KL± Columbia Stotomitp mtljeCttpofilfttigork COLLEGE OF PHYSICIANS AND SURGEONS LIBRARY _: , Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/lecturesonmateriOObeck S. S. <& W. Wood's Medical Catalogue. Clinical Lectures on the Principles and Practice of Medicine. BY JOHN HUGHES BENNETT, M.D., F.R.8.E., Professor of Institutes of Medicine, and Senior Professor of Clinical Medicine in the University of Edinburgh, 1 vol. 8vo. 1005 pages. "With five hundred Illustrations on Wood. Price, If 6, free of Postage. ""We recommend this volume with the most unqualified praise, to the attentive considera- tion of the practitioner and students. "We have met with DO work of late years 00 I). eiples of Alodlcine more likely to advance the truo and rightful study of our art." — Med •> 'limes and Gazette. "One of the most valuablo books which havfi lately emanated from the medical press. No one devoted to the profession will fail to peruse theso lectures, and acquaint himself with the discoveries of so ardent an explorer in the field of medicine." — New Yurie Journal of Medi- eine. ""We most heartily commend it to the young and old, tho disciple and the master alike." — Charleston Me*~ical Journal and Review. " A new work, in which tho applications of the microscope to clinical medicine are treated by a mastor hand. Tho great value of this work is, that it embodies, in a clear and concise manner, all the applications of the microscope to practical medicine. It is, in fact, a perfect manual on this Bubject, and as much to be welcomed by all who consider di°,gnosis as the most important element in the study of disease." — New Orleans, Medical News and Ifospi tal Gazette. SILVER SUTURES EST SURGERY. BY J. MARION SIMS, M.D., Surgeon to the Women's Hospital. 69 pages, 8vo., with Illustrations on "Wood Price, 50 cents, free of Postage. OF NATURE AND ART IN THE CURE OF DISEASE. BY SIR JOHN FORBES, M.D. (OXON.), F.B.S., Fellow of the Royal College of Physicians, Physician to the Queen's Household, etc., etc From the Second London Edition. Price, $1, free of Postage. " The error which the author regards as the great taint of medical science, and which he combats throughout the book, is a want of trust in the powers of Nature to arrest the pro- cesses of disease, and a consequent overweening faith in remedial agents as the sole means of cure. His m»in object is to endeavor to expose these misconceptions, and to impress the minds of the younger and less prejudiced members of the profession with the truth and importance of the principles advocated, and also to prepare a work which might convey to educated members of the general public a juster knowledge of the real nature of disease, and the true character and powers of the medical art "We cannot but believe that the courageous advocacy by Sir John Forbes of views so much opposed to the prejudices of a large class in the profession, have contributed not a little towards the reformation of the drugging system. Most sincerely do we thank him as a benefactor of his profession and of mankind." — Brit, and For. Medico- Chirurgical Review. " This boot gives explicit and coherent expression to that feeling of reaction against violent or perturbative practice, which has been going on in the profession for the last twenty-five years, and may now be considered as settled and fixed He explodes, almost by a simple statement of it, the opinion of disease being a separate entity destructible by the introduction into the system of an appropriate remedy ; and he recalls to our attention, in a truly philo- sophical form, the sanative powers of Nature All this, Sir John Forbes does ably -\4 well, and we listen to him with the attention due to a master in Israel." — Edinburgh msdical Journal. " In this volume Sir John Forbes aims to show that Nature has much more to do with tne cure of disease than is generally supposed either by laymen or by the profession, and that Art »**complishes much less in that way than is commonly imagined. The book is designed not e^erely for the profession, but for intelligent readers generally." — British Quarterly Review. . . . . " We recommend this thoughtful and suggestive book to the careful perusal of »il who value health, and especially to those who habitually resort to medicine. They will be kegs ready to fly to pills ind powders when they know th» mischief these produce." — The Critic. &. V ITU ('OKI H li !) P L A T E S . Translated and Edited by GEORGE C. BLACKMAN, M.D., "Fellow of the Royal Medical and Chirurgical Society of London, &o., &e. Third edition. Price $3 50, free of postage. " One of the most valuable works that has recently been issued from the press."— Medical &eaminer.fy ■' We regard the present work as the best general treatise that has ever been r-ablished on Syphilis, and are much mistaken if it does not soon become the authority of the day. Tho colored illustrations are the most beautiful and faithful things of the kind we havo yet seen." — Medical Chronicle. "The best general treatise on Syphilis extant." — Langbton Paeker, Surgeon to the Queen's Hospital, Birmingham. " To every country practitioner we say, obtain the work of vidaL The precepts are excellent, the plates magnificent." — Georgia Blister and Critic. " We do not know a better." — New Jersey Medical Reporter. " We have never seen a book on this subject which appeared so well calculated to meet the wants of students and young practitioners as this." — Ne>w Hampshire Journal of Medicine. " A better work than this of M. Vidal's is not extant" — Western Lancet. "Of inestimable value to the practitioner,, both for its principles and practice." — New Orleans Medical and Surgical. Journal. "A library in itself, full of valuable hints and landmarks, whereby tho physician may assist his own experience and reason to unravel the knotty points, and decide on the more difficult ijuestions arising in venereal surgery." — Peninsular Journal of Medicine. "We most cordially recommend it to the consideration of our readers." — Upper Canada Journal. " One of the most complete and usefnl treatises on syphilitic diseases we know." — Southern Medical and Surgical Journal. Essays en Infant Therapeutics; To which are added, Observations on Ergot ; History of the Origin of the Use of Mercury 1b Inflammatory Complaints; with the Statistics of the Deaths from Poisoning in New York, in the Years 1841-'2- , 3, BY JOHN B. BECK, M.D., Professor of Materia Medlca and Medical Jurisprudence in the College of Physicians andSurgeoBt of New York, &c, &c. Second Edition. Enlarged and Revised. Price 75 cts., free of postage. " A perfect gem. We regard It as one of the most useful books In our library." — New Jersey Med. Reporter. " A most valuable and admirable work It is — one which the interests of humanity will scarcely allow any physician to be without." — Peninsular Jour, of Med. " One of the most valuable books which ever issued from any press. No one, however learned, can read it without profit." — N. Hampshir. Jour, of Med. " It is certainly a very valuable work, and should go as the companion and antidote of most of cur works on the diseases of infants, to modifv !ieir reckless recommendation of the use ol the most powerful drugs on the susceptible conspirations of children." — Bvj/alo Med. Jour. "An excellent little work, from the very highest authority." — Western Lancet. "This little book should be In the hands of every physician Its moderate cost, and rare conciseness and practicalness, entitle it to attention aud confidence; while the high standing of its lamented author, and his large experience, afford a safe guaranty against error."- Mem- phis Medical Recorder. THE MEDICAL PROFESSION IN AHCIENT TIMES. By JOHN WATSON, M-D., Surgeon to the New York Hospital Price $1 50 — or $1 75 by mail, free of postage. "The result of long ind laborious Investigation on the part of the author, to whom th« thanks of the profession are due, for a most interesting and agreeable sketch of the history of ancient medicine.*' — Boston Medical and Surgical Journal. " One of the most valuable histories of ancient medicine which has yet been published."— North- Western Medical and Surgical Journal. 8. S. $f W. Wood's Medical Catalogue. LECTURES OH THE ERUPTIVE FEVERS, A.S NOW IN THK OOUESB OP DELIVERY AT ST. THOMAS* HOSPITAL, LONDON. By OEORGE GREGORY, M. D., Fellow of tho Royal College of Physicians of London, Physician to the Hmall I'ox nnd VacclD- atlon Hospital at High Gato, Corresponding Mem her of I lie National Institute of W nsh- Ington, etc First American Edition with numerous additions and amend- ments by the Author, Comprising his latest views With Notes and an Appendix, embodying the most recent opinions on Exnnlho- matlc Pathology, and also statistical tables and colored plates. By n D. BULKLEY, M D., Physician for the New York Hospital, Fellow of tho New York College of Physicians n'A Surgeons, etc., etc. Price, %i JjO, free of postage. "This is a beautiful volume, and got up in the most attractive style. The volume contains the fullest and most comprehensive account of that most Interesting cla<-s of diseases, the I ' - antbemnta, to be met with in a single volume in the English language or in any language. We have no hesitation in saying that the smallest medical library is most Inmi ntabiy defei without this book, and whoever procures It will feel that it Is absolutely Indispensable to the general practitioner." — Niis/i/ville Journal of Medicine and Surgery. "The very best which has yet been published on Kruptive Fevers; and one which it should be the duty of every physician to provide himself with." — Northern- Lancet. " We cordially recommend It as the production of a man who has thoroughly investigated the subjects of which it treats." — Western Journal of Med, and Surgery. " This work abounds with valuable information in regard to a class of diseases of very fre- quent occurrence and of fearful mortality." — Stethoscope. OPHTHALMIC K'EMOEAKBA Respecting those Diseases of the Eye which are more frequently met with In Practice. By JOnN FOOTE, FELLOW OF TIIR KOYAI. COLLEGE OP BURQEOXS IN LONDON, ETC., ETC. Price, 87 i cents, fre-e of postage. u ' A delectable, pithte and righte profitable worke' — a genuine nnilfvm in parro — conlsirdng a brief account of nearly every ophthalmic disease, and the most approved treatment, without theory, or speculation, or doubtful practice. ' — Buffalo Med. Journal. "A very useful little manual on Ophthalmic Diseases, drawn from the highest sources, and the best authorities, iothe personal experience of the author, altogether forming a very conve- nient book of reference to the student nnd practitioner of medicine. There is no subject con- nected wilh the eye, passed over; and the rules of treatment laid down are in a bign degree safe and judicious." — N. York Journal of Med. " His definitions are accurate, his descriptions are concise and e'ear. pnd his treatment of this very important class of diseases, is authentic, and In accordance vith sound experience." — Oklo Med. and, Surg. Journal. THIRD EDITION OF Lectures on Materia Medica and Therapeutics, Delivered in the College of Physicians and Surgeons of the University of the State cf New York, by JOHN B. BECK, M.D., Late Professor of Materia Medica and Medical Jurisprudence, prepared for Vie press by his friend, C. R. GILMAN, M.D., » Professor of Obstetrics, <&&, in the College of Physicians and Surgeons, Neio Yor/z. One vol. Svo. Price $3, free of postage. "Admirable for students. Everything is clear and concise." — IT. Y. Medical Timen. "Asa text-book for the use of students, we know of no better treatise, bdJ very few Indeei tnot are so well adapted" — American Journal of Medical Sriern-e. " We know of no work of its size on Therapeutics which is so elaborate, and so worthy of ti« confidence of the profession, so thia." — Boston Medical and Surcical Jottmc^. iS. S. «$• W Wood's Medical Catalogue. An ENTIRELY NEW AND VALUABLE WORK oh Digestion and its Derangements. The Principles of Rational Medicine applied to Disorders of the Alimentary Canal BY THOMAS K. CHAMBERS, M.D. Price $2 'lb. free of Postage. "This is no common publication, to be taken up and thrown aside, but the result of deep stud* and patient investigation. The author has travelled step by step through the Intestinal carml, assigning to each part, where possible, its definite symptoms and treatment." — Dublin Quar- terly Journal of Med. Science. " Digestion and its Derangements, is one of the most interesting and instructive works of its kind that we have read ; snd we believe Dr. Chambers has done good service to medical science in showing, as he has done, the intimate relation which exists between physiology and practi- cal medicine." — Med.-Chirurgical Review. "A work of rare merit, and should be In the hands of every practitioner."— Eclectic Med. Journal. *' To the practitioner, no work is better adapted, and to the general reader much will be found to direct in managing the digestive apparatus — an apparatus, when out of order, the moai diffi- cult frequently to restore." — Ohio Med. atid Surg. Journal. " Very few special works will compare with the one before us; the philosophical views of its author, their basis upon the strongest and firmest grounds, the lucid practical deductions, the felicity of expression, and the easy and pleasina style, all tend to make it not only an agreeable but an eminently practical work." — Nelson s American Lancet. " We desire to direct the attention of the profession to this useful volume." — Cincinnati Medical Observer. " Should be studied by everyone." — Charleston Medical Journal. " We sincerely recommend it as one of great value, which should be in the possession o5 every practitioner." — Boston Medical and Surgical Journal. "Dr. Chambers wields a vigorous pen, and in the work before us the traces of a master mind Illuminate every page." — Western Lancet. "Dr. Chambers' book is one of the most philosophical which has for some time emanated from the British medical press. It is a book which we would, with a good conscience, recom- mend to a brother practitioner, or place in the hands of a pupil." — Association Med. Journcl. "The volume abounds with originality, as was, indeed, to have been expected froip a physi- cian of such eminence as the late Dr. Chambers, who is not so much notorious for having han,ner. LECTURES MATERIA MEDICA AND THERAPEUTICS, DELIVERED IN Till COLLEGE OF PHYSICIANS AND SURGEONS UNIVERSITY OF THE STATE OF NEW YORK. JOHN B. BECK, M.D.; LATE PROFESSOR OF MATERIA MEDICA AND MEDICAL JURISPRUDENCE. PREPARED FOR THE PRESS BY HIS FRIEND, C. R. GILMAN, M.D;, PROFESSOR OP OBSTETRICS, ETC., IN TILE COLLEGE OF PHYSICIANS AND SURGEONS, N. T. THIRD EDITION. NEW YORK: SAMUEL S. & WILLIAM WOOD, 389 BROADWAY. 1861. yte^U /r// Entered according to Act of Congress in the year 1851, by A. 8. BECK, In the Clerk's Office of the District Court of the United States, for the Southern District of New York. It. CRAIGHEAD, Printer and Stereotyper, Caitort BuilUing, 81, 83. and 85 Centre st.,N. T. alumni nf tyt dfalleje PHYSICIANS AND SURGEONS ftliukrstii) of ijrt £tak of gttfo %mh Gentlemen : I dedicate these Lectures to you in the hope that in their present shape they may meet with a portion of that favor with which you received them when they came from the lips of the Author. C. R. GILMAN. PREFACE TO THE FIRST EDITION. In presenting these Lectures to the friends and admirers of the late Dr. Beck, and especially to the Alumni of the College in which he labored so long and so faithfully, a -word or two explaining my own connexion with them seems to be proper. After the death of my friend I was informed that he had partly prepared his Lectures for the press, and I was requested to look at the papers and give an opinion as to whether they were in a state fit for publication, and if so to prepare them for the press. With this request I felt very reluctant to comply. Quite a number of circumstances seemed to me to point out another person for this duty ; and for myself, I felt that neither by previous study nor by habits of thought was I at all rea- sonably fitted for this task. There existed, indeed, but one reason why I should be selected, and that, having undertaken the duty, I have placed with a pride deeply mingled with sorrow upon the title-page. We were friends. For twenty -five years of constant intercourse, no shade of doubt, distrust, or ill- feeling, passed between us. This, and deference to the wishes of one whose devotion to his happiness when living, is only equalled by her zealous interest in his fame when dead, induced me to undertake this labor. I found, on examination, that on most subjects the Lectures had been re-written with apparent care ; on others, this was done only partially ; and in one or two VI PREFACE TO THE FIRST EDITION. instances the leaves of the old Lectures were intermingled with very small portions of the new manuscript. Such was the form in which these Lectures came into my hands. Though well aware of the great amount of labor which the preparing of such a mass of matter for publication would involve, I did not shrink from it ; I believed that the Lectures contained a valuable digest of the present state of knowledge in this department, and that they would be acceptable to the profession and useful to medical students. Whether my estimate was the dictate of sound judg- ment or of partial friendship, the profession into whose hands I now commit the work will, of course, decide for themselves. In preparing the work for the press my agency has been merely ministerial. Where the manuscript was re-written, and free from verbal inaccuracies, it passed out of my hands untouched ; where it seemed to me that the language could be made more clear, verbal alterations have been made ; where, as happened in a very few instances, a fact was stated inaccurately, the state- ment was corrected ; further than this I did not feel at liberty to go. The opinions are those of Dr. Beck, not of his Editor. In some cases these opinions are contrary to those which I have formed, and been in the habit of teaching ; still they were his, and I did not attempt to modify or impugn them. In a few places I have added a few words where I thought by doing so I could make the book useful for students : in all cases these additions, u ne illo imputantur" are included in brackets. To these remarks there are two exceptions of sufficient importance to be specially noticed and explained. On examining the manu- scripts I found proof of a fact of which I was before cognizant, viz. that on many of what are called the "New Remedies," Dr. Beck did not lecture. He was in truth, as these Lectures in almost every page will prove, not a runner after new things ; his study was much more into the indications of treatment, the circumstances modifying the operation of medicine, and those kindred topics which I should call the philosophy of Materia Medica, than into the character and claims of new and fashion^ able therapeutic agents. This explains the fact that many " new things" found no place in his Lectures. I had no disposition PREPACK TO THE FIEST EDITION 1 . Vn to alter them : in this respect I shared his opinions, ;nnl concurred heartily in his plan of touching. Still there wov two subji which I supposed it proper to introduce; into the book, although I found no notice of them in the Lectures. One was, to be sure, a new and fashionable, and a most extravagantly vaunted ag Cod Liver Oil; still it appeared to me that in a matter with which the mind of the profession is at present so much occupied, something ought to be said. I have, therefore, prepared an article which 1 hope may not be useless. The other subject to which I referred is Anaesthetics. These agents have been intro- duced during the period of Dr. Beck's failing health, and he never lectured on them. He knew that they were noticed incidentally by two of his colleagues, Dr. Parker and m} r self, and that I devoted considerable time to a rather full considera- tion of the whole subject ; hence he felt the less necessity for treating of them. When, however, his Lectures came to be presented to the profession " in a book," and especially when they were offered to students as a text book of Materia Medica and Therapeutics, it was obviously proper that a consideration of those agents, whose use is so wide-spread, and whose utility is scarce now a subject of doubt, should appear in it. I accord- ingly prepared an article on Anaesthetics, in which I have tried to do justice to a class of remedies, the introduction of which into practice is, I firmly believe, a great boon to humanity. In conclusion, I have to acknowledge valuable assistance from Professor Lewis C. Beck, in the revision of the article on Proximate Principles ; and to confess my own obligations for the matter I have added, toJPereira, whose book, a great store- house of valuable knowledge in the whole subject of Materia Medica, I have consulted with confidence, and used when I needed it with freedom. PREFACE TO THE SECOND EDITION. Ltf preparing this edition for the press, the editor has felt it his duty to make only such changes in matters of detail as shall render the book more useful to students, as presenting an accu- rate view of the present state of knowledge on the subject of Materia Medica. It is the boast of the cultivators of Medical Science that theirs is in a pre-eminent degree a progressive science; hence the absolute necessity of revising Text books from time to time. Such revision it has been the editor's aim to give this book. As to those great principles of Therapeutics which constitute the distinctive merit of the work, they remain untouched. Time can only serve to confirm their truth and increase their value. PREFACE TO THE THIRD JEDITIOE The Editor is again called to jthe grateful duty of revising an Edition of Beck's Materia Medica. » That such a book should continue for so many years the text book of Materia Medica is proof that our science is becoming more settled, and in a good degree certain. In this Edition few changes have been made. The author was not, and the Editor is not a vaunter of New Remedies ; few of these have been deemed worthy of record in a book which claims to establish new principles of Therapeu- tics, and give the best means of putting those principles into practice. New York, October, 1861. CONTENTS. Page Introduction 11 Physiological and Therapeutical Effects of Medicines, 14 Modes in which Medicines may be brought to act on the System, 18 Circumstances Modifying the Effects of Medicines, 24 Classification of Medicinal Agents, 28 Combination of Medicines, 31 Proximate Principles . . 36 Organic Acids, 38 Organic Alkalies, and the Allied Substances, 41 Oleaginous, Resinous, and Bituminous Principles, 44 Alcoholic and Ethereal Principles, 48 Sugars and their Congeners, 49 Emetics * 52 Effects on the System, 54 Various Circumstances Modifying the Effects, 57 States of System favorable and unfavorable to their use, 61 Mode of Administering, 63 Combination, 91 Application in the Treatment of Diseases, 66 Individual Emetics, 79 Cathartics 92 Effects, 93 Circumstances Modifying the Effects, 97 Mode of Administering, 99 Therapeutical Effects, 101 Use in Particular Diseases, 102 Classification, 111 Individual Cathartics, 112 Saline Cathartics, 126 Mercurial Purgatives, 143 Combinations, 145 Anthelmintics . 150 Pules for the use, 154 Individual Anthelmintics, 155 Sialagogues 163 Mercury, 163 Its Physiological Effects, 164 Practical Applications of Mercury in the Treatment of Diseases, 176 Preparations of Mercury, 185 Diaphoretics 193 Effects, 193 Pules for their Application, 197 Practical Applications, 198 Individual Diaphoretics, 201 X CONTENTS. Page Expectorants 209 Practical Applications, 211 Eules for Administration, 215 ■ Individual Expectorants, 215 Antispasmodic Expectorants, 225 Diuretics 228 Effects, 228 Application in the Treatment of Diseases, 232 Eules for Use, 235 Individual Diuretics, 235 Emmenagogues 261 Parturients 265 Dangers from the Use of Ergot, 268 Sedatives 271 Bloodletting and its Effects, 271 States of System favorable and unfavorable to Bloodletting, 281 Rules in Relation to Bloodletting, 294 Therapeutical Applications of Bloodletting, 295 Other Sedatives, 310 Refrigerants 334 Practical Application in the Treatment of Diseases, 339 Demulcents 343 Narcotics 355 Effects, 356 Opium, its Properties, and Use in the Treatment of Diseases, 355- 377 Other Narcotics, 377 Anesthetics 394 Effects, 395 Rules for Administration, 397 Applications to Disease, 393 Individual Anaesthetics, 401 Stimulants 405 Effects, 405 Practical Applications, 410 Individual Stimulants, 415 Nervines 433 Effects, 433 Diseases in which they are applicable, 434 Individual Nervines, 438 Tonics 452 Effects, 452 As Antiperiodics, 455 Individual Tonics, 457 Astringents L^91 Individual Astringents, 495 Revulsives , 504 Divided into five Classes, 504 Individual Epispastics, 509 Practical Applications, 515 Alteratives .... ...... 517 Application to Diseases, 518 Individual Alteratives, 520 Local Alteratives, 541 Chemical Alteratives, 547 MATERIA MEDICA T H E RAPEUTIC S. INTRODUCTION. By the Materia Me dica is meant that branch of Medical Science which treats of the Instorv, preparation, properties, and effects upon the living system, in health and disease, of the various agents which are used for the prevention or cure of disease. It includes two distinct depart- ments — viz. First, Materia^Medica^proper, embracing simply an account of the history and properties — physical and chemical — of medicinal agents, and of their effects on the system in bjjalth. Second, Therapeu- tics, That which relates to the effects of these agents in their applica- tions to the management of disease. It is in this extended sense that I propose to consider it in the following course of lectures ; and I shall therefore, besides giving you a description of the various properties of medicines, endeavor to lay before you the general principles which are to govern you in their use. There are several points of view in which medicines are generally considered in the books — viz. their natural history — their physical, their chemical, and finally, their therapeutical properties. With regard to the natural history of medicines, it is not my inten- tion to go into any minute botanical or mineral ogical descriptions. I shall give only such general, concise notices as may be more immediately applicable to practical purposes ; referring those who feel an interest in the subject to the Dispensatories for fuller information. Under the head of physical properties I shall call attention particu- larly to such circumstances as may assist in ascertaining the purity 2 MATERIA MEDICA AND THERAPEUTICS. of the article as used in medicine. This is a subject of great importance, and one often neglected. To those who know to what an extent the adulteration of medicines is carried, and how often, from this cause, the expectations of the physician are frustrated, it will scarcely be neces- sary to say anything to show the importance of such knowledge as shall enable the practitioner to be certain that he is really giving the medi- cine which he has ordered. In the next place, of their chemical proper- ties. A knowledge of the chemical properties of the medicines is no less necessary to the mere practitioner than it is to the scientific phy- sician. By discovering the active principles of vegetables, it has ena- bled us to separate them from inert matter, and thus not merely to improve the mode of their administration, but to increase their activity. For a striking;: illustration we need 2:0 no further than Peruvian Bark. Whoever compares the unwieldy and nauseous doses of this article as formerly given, with the elegant and condensed preparation made from it in the form of the sulphate of quinine, must at once admit the utility of chemical knowledge as applied to the Materia Medica. In addition to this, a knowledge of the chemical properties and relations of medi- cinal substances to each other, is the only thing which will enable the practitioner to avoid that very great though common error of giving articles which decompose each other, and either neutralize the powers of each, or produce compounds whose effects are entirely different from those intended. With regard to the Therapeutical properties, these are the most im- portant, and they shall claim the principal share of attention. To them a knowledge of all the other properties is only subservient. This is a part of our subject of no small difficulty. The virtues ascribed to medi- cines are so multifarious, and if we are to believe the reports of differ- ent writers, so positively contradictory, that it requires the soundest exercise of judgment, connected with no small share of experience, to decide what are really the effects of medicines upon the living system, and how they may be rendered available in the cure of diseases. And as we cannot in all cases call in question the accuracy of the statements of distinguished men, however contradictory they may at first sight appear, it will frequently become a subject of philosophical and instruct- ive inquiry to investigate the causes of this discrepancy. Such investi- gations are worthy of the highest efforts of intellect, as their object is to show that medicine is not an uncertain art, but a science, built upon fixed and rational principle. The principles upon which these investi- gations will be conducted are exceedingly simple. Without entering into any process of reasoning to establish it, the proposition may be assumed, that under similar circumstances the same medicines will produce similar effects. This is a self-evident proposition ; and by carefully apply- ing it, we shall be able, in most cases, to arrive at a satisfactory solu- INTRODUCTION. ] 3 tion of the contradictory accounts which arc upon record in relation to the effects of medicines. In all cases, therefore, in which the effects of the same medicine arc reported to be different, the first question to be determined is, was the medicine really the same ? From the ambiguity of nomenclature, and the fluctuations which it has undergone, it will not unfrequently be found that the same term has been applied to substances totally different. Independently of this general error resulting from the confusion of terms, there are other circumstances which require investigation to ascertain the character of medicines. The virtues of medicinal vege- tables especially, depend much upon the season of the year in which they are collected — upon the part of the plant used — upon the mode of preparation — upon the length of time they have been kept, THERAPEUTICS. adoption, except in cases of diseases intractable to the ordinary modes of treatment — such as hydrophobia, tetanus, and the like. Of the various circumstances modifying the effects of medicines, — The human system is not always the same. It differs at different periods of life, in different climates, and under various circumstances. It is very evident, therefore, that the impressions made upon it must also vary. In making out, therefore, a full and complete history of the effects of medicinal agents, it becomes necessary to analyse in detail all the cir- cumstances which have an influence in modifying the condition of the system. 1. Age, — This modifies the condition of the human system, and, of course, the effects of medicinal agents. In infancy all the textures are exceedingly delicate, and much more easily affected by impressions made upon them than at any subsequent period. This is particularly the case with the mucous membrane and the skin, the two surfaces to which all medicinal agents are applied. The brain and nervous system, too, are more delicate, and exercise a more predominating influence over every other part of the body. Hence it is that the brain is so easily excited by irritations, and that convulsions and organic dis- eases of this organ are so common at this early period. The vascular system, too, is now in a condition entirely different from what it afterwards comes. Not merely is the power of the heart and blood- vessels much less, but there exists a great difference in the relative size of the arteries and veins, as well as in the quantity of blood which they circulate. In advanced life, in all these respects, the system has under- gone a complete revolution. The tissues, from being soft and delicate, become dense and firm — their sensibility and the activity of their functions are lessened. The brain and nerves, from being soft, become firm and solid — their functions are impaired, sensation is blunted, and all the motions impeded. Hence pain can be much better borne in old age than in infancy. The blood-vessels, too, now become more solid, in many cases even ossified, and the venous blood in the system bears a much larger proportion to the arterial than it did at pre- vious periods, and venous congestions are common. From all this it is very evident that the system undergoes a great change, and it would seem as a matter of course that the effects of agents applied to it must be greatly modified by these changes, and such indeed is proved to be the case by observation and experience. Almost every medicinal agent is more or less modified in its operation according to the period of life at which it is administered. For example : Emetics are given at all ages, and yet how different are their general effects. In infancy vomiting is excited with little or no difficulty, and so far as the mere mechanical process is concerned, attended with no danger. If, however, some active article be used, even in doses INTRODUCTION". 25 suitable to the ago, the consequences may be fatal. Tartar emetic thus been known to produce vomiting which ended in death. In advanced life, on the other hand, from (he impaired sensibilitj of the organs concerned, vomiting is not bo readily excited, while the mechanical process, which in children is attended with no dai ■■ r, is now frequently destructive of life, owing to the tendency which there exists at this period to venous congestion of the brain. Cathartics afford a second illustration. In early life, as a general rule, this class of medicines operates much more readily than they do afterwards. As we advance in years, the intestines, in consequence of their repeated stimulation, have their sensibility impaired and their contractile power lessened, and cathartics make less impression ; accordingly, they require to be used in much larger closes, and the more active articles selected. On the other hand, it is to be recollected that the intestines of children are more liable to be lined with col- lections of viscid mucus; and when this is the case, they can bear much larger proportional doses. Opium furnishes another illustration. While to adults this drug may be given with perfect safety, in its effects upon children there is frequently nothing so uncertain. Not nnfrequently the simplest preparations of it, administered, too, in reasonable doses, have been attended by alarming and even fatal symptoms. The syrup of poppies and Paregoric have both operated occasionally in this way. I shall notice only one other illustration, and that is Venesection. This is a remedy resorted to, and very properly, at all ages ; and yet in many cases it is to be feared without due regard to the dif- ference of effect produced by it. As a general rule, children do not bear the loss of large quantities of blood so well as adults. One or two bleedings they may bear, if carried any further they sink under it, Nor do they recover from syncope, when induced by venesection, so readily as adults. On the contrary, such is the deficient reaction in them, that this state is always attended with more or less danger. In old age, the same general rule holds good. Moderate quantities of blood may be abstracted with beneficial effect, while the loss of large quantities is followed by great prostration of the powers of life. The foregoing illustrations, selected from a thousand others, which might be adduced, are abundant to show the importance of investigating the effects of remedies at different periods of life. Unless this be done, it is idle to suppose that they can be properly or even safely employed in the treatment of the various diseases to which the human frame, from infancy to old age, is liable. 2. Sex. — This modifies very greatly the condition of the human system, and it must therefore, also, as a matter of course modify the effects of medicinal agents. As a general rule, the constitution of 26 MATERIA MEDICA AND THERAPEUTICS. females is much more delicate than that of males. Their nervous sys- tem is also much more excitable. Hence impressions are more easily made upon them by medicinal agents. The more active articles accord- ingly require to be used with much greater caution in them. In vene- real hospitals it has been observed that only half the quantity of mercury ] s necessary to produce precisely the same effect as in males. Indepen- dently of the general delicacy of constitution, there is another circumstance attending the female which greatly modifies the effect of remedies, and that is a state of pregnancy. During this state, women bear blood-let- ting much better than at any other period ; for the purpose of subduing disease, it is frequently necessary to carry it to a much greater extent than under the ordinary conditions of the system.* Tonics, on the other hand, are not borne so well, and do not appear to produce precisely the same effects. The Peruvian bark, accordingly, very frequently fails under these circumstances to arrest the paroxysms of intermittent fever. In the advanced stages of pregnancy, the use of emetics is frequently fol- lowed by a premature expulsion of the foetus. 3. Peculiar Habit and Constitution of Body. — This modifies very greatly the effects of remedies. Ceteris paribus, fat persons are vomited with more facility than lean ones. As a general rule, fat persons have less blood in proportion than lean ones, and on that account do not bear the loss of such large quantities. In delicate and irritable habits, blisters cause a great degree of nervous and vascular excitement, attend- ed not unfrequently with the most distressing effects on the system at large. There is, perhaps, no medicine which shows in a more striking manner the modifying effects of temperament than mercury — an article which, in robust constitutions, may be given with impunity, in nervous and irritable habits, especially if carried to any extent, is followed by effects the most disastrous, augmenting general irritability, and predis- posing the system to the invasion and development of various and even fatal diseases. 4. Climate and Season. — By the powerful effect which these exercise upon the human frame, they exert a modifying influence on the effects of remedies. So fully was the celebrated Baglivi impressed with the truth of this, that he frequently adds, in giving an account of his treat- ment, " Vivo et scribo in ^Ere Romano." Celsus has observed, that "medicines differ according to the nature of the climate; one kind being necessary in Rome, another in Egypt, and a third in France." To the same effect Baglivi says that, " The Spaniards, any more than the Italians, if their physicians may be credited, cannot well bear rough medicines of any kind." By some it has been supposed that in hot climates, and in warm weather, venesection was a remedy which ought * Though this opinion was formerly almost universal, I doubt its correctness. — C. E.G. INTRODUCTION. 27 not to be resorted to for fear of the debility which it might induce. Erroneous as this opinion certainly is, tlierc can be no doubt that under certain conditions of season and climate, this evacuation cat be better sustained by the constitution than it can under others. As a general rule it is more indicated and better borne during the winter and spring than it is at other seasons. In dry weather, too, it is bettor supported than it is in moist weather. Yet, as a general fact, the natives of moist and foggy England bear bleeding better than Ameri- cans ; it depends probably on their mode of life. Hillary remarks, that in Barbadoes, under equal circumstances of pain, inflammation, and other symptoms, he always found the blood much less sizy and buffy than it was in England, and a consequent modification of the treatment was called for. Mr. Boyle says the same of the coast of Africa. During the prevalence of the sirocco, it has been observed in Egypt, as well as in Italy, that owing to the depression occasioned by it, seda- tives cannot in any case be with safety administered. The effects of mercury, too, are modified very greatly by the nature of the season and the climate. In hot climates it is much more diffi- cult to bring the patient under the influence of this remedy, than in more temperate regions. On this account it is, that such large quan- tities are required and used in tropical regions. Independentlv, how- ever, of mere temperature, certain regions seem to be adverse to the kindly operation of this metal on the human system. In Egypt, accord- ing to Baron Larrey, the use of mercury, even in venereal disease, requires the greatest caution. If used with the same freedom as in Europe, it produces hepatic and various other affections. 5. Habit. — This greatly modifies the effects of many medicinal agents ; but its influence is not the same in all cases : it diminishes the susceptibility of the system to the impression of some medicines it greatly increases it to that of others. Opium furnishes a strikino- illus- tration of the first of these. The quantity of this drug that can event- ually be borne, after the system has been habituated to it, is reallv astonishing. The Malays will swallow from 20 to 30 grains, dailv, with perfect impunity; and in civilized society, persons have been known to take almost any quantity without suffering any inconvenience.. Mer- cury, on the other hand, observes a different law, and the system, so far from becoming habituated to its use, becomes more and more sensible to its operation. When a person, for instance, has been salivated several times, the smallest quantities of mercury will sometimes produce the most violent effects. 6. The actual condition of the Systjmjit the time oj 'Jjtkin^Jhe Medi- cine, with regard to health and disease. — Of all the circumstances which modify the effect of remedies, this is the most striking and important. 3 28 MATERIA MEDICA AND THERAPEUTICS. Medicines do not always produce the same effects in a state of disease Avhich they do in perfect health. In different diseases, too, the effects of the same remedy differ entirely — almost every remedy and every disease furnishes an illustration of these facts. In apoplexy, for instance, the most active emetics fail to produce their ordinary effect. In cer- tain diseased states of the intestinal canal, and of the system, the most drastic cathartics can be made to produce little or no effect. In deli- rium tremens, quantities of opium have been given with very little effect, which, in the ordinary conditions of the system, would inevitably have been followed by apoplexy and death. In tetanic and neuralgic affec- tions, unaccompanied by inflammation, narcotics may be given to the greatest extent without producing any of their ordinary effects. In congestion of the brain, and inflammation of serous membranes, im- mense quantities of blood can be taken without producing syncope? ■while in other diseases, particularly of an irritative character, the system succumbs immediately to the loss of the vital fluid. I have thus, in a general way, noticed some of the circumstances modifying the effects of medicinal agents. When I come to treat of them in detail, all these circumstances will necessarily come again under review, for more special and particular consideration. Of the Classification of Medicinal Agents. — In every department of knowledge, a general classification of the various subjects embraced in it is of the greatest utility. It simplifies the science, and thus facilitates the acquisition of it. It is, in fact, nothing more than a generalization of otherwise individual and detached facts, by some principle of com- mon relation. Any principle may be adopted as the basis of a classifi- cation, and almost every classification will be found to give rise to new combinations and interesting analogies. It is not to be inferred, how- ever, that it is a matter of indifference what classification is adopted; on the contrary, not a little of the interest, as well as character of the science, may depend upon the selection which may be made. The principles which, it appears to me, ought to be chiefly held in view in the construction of a classification of the Materia Medica, are the follow- ing : — In the first place, the basis of it should not be theories, but well established facts. Unless it be so, it is evident that the classification must be fluctuating in its character, at the same time that it may lead to serious practical errors. In the second place, as the great object of this science is the investigation of the effects of medicinal substances upon the human system with a view to the cure of disease, such a clas- sification should be preferred as is best suited to the attainment of this object. By keeping these principles in mind we shall be able to form a pretty correct estimate of the value of the classifications which at various periods have been offered. INTUODUCTION. 29 Among the earliest attempts at arranging tbe articles of the Materia Medica was that of classifying them according to their sensible proper- ties, sucli as color, smell, taste, &c. Such a classification baa the advan- tage of being founded on plain and obvious properties appertaining to medicinal substances, and this, so far as it, goes, is much in its favor. It presents also a very interesting view of the analogies of these substanct so far as their sensible properties are concerned. And if these proper- ties furnished any true index of their medicinal effects, the classification would be unexceptionable. Such, however, is not the case, and it fails, therefore, in the principal object for which an artificial arrangement may be useful. The next attempt was founded on the botanical relations between plants. This of course can only apply to vegetable medicines, and on that account is defective as the basis of a classification which ought to embrace all medicinal agents, whether animal, mineral, or vegetable. So far, however, as it can be applied it has been attempted by Murray and De Candolle,* It is liable, however, to the same objection with that founded on the sensible qualities of substances, inasmuch as the natural affinities lead to no certain conclusions in relation to the medi- cinal properties of plants. By some the chemical properties of substances have been adopted as the basis of classification. This is evidently, however, the very worst that could be chosen, both for the uncertainty and imperfections, even at the present da} 7 , of the analysis of vegetable substances, and from its leading to no certain conclusions concerning the effects of medicines npon the living system. The last principle adopted as the basis of a classification is that of the medicinal properties, or, in other words, of the effects which they produce upon the living system. Of all the systems, this embraces the greatest number of advantages, and is the most decidedly practical and useful in its applications. Like the others, however, it is very far from being perfect. This arises from the limited extent of our knowledge in relation to the animal economy, as well as the effects of medicinal sub- stances upon the system. It is in consequence of this that so many different classifications have been proposed, all based upon the same common principle, but varying in the application of that principle according to the particular views which may be entertained in relation to the laws of the animal economy and the action of remedies. All this will be found abundantly illustrated by an analysis of the classifi- cations of Cullen, Murray, Young, and indeed every other modern writer * Essai sur les proprietes medicates des plantes, comparees avee leurs formes exterieures et leur classification naturelle. Par M. Aug. Pyr. de Candolle, Prof. &c. Seconde edition. Paris. 1816. 30 MATERIA MEDICA AND THERAPEUTICS. on the subject of the Materia Medica. In their details, however, all these classifications are liable to objection. By some, medicines have been classified according to the particular part or tissue of the system upon which they are supposed to exert a special influence. This is the basis upon which the classifications of Alibert and Eberle are founded. Specious as this is, it is' nevertheless obnoxious to an objection which is insuperable. "With the exception of those agents which are purely local in their operation, there is no medicine which is limited in its effects to any particular part of the body. Directly or indirectly, it extends its action more or less to other portions of the system. In applying it, therefore, to individual articles the principle of the classification is constantly violated. For example, opium, in a classification of this kind, is placed under the head of those agents which exert their influence on the nervous system • and so it does — but besides this it also exerts an influence on the vascular system, on the skin, on the liver, on the urinary organs, and thus the very prin- ciple of the classification is contradicted. So also with almost every other agent. This, therefore, can never furnish a solid foundation for a classification. From what has been said, it must be obvious how impossible it must be to frame a classification that shall be unexceptionable. In the one which I propose as the basis for the present course of lectures, my only objects will be simplicity and convenience, and I shall arrange medi- cines according to their more prominent and acknowledged effects on the system, first into Six Great Classes. 1. Evacuants. 3. Narcotics. 5. Revulsives. 2. Depressants. 4. Excitants. 6. Alteratives. The first class I subdivide into nine orders, as — 1st. Emetics, 2d. Ca- thartics, 3d. Anthelmintics, 4th. Sialogogues, 5th. Diaphoretics, 6th. Diuretics, 7th. Expectorants, 8th. Emmenagogues, 9th. Parturients. Of Depressants, I make three orders, viz. — 1. Sedatives, 2. Refrige- eants, 3. Demulcents. Narcotics I do not divide. Of Excitants there are four orders, — 1. Stimulants, 2. Antispasmodics, 3. Tonics, 4 Astringents. Of Revulsives two, Internal and External. Of Alteratives two, Vital and Chemical. INTRODUCTION. 31 ON THE COMMNATION OF MEDICINES. (Condensed and Abridged from Barbier.) Of the Combination of Emetics with other Medicines. — For very obvious reasons the combination of emetic medicines with those of other classes must be exceedingly limited. They would, as a matter of course, be ejected before they could produce any decided effect. Some com- binations, however, of importance are in use. There are only three cases in which emetic medicines may be combined with other medicinal agents, viz. : — 1. When the emetic medicine enters into the composition in so small a quantity that it cannot excite vomiting. 2. When the matters associated with the emetic are only auxiliary to its operation as an emetic. 3. When by the union of different ingredients the emetic is decom- posed and loses its property. Combination of Emetics with Tonics. — These generally do not admit of combination. Tartar emetic, especially, is decomposed by most of the vegetable tonics and astringents, and therefore if united, the emetic property is destroyed. This is the case with cinchona, nut galls, columbo, «fcc. Hence vomiting, too, by tartar emetic may be arrested by the administration of a decoction of Peruvian bark. Emetics and Stimulants. — Combinations of these are not uncommon in pharmacy. The wine and tinct. of ipecac are instances. So also if tartar emetic be dissolved in alcohol. In all these the effects of the emetic and stimulant are observed. In analysing the effects of these compounds, we shall find that the stimulant property shows itself first; that it exalts the sensibility of the digestive passages, and thus gives more scope to the subsequent impression of the emetic ingredient. This combination is useful in cases of poisoning by opium, or where the stomach is rendered torpid by the poisou. Here antimony acts much more powerfully and promptly, if given in alcoholic solution. This combination is also useful iu cases of coma, &c, where you wish to vomit the patient, and the stomach is torpid. Emetics and Demulcents. — If tartar emetic or ipecac be mixed with gum arabic, or any other gummy or oleaginous matter, the effect is to diminish the force of their impression. The mucilaginous matter also relaxes the tissue of the digestive organs, and renders them less sensible to irritation from substances in the alimentary passages. Emetics and Refrigerants. — Here two things are to be considered ; the chemical action of vegetable acids upon the emetic substance, and the refrigerant action of those acids upon the organs where emetics 32 MATERIA MEDICA AND THERAPEUTICS, exert their power. Tartaric and citric acids decompose tartar emetic,, but the new saline substances which are formed remain in solution in the liquor, and equally produce vomiting. One may add to an emetic water, syrup of lemons, or currants, without destroying its emetic virtue.. If, during the action of an emetic, currant water or lemonade be drunk, it weakens the irritation which the emetic has established upon the gastric and intestinal surface. Emetics and Narcotics. — Emetic medicines are frequently combined with opium, as Dover's powder, or laudanum in a solution of tartar emetic, &c. ; but here the emetic is not generally in sufficient quantity to vomit. Emetics and Purgatives. — This is a very common and useful com- bination. One or two grains of tartar emetic with one or two drachms of sulphate of soda or sulphate of magnesia, in four cups of water, or ten or twelve grains of ipecac in a cup of infusion of senna, &c. These are called emetico-cathartics, and generally operate both ways. The effect of an emetico-cathartic is always mild, as it usually consists only of half a dose of emetic and half a dose of purgative. Most commonly it causes two or three vomitings and two or three stools. The irritation which it causes in the alimentary canal is always mild, moderate, and transient. This combination is beneficial when you wish to irritate mildly the digestive passages, and to obtain at once, without wearying the patient, evacuations up and down. They are not to be used where simple vomiting is your object, as in cases of poisoning, obtained from amber, consists of four atoms of carbon, two atoms of hydrogen, and three atoms of oxygen. If one atom of oxygen is added to this, we have the constitution of malic acid. If one more atom of oxygen is added, that of tartaric acid. And by adding yet another atom of oxygen, that of formic acid. Again, cane sugar and gum arabic have precisely the same constitu- tion, viz. twelve atoms of carbon, eleven of hydrogen, and eleven of oxygen, so starch and lignin have each twelve atoms of carbon, and ten each of hydrogen and oxygen ; they are isomeric (from the Greek, itfog, equal, and ixspocr, a part). Cases of this kind are very common among organic substances, and they seem usually to depend upon peculiarities of atomic arrangement. From these peculiarities in the constitution of organic bodies, they have a very unstable character — are very liable to spontaneous decom- position — are decomposed by a red heat, and nearly all of them are partially changed by a temperature far below ignition. The proximate analysis of organic bodies varies considerably with the nature of the substance to be separated, and some of these will be hereafter noticed. The ultimate or elementary analysis consists in the decomposition of the body by heat, in contact with some other sub- stance. The mode now generally adopted is to burn the matter to be analysed by means of oxide of copper (obtained by the decomposition of the nitrate of copper), so as to convert its carbon into carbonic acid, and its hydrogen into water, both of which are collected and weighed, and the proportion of each of the above elements atomically determined, the oxygen being estimated by difference. "When the matter contains nitrogen, it is collected in the form of gas, or it is converted into 38 MATERIA MEDIC A AND THERAPEUTICS. ammonia, by mingling the substance with a mixture of hydrate of lime and caustic soda, and subjecting the whole to a red heat. There are, however, several precautions necessary to the success of these processes, for- an account of which I must refer you to standard chemical works. Although most of the proximate principles employed in the Materia Medica are derived from the vegetable kingdom, a few of those obtained from animal products have been recently introduced. I shall briefly notice some of the more important proximate principles. The following will, I think, be found to be a convenient classification of these proximate principles. I. Organic acids and their compounds, with bases. II. Organic alkalies and the substances allied to them. III. Oleaginous, resinous, and bituminous principles. IV. Alcoholic and ethereal principles. V. Sugars and their congeners. I. ORGANIC ACIDS. These acids are characterized by having, with an exception or two, a sour taste, changing the blue of litmus, but more especially by their power of combining with salifiable bases. Like all organic principles, they are decomposed by a red heat ; though they are in general less liable to spontaneous decomposition than most other organic products. Some of the organic acids are the products of nature alone ; some are the production of nature and of art ; and some are exclusively the products of art. Among the more important of these bodies are the following. Acetic Acid. — This acid exists in the sap of almost all plants, either free or combined with potassa or lime, and is also abundantly the pro- duct of art. In a concentrated form, it is most advantageously prepared by the decomposition of the acetate of soda by sulphuric acid and sub- sequent distillation. It may also be obtained by the distillation of common vinegar, which is prepared by exposing malt or vinous liquors to the free access of atmospheric air, at a temperature slightly elevated. When this acid is combined with bases it forms a class of. salts called Acetates. What is termed Pyroligneous acid, is an impure acetic acid prepared by the distillation of wood. When first made, it is of a dark color, holding in solution a portion of tar and volatile oil, from which, how- ever, it may be freed by subsequent processes. When metallic acetates in an anhydrous state are subjected to de- structive distillation, they yield, among other products, an inflammable volatile substance called Acetone or Pyro-acetic Spirit. When pure, it PROXIMATE PEINOIPLES. 39 is a colorless, limpid liquid, having an empyreumatic odor and a dis- agreeable taste. It burns with a bright flame, and mixes in all propor tions with water, alcohol, and ether. By the action of acids it under- goes a variety of changes. Benzoic Acid. — This is the Flowers of Benzoin of the shops, a name which it has received from having been originally obtained from the Gum Benzoin, the produce of the Styrax benzoin (Dryand.). It exists also in the Balsams of Peru and Tolu, and several aromatic plants. It may be obtained in a state of purity by gently heating gum benzoin in a shallow iron vessel with a cone of paper placed over a paper diaphragm pierced with pinholes (Mohr's subliming apparatus). It occurs in white acicular crystals of a satiny appearance; has an aromatic rather than a sour taste, though it reddens litmus. It combines with bases and forms a class of salts called JBenzoates. Citric Acid. — This acid exists in great quantity in the juice of limes and lemons; it is found in many other fruits, as in gooseberries, cur- rants, &c, in conjunction with another acid, the malic. It exists, when pure, in the form of large transparent crystals, which have an agreeable acid taste. It reddens litmus powerfully, is freely soluble in both hot and cold water, and combines with bases forming a class of salts called Citrates. Gallic Acid. — This acid is formed from tannin by a kind of fermen- tation. It is obtained from the gall nut. "When pure, it is in the form of small, feathery, and nearly colorless crystals, which have a fine silky lustre. Its taste is slightly acid and styptic; it is soluble in 100 parts of cold, and in three parts of boiling water. Gallic acid does not preci- pitate gelatin, by which it is distinguished from tannic acid, with which it is often associated. With a proto-salt of iron no change is produced, but with a per-salt a deep bluish black precipitate falls, which disappears when the liquid is heated, from the reduction of the peroxide of iron to the protoxide at the expense of the gallic acid. With bases this acid forms Gallates. Lactic Acid. — This is the result of the fermentation of milk. It may also be extracted from great varieties of liquids containing decomposing organic matter, as sauer kraut, a preparation of white cabbao-e, the sour liquor of the starch-maker, &c. In the purest form in which it can be obtained, it is a syrupy, colorless liquid, having an intensely sour taste and acid reaction. With bases it forms Lactates. Meconic Acid. — This acid is found in opium, and when pure, crystal- 40 MATERIA MEDICA AND THERAPEUTICS. lizes in small, colorless, pearly scales, which are soluble in four parts of boiling water, and also in alcohol. It has an acid taste and reaction, and with bases forms Meconates. The most remarkable feature of this substance is its property of striking a deep blood-red color with a salt of the peroxide of iron. Oxalic Acid. — This acid occurs in the juice of several plants, espe- cially in that of the Rumex acetosa, L., or common sorrel, the Oxalis acetosella, Z., or wood sorrel, and in the varieties of Rhubarb. It is usually in combination with potash as an acid salt or with lime. It is also the produce of art, and is now manufactured in large quantities by the action of nitric acid on sugar, starch, and dextrine. It crystallizes in slender, colorless, transparent crsytals, which dissolve in eight parts of water at 60°, and in their own weight or less of hot water. The aqueous solution has an intensely sour taste, a powerful acid reaction, and is highly poisonous. Oxalic acid, when heated with sulphuric, yields carbonic oxide and carbonic acid. With bases it forms Oxalates. Prussic Acid. — This acid, also known by the name of hydrocyanic acid, is remarkable for its poisonous properties. It exists in the bitter almond, the kernels of plums and peaches, the leaves of the cherry- laurel, and in several other plants. It is also largely obtained by pro- cesses of art from various animal matters. When obtained pure by the decomposition of the cyanide of mercury, it is a thin, colorless, and exceedingly volatile liquid, with a powerful odor, resembling that of peach blossoms, or bitter almond oil ; it has a feeble acid reaction, and mixes with water and alcohol in all proportions. In its anhydrous form, it is one of the most deadly poisons known, and even when largely diluted with water, its effects upon the animal system are very energetic. It combines with bases, forming salts which are called prussiates, or hgdrocyanates. [The researches of Liebig, Wohler, &c, haye proved that hydrocyanic acid does not exist ready formed in bitter almonds, but is formed by the action of synaptase on amygdalin. The presence of water is essential to this action. The same is probably true of many other vegetables from which the acid is obtained.] Tannic Acid. — This acid, sometimes known by the name of tannin, exists in the bark of various species of quercus, and many other trees ; and in gall nuts, from which it is procured in the greatest quantity. In the purest form in which it can be obtained, it occurs as a slightly yellowish, friable, 7 porous mass, without any tendency to crystallization. It is very soluble in water, less so in alcohol, and very slightly in ether. It reddens litmus, has a pure astringent taste, without any bitterness, and with bases forms tannates. PROXIMATE PBINOIPLES. 41 Tannic acid is often associated with, and mistaken for, gallic ■" id. The proto-salts of iron are not altered by tannic acid, but in the pcr- salts it occasions a dark blue precipitate; it is the basis of writing ink. It also precipitates animal gelatin, forming a yellowish, viscid, elastic mass, called tannogelatin, which is the essential basis of Leather, Tartaric Acid. — This is the acid of grapes, of tamarinds, and several other fruits, being found in them sometimes free, but generally in combination with lime or potash. The tartaric acid of commerce is wholly prepared from the tartar or argol, an impure acid tartrate of potash, deposited from gr%pe juice, in the act of fermentation. When pure, it occurs in transparent, often highly modified crystals, the primary form of which is a rhombic prism. It has a very sour taste, and red- dens litmus powerfully; is soluble in both cold and hot water, and slightly so in alcohol. The crystals undergo no change by exposure to the air, but its aqueous solution soon becomes covered with mould. It is a cheap substitute for citric acid in lemonade and effervescent solutions. With bases, it forms an important class of salts, called tartrates. Valerianic Acid. — This acid exists in a variety of products, but has usually been obtained by the oxidation of an oil procured by distilling the root of the common valerian, Valeriana officinalis, L., or by drop- ping the volatile oil of potato-brandy (fusel oil), slightly warmed, upon platinum black. In this case, the acid bears the same relation to the fusel oil, as acetic acid does to alcohol, or formic acid to wood spirit. It is a colorless, oily liquid, with the odor of valerian, and a sour, pun- gent, and nauseous taste. It dissolves in all proportions in alcohol and ether, and forms with bases a well characterized class of salts, called valerianates. ii. — organic alkalies, and the allied substances. Under this head are classed all those proximate principles which are capable of uniting with acids, and of forming with them saline com- pounds. The existence of this class of bodies w r as discovered in 1803, by Sertuerner, a German apothecary ; but they excited no attention until about the year 1816, when he ascertained their true nature. Since that time, this department has been cultivated by several chemists, but especially by Robiquet, Pelletier, and Caventou. The organic alkalies consist of carbon, hydrogen, oxygen, and nitro- gen. They are for the most part solid, of a white color, and mostly crystalline when in a state of purity, usually inodorous, but having a 42 MATERIA MEDICA AND THERAPEUTICS. bitter or acrid taste. They are not affected by exposure to air or light, but are in most instances decomposed by a moderate heat. They change vegetable blues to green. In water, they are nearly insoluble ; in cold alcohol, sparingly soluble; but in boiling alcohol, readily so. From the hot alcoholic solution they are deposited, on cooling, generally in the crystalline form. These substances are never found in nature in a free state, but appear in every case to be combined with an acid, forming a salt more or less soluble in water. The process for separating them, which is generally applicable, is to digest or macerate the substance containing the alkali in water, acidulated with muriatic acid, and to add to the filtered solu- tion a more powerful salifiable base, as ammonia, lime, or magnesia. The organic alkali is thus separated from the acid, and, being insoluble in water, is precipitated. This precipitate, mixed with some animal charcoal, is then dissolved in boiling alcohol, and the solution filtered while hot and evaporated. The pure alkali is thus usually obtained, but sometimes the latter part of the process requires to be repeated. I shall very briefly notice a few of the more important organic alkalies. Morphine. — This is one of the alkalies found in opium. When crystallized from alcohol, it forms small but very brilliant prismatic crystals, which are transparent and colorless. Although it has a bitter taste, it is almost insoluble in cold water. It forms salts with acids, which are mostly soluble and crystallizable. This alkali, in powder, strikes a deep bluish color with neutral persalts of iron. Narcotine is another alkali found in opium, and often associated with morphine. When pure, it is in the form of colorless prisms, which are tasteless and almost insoluble in water. It is distinguished from morphine by its solubility in ether. Codeine, Thebaine, Narceine, Pseudomorphine, and Meconine, are the names given to other alkaline principles extracted from the very complex substance, opium. Quinine. — This is the alkali of the Peruvian bark, in which it is associated with the kinic acid. It is in the form of white needle-form crystals, which have an intensely bitter taste, and are soluble in about 200" parts of boiling water. With acids it forms salts, which are generally crystallizable. The subsulphate of quinine is manufactured on a large scale for medicinal use. Cinchonine exists in large quantity in the Cinchona condaminea, 1'ItOXIMATK I'KJNCII'I.KS. 43 Ilumb., or pale bark, and is associated wi.t.li quinine in all the Bpeci< oi the Peruvian barks. When pure, it crystallizes in small bat brilliant prisms. It is but very feebly soluble in water, dissolves readily in boil- ing alcohol, and lias but little taste. It unites with all acids, and forms a series of crystal] izable salts. When both the above bases arc present in a sample of bark, they may be separated by converting them into sulphates. The salt of quinine is the least soluble of the two, and crystallizes first. Quinoidine or Chinoidine, a substance obtained from the mother- liquor in the process for procuring sulphate of quinine, has been shown to be quinine in an amorphous state. It bears the same relation to ordinary quinine that uncrystallizable syrup does to crystalline sugar. In its purest form it occurs as a yellow or brown resin-like mass, insolu- ble in water — freely soluble in alcohol and ether. It is easily soluble, also, in diluted sulphuric acid, from which it may be precipitated by ammonia. The weight of this precipitate, when compared with that of the substance originally employed, affords the means of deter- mining the purity of the sample. Strychnine. — This is an alkaline body, highly poisonous, found in many species of strychnos. When obtained by evaporation from its alcoholic solution, it occurs in the form of small, white, four-sided prisms, or octahedrons. It is very sparingly soluble in water, dissolves in hot and somewhat dilute spirit, but neither in absolute alcohol nor ether. With acids, it forms colorless and crystallizable salts. Brucine. — This is found in the bark of the false Angustura, now known to be the Strychnos nux vomica, L. It resembles strychnine in its properties, but is much less poisonous. When pure, it occurs in colorless rhombs, which are readily soluble in alcohol. With acids it forms salts which have a bitter taste and are generally crystal- lizable. Emetine. — This is an alkali found in the root of the Cephaelis ipeca- cuanha, WillcL, and Viola ipecacuanha, L. When completely pure, it is white, uncrystallizable, nearly tasteless, but very poisonous. It neu- tralizes acids, but its salts are little disposed to crystallize. Yeratrine. — Found in the various species of Veratrum. It is white, pulverulent, inodorous, of an acrid taste, but without bitterness. It is insoluble in water, but is soluble in alcohol and ether, has an alkaline reaction and neutralizes acids. Even in minute quantity it acts violently on the membrane of the nose. There are also Aconitine, the active principle of the Aconitum napel- 4 44 MATERIA NEDICA AND THERAPEUTICS. his, L., or monkshood ; a very virulent poison ; Berberine, an organic base found in the Berberis Nectrandra rkodici .of Schomburgh ; Baturine, a substance obtained from the seeds of the thorn apple, Datura stramonium, L. ; Nicotine, a very poisonous alkaline principle obtained from the various species of tobacco, &c. Substances someivhat allied to the preceding but not alkaline. — There are various substances somewhat allied to the preceding, but which do not give an alkaline reaction, nor combine with acids. The most important of these are, colocyntin, a bitter resinous matter extracted from colocynth ; gentianin, obtained from Gentiana lutea, B., or gen- tian, of a yellowish color, inodorous, but having the aromatic bitterness of the plant; Piperin, a white crystalline substance abstracted from black pepper; Rliubarbarin, the active principle of the rhubarb; Salicin, a white crystalline body obtained from the bark of the white willow, Salix alba, B., having a bitter taste and resembling the sulphate of quinine ; Thein, the active principle of tea and coffee, occurring in white anhydrous crystals as the result of sublimation, &c. III. OLEAGINOUS, RESINOUS, AND BITUMINOUS PRINCIPLES. Oils and Fats. — Oils are characterized by a peculiar unctuous feel, by inflammability, and by insolubility in water. The fats seem to differ from them principally in consistency. The oils are divided into fixed and volatile ; the former are compara- tively fixed in the fire, and therefore give a permanently greasy stain •to paper ; while the latter, owing to their volatility, produce a stain which disappears by gentle heat. Fixed Oils and Fats. — These bodies in general have but feeble odor, and scarcely any taste. They are all insoluble in water, and but slightly soluble in alcohol, with the exception of castor oil ; in ether and the essential oils they dissolve in large quantity. By exposure to the air some of these oils become hard and resinous, while others thicken slightly, become rancid, but never solidify ; hence they are distinguish- ed by the terms drying and non-drying oils. To the first class belong the oils used in painting, as linseed, rape, poppyseed, and walnut ; and to the second, olive and palm oils, and all the oils and fats of animal origin. The consistency of these substances varies from that of the thinnest olive oil, to that of solid, compact suet ; the difference being due to the variable proportions of solid and fluid fatty principles associated in the natural product.. By means of a fixed alkali the oil or fat is decompos- ed into an acid which combines with the base, forming a true salt which PROXIMATK rUINCII-I.KS. 45 is a snap, and a substance having a sweetish taste, and which is soluble in water and alcohol, called glycerin (from yXuxug, «'w«7). One of thee acids formed during the process of 'saponification is called the stearic acid, the basis of which is stearin (from tfreap, tallow), the solid semi-crystal- line matter of fixed oils and fats. The other is termed olein (from ;Xaiov, c«7), the principal constituent of the liquid oils and the liquid portions of fats, which is converted into oleic acid by combination with an alkali. In most fats, also, and especially in that of the human body, another crys- talline substance exists, called margarin, and which by combination with bases is converted into glycerin and margaric acid. To the above property of the fixed oils it may be added, that although insoluble in water, by trituration with sugar or gum they may be sus- pended in it, and they then form a class of preparations which in phar- macy are called emulsions. They also unite with the common metallic oxides, forming varnishes and plasters. Among the more important of this class of substances are the fol- lowing : Olive Oil, expressed from the fleshy part of the fruit of the olive, Olca europwa, L., cultivated in France, in Italy, in Spain, and on the coast of Africa. It has a fine greenish yellow color, slight odor, and agreeable taste. When pure, it has less tendency to change than almost any of the fat oils ; but it is often adulterated with inferior oils. Almond Oil, expressed from the kernel of the Amygdalus communis, L. It has a pale yellow color, and a slight but agreeable taste. It is used in pharmacy for the preparation of emulsions ; it soon becomes rancid when exposed to the air. Rape Oil. A thick yellow oil expressed from the seeds of Brassica rapa, L., and Brassica napus, L. It is much employed in France for burning in lamps. Linseed Oil. The well-known oil obtained by expression from the ripe seeds of the common flax, Linum usitatissimum, L. Castor Oil. This is the Oleum ricini of pharmacy, obtained by ex- pression from the seeds of the Ricinus communis, L. It is a thick, vis- cid oil, having a somewhat nauseous flavor, often nearly colorless, or only of a pale straw color. It differs from most of the class by its beino; soluble in all proportions in pure alcohol. Croton Oil, a thick brownish oil expressed from the seeds of the Cro- ton tiglium, L. It has a peculiar odor, an acrid taste, and is violently purgative in doses not exceeding even one drop. Palm Oil. This is the produce of various species of palm. It has the consistency of soft tallow or of butter, an orange yellow color, and a peculiar odor. It soon grows rancid ; extensively used in the manu- facture of soap and candles. Among the animal fats and oils may be mentioned mutton suet, the 46 MATERIA MEDICA AND THERAPEUTICS. fat of sheep, having a -white color and a little odor when fresh, hut acquir- ing a rancid smell when exposed for some time to the air ; beef fat, the fat of oxen, of a yellowish white color, and requiring a heat of about 100° for its fusion ; hog's lard, a white inodorous soft fat, the fusibility of which .fluctuates between 80° and 88° ; human fat, which is soft, yel- lowish, inodorous, solid at about 64° ; whale oil, spermaceti oil, and the cod liver oil, or the oil obtained from the liver of the common cod fish, Morrhua vulgaris, which has lately been so much employed in medi- cine. Under this head, also, may perhaps be placed the different varieties of butter and wax. Volatile or Essential Oils. — These oils are so named from their solu- bility in alcohol, such solutions being called essences, and from their vola- tility. It is in consequence of this last property that they are usually obtained by the distillation of the plants, or parts of plants which con- tain them, with water. Some, however, are obtained by expression, as the oils of lemon, orange, and bergamot. The essential oils have a penetrating odor and taste ; are for the most part soluble in alcohol and very sparingly soluble in water. When pure, they pass into vapor at a temperature somewhat above 212° ; but when distilled with water they pass over at its boiling point. They are very inflammable, and burn in the air with a clear white light. Their adul- teration with the fixed oils can be determined by the greasy stain com- municated to paper, not being removed by warming. A solid crystalline matter, corresponding to the margarine of the common oils, frequently separates from these bodies ; it bears the general name of Stearoptene but is supposed to differ in almost every case. Oil of Turpentine. — This is obtained by distilling with water, crude turpentine, which exudes from various pines and firs. The oil comes over with some resin, and is purified by a second distillation, when it forms the essence or sp>irits of turpentine. The pure oil is a thin, color- less liquid, having a peculiar odor. It is sparingly soluble in alcohol, and is so inflammable that it becomes dangerous when kept in large quantities. By contact with oil of vitriol it is changed into another liquid called terebine. With hydrochloric acid it forms a compound which has been called artificial camphor, from its resemblance in odor and appearance to that substance. Oil of Lemon. — This is obtained both by expression and distillation from the rind of the fruit. It has the same composition as the oil of turpentine, but differs from it in odor. The oils of orange feel, bergamot, pepper, juniper, savin, laurel oil, are also isomeric with the oils of tur- pentine and lemon. Oil of Aniseed. — The oil distilled from the seeds of the Pimpinella anisum, L., consists of two substances, one of which is a liquid oil, and the other a solid crystalline substance so abundant as to cause the whole PROXIMATE PRINCIPLES. 47 v to solidify at the temperature of 50*. The solid essence may be sepa- rated by pressure. Cam])hor. — This is a concrete essential oil. it is obtaine I b} di 'il- lation from the Laurus campkom, />., nnd several other plants. I' subsequently purified by sublimation, and is then a white, translucent, crystalline mass, which is difficult to powder, and having a powerful and very familiar odor. It is insoluble in water, hm freely soluble in alcohol, from which it may be obtained in the form of brilliant crystals. Resins and Balsams. — Resins are the inspissated juices of plants, and commonly occur either pure or in combination with an essential oil. They are solid at common temperature, brittle, inodorous, and insipid; generally of a yellow color ; some are transparent; soluble in alcohol, ether, and the essential oils ; from the former, they are precipitated by water, in which they are quite insoluble. The most important of these substances are common resin, or rosin, copal, lac, sandarach, rnastich, and dragon's blood. In pharmacy, resins melted with oil and wax, are used to make p)lasters and ointments. Gum Resins. — These are the concrete juices Gf certain plants, and consist of resin, essential oil, gum, and extractive matter. The two former are soluble in alcohol, and the two latter in water. Their proper solvent, therefore, is proof spirit, or a mixture of alcohol and water. Under this class are included several valuable medicinal agents, such as aloes, ammoniacum, assafoetida, euphorbium, galbanum, gamboge, myrrh, scammony, and guaiacum. Balsam. — [By some chemists this term is applied exclusively to the compounds of benzoic or cinnamic acid with resins. Others include among them some of what are more properly called oleo-resins, com- pounds of resin and volatile oils. The balsams of Peru and Tolu are types of the former class ; Canada balsam and copaiva of the latter.] They are generally odorous and pungent. Some of them are liquid, as balsam copaiva and the balsam of Peru and Tolu ; others are solid, such as storax and benzoin. Caoutchouc, commonly called elastic gum, or India rubber, is the produce of the Siphonia elastica, JPers., a native of Brazil, and of several East India trees, which yield milky juice, hardening by exposure to the air. In a pure state, it is nearly white, the dark color of the common caoutchouc being caused by smoke and other impurities. The most remarkable property of this substance is its elasticity. It is inflam- mable, and burns with a bright flame. In water and alcohol it is per- fectly insoluble. The best solvents are petroleum, purified naphtha, oil 48 MATERIA HEDICA AND THERAPEUTICS. of turpentine, coal oil, and especially the thin oily liquid obtained from the distillation of the caoutchouc itself. In a state of solution it is employed for forming varnishes,, for covering cloth so as to render it ■water proof, &c. Gutta Percha. — The concrete milky juice of the Isonandria Gutta (Hooker), a tall tree, native of Singapore and the Malay Islands. As imported, gutta percha is a whitish, opaque solid ; density, 0.79. Not acted on by water, alcohol, alkaline solutions, muriatic and acetic acids. It is charred by sulphuric acid, and readily dissolved by spirits of turpen- tine. In hot water it softens, becomes plastic and readily welded by pressure. "When cool it resumes its hard, tough state. It is very extensively used in the arts. A solution of it in ether has been recom- mended as a dressing to wounds. IV. ALCOHOLIC AND ETHEREAL PRINCIPLES. Alcohol. — This principle does not exist ready formed in plants, but is the product of vinous fermentation, and is the intoxicating ingredient of all spirituous and vinous liquors. In its pure form it is a limpid, colorless liquid, having a penetrating odor and burning taste. The lightest that can be obtained by simple distillation, has a specific gravity of 0*825 r but by other processes it has been brought to the specific gravity of 0-7947, at 60°. In that state it boils at 168°, and does not become solid even in the most intense cold. It is highly inflammable, burning with a pale bluish flame, and yields carbonic acid and water as the products of its combustion. It is remarkably expansible by heat ; unites in all proportions with water, the combination being usually attended with a diminution of volume and an increase of temperature. The solvent powers of alcohol are very extensive, many salts, various organic bodies, as the alkalies, resins, essential oils, uncertain strength. Sherry wine containing no acid cannot be had. I rejoice to say that it is infinitely less used in New York now than formerly. Especially should its use as a domestic remedy be discouraged.] SULPHATE OF ZINC. Zinc was not known to the Greeks or Romans, although they were aware of the method of converting copper into brass by means of an ore of zinc. It was first noticed in 1280. The preparation at present under consideration was first known in Germany about the middle of the six- teenth century. In the mines of Goslar, in Germany, it is found native — what is used in medicine is prepared artificially. There are two kinds of it met with in the shops. The impure, ov what is commonly called white vitriol, and the pure or crystallized. Sulphate of zinc is prepared by the direct combination of its consti- tuents. For this purpose zinc, cut into small pieces, is subjected to the action of diluted sulphuric acid — effervescence takes place ; when this is finished, the solution is filtered through paper; it is then boiled down until a pellicle appears, and set aside to crystallize. Here water is first decomposed. The zinc is oxidized and then the sulphuric acid unites with it. The hydrogen escaping causes the effervescence. Properties. — When pure, this salt exists in the form of small white rhombic prisms, resembling crystals of sulphate of magnesia. It has no smell, but has a styptic metallic taste ; when exposed to dry air it slightly effloresces — soluble both in hot and cold water. Two and a half times its weight of the latter, and less than its own weight of the former. In alcohol it is insoluble. Effects. — Sulphate of zinc is a powerful and in many cases a valuable emetic. It is peculiar in its action, combining with its emetic operation the effect of a local astringent, checking secretion from the mucous membrane of the alimentary and pulmonary tissues. It is more speedy in its operation than any of the preceding articles. Unlike ipecac, and tartar emetic it causes little or no nausea, and does not produce repeated emesis. On the mucous membrane it acts powerfully as an astringent, separating and clearing out morbid accumulations of mucus, and moderating and even suspending secretion for a time after its operation. On the system at large, it does not produce any of the debilitating and 86 MATERIA MEDICA AND THERAPEUTICS. relaxing effects which follow the use of other emetics ; and even the stomach itself seems to be invigorated after its action. As an emetic, it is suited to all such cases as require a prompt and complete evacuation of the stomach, unaccompanied by any relaxing effects on the system. The most frequent use of it is in cases of poisoning. It is also used, in cases where it is desired, by means of an emetic, to unload the pulmonary organs of superabundant mucous secre- tion, and to check the further secretion of it. In excessive doses, sulphate of zinc operates as an irritant poison. In using this article, the crystallized ought always to be preferred. It is purer, and in consequence of its containing more water of crystalliza- tion, not so strong. Dose, &c. — For an adult, 10 to 20 grs. as an emetic. To be taken in | ij of mint or common water, with the addition of f i of sp. lavender. For children, grs. ij may be dissolved in § j of water — a teaspoonful every ten or fifteen minutes. SULPHATE OF COPPER. Known by the common names of blue vitriol, blue stone, &c. There are several modes in which this article is obtained. 1. From the native sulphuret. By exposure to a moist atmosphere this undergoes chemical changes ; the sulphur is converted into sulphuric acid, while the copper is oxidized, and thus the sulphate is formed. In this state it is washed down by the rain and other waters of the mines. By simply evaporating these waters the salt is obtained. A large pro- portion of it is thus obtained from the copper mines. 2. A second mode is to roast the copper pyrites (sulphuret of copper) in a reverberatory furnace, during which it absorbs oxygen and is converted into the sulphate. It is then lixiviated and the solution evaporated till it forms crystals. 3. The third mode is by the direct action of sulphuric acid on copper. This is the mode in which it is usually prepared in this country. Properties. — A crystalline salt of a beautiful deep blue color. The crystals are semi-transparent, and when exposed to the air slightly effloresce — without smell, but has a harsh, styptic, metallic taste. • Solu- ble in four parts of water at 60°, and in less than two parts at 212°. In alcohol insoluble. Purity. — The sulphate of copper of the shops is generally very pure. The only adulteration which it sometimes contains is sulphate of iron, existing in the native sulphuret. Effects. — In its local action astringent, and in large doses irritant. EMETICS. 87 As an emetic, prompt and powerful — very analogous to the sulphate of zinc used in the same cases, especially in poisoning. Not so good, however, as the sulphate of zinc, because more apt to cause local irrita- tion and inflammation, where it is retained, as is frequently the case in poisoning by narcotic agents. Dose. — Adults, 5 to 10 grs. dissolved in two or three ounces of water. Children, one eighth to one sixth gr. every quarter of an hour. SQUILL. The product of the Scilla maritima, the Sea Onion, a perennial plant growing to the height of two or three feet, shooting from a large bulb, with fibrous roots. It grows native on the sandy shores of the Medi- terranean, in France, Spain, Italy, Greece, Syria, and Barbary. The part used in medicine is the bulb. In its appearance this resembles the common onion, though much larger. Its size varies from that of a man's fist to a child's head. It is composed of concentric layers or scales, each of which is covered with a thin membrane of a whitish color. The fresh bulb contains a large proportion of acrid juice, which inflames and vesicates the skin. By drying, the greater part of this acridity is dissipated. For medicinal purposes, the bulb is cut into small slices and dried. In the shops, there are found two varieties of it — viz. the red and the white. In medicinal properties they do not differ, and are used indiscriminately. The squill has no smell — taste bitter, acrid, and nauseous — as it has a great affinity for moisture, and then becomes mouldy, it should be kept in tightly corked bottles. Composition. — According to the analysis of Vogel, the dried squill contains an acrid volatile matter — a bitter substance called scUlitinaj tannin, gum, citrate of lime, and lignin. Its active properties are extracted by water, vinegar, and alcohol. Scillitina. — According to Vogel, 100 parts of the dried squill yielded 35 of this principle. A whitish transparent deliquescent substance, which, when dry, has a resinous fracture, and may readily be reduced to powder. Its taste is bitter and subsequently sweetish. It readily dissolves in water, spirits of wine, and acetic acid. The substance sold in the shops as scillitina is a treacle-like liquid. Effects. — In small doses, squill acts as a stimulant to the mucous membrane — especially the bronchial and gastro-intestinal portions of it, promoting secretions from them. At the same time it excites the secretory action of the kidneys. In larger doses, it causes nausea, vomiting, and sometimes purging. With regard to its action on the circulation, there is a difference of opinion. By some it is supposed to excite the pulse, and, therefore, is objected to in all cases where inflammatory action is present. This, 88 MATERIA MEDICA AND THERAPEUTICS. however, does not appear to be the case. As a general rule it does not excite the circulation. Nevertheless, from its ac ting as a local stimulant, it is not suitable where inflammation is present. In excessive doses, it acts as a narcotico-acrid poison, causing severe vomiting, purging, griping, strangury, inflammation of the stomach and intestines, convulsions, and death. 24 grs. of the powder have proved fatal. As an emetic, this article is little used at present, except for children. A great objection to it is the uncertainty of its action. In some cases very small doses cause severe vomiting, while in others large doses produce but little effect. It is objectionable, too, where the stomach is irritable. Forms. — Powder. — Ten grs. act as an emetic in an adult. Not used in this way. In children the only forms in which it is used are those of oxymel or syrwp. Oxymel. — Prepared by boiling the vinegar of squill with honey. Syrup. — Boiling vinegar of squill with sugar. Dose — half a tea- spoonful to a teaspoonful every quarter of an hour till it operates. LOBELIA INFLATA. This is a biennial plant, known by the common names of the Indian tobacco, wild tobacco, emetic weed, &c. It grows native in every part of the United States, and is generally found along road sides and in old uncultivated fields. It rises to the height of from one to two feet, with a single, erect, hairy stem, branching about midway. The fruit is an oval, striated, inflated capsule, containing in its two cells a great num- ber of small brown seeds. It commences flowering in the month of July, and continues in bloom until November. When broken or cut it emits a milky juice. The proper period for gathering this plant is in the months of August and September, when the capsules are full and numerous, and when the leaves are just beginning to fade. It is then to be plucked up by the roots and dried quickly, either in the sun or in an oven. It may be kept whole or in powder. It should always be packed tightly and kept for some time in a dark place. Every part of the plant possesses medicinal properties ; but the parts most powerful are the leaves and capsules. These should, therefore, be preferred. Physical Properties.— Indian tobacco, when dried, has a smell slightly irritating. When chewed for a short time, its taste is acrid, resembling that of common tobacco, and like that, too, causes a flow of saliva, sick- ness at stomach, and giddiness. Its powder is of a greenish color. EMKTICB. 89 Chemical Corn/position and Properties. — According to the anal] Doctor Procter, the lobelia contains a peculiar alkaline, acrid principle, upon which its active properties arc supposed to depend. Tins is called Lobeline. Also gum, gallic acid, volatile oil, greenish resin or chlorophyle, a green, fixed, oily matter, salts of lime and potassa, oxide of iron and lignin. Physiological Effects. — In small doses, this article promotes the secretions of the gastro-puhnonary tissues and at the same time affects the nervous system as a narcotic. In larger doses, it proves emetic, and its operation is accompanied with copious secretion from the mouth and fauces and general relaxation. In still larger doses, it acts as a poison, producing great anxiety and distress, excessive prostration, con- vulsions, and finally death. From the preceding account of its effects, the indication for its use is obvious. It may be resorted to whenever it is desirable to produce an emetic effect and at the same time free secretion from the gastro-pul- monary tissue, and to make an impression on the nervous system with the view of causing relaxation. By many physicians the lobelia is looked upon as a dangerous re- medy, and its use has been accordingly proscribed by them in all cases. This is certainly going too far. If imprudently used, it is unquestion- ably a most dangerous remedy, and in the hands of empirics it has been the cause of melancholy and fatal results. The same, however, may be said of many other remedies in common use. This, therefore, is no valid objection to the cautious and prudent use of it. The testimony of many highly respectable practitioners has certainly established the fact that, if properly exhibited, it is both a safe and valuable remedy. Forms of Administration. — 1. Powder. — This is probably the best form in which it can be used as an emetic. It may be given in syrup or made into pills. The average dose for an adult is from ten to twenty grains, which may be repeated in half an hour, if necessary. 2. Tincture. — This is prepared by digesting two ounces of lobelia in two pints of diluted alcohol, for ten days, and then straining. Of this half an ounce .is a dose as an emetic. To produce simply the antispas- modic and expectorant effect, one or two drachms may be given evejy two or three hours ; to a child, five to twenty drops. sinapis {mustard). Of this there are two species — sinapis nigra and sinapis alba. The sinapis nigra is a plant three or four feetThigh, with wide spreading branches. The sinapis alba is rather smaller. They derive their names from the color of the seeds. Both plants are natives of Europe, but 90 MATEBIA MEDICA AND THEEAPEUT1CS. cultivated in this country. The seeds of the hlack mustard are much smaller than those of the white. They are, however, analogous in their properties and are used indiscriminately. In their entire state, these seeds have no smell, but when bruised have a peculiar and penetrating odor. The black is much more pungent than the white. Mustard is a powerful stimulant to the stomach and the whole sys- tem. In small doses it excites the stomach and promotes digestion. In larger doses, it excites vomiting, and in still larger it acts as an irri- tant, causing vomiting, purging, and inflammation of the stomach and bowels. When used as an emetic, it is only suited to cases jn which there is great torpor of the stomach, and where that organ requires to be powerfully stimulated, such as cases of narcotic poisoning. Mode of Administration. — From a tea-spoonful to a table-spoonful of the flour of bruised mustard in a tumbler of water. • anthemis nobilis {chamomile). This is a native of Europe growing all over the continent and in Eng- land. From the large quantities of it which are used, it has been made an object of cultivation in that country, and most of what is used in medicine is raised by the growers of medicinal plants. The part used is the flower, and by cultivation these become double, and in this state are generally preferred. What is used in this country is generally obtained from England and Germany. Chamomile flowers have a strong and fragrant smell, and a bitter, aro- matic taste. The best are those which are large and of a whitish color. By long keeping they lose much of their activity. They contain a volatile oil, bitter extractive, and tannic acid. Effects. — Chamomile is an aromatic bitter tonic, and it is only when given in a certain way that it proves emetic. This is in the form of warm infusion and taken in considerable quantity — § ss to a pint of boiling water. It is mild in its action, and is chiefly used to aid the operation of other emetics. TURPETH MINERAL. This is the hydrargyri sulphas flavus. It was formerly much used, but has been of late pretty generally discarded. Still it is a powerful and in certain cases a valuable emetic, especially in croup and cynanche maligna. It will sometimes act well in cases where other emetics fail to operate or run off by the bowels. It often produces very copious secre- tion from the fauces. Dose three grains. EMETICS. 01 COMBINATION OF EMETICS. Emetics are combined either, First,, to increase their efficiency by securing the effects of different agents, e.g. tartar emetic with ipecacu- anha. Ipecacuanha is limited in its action to the stomach. Tartar emetic affects the duodenum, liver, &c. By uniting the two, we secure the prompt and certain action of the vegetable with the greater power of the mineral emetic. Second, To modify the effects of one remedy by the other, e.g. Squill, though it promotes secretion powerfully, is at the same time stimulating; this latter quality is corrected by antimony ; and, on the other hand, the depressing effects of antimony are moderated by the squills. Hence the great value of Coxe's hive syrup, in which both these emetics are united with senega. [This preparation has gone very much out of vogue, and is, I think, of little value. — Ed.] CATHAKTICS, Cathartics are defined to be "those medicines which quicken or increase the evacuations from the intestines; or which, when given in a certain dose, produce purging."* In relation to this definition the same remarks may be made which were applied to emetics. As a simple definition of the term cathartic it is very correct. Purging, however, is only one of the effects of these articles. They produce a great number of others, all of which are neces- sary to be taken into view for the purpose of justly appreciating their operation on the living system. In treating of this class of agents, I shall observe the same order which was adopted when discussing the subject of emetics. 1. OF THE ORGANS IMMEDIATELY ACTED UPON BY CATHARTICS. These are the intestines, the liver, and the pancreas. The Intestines.— -These form a continued canal from the pylorus or lower orifice of the stomach to the anus. The whole length is about six times that of the body. From this simple fact some idea may be formed of the extent of surface upon which the immediate impression of cathartics is made. These intestines are divided into the small and the large, differing from each other in a number of important particulars. The small intestines are about four times as long as the large ; they have three coats or coverings — the external or serous covering, the mid- dle or muscular, and the internal or mucous lining, all united together by intermediate cellular tissue. Of these, the two last are especially important, as connected with the operation of cathartics. The muscu- lar coat is made up of two sets of fibres, one longitudinal, the other circular. By a regular series of contractions of these fibres from above downwards (the one set shortening, and the other contracting the canal), there is a motion produced in the intestines which is called the peri- staltic motion, and by means of which the contents of the intestines are propelled downwards. In the large intestines, especially the colon, this coat assumes a different character. The longitudinal fibres here are * Murray. CATHAKTIC8. 03 collected into three bands, which are called ligaments of the colon. At the same time, the circular fibres are also formed into bands, mor< numerous but equally distinct. In consequence of this, in a great num- ber of places, the intestine consists only of the serous and mucous coats. These places between the muscular fibres bulge out and arc formed into distinct cavities, which arc termed the cells of the colon. In consequence of this organization, the descent of the feces is rendered more gradual ; and when the action of the canal becomes torpid, they do great mischief by retaining the contents. The peristaltic action in the large intestines is much less powerful than in the small ; on the other hand, however, they enjoy the benefit of greater pressure from the abdominal parictes — the whole length of the colon being contiguous to them. In the inner lining of the intestines is a mucous tissue. It is plentifully sup- plied with blood-vessels and mucous follicles, from which is poured out the mucus which lines the whole tract of intestines. The fluids secreted and poured into the intestines are an aqueous or serous fluid from the exhaling vessels — mucus, bile, and the pancreatic fluid. After this sim- ple view of the construction and function of these organs we shall be better able to understand the precise effects of cathartics upon them. II. OF THE EFFECTS OF CATHARTICS. When a cathartic is taken, the organ immediately affected is the stomach, and the first effect is a disgust for food ; frequently nausea ensues, and sometimes actual vomiting. If this takes place, the medi- cine may be ejected, and no other effect produced, the stomach and other organs returning in a short time to their natural state. If the medicine be retained, in about an hour (more or less, according to cir- cumstances) an uneasy sensation is felt in the abdomen, which increases gradually, and sometimes amounts to pain. An increase of inter- nal heat now takes place, accompanied with borborygmus, and a feeling as if the lower part of the abdomen were swelled. At the time these sensations are experienced, the pulse becomes small, and a slight sense of coolness is felt over the surface. In a short time, however, the pulse becomes quicker and more frequent ; animal heat is developed, and the skin becomes dry, and warm. During this period, colicky pains are felt, and evacuations now take place from the bowels, which are repeated more or less frequently according to the activity of the purge and the condition of the intestinal canal. Not merely the number, but the size is well as quality of the evacuations, differ greatly according to circum- stances. The l ength of time which a purge takes to complete its operation is from six to eight hours ; in this respect, however, there is considerable 94 MATERIA MEDICA AND THERAPEUTICS. difference, according to the article used. Some take even longer time, say twelve hours ; while others again act in three, four, or less. After the operation of medicine the patient is generally left in* a state of lassitute and heaviness, sometimes with a tendency to sleep. Such are are the ordinary sensible effects of a cathartic. To understand more fully the changes which the organs and the system at large undergo during this process, it will be necessary to analyse the foregoing effects a little more in detail. In doing this I shall pursue the same order as in emetics. 1. The first effect of Cathartics is to produce a peculiar action hi the mucous membrane lining the intestinal canal. This is accompanied with a determination of blood to the part, and augmented sensibility. To these are owing the sense of heat and swelling which is one of the first effects of this class of remedies. The action thus excited by cathartics is by no means uniform. According to the article used, it differs mate- rially in a great number of respects. In some cases it is mild in degree, and transient in duration. In other cases it is so decided as to produce irritation, and even actual inflammation. In some cases this action is extended to the whole intestinal tract, while in others it is limited to particular portions. From experiments made upon living animals, it would appear that the _parts_ of the intestinal. ca„nal . which are principa lly acted upon by purgative medicines are the duodenum, the colon, and the rectum. In persons who have died shortly after taking drastic purges those parts have been found in a state of inflammation. The reason of this probably is, that the jejunum and ilium, from the fact of their being loose and floating, are enabled to propel the medicines more quickly through them, and in this way lessen their action. The duo- denum, colon, and rectum on the other hand are fastened down. 2. The next effect of Cathartics is to cause secretion from the mucous membrane of the intestines. This is sometimes the result of the above described irritation ; but most cathartics operate in a different and purely physical way, by what is called endosmosis and exosmosis. With the laws regulating these you are probably familiar, and thus prepared to understand how, if a saline solution be introduced into the intestines, it has an influence on the blood-vessels, which varies according to the strength of the solution. If it be somewhat concentrated, the effect of its proximity to the blood-vessels will be to cause the exosmose of the serum to exceed the endosmose. The current will be strongest from the blood-vessels into the intestine, and the saline solution will be diluted to near the standard of the blood. If, on the contrary, the saline solu- tion is very weak, its specific gravity below that of the serum of the blood (1025"30), the current will be reversed and endosmosis will take place, the saline solution will flow into the vessels, in other words it will be absorbed. CATHARTIC'S. 05 It is in this way that the salines act as purgatives. 3. Cathartics increase the natural action o f - t h e museu l a P M&4 of the intestines. From the Intimate connexion existing between the mu< lining and the muscular coat of the intestines, the impression made upon the former is speedily transmitted to the latter. In this way, as well as from the stimulus of the various matters secreted in the intestini -, the muscular tissue is excited to increased and sometimes irregular action. To tli is are owing the colicky pains which are felt during the operation of cathartics. In the impression which is thus made upon the muscular coat of the intestines, there is a great difference among cathartic agents, some acting powerfully in this way without causing any free secretion from the mucous surface. 4. Cathartics promote secretion from the liver. [This they do In- special action of their molecules upon the liver after their absorption. — Ed.] In the power which they possess of thus calling the liver into action there is a marked difference between cathartics. Calomel, for example, possesses it in an eminent degree, while the neutral salts are destitute of it. 5. Cathartic* increase the secretion from the paMcreas. This is nearly as certain as their operation on the liver, although from the character of the secretion, &c, we cannot have the same demonstrative proof of it. It is effected in the same way as in the case of the liver. 6- Actual evacuation of the contents of the intestines is the last effect produced. This is accomplished in the following way. The rectum first contracts; this is immediately followed by a similar action of the dia- phragm and abdominal muscles. By this combined pressure downwards, the levator ani is elongated, and the resistance of the sphincters is over- come and evacuation takes place. When the freces have been voided, the diaphragm rises and the abdominal muscles become relaxed — the levator ani retraets the intestine, and it is again closed by the sphincter: During this process the lungs are filled with air, and expiration is prevented. From the foregoing analysis it appears that purgation does not con- sist simply in evacuating the contents of the intestinal canal. It sets into more or less active operation a large extent of mucous tissue, and a number of important glands. It is only by bearing this in mind that anything like a just conception of the influence of cathartics upon the system can be formed. Of the Remote Effects of Cathartics. — These are various and important. (a.) On the Mucous System. — A very large extent of this system vie. from the stomach to the rectum, is directly acted upon by cathartic medicines; and the effect here is, as already stated, to iucrease exhala- 96 MATEEIA MEDICA AND THERAPEUTICS. tion and secretion. From the great determination of fluid which thus takes place to the intestines, the secretions from other portio ns of the mucous system, instead of being increased, are diminished. This is particularly the case with the part of it which lines the mouth and oesophagus. Hence it is, that during the operation of cathartics, the mouth becomes dry, and thirst is created. A similar effect is also produced upon the membrane lining the trachea and bronchial tubes. (b.) On the Brain and Nervous System. — The effect of cathartics is to impair temporarily the energy of the brain and nervous system. Debility ensues, the intellectual functions are not performed with vigor or ease, and there is a great disposition to drowsiness and sleep. All this is owing to the concentration of vital energy in the intestinal canal, depriving the brain of its due share — to the great determination of blood to this part, — as well as to the direct debility induced by the evacuations which cathartics produce. (c.) On the Vascular System. — The first eifect of cathartics on the circulation is to produce an unequal distribution of blood throughout the system. In consequence of the action excited in the intestines, a great determination of blood takes place to these organs, and, as a matter of course, the relative proportion in other parts of the system must be diminished. Hence it is, that, during the operation of these agents, the pulse becomes more frequent and smaller than natural, and, when colicky pains come on, unequal, just as in enteritis and in dysen- tery the pulse is small and frequent. After the operation of the cathartic is completely over, and the temporary determination to the intestines has subsided, the blood again is uniformly distributed throughout the system — the pulse lessened both in force and frequency. This is evidently the result of the depletion which the system under- goes, and is in proportion to the number and copiousness of the evacuations. During the act of passing the feces, from the muscular contraction and straining which take place T there is a temporary interruption to the free and equal circulation of the blood. In degree this is always in proportion to the difficulty attending the operation. Hence it is that old persons whose bowels are torpid sometimes die of apoplexy while straining at stool.* On the blood itself, the effect of cathartics is, by taking from it through the intestinal capillaries a large amount of its serum, to alter the quality of the general mass, by compelling (so to speak) the vessels to supply their loss from the fluids that may be within their reach. It is in this way that cathartics promote absorp. * Mr. Hennen says, " I scarcely recollect a situation in whieh bleeding afte r amputations, especially of the lower extremities, occurs more frequently than in the act of passing fsecal accumulations." — P. 210. CATHARTICS. ft? tion, and aid in the removal of dropsical accumulations. They may promote absorption in another way. When the capillary Bystem is inflamed and congested, it may from that cause be unable to perform its function of absorption. Cathartics, by removing tlie congestion or inflammation, may restore to the vessels the power they had lost. ((/.) On the Cutaneous System. — Between the skin and mucous membrane lining the alimentary canal, there is not merely a great analogy in structure, but great sympathy of action. Illustrations of this we see continually in the occurrence of cutaneous affections from disorder of the stomach and bowels. Hence the skin is powerfully influenced, when so extensive an action is excited in so large a portion of the mucous membrane as is the case during the operation of cathar- tics. Accordingly, under catharsis, the skin becomes dry and cool, and perspiration is suppressed. When the operation ceases, the func- tion of the skin is again restored. This is the effect of a single cathartic. When frequently repeated, the effect is more permanent, and new action is eventually set up in the extreme vessels of the surface. It is by this alterative effect, as well as by the constant diversion of action from the surface to the intestines, that cathartics prove so beneficial in many cutaneous affections. Of the Circumstances Modifying the Effects of Cathartics. — (a.) Age. — As a general rule, cathartic medicines operate much more readily at an early period of life than they do afterwards. This is owing to the greater sensibility of the intestinal canal at this period. Even without taking medicines, children have a more frequent call to evacuate the faeces than adults. A healthy child has generally a couple of loose light-colored evacuations a day. In giving cathartics, therefore, to children, the milder articles are preferred. From the o;reat sensibility of the intestinal canal as well as of the whole nervous svstem in children, active cathartics are apt to produce the most unpleasant consequences. In some cases fatal convulsions have thus been induced, while in others, especially if the purging has been protracted, general and fatal exhaustion has been the consequence. Notwithstanding this general sensibility of the intestines of children, there is a condition of these organs which enables them to bear larger proportionate doses of some cathartic medicines than adults. In children there is a great tendency to the secretion of mucus in the intestines. This becomes viscid, and adheres to the inner lining of these organs, and in this way interferes with the action of cathartics. As we advance in years, the intestines, in consequence of their repeated stimulation, have their sensibility impaired, and their contractile power proportionably lessened. The natural secretions, too, of the mucous membrane become less copious, the bowels sluggish, and the stools more scanty and hardened. 98 MATERIA MEDICA AND. THERAPEUTICS. Old persons seldom have an evacuation oftener than once in two or three days. From this condition of the intestines, it happens that cathartics produce less effect upon old persons, and must be used in larger doses and the more active articles selected. (b.) Sex. — From the greater delicacy of the female constitution and from their nervous temperament, equal doses of the same medicine will be more apt to produce violent effects in them than males. This is the case with regard to cathartics, and especially the more active ones. During the state of pregnancy, cathartics should be used with a certain degree of caution, inasmuch as their use may be followed by premature action of the uterus and a consequent expulsion of the foetus. This is owing to the sympathy existing between the intestinal canal and the uterus, and it is more especially apt to occur in irritable temperaments and those who are prone to abortion. It is most apt to follow the use of such cathartics as produce much irritation about the rectum. In preg- nancy, therefore, articles of this kind should be carefully avoided and the milder ones always selected. It is not to be inferred from this, how- ever, that cathartics are always dangerous remedies during pregnancy. On the contrary, in cases of acute disease, very active articles may and have been given not merely with impunity but with benefit. During the yellow fever of 1*793, Dr. Rush states that he had recourse to the use of calomel and jalap in the cases of several pregnant women, who were attacked with the fever, and he was so fortunate as not merely to save his patients, but to do it without producing miscarriage. In one of the cases, too, the female had miscarried twice before. (c.) Climate. — As a general rule, active cathartics are not borne so well in hot climates as in temperate and cold ones. This is owing no doubt to the greater sensibility of the mucous membrane, rendering this part of the system more liable to active irritation. Dr. Rushenberger, surgeon in the American Navy, remarked during a cruise of the United States frigate Brandy wine, in the Pacific Ocean, in 1826, '7, '8, '9, that the soldiers and sailors did not bear the operation of purging as well in the kot latitudes as in the cold and temperate ones.* Independently, however, of mere temperature, there appears to be something peculiar in certain regions which modifies the operation of cathartics. (d.) Habits and Mode of Life. — All debilitating causes acting con- tinuously upon the system, either in the way of occupation or mode of living, have a direct tendency to impair the capability of the constitu- tion for sustaining the action of powerful cathartics. Dr. Ferriar states that the natives of the manufacturing town of Manchester bear evacua- tions very badly. In ordering cream of tartar in cases of dropsy, in the Manchester Infirmary, he found that the patients could not bear the * American Journal of the Medical Sciences. Yol. vi. p. 348. OATHABTTCS. 00 same quantities which are prescribed by Dr. Home in the Royal [nfirmary of Edinburgh, and tbat even in giving the ordinary quantity, cordials and tonics were necessary at the same time.* Literary and studious habits, from the derangements of the nervous system which they are apt to induce, have a general tendency to impair the power of the constitu- tion to sustain active purging. In all the cases, however, connected with the mode of life, there is none which so strikingly modifies the effeel of cathartics as intemperance. Where this habit has been long persisted in and the system undermined by it, active purging, like bleeding or tartar emetic, not unfrequently produces exhaustion and death. (e.) Frequent Repetition. — As in the case of all other medicines, this modifies very strikingly the effect of cathartics. In some cases it ren- ders the bowels preternaturally irritable, so that the simplest articles and the smallest doses will excite purging. In others, again, a contrary effect is produced, and a confirmed habit of costiveness induced. In these cases the difference of result depends altogether upon the condition of the intestinal canal, and the precise manner in which the purgation is conducted. [Much depends on the article used.] (/.) The actual condition of the system as to disease, — This modifies in a most important manner the effect of this class of remedies. In a state of health they produce irritation and derangement of the system ; in disease they remove it. The condition of the vascular system modi- fies the effect of cathartics. In a full plethoric habit generally they never operate as well as when the system is somewhat reduced. Hence in such cases previous blood-letting always facilitates their operation. Not unfrequently cases are occurring in which after the most active articles fail to move the bowels, they yield immediately on the use of venesection. [This is especially true where there is congestion of the brain.] The state of the intestines, too, greatly modifies their action. In some cases, for example, these organs are so lined with viscid mucus as that the most active agents make no impression at all. The state of the brain and nervous system also greatly modifies the action of these agents. In apo- plexy and hydrocephalus, for example, the torpidity of the bowels is so great that the most active cathartics produce little or no effect. Maniacs have been generally supposed to be in a great measure insusceptible to the action of ordinary cathartics ; observations, however, on a large scale have shown this to be erroneous. Rules to be observed in using Cathartics. — 1 . Given on an empty sto- mach cathartics act more efficaciously and are less apt to be rejected. [Aloes is an exception to this rule. Aloetic pills, e. g. dinner pills, are best taken with food. — Ed.] * Medical Histories and Reflections. By John Ferriar. il.D. — P. xlv. 100 MATERIA MEDIC A AND THERAPEUTICS. 