Tills work must be consulted in the Boston Medical Library 8 Fenwaj rF oNv Sjfo^d'ii "~ "" 1 ' fj_ j.'JiJ Jill vj \A ,2.f^p^^ll Digitized by the Internet Archive in 2011 with funding from Open Knowledge Commons and Harvard Medical School http://www.archive.org/details/americaneclecticOOscud THE AMERICAN ECLECTIC Materia Medica AND THERAPEUTICS. BY ' ^-^ -f^ '^•: ^■' JOHN M. SCUDDER, M. D. Professor of the Principles and Practice of Medicine in the Eclectic Medical Institute of Cincinnati ; Author of the Eclectic Practice of Medicine, the Principles of Medicine, Diseases of Women, Diseases of Chil- dren, Specific Medication, Specific Diagnosis, on the Keproductive Organs and the Venereal, Etc. TENTH EDITION, REVISED AND REWRITTEN. I // CINCINNATI: PUBLISHED BY THE AUTHOR. 1883. Entered siccording to Act of Congress, in tlie year ]883, BY JOHN M. SCUDDER, In the office of the Librariiin of Conirress. PREFACE TO THE TENTH AND REVISED EDITION. Whilst there have been great advances in the science of medicine, especially in therapeutics, since this work was first issued, the author deems it of importance to the profession that the old remedies and old methods should be kept in view. The practitioner needs to re- new his acquaintance with them from time to time, that he may lose nothing good of the old practice, and that he may clearly trace the connection between the old and the new. The student requires it,' that he may attain a complete knowledge of therapeutics and materia medica. We claim to be a free and liberal class of physicians, and we do not recognize the right of any man either inside or outside of the Eclec- tic ranks to dictate what we shall use or how we shall use it. Every practitioner is personally responsible for the results of his practice. If he does a patient a wrong by large doses and poisonous efi"ects, he is guilty to the extent of the wrong. If he fails to give reliefer save life because of small doses and inefficient remedies, he is equally guilty. A physician is responsible to his patients in that he agrees to furnish that knowledge and skill which comes from thorough study and close observation. He can not claim that he has done his whole duty, unless he has been "eclectic" in fact, choosing from all sources that which to him seems best. I do not think that any one can know what Eclecticism is unless he has studied it from the beginning. It is wonderful what a mass of material the "fathers" had gathered together, and it is a matter of equal interest to note the evolution of our present practice — spe- cific medication — from this. The reader may think it strange, but three-fourths of modern homoeopathy ia from this source, and nine- tenths of modern Eclecticism. yi^ PEEFACE. The old-time Eclectic ujed a weak infusion for its direct effect, where we now use five or ten drops of a powerful tincture in water for the same purpose. There was not even the difference in dose that many persons have supposed. True, our old doctor made a libe- ral use of emetics, cathartics, diaphoretics, and diuretics, but he knew when to use them. He vomited his patient when the stomach contained material it could not dispose of, and which was not only a cause of disease, but prevented the action of needed remedies. He did not put an emetic in an irritable stomach, or use it when it was not needed. He was rather free in the use of cathartics, but they were simple and mild, and he managed to " put them in the right place," and stopped when unpleasant materials had been removed from the bowels. Though rough in his external appearance, he was "wise in his gen- eration," and left it for modern scientists to go over the pons asinornm with quinine, morphine, and whisky, for all diseases to which flesh is heir. Whilst we wish to do full credit to the "fathers " in our school, and present their views fairly, we will endeavor to show that our present teaching of "small doses of pleasant medicine for direct effect," is the rational outcome of the old studies. It will be presented in brief form, yet sufficiently full for all practical purposes. "With the old and the new before him, the student should be able to make Ms study of therapeutics thorough, and his materia medica the assurance of a successful practice. OOISTTENTS. PART I . General I'herapeutics 9 Methods of Cure 10 Disease 33 Law in Medicine. • 44 Action of Medicines upon the System 51 Art of Prescribing Medicines 75 Preparation of Remedies 93 PART II. Special Therapeutics 95 Classification of Agents 97 Division I — Eliminatives. Class I. — Emetics 98 Remedies 115 Anti-emetics 136 Class II.— Cathartics d 139 Remedies 159 Class III. — Diaphoretics 187 Remedies 202 Class IV.— Diuretics 228 Remedies 241 Division II. — Neurotics. Class v.— Sedatives ' 268 Remedies 278 Class VI.— Narcotics 310 Remedies 320 Class VII.— Stimulants 348 Remedies 351 Class VIII.— Anaesthetics 388 Remedies 402 Division III. r Class IX. — Refrigerants — Antipyretics 409 Remedies 419 8 CONTENTS. Division IV, — Hematics. Class X.— Tonics 427 Remedies 433 Class XL— Alteratives 472 Remedies 476 Division V. Class XII. — Revulsives 504 Remedies ,....„ 511 Division VI. Class XIII.— Astringents .......536 Remedies. 542 Division, VII. Class XIV. — Expectorants 561( Remedies •. 567 Division VIII. Classi-XV. — Antiseptics 584 Remedies 590 Division IX. — Uterina. Class- XVI. — Emmenagogues 605 Remedies. • 607 Class XVII.— Parturients 619 Remedies 622 Class XVIII.— Abortives 629 Remedies 630 Division. X. Class XIX. — Antispasmodics 632 Remedies 636 Division XI., Class XX.— Anthelmintics 648 Remedies 651 Division XII. Class XXI. — Sialagogues. ;..657 Remedies 658 Class XXII.— Errhines 660 Remedies 661 Division XIII. — Chemica. Class XXIIL— Antacids 665 Remedies 669 Class XXIV.— Antilithics ..676 Division XIV. — Mechanica. Class XXV.— Demulcents 686 Remedies 688 Class XXVI.— Emollients ..700 Remedies ,.703 Class XXVII.— Diluents 709 Division XV. Class XXVIII.— Antidotes 713 A PRACTICAL TREATISE GENERAL AND SPECIAL THERAPEUTICS. PA_IIT I. GENERAL THERAPEUTICS. The term Materia Medica embraces all of those agents termed remedial or curative, which are employed either with a view to palliate or cure diseases. It treats of their natural characters, sensible qualities, chemical properties, and of their mode of action. Remedies may be divided into two great classes. The first may be termed losychieal or mental remedies, and embraces all those influences which may be brought to bear upon the mind of a person laboring under disease, and which often, if rightly applied, tend much to facilitate a cure. The second may be termed corporeal remedies, and embraces all agents of a curative nature, whether imponderable or pon- derahle. T hera'peutics is that branch of medical science which treats of the administration of remedies, and their effects upon the system. Thus, it treats of the changes in function, sensa- tion, or action, wrought upou the system when in a state of disease, by the exhibition of the various agents included under the term materia medica, by which disordered function, sensation or action is subdued. In other words, it treats of the precise steps or series of influences by which morbid phenomena or diseased action is arrested, and health re-es- tablished. In a more extended signification, thecapeutics embraces not only the administration and mode of action of remedies, (ix) 10 GENERAL TIIEKAPEUTICS. but it likewise takes cognizance of the morbid process ex- isting— the pathology of the disease, the variance from a physiological condition or state of heaUh. Thus says Dr. Dunglison : "To be a good therapeutist, a man must be well versed in every department of medicine, and be capable of observing and reasoning well. He may be a good observer, and yet a bad reasoner. He can not practice well unless he is both." METHODS OF CURE. It is maintained by homeopathists that there are but three possible relations subsisting between the symptoms of dis- ease and the specific effects of remedies. The first is oppo- sition, the second resemblance, and' the third heterogenity ; con- sequently there are but three methods of removing disease by the use of medicine, namely: Antipathic, Homeopathic and Allopathic. Antipathia. The antipathic method of curing disease consists in the use of appliances or medicines that produce effects of a na- ture opposed to the symptoms of the disease, and hence the axiom '■'■ Contraria contrariis opponenda."" Hippocrates enter- tained these views, and may be regarded as the founder of this doctrine; for says he, "All diseases which proceed from repletion are cured by evacuation ; and those which proceed from evacuation are cured by repletion. And so in the rest, contraries are the remedies of contraries." Much of the practice in vogue at this time is based upon this principle. Purgatives are exhibited to relieve constipa- tion; cold is employed to alleviate the efTects of burns or scalds; narcotics to abate pain, etc. Homeopathic johysicians object to antipathic remedies; they assert that, although the primary effects of the agents named may. produce phenomena opposed to the disease, yet. their secondary efibets are similar to those which they are exhibited to remove. They maintain that the primary eflect of opium is constipation, hwt its secondary effect diarrhea; the primary action of purgatives is followed by constipation. These secondary effects do sometimes follow the administra- tion of remedies, though this can not be considered the rule, HOMEOPATHIA. 11 but the exception. Thus diarrhea is of very uncommon oc- currence as a result of the administration of opium; and though constipation may, and often does follow tjie use of purgatives, yet it is by no means an invariable result. HOMEOPATHIA. The homeopathic method of practice is that founded by Dr. Hahnemann upon the maxim ^^Similia similibus curan- tiir" or in exhibiting remedies capable of producing effects similar to the disease for the removal of which it is given. A few of the many examples claimed by the homeopath- ists as evidences of remedial agents producing eftects similar to those of the disease for which they were administered, and by their so-called secondary efi'ects proving curative, may serve to illustrate the doctrine which they maintain to be the only true one. They assert that white hellebore has cured patients attacked with violent cholera, and yet it caused a disease similar to cholera, when exhibited. In a disease attended with great sweating, which occurred in England, called the " sweating sickness," it was treated successfully only by the use of sudorifics. Purgatives will cure the dysentery; tobacco oc- casions nausea and giddiness, and relieves the same; senna occasions colic, and is one of the remedies for this disease; ipecacuanha cures dysentery and asthma, because it pro- duces hemorrhage and asthma; belladonna causes a sense of choking and horror of liquids, with fixed and sparkling eyes, and propensity to bite attendants — in short, a disease having the semblance of hydrophobia, which it is said this agent has cured. Opium relieves lethargy and stupor by converting it into natural sleep, and the same agent is a cure for constipation. The vaccine disease protects from small- pox upon the same principle. Cold, either in the form of snow, cold water, or some freezing mixture, is found to be the best application to frost-bitten parts. In scalds or burns, relief is obtained by exposing the part to heat, or by the application of heated spirits of wine, or oil of turpentine. "We can not better illustrate Hahnemann's views of the action of remedies, than by giving the language of Percira. " The medicine sets up in the suflering part of the organism 12 GENEEAL THERAPEUTICS. an artificial but somewhat stronger disease, vvhicli, on ac- count of its great similarity and preponderating influence, takes the place of the former, and the organism from that time forth is afiected only by the artificial complaint. This, from the minute dose of the medicine used, soon subsides and leaves the patient altogether free from disease; that is to say, permanently cured." Hahnemann conceives that the secondary efiects of medi- cines are always injurious, therefore he recommends that no more be given than is absolutely necessary to cure the dis- ease. Proceeding upon this principle, he has reduced the doses of medicines to such a minute state of division, that in many cases no human intellect is capable of appreciating the slightest influence from their administration. Many of them, when exhibited in full or ordinary doses, produce efifects scarcely appreciable, and when reduced to the mil- lionth, quintillionth, or even decillionth part of a grain or drop (the usual dose being large, say one or two drachms of the powdered article, or sixty drops of the tincture), how they then can exert any controlling influence over a disease that is grave, if they do so, as is asserted, is a mystery inca- pable of being solved by finite minds. To give credence to such a doctrine requires a stretch of imagination that we imagine few possess. The method of obtaining these minute doses consists in reducing the solid to a powder, and mixing one grain of it with ninety-nine grains of sugar of milk — this is called the first attenuation; the second attenuation is obtained by mix- ing one grain of the first attenuation with ninety-nine grains of sugar of milk ; and the third by mixing one grain of the second with the same quantity of sugar of milk, as before. In this way Hahnemann proceeds to the thirtieth attenuation. Alcohol is the diluent of liquid medicines, and the attenua- tions are obtained in the same manner — that is, by mixing one drop of the mother tincture or liquid with ninety-nine drops of water, and in this manner continuing the dilutions up to thirty, as in the case of solid substances. The annexed table shows the strength of the difl'erent attenuati-ons : First attenuation, — one hundredth part of a grain. HOMEOrATHIA. 13 Second attenuation, — one thousaudtli part of a grain. Third " " millionth " " Sixth " " billionth " " I^inth " " trillionth " " Twelfth '• " quadrillionth " " Fifteenth " " qnintillionth " " ) Eighteenth " " sextillionth " " Tvventy-first " " septillionth " " Twenty-fourth " " octillionth " " Twenty-seventh " " nonillionth " " Thirtieth , " " decillionth " " The miniitei>.ess of the dose is carried to the same extreme, as seen by the following table, as presented by Pereira : Charcoal, one or two deciliionths of a grain, Chan-iomJle, two quadrillionths " " iNutmeg, U\c> milliontbo " " Tartar emetic, two billionths " " Opium, two deciliionths " " Arsenious acid, one or two deciliionths of a gr. • Ipecacuanha, two or three millionths of a gr. In modern homoeopathy the decimal is used in the place of the centessiuiul. Thus a first trituration would be one of the remedy to nine of sugar of milk; tlie second one of the first to nine more of the sugar ; the third one of the second to nine of the sugar, and so on. Dilutions are made in the same pro- portions wifhout reference to shakes, and thirty one-ounce bot- tles, with thirty ounces of alcohol, would be sufficient to carry one drop of a remedy to the thirtieth dilution ; and a thousand bottles and a thousand ounces of alcohol would carry it to the one-thousandth, which they mark M. Increasing the potency of a medicine by trituration or shaking, is now generally aban- doned. Such are the doctrines, and such an outline of this far- famed system of infinitesimal practice. The principal facts urged against the doctrine, may be embraced under four heads : 1st. Many of our most certain and valuable medicines do not act homeopathically ; sulphur does not produce scabies, nOr does cinchona, or any of its preparations, give rise to intermittent fever; and yet these agents arc used with great 14 GENERAL THERAPEUTICS. certainty for the removal of the diseases named, and no one questions their utility. Andral took quinia without con- tracting intermittent, — and who has seen that disease, or one similar to it, follow the use of cinchona? We have often emplo3'ed it, without ever witnessing such results. It may be urged, however, that the diseased state whicli previously existed, precluded the development of that disease. Xor have we ever seen scabies follow the use of sulphur; but, perhaps, the homeopathist might say the existence of a previous morbid state acted as a Jbarrier to its occurrence. Acids and vegetable diet cure the scurvy, but they never produce a disease analogous to it. 2d. Pereira asserts that many homeopathic remedies would increase the original disease, as acrids in gastritis, canthar- ides in nephritis or cystitis, or mercury in spontaneous salivation. 3d. The doses in wdiich these agents are exhibited, are so exceedingly small, that it is difficult to believe they pro- duce any effect on the system, and therefore we would sup- pose that the reputed homeopathic cures are clearly refera- ble to a natural and spontaneous effort of the system, aided, perhaps, by strict attention to diet and regimen. 4th. Homeopathia has been put. to the test in numerous cases, without the least perceptible improvement or change in the nature of the disease, and this under the immediate inspection of some of the most eminent memba*^s of that system of practice. "Andral tried it in 130 or 140 patients, in the presence of the homeopathists themselves, adopting every requisite care and precaution, yet in no one instance was he successful." Recently it has been put to the test, in some of the European hospitals, in a large number of cases ; a given number of cases being treated homeopatliically, and the same number of cases (all being similar) being left to the unaided efforts of the system, — regimen and dietetic rules alone being enjoined, — and the results were not very dis- eimilar in the two classes of cases. If these be facts, the attenuated system of practice adopted by Dr. Hahnemann, can not be one upon which the practi- tioner of medicine can place reliance with any degree of confidence in diseases of a formidable character. HOMEOPATHIA. 15 Whether we regard tlie homeopathic system of practice as wholly negative in its effects, or as positively curative, it matters not, so far as its merit is concerned. That it pos- sesses merit, we do not feel at liberty to deny ; but whether of a positive or negative character, is a question about which "there is much dispute. So far as the rules of dietetics, as enjoined by homeopathists upon their patients are concerned, wc have never seen any that surpassed, if, indeed, equaled, those which they have adopted. And so far, all will admit that their system of medication is positively useful and cura- tive ; and may Ave not inquire, is not much of the succes** which they claim for their practice, to be fairly and justly ascribed to this cause? Does not that rigid regimen, that scrupulous avoidance of every article of diet of an oppres- sive or indigestible character, leave nature free to act, and does it not invite her to assert her own prerogative? — does it not leave the vis vitce, the vis medicatrix naiurcE unoppress- ed, unobstructed, and independent, by which her powders rally, and she throws off" disease, and abnormal action is arrested? May we not reasonably account for many cures in this way? We think it is not unreasonable to award much credit to this system of practice, upon the grounds above named. Then if it be not regarded as positively curative in this respect, so far as a system of medication is concerned, yet it is important for the reason that it leaves nature free to act and rid herself of disease, and is, therefore, to be regard- ed as a highly valuable mode of negative medication. Do we not daily see febrile and inflammatory diseases relieved in this way, without a particle of medicine ; every one of com- mon observation knows this to be an indisputable fact. How often do we see many of the most obstinate diseases relieved by the unaided efforts of the system. We have often seen patients recover, who we believed to be dangerously ill, but who, from an aversion to drugs, a fear of poisonous agents, penuriousness, or some other cause, did nothing of an active character. Then may we not truly say, nature is all-power- ful iu throwing off disease. If, then, nature effectually eradicates a vast number of diseases, and those that baffle the skill of the most experienced physicians, even when called at an earlj^ hour in their course, and aided bj the best 16 GENERAL THERAPEUTICS. of care, may we not reasonably concladc that recoveries would be very numerous if no physician of any kind was culled, and no medicine administered. May we not reasonably and justly conchide, from what has been just stated, that the attenuated form of medication — the infinitesimal doses, often receive credit when none should be awarded to it ; that their influence is imaginary, and not real; that they exercise no positive curative agency in many, perhaps not in any case in which they are admin- istered, but in which it is ascribed to them ; that their eftects are negative, and that the powerful influences, benefits and advantages, claimed to follow from the exhibition of the millionth or decillionth part of a grain of charcoal, common salt, or of silex, or sand (and all other agents when admin- istered in a form so attenuated), and carried out according to the doctrines of Hahnemann, are but an imposition on the credulity of the people, which must be apparent to any one who investigates the subject. Does it not seem to be practic- ing upon the expectant plan wholly ? Does it not seem to be a mere placebo — the bread-pills, or colored-water exhibited in a new form. To believe that a dose of the most simple agent, so minute that it is entirely beyond the conception of the human mind, exercises such a powerful control over the human system when in a state of disease, requires an imagin- ation so acute (it seems to us) as it falls to the lot of but few mortals to possess. As well may we imagine that the mil- lionth or decillionth part of a grain of our daily sustenance, taken three times a day, will be sufiicient to sustain life ; that it will support the wants of the animal economy, and maintain all the varied processes of secretion, excretion and innervation, as that a similar amount of salt, charcoal, etc., will eftect great sanative changes upon the human body when in a state of disease. Although we can not repose confidence in the Hahneman- nian system of medication as a whole, — as a positirely curative system, — but must regard it as a negative one, yet we are fully satisfied it will be of great good to the medical profession, and to mankind generally. We have long since been fully persuaded that too much medicine was used — that the patient was too frequently and too largely dosed with drastic, corro- ALLOPATHIA. 17 sive, or poisonous drugs, without any definite object or well- defined reason in view on the part of the physician. Less medicine will be found to be to the advantage of patients, and physicians will learn from the homeopathic system to administer it in smaller quantities, to give it less frequently and with a definite object in view, and above all, to repose more confidence in the recuperative powers of the system, when, untrammeled by the use of nauseous, and often oppressive and disease-creating drugs. In this light we view homeop- athy as positively advantageous, and as calculated to bring about, or aid in bringing about an important reform in the practice of the healing art. We regard the principle of " Similia Similibus Curantur,'" as laid down by Hahnemann in the administration of medi- cine, as true in some cases, but not as being an infallible or invariable rule, by which the physician is to be governed in all cases. Disease was treated upon this principle long before the day of Hahnemann ; but when disease is treated in accordance with this axiom, the remedy, in order to prove efi'ectual, is best given in sensible doses. Allopathia. . The allopathic or heteropathic method of cure is based upon the exhibition of remedies which produce phenomena neither similar to, nor exactly opposite to those of the disease^ It consists in curing disease upon the axiom " Contraria Con- trariis Curantur." By this mode, a cure is effected by counter-irritation or antag- onism; in other words, by establishing an artificial or second- ary disease that shall displace the primary one. This practice is based upon the influence which one disease is known to exert over another ; as, for instance, the supervention of diarrhea during the progress of some other disease, with a subsidence of the original disease, apparently the result of the diarrhea. Occurrences of this kind undoubtedly first prompted the use of agents producing alvine evacuations in similar cases. Cutaneous eruptions sometimes appear and are soon followed by the disappearance of an internal disease existing at the same time ; and the disappearance of the eruption is often followed by some internal disorder. These 18 GENERAL THERAPEUTICS. occnrrences then point to the use of blisters aid other revul sivcs, with the view of estabhshing an artilicial disease. One disease seems to modify another, then, bj estabhshing a new point of excitation — an artificial disease ; thus by securing an increased nervous and vascular afflux to that part, tlie original disease is modified or subdued. The main- tenance or duration of the primary disorder depends upon the concentration of nervous and vascular afflux to the part secondarily atiected ; now it is evident that if a new point of excitation is established, in proportion to the concentra- tion there, or to its localizing influence, must be its power to derive from and weaken the force of the original disease. Many of our medicinal agents prove curative, by exciting a stronger irritation than exists at the location of the primary disease, the effects of the remedies being produced in another part of the system, and in a difterent tissue. There are but few remedies but what act to a greater or less extent in this jnanner. Thus all the appliances brought to bear upon dis- ease, make new impressions, modify the old ones, and change the sensation, action, or function of some oi-gan, tissue or part, by which the original morbid condition is altered or subdued ; in other words, they exert a relative influence over disease, or cure it by conversion, or by the production of a new pathological state that subsides as soon as the action of the agent ceases its operation. In the present state of our knowledge of the action of remedies, and the laws governing the annual econom}', we can give no satisfactory theory or hypothesis of the manner in which this cure by revulsion or counter-irritation is accom- plished. Dr. Parry advances the theory that most diseases consist in, or are attended with local determination of blood, and that it is a law of the human constitution that excessive morbid determination to two difierent parts shall not exist in the same person at the same time. This will not explain, however, even admitting the proposition, why the secondary excitation and determination detracts the circulation from and relieves the parts primarily irritated. Again, we have attempts to account for it, by the supposition that the system only generates a certain quantity of nervous force in a given time ; in disease, the part aftectcd receives much more than ALLOPATHIA. 19 its normal proportion, and by a secondary excitation this snrplus is determined to the point last afi'ected, and thus the original disease is much mitigated. ' These are hypotheses which it would be unprofitable to pursue further, but we may notice with much advantage the laws which appear to govern the action of such remedies as come under this head, and which afiect the secretions. These have been arranged by Miiller as follows : 1. The increase of a secretion in a tissue, a, which is less irritable than the organ b, is incapable of producing a dimi- nution in the secretion of the latter; hence, for example, artificially excited secretions from the skin, as by a blister, m the neighborhood of the eye, in inflammation of the lat- ter organ, are of no service, because the eye is a more irrit- able part than the skin. 2. An increased secretion in a certain tissue, a, can not be diminished by exciting the same secretion in another part of the same tissue, a; on the contrary, such a procedure would rather increase the secretion from all parts of the tissue than diminish it, because the relation which exists between the different parts of one and the same tissue is that of sympathy, not of antagonism. Hence, a discharge from the generative or urinary organs can not be arrested by an artificially excited diarrhea. 3. On the contrary, the secretions of tissues which do not belong to the same class of structures often antagonize each other. Thus, increase of the cutaneous secretion fre- quently induces diminution of the secretion of the kidneys. In summer, the cutaneous exhalation is more abundant, and the urinary secretion proportionably scanty; in winter, the reverse is the case. Effusion of watery fluids into the cel- lular membrane and serous cavities is attended with dryness of the skin and diminution of the urinary secretion, the quantity of which is observed to increase in the same pro- portions as dropsical effusions diminish. Suppression of the exhalation of the skin by cold gives rise to mucous dis- charges from the intestinal and pulmonary mucous mem- branes. 4. It is only toward the termination of consumptive disease that this relation of antagonism between the secre- 20 GENERAL THERAPEUTir3. tions ceases to exist; when, in consequence of the relaxed state of the tissues, all are at length increased in quantity. In the colliquative state that precedes death in phthisical patients, colliquative diarrhea, profuse sweating, and dropsi- cal effusions take place simultaneously. 5. When one tissue is excited to increased action by an impression made upon another, either the secretion of the two must have been in some respects similar, as in the case of the skin and kidneys, both of which have the office of excreting water from the blood; or the organ thus excited must have had a predisposition to morbid action, which is the rational explanation for the circumstance that the im- pression of cold produces in one person an affection of the mucous membrane of the lungs; in another a disordered secretion of mucus in the intestinal canal. Brunonian Theory. Dr. John Brown maintained the doctrine that all living beings are endowed with a peculiar principle, which he terms excitability, and that serves to distinguish them from inani- mate bodies. " The agents which support life are termed exciting powers, and these, acting upon the excitability, main- tain life ; in the language of Brown, they produce the effect called excitement/' Those agents that modify the excitability, and produce a greater or less degree of excitement, are termed stimulant powers; these are either universal or local. When the exciting powers act moderately, health is produced; when they act with too great energy, they cause indirect debility. He arranged all diseases under the two divisions of sthenic and asthenic, and maintained that all remedies acted as stimuli; so that we had only to increase or diminish their force ac- cording to circumstances, for they differed from each other i^ little more than the degree with which they exerted their stimulant power. He also maintains that they could not cause exhaustion of the excitability except by excessive action, or by producing previous over-excitement. In answer to this theory, it may be said that many, per- haps all of the narcotic and sedative agents produce ex- haustion, without occasioning any apparent excitement DOCTRINE OF COXTRA-STIMULUS. 21 previous to this effect. Such is the case with digitalis, hy- drocyanic acid, and many other agents that might be named. It is utterly impossible to ascribe death (when they occasion it) to any previous excitement which they produce. Agents which prove most destructive to life, seem to exert the least excitant influence over the animal economy. It can not be said that agents which exert no obvious excitant influence over the system, or those which produce no immediate or unmistakable impressions upon the organs of our bodies, are less curative, or produce less mistakable effects upon the system, than those that possess clearly excitant powers. The great majority of our medicines, says Pereira, act neither as stimulants nor sedatives merely ; they alter the quality of the vital actions, and this alterative effect has beeu quite overlooked by the Brunonians. Doctrine of Contra-Stimulus. This doctrine is but a modification of the Brunonian theory. It was first advocated b}'^ Rasori and Borda, and Bubsequently by Tomasini and other distinguished Italian physicians. According to this doctrine, there are but two classes of medicines — stimulavts or hypersthenics, and coiitra- stimulants or hypostheiiics. "The first exalt, the second de- press the vital energies." This hypothesis obviates one of the objections to the Brunonian theory, since it recognizes agents that do posi- tively possess the property of reducing vital action. From these positions it will be seen that contra-stimulants, or depressing agents, are indicated in all cases of exalted organic action ; and stimulants are demanded in all de- pressed states of the vital forces. Although the general principles of this doctrine are correct (providing we take a correct view of the pathology of disease), yet the deductions drawn from them are fallacious in many respects. Wine and other alcoholic liquors are stimulant, and to relieve the inebriation which they occasion, cordra-stimulants, say the advocates of this theory, must be employed ; yet who uses the digitalis, or hydrocyanic acid, to relieve that state of torpor which those liquids produce? Or do those who are in. the habit of resorting to the use of tartar-emetic and the 22 GENERAL THERAPEUTICS. lancet, in high febrile or inflammatory action, employ them to relieve intoxication ? Many agents denominated contra-stimulants, act locally and primarily as stimulants, as in the case with the majority of cathartics. Some of the narcotics (as the opium) act primarily as stimulants, and secondarily as sedatives, provid- ing the dose is sufliciently large. Many agents, and even whole classes of remedies, exert neither a primary stimulant, nor a secondary contra-stimulant influence over the organs of the body, to which we can ascribe their curative powers. This is especially the case with tonics, astringents and alter- atives. The advocates of this doctrine are by no means agreed as to the action of certain agents, for some regard cinchona as stimulant, and others as contra-stimulant. Cold is the most powerful contra-stimulant, if carried to excess, and yet how vigorous the reaction, how violent the inflammation that often follows its moderate application to the system. From this it will appear that the broad ground of stimulant, or contra-stimulant, as advocated by them, and as applied to therapeutic agents and influences, is based upon an erroneous foundation. Agents the most dissimilar and opposite in their effects are grouped together, while those possessing analogous properties are separated by the founders of this doctrine. "They judge of the nature of a disease," says Pereira, " by the effect of the curative means, and of the virtues of medicines by the nature of diseases. So that if a disease now supposed to be sthenic, should hereafter prove to be asthenic, the medicines used to relieve it would immediately pass from the class of contra-stimulants to that of stimulants." As fallacious as are these doctrines, one truth has been derived from this source, and this is the tolerance of large quantities of some remedies by the system, when laboring under disease. In febrile and inflammatory action, when the grade of excitement is high, patients can bear much larger doses of some agents without causing evacuations, than under other opposite states of the system. Under the circumstances named, much larger doses of emetic or ca- thartic substances are required to produce their ordinary eflTects, than when the grade of excitement is less vehement. CHRONO-THERMAL SYSTEM OF MEDICINE. 23 From this it appears that the state of excitement increases the tolcroMce o1i the remedy . Chrono-Thermal System of Medicine. The system of medicine advocated by Dr. Samuel Dick^- son, styled the Chrono-Thermal, assumes the position that all disease is a unit; that unity of morbid action is the type of disease; that this morbid action in all diseases is one and identical, and that this is intermittent fever ; in other words, all diseases assume periodicity. In presenting an epitome of this system of medicine to our readers, we can not do better than to make such extracts from the writings of Dr. Dickson as will give a clear idea of his views. The doctrines advanced by him, though peculiar, convey much truth, and we can not but think that their perusal will gratify and prove instructive to our readers. The following are the positions assumed by Dr. Dickson on the subject of health and disease: 1. The phenomena of perfect health consist in a regular series of alternate motions or events, each embracing a spe- cial period of time. 2. Disease, under all its modifications, is, in the first place, a simple exaggeration ov diminution of the amount of the same motions or events, and being universally alternative with a period of comparative health, strictly resolves itself into fever — remittent or intermittent, chronic or acute; and all local aft'ections, or structural lesions, occurring during its progress, are but incidental occurrences, not original mala- dies. Dr. Dickson terms all remedies " chrono-thermal, from the relation which their influence bears to time, or period, and temperature." Disease, according to this system, is much simplified, and is amenable to a principle of treatment equally simple. A disease partakes of the nature of ague throughout all its modifications; those agents best calculated to relieve that disease, according to this theory, will be found most eflJeetual in removing the same disease when it presents itself under some of its diversified forms, although not recognized ordi- narily as being allied to ague. 24 GENERAL THERAPEUTICS. Hippocrates announced, says Dr. Dickson, more than twenty-three centuries ago, the unity of morbid action, and that the type of all disease is one and identical. These posi- tions Dr. Dickson maintains with great enthusiasm, and proposes to prove " the unity of all morbid action, and the unity and identity of the source of power of various agencies, by which disease of every land may be caused or curedJ' Disease is an error of action, says he; a greater or less variation in the motion, rest and revolutions of the different parts of the body, reducible, like the revolutions of health, into a systematic series of periodic alternations, in the course of which the matter of a structure occasionally, by its atomic changes, alters its natural character and chemical relations; so much so in some cases, as to become even completely de- composed and disorganized. Again he remarks : " The human body, whether in health or disease, is an epitome of every great system in nature. Like the globe we inhabit, it has in health its diurnal and other variations — its sun and shade— its times and seasons — its alternations of iieat and moisture. In disease we recog- nize the same — long chills and droughts — the same pas- sionate storms and outpourings of the streams, by which the earth at times is agitated — the matter of the body assuming in the course of these various alterations, changes of charac- ter and composition, such as abscesses, tumors and eruptions, typical of new forms, as mountain masses, earthquakes and volcanoes. All these, too, like the tempests and hurricanes of nature, intermitting, with longer or shorter periods of tranquillity, till the wearied body either regains, like our common mother, its wonted harmony of motion, or like what we may conceive of a world destroyed, becomes resolved into its pristine elements." " The actions of life in health are all, as you have seen, •periodic, and however, or by whatever caused, their morbid modifications, termed disease, are periodic also." Although he assumes that ague is the type of all diseases, yet he accounts for the differences met with in the different forms of disease, by saying that all agues are not equally perfect. The different stages may, and often do, vary in duration ; the bolder features or symptoms may be all more CHROXO-THERMAL SYSTEM OF MEDICINE. 2o or loss subdued; the intermission, or immunity from suffer- ing, instead of extending to a day, or days, may be only an hour or two in duration. This disease is now no longer ague. Physicians change its name to re^nittentf eve?'. All the differ- ent grades of fevers — ras remittent, continued, typhus — as well as the innumerable varieties of other diseases, are but shades or modifications of the same disease, although christened or baptized by a new name. "Call the symptoms ague, fever, or what you please, con- stitutional disturbance is the prelude to every disease, the precursor of every kind of local mischief; though in nu- merous cases, if not in all — more especially after repeated paroxysmal recurrence — superadded phenomena appear, and these last may be either functional or organic — and in some instances they are of a kind so grave and important as to throw the constitutional symptoms for a time altogether into the shade. Some part of the system, in a word, may be so much more prominently implicated than another, as to become the chief feature of the case^'unctionalli/, if the motions be only anatomically altered — organically, if the part in question be threatened with a change in its structure tending in any w^ay to its destruction or decay." "The causes of all disease can only affect the body through one or more of the various modifications of nervous percep- tion. No disease can arise independent of this ; no disease can be cured without it." Among the agents which he styles chrono thermal, and occupying a prominent rank, is the cinchona. This agent he regards as valuable in gout, rheumatism, scrofula, scurvy, diseases of the bones, gangrene, etc., as well as in a multi- tude of other diseases assuming periodicity, and he refers to corroborating testimony to sustain his position. Prussic acid is next in importance to the bark — this he esteems ex- ceedingly valuable. Opium and the salts of morphia occupy the third rank in the list of chrono -thermal agents, and next to them alcohol, wine, and malt liquors are noticed. These act beneficially, or the reverse, says he, in no other manner than by changing the temperature of the brain. Musk, valerian, camphor, silver, zinc, arsenic, asafa?tida, 26 GENERAL THERAPEUTICS. nux-vomica, strychnia, iron, copper, with a large number of agents from the vegetable kingdom not noticed in this place, with various other appliances, are all denominated chrono- thermal remedies. They are employed with a view to destroy the periodic character of all diseases, and with a view of expelling them from the system. Such is an outline of the chrono-thermal system of practice ; and although some of its features do not accord with the doctrines now styled orthodox, yet there is some truth in them. Upon taking a general survey of the innumerable diseases to which our bodies are subject, every one must see at once the tendency there is to exacerbations and remis- sions, thus constituting the periodicity which Dr. Dickson maintains all diseases assume. The periodic character of many being irregular as to time, intensity, duration, etc., does not seem to militate against the doctrine in question. The fact that exacerbations and remissions do occur, although irregular, goes far to prove the truth of one proposition of our author. As to the agents used, it may be questioned whether all those named, and those in general use act as antiperiodics. It may be said, however, that they lessen exalted organic action, and subdue or break down the exacer- bation, and thus exhibit their claim to be ranked with anti- periodics. Hydropathy. Although the " ?yjaier-ci(re treatment" had been employed to a limited extent as an auxiliary remedial measure long anterior to the days of Priessnitz, yet to him belongs the credit of introducing it into general use as an independent curative system. As an independent course of treatment (all drugs being rejected), we think it erroneous ; but as an auxiliary to other means of cure, there is no doubt but that it is one of the most efficient that can be adopted. The efficacy of hydropathy is fully recognized by Dr. Pereira, who remarks: "The cold-water cure, or hydropa- thy, though not yet admitted, by the medical profession, among the legitimate means which may be beneficially em- ployed in the treatment of diseases, undoubtedly includes! HYDROPATHY. 27 poH'erful tln^rupoutic agents." lie farther says : " It does not confine itself to the use of cold water only, but includes dry sweating, diet, exercise, and regulated clothing." Prof. Carpenter remarks that the hot-air batli, in some cases, and wet sheet, as used by hydropathists, act powerfully as diaphoretics, and will probably be more extensively em- plo^'ed, as the importance of acting on the skin, as an extensive collection of glands, is better understood. Prof. Williams says : " The reaction which follows the judi- cious use of cold, as a therapeutic agent, may prove service- able not only in resisting the further influence of cold, but also to remove congestions and irregularities in the circula- tion from other causes, and to excite in the capillaries and secernents, new actions which may supersede those of dis- ease." Dr. Edward Johnson, in his w^ork on hydropathy, says: "In examining the subject of hydropathy, we are first to consider it as one great whole, consisting of many parts, as the wet-sheet packing, the blanket packing, the dry sweat- ing, the vapor sweating, cold baths of various kinds and dif- ferent degrees of power; clothing, systematic exercise, and regulated diet. In inquiring into its mode of action, there- fore, w^e must first look to its general cflects as one whole. These, I presume, will not bo disputed by any. one. They are to strengthen the digestive functions; to cool the sys- tem; to increase the appetite; to allay excitement; to purify t>he blood ; to strengthen the muscular fiber of the heart; to quicken the action of the skin (which is to the hydropathic treatment what the stomach and bowels are in the drug treatment; to overcome internal congestions ; to restore and augment all the secretions and excretions ; to accelerate the change of matter, and thus renovate the tissues- of all the organs, and to invigorate the vital principle." Again, Mrs. Mchols remarks : " It prescribes a pure and healthy diet, carefully adapted to the assimilating powers of the patient ; it demands pure air and strengthening exercise, with other moral hygienic conditions. The application-s of water, according as they are made, are cleansing, exciting, tonic, or sedative. Water clears the stomach better than any other emetic, produces powerful and regular evacuations 28 GENERAL THEKAPEUTICS. of the bowels, excites the skin — tlie great deterging organ of the system — to throw off masses of impurities, stimulates the whole absorbent and secretory systems, relieves pain more effectually than opium, dissolves acrid and poisonous mat- ters, purifies the blood, reduces inflammation, calms irrita- tion, and answers fully all the indications of cure ; to fulfill which, physicians search their pharmacopeias in vain. The proper application of the process of the water-cure never fails of doing good. Its only abuses come from ignorance. The water-cure physician requires a full knowledge of the system, and a careful discrimination in applying it to various constitutions, and the varied conditions of disease." Hydro- pathists are opposed to all medicines, at least manj'' of them. "Unassisted nature, where there is a large stock of vitality, may triumph over both disease and medicine. The success of the homeopathic practice shows, that the less medicine taken, the oftener nature asserts her rights. But the water- cure equalizes the circulation, cleanses the system, invigorates the great organs of life, and by exciting the functions of nutrition and excretion, builds up the body anew, and re-cre- ates it in purity and health." For medicinal purposes, soft, fresh, pure spring water is always to be preferred. Lime-stone water, or water con- taining saline matter in solution is not so good, and even soft water — as rain-water, if it has been standing in tanks or cisterns — is less beneficial. The modes in which water is employed as a remedial agent are numerous ; we may notice, with advantage, the pluvge-bath, the pouring-bath, the dripping -sheet, the douche, the sitz-bath, the wet-sheet pack, and the blanket-pack. The plunge-bath consists in immersing the entire person in the ordinary bathing apparatus. In all cases the head should be wet before applying the water to the surface. The pouring-bath consists in applying a suitable quantity of water to the surface, by expressing the water from a sponge, or by pouring it from a suitable vessel upon the body. In using the dripping -sheet, the entire body is to be envel- oped in a sheet dipped in cold water while the patient is standing; at the same time rubbing him briskly outside of HYDROPATHY. 2b iiid with the sheet. This bath is much prized in febrile dis- eases, but it is obviously inappropriate when the patient is much reduced, or in the advanced stages of disease. The douche is applied by dashing cold water upon the sur- face of the body, or by directing a stream or jet of water from a force-pump, or by an affusion of water from a hight varying from five to twenty feet, letting it fall on different parts of the body; the full force of the douche not being allowed to fall upon the head. This is powerfully excitant, and often proves eminently serviceable in certain forms of chronic disease, as in spinal and nervous affections, in tumors and rheumatic swellings, as well as in many other cases. The sitz-hath is a highly efiicacious mode of applying water in some diseases. It consists in seating the patient in water at first tepid, but by degrees diminishing the tempe- rature to its natural standard. The water should completely cover the pelvic region, which may be done in the absence of the proper sitz-hathivg apparatus, by substituting the ordinary wash-tub, with a suitable amount of water. It is employed as an excitant and tonic to the pelvic viscera and bowels, and as a derivative in diseases of the brain and superior parts of the body. The shallow or half-hath is similar to the other ; the patient is seated in shallow water (say three or four inches deep), and rubbing the body, or being rubbed by an attendant. It is esteemed beneficial in febrile and congestive states of the system. The wet-sheet pack is said to be the most powerful and universally applicable mode of applying water in the cure of disease, and consequently has been denominated the shed anchor of hydropathic practice. It is extensively employed in nearly every variety or stage of disease. It is especially useful in febrile diseases, to diminish the excessive heat of the surface, lessen exalted action, equalize the circulation, promote perspiration, relieve pain, subdue spasms, remove obstructions, and secure tranquillity, which usually is suc- ceeded by a profound and refreshing sleep. It consists in spreading one or more comfortables and two or more blan- kets upon a bed or mattress, over which a sheet that has just been dipped in cold water and wrung until no more will run 3G GENERAL THERAPEUTICS. from it, has been spread. Upon this the patient 19 to be placed, being divested of his clothing, and the wet sheet wrapped closely around the body, so as to bring it in contact with every part of the surface, the face excepted. Then the blankets are to be tightly w^rapped around him, and over these comfortables, blankets, or a light feather-bed may be thrown. If very weak or chilly, heated bricks or bottles of hot water may be applied to the armpits and to the feet. If the reactive powers of the system are suflBciently strong, artificial heat is to be avoided. If the head ache, a towel dipped in cold water is to be applied. In this condition the patient should remain until reaction is complete, and warmth fully established. In most cases the patient sweats freely. If uneasy and nervous, the covering may be removed at any time, when immersion or affusion of cold or tepid water should be immediately resorted to. This rule is not to be vio- lated, except in high grades of inflammatory action, when one wet sheet after another is to be applied in quick succession. The blanket-pack consists in the application of dry blankets, instead of the wet sheet, until perspiration is excited, when some one of the cold baths is to follow, succeeded by brisk frictions with the coarse towel, flesh brush, or dry hand, in order to excite the skin and produce a healthy and vigorous reaction. If the strength will admit, he should rub himself vigorously in all cases. The reader must not understand that the baths are always to be cold, as in the earlier days of the water-cure. We eni- jiloy them at all temperatures from 30° to 180°. Tlic temper- ature of the bath is adapted to the condition of disease, and it is a little singular that nearly the same effect follows from brisk sponging with water at 32° and as hot as can be borne. Ablutions, affusions, etc., when applied to the surface in febrile and inflammatory states of the system, serve to de- press the exalted action, act as sedatives to the circulation, diminish the temperature of the body, promote perspiration, and break up that morbid association of action upon which the continuance of disease seems often entirely to depend. It is also a very powerful means of revohitionizing the system in chronic aftections. The shock, the new aiii pow- erful impression which it imparts tc tens of thousands of HYDEOPATHY. 31 nervous fibrilla and capillary vessels, spread out on that ex- tensive, highly sensitive and strongly sympathizing tissue, the skin, is indeed great, and v^e must at once recognize the utility and immense importance of these applications to the surface. The shock which it imparts to the whole nervous system is calculated to secure a vigorous reaction, if prop- erly applied ; to arouse all the secretory and excretory organs of the body, impart new vigor and energy to languid and atonic organs, augment muscular and nervous activity and power, and yet calm irritated action, and secure tranquillity when the nervous and muscular equilibrium is interrupted. In these ways it increases the vital forces, and stimulates the recuperative powers of the system ; hence it may be said to be one of the most important alteratives and tonics of the materia medica. We have thus given a synopsis of the most prominent theories advanced upon the subject of practical therapeutics. In each of these we find some truths, but in all much error. The main difficulty wdth all of them appears to be that their originators did not pay sufficient attention to the facts of pathology, or if they did this, that their reasoning was based upon the action of remedies that we would not con- sider curative under any circumstances. To properly understand this subject, it is necessary that we fully understand the pathology of disease, the reasons why the system, or a special organ, deviates from its normal healthy action, the causes that produce this, and the changes in structure that are occasioned by it. Knowing this, we should then carefully observe the means by which nature removes diseases, recollecting that the all-wise architect who formed our bodies to meet every requirement of our exist- ence, was not forgetful that they would be subject to disease. Can man be more wise than his Maker? If he can not, why then should he try to add something to that which was be- fore perfect ; why should he try to create new eliminating- organs, to make a laboratory of a man's sanguineous system, trying by means of poisonous chemical agents to counteract .a materles morbi of which he knows nothing? In the next place, the therapeutist should carefully choose such means 32 GENERAL THERAPEUTICS. as will assist nature in relieving herself of disease, by acting in the same manner and exciting the same parts and organs, as do relieve the system of the morbific matter, when the natural powers of the system are the physician. We would strongly impress it upon the mind of the reader, and especially upon the student, that no man ever yet cured a disease, nor ever will. All that any can do is to assist nature in effecting a cure. How often do we hear physicians talk of healing wounds, as if the entire process depended upon their skill, when, with their utmost efforts, they could not produce a single cell, fiber, or even a fluid similar to the coagulable lymph which is the basis of repair. What then is the province of the physician? The fol- lowing propositions, laid down by the eminent German physician, Hufeland, express our views of it : 1. Art sometimes can take away the whole disease by removing the exciting cause, and so dispense with the in- ternal curative process of nature, e. g., by removing a foreign body, a poison, a gastric accumulation which produces the disease, etc. 2. The vital power is sometimes too exalted, and its operations too impetuous and violent; — so much so, that it may consume itself or injure noble organs. Here art can effect that degree of reduction and depression which is requi- site to bring on a perfect crisis, and to prevent dangerous oc- currences. 3. On the other hand nature may not have sufficient power, to perform the internal curative process. Here art interferes, raises and makes up, by suitable and strengthen- ing remedies, the deficiency ; and thereby only renders the internal cure possible. 4. Art can remove obstacles, which render the curative process of nature difficult or impossible. Under this head falls the important point of a proper diet, quietness in febrile diseases, guarding from the influence of impure air, injurious aliments and the like. 5. Art can support nature in combating particular forms of disease, by appropriate remedies conformable to the malady. 6. Art can assist nature in the commencing crisis and bring it to perfection. DISEASE. 33 7. Finally, there are morbific matters and conditions ot wliich unassisted nature can not get rid, e. g., the syphilitic virus, mechanical lesions, etc. lu such cases the assistance of art is indispensable, either for improving the quality of that matter by means of agents counteracting its virulence, or for lending mechanical or surgical assistance. Such is the province of the art of healing, and such are its limits. The physician must not pretend to be magister, but minister naJurce, her servant or rather assistant, her ally, and friend. He is to go with nature hand in hand; and in performing his great task, he is not to forget that it js not he, but nature that operates; — regard nature, be always guided by her, and never interfere to disturb her. With this introduction we propose to give our views of therapeutics, and in doing this we shall consider it under the three heads named above. First, the general pathology of disease. Second, the means by which nature removes dis ease. And third, the mode in which agents act upon the system. Disease. Disease is a departure from health. The first study of med- icine— anatomy — gives us a knowledge of healthy structure. The second study of medicine — physiology — notes all the ac- tivities of this healthy structure under normal conditions, and gives us a standard of healthy function. From this standard of structure and function we make the measurement of disease. It may be well to understand first of all, that the diseased man is in a worse condition than the well one. To the extent of his disease he is incapacitated for his work, and his sensa- tions are painful instead of pleasurable. He loses his flesh, his strength, his functional activities, and is below his normal condition. He Avho fails to recognize that disease is a wrong life, and that impairment and debility are its essential features, has no business to practice medicine. We say of the healthy man that he is able to do a man's work in the world, and do it pleasurably. We say of the healthy part, it is able to do the work of the part, and do it pleasurably. When a man can not do his work he is sick ; to the extent that he can not do his work, is the gravity of his sickness. „When his efforts to do the things he has been accus- 34 GENERAL THERAPEUTICS. tpmed to are unpleasant or painful, he is sick, and the extent of the unpleasantness is frequently the measure of the disease. When an organ or part can not do its work, it is sick, and the extent of the impairment is the measure of tlie wrong. When an organ or part gives un})leasant or painful sensations, it is sick, and these are also the measure of disease in some cases. In thinking of disease as a wrong life, rather than some- thing that has taken possession of a man — tl-.at he has caught, or that has caught him — we have made an important advance. It is his life that we liave to deal Avith, and it is his life im- paired. It is death that we meet in the sick chamber. To the extent and gravity of the disease, death is taking the place of life. Death comes in the impairment of structure and func- tion ; life comes with its restoration to the normal conditions. We should be conservers of the life, and to do this we should restore the conditions of health, in so far as we have control over them. Thus we might write our first therapeutic axiom as follows: In disease there is always ivipah-ment of life, therefore remedies should always conserve the life, and increase the patienVs power to resist disease, and regain his normal condition. In our study of disease we do not forget that there may be a present cause which should be removed. We see a man crossing the street Avith a burthen, then slij) and fall. He asks our assistance to rise, but he is weighed down with the load Avhich has fallen on him. Will we pull his arms out in an effort to raise him? or curse him, kick him, and cuff him, to stimu- late to renewed effort ? Or will we lift off the load, and then give him a hand ? It is a very homely simile, yet it presents the matter in a fair light. A patient is suffering from diphtheria, smallpox or typhoid, in a dark, ill-ventilated room, or a house ijermeated by sewer gas. A person is developing a phthisis ])ulmonalis in a low, dam]) and dark locality. A patient is doing badly, with dirt, bad air, insufficient food, >vant of rest, etc. A man has grown a nervous dys})epsia and a dyspeptic nervousness by the abuse of tobacco. A woman is exhausting her little stock of life in frequent child-bearing or prolonged lactation. A woman or man is exhaustino; his or her little stock of life in marital DISEASE. 35 excesses. People are exhausting their digestive powers and growing confirmed dyspepsia, by bolting their food without chewing. What shall be done with them ? Which is the first step towards a cure ? These are common examples, and every reader can multiply the instances given ; and as he does, he will see clearly the necessity of removing the cause of the wrong. The causes of disease are many, and the means of removal are many, but to the thinking physician the problem soon solves itself. If we found a patient with a thorn or splinter in his hand or foot, it would be good practice to remove it. If we find a worthless tooth a cause of persistent neuralgia, it is good prac- tice to extract it. If we find a woman suffering blood poison- ing from a retained placenta, it is good practice to effect its removal. In the same way, if we find a patient suffering from unpleasant accumulations in the stomach, which are a source of irritation, and by decomposition cause blood poisoning, it is good practice to give an emetic and remove them. If a pa- tient is suffering from accumulations in the bowels, a cathartic for removal is good practice. If, from arrested secretion of the skin, the blood Contains effete material, a cause of disease, it is good practice to stimulate the skin to increased activity, and effect its removal. In like manner, if the kidneys fail to remove their part of the waste, and its retention is a cause of disease, diuretics are rational remedies. The reader will see that these are the results of applied common sense — the sense we find best adapted to the ordinary affairs of life. The matter is plain to the simplest mind — there is a known cause of disease present, there are direct means for its removal, and with its removal the living body regains its normal condition. It is the load which prevents the man from rising; you take it off, and he is able to get up. In other cases we do not remove the cause directly, but we neutralize it so that it is no longer noxious and disease-pro- ducing. In toxicology we might illustrate it by arsenical, lead, and oxalic acid poisoning. The patient has taken arsenious acid, we give him hydrated sesqui-oxide of iron, and in arseniate of iron we have lost the poison. The patient has been poisoned Avith lead, and we give iodide of potassium, and in iodide of lead we have lost the cause of disease. The patient has taken 36 GENEEAL THERAPEUTICS. oxalic acid, and we give a preparation of lime, and with the change to oxalate of lime the injurious influences cease. Our patient has ague or other periodic fever ; we give qui- nine, which neutralizes the cause, and the fever ceases. He is influenced by a zymotic cause, and has the evidences of blood poisoning; we give the proper anti-zymotic, and we arrest the process. The tongue is pallid and dirty, and we give sulphite of soda ; it is red, and covered with a glutinous nastiness, we give sulphurous acid ; it is red, dry, and brown, we give muriatic acid. The patient gives an unpleasant fetor, like decomposing flesh, and we give chlorate of potash. Or the tongue may be broad and pallid, showing acidity, and a solution of bicarbonate of potash gives relief. Or it may be deep or dusky-red, show- ing alkalinity, and an acid proves the remedy. There are special causes of disease, for some of which we know the antidote or remedy, but for others it is yet unknown I have named quinine for that which is usually known as ma- laria, and is marked by periodicity. Tincture of muriate of iron is quite as certain in some phases of erysipelas, and Rhus in other cases. Phytolacca meets the poison of diphtheria in the majority of cases. Sulphide of calcium for the condi- tion of furuncular inflammation, or inflammation of cellular tissue with low grade of deposit. The entire system of antiseptic surgery is based upon this principle. The atmosphere is loaded with germs which favor sepsis and putrescence, if they are not the cause of it. That a wound do well these germs must be excluded, or their putres- cent activity destroyed by antiseptics. If, as in the olden time and now in minor wounds, the cut is bound up in its own blood, and as it were hermetically sealed, the process of repair goes on kindly. Or if a surgical operation is performed with antiseptic precautions, and covered with an antiseptic dressing, the repair goes on without disturbance. If further investigations should prove that some diseases are' due to these micro-organisms, as has been so stoutly affirmed, then the province of medicine will be to protect against the contagium, and employ means to destroy and remove the organ- isms. The recent experiments of Koch would suggest anti- septic inhalations and respirators in phthisis, and in the lower DISEASE. 37 grades of pneumonia, and we await further study to determine the advantages to be obtained in this way. These are not tiie only examples that might be given, and it is well for the reader to look the entire field over carefully. He might think of syphilis and the syphilitic virus, which infects the lymphatic system and poisons the springs of the blood. For this we have as yet no antidote, though in the good time coming it will probably be found. An enlarged spleen may be the cause of imperfect blood making or of leuco- cythemia. A failure of the pancreas from low inflammatory action or change of structure, may so impair blood making and the nutritive processes that the person can not live. The virus of small-pox, scarlatina, whooping cough, typhoid and typhus fever, and other diseases of like character, must find antidotes in the future. We may put the matter in the form of an axiom — If the cause of dieease is jpresent it should be removed or neutralized, unless such removal by remedies is more dangerous to the life of the patient than its continued presence. Can we see in these methods a rational use of medicines; and that for the administration of every drug, and for every other procedure, we must have a reason ? Why do we give an emetic in disease ? Is it because it was given by Dr. Thompson, Dr. Beach, Dr. Jones, or some other man ? O no ! it is because in this particular case we see the evidences of unpleasant ma- terial in the stomach, which acts as a cause of disease. Smith is attacked with fever to-day, and we give him an emetic with most marked success. Thompson has a fever next week ; shall we give him an emetic because it benefited Smith? Not unless he shows the same evidences in a broad and loaded tongue, and full, oppressed epigastrium. Shall we give cathartics to all patients merely because they are so "highly recommended," and have been used with benefit by Wood, Pereira, Copeland, Jones, and others ? Not by any means ; we use a cathartic because in this particular case we have the evidence that there is something; in the bowels which is a source of irritation and a cause of disease. Shall we give quinine in all cases and in the extravagantly large doses that are recommended by nearly all the teachers of re()ular medicine? Not by any means; we give it because 38 GENERAL THEEAPEUTICS. there is the distinct indication, periodicity ; and if we do not find this indication, we do not give the medicine. Shall we give morphine to relieve pain, because the mass of the profession use it so freely, or because writers testifiy that they "employ it with the greatest advantage", or it "has been found highly useful," etc. Not by any means ; we pre- fer to look for the cause of the pain, and by getting rid of the condition of disease of which pain is a symptom, we get rid of the pain. Our third axiom might therefore take this form — We do not use remedies because they have been " highly recommended/' or have been found useful in named diseases, by writers or teachers of medicine ; we use them because in the particular case there are evidences of disease calling for the particular remedy. We do not prescribe at names, but for conditions ; we are not governed by authority, but by observation and the simple ruless of reason. Having given some thought to the " cause " of disease, and the necessity of its removal, we may study the " effects" upon the human body. The relation between cause and effect is just as absolute in disease as elsewhere in nature. There is no effect without a sufficient cause, and there is no particular effect without its particular cause. It is true that what seems to be effect, does not always cease when the cause is withdrawn. An injury is done the structures of the body — and until com- plete repair has been effected, there can not be normal func- tional activity. The derangements of structure and function following causes of disease are multiform, because the body that is impressed is a very complex structure. A recent writer, speaking of this, says of the head of a spermatozoon — if you will imagine this as large as the Great Eastern, and filled with machinery as delicate as the finest watch, you will only approximate the delicacy and complexity of structure. Organic forms are wonderful creations, and it is well to get a conception of them. Last night I had on the page of my book an insect so small that I strained my eyes to see it — the point of a pin would cover it, yet this creature had six legs, with five perfect artic- ulations each, muscles to move them, antennae more flexible and with a finer sense than an elephant's trunk, wings with powerful wing muscles, a skeleton, feathers, a complete diges- DISEASE. 39 tlvc apparatus, a nervous system, and an apparatus of procre- ation. It is a fair example ; think of every part of the human body as composed of a like minute and perfect structure. You have heard some mean persons' souls described as ^' that thousands of such might dance on the point of a cambric needle." Of the living molecules of the human body, millions might play in the same space. But with our gross senses we can not take cognizance of the wrong of these minute structures. We may agree with Vir- chow, that all functional activity springs from cells, and that all abnormal life (disease) is due to wrong of the living cells. We may go further and agree with Grauvogl, that all life is due to the- movements of the molecules of living matter, and disease must be due to changes of these molecules. But as they are so far beyond our senses, the knowledge is of no prac- tical benefit. Only this thought will suggest itself. If the basis of our tissues are thus minute, and the structures so fine and com- plex, is there good reason why we should rely upon such gross remedies, and such violent effects. Will a watch-maker re pair a watch with a sledge-hammer. Practically it serves our purpose better to divide the body into a few principal parts, having somewhat distinct functions, and study these. For a full consideration of this subject the reader is referred to my Principles of Medicine; here we will make but a brief synopsis of the subject. The Forces of Life. — Having a body, it must be set in mo- tion and kept running, for the motion is life. Movement ne- cessitates force, and we have to learn how this body receives force from without, liberates it for its varied movements, and regulates it for its normal uses. This force is one, but as it manifests itself in different ways, it is of advantage to study it as formative force, heat, and electricity. These forces are also conditions of life. The impulse (for- mative), from the parents, is to a certain extent the measure of the life of the child, both as to its activity and duration. A temperature of 98° is indispensable to healthy life — if it is increased, the i)erson is sick. A certain amount of electricity is necessary to healthy life ; if it is deficient there will be dis- ease, if it is in excess there will be disease. 40 GENERAL THEEAPEUTICS. Measurement of Disease. — This brings us to the considera- tion of the common rule for the measurement of disease, and for the application of remedies. Disease is either an excess, defect, or perversion. There maybe an excess of structure, de- fect of structure, or perversion of structure; an excess, a defect, or a perversion of any function. If there is an excess, such remedies should be employed as Avill lessen or remove it. If there is a defect, such remedies are to be employed as will increase or restore it. If there is a perversion, such remedies are to be employed as will rectify and bring back to a normal condition. The Conditions of Life. — It is a first duty of the physician to see that the conditions of life are right. A well man may live and even enjoy comfortable health under very bad con- ditions, because the human body has great adaptibility, and power of resisting unfavorable impressions. But the sick have lost this resisting power, and bad conditions of life may cause a disease to prove fatal that in other circumstances would ter- minate in health. The first group of conditions are — light, air, exercise, food. If we use the prefix " good," we will express right conditions, as good light, good air, right exercise, good food. If these conditions are wanting, they must be obtained. Division of Function — As we continue our study, we find that the organs of the body group themselves into a digestive apparatus, a blood-making apparatus, a respiratory apparatus, an excretory apparatus (skin, kidneys, bowels), an apparatus for reproduction, and a nervous system, an apparatus for inner- vation. The selection of food, its preparation for use, its mastication, insalivation," gastric digestion, and intestinal digestion, is the study of the first, and a study that can not be too thoroughly made. The food is the life of the man. It furnishes the ma- terial for the continuous renewal of the body, without which the man would die, and it furnishes the force which gives activity to all parts of the body, and a surplus for the world's work. The apparatus of blood-making is not as thoroughly studied as it should be. The lacteals, the mesenteric glands, the entire lymphatic system with its glands, the ductless glands DISEASE. 41 (spleen, thyroid, thymus, and supra-renal capsules), the paii- :;reas, and especially the liver, are all to be looked over in this rtudy. Wrong of any part may cause a wrong of the blood, a wrong of nutrition, and a wrong of structure, with a still further wrong of function as a result. The apparatus of respiration is essential to every moment of life. Stop it, and the life stops. Retard it, and the life is retarded. Impair it, and the life is impaired. The excretory apparatus has oflPered therapeutists a fruitful field for study. The material of excretion is a tangible nasti- ness that impresses itself on the dullest minds. It looks bad, it smells bad, and without trying it one can readily say that it tastes bad, and it is something that people do not like to carry about their bodies, or come in contact Avith. Further than this, common experience has shown that it is disease-produ- cing, whether retained in the blood, or re-absorbed after it has been excreted. There is nothing clearer than that this unpleasant matter should be removed from the blood, and we have large classes of remedies lookino; to this end. The fact that human excretion is eminently poisonous when once out of the body, is not so well appreciated. True, peo- ple do not defecate or urinate in their clothing, but they some- times do worse. They so arrange the place of deposit, that it filters into wells, cisterns, milk houses, cellars, and poisons springs and water courses. One would object if he saw his neigh- bor hang himself over the well-curb to defecate in the water, but the thing is done all the time, but in a more modest way. Human excreta in water, in milk (and the water cows drink), in food, is a common cause of diphtheria, typhoid fever, spotted fever, cerebro-spinal meningitis, Asiatic cholera, and the entire catalogue of zymotic disease. It is material to breed a pestilence. The apparatus for reproduction and the perpetuation of the species, occupies a minor place in the study of medicine, but yet is one of great importance. It is at the bottom of many diseases of men, and the majority of the diseases of women. What may we say of the apparatus of innervation further than it is nearly always at fault in disease. In some cases it gives the major wrong, in others it is secondary and small, but in all it needs to be studied with care. Through it we reach 42 GENERAL THERAPEUTICS. every part of the body, and can influence every function. With riglit innervation our patients readily recover, with wrong innervation they suffer and remain sick. tStrudural Disease. — There must bo change of structure for every wrong of function, but as before remarked we only no- tice the frross changes not the more minute ones. We find an increased nutrition, and a part or organ becomes too large, and we call it hypertrophy. AVc find an organ, part or the entire body, becoming too small, and we call it atrophy. Or we find the structures changing in quality or in form, and we call it perversion — degenerations, deposits, or growths. I have made this brief review of the subject only to stimu- late the reader to a thorough study of it. It furnishes the basis for a rational practice of medicine, stimulates to close observation, and to the careful use of remedies. Expression of Disease. It is a fact that disease has definite expression, which may be studied and learned. The same condition of disease will give the same expression, so that, having learned the language of disease, we have a certain guide in diagnosis. It will not be amiss in this connection to remind the reader of the abso- hite law that like causes produce like effects. If the symptom or expression is the effect, like symptoms must show like con- ditions. It may be urged that the symptoms of disease are sometimes masked, or that the evidence of grave disease may be covered up by symptoms of minor wrongs (usually of the nervous sys- tem), or that patients and nurses may mislead the physician. This may be the case, but knowing the many deceptions which may lead him astray, the doctor guards himself against them. " He who is forewarned is thrice armed." The common methods of diagnosis, which names diseases and classifies them, does not serve our purpose in therapeu- tics, however useful it may be in studying the natural history of disease. In this method the most diverse conditions of disease may be covered by the same name, and he who pre- scribes for or at names is sure to go wrong. In modern therapeutics we associate certain remedies with DISEASE. 43 certain expressions of disease, tlie remedy proving enrative in such eases. Thus we say that a broad, pallid, and dirty tongue indicates a condition of disease which will he met by suli)hite of soda; a dusky red, with brown coating, indicates a condi- tion which will be met by muriatic acid ; a bluish, full ap[)ear- ance of the face, like one who has been long exposed tt) cold, is met by baptisia; a pallid mucous membrane, with pidta- ceous or fibrinous deposit, is met by phytolacca; a small, fre- quent pulse is met by aconite ; a full, frequent pulse is met by veratrum ; a small, sharp pulse, with nervous hypersesthesia, is met by rhus; dullness, disposition to sleep, coma, dilated pupils, are met by belladonna ; distinct periodicity in disease is met by quinine, etc., etc. How this relation between disease expression and drug ac- tion has been determined might be made an interesting studv, if we had time. Suffice it to say, that much of it has grown from the observation of the effects of medicine when given in the ordinary empirical way. Careful observers have noticed that in some cases the medicine was markedly curative, whilst in others it was not. They would remark some peculiarity or special symptom in the cases benefited, and would afterward give the medicine where that peculiarity or symptom was ob- served; and thus the relation between such expression or symptom and the drug, would l)e established. In other cases the relation has been established by careful experimentation on the sick. Some peculiar action of the drug, or some special want of the patient would suggest a particular drug. It would be used again and again, until the relation between disease expresssion and drug action was established. In still other cases the relation has been established by proving the remedy on healthy persons, and determining by this its quality of ac- tion, and its affinity for special parts. This is the homceojia- thie method, and the law they insist upon is, similla similibus. But it is also the physiological method; for, the influence of a drug having been determined, as to its quality and selection of special organs, parts or functions for its action, the agent is employed when such action is required. A remedy being- something which opposes disease, we are quite correct when wo say it is antipathic. It is well to bear in mind that a remedv is a force which 44 GENERAL THERAPEUTICS. opposes disease. It may not seem so when we take tlie mate- rial in our hands, and to all our senses it seems inert. But locked up in its molecules is a wonderful power, sometimes in the smallest compass, which is sufficient to change the entire current of life, and make it flow in a different direction. Law in Medicine. Whilst physicians have talked of " science in medicine," of "scientific medicine," they have held to the opinion that there was nothing more uncertain than medical practice. They have even gone so far as to say that in giving a drug no man could absolutely predict its effect upon the patient. The practice of the day has fully borne out the statement, for there is nothing so uncertain as the ordinary drugging; and of the work of the majority of practitioners we might assert with Oliver Wendell Holmes — " It would he better for mankind if all the medicines wer3 at the bottom of the ocean, though it might be worse for the fishes." We believe that we are reaching a reign of law in the med- ical profession, and to that end will make certain propositions which I hope may convince the reader, or at least cause him to look over the subject carefully. 1. The law is absolute that " like causes produce like effects," and is as true in medicine as it is throughout the universe. 2. A cause is a force which, acting upon matter, sets it in motion (or modifies its motion), or changes its form ; and this motion or change of form we call an effect. 3. The e^^ect follows the cause, but that which follows is not always to be regarded as the effect. The post hoc is to be dis- tinguished from the propter hoc by careful observations of the force applied and the effect produced in different cases. 4. A medicine is to be regarded as a. force which will mod- ify motion, set up motion, or change the form of matter, in the human body. In these respects it is a tangible thing, sus- ceptible of observation, and its action and result formulated. If any one is inclined to dispute that medicine is a force, let him take two or three grains of podophyllin, or a drachm of lobelia or jalap, and await the course of events. What is true of one remedy is true of all remedies, and violence or activity DISEASE. 45 through a large quantity, or by some specially acrid quality, is not necessary. A minute quantity of hydrocyanic acid, glo- noine, or any of the more intense poisons, will prove this. It might also be proven by the fraction of a grain of syphilitic or small-pox virus, introduced into the circulation. 6'. The force of a remedy is for the time being locked up in it, as is the case in coal, wood, gun-powder, nitro-glycerine, etc., and is set free in the body by decomposition or recompo- sition, as is the force in the articles named. 6. The effect is the motion or modification of motion, or change in the form of matter in the structure of the bodv, the result of the force of the medicine. 7. We employ medicines to cure disease, and we employ them because they contain a force which opposes diseased ac- tion, aids the body to remove disease, or aids the natural pro- cesses of life — all looking towards the condition we know as health. 8. Now we may postulate our problem thus: A medicine or remedy is a certain force, which acting upon a living body, is a cause, health, or some change looking toward it, being the effect. If one notices the proposition carefully, he will see that something is wanting, and that this something is the con- dition of the body which is lo be acted upon. This we will call the " tertium quid," or the third element in a rational system of medicine. 9. With this we may make our problem read : With a known remedy and a known condition of the body, the result must be certain, for we have all the elements of nature's law that " like causes produce like effects." 10. The difficulty in practical medicine has been that we have worked with unknown quantities. Physicians have not known their remedies, and they have not observed the condi- tions of the body as determining the remedy, and the result has been uncertain and frequently unfortunate. 11. Let us consider again that medicine being a force, its action upon the body may not be towards health, but the re- verse, even though under right conditions the medicine might be good. Steam as a force is a good and useful thing when rightly applied, but the piston that does good work in manu- facturing is not so good when it crushes a man's leg or body; 4# GENEEAL THERAPEUTICS. or the steam which propels the boat is not so good when it bursts the boiler and blows up the people. If now we take some examples from our every-day work we may see these abstract propositions easier. In all these matters one wants to see things clearly, and be able to prove them by his experience. Let us take an ordinary problem in nature as an example of this method of reasoning. The earth moves around the sun in a definite orbit, which we are now able to measure with the same accuracy as a line of raih'oad from Cincinnati to Chicago. This has been determined, not by chain or compass, but by pure reason. This may be postulated in the following manner : a, the sun, as a force ; b, the weight (specific gravity) of the earth ; c, the attraction of other bodies in our solar sys- tem; d, motion in this well defined orbit the result. The earth has so moved as long as these conditions have existed, and will so move to all eternity, if the conditions continue to exist. It is only a fair example of the law that " like causes produce like effects." Let the first example in medicine be — a, aconite, the force; b, a small frequent pulse, the condition of the body (tertium quid) ; c, the effect, health. To put it in a different form let us say — a, aconite expend- ing its force in lessening the frequency of the pulse and giv- ing a right circulation, and reducing the temperature to 98° ; b, condition of the body, a small, frequent pulse, temperature 104°, arrest of secretion ; c, result, the pulse comes down, the temperature is reduced, and because of this, secretion and other functional activities are established, with a return to health. Aconite the cause, health the effect. The second example shall be — a, quinine (the force) ; b, pe- riodicity (the condition) ; c, health (the effect). Any one who has had an experience with quinine, and has used it in a rational way, will see the truth of the eleven propositions in this example. Our patient may have an ague with its chill, hot stage, sweating stage, and intermission, re- peated day after day. The periodicity (the condition) is marked, the remedy (quinine) jwssesses the requisite force, and the result is a cure. In a second case our patient has a severe fever, every function is deranged, and his life is impaired. We DISEASE. 47 observe it closely and note the distinct remissions, and say " periodicity" (the condition), quinine (the force), and the re- sult (effect) is health. Or, third, our patient has an inflam- mation of the lungs, every symptom being clearly pronounced ; but, as \vc observe the case closely we again observe the ex- acerbations and remissions, and we say, periodicity (the con- dition), quinine (the force), the result health. You can mul- tiply such cases from your experience. Let us take as a third example — a, podophyllin (the force) ; b, full veins, full tongue, full face, full abdomen (the condi- tion); c, health (the effect). It will not do to mistake the condition with reference to the remedy. Thus we Avould make a very common mistake if Ave said " constipation " (the condition), for the patient might have a pinched face, small red tongue, and an irritable stomach and bowel, and the result would be, an increase of disease. Taking this remedy again we might say — a, podophyllin (the force) ; b, fullness of face with dizziness and headache (the condition) ; c, relief from these unpleasant symptoms (the effect.) As a fourth example we will say — a, sulphite of soda (the force) ; 6, a broad pallid tongue, dirty (the condition) ; c, re- lief from all the disease (the effect). Sulphite of soda has cured many different diseases — that is different according to the received nosology — but if the phys- ician has noticed, they have all had something in common, and this something is the broad, jyallid tongue, with a dirty coat. Not that it will cure every case with this symptom, for there may be something beyond this, or something additional may be necessary. While we cure some diseases with one remedy, a very large number require additional ones, for there are several things that need be done. Baptisia gives us a fair example of — a, the force ; b, a full purplish-red face, the expression of condition ; c, cure, the result. Take Gelserainum, the force ; a flushed face, bright eyes, con- tracted pupils, restlessness, general headache, the expression of condition ; the result, relief of unpleasant symptoms or cure. 48 GENERAL THERAPEUTICS. Or, Macrotys the force; uterine pain, with sense of fiillnes? and tenderness the expression of disease; result, cure oi' relief. Or, Collinsonia the force; an uneasy sensation as of a for- cign body in the rectum, with heat and contraction, the ex- pression of condition ; result, relief, and it may be cure. Of course this cure is usually one of hemorrhoids, but it may be something else, frequently ovarian or uterine. Or, Santonine the force ; retention of urine (acute, as in the fevers of childhood, or in women after childbirth), the con- dition ; result the urine is passed. Or, Belladonna the force ; dullness, inclination to sleep, the expression of disease ; result, relief and cure. Or, Rhus tox. the force; frontal headache, starting in sleep, sharp pulse, redness of tip of tongue, the expression of dis- ease ; result relief, and cure. I have given sufficient examples to show the application of the eleven propositions to the diagnosis and treatment of dis- ease. The reader can follow it out at his leisure, bringing ex- amples from experience to establish the truth of each one of them. Right reason is quite as profitable in medicine as in other professions or pursuits, and we will never have a " sci- ence of medicine " until physicians are willing to use it and rely upon it. Mode by which the Natural Powers of the System Remove Disease. " There is," says Dr. Williams (Principles of Medicine, p. 38), "in organized beings a certain conservative power which opposes the operation of noxious agents, and labors to expel them Avhen they are introduced. The existence of this power has long been recognized, and in former days it was imperso- nated. It was the archoeus of Van Helmont ; the onima of Stahl ; the vis medicatrix naturcB of Ciillen. But without sup- losing it to be aught distinct from the ordinary attributes of living matter, we see its frequent operation in the common performance of excretion ; in the careful manner In which noxious products of the body, and offending substances in food, are ejected from the system ; in the flow of tears to wash a DISEASE. 49 grain of dust from the eye; in the act of coughing and sneez- ing to discharge irritating mattei's from the air-passages, and in the slower, more complicated, but not less obvious ex- ample of inflammation, effusion of lymph and suj)puration, by Avhich a thorn or other extraneous object is removed from the flesh. "This vis conservatrix is alive to the exciting causes of dis- ease, and in persons in full health it is generally competent to resist them. How it resists them will depend upon what they are. For instance, is cold the cause? — This throws the blood inwardly, which, by increasing the internal secretions and ex- citing the heart to increased action, establishes a calorific pro- cess which removes the cold. Is the cause improper food ? — The preserving power operates by discharging this speedily, by vomiting or by stool. Is it a malarious or contagious poison ? — It is carried off by an increase of some of the se- cretions. But if this resisting power be weakened, locally or generally, or if the exciting cause be too strong for it, then the cause acts, and disease begins." It has already been stated that in many cases the natural powers of the system are sufficient for the restoration of health, and also that the physician who proposes to benefit the sick should carefully assist these efforts of nature. The question now comes up, how does nature remove disease? In general disease we note the fact that the temperature comes back to the normal standard, the circulation of blood becomes normal, innervation becomes normal, secretion is established and effete material removed, digestion commences, good blood is made, and the tissues are rebuilded. In disease of parts it is very nearly the same. Wrongs of temperature are righted, a good circulation is established, imperfect mate- rials are removed, and normal nutrition is established. This seems to embrace the entire subject, and explains the method of cure in all forms of disease. For, with a right temperature, a right circulation, a right removal of waste, a right nutrition, and a right innervation, we must have health of the entire body, and of its parts. But if we examine it again and analyze it, it becomes more complex. The temperature may be increased, diminished, or unequal, 50 GENEKAL THERAPEUTICS. and arise from faults of food supply, respiratory wrong, wrongs of the skin, wrongs of innervation, or wrongs of the blood. The circulation may be too rapid, too slow, too strong, too feeble, irregular, or changed from its normal character in a score of ways. And then these changes may be dependent upon wrongs of the blood, wrongs of the temperature, wrongs of innervation, wrongs of excretion, etc., etc. The wrongs of innervation are multiform. Too much, too little, and perverted in a score of ways. We study these wrongs of innervation for years, and yet almost every week will show us some new phase of wrong innervation. If we trace the course of any general disease where no treatment has been pursued, we will find that increased secre- tion and consequent elimination always precedes a change for the better; and the same is true where even the most oppo- site remedies have been used. Without this increased elimi- nation does take place, death is inevitable. This accounts for the great success of Reformed Physicians in treating the com- mon acute diseases oj this country. Their attention has been especially drawn to the importance of due attention to these emunctorles, and a large portion of the treatment is directly to stimulate elimination in this way. This will be apparent by a mere glance at the agents most used. In addition to this, the fact generally recognized by them, that in disease there is always a depression of the vital force of the system, and that this should be kept up by ionics and stim.i.dants, has also added materially to their success. With a return to a normal temperature, a normal circula- tion, a normal excretion, and a right innervation, the patient has a desire for food. Frequently the appetite is the best guide to the required food, and if not stimulated, or modified by suggestions, it may be safely followed. The food is digested as the stomach and intestinal canal gain power, good blood is made, and nutrition of tissue commences. These are all natural processes, and even in severe and pro- tracted disease, nature Is able to accompllsli it all. I have watched the case of typhoid fever go through all Its phases without medicine, and on the twenty-first day terminate as above named — the restoration of a new body going on steadily ACTION OF MEDICINES. 51 iintil in six wooks the person would be as sound and able as '"yefore infection with the poison. As we are taught to observe and follow nature's footsteps in these things, we use our remedies to facilitate what nature might accomplish without our aid. We do the things that she does. We do them in the same order, and we endeavor to do them in the same quiet way. In so far as we work with the vital powers, we are successful ; when we oppose them we had better not practice medicine. That nature is able to cure almost all curable diseases, is clearly proved by the results of homoeopathic treatment. There are very few medical men who have any faith in the efficacy of their attenuations and dilutions, and yet we find that more favorable results are obtained under this treatment than under the old depletive system. This well-known fact is sufficient evidence that patients will get well without med- icine, and that medicine said to be scientifically administered, is responsible for no small percentage of deaths under regu- lar treatment. As has been remarked, every part of the body and every function can be reached through the nervous system, and by small doses of remedies. Thus excess maybe reduced, defects may be increased, and perversions may be rectified. And as the practitioner gains experience, he will find that he can ac- complish these things with remedies that act kindly, that are pleasant in form and small in dose ; and he will, from time to time, replace his old remedies with new. Action of Medicines upon the System. We might arrange all remedial agents in three classes, ac- cording to the effect they exert upon the system, whether it is physical, chemical or vital. All agents act in one of these three ways, though it is impossible sometimes to distinguish between them, as an agent may first affect the body by its physical properties, and secondly by both a chemical and vital change in some of its constituents. Physical Effects of Bemedies. — The action of remedies may be owing to their form ; in this case we say the action is physical ; but this is the case with but very few agents, and 52 GENERAL THERAPEUTICS. these are the anthelmintics : thus the hairs of the pods of mu- cuna pruriens, or the stanni pulvis of the phat-macopoeia, are said to act in this manner. These agents are supposed to act mechanically in destroying worms. All other agents that have heen said to act in this manner, would produce no effect at all if they did not act in a living body ; hence we may name such agents physico-vital. Chemical Effects of Remedies. — According to Pereira, in consequence of the mutual affinities which exist between some medicines and the constituents of the tissues and of the blood, numerous and important chemical effects are produced in the animal economy. The halogenous bodies, some of the ^combustible metalloids, the acids, the alkalis, metallic salts, tan- nin, creosote and alcohol act in this way. 1. The halogenous bodies (chlorine, bromine and iodine) ab- stract hydrogen and unite with bases. Indirectly they be- come oxydizers by taking hydrogen from water and setting free the oxygen. In some cases they may, perhaps, combine directly with organic substances. 2. The non-metallic combustibles (sulphur and phosphorus) combine with both oxygen and hydrogen. 3. The acids (sulphuric, nitric, hydrochloric, phosphoric and acetic) combine with bases, decompose many salts, and unite with or decompose the organic constituents of the body. 4. The alkalis unite with acids, decompose some salts, and combine with or decompose the organic constituents of the body. 5. Most metallic salts react chemically on the organic tis- sues, and give rise to the formation of new compounds. 6. Tannic and gallic acids. — Tannic acid, in the impure state called tannin, acts on the animal tissues in virtue of its affinity for their constituents. It forms with albumen and gelatine compounds which are insoluble in water ; and it also combines with fibrine. When taken into the stomach, it unites with the constituents of the epithelium, and of the mucous membrane of the alimentary canal. It becomes ab- sorbed, and is evacuated from the system in the urine. 7. Creosote, Alcohol and Ether. — Both creosote and alcohol cause the coagulation of albumen. TARTS TO WHICH MP:DICINES ARE APrLIED. 53 III addition to tlic classes of agents named, there are but very few but what exert some chemical influence on the sys- tem. As a general rule, however, the beneficial effect of a remedy is not entirely dependent upon its chemical effect, but upon some change in the vital force of the system, so that we might justly call the action of this class of agents chemico-vital. Vital Effects of Medicines. — The influence of all remedies upon the system must for the most part be vital in its nature, though it may depend in some part of its action on its physical condition, or on its chemical properties; its major action is such only as could be exerted in a living body. The class of vegetable remedies exert the least physical or chemi- cal effect upon the system ; they appear to act directly upon the vital force of the entire system, or on some particular organ or parts. These remedies either stimulate or depress the functions of the different secreting and excreting organs, increase or diminish digestion and sanguification, stimulate or depress the nervous system, etc. They might be divided into three classes according to their effects upon the system, though such a division would but generalize the subject. The first of these classes would include all those agents which highten or augment vital action, and would hence be called stimulants; the second those that depress nervous action, or sedatives ; and the third those that alter either the nature or quality of vital action, being neither stimulant nor seda- tive ; this class might be called alteratives. Parts to avhich Medicines are Applied. Medicinal substances are principally applied to the skin- and mucous membrane; to serous membranes, to wounds, ulcers, etc., though in some few instances they have been in- troduced into the circulation by injecting the medicinal sub- stance into the veins. Apjplication to the Skin. — Applications are made to the skin- with a view to their local effect, as well as with a view to their remote influence upon distant parts. Liniments, lotions, embrocations, fomentations, cataplasms, blisters, setons, issues, etc., are employed to relieve local painful affections, and to establish a new action and exert a 54 GENERAL THERAPEUTICS. derivative influence in deep-seated disorders attended with irritation, congestion, or local inflammation. The methods of application are four, viz., the enepidermic, iatralepiic, endermic, and hypodermic. The enepidermic method is that by which the medicinal agent is applied to the skin unassisted by i'rictions, as when we apply sinapisms, blisters, poultices, fomentations, baths etc. In many instances the medicated vapor-baths, consisting of a solution of the volatile principles of either vegetable or mineral agents, aftbrd much relief in outaneous diseases, as well as in the diseased states of internal organs, mucous sur- faces, etc. Sinapisms, blisters and other counter-irritants arc used princi- pally for their revulsive effect; they give rise to a new point of excitation, and detract the circulation and nervous influ- ence from internal organs to the surface. Though we can not analyze the modus operandi of this action, yet the fact (the main thing), is very apparent. Poultices, fomentations, etc., are used to relax the parts to which they are applied, to apply heat or cold to a part, and to shield parts from the action of the air. The iatraleptic method consists in the application of medi- cated substances to the surface, aided by frictions. It is also termed the epidermic method. Many substances are employed. in this way, as liniments, ointments, etc. ; also par- ticular agents, as many of the narcotics, camphor, sulphate of quinia, aconite, belladonna, morphia, etc. The' endermic application, sometimes termed the emplastro endermic method, consists in applying medicated substances to the denuded dermis ; the epidermis being removed by a blister. The hypodermic method is an injection of the medicinal substance under the skin into the cellular tissue, from whence it is rapidly absorbed by the blood-vessels. By this means any soluble substance may be directly introduced into the blood, and its action will be much more rapid thon when taken by the stomach. Of course the remedies used in this way must be non-irritant, or else inflammation of the cellular tissue will result, followed by suppuration. The hypodermic syringe PAETS TO WHICH MEDICINES ARE APPLIED. 55 now made is a very perfect instrument, and can be used with- out the least danger, always avoiding veins. Morphia is the remedy in most common use, and the solu- tion employed is grs. x. to water oj- Atropia is used in the proportion of grs. vj. to water .^j.; strychnia, gr. j. (sulphate of strychnia should be employed, and to the ordinary commer- cial article a small amount of acetic acid must be added) ; sul- phate of quinia, grs. x. (three or four grains of tartaric acid is necessary to effect the solution) ; pilocarpin, grs. iv. Of these solutious the quantity used will vary from gtt. x. to oj- Applications to the Mucous Membranes. — Agents are often applied to the different mucous membranes, as the pituitary, trachea-bronchial, g astro-intestinal, recto-colic, urino- genital, and utero-vaginal membranes. Medicines are applied to thenasal or pituitary mucous mem- brane to irritate it, and excite an increased secretion, in dis- ease of that surface and parts adjacent, when they are called errhines. The nasal douche and the spray apparatus are means of applying remedies to the nasal mucous membrane in cases of catarrh and ozsena. Medicinal agents, when properly applied to the tracJiea- bronchial mucous membranes, are capable of exerting the most salutary influences. They are mostly employed for local purposes, as in phthisis, chronic bronchitis, asthma, etc. Nu- merous are the substances which have been applied to this membrane — nitrate of silver, sulphate of Iron, cinchona, pinus canadensis, myrrh, etc., when reduced to an Impalpable pow- der, have been inhaled in certain states of the pulmonary organs with advantage. The fumes of tar, resins, balsams* and various ethereal solutions, have been strongly recom- mended as inhalations in certain diseases. The modern spray apparatus is the best means of applying remedies to the nasal, laryngeal, tracheal, and bronchial mu- cous membranes. With this the fluid is finely comminuted (pulverized), so that It is carried by the air breathed to all parts Several patterns of steam atomizers will be found In the market, the jet of steam from a small boiler carrying the medicated fluid. The air apparatus is simpler and cheaper, and will serve most of the uses In this treatment. Any agent that can be held in solution may be used in this way, and 56 GENERAL THERAPEUTICS. inhaltitions may be stimulant, sedative, alterative, tonic, in- creasiiif; secretion, diminisiiing secretion, etc. Simple aqueous vapor, and other medicated vapors are often highly useful in disease of the lungs and throat. The vapor may be inhaled through a teapot, or basin covered with an inverted funnel, or by inserting a tube through the stopper of a wide-mouthed jar containing the warm medi- cated fluid. ]l^arcotic and emollient agents are employed, in this way; also, hot vinegar, sulphuric ether, camphor, tinc- ture of iodine, tincture of conium, chlorine gas as it issues from moistened chloride of lime, etc. Medicinal agents are mostly applied to the gasiro-intcstinal mucous membrane, which is termed the method by ingestion. From the great susceptibility of this membrane to impres- sions made by medicinal agents, and from the facility with which they are absorbed, and the nervous sympathy existing between this membrane and other parts of the body, it pre- sents the most useful surface for the sanative application of medicinal agents. Their remote effects are more readilj' and more certainly secured than when applied to any other part of the system. The recto-colic mucous membrane is readily affected by agents which are absorbed, as opium, tobacco, etc. ; but twice or three times the ordinary dose is required to produce the desired effects. Medicines are applied to the rectum to relievo disease in that or adjacent organs, as the bladder, uterus, or prostate gland; sometimes to secure alvine evacuations, by dissolving hardened feces, or exciting the peristaltic action of the bowels; sometimes with a view to their derivative action in diseases of the brain, and occasionally to remove the ascaris vermicularis, or small thread-worm. If the substances applied to the rectum are solid, they are termed suppositories; if fluid, enemata, lavements, or clysters. To the urino-genital mucous membrane, caustic or medi- cated bougies are applied ; or anodyne, demulcent, astringent. or refrigerant injections are employed ; and, in some cases, medicated fluids are injected into the bladder. Remedies are applied to the vtero-vaginal mucous mem- brane, to remove local disease, as in inflamnuition, morbid ACTION OF MEDICINAL AGENTS IN THE STOMACH. 57 growths, etc. ; they arc also used to check excessive secre- tions, sanguineous discharges, and to promote the catanienial discharge. On the Mode in avuich Medicinal Agents Act when In- troduced INTO THE Stomach. A legitimate, and bj no means unimportant or uninterest- ing question, is, as to the mode by which medicinal sub- stances act when introduced into the stomach, so as to remove abnormal states of the general system, or of particu- lar organs. We will first look at their apparent effects, before examining the mode by which their action is effected. E-cmedies may operate directly upon the organs diseased, and newly impress them, — change the morbid action present by substituting a new and different one that shall supersede or displace the primary affection ; and by this means a cure is sometimes effected. Thus in dysentery, diarrhea, cholera morbus, nausea and vomiting, and many other disorders affecting specifically particular tissues, by exhibiting agents that exercise a specific influence upon the parts diseased, a new impression is produced corresponding with the morbid one already existing, though differing from it in kind and intensity of action, and by this means the original one is effectually removed. Indeed the substitution of a new- action or impression in a diseased organ, often most effectu- ally removes the primary one, and as soon as the part recov- ers from the temporary medicinal action, a normal state ensues. Although results of this kind do not always follow, yet the exceptions to this rule constitute no valid objection to the truth of the general proposition. In this way cathartics prove beneficial in dysentery and diarrhea, emetics in cases of nausea and vomiting, and can- tharides, turpentine, and other stimulating diuretics, in chronic irritation, or inflammation of the urinary organs. That other impressions and modes of action may follow the (exhibition of these remedies, by which aid may be derived in subduing the morbid states, can not be doubted. Thus, they may excite the surfaces Avith which they come in con- tact to an increased secretion, and thus deplete the distended vessels, while the increased secretion may remove a noxious 58 GENERAL THERAPEiJTICS. material from the blood, which has assisted to keep up the disease; the increased secretion may likewise shield, and thus lessen the irritability of the inflamed or irritated surfaces. Tlie impression which they make upon other organs, or upon the general system^ may also enable us to account in part for their sanative influences upon those tissues. In the second place remedial agents may exercise a sym- pathetic influence upon the whole system. Some medicines act primarily upon the solids, and these impressions are transmitted through the agency of the nervous system to every part of the body. The remote efiects of medicines are far from being confined to the parts with which they are brought into direct contact ; on the contrary, parts dis- tant from these are strongly influenced or impressed by remedial agents. Emetics, for instance, act primarily and specifically upon the stomach, but their most important sanative influence is transferred through nervous sympathy to other organs, and thus every tissue of the body is influ- enced or newly impressed by them ; old associations and perverted sympathies are broken up, and a new action estab- lished, the tendency of which is, by this change of action and sensation, to restore the system to health. The same remarks apply to cathartics. They act specifi- cally upon the alimentary canal, causing alvinc evacuations, and thus remove the vitiated and disease-creating accumu- lations of the intestinal canal — a prolific source of disease. But this is far from being the only way in which these con- tribute to the restoration of health. They excite the intest- inal exhalents, and thus act as depletives, thereby promoting increased absorption and nutrition; they also exercise a strongly revulsive influence, by which a new surface or point of excitation is established, and by this counter-irritant etiect, remote organs are relieved of congestion, inflammation and other morbid states. The whole system is impressed by their action, and important changes wrought upon the animal economy. Tonics and stimulants may act directly u[)on the sentient extremities of the nerves of the stomach, and thus arouse or excite that organ to increased energy, and thereby promote digestion ; and thus favor the process of chymitic a- ACTION OF MEDICINAL AGENTS IN THE STOMACH. 59 tion and cliylificatioii, and by this means indirectly promote nutrition and the renovation of an exhausted or enfeebled system. By the agency of the same classes of medicines, a transmitted influence is extended through the nerves to every part of the body, and in this manner every liber is newly impressed, and a modified state of the vital manifestations in evory part of the body is the result. In the same manner we may explain the therapeutic agency of other classes of agents in the removal of disease. In this way we may explain the highly sanative effects of ablutions — we apply them to the surface and the impression there made is transmitted to every portion of the sj'stem, and a general reaction results from a timely and appropriate resort to these means. Tlie advantages attending their employment, often so conspicuous, can be explained only upon the ground that the new impression made upon the surface is transmitted by nervous sympathy to other parts of the body. That the animal economy possesses the faculty of trans- mitting impressions, whether morbid or sanative, from one part to another is indisputable. This power is essential to the preservation of living beings, and the vital actions would soon cease, did not a connected medium exist, by which each part is brought into a reciprocal relation and mutual depend- ence upon others. The brain and nervous system constitute the medium through which these sympathetic phenomena are transmitted, and remedial as well as morbid impressions are propagated through this source to all parts of the animal economy. Thus every therapeutic agent or appliance may be said to alter or modify the sensations, actions, functions or condition of some organ through this medium ; their primary action may be upon particular parts, and remote from those over which they exercise an important curative influence, and this sec- ondary influence may not be in every case immediately appreciable. How wonderful then is the bond of union which exists between the various organs of our bodies ; that it does exist, does not admit of a doubt ; that a reciprocal intercourse of relations, sensations, and sympathies is main- tained between all parts of the animal economy is apparent. These links unite all parts of the system, and thereby estab- 60 GENERAL THERAPEUTICS. lish that concurrence of action, and that perfect harmoiiy of function, which when beheld, can not fail to strike the observer with wonder and admiration. In this way then are we enabled to explain man}^ of the sanative influences wn^ought upon diseased organs or states of the system, by the administration of medicinal agents. Again, remedies may act directly upon the blood, either adding something to it, or modifying its constituents. We have a large class of agents termed restoratives that act in this manner; they are of great importance in the treatment of any disease in which the blood mass has lost its normal character. In health, food is the proper restorative, it sup- plies the blood with all its constituents, with all substances required to supply growth, to repair w^aste, and to maintain the various functions at the healthy standard. Disease may result from improper food, or want of assimilation in that which is taken, and thus we have as the proximate cause a defect of some of the constituents of the blood. We have a familiar example of this in Chlorosis or Ansemia ; in both these diseases there is a defect in the quantity of the red globules of the blood. The treatment in this case should be directed to the restoration of the defective material ; this is done by the administration of iron, which assists to form the deficient element. Again we suppose that the class of ton- ics add to the blood some vital constituent that is lacking; no one can have failed to notice the beneficial eftects of this class of remedies upon the system: all of them are readily absorbed, and chemists inform us that they are not excreted, without they are taken in large quantities. This being the case, it is reasonable to suppose that they remain in the blood, and assist in supplying material to the various parts of the body. Some agents exert a modifying influence on the blood, and on the system ; these agents are generally termed altera- tives. This class of agents we know less about tlian any other; there is no doubt that many of them owe their medi- cinal action to their effect as eliminatives, but their entire effect can not be ascribed to this cause, so that we must sup- pose a part of their action at least must depend upon their influence on the blood. ACTION OF MEDICINAL AGENTS IN THE STOMACH. 61 Again, some classes of agents owe their sanative influence to their eliminative action, either stimulating the excretory organs of the body to a normal performance of their func- tion, or uniting with a morbid material in the blood, pass with it through an excretory organ, by virtue of their spe- cial affinity for it. To this class of agents belong cathartics, emetics, diaphoretics, diuretics, etc. They are used to re- move morbid material from the circulating fluids. " To restore the natural secretion of a part when its diminution or stoppage results from torpor or deficient vascular activity of the secreting organ. To augment the natural secretion of a part, and thereby diminish the quantity of circulating fluid. To augment the natural secretion of a part, and thereby to promote absorption — as in dropsy. To augment the secretion of one part, and thereby to lessen the secretion of some other part. To augment the secretion of an organ, and thereby relieve local determinations of blood to remote parts ; as when we administer purgatives to relieve deter- mination of blood to the brain. To promote secretion, and thereby to favor the subsidence of diseases whose natural termination is by increased secretion. To produce exhaustion (the secondary effect of evacuants), and thereby to act as antiphlogistics." In the further consideration of this subject, we will adopt the propositions of Headland, with some modifications, as the basis of our remarks. Perhaps no other writer has done more to unravel the intricate questions in regard to the action of remedies than this author, and we will quote freely from his work where his views appear to be founded upon fact or correct reasoning. He bases his views of the action of remedies introduced into the stomach, upon ten propositions These propositions relate to the general conduct of medicines after their introduction into the stomach, and before their absorption into the blood, and of their subsequent effects after they have passed into the blood. They are as follows: Prop. I. That the great majority of medicines must obtain entry into the blood, or internal fluids of the body, before their action can be manifested. Prop. II. That the great majority of medicines are capa- 62 GENERAL THERAPEUTICS. ble of solution in the gastric or intestinal secretions, and pass without material change, by a process of absorption, through the coats of the stomach and intestines, to enter the capil- laries of' the portal system of veins. Prop. III. That those medicines which are completely in- soluble in water and in the gastric and intestinal juices, can not gain entrance into the circulation. Prop. IV. That some few remedial agents act locally on the mucous surfaces, either before absorption, or without being absorbed at all. That they are chiefly as follows : a. Irritant emetics. h. Stomach ansesthetics. c. Irritant cathartics. Prop. Y. That the medicine, when in the blood, must per- meate the mass of the circulation, so far as may be required to reach the parts on which it tends to act. That there are two possible exceptions to this rule: a. The production of sensation or pain at a distant point. h. The production of muscular contraction at a distant point. Prop. VI. That while in the blood the medicine may un- dergo changes, which in some cases may, in others may not affect its influence. That these changes may be : a. Of combination. h. Of re-construction. c. Of decomposition. . Prop. VII. That a first class of medicines, called hematics, act while in the blood, which they influence. That their action is permanent. 1. That of these, some, called restoratives, act by supplying, or causing to be supplied, a material wanting, and may re- main in the blood. 2. That others, called catalyiics, act so as to counteract a morbid material or process, and must pass out of the body. Prop. VIII. That a second class of medicines, called neu- rotics, act by passing from the blood to the nerves, or nerve- centers, which they influence. That they are transitory in action. 1. That of these, some, called stimulants, act so as to exalt nervous force, m general or in particular. ACTJO?^ OF MEDICINAL AGENTS IN THE STOMACH. 63 2. That others, called narcotics, act so as first to exalt ner- vous force, and then to depress it, and have also a special influence on the intellectual part of the brain. 3. That others, again, called sedatives, act so as to depress nervous force, in general or in particular. Prop. IX. That a third class of medicines, called astring- ents, act by passing from the blood to muscular fiber, which they excite to contraction. Prop. X. That a fourth class of medicines, called elimina- tives, act by passing out of the blood through the glands, which they excite to the performance of their functions. The first proposition affirms that the great majority of medicines must enter the blood before they can exert their peculiar influences upon the system. That this is true is readily proven by the fact that medicinal agents introduced into the stomach disappear, and no trace of them can be found in the alvine evacuations, unless they are agents which act specifically upon the alimentary canal. It is proven by the action of remedial agents upon the child at the breast, showing that the remedy has been absorbed, and that the milk of the mother has been medicated, it being rendered pur- gative by senna and narcotic by oj^ium. Rhubarb in the se- cretions, madder in the bones, silver in the skin, and mercury in various parts of the body, when these agents have been administered, are additional examples going to prove the same proposition. Again, the odor of musk, garlic, onions, and various other agents, is readily detected in the cutane- ous excretions, and in the breath. The coloring matter of indigo, iodine and madder is recognized in the milk, and the same ^ principles, as well as the chemical constituents of agents almost without number are readily detected in the urine. It is said that the amanita muscaria, a species of fungus, produces inebriation, and that the inhabitants of l^orthern Asia use it for this property. He who has eaten it will, in the course of twenty-four hours, have slept himself sober; when if he takes a teacupful of his urine, he will again become intoxicated ; and a party of drunkards, it is said, may keep up their debauch for an indefinite period of time 64: GEXEEAL THEEAPEUTICS. by drinking the urine of each other — one only having eaten the fungus. That medicines act after having gained entrance to the blood, and that this is requisite to their action, is proven by the fact that remedies act in the same way when introduced into any other part of the system, or by being injected into the veins, as they do when introduced into the stomach. Thus iodine injected into the scrotum, for the cure of hydro- cele, has been detected in the urine. Croton oil, or a liquid preparation of gamboge, jalap, or rhubarb, rubbed in suffi- cient quantity upon the abdomen, produces purging. A moistened leaf of tobacco applied over the radial artery, has been known to produce vomiting. A solution of aconitina applied to the skin, will produce numbness and tingling of distant parts. When medicinal substances are injected under the skin, they produce the same eiFect as when introduced into the stomach : thu?, emetic substances produce vomiting; castor-oil, purging; opium, or its active principles, narcosis; strychnine, convulsions, etc. It is proved that remedies must act through the blood, and not through the medium of the nerves, by the direct experiment that a poison will not act when introduced into the body, if the circulation from the part is cut off. Or the reverse experiment of Magendie proves this position. He introduced into the crural arter}^ of a dog, the barrel of a small quill, upon which he fixed the vessel by two ligatures ; the artery was divided in a circular direction between the two; he then did the same with the crural vein; thus all communication between the thigh and the rest of the body was interrupted, except the arterial blood, which passed to the thigh, and the venous blood, which returned from it. The poison introduced into the part produced its eftect in the ordinary time — about four minutes. In this instance there could be no doubt but that the poison was absorbed by the. veins, and through them carried into the circulation, from which it acted. The objection that some agents act so rapidly that there is not sufficient time for their absorption and convej'ance in the the circulating fluids to the part on which they act, is also re- moved by direct experiment. Mr. Blake made an experiment ACTIOT^ OF MEDICINAL AGENTS IN THE STOMACH. 65 on a dog in order to test the rapidity of absorption : he placed half a drachm of hydrocyanic acid on the tongue of the animal, having first fitted a tube into the larynx, so as to prevent the vapor from passing into the lungs ; he found that fifteen seconds elapsed before any morbid symptoms appeared, and death did not occur until forty-five seconds after the exhibition of the poison. Mr. Blake also found that a chemical agent would traverse the entire circulation of a dog in nine seconds, and of a horse in twenty seconds ; 80 that sufficient time elapses for the absorption and convey- ance through the system of even those agents that act with the greatest rapidity. The second proposition states that the great majority of medicines are capable of solution in the gastric or intestinal secretions, and pass without material change, by absorption, into the capillary veins of the stomach and intestines. That they do this is proved by the facts already stated, but the -question is, how is it accomplished ? The physical agency by which absorption is accomplished (imbibition of Magendie, or endosmosis of Dutrochet), consists in the tendency of rarer fluids to permeate membranes into cavities containing those of greater density. The circumstances which determine the passage of fluid through the coats of a vessel are principally five : 1. The densities of the liquids. — Other things being equal, the lighter of the two tends to pass through to the heavier, more than the heavier to the lighter. 2. Their attraction for the intervening membranes. — That one passes through most, which has the greatest aflinity for the mem- brane. 3. The affinity of the fluids for each other. — A fluid passes through more rapidly when it is readily taken up and dissolved by that on the opposite side. 4. The motion of the fluid on one side promotes the passage through of that on the other, because it is carried ofi^" as fast as it permeates the membrane. 5. The last law is that any 'pressure on the fluid on one side of the membrane has a powerful influence in determining the passage of the current from that side. Magendie demonstrated the fact that when there was vas- cular repletion, absorption was very slow ; but by depleting the vessels, absorption became very active. In one instance 5 66 GENERAL THERAPEUTICS. he injected about a pint of water into the veins of a dog; and placing in the pleura a moderate dose of a substance with the action of which he was familiar, he found that its efiects were not apparent until many minutes after the ordi- nary time. In another experiment he depleted the vessels by abstracting a half-pound of blood, and the efiects which ordinarily did not occur until the end of two minutes, devel- oped themselves in thirty seconds. Remedies, however, can not be absorbed without they are first dissolved and held in solution. A large number of agents are soluble in water, and these are readily absorbed. Some are rendered soluble by the addition of an acid to the water, and as the gastric juice contains an acid we have here the materials for their solution. Again others require a fluid with an alkaline reaction; and passing down into the duo- denum they come in contact with the bile, an alkaline fluid, and are thus rendered soluble. Albumen and like matters are rendered soluble by the action of the gastric juice. Thus a great majority of remedies are rendered sohible, and are then absorbed ; but we have agents that are insoluble in any of these fluids, and these either pass through the alimentary canal without exerting any medicinal influence, or they act as irritants or sedatives to it. The third proposition afllrms that those substances that are insoluble can not be absorbed into the circulation. This is a generally admitted fact and needs no proof, as its aflSrm- ation would conflict with well-known physical laws. The fourth proposition afiirms that some remedies act locally on the parts with which they come in contact. Some of these agents act first upon the stomach and intestines and are then absorbed ; others are entirely insoluble and after their action pass from the body with the feces. These agents may be classed as follows : 1. Antacids, 2. Chemical Aiiii-. dotes, 3. Astnngents, 4. Ancesthetics, 5. Irritant Emetics, 6. Ir- ritant Cathartics, 7. Agents lohich affect the 'process of Endos- mose. 1. Antacids are employed to neutralize acidity of the stom- ach ; they combine with and neutralize free acids contained in this viscus ; they are then absorbed. Pcreira states that they ACTION OF MEDICINAL AGENTS IN THE STOMACH. 67 probably aid in the digestion and absorption of fatty substan- ces, especially when there is a deficiency of bile and pancre- atic juice. 2. Chemical Antidotes are used to counteract poisons by rendering them insoluble, or converting them into harmless substances. 3. Astringents exert their effect locally as styptics, checking hemorrhage from the stomach. 4. Anesthetics are employed to relieve gastrodynia and other painful diseases of the stomach. They include hy- drocyanic acid, creosote and tris-nitrate of bismuth, and probably some others. They act in the same manner as aconite or morphia in painful diseases of the skin, by par- alyzing the sentient nerves of the stomach — this action depending on local contact. The first two are afterward absorbed ; but the third is insoluble, and acts also as an astringent to the mucous surface. 5. Irritant Emetics act by producing local irritation of the mucous membrane of the stomach. The impression is trans- mitted to the spinal cord, and by a reflex action the muscles concerned in the act of vomiting are excited to action, to expel the offending substances. Such agents produce but little nausea, and unlike specific emetics, which act upon the stomach into whatever part of the system they are introduced, these act only when brought into direct con- tact with the mucous membrane of the stomach. 6. Irritant Cathartics act in a similar manner as the same class of emetics; that is by their irritant effects on the mucous membrane of the intestinal canal, they cause an increased secretion from that canal, and stimulate the peri- staltic action. Their action differs widely from that of spe- cific cathartics; for these latter, as castor-oil, aloes, rhubarb, colocynth, elaterium and others will act as cathartics if absorbed through the skin, or injected into the veins. Many agents act in both ways, that is, they are partially absorbed and exert their influence through the blood ; but being slowly soluble in the fluids of the body they exert a direct, irritant effect upon the walls of the intestine. We have examples of this in the class of resinous cathartics — as scammony, gamboge, euphorbium, podophyllin, etc. These agents 68 GENERAL THERAPEUTICS. are sometimes of great value in disease of distant parts of the system, by their revulsive or counter-irritant effect. 7. Some agents effect the process of jEndosm.ose — they may increase the absorption of other agents, or they may cause an endosmose of the blood serum into the stomach and intestine, or they may entirely check the process of endos- mosis. Pereira makes the following classification: " 1. Substances which undergo Endosmose and Exosmose with the Serum oftheBlood. — The kind of endosmotic influence which these bodies exercise varies, in many cases, with the degree of concentration of the solution. Yery concentrated solu- tions in general cause endosmose of the serum; whereas dilute solutions have a reverse effect, and give rise to endos- mose of the solution ; and for solutions of an intermediate strength, the two currents are equal. "a. Substances which cause Endosmose of the Serum. — This division includes concentrated solutions of various salts (phosphate of soda, nitrate of potash, chloride of sodium, iodide of potassium, tartrate of potash, sulphates of soda and potash, phosphate of potash and alum), native Seidlitz water, Pultna- water, sufficiently concentrated solutions of certain vegetable purgatives (manna and the extracts of sen- na, rhubarb, the herb mercury, tamarinds, cassia, colocynth and aloes, resins of scammony and jalap, and castor-oil), of various narcotic substances (one part of .the alcoholic extract of the following substances to five parts of water : black hellebore, hemlock, henbane, aconite and belladonna), solution of cane sugar (this causes a very powerful current), dilute spirit, and a solution of cantharidin in olive-oil. " b. Substances which cause Endosmosis of the Solution. — This division includes water (which produces the strongest cur- rent), dilute solutions of salts (phosphate of soda, nitrate of potash, chloride of sodium, and iodide of potassium), solu tions of certain acids (acetic, tartaric, citric and sulphuric acids), of ammonia, of nitrate of strychnia, and of sulphate of quinia, hydrocyanic acid, laurel water, and certain non- purgative mineral waters. "2. Substances which do not undergo Endosmose and Exos- mose with the Serum of the Blood. — These may be arranged in two divisions : ACTION OF MEDICINAL AGENTS IN THE STOMACH, 69 " a. Substances whi^h penetrate the Membrane and render it unfit for Endosmose. — To this division belong the solution of snlphureted hydrogen and decoction of tobacco. Un- der the influence of either of these liquids, the membrane becomes permeable, and yields to that liquid which exercises the greatest amount of pressure. " b. Substances whose presence puts a stop to the Phenomena of JEndosmose, and renders the llembrane impermeable to either Liquid. — To this division belongs the solution of hydrochlo- rate of morphia." According to the generally received opinion of the laws of endosmosis, the purgative salts are purgative only because they are of greater density than the blood, and therefore cause an endosmose of the serum of the blood to the intes- tine, the increased distension exciting the peristaltic action of the bowels ; hence these agents are generally hydragogue cathartics. This action is according to the law of endosmo- sis, that a fluid of great density, when separated by a membrane from one of less specific gravity, will cause an endosmosis of the lighter fluid. This theory of the action of saline purgatives is adopted by Poiseble, Liebig, Matteuci, Dr. Pereira, and Dr. Gold- ing Bird. They also contend that when these salts are much dikited they become diuretics and are excreted by the kid- neys. On this point Dr. Bird states " that when saline sub- stances, especially, are intended to reach the kidneys, it is necessary that the density of their solutions should be much below 1.028 ; the proportion of solids dissolved in the aqueous vehicles prescribed being always less than five per cent. Daily experience in the employment of remedies will show the importance of this law in a therapeutic sense. Thus a tolerably strong solution of the tartrate, or the acetate of potass, will altogether escape the action of the absorbents ; indeed, so far from being imbibed by the capil- laries, it will actually excite an exudation of water from these vessels into the stomach and small intestines, thus becoming diluted by exosmosis, a sensation of thirst is excited, by which the patient is compelled to drink for the purpose of supplying the water removed from the blood by exudation. In strong solutions, the salts alluded to stimu- 70 GENERAL THERAPEUTICS. late the bowels and purge. They are moreover said to act as hydragogue purgatives, producing watery motions, a fact capable of ready explanation on physical laws ; exudation of water from the exhalents (capillaries) occurring on account of the density of the saline solutions traversing the intestines. We can hence readily perceive why half an ounce of acetate or tartrate of potass will purge, and a scruple of either excite diuresis." The fifth proposition states that medicines after they gain access to the blood, must permeate the mass of the circulation so far as to gain access to the parts on which they tend to act. This is proven by the fact that the agents may be detected in the different parts of the body, and in the secretions and excretions. We suppose that remedies have a special affinity for the parts on which they tend to act. As to the reason why particular agents act upon particular organs instead of others it is idle for us to speculate. Why do cer- tain agents seek out and act upon the kidneys instead of other organs, and why do cathartics exert a specific influence upon the intestines, even though introduced into the blood vessels, or into some of the cavities of the body, or absorbed through the skin, and not taken into the alimentary canal? The reason we can no more explain than we can the reason why the planets are kept revolving in their orbits. If we are told that the movements of the planets are the result of attraction, so we may say that the determination of medi- cines to certain organs is occasioned by similar attractions. This, however, explains nothing, and we must after all, be content with the broad fact that such phenomena do occur, and that they are governed by certain laws ; but the cause why they occur must forever remain concealed. As readily could we explain the reason why one plant possessing the most deadly poisonous qualities, and another that is not only innocuous, but delicious, and highly nutritious, should be pro- duced from the same soil, both being placed in the same conditions. The sixth proposition states that while in the blood, medi- cines may undergo changes, which sometimes affect the action of the agent, and at others do not. This proposi- tion is too circumscribed for practical jjiuposes ; lor iubtance, ACTION OF MEDICINAL AGENTS IN THE STOMACH. 