthina Vulgaris, or Gum Turpentine, in Avhiskey, or brandy; of this from 3 ii. to f ss. may be taken, diluted Avith water. As the dose varies according to the disease, Ave shall briefly recapitulate on this head. In doses of 3 i. or less, taken repeatedly in the day, it is used in removing chronic pains of the limbs, chest and else- Avhere. In doses of 3 i. to 3 ii. or 3 iii., it is used in adults laboring under Epileptic Convulsions, Puerperal Fever, obstructions of the bowels, and the irritable state Avhich attends YelloAv Fever. As a Vermifuge, in doses of 3SS. to f i. f ii. in cases of Tae- nia—and in smaller quantities in the other species of Avorms, combined with Castor Oil. As an external remedy— CREOSOTE. 303 It is employed as a Rubefacient in numerous diseases, on the principle of counter-irritation. As in the form of Liniment in Chronic Rheumatism, Sprains, Neuralgic affections, etc In the form of Fomentation, to produce redness of the skin in Puerperal Peritonitis. As a powerful local stimulant, it is recommended by Dr. Kentish as an application to scalds and burns, particularly if attended Avith great constitutional depression. It is an ingredient in many nostrums. Whitehead's Essence of Mustard contains Turpentine, Cam- phor, and a portion of the Spirits of Rosemary. St. John Long's Liniment consisted of Oil of Turpentine and Acetic Acid, held in suspension by yolk of eggs. CREOSOTE. So called from its poAver of preserving meat, from Kreas, flesh, and sozo, I save. A substance of the nature of volatile oil, discovered by Reichenbach in the products of the distillation of wood. It was discovered Avith five other principles, called paraffine, cupione, picamar, cappomer, and pittacal. Preparation. Properties— Colorless oleaginous liquid, of the consistence of oil of almonds. Taste, caustic and burning, followed by sweetness. Odor, penetrating, disagreeable, like smoked meat. To the touch greasy, volatilizable by heat. Medical properties and uses- Irritant or stimulant, narcotic, styptic, antiseptic, mode- rately escharotic, and by some, alterative and astringent. Of all the various uses to which Creosote has been applied in medicine, there is none in which its efficacy has proved more valuable, than in checking vomiting, unconnected with any organic disease of the stomach. Its utility has been very favorably spoken of by several distinguished practition- ers, viz.: Drs. Eliotson, Thompson, etc. It has been employed in the vomiting Avhich accompanies the colica pictonum, or painter's colic—in attacks of ordinary colic, in hysterical conditions of the system attended with vomiting, in vomiting from pregnancy. It should be observed, that it is chiefly useful where the condition of 37 304 CREOSOTE. the stomach depends upon nervous irritability of the system, and to be improper in those cases complicated Avith inflam- mation. ft. Creosote, gtt., vi. Mucilage, f ii. Water, f iv. Dose, f ss. to f i. every tAvo or three hours, according to circumstances. Or, In the form of pill as folloAvs: ft. Creosote, 1 drop. Aromatic confection, grs. iv., for pill 1. The form of pill preferred in those cases Avhere patients have a strong dislike to the creosotic odor, and administered as above. Creosote has been useful in arresting vomiting after other articles have failed. In diseased conditions of the mucous membrane of the Ali- mentary Canal, it has been employed Avith considerable ad- vantage, and the forms in Avhich it is more particularly use- ful is in Cholera Infantum, Diarrhoea and Dysentery of adults, accompanied, as they often are, Avith pains, griping, &c In Hemorrhage from the boAvels, and from other organs of the body, it has also been employed, and Avith beneficial ef- fects, proving itself often more valuable than the Spirits of Turpentine. In Diabetes, Creosote is, perhaps, the most generally effica- cious of any known remedy. Dr. Elliotson has reported four cases, differing in many general respects, in all of which it was of the greatest service. In Epilepsy it has been tried, but without any satisfactory results. Creosote has been pretty generally tried in affections of the lungs—but the experiments of several persons have deter- mined, that it is not a remedy Avhich should be given in Con- sumption, though in cases of increased secretion from the bronchial tubes, Avithout inflammation, and in Asthma, depend- ing upon a morbid excitability of the mucous membranes of the bronchia, it has been found of eminent service. External application of Creosote- Toothache—Preferable to other remedies—relieving the pain more certainly and speedily, and prevents its recurrence for a longer period—Chiefly useful Avhen the nervous pulp is exposed—Introduced into the cavity of the tooth by means of a camel's hair pencil, or quill. In various cutaneous diseases—as Scabies, Ring-Worms, Im- petigo, Acne Rosacea. ALCOHOL AND ITS COMBINATIONS. 