2. Period of clay. — In this respect different articles vary. Some are best given at night, others in the morning. 3. Always dilute with warm gruel as soon as it begins to operate. This allays irritation and promotes secretion. 4. To gain full effect a patient to be kept for twenty-four hours on diluents. 5. Examine the evacuation. 6. Don't be satisfied with giving a purge — see the effect; see that the effect you desired to produce is attained. Evacuations produced by Cathartics. — These differ greatly in their number, size, and quality, according to the article which may be used. The first evacuations which are passed are made up of the fasces remaining in the large intestines and the alimentary substances reduced to chyme, which have passed the digestive organs and have had their progress accelerated by the action of the medicine. After this the evacuations assume a different appearance and become more liquid, in consequence of the different fluids secreted into the intestinal canal. Serum is poured out from the exhalants of the inner surface of the intestines ; mucus from the mucous follicles ; bile from the liver ; and pancreatic juice. In addition to these are the various kinds of drink which may have been used during the operation ; of these various materials are made up the evacuations, differing in the relative propor- tions of the several ingredients according to the particular medicine used, and the actual condition of the intestines and the system at large. From the character of the evacuations, therefore, it may be inferred what tissues and organs have been particularly acted upon by the medicine. If they are watery, the exhalants of the intestinal canal have been excited into increased secretion, if mucous, the mucous follicles have been acted upon, if bilious, it is an evidence of increased secretion from the liver. According to the predominance of either of these secreted fluids, and other circumstances, such as the nature of the food which may have been used, &c, the evacuations will be found to differ in their consist- ency and color. For the purpose of forming a correct opinion in relation to the evacuations, it is important to be familiarized with their appear- ance in a state of health, as well as the various modifications they may undergo from articles of diet and medicine, as well as from disease. A perfectly healthy evacuation has a color, consistence, size, and smell peculiar to itself, and which can be better learned from observation than from description. In morbid states of the intestinal canal they assume a great variety of appearances. In jaundice they are clay-colored. In dysentery, bloody, mixed with pus, mucus, &c. Various medicines have the effect of altering the evacuations. The use oiiron makes them black; sulphur, too, darkens them. Hematoxylon CATHARTICS. 101 makes them of a blood-red cblor. Senna gives them a greenish, tinge ; calomel, also, frequently renders them green. Food and drink, too, greatly vary tlie appearance of the evacuations. The common vegetable tomato turns them black; spinach makes llicm green. Claret gives them a peculiar lake tinge.* THERAPEUTICAL EFFECTS. Various modes in which Cathartics prove Curative. — These, as they lie at the foundation of their use in different diseases, require to be care- fully analysed. (a.) Cathartics jnove Curative by simply unloading the Intestinal Canal. — A constipated state of the bowels, accompanied with an unna- tural accumulation of fajcal matter in the large intestines, interferes in a great many ways with the healthy action of the different organs of the human body. Not merely the abdominal organs, but every other part of the system, is directly or indirectly affected by it. To remove this, therefore, in every disease in which it occurs, is, of course, a leading indication ; and this is to be accomplished by the use of cathartic agents. (b.) By making a new and peculiar impression upon the Mucous Membrane of the Intestines, altering existing action and -promoting secre- tion. — The interruption in the natural secretion of the mucous mem- brane of the intestinal canal is a constant occurrence in diseased condi- tions of the system, and the restoration of these secretions is one of the essential means of cure. By the use of appropriate cathartics this is effected. (c.) By promoting the secretory function of the Liver. — In a great variety of diseases the liver becomes disordered in its functions. Not merely the quantity of bile is lessened, but the character of it is very much changed from its natural and healthy state. Among the means calculated to correct this condition of the liver, cathartics, and especially calomel, are the prominent agents. (d.) By creating a new action in the Intestines, and keeping up a de- termination of fluids to this part, and thus relieving other parts of the system, by transferring action from one part of the system to another. — In this way cathartics act upon the principle of revulsion or counter- irritation, and they thus prove eminently beneficial in a great number and variety of affections. To produce this effect in the most decided degree, the purgation should be continued for a suitable length of time, * Mr. Hennen states that " by the use of lamego and other deep-colored wines of Portugal, the stools acquire a tinge almost approaching to black." He adds, "I have known some attempts made to impose upon medical men by persons who have been acquainted with these facts." — Military Surgery, p. 373. 102 MATERIA' MEDIC A AND THERAPEUTICS. and such cathartics selected as are capable of producing a decided impression upon the intestinal canal. In this way almost every organ and tissue in the body may be indirectly influenced by cathartics. (e.) By acting as simple evacuants, and in this way lessening the quantity of circulating fluids, and improving the action of the Heart and Arteries. — The cathartics best calculated to produce ThisTfFect are those which act powerfully on the exhalants of the intestinal canal, and cause copious watery evacuations. The amount of effect which they are capable of producing in this way must appear obvious, if we reflect for a moment on the extent of surface upon which they act, and the quantity of fluid which may be drained from the system through their agency. (f.) By equalizing the Circulation. — This effect may be produced in two ways, according to the cause producing the unequal distribution of blood. In some cases, this is owing to the pressure of the overloaded and distended intestines upon the large blood-vessels of the abdomen, which thus mechanically interferes with the circulation in those vessels, and as a consequence causes congestion about the head and chest. Cathartics, by simply unloading the intestines, remove the pressure, and thus relieve the obstructed circulation. In other cases, the unequal dis- tribution of blood is owing to undue accumulations in particular parts, in consequence of inflammation or congestion. Cathartics; by exciting an action in the intestinal canal, and making it a new centre of afflux for the fluids of the system, divert from other parts, and thus equalize the circulation. [(g.) Cathartics often serve a most important purpose_a^depuratives, enabling the circulating fluid to rid itself of noxious matters! Hence their utility in gout, rheumatism, and other diseases dependent on the presence of noxious matters in the blood.] OF THE USE OF CATHARTICS IX PARTICULAR DISEASES. There is no class of medicinal agents more generally resorted to, or more really useful, than cathartics, if used with due discretion. To a certain extent, they may be rendered available in almost every disease to which the system is exposed. The very fact, however, of their being so generally useful, renders them liable to be abused. One would sup- pose that the opinion was entertained by many that purging could never do harm,- but was always attended by beneficial consequences. Hence they appear to be prescribed almost as a matter of course, with- out much regard to the existing state of the system, or to the important effects which these agents produce. That this statement is by no means exaggerated must be apparent to every competent and attentive CATHARTICS. 108 observer, and it shows the necessity of establishing, if possible, Borne of the leading facts and fundamental principles by which the use of th< e agents may be regulated. This I sh;ill attempt in the following remarks. I. Of Fevers. — Without entering into any discussion on tin; nature of fever, it is only necessary to notice some of the prominent phenomena attending it, for the purpose of elucidating the principles upon which cathartics are used. 1. In fever, it is often observed that the natural peristaltic motion of the bowels is impaired. Hence costiveness is a prominent symptom, and the contents of the intestinal canal are retained a much longer period than they should be — and being so retained, they necessarily act as a cause of irritation, and thus increase the general febrile symptoms. 2. It is observed in fever that the function of the mucous lining of the intestines becomes disordered. Hence, the secretions of this sur- face are lessened in quantity and altered in character — in some cases becoming highly vitiated and unnatural in their appearance. '3. It is observed that the functions of the liver are frequently dis- ordered, and the liver itself congested. The quantity of bile is greatly diminished, and frequently much altered in its character. 4. The abdominal viscera are generally more or less crowded with blood, and their secretory functions more or less impaired. Now, to obviate and correct these conditions of the abdominal organs, cathartics are the remedies resorted to, and they operate in the following manner. They evacuate the contents accumulated in the intestines — they pro- mote the secretions of the mucous lining of the intestines — they excite the liver and promote the secretion of bile — and lastly, they aid in restoring the secretions of the other abdominal viscera. In consequence of these local effects, others of a general nature ensue. The circulation becomes more free and uniform, the blood is more equally distributed and general excitement is diminished. In endeavoring to accomplish these objects by cathartics, there are two things specially to be regarded. One, the proper selection of cathar- tics, the other the particular condition of the mucous lining of the intes- tinal canal. It has already been stated that cathartics differ greatly ; some act mildly, others produce great local irritation ; some promote secretion, others are in a great measure destitute of this power. Now the cathartics which are required in fever, are such as will evacuate the bowels, restore abdominal secretion, and at the same time produce as little local irritation as possible. All drastic cathartics are therefore improper; they have a tendency to create local inflammation of the intestines, and in this way aggravate the general febrile commotion. Among the cathartics best suited to fever, calomel takes the lead. It promotes in a manner peculiar to itself hepatic and intestinal secretion, 104 MATERIA MEDICA AND THERAPEUTICS. ■while it produces little or no local irritation. As an adjunct to calomel, castor oil is invaluable. It evacuates most thoroughly the contents of the bowels and has a tendency to allay irritation. In addition to these, the saline cathartics, jalap, rhubarb, and magnesia, may be used with safety and advantage. With regard to the condition of the mucous lining of the intestines, it is to be recollected that in fever it is frequently the seat of inflammation, and when this is the case, active purging ought to be avoided. Even this, however, should not preclude the occasional use of calomel, and the regular evacuation by mild means. As fevers differ in their phenomena, the use of cathartics as well as of all other agents must evidently be very much modified by this circumstance. For the purpose of illustrat- ing this, let us notice briefly the more striking varieties of fever. (a.) Intermittent Fever. — The essential means of cure in this form of fever are tonics [anti-periodics] of various kinds, administered during the intermission, with the view of preventing the return of the parox- ysms. For the safe and effective use of these agents, however, the sys- tem must be properly prepared, and among the agents used for this purpose, cathartics are the most efficient. The reasons of this will be apparent from the following considerations. From the nature of the convulsion through which the sj'stem goes during a paroxysm of this form of fever, it is evident that a congestion of blood must take place in the abdominal viscera. The necessary consequence of such congestion is a derangement of function in the parts concerned, showing itself in disordered action of the stomach, liver, and bowels ; the tongue is furred, the stomach is nauseated, and the bowels constipated. In the collapse, of the system which takes place during the sweating stage, although the congestion is partially and sometimes entirely relieved, yet this dis- ordered condition of the digestive organs remains behind to a greater or less degree. Now, if in this state of things tonics [anti-periodics] be at once resorted to, it will be found not merely that they are uncertain in their effects, but they frequently render permanent the periodical congestion which takes place during the paroxysms. To obviate all this, suitable preliminary evacuation is required. The best cathartics for this purpose, are such as will promote hepatic and intestinal secre- tion without producing much irritation. The best articles to accom- plish these objects are calomel followed by castor oil, or calomel and jalap in combination. In ordinary cases, and when the disease is taken in its commencement, a single cathartic will answer every purpose. When, however, the paroxysms have been continued for some time, where there is great bilious derangement, fulness of the abdomen, foul tongue, &c, repeated purgation may be necessary before tonics will pro- duce their effects. In intermittent fever, then, cathartics are to be considered merely as CATIIAJflK'S. I'). r > preliminary agents to bring the system, and especially the digi fcive organs, into a condition appropriate to the use of tonics [anti-pcriodics]. The best period for giving cathartics is during the intermission. (/>.) Remittent Fever. — Here the use of cathartics is still more impe- ratively called for. In this form of fever the congestions of the abdomi- nal viscera are of a more permanent character than the intermittent. In consequence of this the functional derangements of the liver, stomach, and intestines are more marked, and it is for the improvement and cor- rection of tli esc that cathartics are so essential, and 1 he y must be repeated according to circumstances until these objects are accomplished. The articles most useful here are calomel followed by castor oil, calomel and jalap, the saline cathartics, and magnesia. In this form of fever, inflam- mation of the stomach and bowels is not an uncommon occurrence, and when this is the case, all active cathartics should be avoided. Continued Fever. — Cathartics are no less important than in the pre- ceding forms of fever, and they aet by restoring intestinal and hepatic secretion, moderating general excitement, and w 7 here the head is much affected, exercising a salutary revulsion upon the bowels. As fevers of this kind differ materially, the kind of cathartics and the degree of pur- gation must be determined by existing circumstances. "Where the liver is particularly implicated, calomel is an article never to be overlooked. Where the head is affected, such articles as are calculated to produce a decidedly revulsive effect may be used, such for example as jalap and cream of tartar. In these cases, too, more free purging will be required and prove beneficial. In the use of cathartics, the period ought to be specially considered. In the commencement, purges of an active nature may be required, while as it advances, and especially towards the latter period, such milder articles are only to be used as will evacuate the bowels without pro- ducing irritation on the one hand or debility on the other. From the foregoing, it must appear evident that Cathartics are agents of great value in fever generally. At the same time, it is to be recollected that in their practical application great abuses have arisen and much injury is constantly done. This has probably arisen from attaching to them an importance somewhat exaggerated. They are accordingly, by many, relied upon almost exclusively in the cure of fever, and the most active purges are repeated from day to day throughout the disease, with the most unceasing and relentless assiduity. The considerations which have already been offered, must convince any reflecting person that such practice is irrational and attended with danger. Besides, it should be recollected, that fever is a disease affecting the whole system — all the functions are disordered and all the secretions are more or less prevented. Now, cathartics are only one of the means of cure, and, although some mild cases of fever may yield to them alone, yet more aggravated forms 106 MATERIA MEDICA AND THERAPEUTICS. of it are not to be managed by exclusive attention to the bowels. Im- portant as this is, the other secretions, especially that of the skin, require equal attention. If this important fact was constantly borne in mind, it would tend to limit the use of cathartics within their proper bounds, and obviate much of the evil resulting from- their use. [In the abdominal typhus, now so much more common than when Dr. Beck practised, too much caution cannot be used in prescribing cathartics, especially calomel.] The great objects then to be gained by the use of cathartics, in fever, are : — 1st, To relieve congestion of the abdominal organs. 2d, To restore secretion — in both these ways they prepare the system for the use of tonics. The evils they may, if injudiciously used, produce, are : — 1st, They may produce irritation or inflammation. 2d, They may produce too much debility. Inflammation. — I come next to consider the use of cathartics in the various forms of inflammation. The principles upon which they may be rendered available, are the following : 1. In all cases of inflammation, the functions of the system become more or less disturbed, and among these none more so than those of the intestinal canal. Hence, costiveness is a frequent attendant in these cases. The intestines being unnaturally overloaded, the general irrita- tion of the system is increased, and as a consequence the local irritation is aggravated. Again, in all cases of inflammation, in consequence of the general disturbance of the system, the functions of the mucous lining of the intestines are deranged. The natural action of the secretory vessels of this tissue is impaired, the general excitement is increased, and the local inflammation aggravated. To obviate these conditions, cathartics of various kinds are used, and with the greatest advantage. By keeping the bowels continually in a free state they remove a constant source of irritation ; at the same time, by the impression which they make on the mucous membrane, they restore the natural secretions of the part. In this way, general excitement is directly lessened, and indirectly the local inflammation moderated. This is one mode in which cathartics are rendered benefi- cial in inflammation. 2. Cathartics, some more and some less, deplete all the organs and tissues upon which they operate, and in this way by the evacuations which they produce, lower excitement and thus prove useful. 3. Another mode in which cathartics prove beneficial in many cases of inflammation, is by the new action which they create in the intestinal canal, operating on the principle of revulsion. CATIIAUTHK. J 07 For the purpose of illustrating the foregoing, let us notice briefly Inflammation as it assails different parts of the body. (a.) Inflammation of the Brain. — In all inflammations affecting this organ, there can he no question as to the utility of cathartics. Theor) sanctions, experience confirms it. In all cases of this kind there is a general tendency to torpor of the bowels. In consequence of this, accumulations are apt to occur in them, and by their distension and pressure on the surrounding organs and large blood-vessels, they crowd the blood unnaturally towards the upper part of the body. By the judicious use of cathartics this is obviated. But they operate still further and more decidedly. They create a determination to the abdominal viscera, and they relieve the brain, upon the principle of revulsion. From the inactivity of the bowels generally attending these cases, such articles will be required as act efficiently and freely. Among these, calomel, jalap, senna, salts, and in some cases, croton oil, are most to be relied on. To produce their full revulsive effect, it is necessary that their action should he kept up for a considerable length of time. For this purpose they should be repeated from day to dav according to circumstances. Trachitis. — In this disease cathartics may be used with advantage as auxiliary to other remedies. In the selection of the cathartic, the preference should be given to calomel. Besides operating most effi- ciently on the liver and intestinal canal, this article possesses the additional advantage of extending its sympathetic action to the inflamed membrane — promoting the secretions of the part and lessening general excitement. To obtain the best effects of this article it should be given in full doses, and repeated at suitable intervals. As an adjunct, castor oil is the best article that can be used. [Dr. Beck's fondness for calo- mel is not shared by the physicians of the present day. — Ed.] Inflammation of the Lungs. — The propriety of having recourse to cathartics in this form of disease, has been made a question by some eminent authorities. Among the objections urged against their use, the most common and forcible is that they interfere with expectoration and perspiration, both of which are looked upon, and justly, as exceed- ingly important in the solution of thoracic inflammations. To a certain extent this objection is founded in truth. That active purging does have a tendency to check expectoration is certainly true* and if it be resorted to when this is freely going on, there is no doubt it may prove injurious. It is to be recollected, however, that expectora- tion only commences at a certain period of the inflammation, and the use of cathartics antecedently to this period can be no more objection- able than venesection or any other antiphlogistic remedy. With reo-ard to perspiration, it is to be remarked, that in inflammation of the lungs, as in all other inflammations, this process never takes place, at least to 108 MATERIA MEDICA AND THERAPEUTICS. any salutary extent, while the general excitement of the system is above a certain standard. It is only when this is properly subdued that the skin becomes free and perspirable. Purging, therefore, in the early periods of the disease, by lessening excitement, rather favors than otherwise the subsequent process of perspiration. In the early stages of thoracic inflammation, therefore, purgatives are not merely innocent, but may be made exceedingly valuable auxiliaries ; and they operate both by lessening general excitement and producing a revulsive action upon the intestinal canal. When, however, the inflammation is coming to a regular crisis, when the skin is soft and moist, and the secretions from the mucous membranes of the lungs free, active purging should be .avoided. This is the practical distinction to be observed in these cases. The eathartics best suited here are calomel, castor oil, and the neutral salts. Inflammation of the Abdomen. — In almost every case of this kind, cathartics may be used with advantage. In the selection of cathartics, however, and in the extent to which the purgation ought to be carried, there will be found a great difference, according to the particular tissue or or<>'an which may be the seat of inflammation. This will be best illustrated by noticing in detail a few of the more important. Inflammation of the Mucous Membrane of the Stomach. — This may exist either in the acute or in the chronic form, and in both suitable evacuation of the bowels is a point of great importance. In relation to this practice, I am aware that a great difference of opinion exists. The propriety of it, however, appears to me to rest upon various considera- tions. In the first place, should the faeces be suffered to accumulate in the large intestines, the mere pressure upon the stomach which the distension would occasion would increase the gastric irritation. In the •second place, accumulations in the large intestines would have the effect of creating irritation in the mucous membrane of these organs, which might be extended, sympathetically, to the mucous membrane of the •stomach. To remove, therefore, all cause of irritation from this, source, it is essential that the large intestines should be kept freely evacuated. In the mode of doing this, however, certain precautions are to be attended to. As a general rule, it is not to be accomplished by the introduction of cathartics into the stomach. In the irritable condition of the stomach in these cases, ordinary purgatives will be very apt to be rejected, and therefore will prove useless. In addition to this, if they are articles of an active character, even should they be retained, they will be apt to act as local irritants, and thus aggravate the inflammation. On these accounts, active enemata, repeated at suitable intervals, are to be preferred in these cases. To all this, however, there is an exception to be made in favor of one cathartic — and that is calomel. This article does not act as a local irritant. Even where it comes in contact with CATHARTICS. 109 inflamed surfaces, so far from increasing inflammation, it frequentl} ha the effect of allaying it. From its small bulk, also, it can readily be taken, and is retained on the stomach when every other article is rejected. Calomel, therefore, is a remedy which may be used without any danger of increasing irritation; and, at the same time, by its antiphlogistic ope- ration on the irritated surface, and its purgative action on the liver and bowels, may prove eminently beneficial. Inflammation of the Mucous Membrane of the Bowels. — Cathartics here may be used upon the same principles as in inflammation of the stomach. To keep the bowels properly evacuated is essential. This, however, is to be accomplished by the mildest means. All active, and especially drastic, cathartics prove injurious. The best articles to be used are calomel and castor oil. Inflammation of the Serous Membrane of the Abdomen. — In this form of inflammation, considerable difference of opinion exists with regard to the use of cathartics. By some the} 7 are considered as highly injurious. This opinion does not, however, appear to be well founded. In cases of peritoneal inflammation the bowels are generally costive; and where this is the case, it must necessarily add to the existing inflammation. By the use of cathartics, this is obviated. Besides, where the mucous membrane is free of disease, copious secretion may be produced from this surface by the use of appropriate cathartics, and in this way may aid very powerfully in relieving the peritonseal inflammation. Inflammation of the Liver. — With regard to the use of cathartics in this form of inflammation, there is in American and British practice very little difference of opinion. By the French, and especially the followers of Broussais, they are reprobated. Their objections go upon the supposition that purgatives are all irritating in their nature. That some purgatives are so is unquestionably true, and these ought certainly to be avoided. Every active cathartic, however, is not of this character. Calomel and castor oil are not so, and these may be used with perfect impunity so far as any irritation which they occasion is concerned — and so far from being injurious, their use is sanctioned both by theory and experience. After the free use of the lancet, there is no remedy so salu- tary as a large dose of calomel, followed by castor oil and some of the saline cathartics. Should these act freely on the bowels, they relieve the oppression and fulness about the region of the liver, and at the same time aid in subduing inflammation; and they operate by the free secre- tion which they produce from the liver and the mucous membrane of the intestines, acting both as evacuants and revulsives. When tardy in their operation, they should be aided by enemata. Inflammation of the Kidneys and Bladder. — In both mild cathartics may be used with advantage. They relieve the inflamed organs from the pressure resulting from an overloaded state of the bowels, and at the HO MATERIA MEDIC A AND THERAPEUTICS.' same time act beneficially as evacuants. From the sympathies existing between the kidneys and bladder and the rectum, all such cathartics as are apt to produce irritation in the latter organ should be avoided. Some cathartics, too, have a tendency to pass off by the urinary organs, and when this is the case they add to the existing inflammation. Upon this principle,, the saline cathartics are objectionable. Rheumatism.-^— -In the acute form of this disease, cathartics are of great value. They prove beneficial, as evacuants, by diminishing general excitement, and as revulsives, in keeping up a determination to the bowels.- The best articles to be used are an occasional dose of calomel, followed by the saline cathartics. [Most of us now give the salines without calomel.] Gout. — Here, cathartics are no less needful. Everything connected with this disease shows how intimately it is associated with disorders of the digestive organs. From the slow and continued operation of vari- ous causes, the secretions of the liver and bowels become vitiated — there is costiveness and acidity — the bowels become loaded with mucus, and a general debility of the whole abdominal system ensues. In this condition of things, free evacuation of the alimentary canal, and a con- stant action on it, cannot fail to do good. Dropsies. — There is perhaps no class of diseases in which the use of cathartics has been so generally concurred in as in dropsies, and there can be no question with regard to their general utility. They are not, however, to be given indiscriminately. For the purpose of understand- ing the principles upon which they are to be used, and the extent to which they may be carried, it is necessary to have correct notions of the disease for which they are prescribed. By dropsy, in the ordinary acceptation of the term, is meant nothing more than the accumulation of fluids in different parts of the body. This, however, conveys a very imperfect idea of the real nature of the affection. This accumulation of fluids is a mere effect or consequence of some deranged condition of the system at large, and more especially of the capillaries, the vessels con- cerned in excreting and absorbing the fluids. [Distension of the blood- vessels, either of the whole or part of the body, is the essential condi- tion of the occurrence of dropsy. It is probable that the distended arteries, or the arterial capillaries, sometimes relieve themselves by pouring out the serum of the blood, but it is from the veins and venous capillaries that this exhalation takes place to the greatest extent; while at the same time, their distended state entirely prevents the taking up of effused fluids, a function, in the normal state of the system, performed by the veins. Now, this essential condition of dropsy, distension, may be the rapidly induced effect of some suddenly applied cause, or it may result gradually from some chronic condition. In the first case, the consequent dropsy will be active or acute ; in the latter, passive. Scar- CATIIAKTK S. Ill latina dropsy, and the dropsy which suddenly follows exposure to cold in. persons previously in good health, are familiar examples of active dropsy; while the anasarca of pregnant women and cardiac, dropsy be- long to the passive variety. From this view of dropsy, it. is obvious that our attention should be very mainly directed to the removal of the distended state of the vessels; and as, in very many cases, the direct diminution of the quantity of circulating blood is forbidden by the debi- litated condition of the general system, we must resort to purgatives, diuretics, and diaphoretics, in order to eliminate from the vessels their more watery parts, being well assured that the partially emptied v< will seize on watery fluid wherever they can find it. Cathartics are the most important of these evacuants, as more certain than diuretics, and more efficient than diaphoretics.] CLASSIFICATION OF CATHARTICS, Cathartics may be advantageously classified, according to their effects, into three divisions. 1. Those which operate principally by increasing the natural peristaltic action of the intestines, causing little or no increase of secretion from the mucous lining of these organs. As a general rule, they act with great mildness, and their operation is limited in a great measure to evacuating the existing contents of the bowels. To this division belong the whole class of what are usually called Laxatives. Under this head may be ranged castor oil, magnesia, sulphur, manna, 'purging cassia, tamaHnds, rhubarb and aloes, charcoal. 2. Those which, in addition to increasing the natural peristaltic motion, stimulate the exhalant vessels of the intestines, and thus cause free secretion from them. Besides unloading the bowels, these produce watery evacuations. In the degree of activity in the articles of this class there is a good deal of difference, some operating very mildly, while others produce considerable irritation. To this division belong the whole class of hydragogue cathartics ; neutral salts, jalap, Mag cqjjjle, senna, scammony, gamboge, siipertartrate of potass, colocynth, elaterium, croton oil. 3. Those which, in addition to increasing the natural peristaltic motion, excite the mucous follicles of the intestinal canal, and at the same time extend their influence to the liver. The evacuations pro- duced by this class are mucous and bilious. To this belong calomel and blue pill. Other cathartics act also on the liver, especially the drastic ones, but not in the way calomel does; calomel produces its effect mildly — the others by irritation. 112 MATERIA SIEDICA A JO) THERAPEUTICS. INDIVIDUAL CATHARTICS. CASTOR GIL. The plant which yields this valuable article is the Ricinu s communi s, so called from the seeds resembling in shape and color the insect called the tick (ricinys). It grows in great abnndance in the East Indies, where it is native. It is also a native of Africa. In the "West Indies, in various parts of Europe, but more especially in the southern part of the United States, it is extensively cultivated. It is an annual plant of very speedy growth, from four to six feet high. In the warmer climates it sometimes attains the height of eight, ten, twenty, and even thirty feet. — (Ray, Roxburg.) The oil used in medicine is obtained from the seeds. These are inclosed in rough capsules, which are about the_ size of a large marble, of a pale green color, and covered with flexible prickles. Each of the capsules contains three_ seeds, which are expelled by the bursting of the capsules. The seeds are of an oval shape and of the size of a small bean, a quarter to one third of an inch long, of a pale. greyish color, marbled with yellowish brown spots and veins. When the external coat is taken off, it leaves a kernel of a white color, which has a sweet- ish, oily, and somewhat nauseous taste. In their action on the system, the seeds are acrid and irritating; three or four of them prove actively emetic and cathartic. Modes of preparing the oil. — These are different in different countries. In the United States, -where the oil is manufactured very extensively, the process is the following : — The seeds, after being well cleansed, are put into a shallow iron receiver, where they are subjected to a very gentle heat, for the purpose of rendering the oil sufficiently liquid for easy expression. They are then put into a powerful screw press, by which a whitish oily liquid is obtained. This is then put into clean iron boilers, mixed with water, and boiled. During the boiling, the impurities which rise to the surface are skimmed off, until, at last, a pure oil is left on the surface of the water. The clear oil is now carefully separated, " and the process is completed by boiling it with a minute proportion of water, and continuing the application of heat, till aqueous vapor ceases to rise, and till a small portion of the liquid, taken out in a vial, preserves a perfect transparency when it cools. The effect of this last operation is to clarify the oil, and to render it less irritating by driving off the acrid volatile matter.' T If the heat employed be too great, the oil becomes of a brownish color and of an acrid taste. Great care, therefore, is necessary in regulating the degree of heat. Good seeds, by this process, yield twenty-five per cent, of oil. By Alcohol. This is another mode recently suggested in France, CATHARTICS. 1 I 3 and is founded on the solubility of castor oil in alcohol. It. consists in macerating the kernels, made into u paste, in cold alcohol. In this way 3 vi of oil are extracted from a pound of the seeds. The mode of preparing castor oil is a matter of much practical importance, inasmuch as it modifies its qualities and effects*. It has already been stated that the seeds are exceedingly iiritating, and the same is sometimes the case with the oil. What the cause of this may be, is a point which has given rise to a difference of opinion. By some it is supposed to be owing to an acrid principle residing in the seeds, while by others it has been attributed to the employment of heat in the preparation. With regard to the acrid principle, some suppose it to reside in the •shells, while others locate it in the embryo. According to Guibourt, however, the shells contain none of it; and the only effect which they can have is to color the oil. Nor does it reside exclusively in the embryo. The truth is, the whole kernel appears to contain a volatile acrid principle. By boiling in water this principle is carried off, and a bland and almost colorless oil is obtained. With regard to the agency of heat, it appears that too great a degree of heat, or too long continued, changes the nature of the oily principle itself; in consequence of which it becomes deeper colored and acrid. From the foregoing it would seem : 1. That the removal of the shells is not necessary. 2. That the great point is the proper graduation of the heat. Properties. — Castor oil is a thick, viscid fluid ; little or no smell ; a mild and somewhat nauseous taste, leaving behind it a slight sensation oflicrimony in the throat. When pure, it is colorless. Generally, however, of a light straw color. When prepared by decoction, or when the degree of heat has been too great, it is of a brownish color, and has a hot and acrid taste. When exposed to the air, it becomes thick and rancid, without becom- ing opaque. Composition. — When distilled, castor oil yields, besides a little gas, water, and acetic acid — A colorless, odorous, volatile oil. Two fatty acids — the Rieinic and Oleo-Ricinic, or Elaiodic ; both excessively acrid. A residual solid matter of a peculiar character. The volatile oil and the acids make up about one third, while the residual matter makes up the remaining two thirds. Castor oil possesses the general properties of the fixed oils, except that it is wholly soluble in alcohol and ether. Diluted alcohol dissolves about two thirds. Purity. — Sometimes adulterated with more common oils. This is tested by its solubility in alcohol. If castor oil be genuine, by adding 114 MATERIA MEDICA ASTD THERAPEUTICS. to it an equal quantity of alcohol of sp. gr. '820, a uniform solution will be made. On the contrary, if it form a milky mixture or any portion remain undissolved, an adulteration with some of the more common fixed oils may be suspected. Effects. ->- As a cathartic it possesses many valuable properties. It operates gently, yet efficaciously. While it thoroughly evacuates the intestines, it c auses_no_griping ov pain. The number of evacuations caused by a single dose seldom exceeds two or three. Besides operat- ing mildly, it produces its effects with more rapidity, than jmost other cathartics. It frequently acts in a couple of hours, and seldom takes longer than three or four. A peculiarity attending its operation was remarked by Dr. Cullen, viz. if it be frequently repeated, the same effect will be produced by diminished doses. Generally speaking, the oil may be recognised in the evacuations, sometimes appearing in masses, and in one case mentioned by Pereira in the form of nodules, like biliary concretions. From the peculiar operation of this article it is an exceedingly valua- ble cathartic, and well calculated to fulfil many indications which no other can accomplish. It is adapted to all cases, when the object is to evacuate the bowels freely, without causing any irritation, and without producing alvine secretion. It is admirably well adapted to follow the. use of mercurial cathartics, of which it insures the operation without altering the effects. For this purpose it is superior to any other cathar- tic. For children it is a peculiarly safe and good laxative. In some cases, an objection to its use is that it leaves the bowels costive. In other cases this is an advantage. Mode of administration and dose. — For adult, |j ; child 3j to 3 ij. Simply thinned by heat, the best form of giving it, or mixed with syrup, sugar, hot coffee, or milk, or in emulsion with yolk of egg and sugar, or floating on spirit. MAGNESIA. Magnesia is used in medicine in three different forms — magnesia, car- bonate of magnesia, and sulphate of magnesia. At present the two first are only to be considered. Magnesia. — From the manner in which it is prepared, commonly called magnesia usta or calcinata. It is prepared by subjecting the carbonate of magnesia in a crucible to a red heat for about two hours, or until no effervescence is produced on the addition of diluted acetic acid. During this process, the water and carbonic acid are driven off and the pure magnesia left. When cool, it is to be put into tightly stopped bottles. CATHARTICS. 11.", Composition, — One eq, magnesium = 12, one eq. oxygen 8 20. Properties. — A white powder, without snoel], and, if perfectly pure, without taste. I t is very li g ht, its specific gravity being '!'■>. It . i sparingly soluble in water — more so in cold than in hot. According to Dr. Fyfe, it requires 5,142 parts of cold water and 36,000 parts of hot to dissolve it. With acids it docs not effervesce. Uy exposure to the atmosphere, it slowly attracts carbonic acid and is converted into the carbonate. Hence the necessity of keeping it in tight bottles. Parity. — The most, common adulteration is the admixture of car- bonate of magnesia. This is ascertained by adding to it a little diluted hydrochloric acid. The best way is to mix a little of the magnesia in water and then add a few drops of acid. If pure, it should not effervesce. Sometimes it contains lime, either added fraudulently, or obtained from the carbonate, from which it has been prepared. This may be ascertained by dissolving the magnesia in hydrochloric acid, neutralize the acid solution with ammonia, dilute it with water, and add to it a solution of oxalate of ammonia. If there is a wdiite precipitate, it shows the. presence of lime. Carbonate of Magnesia, commonly known by the name of magne- sia alba and sub-carbonate of magnesia. In Hindostan and some parts of this country it is found native. What is used in medicine is prepared artificially. The mode of preparing it is to add together solutions of sulphate of magnesi a and carbonate of potash or soda — boil the mixture "tor a short time, stirring it the while. On standing, the carbonate of magnesia is precipitated, while the sulphate of potash or soda is held in solution. The liquor is then to be poured off, and the precipitated powder well washed with boiling distilled water and dried. The washing separates whatever of the sulphate of potash or soda may remain in combination with it. Sometimes it is dried in wooden moulds, in consequence of which it has the square form in which it is found in the market. Another mode of preparing it is from the bittern, or liquor which remains after the crystallization of salt from sea water. The bittern consists chiefly of muriate and sulphate of magnesia. This is heated to 212° and a solution of carbonate of potash is added. The same process is then gone through as before. In the United States this article is extensively manufactured, particu- larly at Boston and Baltimore. Composition. — According to Berzelius, 100 parts consist of magnesia, 44-75 ; carbonic acid, So'11 ; water, 19*48. Properties. — Carbonate of magnesia, as found in the shops, is either in powder or square, masses. It is perfectly white, tasteless, and without smell ; very light (48 grs. fill an ounce measure, Pereira). It i? nearly 116 MATERIA MEDICA AND THERAPEUTICS. insoluble in water, requiring ,2,473 parts of cold, and 9,000 parts of boiling- water to dissolve it. In carbonic acid water, readily soluble — unaffected by exposure to tbe atmosphere — effervesces witfr acidTand is decomposed by a strong heat. Impurities and Adulterations. — Magnesia frequently contains car- bonate of lime (chalk), sometimes added fraudulently, sometimes arising from the presence of calcareous salts in the compounds employed in the preparation of magnesia. Effects. — Magnesia, either in the state of calcination or of the car- bonate, is a gentle laxative. From its great affinity for acids, it readily unites with these in the intestinal canal, and when it meets with enough of those existing there, it forms soluble salts, and thus its activity is increased. From the fact of its thus uniting with and neutralizing acids, it acts powerfully in allaying gastric and intestinal irritation. As a cathartic, this article is peculiar, and it is indicated where jicidity and disordered secretion of the stomach and bowels are present. For children it is an invaluable agent. It corrects acidity, allaysjrritation, and operates with sufficient activity as a cathartic. It does not gene- rally produce any serous evacuations, unless the quantity of acid with which it meets is very great. [In such cases it often operates very vio- lently, causing pain and profuse serous discharges ; this is a very great objection to magnesia. The article is, I believe, very much abused ; as a habitual or domestic remedy, its use ought to be proscribed.] It gene- rally renders the evacuations of a lighter color. Calcined magnesia is preferable to the carbonate, because in the latter so much carbonic acid gas is extricated as frequently to cause painful distension of the intes- tines. Magnesia, when used for a long while, sometimes accumulates in the bowels in solid, hard masses, concreted by intestinal mucus, and they may cause mischievous irritation. A mass of this sort, weighing from four to six pounds, was found in the colon."* Dose. — Of the carbonate for an adult, from 3i to 3 ij ; a child from 2 to 10 grs. Calcined magnesia somewhat less. It may be given in milk or water intimately mixed. If a glass of lemonade be taken imme- diately after the magnesia is swallowed, its efficacy as a cathartic is increased. Of course its power as an antacid is diminished. Where flatulence is dreaded, give the alkali in mint or anise water. This substance is extensively diffused throughout the mineral, the vegetable, and the animal kingdom. It is found native and in combi- * Pereira sub Yoce. CATHARTICS. lien nation either in the sulphurets or in the state of sulphuric acid. W native it is found either in musses or crystallized. Native sulphur is found most abundantly in v olcanic countr ies, and the great mass oi what we use in the arts and in medicine comes from the south of Italy, where it abounds. The sulphur of commerce is procured chiefly by distillation from the native sulphur, though in some parts of Europe it is obtained from the sulphuret by strong heat. Sulphur is found |n the shops in two states. In rolls, the roll of brimstone of commerce, and in fine powder, the flowers of sulphur. Of each of these there are, or at least were, two varieties'; forroll brimstone was formerlj prepared by simply melting the crude sulphur, when the impurity being allowed to subside, the pure sulphur was poured off and received into moulds. Now, however, the roll sulphur is usually prepared by distillation, the product being afterwards melted and run into moulds. If the product of distillation be received into a large sulphur chamber, it is deposited upon the walls in the form of fine powder. This is the common flowers of sulphur. And if this be afterwards carefully washed till the water no longer stains litmus, it is the sulphur lotum — the washed sulphur oi the shops. Properties. — An elementary body of a pale yellow color, permanent in the air. When in rolls or masses it is crystalline or amorphous. It has little smell unless rubbed, and no taste ; is a bad conductor of elec- tricity ; it is perfectly volatilizable — fuses at 400°. Effects. — In closes of from one to three drachms sulphur acts as a mild evacuant of the alimentary canal, causingjittle irritation, and hav- ing scarce any effect on the secretions. It is a good remedy where a purgative is wanted, and yet some diseases of the rectum, as stricture, prolapsus ani, or hemorrhoids, render the irritating effect of ordinary purgatives objectionable. To render it more prompt and certain it is often combined with cream of tartar, and less frequently with magnesia. [It is much to be regretted that sulphur is so little used as a laxative ; we have few that are as good, especially for children.] Dose as a purgative, 3 i to 3 iij... MANNA. [A concrete juice obtained from several specimens of the genus Fraxi- nus, and also of genus Omits (a genus detached from Fraxinus by Per- soon). A substance resembling manna is obtained from trees of two or three species, as Hedysarum and Eucalyptus^ Manna is obtained by making slight incisions in the bark, though some of it flows spontaneously. The juice appears first as a clear viscid fluid, but soon concretes in the shape of ridges or stalactites. The 118 MATERIA MEDICA AND THERAPEUTICS. manna harvest begins in July and continues till October. There are many varieties, which seem to depend on the season and mode of col- lection. Of these the flake manna is the best. It comes in pieces from one to six inches long, brittle, dry, white or yellowish white, h oi lowe d in the side to which it has adhered to the tree. It has a faint odor, and a sweet, though somewhat sharp, peculiar taste. Manna in sorts. — This is a common kind, and seems to be ajmixture of the flake with fatty manna. It is in smaller pieces, palejbrown, not flaky or crystalline. Fatt y Man na. — This is rarely met with. It is of a reddish brown, soft, viscid, having a strong honey smell, and a mawkish-taste. It con- tains many impurities. Composition. — The principal ingredients in manna are a peculiar sweetish principle called ^mannite, 60; sugar and a bitter purgative matter, 5*5 ; and water, 32. Manna softens by the heat of the hand, and melts at 125°. It dissolves in three parts of water and in eight of alcohol. Effects. — Manna is nutritive and laxative. It operates mildly, but is apt to produce flatulence and griping. From its mildness it was for- merly often given to women, especially when in the state of pregnancy. For the same reason, and for its sweetish taste, it was given to children. But it is now very rarely used alone, and not by any means as fre- " quently in combination with senna, with which it was once the fashion in medicine to unite it. Dose. — One ounce for an adult, three drachms for a child. cassia fistula [purging cassia). The cassia fistula grows in the East Indies, Egypt, Arabia, and Per- sia, also in the West Indies and South America. It is a fine tree, thirty or forty feet high. The fruit is a cylindrical pod about an inch in dia- meter, and from one to two feet long. The outside is hard and dark brown ; the inside divided into numerous cells, each of which contains one smooth, oval, shining seed, imbedded in a soft pulp. This pulp is the part used in medicine. Effects. — To produce any effect, it must be taken pretty freely, as a small quantity, being digested, fails altogether of any cathartic effect. An ounce will act as a mild laxative. Its coloring matter often blackens the stools. It is very little used. tamarindi fructus [tamarinds). This is the fruit of a large and very beautiful tree growing in India, Arabia, and Egypt, and also in the West Indies. The fruit is a pod the CATHARTICS* I I size of that of the garden bean. It lias a brittle woody dusk, containing one or more seeds imbedded in a pulp. It is imported free from bu ! , and is preserved in raw sugar. Effects.— K very gentle cooling laxative, usually employed to make a pleasant drink in fever. It is very rarely used alone as a laxative. Tamarind whey, made by boiling an ounce of tamarinds in a pjnl of milk and straining, is a pleasant cooling drink, also slightly laxative. This is the product of different species of Rheum, of which there are a number. This plant grows in Tartary and China, and is cultivated in different parts of Europe. Which of the species yield the rhubarb of commerce, is not precisely known. The species cultivated in England is the R. palmatum. In France, the R. undulatum, compactum, and Rhaponticum, The mode of preparing it in the East is the following: The root is dug up in the spring and autumn, and after removing the bark it is cut into pieces, through which holes are bored for the purpose of passing cords. By these they are hung up and dried. During this process the root loses much of its weight. General properties.~*-Rhuharb comes in solid pieces of considerable size, covered with dust of a yellow color. When this is rubbed off, the surface presents a reddish white tint, of a reticular appearance. When broken, the fracture is rough, presenting a variegated appearance, owing to the intermingling of white, red, and yellow parts. Here and there are found a stardikc spot, and numerous streaks and veins of a red color; its odor is peculiar and aromatic — taste bitter and astringent. When chewed, stains the saliva yellow and feels gritty, owing to the oxalate of lime ; yields a powder of a yellow color. The principal varieties of this article found in the market, are the Turkey, Chinese, and European, Turkey. — This is the same as the Russian rhubarb, and is the best kind. This rhubarb comes from Tartary, and is brought to a place called Kieatcha, a Russian town on the frontiers of China. Here the article is examined by an agent of the Russian government, and the bad pieces rejected. Thence it is sent to St. Petersburgh, from -whence it is exported to different parts of Europe. Formerly it was sent from Tartary to Turkey through Natolia. Hence the name of Turkey rhubarb, which it more commonly bears even at present. . Chinese. — Also called East India, rhubarb. This comes from Canton, and is supposed to be obtained from a species of rheum, growing in China. Although resembling each other in their general properties, the 120 MATERIA MEDIC A AND THERAPEUTICS. Russian and Chinese R. may be readily distinguished. This is import- ant, as the first is much dearer than the second, and frauds are frequently practised in the sale. They_ differ — 1. In the shape of the pieces.. The Russian has a somewhat angular appearance," as if the bark had been shaved off, taking pieces of the root with it. The. Chinese is rounder, as if the bark had heen merely scraped off. 2. The perforations are different. In the Russian they are large, sometimes only partly through the pieces. They are evidently made for the purpose of examining the condition of the inner part of the root. In the Chinese the holes are small, and pieces of cord frequently found in them. The insides of the perforations, too, are dark colored, and frequently decayed. The holes here appear evidently made simply to pass cords through, and not with a view to examine the root. 3. The texture and weight are different. Russian rhubarb is not so compact and heavy as the Chinese —cuts with less facility, in consequence of giving way before the knife. 4. Color. — Russian rhubarb has a more lively fresh appearance. Powder, bright yellow ; Chinese, orange. 5. Smell of Russian rhubarb more aromatic — taste, pleasant. European Rhubarb. — This is different both in appearance and in effect on the system, from the preceding varieties. It is in large pieces — more woody in its texture — scarcely gritty under the teeth — when chewed somewhat mucilaginous, and only slightly colors the saliva — pasty under the pestle, and its powder darker colored In England, this is said to be extensively used to adulterate the foreign rhubarb. Purity. — In the state of powder it is hardly possible to judge well of the quality. The only properties by which any opinion can be formed, are the taste and color. The best plan is to buy it in the root and have it pulveriszd. In selecting the root, those pieces should be preferred which "are moderately heavy and compact — of a lively yellowish color — brittle — presenting, when broken, a fresh appearance, with reddish yellow veins intermingled with white ; odor decidedly aromatic, brittle, an astrin- gent but not mucilaginous taste — gritty — staining saliva yellow — pow- der bright yellow, or yellow mingled with orange," U. S. Disp. When very light, rhubarb is usually rotten or worm eaten. When very heavy and compact it is of inferior quality. Although Russian rhubarb is superior to the Chinese, yet the best kinds of this latter are very good and much cheaper. Real Russian rhubarb is very rarely seen here. Composition. — The principal constituents of rhubarb are : — 1. Rhu- barberic acid. This is the yellow, coloring matter of rhubarb. 2. Gal- lic and tannic acids. These constitute the astringent matter. The red veins are the seat of this astringent matter. 3. Oxalate of lime. This CATHARTICS. I _' J gives tlie gritty taste to rhubarb. In the different varieties, the propor- tions of this differ. In European rhubarb there is scarcely any, while in Asiatic rhubarb, Brande found 14 per cent. 4. Starch. The pro- portion of this differs. The English contains a large quantity — 11 per cent., the Asiatic very little. Besides these it contains gum, lignin, various salts, and water. Rhubarb yields all its virtues to alcohol and water. Effects. — As a cathartic this article is peculiar, in the fact of its com - bining a cathartic and an astringent operation. In small doses, it acts as a tonic to the digestive organs, and proves astringent. In full doses it acts as a cathartic, and leaves behind it an astringent effect. In its general operation it is mild, the only unpleasant effect which it pro- duces is griping. The evacuations which it causes are faecal rather than watery. It promotes secretion moderately. It app ears to act more on the muscular than on the mucous coat of the intestines. Al- though it gripes, it never produces inflammation of the bowels like some of the more active articles. During its use the coloring principle is absorbed and shows itself in the urine. Pereira says, the milk of nurses using it purges — differs from aloes, in not acting so much on large intestines. From the peculiarity of its action, it is suitable only in certain condi- tions of the system. "When the bowels are relaxed, and when a pur- gative and astringent tonic effect is required, it is exceedingly valuable. Hence it is so used in the summer complaints of children. When free secretion from the intestines is required, it is objection- able, and in general in febrile and inflammatory states of. the system, it is improper. As a remedy in habitual costiveness, too, it is objectiona- ble, although in some cases, where costiveness depends on laxity of intestines, it is good. As a purgative for children whose bowels are apt to be debilitated by acid and flatulence, it is an excellent article. Dose. — Powder, 20 to 30 grs. Pill. — Simple and compound, vide Pharmacopoeia. Mixture. — Generally rubbed up with mint water. Aromatic Syr up. — This is an excellent laxative for children. Dose 3 i to 3 iij- This drug is the inspissated juice of the leaves of different species of the aloe. The mode of obtaining it is very simple. The leaves are cut near their roots, and then placed with the cut end downwards. The juice, of a greenish yellow color, readily exudes from the leaves, in which it is lodged in large longitudinal vessels. It is then collected and evaporated by exposure to the sun, or by boiling, until it becomes 122 MATERIA MEDICA AND THERAPEUTICS. about the consistency of honey, when it is poured into skins or cala- bashes. This forms the purest kind of aloes. In some places, the leaves are subjected to pressure for the purpose of increasing the quan- tity.. In this way the real aloetic juice becomes mixed 'with the muci- laginous juice of the leaves, and the quality of the article is impaired. In other places the leaves are boiled after the juice has exuded, and the decoction evaporated to a suitable consistence. In this way a still inferior kind of aloes is obtained. The principal varieties of aloes are the following : The Socotrine, pure Hepatic aloes, Cape, aloes, and Barbadoes aloes. 1. Socotrine Aloes. — This is obtained from the Aloe socotrina, and comes from Socotra, an island near the Straits of Babelmandel. The greater part of it is carried to Egypt, and thence to Smyrna, from whence it is exported. A good deal of it, however, goes to Bombay, and thence to Europe. This comes in pieces of a reddish .brown color, sometimes of a garnet red, sometimes of a golden red. The best pieces have a smooth, glassy, conchoidal fracture, edges translucent; very good pieces, however, break with a rough fracture. Its taste is bitter, odor aromatic, and by no means disagreeable, resembling that of myrrh. Heat readily melts it ; and under the fingers, it softens like wax. Its powder is of ajjolden yellow color. 2. Cape Aloes. — This is the product of the Alqe^spicata, It comes from the Cape of Good Hope. In mass it is of a deep brown color, with a greenish tinge; in thin laminae, it is red and transparent. Frac- ture, glossy and resinous. Has a very strong and disagreeable odor, without any aroma. Powder greenish yellow. 3. Barbadoes Aloes. — Product of Aloe vulgaris. Comes from the West Indies in large gourds, weighing from 60 to 100 pounds. Gene- rally known by the name of Hepatic aloes. Of a dark brown or liver color; its fracture generally dull, not so smooth, nor its edges so sharp or transparent as the first two kinds. Taste bitter and nauseous. Odor strong and nauseous, without any aroma. Powder dull olive yellow. Besides these there is another kind of aloes — the Caballine or Horse aloes, ho called from its being used in veterinary practice. ~~ This iT a very inferior kind, and is said to be prepared by boiling the leaves after the better kind of aloes has been obtained from them. It is opaque and almost black, and has an exceedingly offensive odor. Generally mixed with sand and other impurities. Composition. — Aloes contains a bitter principle called alorsin, proba- bly a compound of several proximate principles, a resinous matter, a trace of albumen, and an acid, by some thought to be gallic. It yields its virtues to both water and alcohol. It is almost entirely CATHARTICS. 123 dissolved in boiling water, which, on cooling, deposits the substance called resin. Effects. — Aloes in small doses is st omachic, improving appetite and assisting digestion. Its action as a purgative is peculiar, and it fulfils certain indications better than any other drug. It is ver y slow ; eight, twelve, or even twenty-four hours elapse before it operates. It does not disorder the stomach, but on that organ is rather tonic. It acts on tin: liver, increasing its secretion s. It acts especially on the lower intestines, and is very apt to produce irritat ion in the rectum and pelvic viscera. It affects mainly the muscular and very little the mucous coats of the intestines, producing large', thick, copious, and bilious stools. From these peculiarities of its operation, the class of cases to the treatment of which it is specially appropriate, is very obvious. When we desire to unload the bowels without disordering the stomach ; when the liver is torpid, and we wish to rouse it to action, without stimulat- ing the mucous membrane ; when we desire to remove costiveness, and yet avoid debilitating either the system at large or the intestinal canal in particular, no other remedy will meet our wishes with the certainty of aloes. Preparations and modes of administration. — Aloes in substance is only given in pill ; if the full effect is desired, 10 grs. must be given ; to remove the habit of costiveness, a much smaller quantity given in daily doses will answer. For this purpose we have no cathartic supe- rior to the dinner pill, a combination of aloes, extr. wormwood and gum mastic. Decoction of aloes is so very unpleasant, that though officinal it is not much used. [Except as enema.] Tinct. aloes cum myrrha, elixir proprietatis. — This is a most excellent purgative for children ; both as a remedy for torpid liver, habitual con- stipation, or worms, it answers an admirable purpose. carbo ligni {vegetable charcoal). This is a well-known substance, with the sensible qualities of which you are all familiar, and of the chemical history of which it is not neces- sary I should speak. It has the property of absorbing different erases, and, though in a degree far inferior to animal charcoal, of destroying the taste and smell of a variety of animal and vegetable substances, especially when they are putrid. Its uses in medicine are various ; but at present it is only to be noticed as a cathartic. It had at one time a very great reputation, 9 124 MATERIA MEDICA AND THERAPEUTICS. especially in obstinate constipation, in obviating which, Dr. Daniel says it will succeed when mercury, &c, &c, fail. Most late authorities deny altogether its powers ; and as it is totally insoluble, it is difficult to imagine that it can produce any other than mechanical effects. Perhaps, as suggested by Dr. Chapman, it may produce an antiseptic effect on the excretions present in the bowels, and thus render them less irritating, while in its mechanical effect the mass is evacuated. It is now little used as a cathartic. It may be given in almost any quan- tity — a tea-spoonful is the usual dose. JALAP. For a long time the plant supposed to yield this substance was the Convolvulus jalapa. This is now ascertained not to be the case. The plant which yields it is Ipomcea jalapa, called also the Ipomcea purga. This is a climbing plant, growing native in Mexico. The jalap of medi- cine is the root, and derives its name from Jalapa, a place about which the plant grows abundantly, and from which it is sent to Vera Cruz and thence to other countries. It was first brought to Europe about A.D. 1610. The root is tuberose, and as found in the market, the tubers are either entire or cut into slices. They are of various sizes, sometimes as large as a man's fist, but generally much smaller. "When entire, they are of an oval shape, with pointed extremities and marked with incisions on their surface, evidently made for the purpose of drying. They are solid and heavy, coveredjvith a brown, wrinkled cuticle. Wh en brok en they present a surface of a deep yellow grey color, interspersed with deep brown concentric circles. The slices vary in size and shape. \te powder is of a pale brownish color, with a peculiar odor and a taste somewhat sweetish and pungent. When swallowed it affects the throat with a sense of acrimony and causes a flow of saliva; when in- haled it causes sneezing and coughing. Purity. — The best pieces of jalap root are those which are the hard- est, most difficult to pulverize, and which have the greatest number of concentric circles in the interior. The inferior or spurious pieces are light — whitish internally, and spongy or friable. Jalap is apt to be worm-eaten. These animals, however, only devour the amylaceous and gummy parts, leaving the resinous part untouched. This renders it stronger, as the resin is the active part. Hence this should not be used for the powder. For obtaining the resin it is equally good. Jalap yields its virtues partly to alcohol, partly to water, wholly to dilute alcohol. Effects. — A very active, efficient, and safe cathartic. It quickens the peristaltic action and promotes intestinal secretion. Its operation is CATIIAUTICS. ] 25 generally attended with nausea and griping. The evacuations are watery. The general effect on the intestines is de bilitatin g, and it doe not heat or excite the system like some other cathartics. Uses. — In all cases where it is desirable to evacuate thoroughly the intestines, when torpid and loaded with mucus, rind especially flic large ones, and to make a decided impression on them in the way of intestinal secretion, jalap may be used with advantage. It is speedy in its operation. When the bowels are in a state of irritation, or when hemorrhoids, &c., are present, it is objectionable. Forms. Powder. — Dose 10 to 30 grs. Generally given in combina- tion with calomel. Pulv. Jal. Oomp. — Pulvis purgans ; Jalap 1 part. Bi-tart. Pot. 2 parts. Dose. — 40 to GO grs. Much used in dropsy. Tinct. — Seldom used alone ; sometimes added to purgative draughts in doses of 3 i to 3 ij. Extract. — In this yon have a combination of resin and gummy extractive. The resin, however, is the only active part. The advantage of the gummy part is, that it makes it operate more mildly. If water be not used you only get the resin. Of the resin the dose is from 3 to 6 grs.; of the extract 10 to 20 grs. The extract is a dark brown substance, not used by itself, but enters into the manufacture of pills. podophyllum peltatum — radix {May apple — the rhizome). This is a plant common in almost every part of the United States. The leaves are poisonous. The root, the part used in medicine, is smooth, dark brown color, white within, from three to six feet long, having an acrid, disagreeable taste. It gives up its active principles to water and alcohol. Effects. — As a cathartic it resembles jalap, producing the same watery stools, but by some it is said to gripe less though it nauseates more. Dose and mode of administration identical with those of jalap. h a^rt & , fey^*^ "f^ ^ - XV j Xx&J^ Phytolacca decandria (the Poke weed — American nightshade). A common plant indigenous to this country, and growing in every part of it from New England to Florida. It is found in open woods and uncultivated fields. It grows to the height of six or eight feet, and 126 MATERIA MEDIC A AND THERAPEUTICS. dividing into numerous spreading branches, with large rich leaves and purple berries. The root, which is perennial, is large, fleshy, and fibrous, dividing into two or three branches. The parts used in medi- cine are the root and the berries. The root is the most powerful and is generally used. When dried it is of a yellowish brown color, without smell, taste slightly sweetish, but followed by a sense of acri- mony. Its virtues are extracted both by water and alcohol. Effects. — This article acts as an emetic, cathartic, and narcotic. As an emetic it has been said to resemble ipecac, and by some it has been recommended as a substitute for that article. It differs, however, very much from it. It is very slow in its action, taking at least an hour before it operates, and after it once begins it continues to vomit for three or four hours. At the same time it purges, and although the vomiting which it produces is mild, yet sometimes narcotic effects follow, such as vertigo, impaired vision, &c. It is therefore very different from ipecac. In small doses it appears to act as an alterative, promoting the secretion of the liver and acting moderately on the bowels. Form, Dose. — 20 to 30 grs. in powder as emetic, 1 to 5 as alterative. As the latter it is used principally in chronic diseases. A saturated tincture of the berries is also used in the country in rheumatism — a teaspoonful three times a day. As a local application in the form of ointment it is also used in Tinea capitis and other cutaneous affections with great advantage. 3 i of powdered root or leaves to 3 i of lard. The proper period for gathering is in the autumn after the leaves have fallen. To be cut in thin transverse slices, dried, pulverized, and kept in tight bottles. Dr. Taswell, a country physician, who has used it a good deal, recommends it to me very highly. He says its action on the liver is very like calomel, and that it even salivates. In combination with aloes and gamboge he uses it as a cathartic. The pill is grs. ij aloes, ■J- gr. of each of the others ; one pill is laxative, four a full dose. SALINE CATHARTICS. SULPHAS SOD^E. This is the common Glauber's Salts, and is so called from Glauber, by whom it was first prepared. It exists in a native state and is also prepared artificially. Native State and Preparation. — In its native state this salt is found existing frequently in mineral waters, also in sea water. It sometimes CATHARTICS. 127 effloresces on the surface of the ground in the neighborhood of salt lakes. Captain I'Vaiiklin states that to 1,1k; north of Carlton Bouse, OD the river Skatchawan, hit. 53° 20', is a small lake, on the Bhore of wbicb, in summer time, it effloresces in the form of a white powder to the depth of two or three inches.* According to Captain Hall, in his "Journey to South America," the valley of Copiapo, on the coast of Chili, is covered with a layer of this salt several inches thick. It has the appearance of snow on the ground. f The salt used in medicine is artificially prepared. It is generally obtained during the processes for the manufacture of muriatic acid. The muriatic acid is obtained from the muriate of soda, which is decomposed by the action of sulphuric acid. After the muriatic acid is separated by distillation, a salt remains which is the sulphate of soda with exec-- of acid. For the purpose of neutralizing this excess of acid, the salt is dissolved in boiling water, and to this is added carbonate of lime. The solution is then evaporated, filtered, and crystallized. Chemical Composition. — Sulphate of soda consists of one equivalent of sulphuric acid, 40 ; one of soda, 32 ; and ten of water, 90 = 162. It contains, therefore, more than half its weight of water. Properties. — This salt, when first prepared, is in white, transparent crystals, and has a cool, bitter, and nauseous taste. When exposed to the air, it effloresces, and is converted into an opaque white powder. When subjected to the action of heat it undergoes watery fusion/}; It is soluble in three parts of cold water and in one part of boiling water. In alcohol it is insoluble. Physiological Effects. — This is a valuable cathartic, and was formerly much more extensively used than it is at present. It is speedy in its operation, and acts by promoting free secretions from the internal surface of the intestinal canal, aud thus causing copious serous evacuations. It operates _mildly, producing only a slight disagreeable sensation in the stomach, and afterwards transient uneasiness in the bowels. The great objection to it is its exceedingly nauseous taste and its consequent offen- siveness to most stomachs. It is on this account, principally, that it has been so generally superseded by the sulphate of magnesia. Dose and Mode of Administration. — To an adult the dose is about one oun&e, dissolved in water. To disguise the taste, a portion of lemon juice or cream of tartar may be added. Like some other saliues (espe- cially nitre) sulphate of soda has a very notable_effect_ou the plasma of the * Franklin's Journey to the Polar Sea, p. 506. f Vol. ii. p. 22. Quoted by Dr. Thomson in the London Dispensatory, p. 565. X Mr. Brande says, " it sometimes liquifies hi very warm climates, and therefore should be previously dried if intended for equatorial consumption, it being only necessary to recollect that half an ounce of the dried sulphate is equivalent to about au ounce of crystals." Manual of Pharmacy, p. 164. 128 MATERIA MEDICA AND THERAPEUTICS. blood, diminishing the quantity of fibrine. This is probably not a uni- versal nor a very constant effect of the salines, still it is interesting as throwing light on the modus curandi of these articles in inflammation. SULPHAS MAGNESIA. This is called the bitter purging salt. It is also known by the name of Epsom salts, from its having been first artificially obtained from the evaporation of the water of the celebrated Epsom Springs in England. This was done by Dr. Grew, in 1675. Native State and Preparation. — This salt is found native in its pure state, either in the forms of crystal or in the state of efflorescence. In the mercury mines of Idria, it is found crystallized. In Andalusia in Spain large tracts of land are covered with an efflorescence of it after floods. It also exists in certain caverns in some of our Western States. What is used in medicine is prepared artificially and chiefly from the liquor which remains after the crystallization of muriate of soda (com- mon salt) from sea water, which holds sulphate of magnesia in solution along with muriate of magnesia. By boiling and evaporation, crystals of sulphate of magnesia are deposited. The salt thus found is not pure, inasmuch as it contains muriate of magnesia, in consequence of which it deliquesces. For the purpose of obtaining it in a state of greater purity another method of preparing it was adopted by Dr. Henry of Manchester, from magnesian limestone. According to this process the magnesian. lime- stone, consisting of the carbonates of magnesia and lime, was first cal- cined for the purpose of driving off the carbonic acid gas. The magnesia and lime were then treated with muriatic acid with the view of taking up the lime. The muriate of lime is thus held in solution while the magnesia is precipitated. The two are then separated, and the magnesia is converted into the sulphate by the addition of sulphuric acid.* Pre- pared in this way, it contains no muriate of magnesia, and, therefore, does not deliquesce. At Baltimore it is prepared from the silicious hydrate of magnesia, marmolite. Chemical Composition. — This salt consists of one equivalent of sul- phuric acid, 40 ; one of magnesia, 20; and seven of water 63 = 123. Properties. — Sulphate of magnesia usually forms small needle-like crystals — white and transparent. Its taste is bitter and saline. When exposed to the atmosphere, if pure, it slowly effloresces. When it deli- quesces, it is owing to the presence of muriate of magnesia. It dis- * Thomson, vol. ii. p. 314. CATHARTICS. 129 solves ia its own weight of water at GO , and in t hree-fourths of its weight of boiling water. In alcohol, it is insoluble. Effects. — Like those of sulphate of soda, though it is less apt to offend the stomach or gripe, and operates rather less promptly. It is the best and fur the most commonly used of the saline purgatives. Tlie dose is from one to two ounces. The best way of disguising its taste is to add lemon juice to the solution. TAUTRAS POTASS-dE ET SOD^K. This is commonly called Rochelle salts, from its having been first prepared and introduced into practice by an apothecary of Rochelle in France, by the name of Seignette. From him, too, it was called the salt of Seignette. The discovery of this salt was made in 16*72, but its composition was kept a secret. From this circumstance, no doubt, it gained great celebrity, and from its being supposed useful in almost all complaints, it was called Sal polychrest, or the salt of many virtues. In 1731, the chemical constitu- tion of it was ascertained by Bouldac and M. Geoffroy. Mode of Preparation. — This salt is prepared by simply adding bitar- trate of potassa finely pulverized to a solution of carbonate of soda. Here the excess of acid in the bi tartrate of potash combines with the soda, forming the tartrate of soda, while the carbonic acid escapes with effervescence. In this way a double tartrate of potash and soda is formed. Chemical composition. — Rochelle salts consists of two equivalents of tartaric acid, 132; one of potassa, 48; one of soda, 32; and ten of water, 90 = 302. Properties. — It is in large, white, regular crystals ; taste, bitter and saline; slightly effloresces when exposed to the air; soluble in five parts of water at 60°, and in much less boiling water. Physiological Effects. — Similar in its operation as a purgative to those already noticed. It is less unpleasant than most of the saline cathartics, but it is also less active. Dose. — From one ounce to an ounce and a half is a dose for an adult. TARTRAS POTASS^E. Tartaric acid combines with potash in two proportions, the one form- ing an acidulous salt, bitartrate of potash ; the other a neutral salt, tar- trate of potash. This last is commonly called soluble tartar, from its great solubility in water when compared with the bitartrate, which is very insoluble. Mode of Preparation. — Soluble tartar is prepared by taking a solu- 130 MATERIA MEDICA AND THERAPEUTICS. tion of carbonate of potash, and adding to it bitartrate of potasb reduced to a fine powder, and boiling. Here tbe excess of acid with bitartrate is neutralized by the potash, while the carbonic acid escapes with effer- vescence. By a slow evaporation regular crystals form. Chemical Composition. — One equivalent of tartaric acid, 66 ; and one of potassa, 48 = 114. Properties. — If properly prepared, soluble tartar forms in white crys- tals. As generally found in the shops, however, it is in a granular form. To obtain regular crystals the evaporation ought to be slow and nearly spontaneous. As commonly made, however, on a large scale, the evaporation is hastened by frequent stirring, which interferes with the crystallization. It has a cool, bitterish taste. In the form of crys- tal, it is soluble in its own weight of cold water; in the granular form, it requires four times its weight. In hot water its solubility is increased. In alcohol it is also soluble. When exposed to the atmosphere it deli- quesces. Effects. — As a cathartic this salt acts mildly yet efficiently. It causes no griping, and possesses the properties of correcting the griping effects of senna and other cathartics. It operates quietly with them; and like the other saline cathartics, produces watery evacuations from the bowels. Dose. — From 3 ij to 3 j in any bland fluid. Not much used. SUPER-TARTRAS POTASS^E CALLED ALSO BI-TARTRATE ACID TARTRATE. This is called crystal of tartar or cream of tartar, and is a salt exists ing in the juice of the grape, and is deposited in the form of a crust on the sides of casks of wine, during the slow fermentation which wine undergoes when kept. This goes under the name of tartar, and is either red or white, according to the wine from which it is deposited. By dissolving this substance in boiling water and filtering, brown crys- tals are deposited. The coloring matter is then separated by again boiling the crystals, and adding white clay, whites of eggs, or wood- ashes, which attract the coloring matter. 'Properties. — Crystals of tartar consist of small, irregular, brittle, whitish crystals. They are easily reduced to powder, and in this state are called cream of tartar. Its taste is sharp and very acid, very spar- ingly soluble in water, requiring 120 parts of cold and sixty parts of boiling water to dissolve it. It is insoluble in alcohol, which explains its deposit from grape juice when the vinous fermentation begins and alcohol is found. Composition. — Potash, 1 atom, 47; tartaric acid, 2 atoms, 132 ; water, 1 atom, 9. Total, 188. CATHARTICS. LSI JEffectson the System. — This is a pleasant; cooling Laxative. It requires to be taken in doses from 3 i'j to 3 j to produce its effect. It i- ta in solution sweetened with sugar. [This solution should always be made with boiling water, and when cold, decanted from off the undis- solved lime, y Btrong pressure, more elaterium is made, but it is of inferior quality. By evaporating the juice a still inferior quality is produced. Then again, if the juice from which the elaterium is deposited be suffered to stand too long before it is separated, a mucilaginous matter subsides, which greatly impairs its strength. This renders the elaterium dark and gummy. The adulterations are with chalk and lime, generally of the Maltese kind. Tests. — It should be friable, of a pale green greyish color, floating on water, not effervescing on the addition of diluted hydrochloric acid. If it does, it shows the presence of chalk. If the acid solution be neu- tralized by ammonia, gives no precipitate on the addition of oxalate of ammonia. If chalk be present, throws down a copious precipi- tate (oxalate of lime). Touched with the tincture of iodine gives no evidence of presence of starch. If this be present turns it blue. Chemical Composition. — According to analysis of Mr. Ilennel of Lon- don, elaterium contains in TOO parts, 40 parts of a peculiar crystal Iizable substance which he calls elaterin . 17 parts of green resin, starch 6 parts, woody fibre 27 parts, saline matters 6 parts. Effects. — -Elaterium is among the most active of the hydragogue cathartics, causing free secretion and copious watery evacuations. If the dose be somewhat large it acts with great violence, causing sickness and vomiting, together with irritation, and in some cases actual inflam- mation of the mucous membrane of the bowels. From the local irrita- tion which it produces, general febrile excitement is apt to occur during its action ; the pulse becomes excited, the tongue and skin dry, together with great thirst As this article operates so powerfully, its use must be limited to those cases in which the bowels are torpid, and where it is desirable to excite a powerfully revulsive action in the intestines and to cause free intestinal secretion. On the other hand, whenever any local irritation of the intestines exists, it ought not to be used. In delicate habits, too, and in young subjects it is improper. This article is uncertain and variable in its operation, large doses at one time produce little effect, while small ones are sometimes followed by violent effects, owing either to difference in the strength of the article or in the state of the intestines. Mode of Administration. — The best form is that of pill, made with ex- tract of gentian. The dose must vary with the strength ; of the best kind one sixteenth to one eighth gr. is sufficient ; of the ordinary kind one half a grain ; of the black kind 2 or 3 grs. are sometimes used. The 142 MATERIA MEDICA AND THERAPEUTICS. dose to be repeated every two or three hours until the desired effect is produced. Elaterin is crystalline, very bitter, no smell, neither acid nor alkaline ; insoluble in water and soluble in hot alcohol. One sixteenth of a grain operates like a dose of elaterinm. CROTON OIL. The plant which yields this is the Croton tiglium, a tree growing ten or fifteen feet high in China, Cochin China, Ceylon, the Molucca islands, and the greater part of the East Indies. The fruit is a capsule about the size of a filbert, with three cells divided by membranous partitions, each containing one seed. It is from the seeds that the oil is obtained. They are about the size of the castor oil seeds ; ^vTeweoTTaterally they have an oblong shape, but from either extremity their shape is four-sided, having two of the sides convex and the other two somewhat flattened. The shell of the seed is black, but is covered with a soft yellowish brown epidermis. The kernel is of a yellowish "oTown color. The seeds have no smell ; taste at first mild but soon becomes hot and burning, this con- tinues for some time. The seeds are imported from the East Indies in cases, and from the friction which they undergo during their transportation the epidermis is generally rubbed off. On their first introduction into Europe they were known by the name of Molucca grains. The croton seeds are actively cathartic, producing the effects of a hvdragogue. This is the form in which this article is- frequently used in the East Indies. The seeds are first well dried by a fire and the shells carefully removed. This is supposed to correct the acrimony of the seeds. They are then pulverized and made up into pills with honey, each pill containing 2igrs. of the powder. Two of these pills are an ordinary dose for an adult. Mr. Marshall says this dose is about equal to 3 ss of jalap or to grs. vi of calomel. The stools are invariably watery and copious. It operates without nausea and griping, except in occasional instances. In Europe and in this country the only preparation that is used is the oil. Croton Oil. — This is obtained by first roasting the seeds and then separating the shells ; after this subjecting them to strong pressure. In this way 50 per cent, of their weight of oil may be procured. The oil is of a reddish yellow color, with a faint odor and of an unctuous thickness, like castor oil. Its taste is hot and acrid, leaving an uneasy feeling in the mouth and throat, which continues for some hours. GATHABTICS. L43 Chemical Composition. — Dr. Nimmoj who early investigated the ab- ject, states the composition thus: — acrid purgative matter 10, bland fixed oil 55 = 100. This acrid matter was supposed to be of a resinous nature, but the subsequent analysis of Brau.de established the existence of a peculiar principle, crotonhi, and an acid, crotonic. Crototi oil is soluble in ether, the fixed and volatile oils. Tn absolute alcohol cold it is insoluble but soluble in hot, from which it is again de- posited on cooling. Effects. — Croton oil is an active hydragoguc cathartic and operates with great rapidity, producing copious watery evacuations. In moderate doses, although it operates actively, it does not produce much nausea or griping. If the dose be somewhat large, it occasions considerable intestinal as well as general irritation. As a cathartic it is suited to those cases in which there is great torpor of the bowels and where an active revulsion upon those organs is desirable. In children and feeble habits, or where inflammation of the intestines is present, it ought not to be used. What is peculiar to this article is that the simple applica- tion of it to the tongue, without swallowing, will cause purging. One or two drops applied in this way will operate, and maybe resorted to in cases where the patient has lost the power of deglutition, as in apo- plexy, tetanus, &c. This oil is variable in its action. Mode of Administration. — The ordinary mode is that of jrill, made up with crumbs of bread, each pill containing a drop of the oil. To an adult, one or two of these is an average dose. A better way is to take a pill every hour or two until the desired effect is produced. MERCURIAL PURGATIVES. CALOMEL. Of the history and properties of this most important article I shall speak at large under the head of sialagogues; I now refer to it only as a cathartic. In this respect, it is peculiar and produces effects widely different from those of other medicines of this class. The peculiar effects of calomel depend not upon its mere cathartic power, but on its action upon the liver and the mucous membrane of the bowels. The chief of these peculiarities are : — 1st. Its action on the mucous membrane is peculiar and often very < salutary — increasing the secretion, and seeming to enable the membrane | to throw off any viscid mucus with which it may be coated. 2d. Its influence on the liver is marked, and its cathartic operation lias been by some attributed to its increasing the flow of bile. 144 MATERIA MEDICA AND THERAPEUTICS. 3d. It is slow, often taking from 8 to 12 hours to produce any effect — the motions are few and commonly large. 4th. The operation of calomel is rarely attended by much griping, butoften by nausea and prostration even to the extent of fainting. 5th. The action of calomel is permanent, and it does not leave behind it that tendency to constipation which follows the use of many cathartics. 6th. There is yet another peculiarity in the operation of calomel to which I wish to call your especial attention, and that is that when given in large doses, it does not produce any corresponding irritation. On the contrary, it seems to act as a sedative to the intestinal canal. On this principle, scruple doses of calomel have been given in dysentery and other intestinal disorders. The purgative effect is not increased, and the irritation is lessened by thus doubling the dose. Its depressing effect on the whole system is very markedly increased. From a scruple of calomel, the alvine evacuations will be neither more numerous nor more copious than from six or eight grains, but the prostration will be far o-reater. Cases are recorded where by mistake very large doses of calomel have been taken, 3 i or more. The purgation was generally very moderate. Of late years immense doses of calomel have been given in Asiatic cholera and some other diseases. [Pereira gives some cases from the records of a London cholera hospital, in which calomel was given in frightful doses. Three drachms on the entrance of the patient into the hospital, and one drachm every hour till in some cases 20, 25, and 30 drachms were given. In none of these cases did violent irritation or profuse salivation occur. Seventeen out of eighteen cases recovered. The patient who died took 53 drachms in 42 hours, without sensible effects. The best that can be said of this practice is, that it did not kill. — Ed^\ For the purpose of testing the effects of calomel upon the stomach and intestines, Mr. Annesley instituted some experiments upon dogs which are very curious and interesting. He took three healthy dogs, and gave to one 3 i of calomel ; to a second, 3 ij ; to a third, 3 iij. After this they were tied up in a room. Twenty-four hours after they had taken the calomel, the dogs were all killed ; and five minutes after they were dead, they were examined, and the vascularity of the stomach was found to be in the inverse ratio of the calomel which they had taken, i. e. in the dog who had taken 3 iij, the vascularity was the least, and so on. For the purpose of com- paring this with the condition of the stomach of a dog which had taken no calomel at all, an examination of another dog was made, and here the stomach was more vascular than in any of the others. From these experiments, Mr. Annesley draws the conclusion, "that the natural and healthy state of the stomach and intestinal canal is high vascularity, and CATHARTICS. 145 that the operation of calomel in large doses is directly tlie reverse of inflammatory." Therapeutical Effects of Calomel. — Upon the use of calomel as a purgative in different diseases, so much was said in my geperal remarks on purgatives, that T will not now go into the subject in detail. Suffice it to say chiefly by way of recapitulation, that in fevers and inflamma- tions, whatever be tlie type of the former, or the location of the latter, calomel may, witli the precautions and restrictions which were detailed when I spoke of purgatives generally, be used with excellent effect. In jaundice, too, it will often produce the happiest results. For obstinate constipation depending on torpor of the bowels it may be also given with advantage. PILULA HYDRARGYRI {blue pill). This is a mercurial purgative, not so much used as a cathartic, yet capable, when given in adequate doses, of producing free purging, with most of the advantages which attend the operation of calomel. Of its pharmaceutic history I shall speak under the head of siala- gogues. Its dose as a purgative should be from 15 to 20 grs. The practice of giving five grs. of blue pill at bedtime, and a senna draught in the morning, so highly recommended by the late Dr. Abernethy, has lost some of its favor with the profession ; yet for a very large class of cases of constipation it is of great value. Blue pill is an excellent pur- gative for children ; five grs. given at night will commonly operate in the morning; and its influence, if given early in the febrile and inflam- matory affections of children, is usually most salutary. COMBINATION OF CATHARTICS. In what has been said of individual cathartics I have confined myself to a notice of the effects which they produce when given separately, and I have done this with the twofold design of showing- that all cathar- tics do not act precisely alike, and to enable you to understand the prin- ciples upon which they are combined in our ordinary prescriptions. On this account I have omitted saying anything in relation to these combi- nations until the present time. After stating briefly the object to be attained by uniting different cathartics in one prescription, I shall ana- lyse the whole of them with the view of illustrating the principles upon which these combinations should be made. 1. The first object to be attained by combining cathartic medicines is to increase their activity. This may be done either by increasing the rapidity with which they operate or by increasing the actual effect produced, 146 MATERIA MEDIC A AND THERAPEUTICS. 2. The second object is to make them act more mildly. A number of valuable cathartics, you now know, act with such intensity and pro- duce effects so unpleasant, in the way of nausea and griping, when given alone, that their use in this way is exceedingly objectionable. By judi- cious combination this may, to a very great extent, be obviated. 3. The third object is to obtain in one combination the effect of differ- ent cathartics. As I have already stated, these articles act in various ways — some increase the peristaltic motion — others cause copious secre- tions from the inner surface of the intestines — while others again act by promoting the biliary secretions. Now by uniting different cathartics all the effects may be produced by one prescription. These are the principal objects to be gained by combining these arti- cles, illustrations of which you will find in the notice which I shall now take of the different substances belonging to this class. Laxatives, generally speaking, do not admit of combinations. Being- used for their mildness and simplicity, they do not require anything to modify their operation. In fact as a general rule, the best form in which they can be given is alone. They are sometimes, however, com- bined, and then their effects are very much modified. Castor oil is best administered alone. Manna and cassia, from the quantity in which they are obliged to be taken, are apt to sit heavy on the stomach and frequently to cause griping and uneasiness. On this account they are generally combined with the more active purgatives, of which I shall speak hereafter. Sulphur and cream of tartar are fre- quently combined, and the compound is more active than either sepa- rately. Sulphur and magnesia combined frequently answer an excel- lent purpose. You have a gentle laxative suited to acid states of the digestive organs. As magnesia only operates as a cathartic when it meets with an acid in the alimentary canal, its activity is promoted by following it with cream of tartar. Of Purgatives. — It is in these especially that the advantages of com- bination are shown. Senna. — This substance, as already stated, when given alone is apt to produce a great deal of griping. By combining it with manna this is corrected. It is rendered milder in its operation, though not less effec- tual — at the same time all the unpleasant effects of the manna when given alone are obviated by the senna. By combining senna with some of the neutral salts its griping effects are also corrected, while the com- pound is more active in clearing out the bowels than either separately. A very good combination consists of senna, manna, and epsom salts. It acts thoroughly yet pleasantly. Rhubarb. — This is a cathartic which is given very conveniently and advantageously alone. It is mild in its operation and sits easily on the stomach. It is frequently, however, combined with advantage. With CATHARTICS. 14 7 magnesia it forms a very valuable compound, in all cases where yon wish an antacid effect together with a' tonic purgative. This is pecu- liarly useful iu cases of enfeebled and deranged stomach from over feed- ing or over drinking. The most common combination of it, however, is with calomel. Here you combine the peculiar operation of l><>t)i — that of the rhubarb on the stomach and intestines, and that of calomel on the liver. With aloes, which is laxative and tonic, it. forms ;i us< ful tonic. It combines the united operation of rhubarb on stomach and small intestines and aloes on large. Jalap. — This is a very active cathartic and operates well when given alone. Generally, however, it is combined. With equal parts of cream of tartar, it makes the pulvis purgans so commonly used. By this union the jalap is rendered milder and the whole effect is •increased. United with calomel the double effect is obtained upon the liver and upon the intestinal canal. Scammony. — This is an active article and liable to gripe when given alone. This is corrected by combination with other cathartics, and what is singular those of a very active character. By a union of Aloes, Scammony, and Colocynth, in the form of the compound colocynth pill, you get a preparation more permanent in its operation than aloes alone, and yet without the irritation and unpleasant effects cither of scammony or colocynth. Gamboge. — This is a very active griping cathartic, operating with uncommon celerity, and usually when given alone commencing its action in the stomach and causing nausea and vomiting. On these accounts it cannot well be given alone. By combination, however, it is rendered a manageable and valuable cathartic. With aloes, which is very slow 7 in its operation, and does not affect the stomach, it forms a purgative in which the effect of gamboge on the stomach and bowels is corrected, and yet more active than aloes alone. Generally speaking, gamboge is used only in small quantities, sav gr. j., to increase the activity of other articles when you want to produce a strong hydragogue effect. JSlaterium. — This is generally given alone. Croton Oil. — Generally speaking, this article has been used in its un- combined state, and principally with the view of getting the very active hydragogue effects which it produces. By combination, however, it may be made much more available as a general cathartic. In combination with Calomel or Blue pill, in the dose of half a drop to six or eight grains of the latter, its general efficacy has been increased, while the nausea and griping which it is apt to pro- duce have been obviated. With the compound pill of rhubarb, too, it forms a good combination. Neutral Salts. — Very commonly these are given by themselves, and 148 MATERIA MEDICA AND THERAPEUTICS. this is a very good way when the object is merely to wash out the exist- ing contents of the intestines. Their activity is considerably increased by mixing them together. This curious fact is illustrated in some mine- ral waters (such as Cheltenham salts). Another instance is in the sul- phate of magnesia, which acts with great effect if the muriate of mag- nesia be present. Of the combination of the neutral salts with senna and manna I have already spoken. Calomel. — This article enters into a great number of combinations, which it is unnecessary to enumerate. In all cases where the object is to promote the secretion from the liver, it forms a useful addition to cathartics. It may be given either alone, and then followed in five or six hours by some quick cathartic to carry it through the bowels, such as neutral salts;, or it may be given in combination with other articles, such as powder of jalap, rhubarb, extract of butternut, may apple, croton oil, &c. d'e. In this way you get the combined operation of calomel on the liver, and the other articles on the intestines. enemata {clysters). From the great susceptibility of the mucous surface of the lower bowels, it is evident that medicinal substances may be applied to it to produce impressions not merely on the intestine itself, but on the sys- tem at large. Hence enemata are used for a great variety of purposes. At present I shall only speak of them as agents intended to evacuate the bowels, either by their own powers, or by promoting the operation of cathartics. Used for this purpose, they are of very great value. Cathartic enemata operate in two different ways; first, by the mere stimulus of distension causing contraction of the gut; second, by an irritation of the mucous membrane of the rectum, they stimulate the muscular coat,, and in that way provoke contraction. This impression is frequently conveyed to the upper portion of the large intestines. Enemata are capable of fulfilling three indications : 1. They evacuate the lower portion of the alimentary canal. 2. They assist and expedite the operation of cathartics. 3. By the irritation on the intestine they act as revulsives, and thus relieve distant parts. They are made more or less stimulating according as they are intended for one or other of these purposes. To evacuate the lower bowels we use either those which act by mere distension, or those which are only moderately stimulating. 1. Warm water, warm gruel, molasses and water. These operate by distension only. The quantity to be given is from a pint to a quart. Pereira objects very strongly to the large enemata recommended by CATHARTICS. 1 19 ■ late authors, insisting that "it is rarely proper to use more than a pint." That "large quantities destroy the tonicity of the gut," &c, I think experience has shown the entire safety and manifest utility of large enemata. Injections may be made slightly more stimulating by adding to tlie warm water, salt, oil, or soap. These are of course more efficient and better calculated to aid the operation of a cathartic. If a still more active enema is desired, decoctions or infusions of the various purgatives may be used, as dec. aloes, inf. senna', solutions of the purgative salts, &c. If a strong revulsive action is required, dec. colocynth, or the spirits of turpentine (made into emulsion with gum arabic or eggs), may be tried. The instrument used, and the manner of using it, are by no means indifferent matters. The best instrument is the valve syringe, but the ordinary enema syringe, if good, will answer very well with care. The tube or bag to which a pipe is attached, and from which, the pipe being introduced into the rectum, the fluid is allowed to run by its own gravity, has the great advantage that it is impossible to do any harm with it. The common pipe and bladder are unhandy, but safe. The fluid should be injected very gradually, and the greatest care taken to avoid injuring the parts with the pipe. [Moving the bowels every day with a large enema of cold water has cured very many cases of chronic piles. It should be continued for a year, and resumed on any return of the difficulty. Even where cure is not effected, the comfort of the patient is much increased.] ANTHELMINTICS. Anthelmintics are those medicinal substances which possess the power of destroying and expelling worms from the human system. I shall first give you a brief account of some of the different kinds of worms which are found infesting the human body. They may be divided into two general classes, viz. those which infest the intestinal canal, and those which are found in other parts of the body. I shall treat of the first of these only. Of those Worms which infest the Intestinal Canal. — These are of five species, three possessing an alimentary canal, hence called hollow worms,' Coelelmintha — two having no abdominal cavity, called solid worms, or Sterelmintha. The hollow worms — nematoid worms — are ascaris lumbricoides, ascaris vermicularis, and tricocephalus dispar — called respectively the large round worm, the small thread worm, and the long thread worm. The solid worms are : Taenia solium, the common tape-worm, and Bothriocephalus latus, the broad tape-worm, formerly called Taenia lata. The Tape-worm, Tcenia. — This is a very long worm, made up of flat articulations, united by means of a border or edge varying in breadth and thickness. It is of a whitish color, and varies in length usually from twenty to thirty feet. It generally occupies the small intestines. Th^head is turned upwards and firmly insinuated in the mucous mem- brane, while the body extends floating down the intestinal canal. There are two species which have been found in the human subject. Taenia lata, or, as it is now called, Bothriocephalus latus — the broad tape-worm. This species has been found chiefly in the inhabitants of Poland, Switzerland, Russia, and some parts of France. In other parts of Europe it is not found. In this species the articulations are broader than they are long, and the whole worm is broader and thicker than the other species — the taenia solium. The breadth varies from one eighth to one quarter or more of an inch. Its general length is from fifteen to twenty feet. Its color is dusky and not so white as the taenia solium. Tamia Solium. — The solitary worm — so called from its being sup- posed that never more than a single one was found in the intestinal ANTHELMINTICS. Id] canal at the same time. Satisfactory observations have, however, proved this to bo incorrect. Tins species is found in the inhabitant of Europe generally, with the exception of those nations in whom the taenia lata is met with, in whom it, is not often found, though occasion- ally the two species of worm are found in the same individual at the same time. Among the Egyptians it is also common. It is not so broad or so thick as the other species, its length however is greater, averaging from twenty-five to thirty feet. Its color is commonly a pale wliite. This species of ta3nia is never passed entire, and it possesses the curious property of parting with a number of joints and reproducing others to supply their place. This worm is Hermaphrodite, having a double sexual apparatus in each joint. Ascaris Lumbricoidcs. The long round worm. This animal is about the thickness of a common quill and from six to ten fingers' breadth long. When first passed it has a transparent appearance, but it soon acquires an opaque yellow tinge. The general shape of the body is cylindrical, but tapering towards the extremities. It is found both in children and adults; in the former, however, it is most common. Its natural abode is in the small intestines, more especially the jejunum and ilium. Occa- sionally it passes into the stomach and makes its way out by the mouth. Unlike the taenia it exists in great numbers — fifty, a hundred, and even a greater quantity having been discharged, in a few days-, from the same person. Occasionally it is found with other worms. Ascaris Vermicularis, also known by the name of Oxyuris vermicularis — the maw or thread worm. The common name by which they are known is ascarides. This is a small worm with an obtuse head, and varying in length from one line to five and six lines. The part of the intestines in which this worm is generally found is the rectum, sometimes also in the colon, and occasionally in the coecum. In children and young subjects they are more common than in adults. In females they are sometimes found in the vagina, from whence they have been known to pass up into the urinary organs. In some very rare cases, they have been detected in the stomach and oesophagus. The worm is never found alone, but always in conglobate masses. According to Bura, the ascarides live longer in the human body than any other worm. Tricocephalus Dispar — thread worm — the long thread worm, or capil- lary headed worm. This is a slender worm from one and a quarter to two inches in length, and in breadth not more than about half a line. Its color is usually white. This worm is not of a uniform size throughout its whole length. The extremity where the head is situated, is very slender and resembling a thread, and from this it derives its name. For about two thirds of its length it continues of this size. The remaining one third towards the tail is much larger. Pereira says " it does not appear that the long thread worm ever excites any symptoms." 152 MATERIA MEDIC A AND THERAPEUTICS. Evidences of the Existence of Worms. — It is by no means easy to decide in all cases whether worms are actually present. This arises mainly from two causes. In the first place they most commonly occur in very young subjects, who, of course, can give no accurate account of their symp- toms or sensations; and in the second place, the sympathetic irritations occasioned by worms in the intestines, are so diffused over the whole svstem, so remote frequently from the intestines, and so varied in their cha- racter, that it is not always easy tp trace them up to their original source. The symptoms may be divided into two classes, viz. primary and secondary. L Primary Sym})toms. — By these I mean the immediate symptoms of local irritation in the intestinal canal. The first of these is pain in the abdomen. As may naturally be inferred, from the moving nature of the irritating cause, these pains are not fixed in any particular spot, but wandering over the whole abdomen. They differ, too, in intensity, vary- ino- from a mere sense of uneasiness to pains of a more sharp and pricking character. Whenever the stomach and intestines are empty, these pains are aggravated, and on taking food they are usually relieved. The ab- domen becomes tumid and tender. The second symptom is derangement of the functions of the stomach and bowels. This exhibits itself in nausea, eructations, and sometimes vomiting. The appetite is variable — at one time entirely gone, and at another voracious. The bowels are irregular — sometimes costive, some- times relaxed. Not unfrequently tenesmus is present. Such are the primary and local effects of worms, viz. irritation in the intestinal canal and a consequent derangement of the function of digestion. 2. Secondary Symp>toms. — These are various, and show themselves in almost every part of the system. The countenance is generally changed in its appearance. Usually it is of a pale or leaden color, with a red spot on the cheek. The eye becomes dull and frequently fixed ; the pupil is dilated, and the under eyelids become tumid and have a bluish streak upon them. The nose is tumid, and itches incessantly. Children are constantly picking their noses. The mouth is full of saliva ; the upper lip swollen ; the tongue foul and the breath offensive. The brain and nervous system are also greatly affected. There is head- ache, especially after taking food — singing in the ears. Disturbed sleep, and vertigo. Delirium and fainting have all been known to occur. Amaurosis, deafness, apoplexy, and epilepsy have resulted from the pre- sence of worms. The foregoing is a general account of the symptoms indicating the pre- sence of worms. You are not to expect to meet the whole of them in any particular case. ANTHELMINTICS. IBS After all, however, the only certain Bign is the actual evacuation of worms from the intestinal canal. [And then we are uot sure thai the previous symptoms have resulted from worms.] Symptoms produced by the different species of worms. — 1. Asoarides. — As those reside chiefly in the rectum, they cause an excessive irrita- tion about the anus, sometimes extending to the neck of the bladder. 2. Taenia. — As may naturally be supposed, the sensation occasioned by this worm is peculiar. Occasionally pricking or biting is felt; most com- monly, however, it is that of something alive and moving. The abdo- men swells at intervals, and then subsides, as it were, by undulation. From time to time, also, a sense of coldness pervades the abdominal viscera; the appetite, is voracious, while the more the person cats, the thinner he becomes. The complexion is livid, the eye is dilated ; con- fusion of the head and vertigo. There is sickness at stomach, and sometimes vomiting, with general weakness in all the limbs, and frequent trembling of the whole body. [These violent symptoms are by no means universal. 1 have known a man in the most florid health pass joints of taenia.] 3. Lumbricoides. — The sensation caused by these animals is much more severe generally than that of the taenia. This arises from the greater number of these generally present, and from their insinuating their sharp points into the mucous lining of the intestines. About the umbilicus, accordingly, severe colicky pains are frequently felt, together with rumbling of the abdomen. Origin of Worms. — The advocates for spontaneous generation have made the existence and multiplication of intestinal worms and other parasites the great foundation of their theory. Their whole argument amounts, when stripped of its verbiage, to this. We do not well see how a worm can have got into the intestines of a man, still less of a foetus in utero (where they have been found), or into the liver or the eye ; and therefore we will insist that it did not, but has been generated in the spot where we find it. This is an argument not from our knowledge, but from our ignorance, and is entirely unphilosophical. I need not tell you after this, that I do not believe at all in the spon- taneous origin of these animals. However they may originally get into the human body, they are propagated in the. ordinary way, though only under certain circumstances of the human body are their germs developed. Circumstances favoring the development of worms. — These are various, and in a practical point of view are worthy of investigation. A knowledge of them is the only thing which can lead to a correct and philosophical use of the various remedies proposed for their extermina- tion. 1. A peculiar condition of the intestinal canal. — The precise condition of the intestines favorable to the development of worms is that in which 154 MATERIA MEDICA AND THERAPEUTICS. large accumulations of mucous and other secretions have taken place, and are found lining the inner surface. * 2. Age. — It is a well known fact that children are more liable to worms than adults, and the reason is that there is a greater tendency in them to mucous and crude accumulations in the intestines. There are only two species of worms that children are liable to, viz. ascarides and lumbrici. 3. Sex. — As a general rule females are more liable than males. 4. Diet. — It is a fact well ascertained that certain kinds of diet are more favorable to the production of worms than others. This must necessarily be the case. The too frequent use of crude and raw vege- tables and fruits has this effect. The excessive use of sugar, milk, butter, and cheese, and abstinence from animal food, have the same tendency. In a still more striking manner does the abstinence from the use of salt produce this effect. 5. Climate. — Independently of mode of living, the climate seems to exercise a certain infjuence in developing worms. They are especially common in India and the western coast of Africa. I have already stated that the taenia lata is only found in the natives of the north of Europe. Taania solium is very common in Switzerland. Blacks are more obnoxious to worms than whites. (Pereira.) 5. Disease. — In fevers worms are sometimes discharged. Now, in many cases of this kind, practitioners have been in the habit of ascribing the fever to the presence of these animals. This has been carried too far. Although there can be no question that the irritation of these animals is capable of producing febrile excitement in the system, yet in a great majority of these cases their presence is a mere coincidence, and so far from having been the primary cause of the fever, it is merely the condition of the system and of the intestinal canal occasioned by the fever which has favored their development. In debilitating diseases they are very common. Dr. Isaac Wood of this city says that when the cancrum oris prevailed endemically at the Alms House, the intestines of such children as died of it were found " stuffed full of worms.'''' I believe with Pereira, that we know very little of the circumstances which favor or check the production of intestinal worms, and that Referring their formation to a debilitated state of the alimentary canal is a mere hypothetical assumption. PRACTICAL RULES TO BE OBSERVED IN THE USE OF ANTHELMINTICS. These are few and simple, and directly deducible from what has already been stated. As worms are always associated with certain conditions of the system, and more particularly of the intestinal canal, you are carefully to analyze ANTHELMINTICS. 