71 we administer a dose of some agent, we wish to know first, whether it is changed before being absorbed, as we know this does take place in some instances, and whether this change affects the action of the remedy or not; then we wish to know what changes, if any, take place while the agent is in the blood. We will first consider the changes that take place in the stomach. According to Pereira, " Some substances undergo no obvi- ous chemical change, but being liquid or soluble, mechani- cally mix with the fluids of the part to which they are applied and become absorbed, as venous aqueous liquids, hold- ing in solution coloring^ odorous and other matters." Some substances undergo more or less chemical change by the action of acids, bases, salts, albumen, casein, ptyalin, pepsin, or other substances with which they come in contact ; and the newly formed body is, if soluble, absorbed but not otherwise. The alkaline and earthy carbonates are decomposed by the acids of the alimentary canal, with the evolution of carbonic acid. Most of the metallic oxides, and the metallic, alkaline and earthy salts, form new compounds with albumen, casein, etc. Chalybeate ^preparations, when swallowed, are partly con- verted into sulphuret of iron, which darkens the feces. The acids, both inorganic and organic, combine with ,bases; and the salts which, are thereby formed unite with organic matters. After being absorbed, medicinal agents may be changed in their combination ; they may be reconstructed or decomposed. Our knowledge, however, of these processes in the blood is not sufficient to elucidate any facts which would have any bearing on the action of remedies ; neither can we tell whether an agent has been chemically changed in the blood, or in the stomach, or the excretions. We do know, how- ever, that very few changes take place in the blood which affect the action of the remedy. The seventh proposition maintains that a certain class of medicines, called hematics, act while in the blood, which they influence; and that their action is permanent. These agents 72 GENERAL THERAPEUTICS. are supposed either to add a material to the blood which was deficient, or to remove a material from the blood which was unnatural to it, or in some way change its character. The first of these classes, called restoratives, embraces the most important agents of the materia medica; as already stated, they add to the normal constituents of the blood, and thus form a portion of the circulating fluid. They must then be such agents as would assist to form this fluid in a healthy state of the sj^stem, i. e., the blood must normally contain their analogues. It must not be supposed, however, that these agents are restorative in all conditions of the system, for the constituent of the blood which they increase may be in excess ; hence a large number of them only prove restorative in certain forms of disease. Headland lays down the following minor propositions in regard to their action : "1. That they act in the blood, and that their effects are permanent. " 2. That there are naturally in the blood substances which resemble or coincide with them. " 3. That they are of use when a disease depends on the want of one or more materials in the blood." The following classes of agents may be called restoratives in this sense : Tonics, chalybeates, acids, and alkalies. The first class or toiiics act first by increasing the tone of the stomach and entire alimentary canal ; thus stimulating (though the effect is permanent) the process of digestion and assimilation, thus improving indirectly the quantity and quality of the blood. Do they do this merely by contact, acting locally, or are they first absorbed, then acting from the circulation? The bitter principles of agents of tliis class are almost invariably alkaloids, readily soluble in water, or in the gastric juice, and hence quickly absorbed, so that the contact of these agents with the surfaces of the alimen- tary canal is but of very short duration, and extends gener- ally to only a portion of the stomach : this would tend to prove that they acted after being absorbed. By this stimu- lation of the digestive process we might account for the entire medicinal action of this class of remedies, as by this ACTIO?^ OF MEDICINAL AGENTS IN THE STOMACH. 73 means tliey increase the quantity and quality of the blood, and the nutrition of the system ; but we have reason to believe they do more than this. In miasmatic diseases, and fevers caused by the retention of an excretion, they are very efficient in counteracting the septic tendency of the morbid material. Is this action not owing to their counteracting the chemical changes going on in the body, in a similar manner to the action of hops in checking the fermentation of malt in the manufacture of beer? In regard to the action of cinchona, which may be taken as the type of this class of agents, Sundelin observes : " The general operation consists in the increase and exaltation of the tone of the irritable fibers of the vessels; hence, by its use the pulse becomes fuller, stronger and regular, and the muscular power increased; also in the general augmentation of the cohe- sion of the organic mass ; hence, it counteracts a tendency to liquefaction and disintegration, diminishes profuse secre- tions, which proceed from atony of the extremities of the vessels, and of the secerning surfaces and organs, and im- proves generally the crasis; and lastly, in the augmentation of the vital energy of the sensible system. By the last-men- tioned property it restores sensibility, when defective or ab- normally increased, and the property of reaction of the nervous system to their normal state, and augments the influence of this system on the muscular fiber, and on the reproductive system." The diflerent compounds of iron, or chalybeate remedies, act by directly supplying a material to the blood. They appear to be of benefit in but one condition of the system, that of anemia; and this disease or condition depends upon a deficiency of the red globules of the blood. The coloring matter of the red globules or hematosin, contains this miner- al, and Avithout a due supply of it the red globules can not be formed. Thus, by the administration of iron, the solid constituents of the blood in a case reported by M. Simon, had increased from 128.5 to 193.5 in 1,000 parts. The first effect of the iron is probably upon the red globules; it restores the deficient material, thus improving their condi-, tion, and by this means stimulates the entire system to a proper performance of its functions. 74 GENERAL THERAPEUTICS. Acids prove indirectly restorative in some cases by increas* iug the amount of the acid in the gastric juice, as in casea of weak digestion depending upon deficient secretion of this acid. It may increase the acid of the gastric juice either directly or indirectly ; it increases it directly by being added to it, indireetly by being absorbed into the blood where it would set free more of the acid than the stomach is required to furnish. If, however, there is too much acid secreted, these agents will cause indigestion; the same result will fol- low their inordinate use. It is stated by Pereira that acids always combine with bases before absorption. Other authors suppose that they are absorbed as free acid ; in either way, the alkaline base is derived from the blood, and hence they decrease the alka- linity of this fluid. The blood always has an alkaline reac- tion ; hence there is rarely, if ever, a free acid in it. The beneficial efl'ects of the vegetable and mineral acids in typhoid and other low forms of fevers, has been supposed by some authors to be owing to their neutralizing the excess of alkali, which existed in the blood in those diseases. According to Headland, the beneficial efiects of vegetable, acidulous drinks in febrile diseases, seems to be the restora- tion of the blood to a more natural condition, by supplying a material for oxydation. lie says: "In fact, I suppose that in fevers the supply of the natural blood fuel is deficient ; that the nitrogenous tissues are then oxydized to maintain the animal heat — causing not only wasting, but tending to keep up the fever by the excessive amount of oxygen de- manded by this abnormal combustion ; that in such a case the vegetable acid is well adapted to take the place of lactic acid, the natural fuel. For though in health the ingestion of such an acid is immediately followed by an increased acidity of the urine, when used in fevers it does not pass into the urine. It is then disposed of, or burnt, in the blood. The alkaline salt of the same acid is similarly burnt, as it would l^e in health ; but it leaves a residue, an alkaline car- bonate, which exerts upon the system the usual operation of an alkali." Again, the mineral acids have been strongl^'^ recom- mended in phosphatic deposits from the urine; they are THE ART OF PRESCRIBING MEDICINES. 75 supposed to increase the acidity of the urine, and by this means the phosphatic salt is held in solution. O'l this sub- ject Dr. Golding Bird says : "Unfortunately there is a great uncertainty attending their use; indeed, I feel ahnost in- clined to question whether any of the mineral acids, except the phosphoric, really do reach the urine, and thus destroy its alkaline character; certainly in the majority of cases, even their continued employment appears to be utterly in- eft'ectual in rendering the urine acid." Alkaline agents prove restorative in those cases where there is a deficiency of these agents in the system, or an excess of acid ; in the former case they supply the deficient material, and remain in tlie blood ; in the latter they neutral- ize the excess of acid, foruiiiig salts, and are excreted from the sj^stem. They are also used to counteract the lithic acid deposit. They are supposed to be useful in rheumatism by neutralizing the acidity of the blood and the secretions. The second class of hematic medicines, according to the proposition we are now considering, are called catalytics (from KazaXuco, to loosen, break up, dissoloe), from their sup- posed action in destroying or counteracting certain morbid agencies. The term employed to designate this class of remedies is certainly no more appropriate than the one for- merly used — the agents included under this head forming the old class of alteratives. The action of this class of remedies is so obscure that we will defer what we have to say upon them till we come to consider alteratives as a special class. The consideration of the eighth, ninth and tenth propositions may well be deferred until we treat of the classes specified in them. The propositions themselves state all we know of their mode of action. On the Art of Prescribing Medicines. Independent of the knowledge of diseases and the treat- ment of them, says Dr. Thompson, much of the success of the practitioner depends on circumstances connected alto- gether with the form in which the remedies are exhibited. In prescribing a medicine, even the best calculated to fulfill the object of the practitioner, it is necessary to consider the age. sex, temperament, habits and idiosyncrasy of the patient. 76 GENERAL THERAPEUTICS. before tlic close can bo properly apportioned; and, as far as the medicine itself is regarded, the most convenient and agreeable form of exhibiting it, whether it should be given alone, or combined with other ingredients, and how far these arc likely to impede, modify, or facilitate its operation. An attention to these circumstances is absolutely requisite to prevent the errors which too frequently occur in forming a prescription. Forms in which Medicines are Exhibited. — Medicines are exhibited in the solid, liquid and gaseous state. Solids arc employed internally in form of powder, pill, bolus, electuary, conserve and lozenge ; and externally, of cataplasm, ointment, cerate and plaster. Liquids are employed internally in the form of infusion, decoction, mixture, tincture, sirup and fluid extract ; and externally, of baths, washes and liniments. Gases are employed internally by inhalation, or by applying it lo- cally to some of the mucous canals, as the vagina, rectum, etc.; externally they are applied in cases of local disease, or in the form of aqueous vapor to the whole surface, in cases of skin disease, or to produce perspiration. Powders. — To form a powder, the remedy is finely commi- nuted, either by grinding, trituration in a mortar, levigation, elutriation, etc. It is the simplest, and perhaps the least objectionable form of preparing all remedies that can be re- duced to powder; those agents, however, which are very unpleasant to the taste, those which deliquesce rapidly when exposed to the air, or are very volatile, or which are not readily diffused in water, can not with propriety be admin- istered in this form. " Some substances can not be reduced to powder unless they be very much dried, and the heat necessary for that purpose alters their properties ; even the impalpable form given to powders is injurious to some resin- ous substances, and we can not be surprised that a great alteration should be eftected in a short time by the action of air on so great an extension of surface as takes in the opera- tion usually adopted for reducing drugs to fine powder." Many object to the employment of crude drugs in the form of powder, on account of the large size of the doses neces- sary, and from the fact that the woody and inert matter produces more or less irritation of the stomach. THE AKT OF PRESCRIBING MEDICINES. 17 The active princijyles of plants, as now obtained in the pow- dered form, are not liable to the above objections. The dose is small, there is no inert matter to produce irritation, and if the taste should be nauseous, it is easily disguised, owing to the small bulk of the agent. Powders may be given in cold water, when they are readily miscible, and the taste is not nauseous ; or in sweet- ened water. Resinous or heavy powders are best adminis- tered in mucilage or sirup; nauseous agents, if the bulk be small, may be enveloped in preserves, or administered in gelatine capsules. Pills. — Pills are formed either of extracts having a proper consistence to take and preserve a rounded form ; of dry solids which are combined with sirup, soap, extract of licorice, or some conserve, so as to form a pill mass; or of a tincture or fluid-extract combined with crumbs of bread, licorice, etc. This form of administration is especially adapted for medi- cines which have a very nauseous taste or flavor, and such as require but minute doses to operate, or in cases where a slow action of the remedy is desired. They are objected to by many practitioners from the fact that a majority of pa- tients have an aversion to pills, and because they are slow to act, not being as readily absorbed as when given in other forms. Electuaries, Covfections, Conserves. — Electuaries are mixtures of vegetable remedies, and light, earthy powders, combined by means of sirup or honey, so as to form a mass of tolera- ble consistence. Confections, or conserves, are vegetable matters beat into a uniform mass with refined sugar. In either case sufficient saccharine matter is employed to pre- serve as nearly as possible, the properties of recent vegeta- bles, and prevent decomposition. In many instances this is a very available form in which to administer remedies, espe- cially in the treatment of children. In some cases, however, the stomach will not tolerate the sugar, and in fever it is often detrimental to the patient. Lozenges. — Lozenges, or troches, are powders mixed up with glutinous substances into little cakes, and afterward 78 GENERAL THERAPEUTICS. dried. They are adapted for the administration of remedies of a pleasant flavor, and especially where it is desirable to bring it in contact with the mouth, fauces, upper part of the air-passages, as in sore mouth, sore throat, coughs, etc. They are administered by slowly dissolving in the mouth. "We might here notice with advantage the two forms in which medicines are now so frequently exhibited — that of extract, and what are termed '■'■ concentrated remedies ^^ or proX" imate vegetable principles. Extracts. — Extracts are solid, or semi-fluid preparations, obtained by evaporating aqueous or alcoholic solutions of vegetable substances. When water is employed as the men- struum, they are termed watery extracts, and then consist of gum, mucilage, albumen, extractive, and saccharine matter, and such active principles as may be soluble in this fluid. They are generally very liable to decomposition, and owing to this fact, and that they contain large quantities of inert matter, the most of them are inferior preparations. When prepared with alcohol, they are designated as alcoholic extracts; and if water is employed in addition, hydro-alcoholic extracts. The two latter form when well prepared, and if the active prin- ciples are soluble in these menstrua, very efllcient and eli- gible preparations. Proximate Principles. — All vegetable remedial agents con- tain certain ijroximate principles, upon which the medicinal value of the agent depends. In these, when pure, there is no variation of strength, the physician knowing precisely when he prescribes them, how much medicine his patient will take, which can not be said of any other preparation. Of these principles we haA^e the alkaloid, resinoid, oleo-resin- ous, vegetable acids, and neutral substances. Of these the two first are the ones in most common use. When "well pre- pared " they are, in a majority of cases, the best form in which vegetable remedies can be administered, " but " we have found by experience that it is not safe to take the word of every pharmaceutist who pretends to prepare these agents, that they are " efficient agents," or even that they are what they purport to be. We would be the last to throw dis- credit on concentrated medicines, yet we are confident that THE AKT OF PRESCRIBING MEDICINES. 79 many inert agents, of this class, are palmed oft' upon the pro- fession, greatly to the detriment, not only of the physician and his patients, but to the cause of reformed medicine. Cataplasms. — Cataplasms, or poultices, are employed exter- nally, to soften and relax the skin, and to exclude the air. They are formed of such substances as when wet will be somewhat tenacious, and accommodate themselves accurately to the part they are intended to protect. They may be em- ployed solely with reference to the indications named, or they may be medicated by the addition of narcotic, stimu- lant, or other agents to the poultice. Ointments. — An ointment is an unctuous substance, hav- ing a consistence but little firmer than lard, of which they are principally prepared. They are employed to bring medicinal agents in contact with the skin, by gentle rubbing, or more properly by inunction. Cerates. — Cerates are unctuous compositions, possessing more firmness than ointments, on account of the wax which they contain, and from which they derive their names. Their consistence is such that they can be spread upon cloth, and thus form a dressing. Piasters. — Plasters difter from cerates in possessing a much firmer consistence, so that the aid of heat is requisite to spread them, when they are pliable and tenacious, readily adhering to the skin. Each of these three forms of applica- tion may be employed to bring medicinal agents in contact with external parts, or through the skin to act upon inter- nal organs ; and, as it will readily be seen, one will be more applicable than another in certain cases. Infusions. — An infusion is a solution of vegetable matter, obtained by maceration of the substance, either in cold or boiling water. A large proportion of vegetable remedies yield either a part or all their virtues to water by infusion; but in addition to the medicinal principles of the plant, water extracts the gum, starch, mucus, etc. As far as success in practice is concerned, we have no doubt but infusion and decoction are the most eligible forms of administering such vegetable remedies as yield their prop- erties to water. However much "^m" practice may be laughed at. we know that this practice has proven eminently 80 GENERAL THERAPEUTICS. successful in the hands of our old practitioners. In these forms the remedy is readily absorbed ; there need be no doubt of its purity, or that it is well prepared ; and again, it is certain in this case, that the patient will receive sufficient diluents, a matter that is of the first importance in the treat- ment of many diseases. Infusions are objectionable, principally from the large size of the doses, and sometimes from the unpleasant taste of the remedy; the objection is also urged against them that they have to be often prepared, as they are liable to ferment- ation. ISTotwithstanding these objections we should prefer to administer remedies in this form providing the therapeu- tic properties of the agents could not be obtained in a pleas- anter form. It may be supposed by the reader that this can be accomplished in every case, but our experience proves conclusively that some agents can only be administered in this form if we wish to obtain their full therapeutic action. Decoction. — Decoctions are also solutions of vegetable mat- ter in water, but they are obtained by boiling. They are intended to afford more powerful remedies than can be obtained by the simple infusion of the same substances in cold or even in boiling water ; but, although by the opera- tion of boiling, the solvent power of the water is increased, and a greater quantity of the soluble parts of any vegetable body are consequently taken up by it, yet it does not follow that the medicinal virtues of decoctions are greater than the infusions. On the contrary, if the active principles of a plant be volatile, or if they consist chiefly of extractive mat- ter, this form of preparation often renders the remedy alto- gether inert, either by dissipating the volatile matters or by favoring the oxyzement of the extractive, which, in a contin- ued temperature of 212° attracts the oxygen of the atmosphere so rapidly, that it is soon converted into a soluble, insi^Did, inert matter, and precipitated in the fluid. For these reason fs only certain agents can be employed in this form with advan- tage, and it is an important point in studying the materia medica to impress the mind in regard to this point with any given agent. Mixture. — A mixture in pharmaceutical language, is a preparation in which different ingredients insoluble in water THE ART OF PRESCRIBIXG MEDICINES. 81 are held in suspension by means of mucilaginous or saccna- rine matter. It is a very convenient and desirable mode of administering many remedies. Tincture. — Tinctures are spirituous solutions of such of the proximate principles of vegetables and animals, as are soluble in either pure or diluted alcohol. From vegetable agents submitted to its action, dilute alcohol takes up sugar, resin, extractive, the alkaloid and allied principles, volatile oils, camjjhor, tannin, most vegetable acids, etc., and in addition more or less of the resinoid princii^le upon which the virtues of many plants depend. Alcohol undiluted is employed where It is desired to extract all the resinous principles of some agents. Tinctures are the most eligible preparations of vegetable remedies, whether we have reference to their preservation, to the ease with which they are dispensed, or to their certainty of action. With the majority of remedies in common use, the tincture is now prepared so that the dose is very small, and dispensed with water, it may be graduated to the fraction of a drop. With a good sized pocket case a physician can carry thirty to fifty of tliese remedies, in quantity sufficient for two or three days' patients, — the only care being to re- new the vial corks from time to time to prevent leakage. In dispensing tinctures we usually call for a glass half full of water and a teaspoon. The few drops (v. to xxx.) are poured into a teaspoon and then into the glass. The dose is pretty uniformly one teaspoonful, repeated every one to three hours, as the condition of the patient may demand. I find that patients do not object to medicines, if they can see a clean tinc- ture put into clean water, and there are but very few that have an objectionable taste, and none, the foul odor of the old- fashioned drugs. The child takes its medicine kindly, when it finds that the physician does not abuse its confidence by giving it a nastiness in disguise. Sirup. — Sirups are saturated solutions of sugar in water, either simple or medicated by the addition of some vegeta- ble principle. Medicated sirups, in the Eclectic pharmacy, are frequently prepared by extracting the medicinal princi- ples of plants with alcohol, which is then displaced, and the residue is formed into a sirup. It is not a very eligible form 6 82 GENERAL THERAPEUTICS. for the ad mini strati on of remedies, but it is very frequently employed to render more active remedies palatable. Fluid Extracts. — "Fluid extracts," according to Wood, are " highly concentrated solutions of the active constituents of medicines or the active constituents themselves, extracted in a fluid form." The menstruum employed in the preparation of these extracts is diluted or undiluted alcohol, depending upon the character of the principles contained in the plant ; in their preparation a portion of the alcohol is displaced, audits place supplied with sugar. According to the pharmacopeias, one pint of the extract should be equal to one pound of the crude agent ; but many of the Eclectic preparations are three, four, or five times this strength, in fact, " very variable." If " well " and " carefully" prepared, this might be a very available form for the administration of many agents, as the preparations are usually pleasant to the taste, and do not contain sufficient alcohol to make them objectionable. But, from our experience with fluid extracts w^e should hesitat-D to recommend the majority of them as " highly concentrated solutions of the active constituents of medicines." Baths. — Baths are either simple or medicated ; in both cases they are employed either to directly aflfect the skin, or for their influence upon a general disease. In addition to their value in diseases of the surface, it is sometimes a very valuable method of afi'ecting the general system. "Washes are solutions of medicinal agents in water or other mens- trua, and are principally employed for their local influence. LinlmeiUs. — "These are compositions which have the con- sistence of oil or balsam, so as to allow them to be easily rubbed upon the skin. They are generally more active remedies than cerates or ointments, and act as local stimu- lants, relieving deep-seated inflammations and pains." Of the Form and Composition of Extemporaneous Prescrip- tions.— In every prescription, says Dr. Thompson, simplicity should be kept in view, and when one medicine will answer the intention of the prescriber, it ought to be preferred. The nauseous taste, hoAvever, and the other qualities of a great majority of drugs, require the addition of others to modify their action ; but although medicines are more THE ART OF PRESCRIBING MEDICINES. 83 generally prescribed in a compound form, yet the practice of accumulating a great variety of ingredients in one pre- scription must be avoided. Medicines exhibited in the fluid form operate sooner and with, more certainty than in the solid state; but in choosing the vehicle or solvent, the taste of the patient ought not to be overlooked. Thus, for those to whom peppermint-water is not disagreeable, the nauseous taste of sulphate of mag- nesia is more completely concealed by that vehicle than any other ; if cinchona bark in powder be ordered, milk effect- ually covers its taste, provided the dose be taken the moment it is mixed ; and if aloes, the most nauseous article of the materia medica, be prescribed in a fluid form, a solution of extract of liquorice renders it by no means unpalatable. Medicines which, when given alone, produce griping, re- quire the addition of aromatics to correct that quality ; and when they operate with violence, mucilages and demulcents are sometimes necessary to soften their acrimony, or nar- cotics to moderate their action. In the use of concentrated remedies, especially resinoid preparations, it is of much ad- vantage to triturate them with sugar or sugar of milk, not only for the purpose of rendering them more soluble, and thus increasing their activity, but also to prevent irritation of the stomach and intestinal canal. In prescribing cathartics, it is often important to consider the part of the alimentary canal on which we wish them to act. Thus, rhubarb, sulphate of magnesia, leptandrin, etc., act chiefly upon the duodenum ; jalap, podophyllum and juglandin upon the lower part of the small and large intestines ; aloes on the rectum., and bi- tartrate of potassa upon the entire length of the canal. An- other reason for prescribing medicines in combination is the frequent need of fulfilling two or more indications at the same time. Thus, the same dose ma}^ be required in colic, to allay pain and evacuate the bowels, or in fever to deter- mine to the surface, to allay irritation and produce sleep. But in combining medicines, care should be taken not to bring together incompatibles, or substances that decompose each other, or chemically combine, altering the nature of the mixture, and forming new compounds, which may be entirely diflferent from the agents employed — without, indeed. 84 GENERAL THERAPEUTICS. the resulting compound is the agent desired. Thus acids and alkalis are incompatible, unless the neutral salt they produce be the remedy required. The following are the objects to be obtained, says Dr. Paris, by mixing and combining medicinal agents : Object 1. To promote the action of the basis or principal medicine. a. By combining the several dift'erent forms or preparations of the same substance. b. By combining the basis with substances which are of an analogous nature, i. e., which are individually capable of producing the same or kindred effects. c. By combining the basis with substances of a different nature, and which do not exert any chemical influence upon it, but are found by experience, or inferred by analogy, to be capable of rendering the stomach, or system, or any par- ticular organ, more susceptible of its action. Object 2. To correct the operation of the basis, by obviat- ing any unpleasant effect it might be likely to occasion, and which would pervert its intended action, and defeat the object of its exhibition. a. By chemically neutralizing or mechanically separating the offending ingredients. h. By adding some substance calculated to guard the sto- mach or system against its deleterious effects. Object 3. To obtain the joint operation of two or more medicines. a. By uniting those substances which are calculated to produce the same ultimate results, but by modes of operation totally different. h. By combining medicines which have different powers, and which are required to obviate different symptoms, or to answer different indications. Object 4. To obtain a new and active remedy not afforded by any single substance. a. By combining medicines which excite dift'erent actions in the stomach and system, in consequence of which new or modified results are produced. b. By combining substances which have the property of THE ART OF PRESCRIBING MEDICINES. 85 acting chemically upon each other; the results of which are : 1st. The formation of new compounds ; 2d. The decomposition of the original ingredients, and the development of their more active elements. c. By combining substances, between which no other chemical change is induced than a diminution, or increase, in the solubility of the principles in which their medicinal virtues reside: 1st. By the intervention of substances that act chemically; 2d. By the addition of ingredients whose operation is en- tirely mechanical. Object 5. To atford an eligible form. a. "With reference to its efficacy. h. With reference to its taste or appearance. c. With reference to its consistence or equable mixture. d. With reference to its preservation. In writing a prescription, the practitioner should, if pos- sible, use pen and ink, and the name of each ingredient should be given at full length ; or if abbreviated, the abbre- viation should be one in common use, and which will be readily understood by the pharmaceutist. The prescription should, in every instance, be written in a plain, legible -hand, with the symbols correctly given, and full directions as to dose and time of administration, and should be carefully re-read after it is written, in order to ascertain its correctness. In writing a prescription, the first object is the principal or m'ost active ingredient, which is called the basis; the next, the adjuvans, or that which is designed to promote the action of the first; the third, the corrigens, or that designed to cor- rect or modify the action of the principal remedy ; and fourth, the vehiculum, or that in which the agents are to be administered. In writing a prescription, it is not always advisable to place the different agents in the order just named, but in the mode best fitted for compounding the medicine. Thus, salts and other soluble solids should be placed before the menstruum in which they are to be dis- solved; and volatile agents should always be placed last, as they are necessarily the last ingredient added in the manipu- 86 GENERAL THERAPEUTICS. latioii of the compound. "When an infusion, decoction, or even poultice, is ordered to be prepared in the patient's house, it is always necessary to give specific directions to the one who is to prepare it; otherwise, in many instances, the remedy will be so poorly prepared, that no benefit will result from its use. In country practice, where the practitioner famishes the medicine, it should always be a rule to keep every thing iu the office properly labeled, and never let a package of medi- cine be dispensed unless it is plainly marked with directions for use. An observance of the rules just laid down, though they may seem of minor importance, will sometimes prevent serious mistakes, and always show a laudable care for the welfare of the patient. Circumstances connected with the State of the Patient. — Of these, we have to notice the age, sex, temperament, Jiabits, idiosyncrasy, disease, climate, mode of living, mental action, and to some degree the previous diseases of the patient, as very important considerations in the administration of remedies. Age. — In works on materia medica, the doses named, and the description of the therapeutic action of diflferent remedies, apply to the treatment of adults, without the contrary is stated. As far as the dose of an agent is concerned we may, in most cases, consider the following table, originally drawn up by Gabius, as a sufficient guide for the young practi- tioner: AGES. PROPORTIONAL QUANTITIES. DOSES. For an adult, suppose the dose to be One, or 1 drachm. Under 1 year, will require only l-12th, or 5 grains. Under 2 years, will require only l-8th, or 7i grains. Under 3 years, will require only l-6th, or 10 grains. Under 4 years, will require only l-4th, or 15 grains. Under 7 years, will require only l-3d, or 1 scruple. Under 14 years, will require only 1-2, or I- drachm. Under 20 years, will require only 2-3ds, or 2 scruples. Above 21 years, the full dose. Above 65 years, the inverse gradation of the above. All tables, however, can be regarded but mere approxima- tions, and can not apply to all remedies. Thus in early lifo the system is very susceptible to the action of narcotics, especially to opium, so that these agents if administered at all, should be given in much less than the proportionate dose; THE AKT OF PRESCRIBING MEDICINES. 87 while of castor-oil and some other agents much more than the dose named is required to produce their effects. Again, it must be recollected that in early life the mucous membrane of the stomach and alimentary canal is very susceptible to any cause of irritation, and hence irritant remedies should always be avoided. One of the authors, in his early practice, found that he met with much less success in the treatment of dis- eases of children than any other class of cases, and less than some of his professional brethren ; he attributed it to the administration of such agents as were not readily soluble in the stomach. Convinced that such remedies did in many cases produce irritation of the gastric mucous membrane, with its train of unfavorable symptoms, he resolved that under no circumstances would he administer them, and by carefully selecting such remedies as would not produce irri- tation he has found infantile cases to yield as readily to treatment as any others. From one to three years of age we find a peculiar erythism of the mucous membrane of the alimentary canal, or at least an increased predisposition to irritation, which is undoubtedly the cause (providing we do not attribute it to the medication) of a large proportion of the mortality at this age. Here especial care should be used, not only in not giving agents which produce irritation, but in constantly guarding against it by the employment of such measures as we well know counteract it. We must also notice the fact of the acute, nervous sensibility of the patient at this time, and that very great advantage may be gained by impressions made upon the skin of a soothing and agree- able character. Hence it is that baths of various kinds at this age become among our most important means of cure. In old age it is generally stated that the doses of medicines should be decreased ; but this ig not on account of an in- creased sensibility to the action of medicines, for the reverse is the case ; but because the strength of the patient is unable to sustain, without injury, the same impression from a remedy as in the full vigor of life. Sex. — Although some females possess as much bodily etrength and vigor of constitution as the majority of men, and require as large doses of medicine to produce a given effect, yet the greater delicacy and sensibility of the female frame, as a G 88" GENERAL THEBAPEUTICS. general rule, requires not only caution in apportioning the doses of active medicines, which should be less than those ordered for men of the same age, but the medicines them- selves should be such as are likely to fulfill the indications required without much violence. The state of the uterine system too must not be overlooked, for the periods of menstruation, pregnancy and lactation are attended with peculiarities in relation to the action of medi- cines. Thus the employment of aloetic and drastic purgatives must be suspended during the catamenia and period of preg- nancy ; agents likewise which exert any powerful influence upon the system should not be administered at these times. Agents which are absorbed and communicate injurious pro- perties to the blood, should be avoided during pregnancy and lactation ; so too should all cathartic or other medicines which communicate their properties to the milk of the mother, while she is nursing. Temperamerit. — It is doubtless true that temperament exer- cises a great and important influence over the action of medicines; yet temperaments are so poorly described, and the facts so illy defined in regard to their therapeutic rela- tions that we are almost tempted to pass the subject by, as one that can only be learned by long practice. The sanguine temperament does not bear stimulants well, and is very readily aft'ected by quinine and morphia, as is also the ence- phalic; while persons of a lymphatic temperament will generally require increased quantities of all remedies to pro- duce a certain efi'ect. We might consider the bilious tem- perament as the medium between the two named, the sanguine and the encephalic being more and the lymphatic less sensi- tive to the action of remedies. Habit. — Under this head we shall consider only the pre- vious habits of the patient in regard to taking medicine, and the influence that tliis will subsequently have in modifying the cflects of remedies. Persons addicted to the use of spirits, narcotics and other stimulants, are less easily excited both I5y medical stimulants and narcotics ; and the knowledge of the habits of a patient, as far as the exhibition of purga- tives is concerned, is absolutel}' necessary for the [)resoribor — many people being in the almost daily habit of taking this THE ART OF PRESCRIBING MEDICINKS. 89 class of remedies without consulting a medical practitioner. In the first of these cases, larger doses of stimulants and narcotics are required to produce the ordinary effects of th'-^sc remedies; but in the second a change of the purgative usually taken will generally be sufficient. It should, how- ever, be recollected that in prescribing a narcotic which' has not previously been taken, the dose should be no larger than usual. In the employment of most remedies which require to be long continued, the dose will have to be increased in order to produce the necessary effect. In some cases, indeed, a remedy will entirely lose its influence upon the system, when by substituting another having a similar action, the full eft'ect will be produced. Idiosyncrasy. — The individual peculiarities, or as the term is, idiosyncrasy of patients to the action of remedies, is of much importance, and can not be too carefully considered by the physician. It is well known that many persons are peculiar- ly affected by substances taken into the stomach, either in the form of food or medicine, in a manner different from the majority of mankind. Such cases are generally only discovered by accident or time; but the practitioner called to attend on a patient for the first time, should always in- form himself in regard to this particular as well as he can, never neglecting such information as may be volunteered by 'the patient or his friends. Any facts obtained in this way, or accidentally discovered, should be stored up in the mem- ory for future guidance when treating the same patient. A jdi^-sician who, from long attendance upon a patient, is tho- roughly acquainted with all his constitutional peculiarities in regard to the effects of medicines, has much greater advantages in treatment than one who has all this to learn. Ilencc we have here a good reason for the preference of patients to their family physicians, and a strong reason against the very prevalent custom of many Eclectic phy- sicians changing their location every year or two. Peculiarities in the effects of medicines are sometimes generated by disease; a remedy having an entirely different action from what was expected, or even from what it had had at previous times. As examples of these idiosyncrasies, might be mentioned 90 GENERAL THERAPEUTICS. the well-known effects of ipecacuanha, in causing in some persons, merely by its smell, severe asthmatic attacks ; the cutaneous eruption sometimes produced by copaiba and the turpentines; and the very singular and inconvenient effects of opium and its salts, upon some persons, etc. In some instances the'effect of the idiosyncrasy is to render the patient much more susceptible to the action of remedies; while in others it has a contrary effect. Disease. — The character of the disease always has more or less effect in modifying the action of remedies. Thus the Susceptibility of the patient to the action of medicines is sometimes greatly increased, while at others it is greatly diminished. Again, new susceptibilities are occasionally manifested, and effects wholly unexpected produced. Thus, in irritation or inflammation of .the- stomach, very minute doses of an emetic will act promptly, while in certain affec- tions of the nervous system, as delirium tremens for exam- ple, it is hard to produce emesis with the largest doses of the remedy. In certain conditions of the brain, small doses of opium will excite to phrensy; while in others^ as in tetanus, mania, etc., the largest dose will produce but little effect. In diarrhea opium checks discharges from the bowels, while in spasmodic colic it favors the action of cathartic medicines. Numerous other examples of this might be noticed ; but in this place all that is necessary is to direct the mind of the reader to the fact, and the importance of bearing it in mind in the study of disease, and the agents to 'be used in com- bating it. Climate. — Climate modifies the action of medicine by altering the condition of the system. Thus, in warm cli- mates, the muscles, the heart and arteries lose power and tone, the textures become relaxed, perspiration is pro- fuse, and internal organs, especially the liver, are too much stimulated by blood, which has lost more than usual of its water, and less of its hydro-carbon. Hence the im[)ortance of usins: with caution such remedies as act with harshness upon the alimentary canal, or upon the liver. There is also a marked tendency in diseases to assume a typhoid or ady- namic form, which should teach us the impropriety of using agents which debilitate the system, and the absolute neces- THE ART OF PRESCRIBING MEDICINES. 91 sity of usii.g sucli means from the beginning as will keep up the vital powers. In miasmatic regions, it will often be found that agents which prove curative in similar diseases in otiier parts of the country, will have but little, if any effect; the disease being controlled, if we may so speak, by the intermittent influence. Here the agents termed anti- periodics w^ill produce efiects that we would not expect in disease where this influence is wanting. The influence of climate in the production of disease, and the action of reme- dies has not as yet been sufficiently investigated, and we have not therefore the data to give, even if we had the space, a full account of its bearings. It is, however, a fruit- ful field of inquiry, and one the cultivation of which will add much to our practical resources. Mode of Living. — This like climate modifies the action of medicines by altering the condition of the system. It would be impossible, however, in this place, to notice all its bear- ings; all that we wish to do, being to call attention to its existence. In persons- of vigorous health and accustomed to out-door exercise, we find disease almost always assuming a sthenic type, and remedies, as a general rule, will have to be administered in larger doses to produce their effects. This is not, however, the case with cathartics, which, when they have not been habitually used, generally operate in small doses; while in persons of sedentary habits, we usually find habitual constipation ; to remove which, larger doses of medicine are generally requisite. Extreme mental exer- cise predisposes to affections of the brain, and in disease of sdch persons care will be required to administer nothing that will increase this predisposition. Want of exercise and seden- tary habits not only predispose to certain forms of disease, but likewise exert an influence upon the action of medicinal agents. Thus, if w^e except cathartics, remedies require to be administered in smaller doses, debilitating agents have to be avoided, and much care is requisite to support the vital powers of the system. Mental Action. — There can be no doubt but that the state of the patient's mind materially influences the action of medicines. As a general rule, they will act with greater certainty and more promptly, if the patient knows they have 92 GENERAL THERAPEUTICS. been given to produce a certain effect. Indeed we have known effects produced from a harmless placebo, which were owing entirely to the mental impression that such results would occur. This, however, is not alwaj^s the case ; for instance, we order three or four doses of opium, one to be given every hour until the patient goes to sleep ; the pa- tient knowing the directions, the probability is, that the the expectation and watchfulness for the next dose Avill pre- vent sleep until all are taken, though one dose under ordi- nary circumstances would have produced the required effect. Faith in the physician and the medicines administered, is often of more beneiit than the remedies themselves. We have seen diseases treated without any benefit by one phy- sician, when the same remedies continued under the direc- tion of counsel in whom the patient had implicit confidence, produced the most marked beneficial effect. From those facts the reader will see the importance of gaining the con- fidence of the patient in all cases, but more especially in nervous and chronic forms of disease. Previous Diseases of the Patient. — The character of previ- ous diseases sometimes has an important bearing on the administration of medicines. Thus, to persons who have had chronic inflammation of the stomach, it would be inju- dicious to administer drastic or irritant medicines : the same may be said where chronic or recent acute inflammation of the small intestines has existed. Where a patient has been subject to hemorrhoids, \although not existing at the present time, it would be highly improper to administer aloetic or drastic purgatives. Where chronic disease of the kidne}'^ has existed, we would be careful how we administered irri- tant diuretics, etc. All tliese circumstances in the pre- vious history of the patient, should be inquired into and carefully weighed, ajid the exhibition of remedies governed accordingly. The great success of some j)ractitioners de- pends in part upon the care with which they gather and consider all these circumstances; while the want of success by many is no doubt owing to their considering them be- neath their notice. PREPAKATION OF KEMEDIES. 93. The Pkeparation of Remedies. Success in practice necessitates the employment of good med- icines. Much of the uncertainty of medicine is due to tiie bad quality of the drugs sohl in the market. When reme- dies are unreliable, the physician soon loses faith, and reaches the condition of a cathartic, quinine, morphine and whisky doctor. He fails so often with the medicines of the Pharma- copoeia, that he deems it useless to study them. It is true that the drugs of the market are adulterated in every possible way, and that preparations are of all degrees of worthlessness. Even chemicals must bear the name of some responsible house, and the cork sealed with their seal to give a reasonable assurance of their purity. Whilst with preparations of vegetable remedies it is still worse, and Ave can safely say that nine out of every ten are unfit for our use. To have a good remedy from the vegetable kingdom it is necessary that it be gathered at the proper season, in the right locality, and that it be carefully preserved. With the ma- jority of remedies it is necessary that they be prepared from the fresh crude material ; as it is gathered, partly dried, wholly dried, but always recent. Some few may be dried and stored for future preparation. We now prepare nearly all vegetable remedies with alcohol, and the larger number in the form of tincture (good fluid ex- tracts are tinctures). That the physician may be certain as to the quality of these remedies when he makes his purchases, it is well that he should prepare some of them himself. Office pharmacy is profitable in this way if in no other. It may be very simple. You gather the agent in the sea- son when its virtues are greatest, pound it up in a mortar, if you have one, on a board with a hatchet or hammer if you have no mortar, put it in a glass or glazed vessel that can be tightly stoppered, cover it with twice its Aveight of alcohol (76 to 98 per cent, as the crude article contains resinous sub- stances), and let it stand fourteen days. It is now ready for use. Pour off the tincture, express all you can get out of the drug, and if you want a very nice article, filter through paper. Your Pharmacist turns up his nose at the crude process, but it won't turn up when he is shown the product and has it 94 GENERAL THERAPEUTICS. compared with the " fluid extracts " on his shelves. It is a sound and reliable remedy, and will give success in practice. The process of percolation is a nicer method, and the one we advise, and it also is so simple that the doctor can hardly go astray in it. The crude material, if green or partly dried, is finely powdered up ; if dry, is ground or powdered, and being wetted with alcohol is packed in a tin or glass percola- tor. The percolator may be a perforated diaphragm, or its lower part may contain tow ; in either case it may be stopped with a cork. The material is now thoroughly wetted, and in twenty-four hours the cork may be removed, and the fluid allowed to pass through. Two parts by weight of alcohol to one of the crude drug is the proportion advised, and this may be poured into the percolator gradually, as the tincture passes. The skilled pharmacist can prepare a fluid preparation which will represent the drug ounce for ounce. Yet the ma- jority of preparations sold will not come up to the standard of eight ounces to the pint. What we care for first is the quality of the remedy, its strength is a secondary matter. Yet we want our tinctures as strong as may be, that it can be carried readily in our pocket cases. Chemicals should be bought of well-known parties, and bear the label of a first class manufacturing house. If a med- icine carries the name of such a house as Powers and Weight- man, we feel satisfied with it. The sophistication is so great in the market that we can not trust others. I have seen San- tonine sold that contained eighty per cent, of chlorate of pot- ash. Morphia that was adulterated one-fourth, one-half, three- fourths, with cinchonidia ; Quinine that was three-fourths cinchonidia ; even bitartrate of potash would be one-half or two-thirds inert or foreign matter, and so all through the list. It is advised that " proprietary articles," compounded arti- cles, elixirs, peptics, and " fancy pharmacals" of all kinds be severely let alone. If the physician is capable of practising medicine, he is capable of selecting his own remedies, and making his own combinations for the case he has in hand. It is well, also, to looJc Avith suspicion upon " new remedies " advertised and pushed by manufacturing establishments. The introduction of a new remedy is the work of time, and it should come by and through physicians, not drug houses. PART II. SPECIAL THERAPEUTICS. Special Therapeutics is that branch of medical science which treats of the application of special remedies in the cure or alleviation of disease. Under this head we will con- sider the different agents in classes, and the application of these classes in the treatment of special forms of disease, and then examine each individual agent in the same manner. It is not the intention of the authors to make what might he called a strictly scientific classification of agents, but to make such an one as they think will give the student and general reader the clearest view of the subject. The intention is to sacrifice every thing that is not strictly practical — to make the work a full, safe and reliable guide to the practitioner.. In the classification of remedies, those will be considered first that are most frequently indicated in the treatment of those diseases that make up the major part of daily practice. The first general division may be termed eliminatives, from their principal influence upon the system — eliminating mor- bid materials from it. This will be divided into four classes . emetics, or those agents that produce evacuation from the stomach ; cathartics, those that cause evacuation from the bowels; diaphoretics, those that cause an increased secretion from the skin ; and diuretics, those that cause an increased secretion from the kidneys. The second division may be termed neurotics, because their principal influence is exerted upon the nervous system. This will be divided into three classes: sedatives, or those agents that depress nervous energy, without producing any previous excitement ; narcotics, those that first exalt and then depress nervous energy, and also produce sleep ; and siimidants, agents which increase the evolution of nervous force. To (95) 96 SPECIAL THERAPEUTICS. this may be added a fourth class, termed ancesihetics, which render the patient unconscious of pain. The third division embraces the internal remedies and local apph'cations used for the purpose of reducing the temperature of the entire system or of a particular part. The class is termed refrigerant. The fourth division embraces those agents which act prin- cipally upon the blood, and hence may be called hematics, or blood medicines. These may be divided into two classes — ionics, or agents that restore the normal quantity and quality of this fluid ; and alteratives, those agents that alter, destroy, or I'emove any morbid material from the blood. The fifth division embraces incidentally all those agents which act by revulsion, producing a new point of irritation, and directing to this the vascular and nervous affiux, and in this way relieving disease of more important parts. It em- braces but a single class, which from their action take the name of revulsives. The sixth division embraces but a single class, called astrin- gents, agents which cause contraction and condensation of the tissues of the body. The seventh division embraces but a single class, expecto- rants, agents which rectify wrongs of the respiratory apparatus. The eighth division consists of those agents which counter- act putrefaction, or the septic tendency, and are, in conse- quence of this action, termed antiseptics. The ninth division embraces those agents which act specifi- cally upon the uterus, and may be divided into three classes — emmenagogues, agents which promote the menstrual secretion ; parturients, those which Increase the expulsive efforts of the womb, and accelerate the process of parturition ; and abortives, agents supposed to effect the dislodgement of the fetus in utero, producing abortion. The tenth division embraces all agents that counteract spas- modic action, the single class being termed antispasmodics. The eleventh division embraces but a single class, anthel- mintics,— agents which destroy or cause the evacuation of worms. CLASSIFICATION OF AGENTS. 97 The twelfth division embraces two classes that increase special secretions: sialagogues, those agents that increase the salivary secretion ; and errhines, agents that increase the nasal secretion. The tliirteenth division embraces three classes, the action of which is chiefly chemical : they are acids and antacids, agents which regnlate acidity ; and antilithics, agents which connteract the tendency to the formation of calculous deposits. The fourteenth division embraces three classes Avhich act mechanically : they are demulcents and emollients, agents which soften and relax the tissues to which they are applied, and shield them from irritation; and diluents, agents which aug- ment the fluidity of the blood and other animal fluids. The fifteenth division embraces a single class of agents, called antidotes, agents capable of neutralizing or lessening the action of poisons. The following: table will exhibit this classification : — 1. Eliminatives, 2. Neurotics, 3. Refrigerants, 4. Hematics, 5. Revulsives, 6. Astringents, 7. Expectorants, 8. Antiseptics, 9. Uterina, 10. Antispasmodics, 11. Anthelmintics, ,0 f Sialagogues, \ Errhines, 13. Chemica, 14. Mechanica, 15. Antidotes, f Tonics, \ Alteratives, r Emraenagogues < Parturients, (^Abortives, f Antacids, - t Antilithics, f Demulcents, J, Emollients, (Diluents, Ageuts that evacuate the stomach. Agents that evacuate the bowels. Agents that increase the secretion of the skin. Agents that increase the secretion of the kid- neys. Agents that lessen nervous sensibility. Agents that produce sleep. Agents that increase nervous energy. Agents that produce insensibility. Agents that diminish the heat of the body. Agents that give tone" to the system. Agents that modify organic action. Agents that cure by producing a new point of irritation. Agents that cause condensation of the tissues. Agents that increase and favor expectoration. Agents that counteract putrefaction. Agents that promote tbe menstrual secretion.' Agents that excite contraction of the uterus. Agents that produce abortion. Agents that counteract spasms. Agents that remove worms. Agents that increase the secretion of saliva. Agents that increase the nasal secretion. Agents that neutralize acidity. Agents that prevent calculous formations. Agents that shield the tissues. Agents that soften and relax them. Agents that increase the fluidity of the blood. Agents that counteract the action of poisons. 98 SPECIAL THEEAPEUTICS. DIVISION I. CLA^SS I EMETICS. Emetics are a class of remedial agents which by producing a specific impression upon the sentient nerves of the stomach, or upon the nervous centers, are capable of exciting vomiting. Emetics may be divided into two classes, according to their mode of action : the first class prove emetic by their irritant effect upon the mucous membrane, and sentient extremities of the nerves of the stomach ; the second, by being absorbed into the blood either afiect the nerve centers, or by having a specific aifinity for the mucous membrane of the stomach act there upon the terminal branches of the pneumogastric nerve. Action of Emetics. — The action of both of these classes of emetics is similar in some respects; that is, in both the im- pression is transmitted to the pneumogastric nerve, or to the medulla oblongata, from which it arises; this excites the sensation of ??ai(sea, which is referred to the stomach. The reflex action is transmitted downward through the spinal cord to the muscles concerned in the process of evacua- tion, calling into action the muscles of the larynx, the dia- phragm, and the abdominal muscles. The act of vomiting may be thus described : the patient first draws a quick, deep breath, the rima-glottidis is spasmodically closed to prevent the egress of the air, and thus prevent the diaphragm from being forced upward. The muscle of the stomach itself con- tracts, and the pylorus is at the same time forcibly closed : the abdominal muscles contracting press the stomach against the diaphragm, but being unable to act upon it, the stomach, EMETICS. 99 wliich endures the pressure, is forcibly emptied of its contents. The action of a specific emetic is not dependent upon the quantity, the nauseating taste, or the unpleasant smell of the article ; some of the most energetic emetics will act very effi- ciently m minute doses, while the same article may have but little taste, and be entirely devoid of offensive odor. A like result follows from injecting them into the veins, or into the rectum, and not unfrequently from their external application ; showing most conclusively that emesis is induced by the specific influence which they exert upon the nervous centers. Specific emetics always produce more or less nausea and relaxation of the system, whether their action is carried to emesis or not ; while on the contrary, irritant emetics pro- duce but little nausea, but merely a feeling of discomfort in the stomach. The susceptibility to the influence of emetics is extremely variable in different persons, and a difference not unfre- quently manifests itself in the same person at diflerent times, depending upon the character of the disease, and a variation in the gastric sensibility of the patient. A dose that will scarcely affect one, may produce hyper-emesis in another, or in the same person at another time. Therapeutic Indications. Emetics are employed in a diversity of diseases, and to fulfill a great variety of indications. They make a very powerful impression upon the system, and often effect import- ant changes in the pathology of disease. Emetics are often valuable, and even very important agents when no specific disease exists, as well as in the opposite condition. When a train of morbid sensations, and an extensive chain of per- verted sympathies exist, emetics are important agents in revolutionizing the w^hole system, and breaking up that con- catenation of depraved sympathies. We shall next proceed to notice, in detail, the various indications which emetics are capable of fulfilling, and their adaptation to the treatment of different diseases. I. Evacuation of the Stomach. — They are valuable for the 100 SPECIAL THERAPEUTICS. purpose of evacuating the stomacti when that organ is over- distended with indigestible articles of food that oppress it> and thereby disturb the normal condition of the system. They are also useful when a redundancy of acid, or mucus is generated in the stomach. The nausea and vomiting which take place in such cases, pain in the stomach or head, or the ^'-sick-headache,^' are often relieved by their use. "When from an inverted peristaltic action of the duodenum, acrid, bilious matter is thrown into the stomach, when any vitiated accumulations take place in that organ, or when poisons, pa^^ticularly those of the narcotic kind, are lodged in the stomach, emetics are pre-eminently useful for the pur- pose of ejecting the offending matter. II. Action in Febrile Diseases. — Emetics are valuable thera- peutic agents in the treatment of febrile diseases in general. During the early stages of many attacks of fever, the em- ployment of erqetics is of unquestionable importance. In the various forms of intermittents, and bilious remittents in particular, this class of agents may be administered with much advantage. They are also found useful during the early stages of typhus, typhus icterodes, continued, and synochal grades of fever. 1st. In the intermittent and bilious remittent fevers, and even in other types, when there are evidences of a morbid biliary secretion being thrown into the stomach by the in- verted action of the duodenum, or in any case where there are vitiated materials accumulated in that organ, producing irritability, nausea, and a morbid sensibility, emetics are exceedingly valuable for the purpose of quieting that irrita- bility, removing those vitiated materials, and for preparing the stomach for the reception and retention of other medicines, which would be rejected if it were not for this preparatory treatment. The removal of the vitiated secretions of the stomach, and such food as may be undigested, is of the first importance in all cases, for if not removed in this manner they are excreted by the bowels, and in their passage more or less is absorbed and conveyed into the circulation, thus vitiating the blood-fluid. They are not only of use in check- ing nausea and vomiting, which often prevent the use of the necessary remedies, but by their cleansing and exciting EMETICS. 101 influence on the mucous membrane, they promote the ready absorption of agents which are administered after their action. 2d. By their mechanical action they compress the liver and abdominal viscera, they remove visceral congestions, overcome obstructions in the liver and portal circle, stimu- late the chylopoietic viscera and glands of the intestines to action, give a powerful shock to the nervous system, and break up the morbid associations and diseased sympathies which often sustain and keep up the recurrence of the febrile paroxysms. 3d. The shock which they give to the nervous system is very frequently the means of arresting the disease, and restoring the patient to health, if resorted to before the sys- tem becomes prostrated, or the disease fully seated. They break the chain of pathological associations, substituting their own impression for that of the existing disease, and break up or counteract the periodic tendency. 4th. An emetic given a short time before the expected attack of the cold stage of ague, in order to have it in full operation at the time of the paroxysm, not unfrequently arrests it ; and should it not, it renders it much milder — the cold stage is of shorter duration, and the reaction is compara- tively feeble. They also prepare the system for the recep- tion of tonics, whose remedial powers seem to be materially augmented by premising their administration with an emetic. 5th. They promote the secretion and remove congestion of the lungs, and thus aid in decarbonizing the blood ; they also increase the renal, gastric, biliary and pancreatic secre- tions, and by their mechanical effects upon the abdominal viscera, and their influence over the hepatic secretions they often produce copious alvine evacuations. They thus prove depurative, removing from the blood the products of disin- tegration and chemical change, the presence of which is often as we have already seen a proximate cause of these diseases. 6tli. By nauseating and relaxing the sj^stem, they most effectually overcome that spasmodic and constricted condi- tion of the cutaneous exhalents which attends fever, and 102 SPECIAL THERAPEUTICS. thus lesson the exalted action in the cutaneous capillaries, and consequently the abnormal generation of caloric which attends their increased activity. 7th. They act indirectly as sedatives, depressing the vas- cular and nervous excitement, thereby promoting diaphoresis. The cutaneous exhalation acts indirectly as a refrigerant, by the evaporation which takes place from the surface, in this way counteracting the abnormal generation of caloric. These influences properly carried out, tend in a very pow- erful manner to lessen the intensity of the excitement,and to hasten the supervention of convalescence. 8th. By increasing the secretions in general, but particu- larly those of the lungs, liver, kidneys and skin, they act as depletives ; and in this way supersede the necessity of resort- ing to the lancet. During the period of nausea and relaxa- tion, they serve to depress the vascular and nervous action, and exert a sedative influence over the circulation ; thus again, just as surely, and much more safely, fulfilling those indications for which the lancet is said to be alone adequate. 9th. They exert a revulsive influence, by making the stom- ach the center of an artificial fluxion, and thus detracting from the inflammation or congestion existing in some other organ. This influence is one of great, importance in the treatment of all diseases, but particularly those of an inflam- matory character; since by counteracting local congestions by virtue of their strong centrifugal influence over the cir- culation, they aid in a very powerful manner in equalizing the circulation and nervous excitement. III. Action in Diseases of the Respiratory Apparatus.— Emetics are very important remedies in the various forms of pneumonia : in pleuritis, in pneumonia biliosa, in peri- pneumonia or in pneumonia proper, frequent gentle emetics will be found of great utility. Some have objected to the use of this class of remedial agents in the treatment of pneu- monic inflammation, in consequence of the mechanical com- pression attending emesis. It has been asserted that they aggravate the sufterings of the patient and the intensity of the disease; but experience has fully convinced us that the objection urged against their use in this respect is not valid, EMETICS. 103 especially when the mild vegetable agents to whicli we resort, are substituted for the poisonous minerals in common use in the old system of practice. 1st. In the most violent forms of pleuritic inflammation emetics administered in nauseating doses, for some time before full vomiting is desired, aided by copious draughts of warm diaphoretic infusions, will in a very short time produce a general relaxation, and a free perspiration ; and when the system is thus brought under the influence of emetics, vom- iting, instead of aggravating the sufferings of the patient, will generally give prompt and in many cases entire relief. The violence of the pain, and the respiratory suffering will be speedily mitigated, and will not be attended with a sub- sequent recurrence. 2d. In the various forms of pneumonia the smaller bron- chial tubes and air-cells of the lungs will be found obstructed or loaded with a viscid tenacious mucus, unless the intensity of the inflammation has arrested the secretion. If it is arrested, emetics by their sedative influence upon the system, will diminish the inflammation and restore the secretion. If the secretion has not been arrested, and the bronchial tubes and air-cells are loaded with it, an emetic will be found exceedingly valuable in removing the obstruction. They likewise exert many other salutary influences upon the system in the treatment of these diseases. They are important expectorants, they are valuable as diaphoretics and revulsives, they equalize the circulation, they act as depletives, they depress the vascular and nervous excitement, and exert a very powerful influence in subduing the inflam- mation. They are equally applicable in the treatment of the various forms, and different stages of pneumonic inflammation, un- less there is extreme prostration. 3d. Emetics are by no means an unimportant class of agents in the treatment of the various forms of cynanche, especially so in that form designated as croup. The speedy relief which they often afford in that disease is truly sur- prising. In cases where the patient is threatened with immediate suffocation, from the accumulated mucus in the larynx, trachea and bronchia, or from the pseudo-mem- 104 SPECIAL THERAPEUTICS. branous formiition which is the result of the inflammatory action in the larynx, an emetic will frequently give prompt relief. In order to secure the full advantages which this class of agents is capable of affording in this disease, it be- comes necessary to repeat them frequently, and in some cases, much advantage will be gained by giving them so as to keep up a constant nausea and occasional vomiting for several hours. 4th. Asthma is another disease in which emetics are prom- inent remedies. They invariably give temporary relief, if ta- ken during the asthmatic paroxysm; and if the patient is young, or the disease not too firmly seated in the constitution, an energetic and persevering course of emetics, assisted by suitable expectorants, together with auxiliary means both dietetic and medicinal, will do much toward eifecting a radical cure. They are also valuable in hooping-cough, ner- vous-cough, chronic bronchitis, and the various catarrhal diseases occurring during the cold and variable seasons of the year. TV. Action in the Exanthemata. — They are very useful in the exanthematous diseases, as measles, scarlatina and small- pox, especially in the early stages. When the pharynx and contiguous parts are ulcerated, inflamed, and swollen to such an extent as to impede resjoiration and deglutition, emetics will lessen the inflammation and swelling, cleanse the ulcers, remove the viscid secretions, establish a new action in the parts, equalize the circulation, act as diaphoretics; and if there is oppression of the lungs, which is frequently the case, especially in measles, they will remove it. They fulfill many other indications in these diseases. Thus, during the early stages of these complaints, if the eruption is tardy in making its appearance upon the surface, or when it has appeared, and a retrocession has taken place, emetics, by producing a determination to and relaxation of the skin, will bring it again to the surface. V. Action in Rheumatism. — Emetics are occasionally cm- ployed in gouty and rheumxitic aftections with much advan- tage. When an arthritic habit obtains, a dyspeptic state of the stomach is generally present, in many cases a redundancy of acid being generated, in which event a course of mild emetics will do much toward arresting the paroxysms ; and EMjETICS. 105 used in conjunction with proper restoratives, tliey will very materially aid in eradicating the arthritic habit. In inflam- matory rheumatism, and even in the chronic form of this complaint, emetics, if given to keep np a constant nausea and diaphoresis, and to such an extent as to occasionally produce emesis, will recommend themselves as effective agents. They remove any morbid secretions from the stomach, subdue inflammatory action by their sedative and diaphoretic influence, and by acting as revellents, equalize the circulation. VI. Aciion in Hepatic Affections. — In chronic hepatic aflec- tions, in torpor of the portal circle, in visceral obstructions, and in diseases of the glandular and lymphatic systems, emetics are useful in removing the torpor, and restoring the various organs implicated to a normal performance of their functions. The influence which they exert upon the sympa- thetic system of nerves, and the shock which they impart to the whole sj'stem in the act of vomiting, by the severe com- pression of the abdominal viscera, and by exciting a new action in the nervous, vascular and lymphatic systems, tends to prepare the patient for the reception of tojiics and alter- atives, when their influence will be doubly appreciable. In jaundice, experience decides in favor of their employ- ment. If the biliary ducts are obstructed by calculi, pro- ducing jaundice, or if it arises from hepatic torpor, or func- tional derangement of that organ, emetics are valuable for removing the obstruction, by compressing the liver in the act of vomiting, and in arousing and restoring the healthy secretory functions of that organ. VII. Action in Dyspejjsia. — Gentle emetics are very useful in the treatment oi dyspejma, dependent upon debility or func- tional derangement of the stomach. Frequent mild emetics remove the morbid accumulation of acid and mucus from the stomach, and counteract the tendency to their genera- tion ; they remove the oppressed state of the stomacfh, in- duced by the presence of these morbid accumulations. In such conditions, the digestion is impaired, the gastric juice is vitiated, and its solvent properties weakened, chymifica- tion is imperiect, and the chyle is unhealthy. The intimate sympathetic relatii 'US existing between the digestive appara- 106 SPECIAL THERAPEUTICS. tus and the brain, are manifestly deranged by this unhealthy state of tlie stomach. Emetics are important for the pur- pose of counteracting this condition of the stomach, and the morbid sympathies which arise from it. VIII. Action in Hypochondriasis. — Hypochondriasis is another disease in which emetics frequently prove beneficial. They often arouse the mental and physical energies of the hy- pochondriac, and dispel those gloomy forebodings which are essential characteristics of that disease ; they also increase the susceptibilities of the system to other remedies. In this disease there generally exists a congestion of the portal cir- cle, and a torpid and deranged state of the digestive organs, and a morbidly sensitive state of the brain and nervous sys- tem ; in these conditions we have often witnessed the salu- tary influences of emetics. IX. Action in llania. — Emetics are also administered with much advantage in mania, arising from intemperance. In such cases the extreme insensibility of the stomach, some- times requires that they should be administered in unusually large doses. In ordinary intoxication, they will evacuate the stomach, lessen the cerebral oppression, arouse the sensi- bilities of the nervous system, and restore the inebriate to a state of sobriety and consciousness more speedily than any of the ordinary remedies with which we are acquainted. If ma- nia has arisen from the too free use of alcohol, an emetic not only evacuates the stomach, and thus removes the exciting cause, but it acts as a sedative, revellent, and an antispasmo- dic ; it equalizes the nervous energy and excitement, and in many cases subverts the morbid habit. X. Action in Diseases of the Brain and Nervous Si/stem. — In relation to their employment in apoplexy, a contrariety of views prevails. When apoplexy attacks a patient while the stomach is in a state of engorgement, the use of an emetic is of primary importance; but as a general rule their use is highly improper, and often dangerous. In this disease, as well as in all others in which the brain and nervous S3'stem are deeply involved, much larger doses will be required to accomplish the desired object. Congestion, irritation and inflammation of the brain, or a morbid erythism of the nervous system, will require en- EMETICS. 107 largod doses to secure their ordinary effects. The same is the case when there is a lack of the due oxygenation or aer- ation of the blood, as in asthma, croiq), bronchitis, asphyxia, etc. The venous blood is oppressive to the brain, paralj^zing the sensibilities of the nervous system, and thus deadens the susceptibility of the stomach to the influence of emetics. In such cases very powerful emetics are required, and their ordinary dose should be doubled or even quadrupled. Emetics have also been used in amaurosis. If the stomach is disordered, they maybe employed with a prospect of some advantage, but in most cases their use will not result in much benefit. In epilepsy emetics are occasionally beneficial, although a contrariety of sentiment obtains relative to their utility in this disease. When the disease arises from a disturbed con- dition of the digestive organs, evidenced by nausea, flatu- lence, and other symptoms of indigestion, and in those forms of epilepsy assuming a periodic character, they frequently prove serviceable, and a persevering course of long duration has in some cases prevented a recurrence of the epileptic attack. They should be administered every third or fourth day, and in those forms which assume a regular periodicity a short time before the expected attack. Dr. Smith of 'New York asserts that they are more efiectual in epilepsy and hysteria than any of the ordinary remedies used. They are often used with great advantage in the different forms of hysteria. In the convulsive form of this disease, we have found them more speedy in arresting the convulsions than any other agents we have been in the habit of using. In those cases simulating syncope, emetics will arouse the patient and restore her sensibilities in most cases, as soon as they have produced nausea and full vomiting. In the chronic form of the disease, they are regarded by some of the most eminent physicians as being more effectual in removing the morbid state of the nervous system, upon which this disease is supposed to depend, than any other class of medicinal agents. The shock which they impart to the whole system, but particularly to the nerves, seems to prepare it for the reception of antispasmodics, tonics and alteratives, 108 SPECIAL THERAPEUTICS. which agents are found doubly efficient wliere preceded hy, or alternated with, an occasional emetic. In spasmodic and convulsive affections they are preeminent. \ By nauseating and relaxing the system, they often exert a very powerful influence over the spasm ; in these cases they are given not only by the mouth, but also used as enemata. 11. Action in Amenorrhea. — Wherever amenorrhea arises from a sudden check of the menstrual secretion, in persons of a plethoric habit, by exposure to cold, a spasm or con- striction of the extreme uterine vessels is the result; when emetics, accompanied by w^arm diluents, pediluvia and fo- mentations, Avill in many instances speedily remove the con- striction and restore the secretion. The nauseating, relaxing, sedative and diaphoretic influences in such cases are very desirable. In other cases, induced by any sudden mental excitement or emotion, or by any of the depressing or exci- ting passions, such as excessive anger, fear, joy or grief, causing a sudden abstraction of the vital and vascular afiiux from the uterus and concentrating it upon the brain, or any other organ, they will not unfrequently be found valuable auxiliaries in equalizing the excitement, and restoring the catamenia. In chlorosis arising from retention of the menses, when there is a languid circulation, with a depraved and variable appetite, emetics, in conjunction with chalybeates and tonics, will be found important in breaking up the chlorotic habit. In many cases it wnll be found that restorative agents Avill have but little if any effect, the digestive organs being so ob- structed and weakened that those agents which are indispen- sable to the restoration of the normal quantity and quality of the blood can not be absorbed. In these cases we find more or less nausea, loss of appetite and loaded tongue. In such cases we have seen removed from the stomach by the action of ar emetic, such quantities of offensive mucus and vitiated secre- tion, that we could not be surprised that our iron and tonic? had proven ineffectual; in such cases as these .the careful administration of an emetic is the first step toward a cure. In dysmenorrhea, repeated emetics, the hip-bath and Jb- mentations, aided by anodynes and antispasnuulics, will EMETICS. 109 prove of much advantage in subduing the morbid sensibility of the uterus and removing the spasm. We do not speak of tlieir employment alone, because a combination of influ- ences will be found more efiectual than any one class simply. XII. Action in Drojysy. — Emetics are frequently prescribed with great advantage in the various forms of dropsy, but particularly in ascites and anasarca. Their action promotes the activity of the absorbent system ; vascular excitement retards absorption ; emetics, therefore, by lessening vascular excitement, and producing depletion, favor this process, and prove of great utility in dropsical cases. The full advantages of these agents can not be so eflect- ually secured when the patient is permitted to drink freely of diluents during their operation. When given in this manner, the fluid furnishes the material for absorption ; con- sequently the vessels are kept in a state of repletion, and the reabsorption of the exhaled fluid goes on slowly, if at all, and they fail to prove beneficial. When, however, a dry emetic is given — that is, an emetic with but a small quantity of fluid — it nauseates longer, proves more decidedly sedative, acts more effectually upon the lungs, kidneys, skin and in- testinal exhalants, and thus more effectually depletes, at the same time that it facilitates the process of absorption. A very eminent writer relates a case in which a single emetic so effectually excited the mucous membrane of the stomach as to cause the patient to vomit six pints more than he drank during its operation. They also act as revulsives, and while increased exhalation is taking place in the alimentary canal, and the other great eniunctories of the system are active, the dropsical effusion must be lessened, and occasionally it has been entirely ar- rested, and a speedy cure has been the result. It is, doubt- less, in these various ways that emetics increase the action of the absorbents, and effect the removal of the effused fluids. XIII. Action in Glandular Diseases. — In diseases of the glandular system, such as enlargements of the glands, bu- boes, scrofulous tumors, hernia humoralis, etc., they not unfrequeutly disperse them with great rapidity, owing prob- ably to their revolutionizing influence over the absorbent 110 SPECIAL THERAPEUTICS. system. They may be used in many of the cachetic habits of body Avith much advantage. Mild emetics may precede or accompany the use of alteratives and general restoratives, in many of those depraved and vitiated states of the sys- tem characterized by cutaneous eruptions, and foul and ill-conditioned ulcers. The influence of alteratives and cor- roborants seems to be more decidedly sanative when they follow emetics, or when emetics are occasionally prescribed during the course of their administration, than when the important influences of this auxiliary class of agents are omitted. XIV. Action in Phthisis Pulmonalis. — In the early stages of phthisis pulmonalis, gentle emetics are of great import- ance. They expel the mucus from the bronchial tubes and air-cells of the lungs, lessen the dyspnoea, and act very bene- ficially as expectorants. They lessen the irritation and con- gestion in the lungs, and equalize the circulation, diminish arterial excitement, and relieve laborious respiration; and in a short time, if early resorted to, will frequently eflect a cure. In some cases we have administered them every morning, or every other morning, in nauseating doses, until they had re- laxed the system, and then increased the dose until gentle emesis ensued ; and this course, if persevered in for several weeks, aided by demulcent expectorants, and such agents as will improve the quality and quantity of the blood, will be followed by the happiest results. It checks the cough, allays the irritation of the lungs, mitigates the urgent symptoms, and is often of itself attended with an increase of strength. An occasional emetic, throughout the whole course of tlie disease (if there is not too much debility), will give great temporary relief; in the advanced stages of the disease they are too debilitating, and should rarely be prescribed. XV. Action in Diabetes. — Emetics are found to be very useful in diabetes. In several cases in which we have used them, they seemed to exert a very ha[)py influence. Others speak very favorably of their use, and cases are recorded in which a single emetic has effectually arrested the disease. They equalize the circulation, stimulate the digestive appa- ratus, promote the secretions of other organs, and probably EMETICS. Ill in this way lessen the burden imposed upon the kidneys, giving them time to recover their tone. XVI. Action in Ophthalmia. — Ophthalmia is another disease in which emetics are found to exert an important influence. Much authority might be adduced in favor of their adminis- tration in this affection, when there is a deranged condition of the digestive organs, and acidity of the stomach ; which is by no means an unfrequent occurrence, both in the acute and chronic form of the disease. In acute ophthalmia, their depletive, revulsive and sedative influence over the disease is very conspicuous. XYII. Action in Dysentery. — In dysentery they are often resorted to with great advairtage. This disease is often con- nected with, or dependent upon a redundancy of vitiated bile, or other irritating materials accumulated in the prim?e vise. When this is the case, emetics are indispensable ; their tendency to equalize the circulation and promote diaphoresis, renders them especially valuable. XVIII. Action in Hemorrhage.— Emetics are occasionally employed in the various forms of hemorrhage. With regard to their use in hemoptysis, some discrepancy of opinion exists. When administered in nauseating doses, for some time be- fore emesis is effected, they diminish the momentum of the circulation by their sedative influence, relax the sj'stera, and equalize the circulation ; and may be occasionally prescribed with safety and advantage. But as a general rule, we con- ceive that their mechanical influence would be hazardous; the impetus which they give to the pulmonary circulation renders their indiscriminate employment objectionable, and in many cases dangerous. In active hemorrhages they should be used with much caution. If administered in small doses and not often repeated, their equalizing, revulsive and seda- tive influences counteract any bad effect that might other- wise occur. In passive hemorrhages from the lungs, and in those witnessed in the incipient stages of phthisis pulmonalis, mild emetics are valuable auxiliaries to expectorants and other pectoral agents. The same objection does not rest against their use in uterine hemorrhages; an equal amount of meclianical force ig not exerted upon the uterine vessels in emesis; neither, in 112 SPECIAL THEEAPEUTICS. like cases, is the same impediment presented to interrupt the uterine circulation, as is the case in hemoptysis. Emetics cause contraction of the uterus, and thus the orifices of the bleeding vessels are closed, and many cases are reported in which they have proved efficacious. H(Ematemesis is often owing to visceral engorgement, or torpidity of some of the abdominal viscera, producing irregu lar congestions, and hemorrhages. Emetics remove the venous congestions, and by the pressure which they cause to be exerted upon the diseased viscus, the exhaling vessels are compressed, and the hemorrhage is arrested. Specific Indications for their Use. The tongue is broad, full, dirty, and especially coated at its base. There is sometimes nausea, disgust for food and drink, and everything taken seems to stop at the stomach. The patient complains of sensations of weight and oppression at the epigastrium. Conditions Contraindicating their Use. 1. They are contraindicated in apoplexy, phrenitis, cere- bral congestions, in short in all cases where a great deter- mination to the brain exists. 2. They are improper in advanced stages of pregnancy, in hernia, aneurisms of any of the large vessels, hypertrojDhy of the heart, or ossification of the arteries or valves of the heart; we might say in any disease of the circulatory system. 3. They are improper in all cases of extreme debility, as in the more advanced stages of febrile and inflammatory disease, etc. 4. In g astro-intestinal irritation or inflammation, their ordinary use is very improper. As a general rule emetics are inadmissible in the above cases, but we can lay down no infallible rule for their employ- ment, as circumstances may occur in such relations to the usual contraindications, as to justify their use. In febrile affections, where there is great excitement, if no danger would result from a delay, emetics should not be administered until the fever abates. If they are prescribed during the exacerbation they do not operate so kindly and EMETICS. 113 iifFectually as they do during the declination or stage of apy- rc.xia. Not only so, hut largely increased doses are required to produce the same effect. During the hight of the fever, every jfiher is tense, and the exalted erythism of the nervous and vascular systems lessens the susceptibility to their influ- ence. They should be administered, at first, during the pyrexial stage, in nauseating doses, to relax the system; and this influence should be aided by warm infusions of eupato- rium, *>r chamomile ; when there is sufficient relaxation, and perspiration is induced, the dose may be increased, and repeated every twenty or thirty minutes, until the stomach is thoroughly evacuated, and the whole system is brought under their influence. Another rule pertaining to the administration of emetics (and one not to be rejected as unimportant), is the avoidance of cold drinks during their operation. It is improper for them to be given even when the mildest emetics are pre- scribed, but especially so during the use of tartrate of anti- mony. When the stomach is relaxed by the. emetic, and large quantities of warm fluids, cold drinks often produce violent (and in some cases fatal) spasms of that organ. The shock is powerful, and its effects not unfrequently irreme- diable, even when the most potent stimulants and antispas- modics are speedily used. Dr. Eberle notices two cases of sudden death caused by drinking cold water, soon after tak- ing a dose of tartar emetic. Another rule, never to be violated, is the use of simple, digestible and unirritating diet for twenty-four hours after an emetic. Emetics produce a temporary relaxation of the muscular fiber of the stomach, and lessen its digestive pow- ers ; hence the necessity for time to enable it to recover from this enervation, before being taxed with the elabora- tion of even a small portion of most of the ordinary indi- gestible articles of diet in daily use. Recapitulation. 1st. Emetics serve to expel any morbid or vitiated matter, whether undigested food, secretion, or poison from the stomach. 2d. They serve to promote general relaxation, equalize 8 114 SPECIAL THERAPEUTICS. and lessen the momentum of the circulation, counteract con gestion, excite the liver and other glands to action, promote diaphoresis, and act as depletives, deobstruents, and elimin- atives. 3d. The shock which they" impart to the nervous system is often productive of much good in the early stages of fever, and likewise in many chronic diseases, arresting the disor- dered action by supersession. 4th. Emetics are often productive of much good in spas- modic or convulsive action, being by virtue of their action on the brain and nervous system, powerfully antispasmodic. 5th. In many chronic afiections of the chylopoietic viscera, and glandular system, they prove beneficial by newly excit- ing those organs, promoting absorption and the various secre- tions and excretions — thereby subverting morbid action. 6th. They promote the bronchial secretion, and facilitate expectoration, and therefore are of great importance in dis- eases of the respiratory organs, such as croup, asthma, per- tussis, bronchitis, pneumonia, etc. 7th. From their supersedent, sedative, depletive, revulsive, relaxing, deobstruent, depurative and equalizing efl:ects, they often exert a revolutionizing influence upon the entire system, thereby breaking up perverted associations, and in many instances completely subverting existing morbid sym- pathies, and effecting permanent cures. In these various ways they serve as valuable auxiliaries to the use of toiiics, alteratives, etc., co-operating with, and materially facilitating their curative action. ANTI-EMETICS. Following the consideration of remedies which produce emesis, we will briefly study the remedies and means which check nausea and vomiting. In some cases these remedies act n|-,on and through the nervous system, being sedative in one case, stimulant in another. In other cases the action is topical ujiOM tiie mucous meinhrauc of tlie stomach. In others it is chemical, comprising acids, alkalies, and antiseptics. In still others the action is upon a different part, with which the stomach is in sympathy. Tlic nausea and vomiting being sympathetic, it is relieved when the original disease is removed. IPECACUANHA. 115 IPECACUANHA. THE ROOT OF CEPHAELIS IPECACUANHA.— BRAZIL, Prep AERATIONS. — Powder, Tincture, Syrup, Emetina, or Emetia. Dose. — The dose of the powder will be from grs. x. to grs. XXX , every ten or fifteen minutes with warm water, or some warm stimulant infusion; of the tincture gtt. x. to oss., every ten minutes with warm water or a warm infusion. Emetia is rarely used by hypodermic injection, the dose being one to two grains. Therapeutic Action. — Ipecacuanha is emetic, diapho- retic, expectorant, laxative and alterative. In full doses it is one of the mildest and most valuable emetics known. If it does not produce emesis, it generally soon proves cathartic. If administered in smaller doses, it acts as a stimulant, dia- phoretic, expectorant, or laxative; and in still smaller doses, as a tonic and alterative. Its first effect upon the system, Avhen administered, is that of a stimulant, or irritant to the mucous membrane of the stomach, and not until its active properties have been absorbed, does it cause nausea, depres- sion, and vomiting. Hence it belongs to the class of specific emetics, — those which produce emesis when introduced into the circulation from any part of the system. As an emetic the ipecacuanha does not depress the system like many other of the vegetable emetics. It may, therefore, be resorted to in cases of debility, when other agents would be inadmissible. As a mild, effectual agent it may be pre- scribed whenever there is a foul state of the stomach, arising from a redundancy of mucus, or of the biliary secretion, or retained indigestible aliment. Its mildness and efficiency recommend it, when the object is simply to evacuate the stom- ach, or when a gentle influence of this kind only is desirable. Its gentle action also renders it a very popular and highly valuable emetic, in numerous diseases of children. It is used in minute doses as an alterative, either alone or combined with other agents, as sulphur, cream of tartar, guiacum, sarsaparilla podophyllin, sanguinaria, taraxacum, etc. In hepatic torpor, and where there was obvious derange- 116 EMETICS. raent of the chylopoietic system, we have often combined it with the extract of taraxacum, podophyllum, and sanguinaria, forming the mass into pills, which have proved highly bene- ficial. In small doses it often proves valuable as a stimulant, tonic, and alterative, in dyspepsia, and other diseases, combining it with some of the bitter tonics, the action of which it facilitates. It is sometimes combined with cathartics ; two or three grains of it greatly facilitate the action of these agents, and even render small doses more efficient than large ones, when given uncombined. As an expectorant and diaphoretic it is often combined with the more stimulating agents, as the squill, senega, etc. Specific Indications. — Irritation of bronchial mucous membrane and air-cells ; irritation of stomach ; irritation of small and large intestines. Specific Uses. — In acute bronchitis and pneumonia ; in nausea, vomiting, and irritative dyspepsia; in cholera infan- tum, diarrhoea, dysentery, monorrhagia, and hemoptysis. In bronchitis, and especially in pneumonia. Ipecac in small doses takes a first place. As the pulse is frequent and the tem- perature increased, it is usually combined with Aconite. In irritation of the stomach, especially if the pulse is fre- quent, and the temperature is increased. Ipecac is the remedy. In cholera infantum. Ipecac is suggested as a principal rem- edy. With frequent pulse and increased temperature of the abdomen, it is given with Aconite. With pallid or yellowish face, abdominal pain, pallid tongue, nausea and vomiting, it is associated with Nux. In the ordinary diarrhoea of irritation Ipecac is a very cer- tain remedy. Give it with Aconite or Nux, as may be indi- cated. In the common form of dysentery — colitis, or simple inflam- mation of the large intestine — Ipecac is as near a specific as we can imagine. In zymotic dysentery it may form a part of the treatment, but anti-zymotics will take precedence. Dose. — For these uses the dose will be small — Tinct. Ipecac gtt. v. to gtt. XV., water 5iv.; a teaspoonful every hour. LOBELIA. 117 LOBELIA. THE ENTIRE PLANT, THE SEEDS, O? LOBELIA INFLATA.— U. S. Prrpaeations. — The powdered seeds, the powdered plant, the tincture, the acetous emetic tincture, the oiL Dose. — The dose of the powdered seed will be from grs. x. to grs. XX. every fifteen minutes; of the powdered plant, oss. to 5j-; of the tincture gtt. x. to gtt. xx. every ten minutes; of the acetous tincture 5ss. to 5j- every ten minutes. The oil is not used as an emetic. Tlie acetous emetic tincture (Lobe- lia, Bangui naria, Ictodes, aa.) is a very good i)reparation, and may be used in doses of one teaspoouful every ten minutes to free emesis. The emetic powder (Lobelia, Sanguinaria, Ipe- cacuanha, Ictodes, «a. Capsicum one-eighth part) is employed in infusion when stimulation is thought necessary. Therapeutic Action. — Lobelia is emetic, expectorant, diaphoretic, antispasmodic, sedative, and sometimes cathartic. It acts in a manner similar to tobacco, though it is much milder, and is generally regarded, when given in large doses, as an acro-narcotic poison. When the herb is chewed incautiously, it occasions a sensa- tion of burning and distension, which extends down the oesojih- agus, and finally nausea and vomiting follow, attended with giddiness, tremors, and headache, with excessive prostration. In some instances purging occurs as well as emesis, with copi- ous perspiration and general relaxation. If the dose is too h\rge and frequently repeated, it usually produces general prostration and relaxation, accompanied with profuse perspi- ration. Extreme nausea, great anxiety and distress, are the two frequent concomitants of its administration ; nevertheless, the usually short duration of these symptoms, and the salutary impressions which it makes upon the system, compensate, in most instances, for any transient deleterious effect wliich it may ])roduce. If it acts promptly as an emetic, the unpleas- ant effects named are much less liable to be manifested. Lobelia is a prompt, safe, and efficient emetic, equaled by few, and surpassed by none, when resorted to for this purpose. It operates promptly and very thoroughly, but its action is less protracted, and less apt to produce such compression of 118 EMETICS. the liver as will cause copious bilious evacuations than other agents often used. As an emetic it may be resorted to in all cases where a gentle, yet efficient agent may be demanded. As a general rule, during the forming or early stages of many febrile affections, the use of this article will be founhoid fever attended with tym- panitis ; the same combination is also very useful in the tym- panitis of puerperal peritonitis. In constipation arising from hardened feces, castor oil lubri- cates the bowels, and causes their evacuation. It may be com- bined with harsh and acrid medicines to lessen their irritating properties. It is considered a mild and useful cathartic for children, and when there is an irritable condition of the bowels, and a simple agent is required, perhaps there is no cathartic which answers a better purpose. It is combined with many anthel- mintics, as worm-seed oil, to assist their action. Infants re- quire relatively larger doses than adults. A ])eculiarity with regard to this agent as a cathartic is, that reduced quantities arti required to produce purging after it has been frequently administered to a patient. The seeds of the castor oil plant are powerfully cathartic and emetic. Tvv'o or three of them will purge, and seven or eight will act violently, ])roducing emesis and hyper-catharsis. As a means of disguising the taste of this article, the Elcc- iiiary of Septimus Piesse will probably be found the most effi- cient. I^ Castor Oil .^iij., white soft soap 5j-, simple syrup oj., oil of cinnamon, gtt. vj. Rub the soap with the simple syrup in a mortar, and then add gradually the castor oil, with constant trituration, until it is thoroughly incorporated with (he above ingredients. Finally, mix with the electuary thus formed, the oil of cinnamon, or any other essential oil that may bo preferred. By this means a gelatinous electuary will bo f)i-;ned, which is rather palatable than otherwise, and nearly equals, bulk fjr balk, castor oil in strength. 170 ■ CATHAKTICS. ALOES. THE INSPISSATED JUICE OF THE LEAVES OF ALOE SI'ICATA.— SocOTr.A. Dose. — From the fraction of a grain to grs. v. or grs. x. Of a tinctnre, gtt. j. to gtt. xx. Therapeutic Action. — Aloes is cathartic^ stimulant^ tonic, stomachic, cunuenagogue, and antlielniintic. As a cathartic, it is slow to operate, owing to its action be- ing principally upon the lower portions of the intestines. It does not act upon the intestinal mucous membrane, producing depletion, but mostly upon the muscular coat, stimulating it to increased activity, thus quickening the peristaltic action of the bowels, causing alvine evacuations. The discharges caused by taking aloes are not thin and watery. It seems also to augment the biliary secretion. In small doses it acts as a tonic, excitant and aperient; it promotes digestion, and gives tone to the stomach, and is therefore found useful in dyspe})sia. As a tonic and stomachic, it is used with much advantage in general debility, attended with loss of appetite and a torpid state of the bowels. It quickens the circulation, and causes an increased warmth of body, clearly demonstrating its exci- tant powers. From what has been said, it will readily be seen that aloes is not a suitable cathartic in habits that are of a sthenic char- acter. If there should be any irritation of the bowels, its harshness would render it inadmissible; and should there ex- ist a febrile or inflammatory habit, it would be too excitant and tonic, and not sufficiently depletive. But in torpid or debilitated states of the system, it is not only proper, but in many cases a highly important medicine. Accordingly it is recommended in chlorotic states of the system, scrofula, hypo- chondriasis, indigestion, habitual constipation, etc., combined with alkaline agents, as castile soap and aromatics, to counter- act any irritating effects which it might produce. Aloes is said to be ])ossessed of ominenagogue properties, and as such is extensively employed in amenorrhoca. \\ liethrr it exerts any influence over the uterine secretion, by a direct action upon that viscus, is not determined ; the probability is that it acts indirectly or sympathetically by producing a deter- SCAMMONIUM. 171 niinatlon to the lower bowels aiul pelvis, thus producing or accelerating the menstrual flux. The strong influence of aloes manifested u[)on the rectum has caused it to be used for the removal of ascarides, or small worms, that have their habitat in this portion of the intestines. A singular fact in relation to the modus opcr;nidi of this agent is, that small and large doses produce very neai'ly the same amount of purgation. It may be used in cerebral , con- gestions as a derivative, but is not admissible in hemorrhoids, owing to its strong action upon the rectum, aggravating them when they exist, and often producing them ; for the same reason it is not admissible in advanced pregnancy, or in men- orrhagia. SCAMMONIUM. THE GUM RESIN OF CONVOLVULUS SCAMMONIUM.— Syria. Dose. — The dose of Scammony will vary from gr. j. to gr. X., according to the action desired. Therapeutic Action, — Scammony is very active, harsh and drastic, and for this reason the cases in which it is admis- sible as an independent cathartic, are by no means numerous. Its highly drastic properties would prechide the propriety of its employment in all cases where an irritation of the mucous membrane of the bowels exists. Its disagreeable taste also renders it an objectionable agent. The Scammony may be combined with other active and equally harsh or drastic cathartics witli advantage, their drastic action being modified and rendered comparatively mild by combining two or more of them together. So with this arti- cle, it may be added to other cathartics and aid in forming a purgative compound decidedly superior to either article alone. It is appropriate in torpid states of the bowels, obstinate constipation, coma, apoi)lexy, cerebral congestions or inflam- mations, etc., cases in which a powerful derivative impression is desirable. It is sometimes employed as a vermifuge; it fre- quently destroys worms, and causes their evacuation, probably on account of the violence of its action. 172 CATHAKTICS. GAMBOGIA. A GUM-RESIN OBTAINED FROM GARCINIA IIANEURII.— India. Dose. — From one-half grain to five grains. It is better to give it in small closes, frequently repeated. Therapeutic Action. — Gamboge is one of our most jww- erful drastic, hydragogue cathartics ; it often produces nausea and vomiting, violent tormina, and frequently irritation, or even dangerous inflammation of the gastro-intestinal mucou.s membrane. Its harsh and drastic })roperties may be lessened by combining it with other cathartics less harsh, and its bene- ficial effects still secured; or it may be united with demulcents which counteract the violence of its action, still securing its active operation upon tlie system. It should rarely or never be given alone as a cathartic, though it is extensively used variously combined, forming the base of many of the popular pills of the day. The cases in which Gamboge is mostly used are, obstinate constipation of the bowels, hepatic torpor, dropsy, coma, phrenitis, apoplexy, cerebral congestions, etc., whenever a strong revulsive impression is desirable. The remarks made upon Colocynth in the same or similar cases, are apj)lical)le to Gamboge, though tliis is still more efficient than that agent. In torpor of the liver it may be combined with Sanguinaria and Podophyllin witli great advantage ; the compound extract of Colocynth is also a valuable addition. These articles made into pills, qualified bv the addition of aromatics and stimu- lants, will be found very useful in all cases where active cath- artics are desirable, and where a deobstruant is indicated. COLOCYNTHTS. THE FRUIT OF CITRULLUS COLOCYNTIIIS— Japan, Spain. Prep A RATIONS. — Tincture of Colocynth. Extract of Col- ocynth. Dose. — For its specific use the dose is very small. I^ Tine. Colocynth gtt. j. to gtt. v., water Siv.; a teaspoonful eveiy liour or two. Of the crude article or of the extract, r.s a cathartic, grs. v. to grs. x. COLOCYNTHIS. 173 Therapeutic Action. — Colocynth, when administered incautiously, acts violently upon the bowels, and in some cases ])i'oduccs dangerous and even fatal inflammation of the bowels. It is justly termed a powerful drastic hydragogue cathartic. From the violence of its action it sometimes causes tormina, inflammation of the mucous membrane, and bloody discharges. It sometimes produces nausea, vomiting, and long-continued hypercatharsis. It will readily be seen from what has already been said, respecting the action of this agent, that it M'ould be highly improper to administer it in the advanced stages of most dis- eases, or in any case of great debility; as also in all cases attended with or predisposed to irritation or inflammation of the bowels. As a powerful deobstruent and hydragogue cathartic, it is recommended in the early stages of fevers, and in dropsy, par- ticularly in passive dropsies, or those arising from visceral obstructions; it removes large quantities of serum, and is therefore powerfully depletive ; and an additional reason for its use in dropsies is its supposed diuretic powers. It is also employed in torpor of the liver, and obstinate constipation, thouffh we have more effectual agents. It is also used in amenorrhoea : as a deobstruent in this case it often proves ben- eficial. In cerebral congestion or inflammation, in apoplexy or coma, when a very powerful derivative influence is desira- ble, this agent constitutes one of our most efficient cathartics; it is also highly recommended in paralysis, especially in para- plegia. Though extremely harsh and drastic in its action, yet if properly qualified by combining it with other cathartics, or if united with demulcents and aromatics, it is rendered mild and perfectly safe, and constitutes one of our most valuable purgatives. Specific Indications. — Pains resembling colic in the iliac and hypogastric region ; tensive rheumatic pain, with muscular contractions ; painful diarrhoea with tenesmus and mucoid discharges ; dysenteric evacuations with pain resembling colic. Specific Uses. — Following the indications as above, we find a most important field for this remedy. In colic affecting the lower abdomen, and especially if there is a desire for stool, there is no more certain remedy than Colocynth. In dysen- 174 CATHAETICS. teiy where the pain is iu the right iliac region^ or when the dysenteric tormina involves the entire abdomen, Colocynth may be administered. Persistent diarrhoea with tormina and mucoid discharges calls for Colocynth. It is also a valuable remedy in rheumatism, in lumbago and sciatica, and in some cases of neuralgia. The reader will be governed by the indications as named, in these cases. ELATEHIUM. DEPOSIT FROM THE JUICE OF MOMORDICA ELATERIUM.— Greece. Dose. — The dose of Elaterium runs from one-tenth to one- fourth grain. Therapeutic Action. — Elaterium is a drastic hydragogue cathartic, and said to be diuretic. As a powerful hydragogue cathartic, in minute doses, this article is unequaled by any other agent in the materia medica. If too freely employed, the violence of its action admonishes the physician of the ne- cessity of prescribing it cautiously, not always, however, until it is too late to repair the injury. If administered in large doses it causes excessive nausea and vomiting, irritation of the mucous membrane, or even an inflammation that may prove fatal. The violence of its action and the high price of the article, probably prevent the frequent and too free use of this agent. Cautiously administered, Elaterium may be used with great propriety in cases where we wish to produce a powerful deriv- ative and depletive effect upon the system ; particularly when the patient is of a pletiioric habit, and has a strong and vigor- ous constitution. In debilitated states of the system it is in- admissible, as well as when there is any irritation of the intes- tinal mucous membrane. It is principally used in the treatment of dropsy, to which it appears to be especially adapted, often proving successful in the most obstinate cases, and after a variety of other measures have proven abortive. It has proved a highly important hy- dragogue, promoting absorption, and at the same time lessen- ing effusion by diverting the increased vital action from the point of effusion to the intestinal mucous membrane. OLEUM TIGLII. 175 RHAMNUS. THE BARK OF RHAMNUS CATHARTICUS, R. FRANGULA, R. CAROLINIANUS. K. PURSIIIANA.— U. S. Preparation. — A tincture of the recent bark. Dose. — The dose of Rhamnus will vary from gtt. x, to 5j-, according- to the action desired. Therapeutic Action. — All the species of Rhamnus are cathartic, differing only in their activity. In the olden time, only the berries of the Rhamnus Catharticus were employed ; but from their activity and the danger of gastro-intestinal irri- tation, they were but little used. Still, I am satisfied that in proper dilution and in small dose, the tincture of the seed would prove quite as good as the so much advertised Cascm-a ^Sagrada. The bark is much milder, and may be employed for the ordinary purposes of a cathartic. The Hhamnus Purshiana, the species obtained on our western coast, has recently been quite extensively employed, and is a fairly good remedy if used with care. It is extremely nasty, and few persons will care to take it in preference to more pleasant drugs. Still it has this virtue, that there is less danger of constipation following its action, and in some cases it may break up habitual constipation. The Rhamnus Carolinensis, our southern species, is now being used in place of the Purshiana, and it is said with equally good results. OT.EUM TIGLII. THE EXPRESSED OIL OF THE SEEDS OF CROTON TIGLIUM.— East Indies. Dose. — Croton oil is administered in doses of one or two drops; in cases of coma and where there is great torpor or insensibility, from five to ten drops will produce but a feeble iippression upon the patient. It is better to administer it in l)ill or emulsion, and half a drop at a dose, repeated suffi- ciently often to obtain its efi^ects. Therapeutic Action. — Croton oil is a speedy and pow- erful hydragogue cathartic. If we except elaterium, it is more energetic, and produces more effect upon the system in minute doses than any other cathartic agent. The activity of the oil, the certainty and efficacy with which it acts, and the smallness 176 CATHARTICS. of the dose required to produce these powerftil impressions upon the system, together v/ith the facility with which it niav be taken, and the comparative miklness of its action, render it an agent w^orthy of notice. It may, however, be so admin- istered as to produce vomiting, hypercatharsis, violent tor- mina, gastrointestinal irritation or inflammation, or even fatal results. It is evident that an agent of such powers should be admin- istered cautiously, and so combined with demulcents and aro- matics, and so timed, as to render its operation as mild as possible. If administered in cases of great debility, it should be so combined with demulcents and stimulants as to prevent its irritant and exhausting effects. It acts rapidly, often in one hour, and frequently produces a disagreeable burning in the fauces and throat. In cases of mania or furious delirium, the facility with which it can be administered gives it a superiority over all other cathartics. If the patient will not take medicine, he may be deceived by giving the oil in wine, milk, etc., and thus its full advantages are secured. In spasm of the glottis, epilepsy, and neuralgia, it is supposed to prove valuable, independent of its purgative property. The seeds have been used in India for their cathartic pow- ers, in doses of one or two grains; they are not used in this country. Four drops of the oil, applied to the umbilicus, often purges. Applied externally it acts as a suppurant revellant, produ- cing rubefaction, and finally vesicular and pustular eruptions, and proves a valuable derivative. It has been employed for this purpose in chronic bronchial affections, phthisis, chronic laryngitis, rheumatism, neuralgia, glandular enlargement, spi- nal diseases, etc. ; it is sometimes used in its pure state, but more frequently diluted with olive oil, turpentine, alcohol, etc. COLCHICUM. THE BULB OF COLCHICUM AUTUMNALE.— EuRorE. Preparations. — Tincure of Colchicum. Wine of Col- chicum. Dose. — Tlie dose of either of these preparations will vary from one to thirty drops. COLCHICUM. 177 Therapeutic Action. — Colchicum is cathartic, emetic, diaphoretic, diuretic, expectorant, sedative, anodyne, and acro- narcotic. In small doses it promotes the secretions, especially that from the m neons memhranc of the bowels. • If the doses are larger, nausea, vomiting and purging, with a reduction of the ])ulse, are the ordinary effects; a sense of debility with headache, also follows its use. These effects are not invariable, and not dependent upon the degree of purgation ; copious per-^ spiration, increasing the biliary secretion, or an augmented flow of urine, are common effects following its use; salivation sometimes results. In gout and rheumatism, it is said in some' cases to strikingly increase the amount of uric acid in the urine. In over-doses it acts as a violent poison, causing severe pain in the bowels, vomiting, acute tenesmus, small, slow and feeble pulse, cold feet, and weakness of the limbs. The colchicum is a peculiar and very interesting remedial agent. Its j)eculiarity arises from the number of properties which it possesses, and from the diversity of impressions which it makes upon the system. Operating as it does, sometimes violently as a hydragogue cathartic, perhaps as an emetic; sometimes as a diaphoretic or diuretic, at others as an expec- torant; now as a stimulant to all the secretions, then upOu' one secretion only, or upon a part of them ; and again, as' it sedative, diminishing the momentum of the circulation, while at another time it acts in small doses as an anodyne, lessening the nervous sensibility. In large doses, it almost invariably i)roduces purging, at- tended with nausea and vomiting, a burniup' sensation in the stomach, tenesmus, and sometimes strangury. Colchicum has been regarded as a specific curative agentj in tlie treatment of gout, but at this time it is considered merely as giving temporary relief. The similarity existing between gouty and rheumatic affections, suggested the em^ ployment of this agent in the latter disease, also. But the high estimate placed upon it in gout as a curative agent, is not fully realized in the treatment of rheumatism. As a hy- articularly to children, and to have been useful in restoring to the blood the saline principle which it had lost in cholera. SULPHUR SUBLIMATUM. Dose. — As a laxative, the dose of sulphur is 5j. to oiij- ; as an alterative, excitant and diaphoretic, 5ss. It may be admin- istered in molasses, syrup, or honey, in the form of an electuary, or in milk or spirits. Therapeutic Action. — Sulphur is laxative, diaphoretic, stimulant and alterative. In large doses it acts mildly as a laxative, and as such is prescribed with advantage in diseases of the rectum, as hemorrhoids, stricture, prolapsus, etc. In order to render it more active, it is often combined with bitar- (rate of potash or magnesia, and then forms a very pleasant cathartic in pregnancy. It is a popular remedy in many cutaneous diseases, particu- larly scabies, or itch; in prurigo, impetigo, and other diseases of a similar nature, it often proves valuable. In chronic ca- tarrhs, asthma, and. other chronic pulmonary diseases, it may occasionally be employed with advantage. In small doses sulphur acts as a gentle stimulant to the organs of secretion, particularly the cutaneous, renal and pul- monary, and serves to promote them by increasing the capil- lary circulation ia these organs. It frequently proves valuable as an alterative in constitutional taints of the system, as scrof- ula, secondary syphilis, glandular enlargements, rheumatic and gouty affections, mercurial rheumatism, etc., together with the long list of cutaneous diseases. It is not only valuable as an internal medicine, but also as an external application in the form of an ointment, or of the siil[)liurous acid gas, as a bath, the head being jirotected from its effects. In these forms it is mostly employed in cutaneous diseases, particularly in scabies. DIAPHORETICS. 187 OLA.SS III DIAPHORETICS. Diaphoretics are a class of remedial agents whicJi aug' ment cutaneous transudation ; if they produce copious per- spiration, tliey are called siulorijics; if they but increase the insensible transpiration, they are called diaphoretics ; the action of the two classes are the same, the degree of influ- ence upon the cutaneous exhalants constituting the only difference. The function of cutaneous transpiration is one of great importance to the welfare of the animal economy, so much so, indeed, that when it has been entirely arrested death ensues. To appreciate the importance of this secretion, we have only to consider the extent of the excretory apparatus of the skin, and the amount and character of the matters excreted. In regard to the extent of this apparatus, Erasmus Wilson says: "I counted the perspiratory pores in the palm of the hand, and found 3,528 in a square inch; now each of these pores being the aperture of a little tube, about a quarter of an inch long, it follows that in a square inch of skin on the palm of the hand, there exists a length of tube equal to 882 inches, or 73.5 feet. Surely such an amount of drainage as 73 feet in every square inch of skin, assuming this to be the average of the whole body, is something wonderful, and the thought naturally intrudes itself, — ' What if this drainage were obstructed?' The number of square inches of surface in a man of ordinary hight and bulk, is about 2,500 ; the number of pores therefore, is 700,000, and the number of inches of perspiratory tube, 1,750,000, that is, 145,833 feet, or 48,600 yards, or nearly 28 miles." It has been estimated by Seguin, from careful observa tions, that eleven grains of matter are cxci'eted from the 188 SPECIAL THERAPEUTICS. skill per nuniitc, being equal to thirty-three ounces in twenty-four liours. This consists of — Organic matter, 107.47 grains. Saline matter, . 81.92 " AVater and volatile matter, .... 15,050.01 " The maintenance of the normal condition of this very extensive and highly sensitive tissue, is of primary import- ance in the preservation of health. This is satisfactorily proven by the morbid conditions so frequently ai;d so speedily induced by the suppression of perspiration, or by derangement of its normal function. When we take into consideration the extent of the cutaneous tissue, the innu- merable sudoriferous glands, the ducts of which i")enetrate it and empty upon its surface, through which much of the effete matters of the system should escape, and through which they do escape, in a state of health, we can not be insensible to the important office which it performs. "We can also readily understand the extensive influence which it is capable of exerting upon the whole system if its normal functions are destroyed, and also to the very salutary and extensive influence which may be exerted upon it, and through it upon the entire system, in subverting morbid action in disease. There are four great emunctories through which all the decayed or decaying materials generated in the system In* the processes of disintegration, and which can be no longer subservient to the purposes of the animal economy, — but which if retained, must act as sources of disease, causing fever, irritation, inflammation, etc., — are excreted. Through these emunctories, the bowels, kidneys, lungs and skin, these obnoxious materials must pass off. jSTow if any of these ex- cretory organs fail to perform their function, and elimiinition does not take place, the retained excrementitious materials must become irritants, and if long retained, they will not only vitiate the blood by their presence, but they will com- municate the same process of decay to the blood, and hence some variety of fever or inflammation will be the rcsidt. From these remarks relative to the excretions in general, and from the im}iortant functions which the skin is destined to perform, the following deductions nuiy be drawn : First, DIAPHOEETICS. 189 we infer from the great amount of effete material thrown off in this way by this extensive excreting surface, that any cause that may arrest or diminish its normal action, and cause a retention of them, will be a cause of general disease, show- ing itself in some of the numerous forms of fever; or if some ];1articular organ or tissue be predisposed to take on a diseased action, we may witness a local disease, or one in which the intensity of the excitement is concentrated upon a certain part, while other parts are but sympathetically af- fected, "Health," says Dr. Eberle, "is very intimately connected with the regular, performance of the perspiratory functions. Whenever the transpiration by the skin is suddenly checked, more or less derangement of the system is invariably the consequence." He further observes, "That portion of the circulating fluid yhich nature designs to be cast off by the cutaneous emunctories, as no longer fit for the purposes of the animal economy, is retained, and becomes a source of morbific irritation to the heart and other organs." We may also infer from its functions, and from the sympathetic rela- tions which it bears to the glandular, lymphatic, mucous, serous and nervous systems, exalting, modifying or arresting their functions according to its own normal or abnormal condition, that it is an important tissue to act upon, and through which to counteract diseased action, whether exces- sive or diminished. Experience has fully convinced us that suppression of the perspiration is a very fruitful source of disease. It is true that this suppression is often counterbalanced by some other emunctory taking upon itself a vicarious action, thus sup- plying the place of the one whose functions are impaired. We are also quite as well convinced that the restoration of this function is of infinite importance, and that those agents which restore it, whether they act directly or indirectly, are therapeutic agents of the first importance. The views that we have above expressed relative to the utility of this class of remedies, and the importance of re- storing this secretion in numerous diseases, are corroborated by many of our most distinguished authors, as Drs. Wood, Eberle, Thompson, Paris, etc. 190 SPECIAL THERAPEUTICS. In opposition to these views, we present those of Dr. Dunglison. He says: "It may admit, however, of well- founded doubt, whether disease be ever induced by suppres- sion of the cutaneous exhalation." He supposes that cold, operating upon a limited part of the surface of our bodies, morbidly impresses the cutaneous capillaries of that part, and that the local or general disease is sympathetic, or that the internal capillary system sympathizes with the morbid condition of the external capillaries. He says : "This irreg- ular action of the capillaries of the part is the first link in the chain of phenomena, not the obstruction of perspiration." "We readily admit that the first morbid impression from cold thus applied, is made upon the superficial capillaries; but this impression consists in a spasm of the minute vessels; the sudoriferous glands do not receive a supply of blood, and their excretory ducts are closed. There is a general cutan- eous paralysis, and thus the excrementitious materials thrown into the capillaries to be eliminated, are retained; they ac- cumulate, render the blood irritating, and produce fever, inflammations, etc. If, as Dr. Dunglison contends, the ir- regular action of the capillaries constitutes the^rs^ link in the chain of morbid phenomena, the superior efiicacy of diapho- retics would be none the less important in breaking that "link" ; for no influence which can be brought to bear upon the system when it is in a state of disease, so effectually sub- verts capillary excitement as diaphoretics. Yet, strange as it may seem, Dr. Dunglison still further remarks that, "In any mode, consequently, of viewing the subject, it does not appear that we can ascribe any extensive series of morbid phenomena to simple suppression of perspiration. Such being the fact, the indication of restoring suppressed perspi- ration— if it be admitted at all — must exist much less fre- quently than has been imagined. He further observes that but few classes are more frequently used, "and probably none which are more uncertain in their operation, and on which less reliance ought to be placed." Again he remarks "Perhaps we have no class of remedies more uncertain in their operation than anatomical diaphoretics, as ordinarily administered. It might indeed be said that there are no agents so devoid of any beneficial action." He finally suraa ^ - DIAPHORETICS. 191 np the matter in such a way that we can not fail to see the little importance which he attaches to this class of remedial agents. He says : " On the whole, then, even in febrile and inflammatory aft'ections, the use of the ordinary internal diaphoretics is uncertain, and generally of no avail." These views of this distinguished compiler we conceive to be eminently erroneous ; instead of diaphoretics being " of no avail" in febrile and inflammatory diseases, and instead of the indication of restoring suppressed or diminished per- spiration rarely existing, their employment in the cases referred to should constitute one of the cardinal measures in the treatment of such cases, and the restoration of the cutan- eous transpiration is to be regarded as an indication of para- mount importance. It is true many of the diaphoretic agents act indirectly upon the cutaneous capillaries, removing the spasm, and augmenting the secretions ; yet their importance as curative agents, and the necessity of restoring or promot- ing that secretion is none the less imperative. Action of Diaphoretics. — Diaphoretics may be divided into two classes, according to their mode of action : the first of these classes act directly upon the glands of the skin, and hence we name them specific diaphoretics ; the second class produce diaphoresis indirectly, and on account of some other property possessed by them : these may be named indirect diaphoretics. Specific diaphoretics stimulate the sudoriferous glands to increased action, and thus increase the secretion. We sup- pose that they act in the same manner as specific diuretics or cathartics; they have an afiinity for this secreting structure, pass to it, and are eliminated by it; and in this manner stim- ulate it to increased action. Volatile diaphoretics belong to this class, as also ammonia and its various salts, and some acrid agents, as guiacum, senega, etc. The best example of this class is probably the asclepias tuberosa, or its active principle, asclepin. These agents are not always certain in their action, owing to the peculiar state of the system, or the difl[erent hygrometric states of the surrounding air. But as they act directly from the blood upon the secreting apparatus, if this is in a condition to be impressed by stimulus, these agents act as direct diaphoretics. 192 SPECIAL THERAPEUTICS. Indirect diaphoretics may act by relaxing the cutaneous tis- sues, or by determining the circulation to it. The effect of remedies which relax the system, in the production, of dia- phoresis, may be accounted for by the relaxed state of the capillary vessels of the skin, and the' readiness with which the watery portions of the blood will pass through their coats in this condition, and also by the relaxation of the tissues sur- rounding the sudoriferous glands and ducts, whereby they are enabled to freely receive and throw their secretion upon the surface. This condition of the cutaneous surface is pro- duced by emetics and nauseants ; we also notice it in the relaxation which follows fever, and in the night-sweats of debilitating or exhausting diseases. .• . Determination of blood to the skin is an important part of diaphoresis; anything that will determine to the surface will increase the secretion, providing the cutaneous' tissue is relaxed. Thus, in fever we have an increased circulation and determination to the surface, but the skin is constricted, hot and dry, and the walls of the capillaries tense and rigid; hence it is impossible for transudation to take place. But if the temperature and pulse are reduced by sedatives, we then have all the conditions present (if the body is kept warm) for the production of indirect diaphoresis. The action of all diaphoretics is promoted by cleansing the skin, keeping the body warm, and by the free exhibition of warm diluents. Diaphoresis may be produced, simply by bathing the feet in warm water and keeping the body warm. The warm water relaxes the skin, and the heat determines to the surface. The wet-sheet pack acts in a similar manner. Its tirst effects ^re indeed the opposite of diaphoresis ; but when reaction takes place, the circulation is determined to the surface, which is relaxed by being in contact with the water. Lastly, if the skin is kept cool, diaphoresis is prevented; that which would have been eliminated by the skin passes off by the kidneys. Thus, if we wish to produce diapho-* resis, the skin should be kept warm, and the fluids taken should also be warm; while, if we wish to produce diuresis, we administer the remedy or diluents cool, and also keep the skin cool. DIAPHORETICS. 193 Therapeutic Indications. Very different diaphoretics are demanded in different states of the s^'stem. If obstructed perspiration depends upon an exalted vital action, as in fever, nauseants, refrigerants, sedatives, ablutions (either tepid or cold), aided by any of the warm diaphoretic infusions, or even cold acidulated drinks, as iced water, lemonade; etc., will diminish the momentum of the circulation, lessen the vascular tonicity, and favor not only the restoration of the cutaneous transpiration, but other organs may be excited to resume their functions also. These agents act as sedatives, and indirectly as diapho- retics; they diminish morbid excitement throughout the vascular system, and particularly in the capillaries, and pro- mote the secretions. A combination of properties as seda- tive, refrigerant, anodyne, nauseant, expectorant, diuretic, diaphoretic, etc., frequently adds much to their medicinal virtues ; a combination of diaphoretics is always better than single articles. Obstructed perspiration may depend upon a slow and languid circulation, in which case the skin will be shriveled and cold, indicating the cutaneous torpor and internal con- gestion; in this case a very different class of diaphoretics will be demanded. In these cases copious draughts of warm, stimulating diaphoretic infusions, as the aristolochia, eupa- torium, monarda, asclepias, etc., aided by stimulating ablu- tions and brisk frictions to the surface, will prove most beneficial. These measures tend to relieve the internal con- gestions or visceral engorgements, by inviting the blood back to the surface, and by the determination to, and excitement of the sudoriferous apparatus, diaphoresis is the result. In the advanced periods of life, when diaphoretics are de- manded, a very different class should be selected to meet the indications. In the diseases of old persons the reaction is feeble ; instead of that vigorous constitution and correspond- ing reaction of youth, their diseases, both febrile and inflam- matory, are not attended with a high grade of vascular excitement, and consequently our remedies, both internal and external, to produce diaphoresis, should be of a stimu- lant character, l^or is it necessary or proper to carry 13 194 SPECIAL THERAPEUTICS. cliapboresis to the same extent, even in the same diseases in aged persons, that we should in the young and vigorous. In such cases we frequently find it necessary, as well as ad- vantageous, to add spirits to even the exciting diaplioretic infusions, and to the warm ablutions. In the various forms of pneumonia we avoid stimulating diaphoretics, except in the advanced stages of the disease, unless they are combined with nauseants and expectorants. In these cases cold or acidulated drinks, or even stimulating or exciting diaphoretics, unless modified by nauseants and sedatives, are improper. A similar modificatioi] in our ex- tent al applications should be observed. In high grades of fever we admit cold air to the surface, cold ablutions, etc., the whole course being refrigerant during the excitement ; but in pneumonia Ave keep the surface warm, apply warm ablutions, or warm and emollient fomentations to the surface, to invite the blood to the superficial capillaries, in order to relieve the hypersemia of the lungs, and maintain constant diaphoresis. We resort to diaphoretics devoid of stimula- ting properties, as the asclepias tuberosa, etc., and we com- bine them with nauseants. Diaphoretics are a very important class of remedial agents in all those diseases that arise from atmospherical vicissitudes. In these diseases, torpor of the sudoriferous apparatus con- stitutes the first link in the chain of morbid phenomena which follow, and diaphoretics constitute our most valuable therapeutic agents to restore that secretion, and thus remove the cause of the diseased action. I. Action in Fever. — Diaphoretics are of primary impor- .tance in the treatment of all febrile affections; the class of diaphoretics, and the extent to which they should be carried in particular cases, can only be determined by the stage of the disease, the grade of excitement, the age and vigor of the patient, its congestive, sthenic or asthenic tendencies, etc. All of these circumstances must be taken into consideration in determining the extent to which diaphoresis should bo carried, and tlie proper diaphoretics to be selected and used. In the early stages of most fevers, if the patient is young and vigorous, copious and protracted perspiration should be secured and maintained by cold or tepid baths, by nauseants DIAPHOKETICS. 