305 To Chilblains. In Burns. In Ulcers of the scrofulous, phagaedenic, and venereal kinds, it has been found most useful, and in others having a cancerous appearance. To correct the fetor from ulcerated surfaces. ALCOHOL AND ITS COMBINATIONS. Alcohol is the product of the Saccharine principle, and is formed by the successive processes of vinous fermentation and distillation. It is presented to us variously combined, according to the substances from Avhich it is obtained, and of different degrees of strength. It is the same substance in rum, brandy, gin, whiskey, in wines, and in the number of intoxicating drinks, which the ingenuity of man has discovered in every section of the coun- try throughout the globe. Its flavor, hoAvever, is modified according to the substance from which it is obtained, and its strength is influenced by a variety of circumstances which will be detailed to you from another chair. From all these different liquors, the spirit can be obtained perfectly pure, and concentrated by repeated distillations. When thus obtained, it is colorless and transparent, its odor is fragrant, and its taste highly pungent; in its specific gravi- ty it is lighter than Avater, and this will be in proportion to the degree of concentration. Its effects upon the system, are those of a powerful, and highly diffusible stimulus, increasing the activity of the cir- culation, exciting muscular energy, and great exhilaration of spirits. Given to a large extent, these effects are followed by intoxication, temporary delirium and stupor, exhibiting a strong analogy to the Narcotics, a class of medicines soon to be described. In this state of concentration of Alcohol, it is seldom used internally, for though it might be employed, to rouse the pow- ers of the system, it could seldom be used advantageously to repress irregular action, to graduate the excitement, to dimi- nish irritation, or to induce sleep. It is, therefore, principally employed as an external appli- cation to burns—to certain states of local inflammation not connected with increased action, to restrain hemorrhages, and for the relief of muscular pains. 306 ALCOHOL AND ITS COMBINATIONS. In the state of dilution in which it exists in spirits, and in wines particularly, it becomes more extensively useful in dis- eases, being more agreeably exciting, more cordial and plea- sant to the stomach, than any other stimulating article em- ployed in medicine. In the state of Wine, the stimulant operation of Alcohol is less sudden and more permanent. It excites action without exhausting the excitability in any great degree, and from its gradual operation, may be considered in comparison with ar- dent spirits, as exciting a Tonic effect. To these may be added the nutritious substances which exist in Wine, by which the system is invigorated and sup- ported. The diseases, therefore, in Avhich Wine is applicable, may be readily supposed to be of the typhoid character, when the indication is to support the strength of the patient, and to ob- viate symptoms of debility. It is in these cases that it acts not only as a stimulant, but by inducing a more healthy action in the blood-vessels of the brain, it removes the unpleasant symptoms Avhich so often at- tends in these cases, as delirium, subsultus tendinum, restless- ness, &c. By the agreeable sensation it gives to the stomach, it is not only refreshing, but it communicates tone to the bowels, and excites a desire for nourishment. Gently assisting, therefore, and cherishing the languid poAvers, it promotes all the natu- ral evacuations, without increasing the disease, and by quick- ening the languid circulation, prevents those congestions from taking place in various parts of the system, which aggravate the original affection. For the production of these effects it must be given frequently and Avith great freedom, and, there- fore, Ave may say with safety, that in all severe cases, Wine is the article chiefly to be depended upon. By this practice being perseveringly employed, we may with confidence declare that many have been preserved from malignant diseases by the proper use of Wine alone. But in advocating the use of Wine in the low stages of Fe- ver, I would caution against the abuse of it. There are cir- cumstances in the constitution of the patient, or the disease, which plainly forbid its use. In advising it, therefore, its effects are to be duly considered. If it does not give uneasiness to the stomach, nor increase the Fever, restlessness, and raving—if the sick are refreshed, composed, and inclined to sleep by it, have greater freedom from their sickness, or are better supported under it, the con- clusion is, that it must be a safe and suitable remedy, and Avithout fear we may direct its use in such quantity, time and ALCOHOL AND ITS COMBINATIONS. 