155 these. It is only by so doing that you will be enabled to make ;i proper selection of the articles appropriate to any particular case; and a in almost all cases the intestinal canal is in a deranged state, ;i general rule is to begin with those articles which shall correct this condition of it. Of course the first remedies are active cathartics, and especially those that possess the power of separating mucus from the inner surface of the intestines, such as aloes, senna, and the like. By these means alone you frequently not merely get rid of the worms, but you correct that condition of the intestines which favors their propagation. In ca where this condition of the intestines is accompanied with great laxity and debility, tonics are essential, and it is here that iron proves so valuable. If after the use of these remedies the worms still remain, recourse may be had to those articles which act more especially upon these ani- mals. After the worms are expelled, endeavor to fortify the constitu- tion against their return by the use of such means as the nature of the case may render appropriate. In cases of fever supposed to be owing to worms, do not be led astray by importunities of friends to treat it exclusively for these animals. CALOMEL. Calomel is certainly among the very best anthelmintics that we pos- sess. It acts, probably, simply by clearing away more effectually than any other medicine the mucus and other viscid materials generally found lining the intestinal canal in cases of worms, and in which these ani- mals are always found imbedded. [All this about worms imbedded in the mucus of the stomach and bowels is mere hypothesis — there is no proof of its truth.] It should be given in such quantities and so often repeat- ed, as to produce its full effect upon the whole secretory apparatus of the intestinal canal, and this object should be accomplished with as much rapidity as possible. The best plan, therefore, is to give it in large doses, with the view of making a decided impression at once upon the intes- tinal canal, and then following up its use by some active cathartic, for the purpose of carrying off quickly the matters which may have been separated by the action of the calomel. In this way the worm is first removed from its bed of mucus, and then hurried out before it has had time to make any new attachments. It should never be carried to the extent of producing salivation. This can do no good as a mere anthel- mintic, and may do much injury to the constitution. Jlode of Administration. — To adults, from ten to twenty grains, and to children, from three to five grains, may be given at night on going to bed ; to be followed early in the morning by some active and quick purge, such as castor oil, salts and senna, off without leav- ing any serious injury behind them. From this combination of proper- ties, it is not difficult to conceive how this article proves so efficacious as an anthelmintic — acting primarily as a kind of narcotic upon the worm, and secondarily, upon the intestines as a laxative, and thus aiding the expulsion of the animal. It should be recollected, in using this article, that the fresh root is much more potent than when it has been kept for a time. This fact ■was noticed by Dr. Gardner, and has been confirmed by subsequent trials. Due allowance for this should, therefore,, be made in its administration. ANTHELMINTICS. 1 1 Mode of Administration. Infusion. — This is the host form of giving it, and is prepared by putting balf an ounce of the root to a pint of boiling water. Of this, from half an ounce to an ounce may be given to a child, and half a pint morning and evening to an adult. MBLIA AZEDARECK. The pride of India or pride of China. — A tree of 30 or 40 feet ; native of Syria, Persia, and North of India, and cultivated at the South and West of this country for ornamental purposes ; at the South it is planted in cities and towns. It does not flourish north of Virginia. The part used is the bark of the root, and the recent bark is preferable. It is emetic and cathartic ; if given in considerable quantities proves narcotic; like the spigelia. Decoction. — Four ounces of fresh baric boiled with a quart of water to a pint. Of this, half an ounce night and morning to a child for three or four days, and then cathartic. Although not much known in regular practice, this article has been long used as a vermifuge. So early as the time of Celsus it was recom- mended. In Ireland the use of it for this purpose is an old practice among the common people. In the same way it is also much used in this country. The virtues of salt as an anthelmintic have received the sanction of the highest authorities. Brera speaks highly of it. Heberden does the same. Rush and Barton also commend it. It may be given in doses of from one ounce upwards, dissolved in a moderate quantity of water; also as an enema — the best form ao-ainst ascarides. CAMPHOR. Camphor is now in general use as an anthelmintic. It is not a new remedy. So long ago as the year 1*759, an essay was written upon it by Pringle. On the worm itself it would seem that camphor produces some deleterious effect, by asphyxiating or even destroying it. On the intestines it operates, too, very efficaciously in quieting irritation, and giving tone, and thus counteracting the tendency to the development of the verminous germs. Brera and Barton speak of it in terms of high commendation. It is against the lumbricoides that it has been chiefly found successful. Mode of Administration. — The form recommended by Brera is to 162 MATERIA MEDIC A AND THERAPEUTICS. mix 3 ss of camphor and 3 i of gum arabic in a pint of water. Of this a small spoonful may be given at a time. To children, to whom it is difficult to administer medicine by the moutb, it may be given in the form of injection, made by taking one or more ounces of the foregoing solution, and adding tepid milk according to the age of the patient. It is excellent in case of ascarides. In the form of the mineral solution, or Fowler's solution, this metal has been used with efficacy against the taenia. Dr. Fisher, of Massachu- setts, by whom it has been chiefly used, recommends it as an article which never has disappointed him in a single instance. He directs it to be taken two or three times a day in as large doses as the stomach will bear, and its use continued until the worms are destroyed. Do not follow this practice very far, or before the worm is destroyed the patient may be. The flowers of the Brayera anthelmintica, a tree about twenty feet high, belonging to the family of the Rosacea?. It has been used as an anthelmintic by the Abyssinians for more than two centuries ; was mentioned by Bruce, who gave a good figure of it. Braver, a French physician residing in Constantinople, introduced it into European practice, and from him it has its generic name. The tree is native to the table-land of North-eastern Abyssinia. The part used in medicine are the flowers, which have been sold in this country at enormous prices. It has been employed with great success by Chomel and Sandras in Paris, and by Budd and Todd in London. Its physiological effects are slight ; nausea and even vomiting have sometimes followed its use, but this is rare. A moderate operation on the bowels is not uncommon. It is by poisoning the worms that it acts as an anthelmintic. It has been equally successful against both the forms of taenia. Dose, half an ounce of the powdered leaves infused in half a pint of water; taken in the morning on an empty stomach. The powder and infusion should be swallowed together. It is said to be more successful when preceded by a mild laxative. [cucurbila pepo (Pumpkin). The seeds of this plant made into a paste and taken in the morning fasting, followed in an hour or two by a full dose of castor oil, have of late been given with success in tapeworm. The dose is one or two ounces.] SI ALA <;o <; i; i;s. Medicines which excite the salivary glands and increase their secre- tion are called Sialagogues. These are, according to their mode of acting, divided into topical or remote. Of the former, sometimes called masticatories, it is not my intention to speak ; they are little used in medicine. Of the latter, the remote sialagogues, or those which produce a salivary flow by specific action, there is but one which by the certainty and regularity of its action deserves special notice. This is mercury. The preparations of gold, antimony, and iodine sometimes produce this effect; it has fol- lowed occasionally the use of nitre and hydrocyanic acid. But it is an exceptional not a regular or constant effect. Under this head then I shall speak only of mercury and its preparations. Mercury {Hydrargyrum, quicksilver, called by the Latins argentum liquidum, aqua argentea, etc.). Although known to the ancients, mercury was not by them used as a medicine. It is mentioned by Dioscorides, Pliny, and others, but always as poisonous. Its first use as a medicine has generally been credited to the Arabians, but Dr. Morrison informs us that it was used in China at a very early period, externally and internally, and as early as A.D. 745 it was termed by them the elixir of life. It was certainly used externally and internally by the Arabians ; its innoxiousness is expressly asserted by Avicenna. To the great empiric Paracelsus can probably be attributed only the credit of popularizing what was pre- viously known. The power of mercury to produce salivation was first discovered by a monk in the 13th century. In the loth century it was first used (externally) to cure the venereal disease by Jacobus, an Italian surgeon. Calomel was first described by Crollius, A.D. 1608. Except for the venereal disease, mercury was not extensively used till the beginning of the 18th century, when it was introduced into the treat- ment of febrile and inflammatory complaints. This practice took its 164 MATERIA MEDICA AND THERAPEUTICS. rise in our own country, and it is to American physicians that is mainly due the credit of extending the use of this powerful agent. The circumstances under which it originated were the following : — More than a century ago (A J). 1735) the American colonies were desolated by a most, fatal epidemic sore throat of a putrid character. It first appeared at Kingston, N. H., 1735, reached Boston in September, whence it progressed, though very slowly, westward, reaching the Hudson river in a little less than. two years; it spread over the whole country, causing the most frightful ravages, especially in New England. Dr. Douglass of Boston states that one fourth of the inhabitants of that town took the disease and one in thirty-five died. In other places the proportionate mortality was very much greater — equalling one sixth, one fourth, and sometimes one third of those attacked. It was in combating this dreadful epidemic that mercury was first introduced into practice in the treatment of inflammatory complaints, and the credit of this great improvement is due to Dr. William Douglass of Boston. He used calomel and used it freely. By Dr. Jacob Ogden of Long Island the practice was carried to a greater extent, and his success was, in his own words, "beyond my expectations." He gave calomel to children in doses of 2 to 4 grains, to adujts 6 to S, repeated every twelve, eighteen, or twenty-four hours. From the success which attended the use of mercury in this disease it came very naturally to be used in others, and by the middle of the 18th century it was resorted to very frequently in pleurisy, pneumonia, &c. &c. When given as a cathartic large doses were administered. As an alterative, one or two grains were given combined with opium, camphor, or antimony, according to circumstances. From the foregoing brief sketch of the origin of the mercurial practice, it is very certain that it prevailed here long before it was known in any other country. I have been thus minute, because the credit of this practice is by Dr. Armstrong claimed for a Dr. Hamilton who, from Armstrong's account, first had his attention directed to it in 1764, a period at which it was in very general use in this country. PHYSIOLOGICAL EFFECTS. Local Effects. — These differ very much, according to the preparation of this metal which is employed. Some of them appear to produce little or no local effect, while others are actively irritant and caustic. In rela- tion to calomel, much difference of opinion has been expressed. W'hile by som,e it is supposed slightly irritant, others consider it rather as a local sedative. [The soothing effect of calomel ointment and of dry calomel on irritable sores, in herpes, impetigo, &c, settles the question of its sedative character.] 8IALAGOGUES. I r * r > Remote Effects. — TIioso vary considerably with the manner in which it is used, and also with the particular preparation which may be selected. The differences between the various preparations will be mentioned hereafter. At present, I shall only notice the general effects of this agent. In small repeated alterative close?, the effeet of the mercurials is to promote gently the secretions, but particularly those of the mucous system. Tin's they do without causing any sensible evacuations, and without producing any general disturbance of the system, provided their vise be not continued too long. In larger doses, they act more manifestly upon the secretions, augment- ing those of the mucous membrane, exciting the liver, and causing evacua- tions from the bowels. The first symptoms of salivation are tenderness and swelling of the gums, which become of a pale rose color, and at the part surrounding the teeth of a deep red. The soreness increasing, the tongue swells, the breath has a peculiar fector, and a styptic taste is perceived in the mouth. The salivary glands now swell and are tender, and there is a profuse flow of saliva and mucus from the mouth. To this, ulceration of the mouth often succeeds, and in severe cases the teeth are loose, and the gums gangrenous. The local irritation is accompanied with a degree of prostration which is sometimes dangerous and has proved fatal. Even in mild cases, fat is usually absorbed pretty rapidly and more or less emaciation results. Remote Effects on the Mucous System. — The sympathy of action between different portions of the mucous membrane is perhaps in no instance so strikingly illustrated as in the operation of this agent. Its impression gradually extends itself to all parts of the system, until sooner or later not a ramification of this tissue in any part of the body remains unaffected, .The membrane lining the alimentary canal, from the mouth to the rectum, as well as that lining the pulmonary, the uterine, and urinary organs, are all more or less influenced by it, and the general effect is to produce an increase of secretion from them. The evidences of this fact are so obvious as to require no illustration. In the alimen- tary canal we see it in the moist state of the mouth and in the increased evacuations from the bowels. 0)i the Glandular System. — Here the effect of mercury is still more marked even than it is on the mucous system. It excites into action almost all the secretory glands r and increases in a remarkable manner the quantity of secreted fluids. The gland upon which this is first and espe- cially exerted is the liver, as is shown by the change wrought in the character of the intestinal evacuations, wdiich frequently assume a decidedly bilious hue, from the operation of a single dose of mercury. The pancreas is probably affected in a similar way, although we have not 166 MATERIA MEDICA AND THERAPEUTICS. the same striking evidence of the fact. On the kidneys, a like effect is produced. The glands, however, on which this effect is most palpably exerted are the salivary, which under the influence of this agent pour out continued and profuse evacuations. [The most constant effect of the free use of mercurials is salivation. The first symptoms are slight tenderness and swelling of the gums, with a pale rose color, and a deep red at the edges near the teeth. The mouth is sore; the tongue swollen ; a coppery taste is felt; the breath has a peculiar fcetor ; the salivary glands are tender and swollen. There is free flow of saliva and buccal mucus, often to the extent of several pints in twenty-four hours. While these effects are produced, the pa- tient emaciates very rapidly, fat being absorbed. The blood is com- monly buffy. Salivation is now rarely pushed to the extent formerly common. The old writers speak very complacently of a flow of three quarts as a good, free discharge. Now we touch the gums and secure all the good effects of mercury. The saliva flowing under the irritation of mercury, differs from the healthy secretion in being less viscid, and containing a substance analogous to coagulated albumen, as it exists in the serum of the blood. Mercury seems to assimilate the saliva to the exhaled fluid of serous membranes. As a sequel to salivation we often see ulceration of the mouth, fauces, and throat, with occasional gangrene. The teeth are loose, bits of rot- ten gum or necrosed jaw are discharged, and the saliva is of the most disgusting fcetor. These local troubles are attended by irritative fever, with rapid wasting of strength, profuse sweats, sleeplessness, nervous tremors, and sometimes fatal prostration. All these evil effects have again and again followed the use of " a few grains of calomel," a single blue pill, or the like so called "harmless dose" Among the less com- mon evil effects of mercury are mercurial tremblings (tremor mercurialis) , marked by unsteadiness of the limbs, tremors, vertigo, stammering, loss of memory, and finally convulsions, often fatal. Diseases of the skin have followed the use of mercury so often that systematic writers speak of eczema mercuriale, lepra mercurialis, erysipelas mercuriale, in the progress of which the epidermis is detached, and the hair and nails fall off. Mercury often destroys life, by producing the cachexia mercurialis ; the powers of digestion are gone, appetite lost, while a wasting diarrhoea, often dependent on ulceration of the intestines, hurries the poor sufferer into the grave.] On the Cutaneous System. — From the sympathy existing between the mucous membranes and the skin, articles that make an impression on the one are very apt to affect the other. This is the case with mer- cury. Its effect is transmitted to the cutaneous structure, and exhibits itself sometimes in a simple increase of the natural exhalation from the skin, and at other times in altered action of the part. 8IALAG0GUES. 107 On the Nervous System, the effect of mercury is that of an irrit ant. If its use be continued for nny length of time it disturbs the equilibrium of the nervous system, and frequently causes excessive gcHfiia] irrita- bility. On the Vascular System, the effect of tliis agent varies with the con- dition of the system, and the quantity which may be given. If con- tinued for any length of time it unque stionably acts as a stimulant to the circulation, and establishes throughout the system an excitement peculiar to itself. On the Blood and Fluids. — When a patient is under the influence of mercury, the blood assumes the same buffy coat which it does in cases of inflammation, and according to the observations of some becomes of a much darker color than natural. The effects of mercury on the blood are to di minish the amount of fibrine, albumen, and red globules in it, and to increase the water, and perhaps the fatty matters. Hence its coagulability is diminished, the clot is smaller and less firm. On the Saliva it produces some striking changes. By Dr, Bostock, who analysed very carefully the saliva of a patient under full mercurial influence, it was ascertained that the character of it was very much altered, being changed from "the state of a mucous to that of a serous, or rather an albuminous fluid ;" and he supposes that the operation of mercury upon these parts is to counteract the ordinary secreting pro- cess, and to reduce the action of the glands to that of mere transuda- tion. He also suggests, that as one operation of mercury is to change a mucous to a serous fluid, whether we may not conceive that the action of this remedy in the cure of glandular obstructions consists sim- ply in producing this change of secretion; and whether even in the removal of the diseases of surfaces, mercury may not operate upon the same principle, by counteracting the effect of specific secretions, and reducing them to the mere transudation of a serous fluid. Dr. Ure found that ordinary saliva contained a peculiar acid, the sulpjio-cyanic acid, which was not present in the saliva which flows during mercurial salivation. Circumstances Modifying these Effects. — With the different conditions in which the human body is found, the effects of this agent vary very considerably. In a practical point of view these variations are exceed- ingly important. Age. — It is a fact supported by abundant observation, that children can bear larger proportionate doses of calomel than adults. This may be owing probably to the intestines at this early age being more com- monly lined with mucus, which prevents the absorption of the mercury. Another fact equally well established is that infants are not so readily salivated as adults. Indeed in children under two or three years of age salivation is a very rare occurrence. Maunsell savs, " we have never 168 MATERIA MEDICA AXD THERAPEUTICS. succeeded in salivating a child under three years old," p. 6S. Dr. Rush, in speaking- of its use in croup, states that "he never knew it excite a salivation when given to children whose ages rendered them subjects of it."* Dr. Warren of Boston says, "I have never known an infant to be salivated, notwithstanding I have given in some instances large quantities with this view."f The same appears to be applicable to the external use of it. Dr. Percival remarks that he " repeatedly observed that very large quantities of th-e unguentum ceruleum may be used in infancy and childhood, without affecting the gums, notwith- standing the predisposition to a flux of saliva at a period of life incident to dentition."| When, however, they do become salivated, as is some- times the case, its effects are most disastrous. Sloughing of the gums and cheeks, general prostration, and death not unfrequently occur. Dr. Blackall remarks, " a general opinion prevails that the constitutions of infants resist mercury in a remarkable degree. Its entrance into the system they .certainly do resist more than we could expect.; but they are greatly overcome by salivation ; and the possible occurrence of such accidents may well set us constantly on our guard."§ Sex. — As a general rule, females appear to be much more readily affected by mercury than males. On this point a striking fact is recorded by Mr. Carmichael. He states that on his first appointment at the Lock Hospital in Dublin, he-made no distinction between the quan- tity used whether for males or females. He soon found, however, that in females this was constantly followed by excessive salivation, attended with .dysenteric affections, extreme debility, and sometimes dropsy, while in males none of these effects ensued. On using half the quantity, this was obviated, and at the same time the full mercurial effect obtained. || Temperament and Constitution. — This modifies very greatly the effect of this agent. Nervous and irritable habits, as a general rule, bear very badly the operation of this metal. Indeed, if carried to any extent in them, it is very apt to be followed by effects exceedingly distressing and injurious. Among these the most common and marked are restlessness, anxiety, and a general increase of constitutional irritability, predisposing the system to the invasion and development of various diseases. Mr. Travers states that ho has " seen in more than one instance, acute pneu- monia, and in another mania, set up by the excitement of mercury, which proved speedily fatal, without any previous organic disease, or prohibi- * Obs. and Inqs., vol. ii. p. 379. f View of the Mercurial Practice in Febrile Diseases. By John "Warren, M.D., p. 146. % Percival's Essays, vol. ii. p. 318. § Blackall on Dropsy, p. 126. || An Essay on Venereal Diseases, &c. By Richard Carmichael, M.R.I.A., p. 307. SIALAGOGT/ES. 160 tory disposition."* Tremors and paralysis have also been known to result from its long continued use Dr. Falconer of Bath says, " I have seen repeatedly from this cause (the use of mercury) such a shocking depression of spirits, and other nervous agitations with which it was accompanied, as to make it more than merely probable that many of the suicides which disgrace our country were occasioned by the intolera- ble feelings that result from such a state of the nervous system."f Climate and Temperature. — Although warm climates and the warm seasons of cold climates are considered most propitious to the adminis- tration of mercury, yet it will be found much more difficult to bring the system under its influence under these circumstances. It is on this account that so much larger quantities are required and used in tropical regions, and the reason doubtless is the great tendency which there is to the skin, diverting its action from other parts. Mr. Ainslie says, this was so commonly .observed in the East Indies, that he was " in the habit of recommending those who could do it with convenience, to remove during the time they were using it .(mercury) to some cold situ- ation.'^ In the days of Sydenham, it was customary to send syphilitic patients to the south of France, as experience had proved that large quantities of mercury could in that climate be introduced into the sys- tem without producing salivation.§ As a, general rule, it may be laid down, that a constant and active determination to the skin always inter- feres more or less with the specific action of mercury on the salivary glands. Hence it is that Plummer's pill is less likely to salivate than some of the other preparations .of this metal. Independently of mere temperature, certain regions seem to be adverse to the kindly operation of this metal on the human sj'steim In Egypt, according to Baron Larrey, the use of it, even in the venereal disease, requires the greatest caution ; if applied with the same freedom as in Europe, it produces fatuity, hepatic disorders, y gentle friction for twenty or twenty-five minutes. This to be repeated daily, and when the patient is able to do it, it should be per- formed hy himself. 3. Fumigations. — This was a mole formerly practised, but not much in vogue at present. In using this the patient is first undressed, and then put into a box with an opening at the top for the head. In the hottom of the box is a small grate with a heated iron in it. On this the mercurial preparation is thrown, and thus converted into vapor. This vapor surrounds the whole body, and thus by direct application to the skin produces its effects. Various mercurial preparations have been used for this purpose. The first was cinnabar. This, however, proved exceedingly injurious from the evolution of sulphurous vapor which was apt to be inhaled. Mr. Abernethy used a powder prepared by adding 3 vi. of distilled water to 3 ij of aq. ammonia, and then throwing 5 iv. of calomel into the liquor, and shaking it. On filtering and drying a grey powder was left This, he says, contains a good deal of quicksilver in a metallic state, but which becomes oxidized on being converted into vapor. Dose, half an ounce a day. (a.) This mode affects the system more rapidly than any other ; and frequently does so when all other means have failed. It is useful when the speedy operation of mercury is necessary. (b.) The objection to it is that it brings on ptyalism before a sufficient quantity of mercury is introduced, and that it causes sometimes debility and prostration. M. Ricord, at the Hop. du Midi, makes very frequent use of mercu- rial fumigation in old syphilitic cases. He uses cinnabar, volatilized in a small furnace ; the fumigations are continued from a quarter to half an hour. 4. Inhalation. — This mode was practised during the cholera in this city. This is done by having a tin vessel with a bar of hot iron in it. To this was attached a flexible tube, one end of which was in the pa- tient's mouth. Ten grains of the grey oxide thrown every few minutes on the hot iron and inhaled, it salivates in a few hours. MODES OF JUDGING WHETHER THE SYSTEM IS AFFECTED BY MERCURY. 1. Salivation. — This is the most certain test. Sometimes, however, this is produced by a minute quantity of mercury, and then no test. 174 MATERIA MEDICA AND THERAPEUTICS. 2. The Character of the Stools, — This is of great importance to show the effect of this agent on the hepatic and intestinal secretions. When the evacuations are of a dark grey color, it is a proof that the article acts merely on the intestinal canal. When they become yellowish it proves that it has acted on the liver* The green_cglqr • of the stools which is so common when calomel has been given, is owing not to the calomel directly, but to the intermixture of bile from the liver and gall bladder with the tough viscid secretions of the intestines. When, therefore, these evacuations appear, it is a proof that these organs have been excited into action and evacuated. Now, in many cases of diseases of children this is important. Young children we know cannot be salivated, and this then becomes an important indication as to the extent and kind of action produced. In croup these are the kind of evacuations which generally give relief. 3. The Abatement of the Disease for which the Medicine was given. — Do not rely too much upon any of these tests of the operation of mercury, but watch the patient, and if the mercurial irritation appear, even in a slight degree, stop the use of the drug. Especially is this important in children. Salivation. — As this is one of the most curious and interesting of the effects of mercury, it ought to be specially studied. It has been a question much disputed whether it is merely the evidence of the system being affected, or whether it is also curative. I believe it is powerfully curative as an irritant and depletant. There are two points in relation to salivation of practical impor- tance. 1 . The time required to produce it. This varies greatly according to the peculiarity of the constitution, the nature of the disease, and the mode of using the mercurial. With regard to constitutional peculiarity there is every difference. In some cases, the smallest quantity will produce salivation, and that in a very short time ; sometimes in the course of twenty-four hours. In other cases, the exhibition of the remedy for weeks and even months will fail to produce this effect. The state of the system, too, as to disease, causes a great deal of difference. Then the preparation used makes a difference. Calomel and blue pill salivate more readily than corrosive sublimate. By combination, too, with opium, the effect may be facilitated. 2. Excessive Salivation. — Salivation once excited is exceedingly uncertain in its effects — sometimes excessive — producing ulceration and great prostration. Owing, first, to some constitutions being especially susceptible of its action ; second, to its accumulating in the system without producing any manifest effects, when it suddenly bursts forth with great violence. Under these circumstances the patient usually SIALAGOGUES. 175 suffers greatly and for a long time. The treatment must bo both • ■ Btitutional and local. Constitutional. — 1st. Purging. This lessens the general irritation, and derives from the mouth, but ars it increases debility it is only to be used where the patient has some strength. 2d. Opium. This relieves pain, allays irritation, and will sometimes diminish the secretion. 3d. Iodine has been used as a sort of antidote to mercury ; its powers are more than doubtful. Local. — A great variety of washes and gargles have been used as remedies for mercurial sore mouth. Infusions of green tea and other mild vegetable astringents; the water infusion of opium, lime-water properly diluted, solutions of carbonate soda, sugar of lead, &c, &e. [Chloride of Sodium, properly diluted, is the best wash I know.] MODES IN WHICH MERCURY PROVES CURATIVE. These are various, differing according to the extent to whieh it is carried. By acting simply as a cathartic. As has been already inti- mated., mercurial cathartics, especially calomel, operate in a way peculiar to themselves, promoting hepatic and intestinal secretion, and it is by this peculiar action that it proves so salutary in many cases — relieving hepatic congestion and proving revulsive from other parts of the system. By its peculiar effect in promoting secretions from the mucous membrane. If its use be continued long enough to bring the system fully under its influence as evidenced by ptyalism, it promotes the secretion of the extreme vessels in every part of the system. In this way it relieves unequal distribution of blood by the uniform and permaneut determina- tion of fluids which it keeps up to these extreme vessels, and produces a general change of action in the secretory and absorbing vessels. This latter is wdiat is usually called the alterative effect of mercury. By promoting absorption. In some cases, it proves curative by its effects on the salivary glands acting on the principle of revulsion. Lastly, in syphilitic diseases, it appears to prove curative by some specific agency. Modus Operandi of Mercury, — Is mercury absorbed? This matter, though till of late fiercely debated, is now settled; no one doubts the absorption of this as of other medicines. 176 MATERIA MEDICA AND THERAPEUTICS. PRACTICAL APPLICATIONS OF MERCURY IN THE TREATMENT OP DISEASES. There is perhaps no one article of the materia medica concerning whieh there has been so much difference of opinion as the use of mercury in various diseases. By some it is reprobated as an agent profoundly deleterious to the constitution,, while by others it is looked upon as the panacea for almost every disease. By impartial and experienced ob- servers both these extremes must be viewed as equally erroneous. That the profuse and indiscriminate use of it which has been too common has been productive of great mischief cannot be questioned. At the same time it is equally unquestionable that by its judicious use many diseases are controlled and subdued which otherwise are wholly unma- nageable. Even in these, however, it depends in a great measure upon the manner in which it is used, whether it proves salutary or otherwise. For the purpose of illustrating this, I shall notice its use in some of the more important classes of diseases, and in doing so, I shall endeavor to point out the general principles upon which it is to be prescribed. Fevers. — The principles upon which mercury may prove beneficial in this group of diseases are very simple. There is generally present in fever a congested state of the liver and abdominal viscera,, in conse- quence of which the secretions of these organs are interrupted and sometimes changed in their character. In fever, the whole of the mucous tissue, and especially the mucous tissue of the alimentary canal, becomes deranged in its secretory func- tions. Irregular distributions of blood take place in different parts of the system, showing themselves sometimes in one organ and sometimes in another, either in the form of inflammation or of simple congestion. Now, these are among the prominent conditions of the system ob- served in fevers, and it is for the correction of these that mercury may be rendered available. It acts on the liver and other abdominal viscera, and promotes the secretions from these organs. The evidence of this is seen in the altered condition of the evacuations from the bowels. It acts on the whole of the mucous tissue of the alimentary canal, and excites the whole of the secretory apparatus of this tissue. If its use be continued long enough to bring the system fully under its influence, it promotes secretion from all the extreme vessels of every part of the system. In this way it relieves unequal distributions of blood, by the uniform and permanent determination of fluids which it keeps up to these extreme vessels. These are the ways in which mer- cury proves beneficial in fevers — by certain effects which it produces on the abdominal viscera, and by its general action on the secretions. It is by no means necessary to carry its use so far as to produce all these S1ALAG0GUKS. 177 effects in ever}' case of fever. In some cases, all that is required i to obtain its effects on tlie abdominal viscera him] the mucous tissue; while in others no good is done until the whole system is brought under its influence. This will he sufficiently illustrated by briefly no- ticing the different forms of fever. Intermittent Fever. — In this form of fever there is always more or less of disorder of the bowels, and not (infrequently of the liver. The former become torpid in their action and deranged in their secretion, while the latter is often congested, and, as a consequence, impeded in its function of secretino; bile. Hence it is that the discharges from the bowels are scanty and unnatural, and there is a sense of fulness and oppression in the epigastric region. That these symptoms should ari.-e is what might naturally be expected, from what takes place during the paroxysms of this fever. Thus, during the cold stage, the general reces- sion of blood from the surface, and the congestion of the large organs and blood-vessels, particularly those of the abdomen, during the hot, the general reaction and febrile excitement, all are calculated to pro- duce just such disorder of the liver and intestines as we find present in this disease. If the paroxysms have been frequently repeated, the dis- order of the abdominal viscera will be proportionally aggravated, and become more or less chronic. Now, before the disease can be radically cured, this condition of the abdominal viscera must be corrected by the use of appropriate medicines. Among these, cathartics are means most valuable, and of them the most efficient is calomel, aided by other agents to carry oft" the secretions which it produces. When properly given, and when it produces its legitimate effects, calomel excites the action of the torpid and congested liver, and promotes the secretion of the mucous membrane of the intestines in a way which no other article does. The best mode of giving it to 'promote these effects is to admi- nister a large dose, say ten grains, and in the course of five or six hours to follow this with castor oil, to carry off more completely the morbid contents of the intestines. In many cases a single dose will answer every purpose ; sometimes, however, it will require to be repeated. Now, the object of all this is not to arrest the fever, but simply to pre- pare the system and especially the abdominal organs, for the adminis- tration of tonics. If this course has been pursued, as a general rule, it will be found that a few doses of cinchona or quinine will readily arrest the progress of the fever. On the other hand, if this preliminary action on the abdominal viscera has been neglected, the operation of tonics will be always more or less uncertain. In ordinary cases, therefore, of intermittent fever, the only use that it is desirable to make of mercury is to obtain its effects as a cathartic on the liver and intestines, with the view of preparing the system for the subsequent action of tonics. 178 MATERIA MEDICA AND THERAPEUTICS. In some cases, however, the use of this agent requires to be carried further. When the paroxysms have been repeated for a length of time, and as a consequence permanent obstructions have taken place in the abdominal viscera, it becomes necessary to make a more decided impres- sion on the- system, and even to cany it to the point of ptyalism. For this purpose, the blue pill may be given at night, and followed in the morning by mild laxatives, and continued until the desired effect is pro- duced. In relation to the effects of mercury, when given alone in this fever, Dr. Johnson gives the following interesting fact. He states that in two ships of war in the East Indies, in consequence of the great number of intermittents, the bark had been entirely expended, and jn this dilemma their only resource was mercury; "and, though this medicine," he adds, " invariably stopt the paroxysms as soon as the system was affect- ed, yet three fourths of the patients treated on this plan relapsed as soon as the effects of the mercury had worn off, and that after three, and in a few instances four successive administrations, so as to excite ptyalism."* [This story seems to me to be very discreditable to the medical men concerned. The idea of being driven to the use of mer- cury, and that pushed to salivation because they had no bark, is pre- posterous. — How coolly they speak of three or four salivations !] Remittent and J3ilious Fever. — In these forms of fever, the value and efficiency of mercury as a general remedy, is established beyond all doubt. In the East Indies, where they prevail to so great an extent, the concurring testimony of the most intelligent practitioners unites in pronouncing mercury indispensable, and in fevers of our own country it has been found no less so. Among the symptoms characterizing these forms of disease, there are. none more striking than those which indicate a congested condition of the abdominal viscera, and a deranged state of the stomach and intestines. There is always more or less oppres- sion at the prsecordia, sickness, vomiting, together with costiveness, and a vitiated state of the intestinal secretions. To correct these there is no agent so valuable as mercury. Having premised venesection more or less extensive, calomel is to be given in large doses, say often or twenty grains, and repeated according to circumstances, for the purpose of act- ing on the liver and restoring the secretion of that organ, and also on the mucous membrane of the intestinal canal, with the view of separat- ing mucous accumulations and changing the secretory action of the membrane. While giving calomel in this way, it will be necessary to interpose occasionally some brisk cathartic to carry off more effectually the morbid secretions from the intestinal canal, and for this purpose cas- tor-oil or a combination of salts and senna are the best. In this way, * On Tropical Diseases, vol. i. p. 139. SIALAGOGUES. 17!) not merely the immediate effects of the mercury on the abdominal viscera are more thoroughly secured, but the eventual operation of this agent on the system at large will be more speedily and certainly brought about. In true typhus, if mercury is to be used at all, which is very doubtful, it must be with very great caution, and early in the disease. Later, it is certain to do nothing but harm. As a general summary of the true prac- tice in fevers, I state that mercury in intermittent and remittent fevers is not to be used as a specific. You want the effects of calomel on the secretions of the bowels and liver, to restore these to health, not that such restoration of the secretions will always check the fever, but they prepare the system for other remedies. Now, this effect of mercury on the secretions may very often be produced by one purgative dose of calomel ; in other cases, more protracted, or originally more severe, several purgative doses may be necessary. In a few cases we may, by the severity of the congestive affections, be obliged to go so far as to get the constitutional effects of mercury ; but remember in all these cases, it is not to be used as a specific, but to prepare the way for tonics. Inflammation. — There is no class of diseases on which the efficacy of mercury is more triumphantly shown than in inflammations. This is, as I have before stated, an American practice. In these cases, we use it with a view to its general alterative effect; and when the system is put fully under its influence, it exercises a wonderful power in arresting the progress of inflammatory action. In consequence of this, it is called an anti-inflammatory ageut. A beautiful illustration of this is-afforded in iritis. How mercury does this we cannot exactly say, probably by some change in the blood. The fact however we know ; it is the result of observation. Calomel is the preparation commonly used, and we repeat it until the system is affected. It is, however, not equally useful in all inflammations; in some, indeed, it is injurious, especially in scrofulous habits. Tonsiiitis. — In ordinary inflammation of the tonsils, calomel may be used with great advantage. After suitable depletion it should be given in a large dose, say ten grains, and followed after an interval of five or •six hours by castor oil or some other mild laxative. In this way, it operates beneficially, in two modes : — first, by creating a new action in the liver and mucous membrane of the alimentary canal, upon the principle of revulsion ; and second, by the peculiar effect which it has in % restoring the secretion of the mucous membrane of the part inflamed. In consequence of this latter effect, it will not unfrequently be observed that a single dose of calomel will produce a complete change in the character of the fauces, causing a moist state of the inflamed parts, and lessenino- the redness and tumor. ISO MATERIA MEDICA AND THERAPEUTICS. Laryngitis. — This disease may be either acute or chronic, and in both calomel is an agent of great value. To be really useful, however, it should be carried to salivation. When this effect is produced, the case generally terminates favorably, and it operates no doubt in a great measure by the free secretions which it produces from the mouth and fauces as w^ell as by the counter irritations which it occasions in the gums. In the acute form, from the great rapidity with which the disease runs its career, the great difficulty is to gain sufficient time to produce the proper mercurial effect on the system. In cases of this kind, there" fore, after the depletion, it is to be introduced as speedily as possible and in as large doses as the system will bear. In the chronic form, abun- dance of time is allowed for its more gradual introduction. The utility of calomel in both these forms is established by unquestionable experience. In inflammation of the glottis arising from the inhalation of steam, calomel has proved eminently successful. Several interesting cases of this kind are related by Dr. Wallace, which were treated by giving to a child two grains of calomel every half hour or hour. Trachitis. — There is no form of inflammation in which mercury has been more celebrated than in this. Who first suggested it cannot be determined with any degree of certainty. It is, however, unquestionably an American practice, and was in extensive use in this country during the last century. With regard to the operation of this agent in the disease, it appears to be well established that no great relief is afforded by it until evacuations of a peculiar character are produced. These evacuations are of a dark green color, resembling in their general appearance boiled spinach, and they are, as before stated, combinations of bile and mucus. To produce these, calomel must be given in large and repeated doses ; from 3 to 5 grs. at a dose, repeated every two, three, or four hours. Frequently it is only after the exhibition of 30 or even 50, and in some cases 100 grs., in this way, that such discharges are obtained. They are always followed by a manifest amelioration of the disease, and from the difficulty of producing salivation in young sub- jects, fortunately this result very rarely follows the use of such large quantities of this article. Of the manner in which calomel accomplishes its purposes in this disease I have already spoken under the head of cathartics. Bronchitis. — In this variety of inflammation, whether acute or chronic, calomel frequently proves exceedingly beneficial. In the former it may be used at first as a cathartic, and after this with a view to its alterative effects. In the latter, i. e. the chronic form, it is of more doubtful effi- cacy. By judicious combination, however, with opium and antimony it" may be used sometimes with great effect as an alterative — changing gradually the condition of the mucous membrane of the bronchi and eventually effecting a cure. SIALAGOGUES. 181 Dysentery. — Fn this disease mercury is a remedy of inestimable value. Associated witli inflammation of the intestines, there i generally a dis- ordered condition of the liver, as is shown in the absence of bile. In the treatment one of the great objects is to restore the healthy secretion of the liver, and nothing does this so effectually as eah.mel. Besides this, it acts peculiarly on the mucous membrane of the intestine itself, lessening the inflammation, and promoting secretion. In addition to all this, if carried so far as to affect the gums, it acts still more powerfully in the progress of disease. With regard to the modi; of using calomel in this complaint, there is considerable difference of practice. By some very large doses arc used, while by others small ones are preferred. The mode I prefer is, after suitable depletion, to give one or two large d< of 10 or 20 grs. at first to obtain, if possible, a decided cathartic effect, and after this to trust to smaller and repeated closes for the purpose of producing its alterative effects on the system. Should the gums become touched, the patient may generally be considered free from danger. Pleurisy and Pneumonia. — The great remedy here of course is vene- section carried to the extent of producing a decided impression at once on the system. After this, to subdue whatever inflammatory action may still remain as well as to counteract the consequences of inflammation in the way of effusion, there is no remedy so effectual as calomel with the view of affecting the mouth. In those cases in which venesection, although carried as far as can be justified by the strength of the consti- tution, does not subdue the disease, calomel is the only remedy which can be depended upon. Pericarditis. — The first and great remedy in this disease is venesection, with the view of impairing the action of the heart. This, together with other antiphlogistic means, such as cathartics, anti- monials, etc., may do much in mitigating the violence of the disease. Alone, however, they are not always adequate to effect a cure. They may arrest the inflammation, but they cannot prevent some of the con- sequences of it. Effusion may have taken place, and to produce absorp- tion the agency of mercury is required. To obtain all its salutary effects it must be carried to the extent of affecting the gums, and this ought to be done as speedily as possible. For this purpose calomel is to be administered in doses of five or six grains three times a day, com- bined, if necessary to prevent purging, with suitable proportions of opium. [To get the patient promptly under the influence of mercury, a thing essential to his entire recovery, inunction may be used while the calomel is given freely.] To obtain the full effect too, it is desirable to keep the gums sore for some days. Hepatitis. — There is no form of inflammation in which the peculiar powers of mercury are more strikingly illustrated than in this disease. After due depletion it is to be resorted to with the double view of pro- 182 MATERIA MEDICA AND THERAPEUTICS. moting secretion from the liver and eventually producing its general effects on the system as indicated by salivation. In habits broken down by intemperance, where depletion cannot be carried safely to any great extent, as well as in persons advanced in years, it is the only remedy to which the safety of the patient can be trusted, and in these cases it sometimes operates with wonderful efficacy. Rheumatism. — In this disease, both acute and chronic, the use of mercury has been greatly lauded, but it is to be feared too indiscrimi- nately. In the acute form, as a general rule, calomel should be used only as a cathartic. In this way, aided by other cathartics, it proves exceedingly useful. Carried however so far as to produce salivation, little or no good is to be expected from it. Mackintosh says, " I have often seen the tongues of patients swollen and ulcerated and profuse salivation induced without the least signs of amendment. 1 '* In chronic rheumatism, an alterative mercurial course, so as to touch the mouth, in some cases proves useful, although as a general remedy it is not to be depended upon. When it has any connection with syphilis, mercury becomes essential. There is another form of chronic rheumatism in which a mercurial course is of great service, and that is when it arises from imprudent exposure to cold during the use of mercury. This was originally noticed by Dr. Bradley, in 1806, who states that he met with several cases of rheumatism which attacked persons while under the influence of mercury, for the cure of complaints totally unconnected with syphilis. In these cases, all the ordinary remedies failed, and they were only cured by having recourse again to mercury till the mouth became affected, and as soon as this took place, the com- plaint yielded.f Dr. Scudamore confirms this observation and he says, "I have, in every case of this kind, seen that all the ordinary methods of treatment are of no avail, or afford only palliative and very tempo- rary relief; but I have invariably had the satisfaction of witnessing the cure to be effected by resuming a well conducted mercurial course."^ In Gout the utility of mercury depends entirely upon the mode in which it is used. If given simply as a cathartic, or in moderate quanti- ties to produce an alterative effect on the secretions of the liver and intestines, it proves of great advantage. When carried so far as to excite mercurial fever or to salivate, it invariably does harm by increasing the general irritability of the system, prostrating the patient's strength, and even increasing or bringing back the gouty paroxysms. Several cases of this kind are related by Scudamore. Iritis. — In this form of inflammation the use of mercury is essential, * Practice of Physic, vol. ii. p. 420. f Med. Reports, &c. by S. A. Badsley, M.D., p. 43. Lond. 1807. \ P. 103. He also thinks that gouty habits are more easily aflected by mercury, p. 103. 8IALAG0GTJES, ', \2 and there is no affection in which its efficacy in more beautifully illus- trated. Along with suitable depletion, it. is the only remedy on which we can depend for arresting the progress of inflammation as well as re- moving its effects. In the first place it prevents the effusion of coagu. lable lymph from the iris, and in the second place it, promotes absorp- tion, if there is effusion. No great benefit, however, is derived from it until the mouth becomes sore, and it is astonishing how speedily after this a change takes place in the appearance of the eve. To have the full benefit of it the soreness of the mouth should be kept up for some time. In cases where the constitution is sound and vigorous calomel may be introduced in considerable doses with the view of affecting the gums as speedily as possible. When, on the other hand, the habit is broken down or scrofulous, it must be exhibited in smaller quantities and gradually. In all cases it should be combined with suitable pro- portions of opium. Ophthalmia. — Besides iritis there arc. several other inflammations of the eye in which mercury is a valuable remedy. In the 'purulent or Egyptian ophthalmia, in sclerotitis (or the rheumatic ophthalmia of Mackcnsie), and the catarrh o-rheumatic ophthalmia, the use of calomel and opium carried to the extent of affecting the mouth is attended with the happiest effects. Apoplexy. — In this disease mercury, as a general rule, can be of no further use than as an active and efficient cathartic, and with this view it may be used with great advantage with other cathartics of a more irritating and drastic character. On this subject I have already spoken under the head of cathartics. Paralysis. — As a cathartic calomel may be used with great advantage in cases of paralysis. By Dr. Colles of Dublin, the use of it has recently been carried much further. By him several interesting cases are related in which a complete cure was effected by producing salivation. The result of these cases would certainly tend to show that it is a remedy of great value.* Epilepsy. — In this disease mercury has been extensively used and with various results. In some cases it has proved successful, while in others it has failed. Of its beneficial effects when used as a cathartic there can be no question. In several cases which have fallen under my care, occasional doses of calomel, aided by other active cathartics, have proved of eminent advantage. Of its effects when carried so far as to cause salivation I have no experience in this disease. Bv some, however, it is spoken of in the highest terms.f * Practical Observations on the Venereal Disease and the Use of Mercury. By- Abraham Colles, M.D., p. 197. Am. Ed. f See Cook on Nervous Diseases, p. 401. 184 MATERIA MEDICA AXD THERAPEUTICS. Mania and Hypochondriasis. — As a cathartic, in both these affec- tions, there can be no question as to the utility of calomel. In Hypo- chondriasis more especially, associated as that disease frequently is with obstructions of the abdominal viscera, it is particularly beneficial. In some cases, .too, carried to the extent of salivation, it has had the happy effect of completely restoring the patient. In these it operates, no doubt, by removing local obstructions, equalizing the circulation as well as the nervous excitement, and probably too as a counter-irritant, by the irrita- tion which it produces in the mouth. Dropsy. — There is no class of diseases in which mercury in some shape or other has been more generally used than in the various species of dropsy. The general principle upon which it has been prescribed is, that it promotes the absorption of the effused fluid, and it has accord- ingly been given indiscriminately to accomplish this object. To any one at all acquainted with the real nature of dropsical affections, it must be evident that this is a very empirical mode of using this potent remedy. Dropsy, as I have already told j 7 ou, is not so much a disease in itself as it is the consequence of other diseased conditions of the sys- tem. Accordingly, you will find it sometimes resulting from and asso- ciated with diseases of the liver, the heart, or the kidneys. Generally the result of inflammatory action, it sometimes is a consequence of sim- ple obstruction in the circulation, and sometimes of mere debility. From this plain statement, it must be evident that so potent a remedy as mercury cannot be applicable in every form of it, and extensive expe- rience has satisfactorily established this fact. In many cases it acts with decided and astonishing efficacy, while in others it proves injurious. The kinds of dropsical affections in which mercury is most useful are those which are connected with inflammation or some hepatic disorder. Even here, however, the use of it must be confined within certain limits. When the liver becomes indurated, mercury, so far from doing good, does harm, and hastens on a fatal result. In those cases in which it is connected with diseased kidneys, it has not been found a salutary remedy : in these cases the urine will generally be found coagulable by heat. There is no form of dropsy in which mercury has been more freely used than in hydrocephalus. With regard to the effect of it, experience differs ; while some speak highly of it, by others it is looked upon as a doubtful remedy. Now, with regard to this disease, it is to be recollected that in its primary shape it is an inflammation, while the effusion is a mere consequence of the inflammation. Now, mercury, if used in the first stage, in conjunction with bloodletting and other remedies, may prove exceedingly advantageous. As to its efficiency in promoting absorption after effusion has taken place, I am somewhat skeptical. With regard to the cases which have been reported as having been 8IALAOOGUE8. I 5 cured by calomel, it is to be recollected that symptoms very analogous to those which characterize hydrocephalus may exist vvithoul there being any actual effusion. Every now and then we meet with cases of this kind. The inflammation of the brain may terminate in simple disten- sion of its vessels, producing symptoms like those of effusion ; then, again, the same may occur from a congested state of the liver and abdominal viscera; also from exhaustion. Now, from all these, a child may recover by appropriate treatment.; and these are the cases which may be reported as cases of hydrocephalus with effusion. In the cases depending upon hepatic congestion, calomel may and does prove exceedingly salutary in relieving the secondary symptoms of cerebral oppression. As a general rule, in using mercury in dropsical affections, there ought to be some vigor of constitution. In old and debilitated subjects, it is a remedy which requires very great caution. In Chronic Affections of the Viscera, arising from ordinary inflam- mation as of the liver, lungs, ss ) and pulverized liquorice root ( § ss).f In this way a soft bine mass is formed. For the purpo e of ascertaining whether the mercury has undergone the necessary trituration, or as it is usually called is " killed," a small portion of the mass may be rubbed with the end of the finger on a piece of glass or paper. If no globules are perceptible, it is an evidence of it-, being sufficient. As the manufacture of this pill requires a good deal of time and labor, it is very apt to be imperfectly prepared. At Apothecaries' Hall in London, where the article is made; in the greatest perfection, the trituration is effected by means of " a machine impelled by a steam engine, consisting of a circular iron trough for the reception of the materials, in which revolve four wooden cylinders, having also a motion on their axis; in this way the admixture of the mercury is perfectly and unexceptionably effected.''^ With regard to the precise state in which the mercury exists in the preparation, there is some difference of opinion. By some it is supposed to be simply in a state of minute division, while by others it is thought to be converted into an oxide. [There is now no doubt among the best informed pharmaceutists that the greater part of the mercury in this and the analogous prepara- tions is in a state of mere mechanical division — the only dispute is whether any of it is oxidized. If there is any oxide in the preparation, the proportion is certainly very small. — Ed.] Three grains of the blue mass contain one of mercury. Impurities and Adulterations. — The only important impurity to which the blue mass is liable arises from the accidental presence of sulphuric acid in the confection of roses. This acid is sometimes added to heighten the color of the confection, and in this way a sulphate of mercury may be formed during the trituration, and thus the preparation be rendered not merely uncertain but irritating. Effects. — This is a mild and exceedingly valuable preparation of mercury. Like the others, its effects differ with the dose. In small doses it gently stimulates the liver and increases the secretion of bile ; at the same time it promotes the secretions of the mucous membrane of the digestive organs generally. In this way it produces the effects of a general mercurial alterative. If its use be continued sufficiently long * Edin. Med. and Phys. Jour., vol. vi. p. 513. •J- The liquorice root is added to give consistence to the mass. % Brande's Manual, p. 500. 13 188 MATERIA MEDICA AND THERAPEUTICS. it produces all the constitutional effects of mercury. If given in larger doses it acts as a cathartic. Dose and Mode of Administration. — The usual form in which it is administered is that of pill — or the blue mass may be given diffused through some mucilaginous vehicle. The dose is from 4 to 5 grs. repeated once or twice a day. Tn doses of 15 or 20 grs. it purges. 3. Hyd. cum Creta. — This is mercury in combination with chalk? and is prepared by triturating three parts of mercury with five parts of prepared chalk until globules are no longer visible. It is in the state of a greyish powder. Chemical Composition. — 8 grs. of this preparation contain 3 grs. of mercury. The state in which the mercury exists here is simply one of minute division. Effects. — This is the mildest of all the mercurial preparations. In iits general operation it is the same as the blue pill. The addition of lihe chalk is supposed to render the preparation milder. From the great mildness of this article it is exceedingly valuable as an alterative "for children. Dose. — From 5 to 20 grs. twice a day. Children, 2 or 3 grs. 4. Unguentum Hydrargyri. — This is the blue ointment, and is •prepared 'by rubbing up pure quicksilver with lard until globules are ■no longer visible. There are two kinds of this ointment used — the strong and the mild — the former contains half its weight in mercury, the latter one-sixth. In this preparation mercury exists in the same state in which it does in the blue mass and the hyd. cum creta. The strong mercurial ointment alone is used in New York. Effects. — Rubbed on the surface it produces all the constitutional effects of mercury. If you wish to salivate speedily half a drachm may be rubbed in the skin every hour, marking the effect each time and vary- ing the seat of application. If you do not wish to excite salivation so speedily 3 ss or 3 i every night and morning will answer. The parts best suited for the application are where the cuticle is the thinnest, :as the inside of the thigh, and it is best to do it before a fire, to liquify the ointment and promote absorption. The occasional use of the warm bath promotes its operation ; where a second person has to perform the friction, the best mode is to cover the hand with a pig's bladder, turned inside out. :5. Oxides of Mercury. — (a) Protoxide. — This, in the pharmaceutical language, is known by the name of the Oxydum Hydrargyri Cinereum, and by the common names of the black, grey, or ash-colored oxide. Properties. — It is a dark colored powder, varying in its shades, some- 8IALAG0GUEH. 189 times black, at others grey, or ash-colored. It is destitute both of ti and smell. In water it is insoluble. Chemical Composition. — As found in the shops, it varies considerably in its composition, and to this is owing the difference in color. The principal ingredient is the protoxide. Besides this, however, it contains frequently calomel, peroxide, and metallic mercury. The first of these — calomel, arises from the imperfect decomposition of that salt in the ori- ginal preparation. A portion of the calomel remains undecomposed, and this mixing with the protoxide gives it the peculiar grey color. The other ingredients arise from the action of light npon the black oxide. On exposure to light, a portion of it loses its oxygen, and is reduced to the metallic sla te, while the same oxygen goes on to another portion, and forms the peroxide. The combination of peroxide with the black oxide gives the whole an olive color. Physiological Effects. — This is a mild preparation of mercury, pro- ducing the general effects of the drug on the system. A great objec- tion to it is the variable nature of its composition. Dose. — From one to three or four grains, twice a day. It is very lit- tle used. 6. Red Precipitate. — Hydrargyri nitrico-oxidum. — This is prepared by taking purified mercury, nitric acid, and distilled water, and boiling them in a glass vessel until the mercury is dissolved. Then evaporate the water, when a white mass will be left. Rub this into powder, and put it into a shallow vessel, then apply a gentle heat, and gradually in- crease it until red vapors cease to arise. Properties. — When properly prepared, this is of a bright red color, and shining scaly appearance. It is without smell, but has an acid metallic taste. When pure it is perfectly insoluble, but as it generally contains a little nitrate of mercury, it is slightly soluble in water ; at a red heat it is decomposed ; oxygen is given off, and metallic mercury produced and vaporized. Effects. — From the great activity of this article it is not used internally. When accidentally taken, it proves irritant and poisonous. It is only used as a local application. In its pure state it acts as an escharotic, and in the form of powder is applied to chancres, indolent ulcers, .] rn gyr rrr~rr . ' .-',- -\ -.- V^sJy**** £&~*^**** } DIAPIIOEETICS The term Diaphoretic is applied to that class of medicinal agents •which possesses the power of increasing the natural exhalation from the skin. When this is carried to the extent of producing actual sweating, they are sometimes denominated Sudorifics. The terms, however, are generally used indiscriminately — and in reality the distinction is a mat- ter of no great consequence, as the difference between them is only in the degree of effect produced. What shows this conclusively is, that, if what are strictly called diaphoretics be given in increased doses, a sudo- rific effect may be produced, and vice versa. In the case of diaphoresis, the discharge from the skin passes off in the form of insensible vapor, ■while in the case of sweating it is in the state of a fluid. The class of agents, therefore, of which we are now to treat are those which increase the discharge from the skin, whether this be in the form of vapor or fluid. The modes in which a diaphoretic or sudorific effect may be pro- duced are various. In some cases, it is produced by agents which have a tendency to relax, and debilitate the system ; in others, again, by those agents which stimulate. Sometimes, it is produced by agents taken internally ; while in others, by those acting directly upon the skin. Effects of Diaphoretics. — Acting on a surface so extensive as the skin, and producing frequently very copious evacuations from it, it is evident that diaphoretics must cause very important changes in the system. Among these the following are the most striking : — 1. They change the state of the Circulation. — From the increased de- termination of blood which takes place to the surface during the process of perspiration, it is manifest that the quantity of that fluid in other parts of the system must be diminished. Ilence it is that in cases of internal congestions, as soon as free perspiration is brought about, relief is obtained. In this way, a more equal and uniform distribution of the circulating fluid is produced. With regard to the action of the heart and arteries, the effect of sudorifics must necessarily differ, according to the character of the article used. If it be stimulating, the heart's action 194 MATERIA MEDICA AND THERAPEUTICS. will be increased, and the pulse will become fuller and more frequent, and vice versa. The effect of mere sweating, however, upon the vascu- lar system is to diminish action. Hence, under the operation of sudo- rifics which are not stimulating, the pulse becomes slower and softer ; and if the .sweating be carried too far it becomes weak, tremulous, and frequent. "With regard to the effects of sweating on the blood itself, it is evident that it must diminish the quantity of that fluid. It might naturally be supposed, too, that it would have a tendency to render the blood thicker by draining off the thinner or serous part. This, however, is not found to be the case, doubtless because the loss is promptly supplied by the absorption of watery fluids by the blood-vessels. 2. Sudorifics produce a change in the condition of the Skin. — Under their influence not merely an increased flow of blood takes place to the surface but the condition of the exhaling vessels is changed, according to the previous condition of the skin and the kind of sudorific agent which is used. Thus, if there be a great degree of general excitement present, and the skin be hot and dry, the effect of debilitating sudorifics will be to cause diminished action and relaxation of the cutaneous ves- sels. If, on the other hand, the skin be cold, dry, and torpid, and sti- mulating sudorifics be administered, there will be increase of action in the cutaneous vessels. Besides this mere increase and diminution of action, there is every reason to believe that under the use of certain ao-ents, a new action is set up in the capillaries of the surface, producing an alterative effect. 3. Sudorifics produce a change in the Temperature of the Body.— -The necessary effect of sweating is to lessen the animal heat, and the extent to which this is carried is of course proportioned to the duration of the process and the quantity of fluid which is lost. The effect thus pro- duced is obvious to the senses, and may be easily appreciated by a pro- per thermometer. Thus, if the natural heat at the commencement of perspiration be at 108° or 110°, after this process has continued for six or seven hours, the thermometer will hardly be raised to blood heat. 4. Sudorifics produce a, change in the conditions of various portions of the Mucous Membrane. — During the operation of sudorifics the flow of blood is diverted from the mucous tissue, and the secretions from it are generally diminished. Thus in the mouth and fauces dryness and thirst are produced. The most striking illustration of this, however, is noticed in the intestines. Between these and the skin there is a won- derful sympathy. Thus, if perspiration be suddenly checked, diarrhoea frequently occurs. So also during the operation of an ordinary cathar- tic, the skin becomes cool, dry, and torpid. On the other hand, free perspiration interferes with the due operation of a cathartic, and checks the determination to the bowels. The same holds good in relation to DIAPHORETICS. 105 the mucous membrane of the lungs. Eence it is that a warm climate and all those agents which act on the skin are so I" aeficial in certain affections of this membrane. 5. Sudorific* produce a change in the condition <>/ the Urinary Or- gans. — The Sympathy ' between ElTe skin ;wih potassw, 3 i. This is one of the most valuable and efficient sudorifics we possess, and furnishes a beautiful illustration of the effects and advantages of combining medicines together. Opium and ipecac, both determine to the skin, but neither of them in the way that the compound does. The potash is generally supposed merely to aid in the trituration of the opium. It would seem, however, to aid also in modi- fying the general effect of the combination, inasmuch as the opium and the ipecac, alone do not produce the same effects. From the nature of its ingredients, this powder is peculiar in its operation, and requires to be given with certain restrictions. Opium, while it acts on the skin, shuts up the other secretions, and is stimulant to the brain. It cannot, therefore, be given where vascular action runs very high, where the tongue is dry, where the bowels are costive, and where the brain is dis- ordered. Again, ipecac, affects the stomach ; and in consequence of this, Dover's powder is improper when the stomach is irritable. On the other hand, where vascular action is moderate, or has been properly subdued by venesection, where the tongue is moist, the bowels free, the head undisturbed, and the stomach not irritable, it may be used with safety. In all cases where the object is to quiet irritation and pain, and at the same time act on the skin, it is an admirable article, as in dysen- tery, chronic rheumatism, &c. Dose from 5 to 10 grs. . EUPAT0RIUM PERFOLIATUM. Known by the common names of boneset, Indian sage, thorough-wort^ cross-wort, vegetable antimony. It is a plant indigenous to every part of this country, growing from two to five feet high, flowers from July to October, and is found in meadows and near the banks of streams. Although every part of the plant is active, yet the leaves and flower DIAPHOEBTIOS. 207 are the most so. Those, therefore, are used with the sterns in the form of the herb. As found in the market, it is in bundles prepared by the Shakers. Boneset has a faint odor, but an intensely bitter taste ; no satisfactory analysis of it is yet made. It yields its virtues both to alco" hoi and water. The effects of this article differ very much according to the manner of using it. In moderate doses, and in the form of powder or cold infusion, it is tonic. In larger quantities, and in warm infusion, it sometimes proves emetic and laxative, but more commonly acts as a sudorific. It is owing to its decided action on the skin that it has received one of its names, " vegetable antimony." Boneset, therefore, may be considered as a tonic sudorific, and as such has been used with much success in fevers, typhoid pneumonia, and rheumatism. The name boneset is said to be derived from its success in a rheumatic fever which prevailed in New England, and was called "break-bone fever P Forms. — As a tonic in powder, 20 to 30 grs. ; or cold infusion ( 3 i to lb. i boiling water) ; 3 i 3 or 4 times a day; as & diaphoretic, warm infu- sion in larger quantitieTand oftener repeated. ASCLEPIAS TUBEROSA. Known by the common names of pleurisy root, butterfly weed, decum- bent swallow-wort. A plant two or three feet high, indigenous in every part of the United States, but most abundant at the South. The root is perennial and sends up a number of stems, some erect, others decum- bent ; differs from the other species of asclepias in not giving out a milky juice when wounded. The part used is the root, which is large and tuberose, externally brown, internally white and striated; when fresh has a nauseous sub-acrid taste ; when dried, bitter, but not unplea- sant. Powder, dirty white. According to Bigelow, its most abundant soluble portions are bitter extractive and fecula. It yields its virtues to boiling water. In suitable doses it acts as a sudorific and expectorant, without increas- ing animal heat or exciting the circulation. On the stomach it proves slightly tonic If in large quantities it proves laxative. The general effect of this article is to promote the secretions of the mucous mem- brane of the stomach, bow r eIs and lungs, and of the skin, without any marked effect on the circulation. It has been used with advantage in pulmonary complaints along with suitable depletion. Hence its name, pleurisy root. Also in rheumatism. Forms. — Powder 20 to 30 grs. several times a day. Best form is decoction, when used as sudorific. Boiling 5 j in quart of water — 3 ij 208 MATERIA MEDICA AND THERAPEUTICS. every two hours. For children 3 ij boiled in pint of milk — 3 j two or three times a day. In this way proves diaphoretic and laxative. ARISTOLOCHIA SERPENTARIA. This is a small plant about eight or ten inches high, growing in the woods in the Middle, Southern, and Western States. The part used in medicine is the root, which is perennial, and consists of a number of slender fibres shooting from a horizontal caudex. When fresh the color of the fibre is yellow ; by keeping it becomes brown. The powder is of a grey color. Its smell is strong,, aromatic,, and camphorous. It has a warm and bitter taste. By analysis this root is found to contain a volatile oil r a yellowish bit- ter principle, resin, gum, lignin, and various salts.- Its virtues are extracted both by water and alcohol. JEffects. — A stimulant, aromatic diaphoretic, admirably adapted to those forms and stages of fever which are characterized by debility. Generally used as an infusion. 3" ss-of the root to one pint of boiling water ; macerate for a couple of hours and then strain \ of this one or two ounces every couple of hours- in fever. -•''" ' * v EXPECTORANTS Expectorants arc defined to be those medicines which facilitateor promote the rejection of mucus or other fluids from the lungs and trachea. There is, perhaps, no class of agents which is so much used and so much abused as this. They are resorted to on all occasions of cough, without any precise notions as to the mode of their operation or the actual effects which they produce. Hence it is, that in the ordinary course of practice, they do a great deal more harm than good. It be- comes important, therefore, that they should be made the subject of special investigation, and with this view, let us look at the nature of the parts upon which they act, and the causes which give rise to difficult or deficient expectoration. The whole of the air passages are lined with mucous membrane. This secretes mucus, a certain amount of which is necessary to keep the mem- brane in a state to perform its function, not, for the present, to speak of its importance as an excretion. When this secretion is in due propor- tion respiration is performed, so far at least as this part is concerned, naturally and easily. There is neither cough nor irritation. It hap- pens, however, from various causes, that this organ becomes disordered, and one of the first and most striking of the effects is a change in the quantity as well as quality of its secretion. Now, the disorder of the mucous membrane is of different characters in different cases, conse- quently the effect as to the state of its secretion differs very much. In some the membrane becomes inflamed or constricted, and then the quan- tity of secretion is greatly lessened. Now, the consequence of this is, that when the air in respiration passes over this dry membrane it causes irritation and produces cough, which is nothing more than an effort to get rid of some irritating cause. In other cases the membrane may be so disordered as to give rise to an increase of secretion. The effect of this will be, of course, partially to obstruct the tubes and cells through which the air passes in respiration, and this will give rise to cough. In other cases, again, the membrane may be so disordered as to pro- duce a viscid, tenacious secretion, which may adhere to it, and in this way keep up a constant irritation. Now, in all these cases you per- ceive the real and primary seat of all the difficulty is in the condition 210 MATERIA MEDIC A AND THERAPEUTICS. of the mucous membrane of the respiratory organs, and the change which follows in the character and quantity of its secretions. In the treatment, the great object is, or ought to be, to effect such a change in this disordered membrane, as will restore its secretions to their natural quantity and quality. Now, it is very evident that this must not be effected by any one set of remedies, they must be adapted to the particular character of the disorder. Among these, what are commonly called expectorants are of the least importance. Still, how- ever, they may be rendered very valuable and useful if properly ap- plied. In addition to the disordered state of the mucous membrane, there are other conditions of the respiratory organs which require to be noticed, and which give rise to the same difficulty. Morbid matter may be found in consequence of ulceration, the presence of softened tuberculous matter, or of pus, as in abscess. Now, in all these cases, expectoration may require to be assisted. Again, the bronchial tubes may be the seat of spasmodic stricture, interfering at once with respira- tion and secretion. The prominent symptom which indicates each of these morbid conditions is cough, and the great error in the use of expectorants is, that everything is generally directed to suppress this symptom, and this, not by removing the cause of the cough, but by giving anodynes. These simply lull the cough, but do not change the condition of the parts — nay, sometimes make it materially worse, and that in two several ways. 1. They check secretion. Now, secretion is nature's mode of reliev- ing overloaded vessels. This relief may be essential to the removal of the disease ; opiates render it unattainable. 2. They suppress cough. Here, again, cough is nature's effort to re- move something out of the larynx, trachea, or bronchi. Suppress this effort, and the cause of irritation will remain to aggravate the present disease, or perhaps to cause another and more serious one. Cough is a forcible expiration ; and, while it is ordinarily an index of something wrong, some cause of irritation in the lungs, is an effort of nature to get rid of this offending cause. It is a natural, and often a very salutary process. But, like other similar natural efforts, it may be excessive or irregular, and then it may irritate and exhaust the system. Under such circumstances it may be proper to modify or control the action of this agent, so as to secure all its good without any of its evil consequences. But this is to be done by removing the cause of cough, if that be possible, not by suppressing it with opium, as is too much the habit of some. All that opium can do under such circumstances is by diminishing the sensibility to check the efforts of nature to rid herself of the irritating cause. To show how absurd this opium practice is, ima- gine that the cough were excited by a bean or other physical irritant in EXPECTORANTS. 211 the trachea. Who would think of giving opium? Let this analogy guide your practice: Get rid of the bean — remove the cause and the effect will cease. To do this it, is, of course, essential that wre investi- gate the case, and ascertain, if possible, the cause of cough. Now cough may arise from disordered conditions of the fauces, especially elongation of the uvula, from morbid states of the larynx, or of the mucous mem- brane lining the bronchial tubes, or of the lungs, or the pleural mem- brane, from effusions into the cavity of the chest, diseases of the heart, or sympathetically from disorder of the stomach, liver, It is accordingly considered as an expectorant and emmenagogue, as it is stimulant in its action ; it can only, of course, be used in cases marl ed by debility, and wbere there is a total absence of febrile and inflam- matory excitement. The diseases in which it has been used are chronic catarrh, humoral asthma, phthisis pulmonale, and other pulmonary affections, in which there is excessive secretion, but a deficiency of power to expectorate. It is also used with advantage as a local stimulant to spongy gums, ulcerated throat, and foul ulcers. Form of Administration. — It may be given in powder or pill in the dose of from 10 to 30 grains. It is generally, however, given in combination, and enters into the composition of a number of officinal preparations; among these the following are the most important. 1. Mistura Ferri composita. 2. Tinct. Aloes cum Myrrh. ANTISPASMODIC EXPECTORANT ARTICLES. To this general head belong all the relaxing articles. There are a few, however, which may be said to operate more directly upon the pul- monary organs in the way of allaying spasm. TOBACCO IN THE FORM OF SMOKE. Tobacco operates in two ways upon the pulmonary organs, in both of which its influence may be salutary ; it increases secretion from the mu- cous membrane lining the respiratory tubes, and by its general narcotic influence on the nerves and on the circulation it allays irritation and alleviates cough. In spasmodic affections of the chest, such as asthma, smoking has accordingly been used frequently with advantage. STRAMONIUM IN THE FORM OF SMOKE. The general effects of stramonium as a narcotic will be noticed under that head. Introduced into the system in the form of smoke of the dried herb, it has long been a popular remedy in spasmodic asthma, and in many cases, unquestionably, has proved beneficial. Like tobacco, it operates locally and generally. It allays irritation of the mucous mem- brane, and thus promotes free secretion, while at the same time, by its general operation on the nervous system, it counteracts spasm and ren- ders respiration more free and uniform. 226 MATERIA HEDICA AND THERAPEUTICS. VAPOR OF SULPHURIC ETHER. This is used by simply putting a couple of teaspoonfuls of ether into a cup and holding it to the mouth. The warmth of the hand applied to the cup is sufficient to cause an evaporation of the ether which is thus inhaled. This may be repeated three or four times a day, and is useful in catarrh and whooping-cough. EXPECTORANT EMETICS. The act of vomiting may prove curative in diseases of the lungs by its general operation on the circulation and on the secretions of the mucous lining of the lungs, promoting secretion in some cases, and separating viscid secretions already formed in others, or by expelling secreted mat- ters. During the contraction of the diaphragm and abdominal muscles an impulse is communicated to the whole bronchial system. In conse- quence the expiratory effort is increased, and the expulsion of mucus and other matters from the pulmonary tubes is brought about. Now the kind of emetic used must differ according to the condition of the system. If inflammation be present tartar emetic, ipecac and such articles as nauseate must be used. If there be no fever or inflammation, but simple accumulation of mu- cus or pus, sulphates of zinc or copper. In children this distinction is essential. COMBINATIONS OF EXPECTORANTS WITH ONE ANOTHER. There is perhaps no class of medicinal agents more uniformly given in combination than expectorants, and with the greatest advantage. The principle on which these combinations are made is simple and obvious, that of uniting the different modes in which these agents produce their effects. As already stated some expectorants operate locally and directly upon the lungs. Others produce their effects by impressions made upon neighboring parts and transmitted to the lungs. "Now to a greater or less extent the effect of these different modes may be united in one pre- scription. For the purpose of illustrating this let us run over some of the articles belonging to this class. Demulcent substances, such as liquorice, gum arabic, &c. These are given alone in the form of solutions when you wish simply to obtain their soothing effects upon the fauces. Usually, however, they are given EXPECT0BANT8. 227 in combination with other substances to render them more efficient. They form the basis of almost all expectorant mixtures. Ipecacuanha. — This is frequently given alone. Usually it is added to the demulcent vehicles already mentioned, and in that way you get an excellent and efficient combination calculated to soothe irritation, pro- mote secretion, and moderately relax the system. Tartar Emetic. — This, as an expectorant, is usually given in combina- tion with demulcent articles, and you then get the soothing effeel of the latter with the peculiar and relaxing effects of the former. This forms the active ingredient, in many of the expectorant mixtures which are given in cases where inflammatory action is present. The antimony may be added either in the form of tartar emetic itself or of the antimo- nial wine. Polygala Senega! — Sometimes this is prescribed alone and yon then get the peculiar effects of the remedy upon the mouth and fauces and upper part of the trachea, causing copious secretions from these puts. Senega is, however, stimulating in its nature, and therefore in cases where this might prove objectionable it is advantageously combined with tartar emetic. A valuable combination of this kind is the Hive syrup of Dr. Coxe. This is prepared in the following way. B,. Polygal. Seneg. contus. Scillse Marit. contus. aa 3 viij. Aq. purse 3 viij. Boil together over a slow fire until the water is half consumed, strain off the liquor, and then add of strained honey four pounds. Boil the honey and the strained liquor to six pounds, or to the consistence of a syrup, and add to every pound of this sixteen grains of tartar emetic, that is one grain to every once. The dose varies from ten drops to one or more teaspoonfuls every quarter, half, or one hour, according to the age of the patient or the violence of the disease. This combination proves expectorant, emetic, purgative, and diaphoretic. Scilla maritima. — This is generally given in combination either with tartar emetic, antimonial wine, or ipecacuanha wine, and you then get the united operation of the two ingredients — the peculiar effect of the squill on the mucous lining of the lungs and the general relaxing effects of the antimony on the system. Accordingly it is observed that when the skin is hot and dry the squill does not prove expectorant unless thus combined with a relaxing: and sudorific article. DIUBETICS The term Diuretic is applied to that class of medicinal agents which. possess the power of increasing the urinary secretion, or, in other words, of exciting into increased activity the functions of the kidneys. In a general sense, this class embraces a wide range of agents. The urinary secretions may be interrupted from various causes. Thus, for example, inflammation of the kidneys will lessen the quantity of urine. By the use of venesection and other antiphlogistic remedies, the inflamma- tion of these organs is subdued and the secretion of urine restored. In a certain sense, therefore, all these agents may be considered as diuretic. It is not, however, in this enlarged way that we shall consider this class of agents, but shall restrict it to those which appear to act directly in promoting the urinary secretion. Effects. — In analysing these, it is important to distinguish between the effects produced upon the kidneys themselves and those which are pro- duced on other parts of the system. On the Urinary Organs. — The effects of diuretics are here obvious. They increase the flow of blood to the kidneys, increase the vital action of these organs, and promote their secretory functions. In some cases, active irritation and even inflammation of these organs is the result. Diuretics may then be considered as local stimulants to the kidneys, the degree of stimulation produced by different articles differing [and also, as appears from the researches of Dr. Golding Bird, its character. Some diuretics merely increasing the watery portion of the urine, while others seem to stimulate the organ in the performance of its great function of depurating the blood, and increase in a very remarkable manner the quantity of solid matter eliminated in the urine. To the former class belong most of the vegetable diuretics, as squills, colchicum, digitalis, all those agents which out of the body produce no chemical effects on ani- mal matter. To the latter belong all the agents which have this power, viz. the alkalies, the alkaline carbonates and the alkaline citrates, tar- trates, acetates, &c, these latter being in the system converted into car- bonates. These substances when circulating in the blood, and thus brought into contact with the different tissues, act chemically upon them by combining with the albumen and fibrin, and making with them a solution which readily enters the blood by endosmose. On the fatty DIUItETrCS. 229 elements of the tissues their action, though not identical, is the same in result, for with them tlie alkalies form an emulsion which readily transudes animal membrane, and, of course, can pass both into and out of the bloodvessels. It is for this reason that alkalies are now so much used in Fevers, Rheumatisms, &c, &c, in which diuretics have hitherto either not been given at all or have not been prescribed understanding]}'. —Ed.] Effects on the Vascular System. — Like all evacuations from the system, the natural effect of an. increased flow of urine is to diminish the activity of the circulation. This effect, however, is gradual and usually moderate in degree. As, however, many of the articles are stimulants, the heart and arteries may at first be excited. The effect, therefore, on the circulation, will depend entirely upon the nature of the diuretic agent as well as upon the quantity of urine which may be secreted. On the blood itself some change must also be effected. This must of course vary greatly in consequence of a number of circumstances. If the quantity of watery fluid separated from the blood and discharged by urine be counterbalanced precisely by the quantity taken up by the absorbents from the stomach and bowels, then the blood may remain without much alteration in this respect. Generally, however, this is not the case, and then the blood must vary in the relative proportion of water which it contains. In the saline materials too, contained in the blood, a considerable change takes place ; but what the extent of these changes in the circulating fluid is, and what its precise nature, it is not in the present state of our knowledge easy to say. Experiments and observations to elucidate these points would no doubt lead to many important conclusions. The Skin. — Between the skin and the urinary organs there is an intimate sympathy, and one of the most striking and immediate results of an increase in the secretory function of the one is a diminution of that of the other. Hence in all cases where diuresis is long continued, blood flows less freely to the surface — its vital heat is lessened and exhalation is diminished. A striking illustration of these phenomena is witnessed in diabetes. On the other hand where the urinary secretion is impaired, frequently the skin exhales profusely. In cases of suppres- sion of urine, for instance, it has been remarked that there was profuse sweating and that the perspiration had a urinary smell,* and contained urea. The Exhalant System. — The general effect of continued diuresis is to lessen exhalation throughout the system. As already stated, such is the~effect on the external surface of the body. On the mucous surface * Mackintosh, vii. p. 269. 230 MATERIA MEDICA AND THERAPEUTICS. a similar effect appears to be produced. In Diabetes, this is illustrated in the distressing thirst, hunger, and peculiar sense of emptiness in the stomach, which characterize this complaint.* On the serous surfaces we have no means of ascertaining precisely what effect is produced. The probability, however, is that the same thing occurs here. This may fairly be inferred from the fact, that when increased exhalation takes place from the serous tissues (constituting dropsies) the urinary secretion is usually impaired, and on the other hand, when the urinary secretion becomes copions, dropsical accumulations lessen and disappear. The researches of modern physiologists have given much distinctness to our views of the action of diuretics. We now know that absorption being dependent on endosmose, fluids will not be taken up for the alimentary canal unless their specific gravity is less than 1.026 (that of serum), and that when they are so dilute, they are taken up with great rapidity. We know that the kidneys (the organs through which the system rids itself of superfluous water) perform two distinct functions, one that of excreting water, the other that of depurating the blood. We know that these two functions are independent the one of the other, that the quantity of water in the urine may be very great, and yet the depurative function be very imperfectly performed, andj vice versa. Indeed we have reason to believe that these two functions are seated in two different tissues of the kidney — that the malpighian bodies separate the water from the blood, while the uririiferous tubes and their capil- laries eliminate the urea, uric acid, &c, the solid constituents of the urine, to which it owes its peculiar qualities. It is on the former, as before remarked, that the vegetable diuretics and those which have no chemical action on the vessels, act, while the alkalies, &c, by chemi- cal combination with the elements of the tissues, facilitate their disinte- gration, their passage into the blood, and their subsequent elimination by the kidneys. On the Absorbent System. — The general opinion of writers is, that diuretics excite very powerfully the action of the absorbents. This was the opinion of Dr. Cullen. CIRCUMSTANCES MODIFYING THE EFFECTS OF DIURETICS. Of these there are several which require to be noticed as exercising an important bearing on the practical application of these agents. 1. Temperature and Season of the Year. — Whatever has a tendency to check the determination to the skin increases the secretion of the urinary organs. Hence it is that in cold weather and in cold situations the quantity of urine is always increased, while in warm weather and * Elliotson. DITJBEnCS. 281 in warm latitudes the reverse takes place. For the same reason diure- tics act more powerfully on the kidneys in cold than in warm weather. 2. The Quantity and T£ffiJ28£&iy£& "J th& Finn! taken during their U86t — F re e dilution aids very materially the effect of diuretics, provided the diluent be cold, [f it be warm, instead of determining to the kid- neys, it may pass off by the skin. So remarkably does the eff cl of these agents depend upon the temperature of the diluent, thai the same article may frequently be rendered diuretic or diaphoretic, according the diluent is cold or warm. Spiritus JMindcrcri, for example, which if taken with warm drinks is diaphoretic, acts as a diuretic, if the drinks be cold and the person be kept cool at the same time. On the other hand, the salt of tartar and nitre are powerful diuretics, yet, when laken with warm drinks and tin; body kept warm they prove sudorific, with- out acting on the kidneys at all. 3. The form in which they are given. — This exercises a controlling influence on the operation of diuretics, especially the salines, many of which, if given in strong solution, act as purgatives, by causing an endosmosis from the intestines to the saline solution ; while if given largely diluted, so that the specific gravity of the fluid is less than 1.026 (that of the serum of the blood), they are readily absorbed, and being carried to the kidneys are thence eliminated with the urine, and act as diuretics. 4. The Condition of the Skin. — As already stated, there is a recipro- cal relation between the skin and the kidneys. If the excretion from the one be augmented, that from the other is lessened. Hence, if the skin be in a moist state, diuretics produce little effect. For the same reason, if the patient exercises freely during their use, their operation is interfered with. 5. The Condition of the Bowels. — There is perhaps no one circum- stance which so greatly modifies the effect of this agent as the state of the bowels. Thus, during the use of diuretics, if the bowels become relaxed, the effect on the kidneys will be arrested ; of this we have numerous illustrations. Turpentine, which if given in small doses acts powerfully on the urinary organs, loses this property altogether, if given in doses sufficiently large to prove cathartic. Nitre, when given alone, is one of our most decided diuretics, and its presence may be detected in the urine. But if this be combined with some cathartic, it fails in this respect, and it can no longer be detected in the urine. 5. The_Conditiort of the System as to Disease. — In certain diseased states, particularly dropsy, the action of diuretics is exceedingly uncer- tain'; this we now know to depend on the fact that a large proportion of dropsies are caused by organic disease of the kidneys, the liver, or the heart. Now, if the kidney be disorganized, it cannot perform its function, and it is worse than in vain to goad it with stimulants — as 232 MATERIA MEDICA AND THERAPEUTICS. well stimulate an apoplectic brain or a lacerated muscle. If the liver is diseased the portal circulation is so obstructed that the kidneys do not receive their due amount of the raw material from which they are to manufacture the urine. They cannot produce urine when its ele- ments are not supplied them. So with disease of the heart — the circu- lation is interrupted, and till that difficulty is removed we stimulate the kidneys to no possible purpose. It is in these heart dropsies, that digi- talis, by its soothing power over the disturbed circulation, acts as a diuretic. MODES IN WHICH DIURETICS PROVE CURATIVE. 1st. As local stimulants. In this way they operate when the kidneys are torpid and inactive ; they restore, by their direct circulation, energy to the organ, and promote the secretion of urine. 2d. By their agency in the removal of dropsical accumulations — this has already been alluded to. [3d. By their effect in increasing the depurative function of the kid- neys, and thus increasing the waste of matter, they may promote the removal of diseased products of low vitality, which often present them- selves either in the form of albuminous deposits in the glands, furuncular diseases of the cellular tissues, or incrustations on the skin, as in some of the tuberculous cutaneous diseases. — Ed.] APPLICATION OF DIURETICS IN THE TREATMENT OF DISEASES. A few observations will serve to show the extent to which these agents may be applied. Fevers. — Like every other organ destined to the purposes of secre- tion, the kidneys are more or less deranged in every case of fever. Hence, not merely the quantity of urine is lessened, but the character of it is changed in various degrees. Now, in the management of fever one of the great objects to be accomplished is to restore all the secre- tions. This holds true no less of the urinary secretion than it does of the others. As a general rule, however, the accomplishment of this object does not require the use of specific diuretics. The condition of the kidneys in fever is consequent upon the morbid states of the san- guineous and nervous system, and the most efficient mode of restoring the urinary secretion is by the use of those remedies which are resorted to for the purpose of subduing general excitement. Except in particu- lar cases, therefore, mere diuretics are not remedies that can be ren- dered very available.* Among this class of agents, however, there * [The views of G. Bird, before alluded to, tend to modify the opinion here e-spressed, and to extend the uses of these agents in fever. — Ed.] are some which possess other properties which render them r< quently beneficial. This is the case with nitre, which i refrigerant as well as diuretic; so also cream of tartar is refrigeranl and ! tive. These, therefore, 7iuiy be prescribed with great benefit. As a general rule it may be lai the air it is changed into a liquid of an oleaginous appearance ; soluble in ball' it- weight of water and twice its weight of alcohol. In small doses diuretic, and in larger ones cathartic. As a diuretic the dose is from 3 j to 3 j ; cathartic 3 i j to 3 iij — given in solution, vary- ing in strength according as one or the other effect is desired. [This is one of the best of Golding Bird's depurative diuretics, and as such, may be given with the best effects in rheumatism, in fever, and other diseases, always largely diluted so that it may be absorbed and act on the kid- neys. — If it purge it is not, as a general rule, absorbed.] Spiritus nitri dulcts, also called Spiritus etheris nitrosi, spiritus etheris nitrici, spirit of nitric ether, sweet spirits of nitre. — It is made by the action of alcohol upon nitric acid. It is a colorless liquid, has a fra- grant odor and a slightly sweetish and acidulous taste. Its specific gravity should not exceed 0.S34. It is inflammable and very volatile. It is soluble both in water and alcohol ; when added to the tincture of guaiac it has the singular property of producing a deep blue color. Effects on the System. — Spirits of nitre acts decidedly upon the kid- neys and promotes very considerably the flow of urine. It is also refri- gerant and somewhat antispasmodic. It is therefore an exceedingly useful article when you wish to allay thirst, moderate heat, and promote the urinary secretion. It is grateful to the stomach, relieving nausea and flatulency. Dose. — It may be given in doses of from 30 to 60 drops repeated every three or four hours or oftener. [A few drops taken in parsley tea is an excellent diuretic for infants.] DIGITALIS PURPUREA. This is the Foxglove, a beautiful biennial plant found native in various parts of Europe. In Great Britain it is indigenous, and in the north of England it grows abundantly, and presents a magnificent appearance about the hills and the borders of fields. It is generally found in dry and sandy soils. In the United States it is also found in abundance, but is not indigenous. It is cultivated here for the beauty of its flowers and 240 MATEEIA MEDICA AND THEEAPEUTICS. for medicinal purposes. In the East Indies it is also cultivated. Mr. Ainslie states that lie saw it growing in the botanical garden at Banga- lore, although the plant was not robust.* It has a knotty fibrous (perennial) root, which sends up a stem about four feet high, Its flow- ers are numerous and beautiful. They are large and of a bell form. From their resemblance to the finger of a glove, the name digitalis is supposed to be derived. They are of a bright purple color, sprinkled with eye-like spots. The parts used in medicine are the leaves. Physical Character of the Leaves. — The leaves of the digitalis differ from one another in size and shape. The lower ones are egg-shaped, and about eight inches long and three in breadth. Both are slightly serrated and have wrinkled surfaces, the upper of a dark green color and the under pale and downy. While fresh they have no smell, but on being dried they acquire a slight narcotic odor. Their taste is bitter and nauseous. Their powder is of a beautiful deep green color. Chemical Compositim~ancT Properties. — Digitalis imparts its active properties both to water and alcohol. Its active principle has been isotated as a crystalline resinous matter, bitter, acrid, soluble in alcohol, and sparingly so in water and ether. It has not been used in medicine. Physiological Effects. — These vary very greatly with the dose in which it is given, and the length of time it is continued. When given in very small doses, it does not produce any very marked effect on the system. Given in closes sufficient to bring the system under its influence, it operates first as an excitant, and afterwards as a sedative. The primary effects are a sense of weight in the head, vertigo, headache, increased heat of surface, and obscured vision. Along with these, there is a sense of heat and itching in the pharynx and oesophagus, extending sometimes to the larynx and trachea. Nausea and purging sometimes take place. The kidneys are excited, and an increased secretion of urine results. According to Jorg, too, the genital organs are excited, and " in the female, symptoms identical with those which precede the menstrual flux" are produced. On the pulse, the primary effect is to increase its force and frequency. On this point there has been much difference of opinion, it being contended by some that digitalis acts primarily as a sedative upon the circulation. That such, however, is not the case is proved by abundant observations. So long ago as the year 1800, a series of experiments were made by Dr. John Moore, which conclusively establish this point. From one and a half to four grains of digitalis were taken by himself and others, and as a general result, the pulse increased in force and frequency during from half an hour to an hour. The primary stimulant effect thus produced is succeeded by a sedative * Ainslie, Mat. Med., pref. p. 21. DIURETICS. 241 influence mani fested more especially in the circulation. After the sti- iiinliint action has passed oil', both tJj<: force aii'l frequency of the pwl-c are lessened sometimes in a most, remarkable manner. This is especially observed when the use of digitalis has been con- tinued for a certain length of lime. Under these circumstances, the pulse frequently comes down from 100 and upwards to 80, "70, and even 40 and 30 in a minute, and tins effect continues for several days, and even weeks. With regard to the effect on the circulation, there is a circumstance which has been noticed, which is of practical interest : that it varies with the position of the patient. Although observed previously, Dr. Baildon has the credit of first noting this curious fact, lie observed it in his own case while taking the medicine for what he supposed to be pulmonary consumption. After the digitalis had produced its full effect on his system, as indicated by the reduction of the pulse to about 40 beats in the minute, he found that "his pulse was not lessened in frequency when he stood erect; it was then upwards of 100. When he sat down it fell considerably; when lying on his back it fell much more. Thus, during the time it was at 40 when lying, it was about 75 when sitting, and above 100 when standing. This was invariably the case." The same fact he observed in patients to whom lie gave it to any extent. The necessity of attending to this circumstance in the use of this drug is self-evident. [Digitalis is a type of the " aqueous diuretics" of Dr. G. Bird. It increases the quantity of water discharged by the urine, but not aug- menting the solids in the urine, does not at all affect the metamorphosis of tissues or aid in depurating the blood.] With regard to the effects of digitalis, there is this peculiarity : they are not limited to the period during which the article is used, but con- tinue for three, four, and five days and even longer after its use is relin- quished. Dr. Baildon states that when he took digitalis in his own case for phthisis, after his pulse sank to 36 he discontinued its use, but that it took nearly one month before it returned to its natural standard, *72. So also the increased secretion of urine will be continued for several days after the medicine is stopped. In relation to the sickness at stomach which it produces, it frequently does not come on until some time after the exhibition of the medicine has been discontinued. After ceasing, too, " it will recur as violently as before, and will continue by repeated attacks in this manner for three or four days, at distant and more distant intervals."* In large doses, or if its use be continued too long even in ordinary doses, digitalis produces the effect of a narcotico-acrid poison. When long continued, it sometimes accumulates in the system and eventually * Duncan's Med. Com., voL v. p. 371. 242 MATERIA MEDICA AND THERAPEUTICS. gives rise, rather suddenly, to vertigo, impaired vision, nausea, saliva- tion, vomiting and sometimes purging, copious perspiration and very- free diuresis, accompanied with great prostration and sinking of the pulse. If the symptoms are not relieved, general prostration, convul- sions', and death result. [This does not occur as often as the remarks of good authors would lead us to anticipate. Dr. Holland (Medical Notes) says, that after a rather extensive use of digitalis he has never seen ill effects from it.] From the foregoing, then, it appears that digitalis in its primary ope- ration is exciting, while its secondary action is sedative, and that it developes its principal powers upon the circulation and upon the urinary oro-ans. The proper indications for its use are those conditions of the system in which it is desirable to impair the action of the heart, or to excite powerfully the urinary secretion. Circumstances Modifying the Effects of Digitalis. — As the result of observation and experience, it has been ascertained that the activity of digitalis is a good deal modified by a variety of circumstances, such as the mode in which the plant grows — the season of the year when the leaves are gathered — the part of the leaf that is used — the manner in which it is dried, and the length of time it is kept. By some it has been supposed that the virtue of the digitalis became deteriorated by cultivation. By Dr. Hamilton, however, the contrary is asserted, and he states as the result of observation that when carefully cultivated in gardens where there is a free exposure to the air, it yields a larger and more vigorous leaf than it does in shaded lanes and hedge rows where it is found growing spontaneously.* The season of the year when the leaf is gathered is of still greater importance. It is well known that in vegetables, the strength of particular parts varies with the season, de- pending upon the evolution and rising of the sap. In the spring before the sap has ascended, the principal power is in the root, and it is not until some time afterwards that this power is imparted to the leaves. Different seasons, therefore, are appropriated to gathering, according to the part of the plant which may be used. In the present case the pro- per period, according to Dr. Withering, is " about the time the flower- ing stem has shot up, and when the blossoms are coming forth." It is then that the leaf possesses the greatest strength. Not unfrequently, by those who deal in this article, this rule is altogether disregarded, and the leaves are gathered very late in the summer or in the autumn. The difference in power and effect may easily be imagined. By Dr. Withering, who studied and understood this vegetable more thoroughly than any other person, the small leaves are considered more powerful * Observations on the Preparation, Utility, and Administration of the Digitalis. Prepared by Wm. Hamilton, MD., p. 18. I.IUKKTJCK. 248 than the large, ami lie directs only the leafy pari to be used the stalk and middle being rejected. In drying the leaves for preservation, great care is to be taken. They should be dried separately in the air or in a tin pan before tlie fire, with a heat just suflicicnt to allow of their reduc- tion to powder. If it be possible, it should be done with the* exclusion of light. Both light and great heat have a tendency to impair their virtues. After drying they should be kept in opaque vessels, i eluded from light and moisture, or they may be pulverized and kept in the same kind of vessels. The best plan is to have digitalis fresh every year. PRACTICAL APPLICATION. 1. Inflammation. — From the very decided effect which digitalis has in lowering the force and frequency of the pulse, it was very natural to suppose that it might prove exceedingly advantageous as a remedy in controlling inflammatory action. Experience, however, has satisfac- torily established the fact that in the primary stages of inflammation it is not to be depended upon. After suitable depletion, it may prove a useful auxiliary by quieting the irritation of the heart. 2. Hemorrhages. — Here too much was expected from digitalis, but experience has proved that the remedy, though not without power, is not adequate to the control of active hemorrhage, and as has been sug- gested by Mr. Brodie, its use is not without danger. 3. Pulmonary Consumption. — So great were the advantages sup- posed at one time to result from the use of digitalis in pulmonary con- sumption, that its ardent advocates were ready to proclaim it a specific for that formidable disease. Time has dissipated this fond anticipation, and proved that though digitalis will do something in this complaint, it falls far short of being a specific. To moderate the action of the heart, and diminish the general irritability of the system, may alleviate the unpleasant symptoms of tuberculous deposit in the lungs. This is all that digitalis can do. 4. Dropsy. — In this disease digitalis has been more celebrated than any other, and it is no doubt a remedy of great value. It is not appropriate to every form of the disease, nor to every state and condition of the system. As a general rule it will succeed best in asthenic rather than sthenic dropsies ; but its best powers in dropsy are manifested in those cases where the effusion is consequent on organic disease of the heart ; here by quieting the circulation it diminishes exhalation, while by its stimulating effect on the kidneys it moves the fluid. Diseases of the Heart and great vessels. — In many of these affections a great deal can be done by the steady use of digitalis. It moderates the force of circulation, and thus probably delays the progress of aneu- 244 MATERIA MEDIC A AND THERAPEUTICS. risms in very many cases, while in a few by favoring coagulation of the blood in the sac it may promote a cure. In very many functional dis- orders of the heart digitalis will, by moderating the force of the circula- tion, afford temporary if not permanent relief. Modes of Administration. — Substance. — In this state it may be given either xapill or powder ; do9e, to begin with, from gr. ss to gr. j twice a day to be increased gradually by the addition of J of a gr. a day, or the original dose to be repeated at shorter intervals, say of six or eight hours. In using the digitalis in substance, great care should be taken to see that it has the green color and the peculiar smell of the fresh plant ; other- wise there is no certainty in its operation. Infusion. — This a more common form than the substance, and is prepared by infusing 3 j of the dried leaves for four hours in half a pint of boiling water. To th"Ts*when strained | j of any aromatic spirit is to be added to preserve it from spoiling. Of this from 3 ss to § j may be taken twice a day. In this form it has generally been supposed that the digitalis operates more powerfully and successfully as a diuretic, and it is accordingly in this way that it has been customary to prescribe it when administered in dropsical affections. Tincture. — Of all the preparations, this for general use is the most valuable. It is the form in which it is generally prescribed to produce the specific effect of the article on the circulation. As a diuretic, it is inferior to the infusion. The dose of the tincture to begin with, is from ten to twenty drops twice a day, to be increased gradually a drop or two a day until the desired effect on the pulse is produced. RULES TO BE OBSERVED IN THE USE OF THIS ARTICLE. From the very powerful and peculiar effects which digitalis produces on the system, too much caution cannot be observed in its exhibition. For the purpose of guiding you a little on this subject the following rules may be observed. 1. See that the article is really what it professes to be and ascertain as far as you can the strength of the preparation, wdiether it is in the form of powder or tincture. From what has been already stated in rela- tion to the variable strength of the leaf, the necessity of this precaution is perfectly obvious. With regard to the tincture, there is still another precaution necessary. Not unfrequently in apothecaries' shops, it is customary to leave tinctures upon the dregs, and gradually pour off the clear part for use — " the dregs are afterwards pressed out, and the last portion of the tincture acquires, by this careless proceeding, double the strength of the first." In this way accidents of a serious nature have sometimes occurred. Mr. Brande relates a case of a person laboring under hydrothorax who was in the DIURETICS. 245 habit of taking forty drops of the tincture of digitalis every night on eroina: to bed. Being in the country without his medicine, he wot obliged to send to an apothecary there for some of if, and of tin- he took the usual quantity. In the morning he was dead! From the symptoms it was suspected to be owing to the medicine, and on inquiry it was found that the tincture had been kept standing on the leaves 80 long that at the time it was sold, it had evaporated so much as to render it necessary to shake out the leaves and squeeze them to obtain the necessary quantity. In this case the strength of the article was so greatly increased as to leave no doubt that the patient died from the effects of the medicine and not from disease. 