195 refrigerant and sedative diaphoretics, or tliey may be com- bined with those possessing stimulating properties. It is proper here to remark, that their employment should be pre- ceded by the free use of cathartics, or emetics if indicated. In similar attacks of old persons, the stimulating diaphoret- ics and tepid ablutions should be employed, but in this case gentle diaphoretics alone are indicated. Id the advanced stage of fevers, especially those of a typhoid type, free per- spiration is too debilitating to be tolerated by the system, and should be avoided; but gentle diaphoresis or simple moisture of the surface is beneficial. If the fever is of an adynamic character, gentle and excitant diaphoretics, aided by tepid stimulating ablutions to the surface with brisk fric- tion is very important. Their sanative powers seem to depend upon a variety of influences which they exert upon the system. First, they remove the constriction of the cutaneous capillaries, and act as depletives by increasing the perspiratory function, and may therefore be regarded as antiphlogistic. Secondl}', the evaporation which attends perspiration carries off the caloric, and thus lessens the abnormal heat of the system; in this sense they may be regarded as refrigerants. Thirdly, they equalize the circulation, by determining the blood to the surface; they remove congestion of internal organs. Fourth, they promote the elimination of morbid material from the blood, which if retained would prove a source of irritation, often producing fever, or if it already exists, it would tend to perpetuate it and render its type lower. They modify the condition of the skin, they soften and relax it, they les- sen the heat and tension of it, and by an intimate sympathy existing betM'een this extensive surface and every other organ or tissue of the body, a like salutary influence is exerted upon all. II. Action in Inflammation. — The remarks which have been made relative to their utility in febrile disease, and to their therapeutic action, apply with equal force to their • employ- ment in inflammatory diseases. It will be recollected, that atmospheric vicissitudes play a very important part in the pro- duction of the phlegmasia, as well as fevers. When one organ or tissue is more disposed to take on morbid excitement 196 SPECIAL THERAPEUTICS. than another, we meet with a local instead of a general disease ; thus a number of persons exposed to the same morbific influences, may be the subject of as many different diseases ; or but a small part of the number may contract disease, owing to the predisposition of some systems, or some organs to take on diseased action. Those who do not contract a disease are indebted for their escape to the sound and vig- orous constitutions which they possess, for warding ofl' the morbid influences, and securing them against its eft'ects. In inflammatory, as well as in febrile diseases, they are important as depletives, or antiphlogistics. They remove cutaneous spasms, lessen the morbid heat, abate the fever, produce sedation, invite the circulation to the surface, and thus act as revulsives, equalize the circulation, relieve pain, overcome the tension of the tissues implicated, and thus act as emollients, etc. They thus do as much, if not more, to eflfect a resolution of the disease than any other class of agents with which we are acquainted, providing proper per- severance and energy of action characterize their mode of employment. The intimate sympathy existing between the cutaneous surface and the lungs, or between the functions of each, points to the employment of diaphoretics in pulmonic inflam- mation, as a class of remedial agents of singular efficacy. When perspiration is copious, the skin moist and relaxed, respiration is less painful and less laborious, and the distress or oppression in the chest is mostly, if not entirely relieved. The functions of the skin and lungs, it will be recollected, are analogous in several respects, and a very close sym- pathy exists between the two. Yf e would therefore suppose that any agent which would relax the skin, and increase its secretion, would prove beneficial in arresting inflammation of the lungs — and experience has proved this to be true. The same remarks apply to their employment in dysentery and diarrhea. The most superficial observer has not failed to notice the immediate influence which the obstruction of the cutaneous transpiration often exerts upon the bowels. Here, also, we have the same continuous membrane, and the same continuous sympathy, and the modifications of the function of either membrane influences that of the other; DIAPHOEETICS. X97' hciicc the great value of diaphoretics in these diseases. Dia- phoretics, possessing anodyne and sedative properties, are of peculiar advantage in these cases. They are revulsives, determining the circulation to the surface, thus relieving internal hypcrsemia. They are anodyne, and lessen pain and dysenteric tenesmus. By their anodyne and sedative influence they lessen the pain and irritation in the bowels, diminish the mucous and intestinal secretions, and also diminish the augmented peristaltic action upon which the fre- quent discharges are dependent. They excite the cutaneous emunctories, equalize the circulation, break up morbid sym- pathies, and throw off the excrementitious matters which if retained can not fail to derange the sj-stem, and increase the existing disease. III. Action in Rheumatism. — Diaphoretics are of much im- portance in rheumatism, and they probably owe their bene- ficial influence not only to the effects which have been before alluded to, but also to their eliminative action in removing from the system a morbid material upon which the disease depends. Dr. Williams states that " The perspiratory secretion contains lactic acid and lactates of soda and ammonia, which probably proceed from the transformation or decay of the textures, particularly the muscular, which the recent re- searches of Liebig have shown to contain a preponderance of this acid. Hence these products abound during great muscular exertion, and when perspiration is checked by ex- ternal cold, they may be retained in the blood, causing rheumatism, urinary disd'rders, or various cutaneous diseases. The very serious effects sometimes resulting from sudden cold on the perspiring bod}^ may be partly owing to the same cause, as well as to the disorder produced in the circu- lation. Rheumatism is especially liable to occur as an effect of cold, where the body is fatigued with much muscular exertion ; and I have frequently observed that the rheuma- tism chiefl}' affects the limbs which have been most exercised. Where the skin fails to excrete, an increased task is thrown on the kidneys, whence may result various diseases of these organs; and if these organs fail in the task, the lactic acid accumulates in the blood, and probably acting as a ferment, 198 SPECIAL THERAPEUTICS. causes the formation of more, and of the kuidred products, lithic acid and its compounds and products; tlicse, in inflam- matory subjects, excite rheumatic fever; in cachetic persons, miliary fever, erysipelas and pemphigus; and in more torpid frames, various local rheumatic or gouty affections. All these cases are frequently remarkable for the acid character of the cutaneous and renal excretions; and in a few instances, the blood has been found to possess acid qualities, or to bo deficient in its usual alkaline reaction." The direct action of diaphoretics in this disease is, then, to stimulate the sudoriferous apparatus to increased elimination, and as lactic acid is a normal constituent of this secretion, it is removed from the system in large quantities; lactic acid being the supposed cause of rheumatism, its removal is fol- lowed by a cessation of the disease. Such agents as increase both the secretions from the skin and kidneys, prove most advantageous; and as the materies morbi is an acid, we would suppose that alkaline diaphoretics and diuretics would prove the most valuable agents, and experience fully sub- stantiates this conclusion. As the type of such a diaphoretic, we may mention the compound of asclepias tuberosa (3j.)> eupatorium perfoliatum (3j.), sanguinaria canadensis (3ij.), and nitrate of potassa (3ij.); in this we have active diapho- retic and diuretic agents, with the alkali to neutralize the excess of acid. Again, by promoting perspiration, we cause relaxation of the system, equalize the circulation, and remove the ten- sion of the inflamed part. To fulfill these indications, we not only administer diaphoretics, but we also resort to emol- lient fomentations, to the alcoholic vapor-bath, to embroca- tions, brisk frictions, etc., to relieve the pain, subdue the irritation and inflammation, and assist in producing diapho- resis. Moderate diaphoresis sometimes gives much relief in gout, but the employment of these agents is not as beneficial as it is in rheumatism. IV. Action in Cutaneous Diseases. — In the acute exantho- matous diseases, this class of agents proves very beneficial. Moderate diaphoresis tends to advance the eruption, and moderate the i'ebrile action, and in cases where the eruption U DIAPHORETICS. 199 tardy, or where there lias been a retrocession of the eruption, stiniulating diaphoretics, aided by tepid ablutions of an ex- citant character, are of decided utility. In the chronic cutaneous forms of disease, as in Iicrpcs, lepra, etc., a moderate moisture of the surface, promoted by the use of the medicated vapor-bath, continued for weeks, or oven months, constitutes an important part of our remedial treatment. V. Aciio7i in Droimj. — In dropsies they are less beneficial than we might be led to suppose. From the large quantity of serous fluid which they evacuate, we should suppose they would be important, but experience does not confirm this view; they occasionally, however, prove important. In dropsy it is difficult to induce sweating; if, however, we suc- ceed, advantage results from their use. The use of the tepid- bath, with brisk frictions to the surface, tends to invite the circulation to the skin, restore the perspiratory function which is always torpid, and promote absorption, which is an indication worthy of our attention in this disease. VI. Action in Disease of the Kidneys. — The kidneys are closely connected in function with the skin, and when either is diseased the other performs a vicarious function, its se- cretion being increased to make up for the deficit in the other. Thus in suppression of urine, the perspiration some- times acquires a marked urinous odor, and when the skin fails to perform its function, the secretion of the kidneys is increased. From these facts we can readily appreciate the importance of diaphoretics in renal diseases. Thus, in ne- phritis, no measures that can be adopted will produce such speedy relief as the production of free diaphoresis; they not only equalize the circulation, and thus remove the congestion of the kidneys, but they likewise remove much of the ma- terial that would have been excreted by the kidney in its normal condition. The same remarks will apply to other acute diseases of these organs. Suppressed or diminished perspiration is supposed to exert some agency in the production of calculous affections. In some of these conditions of the system they may prove ben- eficial by removing the irritation of the kidney, and by 200 SPECIAL THERAPEUTICS. causing tlio skin, for the time being, to perform a vicarious function. We might extend the same remarks to their employment in diabetes. By determining to the surface, we change the organ of depuration, we throw the burden upon the skin and relieve the kidneys; hence the importance of the in- duction of a constant and free action of the skin. The frequent use of the hand-bath, accompanied with brisk fric- tions, cleanses the skin and invites the circulation to the sur- face, and gives the kidneys an opportunity to regain their nor- mal vigor. In connection with this, hydragogue cathartics, stimulating diuretics, tonics and astringents, cooperate in eftecting a cure. Recapitulation. 1st. Diaphoretics are important both as depletives and eliminatives, lessening vascular repletion, and promoting the elimination of effete materials existing in the system. 2d. They overcome the vital tonicity and cohesion of the capillaries of the surface, and thus promote perspiration, equalize the circulation, counteract congestion, and serve to lessen fever and inflammation. 3d. Ey their excitant action on the sudoriferous follicles and capillaries of the surface, they act as mild, but none the less efficient revulsives, diverting excitement from internal organs, equalizing the circulation, and thus proving very effi- cient agents in the treatment of inflammation of anv of the internal viscera. 4th. The surface is the great refrigerator (as well as one of the great depurating organs of the system), and hence the utility of suitable diaphoretic means and a}»pliances; diaphoresis serving to carry off" the morbid heat of the sur face, and lessen the excessive generation of caloric. Either cold or warm ablutions, as well as internal agents, may facilitate tliis result. 5th. Diaphoresis promotes absorption by reducing the serum of the blood ; and hence their utility in dropsies, par- ticularly in those of a sthenic character. Gtli. Diaphoresis exercises an emollient influence upon the DIAPHORETICS. 201 entire surfuce, according to its degree, by which a soothing and rehixing influence is extended by contiguous and con- tinuous nervous and capillary sympathy, to deep-seated and remote parts, lessening internal excitement and inflamma- tion. By this means they may arrest fever or inflammation, modify or change its type for the better, if they do not efl:ect a radical cure. 7th. They are useful both in acute and chronic diseases; free sweating being indicated as a general rule in the acute forms of disease, and an increase in the insensible transpira- tion in chronic affections. 8th. The extent of their use in acute disease, must depend upon its duration, they being used freely in the early stages, and before there is much exhaustion ; and less freely, or even sparingly, after the patient has become prostrated by its duration. 9th. In diseases attended with a high degree of excite- ment, nauseating and sedative diaphoretics, with the free use of ablutions, either tepid or cold are demanded. 10th. In coldness of the surface, wnth a languid state of the circulation, accompanied with internal congestion, ex- citant and stimulating diaphoretics, assisted by warm or even hot stimulating baths, are indicated. 11th. In old age, and in the advanced stages of disease, if attended with debility, diaphoretics of a tonic and stimulat- ing character are indicated. 12th. Suitable diaphoretic measures, modifying as they do every organic function of the body, are among our most important curative, as well as auxiliary means in the treat- ment of nearl}' all diseases. 202 DIAPHOKETICS. SERPENTARIA. THE EOOT OF AraSTOLOCIIIA EERPENTARIA— U. S. PPtEPARATiONS. — Tiiicture of Serpentaria. Compound tincture of Serpentaria. Dose. — Of either tincture gtt. x. to 5j- Therapeutic Action. — Serpentaria is diaphoretic, stimu- lant, tonic, stomachic and diuretic. It is especially valuable as a diaphoretic and tonic. To fulfill these indications in the treat- ment of disease, no article v/ith which we are acquainted, sur- passes the one now under consideration. It may be exhibited as a diaphoretic during the early stages of febrile and inflam- matory diseases with advantage ; but it is in the advanced stages, especially in typhoid fevers, that we have found it most important. Acting as it does upon many of the secre- tions, stiniulatino; and Dromotina; them, and as an excitant to the vascular system, while at the same time it exerts a sus- taining influence on the enfeebled system, it is rendered an agent of rare virtues in the cases referred to. Prof Wood states, that it is admirably adapted to the treatment of typhoid fevers, whether idiopathic or symptomatic, when the system begins to feel the necessity for support, but is nnable to bear active stimulation. We have found the Serpentaria very useful In the exanthe- matous diseases, when .the excitement was feeble, and the eruption tardy in making its appearance, for the purpose of facilitating the eruptive process. It is equally valuable when a retrocession has taken place, causing a determination to the surface, thereby relieving congestion of internal organs, and reproducing the eruption. In small doses it promotes the appetite ; in large doses it produces diaphoresis if the surface is kept warm, apd diuresis if exposed to the cold air; it may also cause nausea, and act as an a])erient. PILOCARPUS— J ABORANDI. THE LEAVES OF FILOCARPUS PENXATIFOLIUS.— BuAZiL. Preparations. — An infusion of the leaves. Tincture of Pilocarpus. Pilocarpin. PILOCARPUS. 203 Dose. — An infusion of 5iss. to .^iv. of hot water may be taken in tablcspoonfiil doses every ten minutes, to produce the full effect of the remedy. The tincture may be given in doses of gtt. X. to gtt. XXX. in hot water. The dose of Pilocarpi n is one-half grain ; it may be used by hypodermic injection in doses of one-eighth to one-quarter of a grain. Therapeutic Action. — Jaborandi is the most powerful diaphoretic known, and should only be employed when there is need for a prompt and efficient action upon the skin. The old word " sudorific " expresses the quality of the action^, which resembles that obtained by the spirit vapor batli, with the use of the compound tincture of Serpentaria. The first influence of the remedy noticed (when taken in full doses) is a flushing of the face, and sometimes of the entire trunk, with increased fullness of the pulse, and occasionally pressure on the brain. Then perspiration breaks out in drops, and soon the patient is sweating from every pore. It has been employed in commencing uraemia from scanty secretion of urine ; in acute albuminuria; in puerperal con- vulsions; in tardy appearance or retrocession of the eruption in the eruptive fevers ; in puhnonary apoplexy ; in dropsy of the cavities, especially in hydropericardium, and hydrothorax. The advantage of a powerful remedy like Pilocarpin, which may be held in solution and used by hypodermic injection, is, that it offers a powerful means of acting upon the skin, and providing revulsion, when the patient is unconscious, and can not take the ordinary remedies. It has not been named as a remedy for Asiatic cholera, and possibly has not been tested in this disease. Yet I should think, from the influence it exerts upon the circulation, and upon the skin, that it might prove curative. I will be sure to test it if I see another epidemic of this disease. Jaborandi is thought to be a true galactagogue, increasing the secretion of milk, in doses short of diaphoresis. When studied in small doses, it will probably serve other useful pur- poses in the practice of medicine. 204 DIAPHORETICS. ASCLEPIAS. THE ROOT OF ASCLEPIAS TUBEROSA— U. S. Preparations. — An infusion. Tincture of Asclepias. Asclepin. Dose. — Tlie infusion may be taken freely. A drachm of the tincture added to .Siv. of water may be given in teaspoon- ful doses. The dose of Asclepin is gr. J to gr. j- Therapeutic Action. — The Asclepias is diaphoretic, ex- pectorant and laxative. In addition to these properties, it is said to possess those of a subtonic, diuretic, carminative and antispasmodic character. These, as well as its cathartic prop- erties, are too feeble to render it a reliable agent in cases re- quiring active remedies. The Asclepias acts as a diaphoretic and expectorant with- out sensibly increasing the action of the heart and arteries, or heat of the surface. We have found it a mild, slow, but pretty sure diaphoretic, acting conspicuously upon the pulmo- nary mucous membrane, promoting expectoration. It rarely, if ever, produces profuse diaj^horesis, but in a short time after it is administered, the skin will be observed to feel soft and cool, and slightly moist. It is a valuable remedy in pleurisy, pneumonia, bronchitis, and other pulmonary diseases, if given to the extent of producing a softened state of the skin, and free diaphoresis. The Asclepias Syr'iaca is diaphoretic, expectorant, diuretic, and said to be anodyne ; it is supposed to possess properties analagous to the preceding species. It has undoubtedly been too much neglected by the medical profession, its medical vir- tues justly entitling it to a notoriety which has not been awarded it. It appears to be diaphoretic and expectorant, like the preceding article, and it is said to exert an anodyne and soothing influence upon the system. ASCLEPIAS INCARNATA. This variety of the Ascle])ias is said to possess j)ropertics similar to the others, though in large doses it acts as an emetic and cathartic. Its properties and thenipeutic a[i[)lication have not been properly investigated. Tongo and Dtirand, in their OPIUM. 205 Manual of Materia Medica, include it with the Syriaca, and say they are used with success in the same doses, and in the same manner as the Tuberosa, in pectoral affections, etc. Dr. Tully states that the root of this species may be advantage- ously administered in catarrh, asthma, rheumatism, syphilis, and verminous affections. ^ IPECACUANHA. Ipecacuanha deserves a notice here, as it enters into many of our most efficient diaphoretic compounds. (For general description, see Emetics.) In small doses, as one grain, re- peated every two, three, or four hours, or oftener, it produces a relaxed and softened state of the skin, with slight diapho- resis. It is, however, rarely used alone, being combined with other agents, especially opium, adding much to the efficiency of the preparation, Pulvis Ipecacuanha et Opii Compositus. — Diaphoretic Poio- der. — ]^ Opium o^s., camphor Sij., Ipecacuanha Sj-? bitartrate of potash oviij. Pulverize separately and mix. This preparation is useful not only for its diaphoretic but also for its anodyne effects. It is used in the forming stages of fevers and inflammatory affections, in coughs, colds, nervous irritation, etc., as a diaphoretic and anodyne. It is frequently combined with other diaphoretics, as Asclepin, and with anti- periodics in the treatment of intermittent diseases. Pulvis Ipecacuanha Compositus — Dover's Powders. — ]^ Ipe- cacuanha in powder, opium in powder, aa. 5j., sulphate of pot- ash powdered, Sj. Mix. " This powder acts as a powerful sudorific, and is very efficaciously given in all cases, whether inflammatory or not, in which sweating is indicated, the relaxant power of the ipe- cacuanha acting upon the skin. The dose is from five to ten grains, diffused in mucilaginous fluid, or in the form of bolus. OPIUM. Opium, the general properties of which will be considered under the class of Narcotics, is a very important diaphoretic. In cases where tiiere is a dry and constricted state of the sur- face, restlessness, nervous excitability or irritability, as in 206 DIAPHORETICS. fevers, inflammatory diseases, etc., the anodyne, sedative, and tranqnilizing influences of opium are almost invariably accom- panied by a relaxation of the surface and free perspiration ; this is especially the case if aided by quiet, warmth, and the free use of warm diluents. Ipecacuanha, camphor, nitrate of potash, and other nauseating and sedative, agents, associated with opium, greatly contribute to accomplish this desirable end. Ablutions, either cold or tepid, according to the state of the surface, and depressed or exalted manifestations, are like- wise powerful auxiliary measures in securing the fulfillment of this indication. ANTHEMIS. THE FLOWERS OF ANTHEMIS COTULA Dose. — Of infusion, one ounce to a pint of boiling water, from one to two ounces, or more if indicated. Therapeutic Action. — Wild Chamomile possesses sudo- rific, tonic, emetic, and rubefacient properties. Although but little used as a dia})horetic, yet it affords us an admirable one in certain cases. In low grades of fever, where the vital powers are depressed, or where there is congestion of internal organs, with a cold, shrunken, or shriveled condition of the surface, a weak and warm infusion of this article exerts a de- cided influence in determining the circulation to the surface, and promoting diaphoresis. LOBELIA SYPHILITICA. Dose. — Of the powdered root of Lobelia Syphilitica, from grs. XX. to 5j , taken in some warm diaphoretic infusion ; of a decoction of an ounce to a pint of water, from one to three ounces. Therapeutic Action.— Lobelia Syphilitica is diaphoretic, diuretic, emetic, purgative, and said to be antisyphilitic. Its medical properties and Uses, however, are but very imperfectly understood. The root, when administered in small doses, acts as a sudorific and diuretic; in larger doses, as an emetic and cathartic. Rafinesque states that it is chiefly sudorific and diuretic. It was employed by the Indians as a specific in the treatment of syphilis; the secret of its use was purchased of . LOBELIA SYPHILITICA. 207 them by Sir H. Johnson. Its utility in this disease requires confirmation ; indeed, the limited trials made with it have shown that it possesses no powers of this kind. Lobelia Cardinalis. — The Cardinal Floicer, according to Griffith, possesses much the same properties as the agent last considered. It is also recommended as a valuable discutient poultice to glandular swellings, painful tumors, etc. It is used principally in decoction, one ounce to a pint of water. Dose, one to two ounces, repeated as often as necessary. POLYGONUM PUNCTATUM Dose. — This agent is principally given in infusion, one ounce to a pint of boiling water. Dose from one to two ounces. Polygonum Punctatum, fully considered under the division Emraenagogues, possesses pretty active stimulating diaphoretic properties, together with others of a diuretic, expectorant, and antiseptic character, which render it a very efficient agent in some forms of disease. As a stimulating diaphoretic it is an excellent remedy, taken in the form of warm infusion, in sndden suppression of the perspiration, in colds, febrile and inflammatory diseases, and especially when the action of the heart is depressed from internal congestion, Avith coldness of the surface and deficient capillary circulation. DIOSCQREA. THE ROOT OF DIOSCOREA VILLOSA. Preparations. — Au infusion. Tincture of Dioscorea. Dioscorin. Dose. — The infusion may be taken in doses of 5j-, the tincture gtt. j. to gtt, xxx. Dioscorin gr. j. Therapeutic Action. — The Dioscorea is diaphoretic, ano- dyne, antispasmodic, anti-emetic and expectorant. It seems to act as a very gentle diaphoretic, without exciting the action of the heart and arteries, or increasing the temperature of the body. It has been but little used, however, for this purpose, although it might undoubtedly be employed with much ad- vantage. It appears to act as an anodyne and antispasmodic, and likewise as an anti-emetic in the disease in which it has been principally employed. The only affection in which it 208 DIAPHORETICS. > has been used sufficiently to give a fair test to its virtues, is bilious colic. In many instances it lias appeared to act with great promptitude in allaying nausea and vomiting, and re- lieving the pain and spasmodic action invariably present in that disease. In various cases of great severity, where other remedies had been faithfully and perseveringly employed, and when all had proved unavailing, the nausea and vomiting, se- vere pain and spasms continuing unabated, with a dry and husky state of the surface, the Dioscorea has aiforded entire relief in every respect, in twenty or thirty minutes, and the patient has fallen into a comfortable state of repose, and slept quietly the first time since the attack. PTEROSPORA. THE ROOT OF PTEROSPORA ANDROMEDA. Dose. — Of the Pterospora, in powder, from grs. xx. to half a drachm, or even one drachm, every twenty or thirty min- utes, or less often, in sweetened water. Of an infusion, of half an ounce to a pint of boiling water, one to two ounces. Therapeutic Action. — Pterospora is one of our most powerful and efficient diaphoretics, yet, from its scarcity, it has not yet come into general use. It has been employed as a sudorific or diaphoretic, in febrile affections, with great ad- vantage. It is used in all forms of fever, but especially in those of a typhoid, continued or remittent character. If taken freely, it produces free perspiration without accelerating the action of the heart, or increasing the temperature of the body; but, on the contrary, it appears to exert the reverse influence, and stops, as Rafinesque asserts, the fever in a few hours. POLEMONIUM. THE ROOT OF POLEMONIUM REPTENS. Preparations. — An infusion. Tincture Polemoninm. Dose — The infusion may be taken in doses of one ounce. The tincture in doses of gtt. v. to gtt. xx. Therapeutic Action. — Polemoniura is diaphoretic, ex- pectorant and excitant. It appears to act ])rincipal]y as a diaphoretic and expectorant. As a diaphoretic it is exhibited in febrile diseases, and inflammations of the respiratory appa- I CAMPHORA. 209 ratus. In the different forms of pnlmonic inflammation, plenri.sy, bronchitis, etc., a warm infusion has been found ad- mirably adapted to the production of diaphoresis, the promo- tion oC expectoration, and the cure of the disease. It appears to be best adapted to the relief of febrile diseases attended "vvith coldness of the surface, a dry, torpid, and constricted state of the skin, with general languor, and internal venous congestion. It is a popular and valuable remedy in chronic pulmonary diseases — as catarrhs, asthma, bronchitis, coughs, and even consumption, keeping up a constant determination to the sur- face, and thus relieving the parts diseased, as well as exerting a stimulating and eliminative influence upon the system. It is also regarded as worthy of much attention in chronic dis- eases of the liver, and with man'y it enjoys a high reputation in these affections. HELENIUM. THE HERB OF HELENIUM AUTUMNALE.-U. S. Dose. — Of the powdered ])lant, 5ss. to 5j-, given in some Avarm infusion; of an infusion of half an ounce to a pint of boiling water, one to two ounces, and repeated as often as may be necessary to secure its effects. Therapeutic Action. — Helenium is diaphoretic, tonic, expectorant, errhine, anthelmintic and expectorant. It is a new remedy, whose properties are not as yet well understood. It is valuable as a diaphoretic and aperient in debilitated con- ditions of the system requiring the use of remedies capable of fulfilling the indications named, and especially useful as a tonic and excitant in the advanced stages of typhoid fever. CAMPHORA. Dose. — Of Camphor as a diaphoretic, from one to ten grains, given in the form of emulsion. Camphor is a valuable diaphoretic, and may be used to ful- fill this indication in almost every state of febrile and inflam- matory disease. Its operation may be promoted by the free use of tepid diluents, and by associating it with opium. Ipe- cacuanha, nitrate of potash, etc., in the several cases in which these remedies are found beneficial. U 210 DIAPHOKETICS Jt is useful iu various nervous affections, chronic and even acute rheumatism^ gout, irritation of the urinary organs, etc. EUPATORIUM. Dose. — Of an infusion of one ounce to a pint of boiling water, from one to four ounces. Eiipatorium Perfoliatum, or Boneset, the properties and uses of which are fully described under tlie class of tonics, is a valuable diaphoretic. An infusion, taken freely Avhile warm, is highly useful in promoting perspiration in colds, coughs, pneumonia, inflammation, and the various forms of fevers, especially in the early stages, if given to the extent of produ- cing nausea and vomiting. It is also useful in smaller doses, in the advanced stages of the same diseases, when a sustaining diaphoretic is demanded. EUPATOKIUM AROMATICUM. White Snake-root, described under the class Antispasmodics, is a valuable diaphoretic, expectorant, and antispasmodic. It is particularly useful as a diaphoretic in acute pneumonic in- flammations, and is also valuable for its expectorant properties. For this purpose it is exhibited freely in the form of a warm infusion. SAFFRON. THE STIGMAS OF CROCUS SATIVUS. Dose. — Of the powder, grs. x. to grs. xx. ; of an infnsion of one drachm to a pint of boiling water, two to four ounces. Theeapeutic Action. — Saffron is diaphoretic, stimulant, emmenagogue, and antispasmodic. Its medical virtues have been variously estimated; while some have ascribed great im- portance to it as a stimulant, antispasmodic, or narcotic, others have assigned to it a prominent place among emmenagogue and diaphoretic agents, while by many at the present day it is regarded as an agent devoid of any active properties. It is a popular remedy in domestic practice, especially in exanthematous diseases; and inasmuch as it is more frequently used as a diaphoretic than for any other purpose, we have thought proper to arrange it under this class. HEDEOMA. 211 CARTPIAMUS. THE FLOWERS OF CARTIIAMUS TINCTORIUS. Dose. — Of an infusion of half an ounce to a pint of boil- ing water, from two to six ounces, repeated as often as may be necessary. Therapeutic Action. — The Carthamus is diaphoretic and laxative, and very frequently used as a substitute for saffron. It does not appear to be possessed of very active properties, and is mostly employed as a diaphoretic in the eruptive dis- eases, as scarlatina, measles, etc., for which purpose a warm infusion may be taken freely. It is employed frequently as a laxative and diaphoretic in diseases of infants, and is a \evy mild, safe, and unirritating remedy. ASARUM. Dose. — Of the pulverized root from gr. xx. to one drachm ; of an infusion of one ounce to a pint of boiling water, one to three ounces. Wild Ginger, described in the class Emraenagogues, is de- cidedly diaphoretic and excitant, and when a weak and warm infusion is drunk, or when the powder is employed in small and repeated doses, aided by warm diluents and confinement to bed, it rarely fails to cause a determination to the surface, and induce copious perspiration. It is sometimes used in sudden colds, catarrhal, febrile and inflammatory affections, when the skin is harsh and dry, and the perspiratory action arrested, with the best effects. HEDEOMA. THE PLANT OF HEDEOMA PULEGIOIDES— U. S. Dose. — The infusion may be taken in any quantity that the stomach will bear. The dose of the oil is gtt. v. to xv. Therapeutic Action. — Pennyroyal is diaphoretic, em- menagogue, and stimulant. It constitutes a grateful aromatic stimulant and diaphoretic, and is used with advantage in feb- rile and inflammatory diseases, as a warm diaphoretic drink, when pleasant to the patient. It is a popular remedy in sud- den colds, suppressed menstruation, flatulent colic, spasm of 212 DIAPHOKETICS. the stomach and bowels, etc. In suppressed lochia it is prob- ably one of our most ejfificient remedies, and is one that we have used almost to the exclusion of any other, and with the best results. SASSAFKAS. The bark of the root of the Laurus Sassafras is diaphoretic, stimulant, antiseptic and alterative. It is employed in the form of a warm infusion, with a view to exciting the capillary circulation of the surface in both acute and chronic exanthe- matous fevers. In variola rubeola, scarlatina, etc., many of our practitioners think it one of the most valuable articles known. It is regarded as acting specifically upon the disease, and in cases of retrocession of the eruption, or when slow .in making its appearance upon the surface, or when it is imper- fectly developed, an infusion may be used with a prospect of advantage to the patient. GUAIACI LIGNUM. Dose. — Of a decoction made of guaiacum one ounce to a pint and a half of boiling water, and boiled down to a pint, from two to six ounces. Guaiacum AYood is diaphoretic, stimulant and alterative. A decoction produces warmth in the stomach, increases the temperature of the surface, and if the patient is warmly cov- ered in bed, and the decoction taken warm, it acts as a gentle diaphoretic; but if the surface is exposed to the air, diuresis follows. GUAIACI RESINA. Dose. — Of the Guaiacum, from grs. x. to oss., in pill, bolus, or emulsion. Guaiacum Resin acts as an acrid stimulant, causing vascular excitpmcnt, increased warmth of the surface, with augmented activity of the secreting organs — as the skin and kidneys. Used in connection with diluents, the skin being kept warm, it acts energetically as a sudorific ; if the surface is kept cool, however, its action is manifestly directed to the kidneys. PLANTANUS. 213 GERARDIA PEDICULARIA. Dose. — Of an infusion of an ounce to a pint of boiling water, two to three ounces. Therapeutic Action. — The plant is said to be an impor- tant diaphoretic and febrifuge. Dr. Waun, of Alabama, ac- quired some knowledge of its efficacy as a remedy in domestic practice, and was induced to communicate the results of hi.s inquiries respecting the Gerardia to the Eclectic Medical Insti- tute, in order to secure a full trial of its virtues. He states that upon the supervention of afebrile attack, the free. use of this article occasioned free perspiration, and effectually arrested the fever. It has been employed to a limited extent by Ec- lectic practitioners as a diaphoretic and febrifuge, and bids fair to answer a valuable purpose as a remedial agent. The plant deserves further investigation. PYCNANTHEMUM. The Pycnanthemum Virginicum, or Prairie Hyssop, noticed under the class of stimulants, if taken freely in the form of warm infusion, acts promptly as a diaphoretic. It may be employed in sudden colds, checked perspiration, and in the early stages of febrile and inflammatory diseases with advan- tage as a diaphoretic. It is quite similar to hyssop, rosemary, and the mints, in its properties. PLATANUS. Dose. — Of an infusion of one ounce to a pint of boiling water, from two to six ounces. The bark and twigs of the Platanus Occidentalis, or Syca- more, is said to be diaphoretic, diuretic, anodyne, arid antispas- modic. It is sometimes employed in infusion in the acute ex- anthematous fevers — as measles, scarlet fever, etc. — when the eruption is slowly or imperfectly developed, or when it recedes. It is used as a diuretic in nephritic affections, calculous irrita- tion, and other diseases of the urinary organs. It has also been used in pertussis, night-sweats, and dysentery, with ad- vantage. We have used a strong decoction of the bark of this and the white oak in night-sweats, the infusion being used internally at the same time. 214 DIAPHORETICS. ICTODES. Dose. — Of the recent root, from grs. v. to grs. x. ; but if dry and long kept, the dose will have to be increased to grs. XV. or 5ss. mixed in simple syrnp, or warm water sweetened. Ictodes Fetida, or ShmJc Cabbage, described in the class Expectorants, is decidedly diaphoretic as well as expectorant. It exerts a specific influence over the cutaneous exhalants, causing a relaxed and softened state of the skin, a determina- tion to the surface, and gentle perspiration. The powder or infusion, given in repeated doses, not only causes pers[)iration, but promotes the secretion and expectoration of bronchial mu- cus; hence it is a very valuable agent in the treatment of pul- monary affections. ARALIA SPINOSA. This species of Aralia, commonly called Southern Prickly Ash, or Angelica Tree, is highly stimulant as well as diapho- retic. The bark is employed as a stimulant diaphoretic in chronic rheumatism, spasmodic affections, etc., in the form of a decoction, which, if taken warm and freely, causes free per- spiration. XANTHOXYLUM. Xanthoxylum, or Prickly Ash, is also diaphoretic as well as Stimulant, and owes much of its curative influence to this property. The warm infusion, if taken freely, and aided by external heat, warm pediluvia, etc., will act powerfully as a diaphoretic; it is principally used in torpid states of the sys- tem, and when a stimulating agent is required. MEZEREUM. Mezereum, described under the class of Alteratives, is a stimulating diaphoretic, and has afforded much benefit in the treatment of cutaneous diseases and chronic rheumatism. It is rarely employed with a view to the })roduction of free per- spiration or sweating, but for the purpose of augmenting the insensible transpiration, for which it is esteemed valuable in the treatment of many chronic affections. ANGELICA. 215 INULA. Dose. — Of the powder, from grs. xx, to 3j-; of ix decoction of an ounce to a pint of boiling water, one to three ounces. Inula Helenium, or Elecampane, if taken in the form of u warm decoction or infusion, acts very conspicuously upon the cutaneous emunctories, causing diaphoresis. Its effects are greatly augmented by the application of external heat and quiet. It has been esteemed useful in both acute and chronic catarrhal affections, and in the acute exanthemata, when the eruptive process is not perfected, and when a stimulating dia- })horetic seems to be required. In sudden colds, check of per- spiration, and cough, a warm infusion of Inula answers an admirable purpose. ZINGIBER. Ginger, in addition to its stimulant properties, under which class it is considered, is highly diaphoretic, and often used to fulfill this indication. In sudden colds, checked perspiration, etc., a warm infusion, taken freely, and aided by external warmth, and the hot pediluvia, exerts a very decided influence UDon the cutaneous emunctories in causing: sweatino-. It is much used in this way in domestic practice, and often with very satisfactory results. It is an excellent stimulant and carminative in flatulency, borborygmus, and spasm of the stomach and bowels, caused by eating green fruit or irritating articles of diet. ANGELICA. The roots and seeds of the Angelica Atropurpurea and other species, if used in the form of a warm infusion, will pron\ote the perspiratory function, and are frequently em- ployed for this purpose in coLds, coughs, and the incipient stages of many of the miid forms of fever. The infusion or tincture is highly esteemed by many as a gastric stimulant in spasmodic colic, flatulence, pain in the breast, hysteria, and other nervous disorders. 216 DIAPHORETICS. MENTHA. The Mentha Piperita and M, Yiridis, are decidedly diapho- retic. Tlie Spearmint is to be preferred to the Peppermint, it being more energetic and certain in its action, and generally more acceptable to the stomach. The warm infusion should be taken liberally, the patient at the same time keeping quiet and warmly covered up in bed. In the incipient stages of the milder forms of fever, and other diseases, especially if ac- companied with nausea and vomiting, or a morbidly irritable state of the stomach, a strong infusion of the mint Avill be found an appropriate and useful diaphoretic. In flatulence, colic, spasm of the stomach and bowels, etc., it is an excellent stimulant and carminative. MONARDA. Dose. — Of an infusion of one ounce to a pint of boiling water, one to six ounces. The Monarda Punctata, and other species of Horsemint, possess highly excitant, together with very energetic diapho- retic properties. The warm infusion of either of the medici- nal species of the Monarda, if taken freely, and while tlie pa- tient is warmly covered in bed, rarely fails to induce copious perspiration. Owing to its highly excitant action it is more especially applicable to torpid states of the system, with dimin- ished action of the various secreting organs, but more especi- ally the skin and kidneys. An infusion seldom fails to act promptly upon these emunctories, and is also useful in flatu- lence, flatulent colic, spasm of the bowels, nausea, etc. SATUREJA. The Satureja Hortensis, or Summer Savory, like the sago, is an excitant diaphoretic, if used in the form of warm infusion. It is more exciting than the latter article, but employed in ])rctty much the same cases and in the same way. In the early stages of febrile and inllammatory roves highly beneficial as a remedy in the incipient stages of those diseases arising from the influence of cold acting upon the system when in a state of perspiration, and arresting that function. In the simpler forms of disease this agent will cause a determination to the surface, relieve internal congestions, and if assisted by other appropriate measures, will ])roduce free perspiration. T H Y I\I u a. Thyme is another of the aromatic stimulants that is often used in warm infusion to promote the perspiratory process. It is ap[)licable to most cases in which the hyssop, satnreja, aage, etc., arc used, and may be exhibited in the same manner. 218 DIAPHORETICS. EMETICS. Ipecacuanha, already named as a diaphoretic, and many other agents of this class, exert a similar influence. Most of them, and perhaps all, produce this effect by virtue of their nauseating-, relaxing and sedative properties; they are conse- quently indirect in their action. Agents of this class, if given in small and repeated doses, so as to keep up continued nau- sea, rarely fail to produce relaxation of the cutaneous tissues accompanied with increased diaphoresis. They are exceed- ingly valuable in febrile and inflammatory diseases, to main- tain a constant relaxation of the skin, decrease the force and frequency of the circulation, and kee]> up continued perspi- ration. They serve to produce a state of relaxation and de- pression incompatible with that exalted vital action, tension and rigidity which invariably exist in high grades of fever, or in the acute plilegmasia, as in pneumonia, infl^ammation of the serous membranes, acute rheumatism, etc. We have then to regard them as exceedingly valuable indirect diaphoretics — liobelia, Sanguinaria, Euphorbia, Gillenia, Apocynum, Verbena, etc., are among the most valuable agents of this class wiiich contribute to the production of diaphoresis under the circumstances named. POTASS^E NITRAS. Dose. — Of Nitrate of potash, from grs. x. to oss., mixed with sugar or taken in solution. If taken as a refrigerant, it should be dissolved in water, and swallowed immediately. Therapeutic Action. — Nitrate of Potash is diaphoretic, diuretic, antiseptic, refrigerant and sedative. If taken in doses of one ounce, it acts as a poison, and has caused death in several instances. Its effects, however, are by no means uniform; for in other cases the same quantity has been known to exert no injurious effect upon the system. When taken in poisonous doses, it acts as an acro-narcolic, causing nausea and vomiting, violent pain in the bowels, with free catharsis or bloody stools, indicating gastro-intestinal inflammation, together with a disordered state of the nervous system, marked by giddiness, convulsions, disposition to .syncope, palsy, etc. When taken largely diluted with water, its poisonous effects rOTASS^ NITRAS. 219 seem to be much lessened, or very nearly lost. The amount of dilution, and the use or abstinence from diluents after tak- ing- it, may account for the discrepant statements regarding its action. In medicinal doses it acts as a diaphoretic, diuretic, refrige- rant and sedative — its refrigerant and sedative influence being most readily appreciated when the surface is preternaturally hot, as is the case in febrile and inflammatory disorders. It greatly diminishes the force and frequency of the pulse, often from 70 to 60 beats in a minute, in a short time. Sunderlin says, "Nitre diminishes the orgasm and plasticity of the blood, perhaps by a chemical action on the cruor and fibrlne." Its action on the urinary organs is clearly manifested by the increased secretion and presence of the salt in the urine. It belongs to the class of renal depuratives, greatly increasing the solids of the urine. Like other neutral alkaline salts, it often acts upon the bowels, and if long continued, it frequently gives rise to pain and griping. It has been found a very efficient prophylactic in habitual attacks of cynanche tonsillaris, or quinsy, and is' also very val- uable in shortening the paroxysm. Several cases have come under our notice where it has been used in this way. It is also efficacious in obstinate spasmodic asthma, in short- ening the paroxysm. A very convenient and effectual mode of exhibition, is in the form of nitrous fumigations, consisting in inhaling, for fifteen or twenty minutes, the smoke of burn- ing paper, prepared by dipping it in a saturated solution of nitre, and afterward drying it. LIQUOR POTASSiE CITRATIS. Dose. — Of this preparation, one-half ounce, diluted with water, once in one, two, or three hours, according to symp- toms. It is often used extemporaneously, in the form of an effervescing draught, as — ^ Lemon juice oSS., carbonate of potash grs. xv., water .5ss. ; dissolve the potash in the water, and mix the two, and take while in a state of effervescence. Solution of Citrate of Potash, or Neutral Mixture, is an ex- cellent refrigerant diaphoretic, remarkably well adapted to the relief of febrile conditions, as a hot and dry state of the skin, 220 DIAPHORETICS. and much thirst. It is found particularly useful in intermit- tents and remittents; this is especially the case when taken in a state of effervescence. The carbonic acid seems to cover the taste of the citrate of j)otash, and adds to the diaphoretic powers of the salt its own quieting influence on the stomach. LIQUOR AMMONIA ACETATIS. Dose. — The dose is half an ounce every two or tliree hours. Therapeutic Action. — Solution of Acetate of Ammonia, or Spirit of Mindererus, is diaphoretic, stimulant, diuretic, and refrigerant. It is regarded by allopathic physicians as a cer- tain and efficient diaphoretic in febrile and inflammatory dis- eases. It has been much used as a stimulant in certain stages of these diseases, when opium, alcohol, wine, etc., are inad- missible, owing to the cerebral excitement which they occasion. When employed as a diaphoretic it is liable to augment the urinary secretion, and this is especially the case when cold air is brought in contact with the surface, and when exercise is taken. In order to secure its full advantages as a dia])horetic, the patient should be kept still in bed and warmth a})plied to the surface. Externally, it has been employed as a discutient and resolv- ent, in mumps and other local inflammatory diseases; it is a-pplied by saturating several thicknesses of flannel, and keep- ing them constantly wet on the part.- TOPICAL DIAPHORETICS. CALORIC. Heat properly applied to the surface of the body is not only ail im[)ortant auxiliary agent to the use of diaphoretic reme- dies, in the production of perspiration, but it is also one of the most powerful single measures in the hands of the physi- cian of producing determination to the surface, relaxation of the skin, and sweating. Either dry or moid heat, if apj)1ied to the surface at a tem- perature exceeding that of the bcnly, acts as a general excitant, VAPOR BATH. 221 increasing the fullness and frequency of the pulse, the heat of the surface, and its secretion. If applied to the surface a few degrees below that of the body, it exerts a soothing and relaxing influence upon the cutaneous tissue, lessening exalted capillary action in the vessels of the surface, removes constric- tion, and strongly disposes to perspiration. WARM AIR. Air, when heated to the temperature of from 85° to 100°, and brought in contact with the surface of the body by placing a burning lamp under the chair upon which the patient is seated, surrounding the body with a blanket, the head being uncovered, or by conducting the heated air through a tube under the bed-cover, thus bringing it in contact with the body, exerts a gentle excitant influence on the cutaneous tis- sue, and occasions copious perspiration. It seems to exert a soothing, tranquilizing influence on the nervous system, and in this way also predisposes to diaphoresis. It is said by Dr. A. T. Thompson, to surpass either the warm water or vapor- bath, for certainty of producing sweating. The warm-air bath has been found beneficial in chronic, deep-seated neuralgia, in rheumatism, both acute and chronic, in the early stages of febrile and inflammatory diseases, chronic cutaneous diseases, etc. By elevating the temperature, it becomes excitant, and may be used in violent spasmodic action, internal congestions, etc. Its dia[)horetic effects will be much aided by using some mild, warm, diaphoretic infusion, one or two doses of the Su- dorific Tincture, or, when sweating has commenced, by copi- ious draughts of cold water. ALCOHOLIC VAPOR BATH. This is very similar to the warm air bath, consisting prin- cipally in the application of hot air to the surface, very little vapor being generated by burning alcohol. The vapor or heat of burning alcohol, or some dilute alcoholic liquid, may be applied to the surface in a similar manner to the application of hot air. The most common way of employing it is to l)lace the patient in a wood-seat chair, place his feet in a bucket of hot water, and surround him with a blanket, so as to 222 DIAPHOKETICS. keep in the heat. Then take a shallow vessel, as a saucer or l)late, pouring it part full of alcohol, diluted so that the flame will not rise high enough to burn the patient, slip it under the chair, and light it with a match or piece of paper. During the time of taking the bath, the patient should take some dia- ])horetic internally, as the sudorific tincture, diaphoretic pow- der, or some warm diaphoretic infusion. This process may be continued from ten to thirty minutes, according to the vigor of the constitution, the effect produced, or the intractable character of the disease. If the patient can not sit up, the vapor may be conducted under the cover, by raising it from the side of the bed with a chair, and supporting it over the patient — the burning alcohol being set by the side of the bed, and so surrounded that the vapor can not escape. Of all the measures to which we have resorted for the pro- duction of diaphoresis, the burning alcohol is the most efficient, if aided by the internal use of warm diaphoretic drinks. We care not how high the grade of inflammatory action, or how intense the fever, it will cause a copious perspiration, with a reduction of organic action, mitigation of the pain, heat of surface, and nervous disturbance, in a very short time. In cases attended with pungent heat of the surface, a dry or husky state of the skin, Avith a full and bounding pulse, great rest- lessness, and intense febrile or inflammatory action, it is much better to premise with cold ablutions for twenty or thirty minutes, before resorting to the use of the vapor bath. la acute or inflammatory rheumatism, and also in the chronic form of tlic disease, we know of no remedy of equal utility. It is much more stimulating to the surface than the aqueous vapor bath, even when both are applied at the same temperature, and hence is better calculated to relieve internal congestions. In sudden cold, suppressed perspiration, acute local inflammations — as pneumonia, pleuritis, hepatitis, enteritis, nephritis, etc. — in spasmodic action, violent painfnl affections, etc., it seems to relax the whole system, lessen organic action and the erythism of the nervous system, and induces copious perspiration. The advantages thus gained over diseased action, if maintained by other appropriate medication, ca;i not fail, in thousands of in- stances, to put a speedy stop to the most formidable diseases VAPOR BATn. 223 in a few hours, without the use of the lancet, calomel, or tartar emetic. It is obvious that this energetic course, and tlie production of such free and continued perspiration, wonhl be highly det- rimental, or even fatal to the patient, in the advanced stages of acute or chronic diseases, if great debility exists. WARM VAPOR BATH. This bath occupies an intermediate position between the warm air bath and the warm water bath. Vapor, to produce similar effects, requires a higher temperature than warm water, and not so high as warm air. This may be applied by seating the patient on a chair over a kettle of boiling water, surrounding him loosely with a blanket, to prevent the escape of the vapor, and putting hot bricks, stones, etc., in the water, to keep up sufficient heat; or it may be applied by enveloping the patient in a blanket kept at some distance from the body, within which the vapor may be conducted by a tube leading from a closed vessel kept boil- ing by means of a spirit lamp; or the vapor may be conducted under the cover of the bed. What is termed the Medicated Vapor Bath consists in im- pregnating the vapor with certain medicinal agents Avhich may be supposed to exert a beneficial influence in removing the existing disease. The agent or agents used in this case are formed into a decoction, the vapor of which is used, or they are dissolved in the Avater used for the bath. Camphor, sul- phur, and various gases, have been used in many cases as inde- pendent remedial agents in the form of a vapor bath. As a therapeutic agent, warm vapor applied to the surface serves to soften and relax the cutaneous tissue, gently excite the capillary circulation of the surface, and produce copious sweating. It is more soothing and relaxing than the warm air bath, and possessed of greater power as a sudorific. It is employed in colds, sudden check of perspiration, and in the early stages of febrile and inflammatory excitement, when the surface is dry and constricted, with pain, restlessness, oppres- sion, etc., either as principal or auxiliary means of producing perspiration. In almost every variety of febrile or inflamma- 224 DIA.PHOEETICS. tory attack, it may be resorted to with a prospect of advan- tage, and also in many foi'ms of chronic inflammation, rheu- matism, and in many chronic cutaneous diseases. It has also been used with much advantage in araenorrhoea, dependent upon subacute inflammation of the uterus, especially when accompanied with a dry and harsh skin, and want of perspi- ration. Topical or Local Vapor Baths are useful in local diseases, as painful inflammatory affections of the joints, rheumatism, gout, neuralgia, painful swellings, tumors, etc., and as an anodyne and soothing application to painful wounds, contusions, frac- tures, etc. The vapor douche consists in directing a jet of aqueous vapor upon a particular part ; it is really a topical vapor bath. It is employed in otalgia, otitis, otorrhoea, etc., by introducing the vapor into the ear through the orifice of a funnel inserted over a vessel of hot water. It may be applied to the genital organs, neck of the uterus, etc., in dysmenorrhoea, painful irri- tation or Inflammation of the neck of the uterus or vagina, and likewise In many other painful local affections. WARM WATER BATH. The tepid bath consists in the immersion of the body in warm water at a temperature varying from 75° to 90°. It serves to cleanse the surface, equalize the circulation, allay thirst, relax the cutaneous eraunctorles, promote diaphoresis, and lessen organic action and the temperature of the body. It seems to act rather as a refrigerant and sedative, as is manifested by the languor, loss of muscular power, faintness, and somnolency, which soon follow the transitory excitement at first produced. It Is sometimes used In some of the acute phlegmasia, after other measures, but it Is not to be relied on in the production of diaphoresis. When elevated to a higher temperature, or what may be termed a hot bath, it then becomes excitant, and proves serviceable In relieving congestions of Internal organs, and In promoting the eruptive process in some of the exanthe- mata. The warm water bath is employed in chronic Infliuii- matlons, spasmodic and convulsive diseases of children, amen- orrhoea, dysmenorrhoea, etc. COLD BATH. 225 The Coxeluvium, Semicupium, oi- Hip Bath, is employed in iiitiiuninatory or spasmodic affections of the pelvic viscera, amenoi'rhcea, dysmenorrhoea, spasm of the ureters or urethra, as in the irritation caused by the passage of urinary calculi, etc. It may aid indirectly in the production of diaphoresis, but it can not be depended on for this purpose. The warm Pediluvium, or Foot Bath, favors diaphoresis by equalizing the circulation, lessening exalted action, and relax- ing cutaneous constriction through a sympathetic influence. It is one of the most valuable adjuncts to internal diapho- i-etics, and as it is easily used, it is a favorite remedy both in iloinestic and professional practice. Fomentations and Poultices act as topical baths, owing to the warmth and moisture which they contain. They thus serve to soften and relax the parts to which they are applied, and exert a sympathetic influence upon the entire system, which may result in diaphoresis. COLD OR TEPID ABLUTIONS. Cold or tepid ablutions, although they exert no direct agency when applied to the surface, in the production of perspiration, yet their indirect influence, in many instances, is of great importance. They act as refrigerants and sedatives ; even if the ablution Is tepid, the speedy evaporation which follows carries off the heat of the surface, and lessens capillary activ- ity and even general vascular excitement, rendering them refrigerant and sedative. Cold affusions, the cold douche, or cold immersion, all act in the same indirect manner in promoting perspiration. Their fi'ee and frequent application to the surface when it is hot, dry and constricted, and when accompanied by intense febrile and inflammatory excitement, serves to lessen the undue vascular excitement, cool and relax the skin, and promote diaphoresis. Their action, though indirect, Is none the less important, and should never be overlooked by the ]>hyslcian in the cases referred to, as they are among the most powerful auxiliary measures to which he can resort to reduce exalted vital action, and induce perspiration. (See Refrigerants.) 15 226 DIAPHORETICS. COLD WET-SHEET PACK. This is one of the most powerful means of inducing diapho- resis with wiiich we are acquainted. It is especially applica- ble in febrile and intlamniatory diseases, as well as in sonic chronic affections. In high grades of fever, when the skin is liot, dry, and constricted, its use is pleasant to the patient, cooling the surface, relaxing the skin, subduing nervous irri- tation, and })roducing profuse sweating. The personal expe- rience of a physician may illustrate its use and action. Some years ago he caught a severe cold from exposure, perspiration was entirely checked, and he had alternate chills and flushes of fever. There was also such a degree of pain in the back and limbs, and general nervous irritability, that he could not sleep for tv/o nights preceding. He made up his mind that as he did not like to be sick, and had an aversion to swallowing his own medicine, he would take the wet sheet pack. (Family opposed, said it would be certain to kill him.) The sheet was wrung out of cold water, and laid upon a blanket which cov- ered the bed, and upon this our doctor got, and it was well tucked in around him, putting as many extra blankets above as he could well bear. For the first five minutes it was one continued chill, shaking as badly as ever man did with the ague; but after this it soon grew pleasant, the pain ceased, and in less than fifteen minutes he was sound asleep, and slept comfortably for two hours, the first ho had had for two days. Upon awaking he was in a profuse perspiration, and was told he had been so since he went to sleep, and what was better, the disease had entirely left him, and did not re-appear. We have tried this means of producing diaphoresis in manv cases, such as has been named, and always with the most ben- eficial effects; we would, therefore, strongly recommend it to the notice of the profession. Objections arc frequently made to its use by patients, Avho can not understand why we shouhl wish to put them in cold water, when probably the disease originated from what they supposed a somewhat similar expo- sure. These objections, liowever, are removed after one or two in a community have experienced its beneficial effects. FRICTION. 227 HOT BLANKET PACK. When the circulation is feeble, a blanket may be wrung out of hot water and applied as the ordinary wet-sheet pack. It is especially indicated when the temperature is low, and the skin atonic. HOT SPONGE BATH. In the same conditions we employ water as hot as it can be borne, by sponging the surface rapidly. A small part should be taken at a time, rapidly dried, and covered with flannel. FRICTION. Friction of the surface with a flesh-brush or dry flannels, serves to excite the cutaneous exhalants to increased activity, and favors the production of diaphoresis. It is usually em- ployed with ablutions and baths, as an additional measure, and not as an independent therapeutic agent. It will be found advantageous in many chronic diseases, local dropsies? indolent tumors, chronic swellings, indurations, etc., as a means of producing revulsion. 228 SPECIAL THERAPEUTICS. OLA.SS IV DIURETICS. Diuretics are those agents which, acting on the kidneys, promote the secretion of urine. The renal secretion is one of the most important depurants in the body, removing in twenty-four hours, in health, from 600 to 700 grains of solid matter. This material is the product of the disintegration of the nitrogenized tissues of our bodies, and is so consti- tuted that it can not be retained without producing disease. Such agents then, as will restore this secretion when dimin- ished or suppressed, or that in certain states of the system will greatly increase it, can not but be regarded as among our most valuable means of removing disease. The kidneys differ from all other secretory organs in being adapted to perform two entirely separate and distinct func- tions ; this adaptation being manifested by their anatomical structure. These functions, are the excretion or pumping off of the excess of water from the blood, and removing from the blood certain nitrogenized matters, the products of the waste of the tissues. The first merely relieves vascular turgescence, while the second is depurative, removing morbid matters from the blood. The sohds of the urine constituting its proper secretion, are urea, uric acid, creatine, creatinine, fdppuric and lactic acid, and the soluble salts. Urea forms the largest ahiount of the solids of the urine; 270 grains, or more than half an ounce, being excreted by a healthy adult in twenty-four hours. Its chemical formula is Co, N"o, II .J, Oo. This is a highly nitrogenized compound, and constitutes the form under which a large quantity of nitrogen is expelled from the system. Urea is produced by the disintegration of the worn-out tissues of the body; it contains as much as five-sixths of the nitrogen tak-en into DIDEETICS. 229 the body, and it constitutes the mode by which the largest portion of nitrogen is removed from the body. Dr. Go] ding Bird states, that "Its origin must be traced to the destruc- tive assimilation of those tissues of the body which are removed to make room for new matter. Minute quantities of urea escape from the system b}' the skin, but this body is removed so rapidly from the blood by the kidneys, that very minute traces of it only can be obtained, unless these organs become diseased, and are then no longer fitted to perform their important functions of depuration." The eflects produced by the retention of this element in the blood, from defective secretion of the kidneys, is well shown by the experiments of Prevost and Dumas. They extirpated the kidneys of dogs; on the third day after the operation, vomiting commenced, there was diarrhea of a copious brown liquid, fever, with heat varying as high as 110°, and sometimes as low as 92°; pulse very small and fre- quent, breathing labored, death ensued from the fifth to the ninth day. After death there w^as found effusion of serum in the brain, copious mucus in the bronchia; the liver was inflamed, and the bladder much contracted; the blood was more watery than natural, and contained urea, five ounces of the blood of a dog yielding twenty grains of urea. The symptoms appearing in man from retention of urine are ob- stinate vomiting, diarrhea, tj'phoid s^^mptoms, low muttering delirium, epileptic convulsions, coma, etc. All these effects, says Dr. Williams, may be traced to excrementitious matters being retained in the blood, especially urea, which has, in very many instances, been detected in considerable quanti- ties— in the greatest amount acting on the system as a nar- cotic poison ; in smaller, acting as an irritant, inducing low inflammations in various membranes and viscera; and in a still lower degree causing sundry functional disorders, fluxes and dropsies, impoverishing the blood, and inducing degene- ration of certain textures. Uric acid, creatine and creatinine, are substances similar to urea; that is, highly nitrogenized bodies. Like urea they arc excrementitious substances, the product of the waste of the tissues; their amount is small compared with urea, but they are probably as deleterious to the system, according to 230 SPECIAL THERAPEUTICS. their quantity, as that body. Hippuric acid is also a small constituent of the urine of man, and not always present. It diflers from the others in containing but a small proportion of nitrogen, and is probably formed by the disintegration of the carbonaceous tissues. From what has been stated above, it will readily be seen that this is one of the most important excretions of the body. Through the kidneys we have eliminated a large amount or the excrementitious materials formed by the disintegration of the nitrogenized tissues of the body; and it has been sat- isfactorily proved that the materials thus excreted, if retained, will act as a most virulent poison on the sj^stem. If this excretion is, then, so important in health, what must it bo in disease, when disintegration of the tissues of the body is actively going on? And what benefit must be derived from such agents as will promote their elimination? Action of Diuretics. — Diuretics are absorbed into the circu- lation, and act directly upon the secernent structure of the kidnej^s, as is evident from the reappearance of those sub- stances in the urine. The same agents, if injected into the bloodvessels, will exert a similar influence upon the renal secretion. To those agents which increase the secretion of urine, whether taken into the stomach or absorbed from any other portion of the system, or injected into the veins, in suitable quantities, the term direct diuretics is appropriate, and to those agents it is frequently, and should be exclusively applied. Other agents may exert an indirect influence over the urinary secretion, as diluents, by causing vascular repletion, and thereby causing an increased action of the kidneys to remove the water. Cold applied to the surface lessens the amount of the cutaneous secretion, and thereby imposes an additional burden upon the kidneys, and when they are able to perform this function, increased diuresis follows. Cathar- tics sometimes greatly increase the amount of this secretion, by removing congestion of the kidneys, by producing re- vulsion to the bowels, etc. In consequence of these and other agents promoting diuresis by these indirect influences, they may be termed indirect diuretics. Those agents only should be named diuretics, which act DIURETICS. 231 directly on 'lie kidneys', and stimnlate them to increased action, and not those wliich act on some other organ first, and subsequently exert an indirect influence on tlie kidneys. Some of the direct diuretics merely increase the water of the urine, without a proportionate increase of the solid con- stituents: to these Dr. Golding Bird gives the name of renal hydragogues. Though this class of agents greatly increase the fluid portions of the urine, and thus diminish its specific gravity, yet it is found that the solids are increased, though not proportionately ; the excess of water washing away but a small additional amount. Others, having a direct chemical action upon the body, greatly increase the amount of the solids, either with or with- out a proportional increase of the entire amount of the urine. To these Dr. Bird gives the name of renal depuranls. In regard to the action of the renal hydragogues, Dr. Bird ]ajs down the following proposition : '• Remedies which exert no chemical action on organic matter out of the body, appear to be incapable of augmenting the quantity of solids in the urine, and hence are only of use in increasing the elimination of water — they may and do act as renal hydra- gogues, but not as renal depu rants." In proof of this jDropo- sition, we may adduce the following table, calculated by Dr. Bird, from Krahmer's observations : Medicines given. N'one, - - - Juaiper, - Venice Turpentine, Squills, - Digitalis, Guiac, Colchicum, - Solids in the urine of 24 hours. 2.40 ounces. 2.12 1.94 " 2.25 " 2.45 " 2.43 " 2.32 " Combustible (animal) matter in. 1.28 ounces. 0.94 " 1.11 " 1.04 " 1.28 " 1.38 " 1.86 " Saline matters in. 1.13 1.18 0.83 1.21 1.17 1.05 0.96 Itenal depm-ants, though they generally increase the amount of urine passed, greatly increase the solid constituents of it. This they do, not only by stimulating the proper secretory apparatus of the kidney, but by increasing the metamorpho- sis of tissue within the body. The agents composing this class all exert a chemical influence upon dead animal matter, and when absorbed, they tend to break down all the imper iectly organized tissue, and by their direct action upon the 232 SPECIAL THERAPEUTICS. kidneys they cause it to be excreted. This class of agents embraces the alkalies, the carbonates and their salts, with such acids as in the animal economy are capable of being con- verted" into carbonic acid, including the acetates, citrates, and tartrates of soda and potassa. In regard to their action we may adduce the following example from Dr. Bird: Without Medicine. Quantity of urine in twenty-four hours, f 3^"^J- Specific gravity of, - - - j 1.025- Solids in, - - - - i 41G grs. After 3i'j- pot- acet. fSxlvj. 1.017. 782 grs. The reason why, probably, this class of diuretics is not held in greater repute by many practitioners is, that in fevers and other acute diseases, attended with increased metamorphosis of tissue, the vegetable liydragoguc diuretics are administered instead of the true rencd dejpurants. We are satisfied that this is the fact, and would call the attention of the reader especially to this latter class. In the diseases just named the worn-out and exhausted tissues, floating in the blood, become a constant source of disease; in many instances we may assume that it is the disease — they are, however, in such a condition as not to be readily excreted. ISTow, it is a well known fact, that the alkalies break up these into various secondary products, even without the body, and we may readily suppose that the change that takes place in the cir- culation is such as to fit the worn-out tissues for excretion. Dr. Bird makes the following highly interesting observa- tions upon the case given above, in which the acetate of pot- ash was given, and upon the use of diuretics : he says, " The results of these analyses show that, after deducting the excess in the amount of soluble salts, arising from the conversion of acetate of potassa into carbonate in its transit from the stom- ach to the kidneys, the solids of the urine, separated from the blood under the influence of the chemical diuretics, exceeded those excreted without its aid by one hundred and ninety grains. AYe further learn that, although a lai-ge pro- port'on of matter was metamorphosed into both uric acid and urea, after the administration of the acetate, still that the greatest increase was in that mixture of organic products set down as extractive, and which, as we have seen, consistcii DIURETICS. 233 chiefly of creatine, creatinine, uroxantliin, and matter i-icli in sulphur. In the example adduced, not only did the patient lose an excess of thirty ounces of water in twenty-four hours, but she wasted to an extent of one hundred and ninety grains more than if no remedy had been given ; and to this extent had the blood been depurated of those elements which yielded easiest to the infl.uence of the alkaline salt. As it can not be denied, that vital force is ever active in opposing the chemical changes to which all living fibers are obnoxious, it is fair to assume that this resistance will increase with the vital endowments of a part; or, in other words, that the ele- ments of our frames resist chemical influences in the ratio of their vitality; it would follow that such constituents of our bodies as present the greatest departure from health, are less highly vitalized, and thus would be expected to yield the easiest to the influence exerted by the alkaline diuretics, or renal depurants. As a result of this view, we should expect that when we cause an alkaline carbonate to circulate through the blood, it exerts an influence on the nascent elements of those matters Jess highly influenced b}' life, resembling that which it exerts on dead matter, aiding their resolution into substances allied to those produced out of the body, and actually causes the matter to assume so soluble a form as to allow of its ready excretion. This remarkable effect of the alkaline diuretics (although now demonstrated by actual exper- iment, and the results of their chemical influence detected in the stream by which they are washed from the body) was not overlooked by the observing physicians of former years. It was, indeed, acted upon by the old phj'sicians — witness the host of apozems, diuretic decoctions, and diet-drinks, in which renal stimulants abound ; and let us not shut our ej-es to the success of the practice; for unless we deny all cre- dence to the statements of the painstaking practitioners of past times, those who will read their quaint records of cases, will learn how generally they succeeded in curing the effects of a co.co-cBmia, an unhealthy blood, as evidenced in various eruptive affections, cellular membranous sores, furunculi, and very man}- such ailments. It is true, that in looking at some of their prescriptions we do not generally observe rem edies which have now much confidence placed in them as 234 SPECIAL THERAPEUTICS. trustworthy diuretics ; but then an important element of their potions is, most undoubtedly, the water of the decoction employed, not in doses of tablespoonfuls, but as was common in former days, of pints. A most important truth here de- mands our attention. It may be said, that it is true that if a patient takes a pint or two extra of water he wilf, supposing that no organic lesion exists, excrete a large bulk of urine from the necessity there exists for pumping off" the excess of diluent partaken of. In this way a pint or two of water becomes a diuretic : this every one's experience will enable him to admit ; but what is this, it may be asked, but the mere drawing oft' of excess of water — where is the proof of blood-depuration? This proof is afforded by calculating the amount of solid constituents of the urine. It will then be found that the excess of water does not escape alone, but there is really washed away with it, a certain, although not very large, quantity of solid debris." Therapeutic Indications. I. Action in Febrile and Infiammatory Diseases. — In all febrile diseases, there exists generally a torpor of the excre- tory organs, and hence the metamorphosed tissues — the worn- out materials of the system — are not eliminated, but remain in the circulation. We have also mentioned the fact in a previous part of this work, that fever in a majority of cases is caused by, either the retention of an excretion, which acts as a foreign matter, — a ferment in the blood, — or by the intro- duction of such a material into the circulation from without. In either case the decaying matter while in the circulation, acts as a ferment, transmitting its decomposing tendencies to every portion of the blood that is not sufficiently vitalized to resist this chemical influence. If such is the case, and we believe it is well substantiated, we can plainly see the bene- ficial effects that would follow the use of such agents as would cause the elimination of an ounce and a quarter of thisexcrementitious matter every twent3'-four hours. Renal depuratives are then indicated in all febrile diseases, for their eliminative action. They not only stimulate the kidneys to normal action, removing such mateiial as is already fitted for excretion, but by their chemical action DIURETICS. 235 while in the circulation, they so change the loss vitalized por- tion of the circulating fluid that it is also excreted. The alkalies and their salts, which form the principal agents of this class, also act as refrigerants, lessening the heat of the body. When we wish to produce this effect, we administer a salt of some of the organic acids, the acetates, citrates, etc: this salt in its passage through the blood to the kidneys, is converted into a carbonate. In order to convert one equivalent of such a salt (for instance the acetate of potash), into a carbonate, eight equivalents of ox^-gen must combine with it. This oxygen, therefore, which is appropriated by the diuretic, is abstracted from the amount which would have acted upon the tissues of the body, and not only is there a less amount of heat generated, but there is also a marked decrease in the waste of the tissues, owing to the fact that the remedy has appropriated oxygen, which otherwise would have acted directly upon them. We have therefore four effects from such a salt: first, it stimulates the kidneys and causes an elimination of such material as may readily be excreted by them; second, it so changes those parts having a low degree of vitality that they arc fit material for excretion ; third, by appropriating oxygen to form a car- bonate it proves refrigerant; and lastl}', it diminishes the production of effete matters — the breaking down of the tissues by presenting their oxj-genation. In sthenic fevers they act as antiphlogistics, that is, ac- cording to many eminent authorities, they have the power of diminishiiig the amount of fibrine in the blood. Guliver has also noticed that they counteract the tendency of the blood-corpuscles to become aggregated in rows, a tendency especially observed in inflammation ; and by diminishing the amount of the serum, they lessen vascular repletion. In asthenic or typhoid fever, they indirectly increase the strength of the patient, by removing the materies morhi, wliich so depresses the vital powers, and especially the brain and nervous system ; and may not the change which they effect in such material, even if it is not excreted, prevent its acting as a ferment in the blood? Dr. Golding Bird states that he has found them of great value in remittent and intermittent fevers; though they are 236 SPECIAL THERAPEUTICS. aot antiporiodic, yet he believes they will eft'ect that which quinine and its allies can "not do. He says: "When to a person suffering from the effects of marsh malaria, acetate of potash has been administered to the extent of 3ij. in the course of twenty-four hours, largely diluted, and continued for two or three weeks ; not only is no injury effected by the remedy, but the most marked benefits are observed to result The patient's skin becomes less dusky, the expression moro healthy, the dull aspect of the eyes changed for one of cheer- fulness, the engorgement of liver and spleen lessens, and t). o paroxysms of ' dumb ague' disappear." The vegetable hydragogue diuretics are also useful in these diseases, and especially is this the case wdien they are given in infusion or decoction. The diuretic agent stimulates the kidneys to remove the serum of the blood, and thus the vessels are depleted, while the water of the decoction or in- fusion acts as a depurant, washing aw^ay some of the detritus of the system. They are, however, comparatively unim- portant agents, in these diseases, so far as their diuretic properties are concerned ; but many of them exert other in- fluences upon the system, which may be beneficial. II. Action in Hheumatisrn. — The class of diuretics termed renal depurants^ are among our most valuable agents in the treatment of rheumatism. In several instances we have wit- nessed the beneficial action of the acetate, or nitrate of po- tassa, in these cases, with surprise. We have seen the severe symptoms disappear in twenty-four hours, and in a few days the patients would be well. This, however, is not invariably the case; for we have also known instances where, unless they were combined Avith other agents, they produced no effect. In such cases, however, a combination that will effect both the cutaneous and renal excretions, as the com- bination named under the head of diaphoretics (eupatorium perfoliatum, asclepias tuberosa, sanguinaria canadensis and nitrate of potassa), we have never known to fail, if properly carried out. Dr. Golding Bird strongly recommends the acetate of po- tassa in this disease; and the success of his treatment, in tlio wards of the London Hospital, would go to prove that ho has not overestimated its value. In regard to its use, he DIURETICS. 237 says: "I would not willingly use language which was not completely compatible with experience ; but I do not still hesitate to declare that I have never seen the disease in question yield with so much facility to any other remedy. In the severest cases which have been admitted into the hospital under my care (and I prefer alluding to them rather than to cases in. private practice, as they have the ad- vantage of being watched by many, and less chance of error arising in the reports of the progress of the patients), I have seen the cure to be more rapid, and the immediate relief to the patient more marked by the use of the acetate of potassa, in quantities of half an ounce, administered, largely diluted, in divided doses, in twenty-four hours, than by any other treatment. In three days I have repeatedly found the ex- quisite pain of the joints nearly absent, the patient compara- tivel}'^ comfortable, and able to bear with greater ease the helpless state in which the still swollen joints place him. In no case has any ill eftect followed the use of the remedy, and while the cure has been far more expeditious, the ill effects of colchicum and mercury have been avoided. The pain remarkably and suddenly lessens, as soon as the urine becomes alkaline, and rises in specific gravity." In chronic rheumatism, these agents are also very valuable. Whenever they produce a marked increase of the solids of the urine, the disease yields to their use. The beneficial effects of the iodide of potassium, is, probably, due to a greater extent than is supposed, to the diuretic properties of this salt. In two cases particularly noticed by us, where this agent proved beneficial, it acted as a diuretic, the solids of the urine being much increased; and in other cases we have derived similar benefit from other salts of potassa. III. Action in Chronic Diseases. — In chronic disease, where there is evidence of an unhealthy state of the blood, the class of renal depurants will be found highly beneficial. They may be truly called alteratives in many cases ; that is, they remove the vitiated materials circulating in the blood, and thus promote digestion, assimilation and nutrition. We have seen the habitually coated tongue, the sallow skin, cutaneous eruptions, foul stomach, etc., disappear under their use. when tonics and restoratives had proved of no avail 238 SPECIAL THERAPEUTICS. And may we not ask, is not the beneficial eiFeot of our com- pound sirup of stillingia and iodide of potassium, so fre- quently used in such, cases, partly due to their acting as renal depurants? We have noticed under their employment an increased amount of the solids of the urine, which would tend to prove it. IV. Action in Dropsy. — As we have already given a some what extended account of the action of diuretics in this dis- ease, under the head of cathartics, a short notice will suffice here. The class of diuretics principally used in dropsy are those termed renal hydragogues, or those that increase the fluid portions of the urine: of these some are topical stimu- lants to the kidneys, others to the entire system, while still another class are sedatives. They prove curative in two wa}' s : first, by removing the serum of the blood, and second, by their derivative influence. All diuretics decrease the fluid portions of the blood, and thus they not only lessen the amount of fluid circulating in the vessels, but they also destroy the balance existing between the solids and fluids of the blood. We have already referred to the law that when a portion of the circulating' fluid was abstracted, absorption through the veins became active, in order to replace the amount so removed. If no fluids are in- gested to replenish this loss, absorption will take place from any fluid that has been eff'used; and this dropsical efi"usion will be taken to supply the amount of serum abstracted. Undoubtedly much advantage is often secured by the derivative influence of diuretics, particularly those of an exciting character. They stimulate the kidneys to increased activity, and render these organs the center of fluxion to which the circulating fluids are directed in increased quanti- ties, and from which the serum is abstracted by the increased activity of these organs. While this local derivative action continues, the vessels implicated in the diseased action, and from which the serous exhalation or dropsical effusion is taking place, are reli^v'-ed of their burden, and allowed an opportunity of recovering their tone. This point is no longer the center of fluxion, or, at least, it is only so in a dimin- ished degree; consequently, the eftusion ceases, or becomes diminished in proportion to the action of the renal stimulant. DIURETICS. 239 Tlie sedative diuretics arc indicated in sthenic habits, or wlienevcr there is dropsical effusion attended with vascular activity; they are contra'indicated when the habit is asthenic, as when the dropsy is of a passive character, the stimulant diuretics arc required. It must be borne in mind that hydragogue cathartics are of primary importance in all cases of dropsy, while diuretics are but secondary, though important; and this is especially true in dropsies arising from indurations or visceral engorge- ments of any kind. In such cases hydragogue and deob- struent cathartics are not only important therapeutic agents, but they are indispensable to success. Y. Action in Diseases of the Urinary Organs. — In diseases of the urinary organs they become the most efficient agents at our command. In acute inflannmation of any portion of the urinary apparatus, refrigerant and demulcent diuretics are of the first importance; they increase the quantity of the urine, and being excreted with it, they lessen its acrid character, and lessen its irritant action upon the inflamed tissues. In chronic inflammation, catarrhal affections, or in cases of ulceration of the mucous membrane of the urinary passages, the balsamic diuretics are demanded; these agents probably act as direct local stimulants, and by the new action which they set up, the morbid process is relieved. The tonic and astringent diuretics, as the uva ursi, pipsissewa, buchu, etc., often prove highly valuable in the same cases. They are also used in diabetes, in conjunction with other agents, with decided advantage. The same class of agents are often employed in combination with the mineral acids, in cases of phosphatic deposits, and with alkalies in cases where the lithates are in excess. In these diseases they seem to act by medicating the urine, which comes in direct contact with the diseased tissue, and in this way they act as topical reme- dies. The balsam of copaiba, cubebs, etc., probably owe a portion of their virtue in the cure of gonorrhea to their impregnating the urine with their mew^icinal properties, and being thus brought into direct contact with the inflamed mu- cous surface. 240 SPECIAL THERAPEUTICS. Recapitulation. 1st. Diuretics are useful in any disease in which there ia a diminution or suppression of urine; in such cases they stimulate the kidneys to normal action, and thus promote the elimination of the normal constituents of the urine. 2d. A certain class of them greatly increase the solids of the urine, not only by causing an elimination of such ma- terials as are already fitted for excretion, but also, as we suppose, by so changing the less vitalized material as to per- mit its elimination. 3d. The alkaline diuretics not only increase the solids of of the urine, and thus prove eliminative, but they also act as refrigerants, and to some degree prevent the disintegration of the tissues of the body, by combining with a portion of the oxygen in the circulation. 4th. They promote the absorption of dropsical effusions, by lessening the quantity of the circulating fluid, and by •destroying the balance between the solids and fluids of the blood — absorption being active in proportion to the diminu- tion of serum in the vessels. 5th. They act as counter-irritants, causing the formation of a new point of excitement and fluxion, by which means other parts are relieved. 6th. They act topically in diseases of the urinary organs ; their virtues being in part transmitted to the urine, they are brought into direct contact with the diseased tissue. 7th. They augment the elimination of water, and thug enable the urine to hold in suspension any material requiring much of this fluid to hold it in solution. They also act as solvents in calculous aflections; but most probably this ia only in proportion to the amount of water excreted — water, according to the best authorities, being the best solvent for " stone.'' EUrATORIUM. ^41 EUPATORIUM. THE ROOT OP EUPATORIUM PURPUREUM. Dose. — The Eupatorium Purpureum is mostly employed in the form of a- strong decoction, oj- to Oiss. of water, boiled down to one pint, of which one to four ounces is a dose. The tincture can be used with advantage in ordinary practice, and will give good results in small doses. Therapeutic Action. — Queen of the Meadow is diuretic, stimulant, astringent, tonic, and antilithic. There is no doubt .that this agent exerts a specific influence upon the kidneys, increasing the quantity of urine secreted, and to some degree the amount of solids excreted in it. From the combination of properties which it possesses, its utility in urinary affections will be readily inferred. It has been employed in atonic dropsies, chronic nephritis, catarrhous vesicae attended with ulceration, chronic irritation of the bladder with increased mucous secretion, etc. It has also been employed in hematuria, gleet, leucorrhoea, amenorrhosa, and other forms of female weakness, rheumatism and gout, with complete success. It is a popular remedy in gravel, and indeed said by some to possess solvent powers; although we can not award it any positive powers of that kind, yet, as it increases the amount of water excreted, which is acknowledged to be the best solv- ent for stone, and allays irritation of the bladder, we must consider it as at least the equal of Uva Ursi and Chimaphila, and useful where those agents are usually thought to be avail- able. It is associated with the root of the horse-radish, juni- per berries, and other diuretics, in dropsy; and with the buchu, l)ipsissewa, uva ursi, etc., in chronic affections of the kidneys, bladder, urethra, etc., when attendant with a redundant mu- cous discharge. Eupurpurin, when carefully prepared, is one of the most reliable of our concentrated remedies, producing, so far as our experience has extended, all the medicinal effects of the crude root. We frequently administer it in the pill form, one drachm of the article being rubbed up with prussiate of iron, until it has sufficient consistence to form pills, and divide it into thirty. These pills we have used as a diuretic in dropsy, with suitable 16 242 DIUEETICS. cathartics, with the most satisfactory results, and this is espe- cially the case when the patient is greatly debilitated. They are also among our most efficient curative agents in diseases of the kidneys, bladder, and urethra. In one case of marked albuminuria, where other agents had failed to produce any relief, the continued use of these pills, one three times per day for two weeks, entirely relieved the patient. In two cases of diabetes insipidus, their use was attended with the same re- sults. We have also employed them in incontinence of urine, especially in children, with good effect. Tliey are of the most importance, however, in allaying irritation of the blad- der; in many cases of this kind, caused by displacement or chronic inflammation of the uterus, or arising during or after pregnancy, we have obtained more benefit from tlieir use than from any other agents. From experience, then, we can rec- ommend this preparation to the favorable notice of the prac- titioner. SCOPARIUS. THE TOPS OF CYTISUS SCOPARIUS. Dose. — Of an infusion of one ounce to a pint of boiling water, one to two ounces. Of a decoction of one ounce to a pint and a half of water, boiled down to a pint, one to one and a half ounces. Thehapeutic Action. — Scoparius is diuretic, laxative, tonic, and in large doses emetic and cathartic. Mead and Cullom recommend it strongly for its diuretic properties. Pe- reira speaks of it as a powerful diuretic, and says : " I can not call to mind a single case in which it has failed to act u[)()n the kidneys. In some cases it i)roduces a most marked and beneficial effect upon the dropsical effusion. According to my experience it is more certain than any other diuretic in dropsies." BUCHU. THE LEAVES OF DIOSMA CRENATA.— Cape of Good Hope. Preparations. — An infusion of the leaves. Tincture of Buchu. Dose. — Of an infusion, Sj. Of the tincture, gtt. x. to oj- Therapeutic Action. — Buchu is diuretic, stimulant, tonic, and diaphoretic. It exerts a specific influence upon the uri- CHIMAPHILA. 243 nary organs; ^yh^le by its tonic, stimulant, aromatic, and dia- phoretic qualities, it promotes the appetite, relieves flatulence, and favors diaphoresis. The volatile oil furnished by the leaves of the Buchu is absorbed into the circulation, and com- municates its odor to the excretions shortly after it is taken. In Europe and in this country Buchu has been mostly ad- ministered in disordered states of the urino-genital organs. It is especially appropriate in chronic aiFections attended with copious secretion. In cystorrhoea, attended with profuse secre- tion, it often checks it and lessens the irritable condition of the bladder, thereby enabling the patient to retain his urine longer. CHIMAPHILA. THE HERB OF CHIMAPHILA UMBELLATA. PREPA-EATIONS. — A decoctiou. Tincture of Chimaphila. Dose. — Of the decoction 5J, Of the tincture gtt. x. to oj- Therapeutic Action. — Chimaphila is diuretic, tonic, as- tringent and diaphoretic, and said by some authors to be alter- ative. It exercises a specific influence over the urinary appa- ratus, increasing the renal secretion, and at the same time it is thought by some to lessen the quantity of lithic acid or lith- ates secreted. It is especially serviceable in chronic diseases of the genito-urinary mucous membrane, as in chronic catar- rhal affections of the bladder, chronic nephritis, or urethritis attended with purulent or profuse mucous discharge. It is also beneficial in calculous and prostatic aifections, diabetes, in the advanced stages of albuminuria, and in other disorders of the urinary organs attended with local debility, or chronic irritation or inflammation. Its utility in the aifections named, may undoubtedly be ascribed in part to its astringent and alterativ^e action, and in part to its diuretic and tonic proper- ties. Chimaphilin, the concentrated principle of the Chimaphila unibellata, is a light yellowish-brown powder, having a faint^ not disagreeable odor, and a feeble taste. It is mildly diuretic, and is especially indicated where there is debility of the uri- nary organs, and a tonic is desirable. As an alterative it is highly recommended by some in the treatment of scrofula. 244 DIURETICS. It is also said to be an efficient remedy in the treatment of chronic rheumatism. Dose grs. ij. to grs. v. UYA URSL THE LEAVES OF ARCTOSTAPHYLOS UVA URSI.— Europe, America. Preparations. — A decoction. Tincture of Uva Ursi. Dose. — -The dose of a decoction will be one tablespoonful. Of the tincture gtt. x. to 5j. Therapeutic Action. — Uva Ursi is diuretic, astringent, tonic and antilithic. Although it is not an active diuretic and indeed acts feebly as such, yet from its specific action upon the urinary apparatus, an action not exerted by any other vegetable astringent, we have thought it proper to consider the agent in this place. The benefit derived from its use in the diseases to which it is specially applicable, is due, no doubt, in great part to its astringent and tonic influence upon the kidneys and mucous membrane of the urinary organs. It is a popular remedy in chronic nephritis, and ulceration of any part of the urinary passages ; also in diabetes, catar- rhus vesicae, incontinence of urine, leucorrhoea, gleet, menor- rhagia, and other diseases of the mucous surfaces attended with a redundant mucous secretion, and accompanied with either local or general debility. JUNIPERUS. THE TOPS, BERRIES AND OIL OF JUNIPERUS COMMUNIS. Preparations. — An infusion. Tincture of Juniper. Oil of Juniper. Dose. — Of the infusion 5j- to .5J. Of the tincture gtt. x. to 5ss. Of the oil gtt. ij. to gtt. v. Therapeutic Action. — Juniper is diuretic, stimulant, carminative, emmenagogue, diaphoretic. The berries and tops exert an influence upon the system analogous to the turpen- tine's. The berries act specifically upon the urinary organs, imparting a violet odor to the urine. Taken too freely, they cause irritation of the bladder and heat in the urinary pas- sages; Pisa asserts that their continued use produces bloody urine. They act upon the skin, relieve flatulence, and pro- mote the catamenia. The foregoing effects depend upon the YERDASCUM. 245 presence of the volatile oil which they contain, which, accord- iiic to the experiments of Alexander, when exhibited in doses of fonr drops, is one of the most powerfnl diaphoretics. Oil of jnniper is dinretic, carminative and diaphoretic, and may be administered to fnlfill the same indications as the in- fusion of the berries. PETROSELINUM. THE ROOT OF APIUM PETROSELINUM. Theeapeutic Action. — Parsley root is a mild, unirrita- ting diuretic, especially adapted to irritated and inflamed states of the urinary apparatus, as in gonorrhoea, cystitis, ne- phritis, urethritis, and in the painful micturition caused by displacement of the uterus. It augments the flow of urine, and by increasing its quantity lessens its acridity, thus afford- ing much relief in the diseases named. It is also employed advantageously in hydropic aifections, but as an independent article in these cases it is not to be relied upon. CUCURBITA. THE SEEDS OF CUCURBITA CITRULLUS, CUCURBITA PEPO. Therapeutic Action. — The seeds of both the watermelon and pumpkin are esteemed useful for their diuretic qualities. They are simple, mild and unirritating, and often of great service in Cases of strangury, ardor-urinse of gonorrhoea, sup- pression of urine, and irritated and inflamed states of the urinary organs generally. They may be employed either alone, or combined with other diuretics, as parsley, cleavers, etc. The pulp of watermelon is refrigerant, diluent, and diuretic, and both admissible and useful, if taken with due restrictions, in febrile and inflammatory disease. YERBASCUM. THE LEAVES AND FLOWERS OF VERBASCUM THAPSUS. Therapeutic Action. — Verbascum is diuretic, demulcent, emmollient, pectoral, diaphoretic, and is said to be antispas- modic and alterative. A decoction of the leaves acts upon the urinary organs, promoting an increased secretion of urine. 246 DIURETICS. It is a mild and simple diuretic, well calculated to relieve irri- tation and inflammation of the genito urinary mucous mem- brane. Gonorrhoea, dysuria, suppression of urine, etc., are much benefitted by its use. The leaves and pith are employed externally, made into fo- mentations and cataplasms, in cases of white swelling, hem- orrhoids, indurated glands, and other inflammatory swellings- The pith is regarded as an important ingredient in the fomen- tation recommended in Beach's Practice, in cases ofhydrar- thrus. ALTH^A. THE KOOT OF ALTH.^A OFFICINALIS. Theeapeutic Action. — Marsh Mallows is diuretic and demulcent. As a diuretic it may be employed in nephritis, cystitis, or other inflammatory aifections of the urinary or- gans. It increases the secretion of urine, and exerts its de- mulcent influence upon all parts of the urinary mucous mem- brane. We have administered it with much success in acute cystitis, and to relieve the ardor-urinee of gonorrhoea. It is also a favorite remedy in strangury especially when caused by the action of cantharides. It is employed with advantage as a demulcent in inflammation of the fauces, tonsils, throat, and upper part of the larynx, and in coughs, hoarseness, etc. GALIUM. THE HERB GALIUM APARINE. Theeapeutic Action. — Cleavers is said to be diuretic, aperient, refrigerant and antiscorbutic. It may be used with much advantage in acute nephritis, cystitis and gonorrhoea, as it is refrigerant, lessening the irritation and inflammation of the aflected parts, and diminishing the acridity of the urine. It should not be used, however, in torpid and debilitated states of these organs. It has been used with benefit as a diuretic and refrigerant drink, in acute febrile and inflammatory dis- eases, almost invariably increasing the flow of urine; it has the advantage of agreeing well with the stomach. The other sj)ecies of Galium possess similar virtues, and may be substituted for this. CAROTA. 247 ASPARAGUS. THE ROOTS AND YOUNG SHOOTS OP ASPARAGUS OFFICINALIS, Therapeutic Action.- — Asparagus is considered to bo diuretic, aperient, deobstruent and sedative. A decoction of the roots or young shoots seems to augment the flow of urine without exciting the action of any other part. It is a very mild and unirritating diuretic, and may therefore be used in inflammation or irritation of the kidneys, bladder or urethra. Aperient and deobstruent properties are ascribed to it, and at one time it was exhibited as an alterative and purifier of the blood. OAR OTA. the; root and seeds op daucus carota. Therapeutic Action. — Wild Oarrot is diuretic, excitant, aromatic and carminative. The seeds are diuretic, stimulant, aromatic and carminative, and are used in nephritic diseases, gravel, irritation and inflammation of the bladder and urethra, suppression of urine, dysuria from blisters and other causes, gonorrhoea, dropsy, etc. The dose of the pulverized seed is from half a drachm to one drachm, or one ounce of the bruised seed may be added to one pint of boiling water, and the whole taken in the course of the day. The root is used in the form of a decoction in painful micturition, inflammatory diseases of the urino-genital orans, and sometimes in dropsy. Its properties are analogous in every respect to those of the seeds. The root of the common garden carrot is in much repute as a cataplasm in cases of phagedenic, ill-conditioned and indo- lent ulcers, chapped nipples, and as an application in the ul- cerated stage of cancer. It is somewhat stimulant, and changes the diseased action of the ulcerated surface, corrects the fetor, allays the pain, and often proves eminently benefi- cial. The poultice is formed by scraping or grating the root, and mixing it with water. The boiled and mashed root acts simply as an emollient poultice, and is useful in cases of burns, painful tumors and inflamed surfaces. 248 DIUKETICS. EPIGEA. THE LEAVES OP EPIGEA REPENS. Therapeutic Action. — Epigea is diuretic, astringent, and said to be tonic and autilithic. It is esteemed a very useful diuretic, and has been employed successfully in gravel, sup- pression of urine, dropsy, etc. It appears to be more especi- ally adapted to the relief of chronic affections of the urinary organs attended with an increased secretion of mucus, or with a discharge of purulent matter, as in catarrhus vesica, or in cases where a suppurative action is going on in the kidneys, bladder, or urethra ; consequently, it is to be classified with the tonic or astringent diuretics, as the uva ursi, chimaphila, etc., though it is superior to either of these. VACCINUM. THE LEAVES OF VACCINUM FRONDOSUM. Therapeutic Action. — Vacoinum is diuretic, tonic and astringent. The leaves possess decided diuretic properties, and as such are used in dropsical affections, especially when accompanied with great debility. They, like the preceding article, are adapted to that class of urinary affections attended with chronic irritation or inflammation and a profuse mucous or purulent discharge ; they are also recommended in calcu- lous affections to relieve irritation. COLLINSONIA. the root of the collinsonia canadensis.— u. s. Preparations. — In its olden time use as a diuretic, an in- fusion of the entire plant was employed. For its specific use, we employ a tincture of the root. Dose. — Of the tincture, from the fraction of a drop to oss. according to the use of the remedy. Therapeutic Action. — CoUinsonia is reputed diuretic, diaphoretic, tonic, astringent, stimulant, carminative, emetic, discutient and lithontriptic. Numerous arc the properties said to be possessed by this agent ; and it is often employed in do- mestic practice for various purposes. It is esteemed diuretic, COLLINSONIA. 249 and has been used in dropsies and chronic diseases of the uri- nary passages, and is a reputed litliontriptic, and as such has been highly extolled in calculous affections. As to its capa- bility of dissolving urinary concretions, we have our doubts, although it may be serviceable in allaying the irritation caused by the presence of calculi. It has been found useful in colic, spasm of the stomach and bowels, and " after-pains,"' owing to its stimulant and carminative properties, and favorable re- ports are made of its utility in " night-sweats." As a tonic it has been recommended, in indigestion, and as a diaphoretic in rheumatism. It has also been said to be an effectual remedy in headache. Prof. Wood states that a decoction of the fresh root is said to have been used with advantage in catarrh of the bladder, leucorrhoea, gravel, dropsy and other complaints; and the leaves are applied by the country people, in the form of cataplasm or fomentation, to wounds, bruises and sores, and in cases of internal abdominal pains. Specific Indications — Irritation with sense of constric- tion in the larynx. Pressure at the supra-renal notch. Op- pression with tightness in epigastrium. Painful constriction of rectum, of ostium vaginse, and of urethra. Hemorrhoids, with contraction of the sphincter, and sense of foreign body (irritant) in the rectum. Specific Uses. — The indications as above given will give a quite extended field for this valuable remedy. Our first use of the remedy was in minister's sore throat, for which it is as near a specific as a remedy can be for the name of a disease. It is also a prominent remedy in chronic laryngitis, and in some cases of trachitis and bronchitis. In functional heart disease, with gastric irritation, it is a prominent remedy. It is also a remedy in some cases of chronic gastritis, and irritative dyspepsia. In these cases 1 give it in the large doses — I^ Tinct. Collinsonia oj- to .^ij.. Simple Syrup Siij- to ,5iv. ; a teaspoonful every four hours. In diseases of the rectum, and in hemorrhoids with the in- dications given, we employ the small dose — B« Tinct. Collin- sonia gtt. V. to gtt. X., water .jiv. ; a teaspoonful every three or four hours. With the sense of constriction, and of an irri- tant body in the rectum, it is as prompt and direct as any rem- edy in the materia niedica. 250 DIUKETICS. It is not so frequently indicated in diseases of women, or in diseases of the urinary organs, but cases will be found in which it goes directly to the spot, and gives relief. ERIGERON. THE PLANT OF E. HETEROPHYLLUM, E. PHILADELPHICUM.— U. S. Therapeutic Action. — These species of Erigeron are diu- retic, tonic, diaphoretic and astringent. The two species pos- sess identical medical properties, and are highly esteemed by manv practitioners in gravel, nephritic affections and certain forms of dropsy. Dr. Wistar of Philadelphia used them with much advantage in hydrothorax' complicated witii gout. The infusion or decoction of fleabane is said to have increased the secretion of urine in a single day, from twenty-four to sixty- seven ounces. From this we may infer that it possesses no ordinary amount of diuretic power. It affords relief in stran- gury produced by cantharides, suppression of urine, gravel, diabetes, chronic nephritis, and other urinary affections. It has also been recommended as a diaphoretic in cutaneous dis- eases, rheumatism, etc., and as an astringent in hemorrhages and chronic diarrhoea, though it is not equal to the Canada Fleabane for this latter purpose. It is also said to have been serviceable in coughs and catamenial obstructions. ERYNGIUM. THE ROOT OF ERYNGIUM AQUATICUM. Preparation. — Tinct. Eryngium. Dose. — From the fraction of a drop to 5ss. Therapeutic Action. — Eryngium is considered diuretic, diaphoretic, expectorant, stimulant, sialagogue, and in large doses emetic. This agent is said by some to be a powerful diu- retic, useful in atonic dropsies, and also in gravel, chronic ne- phritis and other urinary disorders. Its efficacy as a diuretic may have been overrated by the class of writers referred to, but still there is sufficient respectable testimony in favor of its utility in this respect to entitle it to further notice. It acts as a general excitant, promotes expectoration and diapho- resis, and when masticated j)rovokes a free flow of saliva. As an expectorant, it has been used with advantage in chronic ARALIA. 251 bronchial affections, attended with free or profuse expectora- tion. It has also been employed in languid states of the stom- ach to promote the appetite and digestive powers in cases of general debility, and in the convalescence of many diseases. Specific Indications. — Burning with itching in the blad- der, and upper part of the urethra. Burning sensations in the region of the kidneys, and down the ureters. Specific Uses. — The Eryngium is a prominent remedy in chronic diseases of the bladder, either inllammatory or ii-rita- tive. Associated with a sedative it meets tlie indications in acute cystitis. Alone it relieves unpleasant irritation which might result in inflammation. It is also a valuable remedy in chronic cystitis, when there is but little secretion, and sometimes when there is a free deposit of the triple phosphates. Occasionally it exerts an admirable influence in relieving uterine irritation, the bladder being also involved. It is a remedy to be thought of in chronic nephritis, or in- deed in any case in which the deep seated burning is a marked symptom. ARALIA. THE BARK OF THE EOOT OV ARALIA HISPIDA.— U. S. DoSE.^ — Aralia is mostly administered in decoction. One ounce of the dried root to a pint and a half of water, boiled down to one pint. Dose, two to four ounces, repeated as often as the stomach will bear it. Therapeutic Action. — Aralia is diuretic, alterative, pur- gative, emetic and detergent. It is an important diuretic, though but little used, and apparently but little known. It is the most efficient remedy in dropsies, especially in anasarca and ascites, with which we are acquainted. As an individual agent, if we were to select but one, for the cure of the varieties of dropsy named, this is the one we should choose. It greatly augments the flow of urine, promotes absorption, and if taken very freely, causes catharsis. It is an excellent vehicle for the exhibition of cream of tartar ; one or two ounces added to a pint of a strong decoction of Aralia, and taken in the course of twenty-four hours, will rapidly reduce any dropsi- cal swelling. Like other species of Aralia, it possesses val- uable alterative properties, and if taken in large doses, it is emetic. 252 DIURETICS. LIATRIS. THE ROOT OF LIATRIS SPICATA. Dose. — Of the powdered Liatrisfrom one-half to one drachm, taken in some warm infusion. Of an infusion of one ounce to a pint ot boiling water, macerated for two hours, from one to four ounces. Therapeutic Action. — Liatris is diuretic, stimulant, dia- phoretic, tonic and emmenagogue. It is a mild, and yet en- ergetic, stimulating diaphoretic, and very valuable whenever an agent of this character is indicated. It is also an excellent stimulant, appropriate in all cases where a carminative and excitant are required, as in the debility of the digestive or- gans, colic, spasm of the bowels, etc. It is a useful and even superior stimulating diaphoretic, and may be employed in the advanced stages of fever, and where there is coldness of the surface and want of action in the cutaneous capillaries. As- sociated with these valuable properties are its tonic powers. Some regard the Liatris as an emmenagogue and deobstru- ent, and it may possess such properties. Its supposed emmen- agogue powers may depend upon its genei'al excitant influence upon the whole system, or upon the secretions in particular, or its direct action upon the urinary organs may be sufficient to account for its sympathetic action upon the uterus. It is frequently recommended in scrofula, pains in the chest and af- ter-pains, and is said to exert a salutary influence in all these cases. TARAXACUM. Dose. — Of a decoction of two ounces of the bruised root to a quart of water, boiled down to a pint and strained, one to three ounces, three or four times a day. Of the extract, from twenty grains to one drachm, three times a day. As a diuretic and curative agent, Taraxacum is beneficial in those dropsical cases occasioned by hepatic torpor or en- gorgement, and visceral enlargements and obstruction, when unattended with over-excited vascular action. Its tonic, a|>e- rient and alterative ])roperties, associated with its dini'clicr action, contribute mu(;h nndoubledly to the i-elief of those cases to- which it is thought to be especially adapted. Tt is SCILLA. 253 mostly employed in the form of a decoction or extract. The bitartrate of potash, or some other saline purgative, is fre- quently added to the decoction. SAMBUCUS. The young roots of the common elder possess diuretic prop- erties. A decoction made of the roots and drank freely, will be found beneficial in dropsical affections ; it may be associa- ted with juniper berries, horseradish, cream of tartar, etc., w^ith much advantage. The inner bark of the elder forms an effi- cient hydragogue cathartic and diuretic; it may be employed tinctured in wine or cider. It Is taken to the extent of keep- ing the bowels loose. PAREIRA. THE ROOT OF CISSAMPELOS PAEEIRA.— South America. Dose.— Of an infusion of Pareira, one ounce to a pint and a half of boiling water, macerated for two hours in a tightly covered vessel, and strained, from one to three ounces. Of the tincture, from ten drops to half a drachm. Therapeutic Action. — Pareira is esteemed diuretic, tonic, lithontriptic, antilithic and aperient. It acts specifically upon the urinary organs as a diuretic, changing the quality of the urine, and lessening irritation of the genito-urinary mucous membrane. At one time it enjoyed a high reputation as a lithontriptic, or dissolver of stone, but it does not at this time retain that repute, although it is believed to change the qual- ity of the urine, and consequently destroy the tendency to the production of calculi, and is therefore pronounced antilithic. It is now employed almost exclusively in discharges from the genito-urinary raucous membrane, as in chronic irritation and inflammation of the kidneys and bladder, gonorrhoea, leucor- rhoea, calculous affections, etc. SCILLA. THE BULB OF SCILLA MARITIMA. Dose. — As a diuretic, squills are generally administered in powder, this being the most efficient form in which they can be given ; dose, grs. j. to gr. iij., repeated two, three, or four 254 DIUKETICS. times a clay, until nausea is excited, or its action on the kid- neys evinced. Its preparations will be described under the class Expectorants. Therapeutic Action. — Squill is diuretic, expectorant, emetic and acro-narcotic. In small doses it excites the secre- tory and excretory organs. It prcmotes the bronchial and intestinal mucous secretions, and increases the secretion of urine in a remarkable manner, thereby promoting the absorp- tion of effused fluids, an indirect effect arising doubtless from the increased diuresis. It acts as an irritative stimulant upon all the surfaces and parts with which it comes in contact, and thus disturbs the process of digestion and assimilation. As a remedial agent it is principally used as a diuretic and expectorant, and sometimes as an emetic. As a diuretic it is a popular remedy in dropsies requiring the use of stimulating remedies of this class ; torpid and leucophlegmatic states of the system are the ones in which it is most frequently used. COPAIBA. THE OLEO-RESIN OF COPAIFERA OFFICINALIS.— SOUTH America. Dose. — Of Copaiba from gtt. xx. to 5j- or more, three times a day, in capsules. This is said to be the most efficacious way to exhibit it in urinary diseases. Therapeutic Action. — Copaiba is diuretic, stimulant, lax- ative and emetic. In small doses it acts as a special stimu- lant to the mucous surfaces, causing a sensation of warmth in the stomach, eructations, and often from its nauseous taste nausea and vomiting; by its continued use the appetite is im- jiaired and the digestive functions disordered. From the ab- sorption of the balsam or its oil, a stimulant action is exerted upon all the secretory organs, the mucous membranes and urino-genital organs in particular. The oil escapes in part by the pulmonary exhalation, as is perceived by the breath. It increases the renal secretion, and manifests its presence in the urine by its balsamic odor, bitter taste, and change of color. It excites a sensation of warmth and tickling in the urethra, and sometimes an irritation of the testicles. It also excites the pulmonary and gastro-intcstinal mucous membranes, and sometimes occasions a scarlet colored eruption on the surface. CUBEBA. 255 The diseases in which the Copaiba is founJ to be the most useful, are those affecting mucous surfaces, especially the urino-genital mucous membrane. It is a common remedy in gonorrhcea. In that disease some administer it in the first stacres, in order to arrest the disease, while others wait until the acute inflammatory symptoms subside. Leucorrhqea is another of the diseases affecting mucous surfaces, in, which this remedy has obtained considerable re- pute. We have employed the solidified Copaiba and pow- dered cantharides, in the form of pills, with much apparent benefit. In chronic bronchitis, occurring in old or debilitated persons, and attended with profuse secretion. Copaiba has afforded much relief. In chronic diarrhoea or dysentery, at- tended with mucous discharges, especially when symptoms of ulceration exist, it has been found beneficial, and is highly rec- ommended. CUBEBA. THE BERRIES OF PIPER CUBEBA. Dose. — ^Cubebs are most efficient when administered in powder ; dose, 5ss. to o}-, two, three, or four times a day, or as often as the stomach will bear it. Of the tincture, 5ss. may be given three times a day in a glass of water; of the oil, gtt. X. to XV. in emulsion. Therapeutic Action. — Cubebs are diuretic, diaphoretic, stimulant, carminative and expectorant. Like Copaiba they appear to exert a specific action on the urino-genital apparatus, acting as diuretics, deepening the color, and imparting a pecu- liar aromatic odor to the urine. When taken in small doses they act in a similar manner to other peppers, stimulating the stomach, augmenting the appetite, and promoting digestion. In large doses they sometimes cause nausea and vomiting, burning pain, tormina and sometimes purging; they also cause increased" frequency of the pulse and thirst, and sometimes give rise to urticaria, and according to Dr. Duncan, produce swelled testicles. They have long been used in gonorrhoea, gleet, etc., with advantage; they moderate the inflammation, and consequently the discharge. If they do not soon produce this effect, they 256 DIUKETICS. should be discontinuedj as their continued use in such cases affffravates the disease. Tliey have been administered in gleet, but alone they rarely produce any beneficial effect. In two or tliree cases we have used the combination already spoken of with entire success, but in many cases it has failed. In small doses we have ad- ministered them in combination with Hydrastine, in chronic irritation and inflammation of the bladder, with successful results. ONOSMODIUM. THE ROOT AND SEEDS OF ONOSMODIUM HISPIDUM.— U. S. Dose. — It is employed principally in the form of an infu- sion, half an ounce of the bruised seeds, or one ounce of the root, to a pint of boiling water. Dose two to four ounces, every three or four hours. Therapeutic Action. — Onosmodium is diuretic, and re- puted lithontriptic. The roots, tops and seeds of this plant have the reputation of exciting the kidneys to increased action in a powerful manner, greatly increasing the quantity of urine excreted. The seeds act promptly, an increased flow of urine soon following their exhibition, as is also the case,, as is said, with the roots and tops. It has been reputed a useful remedy in dropsy, and we would suppose from its hydragogue action upon the kidneys, that it would be found useful in this disease. In chronic irritation and inflammation of the urinary organs, and especially in irritation of the bladder, caused by the pres- ence of calculi, the mildness of its action renders it highly serviceable. It is also reported as highly beneficial in sup- pression of urine and strangury. POLYTRICHUM. THE PLANT OF POLYTRICHUM JUNIPERINUM. Dose. — Of an infusion of one ounce to a pint of boiling water, macerated for two hours, one-half to one ounce every one or two hours, or oftener in cases of dropsy. Therapeutic Action. — This is one of the most valuable of our indigenous diuretics, acting mildly, and yet largely in- creaoing the urinary secretion. It has been used with much OLEUM TKREBINTHIN^. 257 success in dropsical diseases, and is capable of speedily and certainly reducing dropsical effusions. It is said to have caused the excretion of several gallons of fluid in twenty-four hours. It has also proved a good agent in acute stages of gonorrhoea, almost invariably relieving the tronblesome ardor- urino» attending that disease. It has also proved useful in cystitis and vesical irritation. As a diuretic we would rec- ommend it as among the best and most reliable of this class. DIGITALIS. Dose. — Of powdered Digitalis, fron gr. ^ to grs. iss., re- peated every six hours. Of an infusion of one drachm to half a pint of boiling water, .5ss. Of the tincture, gtt. ij to gtt. x. Digitalis, exhibited in small and gradually augmented doses, acts as a specific excitant to the kidneys, promoting the secre- tion of urine ; on account of this property it has been much used by some practitioners in dropsical effusions. Pereira says : " Of all remedies for dropsy, none have gained more, and few so much celebrity as fox-glove." Its curative powers are referred to its sedative influence, repressing arterial ex- citement ; to its power to promote the action of the absorbent vessels, and to its diuretic action. OLEUM TEREBINTHIN.^. Dose. — As a diuretic and special excitant of the urinary organs, ten to thirty drops, repeated every two, three, or four hours. In small doses, frequently repeated, turpentine acts as an excitant to the kidneys, and causes an increased flow of urine. It is thought to exert a specific influence upon the mucous membrane of the bladder and uretlira, exciting the vessels and the mucous follicles to a new and healthy action, and thus checking excessive mucous discharge. It is useful in chronic and atonic dropsies, as a stimulating diuretic and derivative. It has also been administered with advantage in ulceration of the kidneys and mucous membrane of the bladder, suppres- sion of urine, gleet, chronic gonorrhoea, blennorrhoea, leucor- rhoea, diabetes, etc. 17 258 DIUKETICS. EQUISETUM. A decoction or Infusion of the common Scouring Rush, acts as a mild and simple diuretic, and as such it has been used in gravel, dropsical affections, irritation and inflammation of the urinary organs, strangury, suppression of nrine, and other similar affections. ARMORACIA. The root of the Horseradish is an excellent stimulatino; din- retic in passive dropsies. It is mostly associated with other agents, as the dwarf elder, juniper berries, the root of the com- mon elder, and other diuretics. It is adapted to torpid and atonic states of the system.' The infusion of an ounce to a pint of boiling water may be administered in doses of one to two ounces. (See Stimulants.) EUBUS ODORATUS. The roots and leaves of the Flowering Raspberry, described in the class Astringents, are said to exercise a specific influ- ence over the secretory functions of the kidneys. They have been found beneficial in suppression of urine, gravel, and in cases of chronic irritation or inflammation of the urinary organs, attended with a mucous or purulent discharge. It may be classed with the tonic and astringent diuretics. It is ex- hibited in the form of a decoction, which may be taken freely. SMILAX PEDUNCULARIS. The root of the Jacob's Ladder is said to possess strong diuretic and lithontriptic properties. Whether it really pos- sesses the virtues reported to belong to it, wc arc unable, from present knowledge, to say. Several botanical Avritera and ])ractitioners who have administered it frequently, speak very favorably of it as a diuretic in suppression of urine, dro[)sies, etc., and also in calculous affections. It promotes the flow of urine, and relieves the irritation incident to urinary deposits. It is used in the form of a decoction, a pint being taken in the course of twenty-four hours. CANTHARIS. 259 MODEOLA. Modeolii, or Indian Cucumber, is said to be a refrigerant diuretic, and well adapted to the relief of nephritis, cystitis, and other inflammatory states of the urinary apparatus. Prof, Barton thought it useful in dropsies. It is an article that has attracted but little attention, and we are not aware that it possesses any particular merit as a diuretic. PINUS PENDULA. The bark of the Tamarac, elsewhere described, possesses diuretic properties, and as such may be used Avith advantage in atonic dropsies, owing to its tonic and stimulating proper- ties. It is mostly combined with other more active diuretics, Avhen administered in dropsy. The decoction may be used freely, a pint or more being taken in the course of the day. MENTHA yiRIDIS. The Spearmint is administered as a diuretic with advantage in suppression of urine, strangury, passive dropsies, diabetes, and other disordered states of the urinary organs. It is often combined with other diuretics to improve their taste, prevent nausea, and add to the efficacy of the combination. A satu- rated tincture, prepared with Holland gin, or the green herb bruised and digested in the same liquid, is said to be very val- uable as a diuretic. (See Stimulants.) CANTHARIS. Dose. — Of the powder, one to two grains, in the form of a pill. Of the tincture, ten drops, gradually increased to one drachm. Spanish Flies exerts a specific stimulant influence upon the urinary apparatus. It is employed in a variety of diseases affecting the genito-urinary organs, among which may be named passive dropsy, dependent upon torpor of the kidneys, diabetes, paralysis of the bladder, incontinence of urine, amen- orrhoea dependent upon uterine torpor, in loss of sexual power as an aphrodisiac, in spermatorrhoea, blenorrhoea, gleet, leu- 260 DIUKETICS. corrhcBa, and other diseases of the urinary organs attended with a mucous discharge. OXYDENDRON. THE LEAVES OF OXYDEXDRON ARBOREUM— U. S. Preparations. — Extract of Oxydendron. Tincture of Oxydendrou. Dose. — Of the extract, grs. ij. to grs. iv. Of the tincture, gtt. V. to 5ss. Therapeutic Action. — The Oxydendron is recommended as a specific for dropsy, stimulating the kidneys to a profuse removal of water. Dr. John W. Davis reports a series of cases cured {Journal '81, p. 497), and others have used it with success. It is a new remedy to us, and we have not had an opportunity of testing it. SANTONINE. Santonine is excreted by the kidneys, and will sometimes cause irritation and partial arrest of secretion. It always colors the urine, and sometimes the color is so deep (green or blue) that people are frightened. It also aflPects the brain, sometimes causing giddiness, and disturbed vision, everything seeming green or blue to the patient. It is especially for retention of urine, from atony of the blad- der, that we prescribe it. It is probable that this wrong is due to deficient spinal innervation, and we sometimes have impaired respiration and tympanitis from the same cause, and for which Santonine may prove a remedy. Retention of urine is not an uncommon symptom in the advanced stages of acute diseases of children. It is always an unpleasant symptom, for if not noticed and promptly re- lieved, the disease will terminate unfavorably. Here San- tonine in doses of one-quarter to one-half grain, triturated with sugar, is specific. It acts promptly, sometimes giving relief with the first dose, but it should be repeated until the water passes freely. It is also the remedy in difficult micturition and retention following parturition, and its early use will save the physician much trouble, and the woman much suffering, I do not claim, RHUS AROMATICA. 261 of course, that it will give relief where the tissues have lost their life by the long continued pressure of the head in diffi- cult labor. But I am satisfied that its early use may prevent sloughing in some cases, when the ordinary want of knowledge allows retention of urine, the collection and puti'escence of uterine discharges, and the general condition of nastiness that 'is allowed in many cases. Whilst Santonine is not cleanliness, and not a topical anti- septic, it is one-third (and a very important third) of a good treatment. HHUS AROMATICA. THE BARK OF THE ROOT OF RHUS AROMATICA— U. S. Preparation. — A tincture is prepared from the fresh bark of the root. Dose. — The dose will vary from five to twenty drops. Therapeutic Action. — Dr. McCIanahan, of Missouri, introduced this remedy as a specific for incontinence of urine, but whilst it relieves in some cases it fails in others, as we would suspect. Of its uses the doctor writes : — " The great superiority of this remedy in the treatment of diabetes and enuresis led to its use in other abnormal condi- tions of the urinary and genital organs, viz., hematuria, ute- rine hemorrhage, menorrhagia, leucorrhoea, and other exces- sive discharges, accompanied by a relaxed condition of the uterus. I have found the remedy to act well in hematuria arising from various causes; it will be found a fine remedy in hemorrhage of the kidneys arising from a general diseased condition of the blood, accompanied by general debility, that form which sometimes precedes Bright's disease; and it will, many times, relieve the same arising from falls, blows, calcu- lus, etc. A friend of mine. Dr. Gray, has relieved two cases of chronic hematuria with the Rhus aromatica, which he could not manage with any other remedy. I was also highly de- lighted with its action in uterine hemorrhage; indeed I have given it a place in my obstetric case; I regard it inferior to no remedy. I use it in the same capacity as cinnamon, erige- ron, ergot, etc., the dose varying from five to twenty drops of the tincture, according to the urgency of the case. " For the last three years I have used this remedy largely in 262 DirKETics. minor diseases of children ; time and space will not admit of further examples, hence I will only describe the conditions lo which it is applicable : Stools profuse, skin cool and sallow, pulse small and feeble, loss of flesh, abdomen flabby, tongue pale, trembling and moist, trembling in lower limbs, general sense of lassitude and languor. Dose for infants, ten to twenty drops in a half glass of water, teaspoonful as often as necessary ; for children, perhaps five drops of the first dilution." BURSA PASTORIS. THE PLANT OF CAPSELLA BURSA PASTORIS.-Europe, U. S. Peeparation. — A tincture of the recent plant. Dose. — The dose will vary from the fraction of a drop to thirty drops. Therapeutic Action, — Shepherd's Purse has a special action upon the kidneys and urinary tract, relieving irritation and promoting functional activity. It has given good results in incontinence of urine, especially in aged people and in women. It may be employed in chronic nephritis Avhen a prominent spmptom is, frequent desire to pass urine and ina- bility to retain it. It has also been used with advantage in irritation of the bladder and chronic cystitis, and in women in chronic metritis. In some cases it seems to promote the menstrual function, and when this is tardy, scanty, or arrested, it may be used as an eaimeuagogue. SPIRITUS ^THERIS NITROSI. Dose — Of spirit of nitric ether, from 5ss to 5j, or even 5ij, every two, three or four hours. Therapeutic Action. — Sweet spirits of nitre is diuretic, diaphoretic, stimulant and antispasmodic. It is an excellent diuretic, mild and unirritating in its action, and well adapted to the relief of inflammatory states of the urinary organs, as gonon-hcea, gleet, ardor-urinte, strangury, suppression of urine and other kindred disorders. In suppression of urine and dysuria recurring in infancy, it is a convenient and useful rem- edy. In the cases named, it may be given in some diuretic infusion, as melon-seed, spearmint, juniper, mullein, etc. POTASS^ ACETAS. 263 It is much employed in febrile diseases, for the reason that it 2)romotes diaphoresis as well as diuresis. If it fails to pro- mote the renal, the cutaneous secretion will be incroased. It acts both as a general stimulant and cutaneous excitant or diaphoretic. As a stimulant, carminative and antispasmodic, it is uiseful in gastrodynia, flatulence and intestinal spasms ; tincture of opium, sulphuric ether, or camphorated spirit of lavender, add much to its efficacy in these cases. In febrile diseases attended with nausea and vomiting, gastric irritability, or restlessness and inquietude, it allays the irritability, and often procures sleep; thus manifesting anodyne, antispasmodic and nervine powers. POTASS^ ACETAS. Dose. — Of acetate of potash, from grs. x. to 5j. largely diluted with water, and repeated as often as may be neces- sary. We administer three drachms daily in diseases in which we need its depurative action. . Therapeutic Action. — Acetate of potash belongs to our class of renal depuranis, and may be considered as the type of this class. It is a certain and efficient diuretic when given largely diluted with cold water, but frequently proves diaphoretic if given in warm water, and the surface is kept warm. It does not, like tlie organic diuretics, greatly increase the amount of urine voided, though this is some- times the case, but invariably increases the amount of solids held in solution in it. (See Action of Diuretics.) In febrile diseases we administer this agent to remove from the blood any morbid or disintegrated material which may be retained within it; and if this is accomplished, we have removed one of the principal, if not the principal, cause of the fever. When acetate of potash is given in fever, it acts first as a refrigerant, lessening the morbid heat of the body ; it causes an increased secretion of urine, and a remo- val of a large quantity of excrementitious organic matter, the product of disintegration of the tissues. It also, in a majority of cases, lessens the heat of the surface, relaxes the skin, and causes gentle perspiration. That it does "purify^' the blood, may be easily ascertained by the changed character 264 DIURETICS. of any exudation from that fluid, as the ^'coating'' of the tonguo. which will rapidly lose its dark color, and in a few days will be entirely removed. We do not claim that this agent alone will cure fever (and yet we have seen the fever removed by it in less time than by any other treatment), but we believe it fulfills one of the prominent indications of cure. In febrile diseases we administer one drachm three times a day, witii bitter tonics and suitable diaphoretics, keeping the bowels in a soluble condition ; and since we have adopted this treatment, no case has passed over the seventh day. It may be adminis- tered in acute inflammations, as pneumonia, hepatitis, etc., with the same success, appearing not only to lessen the febrile excitement, but checking the ])rogress of the inflam- matory action in a remarkable manner. It is also among our most reliable agents in the treatment of rheumatism, whether acute or chronic. In acute rheumatism we have seen entire relief given in forty-eight hours, the remedy increasing the solids excreted in the urine of twenty-four hours, not less than 260 grains, after deducting the three drachms of the salt administered. We have also found that in chronic rheumatism the disease could be as effectually subdued by this as by any other remedy, and in a much shorter space of time. In scrofula, secondary syphilis, chronic skin diseases, or any cachetic habit of body, when we have good reason to suppose that the blood is diseased, or contains the disinte- grated elements of the worn out tissues, this will be found one of our most beneficial alteratives. On this subject Dr. Golding Bird says : " I would most earnestly beg those who are now doing the honor of listening to my remarks, to give a careful and steady trial to the depurating or chemical diuretics, especially the salts of potash with vegetable acids, when they are called upon to treat a chronic affection in which the exciting cause, or existing disease, depends upon the presence of some product of less vitality or imperfect organization. I fully believe that in many instances such matters will often be found to yield, whether they present themselves as albu- minous deposits in glands, furnncular disease of cellular tissue, or incrustations on the skin, as in some of the squa- mous and tubercular cutaneous diseases. That they will POTASS^ BITARTKAS. 265 cucceed in increasing the waste of matter, is, from my obser- vation, beyond all doubt; that the lowest vitalized matters will yield to the solvent the readiest is most probable, and that an important and powerful addition has been made to our supply of therapeutic weapons is certain." Acetate of potash is exhibited in the uric acid diathesis. It is decomposed by the digestive and assimilative process, the vegetable acid set free, .while the alkali is absorbed into the circulation, thus destroying the acid, and greatly promot- ing the action of the kidneys, and thereby counteracting the formation of urinary concretions. POTASS^ CITRAS. Dose. — Of the solid citrate of potash, from gr. xx. to 5j- largely diluted with water. Therapeutic Action. — Citrate of potash belongs to the same group, possessess the same properties, and may be used to fulfill the same indications as the acetate just described. It increases the secretion of urine, causing an elimination of the disintegrated or broken-down tissues of the body, proves refrigerant, and if the surface is kept warm, and the remedy given in warm water, it induces diaphoresis. Pereira states that " it is an excellent refrigerant, soothing or sedative dia- phoretic, in fevers witli a hot and dry skin, and is less a[it lo act upon the bowels than tartrate or acetate of potash." POTASS^ BITAPTRAS. Dose. — As a diuretic, 5j to 5ij, largely diluted with water. Cream of Tartar, elsewhere fully described, is entitled to a passing notice under this head. It is diuretic, cathartic, and refrigerant. It is a very good diuretic in those dropsies termed sthenic, given in small doses, largely diluted and fre- quently repeated. Its action as a diuretic is greatly j)ro- moted bv <>ivinir it in some diuretic infusion or decoction, and hence its curative powers in dropsy augmented. It also acts as a refrigerant aperient ; and, if the dose be large, as a hydra- gogue cathartic. Its utility in dropsy depends upon this com- bination of properties. 266 DIURETICS. It is not as good as either the acetate or the citrate as a renal depurant, ou account of its tendency to pass otf by the bowels. An excellent and very pleasant diuretic and refrige- rant drink in febrile and inflammatory diseases is prepared by dissolving one or two drachms of this agent in one pint of boiling water, to which sugar, lemon juice, or lemon-peel may be added : it is taken cold. Cream of Tartar Whey is pre- pared by adding about two drachms of the bitartrate to one pint of new milk; the curd is removed by straining; diluted with water, it forms a pleasant and useful drink in dropsies, and some febrile diseases. POTASS^ NITRAS. Dose. — Of Nitrate of Potash, as a diuretic, from grs. x. to grs. XX., dissolved in 5J. of water, and repeated every two, three, or four hours. As a refrigerant, diaphoretic, and diuretic, Nitrate of Pot- ash is very valuable in febrile and inflammatory diseases. It promotes both the perspiratory and renal secretions, dimin- ishes the temperature of the body, and lessens the frequency of the pulse. It will be readily seen that such a combination of properties Avill render it an efficient agent in controlling febrile and inflammatory action. Its powers in this respect are greatly promoted by combining it with ipecacuanha and other nauseating and diaphoretic agents. We frequently make use of the compound powder of Asclepias and Nitrate of Pot- ash, spoken of under the class diaphoretics, in these diseases, and especially in acute or inflammatory rheumatism, and with the most satisfactory results. This cond)ination pro- motes the secretions, especially of the skin and kidneys, and greatly lessens exalted organic action. In bilious fever, at- tended with torpor of the liver, hepatic congestion and intes- tinal inactivity, it may be associated with small doses of Po- dophyllum or Podophyllin with much benefit. (See Dia- })horetics.) TINCTUKE IRON. 267 SODiE ACETAS. Therapeutic Action. — Acetate of Soda is a mild diuretic, similar in its properties to Acetate of Potash, but not near so efficient in its action. It may be employed as a substitute for that salt, and may be (exhibited with greater facility from the fact that it is not deliquescent. It is seldom used at the pres- ent day. TINCTURA FEURI CHLORIDI. Dose. — Of this agent, from gtt. x. to oss. or even 5j., given largely diluted with water. Tincture of Muriate of Iron, described under the class As- tringents, is tonic, astringent and diuretic. It is thought to exert a specific influence over the urinary organs, and hence has been used in gleet, long-standing gonorrhoea, dysuria, irri- tability of the bladder, especially of females, in chronic mu- cous discharges from the genito-urinary organs ; in passive uterine, renal, and vesical hemorrhages; and in spasmodic stricture of the urethra, preventing the introduction of the catheter. In the latter case from ten to twelve drops are given every ten minutes until the spasm is overcome. 268 SPECIAL THERAPEUTICS. DIVISION 11. OLA.SS V. SEDATIVES. Sedatives may be defined to be those therapeutic agents which calm or diminish irritation, and I'ectify sympatlietic innervation. They may be divided into general and special,^ the first exerting their medicinal inflnence upon the entire system, and the second producing their effect upon a special part. Sedatives are commonly classed with narcotics, but as the latter agents act first as excitants before producing their sedative influence, and as they exert a special influence over the intellectual functions, are anodynes, and produce sleep, there is a marked boundary between the two classes. Again, sedatives are not ordinarily used to lessen pain or procure sleep, but as contra- stimulants or direct depressors of exaltevith advantage in some diseases of this organ. We can see very readily how this may be. The cardiac nerves are derived from the upper part of the sympathetic, and judging from the anatomy of the part, the first cervical ganglion being tbe prin- cipal nervous mass in the cervical region, must furnish inner- vation through the cardiac nerves, as it certainly controls the circulation and nutrition of the brain. The Cactus is a specific in heart disease, in that it gives strength and regularity to the innervation of the organ. Its influence is permanent, in that it influences the waste and nu- trition of the heart, increasing its strength. It exerts no in- fluence upon the inflammatory process, and hence is not a remedy for inflammatory disease. Feelings of weight and pressure at the praecordia, difficult breathing, fear of impending danger, etc., are at once removed. Such irregularity of action, whether violent, feeble, or irreg- idar, as is dependent upon the innervation, is readily controlled. Thus in the majority of cases oi functional \\Q'.