307 manner, as the disease seems to require, and the sick can bear. If it produces effects the contrary to these, we may safely conclude that it is injurious, and that it ought to be ab- stained from, or given in moderate quantities. Thus carefully exhibited, Wine will be found, says Dr. Chapman, not the least important of the stimuli, at a proper period in these diseases, being readily taken, even when other medicines are rejected, and Avith unrivalled effect it sustains, in many instances, the exhausted powers of life. The state of the skin should also be consulted in the adminis- tration of Wine. If it is hot and dry, it ought not to be given, but when the heat is 98°, you may almost, invariably, admin- ister it with safety, and, if the disorder really demands it, with advantage. Few remedies have been abused more than Wine in Fe- vers. ^ It is still given by many practitioners of the present day, in every stage and complication, Avith too free a hand, without a proper consideration of the organic derangements Avhich forbid its use. There are circumstances, hoAvever, in Febrile diseases, which renders it indispensable to save the life of the patient. It is demanded in cases commencing Avith such excitement, as to render the use of depletives essential, when in their course, some unexpected symptoms of sinking of the vital poAvers, or a sudden collapse comes on, which render the use of Wine, Brandy, and Ammonia, necessary. Such cases are not unfrequent, not only in Typhus Fevers, properly so called, but even in some of the more acute affections, as Bilious Fe- vers, and Intermittents of a malignant character, During the summer of 1831, several patients wTere admitted into the Hospital, who trading to Savannah, were detained in the river several days, and others of the crew of the Revenue Cutter, were attacked with Fever of the climate, and of a very violent character. After the third or fourth paroxysm, great prostration ensued, Avith congestion, and such feebleness of the vital poAvers, that reaction seemed as if it could never be excited. Several of the patients were only restored, by the free use of Stimulants. Again, the practice becomes useful in persons above the middle age, Avho have lived intemperately, and in Avhom these sudden changes are likely to occur. The practitioner should be much on his guard in acute cases of" Fever, and he will have reason to congratulate him- self, who can provide for these emergencies, but he will be doubly happy, who, by much care, can foresee and prevent them, 308 ALCOHOL AND ITS COMBINATIONS. Stimulants become necessary in the advanced stages of Ty- phus Fever, Avhen the symtoms indicate a failure of the ner- vous and circulating systems,and especially when evacuations have in the beginning been judiciously employed. Here the administration of Wine often acts like a charm, by rousing the languid poAvers and abating the restlessness. The quantity of Wine -Avhich should be administered in Typhus, must of course depend upon the symptoms, and the degree of action existing in the system. Sir John Pringle was in the habit of ordering in the Jail or Hospital Fever, from a quarter to a half pint a day of the strong kinds of Wine, (which quantity Avould now be con- sidered insufficient in many cases,) and of the Rhenish, or small French Wine, as much as a quart a day. In the Low or .Nervous Fevers, Dr. Gilchrist allowed a bottle a day, and Dr. Heysham gave as much as two bottles and a half in the space of tAventy-four hours, in the Putrid Fever Avhich appeared at Carlisle, in 1781, and thinks that even more might sometimes be given Avith advantage. In the last stage of the Jail Fever, Dr. Carmichael Smith has given with advantage twro bottles of Madeira a day, for several days together. . Upon the subject of quantity, no precise directions can be given. In some of the above instances it may have been given in too large quantities, and in others not sufficient. The strength may certainly be roused by powerful stimuli, used to a great degree, but it may be questioned Avhether the patient has been benefitted, since Ave have seen this new excitement immediately followed by an inflammatory con- dition of the brain, or the excitability so much Avorn out, that no subsequent attempts could renew the powers of life. Perhaps a pint a day may be generally sufficient, but upon this subject, no precise quantity can be specified. The choice of Wine is no matter of indifference. To obtain the medicinal effects of Wine, a preference is commonly given to Port, as being less disposed to acidity, and possess- ing a less degree of Spirit than Madeira. When this cannot be obtained, good old Madeira will be found to possess every quality Avhich is necessary to excite action, and to supply the pabulum upon Avhich this action is to be maintained. Next to these is Sherry. As a general rule, it will be found advisable to allow the sick their favorite Avine, When Wine cannot be procured, Cider, Porter or Spirits, diluted with Avater, sAveetened and acidulated, are tolerable substitutes. Dr. Cullen Avas of opinion, that the last men- tioned compound and Opium produced all the effects of Wine, but Opium does not support the pulse like Wine. ALCOHOL AND ITS COMBINATIONS. 