2. As the effects of digitalis are obtained not from a single dose, bu1 from repeated doses, and as these effects arc apt to be violent and even dangerous if the use of the remedy be carried beyond a certain limit, it is essential in all cases to observe very carefully and repeatedly the state of the patient while the medicine is administered. As soon as any effect is produced on the pulse, its use is to be intermitted. By Dr. Withering the rule is laid down that it should be continued until "it either acts upon the kidneys, the stomach, the pulse, or the bowels ; but let it be stopped at the first appearance of any of these effects." The pulse should accordingly be incessantly examined to enable you to judge of the manner and extent of its action. The reason for the necessity of stopping the remedy as soon as its effects begin to appear, is, that they accumulate in the system, and then there is no proportion between them and the individual doses which may be administered. 3. Another precaution necessary in using it is founded on the fact that though in persons who continue taking digitalis for any length of time, larger and larger closes may be taken with impunity, resembling, in this respect, opium ; yet, if the use of it be suspended for any length of time the effect of habit wears off and the system loses the power of bearing such large quantities. If given, therefore, under these circum- stances, serious and even dangerous consequences may arise. As a pru- dential measure, therefore, you are always to commence agaiu with moderate doses. 4. Dangerous prostration has sometimes followed a sudden rising from the chair or bed. Let your patient be cautioned against the sudden assuming of the erect posture. [5. With all the precautions that can be taken it is a very dangerous as well as a very uncertain remedy. It proved fatal in one case, in the hands of the most prudent and one-of the most skilful physicians I ever knew — the late Joseph Parrish, of Philadelphia. — Ed.] 246 MATERIA MEDIC A AND THERAPEUTICS. SCILLA MARITIMA. This has already been noticed under the head of emetics. As a diuretic, it is still more valuable. To obtain its full effect in this way it is necessary, however, to give it to a certain extent. Taken in certain quantities, this article causes nausea, vomiting, and purging. By Dr. Home of Edinburgh, it was maintained that the production of actual vomiting was necessary to secure the full diuretic operation of it, and he relates several cases of dropsy which seem to support this view. Others contend that vomiting interferes with its subsequent action as a diuretic. Whether actual vomiting be necessary or not, one thing is certain, that some impression ought to be made on the stomach in the way of nausea, before its full effect will be obtained. The rule laid down by Dr. Black- all is, perhaps, the best ; carry it to the fullest extent which the patient can bear without causing sickness. To get at this point, begin with small doses, gradually increasing them until either a suitable diuretic effect is produced, or until slight nausea is brought on. A little less than this is then to be continued, .until the desired effect is produced. In its general effect on the system, squill is usually considered stimulat- ing. Yet it is observed that when the system is under its full influ- ence, especially if nausea and vomiting be present, the pulse is ren- dered much slower. This is particularly remarked by Dr. Home. In some cases the pulse was reduced as low as 40. Mode of Administration. — Substance. — Most usually in the form of pill ; from 1 to 3 grs., two or three times a day, frequently combined with calomel. Vinegar. — This is the better form, inasmuch as the dose can be gra- dually increased. Of this about 30 drops three times a day may be commenced with — increase to 50 or till nausea is produced. Used in dropsies in which the urine is not coagulable or where the inflammatory diathesis is not present. convolvulus panduratus {the wild potatoe). An indigenous plant with a climbing stem, growing ten or twelve feet long. The active part is the root. This is about three inches thick, and two or three feet long, branched at the bottom — externally, whitish and milky, with somewhat of an acrid taste. Effects. — Diuretic and cathartic. In powder it purges, but does not act as a diuretic. In infusion, according to Dr. McLean, it is one of the best diuretics we have. He recommends it to be made by adding an ounce of the root cut into small pieces to a pint of boiling water. Of 1'irrjRBTICS. L'17 this, tlic dose is |* sa. every two hours ; the addition of juniper berries increases the effect. It does not stimulate the system, sits well on iIj' stomach, and is very popular in some parts of the country in many com- plaints. .IUNIPERUS COMMUNIS. This is the common juniper, a low, branching evergreen, growing on heaths and hills. It is a native_of_Europc, but naturalized in this coun- try. It grows about six or seven feet high, and if properly cultivated, fourteen or fifteen feet. The parts used in medicine are the Imgies-and tops — principally the berries. The berries are about the size of co mmon currants, and purplish black in color; they have a peculiar aromatic tcrebinthinate odor, and a warm, sweetish taste, followed by bitterness. The best kind are imported into this country from the Mediterranean. The berries produced in this country, although equal in appearance, are very inferior to the foreign, and are not much used. Composition. — Volatile oil, 1.00; wax, 4.00 ; resin, 10.00; peculiar kind of sugar, with acetate aud malatc of lime, 30.80 ; gum, 7.00 ; Hgn'm, 35.00 ; water, 12.90. Both alcohol and water extract the virtues of the berries. The active properties of this article depend upon the volatile oil, which is obtained by distillation. Effects. — Acts decidedly on the urinary organs, promotes the secre- tion of urine, and imparts to that fluid the odor of violets. To the blad- der, it proves stimulant and tonic, exerting a special influence over its muscular and mucous tissues. Hence, in debilitated states of that organ, it sometimes restrains secretion and augments its contractile powers. Upon this principle it has been found useful in catarrh of the bladder, &c, and in some cases small calculi have been expelled during its use. If given in large doses, it causes great irritation of the urinary organs. On the system at large, the general effects of this article are stimulat- ing ; cordial to the stomach ; it excites the circulation, and quickens the functions generally. Form of Administration. — The common form is that of i nfusio n. |j of bruised berries to a pint of boiling water — dose §juj_to_JJ5^ every four hours. Oil of Juniper. — Obtained by subjecting the fruit to distillation with water. Limpid, transparent, nearly colorless, lighter than water, and has the odor and taste of the fruit. This is one of the most powerful diuretics we have. Dose, from two to six drops mixed with sugar and mucilage. "Christison says that five minims of the oil with 3 j of sweet sp. of nitre, three times a day in any common vehicle, produced diuresis in dropsy where other means had failed. 248 MATERIA MEDICA AND THERAPEUTICS. APOCYNUM CANNABINUM. Indian Hemp. — An indigenous herbaceous plant, growing in every part of the United States. It grows two or three feet high, with a horizontal .root five or six feet long. Both the stem and r oot, when fresh, abound in milky juice. The bark of the stem isTough and fibrous, and can be peeled off in strings. By the Indians it is used as a substitute for hemp, in making their bags and fishing nets, &c, and from this the common name of Indian hemp is derived. The only part used in medicine is the root. The root is from five to six feet long, and about one third of an inch thick. It is composed of two parts, a cortical, brown and rough with- out, and white and smooth within ; and a ligneous part, which is a cord of a yellowish white color. Its taste bitter and nauseous, odor strong and unpleasant. When dried, the root is brittle and readily pulverized, yielding a powder very much like that of ipecacuanha. Composition. — It contains a peculiar bitter principle, apocynin, tannin, an acid (probably the gallic), gum, resin, wax, fecula, coloring matter, and lignin. Both water and alcohol extract its virtues. Water does it to a greater extent than alcohol. The cortical part yields a much larger proportion of active ingredients than the ligneous. Effects. — Resembles in many respects colchicum. In moderate doses, promotes the secretions of the mucous membrane, acting as an alterative and expectorant. In large doses it causes nausea, vomiting, and free purging. Along with these, it lowers the frequency of the pulse, and increases the secretions from the skin and kidneys. Like many other diuretics, it is by no means certain in its action on the kidneys ; in some cases producing a free evacuation of urine, while in others little or no effect of this kind is produced. In its action on the bowels it is powerfully hydragogue. The powder applied to the nostrils acts as a sternutatory. Mode of Administration. Substance. — Fifteen grains prove emetic and operate very much like ipecac. If the dose be large, it vomits and purges. Decoction. — This is the best form, 3 ij of the dried root boiled in three pints of water down to two pints ; of this § j to 3 ij three times a day, or often er. Used principally in dropsy. The juice of the root or plant is used as a local application in cutaneous affections. Colchicum autumnale. — Of this I shall speak at large when I come to treat of sedatives. Turpentine. — This has been already noticed under the head of DIURETICS. 249 anthelmintics. In large doses, it acts speedily and powerful!] on the intestines, and in this way is used for the purpose of evacuating the tape worm, Given in small doses, it a ffects not the bowe ls, but the ur inary organs, exciting them to increased action and promoting the How of urine; occasionally it causes a good deal of irritat ion, sometin strangury and suppression of urine. Most generally, however, it merely increases the flow of urine. Under its use, the fluid always acquires the peculiar smell of violets. So decided is the affinity of this substance for themrinary organs, that even breathing the vapor of it for a short time imparts the same odor to the urine. In its general operations on the system, this article is stimulating. Given in doses of fifteen to thirty grains, it quickens the" pulse, increases animal heat, and causes some degree of exhilaration. As a diuretic, therefore, its use is to be limited to those cases in which a stimulant is indicated. Besides increasing the flow of urine, " it is said to possess the remarkable property of increasing the lithic acid in it, and it certainly appears at times to bring on lithiasis in those whose fits of gravel are habitually carried off" by copious discharges of lithic acid and lithate of ammonia." — Christison, p. 922. Although acting on the urinary organs, turpentine is not a very reliable diuretic. Form, &c. — Ten to twenty or thirty drops, diffused in water with mucilage and sugar. CANTHARIDES. A full account of this article will be given under the head of Epi- spastics. It is sometimes used internally, and its effects differ greatly according to the quantity in which it is taken. In moderate doses, it acts as a gentle stimulant to the alimentary canal, and speedily produces a sense of irritation in the urethra, accom- panied with an increased desire to pass urine. In some cases, the quantity of urine is increased, in others not. Although, therefore, it acts decidedly on the urinary organs, it is not uniform in its operation as a diuretic. In large doses, it produces great irritation of the urinary organs, causing all the symptoms of strangury. There is pain and burning in the bladder, with constant desire to pass urine. The secretion of that fluid, instead of being increased, is diminished, while the inflammation of the neck of the bladder and urethra causes a constant desire to pass it. In these organs, a state of things is brought about analogous to that which exists in the intestines, in cases of dysentery. Along with all this, there is general feverish excitement of the system. In still larger doses, it acts as an irritating poison. 250 MATERIA MEDICA AND THERAPEUTICS. According, therefore, to the manner in which it is used, cantharides may be made to produce the effects of a mild stimulant or of a power- ful irritant to the urinary organs. Upon the general system, it acts as a stimulant. Form and Dose. — Fil l i to ij grs. Tinctu re, ten | to sixty drops in barley water or gum water. A very free use of diluents is essential, while using this article, both to render its diuretic operation more certain, and to prevent strangury. COPAIBA. This is the product of different species of the Copaifera, a genus of plants growing in the warm regions of South America. The Copaifera officinalis is a lofty tree growing in Venezuela and some parts of the West Indies. The greater part of the copaiba of commerce, however, is 'obtained from the Copaifera multijuga, a native of the province of Para, in the Brazils. The balsam is obtained by boring or wounding the tree to the pith near the base of the trunk, where it flows so freely that twelve pounds have frequently been collected in three hours. When it first flows, it is a clear, thin, colorless fluid ; but by being kept, it acquires a yellowish color, and becomes thickened. Balsam of Copaiba is clear and transparent, of the consistency of olive oil, and of a pale golden color. It has a peculiar and fragrant odor, and an acrid bitterish taste. It is lighter than water. When exposed with an extended surface to the action of the atmosphere, it gradually thickens until it at length becomes solid, dry, and brittle, like resin. When triturated with T \ magnesia, it gradually becomes solid. When copaiba becomes very old, it is susceptible of crystallization. Pelletier has seen it thirty years old ; the resinous crystals had the pro- perty of polarizing light. By long keeping, its virtues are impaired ; the fresher the better. In ivater it is insoluble ; in alcohol, ether, and the fixed and volatile oils, perfectly soluble. Chemical Composition. — Copaiba consists of volatile oil and resin. According to the analysis of Stolze, 100 parts consisted of vo latile oil, 38 parts ; yellow hard resin (copaivic acid), 52.75 ; broiun soft resin, 1.66 ; water and loss, */59. The active part is the oil. After copaiba has been deprived of its volatile oil, by distillation, a brownish resinous mass is left. This is sold as the resin of copaiva. It consists of the two resins before mentioned, which may be separated by rectified spirit. This dissolves the acid resin (copaivic acid), but leaves the viscid one. — (Pereira.) Parity. — According to Dr. Paris, a great deal of the copaiba used in DIUKETICS. 251 London is factitious ; and he states that a trial tool place between the owner of certain premises that were burnt down and the governor of the Sun Fire Office, in consequence of the latter refusing to indemnify the proprietor for his loss, because the fire had been occasioned by his making balsam of copaiba. The articles with which it is sometimes adulterated are common oil, Venice turpentine, and cantor oil. Of these, the most difficult of detec- tion is castor oil, from the fact of its being soluble in alcohol as well as the balsam, which the other oils are not. To detect the presence of castor oil, the following tests may be resorted to. 1. Boil one drachm of the copaiba in a pint of mater till the tirjaid is entirely evaporated. If the copaiba be pure, a hard resinous mass is left behind If it contain castor oil, it will be more or less soft, according to the quantity of oil present. 2. Shake together in a bottle one part of aq. ammonice with two and a half of copabia. If the copaiba be pure, the mixture will speedily become clear and transparent ; if it contain castor oil, it will remain more or less opaque. The presence of turpentine may be detected by the odor, when heated. A simple way of doing this is to drop a little of the suspected article on a heated spatula. The presence of common oil maybe detected by the action of alcohol. Pure balsam is soluble in about four parts of alcohol — common oils are not. It is sometimes mixed with rape oil. In this case if dropped into water, it will not preserve its spherical form on the surface as it will if pure. Effects. — Copaiba is a local and general stimulant. When taken into the stomach it creates a sense of warmth, which is followed frequently by a general disturbance of that organ. Eructations charged with the balsam take place, accompanied with nausea, loss of appetite, and some- times vomiting. These effects are frequently so disagreeable as to prevent the continuance of it. The constitutional effect of the copaiba is principally developed in its action on the mucous membranes, and more especially on the urinary organs. It excites the kidneys, increases the flow of urine, and at the same time exerts a peculiar influence over the mucous lining of the bladder, and more especially of the urethra. To the urine it imparts a bitter taste and a peculiar balsamic smell, different from the violet smell produced by the turpentine. "When given in too large doses, this article irritates and disorders the stomach, causing heat, pam, nausea, vomiting, purging, and pain of the bowels. The general system, too, becomes excited, producing heat of skin and fever; sometimes the nervous system is peculiarly affected, 17 252 MATERIA MEDIC A AND THERAPEUTICS. producing, according to Armstrong, " a sort of vibratory feeling in the brain, or causing a febrile anxiety, with a mental disturbance bordering on delirium." Another curious effect sometimes follows its too free use, and tbat is an eruption somewhat resembling the nettle rash. This more commonly occurs where the stomach has been disordered by it, sometimes without this. In some cases " hematuria andischuria are brought on by it." Mode of Administration. — As the taste of this article is exceedingly disagreeable, the form in which it is given is' a matter of great import- ance, inasmuch as it frequently depends upon this whether it can be taken at all. The simplest and best form of giving it, if it can be taken, is to drop it on sugar. Another mode is to give it floating on water with the addition of a little bitter tincture to cover the taste. None of these answer so well, however, as to incorporate it with muci- lage, with the addition of other ingredients to cover the taste. Recently another mode of giving copaiba has been introduced in the form of gelatine capsules. They are made of a compound of gelatine, gum, and sugar ; with this the distended and greased bladder of the tench (or other small fish) is coated and afterwards the air and membra- nous mould are withdrawn. (Pereira.) Each of these capsules contains about ten drops of copaiba, and the object is to cover the taste and smell of it. When they get into the stomach the capsule dissolves and the balsam escapes. When made into pills with magnesia the masses not , unfrequently pass from the bowels unchanged. __■;.< Oleum Copaib^e. — The volatile oil is the active part of the copaiba, the resin being almost entirely inert. It is obtained by distillation from the balsam. As first obtained it is of a beautiful green color. By redistillation it is colorless. When perfectly pure it is limpid and color- less ; volatile and inflammable, with an acrid taste, and a peculiar aro- matic color. This possesses all the active properties of balsam, and has recently been introduced into practice. The dose is from 10 to 20 drops taken on sugar, or made into an emulsion. R, . 01. Copaibae 3 ij Gum. Arabic. 3 ss Aq. Cinnamom. § ij Syrup. Simp. 3 iss Tinct. Theb. 3 ss Tablespoonful three or four times a day. Diseases in which the Copaiba is used. — Copaiba is almost exclusively used in mucous inflammations, especially gonorrhoea, for which it has long been the remedy. It used to be given only when the disease had DIURETICS. 258 passed into the chrome stage, but now is often used and with suca very early. The free use of saline purgatives combined with plentiful dilution will prepare the system for copaiba in a single day. It, should be given in full doses for three or four days, and then In smaller for about ;i week. ["It has less curative power over gonorrhoea in ilie female than in the male." — Ricord,] Copaiba is also used by Bome practitioners in ch rOnic catarrh of the bladde r. In old cases of bron- chitis it lias also sonic reputation, and may be used in leueonlio-a with prospect of advantage. The plant which yields this is the Piper cubeba, a species of pepper growing- native in Java, New Guinea, and the Isle of France. It is a climbing perennial plant. The fruit is a berry which grows in clusters. It is this part dried which is used in medicine. In their appearance cubebs resemble the common black pepper, with the exception of being lighter colored and having small stalks attached to them. Within the cortical part, which is hard, there is a single loose round seed, with a black coat — whitish and oleaginous within. The berries have an agree- able and fragrant odor. When chewed they have a pungent, aromatic, and slightly bitter taste, leaving a sensation of coolness on the tongue resembling that which is produced by peppermint. The powder is of a dark color and has an oily appearance. Composition. — According to Vauquelin, cubebs contains, ]. A volatile oil. 2. A resin resembling that of copaiba. 3. A small quantity of another colored resin. 4. A colored gummy matter. 5. Extractive. 6. Saline substances. According to Thomson the volatile oil resides chiefly in the nucleus. It is important to recollect that when pulverized the cubebs part very readily with the volatile oil, and then' active properties are greatly im- paired. To obviate this the best plan is tdfckeep them in the state of berry — or if pulverized in bottles closely stopped. Purity. — In the form of beny, according to Dr. Paris, it is frequently mixed with " Turkey yellow 7 berries," the dried fruit of the Rhamnus catharticus (common buckthorn). In powder it is apt to be adulterated with powdered pimento (allspice). Effects. — In their general operation on the system cubebs resemble black pepper. In moderate doses they act as a general stimulant to the stomach and to the system at large. In too large doses they cause pain and heat in the stomach and bowels, followed by nausea, vomiting, and purging ; the circulation is excited, skin hot and dry, and fever pro- duced. They exert a specific influence on the urinary organs, increasing the 254 MATERIA HEDICA AND THERAPEUTICS. flow of urine and imparting to it a peculiar odor. When they purge they are said to impart the same cool sensation to the rectum as they do to the mouth when chewed. There are several important consequences supposed to have resulted from the use of cubebs which it is well to be acquainted with. If the bowels are not kept freely open during their use the powder insinuates itself into the mass of faeces and causes excoriations of the rectum or hemorrhoids. Urticaria is another effect which has some" times been produced by it. Pereira says that he has known an erup- tion of this kind suspected as being of syphilitic origin. A case is related, by Mr. Boughton, in the London Medical Gazette, in which temporary paralysis followed the use of cubebs in doses of 3 ij, three times a day. In the first volume of the Medical Gazette Mr. Brodie relates a case in which it was given in chronic inflammation of the bladder. The irritation of the bladder produced by it was so great that it tended, as he thinks, to hasten the patient's death ; and Dr. Thomson gives a case in which the febrile irritation was so great as to endanger the life of the patient. From the foregoing it would seem that although generally a safe re- medy, it ought not to be used with unnecessary freedom. Mode of Administration. — Powder. — This is the common mode of giving it, and the best menstruum is milk. The dose is from 3 .ss to 3 ij, in half a tumbler of milk, two or three times a day. To have the full effect it should be freshly pulverized. Tincture. — ( 3 v cubebs to lbs. ij proof spirit.) This is a good prepa- ration, and may be given in doses of from 3 j to 3 ij« [B Pulv. pip. Cubeb. 3 ij ; Sub-nit. Bismuth, 3 ij ; Bi-Carb. Soda?, 3 j. M. Is one of the best helps to digestion I know of. Dose, 5 to 10 gr. after each meal.] Oil op Cubebs. — This is obtained by distilling the pulverized cubebs with water. It is a transparent, slightly colored volatile oil, with a hot, aromatic, bitter taste, and the peculiar odor of cubebs. This produces the same"ffect as the berry, and is a good form of giving it. The dose to begin with, is ten or twelve drops on sugar or suspended in water by mucilage. apium petroselinum (Parsley). A small plant, a native of the north of Europe, but cultivated every- where in gardens. Every part of it contains an essential oil, to which it appears to owe its virtues^ The part used is the root. This is the most powerful in its operation, yet every part of the plant appears to possess diuretic properties. Although a common this is a very valuable diuretic in a great num- ber of cases. It is mild in its operation and generally sits well on the DIIKKTMS. 255 stomach. It is admirably suited to those cases of strangury broughl on by blisters. In the ordinary suppressions of urine m children it i valuable article. To increase the efficacy of it the Beeds of the water- melon are frequently added ; or the sweet spirits of nitre. The form of giving it is infusion made by adding a pint of boiling water to § i of parsley. The recent rootia the most efficacious — a ten- cupful of the infusion may he taken every three or four hours by an adult. Daucus Carota [Wild Carrot). — The wild as well as the cultivated carrot is officinal, but though formerly esteemed a diuretic they have lost their reputation. The root of the common carrot is used as a poul- tice to foul ulcers, and acts as a very pleasant stimulant and corrective. Bucnu. — This is the Hottentot name for several species of plants lie- longing to the genus JD wsp ia, or, according to Willdenow, to the genus Barosma. They are shrubs growing at the Cape of Good Hope, and the leaves, when reduced to powder, have long been used by the natives as a perfume to anoint their bodies. The part used in medicine are the leaves. These are collected from the Barosma crenulata, the Barosma crenata, and the Barosma serratifolia, and sold in the shops as the Bu- chu leaves. The leaves are from half an inch to an inch long, and three or four lines broad. They are of a firm consistence, smooth and shining, with serrated edges, and of a pale or yellowish green color. They have a strong' and aromatic odor, and a bitterish taste, somewhat resembling that of mint. Their virtues are extracted both by water and alcohol. Effects. — The Buchu leaves are aromatic and stimulant. Taken in- ternally, they give tone to the digestive organs, promoting the appetite, and correcting nausea and flatulency. In addition to this they are dia- phoretic and diuretic. Mode of Administration. — Powder. — Twenty to thirty grs. taken in a little wine, two or three times a day. Infusion. — This is the common form of giving them. 3 ss of buchu to half a pint of boiling water. 5 i to 5 ij, two or three times a day. Tincture. — 3 ij leaves to lb. j proof spirits, macerated for seven days and strained — 3 i to 3 iv. The diseases in which Buchu has been almost exclusively used are those of the urinary organs. In chronic inflammation of the bladder it frequently proves exceedingly beneficial, allaying irritation, and check- ing excessive secretion. In irritation of the urethra, in spasmodic stric- ture, and affections of the prostate, it sometimes also does good. Like all remedies of this class, however, it is uncertain in its effects. As a stimulating diaphoretic it has also been used with advantage in rheu- matism. 256 MATERIA MEDICA AND THERAPEUTICS. ARBUTUS UVA URSI. This is the bearberry, and is a small evergreen shrnb, growing native in the northern regions of Europe and America. It also grows in the northern part of the United States, particularly in New Jersey. It bears a small round berry of a red color. The part used in medicine are the leaves. They have a bitter, astringent taste ; when fresh, no smell ; when dried and pulverized, acquire the smell of Hyson tea. The pow- der is of a light brown color, with a greenish tinge. The young and green leaves should only be used. The principal ingredient in these is the tannic acid ; so abundant is it that in Russia they are used for tanning. Besides this they contain bitter extractive, gum and resin, &c. Effects. — The uva ursi is astringent and diuretic Under its use, the urine becomes dark-colored, showing the absorption of it into the circu- lation, and its subsequent elimination through the kidneys. In this way it exerts a peculiar tonic and astringent power over the urinary organs. Upon this principle, it has been used in those cases in which the coats of the bladder are in a relaxed condition, accompanied with increased mucous secretion from them. In various chronic diseases of the urina- ry organs, it has been used with variable success, sometimes doing a good deal of good, at other times none at all. In acute cases, of course it is injurious. Form. — Powder, ±)\ to 3 i three times a day. Decoction. — Best form, § i, water § xx. Boil to pint and strain, 3 i to I ij three or four times a day. PYROLA UMBELLATA CHIMAPHILA UMBELLATA. Known by the common names of pipsissewa, wintergreen, rheumatism weed, &c. It is a beautiful evergreen, from six to eight inches high, found native in the northern latitudes of Europe, Asia, and America, and abounds in every part of the United States. The whole of the plant possesses active properties, but the parts used are the leaves and stems. The fresh leaves, when bruised, have a peculiar odor. They have a bit- ter, astringent, and somewhat sweetish taste. The principal constituents are bitter extractive, tannin, resin, and gum. Both water and alcohol extract all its virtues. In its effects, the pipsissewa is very analogous to the uva ursi, being tonic, astringent, and diuretic. Like that, too, it turns the urine black. To the stomach, it is a pleasant tonic : it improves the appetite and in- DIURKTICS. 2. r >7 creases tlic general strength. The diseases in which it, has bei are chronic affections of the urinary organs, dropsy, and scrofula. Form. Decoction. — ? ij to three pints of water boiled down to a quart. A pint in twenty-four hours. PAREIRA URAVA. This is the Cissampclos pareira, a plant growing on the Spanish Main and in the West India islands. It is generally called Pareira brava. which means wild vine, from the supposed resemblance of the root to that of the wild vine. It is a climbing shrub, with a large root, which is the part used in medicine. This comes in roundish pieces from half an inch to three or four inches in diameter, and from half a foot to three or four feet long, sometimes split longitudinally. Externally, it has a dark brown wrinkled appear- ance, and furrowed cortex. Internally, it is of a yellowish grey color, with concentric rings; very porous and easily split. It has no smell ; taste, at first sweetish, afterwards becomes intensely bitter and aromatic. Co7?iposition. — According to Feneulle, it contains starch, soft resin, yellow bitter principle, broivn coloring principle, nitre, with various other salts. More recently by "Wiggers, a new vegetable alkali has been dis- covered, which he' calls cissampelina. This is insoluble in water, solu- ble in ether, alcohol, acids, and of an intense sweetish bitterness. Effects. — Analogous in its action to the TJva ursi ; tonic, diuretic, and if used in considerable doses, aperient. Although recently brought into notice, it is not a new remedy. It was introduced into Europe two cen- turies ago (1648), and gained great celebrity as a specific in affections of the urinary organs. It was even supposed capable of curing stone in the bladder. After that it fell into disuse. Very recently it has a»-ain been brought forward, especially by Sir Benjamin Brodie, who recom- mends it very highly in chronic inflammation of the bladder, and gives it the preference to Uva ursi. Like all these remedies, however, it is uncertain in its operation. Form and Dose. Infusion or Decoction. — The common form is infu- sion. 3 vi — boiling water one pint; macerate for two hours. Dose, 5 j to 3 iij. Brodie boils half an ounce of the root in three pints of water down to one pint ; eight to twelve ounces of this to be taken dailv. Extract. — Grs. x to xxx. This is generally added to the infusion to increase its strength. Tinct. of Hyosciamus is also added to allay irri- tation. 258 MATERIA MEDICA AND THERAPEUTICS. CAHINCA. This is the root of the Chiococca racemosa or anguifuga, a plant grow- ing in the interior of the Brazils. The term cahinca seems to be de- rived from the Brazilian Indians. It is a vine-like shrub, growing five or six feet high, with a root two or three feet long and about the thickness of a straw or quill or that of the little finger ; of a reddish-brown color externally, with the surface knotty and wrinkled. The part used is the baric of the root, in which all the virtues of the article are supposed to reside. This bark has a bitter nauseous taste — is brittle, hard, and about a line thick. The inner part of the root has no taste. Composition. — According to the analysis of Caventon and Pelletier, it contains, first, a crystallizable principle, in which all the bitterness of the bark resides. This is called kahincic acid. Second, green fatty matter. Third, yellow coloring matter. Fourth, colored viscous matter. The virtues of the article are extracted both by water and alcohol. They appear to reside in the crystallizable substance. Effects. — Cahinca is diuretic and tonic, and at the same time acts on the bowels ; according to the dose in which it is given, it operates as a mild laxative or an active purgative. In considerable doses, it proves emetic also. Like many other diuretics it is by no means certain in its action. If it affect the bowels freely, its diuretic action is generally slight, and vice versa. Form — Decoction. — ( 3 ij to a pint of water boiled half away.) One or two tablespoonfuls three or four times a day. Watery Extract. — This is a good preparation, possessing all the virtues of the article. Dose. — 10 to 20 grs. The diseases in which it is chiefly used are dropsy and catarrh of the bladder. Muriated Tincture of Iron. — This possesses a good deal of diuretic power, and, in cases requiring the combination of tonic and astringent action on the urinaiy organs, answers a valuable purpose. In cases of retention of urine from spasmodic stricture, it frequently gives relief. It is to be taken in doses of ten drops every 10 or 15 minutes, till relief is obtained. This sometimes does not occur until nausea supervenes. Also given in chronic inflammation of the bladder, gleet, leucorrhoea, the latter stages of gonorrhoea, and in passive secretion from the kidneys and bladder. Dose. — 10 to 20 drops or more in some mild diluent. Mercury. — Of the general operation of mercury on the system, a very full account has already been given. Its action on the whole secre- uiuiumcs. 259 tory system was tlicn specially noticed. Among others it excitee into increased action the kidneys, and in this way increases the secretion of urine. By most writers on the materia medica, the diuretic operation of mercury is explained exclusively upon the principle of its stimulating the absorbents. Hy this means an increased quantity of fluid gets into the circulation which is afterwards directed to the urinary organs. In this way the efficiency of mercury in dropsy is explained. To me thi i does not appear altogether satisfactory, inasmuch as it excludes the primary operation of this article on the kidneys. In dropsies, mercury acts beneficially in various ways. In the first place, by stimulating directly the kidneys, in the same way that it stimulates the liver. It thus restores the functions of these organs, which in dropsy are generally impaired. In the second place, it acts by restoring all the secretions of the system, which are all more or less impaired in dropsy. In this way exhalation is diminished from the surface yielding the dropsical fluid. In the third place it acts by stimulating the absorbents. In all these ways combined it acts in removing dropsical effusions, and it is for these reasons that it is so efficient. [If anasarca depend on obstruction of the portal circulation by diseased liver, mercury, by modifying this diseased condition, may enable the kidneys to do their work better. It is in such cases and in this way that mercurials cure dropsy.] EMMENAGOGUES. This term is applied to a class of medicines "which is supposed to possess the power of promoting the menstrual discharge. This class of agents has been the subject of much difference of opinion. Many- practitioners deny that any article of the materia medica possesses any specific power to act on this so called uterine secretion. That the ope- ration of the supposed emmenagogues is excessively uncertain, all admit. Still there are a few agents which do increase the flow, and though many of them do and all may act indirectly, yet practical convenience justifies us in retaining the class that attention may be directed more strongly to their power, whether direct or indirect, specific or general, of pro- moting the discharge and thus relieving some very common and very distressing forms of diseases. Suppression of the menses may result from a variety of causes, and is generally, perhaps always, only a symp- tom of some derangement of the general health, and of course those agents which restore it, must do so by acting on the disease of which it is a symptom. Hence, in varying states of the system, bleeding, acrid purges, stimulating diuretics, tonics, antispasmodics, each and all may act as emmenagogues. Doubting whether we have any article entitled to the name of specific emmenagogues, I shall speak of the articles commonly included in this class under four heads. Stimulating diuretics. Cathartics. Tonics. Local remedies. Stimulating diuretics. — The modus operandi of these articles is very simple; by their local impression on the bladder they stimulate the uterus by contiguous sympathy. Of these the most popular are certain vegetable infusions, or the volatile oils obtained from them, as rue, pen-' nyroyal, tansy, &c. Their powers are very commonly (in domestic practice) aided by giving with the infusion a quantity of some ardent spirit, as gin, whiskey, or the like. The essential oils of these and other plants are also occasionally given as emmenagogues. There is no reason to suppose that either the infusion or the oils have any special power over the uterus ; they act as acrid and very uncertain stimulants, and the number of cases in which they can be advantageously, or even safely used, is exceedingly small. KMMKNAfJCKJUKS. 2G1 There are two stimulating diuretics in common use which deserve special notice, cantharides ami savin. Of the former I shall give the history when speaking of epipastics; it suffices here to say that, from its agency on the urinary organs of which f have already spoken, i cially when it produces strangury, it may, by transmitting its irritation from the neck of tlic bladder to the uterus, stimulate that organ, and sometimes bring on the menstrual discharge. It is generally given in tincture, of which twenty drops twice a day is a good dose to begin with ; it may be increased till some symptoms of strangury appear, when it should be stopped and diluents given to relieve the bladder. It is appropriate only to those cases where suppression occurs in dull leuco- phlegmatic girls. To the nervous, the irritable, the sanguine, it can do nothing but barm. savin (junipcrus sabina). This is an evergreen shrub, growing in the south of France, also in Canada; it rises to about the height of three or four feet. The stem lias a brownish bark ; the leaves, the part used in medicine, are small and bright green. They have a strong, disagreeable odor, and a hot, bitter, acrid taste. Their active principles are given up to both water and alcohol ; to the latter in the greater quantity. They contain a large amount of an odorous acrid oil, which is obtained by distillation with water. Nearly fifteen per cent, of oil has been obtained from them. Effects on the System. — Savin is a stimulant whose action is directed to the pelvic organs. It produces irritation, and sometimes inflamma- tion of the rectum, and has frequently caused abortion, for which nefa- rious purpose it is not unfrequently used. As an emmenagogue it is rarely used in regular practice, and should only be ventured on in cases like those for which cantharides is advised — the phlegmatic, torpid, nnirritable. To the plethoric it would be and often is poison. Mode of Administration. — Powder — dose, ten to twenty grains three times a day. Infusion and Decoction. — Safer than the powder ; the oi7, one to five drops. This is the dangerous preparation. GUIACUM. The only form in which this is used as an emmenagogue is the vola- tile tincture, and this is certainly a most valuable, safe, and reliable article. It is highly recommended by Dewees, who used it with a con- fidence that he had in very few remedies. It is appropriate to all cases except where excitement and plethora are very manifest. 262 MATERIA MEDIC A AND THERAPEUTICS. Dose. — Thirty drops in a glass of milk thrice a day, to be increased till a drachm is taken. If it purge, give a few drops of laudanum with it; if, on the contrary, the bowels become costive, they must be kept soluble by aloes. Purgatives that are useful in Amenorrhea. — Of these I will only men- tion aloes as infinitely the most valuable. It should be given during the interval in doses just sufficient to keep the bowels soluble, but immedi- ately before the time when the discharge should appear, a few purgative doses may be tried. Combined with guiac (five grains of each in pill), it often produces most excellent effects. Tonics given for Amenorrhea. — Two different classes may be used under different circumstances. 1. The vegetable tonics, of which caluraba is the best, may be given as stomachics to give tone to the stomach, and improve the appetite. 2. The ferruginous tonics, which are appropriate to all those cases where anemia and chlorosis are present. Neither of these classes of tonics should be given till the digestive organs are in a healthy state, tongue clean, bowels regular, secretions healthy. Local Remedies useful in Amenorrhea. — (a.) Leeches. — These ap- plied to the vulva have been recommended by some with the view of determining the blood to the uterine organs, and aiding in this way in the restoration of the menstrual flux. They have been supposed to be particularly useful in cases where the interruption of the menses has been very sudden, occasioned either by exposure to cold or some violent impression made upon the system ; or in cases where determinations to some other organ or organs exist along with the suppression. All this may be true, and, no doubt, in some cases they may prove advantageous. The great objection to them is the difficulty of getting patients to sub- mit to their use. Indeed, the indelicacy attending the application of leeches in this way is so great as to prevent their being generally re- sorted to. A good substitute, and perhaps preferable in most cases, is to apply them to the inside of the thighs, and to the ankles. Indeed, by Laennec, it is asserted that in these situations they produce quite as great a derivative effect as they do when applied to the vulva, espe- cially if applied to the thighs and ankles at the same time. Used in this way they may sometimes be resorted to with advantage. [I think much more highly of this remedy — use it often and usually with good effect. — Ed.] (b.) Lnjection of Aqua Ammonia into the Vagina. — This is an emme- nao-ogue remedy, which was originally suggested a few years since by Lavagna, and has been attended with no inconsiderable success. By him, four cases of amenorrhoea are related as having been cured in the same number of days by injections of warm milk with aq. ammonias in EMMENAGOGUES. 263 tlie proportion of from ten to twelve drops to the ounce. — Since then it has been tried in this country, and with success. Dr. Hosacfc relate case of amenorrhea of ten years' standing which had resisted all the oridinary aloetic and mercurial emmenagogues, and which was relieved by an injection into tlie vagina of aq. ammonias and rain water in the proportion of 3 »s to § viij. The injection was repeated three time day. It caused a slight degree of irritation, and in about five weeks the menses were restored. By Dr. Gloninger of Pennsylvania two cases of a similar kind are also related. In one, madder, polygala senega, helle- bore, cantbarides, iron, aloetics, and mercurials were all tried without any advantage. After this, injections of milk and ammonia (ten drops to the ounce) were given four times a day. At the expiration of eight- een days the menses appeared. In another case, by the same mean-. they were restored in the course of a couple of weeks. — N. Y. Med. and Phy. Jour., vol. iii. p. 38. (c.) Pediluvia, Warm Fomentations, dtc. — The efficacy of immersing the feet in warm water has long been known. It certainly has a most powerful influence in determining blood to the lower extremities, and in this way intermediately to the uterine organs. In some cases ren- dering the water stimulating by the addition of mustard has an excel- lent effect. Warm fomentations, fumigations, and the semi-cupium, act in the same way by relaxing the vessels and determining to the uterine organs. In cases of sudden suppression especially they frequently have an admirable effect. (c?.) Dry Frictions. — Frictions on the thighs have been recommended by some as advantageous in restoring the menstrual discharges. Electricity. — Electricity has been strongly recommended by Nauche and Siebold of Germany, and by Dr. G. Bird in England. It was used at Guy's Hospital with great, and, in some cases, almost instant success. It is proper only in those cases where the other functions being well performed, anaemia not present, the absence of the menstrual secretion is the only symptom of disease. In such cases it will often answer an admirable purpose. A variety of other substances have been used as emmenagogues, as hellebore, madder, senega, and of late strychnine. Neither of them have held their reputation, or justified the confidence with which they were commended to the profession. PARTURIENTS • By this term is meant those medicines which possess the power o aiding and increasing the parturient action of the uterus. Although a number of agents have been supposed capable of producing this effect, yet there is only one whose character is sufficiently established to entitle it to special notice. This is the ergot, SEC ALE CORNUTUM. This is known by the common names of the spurred rye and ergot. It is a dark-colored crooked excrecsence growing from the rye, pointed at its extremities, and resembling the spur of a cock. Concerning the nature and origin of this very singular substance various opinions have been entertained. By De Candolle, it is supposed to be a parasitic plant belonging to the natural order of the Fungi ; and he gives to it the name of the Sclerotium clavus. Others suppose it to be nothing more than a disease of the grain itself, produced, as has been conjectured by some, by the puncture of an insect. More recently Mr. Quekett, who has made the ergot the subject of an elaborate investigation, asserts that it " is produced by a particular species of fungus, which developes itself upon or in the grain, whilst the latter is very young, causing its remarkable alteration from a healthy state, in form, color, chemical composition and properties." And the ergot, he considers to be "a mass composed of the constituents of the diseased grain, mixed with fungic matter, occupying the place of the healthy ovary, of which can be observed some relics in its triangular shape, and the furrow on one of its sides, both conditions being those of the perfect grain also." To the fungus producing the ergot, Mr. Quekett proposes giving the name of Ergotoetia abortans* called also Oidium Abortefaciens. Mye, although the most common, is not the only grain on which the * Observations on the Anatomical and Physiological Nature of the Ergot of Rye, and some other Grasses. By Edwin J. Quekett, Esq., P.L.S. Jour, of Pharmacy, vol. x. p. 116. PAETUEIENTS. 265 ergot grows — it is round, also, attached frequently to barley and wheat. Properties. — The ergot is generally about ball' an inch or a little more in length and half a line or more in thickness — curved and pointed at its extremities — with a deep longitudinal groove on one or both of its sides. Externally its color is deep violet, internally white. Its texture is hard and brittle. It has a slightly acid and pungenl (no1 very marked) taste, and a faint unpleasant odor, which is perceptible, however, only when the article is in considerable quantities. It is specifically lighter than water. Sound rye is heavier. : Chemical Composition and Properties. — According to Vauquelin, ergot contains the following constituents: first, a yellow fawn-colored matter, soluble in alcohol ; second, a violet-colored matter, insoluble in alcohol, but soluble in water ; third, a sweetish oleaginous matter, in great abundance; fourth, a free acid, probably the phosphoric; fifth, an azotized matter in great abundance, which easily became putrid ; sixth, free ammonia, which escaped at the temperature of boiling water. The virtues of ergot are yielded both to alcohol and water. Effects. — Aside from its peculiar and truly specific effects on the uterus, ergot in the usual dose in which it is given as a parturient has very little if any effect on the system. In large doses it affects the brain and nervous system, causing headache and giddiness. It also produces severe irritation of the stomach and. bowels, nausea, sometimes griping, purging, with cramp in the legs. It is upon the uterus, and especially the pregnant uterus, that ergot shows its powers. When given to a woman in labor it calls into most vehement action the con- tractile powers of the uterus. The pains thus excited differ most markedly from those of natural labor. Instead of the alternate contrac- tion and relaxation of the uterus which takes place in the latter, the contraction is permanent, or continued with only partial remissions. The pains accordingly do not intermit as in natural labor, but there is a constant contraction, though not equally severe at all times. An interesting and valuable peculiarity attending the action of this agent is that it produces its effect on the uterus with great promptitude. As a general rule it developes its action within twenty minutes or half an hour.* Another peculiarity attending the action of the ergot is that it leaves the uterus in a state of permanent tone after its contents have been * In twenty cases observed by Prescott, the time was precisely marked. " In two of them the increased strength of the pains and the continued action com- menced in seven minutes from the time the decoction was taken ; in one case, it was eight minutes ; in seven, it was ten ; in three, eleven ; and in three others it was fifteen minutes. In the four remaining cases, there was no apparent opera- tion until twenty minutes had expired." — P. 11. 266 MATERIA MEDICA AND THERAPEUTICS. expelled. Hence it is that its action is never followed by hemorrhage. [I wish this were true, but think it is not.] The effect which ergot thus produces on the impregnated uterus is not limited to the full term of pregnancy. It exerts the same kind of influence during the whole of gestation, and hence it is that it has been too frequently used for the criminal purpose of producing abortion. Whether it really possesses this power has by some been doubted [but abundant experience has settled the question, and the remedy is now used in regular practice to induce premature labor. — Ed.] Uses of the Ergot. — From the effect of ergot, the -general use to which it is applicable is obvious. It is to produce uterine contraction, with a view to expel the contents of the uterus or to arrest hemorrhage. Although used empirically long before, the attention of the profession was first called to the value of the ergot as a parturient agent in 1808 by Dr. Stearns, then of Saratoga county in the State of New York. Possessing such remarkable powers it at once attracted great interest and was speedily introduced into general practice. From the account which has been given of its effects it is evident that it is a remedy of great power, and that it cantiot be used indiscriminately without much danger. Nevertheless there are certain cases in which it may be used with advantage, and if properly guarded, without risk. Every now and then cases are occurring in which it is desirable for the safety of the mother as well as that of the child, to quicken the action of the uterus for the purpose of expediting the delivery, and it is in such cases that we are furnished in the ergot with a valuable resource. The rules which should govern its exhibition are few and simple, and are directly deduci- ble from the manner in which it acts upon the uterus. In the first place, it should never be used in the incipient stages of labor. The object of nature in this stage is a specific one, and it is to relax and dilate the mouth of the uterus. In other words, the object here is not to expel the child, but to prepare the parts through which the child has subse- quently to pass. Now this is best accomplished gradually and by the repeated recurrence of pains at intervals, just as take place in unassisted labor. To stimulate the uterus at this period by the use of ergot would be creating a disproportion between the means and the end. The uterus would make unavailing efforts, which might terminate in rupture of that organ ; or if this did not happen, unnecessary pain and suffering ■would be given to the patient, while from the long continued pressure to which the child would be subjected, that might be destroyed. In the second place, it should never be given until the mouth of the uterus is dilated, the membranes ruptured, and the external parts dis- posed to yield. In other words, it should never be given until the parts through which the child is to pass are in a state to admit of a speedy delivery, under the forcing and expulsive pains of ergot. On this I'AKI I KIKVI'S. 267 account it is an agent which as a general rule should be used with caution in first labors, inasmuch as the parts to I": dilated are more unyielding than they arc. subsequently. In all cases in which the babit is plethoric and the fibre rigid, relaxation ought to be promoted by venesection, &c, antecedent to its use. In the third place, if should never be given where the presentation is preternatural, and where the operation of turning may be required. During the powerful and unre- mitting contraction brought on by ergot, this operation would be, if wholly impossible, attended with great danger. Lastly, it should never be given except when nature is incompetent to a safe delivery. By too many, it is to be feared, it is used merely as a time-saving agent. Nothing can be more reprehensible than this practice. As a general rule nature is competent to a safe delivery, and we may rest assured that the best plan is to leave her alone to accom- plish the work. Artificial and violent interference cannot but be improper. From the foregoing, therefore, it may be inferred under what circum- stances it may be used with advantage. In cases of natural labor, where the membranes are ruptured, the os uteri dilated, and the head of the child descended into the pelvis, it may be used, provided the natural efforts of the uterus are unable to accomplish the delivery. In such cases it ought to be used in preference to the forceps. [Besides its use as a parturient, ergot has been used as a uterine stimulant in a variety of cases, and often with great success. To some of these uses I will allude. 1. It has been, as I before stated, used to bring on premature labor in cases of deformed pelvis. The best plan in these cases is, not to rely exclusively on the ergot, but to give four or five doses at intervals of four to six hours, and then rupture the membranes. The operatiou of inducing premature labor for any cause involves very great responsibility, and should never be undertaken without very deliberate consideration, and, if it can be had, a consultation. It should never be done earlier than the seventh month. 2. As a means of exciting uterine contraction, and checkino- benior- rhage after labor, here ergot is often of great value. It will in many cases do good, and, in proper doses, never can do any harm. It should be given the moment the child is expelled. 3. Ergot has been successfully used to excite uterine contraction and to expel foreign bodies from the uterus ; by its agency polypi of the uterus have been crowded into the vagina and brought within the reach of the ligature. Hydatids have in the same way been expelled. Ergot has been ad- vised in retained placenta ; it ought not to be depended on ; also in puerperal convulsions, where it is much more likely to do harm than, good. — Ed.] IS 268 MATERIA MEDIC A AND THERAPEUTICS. DANGERS TO BE APPREHENDED FROM THE USE OF ERGOT. 1. Prolapsus Uteri. — Dr. Dewees states that lie has heard of several cases of this kind occurring in the practice of a physician who was in the habit of using ergot indiscriminately in almost every case of labor. That it may produce this effect occasionally, even in the hands of those who use it discreetly, is proved by a case which is related by the same writer. A lady aborted a little beyond the fifth month with twins. As the involucra did not come away for some days after the embryos, twenty grains of ergot in powder were given with the effect of bring- ing them away. The patient, supposing something was left behind, shortly after took another dose, contrary to the advice of the phy- sician. The result was a renewal of the pains and a protrusion of a considerable portion of the uterus through the os externum. This fact ouo-ht to furnish a caution in relation to the use of this article, in cases where the contents of the uterus have been evacuated, and where of course there is nothing to prevent that organ from being prolapsed.* 2. Rupture of the Perinceum. — I am not aware that this has actually occurred from the use of ergot. If it has it is not likely to be reported. From the violence of the pain, however, produced by the ergot, it is an accident much more likely to occur than under the ordinary pains of labor. The fact has not escaped the observation of those who have used it. Dr. Ward says, " the contraction of the womb has in some cases been so powerful, that I believe a laceration of the perinseum would have taken place, unless I had prevented it by counter-pressure."f 3. Hour-glass Contraction of the Womb and Retention of the Pla- centa. — It is only recently that attention has been called to this effect of ergot, by M. Chavasse, surgeon, of Birmingham in England. In re- lation to it he says, "I am convinced that since the ergot has been called into use, cases of this kind have been of far more common occur- rence than formerly,"^ and he states a number of facts corroborative of the truth of this from his own practice as well as that of some of his professional friends. Mr. Jukes, of Birmingham, states that in his first trials with the ergot, he had no less than six cases of retention of the placenta, almost in succession; three of which are well marked cases of hour-glass contraction.§ Mr. Elkington says, that " the exhibition of it was so often followed by irregular action of the uterus, sometimes by increasing and inefficient pains, and by retention of the placenta, that I now seldom use it."| Since I have used it less frequently I have had very few cases of retention of the placenta. Mr. P. H. Chavasse con- * American Jour, of Med. and Physical Science, vol. i. p. 259. ■J- N. T. Med. and Phys. Jour. vol. iv. p. 202. \ State Trans, vol. iii. p. 352. § Ibid. p. 354. || Ibid. p. 354. PAKTriUKNTK. 269 firms the same, and expresses the belief that it is a frequent can hour-glass contraction of the womb.* He also states thai in all the eases which came under his observation the retention of the placenta was not occasioned by any adhesion of it to the uterus, but simply by the hour-glass contraction.! Dr. lleane says,, that " in the administration of ergot he never '•(in- siders himself safe after the birth of the child, until by Blight extension he'has drawn the placenta into the vagina, for he has had three cases in which the os uteri has contracted so powerfully round the funis, as to make it necessary to introduce the hand into the uterus, " a painful and difficult task," he adds, " from the resistance which the os uteri offered to every attempt at dilatation.''^ [4. Besides tdiese many and great dangers, there are others affecting the mother, viz. rupture of the uterus. No person can witness the tre- mendous efforts to which the uterus is excited, when ergot produces its full effect, without the most vehement apprehension of this disastrous accident. Although this may happen in any case, and is, therefore, an objection to using the drug at all, yet it is more to be apprehended when the ergot is given before the parts are well prepared to give way before the head, and permit it to pass without delay. The violent shock given to the nervous system. From this the patient may not reco- ver for a long time, or it may cause convulsions or puerperal mania. It is to the child that ergot is most fatal. Some have supposed that it has a directly poisonous influence, but this I think is not proven ; and its fatal effects, of which, alas ! there can be no doubt, are to be explained by referring it to the constant and very violent pressure made on the head. This danger will be diminished — it can never be avoided — by not giving the drug till the parts are prepared to let the head pass with facility. I lay it down as a rule, to which there are exceedingly few exceptions, bhat where ergot is given and produces its full effect, if the child is not expelled in half an hour, that child will be still-born. — Ed.] Chronic Uterine Discharges. — In these cases, ergot is recommended by Dr. Marshall Hall. In one case of menorrhagia, alternating with leucorrhoea, of four years' duration, ergot was given successfully in doses of five grains, four times a day, beginning just before the expected return of the menses. In several cases of leucorrhoea, too, it was used by him with success. The effects of the remedy, according to him, are generally perceived at the end of five days. It should, however, be continued some time longer.§ By Dr. Bellinger, of Charleston, ergot was tried in menorrhagia ; * Med. Gazette, Jan. 1839, p. 640. f Ibid. p. 355. % Ibid. p. 355. § American Jour. Med. Science, vol. vi. p. 697. 270 MATERIA MEDIC A AND THERAPEUTICS. and he states the hemorrhage was increased, and the sufferings of the patient greatly aggravated.* Mode of Administration. — Ergot is given in substance, infusion, and tincture. Tincture. — Of the saturated tincture, a drachm may be given every twenty minutes till an effect is produced. If in substance, dose 3i, to be repeated every twenty minutes, till er- got pains are produced. In this form, ergot very often offends the sto- mach, causing nausea and even vomiting. Infusion. — Generally made by pouring a teacupful of water on one drachm of ergot in coarse powder, and giving one fourth every twenty minutes. [The tincture is the preparation I generally use ; I think it more reli- able than either of the others. The fluid extract can also be depended on. — Ed.] * Ibid. vol. vii. p. 272. SEDATIVES. By Sedatives are meant that class of agents whose d irect operatio n ifi to lessen action in the system. By some high authorities, the existence of such a class of agents is not merely questioned, but positively denied. I will not go into any lengthened discussion of this point at present, as it will abundantly appear hereafter that though their number is undoubt- edly limited, yet there arc certain agents whose operation is directly and immediately to lessen action in the system, and that without any previ- ous excitement or any narcotic power. By some writers, sedatives are confounded with narcotics. Now it is true that narcotics, like seda- tives, repress and impair action, but between the two are wide differences. For although both in their ultimate effects repress action, yet narcotics in their primary action are exciting, while sedatives are directly and immediately repressing. For example, opium is in its first action excit- ing, and only secondarily does it prove sedative — it is a narcotic. Blood- letting, on the other hand, is at once depressing — it is a sedative. Sedatives act mainly on the vascular system, while narcotics affect most obviously the nervous system, and the practical application of the two classes of agents is entirely different ; this affords us a strong, and to me controlling, reason for considering them apart. As the articles belonging to this class are few and important, I shall notice them so fully and elaborately as to preclude the necessity of any further general remarks. INDIVIDUAL SEDATIVES. BLOODLETTING. Less slaughter, I am convinced, has been effected by the sword than by the lancet, that minute instrument of mighty mischief — Reid on Nervous Diseases. You need scarcely be told that this is one of the most potent agents which the practitioner has to wield in the treatment of diseases. 272 MATERIA MEDICA AND THERAPEUTICS. According as it is used, it may either save life or destroy it. It is, there- fore, essential that you should be thoroughly instructed in the various circumstances which either indicate or forbid its use. It is the more necessary tbat this subject should be very carefully investigated in this country, as -there is but too much reason to fear that great mischief has been done by the indiscriminate use of the lancet. In discussing this subject, I shall pursue the same order that has been hitherto observed, and treat, — Of the Effects of Bloodletting. — On the Vascular System. — Here the effects produced are two-fold, viz. upon the blood itself, and upon the system circulating the blood. On the Blood. — The first and obvious effect of bloodletting is the sim- ple diminution of the actual quantity of blood in the system. But, although the whole quantity of blood in the system is diminished, it does not follow that the quantity in each individual organ is proportionally diminished. Generally speaking, it is so with every part of the body except the brain. From the peculiarity of structure of this organ, it is evident that it cannot admit of the same loss of blood as all the other organs of the body. Indeed, by some this idea is carried so far, as to main- tain that under no loss of blood from the system at large can any material change take place in the quantity of blood circulating in the vessels of the brain. This view was, I believe, first promulgated by Dr. Alexan- der Monro, primus, and has been argued pro and con by Burrows, Aber- crombie, and others; professional opinion, though very much divided till of late, has now, I think, settled down to the conviction, that though Dr. Monro's view is not in its full extent correct, yet the variation in the quantity of blood in the brain is by no means as great as in the other organs. In many cases the veins of the dura mater do not parti- cipate in the general bloodlessness which characterizes death from hemorrhage. This then is the first effect of bloodletting, viz. to diminish the quan- tity of the blood in the system generally, without,, however, diminishing it in the same proportion in every particular organ. [This effect is but transient, the normal quantity is soon restored by endosmosis. The more important change is in quality, for immediately after a bleeding the vessels take up watery fluid from some part of the system, and thus the proportion of water in the blood is increased and the fluid is less stimulating to the heart and arteries. [The following table from Becquerel and Rodier illustrates very strik- ingly the effect of bleedings on the blood. It gives the mean results of the first and third bleedings in ten of the patients in Cruveilhier's wards. SEDATIVES. 273 r First bleeding. Third blei Density of defibrinated blood, L056-0 lonw; Density of scrum, 1028-8 1025'6 Water, 793-0 833*1 Solid residue, 207-0 L76'9 Albumen, 05-0 «it-0 Fibrinc, 3-5 3-4 Corpuscles, 129-2 99'2 The general conclusion from these tables is that bleedings increase the quantity of water in the blood and diminish its specific gravity; that the quantity of albumen and fibrine is scarcely at all affected, while the corpuscles are diminished in a very notable degree. — Ed.] A second effect of bloodletting is to diminish the activity of the circu- lation. The heart contracts with less power upon its contents and pro- pels a less quantity of blood into the arteries. The pulse, accordingly, which is the index of the heart's action, becomes smaller, less blood and of a less stimulating quality is also sent into the capillaries, and their action is diminished. On the surface you see an evidence of this in the paleness which ensues, and the same takes place throughout the system. These, then, are the two effects which it produces on the vascular system, viz. lessening the quantity and impoverishing the quality of blood, and, as a consequence, impairing the actiou of the heart and bloodvessels. On the Brain and Nervous System. — As the energy of the brain de- pends upon the due degree of stimulus which it receives from arterial blood flowing through its substance, it is evident that whatever deranges the circulation must also derange the condition of the brain. As alrea- dy stated, the actual quantity of blood in the brain is in all probability always very much the same. It is mainly the alteration in the compo- sition of the blood that affects the brain ; still though the condition of this oro-an be not affected by any increase or diminution of this fluid, yet there are various other modifications of the circulation which may affect it. For example, although the quantity of blood in the brain at any one time may not vary, yet the quantity circulated in a given period may vary greatly, according to the frequency of the contractions of the heart. So also may the power or momentum with which the blood is driven by the heart to the brain, and in both these ways may the ener- gy of the brain be impaired. Now, as already stated, when blood is abstracted by venesection the action of the heart is impaired, the circu- lation becomes slower, and the force with which it is driven to different and distant parts is lessened. The brain participates in this general effect — the blood is driven less forcibly to this organ, while the quan- tity circulating through it is also less. The result is that the energy of 274 MATERIA MEDIC A AND THERAPEUTICS. the brain and nervous system is more or less impaired ; and giddiness, sickness at stomach, and even fainting come on. Relaxation and consequent loss of power in the muscles, with coldness and a contracted state of the skin, are effects of the loss of blood so familiar and so easy of explanation that they need only be named. Circumstances Modifying these Effects. Age. — This is a cir- cumstance modifying very greatly the effects of venesection, and requires especial notice as lying at the basis of the use of this important remedy at various periods of life. As a general rule, children do not bear the loss of blood as well as adults. A striking illustration of the difference between the effects of venesection in children and adults is seen when syncope happens to be. induced. Adults, as a general rule, very readily recover from this state. In children, on the contrary, such is the deficient reaction that they recover very slowly, and this state is always attended with more or less danger. Armstrong says, " do not bleed to actual syncope in children, as they are apt to fall into convulsions, of •which they may die. Another reason is that a violent reaction takes place after syncope. Children do not recruit from very large bleedings like adults, especially in a confined atmosphere." From twenty to fifty, man is in his fullest strength and vigor, and it is during this period that the loss of blood can best be borne by the human system. In Old Age the action of the heart is impaired, the circulation becomes slower, and the general powers of the system sensibly fail. Under the loss of blood, as a matter of course, reaction does not so readily take place, while, if the quantity be at all large, great prostration will follow. Hence at this period, although moderate quantities of blood may be taken with benefit, and are indeed frequently rendered necessary by the venous congestions to which at this period of life we are especially obnoxious, yet excessive depletion is often succeeded by dangerous or even fatal sinking of the system. Sex. — Other things being equal, as a general rule, females do not bear the loss of as much blood as males. This is owing obviously to the greater delicacy of their constitutions as well as their more simple mode of life. In considering the effects of venesection on the female system, there are three conditions of it which require to be noticed, that of men- struation, 'pregnancy, and that immediately succeeding the cessation of the menses. During menstruation the use of bloodletting has been by many objected to, but without just reason. The ordinary menstrual discharge is by no means so great as to produce anything like debility in the sys- tem from its mere quantity, and to render the loss of blood by artificial means at all objectionable, if it should be necessary. You should, SED ATI VICS. 275 therefore, never be deterred from the use of this remedy under tl circumstances, provided the otlier symptoms require it. During pregnancy, also, prejudices bave existed against the a e oi venesection. As a matter of fact, however, bloor. Leeds was, I believe, the firsl person who made experiments with tliis view upon animals. He bled dogs to death, and uniformly found that whether the blood had been drawn from an artery or a vein, serum was effused into the brain. With regard to the effect of profuse bloodletting on the other internal organs, our facts arc more scanty. Generally, however, the bronchiae are found closed and the lnnjxs oedernatous. In some cases effusions into the pericardium and cavity of the pleura have been observed. The great practical conclusion to be drawn from these facts is, that there is a point beyond which bleeding should never be carried. In tin- application of this principle to apoplexy or hydrocephalus, it is obviously of the greatest importance. States of the System favorable to the use of Bloodletting. — Under this head I propose not to indicate all those cases in which venesection is absolutely necessary, but simply to designate those general conditions of the system more or less favorable to the safe use of this remedial agent. Of the favorable states of the system the following may be mentioned. 1. General Plethora. — Other things being equal, just in proportion to the quantity of blood in the system, is it able to sustain the loss of it. 2. A state of General Vascular Excitement. — The reason of this is obvious. As one of the effects of bloodletting is to reduce the action of the heart and arteries, it is very evident that when this action is excited bevond the natural standard, the abstraction of blood can be borne much better than in the natural condition of the system. As a general rule, therefore, a state of arterial excitement increases the capability of the system for bearing the loss of blood favorably. To this there are certain exceptions, however, which will be noticed hereafter. 3. A state of Local Inflammation. — As local inflammation is always associated with more or less general excitement, there is the same reason for this being favorable to the loss of blood as in the last case. In addi- tion, however, there is another reason drawn from the local affection. This acts as a kind of permanent stimulus to the heart and blood- vessels, and therefore the loss of blood in these cases is less felt than under any other circumstances. 4. A state of Local Congestion. — An organ, instead of being actively inflamed, and in consequence of this, having its substance overloaded with blood, may be congested. Now, this is a state in which the venous system of the part becomes crowded with an unnatural share of blood, and the part becomes, as it were, apoplectic. In this state the general system, instead of sympathizing as it does in inflammation, by causing great vascular excitement, does it in a different way. There is a general 282 MATERIA MEDICA AND THERAPEUTICS. oppression, the circulation instead of being quickened is impeded, and the pulse is actually slower than natural. In short, the system, like the organ affected, is in a state of oppression. Now, this condition is also favorable to the abstraction of blood. By relieving this congestion which oppresses the system, the circulation becomes liberated and more free in its movements ; the pulse increases in fulness and frequency, while the whole strength of the patient is invigorated. The States unfavorable to the loss of Blood are the fol- lowing : — 1. "Where there has been already a considerable loss. — In these cases the further abstraction of blood may be immediately at- tended by dangerous if not fatal consequences. 2. "Where in consequence of some shock given to the System, the func- tions of the Brain and Nerves are partially suspended. — An instance of this you have in ordinary concussion of the brain. Although it is a very common practice on the receipt of an injury to have instant re- course to venesection, yet nothing can be more irrational or dangerous. The brain and nerves have been so much depressed by the shock that any further debilitation, and especially by such a remedy as bloodlet- ting, will often prove fatal. When the system recovers from this state and reaction is fully established, then bleeding is proper to prevent inflammation. Some authors advise to bleed as soon as reaction be- gins, thinking thus to prevent the possibility of inflammation. This is a practice to be resorted to with very great caution ; reaction is an effort of nature to restore the system to its natural condition, and we should never interfere with it till well assured that it is excessive. 3. Where the Brain and Nervous System have been affected in a peculiar way by violent injuries. — An illustration of this you have in ordinary burns or scalds. Here, too, the vital energies are overwhelmed, and a true reaction must be allowed to take place. With this, of course, nothing is so sure to interfere as bloodletting. 4. Wliere the Brain and Nervous System have been impaired in their tone by causes of more permanent operation, rendering the whole habit nervous and irritable. — This state may be induced by either intellectual or physical habits. Among the first may be mentioned excessive and irregular mental effort, and among the second may be specially noticed the excessive use of intoxicating liquor [and masturbation]. 5. A state of real debility. — Of all the states perhaps this is the one most decidedly unfavorable to the loss of blood. You are to distin- guish here, however, very accurately between real and apparent debi- lity ; while the first is in every respect unfavorable to the loss of blood, the latter frequently requires it. Illustrations of real debility you have in the latter periods of disease ; of apparent, in various congestive affections. BKDATIVKB. L'83 Op THE ORDINARY MODES OB 1 JUDGING OF THE PROPRIETY OB [IMPRO- PRIETY OP UAVJNU RECOURSE TO VENESECTION. Pulse. — The |nil ■■• i- the index by which wo judge of the actual <•* >n< lit ion of the lir-ai 1 find bloodvessels, and the importance of understanding its relation to morbid states, therefore, must be self-evident. A great variety of pulses have been distinguished by practical observers. Many of these distinctions are, however, altogether too minute to have any useful and practical application, The more important arc the following, and they all de- pend upon various modifications of the action of the heart, the quantity of blood thrown out of that organ, and lastly the condition of the arteries themselves. A Frequent Pulse, in which there arc a greater number of pulsations in a given tinjp than natural. This pulse depends upon the rapidity with which the contractions of the heart succeed each other. The re. verse of this is the infrequent pulse. A Quick Pulse. — This is often confounded with a frequent pulse. It is, however, entirely distinct. A pulse is said to be quick when each pulsation is performed in a shorter time than natural, and has no refer- ence to the number of pulsations in a given time. This pulse de- pends upon the rapidity with which the heart contracts upon its con- tents. It is sometimes also called the jerking pulse. The difference, then, between a frequent and a quick pulse is this. Frequency relates to the number of beats in a given time. Quickness to the suddenness of the individual beats. The reverse of the quick pulse is the slow pulse, in which the indivi- dual pulsations occupy a longer time than natural. The infrequent and slow pulse generally go together, and for practical purposes may be con- sidered as the same. A Strong Pulse. — By this is meant a pulse in which the artery gives resistance to pressure. It depends upon the force with which the heart contracts. The reverse of this is the weak pulse. A Full Pulse. — The difference between this and the strong pulse is that the former is characterized by its size and volume. The full pulse depends upon the size of the artery and the quantity of blood thrown out by the heart. The reverse of the full pulse is the small pulse. A Hard Pulse. — This is also called the tense or chorded pulse, and is that pulse in which the artery feels like a wire or tense cord. It seems to depend upon a rigid or spasmodic condition of the artery itself. Generally speaking, the hard 'pulse is full ; not unfrequentlv, however, t is small and quick. When a pulse is hard and small it is called a wiry pulse. Sometimes known also by the name of catgut pulse. When a pulse is hard, quick, and small, it is called a sharp pulse. The reverse 19 284 MATERIA MEDICA AND THERAPEUTICS. of the hard is the soft pulse, in which the artery yields readily to the fingers and on pressure becomes easily imperceptible. An Oppressed Pulse. — This is also known by the name of the suffo- cated pulse. By it, is understood that pulse which is apparently weak and small, but which becomes fuller and stronger after depletion. It depends' upon a congested state of some portion of the circulating sys- tem interfering with the free movement of the blood as well as the action of the heart and bloodvessels. A Regular Pulse, when the pulsations in a given time are regular and uniform. The reverse is the irregular pulse. The irregular pulse may be considered as of three different kinds, viz : The intermitting. — When one or more beats are lost in a given time. This arises from various causes, as organic disease of the heart, want of blood in the artery or weakness in the heart's action, or disorder of the ■stomach and bowels, agitation of mind, &c. In many persons it is matural and only disappears in sickness. (Heberden.) The rebounding pulse, when two quick strokes are followed bj a slow •one. This is indicative of aneurism of the aorta, ossification of the heart, hydrothorax. Unequal Pulse, when each subsequent pulsation increases in strength. This, if soft, is said to indicate a sweat. The foregoing are the most important distinctions to be made in rela- tion to the pulse. To judge correctly of them requires tact and expe- rience, only to be acquired by practical and accurate observation. As aids, however, in examining and judging of the true character of the pulse, the following rules may be observed. For this purpose the artery at the wrist is usually selected because it is more exposed. The pulse of the patient should not be judged of from feeling it imme- diately after entering the sick room. Any emotion will quicken the action of the heart, and of course produce a change in the pulse. The mere presence of a physician, especially if it be a first visit, and the necessary answers to his interrogatories, will very generally occasion some additional excitement. In females and irritable patients this is much more likely to occur. On this account the best plan is to feel the pulse several times during your visit. By a neglect of this plain and simple rule, serious blunders have not unfrequently been committed, especially by those who are ambitious of gaining a reputation for prompt and dashing practice. The position of the patient's arm should be attended to. It should be placed in such an attitude that the muscres are relaxed and all pressure removed. In feeling the pulse, compress the artery firmly with your first three fingers. Then raise the 'two uppermost gradually. If the pulse be SKi'A'J i\ E . 285 really strong, it will strike fully against the remaining finger. If it be weak, it recovers fulness gradually. Feel the pulse in both arms. The necessity of this appears from the fact that the pulse is not always the same in both arms. A. congenital difference of this kind is recorded by Morgagni. Zimmerman rela the case of a lady thirty-nine years of age who bad long complained of rheumatism and of a singular coldness which extended down the right leg to the foot. During several weeks the pulse in the right arm was 50, and in her left from 80 to 92. In the former it was weak, in the latter strong. The pulse of children under two years should be felt, if possible, while they are asleep. The necessary restlessness and excitability of children at that age invariably quicken the pulse. By some physicians it is advised to use a watch to count the num- ber of beats. This will do very well for a young beginner in practice. After you get a little familiarized with the pulse, however, it is best not to depend upon any aid of the kind; it is apt to fix your attention too much on the mere /requeue;/ of the pulse. In this way many errors have arisen. The best plan is to accustom yourselves to judge of the pulse by its general character, without confining yourselves to one par- ticular characteristic. The best practical physicians I have ever known never resorted to counting the pulse by a watch. To judge of the pulse, great experience is necessary. With the exception of the mere frequency, which can be measured by a watch, everything else is, as you perceive, a matter of feeling and sensation. To enable you, there- fore, to discriminate accurately you must be in the constant habit of feeling the various kinds of pulses. Cultivate the tactus eruditus. The importance of this, gentlemen, you will find when you get into practice, and when you see learned physicians differing in consultation and unable to determine whether a pulse is hard or soft. That great man Dr. Wm Hunter is said to have been completely destitute of this nicety of discrimination. Natural Frequency of the Pulse. — In making up a judgment in rela- tion to the pulse, it should be recollected that there are several circum- stances which modify its frequency. Of these, the most important is age. From infancy to old age the frequency of the pulse is gradually diminishing. The general average is : Infancy, 140; at two years, 100 ; at puberty, 80 ; manhood, 75 ; old age, 60. Sex. — As a general rule the pulse is from eight to ten beats in the minute, faster in females than males. Temperament also makes a difference — the sanguineous have the pulse faster, the melancholic slower than the average. In cold climates the pulse is slower than in hot. The effect of posture is curious, but till recently has attracted little attention. By Dr. Graves, of Dublin, it has lately been iuvesti- 286 MATERIA MEDICA AND THERAPEUTICS, gated. He found the pulse in the erect posture in healthy persons from six to fifteen beats more frequent than in the horizontal. This differ- ence increases with the frequency of the pulse at the time of making the experiment. Thus, if the pulse is only sixty, the difference is not more than six or eight; if the pulse has been raised by exercise to 90 or 100, the difference is frequently as great as twenty or thirty. On placing the body in an inverted position, i. e. with the head down- wards, the pulse was neither retarded nor accelerated, but very much diminished in strength — a fact which Dr. G. explains by "the weight of the blood pressing on the aortic valves, and thus necessarily opposing an unusual impediment to its egress from the left ventricle." In the morning, the pulse is generally more calm and less frequent than in any other part of the day ; after meals it generally increases in frequency. In many cases the pulse is characterized by some peculiar constitutional idiosyncrasy, rendering it preternaturally frequent or slow. Heberden relates the case of a man aged fourscore, whose pulse during the last two years of his life was seldom over thirty, and sometimes not more than twenty-six ; yet, he enjoyed good health. Napoleon's pulse is said to have been only forty-four in a minute. Dr. Copland mentions a case of a man eighty-seven years old in good health and spirits, whose pulse is only twenty-nine in a minute. Dr. Thomson relates the case of a man whose pulse in health was never more than forty-five ; and what is very curious, whenever he was feverish, it fell to forty. Having thus noticed the different varieties which the pulse assumes, and pointed out the circumstances which modify even the healthy con- dition of it, it will be easy to understand what I have to say in relation to the use of the lancet as indicated by it. Of all the different kinds of pulses which have been enumerated, the one which calls most imperatively for the use of the lancet is that which is characterized by frequency and hardness. When this kind of pulse is present, it indicates the existence of inflammatory action, and of course shows the necessity of bloodletting. Mere frequency of the pulse does not require or justify it. Usually this occurs in habits naturally irrita- ble or rendered so by the operation of debilitating causes, in both of which cases venesection, so far from diminishing, would only serve to increase it. Nor does mere hardness of the pulse, unaccompanied by frequency, always indicate the necessity of bleeding. In aged persons, not unfrequently the pulse assumes a peculiar hardness from ossification, or some other organic changes in the artery; it is only where hardness and frequency are combined that venesection is rendered necessary. The oppressed is another pulse requiring the use of the lancet, and here its propriety is indicated by the development or rise of the pulse, .as it is called, after depletion. With regard to the other conditions of the pulse, they may or may SEDATIVES. 287 not indicate the necessity of bleeding, according to circum fcanei . A strong pulse, when the system is plethoric, and there is danger of local determination, may require bloodletting, while under other circum tai it may not. Sometimes a, soft pulse may demand extensive depletion. Not unfrequently a pulse preternaturally slow calls for the rnosl active depletion. Tins occurs in apoplexy and other diseases, when ther< oppression of the brain. Jn cases of this kind, the pulse is sometimi slow as fifty and forty in a minute. Here, however, it is necessary to make a nice distinction, as all cases of this kind do not require bloodlet- ting. They only do so when this condition of the pulse exists with active determination to the brain. Sometimes a very small pulse requires bloodletting. Illustration- of this occur in such diseases as enteritis, dysentery, &c, where, from the great flow of blood to the internal organs which are diseased, the ves in the extremities are deprived of their ordinary proportion. How to distinguish when a small pulse requires depletion is not very easy. The rule laid down by Lawrence is, that when the heart beats proportion- ally stronger than the arteries, bleeding may be resorted to, and vice versa. The only safe rule, however, is the actual effect produced on the pulse during the flow of blood. If it fills and rises, it is a proof of its propriety, and vice versa. From all this it is evident, that however much valuable information may be gained from the state of the pulse, it is by no means an infalli- ble guide to the use of the lancet. In all cases it must be taken in con- nexion with the other symptoms. Pain is another circumstance by which a judgment is formed con- cerning the propriety of venesection. Mere pain, however severe, when unaccompanied by any corresponding derangement in the circu- lation, does not require depletion. Striking illustrations of this you have in ordinary toothache and in tic douloureux. Indeed, mere pain does not usually exercise much influence in accelerating the movements of the circulation. A high authority, the late Dr. Heberden, says, " it is often supposed that great pain will quicken the pulse ; I am more sure the mere pain will not always do it, than I am that it ever will." He adds, "the violent pain occasioned by a stone passing from the kidneys to the bladder is often unattended with any quickness of pulse ; aud the excessive and almost intolerable torture produced by a gall stone passing through the gall ducts, has in no instance quickened the pulse beyond its natural pace, as far as I have observed, though it be a disorder which occurs so frequently; and this natural state of the pulse, joined with the vehement pain about the pit of the stomach, affords the most certain diagnosis of the illness. I have seen a man of patience and courage rolling upon the floor and crying out through the violence of this pain, which I was hardly able to lull into a tolerable state with nine grains of opium, given 288 MATERIA MEDICA AND THERAPEUTICS. in twenty-four hours, to which he had never been accustomed, and yet his pulse was all this time as perfectly quiet and natural as it could have been in the sweetest sleep of perfect health." Mere pain, then, does not render venesection necessary. When, however, it is associated with a hard and frequent pulse, or with a strong slow pulse, as in congestion of the brain, or with general inflammatory symptoms, then it forms a most valuable criterion by which to judge not merely of the necessity of depletion, but of the extent to which it may be carried. A tongue with a white fur, if other symptoms correspond, is an index of the propriety of bloodletting, as it generally indicates the existence of inflammation. The quantity, of course, to be regulated by other cir- cumstances. Mr. Lawrence, in a lecture on disorders of the digestive organs, speaks of a tongue as white, " not in consequence of its being covered by any deposit or secretion, but as if from the substance of the tongue itself being rendered white. This is observed in cases either of plethora, when passing almost into a condition of disease, or in cases of active inflammatory disturbance, and is an indication of these states rather than of particular disturbance of the stomach. It is a tolerably unerring criterion of the existence of inflammation,, and it may be considered as a sign that we ought to bleed those individuals in whom it is noticed." — London Medical Gazette, vol. v. p. 197. If along with the other symptoms already noticed the skin be hot and dry, it is an additional reason justifying the use of the lancet. The Nature of the Part Affected is a very important circumstance in enabling us to judge of the necessity of bloodletting. Analogous symptoms resulting from diseases of different organs require different modes of treatment. Inflammation occurring in different organs demands a totally different use of the same remedy. Diseases of the chest, for instance, require more prompt and repeated depletion than those of any other organ, and the relief which it affords is more apparent. Inflammation of mucous membrane docs not generally require the same active depletion as that of the serous membranes. The Stage of the Disease is a very important circumstance in deter- mining upon the propriety of bloodletting. Even in diseases requiring this remedy, if it be delayed beyond a certain period, it is wholly inad- missible. As a general rule, in all cases where it is called for the earlier it is used the better. And this because it makes a more immediate and decided impression, and at a time when the powers of the constitution are best able to sustain the loss of blood; and also prepares the system in the best possible way for the effective operation of whatever medicines the case may require. After bloodletting, for instance, emetics, cathar- tics, and in fact all other remedies act more efficiently than they would previously. si: DATIVES. 2 9 Of the Appearance of the Blood. — By many mud Btrei • ba been laid upon this as indicative; of the propriety and necessity of bloodletting. That the blood assumes different appearances in differenl condition of the system, is certain, and from these, important conclusions may un- questionably be drawn in many Cases, especially if taken in connexion with other circumstances. As a genera! rule, when the proportion of crassamentum in the blood is large, it may be taken as the evidence of constitutional vigor, and of the capabilities of the system for sustaining the loss of blood. As a general rule, too, when the crassamentum is very firmly coagulated, the loss of blood can be better sustained than when it is loosely held together. The more slowly the blood coagulates the better will the abstraction of blood be borne. Of all the characteristics of the blood, that upon which the greatest reliance is usually placed is the huffy coat. As this by many is looked upon as a certain sign for the necessity of bloodletting, it is proper to dilate a little upon it. The formation of the buffy coat is owing to the manner in which the blood coagulates. In the ordinary healthy con- dition of the fluid it coagulates rapidly, and when that is the case the red globules remain diffused throughout the whole mass. In certain morbid states, however, the blood coagulates more slowly and the red globules gradually subside towards the bottom. On examining the blood, therefore, it will be found that while the middle and lower parts of the crassamentum contain the red globules, the upper part is destitute of them. This part thus deprived of the red globules makes what is denominated the buffy coat. That this buffy coat is present in cases of inflammation is unquestionable, but as the formation of this coat depends (as already explained) upon the slow coagulation of the blood, it is very evident that whatever modifies the coagulation must also modify this peculiar appearance. For example, if blood be drawn from a small ori- fice and very slowly, it will coagulate so rapidly as to prevent the form- ation of the buffy coat, even though under an opposite mode of abstrac- tion it would show it. On the other hand, numerous observations have established the fact that the buffy coat is frequently present when no inflammatory action exists. If blood be taken from a person in full health, after violent exercise, the buff will show itself in the blood. In pregnancy the blood often puts on the same appearance. The same thing is observed in blood drawn from persons under a mercurial course. In the last stages of disease it sometimes shows itself. Sir Astley Cooper relates the case of a patient in Guy's Hospital " in the last stage of scurvy, whose blood- vessels were so weak that a slight pressure on the skin produced ecchy- mosis, whose gums frequently bled, and whose pulse was exceedingly quick and feeble." By way of experiment a small quantity of blood was taken from his arm ; " after standing a few hours it became not 290 MATERIA MEDICA AND THERAPEUTICS. only buffy but considerably cupped." In pulmonary consumption it not u infrequently continues to be seen to the last moment of life. From the foregoing facts, it is evident that the buffy coat is by no means an infallible criterion by which to judge of the necessity of depletion ; it should be considered in connexion with the other circumstances in the case, and if this precaution is observed it may assist materially in form- ing a correct judgment. Of the extent to which Bleeding should be carried. — On this subject it is impossible to lay down any precise rule. In determining the quan- tity to be taken in any particular case, everything must depend upon the constitution of the patient, his general habits, the character and seat of the disease, and above all the effect produced upon the pulse. In acute disease, where the patient is seen in the early stages and when it is desirable to make a decided impression, the best plan is to carry the bleeding so far as to affect the pulse, and in some cases to produce actual syncope. With regard to the repetition of the bleeding, this must be decided by existing symptoms. If those originally indicating venesection be not mitigated, or if, after being partially subdued, they return with their primitive violence, the remedy may be repeated, as a general rule, after an interval of about six hours. In cases of great severity, however, or when the disease is known to run its course in a very short period, as in laryngitis, it may be repeated after a shorter interval. Generally, however, the necessity of a second bleeding will be greatly lessened by conducting the first in such a way as to make a decided impression on the system. In having recourse to venesection in children, the greatest discretion should be exercised, both in regard to the quantity which is drawn as well as to its repetition. It has already been stated, when speaking of age as modifying the effects of this remedy, that young children bear bleeding very ill. If carried at all far, they are apt to sink under it. From a child six months old the average quantity may be put at one ounce, and if necessary to repeat it, another in twelve hours afterwards. Should young children be bled to syncope under any circumstances ? This is recommended in some cases where the child is plethoric and the inflammation runs high. In some very rare cases it may be judi- cious, but beyond all doubt it should be resorted to, if at all, with extreme caution. [I concur in the opinion of a late writer who says, " bleeding children to syncope is the worst practice that can be ima- gined."] In taking blood from persons advanced in years, due allowance should be made for that circumstance, and more moderate quantities taken than from younger persons. Different modes of abstracting blood. — These are general and local. Everything that has already been said applies to general bloodletting ' SEDATIVKS. 201 and to the ordinary mode in which it is drawn from the arm. The other modes are taking it from the external jugular vein and from, an artery. These only require a brief notice 1. Jugular Vein. — Next to drawing blood from the arm, this is the mode of general bloodletting which lias been the most popular. I think that in some cases bleeding from the jugular vein has a great advantage. In the first place it draws blood more directly and imme- diately from the head, and empties the veins and sinuses of thai organ in a way which cannot be accomplished by bleeding from the arm. Hence in certain diseases of the brain its beneficial effects are much more prompt and unequivocal. In the second place, as the vessel is larger than those of the arm, blood can be drawn with much more rapidity and certainty. The im- portance of this must be self-evident, after what has been already said in relation to difference of effect between the rapid and slow abstraction of blood. Notwithstanding this it should not be used where bleeding from the arm will answer, inasmuch as it is attended with more incon- venience and not unfrequently with some danger. 2. Arteriotomy. — This is another mode of general bloodletting much more common formerly than at present. Among the ancients it was in great favor. At present the only artery opened is the temporal. What the precise difference is between drawing blood from the vein and an artery is a question of importance, and has given rise to some interesting investigations and experiments. The most valuable are those of Dr. Leeds, and from them the following conclusions were drawn. (1.) Taking blood from an artery diminishes more especially the quantity of venous blood ; therefore, arteriotomy is to be performed when the veins are tumid. (2.) The loss of arterial blood does not speedily disturb the respira- tion, nor the heart's motion, nor does it rapidly break the strength ; therefore, when we particularly wish to preserve entire the more important functions let arteriotomy be had recourse to. (3.) From arterial bleeding, convulsions appear not apt to occur ; therefore, against such affections arteriotomy would most avail. (4.) Blood let from veins does not particularly diminish the quantity of venous blood, but greatly disturbs respiration and the heart's motion, debilitates to a surprising degree, makes the veins very turgid, and induces convulsions ; therefore, when the circulation is universally strong, as in every active inflammation, venesection will be most serviceable. Local Bloodletting. — 1. Leeching. — This is one of the most com- mon of the modes of local depletion at present in use. The animal by 292 MATEEIA MEDICA AND THEEAPEUTICS. whose means it is effected is the Hirudo Medicinalis, very common in Europe and in this country, found inhabiting lakes and stagnant pools* The leech is of various sizes, the European leech is generally from one to three inches in length, while the Indian leech is six or seven. •The body of this animal is composed of cartilaginous rings capable of great distension. Its month is triangular, and the wound which it inflicts is of the same shape. These animals are very much affected by the weather. During the winter they remain in an almost torpid state, hid deep in ground at the bottom of the pools. They are caught in the spring and autumn, and as they generally rise to the surface before a thunderstorm, this is a very good time for collecting them. As there is frequently considerable difficulty in making leeches bite well, various modes have been proposed to effect this object. The best are the following. The part to which they are to be applied is first to be well washed, and if covered with hair to be shaved. For the pur- pose of making the leech fasten, it is recommended to puncture with a lancet so as to draw a little blood. The leeches are then to be confined over the spot by means of a common wine glass. It generally takes from half an hour to an hour for leeches to fill themselves. Commonly after being filled they fall off spontaneously. When they do not let go, they may be separated by means of a pin or thread drawn between the leech and the skin. The quantity of blood which a leech draws must of course vary with the size of the animal, and the facility with which the blood flows. As a general rule, not more than about two drachms is procured. The quantity actually taken away by the leeches is small when compared with what may be procured from the bites after they fall of. To do this the part is to be sponged with warm water, or what is better, a common warm bread and milk poultice is to be applied. This causes a free dis- charge of blood without any inconvenience to the patient. The facility with which they bite, as well as the quantity of blood, depend greatly upon the character of the surface to which they are applied. In delicate skins, where the capillary circulation is active, more blood is always drawn than in dense and rigid skins. Hence, in children and delicate persons, the hemorrhage from leeches is some- times excessive. For the same reason, certain parts of the body are more favorable to the application of leeches than others. Effects on the System. — These are local and general. Their first and immediate effect is to unload the system of capillary vessels upon which they act. In addition to this, by the wounds which they inflict, they cause a certain degree of irritation in the surface. These are the local effects. The general are analogous to those of venesection, and vary according to the quantity of blood which the leeches abstract. Accidents happening from the use of Leeches. — In speaking of the SEDATIVES. -' :, - ; effects of leeches, tliesc require notice, especially as some of them are of very serious import. 1. The first is excessive bleeding. This happepe nol [infrequently, and occurs most commonly in children and in those whose capillary vessels arc very active. In a hot climate it is sometimes difficult to stop the bleeding from leeches as well as from phlebotomy.* Dangerous and even fatal hemorrhages have thus been known to occur in young subjects. In all cases, therefore, a child to whom leeches have been applied should never be left until after it has been ascertained that there is no danger from this source. Sometimes it is difficult to arrest the bleeding even by artificial means, and various modes of doing this have been resorted to. Generally speaking the application of adhesive plaster with a compress and bandage will answer every purpose. Another good way is a piece of sponge rolled in flour or gum arabic. The simple application of cold water some- times succeeds. If, however, the bleeding still continues, the best plan is to put the point of a stick of lunar caustic into the orifice and hold it there for a short time. After this a small piece of punk is to be applied. This generally adheres and puts a stop to the bleeding, In other cases the actual cautery requires to be applied. In Lord Byron's case the bleeding could not be stopped till the actual cautery was used. If after this it should still continue, nothing is to be done but to make constant pressure on the part until it is arrested. Where pressure cannot con- veniently be made, Mr. Marshall of Dublin recommends pinching up the portion of skin around the leech-bite, and continuing moderate but not painful pressure for ten or fifteen minutes, when the hemorrhage will be found to have ceased. 2. Opening into an Artery. — This sometimes happens from the appli- cation of leeches, and requires to be guarded against. A case of this kind occurred in which the temporal artery was thus opened, and Sir Astley Cooper was obliged to divide the artery completely before the hemor- rhage could be arrested. 3. Inflamed Leech-bites. — This is sometimes an unpleasant conse- quence of the application of these animals. The best way to treat this is upon the principle of Mr. Iligginbottom, by the application of nitrate of silver. Sometimes an erysipelatous inflammation takes place, which has usually been ascribed to an irritable state of the skin. It has been ascertained, however, now to be owing to the forcible pulling off of the leech, causing the teeth to be separated and left in the wound. This shows of course the propriety of leaving the leech to drop off. Number of Leeches to be apirtied. — In adults from ten to thirty may safely be applied. To an infant one or two are sufficient. * * Aiuslie, vol. i. p. 192. 294 MATERIA MEDICA AND THERAPEUTICS. 2. Cupping. — This operation is performed by first scarifying the part and then applying exhausted cups, for the purpose of taking off the pressure of the atmosphere. In this way a determination of blood is caused to the part, and a free evacuation from the scarified vessels. Of the particular manner of performing the operation it is unnecessary to speak. Cupping is analogous to leeching, inasmuch as it bleeds locally ; it dif- fers, however, in some important respects. It creates more external irri- tation, and it has, therefore, the advantage of being more of a counter- irritant — it draws blood more promptly, and lastly, you have the bleed- ing more under your control ; none of the accidents which occur after leeching take place here. Relative Value of General and Local Bloodletting. — General bloodletting takes blood promptly and suddenly from the system ; local bloodletting takes it slowly and gradually. General bloodletting, therefore, makes a prompt impression upon the action of the heart and blood-vessels, from the mere suddenness with which the stimulus of the blood is withdrawn from these organs. This effect may, therefore, be produced almost independently of the quantity of the blood drawn. Local bloodletting, if it affects the heart and cir- culation at all, must do it by the actual quantity of blood lost. General bloodletting affects the whole circulation and acts upon the system — through the intervention of the general circulation. Local bloodletting on the contrary acts on the capillary system of vessels, and through that on the system at large; or in other words, general bloodletting acts pri- marily on the heart and arteries, and secondarily on the capillary vessels ; while local bloodletting acts primarily on the capillary vessels, and secondarily on the heart and arteries. In general bloodletting all the effects are to be attributed to the mere loss of blood. In local bloodlet- ting there is an additional effect obtained in the local irritation which is caused, and which in some cases is of great practical advantage. The practical distinction then between the two modes of depletion is this. Whenever you wish to produce a prompt and decided effect on the heart and blood-vessels, and whenever the general circulation re- quires particularly to be operated on, general bloodletting is to be pre- ferred. When, on the contrary, you wish simply to unload a portion of the capillary system, without any special regard to the general circula- tion, bleeding by local means may be resorted to. In children leeching acts as a general bleeding. General Rules to be observed in relation to Bloodletting. — Always bleed a patient yourself, or at any rate be present when your pa- tient is bled. — The reasons of this are obvious, from what has already been said. The effects of bloodletting differ entirely according to the SEDATIVKS. 205 maimer in which the operation is performed — whether by a large or a small orifice, whether the patient be sitting up or lying down, &c. &c. Now all this can only be properly regulated by being present. With regard to the quantity of blood to be drawn it is impossible for a ph cian to say d priori how much blood requires to be taken. This is to be judged of entirely by the effect at the time. In some countries, and I am sorry to say in some parts of this country, the operation of blood- letting is trusted to a distinct class of men — a regulation more objec- tionable and dangerous cannot be well imagined. [Bleeding has gone so much out of fashion that the professional bleeder has passed away with the last of the cocked hats.] Always, then, gentlemen, carry your lancet with you and perform the operation yourselves.* In bleeding have special regard to the orifice which you make. Tri- fling as this direction may appear, it is nevertheless of the very greatest importance — and the reason is obvious, from the difference of effect produced by the drawing of blood from a large and a small orifice. As a general rule, in all cases there ought to be a good-sized orifice made. Otherwise you will not obtain all the advantages to be derived from general bloodletting. In all cases determine precisely what your object is in drawing blood. Unless you do this, you never can direct your bleeding in such a way as to attain this object in the best possible man- ner. When blood is flowing, feel the pulse of your patient. As the object in drawing blood is to produce a certain effect and not merely to take a certain quantity, this is to be judged of only by the effect pro- duced at the time. In bleeding children, the greatest caution should be observed in watching the effects. The best plan is to set them upright, and if any paleness of the countenance or faintishness appears, the bleed- ing should be instantly arrested. This rule is applicable, whatever be the mode of abstracting blood, whether by venesection, or by leeches, or by cups. With regard to leeches, especially, great care should be exer- cised. This has already been alluded to, but it cannot be too frequently insisted upon. The kind of lancet which is used is a matter not altogether unimport- ant. In this country there are two used — the spring lancet, and the ordinary thumb lancet. [The spring lancet may also be numbered with the things that were. It is never used, and certainly never should have been.] Practical or Therapeutical Applications of Bloodletting. — Before proceeding to notice the use of this important remedy in various diseases, it will be proper to state the different modes in which it proves * Until recently the Edinburgh College of Physicians prohibited their fellows from using the lancet or the scalpel ! I 296 MATERIA MEDICA AND THEEAPEUTICS. curative. It diminishes the actual quantity of blood in the system. In this way unnatural fulness of the general vascular system as well as local accumulation of the blood are corrected. It changes the quality of the blood itself, diminishes the action of the heart and arteries, and when carried so far as to produce syncope, suspends temporarily the action of the vascular system. In this way excessive and morbid action of that system is controlled. It impairs the energy of the brain and nervous system, and relaxes the muscles and the whole system of capillaries. In one or more of these modes does bloodletting exert its curative influence in various diseases. In the notice which I shall take of its application, all I shall attempt will be to give a few leading facts and principles. To go into the necessary details in relation to each individual disease would occupy a volume. Of Fevers. — The general principles upon which the use of blood- letting is resorted to in this class of diseases are the following. It is observed as a matter of fact, that the circulation almost always becomes preternaturally excited. In this state of things there is always more or less danger of some local embarrassment. Moreover in a great majority of cases of fever, local embarrassments take place, showing themselves sometimes in the shape of inflammation either of the brain or of the viscera of the thorax, or of the abdomen ; in other cases, in the form of simple engorgements or congestions of those parts. Now, in the management of fevers, the great object is to regulate the circula- tion, so as to prevent, if possible, any local embarrassments, or to counteract and subdue them when they occur in the shape of inflamma- tion and congestion. For the accomplishment of these objects bloodletting is mainly used in fever. Simple and obvious as this general principle would seem to be, the application of it is not always easy. For fever presents itself under a great variety of forms and manifestations, and occurs in consti- tutions essentially different from one another, under different circum- stances of climate and temperature, and from various causes. Now, all these circumstances exert an essential influence over the general charac- ter of the disease, and of course greatly modify the treatment. Again, the same fever presents itself in different stages, in each of which the treatment must necessarily vary. If all this be true of the treat- ment generally, it must be so in an especial manner of a remedy so potent as bloodletting. The due administration of this remedy, there- fore in fevers, requires not merely a knowledge of general principles, but practical tact and extensive experience in adapting these princi- ples to individual cases. To enter a little more into detail, let us briefly notice the different forms of fever. Intermittent Fever. — This consists of two remarkable periods, in each of which the system is in an entirely different condition — the paroxysm SEDATIVES. Jl/7 and the intermission. In the period between the paroxysms, the inter mission, all febrile action has disappeared^ and the system ha returned to a state of health, with the exception of being somewhal d< I ilitatcd. In the simple unprotracted form of this disease, too, no local obstruction now exists. Jn this period, therefore, bloodletting is not required. On the contrary, if resorted to, it might prove actually injurious. The sys- tem is already debilitated by the previous paroxysm, and if blood r< abstracted it would merely add to the existing; debility, and probably render the system more liable to the return of the paroxysm. Besides this, it is to be recollected that in the state of partial collapse which succeeds the paroxysm, the loss of blood cannot be borne so well as under other circumstances. During the intermission, therefore, as a general rule, bloodletting is not advisable. Let us now see if bloodletting- be proper in the paroxysm. As already stated, our great object in the use of bloodletting in fever is to prevent or to subdue local engorgement and inflammation. Now, during the paroxysm, there are two periods when these local embarrassments occur — in the cold stage and in the hot. In the cold stage the blood retires from the surface of the body, and all the internal viscera become more or less congested. This applies to the brain as well as to the viscera of the chest and abdomen. In the hot stage, the action of the heart and arteries is excessive, and, as is always the case under such arterial excite- ment, the large viscera are in danger of congestion and even inflamma- tion. In some cases one or the other of these actually takes place. In both of these periods, then, that state of system is present which may require bloodletting. It is not to be inferred from this, however, that it is in all cases necessary. On the contrary, in ordinary intermittent venesection is not required. The paroxysm is of short duration, and the congestion during the cold stage, and the excitement during the hot, come to a spontaneous, speedy crisis. To bleed in the cold stage, is very generally not merely useless, but dangerous,* and if at all prac- tised, the only proper time for it is during the hot stage. The period most usually selected for the abstraction of blood is the hot stage, and this would certainly more naturally be suggested as the most appropriate. The great vascular excitement — the heat of skin — the flush of countenance — the tendency to cerebral congestion — would all * Senac, one of the best writers on intermittent fever, says, " But such has been the rashness of some men, that they have ventured to open a vein during the cold fit. This practice is unreasonable and dangerous. "When the pulse is so depressed as to be almost imperceptible ; when the blood scarcely circulates : when the vital principle seems to be already overpowered, what benefit is expected from bloodletting ? Can it be had recourse to without danger in old persons, as such are sometimes known to expire under the violence of the cold fit '?" — Senac on Fever, p. 196. 