\vt disease, it gives prompt relief, and, if continued, will effect a cure. In those cases in which there is another lesion acting as a cause, as in some gastric, enteric, or uterine lesion, this must receive attention, and be removed to make the cure radical. In structural heart disease, the first use of remedies is to relieve the distressing sensations in the region of the heart, and the unnatural fear of danger which attends them. As these spring from disordered innervation, in the majority of cases, the Cactus gives prompt relief. As we have seen above, its continuance favors normal waste and nutrition, as well as regular action. Hence, its continued use is followed by the removal of adventitious tissue, and an increase in the strength of its contractile fibre. Thus it proves curative in many cases of structural heart disease, I have some cases on my case-book of such aggravated fi)i'm that no one would believe they could live a twelve-month ; PULSATILLA. 297 yet after ii lapse of five years, they are enjoying comfortable health. But it M'ill not relieve or cure cases of valvular deficiency, dilatation of the openings of the heart, or fatty degeneration. It is well in estimating its action, to bear this in mind. In its influence upon the nervous system, it more nearly re- sembles Pulsatilla ; giving relief in tliat condition known as nervousness. But further than this, it gives regularity of cerebral function, and permanently improves nutrition of the nervous centers. PULSATILLA. THE FRESH PLANT PULSATILLA NIGraCANS.— Europe. PREPARATION. — A tincture of the fresh plant gathered whilst in flower. Dose. — The dose of Pulsatilla will vary from the fraction of a drop to two drops.- Specific Indications. — The patient is nervous and de- spondent, cries easily; the pulse is small and frequent, but soft ; the extremities cold ; menses tardy and scanty, the pa- tient feeling nneasy and depressed at this time; sense of full- ness and weakness in back and hips at menstrual period. Therapeutic Action. — Pulsatilla lessens the frequency of the heart's action by strengthening its innervation, acting in this way very much like Cactus. The circulation is feeble with frequent pulse, and this remedy gives increased strength, and thus diminished frequency of movement. It strengthens sympathetic innervation in all parts, but more especially to the pelvic viscera, and in this way, probably, exerts its influence upon the reproductive apparatus. It also exerts a direct in- fluence upon the cerebrum, influencing the anterior and up- per lol)es, as well as the sensory ganglia — the mind and auto- matic functions. Pulsatilla is largely employed to relieve the condition known as nervousness. The patient can not command the functions of the brain, and is uneasy and restless. Sometimes with these symptoms there will be severe headache, which the Pulsatilla relieves. We use it to relieve the head-symptoms that are met with in spermatorrhoea, prostatorrhoea, and other functional wrongs 298 SEDATIVES. of the reproductive apparatus of either sex. The patients' fears are a source of continuous uneasiness and suifering. They fear they will die suddenly, or early in life; they fear they will lose memory, and the ability to think well; they fear they will lose procreative power, and losing this, will have lost the "chief end of man," This nervousness gives certain unpleasant heart symptoms, relieved in some cases by Pulsatilla, in others by Cactus. The patient complains of oppression, trembling, uneasy sensations in the prsecordium, and a feeling as if the machinery of life would stop. The circulation is feeble, and the pulse frequent and irregular. A large field for its use will be found in the many unpleas- ant symptoms which arise froni'wrongs of the uterus and ovaries. These may be local or reflected to other parts, or may influence the brain and mind. But wherever they are, the common word "nervousness" describes them. Abdominal and pelvic tremors, palpitation, uneasy muscular contractions, formications, weight, dragging fullness, frequent desire to urinate, etc., etc. Pulsatilla is one of the most certain enimenagogues when, with such symptoms as have been named, there is arrest of, or tardy appearance of the menses. We use it alone, or in many cases associate it with the Macrotys. It is an excellent remedy in obstetrical practice to relieve the groundless fears of the pregnant and parturient w^oman. We can hardly concede the homoeopathic teaching that " it will turn the child in preternatural labor." But by rectifying wrongs of innervation and relieving the mind, it renders labor easier. MELLILOTUS. THE PLANT MELLILOTUS ALBA— Europe. Preparation. — A tincture is urepared from the fresh leaves and flowers. Dose. — From the fraction of a drop to five drops. Therapeutic Action. — It has given excellent results in the treatment of neuralgia, especially when associated with debility. It has cured cases of many years' standing. A strong indication for its use is a marked soreness and lameness, which ^scuLus. " 299 follows the attacks of paia. It may be administered in colic^ painful diarrhoea, dysuria with painful desire to urinate, in dysmenorrhoea associated with lameness in the hip, and along the course of the sciatic nerve, and in some cases of rheuma- tism where such lameness is a marked feature. ^ S C U L U S. THE NUTS OF ^^SCULUS GLABRA— U. S. Preparation. — A tincture is prepared from the recent roots when fully matured. Dose. — The dose will be from the fraction of a drop to five drops. Usually we add gtt. v. to gtt. x. to water .jiv., and administer a teaspoonful everyone or two hours. Specific Indications. — Sensations of tightness in the chest and about the jjrtecordia. Asthma, with continuous difficulty in breathing. Sense of tightness and constriction about the rectum, with uneasy sensations. Hemorrhoids. Therapeutic Action. — The J]^sculus is a sedative to the pneumogastric and respiratory nerves, slowing the circulation when frequency of pulse depends upon excitement here. It is not determined whether it exerts its influence upon the spi- nal or sympathetic nervous system, but probably on the first. This remedy has a very important use in controlling the difficulty of breathing in a form of asthma not paroxysmal. In this case the difficult breathing is persistent, and though worse at times, it has no violent paroxysm. It will also be found a valuable remedy in some cases of phthisis, where diffi- cult breathing and oppression are prominent symptoms. It has been used for a long time as a remedy for hemor- rhoids, and if the indications are follow^ed, it proves a verv good one. There is a peculiar irritation of the small intes- tine, with contraction and colicky pains in the neighborhood of the umbilicus, which is relieved by this remedy. I have known this uneasiness and contraction, with intestinal dvs- pepsia, which had persisted for weeks and months, to be per- manently cured by carrying a fresh buckeye in each trousers pocket. We get the same result from the administration of the small dose. 303 SEDATIVES. AMYGDALA AMARA. Therapeutic Action. — The Bitta^ Almonds arc more or less poisonous to all animals, causing tremors, weakness, palsy, convulsions, and coma. On more tliey cause nausea, vomiting and purging, a feeling of intoxication, and in some instances a swelling of the face and head. In large doses they arc ca- jjable of producing serious and even fatal results, showing that they are analogous to the prussic acid in their effects. The Aqua Amygdalae Amarce, or distilled vater of bitter almonds, is poisonous, whether taken internally or applied externally. The emulsion of the almonds is also poisonous. They are but little used for medical purposes, although applicable to the relief of the same cases in which the prussic acid is suggested, such as gastrodynia, pertussis, phthisis, and other pulmonary affections. They have also been exhibited in agues ; to expel the ta])e- worm ; to relieve pain in dysmenorrhoea, etc. The sedative action upon the nervous and vascular systems, together with their demulcent qualities, entitle them to our notice in cough and irritation of the respiratory organs. AMYGDAT.US. THE LEAVES AND BARK OF AMYGDALUS PERSICA. Therapeutic AcTioN.^j-The leaves of the Peach tree, con- taining as they do a considerable quantity of hydrocyanic acid, are poisonous when taken in large quantities; the liurk is much milder in its action. An infusion of either the barlv or leaves exerts a sedative influence upon the system, and is some- times employed to lessen nervous irritability and the frequeiicv of the heart's action in fevers. It has likewise been employed in irritation of the respiratory passages, combined with exjiee- torants and demulcents, and in irritable states of the bladder, urethra, etc. We consider an infusion of the bark one of our most j)OW- erful means of checking irritation of the stomach ; and we have frequently foi;nd it beneficial in gastritis. In the ex- treme irritability of the stomach and consequent vomiting, which frequently proves one of the most dangerous sym])t()nis LYCOPUS. 301 in cholera infantum or summer complaint, we know of no arent that exceeds this in value. We have employed it in many cases with entire success when all other remedies failed to produce any benefit. It also appears to exert a beneficial influence upon the bowels, quieting the irritation and lessening the frequency of the discharges. LYCOPUS. ■ . THE HERB OF LYCOPUS VIRGINICUS. Prkpahation. — A tincture of the root. Dose. — The dose will vary from the fraction of a drop to ten drops. Theeapeutic Action. — The Lycopus is sedative, tonic, astringent, narcotic, and diaphoretic ; it is one of our many valuable indigenous medicinal agents. In a certain class of diseases we regard it as a valuable therapeutic agent; yet it is not extensively employed, and by the majority of practitioners, it is not used at all. The properties which it possesses seem to be happily blended together, and to adapt it to the relief of certain morbid symptoms in a remarkable manner. It is a mild sedative narcotic, feebly tonic and moderately astringent. The Lycopus may be associated with the Eupatorlum and other pectoral agents, and administered in pulmonary com- plaints with great advantage. In drop doses it frequently proves an admirable remedy for the relief of irritative cough in chronic disease of the lungs. It is employed In all cases of excessive vascular excitement with great advantage. Its mild and congenial sedative prop- erties render It a remedy of great value in lessening tumult- uous action. For this purpose it has been employed in feb- rile and inflammatory affections ; more especially in the va- rious forms of pneumonia: In these diseases its mild sedative and narcotic properties render it peculiarly valuable in lessen- ing general irritation and diminishing exalted organic action. In acute diseases of this character, and in the chronic diseases of the respiratory organs attended with hemorrhage, it is very useful. In those diseases of a chronic character, in cases where there is a frequent hemorrhage or a tendency to hem- orrhage from. these organs in the incipient forms of phthisis, 302 SEDATIVES. or even when the complaint is somewhat advanced, and even in the confirmed stages of that complaint, the sedative and tranquilizing inflnences of the Lycopus, together with its mild tonic and astringent properties, render it an agent of very great importance. It somewhat lessens the momentum of the circulation, the irritability and excitability of the nervous and vascular systems, and hence controls febrile excitement, and lessens the heat of the body ; it lessens irritation in the lungs and consequently the harassing and exhausting cough ; and if the patient is the subject of hemorrhage from the lungs, it lessens vascular excitement, and the quantity of blood that circulates in the lungs in a given time, and in this way the irritation and' the cough ; and in the advanced stages of the disease, when the expectoration is copious and debilitating, the sedative, astringent and tonic influences of the Lycopus point to it as an invaluable palliative remedy, if not a curative agent in all such cases. Its properties can not injure under any circumstances of the kind, and it may be resorted to with a strong probability of at leasL mitigating all the urgent symp- toms, and even of effecting a cure. It may be used in debility and irritability of the nervous system, and in either acute or chronic diseases attended with Avakefulness and morbid vigilance. It has been used as a tonic in general debility, and also indigestion, though but seldom used in this case unless attended with pain and distress in the epigastric region. It is used by some to purify the blood in cases of old ulcers, and at the same time the ulcers are to be washed or cleansed with the infusion. It is also simmered in fresh butter, sweet oil or Unseed oil, and a little beeswax added to form an ointment, which has been found useful in burns and irritable ulcers. T A B A C U M. Dose. — Grs. iij. to x. Of infusion, gtt. xl. to Ix.. As an enemata, grs. xv. to xxx. Tobacco is fully described under Narcotics, but still it merits a passing notice under the class of Sedatives. Tobacco greatly depresses the action of the heart and arteries. It is rarely used for purposes of this kind. In cases of high excitement, CONVALLAEIA. dU3 spasmodic action, etc., it nuij he used. It is mostly used in the form of enemata. As it is so fully described under the class of Naacotics, we shall not extend our remarks here, but refer the reader to that class. CONVALLAEIA. THE ENTIRE PLANT CONVALLARIA MAIALIS.— U. S. Pr.EPARATiONS. — A tincture of the entire plant. Conval- laramin. Dose. — The tincture may be given in doses of from one to thirty drops. Of Convallaramin, gr. 1-30 to gr. ^. Therapeutic Action. — Convallaria Maialis has a direct action upon the heart, giving better innervation and greater strength to its movements. When the frequency of pulse de- pends u])on feebleness, this remedy will lessen the number of pulsations in a minute. M. Germain Sec makes the following statements in regard to it: — "1. The Convallaria maialis, or Lily of the Valley, is an im- portant cardiac remedy. " 2. In the form of the aqueous extract of the whole jDlant, given in the dose of from 15 to 20 grains daily, the maialis produces constant and favorable effects on the heart vessels and the respiration, slowing the beats of the heart, establish- ing the normal rhythm, increasing the force of the heart and the arterial pressure. The respiration becomes deeper and the sense of suffocation and the desire for air less troublesome and painful. " 3. The most powerful, constant, and useful effect is its diuretic, which renders it of great use in dropsies of cardiac origin. "4. There are no contra-indications, for the remedy is appli- cable to all the affections of the heart. In addition to that, it has no bad effect upon the cerebro-spinal system, nor on the digestive organs. Moreover, it has no cumulative effect, nor unpleasant after results. " 5. For these reasons, maialis is superior to digitalis, which we are often obliged to give up, or at least reduce the dose of, on account of the vomiting, loss of appetite, digestive disor- ders, cerebral excitement, and dilatation of the pupil, which it 304 SEDATIVES. SO often produces after a more or less prolonged use. Digitalis often brings about a weakness of the heart and an increase in the number of the contractions, and in short often has directly opposite effects to those desired. " G. To combat cardiac dyspnoea, maialis is inferior to mor- ])hia, and more particularly to the preparations of iodine, but morphia tends to cause suppression of urine." ACIDUM HYDROCYANICUM DILUTUM. Dose. — One to ten drops of the medicinal acid, in almond or arable emulsion, or simple water : very cautiously increase the dose until its effects are apparent. The acid procnred at dlffei'cnt places, and In different parcels, is found to be very variable in Its strength, and therefore requires the utmost pre- caution in its administration. Therapeutic Action. — Prussic acid is sedative, anodyne, uarcotic ; it is an energetic poison. Its effects on all classes of animals are loss of sensation and voluntary motion, Avith convulsive movements. A single drop of the pure acid, ap- plied to the throat or eye of a vigorous dog destroys it in a few seconds. In small doses on man it produces an increased flow of sa- liva, irritation in the throat, bitter taste, nausea, quick and sometimes slow respiration, vertigo, pain in the head, drowsi- ness, and sometimes an increase, and at others a reduction, in the frequency of the pulse — salivation and ulceration of the mouth have occurred from its use. In poisonous doses it causes faintness, vertigo, tetanic con- vulsions, insensibility, dilated pupils, small pulse, and diffi- cult and spasmodic respiration. These symptoms continue but for a short time. In very large doses death succeeds so speedily, that the foregoing symptoms are not manifested — the pulsations cease ; two or three deep inspirations may occur, and finally a state of insensibility and death follows. Post-mortem appearances generally present a glaring, or peculiar staring expression of the eyes and countenance, the peculiar odor of the acid is observed, and venous engorgement, PRUSSIC ACID. 305 while the arteries arc empty; the blood is fluitl and dark, or bluish, and the mucous membrane of the stomach injected. The vapor of the acid produces numbness of the part to which it is applied from its action on the nerves. It acts as an irritant on the mouth and nose; causes salivation, vomiting and [)urging. It is supposed to be absorbed, and thus act on the brain and nervous system, but its effects are so rapidly manifested that many suppose it acts directly upon the nerves of the part to which it is applied, and its further action is ex- tended to the sensorium-communc with the rapidity of electricity. When prussic acid causes death, it may arise from an arrest of respiration, or from a stoppage of the heart's action. In some instances death occurs so suddenly that it can not be attributed to obstructed respiration ; while in others the heart still pul- sates, as has been observed by experimenting upon dogs and rabbits. It appears to act as a direct sedative to the nerves, whether used externally or internally, and thereby suspends innerva- tion,, and hence its sedative action upon the vascular system, and its capacity to lessen pain and spasmodic action when ])resent. Hydrocyanic acid was at one time in high repute in pul- monary diseases, such as phthisis, asthma, pertussis, dyspnoea, spasmodic cough, chronic catarrh, etc., to allay nervous irrita- bility and reduce vascular excitement. In incipient phthisis it is said to arrest the disease in some cases, while in the con- firmed stages it acts as a palliative by lessening the cough, night-sweats and hectic symptoms. Its exhibition in various neuropathic affections, as chorea, hysteria, epilepsy, tetanus, etc., has, it is asserted, been attended with manifest advantage. In imperfect digestion attended with pain in the stomach, it has been associated with tonics and found beneficial. It has been employed, with equivocal advantage, as an anodyne in cancer, ticdoloureux, rheuma- tism, etc. Breva extolled it as an anthelmintic, but Elliotson has employed it Avithout the least advantage for this purpose. Antidotes. — The antidotes to this acid and those substances which contain it (as the cherry laurel, bitter almonds and its essential oil, etc.), or the rgents found most effectual in the 20 306 SEDATIVES. treatment of its effects, arc chlorine, ammonia, cold affusions, and artificial respiration. Owing to the rapidly fatal charac- ter of the j)oison, physicians are but seldom called in season to treat its effects. SPIRITUS ^THERIS NITROSI. Spirit of nitrous ether — sweet spirits of nitre — is markedly sedative in some cases. It lessens the frequency of the pulse, brings down the temperature, relieves nervous irritation, and stimulates secretion from the skin and kidneys. With the old ideas of the depressing action of the sedatives, the pliysiclau can hardly see how such results can follov/ the administration of a strong alcohol. But experiment will prove the fact, and will go far towards establishing the doctrine I have taught for years, that the medicinal action of sedatives was by improving the functional power of the heart and blood-vessels; that, instead of being depressants, they should rather be regarded as stimulants. This is now the established 'doctrine with re- gard to digitalis, is conceded by the majority with regard to aconite, and v.'ill be found equally true of the small dose of veratrum. In the fevers of childhood, when the skin, though hot, is slightly moist, a teaspoonfnl of spirits of nitre in a half-glass of M'atcr, will lessen the frequency of the pulse and lower the temperature like aconite or veratrum. There are cases in which the first can not be used, owing to its unpleasant effect on mouth and fauces, and we do not care to use the second ; this remedy may then be tried. NITRO-GLYCERINE. Preparation. — One ])art of NItro-Glycerlne is dissolved in one hundred parts of Alcohol. Dose. — Of this preparation the dose will vary from one to five drops, the small dose being advised. Therapeutic Action. — In migraine one or two droj)s of a one-per-cent solution of nitro-glycerine produces, within a few minutes, a diminution of tension in the previously corded (cmporal artery and rcllcl of the pain, which in some cases POTASSiE BICHROMAS. 307 docs not return, but in some others recurs when the physiolog- ical effects of the drug have passed off. As individuals are affected differently by 'nitro-glycerine, I always begin with one minim of a one-per-cent solution, but sometimes find it necessary to increase the dose to three or four, to produce the desired effect. In some cases of asthma, it has relieved the breathing in a most remarkable manner: the cases in which it answers are such as would be relieved by amyl-nitrite, but its effects are more marked, and the relief is more durable. In angina pectoris, the relief given by nitro-glycerine is almost complete ; but as several cases have been reported in the journals, I need only mention it. The relief in these cases is not simply temporary ease from pain, but if the remedy be given thrice daily in gradually increasing doses, beginning with one minim of the one-per-cent. solution and steadily ad- vancing to eight minims, the attacks lessen both in frequency and intensity. One of my patients, who has suffered severely from angina, always carries a bottle of the medicine in his pocket, and he tells me that, by taking a dose of five drops, when he is threatened with an attack it is always prevented. — Mr. A, W. Mayo Robson, in British Med. Journal. POTASSII BICHROMAS. Dose. — For the ordinary uses, gr. J to grs. ij. to water Siv., a teaspoonful every hour. Therapeutic Action. — Bichromate of potash exerts a specific influence upon the throat, larynx, and trachea, and to a less extent upon the mucous membrane of the bronchial tubes. It is especially when an exudation is thrown upon the sur- face, as in diphtheria and pseudo-membranous croup, that it has been found of special importance. In a case of diphtheria where the hoarseness and cough show the involvement of the larynx, and the remedies, Aconite and Phytolacca, do not con- trol the disease, they may be supplemented by this remedy. It has been employed with marked benefit in pseudo-mem- branous croup, alternating it with Aconite, and applying Stil- lingia liniment to the throat. In any inflammation showing a tendency to a low grade of deposit, bichromate of potash may he thought of as a possible remedy. 308 SEDATIVES. POTASSII CYANIDUM. Dose. — Grain | cautiously increased to gr. |-., or it may be dissolved in eight times its weight of distilled water; a solu- tion called by Magendie the medicinal hydrocyanate of potash. Dose, gtt. j. to X., in emulsion or mucilage, and cautiously in- creased till its effects are manifest. The cyanuret of potassium is a powerful sedative, possess- ing the properties of the hydrocyanic acid, for which it has been recommended as a substitute. It is employed in the same diseases, and under the same circumstances. It is employed topically in facial neuralgia, sciatica, and other forms of neuralgia, in the form of a solution or ointment. Solution, gr. j. to gr, iv., water .^j. ; or Ointment, gr. ij, to iv., adeps, oj. When added to poultices it relieves pain. An- dra^ applied it in cephalalgia, which had resisted for ten months other powerful agents, as setons, blisters, bleeding, etc., gr. viij. to water oj., and applied by compresses wet with it to the forehead and temples. POTASSII FERROCYANURETUM. Dose. — One-half ounce dissolved in four ounces of water ; one teaspoonful every three hours. Therapeutic Action. — The prussiate of potash is seda- tive, but of little activity, rarely used in medicine. Dr. Smart, of Maine, however, considered it a valuable sedative in febrile and inflammatory diseases, and thinks it astringent and useful in the colliquative sweats of phthisis; he also says it produces ptyalisni. The same writer has found it useful in neuralgia and pertussis. In over-doses it produces giddiness, coldness and numbness, with a sense of sinking in the epigastric region. It is to be recommended in ovarian irritation, and in hypera^s- thesia of the reproductive organs at the menopause. In chronic disease where there is marked irritability of the nervous system, with frequency of pulse, we will find it an ox'cellent remedy. It lessens irritation of the nervous system, and acts as a special sedative to the circulation. In chronic disease of the reproductive organs in women, with hysterical manifestations, it exerts a direct and marked influence — so in hypochondriacal affections in the male. POTASS^ NITRAS. 309 It exerts a decided influence upon mucous membranes. When they are pallid, lax, and give increased secretion, the prussiate of potash may be used with advantage. It makes little difference, whether of nose, throat, bronchial tubes, in- testinal mucous membrane, or chronic vaginitis with leucor- rhoea, the influe'.ice is tlie same. POTASSJ^ NITRAS. Dose. — Grains v. to xv., every two or three hours. The nitrate of potash, elsewhere described (see Diuretics), is diuretic, refrigerant, sedative, antiseptic, detergent, diapho- retic, antiphlogistic. As a sedative or contra-stimulant, the nitrate of potash is of great value. It is used in febrile and inflammatory diseases as a sedative or antiphlogtisic, and also to promote certain secretions, with great advantage. In diseases of a sthenic character, or when there is a phlogistic diathesis, the nitrate of potash, associated with mucilaginous "agents — ipecacuanha, 0})ium, camphor, etc. according to the indication to be fulfilled, is capable of doing- much good by reducing vascular activity, and promoting secretion. 3i0 SPECIAL THERAPEUTICS. OL^SS VI. N'ARCOTICS. l!^ARCOTics may be defined to be agents which lessen tho sensibility and irritability of the nervous system. The}' first act as excitants to the nervous and vascular systems, and secondarily, as sedatives to the sensorial and vital powers ; and if given in suitable doses, they produce torpidity of all the functions, insensibility and sleep. The encephalon, and its appendages, it would seem, are the parts upon which the influence of narcotics are principally expended. ITarcotic and sedative are generally considered as synonym- ous terms, and the general opinion is, that a narcotic agent is sedative, and vice versa. It is true, that most of the nar- cotics are sedative — their secondary influence being that of sedation. On the contrary, many articles having no narcotic property, and rarely if ever used as such, are commonly classed with narcotics, as digitalis, veratrum viride, lycopus, etc.; and again many therapeutic agents, used as sedatives, are never classed with narcotics, as nauseants, kalmia latitb- lia, prussic acid, prunus virgiuiana,, the lancet, tartrate of antimony, etc. From these considerations it will appear that, at present, no well-marked line of separation between the two classes of agents commonly denominated narcotic and sedative, exists; and yet we think there is snflicient dif- ference in their therapeutic action and applicability, to war- rant a distinction, notwithstanding the same articles, many of them, may possess properties, and fulfill indications common to both. As has already been intimated, the principal dif- ference between the two classes, consists in the j^rimaiy exci- tation consequent on the administration of narcotics — the secondary efiects in both cases are quite similar. Sedatives, however, do not possess the anodyne, or soporili:^ properties which characterize narcotics, and consequently arc adapted NARCOTICS. 311 to the fulfillment of somewhat different indieations in the treatment of disease. The latter are administered as ano- dynes and hypnotics; they alleviate pain, allay nervous irritation, counteract spasm and procure rest; while true sedatives are administered to subdue preternatural excite- meijc, to abate excessive or exhausting organic movements, and to counteract excessive vascular action. Acti07i of Narcotics. — All narcotic agents are soluble in the lluids of the bod}', and hence they are readily absorbed ; some of them are very soluble, and their absorption is imme- diate ; hence they act very rapidly. The remedy after being absorbed is conveyed by the circulation to the nervous cen- ters, and produces its specific effect upon them. Why a cer- tain agent will act as a narcotic, and what effect it has upon the nervous system is not known, and probably never will be ; we therefore have to be satisfied with a knowledge of the symptoms it produces. That this class of agents are absorbed, and are carried by the blood to the part on which they tend to act, has been proved beyond a doubt. Thus those agents will produce their specific efl'ects when absorbed from any part of the system, or when injected under the skin. Another evidence that they are absorbed into, and act from the circulation, is the celerity with which they produce their narcotic effects when applied locally. Opium, for instance, when applied to ulcers produces costiveness, headache, nau- sea, etc., and in short, the endermic or topical application of it is followed with the same unpleasant symptoms that attend its internal exhibition. The attempts to ascertain the locality upon which these agents act, has not thus far been attended with much success. Flourens was of the opinion that opium acted specifically upon the cerebral lobes; that belladonna, when the dose was small, acted upon the tubercula quadrigemina, and in large doses upon the cerebral lobes also, etc. These opinions were founded entirely upon the symptoms produced by the agent, and not by any pathological change in the part supposed to be acted upon. ISTarcotics also act directly upon the nerves of the part Avith which they are brought in contact. Thus when taken internally they prove topically sedative to the nerves of the 312 SPECIAL THERAPEUTICS. stomacli, and arc often thus used to relieve tlie pa.in in gastrodj'nia, to allay the excitement and irritation of the gastric nerves in nausea and vomiting, etc. When taken before eating they often lessen the appetite, and may even destroy it by lessening the gastric innervation ; for the same reason they retard the process of digestion — chymiiica- tion, chylification and defecation may be arrested by the paralyzing influence of the narcotic. The first sensible influence of narcotics upon the systenij when administered in either excitant or sedative doses, is an increase in the activity of the circulation and cerebral func- tions:— the force and rapidity of the pulse is augmented, the skin becomes hotter and drier, and there is increased mental and physical activity. They produce vivacity, a lively imag- ination, quicken the perceptive faculties, and give muscular vigor and courage. If, hov\' ever, the agent is administered in doses sufiiciently large, the excitement will be of short dura- tion, and the anodyne and soporific effect will be more intense and continue longer. The relative intensity of these primary and secondary effects varies in the different narcotics, and even in the same narcotic in different doses. If the dose is large, heaviness of the head, dullness of the intellectual fac- ulties, dimness of sight, muscular weakness, diminution of the motor power, prostration and loss of energy, and a tend- ency to coma are the results." In some cases vertigo, ceph- alalgia, convulsions, hallucinations, total loss of the mental faculties, — and if the dose of the narcotic is sufficiently pow- erful,— a profound coma ensues ; the pulse is full, slow and laboring; the respiration slow and stertorous; in a few hours the skin becomes cool and clammy, and the extremities cold; the pulse is feeble and threadlike, and death follows. Death is supposed to result from deficient innervation of the res- piratory organs ; the narcotic overpowers tlie brain and nervous system, due innervation is not transmitted to the respiratory apparatus, there is not sufficient aeration of the blood, and the patient dies asphyxiated. ISTotwithstanding the deadly efiects which they occasionally produce, when injudiciously taken, they can be used in suit- able quantities to secure their anodyne and hypnotic influence with as much safety and certainty of success, as emetics or NARCOTICS. ^13 cathartics, in the various cases in which tliey are pre- scribed. The modus operandi of each narcotic seems to be peculiar to itself; each seems to exert an influence over the sensibili- ties of the system, in some particulars different from any other. Thus, after one has failed to induce sleep, complete success will often attend the administration of another; and here lies the great advantage of having recourse to a variety of different agents whose general properties are the same. Therapeutic Indications. By the sedative influence of narcotics upon the nervous sys- tem, their general tendency is to lessen the secretions of the dif- ferent organs, as the liver, kidney's, mucous secretions, etc., when the parts are in a normal state ; hence they produce constipation, by lessening the secretions poured into the bowels, and by deadening their sensibilitj^ and lessening their peristaltic action. It is true there are exceptions to this gen- eral rule, for some of the agents of this class promote instead of retarding the secretions; while others w^ncli lessen them in a health}' or normal state of the organs, often restore them when diminished or arrested. In opposite pathological states of the same organ, when the secretion is either diminished or excessive, tliey often restrain it when too profuse, and promote it when scanty, and thus exert a marked control over the secretions. When speaking of opium we shall endeavor to illustrate this peculiar action, and the proper therapeutic application of this class of agents to such cases. The three principal indications which the physician wishes to accomplish by the administration of narcotics, arc the alleviation of pain, the production of sleep, and the relief of spasm. As antispasmodics their utility is dependent upon their anodyne properties. There is one circumstance con- nected with the administration of narcotics as anodynes or hypnotics which deserves a passing notice. The physician is often disappointed when he prescribes them as soporifics, when most desirous of securing repose to his exhausted and tortured patient. The disappointment springs from adminis- tering the agent in excitant, and not in sedative doses. If administered in doses not large enough to secure sleep, it 314 SPECIAL THERAPEUTICS. augments the excitement, and maintains wakefulness, and often begets a morbid vigilance. If the dose is increased, the nervous and vascular excitement, the excessive organic action and pain are alleviated, and all care and anxiety subside; the morbid sympathies are arrested, the mental and physical turmoil ceases, and the patient falls into a calm and comfort- able state of repose, to awake invigorated and refreshed. Those who clamor so vehemently against the use of nar- cotics, and offer as substitutes " relaxants, nervines and anti- spas7nGdics," deprive themselves of an invaluable class of medicines without pointing out, or being able to point out real substitutes ; they have no medicines with which they can produce the same happy and very desirable influences. If the disease in which narcotics are administered is of a protracted character, and the frequent and long-continued use of them becomes necessary, the dose will require to be augmented. The system gradually, and with more certainty loses its susceptibility to this class of agents than any other ; and hence the necessity of duly increasing the dose. With regard to their therapeutic application to particular diseases, much might be said, but we will omit many points until we come to the description of particular agents of this class. They are adapted to certain stages of almost all dis- eases ; sometimes they are prescribed as independent curative agents, but more frequently as auxiliaries, and not unfre- quently, simply as palliatives. I. Action in Diseases of the Lungs. — Opposite opinions obtain relative to the use of narcotics, and particularly with regard to the use of opium (which, in some respects, is sui generis), in the various forms of pulmonic inflammation, because it is said to arrest the mucous secretions; but it would seem that the objection to the use of this article, either in the primary or secondary forms of this class of dis- eases, is not founded upon a proper understanding of the pathological changes which follow from its use, or which take place spontaneously as the disease advances. During the early stages of pneumonia and bronchitis, the acute in- flammatory action either arrests or greatly diminishes tlie normal secretions; the suppression being due to the pathol- osrical condition of the mucous membrane. In such cases T^TAECOTICS. 315 small doses of opium would increase the intensity of the in- flammation as readily as any other excitant; and if the secretion was not arrested, but only diminished, it would entirely arrest it by its excitant influence upon the system. ISTow, if given in sedative doses, it will change the patholo- Cfical condition which caused the arrest of the secretion ; nauseating expectorants combined with it would render it doubly valuable. In sedative doses its influences would be reversed; it would lessen the intense inflammatory action which caused the diminution or arrest of the secretion, and thereby contribute to its restoration. In the advanced stages of the acute form *of the above diseases, or in their chronic form, the pathological condition of the inflamed parts has materially changed since the acute inflammation existed; which change is characterized by a,n increased or profuse morbid secretion from the mucous membrane. In this case it will diminish the secretion, by diminishing the inflammation upon which the increased secretion is dependent ; thus they may be said to promote it in the first case, and diminish it in the second. In the last stages of phthisis pulmonalis, in many cases, the administration of narcotics is an act of mercy, smooth- ing the sufferer's pathway to the grave. They lessen the irritability of the lungs, check the harrassing cough, relieve the pain, check colliquative diarrhea, and in this way not only prolong life, but make the last days of the patient, if not easy, endurable. II. Actio7i in Diseases of the Stomach and Bowels. — In gas- trodynia narcotics are valuable for their topical influence upon the nerves of the stomach ; they often produce a local torpor of these nerves, and thus relieve the severe pain. In irritability of the stomach producing continued nausea and vomiting small portions of morphia will allay this irritation, and check nausea and vomiting without producing any sensible eflfect upon the general system. The same agent is often employed in very minute doses in combination with demulcents in acute gastritis, and with marked success. In peritoneal enteritis there is a concentration of morbid sc-nsibility and irritability, connected with excited organic action in the peritoneal and muscular coats of the bowels* 316 SPECIAL THEEAPEUTICS. the tension of the parts, owing to tlie active inflammation, approaches a spasm. This concentration of vital organic action in the exterior coat of the howels, acts as a derivative to the mucous membrane, and thus its secretion is dimin- ished, and the combined influences often produce obstinate constipation. Opium, by its contra-stimulant power, lessens the inflammatory action and morbid sensibility, restores tho secretions, removes the spasm, and may act indirectly as an aperient, and even aid the action of cathartics. The same narcotic is administered in another form of in- flammation, both to restore and restrain the secretions and excretions. In diarrhea, we have an inflammation of the mucous coat of the intestines, with augmented secretion soon after the attack, and with frequent alvine evacuations, owing to increased peristaltic action. Opium lessens the undue activity of the bowels, and their morbid sensibility; it tends to arrest the inflammation by its contra-stimulant powers, changes the pathological character of the disease, and diminishes the secretions; and thus acts indirectly as an astringent. The same article in the two cases just referred to, exerts the same influence in each, yet owing to the opposite patho- logical conditions existing in the two cases, the results vary. In the first instance the secretion is increased, and a laxative influence produced; in the second, the secretion is dimin- ished, and constipation follows. For the same reason that opium is so valuable in peritoneal enteritis, it is also valuable in that painful aftection, colica pictonum, and in nervous and spasmodic colic. In tlicso cases there is a diminution of the secretions, a violent tension, or even spasm of the muscular coat, obstinate constipation, etc., attended with violent pain. In such a case, a sedative dose of opium allays the pain, resolves the spasm, promotes the secretions, and facilitates the action of cathartics. III. Action in Fevers. — In febrile and inflammatory diseases they are valuable as anodynes, as sedatives, and as diapho- retics. As anodynes they are very beneficial in relieving pain and subduing nervous irritability, which very frequently greatly aggravate the disease. As sedatives or hypnotics, tlicy induce sleep, and thus directly sustain the strength, by NARCOTICS. 317 calming the existing excitement, and allowing that repose which nature demands ; they also prevent, according to some authors, the rapid oxydation Avhich is taking place in these diseases. By subduing exalted organic action, overcoming, the tension of the muscular system, and removing cutaneous spasm, they prove highly antiphlogistic, and valuable auxil- iaries to nauseants, diaphoretics and refrigerants. TV. Action in Local Diseases. — A local injury or a morbid exaltation of organic action of a local character, from what- ever cause it may arise, very often produces general disease, and not unfrequently destroys the patient, from the severe pain and nervous irritability which it induces. Thus a burn, bruise, or abrasion of parts, a painful tumor, boils, felons, irritable ulcers, white swellings, gout, rheumatism, etc., by their high grade of local excitement, may involve the whole system in a general diseased state, through the sympathetic irritation which it produces in all parts of the system. From a w^ound or an injury done to a nerve, as by the thrust of a nail, thorn, or any sharp instrument, at any season of the year, but especially during the hot season, when there is increased irritability and excitability of the nervous system, that formidable disease, tetanus, not unfrequently results. In such cases a sedative dose of a suitable narcotic, together with the topical application of a similar agent, lessens the impressibility of the nervous system in general, and the nerves involved in particular, and prevents the cerebro-spinal centers from appreciating the local injury, until suitable means can be adopted to allay the local irritation, and pre- vent the morbid effects upon the entire system. In numerous cases of both local and general disease, the induction of sleep by the use of narcotics, which at the same time are capable of allaying pain and excessive vascular and nervous excitement, so prejudicial to recovery, and even de- structive to the life of the patient, if permitted to continue long unabated, is of the utmost importance. In cases of violent neuralgic pain, arising from loss of blood, and not dependent upon vascular repletion or cerebral inflammation, a sedative dose of opium will speedily alleviate the pain, and subdue the vascular excitement. 318 SPECIAL THERAPEUTICS. In cancerous, scrofulous and syphilitic diseases, where there is much irritation, pain and general excitement, they will prove valuable palliatives, and may, as auxiliary agents, exert a salutary curative influence. In incurable cancer, where the pain is severe, and the repose of the sufl'erer thereby interrupted, they afford great relief by allowing re- pose, and invigorate the system by securing a temporary respite from the protracted torture. ITarcotics are very important as topical agents, in painful scirrhus, or scrofulous tumors, hernia humoralis, nodes, buboes, or in any local or painful inflammatory affection. The sedative and anodyne influence of narcotics in the form of poultices, liniments, ointments, etc., renders them valuable therapeutic agents. They lessen the pain by their sedative, anodyne and emollient influence, and prove exceedingly valuable as discutients, if the suppurative process is not too far advanced. If there is no chance for discussion, they will advance suppuration. In cases of cancer of the uterus, bladder or rectum, in cases of hemorrhoids, or any painful and irritated condition of those parts, narcotics are occasionally used with much ad- . vantage as palliatives, and not unfrequently prove beneficial as curative agents. They may be used in the form of injec- tions, ointments, etc. They are of great importance in the various spasmodic diseases. As anodynes they calm and allay that morbid ery- thism of the nervous system, and the inordinate organic action upon which spasm depends. Their value is very considerable in neuropathic diseases; in all the numerous forms of which, as mania, hysteria, delir- ium tremens, etc., narcotics occasionally procure more or less relief. In many cases of troublesome cough, occurring during the cold and variable season of the year, and arising from an irritation of the pneumogastric nerves, distributed to the mucous membrane of the air-passages, and not dependent upon an inflammation, narcotics, particularly opium, or mor- phine and its salts, will alhiy the ii'ritation, and check the tickling cough, generally very promptly. NAECOTICS. 319 Conditions Contraindicating their Use. JSTarcotics are contraindicated in cases of extreiiie debility, unless they are of a stimulant character, and administered in stimulant doses, or in combination with stimulants. They are also objectionable in encephalitis, and in paralysis, unless it is connected with, or dependent upon some local irritation or inflammation ; when if other symptoms seem to demand their employment, they may be used. ISTotwithstanding the numerous cases in whicli they are used, and the immense advantage gained by their employ- ment, yet it must be confessed that their long-continued use is prejudicial to the well-being of the patient; for their gen- eral tendency is to destroy the functions of the nervous sys- tem. The same remarks, however, will apply with much force to the constant and continued use of medicinal agents generally. A dry skin, dry tongue, and hard pulse, centra- indicate the majority of narcotic remedies. They are admin- isted, when needed, when the skin is soft and moist, the pulse soft, and the tongue moist. Recapitulation. 1st. They are administered as anodynes in cases of inordi- nate and excessive pain. 2d. They are prescribed in various acute diseases, attended with morbid vigilance, as hypnotics — or with a view to the production of sleep. 3d. They are useful as antispasmodics; in spasm of any part they are used with advantage, from the fact that they diminish innervation, as well of the motor as of the sensitive nerves. 4th. They are administered as sedatives in febrile and inflammatory diseases, to allay exalted organic action, as well as to alleviate pain ; they are also administered, to secure their diaphoretic influence, either alone or in combination with other agents ; also as stimulants, when given in small doses, in the advanced stages of fever. 5th. In cases of acute pneumonia they are administered in sedative doses, to restore the pulmonary secretion. 320 SPECIAL THEEAPEUTICS. 6tL. Daring the secondary stage of pulmonic inflamma- tion, when the secretions are profuse, they are administered to check them. 7th. In acute inflammation of the mucous membrane of the bowels, they arrest the secretion, lessen the pain and increased peristaltic action, upon which the frequent purging depends. 8th. In cases of colica pictonum, or peritoneal enteritis, they allay the pain, resolve the spasm, and facilitate the action of cathartics. 9th. In injury of a nerve, or excessive local pain, they pre- vent the brain from appreciating the local lesion and pain, until suitable local applications can be made, and the morbid sensibilities lessened; and thus prevent general disease, and often save the life of the patient. 10th. In irritation of the pneumogastric nerve, attended wdth a severe cough, in irritation of the mucous membrane of the stomach attended with nausea and vomiting, they often give prompt and speedy relief. 11th. In the various forms of neurosis, they are used as sedative^, anodynes, and antispasmodics. 12th. In cases of incurable cancer, and other incurable diseases, they are resorted to as palliatives, relieving the pain, procuring sleep, and making the last days of the patient more comfortable. 13th. As topical applications in scirrhus, scrofulous and all painful tumors, painful and irritable ulcers, hemorrhoids, cancer of the uterus, etc., they are important as local ano- dj'nes, discutients and emollients. OPIUM. THE CONCRETE JUICE OF PAPAVER SOMNIFERUM.— Asia. Preparations. — Opium is given in substance (pill), in powder, in tincture, the alkaloid morphia and its salts, the sulphate of morphia being most coraraonly employed. Dose. — The dose of Opium and its preparations varies greatly, according to the condition of the patient and the indi- cations to be fulfilled. The ordinary dose of Opium is one to OPIUM. 321 two grains. Of a tincture (U. S. P. lautlanum), ten to thirty drops. Morphia is used in doses of from one-eighth of a grain to one half grain ; kirger doses should be rarely employed. Therapeutic Action. — Opium or its preparations, in fatal doses, produce the following phenomena: Vision is impaired, weakness ensues, consciousness is lost, coma supervenes, the surface becomes cold, the pulse small, respiration hurried and stertorous, occasionally convulsions, and finally symptoms of an apoplectic character are fully developed. Before insensi- bility occurs, as well as when the effects are passing ofip, the patient often experiences an itching of the skin, and in some cases a miliary eruption appears They are said to cause diffi- culty in voiding the urine, which is supposed to arise from the weakened or paralyzed state of the bladder. This last effect, according to Pereira, is more liable to follow the acetate of morphia. They are employed with benefit in all cases of excessive pain, violent spasmodic action, in cases of loss of sleep, ex- treme restlessness, in gastric irritation with nausea and voni- iting, in irritation of the respiratory organs attended with troublesome coughing and redundant expectoration, dysentery and dysenteric tenesmus, cholera morbus, cholera infantum, etc. In these cases, and many others in which they may be employed, they relieve pain and local irritation, promote rest, and in this way not only act as palliatives, checking the progress of the disease, but in many cases as curative agents — the natural powers of the system being sufficient to remove the cause of the disease, if the nervous excitement is subdued. It must be recollected that when we wish to obtain the pri- mary stimulant effects of opium, as in the low forms of fever, etc., or its influence in the suppression of morbid discharges, the salts of morphia are not so efficient in action as the crude article. We have found the sulphate of morphia a very valuable remedy in cases of excessive nausea and vomiting, as in cholera morbus, Asiatic cholera, etc. In some cases where there are indications of crude ingesta or any morbid accumulation in the stomach, a gentle emetic may be given. As soon as the stom- ach is thoroughly evacuated, the sulphate of morphia may be uiven in doses of from one-eis>hth to one-fourtii of a a'rain in 21 322 NAKCOTICS. a small quantity of cold water or lemonade, repeated as often as may be necessary, all fluids being interdicted for several hours. This course rarely fails to tranquilize the stomach, and prepare it for the reception of other remedies. In mania caused by intemperance, these agents have been found highly useful. In febrile and inflammatory affections, and various diseased states of the .system, attended with vio- lent pain and great nervous excitement, they are invaluable for relieving pain, quieting restlessness, reducing exalted or- ganic action, inducing diaphoresis, and in spasmodic states of the bowels, facilitating the action of cathartics. As topical ajjplications, the salts of morphia possess great advantages over the opium. In painful diseases of a local character, as neuralgia, rheumatism, etc., they seldom fail to afford more or less relief. In using them for this purpose, a blister is applied over the affected ])art, the epidermis removed, when they are applied to the naked derma. In cases of exces- sive nausea and vomiting, and also in gastrodynia, spasm of the bowels, etc., the same mode of employment is often pro- ductive of prompt relief. AVe occasionally adopt this mode of exhibition when we wish to bring the general system under its sedative, anodyne, and soporific influence, Avhere from cer- tain causes their exhibition by the mouth is impracticable. When used endermically, double or even triple the ordinary dose is to be employed, in order to secure their anodyne influ- ence. They are sometimes used in the form of enemata to relieve pain, dysenteric tenesmus, nausea and vomiting, when the stomach is weak and irritable. For this purpose they are dissolved in a solution of starch and mucilage. Where these preparations can not be taken by mouth, the effect is obtained by the use of the hypodermic injection of morphia. The action is prompt and certain, and there is not the danger of slow or imperfect absorption, or change of the remedy by the digestive fluids. The common solution for liypodermic injection is — I^ Sulphate of morphia gr. x., dis- tilled water 5j-, of which from gtt. x. to 5ss. may be used. Tlie hypodermic injection of morphia has been extensively employed for the relief of neuralgia, and in some cases the relief has been prompt, and permanently curative. But iu n)any other cases it only gives temporary relief, and requires OPIUM. 323 frequent repetition, with increase of dose, and is not curative. In other cases its permanent influence is bad, arresting secre- tion, impairing- the appetite and digestion, interfering with nutrition and normal innervation. To obtain the greatest relief in these cases, the injection should be used at the point of pain. This is contrary to the common use, which selects the inside of the arm as the most favorable point for injection, and trusts to its general rather than its topical action. In deep seated neuralgia, as in sciatica, I have made the deep puncture, and discharged the solution of morphia in contact with the nerve. In some cases of inflammation, in the early stage, the hypo- dermic injection has been used with good results. This has been especially the case in pleurisy and acute peritonitis (not zymotic). But when used in inflammation there must be a soft pulse, a moist skin, and a moist tongue. If the skin is dry, the tongue dry, and the pulse hard, no preparation of opium should be used, either by the mouth or by hypodermic injection. The hypodermic injection of morphia has been employed in cholera morbus, and associated with strychnia it can be used with good results. It has been used with success in Asiatic cholera, and is one of the means that should be thoroughly tested in the coming epidemic. I have used the hypodermic injection of strychnia, keeping patients alive twenty-four hours longer than they could have lived otherwise; and it is possible that in many cases the two remedies can be associated. The hypodermic injection of morphia is the treatment for •puerperal convulsions. In every case in which I have used it, it has been successful, and others give a like favorable report. The quantity injected should be from one-third to one-half grain, repeated as necessary. It has served my purpose better than chloroform, relieving the convulsions quicker, and being more permanent in its efi'ect. In surgery it may be used to relieve a patient from shock, either at the time of injury or from an operation. It is also claimed that a small hypodermic injection of morphia is a good preparation for chloroform. One thing is certain, that very much less chloroform can be used, if the patient has had mor]3hine. 324 NARCOTICS. CHLORAL HYDRATE. Dose. — From grs. v. to 5j- Physiological Action. — The physiological action of chloral has been differently interpreted. Liebrich, who first discovered its hypnotic action, also Richardson and Personne, who have thought that they had discovered chloroform in the air breathed out by men and animals treated with chloral, ascribed it to a decomposition of chloral in the body, and its conversion into chloroform by the alkaline blood. But closer examination proved that almost all the chloral taken into the body passed with the urine in the shape of nrochloral, and only a very small quantity of chloroform is formed by contact of chloral with blood, even for some time. It must, then, be rather due to the property common to diffusible chlorides, especially of organic origin, upon the cerebro-spinal centers. Chloral hydrate acts primarily and directly upon the gray sub- stance of the medulla oblongata, some gray substance of the cortex, and upon the posterior tubercular qundrigemina. The respiratory centers are primarily affected, and from them a reflex action is exerted upon depressory fibres of the pneumo- gastric of the heart, causing a reduced pressure of the blood in the arterial system, when moderate doses are taken. In large doses, the psycho-motor and motor fibres of the gray mass of the cortex of the middle cerebral lobe, are there included in its action, which is then intensified, the circulation and res- piration much affected, and complete muscular relaxation ])ro- duced. The center of the common sensation is temporarily paralyzed. The sensation of the skin and the vegetative func- tion of the body are but imperceptibly disturbed. Direct action upon the blood by chloral is very slight, nor does it coagulate albumen to any extent. Clots found in the vessels after fatal doses of chloral, are due to the slasis of the blood in the vessels from lack of propelling power in the heart and arteries. The hypnotic action seems mostly due to a sus- pension of the action of the conducting fibres from the sen- sory to the motor centers. No impression being carried from the sensory center to the motor, and especially psycho-motor, the body rests, that is, it is in an inactive state, very much CHLOKAL HYDRATE. 325 akin to that of natural sleep and hybernation. It is in no wise an ana3sthetic; but tlie lack of perception of sensation is there, the same as all rellex motion (exce[)t that carried on in the vegetative organs) is extinct. — Pi'of. Jeancon. Tpierapeutic Action. — It has been asserted that chloral is as good a poison as strychnia. Chloral, like all ])0\verful drugs, has a therapeutic and a poisonous action. Whether it will act as a poison or as a medicine will be determined by the quantity given and the circumstances under Vt^hich it is admin- istered. It is a well established fact that the drug in full doses depresses the centers at the base of the brain, i-enders respira- tion slower, weakens the heart's action, lowers the tempera- tui'c, and produces muscular relaxation. It follows, then, that chloral, in cases of great depression, is a poison. It should never be given when the heart action is feeble. As a hypnotic, by its action on the cerebrum, chloral is val- uable when sleeplessness results from great excitement of the nervous system. AVhen inability to sleep results from severe pain, chloral is inferior to many drugs that we possess. As an antispasmodic, when not contra-indicated by de[)res- sion, we may employ it in spasmodic diseases. Puerperal con- vulsions may be checked by the drug. After a full dose of morphia administered hypodermically, the patient may bekept quiet with chloral. In tetanus chloral will help to control spasm, but too much reliance must not be placed in it. In delirium tremens the drug is much relied upon by some physicians, and often improperly administered ; the depression met with in old topers renders chloral a dangerous hypnotic In those cases where we have great excitement, increased tem- perature, and flushed face, chloral may be employed to })roduce sleep. Where the face is pale, skin bathed in perspiration, circulation feeble, and muscular system relaxed, chloral is contra-indicated. In acute mania, with inability to sleep, we may place great reliance on chloral; if not contra-indicated I regard it as the best hypnotic at our command. In cases where great increase of temperature with excite- ment and inability to sleep follow surgical operations, chloral may be em[)loyed as a hypnotic with great advantage. Ill obstetrical practice, I have used chloral with good effect. 326 NAKCOTICS. The distressing pains in the first stage of labor, may be ren- dered less exhansting, and rigidity of the soft parts overcome Avith this drug; severe after pains may be quieted with cliloral. As a local application, chloral may be used as a stimulant and deodorizer to indolent and bad smelling wounds. Twenty grains to the pint of water forms a good api)lication. Trit- urated with camphor in equal proportions, it forms a fluid which, if painted upon parts suffering with neuralgia, giv'es at least temporary relief. — Prof. Locke. HYOSCYAMUS. THE LEAVES qF HYOSCYAMUS NIGER,— Eueope Prepaeations. — Extract of Hyoscyamus. Tincture of Hyoscyamus. Hyoscyamia. Dose. — The dose of the extract will be from gr. one-half to grs. ij. ; of the tincture from gtt. j. to 5ss. ; of Hyoscyamia gr. one-sixtieth. Hyoscyamus is Narcotic, anodyne, sedative, and antispas- modic; it is one of the most important agents belonging to the class of narcotics. Its effects upon the system vary very much according to the dose administered. In small doses it acts as an excitant; but if frequently re- peated, it has a sedative and tranquilizing influence upon the system. This is especially the case with patients of a highly nervous and irritable habit of body; in such it lessens irrita- tion of the general system, and diminishes the morbid sensi- bility existing in any organ. Many autliors do not admit that it exerts a primary excitant action. It does not induce constipation, like opium; on the contrary, it frequently ])roves laxative, and occasionally acts as a diaphoretic and diui-etic. 1)1 large doses hyoscyamus acts as an acjro-narcotic jioison. The symptoms which evince its acro-narcotie action arc thirst, nausea and vomiting, violent pain in the bowels, purging, dis- turbance of vision, distortion of the face, dilated pupils, loss of speech, prostration, coma, delirium, paralysis, petechia, convulsions, etc., followed by death. Upon dissection, the stomach and bowels exhibit evidences of inflammation. BELLADONNA. 327 In medicinal doses the Hyoscyamus is fomul to be very val- uable fur its soothing and tranquilizing intiiienee over the nei'vous system, especially in those cases in which, from idio- syncrasy, the opium is found to be inadmissible. It alleviates pain and irritation, pi'omotes sleep, secures quietude, and counteracts spasm. For any of these purposes, however, it is far inferior to opium, and especially as an anodyne and hyp- notic, unless it is in those cases in which opium causes head- ache, torpor of the bowels, and otlier unpleasant effects. Hyoscyamus is employed as an anodyne in violent painful affections, in many cases with much benefit. Among the dis- eases of this character in which it has been found beneficial, may be named gouty disorders, rheurantism, neuralgia, scir- rhns, carcinoma, periostitis, pleuritis, pneumonitis, trachitis, painful abscesses, nocturnal syphilitic pains, painful affections of the genito-urinary organs, violent colic pains, painful spasmodic disorders, etc. BELLADONNA. ■ TilE LEAVES OF ATROPA BELLADONNA.— EUEOPE. Peepaeatioxs. — Tincture of Belladonna. Extract of Bel- ladonna. Atropia. Dose. — The dose of the tincture will vary from the frac- tion of a drop to five drops. For its specific use we add gtt. v. to gtt. XX. to- water Siv., and give a teaspoonful everv hour. The extract may be used in doses of from gr. 1-20, to gr, 1-2, according to the action desired. The dose of Atropia is from gr. 1-100 to gr. 1-20. Specific Indicatiojn^s. — The patient is dull, inclined to sleep, the eyes are dull and pupils dilated — the condition of congestion of the brain, of w'hich coma is a further symptom. Impairment of the capillary circulation with congestion, in any ])ortion of the body, is an indication for Belladonna. The skin is red, and the finger drawn across it leaves a somewhat permanent white line; dusky redness of the surface from cap- illarv congestion, calls for Belladonna. A very free flow of urine — diabetes insipidus — is an indication, as is deep aching of the loins or back with sense of fullness. A dull heavy head- 328 NAKCOTICS. ache, with a feeling that the person could go to sleep if it were not for the pain, is a common indication. Therapeutic Action. — Belladonna is sedative, narcotic, antispasmodic, diaphoretic and diuretic, and is a powerful nar- cotic or cerebro-spinant. It greatly diminishes tlie sensibil- ity and irritability of the system when morbid states obtain, and in the healthy state its effects are as follows. It occasions dryness of the mouth .and throat, thirst, visual illusions, di- lated pupils, giddiness, delirium, singing in the ears, or im- paired hearing, numbness of the face, difficult deglutition, and articulation, sense of constriction about the throat, nausea, occasionally vomiting, a cutaneous eruption like scarlatina, and an increase of the cutaneous, renal and mucous secretions. If the quantity taken be large, the pupil becomes largely dilated and immovable, and the eye quite insensible to light, conjunctiva injected, tongue, palate, and throat dry, deglutition difficult, nausea, prostration, difficulty or inability to maintain the erect position, constant movement of the hands and fingers, delirium or intoxication, a red and tumid face, sometimes fits of laughter, and sometimes furious delirium ; finally the pa- tient becomes comatose, the stomach and bowels lose their im- pressibility or normal sensibility, and the whole nervous sys- tem seems to be paralyzed. "A feeble pulse, cold extremi- ties, subsultus-tendinum, deep coma or delirium, and some- times convulsions, precede its fatal termination." In the modern practice of medicine we employ it as a rem- edy for congestion. It stimulates the capillary blood-vessels in all parts of the body, but more especially in the brain and spinal cord. In congestion of the brain it has no equal. The patient is dull, and inclined to sleep most of the time, the face is dull, expressionless, the eyes are dull, the pupils are dilated. AVhcre the face is flushed the color is dusky. This it will be remem- bered is a common complication in the acute diseases of chil- dren, and with the old means of cure arc unfavorable condi- tions. We meet this condition now with small doses of Bel- ladonna, gtt. V. to gtt. X., water siv. ; a teaspoonlul every hour. In very small doses, gtt. ij. to gtt. v. to water .^i^., a tea- sj^oonful every four hours, it is a prophylactic against scar- let fever. Not that it will antidote the contagion in all cases. STRAMONIUM. 323 for we must be satisfied if it will do it in a part. I have been called to a first case of scarlet fever in a family of four to eight children, and with the prophylactic administration of Belladonna, have had no other cases, or but one or two more. I have used it in my own family with these results. But if it does not prove prophylactic, it will have done no harm, and iiulecd I have thought when Belladonna had been taken the disease was much mikler. Belladonna is a valuable remedy in diabetes insipidus, and even in diabetes mellitus it checks the flow of urine in some cases. It relieves the unpleasant sense of fullness and weight in the loins and the weak back. In some cases a Belladonna plaster applied to the back across the loins, will have tiiis effect. It is a valuable remedy in sore throat, whether diphtheritic, scarlatinal, or the ordinary sore throat. For this purpose it may be administered with Aconite, Phytolacca, or alone. In chronic disease of the brain, with sense of fullness, diz- ziness, drowsiness, dull heavy aching, it is an admirable rem- edy. It is to be thought of when indications of apoplexy are observed, there being the dull eye, dilated pupil, and drow- siness. It is the remedy for headache, when the pain is dull and heavy, and the patient feels sleepy. STRAMONIUM. THE LEAVES AND SEEDS OF DATURA STRAMONIUM.- U. G. PnEPARATiONS. — A tiucture of the fresh leaves. An oint- ment of the fresh leaves. Dose. — The dose of the tincture will be from the fraction of a drop to five drops. Specific Indications. — Acute delirium (maniacal), when the patient is passionate and violent. The patient can not control his tem[)er, feels an almost uncontrollable desire to destroy something, or injure somebody. Therapeutic Action. — Stramonium is described as nar- cotic, antis[)asmodic, sedative, and andodyne; it is a powerful narcotic poison, closely resembling the Belladonna in its effects on the .'system. In small and repeated doses it lessens the 330 , NARCOTICS. sensibility and often alleviates pain, but does not induce sleep. By mitigating- pain, however, and tranquilizing the system, it may indirectly dispose to sleep, but it can not be regarded as a soporific. If the dose be large, it causes thirst, nausea, vertigo, head- ache, dimness or perverted vision, dilated pupils, dryness of the throat, sensation of suflbcation at times, with peculiar de- ranged sensations about the fauces, oesophagus and trachea, nervous agitation or disturbed state of the cerebral functions, and may cause diaphoresis, diuresis, and relaxation of the bowels. The pulse is but slightly affected. " In fatal doses the leading spraptoms are flushed countenance, delirium (usu- ally maniacal), dilatation of the pupil, dryness of the throat, loss of voice, difficulty of deglutition, convulsions, and, in some cases, palsy." If the dose is not excessive these effects subside in five or six hours. If the dose is large, it may cause stupor, convulsions and death. The diseases in which it has been employed with most ad- vantage are those of a nervous character, as neuralgia, or tic- douleureux, mania, epilepsy, etc. In rheumatism, sciatica, etc., it often affords relief, and in spasmodic pain of the bowels, unattended with inflammation, and in syphilitic pains it has been found useful as an anodyne. It has acquired considera- ble reputation in mania and epilepsy. A large number of cases of the tw^o diseases are reported, in which it is said to have either cured or greatly mitigated the attending symp- toms. It has been found useful in dysmenorrhea, when attended with nervous irritation. In some cases it affords prompt and permanent relief. The seeds of Stramonium are esteemed valuable to prevent abortion, it has been found to give speedy and certain relief, by Prof. Baldridge, Dr. Wade and others. Dr. Wade asserts he has used it in cases attended witii violent bearing-down pains and every symptom of a speedy abortion, with perfect success. We employ it now as a remedy in the maniacal delirium that is sometimes met within fevers and inflammations. This is a very unpleasant complication, and in zymotic fevers almost invariably fatal under the ordinary treatment. Five CONIUM. 331 to twenty di-ops may be added to a half glass of water, and give in teaspoonfnl doses every iialf lionr or hour. The dried leaves are smoked for asthma. Fomentations of stramonium leaves hot are used in the early stages of inflam- mation to relieve pain and check determination of blood. The stramonium ointment is employed as a local application to irritable hemorrhoids, and especially in that unpleasant hy- pertrophy of the skin about the anus whicli is attended with pruritus, and sometimes with sero-purulent secretion. CONIUM. THE LEAVES. OF CONIUM MACULaTUM.— Europe Peeparations. — Tincture of Conium. Extract of Conium. Dose. — From the fraction of a droj* to five drops of the tincture. Of the extract, gr. ^ to gr. 5. Therapeutic Action. — Hemlock is narcotic, antispas- modic, sedative, alterative, and resolvent. It is a very pow- erful narcotic, and when administered in large or poisonous doses, it produces vertigo, dilated pupils, impaired vision, de- lirium^ convulsions, coma, difficulty of speech, tremors, paral- ysis, and ultimately death. Its modus operandi is not exactly understood. On examinations made upon the bodies of those animals destroyed by hemlock, venous congestions, congestions of the cerebral vessels and a fluid condition of the blood, are appearances occasionally presented. It is sometimes used as an anodyne and hypnotic in painful glandular enlargements, scirrhous and cancerous ulcers, noc- turnal and syphilitic pains, rheumatism, neuralgia, etc., with evident advantage. Enlargement of the viscera, as the liver, spleen, pancreas, mesenteric glands, scrofulous tumors, carci- nomatous affections of the breasts, testicles, uterus, and other internal organs, tertiary syphilis, foul and painful ulcers, indu- rations of glands, obstinate cutaneous diseases, as lepra, herpes, elephantiasis, chronic catarrh, phthisis, bronchocele, etc., are a few of the numerous diseases and cachectic and depraved states of the system in which the hemlock has and may be adminis- tered, with a view either to its palliative or curative action. 332 NARCOTICS. CANNABIS. THE RESINOUS EXUDATION FROJI THE PLANT CANNABIS INDICA.— Asia. PREPxiriATiON. — A tincture is prepared from the Gunga or Churrus imported from India. Dose. — The dose will vary from the fraction of a drop to five drops. In the majority of cases gtt. xx. is added to water .5iv., and given in teaspoouful doses every two to four hours. Specific Indications. — Burning in the urethra and throughout the urinary tract. Frequent micturition with burning. Excitement of the reproductive function with erec- tions, lascivious dreams and thoughts. Chordee. Gonorrhoea. Therapeutic Action. — Indian Hemp is said to be nar- cotic, anodyne, antispasmodic, sedative, and aphrodisiac. It has been used mostly as a sedative in painful spasmodic aflFec- tions. In neuralgia, sciatica, and chronic rheumatism, it lias been found to be quite efficient. In convulsions, coughs, asthma, and pertussis, it is said to mitigate the urgent synij)- toms. It enjoys some reputation as a curative agent in tetanus and hydrophobia, owing to its sedative action. We employ Cannabis principally in the treatment of gonor- rhoea, where it exerts a most marked influence. In the early stage of the disease it is given with Veratrum or Gelseminum, in a later stage with Macrotys. In some cases it proir[)tly arrests the disease, in others its action is slow", but I prefer it to the old-fashioned copaiba and cubebs. If one will carefully note the indications as given, they will see that its use may be extended to wrongs of the re[)roduc- tive functions and to diseases of the bladder and ijrostate gland. I have found it useful in some diseases of women, where hyperesthesia of the genitals was a prominent feature. T A B A C U M . THE LEAVES OF NICOTIANA TABACUM.— U. S. Therapeutic Action. — Tobacco is described as narcotic, sedative, antispasmonic, emetic, diuretic, laxative, errhino, sialagogue and discutient. In over-doses it is a powerful acro-narcotic poison. In smaller doses It produces a sensation of heat in the throat and TABACUM. 333 warmth in the stomach, v'ith nausea, diuresis, and sometimes purging. It also quiets restlessness, calms mental and corpo- real inquietude, and produces a state of general languor or repose. If applied to the nose, it excites a copious flow of mucus, or if chewed, the flow of saliva is greatly increased. In larger doses it produces extreme nausea and vomiting, 2)urging, great prostration, and other symptoms indicative of its violent acro-narcotic qualities, such as languor, muscular relaxation, trembling of the limbs, faintness, great anxiety, impaired vision, confused intellect, pulse small and feeble, res- piration laborious, cold and clammy state of the surface, and in extreme cases convulsions, alarming and even fatal prostra- tion. The most common symptoms are nausea, vomiting, in some cases purging, relaxation of the muscles and extreme prostration, with great depression in the action of the heart and arteries, manifested by a feeble pulse, paleness of the face, cold sweats, tremors, paralysis, stupor, etc. Its primary ac- tion is upon the brain and nervous system, as is manifested by its capacity to reduce iirst the nervous, and secondly the vas- cular powers. This view of its action is demonstrated by the experiments of Sir B. Brodie, who, after decapitating animals, injected an infusion of tobacco into the rectum, and kept up artificial respiration, and thus sustained the action of the heart and arteries, while an equal quantity of the poison injected into the rectum of a healthy animal, or introduced into the stomach, soon paralyzed the heart and caused death. It is liable to produce the effects stated, when used to excess, by taking it into the stomach, smoking, using it in the form of injections, or applying it to the abraded surface. The practice of chewing and smoking, now so common throughout the M'orld, is the most disgusting, filthy, and loathsome of any to which the perverted taste of man can become habituated. These vices, so highly relished by many, are quite as obnox- ious to others ; and if we say nothing about the dyspepsias which they occasion, or the disordered innervation, emaciation, general debility and nervous prostration, with a train of sym- pathetic derangements which they produce, there is still enough to call loudly for reformation. Tobqcco is a potent agent in spasmodic colic, ileus, stran- gulated hernia, obstinate constipation from peritoneal inflam- 334 NAKCOTICS. mation and other causes, employed in the form of euemata. It should be employed very cautiously, at first very small portions being used. In incarcerated hernia, it is a remedy of great power. The tension of the parts is soon removed, the tumor becoming soft and relaxed. " In colic from lead, and in obstinate con- stipation from spasmodic constriction, the tobacco clyster has sometimes proved most beneficial." — Pereira. In dysentery, the tobacco injection is said to afford great relief. — Dr. O'Brien. In lead colic, compresses, soaked in a decoction of tobacco and applied to the abdomen, have been recommended by Dr. Graves. In tetanus, the tobacco clyster has often proved valuable, having afforded relief after other means had failed. In periodical epilepsy, by the application of the tobacco cataplasm to the scrobiculus cordis before the paroxysm, it was prevented. The cataplasm, applied to the throat in spasm of the rima glottidis, gave relief. — Dr. Wood- In spasmodic asthma, either smoked or taken internally, in nauseating doses, it often affords relief. As a topical remedy, it is anodyne and sedative, and as such may be used in neuralgia, rheumatism, gout, glandular inflam- mations and swellings, as the testicles, buboes, scirrhous and scrofulous tumors, erysipelatous inflammations, phimosis and paraphimosis, painful hemorrhoidal affections, etc. CAMPHORA. THE CONCRETE VOLATILE OIL OF CAMPHORA OFFICINARUM.— Asia. Prepaeation. — Tincture of camphor. Dose. — The dose will vary from the fraction of a drop to ten drops. Therapeutic Action. — Camphor is described as narcotic, excitant, diaphoretic, antispasmodic, anodyne, anthelmintic, expectorant and rubefacient. While some describe it under the class of Narcotics, others refer it to Stimulants, and others to Diaphoretics or Antispasmodics; while some, extend a sepa- rate notice to it under each of these classes. LACTUCARIUM. 335 Camphor acts specifically on the nervous system, producing an anodyne and exhilarating inlinence upon it. In large doses it disorders the mental faculties, external senses and volition, causing lassitude, giddiness, impaired vision, drowsiness, de- lirium, stupor and convulsions. In small portions it acts as a vascular excitant, increasing the fullness of tiic pulse, and somewhat its frequency, and the temperature of the body ; and if the surface be kept warm, it promotes diaphoresis, especially if conjoined with opium. Camphor is sometimes useful in fevers and inflammatory diseases, particularly in low grades, or those of a typhoid character, when attended with a frequent, irritable pulse, dry skin, restlessness, morbid vigilance, subsultus, low muttering delirium, etc. In these cases it determines to the surface, and favors diaphoresis ; while it augments the fullness of the pulse without materially increasing its frequency. It likewise les- sens or arrests the irregular muscular contractions, and seems to calm nervous excitement, tranquilize the system and dis- pose to sleep. Its utility in these cases is often greatly in- creased by combining it with opium, ipecacuanha, carbonate of ammonia, capsicum, or quinine, according to the indica- tion desirable to be fulfilled. ' It is also valuable in other forms of fevers, either alone or conjoined with other remedies to promote diaphoresis. LACTUCARIUM. THE INSPISSATED JUICE OF LACTUCA VIROSA.— U. S. Dose. — One to five grains. Therapeutic Actiox. — ^Xiactucarium is narcotic, anodyne, sedative, diaphoretic, diuretic, hypnotic and antispasmodic. It is a valuable anodyne and palliative in many affections at- tended with nervous irritation and vascular excitement, when opium is not an appropriate remedy. While opium acceler- ates the pulse and produces either stupor or delirium, the lac- tucarium alleviates pain, diminishes the rapidity of the pulse, reduces the animal heat, and disposes to sleep. It is, however, to be regarded as an anodyne and sedative, rather than hypnotic. In these respects its action or effects upon the system resemble those of Hyoscyamus. 336 NARCOTICS HUMULUS. LUPULINA. THE STROBILES OF HUMULUS LUPULUS. THE YELLOW GLANDULAR POWDER SEPARATED FROM THE STROBILES. Peepaeations. — Tincture of Humulus. Tincture of Lupulin. Dose. — The dose of the first will be from gtt. v. to oss.; of the second, gtt. j. to gtt. x. Of Lupulin grs j. to grs. x. Therapeutic Action. — In cases of nervous irritability attended with wakefulness, hops are anodyne and hypnotic, and are frequently exhibited to alleviate pain, tranquiiize the system and procure sleep ; even a pillow filled with hops and moistened with spirits, favors this desirable end. In delirium tremens, morbid vigilance and nervous excitement, they fre- quently compose the nervous system, while at the same time their tonic and stomachic properties impart increased en- ergy to the organic actions, rendering them of great utility in debilitated and irritable states of the nervous system. Well hopped ale is valuable as a tonic and stomachic, especially in nervous habits, during the convalescence of many diseases, owing to the hops which it contains. The hops (as well as the wort), are thought to be diuretic, and have been employed to correct the lithic acid deposits. Lupulin may be administered in the same cases in which the hops are recommended. The effects are even more cer- tain, while its exhibition is attended with much greater con- venience. In all cases when a feeble anodyne is required, and when opium is inadmissible, this agent is useful, as in spasm of the stomach or bowels, after-pains, and irritable states of the nervous system. S O L A N U M. THE PLANT SOLANUM NIGRUM.— U. S. Preparation. — A tincture is prepared from the fresh plant when flowering. Dose. — The dose will vary from the fraction of a drop to five drops. Specific Indications. — The room seems to be turning round, and wlien the patient shuts his eyes, the bed seems as PLANTAGO., 337 if turning, and he will fall out; dizziness; mind wanders, and patient fears that he will lose it. Skin is flushed red, and the patient sinks into a stupor, with stertorous breathing. Therapeutic Action. — The Solanum is but little used in medicine, though it is a powerful agent, and should be made to serve a good purpose. The indications given will point the way to a better study, when I hope we may be able to define its uses better. There are some chronic diseases of the brain which show the symptoms named, and some acute diseases that give us the peculiar red, hot (and moist) skin, with stupor, that would cause us to select this remedy. It will be noticed that its action is somewhat like Belladonna. GUARANA. THE PREPARED SEED OF PAULLINIA SORBILIS.— Brazil. Preparation. — Tincture of Guarana. Dose. — The dose will vary from one to ten or even twenty drops. Therapeutic Action. — The action of Guarana is some- what analogous to Caifeine. Its primary effect is that of an excitant to the brain and spinal cord, and this is followed by a sense of exhaustion and a disposition to sleep. Its principal use thus far has been as a remedy for head- ache, for which it was advertised as a specific. In my opinion it relieves those cases where we would give ether or ammonia. But I have seen it given in doses so large that the cure might depend upon its secondary narcotic action. It has also been used and recommended as a tonic, a remedy for dyspepsia, diarrhoea and dysentery, leucorrhoea, and pain- ful menstruation. TONGA. IMPORTED PROM FIGII— SOURCE UNKNOWN. Preparation. — Fluid Extract of Tonga. Dose. — From ten drops to one drachm. Therapeutic Action. — This agent has been employed in the treatment of neuralgia with great success, and those adver- tising it claim it to be specific. Dr. Ringer says of it: — ;?/; 338 NAKCOTICS. " This remedy, whilst apparently highly useful in neuralgia, produces no toxic symptoms, ibr we have given two half-ounce doses of the liquid extract at half an hour's interval, and re- ])eated it again in two hours, without producing any effect except slight drowsiness. These doses did not aifect the pupil, nor increase nor lessen the secretion of the mouth or skin ; neitlier did they affect sensation of the skin supplied by the fifth nerve. PLANTAGO. THE PLANT PLANTAGO MAJOR.— U. S. Preparation. — A tincture is prepared from the fresh plant when coming into flower. Dose. — The dose will be from the fraction of a drop to five drops. Specific Indications. — Toothache; the teeth are sore; the tooth becomes sensitive; the jaws ache; pain in the temples, extending to the teeth. Therapeutic Action. — This remedy has been employed for the relief of toothache with most excellent success. The cavity of the tooth is well cleansed, and then filled with cotton wetted with this tincture ; a second or third application will sometimes be required before relief is obtained. I have em- ployed it internally for toothache, and for neuralgia associated with toothache. In some cases it has given marked relief when everything else had failed. In all these cases it seems to exert a soothing influence upon the brain, and promotes sleep. It has been given in incipient phthisis, hemorrhage from the lungs, menorrhagia, leucorrhoea, dysuria, and hemorrhoids. PISCIDIA. THE BARK OF THE ROOT OF PISCIDIA ERYTHRINA.— Jamaica. Preparation. — Tincture of Piscidia — Jamaica Dogwood. Therapeutic Action. — It is claimed that the Jamaica Dogwood exerts a marked influence upon the brain, lessening irritation and producing sleep. I have liad no experience with the drug, but hope it may not prove like many other new remedies, to have its principal action upon the physicians and druggists' pockets. BKOMIDE OF POTASH. 339 POTASSII BROMIDUM Dose. — From two to thirty grains. Therapeutic Action. — In moderate doses bromide of potassium lessens the excitability of the nerve centers, quiets pain and produces sleep. In large doses it is an irritant to mucous surfaces, and if continued produces symptoms of bro- midism. Though freely prescribed by many physicians, we think its narcotic power very much over-estimated. If the cases are well selected, and care is used to keep everything quiet, it will cause sleep. It has been combined with chloral, and the com- bination has been deemed better than the single remedy. It is recommended in delirium tremens, but will hardly take the place of chloral, or the hypodermic injection of mor- phia. It is of use in the delirium of acute disease, but is only of advantage in cases showing muscular tremor. It is a valuable remedy in some cases of cholera infantum, restlessness and sleeplessness being prominent symptoms 340 SPECIAL THERAPEUTICS. CLA.SS A^II. STIMULANTS. Stimulants are medicines which produce a temporary increase of one or more of the vital functions. A much more comprehensive signification is often given to this word ; thus, the true stimulant, the astringent and tonic, are distinguished as general stimulants, while emetics, cathartics, diaphoretics, diuretics, emmenagogues, sialagogues, errhines, parturients, etc., are termed local stimulants. In this sense every medi- cine is a stimulant, not excepting, according to many authors, even " sedatives.'' But it is not in this wide and indefinite sense that the word can with propriety be used in the classification of remedial agents. The term stimulant or excitant is here applied to those medicines which produce a temporary increase of the action of the heart and arteries, and in the supply of nervous energy, without any sensible increase in the evacuations or secretions. The first efl^cts of narcotics are those of stimulation, yet we do not consider them as true stimulants. Many agents, however, which we have classed as stimulants, after exerting their stimulant effect, are followed by nervous depression or sedation ; as the alcoholic liquors, etc. It must be admitted that many of the difterent classes of remedial agents glide by an indefinable gradation into each other, and partake of the properties common to other classes. It will also be recollected that numerous articles of the mate- ria medica are possessed of a variety of different properties, — thus we often have an agent possessed of stimuhmt, dia- phoretic, diuretic, expectorant and purgative properties. From these remarks it must be apparent to all that our pres- ent classification is erroneous, or at least not based upon an unobjectionable foundation. "We shall, however, pursue the STI.M'JLANTS. 341 beaten track, ackiiowlcnln-'mg at the same tunc our inability to contine particular medicines to the respective classes under which they may be technically ranked. Action of StlDiuhoits. — Stimulants belong to the class of 7icurotic medicines; that is, they act upon the nerves, and as we have already seen, the action of such remedies is transient. The question has been much discussed, whether stimulants really exalt nervous force (increase its quantity), or whether they merely call it forth (expend that which already exists). We are led to believe that stimulants really increase the amount of nervous force ; for if they did not, we would always have as a result of their use a depression corresponding with the primary excitation — which is not the case. Again, we may maintain a certain degree of stimulation for an indefi- nite period by continuing the use of the remedy, wdiich we could not do, if they merely expended nervous force without causing a reproduction of it. We must, however, carefully distinguish between nervous and vital force ; for nervous force may exist in excess, when the vital force or that power w^hich preserves life, is depress- ed. "l!«[ervous force," says Headland, "may be very much increased, as in high inflammatory fever, without a correspon- ding increase of the vital. The advantage of a stimulant is regulated by this rule. — When there is a failure in vital e)i- ergy, no stimulant will serve to prolong life, for it can not communicate fresh vital power. But there may be no such failure of vital energy, and yet a sudden or accidental defi- ciency of nervous force may serve to peril the continuance of health, or even the tenure of life.^ For a certain degree of this nervous force is necessary both for life and health. When it is diminished, all the functions must sufter : w^hen it fails entirely, the circulation must stop and death ensues. It is in these cases that a stimulant medicine is appropriate. It does not do good by communicating vital energy, but by remedying the want of nervous action, by which want the manifestation of the vital energy is subdued. This must always be borne in mind when the applicability of stimulants is under consideration." The first effect of a stimulant is that of a topical excitant. When taken into the stomach, they stimulate the mucous 342 SPECIAL THERAPEUTICS. membrane to Increased secretion, and the muscular fibers to greater activity; the food is more readily and rapidly digest- ed, and chylosis facilitated. This local stimulating influence is transmitted to every portion of the body by sympathy, and the whole system participates in the excitation. All stimulating agents are soluble in the fluids of the bodj', and are hence absorbed into the circulation, and by it brought into contact with the entire nervous system. These agents, as we have already noticed, prove stimulant to any nerve with which they are brought into contact; thus we Inive the topical stimulation of the stomach, the topical stimulation when applied to the skin, etc. We thus see that they act directly on nerve-matter, whenever brought in contact witb it; and through the circulation they are brought into direct contact with the entire nervous matter of the body. As the result of this, the contractions of the heart are increased in force and frequency, the pulse becomes more energetic and frequent, respiration is accelerated, animal heat augmented, the countenance is enlivened, the intellectual and physical powers increased, and the cutaneous and renal secretions exhibit increased activity. They produce a temporary exhil- aration of mind, revive and elevate the spirits — in a word, the phenomena of health are active when the system is un- der their influence, unless overpowered by disease. In some cases the excitation, when carried too far, or too long con- tinued, may result in febrile or inflammatory action. The super-excitation which follows their too free use, often results in prostration, though this is not always proportioned to the intensity of the previous excitement. As has been already remarked, many stimulants exert an especial influence over particular secretions, or overparticular organs. Thus the carbonate of ammonia is diaphoretic as well as stimulant; the cantharides and juniper diuretic; while the turpentine, gum-resins, copaiba, benzoic acid, etc., though stimulants, exert an especial influence upon the mucous membranes, diminishing excessive secretion — and especially is this the case with the genito-urinary mucous membrane. Those agents, generally denominated tetanies, ov muscular stimulants, as the strychnia and brucia, arc peculiar agcurs. STIMULANTS. 343 whose excitant influence appears to be exerted upon the motor column of the s})inal cord, the motor parts of the brain, and the motor nerves. Thus, in large doses, they cause spasmodic and powerful contractions of the muscles of the body, and they may even produce death in this wa}', by ren- dering respiration impossible. In order that these agents should produce their specific effect, two things are necessary: first, that the muscles to be acted upon should be in a normal condition ; and second, that the nerves passing from the nerv- ous centers to them must be sound, so as to afford a medium for the passage of the increased nervous current. It is proved that they act upon the nerves, and not upon the muscles, by the fact, that when the nerves are injured, so that they can not convey an impression, these agents have no effect upon the muscles, though every other condition is present. As has been before stated, the moderate use of stimulants renders digestion more rapid and more p)erfect, the circula- tion is more vigorous, and its centripetal or congestive ten- dency is superseded by the centrifugal, and all the secretions are facilitated. But if they are too freely used, if the dose is large and too often repeated, or administered with any great degree of persistence, their sanative powers are lost, and they become engines of disease. If too freely employed, irritation, or even inflammation may supervene in the organ with which they come in direct contact — or in a neighboring one, and symptomatic fever may result ; under which many of the functions instead of being promoted by the stimulant, will be retarded. This is the case with the secretions and excre- tions generally — they are always deranged during febrile excitement. Another result follows from exalted organic action, whether it depends upon artificial stimulation, or is the result of dis- ease ; that is, the exalted action is always followed by de- pression to a greater or less extent. This is the case with either mental or physical excitement, prostration being always the result of it, when carried to an extreme. Pros- tration is always the more marked the greater the stimula- tion. To a certain point stimulation maybe carried without subsequent prostration ; but passing beyond this point, we may say that it is proportioned to the amount of stimulation 344 SPECIAL TIIERAPEUnCS. If one organ is over-excited in any way, some other organ is apt to become equally depressed, or to take on a state of inactivit}', atony or debility. We frequently meet with cases of extreme debility of an organ, or of the general system, when the debility is apparent, but not real, some other organ being over-excited, thereby causing the apparent prostration. This is often a nice point to determine in the progress of disease, and one upon which the most expert diagnostician will sometimes err. "When the prostration is but apparent, and depends upon some local and deep-seated congestion or inflammation, which is oppressive to the vital powers, a course of depletive medication, instead of increas- ing the debility, will often increase the strength, by removing the congestion or cause of oppression, and apparent debility : wdiereas, if the debility had been real, the same mode of medication would have destroyed the patient. The morbid condition, atony or debility of one organ in- duced by over-excitement of another, arise from the with- drawal of the due nervous impressibility and diminished vascular stimulus from the atonic organ, by its concentra- tion upon the one undergoing the undue and artificial stimu- lation. There are numerous cases in which excitants are of great importance, yet the extent of excitation indicated in disease, is a matter of interest to the physician as well as to the patient ; for it must be confessed, the general tendency of the too free and protracted use of this class of agents is to impair the vital energies of the general system, when general stimulants are used, .or of particular organs, when special ones are used, and finally, to wear out the natural sensibility and excitability of the organ, or even the whole system. It may be asserted, we think, as an axiom, which can not be controverted, that super-excitation in a single organ, or in the whole system, whether it is dependent upon excrementi- tious matter retained in the system, and acting as a source of irritation, or is the result of incessant heating or stimu- lating medication, is always compensated for by a corres- ponding loss of action in some other organ or organs, or even in the entire system, and ultimateh', Avith a diminution of the activitv, or even the entire loss of the functions of STIMULANTS. 34o the oi'gaii upon wliicli tliis super-excitation or undue stimu- lation lias been made. From the foregoing i-eniarks, it must appear evident tliat the long-continued use of stimulants of a hot and very excit- ing charactejr, must be attended with great injury. There are some classes of physicians who make the stomach the great theater of therapeutic action — the organ which is made to receive the major part of all their impressions, and the one upon which the nervous and vascular action is con- centrated by the unbalancing weight of their whole mode of medication. This organ is first distended and relaxed by enormous quantities of hot fluid, strongly charged with cap- sicum, or the " composition powder," which renders it the great central organ of sympathies, a center of fluxion, — one upon which the vital energies are concentrated, while other organs are deprived of their ordinary vital afflux by the abstraction or destruction of the equilibrium just referred to. These pungent, acrid, heating medicines acting upon this relaxed and now morbidly sensitive organ, and fol- lowed up for from six to twelve hours, and repeated daily for weeks, and even months, sometimes until " three hundred courses" of the kind are gone through with, can not fail to debilitate the stomach and wear out its natural sensibilities, and produce those of an abnormal character, together with an irritation and thickening of the mucous coat, and a per- manent chronic phlogosis. In this way the normal sensi- bility of the stomach is blunted, and often destroyed ; while other organs lack innervation from the undue concentration, which has there taken place. Chronic gastritis and dys- pepsia are tv/o very common forms of disease which result from the repeated and long-continued use of these pungent acrid excitants. The skin is another tissue upon which they act so frequently, and with such vehemence, that they often destroy its normal functions and produce a state of innerva- tion, or loss of vital energy, incompatible with a state of health in other organs or parts of the system. We do not deny that these measures are capable of ex- erting a very powerful influence over many morbid and dis- eased states of the system; on the contrary, we know that this is the case. "We also admit that, ttirough these influ- 3i6 SPECIAL THEUAPEUTICS. ences, tlie i'uuctions of many otlier org-aiis are frequently restored or improved; but we object to tbis course of medi- cation, because tbe great burden of removing disease is im- posed upon one or two organs. Instead of dividing tbe influences, and tbrowing the burden alternately npon dif- ferent organs and emunctories, one or two are made to per- form tbe eliminating functions which should fall npon all. Another class of physicians pursue a very different mode of medication, and one that nnbalances the normal condi- tions of particular organs, as well as the general system, and proves far more detrimental to the unfortunate victims upon whom its blighting influences are exerted, than the once popular "course" just alluded to. It has been the practice with these physicians to admin- ister mercury in all diseases to which man is heir, for the purpose of stimulating the liver to increased secretion, and through the diseased condition of this viscus, thus produced, remove the disease. I^o thing could be more absurd than such praqtice; for in the normal condition of the system, this secretion is not formed for elimination, but to answer a fur- ther purpose in the economy. Though mercury, at this day, is almost entirely discarded by the better informed, yet it is still made the great therapeutic lever by a large class of routine practitioners; while that important gland, the liver, is made the fulcrum upon which their principal curative means are used. With this weapon of destruction they enter the arena of life and death, too often to insure victory to the latter, or to render the constitution a wreck, and the survivor the subject of the physician's care through life. If called to treat a disease, either acute or chronic, symptomatic or idiopathic, neuropathic or asthmatic, febrile or inflammatory, anemia or plethora, dropsy or excessive excretion, such a physician fancies the liver is torpid, and is suffering from some functional derangement or organic lesion. Indeed it matters not what the case may be, that organ is the one which must take on itself the great burden of throwing oft* the disease. Should it not speedily succeed in doing so, the salivary glands and gums must next receive especial atten- tion. The gums must be " touched" and the glands abnor- mally stimulated, in order to subvert the original diseased STIMULANTS. 347 condition, by setting up a new and abnormal action in the system, counteracting the original one by substituting its ' own. To act upon the liver, remove its torpor, increase and regulate its secretions, restrain them if excessive, render them healthy if unhealthy, etc., etc., appears to constitute in the minds of mercurialists the great therapeutic indicatioiis to be fulfilled. As has been before stated, by stimulating one organ, and making it the point of undue excitation, either general or local irritation may supervene, fever may follow, other organs be rendered torpid or debilitated, and this undue stimulation not unfrequently wears out or greatly impairs the liver, if it does not destroy life itself. The continued excitement of this organ by such treatment is one of the most prolific sources of chronic hepatitis, torpor or derange- ment of that organ, that can be named; indeed, we may safely say that this one agent, so often used, and so entirely depended upon to remove all hepatic derangements, causes more of the identical diseases which it is so often given to remove, than the sum total of all other agencies. The use of mercury to fulfill the indications referred to, is doubtless one of the greatest fallacies of the dominant practice of the nineteenth century, and one wdiich in a future day, and that by no means a distant one, will be viewed as one of the most marvelous and visionary practices that ever obtained coun- tenance from the great mass of the medical profession. Happily even now the more candid professors and practi- tioners confess that the liver is an organ '■^more sinned against than sinning J' It is scarcely necessary to refer to the effects of alcohol as a stimulant, as they are known to all. It is an agent capa- able of doing a great amount of good when judiciously taken, "m disease"; but if too freely and too frequently used, and its use persisted in for any considerable length of time, it is capable of doing a more than equal amount of injury. The excitement which it causes in the system is followed by a corresponding loss of action. It produces enervation, atony or debility of some organs, while others are unduly excited; which excitation is succeeded by irritation, chronic \^ inJiammatiou, ulceration, and a thickening of the mucoua 3J8 SPECIAL THERAPEUTICS. membrane of the stomach; and finally by an entire loss of its natural sensibilities and functions. Visceral obstructions, dropsies, torpor of the glandular system, phrenitis, apoplexy, etc., are but so many pathological states of the system in- duced by undue and improper stimulation. All modes of stimulation, if carried beyond a certain point, result in a morbid over-excitement of the organ acted upon, and finally eventuate in the entire loss of its normal sensibility. Therapeutic Indications. In atonic states of the stomach, when the mucous and mus- cular coats have lost their tone, when the food taken pro- duces oppression, when there is flatulence, acid eructations, and the general evidences of dyspepsia, excitants become valuable. If the disease is transient, and arises from pre- vious over-excitement which has produced a temporary ex- haustion, ether, alcohol, wine, the essential oils, capsicum, aromatics, etc., may palliate, or even give entire relief. In the flatulent colic of children, aromatic excitants sonre- times give prompt and speedy relief. If, however, these symptoms are protracted, w^e may rest assured that it is not a mere temporary loss of nervous energy, but a more per- manent disease, in which agents more permanent in their influence upon the system, are demanded. In such cases, excitants combined with tonics comprise our most efficient curative means; gentle stimulation arouses the torpid gas- tric sensibilities to the influence of tonics, which impai-t permanent tone to the organ, and often restore it to its nor- mal state. In violent spasm of the stomach or howels, dependent upon the translation of gouty irritation to these parts, unattended with inflammation, the most difii"usible stimulants, either alone or combined with narcotics, are of great importance ; external excitants or revellents to the epigastric region are also useful. These combined influences diminish the erythism of the nerves implicated, and frequently give relief. In cojistipation, not attended with inflammation, excitants combined with cathartics often prove valuable auxiliaries, by stimulating the muscular coat, and thus quickening the STIMULANTS. 349 peristaltic action of the bowels, facilitating the action of the cathartic. Thej arc also valuable as correctors of catliar- tic medicines, as they prevent griping. The use of excitants in cases of nausea and vomiting, arising from pregnancy, hardly fails to palliate, and not unfrequently entirely re- moves these unpleasant symptoms. Stimulants are important in the advanced stages of febrile and wfiammatory disease, when a high grade of excitement no longer exists ; even when the prostration is not great, if the arterial excitement is not very vigorous, the moderate use of stimulants will often hasten the progress of convalescence. In fevers of an adynamic type, when the prostration is great and the vital powers are apparently nearly exhausted or rap- idly sinking, the pulse feeble and thread-like, a cold, clammy sweat, etc., active, diti'usible stimulants of the most powerful kind become an indispensable part of the medication — their external employment is also demanded. In typhus and ty- phoid fevers, where the system is prostrated by the vitiated character of the circulating fluids, and a tendency to putres- cence, great advantage is derived from the use of stimulants, either alone or in combination with tonics. In passive dropsies, as auxiliaries to diuretics, they often exert a salutary influence. By their stimulating and exciting powers they impart new vigor to the atonic vessels, and thus counteract exudation. The same remarks apply to their use in passive hemorrhages, indicating great prostration of the vital powers, and in pete- chia arising from the passive transudation of the diseased and dissolved blood, through the relaxed parietes of the atonic vessels. These hemorrhages are of frequent occur- rence in adynamic fevers, typhus, typhoid, and other malig- nant and putrid fevers, scorbutis, etc. ; in which cases the local revellent influence of an active excitant, as the capsi- cum, together with the increased vital energy which it im- parts to the atonic vessels, recommend them to our use. In general debility, torpor or languor of the system, w;hen the circulation is sluggish, in the atony of old persons, and enfeebled and enervated states of the system which occasion- ally occur in both the old and the young, or which arise aa 350 SPECIAL THERAPEUTICS. secondary results of other diseases, excitants, alone or con^ joined with tonics, are the therapeutic agents upon which our main reliance must be placed. Paralysis is a disease of the nervous system, in which stim- ulants, both as internal and external agents, may be used with a prospect of advantage. When, however, the paralytic aflection arises from a lesion of the cerebro-spinal axis, con- gestion or inflammation of those parts, this class of agents are contra'indicated. A gentle excitant in hysteria, may sometimes be used with much advantage ; a combination with antispasmodics in- creases their value. In other nervous affections, palpitation of the heart, headache, delirium tremens, and in all cases where there is either a permanent or transient depression of the vital powers, the diffusible stimulants, as camphor, wine, ammonia, etc., may be used as palliatives, or in some cases as curative agents. Aromatics are spoken of by some authors as a distinct class of excitants or stimulants, but a distinction of this character is wholly uncalled for. They may be defined to be stimu- lants possessing a very fragrant or agreeable odor, and which when masticated or taken into the mouth, impart a sensation of warmth and pungency to the taste. Many of these aro- matic stimulants are also tonic and astringent. These medicines are also termed carminatives, and are employed very frequently to remove flatus from the stomach and bowels; but this effect depends wholly upon their local excitant influence upon the mucous membrane of the stom- ach and bowels, and the transmission of that impression to the contiguous muscular coat, from the action of which the expulsion or diffusion of the flatus takes place, and relief follows. If flatus accumulates in the alimentary canal, the muscu- lar fiber becomes paralyzed from over-distension, the bowels losing their wonted energy and contractile power, are inca- pable of expelling or diftusing it through the tube ; hence the pain in flatulent colic. In this case an aromatic stimu- lant imparts tone and increased energy to the stomach and bowels, which enables them to contract upon it, and expel STIMULANTS. 351 it througli the cardia or pylorus, if in the stomach ; if in the bowels, it causes a cliftusion or an expulsion downward. Conditions Contra-indicating their Use. Stimulants are contraindicated in cases of gastro-intes- tinal irritation or inflammation. In such cases their admin istration is attended with increased phlogosis. In febrile and inflammatory affections, excitants are im proper during the early stages, and it is only in the advanced stages of these diseases, after the arterial excitement has been moderated, and rapid prostration is manifestly unavoid- able, that they are proper. Even in these cases, if there is pain in the epigastric region, if it is tender to pressure, if the distress is increased by the use of warm drinks, and the edges and apex of the tongue are red and dry, stimulants are highly improper. In hypertrophy of the heart, in palpitation of the heart, if it depends upon an organic disease of that organ, stimu- lants are inadmissible. They are also contraindicated in phrenitis, apoplexy and cono-estion of the brain. Under circumstances of this char- acter, their employment would be highly prejudicial to the patient. In neuralgia, chorea, tetanus, epilepsy, etc., excitants are occasionally used with profit; but as a general rule they are unimportant, and in many cases very prejudicial. In these cases tonics are more permanent in their influence upon the system, and take the precedence over stimulants, especially if coupled with antispasmodics. CAPSICUM. THE FRUIT OF CAPSICUM ANNUUM Preparations. — The Powder. Tincture of Capsicum. Dose. — The dose will vary from one grain to one drachm of the powder, and from one drop to one drachm of the tincture. Therapeutic Action. — Capsicum is stimulant, carmina- tive, rubefacient, and vesicant. In large doses it is a very 352 STIMULANTS. pungent, acrid stimulant, producing great heat and a sensation of burning in the stomach when swallowed. By Christison it is regarded as an " irritant poison." It acts as a powerful and pure stimulant in arousing the sensibility and promoting liic secretion of organs, when administered in small quantities; yet vascular activity does not seem to be augmented in propor- tion to its local action. In torpid or lethargic states of the system, and in cases of paralysis depending upon torpor of the nervous system, and not upon organic lesion, it is an appropriate remedy. In flatulency and indigestion, attended with a languid and feeble state of the digestive organs, it will be found servicea- ble; it promotes digestion and removes flatulency, by exciting the gastric nerves and stimulating the muscular coat of the stomach to renewed activity. Agues or intermittents have been arrested by its use, and in protracted cases, when tonics fail to exert their normal influ- ence upon the system, from loss of gastric susceptibility, cap- sicum constitutes a valuable adjunct to quinine or other anti- periodics b} increasing the nervous sensibility of the patient. In habitual or accidental torpor or constipation of the bowels, it serves as a valuable adjuvant to cathartics, stimulating the muscular coat, and augmenting the susceptibility of the intes- tines to the action of these agents. Capsicum not only in- creases the activity of cathartic agents, rendering a less quan- tity of them necessary, but it likewise modifies their action, preventing nausea and griping. In the collapsed stage of cholera, in yellow fever, asthenic dropsy or asphyxia, it has been found a useful remedy. When aj)])lied to the surface, cayenne pepper acts as a pow- erful rubefacient and topical excitant, and if long continued, even as a vesicant. For these purposes it is employed when- ever an active remedy of this character is required, as in the low forms of fever, comatose states of the system, great tori)or or insensibility, and in all cases where an active, speedy, and powerful revidsive application is required, this agent has no superior. It is employed as a topical a[7 plication to old and indolent ulcers, either by sprinkling it upon the surface or as a cataplasm, combining it with myrrh, hydrastls, and ulmus fulva ; it excites the parts to healthy action, and promotes XANTHOXYLUM. 353 granulation and cicatrization. In cases of great insensibility it may be s^n'inkled upon a mustard poultice, or a poultice of the Capsicum or the tincture may be applied to the surface previous to the application of the mustard, in order to arouse the sensibility and insure the revulsive and general excitant action of that remedy. It constitutes a valuable adjunct to sti m ul at! ng II niments. XANTHOXYLUM. THE BARK AND BERRIES OF XANTIIOXYLUM FRAXINEUM. • Preparation. — Tincture of Xanthoxylum. Dose. — From ten drops to one drachm. Therapeutic Action.— Xanthoxylum is stimulant, dia- phoretic, carminative, slalagogue, and rubefacient. The bark is an active stimulant, causing general excitement, with a sense of heat in the stomach, and a tendency to diaphoresis. It somewhat resembles Mezereum and Guaiacum in its reme- dial action and adaptation to the relief of disease, but is much superior to either of those agents. It is an excellent remedy in lethargic, torpid, paralytic, and leuco-phlegmatic habits of body, owing to its excitant influence. It has been used with much advantage in chronic rheumatism, and deservedly enjoys a high reputation in domestic practice in the treatment of this disease. In passive dropsies it seems sometimes to be very beneficial, when associated with diuretics and tonics. In lan- guid or atonic states of the digestive organs, it invigorates and promotes the process of chymificatiou and chylification, relieving flatulence, and spasmodic pain in the stomach and bowels. It is sometimes used as a masticatory in toothache, rheu- matic, neuralgic, and paralytic affections about the mouth and throat. It Is also employed as a topical application to indolent ulcers, and as a rubefacient in local affections, either alone or in combination with other agents. The berries possess similar properties to the bark. They have been found highly useful in chronic rheumatism, and in atonic and languid states of the system ; also In flatulence, spasm of the stomach and bowels, colic, cholera morbus, etc., and to qualify the action of other remedies, rendering them 354 STIMULANTS. acceptable to the stomach. They are also especially valuable for their nervine and antispasmodic i)roperties in tranquilizing nervous irritation ; Prof. Morrow regarded them of especial value, and possessed of properties of this kind not heretofore a[)preciated ARALTA THE BARK OF THE ARALIA SPINOSA. Pjrepaeation. — Tincture of Aralia. Dose. — From ten drops to one drachm. Theraeeutic Actioi^. — The Aralia Spinosa is stimulant, diaphoretic, alterative, sialagogue and febrifuge. Its proper- ties appear to be those of a stimulant and diaphoretic, and as such it has been principally employed. We have used it mostly in the same cases in which the xanthoxylura is recom- mended, as a substitute for that agent. It is employed with advantage in chronic rheumatism; and in colic, flatulence, dyspepsia and torpor of the bowels, it will be found a useful stimulant and carminative. Purch asserts that the tincture of the berries is remarkable for relieving rheumatic ])ains. It has also been employed with advantage in colic* Porcher says it has been successfully used in South Carolina in syphilis, and it was employed by the negroes in snake-bites with success. It has been used in chronic cutaneous diseases, and other affections requiring the use of alteratives, like other species of the Aralia. Tlie tincture of the bark was pre- scribed with advantage in the cholera. As a general excitant, diaphoretic and alterative, this agent is possessed of active medicinal properties, which should entitle it to greater atten- tion than it has yet received. ZINGIBER. THE RHIZOME OF ZINGIBER OFFICINALE. Preparations. — Powdered Ginger. Tincture of Ginger. Dose. — From grs. j. to grs. xx. ; of the tincture 5ss. to 5j' ■ Therapeutic Action. — Ginger is stimulant, diaphoretic, errhine, sialagogue and rubefacient. It is a very energetic stimulant, highly aromatic and carminative, and when taken in small quantities augments the tone of the digestive organs, j)romotes digestion, and removes or prevents flatulence, sj)asni PIPERIN. 355 of the stomach or bowels, colic, etc. ; for these reasons it is much used as a condiment in atonic states of the stomach. It is also much employed to impart warmth and flavor to other medicines, as tonics and purgatives, correcting their action by- preventing nausea and griping, and thus rendering them ac- ceptable to the stomach. PIPER NIGRUM. THE DRIED UNRIPE BERRIES OF PIPER NIGRUM. Therapeutic Action. — Black pepper is stimulant, tonic, febrifuge and rubefacient. It is an acrid agent, producing a pungent, burning sensation in the mouth and stomach, which is followed by a glow of heat upon the surface, and increased vascular action ; the pulse is accelerated and diaphoresis pro- moted. It is employed as a condiment with a view to its ex- citant influence upon the stomach to aid digestion ; and in part for its flavor. By some it is regarded as a stimulant to the genito-urinary organs. Its febrifuge properties are thought by many to be impor- tant. The tincture has often been successfully used to pre- vent the recurrence of the paroxysms of intermittent fever. It has been employed for this purpose by many Italian phys- icians, with success, and also in the intermittents of the South- ern and Western States. It may be advantageously combined with quinine and other tonics in this disease, when accompa- nied with gastric insensibility. PIPERIN. Dose. — Grains vj. to grains viij., in powder or in pills. This is a crystalizable substance, obtained from" the piper nig- rum, longum, and even from cubebs; when pure it is white, but, as found in the market, of a straw-yellow color. It is tasteless and inodorous. It has been recommended and employed in the treatment of intermittent fevers, with some success. We have used it in this class of diseases, where quinine could not be taken, in some cases successfully, but in a majority it entirely failed. It was recommended by Magendie as a substitute for cubebs in blenorrhasfia. 356 STIMULANTS. OLEUM CAJUPUTI. VOLATILE OIL OF THE LEAVES OF MELALEUCA CAJUPUTI. Dose. — From two to ten drops, taken in emulsion or on sugar. Therapeutic Action. — Oilof Cajuput is a powerful diffu- sible stimulant, possessing antispasmodic and diaphoretic prop- erties. We have used it with much advantage as a stimulant in typhoid and typhus fevers and malignant scarlatina, and prefer it to any agent of its class, except Xanthoxylum, in these cases. It is also one of our most efficient remedies in painful spasmodic affections of the stomach, and in flatulent colic. As a stimulant in cholera morbus it is not surpassed, if equaled, by any other agent. Tinctura Cajujputi Composita — {Hunn' s Life Drops?) — I^ Oils of Cajuput, Anise, Peppermint, Cloves, aa. fojv Alcohol Siv. Mix. This is one of our most efficient and valuable stimulant and antispasmodic preparations. It may be successfully em- ployed for the relief of cramps in the stomach, colic, cholera morbus, etc. It has been very extensively used by Eclectics in the treatment of Asiatic cholera; and probably no agent has proved more successful. In this disease it is administered in doses of 3j- repeated every ten or fifteen minutes, until spasmodic action is subdued and reaction established. In the collapsed stage the dose may be doubled or trebled. Frequently its use is not only followed by a cessation of the cramp, but also of the discharges, and perfect reaction. In cholera mor- bus its use is followed by the like good results, not only check- ing the vomiting, but frequently arresting the diarrhoea. ARNICA. THE FLOWERS OF AKNICA MONTANA. Prepahation. — Tincture of Arnica. Dose. — Tincture Arnica gtt. x., water §iv.; a teaspoonful every hour or two. Therapeutic Action. — From the experiments of Jorg, Arnica possesses acrid properties. "When swallowed it causes burning in the throat, nausea, vomiting, gastric pains and loss of appetite. The active principle becomes absorbed, quickens MYRRHA. 357 the pulse and respiration, and promotes diaphoresis and diure- sis. Furthermore, it appears to exert a speeific influence over the nervous system, causing headache, giddiness, and loss of sleep." Sundeiin considers it to be closely allied in operation to Senega, from which he says it differs in its stimulating influ- ence over the nervous system, and in its causing constipation. "Arnica is indicated in diseases characterized by debility, torpor, and inactivity. It is administered as a stimulant to the general system in various debilitated conditions, and in typlu)id fevers; to the nervous system in deficient sensibility, as in amaurosis ; to the muscular system in paralysis; to the vascular system and secretory organs when the action of these is languid and requires to have its energy increased." We have also used it with apparent advantage in prostration of the system from injuries, and in concussion of the brain, to pro- mote reaction. As an external application to injuries of any kind where the soft parts are bruised, it has no superior. It may be ap- plied either in the form of a poultice of the flowers, or the tincture diluted with water as a wet dressing. MYRRHA. THE GUMMY RESINOUS EXUDATION OF CALSAMODENDRON MYRRHA.— Asia. Therapeutic Action. — Myrrh is described as stimulant, tonic, expectorant, emmenagogue, diaphoretic and antispas- modic. We would say it was stimulant and tonic, its stimu- lating effects being most conspicuous, while its tonic proper- ties next engage our attention. Taken in small doses, it promotes the ap[»etite and produces gentle warmth in the stomach, aids assimilation, diminishes excessive secretions from the mucous membranes, and invig- orates the ffeneral svs'Lcm. In larsjer doses it causes increased fullness and frequency of the pulse, a sensation of warmth in the mucous membrane of the respiratory passages, and in- creased temperature of the surface. When locally employed it acts as a mild astringent, detergent, antiseptic, topical ex- citant and tonic. Myrrh is indicated in enfeebled states of the general system, with weak, vascular action, and in profuse secretions from mu- 358 STIMULANTS. cons membranes. It seems best adapted to relaxed and lenco- phlegmatic habits. In chronic catarrh, hnmoral asthma, pnlmonary consump- tion, attended with a profuse or debilitating expectoration, and in cases of profuse secretions from other mucous surfaces, as the bowels and genito-urinary organs, it is advantageously used to lessen the secretion or discharge. It is also nsed in other conditions of the pulmonary organs where the secretion is abundant, but not readily expectorated, owing to weakness of the respiratory organs, with a view to aid expectoration. OliEUM TEREBINTHIN^. Dose. — From gtt. v. to 5j., usually in emulsion. Therapeutic Action.— Oil of Turpentine is described as stimulant, anthelmintic, diuretic, cathartic, rubefacient, anti- spasmodic, sudorific and emmenagogue. When taken in small doses it creates a sensation of warmth in the stomach and bowels, and after being absorbed excites vascular activity, stimulates the capillary circulation and the different excretory organs. It is cast off by the different emunctories, as the skin, kidneys and lungs, as is manifest by the odor of their secre- tions. It appears to constringe, or rather to excite the vessels of mucous surfaces, so as to lessen excessive mucous and san- guineous discharges. Its free and protracted use often causes irritation of the urinary organs, and not unfrequently stran- gury and bloody urine. Oil of Turpentine is employed with some advantage in many diseases. As a stimulant in typhoid fevers, especially when accompanied with a tumid or tympanitic state of the abdomen, and ulceration of the mucous membrane of the bowels, it has been esteemed a valuable agent. In puerperal fever it is a valuable agent, to relieve the tym- panitic condition of the intestines. For this purpose it is used as an enema, and as an application to the abdomen by means of flannel cloths wrung out of it warm. In chronic rheumatism, especially in aged persons, or in languid and atonic subjects, its stimulant and diaphoretio properties render it useful in some cases. ARMOEACIA. 359 SINAPIS. FLOWER OF SEEDS OF SINAPIS NIGRA, SINAPIS ALBA. Dose. — As a stimulant, from grs. x. to grs. xx. ; as an emetic, from 5j- to o'j- Therapeutic Action. — Mustard is stimulant, stomachic, emetic, diuretic, laxative, rubefacient, and vesicant. It is an acrid, j)ungent stimulant, and if taken into the stomach in large quantities it produces a violent burning pain, with purg- ing, and sometimes gastro-enteritis. It acts as a general exci- tant to the vascular system, and also upon the organs of secre- tion. Taken in small quantities with the aliment, it exerts a healthful influence over the organs of digestion, promotes the appetite, and aids in the assimilation of articles difficult of digestion. The whole seeds, either before or after they have been soft- ened by maceration in hot water, may be taken in doses of a teaspoonful once or twice a day as a laxative in torpidity of the bowels; especially if this malady is accompanied with dys- pepsia. In the disease last named, we have seen ranch benefit derived from the use of the white mustard seed whole, one half teaspoonful being taken two or three times a day. In headache arising from torpidity of the stomach, they likewise prove beneficial. ARMOEACIA. THE ROOT OF COCHLEARIA ARMORACIA. Dose. — From one-half to one drachm, grated fine. Therapeutic Action. — Horseradish is described as stim- ulant, diuretic, diaphoretic, emetic, antiscorbutic, rubefacient, and vesicant. It acts as a powerful gastric stimulant, but its local action greatly exceeds its general excitant influence over the circulation. It promotes the appetite, improves digestion, and facilitates chymification ; hence it is a valuable condiment in debilitated states of the primse vise. It has been esteemed useful both as an internal and an ex- ternal remedy in paralytic and rheumatic affections, and in the treatment of atonic dropsies, it often affords relief. For this last disease it may be used either in simple infusion or 360 STIMULANTS. combined with juniper berries, pipsissewa, spearmint, the roots of the common white elder, or other diuretics. We have de- rived mucli benefit from a combination of all the agents just named as an auxiliary in the treatment of passive dropsies. PYCNANTHEMUM. THE PLANT PYCNANTHEMUM PILOSUM.— U. S. Therapeutic Action. — Pycnanthemum has been but little used by the profession. It is a very agreeable aromatic stim- ulant and diaphoretic, similar to the pennyroyal or hyssoj) iu its medical properties, but more pungent in taste and excitant in action. We have used it frequently with very gratifying results in cases of colic, flatulency and pain or spasm of the stomach and bowels, and also as a stimulating diaphoretic iu colds, rheumatism and pleurisy. Whenever free perspiration is desirable, and especially in those cases where there is a ten- dency to chilliness, with a languid state of the circulation, a warm infusion of this agent will be found beneficial. It has also been found useful in cases of nausea and vomiting, to allay sickness. CINNAMOMUM. THE BARK OF LAURUS CINNAMOMUM— Ceylon. I Preparation. — Tincture of Oil of Cinnamon. Dose. — From ten drops to one drachm. Therapeutic Action. — Cinnamon is stimulant, tonic, stomachic and astringent. It is one of the most grateful of the aromatic stimulants ; pleasant to the taste, it produces a sensation of warmth in the stomach, promotes the functions of assimilation, and iu full doses acts as an excitant to the ' vascular and nervous systems. Like other aromatics, its local excitant action exceeds its general influence as a stimulant. For medicinal purposes it is often added to bitter and tonic infusions and compounds, and also to purgatives, to improve their taste, and prevent nausea or gri[)ing. It is useful to allay nausea, arrest vomiting, and prevent flatulence. As an astringent, it is useful in diarrhoja, esi)ecially where a topical stimulant is required at the same time. As a cordial and stimulant, it is sometimes em[)loyed in the advanced stages. -piMENro. 301 of fever, and becomes especially valuable if there is diarrhoea. We have used the cinnamon in the form of an infusion with very good effect in ciiecking redundant menstrual and locliial discharges, and also in cases of uterine and other passive licm- orrhages. The tincture is deservedly a popular remedy in post partum hemorrhage, and many physicians would not feel safe without this remedy in their cases. CARYOPHYLLUS. THE DRIED UNDEVELOPED FLOWER OF CARYOPHYLLUM AROMATICUS. East Indies. Dose. — From five to ten grains. Therapeutic Action. — Cloves are stimulant and carmin- ative. Thev are amono- the most stimulating of the aromatic spices, and being possessed of an agreeable taste and odoi", are much used as adjuncts to qualify the taste, smell, and action of other classes of medicine. They are, however, sometimes administered as independent remedies, as carminatives and stomachics, to relieve nausea, vomiting, flatulence and })ain, and cramp in the stomach and bowels. Oleum Caryophylli. — Oil of cloves possesses similar proper- ties, but owing to its acridity it is seldom nsed alone, being employed in most instances as a corrigent of irritating or drastic cathartic remedies, to prevent- either sickness or grip- ing. In large doses it would act as an irritant poison. The oil is frequently a})plied to the hollow of carious teeth to re- lieve toothache. It is not often used as a rubefacient, not- withstanding its pungent qualities would indicate its topical use, if properly diluted before applying to the surface. Dose, from two to eight drops. PIMENTO. UNRIPE BERRIES OF EUGENIA PIMENTO.— West Indies. Dose. — From ten grains to one drachm. Therapeutic Action. — Allspice is stimulant, diaphoretic, stomachic, and astringent. It is one of the most pleasant and grateful of the aromatic stimulants, but its use as a medicine is quite limited, its employment being mostly confined to culi- nary i)urposes. It possesses the aromatic, stimulant, stom- 362 STIMULANTS. achic, and carminative properties of tlie spices generally, and may be used to excite the gastric nerves, remove flatulence, etc., in relaxed and atonic states of the stomach. MYRISTICA. THE KERNEL OF THE FRUIT OF MYRISTICA MOSCIIATA. Dose. — From five to twenty grains. Therapeutic Action. — Nutmeg is stimulant, carminative, aromatic, and narcotic. Tlie activity of both nutmegs and mace reside in the volatile oil which they contain. In addi- tion to their aromatic and excitant properties, they possess considerable narcotic power. Nutmeg is sometimes employed with advantage in uterine hemorrhage, equal parts of pulverized alum and uutmeg, in doses of from five to ten grains, being quite an efficient remedy. CARDAMOMUM. THE SEEDS OF ALPINIA CARDAMOMUM.— India. Preparation. — Tincture of Cardamomnm. Dose. — From ten drops to one drachm. Therapeutic Action. — Cardamom is an aromatic stimu- lant carminative, with slight tonic and nervine ])roperties. It is useful in flatulency, and pain or spasm of the stomach and bowels, especially in infancy. In chronic hysteria and other nervous diseases of debilitated females, whetiier alone or in combination with more active antispasmodics, it often proves serviceable. LAVANDULA. THE FLOWERS OF LAVANDULA VERA. Therapeutic Action. — Lavendar is an aromatic stimu- lant, carminative and antispasmodic. It is mostly employed for its aromatic stimulant qualities, and for giving warmth and flavor to other medicines. It has been esteemed useful in pectoral afl'ections, and in hysteria and other nervous diseases attended with debility. In spasmodic pain in tlic stoniach or bowels and flatulency, it is a useful remedy. ANISUM. 363 Oleum Lavandula. — Oil of lavender is stimulant, tonic and caijninative, and is sometimes used in hysteria, languor, and headache, but is chiefly used as a perfume for scenting eva])o- rating lotions, ointments, and liniments. Dose, one to five drops. Thictura Lavandula Compound. — ly Oil of Lavender, foi'j-; Oil of riosc'.nary, f.jj-; Cinnamon, bruised, 5j-; Cloves, bruisjcd, 5ij-; Nutmeg, bruised, oSS.; Red Saunders, raspeil, 5iij-; Rec- tified Spirit, Oij. ; macerate for f )nrteen days, express and filter. This is a very pleasant and useful stimulant in nausea, flatulence, pain in the stomach and bowels of cliidren. Dose, gtt. ij. to foss. A N E T H U M. THE SEEDS OF ANETHU:.! GRAVE0LEN3. Dose. — Of the pulverized seeds, from grs. xx. to 5j. ; of the oil, gtt. ij. to gtt. v. Therapeutic Action. — Dill seeds possess the properties common to the aromatics. As a remedial agent they are feeble in action, and are mostly used for the relief of infants affected Avith colic, flatulence, etc. They have also been used in cases attended with a scanty flow of urine in infancy, and as a pec- toral in pain in the chest. Fceniculum, Coriandrum, Carul, Dauci, and Angelica, (the seeds,) are aromatic stimulants, possessing similar properties to those last described, and may be used for the same purposes; they are, however, not much used at present. ANISUM. THE SEEDS OF PIMPINELLA ANISUM. Dose. — From twenty grains to one-half drachm in powder. Therapeutic Action. — Anise is an aromatic stimulant and carminative. When taken it imparts its odor to the pul- monary, renal, and mammary secretions. By some it has been supposed to promote the secretion of milk, urine, bronchial mucus, and menses. It is often used in flatulent colic, and' pain in the stomach and bowels, to which infants are subject. Combined with cathartics, it tends to prevent nausea and griping. 364 STIMULANTS. Oleum AnisL — Oil of Anise posseses all the ]>roperties of the seeds, and is nsed for the same purposes. It is often associated with Lobelia, Sanguinaria, Ipecacuanha, and other nauseating expectorants, to conceal any unpleasant taste, and render them loss obnoxious to the stomach, and at tlio same time improve their pectoral qualities. In the preparation of cough mix- tures, it is very useful both as a corrigent and auxiliary to the compound. It may be combined with Copaiba, and used in chronic catarrh and disease of the urinary organs. Dose, five to ten drops. ANGELICA. THE PLANT ANGELICA ATROPURPUREA— U. S. Dose. — Of the powdered herb, from grs. xx. to 5ss. Of an infusion of one ounce to a ])int of boiling water, f.3J. to fsij. Therapeutjc Action. — Angelica is an aromatic stimulant, carminative, diaphoretic, diuretic and emmenagogue. This article is said to jDossess properties similar to those of the cul- tivated or garden Angelica. It is an excellent aromatic stimulant and carminative, and is especially useful when combined with tonics in cases of indi- gestion, flatulence, etc., depending upon an atonic state of the stomach, and when connected with general debilitv. It is also an excellent remedy in flatulent colic and cardialgia. It has the reputation of being diuretic and emmenagogue. LIGUSTICUM. THE PLANT LIGUSTICUM LEVISTICUil.— Europe. Therapeutic Action. — Lovage is stimulant, carminative, and diaphoretic — properties similar to the Angelica. It is mostly exhibited in flatulency, pain in the stomach and bowels, and enfeebled states of the stomach, as an aromatic stimulant and carminative. It has been esteemed diaphoretic and em- menagogue, and used to promote these secretions. Used in infusion. MENTHA PIPEKITA. 365 HERACLEUM. THE ROOT OF IIErwVCLEUM LANATUM— U. S. Therapeutic Action. — Heracleum is stimulant, carmina- tive, and according; to Christison and Griffith, diuretic, expec- torant, and antispasmodic. It has been found beneficial as a stomachic and carminative in dyspepsia, attended with cardi- algia and flatulence, and has been used in epilepsy. The leaves have been employed externally as a rubefacient ; and when made into a cataplasm, form a good application to maturate abscesses. MENTHA PIPERITA. Dose. — The infusion of Peppermint may be freely taken. The dose of the oil, which is used for the same purposes, is from two to five drops ; of the spirit of Peppermint, f 5ss. to folj.; of the essence, gtt. x. to gtt. xxx. Therapeutic Action. — Peppermint Is an aromatic stimu- lant, carminative, antispasmodic, and diaphoretic. It is one of the most grateful of .the aromatic stimulants, and is much used to expel flatus, obviate nausea, and relieve spasmodic pains in the stomach and bowels, and to disguise the taste and correct the nauseating or griping effects of other medicines. For purposes of this kind, few articles equal and none surpass it. It is an efficacious carminative and stomachic, and as such is employed with benefit in gastrodynia, flatulent colic, spas- modic and griping pains in the stomach and bowels, etc. As an adjuvant or corrlgent, it is highly esteemed for rendering less pleasant medicines acceptable to the stomach. In cases of extreme irritability of the stomach, an infusion, or a few drops of its essence, often abates the nausea, and hence Its use in cholera morbus, cholera infantum, and even in spasmodic cholera. The green herb bruised and applied over the epigastrium at the same time will prove a valuable auxil- iary; its action is much aided by wetting It with spirits, or in some cases with laudanum. A strong infusion, taken warm, constitutes an excellent stimulating diaphoretic in colds and the early stages of febrile and inflammatory diseases. 366 STIMULANTS. ORIGANUM. Origanum, or common Marjorum, is a very mild and agree- ' able aromatic stimulant, and is sometimes administered as a diaphoretic. Its infusion has been administered in chronic cough, asthma, and amenorrhoea. It is a feeble agent, and but little used. Oleum Origani. — This oil is very acrid, and a powerful stimulant, and is used only as an external application. It is used in this way to relieve sprains, bruises, paralytic and rheu- matic affections, and applied to carious teeth to check tooth- ache. Combined with sweet oil, it is applied to prevent alo- pecia, or baldness. ROSMARINUS. Rosemary is stimulant, carminative, emmenagoglie, and antispasmodic. It is employed as a gentle stimulant in pains in the stomach and bowels, and as a diaplioretic in colds and the incipient stages of fever. The infusion may be taken freely. OCIMUM.