3C9 Besides Fevers, Wine is employed with much advantage in Tetanus. Dr Rush, and several other American physicians, speak favorably of the practice. Dr. Currie saAv a patient cured of this disease in the Liverpool Infirmary, by drinking nearly a quarter cask of Wine. To the valetudinary and infirm, it affords a wholesome and agreeable stimulus, and to the convalescent from acute dis- eases, the means of renovating their exhausted vigor. Of the use of Ardent Spirits, I need not say much. They are seldom resorted to, except in extreme cases, and it is such cases as will justify their use. Their stimulant operation is not sufficiently permanent, or capable of being regulated, and it is questionable Avhether the patients may not suffer more from the depression which follows the excitement they produce, than he can be benefited by the temporary elevation consequent on their use. Poisonous Operation of Ardent Spirits. When taken in large and poisonous doses, they produce all the effects of the narcotic poisons :—insensibility, apoplectic stertor, labored and imperfect respiration, weak, frequent pulse, Avith paralysis and insensibility of the Iris. Treatment—The administration of an Emetic. If the stomach cannot be excited to action, then titillation of the throat should be practiced—Warm water introduced into the stomach—The cold affusion—The use of the stomach pump—Ammonia as a stimulant, and to counteract the narco- tism induced. The degree of danger arising from Ardent Spirits, Avill be estimatedj by the in-irritability of the Iris, and the Avant of energy in the stomach to expel its contents. If this last can be excited, the patient will recover—but if it cannot, death is usually the consequence, since it is to be presumed that the stimulus has been so powerful as to bring on a fatal state of collapse, by Avhich the powers of vitality are exhausted—and instances are not rare of persons having fallen dead instanta- neously, upon SAvallowing a large quantity of spirits. Morbid appearances—engorgement of the vessels of the brain, and a quantity of serum in the lateral ventricles. Family Solanaceae—Capsicum Annum—Red Pepper. Native of South America, but cultivated extensively in this country. Fruit, an oblong pod. Odor, aromatic. 310 CAPSICUM. Taste, hot and pungent. Capsicum is a very active stimulus, differing in a very es- sential manner from the preceding, in not exciting a narcotic operation on the brain, and in being less injurious in its ope- ration than any other stimulus of the same activity. Effects in small doses. Effects in large doses. It is employed chiefly as a condiment. It is added to va- rious articles of food, either to improve their flavor, or, if dif- ficult of digestion, to promote their assimilation, and to pre- vent flatulence. Much employed by the inhabitants of warm climates. Its constitutional, not being in proportion to its local effects, it is not much employed by physicians, as a general or diffusible stimulus, though much in repute with irregular practitioners and the common people, for a great variety of purposes. From the peculiarity of its operation, i. e., from the consti- tutional not being in proportion to the local effects, it is em- ployed in cases and circumstances which would seemingly forbid its use, and to this only can we impute the impunity Avith which it is administered, in the excited states of the system. Chemical History— From this article, a peculiar substance has been obtained, to which the term Capsicin has been applied. When pure, it is tasteless, inodorous, and crystallizes in acicular frag- ments. Etherial Oil of Capsicum— This oil possesses a most intolerable warmth and acrimony of taste, and concentrates all the stimulant properties of the pod. It is of a brilliant reddish color, has a peculiar odor, and aromatic taste. Preparation. Diseases in wdiich Capsicum is employed. In Febrile diseases. It is employed to support the strength of the patient. It is continued in these cases until a general warmth takes place, which must be kept up as long as debility, or symptoms of congestion exist. It is a valuable auxiliary in these cases, and is much