298 MATERIA MEDICA AND THERAPEUTICS. seem to point to it as the period when depletion was most requisite and could most easily be borne. Memittent Fever. — This form of fever is marked by the same general phenomena as the intermittent, differing only in degree. It has a cold stage, a hot stage, and a sweating stage ; all, however, less marked and distinct. > The chill is less severe — the reaction in the hot stage is less full and developed, and the sweating is partial and imperfect. As, therefore, the fever does not come to the same kind of crisis as in the intermittent, the local embarrassments which take place during the cold and hot stages are not so completely relieved as they are in the intermittent. Hence they become more permanent difficulties and are more likely to run into actual inflammation. The organs more espe- cially liable to this are the brain, stomach, and liver ; all of which, on dissection, furnish abundant evidence of the previous existence of conges- tion or inflammation. Such being the difference between intermitting and remitting fever the general inference would be that venesection is much more necessary in the latter than in the former. And such is in reality the case. In the use of bloodletting in this form of fever, there are several cir- cumstances of importance which ought to be kept in view. In the first place, the earlier in the disease it is resorted to the better. In the early stages it reduces excitement and relieves local embarrass- ments much more certainly and speedily than it does at more advanced periods. In the second place, it is to be borne in mind that, like intermittent fever, the remittent consists of paroxysms, although less marked and distinct ; and, as a general rule, the best period for drawing blood is at the height of the paroxysm. When there is a tendency to sweating it should be avoided. In the third place, in deciding upon the quantity of blood to be abstracted, the best general rule that can be laid down is to be governed by the effects produced at the time. In the last place, although venesection is a remedy sometimes neces- sary in this form of fever, yet it is not invariably so. There is the mild or simple fever, the inflammatory, and the congestive. In the first, venesection is not required ; in the second, it becomes essential ; while in the third, it is also essential, but in more moderate quantities, and with due precautions to ensure reaction. [The practice of bleeding in miasmatic fevers has so generally gone out of favor that I have abridged very much Dr. Beck's remarks upon it. Even thus abridged they do not represent the present state of pro- fessional opinion among us, but are much too favorable to the use of the remedy.] 3. Continued Fever. — In this form of fever, bloodletting is to be HKDATIVKS. 299 bad recourse to upon the same principles, and with the same objeels in view, as in the other forms — to moderare general excitement and to relieve local embarrassments. As continued fever differs greatly in its type by the cause which produces it — by the season of the year — by climate — by the peculiar constitution of the patient, &C, so the use of this remedy may be modified by all these circumstances. In some eases it is not necessary ; in others it may prove actually injurious, while in others again it may be essential to save life. At one time general blood- letting may be required, while at another every benefit may be derived from local depletion. All this can, of course, only be decided by the peculiar condition of the patient at the time, and by the presence or absence of particular symptoms. Affections of the Head. — Before proceeding to notice the application of bloodletting in affections of the head, it is proper to recollect what has already been said in relation to the circulation in the brain and the effects of the loss of blood on that organ. From this, it would seem that the quantity of blood in the brain in the ordinary condition of that organ is always very much the same. If this be so, it may be asked how can bloodletting effect any change in these cases ? To this the answer is that, although the actual quantity of blood in the brain at any given moment may not vary, yet there may be and are other conditions of the circulation in this organ which indicate how the condition of the brain can be changed by bloodletting. The relative proportions of arterial and venous blood in the brain may vary greatly. When the general circulation is loaded, the brain may be gorged with venous blood, and arterial blood find no entrance in sufficient quantity, and hence stupor may supervene. On the other hand, when the system is drained of blood, the arterial flow of blood upon the head may be excessive from the want of venous distension to retard it ; and giddiness, tinnitus aurium, and throbbing in the head may arise from this cause.* In the first of these cases, the loss of blood by venesection would lessen the quantity of venous blood in the brain, which loss would be supplied by an equivalent quantity of arterial, thus restoring the natural and healthy proportions of the two. Here, then, venesection would prove salutary. In the second case, that in which the arterial flow of blood to the head is in excess, the still further 'loss of blood would increase the difficulty and might result in effusion. Here bloodletting would be injurious and a different course of treatment is required. Although the actual quantity of blood in the brain cannot be changed, yet " the impetus with which it enters and the degree of pres- sure it exerts on the nervous matter, is liable to much change,"f and in * Mayo, p. 135. f British and For. Eev. vol. in. p. 324. 20 300 MATERIA MEDICA AND THERAPEUTICS. this way may the condition and functions of the brain be materially altered. When the impetus of the blood is in excess, especially if some cause should at the same time operate to retard the exit of blood from the brain, such a degree of pressure may be excited as to disturb its functions and perhaps give rise to effusion. In this case bloodletting ■would operate advantageously by lessening the impetus of the blood, and of course diminishing the pressure on the brain. On the other hand, when the impetus of the arterial blood is suddenly lessened, the pressure on the brain is so much diminished, as to produce more or less insensibility. In this way the " insensibility of syncope from loss of blood, from the erect posture, and from tapping for ascites," appears to be produced.* Now in this case, venesection of course would be injurious. Although the quantity of blood in the brain may not change, the dis- tribution of the blood in the small vessels may. This is the case where particular parts of the brain are in a state of inflammation.f Where this inflammation is acute, it is accompanied by an increased impetus of the blood to the head, which keeps up the inflammatory state in the brain. By venesection this impetus is lessened. Inflammations of the Brain. — Inflammations may assail either the membranes of the brain or the substance of that organ. The most accurate observers admit that it is not possible in all cases to distinguish between the two. Dr. Abercrombie says, "our knowledge of this sub- ject is not sufficiently matured to enable us to say with confidence what symptoms indicate inflammation of the substance of the brain, as dis- tinguished from inflammation of its membranes ; but the distinction is not of much practical importance."^ Whatever be the seat of acute inflammation of the brain, whether in the membranes or the substance, the treatment is the same, the only difference depending on the severity of the inflammation. In acute inflammation of the brain there can be no doubt about the propriety and necessity of bloodletting ; and the great thing to be attended to is to draw the blood in such a way as to make the most decided and prompt impression. For this purpose it should be taken from a large orifice, and in such quantity as to affect the pulse until it merely flutters under the finger, or until syncope is produced. This should be done, of course, as early as possible, with the view of arrest- ing at once the progress of disease, and preventing the inflammation from terminating in effusion. The necessity of arresting the inflammation before effusion takes place must be apparent, from the structure of the head. When inflammation assails those structures which have a natural * British and For. Rev. vol. iii. p. 325. f Ibid. vol. iii. p. 326. % On the Brain, p. 26. skdativks, 801 outlet, effusion to a certain extent may be Balutary,by aiding in relieving the inflammation. This is the case when the mucous membrane are inflamed. In the brain, however, then: is no outlet for ;my effusion, ami iii consequence of this, when it does occur, it is generally destructive. On this account, it is so important to prevent this termination, and this is to be accomplished by early and copious depletion, as one of the means. In the repetition of the bloodletting, we must be governed by circumstances, by the local symptoms, and the state of the pulse. " Sometimes one, sometimes two, three, or four bleedings will be neces- sary."* Some difference of opinion lias existed as to the best vessel from which to abstract the blood. As a general rule, in adults, every purpose can be answered by taking it from the arm, provided the orifice be large and a sufficient quantity be taken. In children, on the contrary, a much greater effect can be produced by opening the external jugular, and in them it may frequently have the preference. When the force of the disease has been broken, as indicated by the state of the pulse and other symptoms, local bloodletting may be resorted to, if necessary. For this purpose leeches may be applied to the temples or behind the ears. In relation to the use of bloodletting, there are two things worthy of notice. The first is, that everything depends upon its being used early, and to a sufficient extent The second, that to secure its full effect, it must be aided by the use of other means ; and among these, none are so efficacious as active purging and the application of cold to the head. With regard to purging, Dr. Abercrombie rnakqs this striking remark. " In all forms of this disease (inflammation of the brain), active purging appears to be the remedy from which we find the most satisfactory results; and although bloodletting is never to be neglected in the earlier stages of the disease, my own conviction is, that more recoveries from head affections of the most alarming aspect take place under the use of very strong purging, than under any other mode of treatment."! Apoplexy. — Although from the earliest periods bloodletting in apo- plexy has been sanctioned by the general consent of the profession, yet by some of the most respectable authorities of modern times the practice has been deprecated. Among these may be mentioned Kirkland, Fothergill, and Heberden.J It is certainly not to be used indiscriminately here, any more than in other complaints, and it depends entirely upon the manner in which it is used, whether it proves salutary or injurious. In the application of bloodletting, the important practical points to be * Armstrong's Practice, p. 365. \ Diseases of the Brain, p. 174. X See Cooke on Nervous Diseases, p. 137. 302 MATERIA MEDICA A5TD THERAPEUTICS, determined are, the period when it ought to be used, and the extent to which it should be carried. With regard to the period best suited to the abstraction of blood, it is- of the utmost importance to recollect that apoplectic seizures are not always attended by the same symptoms. In some cases, the pulse is full and strong, and the countenance flushed, livid, and tumid, while in others there is great depression of the vital powers, from the sudden shock given to the brain. In these cases, " the face is pale, the skin and extremities cold, the respiration slow and difficult, the pulse feeble and frequent, while both faeces and urine may be discharged involuntarily."* In some of these cases, the shock given may be so great that the system makes no effort of reaction, while in others reaction gradually takes place, resembling in this respect ordinary concussion of the brain. Now it must be evident that in these two conditions of the system the same treatment will not answer. In the first, prompt depletion may at once be resorted to with advantage ; while in the second, the effect of this treatment would be to depress still further the vital powers, and to destroy any remaining efforts of the system at producing reaction. Here, therefore, bloodletting should not be used until reaction has been insured by the use of suitable stimulants, external and internal. After this has been accomplished blood may be taken. With regard to the extent to which the blood should be taken, this must be determined entirely by existing symptoms. When the patient is strong, full habited, with the pulse full and hard, the face flushed, head hot, and no paralysis is present, bleeding may be freely practised until a suitable impression is made on the pulse. On the other hand, if the patient be not strong or full habited, if the pulse be feeble, the face not flushed, and the head has little heat about it, depletion must be practised with more caution ; and in many cases local bleeding [or purg- ing and cold to the head] may be advantageously substituted. Of the means used for local depletion, cups would seem to be decidedly prefer- able to leeches. They take the blood more promptly, at the same time that they make a salutary impression on the brain, by the irritation which they occasion. Patients frequently show evidence of returning sensibility during the operation of cupping. The best places for apply- ing them are the temples, the nape of the neck, or between the shoulders. From the foregoing the conclusion is obvious that, although blood- letting is a remedy of great value in these cases, it must be used with caution and certain restrictions, or it may do more harm than good, by exhausting and prostrating the system. Nothing, therefore, can be more irrational than the too common practice of flying at once to the lancet in all cases of this kind. [The following extract from Dr. Todd embodies * Dewees, vol. i. p. 213. See Copland, pp. 100 and 102. bKlMTlVHK. 803 the true idea of the cure of apoplexy. " The majority of case* of apo- plexy are best treated by purging, shaving the head, and keeping it cool, perhaps blistering; for bleeding is rarely applicable, except l<> tbe young, vigorous, strong, and plethoric."] Hydrocephalus Internus. — Although formerly considered as a mere dropsy this opinion is at present very generally abandoned. Modern researches have shown that in this disease the effusion, so far from con- stituting the disease itself is merely one of the consequences of an ante- cedent morbid affection of the brain. ]>y Abercrombie the following important points would seem also to be established. " 1st. That in the ordinary cases of hydrocephalus, the coma and other symptoms attending it are not to be considered as the direct effect of the effusion, but of that morbid condition of the brain of whieh the effusion is the consequence. " 2d. That we have no certain mark which we can rely upon as indi- cating the presence of effusion in the brain, as slowness of the pulse followed by frequency, squinting, double vision, dilated pupil, paralytic symptoms, and perfect coma, have been seen to exist without any effusion." That all these symptoms may exist in connexion with a state of the brain which is simply inflammatory.* It would seem that acute hydro- cephalus may be considered as a disease " common in infancy, yet occurring occasionally later in life, the nature of which is inflammation of the brain and its membranes, with a tendency to terminate in serous effusion. The disease is characterized by a combination of all or several of these symptoms — pain in the head, sensibility to light, restlessness, starting from sleep and screaming, squinting, convulsions, dilation of the pupils, coma."f If such be the nature of this disease, not merely is the propriety of bloodletting evident, but the limits also which should be put to it equally so. During the early stage both general and local bloodletting may be used with advantage for the purpose of arresting the inflamma- tory action of the brain. As in all other cases the quantity to be ab- stracted must be regulated by the age of the patient, the severity of the local symptoms, and the state of the pulse. In the second stage, when there is reason to believe that effusion has taken plaee, the abstraction of blood would be injurious, as it would increase the tendency to effu- sion. Although, therefore, there can be no doutt that in acute hydro- cephalus bloodletting is a proper remedy, yet it is to be recollected that symptoms analogous to those which characterize this disease frequently exist without any inflammation — arising, in fact, from a condition of things entirely different, viz. the want of nervous energy, the result ot * Abercrombie on the Brain, p. 166 f ilajo. p. 165. 304 MATERIA HEDICA AND THERAPEUTICS. debilitating and prostrating causes. This is a form of disease which has been investigated with great skill by Drs. Abercrombie, Hall, and Gooch, and which is admirably described by the latter. It is chiefly indicated by "heaviness of head and drowsiness, without any signs of pain, great languor, and a total absence of all active febrile symptoms."*' If patients with these symptoms be treated upon the supposition of its being inflammation, they gradually get worse and die from exhaustion, and in some cases towards the last " with symptoms of oppressed brain, as coma, stertorous breathing, and dilated and motionless pupil."f On opening the head after death, "the bloodvessels were unusually empty, and the fluid in the ventricles rather in excess; in two instances death was preceded by symptoms of effusion, viz. blindness, dilated pupil, coma, and convulsions; and after death the ventricles were found dis- tended with fluid to the amount of several ounces, the sinuses and veins- of the brain being remarkably empty ."J In these cases Dr. Gooch very justly infers, "this sudden effusion was a passive exudation from the exhalants of the ventricles occasioned by a state of the circulation the very opposite to congestion or inflammation. "§ Now, it must be evident that the mode of treatment here must be very different from that pursued in inflammation. Instead of depletion, purging, <&c, remedies of a supporting character must be resorted to- Gooch and Hall relate a number of cases in which wine, ammonia, &c, have been successful in curing the disease. For the diagnosis see Hall, Gooch, Abercrombie, f the nature of its powers, and of the best way in which to avail yourselves of them in the treatment of disease. With regard to the mode in which tartar emetic produces its sedative effects, there has been much difference of opinion. By some it has been supposed to be merely the result of the nausea and general relaxa- tion which arc known to follow the use of this medicine ; while others maintain that without the intervention of these effects, it is capable of acting primarily and directly upon the vascular system so as to lessen its action. The latter of these opinions seems to be best supported by fact and observation. In acute cases of pneumonia and rheumatism very large quantities of this article can be given, and the only effect which it produces is to diminish vascular action, without causing other sensible operation, either in the way of nausea, vomiting, purging, or sweating. Facts of this kind unquestionably prove that tartar emetic does exert a primary and independent action as a sedative on the circu- lation. Notwithstanding this, for practical purposes, it is proper to extend our views of the operation of this agent somewhat further, and to embrace the effects of nausea as occurring frequently, most power- fully, in producing its effect upon the vascular system. Circumstances Modifying these Effects. — Age. — From the powerful effect of tartar emetic as a sedative, it is an agent which must be used with great caution in very young subjects. Indeed it requires to be prescribed Avith the same precaution as bloodletting. From inattention to this fact the most dangerous and even fatal consequences have resulted. Actual Condition of the System as to Disease. — This modifies in a remarkable manner the effects of tartar emetic. In health it acts as a sedative on the circulation, but at the same time in very moderate doses it affects the stomach with nausea and vomiting, and sometimes free purging and diaphoresis. On the other hand, in certain affections characterized by high inflammatory action, very large doses may be given without producing any other effect than that of moderating the action of the heart and arteries. This is particularly illustrated in pneumonia and rheumatism. For this interesting fact we are indebted to Rasori and the Italian physicians. It has since been confirmed by the French, English, and American practitioners. Illustrations of the tise of Tartar Emetic in the Treatment of Dis- eases. — Fever. — As a remedy in fever, the reputation of this agent is well established. Under certain restrictions, with due precaution, it may be used in almost all the forms of febrile disease. The mode in which it proves advantageous is obvious from its effects. It operates 312 MATERIA HEDICA AND THERAPEUTICS. by diminishing the action of the heart and arteries, equalizing the cir- culation, and promoting determination to the surface, and in these ways proves eminently efficacious. Acting powerfully on the system, how- ever, its indiscriminate use is not unattended with danger. Where irritability-of the stomach is a symptom of the disease, tartar emetic almost invariably aggravates it, and if persisted in proves exceedingly injurious. Where great debility is present, especially in the advanced stages of fever, this article acts as a poison, prostrating the patient, and hurrying him out of existence. Under other circumstances tartar eme- tic may be resorted to with great benefit as an auxiliary, and sometimes as a substitute for the lancet. The best form in which it can be used is that of solution, in doses of about one-fourth of a grain, repeated every second hour. Inflammations. — As a general remedy, tartar emetic is used exten- sively in almost all inflammatory diseases where the stomach is not the seat of irritation, and with the same intention as in fever. In this country, as well as in England, the practice is to give it in moderate doses. Within a few years a new mode of administering it has origi- nated with the Italian physicians, and since then has been adopted in other countries. The peculiarity of the practice consists in the large doses which are given. It arose with the founders of a new theory which has been started within the present century, and which is called the contra-stimulant theory, or the new Italian doctrine. A brief notice of this doctrine may not be inappropriate, as explaining the rationale of their practice. According to this theory, all medicines are divided into two general classes, viz. stimulants and contva-stimulants. By contra- stimulants are meant those agents which exert a positive action on the living fibre, opposed to that of a stimulant action, and hence their name. In other words, they are direct sedatives. Contra-stimulants are supposed to have the power of subduing excessive excitement, by a specific action of their own, independently of any evacuations being produced from the system. Tartar emetic is one of the substances placed in this class, and, as already stated, the peculiarity of the prac- tice founded on this theory consists in the large doses in which not merely this article, but the whole class of contra-stimulants, are admi- nistered. It is only, however, in a certain state of excitement of the system, or in the language of the theory, when the diathesis of stimu- lus exists, that these doses can be borne. When an opposite state of the system is present, the most injurious, if not fatal, results follow. When a patient bears these large doses well, and without producing any evacuations in the way of vomiting or purging, it is called a tolerance of the remedy, and he is said to tolerate it; and it is mainly upon the manner in which the patient tolerates the remedy that the propriety of its continuance is to be determined. BEDATJVKS. 313 These are four of the leading points of this theory, and it. is apoi principles that tartar emetic is used by them in inflammation . The disease in which it has been most extensively used i pneumonia, and the following will serve as a general illustration of the modi: of giving it. If the attack is very acute, the patient is first to be bled to the extent of eighteen or twenty ounces. If the attack is mild, this may be omitted. He is then put upon the use of tartar emetic, in doses of one grain dis- solved in two or three ounces of sweetened water, to be repeated every two hours. Sometimes the first dose causes vomiting or purgii After this, however, the patient will tolerate the remedy, and he may then go on taking it without any effect of this kind being caused, or any effect produced on the skin. Indeed, when tolerance of the remedy has been once established, it not unfrequcntly happens that patients become so costive as to require the administration of injections. In ordinary cases, after giving about six doses of the medicine, the patient may be left quiet for seven or eight hours, especially if lie has any inclination to sleep. If, however, the disease be violent, and the oppression at the chest be great, the medicine is to be steadily continued until amendment takes place. In some cases, if the symptoms be urgent, the dose is increased to a grain and a half, or to two grains. When the disease is mild, the patient does not tolerate the medicine, and the ordinary effects of it are produced. When violent, on the contrary, instead of these effects, it acts more like an opiate, resembling in this respect the operation of large doses of calomel in dysentery. Generally,* too, the sedative effects of the remedy are most decided when no evacuations take place. Among the advantages of this mode of treating pneumonia, it is urged that it does not leave the patient so liable to relapses, that the subsequent debility is by no means so great as that which follows the ordinary mode of treatment by copious and repeated bloodletting. Acute Rheumatism is another disease in which large doses of this remedy have also been tried, and with great success. In several cases of this kind I have prescribed a grain of tartar emetic every hour, and with evident success. The most striking cases, however, that have come to my knowledge are those which occurred in our state prison, as reported by Drs. Drake and Mauley. In one case, fifty-nine grains of tartar emetic were given in five days, and the patient perfectly cured in eight days from the commencement. In a second case, three hundred and fifty-eight grains were given in nine days, and in a few days after the patient was well enough to leave the hospital and return to his work. In a third case, two hundred and forty-two grains were taken * According to Laennec, the greater number of patients vomit once or twice, and have five or six stools the first day. On the following day they have only slight evacuations, and often indeed vomit none at all. — N. T. Med. and Phys. Jour., No. 26. 314 MATERIA MEDICA AND THERAPEUTICS. in seven days, and the patient was convalescent. In these cases, a grain was taken every ten or fifteen minutes, and in all of them, with the excep- tion of a little vomiting after the first few days, no evacuations were caused of any kind, and nothing occurred during the administration to cause the least apprehension from any ill effects which might have been anticipated from such large and repeated doses. Without recommending this practice to imitation, it must be conceded that it presents exceedingly interesting facts, in relation to the extent to which this article may be exhibited in certain conditions of the system. The practice is certainly gaining ground among the best authorities, both here and abroad. [It is now rarely resorted to, indeed tartar emetic is now little used compared with what it was. — C. R. G.] Mode of Administration. — This has already been incidentally noticed. The first dose may be either half a grain or a grain ; if this causes vomit- ing, a few drops of laudanum may be added to the second dose ; as soon as tolerance is established, the dose may be increased to a grain, or perhaps a grain and a half, and they may be repeated every two or three hours, sometimes indeed every hour, and continued till the disease gives way. DIGITALIS. This medicine was fully treated of under the head of Diuretics, when I called your attention to a somewhat detailed account of its powers as a direct sedative, as manifested particularly in its influence on the pulse. The diseases in which we could avail ourselves of this power were also named. I will not go here into any details, which would of course only be a repetition of what has been said already. One general principle in the use of this drug is sufficiently important to justify a repetition. I mean that digitalis is not a substitute for venesection in inflammatory affections. It is often a useful, sometimes an abused essential adjuvant, but never a proper substitute. HYDROCYANIC ACID (PrUSsic Add). This very extraordinary substance is procured from the laurel, peach, ' cherry, bitter almond, &c, f peach blossoms. This is, however, not correct; its odor is very different; tbe mistake lias arisen from con- founding tbe odor of tbe acid with that of volatile oils with which if. is commonly associated in plants. It is exceedingly volatile, and if a drop or two be put on glass or paper, it instantly congeals, the rapid evapo. ration of one part of tbe acid producing cold enough to freeze the remainder. It is soluble in both water and alcohol, and is exceedingly prone to decomposition. Magendic says, that left to itself in well slopped phials, it sometimes decomposes in less than an hour. It can rarely be kept longer than a fortnight. It is not used in medicine. Medicinal Acid. — There arc a great number of formulas for the pre- paration of this acid, for which I refer you to the pharmacopoeias. Properties. — Like the pure acid, this is colorless, and has the same penetrating odor. It is much more easily preserved than the pure, though in this respect there is a great difference according to the pro- cess by which it is prepared. That obtained from the action of sulphu- retted hydrogen, or the bicyanide of mercury, being most, and that from the action of sulphuric acid on ferro-cyanide of potassium, the least prone to decomposition.* It should be kept in a cold, dark place, in well stoppered opaque bottles. Effects on the System. — Hydrocyanic acid appears to act immediately and directly on tbe nervous system, impairing the general sensibility and irritability of the body. This is perfectly obvious when animals are destroyed by it; and the same general effects, differing in degree are produced by it when given in medicinal doses, provided they be effective. It is, therefore, a direct sedative, and unlike the narcotics in not having its sedative effects preceded by any excitement. Whether it acts on the nerves or by being absorbed, is still a matter of dispute. The predominating opinion is that it is so absorbed. Tbe action, how- ever induced, is on the nervous system, and its effect is to impair energy and depress vital power. It does not directly produce sleep, and its powers as an anodyne are very trifling, if indeed it possesses any.. On the Circulation. — Prussic acid lessens the force of action of the heart and arteries, yet it does not possess any power like that of digi- talis in making the pulse slow. On the Stomach. — Its action is directly sedative ; it impairs sensi- bility and controls irritation at tbe same time ; it rather favors secretion. On the Boivels. — It is rather relaxing, though they are sometimes, costive during its use.f * Christison, p. 116.. f Elliotson, p. 23. 21 316 MATERIA MEDICA AND THERAPEUTICS. On the Kidneys. — Its effects are not marked, though by some it is thought to increase the flow of urine. Such are the effects of hydrocyanic acid on the system, and from them are deduced its practical application to the cure of disease. Affections of the Stomach. — Prussic acid has been a good deal used iu the diseases of this organ. In controlling vomiting it is second in power to no known agent. In gastrodynia and pyrosis it has been much used, and often with excellent effects. In Pulmonary Affections. — In this class of diseases the acid had much more reputation than it has preserved. In phthisis it was once proclaimed as almost a specific. But experience has abundantly proved that except as a palliative it is of no sort of use in the disease. As a palliative, however, it is often of very great value ; it relieves cough, checks night sweats, and by relieving irritation often promotes sleep. In short, it smoothes the pathway to the grave, and perhaps delays the progress of the patient, it can do no more. In Hooping Cough. — Here great advantage may be derived from the acid, if it be used after suitable depletion and evacuation. It mitigates and speedily arrests the spasmodic cough, and accelerates the cure. Dr- Thomson says, " in hooping cough I regard it as the sheet anchor of the practitioner." After an emetic and a brisk purge he gives nothing but the acid, gradually increasing the dose. In Chronic Catarrh it may be used to lull the cough, and diminish the irritability of the bronchial mucous membrane. In the Acute Inflammatory Affections of the Chest. — Though highly commended by Brera, it cannot be relied on. As a substitute for bleed- ing, when the inflammatory symptoms are subdued and great irritability remains behind, it will come in very well. In Dyspepsia. — If this seem to depend rather on an irritable state of the stomach than on inflammation, whether acute or chronic ; if the food causes distress, and digestion is attended with pain, hydrocyanic acid will very often afford relief, and sometimes very promptly. In heart disease, though it is lauded by some, its powers are probably not great. Where irritable action of the heart and arteries depends, as in the absence of organic diseases it often does, on diseases of the stomach, the acid, by relieving the latter, may remove the former symptoms ; where organic disease is present, it can do no good, and may do harm. Mode of Administration, Dose, &c. — Prussic acid is best taken in simple sweetened water; as it is very apt to rise to the surface, the patient should be warned to shake the phial well before taking the medicine. As a matter of prudence, only a small quantity should be left in the possession of the patient at once ; and when a new parcel is obtained, the dose should always be small till it is tried, as the acid SEDATIVES. .',17 varies so exceedingly in si rength. I /iff Ims hrm lost by neglect of tl simple precaution! It is best to begin with a small dose, Bay one or two drops every three or four hours, increasing the dose daily by one drop, till the proper one is ascertained, by the appearance of omi physiological effect — the most common of these is a dryness or stiffness of the posterior fauces, with sluggish movement- of the tongue. The operation of this acid should be most carefully watched. External Application.- — A lotion made by mixing ten or fifteen drops of the medicinal acid with an ounce of water, is used by some to al troublesome itching and irritation, in some of the cutaneous disc; It has also been used with advantage to irritable ulcers. TOBACCO. This is the Nicotiana tabacum. It is a native of America, and its use as an article of luxury was known to the natives long before the disco- very of this continent. Baron Humboldt states that it had been culti- vated from time immemorial by the people of the Oronoco, and was smoked all over America at the time of the Spanish conquest. Accord- ing to the same authority, the plant was " first discovered in the Mexi- can province of Yucatan in 1520, and it was there called Petum" From thenee it was transported to the West Indies and North America. Its introduction into Europe took place in the year 1560, when Jean Nicot, at that time ambassador to the court of Portugal from Francis II., of France, purchased some of the seeds from a Dutchman, who had just brought them over to Lisbon from America. By Nicot the seeds were sent to France, and from these the plant was successfully raised in that country. From the agency which Nicot thus had in introducing the tobacco into France, it received, after him, the name of JVicotiana, the specific appellation, Tabacum, according to Humboldt, being " taken from the word tabac, the name of an instrument used by the natives of America, in the preparation of the herb ;" or, according to others, from the island of Tobago, from which, by some, it is said to have been first brought to Europe. Into England it was introduced by Sir Francis Drake. It owed, however, all its popularity in that country to the cele- brated. Sir Walter Raleigh, whose eulogium of it rendered it fashionable, and brought it into extensive use. The history of tobacco forms a curious chapter in the annals of our race. Next to intoxicating liquor, there is no substance which has gain- ed such an ascendency over hnman taste and appetite as tobacco. There is no nation on the face of the globe, civilized or savage, where it has not found its way. Europe, Asia, Africa, and America, are all familiar with it. There is no condition of society in which it is not a favored 318 MATERIA MEDICA AND THERAPEUTICS. guest. You find it in the palace and the poor-house — in the stately mansion and the humble cottage — in the work-shop and the billiard- room. The lonely exile solaces his weary hours with it — the joyous freeman exults in its influence. Philosophy muses under its power — poetry is inspired and hardy labor cheered by tobacco. "Wherever man is found, its influence is felt and acknowledged. The citizen whiffs his perfumed cigar — the poor man smokes his sooty pipe — the sailor chews his delicious quid — the matron rejoices in her pinch of snuff. On the mountain top and in the lonely valley — on the land and on the broad expanse of ocean — in the dark mines of Pennsylvania and in the glitter- ing halls of Paris — on the rugged hills of Switzerland and in the gold- bearing valleys of California — amid the snows of the North and under the burning sun of the tropics — in battle and in peace — in storm and in calm — in wealth and in poverty — in health and in sickness — the king and the subject — the master and the slave — youth, manhood, and old age — all, all bow to the magic power of tobacco. What is still further curious in relation to this plant is, that it gained this universal ascendency notwithstanding the most powerful opposition. By the wise it was reprobated, by the powerful it was denounced. Even popes and monarchs did not consider it beneath their dignity to engage in the general crusade against it. To give you some idea of the in- dignation excited against this article, I will quote the language of some of those who wrote against it. Old Burton, in his " Anatomy of Me- lancholy," of which the celebrated moralist, Dr. Johnson, says, it was the only book that ever took him out of bed sooner than he wish- ed to rise, gives the following anathema against tobacco. " Tobacco, divine, rare, super-excellent tobacco, which goes far beyond all their panaceas, potable gold, and philosopher's stones, a sovereign remedy to all diseases. A good vomit, I confesse, a vertuous herb, if it be well qualified, opportunely taken, and medicinally used ; but as it is com- monly abused by men, which take it as tinkers do ale, 'tis a plague, a mischief, a violent purger of goods, lands, health : hellish, devilish and damned tobacco, the ruine and overthrow of body and soul." — Vol. ii. p. 109. Another writer, Joshua Sylvester, wrote a poem on tobacco, which he dedicated to Villiers, Duke of Buckingham. This book was entitled, " Tobacco battered, and the pipes shattered (about their ears who idly idolize so base and barbarous a weed ; or at least-wise overlove so loath- some a vanity), by a volley of hot shot from Mount Helicon." — American Quarterly, vol. ix. p. 14. In this work the author questions whether the devil had done more harm in latter ages by means of fire and smoke, through the invention of guns or tobacco pipes, and he conjectures "that Satan introduced the fashion as a preparatory course of smoking for those who were to be matriculated in his own college." SEDATIVES. 319 King James I. of England wrote a formal treatise againsl it, entitled, a "Counter Blast to Tobacco," in which In: say;-, the use ''I' it " toiii loathsome to the eye, hateful to the nose, harmful to flic brain, dan- gerous to the lungs; and in the black, stinking fume thereof, nea resembling the horrible Stygian smoke of the pit that is bottomle ." He states also that "if lie should invite the devil to dine with him, he would among other things give him a pipe of tobacco, a- particularly agreeable to him, to help digestion." The Popes Urban and Innocent XII. both published edicts of excom- munication against all those who took cither snuff" or tobacco. To re- strain the cultivation of tobacco in Virginia, and to prevent its exporta- tion into England, several arbitrary measures were attempted during the reign of James I. By some of the Swiss Cantons, smoking was consi- dered a crime second only to adultery; and to cap the climax of sevei against this poor plant, Amurath IV. made the use of tobacco a crime punishable with death. Still the fragrant weed flourished, and loyal sub- jects and devout Christians, sturdy republicans and slavish Asiatics, all, all resist the law and yield to the influence of Tobacco. Tobacco is an annual plant, growing about four feet high. It is planted in the spring, and flowers in July and August. At one time it was raised to a considerable extent in some parts of England. At present that country, as well as the greatest part of Europe, is chiefly supplied from the State of Virginia. It is cultivated also in every part of the East Indies and in the Eastern Islands. Of the species of tobacco known by the name of Virginia tobacco there are two varieties — a broad and a narrow leaved sort. They do not differ, however, in their properties. In cultivating the plant it is not allowed to attain its full height, but is topped whenever a certain number of leaves are thrown out. This is done to promote the development of the leaves, by preventing the for. rnation of the flowers and seeds. It is cut down in the month of Au- gust, and the plants hung up in pairs under sheds to dry, after which the leaves are separated from the stem, bonnd up in bundles, and packed in the hogsheads in which they are exported. The parts used are the leaves, which are about two feet long and four inches broad ; when fresh they are of a pale green color, and when carefully dried of a lively yel- low. Their smell is strong, disagreeable, and narcotic; their taste bitter and acrid. The active principles of tobacco are a peculiar oil-like alkaloid called nicotina, and a camphoraceous volatile oil termed nkotianin. It is the first of these upon which the active power of tobacco depends. In 10,000 parts of the leaf, 6 parts of nicotina were obtained and 1 of nicotianin. The empxjrcurnatic oil of tobacco, which, as found in the pipe of the smoker, is an active poison, appears to be nicotina attached to a true volatile oil. [Christison.] 320 MATERIA MEDIC A AND THERAPEUTICS. Nicotina is so active a poison that half a grain has been known to kill a dog. [Christison.] Tobacco leaves yield their virtues both in water and alcohol — more so in the latter. Effects. — These differ according to the mode of use and the object had in view in its use. Its effects are local and general. The first are stimulant. If applied to the nostrils in the form- of snuff, it causes sneezing and increased secretion from the nose. Taken into the mouth and chewed, or applied in the form of smoke, it stimulates the salivary glands, and causes a flow of saliva. Its general effects on the system are sedative and relaxing. In large doses it is a virulent poison, acting principally on the brain and heart. It impairs the action of the heart, causing a sense of flutter- ing — excessive faintness — copious perspiration — sense of alarm — sickness and vomiting — coldness of skin — feebleness of pulse — convulsions and death. When used in medicinal doses, we give it simply for the relax- ing effects which it produces, and particularly on the muscular tissue. It produces sickness — sometimes vomiting — relaxation of the bowels — lessens the force and frequency of the pulse — promotes the flow of urine, and causes general relaxation. With regard to the effects of tobacco-, it is important to recollect that they are modified by a number of circumstances. 1. The quality of the tobacco. It is well known that the strength of tobacco varies very much, according to the climate, etc., in which it is reared. In warm latitudes- it is mild ; in cold regions pungent and acrid. Bengal tobacco, I believe, is the weakest ; next to this is the West Indian tobacco. Northern tobacco is the strongest. According to experiments, in 1000 parts of tobacco the following proportions of nicotina were found in different kinds of this article : 8.64 in Havana tobacco, 10.00 in Virginia,, and 11.28 in some specimens grown in France. (See Christison's Dis.) The soil, too, makes a difference in its quality. In a virgin soil it is mild, while in one richly manured it is very rank. (Rogers, 58.) 2. The habits of the person also modify very much the effect of this article. Thus you all know, that if a person has been accustomed to the use of tobacco, he can bear quantities of it which under other circum- stances would produce very unpleasant effects. From the mere force of habit, some persons can remain under the influence of tobacco in some shape or other from morning till night. 3. The age, sex, peculiar constitution, etc., also modify the effects. To children under four or five years it ought never to be given ; it may prove fatal to them. Females are much more severely affected by it than males. Persons of delicate and nervous constitutions too, have their systems much more affected by it than the robust and strong. SEDATIVES. .321 A great difference is observed according as the stomach is full or empty. Tobacco acts upon tlic system in whatever way it, is applied, whether by the month, rectum, lungs, skin, etc. Mode of Administration. — As a medicine it is little used except by the anus ; as a luxury, it is used by the mouth. There are two forms in which this article is used as an injection — smoke and infusion. The latter is the mode generally resorted to, and can be better regulated than the smoke. As tobacco is so powerful a poison, great care should be taken in not giving the injection too strong. One drachm in this way has proved fatal, and sometimes even half a drachm has produced the same effect. As a general rule, therefore, the best plan is never to exceed fifteen to twenty grains, infused upon a pint of boiling water, and draining. This will commonly produce sufficient of the relaxing effects without any of the poisonous ones. "If the in- jection does not come away in five minutes, it should be assisted by throwing up a large quantity of tepid water ; and if its sedation be too great or lasting, such stimulants as ammonia and brandy ought to be administered." (Christison.) Sometimes it is used as a local applica- tion either in the form of cerate or a plaster made of snuff. As a luxury, tobacco, as you know, is used in almost every form. Pulverized and manufactured into snuff, we have every variety, from the acrid Scotch to the more delicate rappee ; of cigars we have all sorts, and shapes, and sizes ; and of tobaccos time would fail me to tell of the short cut and the long cut, the coarse cut and the fine cut, ladies' twist and Virginia twist, pig tail, negro head, and the thousand other forms into which human ingenuity has tortured this article. Of the Uses of Tobacco. — If tobacco in medicinal doses be the active article which it certainly is, it ought to be used with great caution. Like all articles of this kind, it ought to be reserved for such cases and emer- gencies as cannot be met by milder means, and such is the general judgment of the profession. There are cases, however, in which it has been used with advantage, where we require the profound relaxation which this substance produces. The class of cases in which it has been used with advantage are those in which muscular and fibrous tissue requires to be relaxed. Among these are tetanus, and retention of urine arising from spasmodic stricture of the urethra. Several cases are related by Mr. Earle, in which this succeeded where instruments could not be introduced, and where venesection and other remedies had failed. In ten or fifteen minutes after the tobacco enema, urine flowed. It is also used by the surgeons in cases of incarcerated hernia. Dr. Ainslee says the native practitioners in the East Indies are in the habit of apply- ing the leaves warmed to the orifice of the anus in obstinate constipa- tion, and with uniform success in these cases. Applied in this way it generally vomits. 322 MATERIA MEDICA AND THERAPEUTICS. Formerly tobacco was used internally in dropsy as a diuretic. It is not used at present. Externally applied it has been used to promote absorption in swelled breasts or buboe^. The snuff plaster is still occasionally used in croup, but it should be carefully watched, as the constitutional effects may be dangerous. With regard to the use of tobacco as an ordinary luxury, your opi- nion will be frequently asked when you get into practice. On this sub- ject I need not tell you there is a great difference of opinion. By some it is denounced as always injurious. By others it is considered not merely innocent, but even salutary. As is generally the case, truth lies in the middle. If the use of tobacco were attended with the conse- quences attributed to it by some, in what a miserable condition would the poor human race be, wasting under a slow and deadly poison which they are taking in daily, and yet, lamentable to say, totally unconscious of it. A good cause is never promoted by attempts to mystify the truth, and common observation settles the question that the moderate and daily use of tobacco does not always prove injurious. This is as a gene- ral rule ; constitutions, however, are seriously and insidiously injured by its moderate use, while to all its excessive use is unquestionably detri- mental. As the result of a good deal of observation, the conclusions to which I have come in relation to the use of tobacco are the following : 1. It is not necessary for_ man. The inhabitants of the old world before they were acquainted with this article, enjoyed as vigorous health and lived as long as we do in the present day. 2. To some persons, and in certain conditions, it may prove salutary. I know a gentleman who consulted me about twenty years ago. He was plethoric, and was troubled with inordinate action of the arterial system, but otherwise well. I advised him to smoke moderate^, and he is still living, and thinks he owes his life to the prescription. 3. To many it is positively deleterious. I am convinced that a large proportion of the dysjiepsias which are prevalent are owing, as their re- mote cause, to the use of tobacco. It impairs the tone of the digestive organs, and renders the whole system nervous. To those predisposed to consumption, it is manifestly bad. This is a disease of debility, and everything that debilitates the system must be injurious. 4. To young people tobacco generally is injurious, and for a very obvious reason. Until a certain age, the human system does not. receive its full growth and development. If a boy at the age of 14 or 15 begins to use tobacco and spit freely, it must retard his growth, and perhaps lay the foundation of serious disease. 5. It is idle for the moralist or the physician to engage in an indis- SEDATIVES. 328 criminate crusade against the use of tobacco. Tlie one maj exhorl and the other may command, but it will all be of no avail, [t baa become an artificial want, and people arc not to be coaxed or blustered out of it. The physician, however, can do a great deal in preventing the abi it, and this he ought always to attempt. In every patient laboring under chronic disease this ought to he made the special inquiry and direction. With regard to the comparative effects of chewing and smoking, I go decidedly for the latter. If a man smokes as a gentleman, he can only do it at certain seasons and in certain situations. There must be an in- termission. But to chewing there is no limit or check. A man who chews may put a quid in his mouth when he wakes in the morning and keep it there till he goes to bed at night, aye, and all night too. In this way he is constantly kept under its influence. [Much might he said for my favorite pinch of snuff, but I forbear. — Ed.] COLCHICUM AUTUMNALE. This is a small, perennial, bulbous plant, growing native in the tem- perate regions of Europe, where it is found wild in moist meadows. The •common name is the meadow saffron. In this country its cultivation has been attempted, but without much success. The parts used in medicine are the bulbs and the seeds. There are certain peculiarities attending the growth of this plant which are important to be recollected, as they throw light upon the effects of it as a medicine. At the time of flowering in the autumn, a new bulb begins to form on the side of the old one, which partly embraces it. As the new one increases, the old bulb gradually wastes away until the following May or June, when the one is perfected and the other entirely decayed. It is evident from this that the strength of the bulb must vary greatly at different seasons of the year. The proper period for gathering it in England is in June and August. If taken early in the spring the bulb is too young, and if taken late in the autumn the old bulb is exhausted by the new offset. The mature bulb is of an ovoid shape, and about the size of a walnut. When fresh it yields, on cutting, an acrid, milky juice. When dried it is of a brownish color, with a deep groove running through it, and has no smell, but an acrid, bitter taste. Mr. Donovan thinks that drying the bulb interferes with its powers, and Dr. A. T. Thomson says the acrimony on which its virtues depend is partially dissipated by drying and long keeping, and totally destroyed by a heat over 212°. Sir E. Home recommends the wine made of the recent bulbs cut up while 324 MATERIA MEDICA AND THERAPEUTICS. fresh, and immediately thrown into wine. As soon as dug up, it should be cut into slices and dried, otherwise it begins to vegetate. The seeds are small, and when ripe of a dark brown color. They should be gathered when fully ripe and then dried. Their active pro- perties reside in the husk. They should therefore not be bruised when used. All the virtues of the bulb are extracted by wine and vinegar. Effects. — In its effects on the system colchicum is peculiar. It acts as a sedative to the nervous and vascular systems, and at the same time promotes secretion. If given in moderate doses, it lowers the pulse and alleviates pain without producing any other manifest effect. If given in larger closes it causes nausea, vomiting, purging, accompanied with great prostration and depression of the pulse. Although placed by some writers along with diuretics, its action on the kidneys is very uncertain. According to observations of Chelius, a curious effect is produced by it on the character of the urine, and that is to increase the quantity of uric acid. Thus, it is stated that he found on the fourth day after using colchicum, the quantity of uric acid excreted was 0069 parts ; after four days using it was 0*076 ; eight days, 0'091 ; twelve days, 0'112, nearly doubling the quantity in twelve days. In excessive doses it produces all the effects of a narcotico-acrid poi- son ; where it proves fatal there is generally found inflammation of the stomach and bowels. In relation to the use of this article as a medicine, there are two cir- cumstances worthy of recollection. The first of these is the uncertainty which attends its operation. This, as has frequently been remarked, is owing to the difference in the strength of the bulb, from causes already noticed. Another circumstance is that it sometimes acts very unexpectedly, with great activity on the system, and is attended with unpleasant, and even dangerous consequences. Dr. Armstrong accordingly lays it down as a rule, to discontinue the use of it as soon as it brings on sickness or purging. In some cases, too, it produces profound languor and lassitude, without either sickness or purging. This, too, indicates that its use ought to be stopped, for the patient may sink in this state of collapse. Armstrong alludes to a case where death resulted in consequence of con- tinuing the use of it after the purging and sickness had commenced. (Lectures, p. 354.)'* In all cases, therefore, when a patient is under the use of this article he ought to be carefully watched. Forms of Administration. Substance. — The powder of the bulb in doses of from grs. iij. to grs. v. repeated about three times a day. Dr. Armstrong recommends that in this form it should never be used except * See also Beardsley, p. 118. SEDATIVES. 325 in combination with an aperient. If sickness should occur, so much of the powder may be absorbed as to prove dangerous, lie states that be saw one patient's life nearly sacrificed by inattention to bis circum- stance. Acetum Colchici. — The vinegar of colchicum is prepared by mace- rating two ounces of the dried bnlb sliced in two pints of vinegar, and then adding a fluid ounce of alcohol to preserve the preparation from decomposition. Dose from half a drachm to a drachm. Tincture and Wine. — From the variable strength of the bulb the only way is to prepare a saturated tincture or wine. Of these the dosi is from half a drachm to a drachm repeated three or four times a day. As the bulb is uncertain in its strength, the seeds have been lately used as a substitute. A tincture or wine is prepared by macerating an ounce of the seeds in a pint of Teneriffe wine. As the active properties reside in the husk, the seeds should not be bruised. . The dose is from half to one drachm. With regard to all the preparations of colchicum, Dr. Armstrong remarks, that by long keeping or exposure to the light they become more or less impaired in their virtues. Hence he advises them to be kept in a dark place, wrapped in paper, or in opaque vessels. (Lec- tures, p. 353.) Colchicum is not a remedy used in a great number of diseases. It is particularly celebrated in the treatment of gout and rheumatism, and in these it sometimes proves exceedingly valuable. It is supposed to be the active ingredient in the celebrated remedy for the gout, the Eau Medicinale d'Husson. In gout it sometimes produces relief without any sensible evacuation, acting simply as a sedative. Generally, how- ever, you will find that the patient is not relieved until it acts on the bowels. In acute rheumatism, it is advisable to bleed before prescribing the colchicum, although by some it is considered to be a substitute for the lancet. You will not find, however, this to be- the case any more than with digitalis. Both are good adjuvants to bloodletting, but not substitutes for it. Colchicum has also been used, and with some success, in [dropsy and in] inflammatory affections of the chest. ACONITUM NAPELLUS. This is commonly known by the name of monkshood or wolf's-banc. It is a pereunial herbacous plant, growing from two to six feet in height, and found abundantly on the mountains of Germany, France. and Switzerland. Until recently the part used officinally was the leaves. At present, however, the root is preferred as containing more 326 MATERIA MEDICA AND THERAPEUTICS. of the active principle of the plant, and is more uniform in its strength. The root at the thickest part is about the size of the finger, and from four to five inches long, with numerous fleshy fibres arising from it. "When fresh its color is brownish externally and white internally. Its smell is earthy, its taste bitter. After being chewed, it leaves a pecu- liar tingling and numbness on the tongue, lips, and fauces. The same effects on the mouth are produced by chewing the leaves. The root becomes of a darker color when dried. Composition. — No very satisfactory analysis of the root or leaves has yet been made. They contain, however, a vegetable alkali, aconitina, a peculiar acid, aconitic acid, and a volatile acid principle. The alkali exists in the state of a salt, aconitate of aconitina. Effects. — The effects of aconite are curious and peculiar. If a small quantity of the soft alcoholic extract be introduced into the cavity of the peritoneum of a dog, it usually causes vomiting, lessens the force of the circulation, impairs the muscular power so as to cause the animal to stagger, and destroys sensibility without causing stupor. The ani- mal will sometimes follow its owner around the room, recognise him by wagging his tail, and yet be totally insensible to pinching, pricking with needles, &c. Before death slight tremors, but no regular convulsions, generally take place. (Pereira.) On the human subject the effects are the following. If the leaf or root be chewed, or a few drops of the alcoholic tincture applied to the lips, in a few minutes a sensation of numbness and tingling is produced in the part, which lasts for several hours. If the quantity taken into the mouth be somewhat large, the throat and palate become affected. Pereira describes the sensation " as if the velum and soft palate were elongated, and resting on the dorsum of the tongue. To relieve this, frequent attempts are made to swallow. 1 ' When small and repeated doses of the alcoholic tincture of the root are swallowed, they cause a sensation of heat and tingling in the extre- mities, and occasionally slight diuresis. In poisonous doses, the characteristic symptoms are, numbness and tingling of the parts about the mouth and throat, and of the extremities^ vomiting^ contracted pupil, and failure of the circulation. Neither con- vulsion nor stupor, as a general rule, precedes death. It lessens directly the sensibility of the nerves and impairs the action of the heart. It is perhaps, therefore, the purest sedative that we possess. The principal use to which the agent has been applied is that of les- sening morbid sensibility of the nerves, and as such it frequently proves very efficacious. In neuralgic affections, it is sometimes wonderful in its effects — a single local application effecting a cure. In rheumatic affections too, unattended by inflammation, it frequently proves very useful. The best form of it in these cases is the tincture, locally applied. SEDATIVES. 327 About a century ago, this remedy w.'is in great repute in a number of diseases, such as scrofula, phthisis, cancer, dropsy, &C. It, wa- one of the drugs so highly recommended bj Baron Storek ofVienna. After a while it went into disrepute, and it is only recently that its use has been revived. At present it is not supposed to be of much benefit in the diseases in which it was so much landed by Storek. Preparations. — Tlie only preparations which ought to be depended on are the tincture and the alcoholic extract and aconitine. Tincture. — Take of the root, 1 lb.; alcohol, 2 pints. Macerate for 14 days, express strongly and filter. Dose. — 5 drops three times a day. To be used with caution. Ap- plied externally by means of a small brush. Alcoholic Extract. — U. S. Pha., | of a grain every three hours, in pill. Externally in the form of ointment, one part extract and two of lard, or spread on adhesive plaster. Aconitine. — This alkali was first discovered in 1825 by Brando and Peschier. It is obtained by taking the dried and bruised root of aconite, and boiling it in rectified spirit three times successively. Then strain all the liquors and let the spirit distil. Evaporate what remains to the consist- ence of an extract. Here alcohol extracts the aconite from the root, and the extract contains this principle in combination with aconitic acid and other matters. Water is then added to this extract, and the strained liquor is evapo- rated to the consistence of syrup. The water here dissolves out the aconite from the extraet. To this diluted sulphuric acid and water are added. A sulphate of aconitine is thus formed, and this is again decomposed by the addition of a solution of ammonia, which precipitates the aconitine. In this state, however, it is impure. It is now to be again dissolved in diluted sulphuric acid and water, with the addition of animal charcoal. It is then to be strained, and the aconitine again to be precipitated by a solution of ammonia. It is then to be washed and dried. Properties. — Aconitine is found either as a white granular substance, uncrystallizable, or in the state of a transparent colorless mass, having the lustre of glass. It is destitute of smell, and has a bitter and acrid taste. This acrid taste, however, does not belong to the aconitine, inasmuch as it can be separated from it by combining the base repeat- edly with acids and decomposing the salt thus formed. Aconitine is little soluble in water, requiring 150 parts of cold and 50 of boiling water to dissolve it. In alcohol it is readily soluble. Aconitine com- bines with acids and forms salts. They do not, however, crystallize, but dry into a gummy mass. Their taste is very bitter. The solution 328 MATERIA MEDICA AND THERAPEUTICS. of nitrate of aconitine is colorless. That of the sulphate is yellow at first, and afterwards becomes of a dark violet. The alkalies decompose them, precipitating the aconitine. (Phillips.) JEjfects. — From the great activity of this article, it is not safe to use it internally. When pure, and deprived of its acrid principle, it appears to be the most virulent poison that we know of. The twentieth part of a grain dissolved in alcohol will destroy a bird with the rapidity of lightning. This was done with Morrison's aconitine. The fiftieth part of a grain of the same killed a sparrow in a few minutes (Phillips) ; and the same quantity nearly proved fatal to a female to whom it was given. {Pereira.) If a grain or two of aconitine, mixed up with a drachm of lard or a drachm of alcohol, be rubbed on the skin of the forehead, or any other tender part for a minute or two, an effect is produced analogous to that of veratrine and delphine. In some respects, however, the sensations differ. Veratrine " produces a strong sensation of tingling, or rather a sharp feeling, similar to that produced by receiving a succession of electric sparks on an uncovered part of the body." Delphine produces "" a sensation of burning, not unlike that which manifests itself a short time after the application of a blister, but to an unpleasant degree." ^Aconitine produces " a sensation of heat and prickling;" to this succeed " a feeling of numbness and constriction in the part, as if a heavy weight were laid upon it, or as if the skin were drawn together, by the power- ful and voluntary contraction of the muscles beneath. This effect lasts from two or three to twelve or more hours, according to the quantity rubbed in." (Turnbull, p. 58.) Aconitine produces less local irritation than either veratrine or del- phine. Indeed, in no case does it produce any more local excitement than could be accounted for by the mere friction. A minute portion of the ointment applied to the eyes causes almost insupportable heat and tingling, and contraction of the pupil. (Pereira.) There are two forms in which this substance is used as an external application, ointment and solution. Ointment. — This is prepared in the following way : 3 . Aconitine gr. ij. Alcohol gtt. vi tere optime. Et adde Axung. 3 i ut fit ung. If necessary, it may be increased to the strength of four or five grains to the drachm. This is to be rubbed on the part until the pain is relieved, and may be repeated three or four times a day, according to the effect produced. With regard to the aconitine, the same rule holds good as with the veratrine. Unless it produces the peculiar effects of the article on the skin, no good need be expected from it. SEDATIVES. 329 Solution. — One or two grains dissolved in a drachm of alcohol. This may be applied by means of a small sponge brash. Care should be taken in making these applications that the skin is not abraded. [Veratrum Album, U. S. White Hellebore. — Native of Central Km rope. Stem of long leaf-stalks, sheathing each other. Root, the part used in medicine, composed of root-stalk, two inches long, and radicles. Taste at first sweetish, then acrid, bitter and permanent. Its medicinal proper- tics depend on the presence of the alkaloid veratrine. Effects. — A violent irritant poison, causing at first vomiting and purg- ing, then stupor and convulsions. Little employed. Preparation. — The best is the wine. U. S. P. Dose, gtt. xxx to gtt. xl. Veratrum Viride. American Hellebore. — Said to have been long known to the Aborigines, first introduced into practice by Dr. Osgood ; much praised by Ware, Tully, and others. It resembles white hellebore, and like it contains veratrine. Effects. — Resembling hellebore, the less apt to purge.] iJkAJ Veratrine. — This vegetable alkali was first discovered in 1819, by Pelletier and Caventou, in the seeds of the Veratrum sabadilla, or the Helonias officinalis, a plant growing in Mexico. It was afterwards detected by them in the roots of the Veratrum album and the Colchicum autumnale. What is used in medicine, however, is obtained entirely from the sabadilla seeds. Mode of obtaining it. — The seeds of the sabadilla bruised are first boiled in alcohol, and this is repeated three times. The alcohol here dissolves out all Veratrine, along with veratric acid, coloring matter^ and other compounds. The alcoholic solution is then evaporated to the consistency of an ex- tract. This is then boiled three or four times in water, to which a little sulphuric acid has been added. Here the veratrate of veratrine is de- composed, and converted into the sulphate of veratrine. The solution is then evaporated to the consistence of a syrup. This is then saturated with magnesia, and afterwards digested with a gentle heat in alcohol. Here the magnesia decomposes the sulphate of vera- trine, and sets free the veratrine, which is taken up by the alcohol. The alcohol is then distilled off. The extract which remains is then boiled in water, to which sulphuric acid and animal charcoal are added. To the strained solution ammonia is added, which throws down a precipi- tate, which is to be separated and dried. In the latter part of this process, the sulphuric acid unites with the veratrine, while the charcoal abstracts the coloring matter; the am- 330 MATERIA MEDICA AND THERAPEUTICS. monia then again decomposes the sulphate, and throws down the vera- trine. The article thus prepared is the one used in medicine. It is not, how- ever, considered as the pure alkali. It is a compound consisting of pure veratrine, sabadilla, resin of veratrine, and gum resin of veratrine. (Pereira.) .. Properties. — Veratrine is obtained in the form of a light brown or white powder, without smell ; taste acrid and burning, and producing a feeling of numbness and tingling, when applied to the tongue. In water, it is very sparingly soluble, but sufficiently so to render the fluid acrid ; in alcohol and ether, very soluble. It restores the blue color of litmus, reddened by an acid, and unites readily with acids, forming un- crystallizable salts. When heated, it melts, and has the appearance of wax, and on cooling presents a mass of brownish transparent appear- ance; when ignited in the air, it is decomposed and totally dissipated. Effects. — By Magendie, the following results were obtained by expe- riments made upon animals. A very small quantity injected into the nostrils of a dog caused instantly a violent sneezing, which lasted near half an hour. One or two grains thrown into the throat caused a free salivation, which continued for some time. The same quantity injected into any part of the intestinal canal produced inflammation of the part with which it came in contact, succeeded by vomiting and purging. In large doses* it caused great acceleration of the circulation and respira- tion, quickly followed by tetanus and death. One or two grains injected under the pleura or tunica vaginalis produced tetanus and death in ten minutes. The same quantity injected into the jugular vein caused simi- lar effects in a few seconds. On dissection, the mucous membrane of the intestines was found inflamed, and the lungs engorged and inflamed. In the human subject, the smallest quantity taken into the mouth causes free salivation, and if applied to the nostrils, produces violent sneezing. When given internally in medicinal doses, a sensation of warmth is produced in the stomach, which gradually extends itself over the abdo- men and lower parts of the chest, and afterwards to the head and extre- mities. If the medicine be continued, a sense of tingling is felt in dif- ferent parts of the body, and sometimes over the whole surface, accom- panied frequently by perspiration and a sense of oppression. To this succeeds a sensation of coldness, and if the medicine be still continued, nausea and vomiting take place ; sometimes looseness and only occa- sionally purging are produced. Generally the force and frequency of the pulse are diminished under its use, but no narcotic effects take place. When applied externally, in the form of ointment rubbed on the skin, as a general rule, no local irritation is caused. In some cases a slight blis- ter, and in others an eruption appear on the part. The first effect ex- perienced is a sense of warmth and tingling in the part, and, according SEDATIVES. 88] to Turnbull, until this is produced, no effect is experienced from the medi- cine. This is agood criterion to judge of the purity of the article. After the ointment has been applied a sufficient length of time to influence the system, the heat and tingling extend over the whole surface, and the same sensations are produced as those accompanying its internal The pulse is also affected as by the internal use. Applied endermiailh/ the effects are still more decided, but the local irritation is so great as to preclude its use. Form of Administration.' — In consequence of its acrid taste, the best form of giving it is that of pill. The formula recommended by Turn- bull is the following : 1}, Veratrine grs. ij. Ext. hyoscyam. grs. vi. Pulv. rad. glycyr. grs. xii. M. Divide into twelve pills — one three times a day. Tincture. — Magendie directs four grs. to be dissolved in one ounce of alcohol. Of this he advises from ten to twenty-five drops to be given in a cup of broth as a substitute for the tincture of colchicum. As external applications, it may be used either in the form of oint- ment or tincture. The ointment is the best. This is made by rubbing up from fifteen grs. to 3 ss veratrine, with 3 i of olive oil and § i of lard. Of this a piece as big as a nut is to be rubbed with the hand for ten or fifteen minutes on the part affecte.-i. In doing this, care should be taken that the skin be not broken or lenuded, otherwise great irritation will be produced. Where the oint v rmnt cannot be used, a tincture made of 3 i veratrine to § ij of alcohol way be applied in the same way. Besides the alkali itself, the tartrate, acetate, and sulphate, have been used. They produce the same effects, and are given in the same doses. Diseases in which Veratrine has been used. — The diseases in which it has been used by Dr. Turnbull, and as he says with advantage, are: 1. Affections of the heart, unattended by organic disease ; 2. Neuralgic affections. In these it seems to exert its power in the most striking manner. In some cases a single friction gives entire relief. 3. In chro- nic rheumatism ; 4. Gout ; 5. Dropsy. In this case it operates by pro- moting the flow of urine. In all of the foregoing cases, the remedy was applied externally. Delphine. — This was first discovered in 1819, by MM. Lassaigne and Fenuelle. It exists in the seeds of the stavesacre (Delpkinum staphisagria) in combination with delphinic acid. The mode of obtaining it, recommended by M. Couerbe, is the follow- ing : — a saturated tincture of the seeds is to be evaporated to the con- sistence of a thin extract, and heated with water acidulated by sulphuric 22 332 MATERIA HEDICA AND THERAPEUTICS. acid. This solution, when filtered, is to be precipitated by ammonia. The precipitate, after being freed from its water, is to be taken up with alcohol, and again reduced to the consistence of extract, which is likewise to be dissolved in acidulated water. To this solution, when filtered, a small quantity of nitric acid is to be added, as long as any precipitate falls. The liquid freed from this precipitate is again to be thrown down by ammo- nia and the powder dried. (Turnbull, p. 49.) This is the delphine of commerce. Like veratrine, however, this is a compound substance, consisting of delphine, resinous matter, and staphis- acre (an acrid resin). To obtain the delphine separately, dissolve in ether. This takes up the delphine, but leaves the others. Properties. — When pure, delphine is in a state of white powder, without smell, but has a bitter and acrid taste. It is very sparingly soluble in water, whether hot or cold. It nevertheless imparts its bitter taste to the water. In ether it is soluble, and still more so in alcohol. Its solutions in these fluids have the property of rendering syrup of violets green, and of restoring the blue color of litmus when reddened by acid. It unites with the acids, forming salts which are bitter and acrid, and crystallizes with great difficult} 7 . When heated, it melts and resembles wax in its appearance. On cooling it is brittle like resin. Effects. — In doses of half a grain, repeated three or four times a day, delphine may be given without producing any irritation of the stomach. In some cases it operates on the bowels, and most usually causes an increased flow of urine. When taken to thx extent of a few grains, it gives rise to sensations of heat and tingling j v i various parts of the body, analogous to those produced by veratrine. ■ In large doses, it is a narcotico-acrid poison. The salts of delphine act in the same manner as the pure alkali. When applied externally, in the shape of ointment or solution, it causes a sensation of burning, resembling very much the effect produced by a blister a short time after it has been applied. In almost every case it causes a blush of redness on the surface to which it is applied. In this respect it differs from veratrine, which causes no redness. Besides this, the local effect of delphine is more permanent than that of veratrine. Test of the goodness of Delphine. — Turnbull lays down the rule that unless a solution of it in alcohol, in the proportion of four grs. to the drachm, produce a sense of heat and pricking, after being rubbed on the forehead for three or four minutes, it is not good and ought not to be used. Form of Administration. — Internally, it may be given in, pill. IJ Delphine, gr. i. Extract hyoscyamus, Extract glycyrrhizae, aa grs. 12. — 12 pills. One to be taken every three or four hours. rSKDATIVKS. It is generally, however, used as an external application either as oint- ment or solution, in the proportion of from 10 to 80 grs. to the Onn< lard or alcohol. These are to be rubbed on in tlic same way as tlie veratrine, from 10 to 20 minutes, or until the peculiar tingling sensation is caused in the part, and this is to be repeated three or four times a day. Diseases in which Delphine is used. — In its general effects, delphine resembles veratrine, and has been used in the same affections. Chiefly used in neuralgic affections, paralysis, and rheumatism. ACTCEA RACEMOSA. Known by various other names, as Cimifuga racemosa, Cimifuga ser- pentaria, Macrotys racemosa, and by the common names of black snake root, cohosh, squaw root. This plant grows from four to six or eight feet high. It is found native in many parts of the United States, from Canada to Florida. It flowers in June and July. The part used is the root, which is perennial. As found in the shops it consists of a rough, tuberculated head, with numerous radicles, sometimes several inches long. These radicles are brittle, and easily separated. The color of the root is blackish exter- nally, and white internally. It has little smell, its taste is bitter and somewhat astringent, leaving a sense of acrimony on the palate. The proper time for gathering &e root is late in the summer or in the autumn. Its sensible properties are ^id to depend a good deal upon the time of gathering, mode of drying, aQ. According to the analysis oi Mr. Tilghman, it contains fatty matter, gum, starch, resin, green coloring matter, tannin, tvax, gallic acid, sugar, oil, lignin, with salts of lime, iron, magnesia, and jjotassa. The virtues are yielded to water and alcohol. Effects. — In its general action on the system, this article appears to resemble very much the colchicum. It promotes the secretions of the mucous membrane, and at the same time produces an impression on the nervous system, and lowers the action of the heart and arteries. It is very much used by many American practitioners in rheumatism, and is said very often to produce excellent effects. It has also been used in some nervous affections, as chorea. It had at one time great reputa- tion in affections of the lungs, as humoral asthma, chronic bronchitis ; it was even said to have cured phthisis. That it may do good in the former cases is probable ; in the latter, certainly not. 334 MATERIA MEDICA A3STD THERAPEUTICS, Cold. Cold is used in medicine to produce two very different effects, which may be called its immediate and its secondary effects. The immediate effects of cold are to depress vital action ; it is one of the purest and most indisputable of sedatives ; but cold is much more frequently used in the treatment of disease with a view to its secondary effect, or to the reaction which, when not too intense nor too long continued, it provokes. It is with the former of these uses of cold that we are now to deal. Cold as a sedative is used either — 1. To reduce the temperature of the part to which it is applied, or of the whole system. 2. To repress vital action, especially the action of the heart and arteries. The first of these uses of cold will be considered when I speak of re- frigerants, and the use and value of the remedy appreciated ; it is with the latter or the proper sedative effects of cold that we have now to do. Cold, then, is used to repress vital action in internal inflammations, especially of the brain ; the mode of applying it is either by cloths wet with cold water, by ice applied to the head, or by freezing mixtures. As to the use of cold cloths, I remark that their value, indeed their safety, depends altogether on the manner in which they are used. If the water used is quite cold, and the cloths are changed often enough to keep the heat of the part down, nothing but cjood can result ; but if, on the contrary, the water be only moderate/ cold, and the cloths be allowed to remain on long enough to bec6 m e warm, reaction takes place after each application, and the art of man could scarce contrive a more mischievous agent. This is a very great objection to the use of this agent in this way. Everything depends on the nurse, and she is not always a safe dependence. Ice to the head. — This is generally applied in a bladder ; it is free from the objection which I have stated against cold cloths, and if decent care be taken it will always do good, and never harm. The only way, indeed, in which it can do harm, is by depressing the vital powers below the standard of life, and causing either fatal prostration of the whole system, or gangrene of the part to which it is immediately applied. To guard against this remember — 1. The class of patients most obnoxious to this kind of mischief are those whose powers are reduced, and whose capacity of generating heat is small. The two extremes of life present us with illustrations of these states. The old man's powers are worn out, he resists cold badly, his circulation is languid, his extremities are more likely to give way under the local effects of cold. On the other hand, the young child, >IU)ATIVE8. 835 especially the infant, has but a moderate power of producing animal heat, and besides liis vital powers are weak. He, too, resists cold badly. But, aside from age, constitutions differ, and of course the feeble, the ill-nourished, the depressed, and those whose vital powers are failing under the influence of severe disease, will suffer most from intense cold. The rule to be observed for all these facts is -imply to moderate the degree of cold which you use to persons who from age or constitution are ill able to bear up against it, and to watch the effect of cold applica- tions in such patients, and indeed in all patients. With these guards the application of the ice poultice (so called) may be resorted to in inflam- mation of the brain with the best effects. The freezing mixtures are only to be used as substitutes for the ice bag- If it is desirable early in an attack to make a very strong impression on the cerebral circulation, this can be done by pouring from a height ice-cold water on the head. This is a remedy of great power, and should be used with caution. It is not proper where serious organic mischief is suspected. It must not be long continued (three to five minutes is enough). 2. Great care should be taken to prevent excessive reaction after the cold dash by immediately applying to the head either cold cloths or the ice bag, and keeping it there for some time, watching always its effects, and removing the ice if it seem likely to endanger the vitality of the scalp, or the vigor of the general system. To Local Inflammations, the results of injury, cold water is an admir- able remedy. Here the great art is to apply the cold in a moderate degree, but continue it for a very long time. This, however, belongs rather to surgery than to i ^dicine. Internal use of Cold as nausea and vomiting. It is also diaphoretic and diuretic. Here a citrate of soda is formed, while the carbonic acid is diffused through the water. Orange. — This is the product of the Citrus aurantium, a native of Asia, but cultivated in the south of Europe, in the West Indies, and in Florida. The juice consists of citric acid, malic acid, aaicihij/c, alhiuam, sugar, citrate of lime, and water. This is a most grateful refrigerant, allaying thirst and lessening heat. Citric Acid. — This acid is peculiar to the vegetable kingdom, and was first obtained in the solid state by Scheele in 1781. It is found in the juice of many acid fruits, generally in a free state, but sometimes in combination with potash and lime. It is found in the fruits of the genus citrus, in the cranberry, whortleberry, gooseberry, red currant, strawberry, raspberry, cherry, mixed with equal quantities of malic acid. In the tamarind it exists both with malic and tartaric acids. It is always obtained from the juice of the lemon and lime. It crys- tallizes in colorless rhomboidal prisms, Avhich are slightly affected by exposure to a moist air. It is exceedingly acid, but destitute of smell. It is soluble both in hot and cold water, and, in small proportions, in alcohol. Citric acid answers as a substitute for lime juice when that article cannot be procured. Nine drachms and a half of the acid dissolved in a pint of distilled water form a solution equal in strength to recent lime juice. Of this solution or of lemon juice 3j of bicarbonate of potassa satu- rates 3 iijss, 3j of carbonate of potassa 3 iv, and 3j of carbonate of ammonia 3 vi. A scruple of the acid dissolved in a pint of water, and sweetened with sugar which has been rubbed on fresh lemon peel, makes a good substitute for lemonade. — U. S. Disp. Tamarinds. — This is the product of the Tamarindus Indicus, a large tree growing native in the East Indies, Egypt, and Arabia, and from thence transplanted in the West Indies. In every part of India this tree is common, and in all the Eastern islands it grows luxuriantly. According to Ainslee, it is in Java that it attains the greatest perfection, and is an exceedingly beautiful tree. The fruit is a broad ash-colored pod, from two to six inches long, containing numerous seeds, surrounded by a viscid pulpy matter. Tamarinds are chiefly brought here from the West Indies, where they are prepared by placing the pods, previously deprived of their shells, in 338 MATERIA MEDIC A AND THERAPEUTICS. layers in a suitable vessel, and then pouring boiling syrup over them. This congeals on becoming cool. Fresh tamarinds have a pleasant acid taste, without any sweetness. As brought to this country they are in the form of a dark-colored mass, with a sweet acidulous taste. According to the analysis of Vauquelin, the pulp of the prepared tamarind contains in 100 parts (besides the sugar which is added), citric acid, 9.40 ; tartaric acid, 1.55 ; malic acid, 0.45 ; super-tartrate of potassa, 3.25 ; gum, 4.70 ; gelatine or jelly, 6.25 'parenchymatous matter, 34.35 ; water, 27.55. Sometimes copper is also detected in them. This is supposed to be owing to the vessels in which they are frequently prepared. This may easily be ascertained by inserting a smooth iron blade in them. If cop- per be present a reddish crust will form on the blade. Effects. — Tamarinds are agreeably acid and refrigerant. If taken in sufficient quantities they also prove laxative. The common form of using them is that of tamarind water, made by infusing boiling water on the prepared pulp. This is called Acetum, or the Acidum aceticum irnpurum, a peculiar fluid obtained from certain liquors undergoing the acetous fermentation. In wine countries it is obtained from vinous liquors, but in this country it is usually obtained from beer and cider. In its color, vinegar varies from a yellow to a deep red, according as it is prepared from white or red wine. According to analysis vinegar consists chiefly of acetic acid and water, in the proportion of five parts of the first to ninety-five of the second. Besides these, it contains various impurities derived from the liquors from which it is prepared, such as gum, starch, malic and tar- taric acids, coloring matter, a little alcohol, and small proportions of alkaline and earthy salts. Properly diluted, vinegar forms an excellent refrigerant drink, although not so agreeable as the other vegetable acids, and on that account not so much used. As an addition to gargles, it is frequently very useful as an astringent ; as an external application, largely diluted with water, it is very valuable for sponging the surface, for the purpose of lessening morbid heat. Cold. — This is the most decided refrigerant that we know of; and in many cases is most advantageously applied in the management of disease. It may be applied in various ways. 1. In the shape of Gold air ; 2. Cold water taken internally and externally; 3. Ice applied externally and taken internally. KEFRIGEHANTS. 339 I'KACTH'AI, APPLICATION IN TIIK Til K ATM KN I OK DISK A SKS. 1. Fevers. — Whatever difference of opinion may have existed at one time in relation to the use of refrigerants in febrile affections, scarcely any exists at present. That there ever should have been any doubt on the subject seems strange enough. If refrigerant agents posses^ the power of lessening morbid heat, moderating the action of the heart and arteries, and allaying thirst, one would suppose that common Bense as well as reason would have sanctioned, if not suggested, the propriety of their use in fever. In the practice of the present day they are gene- rally resorted to, and may be used with great advantage in all fevers, where the object is to diminish morbid heat and moderate the circula- tion. In many cases, too, they are the best remedies which can be used for the purpose of quieting irritability of the stomach. »In some of the forms of fever in which this is a prominent symptom, besides the ordinary effervescing draughts, cold water and ice in small pieces are among our most efficient agents. The Jiistory of the use of cold water in fever is very interesting. Among the ancients it was a practice by no means uncommon. It was used by Hippocrates; and Galen, who wrote extensively on the use of water, recommends in the highest terms the administration of cold drinks, and even immersion in the cold bath, in cases of ardent fever. The form of affusion, however, as practised in modern times, does not appear to have been known to them, and their practice, such as it was, seems never to have been established upon any scientific or philoso- phical principles. Accordingly, like all other remedies used empi- rically, it sank before the wave of varying opinions and successive theo- ries, and eventually was completely lost in the medical practice of the civilized world. Among some of the ruder nations of Asia and Africa traces of it were, however, to be met with. Lavary, who travelled in Egypt, says it is customary for the inhabitants, when attacked by fever, to bathe in the Nile; and Bruce, the celebrated traveller, states it to have been common among the Abyssinians. The first regular and sys- tematic notice that we have of the practice, however, was in the early part of the last century, by De Hahn, by whom it was extensively used in an epidemic fever of a typhoid character, which prevailed in Breslau, in Silesia, in the year 1737. The manner in which the water was applied was by means of " sponges soaked in cold water to every part of the surface in succession." In general, it was not resorted to until the eighth or ninth day of the disease, or when the case was becoming desperate from the failure of other remedies. Applied in this way, it must have frequently done more harm than good ; at any rate, the practice made no progress. 340 MATERIA MEDICA AND THERAPEUTICS. It was reserved for Dr. William Wright, a British physician, who had resided previously in the West Indies, to revive the practice. In the year 1777, while on his passage from the West Indies to Liverpool, he was seized with a fever which prevailed on board the vessel. Hav- ing tried various remedies, but without effect, and finding, too, that whenever he got upon deck he felt better, and that just in proportion to the coldness of the air, he determined, as he says, " to put in practice on himself what he had often wished to try on others in fevers similar to his own." Accordingly, on the fifth day of the disease, he pursued the following treatment, which I shall give in his own words : " Sept. 9. Having given the necessary directions, about three o'clock in the afternoon I stripped off all my clothes, and threw a sea cloak loosely about me till I got upon deck, when the cloak was also laid aside ; three bucketfuls of salt water were then thrown at once upon me ; the shock was very great, but I felt immediate relief. The head- ache and other pains instantly abated, and a fine glow and diaphoresis succeeded. Towards evening, however, the same febrile symptoms threatened a return, and I had again recourse to the same method as before, with the same good effect. I now took food with an appetite, and for the first time had a good night's rest. " Sept. 10. No fever, but a little uneasiness in the hams and thighs — used the cold bath twice. - "Sept. 11. Every symptom vanished; but to prevent a relapse, I used the cold bath twice." Another person seized on board with the fever was treated in the same way, and with like success. The account from which the foregoing is drawn was published by Dr. Wright in 17&7 in the London Medical Journal ; and it was this simple narrative which struck the eye of Dr. Currie, and suggested the hints which afterwards led to the ingenious and beautiful investigations of this subject by that elegant scholar and accomplished physician. Thus it is that men of genius, seizing the rude ideas of inferior minds, have con- structed theories and perfected discoveries, which have rendered their names immortal. Having received the commendation of such high authority, as might naturally be expected, the remedy became exceedingly popular, and was extensively used, more especially in hospital practice, by Drs. McLean, Jackson, and others. Undergoing the same vicissitudes which have so strikingly marked the history of our art, it has again fallen into disre- pute. Believing it, nevertheless, to be a remedy of value, it may not be useless to designate the leading principles which should govern its use in fever. , 1. It ought not to be used in the cold stage of fever. The internal organs are already in a state of oppression, and unable to react upon the KEFKIQKKANTS. 84 I blood thrown into them, in this condition of things the application of cold to tlio surface will still further increase the oppression, and the con- sequence may even be fatal to the patient. 2. It should never be used when the heat of the system is not - than natural. In judging of the degree of heat, it should Dot bd deter- mined merely by the feelings of the patient, but by actual measurement with a thermometer. For this purpose the bulb of a small thermometer should be placed under the tongue, or in the axilla. The heat in these two places corresponds exactly, and will indicate the heat of the surface of the body, where covered from the contact of the external air. 3. It should never be used when the patient is in a state of perspira- tion. The reason must be obvious. It interferes with a process which is most effectually lessening febrile heat and excitement, at the same time that it would drive the fluids upon the internal organs when they are not in a suitable condition for reaction. 4. It should never be used when local inflammation or congestion of some internal organ is present. Both would inevitably be aggravated by it. 5. It should never be used in the advanced stages of fever, where there is great debility, and where the heat of the system is already much reduced. Under these restrictions this remedy may be used with great advan- tage in fevers, and the suitable period for it is when the exacerbation is at its height. In continued fever this generally takes place towards evening. Gene- rally speaking, it will prove most efficacious if used in the earlier stages of the disease. In applying this remedy certain precautions are necessary. Salt wa- ter is preferable to fresh, as it produces greater reaction, and the tempe- rature of it should be about 40°. The patient is to be placed on a stool in a large tub, and a bucketful of water is to be- poured over his head and shoulders. He is then to be rubbed dry and put into bed. If the remedy agrees with him, it will be found in a short time afterwards that the heat is diminished, the pulse lessened in frequency, and indeed all the febrile symptoms are annihilated. If these effects should be pro- duced, it may with safety be repeated whenever the febrile exacerbation comes on. Such was the practice of cold affusions as recommended by Dr, Currie. At present it is but little used,, and in place of it the safer and more con- venient mode of applying cold in the form of cold sponging has been adopted. Used in this way, it proves exceedingly salutary in allayiug morbid heat, lowering the circulation, and soothing the patient Inflammations. — As a general rule,, as has been already stated, the use of cold in cases of internal inflammations is objectionable. There are, however, two exceptions which require especial notice. 342 MATERIA MEDICA AND THERAPEUTICS. Plirenitis.- — In cases of this kind, in addition to venesection, there is no remedy which exercises so powerful an influence as the application of cold to the head. It may be used in various ways — either by apply- ing cloths dipped in cold water to the head, or by a common bladder filled with ice, or what is still more efficient, pouring cold water on "it from a vessel. In using this the patient is to be raised in bed, and the body to be protected from being made wet. A large empty basin is to be held under the chin, and the cold water is then to be poured from a pitcher on the crown of the head, the stream to be raised gradually as the patient can bear it. This is to be continued until the desired effect is produced. This mode of applying cold originated, I believe, with Dr. Abercrombie, of Edinburgh. " Applied in this manner," he says, " it is a remedy of such power that it requires to be used with much discre- tion. Under the operation of it I have seen a strong man thrown, in a very few minutes, into a state approaching asphyxia, who immediately before had been in the highest state of maniacal excitement, with mor- bid increase of strength, defeating every attempt of four or five men to restrain him."* The same remedy is recommended by Dr. Abercrombie in the convulsive diseases of children, in preference to the warm bath so commonly used.f Gastritis. — There is another form of inflammation in which cold may be used with great advantage, taken internally. Small pieces of ice swallowed have frequently an admirable effect in allaying the gastric irritation. [Intoxication and Narcotic Poisons. — To remove the effects of intoxicating drinks no agent can compare with cold affusion. I have tried this very frequently on men who were " dead drunk" unable to move ; in ten minutes they walk about. It is, however, a remedy of very great power, and only to be used where there is vigor of constitu- tion. In poisoning by opium, &c, it may be relied on with great confi- dence. I have again and again seen persons profoundly narcotized restored to sense and life by the continued use of cold affusion. It is, I am sure, not as frequently used, nor as confidently relied upon as it should be. — Ed.] * Abercrombie on Brain, p. 114. f P. 175, also Tweedie, p. 146. DEMULCENTS This class of remedies was by many supposed to act only mechani- calty, by involving acrid matters in a mild and viscid coating, or by sheathing the surfaces to which they were applied, and thus protecting them from the action of irritants. This is an imperfect view of them, They do in fact act on the vital properties of the system, diminishing tone, relaxing and softening the tissues, and rendering them more flexi- ble. [This effect is probably owing to a dilution of the blood by the absorption of the watery part of the demulcent.] Effects. — On the Mucous System. — When taken by the mouth, emollients, by their bland influence on the nerves of the mouth, pharynx, oesophagus, and stomach, produce a direct soothing influence on those parts, and a like effect on the bronchial mucous membrane. Hence their use in irritations and inflammations of any portion of the gastric and pulmonary membrane. [Is it not possible that demulcents may in the same way affect the vagino-uterine mucous membrane, relax- ing its tissue and promoting secretion from it? If so, the popular notion, that these articles taken during the latter months of gestation facilitate parturition, may be easily explained. I have generally attri- buted their effect (in the reality of which I fully believe) to their opera- tion as laxatives. — Ed.] On the Blood and the Hearts Action. — The effect of demulcents must of course depend here, if not always, on the water in which they are taken : this would impoverish the blood and thus lower the heart's action, and diminish generally the tone of the system. On the Urinary Organs. — Here again these agents act purely as diluents. They increase the amount and diminish the acridity of the urine. Oil and water are the only essential emollients. For though gum, starch, sugar, and gelatine are so termed, they do not act unless water be present. — Pereira, 344 MATERIA MEDICA AND THERAPEUTICS. INDIVIDUAL DEMULCENTS. GUM ARABIC. This is the product of the Acacia vera and Acacia nilotica, native trees of Africa, and found growing in almost every part of that conti- nent. It is a spontaneous exudation from the bark of the trunk and branches. Sometimes the exudation is promoted by artificial incisions. When it first begins to flow it is soft and almost liquid, but by exposure to the air it hardens into tears. In this form it is imported from Barbary and Morocco. The sensible properties of gum arabic are by no means striking. When perfectly pure it is almost entirely destitute of color, or it has a pale yellowish hue. It has no smell, but a slightly sweetish taste, and is more or less transparent. It is hard, brittle, and easily pulverized, yielding a white powder. It has all the properties of pure gum, is com- pletely soluble both in cold and hot water, and in this state it forms what is called mucilage — when this is evaporated it yields the gum unchanged. It is insoluble in alcohol, ether, and the oils. By trituration with the oils, volatile and fixed, it renders them miscible in water. As sold in the shops, gum arabic is frequently mixed with gum Senegal, the product of the Acacia Senegal, a tree growing in the forests of Africa, in the neighborhood of the Senegal. In its general properties this gum does not differ materially from the gum arabic. It comes in larger pieces and is of a reddish color. It is, however, nearly as pure as the gum arabic, and in its medicinal properties is little if at all inferior. Purity. — Gum Senegal is frequently substituted for gum arabic. This may be distinguished by the gum Senegal being clammy and tenacious, while the gum arabic is dry and brittle. This is a fraud, however, of no importance in a medical point of view. Sometimes it is mixed with the gum which exudes from the plum and cherry tree. This is much inferior to the gum arabic and gum Senegal. It is distinguished from gum arabic by being, like tragacanth, insoluble in water, whereas gum arabic and gum Senegal are completely soluble. In the form of powder as sold in the shops, gum arabic is generally adulterated. The articles used for this purpose are starch, wheat, flour, and sulphate of lime. Tests. — 1. Take a little of the suspected article and shake it in a vial, with the addition of cold water. The gum will dissolve in the water, and if there be any of the preceding articles present, they will fall to the bottom. 2. Boil the gum in water — add a little nitric acid and then a few drops DEMULCENTS. 345 of a solution of iodide of potassium, [f starch be present it will striki a blue color. 3. Mix a little of the article with water into a dough. Fix this to the end of a platinum wire and subject it to the flame of a blow-pipe. If it docs not burn away, but leaves anything behind, it is ;i.d nil crated. 4. If the suspected article be mixed with the powder of plum and cherry tree gum, it mates a ropy solution, Gum arabic makes a clear pellucid solution. Effects. — Gum arabic is one of the most common and best of the demulcents. I>y some it is supposed to be positively sedative in its action upon irritated and inflamed surfaces. It is also nutritive, although this is positively denied by some. Experiments to ascertain this were made by Magendie upon dogs, who were confined to the use of this article. In the second week they became emaciated and debili- tated, and finally died of marasmus. In opposition to this, however, there arc other facts which show that it cannot be so entirely destitute of nutritive properties. Haselquist, in his "Voyages in the Levant," gives an interesting account of a caravan travelling from Ethiopia to Egypt in the year 1750, which, during their long journey across the deserts, fell short of provisions. In searching among the merchandise which they were carrying to Cairo, they fortunately found a quantity of gum arabic, and upon this alone more than a thousand persons subsisted for the space of two whole months. Lind also states that the srum Senegal or arabic serves as a sustenance for whole negro towns during the scarcity of other provisions occasioned by a failure of the crops of millet and rice.; and the Arabs who twice a year collect this gum in the inland forests on the north side of the river Niger, have no other provisions to live upon for some months. Gum arabic, therefore, may be considered nutritive as well as demulcent. Mode of Administration. — Generally used in the form of solution ; one ounce of the gum to a pint of boiling water and suffered to cool. Also in the form of syrup, by taking of gum arabic § iv, sugar g>i, boil- ing water a pint. Dissolve the gum in the water; add the sugar and boil to the consistence of a syrup. Also in the form of lozenges. TRAGACANTH. This substance is obtained from different species of Astragalus, but chiefly from the Astragalus verus. This is a shrub growing two or three feet high, and is a native of the north of Persia. The gum exudes spontaneously from the stem and branches in the heat of summer, and is suffered to dry on the plaut before it is collected. It comes in small wrinkled pieces of a whitish color, without smell, and has a slightly 346 MATERIA MEDICA AND THERAPEUTICS. viscid taste. Although considered as a gum, it differs from this class of substances in the degree of its solubility in water. When put into water, it imbibes a large quantity of that fluid and swells, but does not dissolve nor form a fluid homogeneous mixture. It is turbid, and on standing separates from the water and settles down. In alcohol, it is, like gum, insoluble. The principal peculiarity of this substance is the power which it possesses of giving viscidity to water, this being much greater than that of the gums. It possesses this in a degree twenty-four times greater than gum arabic. It is on this account that it is so much used in pharmacy to give consistency to the manufacture of pills and troches. " It appears to be composed of two different parts, one soluble in water and resembling, though not identical with gum arabic ; the other swelling in water but not dissolving." (U. S. Disp.) Effects. — Demulcent and nutritive, though difficult of digestion. In consequence of its great insolubility not much used internally. Princi- pally used in pharmacy. LIQUORICE. The plant which yields this is the Glycyrrhiza glabra, a native of Syria, Barbary, and the south of Europe. It is cultivated, also, in all parts of Europe. In the north of Spain it is raised to a great extent as an article of commerce. That which grows in Spain is considered the best, containing a larger proportion of saccharine matter. The plant grows about four or five feet high. The part used is the root, which is dug up when the plant is about three years old. It is long and flexible, and about the size of the little finger ; externally of a brownish color, and yellow internally. It is without smell, and has a sweet, mucilagi- nous taste. If chewed with the bark on, it leaves a slight degree of bit- terness in the mouth. Composition. — According to analysis, liquorice contains glycyrrhizine, starch, asparagin, resinous oil, albumen, lignin, and salts. The glycyrrhizine is a modification of saccharine matter, scarcely soluble in cold water, but readily so in boiling water, and differing also from common sugar in not being capable of undergoing fermentation. The resinous oil is bitter, and it is to this the slight degree of acridity which the root possesses is owing. The extract is prepared from the root in the following way. The roots, dried and cleaned, are cut .into small pieces and then boiled in water until the liquid is saturated. After the dregs have subsided it is poured off and evaporated to a proper consistence, when it is formed into rolls about five or six inches long and an inch in thickness. These are then dried and covered with leaves. In this state it is imported from Spain and Italy. When pure it is very black, dry, and brittle, DK.MIM'KNTS. .'J 1 7 with :i glossy fracture and sweetish taste. In water it is completely soluble. Purity. — Tlic roots arc frequently worm-eaten and decayed. Those are the best which have the brightest yellow color internally arid when the layers are distinct. The extract is very apt to be adulterated with various articles, Buch as starch and sand. It sometimes also contains a little copper. When pure the extract ought not to become moist, when cxpo-i .| i., the air in a dry place, and it should dissolve in water without having any residue. What is called refined liquorice is nothing more than the foreign extract dissolved in water and the solution filtered and inspissated ; this is usually then made up into little sticks called the pipe liquorice. When this is adulterated with starch it dissolves only partially in cold water, and immediately deposits a dirty white powder possessing the properties of starch. When mixed with carpenter's glue it gives out ammonia, when heated in a glass tube or before a blowpipe. Effects. — Liquorice is an excellent demulcent article, admirably adapted to allaying irritations of the mucous membrane in various parts of the body. Hence it has been used with great advantage in catarrhal affec- tions, and irritations of the urinary organs. Of the root the best preparation is the decoction, made by boiling ? j of the root in a pint of water for about ten minutes. As the bark is acrid, this should be taken off before it is boiled. The extract may be taken either in the solid form or in solution, or in the form of lozenges. marsh mallows (Althaia officinalis). This is a plant growing in Europe, on banks of rivers, and in marshy places, from which circumstance it derives its name. It grows to the height of four or five feet, and the part used is the root. When prepared for the market the epidermis is taken off. It is of a whitish color, destitute of smell, and has a viscous mucilaginous taste. Every part of the plant abounds in mucilage and starch, besides sugar. It also con- tains a peculiar principle which has been called althein, but which is identical with asparagin. Effects. — An excellent emollient and demulcent, and in general use as such in France and Europe generally. It is used in the form of decoction and syrup. In this country it is not much used, being considered inferior to gum arabic. 23 348 MATERIA MEDICA AND THERAPEUTICS. jujube (Rhamnus zizypfaas). The tree yielding the jujube is cultivated in the south of France, in Spain, and in Italy. The part used is the fruit. This is of an .oval shape, about the size of an olive, and of a reddish color. Internally it contains a yellowish mucilaginous pulp, with a sweetish and acidulous taste. It is demulcent and nutritive. If taken to any extent it proves laxative. It is used in the form of decoction. The jujube paste, which is so commonly sold in the shops, should consist of gum arabic and sugar, dissolved in a decoction of this fruit and evaporated to a proper consistence. The preparation, however, very seldom contains any of the jujube. [Would probably be no better if it did.] slippery elm bark {Ulmus fu'lva, the red elm or slippery vim). It is a lofty tree, growing to the height of 50 or 60 feet, and is indi- genous in this country, more particularly in the Northern and Western States. The part used in medicine is the inner bark, from which the epider- mis has been removed. It comes in long flat pieces of a fibrous texture, with a sweetish and mucilaginous taste when chewed. It contains fecula, yum, and ulmin. It abounds in mucilaginous matter, and by infusion or gentle boiling in water it is readily dissolved and forms an insipid mucilaginous fluid. Effects. — The substance is highly demulcent and nutritive. In times of scarcity the Indians are said to live upon it. Another use made by them of it is to facilitate labor. According to Mr. Rafinesque, it is " a specific to procure easy labor to pregnant women by using the tea for two months previous, well known to Indian women, whose easy partu- rition has often been noticed." Med. Flor. vol. ii. p. 271. It is also somewhat diuretic. Mode of Administration. — The common form is that of infusion made by macerating an ounce of 'the bark in a pint of cold water. When ground into powder it makes a kind of flour, which mixed with boiling water makes a mucilage. [The cold infusion of the unground bark is much more palatable.] It makes an agreeable demulcent drink. The powder made into a poultice is an admirable local application. The Sesamum orientale, a native of the East Indies and Africa. From the latter region it was introduced by the negroes into the West DKMULOKWTS. 349 Indies and tlie Southern States', especially Georgia and South Carolina, where it succeeds very well. In this latitude it grows very well, but never comes to seed. Tt is an -animal plant, about three or four feet high, and yields a small, yellowish seed, which is particularly trainable for the quantity and quality of the oil which is obtained from it. Ii said that by expression ninety per cent, of this oil is obtained from the seeds, a larger proportion than that yielded by any other known vege- table, and of a quality fully equal to the common olive oil. liy the negroes the seeds are used as an article of food, boiling them with Indian corn, &c. The oil is without smell, of a sweetish taste, and can be kept a long time without becoming rancid. In China and Japan it is used in cook- ing and as an article of food. Its properties are very analogous to olive oil, and like that in suitable quantities prove laxative. The part used in medicine is the leaves. These abound in mucilagi- nous matter, which is readily imparted to water. Effects. — Emollient and nutritive. The oil is laxative, and is some- times used as a substitute for castor oil. Mode of Administration. — One or two of the fresh leaves stirred in half a pint of cold water in a short time form a thick viscid mucilage, which is used with much advantage in bowel affections, particularly of children. It may be drunk freely. When the leaves are dried boiling water is required. FLAXSEED. This is furnished by the Linum usitatissimum, a well known plant, supposed to have come originally from Egypt, but now found in almost all parts of the world. It grows about two feet high. The part used in medicine is the seeds. These have a mucilaginous and somewhat sweetish taste, and are destitute of smell. They consist chiefly of muci- lage, of which they contain a large proportion, and a fixed oil (linseed oil) ; the former residing in the cuticle, and the latter in the nucleus or parenchymatous portion of the seeds. The oil is obtained by expres- sion from the seeds in the proportion of about one sixth of their weight. The cake which remains after the expression of the oil, is ground up and makes the -linseed meal. As this contains all the mucilaginous part of the seed, it is highly nutritive and is used as food for cattle. Effects. — Flaxseed is emollient and demulcent, and is also nutritive. The seeds, reduced by means of a mill to a soft farina, are used in many parts of Asia, as an article of food, mixed with honey. At Lace- demon it is said to have been used as food for the Helots. In times of famine in Holland it has served as sustenance, and it is stated that the 350 MATERIA MEDICA AND THERAPEUTICS. French soldiers in their retreat from Moscow fed upon the cataplasms of this substance previously used for the sick. Linseed oil is laxative. Mode of Administration. — The ordinary form of using it is the infusion, made by digesting § i of the seeds in two pints of boiling water. The hot water extracts the mucilage from the cuticle without any of the oily matter. To make it more agreeable 3 j or 3 ij of braised liquorice root is added, [or a little lemon juice.] The meal is used for making poultices. The principal use of the oil is as a local application to burns, mixed with lime water. This is the product of the Hordeum distickon, a native of Tartary, but cultivated in different parts of the world. The parts used are the seeds or grains. When the seeds are deprived of their husks, they are called hulled barley ; when deprived of their husks, and afterwards rounded and polished, which is done in a mill, they are called pearl barley ; when the pearl barley is ground into a meal, it is patent barley. Barley contains a large proportion of starch — 67 in 100 parts. Besides this, sugar, gum, gluten, albumen, &e. Effects. — Highly demulcent and nutritious. The husk is slightly acrid and laxative. The pearl barley, therefore, ought to be used. Form. — The usual form is that of decoction, or, as it is called, barley water. The mode of preparing this is important, and it is directed in the Pharmacopoeia. Take two ounces of pearl barley, and wash with cold water, so as to cleau it well, then pour on half a pint of water and boil for a little time, and throw away this water. The object of this is to purify it still more, and remove any mustiness or other unpleasant flavor 'which it may have acquired. Then add four pints of boiling water, and boil down to two pints and strain. This may be flavored with sugar, lemon, &c. This is obtained from the Avena sativa, a plant cultivated in every part of the world. The seeds, when deprived of their husks, are called groats ; then when crushed are called Emden groats. (Pereira.) By simply grinding the seeds, the oatmeal is obtained. According to the analysis of Vogel, 100 parts of oatmeal contain 59 of starch, 8.25 sugar, 2.50 gum, 2 fixed oil, 4.30 albuminous matter, 23.95 fibrous matter. m.Yil I.