- Ocimum Basilicum, or Basil, possesses the general properties of the labiate plants already described, and is used for the same purposes. WINTER! Dose. — one-half to one drachm in powder. The bark of Drymus Winteri is an aromatic stimulant and tonic, and may be used in cases in which canella and cin- namon are indicated. It was highly extolled by its discoverer, Winter, as an anti-scorbntic. It is, say Christison and Griffith, an excellent aromatic, and well deserving attention, had we jiot so many similar remedies. SOLIDAGO ODORA. The leaves of tlie sweet Goklon Rod arc mildly excitant and agreeably aromatic. They are occasionally used in flatulency, colic, etc., as a carminative. The infusion constitutes a very SOLIDAGO ODOKA. ' 367 pleasant diapliovctic and diluent. It imparts an agreeable tlavor and odor to less aeeeptable medicines, and corrects their nauseating and irritating qualities. The infusion may be taken freely. CANELLA. Dose. — From ten grains to half a drachm. Canella bark is an aromatic stimulant and mild tonic. Its aromatic and stimulant properties are dependent upon a vola- tile oil and resin which it contains; its tonic properties on its bitter extractive principle. As an aromatic and carminative agent, it is intermediate between cloves and cinnamon, and quite similar to ginger. AGO R US. DoSE.^-From twenty grains to one drachm. The common Sweet Flag, or Calamus, is an aromatic stimu- lant and mild tonic. In its action it resembles Canella and Angelica. It is but little used by the profession, but might be substituted for the more costly imported aromatics. It has been used in asthenic fevers attended with great prostration and weakened digestive powers, and is occasionally used in the treatment of intermittents. SASSAFRAS. The bark of the root of Sassafras is an excitant diaphoretic, alterative, and said to be antiseptic. It appears to possess the properties of an excitant, with a tendency to the surface. Its infusion forms a very good diluent and diaphoretic in the eruptive fevers. As a domestic remedy it is employed as a diet-drink for its supposed alterative influence in scrofula and cutaneous diseases. AURANTIUM— LIMONIS. The cortical portion of both the sweet and bitter orange and the lemon are mildly stimulant, tonic, and stomachic, and may be used in mild cases where such an action is desired. They are principally used to flavor, and cover the taste of dis- ao;rceable agents. 368 " STIMULANTS. MENTHA VIRIDIS. Dose. — The infusion may be taken ad libitum. Of the oil the (lose is from two to five drops. Therapeutic Action. — This agent is described as stimu- lant, carminative, diuretic, diaphoretic, tonic, emmenagogue, anthelmintic, and antispasmodic. It is employed to expel flatus, check nausea and vomiting, and alleviate spasmodic pains in the stomach and bowels, but for these purposes it is not as good as the peppermint. It is, however, much more efficient as a diaphoretic, and the warm infusion may be used with advantage in colds, the early stages of fever and acute inflammation. It is especially applicable in cases attended with nausea, or an irritable state of the stomach. Spearmint is useful as a diuretic in cases of suppression or retention of urine, and in irritation of the genito-urinary organs. SALVIA. THE PLANT SALVIA OFFICINALIS.— EUROPE. Dose. — The infusion may be taken freely. Therapeutic Action. — Sage is described as stimulant, tonic, astringent, diaphoretic, antispasmodic, and anthelmintic. It is mildly excitant, and feebly tonic and astringent. It may be used in atonic states of the stomach, attended with flatu- lency, as a carminative, and in colds, coughs, etc., as a diapho- retic and pectoral. In the form of cold infusion it has been found useful in checking night-sweats — a result attributable, probably, to its astringent and tonic properties. MONARDA. THE PLANT MONARDA COCCINIA.— U. S. Dose. — The infusion may be taken freely. Therapeutic Action. — Monarda is stimulant, carmina- tive, diuretic, diaphoretic, emmenagogue and rubefacient. It is a powerful excitant and carminative, and may be advanta- geously used in depressed or typhoid states of the system, attended with sinking of the vital powers, with internal con- gestions, and a cohl, pale, and shriveled state of the surface. MELISSA. 369 It is likewise an efficient stimnlant diaphoretic, and may bo used in all cases where an agent of this character is indicated. The Monarda Punctata and Didyma possess similar prop- erties, and may be used for the same purposes. ,1 H Y S S O P U S. The flowering summits and leaves of Hyssop are gently excitant and diaphoretic. It is mostly used as a warm, stim- ulating diaphoretic in colds, coughs, catarrhal affections, and simple forms of disease where sweating is desirable. For this purpose the infusion may be drank freely. C U N I L A. The medical properties of Dittany are analogous to the mints and other labiate plants. It is also said to be nervine and emmenagogue. The warm infusion is usefully employed in colds, slight fevers, rheumatic affections, etc., as a stimulant diaphoretic. THYMUS. Thyme possesses properties similar to the agents just con- sidered. It is seldom used in regular practice. As a domestic remedy, a warm Infusion is often employed in colds, painful and difficult menstruation, to promote perspiration. The infusion may be drank freely. SATUREJA. Summer Savory possesses properties similar to the Thyme. It is a gently stimulating diaphoretic, and may be employed in colds and in mild forms of disease to promote perspiration. The infusion may be taken freely. MELISSA. Balm is said to be mildly stimulant and diaphoretic. It is very mild in its action upon the system, and its infusion is nsed ill febrile and inflammatory diseases as a diluent, or to promote the action of diaphoretics. 24 370 STIMULANTS. COFFEA. The uutorrlfied Coffee is said to possess tonic and febrifuge jiroperties. It was employed by Dr, Grindel, of Russia, and Raspari, as a substitute foi* Ginehona in intermittents ; it is not, however, regarded as of mucli benefit in such cases. An infusion of roasted coffee is a pleasant, though mild, stimulant and anti-soporific, It is, however, in too general use to be employed as a stimulant, most persons being so ac- . customed to its use that it produces but little effect as an anti- soporific. It is useful, and should always be employed in cases of poisoning by opium; T H E A. Tea is a very mild stimulant; and when an infusion is drunk warm, the water and warmth v>'ill produce diaphoresis. It is also astringent, and is employed as an antidote in cases of poisoning by vegetable alkalies or tiie tartrate of antimony. The strong infusion is a very useful remedy in otorrhoea, in- jected into the ear, and sometimes proves effectual when other remedies have failed. It has also been used with advantage as a coUyrium in ophthalmia. C A M P H O R A. Camphor, described under the head of Narcotics, deserves a notice in this place, on account of its stimulant propertie--. As a stimulant it is particularly useful in the advanced stages of continued fevers of a typhoid type, when attended with great depression of both the nervous and vascular systeniy. ^yhen the pulse is frequent, small and feeble, with an excited, irritable or jarring beat, dry skin, or a cold and clammy state of the surface, with low muttering delirium, subsultus tendi- num, and other evidences of approaching dissolution, camphor has proved a remedy of importance. ALCOHOL. 371 ALCOHOL. Physiological Effects. — Alcoliol, or Rectified Spirit, acts locally as an irritant and caustic poison. It causes heat, j)ain, redness and inflammation, with a condensation of the part to which it is applied. Its effects are chemical; it coagulates the liquid albumen or fibrin, and thereby increases the firmness and density of the tissues to which it is applied, while the irri- tation and inflammation which it causes arises in part from the resistance or reaction of the vital powers to the chemical ac- tion of the poison. In addition to its chemical action upon the albumen and fibrin, its highly pungent and local excitant properties are sufficient to produce irritation and inflammation on the surface where applied. The remote effects of alcoholic liquids upon the system are subdivided accordiug to the intensity of its action. Its first and mildest degree of action is manifested by its excitant influence over the arterial and nervous systems. Fre- quency and fullness of the pulse, with a flushed face, an ani- mated countenance, intellectual or mental excitement, with increased acuteness of ideas, and a joyous state of feeling, are among the first or primary effects of this agent. The indi- vidual becomes loquacious, and often very indiscreet in his language. While one drinks to drown his cares, another drinks to give him courage, and another that he may the better enjoy the society of his friends. The second degree is characterized by an impaired state of the intellectual functions and powers of volition commonly called drunkenness or intoxication. s When in this state the individual becomes delirious, and loses the power to control the action of the voluntary muscles. Increased vascular excitement with frequent nausea and vom- iting, are usual concomitants of this state, which is soon fol- lowed by a disposition to sleep, which is attended with copious perspiration. Headache, disgust for food, thirst and lassitude, are some of the symptoms manifested upon his recovery from sleep. The third degree is attended with a state of coma or true apoplexy, when the face becomes livid or pale, respiration is 372 bll.MLLANTS. stertorous, and the mouth frothy. This condition results from the ingestion of large quantities of it in a short space of time. In this state the secondary or sedative influences of the agent are clearly and unmistakably manifested. The pulse is slow, full and laborious, respiration slow, and the pupils mostly dilated, and in some cases convulsions ensue. In some in- stances true apoplexy supervenes, either attended with or with- out sanguineous extravasation. A paralytic state of the mus- cles of respiration, or a closure of the glottis, is supposed to constitute the real cause or causes of death. The moral degradation which it causes is often truly deplo- rable; while the morbid effects resulting from its continued use are very numerous; among which may be named delirium tremens, insanity, disease of the liver, such as a tuberculated state of that organ, scirrhous induration, torpor, enlargement, jaundice, and visceral obstructions. Those addicted to the intemperate use of ardent spirits are particularly liable to disorders of the stomach, such as impaired appetite, dyspepsia, chronic gastritis, and even scirrhus of the pylorus. A. diseased state of the kidneys, general dropsy, melan- cholia, etc., are a few of the many morbid states of the system consequent upon the improper use of alcohol. Its free use often develops new diseases, or renders old ones incurable, by enfeebling the constitution and rendering it incapable of with- standing the necessary mode of medication. On these latter causes its mortality principally depends. Alcohol is absorbed into the circulation, and in this way it exerts its influence upon the nervous system. That it is ab- sorbed is readily proven from its presence in the blood, urine, bile, serous fluids, brain, liver, breath, etc. It accumulates in the system, and well authenticated cases are reported in which the fluids within the ventricles of the brain possessed the odor, taste, and inflammability of ardent spirits. Dr. Ogston states that, in one instance, ho found about four ounces of fluid in the ventricles, possessing all the physical qualities of alcohol. Therapeutic Action. — Spirit of Wine is stimulant, nar- cotic, antiseptic, rubefacient, refrigerant, astringent, sedative, and diuretic, and is employed both as a medicinal agent and for pharmaceutical purposes. viNUM. 373 As a medicinal agent it is seldom employed internally, brandy, gin, wine, or whisky being mostly prescribed when ardent s])irit is indicated. Brandy is the kind most freqnently used as an excitant. It acts as a powerful diffusible stimulant, and as such it is exhibited to support the vital energies in the advanced or typTioid stages of fevers, also in cases of syncope, languor, and other states of depression. It often affords re- lief in cases of flatulency, gastrodynia, spasmodic pains in the stomach or bowels, nervous colic, and also when the food is not readily digested and oppresses the stomach. It some- times relieves nausea and vomiting, particularly in cases of sea-sickuess. VINUM. THE FERMENTED JUICE OF THE GRAPE. The wines recommended in medicine are the Sherry, Port, Claret, Catawba and Delaware (native), and for some purposes, Champagne. It is important that they should be pure; but as there is so much adulteration of what was at first the juice of the grape, not to speak of fictitious wines which possess none of the properties but the name, we, in this country, find it better to confine ourselves exclusively to native wine, the purity of which is undoubted. Wine owes its medicinal properties not only to the alcohol which it contains, but also to the acid and extractive matter; the first rendering them stimulant, the second antiseptic and refrigerant, and the third nutritive. Therapeutic Action. — As a remedy, wine is stimulant, tonic and antiseptic, its stimulant properties being less diffusi- ble but more permanent than alcohol; hence the dose is more easily regulated and its effects more certain.* It is also anti- septic and slightly refrigerant, properties which render it par- ticularly applicable in ataxic fevers and other diseases in which there is vitiation of the fluidi?. In all diseases accompanied Avith much debility, such as cases of extensive ulceration and gangrene, and in the sinking stages of typhus and ty])hoi(l fevers, wine is not only one of the best additions to the bitter tonics, but it is a remedy on which alone there is much reli- ance. In the convalescence from acute diseases it will be found of much advantage in restoring the exhausted health and visor. 374 STIMULANTS. MALT LIQUORS. Therapeutic Actiox. — These agents are used as restora- tives ill the advanced stages of fever, and to support the powers of the system after surgical ojierations and severe injuries. They are said to be objectionable in cases of asthma and dis- eased states of the respiratory or digestive organs. As porter contains a greater amount of the bitter and tonic properties of the hops, and less of the saccharine matter of the malt, it is to be preferred in diabetic and dyspeptic affec- tions. In many cases ale seems to be one of the most con- oenial tonics that can be used. During the convalescent staoe of fever, while the stomach is weak and irritable, and when the vital powers are much exhausted, this answers a valuable purpose in many cases. It acts as a gentle stimulant, abates nervous irritation, restores the appetite and promotes refresh- ing sleep. HYDROCHLORATE OF AMMONIA. Dose. — From five to thirty grains. Theeapeutic Action. — This salt is a mild stimulant, re- solvent and alterative, and is employed by continental physi- cians to fulfill these indications. It is used advantageously in the milder forms of pneumonia and bronchitis, in inflam- mations of serous membranes, pertussis, mucous diarrhoea, passive dropsies, chronic rheumatism and gout. Neligan states that he has found it useful as a stimulant in some forms of adynamic fevers, and also in sub-acute laryngitis. Mr. Class employed it extensively in the early stages of tubercular })hthisis, and, he states, with the most decided beneficial results. We have employed it only in pertussis, in conjunction with belladonna, and in this disease we consider it decidedly beneficial. Mr, Walker found that five parts eacli of this salt and ni- trate of potash, dissolved in sixteen ounces of water, foi'med a refrigerant mixture, which reduced the temperature forty degrees. This mixture may be employed in any case where an external refrigerant is indicated. AQUA AMMONIA. 375 AQUA AMMONIA. Dose. — The dose of Ammonia is from gtt. v. to 5ss., largely- diluted with water. Therapeutic Action. — The local effects of Aqua Am- monia are energetic; applied to the surface it may act either as a rubefacient, vesicant, or caustic, according to the length of time and mode in which it is applied. Its vapor, when in- haled, acts as a powerful irritant to the mucous membranes of the air passages, and hence its utility in cases of syncope. By using it incautiously, however, in cases of insensibility, fatal results have occurred, the agent acting as an energetic caustic, producing inflammation and ulceration of the mucous mem- branes of the air passages. The effects in medicinal doses are those of a general stimulant, producing warmth in the stomach, transient vascular excitement, increased heat of the surface, and a disposition to diaphoresis, diuresis, and increased bronchial secretion. In some cases it affects the head, pro- ducing a sensation of fullness and oppression, but no pain. Its action upon the nervous system is evinced by the increased capacity to muscular exertion and activity, and the facility with which other functions are performed. As a remedial agent it is useful in cases where we wish to rouse the action of the heart, without unduly exciting the brain, alleviate spasm and excite the respiratory organs, as in cases of asphyxia and syncope. It is an appropriate remedy in torj)or or prostration, and sinking of the vital powers in typhoid or typhus fevers, and other adynamic forms of disease. In the cold stage of intermittents, especially of a congestive form, and in the exanthemata when the eruption has receded from the surface, its diaphoretic and stimulant powers render it an agent of much value. Diluents and warm clothing are required to promote its diaphoretic action. As an antidote it is employed in cases of poisoning by the narcotics and sedatives, as the fox-glove, tobacco, and hydro- cyanic acid; its efficacy depends, probably, upon its highly ex- citant action. As an inhalation, the vapor of ammonia is used when a powerful shock to the nervous system is desirable, as in cases 376 STIMULANTS. of syncope, asphyxia, and to ward off an attack of epilepsy. It is also employed to counteract the influence of antestlietic agents; in fact, these agents are never employed without hav- ing the ammonia at hand, so as to be immediately available in case of accidents. Antidotes. — In cases of poisoning by Ammonia, the an- tidotes arc diluted acids, of which the best are vinegar, lemon or orange-juice. The consecutive inflammation is to be treated on general principles. SPIRITUS AMMONIA AROMATICUS. Preparation. — I^ Hydrochlorate of Ammonia .3vj., Car- bonate of Potash 3x., Cinnamon bruised, Cloves bruised, aa, 3ijss; Lemon-peel .^v.. Rectified Spirit, Water, aa, Oiv ; mix them and let six pints distill. Dose. — From one-half to one drachm in water. Aromatic spirit of Ammonia may be exhibited to fulfill the same indications as the simple spirit just named; on account of its more agreeable taste and smell, it is usually preferred to that preparation. It is administered in sick-headache when there is a languid state of the stomach, as a gastric stimulant; and is frequently used for the same purpose in nervous debil- ity, hysteria, flatulent colic, and languid states of the system. AMMONII CARBONAS. Dose. — From five to twenty grains properly diluted with water. Carbonate of Ammonia may be employed to fulfill all the indications of the ammotiiacal pre})arations. It is a stim- ulant diaphoretic, and for this purpose may be advantageously employed in rheumatism, acute inflammations, and in the con- tinued fevers. It has been employed in epilepsy with reputed advantage, in doses of from ten grains to a scru[)le. It has been recommended in diabetes, in scrofula, and to relieve venereal pains and nodes, but the evidence is not clear that it gives any more than temporary relief. ELECrKICITAS. 377 ELECTEICITAS. Electricity is a powerful therapeutic ageiit^ and well deserv- ing a notice under the class of Excitants. Therapeutic Action. — It acts either as a general or local excitant or stimulant, or sedative, according to the mode of application. It excites the vascular and nervous systems, ac- celerates the pulse, arouses the nervous susceptibilities, stimu- lates the muscles to involuntary contractions, and promotes the secretions. Its employment is indicated in atonic states of the system. Paralysis of either the sensor or motor nerves, when uncon- nected with, or not dependent upon organic lesion of the cer- ebro-spinal system, are cases requiring the use of electricity. Old cases of paraplegia and hemiplegia, nervous deafness, amaurosis, paralysis of the fore-arm, occasioned by the ])ois()u of lead or of mercury, topical numbness, asphyxia, etc., uro often entirely relieved or greatly benefited by its application. It should be borne in mind, however, that it can not be ex- pected to afford much, and in general any relief, in those cases of paralysis arising from lesion of the nervous centers; in other words. It Is mostly available in paralysis dependent u[)oii functional and not upon organic lesions of the nervous system. It may be remarked that in amaurosis it is rarely of any avail. In amenorrhoea, when, from the concomitant symptoms, it may be supposed to depend upon uterine torpor, the electrical cur- rent passed through the pelvis from the sacrum to the pubes, is often followed by the most gratifying results. In loss of muscular power, attendant on chronic rheumatism, and in the stiffness and rigidity following sprains or bruises. It has ren- dered essential benefit. In certain convulsive disorders, as chorea, much benefit lias often been known to attend its use. Electricity has been em- ployed to ])romote the absorption of tumors, and serous and synovial cysts, congestions. Indurations, dropsical effusions, as in hydrocele, ascites, hydrothorax, hydrops pericardii, hydrops artlculi, etc. In applying electricity to- deep-seated parts, as the uterus through the vagina, or the meatus auditorlus internus, the 373 STIMULANTS. coiKluctiiig wire is made to pass through a glass or rubber tube. Neligan remarks that the different forms of electricity may be in general indifferently applied, but says that galvanic and magnetic electricity possess the advantages of being more readily em[)loyed, of not being interfered with by the state of the atmosphere, of the effects produced being more under con- trol, and in the facility with which they may be applied to different parts of the body ; hence they are mostly used at the present day. It rarely proves speedily beneficial ; it is only by its long continued employment that benefit is to be derived. It is also necessary that the intensity of it be not too great, as over ex- citement from it is especially liable to prove injurious. It should be further remembered, that it is to be resorted to, as a general rule, only as an auxiliary, and not as a principal therapeutic measure. We now employ the galvanic battery in almost all cases, using the broken or Faradic current, and the constant current. The first is employed for the ordinary purposes of an excitant, and to relieve hypersesthesia of parts. The second is used for its chemical action, influencing the nutrition of parts or even destroying them if desired. The single element battery with Ruhmkorff coil and vibra- tor is the one in common use, and is represented in the market by Kidder, Drescher, Foster, and others. The constant cur- rent battery, consisting of a number of elements, is not so commonly used. If one will take hold of the poles of a battery of this kind, he will find that the current is broken, and is very sensibly felt. One pole will give a distinctly stronger sensation than the other, and this is the positive pole, the current passing into the body ; the other negative, the current passing out of the body. The poles are marked on the battery, and if the ele- ments are properly connected with the coil, there will be no trouble. The first use of the battery is as a direct remedy to the skin and to the cutaneous nerves ; the second is to influence a special organ or part. This influence may be cither sedative or stimulant, and it is essential to know which influence we want, and which wc ELECTRICITY. 379 are p;etting. It Las been said that the positive pole is stimu- lant, and the negative pole sedative, but this will not answei-, and is usually wrong. It is the direction of the current as to the direction of the nerves supplying the part that we are to look at. Tlie current passed in a direction contrary to the nervous flow is sedative; the current passed in the direction of the nervous flow is stimulant. If we are making a general application of electricity to the skin, and want a sedative action, we apply the negative polo. to the spine, and pass the positive pole over the surface. If we wish a stimulant action, the positive })ole is ap[)licd to the spine, and the negative pole is passed over the surface. This general application is one of the best uses of electricity, not only influencing excretion directly, but exerting a most favorable influence u})on the innervation of the patient. Of course it is understood that the poles are embedded in a wet- ted sponge. In making a local use of electricity, we must know whether a stimulant or sedative influence is required. Has the part an increased circulation ? is its condition one of irritation ? If so, we use the sedative, current — the positive pole apj)lied over the part, the negative pole to the spine where its nerves are given off. Are the sensations those of atony or conges- tion— fullness, weight, dragging? — then we want the stimu- lant current — the negative ])ole applied over the i)art, the pos- itive to the spine where the nerves are given off. ELECTRO-P UNCTURE. Electro-puncture, or Galvano-puncture, is the introduction of acupuncture needles in the usual manner: connecting one or more of them with the poles of a voltaic battery, a succes- sion of shocks may be given by the frequent suspension and restoration of the connection ; or they may be made to form a part of the circle in the passage of the electric current. This practice has been adopted in many instances with great success, in rheumatism, neuralgia, local paralysis, sciatica, spasmodic affections, etc. Electro-puncture has been employed in cases of aspliyxia, and it has been proposed to ])ass the needles on each side between the eighth and ninth ribs into 380 STIMULANTS. the diaphragm, and establish an electric current ; and M. Bonr- geois went so far as to })ropose tiie electro-puncture of the lieart in order to accom[)lish resuscitation in asphyxia. Elec- tro-puncture acts powerfully as a special or local excitant, and also revellent. Its local derivation and excitant action point to it as a rem- edy of primary importance in chronic rheumatism, neuralgia, })aralysis from torpor of the nerves, morbus coxarius, sciatica, and affections of the spinal cord. CALORIC. HoT-AiR Bath. — The hot-air bath consists in the applica- tion of air to the surface of the body, heated to the temper- ature of from 98° — the temperature of the body — to 120° or 130°. It is a powerful excitant. Hot- Vapor Bath. — This consists in the use of the vapor of hot water, or the medicated vapor, various medicinal sub- stances being added to the water, or in the application of the vapor of burning alcohol or some kind of ardent spirits heated to 120° or 140°. The vapor bath is excitant, revellant, and sudorific. It softens and relaxes the skin, increases the fullness of the capillaries of the surface, accelerates the i)ulsc, and causes sweating. It is more soothing and relaxing, and consequently better calculated to induce diaphoresis than the hot-air bath. It is also employed in congestive forms of dis- ease, as in the cold stage of agues, and in cholera, also when sweating is desirable, as in rheumatism, gout, local swellings and inflammations, chronic cutaneous affections, chlorosis, amenorrhoea, dropsy occurring in old and debilitated subjocits, old liver affections, scrofula, etc.; in many of which it is an agent of immense utility. The vapor of burning spirit is a much more powerful means in accomplishing the results which follow from the vapor of hot water. It is powerfully excitant, sudorific, revulsive, and relaxing; valuable in the early stages of many febrile and inflammatory affections. Hot- Water Bath. — This bath has a temperature of from 98° to 102°. It is strongly excitant to the nervous and vascu- lar systems. It renders the })ulse fuller and stronger, and causes redness of the skin, with distension of the cerebral ves- NUX VOMICA. 381 sels and violent throbbing, and, if Ion?; continued, may cause apoplexy. It io employed I:.i rheutnatisni. paralysic-. and neu- ralgia. Hot bricks, bottles of hot water, hot flannels, hot sand, hot salt, etc., all exert an excitant influence upon the system. (See Baths, etc., in another part of this work.) Dry and Jiot vapor is more stimulating and exciting to the capillaries of the surface and to the general system, than the vapor of heated water or the medicated vapor^ and less debil- itating to the system, and is therefore better adapted to patients greatly prostrated by disease. Hot air is an excellent excitant and revulsive application in the congestive forms of disease, as in congestive intermittents and remittents, Asiatic cholera, asphyxia from drowning, chronic rheumatism, neuralgic affections, etc. It is sometimes impregnated with sulphurous acid gas or chlorine, and used in chronic cutaneous diseases. NUX VOMICA. THE SEEDS OF STEYCHNOS NUX VOMICA.— East Indies. PnEPAHATiONS. — Tincture of Nux Vomica. Strychnia. Dose. — The dose of the tincture will vary from the fraction of a drop to five drops. For its specific use we add from one to five drops to four ounces of water, and give iu teaspoonfnl doses every half hour or hour. The dose of strychnia will range from one-hundredth to one-twentieth of a grain, accord- ing to the effect desired. Specific Indications. — The patient has pain in the abdo- men which shifts its position ; pain pointing to the umbilicus; hypogastric pain resembling colic ; nausea and vomiting, the tongue being pallid ; yellowness about the mouth, sallowness of skin; pain in right shoulder and region of the liver; diffi- culty in breathing, especially when the patient sleeps ; inability to command the voluntary muscles ; want of power in the bladder to void urine. Therapeutic Action. — In small doses it is stimulant, tonic, diuretic, diaphoretic, laxative, anthelmintic. In large doses it is tetanic or cerebro-spinant, poisonous. In small and repeated doses Nux Vomica promotes the appetite, aids digestion, renders the secretion of urine more 382 STIMULANTS. copious unci its excretion more frequent^ acts as a laxative and diaphoretic. In larger doses it causes weakness and a weighty sensation in the limbs — sensibility to surrounding impressions is in- creased, as the sensation to touch, change of temperature, sound, light, etc. There is depression of spirits and anxiety, tre- mors, rigidity or stiffness of muscles, with inability to maintain the erect posture ; he staggers as he walks, and if the medicine be continued the intensity of its action becomes increased; the voluntary muscles are easily thrown into a spasmodic state, so that by a deep inspiration, or any effort or exertion, a convul- sive paroxysm ensues. In poisonous doses it causes tetanus, asphyxia and death. Slight and transient convulsions appear at first, with great thirst; finally the convulsions become more frequent and severe, every muscle is fixed and rigid, the face and hands be- come livid, the spasm is short, and during the intervals the patient is sensible; no pain is experienced, the pulse and res- piration are susj)ended, and a fatal asphyxia ensues. We employ Nux for the relief of nausea and vomiting de- pending upon gastric atony and enfeebled spinal innervation. The indication is clear : the tongue is pallid and expression- less— atonic; the lower part of the face gives the same evi- dence— yellowness or sallowness about the mouth and feeble expression. The dose should be small — just enough to render the water bitter is sufficient. We employ it in the treatment of colic, both in infants and adults. In infantile colic, whether gastric or intestinal, it stands first in the list of remedies. One drop in a third of a glass of water, given in small doses frequently repeated, gives speedy relief. In the adult we do not want to mistake an inflammatory condition for a purely nervous disturbance, or the colic from hypersesthesia of the intestines for that which is associated with atony. Nux being a stimulant is especially adapted to the atonic cases, in which it gives prompt relief. Five or ten drops are added to a half glass of water, and given in teaspoonfnl doses frequently repeated. In " uterine colic" it is an admirable remedy. The pain is violent, and simulates colic, and there is evidence of an atonic condition, both general and locnl. It is also a remedy in dys- NUX VOMICA. 383 menorrhocti with symptoms as above ; in this case it is usually given with Macrotys. Wc employ Nux and Strychnia in the treatment of atonic diarrhoea, associating it with Ipecac, Enphorbia hyper, or Bis- muth. It is an admirable remedy in cholera morbus, and finds a place in the treatment of Asiatic cholera. In these cases, if it can not be taken by mouth, on account of the irritability of the stomach, we nse it by hy[)odermic injection. If the circn- lation is feeble, the injection should be thrown in over the sternum. Niix is an admirable remedy in the treatment of cholera infantum, being especially adapted to those cases characterized by atony. It relieves nausea and vomiting, strengthens the stomach, improves digestion, gives better innervation, and, with Ipecac or Enphorbia, checks the bowels. Wc employ Strychnia as an autiperiodic in the treatment of ague when there is marked atony of the stomach and feeble spinal innervation. The specific indications given at the com- mencement of this article will point the way to its successful use. The autiperiodic quantity will be about one-fifth of a grain in divided doses. If the remedy can not be given by mouth, it may be used by hy{)odermic injection. In the cold stage of congestive intermittents, as well as in cholera, the hypodermic injection of Strychnia is one of our most powerful means. In some cases the patient is in such condition that no remedy will be absorbed from the stomach, but so long as there is a chance for life, it will be absorbed from the cellular tissue of the chest. It should not be forgotten that Nux is a good remedy in some cases of habitual constipation. One drop in a glass of cold water in the morning on rising, will frequently overcome this unpleasant condition. Its utility in paralysis appears to depend upon an increased or preternatural irritation or excitement in that portion of the spinal cord from which the nerves emanate that supply the l^aralyzed nuiscles, and from which the nervous influence is derived. Its capacity to increase the susceptibility to external im- ]n'essions, has secured its exhibition in the treatment of par- alysis depending upon functional lesion of the sentient nerves, 384 STIMULANTS. as well as in that affecting the motou nerves. Its exhibition in paralysis of the sentient nerves has not been attended with the same happy resnlts as in that of the motor nerves. It has been successfully employed in impoteney. The ex- citement which the Nux Vomica has been known to occasion in the sexual organs induced Trousseau to employ it in that affection, when he found it successful in both males and females. \ IGNATIA. THE SEEDS OP STRYCHNOS IGNATIA.— East Indies. Preparations. — Tincture of Ignatia. Dose. — To water §iv. add gtt. v. to gtt. xx., and give in teaspoonful doses. Specific Indications. — Pain in hypogastrium and pelvis; ovarian irritation; pain with weakness in small of the back; pain along the course of the crural nerves. Therapeutic Action. — The action of Ignatia is very similar to that of Nux Vomica. Our homoeopathic neighbors ,say, give Nux to men, Ignatia to women, and in this I think they are right, though there are many diseases of men in which the latter acts well. I employ it principally as a stimulant to the pelvic organs, and the reproductive function. The condition indicating it is one of atony. The uterus is enlarged, the ovaries enlarged and tender, and there is a sense of uneasiness with weight and dragging, associated with sharp expulsive pains. It relieves pain, and gives a better innervation, both spinal and sympa- thetic. Ignatia is a good remedy in some cases of dysmenorrhoea, associated with Rhus, or with Macrotys or Caulophyllum ; and influencing the menses, promoting a normal and less painful flow, it becomes a remedy for sterility. The reader, by following the specific indications as given, will be able to make this a very serviceable remedy in other cases than those I have mentioned. STArHYSAGRIA. 385 ' STRYCHNOS TIEUTE. Tills is another species ol' the Strychnos, the aqueous corti- cal extract of which affords the poison called the U^kis Tieide. The Upas Tieute consists of Strychnia combined with Igasuric Acid and coloring matter. Its effects are the same as the Nnx Vomica. STRYCHNOS TOXIFERA. This is another species of the Strychnos, and the one which yields the basis of the celebrated poison of Guyana, known as Woorari, Ourari,OY ?7ra?'?j which is said to "produce paralysis with convulsive movements, and death from apparently sus- pended respiration." — Pereira. There are sundry other species of the Strychnos named by systematic writers, most of which are poisonous, but as none of these are used for medicinal purposes, it is unnecessary to devote more space to their consideration. STAPHYSAGRTA. THE SEEDS OF DELPHINIUM STAPHYSAGEIA. .Preparation. — Tincture of Staphysagria. Dose. — To Siv. of w^ater add gtt. x. to gtt. xx. ; dose, one teaspoonful. Specific Indications. — Sense of fullness in the perineum and along the urethra ; mucoid discharge from the urethra; sense of fullness about the anus, and mucoid discharges fol- lowing stool ; enlarged prostate, prosttitorrhcea, spermatorrhoea. Therapeutic Action. — Staphysagria exerts its influence upon the lower pelvic organs. It may be used in chronic cys- titis with raucous discharge, chronic urethritis, the second stage of gonorrhoea, chronic vaginitis, leucorrhoea, chronic inflam- mation of the prostate, and chronic inflammation of the lower portion of the rectum. In these diseases the indications given above will be a good guide. It exerts a marked influence upon the prostate gland, the vesiculse seminales, and the testes, relieving irritation. I have c:::ployed it for years to cure prostatorrha?a, arresting the dis- £5 386 STIMULANTS. charge which has so excited and aUiniied the sufferers. It also exerts a good influence in spermatorrhoea, relieving the mind by checking the prostatic and urethral discharge, and dimin- ishing the tendency to nocturnal emissions. ERYTHROXYLON COCA. THE LEAVES OF EKYTHRGXYLON COCA.— SOUTH AJIEEICA. Preparation. — Tincture of Coca. Dose. — From five drops to half a drachm. Therapeutic Action. — In Columbia the natives use it to enable them to endure prolonged exertion without taking food. It seems to serve a similar purpose to coffee and tea, though it is claimed that it lessens the waste of tissue, enabling the person to endure great fatigue. For some time I have been using this remedy in a class of cases where there was defective innervation, some dyspepsia (imperfect digestion, though the appetite was good), pain in the occiput and neck, with dizziness and inability to stand for any length of time. In three of these cases where the most marked benefit was experienced, the disease had been diagnosed "dumb ague," and treated with quinine to the extent of lessening (stopping in one case) the afternoon feverishncss, but leaving the unpleas- ant symptoms named above. In one case the patient had been a sufferer from rheumatism for a year or more, had ovarian irritation with scanty menstru- ation, functional heart disease, and inability to digest the ordi- nary food used by the family. Anti-rheumatics had removed the pains, the heart-beat had come down from 110 to 70, and the irregularity of pulse had disappeared. She had gained flesh, but had no strength, and was nervous and despondent. The food was changed to a very plain diet in moderation, and the Coca given in fifteen-drop do.ses every four hours, with the most marked benefit. A business man had suflered from overwork, some worry, good living, and want of exercise, and now finds himself with some dyspeptic symptoms, jiain in the occiput, and dizziness. A spare diet was recommended, all stimulants to be avoided, open-air exercise to be taken, and ten drops of Coca every ARTEMESIA. 387. three hoars. He improved steadily, and was himself again in the course of a month. Was it the Coca, or was it the diet, avoidance of stimulants, and the open-air exercise? The reader may answer these questions for himself. I think both had something to do with the cure, but I am sure that without the diet and exercise he could not have recovered. I do not think it well to make a hobby of Erythroxylon Coca, or of any other remedy, but it may be remembered as a very good nerve stimulant in the cases I have named. ARTEMESIA. THE "WILD SAGE" OF THE WESTERN PLAINS. Prepaeation. — It is used in infusion, a tincture is pre- pared, and it yields an oil by distillation. Therapeutic Action. — A correspondent in the West writes : " The herb is used as a fomentation by Our best physi- cians. By the people in infusion for fever, rheumatism, diph- theria, and putrid sore throat. The oil is used as a liniment, mixed with olive oil, in deep-seated erysipelas, with the best results. Bruises, sprains, and swellings, are treated in the fol- lowing manner : the part being bathed with the oil, the hot herbs are bound on the part and covered with oiled silk to prevent evaporation. The results are most gratifying." 3S8 SPECIAL THERAPEUTICS. OLA.SS V^III. AIlT^STHETICS. By the term anaesthetic we understand an agent capable of occasioning a suspension of general sensation. In other words, this class of remedial agents are resorted to, to induce a state of temporary insensibility. Their use may be carried to the extent of causing but partial anaesthesia, but they are chiefly exhibited, however, until a state of entire insensibili- ty is attained. This class of agents may be divided into two kinds ; the first, acting upon the entire system, produc- ing a like insensibility of all parts, may be termed general anoesthetics ; while the second affecting but the parts to which it is applied may be called local anaesthetics. To induce a state of insensibility in cases of excessive pain, especially in painful surgical operations, has been an important desideratum with the profession, eagerly desired for centuries past, and various means have been adopted, at difterent periods, to secure the desired object. It is asserted that the Chinese were not unacquainted with anaesthetic agents as early as the third century. A Chinese book, in the !N"ational Library of Paris, states that when about to perform painful operations, a Chinese physician, by the name of Ho-a-tho, gave his patients a preparation of hemp, which soon rendered them insensible to the operation, however painful. The Greeks and Romans are said to have used anaesthetic agents. M. Yelpeau states, that " The so- called Memphis-stone, dissolved in vinegar, after having been reduced to powder, was used as an anaesthetic agent among the Greeks and Romans; and mandragora was ex- tensively known as possessing anaesthetic properties." Again the same author states that Hugh of Lucca, an eminent physician of the thirteenth century, employed anaesthetics. " A sponge dipped in the juice of nightshade, hyoscyamus, AN^ST 11 EPICS. 389 cicuta, laetuca, mandragora or opium, was put under tlic uoso of patients, and made tliem sleep during operations." The Turks, it is said, have for along time induced anaesthesia on subjects who were going to submit to circumcision. Sir Humphrey Davy used the nitrous oxyde gas to relieve tooth ache, and suggested its use in surgical operations. Mr Wells, of Hartford, emploj^ed this gas in 1842, for extracting teeth without pain ; and others employed this, or some other agent, some 30 years ago, to relieve pain. From the foregoing remarks it seems various agents have, at ditFerent periods of time, for many centuries past, been exhibited with a view to the induction of anaesthesia in pain- ful operations and pain dependent upon other causes. Not- withstanding the use of these agents at difiereut periods by certain physicians, they did not meet with general lavor by the profession, for the reason, perhaps, that they were not regarded as reliable, or their use was not unattended with danger. The advantages and comparative safety of the agents now in use as anaesthetics, have but recently been dis- covered and fully tested. Those formerly used seem not to have been generally known — at least but few nsed them — and no agents of a reliable character in all respects have been known to the profession generally until within quite a recent period. The meed of praise for the discovery and introduction into general use of an agent that would render painful opera- tions painless, was reserved for our countryman. Dr. Morton, of Boston, who made known the results of his experiments with sulphuric ether as an anaesthetic, in 1846. Through the influence of Dr. Morton, and after repeated cautious ex- periments. Dr. J. C. Warren was induced to employ it in an operation performed at the Massachusetts General Hos- pital on the 15th of Oct., 1846. Anaesthesia was but par- tial in this case. On the succeeding day. Professor Hayward operated, having first induced a state of complete insensi- bility of the subject upon whom the operation was to be performed. From this beginning the anaesthetic power of ether, in the form of inhalations, spread with great rapidity throughout the civilized world, and is now regarded as one of the most important discoveries of the present century. 390 SPECIAL THEIlAl EUTICS. About one year after the an?estlictic powers of ctlier bad been established, Professor Simpson, of Edinburgh, after repeated experiments, announced that chloroform was a still more effective remedy for producing aneesthcsia. This new agent soon acquired a reputation equal and even surpassing ether. Its advantages were its more rapid and intense action, its smaller dose, and its more agreeable taste and smell. In addition to sulphuric ether and chloroform, other general anaesthetic agents have been discovered and experimented with; yet none have been found to possess their advantages. Among these we might name the chloride of hydrocarbon, ni- trate of ethyle, henzin or benzole, aldehyde, bisulpiairet of carbon and amelyne. Importance of Ancesthetics. — As to the importance of anais- thetics as therapeutic agents, it appears to us no division of opinion can obtain. That the severity of the sufferings in many painful operations depresses the vital powders, exhausts the nervous energies, or communicates such a shock to the nervous system, and inflicts such an injury on many consti- tutions as to destroy life almost immediately, and in others to jeopardize the recovery of the patient, are truths wdiich none are disposed to dispute. The induction of anresthesia most effectually counteracts such results. Again, the power- ful shock, the great depression, the exhausting and insup- portable effects which the dread of pain, or the fear of an operation exerts upon the nervous and timid, serve, in many instances, to overwhelm the patient and sink his vital powers beyond the possibility of reaction ; hence the prospects of a favorable termination are materially lessened, or, porha])s, entirely destroyed. ISTothing more efliectually destroys the recuperative powers, or the early reactive energies of tlio system, than fear ; fear as to the final result, or dread of pain, overpowers or almost destroys life in many instance?, even before the operation is commenced. Again, an operation is performed much more deliberately, and with mucli less per- turbation by the surgeon, when the patient is not writhing in agony — when he is known to bo enjoying entire immunity from pain, even though the operation be one of great severity. All the circumstances here alluded to, and many more, tend to increase the immediate danger, and lessen the ]>rospecta AX.-E-TIIETICS. 391 of a spocdy convalescence — results whicli arc conntcractcd by tlie indaction of anesthesia. Does anrestliesia diminish tlie mortality followino; severo operations? This is a very important question, and if de- cided in the afiirmative, adds much weight to the reasons already advanced in favor of "'.s employment. That this, is the case, we believe is not Jisvutecl at the present da}-. Mr. Curling says: "I have carefully watched the progress of cases, after operations of various kinds performed upon per- son? lU a state of anaesthesia, and I can, with confidence declare that, so far as my present experience has reached, the constitutional symptoms have been milder, and the cases have proceeded more satisfactorily, than after operations in which no means had been taken to prevent pain. Several of m}^ surgical friends can fully confirm this statement." Prof. Syme saj's: "As to the cases in which chloroform should be employed, it maj' be said that there are hardly any in which pain would otherwise be inflicted, where its use is not desirable for the patient, and incumbent upon the prac- titioner to propose. At an early period of our information on this subject, it was thought that in a state of collapse, or extreme depression from weakness, fatal sinking would be apt to result from the effect of chloroform. But so far from this being the case, it has been found that the most serious operations may be performed under the influence of this agent, in circumstances of the most extreme exhaustion, with results infinitely more successful than could have been anticipated otherwise." These authorities might be multi- plied, but we wish next to see, from statistics, to what extent the mortality is diminished. The following table of the mortality of amputation of the thigh, with or without etherization, collected by Dr. Simpson, will illustrate this point: Names of Reporters. Parisian Hospitals — -Malgaine, Edinburgh Hospital — Peacock, - General Collection — Phillips, Glasgow Hospital — Laurie, British Hospitals — Simpson, Upon patients in an etherized state, No. of No. of Cases. Deaths. 201 12sioal and nervous energies of the system. The facts in the case hear out tlie arguments adduced above in favor of the use of anpes- thesia, if the statistics of European hospitals as Avell as [)ri- "\'ato pi'actice are reliable data npon which to base a conclu sion. Labors have been more rapid, the system less exhausted recoveries more speed}-, while the occurrence of rigors, epliem oral fevers, abdominal pains, convulsions, puerperal inflam- mation and fever, and many other serious diseases incidental to the puerperal state, is greatly reduced by the employ- ment of anaesthesia. Ansesthetics have been employed with unequivocal advan- tage in puerperal convulsions. The violence of the spasm yields promptly to their influence, and is often immediately ar- rested. If other measures fail, their importance in these cases should never be overlooked. They have been used in both idiopathic and traumcdic teta- nus, more especially in the former variety, with much success. Their influence should be maintained for a considerable length of time, in order to secure the advantages to be derived from their exhibition. They have also aftbrded temporary relief in cases of hydrophobia, although not a pro- longation of life. Spasmodic asthma is another afl^ection in which entire and immediate relief of the paroxysm has followed their exhi- bition. The relief they aflrard in these cases, is but tempo- rary, it is true, nevertheless it is a respite devoutly desired by the patient.- In delirium tremens their efi:ects are said to be very satisfac- tory. The induction of ansesthesia is often somewhat difH- cult to be attained in this affection — more especially if ether be the ansesthetic used; but so soon as quietude ensues an artificial sleep follows, whicb is soon succeeded by a natural sleep, more or less protracted, When the patient awakes tc a state of consciousness, he is calm and perfectly composed If the patient is weak, and the system already exhausted by continued debauchery, the induction of anaesthesia should bo gradual. Anaesthetics have been used with great success in cases of ncarcdgia. Th.eir exhibition in this disease is seldom unat- 394 SPECIAL THERAPEUTICS. tended with temporary relief of paii:i ; and sliould the pain return, a repetition of the anaesthetic again removes it, and by two or three repetitions it has, in man}' instances, been entirely subdued. In other painful affections, as toothache, rheumatism, sciat- ica, colic, spasm of the stomach or bowels, etc., their use is salutary and desirable ; even in the more painful and spas- modic forms oi Asiatic cholera, we have no doubt but partial ansesthesia would afibrd much relief; but it should not be allowed to interfere with other medication for the radical cure of the disease. If used at all in this case, it should be only with a view to the relief of the extreme sufferings of the patient. Action of An (Esthetics. — General ansesthetics no doubt act directly upon the cerebro-spinal centers. The inhaled vapors are first absorbed into the blood, as is proved by the detec- tion of them in different parts of the bod}^, — even in ampu- tated limbs, — and in their exhalation by the breath for a considerable length of time after ihe cessation of the inhala- tion. Their first effects are loss of mind and volition, then follow loss of sensation and motion, and lastly the power of respiration. Ansesthetics first cause excitement, attended with ringing in the ears, restlessness, confusion of intellect, and partial insensibility. In some cases, great excitement, accompanied with screaming and violent efforts are among the first mani- festations of its action on the system. Yery soon a sleep, more or less profound, follow^s, consciousness is lost, the mus- cles are rigid, and the sensibility blunted. Soon, how-ever, a state of general relaxation follows, with a profound sleep, and an entire loss of sensibility ; respiration in this stage becomes stertorous, though regular; the pulse is also regular. Final- ly, the respiration becomes irregular, or interrupted, and tl)e pulse w^eak and fluttering, and if permitted to continue in this state for but a few seconds, respiration would cease and death ensue. The order here stated is not always observed, for the effects are irregular in many cases. In some instan- ces no period of excitement is observable, the patient at once sinking into a state of profound narcotism. In others, the sensibility is lost, while consciousness remains unimpaired. ANESTHETICS. 395 Altliougli this is denied, yet cases of parturition, as well as painful operations are reported, in which consciousness remained unimpaired, perception clear, 3'et sensii)ilLty was greatly diminished, or entirely destroyed. In other cases, sensibility remains, as is evinced by the screams and evident suffering — the patient, however, being unconscious, and hav- ing no recollection either of suffering, or of any thing that occurred during the operation. Dr. Snow divides the action of ansesthetics into five stages, or degrees; and though it will be almost a repetition of what we have already stated, yet as our object is to present the subject in the plainest form, we will quote his remarks. "In the ^ra;! there exists a kind of inebriation, which is usually agreeable when induced for curiosity, but is often otherwise, when the patient is to undergo an operation. Consciousness to surrounding objects remains unimpaired, though the- power of vision seems slightly affected, and sen- sation is so much blunted that the pain of disease, which is generally due to a morbid increase of the common sensibility, is in many cases removed or relieved, according to its intensity. " In the second degree, the mental functions are impaired, but not entirely suspended; consciousness, however, no longer continues correct, and a sort of dreamy state supervenes. This degree may be considered analogous to delirium, and to certain states of the patient in hysteria and concussion of the brain ; and it corresponds with that condition of an ine- briated person, who is not dead drunk, but in that state des- cribed by the law as drunk and incaj^aMe. It is very transitory, and if the inhalation be suspended, the patient in a very few minutes recovers the perfect possession of the mind. A con- siderable degree of anaesthesia is induced, even in this stage; and sometimes a high amount of mental excitement, that renders the patient difficult to manage, shows itself. " In the third degree, all voluntary motion is paralyzed ; and often a rigid, spasmodic contraction of the muscles of the extremities occurs. The mental faculties are completely in abeyance, the eyes are most frequently drawn forcibly up- ward, and the vessels of the conjunctiva sometimes become injected with red blood. It does not follow, however, that 396 SPECIAL THERAPEUTICS. nil operation may always be commenced imniGcliafcly the narcotism reaches this degree, for anaesthesia is not a neces- sary part of it. ^^ The fourth degree brings with it relaxation of tlie volun- tary muscles, together with complete insensibility to external impressions, so that no pain is felt even on the infliction of severe personal injuries. Yet, although reflex movements can not be excited by touching even the most sensitive parts of the frame, still some functions of the spinal cord remain, as the sphincters continue contracted, and according to most of its advocates, the action of the uterus in labor is not mate- rially interfered with. The breathing is not unfrequenti}' attended with some degree of stertor. " The ffth degree of narcotism, is the commencement ofihjiiif/. The breathing first becomes irregular, slow, and difiicnlt ; then soon ceases altogether — while the heart continues to beat for a short time, even after the last breath is drawn." Mode of Administration. — G-eneral anaesthetics are all of them administered in the form of vapor. All the ansesthetic agents yet discovered are very volatile, the vapor being in- haled and absorbed into the blood, through the capillaries of the lungs, is conveyed by it to all parts of the system, spec- ially inflecting the brain and spinal cord. Many forms of apparatus have been invented for exhibiting these agents, but like many other things in medicine and surgery, the simplest means has proved the best. The mode in which ether and chloroform are now principally administered in this country, is to take a handkerchief or napkin, folding it three or four double, and pouring on the center of it about a drachm of the anaesthetic. This is applied to the nose, yet not so close as to prevent the inhalation of a sufiicient quantity of air with the vapor: it is brought gradually closer to the face, as the patient comes under the influence of the agent. M. Chassaignac recommends a sponge, about as large as a man's fist, wetted with the anresthetic, and tied up in the corner of a napkin. "The napkin, which contains the sponge in its knotted corner, covers up the patient's eyes, so as to hasten and facilitate the antesthetic stupor. It prevents alsc) too large a proportion of air mingling with the vapor of chloi-o- form." He also recommends that the patient be always ANAESTHETICS. 397 placed in ii recumbent position. This thougli the best position, is not indispensable, for we have seen many cases in which it was administered in a sitting posture, with perfect safety. The question now arises, To ivhat degree should aiicesthcsia he carried in order to obtain its beneficial effects, and yet incur the least danger of a fatal residt? In reference to this question there has been much difference of opinion, some maintain- ing that the second and third degrees are sufficient, illustrat- ing their views by keeping their patients in a half-sleeping, half-waking state, requiring the almost continued adminis- tration of small portions of the ansesthetic ; while others contend that the fourth degree, or stage of toleration, should be secured in all cases before commencing an operation. M. Chassaignac thus describes the symptoms to be noticed, and the stage of tolerance in the exhibition of chloroform, which he believes is the proper degree of anaesthesia to be obtained. After describing the first few inhalations, he says : "I then concentrate my whole attention on the symptoms which reveal the degree of ansesthetic action; the following are the sources of information to which I apply : " a. The state of the pulse. " b. The state of the respiration, appreciated by inspecting the epigastric region, which expresses in a far more signifi- cant manner the state of that function than the costal walls of the thorax. " c. The patient's face, which, by its sinister expression, often indicates the approach of danger, long before the res- piration and pulse have caused any serious apprehension. " d. I attend with particular care to the last manifestations of the period of agitation, and the first appearance of the stage of collapse. At this moment I immediately remove the sponge, and wait for the stage of 'tolerance.' Lastly, when this stage is fully established, on the slightest manifes- tation of returning sensibility, I give the patient small quantities of chloroform by means of the above-mentioned apparatus. "This, then, is the manner in which I proceed, and these are the means by which I seek to obtain, before operating, what I call ' ansesthetic tolerance.' The inhalation is com- menced with all due caution, and when the period of agita- 398 SPECIAL THERAPEUTICS. tion arises, I allow it to pass off without suspending the inhalation, until the patient arrives at the state of collapse. As soon as this is manifested, I suspend completely the in- halation. I wait until the respiration and pulse become regular, and until the patient is plunged into that peaceable sleep which in many persons succeeds to the first stages of anaesthesia. This sleep — with perfect regularity of the great functions, with decrease in the number of pulsations, with complete equilibrium of the respiration, which is deep' and calm — constitutes for me the state of anaesthetic tolerance. " I can affirm, from having experimented a great number of times, that when the patient has arrived at this state he is subject to no kind of danger, whatever may be the time during which it is prolonged. It is to be remarked, that in this state the general insensibility and muscular resolution are present almost in the same degree as in the period of collapse. But when the 'tolerance' exists, sensibility will revive, if we do not take, in this respect, particular precau- tions. And it has been observed that, in patients arrived at this state of almost saturation, very small quantities of chloroform, in doses incapable of bringing on any accident, suffice to sustain the anesthesia, without disturbing in any way the state of 'tolerance' in which the economy is plunged. We have, then, every kind of security that we can wish for; first, against pain, complete insensibility; secondly, against dangerous functional disturbance, perfect regularity of the functions. And besides, the surgeon, exempt from all anxiety on the score of the ansesthesia, can give himself up entirely to the operative department. "This state of 'anaesthetic tolerance,' unfortunately, is not always as easy to obtain as one might believe ; there are subjects whose constitution is, in some manner, opposed to it. It would seem that we c^m only obtain from them excite- ment or collapse, and that the medium state, which consti- tutes essentially ' tolerance,' can not be produced. They commence, as do nearly all subjects, by excitement, and arrive at collapse ; but as soon as this is about to finish, it gives place to new excitement. It is only in children, in certain women, X)r in adults very debilitated, that we pass ANAESTHETICS. 399 from the period of excitement to that of ' tolerance,' with- out observing the state of collapse." It has already been stated that the fourth degree of anaes- thesia, according to Dr. Snow, is the stage termed by M. Chassaiguac that of ''toleration"; but this is not exactly the case, it being a medium between that and the third de- gree. Thus, when we exhibit chloroform, w'e find that when ■we reach the fourth stage, — relaxation of all the voluntary mus- cles, and complete insensibility, or as it is termed by M. Chassaignac, "^Ae stage of collapse,'" — there is more or less irregularity of the respiration and circulation. As soon as this subsides, we have the state of "tolerance" described. Contra'-Indications. — Some states of the system are less favorable to the use of these agents and the induction of anaesthesia than others. Organic diseases of the heart and large vessels, as hypertrophy of the heart, ossification of its valves or of the large arteries, aneurisms, etc., contraYndicate their use, or at least lessen the probability of a successful termination. These conditions do not, however, absolutely forbid their use; but in such cases they should not be em- ployed without they are imperatively demanded, and should then be used with the greatest care and caution. In cases of great plethora, anaesthesia is effected with greater diffi- culty, and with less regularity. To obviate this, a hydra- gogue cathartic should be prescribed, and abstinence enjoined previous to tlie use of the anaesthetic, unless the delay will augment the danger. In order to insure success, quietude or a state of perfect tranquillity should be enjoined and obtained, if possible; not that it is impossible that a state of anaesthesia may be se- cured without the observance of these rules. Talking to the patient, or loud talking in the room, should always be pro- hibited, as it always increases the difficulty of bringing the patient under the influence of the anaesthetic. Food should not be taken a short time previous to the exhibition of the anaesthetic; in other words, the last meal should have time to digest before its administration. The reason for this is, that otherwise the anaesthetic "would be very apt to produce vomiting as its effects were passing off, 400 SPECIAL THERAPEUTICS. or even during an operation, providing the agent happened to be suspended, and the patient commenced to recover from its eftects. A free supply of atmospheric air is absolutely required in conjunction with the anaesthetic at all times ; for without it life is endangered. The failure to observe this precaution has undoubtedly given rise to most of the fatal results aris- ing from the use of chloroform. It is an imperative rule that the one who administers the anaesthetic should watch the pulse, the respiration, and the general state of the patient, closely, from the first inspira- tion until sensibility and consciousness are completely re- stored. "ISTot one beat (says a writer) should the heart give that the finger does not take note of." We think, however, that the signs furnished by the respiration are of more importance. As soon as the pulse begins to sink or flutter, the anaesthetic should be removed, and fresh air admitted. If the respiration becomes stertorous, the inhalation should be discontinued; and should it be irregular and interrupted, the danger is great, and active measures to restore the patient should be adopted. Among these we might mention blow- ing in the face, dashing cold water in the face, the application of strong nasal stimulants, as the ammonia, etc. The im- portance of this last is so great, that surgeons who make much use of these" agents invariably have the ammonia in the room. Should these measures fail, artificial respiration, or the ready method of Marshall Hall, is not to be neglected; it is, indeed, the sheet-anchor of our hopes, or, as a certain writer remarks, the alpha and omega in this emergency; and if long withheld death must be inevitable. Local AncEsthetics. — On this division of ancesthetic remedies we will not have much to say, for as yet the}^ have proved only partial]}^ successful. While general anaesthetics act upon the nervous centers, in great part stopping innervation, and producing complete insensibility of all parts of the body, these act directly upon the nerves of the part, so changing their condition that they no longer transmit im- pressions. If perfect local anaesthesia could be attained, there is no doubt but what it would prove preferable in many cases to ANESTHETICS. 401 its general induction, as it must be admitted that there is more or less danger in the administration of the latter class of agents. Still, we as yet see no prospect of a much greater success than has already been obtained. The first mode of producing local ansesthesia, that is well authenticated, was proposed by Dr. Moore, in 1784. It con- sisted in compressing, by torniquets and pads, the nervous trunks going to the limb to be operated upon. It was tried with partial success by John Hunter, in a case of amputation of the leg. It is stated that in this case, " at the circular incision through the skin, the patient did not cry out, change a muscle of his face, or show any symptoms of pain. At the subsequent parts of the operation, particularly during the sawing of the bones, he showed marks of uneasiness in his countenance, but did not cry out." Dr. James Arnott proposed to employ a freezing mixture, to induce local anesthesia. His mode of applying it consisted in filling a bladder partly full of tepid water, placing it upon the part so as to cover the portion of skin to be rendered insensible ; then gradually dropping in ice, and lastly salt, so as to bring the temperature gradually below the freezing point. This method has proven successful in operations upon the skin and superficial parts, but can never be employed as a substitute for general anaesthetics in the major operations. "We have employed it with success in removing a small subcutaneous tumor, in removing inverted toe-nail, and to remove the sensibility when lancing felons, abscesses, etc. Experiments have been made with the vapor of chloro- form and other agents, applied locally; but they have not proved successful. It has been proved, however, that they are capable of relieving the pain attendant upon many mor- bid states, both of the skin and mucous membrane. Thus the vapor of chloroform, directed upon the part in a jet, will remove the pain of irritable ulcers, and when injected into the vagina, will remove many painful and neuralgic conditions of the uterine and adjacent organs. For this latter purpose, however, it is not equal to carbonic acid gas, which we Imve found eminently useful in relieving dysmen- orrhea, irritation of the uterus, bladder, urethra, rectum, etc., and to relieve the pain in malignant disease of these p:irts. 26 402 ANvESTIIETICS iETHER SULPHURICUS. Therapeutic Action. — As an internal remedy ether is stimulant, narcotic^ and antispasmodic ; its operation in large doses being somewhat similar to alcohol, but it is more diffu- sible and less permanent. It is sometimes em[)loyed as a stim- ulant in typhoid and other low forms of fever, especially when there is nausea, subsultus tendinum, and other spasmodic symptoms present ; its action, however, being very evanescent, the remedy has to be very frequently i-epeate.d. By its stimu- lant influence it cures headache dependent upon a feeble cere- bral circulation — atony. It is also employed to check nausea in cholera morbus and other diseases, and to relieve cramp of the stomach and pain of the bowels. As an antispasmodic, it has been employed in hysteria, spasmodic asthma, tetanus, etc. Used as an ancesthetic by inhalation, it is supposed to be absorbed into the circulation, and acting from this deadens the sensibility of the nervous centers. Its effects arc sometimes partial, pain being completely averted in operations of the most painful character, while consciousness is retained unim- paired. Etherization is a safe and important mode of averting the pain and severity of the shock which the system would sustain in severe surgical operations. Even the actual cautery may bo used without causing pain. Ether is employed many times :;s a relaxing agent, or to counteract the rigidity of the nins- cular fiber, in a variety of cases, among which may be named strictures of the urethra and oesophagus, strangulated hernia, I'ctontion of urine, dislocations, fractures, and anchylosis. In all these cases, the necessary surgical manipulations are very I'.uich interfered with l)y the muscular contractions excited by ])ain. This is particularly the case in dislocations, and in fractures attended with shortening of the limb. In ])artial anchylosis, etherization enables the surgeon in many cases to break up the adhesions without ])ain to the patient or resist- ance from the muscles. Even in lithotomy and lithotri.ty, the incidental advantage is gained of preventing or lessening the inordinate contraction of the muscular coat of the bladder. In short, in most cases in which the necessary surgical meas- ures are likely to be involved in severe nain. or to encounter CHLOROFORM. 403 resistance, as in children, etlierization may be usefully employed. Etherization is resorted to as a palliative in neuralgia and tetanus, and to counteract the effects of over-doses of strychnia. It has likewise been used in asthmatic affections and chronic bronchitis as an expectorant, and as an anodyne and anti.s])as- modic in dysmenorrhoea. Ether is a popular anaesthetic in cases of midwifery. It not only lessens the pain attendant upon parturition, but facilitates that process by securing a relaxation of the rigid soft parts, and promoting the secretions which serve to lubricate these, while it does not interrupt the contractile powers of the uterus. Puerperal convulsions, tetanus, neuralgia, and delirium tre- mens, may be named as additional cases or diseases in which the use of this anaesthetic agent has afforded much relief. The most convenient mode of exhibition, and the one now usually adopted, is by napkin or handkerchief folded and cupped, upon Avhich the ether is poured in small quantities. CHLOROFORM. Dose. — From five to twenty drops. Therapeutic Action. — Chloroform is said to be narcotic, stimulant, sedative, anodyne, antispasmodic, ansesthetic, febri- fuge, and antiperiodic. Taken internally in large doses it occasions a general dimi- nution of sensorial pow'crs, w^ith drowsiness or deep coma, stertorous breathing, complete relaxation, sometimes frothing at the mouth, rarely convulsions, perhaps death. In most in- stances no material influence is exerted on the action of the heart. Its effects may last from a few minutes to one or two hours, according to the period of inhalation. Animals destroyed by chloroform 2)resent no evidences of any peculiar action upon the organs. The blood found in the left cavities of the heart is dark, clearly indicating the action of the heart after respiration ceased. In certain cases exces- sive depression of the heart's action occurs in man, and some- time.s death. Too large a quantity inhaled causes a feeble pulse, and sometimes a prolonged deliquium, requiring power- ful stimulants to restore consciousness. In death from chlo- roform, the lungs were found congested, and patches of })uhno- nary apoplexy were witnessed. 404 ANESTHETICS. Its liability to induce nausea is one objection to its use; nevertheless, it has been advantageously exhibited to arrest chronic vomiting from nervous causes, as in pregnancy. As a local agent, chloroform has been used in a great variety of cases. In obstetrical practice it has been applied to the perineum in case of rigidity and excessive pain. In dysmenorrhoea it has afforded entire relief by introduc- ing a sponge imbued with the chloroform through a tube into the vagina, so as to bring the vapor in contact with the OS uteri. It has been applied to the sacrum, in the same case, with a mitigation of the sufferings. Applied to cancers, it affords relief, and was used for this purpose in 1843 by Mr. Tuson. Great relief has been obtained by the topical application of chloroform in cases of lumbago, sciatica, and other rheumatic and neuralgic affections. It is, indeed, an im- portant palliative, and may aid in effecting a perfect cure. It relieves pain by its narcotic action, it being absorbed into the circulation and acting on the nerves; it acts prima- rily, however, as a revulsive, inducing redness and irritation, and even vesication may follov/ its application. It has afforded great relief in mastodynia or inflammation of the mammaiy gland. Applied to the vulva previous to the application of caustics, or to the urethra, secures entire immunity from pain ; and when applied to the surface pre- vious to the use of the potassa fusa in the formation of an eschai", it is equally valuable in rendering that extremely painful operation painless. Chloroform is said to have afforded i-elief in cases of cholera, applied over the epigastric region. It has likewise been applied over the abdomen in spasm of the bowels and other violent painful alfectious, such as the passage of renal calculi through the ureters, or the passage of biliary calculi through the hepatic duct. . Experiments have been made showing that it is antise])tic, or that it pos-jesses the power of arresting putrefaction. ' Earache is another painfid affection in which it has been advantageously used. CIlLOROFOPvM. 405 It lias been used in "cancer, senile gangrene and slough- ing ulcers, and, in the form of an injection, in profuse dis- charges from the uterus, and as a gargle in foul ulcers of the throat, with the effect of relieving pain, destroying fetor, and promoting the separation of diseased parts." It has likewise been applied to painful wounds and ulcers, swelled testicles, in rheumatic ophthalmia, acute spinal pain and tenderness, lock-jaw, toothache, local spasms and painful local affections, atonic quinsy, and in the form of an oint- ment to papulous eruptions, and in sundry other affections too numerous to mention. A tliird and perhaps more important mode of use as a therapeutic agent, is by inhalation. A full dose of chloroform, exhibited by way of inhalation, causes loss of consciousness, general relaxation and entire loss of sensibility. Chloroform possesses advantages over the sulphuric ether in the smallness of the dose required to produce the desired effect, in its prompt action, more agreeable effects, less tenacious odor, greater cheapness, and the greater facility with which it may be taken. Chloroform has been extensively used in obstetrical prac- tice to relieve the sufferings of the parturient female. It not only relieves pain but facilitates labor. Its use favors various operations, as turning, change of position, etc., and the application of the forceps. Chloroform is likewise used by the surgeon under a vari- ety of circumstances. It not only facilitates the operation of the surgeon, but renders the severest operations painless, and increases the prospect of a speedy cure. The reduction of fractures and dislocations, the amputation of limbs, the extirpation of tumoi's, the operations of lithoto- my, couching, etc., and the reduction of strangulated hernia, as well as many other operations, of a minor character, are ])erformed with greater facility and with greater safety to the life of the ])atient, as well as with freedom from pain while in a state of anesthesia, than while laboring under a state of extreme fear and anxiety, togetiier with intense pain and the muscular I'igiditv or tension of the animal fiber which alwavs 406 AN"^STHETICS. exists, and which often frnstrates the maneuvers of the most skillful operator, and may defeat the operation altogether. Chloroform has been employed by inhalation in various painful spasmodic affections, among which may be named convulsive hysteria, hiccough, asthma, nej)hritic colic, tetanus hydrophobia, and also in delirium tremens, tic doulofireux, and noisy insanity. The danger attendant upon its exhibition is not to be denied when it is administered by reckless or incompetent liands ; nevertheless when we consider the immense number of })atients to whom it has been administered, and the small mortality that has followed its use, it is certainly evident (hat its exhibition is not very liable to be accompanied with fatal consequences. The most convenient inhaler is a handkerchief loosely folded, which is to be sprinkled with chloroform and held over the mouth and nose in such a manner as to admit a due admixture of atmospheric air with the vapor of chloroform. Suspend the inhalation as soon as insensibility is attained, and upon the first evidence of returning consciousness again resort to the inhalation if necessary, remembering in all cases to re- frain from its use soon after eating, and in cases of epilei)sy and organic affections of the heart. When its effects are carried to excess, the horizontal pos- ture, cold air, fanning the face, cold water to tlie head and face, frictions and heat to the extremities, ammonia to the nostrils, and lastly, should all these measures fail to restore the patient, artificial respiration should be employed. CHLORIC ETHER. Dose. — One ounce or more may be inhaled from a sponge, or fronj a handkerchief Chloric Ether is a mere dilution of Chloroform with Alco- hol, as prepared by many, consisting of one ]iart of Chloro- form and eight of Alcohol, although the strength varies ; as prepared by Dr. AVarren under the name of Strong ChIori(! Ether, it consists of one-third ])ure chloroform and two-thirds nearly absolute alcohol. It is an alcoholic solution of chloro- form, or a tincture of chloroform. BISULrniDE OP CARBON. ' 407 Dr. WarrcM has used tliis preparation v/ith entire success in a large number of eases, and eonsiders it safer tl)an the chloroform, and much more agreeable than the ether, it being less liable to produce pulmonary irritation or headache, but more apt to produce nausea, which Dr. AV. thinks no dis- advantage, but rather an advantage. Dr. Knight of Nevv^ Haven, and other surgeons of eminence, corroborate the favor- able views expressed by Dr. Warren of its ansesthetic pov/ers. NITROGENII MONOXIDUM. Preparation. — Nitrous oxide gas is prepared by heating nitrate of ammonium (pure) to 392°, and afterward a little higher, when it is decomposed, giving the gas and water. The gas is passed through warm water into a receiver. Therapeutic Action. — Inhaled, tliis gas produces exhila- ration (hence its name, " laughing gas") and then transient ansesthesia. It is hardly worth our while to inquire here how this loss of sensibility is produced, whether it is by preventing the excretion of carbonic acid gas — asphyxia — or whether it influences the nerve cells directly, like ether or chloroform. The evidence favors this latter view. Nitrous oxide is the safest ansesthetic known; being used principally for the extraction of teeth, it has been administered a larger number of times than all other anesthetics, and the deaths have not been more than one in one hundred thousand. Its stimulant effect is sometimes disagreeable, patients being violent or pugnacious as they are going under its influence. It is adapted to minor operations, when one to five minutes are sufficient ; for though patients may remain under its in- fluence longer, it is not to be depended upon. CARBONEI BISULPHIDUM. Therapeutic Action. — Bisulphide of carbon was intro- duced by Prof Simpson, of Edinburg, as a very active anses- thetic, but its use has not borne out his good opinion of ii. It increases the frequency of the pulse, causes giddiness and unpleasant visions, and quite frequently nausea and vomiting. It is not used internallv. 408 ANESTHETICS It may be used as a local anaesthetic, and diminishes the sensibility of the skin to such a degree tliat minor operations can be performed with little pain. It has been used in earache and inllammation of the ear, for toothache, and very dilute (dro[)])ed in hot water) to the eye in irritable states of the conjunctiva. CARBONEI TETKACHLORIDUM. Chloro-carbon is a thin oily liquid, which produces anaes- thesia by inhalation of its vapor. It is a dangerous anaesthetic, however, and is not now employed. AMYL NITRIS. Therapeutic Action. — When Nitrite of Amyl is inhaled, the face becomes flushed, the pulse and respiration are ac- celerated, but the temperature lowered. If continued, the pulse becomes frequent, small and thready, respiration very rapid, and the skin cyanotic. It is not employed for the ordinary uses of an anaesthetic, but rather to relieve pain. Thus it has been used in neuralgia, in headache, toothache, earache, angina pectoris, dysmenor- rhcea, and to arrest the attacks of epilepsy. It has been employed in India for the cure of ague, using it alone, or in association with moderate doses of quinine. Dr. Sanders says that there is ample proof that it tends to check the return of the attacks, and I'cmoves to some extent the septic condition of the blood, induced by the malarial poison. He en)i)loyed nitrite of amyl with an equal ])art of oil of coriander, of which four drops were poured on a small piece of lint, and put in the hands of tiie ]iatient with directions to inhale freely. " He soon became flushed, and both ins pulse and respiration mucli accelerated. ' When he feels warm all over, the iiduilation is discontinued as thesym])toms continue to increase for some time afterwards. A profuse perspiration now sets in, which soon ends the attack." KEFRIGERANTS. 409 CLi^LSS IX. REFRIGERANTS— ANTIPYRETICS. Refrigerants are defined to be those agents, which, when taken internally, or applied externally, lessen the morbid temperature of the body. This they may effect in two -ways; first, by checking the process of combustion ;• and second, by the direct abstraction of heat. Heat is produced in the animal body by the oxydation of certain components of the food and of the tissues of the body ; the heat produced bearing a direct ratio to the amount of oxygen consumed, or to the amount of carbonic acid gas exhaled, and water formed by the union of oxygen with hy- drogen. Though oxygenation first takes place in the lungs, yet we do not find an increased amount of heat in them, but the reverse ; the constant evaporation of water in expiration tending to keep their temperature belov7 some other por- tions of the system. Arterial blood is a carrier of oxygen, as is proved by its altered color after its passage through the lungs, and this color, the eflect of oxygenation, continues until it has passed through the smaller capillaries. In the capillary sj^stem, then, we may look for the oxygenation of such material as will answer the process of combustion ; and in this system of vessels we doubtless have the evolution of caloric. Heat, then, is very equitably distributed through the body ; the parts, however, furthest distant from the cen- ter of circulation being somewhat the coolest. We find also that in health the system possesses within itself a regulating power, by which the combustive process is augmented in acti\ity when increased calorification is required, or slack- 410 SPECIAL THERAPEUTICS. enecl when the temperature becomes too liigli. This is accompHshed by an appetite for certain varieties of food which furnish a proper pabulum for combustion, and an increased activity of the respiratory organs in the one case, and for articles of diet of an opposite character, and decreased respiratory action in the other. " The means provided by nature for cooling the body," says Dr. Carpenter, " are of the simplest possible character. From the whole of its soft, moist surface, simple eDciporation will take place at all times, as from an inorganic body in the same circumstances ; and the amount of this will be regu- lated merely by the condition of the atmosphere, as to warmth and dryness. The more readily w^atery vapor can be dissolved in atmospheric air, the more will be lost from the body in this manner. In cold weather, very little is thus carried oif, even though the air be dry ; and a warm atmos- phere, already charged with dampness, will be nearly as inefi'ectual. The skin, as already mentioned, contains a large number of glandulse, the office of which is to secrete an aqueous fluid ; and the amount of this exhalation appears to depend solely or chiefly upon the temperature of the sur- rounding air. Thus, when the external heat is very great, a considerable amount of fluid is transuded from the skin ; and this, in evaporating, carries oft" a large quantity of free caloric, wdiich would otherwise raise the temperature of the body. If the atmosphere be hot and dry, and also be in mo- tion, both exhalation and evaporation go on with great rapidity. If it be cold, both are checked, the former almost entirely so ; but if it be dry, some evaporation still continues. On the other hand, in a hot atmosphere, saturated with moisture, exhalation continues, though evaporation is almost entirely checked. — We learn from these facts the great im- portance of not suddenly checking exhalation by exposure of the surface to cold, when the secretion is being actively performed ; since a great chsturbance of the circulation will ])e apt to ensue, similar to that which has been already men- tioned, as occurring when other important secretions are suddenly suspended." In febrile diseases the abnormal increasefof the tempera- ture may arise from two pathological states of the system ; KEFRIGERANTS. 411 iii'st, from any cause that will produce increased disintegra- tion of the tissues, a more rapid circulation of the blood, and increased respiratory action, and consequent oxj'genation ; and second, from any cause that obstructs or diniinishcs cutaneous transpiration, which is the great frigorijic meiuis of relieving the system of superabundant lieat. In in flammation the increased heat is probably dependent M[)on the increased amount of blood sent to the part, and upon the increased chemical changes going on in it. We have already noticed the fact that if, from any cause, an increased disintegration of the tissues should occur, or if the vitality of the circulating fluids was depressed, eitlier by the retention of an excretion, or other cause, an increased amount of combustible material would exist, and increased oxygenation would be necessary. To burn this and fit it to be eliminated, an increased respiration and rapidity of the circulation would be necessary, and the consequence of this would be an increased evolution of caloric ; this gives us the principal symptoms oi fever. ,, Action of Refrigerants. — Refrigerants act in four clifierent ways : first, by directly diminishing the process of calorifi- cation; second, by the direct application of cold; third, by increasing the action of the skin, thus relieving the system of its superabundant heat; and fourth, by an artificial evaporation from the surface, for the same purpose. Among the agents that act directly in diminishing the process of calorification, we might call attention to the class of direct sedatives already considered, and to all agents whose secondary action is sedative. A sedative diminishes the generation of heat in the body, by diminishing innervation, by controlling the action of the heart and lessening the rapidity of the circulation, and consequently of the respira- tory apparatus. These effects are invariably followed by a reduction of the temperature, as the evolution of caloric in the system requires active innervation, circulation and respi- ration. We have another class of agents, however, which, though not- as efficient in this particular, yet are designated by the term refrigerants. These are the vegetable and some of the mineral acids, and the supersalts of the vegetable acids 412 SPECIAL THERAPEUTICS. TliGSG agents act, it is probable, in two different ways : First, they furnish a combustible material to the blood, which re- quires much less oxygen for its combustion than the nitro- genized tissues of the body. Then if the amount of heat evolved bears a direct ratio to the amount of oxygen con- sumed, these agents would prove direct refrigerants. Dr. Headland says : " In fact, I suppose that in fevers the supply of natural blood fuel is deficient; that the nitrogenized tis- sues are then oxydized to maintain the animal heat, causing not on!}' wasting, but tending to keep up the fever by the excessive amount of oxygen demanded for this abnormal combustion; that in such a case the vegetable acid is well adapted to take the place of lactic acid, the natural fuel. For though in health the ingestion of such an acid is immedi- ately followed by increased acidity of the urine, when used in fevers it does not pass into the urine. It is then disposed of, or burnt, in the blood." Second, they act as antiseptics, preventing or retarding the chemical changes going on in the blood and solids of the body, and thus directly prevent oxygenation and the consequent evolution of heat. We un- derstand by the term disintegration or decomposition, when applied to the tissues of the body, a chemical change from a higher to a lower grade of organization. Such a change always gives rise to an evolution of heat, as we witness in the ccdor mordaux, or increased heat of the dead body, caused by rapid decomposition. These agents check this disintegra- tion of the tissues, and consequently lessen the morbid heat of the body. Thus they prove very beneficial in typhus or typhoid fevers, and in all low forms of disease iu which there is a typhoid or septic condition of the blood. The direct application of cold, is among our most powerful refrigerant measures ; and not only so, but it is also one of the most agreeable to the patient when there is an excessive generation of heat. In fever, when taken intenuilly, it operates as a direct refrigerant, reducing preternatural heat, lowering the pulse, and disposing to sweating. There arc very few cases in which cold water, if desired by the patient, may not be taken in moderate quantities. Even in cholera infantum, wlicre drinks, of all kinds, though constantly de- sired, will be immediatel}'' ejected, wc have found ice, or ice- EEFRIGERANTS. 413 water, in small quantities, to be of the greatest utility. The practice of physicians in former days, and even some at this time, of prohibiting entirely the exhibition of cold water, was certainly the most cruel, if not the most unphilosophical mode of treatment that could have been adopted. We have now the most vivid impressions, from actual experience, of what it was to have a fever in those days. Suppose a person with dry mouth, parched tongue — literally burning up — and with a thirst that might be called horrible, begging for but a spoonful of cold water to wet his parched lips ; yet this was positively prohibited, npon the ground that it would proba- bly kill the patient, or produce " salivation.'' If we had to take our choice between cold water, or a doctor with his lancet, calomel, ipecac, tartar emetic and Dover's powder, the regular saddlebag contents of former days, we should certainly prefer the first and omit the last. Cold applications are employed with advantage in all in- flammatory affections where there is general febrile reaction. In many cases they will be found to give more satisfaction than the " hot fomentations" so commonly employed. The rule that we observe in their use is, that if the system is in such a condition that a chill will not follow their application, and if the part to which they are applied is much above the ordinary temperature, they may be used with advantage ; but if the contrary is the case, we apply warm applications. In the first stages of inflammation of the eyes, we may often entirely arrest the disease by the application of cold. Care, however, is required that the cold is not continued long enough to produce such a degree of refrigeration as will endanger the tissues of the eye. In other superficial inflam- matory affections, cold may be often employed so as to speedily remove the disease. Cold applications to the head in phrenitis, in determination of blood to the head, etc., is one of the most common means resorted to, yet w^e have found that refrigeration by evaporation is much the best method of removing the heat in these cases. Cold applied to the entire surface in febrile diseases, is often an important means of subduing or lessening the abnormal heat of the body. Its primary effect is that of a depressing and sedative agent ; thus it lessens the heat of •114: SPECLAL THERAPEUTICS. the surface, causes constriction of the capillary vessels, les- sens nervous irritability, and diminishes the activity of the circulation. If long continued, it causes a determination of blood to internal organs, which are oppressed in their action. Its secondary effects {reaction) are the opposite of the primary effects : thus, there is determination to the surface, the skin is relaxed, and perspiration frequently results. External refrigerants are generally more effectual than those used in- ternally. They are brought in direct contact with an exten- sive, highly vascular, sensitive and strongly sympathizing surface, and through this sympathy they exert a sedative influence upon the entire system. The refrigerant effects of cold, in fevers, are obtained in two ways : by exposing the body to a draught of cold air, or by the application of cold water. Cold air is frequentl}^ beneficial as a refrigerant ; if the body is exposed to a draught of cold air, the increased evapo- ration and consequent refrigeration is grateful and salutary in its influence upon the system. It is necessary, however, that the entire surface should be affected alike ; for if the air strikes but a portion of the body, a severe cold, with aggra- vation of the disease, ^\\\\ be very likely to result. Exposure to the air at a temperature of fifty or sixty degrees, without draught, is much safer, lowering the temperature of the body and reducing excessive vascular action. In febrile diseases, we always direct that the patient be lightly covered when the skin is hot, and, if possible, keep a free circulation of air in the room. We have found this especially useful in the treatment of scarlatina. In the first stages of the disease we keep the patient lightly covered, use the cool alkaline bath, and refrigerants internally; but as soon as the fever com- mences to subside, we direct them to be warmly covered, and mild diaphoretics administered to produce perspiration. Cold water is employed as a refrigerant in the form of a bath, affusion, shower-hath, douche, wet-sheet facie, and as a loash. The temperature of the cold-hath ranges from 33° to about 75°; when below 50° it may be considered very cold. Its pri- mar}^ eflccts are a sensation of cold, paleness of the skin, contraction of the cutaneous vessels and to some degree of those deeper seated, and diminished rapidity of the circula- KEFRIGERANTS. 415 tion. This is soon followed by reaction, the pulse becomes full and frequent, there is determination to the surface, with a softened state of the skin and perspiration. It has been emploj^ed as a refrigerant in fevers of a sthenic type, and many cases are reported in which it has immediately broken up the disease. Owing, however, to want of facilities to em- ploy it, and the natural objections of patients to such rough treatment it is rarely used. The cold affusion, shower-hath and douche, are rarely em- ployed for their refrigerant influence, being better adapted to the treatment of local or chronic diseases (see Hydropa- thy, Part I). The wet-sheet pack is one of the most valuable modes of applj'ing cold as a refrigerant in fevers. Its primary action is the same as the cold-bath, — diminishing the heat of the surface, lessening the rapidity of the circulation, and acting as a sedative to the entire s^^stem. Here, however, the anal- ogy between the two ceases ; for instead of a high reaction as is the case with the cold-bath, it is generally but sufficient to produce an agreeable degree of warmth; the pulse assumes its natural standard, the skin is relaxed, and perspiration es- tablished. We have often seen what promised to be a severe attack of fever, entirely subdued in its incipient stage, by the employment of the wet-sheet pack; and if it Avere not for the almost insuperable objections of patients to its use, w^e have no doubt that a majority of such cases would yield to its use with but little medication, if employed in the early stages. After the disease has progressed for some time we should not expect it to prove so decidedly curative, yet it will be found of great utility when not contra-indicated as an acces- sory means of treatment. The rules that we observe in its employment, are, that when the skin is hot, the pulse quick but not small, and perspiration suppressed, it may be used with advantage. Sponging the body with cold water, as far as a simple re- frigerant is desired, is a valuable mode of application, and much less objectionable to the patient than either of the others mentioned; there is no shock, the fluid being left to evaporate merely cools the surface, and by persevering in its application, the cooling effect is fully obtained and rendere<^ 416 SPECIAL THEKAPEUTICS. permanent. When water is used in this mann^jr, its temper ature, as a general rule, should be but little below that of the body; but this is best regulated by the feelings of the patient. One great advantage of the sponge-hath is the facili- ty of limiting the extent of the eifect to the feelings of the patient, and of applying it even when lying in bed; as soon as the patient feels chilly, he should be carefully dried with brisk friction and warmly covered up in bed. Dr. Thompson notices six varieties of fever in which the refrigerants named are indicated and prove useful: "1. In inflammatory fever (synocha), a rare disease when unaccompanied with topical inflammation, the advantages to be derived from refrigerants are well understood. The cold afi'nsion is admirably adapted for rapidly abstracting the stimulus of heat, diminishing general excitement, and opera- ting as a powerful sedative. In the more advanced stages of the disease, cool sponging is often substituted for the affusion; but when the patient can bear the fatigue of the aff"usion, it is always to be preferred. The greater frequency of this form of fever among the ancients than the moderns (?) 'explains their constant employment of cold drinks and cold bathing in continued fever. " 2. In fevers of a typhoid type, the disease has been cut short by the cold affusion ; but in this case more, perhaps, is to be attributed to the shock and the reaction which follows, than to the refrigerant influence of the affusion. "3. In synochus, or continued fever, gradually assuming the typhoid character, refrigerants in general, but more especially the cold affusion, are chiefly applicable to the early stages of the disease ; and, indeed, no form of remedy is more advantageous when there are no local determinations but when these exist, particularly if the lungs be affected, much caution is required. " 4. In remittent fevers, especially those of warm climates, and in their intense and more excited variety, the cold affu- sion maybe employed with great benefit. In severe attacks also, much advantage is derived from the application of ice or cold water to the scalp. In the remissions, however, the application of cold in any form must be suspended. In yel- EEFKIGERANTS. 417 low fovcr, the'safety of the patient frequently depends solelj' on the early application of the cold affusion. " 5. If hectic be symptomatic of pulmonary affections, or determination to internal organs, the cold affusion is decided- ly contra-indicated ; but even in such cases much benefit is often obtained by sponging the trunk of the body with cold water, mixed with vinegar, while the lower extremities are kept warm in bed. We must, nevertheless, bear in mind that, nndcr an}^ form of hectic, although general refrigerants are useful auxiliaries, yet the cold affusion can scarcely be regarded as admissible. " 6. In eruptive fevers, except measles, the body should be freely exposed to cool air; and even the cold affusion may be safel}^ and advantageously prescribed, should the state of the surface require it, nor should the presence of the erup- tion operate as a reason against its employment. The Hin- doo physicians plunge their patients, during the eruption of small-pox, into cold water, and with the best results. It diminishes the fever, lessens the number of the pustules, and is said to prevent pitting. The writer of this article has long been in the habit of employing the cold affusion in scarlatina during the hight of the eruption, and has seen the severity of the disease instantly checked by it. "In intermittent fevers, when the skin is dry and parched, and the general heat greatly augmented, cold in every form applied to the surface, and cold acidulated fluids taken into the stomach, are of the same value as in continued fever, and greatly favor the accession of the sweating stage." The skin, as has been already stated, is the great refriger- ating organ of the system ; and when it is in a perfectly healthy condition, its functions being normally performed, it would be almost, if not entirely, impossible for an excessive degree of heat to exist. It must then be apparent that if by any means we can obtain a normal action of this tissue, re- frigeration would be the consequence, and the agents em- ployed for this purpose might be termed refrigerants. Thus diaphoretics and diaphoretic measures would become import- ant agents of the class we are now considering. It is not our intention, however, to do more than merely refer to the 27 418 SPECIAL THEliAPEUTICS. importance of these agents as refrigerants in this phico, as tliey have already been fally considered. The various ex- ternal applications referred to not only act as direct refriger- ants, but also indirectly in promoting the cutaneous secretion. As a very important mode of cleansing the skin, and stimu- lating it to increased action, as well as of producing direct refrigeration, we would here refer to the alkaline hath, so well and favorably known to Eclectic practitioners. ISToth- ing, with which we are acquainted, so successfully cleanses the skin, removes the detritus of perspiration, and fits it for normal secretion. It is employed in all stages of febrile dis- ease with perfect safety; its temperature being governed by the condition of the system. Eimporatioyi from the surface is one of the most powerful modes of refrigeration, heat being rapidly conducted from the system by the change of a liquid to a gaseous form. Thus in fevers wliere the skin is very hot, it may be soon brought down to a normal temperature, by sponging the surface with luke-warm water, and promoting evaporation by a current of air or by fanning. It is not in general dis- ease, however, that it is employed with the greatest advan- tage. In inflammatory affections it proves more useful than any other form of external refrigeration, rapidly reducing the temperature of the inflamed part. IVe employ it in phrenitis, determination of blood to the head, etc., in prefer- ence to ice or ice-water ; for we have found by experience that it reduces the heat as rapidly, is more agreeable to the patient, and there is no liability to that reaction which always fol- lows the application of cold, if by any carelessness upon the part of the attendant, it is not continuously applied. In inflammation following injuries, it will also be found prefer- able in many cases to the direct application of cold. In some cases, as in injuries of the joints, if we wish to produce a more rapid refrigeration than can be obtained by the evaporation of water, we employ agents that evaporate very rapidly, as the sulphuric ether, chloroform, etc. SEDATIVES. 419 SEDATIVES. A*^ Y/as remarked in the general description of this class, -iedatives occupy a prominent place in the list of refrigerants or antipyretics. There is a direct relation between the tem- perature and the pulse ; as the one goes up the other goes up ; as the one comes down the other comes down ; with each in- crease of one degree of heat, the pulse is increased in frequency ten beats per minute. The high temperature is associated with an equally frequent pulse; if tlie pulse is brought down, the temperature is brought down with it. It is of no special importance to us to theorize upon this relation, the well established fact being a sufficient basis for therapeutics. That the nerves controlling calorification are intimately associated with those controlling the circulation^ is a sufficient explanation of the interdependence of the two. As has been remarked, we control tlie processes of burning and the amount of heat produced. Veratrum. — With a full and frequent pulse and high temperature we prescribe Veratrum (see Sedatives) and as the pulse comes down the temperature is reduced. Of course, if Veratrum does not diminish the frequency of the pulse, it will not lessen the temperature, but if the indications are followed the results are quite certain. Aconite. — The pulse is small and frequent, the temperature high, and we select Aconite as the arterial sedative and anti- pyretic. In infantile fevers I have seen the tempeature brought down from 105° to 100°, in six or eight hours, by the adminis- tration of this remedy alone. Of course m'C do not expect so marked or so speedy a result in fevers produced by a blood poison, as scarlet fever, or where there is an active process of inflammation. Still Aconite is so certain in its action that it stands at the top of the list. Gelseminum. — The face is flushed, the eyes bright, the pupils contracted, the patient restless, and the temperature markedly increased. These are the evidences of irritation of the cerebro-spinal centers, and which is met by the adminis- tration of Gelseminum. As the nervous system is relieved, the patient rests, the pulse comes down, and the temperature 420 REFRIGERANTS. comes down. I have seen as marked antipyretic effects from this as from any remedy I have employed. Belladonna. — The skin is flnsiied, bright or dull, and when the finger is drawn across it a somewhat persistent white line is left. There is capillary congestion of the skin, and it is not in good condition to regulate tiie temperature. There is congestion of the basilar brain — the patient is dull, sleepy, comatose, and in consequence of this respiratory innervation is deranged, and the temperature runs high. In eiti^er of these cases Belladonna exerts a direct influence in lowering the temperature. In the one case it relieves congestion, and puts the skin in condition to remove the excess of heat ; and in the other it regulates the fires of life. Rhus. — The patient complains of burning heat, the pulse is frequent and sharp, and the skin dry. Rhus relieves the peculiar excitement of the nerve centers, lessens the frequency of the pulse, puts the skin in better condition, and thus lowers the temperature. When indicated it is one of the most direct of antipyretics. STIMULANTS. It may seem a little strange to talk about reducing the temperature by the administration of stimulants, but it is a means to be thought of in low grades of disease. The patient is maintaining a high temperature by burning his body. The nerve centers are irritated by this burning, respiration is fre- quent, the secretions are arrested, and the skin is so harsh and dry, that the heat can not escape. The digestive organs have been so impaired by the disease and by medicines that food can not be taken. If the patient is to recover the temperature must be brought down, and to do this, combustion of the tissues must be stop{)cd. As we can not give food we give alcoholic stimuli — whiskey largely diluted, brandy dilutetl, wine, and rarely malt liquors. This furnishes material for combustion, relieves, the body, lessens irritation, and diminishes the temporaturo. Whilst this accounts for the antipyretic action of alcohol in many cases, it may be further stated that it directly reduces the temperature in other cases when there is no need of calo- ANTirERIODICS. 421 rifaclent material. I have already noticed the fact that sweet spirits of nitre is a sedative, and this, as well as many of the ethers and alcohols, directly lower the temperature. A N T I P E R I O D I C S . All the direct antipei'iodics exert an antipyretic action in some conditions. Bnt unless directly indicated they do harm rather than good by this influence. It is a very great mistake to think that because the calorifacient function can be de- pressed by poisonous doses, the depression will be an advantage if the life is impaired as well. QuiNiA Sulphas. — Of late years, it has been taught that quinine is an auti[)yretic, and students and physicians have been advised to use it for this purpose. There is a small amount of truth in this, but it is associated with a great error. We understand that there is a peculiar cause of disease which gives rise to periodicity. This is a distinctive feature in intermittent and remittent fevers, and is met by an anti- periodic — by quinine. This cause has been given the name of " malaria," but as we do not as yet know what malaria is, it is Avell to give our attention wholly to the expression of disease — periodicity. If a fever has this element, quinine is antipyretic. I have seen the temperature fall from 107° to 100° under the influence of twenty grains. Whilst it may thus reduce the temperature at any stage of the fever, it is well to follow the teaching of Prof. I. G. Jones. " In a remittent fever with high range of temperature and brief and scarcely noticeable remission, com- mence the administration when the fever (temperature) has reached the highest jioint, or when the first evidence of a decline is noticed. Now if quinine is given in five grain doses there is a remarkable fall in the temperature, and probably with the third dose we reach 100° or it may be 98°; with two or three days of suc'.i action the fever is arrested and the patient convalesces." This should be clear enough to intelligent men, but to doctors it reads something like this — Smith has a fever (remit- tent) with high temperature, I give him quinine and the tem- ])erature is markedly reduced and the patient is cured. Jones has a fever (continued or typhoid) with high temperature, and 422 REFRIGERANTS. liecausc quinine lowered the temperature in the case of Smitl\ I will give it to Jones — result, irritation, restlessness, and fur- ther impairment of junction. The ditf'erence between a remit- tent and a continued fever has not been estimated. Reasoning from false premises in this way, our neigiibors have given quinine for everything in tlie slmpo of a fevei'. They have boldly taught that if the moderate dose of five grains does not lower the temperature, then give the drug iu ten or twenty grain doses. Recently some of the more intel- ligent teachers have seen the error and expressed doubts as to whether there are any antipyretics. ANTIRHEUMATICS. In rheumatic fever and acute inflammatory rheumatism a high range of temperature is a prominent feature. In this case, as in that requiring antiperiodics, there is a specific cause upon Avhicli the temperature as well as other symptoms depend. If this cause is destroyed, removed or antidoted, the temperature falls, so that in these cases the antirheumatics are real antipy- retics. I think the reader will liave no difficulty in seeing the relationship between tlie special cause, the increased tempera- ture, the special remedy and the reduction of heat. Salicylic Acid. — It has been claimed that Salicylic Acid was a direct antipyretic, and that the temperature in fever and inflammation might be controlled by its use. As usual, the doses have been largely increased until ten to twenty grairis were given ; now it is conceded that it was all a mistake, and there are no antipyretics. But there is a rheumatism that Salicylic Acid will cui-e, and if these cases had been thoroughly studied, instead of theori- zing, we might have had the special symptoms ])ointed out, so that we could use the remedy intelligently. When it is anti- rheumatic it will be found to lessen the temperature when administered in the ordinary dose of two or three grains. Salicylate of Soda. Saliqylate of Potash. — In many cases we prefer these salts to this acid itself. In pre- scriptions we frequently order: ly Salicylic Acid oj-, A<'eta(t> of Potash 5ij-, water l5iv.; dose a teaspoonful. Tv Salicylic Acid 5j,. Bicarbonate of soda o'j-, water ,5iv. ; close one teaspoonful. ANTIRHEUMATICS. 423 If in rheumatism the tongue has a bluish pallor these pre- parations are likely to be suceessful. In rheumatic iever and inflammatory rheumatism I have seen the heat reduced from 103° or 104,° to 99°, and held there until the patient was freed from the rheumatic poison. Maciiotys. — The rheumatism is uterine or ovarian, or the pains are muscular, or seem to be intensified by muscular contraction. In such cases Macrotys, by o})])osing the rheuma- tic cause, and relieving irritation, brings the temperature down to the normal standard. Bryonia. — The pulse is full and hard, the pain sharp and lancinating, the serous membranes are involved. Here Bryonia is sedative, lessening the frequency of the pulse, taking away its hardness and civino; a better circulation. At the same time it is antipyretic, reducing the temperature by its direct action. The same result will be obtained when the remedy is given in pleuritis, pleuro-pneumonia and peritonitis, the indications for this remedy being present. " The same is true of other remedies which influence the rheumatic poison — Apocynum, Phytolacca, Sticta, Bhus, Col- chicum, etc. ANTIZYMOTICS. We have a group of remedies which antidote the zymotic causes of disease, or oppose zymotic processes, and these are markedly antipyretic when indicated. It is a repetition of the same story. The zymotic poison is the cause of fever, and the frequency of pulse, the excited nervous system, and increased temperature are dependent upon it. If this cause is removed or destroyed the effects cease. We have remedies that possess this antizymotic power, and they are of first importance in these cases. Phytolacca. — There is soreness of the throat with diph- theritic exudation. The pulse is frequent and the temperature high. In this case we find that phytolacca not only relieves the irritation of the throat and strengthens its tissues, but it lessens the frequency of the pulse and the temperature. No remedy exerts a more marked antipyretic action than does this in a case of diphtheria with high temperature. 424 REFRIGERANTS. Baptisia. — The face has a bluish appearance like one who has been exposed to severe cold ; the tongue has a like fullness witii purplish coloration. This describes a condition met with in zymotic and some other forms of disease. The pulse is fre- quent and the temperature liigh, and the usual sedative and batiis do not exert their usual influence. We note the indica- tions for Baptisia and give it with the effect of lessening the fre- quency of the pulse and bringing the temperature down. Sulphite of Soda. — The tongue is broad, pallid and dirty, and with a frequent pulse we have a high range of tem- perature. In this case the ordinary means will fail to produce sedation, and bring down the temperature. Now if sulphite of soda is given In five, ten or fifteen grain doses we find the patient is impressed in all directions. The temperature is lowered, the pulse reduced in frequency, the nervous system relieved, and secretions established. In this case the sulphite of soda is a most powerful refrigerant. Sulphurous Acid. — The tongue is red, moist, and covered with a glutiness nastiness, the temperature is high. In this case Sulphurous Acid will bring down the temperature, lessen the frequency of the pulse, and put the patient in better con- dition in every function. Chlorate of Potash. — The lochial discharge is offensive, and from the absorption of putrerescent material, there is an exalted temperature with frequent pulse, and excited nervous system. I take a special case because it illustrates the action of the remedy. If now, chlorate of potasii is given, a most marked influence will be observed in brinojlno; down the tern- jierature and pulse, relieving the nervous system and restoring the secretions. Muriatic Acid. — The tongue is dusky-red, dry, fissured, and covered with a brown sordcs, tlio patient is suffering from continued or typhoid fever, and carrying a temperature of 104°. Sedatives have been used without good effect. Baths do not serve the pur])ose of putting the skin in condition for the removal of the surplus heat. All medi(Mnes arc suspended and the patient is freely snj)[)licd with water acidulated with \ Muriatic Acid, and soon we notice an improvement. The pulse comes down, the temperature comes down, the secretions FOODS. 425 arc better, and the patient takes food. The antipyretic in- fhience is so marked that no one can mistake it. Acids. — We observe the same edects from other acids. Our Irish fellow citizen drinks his whey and lessens the burn- ing. A Jerseyman takes kindly to cidei', and finds that it cools him off. The patient in the South has lemonade or orange juice, and feels the better for it. Alkalies. — The tongue is broad and pallid, the patient is carrying a high temperature, and the ordinary remedies fail to give relief, we give a weak solution of bicarbonate of soda freely, and the patient is relieved and everything acts kindly. Under the intluence of the soda the temperature falls two to four degrees in twelve hours. FOODS. It must not be forgotten that in many diseases when a high temperature is maintained, the body is being burned, and in consequence of the irritation from this burning, the processes of calorification are increased. If by any means we are able to lessen the burning of the tissues, we diminish the tempera- ture. Whether we slow the fires by the use of the arterial sedatives, lessening nerves excitability, or furnish material for combustion, we reach the same result. Thus, v.'e say that in these cases the patient should have a steady supply of calorifacient food to take the place of the burning body. As we furnish it, and see that the digestive apparatus is in condition to receive it, we find that the tem- perature falls. It may seem singidar that a body will be cooled bv furnishing good material for burning, but it is none the less a fact. In idi()i)athic or symptomatic fevers, with high temperature, if we can give the patient a constant supply of food, we can control the temperature. If food can not be taken, or the physician ])refei'3 medicine to food, there is a probability that the patient will be burned up. Hot milk is a standard food in these cases. Not tliat we oblige every one to take it, for if there is a distaste for milk, we can select other foods of simi- lar character. But if the patient takes his milk kindly, we are sure we are ircttin'j; aloiiii well. 426 EEFRIGERANTS. This applies to clironic desease in which increased tcnipera- tnre is a prominent feature. Take a case of pulmonary phthisis, and with a temperature of J02°, the j)atient is going to his funeral as fast as he can. Bring the temperature down to 100° or 09°, and all the unpleasant symptoms are relieved. This is sometimes accomplished by cod-liver oil, or by cream, or by whisky, but in the majority of the cases a supply of calorifacient food, properly appropriated, will be a prominent means of amenduient. Baths have been fully considered in the introductory remarks, and we have only to add that the means directed to the skin should be carefully studied. Nothing gives greater success in the practice of medicine than the ability to adapt means to special conditions. A good condition of skin is to be sought for in all diseases having an increased temperature as a prominent feature. TONICS. 427 DIVISION IV. OLA.SS X. TOmCS. ToMCS are medicines which produce a permanent exalta- tion of the energies of the general system, without materially increasing the vital manifestations in any particular organ. They give tone to the muscular system without increasing the temjDerature of the body or rapidity of the circulation, producing no immediate and marked excitement like stimu- lants. Their influence is manifested by a very slow and permanent exaltation of organic action, evinced by an in- creased force of the circulation, and increased muscular poweV. The heart contracts with more force, but its con- tractions are not increased in frequency ; the pulse acquires fullness and firmness, and loses that soft, flaccid and atonic character which is a manifestation of debility. The protract- ed use of tonics may produce an increased temperature of the body and an acceleration of the pulse ; but these are but secondary efiects arising from increased nutrition. From what has been said of the influence which they exert, it will readily be seen that they are particularly adapt- ed to atonic states of the system. Their primary sanative impressions are doubtless made upon the nervous system, while the manifestation of these impressions is seen in the increased tone of the muscular system, in the improved state of the secretions, in the augmented force and fullness of the pulse, and in the increased rapiditj'' and perfection of digestion. The increased energy which they impart to the nervous system, the impetus which they give to the circula- tion and the improvement in the digestive functions, together 428 SPECIAL THERAPEUTICS. ■with the increased secretion and absorption which thev effect, are among the many evidences of their sanative powers. Very peculiar, and apparently very dissimilar effects upon the secretor}' organs and tissues follow from the use of tonics, under different pathological conditions of tliese organs and tissues. When the secretions become abnormal and super- abundant, from an atonic state of the secretory organs, this class of agents have the povp'er to restrain and control them. Thus, if the cutaneous exhalation becomes superabundant from debility, as is the case in the advanced stages of phthis- is, typhus and typhoid fever, etc., tonics often promptly restore the tone of the system and arrest it. Also, in phthisis and other diseases of the respiratory apparatus, when the secretion from the lungs becomes excessive from debility; and when this discharge would tend to increase that debility, tonics, combined with astringents, are of much value in arresting the secretion. The same remarks apply to diabetes, chronic diarrhea, leucorrhea, menorrhagia, pas- sive hemorrhages and passive dropsies; in all of which cases, tonics \vill be found important auxiliary agents in restrain- ing the morbid discharges. When, on the contrary, the secretions are lessened or arrested from torpor or atony of the organs, or from a languid or enfeebled state of the cir- culation, or of the general system, tonics are by no means an unimportant class of agents in aiding in the reestablish- meut of them. If the kidneys, skin, uterus or lungs, fail to furnish their due secretion, from a torpid state of the organ, or from an enfeebled state of the general system, tonics are of much importance in restoring them ; in such cases they exert a diuretic, diaphoretic, emmenagogue and expectorant influence. Tonics are mostly derived from the vegetable kingdom, and are remarkable for their bitterness ; though from the similarity of their action, we include in this class the mineral acids and the chalybeate preparations. ^ The chalybeates do not, like the bitter tonics, act to- pically upon the stomach and alimentary canal, imparting new^ vigor to the parts with which they come in ccntiu-t. They act on the restorative principle entirely ; being absorb- ed, they supply a material to the blood, improving its qnali- TONICS. 429 ty, and iu this way exert a tonic influence upon the entire system. Iron is found to be an important ingredient in the red globules of the blood; and when these globules are de- ficient, as they are in anemia, the administration of iron will cause a regeneration of these, and a restoration of the sys- tem to health. Action of Tonics. — Tonics act iu two ways upon the sj's- tem, producing their restorative effects. 1st. Ey their topical influence they give increased nerv- ous and muscular energy to the stomach and bowels, and stimulate the mucous membrane to normal action ; they thus improve digestion, increasing the appetite, and improving the quantity and quality of the chyle. If digestion is imper- fect, the chyle must be unhealthy and scanty, and as the chyle supplies the material for the formation of the blood, which in turn supplies the system with the material to re- plenish the waste of tissue, and for the growth of the body, it is evident that normal digestion must be carried on, if the system maintains its healthy functions. Tonics, then, by their influence over the alimentary canal, prove indirectly restorative, by increasing the appetite, increasing digestion, chymificatiou and chylification, and furnishing a healthy pabulum, both in quantity and quality, for the formation of the blood. 2d. All of this class of agents are readily soluble in the fluids of the body, and hence are absorbed into the circula- tion, and act from it upon every part of the system. We have already seen that they exert a tonic and strengthening influence when topically applied to the stomach ; and we may notice a similar influence, from their application to indolent ulcers, wounds, etc., when applied so that we can notice their effects. If this is the case then, that they impart strength and tone when brought into contact with the tissues, as it undoubtedly is, we have a solution of their efl:ects after absorption. The circulation conveys them to every part of the system, they are brought in contact with every fiber and every cell; and if they act in the circulation as they do when topically applied, they give new energy and tone to every part. They likewise act as restoratives in many cases, adding to 430 SPECIAL THERAPEUTICS. the blood some material that was deficient in it. In this way both the vegetable bitters, iron, acids, and alkalies act as tonics. For a further description of the action of these remedies see general therapeutics. Tonics not only produce their specific impressions when taken internally, but also when applied to the surface of the body, from which they may be absorbed. Their external application is of much importance in all cases where there ia extreme debility, and when the stomach is weak and irrit- able, and will not tolerate the use of medicine. In all cases of extreme debility, they may be used as a bath, or by enema, when they will exert their ordinary invigorating influence upon the system. In the " night-sweats " of debilitating dis- eases, they are often of much advantage, strengthening the skin and checking the morbid secretion. Their topical application deserves a passing notice. They are frequently applied to old atonic and indolent ulcers, and also to gangrenous parts, as topical tonics, with much advant- age. We thus cleanse the gangrenous or ulcerated parts thoroughly and frequentlj^ with a strong decoction of the tonic, and also apply it in the form of a poultice mixed with slippery-elm. Therapeutic Indications. Tonics are administered with much advantage in dyspepsia. When the stomach is debilitated, its coats do not act with the necessary energy upon the alimentary mass, and the gastric secretions are either scanty, or do not possess their proper solvent powers, and chymification will therefore be imperfect, and the train of dyspeptic symptoms follow. These results are counteracted by the nse of tonics, in the manner already referred to. In all cases of asthenia they are indicated, unless it be con- nected with some local inflammatory afiection that would be aggravated by their use. They become important agents in the advanced stages of most of the acute diseases, after fever has subsided, and when high inflammatory action no longer exists; in such cases they enable the system to throw otf the disease, and render convalescence much shorter. In ady- namic fevers, as typhus gravior, typhoid, scarlatina maligna, TONICS. 431 gangrenous erysipelas, or in any case where there is a ten- denc}^ to gangrene or putrescency, they are agents of the first importance. In sniallpox, where the vital powers are ranch prostrate,d, in carbuncle, scorbutis, scrofula, and other similar affections, their employment constitutes an important part o/ the treatment. They are also indicated in passive dropsies and hemorrhages. Debility of a single organ or of the entire system, predis- poses to the morbid influences of surrounding causes of dis- ease, as the infection of certain contagious diseases, changes of temperature causing the retention of a customary secretion, the morbid effects of miasmata, etc. Tonics aid the enfeebled energies of the system in warding off these extraneous causes of disease. Malarious influences occasionally produce almost every variety and type of fever, particularly the intermittent, beside many anomalous diseases which have a more or less periodic character. Hence we have headache, — especially hemierania, — neuralgia, toothache, rheumatism, deafness, dyspnea, convulsions, etc., assuming a periodic form. It has been proved beyond cavil, by medical reports from the mala- rious coast of Africa, that tonics administered as prophylac- tics, are a certain preventative against this influence. In diseases marked by a periodic character the most power- ful tonics are administered. Some of them are supposed to possess antiper iodic in addition to their tonic properties, and are therefore called antiperiodics. The cinchona and its alka- loid principles are examples of this kind. The question then arises, do tonics arrest these periodical diseases by virtue of their tonic properties alone, or are they possessed of febrifuge or antipcriodic powers in addition to these. The latter view appears the most probable, for we find that those agents which act as antiperiodics possess but feeble tonic properties, in diseases in which this periodic element is lacking; that is, they do not increase the appetite, improve digestion, etc., in cases of common debility. These agents may likewise be administered in any stage of the fever, and if the stomach is not in an irritable condition, they will lessen instead of increasing the pyrexia. Why certain agents of this class exert this peculiar antipcriodic property we are unable to explain, any more than we arc why some causes produce 432 SPECIAL THERAPEUTICS. periodic fever ; the fact, however, is evident tliat some of then possess a power over this form of disease that is not possess ed by others of the class. As probably the best explanation of the action of the anti- periodic tonics we will introduce two quotations. Liebig ii' considering- tliis subject, says: — "This action is conjmonlj; said to be dynamic — that is, it accelerates, or retards, or alters in some w^ay the phenomena of motion in animal life. If we reflect that this action is exerted by substances which are material, tangible and ponderable; that they disappear in the organism ; that a double dose acts more powerfully than a single one; that, after a time, a fresh dose must be given if we wish to produce the action a second time; all these considerations viewed chemically, permit only one form of explanation ; the supposition, namely, that these com- pounds, by means of their elements, take a share in the for- mation of new, or the transformation of existing brain and nervous matter." Dr. Wood says in relation to this sul)jcct: " I know of no better explanation of the antiperiodic proper- ty, than that which supposes it to depend upon the power- ful influence exercised by the remedy upon the nervous cen- ters, through Avhich probably the paroxysms are produced. Every consideration in connection with the peculiarities of regular intermittent diseases, leads to the conclusion, that the paroxysms are produced by an influence acting through the cerebral centers, without which the result would not take place. IlTow, if these cerebral centers can be preoccupied by a strong impression from some other source, they may be rendered insensible to the morbid influence, and the parox- ysm, therefore, is set aside." In addition to this influence upon the nervous system, anti- periodics undoubtedly exert a specific and decided influence upon the blood. This they may do in two ways : — First, by counteracting the chemical changes going on in that fluid, — preventing the se]3tic action of the morbid material (which we suppose to be the cause of the fever) upon the blood. They also give increased vitality to the circulating fluids, (see antiseptics). Second, by causing an increased elimina- tion, they remove the cause of the disease. We have long since arrived at the conclusion, that quinia, which ni:iy be TONICS. 433 taken as the type of the aritiperiodic agents, owes its virtues in part, in periodic diseases, to its action on the excretory organs. When successfully administered it invariably causes relaxation and increased secretion from the skin, and this secretion gives evidence by its sensible qualities of an ii> neased elimination of solids. It likewise increases the action of the kidneys, and consequently elimination by this channel. To sum up then, we may say, that antiperiodics act upon the nervous centers, increasing innervation, and changing the character of nervous action ; that they act as tonics, increas- ing the vital force of the system ; that they act as antiseptics, counteracting the septic tendency in the blood; and that finally they act as eliminatives, removing morbid material from the system. In conclusion we may say in reference to this class of agents, that their use is indicated whenever the system is depressed below its normal level. They act directly in sup- port of the vital force, and not as is the case with stimulants to produce merely nervous excitation ; they therefore assist nature in the removal of disease. " Tonics, " says Headland, "'are among the most useful of all medicines. And it is cer- tainly not the least of their recommendations, that we can seldom or never do harm by their use. They are remedies, but not poisons. Many a man has been killed by opium, many a constitution ruined by mercury, but it has never been known that quinine has done the one or the other." CINCHONA. THE BARK OF C. FLAVA, C. RUBRA, C. PALLID A.-South Ameeica. Therapeutic Action. — Cinchona is tonic, antiperiodic, corroborant, stimulant, astringent and antiseptic. It is justly placed at the head of the tonics. The profession generally regard it as one of the most important remedies in the materia medica. Since its first introduction into the list of therapeutic agents, it has lost none of the high reputation which it at first enjoyed. On the contrary, the same popularity and the high ' 28 . * 434 TONICS. confidence then resposed in it as a j)ermanent tonic and anti- periodic are now freely awarded to it. The Pernvian bark — its alkaloid principles — the cinchonia or qidnia,ov their salts — is more frequently resorted to as corroborants in cases of debility, and more especially in diseases of an intermittent character ..3 antiperiodics, than anyone or allothers belonging to this class of remedial agents. The reason is obvious: no other article has so uniformly proved successful. It is the article upon which reliance has to a great extent been j)laced for two hundred vears, during which time it has gained the confidence of physicians and secured a reputation in the treat- ment of diseases assuming periodicity which no other article now enjoys. As a therapeutic agent, the cinchona is mostly employed in cases of debility, unattended with local irratation. " In such we find cinchona improves the appetite, promotes the digestive functions, and increases the strength of the pulse. Tiie mus- cular system acquires more power, and the individual is capable of making greater exertion, both mental and bodily, than before ; the tissues acquire more firmness to the touch, and lose their previous flabbiness; moreover, it has been asserted, and with great probability of truth, that the quality of the blood improves." It often ])roves valuable in arresting profuse and debilitating night-sweats and other profuse discharges arising from debil- ity, particularly in the convalescent stages of fever. It is also important in the advanced stages of continued fevers as a tonic, when there is great debility, provided no syniptoms of celebral inflammation, or inflammation of the digestive or other vital organs be present. The cinchona, or some of its preparations, is extensively used in the treatment of intermittent fever; and it rarely fails to arrest it, if judiciously administered. Some prescribe it not only during the intermission, but also throughout the whole ]>eriod of excitement ; and some premise with emetics and cathartics, while others usually omit all evacuants. Although it may be employed in many cases duritig the pyrexial stage with advantage, yet wo deem it most beneficial, as a general rule, during the period of apyrexia, especially if visceral congestion or local inflammation exist. If adminis- QUINIiE SULPHAS. 435 tered during the stage of excitement, the quantity necessary to moderate it is so great, that it proves irritating and oppres- sive to the stomach, and might increase the intensity of the fever, instead of diminishing it. The same objections are not obnoxious to the use of the sulphate of quinine, and conse- quently, if either is used, the salt is preferable. QUmi^ SULPHAS. Dose. — The dose of Sulphate of Quinine will vary accord- ing to the condition of the patient and the effect desired. For its stimulant and tonic action the dose vi^ill be from one- half to two grains ; as an antiperiodic the quantity given during the intermission will be from ten to twentv grains. In proportioning the dose for children, it is well to add one grain for each year, starting with the quantity of one grain for a child one year old. Specific Indications. — The indication for Quinine is periodicity, and the fevers take the form of remittent and in- termittent. In some cases the periodicity is so marked that the observer can make no mistake, but in others it is very ob- scure, and practitioners to be successful need to be close observers. Quinine will act kindly if the pulse is soft, the skin is soft, the tongue moist, and the nervous system moderately free from irritation. It does not act kindly when the pulse is fre- quent and hard, the skin dry, the tongue dry, and the nervous system excited. These being facts, it becomes necessary, in many cases where quinine is indicated to prepare the jiatient for its use. This preparatory treatment lessens the frequency of the pulse, re- duces the temperature, softens the skin, and relieves irritation of the nervous system. Now the remedy acts kindly and is curative, where it would have caused unpleasant excitement, and probably increased the disease. Therapeutic Action. — Sulphate of quinine is tonic and antiperiodic when administered in medicinal doses, and poses- ses the properties of the cinchona. In large doses it has been observed to occasion severe headache, vertigo, deafness, tinni- tus aurium, diminution or loss of sight, dilated or contracted 436 TONICS. pupils, loss of speech, general trembling, intoxication or deli- rium, coma and great prostration. These unpleasant etfects, following the too free use of the agent, arise, probably, from the exhaustion consequent upon the undue excitement occa- sioned by the over-dose of the medicine. The rule we act upon in its administration is this : Whenever an acute disease exhibits periodicity, we administer the agent during the intermission, or when there is the least excitement of the circulation ; but if this can not be done, owing to the short- ness of the intermission, we give it during thereaction. We have practised upon this plan sufficiently long, we think, to have discovered any injury that might result, but have never seen any. Thus in bilious remittent fever, when tlie remissions are but half an hour or an hour, there not being sufficient time for the administration of the necessary amount of the remedy, we continue it during the exacerbation, and we have almost invariably found that, instead of increasing the fever, it short- ens its duration, the next remission being longer and more complete. In fevers, however, in which there is no symptom of periodicity, we never employ it except as a tonic to prevent prostration. In the advanced stages of continued fever, when there is great prostration of the vital powers, the importance of this agent is not to be overlooked. In all adynamic fevers and diseases characterized by atony and debility, in cachexia of a scrofulous character, in mercurial and syphilitic cachexia, when the vital energies are greatly impaired, in cases of gan- grene or mortification, in passive hemorrhages and profuse mucous discharges, in short, in all cases requiring an energetic and sustaining course of medication, the sulphate of quinine will be found an important agent. We find, sometimes, that owing to the irritability of the stomach, or repugnance to the taste of this agent, it can not be administered, at least in sufficient quantity to effect the desired result. In such cases we employ it cndcrmically, directing one drachm to be rubbed up with two drachms of lard, and freely rubbed into the axilla, groin, and if ncccssaryi the inside of the thighs. We have been enabled, in many cases to control an intermittent or remittent fever in this way, when all other means had failed ; it is particularly CINCHONIDI^ SULPHAS. 