resorted to. In some of the stages of Dyspepsia, employed as a Carmi- native. In Cynanche Maligna—Taken internally and used as a gar- gle. The manner in which it is prepared is the following : Tavo table-spoonfuls of Cayenne Pepper, and two tea- spoonfuls of Salt are to be beat up into a Paste, on which half BLACK PEPPER, 311 a pint of boiling water is to be poured, and strained off when cold—an equal quantity of vinegar being added to the infu- sion, a table-spoonful every half hour, diluted Avith water, is a proper dose for an adult. Used also as a gargle. Used in the form of a weak infusion, as a gargle in relaxed states of the throat. In various diseases attended Avith diminished susceptibility of the stomach, Capsicum is an exceedingly useful adjunct to other powerful remedies—the operation of which it promotes by raising the diminished sensibility of this viscus, as in Chol- era, Intermittents, the low forms of Fever, etc As a Counter-irritant—It is a valuable addition to poultices and cataplasms, for renewing warmth, or exciting counter- irritation. The Tincture may be employed for the same purpose. Some individuals troubled with cold feet, have derived benefit from wearing socks dusted with Cayenne Pepper. Family Piperineaer—Piper Nigrum—Black Pepper. Natural History— Properties—Stimulant and Carminative. It is used as a condiment. It is medicinally employed in checking nausea and vomit- ing, in removing hiccough, in attacks of retrocedent Gout, as a gargle in relaxation of the Uvula. Extended to the treatment of Intermittent Fever. May be taken in the state of powder, or the seeds swal- lowed whole, to the extent of v. to viii., twice a day. The seeds are dipped in a solution of Gum Arabic, and after- wards in powdered Columbo to disguise them. Seldom necessary to administer more than lxx. or lxxx. of these pills before a cure was effected. Piperine, the alkaloid obtained prom Black Pepper, is pre- ferred. The dose is from one to four grains. Valuable adjunct to Quinine. When Piperine is used, it should be only such as is colored, and the deeper the color, the stronger it is. When perfectly pure, or white, it is tasteless and inert. It is often combined with Quinine. Half a grain of Piper- ine, and half a grain of Quinine, is equal to two grains of Quinine. From Pepper an oil has been obtained, which is called the Oil of Black Pepper. It is employed in Fevers of a Typhoid type, and is also a valuable adjunct to Quinine in Intermittents. One drop is equal to three grs. of Quinine. 38 312 CUBEBS- It is recommended as a cheaper and more valuable addition to Quinine than Piperine. The Oil is separated from the Pepper by means, of Ether and Alcohol. Piper Cubeba, or Cubebs. Natural History— It resembles* the common Black Pepper in size. Taste, less pungent than Black Pepper. It is principally known as a remedy in Gonorrhoea. Mr. Broughton's experience with this article. In fifty cases in which he employed it, there Avere five fail- ures, five cases relieved, forty-one cured—the period varying from thirty-six to forty-eight hours, to a period less than a montlr—the average three weeks. That it has advantages over the Balsam of Copaiva, in being admissible in the earliest and Avorst stages of the severest Gonorrhoea, without being productive of any inconvenience to the patient, ot being attended with any injury to the-func- tions of the stomach. The time in which the cures were performed, also entitles it to a superiority. Dose, 3 ss. to 3 ii. of the Powder. 3 ii. to f ss of the Tincture. If no beneficial effects follow, after the administration for two or three days> it should be omitted, and some other reme- dy employed. We have employed this article without much advantage, and are better pleased Avith a combination of the Tincture or Powder with the Balsam of Copaiva, after inflammatory action has been subdued. Sir Astley Cooper's formula : Of the modus operandi of Cubebs iii curing Gonorrhoea— The poAvder is digested in the stomach, the volatile oil enters the circulation, stimulates the secretories of the kid- neys, increases the secretions, and renders it less acrid and irritating to the bladder and urethra—at the same time, the urine being impregnated Avith the oil, the urethra is subjected to the specific impression of the medicine. Cubebs contain an oil, upon which the efficacy of the arti- cle depends, in the proportion of f i. and a{ toa pound. From the existence of this volatile oil, the effects of the poAvder are often unequal. Precautions in using the Powder—that it should be pre- served in closely-stopped bottles, and to be ground, or poAv- dered, a few hours only before it is administered, so as to re- tain as much of the oil as possible. NARCOTICS. 