- I.N-I.-,. 361 Dr. Christison makes seventy-two per cent, of stareh. Effects. — Oatmeal in the form of gruel is emollient, and nutrition , I' proves somewhat laxative. Oatmeal gruel is prepared by boiling one ounce of the meal with thre pints of water to a quart, constantly Btirring it. Then Btrain; lei stand till it cook, and then pour off the clear liquor from the Bedi- ment. It may be flavored with sugar, lemon juice, &c. It ia fre- quently used after giving cathartios, also for encmata. The meal make« an excellent poultice. INDIAN MEAL. This is obtained from the Zea Mays, Maize, or Indian Com. Tin contains seventy-seven per cent, of starch, but no glutei:. It is demul- cent, and highly nutritive. In the form of gruel it is used as a sub ■ tute for oatmeal. This is the Oryza sativa, an annual plant coming originally from the East Indies, but now cultivated in various parts of the world. The rice of commerce consists of the seeds deprived of the husk. According to Braconnot, it contains in 100 parts 85.07 starch, 3.60 gluten, 0.71 gum, 0.29 sugar, 0.13 fixed oil, 4.80 vegetable fibre., 5.00 water, 0.40 saline substance. Effects. — Demulcent and highly nutritive. It sits easy on the stomach, and from the fact that after its digestion a very little residuum is left, it is considered astringent to the bowels. In the form of rice water, it is an excellent drink in irritation of the bowels with diarrhoea, -\<. Of all these the term narcotic is the best, as being the most general and descriptive. They may be defined to be those substances " which first excite and then diminish nervous action, and in appropriate doses stupe- fy." They are distinguished from all other agents by the primary and special influence which they exert over the brain and nervous system. Effects. — As the effects of these agents will be fully exemplified when we come to treat of opium, the present description will be purposely brief. There is no class of agents which differ more fn their effects according to the dose in which they are taken. In very small doses, they appear to exert scarcely any action except a local one, diminishing the sensibility and irritability of the part with which they come in con- tact. When given in larger doses, their first effect is to excite the nervous and vascular systems. The energy of the brain is increased, and the pulse is moderately quickened. This effect takes place in a few minutes after the administration of the narcotic. After a short time a state of diminished sensibility succeeds. The influence of external agents is lessened, the pulse becomes slower, and a general languor overcomes the system. Then follow insensibility and sleep. With regard to the power of producing sleep, it is to be observed that all narcotics do not possess it equally. Some have it in an eminent degree, while others, if they possess it at all, do it only by the relief which they afford from pain and irritation. On the digestive organs the effect of narcotics is to impair the tone of the stomach, diminish secretion, lessen the appetite, and to interfere with the process of digestion. On the intestines they differ in their operation. Some, opium for example, con- stipate, while others, hyoscyamus, stramonium, and the hop, relax the bowels. In very large doses, narcotics prove poisonous, and to the state of the system which is induced, the general term of narcotism is applied. This 356 MATERIA MEDIC A AND THERAPEUTICS. state is characterized by a perverted and prostrated condition of the brain and nervous system. It comes on with giddiness and heaviness of the head. The energy of the brain being impaired, that organ loses its controlling power over the rest of the system. The senses are per- verted. The mind loses its power — stupor or delirium supervenes. The muscles are relaxed or convulsively agitated. Finally deep sleep benumbs the whole system, succeeded by coma and death. With regard to the effect of narcotics there are two or three modify- ing circumstances of importance which ought to be borne in mind. These are the age of the subject, the fact of the system being accustomed to their use or not, and the actual condition of the system as to health or disease. Age. — From the great delicacy and susceptibility of the nervous system in children, the impression made by narcotics is proportionately much greater in them than in adults. Unpleasant effects, therefore, not unfrequcntly occur in them from the smallest quantities. In early life, therefore, narcotics are to be looked upon as uncertain agents, and to be administered with great circumspection, especially as it regards the dose. [This is a caution which cannot be too often repeated. — Ed.] The repeated or habitual use of these agents has a wonderful influence in modifying their effects ; and the general law of the system in relation to them is, that repetition of them gradually impairs their effects. Larger doses, therefore, can be continually borne, and to produce the same effect larger quantities are required to be given. This is remarkably the case with opium. It does not follow from this, however, that when the system has become habituated to one narcotic, it is so to all others. The contrary, indeed, is the fact. A person, for example, who has become accustomed to large doses of opium, may still be affected by moderate doses of other narcotics. The actual state of the system as to disease greatly modifies the effect. In certain diseased conditions, immense quantities of opium and other narcotics can be given with perfect impunity ; nay, with benefit ; quan- tities which, in the ordinary state of the system, would inevitably prove fatal. There are certain conditions of the system in which the use of nar- cotics is contra-indicated. From the primary stimulant operation which they produce, as well as from the determination which they cause to the brain, they are not advisable where great plethora exists, or where inflammation or active determination to the brain is present. For the same reason, where high inflammatory or febrile action is present, and the bowels are costive, they are contra-indicated. In all these cases, if their use be deemed necessary, it should be preceded by depletion and evacuants. NARCOTICS. 357 The uses to which narcotics are applied in the treatment ol are various and important. They arc used : To make a powerful impression on the nervous system, with I lie view of breaking up morbid action. For this purpose they are resorted to in diseases characterized by paroxysms, and in intermission . They are used to procure sleep, to allay gain or irritability of tin system depending upon exhaustion, to c ontr ol spasm, to restrain exc sive secretions, and to repress convulsive reaction. It is the inspissated juice of Papaver somniferum, or white poppy, a plant which is a native of Asia, and from the fact of its growing wild in the southern parts of Europe, it is supposed to have been native there also. The probability, however, is that the seeds of it were conveyed to these regions from Asia. In Greece the poppy was cultivated at a very early period, long indeed before the time of Hippocrates. It is alluded to by Homer in the Iliad, and the Roman historian Livy gives a notice of it as cultivated in the gardens of Tarquin the Proud. It was not, however, for the purpose of obtaining what is now called opium that this plant was so much cultivated by the ancients, nor was it used at that early day as a medicine. Strange as it may appear to us, it was cultivated entirely as an article of food, and the part used was the seeds, which were considered as not merely destitute of all noxious and narcotic properties, but exceedingly nutritious. In such honor was the poppy held, that its discovery was attributed to the god- dess Ceres, and from this circumstance she was named Mecone (from fj,*jxwv, papaver). It was offered to her in her sacred rites, and she was represented as holding it in her hand.- It can hardly be supposed that so much importance would have been attached to the poppy, unless it had been looked upon as a very valuable article of food. That there is nothing noxious in the seed of this plant has been proved by modern observations. Dr. Allston states that he frequently ate large quantities of the black as well as the white seed ; that he found them of a more delicious taste than sweet almonds ; that they are oily and farinaceous, and he never found them to produce any injurious or soporific effects. Besides, they are still used as food in some places as well as the ex- pressed oil, which is as innocent and wholesome as olive oil. In Per- sia, it is stated that, even at the present day, where the plants spring- up too thickly in the fields in which they are sown, the young ones are taken up and used as pot herbs. That the modern poppy plant is identically the same as that which was known among the ancients, is abundantly shown from the descriptions left by Dioscorides and Theo- phrastus. 358 MATERIA MEDIC A AND THERAPEUTICS. When opium, as now used, was first known, is a matter of uncer- tainty. By some medical antiquarians it is traced as far back as the time of Homer, and it is contended that what he describes under the name of vsirsvfag, was nothing more nor less than opium. Against the supposition, however, of this being opium, it is urged that neither Theo- phrastus nor Plinjr, nor any of the ancients, who mention the nepenthes, took it for opium ; and further, that the Egyptian, Arabian, Persian, and Indian names of opium are evidently from the Greek word otfiov, as ofium, aufian, ofium, afiuum, &c. Dr. Allston thinks it most probable that the discovery of the soporific property of opium is due to the Greeks, and that it was first ascertained by Hippocrates, or at any rate about the period in which he lived. It does not appear, however, to have been prescribed with this view in medicine until two or three hundred years after this. Although a native of Asia, the poppy is not confined to any particu- lar country or latitude. It easily accommodates itself to different de- grees of temperature, and is found flourishing in different parts of the world. In Hindostan, Persia, Asia Minor, and Egypt, it is extensively cultivated for the opium which it yields. In Europe it is cultivated principally for the poppy seeds and the oil. In different parts of the United States it has been reared with success, and good opium pro- cured from it. Although it thus appears that the poppy flourishes very well in dif- ferent regions of the world, yet, like many other plants, it is consider- ably modified by situation, soil, and climate, and from the same causes the opium which it yields varies in its powers. " Egypt" is said to produce " a stronger opium than any of the countries on the north side of the Mediterranean ; France, than England or Germany ; and Lan- guedoc, than the northern parts of France ; while Smyrna, Anatolia, Aleppo, and Apulia furnish a juice far more narcotic than Languedoc." (Paris, p. 58.) By some the opium raised in England is pronounced superior to the Turkey or East India opium. If it is so, it is probably owing to the greater care with which it is prepared. In the southern parts of the United States there is no doubt that opium might be ob- tained equal to any in the world, and it might be an object worthy of some of the enterprising capitalists of our country to make the attempt. The poppy is an annual plant. In India, where it attains a much larger size than it does in any other part of the world, it flowers in the month of February. In Europe and America, in June and July. The greatest height to which it attains in situations favorable to its growth, is from five to six feet. Every part of it contains a narcotic juice, but it abounds most in the cajisules, and from them the opium is obtained. The mode of procuring it, as practised in India, is the following : NASCOTICS. 369 When the large c apsul es are about half ripe, longitudinal inci made on their Bides, just deep enough to divide the i sternal part with- out penetrating the internal cavities. This operation is performed in the evening. During the night the juice, which is of a white milky appearance, oozes out, apparently from the vessels of the bark of the capsules, and adheres to the sides of the incision. In the morning I his is scraped off, and deposited in an earthen pot, where it is worked l.y wooden spatulas in the sunshine, until it attains a certain decree of consistency. It is then formed by the hand into cakes. These are laid in earthen basins to be further dried, when tbey arc covered over with poppy or tobacco leaves. It is then ready for exportation, and this is the opium of medicine and commerce, The quantity of this article produced in various parts of the world, and especially in Ilindostan, is enormous. To give you some idea of it, I will merely state, that in one year (1832-3) upwards of 3,000,000 of pounds were smuggled into China from India, valued at upwards of fif- teen millions of dollars. Physical Properties. — Opium comes in opaque masses of considerable size, of a compact texture. It posseses considerable tenacity, and is plastic under the fingers. Its color is reddish brown or deep fawn. Its odor is peculiar and narcotic; taste bitter and acrid. When exposed to the air it becomes hard, breaks with a shining fracture, and yields a powder of a yellowish-brown color. Varieties of Opium. — These are the Turkey, the East India, the Egyptian, and the European. 1. Turkey Opium. — Of this there are two different kinds, the Smyrna and the Constantinople opium. The first of these is what is commonly known under the name of Turkey opium. It is raised in Anatolia, and shipped from Smyrna, This is considered as the best opium. It comes in irregularly-rounded or flat masses, covered with the capsules of a spe- cies of rumex. It is sometimes mixed with another kind, which is in balls or round masses, which are hard and of an inferior quality. Turkey opium contains a larger quantity of morphine than any other kind, the average being about eight per cent. With regard to the Constantinople opium, Guibourt says there are two kinds — the one comes in large flattened masses like the Smyrna opium. This is of a good quality. The other comes in small flattened cakes, from two to two and a half inches in diameter, and always covered with the poppy leaf, the median nerve of which usually marks the middle of the mass. The odor of this kind is similar to the preceding, only feebler. When exposed to the air it dries and blackens. By some it is supposed that the Constantinople opium is the same as the Smyrna, remanufactured and adulterated with gum at Constantinople. Guibourt, however, suggests that the difference may be owiug to the ori- 360 MATERIA MEDIC A AND THERAPEUTICS. ginal preparation of it, by expressing the poppy juice, and mixing this with the juice obtained from the simple incisions. The Constantinople opium is more mucilaginous than the Smyrna — is never covered with the rumex, and contains only about one-half the -quantity of morphine. 2. East India Opium. — This is very inferior to the Turkey opium. It very seldom comes to the United States. It is chiefly sent to China, where an immense quantity of it is sold. There are different kinds of it. Some is in large balls, weighing three or four pounds, covered with a case half an inch thick, made of tobacco leaves and poppy petals agglutinated together; with these the opium is of a pitch-like mass. This is commonly called Bengal opium. It has a strong empyreumatic smell, but not much of the peculiar narcotic, heavy odor of Turkey opium. Its taste is more bitter, equally nauseous, but less acrid. Its color is blacker, and its texture less plastic, but more friable. East India opium contains about half the quantity of morphine which Smyrna opium does. 3. Egyptian Opium. — This comes in round flattened masses, about three inches in diameter, of a regular shape, and appears to have been covered with some leaf, of which only the vestiges remain. It comes from Egypt, and is distinguished from the Smyrna opium by its red color, resembling that of the true hepatic aloes; by its odor being weaker and somewhat musty. Exposure to the air does not blacken it, and it softens instead of drying, in consequence of which its surface is shining, and it sticks to the finger ; and, finally, by its texture being uniform and not granulated, showing, according to Guibourt, that it was mixed before it was made into masses. According to Guibourt, this contains less morphine than Smyrna opium, in the proportion of five to seven. It differs, however, very much in this respect. 4. European Opium. — In France, Germany, and England, very good opium is obtained from the poppy. It can never, however, become an object of cultivation in these countries from the great cheapness of foreign opium. English opium resembles very much the Egyptian, and yields, in some cases, seven per cent, of morphine. From the French opium, Pelletier obtained as much as ten per cent. Purity and Strength of Opium. — As brought into the market, opium is generally very impure, being mixed with various articles, such as the extract produced by boiling the poppy, cow dung, ashes, and dried leaves of the plant, extract of liquorice, gum arabic, tragacanth, aloes, flour, oil, and various other articles. To increase the weight, bullets, stones, fruits, &c, are also mixed with it. Besides this the strength of opium is modified by the quantity of water combined with it. Some is quite soft, some hard. NARCOTICS. 801 Again, the strength varies, as before Btated, according to the locality where the poppy is grown. To ascertain the real Btrength of opium, the only certain mode is to find out the quantity of morphine which it contains. Mode of Detecting Impurities. — By physical examination. In this stones, etc., may be discovered. Make a decoction of the suspected article and strain. In this way Pereira detected ten drachms of stoi and gravel in ten ounces of opium. If to a decoction of opium, when cold, tincture of iodine he added, and a blue precipitate (iodide of Btarch) be thrown down, it shows the presence of flour or starch. The quantity of water in opium is to be judged of by the consi tence and the loss on drying. Opium may be considered as of inferior quality when it is very soft, greasy, light, friable, of an intensely black color, mixed with herbaceous substances, or exhibiting dark brovm or black patches of extract. A weak or empyreumatic odor, a slightly bitter, acrid, or siveetish taste, and the power of marking a brown or black continuous streak when drawn across paper, are also signs of poor opium. To ascertain the quantity of morphine, Pereira recommends the fol- lowing process: "Prepare an aqueous extract of the opium to be examined, and dissolve it in water ; add ammonia to the boiling liquor, and when cool, filter; wash the precipitate on the filter with cold water, dry it, mix it with proof spirit, and add, drop by drop, acetie acid, until the solution slightly reddens litmus. By this means the morphine, and not the narcotine, is dissolved. Precipitate the morphine from the filtered solution by ammonia." Chemical Properties. — From the great importance of opium as an article of the Materia Medica, its chemical character has been investi- gated with the utmost diligence. It is only, however, to the chemists of the present century that we are indebted for any accurate knowledge in relation to it. In 1803, the first discovery of importance was made by Derosne, who detected in it the peculiar crystalline substance now known by the name of narcotine, but at first called the salt of Derosne.. In 1804, Seguin discovered another crystalline substance in opium. Although he described the properties of it, he did not identify it as an alkali. About the same time this latter substance was also obtained by Sertuerner, of Eimbeck in Hanover ; but it was not until so late as the year 181*7 that this chemist distinctly promulgated the fact that this substance was of an alkaline character, and that it existed in combination with a peculiar acid. The alkaline principle he supposed to contain the active part of the opium, aud to this he gave the name of morphine, while the acid was called meconic. By the subsequent observations of Robiquet, not merely the character of morphine as au alkaline substance was confirmed, but it was ascertained that the salt of Derosne was an entirely different principle. By him the name of narcotine was given to it. 362 MATERIA MEDICA AND THERAPEUTICS. The foregoing account is interesting, not merely in itself, but as it led the way to all those discoveries which have since been made of the existence of alkaline substances in a great variety of vegetables. According to the most recent analysis, opium may be considered as made Up of the following constituents. It is one of the most complex articles in the Materia Medica. [Its composition is not even now entirely well settled. The following principles are certainly contained in opium — morphia, narcotina, codeia, narceina, meconine, thebaina, meconic acid, porphyroxin, and sometimes pseudomorphia. It also contains gum, extractive, fat, caoutchouc, resin, and more or less ivater. 1. Morphia or Morphine, the important principle of opium, will be treated of hereafter. 2. Codeia or Codeine, so called from the Greek name of the poppy head — a white crystalline solid, soluble in water, alcohol, ether, a weak solution of potash. Its reactions are alkaline, and it forms salts with acids. They have not been much studied. 3. Narcotina or Narcotine. — A white inodorous substance, crystalliz- ing in prisms which are fluted or striated, distinguished from morphine being insipid ; very soluble in ether, insoluble in alkaline solutions. It does not, like morphia and codeia, affect vegetable colors. Slightly soluble in hot, but not in cold water. Soluble in 100 parts cold or 24 boiling alcohol. Its salts are more bitter than those of morphine, redden litmus, and are precipitated from solution by infusion of galls. 4. Narceina or Narceine. — A white inodorous solid, crystallizes in silky needles, radiating in tufts. Taste slightly bitter and somewhat metallic soluble in water, fuses at about 198°. It has no action on vegetable colors, nor does it combine with acids to form salts. It is, therefore, a neutral principle. Narceine is rendered blue by mineral acids, when so dilute as not to decompose it. The color disappears when much water is added, but the narceine can be restored by saturating the acids by ammoniac. It forms with iodine a bluish compound (iodide of narceine). Heat and alkalies destroy this color. Meconine. — A white, crystalline, colorless solid ; taste at first slight afterwards acrid. Fuses at 194°, becoming a colorless, limpid fluid. Soluble in water, alcohol, or ether. Distinguished from morphia or codeia by not possessing alkaline properties. Meconine is remarkable for not containing nitrogen. It is probably inert. Thebaina (Paramorphia). — A white crystalline solid, having an acrid styptic taste, soluble in ether and alcohol, but hardly at all so in water. Fuses at 302°. Dissolves in weak acids, but does not form crystallizable salts. Pelletier considered it isomeric with morphia, and therefore called it paramorphia. One grain injected into the jugular vein causes tetanus and death in a few minutes. NARCOTICS. 869 Mrconic yield. — A tribasic acid, found i r» the poppy only. When pure baa the form of white, transparent, micaceous scales. Soluble in boiling water, but decomposed by it,; slightly soluble in cold water, and more freely in alcohol. Relieved to be inert. Porphyroxinc. — The name given by Meek to a new principle which he found in Bengal opium. Crystallizes in shining needles, soluble in alcohol and ether, insoluble in water. It is neutral. Its most, remark. able characteristic is the property of assuming a rose color when heated in dilute muriatic acid. Pseudo morphia. — This substance is only occasionally found in opium. It is a whitish solid, reddened by nitric acid, soluble in caustic alkalies. It docs not form salts with acids. It is not poisonous.] Opium is partially soluble in water, alcohol, ether, wine, acetic and citric acids. Its best menstruum is proof spirit. Effects on the System. — Like all narcotics, this substance differs greatly in its effects according to the quantity in which it is taken. In moderate doses, its primary effect is to excite the system. The pulse is slightly increased in force and frequency, and a sense of fulness is experienced in the head ; the energy of the system is increased ; the mind is exhilarated ; the ideas flow more quickly, and a comfortable and pleasant sensation is experienced throughout the whole system. After continuing for a short time these effects pass off, and are followed by a general diminution of the energy and sensibility of the system ; external agents lose their influence on the body; pain, if present, is relieved, and a tranquil serenity pervades the system. Finally, all this is suc- ceeded by drowsiness and sleep. The average period during which the exciting operation of opium continues is from half an hour to an hour, while the sedative effects continue for seven or eight hours. On awak- ing from sleep there is generally felt some nausea and headache, together with slight tremors — the appetite is impaired, and the bowels are left more or less constipated. When given in doses somewhat larger, all these effects are produced in a more marked degree. The primary excitement is much greater, but it passes off more rapidly and is sooner succeeded by the sedative effects, which are also much more marked. The general insensibility is greater — the pulse is slower, the sleep more profound, approaching to a state of stupor. The constitutional disturbance left behind it is also greater. In poisonous doses, the sedative effects of opium principally show 7 themselves, without any of the stimulating effects. Giddiness and stupor speedily come on. There is loss of sense and motion — the breathing is slow but easy — the features become ghastly — the pupil is contracted — the pulse is feeble, and death succeeds. Such, briefly detailed, are the effects of opium ou the system. For the 24 364 MATERIA. MEDICA AND THERAPEUTICS. purpose of understanding them more fully we shall analyze the various effects produced on the different organs and tissues of the body. 1. On the Brain and the Nervous System. — When opium is taken into the stomach, it makes its primary impression on the nerves of that organ. The brain and the rest of the nervous system are next affected. That the nervous system is specially acted on is manifest from all the effects. To this are owing the primary excitement and subsequent in- sensibility. With regard to the brain, it is evident that a greater or less accumulation of blood takes place in the cerebral vessels. Where the dose has been large this is particularly striking, and, where death results, is proved by dissection. As a general rule, in these cases, turgescence of the vessels and effusion into the ventricles are met with. The prominent effects then on the nervous system are primary excite- ment and subsequent depression and insensibility. In large doses, cere- bral congestion, profound sleep, coma, insensibility, paralysis, an4 con- traction of the pupils. 2. On the Vascular System. — A great difference of opinion has exist- ed in relation to the effects of opium on the circulation. According to the experiments of Crumpe, the pulse at first becomes accelerated, but afterwards reduced to the natural standard and even below it. In expe- riments made by Dr. Bard, on the contrary, the pulse from the begin- ning is stated to have been slower than natural. It is to be observed, however, that Dr. Bard does not give any account of the state of the pulse until half an hour had elapsed after taking the opium. During this period he probably would have found the pulse accelerated. The truth is, however, that the pulse varies under the influence of this drug. As a general rule it is moderately excited at first, but as the system gets under the influence, it becomes slower and fuller. In poisonous doses, the pulse appears to vary still more — being sometimes much in. creased in frequency, small and irregular — at other times fuller and slower than natural. (Christison.) In the capillary vessels, the experiments of Alston show that under the influence of opium, the circulation is rendered slower and a conse- quent congestion takes place. As the result of this, blood accumulates in the larger blood-vessels, and the vessels themselves become distended. Hence the increased fulness of the pulse and the sense of fulness about the head and chest which are experienced. (Edin. Med. Essays, vol. v. p. 129.) 8. On the Mucous System. — The effect here is to check secretion and exhalation, and this is owing to a peculiar action on the secretory ves- sels. This effect is observable in almost every portion of the mucous membrane. In that lining the mouth and throat, by dryness and thirst. In the trachea and bronchial tubes, by the diminished expectoration which takes place in morbid states of the membrane lining these parts. NAEOOTICS. 885 In the membrane lining tlie stomach and bowels, l>\ the loss of appe- tite and by the discharges from the bowels being less copioui and li(jiiid. 4. On. the r. Gooch recommends twenty minims of the sedative solution of Battley, repeated once or twice at intervals of two hours unless sleep be induced. When sleep has once been procured, small doses, such as five or ten minims, should be given at intervals of six hours. If these do not pro- duce sleep at night the larger doses may be occasionally resorted to. Constipation should be obviated all this time by suitable cathartics. When opiates have produced the desired effect in this complaint, they should be withdrawn gradually, diminishing the dose and lengthening the interval.* In Delirium Tremens. — In this disease most enormous doses of opium have been given, and as a general result, if profound and long continued sleep follows their use, the patient will recover. But here the same cautions as to the exact condition of the system at the time when the drug is administered, that have been so often insisted on, are to be regarded. If plethora and determination to the brain exist, if the bow- els are loaded, the tongue foul, the skin dry and hot, opium will do no good ; and in delirium tremens, it may be laid down as an almost uni- versal rule that where opium does no good it is certain to do harm. In multitudes of these cases life has been sacrificed in the vain, irra- tional attempt to overwhelm the system by opium. When the skin i9 cool and moist, the bowels free, the pulse soft, and the prostration not extreme, opium will often produce sleep and cure the disease. Where prostration is extreme, a large dose of opium may overwhelm the sys- tem and induce fatal consequences. [Peritonitis. — The use of opium in peritonitis, commended by Arm- strong, has been much extended, and with the happiest effects, by Prof. Clark. He gives, immediately on diagnosticating the disease, from half a grain to one grain of morphine, or an equivalent dose of opium, two grains to five grains, and repeats it every hour or two till the patient is profoundly narcotised. The opium is then continued in such doses as to keep up decided narcotism, as marked by contracted pupil, respiration not over twelve in the minute, deep sleep, from which the patient is roused * Gooch's Essays, p. 152 ; also Burrows, p. 400. 376 MATERIA MEDICA AND THERAPEUTICS. with some difficulty ; in this condition he is kept occasionally allowing a slight let up, till the. pulse falls, then the opium must be gradually diminished in dose and frequency, the practitioner being ready at tfce slightest hurrying of the pulse to plunge his patient again into the deepest narcotism. I have tried this mode of treatment both in puer- peral and idiopathic peritonitis with most encouraging results. In puerperal peritonitis especially my experience warrants me in preferring it to any other practice. It must be carefully watched,, the patient seen every two to four hours. The bowels often remain unmoved for ten days — purges are utterly incompatible with this treatment.] Preparations. — The decoction of .poppy heads is a good fomentation. Poppy heads scalded are sometimes added to bran, hops, and the like when used as a poultice, to make it more decidedly anodyne. JPulvis Opii et Ipecacuanhas Compositus. — This is commonly known by the name of Dover's Powder, and is prepared by taking one part of .opium and ipecac, each, and of sulphate of potassa eight parts, and triturating to a fine powder. Ten grains of this contain one grain of opium. This is an excellent preparation, and furnishes a striking illus- tration of the advantages of combining medicines. The ipecac, renders the opium more certain in its action as a sudorific, and at the same time corrects to a great extent the evil effects which opium alone is apt .to produce on the head. The sulphate is added for the purpose of tri- turating more freely and mixing the ingredients more intimately. By some it is supposed that the general efficacy of the compound is thus increased, inasmuch as the opium and ipecac, alone will not act pre- cisely in the same way as when the potassa is combined. Dover's powder may be used in all cases where a sudorific anodyne is required. The average close for an adult is 10 grs. Tinctura Opii, Tinctura Thebaica, commonly called Laudanum or Liquid Laudanum. — This is prepared according to the U. S. P., by ma- cerating for fourteen days p iiss of opium in powder in two pints of dilut- ed alcohol, and then straining. This tincture is of a deep brownish red color, having the peculiar smell and taste of opium. In this preparation about two thirds of the opium are dissolved by the alcohol (water dissolves less than three- sevenths). The residuum consists of impurities, containing still, how- ever, a small proportion of morphine. Pereira says he has repeatedly prepared morphine from the insoluble residue thus left. Twenty-five drops (or thirteen minims) are about equivalent to one grain of opium. The tincture of opium has some important advantages over the solid opium. It is more speedy in its action. It can be given more conve- niently in minute doses. This is a great advantage when an opiate is narcotics. 877 required for children. Lastly, it can be combined more readjly with other medicines. Tn compatibl es. — Care should be taken Dot to give laudanum in com- bination with am monia, soda, and potash, or their carbonates, a they precipitate the morphine. Most metallic salts and tincture of galls a o decompose it. In the use of this article it is important to know that if it be kepi for any length of time, and occasionally exposed to the air, it becomes thick. This is owing to the evaporation of a portion of the alcohol, and the deposition of the opium. In this state its strength is greatly increased, and infants have frequently been destroyed by giving this even in mode- rate and ordinary doses.* In all cases the tincture should be transpa- rent. 2. Tinctura Opii Camphorata. — This is the common paregoric elixir. This consists of opium, Benzoic acid, oil of anise, liquorice, clarified honey, camphor, and diluted alcohol. Half an ounce of this contains about one grain of opium. This is a mild and valuable preparation of opium, and unites the pro- perties of a narcotic with those of an antispasmodic. The principal use of it is to allay troublesome cough. It diminishes the sensibility of the bronchial membrane to the influence of cold air, checks profuse secre- tion, and allays spasmodic cough. Besides this it is used to relieve nausea and slight pains in the stomach and bowels, and in infants to procure sleep. The dose for an adult is from 3 i to 3 jv 5 for a child, from five to twenty drops, according to the age. Acetated Tincture of Opium. — This is prepared by rubbing up § ij of opium with § xii of vinegar, and then adding half a pint of alcohol, and macerating for fourteen days and filtering. In this preparation, it is supposed that a portion at least of the meco- nate of morphine is decomposed, and acetate of morphine is formed. Pereira, however, says this is not fully established. This is a very mild and valuable preparation of opium. It has all the narcotic effects without producing the nausea, headache, and nervous disorders, which frequently result from the ordinary preparations of this article. Ten minims or twenty drops are equivalent to gr. i of opium. This preparation has been introduced into the U. S. Pharmacopoeia, as a sub- stitute for the ordinary black drop, and has the great advantages of uni- formity and certainty in its strength. 4. Vinum Opii. — This is prepared by taking of opium ^ij, cinnamon and cloves bruised each 3 i, and macerating in a pint of Teneriffe wine * Ellis's Formulary. TJ. S. Disp. 378 MATERIA MEDIC A AND THERAPEUTICS. for fourteen days and filtering. This is nearly the same as the liquid laudanum of Sydenham. It is about the same strength as common laudanum, and may be given in the same doses. From the aromatics with which it is combined, it sits better on the stomach. As a local application, the wine of opium is recommended in cases of chronic oph- thalmia, two or three drops being introduced under the eyelids daily. Morphine — Modes of obtaining it. — There are various modes of ob- taining morphine from opium. The process recommended in the U. S. Pharmacopoeia is the following : Sliced opium is first macerated and worked up with water for a suitable length of time, then filtered, and to this added a mixture of alcohol and water of ammonia, when the mor- phia is deposited in crystals. To purify these, they are boiled in alco- hol, and filtered through animal charcoal. In this process the water extracts the meconate of morphine. This is decomposed by the ammo- nia, while the alcohol seems to suspend the coloring matter and render the crystals purer. Quantity of Morphine in Opium. — This has already been alluded to. As then stated, it varies not merely in the different kinds of opium, but in different samples of the same kind. The Smyrna opium contains the most, varying from nine per cent, or less to fourteen, the Constantinople only one half, and the Egyptian five sevenths of the quantity obtained from the Smyrna opium. Dr. Christison obtained from half a pound of the best Turkey opium 3|- drachms of morphine, and two drachms of narcotine. M. Dublanc procured as the mean of six trials eight per cent, of morphine and three per cent, of narcotine. Properties. — When pure, morphine is in small, beautifully white crystals. The primary form of the crystal is a right rhombic prism. It has a bitter taste, but is destitute of smell. In cold water it is insoluble — boiling water dissolves about one part in one hundred. It is soluble in- forty parts of cold anhydrous alcohol, and thirty parts when boiling. In ether, it is nearly insoluble. It turns vegetable blues to green, and combines with the acids forming crystallizable salts — nitric acid turns it red. It consists of oxygen, hydrogen, carbon, and nitrogen. Effects. — Although the most powerful principle of opium, morphine is not used in medicine in its simple alkaline state. Owing to its great insolubility, it is by no means certain and constant in its effects, depend- ing for its activity, no doubt, upon the degree and kinds of acid it meets with in the stomach. In combination with acids it is, however, very soluble, and it is only in the form of salts, therefore, that it is used. Of these, the ones used are the acetate, sulphate, and hydrochlorate. Acetate of Morphine. — This is prepared by dissolving morphine in NARCOTICS. 379 dilute acetic acid, and then evaporating the solution to drynei . Acetate of morphine crystallizes in Blender needles, but from its deli quesce nt nature is seldom obtained in a crystalline form. It is generally in the form of a powder. It is readily dissolved in water, especially where, there is an excess of acid. In alcohol it is less soluble than in water, It may be given in pill or volution. One sixth of a grain is about equivalent to a grain of opium. Sulphate of Morphine. — This is prepared by dissolving morphine in diluted sulphuric acid. ]>y evaporating the solution, crystals are formed. These are small, white, and feathery, resembling very much in appearance the sulphate of quinine. They can easily be distinguished, however, by adding concentrated nitric acid. This turns the sul phate of morphine red, but not the sulphate of quinine. Sulphate of morphine is soluble in twice its weight of boiling water, and if pure, is easily and readily soluble in cold water. As found in the shops, and especially if obtained from France, it is not always entirely soluble in water. This is owing sometimes to adultera- tions, but oftener to its containing some uncombined morphine, owing to the mode of preparation. This is corrected by the addition of a little acid. The sulphate may be given in pill and solution. One sixth of a grain is equal to a grain of opium. Solution of Sulphate of Morphine. — It is important to know that there are two solutions of this salt of very different strength — that of Magendie, and that of the United States Pharmacopoeia. Magendie's contains sixteen grains to 5 j of water. Of this, five drops are equivalent to one sixth of a grain of the salt. U. S. Pharmacopoeia contains one grain to § j of water — of this, eighty drops are equal to one sixth of a grain. Hydrochlorate of Morphine. — This is preparad by saturating the pure base with hydrochloric acid, and crystallizing. This is a colorless, inodorous, bitter salt, crystallizing in plumose acicular crystals ; it is soluble in sixteen to twenty times its weight of water. It is also soluble in alcohol. The strength of this is the same as the two preceding. This is con- sidered by many as the best salt of morphine for medicinal purposes. To the acetate it is preferable, as it is more easily obtained in crystals, and is not subject to decomposition during its preparation. Effects of the Salts of Morphine. — In their action on the system they do not differ. They produce the same effects, and may be given iu the same doses. Compared with opium and its ordinary preparations, 380 MATERIA MEDIC A A2TO THERAPEUTICS. they differ in many important particulars. While they produce the anodyne and narcotic effects of opium, they are less stimulating — they are less sudorific — they do not have the same tendency to produce con- stipation, and they are less apt to leave headache, nausea, dryness of the tongue, and other unpleasant effects. In all cases, therefore, where the object is to allay pain and nervous irritation, arid to produce sleep, they are preferable to opium. Where the object is to get an astringent effect on the mucous membrane, or a stimulant effect on the system, opium is to be preferred. In cases of chronic irritation, where the daily repeti- tion of an anodyne is called for, the morphic salts are invaluable. Another advantage attending them is, that they may be applied ender- mically. The Hyoscyamus Niger, growing two or three feet high, with large sea-green leaves, and straw-colored flowers. The whole plant has a dark, lurid appearance. It is found in every part of Europe, and extends to Asia. In this country it is supposed to have been naturalized, from the fact of its being found only in the vicinity of houses, road sides, in old fields, gardens, '. York Hospital, the disease which has resisted a great variety of remedies yielded readily to the conium, in grain doses repeated every two hours. It is also used and with great benefit in syphilitic rheumatism. ATROPA BELLADONNA. This is the deadly nightshade, a perennial plant indigenous in Great Britain. It grows in woods and shady places, and is also frequently culti- vated in gardens. It has a thick root with three or four stalks branch- ing from it, and growing to the height of from three to five feet. Its flowers are of reddish color and bell-shaped. It bears beautiful berries of a large size and purple color. The whole plant is poisonous, and the berries have frequently proved fatal. The part generally used in medi- cine is the leaves. Properties. — When fresh, the leaves have a faint narcotic smell, which they lose by drying, without having their active properties at all impaired. Their taste is subacrid and slightly nauseous. Chemical Properties. — According to the analysis of Mr. Brande, bel- ladonna contains an active principle of an alkaline character. This is afropme, and exists in combination with malic acid. Besides this it contains a green resin, wax, starch, gum, lignin, albumen, and various salts. Both water and alcohol dissolve the active principles of bella- donna. Atropine. — This substance is in needle-like crystals of a brilliant white color, without taste or smell ; almost insoluble in water and hi cold alcohol, but very soluble in boiling alcohol. In ether and oil of turpen- tine also insoluble. It unites with the acids, forming crystallizable salts, and seems to possess a greater neutralizing power than any of the vege- table alkalies. * Mat. Med. vol. i. p. 5T5. 38S MATERIA MEDIC A AND THERAPEUTICS. Effects. — These differ with the dose. In very small doses, no sensi- ble effect is produced, with the exception perhaps, in some cases, of a dilatation of the pupils. In these doses the action of this agent is proba- bly in a great measure local. In larger doses, such as it is generally given in medicine, the most marked effects are a sense of fulness about the head, dilatation of the pupil, more or less dimness of the vision, with a sense of dryness and constriction of the throat, accompanied frequently with a difficulty of swallowing. On discontinuing the use of the article, these effects speedily disappear. On the vascular system no marked effect is produced. On the secretions and excretions it produces little effect, although by some it is supposed to increase the secretion of urine. Of all the effects produced by belladonna, the most curious is that of dilat- ing the pupil. This effect will follow, whether taken internally, applied around the eye, or to a wound. When taken internally, so as to affect the pupil, the sight also is much obscured. Applied externally, it gene- rally dilates the pupil without affecting the sight. This, however, is not invariably the case.* The dilatation comes on about an hour after the application, and passes off in the course of two or three days, if the use of the article be discontinued. In poisonous closes it produces dryness of the throat, vertigo, dilatation of the pupil with obscured vision, and a peculiar delirium resembling intoxication. This is accompanied gene- rally with excessive and ungovernable laughter, sometimes with constant talking, and occasionally with a total loss of voice. After continuing some hours, this is succeeded by stupor, slight agitations of the muscles without regular convulsions, and finally death. st, From the foregoing it would appear that belladonna makes a peculiar impression upon the nervous system, lessening sensibility and irritability. This is more especially manifested in the throat and the eye, upon both of which it produces transient paralytic effects. It is accordingly used in medicine with the view of allaying pain and spasm, and obtaining its peculiar effects upon the organ of vision. Modes of Administration. — Powder — made from the dried leaves, is the most uniform in its strength, and is therefore preferable on this account to the other preparations. The dose to begin with is about one grain, to be given once or twice a day, and increased gradually until the specific effects of the article begin to show themselves. To children one eighth of a grain is sufficient as a dose. * Mr. Tyrrell relates two cases of temporary amaurosis produced by the ex- tract, applied to the surface of irritable ulcers of a malignant character. In one case the disease was situated in the vagina, and in the other in the rectum. The pupils of the eyes were extremely dilated, as from the application of the extract to the organ itself, and the patients were incapable of distinguishing any objects for some hours. In the case of ulcerated vagina, the application was repeated, when it produced exactly similar effects. — A. Cooper's Lectures, vol. i. p. 79. NARCOTICS. 880 I .Extract. — This is prepared by bruising the fresh leaves in a mortar, then sprinkling a little water over them, expressing the juice, then evaporating to a proper consistence. Of this the 'lose is one half a grajn repeated two or three limes a day. To ;i child one twelfth is snflieieiit. Like the extract of hcmloek, this is apt to vary in its strength. Diseases in which the IJklladonna is used. — Variant Affections of the Eye. — As already stated, when applied to the eye, it dilute, the pupil and produces a partial paralysis. In Cases of Cataract this is resorted to with great advantage. By the great dilatation of the pupil which it occasions, it enables us in the first place to ascertain the nature and extent of the disease, whether the iris be adherent to the capsule of the crystalline lens or not, whether the cataract be complete or only partial. Then, in the operation, it gives great advantage in fixing the iris and destroying the irritability of the organ. In Inflammation of the Iris, where adhesions are constantly threat- ened, this application, by dilating the pupil, prevents, and sometimes breaks up partial adhesions.'* Finally, in irritability of the eye it answers admirably in allaying irritation ; it is also used in opacity of the cornea.f The mode of applying it in these cases is to drop a little of the infusion into the eye, or a little of the extract dissolved in water may be applied to the lids. J Upon the same principle it has been applied, locally, with success to continued rigidity and spasm in other parts of the system. By Chaus- sier it was used in cases of rigidity of the neck of the womb, interfering with delivery. For this purpose he employed an ointment made by rubbing two drachms of the extract with an ounce of lard. Of this, a bit the size of a filbert was applied to the neck of the womb, and gene- rally succeeded in relaxing the os uteri. § By Dr. Conquest the same practice was resorted to with great success. In applying the belladonna in cases of this kind it is to be used, however, with caution, as the para- lysis may extend to the uterus itself. A case of this kind is related by Blackett, in which both the neck and mouth were dilated and the womb paralyzed. Six hours intervened before the contractions of this organ * See Mackenzie, specially, p. 358. \ See Bayle, v. ii. p. 512. Diet. Mat. Med. \ Mackenzie directs that, the evening previous to the operation, extract of bella- donna, moistened to the consistence of cream, be smeared on the eyebrow and eye- lids, and allowed to remain till about half an hour before the operation, when it is to be washed off with a sponge and tepid water. If the pupil is not by this time fully dilated, a little filtered solution of extract of belladonna in water is to be dropped on the conjunctiva, not rudely dashed, with a hair pencil — P. 502. § See Eberle, v. ii. p. 78. Diet. Mat. Med. v. i. p. 492. 390 MATERIA MEDIC A AND THERAPEUTICS. returned.* [Used in this way it has produced the poisonous effects of the drug.] By Chaussier it was applied also in uterine convulsions. With the same view it has been successfully applied, externally, in cases of spasmodic strictures of the urethra and of the rectum, in chordee,\ haemorrhoids, and in strangulated hernia. Four cases of this latter kind are stated to have been completely relieved in this way .J Hooping Cough. — In this disease belladonna has been extensively resorted to. On the continent of Europe its reputation stands exceed- ingly high. Dr. Eberle states that he used it in twenty cases, and in the majority with great advantage.§ He recommends it to be given by dissolving four grains of the extract in an ounce of sweetened water, and of this giving from eight to twelve drops three times daily to a child under two years old. || By Dr. Thomson one eighth of a grain was given to a child eight years of age, and gradually increased to one fourth of a grain. By Hufeland the proper period for commencing the use of this remedy is said to be about the fifteenth or twentieth day of the disease. 4. Neuralgia. — In this rebellious form of disease, belladonna has been used, and in many cases with great success. Among those who recom- mend it most highly is Dr. John Bailey of England. The cases record- ed by him were all neuralgic affections of the head and face, and it is when seated in these parts that he considers the belladonna peculiarly efficacious. The preparations used by him were the extract and the tincture.^" [Dysmenorrhcea. — Belladonna has been used with success in this disease, both taken internally, applied to the back as a plaster (empl. belladonna?), and introduced into the vagina as a suppository. Combined with ipecac (half a grain of each), it has in my hands exercised more control over this affection than any other one thing. -Ed.] DATURA STRAMONIUM. ' This is commonly known by the names of the Thorn apple, James- town weed, Stinkweed, &c. It is an annual plant, growing to the height of three or four feet. It is found in every part of the United States, Canada, Mexico, South America, also in Europe, Africa, and Asia. With regard to the native country of this plant there has been con- * Bayle, v. ii. p. 513. f Diet. Mat. Med. v. ii. p. 492. % Ibid. Bayle, 513. § On Children, 483, also Mat. Med. v. i. 75. jl Mat. Med. ii. 75. 1 Diet. Mat. Med. vol. i. p. 492. NARCOTICS. 30] Biderable difference of opinion. The common belief Beems to 1": io favor of its being a native of this continent, and that it travelled through the East Indies and Persia to Europe. In the earliest English vrritei on plants it is called the thorn apple of Peru, and the Spaniard a erl that the first seeds of it were received from Peru, under the name of eachos, and that it had previously been held in high repute as a medi« cinal plant both by the natives and the Spaniards in Peru. Into England it was introduced in the reign of Queen Elizabeth from ' !on- stantinople. That the stramonium is not a native of the United States there is every reason to believe. It is always discovered along the roads and near habitations, never in the woods and mountains. Mr. Bafi- nesque says the Indians call it "the white people's plant," and he adds that its migrations can be traced from New England and Virginia, and that in the Western States it has sprung up only since their settlement, and from seeds carried there. This plant blossoms from May to September in the Southern States, and from July to October in the Northern. Properties. — The whole of this plant possesses active properties, and has a foetid, narcotic smell, which of itself sometimes causes headache and stupor. The parts chiefly used in medicine are the leaves and seeds. The leaves are large, from five to six inches in length, of a deep green color on the upper surface and pale green underneath. When fresh and bruised they have a foetid, narcotic odor, which they lose on drying. Their taste is bitterish and nauseous, and when chewed they give the saliva a green tinge. The seeds are small and of a dark coloi 1 , having the peculiar taste of the leaves, but destitute of smell. Chemical Properties. — By Brande the seeds were ascertained to con- tain a peculiar alkaline principle, which he called datiirine, gum, a butyraceous matter, orange-colored extractive, together with various salts. The active properties of the stramonium are yielded both to alcohol and water. Daturine exists in the seeds of the stramonium in combi- nation with malic acid. In its pure state it is in the form of acicular prisms, almost insoluble in water and in cold alcohol. In boiling alco- hol it is very soluble, and with the acids it forms crystallizable salts. Effects. — In its action on the system, stramonium resembles bella- donna. In moderate closes, it causes slight vertigo, and sometimes pain in the head, dimness of vision, and dilatation of the pupil. In some cases nervous sensations are excited in the fauces, amounting even to a sense of suffocation, but more commonly only heat and thirst. Although not soporific like opium, it produces a slight tendency to sleep. On the circulation the effect is not very striking ; in some cases increasing 392 MATERIA MKDICA AND THERAPEUTICS. the frequency of the pulse somewhat, while in others it is rendered slower.* The bowels are moderately relaxed, and the secretion of urine increased. If it be given in somewhat larger doses, say three or four grains of the powdered leaves, in a few minutes it produces giddi- ness, nausea, difficulty of speech, with great thirst, with symptoms ana- -logous to those of intoxication from alcohol. f Like belladonna, it uni- formly dilates the pupil. This is the case especially when applied locally, either in the form of extract or watery solution. This effect comes on in about half an hour after its application, and continues for about two da)'s.J In jyoisonous doses, the prominent effects are sickness at stomach, loss of vision, dilatation of the pupil, delirium,§ amounting sometimes to actual mania and stupor ; in some cases spasms, and occasionally palsy occur. After continuing for a longer or shorter period, patients recover from these effects, although sometimes death is the result. [I have seen perfectly well marked chorea produced in a child of eight years by swallowing the seeds of stramonium. The symptoms went off in about twelve hours. — Ed.] Modes of Administration. — Powder. — Both the leaves and seeds are used. Of the powdered leaves, the dose is from two to three grains; of the seeds, which are stronger than the leaves, one grain may be given twice a day. Extract — Of this there are two kinds, the one made from the leaves, the other from the seeds. The extract from the leaves is prepared by bruising the fresh leaves in a stone mortar, sprinkling on them a little water, then expressing the juice, and evaporating to a proper consis- tence. Prepared in this way, it is uncertain as regards its strength, differing according to the mode of conducting the process of evapora- tion, and the season when the leaves are gathered. The average dose is about a grain, night and morning, gradually increased until the sys- tem is affected. The extract from the seeds is prepared by macerating a pound of the seeds in a gallon of boiling water for four hours ; then taking out the seeds and buising them, after which return them to the liquor ; boil down to four pints, and strain while hot. After this evaporate to a proper consistence. The extract prepared in this way is about twice as strong as that from the leaves, and is more certain in its effects. The dose is from Jto}a grain twice a day. This may be increased every day or two \ of a grain, until some decided effect is produced. Tincture. — This is prepared by macerating four ounces of the bruised seeds in two pints of diluted alcohol for fourteen days, and then filter- * See Experiments by Cooper, in Caldwell, p. 114. for 1805. f Ibid. p. 184. % Cooper, p. 173. § For a striking illustration, quote from Cooper in Caldwell's Therap., p. 186. NAECOTICS. 303 ing. Of this the dose is from ten to twenty drops; may be taken two or three times a day, arid gradually increased. Oi ntmen t. — One pound of the leaves cut into pieces, melted with lard, one pound; yellow wax, half ;i pound. Diseases in which it is used. — From the analogy in effect to the bel- ladonna, it has been found useful in very much the same kind of i e.'ises. Affections of the Eye. — In cataract, inflammation of the iris, c restudied. Circumstances modifying the affect of Anaesthetics. — On this subject we want facts. Age does not seem to contra-indieatc their use, as Pro- fessor Gross says ho has administered chloroform to patients of every age from sixteen months to seventy years without any evil effects. Sex, too, seems to have little influence, and if any such power belong to climate we are yet unable to appreciate it. State of the System. — The only thing from which we should, d priori, expect a modification of the effect of anaesthetics, is present pain, but I am not sure that there is any difference in the facility with which the anaesthetic state is produced in the patient about to submit to a surgical operation and the woman actually suffering pain of labor at the time the anaesthetic is given. The one seems to me to pass into the anaes- thetic state as readily as the other. States of the System unfavorable and favorable to the use of Anaesthe- tics. — The conditions under which anaesthetics are most likely to act irregularly are. — 1. Very great plethora; from the observations of Du- bois and others, it would seem most prudent to remove this plethora before the agent is administered. Yet having done this, care must be taken as to the manner in which the anaesthetic is given, as it usually acts much more promptly immediately after a bleeding, or when the system is much reduced, than under other circumstances. In the case to which I have already alluded, where its effects were so rapid and so serious, the chloroform was given immediately after a free bleeding. 2. The presence of serious disease of the heart or great vessels has been by Mr. Wakley and others said to contra-indicate the use of anaesthetics. This has been denied — certainly the existence of such organic affection should make us pause and duly reflect on the question, and if we judge it best to use the anaesthetic, no doubt great care should be taken to shorten or avoid altogether the period of excitement. Mode of Administration. — A very great variety of inhalers have been proposed. They have nearly all gone out of use, and ether is now almost constantly poured upon a cupped sponge and held over the nose and mouth, while chloroform is dropped upon a handkerchief and held in the same way. Rules for the Administration of Anaesthetics. — 1. The patient should not take food immediately before the operation. 2. The mind should be as far as possible calm and composed. 3. Quiet around is of the utmost importance — loud talking, addressing questions to the patient, &c., are all likely to interfere with the production of the anaesthetic state. 4. As to how rapidly the patient should be hurried through the state of excitement there is difference of opinion, and a different rule 398 MATERIA HEDICA ANC THERAPEUTICS. should prevail as the agent is ether or chloroform. If ether is used, the stimulation is often troublesome, and the deeper stages of narcotism not readily produced. We ought, therefore, to hurry forward the process, place the cupped sponge over the nose and mouth, not pressing on the skin, but quite near, and urge the patient to take full free inspirations — let them follow each other as rapidly as is consistent with their being full and deep. As to chloroform, Prof. Simpson advises that the patient should be plunged as rapidly as possible into complete anaesthesia. This is not the course I would recommend. I think the practitioner will do better to feel his way a little, and allow the effects of the agent to de- velop themselves gradually. There will every now and then be trouble with the stimulating effects, but there will be less danger. 5. Care should be taken that the supply of atmospheric air is at all times ade- quate. There is little doubt but that several of the fatal cases depended on an inadequate supply of air. 6. Watch the case from the first inha- lation till consciousness and sensibility have completely returned. One person should in all operations have charge of the anaesthetic, and he should think of nothing else. In one fatal case the attendant who should have watched the patient was looking at the operation, and the man died. The person who has this charge should keep his finger on the pulse and watch the respiration every single moment of the time — not one inspiration, not one beat should the heart give that he does not take note of. The moment the respiration is irregular or the pulse begins to flag or flutter, the inhalation should cease, and a puff or two of fresh air be blown into the face. As to the degree to which the effects should be carried, it will differ in different cases. In natural labor we need ordinarily go no further than to obtund pain, and this can generally, I think, be done without disturbing consciousness. In surgical operations, complete relaxation of the muscles and profound sleep is generally required. This state, however, must be watched, and when the breathing becomes stertorous the inhalation should be sus- pended. If the breathing is irregular or interrupted the danger is most imminent, and every means of keeping up respiration should be resorted to. Artificial respiration is the sheet anchor in such eases, and I have known great danger removed by prompt and continued artificial respi- ration. Everything will depend on the coolness and self-possession of the operator. 7. When the patient is allowed to emerge into conscious- ness everything that can startle or shock should be avoided, and the brain allowed quietly to recover its equipoise. Ammonia, oxygen, gal- vanism, &c. &c, have been proposed as remedies in excessive anaesthe- sia. They amount to nothing. Artificial respiration is the alpha and omega. Applications to Disease. — In Surgical Operations anaesthetics are almost universally used. On this subject, having no experience of my ANiESTIIKTJCS. 8W own, as I do not practise Burgery, I will quote the emphatic language of my distinguished friend, Prof. Gross. " I have never noticed in any <>f my cases that the rise of chloroform exerted any injurious effects on the recovery of my patients."* In Midwifery. — Here the fate of anaesthetics has been very different from that which it met in surgery. From its first introduction into ob- stetrical practice to the present time, objections of all sorts have been urged against it, and evil consequences of all kinds attributed to it. It was immoral, for it excited in the patient indelicate ideas, and might prompt to improper words. It was irreligious — God had said to woman "in sorrow shalt thou bring forth children" — anaesthesia tried to escape this curse. It predisposed to hemorrhage, to puerperal convulsions, to mania, &c. The child might be poisoned, made an idiot, &c. &c. To this a great deal of jargon has been added about pain being a " conser- vative manifestation of life force" " being 'physiological" and the like. These objections of course never had any weight, and having served their purpose of attracting attention to their authors, may now be chari- tably forgotten. But more tangible objections have been made to anaes- thesia in midwifery. It is said to interfere with uterine contraction, and thus augment the duration of labor. That the first administration of anaesthetics ordinarily checks pain is certain, but in almost every case it promptly returns, and is quite frequently more efficient, so that it is at least doubtful -whether the duration of the process is greater ; but even though it were, are not the advantages obtained worth the sacrifice?! As to its evil influence post partwm, I do not believe that there is exist- ing any proof of such influence. The recoveries after its use are cer- tainly as rapid and as satisfactory in every respect as those without it, and most practitioners who speak from any large experience think more so. But the great objection to anaesthetics remains. They have, and that in a very considerable number of cases, caused death. They are then dangerous to life — that is the great, the sole objection to them. This being certain, as I think it is, the question returns in this form : Are the advantages gained by the use of anaesthetics in midwifery suffi- ciently important to justify us in the use of an agent which may destroy life ? What are these advantages? 1st. Immunity from pain. While the old adage that "pain is an evil" holds true, this will be by all rational persons admitted to be a very great advantage. 2d. Immunity from the shock which great physical pain often inflicts on the nervous system. This shock is, we know, sometimes so great as directly to destroy life ; it very frequently produces a depressing influ- * Trans. Am. Med. Ass., vol. iii. p. 392. f Subsequent experience has convinced me that the pains of labor are more fre- quently made extra-efficient than interrupted. 400 MATERIA MEDICA AND THERAPEUTICS. ence, from which the patient does not rally for hours or days. This is seen after labor in nervous, delicate women, who, having large children, suffer very severely in parturition. In this state of things we are very frequently obliged to give narcotics, and even in some cases these fail for a long time to control the excited nervous system. Now anaesthetics pre- vent all this : opiates remove or control it. But is it not safer to prevent than control evil ? If this be true, if pain is not only an evil in itself, but if it and it alone can and does in any considerable number of cases endan- ger or destroy human life, we are surely justifiable in using a means of warding off that danger, provided the one to which we expose our patient is not greater than that from which we protect her? What pro- portions do these two dangers bear to each other ? We have no statis- tics that enable us to answer this question confidently, and must, there- fore, only answer it conjecturally. What is the danger attending the use of anaesthetics ? The number of fatal cases authentically reported is, I believe, about twenty.* To how many thousands and tens of thou- sands have anaesthetics been given ? How very small, ay, and consi- dering the careless way in which it was first used, how wonderfully smaP is this proportion of fatal cases ? On the other hand, what is the danger to life from the pain (mere pain) of childbirth ? In natural labor and in healthy women infinitely small. In nervous, timid, excitable women (natural labor) not so very small. In cases of lingering labor, especially where the labor depends on a rigid perinenm, the danger is by no means small ; and when we come to the severely painful operations, as turnings the forceps, removing retained placenta (hour-glass contraction) it is very considerable — much, much greater than the danger from anaesthetics' From these premises I deduce the rules as to the use of anaesthetics in midwifery. In natural labor, in patients of good constitution, free from nervousness, it need not be given. In the nervous, timid, excitable wo- man, it may be given, even in natural labor. In lingering labor, where the pains are severe and the suffering great, it ought to be given. In severe operations it manifestly and indubitably increases the patient's chance of recovery, and may not justifiably be withheld. In Delirium Tremens. — Anaesthetics have been used in this disease in very many cases, and generally with the most pleasant effects. It is often somewhat difficult to get the patient fairly under the influence of the agent (especially if ether be used), but once overcome, he is gene- rally quiet, and the artificial usually passes into natural sleep, which con- tinues for many hours ; the patient generally wakes up calm and composed. In these cases, care should be taken not to overwhelm the weak, exhausted system, but to introduce the anaesthetic somewhat gradually. * Now (1856) alas I much larger. ANAESTHETICS. 401 In Puerperal Convulsions. — After suitable sanguineous depletion, anaesthetics may be tried with the best effects. The violence of the spasms is promptly controlled, and the lit. very often arrested al once. Here the caution as to the administration of anaesthetics immediately after bleeding, heretofore given, would apply. In Spasmodic Asthma. — Anaesthetics have in some cases been given with entire and immediate relief to the paroxysm; of course they would produce no curative effect on the disease; but if they only give tempo- rary relief to a fit, it is no small boon. Idiopathic Tetanus. — Mr. Carey reports in the London Lancet (Feb. 1848) a case in which chloroform was used with success. It was admi- nistered so as to keep the patient under its influence for some time. Dr. I. Parrish, of Philadelphia, has reported another connected with erysi- pelas. It has also been used repeatedly in traumatic tetanus and hydro- phobia, with the effect of mitigating the sufferings, though not prolonging the life of the patient. In Neuralgia. — This is one of the diseases in which anaesthetics have been used most frequently, and with the greatest success. They very rarely fail to remove for a time the pain, and though on the patient returning to a conscious state the pain often returns, yet a repetition of the remedy usually removes it again ; and after two or three such returns the disease has in many cases been entirely removed. individual anaesthetics. Sulphuric Ether. — This was the agent first used, and it continues to be the favorite with a small portion of the faculty. Its advantages are : 1st. It is more stimulating, and may therefore be given to patients very much exhausted, with a view to its stimulating as well as to its anaesthetic effects. Its main advantage, however, over chloroform is safety. Not more than one or two deaths have been satisfactorily traced to the use of ether. Objections. — It is so stimulating that it is difficult to get some patients beyond the state of excitement. It has to most persons an exceedingly disagreeable odor, and this is very permanent. It excites coughing very often and headache not unfrequently. To some persons it is so disagreeable that they cannot take it* Still as it is, from the slowness of its operation, safer than chloroform, I would advise all persons to make their essays in the use of anaesthetics with ether; when repeated observations have given them confidence based on knowledge they may try the more dangerous agent. 402 MATERIA MEDICA AND THERAPEUTICS. Mode of Administration. — Ether should be poured on a large cupped sponge, and this held immediately over the mouth and nose, but not pressed down upon the face. As soon as the respiration becomes deep and moderately slow, the sponge should be raised, that a larger propor- tion of air may enter the lungs ; the impression can then be rendered deeper, if desired. The quantity of ether required to produce full anaesthesia is about an ounce, but much more is often used, part being •wasted. Chloroform. — This is, in chemical language, a Tcrchloride of For- myle. It was discovered by Soubeiran, 1831, and Liebig, 1832. It consists of two atoms of carbon, three of chlorine, and one of hydrogen. Physical Properties. — A clear limpid fluid, very volatile, boils at 140°. Sp. gr. 1.480, a pleasant fruit smell, and a sweet taste. It is not inflammable — has great power as a solvent. Preparation. — It is usually made by the distillation of dilute alcohol and chloride of lime. Adulteration. — It is often adulterated with alcohol, which may be discovered by testing the sp. gr. It should not be used if below 1.400. Sometimes it contains sulphuric acid. This may be detected by litmus paper, or the action of nitrate of baryta, on distilled water shaken with the chloroform. Effects. — Chloroform is more powerful as an anaesthetic than ether in the proportion of about eight to one. It is far less stimulating, and the stage of excitement it produces is so short, if a full dose is adminis- tered, as scarcely to be perceptible ; the patient passes almost instantly into sleep, more or less profound. It sometimes excites nausea and vomiting, but very rarely coughing, choking, or any of those evidences of irritation of the air passages from which so much trouble is experi- enced when ether is administered. In fact, it is perfectly agreeable — very powerful — very certain in its effects, but also very dangerous, espe- cially if not watched most assiduously. Mode of Administration. — Chloroform is usually given in a handker- chief, twenty or thirty drops (not more than thirty) are poured on it, and the handkerchief placed about an inch from the face; the patient should be encouraged to take deep, full inspirations ; a little agitation will soon be manifested, but this will generally pass away in a moment, and the patient will continue tranquilly and with apparent pleasure to inhale. Often, if efforts be made to remove it, they will be resisted; gradually the brain is oppressed, consciousness lost ; next come muscu- lar relaxation and deep, perhaps stertorous breathing. Stop, now, and et the operator do his work ; if the patient rouse, give the chloroform again ; a few deep inspirations will probably complete the insensibility. ANAESTHETICS. 408 When it is desirable that the patient should revive, let this be without noise or confusion, and let consciousness return perfectly before any ques- tions :ire asked or remarks made. Let me in conclusion l>< ; g every one who reads these directions never to use chloroform without watching every respiratory act and having the finger upon the pulse every moment. In no other way, I am quite sure, can danger be avoided. And I would beg those who read this caution to remember that it, and the representa- tions of the danger of any but the most cautious use of this drug, come from one of the earliest and most earnest of the advocates for its obstetric use — one who uses it constantly and habitually in all his cases of obstetric operations — in most of those of lingering and painful labor, and in not a few of natural labor. Yet has my experience so taught me that I never touch this agent without dread, and am deeply conscious that nothing but unremitting vigilance has saved me from producing with it the most disastrous effects. Chloric Ether. — This is a mere dilution of chloroform with alcohol, in the proportion of one of the former to eight of the latter. It is used exclusively by Dr. Warren at the Mass. Gen. Hospital ; he thinks that it is more pleasant than sulphuric ether, and safer than chloroform. It has not the unpleasant smell of sulphuric ether, does not produce pul- monary irritation, and very rarely headache. It is more apt to produce nausea, which Dr. W. thinks rather an advantage than an objection. The opinions of this distinguished surgeon are worthy of all possible respect. Chloric ether is also employed by Dr. Knight of New Haven, and other surgeons at home and abroad. Dose and Mode of Administration. — The same as sulphuric ether. Chloroform and Ether. — A mixture of the two anaesthetics in pro- portions of either one of chloroform to two of ether, or one to three, is employed by Prof. Brainard of Chicago, Dr. W. Atlee of Pennsylvania, and some other surgeons. It is supposed to combine the excellences of both agents. Cold. — The use of intense cold as an anaesthetic was introduced to professional notice by Dr. James Arnott, in 1848. It has since been used quite frequently by him and by other English surgeons, and very often with success. On the continent it has been little used, and I do not find that the operating surgeons of New York are very partial to it. Arnott has proved beyond doubt that it is a great mistake to suppose that because long-continued congelation destroys the vitality of a part the same or any other evil effect would follow a short-continued conge- lation. The fact being that a part may be benumbed, the circulation through it stopped, the skin and adipose matter congealed, aud this con- 404 MATERIA MEDICA AND THERAPEUTICS. tinued for five or six minutes, and yet the vitality of the part be entirely restored. Cold thus used entirely destroys the sensibility of the skin, but its influence does not seem to have extended in any great degree to the parts beneath. Mode of Use. — Pound a bit of ice (the size of a large orange will be enough if the congelation is not to be extensive), mix with it about half its weight of salt, and put it into a gauze net, and apply. It should not be kept motionless on the part, but frequently raised that the water may escape or be sponged up. The skin is benumbed almost immediately, there is hardly a sensation of cold, and no tingling or smarting whatever. The surface soon be- comes white and hard. It seems to me that our surgeons ought to give this plan of Arnott's a full trial. My friend, Prof. White of Buffalo, tells me that he has used carbonic acid as an anaesthetic in cancer uteri, with good effect. A bent tube connected with the gas generator was introduced into the vagina. [As Dr. Beck did not lecture on anaesthetics, I have been obliged to supply this sketch. — Ed.] STIMULANTS. Stimulants are those medicinal agents which increase the vita movements of the system at large. Their general effects are simple and obvious ; almost as soon as taken into the stomach, they produce a sensation of warmth, which soon diffuses itself over the whole body. The action of the heart and arteries is accelerated ; the pulse more fre- quent and stronger ; the muscular system is invigorated, while general energy is imparted to the brain and nervous system. In all cases the effects are more or less temporary, varying with the stimulant and the quantity used. Some are peculiarly evanescent in their action, others more permanent. All are followed by languor and debility. Let us analyse a little in detail the effects of these remedies on the different parts of the system. 1. On the Brain and Nervous System. — The brain experiences a marked increase of power and activity. The senses all become more acute. The intellectual faculties, the imagination more especially, are stimulated, the passions excited, and every good and evil propensity roused into exercise. 2. On the Urinary System. — The effects of these agents are strik- ing and peculiar. In the first place, they usually increase the quantity of urine secreted. This may be accomplished by the general impulse given to the circulation, involving the kidneys in the universal excite- ment. In the second place, besides increasing the quantity they alter its quality. It becomes high colored and irritating. Hence the heat and uneasiness which it occasions in all the surfaces over which it passes. 3. On the Skin. — In the general excitement of the circulation which follows the use of stimulants, there is no part which participates more decidedly than the skin. The capillaries are filled, heat is developed, and the secretion from the surface augmented. 406 MATERIA MEDICA AND THERAPEUTICS. CIRCUMSTANCES MODIFYING THESE EFFECTS. Age. — This modifies the effects of stimulants in a very striking man- ner. Their power is always manifested in proportion to the degree of sensibility and mobility in the system. In early life their action is, therefore, much more decided than afterwards. When judiciously used, their effects are most remarkable in invigorating the system. When improperly given their evil effects are quite as decided. The reason of this is plain ; in early life the circulation is naturally rapid and irregu- lar, hence local congestions are common. Now, stimulants still further hurry the circulation and increase the danger. At this period, there- fore, stimulants should be generally avoided. In old age, on the con- trary, the circulation is sluggish, the sensibility exhausted ; here stimu- lants may be used with freedom, and their effect is less, but their use is unattended with the dangers which it has in infancy and ehildhood. Sex. — From the greater delicacy and excitability of the female sys- tem, stimulants produce a more decided effect on women than they do on men. Besides the general difference of constitution there are other circumstances which modify the effects of stimulants in the female. This is especially the case during pregnancy. In this condition of the female system, there is always increased excitement present. Hence it is very evident that the general effect of stimulants must be very differ- ent from what it is in the ordinary state of the system. Temperament and Constitution. — In sensitive and sanguine tempera- ments, stimulants produce more excitement than in the melancholic and phlegmatic. In the application of this class of agents to the treatment of diseases this fact is always to be borne in mind. Climate. — Of all the circumstances modifying the effects of stimu- lants this is, perhaps, the most striking. The inhabitants of Northern regions, whose sensibility is blunted by the rigor of the climate, can bear much larger quantities of ardent liquors than those of warmer latitudes. The apathetic Russian can take with impunity what would prove destructive to the sensitive inhabitant of the South of Europe. Even in our climate temporary exposure to the benumbing influence of cold will produce a similar effect. A person thus exposed may safely take, without any, or at least a trifling effect, what would be sufficient, under other circumstances, to intoxicate him. Repetition. — The same general law holds good here that is found to prevail in other classes of agents. The system becomes gradually habi- tuated to the impression which they make, and to produce the same effect larger quantities are required. Illustrations of this fact are fami- liar to everybody. It is exemplified in the history of every person addicted to the use of intoxicating liquors. I once knew a man, now STIMULANTS. i 07 dead, who began his career of intemperance by taking brandy in drops. What the number of drops was at first I do not know. Be did this with the intention of its serving as a check upon any excess into which he might be tempted. Finding, however, as a matter of coarse, that the exhilarating effects of his drops were gradually lessening, he in- creased the dose, and in this way lie went on practising a constant deception upon himself until he became a perfect sot. In the use of stimulants in the treatment of diseases this fact is of importance. It shows that when they are required the dose must be gradually increased, if you wish to keep up a certain effect. Actual Condition of the System. — The effects of stimulants vary con- tinually with the varying condition of the individual. If the stomach is empty, they are much greater than when it is full. This is known to everybody. Double the quantity of liquor of any kind can be taken after dinner than before. The reason is, that the excitability of the stomach is, to a certain extent, exhausted by the process of digestion. This is evidenced by the tendency to torpor and sleep which succeeds this process. A still more striking illustration is met with in persons who, either from necessity or inclination, have fasted or kept themselves on short allowance for any length of time. In all these cases, from the accumulated excitability in the system, the smallest quantity of stimu- lating food or drink produces the most extraordinary effect. The cele- brated Venetian nobleman, Cornaro, who attained to the age of upwards of one hundred by his abstemious mode of life, relates that he had a violent fever excited, which lasted for several weeks and threatened bis life, by increasing the quantity of his daily allowance of food from twelve to fourteen ounces. Another interesting case occurred in the history of Captain Bligh, who commanded the ship Bounty. In her voyage in 1787 to the South Sea Islands to convey the bread-fruit tree to the West Indies, the men mutinied, and the commander with eighteen men was sent adrift in an open boat. In this condition they performed the unparalleled voyage of 4,000 miles in the open sea. Their sufferings during this period from exposure and want of food were dreadful. They were kept all the time in a state approaching starvation. In this state a teaspoonful of rum dealt out to them occasionally is stated to have acted as a powerful sti- mulant in enabling them to complete this extraordinary voyage without the loss of a single individual. Another illustration of the modifying effect of the actual condition of the system is to be found in those cases where the excitability, instead of being accumulated, has been from some cause or other exhausted. Here immense quantities of stimulating articles can be taken with little or no effect. The advanced stages of typhus furnish many examples. 408 MATERIA MEDIC A AND THERAPEUTICS. In these states, it is astonishing what immense quantities of wine and other stimulants have been administered with but little effect. STATES OF SYSTEM FAVORABLE AND UNFAVORABLE TO THEIR USE. As the effects of stimulants differ so materially according to the actual condition of the system, it is exceedingly important to mark, if possible, with some precision, those in which they may be used with advantage, as well as those in which they may prove injurious. A state of active irritation or inflammation of the stomach is decid- edly unfavorable to the use of stimulants. Whenever, therefore, this state of the stomach exists, you are to avoid these agents. In speaking of irritation of the stomach, you are to make, of course, a proper dis- tinction. In many cases this organ becomes exceedingly sensitive and irritable without the least inflammation. You see this in cases of ordi- nary sea-sickness ; in the sickness resulting from the use of narcotics, tobacco, &c. Here stimulants, so far from being objectionable, are the best things that can be used. The existence of active local irritation or inflammation in any other part of the system is decidedly unfavorable to the use of stimulants, also the existence of general febrile excitement. If given, their effect must be an increase of vascular excitement, and perhaps local congestion. I do not wish you to understand by this, that I consider the use of stimulants improper in every state and stage of what is commonly deno- minated fever. On the contrary, in the advanced periods of the disease, where the energy of the nervous system is exhausted, and a general col- lapse has taken place, this class of agents is essential, and they may and must be given in very large quantities, as before stated. General plethora of the system is unfavorable to the use of stimulants. In this state there is always danger of some local embarrassment, either congestion or inflammation, whenever anything hurries the circulation. Now, stimulants quicken the circulation at a time when the heart and blood-vessels are so distended as to be unable to carry the blood freely through the system. Hence obstructions take place, and apoplexies and the like result. Organic disease of the heart and arteries is unfavorable to the use of stimulants. The hurry and vehemence with which circulation takes place under the influence of stimulants tends to increase organic disease, and endanger rupture of the vessels in case of aneurism. From all this the condition of system favorable to the use of stimulants is evident. It is that in which there is general constitutional debility or nervous exhaustion, especially if unaccompanied by local inflammation, or embarrassment, or organic disease. With these general observations I shall, after a word or two on the difference between stimulants and tonics, STIMULANTS. 10'J pass at once to tlic consideration of tlie application of these to tin: euro of disease. The points of resemblance between tonics and stimulants are, that they both tend to augment the vital powers, to increase muscular strength, and to invigorate every part of the system. The differences are : Stimulants act with greater promptness; their effects follow almost immediately on their administration. Tonics, on the contrary, manifest no influence at all upon the system, till they have been used for some considerable time. The effects of stimulants pass off as promptly as they are induced; while of tonics, as the impression is slowly made, so it passes away slowly. They differ in the degree in which they excite the vital powers. By stimulants this excitation is very great ; vital power is augmented, and vital functions are performed with a degree of vehemence, so to speak. From tonics no such effects result; the exaltation of the vital powers which they produce is moderate ; no violent action follows their use, nor can this effect be produced by any mode of administering them. Increase the dose of a stimulant, and you increase its stimulating power ; increase the dose of a tonic, and its effects are no longer tonic, they are in a high degree irritative. Before passing to the application of stimulants to the treatment of various diseases, I will give you a few general rules for their administra- tion. This is the more necessary, as there is perhaps no class of medi- cines which vary so widely in their operation according to the mode in which they are given. This, indeed, often entirely decides the question whether they are to do good or harm, to save or to destroy. Adminis- tered judiciously, there are few remedies more valuable. Given care- lessly, there are none more dangerous. Rules to be observed in the use of Stimulants. — Begin with small doses, and increase them only as they obviously fail of producing the desired effect. In this way you will often get from a moderate amount the best effects, and you avoid the very great evil of being obliged to oppress the stomach by a large quantity. Change the stimulant as the system becomes accustomed to it. When it no longer responds promptly to the impression of one form of ardent spirits, try another ; if beer after doing well for a time loses its power, resort to wine, and so on. You will often find that the system, when it has become quite insensible to the impression of one stimulant, will be roused by another, even though feebler in its general action. This shows a diversity in the impression made by different articles of this class, and proves the fallacy of that theory of the operation of stimulants which gives to them all a unifor- mity of action, and allows only a difference in degree between one and another. If this were so we should need but one stimulant, and could get all the effects of the class from one individual article. Every day's experience disproves this idea. 410 MATERIA MEDICA AND THERAPEUTICS. To avail yourself of tbe advantage to be derived from following the last rule, use stimulants uncombined. Give one form, and only one, till tbe system ceases to respond to it, and tben resort to anotber to be used in tbe same way. Practical Applications of Stimulants. — There is, perhaps, no class of remedies which has been more abused than the one we are now con- sidering, and there is none which requires more discrimination in their use. The reasons of this are obvious. The general indication for which they are given is to remove debility, either of some particular organ, or of the system at large. Now, debility may exist along with many dif- ferent and opposite conditions of the system. It may be apparent, or it may be real. It may be the result of excessive action and inflammation, or of deficient action. Now, if stimulants be given in these various con- ditions of the system merely with the view of counteracting debility, the most opposite and disastrous effects must be produced. It is evident, then, that the mere presence of debility is no guide to the use of these agents. In all cases, the accompanying state of the organs and the cause of the debility must be taken into consideration. This shows the necessity of extreme caution in their use. All this will be strikingly illustrated in noticing some of the diseases in which stimulants are pre- scribed. 1. Fever. — There is no form of disease in which there has been a greater difference of opinion in relation to the use of stimulants than in fever. While by some they have been freely used, and even con- sidered essential to the cure, by others they have been totally inter- dicted. That these opinions on both sides have been carried to an un- warrantable extreme cannot be questioned. The cause of this difference of opinion and practice is, that the treatment has been deduced in too many cases too rigidly from certain theoretical notions which have been entertained in relation to the nature of fever. Thus for example, by the Brunonians, fever was looked upon as a • disease of debility, and accord- ingly stimulants were proper remedies. On the other band, the Brous- sains, discarding altogether the idea of the existence of fever as an idio- pathic disease, and looking upon it as always the result of local inflam- mation, considered antiphlogistic remedies as the only ones proper. A more enlightened observation has shown the fallacy of both these doc- trines. Fever is not to be considered as a disease of pure debility, or as originating in local inflammation, and yet in the different forms and stages of it both these may be present. In its varied and protracted career, fever presents phenomena entirely different, and these require a corresponding difference in the treatment. In the early stages, where the prominent symptoms are — increased action of the heart and arte- ries, heat of skin, impaired secretion — stimulants are obviously improper ; STIMULANTS. 1 1 I bleeding, purging, and other antiphlogistics are essential, bul in the pro- gress of tlm disease, symptoms of sinking and collapse come on, and here the very free use of stimulants may be required to preserve life. ] will uot happen in every case, and generally speaking, patients do \ better even in tbe last stages of fever without stimulants; especial! this the case in the intermittent and remittent fevers which prevail throughout our country. In typhus the case is widely different, and stimulants are much more frequently required. In the last stage, where general torpor and collapse exist, the judicious use of stimulants is ex- ceedingly beneficial, and from the great insensibility that prevails we arc frequently warranted in giving them in very large quantities. Both the quantity given and tbe continuance of the remedy musl depend on the effects which it produces ; it is, therefore, essential that tbe patient be carefully and intelligently watched. Where under tbe use of stimulants tbe pulse becomes slower and fuller, tbe skin uniformly warm and moist, the respiration more equable and slow, tbe tongue moist and clean, delirium abates and sleep follows; tbe stimulants are doing good. Where on the contrary the pulse is quickened, face flushed, heat augmented, thirst and restlessness produced, and delirium either comes on or is aggravated, the stimulants are failing of their proper effects, and should be stopped. Dr. Stokes says that the use of wine is indicated when in typhus the heart's impulse is diminished with feebleness or extinction of tbe first sound. This state of the heart's action is to be noted by tbe stethoscope, not by examination of tbe pulse. — Dublin Jour. 1839. As to tbe quantity of stimulant that may be required there can be no fixed rule; the effect, and not tbe quantity, should guide us. The pre- vious habits of the patient will afford some indication. Tbe particular- stimulant to be used must also depend on circumstances. Sometimes snake root and volatile alkali will suffice, then brandy in the form of grog, milk punch, &c. ur.h thought it espe- cially useful in controlling uterine irritation, dysmenorrhea, irriv uterus, l to act specifically on the nervous system, Bome of the antispasmodics, in combination with opium, maybe employed. Of these ether and assafcetida are among the best. Ether is very prompt in its action, and in combination with laudanum, is efficient in controlling Bpasm. The tincture of assafcetida and laudanum also acts very well. Where it a difficult to get anything into the Btomach, the same may be accom- plished by an enema. For this purpose, from a scruple to half a drachm of assafcetida may be rubbed up with half a pint of water, with the addition of a drachm of laudanum, and this injected into the rectum. In chronic hysteria, independent of convulsion, in which the whole nervous system appears to be in a deranged condition, some of the agents of this class are the remedies resorted to, and at the head of the list is assafcetida. It acts with more power and efficiency than any other agent. Besides stimulating the nerves, assafcetida is useful in 1 1 1 < ■-«.■ cases by proving laxative. In some cases, sulphuric ether and laudanum, in doses of ten drops of laudanum, and twenty of ether, repeated every two hours, answer a good purpose. Valerian, too, frequently proves beneficial, and particularly in cases where a tonic to the digestive organs is required ; the tincture is the best preparation. Castor, too, in some cases proves salutary — so does the skunk cabbage. .Dr. Thacher states that in a case of violent hysteria, in which musk and other antispasmo dies had failed, two teaspoonfuls of the powdered root in spirit and water afforded immediate relief. Eberle states that he has given this frequently in chronic hysteria, and with advantage. He gave a wineglass of the injusion ( 3 i of the root to a pint of water) every four or five hours. After all, however, antispasmodics are mere auxiliaries, and more may be done in the intervals b} 7 tonics and other remedies calculated to cor- rect the general condition of the system. Spasmodic Asthma. — In this complaint antispasmodics have been ex- tensively used, and in some cases with benefit. The simple inhalation of the vapor of ether frequently proves exceedingly beneficial ; assafce- tida has also been given with advantage. Of the simple antispasmodics, however, the skunk cabbage is the most efficacious. This remedy was first recommended by the Rev. Dr. Cutler, by whom it was frequently found successful when all others had failed. From thirty to forty grains of the dried pulverized root were given every two or three hours during the paroxysm, according to the urgency of the symptoms. After the paroxysm has subsided, the use of the remedy is to be persevered in for some days. This mode of treatment is said to have been obtained from the Indians, who repeat the dose for several mornings after the paroxysm has passed off. By others this remedy has been tried, and with bene- ficial results. 438 MATERIA MEDICA AND THERAPEUTICS. The antispasmodic, however, which answers better in this disease than any other, is the lobelia inflata. This has already been noticed under the head of emetics. As there stated, it combines the action of an emetic and antispasmodic. I have used this at the New York Hospital with success in a case in which all other remedies failed. Colic. — This is a disease which arises from various causes, and is con- nected with varying conditions of the digestive organs. The treatment must of course vary according to the severity of the case — bloodletting, evacuants, warm bath, opium, and the like, are the remedies to be depended upon. As to antispasmodics, they can only be useful under certain circumstances. In the milder forms of it, and where it arises merely from disordered functions and flatulency, they are frequently of great service. In this way, as gentle stimulants, they may be used with advantage in gastrodynia and dyspepsia. In these assafoetida frequently proves a valuable remedy. Where anything like active irritation or inflammation is present, these ought to be abstained from. In the griping to which children are subject, connected with a disor- dered state of the bowels, assafoetida sometimes proves exceedingly beneficial. INDIVIDUAL NERVINES. This is an animal product. It is obtained from the 3foschus moschi- ferus, an animal inhabiting the mountains of Eastern Asia, and dwelling on the highest of the snowy peaks. It resembles the deer a good deal in appearance, and is seldom longer than three feet. On the belly of this animal, between the umbilicus and the prepuce, is a bag covered with hair, of an oval shape, which contains the musk. It is about three inches long and two broad, and is found only in the males. Internally it is lined with a smooth membrane having irregular folds in it. It is this membrane which is supposed to secrete the musk. In the young animal there is no musk found ; it exists only in the adult. The quan- tity which the sac contains is from one to two or three drachms. By rubbing against the rocks the animal frequently expresses a part of the musk, and this is said to be the purest kind. Generally, however, the musk is obtained by cutting away the bag, and this is usually done while the animal is still alive. A small hollow reed is inserted into the bag for the purpose of admitting air, and it is then suffered to dry. It is in this state that the musk is imported from China. NERVINES. 439 Physical Properties. — Musk in the living animal is a viscid Becretion. When dried, it is converted into friable, solid grains. They are unctu- ous to the touch and of u reddish-brown color, resembling agood deal dry coagulated blood. Its taste is bitter and disagreeable, and it- odor is powerful and peculiar — exceedingly diffusible and permanent. In combination with other perfumes, it is said to possess the property 1/^^^ ASSAFCETIDA. The plant which yields this drug is the narthex assafcetida. It grows native in the south of Persia, with a stem about nine feet high and seven or eight inches in circumference at the base. The root is perennial, and when fully grown is as large as a man's leg. It contains a large quan- tity of a foetid milky juice, wdiich is the substance used in medicine. The mode of obtaining it is the following : When the root is four years old (until which time it is not fit to yield it), at the season when the stem begins to wither, this is torn off from the root, which is then ex- posed by digging away the earth that surrounds it. In this state it is left screened from the sun for forty days. The top of the root is then cut off transversely, and after forty-eight hours the juice which has exuded is scraped off. Another slice is then cut off, and this operation is re- peated until all the juice is exhausted, when the root dies. This process occupies about six weeks, and during this time the root is protected from the sun's rays. The juice thus collected is then put together and dried, and this is the assafcetida used in medicine. It comes to this oountry either from India or by the way of Great Britain in bags or cases containing from one to two hundred or more pounds. Physical Properties. — Assafcetida, as imported, is in large irregular masses adhering together, externally of a brownish yellow color, and interspersed with tears of a white, red, or violet blue. When broken it presents a variegated, shining surface of a whitish color, which, on expo sure, changes to a reddish brown. Sometimes, but rarely, the assafce- NERVINES. 1 1 I tida cornea in separate tears. The odor is foetid and resemblee thai of garlic, and its taste is sharp, acrid, and bitter. The besl kind i- thai w 1 1 i < ■ 1 1 is clcai- in its appearance, of a pale reddish color, and contain a greal number of the whitish tears, and has the peculiar odoi ong. On long keeping and exposure to the air, it becomes bard and brittle, and at the same time loses much of its odor and somewhat of it- I i Even when dry, assafu-tida is pulverized with difficulty. Chemical Composition and Properties. — According to the analj is of Pelletier, assafoetida contains in LOO parts, resin, 65 ; gnm, 19.44 ; baf rine, 11.66; volatile oil, 3.60 ; supermalate of lime, 0.30. — (Guibourt.) It belongs, therefore, to the class of gum resins. It is soluble in alcohol, forming a clear solution, which becomes milky on the addition of water. Triturated with water it forms a milky opaque mixture, from which the resin is gradually deposited, unless yolk of egg or mucilage be added. Effects and Use. — This is one of the most valuable and most reliable of the antispasmodics, and from its action on the bowels will often pro- duce the best effects in hysteria and other kindred affections. Its ^ effects on the bronchial secretion have already been noted. (Sec Ex- pectorants.) It also stimulates the uterus, and perhaps the whole genital apparatus, in the male as well as the female. Skunk Cabbage. — This is known by various names, such as the Dra- contium fcetidum, Ictodes jaitidus, Synvplocarpus fcetidus. This singular plant is indigenous in this country, and is found growing in wet woods, swamps, and on the margins of brooks and rivulets. It flowers about the end of April or the beginning of May. The root is the part used in medicine. The proper period for collecting it is early in the spring or in the autumn. It should be carefully dried for use. Physical Properties. — The root of this plant consists of a thick body, with numerous radicles. The body is two or three inches long and one inch thick. The radicles are about the thickness of a common quill. Externally the root is covered with a brownish epidermis; internally it is white and amylaceous. When fresh it has a peculiarly foetid odor. This is supposed to depend upon the presence of a volatile oil which is dissipated by heat and exposure. Its taste is acrid, but it loses this by long keeping. As the virtues of this article depend upon its sensible properties, it is evident that they become impaired by keeping. The recently dried root should therefore always be preferred. Chemical Properties. — "It seems to contain a volatile acrid principle, readily dissipated by heat ; a resinous substance, and a gummy or muci- laginous principle. The seeds contain a considerable quantity of fixed oil." — Edwards's Manual, p. 308. Effects. — This article, if given in moderate doses, proves stimulant and antispasmodic. In large doses it causes nausea and vomiting, and 442 MATERIA MEDICA AND THERAPEUTICS. powerfully affects the nervous system, producing sometimes headache, vertigo, and impaired vision. It was originally introduced into practice, by the Rev. Dr. Cutler, by whom it was highly recommended in asthma. It has been used with occasional success in hysteria, chronic catarrh, pertussis, and chronic rheumatism. Mode of Administration. — The best form is that of powder in doses of from 10 to 20 or 30 grains. As the volatile oil is more apt to be dis- sipated when in powder, it should never be pulverized until required for use. CAJUPUT OIL. This oil was formerly supposed to be the product of the Melaleuca leucodendron. The tree which yields it is now, however, found to be a different species, and is called the Melaleuca cajuputi, a small and beautiful tree, growing native in the Molucca Islands. The oil is con- tained in the leaves, and is obtained from them by distillation. From the small quantity which the leaves contain, the oil bears a high price. It is brought from the East Indies in glass bottles. Properties. — This oil is of a beautiful greenish color, transparent, and very fluid ; its taste is pungent and aromatic, and its odor is penetrat- ing, and resembles that of a mixture of camphor and turpentine. It is lighter than water, exceedingly volatile, and burns without leaving any residue. When dropped in water, it diffuses itself over the surface and rapidly evaporates. In alcohol it dissolves very readily. Adulterations. — From the high price of this article, every temptation is held out for its adulteration, and this accordingly is frequently done. The articles principally used for this purpose are the oil of turpentine, the oil of rosemary, camphor, &c. Its purity is ascertained by some of its properties already mentioned. 1. Drop some of it on the surface of water, and if it be pure it will diffuse itself rapidly over it, and evaporate completely. 2. It burns rapidly when ignited without any residue. — 3. It dissolves entirely in alcohol, which is not the case when sophisticated with tur- pentine. Effects. — When taken internally, cajuput oil acts as a local and general excitant. It produces a sense of warmth in the stomach, and speedily extends its influence to the rest of the system ; the pulse is increased in force and frequency, blood determined to the surface, and perspiration induced. Its use, therefore, is principally in those cases in which it is desirable by means of an excitant to equalize the circulation, and to determine to the sjorface. Dose. — The dose is from two to six drops well rubbed up with sugar. Applied externally, it forms a good stimulating embrocation in cases of rheumatism — one part of cajuput oil diluted with four parts of olive oil. NKHVINK8. Ufl BTRYOIINOS NUX VOMICA. This is tho Vomica Nut. Tt is obtained from a tree growing in various parts of the East Indies. Tt is of a middling size, with a crooked and thick trunk. This tree yields a round fruit about the size of an ora covered with a smooth, hard rind of a beautiful golden yellow color, and filled with a soft, jelly-like bitter pulp. In this pulp are imbedded a number of seeds, generally from three to five. These are the vomica nuts of medicine and commerce. They are round and flat, with a depression in the centre, resembling somewhat in shape the button of a coat. They are from half an inch to three quarters of an inch in diameter, and about a quarter of an inch in thickness, of a yellowish grey color when good (when inferior they are black) ; their taste is bitter and acrid, but they have no smell. Chemical Properties. — Besides several other less important ingre- dients, the vomica nut has been ascertained to contain the three follow, ing principles, upon which its active properties are supposed entirely to depend. 1. Strychnine, a peculiar alkaline principle. 2. Brucine, another alkaline principle. 3. Igasuric acid, so called from the Malay name of the bean of St. Ignatius. This acid, since named Strychnic, exists in combination with both of the alkaline substances just mentioned, forming Igasurates or Strych nates. Effects on the System. — The effects of this article on the system are decided and peculiar. According to the experiments of Magendie, it appears to be established that the nux vomica possesses the singular pro- perty of exciting the spinal marroio and the nerves issuing from it, as well as the muscles supplied by the nerves, without at the same time affecting the functions of the brain, except indirectly. Hence, wheu given in suita- ble quantities, it produces spasms of the muscular system precisely simi- lar to those of tetanus, the muscles becoming sometimes rigidly fixed, while at others there are violent states of spasm alternating with fits of relaxation. On the digestive organs it acts as a tonic, and accordingly it will be found that during its use in moderate doses, the appetite is gene- rally improved, at the same time the evacuations from the bowels are rendered less frequent. " In general, the superior extremities are bent, and the inferior ones extended. The intellectual faculties are not dis- turbed, but there is sometimes present a sort of intoxication. Sometimes the urinary and genital organs are irritated. When the dose is a little too large, there comes on difficulty of respiration, swallowing, speaking, and urinating, general agitation and sweat, but all this is ordinarily un- attended with danger." — Bayle, vol. ii. p. 241. 29 444 MATERIA MEDICA AND THERAPEUTICS. These, then, may be considered as the effects of this agent on the sys- tem when used in suitable doses, viz. — a tonic to the digestive organs, and an excitant to the spinal marrow and its dependent nerves and | muscles. To produce these effects, it is requisite to give it in suitable doses, and continue it for a certain length of time. Modifying Circumstances. — 1. Dose. — This modifies very greatly the effect of this agent. When given in very small quantities, no sensible effect follows. When given in moderate medicinal doses, it produces twitching, pricking, and slight spasms of the limbs ; if the quantity be still further increased, decided tetanic spasms are brought on, propor- tioned to the quantity taken, and the length of time its use may have been continued. Finally, if it be given in still larger doses, it acts as a decided poison. For the purpose of ascertaining the mode in which death takes place, numerous experiments have been made upon animals. " Half a drachm of the powder killed a dog in forty-five minutes, and a grain and a half of the alcoholic extract thrust into a wound killed another in seven minutes. The animals uniformly experienced dreadful fits of tetanic spasm, and died during a paroxysm. The cause of death appears to be prolonged spasm of the muscles of respiration. The spasm of these muscles is apparent in the unavailing efforts which the animals make to inspire. The external muscles of the chest may be felt during the fits as hard almost as a bone, and according to an experiment of Wepfer, the diaphragm partakes in the spasm of the external muscles." According to Fouquier the diaphragm is ordinarily feebly and slowly affected by this agent. Hence it is that in the medicinal use of it, the general tetanus which occurs is attended with little danger. According to the experiments of Magendie, the division of the -spinal marrow and even complete decollation do not interfere with the peculiar action of this substance. On the human subject the effects are the same as those in animals, and the mode of death is analogous. "With regard to the dose requisite to prove fatal, the smallest fatal dose of the alcoholic extract yet recorded is three grains." " Hoffmau mentions a fatal case caused by two fifteen grain doses of the powder ; and in Hufeland's Journal there is another caused by two drachms, which was fatal in two hours." 2. The Actual Condition of the System as to Disease^ — The action of this substance on the spinal marrow and the muscles is the same in a state of health as in disease, with this very striking difference, which was first observed by Fouquier, and afterwards confirmed by others. In cases of paralysis, the first effects of the remedy are felt in the paralyzed limb. In most cases, when spasmodic contractions begin in the para- lyzed parts, they do not -extend beyond this, unless the dose be consider- ably increased. NERVINES. 445 Mode of Adiiihiiii ration. — 1. Powder. — In this form il is seldom given, being uncertain in its effects. It, may 1": given in closes of from four arrive grains, repeated three or four times a day, until it eff are felt. 3. Alcoholic Extract— This is a preferable form to the powder, -till somewhat uncertain from the variable strength of the article. I may be taken in pill in closes from half a grain to two grains, to be repeated three times a day. This quantity per diem may be increased gradually until the desired effect is produced. " Tn general, from lour to six grains a day will be sufficient to produce tetanic action ; but sometimes it has required as much as twenty-four or thirty grains in the day." It is important to recollect, that if the use of the medicine is discontinued, on its being recommenced the smallest doses must be given, and then gradually increased. 4. Tincture. — Ext. nucis vom. grs. iij. ; alcohol, ? i. M. Of this from t\vejvty__to thirty drops may be taken at a time. This is also a good friction to the paralysed part. Strychnine. — This alkali was discovered in 1818 by Pelletier, who found it in the Strycknos nux vomica, and from hence it derives its name. Since then it has been found in the Strycknos ignatia, the Strycknos colubrena, and in the Upas tiente of Java. It exists asso- ciated with another vegetable alkali, brucine, and both are in combina- tion with strychnic acid, formerly called the igasuric acid. It is obtained by boiling the bruised nux vomica in spirit three times successively, and pouring off and straining the several liquors. Distil off the spirit, and evaporate what remains to the consistence of an extract. Here the alcoholic extract contains Strychnate of strycknine, with some admixture. This is now to be dissolved in cold water and strained. The water dissolves out the strychnate of strychnine, and separates some fatty matter united with it. This is then to be evaporated with a gentle heat to the consistency of a syrup, and while warm mao-nesia is added to saturation. After standing for two days, the supernatant liquor is poured off. The magnesia decomposes the strychnate, forming strychnate of magnesia, which is held in solution, while the strychnine is precipitated. The precipitate is then to be boiled in spirit, strained, and distilled. To this add sulphuric acid mixed with water, and afterwards solution of ammonia. Here a sulphate of strychnine is formed, which is again decomposed by ammonia, and the strychnine precipitated. This is then again dissolved in boiling spirit and set aside, that pure crystals may be formed. Pi-operties. — When pure, strychnine is a white crystalline substance ; 446 MATERIA MEDICA AND THERAPEUTICS. when obtained by spontaneous evaporation, it is in minute crystals ; but ■when rapidly evaporated, it is in a granular form. It is without smell, but lias an intensely bitter taste. The bitter is so intense that it im- parts its taste to 600,000 times its weight of water. It requires about 6,600 times its weight of cold, and 2,500 times its weight of boiling water, to dissolve it. In boiling alcohol it is soluble, but scarcely at all in cold. Strychnine acts like the alkalies on vegetable colors, neutralizes acids, and forms crystallizable salts.^ It is unaffected by the atmosphere. It is neither volatile nor fusible,- being melted by heat only at the moment of decomposition, which takes place, however, at a comparatively low temperature. Purity. — As this article is very expensive, the temptation to sophis- tication is strong ; as the quantity which is used at a dose is small, it is of course very important to have it pure, otherwise constant disappoint- ment must occur during its use. The articles with which it is most commonly sophisticated are, mag- nesia and phosphate of lime. To ascertain the presence of these the following tests will answer i 1. Dissolve in boiling alcohoh If pure it will be entirely soluble. 