437 applicable to fcnuiles of a debilitated and nervous habit, and in treating periodic diseases of children. Quinine has also been employed with success as an enema; to an ounce of starch add twenty grains of quinine and thirty drops of laud- anum ; it should be used three or four hours previous to the expected recurrence of the paroxysm. CTNCHONI^ SULPHAS. Dose. — From gr. v. to gr. x. ; three doses, taken during an intermission in intermittent fever, being generally sufficient to prevent the accession of the next paroxysm. Therapeutic Action. — Sulphate of cinchonia possesses most of tlie properties of the sulphate of quinine, but in a milder degree. We have employed it as an antiperiodic with good results, especially in those cases in which, owing to the idiosyncrasy of the patient, quinine could not be taken. It will be found a much pleasanter agent to the taste than quinine, which is a great desideratum ; again, we think it is not so apt to produce irritation of the stomach, or cerebral symptoms; and lastly, rt is sold for about one-half the price, which is no unimportant matter to the country physician wdio furnishes his own medicine. It may be em[)loyed in all cases where the sulphate of quinine is indicated. CINCHONIDI^ SULPHAS. In the earlier manufacture of quinine this alkaloid with others was thrown away in the mother liquor. Afterwards this liquor was evaporated to an extract and held in stock un- til large quantities had accumulated, when it was found profit- able to work it over and remove the alkaloids. Thus when the agent under consideration was introduced there was a large stock, and it was sold at a very low price. Dose. — The dose will range from one to five grains, the an- tiperiodic quantity being fifteen to twenty grains. Therapeutic Action. — In almost every respect this salt is similar to sulphate of quinine. It has the same tonic and antiperiodic properties, but is probably not quite so active. It has been claimed that it is not so apt to produce head symp- 438 TONICS. toms, and that it is more kindly receis'ed by the stomach. It is not so bitter, and some persons take it more easily. As to its certainty, there is a difference of opinion. Whilst some claim that it is less certain, otliers think there is a greater de- gree of certainty. It is to be recommended in place of qninine only when the difference in price makes it an object, and then it may be used for the same purposes, and in the same doses. ALSTONIA. THE BARK OF ALSTONIA CONSTRICTA.— Australia. Preparations. — The finely powdered bark. Tincture of Alstonia. Alstonine. Dose. — The dose of the powdered bark will be from grs. j. to grs. V. Of the tincture, from gtt. ij. to gtt. x. Of the alkaloid, grs. |, to grs. 5. Specific Indications. — The disease shows distinct perio- dicity. The tongue is dirty, the skin is sallow and dirty, the urine is turbid. Therapeutic Action. — The antiperiodic action of Alstonia is more marked than any other agent which has been employed as a substitute for quinine. It is a powerful remedy, and where it is adapted to the case, three or four doses (two grains each) of the bark, will arrest an ague. It does not meet the indication — periodicity — in as large a number of cases as quinine, but where the tongue is dirty and the skin dirty, it Avill be found very certain. As it cures cases of chronic ague that quinine will not reach, the practitioner will be able to study his cases well. The bark of the Alstonia constricta, or Australian fever tree, has been known as a pharmaceutical curiosity — at least, since 1803, when Palm separated from it a bitter principle which he called Alstonine. Dr. Hesse, director of the alka- loid works of Fr. Jobst, at Fcurbach, near Stuttgart, has done much within the past few years to clear up the chemical his- tory of the bark. A ^9rce/.s of his recently published results may be found in the medical journals. His researches leave some points undetermined, and the more practical question of the therapeutical effects of the bark and its alkaloids has ALSTONIA. 439 hardly been approached. Dr. Bancroft has long used the bark ill the hospitals of Melbourne with admirable success in cases of fever. Indeed, its vernacular name shows that the settlers discovered its healing properties before the doctors troubled themselves about it. But this seems to be a drug which will occupy no subordinate place as a mere cinchona substitute. Dr. Hesse says : " Besides, allow me to add that I doubt the efficacy of Alstonine as a harmless remedy for fever, but that, on the contrary, I hold it to be a strong poison akin to strychnine. The Alstonia constricta bark contains about 2| per cent, of this alkaloid, whilst it only yields 0.05 per cent, of Alstonidiu. Tluis you will see it will be difficult to man- ufacture them. The Alstonidiu might have no practical im- portance, whereas this alkaloid (Alstonine) possesses very em- inent therapeutic pro}»erties." Dr. Bixby has used the drug largely during eighteen months, and has prescribed it in hundreds of cases. He finds its ac- tion resembles in many respects the combined action of qui- nine and nux vomica. It is an antiperiodic of the highest type, better, in his opinion, than the quinine or cinchonidine. It is a cerebro-spinal stimulant and tonic, acts positively upon the great sympathetic nerve-centers, and consequently in- creases, positively and permanently, the vital forces of the entire system. A proper sedative should be given before the use of this bark is begun. In general nervous depression it acts like a charm ; in ty- phoid, puerperal and other fevers, in recent colds and rheu- matism, it has produced good results. HYDRASTIS. THE ROOT OF HYDRASTIS CANADENSIS.— U. S. Preparations. — Powdered Hydrastis. Tincture of Hy- drastis. Hydrastine. Dose. — Of the powder, grs. ij. to grs. x. Of the tincture, gtt. j. to gtt. X. Hydrastine, gr. | to gr. J. Therapeutic Action. — The Hydrastis is tonic, stomachic, detergent, and laxative. It is an agent extensively employed by Eclectics, and with the greatest advantage. It seems pas- sing strange that our Allopathic brethren have not yet their 440 TONICS. eyes open to its importance, as we believe that for the fulfilling of some indications it has no substitute. It is a very mild, certain and permanent tonic. None with. which we are acquainted exert a more decided and congenial tonic influence upon the stomach and digestive organs. In anorexia, indigestion, and general debility, arising from a languid or atonic state of the stomach, it is unsur[)assed, re- storing tone to the stomach, promoting the appetite, and act- ing as a general restorative. It may also be employed in those cases of chronic gastritis and chronic irritation of the stomach with altered secretion, which constitute the worst and most persistent forms of dyspepsia. As a topical remedy in all diseases of mucous membranes, except acute inflammation, we believe it has no equal, as it rarely, if ever, produces irritation ; but, on the contrary, it a})pears to quiet excitement and restore normal tonicity to the diseased parts. The alkaloid itself is more soluble than its salts, but the sulphate is soluble in the proportion of four grains to the ounce of water; the phosphate, ten grains to the ounce. Hydrastine possesses most of the tonic properties of the crude article, and may be used for the same purposes. As the dose is small and it is very soluble, it is easily dispensed. Five grains added to a glass of watei" makes an admirable tonic mixture, and may be given in doses of a teas[)oonful to a tablespoonful. We combine it with Podophyllin, giving both in small doses. One-twentieth grain of Podophyllin, and one- fourth grain of Hydrastine, make an admirable stimulant and tonic to the stomach and intestinal canal. But it is principally as a topical remedy that we use Hy- drastine and its salts. It makes an admii'able collyrinm in the proprotion of grs. j. to grs. iv, to water .ij., when there is muco-purnlent secretion. It is an admirable injection in the second stage of gonorrhsea in the proportion of grs. ij. to grs. X., to water .5J. It may be used in some cases of sore throat, in chronic catarrh, and in leucorrhoea. SALICINE. 441 IIYDRASTINE. Hydrastine is a brilliant yellow pi'iiu;i[)lo, ohtained from the Hydrastis Canadensis ; it forms in delicate acicular crystals. It is inodorous, and possesses rather a ])leasant bitter tase. It is freely soluble in cold water, but insoluble in alcohol or ether. S A T. I X. THE BARK OF SALIX ALBA. Preparatiox. — Tincture of Salix. Dose. — From five drops to one drachm. Therapeutic Actiox. — The Willow bark is tonic, stom- achic, antiperiodic, astringent, and antiseptic. It j)ossesses very energetic tonic properties, associated with astringency. It has been resorted to as a substitute for Cinchona in the treatment of intermittents — its action upon the system being similar but feebler, and like that of Cornus florida. It has been exhibited with advantage in dyspe{)tic affections, when accompanied with or dependent on debility of the digestive organs. SALICINE. Dose. — As a tonic in general debility, one or two grains four or five times daily; as an antiperiodic, five to ten grains five or six times daily ; or from forty to sixty during the inter- mission, to be given in substance. Therapeutic Action. — Salicine is tonic and antiperiodic. Much discre[)ancy of opinion obtains among medical men rel- ative to the efficacy of Sallcin or Salicine in diseases of i)erio- dicity. While some have regarded it not only as equal but superior to the sulphate of quinine as an anti[)eriodic, others have ascribed to it but feeble antiperiodic powers. There can be no doubt that it is possessed of valuable tonic properties, and as sucli may be prescribed in cases of general debility, in dys[)e])sia, internvittents, remittents, and in rheumatism show- ing evidences of periodicity. It has been claimed to exert the same influence over rheumatism as salicylic acid, and in some cases to be better. 442 TONICS. CORNUS. THE BARK OF THE ROOT OF CORNUS FLORIDA.— U. S. Prkparation. — Tincture of Coriuis Florida. DosK. — From five drops to one drachm. Therapeutic Action. — Corn us Florida is tonic, corrobo- rant, astringent, antiseptic, and stimulant. It resembles the cinchona in its medical properties and uses, and may be em- ployed as a substitute in the various cases in which that is recommended. When administered it is found to augment the force and frequency of the pulse, and elevate the temperature of the body. It has been employed in intermittent fever as an anti- periodic ; but since the introduction of the sulphate of quinine into general use, it has fallen into disuse. It is more fre- quently prescribed in atonic habits, when there is a relaxed or enfeebled state of the system, than for any other purpose. It is sometimes used as a stomachic bitter in dyspepsia, and as a prophylactic to fevers. In cases of gangrene and mortification, it is occasionally used, both internally and externally. The finely pulverized bark may be applied as a poultice to gangrenous ulcers, or to parts approaching gangrene. P R U N U S. THE BARK OF PRUNUS VIRGINIANA.— U. S. Preparations. — Tincture Prunus. Syrup Prunus Virg. Dose. — Of either, the dose will be from gtt. v. to 5j- Therapeutic Action. — The Prunus Virginiana is tonic, astringent and sedative. The bark of the Avild cherry is regarded as one of our most valuable indigenous remedial agents. It is a mild, unirrita- ting aromatic tonic, and very acceptable to the stomach. ]ts first impression seems to be that of an excitant, agreeably to the testimony of Drs. Morris and Eberle, but it is not gener- ally supposed to be possessed of excitant properties. It is a mild and valuable tonic, used with advantage in cases of dys- pepsia ; es|)ecially when connected with an irritable state of the stomach, or when attended with general irritability of the HEPATICA. 443 nervous system, over which it exerts a manifestly sedative in- lluence. It is well suited to the debility which tblhjws many inflammatory diseases, in wiiich cases it is admissible at an earlier period than the more stimulating and energetic tonics. It has been employed very successfully, as a tonic, in the treat- ment of intermittent fevers, but is inferior to the cinchona. C O L U M B A. THE ROOT OF COCCULUS PALMATUS.— Africa. Preparation — Tincture of Columba. Dose. — From gtt. v. to oss. Therapeutic Action. — The Columba is tonic, stomachic and demulcent, says Pereira, and somewhat aromatic. It is one of our most valuable tonics and stomachics. It is valuable in cases of enfeebled states of the stomach, attended with want of appetite, indigestion and genei'al debil- ity ; no tonic is more appropriate in such cases; and none less apt to disagree with the stomach. In acid indigestion it may be united with bicarbonate of soda, or bicarbonate of potash. F R A S E R A. THE KOOT OF FEASERA CAROLINENSIS.— U. S. Preparation. — Tincture of Frasera. Dose. — From gtt. v. to 5ss. Therapeutic Action — American Columbo is tonic, laxa- tive, antiseptic and febrifuge, when properly dried ; emetic and cathartic, in its recent state. It is a mild, pure, simple bitter, and a very valuable tonic, and may be prescribed in all cases where a simple, pure tonic is indicated. Many think it fully equal to the imported columbo, as a tonic, and it is extensively used in the Western States as a substitute for that article; while others regard it as far inferior to it as a remedial agent in the various cases in which that is employed. H E PAT I C A. THE PLANT OF HEPATICA AMERICANA.— U. S. Preparation. — Tincture of Hepatica. Dose. — From five drops to one drachm. 444 TONICS. Thekapeutic Action. — The Hepatica or Liverwort is said to be tonic, astringent, clennilcent, pectoral and deobstruent. The several species of this plant are not very active reme- dial agents, notwithstanding the high reputation which they at one time enjoyed. It is feebly tonic, slightly astringent, and somewhat demnlcent r.nd pectoral. Its employment has been, to a great extent, empirical ; and the high. ])ralses be- stowed upon it by many botanical physicians, it is believed, are to be received with caution and much allowance. POPULUS. THE BARK OF POPULUS TREMULOIDES. Preparation. — Tincture of Populus. Dose. — From five drops to one drachm. Therapeutic Action. — The bark of the White Poplar is tonic, stomachic, febrifuge and alterative. It is a mild and not an unpleasant bitter, very well adapted to cases of gene- ral debility, emaciation, dyspepsia, attended Avith torpor of the liver or an unhealthy biliary secretion. It has been used as a tonic and febrifuo;e in intermittents with decided advantaije. This, as well as other species of the Populus, is possessed of properties quite similar to the willow; indeed, its tonic qual- ities are, probably, dependent on its salicin. It has been ex- hibited advantageously as an alterative, associated with other alterants, as the burdock, yellow-dock, and yellow parilla, when tonics and alteratives are indicated. POPULUS BALSAMIFERA. Preparation. — Tincture of Populus Bals. Dose. — From five drops to half a drachm. Therapeutic Action. — The buds of the Populus balsam- ifera (commonly called t\\Q "Bahn of G Head Buds'") are fre- (piently employed as a tonic, gentle excitant, and ])cctoral agent. They yield a rich balsamic gum, ui)on which their virtues are dependent. This remedy is exhibited in colds, coughs, chronic bion- chitis, in all chronic bronchial affections, })ain in the thorax, hemoptysis, and even in phthisis they have occasionallv done coPTis. 445 good by relieving pain in the chest, lessening irritation and cough, and in promoting expectoration when it was performed Avith difficulty, owing to weakness in the respiratory organs. PRINOS. THE BARK AND BERRIES OF PRINOS VERTICILLATUS.— U. S. Preparation. — Tincture of Prinos. Dose. — From five drops to half a drachm. Therapeutic Action. — The Black Alder is tonic, altera- tive, astringent, antiseptic, and anthelmintic. It is highly valued by many for its medicinal virtues. The bark has been employed in intermittents as a substitute for cinchona, but its febrifuge powers are feeble. The berries have been used with some advantage in intermittents. For this purpose one pint of the berries may be macerated in half a pint of proof spirits and half a pint of water until the strength is extracted, when the juice is to be expressed and sweetened. The dose is half a wineglassful every two hours between the paroxysms. It is sometimes exhibited as an astringent and tonic in chronic diarrhoea, clironic dysentery, and whenever there is relaxation of the intestinal exhalants. It is more frequently employed as an alterative and antiherpetic agent in cutaneous diseases, and in various cachectic habits of body. COPTIS. THE ROOT OF COPTIS TRIFOLIA — U. S. Preparations. — The Powder. Tincture of Coptis. Dose. — Of the powder, grs. ij. to grs. x. Of the Tincture, gtt. V. to OSS. Therapeutic Action. — The Coptis acts as a tonic and stomachic. It is a mild, simple, and pure bitter, closely re- sembling Hydrastis, Columbo, Quassia, Gentian, etc., in its medicinal projjerties ; and it may be used as a substitute for these medicines when they are not at command. It is a valu- able tonic and stomachic in dyspepsia. In cases of anorexia, but few if any articles will be found superior to this in pro- moting the appetite ; and but few to exceed it, when the diges- tive functions are enfeebled, in facilitating their restoration to a normal standard. 446 TONICS. SIMARUBA. BAUK 01^ THE ROOT OF SIMARUBA AMARA.— South America. Dose. — From five grains to half a drachm. Therapeutic Action. — The Simaruba is said to be tonic, emetic, stomachic, cathartic, diaphoretic, and diuretic. It is tonic and stomachic when given in small doses, but in large doses it causes vomiting and purging, and is said to promote diaphoresis and diuresis. It is not used, however, to fulfill any indication except those of a tonic and stomachic. QUASSIA. THE WOOD OF PICR.ENA EXCELSA. Preparations. — Infusion of Quassia. Tincture of Quassia. Dose. — Of the infusion, from 5j. to ,5j. Of the tincture, gtt. V. to 5ss. Therapeutic Action. — Quassia is tonic, stomachic and antiseptic, possessing all the properties that belong to the other pure bitters. It is employed in cases of anorexia for promo- ting the appetite and assisting the digestive functions. It is wholly devoid of all irritant, stimulant, or astringent proper- ties, and hence has been regarded as the type of the pure bitters. Its use is mostly confined to atonic states of the sys- tem, with indigestion and loss of appetite. CUSPARIA. THE BARK OF GALIPEA CUSPARIA.— South America. Preparation. — Tincture of Cusparia. Dose. — From five drops to half a drachm. Therapeutic Action. — Angustura Bark is tonic, stimu- lant, aromatic, emetic, cathartic, dia[)horetic and diuretic. It may be used in all cases where an aromatic bitter and tonic is indicated. It has been recommended in the malig- nant forms of intermittents and remittents of tropical climates. It has proved very efficacious in the treatment of those dis- eases, if we may believe the testimony of many writers of respectability. It has also been administered to check profuse mucous dis- charges, such as occur in the latter stages and chronic forms of dysentery and diarrhoea, and chronic bronchial affections. CHAMOMILLA. 447 ANTHEMIS. THE FLOWERS OF ANTHEMIS NOBILIS.— EUROPE. Preparation. — Tincture of Antheinis. Dose. — From five to twenty drops. Therapeutic Action. — Chamomile flowers are tonic, stom- achic, corroborant, aromatic, diaphoretic, emetic, antispasmodic and carminative. They possess valuable remedial virtues. As an aromatic tonic, stomachic and corroborant, we know^ of no single agent that is superior. They are valuable in enfeebled states of the digest- ive organs, occurring either as a primary disease, or dependent upon some acute affection. In many cases of indigestion, un- attended with gastric inflammation, they are found to be very acceptable and curative. ANTHEMIS COTULA. THE FLOWERS OF ANTHEMIS COTULA— U. S. Dose. — Cold infusion, Sj. to .5ij., as a tonic ; as a diapho- retic, the warm infusion is given in doses of from .jij. to .^iv. Therapeutic Action. — May-weed is tonic, stomachic, su- dorific, emetic, anodyne, discutient, rev^ulsive and emmena- gogue, being possessed of many properties in common with the preceding variety. In small doses it invigorates the digestive organs and improves the general tone of the system. To ful- fill this indication it should be used in the form'of a cold in- fusion. The warm infusion, taken freely, is very useful for promoting perspiration. CHAMOMILLA. THE FLOWERS OF MATRICARIA CHAMOMILLA.— Europe. Preparations. — Infusion of Chamomile. Tincture of Chamomile. Dose. — Of the .infusion, half an ounce; of the tincture, from the fraction of a drop to half a drachm. Therapeutic Action. — German Chamomile is a tonic, stomachic, diaphoretic, emetic, antispasmodic and anthelmintic, being very analagous to the anthemis nobilis in its medical and physical properties. It is mildly tonic, and very useful in de- 448 TONICS. bilitated states of the digestive organs, wiieii a stomachic and corroborant are indicated. The warm infusion answers a very good purpose as a dia- phoretic in colds, and also in the incipient stages of I'ebrile and inflammatory attacks. For this purpose it should be admin- istered freely. Our Homoeopathic neighbors claim that it relieves irrita- tion of the intestinal canal, and employ it in cholera infantum and in diarrhoea. My experience does not sustain this claim. CASCARILLA. THE BARK OF CROTON CASCARILLA.— West Indies. Preparatiox. — Tincture of Cascarilla. Dose. — From five drops to one drachm. Therapeutic Action. — The Cascarilla bark is tonic, stom- achic, stimulant, aromatic and diaphoretic. It w-as at one time extensively employed in Europe as a febrifuge in inter- mittent and remittent fevers, in the place of cinchona, and by some regarded as superior to that article. Its aromatic and stimulant properties, which it possesses in a high degree, ren- der it much more acceptable to the stomach. In large doses it acts as a general excitant as Avell as tonic, causing an acceleration of the pulse, increased heat of the body and diaphoresis. It may be used with advantage in ato- nic states of the stomach attended with flatulency. MAGNOLIA. THE BARK OF MAGNOLIA ACUMINATA.— U. S. Preparation. — Tincture of Magnolia. Dose. — From five drojis to one drachm. Therapeutic Action. — Magnolia is a stimulant tonic, pos- sessed of aromatic and diaphoretic properties, and has been employed in iutermittents and remittents with advantage. If taken freely between the paroxysms, it has been found capable of arresting them. In torpid and phlegmatic habits of body, where a stimulant is desirable, this may answer a very good purpose, but it can not be relied on as a substitute for the cinchona. EUPATOKIUM. 449 ALETRIS. THE ROOT OF ALETRIS FARINOSA— U. S. Preparation. — Tincture of Aletris. Dose. — From five (lro[)S to half a drachm. Therapeutic Action. — The Aletris is tonic, stomachic, narcotic, discutient, emetic, cathartic, and expectorant. In small doses it is tonic and stomachic. In large doses it is said to produce nausea, vomiting, purging, dizziness and other un- ])leasant effects, which would seem to indicate that it is pos- sessed of acro-narcotic properties. Small doses promote the appetite and assist digestion. It is similar to quassia in its properties, so far as a tonic and stom- achic are concerned. It is used in cases of flatulency, colic, hysteria, and chronic rheumatism. Aletris is recommended in diseases peculiar to females as an article of great value. In cases of frequent abortions, or where a disposition to abort exists, in nervous weakness, pain in the breast or side, cold, coughs, consumption, and uterine derangements in general, it has been recommended as a highly important agent. EUPATORIUM. THE PLANT EUPATORIUM PERFOLIATUM.— U. S. Preparation. — Tincture of Eupatorium. Dose. — From the fraction of a drop to half a drachm. Therapeutic Action. — Eupatorium is tonic, diaphoretic, emetic, aperient, and expectorant. It may be so adminis- tered as to fulfill a variety of important indications in the treatment of disease, according to the dose and mode of adniinistration ; for this reason it is somewhat difficult to say which of its properties is most prominent, and under what class of agents it should be described. Believing it to be more frequently used as a tonic, we shall attach it to that class of agents. Eupatorium is a mild, simple, valuable bitter, rind maybe employed in all cases where the simple tonics are indicated. Administered alone, or associated with other tonics, aromatics, 29 ' 450 TONICS. or stimulants, it answers a valuable pur2)ose in the eonvalos- eent forms of acute diseases. Tlie same may be said of it in dyspepsia, and almost all chronic diseases; as a general tonic, exhibited in the form of powder or small doses of a cold infusion, it answers an admirable purpose. HELONIAS. THE ROOT OF HELONIAS DIOICA.— U. S, Preparation. — Tincture of Helonias. Dose. — From one drop to half a drachm. Therapeutic Action. — Helonias is tonic, stomachic, dia- phoretic, and pectoral. It is used by many botanic physicians with decided advantage. It is adapted to atonic states of the system. It causes an improvement of the appetite, and pro- motes digestion. It is said to have been employed for the purpose of preventing abortions, for which it enjoys a liigh reputation. It has been recommended in cases of chronic rheumatism, jaundice, strangury, etc.; also in colds, coughs, pectoral affec- tions, and consumptive diseases, as a diaplioretic and expec- torant. GENTIANA. THE ROOT OF GENTIANA LUTEA.— Europe. Preparation. — Tincture of Gentian. Dose. — From five drops to half a drachm. Therapeutic Action. — Gentian is tonic, stomachic, slightly stimulant and feebly laxative. The latter properties are so feeble as to rarely receive any especial notice. It possesses all the tonic and stomachic powers of the simple bitters in a high degree, and is remarkably well adapted to all states of the system requiring their use. It proves most valuable in cases of a ])hlegmatic and torpid character, but is contra-indicated in febrile diseases; nor is it adapted to cases of irritation or inflammation of the gastro-intestinal mucous membrane. It is, however, very extensively employed, and is to bo re- garded as an efficient tonic. LTEIODEN DRON. 4 5 I GENTIANA OCHROLEUCA. Dose. — Of tlie powder, from grs. x. to 5ss. ; of the tiiictiiro, the same closes as the preceding variety. Therapeutic Action. — This variety of Gentian is de- scribed as tonic, aperient and antiperiodic. It is deemed of much importance by those who have used it, as a tonic and stomachic in debilitated conditions of the stomach and bowels. It is said to be useful in counteracting the formation of acid in the alimentary canal, and its capacity for imparting tone to the digestive organs adds to the probability of the statement. It has been employed with advantage in intermittent fever, and as an emmenagogue. GENTIANA CATESB^I. THE ROOT. Preparation. — Tincture of Gentiana Catesbsei. Dose. — From five drops to half a drachm. Therapeutic Action, — This species of Gentian is tonic, stomachic and diaphoretic ; it is much used in some portions of tiie Southern States, and is said to be scarcely inferior to the imported article. It is a pure bitter, and as such may be sub- stituted for other agents of this class. It is employed in dys- pepsia and debilitated states of the system, arising from indi- gestion. LIRIODENDRON. THE BARK OF LIRIODENDRON TULIPIFERA.— U. S. Preparation. — Tincture of Liriodendron. Dose. — From five drops to one drachm. Therapeutic Action. — The bark of the Tulip Tree is tonic, stimulant, diaphoretic, diuretic, anthelmintic, aromatic, stomachic. It may be used in all cases of anorexia and im- jialred states of the digestive organs, where a stimulant tonic is indicated. It promotes the appetite and facilitates digestion ; for these purposes it will be found fully equal to the simple bitters. It is often used with gome advantage in intermittents. It is employed in gout and chronic rheumatism, and in the declining stages of the acute form, after the irritated action 452 TONICS. has subsided, as a stimulating diaphoretic and tonic. If ad- ministered freely in tiie form of a warm infusion, it evinces conspicuous diaphoretic properties; and not unfrequently its diuretic powers are equally manifest. EUONYMUS. \ THE BARK OF THE ROOT EUONYMUS ATROPURPUREUS.— U. S. Preparation. — Tincture of Euonymus. Dose. — From five drops to one drachm. Therapeutic Action. — The Euonymus is tonic, aperient, alterative, pectoral and antiperiodic. It is known to but few as a medicinal plant, and its properties are, as yet, we believe, but imperfectly known to any ; nevertheless, we believe it is destined, at no distant period, to occupy a liigh place among our indigenous therapeutic agents. From our own experience we believe it to be a valuable tonic and laxative. It imparts tone to the stomach, facilitates chylosis, and if there is a torpid state of the bowels, no better agent can be administered to promote their action without in- ducing their debility. It would likewise seem, from the testimony of good author- ity, to be possessed of antiperiodic powers of no small im- portance. MENISPERMUM. THE ROOT OF MENISPERMUM CANADENSE— U. S. Preparation. — Tincture of Menispermum. Dose. — From five drops to one drachm. Therapeutic Action. — The Yellow Parilla is tonic, alter- ative, stomachic, laxative and diaphoretic ; but like many other valuable indigenous medical agents, has received little attention from the profession. It is said by some to be laxative, but its laxative properties are not very conspicuous. It is somewhat diaphoretic, though seldom if ever used to secure this influence alone. Associated with its tonic, are valuable alterative ])roperties ; and hence it is extolled by those most familiar with its curative powers, as having a very decided control over a great variety of chronic diseases of a cachectic character, requiring the use of altera- tive measures. PTELEA. 453 S A B B A T I A. THE HERB OF SABBATIA ANGULARIS.— U. S. Preparation. — Tinctiire of Sabbatia. Dose. — From tive clroi)s to half a drachm. Therapeutic Action. — The American Centaury is tonic, stomachic, anthebnintic and diaphoretic. It is possessed of the properties of the simple bitters, and as such is frequently used in dyspepsia, the convalescent forms of fever, and in all cases of general debility. PINUS PENDULA. THE BARK OF THE AMERICAN LARCH— U. S. Preparation. — Tincture of Pinus Pendula. Dose. — From five drops to half a drachm. Therapeutic Action. — Tamarac bark is tonic, diuretic and alterative. It has been employed in almost all chronic cachectic diseases, for its tonic and alterative properties, and is often of much service. In conjunction with other agents, it is used in dyspepsia, chronic he])atic diseases, passive dropsies, and during the convalescence of both acute and chronic diseases. PTELEA. THE BARK OF THE ROOT PTELEA TRIFOLIATA. Preparation. — Tincture of Ptelea. Dose. — From one drop to half a drachm. Therapeutic Action. — The Ptelea is tonic, stimulant, ex- pectorant, alterative, astringent and diaphoretic. Among its uses may be noted its influence in some cases of asthma, greatly relieving the patient, and sometimes accomplishing a cure. It is a good tonic and stomachic, and as such may be used in debilitated states of the system, in dyspepsia, anorexia, in- termittents, convalescent stages of other diseases, and, in short, whenever a corroborant is demanded. We have found the tincture beneficial in chronic rheumatism. Others have used it in the same disease with advantage. Its pungent, excitant, toiiic, diaphoretic, and alterative properties would seem to point to it as a useful remedy, in the chronic forms of that disease, attended with debility and requiring excitants. 454 TONICS. CHELONE. THE LEAVES OP CHELONE GLABRA.— U. S. Preparation. — Tincture of Clielone. Dose. — From five drops to half a draclini. Therapeutic Action. — The Chelone is tonic, stomachic, laxative, anthelmintic and hepatic. It is one of tiie mildest, l)urest and most congenial tonic and stomachic agents in the materia medica. It is unusually acceptable to the stomach, and is valuable in anorexia, languid or atonic states of the digestive organs, and promotes the appetite and facilitates the process of digestion. In cases of confirmed dyspepsia, especi- ally if attended with torpidity of the bowels, it answers a good purpose, as It does in chronic diseases in general, attended Avith debility. BERBERIS. THE BARK AND BERRIES OP BERBERIS VULGARIS.— U. S. Preparation. — Tincture of Berberis. Dose, — From five drops to one drachm. Therapeutic Action. — It is tonic, stomachic, laxative, antiseptic and astringent. It is an energetic tonic, and although laxative, is at the same time astringent. It is useful in dyspepsia, especially when connected with a torpid state of the liver and constipation of the bowels ; promotes digestion, and seems to increase the as- similating functions. PANAX. THE ROOT OP PANAX QUINQUEFOLIA.- U. S. Preparation. — Tincture of Panax. Dose.— From one drop to half a drachm. Therapeutic Action. — Ginseng is feebly tonic, a pleasant stomachic and aromatic stimulant, a gentle nervine, slightly diaphoretic, and somewhat demulcent. It promotes the appetite, facilitates digestion and invigorates the general system, and is considered beneficial in morbid states of the nervous system. Some are in .the habit of em- ploying it as a nervine and antispasmodic, either alone or as- sociated with other ajjcnts belonsrinu: to that class, in cases of debility or irritability of the nervous system. FERRUM. 455 FRAXINUS. The inner bark of the Fraxinus Acuminata, or White-Ash, is tonic and astringent in small doses; if taken freely, it is actively purgative. We think it decidedly alterative. It has been used as a tonic in intermittents, and also as an astringent in hemorrhages. We have used the White-Ash bark with benefit in dyspepsia, general debility and cachectic habits, with a view to its tonic and sustaining powers, and for its aperient action. FEL BOVINUM. Dose. — From grs. v. to grs. x. of the inspissated Gall, three or four times daily. Ox-Gall was at one time regarded as a highly important and peculiarly valuable agent, in cases of dyspepsia attended with a deficient biliary secretion. It is supposed to give tone to the digestive organs, and facilitate the process of chymifica- tion and chylification. If the biliary secretion was scanty, vitiated, or in any respect devoid of its healthy solvent powers, and its due capacity to augment the peristaltic action of the bowels, the ox-gall at one time enjoyed a high reputation for correcting all such morbid states. FERRUM. IRON. Therapeutic Action. — The chalybeate or ferruginous preparations are found to be of much importance in certain states of the system. So far as its physiological effects are concerned, the Iron, so long as it retains its metallic form, is supposed to be inert, or at least to exert but a feeble influence upon the system. It is probable, however, that its mechani- cal action upon the bowels, when in a metallic state, may stimulate them to healthy action, give increased tone and vigor, and thus prove beneficial. It is also said to be useful in re- moving worms, which it is supposed to do mechanically. The.se effects are by no means its most important ones in a therapeu- tic and physiological point of view. When the metallic Iron is taken into the stomach it readily oxidizes, and thereby ac- quires its most prominent powers. Acids, acid wines and 456 TONICS. fruits, assist in giving activity to the metal, by promoting tlic chemical changes upon which its value as a remedial agent depends, and for the same reasons alkaloids and their carbo- nates are inadmissible, while the patient is using Iron. Dur- ing its oxidization, hydrogen gas is evolved, giving rise to un- pleasant eructations. By the internal use of this metal the stools are rendered black. Notwithstanding the changes which the Iron undergoes by oxidation in the system, yet it does not acquire poisonous qualities by these changes, like most other metals. Most of the chalybeate preparations are possessed of as- tringency, in addition to their more prominent tonic and alter- ative properties. They diminish excessive secretions from the raucous membranes, as the gastro-intestinal, giving tone to the bowels, while at the same time they render the alvine dis- charges more consistent, and not unfrequently cause constipa- tion. The sulphate and chloride of iron are more irritating than any other preparations of this metal, and are regarded even as poisonous ; they are, however, very feeble poisons when compared with the mercurial and cupreous salts, and are likewise more decidedly astringent than any of the other fer- ruginous preparations. By the use of chalybeates the blood becomes more florid, or acquires a scarlet color, owing to the increased number of its particles of coloring matter; and the crassamentum also gains ill volume, as well as in firmness or density. These physical and chemical alterations in the sanguiferous fluid render it more stimulating to the organs, and hence the improvement in their fnnctio.ns arising from the use of the iron. The salutary changes attending it are not speedy, but slow and gradual, owing to its very tardy absorption into the ..system. Preparations of iron are contraindicated in cases of irrita- tion or inflanunatiou of the alimentary canal, likewise in ])le- thoric liabits, with a tendency to apoplexy and inflammatory affections. On the contrary, they are indicated when thei'c is a soft lax state of the solids and muscidar fiber, in feel)leness or inertia of the organs, and in leueo])lilegmatiG habits; in cases of antemia and chlorosis they are indicated, and are of primary importance in effecting a cure. FERRI OXIDUM NIGRUM. 457 FERKUM R AMENTA. Dose. — From five to twenty grains, in electuary. The metallic iron, in the form of "filings," is inert in its unconibinecl state; at all events it exerts but a feeble influence upon the animal economy. Its sanative powers are attributa- ble to the chemical changes which it undergoes in the system. By the union with an acid, or some other agent, in the systeni, tiie iron becomes oxidized, and thus acquires its activity as a therapeutic agent. There can be no doubt, however, that the metallic iron will prove useful in cases where there is- torpor in the alimentary canal from want of tone and excitement, as in some forms of dyspepsia, and constipated and sluggish states of the bowels. It is also said to be anthelmintic, and is su[)- ])osed to act mechanically upon the worm. FEREI OXIDUM SQUAMiE. Dose. — From five to twenty grains. The Scales of the Oxide of Iron, found at the anvil of the blacksmith, are possessed of the general properties of the cha- lybeates. They are formed when iron is heated to redness, and consist of a mixture of monoxide and sesquioxide of iron in varying proportions. They are used in domestic practice in cases of amenorrhoea, chlorosis, etc., mixed in molasses or honey, or put into wine. They are considered unfit for use, however, until reduced to a fine jiowder, when they are united with other agents, forming the next preparation, Fevri Oxldum Nigrum, or Black Oxide of Iron. FERRI OXIDUM NIGRUM. Dose. — Five to twenty grains, two or three times a day. The Black Oxide of Iron is a chalybeate j)re[)aration long and extensively used. It is exhibited in the same cases as the other ferruginous preparations. It is tonic, and said to be useful in promoting the menstrual secretion, hence adminis- tered in chlorosis, anemia, and other cachectic states. Royle savs, " It has the advantage of being a compound of the pro- toxide, which is usually considered the most efficacious." 458 TONICS. FERRI CARBONAS. SUB-CARBONATE OF IRON. Dose. — Fi-om grs. v. to oijv as a tonic, alterative, and eni- menagogue. This preparation is not a true carbonate, but a ferric oxy- liydrate. It is extensively employed, and is considered appli- cable to all cases iu which the chalybeates are indicated. Dr. Carmichael recommended it highly in cancerous diseases. Mr. Hutchinson reports many cases of neuralgia, especially facial neuralgia, in which it proved eminently beneficial ; and Dr. Dunglison and many others fully corroborate tliese reports. In chlorotic affections, scrofulous diseases, general cachexia, amenorrhoea, chorea, epilepsy, dropsy, and many chronic dis- eases of long duration, especially when the blood becomes re- duced in quantity, and impaired in quality, as in protracted intermittents, remittents and nervous diseases, great advantage has been derived from its exhibition. It is an antidote to arsenious acid, although not so effectual for this purpose as the hydrated oxide. FERRI SULPHAS. SULPHATE OF IRON. Dose — From one to five grains iu the form of a pill. Therapeutic Actiox. — The Sulphate of Iron is tonic, astringent, emmenagogue and stimulant, possessing many properties in common with the other ferruginous preparations ; consequently its remote effects upon the system correspond with those attending the employment of preparations already named. Its local action is that of a powerful astringent, and if given in a concentrated form, it acts as an irritant by virtue of its chemical action on the tissues. It is employed topically, either in the form of a solution or powder, as a styj)tic, to arrest hemorrhages from bleeding sur- faces. The solution is frequently applied to ulcerated surfaces and to mucous membranes, to lessen p,rofnse discharges. In loucorrhoea, gonorrhoea, gleet, ophthalmia, etc., and as a gargle in ulcerated states of the mouth and fauces, it may be resorted to with advantage. The solution is also employed in various eruptive and herpetic affections as a wash, as in the case of FERKI OXIDU.M IIYDRATUM. 459 lierpes circiiiutiis, poisoning from Rhns, etc. For this purpose from one to ten grains may be added to one ounce of water. FERRI CARBONAS SACCIIARATUS. VALLETT'S FERRUGINOUG MASS. Dosr:. — From one to ten grains in the form of })ills. The Saccharine Carbonate of Iron is one of the most valu- able ferruginous preparations. It is soluble in the fluids of the stomach, and hence is readily absorbed. It is especially valuable in chlorosis and anemia, where the indication is to increase the red corpuscles of the blood; l)nt it may also be employed wherever a preparation of iron is indicated. FERRI FERROCYANIDUM. PRUSSIATE OF IRON. Dose. — From three to six grains. Prussiate of Iron possesses the properties of the other prep- arations of iron, and in addition to these, it is regarded as a valuable antiperiodic. There can be no doubt but that it pos- sesses this last property in a notable degree. Dr. Zollickoffer recommended it as a more certain, prompt, and efficacious remedy in intermittent and remittent fevers than the Peruvian bark. Though we can not go so far as that, we would be will- ing to state that, combined with quinine, it will add at least one-fourth more power to tiie agent. We employ it in prefer- ence to any other preparation of iron in chronic disease, when there is any tendency to periodicity. FERRI OXIDUM HYDRATUM. SESQUI-OXIDE OF IRON. This preparation of iron is similar to the anhydrous sesqui- oxide, or precipitated carbonate, in its general properties, and may be exhibited with advantage in the same cases in which that was recommended. It is not used, however, to any con- siderable extent as a substitute for that and the other chalyb- eate preparations in general use. Its antidotal powers to the arsenious acid, entitles it to our esi)ecial attention as a toxicological agent. It unites v/ith the arsenious acid, forming an insoluble arseniate of iron, and 460 TONICS. lience prevents its corrosive effects upon tlie gastro-intestinal iiuicous membrane. Its efficacy, as an antidote to this poison, has been fnlly shown by experiments made npon animals, and also by the successfnl resnlts which have attended its employ- ment in cases of poisoning in the human subject. Twelve parts of the oxide or hydrate, prepared by ammonia and administered in the form of a pulpy mass, by mixing with water, are required to neuti'alize or render inert one equivalent of the arsenic. The dose of the pulpy hydrate to an adult is one tablcspoonful every five or ten minutes, and to children a dessertspoonful ; repeat it until the urgent symptoms subside. TINCTURA FEREI CHLORIDI. Dose. — From ten to thirty drops in water. Therapeutic Action. — The Tincture of Muriate of Iron is considered one of the most active, certain and valuable preparations of iron. It is decidedly tonic, and an energetic astringent and styptic, and if the dose is large it is an irritant ])oison, owing to the great amount of free hydrochloric acid contained. If taken in large doses, its action is to disorder the stomach. In addition to the tonic and alterative properties of this agent, which, in common with other chalybeates, it jiossesses, it has astringent and diuretic properties in a high degree. It is advantageously employed as a tonic and alterative in scrofula, rachitis, tabes arising from extensive ulceration or sup- puration, and attended with hectic fever and night-sweats; in tabes mesenterica, tabes dorsalis, chlorosis, cachectic habits, in all cases of antemia, in many chronic, and also in the conva- lescent forms of many acute diseases. In asthenic dro[)sics it is likewise useful, especially when it arises from loss of blood, or from amcnorrhoea. It seems to act specifically upon the gcnito-nrinarv oi-gans, as it appears by the increased urinary secretion, and l)v its effects upon the kidneys, bladder, urethra, and prostate gland. Tn cases of leucorrhoea, chronic gonorrhoea, gleet, etc., it has been found beneficial. In dysuria, or retention of urine, arising from a spasmodic stricture of the lu-ethra, Pereira recommends it. In this case the dose is ten drops every ten TINCTUllA FERFvI ClILORIDI. 461 iiiiniites until relief is obtained. The same writer has used it associated with the tincture of cantliarides, in the latter stages of gonorrhoea, with advantage, after oilier remedies had failed. In passive hemorrhages from the kidneys, bladder or uterus, it is found valuable, and is likewise cm[)lo}'ed in chronic diarrhoea, dysentery and cholera infantum, attended with re- laxation of the intestinal exhalants, in which cases its tonic and astringent powers have, in some instances, rendered it an exceedingly important remedy. For this purpose it may be g-iven in small doses, associated with a few drops of the tincture of opium or paregoric. One of the principal uses of this remedy is to antidote the poison of erysipelas, which it does in a very marked manner. In the olden time it was thought to be a true specific for the disease, but a further study has shown that ei'ysipelas (like other named diseases), is not always the same. Many cases are met by this remedy, some by Rhus; others by Veratruni ; and others still by sulphite of soda. Tincture of Muriate of Iron is indicated by the deep color of the part, and by the deep red of the tongue. With these indications it can be administered in doses of gtt. v. to 5ss., every two or three hours, and a local application of the rem- edy pure or diluted with glycerine. To one who has not studied the specific action of remedies, the action of this medicine M'ill be a revelation. We are called to a patient who has erysipelas, and find a pulse of 120, small and hard, a temperature of 104°, a dry skin, scanty urine, consti])ated bowels, tongue dry, brown and fissured, nervous system excited, and inability to sleep. We administer the single remedy, tincture of muriate of iron ; the pulse comes down to 90, temperature to 100°, the skin softens, the urine is increased in quantity, the tongue moistens and cleans, the ner- vous system is relieved, and the patient sleeps. All from one remedy, and a remedy that has not been recommended for these purposes. FERE,I lODIDUM. IODIDE OF IRON. Dose. — From three -to ten grains. Iodide of Iron is a valuable therapeutic agent, possessing both the properties of the iron and iodine; it is the mildest 462 TONICS. form in which the latter agent can be used. It is indicated as a tonic and alterative, in scrofulous or other cachectic affec- tions, if there is much debility, with a soft and relaxed state of the muscular fiber, and an exsanguine appearance of the surface. It^jromotes the appetite, facilitates digestion, in some cases proves laxative and diuretic ; at the same time, we ob- tain the resolvent and alterative influence of the iodine. We have employed it in secondary syphilis, where there was great prostration of the system, with decided advantage, and in such cases as these, would strongly recommend it. The best forms in which this agent can be administered, are the Syrup of Iodide of Iron in doses of 5ss.; or the Syrup of Iodide of Iron and Manganese, in doses of from ten drops to half a drachm. FERRI ACETATIS. Dose. — From ten drops to half a drachm. Acetate of Iron is formed by dissolving the sesquioxide of iron in acetic acid. It is a deep red liquid, having an acid chalybeate taste. It possesses the properties of the other fer- ruginous preparations, and in addition, others, which ren- der it valuable in certain conditions of the system. Thus in typhoid and typhus fever when the system becomes prostrated, it may be used to good advantage, the acetic acid being one of our best antiseptics. It is also a very valuable preparation of iron in the treatment of scorbutis, and especially valuable in those low cachectic states of the systeiu, sometimes produced .by secondary syphilis. In this last case we would especially recommend its trial. FERRI P E RN I T R A S. Dose. — From ten drops to one e system in which a tendency exists to unusual depositions of phosphate of lime, such as in cases of exostosis or formation of bony tumors, as well as in some forms of urinary concretion. It may be employed for a longer period without disturbing the digestive functions than most agents of this class." — Phillips. Dr. Paris states that he has found it to assua2;e the thirst so commonly present in diabetes more effectually than any other acid drink. Hecker says it exerts a special influence over the nervous system, by virtue of which it possesses the power of allaying pain and spasm. Siindelin regards it as a stimulant and tonic to the sexual organs. We have ein[)l<)y('(l it with apparent advantage in some cases of phthisis piilmonalis, where there was marked excita- bility of the nervous system. We also consider it an excellent agent in severe cases of spermatorrhoea, and impotcncy arising from this and other causes. In those severe but obscure ufFec- tions of the nervous system characterized by pal[)itation of the heart, irregular circulation of the blood, sense of fullness and constriction of the thorax, with want of command over the voluntary muscles, it has proved one of our most efficient agents. HYPOPHOSPHITE OF LIME. 465 P H O S P H O R U S. Preparations. — Wc cuiploy Phosphorus in substance in the ioiMii of pills. Tincture of Phosphorus. Dose.— Of Phosphorus, from gr. 1-50 to gr. 1-100. Of t'.io tincture, we usually add gtt. x. to gtt. xx., to water .Siv.; give in teaspoon ful doses. Therapeutic Action. — Phosphorus is thought to be a stimulant and tonic to the nervous system, exerting a special influence U[)on the reproductive organs. In some eases it ex- erts a beneficial influence, and patients improve in appetite and digestion, and many nervous symptoms are relieved. I am not satisfied as to its aphrodisiac power, and would prefer to trust other remedies when this function needs to be strengthened. Tincture of Phosphorus exerts a special influence upon the bladder, prostate, vesiculic seminales and testes, relieving irri- tation and improving the innervation and circulation. I use it in chronic cystitis, chronic prostatis, enlarged and pendulous testes, gleet, chronic ovaritis and vaginitis. It may also be prescribed for pneumonia, stage of hepatiza- tion, when pus appears in the sputa, or when absor[)tion of the effusion is slow. In these cases the pulse is feeble, the tongue pasty, and digestion poor. HYPOPHOSPHITE OF LIME. Dose. — From one to five grains. TiiRRfVPEUTfC Action. — The Hypophosphites belong to the class of Restoratives — agents which add to the body a ma- terial that is deficient, and they are useful when the disease depends on the want of such materials in the blood. " The importance of the element, phosphorus, in the human economy, has not been appreciated until quite a recent period. The amount present in the brain, as shown by investigations at the Cambridge laboratory a few years since, is much larger than was supposed. Not only had the best chemists of Europe fallen into error in tiieir estimates of the quantity of phos- phorus, but also in that of sulphur, the element so closely 30 466 TONICS. allied to phosphorus in its uses and chemical affinities. The vital importance of these agents in maintaining a normal con- dition of the system can be understood by a consideration of the probable fact that in all the operations of the mind, every effort requiring an expenditure of nervous force, they arc called into action." — JMchols. We frequently find cases in practice in which there is un- doubtedly great depression of the nervous power, in fact, want of innervation : cases of chronic disease in which this depres- sion of nervous force appears to be the paramount disease — at least, the hardest to treat. It is in such cases that we have obtained the most benefit from the administration of the hypophosphite of lime. We do not, however, look for imme- diate benefit. The agent has to be ap[)ropriated by the system, and it may be days or even weeks before its infiuence is appa- rent, but we have never been disappointed in its effects at last. In the early stages of phthisis ])ulmonalis, we know of no agent capable of producing such marked beneficial influence upon the disease. Why it increases the strength of the patient and the tone of the digestive organs, relieves cough and op- pressed respiration, etc., we are unable to say, but of the fact we are confident. HYPOPHOSPHITE OF SODA. Dose. — From five to ten grains. The action of Hypophosphite of Soda is similar to the hypophosphite of lime. It should be selected when the tongue is broad and })allid, and there is an evident want of soda. HYPOPHOSPHITE OF POTASSA. Dose. — From five to fifteen grains, three or four times a day. Therapeutic Action. — Hypophosphite of potassa pos- .sesses similar properties to the othor hypophosphites. In some conditionsof the system, where potash is indicated, it will prove the best preparation. EUCALYrXUS. 4i>7 HYPOPHOSPHITE OF AMMONIA. Dose — From five to fifteen grains, three times a day. Therapeutic Action. — Hyp()plK)si)liite of Amiuoniti pos- sesses properties similar to the other hy[)ophosphites, with the additional action of the salt of Ammonia. The indications for its preference will be apparent to the practitioner. HYPOPHOSPHITE OF SESQUIOXIDE OF IRON. This salt is a white, amorphous tasteless powder, like the pyrophosphate, soluble in hydrochloric acid, and in free hypo- phosphorous acid. We are not aware that it has been em- ployed in medicine, except as an ingredient of the compound syrup of hypophosphites. HYPOPHOSPHOPOUS ACID. Dose. — From ten drops to one drachm. A teaspoonful con- tains two grains and a quarter of phosphorus. We employ this preparation when there is an evident want of an acid as well as phosphorus. With a deep red tongue it sometime proves even beneficial as a restorative. Compound Syrup of Hypophosphites. — This syrup is supposed to possess the combined properties of the hypophosphites, and lias been more extensively used than any other preparation. It is employed for the same purposes as the salts of which it is formed, and in many cases it will prove an efficient prep- aration. Still we believe that the salt of lime, in a majority of cases, will be found the most advantao-cous assent. The dose will be a teaspoonful three or four times a day. EUCALYPTUS. THE LEAVES OF EUCALYPTUS GLOBULUS.— U. S. Preparation. — Tincture of Eucalyptus. Dose. — From five drops to half a drachm. Therapeutic Action. — The Eucalyptus is tonic, stimu- lant and antiseptic. When taken into the stomach it imparts a sense of warmth, which sometimes extends to all parts of 468 TONICS. the body. It strengthens the pulse, and increases the tem- perature. It is claimed that when the temperature is low, or unequal in different parts of the body, this remedy may be used with prominent advantage. It is said to improve the appetite and digestion, but my experience does not confirm this. It is also claimed that it is antiperiodic, and may be substituted for quinine in many cases. But I anticipate, that here also, its good effects are dependent rather upon its stimulant influ- ence upon the circulation, than any antiperiodic property. To a limited extent, it is antiseptic, but we would hardly select it when we have remedies that are so much better. BOLETUS. THE ENTIRE FUNGUS BOLETUS LARICIS— Europe. Prepaeation. — Tincture of Boletus. Dose. — I^ Tincture of Boletus gtt. v. to gtt. x., water ,5iv. ; a teaspoonful every hour. Therapeutic Action. — Boletus influences the nervous system, strengthening innervation, and through this blood- making and nutrition. It has been used in intermittent and remittent fever where the patient lacked nervous energy, with good results. Probably its use will be restricted to these cases, as for the ordinary purposes of a tonic we have much better remedies. AMMONII CARBAZOTAS. Dose. — From one-eighth to one half grain. Therapeutic Action. — Carbazotate of Ammonia has been successfully employed as an antiperiodic, taking the place of quinine. Wc can not as yet describe the cases to which it is especially applicable, and therefore it will be first employed when quinine has failed to " break the ague." But if the cases in wliich it is curative are studied, we must be able after a time to prescribe it rationally. The dose is very small, but as It is Intensely bitter, it should be administered in the form of sugar coated pills. cupiiu-Ai. 469 PHOSPHIDE OF ZINC. Dose. — From one-thirtieth to one-sixteenth of a grain in pill, freqnently with one-fourth grain of nnx; vomica. Therapeutic Action. — Phosphide of Zinc has been em- ployed as a nerve tonic and stinuilant, being a better remedy than phosphorus. Its value in these respects has of late been fairly tested in the exhaustive stages of typhoid and other fevers, when the nervous energies have been so far prostrated as to render convalescence, if not doubtful, at least tedious and pro- tracted. The great value of the phosphide is evinced in the most distinct manner when used in the treatment of neural- gia, in angina, loss of memory, and impotence, in loss of sleep from mental anxiety, and generally in those nervous affections that owe their origin to exhaustion and depression of nerve force. CUPRUM. PuRPAEATioNS. — Tiucture of Acetate of Copper (Rade- macher's. Sulphate of Copper. Dose. — Of the tincture, gtt. x. to gtt. xx., to water ,5iv. ; a teaspoon ful four times a day. Of sulphate of Copper, grs. 1-lOtogr.j. Specific* Indications. — The surface is pallid, yellowish or greenish ; the tongue is broad, and has a bluish or greenish pallor; the tissues are full, but soft and doughy. Theeapeutic Action. — Following the above indications, we find that copper improves the appetite and blood-making, the tissues grow firmer, and the patient is able to take the necessary exercise. I have employed it successfully in anemia, Icncocythemia, and in chlorosis, when the ordinary tonics and restoratives had failed. In the experiments conducted at the Pisa Hospital, it was determined that '• sulphate of copper powerfully purifies the nutritive function by virtue of the greater activity which it induces in the internal processes of tissue change; and hence it is indicated in all states of the organism iu which there is (h'riciency or atony of nutrition and impoverishment of the blood." 470 TONICS. ARSENICUM. Prepaeation. — Fowler's Solution. Dose. — From the fraction of a drop to two drops. Therapeutic Action. — In mncdl doses, and when indica- ted, Arsenic may be regarded as a vital stimulant, and one of the most powerful of this class. But we must not forget that the dose must be small, and there must be special indications for its use. What are these indications? In that condition of blood, and of nutrition, where there is a tendency to the deposit of low or imperfect albuminoid ma- terial, yellow tubercle, caseous deposits, or degeneration of tissue, Arsenic may be used as a blood-maker, and especially to improve nutrition. A class of skin diseases depending upon such deposits or on enfeebled nutrition, is cured by Arsenic. Among these are the more chronic affections, the squamae, chronic vesiculse, some of the pustulse, and the tuberculee. It will not cure all cases, it will do harm if injudiciously used, but it affords re- lief in many otherwise intractable. But it should never be employed where there is irritability of the nerve centers, and especially of the sympathetic. This rule, I think, is absolute, and must be constantly regarded. Ki'SQwia \q '.\ nerve- stimulant; quite as much so as phosphorus, with this addition : that its action is greatly intensified when there is already erythism of the nerve centers. It has been successfully employed in some cases of phthisis, presenting the condition above named. Prof Howe uses it in combination with Veratnm, and there is no doubt that this renders the system tolerant of Arsenic where it could not otherwise be employed. Arsenic is topically employed to destroy malignant growths. The majority of the " cancer specialists" use it in some form, and their preparations differ only in the inert material with which it is combined. The preparation now employed most frequently is made as follows: Take Hydrated Sesqnioxide of Iron a sufficient quantity, throw it on a j)ai)er filter, and when of the consistence of ointment, add an equal i)art of T/.ird To this add Arsenious Acid, in the jiroportion of .5ss. to Ty]. lo the ounce. ARSENICUM. 471 Arsenic may bo employed in the treatment of some cases of intermittent lever with excellent results. Tliey are those marked by impairment of sympathetic innervation, and with a general want of nervous excitability. The dose should be very small, gtt. v. to x. of Fowler's Solution to 5iv. of water; a teaspoonfnl every two or three hours. I have used the Homo2opathic pellets, medicated with Fowler's Solution, and though the dose was not more than the twentieth to the one- hundredth of a drop, the effect was marked, where specially indicated. It is also used with advantage In atonic diarrhoea, with in- digestion, the coiiditions being as above named. Es])eeial benefit has been observed in those cases in which there were periods of great depression, followed by hectic fever. 472 SPECIAL THERAPEUTICS. CIL,A.SS XI. ALTERATIVES. Alteratives are defined to be agents which change, in some insensible and inexplicable way, certain morbid actions and conditions of particnlar organs, or of the general system. They produce no sensible evacuation, or modification of function, by which we can in any way judge of their mode of operation. They are administered to counteract certain morbid habits of the body, or cachectic states of the consti- tution, and to reestablish the healthy functions of deranged organs. Their precise modus operandi is involved in much obscurity. Doubtless much efficacy is occasionally attached to certain articles commonly regarded as alteratives, when their sup- posed salutary influence is wholly the result of the recupe- rative powers of the system. ISTevertheless, an inquiry into the action of this class of agents, though it may be some- what speculative, will not, it is believed, be wholly uninter- esting to the therapeutist. The term alterative is extremely indefinite, since nearly every article in the materia medica may alter, modify or change the action of certain organs or parts, promote dimin- ished or suppressed secretions, restrain them if too profuse, change them if abnormal or vitiated, and thus exert either a direct or. indirect alterative influence upon the system. Yet these agents produce some sensible impression, some percep- tible influence upon certain organs or secretions, or upon the general system, which will characterize their action, and impress the mind with the difference between them and agents of this class which act in the manner defined above. It can not be disputed that many of the articles which we call alteratives do act in sensible ways upon the system, as well as in the insensible manner referred to. Some cf them act as general or special excitants upon certain organs or ALTERATIVES. 473 tissues, or as corroborants; but these influences do not seem to be sufKcient to explain their curative action in tliosc al- feetions in which they are administered. There are other articles wliich possess very simihir properties, and exert the same or simihir sensible influences upon the system without ]iroducing_that important alterative influence so desirable in certain chronic diseases. That the value of these agents as al- teratives is dependent in part upon their sensible influence up- on the system, we think can not be doubted; but their special influence in certain forms of disease must be dependent upon some action not yet determined. We may speculate on this peculiar action, but, although our reasoning may be correct, in tlie present state of our knowledge we can not demonstrate it to be so. We suppose, from their known efi^cts, that alteratives may act in the following way : 1. They may change the condition of the blood by a direct influence exerted upon it after the absorption of the remedy; and this change may be either chemical or dynamical. 2. The}^ may in some manner eflect the removal of the worn-out tissues, and favor the process of nutrition. 3. They may neutralize or change the character of decomposing or noxious agents that exist i-n the sj'stem as the result of some pathological process, or that have been in- troduced from without. 4. They undoubtedly favor elimina- tion by stimulating the excretory organs to increased activity. In order that alteratives should act in the ways mentioned above, it is necessary that they should be absorbed. We And that all agents of this class are soluble in the fluids of the bod)', and hence are necessarily absorbed; and as further proof of this, many of them may be detected in the secretions. The alkaline alteratives, as well as the halogenous bodies, iodine, chlorine and bromine, doubtless exert their influence in all four of the ways mentioned. Thus, they change the condition of the blood by acting chemically upon it; they tend to break down the worn-out tissues of the body, and thus pi-eparc the way for nutrition ; thej^ change the charac- ter of some of the products of decomposition, so as to permit of their excretion ; and they act as direct eliminatives, stimu- lating one or more of the excretory organs to increased action. The vegetable alteratives may act in a similar manner; 474 SPECIAL THERAPEUTICS. though as the}' are complex organic bodies, and subject to change wlieu introduced into tlie system, we have no means of knowing either their chemical or dynamical influence upon the blood, or upon the tissues. That they may exert even a more powerful chemical influence than the agents first named, is not impossible. They may add something to the blood, or take something away from it; or by their mere presence they may give rise to a chemical action between the constituents of that fluid, in a manner similar to the action of emulsine, when added to the material of the bitter almond — by its presence giving rise to the formation of hy- drocyanic acid. All the agents of this class that have any well marked influence upon the system, prove directly eliminative; they either increase the secretion of the kidneys, skin or bowels, and the greater their power in this respect, the more efficient are they as alteratives. Thus the stillingia, when given in large doses, is cathartic and emetic; in small doses, it in- creases the secretion of the kidneys, bowels and skin. The compound sirup of stillingia produces a marked increase of all the secretions. Podophyllum, iris versicolor, juglans cinerea, alnus serrulata, chimaphila, etc., all act in a similar manner. We may say, then, that whatever action these agents have in the manner spoken of in the three first prop- ositions, and they undoubtedly have some, they exert a bene- ficial influence b}'^ eliminating m.orbid material from the system. The reason why this action has not been fully re- cognized, is probably from the fact that this increase of the secretions is but gradual, and comparatively small to that pro- duced by agents acting directly and quickly upon these organs. In regard to the therapeutic application of this class of remedies, we will have to refer the reader to the description of the separate agents, as each of them exerts an influence peculiar to itself. As to their general application, they are employed in all chronic diseases in which there is a depraved or vitiated condition of either the solids or fluids. Thus, they are used in scrofula, sypldlis, scorbutls, tabes mesenferica, chronic hepatitis, dyspepsia, chlorosis, chronic rheumatism, chronic cutaneous diseases, etc. In many morbid conditions of the system, in which thia ALTERATIVES. 475 class of agents are indicated, in addition to medicines, a change of air, diet, habits, scenery, employment, society, etc.; will tend in a very marked manner to improve the mental and pliysical condition of the patient, and cooperate witl: the medicinal measures employed in restoring him to a state of health. The cold shower-bath, douche, alkaline or salt hand-bath, the medicated vapor-bath, etc., by keeping the skin in a healthy condition, and by their exciting effects upon the nervous system, also become valuable auxiliaries to the use of the remedies under consideration. In addition to these measures, especial attention should be paid to the regimen of the patient. A diet mild and unirritating in its qualities, easy of digestion, and nutritious, if taken in mode- rate quantities, will greatly contribute to the restoration of health; it furnishes the necessary quantity and quality of chyle for the formation of the blood, and thus acts as a healthy excitant to the vascular and nervous systems, fur- nishing healthy materials for the nutrition or renovation of impaired organs. In addition to the use of alteratives and a correct regimen, such agents will have to be emploj'ed from time to time as are demanded to fulfill special indications, as cathartics, emetics, diuretics, diaphoretics, sedatives, etc. Thus it will be seen that a reliance on any one class of medicines, or on particular agents or remedial measures alone, in the treatment of these chronic diseases, would prove unsuccessful. It is by a combination of medicines, influen- ces, and changes in the management of disease, that we accomplish cures. Repeated changes in the remedial, diet- etic, physical, and mental influences, should be had recourse to in such cases. As one medicine or class of agents, one form of diet, or the physical and mental influences, lose their salutary eflects upon the system, others should be substituted for them. In this way many cures may be effected that would resist a routine practice, and bid defiance to the most potent medicines. The superiority of one physician over another in many instances arises from the judicious selec- tions and modifications which he makes in the various reme- dial measures employed, and in their adaptation to the vari- ous phases of the disease, and to the diflerent states of the svstem. 47G ALTERATIVES. PHYTOLACCA. THE KOOT OE niYTOLACCA DECANDRA. Preparation. — Tincture of Phytolacca (the fresh root). Dose. — From the fraction of a drop to twenty drops. Usu- ally we add gtt. v. to oss. to water giv. ; the dose being one teaspoonful. Specific Indications. — The mucous membranes are pah-, and the epithelium gives way, showing vesicles, erosions, ulceration. De[)Osits in and upon the mucous epithelium, of an ashen-gray color, enlargement of lymphatic glands with pal- lor, mammary pain or inflammation, irritation of the salivary glands, or of the testes. Therapeutic Action. — The Phytolacca is emetic, cathar- tic, alterative, and discutient. It acts as an emeto-cathartic, and exhibits some acro-narcotic powers, such as impaired vis- ion, vertigo and drowsiness. In over-doses, it is said to cause excessive vomiting and purging, with great prostration, and occasionally convulsions. The dust inhaled, while pulverizing the root, produces severe coryza, with headache and prostration. As an alterative, in chronic rheumatism, mercurial rheuma- tism, secondary syj)hilis, etc., but few agents are known to the ])rofession which are so searcliing or more truly alterativ(\ For this purpose the root, extract of the root, berries, or in- spissated juice of the berries, or the tincture, may be prescribed alone, or combined with other agents; while the root may be; roasted and a])plied to the part affected in the form of a ])onl- tice, or the saturated tincture or extract may be used as a local application. The first and most important use of Phytolacca, is its sj)e- eific action in diphtheria. The name here indicates a special pathological condition, and we might expect to find a remedy Avhich would meet the larger number of cases. Unless there is a strong indication for other remedies, I prescribe this as follows: I^ Tincture of Aconite gtt. v., Tincture Phytolacca gtt. X. to gtt. XX., water .jiv. ; a leasj)oonful every hour. Hundreds of cases have been treated with these remedies alone with a success almost marvellous. Of course, the treatment n)ust be conimenccd early. If a patient's blood is saturated PHYTOLACCA. 477 with the poison, luul the tissues of the throat are l(^ster, an exceedingly valuable application. Some use the tartrate of antimony, in the form of ointment or in solution, for the same purpose; but we object to its use for reasons which will hereafter be assigned. The seton is an example of the subdivision under consideration ; as is also the issue, though it is usually commenced by the application of an escharotic. Irritating ointments, as the savin oint- ment, nitric or sulphuric acid ointment, etc., act in a similai manner. The system becomes habituated to the use of the issue and seto7i, and in consequence of their permanency they are found less efiicient than intermittent revulsives, or even those kept constantly in contact with the part, as the irritating plaster. Suppurants are resorted to mostly in the chronic phlegma- sia. In many inveterate pulmonary aflfections, chronic liepa- titis, nephritis, peritonitis, sciatica, lumbago, neuralgia, oph- thalmia, articular inflammation, disease of the brain, etc. Their influence is most apparent when purulent matter i,^ freely discharged. IV. Escharotics or -potential cauterants act chemically ; they disorganize or destroy the vitality of the part to which thev are applied. They are used to form eschars, issues, or arti- ficial ulcers; in this way they act as suppuratives, and are employed in many chronic diseases as counter-irritants. T) ey EEVULSIVES. 511 are mostly ased, liowovx^', to destroy morbid growths, cancer, tumors, to remove the callous of fistulous pipes, etc. Y. The actual cauterant is any mode of applying lieat enough to derange or disorganize a j^art. The incandescent iron, the moxa, heated vapor, liot water or other fluids, all act as actual cauterants. These agents act rapidly, and they are therefore resorted to Avhen a very powerful and speedy im- pression is demanded. They are applied in ca'',es of deep seated pains that resist milder revellents; in neuralgia they are supposed to prove beneficial by suddenly abstracting the nervous energy from the nerve afl'ected. They are also applied to bleeding vessels to arrest hemorrhages, to destroy morbid growths, etc. SINAPIS. The action of mustard as an internal remedy^ liaving been described under the head of Stimulants, we have but to speak of its topical application as a means of producing revulsion. For this purpose it is one of the most important agents in use, no agent with which we are acquainted being as certain, safe and prompt a rubefacient and topical stimulant. It is much employed in all inflammatory visceral affections, as pneumonia, pleuritis, gastritis, hepatitis, hysteritis, perito- nitis, etc., as a means of producing revulsion to the surface, and thus relieving the inflamed organ. In febrile diseases, attended with local congestions or inflammation, it is found to prove beneficial by producing a new point of excitement, thus equalizing the circulation. In low fevers, attended with torpor, coma, local congestions, etc., and in all diseases in which there is a manifest loss of nervous energy, in apoplexy, delirium, and poisoning by the use of opium or other narcotics, mustard cataplasms, by stimulating the nervous system, pre- venting congestions, etc., are found to be important adjuncts to the treatment. They are likewise valuable in the sinking 512 REVULSIVES. stages of disease for their stimulating influence over the cir- culation, aiding as they do in establishing permanent reaction. The Sinapism or mustard cataplasm, is often made with boiling vinegar, which is not the pro[)er mode to })rcpare it, as both heat and acids counteract its stimuhitin"; and rube- facient action by impairing or destroying its acrid qualities. It should be mixed with eitiier cold or tepid water, and when speedy revulsion or stimulation is not required, the pulverized mustard may be mixed with an equal proportion of corn-nical, rye-meal or wheat flour. When applied to the extremities or any part of the surface, it usually soon produces redness with a burning pain, which becomes intense if permitted to remain in contact with the surface for any considerable length of time. The size, strength, continuance and repetition of the sinapism should be determined by the extent, duration, and intensity of the disease, and by the physiological importance of the organ diseased. In cases of diminished sensibility, as in apoplexy, paralysis, typhoid and comatose states of the system, care should be taken lest by the too long application of the agent vesication, obstinate ulceration, or even sphacelus may follow. For purposes of rubefaction, the flour of the black mustard is to be preferred to the white. In cases of violent neuralgic pains, acute peritonitis, and other deep-seated })ainfnl and alarming diseases, the oil of turpentine or tincture of capsicum is sometimes first a])i)lied to the surface or added to the sinapism, in order to increase its excitant and revellent action. OLEUM SINAPIS. The volatile oil of mustard is powerfully acrid and rube- facient, and is ca})ablc of inducing speedy vesication. The vapor which it exhales is exceedingly pungent, causing a co- pious flow of tears and violent sneezing. AVhen applied to the sound skin, it produces a violent burning sensation, with intense redness and vesication. It has been considerably used in Germany as a vesicatory. As a rubefacient thirty drops should be dissolved in a fluid ounce of alcohol, and rubbed over the affected part, or strii)s of linen should be dipped in it and applied to the skin, and allowed to remain until dry; or six or eight drops maybe ARMOKACIA. 513 mixed with u lliiid drachm of either olive or almond oil, and ii!?ed in the same way. The strength of the application and the mode of employing it, should be determined by the thick- ness of the skin and the normal or diminished sensibility of the surface. It has been mixed with mucilage of gum arabic or some demulcent, and taken in doses of one-sixth of a drop in cases of colic. In over-doses it acts as an acrid poison, })roducing gastro-enteric inflammation. CAPSICUM. Cayenne Pepper, fully described under the class of Stimu- lants, is a valuable rubefacient and topical excitant. For this j)urpose the powdered capsicum may be applied as a poultice, or sprinkled upon emollient cataplasms, or upon the mustard sinapism when a more pungent or certain rubefacient is re- (juired. In cases of extreme torpor, as in cases of deep coma occurring in the advanced stages of typhus fever, when the mustard proved unavailing, we have found the Capsicum an important auxiliary. The tincture may be applied by means of friction to the part previous to the application of the mus- tard or some other cataplasm, or it may be simmered in vin- egar and that applied, or it may be mingled with the mustard. It often affords much relief in rheumatism, neuralgia, and local inflammatory affections. It is a certain and speedy ru- befacient, devoid of tiie danger of producing deep-sloughing ulcers when applied as a derivative and topical excitant, as is the case with the mustard in cases of great insensibility. AKMORACIA. Horseradish is often used as a rubefacient, the scraped or grated root being applied to the feet and ankles, wrists, etc., as a revulsive in cerebral congestions, apoplexy, phrenitis, etc. In cases of local inflammation it is employed as a revulsive. When applied to the surface, it causes rubefaction and in- tense pain, and if permitted to remain on for any considerable length of time, vesication may result from the prolonged contact. The bruised or grated roots and wilted leaves are applied as draughts to (he feet in febrile diseases. 33 514 REVULSIVES. LIQUOH AMMONIA FORTIOR. This solution of Ammonia acts promptly as a rubefacient, vesicant and caustic. It is too strong for use without a reduc- tion ; it is employed as a rubefacient and vesicant in the form of the Linimentum Ammonlse Compositnm, and Dr. Gondret's Vesicating Ammoniacal Ointment, which see under the divis- ion of vesicants. LIQUOR AMMONITE. The antacid, stimulant and sudorific properties of the Aqua Ammonite have been noticed elsewhere. Its rubefacient action remains to be considered in this place. It is an active rube- facient, and as such is employed in deep-seated rheumatism, in neuralgia, deep-seated pain and inflammation, spasm of the stomach or bowels, cramps in the extremities, local pains, sprains, bruises, etc., in the form of the Linimentum Ammo- nise or Linimentum Ammonise Compositum. Aqua Ammo- nise acts locally as a corrosive irritant, causing redness, ves- ication, or e\^en ulceration or an eschar, if the strength of the solution and duration of contact be sufficient to cause these latter eifects On account of its speedy action as a vesicant, it is occasionally em[)loycd in sudden attacks of inflammation of internal organs, the result of retrocedent gout. Linimentum Amnionice. — Solution of Ammonia Sj. ; Olive Oil, .jij. Mix. This is a popular rubefacient, much used in local inflammatory diseases, as angina, rheumatism, neuralgia, etc. It is to be applied by gentle friction, or by means of flannel saturated with it and placed upon the affected part. The Dublin College directs equal ])arts of each. OLEUM TEREBINTHINJ^. Oil of Turpentine merits a passing notice under the divis- ion of rubefacients, although its general properties liave been discussed under the head of Stimulants. It is a valuable local application in a great variety of cases. Neuralgia, chronic rheumatism, angina, gout, deep-seated painful affec- (ions, pleurisies, puerperal peritonitis, enteritis, etc., are a f«)w ESSENTIAL OILS. 515 among the many diseases in which the turpentine proves a valuable rubefacient. Rubbed either hot or cold upon the extremities in febrile diseases of an adynamic kind, it contributes much toward arousing the organic actions, localizing the excitement, and restoring the patient to a state of consciousness. OLEUM CAJUPUTI. The Oil of Cajuput, already described, is a valuable topical stimulant and rubefacient in chronic rheumatism, neuralgic pains, sprains and deep-seated painful aifections. When com-, blued with sweet oil, it constitutes a valuable application in' parotitis and other cynanchial affections. ' When applied to a carious tooth it often affords relief in cases of toothache. It is useful in paralysis, employed both as an internal agent and locally. It possesses powerful antispasmodic qualities; it is also a diffusible stimulant and sudorific. For a further description of its therapeutic uses, the reader is referred to Antispasmodics OLEUM MONARD^. The Oil of Monarda, elsewhere noticed, acts powerfully as a rubefacient, quickly inducing heat, redness, pain, and even vesication. It has been employed in typhoid fevers, conges- tive and inflammatory conditions, cholera infantum, rheuma- tism, deep-seated pain, spasm of the bowels, etc., when an active rubefacient is required. For ordinary purposes it should be diluted with sweet oil, alcohol, or some other agent, before it is applied to the surface. The Oleum Cinnamoni (Oil of Cinnamon), Oleum Piperis (Oil of Black Pepper), Oleum Mentha Piperita and Viridis (Oils of Peppermint and Spearmint), Oleum Rosmarini (Oil of Rosemary), Oleum Hedeomee (Oil of Pennyroyal), Oleum Lavandulae (Oil of Lavender), Oleum Sassafras (Oil of Sas- safras), Oleum Succini (Oil of Amber), Oleum Gaultherise (Oil of Wintergreen), Oleum Caryophylli (Oil of Cloves), Oil of Hemlock, and some other essential oils not enumerated in 51G EEVULSIVES. the foregoing list, are occasionally employed as rnbefacieuts. They are combined together, with camphor, alcohol and other substances, and are applied to the surfiice in rheumatic and neuralgic affections, local painful disorders, etc. Some of them are very efficient rubefacients. ^THER SULPHURICUS. Sulphuric Ether, when applied to the surface, acts as a ru- befacient, if evaporation be repressed, and even vesicates in some cases; it also acts as a refrigerant, when applied to the surface, being mostly employed to produce cold by its speedy evaporation. For this purpose it is applied to strangulated hernia to facilitate its reduction, and upon the head in cases of headache, and in inflammatory and congestive states of the brain. When applied to the surface, and the parts quickly covered with a compress, it acts as an irritant, producing red- ness and a highly excited state of the superficial capillaries, and if long-continued vesication follows. When applied with friction, it acts as a topical stimulant. Its general properties are described under Stimulants. ALLIUM. Allium Sativum, or Garlic, already described, is applied to the surface as a topical irritant, rubefacient and revulsive. It is mostly applied to the feet in diseases of the head or thorax. It is sometimes applied as an antispasmodic embrocation in infantile convulsions, its juice being combined with olive oil or some other agent, or it may be simmered in dilute alcohol. It is also employed as a resolvent to indolent tumors, and the juice sometimes dropped into the ear in cases of earache. ALLIUM CEPA. The Onion in its effects upon the system is similar, though milder than garlic. It is much prized as a mild esculent vegetable,-its acrid volatile oil being dissipated by boiling. i The raw onion is applied to the feet as draughts. It is also, ai)plied as a poultice in cases of the bite of the rattlesnake, it being believed to possess antidotal qualities. The roasted or CUPPING. 517 boiled onion constitutes a valuable poultice, a])plictl to suppu- rating tumors, local inflammations, in cynanche, earache, sup- pression of urine, etc. CALORIC. Heat when applied to the surface, at a temperature of from 120° to 150° Fahrenheit, acts promptly and powerfully as a rubefacient. Pediluvia, semicupia, fomentations, lieated vapor, etc., act efficiently as revulsives. Mustard, salt, and some- tiuics other stimulants, as alcoholic liquors, are added to the water to increase its topical excitant action. In deep-seated pain, eitlier neuralgic, rheumatic, or spasmodic, heat often affords great relief by its active derivative powers. A great increase of nervous and vascular excitement takes place to the })art to which it is applied, consequently the pain and local in- flammation abate. Either dry or moist heat, when applied to the surface, acts as a general excitant, and is adapted to the re- lief of depressed states of the vital forces, internal venous congestions, etc. FRICTIONS. Friction with the flesh-brush, coarse towel, dry hand, etc., exercises an important derivative influence in many diseases, both of an acute and chronic character. It often proves highly serviceable in dropsies by promoting absorption. In glandu- lar enlargements, indolent tumors, rheumatism, neuralgia, dys- pepsia, and in many otlier instances, it proves eminently ser- viceable by virtue of its derivative power, and by changing morbid action existing in the vessels of the parts diseased, and by exciting them to a new action, and also by promoting that of the absorbents. Much of the benefit ascribed to the use of various embrocations is dependent upon the friction em- ployed in its application. CUPPING. Di-y cupping is one of the most important revulsives in many cases that can be named. It acts j)roraptly and power- fully as a derivative, causing speedy rubefaction. The capil- laries of the part to which the cups are applied become speed- 518 EEVULSIVES. ily injected, thus clearly showing the therapeutic value of the application. Dry cupping is particularly indicated in deep- seated congestions — in abdominal or thoracic, and likewise in cerebral ; it is also an effectual mode of relieving visceral in- flammations. In abdominal and portal congestions occurring in fevers, the relief which we have often seen immediately follow the application of cups is truly sui'prising. 0])htlial- mia, phrenitis, pleuritis, pneumonitis, hepatitis, neplirltis, etc., are among the phlegmasial diseases in which the use of dry cups will be found useful. Dropsical effusions and hypertrophled organs or parts, are often relieved by their employment. In rheumatism, deep- seated neuralgia, and many other affections of a local character, they are advantageously employed. The use of the scarificator, associated with the cupping, is a therapeutic measure of still greater efficiency in many cases ; possessing, as it does, all the derivative powers of the former, with the topical depletive effects of the latter. By this pro- cess the capillaries of the inflamed or congested parts, or those contiguous, are unloaded, and undue repletion counteracted. It is a measure of great efficacy in local inflammations and congestion. It is appropriate in all the cases to which dry cup- ping is applicable. It is often of great utility in old indolent and callous ulcers , for removing the indurated state of the ulcer, by breaking up and promoting the absorption of the callous structure, and by exciting the vessels involved in the ulcerative process to a renewed and healthy action. In this way some of the most obstinate and protracted ulcers are re- lieved in a short time, very simple dressings being all that are required to complete the cure; and in other cases, com])rcsses may be applied and kept constantly wet with cold water as an additional curative measure. In cases of local poisoning by the bite of a rabid animal, rattlesnake, etc., an immediate resort to the scarificator and cups affords a fair prospect of relief To be beneficial it must be resorted to before the poison has I)een absorbed into the sys- tem. In disordered states of the spinal cord, dry cups or cups conjoined with the use of the scarificator, are often available; and in many chronic affections, such as enlargements or indu- rations of the liver and other simihir diseases, the employment BURGUNDY PITCH. 519 of the scarificator and cups, preceding tlie application of tlio irritating plaster, will be found to contribute much to the speedy and (efficient action of that Important application. ACUPUNCTURE. Acui)uncture consists in the introduction of polished sharp- pointed needles into the muscular tissue. The needles are to be headed with sealing-wax, in order to give the operator better control over them, Avhen they are to be rotated be- tween the thumb and finger, at the same time making pres- sure so as to gradually introduce them from half an inch to one inch into the muscular structure, where they are allowed to remain from twenty minutes to one hour. In this way from three or four to half a dozen may be inserted at the same time. The needles are sometimes medicated before introducing them° by dipping them into a solution of the salts of morphia, ex- tract of Aconite, Hyoscyamus, etc. Acupuncture acts as an especial and powerful excitant, de- rivative or revellent. It is employed in lumbago, sciatica, rheumatism and deep-seated chronic aifections ; also in ner- vous disorders, such as spasmodic and convulsive diseases, asphyxia, paralysis, amaurosis and other forms of neurosis, etc. In many other chronic affections of a kindred character, wlien the object is to produce a si)ecial excitant and revellent influence, acupuncture is employed with advantage. FIX ABIETIS— FIX BUFGUNDICA. Burgundy Fitch is applied to th.e skin as a topical stimu- lant or gentle excitant and rubefacient. It causes a slight in- flammation, which may bo attended with serous effusion with- out vesication. It is said sometimes to occasion vesicular eruptions and even severe poisoning, followed by violent pain, iumefaction, redness and even ulceration. It is employed mostly in slight chronic affections, as in pain and weakness in tiie chest, side, back, loins, etc., and to the joints in articular diseases of a chronic character, chronic rheumatism, etc. AVhen long employed it acts as a feeble counter-irritant and revulsive. . 520 REVULSIVES. Empkistrum Pieis. — Pix Burg, ibiss., Resin and Beeswax, of each, .^ij.. Oil of Mace gss., Olive Oil ,5j., water .5j.; liquefy the pitch, resin and wax, with a gentle heat; add the other articles; mix, and boil to a proper consistence. This plaster acts as a stimulant and rubefacient, and is ap- plicable in chronic pectoral affections, chronic disorders of the liver, chronic rheumatism, etc. Empkistrum Picis cum Cantharides. — Pix Burg, tlbiijss., Cerate of Spanish Flies tbss. ; melt together by means of a water-bath, and stir constantly while cooling. This is an excellent rubefacient, more active than the Bur- gundy Pitch, and applicable to all cases requiring the use of a topical excitant and rubefacient, as rheumatism, catarrh, asthma, phthisis, hepatitis, and the sequelse of pneumonitis and pleuritis. PIX CANADENSIS. The Pitch furnished by the Hemlock Spruce of the United States is often employed as a plaster in the same cases in which the Pix Burgundica is used. It acts as a gentle rubefacient and topical excitant. It is used in chronic pulmonary affec- tions, chronic hepatic diseases, lumbago, and in many other cases requiring the use of gentle stimulating and rubefacient applications. It is frequently applied to weak parts as a strengthening plaster: its utility, however, depends upon its excitant and rubefacient action. R E S I N A. Rosin, or common resin, is much used in tiie formation of ])lasters and ointments, which it renders highly adhesive and slightly stimulant. It is the princi[)al ingredient in numerous stimidating, rubefacient and adhesive plasters. Other agents, as caj)sicum and soap, arc often associated with it when used as a plaster, in order to increase its to[)ical excitant action. The various plasters used, said to impart strength in cases of local weakness, afford benefit by their ru- befacient and topical excitant action. CANTilARIS. 521 ACIDUM ACETICUM. /I Acetic Acid, ap[)lled to the skin, acts as a ruberaciciit and vesicant. Equal })arts of Acetic Acid and water, ap[)lied on linen or cotton, will act as a rubefacient. Heated vinegar Is often applied to the surface as a rubefacle.nt, although much less efficient than the acetic acid. ACIDUM NITRICUM. Nitric Acid, when diluted with six or eight times the quan- tity of water, and applied to the surface, excites rubefactlon, and has been used for that purpose in cholera, spasm of tlie stomach and bowels, and In other cases requiring active levulsives. ACIDUM SULPHURICUM. Sulphuric Acid may be used like the nitric to cause rubefac- tlon. It should be largely diluted, lest its causticity be so great as to cause vesication, or even ulceration. E P I S P A S T I C S. Epls[)astics, or Vesicants, are those topical applications which cause rubefactlon when applied for a limited time, in- flammatiou and vesication when longer applied, and If the duration of the application be sufficient, suppuration or slough- ing of the cutaneous surface may follow. CANTIIARIS. THEitAPEUTiC Action. — Cantharldes are vesicant, rubefa- facient, stimulant, irritant, diuretic, and cmmenagogue. When swallowed they act on the gastro-intestinal membrane as an irritant poison ; if the quantity be sufficiently great, causing inflammation of the mucous membrane, with constriction and difficulty of swallowing, and even an arrest of the process of deglutition. A burning pain In the stomach, nausea and vom- iting follow, with tenderness of the abdomen, violent griping and i)urglng, the stools being bloody, with ptyalism. They .afixict prominently the urinary organs, causing nephritis, cysti- tis, and urethritis, Avlth pain in the hypogastric region and 522 KEVULyivES. loins, a constant and nrgent desire to void urine, with inability or great difficulty of doing so, the urine })assing drop by drop, priapism in the male, perhaps satyriasis, and in the female heat and irritation of the genital organs, and in some cases abortion. Applied to the surface they occasion heat, pain^ redness, with serous effusion and vesication. If long continued, or if the vital powers be weak, as in typhoid conditions, ulceration and even gangrene often follow. Gangrene is quite liable to follow their application in exanthematous diseases, particularly In measles. As internal agents, cantliarides are exhibited with a view to their specific action on the urinary organs. Passive dropsies, diabetes, paralysis of the bladder, inconti- nence of urine, are diseases in which they occasionally afford advantage. They are employed for their specific excitant ac- tion upon the uterus, in amenorrhcea dependent upon a torpid state of the uterine vessels. In some cases abortion follows their use. They are also prescribed for their aphrodisiac powers, for which they enjoy some repute. To produce rubefactlon, the common vesicating plaster may be applied for a limited time and then removed, or the tincture may be combined with soap or camphor liniment. These ap- plications are employed in paralysis, neuralgia, rheumatism, numbness, and Insensibility, to excite the skin and arouse the sensibility, as well as for their revellant action. Used in the manner stated, the plaster is often of much utility in the inflammatory diseases of children. As a vesicant, no agent of the materia mcdica is so much used, nor is there any one so available under all circumstances as the Cantharides. Blisters afford relief, it Is believed, principally by their derivative action. We can not, however, yield the position that they do not afford, In many instances, great benefit by their topical depletive action. By establishing a new secreting surface, and by keeping up a constant drain from the neighbor- hood of affected parts, it Is believed the discharge itself. Inde- pendent of the revellent action, will do much toward relieving the engorged vessels of the affected region, and thereby pro- mote a new and healthful action in (he diseased parts. As derivatives, blisters are esteeiued Imjiortant in a great variety of diseases, by creating an afflux of the nervous en- MEZEREUM. 623 ergy and circulating fluids to the scat of their immediate action. In this manner they relieve irritation or intlammation of the internal or"ans. They are much used in both acute and chronic inflammations. In inflammatory diseases they are not applicable (unless it be in cases of emergency) until after the activity of the excitement has been subdued by ai)propriate means, such as purgation, diaphoretics, ablutions, etc. RANUNCULUS BULBOSUS Crowfoot, if swallowed in its recent state, is a [)()\verful acrid, causing severe pain and inflammation of the stomach. It is not used, however, as an internal agent. Ap[)lied to the sur- face it causes inflammation and vesication, for which ])urpose it was much used previous to the introduction of tlie Spanish fly into general use. The uncertainty or inefficiency of its. action in many cases, and the severity with which it acts in others, causing, as it does, extensive inflammation, followed by deep and obstinate ulcers, has banished it from general practice. JUG LANS. The medical properties and uses of the Butternut have been elsewhere fully described. The active powers of the inner bark as a rubefacient and vesicant justly entitle it to a special notice in this place. The finely scraped inner bark, the bark being quite fresh, applied to the surface, will act promptly and efficiently as an epispastic. The parts being previously rubbed with heated vinegar will greatly facilitate the action of this as well as other vesicating agents. It may be necessary to moisten the bark if it does not possess a sufficient degree of moisture. MEZEREUM. The medical properties and uses of the bark of Mezereon have been fully described in another part of this work. In 'this place we shall extend to it but a passing notice as a topical agent. Mezereon is endowed with a high degree of acridity, and when applied to the surface in its recent state, it is followed by redness, irritation, inflammation, and vesication, for which 524 EEVULSIVES. ])ui'[)ose it has been used in the southern parts of Europe from time immemorial. The dried bark acts in a simiUir manner, but it is less active. ANTHEMIS. Anthemis Cotula, or May Weed, wlien bruised and applied fresh to the skin, occasions redness, inflammation, and in some cases vesication and even ulceration. It is to be confined to the surface by means of a compress. Even fomentations of the article occasion the same results in cases of great suscepti- bility of the skin to the action of acrids. It is seldom used for purposes of the kind. In cases of emergency it may be employed as a derivative. DIRCA. The bark of Dirca Palustris, Leatherwood or Moosewood, is said by Edwards and Vavasseur, in their " Manual of Ma- teria Medica," to act as an epispastic, when applied to the skin. Others make mention of its possessing the same pro[)erties, but say it is slow to act. SUPPURANT REVELLENTS. Suppurant Revellents are those topical applications whose effects extend to the sub-cutaneous tissues; in other words, tliey occasion a deeper inflammation than blisters. They establish a permanent or more [)rotracted revulsive impression and produce and maintain a purulent discharge from tlu; part to which a|)plied ; such is the case with the Perpetual Blister, Irritating Plaster, Crotou Oil, Setons, Issues, etc., although the latter consists in a slough or eschar formed by the ap|)li- cation of escharotics or the potential cautery, to be noticed under the next division of Derivatives. Although formed by the use of the potential cauterant or escharotic, yet, in its effects, it acts as as a suppurant revellent. SUPPURANT EEVELLANTS. 626 EMPLASTRUM PICIS COMPOSITUM. I^ Tar ilbiij,, Buvgimdy Pitch ftjss., Gum Turpentine, Ibj., Podophyllum, Sanguinaria, Arum, Phytolacca, aa., r)X. Boil the tar for half an hour ; then add the pitch and turpentine, previously melted and mixed ; remove from the fire, and add the other ingredients finely powdered, stirring until thoroughly incorporated. In using it, it is warmed and spread with a knife or spatula upon soft leather, and is applied warm, so that it will adhere. It is usually renewed once a day until suppuration is estab- lished; if much inflammation is produced, the ])laster is re- moved, and the parts covered with a cloth oiled, or spread with a simple cerate or cataplasm of ulraus fulva, or bread and milk may be used. Water is never applied to the suppurating surface, the pus being removed by using a soft cotton cloth. Of all the suppurating modes of revulsion, none, so far as our acquaintance extends, bears more than a feeble compari- son to the agent which heads this article. Although it may not act so early after its application as some other agents in use, vet the permanency and efficiency of its action, and its ■great alterative, derivative and topical depletive powers ren- der it justly one of the most important therapeutic measures to which the physician can resort in an extensive train of chronic inflammatory afl'ections. In some instances it requires the renewal of the plaster from day to day for several days before the desired action upon the part is manifested. When it acts, it causes super- ficial inflammation, establishes a new secreting surface, which discharges large quantities of purulent fluid. In chronic bronchitis, chronic laryngitis, catarrhs, phthisis, chronic hepatitis, splenitis, nephritis, etc., as a derivative and permanently sanative agent, it is unsurpassed, if, indeed equaled, by any other agent, whether topical or general. Its influence is positive and unmistakable in most cases. It acts powerfully as a derivative ; its influence extends to deep-seated parts, modifying the action of the capillaries, thus subverting morbid action, and consequently subduing disease. In chronic peritoneal inflammation it is a valuable remedy. In visceral enlargements or indurations, chronic glandular diseases, chronic 526 REVULSIVES. articular rheumatism, and in indurations and enlargements of the ligaments of joints, etc., its value is great. It acts not only as a derivative and suppurant, but also as a resolvent and discutient. Much of its utility in chronic pectoral and visce- ral disorders arises undoubtedly from its alterative influence upon the system, its active principles being absorbed into the circulation. It requires no great stretch of the imagination to believe that the active principles of agents so potent as those entering into its composition are capable of exerting a powerful alterative influence upon the different tissues of our bodies when a morbid condition exists. If the surface becomes very irritable, highly inflamed and painful, emollient poultices, cloths imbued with mucilages, sweet oil, mild ointments, or salves may be applied until the irritation is lessened, when the plaster may be applied again- The dimensions of the plaster should in all cases correspond with the extent of surface or importance of the organ involved in diseased action FONTICULI, OR ISSUES. An Eschar or Slough is formed by the application of either the actual cauterant, escharotics, or potential cauterants. The caustic potassa is probably more frequently used for this pur- pose than any other agent belonging to the division of poten- tial cauterants or escharotics. It combines chemically with the fibrin and albumen of the part by virtue of its affinity for those elements, and consequently causes disorganization by destroying the vitality of the animal fiber. Other caustic or escharotic agents may be used to accomplish the same end, as we shall state when we come to notice the next division of revellents or potential cauterants. Though formed by escha- rotics, yet the issue in effect is a suppuraut revellent. Issues are also formed by the ap[)lication of a small blister to a given part, and upon the blistered surface a small round ball or irritant substance is confined by means of a compress and roller in order to maintain constant irritation and induce suppuration. For this purpose tlie small green fruit of the orange, known as the orange l)i.M-rIes {bacccc aurnntii or issue 'peciH of the shops), after being di'ied and smoothed in a latiic, are employed. A small section of the Iris, Acorus, or Piiyto- OLEUN TIGLTI. 527 lacca, may be used for the same purpose. Their curative powers (lepeutl u[)ou their protracted derivative influences, and upon the discharge of purulent matter. Next to the irritating- [)laster we esteem the issue the most important and valuable of the suppurative revellants. Al- though its formation occasions intense pain, yet the pain is less, taking the whole course, than that resulting from the irritating plaster and most other agents. It is a powerful measure of revulsion. In chronic ophthalmia an issue upon the nape of the neck is often productive of great good. In chronic pectoral disorders, enlargements or indurations of the abdominal viscera or other organs; in chronic rheumatism, sciatica, hip-joint disease, white swellings, caries of the verte- bra, neuralgia, etc., we have found issues among the most im- portant curative measures. Apoplexy, epilepsy, chorea, spas- modic asthma, phthisis, hepatitis, etc., are benefited by the dis- charge of pus as well as derivative action. By the conversion of an old obstinate or indolent ulcer into an eschar, a cure is often effected. As a measure of revulsion, the issue is bene- ficial in diverting excited or morbid action from parts affected. When the discharge from ulcers that have been open for a long time is checked, or when chronic eruptive diseases have receded to internal organs, an issue is important for the purpose of establishing an artificial drain, as well as derivative action, as a substitute for that which has ceased to exist. For directions for forming issues, see Caustic Potassa under the next division. OLEUM TIGLII. Rubbed on the surface, Croton Oil causes rubefactiou, and a vesicular or pustular eruption, and in some instances an ery- sipelatous swelling. Owing to the pustular eruption which it occasions, it is employed as a suppurant revellant to relieve diseases of internal organs. It is often employed in diseased states of the respiratory mucous membrane, as phthisis, chronic bronchitis, laryngitis, asthma, pertussis, aphonia, glandular swellings, rheumatism, gout, neuralgia, spinal irritation, otal- gia, chronic hoarseness, and sundry other chronic affections. Although sometimes used without dilution, it is more frequently combined with other agents, it being mixed with twice or thrice 528 KEVULSIVES. « its volume of alcoliol, ether, sonp liniment, turpentine, olive oil, or some other suitable vehicle. It may cause purging, which is an ohjection to its use. It is mihl and somewhat uncertain as a suppurant revellant, and possesses no advan- tages, indeed is far inferior to the common irritating plaster, as well as other agents belonging to this class. In infancy or childhood it possesses the advantage of being less severe than some other suppu rants, but in other respects it is inferior to them. PERPETUAL BLISTER. The Perpetual Blister consists in the re-applicatiou of the ordinary blistering cerate, from time to time, so as to maintain a constant and protracted discharge. The same result may be secured by dressing the blistered surface with an ointment made of the Cantharides in reduced quantity, or by dressing it with the Savin ointment. This is a mild but quite efficient mode of maintaining a derivative action, and well adapted to the relief of chronic pleuritis, peritonitis, hepatitis, bronchitis and other chronic inflammatory aifections, such as rheumatism, and stirronnded with several thicknesses of linen. When ap- |»lii'd to the part, it is set on fire at the top, and the heat and |»:iin increase as combustion extends downward. The Moxa is employed as a counter-irritant or derivative, and is considered appropriate in chronic diseases attended with lesions of sensation and motion. It is also resorted to as a means of counter-irritation in cases of deejv-seated chronic in- flammation, as of the spine, and in neuralgic affections. 536 SPECIAL THERAPEUTICS. DIVISION VI. OLA^SS XIII ASTRmGENTS. Astringents are remedies which, when brought into con- tact with any portion of the body, cause a contraction or condensation of the tissues. They have been supposed by most writers to exert their influence exclusively upon mus- cular fiber; and hence, to account for their action in all cases, they have asserted that this tissue exists in parts in which anatomists have never been aole to detect it. All living tissues have a certain degree of cohesion and conden- sation, by which they are enabled to perform their various functions in the body. The loss of this, in diseased states, unfits them for the proper performance of their functions. This cohesion is caused by the stimulus of the blood when in a normal condition, and the influence of the nervous system. Action of Astringents. — Astringents have a double action on animal tissues ; they have both a chemical and dynamical action. All the vegetable astringents have the chemical property of coagulating albumen, as also have the mineral agents. This action, however, will not explain their cft'ect upon the living body, for they could not combine with it to any great extent, without causing an entire loss of vitality. As long as the vital force is in action, it opposes these chem- ical reactions, and when chemical laws gain the ascendency in a part, they destroy life in it. The dynamical action of those agents it is impossible to explain ; Ave know that they will cause a condensation of any tissue with which they are ASTRINGENTS. 537 brought in contact, and we have to be satisfied with a knowl- edge of the fact, and admit that the cause is beyond our reach. Astringents are used both as topical and as internal reme- dies. Their topical effect we have already noticed — they cause constriction of any and all tissues with which they are placed in contact. The majority of these remedies are soluble in the fluids of the body, and when administered, are absorbed, and conveyed by the blood to the parts upon which they tend to act — their action in this case being simi- lar to that produced when locally applied. Therapeutic Application. — The therapeutic application of this class of agents is confined principally to excessive mor- bid discharges, and to weakened and relaxed conditions of particular parts. They are often prescribed in hemorrhages of different kinds, as hemoptysis, hematemesis, hematuria, menorrhagia, etc.; but they are more particularly recom- mended in hemorrhages of a passive character. When there is an atonic state of the vessels, the blood escapes by trans- udation through their relaxed walls; these agents increase the cohesion and condensation of the walls of the vessels, and thereby arrest it. In active hemorrhages, when connected with either a phlogistic or plethoric habit, their use is less apt to prove salutary, for they tend to increase the inflam- matory condition. If an important organ is under an intense inflammation, it is evident that astringent medication must prove highly objectionable. Under such circumstances, if an active hemorrhage has occurred, the more active of this class of agents should not be used unless combined with sedatives. But it is always advisable to moderate the in- flammatory condition of the system by the use of hydragogue cathartics, anodynes, diaphoretics, sedatives, and revulsives, before resorting to their use. In passive hemorrhages, no such preparatory measures are required; astringents maybe administered at any time, and their employment will prove highly satisfactory. In excessive mucous discharges they are very frequentU^ and extensively employed with great advantage. Among the various diseases of this character which may be named, arc diarrhea, dysentery, leucorrhea, etc. In these diseases, 538 SPECIAL THERAPEUTICS. if there is active inflammation, with much febrile excitement, their use will be highly improper. This is especially the case in dysentery ; in this disease the vitiated accumulations in the upper parts of the intestinal canal should be removed, and the morbid sensibility of the bowels subdued, as well as the high grade of inflammation and febrile excitement, be- fore they are administered. If this is not done, they in- crease instead of relieving the disease. They are used with much advantage in diarrhea resulting from debility or chronic irritation; when it arises from acute inflammation, however, they are contraindicated. Leucorrhea is another disease in which there is generally a relaxed or atonic condition of a local or specific character, and not unfrequently connected with an enfeebled condition of the whole system. In the three diseases of the mucous membrane last named, this class of remedial agents, if prop- erly selected, and properly timed as regards the intensity of the local or general excitement, will often prove singularly efficacious. They seem to condense the atonic fiber, diminish the size of the morbidly enlarged capillaries of the diseased parts, impart tone and vigor to the weakened and relaxed tissues, and in this way arrest the debilitating discharge. They act as topical tonics, and in local debilitated conditions like the preceding, they are of no small importance as aux- iliaries to the use of tonics. Astringents have also been used with much advantage in diabetic aflections, in conjunction with emetics, hydragogue cathartics, stimulating diuretics, tonics and counter-irritants. By the use of the latter agents we arrest morbid associations, and direct the vascular and nervous afflux from the kidneys, and fix it alternately upon diflferent points, or divide the ex- citement between difl[erent organs, and thus relieve the kid- neys of the undue burden imposed upon them; while the astringent, being carried by the blood to the kidne3's, and being excreted through them, constringes the weakened ves sels, causes a condensation of the tissues, and thus dimin- ishes the excessive product of the abnormal renal action. In irritation or chronic inflammation of the bronchial mu- cous membrane, and even in phthisis, attended with coi)ious and debilitating expectoration, connected with general ASTRINGENTS. 539 debility unci colliquative sweats, astringents of a mild and sedative character, or even the more active ao;ents of this class, when combined with sedatives, frequently prove of much advantage. They diminish the excessive debilitating discharges, and thus sustain the vital energies of the system. In night-sweats not dependent upon any pulmonic affection but arising from some other local and chronic disease, or from general debility induced by a protracted course of some acute disease, astringents constringe the atonic cutaneous exhalants, and arrest the profuse discharge. Astringents are very frequently employed as topical agents. They are used in gonorrhea after the acute inflammatory symptoms have been subdued by other measures; if they are resorted to in the early stages, before a suitable preparatory course of medication to lessen the inflammation, they often aggravate the disease, and often produce chordee, strictures, orchitis, etc. If the milder and less irritating astringents are used, in conjunction with, anodynes and demulcents as injections, they will in many cases afford great relief, and exert a decidedly sanative influence over the disease. Ophthalmia is another local affection in which they are used with occasional benefit. In the chronic form of this disease, after the pain has abated, and when the capillary vessels are left in an atonic condition, mild astringent col- lyria may be resorted to with a fair prospect of restoring the relaxed vessels to a healthy state, and arresting the profuse secretion. They will, however, prove highly injurious, if employed during the early stages of the inflammation ; in this stage mucilaginous and sedative colly ria, with emollient poultices, together with hydragogue and refrigerant cathar- tics, revulsives, etc., are most important. . In apthce, in the anginose affections, as angina maligna, scarlatina maligna, or in any variety of angina, after the acute stage of inflammation has been moderated, they have proved useful. In all cases where there is extensive ulcera- tion with a tendency to putrescence, the vegetable astringents are of unquestionable importance. They act as topical tonics and antiseptics, and should be freely used, either in conjunction with stimulants, or without them, as the case may seem to demand. They may be used in relaxation of 540 SPECIAL THEEAPEUTICS. the palate and elongation of the uvula Avith advantage. They are employed either in powder or as a gai'gle. Astringents are also used as topical applications in pro- lapsus uteri, and prolapsus ani. In these cases they seem to condense the relaxed tissues, and arrest the abnormal mu- cous secretion resulting from the relaxation. Prolapsus uteri, in a large majority of cases, is dependent upon a loss of tone and relaxation of the vagina, and by using these agents in combination with tonics as vaginal injections, wo give tone and strength to this canal, and remove the disease. The injections should be used three or four times a day, and employed cold if the condition of the patient is such that they can be used in this way. They also claim our attention as curative agents in hernia. This disease always arises from a weakened state of some particular portion of the abdominal parietes. The im- portant indication to be fuliilled is to harden and condense the weakened tissue, in order to enable it to oppose the necessary barrier to the advancing abdominal contents. This opposing force is sometimes acquired by the frequent application of strong vegetable decoctions to the part, or by the use of plasters made of some of the most energetic as- tringent extracts. They are important in the treatment of old, irritable, flabby and ill-conditioned ulcers. They are frequently ap- plied in the form of a lotion to the ulcer, and at the same time as a poultice. They may be pulverized and mixed with the ulmus or althffi, and made into a poultice by simmer- ing in milk, or even in water; or a strong decoction may be thickened with the ulmus, or with wheat or i-ye flour. They give tone and renewed vigor to the weakened vessels concerned in the ulcerative process,' and increase the strength of the granulations. Their general external application in the form of baths, yet remains to be noticed. The extensive use which we have made of them in this form, and the happy results which have attended this mode of employment, have given us a very high opinion of them as external medicaments. In adynamic fevers, and, indeed, in the advanced stages of all fevers, wlien there is extreme debility, they may be freely ASTRINGENTS. 541 applied to the surface, by bathing, with great advantage. When there is great prostration of the vital powers, attended with profuse and exhausting colliquative sweats, and when the most potent stimulants and tonics fail to maintain the sinking powers of the system, we may then resort to astrin^ gent decoctions — either alone or in combination with stimu- lants — and apply freely and frequently to any part of the surface with brisk friction, with great advantage. They constringe and give tone to the cutaneous capillaries, and sudoriferous glands and ducts, and thus arrest the exhaust- ing sweat ; and their influence, conjoined with the brisk friction applied to the surface, frequently arouses the sinking energies of the system, and efiects a reaction, which, if main- tained by other medicine, may often result in a cure ; and often an important cure may be ascribed to astringents thus used. In many chronic diseases they are also of great importance when used in the same way. In marasmus, tabes mesenterica, phthisis imlmonalis, scrofula, in dysjyejjsia when of an obsti- nate character, in chronic rheumatism, and in many other chronic diseases, especially if attended with great debility and emaciation, a strong decoction of white oak or hemlock bark, applied once or twice daily, or two or three times a week, with brisk friction, will prove a powerful auxiliary measure in the cure of these very obstinate diseases. Spirits may be added to the astringent bath, or the alka- line bath may occasionally precede it. These modifications and changes will frequently give increased value to the ap- plication. It seems to be a very powerful and valuable mode of medication. It lessens excessive nervous sensi- bility and irritability, by imparting tone to the entire sys- tem, and aids in breaking up morbid associations and cachetic habits. Those who have not tested the utility of this mode of employing astringents in the cases alluded to, and others analogous to them, may be disposed to under- value them, but a fair trial will convince any one of their importance. If astringents are long continued, either as internal or external agents, their general tendency is to lessen the sen- sibilities of the parts with which they come in contact, and augment their density. 542 ASTRINGENTS. QUERCUS. THE BARK OF QUERCUS ALBA, RUBRA, ET TINCTORIA — U. S. Therapeutic Action. — Oak Bark is astringent, tonic and antiseptic. The barks of the different species are similar in their medical ])roperties, and the bark of one species is often used indiscriminately for that of others; those named above, however, are most frequently employed. It is mostly used as an internal agent in passive hemor- rhages, chronic diarrhoea in which there is great relaxation of the intestinal exhalants, an atonic state of the alimentary canal, and in chronic dysentery and ulceration of the mucous mem- brane of the bowels. As a topical application we regard the Oak Bark as one of superior value in many instances. A decoction is advantage- ously em})loyed as a gargle in ulceration of the fauces, and in cases of elongation of the uvula. It is also used in leucor- rhoea, menorrhagia arising from an atonic state of the uterine vessels, and in prolapsus uteri depending upon an enfeebled state of the uterine appendages, also in prolapsus ani and bleeding hemorrhoids, as an injection and as a lotion to the affected parts. Advantage may be obtained from its external application in the form of a bath. The bath is particularly indicated in diseases of children, when a combined tonic and astringent in- fluence is desirable, and when the stomach will not tolerate the internal use of the proper medicines. GALLA. EXCRESCENCES FOUND ON THE TWIGS OF QUERCUS INFECTORIA.— ASIA. Thrhapeutfc Action. — Nutgalls, owing to the large por- tion of tannic acid which they contain, are astringent in a high degree, Galls are mostly employed for internal purposes, in cases of passive alvine hemorrhages, in chronic mucous dis- charges from the alimentary canal, arising from atony of the intestinal exhalants, and also as chemical antidotes. As a topical application, Nutgalls arc beneficial in many cases, requiring the employment of powerf d vegetable astrin- gents. They arc used as a gargle in aphtlue, ulceration of the TANNIC ACID. 543 fcUices, mercurial salivation, relaxation of the uvula, and Id a scorbutic or spongy condition of the gums. STATICE. THE ROOT OF STATICE CAROLINIANA. Prrparation. — Tincture of Statice. Dose. — From ten drops to one drachm. Therapeutic Action. — Marsh Rosemary is astringent, antiseptic, and tonic. It is a very powerful astringent, and is resorted to for that ])urposc in some parts of the country, par- ticularly in the New England States. It is employed in aphthae and ulcerated states of the month and fauces. It maybe used in passive hemorrhages from the bowels, ute- rus, etc. It may be used in night sweats arising from debility, and also in diabetic aifections. As a topical application it is by no means unimportant. As a poultice and also as a wash in flabby, ill-conditioned, fetid, or gangrenous ulcers, it is deservedly a popular remedy. It is also used as a poultice to cancers. In addition to its astrin- gency, the saline properties which it possesses undoubtedly add much to its antiseptic virtues. It maybe used as an injection in lencorrhoea, gonorrhoea, and blenorrhoea, also in prolapsus uteri, prolapsus ani, and as a wash in bleeding piles. ACIDUM TANNICUM. Dose. — From three to twenty grains. Therapeutic Action. — Tannic Acid is one of the most powerful astringents of the materia medica ; it coagulates albumen and causes condensation of all tissues with which it is brought in contact. This agent is much employed to check profuse discharges from the bowels. In diarrhoea, when no inflammation of the bowels exists, it may be given with advantage; in fact, owing to the smallness of the dose, it is ])referable to most other agents. In hemorrhage from the stomach and bowels, it is one of the most efficient agents that can be employed. But we con- sider it to be a waste of time to employ it as an astringent in hemorrhage from the lungs, uterus, kidneys, etc., as before it could prove of advantage it would have to be absorbed. 544 ASTRINGENTS. ACIDUM GALLICUM. Dose. — From three to ten grains. Therapeutic Action. — Gallic Acid is one of the most powerful of the vegetable astringents, although its local action is much mihler than the tannic. It causes constipation of t\w. bowels when used for any length of time, and may be emj)loycd as an astringent in diarrhoea, though for this jiurpose it, is infe- rior to many other astringents. " It can be employed with the greatest advantage in all forms of passive hemorrhages; also to restrain various abnormal discharges It has been found very serviceable in menorrhagia, hemoptysis, hemate- mesis, hematuria, etc. ; also in lencorrhoea, and in checking profuse sweating and profuse expectoration ; it has also been used (and it has been stated with much advantage), in some cases of albuminuria, the discharge of albumen being greatly lessened by its administration." GERANIUM. THE ROOT OF GERANIUM MACULATUM.— U. S. Preparations. — Tincture of Geranium. Geraniin. Dose. — Of the tincture, gtt. x. to 5ss. Of Geraniin, gi". j. to grs. V. Therapeutic Action. — The Crane's-bill is a very pleasant though ])owerful astringent. It is scarcely exceeded by any other indigenous vegetable astringent as an active and efficient agent, nor can any agent be found possessed of equal activity as an astringent, that is more, if indeed equally as acceptable to the stomach. Geranium may be employed in all cases in which this class of medicines is applicable. In chronic dysentery, or in the sub-acute forms of that disease, after premising with suitable cathartics, much advantage is often derived from its exhibition. It is also used in diarrhoea and cholera infantum. II EU CHER A. THE ROOT OF HEUCHERA AMERICANA. Preparations. — Tincture of Hcuchera. Infusion of Heuchera. Dose. — Of the tincture, gtt. v. to 3ss. KINO. 545 Therapeutic Action. — Alum-root is astringent, styptic and antisei)tic. It is a very powerful astringent, and niny be used in cases of excessive morbid discharges wiierever the Geranium or Statice is indicated. It may be used internally in cases of hemoptysis, menor- rhagia, uterine hemorrhage, etc. ; also in cases of diarrhoea and chronic dysentery, xuul whenever there is a relaxed or atonic state of the intestinal mucous exhalants. It may be used in diabetes, leucorrhoea, copious bronchial secretions, night sweats, etc., as an internal agent. CATECHU. EXTRACT OF 'THE WOOD OF ACACIA CATECHU.— India. Preparation. — Tincture of Catechu. Dose. — From ten drops to one drachm. Therapeutic Action. — Catechu is astringent and tonic It is often used as an alvine astringent in cases of chronic diarrhoBa and dysentery, unattended with inflammation. In those cases attended with a relaxed state of the intestinal ex- halants. Catechu is an appropriate agent. In these cases it is often associated with prepared chalk, magnesia, opiates, and aromatics, with decided advantage. Its powerful astringent qualities adapt it to the relief of atonic hemorrhages. It is especially useful in immoderate menstruation, for which pur- pose it may be united with aromatics and opium. KINO. CONCRETE EXUDATION OF PTEROCARPUS ERINACEUS.— SENEGAL. Preparation. — Tincture of Kino. Dose. — From one-half to one drachm. Therapeutic Action. — Kino is astringent and tonic. It is mostly employed to lessen or arrest excessive morbid dis- charges, whether of a sanguineous, serous, mucous or puru- lent character. In cases of diarrhoea and dysentery, unat- tended with febrile or inflammatory excitement, it often proves highly beneficial. It is more frequently exhibited in chronic diarrhoea. In excessive morbid discharges from the bowels, the Kino is often associated with opium and prepared chalk, or some other absorbents, as the carbonate ojl' calcined mafjnesla. 35 546 ASTRINGENTS. H^MATOXYLON. THE WOOD OF II^EMATOXYLON CAMPECHIANUM. Preparation. — Extract of Hfematoxylon. Dose. — From one to five grains in solution. Therapeutic Action. — The Logwood is a mild, unirri- tating astringent, well adapted to all cases of chronic dysen- tery, diarrhoea, and profuse mucous discharges. As a mild astringent^ perhaps we have none equally devoid of irritating properties. We have found great advantage from the use of the extract of Hsematoxylon in substance, and also the infusion in the bowel-complaints which occur in Cincinnati during the winter from the irritating effects of the muddy water, and also in the diarrhoeas common to the hot season. For this purpose we combine it with aromatics and opiates. BURSA PASTORIS. Preparation. — Tincture of Bursa Pastoris. Dose. — From one to fifteen drops. It may be employed in chronic menorrhagia where the men- strual discharge occurs too frequently or continues too long, or when the discharge is almost constant but colorless. There is a frequent desire to pass urine, and a deposit of phosphates. It has also proven a remedy in dyspepsia and chronic diarrhoea. "EPIPHEGUS. THE ROOT OF EPIPHEGUS VIRGINIANA.— U. S. Preparation. — Tincture of E[)ipliegus. Dose. — From five drops to half a drachm. Therapeutic Action. — Tiie Epiphegus is astringent, antiseptic, and said to be antisyi)hilitic. It is an energetic astringent, and as such it has been used in dysentery after the febrile and inflammatory excitement has been moderated. It is better adaj>ted to the relief of chronic dysentery, chronic diarrhoea, and the relaxed and atonic states of the intestinal canal attended with profuse n)ucons discharges. It may be used in diabetic affections, profuse night-sweats, and in cases of profuse and debilitating ex[>ectoration, if not con- tra-indicated by febrile cx(;itcn)ent. KHUS GLABRUM. 547 TRILLIUM. THE ROOT OP TRILLIUM PENDULUM.-U. S. Peepaeation. — Tincture of TriUimu. Dose. — From five drops to lialf a drachm. Therapeutic Action. — Trillium is astringent, tonic, pec- toral, alterative and antiseptic. The Trillium is exhibited in hemorrhagic affections. Iii hemoptysis we have found it a valuable agent. In the incipi- ent forms of phthisis, attended with spitting of blood, cough, pain in the breast, etc., we can recommend the Trillium with much confidence to those who may prescribe it. We have often derived <2;reat advantage from the exhibition of the Tril- lium, Ictodes, and Arum tryphyllum, of each equal parts, in the form of a fine powder, mixed with honey, at the same time directing the free use of an infusion of the Lycopus, in the early stages of phthisis, attended with bloody expectora- tion, and even in the more advanced forms of the disease, attended with copious purulent expectoration, hectic fever, troublesome cough, etc. We have also found it important in passive uterine hemorrhages. In cases of menorhagia, at- tended with general debility, we regard the Trillium an agent of superior utility. It is likewise employed in hematuria with benefit. In this disease it maybe used alone in the form of a powder, or associated with the peach leaves, in the form of an infusion. We have made free use of it in diabetes, and from the advantages derived from its exhibition in those diseases, we think it merits a conspicuous place among the list of our therapeutic agents, and one upon which much re- liance can be placed in that formidable disease. RHUS GLABRUM. THE BARK OF THE ROOT. Therapeutic Action. — Sumach is astringent, tonic, diu- retic, antiseptic, alterative and refrigerant. All parts of the plant have been used in medicine. The bark of the root is used in diarrhoea and dysentery, or " bloody flux,'" made into a syrup, or used in a decoction prepared by boiling in milk. 548 ASTRINGENTS. The leaves and berries are said to be decidedly diuretic, and are exhibited in strangury, deranged states of the renal organs, and whenever this class of agents is required. The bark of the root is considered alterative and somewhat tonic. It is recommended as an alterative in syphilis, scrofula and cutaneous diseases. It may be used internally, and ap- plied externally as a wash. It may be advantageously asso- ciated with the rumex, both as an internal and alterative agent, and also as an external application. An ointment or salve made of the bark or leaves is useful in tinea capitis, herpes, impetigo, and other cutaneous diseases. The bark constitutes a valuable antiseptic and detergent poultice in cases of old putrid, indolent, foul, fetid or gangre- nous ulcers; the decoction being used at the same time as a wash. The decoction is also useful in prolapsus uteri and prolapsus ani ; it may be used as an injection in fluor albus. EUBUS. R. VILLOSUS, R. TRIVIALIS, R. STRIGOSUS, AND R. ODORATUS. Theeapeutic Action. — These agents are described as astringent, tonic, diuretic, detergent and nervine. They pos- sess many properties in common, but as they differ in others it is well to give the therapeutic action of each a separate description. Rubus Villosus. — The bark of the root of the Blackberry is a very valuable astringent. It has long been a popular rem- edy in atonic bowel complaints; is highly extolled by many of the late writers for its efficacy in chronic dysentery, diar- rhoea and cholera infantum, and is especially recommended in the latter complaint. Rubus Trivialis. — The roots of the Dewberry are closely analagous to those of the blackberry, in their medical proper- ties. They possess astringent qualities in a higher degree than the blackberry. They are employed indiscriminately in place of that agent. Rxibus Strigosus. — The leaves of the Red Raspberry are mildly astringent, somewhat tonic, with some aromatic prop- erties. As an agreeable, pleasant and acceptable agent to the stomach, we have no astringent surpassing the Red Raspberry. URTICA. 549 As a mild and agreeable astringent, it is fonnd very useful in the ordinary summer complaints of children. It may be used in combination with cinnamon, in cholera infantum, diar- rhoea, secondary stages of dysentery, and also in atonic and re- laxed states of the intestinal exhalants. K R A M E R I A. THE ROOT OF KRAMERIA TRIANDRIA. PREPAPtATiON. — Tincture of Krameria. Dose. — From five drops to half a drachm. Therapeutic Action. — Rhatany root is astringent and tonic. It is one of the most powerful vegetable astringents, and is a remedy in all those cases requiring the employment of this class of therapeutic agents. It is an appropriate remedy in cases of profuse mucous dis- charges. It is advantageously employed in elironic diarrlioea and elironic dysentery with great relaxation of the intestinal exhalants; it is also used in fluor albus, humid catarrh, blen- orrhoea, diabetes, and in all cases attended with relaxation and debility of the solids. It is recommended in hemorrhagic affections as in hemop- tysis, hematemesis, intestinal hemorrhage, and especially in passive hemorrhages from the uterine organs, as menorrhagia. TORMENTILLA. THE ROOT OF POTENTILLA TORMENTILLA— Europe. Therapeutic Action. — The root of the Tormentilla is astringent and tonic, and may be employed in all cases requir- ing the use of this class of agents. It is a pure and not an unpleasant astringent. It is exhibited in relaxed and atonic states of the solids, and also in cases of excessive mucous dis- charges. URTICA. THE ROOT OF URTICA DIOICA.— U. S. Preparation. — Tincture of Urtica. Dose. — From one drop to half a drachm. Therapeutic Action. — Urtica is astringent^ styptic, tonic, and diuretic. The seeds, leaves, juice and roots of the com- 550 ASTKINGENTS. 1)1011 nettle are all used occasionally for their remedial virtues. We have employed the roots in numerous instances as an astringent with unequivocal advantage, and wo know of no single agent upon which we would sooner rely in all the ordi- nary cases in which this class of agents is indicated. It is powerfully astringent, and well adapted to all cases of chronic diarrhoea and dysentery, and to tiie relief of the summer com- plaints of children. Owing to its reputed diuretic properties, it has been recom- mended in nephritic and calculous affections. The leaves and seeds are the parts mostly used for the relief of diseases of the urinary organs. It is also used in pleurisy, incipient phthisis, and in scorbutic affections. It is said to have [)roved useful in jaundice, and for the removal of worms. \ye regard it as an unimportant agent in the latter diseases. We should place, however, but little dependence upon any portion except the root, in hemorrhagic and mucous discharges. The seeds and flowers have been employed in intermittents in the place of the Peruvian bark. Seeds and flowers are administered in doses of 5j> Pulver- ized root, 3j. to 5ss. or 5j- Decoction, Sj. to Oiss. of water, and boil to Oj.; dose, .jj. to o'j- ; cinnamon may be added. G EUM. THE KOOT OF GEUM RIVALE.— U. S. Dose. — Powdered root, 3j. to 5j- three or four times a day. Decoction, 5J. to Oj. of water; boil and strain ; dose, .3j. to .5ij. Therapeutic Action. — Water Avens is an energetic as- tringent and tonic. In the New England States it is a ])oi)ular remedy in diarrhoea and chronic dysentery. It is likewise employed in passive hemorrhages from the uterus, bladder, kidneys, bowels, and also from the lungs. It is decidedly tonic as well as astringent, and hence the utility of it in enfeebled states of the alimentary canal. It has gained some popularity in cases of phthisis, attended with debility and copious expectoration. MYRICA. 551 M Y R I C A. THE EARK OF MYRICA CERIFERA.— U. S. Preparation. — Tincture of Myrica. Dose. — From five drops to half a tlrachm. Therapeutic Action. — Bay berry is described as astrin- gent, stimulant, tonic, diaphoretic, emetic, sialagogue, errhine, antiseptic and discutient. Bayberry is esteemed valuable in diarrhcea and dysentery. In those complaints attended with general languor and debil- ity, or atony of the bowels, its utility is dependent upon its astringent, stimulant, tonic and diaphoretic action. The warm infusion acts with considerable effect upon the surface. The same reasons seem to point to its use and utility in dys- entery; it is recommended and used with the most gratifying results in scarlatina, both as a general and local agent. While the warm infusion or decoction is being taken freely as a dia- phoretic and stimulant, the throat is to be thoroughly and frequently gargled with the same, loaf-sugar or honey being added. Many children have been saved, it is said, by this article alone, who were thought by their attending physicians to be beyond the reach of medicine. The bark is thought by many to possess superior efficacy in scrofula, a decoction being drank freely, while a poultice pre- j)ared of tlie powdered bark is to be applied to the ulcers or tumors, should any be present. In cases of open ulcers it acts i'.s a topical excitant and detergent ; applied to the tumor it acts as a discutient and resolvent. Some, indeed, have thought that it acts as a discutient and resolvent. Some, indeed, have pro- nounced it a sovereign remedy. The decoction is recommeneded in jaundice and biliary ob- structions; also in engorgements of the spleen, diseases of the urinary apparatus, and for the cure of dropsy. It is much used in febrile and inflammatory diseases, colds, rheumatism, and numerous other disorders, by the Thora- sonian class of physicians. When masticated, it acts efficiently as a sialagogue, and may- be used in paralytic or rheumatic affections occurring about the mouth or })arts adjacent thereto. It is also much valued as an errhine in certain diseases of the head, and in morbid states of the nasal mucous membrane. 