313 The oil may be administered in diseases. In drops, in the dose of x. to xx., three times a day, or in the form of mixture, as the Balsam has been directed. The discovery of the oil an important one, as we have in many instances a remedy for Gonorrhoea, in as small a compass as we have for ague in Arsenic or Quinine. Cubebs has been objected to from its tendency to produce swelling of the Testicle. After very frequent trials of this article, in the form of powder and essential oil, we have only known of one case in which this effect was satisfactorily ascertained to have been produced. In Leucorrhoea it has also been employed. In Chronic affections of the bladder. To the several modes mentioned of administering this article, Ave may state, that it has been given in the form of Enema. Balsam of Copaiva has been employed in like manner, and reported to have cured some cases speedily and effectu- ally. The manner of preparing the enema is the folloAving: ft. Balsam Copaiva, 3 ii. Mucilage, f iv.—mix for enema. The second day the quantity is doubled—the third day 3vi. of the Balsam—the fourth day, 3 viii.—Laudanum is added to tranquillize the rectum, and alloAv of its retention. Adulterations— Adulterated with the other and cheaper kinds of Pepper. It is mixed with powdered Pimento. Cubebs ought to be kept in the pulverized state in a Avell stopped phial, as its essential oil is volatile—and when kept in paper, the latter absorbs a large proportion of it. Division 13. NARCOTICS. Definition of this Class— % m Such substances as diminish the sensibility and irritability of the system, Avithout occasioning any sensible evacuation. This definition is objectionable, inasmuch as with the ex- pression of some of the properties of these medicines, their stimulant operation is not included. Narcotics, though they have been considered by Dr. Cullen and other writers Seda- tives, are Stimulants, endowed with considerable activity, and great diversity of remedial operation. 314 NARCOTICS. Their general effects are, to increase the force and frequen- cy of the pulse, to excite the operations both of the body and mind, giving to them increase of vigor, inducing hilarity and intoxication. These symptoms are soon folloAved by those of diminished action, the pulse becomes sloAver, but is full and soft, the body is less sensible to impressions, respiration is more easy, pain and inordinate motion, if present, are alleviated and de- pressed—the mind becomes inactive, and finally sinks into sleep. To these succeed debility, with lassitude, tremors, and op- pression. Such are the effects of a small dose. If the dose is larger, the symptoms of diminished sense and action are induced without much previous excitement—and if the quantity be still larger, delirium, paralysis, coma, and convulsions super- vene, and death finally succeeds. These are the general effects of Narcotics. They are diver- sified according to the article employed, and not only do they differ widely from each other in their effects upon the S3Ts- tem, but the operation of each is very different at different times, according to age, habit of body, dose and use, and va- rious other circumstances. They all agree in one respect, which is their effect upon the functions of the Brain. Though all of this class agree in operating upon the Brain, their effects are by no means uniform. Some affect in a pecu- liar manner the mental powers, and proportiouably little the other functions of the body, (as a particular kind of mushroom and nitrous oxyde gas.) Opium has the greatest tendency to induce sleep; green tea, on the contrary, to excite watchful- ness. Alcohol and its combinations, Avhich are by some con- sidered Narcotics, excite also the actions of the heart and ar- teries, while others excite little or no action. Opium constipates the bowels, while the Hyosciamus in allaying pain has no such operation. From the action of these substances on the Brain, does speedy dissolution follow-the introduction of a large dose taken into the stomach ? Some experiments of Mr. Brodie, illustrate the manner in which death takes place, under these circumstances. He found that by introducing Narcotic substances in a very concentrated state into a wound, or into the rectum of animals until insensibility was produced, and all the external signs of apparent death—yet, by opening the thorax, and ex- posing the heart to view, it was found contracting Avith con- NARCOTICS. 