2. Subject to a calcining heat, with the access of air. If pure it will be entirely decomposed and dissipated. In its ordinary form it is frequently associated with hrucine. This is ascertained thus : 1. Moisten the suspected strychnine with nitric acid ; if it assume a blood-red color, it contains brucine^ if not it is pure. 2. Mix a solution of the strychnine with a solution of chloride of tin; if it produce a brown precipitate, it contains brucine, if not it is pure. Effects on the System. — These are the same as the nux vomica, only more energetic. When given in sufficient quantities it is, next to the hydrocyanic acid, the most rapid and potent poison we know of. Its terrible effects have been illustrated by numerous experiments upon animals. Dr. Christison killed a dog in two minutes with the sixth part of a grain, injected in the form of alcoholic solution into the chest. A wild boar was killed in the same manner with the third of a grain in ten minutes. Dr. C. thinks there is little doubt that half a grain thrust into a wound might kill a man in less than a quarter of an hour Modes of Administration. — The ordinary and best mode of using it is the form of pill made with the conserve of roses. The best way is to begin with the y 1 ^ or the T 'g of a grain, repeated three times a day and increased until, the characteristic effects of the article are produced. With respect to giving strychnine in the form of alkali, it is well enough to recollect that the activity of it depends upon the degree of acid in the stomach. To obviate the variable effect which might thus NERVINES. 117 be occasioned, J)r. Thomson recommends that it Bhould be given in the form of acetate. This he directs to be prepared by dissolving gr. j of pure strychnine in 3j of distilled vinegar, Six minims of this contain one-tenth of a grain, wliicli is a good dose to begin with. Thi maj be gradually increased. Tincture. — This form is recommended by Magendie; Strychnine, grs. iij. Alcohol, 3 j. M. Dose, 6 to 24 drops. Salts of Strychnine. — Of these there are several. The only one used by Magendie is the sulphate. This acts in the same way as the strychnine, only more active. One twelfth of a gr. is a dose.. APPLICATIONS OF NITX VOMICA AND ITS ALKALIES IN THE TREATMENT OF DISEASES. Serapion appears to have been the first physician by whom the Xux Vomica was used as a medicine. The Arabians gave it as an antidote against the bites of serpents. Between the sixteenth and eighteenth cen- tury, physicians resorted to it occasionally as a remedy for the plague, for tenia, hydrophobia, dysentery, and various nervous affections. It was not, however, until within a few j^ears that any great use was made of it as a remedial agent. In IS 11, Dr. Fouquier, reflecting the fact esta- blished by Magendie, in relation to the peculiar action of the Nux Vo- mica in producing tetanic spasm of the muscles dependent on the spinal marrow, thought it might be applied with advantage in cases of paralysis. He accordingly tried it in a large number of cases, and found it to be a most valuable remedy, proving in many cases a perfect cure. Since the discovery of the strychnine this has been still further tested, and its effi- cacy in many cases fully established. Like all other remedies, it is by no means infallible. In some cases it does no good, while in others it causes effects which no other is capable of producing. Everything de- pends upon the nature of the case. Whenever paralysis is the result of some organic derangement of the brain, such as tumors pressing upon the substance of that organ, diseased alterations in its structure, or extra- vasations of fluid which cannot be absorbed, then this remedy will be of no avail. On the other hand, where the paralysis depends upon simply diminished nervous excitement, it has been completely cured by the use of this article. Dr. Thomson says he considers "strychnine or the ext. of nux vomica most useful in those cases of palsy that proceed from seda- tive impressions on the intestinal nerves, such, for example, as occur 448 MATERIA MEDICA AND THERAPEUTICS. "when carbonate of lead taken into the stomach produces colica pic- tonum ; and indeed in every case of palsy of the motor nerves only, which is readily known by the sensibility of the paralytic limb remain- ing after the power of motion is lost, and by the entire state of the sen- sorium commune." — Vol. i. p. 255. In paraplegia it has generally been found more successful than in hemiplegia. The first effects of the remedy in all cases are convulsive twitchings of the paralysed parts, and no benefit is derived from its use until this effect is produced and conti- nued for some time. If plethora should be present, this is to be corrected by venesection, purgatives, and other appropriate treatment. It is a great advantage attending the use of this powerful agent (strychnine) that it does not at all impair the tone of the stomach ' T on the contrary, it has a tendency to- increase the appetite and promote digestion. In having recourse to the strychnine, the best way is to commence with small doses, increasing them gradually, according to the effect produced. One eighth of a grain twice a day is sufficient to begin with. This may be cautiously increased to one sixth, one quarter, or even half of a gr. twice a day. Should any unpleasant symptoms occur, of course its use should be discontinued, and when the symptoms subside it may again be re- sumed. By observing these general precautions., there is no danger in using this otherwise potent agent. Besides paralysis, strychnine has also been used with success in chro- nic diarrhcea. This, as you probably know, is a very serious disease, and sometimes incurable by any means that we yet are acquainted with. In some cases which had obstinately resisted all other treatment, this remedy effected a cure. Whenever any inflammatory condition of the mucous membrane of the intestines is present it is not to be used. When this is not present, and especially when the disease occurs in fee- ble constitutions and in old people, this remedy is exceedingly advan- tageous. Besides the effect which it produces on the intestines, it acts as a tonic to the stomach, and in this way, no doubt, aids very materially in effecting the desired relief. One twelfth of a grain two or three times a day is sufficient. In recommending this article, I would not advise you to fly to it at once before trying other means. Your best plan is to reserve it till everything else has failed. In certain cases of amenorrhoea, depending upon diminished action in the uterine vessels and the system, this remedy has also been used with considerable success. It stimulates the vessels of the uterus, and im- proves the general tone and vigor of the system, A very good plan in these cases is to combine its use with purgatives, especially when there is a tendency to costiveness, as there frequently is. Brucine. — This was discovered in 1818 by Pelletier, and by Caven- ton in 1819, in the inner bark of the brucia antidjsenterica. It there Nicnvi n E8, 4 1 9 exists combined with the gallic acid, in the state of a gallate. Since then it lias been found united with strychnine in the una vomica and St. [gnatius bean. Brucine is a crystalline Bubstance of a white color, d< tutc of smell, but intensely bitter. In water it is more soluble thai! most other vegetable alkalies, requiring only 850 times its weight of cold and 500 of boiling water for its solution. In alcohol both cold and hot it is very soluble. Tested with nitric acid, it produces a blood-red color. [This blood-red color changes to yellow by heat. This is the test of brucine, and if it happen with strychnine, shows the presence of brucine. It is permanent in the air, but melts at a temperature a little above 212°. On cooling it forms a mass resembling wax.] Effects on the System. — These are the same as the strychnine, only it is less active. It is considered to be about ~ only as active as the strychnine. Modes of Administration. — JPill, of \ to £ gr., to be increased gradu- ally. Creasote. — This is a peculiar substance discovered by Reichenbaeh. It is obtained from tar and pyroligneous acid. It is a colorless, transparent liquid, of an oleaginous consistence. It has a disagreeable penetrating odor, resembling that of smoked beef, with a burning caustic taste. Its specific gravity is 1.037, boils at 397° Far., and is not congealed at the temperature of — 16.0° Far. It burns with a smoky flame, combines readily with acetic acid, water, alcohol, ether, and the alkalies. It coagulates albumen. Fresh meat placed for an hour in a solution of creasote and well dried, may be exposed to the heat of the sun without putrifying. In eight days it becomes hard and smells like good smoked meat. Effects on the System. — Applied to the tongue pure creasote produces severe pain. The tongue, however, is neither red nor tumefied, but con- tracted. Along with this there is a smoky taste in the mouth. Applied to the skin it produces a feeling like that of a burn — causes rubefaction, and destroys the epidermis, which splits and falls off in little rough scales. From experiments made upon animals, it appears that creasote acts as an irritant to the surfaces with which it comes in contact, whether this be the skin or the mucous membrance. In its pure state, if taken internally, it proves poisonous and destroys life. As a medicine it can of course be used only in the state of dilution. As a remedial agent creasote has been used principally as an external application, although in some cases it has been given internally. As an external application, creasote has been much commended in burns, especially those which are attended with excessive suppuration or fungous granulations. It is also used in chilblains. As a styptic it will often control a mere oozing of blood, but over hemorrhage from 450 MATERIA MEDICA AND THERAPEUTICS. vessels of any size it has no power. It has been used in indolent flabby ulcers, in scrofulous and venereal ulcers, and even in cancer. In all these cases it should be watched, and if it irritate, should be suspended. Creasote is often put into carious teeth, and sometimes checks the pain. In some of the scaly eruptions it has, when properly diluted, the best effects. Internally, it has been used in a number of cases. 1. Phthisis JPulmonalis. — In this disease, creasote has been recom- mended as aiding expectoration and also cicatrization of ulcerations. By Dr. Elliotson of London it was tried, but, as he says, without any good effect, when given internally. When used in the way of inhala- tion, however, he reports favorably of its effects. His mode of using it was to put one drop of creasote into rather less than a pint of cold water, and add one drop every time it is employed in order to maintain the strength of the liquid. Through this water the patients were made to breathe for four or five minutes four or five times a day. In those cases in which the ulceration is confined to the mucous membrane, and in cases of simple bronchitis, Dr. Elliotson thinks it has been of decided benefit. Also in asthma. 2. Vomiting. — As an agent for arresting this troublesome affection, Dr. Elliotson thinks that the efficacy of the creasote is fully established. From the stimulant character of this article, it is only suited to those cases of vomiting in which inflammation or structural disease of the stomach is not present. In all other cases, he has found it eminently advantageous in arresting not merely vomiting but nausea. In colic, the vomiting attending pregnancy, sea-sickness, &c, he recommends its use. One or two drops in an ounce of water may be given every hour or half hour till the effect is produced. 3. Diarrhoea. — Creasote has been used with good effect in simple diarrhoea, cholera morbus and cholera infantum ; also as a gargle in malignant sore throat. Modes of Administration. — Internally it is used either in pill or mix- ture. One or two drops dissolved in camphor mixture, or the same quantity made up into a pill, may be given three or four times a day. This may gradually be increased to eight drops. Inhalation. — This may be done either by steeping paper in it and placing this in approximation with the nostrils, or by heating the crea- sote in the neighborhood of the patient, so that he cannot fail to inhale it, in this way ; or a portion of it may be poured into hot water in a Mudffe's inhaler, and the creasote vapor inhaled in the usual manner. Externally it may be applied in the form of lotion or ointment. The lotion is made by adding from two to eight drops to each ounce of distilled water. The ointment is made by rubbing up ten drops with an ounce of lard. NICRVINKtf. 45] For dressing ulcers the creasote water may I"-, used first. Sometimes the purest creasote is used in these cases. To stop hemorrhage the best way is to imbibe a few drops of pure creasote on cotton or lint, and apply it. A well known substance of peculiar smell and bitter, disagreeable taste. Its composition is very complex, its most important soluble parts are, according to lierzelius, a pyrogenous resin united vvitb acetic acid, creasote, ammonia, THERAPEUTICS. As connected -with the history of this medicine, it is not a little singular that the most violent and absurd prejudices existed against its use for a long time after it was first introduced into practice. By some this was carried so far as to assert that those who took it would certainly die in the course of a year. In 1652, Leopold, Archduke of Austria and Governor of the Netherlands, was seized with a double quartan, for which he took the bark. As the cure proved only temporary,, and the fever returned in thirty days, he ordered his physician, John Jacob Chiefletins, to publish a history of the ease, with a view of dissuading from the use of so deceitful a remedy. Notwithstanding this it secretly gained ground, and in consequence of the traffic in it being chiefly monopolized by the Jesuits, the price became most exorbitant. On some occasions it was actually sold for its weight in silver and gold. In England it was chiefly brought into vogue by a physician of the name of Talbot (Sir Robert Talbot — Pereira), who cured agues by a new remedy which was ascertained to be entirely made of cinchona. So great a reputation did he acquire that he was sent for to France, and cured the Prince de Conde, and Colbert, minister of France, "In 1679, the Dauphin son of Louis XIV. suffered from an ague which the Paris physicians could not cure. Talbot was called to Paris, and the phy- sicians thinking it proper to examine his scientific acquirements, began by asking him, '■Quid est febris?' The Englishman frankly answered, 'I do not know; you, gentlemen, may explain the nature of fever, but I can cure it, which you cannot.' This finished the examination. The Dauphin took the remedy and was cured." — Edinb. Med. and Sur, Jour, vol. xxvii., p. 126, As the reward of Talbot's success, it is said that Louis bought the secret for 2,000 louis d'ors and an annual pension of 2,000 livres* Besides this, Talbot obtained letters of nobility and a monopoly of the article for ten years. In consequence of this the price of Talbot's remedy rose to a most extravagant height — a single dose of it cost a louis d'or, and a pound was sold for 100 louis. Physical Properties. — The Peruvian bark as found in the market comes in pieces of various sizes ; some quilled, others flat, of different colors. They all have a bitter sub-astringent taste and an aromatic odor, differing very much, however, in intensity. Varieties of Bark. — The varieties of the Peruvian Bark are exceed- ingly numerous, and different classifications of them have been proposed. The one most generally adopted is that founded on their color, and for practical purposes this is the best. They are accordingly divided into the pale barks, the yelloio barks, and the red barks. These are again divided into two classes according to the color of the epidermis. We have then, 1. The barks with a brown epidermis, pale, yellow,, and red. TONICS. 468 2. The barks nnih a, while epidermis, pale, yellow, and red. [Pereira has abundantly proved, that tliis classification of barks bj their color is objectionable. For, says he, "the same species of bark, thai of e.g. C. lancifolim, in tb THERAPEUTICS. contain so small a proportion of quinine, they are not much used, and the sale at present is very limited. 2. The Yellow Bark. — In the market the yellow bark is known by the name of the Calasaya bark, from the name of the province in Peru where it is collected. It comes both in quills and in flat pieces. The quills are distinguish- ed from the pale bark by being generally larger and thicker, the epider- mis is rougher and the texture of the bark more fibrous. The taste is more bitter than that of the pale, with less astringency. Its color is orange yellow. It yields a powder of the same color. In its chemical composition it differs from the pale in its containing? a larger proportion of quinine than cinehonine. There are two varieties of this bark found in the markeS. 1. The quilled Calasaya Bark. 2. The fiat Calasaya, Bark. Both these come from the same tree ; the only difference being the quilled is taken from the smaller and the flat from the larger branches. Though generally supposed to be the product of the cinchona cordi- folia, [Pereira has proved that it is from the C. calasaya.] 3. The Red Bark. — This is so called from its color. Like the Cala- saya bark, it comes both in quills and flat pieces. They vary in length from two or three inches to one or two feet, and are covered with a rough epidermis. The color of the powder is reddish brown. The taste bitter and astringent, though less so than the pale. This bark yields large proportions both of quinine and cinehonine. The tree yielding it has generally been considered to be the Cinchona oblong i folia. The re- cent researches of botanists, however,, have left it uncertain what the tree is. The foregoing are the genuine cinchona barks % II. Of the Cinchona. Barks with a White Epidermis. — These are known by the name of Carlhagena barks, from the place of their expor- tation. In English commerce they are looked upon as a spurious kind of bark. [Pereira, vol. ii. p. 983.] All these have a whitish micaceous epidermis. They contain only small proportions of cinehonine and quinine. One of them contains a peculiar alkali, called aricinine^ There are several varieties of these barks distinguished by their color — the pale, yellow, and the red. All have a less bitter and more nauseous taste than the preced- ing. Besides the foregoing there are a set of barks which are called the false cinchona barks. These, from their resemblance in external appear- ance to the cinchona barks,, have been at different times introduced into the market as such. They are not, however,, the product of the cin- tonics. 465 chona, but of other trees, and contain neither quinine, cinchonine, nor aricinine. Among them are the St. Lucia bark, the Caribbean bark, &c. Chemical Composition. — Although subjected to a great number and variety of analyses, the chemical composition of the Peruvian bart was very' imperfectly understood until within a very recent period. The first approximation to any acquaintance witli the active principle ofthii drug was -made by Dr. Duncan of Edinburgh in 1803. It had for sonic time been known that an infusion of nutgalls produced ;i precipitate vvith infusions and decoctions of bark, and as this precipitate differed bott from gelatine and starch, the oidy other substance capable of precipitat- ing infusion of galls, Dr. Duncan considered it as a new and distinct principle, which lie called cinchonin. A Portuguese physician by the name of Gomez prosecuted the investigation of this principle still further, and in 1810 described its properties when obtained in a state of purity. It was reserved, however, for two distinguished French chemists, Pelletier and Caventou, to ascertain the true character of this principle, and to show the state of combination in which it exists in the different kinds of bark. By them it was shown that cinckonine is a vegetable alkali, and that it exists in combination with a peculiar acid, which they called the kinic acid. In addition to this they discovered the existence of another vegetable alkali, which they called Quinine, existing also in the same state of combination. These important discoveries were established in 1820. At a later period (1829) the same chemists dis- covered another alkali in a new kind of cinchona. This they called Aricinine. According to the analysis of these chemists, the genuine Peruvian barks contain the following constituents : Quina, Cinchona, Aricina Quinoidine, Kinic, Tannic and Kinovic acids, cinchona red, a yellow coloring matter, a green fatty matter, starch, gum, and lignin. These exist in all the barks, but in different proportions. Quinine, cin- chonine, aricinine and quinoidine will be treated of hereafter; kinic acid exists in bark combined with the vegetable alkaloids and with lime. It crystallises in prisms with rhombic bases — C T H 4 O 2 Ho. Kinovic acid. — A white amorphous substance nearly insoluble in water, soluble in alcohol and ether — in the bark it exists united with lime.— C 12 H 8 O 9 . Tannic acid — called cincho, tannic acid differs from tannin in being less astringent and in giving a green 'color with the salts of the ses- quioxides of iron. Its compounds with acids are more soluble than those of tannin. Cinchona red. — An inodorous reddish-brown substance, nearly inso- luble in cold, but rather more in hot water, soluble in alcohol and 466 MATERIA MEDICA AND THERAPEUTICS. ether — Berzelius regards it as a product of the oxidation of cincho- tannic acid. Cinchona bark yields its active principles to water, wine, and alcohol. Cold water infused upon bark for a certain length of time, acquires the bitter taste and odor of the article. If assisted by moderate heat, the infusion becomes stronger, and while it continues warm is perfectly transparent, but as soon as it cools becomes turbid. By the addition of the mineral acids, particularly the sulphuric, the solubility of the active principles of the bark is increased. This acid decomposes the ki nates and forms sulphates of cinchonine and quinine. Adulterations. — There is, perhaps, no medicine which has suffered so much from this cause as the bark. According to Dr. Paris, it "fell into that discredit in the year 1779, from its inability to cure the ague, and it was afterwards discovered to have been adulterated with bark of an inferior species : indeed Sydenham speaks of the adulteration of this substance before the year 1678 ; he tells us that he had never used to exceed two drachms of cinchona in the cure of any intermittent, but that of late the drug was so inert, rotten, and adulterated, it became necessary to increase its dose to one, two, or three ounces." The frauds which are practised in relation to this article consist not merely in using inferior kinds of bark, but in using the dregs which are left after making infusions, decoctions, and tinctures. These reduced to powder are of course totally inert. In London this kind of fraud is practised to a great extent. The only way to avoid this is to procure the bark in its entire state, and not in the form of powder. If ode of ascertaining the quality of the bark. — The best kind is that which contains the most of the vegetable alkalies. Test for the Vegetable Alkalies. — The best is Tannic acid. This throws down the alkalies in the form of tannates. Infusion of nut-gall is the form in which this test is used, as it contains large proportions of tannic acid. The best bark, therefore, is that which throws down the most copious precipitate with tannin. Effects of Cinchona. — Cinchona possesses in an eminent degree all the properties of a tonic. Its primary operation is on the stomach. When given in small quantities, it simply excites the natural functions of this organ, quickens the appetite, and promotes digestion. If the quantity be large, it frequently excites local heat and irritation, not un- frequently accompanied by nausea, vomiting, and purging. If the use of it be continued, the system at large participates in its effects. The pulse becomes fuller, stronger, and more frequent, the head is affected with a sense of fulness and tension, and sometimes actual pain ; the secretions are impaired, and a general state of excitement is induced. When given in states of debility none of these effects appear, and the TONICS. 407 only evidence of action of the article is to be found in tbe increased strength and tone of the system. Independent of the general effects which cinchona produce a a tonic, it exercises fi peculiar power in controlling and arresting intermit- tent disease. Although there arc other tonics which possess this pro- perty, there is none, with the exception of arsenic, which can at all be compared to it. Mode of Administration. — 1. Substance. — In tbe form of powder it may be given in doses of 3 ss to 3 j, mixed in a glass of port wine or some aromatic. At present the bark is not given in this form, being in a great measure superseded by the sulphate of quinine. 2. Infusion. — The simple infusion is prepared by putting a pint of boiling water on an ounce of bark. Let it macerate for two hours in a covered vessel and then strain. Prepared in this way the infusion contains very little of tbe alkaline principles of the bark. The activity of it may be greatly increased by the addition of 3 i sulphuric acid. This converts the kinates of cincho- nine and quinine into sulphates, wbicb are soluble. The dose is 5 j to 3 ij three or four times a day. From the mildness of this preparation it is only suitable as a sto- machic, not febrifuge. Alkalies, alkaline earths, and vegetable astringents are incompatible with it. 3. Decoction. — This is prepared by boiling an ounce of bark in a pint of water for ten minutes in a covered vessel, and straining while hot. Long boiling greatly impairs tbe virtues of the bark. Dose 3 i to 1 ij. 4. Tincture. — This is prepared by macerating six ounces of bark with two pints of diluted alcohol for fourteen days and then filtering. It is chiefly used as an adjunct to tbe infusion or decoction. In doses of 3 i to 3 iv it may also be used as a stomachic. Compound Tincture of Bark. — This is the celebrated tincture of Dr. Huxbam. It is more agreeable to tbe stomach than the other tinctures of bark. 5. Extract. — [This is officinal, but almost never used. Quinine has banished bark so absolutely that we rarely think of the use of anything but Huxham's tincture and the bark jacket. The latter, though a very homely, is, I believe, a valuable remedy especially for children.] VARIOUS MODES OF ADMINISTERING BARK. 1. By the Stomach. — The ordinary and preferable mode. 2. Applied to the SH71. — The way formerly in use was to apply what was called the bark jacket. This was made by quilting two or three 468 MATERIA MEDICA AND THERAPEUTICS. ounces of finely-powdered bark in a silk or muslin handkerchief, to be worn next the skin around tbe waist. Applied in this way the bark has frequently succeeded in arresting intermittent fever. 3. By the Rectum. — In this way the effects of the bark may also be obtained. For this purpose 3 ij of the powder may be injected with three or four ounces of thin starch ; or three or four ounces of the decoc- tion with a drachm or two of the powder ; and to retain it, ten or fifteen drops of laudanum may be added. Of the Vegetable Alkalies in the Cinchona. — These are three, quinine, cinchonine, and aricinine. The most important of these is the first : 1. Quinine. — It is a white substance, without smell, and intensely bitter. As usually prepared it is not crystallized, though it may be so by care ; nearly insoluble in water; readily soluble in alcohol (espe- cially when hot) and in ether. It melts at 300°, becoming brittle on cooling. It possesses alkaline properties, and unites with the acids forming salts. It is unalterable in the air. Infusion of nutgalls throws down a precipitate from infusion of quinine (tannate of quinine). [This tannate has been used in medicine ; it is tasteless, and equal to sulphate in antiperiodic power.] The only salt of this alkali much used is the sutyhate. Sulphate of Quinine. — This is prepared by boiling yellow bark in powder with distilled water acidulated with sulphuric acid. This is then to be strained. To this add powdered quicklime, which throws down a precipitate. This precipitate, after being washed with distilled water, is to be dried, and then digested in alcohol with a moderate heat; the alcoholic solution is then to be poured off from the residuum, and put into a still or retort and evaporated, till a brown viscid liquor remains in the retort; this is removed from the retort, and as much diluted sulphuric acid added as will completely saturate it. Animal charcoal is then added, and having evaporated the liquor sufficiently, filter it while hot and set aside to crystallize. The rationale of this process is the following: The object of the first part of the process is to make a sulphate of quinine, which is soluble in water ; in the state of kinate it is not soluble. In the first boiling, then, you have the sulphate of quinine in solution, but mixed with various impurities. The object of the second part is to separate these impurities. This is done by adding lime ; this decomposes the sulphate of quinine, and throws down a precipitate composed of sulphate of lime and quinine, both of which are insoluble, leaving the impurities in the water. The object of the third part is to separate the sulphate of lime from the quinine. This is done by boiling in alcohol, which dissolves the TONICS. 469 quinine, nut has no effect on tlic sulphate of Rme« The pure quinine is thus obtained in solution in alcohol; the animal charcoal is added to remove the coloring matter, and the alcohol got rid of by evapo- ration. The object of the last part is to obtain a sulphate of rpuniin; by satu- rating quinine with diluted sulphuric acid. It is in fact a sub- or di- sulpliate. Physical Properties. — This salt exists in fine, silky, needle-shaped crystals, flexible, and of a pearly aspect. Its taste is intensely bitter. By exposure to heat it melts at 240°, and is completely volatilized. In cold water it is very slightly soluble. In alcohol it is very soluble, and slightly in ether. With sulphuric acid it forms a auper- sulphate [a sulphate], winch is much more soluble in water than the di-sulphate. Chemical Composition. — Sulphuric acid, quinine, and water. Adulterations. — Being an expensive article, strong temptations are held out to its adulteration. From the small quantity that is used at a dose, it is evident that a very slight sophistication would greatly impair its effects. The purity of the article, therefore, is a matter of great im- portance. It is adulterated with sulphate of lime, gum, starch, sugar, stearin, salicine. To ascertain the presence of these, the following tests may be used : 1. Heat. — If you put a little of the substance on a piece of unglazed porcelain, or common tobacco pipe, and apply heat, the pure sulphate of quinine will first melt, and spread a little ; it then turns to black arid burns away, leaving nothing but a dark stain, with a peculiar smell of the bark. If any earthy matter be present, this is left on the pipe. This detects sulphate of lime, carbonate of lime, etc. 2. Dissolve a little of it in pure water and boil it in a silver spoon. If it be pure the solution will remain transparent. If adulterated with starch, flour, or any similar substance, a paste will be formed. If the sulphate of lime, &c, the solution will not remain transparent. 3. Digesting in Alcohol. — If it be digested in alcohol, the sulphate of quinine will be dissolved, while the gum, starch, or any alkaline or earthy sulphates will be undissolved. 4. To detect fatty matter, dissolve in water acidulated with sulphuric acid. This dissolves the quinine, but does not the fatty matter. 5. To detect starch, add a solution of iodine. With starch this strikes a blue color; with pure sulphate of quinine, it throws down a precipitate of a brown cinnamon color. 6. To detect sugar, dissolve the sulphate in water and add carbonate of potash. This precipitates the quinine, while sulphate of potash and sugar remain in solution. The sugar may be detected by its sweet taste, 470 MATERIA. MEDIC A AND THERAPEUTICS. or by evaporating the liquid to dryness, and digesting the residue with alcohol, which dissolves the sugar, and affords it on evaporation. 7. To detect salicine, add sulphuric acid. This turns it red [not unless the salicine is in the proportion of T y]. Effects. — The sulphate of quinine produces the same effects on the system as bark, and may, therefore, be use as a substitute for it. In the smallness of the doses in which it is required to be given, as well as its sitting easy on the stomach, it possesses great advantages ; so great that it has nearly superseded the bark. It may be given in powder, pill, or solution. In solution it requires the addition of a little sulphuric acid to make it soluble. A good pre- paration is the following : — $. Sulph. Quinine, grs. xii. Acid. Sulph. diluted, gtt. xii. Sac. Alb. Pulv. Gum. Arabic, aa 3 i. Aq. Cinnamom. § iss. M. The dose varies with the object had in view. When given as a simple tonic, one gr. three times a day. When given to arrest inter- mittent fever, one gr. may be given every two hours. . By some 5 or 6 grs. are given at once. From twelve to twenty-four grains should be given between the paroxysms. In the malignant intermittents and remittents of the South a very much larger quantity is frequently required to control the disease. Ten and twenty grain doses are com- mon, and a drachm or more has been given between the paroxysms. Maillot gave in a case of African fever one hundred and twenty-eight grains in the course of a few hours. These heroic doses should not, however, be given in ordinary cases, as they are beyond a doubt not unattended with danger. 12 grs. of the sulph. quinine are equal to one ounce of bark. Various modes of giving the Sulphate of Quinine. 1. By the Stomach. 2. By the JEndermic method — applying it to the skin. In this way it produces all its effects on the system, and effectually cures intermittent fever. Three or four grains of it finely pulverized are to be sprinkled upon the denuded cutis, and repeated every four or five hours. 3. By the rectum. This is a good mode of giving it and acts very effectually. This quantity must be two or three times greater than that required by the stomach. It may be mixed with a couple of ounces of starch. I have arrested intermittent fever in this way. Besides the Sulphate of Quinine, there are other salts of this alkali which have been used, such as the phosphate, the acetate, and the like. They all operate in the same way, but do not possess any advantage over the sulphate. TONIC'S- 1 7 t 2. Cinchoninc. — This is another of the alkaline principle! exi ting in the bark. It is found in the greatest abundance iii the pub' hark, and exists in the state ofkinate. Cinchorrine is a white crystalline substance, without smell and with a bitter taste, which at, first is not perceptible, in consequence of its dillicult solubility in the saliva. Its solutions are very hitter; in cold water almost insoluble; in hot water slightly solu- ble; in alcohol, especially boiling, very soluble; with the acids it unites, forming crystallizable salts. The only form in which this alkali has been used in medicine is that of the sulphate. In its operation it is very analogous to the sulphate of quinine, and is used in the same way and in the same doses. It is, however, scarcely at all employed. 3. Akicinine. — This is another alkali discovered in the Arica or Cusco bark. It is a white crystal! izable substance, resembling cincho- ntne in most of its properties. It has not yet been used in medicine. Therapeutic Applications. — Bark or rather its alkaloids, for in sub- stance it is scarcely at all given, is used almost entirely as an antiperi- odie, and as such, the number of diseases which are found to yield to its power is much greater than was formerly supposed. Wherever the element of periodicity characterizes a disease, quinine may with confi- dence be appealed to, and will not often disappoint our hopes. CORNUS FLORIDA. The common Dogwood, also called the New England Boxwood. This is a forest tree, found in every part of the United States, although it abounds most in the middle States. It is slow in its growth, and the height to which it attains is from fifteen to twenty and sometimes thirty feet, with a diameter of from four to six inches. In the spring it bears a profu^on of beautiful large white blossoms, which are succeeded in the autumn by clusters of berries of a rich red or crimson color. These berries have a bitter taste, and are fed upon by several species of birds. • The part used in medicine is the bark of the root, stem, and branches, all of which possess medicinal properties, though that of the root is the best. As found in the shops, this is in pieces of various sizes more or less rolled, of a brownish color externally' and yellowish within. It is very brittle, and yields a powder of a brow 7 nish color ; it has little or no smell, taste bitter, astringent, and somewhat aromatic. According to analysis, this bark contains tannin, gallic acid, gum, resin, bitter extractive, and mucilage. By Dr. Carpenter of Philadelphia, it is said also to contain a peculiar principle, to which he has given the name of Cornia. The existence of this principle is, however, doubted by some. 472 MATERIA MEDIC A AND THERAPEUTICS. The best menstruum is water, and in this it is more soluble than the cinchonine. Effects.— In its effects on the system, the dogwood resembles very nearly the Peruvian bark. This has been very fully established by the experiments of Dr. Walker. It has accordingly been used in this country as a substitute for the bark, and with complete success, acting not merely as a tonic, but as an antiperiodic remedy. Although resem- bling, however, the Peruvian bark, it is not to be compared to that article in general efficacy, and therefore is comparatively little used. The fresh bark is apt to disturb the stomach and bowels. This is said to be corrected by keeping it about a year before it is used. Mode of Administration. — In substance it is given in powder in doses of from 3 j to 3 ij. The more common form is the decoction. This is prepared by boiling for ten minutes an ounce of the bruised bark in a pint of water, and straining while hot. Dose, f ij. Besides the Comus Florida, there are two other species, the Comus Circinata and the Comus Sericea, whieh possess properties analogous to the preceding. The willow is a most extensive genus of plants. Nuttal asserts the number of species to be a hundred and thirty. They are natives of Europe and the northern and temperate regions of North America. The salix alba, or white willow, the one commonly used in medicine, has been introduced into this country from Europe, and grows very commouly. Its height is from twenty to thirty feet. It flowers in April and May. The part used is the bark. As found in the shops, it is generally quilled and of a brownish color, fibrous in its texture, and not easily pulverized. It is destitute of smell, and has a bitter, astringent taste. According to analyses of TPelletier and Caventou, the willow bark contains bitter yellow coloring matter, green fatty matter (like that foiHid in cinchona), tannin, resinous extract, gum, wax, woody fibre, and a magnesian salt. The proportion of tannin which it contains is so great that it has been used for tanning leather. More recently the existence of a crys- talline substance has been proved, which is called Salicin. The willow bark yields its virtues to water. Effects. — This acticle is analogous to cinchona in its operation. It is tonic and astringent, and capable of arresting intermittent fever. In every respect, however, it is inferior to cinchona. It is given in substance and decoction, and in the same doses as the cinchona. Salicin. — This substance consists of white and slender crystals, with TONICS. 173 a bitter taste, but no smell. It contains no nitrogen, and does nol form salts with acids; it is not a vegetable alkali. If. is soluble in about twenty parts of cold water. Tn boiling water it is very soluble, a in alcohol, but not so in ether or the essential oils. Effects. — Analogous to the sulphate of quinine, but far inferior in power. In many cases of intermittent fever in which I tried it, itfailed, and they were afterwards cured by the sulphate of quinine. Dose. — From ten to thirty grains. LIRIODENDUON TULIPIFEKA. This is one of the most magnificent of our forest trees, distinguished alike by its great height, its beautiful foliage, and superb flowers. It grows in almost every part of the United States, and not unfrequently attains the height of one hundred and thirty feet. Its flowers expand in the month of May, and are exceedingly beautiful, being variegated with yellow, orange, and green. It flourishes more particularly in the Western States. Its common name is the tulip-tree, or the American tulip-bearing poplar. The part used in medicine is the bark, and this is taken from the root, trunk, and branches, though that from the root is considered the most efficient. As found in the shops, it comes in pieces of various sizes, generally from five to six inches long, and two or three broad, of a rough and fibrous appearance, and of a whitish or clay color, very light, and readily broken. It has a heavy, unpleasant smell, and a bitter, aro- matic taste. It contains gum, resin, iron, muriatic acid, and mucus. By Professor Emmet, a peculiar principle, which he calls Liriodendrine, has also been discovered. This is a white crystallizable substance, not alkaline. It appears to hold a place like camphor between the resins and volatile oils. The virtues of this bark are extracted both by water and alcohol. Long boiling impairs them. Effects. — This substance is tonic, and at the same time stimulant and somewhat diaphoretic. It has been used as a substitute for Peruvian bark in intermittent fever. The most efficacious form of giving it is in substance in the form of powder, 3 ss to 3 ij. The infusion ( 3 j to pint of water), 3 j to 3 ij. and the saturated tincture ( 3 j)#are also used, but are not so efficient. Of the Liriodendrine no use has yet been made. 474 MATERIA MEDICA AND THERAPEUTICS. This substance was first discovered by Oersted in 1819. It is found in black pepper, white pepper, and cubebs. It is crystalline* perfectly white when pure, but as generally found in the shops of a yellow, straw color, without smell, and almost insipid. It is not alkaline, as was at first supposed. In cold water it is insoluble, in boiling water slightly so, in alcohol and acetic acid perfectly soluble. Effects. — Tonic, and used as a substitute for sulphate of quinine in intermittent fever ; owing to its great insolubility, the best form of giv- ing it is in_pill. Dose, grs. vi to viii. [Since quinine has been fur- nished at a reasonable price it has banished all vegetable tonic substi- tutes from the practice, and almost from the memory of physicians.] PRUNUS VIRGINIANA. This is the wild cherry tree [though formerly supposed to be a Pru- nus, it is now known to "Be from the Cerasus serotina], a large and handsome tree growing abundantly in different parts of the United States, where it is indigenous. The part used in medicine is the inner part of the bark, obtained indiscriminately from all parts of the tree, though that of the root is the most active. As found in the shops it comes in brittle pieces somewhat curved, of a cinnamon color, and generally destitute of epidermis. It has a bitter, aromatic taste, with the peculiar flavor of the bitter almond. When fresh or boiled in water it has the smell of peach leaves ; it is easily pulverized — the powder is fawn-color. This bark yields all its virtues to hot and cold water. It was sup- posed to contain hydrocyanic acid [but it does not pre-exist in it]. For medicinal purposes it should be used recently dried, long keeping impairs its virtues. Effects. — This is a most valuable article. It is tonic in each operation, and from the prussic acid which it is supposed to contain, somewhat narcotic. If used in sufficient quantity it manifestly diminishes the fre- quency of the pulse. This gives it a peculiar advantage in all those cases in which you wish to allay irritability, and at the same time .give tone. In dyspepsia, in the hectic of consumption, it is accordingly found very useful ; used also in inflammatory fever, far inferior to cinchona. Form. Powder. — 3 ss to 3 i. The best form is the infusion. This is made by macerating half an ounce of the bruised bark in a pint of cold water for twelve hours, and then*straining. The reason for using cold water is, that boiling water dissipates the volatile principle upon which its activity appears to depend. TONICS. 415 Two or three ounces of this infusion may be taken three or four times a day, or oftcner. FERRUM. Iron is a metal found in almost every part of the globe. It is of a bluish white color, and has a high degree of lustre; it is very ductile and malleable, with a specific gravity of 7.8. Of its chemical proper- ties it is not necessary to speak at present. Effects on the System. — As a general tonic, iron may be ranked as perhaps the first on the list. In its action on the system it produces all the effects which have been described as characteristic of tonics. It improves the condition of the digestive organs, imparts tone to the mus- cular fibre, increases the action of the heart and blood-vessels, and quick- ens the various secretions. Besides these general effects as a tonic, there are some peculiarities attending the action of this agent which require to be noticed. 1. The Permanency of its Operation. — In this respect iron takes the lead of all other tonics. Whatever may be the cause, there is none which is capable of imparting such general vigor to the system, and none whose effects are equally permanent. 2. Effects of Iron on the Blood. — The effect of iron on the blood is peculiar ; other tonics produce an improved condition of the blood, but they do it indirectly, and as a consequence of their influence especially on the digestive organs. Iron acts directly on the composition of the vital fluid itself. This is proved by analysis of the blood before and after the administration of iron. [Simon gives a table of the results of such an examination made on the blood of a chlorotic girl, who in seven weeks took ten ounces of the tincture of iron and sixty-eight grains of metallic iron. Before the use of the iron, the blood contained in 1000 parts 871.5 water, 128.5 solid constituents, haematin 1.431. After the use of iron there were in 1000 parts, water 806.5, solid constituents 193.5, haema- tin 4.598 ! Well may Simon say, "this change in the composition of the blood is truly surprising ! Here the amount of solid constituents is increased fifty per cent., and that of haeuiatin more than 220 per cent. The change in the health of the patient kept pace with that of the blood. The results of the researches of Andral and Gavaret are identi- cal with those of Simon. How very satisfactorily does this analysis ex- plain the wonderful power of iron in cases of prostration from uterine haemorrhage, and in all the forms of anaemia. — Ed.] Preparations of Iron. 1. Limatura Ferri. — Iron filings. As the common filings obtained from the workshop are mixed with copper filings and other impurities, it is necessary to separate them. For this purpose 31 476 MATERIA MEDICA AND THERAPEUTICS. a sieve or piece of gauze is to be placed over them and the iron drawn through this by running a magnet over it. Even after this process the filings are not perfectly pure, and the only way to obtain them is by taking pure iron wire and filing it. The oxidation of iron filings can be prevented by mixing them with an equal weight of pure dry sugar. The mixture must not be exposed to damp ; but dry air will not oxydize it. (Jour, de Phar.) Effects. — In this form iron is in its metallic state, and, as such, like all other metals, exerts no action on the living system. To produce any effect, it must be oxydized, and therefore the filings can only operate as a tonic when they meet with an acid or some other substance in the stomach which will convert them into an oxide. Hence they are best suited to cases marked by the predominance of acidity in the digestive •organs. The evidences of iron filings having taken effect, are fetid -eructations and the black color of the faeces. These are owing to the evolution of hydrogen gas, arising from the decomposition of water dur- ing the oxidation of the metal in the stomach and intestines. Mode of Administration. — They may be given either in substance or -pill — the dose from 5 to 20 grs. ; in substance mixed in syrup, to which "powdered ginger may be added. The common form, however, is that of pill, made with the bitter extract of gentian. [Iron reduced by Hydrogen. — This preparation has been lately intro- * duced by a French pharmacopist, M. Bouchardat. It seems to secure the two great desiderata — an impalpable powder and perfect purity. As such it is probably a valuable addition to our already very numerous list ofchalybeates.-ED.] 2. Oxides of Iron. — There are two oxides of this metal, Protoxide and Sesquioxide (peroxide). Protoxide. — It consists of one equivalent of iron, 28; and one of oxy- gen 8 = 36 Atom No. This is the basis of the native carbonate of iron, and of the green vitriol of commerce. According to Turner, it has never probably been obtained in an isolated form. Beck says that it was first obtained by Stromeyer. In its separate form, therefore, it is not used. (b.) Sesquioxide of Iron. — This is what is commonly known as the red oxide or peroxide. It is found native and prepared artificially. The red hamiatite is this oxide, and is an abundant natural production. It is prepared by subjecting sulphate of iron in a crucible to an in- tense heat, until it is converted into a red substance. It is washed with boiling water and dried. In this process, the protoxide of the sulphate is converted into the sesquioxide by the addition of oxygen which it obtains from the decomposition of a part of the sulphuric acid — the oxy- gen of which goes to the protoxide, while sulphurous acid gas is evolved. TONICS. 477 It consists of one equivalent of iron 28, and one and a half of oxygen, 12 = 40 Atom. No. It is of a reddish brown color, task-less, insoluble, and is not attracted by the magnet. Affects. — This oxide produces the effects of iron on the Bystem, though in a less degree than the other preparations. It is therefore not used by itself. In the state of hydrate, the sesquioxide has recently become very celebrated as an antidote to arsenic. This may be pre- pared by adding ammonia or potash or their carbonates to a solution either of pernitrate or persulphate of iron. The precipitate is to be washed with water and swallowed undried. (Pereira, vol. i. p. 396.) To be efficacious it must be taken in as large doses as the patient can swallow or the stomach retain. Black Oxide. — Oxidum Nigrum. — This is not a definite compound of iron and oxygen. It is a mixture of protoxide and sesquioxide. It occurs native in the form of the magnetic iron ore. It is prepared artificially by taking the scales detached by hammering red hot iron (which become oxydized during the process), purifying by passing the magnet over them, then pulverizing. The powder is of a dark grey color, without smell or taste. Effects. — This is one of the best preparations of iron and dissolves very readily in the stomach (much more so than the sesquioxide), and produces the ordinary effects of this metal. Dose. — From 5 to 20 grs. two or three times a day. [As the strength of this preparation is very apt to vary with the vary- ing proportions of protoxide and sesquioxide, the Edinburgh College has ordered a preparation in which the two oxides are united (for this is a true chemical union and not a mere mechanical mixture) in equal proportions. This is equal in its powers and not liable to alter by exposure to air. (Vide Christison, p. 482.) — Ed.] 3. Carbonate of Iron. — There are two modes of preparing this salt. (a.) By exposing iron wire cut into small pieces to the action of air and water, until it is converted into rust. It is then to be reduced to powder in an iron mortar. In this process the iron is oxydized by the oxygen of the water, which is decomposed, while carbonic acid is attracted from the atmosphere. When prepared in this way, it is known by the name of the carbonas ferri preparatus or the rubigo ferri. (b.) Another mode is by the joint action upon each other of solu- tions of sulphate of iron and carbonate of soda. A double decompo- sition takes place. The sulphate of soda remains in solution, and the hydrated carbonate of iron, being insoluble, is precipitated. The super- natant liquid is then poured off and the precipitate dried on filtering paper with a moderate heat. When prepared in this way, it is called the carbonas ferri precipitatus. 478 MATERIA MEDIOA AND THERAPEUTICS. As found in the shops, this preparation of iron is of a chocolate brown color, without smell, taste slightly styptic. It is insoluble in water. Acids dissolve it and extricate the carbonic acid gas with effer- vescence. Although so called, this preparation is not a carbonate of iron. According to the analysis of Mr. Phillips, it is a compound consisting of variable proportions of the peroxide and the protocarbonate of iron. As commonly found in the shops, Mr. Phillips states the proportions to be about, Carbonate of iron, .... 4 Peroxide of iron, .... 96 100 and when prepared with the greatest care — Carbonate of iron, . . . . 40 Peroxide of iron, .... 60 100 The rationale of all this is the following : — When prepared by pre- cipitation, as already stated, a hydrated protocarbonate of iron is thrown down of a green color. During the process of drying, this precipitate 4 is changed in its character. From the great affinity of iron for oxygen, the protoxide is rapidly converted into the peroxide, in which latter state it is no longer capable of holding the carbonic acid in combination. A large portion is thus converted into the peroxide. A portion, how- ever, remains undecomposed, and this varies according as the drying is slow or rapid. The activity and efficacy of this preparation depend upon the quan- tity of carbonic acid held in combination. Effects. — Although not a pure carbonate, this is a valuable prepara- tion of iron. It is mild yet efficacious, and it may be given in large quantities without any unpleasant consequences. The ordinary dose is from ten to thirty grains three times a day. To obtain the full effect of it, however, it is necessary frequently to give it in doses of one, two, and three drachms. From the great propensity which the carbonate in its solid state has to become changed in its character, it is necessary, if you wish to give it in its pure state, to administer it in one of the following forms : (a). Mistura Ferri Composita. — This is prepared by rubbing up myrrh, carbonate of potassa, sulphate of iron, rose water, spirit of laven- der, and sugar. The mixture is to be poured immediately into a glass bottle and well stopped. This is an imitation of Dr. Griffith's myrrh mixture. In this preparation the sulphate of iron is decomposed, and a sulphate of potassa and a protocarbonate of iron formed. The mix- TONICS. 479 ture at first is of a greenish color; if exposed to the ftir it loses this, in consequence of the protoxide being converted into the peroxide, in which case the protocarbonate is decomposed. To preserve it, there- fore, the bottle should be well stopped, or what is better, it should only be prepared when required for use. Dose, one to two fluid ounces two or three times a day — a valuable preparation. (b.) Pill. Ferri Composite. — These are made by rubbing up myrrh, sulphate of iron, carbonate of soda, and syrup, and made into pills. Here the same changes take place. The sulphate of soda and the proto-carbonate of iron are formed. They should only be made when required for use. Dose, from ten to twenty grains. (c.) Saccharine Carbonate of Iron. — Recently it has been ascertained that if the proto-carbonate, when first precipitated, and before drying, be mixed with syrup or sugar, it will be retained in its original state without undergoing any change. This is an exceedingly valuable discovery, and gives us a most excel- lent and reliable chalybeate. [It is introduced into the U. S. Pharma- copoeia, under the name of PiL Ferri Carbonatis.] 4. Proto- Sulphas Ferri. — This is known by the name of Vitriol of Mars, green vitriol, copperas, and Sal Martis. It is prepared by the action of sulphuric acid upon iron. It is crystalline, with a disagreea- ble, styptic taste ; its color, when recently formed, is bluish green. It is soluble in about two parts of cold and in three fourths of its own weight of boiling water ; in alcohol it is insoluble. When exposed to the atmosphere it not merely effloresces, but undergoes other chemical changes — oxygen is absorbed from the atmosphere. Effects. — This is one of the most active of the preparations of iron, being powerfully tonic and astringent. If given in too large doses it acts as a local irritant to the stomach and bowels, causing nausea, grip- ing, vomiting, and purging. Although a valuable form of this metal, it cannot be given with the same freedom as some of the other prepara- tions ; nor is it so well suited to those cases where the long-continued use of ferruginous preparations is required. Mode of Administration. — The dose is from one to five grains, and the best form of giving it is that of pill made up with myrrh, ammoniac, or some of the bitter extracts. Solution is an objectionable form, unless the water be previously boiled to expel the atmospheric air from it. If this is not done oxygen is absorbed and the sulphate is decomposed. 5. Ferrocyanas Ferri, also called the Prussias ferri, or prussiate of iron. This is the principal ingredient in the common pigment called Prussian blue ; and it is in this latter form that it is used in medicine. Prussian blue as found in the shops is in cakes of a deep blue color, without taste or smell. It is insoluble both in alcohol and in water. 480 MATERIA MEDICA AND THERAPEUTICS. i It is a compound of the ferrocyanate of the peroxide of iron and of alumina. Effects on the System, — Prussian blue is a mild, though efficacious preparation of iron. It sits well on the stomach, seldom producing any nausea or local irritation. In its general operation as a tonic it appears to act with more promptness than the other preparations of iron. Mode of Administration. — A good way of giving it is in powder, in a cup of milk, in doses of from three to six grains, repeated about three times a day. 6. Proto-Phosphas Ferri. — This is prepared by the joint action of solutions of sulphate of iron and phosphate of soda — a double decompo- sition takes place, the phosphate of iron being precipitated, while the sulphate of soda is held in solution. It is a powder of a pale blue color, and without taste or smell. Effects on the System. — It is a mild preparation, but is little ..ysed. Mode of Administration. — It is given in doses of from eight to ten grains, three times a day. Q^t* 7. Tartras Ferri et Potassje.— Also called Ferrum Tartarizalum, or Tartarized Iron. This salt is prepared by the joint action of iron and supertartrate of potassa with water. Here the iron is first oxydized by the oxygen of the water and the atmosphere, and afterwards dissolved by the excess of acid of the supertartrate of potassa. A double salt is thus formed, consisting of the tartrate of iron and potassa. As found in the shops, this preparation of iron is a powder of a green- ish brown color, without smell, and has very little of the disagreeable taste of iron. It is readily soluble in water \ on exposure to the atmo- sphere it becomes moist. Hence, it is necessary to keep it in closely stopped bottles. Effects on the System. — As a ferruginous preparation this has many advantages. From its want of taste and its easy solubility, it is one of the best forms for giving this metal to children. It is less constipating and less exciting, too, than some of the other forms of this metal. [This is the Chalybeate most used by Ricord in sloughing chancres, intractable sores in broken constitutions, * >-*-«L— 482 MATERIA MEDICA AND THERAPEUTICS. This salt is uncrystallizable, strongly reddens litmus paper, and has an acid but not unpleasant taste. It is very slowly soluble in cold "water. In boiling water it is readily soluble. Its pleasant taste has commended it to the use of some practitioners, but it is not much used. Dose. — 5 to 10 grs. three times a day. Ammoniated Citrate of Iron. — This is prepared by adding to the acid citrate of iron in solution (as above described) ammonia, so as to neutralize the acid. A double salt is thus obtained of a neutral cha- racter, and which dissolves much more readily in cold water than the citrate. This is an excellent chalybeate. It has no disagreeable taste, is entirely devoid of irritating power, is readily soluble in water, and forms a rather agreeable draught. That it may be given with alkaline car- bonates is also a great advantage. It is the preparation of iron best adapted to the strumous affections of children and invalids of delicate stomachs. It is highly commended by Dr. Golding Bi-rd in lithuria. Ferro-Tartrate of Ammonia. — May be prepared by adding caustic ammonia to a solution of tartrate of iron. The green solution thus ob- tained is to be evaporated to dryness. In the form of shining brittle fragments of a deep red color, very soluble in water, and strongly saccharine in its taste. Acts like other ferruginous preparations. Its advantages are, great solubility, being palatable, and not readily decomposed. Dose. — For an adult 5 toJLgrSjjn^ powder, pill, or solution ; may be taken in porter without being detected. s. -, ^^^ ^-r ARGENTUM. Silver is found either pure, in combination with other metals, such as gold, mercury, arsenic, and antimony, or in the state of sulphuret, either pure or mixed with the sulphurets of copper, lead, and antimony. The principal mines from which it is obtained are those of Mexico and Peru, and in Europe those of Hungary and Transylvania. Properties. — Silver is of a pure white color, and susceptible of receiv- ing a lustre surpassed only by polished steel ; without smell or taste. In malleability and ductility it is inferior only to gold ; when pure it is so soft as to be cut with a knife; at a red heat it fuses. Its specific gravity is 10.5. The only pure acids that act upon silver are the sul- phuric and nitric. The sulphuric, however, only acts upon it with the aid of heat. The silver of the shops generally contains traces of gold and copper. TONICS. 483 Preparations of Silver. — In its metallic state silver is not supposed to exert any agency upon the human system. The preparation of it which has heen most generally used is the nitrate. Very recently the oxide has also be^n introduced into practice. Nitrate of Silver. — Lapis Infernalis, Lunar Caustic. — This ifi pre- pared by taking an ounce and a half of silver and dissolving it in a mix- ture of one ounce of nitric acid and two ounces of distilled water. This forms a solution which by evaporation yields crystals. By subjecting these crystals to a suitable heat, they become fused, and in this state arc cast into small sticks in circular moulds prepared for that purpose. During this process a portion of the nitric acid is decomposed into nitric oxide gas and oxygen. The nitric oxide escapes, and by union with the oxygen of the atmosphere forms red nitrous acid vapors, while the oxygen unites with the silver to form oxide of silver. With this the remaining undecomposcd nitric acid unites and forms the nitrate of silver. When pure the crystals of nitrate of silver are transparent and color- less. In the form of stick, the pure nitrate is of a white color, with a taste metallic and bitter; breaks with crystalline fracture. On expo- sure to the atmosphere, it does not deliquesce. When subjected to the action of heat, it fuses ; if the heat be increased it is decomposed, nitric acid and oxygen are evolved, and metallic silver left. When exposed to a strong light, it becomes blackish, especially if in contact with any carbonaceous matter. This is owing to the reduction of a part of the silver to a metallic state. (Phillips.) It is soluble in alcohol and in water. Purity. — To be perfectly good it should possess the following pro- perties : ■ 1. The stick should be of a white color ; when colored it shows some impurity ; when the color is blackish it has been contaminated with, organic substances, or formed by moulding in iron vessels ; when the color is very pale it may be owing to the presence of reduced silver, or a small quantity of copper. 2. The fracture should be crystalline and radiated ; when the frac- ture is conchoidal it is impure. 3. It should be completely soluble in distilled water ; any deposit shows an impurity. 4. The solution, when tested with ammonia, should throw down an abundant precipitate (the oxide of silver), which should be entirely redissolved on adding an excess of ammonia. The solution should then remain colorless — the least tinge of blue indicates the presence of copper. The substances which may be deposited by impure lunar caustic dur- 484 MATERIA MEDICA AND THERAPEUTICS. ing its solution, are oxide of copper, reduced silver, and chloride of silver. On separating these deposits from the solution, their character may be ascertained in the following way : 1. If the " deposit" dissolves easily in nitric acid without producing red fumes, and gives a solution which becomes blue when tested with ammonia, it is oxide of copper. 2. If it dissolves slowly in nitric acid under the production of red fumes, and forms a solution which does not become blue with ammonia, it contains reduced silver. In this case the sticks of lunar caustic pos- sess a corroded appearance, and seem to contain air bubbles. 3. If it is insoluble in nitric acid, but easily soluble in ammonia, or if it readily becomes black in the light, it is chloride of silver. The foregoing are impurities arising during the manufacture of the article, owing to impurities in the silver, and in the nitric acid. Sometimes, however, it is fraudulently adulterated, and chiefly with nitre and nitrate of lead. Tests. — 1. If on adding ammonia to a solution of it only a slight pre- cipitate take place, the adulteration may be suspected. 2. To a solution add hydrochloric acid, until no more of the precipi- tate take place. This throws down all the silver in the form of chloride of silver. Then separate the solution from the precipitate by filtration ; evaporate it to dryness. If a residue remain, throw it on burning coals, and if it deflagrates it proves the presence of nitre. ■ Effects on the System. — The most interesting and important of these are the effects which it produces when used as a local application. Of these we shall speak under another head. When taken internally its primary local effect varies with the dose ; if given in considerable quantities it acts as a local irritant, producing heat about the fauces, nausea, and griping, succeeded by actual vomiting and purging; if this quantity, however, be small, no sensible effect of this kind is produced, and the impression which it makes on the nerves of the stomach is soothing and tonic. This is particularly illustrated in irritable states of the organ. Besides the local effect thus produced, an analogous one is extended to the brain and whole nervous system. What the precise nature of this impression is [we know not]. It has been found to cure epilepsy, but its modus operandi is quite unknown. A very curious occasional result of the use of this remedy is the dis- coloration of the skin. The color is bluish, slate color, or bronze, it is usually permanent, but in some cases has faded away. The corion is the essential seat of this discoloration, which is usually referred to a deposit of chloride of silver in the skin, blackened by exposure to air. It is generally incurable, but has been -diminished, in one instance at least, by weak nitric acid washes [Pereira, sub voce). In one instance the mucous membrane of the stomach and intestines was similarly tonics. 485 tinted, and in another all the internal viscera wen: more or li blue. The diseases in which niirutc of silver has been most given are epi- lepsy, chorea, and some forms of dyspepsia. It appears to produce the best effects in those cases of dyspepsia where there is evidence of mor- bid sensibility of the gastric nerves. / y Oxide of Silver. — This is obtained by adding lime water or pure baryta to a solution of nitrate of silver, then washing and drying the precipitate. Here the nitric acid unites with the lime or baryta, while the oxide of silver is precipitated. In the state of hydrate, it is of a black color ; when anhydrous, it is of an olive color, tasteless, and inso- luble in water. Effects. — Oxide of silver is a much less active agent than nitrate. It has little of its caustic or irritating power, and, perhaps, because it less readily forms soluble compounds in the stomach, is less apt to produce irritation there. It is not so prone to discolor the skin, probably being less active both for good and evil. It is used in the same cases as the nitrate. It has been found useful in uterine diseases, especially in uterine neuralgia (irritable uterus), and in some of the forms of leucorrhoea andTlysmenorrhoea. [Very little used and might be less.] Dose. — One or two grains, three times a day in a pill or powder. ARSENIC. In the form of some of its combinations, this metal was known to the ancients. By Dioscorides the sulphuret of arsenic is noticed. The peculiar nature of the metal was first shown, however, by Brandt in 1733. It is an exceedingly brittle metal of a steel grey color, and when re- cently broken has a strong metallic lustre. Its texture is crystalline, destitute of taste — at 356 c F. it volatilizes without being fused, and gives out a garlic odor. By exposure to the air it is speedily tarnished and converted into a black powder, which is called fly powder. This is a mixture of the metal and the oxide. — Sp. gr. 7.5. In its metallic state arsenic is sometimes found native — most com- monly, however, it is found in combination with other metals, such as cobalt and iron. It is not used in medicine. With oxygen it forms two compounds, arsenious acid and arsenic acid. The first is the only one used in medicine. Arsenious Acid. — Commonly called the oxide of arsenic. This sub 486 MATERIA MEDICA AND THERAPEUTICS. stance when first prepared is in large masses, having a vitreous fracture and perfectly transparent. After a while it becomes white and opaque, this change taking place gradually from the surface to the centre. Its specific gravity is 3.7. It has no smell, not even in a state of vapor, as the garlic odor belongs only to metallic arsenic ; it has little or no taste ; it is very sparingly soluble in cold water, more so in hot. In alcohol and oils it is soluble — at 380° it volatilizes, and the vapors condense unchanged on cold surfaces in the form of crystals. Purity. — As commonly found in the shops it is in powder. In this state it is apt to be mixed with flour, powdered chalk, or sulphate of lime. This may be detected by putting some of it on the point of a knife and subjecting it to heat. The arsenious acid will be dissipated, while the impurities will remain behind. Physiological Effects. — When given in small and repeated doses arsenic acts on the system without producing any visible effect, except in the alleviation of the disease for which it may be administered. Even in such doses, gastric irritation marked by heat of the throat, oesophagus, and stomach, sometimes nausea, and, though rarely, gastro- dynia often appear. Febrile movement with dryness of the skin, languor, lassitude, and want of sleep, irritation of the bowels with griping, redness of the eyes, with a degree of conjunctivitis, and dropsical swelling of the face, are frequently noticed {oedema arsenicalis). When any of these symptoms show themselves, the use of the article should be immediately stopped; if this is not done, symptoms of the slow poisoning by arsenic appear. Sometimes the digestive apparatus, at others the nervous system first feels its influence. Hahnemann, quoted by Dr. Christison, says there is a gradual sinking of the powers of life, without any violent symptom,, a nameless feeling of illness, failure of strength, aversion to food and drink, disrelish for all the enjoyments of life, sometimes redness of the conjunctiva, followed by a cutaneous eruption, at others irritation of the stomach, and even in some cases ptyalism. The symptoms produced by large poisonous doses of arsenious acid put on two very different forms. In the one they indicate gastro-enteritis, while in the other there is little irritation of the digestive canal, the poison chiefly affecting the nervous system. In the first, nausea, vomiting, burning pain in the throat and stomach, with a sense of heat, dryness and constriction, incessant thirst, with a difficulty of swallowing, all point to irritation of the stomach ; diarrhoea, tenesmus with a hard and tense abdomen, and occasionally heat and excoriation, all show that the whole track of the alimentary canal is involved. The pulse is quick, small, and irregular, the breathing short and laborious, tongue dry and furred with cold clammy sweats. Tremblings, cramps with occasional delirium, prove that the nervous system has not escaped. TONICS. 487 In the second form of acute poisoning by arsenic, the symptoms oi gastric or intestinal irritation are either absent or very slight; in their stead we see faintness, convulsions, paralysis, delirium, sometimes insen- sibility. These symptoms ordinarily follow a very large dose. Uses. — Arsenic lias been chiefly used as an anti-periodic in miasmatic fevers, and in neuralgic and other affections, when they take the perio- dic form. For this purpose, 6, 10, or even 20 drops may be given three times a day. It should not be continued long at this rate. It is some- times combined with quinine, and succeeds where each separately has failed. Arsenic is of great value in most of the scaly diseases of the skin, as lepra, psoriasis, &c. Five drops, three times a day, is about the proper dose. Arsenic is occasionally employed as a caustic ; its use is always attended with danger. Modes of Administration, (a.) Substance. — It is sometimes used in this form made into pills in doses of from T \ to T \ of a grain. The pills should be prepared with great care. For this purpose the arsenic should be intimately rubbed up with white sugar, and then made up with crumbs of bread. (b.) Solution. — The common form in which it is used in solution is the liquor arscnicalis, or the liquor potassce arsenitis, commonly called Fowler's solution. This is prepared by taking of arsenious acid, finely pulverized, sixty- four grains, and boiling it in a solution of sixty-four grains of carbonate of potassa in a pint of distilled water, until the arsenic is completely dis- solved. To the solution, when cold, add four fluid drachms of compound spirit of lavender, and then as much' distilled water as will make the whole solution up to a pint. In this preparation the arsenious acid combines with the potassa, while the carbonic acid escapes. It is, therefore, a solution of the arsenite of potassa colored by the spirit of lavender. It is a transparent fluid, having the taste, smell, and odor of lavender. Each fluid drachm of this solution contains half a grain of the arsenious acid. The average dose is ten drops two or three times a day for an adult. Dr. Fountain objects to this mode of giving Fowler's solution. He says that given in this way it has to be continued for some time, and it then is apt to accumulate in the system, and produce unpleasant effects. He gives it in doses of ten drops every two hours (in intermittent fever), so as to give 60 or 100 drops during a single intermission, and then stops with it altogether. In this way he has used it, he says, in a great number of cases, and never witnessed any bad effects from it. (c.) Arsenite of Soda. — This is given in solution : 3- Arsenitis sodae grs. iv. Aquae distillat. § iv. M. This is a preparation used by Biett in the Hospital of St. Louis, at 488 MATERIA MEDICA AND THERAPEUTICS. Paris, as a substitute for Fowler's solution. Eacli drachm of this con- tains one eighth of a grain of the salt. From twenty to thirty drops is a dose. » (d.) Arsenite of Ammonia. — This is also used in solution : R,. Arsenitis ammonias grs. iv. Aq. dist. . 3 iv. M. This is also used by Biett in the same way as the preceding. Liquor Arsenici et Hydrargyri Iodidi. — Solution of the Iodide of Arsenic and Mercury. — Donovan's solution. Take of iodide of arsenic and red iodide of mercury thirty-five grains each, distilled water half a pint. Rub the iodides in half an ounce of water, and when dissolved, add the remainder of the water, heat to the boiling point, and filter. This preparation has been found very useful in the treatment of diseases of the skin, and will, perhaps, cure a larger proportion of chronic cases than any other one remedy. Dose from five to ten drops. ZINCDM. 1. Oxide of Zinc. — This is commonly known by the name of the floivers of zinc. There are two ways in which this may be prepared : (a.) By the combustion of metallic zinc in a crucible. During this pro- cess it unites with the oxygen of the atmosphere and is sublimed. (6.) By adding water of ammonia to a solution of sulphate of zinc, a precipitate is thrown down, which is to be separated and dried. Here the sulphuric acid unites with the ammonia, and is held in solution, while the oxide of zinc is precipitated. This substance is a white powder, without taste or smell. It is inso- luble both in water and in alcohol. Effects. — The oxide of zinc possesses tonic properties, but its powers in this way are comparatively feeble. As a remedy in epilepsy and other spasmodic diseases, it was first introduced into practice by the celebrated Gaubias, and from the high authority from which it ema- nated, gained considerable celebrity, which, however, it has not since maintained. Mode of Administration. — The best form of giving it is that of pill made up with confection of red roses, in doses of one or two grains, and gradually increased. Copper. — There are only two preparations of this metal used in medicine. 1. Sulphate of Copper. — This salt has already been described under the head of emetics. When given in small doses, it acts without pro- ducing any sensible local effect, as a general tonic, This is proved by the tonics. 489 fact that it is capable of arresting the paroxysms of intermittent fever. By Dr. Donald Monro it was prescribe] in 1785, in sum'- ca es of this disease with success, after tbe Peruvian bark and other medicines bad been administered, without any benefit. Mode of Administration. — It may be given in 'loses of from one fourth of a grain to one or two grains made into pill with extra'), of cinchona, to be repeated three or four times a day. 2. Cuprum Ammoniatum. — This salt is prepared by rubbing up Bttl- phate of copper with carbonate of ammonia, until the effervescence ceases. It is then to be wrapped in bibulous paper and dried with a gentle heat. A double decomposition here takes place. Part of the sulphuric acid goes to the ammonia, forming a sulphate of ammonia, while the carbonic acid escapes with effervescence, and the copper re- mains in a state of sulphate. The compound therefore appears to be a mixture of subsulphate of copper and sulphate of ammonia. As found in the shops this substance is a violet-colored mass, with an ammoniacal smell and a styptic and metallic taste. On exposure to the atmosphere, its color changes to green, owing to the escape of ammonia. It is soluble in water. Effects. — As a tonic this substance operates in a manner similar to the sulphate of copper. It is milder, however, and therefore may be given in considerably larger doses. Its use originated with Dr. Cullen. Mode of Administration. — The best form is that of pill made up with bread, in doses of half a grain gradually increased to five grains, two or three times a day. Nitric Acid. — This acid is obtained by decomposing nitrate of potassa by means of sulphuric acid. It is a colorless or pale yellow fluid, emit- ting, when exposed to the air, white suffocating vapors and possessing strong acid properties. It is highly corrosive and tinges the skin yellow, the tint remaining till the epidermis is separated. "When exposed to the air it attracts moisture and becomes weaker. It unites with water in every proportion, and while mixing, heat is evolved. In its pure state, it is seldom employed except for pharmaceutical purposes. The diluted acid is made by the addition of six fluid ounces of water to one of acid. In its effects upon the system nitric acid acts as a general and efficient tonic. It is particularly valuable when the constitution has been broken down during a long protracted course of mercurial remedies. In these cases it not merely promotes the general health, but it also lessens the mercurial action upon the mouth and fauces. In chronic hepatitis and dropsy, consequent upon a shattered constitution, it has been found emi- nently serviceable. Besides its effects as a general tonic, the nitric acid produces a pecu- liar taste in the mouth, and when carried to a certain extent some- 490 MATERIA MEDICA AND THERAPEUTICS. * times brings on salivation, and at the same time acts moderately on the bowels. Its dose is from 20 to 30 drops, given in § iij or § iv of water three or four times a day. Besides being given internally, it has been much used in India in the form of a bath in combination with muriatic acid. This is made by taking two parts of muriatic and one of nitric acid, and adding water until the whole is about as sour as vinegar. When the feet are put in this bath it is remarkable that it produces the same effects that it does when taken internally, and in addition to this causes a peculiar excite- ment and irritation of the skin. The nitro-muriatic acid bath is used chiefly in syphilitic cutaneous diseases and in hepatic affections. It was formerly very popular, but hardly retains its reputation. Cotyledon Umbilicus. [A perennial herbaceous plant, about six inches high, flowering in June and July, a native of England, found in dry stony places. It seems to be a gentle tonic to the nervous system, and has been chiefly used in epilepsy. It is highly recommended by Graves of Dublin, and others, but the trials of it in this country have not been very encouraging. A fluid and a dry extract are used. Dose of the former a fluid drachm, of the latter five grains, to be increased if necessary.] ASTRINGENTS. The term astringent is applied to a class of agents which possess the power of corrugating the animal fibre. They have been defined to be those substances which, " when applied to the human body, produce contraction and condensation in the soft solids, and therefore increase their density and force of cohesion." This definition is imperfect only so far as it does not include in it any recognition of the general tonic influence which most of these agents exert over the system. The local effects of astringents are obvious. Wben applied exter- nally to bleeding vessels, they contract the vessels and arrest the bleed- ing ; hence called styptics ; when taken into the mouth they have a peculiar and rough taste, and produce a sense of constriction in the parts with which they come in contact. As a consequence of this con- striction the small vessels circulate less blood, the secretions of the mouth and fauces are lessened, and the general sensibility of these parts to other impressions temporarily is impaired. When swallowed we infer that analogous effects are produced upon the mucous membrane of the oesophagus, stomach, and intestines with which they come in contact. At the same time that they act upon these parts by constring- ing them and lessening expectoration and secretion, they also affect their vital properties, by imparting tone to them. This at least is the case with a great proportion of them. Accordingly, if given in mode- rate doses like tonics, they promote the appetite and assist digestion. If, on the other hand, they be given in very large doses, they disorder the functions of digestion, cause pain, and not unfrequently produce nausea and vomiting. The remote effects of astringents are similar in character, although less in degree than the local effects. Various portions of the mucous tissue, though not locally acted on, nevertheless participate in the effects of these agents. This is particularly the case with the mucous mem- brane lining the pulmonary and urinary organs, and under the continued use of astringents, exhalation and secretion are diminished from these parts. The skin is strikingly affected in a similar way. In the ordinary condition of the system it becomes, under the use of astringents, dry 32 492 MATERIA MEDICA AND THERAPEUTICS. and contracted ; and if excessive evacuations take place they are re- strained. On the muscular system the effect of astringents is analogous to that of the pure tonics. From the direct impressions made hy them upon the mucous membrane of the stomach and bowels, the muscular tissue of these, organs is most particularly acted on. The effect, however, does not stop here. The muscular fibre of the heart and arteries, and indeed of every other part of the system, participates more or less in the same impression. On the vascular system the effects of astringents are striking and important. In consequence of the contraction which they produce in the small vessels of the part to which they are applied, together with the impaired secretion which they occasion, the blood is accumulated in the larger trunks. If this be continued for any length of time, the heart and bloodvessels become crowded, reaction now takes place, the pulse is full and hard, general plethora ensues, and as remote conse- quences, local congestions and hemorrhages may occur. On the brain and nervous system astringents produce no direct effect, except from the properties which they possess in common with tonics. In this way they increase the energy of the nervous system. Indirectly, however, as pure astringents they may exert a powerful agency on this part of the system. By checking the secretions they produce general plethora and local determination to the brain, which not unfrequently is followed by cerebral congestion and paralysis. With regard to the manner in which the remote effects of astringents are brought about, whether by the actual introduction of these agents into the circulation, or by the mere transmission of the local impres- sions, it is impossible to say. In some cases, doubtless, it may be in the first of these modes ; in the majority, it is probably in the latter. Be this as it may, that various parts of the animal economy are thus more or less influenced is certain. From the preceding analysis of the effects of astringents, it is very evident that they cannot be used with safety or advantage in every state of the system ; they ought not to be used where a general plethora exists. In such a state, if by the use of astringents the ordinary secre- tions be checked, the general fulness of the bloodvessels must be in- creased, and apoplexy or some analogous effect may be produced. So, also, when a discharge is taking place from the system in a full habit, such as diarrhoea or hemorrhoids, or the like ; if this be arrested by the use of astringents, the consequence must be injurious, and sometimes fatal. In these cases nature is endeavoring to relieve herself from over- fulness by a critical evacuation, and any interference with this may be hazardous. They ought not to be prescribed where febrile or inflammatory ANTRINl.KMS. 493 excitement is present, Tn fevers and inflammations one of the great objects is to relax the whole system of capillary vessels, or in other words, to promote till the secretions, and generally just in proportion as this object is accomplished will the excitement be lessened. On the contrary, astringents checking the secretions necessarily increase the existing excitement, and frequently cause local obstructions. They ought not to be prescribed where excessive secretion depends upon, or is associated with, active irritation either local or general. To this rule exceptions, however, exist, which will be mentioned hereafter. They ought not, as a general rule, to be prescribed where there is much disorder of the digestive organs, as indicated by furred tongue, defective secretion of bile, costive bowels, THERAPEUTICS. Galls have no smell, but a bitter, astringent taste. Best galls are from Aleppo. Composition. — Tannic acid, gallic acid, a peculiar volatile oil, and a peculiar acid discovered by Braconnet, and called by him Ellagic acid. The proportion of tannin in galls is greater than in any other known substance.- As analysed by Sir Humphrey Davy, 100 parts contained 37 parts soluble in water and 63 parts insoluble (lignin). Of the solu- ble parts 26 were tannic acid ; 6.2 gallic acid ; with a little extractive ; 2.4 mucilage, and 2.4 saline or earthy matters. Galls give up their active principle to water, alcohol, and alkalies. Incompatibles. — Metallic salts which throw down tanno-gallates. Isin- glass throws down tannate of gelatine. Infusion of cinchona, tannutes of cinckonine and quinine. Infusion of opium, tannates of morphine and codeia. Effects. — One of the most powerful astringents we possess. From its bitterness not much used internally. Forms. — Powder. — Dose. — 10 to 20 grs. Infusion. — § ss to § j. Tincture. — 3 ss "to 3 j ; used principally diluted with water as an astrin- gent wash or gargle. Ointment. — 3 j to 3 vij of lard. Ung. Gallce Compositum. — Galls finely powdered, 3 ij ; opium pow- dered, 3 ss ; lard 3 ij, M., an excellent application to piles when not very much inflamed. Besides being used as a simple astringent, galls in the form of infusion are used as an antidote in cases of poisoning by the organic alkalies and those vegetables which contain them, such as mix vomica, hellebore, opium, &c. They form in these cases a tannate with the alkali, which has less activity than the alkali, because probably less soluble. Also in cases of poisoning by tartar emetic. — Pereira. CATECHU. This substance is obtained from the Acacia catechu T a tree twelve or fourteen feet high, growing abundantly in the mountains of Hindostan. It is an extract obtained from the wood. The exterior white part of the wood is first cut off, and then the interior, which is reddish brown, cut into small chips, is boiled in water until all the soluble matter is dis- solved. The decoction is then poured off and evaporated, until it becomes of a certain consistence, when it is spread upon cloth, cut into small pieces, and suffered to dry. This is the catechu of medicine. It cbmes in masses of different shapes and sizes, sometimes in square cakes, at others in roundish or irregular masses. The color varies from a red- AKTIHNOICNTS. 497 dish brown to a deep chocolate or liver color, lis texture is brittle; fracture sometimes rough, at others resinous ; no smell ; taste bitter and astringent, leaving behind a sensation of sweetness. There are a great many varieties of this article; they arc all, however, the same substance, differing only in the mode of preparation. Catechu is almost entirely dissolved by water and by alcohol. Composition. — Tannic acid, a peculiar extractive mucilage. In 1833 a peculiar substance was discovered in it, which was called catechine (catechinic acid). According to the analysis of Sir II. Davy the proportions of ingredi- ents were the following : Bombay Catechu. Bengal Catechu. Tannin, . . . 54.5 . . 48.5 Peculiar extract, . . 34.0 . . 3G.5 Mucilage, ... 6.5 . . 8.0 Insoluble impurities ) _ ~ * A (lime and sand), j 100.0 100.0 All the varieties of catechu are adulterated with sand, starch, and other impurities. Effects. — One of the best and most powerful astringents, and slightly tonic. Forms of Administration. — The solid lump is allowed to dissolve in the mouth. This is better than the catechu lozenges. Powder. — Dose grs. x to xx. Infusion. — Catechu 3 vj, cinnamon 3 i, water a pint. Dose |j to | ij. Tincture. — Dose 3i — a very pleasant addition to chalk mixtures. The inspissated juice of the Pterocarpus marsupium, and other plants. IT. S. The best kind is the East Indian, from the P. mar- supium, a lofty tree growing in the mountains of Hindostan. It comes to us in small angular shining fragments of a deep brown or reddish color ; opaque, hard, and brittle. In the mouth it softens, sticks to the teeth, and colors the saliva red ; has no smell ; an astringent, followed by a sweetish taste — easily pulverized. Its best menstruum is diluted alcohol. Composition. — Tannic acid and peculiar extractive 75, red gum 24-, insoluble matter 1. Recently catechine has been discovered in it. Incompatible s. — The same as galls. Efects. — Astringent, without any tonic power — inferior to catechu. Forms. — Powder, x to xxx_grs. Infusion, 3 i to 5 ij. Tincture, 3 i 498 MATERIA MEDICA AND THERAPEUTICS. to 3 ij- Locally, in powder, to flabby ulcers, and as a gargle, injection, and wash. OAK BARK. The species of oak from which this is obtained in Europe is the Quercus pedunculata, or the Quercus robur, growing in England and all over tbe continent. In this country it is obtained from the Quercus alba, a species of oak very analogous to the English oak. It grows in every part of the Union, but abounds most in the middle states — so called from the white color of the bark. Oak bark, deprived of its epidermis, is of a light brown color; coarse fibrous texture, and not readily pulverized ; has a feeble odor, and a rough, astringent, bitterish taste. Water and alcohol both extract its virtues. Composition. — Tannic acid, gallic acid, tannates of lime, magnesia, and potash, uncrystallizable sugar, pectin, and lignin. — Pereira. The proportion of tannic acid in the bark varies with the size and age of the tree, and the season of the year when gathered. The young bark contains the most ; and according to Sir H. Davy, the bark collected in the spring contain four times the quantity of that gathered in the winter. The inner part of the bark contains the greatest proportion of tannin, the circular or middle portion less, while the epidermis contains none at all. Effects. — Astringent and somewhat tonic. Administration. — Powder, 3 ss to 3 i. Decoction, § i to 3 ij. Principally used as a local application — gargle — injection. [I have cured chronic eczema with it.] Statice Caroliniana [Marsh Rosemary). — A small maritime plant indigenous in this country, from six to twelve or more inches in height ; grows in the salt marshes along the sea coast from Maine to Florida. The part used is the root: this is large, spindle-shaped, fleshy, rough, and of a purplish brown color. No smell ; taste bitter and astringent. Water extracts its virtues. Composition. — Tannic acid, gallic acid, extractive matter, and some common salt. Effects. — Powerfully astringent. Forms. — Decoction. — Boiling 3 ij in 3 xii of water ; usedj internally and externally. The decoction of marsh rosemary is much used as a gargle in the different varieties of sore mouth, venereal sore throat, cynanche ma- ligna, &c. In the second stage of diarrhoea it has great reputation in some parts of the country. ASTRINGENTS. 10'J geranium maculatum [Spotted geranium, Croups foot, Crane's bill). A perennial plant from one to two or three feet high, growing in every part of the United States in low grounds and damp woods. The part used is the rhizom e, which is taken up in the autumn and dried; comes in pieces two or three inches long, and one-third to half-an-inch thick; externally, rough and dark brown ; internally, pale flesh color; has no smell; taste astringent, hut not hitter or unpleasant; if properly dried brittle and easily reduced to powder. Its virtues extracted both by water and alcohol. Composition. — Gallic acid in large quantity, tannic acid, small quan- tity of mucilage, starch, red coloring matter, resin, a small quantity, and a crystallizable vegetable substance. Effects, — An excellent astringent of considerable power; has the advantage over many other articles in this pleasant taste. Hence a good article for children and delicate stomachs. Administration. — Powder. — Dose twenty to thirty grains. Decoction. — 3 i of bruised root boiled a few minutes in a pint of water or milk. Dose § i to 3 ij. [An excellent article for children.] Tincture. — Dose 3 i to 3 ij. ACETAS PLUMBI. This salt is known by the common name of the Sugar of Lead, and is generally prepared by the manufacturer on a large scale. Physical Properties. — Sugar of lead is a white crystalline salt with- out smell ; its taste is sweetish and astringent. When exposed to the atmosphere it slightly effloresces ; soluble both in -water and alcohol ; water at 60° dissolving four times its weight. Chemical Composition. — One eq. of acetic acid, 51 ; one of prot. of lead, 112; and three of water, 27 = 190. Test of its Purity. — Dissolved in distilled water free from carbonic acid, if pure, it makes a perfect solution. To ascertain this, sulphuric acid, or sulphuretted hydrogen in excess, being added to the solution to throw down the lead, the supernatant liquid should be completely vola- tilized by heat; any fixed residue is impurity. (Pereira, vol. i. p. 516.) Incompatibles. — " All those acids and their compounds which form with oxide of lead salts nearly insoluble in water, as the sulphuric, muriatic, carbonic, citric, and tartaric. It is decomposed by lime water, by the alkalies, ammonia, potash, and soda ; the two latter, if added in excess, redissolve the precipitate at first formed. Hard water usually contains three ingredients which decompose it, viz. carbonate of lime, 500 MATERIA MEDIC A AND THERAPEUTICS. sulphate of lime, and muriate of soda; and hence, when dissolved in such water, the solution is always turbid. It is decomposed by solution of sulphuretted hydrogen, which gives a black sulphuret; liquor ammo- nite acetatis also decomposes it, on account of the carbonic acid diffused through it." (Phillips, p. 127.) Effects. — Sugar of lead acts as an astringent to the part with which it comes in contact, whether taken internally or applied externally, by coagulating the albumen of the tissues and forming an insoluble com- pound. Taken internally in moderate doses, its immediate effect is to constringe the vessels of the mucous membrane of the alimentary canal, and so lessen secretion from them. Hence costiveness is one of its immediate effects. If its use be continued, the same astringent effect is extended to other parts of the system. This is especially manifested in the mucous membrane, the skin, and the urinary organs, in all of which the secretions are lessened. In addition to this the temperature of the body is diminished, and the pulse is lessened in force and frequency. In its general operation, therefore, it acts as an astringent and a sedative. If the use of it be persisted in too long, it produces, in common with the other preparations of lead, certain striking effects on the nervous and muscular systems; one of these is a form of colic, called the paint- er's colic ; the other is a peculiar kind of paralysi s. If a large dose of the sugar of lead be taken at once, it acts as an irritant poison. Mode of Administration. — The ordinary mode of giving sugar of lead is in pill, in doses of one or two grains, repeated every two, three, or four hours, according to circumstances. Most generally it is given in combination with opium. Solution. — 3 ij to a pint of water. Diseases in which used. — Haemorrhages, excessive secretion from the mucous membranes, cholera, diarrhoea, chronic dysentery, night sweats. Goulard's Extract. — This is the liquor plumbi subacetatis, or the solution of the subacetate of lead. It is called Goulard's Extract, from M. Goulard, a surgeon of Montpelier, by whom it was more especially introduced into notice. According to the United States Pharmacopoeia, this is prepared by taking of the acetate of lead and of the semi-vitrified oxide of lead (litharge) each eight ounces, mixed in a glass vessel, and boiling for twenty minutes in two pints of distilled water, then filtering through paper. During this process the protoxide is dissolved and a subacetate is formed, which is held in solution. Properties. — Goulard's Extract is either transparent or colorless, or it has a slight greenish yellow tint, arising from impurities in the distilled vinegar : its taste is sweetish and astringent. It is readily decomposed. ASTRINGENTS. 501 Common s^rjnjrj^ter throws down tin; oxide of lead in large quan- titi<;s. Car bonic acid tb'rowe drown the carbonate of lead. Tliis bap- pens iV< lere exposure to the atmosphere. Even distilled water, if exposed to the atmosphere, produces the same effect, by the carbonic acid which it contains. From the effect of carbonic acid on it, it should always be kept in tight bottles. Effects and Uses. — This is only used externally as a local application, and its effect is analogous to that of the solution of sugar of lead. It acts as a local astringent and sedative in cases of local inflammation. When used it requires to be diluted; about four drachms require a pint of water to be added. It is an excellent application to piles where there is little inflammation. This is a triple salt consisting of alumina, potash, and sulphuric acid. In some places it is found native, effloresced on the soil in volcanic regions. This is the case near Naples. The alum "is collected and lixiviated, and the solution made to crystallize by slow evaporation in leaden vessels sunk in the ground." — TJ. S. Disp. Most commonly, however, it is obtained from' the alum ores. It is also manufactured by a direct combination of its constituents. This is the mode in this country, where all the alum for domestic purposes is now prepared. Properties. — Alum is a white crystalline salt, with a sweetish, acidu- lous, astringent taste, without smell. On exposure to the atmosphere it slightly effloresces, its solution reddens litmus paper, "but changes the blue tinctures from the petals of plants green. It cannot, therefore, be properly said to contain an excess of acid." — (TJ. S. Disp.) Alum is soluble in 15 times its weight of cold water, and three fourths of its weight of boiling water. Alum contains a large proportion of water of crystallization, amounting to nearly 50 parts in 100. By exposure to beat it undergoes watery fusion. By increasing the heat the alum swells, the water is driven off, and it becomes a white, friable, spongy mass. This is called Alumen exsiccatum, dried alum, or Alumen ustum, burnt alum. Effects. — Alum is one of the most powerful astringents that we possess. When first taken internally, if the stomach be at all delicate or irritable, it is apt to cause gastric uneasiness, nausea, and sometimes vomiting. To a certain extent this may be obviated by combining it with some aromatic. The best plan is to begin with small doses, and to increase gradually as the stomach is found to bear it. On the bowels 502 MATERIA MEDICA AND THERAPEUTICS. the general effect is to produce constipation. In large doses, however, it, on the contrary, causes irritation, griping, and purging. In its general operation on the system alum proves stimulant. Its use, therefore, should be limited to those cases in which a stimulant astringent is required. Burnt alum differs from common alum only in not having any water of crystallization. It is more astringent. Forms of Administration. — Substance. — It may be taken in powder or pills made up with some tonic or aromatic, in doses of from five to ten grains. Alum Whey. — This is made by boiling 3 ij of alum with a pint of milk, and then straining. Of this a wineglassful at a time may be taken. This is a very pleasant and good way of administering alum. As a Local Application. Powder. — The burnt alum is applied to indolent ulcers to destroy spongy granulations. Solution. — As a gargle, collyrium, and injection. Plug. — A solid stick of alum cut round, introduced into the vagina in cases of haemorrhage from uterus. [ Vaginal Injection. — A very weak solution of alum will suit a larger number of cases of vaginal relaxation and free secretion than any other astringent I know of. It should be very weak — my rule is to make it just strong enough to taste of alum. — Ed.] SULPHURIC ACID. In its pure state, sulphuric acid is not used in medicine. In a state of dilution there are two preparations which are officinal : 1. The Acidum Sulphuricum Dilutum. — This is prepared by adding gradually, and then mixing, one fluid ounce of sulphuric acid with thirteen fluid ounces of water. 2. Acidum Sulphuricum Aromaticum. — This is known by the com- mon name of the Elixir of Vitriol. It is prepared by digesting for three days in a close vessel three ounces and a half of sulphuric acid with two pints of alcohol, then adding bruised ginger one ounce, and cinnamon bruised one ounce and a half, and letting the whole macerate for a week, and then filtering. This forms a dark brown liquid, having an acid taste and peculiar aromatic odor. Both these preparations of sulphuric acid are taken in the same doses and in the same way. From ten to thirty drops, in a cup of cold water, may be repeated three or four times a day. Effects. — In the two preceding forms, sulphuric acid is astringent, refrigerant, and tonic. It gives tone to the digestive organs, improves the appetite, and checks excessive secretion. Over the skin it exerts a ASTEINGEimS- 503 peculiar agency, checking profuse sweatin g more, effectually, perhaps, than any other astringent. On the urinary organe its effeel is to increase the secretion of the urine, ami to render it, acid. Cinder its use the milk frequently acquires a griping quality. If the use of this acid be continued too long, it produces a slow irri- tation of all the digestive organs, heat and pain in the stomach, griping, purging, and general constitutional irritation. In its pure state it acts as an irritant poison. ACKTIC ACID. It is only in its impure state, or that of vinegar, that this acid is used internally. Effects. — Vinegar is astringent, refrigerant, and tonic. Taken in mo- derate quantities it gives tone to the digestive organs, and increases the appetite. In its general action, it lessens the heat of the system, checks secretion, and gives tone. If taken in too large quantities it irritates the digestive organs, causing pain and griping, and if persisted in, pro- duces general emaciation. On this account it is frequently given to correct too great obesity. Mode of Administration. — One or two ounces may be added to a quart of water and drunk freely. Matico. — This remedy was brought to the notice of the profession in the United States by Dr. Kuschenberger, IT. S. N., who obtained a knowledge of it in South America. It consists of the leaves and unripe fruit of a species of pepper, probably the Piper angustifolium. It has a pleasant aromatic odor, and a slight taste. It is very strongly recom- mended as an astringent to check haemorrhages from leech bites, etc., where it can be directly applied. It is also used internally in epistaxis, haemorrhage from the bowels, uterus, etc., and cases have multiplied in which most wonderful effects are said to have been realized from it. Whether subsequent experience will confirm the hopes excited by these reports, is of course uncertain. Mode of Administration. — Inftisio7i.-*-( 3 i to Oj water.) Dose 3 j. REVULSIVES. Bv Revulsives are meant those agents which excite an action in one part of the system, and in consequence overcome a morbid action exist- ing in some other part They are also called Derivatives and Counter- irritants. Usually these terms are limited to those agents which are applied to the external surface of the body. They might, however, be applied with equal propriety to agents taken internally. It is only with those acting on the surface that we have now to do. Before giving an account of individual revulsives, I will make a remark or two upon the principle upon which they are supposed to act. In observing the operations of the animal economy, in various states of derangement from perfect health, it is remarked that morbid actions or irritations are frequently transferred from one part to another, and that in this case the primary one not uncommonly yields altogether to the secondary. This has been observed so repeatedly as to justify us in considering it as a kind of general law. It was in accordance with this that John Hunter laid down the too sweeping generalization that two diseases could not exist at the same time. Why it is, or how it is, that one irritation thus yields to another, it is impossible to say, and I shall therefore not spend any time in useless speculation in relation to it. Now it is upon this simple law or fact that the use of all external revulsive agents is founded, experience having shown that actions or irritations excited by artificial means are capable of producing effects precisely analogous to the spontaneous irritations set up by nature. Re- vulsive medication, then, is nothing more than an imitation of the method of cure frequently instituted by nature herself. This is the principle upon which the use of revulsive agents is founded. They may be divided into several classes according to the degree of effect which they produce. 1. Those which simply promote the flow of blood to the part. 2. Those which produce moderate irritation. 3. Those which blister. 4. Those which produce eruptions of various kinds. 5. Those which destroy the texture of the part — caustics, issues. REVULSIVES. 505 1. Those which Promote the Flow ov Blood to the Part. — To this class belong friction, warmth applied in various ways, such as bottles of hot water, bags of hot salt, etc., warm bathing, local and g< neral. These, though simply are important and valuable revulsive agents. Under continued friction the sensibility 7 and beat of the part are aug- mented, while at the same time an increased flow of blood takes place* The warm bath is still more effective, especially if impregnated with .-alt. By these agents the most striking and beneficial results are frequently produced in the way of revulsion. 2. Those which produce Moderate Local Irritation. — They are commonly called rubefacients. By this is meant those substances that simply produce redness, and a certain degree of irritation of the pari to which they are applied, without causing any discharge. They arc used with great advantage in many cases where the operation of blisters would be unnecessarily severe. Among the best of this class are the following : Aqila Ammonia. — This may be used either pure or in combination with sweet oil, and in either way makes an excellent rubefacient applica- ton. A piece of flannel soaked in aqua ammonias and laid on the skin will, in a very short time, excite considerable pain, redness, and inflam- mation. If the strong aqua ammonias is used, it will blister very speed- ily. The more common form of using it is in combination with sweet oil, and then it forms what is known as the volatile liniment. In this preparation a chemical union takes place between the oil and the ammonia, and a white soap is formed, which is kept fluid by the water of the ammonia. The proportion of oil and ammonia must vary with the strength required. In some cases equal parts are necessary, while iD others a third or a fourth of ammonia will answer. For children the proportion of ammonia, of course, must be less than for adults. Sinapis. — This is perhaps the best of all the rubefacient articles and from it is derived the term sinapism. If it be desired to have its full strength, it is prepared by mixing the pounded mustard with water into a thick paste or poultice. The common practice is to mix it with vinegar; this, however, rather impairs the strength of the mustard. Applied to the skin in this state in a very few minutes it causes a sense of warmth in the part, and in the course of half an hour severe pain. When taken off the skin is red and burning. If it be left on too Jong, actual vesication takes place, and in some cases troublesome ulceration follows. This, therefore, should be avoided. The best plan is to remove it as soon as severe pain is felt, and be careful in leaving it too long on parts possessed of little vitality. By adding flour, its strength may be regulated. In applying it to children, this should be specially attended to. Although an exceedingly efficient and useful rubefacient, this article, therefore, requires to be managed with caution. 506 MATERIA MEDICA AST) THERAPEUTICS. Capsicum. — This is an excellent rubefacient, and used in various forms. It may be made into cataplasm, or the saturated tincture may be rnb- bed on the surface. As a liniment it may be prepared by mixing it with hog's lard. Another simple and good form of using it, where counter-irritation is to be made to the feet, is to dust the insides of the stockings with the dry powder. This keeps up a moderate degree of heat and irritation in the feet, and is exceedingly useful where there is a tendency to coldness of the extremities, accompanied with head-ache. Oil of Turpentine. — This is also a good rubefacient. If applied undiluted it causes considerable smarting and irritation, and is sometimes followed by a vesicular eruption. In this state it may be used in the way of friction, by means of a piece of flannel soaked in the turpentine. The more common way in which it is used is that of a liniment, in combination with other rubefacient articles. Tincture of Cantharides. — This is sometimes used as a rubefacient ; and the experiments of Dr. Alexander prove, that when made by putting 3 i of cantharides into 3 iv. alcohol, it is just strong enough to cause irri- tation of the skin, and not vesicate. This is exactly the strength ordered in the U. S. Pharmacopoeia. An ordinary blister, if taken off early enouo-h, may be made to produce a rubefacient effect only. Camphor dissolved in alcohol is a common and useful rubefacient. It is one of the ingredients in the common opodeldoc, which consists of soap § iii, alcohol Oj, camphor, oil of rosemary, oil of origanum, each 3 ss. Pix Burgundica. — This is the resin obtained from the Pinus abias, or fir tree. The ordinary inode of using it is in the form of plaster. Applied in this way it excites in the course of a day or two consider- able irritation of the part, which is followed by a slight effusion of serous fluid. From the mildness and slowness of its action, it is not adapted to cases where a prompt revulsion is called for. For the pur- pose of rendering it more active and irritating, a small portion of blis- tering ointment may be added to the pitch, while cooling, just before the plaster is spread. Allium sativum. — Garlic has long been known and used as a local irritant. It sometimes, though not often, causes vesication. It is used very much in the same way and in the same cases as mustard. As an application to the feet of children after soaking them it is excellent. Oleum Monardaz Punctata. — The Monarda punctata, or horse mint, is a native plant of this country, and yields an oil which possesses admir- able rubefacient properties. If rubbed on the skin- it speedily causes redness and irritation, and sometimes vesication if its application be too long continued. It was first noticed by Dr. Atlee, of Philadelphia, who recommends it in the form of a liniment with camphor and opium. Properly diluted it may be used in all cases where an ordinary rubefa- cient is required. REVULSIVES. 507 3. Those which blister. — These are called epispastics or vi icants. The term is applied to those agents which possess the power of irritat- ing and inflaming the skin in such a way as to he followed by the for- mation of vesicles. The effects of these agents are obvious. The part to which they are applied undergoes all the changes of ordinary inflammation, [ncreased sensation is first experienced, then comes on heat, redness, swelling, and pain. To these succeeds an effusion of serous fluid from the excited ex- halants, and a consequent separation of the cuticle, forming a vesicle or blister. On removing the epispastic and discharging the serum, the part, unless again irritated, gradually heals, new cuticle forms, and in a few days the whole is restored to its natural state. With these local effects the constitution is more or less sympatheti- cally affected. Like all local inflammations, the effect of blisters is to increase the action of the heart and arteries. The vascular excitement thus produced, however, is rarely excessive, and speedily subsides with the removal of the cause producing it. The nervous system, too, is ex- cited by the action of blisters. In certain conditions of that system, the stimulus of these agents increases the tone and energy of the brain. This is so marked that some persons have resorted to the application of them previously to great mental efforts. The celebrated English barris- ter, Dunning, is reported to have been in this habit. Dr. Thompson states, that the late Sir James Mackintosh tried the effect of it in one of his efforts before the House of Commons, and with great success. — Vol. ii. p. 535. Blisters, then, act both as local and general stimulants. This double operation it is important to bear in mind in the application of these agents in different stages of disease. The effects of blisters are modi- fied by — (a.) Age. — From the peculiar delicacy of the skin in young subjects blisters produce their effects much more speedily than in adults, at the same time that the constitutional irritation which they occasion is much greater. In some cases, especially if left ou too long, the inflammation runs rapidly into gangrene, and proves fatal. In young subjects, there- fore, the greatest caution should be exercised in watching the effects of blisters. [I think that blisters should be banished from the therapeutics of children.] In old persons, too, from the torpid condition of the capil- laries, the inflammation of a blister may readily assume an unhealthy character. (b) Sex. — From the greater delicacy of the female system, blisters as a general rule are apt to produce more irritation thau in males. In the use of them this fact ought always to be borne in mind. During the state of pregnancy their effect is modified. The system then is in a state of increased excitability, and in consequence of this the local 33 508 MATERIA MEDICA AND THERAPEUTICS. as well as general irritation which they produce is apt to be much greater. According to Dr. Dewees they are more apt during pregnancy to produce strangury. In some cases, too, premature labor has been produced by them. Dewees records two instances of this sort.* The peculiar Character of the Skin. — It is well known that in this respect there is every variety. In some persons the skin is naturally thin, delicate, and irritable. In these the slightest causes frequently ex- cite an unnatural degree of inflammation,, followed by proportional con- stitutional disturbance. In others, again, the skin is thick, tough, and torpid ; in these, of course, local irritations are more tardily pro- duced, and affect the system less. Now, in these different states of the skin it is evident that the effects of blisters must differ considerably. (d.) Temperament or general habit of Body. — This also greatly mo- difies the effects of blisters. In irritable habits they frequently cause a great degree of nervous and vascular excitement. I have met with cases of this kind in which a state little short of phrensy has been induced. In habits of an opposite character they produce little or no constitu- tional irritation. In persons much reduced and broken down by debili- tating causes, troublesome ulceration and gangrene not unfrequently follow their application. (e.) The part to which the Blister is applied modifies its effect. A blis- ter applied to the scalp takes twice the time to produce its effect that t does on other parts. If a blister be applied to the scalp immediately after the hair is shaved off, strangury is almost always produced, an effect which does not follow if the application be delayed for twenty- four hours.f (/.) The length of time the Blister is kept applied modifies greatly its effects. In the case of the ordinary blister, if the application ,be conti- nued beyond a certain time, strangury is apt to be induced. (g.) The actual condition of the patient as to disease. — No circum- stance modifies in so important a manner the effects of blisters as this. If applied in the early stages of high inflammatory or febrile excitement, they act as general irritants, increasing heat and quickening the pulse ; while in the more advanced periods they produce a salutary revulsion without any of these effects. In certain conditions of the brain and nervous system, the skin loses its sensibility, and blisters do not produce any effect. From what has already been advanced, it must be evident that there are certain conditions of the system in which blisters are contra-indi- cated. As a general rule they ought never to be used where there is present a high degree of general febrile or inflammatory excitement. The reason of this must be obvious, if we reflect for a moment upon the * Treatise on Females, p. 128-9. f Percival's works, v. i. p. 129. REVULSIVES. 509 effects of a blister. These are local irritation and general excitement. Now in all cases where ;i local inflammation exists, the difficulty of resolving it by any means will always In; pro| .<>rt i< .ii<;f! to the degree of general excitement accompanying it. If a blister be applied when the general excitement is already very great, one of tin: effects will Ik: to aggravate this, and thus to counteract tlic beneficial agency of the blister as a revulsive. Under these circumstances tin: primary inflammation, instead of being relieved, must !»■ aggravated by the increase of the general excitement. Hence it lias been generally observed thai if blis- ters bo applied in cases where great general excitement is present, ante- cedently to suitable evacuations, they do more harm than good. They merely add fuel to the fire. Another condition of the system in which they are contra-indicated is thai in which great constitutional exhaustion is present. From the impaired state of the vital powers, gangrene and death may ensw<-. The condition of the system most favorable to their use is that in which the general excitement is rather below than above the natural standard. In this state of things irritations are most readily transferred from one part to another. Modus in which Blisters prove Curative. — There are three : 1. .By exciting a new action in the part to which they are directly applied. In this way they sometimes arrest the progress of erysipelas. 