552 ASTRINGENTS. » MONESIA. THE BARK OF CHRYSOPHYLLUM BURANHEIM. Therapeutic Action. — Monesia is astringent, stimulant and alterative. It is used in cases of profluviuni of a mucous and sanguineous character, depending upon jjn atonic state of the system. Thus it has been employed with advantage in chronic diarrhoea and dysentery, in chronic bronchitis, hemop- tysis, menorrhagia, leucorrhcea, etc. MA TIC O. THE HERB OF ARTANTHE ELONGATA. Preparation. — Tincture of Matico. Dose. — Of the pulverized Matico, from 5j- to 3ji. Of an in- fusion of o}- to Oj. of boiling water, .^j. to 5ij. Therapeutic Action. — Matico is astringent, styptic and stimulant. It has been employed to check hemorrhage from the lungs, bowels, kidneys, etc. ; but, as it contains neither •tannic nor gallic acids, Pereira supposes that what influence it has in these cases depends upon the volatile oil. It has been used, however, with undoubted advantage in discharges from mucous surfaces, as leucorrhcea, gonorrhoea, etc., possessing similar properties to the cubebs. N Y M P H ^ A. THE ROOT OF NYMPH.EA ODORATA.— U. S. Dose. — Of the powdered root from 5ss. to 5j. Of a decoc- tion of sij. to Oj. of water, boiled for Hfteen minutes, o'j- to Siv. Therapeutic Action. — TheNymphsea is astringent, tonic, discutient and emollient. It has been found beneficial in most cases of excessive mucous discharge, as diarrhoea, dysentery, leucorrhcea, etc. It has also been used in hemorrhagic affec- tions, but in these cases it can not be advantageously substi- tuted for other and more efficient agents. A strong infusion has been found useful as an injection in leucorrhcea, being taken internally at the same time. It forms a valuabl(> d4scutient and emollient poultice in painful inflam- matoi y affections, scrofidous enlargement of the glands, tumors, ERECHTHITES. 553 V. lilto swellings, etc. The decoction is used as a gargle in nlcerated sore nioutli, and as an injection in gonorriujea, gleet, dysentery, and as a wash to old and indolent ulcers. ERIGERON. THE PLANT OF ERIGERON.— U. S. Preparations. — Oil of Erigeron. Tincture of Erigeron. Dose.— Of the Oil, gtt. j. to gtt. v. Of the tincture, gtt. V. to 5ss. Therapeutic Action. — Erigeron is astringent, tonic, diu- retic, diaphoretic and stimulant. It is an important agent in controlling excessive mucous and sanguineous discharges, and has been employed with advantage in dysentery, diarrhoea, uterine hemorrhage, hemoptysis, hematemesis, hematuria, etc. It has also been used with benefit in diabetes, nephritis, cysti- tis, and to subdue the irritation arising from the presence of calculi in the bladder. As an astringent and styptic in hemorrhages, we think the Erigeron is one of our most efficient agents. The most ])ro- fuse and alarming uterine hemorrhage has been speedily arrested by the use of the volatile oil. The extract, tincture and infusion have also been, used in these cases with decided advantage. In coughs and chronic bronchial aifections when attended with copious mucous or purulent secretion, and in the incipient stages of phthisis attended with bloody ex[)ecto- ration, this agent will be found to answer an excellent purpose. ERECHTHITES. THE PLANT OF ERECHTHITES HIERACIFOLIA.— U. S. PREPARATIONS.—Tincture of Erechthites. Oil of Erechthites. Dose. — Of the tincture, gtt. v. to 5ss. Of the oil, gtt. j. to gtt. v. Therapeutic Action. — Fireweed is said to possess astrin- gent, tonic, alterative, emetic, and cathartic properties. The recent plant has })roved emetic and cathartic in large doses, though it is never em[)loyed for these purposes. It has been successfully used in dysentery, relieving the pain and checking the discharge spoelily. It has also been highly recommended ill diarrhoea, cholera infantum, and Asiatic cholera. 554 ASTRINGENTS. OLEUM ERECHTHITES Is said to possess similar properties to the oil of Erigeron. We have used it to a limited extent only, but would substitute it for the Erigeron in any case, if that agent could not be obtained. DIOSPYROS. THE BARK ANB FRUIT OF DIOSPYROS VIRGINIANA. Dose. — Of an infusion of 5ij- to Oj. of boiling water, from one to two ounces. Therapeutic AcTiON.^-The bark of the Persimmon is astringent, tonic, and antiseptic. Dr. Barton considered it one of the most powerful of our native astringents. It is employed with advantage in diarrhoea and dysentery, especially where there is much prostration, and a relaxed and atonic condition of the bowels. It has also been used in cholera infantum, or the summer complaint of children. In these cases it may be given in the form of syrup, tincture, or infusion. In dysentery it may be advantageously combined with Leptandra and Rhu- barb. It has also been employed in passive hemorrhages, it is said, with good results. As a local application, a strong infusion has been advanta- geously em})loyed as a gargle in ulcerated sore throat, and as a wash in sore mouth. The bark is antiseptic, and may be employed in the form of a poultice to gangrenous parts. The infusion is also employed to cleanse and stimulate foul and indolent ulcers. SOLIDAGO. THE LEAVES AND FLOWERS OF SOLIDAGO RIGIDA. Dose. — Of the powdered leaves, from 5ss. to 5j. Of an infusion of ,5j to Oj. of boiling water, f .^ij. to f^iv. Therapeutic Action. — This sj)ecies of Solidago is astrin- gent, styptic, tonic, and diuretic; it is the ai'ticle used by Dr. Bono, of New Jersey, to arrest hemorrhages. It is recom- mended in Iiem()[)tysis and uterine hemorrhage in particular, and is said to be an agent of superior utility. It is also em- ployed in liemorrhage from the bowels and urinary organs and likewise in excessive mucous discharges, as in diarrhoea, dys- piNus. 555 entery, leucorrhoea, etc., and in profuse sweats arising from de- bility. It lias been employed in ehronic diseases of the urinaiy organs, as chronic nephritis, albuniinnria, cystitis, etc., with reported advantage. PINUS. THE BARK AND CONCRETE JUICE 07 FINUS CANADENSIS, Preparation, — Tincture of Pinus Canadensis. Dose. — From five drops to half a drachm. Therapeutic Action. — The inner bark of the common Hemlock affords a mild and valuable astringent, usel'nl in all eases requiring the employment of agents of this class. The decoction is exhibited in chronic bowel connjlaints, and whenever there is a relaxed state of the intestinal exhalants; aromatics may be added to render it acce[)table to the palate, and to improve its medical virtues. Hemlock may also be employed in cases of copious bronchial secretions, in leucor- rhoea, diabetes, etc. ; and likewise in passive sanguineous dis- charges, as from the uterus, bowels, kidneys, lungs, etc. The decoction constitutes a useful gargle in cynanche and the various aphthous and ulcerated states of the mouth. The impalpable powder has been inhaled with advantage it is said in cases of phthisis pnlmonalls. As a topical agent, the decoction may be used in fluor albus, prolapsus uteri and ani, and also as a wash to flabby and gan- grenous ulcers ; the powder is valuable as a poultice to old ulcers, and to parts that are gangrenous. The oil of Hemlock is used for internal and external pur- poses. It is highly stimulant, diaphoretic and diuretic. It has been found useful in chronic rheumatism, lumbago, sciat- ica, and also as a diuretic in cases in which there is tor[)or of the renal organs. It may be used in colic, spasm of the stom- ach or bowels, pain in the breast, etc. The oil or essence forms a useful rubefacient embrocation. It may be combined with other essential oils, and used as a liniment in cases of rheumatism, lumbago, sciatica, sprains, bruises, local inflammations, etc., as parotitis, trachitis, and niastodynia. 556 ASTRINGENTS. SPIREA. THE PLANT OF SPIREA TOMENTOSA.— U. S. Dose. — Extract, grs. v. to 3j. Decoction, made by boiling one ounce of the plant (root is best) in one pint of water; one to two ounces when cold. TiiEKAPEUTic Action. — Hard-back is astringent and tonic. It is an energetic astringent, yet less apt to disagree with the stomach than many otlier agents belonging to this class. It is highly recommended in all the cases in which this class of agents is ordinarily prescribed, such as diarrhoea, dysentery, cholera infantum, menorrhagia, fluor albus, and indeed in most cases of profuse mucous discharges, and likewise in those of u passive sanguineous character. ACHILLEA. Yarrow or Milfoil is a mild astringent and feeble aromatic tonic, possessed of excitant properties. We have used this article mostly for restraining morbid sanguineous discharges. We have found it decidedly benefi- cial in hemoptysis, hematemcsis, and menorrhagia, or })as- sive hemorrhages from the uterine organs. In these cases we have not unfrequently exhibited it alone, perhaps more fre- quently conjoined with the Lycopus Virginicus, and i-arely without deriving much advantage from its use. It has been found beneficial in the bleeding piles, dysentciy, diarrhoea, leucorrhoea, used both inlernally and locally, etc., and some speak of it favorably in intermittents, retention of the menses, flatulent colic, nervous debility, and likewise to remove va- rious obstructions, counteract spasm, and purify the blood. FRAGARIA. The vine and leaves of the Strawberry are mildly astringent and diuretic. They are employed in bowel-compluints like cinquefoil and raspberry leaves. They have a tendency to check excessive mucous secretions and impart tone to the bowels. Th(>y arc also used in dysuria and ])ainfnl irritation of the urinarv organs. In chronic irriladon or catarrhal affections AGRIMONIA. 557 of those organs, they are said to be decidedly valuable. In calculous affections and in strangury, the decoction may be used freely. BIS TORT A. Dose. — Powder, grs xx. to xxx. Decoction, ,5ij. to Ojss. of boiling water ; dose, one to two ounces. The Polygonum Bistorta, or Bistort root, is said to be a powerful astringent, depending on the tannic acid which it contains. It is also tonic, and owing to the presence tjfstarch it is nntritive, and is roasted in Siberia and eaten. Bistort is considered applicable to the same cases in which other astringents are employed, although it is but little used. POTENTILLA CANADENSIS. The root or vine of the common Five Finger or Cinque- foil, is a mild astringent, and very well adapted to the relief of many cases requiring the exhibition of 'these agents. In chronic diarrhoea, dysentery, and wherever there is a relaxed and enfeebled state of the alimentary canal, it is found to be a useful remedy. It checks the secretions, and gives tone and vigor to the bowels. It is also beneficial in sanguine discharges. In passive hemorrhages, particularly in menorrhagia occur- ring in relaxed habits, a strong decoction of the Potentilla is found very useful in restraining the immoderate discharge. In hematuria and hemoptysis, it is capable of doing much good. Diabetes and leucorrhoea are diseases in which advan- tage may be derived from its use. AGRIMONIA. Agrimonia is a mild astringent and tonic, and used in diar- rhoea, dysentery, and passive hemorrhages. Its astringent, tonic, and demulcent properties recommend it to our notice in relaxed and atonic states of the bowels, attended with irritation or chronic inflammation of the mucous membrane, and in cases of either mucous or sano;uineous discharcres. The root is to be ])referred as an astringent and corroborant, and the top as a demulcent and diuretic. We have frequently resorted to the agrimony in suppression of urine, in cystitis, nephritis, and in all cases of irritation or intlammation of the urinary organs. 558 ASTEINGENTS. COMPTONIA Sweet Fern is mildly astringent and somewhat tonic. It is used in New England in diarrhoea, dysentery, cholera infan- tum, and in cases of general relaxation, and in debilitated states of the bowels. In these diseases it forms a grateful astringent, tonic, and aromatic drink, prepared by adding sugar and cream to the decoction. It is acceptable to the storadch and agreeable to the taste. HAMAMELIS. THE LEAVES OP HAMAMELIS VIRGINICA.— U. S. Preparation. — A distilled tincture. Dose. — From the fraction of a drop to half a drachm. Therapeutic Action. — Astringent, tonic, sedative, discu- tient, styptic, antiseptic. The bark and leaves of the Witch- hazel are mild yet energetic stimulants. Though less frequently used than other agents, they are really useful in the various cases in which this class of medicines is indicated. The bark is the most active as an astringent. It is used with advantage in bowel complaints attended with great relaxation of the intes- tinal mucous exhalants in infusion or decoction. The infnsioii of the leaves is useful in varions internal hemorrhages, as he- maturia, menorrhagia, hematemesis and hemoptysis ; and like- wise in diabetes and fluor albiis. Combined with Trillium latifolinm and exhibited freely, it has proved very advanta- geous in the last named diseases. The same combination is also highly valuable in hemorrhagic discharges; and in all these aifections the Lycopus Virginicus constitutes an impor- tant addition. Hamamelis is beneficial in hemorrhoids, particularly in the bleeding piles, with atony of the perineum. Its value in both mucous and sanguineous discharges depends partly on its tonic properties. As a topical application, Hamamelis is valuable, applied to painful inflammatory tumors, sprains, and bruises. Its astrin- gent, antiseptic and discutient jiropcrties render it a valuable application to old flabby, foul, fetid and gangrenous sores or ulcers. Wash and then apply as a wet dressing. ALUMEN. 559 BISMUTH. Preparations. — Subnitrate. T^iqnor Bismuth. Dose. — Of the first, grs. j. to v.; of the second, 5ss. to oj. Bismuth is indicated by an elongated and pointed tongue, red, uneasy sensations in the stomach with heat, eructations of acid or acrid material, irritative diarrhoea. Subnitrate of bismuth may be employed with advantage in some cases of gastrodynia and water-brash, and occasionally as a remedy for nausea and vomiting. It is frequently employed as a remedy for diarrhoea, but is not nearly so good as the solution. I frequently use the liquor bismuth in irritative diarrhoea, and in dysenteric diarrhoea, with excellent results. It may also be employed in the diarrhoBa of typhoid fever, if the dis- charges are largo and too frcciucnt. It will be found an admi- rable remedy in those casesof chronic diarrhoea, with irritation of the stomach and acrid eructations. ■^ CREASOTUM. Creasote is frequently used as a local, and sometimes as an internal agent, with a view to its styptic and indirect astrin- gent effects. When ap})lied to a bleeding surface, it causes coagulation of the albumen of the blood, and thus an obstruc- tion in the mouths of the bleeding vessels; it is also su[)posed to cause contraction of the vessels by its .stimulating influence. A L U M E N. Theuapeutic Action. — Alum is astringent, styptic, pur- gative, and escharotic. Its immediate effect ii\ medicinal doses is that of an astringent. It causes a corrugation of libers and a contraction of the capillary vessels, and thus les- sens or even checks temporarily exhalation or secretion, and hence the dryness of the mouth and throar, the increased con- sistency of the stools, and less frequent purging. If too freely applied to a part, the astriction is followed by irritation, and the ]>aleness first induced by its corrugating effects, is succeeded by ])reternatural redness. Internally, "alum excites nausea, vomiting, griping, purging, and even an inflammatory condition of the intestinal canal." 560 ASTKINGENTS. FERE,! SULPHAS. Dose. — From one to five grains, in the form of pill ; Vel- peau used a solution of three to five ounces of water, to re- j)ress erysipelas; a solution may be used in 0})hthalmia of one to two grains to one fluid ounce ; and as an injection in gleet, four to ten grains to one ounce of water. Sulphate of Iron is a powerful local astringent, and as such is employed to check hemorrhage from small vessels, in cases of cuts, wounds, etc. It is also used to check profuse mucous discharges, as in chronic ophthalmia, leucorrhoea and gleet, and to ulcerated surfaces to stop the purulent secretion. As an in- ternal remedy, it lessens the secretions of the alimentary canal, and hence has been used in chronic diarrhoea, dysentery, etc. It has also been employed to check excessive secretion as in chronic mucous catarrh, humid asthma, leucorrhoea, gleet, dia- betes and colliquative sweats FERRI PERNITRAS. Dose. — From ten drops to half a drachm. The Pernitrate of Iron, heretofore described, is a valuable astringent in dysentery, and the summer complaint of children. It has also been used with advantage to check profuse mucous discharges, as in leucorrhoea, chronic bronchitis, etc., and to control hemorrhage from the stomach, bowels and uterus, es- pecially in persons of a feeble and languid habit. (See Tonics.) TINCTURA FERRI CHLORDI. The Tincture of the Muriate of Iron, Avhich has already been described as a tonic, is a useful astringent and sty|)tic as well as tonic, and is applicable to those cases requiring the astrin- gent and tonic iiction of th.e ferruginous salts. It is })articu- larly recommended in asthenic or passive hemorrhages. In hematemesis, hematuria, uterine hemorrhages, and also in ex- cessive mucous discharges, it has been found beneficial. In cystorrhoen, gleet, and diabetes, and also in suppression of urine, dysurin, etc., it has been found advantageous. It is a useful tonic,. and may be used in chlorosis, scrofida, ana?mia, anorexia, general debility, etc., with considerable benefit. EXPECTOKANTS. 561 DIVISION VIL CI.i^LSS XIV. EXPECTORANTS. Expectorants are agents which promote the evacuation of mucus from the respiratory organs. This they may do by allaying inflammation of the mucous membrane, which in its first stages always diminishes or suppresses the normal secretion of mucus; or by stimulating this membrane when relaxed, causing an increased flow of blood to it, and in- creased action of the mucous follicles ; by rendering it thin- ner and less viscid, enabling the patient to bring it up; or lastly, by exciting an action of the respiratory muscles, causing an evacuation of mucus already secreted, as in the act of coughing or vomiting. This secretion is very materially influenced by a variety of pathological conditions of the general system, as well as of the pulmonary mucous membrane. Thus a high grade of fever will as certainly diminish the pulmonary secretion, as a local inflammation, while an asthenic condition of the system will increase it. It is modified by acute as well as chronic pulmonic inflammation ; by spasmodic action of the air-passages; by irritation of the innumerable ramifications of the pneumogastric nerves; by a paralysis of the nerves distributed to these organs ; or, lastly, by disease of contigu- ous viscera, the heart, stomach and liver. These various conditions influencing this secretion, clearly demonstrate the necessity of properly discriminating between the diversity of pathological states existing, before recourse is had to the more active agents of this class. Action of Expectorants, — A question of much interest to the 36 562 SPECIAL THERAPEUTICS. pathologist, as well as the therapeutist, is, how do these agents termed expectorants act? Do they act specifically upon the respiratory organs, or do they act indirectly upon them in promoting the secretion and discharge of mucus? If we except the various topical expectorants, or inhalations, we may regard them mostly as indirect agents. It can not, however, be denied that some of the balsams, the garlic, onions, asafoedita, etc., w^hen administered are absorbed, and excreted from the blood through the lungs. This is proved by the odor which they impart to the breath, though this is but their volatile principle. This may, however, exert some specific influence upon the respiratory passages in its trans- mission through them, by stimulating the pulmonary ex- halants; but the general rule that the sanative action of expectorants is indirect, remains uninfluenced by this admis- sion. As has been already stated, the diversity of the pathologi- cal conditions of the general as well as pulmonic systems, require very different agents at different times, to fulfill the indications. In many cases, difficult or deficient expectora- tion depends upon an acute inflammation of the pulmonary- mucous membrane. In these cases it is evident that what- ever tends to lessen the inflammatory action, must tend to produce more copious secretion and expectoration. Hence we find nauseant and emetic expectorants of much value in such cases. If we administer nauseants, they act as seda- tives, diaphoretics, antispasmodics, and may produce emesis, if given in sufficient quantities. By their sedative influence they control the action of the heart, and thus diminish the quantity of blood sent to the respiratory organs ; by their relaxant powers they tend directly to lower the inflammation and remove the constriction of the mucous membrane ; and acting as diaphoretics they equalize the circulation, and exert a powerful revulsive influence. Though these agents are among our most efficient expectorants, yet it is evident that they act indirectly upon the respiratory organs. Ca- thartics, emetics, diaphoretics, etc., by their sedative, deple- tive and revulsive influence, equalize the circulation, and thus act as indirect expectorants, in this condition of these organs. Topical revulsives, though local and indirect in EXPECTOEANTS. 563 their action, may often, by exciting a new point of irrita tion, relieve the determination to the hings and increase the mucous secretion. Again, sedatives, as the veratrum viride, gelseminum, aconite, etc, by their power over inflammatory action, often prove our most efiieient expectorants in acute inflammation. In short, whatever tends to diminish the in flammatory condition, tends to promote expectoration if diminished from this cause; while expectorants of an excit ant character are coutraindicated. If, however, the inflammation has been subdued by proper medication and the secretion of the bronchial mucous is profuse, and the vital powers are not adequate to the task of throwing ofl:' the mucus, we derive much advantage from the use of agents of an exciting and sustaining charac- ter, such as the balsams, myrrh, asafoetida, gum ammoniacum, etc., either alone or united with some of the milder tonics, in facilitating expectoration by their stimulant eftect upon the mucous membrane, and by imparting vigor to the res- piratory muscles. Cases of extreme debility of the general system some- times occur in persons advanced in years, or as the result of protracted disease, in which the mucous membrane and fol- licles lose their tone and give rise to a profuse secretion. The catarrhal afifections of old age, cases of humoral asthnia, chronic bronchitis, etc., are examples of this kind. In such cases as these, if the general health is improved, and such agents employed as will condense and give tone to the re- laxed mucous membrane, as tonics and astringents, the amount of fluid secreted will be greatly diminished, and the process of expectoration will be greatly facilitated by the increased vigor imparted to the muscles. In this way some of the stimulating expectorants, and even tonics, may restrain the secretion when profuse, and promote it when scanty. Suppressed or diminished expectoration may also arise from a torpor of the mucous membrane and follicles of the air-pas- sages. In this case some of the more stimulating balsamic agents, as the balsams of Tolu or Peru, myrrh, the terebin- thina, etc., whose active properties seem to be readily ab- Borbed, and pass off through the lungs, may be resorted to 564 SPECIAL THERAPEUTICS. with a prospect of advantage. If any agents, except medi- cated inhalations, exert a direct action npon the hmgs, these may be included in that list ; they stimulate the mucous membrane, cause an increased flow of blood to it, and thus cause an increased secretion and excretion. In spasmodic disease of the respiratory organs, the mu- cous secretion is nearly always much diminished or entirely checked, as in asthma. Here a different class of agents are applicable ; all those that act as antispasmodics, and relax the spasm of the air-passages, prove expectorant. The physician is often called to prescribe for cases of harrassing and protracted cough, unattended with any con- siderable expectoration, arising from an irritation of the mucous membrane of the air-tubes, or from some fixed irri- tation of the pneumogastric nerves. In these cases the use of narcotics, as opium, morphia, hyoscyamus, etc., are found to be the most efiectual agents, when given internally, in allaying the irritation and cough ; while other narcotics used as inhalations, as the tobacco, stramonium, etc., are found, in many instances, to be very valuable, and even in many cases sufficient to speedily arrest it. Spasmodic asthma, spasmodic croup, and spasmodic coughs in general, are easily arrested in many cases by the use of inhalations. There is another source of fixed irritation in the lungs which requires to be noticed ; we allude to the presence of tubercles in the lungs. In this case the tubercle maintains a constant irritation, which gives rise to incessant cough ; the mucus is discharged as soon as secreted, and before it accu- mulates in the lungs to even a limited extent ; hence the appearanee of deficient expectoration ; whereas, if the irri- tation is allayed and the frequency of the cough abated, by the use of sedatives and narcotics, the mucus will accumu- late, and when expectorated, will give the appearance of in- creased expectoration. In tuberculous disease, agents which increase the secretion of the mucous membrane should never be used; for no good can result from their employment, but much injury. The disease is a disease of the blood ; it not being duly elaborated, owing to a deficiency of the vital powers of the system, and the deposit of tubercle is but the result of this defective vitalization. Even if the tuberclt'f EXPECTOEANTS. 565 could be removed by the expectoration, the cause still exist- ing they would still be deposited. Not only do we derive no benefit from these agents, but they directly increase tlie debility of the system, and thus increase the disease. If there is any cure for tuberculosis, it is to be accomplished by allaying th6 irritation of the lungs, and by increasing the quantity and quality of the blood, — directing our remediea to the cause, and not to the symptoms of the disease. There are numerous cases of coughs arising from irrita* tion of the fauces, larynx or pharynx. In such cases demul- cents may be used freely and with advantage. They allay the local irritation which excites the cough, and by their continuous use for a short time the irritation is removed. They are also beneficial in other cases, w^here the cough arises from an irritation of the mucous membrane of the lungs and bronchia. Their soothing influence upon the fauces and mucous membrane generally, with which they come in contact, is extended both by contiguous and con- tinuous sympathy to the mucous membrane of the air-pas- sages, and thus they allay irritation and abate the cough. Expectoration is often facilitated by the act of vomiting. Emetics relax the pulmonary and cutaneous constriction, promote the secretion of mucus, and facilitate its discharge by compressing the thoracic viscera during the act of vomit- ing. Their influence is often very beneficial in the treat- ment of various pulmonary affections. Before closing our description of the therapeutic action of this class of agents, we deem it proper to advert to the salutary efiects of topical expectorants or inhalations. By the use of inhalations of a soothing, relaxing and anodyne char- acter, in cases of inflammation or irritation of the bronchial mucous membrane, great relief is often experienced. If acute inflammation of the respiratory passages exists, inhala- tions of the vapor of hot w^ater, hot vinegar, hot medicated vapor, as from an infusion of bitter herbs, etc., seems to soothe and allay irritation, lessens the inflammation, relaxes the constricted or spasmodic state of the extreme bronchial rami- fications, promotes secretion, and renders expectoration easy. Ether, and some of the volatile oils, are sometimes added to the infusion, which renders the inhalation still more import- 566 SPECIAL THERAPEUTICS. ant in some eases. In dyspnea, ether, in which the extract of cicuta has been dissolved, has been used with great effi- cacy. Camphor has been used with much advantage in spasmodic coughs, croups, asthma, etc. In cases of extreme irritation of the respiratory passages, attended with spasmodic cough, as in some forms of asthma, or in cases of troublesome cough, arising from an irritation of the pneumogastric nerves, unattended with inflammation, the inhalation of the vapor of some narcotic and anodyne agent, or the inhalation of the fames of the same article, will, in many cases, give prompt and entire relief. The stramonium, conium, hyoscyamus, digitalis, tobacco, etc., are used in these cases. In other cases there seems to be a loss of innervation of the lungs from partial paralysis of the nerves distributed to them, in which case agents of an excit- ing character are required. The fumes of boiling or burn- ing tar, resins, feathers, horse hair, balsam tolu and Peru., benzoin, etc., stimulate the nerves, promote the secretion and excretion of mucus, and in this way often give relief. These inhalations are valuable in chronic bronchitis, and other similar diseases. We have thus seen that the majority of the agents belong- ing to this class, exert their influence indirectly, and that they should always be selected with special reference to the condition of the respiratory organs and the general system. As Dr. Dunglison remarks, "Almost every division of medicinal agents may become expectorants, according to the precise condition of the system generally, or of the pulmo- nary organs particularly ; and hence we find an expectorant effect equally from depletives, and from tonics and excitants, from narcotics and counter-irritants, and from nauseants and emetics." Tiie reader will notice that the word " expectorant" is used in a very broad sense. It does not mean that remedies must cause increased secretion of mucus, much less of muco-j)Us. We recognize the fact that in a normal condition mucus is secreted in just such quantity as will lubricate the muous mem- brane of the air-passages, and facilitate respiration. If these pasj^ages become dry, then remedies which increase secretion are curative. If the air-passages are filled with mucus, which LOBELIA. 567 is not removed by an ordinary congli, then remedies that facili- tate its removal are important to free respiration and a relief of the cough. If there is a very large secretion of mucns, re- pi- ration is im[)aired, and a remedy which will check this secre- tion is of benefit, and is called an "ex})ectorant." In the treatment of acnte disease of the respiratory a[)p!ira- tns. we now endeavor to relieve irritation, and stop determina- tion of blood, without producing more than normal secretion. Many times this niay be accomplished by the treatment of the symptomatic fever, lessening the frequency of the pulse, re- ducing the temperature, relieving irritation of the nervous system, establishing secretion, and rectifying wrongs of the blood. And in addition to this we have many remedies which exert a direct influence upon the respiratory apparatus, for the relief of irritation and disease. LOBELIA. Prepaeation. — Tincture of Lobelia Seed. Acetum Lobelia. Dose. — Of the tincture, from the fraction of a droj) to ten drops. Of the Acetous tincture, ten drops to one drachm. Lobelia has been already fully described under the class Emetics, hence, we have in this place only to describe it as an expectorant. For this purpose we consider it one of the most valuable agents of the materia medica, and there is, probably, no other one that is so frequently resorted to for this purpose. Its expectorant action is indirect, as is the case with all our most valuable remedies of this class. We may probably con- sider its action in diseases of the respiratory apparatus, in three ditferent ways, according to the doses administered. Asa Nauseating and Sedative Expectorant. — As a nauseating expectorant we have no better remedy than the Lobelia, given in dosesjust sufficient to keep the patient nauseated. It causes relaxation of the system, diminishes the force and frequency of the pulse, produces diaphoresis, and increases the secretion from the bronchial mucous membrane. To fulfill these indi- cations, it is employed in pneumonia, bronchitis, pleurisy, laryngitis and croup; in all these diseases it is supposed to check the progress of inflammation, check exudation of coag- nlable lymph^ and increase the secretion of mucus; it also 568 EXPECTORANTS. prevents a cleterniination of blood to the lungs in a marked manner. As a Stimulating Expectorant. — In doses not sufficient to nauseate the patient, the Lobelia acts as a stimulant — its influ- ence being especially exerted upon the respiratory organs. It is employed tor this purpose wherever there is evidence of a want of tonicity of the mucous membrane, when the secretion is either deficient or profuse, as in chronic pneumonia, bron- chitis and laryngitis, phthisis pulmonalis, etc. It is also con- sidered an efficient agent to promote absorption in hepatiza- tion of the lungs. In asthenic laryngitis, with loud mucous rales in all parts of the chest, and great oppression, we have no remedy in the materia medica equal to this. It may be given with water in the usual way, or combined with spirits of lavender. SANGUINARIA. Peepaeatioiss. — Acetous Tincture of Sanguinaria. San- guinarine. Dose. — Of the first, gtt. j. to 5ss. I^ Sanguinariue grs. iv., water or syrup Siv.; dose, one teaspoonful. The action of Sanguinaria is something similar to that of Lobelia. It is principally used, however, as a stimulant ex- pectorant, though sometimes as a nauseant, and very rarely as an emetic. In croup, asthma, and acute bronchitis, it has been highly recommended as an emetic, though from the severity of its action we would prefer other agents. It is a valuable stim- ulating expectorant, and may be used either in deficient or re- dundant expectoration, if either depends upon debility of the mucous membrane. Thus in chronic bronchitis, humoral asthma, etc., there is enlargement of the capillary vessels and relaxation of the mucous membrane; the excess of secretion depends upon this. Sanguinaria and other remedies of its class, by their excitant action, stimulate and give tone to the mucous tissue, and the expectoration is proportionately dimin- ished ill quantity. In other cases there is atony, with deficient circnlution and consequent diminution of the secretion ; fre- quently in cases of this kind the Sanguinaria restores the secretion. Sometimes the Sangunaria is given in cases where the secretion is diminished from acute inflammation ; in this SCILLA. 569 case larger doses are employed to nauseate the patient, depress vascular activity, promote diaphoresis, and thus by equalizing the circulation and producing relaxation, it induces expectora- tion. It is exhibited as an expectorant in typhoid and acute j)ueumouia, broncliitis, asthma, croup, pertussis, and in phtl.i- sis pulmonalis. IPECACUANHA. DosR. — Tincture of Ipecac gtt. x. to gtt. xx., water oiv. ; a tea spoonful every hour. Ipecacuanha exerts a specific influence upon mucous mem- branes, relieving irritation, and arresting the iuflammatory process. It also stimulates a better circulation and innerva- tion, increases nutrition, and thus favors functional activity. We employ it with very nuirked advantage in the treatment of infantile pneumonia, associated with Aconite and Vera- trum. In some cases, the prescription of Ipecac alone will be sufficient to arrest the disease in two or three days, especially if given in the first stages. It is also employed with excellent results in diseases of the respiratory apparatus of the adult. SCILLA. DosK. — In substance as an expectorant, gr. j., gradually increased to grs. iij., or grs. v. Syrup of Squills gtt. v. to oss. Squill possesses expectorant and diuretic properties, and in large doses it occasions vomiting and purging. It is employed as a stiuuilant expectorant, where there is evidence of a want of tonicity of the mucous membrane of the air passages, as in bronchitis and pneumonia ; when the acute symptoms have been subdued ; in chronic bronchitis and laryngitis, and in crou[), occurring in children of a debilitated or strumous habit. It is sometimes advantageously combined with nauseants, even in acute inflammation, where there is much debility; but is more frequently combined with other stimulant expectorants, as the gum-resius, as an excitant to the mucous membrane. It is a well ascertained fact, but not generally known, that the Squill, in substance, is a much better expectorant than any of its [)reparutions. ^,0 EXPECTORANTS. SENEGA. THE ROOT OF POLYGALA SENEGA— U. S. Preparations. — Tincture of Senega. Syrnp of Senega. Dose. — Of tlie tincture, gtt. j. to gtt. x. Syrup o^s. to 5j. Therapeutic Action. — Senega is described as expectorant, diuretic, diaphoretic, emmenagogue, stimulant, sialagogue, alterative, emetic, cathartic and resolvent. The therapeutic l)roperties of this agent are by no means inconsiderable, and fi'om the great diversity of active properties which it is ad- mitted to possess, it must be obvious to everyone, at a glance, that it is an important remedial agent, and one that is capable of exerting a strong influence over diseased states of the sys- tem. Its most prominent effect upon the system seems to be that of increasing or promoting expectoration. Senega is an energetic, stimulating expectorant, too exciting to be used in the early and active stages of pneumonic inflam- mation, unless combined with nauseants or demulcents. Its action is in proportion to the dose ; in small doses it is diaphoretic, diuretic, expectorant, stimulant, etc., while in larger doses it acts as an emetic and purgative. It has been used as a general alterative in various cases re- quiring the use of this class of agents, and from its almost universal and searching influences upon the organs and tissues generally, and from the increase which takes place in most of the secretions when it is taken, we can readily infer its altera- tive properties are by no means its least important ones. Probably its action in squamous disease of the skin is the most certain, and for this the tincture may be prescribed in small doses. ARUM. THE ROOT OF ARUM TRIPHYLLUM. Preparation. — Tincture of Arum. Dose, — From the fraction of a droj) to half a drachm. Therapeutic Action. — Indian Turnip is exj)ectorant, dia- ]i!ii)retic, stimulant, rubefacient and febrifuge. The recently dried root is a valuable remedy in coughs, colds, catarrhs and j)ectoral affections; more especially in the chronic and sub- acute forms of these diseases. Even in the acute forms of ALLIUM CEPA. 571 jmlinoiiary inflcunmatlon, if properly combined with uausGii- ting expectorants; or with demulcents, it may ho exhibited with safety and advantage. It has been advantageously em- ployed in pertussis and asthma, and also in chronic rheuma- tism. It seems to be more especially indicated in (hose cases in which ex[)ectoration is difficult, owing to an eiiieebled or atonic state of the respiratory ai)paratus. Even the f.esh root may be employed in these eases, by grating it and mixing it with four or five times its Vt'eiirht of suoar, so as to form a conserve, of which half a drachm may be given. It is some- times infused in milk, and used in coughs, etc. DEOSERA. Preparation. — Tincture of Drosera. Dose. — From the fraction of a drop to five drops. Therapeutic Action. — I use Drosera as a specific in the cough attending and following measles, especially where there is dryness of the respiratory mucous membranes. An expe- rience of twenty years with it, in a large number of cases, has given nie great confidence in the remedy. We also use it in cases of whooping cough, especially where there is dryness of the air-passages, and much irritation of the nervous system. Whilst it is not a remedy for all cases of whooping cough, it is a true specific in those to which it is adapted. I have often seen a serious case of the disease re- lieved in twenty-four hours, and an entire arrest of the cough in two weeks. We also employ it in cases of chronic cough, with dryness of the air-passages and nervous irritation, with much advan- tage. It makes little difference whether it arises from bron- chial irritation or inflammation, or ])hthisis, if associated with irritation of the basilar portions of the brain and pneumo- gastric. ALLIUM CEPA. ThePvAPEUTIC Action. — The Onion is expectorant, stimu- lant, diuretic, rubefacient and discutient. In medicine it is princi[)ally employed for its expectorant and discutient proper- ties. As an ex[)ectorant we consider it far superior to many of the remedies in common use in colds, catarrh, bronchitis, 0ically. A superficial vessel con- taining tar may be placed over a S[)irit-lamp, or a water-bath may be emi)loyed in order to cause the fumes or vapor to be constantly evolved and the atmosphere of the patient's chamber Constantly im[)regnated with a medicated vapor. Aqua Picis Liquidce. — Tar, Oij., water, cong. Oj.; mix, stirring with a wooden rod, for fifteen minutes. After the tar subsides strain the liquor, and keep in well-stop[)ered bottles. Stimulant, diuretc, pectoral, and used in chronic catarrhs, urinary disorders, and sometimes as a wash in chronic cuta- neous diseases. One or two pints may be taken in the course of the day. CREASOTUM. Creasote has been inhaled in the state of vapor in broncor- rhoea, phthisis and chronic bronchitis, as a direct excitant to the mucous surfaces of the respiratory passages, assisting the excretion of the accumulated mucous, or perhaps promoting tiie function of the secretory vessels when deficient from atony. The va[)or may be inhaled by means of the ordinary inhaling bottle, or twenty or thirty drops may be added to one quart of warm water, and the vapor inhaled through a tube introduced into a closely covered vessel or through the stopper of a bot- tle, or even through the spout of a coffee or teapot. EXPECTORANTS. EE8INA. Resin is employed occasionally as a topical expectorant in the varions laryngeal, bronchial and pectoral affections named under the head of Pix Liqnida. It is to be burnt upon live coals, or in some tin or earthen vessel over a lamp, in order to impregnate the air of the patient's room with its fumes. Blotting or common brown paper, that has been thoroughly soaked in a saturated solution of the nitrate of potassa, dried and smoked in a common tobacco pipe during asthmatic parox- ysms, is in many cases productive of great good, by promptly alleviating the distressing dyspnoea and other urgent symptoms. The vapor of hot water, vinegar and water, spirits and water, or many medicated aqueous fluids, is often ])roductive of wreat good when repeatedly and perse veri ugly inhaled in tonsillitis and other anginose affections, as laryngitis and tra- chitis ; also in bronchitis, pneumonitis, phthisis, etc. In many cases they may act only as palliatives, while in others they may prove valuable auxiliaries or even curative. Among the various articles employed in the form of inhalation that are boiled in simple water, vinegar and water, or pome alcoholic liquid and water, and the vapor thus afforded inhaled, with a view to the excitant influence upon the bronchial mucous sur- face, or with a view to the bland, mild and emollient influence of the Avarm vapor, — may be named Chamomile, Hoarhound, Boneset, Mullein, Catnip, Mayweed, Sage, Hyssoj), Elecam- pane, and sundry other articles which it would be superfluous to name. Perhaps the advantage supposed to be derived from these medicated vapors is more imaginary than real ; the real advantage being dei)endent upon the mild, bland, sooth- ino-, relaxant and emollient influence of the gentle warmth brought in direct contact with the tense, irritated, inflamed or ulcerated surfaces within every ])ortion of the respiratory tube. At all events, their utility can not be questioned in many of the cases named. EXPECTORANTS. 583 ^ SEDATIVE INHALATIONS. By a Sedative Inhalation is meant one, that, owing to tlie sedative or nareotic properties of the ingredients, relieves the irritation of the air-passages by its influence upon the nerves distributed to the mucous membrane. They are sometimes employed by smoking in a common tobacco-pipe ; in this way the Digitalis, Stramonium, Conium, Belladonna, tobacco, etc., have been found beneficiul in asthma, coughs arising from irritation of the pneumogastric nerve, etc. Tiie Digitalis was formerly thought by some to be almost a specific in certain forms of asthma. We may employ any of the sedative or narcotic agents in tincture, solution, infusion, or decoction, as inhalations. The apparatus for atomizing fluids, is now so perfect and so cheap, that patients can have them for their own use. For some cases the steam atomizer (Codman & Shurtliff's) will be the best, but for many others the air bulb will be quite as good. This method is especially applicable in chronic catarrh, the remedies being principally from the class Antiseptics. 584, SPECIAL THERAPEUTICS. DIVISION VIII. CLA.SS XV. AITTISEPTICS By the term antiseptic is meant any agency which coun- teracts sepsis or putrefaction. Those agents, therefore, which are supposed to possess the power of destroying or counter- acting the septic or putrescent tendency in the system, are termed antiseptics. This term is so frequently employed by our standard wri- ters on materia medica and therapeutics, to designate a property of medicines, without defining what is meant by such property, or why certain agents act in this manner, that we have ventured upon an innovation in this work, which many may think is not demanded by the present state of medical science or the wants of the profession. Whatever may be the views of others upon this subject, we deem a des cription of the agents supposed to possess this propertj^ their mode of action, and adaptation to the relief of those states of the system termed septic or putrescent, of suificient import- ance to warrant a chapter on this subject. That there does exist in many instances during the pro- gress of disease, a tendency to putrefaction or rapid decom- position within the system, no physician we think will pretend to deny. Sometimes this tendency exists in the whole system ; as is evinced by the general atony and extreme debility that prevails ; by the vitiated state of all the secretions ; hy the dissolved state of the blood ; by the cadaverous effluvia es- caping from the body of the patient; as well as by the lan- guid and unequal circulation, involuntary discharges, and many other symptoms unnecessary to name. These symp- ANTISEPTICS. 585 toms are observed in the malignant fevers, espocially in the aggravated forms of typhus and typhoid, and in some cases of scarhxtina maligna, and confluent small-pox. Gangrenous erysipelas, puerperal fever, many local injuries surgical operations, etc., may be adduced as instances of local disease in which a septic or putrescent tendency often exists, rendering specific treatment for its counteraction indispensable. For convenience, and the better understanding of this sub- ject, we will make the following division of this class of agents: 1. Tonic antiseptics; 2. Stimulant antiseptics; 3. Astringent antiseptics; 4. Chemical antiseptics. Hooper does not recognize the two latter divisions — astringent and chemical agents ; while he adopts two other classes — the antispasmodic and refrigerant antiseptics. The antispasmodic antiseptics that he names, — camphor and asa- foetida, — prove serviceable, as we believe, by their stimulant properties, producing a temporary exaltation of vital action, and not by that influence usually termed antispasmodic ; and therefore we regard such a division as erroneously founded. His division of refrigerant antiseptics likewise appears to be erroneous. Those agents which he names under this division, to w^it, acids, counteract a septic tendency ; but the question is do they do so from their refrigerant action. We think that this eflfect is due in part to their restorative- powers, and in part to their chemical influence. "We can not therefore regard the division of this class of agents into antispasmodics and refrigerants, as being based on a correct pathological view of septic diseases, nor of the therapeutic action of these agents. Although there may be objections urged against the views w^hich we hold upon the subject, yet we believe they will be found to accord better Avith our present knowledge of medical science, than any jthers which have heretofore been advanced. I. Tonic Antiseptics. — As a septic tendency is unquestion- ably connected with, or directly dependent upon a depressed state of the vital forces, whether the depression be general or local, it is obvious that those agents which tend to increasG the strength and vitality of the system, are those upon which much if not our chief reliance should be placed. 586 SPECIAL THERAPEUTICS. Tonics having this power, have accordingly been exhibited with ffrcat freedom to ward off or counteract the existing or anticipated morbid state or septic condition. Hence the use of the Peruvian bark and its preparations, the cornus florida, hydrastis, etc., in such cases. Many of the tonics possess stimulant and astringent qualities also, to which undoubted- ly may be ascribed additional antiseptic powers, whether the agent be employed as a general or topical remedy. By increasing digestion and assimilation they furnish a healthy material for the formation of blood ; and it is probable that they also exert a direct influence when in the blood, upon those parts of it which have not yet lost their vitality — pre- venting the progress of the septic tendency. Any measures that will increase or give strength to the vital force of the system, enabling it to resist chemical changes, will prove most powerful antiseptics. II. Stimulant Antiseptics. — Stimulants prove antiseptic in a similar manner to tonics : that is, they temporarily increase innervation, and thus strengthen the vital powers of the system. The extreme depression produced by a septic con- dition of the biood, depends in part upon its paralyzing in- fluence upon the nervous centers; stimulants counteract this depression by giving rise to an increased evolvement of ner- vous energy. These agents, however, to prove beneficial,, should be combined with tonics, so that the favorable im- pression produced may be rendered permanent. They also give an increased vis a tergo to the circulation, and probably by this means tliey may favor the excretion of the morbid material. In this way brandy, wine, and other alcoholic liquors, as well as many of the vegetable stimu- lants, as serpentaria, myrrh, capsicum, camphor, etc., prove beneficial. III. Astringent Antiseptics. — This division is not as well marked as the preceding, but there are so many articles pos- sessing this property M'hose principal action seems to be owing to their astrlngency, that we have thought the ar- raugeraent here adopted fully warranted. These agents are ])rlncipally used toj)Ically. Of this class we may name the barks of the different species of oak, hemlock, the sumach, marsh rosemary, wild indigo, etc. Perhaps many of the ANTISEPTICS. 587 agents employed for this purpose, and belonging to tliis di- vision, are dependent for their value, in part, upon some tonic or stimulant influence which they may exert. The mineral agents, as the sulphate of zinc, alnm, etc., used as antiseptics, may likewise owe part of their influence to their astringent and stimulating properties, as well as to their chemical influence. Astringents act as topical antiseptics by causing a conden- sation of the relaxed tissues, and imparting a normal degree of tone to the parts. lY. Chemical Antiseptics. — The antiseptic action of many remedies can not be accounted for in any of the three ways named; and the question now arises, how do such agents operate? We have no doubt that they act chemically upon the parts undergoing decomposition, although it may be im- possible to give a clear and philosophical explanation of this intricate subject. Sepsis or decomposition is a chemical change, a breaking up of the complex molecules which form oUr bodies, and the formation of less highly organized and vitalized compounds. So long as the vital force exists in normal strength, this chemical change is held in cheek ; it is exerted just far enough to break down the worn-out tissues of the body. But as soon as the vital force is greatly weakened, this chem- ical change assumes greater intensity. "The influence of poisons and of remedial agents on the living animal body evidently shows that the chemical decompositions and com- binations in the body, which manifest themselves in the phenomena of vitality, may be increased in intensity by chemical forces of analogous character, and retarded or put an end to by those of an opposite character ; and that we are enabled to exercise an influence on every part of an organ, by substances possessing a well defined chemical action." — ■ {Liebig.) Having established the point that there is a chemical action going on incompatible with the living principle or laws of life, is it not self-evident that any agent possessing a sufii- cient degree of chemical power to counteract the existing change, will arrest putrescency. If there is a putrescent or septic secretion, the chemical agent may neutralize and 588 SPECIAL THEEAPEUTICS. destroy its poisonous action upon other parts, as fast as se- creted, and thus prevent the propagation of the septic ten- dency. Among the many agents belonging to this division may be named the mineral acids, pyroligneous acid, creosote, sul phate of zinc, chlorine and its salts, carbonic acid gas, niter alum, carbo Hgni, yeast, alcohol, sugar, etc. That some of these agents act' in other ways is not to be denied; neverthe- less their chemical action is believed to be the most important. In Hooper's description of antiseptics, although he does not positively ascribe their curative powers to their chemical action, yet the reader can not but infer from the following quotations, that such are his views respecting some agents at least. "The presence of air, though not necessary to putrefaction, materially accelerates it; and those gases which contain no oxygen are very efficient in checking, or altogether prevent- ing the process. Carbonic acid also remarkably retards putrefaction; and if boiled meat be carefully confined in vessels containing that gas, it remains unchanged for a very long time, as seen in Mr. Appert's method of preserving meat." " There are many substances which, by forming new com- binations with animal matter, retard or prevent putrefaction : such as chlorine, and many of the saline and metallic com- pounds ; sugar, alcohol, volatile oils, acetic acids, and many other vegetable substances, also stand in the list of anti- putrefactives, though their mode of operating is by no means understood." The earths and salts are antiseptics, and probably act by absorbing the acids formed in the process of putrefaction. Carbon or charcoal of wood is one of the most powerful antiseptics, and probably not only acts by preventing oxy- genation of organized matter, but also in a manner similar to that just described above. It will restore tainted moat, and purify offensive water. Casks are now charred to con- tain water on long sea voyages, and it will continue pure and sweet in them for a long time. Charcoal in powder is suc- cessfully used in the cure of looseness of the bowels, and it has been known to cure intermittent fever. ANTISEPTICS. 589 Carbonic acid, chlorine, the saline and metallic compounds, acetic acid, etc., to which reference is made in the above quotations, are denominated antiputrefactives, and if so, how do they act, if not chemically? The new affinities which arise from their application, and the new combinations formed by their union with the products generated by de- composition, may so change the character of the decom- posing material, as to prevent the communication of the destructive process to the still vitalized tissues. That such chemical changes and reactions do occur in the body is not doubted ; and to this action, and this alone, are we to refer for a satisfactory explanation. "Warmth, air and moisture," says Pereira, "are the most powerful agents in promoting putrefaction, and their exclu- sion, therefore, is among the most effective antiseptics. Thus, cold, a vacuum and desiccation, are good conservatives of dead organic matters. Alcohol, sirups, fats and volatile oils are antiseptics; all act by excluding air, and some of them (alcohol) likewise by abstracting water from the or- ganic matter." The study of microscopy has shown that in all putrefactive processes there is developed certain micro-orgunisiiis, either vegetable or animal, and that this development keeps pace Avith the putrefaction. Whether the micro-organisms are the cause of the sepsis, or the result of it, is a disputed question, but the experiments of Tyndal, Pasteur, and others, would go to prove that some forms of decomposition are due to the pres- ence of these germs, and their rapid development. An organized body which will undergo rapid decomposi- tion if exposed to air containing these germs, will not undergo putrescence, if these germs are excluded. A wound exposed to an air containing the germs of these micro-organisms, will suppurate freely and the tissues will lose life and maybe slough, whilst under an antiseptic dressing there will be little pus formation and a rapid repair. Whether the modern doctrine that putrescence is due to the presence of these micro-organ- isms, is correct, or not, it is true that the antiseptic dressing of wounds and injuries is a great advance in surgery. In the consideration of the agents employed, we will adopt the more modern classification into antizymotics, and antisep- 590 ANTISEPTICS. tics. Some remedies belong alike to both classes, and may be used internally or locally, others belong to but one. Antizymotics are internal remedies which antagonize zymotic poisons, and the putrefactive processes of zymosis. Certain causes of disease, from their tendency to sepsis of the blood and tissues, have been termed zymotic, and the impair- ment of life which follows and which is inclined to propagate itself, is called zymotic. Typhoid symptoms are characteris- tic of these diseases. Exudations from the blood are dirty or dark-colored. As we usually look at the tongue to obtain this evidence, we find it dii'ty, or dark-colored — shades of brown and black. Typhoid and typhus fever, diphtheria, spotted fever, some forms of erysipelas, the severer types of small- pox, scarlet fever and measles, puerperal fever, typhoid pneu- monia, and typhoid dysentery, are examples of this class of disease. Antiseptics arrest the process of sepsis by their topical action, either destroying the septic poison, or the septic germs, or strengthening the tissues to resistance. The majority exert a chemical action upon devitalized tissues or secretions, and "will prevent putrescence if admixed with an animal sub- stance not outside of the body. Some of them may be called disinfectants, and are employed to destroy septic material and germs in the atmosphere, or in houses, di-ains, cellars, or even the earth around dwellings. These are of very great importance in preventing the propa- gation of disease, and in stamping out infectious and zymotic poisons. ANTIZYMOTICS. SODII SULPHIS. Dose. — This remedy is given in doses ranging from grs. j. to grs. XXX. Specific Indications. — The indications for Sulphite of Soda are a broad, pa//ic/, dirty tongue. The pallor is of the tis- sues of the tongue, the coating or fur is dirty, usually whitish or yellowish, and thick and moist. TiiEHAi'KUTic Action. — With these indications Sulphite of Soda is one of the most direct remedies we possess. It MAGNESII SULPHAS. 591 arrests the septic process, lessens the nervous excitation, slows the pulse, reduces the temperature, favors excretion, cleanses the stomach and bowels, and favors digestion. It makes no difference what the name of the disease is, or where it is located. It may be an ague, remittent fever, ty- phoid fever, small-pox, pneumonia, dysentery or diarrhoea, its curative influence is equally marked. In some cases it seems to fill all the indications for treatment, in others it prepares the way for remedies which influence the various functions of life. As a local remedy it is not frequently used, but occasionally it may be employed with good results. We would select those cases in which wounds or ulcers secreted a dirty pus, and the tissues were pallid and enfeebled. MAGNESII SULPHIS. Dose. — From two to ten grains. Therapeutic Action. — Following the same indications we would use Sulphite of Magnesium in cases showing typhoid or zymotic symptoms, the tongue having the same nasty coating, but not being so pallid. There are also cases in which the stomach will not tolerate the salt of soda, but will receive the Magnesium kindly. It may be employed in all cases of disease when these indi- cations present, and will be found a most excellent remedy. • Bisulphite of Sodium. — Dose, grs. v. to grs. xx. Sulphite of Potassium. — Dose, grs. v. to 3ss., in weak solution. Sulphite of Ammonium. — Dose, grs. j. to grs. v. Sulphite of Calcium. — Dose, grs. j. to grs. v. These sulphites have a similar antizymotic action and may be employed in somewhat similar cases. The Bisulphite of Soda is the same as Sulphite of Soda. Sulphite of Potash will be chosen where mucous membranes have a bluish color, and where there is muscular tremor. Sulphite of Ammonium is selected when a stimulant is required, or where there is a ten- deney to convulsive action. Sulphite of Calcium may be selected where there is inflammation of cellular tissue, or furuncular disease of the skin. 592 ANTISEPTICS. SODII SULPHOCARBOLAS. Dose. — From five to twenty grains. Therapeutic Action. — Sulj)ho-carbolate of Sodium may 1)6 employed in similar cases to the sulphites just described. It is claimed tliat carbolic acid exerts a very direct influence in controlling the temperature, as well as in opposing the sep- tic process. And this combination is thought to possess the properties of carbolic acid in a full degree. It has been rec- ommended in typhoid, typhus and scarlet fever, and especially in typhoid pneumonia, and when there is a low grade of de- posit. It has also been employed with reported good success in the treatment of phthisis pulmonalis. ACIDUM SULPHUROSUM. Dose. — From ten drops to one drachm. Specific Indications. — Sulphurous Acid is indicated by a tongue of ordinary redness showing a glutinous nastiness, yellowish brown in color on its surface. Tissues look as if they had lost vitality, deep red, and as if they might slough. The tongue sometimes looks as if fecal matter had been rub- bed over it. Therapeutic Action. — With these indications. Sulphu- rous Acid becomes one of our best antiseptics. We employ it in the advanced stages of remittent fever, in typhoid fever, typhoid pneumonia, typhoid dysentery, scarlet fever, small- pox, diphtheria, puer])eral fever, and in surgical fevers. It is a very serviceable topical remedy in cynanche maligna, in scarlatina maligna, and in diphtheria where the mucous membranes show dusUy coloration. We use it as a gargle, or with the air-spray apparatus. It is also a good remedy in vesicular and pustular disease of the skin, taken internally in full- doses, and used as a wash. ACIDUM MURIATICUM. Dose. — For ordinary use it is added to water so as to make a pleasant acid drink, and given freely. Specific Indications. — The tongue is deep- red, dry and contracted, and has a brownish coating. Or it is deep or dusky red, moderately full, slick, and looks like a piece of spoiled beef. BAPTISIA. 593 Therapeutic Action. — The symptoms above named are common in the advanced stage of" continued fevers, and in other diseases which deveh)p typhoid symptoms in their prog- ress. In sonic years and in some localities, the deep-redness, and brown coating of tlie tongue is the common feature of disease, and the acid treatment is the best that can be employed. Anstie & Chambers, of England, report some hundreds of cases of typhoid fever treated with acids alone, with good food (usually milk), good air, cleanliness and good nursing, in which the mortality was below four per cent., and in one year dropped down to one })cr cent. If a physician should have but one death in twenty, in a season of typhoid fever, he would think himself doing remarkably well. Many take a great deal of credit where they have but one death in five. Let it be remembered that whenever an acid is indicated by the deep redness of the tongue, it will be a part of a godd treatment. Whether the disease is a fever of low grade, an inflammation of the lungs, a dysentery or a diarrhoea, it is alike beneficial. When a dilute muriatic acid can not be taken, lactic acid in the form of whey, or a good sharp cider may be given in its place. BAPTISIA. THE LKiiVES AND BARK OF THE ROOT OF BAPTISIA TINCTORIA— U. S. Preparation. — A tincture of the bark of the fresh root. Dose. — From the fraction of a drop to five drops. Specific Indications. — The face is full and purplish, like one who has been long exposed to cold. There is the same fullness and coloration of tongue and fauces. Therapeutic Action. — With these indications, Baptisia is one of the most certain of antiseptics. We employ it in continued fever, in remittent fever Avhen typhoid symptoms are developing, in scarlet fever, and in dysentery and diar- rhoea. In many cases of disease, the indications for Baptisia will be pronounced the first day, and the remedy is given at once, without waiting for other evidences of sepsis or putres- cence. This, of course, is true of all the remedies we have considered, though manv times thov arc not given until a 38 594 ANTISEPTICS. more advanced stage. An cai-ly administration of the pro{)er antiseptics can not be too strongly nrged. In high grades of inflammation of the bowels or other in- ternal organs, witii a tendency to gangrene or mortification, Baptisia enjoys a high reputation. It is often resorted to as a gargle in diseases of a putrid character, alfecting the throat. In scarlatina maligna, angina maligna, and in the malignant forms of variola affecting the fauces, and also in ulceration caused by mercury, and in all the ordinary forms of ulceration of the mouth and throat, this agent answers an admirable pur- pose as a gargle. It is valuable as a topical agent in cases of syphilitic ulcers, and in white-swellings and fever-sores; in i)hagedenic, foul, fetid, and gangrenous nlcers, also in sore nipples, chronic and scrofulous ophthalmia, fetid leucorrhoeal discharges, whether attended with ulceration of the genital organs or not. It acts as a topical tonic and gentle excitant to the vessels and parts implicated in the ulcerated ])rocess. For external })urposes it may be employed in the form of a cataplasm, fomenttition or decoction. The cortical portion of the root may be pulverized and mixed with slippery elm and applied as a poultice to foul and gangrenous ulcers and parts, or it may bo bruised and used as a fomentation, or a strong decoction may be prepared and cloths dipped in it, asul applied to the affected part; or the same may bo used to cleanse fetid and putrid ulcers, while at the same time advantage may be derived from its internal use. In cases of apprehended or existing gangrene of the bowels, cloths should be di[)[)ed in the strong decoction and frequently applied to the bowels, and at the same time the pa- tient should take the decoction internally. An ointment, ])re- pared by simmering it in cream, has been found beneficial in sore nipples and ulcerated breasts. POTASSII CHLORAS. Dose. — The dose will range from grs. ij. to grs. xx. Specific Indications. — Tlie odor is like decomposing flesh. The odor from an offensive lochial discharge (putres- cent), and from cynanche maligna, is the ty[)ical indication. Mucous membranes are bluish white, and the coating of the tonjiuc thick and dirtv. CHLORATE OF POTASH. 595 Theeapeutic Action. — Chlorate of Potash has been largely employed as an antiseptic, and many times with excel- lent resnlts. Yet physicians have been snrprised at the want of nniformity in its action, and the occasional unpleasant re- snlts which they have been loth to attribute to the medicine. It is a very good remedy when indicated — none better; it will sometimes do much damage, if contra-indicated. We find a prominent place for it in obstetric pi'actice, and it seems to be par excellence the remedy for putrescence in uterus or vagina. A-s already remarked, the odor is so characteristic that there can be no mistake. Blood is retained, and the lochia becomes oifensive; a portion of placenta is retained, and evidence of putrescence is soon manifest; the ordinary discharges become putrescent and are offensive. In these cases the patient complains of pain and weariness, chills and fever follow. It may be of brief duration, but the blood is poisoned, and there is a slow recovery and impairment of the health for a long time. Or we may have a grave puer- peral fever, metritis, or peritonitis, developed from these causes. Here the old adage, " an ounce of prevention," etc., comes in good play. It is a case of abortion, and despite our efforts the placenta is not found, or a portion of it remains behind. It is a case of labor at full term, and a shred of placenta or membrane, or blood-clot, remains. We know there will be putrescence and blood poisoning, and we provide against it by the administration of small doses of chlorate of potash. Chlorate of Potash has been given internally in malignant sore tliroat and in diphtheria, with excellent results. It has also been used in the advanced stages of inflammation showing typhoid symptoms, and in the continued fevers. It will find a prominent place in surgical fever, if the indi- cations are noted and strictly followed. I recall a case of am- putation in which the discharges from the stump had the char- acteristic odor, the surgical fever assuming a grave type. The patient was relieved by the admkiistration of five-grain doses every two hours. As a topical remedy, a solution is used in sore mouth, sore throat, catarrh, influenza, ozsena, vaginitis, and gleet. In some of these cases the curative action of the remedy is very decided. 596 ANTISEPTICS. Chlorate of potash is an irritant to the kidneys, and the danger that attends its administration in some cases is due to this. The physician does not note this fact, and makes his usual prescription, and dose by dose the urine becomes scantier, until finally ursemic irritation, followed by coma, is the result. This danger should always be borne in mind, and the remedy used with care. ANTISEPTICS. THYMOL. Preparations. — For local use it is employed in solution in the proportion of from 1 to 1000, to 1 to 200 parts of water, using a small portion of alcohol to effect the solution. For internal use, 1 to 3000 parts of water, in doses of a teaspoon- ful to a tablespoonful every two or three hours. Therapeutic Action. — Thymol is one of the most power- ful topical antiseptics, and being less irritant and offensive than many others, it is largely employed as an antiseptic dres- sing. In surgical operations and wounds, the stronger solu- tion may be used as a wet dressing, as a spray, and to moisten the instruments; the solution of 1 to 1000 is thought strong enough. ^In many cases the continued application of Thymol prevents inflammatory action, and pus is formed in but small quantity, and there is no surgical fever. When the part is examined under the dressing, it is seen to be of normal color, normal temperature, and free from pain. It has been employed as a gargle, and ^vlth the spray appa- ratus in diphtheria, and malignant sore throat, in severe ton- sillitis, and in acute and chronic catarrh. It has been sug- gested as a good injection in gonorrhoea, and used with advan- tage in the treatment of leucorrhoea. ACIDUM SALICYLICUM. For internal use, it should be prepared from oil of winter- green. For external use, it may be prepared from carbolic acid. Dose. — Internally, the dose will range from grs. j. to grs. x. It may be given in two grain pills, or in solution, with acetate SALICYLIC ACID. 697 of ammonium, acetate of potasli, or bicarbonate of soda. For external use, I generally employ it with borax, one' drachm of each to the pint of water. THERA.rEUTic AcTioN — Salicylic acid is employed as an In- ternal remedy for the cure of rheumatism and has gained considerable reputation. I should select for its administra- tion, cases of sub-acute rheumatism, or the acute disease, with a liigh temperature, but soft skin, and a bluish tongue, moist. In some years it answers an excellent purpose, but at other times it is of no benefit. It has been claimed to have marked antipyretic properties, and has been employed In very large doses, as much as twenty grains every three hours. But this use has been found to do more harm than good. In solution with borax it is one of the best antiseptic dress- ings I know. Whether it is an Injury, a surgical operation, or an inflammation terminating in suppuration, it may be em- j)loyed with good results. In at the same time, there is but little loss of blood. Warm diluent drinks are the simplest agents that can be used, and are frequently apparently successful : if the stomach does not reject them, and they are grateful to the patient, they may always be allowed. Friction over the uterine globe is frequently successful in increasing the frequency, length, and intensity of the pains, and may be resorted to for this purpose. Change of posture, or exercise in the room, when not contra-indicated, is a very efficient means of stimulating the contractions of the uterus. It also gives relief to the patient to change her position, sit up, or walk in the room, as lier own inclination dictates. ERGOTA— SECALE CORNUTUM. THE FUNGOUS GROWTH ON RYE. Preparations. — Powder. Infusion. Tincture of Ergot. Dose.— Of the powder, grs. x. to grs. xv. every fifteen to thirty minutes ; of an infusion, .5j.; of the tincture, gtts. v. to .5j- Therapeutic Action. — Ergot is a prompt and very effi- cient parturient, and as such is more frequently exhibited than any other article of the materia medlca. Indeed it is believed bv many to be the only article now known capable of exerting a specific action upon the uterus, causing its fibers to contract and its contents to be expelled. In small doses it exerts no obvious effiict upon the male, and upon the uterus of the unimpregnated female it has also been said by some to exert no perce})tible influence; and even in a state of pregnancy others have asserted that it does not act usually upon that organ unless it is in a parturient state — unless labor has absolutely commenced. Its action upon the unimpregnated uterus is clearly manifested by the bearing-down pains or uterine contractions which it causes, and by its ca- pacity to check uterine hemorrhage, expel hydatids, polypi, etc., I ERGOTA. 623 and even to Indnce metritis, and the frequent abortions which it has caused may be cited as })roofs of its action upon that or- -gan before gestation is completed. In over-doses ergot is an acro-narcotic poison. Nausea, vomiting, vertigo, dimness of sight, loss of sensibility, cold- ness, and insensibility of tlie extremities, convulsions, and other disordered states of the nervous system ; typhoid and epi- demic diseases, with abscesses and gangrenous ergotism of va- rious parts, which become black, dry, and shrunk, attended with loss of tiie toes, etc., etc., are evidences of its deleterious effects upon the system. When taken for a long time in large quantities mingled with the food — circumstances Avhich have occurred in many of the European States, as France, Prussia, Bohemia, Saxony, Denmark, Switzerland, etc. — the effects stated which were satisfactorily traced to this cause, can not fail to establish its character as a poison. The most important therapeutic application of the ergot is that of a parturient. When the contractile energies of the uterus are feeble or insufficient to secure the delivery of the foetus the ergot is an appropriate agent. Labor not unfre- quently cpmmences and continues for a long time, but owing to the feeble contractile action of the uterus, it does not ad- vance, and the strength of the patient may become exhausted; or the pains may be strong and the contractile energies of the uterus may be such as to advance the labor during its early stages, but its powers may become expended, or it may pass into a state of inertia ; or one set of uterine fibers may act pretty efficiently while the other set is inactive (a circumstance which we have witnessed in several instances), or the strength of the patient may be exhausted. In either condition the ergot will be found exceedingly important in arousing the uterus to in- creased action. Prior to the administration of the ergot in all cases, it be- comes the imperative duty of the accoucheur to ascertain, first, that there is a proper presentation of the foetus; second, that there is a proper conformation of the pelvis and soft parts; and third, that the os uteri is dilated or easily dilatable, and the soft parts relaxed and lubricated with the proper secretion. It is evident a deformity of the pelvis, a contracted pelvis and large head, rigidity of the os uteri and soft parts, apresen- 624 PARTUKIENTS. tatlon that would offer a mechaMical impediment to the delivery, are circumstances which contraindicate its exhibition ; nor should it be given early or before the head has descended in- to the pelvis. Ergot is indicated when the life of the patient is endangered by extreme exhaustion from the long continuance of labor, or by hemorrhage occurring during labor, after the rupture of the membranes, provided the placenta is not situated over the OS uteri, and also in cases of death of the foetus, when the speedy completion of the labor is required in order to save the life of the patient. It is indicated when the placenta is retained from want of uterine contraction. In cases of hemorrhage, however, the manual extraction of the placenta should take the precedence, as the death of the patient might ensue before the action of that agent Mould cause contraction and its expulsion. The introduction of the hand generally excites uterine contractions. In anticipated hemorrhages (for there are some females sub- ject to flooding at every confinement), its use is indicated fif- teen or twenty minutes before labor is expected to be com- pleted, in order to insure the immediate expulsion of the pla- centa and the early tonic contraction of the uterus. We omitted to state in its proper place that in oiates and foot pre- sentations it may be necessary to use it, to prevent the child from becoming asphyxiated — a circumstance which may occur from the compression of the cord between the head and the bones of the pelvis, if the head is long retained in this position. The accumulation of clots or coagula in the womb, the for- mation of hydatids or the presence of polypi, indicate the use of the ergot. In uterine polypus, it has been employed to se- cure the descent of the tumor into the vagina, in order to ren- der it accessible to mechanical extIr{)atIon. Ergot is employed to restrain uterine hemorrhage, whether puerperal or non-puerperal. It causes a contraction of the muscular fibers of this viscus and thereby compresses and empties the vessels and closes their orifices. It is also found to restrain excessive lochial and catamenial discharges, showing that a state of pregnancy is not, as has been asserted by some, an indispensable condition to Insure its specific action upon the uterus. EEGOTA. 625 In cases of abortion or threatened abortion, attendotl with hemorrhage, or in cases where abortion is desirable from a de- formity of the pelvis, the pelvis being so contracted as not to admit the passage of a full-growa fsetns, the ergot has been employed. Its utility in arresting hemorrhages from other organs has been asserted, but it is difficult to explain its therapeutic action in these cases, and indeed many writers think its capacity to arrest hemorrhages from the nose, gums, lungs, stomach, bowels, etc., as has been asserted by some, is more than doubt- ful. It can not be denied, however, that many respectable medical men repose confidence in its utility in these cases. Notwithstanding the Ergot is justly entitled to a high meed of praise for its true value as a parturient, yet the fact that it is capable of doing serious injury to both mother and child, if injudiciously employed, should not be disguised. That it has often destroyed the child does not, we think, admit of a reason- adle doubt. When given as a parturient, its action upon the uterus is generally percej)tibleand unmistakable in from ten to twenty minutes, in the violence and unceasing character of the pains: they are constant, unremitting, or if they do remit, the remission is but momentary — they do not usually cease until the expulsion of the'child, and in many instances they continue for some minutes after, and thus secure the speedy removal of the placenta and also the contraction of the uterus into a glo- bular form. If there should be a distortion of the pelvis capa- ble of producing a mechanical impiediraent to the advancement of the foetus, it is evident this unceasing, forcing, contractile effort on the part of the uterus to get rid of its contents, might assume such violence as to cause its rupture or the death of the child. When the uterus is full}' under its influence, that alternate contraction and relaxation observed in the natural process of labor, is no longer witnessed — a permanent rigidity of the soft parts is maintained, and unless they are soft and flexible — in other words, in a state of proper relaxation before the ergot is administered — it is evident a laceration of them may ensue, and in this way also endanger the life of the mother. 40 626 PAETUKIENTS. USTILAGO MAYDIS. THE FUNGUS GROWING ON ZEA MAYS. Peepaeatton. — Tincture of Ustilago Maydis. Dose. — From the fraction of a drop, to 5j. Therapeutic Action. — This fungus (corn smut) has a very similar action to ergot of rye though its parturient action is not nearly so strong. Given in moderate doses, say 5ss, it is thought to increase the force of uterine contractions. It is employed to stimulate spinal and sympathetic innerva- tion, and to give strength to the capillary and venous circula- tion. It may be given in hemorrhage from the uterus, bowels, or lungs. In impairment of the cerebral circulation with diz- ziness, inability to command the voluntary muscles, or the ac- tivities of the brain, this remedy will sometimes serve a better purpose than Ergot or Belladonna. In diseases of women, it may be thought of when the person has a pendulous abdomen, full and relaxed perineum, and in- crease in size of the uterus with atony. CAULOPHYLLUM. Preparation. — Infusion. Tincture of Caulophyllum. Dose. — Of an infusion, Sss. to oj- ; of the tincture, gtts. v. to5j. Therapeutic Action. — Caulophyllum is described as being parturient, emmenagogue, antispasmodic, diaphoretic, diuretic and alterative. It possesses some reputation as a parturient; many considering it the equal of ergot. Its action, however, is stated to be essentially different, for while the ergot produces continuous spasmodic contractions, this agent merely stimu- lates tiie normal uterine action. As a parturient the warm in- fusion is administered freely. It is a very good emmenagogue, applicable in almost all conditions of the system. Many who have used it attest to its merits in hysteria and other nervous affections. It appears to impart a vigorous and healthful energy to the nervous system. The Indians of our country employ it with great advantage as an antispasmodio and emmenagogue. It has been found useful in chorea, epil- epsy, tremors, spasms of the stomach or bowels, and also as a CAULOPHYLLUM 627 remedy preparatory to parturition. It is said to be exten- sively used among the Indians to faciliate parturition. We liave used it often, and known of its being used frequently by others, for a few weeks prior to eonfinement, as a prepara- tory measure to the important changes which take place at that time, with great apjiarent advantage. In many instances, when the females had been invariably the subjects of tedious and difficult labors, by the use of it for two or three weeks be- fore confinement, all the anticipated difficulty vanished, the labors were rapid and easy, and the recovery speedy when com- pared with previous confinements. Although it may be some- what difficult to assign a satisfactory reason as to the effects stated, or in other words its therapeutic action maybe difficult of explanation, yet the effects have been so apparent, that any one knowing the character of different labors, would be forced to ascribe the different results to the use of this remedy. We have employed it to a considerable extent in the treat-, ment of chronic uterine disease, metritis, ovaritis, inflamma- tion of the cervix uteri, leucorrhoea, etc. It tends to subdue chronic inflammation, lessens irritability, and gives tone to the uterine organs. We have also employed it with advantage in chronic nephritis, albuminuria, cystitis and urethritis. There are various other articles said to exert more or less in- fluence over the parturient uterus, augmenting its contractile and propulsive powers when they are feeble, or not sufficient to advance the labor and secure the early expulsion of the fetus. Amono; these agents mav be named the Macrotys Racemosa, or Black Cohosh. This article has been elsewhere fully described, and its parturient powers remain to be noticed. It has been employed by many as a substitute for the ergot, it being supposed to act upon the parturient uterus, and augment its contractile energies. Adea Alba, is also reputed a parturient. Mode of exhibi- tion the same as that of the Macrotys. Asarum Canadense, is likewise said to increase the partu- rient efforts of the torpid uterus. Many other articles, as ginger, black pepper, capsicum, tansy, etc., are in common use in domestic practice, as parturients. They are thought to excite the uterus and facilitate labor; and in many instances, to gratify the caprice of the patient, or that 628 PAKTURIENTS. of her friends, we have given some of these agents, and with apparent benefit. It would seem, indeed, that almost any warm or excitant infusion, will occasionally prove beneficial;, not, as we apprehend, by any specific action which they mayi exert upon the uterus, as is the case with the ergot, but by; newly exciting or impressing the nervous system, and perhaps by increasing vascular excitement and arousing the organism to renewed action. Another measure of great merit consists in the constant ap- plication and very frequent repetition of hot cloths — cloths wrung out of hot water and applied every five minutes over the hypogastric region — the hotter the application the better. Hot spirits might be applied in the same way. This applica- tion rarely fails to increase the force and activity of the pains, and will in most instances answer as a substitute for the ergot. We know not but cold applications might answer the same or a similar purpose. We have never tested their efficacy. We have applied cloths wet with cold water or spirits of vine- gar, over the hypogastric region, immediately after the birth of the child, to secure the speedy expulsion of the secundines and arrest hemorrhage, and have found them to cause an im- mediate contraction of the uterus in every case, even after grasping and frictions had failed. We recollect having applied cold camphorated spirts, or cold whisky over the uterine region, in a few cases of parturition, in which the pains were very feeble, or else the uterus had fallen into a state of inertia. These applications seemed to arouse and restore the lost powers of that organ, and do much in facilitating the labor. From this we infer the impression of the cold liquid upon the nerves distributed to the uterus and surrounding parts, induces a vigorous reaction in those parts, and thus the uterus is aroused, and its propulsive powers re-established, or greatly augmented. ABOETIVES. 629 CLi^SS XVIII. ABORTIVES. Abortives are those agents which are capable of produc- hig an abortion or miscarriage in pregnant women. They are supposed to exert a specific influence over the gravid uterus, and to be capable of inducing uterine contractions, and eft'ecting the expulsion of the fetus. We think that this class of reputed agents might with much propriety be stricken from the materia medica. That certain agents are capable of producing abortion, and do, under particular cir- cumstances, have that effect is not denied, but that they produce it by virtue of any specific influence exerted upon the uterus under the ordinary circumstances of their admin- istration, is very questionable. Those agents which do produce abortion, act as very pow- erful stimulants or irritants. By the violence of their action upon the system, and especially upon the pelvic viscera, they incidentally excite the uterus to contraction, and cause the expulsion of its contents. Emetics, drastic cathartics, active stimulants or excitants, vesicants, stimulating diuretics, etc., not unfrequently induce abortion in this manner. Lifting, riding, leaping, over-exertion, excessive venery, sudden fright, or any strong mental emotion, excessive use of stimu- lants or condiments, scanty and innutritions diet, may each in its- turn, and under certain circumstances, produce the same result. Ergot is said to be an abortive by some, while others deny it, and say that it acts only upon the uterus during the pro- cess of parturition. It is claimed by others that this agent acts upon the uterus at any time, whether in its gravid or non-gravid state. The action of this agent, however, has been already fully considered. 630 SPECIAL THERAPEUTICS. There are other articles spoken of as abortives, but for the reasons above given, and as these articles are all referred to, and their properties given in the description of other chisses, we think it enough merely to name them in the present instance. The reputed abortives are, the savin and its oil, oil of tansy, rue and its oil, actea alba, gossypium, asaruin canadensis, black hellebore, etc. ]Sro agent of this class can be administered with any pros- pect of safety, for the production of abortion ; their action in almost every instance produces severe uterine inflamma- tion, or such a loss of power that uterine hemorrhage is the result. NYSSA MULTIFLORA. Preparation. — Tincture of the recent bark. Dose. — One teaspoonful every half hour to two hours. Therapeutic Action. — Dr. J. W. Pruitt writes: "My knowledge of it is from reports of those who have used it. Many years ago a very intelligent country old lady informed me of its antiabortive effect. It was given in decoction freely. My friend Dr. Thompson, of this place, informs me that he lias had very satisfactory results from it in several cases of threatened abortion, giving it in infusion, in tablespoonfnl doses every few minutes ; the doctor informs me it is very effi- cacious in false and inefficient pains. He obtained his knowl- edge from a colored woman, ninety years old, who had lived all her life among the Cherokee Indians." VIBURNUM. THE BARK OF THE ROOT OF VIBURNUM PRUNIFOLIUM. Preparation. — Tincture of Viburnun. Dose. — From the fraction of a drop, to ten drops. Therapeutic Action. — Viburnum exerts a direct influ- ence upon the uterus, quieting irritation and stopping contrac- tions of its muscular flber. It is the most certain remedy to j)revent or arrest the progress of abortion, that we liave, and in any case when it can be stopped, this remedy may be relied VIBURNUM. 631 on. I have used it for ninny years, and place so nincli confi- dence in it that I always carry it in my pocket case for this purpose. It will be found a good remedy in case of habitual abortion, given in small doses up to the fourth or fifth month, or if not given constantly, it should be administered for a week at the ])eriod when the monthly flow would recur. It is a valuable j-emedy in some cases of dysmenorrhoea, in irregular and profuse menstruation accompanied by pain. The diseases of women in which it is useful, are those associated with painful contraction of the pelvic muscles. VIBURNUM OPULUS. Preparation. — Tincture of Viburnum Opulus. Dose. — From the fraction of a drop to ten drops. Therapeutic Action.— This species has a somewhat simi- lar influence to the other, and may be used to prevent or arrest abortion or miscarriage. It would be selected when spasmodic action or cramp of the muscles is a special feature. Hence the common name of the remedy : cramp bark. It will be found a valuable remedy in dysmenorrhoea, and in many painful affections of the pelvic viscera. It relieves irri- tation, promotes a normal circulation and nutrition. 632 SPECIAL THERAPEUTICS. DIVISION X. CLA-SS XIX. ANTISPASMODICS. Antispasmodics may be defined to be those agents which counteract spasm. They may be justly divided into two classes, the direct and the indirect, though we have no positive proof that there are any agents possessing direct antispas- modic properties. The mode in which these agents act is involved in much obscurity. So much so, that very different views are held by different authors. By some they are classified with nar- cotics, others class them with diiFusible stimulants, others with special stimulants, while others again have determined that they are sedatives, admitting at the same time that their first efl'ect is stimulant. Action of Antispasmodics. — In attempting to solve the prob- lem, of how this class of agents act, we will first have to notice the cause of convulsion or spasm. Spasm may arise in two diflerent ways; first, as an exaltation of the natural irritability of the muscular fiber; and second, from an irrita- tion of the nervous centers. Muscular fiber is endowed with the peculiar property of irritability, or contraction on the application of some stimu- lant. This property may be either increased, or diminished. In the first instance we may have an excessive contractility or spasm, from the influence of a slight stimulus; avc have an example of this in the irritability of the bowels in Uentery, ■where the action is so rapid that the food is passed through the intestines so rapidly that it can not undergo the digestive ANTISPASMODICS. 633 process. Again we have it in the tonic spasm or cramp, in which the contraction is not alternated with relaxation. " Such spasms, " says Dr. Williams, " are not unfreqiiently felt in the calves of the legs ; and in the different muscular canals, the gullet, the stomach, the intestines, and the glottis, which occasionally present this state of continued contraction. lu most of these cases, it is accompanied by pain more or less severe, and may lead to serious obstruction to the function of the organ. When in a more moderate degree affecting the voluntary muscles generally, it constitutes catalepsy, in which, from the muscles remaining contracted, the limbs will retain whatsoever attitude they are placed in, until the spasm is over. But the extreme example is tetanus, m which the spasms are so violent and so enduring, that they may be said to squeeze the patient to death. The pathological cause may be, either an irregular supply of blood to the muscle, or irritation, direct or indirect, of the motor nerves by which the muscles are excited." It is obvious that in this case sedatives will prove valuable antispasmodics. They lessen the irritability of the muscle, and also its stimulant to action. The efficacy of lobelia and other emetic agents, in the more severe cases of this kind, is to be ascribed in part to its sedative influence, to the severe shock produced upon the system, and to its equalizing the circulation. These, however, are but temporary means, aiid our main dependence for a radical cure will have to be placed upon such agents as will give tone and strength to the entire system. The second cause of convulsions or spasms is an irritation of the nervous centers, either centric, arising within the nervous matter ; or eccentric, tlie irritation being transmitted to the spinal cord from some other portion of the system. Inflammation or other disease of the brain and spinal cord, or their membranes, may give rise to the first variety, as in apoplectic and epileptic convulsions arising from disease ''f the brain, convulsions arising from spinal meningitis, etc. By an eccentric irritation, ^ve understand one that exists in some other portion of the body, but which is transmitted to the spinal cord by the sensitive nerves, and gives rise to a rejicx action. Such we have in the convulsions arising from 634 SPECIAL THERAPEUTICS. teething, from worms, from acrid matters in the alimentary canal, from uterine or renal irritation, etc. Again, we may suppose that the same result would follow from mal-nutrition, as we observe in chorea, in some cases of epilepsy, etc. Here, undoubted!}'', the disease exists in the blood ; it either fails to supply a proper quantity and quality of nutritious matter to the nervous system; or else it contains an irritant material capable of exciting a reflex action of the spinal cord. " When these phenomena," says Dr. Williams, " arc general or extensive, as in convulsions, tetanus and paraplegia, we must refer them to an undue excitement or erythism of the spinal and prolonged medulla; but the more partial exam- ples, as palpitation of the heart, and spasm of the bronchi, from intestinal irritation, etc., may arise from similar excite- ment of a small portion of it only, or of the incident nerve of the part which occasions the phenomenon, or of the excito- motory nerve of the part which exhibits the phenomenon. " If we seek to know the causes of this excitement, we shall find that, as in excess of other vital properties, it is sometimes referable to an increased flow of blood through the spinal marrow or its nerves, or the branches of the sym- pathetic nerve. Thus the early stage of inflammation of the spinal cord or of its sheath, is attended with convulsions or tetanic spasm. It is very probable that the spinal excite- ment (convulsions) occurring in epilepsy and apoplexy, is in part due to the flow through the medulla being increased in proportion as that through the brain is impeded ; a con- sideration of the causes of convulsive paroxysms, and of the distribution of the vertebral arteries, much countenances this supposition. But in many cases, the excitement seems to be of a more direct nature. Strychnia, in a poisonous dose, excites the medulla so speedily, causing tetanic spasm, that its eflect can scarcely be due to increased flow of blood. So, too, we know that mechanical irritation of the spinal marrow, or of its nerves, will cause convulsive motions; and we find this exemplified in the eflect of tumors and spicula of bone in the spinal canal, in the head, or in the course of nerves. But nothing exhibits this element of nervous irri- tation (apart, so far as is yet known, from vascular influence) 80 fearfully as traumatic tetanus. The irritation here begins ANTISPASMODICS. 635 in a distant nervous branch, and is pi jpagatcd to the medul- laiy center, the excito-motory function of wliich at lengtl' exhibits a state of erythisni wliich destroys life either di- rectly by tonic spasm of the muscles of respif^ation, or by exhaustion. "Another cause which maybe fairly assigned for increase of the involuntary excito-motory property, is accumulation by rest. This causes the augmentation of this property in the medulla, in narcotism from opium, and in injuries of the spine, which suspend the exhausting influence of volition on the whole or part of the marrow, in which the nervous en- ergy therefore accumulates, and becomes unusually abun- dant. There is a natural increase of this property in sleep, which, by suspending the sensorial functions, augments the energy of those of the medulla; and this accession of power,' which maintains the movements of respiration during sleep, also disposes to the occurrence of spasmodic attacks at this time ; hence the fits of epilepsy and asthma commonly come on during sleep. So, likewise, sedentary habits and too much indulgence in sleep, may cause an accumulation and morbid excess of involuntary nervous power, and develop convulsive and spasmodic symptoms, which are the result of its overflow. From what has been stated above, it will be seen that al- most all classes of the materia medica may furnish articles which will prove antispasmodic under certain circumstances. If spasm depends upon an irritation of the spinal cord, its membranes or nerves, such agents as tend to remove this irritation are indicated. If it depends upon an unequal cir- culation, those remedies which counteract this condition will prove useful. If it depends upon an eccentric cause of irri- tation, as morbid material, worms, etc., in the alimentary canal, the agents that wdll remove them prove the most val- uable antispasmodics. And lastl}^, if it depends upon the condition of the circulating fluids, this will have to bo changed. The agents generally classed as antispasmodics, as the musk, castor, asafoedita, galbanum, etc., are probably bene- ficial on account of their gently stimulant and soothing in- fluence upon the system. They are valuable in cases of 636 ANTISPASMODICS. eccentric convulsions, from the fact that such cases are fre- quently caused by irritation of tiie alimentary canal, and these agents allay such irritation. They may probaMy owe their beneficial effect in hysteria in part to the same cause ; l)ut there can be no doubt that their slightly stimulant influence, an<:l the impression made upon the mind of the patient, have much to do with their antispasmodic powers. CHLOROFORM. Chloroform, fully considered under the head of anaesthetics, deserves a first place in this list, for it may be successfully employed when internal remedies can not be given. Used as an inhalation it is one of the most powerful antispasmodics in the materia medica. Whether it is a case of convulsions in children, an attack of epilepsy, hysterical convulsions, or the greatest of all, puerperal convulsions, its action is very cer- tain. It relieves irritation of the cerebro-spiual centers, and relaxes the muscular system. Its use is safer than might at first appear. The physician gives it with an abundant supply of air, and as it is adminis- tered the breathing becomes easier, the pulse better, and the muscular system commences to relax. The convulsion passes off before ansesthesia occurs, and the inhalation is then sus- pended, or used in less quantity. In infantile convulsions, we frequently meet with cases when it is impossible to give anything by mouth. Here in place of the olden times hot bath, and enema, chlorofi)rm is sprinkled upon a napkin and held to the nose, and in a brief time the spasm subsides, and the child can take the proper remedy. ^THER SULPHURICUS. Therapeutic Action. — Sulphuric Ether is a very power- ful and speedy excitant and antispasmodic, and is very well adapted to the relief of painful spasmodic affections, attended with a pale, cold skin, small feeble pulse in the absence of local vascular excitement or inflammation. As an excitant the reader is referred to this article under that class. Among the numerous cases of spasm in which it may be properly cm[)loyed CHLORAL. 637 may be named that of the stomach or bowels, singultus, con- vulsive hysteria, subsultus tendinum, ilalulent colic, tetanus, spasmodic asthma, spasm of the ureters or hepatic ducts, pre- venting the passage of renal or biliary calculi, etc. In the advanced stasjes of continued fevers after assumino- a typhoid type, and when attended with hiccough and subsul- tus tendinum, it often affords great relief It has been used half an hour before the expected paroxysm of intermittent ; it causes diaphoresis and prevents the attack. Nervous headache, occurring in nervous females, as well as in many other cases when unattended with cerebral excite- ment, is often promptly relieved by its use. It is recommended in sea-sickness, taken in wine. Durande has recommended it as a solvent of biliary calculi, in which he combines three parts of ether with two of oil of turpentine. Bourdier used it to expel the tape-worm ; he employed it by the stomach and rec- "tum in an infusion of male-fern, following one hour after with a dose of castor oil. Ether is frequently employed in spasmodic asthma, pertussis, dyspnoea, chronic catarrh, phthisis, etc., in the form of inhala- tion. For this purpose it may be dropped on sugar and held in the mouth, or dropped into warm v'ater or some medicated liquid, and the vapor inhaled. The ethereal tincture of Coni- uni maculatum has been used as an inhalation in phthisis, spasmodic cough, etc. CHLOEAL. Hydrate of chloral will be found an excellent antispasmodic when the convulsions are due to an extrinsic irritation, or to a state of hypersesthesia of the spinal cord. The evidences of such irritation will sometimes be found by getting a history of the case, by our knowledge of the exciting cause, or by the evidences of pain in the contraction of the facial muscles. For children the solution may be of the strength of one or two drachms to two ounces of water, the dose being a teaspoon- ful frequently repeated until relaxation occurs. For the adult the dose will be from ten to twenty grains. This remedy must not be used where there are evidences of cerebral anaemia. 638 ANTISPASMODICS. MORPHIA. The hypodermic injection of morphia is the most certain remedy we have in puerperal convulsions, or in any case (adult) where the convulsion has been preceded by severe pain. In puerperal convulsions time is wasted in trying to give internal remedies which may not be absorbed if they reach the stomach, or may be ineffectual if absorbed. Chloroform is a very certain remedy, but tliere are some cases that it will not control, and others in w.hich its use must be maintained too long. The hypodermic injection is certain, speedy in its effect, and the relief continues. The injection should be of the common solution, gr. x. to water Sj., in quantity so that the patient shall have from one- fourth to one-third grain. It may be repeated if a first injec- tion is not suflficient. GELSEMINUM. THE KOOT OP GELSEMINUM SEMPERVIRENS, Preparation. — Tincture of Gelseminum. Dose. — From the fraction of a drop to half a drachm. Specific Indications. — The face is flushed, the eyes bright, the pupils contracted, the patient restless and uneasy, the head hot. Therapeutic Action. — With these indications, there is no remedy superior to the Gelseminum as an antispasmodic. In many cases the practitioner is warned of the coming convul- sion in time to relieve the irritation which causes it. A child will have fever with the symptoms of determination to the brain above named ; if allowed to progress convulsions will result. The physician notes the symptoms, gives Gelseminum in small doses, the irritation is relieved, the fever passes away? and the convulsions avoided. In infantile convulsions it is used to arrest the convulsions Avhen these evidences of irritation arc present. Here the dose may be larger, and repeated until relaxation and relief is obtained. We use it in the treatment of hysteria when these symptoms present. When the indications are present it gives speedy relief. ASAFCETIDA. 639 It is not SO certain in ])uevperal convulsions, but there are many cases in wliicli its timely administration will effect a cure. LOBELIA. Lobelia is one of our most powerful antispasmodics, and is adapted to a class of cases that show symptoms opposite to those which would indicate Gelseminum. There is a full and oppressed pulse, or a feeble pulse, oppressed respiration, and the countenance has lost all expression, is full and sodden. In these cases we give it alone or with a stimulant, as Cap- sicum, until nausea and complete relaxation is produced. It is a very unpleasant remedy to take, and very unpleasant in its action, and for this reason we use other means when we can. It is especially good in hysteria because it is unpleasant. Its nastiness stimulates the will, and if a patient knows that Lobelia and Capsicum is coming, she Avill make a powerful effort to control the hysterical manifestations. ASAFCETIDA. THE GUM RESIN OF FERULA ASAF(ETIDA. Preparation. — Tincture of Asafoetida. Dose. — In substance, grs. ij. to grs. x ; of the tincture, oss* tooj. Therapeutic Action. — Asafoetida is described as antispas- modic, stimulant, laxative, expectorant, emmenagogue, anthel- mintic and nervine. It acts as a general excitant, causing increased frequency of the pulse, respiration is quickened, the temperature is aug- mented, the bowels are excited to action, alvine mucous secre- tions are promoted, as well as from the bronchial mucous mem- brane, headache and vertigo are experienced, irritation in the genito-urinary organs, with an increased venereal proi)ensity. Its utility is generally admitted in spasmodic and convul- sive disorders in which the functions of the excito-motor system are involved. It appears to be a nervous stimulant, its peculiar excitant action being manifested upon the brain and nervous system. It is slowly absorbed, as is manifested by the alliaceous odor emanating from the different secretions. 640 ANTISPASMODICS. SAGAPENUM. Dose. — In pill or emulsion, grs. v. to 3j. or 5ss. Sagapenum is supposed to be derived from one species of the asafoetida plant. Its properties are similar to asafoetidu and Other gum-resins. It is regarded, however, as holding aii intermediate rank between the asafcEtida and ffalbanum. It is occasionally employed as a stimulating antispasmodic and emmenagogue, in hysteria, amenorrhcea, chlorosis, and some other kindred diseases, but is now seldom used, and scarcely merits a passing notice. AMMONIACUM. THE GUM EESIN OF DOREMA AMMONIACUM. Dose.— From ten grains to half a drachm, in pill or emul- sion ; emulsion is preferable. Therapeutic Action. — Ammoniacum is antispasmodic, stimulant, expectorant, laxative, diaphoretic, diuretic, and emmenaji'osiue. Ammoniac is applicable to the same cases in which the asa- foetida and other fetid gum-resins are indicated. It occasion- ally promotes the secretions^ as diaphoresis, diuresis, and the menstrual discharges. Although we arrange this agent under the class of antispas- modics, and among the fetid gum-resins, yet it is more fre- quently employed as an excitant expectorant in chronic pul- monary affections, such as chronic catarrhs, the asthma of old persons, etc., with profuse secretion from debility of the ves- sels, or in chronic coughs and pectoral disorders with deficient expectoration. GALBANUM. THE GUM-RESIN OF GALBANUM OFFICINALE. Dose. — From ten grains to half a drachm, in pill or emul- sion, prepared by triturating it with gum arable and loaf sugar. Therapeutic Action. — Galbanum is antispasmodic, stim- ulant, expectorant and emmenagoguc. The medical properties and effects of this agent arc analo- gous to those of the fetid antispasmodic gum-resins already MOSCHUS. G41 noticed. It appears tc) occupy an hitermediate rank between the asafoetida ijnd gum amuioniacum, it being less energetic than the former, but stronger than the latter. As a stimulant to the vascular system, it is said to surpass the asafoetida ; but as an antis[)asmodic, it is greatly inferior to that drug. The Germans have ascribed a specific stimulant influence to it over the uterus. It is less frequently employed than asafoetida or ammoniacum, and but rarely used in the United States. It is more especially adapted to relaxed and torpid habits, while it is inadmissible in febrile and inflamma- tory states of the system. C A S T O R E U M. Dose. — From grains x. to xx., in pill or emulsion. Therapeutic Action. — Castor is described as antispas- modic, stimulant and eramenagogue. It has been employed in medicine for many centuries. The views of different writers as to the efficay of castor seem to be somewhat discrepitant. Mr. Alexander Jorg and his pupils, both males and females, experimented with it, took it themselves and gave it to others, and watched its effects, and assert that no visible impression was manifested, except that the odor of castor was evolved from the stomach by eructa- tions that followed its exhibition. MOSCHUS. Dose. — From one-half to five grains. Therapeutic Action. — Musk is described as antispasmodic, stimulant, narcotic and aphrodisiac. 'It acts peculiarly upon the brain and nervous system, producing an exaltation of the cerebral nervous energies, at the same time acting as a diffusi- ble vascular stimulant, and secondly as a narcotic. The particular diseases calling for the use of Musk are hys- teria, chorea, epilepsy (especially of children), tetanus, hydro- phobia, pertussis, low fevers, or typhoid stage of continued and exanthematous fevers, typhoid pneumonia, etc., attended with delirium, subsultus tendinum, singultus and tremors. 41 642 AXTisrASiiOBics. AMMONir BROMIDUM. Dose. — The usual dose of this salt for an adult is ten to fif- teen grains, but it nuiy be increased to thirty grains. For a child of two to four years the dose may be from three to five grains. We employ it in solution. Therapeutic Action. — Bromide of Ammonium is one of our most certain and usefid antispasmodics, influencing tlie brain and spinal cord directly. Whilst bromide of potash is sedative and depressant, this is a mild stimulant. The indica- tions for its use are the involuntary movement of muscles and tendency to loss of consciousness. We employ it in the treatment of convulsions of children, both to preven-t when threatened, and after they iiave passed off to prevent recurrence. It Avould not be the case asking for ' Gelseminum, Rhus, Lobelia, or Belladonna, or the ease carrying a high temperature. When clnldren are subject to convulsions, I know of no remedy equal to this to be given on their first appearance. It is probably the most certain remedy of the matcM-Ia med- ica in the treatment of c])ile[)sy, and if we selected a remedy empirically, it would be this. The usual proportion is, Bro- mide of Ammonium .^ss , water .^iv. ; a teaspoofid four times a day. But many cases will require double or treble this quantity to antagonize the tendency to convulsions. If it holds these in check, it must be continued for months, until the morbid habit is broken u[). OLEUM ANIMALE EMPYREUMATICUM. Dose. — Five to twenty drops on sugar or dissolved in water. Animal oil is a powerfid agent, acting as an energetic poison, both as a local irritant and as a narcotic. It is esteemed anti- spasmodic, narcotic and excitant to the vascular and nervous systems. Hysteria, epilej^sy, ague, typhoid states of the sys- tem, spasmodic and convulsive disorders, and other nervous affections, are among the diseases in which it is said to have been found beneficial- CYPRIPEDIUM. 643 VALERIANA. THE ROOT OF VALERIANA OFFICINALIS. Prepaeation. — Tincture of Valerian. Dose. — From one drop to half a drachm. Therapeutic Action. — Valerian is antispasmodic, nervine, tonic, narcotic, and stimulant. It acts as an excitant to the cerebro-spinal system. If taken in large doses, headache, gid- diness, mental excitement, optical illusions, as flashes of light passing before the eyes, restlessness, nervous tremors, and in some cases spasmodic action, follow its exhibition. Valerian at one time enjoyed a high reputation as a nervous excitant and antispasmodic. The diseases in which it has been principally used are thofee of a nervous character, such as epi- lepsy, chorea, hysteria, hypochondriasis, ataxic fevers, attended with restlessness or morbid vigilance, nervous headache, neu- ralgia, and other neuroses dependent upon increased suscepti- bility of the nervous system, and not on organic derangements or permanent irritation. It has attained considerable notoriety in epilepsy, but its virtues in that disease have undoubtedly been overrated. Associated with Macrotys, it is an excellent remedy in chorea, and probably this is its best use. We give both in full doses, and continue until the patient has full command over the muscular system. CYPRIPEDIUM. THE ROOT OF CYPRIPEDIUM PUBESCENS.— U. S. Preparation. — Tincture of Cypripedium. Dose. — From five drops to one drachm. Therapeutic Action. — Cypripedium is antispasmodic, nervine, tonic, stimulant, and diaphoretic. In numerous affec- tions termed neuropathic, or nervous, we have employed the Cypripedium with decided advantage. It equalizes and ener- gizes the nervous powers, lessens excitement, allays nervous irritability, alleviates pain, and appears to invigorate both mind and body, leaving the patient more cheerful and lively than when any of the narcotics or many of the antispasmodics are prescribed. 644 ANTISPASMODICS. The diseases in which it is indicated are hysteria, or chronic hysteroid affections, hypochondriasis, delirinm tremens, chorea, epilepsy, hemicrania, nenralgia, ataxic or nervous fevers, and that vast train of nervous disorders or derangements of the nervous functions concomitant to many acute as well as most chronic diseases. In low fevers accompanied with morbid nervous excitability, or irritability, as manifested by restless- ness or inquietude, with vigilance or morbid watchfulness, and great sinking of the vital powers, Lady's-slipper allays nervous excitement, produces a calm or tranquil state of mind, invigo- rates the system, and favors sleep. SCUTELLARIA. THE HERB SCUTELLARIA LATERIFLORA.— U. S. Peeparation. — Tincture of Scutellaria. Dose. — From five drops to half a drachm. Theka^peutic Action. — Scutellaria is antispasmodic, ner- vine, and tonic. Scullcap is peculiarly available in diseases of a nervous character. While it acts as a tonic, invigorating the powers of the digestive organs and augmenting the energies of the general system, its nervine and antispasmodic properties point to it as a useful remedy to allay morbid irritability of the nervous system. It is but little used in violent spasmodic ac- tion ; nevertheless, it is v/ell adapted to the relief of that mor- bid state of the nervous system upon which spasm depends. JEFFERSONIA. THE ROOT OF JEFFERSONIA DIPHYLLA. Peepaeation. — Tincture of JefFersonia. Dose. — From five drops to half a drachm. Therapeutic Action. — Twinlcaf is antispasmodic, stim- ulant, expectorant, diaphoretic, diuretic and alterative. Jef- fersonia has been employed in many of the nervous and spas- modic diseases in whicii the remedies of this class are used. ) Thus it has been used in epilepsy, chorea, hysteria, etc., with; reputed advantage. Its effects are not immediate. It aj)pears to act by changing the peculiarly irritable condition of the nervous system, upon which spasmodic disease depends. ICTODES. 645 It has proved efficacious in many cases of chronic rheuma- tism, especially in that form denominated chronic mercurial rheumatism. Its utility seems to depend upon its stimulating, diaphoretic, diuretic, and alterative action. From the success Avhich has attended its exhibition in syphilitic and mercurial affections, there can be no doubt that it is an important alter- ative, and we are confident it will be found such in many chronic affections requiring the use of this class of agents. EUPATORIUM AROMATICUM. THE ROOT. Preparation. — Tincture of Eupatorium Aromaticum. Dose. — From five drops to half a drachm. Therapeutic Action. — This species of Eupatorium is antispasmodic, nervine, diaphoretic, and expectorant. It is esteemed a valuable nervine and antispasmodic, and one pecu- liarly adapted to many cases of debility and irritability of the nervous system, such as hysteria or hysterical affections, chorea, tremors, convulsive or spasmodic diseases, subsultus tendinum, restlessness and morbid watchfulness, etc., occurring in the advanced stages of fevers. In many of these nervous disoi'- ders we have combined it with Cypripedium or Ictodes with decided advantage. It is valuable as a diaphoretic and expectorant. It may 1)0 freely exhibited in all febrile and inflammatory diseases as a diaphoretic ; the warm infusion should be taken very freely, and to render it more stimulating, the Aristolochia may be combined with it. ICTODES. THE ROOT AND SEEDS OF lOTODES FCETIDA. Preparation. — Tincture of Ictodes. Dose. — From ten drops to one drachm, j Therapeutic Action. — Ictodes is antispasmodic, nervine, stimulant, expectorant, narcotic, diaphoretic, emmenagoguc, and anthelmintic. It appears to be a valuable nervine and antispasmodic, and as such it maybe used advantageously. We have found it decidedly useful in hysteria. It has answered a valuable pur- V 646 ANTISPASMODICS. pose ill oui' hands in many instances, in removing that morbid state of the nervous system so frequently met with in weak and delicate females, who are the subjects oF frequent hysteri- cal attacks. In such cases, it often affords relief after other agents fail. The tincture or infusion may be administered several times daily ; or the tincture combined with the tincture of asafoetida, will be found a useful compound. In various other affections of a nervous character, such as chorea, epilepsy tremors, etc., it not unfrequently proves serviceable in alhiy- ing nervous irritation. PiEONIA. The root, flowers and seeds of the Poeonia have been used since the days of Galen as a remedy in epilepsy. For this })urpose the root. was cut into sections, attached to a string and worn about the neck, as an amulet or charm. It has been used in some other forms of neuroses, as palsy, convulsions, etc., but its action is feeble and is mostly abandoned. Willis recommends the seeds in the incubus of hydrophobic patients. OLEUM SUCCINI. Dose. — From five to fifteen drops, increased to thirty drops, in aromatic water, with the addition of gum arable and sugar. The volatile Oil of Amber is a highly stimulating antis[)as- modic. It promotes the secretions, and when applied locally is highly irritating to the ])arts, and acts as a rubefacient. The diseases in which the Oil of Amber has been employed beneficially, are those of a nervous character ; more especially in those attended with spasmodic or convulsive movements. In the chronic forms of hysteria, and in infantile convulsions arising from dentition, intestinal irritation or worms, also in pertussis, this oil has been advantageously employed. OLEUM CAJUPUTI. Dose. — From five to ten drops, on sugar or in emulsion. CajuputOil is a powerful antispasmodic, diffusible stimulant, and sudorific. In many of the violent painful spasmodic alfec- tions of the stomach and bowels it is a very efficacious rem- edy, also in flatulent colic and tympanitis. VIBURNUM. 617 As a diffusible stimulant, it lias but few, if indeed any su[)e- riors. In ty[)lK)id, adynamic, or ataxic fevers, where there is great depression, great sinking of the vital powers, and where a speedy reaction, an exaltation of the vital manifestation, is desirable, this oil, as a i)rompt and energetic diffusible stimu- lant, is one of the most certain that can be employed. Its potent stimidant, antispasmodic, and sudorific properties have secured for it a high reputation in the treatment of Asiatic cholera. It was used in the season of 1849, in thai epidemic, associated with the oil of pe|)permint, cloves, anise, and alco- hol, in the form of Hunn's Life Drops, with great advantage. VIBURNUM. THE BARK OF. VIBURNUM OPULUS. Preparation. — Tincture of Viburnum O. Dose. — From the fraction of a drop to half a drachm. The bark of High Cranberry is antispasmodic, nervine, and tonic. It is very efficacious in relieving s|)asmodic pains by relaxing the spasm, as in cramp or spasm of the stomach and bowels. It is also useful as a tonic and nervine, and may be used in debilitated states of the system, accompanied with nervous irritation. 6i8 SPECIAL THEEAPEUTICS. DIYISION XI < ■ • » ► OLA.SS XX ANTHELMINTICS. Anthelmintics may be defined to be agents which destroy or expel worms, or prevent their formation and development. They accomplish this in different ways : 1st. They may act as poisons to the worms, and this is the effect which many of the direct or specific vermifuges undoubted!}^ have. They may directly kill the worms, or so weaken or deaden them that they can not retain their posi- tion in the bowels, especially if the peristaltic action is in- creased by the action of a brisk cathartic. As examples of this class of anthelmintics, we may notice the spigelia mary- landica, or pink-root, the chenopodium anthelminticnm, artemesia santbnica, aspidium felix mas, and, according to some authorities, the mucuua pruriens, or cowhage, and the pulvis stanni, or tin filings. 2d. Active and continued purgation may remove them, either by cleansing the stomach and bowels of the increased quantity of mucus and other matter upon which they subsist, and which forms their nidus; or by so debilitating them that they are rendered incapable of maintaining their posi- tion against the augmented peristaltic action of the intesti- nal canal, while under the influence of a powerful drastic cathartic. 3d. They may act directly upon the worms and disor- ganize or destroy them simply by their mechanical influeir^. Some of the anthelmintics of this class have been supposed to pierce the worms, and thus destroy them; the cowhage is an example of this kind. Drastic cathartics may alfso act ANTHELMINTICS. 649 as mechanical irritants, and destroy and remove them. They are also removed by the asperity of some of the metallic agents, as the ferri ramenta, tin filings, etc. 4th. Tonics may exert an indirect influence upon them that will tend to prevent their generation, and to their de- struction and expulsion if they do exist. They doubtless act as prophylactics by invigorating the digestive organs, and removing that morbid condition which favors their genera- tion. The deranged state of the digestive organs when the patient is infested with worms, would justify us in coming to the conclusion that a very morbid condition of the in- testinal canal does exist when they are present. Their connection, says Dr. Joy, with a debilitated state of the constitution, and in many cases with a scrofulous habit, seems to be pretty well made out. The inactivity of the lacteal and absorbent vessels, and the consequent accumula- tion in the intestines of chyle and mucus, which form so congenial a food or so favorable a nidus for these animals, together with the generally weakened condition of the di- gestive organs in strumous patients, enable us in some de- gree to comprehend this cause ; yet it is indubitable that they are also met with in the robust and healthy. Rush has even endeavored to make it appear that they are indicative of, or almost essential to the possession of perfect health; in which opinion, however, he has but few followers. It would seem that whatever produces a redundancy and stag- nation of nutritive or animalized fluids in the intestinal tube — whether it be a too abundant supply of food, too active a chylification, or too great a secretion of mucus — is to be ranked among their causes. If, then, a morbid con- dition of the alimentary canal is a predisposing cause of worms, we should expect that such agents as would remove this condition would also cause the removal of worms, and prevent their regeneration. By the free use of tonics we accomplish these indications, we invigorate the digestive organs, and prevent the formation of this morbid accumu- lation, which is conducive to their generation, and upon which they subsist. Several very valuable tonics have been considered as among the best anthelmintics, as the chelone, tansy, quassia, gentian, iron, etc. 650 SPECIAL THEEAPEUTICS. 5tli. Some of the alkaline and acid agents act as prophy- lactics, and not nnfrequently remove or destroy worms. They probably act by dissolving the intestinal mucus, upon which the worm subsists, or by counteracting the production of the vitiated accumulations which favor their generation and growth. There are some very effective anthelmintics, as the corsi- can, wormwood, male fern, etc., that exert no very visible influence upon the human system. It may be somewhat difficult to explain satisfactorily their modus operandi, but we suppose they must act as poisons to the worms. Though they produce no very perceptible effect upon man, yet that is no reason that they do not prove most virulent poisons to these entozoa. " Of the medicines enumerated under the head of specific anthelmintics," says Dr. Joy, "several are of a highly dan- gerous nature, and, we repeat it, quite disproportioned to the importance of the malady; and some of the rest have a doubtful claim to the place which they occupy. Thus, it is very uncertain whether the salts of iron, as well as bitters and mineral acids, do not owe the whole of their beneficial influence, not to any direct or immediate impression on the worms, but to their gradual effect in improving the tone of the stomach and intestines. The employment of such meas-' ures as strengthen the body, constitutes by much the most important part of the treatment of worms, as it tends not only to prevent their formation, but also to remove the irritable state of the system so often present, and to add energy to the various functions, on the imperfect perform- ance of which, much more than the presence of these ani- mals, the troublesome symptoms depend. A diet consisting of food of easy digestion, and so restrained in quantity as to insure its perfect assimilation, along with a healthy habita- tion, a dry atmosphere, and regular exercise, will often, alone or with the aid of the mineral and vegetable tonics, prove perfectly sufficient to attain the desired end. If, however, they fail, and the evidence of the existence of worms and of their inducing irritation in the system, continues strong, the employment of some of the best established and safest of the anthelmintic medicines becomes justifiable. If a ARTEMISIA SANTONICA. 651 scrofulous diathesis, as is so oftcu the case, co exists, all those means wiiich we know to be useful in its nuinagenient must be simultaneously brought into aetion. As to the nervous affec- tions whieh form the great bulk of those fairly traecable to worms, we must endeavor to palliate them as they arise, by the use of a mild and demulcent diet, the tepid bath, and other antispasmodic remedies, until we can succeed in removing tlieir cause by the means just alluded to." CHENOPODIUM. THE SEEDS OF CHENOPODIUM ANTHELMIXTICUM. Dose. — Oil of Wormseed, from ten to twenty droi)S. Therapeutic Action. — Wormseed is antlielmintic, anti- SDasmodic, and emmenagogue. It is considered one of our most efficacious indigenous anthelmintics. It is employed for the destruction of all kinds of worms, but especially for the hinihricoid. A dose maybe prescribed morning and evening, on an empty stomach, for three or four days, and then followed with a brisk cathartic, and if necessary repeated until the desired object is accomplished. SPIGELIA. THE ROOT OF SPIGELIA MARILANDICA. Therapeutic Action. — Spigelia is anthelmintic, cathartic, and narcotic. Its anthelmintic powers, it would seem, are mostly restricted to the Inmbricoid worm, as it does not prove very destructive to other kinds of entozoa. It acts as a poison to them, owing, probably, to its narcotic powers. ARTEMISIA SANTONICA. THE TOPS AND SEEDS. Dose. — Of the powdered Worm-seed to children, from grs. X. to 3ss. ; to adults, oss. to 5ij. two or three times a day. This agent has been considered a very efficient anthelmintic, especially for the expulsion of the lumbricoides, and the asca- ris vermicularis. It is prescribed in the form of powder, infusion, exti"act, or electuary. 652 ANTHELMINTICS. SANTONIN. Dose. — In administering tlie Santonin, we combine it witli white sngar, eqnal parts, of whicli the dose is from one to five grains for children one or two years of age; for an adult, from two to ten grains of the compound. Santonin, the active principle of Artemisia Santonica, is obtained in white, four-sided prisms, very brilliant, without odor or taste; it is soluble in alcohol and ether, but insoluble in water. Therapeutic Action. — Santonin is considered by many one of the most efficient anthelmintics, and yet the least dan- gerous that can be administered to children. We have em- ployed it for this purpose, and so far have been highly pleased with its action. As it is tasteless, it possesses great advantage over many other agents. When given for this purpose, it should be followed by a cathartic sufficient to produce two or three free evacuations from the bowels. Santonin, however, possesses other properties which render it of much more value as an anthelmintic. In suppression of urine, especially In children, we know of no agent so valuable; when administered in doses of from one-half to two grains we have never as yet seen it fail to produce the desired result. It is also the most efficient single agent we have ever employed in relieving that irritation, pain, and scalding sensation In the base of the bladder and urethra, that so frequently accompanies uterine disease. We have also used it with advantage In chronic nephritis and albuminuria. ABSINTHIUM. THE FLOWERING HERB ARTEMISIA ABSINTHIUM. Dose. — From twenty to forty grains, in substance. Absinthium is tonic and anthelmintic, and when externally applied is said to be discutient and antiseptic. It Is sometimes used as an anthelmintic to expel the ascarls vermlcnlaris and lumbricoides, but is not in general use. For a full description of its properties, sec tonics. Kousso. 653 FILIX MAS. THE ROOT OF ASPIDIUM FILIX MAS. Dose. — One to three drachms, in the form of pill, electuary, or emulsion, morning or evening, or evening only, lor two or three days on an empty stomach, and follow with a brisk ca- thartic. Decoction, one ounce to a pint of water, in three or four doses. Therapeutic Action. — The Male Fern possesses anthel- mintic properties of superior efficacy, according to the testi- mony of some authors. It is also said to be slightly tonic and astringent. At the present day it is mostly prescribed to destroy taenia or tape-worm, but it is said to have been employed with suc- cess for destroying lumbrici, and the tricocephalus also. It may be administered in the form of powder, decoction, ethereal extract, or ethereal tincture of the buds. FUCUS HELMINTHOCOETON. THE PLANT. Dose. — In powder, from ten grains to two drachms, in the form of an electuary. Therapeutic Action. — The Fucus Helminthocorton, or Corsican Moss, is employed in Europe as an anthelmintic, but is seldom, if ever, used in this country. It is said to produce scarcely any appreciable influence upon the system ; but is said to act very powerfully on intestinal worms. It is mostly exhibited to children for the expulsion of the lumbricoid worm. KOUSSO. THE DRIED FLOWER TOPS OF BRAYERA ANTHELMINTICA. Kousso is an anthelmintic, and has gained a great reputa- tion as a means of expelling tape-worm. "It is generally administered in the following manner: Half an ounce of the powdered flowers are to be mixed with ten ounces of hike-warm water, and infused for about a quar- ter of an hour, for an adult. A little lemon juice is then to be added and it sweetened, and the infusion being stirred up, the whole (both liquid and solid) is to be swallowed at 654 ANTHELMINTICS. two or three draughts^ at short intervals, being washed down with cold water and lemon-juice. To promote the operation, tea (without sugar or milk) may be taken. In three or four, hours, if the bowels have not operated, a dose of castor oil or a saline purgative should be administered. When given to children, a smaller dose may be used — from a drachm upward." — Thompson. AZEDARACH. THE BARK OF THE ROOT OF MELIA AZEDARACH. Dose. — In substance, twenty grains. Decoction, four ounces to two pints of water, boiled to one pint. The dose to a child is half an ounce, every two or three hours, until it produces vomiting or purging. Therapeutic Action. — Azedarach is anthelmintic, emetic, and cathartic, and in large doses said to be acro-narcotic. The fresh bark of the root, if taken in large doses, not un- frequently produces vomiting and purging, but is rarely and perhaps never resorted to exclusively for such purposes. It is also said to be narcotic ; and this property is more especially manifested if the bark is obtained in the months of March and April, while the sap is ascending to the branches. The fresh bark of the root is an active anthelmintic, and as such is said to have become the most j)opular remedy among the people of the South. GRANATUM. THE RIND OF FRUIT AND BARK OF ROOT OF PUNICA GRANATUM. Therapeutic Action. — Pomegranate Bark is said to be anthelmintic, astringent, emetic, cathartic and narcotic. All parts of the Punica Granatum are used for medicinal purposes, as the bark of the root, rind of the fruit, flowers, and juice surrounding the seed. All are astringent, owing to the pres- ence of tannic acid. The bark of the root, in small doses, produces no visible effects upon the system; but in full doses it occasions nausea, vomiting, and in some cases, giddiness and faintness, trem- blings, and a sensation of intoxication, showing it is possessed of narcotic properties. OLEUM TEKEBINTHIN^. Go5 Prof. Locke has fouiul Pomegranate almost ti specific for tai)e-\vorm. He gives this formula : " ^i Take half a pound of bark from the Pomegranate root, add two and a half pints of boiling water, let the mixture stand in a warm pU\ce for at least two hours, then boil down to one pint, strain while hot through a line wire strainer. To every six ounces of the de- coction add one drachm of the fluid extract of Jalap and five drops of the Oil of Anise. Six ounces of the preparation is regarded as a dose ; and the medicine should be given warm. It should be repeated every two hours until the worm is ex- pelled. Three hours prior to the administration of the first dose the bowels should be evacuated by the action of a cathar- tic, none being better than our antibilious ph}sic. " In some eases the slender neck of the worm might be sev- ered in the act of expulsion, and pass unobserved, though the death of the creature might be assured. The presence of the entire worm in the discharge is alone satisfactory. If the head of the parasite does not appear in the evacuation, it is best to administer a second dose of the medicine and await its action. If, at a subsequent period, it be known that the worm Avas being reproduced from the unexpelled and living head, a repeated trial of the medicine might be made, but I have not had a failure. If I ever fail with the dose recommended, I shall administer a larger one." OLEUM TEREBINTH! N^. The oil of Turpentine is a popular, and may be justly con- sidered an important anthelmintic tor the removal or destruc- tion of all kinds of entozoa. In addition to its vermifuge powers it possesses cathartic properties which give it additional claims to our attention in this case, for it renders the employ- ment of others unnecessary in most cases Avhen it is used in suitable doses. It has been highly extolled for its efficacy in destroying the taenia or tape-worm. In cases of this kind it must be admin- istered in doses sufficiently large to produce copious alvine evacuations. From one to three ounces may be given at once, the bowels being previously evacuated by an active cathartic, 65Q ANTHELMINTICS, and if it does not operate in a few hours, followed with a large dose of castor oil. It is very efficacious in cases of the lumbricoid worm ; but tlie dose is much smaller. In this case a few drops mav bo mixed with sugar, or it may be made into an emulsion with the yolk of an egg, or some mucilage and sugar. In cases of choking, spasms, or convulsions arising from the presence of worms in the stomach, a few drops on sugar may be taken, and at the same time it may be rubbed over the stomach and breast with much advantage. In this way it often gives prompt relief. MUCUNA PRURIENS. THE HAIRS OF THE PODS. Dose. — From five to ten grains in molasses or syrup. Therapeutic Action. — The Mucuna is justly regarded as a powerful mechanical anthelmintic. It has long been cel- ebrated for this purpose. It is evident that this agent acts mechanically from the effect which it exerts upon the worm after being removed from the body and brought in contact with it, and from the efficacy which it manifests in removing worms when administered internally. The fact that worms are discharged alive when this agent has been employed is evidence that its anthelmintic powers are dependent upon its mechanical action, and that it acts by piercing and tormenting the worm. SIALAG0GUE3. 657 DIVISION XII. OLA.SS XXI. SIALAGOGUES. SiAiiAGOGUES or masticatories act as topical excitants. They are pungent or acrimonious articles which when mas- ticated cause a copious flow of mucus from the lining membrane of the mouth, and at the same time the orifices of the ducts of the salivary glands are excited, and this excitation is extended to the salivary glands whose secretory functions are greatly augmented and salivation is established. They are local excitants and very limited in their curative influences upon the system. They act as revulsives and also as depletives. The new action which they set up in the salivary organs renders these glands the center of fluxion, and to them an increased determination of vascular and nervous excitement takes place — in this way they act as topical depletives and as revulsives. The copious secretion which they cause, greatly augments their derivative powers. In this way other organs in a state of undue excitement are relieved by withdrawing the excitement and concentrating it upon the salivary organs. Therapeutic Application.-^— The more stimulating or pun- gent sialagogues are used as masticatories in toothache, head- ache, congestions of the brain, paralysis of the tongue or muscles of deglutition if the cause is local and not depend- ent upon some morbid state of the brain, facial neuralgia, aphonia, dysphonia, difficult deglutitition, etc., etc. There are many vegetable agents that produce salivation. The iodine, iris, calamus, cochlearia, zanthoxylum, sanguin- laria, mezereon, capsicum, piper, nicotina, etc., are occasion- ally used as sialagogues. Some agents that act as nauseanta are also used as sialagogues. 42 658 SIALAGOGIJES. PYRETHRUM. Dose. — As a masticatory, from 5ss. to 5j- Pellitory root is a powerful local irritant. If applied to the surface of the body it acts as a rubefacient. It is but seldom employed internally, although formerly exhibited as a gastric stimulant. At the present time, it is resorted to almost exclusively as a masticatory and sialagogue, it being chewed in certain forms of headache, neuralgia, neuralgic and rheumatic affections of the face and head, toothache, etc. It is likewise used as a local stimulant in paralysis of the tongue, throat, and parts adjacent, as the muscles of deglutition. ARMORACIA. ''' The root of Horseradish is a pungent, acrid stimulant, some- times used as a masticatory in paralytic affections of the tongue. It acts efficiently upon the salivary organs, causing a copi- ous flow of saliva, while its exhalations excite a flow of tears. If taken internally it acts upon the general system as a stim- ulant, and as a diuretic and diaphoretic. MEZEREUM. The medical properties of the Mezereon have been fully described under the class of Alteratives. As a topical remedy it is sometimes used as a masticatory to relieve toothache, and difficult deglutition depending upon paralysis. It is a power- ful acrid and excitant agent. In paralytic, rheumaticand neu- ralgic affections of the face, tongue, organs of deglutition, etc., a small portion of the bark is to be kept constantly in the mouth. CALAMUS. When masticated the root of the Sweet Flag acts as an ex- citant to the salivary organs. It may be used whenever a top- ical stimulant of this character is required, as in the rheumatic and paralytic affections about the mouth. The Calamus is occasionally substituted for tobacco, by those desirous of dis- continuing the use of that nauseous aacnt. XANTHOXYLUM. 