315 siderable force. He found, also, that by inflating the lungs, and keeping up artificial respiration, the actions of the heart could be continued for a considerable time. He, therefore, concluded, that death, under these circum- stances, was owing to the respiration being affected, and at length ceasing. The lungs are, therefore, more dependent upon nervous in- fluence for the performance of their functions than the ciicu- lation, and it is through them that the death of the heart takes place, and finally death of the body. One of the means of recovering a patient from the poison- ous operation of Narcotics, is the employment of artificial respiration, and this circumstance confirms the views taken by Mr. Brodie upon tlm operation of these substances, and the manner in which they prove destructive to the body. For some experiments confirming these views, refer to Dr. Le Gallois's Avork, etc The impression of Narcotics upon the stomach, is extended by nervous communication Avith every part of the body.. Are the Narcotics Stimulating, or Sedative in their opera- tion ? Dr. Cullen was of tho opinion that they were Sedative in their operation, Dr. Brown maintained that they were Stimulants, surpass- ing all others in the diffusibility of their action, and that the debility which ensued was the result of this increased action. This opinion is supportsd by the known operation of these substances. They are all referable to excitement, which in proportion as it is strong and diffusible, is at the same time transient in its duration, and soon followed by symptoms of diminished action. If the dose is large, the stimulant effect is so rapid as to be hardly perceptible, and hence the Sedative, or depressing effects only appear. A dose still larger puts an end to life, without any symptoms of previous excitement. How is this explained ? In the same manner as Avhen speaking of the poisonous operation of ardent spirits. A col- lapse of the system takes place from an engorgement of the vessels of the brain, with an effusion of Serum in the Lateral Ventricles. The conclusion, therefore, of this subject would be, that Narcotics are directly Stimulant and indirectly Sedative. Reasons for considering the Narcotics Sedative. One of the arguments advanced, isdeiived from their sopo- rific effects, or tendency to induce sleep. But how is sleep induced ? Can it not be brought on by any other than a direct Sedative operation ? or rather is it 316 NARCOTICS. not in common, the effect of positive and direct Stimulating operations ? Dr. Rush, in considering the causes of sleep, says : Natural sleep is brought on by a diminution of the excitement and ex- citability, by the continued application of Stimuli, Avhich act upon the body in its Avaking state. He then goes on to state, that sleep may be brought on at an earlier hour by an-increase of the force of such Stimuli, as a long ride or Avalk, unusual exercise of the understanding, the action of strong passions or emotions, etc. Artificial sleep, he then adds, may be induced at any time, by certain stimulating substances, as opium, etc. Opium, in the production of sleep, operates in the same manner as the natural stimuli above mentioned—they all wear out the excitability, and bring on that state of indirect debil- ity which is followed by sleep. If these medicines were directly sedative, they Avould bring on sleep at all times, and under all circumstances, and the sooner and more perfect, the stronger they are, or the greater the quantity. Instead of this, if you give a man ready to drop asleep from ( fatigue and watching, a dose of any soporific medicine, it will i A \ Put off sleep for some time. Here then the Stimulus of the I /I * Narcotic medicine seems to have the effect of putting off I f \ *sleep as long as tho sensibility and excitability of the body k J V* sumc*ent to support their effects. V . * rived from their poAver of relieving pain. W W The operation of Narcotics in relieving pain does not J tr JePe»d upon their rendering the brain torpid and insensible, \> n yt producing an excitement in the brain different from the // painful impression, and thus relief is obtained. That it is not »J J37 anv. Sedative operation Ave know, from the Narcotics excit- J ing pain and inflammation Avhen applied to any tender part, * i aa^the globe of the eye or the surface of a wound. We know, l, \ too, that these medicines are contra-indicated in diseases r #V wnere Pain is a consequence of high action, and are only em- { P1(*yed after the activity of the circulation has been reduced. If J-Key exerted any sedative operation, why are they not at- tended in such cases with the same feelings of relief Avhich i» follows blood-letting when propeily and judiciously pre- ✓ scribed ? The most satisfactory explanation is established upon the stimulating effect of these medicines. ^ A third proof of the Stimulating operation of Narcotics, is de- rived from their exhilarating, and producing intoxication. I have already spoken of the use of Opium in Eastern coun- tries, where wine and liquors are forbid, for the production Text loss on p. 317-318 NARCOTICS. 