2. By their stimulating effect on the general system. In this way they sometimes prove beneficial in low fevers, in paralysis, &c. 3. As derivatives they relieve inflamed and congested parts by direct- ing the flux of blood to the surface and from the diseased part or organ.. INDIVIDUAL EPISPASTICS. CANTHARIDES. The iusect used for ordinary blistering is the Meloe vesicatorius, or more properly the Cantharis vesicatoria. It is found adhering to the leaves of a number of plants, such as the ash, elder, lilac, white poplar, &c, in Spain, France, and Italy. From its having been made an article of commerce more particularly in Spain, it has received the name of the Spanish fly. The mode of collecting them is by simply shaking them from the branches of the trees early in the morning, while they are yet in a torpid state from the cold of the previous night. This is done by persons covered with masks and gloves, who receive them on cloths spread under the tree. After this they are instantly put into a sieve 510 MATERIA MEDICA AND THERAPEUTICS. and exposed to the fumes of boiling vinegar. This kills them, and after this they are dried either by the sun or in a stove. The cantharides belong to the beetle tribe of insects. They are from six to ten lines in length, and two or three in breadth, of a golden greenish color, and when alive have a foetid, penetrating odor, by which swarms of them may be detected at a distance. At Dijon, in France, it is stated that the public walks were at one time deserted in con- sequence of the disagreeable odor occasioned by these animals. — Diet. Mat. Med., vol. iv. p. 300. When dried they retain a good deal of this offensive odor; their taste is acrid. The powder which they yield is of a greyish brown, mixed with shining particles. To have them good they should be kept perfectly dry; when suf- fered to become moist they lose their vesicating property. They should, therefore, be occasionally spread out and exposed to the air. If kept in bottles tightly closed, they retain their virtues for a great length of time. Adulterations. — In the state of powder cantharides may very easily be adulterated by the admixture of various articles. The only way to obviate this is to buy in the insect state. In this state, however, they are frequently mixed with another insect, the Jfelolontka vitis. This is distinguished by its square form and black feet ; as this insect does not possess any vesicating power, it should be carefully separated. Chemical '■Composition, &c. — By the researches of modern chemistry the vesicating property of the cantharides has been found to reside in a peculiar principle which is called Cantharidin. This was discovered by Robiquet in 1810. It is obtained in small crystalline micaceous plates, insoluble in water and cold alcohol, but soluble in boiling alcohol, ether, and oil. Effects. — The effects of cantharides applied as a blister are those already described under the head of epispastics generally. In addition to these, however, they produce under certain circumstances strangury, a peculiar irritation of the urinary organs, accompanied by a spasmodic constriction of the sphincter of the bladder. There are great pain and difficulty in voiding urine, and the quantity which is discharged is exceedingly small. The circumstances under which this effect is most likely to occur, are those in which the protecting power of the cuticle is either impaired or entirely destroyed. Thus : .1. When the blister is kept on so long that the cuticle is entirely .removed, and the blister then comes in actual contact with the sub- jacent parts. 2. When the blister is applied to a part recently shaved, as a scalp. 3. When the blister is applied to parts where the cuticle is already REVULRIVKS. . r , 1 ) destroyed, either by previous blistering, wounds, ulcerated surface, or the like. Under ;il! these circumstances may this effeel be produced. Modes of Application . — The Ointment. — This is the ordinary and best mode of applying cantharides for the purpose of vesication. This ointment is made of resin, wax, and oil, or lard. In preparing it, great care should be taken not to add the flies to the other ingredients while they are hot, as heat impairs the vesicating power. This is the reason why in the pharmacopoeia it is directed that the flies are to be added just as the other ingredients are cooling and becoming solid, for the same reason, in spreading a blister, care should be taken not to soften the ointment by means of heat. In preparing and applying a blistering plaster, there are several things important to be observed : 1. The plaster should be spread thick. If this is properly done, the vesication is not only more certain, but is produced in a shorter time. On the other hand, if the plaster be spread thin, the vesication is apt to be imperfect and in patches, and requires a longer time. Linen is better than leather. 2. The practice so very common of sprinkling the plaster over with dry fly powder cannot be too severely reprobated. Although intended to make the blister more potent, it always has a contrary effect. The blister never draws so well, probably in consequence of its not adhering so closely to the skin. Besides strangury is much more apt to follow from the particles of the powder adhering after the blister has been removed. 3. Let the surface to which the blister is applied be properly cleansed, and if it be cold and torpid, or if you wish the blister to act very promptly, stimulate the skin by some rubefacient, as turpentine, mus- tard, or the like. 4. It is important that every portion of the* blister plaster should be kept in actual contact with the skin, otherwise the vesication will be in patches. To prevent this, put a bandage over the blister, or fasten its edges down with adhesive straps. 5. The usual period for leaving on a blister in an adult is twelve hours, but there is every variety, as before noted, in the sensibility of the skin ; the best plan is to raise a corner of the plaster after eight hours, and if small vesicles are formed, the work is done, the plaster may be removed, and simple cerate substituted. 6. Where blisters are used to subdue internal inflammation, they should be large ; the same amount of irritation follows a small as a large blister, and the amount of proper and useful counter-irritation is null. 7. Remember that in internal inflammations, the great principle on which blisters prove curative is that they excite an irritation more powerful than the inflammations. Of course, when the inflammation 512 MATERIA MEDIC A AND THERAPEUTICS. runs high, this is impossible ; always under such circumstances reduce the inflammation to the blistering point by venesection, evacuants, &c. 4. Agents which produce Eruptions and Pustules. — These differ very materially in their effects from blisters. They are more permanent in their operation. The inflammation which they produce is of the phleo-monous character, while that excited by blisters is erythematic. (a.) Tartar Emetic. — Although the peculiar effects of this substance on the skin had been previously noticed, and some practical applica- tions had been made of it, yet it was not until the year 1821 that it was fully brought before the public as a revulsive agent. In an essay written expressly on this subject, Dr. Jenner gave, at that time, a full account of its successful application, and since then it has been in exten- sive use. There are two modes in which it may be applied — in the form of strong solution or of an ointment. Rubbed on the skin in either way, local irritation is first produced, which is succeeded by a crop of pustules, resembling in their appearance and progress those of small-pox. The first of these modes was originally suggested, in 1773, by Dr. Bradley, of London. The second is that recommended by Dr. Jenner, and is the one commonly used at present. The formula for the ointment, as proposed by Dr. Jenner, is the following : JJ Antimon. Tart, (subtil, pulv.) 3 ij. Ung. Cetacei . . 3 ix. Sacch. alb. . . . 3 i. Hyd. sulph. rub. . . gr. v. Mi The sugar is added merely to prevent the ointment from becoming rancid. Every purpose, however, may be answered by simply rubbing up a suitable proportion of tartar emetic with lard. The length of time which it takes to produce its effects, varies with the strength of the application and the susceptibility of the skin. When_it is desirable to brino- out the pustules as speedily as possible, the skin should be previ- ously prepared by friction, either dry or with strong vinegar. The oint- ment should then be rubbed on the part briskly for ten or fifteen minutes. In this way a crop of pustules will be brought out in a few hours. Where it is not required to produce the effect so rapidly, a portion of the ointment may be rubbed on the part for a few minutes twice a day ; and, generally, in the course of one, two, or three days, the effect will begin to show itself. "When the solution is used, after preparing the skin by friction, it should be applied as hot as it can be borne. Pustules are thus rapidly produced. " They are small and numerous, and speedily heal, leaving REVULSIVES. 518 no traces behind them." — Thompson, vol. ii. \>. r,r>r,. This is a mode well suited to females. When the eruptions come out large and full, they are sometirm ceedingly painful, and cause a good deal of irritation. The best dn - ing in this case is a bread and milk poultice or simple cerate. If it be desirable to keep out the eruption for some time, fresh appli- cations of the ointment may be made. From the effects of tartar emetic thus applied, it is evident that its action is entirely different from that of an ordinary blister. It not m< irritates the skin, but produces actual disease of that structure, and to this circumstance, no doubt, may its efficacy in many eases, as a revul- sive, be attributed. (l>.) CiiOTON Oil. — Rubbed on the skin, croton oil produces, after two or three days, a fine pustular eruption. It is usually combined with two or three parts of olive oil. As a revulsive it is less severe than tartar emetic, and more permanent in its operation than a blister. It some- times, but rarely, purges, which is an objection to its use. (c.) Nitro-Muriatic Liniment. — A liniment composed of nitro-muri- atic acid and spirits of turpentine, produces effects somewhat similar to those of croton oil. It is made by mixing two parts of acid with one of turpentine, and five of camphorated oil or simple lard. Rubbed with a sponge on the skin it will cause redness and heat in four or five min- utes. If continued, small vesicles make their appearance, and a further rubbing causes excoriation and a free exudation of serum. As a local irritant this has the advantage of producing immediate effect. The pain is said not to be very severe. This is said to be the liniment of the notorious London Quack, St. John Long. There remain only to be considered those revulsives which destroy the texture of the parts to which they are applied, or so affect it as to cause a permanent suppuration, or as the phrase goes, keep up a discharge from the part. These are issues, setons, and moxas. Issues. — These are artificial ulcers created in different parts, to pro- duce local irritation and a purulent discharge. They are made in different ways : 1. By making permanent blisters. This is done by dressing the blistered surface with some irritating salve, as savin or the like, so as to keep it open and promote suppuration. The best salve for this purpose is Ung. cantharidis one part, Ung. Sabinse seven parts. 2. By making an incision of suitable size, and putting one or more peas in it, securing them by a bandage or an adhesive strap. 514 MATERIA MEDICA AND THERAPEUTICS. 3. By applying pure nitric acid or caustic potassa to the part, and thus destroying the vitality of the skin. When this sloughs out, the sore may be kept open either by peas or by the occasional use of an irritating salve. 4. Issues may be made by the actual cautery. In using this, great care is required to have the iron at a white heat, and to apply it rapidly. This is much used in France, especially to the os uteri. Seton. — This is a cord of silk or thread inserted by means of a flat seton needle under a small portion of the skin and cellular tissue ; it soon excites a suppuration, which may be increased by drawing the thread backwards and forwards, and also by putting an irritating oint- ment on the thread and drawing it into the wound. Of these modes of getting a discharge from the skin the blister issue is the least severe, the seton the most so, and probably the most effectual. The nitric acid issue is preferred by most surgeons, I believe. Situations in which Issues or Setons may be made. — They should not be put over a bone or tendon when covered only by skin, nor in imme- diate proximity to a large nerve or blood-vessel, nor on the belly of a muscle. The best situations are: — -1st. The back of the neck. 2d. The middle of the humerus, near the insertion of the deltoid. 3d. In the hollow on the inside of each knee, above the flexor tendons. 4th, On each side of the spinous processes of the vertebrae. These are the best places, but issues may be put where there is beneath the skin enough cellular substance to protect the parts below. Effects as compared with Blisters. — Issues produce less local irritation and more discharge, and their operation is much slower. Moxa. — This remedy was introduced by Baron Larrey, who became acquainted with it during Napoleon's campaigns in Egypt. It is made by rolling carded cotton or some similar combustible into a cylinder about an inch long and half as thick. This is applied to the skin and kept in contact with it by means of a metallic ring and handle. The moxa is then set on fire, and the combustion hastened, if necessary, by a blow- pipe. The influence of the fire should be limited by covering the part with a bit of wet cloth, having a hole in its centre the size of the moxa ; when the combustion is completed the parts should be washed with strong aqua ammonise, which greatly relieves the pain. An eschar is thus formed, and when the slough separates it may be dressed with ointment, stimulating or not, as it is desired to heal or keep open the sore. The effect of the moxa differs from the actual cautery with the iron, in that the heat being more gradually applied penetrates deeper. The same rules and restrictions as to the parts on which they may or may not be placed, apply to moxas as to issues. Moxas are made of cotton, recommended by Larrey • this may be previously REVULSIVES. 515 soaked in a solution of nitre or chlorate of potash ; or of a coil of paper similarly soaked and dried; or the bulb of the sunflower. Their effecte do not vary, the degree of inflammation depending on the closeness with which the moxa is applied to the skin, its size, and the intensity of the combustion. PRACTICAL APPLICATION OF REVULSIVES. 1. Of those which simply promote the flow of blood to the surface. Wherever internal congestions exist, and the surface is consequently cold, torpid, and comparatively bloodless, revulsives of the first class are proper. Hence their use in the early stages of fevers, inflam- mations, and congestive diseases. Their range is from the slight ch ill- ness produced by transient exposure to cold, and cured by soaking the feet at bed-time, to the intense congestion of typhus, when the whole body may be enveloped in hot blankets, or the hot bath used. 2. The rubefacients act in the same way, and are appropriate in the same wide range of cases. 3. Of Blisters. — These, though acting on the same principle, are used in cases where the difficulty to be overcome is of a more serious and more permanent character. As blisters are extensively used, and as their use, unlike that of the two previous classes, is pretty sure to do harm when it does no good, let us refer iu detail to some of the diseases in which they are used. 1. Fevers. — Here everything will depend on the stage of the disease, and the state of the system. Blisters should never be used till the general excitement has given way to the use of evacuants ; then they aid in breaking up the remains of the disease, and preventing or removing local determinations. 2. Inflammations. — The use of. blisters in internal inflammations is very common and very beneficial. The same rules are to control the time of their application as have been so often repeated. The general excitement must be in some degree subdued, the vehemence of inflam- matory action checked, else will blisters add fuel to the flame, and increase the diseased action they were meant to control. The good they can do is limited to certain stages of the disease, and states of the system. To go a little into the consideration of particular inflammations : 1. Those of the Thoracic Cavities. — Here blisters show their best powers, and if only the disease has been checked by depletion, or if its original character was not too violent, they will produce great and good results. 2. In Inflammations of the Abdominal Viscera. — Here, too, blisters will sometimes produce the best curative effects. An objection to their 516 MATERIA MEDICA AND THERAPEUTICS. use is that they deprive us of the use of pressure as a test of the pro- gress of disease. This is an additional reason for not using them very early. 3. Inflammation of the Brain. — Here, too, blisters are, by universal consent, remedies of great value, but a question is raised as to where they should be applied. Some shave and then blister the scalp ; others apply the blister to the nape of the neck, or even to more distant parts. I believe the latter is the true practice ; from the peculiarities in the cerebral circulation, it is, I think, impossible, or nearly so, to cause determination to the scalp, without causing a like determination to the brain itself. Hence the advantage of putting the blister at a distance ; and this I believe common experience has sanctioned. The best places are over the stomach, on the back of the neck, along the spine, and upon the extremities. They create a revulsion from the brain, take off the current of blood from the organ, and often produce a most salutary influence on the disease, co-operating markedly with other remedies, as purgatives, &c, &c. 4. Inflammation of the Veins, or Absorbents in the Extremities. — In these inflammations the application of a blister along the whole track of the vessel will often produce the most admirable effects. 5. Inflammation of the Joints. — Whether the disease be acute or chronic, advantage can be derived from blisters. They are best used as successive blisters, allowing one to heal before the other is applied. This practice we owe, I believe, to Dr. Physic of Philadelphia. USE OF ISSUES AND SETONS IN DISEASE. From the nature and mode of their operation it is obvious that these revulsives act very little, if at all, as counter-irritants, and mainly as local depletants and derivatives. From the slowness of their action, too, they are unavailing where an immediate impression is required. All these facts look to their employment in chronic cases, and in such mainly are they used. When the habit is full, this fulness may en- danger particular organs, as the brain; the danger can often be warded off, and the current made to set in a different direction, by establishing an issue. Hence their use to prevent apoplexy. In chronic inflamma- tions they are used, I think, less than formerly, practitioners preferring repeated blisters to the action of an issue. Moxa. — Baron Larrey first used moxas in paralysis, and was very successful ; subsequently he and others have used them in various spasmodic affections, and in neuralgia, chronic affections of the abdomi- nal viscera, rachitis, morbus coxarius. By Wallace it was used, and highly recommended, in a very wide range of neuralgic, paralytic, and rheumatic affections, epilepsy, and other spasmodic diseases. It has rather lost than gained ground during the last ten years. ALTERATIVES In a certain sense all medicines arc alteratives, inasmuch as they pro duce more or less alteration in the existing state of the system. Com- mon usage has, however, restricted the term to a particular class of medicinal agents. In this restricted application, ft is used to designate those remedies which, without causing any very marked or sensible evacuations, act upon the system at large and produce a gradual change in its condition. Pliysiological Effects. — If given in a suitable way, these agents generally prove excitant to the digestive organs. The appetite is increased, perspiration promoted, the quantity of urine considerably augmented, and the health improved. If their use be continued beyond a certain period, however, other effects are produced. General excite- ment comes on, and the specific effects of the individual agents are developed. If their use be still further persisted in, they prove poisonous. In addition to these, the proper alteratives, there are certain other agents which I shall consider under this head, distinguishing them as local alteratives (those which change the vital action of the particular part to which they are applied) and chemical alteratives, or those which produce their curative effects by a chemical change in the various fluids of the body. Under the first of these sub-classes, I shall speak of those agents more commonly called caustics, and under the latter of antacids and antilithics. Peculiarities of this Class of Agents. — The particulars in which alteratives differ from other classes of medicinal agents are : — They require to be taken in minute doses and repeated at stated intervals, and continued for a certain length of time. Unless this is done, the effect is not obtained. The period required varies according to circumstances; but the average for a full course, perhaps, may be put at from two to four months. Mules to be Observed during their Use. — 1. During a course of alter- ative treatment, particular attention should be paid to the patient's 518 MATERIA. MEDICA AND THERAPEUTICS. general mode of living. As the course of medication through which he has to go is long and debilitating, it is improper to reduce his general powers by a too abstemious diet. On the other hand, care should be taken that all excitement should be avoided. The best general rule is to let him live according to his usual mode, reducing somewhat the quantity, of animal food and interdicting altogether the use of stimulants, whether in the shape of drinks or of higb-seasoned food. 2. The clothing of the patient should be particularly attended to — as one great object is to keep up an equable action on the skin, so as to secure the general operation of the remedies upon the whole system. Flannel should always be worn next the skin in the winter and spring, and cotton during the warm weather of summer. 3. Frequent recourse should be had during a course of alterative treatment, to the use of the tepid bath 92° to 94°. This co-operates very powerfully in determining to the surface, equalizing the circulation, and lessening general irritability. 4. The digestive organs should be especially attended to. In propor- tion as they are kept in due order will the specific operation of the alterative be obtained. 5. Above all things, in an alterative course (more especially of mer- cury), it is important to keep the nervous system as free from irritation as possible. For the kindly operation of this agent, the mind as well as the body should be kept tranquil. APPLICATION TO PARTICULAR DISEASES. The first which I shall notice is : 1. A Disordered Condition of the Digestive Organs. — This, though not known by any particular name in the books of Nosology, is one which you will very frequently meet with in practice, and a due understanding of its nature and its reciprocal relations with the state of the system at large, will enable you to treat successfully many diseases which otherwise might prove altogether unmanageable. The state of the digestive organs will vary of course in degree. Generally, however, it is characterized by the following symptoms : diminution of appetite and impaired digestion ; sometimes, however, the appetite will not be materially affected or it may be even excessive ; the excretions from the bowels are generally deficient in quantity, of an unnatural color and foetid. The tongue, particularly at the back part, is dry, whitish, or furred. This is most apparent in the morning. The fur extends from the root of the tongue along the middle to the tip, while the edges remain clean. If the disease progresses, a tenderness is now felt in the epigastric region on pressure, and the patient appears to AI/I'KKATIVKS. 519 breathe more by tlic ribs, and leas by the diaphragm, than in health. Along with these symptoms, the mine is frequently turbid. The mind is also frequently- irritable and desponding, " anxiety and languor are expressed in the countenance. The pulse is frequent or feeble; and slight exercise produces considerable perspiration and fatigue." At night there is restlessness, and if patients sleep they awake unrefreshed and in a state of great lassitude. Now this state of things shows not merely a deranged condition of the digestive organs, but also general weakness and irritability of the nervous and muscular systems. This condition of the system you find frequently in persons who are naturally of a nervous and irritable temperament. You see it also in cases of local irritation implicating the digestive organs, or of a general irritation of the nervous system, as in cases of secondary syphilis, j . ftj ioduretted ointment. Another mode of external application is by solutions of various strength. The following are recommended by Lugo! as injections. No. 1. Tji Iodine grs. ij Iodide of potass, grs. iv Dist. water g)j These are used in ozena, fistulous sinuses, &c. Caustic Iodine. — This Lugol prepares thus : ]J Iodine . 3 i. Iod. of potas. . 3 i. Dist. water . 3 ij M. This is used for repressing excessive granulations, &c. Baths. — This is one of the favorite forms of using this article by Lugol. The following is a tabular view of the mode in which the baths are pre- pared for children and adults : BATHS FOR CHILDREN. Age. Water. Iodine. Iodide of Potassium."^ 4 to 7 7 to 11 11 to 14 36 quarts. 75 " 125 " 30 to 36 grs. Troy. 48 to 60-72 " 72 to 96 60 to 72 grs. Troy. 96-120-144 " 144-192 " Age. Water. BATHS FOR ADULTS. Iodine. Iodide of Potassium. No. 1. " 2. " 3. 200 quarts. 240 " 300 " 2 to 2* drs. Troy. 2-24-3 3-H 4 to 5 drs. Troy. 4-5-6 " 6-7 These baths are generally ordered three times a week. Lugol, p. 180. 3. Iodides of Mercury. — Of these there are two, the Protiodide and the Biniodide. Protiodide of Mercury. — This is never found in 526 MATERIA MEDICA AND THERAPEUTICS. nature. It is a greenish yellow powder, without smell, and with a slight metallic taste. By exposure to light it is decomposed, and its color changed. It is insoluble in water and alcohol, but soluble in ether, and slightly so in an aqueous solution of the iodide of potassium. Preparation. — It is prepared by rubbing up mercury and iodine in equal proportions, with the addition of a little alcohol, until globules are no longer visible. The alcohol is added to aid the solution of the iodine. It consists of one equiv. of iodine and one of mercury.. Mode of Administration. — The dose of this is from one to two grains daily for adults. Pill. — This may be made by rubbing up of the protiodide gr. j., with extract of juniper grs. xii., and liquorice, q. s. ; divide into eight pills. Of these two may be taken, night and morning, gradually increasing the dose. Ether of the Protiodide. — Made by dissolving one part of protiodide in 48 parts of sulphuric ether. Of this from 5 to 20 drops may be taken in distilled water, gradually increasing. Ointment. — Protiodide 3_ss + with lard fj^ Biniodide of Mercury. — Like the protiodide this is not found in nature, but prepared artificially. It is a powder of a beautiful scarlet color. It is insoluble in water, but soluble in alcohol, ether, solutions of iodide of potassium, &c. " It combines with other alkaline iodides (as iodide of potassium) forming a class of double salts, called the Hydrar- gyro-iodidesP — Pereira. It is unaffected by the atmosphere, but decom- posed by light. Preparation. — It may be prepared by rubbing up with the addition of alcohol, two parts of iodine, and one of mercury, until globules are no longer visible. It consists of two eq. of iodine and one of mercury. Mode of Administration. — The dose is ^ to \ of a grain, night and morning. ■Pill. — Made the same as the preceding, or it may be given dissolved in alcohol or ether. Ointment. — 15 grs. to § i of lard. Effects of the Iodides of Mercury. — Both of the Iodides of mercury are powerfully irritant and caustic. The biniodide is nearly as caustic as corrosive sublimate. The protiodide is much milder. They should both, however, be used with caution. Like other mercurials, their con- tinued use causes salivation. Combining the properties of iodine and mercury, they have been used with advantage in cases of syphilis occurring in scrofulous constitutions. 4. Iodide of Starch. — This is prepared by rubbing up 24 grs. of iodine with a little water, and then adding gradually §j. of starch, the trituration to be continued until the compound assumes a uniform blue AI/I'KKATIVKS. Yll color. It is th on dried with a gentle beat, so ae not to drive off tbe iodine, and to be kept in well-stopped bottles. The comhination of stare!) renders the aetion of the iodine much milder. 3 ss of this may be taken three times a day, and increa ''I gradually. Dr. Buchanan has given as much as three ounces in a day. 5. Iodide of Iron, — This is an " opaque iron-grey crystalline ma with a faint metallic lustre," and an astringent taste. It is volatile, very deliquescent, and very soluble both in water and alcohol. By exposure to the air it attracts oxygen, and " forms sesquioxide of iron." Preparation, — Made by mixing certain proportions of iodine, water, and pure iron filings, and subjecting them to heat in a sand bath. When it has acquired a greenish color pour off the liquor, and wash the residue with boiling water. The liquors are then to be evaporated, and the salt dried. It contains one eq. of iodine, and one eq. of iron. This preparation combines the tonic effects of iron with the peculiar effects of the iodine, and is accordingly used in all cases where this kind of combination is required, as in chlorosis, asthenic dropsy, chronic vis- ceral engorgements, &c, &e. Fom its great solubility, it acts w r ith great power on the system. Dose. — Three to eight grains, two or three times a day, in pill or solution. 6. Iodide of Arsenicum. — This is a solid, of an orange red color, volatile and soluble in water. It is prepared by gently heating in a tubulated retort placed in a sand-bath, a mixture of one part of finely- pulverized arsenic with five parts -of iodine. The iodide is afterwards to be sublimed to separate the excess of arsenic. It consists of 1J eq. of iodine, and one eq. of arsenic. (Pereira). Mode of Administration. — Internally it has beeu used by Dr. Thom- son of London, with success in cases of lepra and impetico. He began with T l - of a gr., three times a day, increased to ^ of a gr. Beyond this, its use is dangerous. Ointment. — Iodide of arsenicum, grs. iij ; lard, 3 j. Used by Biett in phagedenic tubercular disease of the skin.] 7. Iodide of Lead. — This is a powder of a beautiful yellow eolor, partially soluble in acetic acid and in alcohol. In cold water it is inso- luble, but perfectly so in boiling water, from which it separates as the solution cools in fine brilliant scales. It consists of one eq. of iodine and one eq. of lead. It is prepared by the reciprocal actions of solu- tions of iodide of potassium and acetate of lead. Iodide of lead is pre- cipitated and acetate of potash in solution. The precipitate to be washed and dried. Perfect solubility in boiling water is the test of its purity. 528 MATERIA MEDICA AND THERAPEUTICS. Effects. — In its local action on the skin iodide of lead does not appear to be irritant; internally it is mild, though in some cases it has produced irritation of the stomach and constipation. Its general action is alterative, like iodine. It is used internally and externally in cases of glandular enlargement. Less active than iodine. Mode of Administration. — One-fourth to half a grain twice a day, gradually increased. Ten grains may be given without inconvenience. (O'Shaugnessy in Lugol.) Ointment. — 3 j to 3 j of lead. 8. Iodide of Sulphur. — This is a compound of a massy appearance 7 of a dark color, and a lamellated structure. It is prepared by heating gently four parts of sulphur with one of iodine. Part of the iodine volatilizes, while the remainder unites with the sulphur. (Pereira.) It has the peculiar smell of iodine, and stains the skin as it does. If it be boiled in water the iodine volatilizes with the steam, and the sul- phur is deposited nearly pure. It consists of one eq. of iodine, and one eq. of sulphur. Mode of Administration. — Not used internally, only as an external application in the proportion of about 3j to §"j of lard. 9. Iodide of Zinc. — This is a white crystalline salt in needles, very deliquescent, and very soluble in water. It has a disagreeable and styptic taste. It is prepared by the joint action of solutions of sulphate of zinc and iodide of baryta, filtering and evaporating to dryness, or by subjecting to heat and subliming twenty parts of zinc with 110 iodine. I am not aware that this has been used internally. It is recom- mended as an external application for discussing tumors by Dr. Ure, who proposes it as a substitute for the ointment of the iodide of potas- sium : Ointment lod. — 3 j to 3 j lard; a drachm of this to be rubbed on the tumor twice a day. 10. Iodide of Gold. — Of a greenish-yellow color, insoluble in cold, but slightly so in boiling water. Heated in a crucible, iodine vapors are given off, and metallic gold is left. It has been used internally in venereal affections in doses of from T L to -jL- of a grain. (Pereira.) Effects and Uses of Iodine. — When taken in small and repeated doses, iodine operates like the other agents belonging to this class of alteratives. It alleviates certain diseased conditions without producing any sensible effect on the system. In this way it may be taken for weeks and even months. During this time the functions of the diges- tive organs are generally improved, and the appetite is frequently ALTERATIVES. •'320 greatly increased. Lugo! states that ;it the Hospital of St. IVouis, where this "remedy was extensively used, this effeel was so decided thai the ordinary hospital allowance was not sufficient to satisfy the pa In many cases tin's is the only effect produced. In other cases, from its genera] operation on the secreting and absorbing system, itf effeel .-ire more visible. Sometimes it proves powerfully diuretic, while, in others this is not observed, and sometimes it acts as emmcriagogu , while at others, again, it produces no effect on the uterine organs. On the glandular system effects of a peculiar and striking character have occa- sionally been noticed. These are a diminution and wasting of the mammce in females, and of the testicle.? in males. Occasionally saliva- tion is produced by it. On the adipose tissue its effect varies; ome- times it occasions emaciation, while in others a co ntrary effect is pro- duced. According to Lugol it always increases the growth and size of the body. There can be no question that iodine acts on the whole system of capillary vessels, exciting under different conditions of the system sometimes one organ and sometimes another. If the use of iodine be persisted in too long, it affects the system like a poison. In some cases the stomach and bowels become disordered there is vomiting and purging accompanied with general excitement and disturbance of the system. In other cases the nervous system is assailed by tremors ; general prostration, loss of appetite, and emaciation are the prominent symptoms. DISEASES IN WHICH IODINE HAS BEEN USED. 1. Bronchocele. — This was the disease in which iodine was first used, and it is to Dr. Coindet, of Geneva, that we are indebted for its first introduction into practice. It was originally suggested to this phy- sician by his reflecting on the fact that iodine has been discovered in the sponge, an article which in the form of burnt sponge has long held a high reputation among the vulgar as well as among physicians, as a cure for bronchocele, and from this circumstance he was induced to sus- pect that the virtues of the sponge depended upon the presence of iodine.* Living in a district of country where this disease prevails ex- tensively, he had immediate opportunities of putting his suggestions to the test of actual experiment, and was speedily gratified by obtaining the most decisive proofs of its efficacy. Immediately on the annunciation of the beneficial effects of iodine in this disease, experiments were made with it by practitioners in various parts of Europe, all of whom concurred in celebrating its virtues. In this country it was tried, and * Memoire de M. Coindet in Bayle's His. vol. i. p. 6. 530 MATEEIA MEDICA AND THERAPEUTICS. with equal success. From the extensive experience which we have thus had of this remedy, we are now able to form an impartial opinion in relation to its real virtues. Although not a specific in this disease, as it was first supposed, yet it exercises a wonderful control over it, and such as no other medicine is capable of. Bayle has made a summary of the cases treated by a number of physicians, and as the result he states that of 354 — there were 264 cases of goitre cured.* 2. Scrofula. — This is another disease in which this remedy has been peculiarly successful, and it is to Dr. Coindet that we are also indebted for suggesting its use here.f It has been used by different physicians, but by none so extensively or successfully as Lugol of Paris. It appears that during seventeen months, 109 scrofulous patients were treated with iodine alone, at the Hospital St. Louis, of which 61 were males and 48 females. Of these, 39 (29 males, 10 females) were still under treatment at the time of the report; that 30 (17 males, 13 fe- males) had left the Hospital much improved ; that in four cases (2 males and 2 females) the treatment was ineffectual ; and that 36 (13 males and 23 females) were completely cured.J By Lugol the iodine is used both internally and externally, and, what is new in his practice, in the form of baths, to which he attaches the greatest efficacy. 3. Chronic Enlargements of the Viscera. — In the enlargements of the liver, spleen, mammae, testicles, and ovaria, iodine has been used with great advantage. 4. Dropsies. — In some cases of ascites, I have used iodine with the happiest effects. By Dr. Thomson three cases of ovarian dropsy are stated to have been cured by the internal and external use of this agent.§ 5. As an emmenagogue, iodine is particularly spoken of by Coindet and others. In several cases, I have witnessed its effects on the uterine organs. Magendie states that he gave it in a case represented to be one of suppressed menstruation, and in three weeks abortion was the result.|| 6. Nervous Diseases. — In eleven cases of chorea it was used by Dr. Munson with success. By the same physician it was also used with advantage in cases of paralysis, arising from tumors or fluids pressing on the brain or spinal marrow, or from morbid thickening of the invest- ing membrane of the cord itself. * Therapeutique, vol. i. p. 194. f Ibid., p. 25. X Lugol on Iodine. Translated by O'Shaugnessy, p. 8. § Mat. Med. vol. i., p. 346. | Bayle, pp. 10, 195. ALTERATIVES. 521 7. Diseases of the Skin. — Where, as is very common, diseases of the skin are connected with, if not dependent on, scrofula, iodine may be used with the greatest advantage. Chronic cases, of eczema in par- ticular, yield to it promptly. 8. Lastly. In syphilitic diseases it has recently been need, and with apparent advantage ; also to arrest salivation. Gold. — This metal is found in almost every part of the world, and only in the metallic state, either alone or alloyed with other metals. It is of an orange yellow color, and exceeds all other metals in malleability and ductility. Exposure to air and moisture for any length of time pro- duces no change in it. It is not oxydized or dissolved by any of the pure acids. Its only solvents are chlorine and nitro-muriatic acid. According to Sir II. Davy, the agent in both cases is the chlorine. Physiological Effects. — When taken in small and continued doses, this article operates like most of those belonging to this class. It gently stimulates the digestive organs and improves the appetite, at the same time that it moderately excites the pulse. The only, marked and sensi- ble effect, however, which is produced, is that of increasing perspiration and the flow of urine. The latter it does uniformly and to a very de- cided extent.* If it be given in larger quantities, it produces a general febrile excitement of the system, accompanied with a universal heat of the skin. The bowels are generally constipated. In some cases there is dryness of the mouth and throat. The gums become affected, and sali- vation ensues. According to M. Niel, the salivation produced by gold differs from that of mercury in many important respects. It is always mild — never producing the severe irritation and inflammation of the gums and mouth which so frequently accompany mercurial salivation. It is less protracted in its duration, and is unattended by the disgusting fcetor of mercurial salivation. PREPARATIONS OF GOLD. 1. In the state of Metal. — By Chrestien and others it has been used, and is said to produce the same effects as the salts of gold. This is supposed to be the mildest of the preparations of gold, but equally efficacious, though more slow in producing its effects. It is given in doses of from a quarter to one grain three or four times a day in pill or powder. 2. Chloride of Gold. — This is prepared by dissolving by the aid of * Niel, p. 59. Delafield Med. Rep. v. ix., p. 182. 632 MATERIA MEDICA AND THERAPEUTICS. lieat, one part of gold in three parts of nitro-hydrochloric acid.* The solution is to be evaporated until vapors of chlorine begin to be per- ceived, and then suffered to crystallize. This salt is in small crystalline needles, of an orange red color, with- out smell, and of a strong, styptic, acid taste. It is readily soluble in Water, alcohol, and ether. It consists of 1 eq. of gold and 3 eq. of chlo- rine. It is, therefore, a terchloride of gold. Effects. — This is a very active preparation, resembling somewhat cor- rosive sublimate. It requires, therefore, to be given in small quantities and with caution. Dose. — One twentieth to one eighth of a grain once or twice a day, made up into pills with starch, or in solution with distilled water. 3. Chloride of Gold and Sodium. — This is prepared by dissolving eighty-five parts of chloride of gold to sixteen of chloride of sodium in distilled water. The solution is to be evaporated by a gentle heat until a pellicle forms, and then set by to crystallize. — (Pereira.) It consists of large quadrangular prisms, of a beautiful yellow color. They are soluble in water, and consist of 1 eq. of chloride of gold, and 1 of chloride of sodium, and 4 of water. This is a milder preparation of gold than the preceding. It is, also, less expensive, and is, therefore, the most used of any of the preparations of this metal. It is given in the same doses as the chloride. 4. Oxidb of Gold. — " This is prepared by boiling four parts of calcin- ed magnesia with one part of chloride of gold and forty parts of water. Then wash, first with water, to remove the chloride of magnesium, afterwards with dilute nitric acid, to dissolve the excess of magnesia." — - (Pereira.) The oxide of gold is of a brown color, in the form of hydrate, reddish yellow, insoluble in water, but soluble in hydrochloric acid. It consists of 3 eq. oxygen and 1 eq. of gold. It is, therefore, a teroxide of gold. It is given in pills in doses of one tenth of a grain to one grain a day. With regard to the use of the salts of gold, there are certain objec- tions to their internal use. In the first place they are very active, and sometimes cause a good deal of local irritation in the stomach. In the second place, they are very readily decomposed by a great variety of substances, and thus lose their activity. * Aqua Regia,-~Qiie part of nitric and two of hydrochloric acid. Al.TKKATIVKH. 539 DMHSASEB IM WHICH GOLD IH i;skh. 1. .Syphilis. — This is the disease in which gold was specially recom- mended by .Dr. Clirestien, as a substitute for mercury. This interesting fact was announced in a work which appeared in the year 1811,* in which a number of cases are reported in which it proved successful, According to the representations contained in this work, it would appear that gold is capable of curing syphilis under all its forms, and that in its general operation on the system it possesses many advantages over mercury. It is efficacious, yet gentle. It may be administered with perfect safety at any season of the year, and under any complica- tion of the disease. Persons of either sex may be put upon it with equal safety. The only precaution which he enjoins during its use, is the observance of strict temperance. In other respects, the patient is not required to change his accustomed mode of living. Very shortly after the appearance of this work our distinguished countryman, Dr. Samuel L. Mitchill, made the medical public in this country acquainted with its contents, and immediately commenced a series of experiments with gold in the New York Hospital. The result of his experience is contained in the following letter to the late Dr. Dyckman : " The efficacy of the medicine has been tried year after year in the New York Hospital. My practice with it there has been witnessed by all the attendants of the wards. It possesses admirable virtues against syphilis. Without presuming to affirm that it is capable of eradicating the distemper in every instance, my opinion, upon the whole, is that the muriate of gold will effect all that is achieved by the muriate of quicksilver, with incom- parably less inconvenience to the patient. He gets well under the operation of the former without the hazard of a sore mouth or a salivation, and with very little wear and tear of constitution. I con- sider the introduction of this preparation into common use as one of the greatest improvements in modern medicine ; and I wish it was already as universal as the malady it is intended to remove. The muriate of gold is found to increase the quantity of urine, in many instances to such a degree that it ought to be ranked among the diuretics of the materia medica."f In 1812, Dr. J. C. Cheesman, of this city, published an inaugural dissertation, in w r hich are detailed a number of cases of primary syphilis which had been successfully treated by this remedy in the New York Hospital.J In 1816 its use was again revived in that institution, and in 1817 a report was published by Drs. J. K, * De la Methode Iatraleptique, etc., par J. A. Chrestien, Paris, 1S11. f Duncan's Edinburgh Dispensatory, edited by Dycknian. % New York Med. Rep., vol. six. p. 180. 534 MATERIA MEDIC A AND THERAPEUTICS. Rodgers and Delafield, containing an account of 81 cases of syphilis successfully treated by the same remedy. The results of all this experi- ence at the New York Hospital seem to be then : 1. That in the treatment of primary syphilis, the muriate of gold possesses powers fully equal to those of mercury. 2. In cases cured by gold, secondary symptoms did not supervene more frequently than in cases which have been cured by mercury. 3. In secondary syphilis, gold is not to be depended upon for a radical cure. Never having used the gold myself I can add nothing from my own experience in relation to it. Although not used much at present, there are still physicians in our city who are in the habit of using it, and who rely upon it with great confidence. 2. Scrofulous Affections. — Several cases of this kind are recorded by Chrestien as having been cured by the use of gold.* Similar cases have also been reported by Niel. 3. Goitre. — By both Chrestien and Niel cases of this disease are stated to have yielded under the use of this remedy. 4. Dropsy. — From the decided effects of gold in promoting the flow of urine, it has been used in this form of disease, and in some cases it has proved successful. The late Dr. J. Low, of Albany, rejates that he tried it in a well marked case of ascites, and that it " was attended by the best effects." [Oleum Jecoris Aselli ,(CW Liver Oil.) — This oil, which has of late years gained so much celebrity, is obtained from the livers of vari- ous species of the genus Gadus, especially the G. Morrhua, G. Callarias, G. Molva, G. Carbonarius. It is, however, probable that much of the oil of commerce is obtained from other species, or indeed from species of other genera, especially the Raia. Three species of oil are spoken of, the brown, the light brown, and the pale or yelloiv. These varieties do not depend upon the species of cod used, but upon the manner in which the oil is obtained. If the livers are, as is often done, thrown into a tub with a perforated bottom, and the oil which runs spontaneously from them promptly collected and skimmed or strained, it is pale ; if this is allowed to remain on the livers till they become putrid, or the oil is kept in a wet place, if due care is not taken in its preparation or preser- vation, it takes a darker hue, and then we have the light brown oil. When, after the pale oil has run off, the livers are boiled in iron pots for * Methode Iatraleptique. ALTERATIVES, 585 from twelve to twenty hoars, an oil is obtained of a 'lurk color, rani un- pleasant smell, and nauseous taste ; this is tin- brown oil. Physical Properties of Pule Oil. — Fluid at ordinary temperatures, of a bright yellow or golden color; fishy taste, more or less strong, and a smell resembling in the very pale qualities that of freshly-boiled cod, but stronger. Between this and the dark brown oil there is every shad'-, of difference in color, and every degree of rank iishiness in the taste and smell. The pale oils have generally the consistence of olive oil, and are clear ; the browner are thicker and more or less turbid. There is a very great difference of opinion as to the relative merits of the varieties of oil. The Germans, who of late years have nsed the oil most freely, pre- fer the darker kinds; in England and in this country, the paler are pre- ferred ; and it is confidently asserted that the oil can be deprived of its most offensive properties of smell and taste, and yet retain its remedial powers. Chemical Analysis. — Cod liver oil is composed of margaric and oleic acids, biliary matter, iodine, phosphorus, butyric and acetic acid, a pecu- liar substance discovered by De Jongh, and by him called Gaduine, with several organic salts and acids in small proportion. These ingredients exist in the varieties of oil in varying proportions. The pale oils con- tain most iodine and inorganic salts, while the darker sorts have most biliary matter, butyric, and acetic acid. Effects on the System. — Cod liver oil does not produce marked sensi- ble effects with any constancy. Sometimes it offends the stomach, causing nausea or even vomiting. In some rather rare cases, it purges ; in a few cases it has increased the flow of urine, or the perspiration, but generally it affects, none of the secretions. • No effect can be expected from it, as a general rule, unless its use be continued for a considerable time ; say on an average three to four months. Use in Disease. — The use of cod liver oil, though now a fashion, is by no means a strictly new thing. The oil was used nearly a century ago by Percival and Bardsley, in England ; and in Germany it has been a popular remedy from time immemorial. The attention of the profes- sion was again directed to it about thirty years ago, by several German physicians, who published in rapid succession histories of cures effected by cod liver oil in rheumatism, gout, scrofula in all its varieties, and finally in phthisis pulmonalis. From Germany the practice passed into France and England, and has been adopted in both countries. In Eng- land the oil has been highly appreciated by Dr. J. Hughes Bennet, and most extravagantly lauded by Dr. Williams. But amid all the lauda- tion and enthusiasm which the new remedy has excited, not a few have declared it of little value, and a still greater number have confessed that enlarged experience has very much moderated their expectations of 536 MATERIA MEDICA AND THERAPEUTICS. benefit from it. The disease in which it was first used by Schenk, in Germany, was rheumatism. He reported a large number of cases of chronic inflammatory rheumatism, in which its use produced the best effects. Subsequent observations have, to a certain extent, confirmed the views of Schenk. The forms of rheumatism in which it was first likely to do good are those in broken-down habits, those depending on imperfect digestion, and those occurring in scrofulous subjects ; and where in old people the tendons and muscles are rigid, the joints stiff, &c. Gout. — In this disease the oil has been given a good deal, but not with the same amount of success as in rheumatism. Scrofula. — The Scrofulous Diathesis. — Here it is that cod liver oil has gained most of its reputation, and by many it is still considered almost a specific. Now that the steady and pretty long-continued use of the remedy has, in very many cases, produced the most admirable effects, cannot be doubted, and it seems to do this chiefly by its influence in correcting various derangements of secondary assimilation. Whether this change is effected by suppl) T ing to the digestive organs a material with which they can repair the various results of defective nutrition, or whether it is by giving to the digestive function power to perfect the assimilation of food taken, is by no means easy to say. Be this as it may, in very many of these cases, whether of caries, of scrofulous ophthalmia, of tabes mesenterica, or tubercular peritonitis, or of various diseases of the skin, connected more or less closely with scrofula, as eczema, herpes, and some forms of impetigo, it has produced excellent effects. Under its use the constitution in general seems to gain vigor, the complexion is clearer, the eye more lively, the mind cheerful, the strength improved, and a remarkable tendency to the deposit of fat shows itself. While the change in the natural functions is going on, as manifested by the general improvement in the aspect of the patient, the disease frequently gives way ; chronic ulcerations heal, enlarged glands diminish in size, chronic eruptions disappear, the scrofulous ophthalmia is relieved. Phthisis Pulmonalis. — In this disease the oil has been used, and by some of its vehement admirers it is said to be equally beneficial in every stage. This is not, however, the common opinion ; generally the best effects were found to follow its use in the early stage, where the tubercles had not yet begun to soften, or wmere the process had but begun. Here the use of the oil has in very many cases been followed pretty promptly by diminution of the expectoration, disappearance of the night sweats, and by very marked increase in size, not occasioned by the mere deposi- tion of the fat, but also by an augmentation of the size of the muscles, and a proportionate augmentation of the muscular power. In some cases this improvement has been persistent, and the proportion of such cases, where the. disease was in its early stage, has been large. In AT.TEKATIVEH. 581 phthisis, wiili softening, after the formation of cavities, though the relief for ;i time bas been very decided, the night sweats ceasing, the cough becoming freer, and the expectoration less profuse, in some cases, too, flesh and strength being regained in a most remarkable degree, yel fchie apparent cure has only amounted to an arrest of the disease for a time. In a few months the symptoms return, and the fatal event, though po t- poned, is not prevented. Such and so greal are the advantages which sonic of the most eminent men among our contemporaries think they have observed from the use. of this agent in that most dreadful of all diseases, phthisis pulmonalis. Is there, then, hope that this terrible scourge is to be at last subdued? Will it finally acknowledge the curative power of this medicine ? We may hope, but cannot yet confi- dently believe. In the meantime, what is our duty to our patients and our profession? Try this remedy fairly, but carefully. Let us ascertain, if possible, what arc the circumstances under which it is most likely to do good ; what are the cases most likely to be benefited by it; what are the states of system which contra-indicate its uses ; what cases arc likely to be injured by it. These most important questions are all yet to be settled. On no one of them is our present knowledge at all what it must be before cod liver oil can be given in any other way than empiri- cally. It is generally supposed that a state of plethora, of active irrita- tion, of general or local inflammation, or of great nervous irritability, contra-indicate the use of this oil. On the other hand, it is believed most likely to succeed in those patients who arc of sluggish, apathetic habit of body, and those most deeply and most fully tainted with scrofula. Modes of Administration. — Although many modes of covering and disguising the smell and taste of this nauseous oil have been proposed, yet none have availed anything. It can best be taken either alone or floating on some aromatic water. The dose at first should be small, say a teaspoonful thrice a day ; never to be taken on an empty stomach, which it is almost sure to offend, but usually about one, or two hours after meals. As the stomach becomes reconciled to it. the d< se may be increased to an ounce three or four times a day. By Mr. Emery so muchas a pint, and in some cases a pint and a half, was given in cases of lepra every day ; and the result, he reports, is most encouraging, some- very protracted cases being entirely cured by it. Such doses are rarely necessary, and very rarely could patients be persuaded to swallow them. Sometimes, when the stomach rejects the oil, if it is omitted for a few days or weeks, and then given, it will be retained. [Little has been added to our knowledge of the oil since the above was written ; few doubt its value in phthisis. — 2nd Ed., Editor.] Sarsa.paiulla. — This is the root of a number of species belonging to the genus Smilax. It has generally been supposed to be a product of 538 MATERIA MEDIC A AND THERAPEUTICS. the Smilax sarsaparilla. It is doubtful, however, whether any of the sarsaparilla of commerce is obtained from this source. The species which are now supposed to yield it, are the Smilax officinalis, Smilax medica, and the Smilax papyracea. These grow in Mexico, Guatemala, and the warm regions of South America. The smilax is perennial, and has a climbing or trailing stem, beset with prickles. The name sarsaparilla is derived from two Spanish words which signify a small thorny vine. The part used in medicine is the roots, which consist of long and slender runners, issuing from a common head with the stem. These runners are the preferable part. As found in the market, they come in bundles from about two to four feet long. They are about the thickness of a common quill, cylindrical, and with longitudinal fibres, and with more or less radical fibres upon them. They consist of a thick cortical part, covered with an epidermis which can easily be separated ; a thin inner layer of woody fibre, and a central medulla or pith. The color of the exterior varies from red to brown and grey. In the dry state they have no smell ; on boiling the smell becomes decided. The taste is mucilaginous, and if chewed for a little time, decidedly acrid. Varieties of Sarsajyarilla. — The principal varieties of this drug in the market are the following : 1. The Lisbon or Brazilian sarsaparilla. This is the product of the Brazils, and until of late years found its way to the different parts of the world through the port of Lisbon. Hence its name. It is supposed to be the root of the Smilax papyracea. This kind of sarsaparilla is of a reddish brown color, and abounds in amylaceous matter, both in the bark and pith. 2. The Jamaica Sarsaparilla. — Supposed to be the product of the Smilax officinalis. It comes from the bay of Honduras, and derives its name from its being brought to England from Jamaica. It is distin- guished by its reddish color, from whence it is called the red sarsaparilla. It has more radical fibres attached to it than the preceding. Contains but little amylaceous matter. 3. Honduras Sarsaparilla. — This comes from the bay of Honduras, and is of a dirty or greyish brown color. It has very few fibres attached to it. Under the epidermis is a thick amylaceous layer, which gives it a mealy appearance : hence called mealy sarsaparilla. 4. Vera Cruz Sarsaparilla. — This is supposed to be the product of the Smilax medica. It comes from Mexico. This has very few fibres attached — of a light greyish color. It is more fibrous than the other varieties, and contains no starch. Tests of the Quality. — The best test of the quality of sarsaparilla is ALTEKATIVKS. 580 the taste. The more nauseous and acrid thia is, the better. In addition to this, the roots which have a red color, and have the greatest Dumber of root fibres, are considered the best. The quantity of starch contained in them, so far from being a proof of goodness, is perhaps the rever e. Effects. — Sarsaparilla does not produce any direct and sensible eifects on the system with constancy. So metime s il is diap horetic , a gain diu- retic; in very large doses it irritates the stomach, and is said to prod v ertig o. In me dicinal doses it acts as an alter ative merely, i mpr oves the appetite, strengthens the digestion, and invigorates the whole system. It is given with advantage in secondary and tertiary venereal diseases, especially where the system has been broken down by the diseas e and the abuse of mercury. In these cases it is usually united with stimu- lating diaphoretics, as mezereon, sassafras, &c. In chronic rheumatism not connected with syphilis, it often does good; so, too, in chronic diseases of the skin, especially if they occur in broken-down constitutions. Mode of Administration. — Sarsaparilla is given in infusion and d ecoc- tion, svnip and liquid extract, and usually united with gnaiac, mezereon, and sassafras. The officinal syrup and liquid extract used are the pre- ferable preparations. MEZEREON. The tree which yields this is the Daphne Mezereon, growing wild in England and the north of Europe. It is a very hardy plant, growing to the height of four or five feet. The bark of the root is the part used in medicine, the ligneous part being nearly inert. The proper season for digging up the roots is the autumn, after the leaves have fallen. By Vauquelin, a peculiar principle has been discovered in the mezereon, to which he has given the name of Daphnin. Mezereon is a -powerfully stimulating diaphoretic, exciting the action of the vascular system, and acting also on the bowels and urinary organs. If given too freely it causes nausea, vomiting, and purging. In its general operation, therefore, it is much more active than either guaiac or sarsaparilla. In substance the dose of this article is from five to ten grains. It is seldom used in this way, however. The best form is that of decoction. This is made by boiling § ij of the mezereon with 3 ss of liquorice root in lbs iij of water down to a quart. Of this tour or five ounces may be given three or four times a day. Even thus, however, it is at present seldom used alone. SASSAFRAS. This is the sassafras officinale, a tree growing in great abundance throughout the United States. It grows frequently to the height of 35 540 MATERIA MEDICA AND THERAPEUTICS. thirty or forty feet, and even more. The wood, root, and bark, are all used in medicine. Its active properties are extracted both by alcohol and water. Sassafras is a stimulating diaphoretic and diuretic, and is used in the same cases with the preceding articles. The best form of giving it is the in fusio n, as decoction dissipates the oil. In this way it is much used as a common domestic remedy. The o^_is also a good prepara- tion in doses of gtt. ij to iv, rubbed up with sugar and water — seldom used, however, GUAIAC. The tree which yields the Gnaiac is the Guaiacum Officinale, a native >ef Jamaica and South America, rising generally to the height of forty feet. Every part of this tree possesses medicinal properties, but the wood and a peculiar substance, guaiacum, afforded by it are the only parts used. This peculiar substance exudes spontaneously from the trunk of the tree in the form of tears, or from incisions made into the trunk. From these it flows out very copiously, and is concreted by the sun. Formerly this was supposed to be a gum resin, but Mr. Brande declared it a substance sui generis, differing both from gum and resin. "Its most remarkable property," according to him, "is the change of color which it undergoes when sub jected to oxygenating agents." When reduced to powder its tint is pale grey, but by exposure to air and light it soon becomes of a dingy green. It is now considered a peculiar resin. It is upon this substance that the virtues of the guaiac wood entirely depend. The guaiac wood comes in large, solid, and heavy pieces, of a yellow color, having but little smell, and a slightly warm, subacid taste. When used for medicinal purposes it is rasped. The guaiac resin is sometimes found in the form of tears, but generally in large fused masses " with little smell and taste, brittle and semi-transparent, and of :a greenish brown color." — Brande. "The sensible effects of the guaiac are a grateful sense of warmth in the stomach, dryness of the mouth, and thirst, with a copious flow of sweat, if the body be kept externally warm, or if the guaiac be united with opium and antimonials ; but when the body is freely exposed, instead of producing diaphoresis, it augments considerably the secretion of urine." (Thomson's Disp.) Guaiac is a warm, stimulating diaphoretic, and has been much used as an alterativcremedy in cases of secondary syphilis, cutaneous affec- tions, and the like. It was originally employed by the native Indians of St. Domingo as an antidote to the lues venerea. It was from them that the Spaniards became acquainted with its virtues, and in the year ALTERATIVES. 6 I I 1508 it was introd need into Spain, tt speedily gained greal celebrity throughout Europe, ami until the laal centurj continued to enjo high a reputation as a specific against the venereal that it wat called the lignum sanctum. More accurate observation has, however, decided that il, possesses no siieli powers. It nevertbelc exercises some con- trol over the venereal virus, and in eases where the skin becomes a ffected with ulcers and blotches it is a remedy of great value, when used in combination with some of the mercurial preparations. For the purpose ofproaucing the greatest sudorific effect from the guaiac, the body should be kept warm, and the guaiac should be combined either with opium or antimonials. If the patient be freely exposed, it i- apl to run off by the kidneys instead of producing diaphoresis, The gum guaiac may be given either in s ubstance , in doses of from grs. x to 5 ss, in pill or bolus, or what is better, made into an emulsion with water, by means of gum arabic or the yolk of an egg. If given in larger doses it is apt to produce a purgative effect. An excellent preparation of it is the ammoniated tincture, or, as it is commonly called, the volatile tincture of guaiac. This is made by a combination of powdered gum guaiac with the aromatic spirit of ammonia. Of this, the dose is one or two teaspoonfuls, two or three times a day. Water decomposes it, and therefore it should be given saturated with some viscid substance. This is an admirable stimulating diaphoretic, and may be used with the greatest advantage in cases of chronic rheumatism. It possesses over the guaiac alone the advantage of a combination of the ammonia, which co-operates powerfully as a stimulating diaphoretic. *[This was the favorite remedy of Dr. Dewees in amenorrhcea and dysmenorrhea.] LOCAL ALTERATIVES. By these I mean those agents] which possess the power of altering the condition of the part to which they are applied, in such a way as to remove diseased action. They are the agents usually described under the names of caustics and escharotics. These terms, however, are objec- tionable, as they are calculated to convey erroneous notions in relation to the effects and operation of many of the articles belonging to this class. This will bo abundantly obvious, when we come to consider them in detail. NITRATE OF SILVER. Of all the local alteratives this is by far the most valuable, and exerts a most astonishing influence in changing the condition of the parts to 542 MATERIA MEDICA AND THERAPEUTICS. •which it is applied. When used in the form of the solid stick, its effects differ, of course, according to the mode of applying it. If lightly rubbed over the skin, previously moistened, or over the surface of a wound or ulcer, it first induces a white film, which, when exposed to the air for a few hours, assumes a darker color, and finally becomes dark grey or black. As it undergoes these changes of color, it gradually becomes harder, and forms an eschar resembling black sticking-plaster. In the course of a few days the eschar becomes corrugated and begins to separate at its edges, and at length peels off altogether. Here the nitrate of silver makes a chemical union with the albumen of the skin forming the white film. This becomes gradually hardened, and the change of color is owing to the partial reduction of the silver. Again, if the skin be moistened, and a stick of nitrate of silver be rubbed lightly over it five or six times, vesication takes place. In the course of four or five days the blackened and separated cuticle falls off and the part heals. Again, if rubbed repeatedly on a part it acts as a caustic, destroying its texture. When applied to mucous membranes, it forms a thick white compound with the animal matter of the mucus. This protects the part underneath from the caustic effects of the silver, so that the effect is by no means so violent as it would seem. Simply stated, these are the effects of the local application of this agent, and it is upon these that it is used in a great variety of affections with the most singular success. The best form in which to use it is that of solid stick. 1. In cases of External Inflammation. — That nitrate of silver, locally applied, has the pow T er of arresting inflammation, was first noticed by Dr. Higginbottom, who has written an invaluable treatise on the effects and uses of this agent. The mode of applying it is the following: the part is first to be w r ashed with soap and water, and then dried. The inflamed and surrounding part is then to be moistened, and a long stick of nitrate of silver is to be passed over the moistened surface, taking care that not only every part of the inflamed skin be touched, but also the surrounding healthy skin to the extent of an inch or more. The number of times the stick is to be passed over the inflamed surface, depends upon the degree of inflammation present. In some cases sim- ply blackening the skin will be sufficient, while in others actual vesica- tion may be necessary. In very slight cases, accordingly, passing the stick once over the part will be sufficient. In ordinary cases, two or three times will be necessary, while, as vesication is required, it must be applied more frequently. ALTERATIVES. G 13 DISEASES IN wmcn THE NITRATE OF SILVER IS USED, These .are various, and require to be noticed in detail, as in many of them a difference in the mode of applying \t necessary. 1. Phlegmon. — In cases of ordinary phlegmon, simply moistening the part and rubbing it over with a stick of nitrate of silver, will some- times have the effect of arresting the progress of inflammation, without any other application. 2. Paronychia. — Whitlow.— -In cases of this kind, frequently the best application to the part is nitrate of silver, first moistening the sur- face and then rubbing the stick once or twice over it. In case suppura- tion should have actually taken place, the best plan is to open the abscess, then applying the nitrate freely within the cavity, and after- wards cover the whole with a cold bread poultice. In most cases this will entirely relieve the pain and irritation, after the immediate smarting of the application has subsided. Should the inflammation be increased in a day or two, as it sometimes is, the application may be renewed. 3. Erysipelas. — There is perhaps no disease in which the effects of the local application of the nitrate of silver are so striking as in this. For the first suggestion of it, I believe we are indebted to Mr. Higgin- bottom, who has detailed some very interesting cases, in which it was used with success. As yon all know, this disease is not always purely local. It is connected with constitutional derangement requiring general treatment. Bloodletting, purging, antimonials, etc., are of course to be first resorted to. If these should fail to arrest the disease, the best mode is first to moisten the whole inflamed surface and then pass a long stick of the nitrate over every part of it, extending the application a little distance beyond on the surrounding healthy skin. Strange as it may be, the progress of the inflammation appears to be immediately arrested, and in the course of two or three days frequently every appearance of inflammation will have disappeared. In about five or six days, the eschar separates. 4. Inflammation of Absorbents. — In eases of this kind, which frequently are so painful and dangerous, there is nothing so prompt and efficient as the local application of this remedy. Generally speaking, inflammation of this sort arises from some local injury extending in the extremities to the axilla and groin. In such cases the best plau is to rub the nitrate not merely over the part first affected, but over the whole course of inflamed absorbents. 5. Punctured Wounds. — In the slighter of these the effects of the 544 MATERIA MEDICA AND THERAPEUTICS. application of the nitrate are really astonishing, in arresting the inflam- mation and entirely curing the injury. In these cases all that is neces- sary to be done is to moisten the part first and then pass a stick of the nitrate to the wound, and to pass it once or twice over the whole inflamed part, extending it about an inch beyond on the healthy skin. Generally.nothing else is necessary. Where the case has been neglect- ed and matter has already formed, the matter is to be evacuated and the nitrate applied within the cavity. A cold poultice is then to be applied. In two or three days the application may be renewed, in case there should still be any swelling or inflammation left. In this way ordinary wounds from instruments, etc., the bites of animals, inflamed leech bites r and vjounds received in dissection^ may be treated. Where the punctured wound has been extensive, a good way of treating it is to apply the nitrate first and then bring the edges together by adhesive plaster. In this way the excessive inflammation and sup- puration which frequently attend these cases are kept down, and the part heals nearly as by the first intention. 6. Bruised Wounds. — In these cases, whether of simple bruised wounds, or of the more severe kind, accompanied with inflammation or followed by sloughs, the application of the nitrate is attended with the same salutary effects as in punctured wounds. 7. Ulcers. — In the treatment of these intractable cases, the nitrate of silver pi-oves an invaluable remedy. In small ulcers, simply applying it to the surface and a little on the surrounding skin, and after this covering; the whole with gold-beater's skin, is all that is necessary. In large ulcers with inflammation, or in old ulcers, the treatment is the following: first apply a bread and milk poultice over the ulcer, and let the patient keep his bed for 18 or 24 hours. All the inflamed parts are then to be well washed with soap and, water and wiped dry, They are then to be moistened with water, and a long stick of the nitrate is to be passed all over the inflamed and ulcerated surfaces twice,, and rather more freely on the ulcer itself. It must also be carried somewhat on the surrounding skin. Lint must then be applied to the ulcer, and the whole inflamed and ulcerated parts covered with the neutral ointment,* spread on linen. A compress of linen five or sis folds thick is then to be put over the ulcer, and a common roller to be * § Empl. Plumbi lbs. if. 01. Oliv. lbs. ij, Cretffi ppt. 3 xvij. Aeetum Distillat. lbs ij. M. The acid and chalk to be well mixed in a mortar, the lead 1 , plaster, and oiT, previously slowly melted together, are next added^ and the whole stirred till eool. A LTERATIVES. 545 loosely applied round the whole. On the fourth day the leg is to I"; examined, when it will be found that the inflammation i nearly if not entirely gone, and the ulcer is in a healing state. The nitrate must then be applied on the whole of the ulcer, and once lightly over the skin immediately surrounding it, one or two inches in breadth. The lint, ointment, etc., to be applied as before. Every third or fourth day this is to be repeated until the ulcer is healed. After the first or second application the patient may walk about. Caustic Potash. — Tin's is the hydrate of Potash. Also called the potassa fusa, or fused potash. It is prepared by evaporating a solution of potassa in a clean iron vessel over the fire until ebullition ceases and the potassa melts. Jt is then poured into proper moulds. The best kind of moulds are of iron and of a cylindrical shape. In this process all the uncombined water is driven off by the action of heat, and the potassa remains in the state of hydrate. It contains one equivalent of potassa 48, and one of water 9 = 57; or in 100 parts, 84 potassa and 16 water. When perfectly pure, the hydrate of potassa is of a white color. The officinal preparation, however, owing to impurities, is greyish or bluish. It is soluble in water and alcohol, but usually not entirely so, in conse- quence of the impurities; when pure, it is entirely soluble. It has a very strong affinity for water and carbonic acid, which it attracts rapidly from the atmosphere, and, in consequence of this, it deliquesces. Hence the necessity of keeping it in tightly-stopped bottles. Purity. — The officinal hydrate contains various impurities, such as peroxide of iron, carbonate of potash, silica, alumina, &c, which exist in the carbonate of potash, from which the solution of potassa is prepared. These, however, do not interfere with the medicinal virtues of the article. They may be separated by digesting it in alcohol, which takes up onlv thc pure alkali ; by evaporating this alcoholic solution to dryness and fusing the mass thus obtained. Effects. — This is the strongest caustic that we possess, and hence was known by the name of ca usticuifl fnmmiirtp nrerrimMm When applied in the solid form to any part, it quickly destroys its vitality, and extends its action to the parts beneath, forming a slough, which is afterwards thrown off, leaving behind it au open ulcer. The princ ipal us e of this article is t o form issu es. In rising it for this purpose, however, it is necessary to be cautious. As it is very deli- quescent, it is apt to spre ad, and thus extend its effects too far. A piece of adhesive plaster should, therefore, be first applied to the part, with a hole cut in it of a suitable size where you intend making the issue. To this open part the caustic, moistened at one end, should be rubbed until 546 MATERIA MEDICA AND THERAPEUTICS. the part becomes discolored or dies. It is then to be washed and a poultice applied. When the eschar separates, the issue is to be con- tinued by keeping a pea in it. It is also used to destroy warts and fungous growths. Potassa cum Calce. — This is also called the Causticum commune mitius, or the Causticum commune cum calce. This is prepared by eva- porating solution of potassa to one third, and then adding as much newly slacked lime as will bring it to the consistence of a solid paste. This is then to be preserved in well-stopped bottles. This consists of the mixed hydrates of potassa and lime. It possesses the advantage of being less deliquescent than the caustic potassa. It is, therefore, more manageable. It is milder and slower. Its general action, however, is the same. When applied, it is made into a paste with rectified spirits. Arsenious Acid. — Although commonly ranked among them, this article produces effects very different from the simple caustics. When applied in small quantities to the sound skin, it does not pro- duce any effect. When applied in considerable quantities, however, it has been known to cause local irritation, followed by a pustular erup- tion, and in some cases the constitutional effects of it have been deve- loped. Several cases are recorded in which this article has been applied by mistake to the head for hair powder, and in all these constitutional effects have followed. One proved fatal. When rubbed on the sound skin in the shape of ointment, it produces generally a pustular eruption ; sometimes an eschar, and not unfrequently the system becomes consti- tutionally affected. — (Christison.) When applied to surfaces deprived of the cuticle, the effects are much more energetic. Great local irrita- tion is caused, while the poison is absorbed frequently with great rapidity, and all the constitutional effects of it developed. Applied to eruptions, ulcers, and wounds, it has frequently proved fatal. In its application to ulcerated surfaces, there is a circumstance of great interest which has frequently been noticed; and that is, that while some persons are affected by a single application, " others have had it applied for a length of time without experiencing any other consequence than the formation of an eschar at the part." — (Christison.) For this two reasons have been assigned. The first is, the difference in the quantity applied. When a large quantity is applied, the part is speedily disorganized, and absorp- tion is thus prevented. On the other hand, where the quantity is small, the local effect is trifling, and absorption readily takes place. A second is the condition of the sore to which it is applied. If there be any bleeding vessels, absorption takes place very readily, and the system is easily affected. On the other TTand, if there be no bleeding vessels, this effect is much less likely to happen. — (Christison, p. 223.) ALTERATIVES. 54 7 The practical conclusions to be drawn from the foregoing are import- ant, and they are the following : 1. The ar senic should alway s be applied strong, so as to di organize tho part as speedily as possible. 2. Before applying it the part should never be prepared bj cutting and paring, so as to cause bleecnng. By attending' to these precautions, the absorption of the article may probably in many cases be prevented, and many evil effects obviated. When properly applied to an ulcerated surface, the part is destroyed and sloughs off; a new action is thus created, and a healthier secretion promoted. The disease in which arsenic has been chiefly used is cancer , and this is the article generally resorted to by empirics. In many cases it no doubt serves a good purpose in improving the character of the sore, and perhaps retarding the progress of the disease. Experience, how- ever, has abundantly shown that it cannot eradicate the disease, while from the absorption the most dangerous and even fatal consequences have resulted. By regular practitioners it is, therefore, in a great mea- sure abandoned. It is also used in Lupus with advantage, and more recently in Ony- chia maligna with great success. (Pereira.) Mode of Application. — The best form is the ointment. This is made by rubbing up one scruple of finely-powdered arsenious acid with one ounce of simple cerate. This must be applied with caution and the effects watched. The preparation used for onychia maligna is arsenious acid, grs. ij ; spermaceti oint. 3 i. [Hydrargyri Supernitras (the Acid Nitrate of Mercury). — A so- lution of the nitrate of mercury in nitric acid, under the name of the acid nitrate of mercury, is much used as a caustic in Paris, and has been adopted by some practitioners in England and the United States. It is chiefly used in cases of severe and extensive ulceration of the os uteri. It should be applied by a brush, and very great care taken that it does not fall upon the vagina, or touch the healthy tissue of the uterus. — Ed.] CHEMICAL ALTERATIVES. The two most important classes of chemical alteratives are : 1st. Antacids, or those remedies which obviate acidity of the stomach by combining with and neutralizing the acid. 548 MATEEIA MEDIC A AND THEEAPETTTICS. 2d. Lithics, or tliose remedies which are given to counteract the dis- position to form urinary calculi. I shall speak of'each of these in their order. Antacids. — The presence of acid in the stomach is essential to the performance of its functions. It is of course only when this is in excess that it becomes a proper subject for medicinal treatment. It is not yet well settled what acids are present in the gastric juice, nor in what state they exist in that fluid, some supposing that muriatic, acetic, and lactic acids exist in a free state. Blondelot, on the other hand, denies altogether the existence of free acid in the stomach, insist- ing that the acidity of the gastric juice depends on the presence of the acid biphosphate of lime. The probabilities are that free acids exist, and that the same acid does not exist in the gastric juice of different animals, nor in that of the same animals at all times; for though the acidity is essential, it seems that this quality in the absence of one acid can be communicated by another. The acids which are thought to exist in the normal state in gastric juice are, as before stated, the muri- atic, lactic, and acetic, and it is probable that when acid is in excess, it is by the increase of one or other of these. They are in all cases deve- loped from the food ; muriatic from animal food, lactic and acetic from vegetables. It is then to saturate the excess of these acids, and not to neutralize the gastric juice, or remove acid from the stomach, still less to render it alkaline, that antacids are given ; and if you remember, 1st. That the excess of acid is generated from changes- in the food. 2d. That these changes depend on imperfect digestion. 3d. That digestion cannot but be imperfect, when there is in the stomach sufficient alkali to neutralize the gastric juice, you will readily understand the reason for a fact, long familiar to practical men, viz. that it is very possible to remove an effect of disease, and yet not remove, but actually aggravate the disease itself. Here the essence of the dis- ease is the disposition in the stomach to produce an undue quantity of acid from the food, and in neutralizing this excess of acid, and thus removing an effect, we may aggravate the disposition in the stomach, which is the disease. This injurious effect of antacids may be, in part and for a time, pre- vented by the use of vegetable bitters, and alkalies ought not to be long used, without giving the tonics; but even with these the evil effects cannot be prevented entirely, if the remedy is used freely, and for a long time. Always, therefore, discourage the long-continued use of alkalies, especially the too common practice of taking them immediately after each meal. Magnesia. — Under the head of cathartics this earth has already been ai.tki.wi ivks. 549 noticed, and it was then mentioned thai it was nsed in three forms, viz: the sulphate, the carbonate, and the pure magnesia, or magnet ia usta, [n either of these two latter forms, magnesia may l>e nsed as an antacid. The difference between them is, thai when the carbonate is used, large quantities of carbonic acid gas are extricated in the stomach. In instances the extrication of this gas is objectionable, from the distension of the stomach which it occasions. Generally, however, no harm can arise from it, and the stimulus of the gas is, in many cases, rather grate- ful than otherwise to the stomach, and whenever nausea and vomiting are present, may be exceedingly beneficial. As an antacid, magnesia is one of the most efficacious articles that we possess. Nexl to ammonia, it has the greatest power of neutralizing acids of any of the alkalies or alkaline earths. It is peculiar to this article that, when it combi with an acid in the stomach, it proves purgative. In this respect it differs from the other antacids. Mode of Administration. — It may be given in doses from 3 ssto__3^ in milk and water. To correct the flatulence which it occasions, a small quantity of some aromatic may be added. In dyspeptic states of the stomach, a little of the compound spirit of ammonia is frequently bene- ficial. Of the pure magnesia the dose may be about one third less than that of the carbonate. Greta — Chalk. — This is a friable carbonate of lime, and is found in great abundance in different parts of Europe. In the South of England, particularly, it exists in great quantities. Marble is the hard carbonate of lime. With the acids chalk effervesces, the carbonic acid gas being extricated. "With muriatic acid it effervesces violently, and dissolves almost entirely, leaving a colorless solution. When by levigation and washing the chalk is separated from any im- purities that may be associated with it, it is called Creta preparata or Pre- pared chalk. This is the form in which it is used in medicine. As an antacid, it has been and is still used. It differs from magnesia in not producing any purgative effect. On the contrary, it proves absorbent and astringent. It is, therefore, used with much advantage in cases in which magnesia would be improper. The dose of it is from 3j to 3 j- The common form in which it is prescribed, is that of the chalk mix- ture, i i eLuh, z+^Y* t *^ ' ^^"^ Lime "Water. — This is a limpid, colorless fluid, without smell, and having a strong, styptic, acrid taste. It changes vegetables blues to green. It unites with oil, forming an imperfect soap. When exposed to the air, a pellicle forms on its surface, which, when it becomes of a certain thickness, cracks and sinks to the bottom. It is then succeeded 550 MATERIA MEDIC A AND THERAPEUTICS. by others of a similar character. The explanation of this is the follow- ing: The lime of the lime water attracts carbonic acid from the air, and forms a carbonate on the surface, which is the pellicle just mentioned. By successive formations the whole of the lime is thus abstracted. It is for this reason that it is necessary to keep lime-water in closely stopped bottles. As an antacid, lime-water is much used, and is an article of great value. Besides the power which it possesses of neutralizing acid, it has the still further property of dissolving the sordid mucus with which the stomach and bowels are generally loaded in dyspeptic and otherwise debilitated states of these organs. In the same way it proves serviceable in cases of worms by dissolving the slimy mucus in which these animals are imbedded. The dose is from 3 j to 3 ij, or 3 iij. Where the stomach is irritable, a good form of giving it is, mixed with an equal quantity of milk. Potash. — Carbonic acid combines with potash in two proportions, constituting a carbonate and a bicarbonate. (a.) Carbonate of Potassa. — (Salt of Tartar.) — As found in the shops, this salt is in white grains, with an alkaline and nauseous taste; it changes vegetable blues to green, and unites with oils and forms soap. On exposure to the air it is very deliquescent, and forms a fluid of the consistence of oil. This salt contains one proportion of carbonic acid with one of potassa. It is soluble in water, but insoluble in alcohol. (b.) Bicarbonate of Potassa. — This salt is prepared by passing_a_stream of carbonic acid gas through a solution of the carbonate of potassa. When it ceases to absorb carbonic acid, it is to be filtered and eva- porated slowly until regular crystals form. This salt contains twice as much carbonic acid as the preceding carbonate, or two proportions of acid to one of potassa. This is white, crystalline, without smell, and having a weak alkaline taste, without any acrimony. On exposure to the atmosphere it does not undergo any change. It is soluble in about four parts of cold water. Effects on the System. — In their effects, these salts do not differ much. They are both powerfully antacid, and extend their operation from the stomach to the urinary organs, increasing the secretion of urine, and altering the chemical constitution of that fluid. Although possessing the same general properties, however, the bicarbonate has great advan- tao-es over the carbonate. It is less nauseous and acrid in its taste, and agrees better with the stomach. The dose is from grs. x to grs. xxx, in some mucilaginous vehicle. (c.) Liquor Potass^e. — (Solution of Potassa). — This is another form in which potassa is used. It is prepared by making separate solutions ALTERATIVES. 651 of carbonate of potassa and caustic lime in boiling water, and then mix- ing these together, and when cold, straining, osciamus niger, *i80 I [ypnoticSj 356 India rubber, 47 [ndian sage, 206 " hemp, 248 " meal, 351 Inhalations, 216 [odine, 522 " preparations of, 523 Ipecacuanlia, 79, 216, 227, 233 Iron, 475 " ammonio-tartrate, 486 " carbonate, 56, 477 " citrate, 481 " filings, 15fi, 475 " lactate, 481 " muriated tincture, 258, 481 " oxide, 476 " phosphate, 480 " sulphate, 156, 479 " tartrate, 480 Issues, 514 Jalap, 124, 147 James's powders, 204 Jamestown weed, 391 Jerusalem oak, 158 Jujube, 348 Juniper, 217 Juniperus communis, 247 " sabina, 261 Kino, 497 Kooso, 162 Lactucarium, 381 Laudanum, 376 Laxatives, 111 Lead, acetate of, 499 Leeches, 291 Lemon, 336 Lignin, 50 Lime water, 549 Linseed, 349 Liquorice, 346 Liriodendron tulipifera, 473 Lithics, 552 Lobelia, 88 Lobeline, 89 Lupulin, 3S3, 406 Macrotys racemosa, 333 Magnesia, 114, 548 " carbonate, 115 " sulphate, 128 Male fern, 158 Mallow '. man h, '■'> 17 Manna, 117 Marsh rosemary, 49 Materia mi dica denned, 1 1 Matico, 608 May apple, 125 Meadow saffron, 323 Meconine, 22 Medicines, effects of absorption of, 14, 17 " modus operandi <>(; L6 " methods of applying, 18 '• circumstances modifying the effects of, 'i 1 " classification of, 28 \ " combination of .'!1 Melia azedareck, 1 61 Mercury, 163, 258, 520 " pathological effects <>r. 1 10 " modes of introducing, 172 " ' black oxide, 188 " chlorides, 190 " iodides, 525 Mindereri spiritus, 204 Monarda punctata, 507 Monkshood, 325 Morphine, 42, 378 " sulphate, acetate, and hy- drochlorate of, 378, 379 Moxa, 514 Mucuna pruriens, 157 Musk, 438 Mustard. 89 Myrrh, 224 Narceine, 42 Narcotics, 34, 355 Narcotine. 42, 362 Nervines, 433 Neutral mixture, 205 salts, 147 Nightshade, American, 125 " deadly, 387 Nitre, 235 " sweet spirits of, 239 Nitro-muriatic liniment, 513 Nux vomica, 443 Oak bark, 49S Oatmeal, 350 Oils, 44; enumeration of the more m- portant, 45-47 Opium, 25. 357 Orange, 337 Oxydum hydrargyri cinereum, 188 Paint, Indian, 219 Papaver somniferum, 357 Paregoric, 377 Pareira brava, 257 Parsley, 254 Parturients, 264 562 INDEX. Peru, balsam of, 222 Peruvian bark, 462 Phosphorus, 431 Phytolacca decandria, 125 Pill, blue, 145, 187 Pink root, 160 Pipsissewa, 256 Pix burgundica, 507 Pleurisy root, 207 Plumbi acetas, 499 Plummer's pill, 191, 521 Podophyllum, 139, 158 Poke weed, 125 Polygala senega, 217, 227 Polypodum filix mas, 15S Pomegranate, 159 Potash, 550 Potassa, caustic, 545 " citras, 205 " cum calce, 546 Potassse nitras, 235 " carbonas, 550 " liquor, 550 " et sod. tart., 129 " acetas, 239 " sulphas, 131] " supertartras, 130 " tartras, 129 Potato, the wild, 246 Powders, antimonial, or James's, 504 Pride of India, 161 Principles, vegetable proximate, 36 Prunus virginianus, 474 Prussic acid, 40, 314 Pseudomorphine, 42 Puccoon, 219 Pulse, 273 Pulvis antimonialis or Jacobi, 204 Pulvis Doveri, 206 Pumpkin, 162 Purgatives, 32 Pyrola umbellata, 256 Quassia, 458 Quicksilver, 163 Quinine, 42, 458 " sulphate of, 452 Quinoidine, 43 Red precipitate, 189 Refrigerants, 31, 336 Resins, 47 Revulsives, 504 Rheumatism weed, 256 Rhubarb, 119, 146 Rice, 351 Ricini oleum, 112 Rochelle salts, 129 Rubefacients, 505 Saffron, meadow, 323 Sage, Indian, 206 . Sago, 51, 352 Sal de duobus, 131 Sal diureticus, 239 Salep, 354 Salicine, 472 Salix, 472 Salt, common, 161 Saltpetre, 235 Sanguinaria, 219 Sarsaparilla, 537 Sassafras, 539 Savin, 261 Scammony, 135, 147 Scilla maritima, 86, 219, 227, 246 Secale cornutum, 264 Sedatives, 271 Seignette, salt of, 129 Senega snakeroot, 217 Senna, 132, 146 Setons, 514 Sialagogues, 163 Silver, nitrate of, 483, 541 " oxide of, 485 Simaruba, 459 \ Sinapis, 89, 505 Skunk cabbage, 441 Slippery elm, 348 Snakeroot, 217 " black, 333 Soda, 551 " carbonate and bicarbonate, 551 " sulphate, 126 " phosphate, 132 Soot, 451 Soporifics, 355 Spigelia marylandica, 160 Spiritus mindereri, 204 " etheris nitrici, 239 Spurred rye, 264 Squaw root, 333 Squills, 86, 219, 227, 246, 263 Stannum, 157 Starch, 51 Statice caroliniana, 499 Stinkweed, 391 Stramonium, 225, 390 Strychnine, 43, 445 Strychnos nux vomica, 443 Styptics, 491 Sudorifics, 193 Sugar of lead, 499 ' Sugars, enumeration of various, 49, 50 Sulphur, 116 Swallow- wort, decumbent, 207 Tamarinds, 118, 337 Tannin, 495 Tapioca, 353 Tar, 217 Tartar, cream of, 130, 238 " emetic, 82, 204, 216, 227, 310, 512 IMH.X. )6S Tasteless purging salt, 182 Temperants, 837 Thebaine, 42 Thorn apple, 391 Thoroughwort, 200 '\\,\k „•,..,, - 'j 5, :;i7 " Indian, 88 Tolu, balsam of, 217, 223 Tonics, 31, 452 Tragacanth, 345 Turmeric, fed, 219 Turnip, Indian, 220 Turpentine, oil of, 158, 248, 265, 506 Turpeth mineral, 90 Urine, states of, 552 Uva ursi, 256 Valerian, 439 Vegetable antimony, 206 Venesection, 25 Veratrine, 43, 329 Veratrum album, 329 " viride, 329 Vesicants, 50,7 Vinegar, 338 Vitriol, while, 85 " blue, 86 Vitriolated tartar, 131 Volatile alkali 551 Wake-robin, 220 Wash, yellow and black, l o i Water, 156, 201, 555 Willow, 1=72 Wintergreen, 256. Wolfs bane, 825 Worms, account of the various kinds which infesi the human body, l-'-'i ; symptoms of, 152: their origin, 15:): medicines for expelling, 155 \Vm mseed, 160 Yellow wash, 191 ; Zinc, oxide of, 488 " sulphate, of, 85 S. S. 4- W. Wood's Medical Catalogue FOURTH EDITION OF A Sorio3 of Anatomical Platos, With References and Physiological Comments, Illustrating the structure of the different paru of the human body, with 200 Hates, 4to, by JONES QUAIN, Ml), Prof( ■■• at and Physiology In the University of London; and w. J. E. WILSON, M.D , l.< • Hirer 01 cal and Surgical Anatomy and L'hyslology, Fourth edition. Revised, ,1,1/, > ■, .,:, .. ., by JOSEPH 1'A.NOOAST, M.D., Professor of General, Descriptive, and Buqrlcal Anatomy lr Jefferson Medical College of Philadelphia, Lecturer on Clinical Burgcry at the 1'tal Hospital, Ac Price $l. r >, free of postage. " Much superior as a system to any that have been hitherto published In this eOQDtl dtecbloo-OhtrwQical Itemle/w, "The plates aro for the most part exceedingly well executed. It Is the cheapest wort: of lb* kind ever published in this country." — American Jourwd of Medical Bdenues. "The text and plates both being excellent, the book is a treasure indeed.' 1 — Iio»ton Mtd* •-»' and Surgical Journal. A TREATISE ON THE Etiology, Pathology, and Treatment of Congenital Disioc* tions of the Head of the Femur. ILLUSTRATED WITH PLATES. By JOHN MURRAY CARNOOIIAN, M.D., Lecturor on Operatic Surgery with Surgical and Pathological Anatomy, etc., etc. "Typographically, this is one of the most beautiful works that has emanated from the ined!- oal press of this country The plates, drawn from nature, are well finished, and are irery cred- itable to our draughtsman. The work itself treats of one of tho forms of congenital deformity, the cause of which Is unknown, and the cure doubtful. The work nils a gap which ban long been void, and the practitioner will gladly welcome Its accession." — Literary Woi-IaI. "This is a praiseworthy attempt to draw the attention of the profession to a remarkable pathological condition of the coxo-fetnoral articulation, which has frequently been mistaken for other diseases of this part, especially morbus coxarius, ooiarthrocace, or the so-called bip- disoase." — Ohio Med. A Surg. Journal. " By far the most complete and systematic work in the English language, and the only od« which' contains any directions for treatment ." — Brit. Am Med. & Physical Journal. " It is remarkable, in view of the numeroti> and exceedingly "aluable treatises and contribu- tions made by English surgeons on the pathological condition of the joints, that the subject of congenital dislocation of the head of the femur, should have been so'almost entirely unnoticed by them. " We feel a pride that the first monograph on this subject in the English language is from the pen of an American, and that is creditable to its author." — Am. Journal Med. 6cit ■<■ ex. "The work before us, giving an account of a special department of surgery, cannot ts.ll to prove of interest to the practical surgeon, as it appears to be an elaborate and faithful dehnea tion of a very distressing and badly-understood affection, which, until recently, has been deemed Incurable, and to which the attention of the profession has been directed only within the last few years."— Medical Examiner. THE YOUNG STETHOSCOPIST j OB, THE STUDENT'S AID TO AUSCULTATION, By HENRY ■' SOWl/zMJH, MU*, OlTl 69 Till" WTTOKTIANS OF MASSACHUSETTS GENESAJ. HOBPEIAZ-, •-ice, $' -5, free of postage- "This is an exceedingly clover tittle work— clear, concise, and to the purposp, V> i£S*t,w r no work on the subjeot better adapted to the wants of the student who Is just beginning &? •tudy of auscultation." — Medical Examine''" " We are fully convinced that this work k ..„,, onapted to the wants of the students, and that it supplies an obvious deficiency in the medical literature of our country. Piain and simple in its arrangement, accurate in details, and sufficiently extensive for elementary pur- poses, it should become the companion of every student of auscultation." — Western Lanct J "This is a concise, yet clear and comprehensive — compact, yet sufficient, summarv of the essentials of auscultation, by an accomplished Stethoscopist, who derived at once his zeal and his knowledge from the fountain head, the teachings of the great Louis."— Annalist. "This is a practical work on auscultation, and well calculated to Interest and instruct all who have a love for the science of physical diagnosis, v — MifWruri Med. a/id SurgicaJ Jitw ".'. "Dr. Bowditeh has the honor and credit of having given to the profession one of the mint concise, clear, and comprehensive works on physical diagnosis, hitherto published In any country." — New York Journal qf Medici* e. " It Is a concise, clear, and comprehensive treatise on physical diignosis, such as every stri- dent requires." — Western JnurmU of Medicine and Surgery. " It is an excellent elementary treatise, clear, precise, and accurate, and may, afl each, be itrongiy recommended to the student " — Am. Journal 0/ Medical Sciences. ubHn Quarterly Jour- nal of Madia il Science. "The profession, already indebted to Prof. Budd, for one of the best monographs on Diseases of the Liver, will not fail to appreciate the present excellent work on gastric affections."— Southern Medical and Surgical Journal. " We regard it as one of the best and most reliable works on the subject, that has appeared for a long time." — Eclectic Medical Journal. "The whole subject is brought up quite to the times, treated in a full, clear, scientific, and highly practical way. " We must say we should suspect any physician of neglect or indifference to the best interest of the sick, who neglects to consult Budd on Diseases of the Stomach." — Iowa Med. Jour. "The work will be found an excellent monograph, which the dietetic habits of many Ameri- cans renders of peculiar interest to the profession in this country." — College Jour. Med. Science. The Practitioner's Pharmacoposia, and Universal Formulary; Containing Two Thousand Classified Prescriptions, selected from the practice of the most eminent British and Foreign Medical authorities, &c, &c. By JOHN FOOTE, M.R.C.S., London, with additions by Benjamin "W. McCreadt, M.D., Professor of Materia Medica and Pharmacy in the College of Pharmacy, N. Y., &c. Price $1 25, free of postage. " Dr. Foote's Formulary Is an excellent one of its class, and we take pleasure in commending it to the profession." — Medical Examiner. " We recommend it as the best work of the kind with which we are acquainted." — New York Medical Times. " This is another of those works designed to assist the practitioner in time of need and argency ; it will be found to meet very fully these Indications." — Nelson's Am. Lancet. " Its appropriate place is on the table or desk ready for daily or hourly consultation. No one who possesses it, and appreciates its merits, will give it a place elsewhere, except to rest, whilst he is doing the same." — Medical Counsellor. "The newest in regard to the materials which compose it, the easiest of reference, and the most valuable compendium for daily use." — New Hampshire Journal of Medicine. SECOND EDITION OF THE DISEASES OF THE RECTUM, By RICHARD 'QUAIN, F.R.S., Professor of Clinical Surgery In University College, SurgeoH to University College Hospital, &o. With colored plates. 8vo. Price |2 25, free of postage. "An extremely good guide for all who have to deal with these troublesome complaints."— British and Foreign Medico-Ohirurgical Review. "Few works on the subject contain bo much useful and really practical Information." — Asso* elation Medical Journal. "It Is the best treatise on the diseases of the rectum." — New York Journal of Medicine. " It is one of the best we have met with on the subject." — Ihiblin Q'ly. Jour. Med. Science. "Wo are acquainted with few works so practical, concise, clearly written, and distinguished by such sound sense as ta».s." — Medical Times and Gazette. THE DISEASES OF WOMEN AND CHILDREN. BY GUNNING S. BEDFORD, A.M., M.D., Professor of Obstetrics, the Diseases of Women and Children, and Clinical . wifery, in the University of New STork, Author ofthi Pi and Practice of Obstetrics. SIXTH EDITION, CAIIEFULLY REVISED AND ENLARGED, 8vo, 653 pp. S. S. * W. WOOD, 389 BROADWAY, NEW YORK. Price, $3.25, free of Postage Tub rapid and wido-sproad circulation of this eminently practical work is, wo think, without precedent — having reachod its Sixth Edition in little over j from the day of its first publication. It is a storehouse of knowledge for the and practitioner of medicine — full of practical precepts and bod-side information. Rarely has any medical publication met with such universal commendation from the medical press, botli at homo and abroad. " Successful as the work has boon at home and abroad, we were not prepared to see it achieve a success exceedingly rare in the history of American medical authorship, viz., a Translation into the French language. We congratulate the author upon this high compliment paid to his labors in the still new field of pathology, where so many struggle vainly for reputation. While this tran is the highest possible acknowledgment of the value of Dr. Bedford's labors, it secondarily reflects creditably upon the rising importance of the American school of medicine. — American Medical Times. "We hail the advent of such a work, abounding in practical matter of the deepest interest, and illustrated by principles and laws ordained by nature. Xor can we refrain from expressing our surprise and gratification at finding the book so remarkably exempt from the superficial views that abound in the great thorough- fare of medicine. The rapid sale of this work we believe to be unprecedented irj the history of medical literature in this country, which must be highly gratifying tc the author, showing, as it does, the degree of estimation placed upon his labors by the medical public." — If. Y. Jour, of Med. and the Collateral Sciences. " We are quite sure that the work will be a welcome addition to professional li- braries in Great Britain as well as America." — Brit, and For. Med.-Ohir. Review. " We think this thw most valuable work on the subject ever presented to the profession. We have perused every page of the book with interest, and speak, therefore, from personal knowledge." — Cincinnati Med. Jour. " A careful perusal of Dr. Bedford's book has led us to believe that its value wiL continue to be acknowledged, and the author recognized as a most able and acute practitioner of medicine. The work is of the most practical character; every thing is made to tend toward the relief and treatment of disease, and remarkable skill is shown in quickly arriving at an accurate diagnosis. To get at once to the point is the pervading characteristic of the author's teachings. We cordially recommend it to all practitioners and students of medicine." — London Lancet. " It is to be regretted that we have not more such books in Great Britain." — London Medical Times and Gazette. " The style of the author is very graphic. The book not only proves Dr. Bedford to be a sound physician and an excellent clinical teacher, but it also affords evidence of an extensive acquaintance on his part with the literature of his subject on this side of the Atlantic." — London British Medical Journal. "An examination of this work convinces us that the author possesses great talent for observation, and that his opinions are sound and practical. He shows an intimate knowledge of the doctrines of the ancients and the opinions of the moderns. The variety of instruction contained in this volume, the ability with which it is pre- sented, and the truthful practical character of the doctrines advanced, give to it very great value." — Gazette Medicate, Paris. S. S. $> IV. Wood's Medical Catalogue " The working men in America ure always on the look-out tor the new lights rising over the old world, and they often too hastily adopt as the pnre gold of science, the crude lucubrations which must find place with more valuable matter in the weekly medical press. But this observation does not apply to our author, who is jredita-bly known by other works, and hi the one before us shows himself to be a judicious physician, anxious alike for the good of his patients and of his pupils ; one who has acquired the happy art of teaching how to get at the characteristics of disease, and how to drag at the chain of effects, until the mind grasps the first link in the chain." — Rankin's Half-Yearly Abstract of the Med. Sciences. " The subjects have been developed with no ordinary powers of clinical instrua tion." — N. 7. Med. Times. ' W e have been both pleased and instructed by a perusal of the book, and con fidently recommend it, therefore, to the profession, as an excellent repertorium of clinical medicine. The eminently practical ideas of the author, clothed in simpla and perspicuous language, ars delivered in quite an attractive, affable, and off-hand manner." — Philadelphia Med. Examiner. " It is not often that British critics commend an American book ; so when their approval is obtained, we may rest assured that the work commended is of no ordi- nary merit. Dr. Bedford's book is characterized by Dr. Churchill as ' worthy of its author, a credit to his country, and a valuable mine of instruction to the profession at large. 1 We have read every page of the work, and feel called upon to say that we regard it the most valuable contribution on the subject ever offered to the profes- sion." — Charleston Med. Journal and Review. " A work of great practical interest— one well calculated to interest and instruct the busy practitioner ; it points out to him the most modern therapeutical agents, and their method of administration ; and, above all, gives beautiful and satisfactory explanations, physiologically, of the symptoms of disease. This latter quality is a great merit of the book. As a faithful representation of the daily labors and duties of a physician of our day, and as an accurate delineation of the diseases of women and children, it is well deserving of our praise." — Virginia Med. and Surg. Jour. " We were actually fascinated into reading this entire volume, and have done so most attentively ; nor have we ever read a book with more pleasure and i rofit. There is not a disease connected with infancy or the female system which is not most ably discussed in this excellent work." — Dublin Quarterly Journal of Medical Science. " Professor Bedford's book is a good one. , We like it, for we can digest a dinner over it without going to sleep, and that is more than we can say of most medical books." — New Jersey Med. Reporter. " To read this work is to be struck with its truthfulness and utility ; we find all tnat is useful in practice, ably communicated, and elegantly expressed. American works are not generally read on this side the Atlantic, but we recommend Dr. Bedford's book as worthy of the very best attention of the profession." — Midland Quarterly Journal of the Medical Sciences, London. " TVe have said, on former occasions, that the man who will bring forward clinical or practical instruction to bear upon the medical teachings of our country, will be immortalized. We want practical observations — fresh from the bed-side. Dr. Bed- ford's volume is drawn from an extensive clinic, founded by him in the University of New York, and is fortified by much reading and research. This is a good book, and the profession owes Dr. Bedford hearty thanks for the labor he has bestowed upon it." — Philadelphia Med. and Surgical Journal. " The work before us is eminently practical, and therefore valuable as a contri" bution to medical knowledge. Prof. Bedford's extensive opportunities have enabled him thus to bring together a large number of the most interesting cases of female and infantile affections, and to indicate his views of their treatment. Li the accom- plishment of the task, the author has evinced a degree of discernment which w T ilL doubtless, add materially to his already extended ^reputation." — Southern Med. and Surg. Journal, Augusta, Georgia. " No one can read this book without becoming convinced that it contains much valuable instruction, and is the result of a large experience in this specialty." — New Hampshire Jour, of Med. "The work contains graphic descriptions of the diseases of women and children, with judicious advice as to treatment." — Boston Med. and Surg. Jour. Price $3.25, toy mail, free of postage. »S'. cf- W. Wood's Medical Catalogue. Lectures on Natural and Difficult Parturition. BY EDWAED WILLIAM MUKI'IIY, A.M., BUD, Professor of Midwifery, University College, London ; Obstetric Ph/UStciCM, OMntrsttp CoU lege Hospital ; and formerly Assistant- J'hj/Mirian to Dublin Lf/ingAn HoH/nUU One vol. 8vo. Price $1 7ft, free of postage. Illustrated by Seventy Engravlnga, "This Is a very excellent trcatlce on Obstetrics." — American Journal of Mid. 80U/IWM. " It lias high claims upon the attention of the profession ; even old practitioner! may con mi If lis pages wlili profit " W" know of no work which we can so heartily commend to the Student, and to the eo eoucheur In active practice afl that which constitutes the Subject of tola notice.'— fjmithern Journal of Medicine and Pharmacy. "The author writes like ono thoroughly acquainted with the literature and practice Of tbll branch of the profession; and the work must certainly be regarded as a most excellent one >.1 its kind. The view of the author seems to be to condense within a moderate corni MS 1 I mass of materials furnished by other and more voluminous works." — New Orleant Medical anil Surgical Journal. "The subjects are well chosen, and suitably arranccd ; covering all the grojnd usually em- braced In a course of lectures on obstetrics, all of which are presented In n cl wr and forcible manner. The style is luminous and readable Throughout, the work Is Illustrated by wood- cuts exhibiting the different stages of labor, the organs involved, and the Instruments employed In delivery." — St. Louis Medical aud Surgical Journal. "The studont will find it replete with accurate and lucid instruction." — London Med. 0'ar.et1& "This is an excellent book. It is commended to us by the position and rich practical expe- rience of the author. It is comprised within limits which will not exhar.Pt while it improves, and Is not so expensive as to make it a very serious question whether it shall be bought or net. It consists of thirteen lectures, on Important matters; embracing, In short, what It behooves every practitioner to know, and to know thoroughly." — Boston Medical y P. 8. TOWNSEND, M.D., under the supervision of; and with Notes and Addi- tions by, VALENTINE MOTT, Ma»., Professor of Surgery in the University of New York, (fee, dkc, with Additions by GEORGE C. BLACKMAN, M.D., Professor of Surgery in Medical College of Ohio, Ac. In 8 vols. 8vo. anil a Quarto Atlas of Plates. Price $15, free of postage. Of this valuable work, the revisions anil additions, &c, Dr. Mott has furnished the following recommendation, viz. : " Depau Row, July 11, 1856. " 6. 8. & W. Wood: My Friends: I have looked through the three ponderous volumes your last edition of Velpeau generally : some of the chapters I have examined with great care. " My astonishment is renewed in beholding the prodigious labors and learning of Velpeau. " The new arrangement ol some of the chapters, particularly the extended one on aneu- risms, have greatly improved the work. " The additions In brackets throughout the whole text, as made by Dr. Blackman, with the American Appendix, of more than one hundred pages, brings it up to the present time in Euro- pean and American Surgery. "It is now, indeed, a National Surgery, and ought to be laboriously and faithfully studied by our pupils, and made a constant work of reference by every Surgeon. "Truly, your friend, V. MOTT." " The present edition of this work is an improvement upon its predecessors. The hand ol revision is seen principally in the second volume, while to the third, we have added an Ameri- can appendix of 134 pages. Of the additions which Dr. Blackman has made to the text, we shall not speak farther than to say that they are judicious, and are designed to bring >.be litera- ture of each subject down to the present time. The editor exhibits that extensive and critical knowledge of the progress of surgery which has always characterized his writings, and which peculiarly fitted him to the task of revising a work of such literary researches as the Elements of Velpeau. " The American Apr endix added to the third volume embraces a large number of subjects which could not be inserted in the body ol the work. This portion adds much to the value of the fourth edition, by rendering it complete in its historical details of operations to the present •line." — Nemo York Journal of Medicine. " ' Mott's Velpeau ' is too widely known to the profession In this country to require a special ootice at our hands. It is universally admitted to be the most extensive work on operative mrgerv that has ever appeared in the English language. " In his preface, Dr. Blackman remarks that it has been his object to arrange the work more methodically, and to incorporate the more important contributions made in the department oi Operative Surgery, during the past ten years. His valuable statistics of operations on the arte- ries, of amputations, of exsections of the bones, &c, are to be found under their appropriate beads in the text of the work. His Appendix, arranged in alphabetical order, and comprising I SI pages, with numerous wood-cuts, is at the end of the volume, and contains much valuable Information for the practical surgeon." — Western Lancet. "The previous editions have been long known and appreciated by the profession; and the present one will be equally w»ll received as a decided improvement upon its predecessors, in iccordance with the progress of the operative science and art to which its twenty-eisht hun- dred and seventy-three elosely printed pages are devoted. * * * Dr. B'ackman has per- formed his laborious and responsible task with adequate fidelity and ability ; and has well earned the respect as well as thanks, of all who desire to possess one ot the most voluminous \m\ comprehensive, if not the most authoritative, treatise on the elements of Operative Snr- ;ery yet published In the United States." — American Journal of Medical Sciences. " It is a work which embraces almost every known or imagined operation of early or lata times, and is indispensable as a work of reference to surgeons." — 1U. Ala. Med. A Surg. Jour. The Anatomical Remembrancer; OB. COMPLETE TOCKET ANATOMIST: Containing a concise description of the structure of the human body. Second Edition. With corrections and additions by C. E. ISAACS, M.D., Demonstrator of Anatomy in the University of New Vork. Price 50 cts., free of postage. "It Is anatomy — clear, correct, and practical — in a nut-shell." — Nelson's American Lancet "A very completo and convenient little book, for the use of students in the dissecting-room." ^Southern Med. and Surg. Jour. "It presents, In admirable miniature, an outline picture of the whole subject, so concen- trated that a short time only is necessary to review the whole science. It Is, in fact, anatomy. In a nut-shell." — Eclectic Med. Jour. "A valuable little companion for the student of anatomy, or for any persona who may ba preparing tharasolves for an examination."' — Western Lancet. COLUMBIA UNIVERSITY LIBRARIES This book is due on the date indicated below, or at the expiration of a definite period after the date of borrowing, as provided by the rules of the Library or by special ar- 1 rangement with the Librarian in charge. DATE BORROWED DATE DUE DATE BORROWED DATE DUE C23M UO)M 100