317 of these effects-^-and that it is often had recourse to, to induce mirth, to dispel melancholy, and to relieve the mind of its troubles and disappointments. With the views Ave have given you, of the effects and ope- rations of Narcotics, they evidently become in practice remedies of great importance. The proper administration of them, calls for much both of experience and discrimination on the part of the practitioner. They may be so employed, as to produce a stimulant im- pression, or a state of depression may be occasioned, Avithout any previous excitement being apparent. To obtain the stimulant effects, they must be given in small doses frequent- ly repeated, and thus the excitement they produce is kept up and sustained. When the design is to mitigate pain, to procure sleep, to relieve irritation, to deaden sensibility, they should be given in full doses, and at distant intervals. Rules in the administration of Narcotics, furnished from Chapman's Therapeutics : 1. We should begin Avith small doses, in order to test their action upon the system, These may soon be increased, as there is no class of medicines to which the system becomes sooner habituated, or which loose their effect more quickly by repetition than the present. 2. It is wrong to combine many of these articles in one. prescription, or to use any number of them at one time. The importance of this rule will be obvious from the preced- ing observations. The system becoming habituated to one stimulus, Ave reneAv the first impressions by changing it for another, and in this manner keep in our employment a corps of reserve. > 3. It is proper to change the part of the body to which Ave apply stimulants, as sensibility will be left in one place toy a remedy, Avhen completely exhausted in another. The stomach becoming enfeebled, we can have recourse to the skin, and from this last to the rectum—it being observed that impressions may be excited in the system by applications to this part of the Alimentary canal, Avhen their operation.has in a great measure ceased elseAvhere. 4. The fourth rule in the employment of stimuli, is to*'en- deavor to graduate the strength of the stimulus, to the state J of excitability. This is a rule of much importance in prac- tice, and from attention to which very happy results, will often be obtained. In all cases of disease the st.™>ni*tJi q£ the stimulant should be proportion?'4 ' the system, as without i* duced, and the sysf' which should x 318 PARTICULAR NARCOTICS. PARTICULAR NARCOTICS. Family Papaveraeae-Papaver Somniferum, or Poppy, Opium. Opium is the most valuable of the Narcotics. It is obtained from the above plant, Avhich grows in the four quarters of the globe. It is chiefly cultivated in Asia, also in Africa, particularly about Thebes in Upper Egypt, hence called Thebaic Opium. Description of the plant— The method pursued in obtaining the opium from the pods of the plant, is the following : At the time the pods are nearly ripe, incisions are made into them in the evening, and from them there oozes out a considerable quantity of a milky fluid. This fluid is scraped off early the next morning from the wounds, with an iron scoop, and worked in an earthen pot for a long time in the sun, until it becomes of a considerable consistence. This is then made into lumps of a globular form, which are covered with the leaves of the poppy, so as to prevent their running or sticking together. The operation is repeated three times, but the produce gradually decreases in quantity, nor is it of so good a quality. Opium is prepared in many places, but there is commonly known in commerce the following .-—The Turkey, East India, Egyptian, and European Opium. Qualities of the best Opium— Tenacious, possessing considerable tenacity. Fracture, shining Avhen broken. Color, dark brown. Taste, nauseous, bitter, acrid. Smell, disagreeable, heavy. Adulterations—-Frequently found in our markets mixed with leaves, stalks, seeds, &c.—and they are worked in when the opium is in a soft and recent state, for the purpose of increasing its Aveight and consistence. The quantity of these inert substances is frequently so great, that an ounce yields only four and a half, to five and six drachms, of soluble and extractive matter. It is adulterated with various other substances—with ex- tract of liquorice, Avhen the specimen is brittle and tastes " sweet»»-SQmetimes with Gum Arabic, or Tragacanth. It is mixed with sand and gravel, which is very common in order to increase its weight, and the- Opium feels gritty between rit&~ ^^^^ '" "^ :^p.™>r to the Turkey, and yields y* "" Article has been much *« have been very \ NATIONAL LIBRARY OF MEDICINE NLM D3EblE71 D 1 ffi/fcjKgJHffffl JSiKK5»S»lf^ ftvfe <:S^^^fe^w S'^^iS^^^wS- %SvvvvfcSoSo&v • vt lyl M$ NLM032612710