669 ZINGIBER. The rhizoma of Zingiber Officinale, or common Ginger, wlien masticated, causes a copious flow of saliva. It has been used to a limited extent as a masticatory in neuralgia, rheu- matism, paralysis, etc., of the organs of deglutition and con- tiguous parts. It is, however, but little employed as a sialagogue. TABACUM. Tobacco is a very common masticatory and sialagogue. This article possesses properties differing very materially from other agents named as raasticatories or sialagogues. It acts as an acro-narcotic poison, manifestly depressing the nervous system. Owing to its narcotic properties it is sometimes chewed to relieve toothache, rheumatic and neuralgic aifections about the face and head. XANTHOXYLUM. The berries and bark of the Prickly Ash, when masticated, act as highly excitant agents to the mucous membrane of the mouth, occasioning a copious flow of mucus, while at the same time the salivary glands are aroused to increased action, and a flow of saliva follows. They are sometimes used in paralytic, rheumatic and neuralgic disorders of the vocal organs, organs of deglutition, and neighboring parts. The Iris, Sanguinaria, Capsicum, Cubebs, Black Pepj^er and sundry other pungent and excitant agents, when masticated, cause an increased flow of saliva, and are applicable to the cases in which the preceding agents have been recommended. 660 SPECIAL THEEAPEUTICS. CIL.A.SS XX II. ERRHmES OR STERNUTATORIES. These agents cause an increased secretion from the pitui- tary or schneiderian membrane and sneezing. The term sternutatory was formerly applied to those agents which produced sneezing — the two terms are now used as synony- mous. The application of this class of agents is very lim- ited. They are restricted to diseases of the head, and act as derivatives. They stimulate the pituitary membrane and cause an afflux to it, and an increased secretory action. By their topical excitant influence they render the pituitary mucous membrane the center of fluxion, and its mucous follicles are stimulated to an increased secretion. The same influence extends to the frontal, ethmoidal and sphenoidal sinuses, and also to the ductus ad nasum, by both a continuous and contiguous sympathy. In this way the secretion of tears is also greatly augmented, and there is consequently a derivation of the circulation from contiguous and adjoining parts. The copious secretion exerts its salutary influence not as a derivative alone but also as a topical depletive. Un- doubtedly much of the advantage gained by the use of these agents in the diseases about to be named, is ascribable to this particular influence, though most authors attribute their sanative powers exclusively to their derivative influence. If the errhine be too strong, or if it remains in contact with the mucous membrane too long it arrests the secretion, yet ts derivative powers are still manifest — showing that deriva- tion is not the only way in which they prove beneficial ; and proving most conclusively that the copious secretion, while, it acts as a topical depletive, augments the derivative powers of the drug. Therapeutic Application. — Their modus operandi at once suggests the cases in which they may be employed. Bj EIIRIIINES. 661 their excitation of the nasal mucous surfaces they produce a derivation of nervous and vascular action from adjacent and diseased organs. They frequently give relief in cases of cephalalgia by their revulsive influence and local excitant action upon the nasal organs. In catarrhal aft'ections or in cases of obstruction in any of the nasal sinuses, sternutation is attended with advantage by removing the obstruction. In ophthalmia the}'' are used occasionally with advantage. In disease of the ears, in rheumatic or jDaralytic affections of contiguous parts, they may be used with a prospect of bene- fiting the patient. They have also been used in toothache. In ulcers of various kinds, particularly in those of an^ indolent character they are indicated. Nasal polypi, concre-. tions or tumors situated in the nose have frequently been removed by the use of those of a caustic character. Those errhines that produce sternutation are contra-ivdica- ted in all cases where there is a predisposition to apoplexy,;, and whenever there is an undue determination to the brain. They are also contra-indicated in hemorrhages, aneurismal, tumors, pregnancy, particularly if advanced and there is a pre- disposition to abortion, hernia, etc., for the very good reason that succussion attending the act of sneezing, acts violently and mechanically upon the organs implicated in the diseases referred to. MYEICA. The Myrica Cerifera, or Bayberry, is an indigenous shrub of much value as a medicinal agent. The finely pulverized bark acts powerfully as an errhine, for which purpose it is, often used in neuralgia of the head and face, in cephalalgia or, headache, catarrhal afiections and ulcerated states of the pitu-^j itary membrane, obstructions of the ethmoidal, sphenoidal or, fi-oMtal sinuses, chronic ophthalmia, obstructions of the ductus-; ad-nasi, rheumatie affections of the face, and in various other local diseases of the head. 662 EKKHINES. SANGUINARIA. The pulverized Blood-root acts very efficiently as an crrliine or sternutatory. It is employed in the same cases as the Bay- berry, such as obstructions of the various sinuses connected with the nasal passages, catarrhal affections, rheumatic and neuralgic diseases, cephalalgia, ophthalmia, polypus, etc. ASAKUM EUROPiEUM. The root and leaves of the Asarabacca are chiefly used at the present day as an errhine, or cephalic snutf. The root is very acrid, and when one or two grains are snuifed up the nos- trils they cause violent irritation and sneezing, accompanied with a copious flow of mucus, which may continue for several days. The leaves are milder, and are therefore preferred, yet they are sufficiently active to excite the schneiderian membrane, and occasion sneezing with a flow of mucus that may become protracted. ASARUM CANADENSE. Wild Ginger, or Canada Snake-root, is occasionally employed as an errhine in cephalalgia, ophthalmia, and in rheumatic and paralytic affections about the head, face, mouth, etc. ; also in obstructions, ulcerations, and chronic affections of the various sinuses or surfaces covered by the pituitary membrane. The powdered root is most efficient, but the leaves are likewise employed. VERATRUM ALBUM. The finely pulverized Veratrum acts as a violent errhine ; indeed, its qualities are so acrid, and its action so severe, that its admixture with some mild powder, as licorice, starch, or flour, is indispensable to its use. In cei)halalgia, nasal obstruc- tions, amaurosis, and certain encephalic affections, Veratrum has been used with a view to excite the secretory action of the schneiderian membrane. It is but seldom used. Veratrum Viricle possesses similar properties, and may be uHod for the same purpose. PHYTOLACCA. G63 TABACUM. Tobacco v/hen converted into snuff, and taken into the nos- trils, acts on those unaccustomed to its use as an excitant to the nasal mucous membrane, causing an increased flow of mucus and not unfrequently sneezing. It is employed as an errhine in chronic catarrhal affections, obstructions of the various sin- uses, neuralgic and rheumatic affections about the head, etc. EUPHORBIUM. The concrete, resinous juice of one species of the Euphor- bia (species not determined), is sometimes employed as a ster- nutatory and errhine. It causes violent sneezing and a dis- charge of bloody mucus from the nostrils, with much suffer- ing to the patient. From the violence of its action it is neces- sary to largely dilute it with some mild powder, as wheat-flour, starch, Licorice, Asclepias, or some other substance. When thus diluted it may be used as an errhine in amaurosis, deaf- ness and other affections of the head. IRIS FLORENTINA. Florentine Orris is occasionally employed as an errhine in chronic catarrhs, headache, paralytic and rheumatic affections of the head, etc. It is sometimes masticated to conceal an offensive breath, owing to its pleasant odor ; or used as a den- tifrice, associated with Gum Myrrh, Cinchona and other arti- cles for the same purpose. hns Versicolor, or Blue Flag, is employed, though rarely, as an errhine. It is more acrid and less pleasant to the smell, and is but little used for that purpose. PHYTOLACCA. The root of the Phytolacca Decandra, or Poke-root, is like- wise employed as an errhine in cephalalgia, catarrhal affections, rheumatic and paralytic disorders, also in cases of polypi. In the latter affection it is united with the Sanguinaria and em- ployed as an escharotic. For ordinary use the povvdered root 664 ERRIIINES. should be diluted with some mild aud less irritating; ajrent. It acts violently as an errhine and sternutatory, and to some individuals, it proves quite poisonous when inhaled, even in small quantities. APOCYNUM. The Indian Hemp is occasionally (though but seldom) employed as an errhine in the various cephalic disorders already named under the preceding agents. It may be used in cases of headache, in conjunction with Orris, Licorice, Cin- namon, Bayberry, etc. ; also in cases of nasal obstructions, chronic catarrhal affections, chronic ophthalmia, etc. ANTACIDS. 665 DIVISION XIII. OLA.SS XXIII. ANTACIDS. Antacids are those agents which correct acidity, in what- ever part of the system found, whether in the stomach, intestinal canal, blood or urine. Their action is essentially chemical, as they combine with acids in the system, forming neutral salts, the same as they would if brought togetlier in the chemist's laboratory. They have, however, a secondary action ; they not only neutralize the acid, checking its mor- bid action at the point where it is generated, but by remov- ing this they may remove the cause of a disease at another and different part of the system. As an example of this, we might refer to the severe frontal headache, caused by acidity of the stomach, which is removed by the exhibition of antacids ; while at the same time they remove the local irritation and pain of the stomach, caused by the presence of an excessive quantity of acid. Antacids are principally employed to remove acidity of the stomach ; and an important question in the consideration of their action and uses, is the condition of this viscus, that would give rise to an excessive generation of acid. In the normal condition of the stomach when it is empty, it has been shown by Dr. Beaumont, that the fluid which moistens its surface is slightly alkaline or neutral. The gastric juice, nature's solvent for aliment taken into the stomach, is acid ; and this acid, whether it be muriatic or lactic, or both, is an, essential constituent of it. But this acid leaves the stomach with the chymo, and is neutralized in the small intestine by G66 SPECIAL THERAPEUTICS. the secretion of tlie pancreas, the liver and the intestine ; the stomach being freed from acid when digestion is completed. ''It is right, then," says Dr. Budd, "that while the stomach is empty of food, it should contain no free acid; and that the acid which is requisite for digestion, and which is secret- ed by the glands of the stomach on the contact of food should, after performing its office, pass into the duodenum, and in its course through the intestine, be either directly absorbed or be neutralized by the alkaline fluids with which it is then mixed. But in various derangements of the stomach the gastric acid is often secreted at unseasonable times, or in too great abundance; or other acids are formed in considerable quantity from the food, and the contents of the stomach are in consequence unduly acid." A superabundance of acid in the stomach may be caused in three ways : 1. By secretion from the glands of the stomach ; 2. It may be taken in the food ; 3. It may be generated by decomposition or fermentation of the food in the stomach. 1. We have already seen that the stomach in its normal condition only secretes acid for the process of digestion, and that this acid is removed from the stomach with the chyme; none being left or secreted when the stomach is empty. What then will cause an untimely or excessive secretion of this acid ? It has been found by experiment, that irritation of the stomach will cause an increased secretion of this acid at any time — Dr. Beaumont and Spallanzoui having collect- ed it for their experiments by mechanical irritation of the mucous membrane. This, then, would account for its secre- tion, in irritation or chronic inflammation of the stomach (dyspepsia), simple ulceration, etc. A source of irritation in some other organ that can affect the stomach by a reflex nervous influence, according to Dr. Budd, will also cause an excess of secretion like direct irritation, as is often mani- fested in the gastric irritation during the passage of gall stones, in organic diseases of the brain, in tubercular disease of the lungs, and various other aftections. The same author states, that "Excessive secretion of gastric acid may result from some fiiult, either inherited or acquired, in what have been termed the secondary assimilating processes, leading to ANTACIDS. 667 certain unhealthy conditions of the blood. This is seen most distinctly in gouty persons, and in men of middle age, who have led the life that disposes to gout. The excessive acidity of the stomach, to which such persons are prone, eems to result, for the most part, from an excessive secre- tion of gastric acid." In each of these cases there may be an excess of acid in the system, and this is probably the case where it depends upon a fault in the secondary assimilating proces^^es, resulting in an unhealthy condition of the blood. But where the ex- cessive acidity of the stomach is caused by some irritation of that viscus, the acid of the system may be so monopolized that there is not sufficient to maintain the normal acidity of the urine, showing conclusively that it is deficient in the blood. In the first case, an alkali not only acts as an antacid, neutralizing the free acid in the stomach, and allaying the irritation produced by it; but, being absorbed into the blood, it acts as a restorative, lessening the abnormal acidity of this fluid. In the second case, although an alkali will neutralize the acid in the stomach, and thus give temporary relief, yet, as there is not a superabundance of acid in the system, it will eventually prove a positive injury, by rendering the blood and urine excessively alkaline. 2. In persons of feeble digestive powers, acids, as we have already noticed, are formed from the food by a process of fermentation. This does not occur when the stomach is in a healthy condition ; the healthy gastric juice being in sufficient quantity for digestion, prevents fermentation, and the generation of acid. "But if the gastric juice be un- healthy, or be secreted too sparingly, or if, from obstruction of the pylorus or otherwise, the food be too long detained in the stomach, it often happens that digestion is disordered, and that there is set up in the stomach some fermentative process by which great quantities of acid are generated. This is especially the case, as Lehmann has asserted, in ca- tarrhal states of the stomach, when, while the solvent juice is poured out sparingly, an unhealthy mucus is secreted, which rapidly decomposes and acts as a ferment for the food." Organic disease of the stomach may give rise to all these conditions, or they may arise from simple debility of 668 SPECIAL THERAPEUTICS. this viscus. The generation of acid from the fermentation of the food (which may generally be diagnosed wlien diges- tion is imperfectly and slowly performed), is not by any meuns a pathognomonic symptom of the condition of the stomach, and other symptoms will have to be considered in forming a diagnosis. Other diseases frequently result from this fermentation and generation of acid in the stomach, such as colic, diar- rhea, sick headache, etc. These are frequently relieved by the administration of antacids, as well as the heartburn., or pain in the stomach. Yet we must consider them only as palliative remedies, relieving the present disagreeable symp- toms; while to eft'ect a permanent cure, such remedies will have to be employed as give tone and strength to the di- gestive organs, thus removing the cause of the disease, or as we might more appropriately term it, morbid symptom. "An excessive formation of lactic acid in the stomach," says Dr. Budd, "may lead to impurity of the blood in vari- ous ways. The derangement of digestion that attends the excessive formation of acid, may give rise to the formation of other hurtful matters in the stomach itself, and also dur- ing the subsequent passage of the vitiated products of di- gestion through the bowels; and these hurtful matters and part of the uncombined acid may be directly absorbed by the bloodvessels; or possibly, as Dr. Prout suggested, they may be absorbed by the lacteals, and cause additional im- purity of the blood by preventing the proper completion of the chyle. Again, as I have just stated, excessive acidity of the stomach frequently causes or co-exists with defective action of the liver, kidneys and skin; and defective action of these important excreting organs may obviously lead to further contamination of the blood. Knowing, then, that an excessive formation of acid in the stomach may lead to impurity of the blood in so many ways, we can hardly won- der at the general or remote disorders which this condition sometimes induces." In many diseases we have an evidence of an increased acidity of the blood, in the sour smell of the perspiration and the breath, the increased acidity of the urine, and the Bour sm-elling and green alvine evacuations. In these cases ANTACIDS. 669 antacids prove curative by neutralizing free acid, wliether in tlic stomach or the blood. In fevers we frequently meet with this condition, the acid character of the excretions being very apparent to the smell. This is particularly apt to be the case in the fevers of chil- dren. Here a prominent indication is the removal of the acidity, and the agents which accomplish this do more: by being absorbed into the blood, and excreted by the kidneys, they modify the character of the morbid matter in this fluid, and stimulate the urinary organs to eliminate it from the system. Alkalies, as has been stated (see diuretics), are among our most important agents in the treatment of fevers and inflammations. Rheumatism, according to the present generally received opinion, is caused by an excess of acid in the system. Al- kalies have been found to be among the most successful agents in the treatment of this disease. They have been employed in diabetes as auxiliary agents, as it is said, with much benefit; the sour as well as saccha- rine smell in this disease would indicate their employment. They are of much importance in the lithic or uric acid diathesis, as they counteract the generation of this acid, or if it does exist in the blood, it is neutralized there by the alkali. CALX. Therapeutic AcTiON.-»-Caustic Lime, or Quick Lime, is a very powerful escharotic, and as such has been used, though thou2;h not exteiisivelv. It is an eners;etic caustic, and has been applied (though seldom) as a moxa, the quick lime being placed in a tube open at both ends, and one end confined to the part where the eschar is to be made, while the lime is moistened with water, which causes a speedy disorganization of the parts. It is considered resolvent, having been found to soften glan- dular enlargements. It counteracts tlie formation of uric acid, and after being absorbed it promotes diuresis, but diminishes other secretions. 670 ANTACIDS. It is a valuable disinfectant thrown into vaults, sinks, damp cellars, etc., for the purpose of destroying or neutralizing the miasmatic effluvia which frequently arises from such situations. AQUA CALCIS. Therapeutic Action. — Lime-water is antacid, desiccant, anthelmintic, and resolvent. It is a valuable remedy in those forms of dyspepsia attended with acidity of the stomach, sour eructations, and vomiting or spitting of food. For this pur- pose one part of the aqua calcis may be mingled with two or three parts of milk. This mode of employment is found very salutary in alleviating the nausea and vomiting, as well as in giving tone to the stomach and allaying all the unpleasant symptoms. In many cases of this kind we have employed it with evidences of unequivocal advantage. Gouty and rheumatic affections, with a tendency to the for- mation of uric acid, point to lime-water as a suitable medicine to counteract its generation, and destroy it when it exists. For the same reasons it may be employed to counteract the forma- tion of calculous concretions in the urinary organs. In diarrhoea and chronic dysentery, when the raucous dis- charge is great, it is useful. In those cases attended with a relaxed state of the intestinal exhalants, its tonic, antacid, and desiccant properties render it an appropriate remedy. It is considered astringent by some, still it does not corrugate the muscular fiber to which it is applied as that class of agents does; it seems, however, to dry up or greatly diminish intesti- nal exhalation, and thus proves valuable in these cases. It has also been used to check excessive bronchial secretion, secre- tion from the bladder, etc. CRETA PR^PARATA. The Prepared Chalk is an important antacid, and as such is very frequently employed to neutralize the acid generated in the primse viae. It is extensively used in the bowel complaints of children arising from the existence of acid iji the alimentary canal. It unites witii the free acids in tlie stomach (acetic and hydro- chloric), forming salts (acetate of limo and chloride of calcium) MAGNESIA CALCINATA. 671 which are not purgative, but readily absorbed into the circula- tion, when tlieir effect seems to be to lessen the secretions. Although it is not astringent, yet it seems to exert an indirect influence of this kind upon the bowels, probably in part by destroying the acid, thus lessening the irritating character of the alimentary contents. It also seems to act as a desiccant, for it often lessens the alviue evacuations when acid can not be supposed to be present. Not only so, it seems to exert an influence in diarrhoea not witnessed whea other agents of an alkaline character are })rescribed. MAGNESIA CALCINATA. Dose. — As an antacid for a child, grs. ij. to grs. x. ; for for an adult, grs. x. to 5ss. ; as a laxative for a child, grs. v. to x ; as a laxative for an adult, 3j. to 5j- It may be given in milk or sweetened water. Therapeutic Action. — The Calcined Magnesia, already fully described as a medicine under the class of Laxatives, is a very important antacid. In diarrhoea and dysentery, and in the summer complaints of children, arising from the presence of acid in the prirase vise, it is highly useful. It not only unites with the acid, but seems to dry up the secretions, or in other words, to act as a desiccant. It is also useful in lithiasis, attended with an ex- cessive secretion of uric acid. If administered in large doses it acts as a laxative, the mag- nesian salts formed by the union of the Magnesia with the free acids of the stomach being purgative. It is useful in cardiaigia, acid eructations, acid dyspepsia, and in the nausea, vomiting, heartburn, acidity of the stomach, etc., attending pregnancy. It is also employed as an antidote to neutralize the mineral and other acids v/hen introduced into the stomach. In gouty and rheumatic habits it is often bene- ficial. It is used as a laxative in diarrhoea and dysentery; often combined with aromatics and rhubarb. MAGNESIA CARBONAS. Dose. — As a laxative, grs. x. to 3j- ; as an antacid, from grs. V. to .^j. 672 ANTACIDS. The Carbonate of Magnesia, previously described under the class of Laxatives, is very similar to the calcined in its prop- erties and effects upon the system. In the case of poisoning by the use of mineral acids, and in cases of cardialgia, when the object is to neutralize the acid in the stomach, the calcined magnesia is preferable, for the reason that it does not effervesce with the acids, consequently does not cause flatulency. It is, however, prescribed in acidity of the bowels, cardialgia, in cases of excess of uric acid, etc. The reader is also referred to this agent under the class of Laxatives for a detailed account of its properties. LIQUOR POTASS^ Dose. — From ten drops to half a drachm, largely diluted with some mucilaginous fluid, an infusion of orange-peel, or some of the vegetable bitters. Therapeutic Action. — The Aqua Potassse is antacid, an- tilithic, diuretic, alterative, and if applied to the surface in a concentrated form, it is an active caustic; if suitably diluted, it acts as a local stimulant. This liquid is but rarely used at the present day, other, milder and more acceptable preparations of potash being sub- stituted for it. It has been used as an antacid and antilithic in some cases with great success. It can not, however, be regarded as a lithontriptic, as it at one time was, but rather as a useful agent for counteracting that condition of the system which results in a redundant secretion of uric acid, and in the formation of urinary calculi. It is sometimes used with success in enlarge- ments and indurations of the lymphatic glands, occurring in scrofulous and syphilitic habits, and in some other diseases, in conjunction with the compound decoction of Sarsaparilla. POTASS^ CABBONAS. Dose. — From one to ten grains in solution. The Carbonate of Potash is occasionally resorted to in cases of indigestion, attended with acidity of the stomach. Not- withstanding this salt is used for the purposes indicated, yet the bicarbonate of the same alUali is mostlv substituted (or it. BICAKBONATE OF POTASH. G73 It is likewise resorted to, though rarely, as an antilithic. In those cases of gravel attendinl with a red deposition in the urine, it j)roves beneficial. ]t is less acceptable to tiie stom- ach than the bicarbonate, and hence is less frequently used. BICARBONATE OF POTASSA. Dose — From two to twenty grains. The medical properties of this salt are similar to those of the carbonate of the same alkali. The additional equivalent of carbonic acid renders its local action much less energetic, and hence it is not adapted to the formation of eschars and as an application to ulcers when caustics are indicated. From this cause it is decidedly preferable to the carbonate in consequence of its greater acceptability to the stomach and the mildness of its taste. It is an important antacid in cases of lithiasis, and other cases requiring the use of such agents. It is superior to the alkalies derived from the soda, in conse- quence of the urates of potash formed in the urine being decidedly more soluble than those of soda. It is not unfre- quently employed to modify the quality of the urine in eases of redundancy of the uric acid in that fluid, and in disordered states of the urinary organs arising from that cause. It is also used in cases of glandular enlargements with success. In cases of acid indigestion it is probably unequaled by any other antacid. In cases of cardialgia it will often give prompt relief, and effectually eradicate the tendency to the genera- tion of acid in the stomach, especially when administered in conjunction with some of the bitter infusions. A frequent and important use made of this article is in the form of effervescing draughts, in cases of nausea and vomiting arising from an irritability of the stomach. For this purpose it may be united with the citric acid, tartaric acid, lemon juice, or the dilute sulphuric acid. Grs. XX. Bicarbonate f ^^"^''['[^ f ,9'^"''^ ^f\ ^''' ^''^^ ' ^^ Potash. i Crystals of 1 artaric Acid, grs. xv. ; or (Lemon Juice, 5'j- to o'ij- Mix either of the acids in cold water, and sweeten with loaf- sugar or some syrup, as lemon, and then dissolve the jjotash in a separate portion of water and add the liquids together, 43 674 ANTACIDS. and when in a state of effervescence drink it. This draught promotes the secretion of urine and perspiration. SOD.^ CARBONAS. Dose. — From two to ten grains, in solution. The medical properties of the Carbonate of Soda are very similar to those of the Carbonate of Potash. It is less acrid and less unpleasant to the taste than the Potash, but the effects of the two salts upon the system are very analogous. The Carbonate of Soda is generally preferred as an antacid and antilithic to the potash, being less unpleasant. It is mostly employed in cases of acidity of the stomach, and in those forms of lithiasis attended with an excessive secretion of uric acid. SOD^ BICARBONAS. Dose. — From five to twenty grains, in solution. This salt is less caustic than the carbonate of soda, and less unpleasant to the taste, but in other respects its properties and effects upon the system are analogous to those of the other caustic alkalies. It is employed in dyspepsia, attended with a redundency of acid in the stomach, as an antacid ; also in cases of lithiasis, accompanied with an excessive secretion of uric acid. It is also resorted to occasionally as an alterative and resolvent in scrofula, glandular enlargements, syphilis, and as a diuretic in hydropic cases, especially in those resulting from glandular diseases. It has been resorted to with advantage in infantile croup, to facilitate the expectoration of the pseudo-membra- nous formation in the trachea, in doses of one grain every five minutes. It is frequently employed in the form of the effervescing draught, seidlitz or soda powders, etc. They allay thirst, fever, nausea, and vomiting, and prove highly refreshing to the patient. They are also useful as lithontriptics and diuretics, but should be employed in the lithic or uric acid diathesis. LIQUOR AMMONIA. Dose. — From five to thirty drops, largely diluted with water, or some demulcent drinks. AMxMONIA CARBONAS. 675 In those forms of dyspepsia attended -with preternatural acidity of the stomach and flatulence, it often exerts a highly sanative influence upon the system. In such cases it is not only administered with a view to neutralizing the free acid in the stomach, but also as an excitant to the digestive organs. It is useful in sick headache when dependent upon acidity of the stomach, likewise in heartburn produced by the same cause. In cases of poisoning from mineral acids, ammonia might be used, largely diluted, with a view of neutralizing the acid. It is particularly recommended in cases of poisoning by the prussic acid. It is appropriate when the oil of bitter almonds has been taken. In cases of poisoning by acids, it is taken internally, and if prussic acid be the poison, it may be cautiously inhaled. Antidotes. — Juice of the lemon, orange, vinegar, etc. AMMONIA CARBONAS. Dose. — From five to ten grains. In this place we shall simply speak of the Carbonate of Ammonia as an antacid. Though less frequently used for that purpose than to fulfill sundry other indications which are re- ferred to under another head, still it proves valuable as an antacid. It is sometimes employed in cases of acidity of the stomach, being similar to the aqua ammonia in its properties and effects upon the system. Its local action is less energetic than that of the liquor ammonia ; the carbonic acid with which it is combined serving to diminish the intensity of its local eff'ects, and render it much milder. The ammonia is employed in gouty afi^ections, particularly those of an atonic character, and likewise in acidity and de- rangements of the stomach dependent upon habits of debauch- ery. It is less frequently used, however, than the antacids to which reference has already been made. It is frequently employed in the preparation of the efferves- cing draught. f^ , . n k C Lemon Juice, 5vj. ; or Crystalized Citric v^arDonate oi Am- j a'i • /^^ti rn < Acid, grs. xxiv. : or Crystalized iar-: monia, grs. XX. 1 j. • * -j ' ° (^ taric Acid, grs. xxv. 676 SPECIAL THERAPEUTICS. CLA-SS XXIV. ANTILITHICS. Antilithics are agents which counteract the predisposition to the formation of calculous concretions in the urinary organs. The urine, when it is strictly healthy, instead of being a simple homogenous fluid, is one of the most heterogenous character. It is a chemico-vital fluid, holding various sub- stances in definite proportions in a state of solution. Changes in its composition are constantly occurring, or liable to occur. A redundancy or a deficiency in any of the healthy constituents of that fluid is to be regarded as a state of disease. If they are augmented beyond the standard of health, that fluid is not capable of holding them in a state of solution, and they are liable to be deposited, if not thrown off, in the form of a urinary sediment, which, by farther accretion, may result in the formation of urinary calculi. The general habit of body which tends to the formation of urinary sediments, is termed the calculous diathesis. ISo inquiries relative to the changes which are taking place in the system, can be more interesting to the pathologist than those which pertain to the investigation of the causes of the calculous diathesis, the modifications of health, the changes which take place in the urine, and the elements which it holds in solution in a state of health, and the depositions which often follow any transition from a healthy to an un- healthy state. The most trivial disease of the genito-urinary organs often awakens the most lively apprehensions of the patient, and this is especially the case when calculi are supposed to be formed and to exist in the kidneys or bladder. The serious operation resorted to for its removal, together with all the suf- fering (which is by no means trifling), renders it a disease ANTILITHICS. 677 doubly alarming to tlio patient, as well as formidable to tlio physician. Agreeably to chemistry, these urinary depositions vary as to composition in ditferent individuals, or even in the same individual at ditt'erent times, arising from modifications of health, diet, drinks, exercise, etc. All the various urinary compounds, says Prout, are com- posed of the four following elementary substances: 1. The lithic acid and its compounds; 2. The oxalate of lime; 3. The cj'stic ox^'d ; 4. The earth 3^ phosphates. The same author remarks, relative to the forms in which urinary deposits occur, that though all are composed of the same ingredients, yet they may be "divided into three classes, viz.: 1. Pulverulent or amorphous sediments ; 2. Crystalline sediments, usually denominated gravel; and, 3. Solid con- cretions, or calculi formed by the aggregation of these latter sediments." The chemical history of the crystalline sediments or gravel and the solid concretions or calculi, can alone point to the true indications of cure. The calculous diathesis in some cases seems to be heredi- tary, when it is extremely ditRcult to eradicate, and may be irremediable; diet and regimen, aided by suitable chemi- cal antilithics and corroborants, may, however, accomplish much. The two principal diatheses are the lithic or uric acid dia- thesis and the phosphatic. Most of the amorphous and puUerident sediments consist of lithic acid and its compounds. Agreeably to the data of Dr. Prout, two-thirds of the whole number of urinary calculi are connected with or arise from the predominance of this diathesis. The lithic deposit often forms the nucleus around which or to which other deposits become attached, and thus calculous concretions are formed. " The yellowish, or nut brown, reddish brown or lateritious, or pink sediments," characterize the lithic acid diathesis. The white or gray precipitates constitute the earthy phos- phates and characterize the phosphatic diathesis. " What the essential characters of these diatheses are, " says Dr. Eberle, " it would be in vain to inquire." 678 SPECIAL THERAPEUTICS. It appears evident, however, that the lithic ucid diathesis arises from the generation of acid as in acid indigestion. Wliatever tends to enfeeble the digestive organs is particular- ly calculated to favor the production of this diathesis. " It appears, moreover, " says Dr. Paris, " that whatever tends to disturb the process of digestion, by favoring the production of acid, may be considered as the exciting cause of lithic de- posits, especially when the cutaneous functions are imper- fectly performed." Those who use vegetable diet mostly, seem to be most frequently the subjects of this diathesis. Dr. Wilson Philip remarks, that acid and acescent ingcsta tend to increase the deposition of lithic acid from the urine and to prevent that of the phosphates. The production of perspiration prevents the lithic deposit and promotes the phosphatic deposits. Dyspepsia favors the lithic while it lessens the phosphatic diathesis by producing acidity in th.e primse vise and rendering the skin less active. Indolence diminishes the activity of the digestive organs, and the activity of cutaneous transpiration, which favors the lithic acid diathesis by diminishing the amount of acid which should pass oft' through the cutaneous emunctories. It would seem that the lithic acid diathesis is intimately connected with the arthritic habit. It has been frequently remarked that the children of gouty parents have some of them been the subjects of gouty attacks, while others have been the sulj- jects of calculous aftections. This view is further corrobora- ted by the concretions of the urate of soda met with in the joints of those who have been the subjects of repeated ar- thritic attacks : also from the derangements of the stomach and bowels. From the foregoing remarks it is evident that there is a redundancy of acid generated in the system, arising in part at least from an enfeebled state of the digestive apparatus and from the fermentation and generation of acid which takes place from the use of large portions of indigestible vegetable food, the use of acids, etc., with a deficient action of the perspiratory vessels ; for when they are active or when the in- sensible perspiration goes on freely, the lithic acid is carried oft* by the skin and its deposition in the urine ceases, or is di- minished, the preponderance of acid in the circulation and ANTILITHICS. 679 urinary secretion is counteracted. This diatlie&is is iiicVicatcd by the high color of the urine, and by the red, yellow, late- ritious or pink-colored sediment deposited in the urine, re- sembling brick-dust; it being the crystals of lithic acid or lithate of ammonia. The urine in this case reddens litmus paper, showing that it is decidedly acid. From what has been said relative to the exciting and proximate causes of this form of lithiasis, the treatment both medical and dietetic must be evident. If this variety of cal- culi be present, or if this diathesis exist, alkalies are of pri- mary importance. They unite chemically with the acid in the prinife vise and neutralize it ; they are also absorbed and destroy the acid in the circulating fluids, and in the secre- tions, particularly the renal secretion, and thus prevent the de- position of the crystals of lithic acid, and if it exists in the urine, this being medicated, destroys it or prevents calculous concretions. In connection with the foregoing agents, tonics to im- prove the functions of the stomach, mild diaphoretics to augment the insensible perspiration, and the alkaline bath will be found advantageous. Especial attention should be paid to the diet; mild, nutritious and digestible diet, with an increase of animal food, should be taken, not in excess, but in sutJicient quantity to sustain the vigor of the system. All excesses should be carefully avoided. Moderate exercise, change of diet, air, exercise, scenery, society, etc., and every thing calculated to invigorate the physical and nervous powers will be calculated to counteract the tendency to the formation of lithic deposits. By strengthening the digestive organs we render the chyle healthy, and prevent the undue formation in the chylopoietic organs of those materials, from which the urinary deposits are formed in the kidneys. The alkalies pass through the circulation, are separated by the kidneys, and " exert a sol- vent influence upon the lithic concretion, existing in the kidneys and bladder." The capacity of any agents now known to dissolve these concretions when fully formed into gravel or calculi, is, to say the least about it, problematical. They should be viewed as palliatives, or at best as pre- ventives of this diathesis, and not as curative agents. 680 SPECIAL THERAPELTICS. Phosphatic Diathesis.— This diathesis is exceedingly im- portant in a therapeutic, as well as pathological point of view. The phosphoric acid and its numerous compounds in the form of urinary calculi, are truly formidable. "It is," says Paris, "to the abundance of its compounds that we are 10 look for mischief." In this form of lithiasis the color of the urine and the character of the deposits differ ma- terially from those of the former habit. In this diathesis the urine is pale, and contains white gravel or precipitate of the earthy phosphates. The crystals are pale brown, gray or white, and composed of the phosphoric acid, united with magnesia, ammonia or' lime, mostly the latter; constituting the phosphates of mag- nesia, ammonia or lime respectively. In the formation of these calculous concretions, the alkaline principle prepon- derates. In the phosphatic diathesis the symptoms are decidedly cachectic. The general habit is morbid or depraved — pros- tration of the whole system — debility and irritability of the nervous system in particular — lack of innervation^ — the nu- tritive and assimilating functions are impaired — in some cases the bladder loses its muscular power, arising from dis- ease of the prostate gland, or injuries or diseases of the spine. Says Eberle, " The circumstances which appear to favor the formation of phosphatic diathesis are injuries done to the back, and whatever produces a nervous state of the system, as fear and mental anxiety, and also the long use of alkaline remedies." Dr. Prout, after remarking that deposition of the earthy phosphates from the urine was attended by very distressing S}' mptoms, says, " They consist in great irritability of the system, and derangement of the chylopoietic viscera in general, such as flatulence and nausea, obstinate costiveness, or peculiarly debilitating diarrhea, or both, frequently alter- nating; and the stools are extremely unnatural, being either black or clay-colored, or sometimes li e yeast." lie further observes there is pain, weakness and uneasiness in the Ij.ick and loins, a sallow, haggard countenance, and symptoms analogous to those of diabetes. This diathesis is most frequently met with during the ANTILITHICS. 681 middle or advanced periods of life, and after the process of ossification is completed. "Tlic urine of infants and nurses contain very little phos- phate of lime and phosphoric acid; it is not until after ossi- fication is finished that these elements are found in iibun- dance in the urinary fluid. That of old men on the contrary-, contains a great quantity of them ; the bony S3'stenr, already overcharged with the phosphate of li-me, refuses to admit more of it. This saline substance would ossify every part, as it does sometimes in the arteries, ligaments, cartilages and membranes, if the urine were not to remove the greater part of this superabundant portion. In rachitis it is by the urine that the phosphate of lime passes off; the absence of which causes the softness of bones." The medication in this form of lithiasis is very evident. The redundancy of the alkaline deposits or earthy phos- phates, points unequivocally to the employment of acids, especially the mineral acids, as chemicals agents, to counteract this diathesis. In connection with acids, corroborants and alteratives to restore the tone of the general system, improve digestion, give energy to the nutritive and assimilating func- tions, and to give increased innervation, and thus counteract the deranged state of the chylopoietic viscera, and depraved or cachectic habit of body met with in this diathesis. The nitro-muriatic acid bath may be resorted to with a prospect of much advantage. The diet should be miostly vegetable, easily digestible, taken freely, but not in excess. Change of scenerj', air, society, moderate exercise, regular habits, — in short, every measure calculated to improve and elevate the mental and nervous powers, as well as physical stamina, — are demanded. It is proper in this place to remark that these diatheses not unfrequently alternate — the lithic may be converted pontaneously, or by the free and protracted use of alkaline medicines into the phosphatic; while the latter, by the use of certain dietetic measures, or by the use of acids, may be converted into the former. These changes are by no means unimportant, either in a pathological or therapeutic point of view. The conversion of one diathesis into another, as is often evinced by the change of urinary deposits from the 682 SPECIAL THERAPEUTICS. use of medicine, has frequently caused the ignorant pre- tender to imagine that his agents were solvents of tiie stone or lithontripties, and effecting cures by dissolving the cal- culi ah-eady supposed to be formed, and lodged in the kid- ueys or bladder; and as an evidence of the truth of his views he points exultingly to the deposits which have changed in character and greatly increased in quantity under the use of his medicine. This fact alone is often an evidence of his ignorance. He has given acids when alkalies should have been used, or used alkalies when acids would have been proper, or prescribed improper diet, and thus converted the deposits into those of an opposite character, and by the free use of his medicine has furnished the material of increased deposits. This increased lithic or phosphatic deposit, he supposes, is the calculi or stone which his medicine has crumbled to powder, and is now passing off freely^ when in reality it is a change of the diathesis or an aggravation of the one already existing. The pathological character of the disease is now nlore intractible than before. The judicious physician will closely watch for these changes, and modify his treatment accordingly. Though the principal forms of lithiasis are two — the Uthk and ■phosphatic — yet the form, chemical character, gravity, etc., of the different forms of urinary calculi, resulting from their diathesis, are very variable. 1. LiTHic OR Uric Spe- cies OF Calculi. Form, flattened and oval; specific gravity, 1.500; color, reddish, brown; surface, smooth, with a lami- nated texture; chemical, composition, lithic acid; mostly soluble in alkalies ; common form of calcu- li— often constitutes the nuclei of other species. f Color, dark brown ; texture, harder or more firm Mulberry Calculus. | than other species ; consists of the oxalate of lime — ( by heat is converted into quick-lime. 3. Bone Earth. 4. Triple. 6. Alternating. Color, gray or pale brown ; surface smooth ; struc- ture laminated; composed mostly of the phosphate of lime. Color, brilliant white; surface uneven; less com- pact; is termed aramoniacs ; magnesia pliosphate; mixed with, the phosphate of lime, pure alkalies decompose it by extricating its ammonia; attains a large size. Exhibits different concentric of diflfercnt species. laminic; compound ANTILITHICS. G83 Notwitlistanding the general and very [)laiii rales wliich have been laid down to guide the therapcitist iu the admin- istration of acids and alkalies as already indicated iu the diathesis referred to, yet when they do exist until calculous concretions are formed, and when these concretions are lam- inated and of a compound character, the same measures may be resorted to to destroy the diatheses and prevent the further accretion to the nucleus already formed. In cases of the compound calculi, the use of acids and alkalies al- ternately will prove beneficial, or act as solvents — or as li- thontriptics, some therapeutists suppose — by medicating the urine, which, if acid, will destroy the lamina composed of the earthy phosphates, and vice versa when the alkalies are used and the lithic concretes are exposed to the medicated alkaline fluid. "In the alternating calculi it may be judi- cious to exhibit.these remedies alternately, as the symptoms of the case and the deposit of the urine may indicate." In this way these agents frequently corrode the calculi, render them rough and irritating to the urinary organs, which is often the cause of great irritation and suffering to the patient. In this way a disadvantage instead of an advantage, may result from these reputed chemical lithontriptics. AVith regard to the causes which give rise to these dia- theses, they are various and obscure. They seem, however, to be dependent upon some morbid condition of the stomach and chj'lopoietic organs. A dyspeptic state of the stomach seems to favor these habits, but particularly that of the lithic character. A morbid state of the digestive apparatus un- doubtedly strongly predisposes to lithiasis. It is not im- probable that the digestive organs form the materials, while the kidneys separate them from the blood. A morbid con- dition of the renal emunctories may separate that which in a healthy state would not be manifest. It is also very reason- able to suppose the urine, owing to some chemico-vital defect in its properties, is rendered incapable of holding in solution the phosphates and lithates, and hence they become deposited or precipitated in the form of powder, which forms the nucleus of the calculous concretions ; these concretions grow by accretions of the respective depositions already named. 684 SPECIAL THERAPEUTICS. LiTnONTRIPTICS. Immediately and very intimately connected with the class of agents termed antilithics, are those called lithontriptics. or solvents of urinary calculi. That we are in possession of any known agents of this character, is highly qnestionahle Some of the acid and alkaline antilithics, as stated unde that class of agents, will gradually destroy the stone, or cause it to dissolve or disintegrate by rendering the urine a chemical solvent. To accomplish this desirable object, re- course is had to the acids and alkalies respectively, to coun- teract the diathesis, giving rise to the particular calculous concretion, or cause a disintegration of that already existing. These measures, even when they do not cause a disintegra- tion of the calculi, often greatly mitigate the sufferings of the patient. It is probable that these agents act mostly by counteracting those morbid conditions which give rise to calculous concretions, while the chemico-vital influences of the system cause its gradual solution. This view of the sub- ject seems to be satisfactorily proved when the calculi is of the lithic acid character, by bringing the chemical solvents in direct contact with it, by injection, when it is found the bladder wdll tolerate the presence of an alkaline solution of sufficient solvent power to dissolve it. It would seem, however, from the experiments of Brodie, that tlie phos- phatic and carbonaceous concretions, when imperfectly formed, may be dissolved by injecting a Aveak solution of nitric acid into the bladder. Unfortunately, says Paris, the irritable state of the bladder will not permit the retention of the proposed menstruum in contact with the calculi i'or a sufficient length of time to accomplish any material sohi- tion ; and this mode of medication, at first view so plausible, and so full of promise, often proves unavailing, if not abso- lutely prejudicial. Another and very ingenious mode of causing the disinte gration of calculi in the bladder is suggested by AI. M Prevost and Dumas. It consists in the ai>i)lication of gal- vanism, by passing a double sound into the bladder, and bringing one end in contact with the calculus, while the other is in contact with two vessels of water, connected toiirethcr ANTILITHICS. 685 bj the opposite poles of a galvanic apparatus. By passing a galvanic current through urinary calculi after being re- jnoved from the subject, or through them when placed in the bladder of a dog, the disintegration of the concretion has been eff'ected. The proposition of these gentlemen has not been very favorably received. It is supposed that any de- composing power of this character, introduced into the bladder, might act with too much violence upon that viscus, and consequently would not be altogether devoid of danger. It must be admitted that the suggestion is highly plausible, and liberality forbids that it should be rejected without a fair trial. After all our speculations upon the solvent power of differ- ent agents, it must be admitted that they often, and I may safely say, generally fail to accomplish the desired object; and in many cases, where the urgent symptoms disappear, and the lithontriptic is supposed to have effected a cure, the asperities of the concretion are removed, and it becomes en- veloped in a coat of mucus, or imbedded in a cyst, which shields the bladder from its action, and thus obtains for the medicine the erroneous appellation of a true lithontriptic. We confidently look forward to the time, which we hope is not far in the future, when we shall be in possession of in- fallible agents for the relief of this much to be dreaded aifliction. "With our present state of medical knowledge, the depart- ment of surgery affords the only certain lithontriptic, in the instrument called a lithontriptor, by which the calculus is crumbled to powder in the bladder, when it is readily passed oft' in voiding the urine. 686 SPECIAL THERAPEUTICS. DIYISION XIV. or.A.ss XXV". DEMULCENTS. Demulcents are agents administered for the purpose of correcting the action of drastic or irritating medicines upon the mucous membranes, or to allay irritation or inflamma- tion of those surfaces. When given to modify the action of an irritant upon a sensitive surface, they may be com- bined with it so as to involve the acid itself, or to so cover the mucous surface as to shield it from the effects of the remedy. Demulcents do not prove valuable as medicines by chang- ing the acrid or corrosive properties of the agents Avith which they are administered, but simply by involving them in a viscid fluid, or by shielding the parts with which they come in contact. They are also valuable in cases in which the secretions poured into the primse vise become vitiated and irritating to the mucous membrane. They unite with it, dilute it, and thus destroy its irritant properties, besides shielding the mucous surfaces from its action. Many writers upon therapeutics have very erroneously, as it seems to us, classed demulcents and emollients together, and regarded them as synonymous. It can not be denied that their properties are the same in most oases, but the dif- ference between the two classes consists in their application or mode of employment. While the term demulcent is em- ployed to denote internal agents, — those especially adapted to diseases of the mucous membrane, — the term emollient is ap- plied to those external agents employed to soften and relax the tissues, allay irritation, inflammation and pain. DEMULCENTS. 687 These agents, when taken into the stomach, soothe and allay irritation and inflammation, and are found to be very valuable in many diseases. They consist of the various mucilaginous articles, as the ulmus fulva, flax-seed, gum- arabic, etc., and some of the expressed oils, as the olive, almond, etc. Their properties and mode of action very clearly point to their proper therapeutic employment. In all inflammatory aiiections of the respiratory apparatus, they are of unques- tionable utility, their soothing influence upon the fauces, glottis and trachea, is extended to the entire mucous mem- brane of the air-passages, by contiguous and continuous sympathy, and the diseases materially modified by their em- ployment. They are also employed in the form of emul- sions, sirups, troches, etc., in cases of harrassing cough, with much advantage. They are very important agents in the treatment of gas- tro-enteric inflammation. In gastritis, enteritis, diarrhea, etc., they come in direct contact with the parts inflamed, and allay the pain, irritation and exalted organic action, with more certainty than most of the classes of therapeutic agents. It is true, many of these agents, especially those of a mucilagi- nous character, are digested, which may diminish their benefi- cial influence to some extent; yet the intimate sympathy ex- isting between every part of the mucous membrane, enables us to account for the sanative and very desirable remedial influ- ence exerted by this class of agents. They may also prove valuable by mingling with the intestinal contents and ren- dering them less acrid and irritating. They are, many of them, very nutritious, and very easily digested, and may be taken freely in febrile and inflamma- tory diseases, where there is extreme debility of the digestive organs, and where it is necessary that the patient should have unirritating and easily digested diet, and where the stronger articles would overpower the enfeebled organs and destroy life. They arc also valuable in calculous affections, and in cases of nephritis, cystitis, or urethritis; but it is difficult to com- prehend how they influence the urino-genital mucous mem- brane, aside from their soothing action upon the other 688 SPECIAL THERAPEUTICS. mucous surfaces, and their influence in allaying excitement in the general system. We believe a close sympathy exists between every part of the animal economy; but this is more especially the case between similar tissues and structures, of which the mucous membrane atlbrds the best example. Some have supposed that the various demulcent agents enter the circulation unchanged, and are carried to the uri- nary organs and pass ofi' through them, and thus exert a direct influence upon the parts diseased. This supposition, how- ever, has no foundation in fact; for the changes wrought upon all the mucilaginous demulcents b}^ the digestive or- gans, as already stated, preclude the probability of their exerting a direct influence upon these organs, unless they act as diluents. The large quantities of aqueous fluid gene- rally taken with them renders them diluents; and in this way, by increasing the fluid portions of the urine, they lessen its acrimonious character. ACACIA. THE CONCRETE JUICE OF ACACIA VERA— GUM ARABIC— Asia. Therapeutic Action. — Gum Arabic is demulcent, nutri- tious and emolHent. It is much employed as a demulcent in inflammatory and catarrhal affections of the mucous surfaces. From its viscidity it serves to shield inflamed and irritated surfaces, and hence its utility in irritation or inflammation of the fauces, larynx, trachea, bronchia, lungs, stomach, bowels, urinary organs, etc. Slowly dissolved in the mouth, it serves to allay cough by diluting the secretions and lessening the irri- tation going on in the respiratory apparatus. In gastritis and mucous enteritis, it is highly valued. It is particularly serviceable In cases of poisoning by any of the acrid or corro- sive agents, by shielding or protecting the mucous surfaces. It is much used associated with harsh or acrid medicines, as dras- tic cathartics, or irritant diuretics and expectorants, to involve them in a mild viscid medium, and thus lessen or prevent them from doing injury to the mucous membranes and parts upon which they act. MALVA. 689 As a pharmaceutical agent, it is extensively used to suspend or diffuse oily, resinous, and other insoluble substances in aqueous fluid, and to give tenacity to pills, troches or lozenges. A Htrou" solution has been applied to burns — it alleviates pain and sometimes prevents blistering. It may be employed as an emollient in other local inflammations. ALTHiEA. Marsh-mallow root is one of our most valuable demulcents, and is especially adapted to the relief of irritation and of inflammation of mucous surfaces. Gastritis, mucous enteritis, nephritis and cystitis, gonorrhoea and bronchitis are among the diseases in which it may be employed with advantage. The ])owdered root and the decoction are often conjoined with acrid or irritating agents to modify their action and render them more acceptable to the stomach. It forms an excellent demul- cent drink in febrile diseases attended with intestinal irritaiioiw. The leaves and tops possess the same properties to a less extent, ALTH^A ROSEA. The root, leaves and capsules containing the seeds of the Hollyhock, possess properties similar to the marsh-mallow. They are used for their demulcent and emollient properties in cases of irritation or inflammation of the mucous membranes. It is employed in the form of decoction, either alone or com- bined with Licorice, and sweetened with loaf-sugar, to which lemon-juice or aromatics may be added to impart to it an agreeable flavor. The roots and leaves are sometimes made into a poultice and applied to painful ulcers and inflamed sur- faces, or cloths dip[)ed in the mucilage are applied to burnt, abraded or inflamed parts, and to the eyes in cases of o[)hthalraia. MALVA. The herb and flowers of the Malva Sjlvestris, or Common Mallow, abound in a mucilage which they readily impart to water. They are demulcent and emollient, and are exhibited in irritated and inflamed states of the alimentary canal, pul- monary and urinary organs, etc. We have often prescribed a 41 690 DEMULCENTS. decoction of malfow in dysiiria and irritated or painful states of the urinary organs, with decided advantage. In dysenteric tenesmus the decoction is useful in the form of enemata, and the fresh j)lant constitutes an excellent relax- ing emollient, and suppurative cataplasm, in cases of external inflammation. TRAGACANTHA. Tragacanth is demulcent and nutritive, but owing to its difficult solubility and digestibility, it is seldom used for inter- nal purposes. The powder is sometimes employed as a vehicle for the exhi- bition of heavy or active agents, but not on account of any specific action which it exerts; and its aqueous solution, being possessed of great viscidity, is also useful for the suspension of heavy or insoluble substances. It is rarely used as a sim- ple demulcent or sheathing agent in irritation or inflammation of the mucous surfaces, as it is not so digestible as gum arabic and most other demulcents, and ])ossesses no advantages over them in other respects. In pharmacy, however, it is used to give consistence to troches, for which it is preferred to gum arabic. AMYGDALA. The fruit of the two varieties of the Amygdalus (Bitter and Sweet Almond) possesses demulcent and emollient properties. The kernels of the Amygdala Dulcis, or Sweet Almond, are mostly used for their demulcent and nutritive ])roperties. An emulsion, ])repared by tritui"ating the blanched almonds with water and loaf sugar, constitutes a ])leasant vehicle for the exhibition of other medicines, and a useful preparation in coughs, chronic catarrh, and inflamed states of mucous surfaces generally. Oleum Amygdala. — The oil obtained by expression from the kernels of either the bitter or sweet almonds, possesses demul- cent, emollient, nutritive, laxative and })ectoral properties, and mav be used in all cases of irritation or inflammation of mu- cous surfaces, whether the result of disease, or caused by acrid or irritant medicines. ULMUS. 691 S E S A M U M. The leaves of the Benne Plant afford a gummy substance Avliich is readily extracted by water, forming a bland mucilage which is much employed in the Southern States, in various diseases of the mucous membranes in which demulcents are demanded, such as diarrhoea, dysentery, cholera infantum, irri- tation or inflammation of the respiratory passages, urinary organs, etc. This rich, bland mucilage may also be taken with much freedom in febrile and inflammatory states of the system not attended with any special irritation of the mucous surfaces. One or two fresh leaves to half a pint of cold water, or the same quantity of dried leaves introduced into a similar amount of hot water, if stirred about for a short time, afford a muci- lage of proper consistence. Lemon-juice adds much to its flavor. CYDONIA. Quince Seeds abound in mucilage, which is demulcent and nutritive. It may be employed in irritation or inflammation of the respiratory, intestinal and urinary mucous membranes, like other demulcent remedies. The decoction is employed as an emollient to cracked lips, sore nipples, inflamed eyes, painful hemorrhoidal tumors, ery- sipelatous inflammation, burns, scalds, etc. ULMUS. The bark of Slippery Elm is one of our most valuable medicinal agents, on account of its highly demulcent and emol- lient character. As a demulcent it is applicable to all cases in which mucilaginous remedies are indicated. It is especially appropriate in diseases of the mucous membranes, such as diarrhoea, dysentery, and affections of the urinary organs; also in coughs and irritation of the replratory passages. It is one of the best agents to which we can resort in gastritis, whether induced by acrid or irritating substances taken into the stom- ach, or the result of general causes. It is also of much service in inflammation of the fauces, larynx, and trachea, and in apthse. It constitutes an excellent drink in the febrile and phlegmasial diseases, especially if any tendency to intestinal irritation exists. 692 DEMULCENTS. TUSSILAGO. Colt's Foot is demulcent, tonic, expectorant aud pectoral., It is chiefly used on account of its demulcent aud pectora | properties. It was formerly mucli esteemed in coughs, colds, phthisis, and other lung affections. It is made into a decoc- tion, an ounce and a half being added to a pint of water. j GLYCYRRHIZA. Licorice-root is highly esteemed as a demulcent and expec- torant in bronchial affections, bowel complaints, and diseases of the urinary organs. Indeed its mild demulcent qualities render it very useful in acute inflammatory affections of mucous membranes, particu- larly those of the respiratory organs. It is much used to give flavor to other medicines and modify their action, especially the acrid stimulating expectorants, the Squill, Sanguinaria, Senega, etc. CHONDKUS. Irish Moss possesses demulcent, expectorant and nutritive properties. Owing to this combination of therapeutic virtues it is valued in both acute and chronic bronchitis, phthisis, and other disorders of the lungs; also in gastritis, mucous enteritis and diseases of the mucous membrane of the alimen- tary canal, attended with irritation. It is of service occasion- ally in dyspepsia, and has been named in scrofula, rachitis, enlarged mesenteric glands, etc. ; also in acute diseases of the urinary organs. It is usually employed in the form of decoc- tion or jelly. CETRARIA. Iceland Moss is mostly employed as a therapeutic agent, on account of its demulcent and nutritive qualities. It is much esteemed in the inflammatory diseases of mucous surfaces, especially those of the respiratory organs. It aboundsi in mucilaon luck of the cerumi- uous secretion. TYPHA LATIFOLIA. The roots of the Reed Mace are employed as an emollient and discutient cataplasm in cases of boils, painful, indolent and indurated tumors and white swellings. LILIUM CANDIDUM. The root of the common Meadow Lily is said to possess emollient, demulcent, tonic, astringent and nutritive qualities. The roots, when roasted or boiled, constitute a useful emol- lient poultice, highly beneficial in painful tumors and local in- flammatory aflFections. TILT A GLABRA. The bark of the Basswood or Linden Tree, when pounded or scraj)ed fine, and properly prepared by simmering or boil- ing in milk, ibrms an excellent eiuollient poultice. It may be used in irritable and painful ulcers, inflammatory swellings, burns, scalds, etc. It is nearly equal to the slippery-elm in point of value as a poultice, although but little used for that purpose. SAURURUS CERNUUS. The roots of the Suururus Cernuus or Lizard Tail, are hiohlv useful in the form of a [)Oultice. They possess valuable dis- cutient, as well as emollient properties, which render them of much utility in painfid swellings, scrofulous tumors and local inflammations, as the cynaucheal affections, and in deep-seated disorders. It constitutes an excellent dressing for blisters, burns, erysipelatous inflammations, etc. 45 706 EMOLLIENTS. DAUCI. The root of the cultivated Carrot, when boiled in milk or water until it attains a degree of softness suitable to form a cataplasm, constitutes a useful poultice in all cases of iuflani- niation or ulceration in which the preceding agents are em- l)loyed. The skin is to be removed and the boiled carrot mashed into a soft pulp. To obtain the peculiar influence of the carrot, the fresh roots should be grated. When the cata- plasm is thus prepared, it acts as a feeble excitant to the ves- sels involved in the ulcerative process. SOLANUM TUBEROSUM. The root of common Potato, when boiled until it is soft and mashed into a pulp, to which a little lard, fresh butter, or some animal oil is added, to render it moist and give it a proper consistence for a poultice, answers a useful purpose in cases of boils, painful tumors, etc. MEDULLA SASSAFRAS. The mucilage obtained by macerating the ])ith of Sassafras in water, is useful when applied by means of cloths to inflamed surfaces. It is often resorted to in cases of acute ophthalmia. It serves to soothe and allay inflammation, relieve pain, main- tain a soft and relaxed state of the parts, and protect them from the action of the atmos[)herc. FOMENTATIONS. Fomentations of Hops, Tansy, Wormwood, Smart- weed, Mullen, Chamomile, May-weed, Eupatorium, and sundry other herbs, whether used singly or collectively, prove highly useful in both external and deep-seated inflammations. Their utility depends upon their warmth and moisture in i)art, but inde])endent of these qualities, they undoubtedly exercise a specific influence, at least many of them, over the organs or parts to which they are applied. That such is the result when narcotics arc used, no one can deny ; and if they produce results that can not be ascribed to the warmth and moisture of GOSSYPIUM. 707 the fomentation simply, is it unreasonable to suppose other ao-ents may produce different effects also ? Fomentations are valuable in plcuritis and other varieties of pulmonic intiammation ; also in hepatitis, enteritis, and other forms of abdominal intiammation. They arc also of much service in rheumatism, white swellings, diseases of the joints, enlarged glands, inflamed tumors, old, indolent and irritable ulcers, and-in hemorrhoids and other local and pain- ful affections. If applied very warm, they first act as revul- sives, and subsequently as emollients; by overcoming . the tense or rigid state of the muscular fiber, softening and relax- ing the parts, and subduing inflammation, promoting suppu- ration, etc., they contribute much to the relief of painful local affections. Cloths dipped in hot water and repeatedly applied, exert a similar, though less ap[n"eciable influence, over local inflammatory diseases, thus proving,__as we think, the specific influence and superior efficacy of the different bitter herb fomentations over the simple warmth and moisture of the warm moist cloths. The vapor of warm water or burning alcohol, if the temperature does not exceed one hundred or one hundred and ten degrees, serves to allay pain, irritation and inflammation, by softening the tense tissues and relaxing the inflamed fiber. GOSSYPIUM. Raw Cotton is chiefly employed as an emollient dressing to recent burns, scalds, blisters, erysipelas, etc., to protect the inflamed part from the atmosphere, to relieve pain, diminisb inflammation, prevent vesication, and to absorb the fluid, whether ichorous, sanious, or puruloid, which may be secreted by the ulcerated or inflamed surface. In cases of burns^ the earlier it is applied the better, although it is employed in all stages. If any blisters are present, they should be opened. A large pledget affords, in many instances, much relief in lumbago and other forms of rheumatism. The ordinary wad- ding, prepared for milliners and other purposes, is the most convenient for use. This should be applied in successive lay- ers, the unstarched side (if it be starched), next the burnt sur- face, so as to entirelv exclude the air. Surgeons think it 708 EMOLLIENTS. advisable not to remove it in cases of burns for five or six days, and then only the outer coverings, unless circumstances render the removal of the entire covering necessary. " Some surgeons, in extensive burns, use a S})irituous or tur- pentine wash before applying the cotton." AD EPS. Lard is emollient, demulcent and nutritive. It is difficult of digestion, and is seldom if ever employed internally for medicinal purposes. Lard is frequently used as an emollient by means of fric- tions in cases of rigidity of the perineum and other soft parts concerned in the process of generation during the act of par- turition. It is in common request among accoucheurs for lubricating the hand, in rendering assistance to the parturient female. Lard is sometimes added to poultices to render them soft, preserve their consistence, and prevent adhesion. It is chiefly used in pharmacy as an ingredient of ointments, cerates and liniments, for which it is extensively employed. It is frequently a constituent of laxative enemata, and is sometimes employed alone as a simple dressing to ulcers, blisters and excoriated surfaces, care being taken to avoid that which is rancid,* Pereira and Christi.son both assert that irri- tation or ulceration ensue when it is employed as a dressing to blistered surfaces, without observing this precaution. The fresh lard, or that free from salt, should always be sought. DILUENTS. 709 CLASS XXVII. DILUENTS OR ATTENUANTS. Diluents or attenuants are imperiously demanded by the laws of animal instinct, to lessen the inspissated and viscid character of the blood, both in a state of health and disease. They allay thirst and render acrid secretions less irritating and more abundant, by furnishing the necessary supply of materials for secretion, and in this way they lessen irritation, iuilammation and fever. When we take into consideration the incessant drain of fluids by the great emunctories of the system, as the urinary and intestinal secretions, the cutaneous and pulmonary tran- spirations, and the preponderance which the liquids enter- ing into the composition of the animal economy bear to the solids, it is not strange that the demand for liquids should be more imperious than it is for solids. The sensation of thirst is often dependent upon the inspissation of the blood, and as soon as it is diluted by injecting fluids into the veins, it is allayed. If taken into the stomach or injected into the bowels, it is absorbed, and dilutes the blood and allays thirst. Thirst is also a very prominent evidence of disease, especial- ly those of a febrile and inflammatory character. In such cases their utility is not exclusively dependent upon their attenuating properties. The demand for drinks does not always arise from inspissation of the circulating fluids. Hence they can not be properly called diluents (when this is not the case). The highly exalted organic action which arises in the mucous membranes of the alimentary canal, occasions the thirst in these cases, and the well-known influ- ence of liquids, and particularly cold water and acidulated drinks, etc., in diminishing this excitement and allaying the thirst, explains their therapeutic application in such cases. Cold drinks act as refrigerants. Warm drinks do not. Cold 710 SPECIAL THERAPEUTICS. drinks lessen the organic actions in the intestipal mucous mem- branes, and warm ones are comparatively inert ; hence the de- mand for cold drinks in febrile excitement. In many cases of fever the sensation of thirst is very imperious, arising from the united causes just referred to, that is, from the diminution of the ser'ous fluid in the blood, and also from the morbid ery- thism existing in the mucous membranes. So long as this ery- thism, or exalted organic action in these membranes exists, imbibition or venous absorption goes on slowly, and hence the difficulty of allaying thirst. From what has been said, it will readily be seen why it is we have such intense thirst in Asiatic cholera, cholera morbus, and even after the action of a powerful hydragogue cathartic, and the reason why it is so difficult to allay that thirst. If no such exaltation of organic action existed, the reduction of the serous fluid would facilitate absorption, and the urgent thirst would be speedily allayed. In febrile and inflammatory states of the system, particu- larly in inflammation of the mucous membranes, the secre- tions become acrid, and act as local irritants or excitants, and often exert an agency in maintaining the febrile and inflam- matory excitement; such is the case in gastritis and enteritis. In bronchitis the saline secretion excites the mucous mem- brane and induces coughing to expel it. In such cases warm diluent drinks, cold water, demulcent drinks, etc., lessen the acrimony of the secretion by diluting it, or they may involve it and shield the abraded and morbidly sensitive mucous surfaces from the action of the acrid secretions and accumu- lations. It is true they do not act directly upon the mucous surface of the lungs in pulmonic aflections, but their influ- ence upon the mucous surfaces is extended to the lungs by continuous sympathy; and hence the importance of mucila- ginous diluents in those aflections. In diseases of the urinary organs, particularly in inflam- mation of those organs, as in nephritis, cystitis, or uretliri- tis, the free use of demulcent or mucilaginous infusions is of unquestionable utility. They serve to weaken the saline comp'.)und — the urine — and lessen its stimulating ])roperties, and, in part, to prevent the irritation which it would produce upon the inflamed parts. DILUENTS. 711 They may either facilitate or retard digestion, depending upon the quantity of liquids taken. If the salivary and other secretions are scanty, and not sufficient to exert upon the alimentary mass the due solvent influence preparatory to the gastric action upon it, they are found to promote the process of chymification ; on the contrary, if no such aid ia required, the free use of diluents, a short time before, during or immediately after meals, will retard the process of chymi- fication by too much diluting the gastric secretions, and by rendering the alimentary mass too soft and pulpy for the stomacli to exert its necessary influence upon. In cases where acrid and poisonous agents are taken into the stomach, diluents are required to weaken the deleterious poison and prevent it from acting violently upon the stomach. In the same cases they favor the action of emetics, and should be used freely to cooperate with them in the production of emesis. In the treatment of dropsy, the ordinary use of diluents ij objectionable. The exhalation or dropsical eff"usion is de- rived from the blood, and as a corresponding diminution in the quantity of that fluid must follow, and as absorption is slow in proportion to the existing vascular fulness or reple- tion, and active in proportion to the reduction of it, it is evident the free use of diluents, by furnishing the materials for absorption, would retard the removal of the dropsical eft'usion, and is, therefore, objectionable. However, the same objection would not rest against the use of active diuretic infusions, as a solution of the bitartrate of potassa, juniper berries, horse-radish, etc. ; for though they would supply materials for absorption, yet the advantages gained by the increased flow of urine would preponderate and ren- der them valuable therapeutic agents. They are also important as diaphoretics. The free use of warm diluent drinks removes the constriction of the cutane- ous emunetories and promotes perspiration ; and hence their great importance as diaphoretics, diuretics, etc., in the treat- ment of febrile and inflammatory diseases. Even cold water, acidulated and refrigerant drinks frequently act as diapho- retics and diuretics, as well as diluents. When there is vas- cular excitement, with a hot, dry, and constricted state of 712 SPECIAL THERAPEUTICS. i\iQ dermoid tissue, there is a corresponding exaltation of organic action on the mucous membranes, and in the inter- nal organs generally. In such cases the sedati\-e influence of cold fluids lessens the internal orgasm, and by continu- ous sympathy abates the external heat, the capillary excite- ment, and removes the cutaneous spasm, and proves diaphoretic, diluent, and febrifuge. Another cogent argument in favor of the employment of simple diluents or unmedicated medicaments in febriM and inflammatory excitement, is the continued waste which the system has to sustain in the various secretions and transpira- tions. They diminish the aqueous portion of the blood rapidly, and when this reduction is not compensated by the ingestion and absorption of more, the residue of the blood loses its requisite fluidity ; hence it does not flow so freely through the capillary system ; not only so, it becomes too exciting, too stimulating to the heart and arteries, and causes congestions and inflammations, and often aids in maintain- ing the excited organic actions until the continued excite- ment exhausts the recuperative energies of the system and the patient. The superiority of that system of practice which tolerates the use of no medicines that will not admit of the free use of cold drinks in the treatment of febrile and inflammatory diseases, is a desideratum of in- finite importance to the sick, as Avell as a source ot great comfort to the parched and famishing patient. These sani- tary influences are of immense importance in the treatment of many diseases. They subdue augmented arterial excite- ment, restore the secretions and maintain their healthful qualities, and thus prevent them from becoming vitiated and irritating. They calm and allay nervous excitement, and though simple, are none the less important as curative means. ANTIDOTES. 713 DIVISION XV. OLA^SS XX^IJI. ANTIDOTES. Antidotes are defined to be those agents which arc cap- able of counteracting the injurious effects of poisons. They may properly be divided into two classes, direct and indirect. according to their action : thus, an agent which, when ad- ministered, will chemically combine with a poison and ren- der it insoluble or inert, would bo called a direct antidote ; while one that would evacuate it from the system, or shield the mucous membrane from its action, would be termed indirect. In the treatment of cases of poisoning, Pereira mentions five indications to be fulfilled: " 1. The most important is the removal of the poison from the part to which it has been applied. From the stomach it is removed by the stomach-pump, by the nse of emetics, by tickling the throat with the finger or a feather dipped in oil ; and, in the case of irritant poisons, by promoting vom- iting by diluents and demulcents. In corrosive poisoning (as b}' strong acids and alkalies), the use of the stomach- pump is dangerous. As house or domestic emetics, a dessert- spoonful of flour of mustard, or a tablespoonful of common salt, stirred up in a tumblerful of water, or strong soapsuds, may be used. But the more efiective emetics are one or two scruples of sulphate of zinc, or five to fifteen grains of sul- phate of copper. The emetic should be given in a glass of warm water, and repeated in a quarter of an liour if it has not operated. From the bowels the poison is best removed by the use of castor-oil and laxative enemata. 714 SPECIAL THERAPEUTICS. " 2. Another indication in the treatment of poisoning is the use of chemical neutralizers, called cheniical antidotes. These either render the poison insoluble, and thereby pre- vent its absorption, or convert it into a harmless soluble sibstance. " 3. A third indication is to sheathe the living part from pontact with the poison, by which not only the topical irri- tant action, but also the absorption of the poison is pre- vented or lessened. These may be termed mechanical anti- dotes. Thus in poisoning by acrid or caustic substances, considerable relief is attained from the use of diluents, de- mulcent and mucilaginous liquids, oils, and line impalpable powders. They lessen the irritant effect of the poison by enveloping it ; and by sheathing the stomach and bowels, they also retard absorption. "4. A fourth indication is to counteract or relieve the effects of the poison. This is effected by agents which may conveniently be termed dynamical antidotes. Thus coffee is given to counteract the narcotism produced by opium; fimmonia to relieve the depression caused by foxglove or prus- sic-acid; opium to allay the acute pain produced by irritant poisons, etc. " 5. A fifth indication is to promote a speedy removal of the poison from the system after its absorption. Most poisons are absorbed into the blood, and are subsequentl}'^ expelled from the system by the excreting organs ; but it is very doubtful "whether we have any means of accelerating their elimination." Poisons have been very judiciously classed by most toxicol- ogists under the three following heads : Irritants, NarcoticSy and Aero- Narcotics or Narcotico-Acrids. These very signifi- cant terms convey to the mind the different effects and symptoms which may be expected to arise when the articles of either class are taken in poisonous doses. The first class — irritants — embraces the vegetable acrida and corrosive minerals. These agents produce f/astro-intes- tinal inflammation, and if still more freely taken, a destruction of the mucous membrane. Among the vegetable acrids wo might name a large number, including most of the emetics and drastic cathartics, as the squill, euphorbia, etc., among ANTIDOTES. 715 the former, and the scammony, elaterlum, gamboge, etc., from the latter. As examples of the corrosive mineral agents, we might name the different preparations of arsenic, antimony, mercury, copper, zinc, silver, gold, etc. The second class endjraces all those varcotics which arc not possessed of acrid properties; as the opium, morphia and its salts, conium, stramonium, belladonna, hyoscyamus, etc. They act feebly on the part to which they are applied, but powerfully* upon the brain and nervous system. The third class presents us with a list of agents which partake somewhat of the nature and properties of both the former. The acf^o -narcotics are very apt to |)roduce gastro- enteric inflammation if incautiously used, and many of them if taken in large quantities, act very powerfully on the brain and nervous system. Many very deadly poisons, as w^ell as valuable medicinal agents belong to this class. As examples we may enumerate the aconite, veratrum album and viride, hellebore, tobacco, lobelia, arnica, etc., all of which frequently exhibit the evidences of their irritant and narcotic powers, even when administered in medicinal doses. In the treatment of all cases of poisoning, no matter what agent has been used, certain general indications have to be fulfilled. Thus a first and prominent indication is to remove the poison from the stomach as speedily as possible. This may be accomplished with the stomach-pump, by the use of emetics, or mechanical irritation of the fauces to produce vomiting. If the poison is readily soluble, drj- vomiting is preferable for the reason that when^ the poison is dissolved in a large quantity of fluid, it is absorbed with more facility, than when no diluents are administered. ' If, however, the stomach-pump is at hand, free dilution is not objectionable, providing the pump is immediately used. These remarks apply more especially to the narcotic poisons. If the poison is a vegetable acrid or corrosive mineral, the use of diluents, mucilaginous or demulcent liquids, oil, etc., are indicated to shield the stomach against their corrosive influence, and to some extent prevent absorption. If there is a chemical antidote to tVie poison employed, — one that will either change it into an insoluble or inert com- pound,— this should be employed from the first, and continued 716 SPECIAL THERAPEUTICS. until all symptoms of poisoning are removed. If the poison has been absorbed and produced its general efteets npon the system, these will have to be counteracted as a general rule, by agents which have an opposite effect. Sometimes it is necessary to employ these three means at the same time ; while we may attempt to remove any free poison from the stomach by evacuating that viscus, we administer the chemical antidote, and counteract its general influence by other measures. Agents which promote absorption should be invariably avoided, when the poison taken is liable to be absorbed and produce general effects. The effects of local poisoning, as the bite of a rabid animal, the rattlesnake, viper, copperhead, eta?, and wounds made in dissection, or with an instrument impregnated with putrefactive animal matter, are best counteracted by the immediate excission of the part, or by scarifying and cup- ping. In this way we effect the removal of the blood impregnated with the poison, as well as the poison itself. Ligatures applied to a limb above the part bitten or wounded, act upon the same principle. Caustics are also occasionally applied to the seat of the injury and the part converted into an eschar, suppuration is established, and the poison if not destroyed is drained from the injured parts. If the ligature, cups or caustic be relied on, the earlier the application the greater will be the prospect of success. The influence of these animal poisons is always depressing, and hence it is of the greatest importance that tonics and stimu- lants should be freely employed to counteract this. Free use should also b^ made of those agents which when taken internally counteract the septic tendency in the blood. The physician is not always called upon to treat the early effects of poisons, and even if he were, secondary phenomena would generally arise demanding his attention. Tliese sec- ondary symptoms or poison-induced diseases, are to be treated on general principles, without any especial regard to the cause which produced them. The following table of poisons, their sj-mptoms and treat- ment, has been compiled from the best sources : ANTIDOTES. 717 IRRITANT POISONS. Acids. Sulphuric. Nitric. Muriatic. Nitro- Muriatic. Oxalic. Acetic. Citric. Tartaric. Eemarks. — The animal and vegetable acids (with the ex- ception of the oxalic) are rarely used as poisons. The oxalic acid, from its resem- blance to epsom salts, has been frequently tak- en by mistake; and, from the ease with which it is procured, has frequently been employed as an instru- ment of mur- der. Symptoms. Alkalies and THEIR Salts. Ammonia. Strong liquor or hartshorn. Muriate of ammonia or sal ammoniac Potassa. Caustic po- tassa or li- quor potassas. Carbonate of potassa 0 r pearlash. Nitrate of potassa. Sulphuret of potassium. Soda. When a poison of this class is internally administered, the con- sequences which it produces are either the immediate and com- plete destruction of the parts with Avhich it comes in contact (an effect determined by the more powerful escharotics alone), or such a degree of irritation as leads to infiammation of some part of the intestinal tract, suc- ceeded by its usual consequences — increased vascularity, effusion of coagulable lymph, and occa- sionally of blood, ulceration, soft- ening, and sometimes thickening of the villous coat, and lastlj^, gangrene or slough. These ef- fects are observable in the mouth and fauces, in the sesophagus, stomach, small and great intest- ines ; but they do not invariably occur in all these places, nor in all with the same degree of in- tensity. Such being the patho- logical condition of the intestinal tube, the accompanying symp- toms may be easily conceived. The epigastrium becomes the seat of a burning pain, and shortly after vomiting ensues, by wliich the contents of the stomach are first rejected, and subsequently a viscid mucus, streaked with, and often containing coagula of blood. The epigastrium is obviously swollen, tense and tender, and the distress in this region is great- ly augmented by pressure. The inflammation is sometimes con- fined to the stomach, but more usually it extends to the lower intestines, producing general ab- dominal pain and tenderness up- on pressure, purging accompanied by tenesmus and bloody dejec- tions. When the deleterious sub- stance belongs to the class of escharotics, and is either very soluble in water, or has been ad- ministered dissolved in some chemical menstruum, the mouth, tongue and throat are the parts which first suffer from its action, and to which the earliest symp- toms are referred. These are burning pain and a sense of con- striction in the fauces, prevent- In poisoning with th« acids, alkaline.t and the fixea oils are antidotes. For the mineral acids we may ad- minister magnesia, chalk (or whiting), with milk, soap- suds, dilute solution of car- bonate of soda or potassa, or almond, olive or lamp oil. AVith the exception of the nitric and oxalic acids, these agents may be used as anti- dotes indiscriminately; but in poisoning with tlie two acids named, the carbonates of lime and magnesia alone can be employed with safety ; and for the oxalic acid the first of these is decidedly preferable, as the resulting compound, oxalate of lime, is inert. In poisoning by sul- phuric acid, water should not be drank, on account of the heat generated by their mix- ture. The subsequent in- flammation should be treated on general principles. The vegetable acids, as vinegar, lemon juice, citric and tartaric acids, are anti- dotes to the action of alkalies; as, also, are the fixed oils, they forming soaps with them, thus destroying their corrosive properties. In poisoning by nitrate of potassa, mucilaginous drinks should be freely adminis- tered, and the resulting in- flammation treated on gene- ral principles. It is said that comrijon salt, or the liquid chloride of soda, \Yill decompose and neutral.- ize the sulphuret of potas- sium. 718 SPECIAL THEKAPEUTICS. IRRITANT rOISONS— Continued. Earths and Compounds. Baryta. Carbonate of baryta. Chloride of barium. Nitrate of baryta Lime. METALS. (a.) Antimony. Tartar Emetic. Chloride ovBut- ter of Anti- mony. Oxyd of Anti- mony. (6.) Arsenic. Arsenious Acid or White Ar- senic. Yellow Sulphu- ret of Arsenic. King's Yellow. Red Sulphuret of Arsenic. Fowler s Solu- tion. Arsenical Paste. Arsenical Soap. Arsenite of Cop- per. Symptoms. ing or materially impeding the act of deglutition, and the en- trance of air into the lungs. In addition to these local symptoms, it may be also observed that the constitution will be always found to have undergone serious dis- turbance. The pulse will be rap- id and feeble; the countenance will be flushed, or exhibit a dead- ly paleness ; there will be exces- sive prostration, and the entire body will be covered with a cold and clammy sweat. — [Apjohn.) (a.) In poisoning by the prep- arations of antimony, the agent is generally rejected by vomit- ing; in fatal cases the vomiting becomes obstinate, there is burn- ing pain in the stomach, purging accompanied with violent colicky spasms, constriction of the throat, distressing cramps of the limbs, delirium and convulsions. ( h.) Nausea and faintness are the first symptoms, to which suc- ceed a burning pain in the stom- ach; obstinate vomiting, which, if it does cease for a moment, is immediately excited by any kind of drink; a sensation of dryness, heat and tightness in the throat; diarrhea, accompanied with te- nesmus; abdomen tense and pain- ful ; pulse small, quick and fee- ble; the surface cold and clam- my ; the urinary organs affected with violent burning pain and suppression; delirium, convul- sions and death. In cases of poisoning by muriate of baryta, a solution of soda or magnesia admin- istered will prove an anti- dote. This should be done without loss of time, for the poison acts rapidly. By this means the bary tes is convert- ed into the insoluble sul- phate, which is inert. If the carbonate should have been the preparation used, the soluble sulphates should be replaced by copious draughts of dilute sulphuric acid. The antidotes for lime are the same as for the caustic alkalies. In cases of poisoning by any of the preparations of antimony, if vomiting has not occurred, it should be excited by tickling the fauces with the finger or a feather dipped in oil, and by tepid bland liquids. The antidote is tannic acid, and vegetable substances containing it, as tea, galls, white-oak bark, Peruvian bark, etc., which should be immediately and freely administered in solu- tion or infusion. In cases of poisoning with any of the preparations of arsenic, the first indication is to remove from the stomach any of the free poison. For this purpose, an active emetic of ipecacuanha and mustard should be administered, and the stomach tlioroughly evac- uated. The hydrated sesqui-oxyd of iron should then be freely administered as an antidote to the poison. If it has been obtained before the emetic was given, it should not be delayed for its action, but administered immediately. Whon the poisoning has bceu occasioned by arsenite of potassa { Fowler's solu- tion), soda, or ammonia, or liy t'le suits of arscniousacid, ANTIDOTES. 719 IRRITANT POISONS— Continued. Poisons. Children have been poisoned, it is stated, by chewing visit- ing cards ; ar- senic having been used in the enamel. Bismuth. Nitrate of Bis- 7nuth. Pearl Powder. Oxyd of Bis- muth. (c.) Copper. Sulphate of Copper or Blue Vitriol. Acetate of Cop- per or Verdi- gris, Carbonate of Copper. Food cooked in dirty copper vessels,or pick- les colored green by cop- per. Gold. Chloride of Gold. Fulminating Gold. Purple of Cas- sius. Jidide of Gold. Cyanide of Gold. Chloride of Gold and Sodium. Symptoms. (c.) The symptoms of poison- ing by copper are headache, cut- ting pains of the bowels, vomiting and purging, coppery taste in the mouth, and strong aversion to its taste, cramps in the legs, and pains in the thighs, jaundice, etc. The pulse, almost from the commencement, is small, quick and feeble. after giving the first dose, vinegar should be added to the antidote, to neutralize its acidity. The general symptoms will have to be treated upon gen- eral principles. Evacuation of the poison by the stomach-pump or emetics is the first indication — milk and mucilaginous drinks are recommended to shield the stomach. The inflammatory symp- toms are to be treated on general principles. No time should be lost, and none of the ordinary means omitted for expelling the poison from the stomach. Albumen administered in any of its Jbrms, as white of egg, milk, etc., retards the action of the poison. The subse- quent treatment should be the same as for other irritant poisons. In poisoning by any of the different preparations of gold, the same treatment should be pursued as in poi- soning by M:e bichloride of mercury. The salts of gold are siiid to be decomposed by sulphate of iron, and thia has been recommended as an antidote. 7:^0 SPECIAL THERAPEUTICS. IRRITANT POISONS— Continued. [d. ) Lead. Acetate of Lead Sugar of Lead. Carbonate of Lead. Red Lead. White Lead. Water, food or liquors im- pregnated with lead, frequent- ly produce the symptoms of lead poisoning; as, also, do the different occupations where lead is freely employ- ed. Silver. Nitrate of Sil- ver. (e. ) Mercury. Bichloride of Mercury o r Co rr 0 siv e Sublimate. Cyanide of Mer- cury. Iodide of Mer- cury. Nitrate of 3Ier- cury. White Precipi- tate. Red Oxyd o r Red Precipi- tate. Sulphate o r Turpcth Min- eral. Vermillion o r Red Sulpihu- ret. Calomel. Symptoms. (d.) When a soluble salt of lead is taken or administered for the purpose of poisoning, the morbid phenomena that jensue are similar to those produced by other irritant poisons. But if some of the insoluble, or even small doses of the soluble prepa- rations, is taken, or if the poison is taken with the food, water, etc., or is introduced into the system from the occupation of the pa- tient, the results are very differ- ent. From the commencement, there are either none, or but very slight symptoms of irritation of the alimentary canal. A lead colic is after some time developed. This sometimes begins suddenly; more frequently it is preceded by gastric derangement, such as nau- sea and vomiting; cramps of the stomach next set in, and these gradually extend over the abdo- men, and at length degenerate into a colic, scarcely to be distin- guished from the ordinary form. The abdomen is usually tense, the navel drawn in ; the pain is intermitting, and is relieved by pressure ; the bowels are general- ly costive, though sometimes there is diarrhea; the urine is scanty; the saliva copiously secreted, and of a bluish color; there are dull aching pains in the limbs; the skin exhibits a dull, cadaver- ous aspect, and is bathed in a cold, clammy sweat; the coun- tenance is gloomy and despond- ing, and the pulse, though some- times accelerated, is generally slower than usual. (e.) Violent symptoms of irri- tant poisoning ; harsh, metallic astringent taste; burning pain in the stomach ; vomiting and purging frequently of bloody matter ; often irritation of the urinary organs, and sometimes suppression ; tightness and burn- ing ia the throat, occasionally so great as to prevent speech; coun- tenance not always pale, but sometimes flushed; tendency to doze; stupor, convulsions and deal h. — ■ (^Dungliaon. ) In cases of poisoning b_y any of the salts of lead, the first indication is to remove it from the stomach. For this purpose the sulphate of zinc is probably the best agent, as it not only produces free emesis, but also acts as an antidote. The salts of lead are converted into insol- uble compounds by the ad- ministration of the sulphates of soda or magnesia in solu- tion. The '■^ white liquid physic" is also a very useful antidote. In chronic lead poisoning, attended with lead colic, the bowels should be kept regu- lar with the cathartic last ■named : tonics and stimu- lants should be employed to increase the strength, and above all the patient sliould be removed from the cause o? the disease. Common salt immediately decomposes the nitrate of silver, destroying its activity. The inflammation should be treated on general principles. In cases of poisoning by mercury, albuminous sub- stances, as white of egg, milk, a mixture of wheat flour, etc., should be immediately and freely administered. This does not prevent, but only retards the absorption of the poison, and consequently its constitutional effects will be liable to be produced. The inflammation, salivation. etc., will have to be treated on general principles. ANTIDOTES. 721 IRRITANT POISONS— Continued. (/. ) Organic Irritant Poi- sons. Convolvulus Ja- 'apa. Jalap. Convolvulus Scammonia. Scammony. Croion Tiglium. Purging cro- toii. Cciimis Colo- cynthis Colocynlh. Euphorbia Offi- cinarum. Euphovbium. Spurge. Momordica ela- ierium. Squirting cucumber. Etc., etc., etc. Symptoms. (/.) The vegetable acrids, -when swallowed in large doses, very generally give rise to vomiting, by means of which the poison is discharged. Sometimes, howev- er, they are retained by the sto- mach, particularly when the quantity has been small ; and in these cases diarrhea usually sets in, attended by abdominal pain, which is at first remittent, but becomes more constant in propor- tion to the development of in- flammation in the intestinal tube. The belly now becomes tense and tender. The debility is great, and giddiness and tendency to delirium, are sometimes, though rarely, observed. In the treatment of cases of poisoning by the vegetable irritants, the practitioner will have to be governed by gene- ral principles, as there is no chemical antidote to them known. The first indication in every case is to remove the poison from the system as soon as' possible; thus, if emesis has not already been produced, an emetic, or the use of the stomach-pump, is necessaiy. If vomiting has been produced, it may be rendered much easier by the free use of diluents, and the stomach and bowels may b€ shielded from the action of the irritant by demulcents. If it should be desirable to produce catharsis, an unir- ritating agent, as the castor oil, Avould prove most useful. ACRO-NARCOTICS. Solan EiE. Alropa Bella- donna. Deadly night- shade. Datura Stra- monium. Thorn apple. Nicotiana Ta- bacum. Tobacco. Symptoms. The symptoms of poisoning by belladonna and stramonium are: dryness of the throat and fauces ; dilation of the pupil and insensi- bility to light; delirium, usually of a very extravagant descrip- tion; stupor, coma and death. Convulsions of a violent nature are rare, though, occasionally, muscular twitchings and subsul- tus tendinum have preceded death. The symptoms pi'oduced by to- bacco are, in the first instance, slight excitement, followed by giddiness, syncope, nausea and vomiting, feeble pulse, a state of stupor or lethargy, insensible pu- pil, laborious breathing and con- vulsive twitches of the muscles generally. Treatment. In cases of poisoning with belladonna or stramonium, the first indication is to re- move the poison from the stomach as soon as possible, with the stomach-pump, or an emetic. As an emetic, from half to a tablespoonful of mustard in a glass of water will probably he found the best. After the stomach has been evacuated we may derive benefit from the use of a decoction of green tea or nut-galls. The depression, and other symptoms produc- ed, must be treated on gener- al principles. In poisoning with tobacco, the same treat- ment, with tlie employment of the vegetable acids and coff"ee, or if the depression of the vascular system be extreme, the use of the stronger stimulants, as am- monia, brandy, etc., and the cold douche should be re- sorted to. 46 722 SPECIAL THERAPEUTICS. AORO-NARCOTICS— Continued. UMBELLIFERiE. Conium Macu- laium. Com m o n hemlock. Cicuta Virosa. Water hem- lock. (Enanthe Cro- cata. Hemlock dropwort. jEthusa Cyno- pium. Fool's pars- ley. Ranuncula- CEJE,. Aconitum Na- pellus. Monk's head. Helleborus Ni- ger. Black helle- bore. Dif/italis. Purpurea. Melantiia- CEJE. Vera ir urn Al- bum. Wliite hel- lebore Viratrum Vi- ride. American hellebore. Cole f lie um. Autumnale. LAGONIACEiE. Slri/ehnos Nux Vomica. Slri/elinos Tie- uie. Symptoms. The symptoms produced by conium arc, giddiness, delirium, coma and convulsions. By the cicuta, gastric irritation, vomit- ing, giddiness, profound coma and insensibility, and finally, very violent tetanic convulsions. By the oenanihe, burning heat in the throat and epigastrium, stupor, and in every instance violent convulsions. By the celhusa, nausea, vomiting, headache, gid- diness, sopor, partial paralysis and numbness of the extremities, sometimes pain in the stomach, lividity of the surface, and great dyspnea have been observed. The symptoms produced by aconite, are burning heat in the throat, vomiting, purging, numb- ness, partial paralysis, delirium and convulsions. By the hellebore, vomiting, de- lirium and convulsions. By the dirjitalis, feeble and re- tarded ])ulse, violent pain over the eyes, confusion of intellect, extreme prostration ; to which succeed profuse diari hea, de- lirium, convulsions and general insensibility. The symptoms of poisoning by these agents are, violent vomit- ing (sometimes of blood) ; tenes- mus; burning sensation of the mouth, throat, oesopliagus and in- testines ; constriction of the throat, Avith a sensation of stran- gulation; griping pain in the bowels; small, and in some cases almostimperceptible pulse ; faint- ness ; cold sweats; tremblings; giddiness; blindness; convul- sions and insensibility. The symptoms of poisoning by the strychnia and brncia, and the agents that contain them arc, The treatment should be tlie same as for the solanece; no antidote is known, though an infusion of galls has re- tarded their action. The treatment should be the same as for the solaneje. The treatment for poison- ing by these agents should be the same as above; emet- ics, however, will not have to be used. Hahnemann recom- mends coffee as a drink and as a clyster ; astringent in- fusione, demulcent liquids, and opium, are strongly re- commended. Chlorine, bromine and iodine have been recommended as antidotes to all of the acro- narcotic poisons. In cases of poisoning by tiiese agents, it is recommend- ed to evacuate the stomach by the stomach-pump or an active emetic immediately. Whe- ther this is done or not, the ANTIDOTES- 723 ACRO-NARCOTICS— Continued. Poisons. Strychnos Tox- ifera. Wourali. Ignatia Amara. St. Ignatius Bean. The active principles. Strychnia. Brucia. Symptoms. a feeling weight and weakness in the limbs ; trembling of the limbs, and rigidity, or slight spasms when motion is attempt- ed ; increased sensibility ; the voluntary muscles are thrown in- to a convulsed state on the slight- est motion ; finally, tetanic spasms of the entire body are produced, which pass off, and a calm succeeds; which, however, is suc- ceeded by more violent spasms. This continues until the violence of the paroxysm destroys life, ap- parently by producing a state of asphyxia. patient should at once be made to swallow as much sweet-oil, lard-oil, lard, or other fixed oil, as the sto- mach will retain; at least, from two to four pints should be administered; if the sto- mach-pump can be obtained, the stomach may be emptied after each pint of oil taken. Tliis has been found to be the best antidote to the poison, though chlorine, iodine and bromine, have been recom- mended. The secondary symptoms will have to be treated on general principles. NARCOTICS. Poisons. Hydrocyanic Acid, Prussic Acid. Opium and its Proximate Principles. Symptoms. In poisoning by hydrocyanic acid, the symptoms arc : a re- markably bitter taste, sometimes described as hot; a sensation of faintness and giddiness; saliva- tion, which is succeeded by tetanic convulsions and insensibility. If the quantity taken has been large, it destroys life almost immediate- ly. If the patient recovers, its influence passes off very quickly. The Avhole period of suffering rarely exceeds half an hour. Opium or morphia, when given in poisonous doses, rarely produce their primary stimulant effects. Stupor, approaching to coma, al- most immediately sets in ; the breathing is slow, sometimes ster- torous; the pulse is usually about ninety, weak and irregular, occa- sionally slow, full and strong, like the pulse of apoplexy ; the muscles are relaxed; the face is pale and tranquil, sometimes tumid, suffused and anxious ; the body is usually bathed in sweat. AVhcn a case of poisoning by opium terminates favorably, the patient falls into a sound sleep, lasting 24 or 30 hours; out of Treatment. There is no antidote to the action of this poison. The most important agents in the treatment of poisoning by it, or substances which contain it, are ammonia, chlorine, the cold affusion, and artificial respiration. Chlorine is the most efficient of these, in the form of chlorine water, weak solutions of chloride of lime or soda. Inhalation of li- quor ammonia diluted is next in importance ; the cold af- fusion may be used as an ad- juvant. In treating a case of poison- ing by opium or its active principles, the first object to be attained is the evacuation of any poison that may re- main in the stomach. The best means of accomplishing tliis, is to resort to the sto- mach-pump; but when this can not be obtained, an emet- ic of mustard ; or if that does not succeed, of sulphate of zinc should be administer- ed. It will be recollected that sometimes the stomach is so paralyzed that emesis can not be excited. The next point is to remove the drow- 724 SPECIAL THERAPEUTICS. NARCOTICS— Continued. FoiaoDS. Symptoms. Treatment. which he wakes merely affected by slight nausea, thirst and ver- tigo. The symptoms of poisoning by hyoscyamus are, giddiness, loss of speech, great dilation of the pupil, delirium, frequently of the most violent type, and subse- quently a lethargic or comatose state. siness and stupor : here every thing calculated to stimulate the patient should be em- ployed, the cold affusion, cold douche, etc. ; but above all, the patient should be kept constantly in motion. Driving the patient over rough roads in a wagon, he being supported on each side by an assistant, would pro- bably be one of the best plans. HXOSCTAMDS. The treatment should be the same as in poisoning by opium. INDEX OF INDICATIONS. Aconiic. The small, frequent pulse, wltli increased temperature — quinsj% croup, irritant diarrhoea and dysentery -gtt. v. to s. to water Siv 127,283,418 Alcoholic Stimuli. When there is prostration, the pulse being soft and feeble — small quantities frequently repeated 371 Aloes. The patient evacuates the lower bowel with difficultj- — gtt. x. to water 5iv 170,615 Alumina (aluminium oxide). Can not pass the urine without great straining, as at stool — a trituration, 1-100 to 1-10, dose one grain. Alcfris Farinom. Too frequent menstruation, with labor-like pain and sense of debility in pelvis; complains of pelvic articulation, or ina- bility to support the body on the feet — gtt. x. to sj. in water ,5iv....449 Ammonium Muviaticnm. Deep or dull redness of the surface, effaced by pressure slowly returns — 3j t.o water .iiv.. and as a bath 374 Ammonium Bromidum. Convulsive action of the muscles; convul- sions when there is a return to consciousness; epileptiform disease — 3ij- to sj. in water ^iv 642 Ammonium. Jodichtm. Dizziness, difficulty in controlling the voluntary muscles, dull headache — oij- to 5ss. in water 5iv. Amj/r/dalis Feraica. An elongated and pointed tongue, reddened tip and edges, gastric tenderness — an infusion, or of tlie tincture gtt. XX. to o'j- ill water .^iv 300 Apis (tincture of the honey bee). Itching with burning of the sur- face, especially of the genitalia or urinary passages — gtt. x. to water ,5iv. Apocynum Ccamahininiu Fullnessof eyelids, swellingof the feet, oede- ma of any portion of the superficial cellular tissue, dropsy — gtt. v. to gtt. XX. in water .oiv... 122,664 Aralia Hispida. Dropsy of cavities — an infusion, or the tincture, 3ss. to water oiv...-. ■ 251 Antimonium Tarlaricum. Stridulous breathing, with difficult respi- ration, seemingly from want of muscular power — 3d to 6th decimal trituration in doses of one-fourth grain. Arrjenium, Niiri(:um. Intense tormina and tenesmus, with discharge of pinkish mucus, streaked with bright blood — one-third to one- fourth grain in form of pill 530 Crib) 726 INDEX OF INDICATIONS. Arnica. Tensive pain in the back as if bruised or strained ; muscu- lar pain and soreness when the limbs are moved ; feeble respiration ^\ — gtt. X. to water siv 330"' Arcwece Tela (a tincture of the web of the tela medicinalis, found in cellars, barns, and dark places). Periodicity; fever of a hectic character; persistent ague with nervousness or hysterical symp- toms; pulse full and irregular — gtt. x. to oj- in water ,^iv 651 Araiine DIadema (a tincture of the spider's web, cross spider). Chills with confusion of ideas; chills prolonged, with prostration ; febrile reaction not high 651 Arsenicum (Fowler's solution). Skin has lost its elasticity, epidermis dry; tendency to the formation of vesicles; tongue contracted and pointed ; pulse soft and easily compressed — gtt. j. to gtt. x. in water 5iv. (Donovan's solution ) AVe employ this ])reparation in the treatment of secondary syphilis, if the tongue is small and its red- ness increased 470 Arum Triphyllum. Intensely sore throat, bleeding, with marked fetor; sense of fullness and swelling of the throat and tongue — gtt. x. to water siv 570 Asclepias 2\ihcrosa. Pulse strong, vibratile; skin moist, [lain acute and seemingly dependent on motion — gtt. x. to .^j. in water si v. 204, 577 Aurum Muriaticam Natronatum (chloride of gold ami sodium). Indo- lent chancres and buboes, not sensitive; secondary and tertiary symptoms; in all cases the tongue is contracted and redder than usual — gr. 1 60 to 1-12, in pill or lozenge. In its action the proper- ties of gold differ but little from those of mercury. Alkalies. A broad, pallid tongue 425 Acids. A deep red tongue 425 Acidum Benzoicum. Very strong smelling urine 575 Acidum Carbolicum. As a topical antiseptic, one part to five or twenty of glycerine or linseed or olive oil 598 Acidum Ilydrocijanicnm. An elongated and ]>ointed tongue, reddened tip and edges; uneasy sensations in stomat h, with painful retchings — ^gtt. v. of the commercial acid to water oiv. in small and frequently repeated doses 304 Acidum Muriaticum. A deep-red tongue, brown coat and sordes..424, 592 Acidum Nltricum. Violet color of tongue; in many oases it seems like a transparent color over red — gtt. xx. to water oiv.. 521, 534 Acidum Sulphurosum. Tongue of natural color, full, dirty; tissues of throat look full and lileless. The skin has a rusty, likdess ap- pearance ■• 592 Baptisia. Face full, dusky, purplish-red, like one who has been in the cold for a longtime; tongue has the same dusky, purplish color; headache dull, pulse oppressed — gtt. v. to x. to water ,5iv 424,593 Baryta Carhonica. Weight and pressure about the pubes ; scanty menfitruation ; very sensitive to cold. (2d to 6th trituration, in doses of gr. i to gr. j). INDEX OF INDICATIONS. 727 ^(ichcrlnce Sulphas. Profuse monorrhagia, with an active circula- tion—gr. j. to grs. ij. BcllaJunna. Dullness, hebetude, disposition to sleep, coma, eyes dull, pupils dilated — gtt. v. to gtt. x. in water siv 327,420 Bismuth, (liquor). Tongue red, papillas prominent; uneasy sensa- tions in stomach towards the close of digestion, extending down wards and terminating in diarrhoea — gastro-intestinal irritation — ■ gtt. XX. to 3j 559 Bromine. As an inhalation in croup — gtt. x. tQ water 3j , heated. Bromide of Potassium. For sleeplessness and restlessness, when there is a vigorous circulation, but without fever ; epilepsy or con- vulsions with irritation of sexual organs; strong excitement of sexual organs 339 Boletus Laricis. Chills confined to the back ; chills alternated with flushes of heat ; great weight and debility of the back — gtt. x. to water 3iv 468 Bryonia. Pain of a tensive cutting character, of serous membranes ; headache extending from forehead to occiput, right side; right cheek flushed ; cough hacking, as from some irritating substance; rheumatic pain has the same tensive, cutting character 290, 423 Ca/x (lime.) A remedy for boils, and inflammations of cellular tis- sue having something of this character. In infantile dyspepsia, when the discharges from the bowels are green, and the child throws up curdled milk — Lime water 669 Calx Chlorinata. The tongue is pal. id, breath fetid; inflammation of cellular tissue, with tendency to sloughing — 3J. to water Oj., fil- tered ; dose, gtt. x. to 3ss., largely diluted 497 Camphor. Insomnia and restlessness, the pulse being soft, tongue moist; diarrhoea — gr. J to gr. j 209,334,370 Calcarea Carbouica. Enlargement of lymphatic glands; pallid ine- lastic skin ; softness of tissues; diseases of the reproductive appa- ratus of women, with these symptums — Homoeopathic triturations; Cactus Grandi flora. Irregular movements of the heart; irregular pulse, usually increased in frequency; unpleasant sensations in praecordia and fear of impending danger. The action of the heart is always impaired, never increased — gtt. x. to 3j. in water 5iv 295 Cannabis Iiidica. Painful micturition with tenesmus ; insomnia with unpleasant dreams during momentary sleep — gtt. x. to xx. in water s'lv 332 Carbo- Veg. Pallid skin, feeble circulation, with hemorrhage ; pale I * tongue, with slight coat, lifting in patches ; tumid, doughy abdomen. ' It is the remedy for asthenic hemorrhage — 2d dec. trituration, dose gr. j 60li^ CaidophyJlum. Uterine pains and tenderness in persons of full but lax habit; rheumatic pains in asthenic plethora. In labor with deficient pains when the tissues give a sensation of fullness as from congestion — gtt. xx. to water 5iv 615,626 728 INDEX OF INDICATIONS. Capsicum. In full doses (oSS. to oj-) in delirium tremens, with feeble pulse, cold extremities, and pallid face 351,513 Chamomilla. Green watery diafrhoea ; head sweats; very sensitive. — gtt. X. to water siv ; 4-17 Chionanthus. Pain in epigastrium and right hypochondriuni, simu- lating colic, sometimes extending to abdomen ; intense pain in re- gion of the liver, extending to umbilicus, with great prostration and sometimes nausea; jaundice— gtt. ij. to gtt. x. as a dose 49D Chelidonium. Scybalous faeces; pain in right shoulder and in dorsal spine ; greenish-yellow tinge of skin. Chloroform. In doses of gtt. j. to gtt. x. it may be given in severe and protracted chills; in the same dose it is regarded as a solvent for biliary calculi. Used as an anaesthetic. Notice that respira- tion is regular and free — 403. G3G Chloral. May be used to produce sleep, if the pulse is soft, circula- tion and temperature equal, temperature not above 100^. In small dose (one grain) it may be used in irritable dyspepsia, associated with hydrastia — Dose, grs. v. to grs. xx. 324,037 Cinnamon, (a tincture of the oil.) This is the most certain remedy I know in post-partum hemorrhage^gtt. xx. toSJ-, repeated as often as n ecessa rj' 3G0 Cimicifitga. See Macrotys 423, 007 Cinchona or Cinchomdia Sulphas. Has nearly the same value as sul- phate of quinia, but not so apt to produce head symptoms. May be ussd as an antiperiodic if the pulse is soft, skin soft, tongue moist, and nervous system free from irritation. (The antiperiodic quantity for an adult is grs. x. to grs, xv.) .437 Citrus Limonum. Lemon juice is a remedy for rheumatic pain, when the tongue and mucous membranes are very red, the urine being alkaline 367 Coca. Easily tired; feeling of weariness ; difficult and labored res- piration; temperature not increased — gtt. j. to gtt. xx 386 CoUinsoma. A sensation as if some foreign body was lodged in the rectum, with contraction of the sphincter ; contracted and painful l^erineum — gtt. x. to water 5iv. In chronic laryngeal irritation or inflammation, with sense of tickling in larynx, and cough arising from use of the voice — 3J. to syrup siij '. .-...248 Colocynth. Cutting pain in the abdomen, with diarrhoea. and dyscn- terj', tenesmus increasing the pain — gtt. v. to gtt. x. in water 5iv...l72 Conium. In rheumatic or neuralgic pain of feeble old persons; or in local disease with cacoplastic deposit — gtt. x. to oJ- in Avater oiv....331 Cuprum. A-blood-maker after severe hemorrMge or exhaustive dis- charges, the skin being pale and transparent. In chlorosis and other diseases, when the skin has a dirty greenish tinge. The tongue is usually clean and the breath sweet — gtt. v. to -gtt. x. in witer .5iv./ 469 C^pj/^xcZumi. In nervousness and sleeplessness from aton}' — gtt. ij. to gtt. XX. ...; 643 INDEX OF INDICATIONS. 729 Cuhcba. A remedy in the second stage of gonorrhoea, when the acute irritation has passed bj' ; in enfeebled conditions of the largo in- testine and rectum — grs. ij. to grs. x.... 255 DlgitaVs. The stroke of the pulse is feeble; the current of blood is easily stoppca by pressure; the sounds of the heart faint — gtt. x. to water 5iv 237 Dioscanxt. Abdominal pain of the nature of colic, with tendernoss on pressure — gtt. x. to 3j., water s'lv. 207 Drosera. The cough is expulsive as from irritation that can not be controlled ; the cough of measles ; whooping cough — gtt. x. to oj- in water 5iv 571 Elaierium. (Elaterium oSS., alcohol Oj.) It. lias a specific influence upon chronic inflammation of the bladder. Passages of mucus or muco-pus with tenesmus ; deep soreness in the bladder -with drag- ging in the perineum — oSS. to oj- at first to catharsis, then in doses of gtt. j. to gtt. V 174 E'-igeroR, (Oil of) A remedy in active hemorrhage, with strong and not very frequent pulse — gtt. j. to gtt. v i..554 Eflodyction Glut'mosum (Yerba Santa). Cough with abundant and easy expectoration — gtt. v. to xx. with syrup. Eryngium. Uneasiness in the bladder, frequent desire to urinate, and painful micturition ; pain in the bladder extending to the loins — gtt. X. to 5j. in water 5iv. 250 EpUohium. Diarrhoea with colicky pains ; feculent discharges witli tenesmus; diarrhoea with contracted abdomen; chronic diarrhoea with harsh, dirty, constricted skin — an infusion, or of the tincture • gtt. X. to gtt. XX. Ether Sulpliuric. Headache, with pallid, expressionless face, feeble pulse, and cool extremities — gtt. v. to x. on a lump of sugar.. ..402, G3G Eucalyptus. Sensations of coldness and weight in bowels ; cohl ex- tremities; cold perspiration; perspiration during chill — in small dose, gtt. X. to water 5iv. ; or in ague the larger dose of gtt. x. to oj-467 Eupatortum (Perfoliatum). Full pulse, full skin, tendency to perspi- ration even during fever ; deep-seated pains in muscles and bones —gtt. v. to gtt. XX. in water 5iv. 210,293 Eupiiforium (Purpureum ) Urine scanty, milky ; weight in loins; skin hot, dry, and constricted — gtt. x. to 3j' in water Siv. ...241 Euphorhia (Ilypericifolia). Diarrhoea, the discharges being greenish and irritant; frequent desire to go to stool, which relieves some- times without any motion — gtt. x. to water giv 125 EiipJiarhia (Corollata). The elongated and pointed tongue, prominent papillgo; uneasy sensations in the stomach and bowels as of a desire to go to stool — gtt. X. to water .^iv 125 i^'rr;/Hi (tine, of the acetate). Pallid, transparent skin; blueness of veins; dull, heavy pain in back of head — gtt. j. to gtt. v. in a wine glass of water three times a day 463 730 IXDEX OF INDICATIONS. Ferrum (tincture of the chloride). Erysipelatous disease, the part affected being deep red ; tongue deep red; mucous membranes and throat somewhat full, and showing same redness — gtt. v. to gtt. xx. at a dose 4G0, 560 Ferrum (syrup of the iodide). Enlargement of the lymphatic glands, without deposit in connective tissue; pallid though lull tissues; diSioalty in retaining urine; somatimes stillicidium — gtt. v. to ,5ss. 431, 49j Gallic Add. Hemorrhage, with feeble pulse, cold extremities, and inelastic skin — dose, grs. v 544 Galium. Nodulated growth or deposits in skin or mucous membranes — gtt. X. to water 3iv 44G Gaultherla. Irritation of the base of bladder and prostate, leading to sexual excitement; increased sexual excitement, evidently from "wrong of the reproductive organs, and not the mind — gtt. v. to X...48S Gelseminum. Flushed face, bright eyes, contracted pupils, increased heat of head, restlessness and indisposition to sleep, pain in the e.nti;re head; urine is passed with difficulty and in small quantity, with sense of irritation in the urinary organs, 285, 419, 638 Gentlana. Sense of depression referred to epigastric region, and asso- ciated with sense of physical and mental weariness — gtt. j. to gtt. v.450 Gaclus Morrliua (cod oil). Deposit of cacoplastic or aplastic material in cellular tissue, with tendency to breaking down, with subacute inflammatory action 422 Geranium. Diarrhoea with constant desire to go to stool; chronic diarrhoea with mucous discharges — gtt. j. to gtt. x 544 Ginseng. Nervous dyspepsia; sensation of dullness in head, with ina- bility to control the voluntary muscles — gtt. x. to 3j. in water 5J....454 Gossijplum. In large doses will bring on and stimulate uterine con- traction. As an emmenagogue when there is backache, with sense of dragging in the pelvis; sense of fullness and weight in the blad- der, with difficult micturition — gtt. x. to 3j. in water siv 609 Graphites (1st homoeopathic dilution). Tardymenstruation, with dis- turbance of the nervous system; skin pale, or pale with dirty tinge; slow, difficult respiration, almost stopping during sleep. Grlndella. Asthma; labored respiration with duskyflushing of face; (person plethoric;) old atonic ulcers; tissues full — oj. to syrup sij ; as a local application, 5j. to water Oj 501 Guarana. Headache, with pallid face, feeble pulse, increased by ex- ertion— gtt. X. to 3ss. as a dose 337 Hanuimells. Fullness and relaxation of tissue; fullness of veins, in- clined to dilatation ; laxness of muscular fibre; increased secretion of mucus; sensations of fullness, weight and dragging — distilled extract: doic, gtt. j. to gtt. xxx. ; and as a local application, one part to three or four of water 558 Heilroma (Pennyroyal). To restore the lochial discharge — use as an infusion 211,614 INDEX OF INDICATIONS. 731 Ildlihorm (Niger). Dullness of intellect, heaviness of head, coldness of forehead, with clanuny sweat ; jelly-like mucous discharge from the bowels — gtt. j. to gtt. v. in water 5iv 178. GIG Ileloiiias. Mental depression and irritability associated with chronic disease of the reproductive organs of women — gtt. v. to o^'^- in water 5 iv -IT/J Hydrastis. Irritation with enfeebled circulation, whether used as an internal remedy or as a local ajiplication. It is not a remedy lor acute inflammation with arrest of secretion. It is especially appli- cable in diseases of mucous membranes, should not be used when connective tissue is principally involved — sulphate or phosphate of Hydrastia, gr. j. to water oiv ■ 439,441 Ilypophospliite of Lime. Is especially indicated when there is a de- posit of aplastic or cacoplastic material in connective tissue, slight inflammatory symptoms resulting; tuberculosis; phthisis pulmon- alis — grs, ij. to grs. v. three times a day 465 Ili/pophosphitcs, (Compound syrup.) When there is an enfeebled cir- culation, and feeble nutrition of nerve-centres. The surface is usually pallid, waxen, and the extremities inclined to be cold 4G7 Ilyoscyamiis. " Delirium with hallucinations" — gtt. v. to gtt. x. water 3iv 32G Hypericum Perforatum. It is claimed that it exerts a marked influ- ence in relieving irritation in injuries of the spine, and in punc- tured or lacerated wounds of the extremities, preventing tetanus. Relieves the excruciating pain of such injuries — gtt. v., water 51 v. Iheris Amara. Cardiac hypertrophy; dropsy from cardiac disease"; asthma associated with cardiac disease; pulse " purring," full and tremulons. I'jnatia. Morning chills ; feels better out of doors ; deep-seated and dull pain in epigastrium, feeling as if the stomach was dragged backwards; weak empty feeling in stomach; pain shooting from right hypochondrium to shoulder— gtt. v. to water giv 384 Ipecacuanha. Irritation of mucous membranes, with increased secre- tion— diarrhoea, dysentery; inflammation of parenchyma of lung — gtt. V. to XV., in water giv 115, 137, 205, 569 Iodide of Potassium. Pale, leaden-colored tongue, usually full ; con- traindicated by contracted red tongue. Antisyphilitic with this indication — grs. v. to grs. x 494 Iodide of Ammonium. Dull pain in head with dizziness, and inability to command the voluntary muscles— 5ss., water 5iv. ; a teaspoonful three times a daj' 495 Iris. Fullness of throat, enlargement of thyroid gland, fullness of throat with pulsation of arteries — gtt. x., water Siv., and as a local application 179 Juglans Cinerea. In large doses it is an excellent laxative ; in small doses it rslieves irritation of the stomach and intestines, and pro- motes digestion. It may be thought of as a remedy in chronic ecze- ma—gtt, Y. to water giv 164, 491, 523 732 I^-DEX OF INDICATIONS. Kalm'ia. In sypliilis with excited circulation^gtt. v. to x., water 5iv. Lavandula, (Compound spirit). The child's stimuhmt; combined • with i^obelia in asthenic bronchitis, and in atony of bowels with ])ain , 302 Ladle Add. Deep redness of the tongue, deep redness of skin, ■ - pulse oppressed. (Whey is a most excellent form.) G97 Lcpfandra. Dull heavy pain in right hypochondrium, fullness uf ab- domen ; tongue coated markedly white, but not a fur ; is thirsty but can not drink water; restless and cannot sleep — Leptandrin ■ gr. •} to gr. j. ; tincture, gtt. x., water giv. 166 Ljithlum, (Benzoate of).) Uneasiness in the loins, extending to the bladder; passage of mucus with 2:>hosphates from bladder ; fullness and tension in perineum, and desire to micturate frequently, with difficulty in passing urine — gr. j. in a glass of water three times daily 498 Lobelia. Sense of fullness and oppression in praBCordial region ; op- pression of chest and difficult respiration; sharp lancinating pain starting in heart and radiating to left shoulder and arm; mucous rattling in throat; full, oppressed pulse, weak pulse — -stimul-uit doses, gtt. X. gtt. XX. at a single dose in angina pectoris; gtt. x. to water 5iv. in ordinary disease; combined with Lavender ibr as- thenic bronchitis of the child .....117, 294, 567, 639 L^ycopus. Chronic cough with frequent pulse and high range of tem- perature; hemorrhage with frequent pulse; albuminuria with fre- quent pulse; Bright's disease — gtt. x. to gtt. xx., water 5iv 301 JIaa-ofi/s. Muscular pains; uterine pain with tenderness ; false pains, irregular pains; rheumatism of the uterus; dysmenorrhcea. An anti-rheumatic when the pulse is open, the pain paroxysmal, the skin not dry and constricted^ — gtt. x. to gtt. xx., ^yater ^iv 423, 607 Menlspermum. Skin brown, tongue coated at base, tip red. irregular appetite, constipation — 5j- to water siv 4D1, 45!? Mentlia Virldlt^. Scanty secretion of urine, frequent desiio to iir.S'S water — gtt x. to gj., water 5iv 21G, 259 Mercury. I do not believe in the use of mercury, becaa.so jdiysicians can not learn to use such remedies rightly, and wh^n cmitia inJi- cateid it produces such terrible and lasting effects. But in this index of indications for remedies it will not do to pass it by without pointing out the special indications which will permit its use in small medicinal doses. The tongue is contracted, elongated, .pointed, of rather more than usual redness, and the papilla; prominent. With a full, pallid, expressionless tongue, and marked absence of papillae, it will prove a poison, sometimes of the most virulent kind. Mi/chfdlu. Uneasy sensations in the pelvis, with dragging, tendernes.^ on i)ressure, frequent desire to i)ass urine, and difficulty of evacua- tion — ,"5.). to water ,5iv 611 Myrini. Increased secretion from mucou.s membranes, thcx-'bcing lull i'.nd relaxed ; full, oppressed pulse; imiierf'ect circulatiiui ti> MirfM((> and extremities '~)\, 661 INDEX OF INDICATIONS. 73j Morphia. The pulse is small and soft, waves short and square, dis- tance between waves lone — this is the specific indication. It is per- missible to relieve pain or produce sleep, when the pulse is soft. tongue moist 3:^1. G?^'^ Ncpcia Odafla. Pain in abdomen, flexing of the thighs upon the abdomen, w-rithing of the patient, persistent crying — 3j ; water 5iv. Nicutlaud Tahaciim, (tincture of the fresh plant.) I\ieumonia or bronchitis, with pallid skin, coldness of extremities, imperlect cir- culation of blood — gtt. 5., water 5iv 302, 332 Nitric Acid. Violet color of tongue, transparent, the redness of the tongue showing below — gtt. xx., water and syrup sij. 521, 534 Nitrate of Soda Violet color of tongue,, transparent, the tongue being somewhat pallid below; tongue lull, sv/ollen, covered with a white or yellowish mucus — grs. x. to oU-i water oiv. Ntix Vomica. Sallow, expressionless tongue, with nausea and vom- iting; sallow, expressionless mouth, with tinge of yellow; abdom- inal pain, paroxysmal, pointing at umbilicus; tumid abdomen with i)aroxysmal pain; paroxysmal pain in right hypucliondrium, shooting to right scapula; paroxysmal pain in uterus, extending to umbilicus; in diarrhcea the discharges are hlrge, and at- tended with colicky pain 138,381 Oleum Murrluae. Tissues soft, atonic, with aplastic or cacoplastic deposit ; soft, feeble tissues, frequent pulse, with increased temper- ature part of the day 492 Opium. The pulse is small, with short waves, gives a sensation of fuUuess. It is permissible to relieve pain and induce sleep, when tlie i)ulso is soft and open, the skin soft and inclined to moisture, tongue moist 205, 320 Potasace Curbonas. Pallid, expressionless tongue, fullness of muscles, greater loss of strength than can be accounted for by conditions of disease- — add to water so as to make a pleasant drink, and con- tinue until tongue assumes its normal redness 672 Poiasscv CJiioras. The antiseptic of the puerperal state; when por- tions of the placenta, blood-clots, etc.. are retained and undergo- ing decomposition; fetid lochia), fetid breath, fetor as from decoui- l)0.-ing animal matter — from grs. v. to gij- ii^ay Ijc given in the twenty-four hours, and used as a local application 424, 594 Pota&soi Nitras. Scanty urine, with difficult respiration; difficult deglutition as from paralysis of muscles of the throat; enlarge- ment of tonsils. Burned to relieve asthma — gr. v. to 3'j-) water ,5.iv. 218, 266 Potasscc Permanganas. As a local application only, in phlegmonous erysipelas, in inflammation where tissues have lost vitality, and are inclined to slough ; in the early stage of felons and boils, to arrest the ])rogress of inflammatory action — ordinary use, 3j- to water Oj ; lor the last use grs. x., water 3j. Potassii FciToc'/anidum. Hysteria or hypochondriasis, with slow imi'errect Vva^ie and nutrition — ;7J..to 5ss., water s'lv. 308 734 INDEX OF INDICATIONS. Potassce Sulphas. The color of the skin is dirty, tissues full and sod- den, skin scaly ; wounds heal slowly, inflame and suppurate — gr^ V. to grs. X. three times a day in a glass of water 496 Pentlujrum ScdoiJes. Catarrhal inflammations; nasal catarrh, with fullness of mucous membranes and abundant secretion; spongy gums; fullness of fauces and mucous membrane of pharynx; catarrhal disease of stomach, catarrhal diarrhoea — gtt. x. to 3j., water oiv 465 Phuapliorus, (tincture of) Vesical and prostatic irritation, with mu- coid discharges; fullness with dragging in perineum; discharges of mucous from rectum, with sense of weariness from lower ex- tremities. In pneumonia with sense of oppression, and difficulty of expectoration, livid face — gtt. v. tox., water siv 465 Phoiiphonis. (Phosphorated oil, Phosphorus pills; dose, g;\ 1-100 to 1-50.) As a nerve stimulant, especially when there is I'eebie re- productive power. Indications — a soft pulse, cold extremities, in- elastic skin, pendulous scrotum, fullness of lower abdomen in women, without sharp pain 465 Phosphate of Soda. As a restorative when there is j^allidity of the tongue and mucous membrane, and constipation. It is especially valuable for children — grs. j. to grs. xx., three times a day. Phytolacca. Soreness of mouth, soreness of throat, with tendency to death of epithelium; diphtheritic deposits, fullness about throat externally; enlarged cervical epithelium; caking of breasts, inflam- mation of breasts, sore nipples; disease of the skin or of the blood with death of and imperfect reproduction of the epithelium — gtt. X to 3j., water siv 423, 476, 663 Pix Llquila. (Glycerole of Tar.) The remedy for pruritus ani, p.nd for some diseases of the skin with pruritus. For couah with pro- fuse bronchial secretion, add one part of glycerole of tar to seven parts of glycerine, two parts of water 581 Podophyllum, Podophyllin. Fullness of veins, fullness of face, full- ness of abdomen, fullness of tongue with pasty secretion...... IGl Polygonum. Want of menstrual flow, chilly sensations in back, ten- sive pain, pain of legs, skin harsh and inactive — gtt. x. to ."ij., water 5iv 207, Gil Propylamin. In rheumatism when febrile action has been relieved — gtt. v. to gtt. X., mint water 3iv. Pulsatilla. Patient is nervous, despondent, restless, sleepless; pulse soft, easily compressed; eyes dull, dark lino under them; repro- ' ductive excitement ; fear of impending danger; menses arrested, tardy, scanty — gtt. x. to gtt. xxx., water siv 297, 608 Quinia Sulphas. Periodicity — the pulse being soft, skin sol':, tongue moist and cleaning, nervous system free from irritation — antiperi- odic quantity grs. x. to grs. xx. As a stimulant, in small doses, when the above conditions of body are present 435 INDEX OF INDICATIONS. 735 Rheum. Irritation of stomach, nausea, vomiting; tongue elongated, reddened at tip and edges; dianliuia, witli tenderness on i)rej5sure; sour smell of child— gtt. x. to gtt. xx., water siv • 160 Rlitts Tax. Small, sharp pulse; jiain in forehead, especially in left orbit; burning jtain ; tongue shows red spots on upper surface of tip— gtt. v., water 5iv - 289, 420 Rume.c Crispiia. Cough, with sense of irritation in trachea and lar- ynx—gtt. V. to 3ss., syrup sij 482 Salicin. Periodicity, the patient complaining of severe i^ain, rheu- matic in character, or simulating rheumatism — antiperiodic quan- tity grs XV. to grs. xxx., in divided doses. As an anti-rheumatic, the febrile action being controlled by the sedative 422, 441 Salvia. Profuse sweating, continued inaction of the skin, feet sweat and get cold, night sweats — gtt. v. to Sj-, water 3iv 217, 368 Salicylic Acid. Anti-rheumatic, and the indication, rheumatic pain without much febrile re-action ; sub-acute rheumatism. The tongue is slightly leaden colored, and shows spots when the fur is lifted — as an anti-rheumatic, grs. ij, in pill, every three hours until grs. XX. are taken. An admirable local application in chronic ca- tarrhal disease of mucous membrane. li Salicylic Acid, Borax aa. 3j , water Oj 422, 596 Sambucus Canadensis. In disease of the skin, when the tissues seem full; epidermis separates and there is abundant serous discharge which forms crusts; indolent ulcers; tissues lull, flabby, as if con- taining water — gtt. x. to gtt. xx., water 5iv 253 Sanguinaria, (Nitrate of). Tickling or irritation of throat with cough ; sense of irritation in nose ; uneasiness at supra-sternal notch ; sense of uneasiness and burning in stomach, with nervousness — grs. j. to grs. ij , syrup and water 5iv 568 Secaie, Ergot. Dullness of intellect, disposition to sleep, dizziness; tissues full, inelastic; pulse oppressed; iullness of abdomen; hemorrhage with above conditions — gtt. j. to o^s 622 Scutellaria. Hysteria with inability to control the voluntary muscles ; nervousness manifesting itself in muscular action — gtt. v. to 5j., water 3iv. Sometimes quite large doses will be required 644 Senecio. Enlargement of uterus with uterine cr cervical leucorrhcea; difficulty in urination — gtt-. v. to cj , water siv 612 Sodw Sulphas. As an antidote to lead — Jss. to water 5iv. To increase waste, when the skin is full, inelastic with brownish-sallow discol- oration— grs. ij. to grs. xv. in a glass of water three times a da.y. It is a remedy in dysentery when there is the same appearance of skin. 185 8odce Salphis. The tongue is broad, pallid, and has a dirty coat — grs. ij. to grs. XX.., 590 Spongia Tasta. (In homoeopathic dilution.) Hoarse croupal cough, wheezing inspiration, soreness and burning in air passages — gtt. s. to water siv. 736 IXDEX OF INDICATI02;c;. Stillingid. — Irritation of superior pharj-nx, and just behind the fauces, causing cougli; hoarse croupal cough, paroxysmal, as if iroui great laryngeal irritation ; skin disease, showing njarkcd irritation, with icliorous discharge — for croup, the stillingia liniment as an external application ; for chronic cough, the same, half to one drop on a lump (if sugar; other rises, the tincture, gtt. x. to oU- water s'lv 478 Sticta. Cough, with pain in shoulders, extending to the occiput ; rlicunsatie pains, with soreness of shoulders, cervical region, and occiput — gtt. X. to .oj., water 5iv. Sulphurous Ariil. Tiic mucous tissues are of normal redness, but full and leeble; the tongue is coated with a moist, glutinous fur, having a tinge of brown — 3S£. to water 3iv. ; as a local application it is best used with a spray apparatus.,. 42-1 SfrycJinia. As an antiperiodic when the patient has difficvilt respira- tion, tardy and feeble urination, sufiers iVom nightmare — gr. 1-GO to 1-20. In cholera or choleraic diarrhoea, with the same symptoms attd great muscular debility 381 Sulphur. The skin is dirty, sallow, brownish, and the mucous mem- brane has a dirty hue 186, 495 Stramoniuin. Delirious; cannot rest in any position ; continuously talking; seems to be i'earful — gtt. v. to x., water 5iv 329 Trifulium Pra/enfic. An infusion of red-clover, has a specific influ- ence in spasmodic cough, whooping cough, and the cough of measles. Thuja Occidentalis. Syphilitic or other diseases of bad blood, with warty excrescences, or ulceration, showing prominence of papillae — gtt. X., water o'V-- -jO^ Urt'tca Dtuica. Chronic diarrlioea or dysentery with evacuations of mucus; chronic inflammation of bladder with abundant mucous discharge — gtt. x. to ,5j., water 5iv 549 UveJalia. Enlargement of the spleen, ague cake ; hypertrophy, with sensations of weight and drag 482 ScuUcap 644 Scutellaria lateriflora 644 Secale cornutum — 622 Sedatives 268, 419 action of. 269 therapeutic indications 270 topical uses 277 recapitulation 277 Sedative inhalations 583 Seidlitz powder 184 Senecio gracillis 612 Senega 570 SeneUa snakeroot 570 Senna 167 Serpentaria 202 Sesamum Indicum 691 Scsquicarbonale of potassa 521 Setaceum 528 INDEX. 747 PAGE. Shepherd's purse 262 Sevum 698 SiahigOi^ues 657 therapeutic application 657 Silphium 490 Silver, nitrate of. 530 Simaruha aniara 446 Sinapis 511, 359 yixunic cabbage 214 Slippery elm ' 691 Smart weed. 207 Smilax officinalis 258, 480 Sodie acetas... 267 bicarbonas 674 carbon as 674 et potassa tartras 184 phosphas 186 sulphas 185 Sodii cbloridum , 132 Sodii sul[)his 590 sulphocarbolas 592 Sodium, chloride of 604 Solanum dulcamara 486 nigrum 336 Solidago odora,, 366 rigida 554 Solomon's seal 704 Sourwood ..260 Spanish flies 521, 616 Special therapeutics 95 Spider's web 651 Spigelia Marilandica. ., 651 Spircea tomentosa 556 Spirit of ammonia 376 of niter, sweet , 306 pyroxilic 573 vapor bath 221 Spiritus SBtheris nitrosi 262 pyroxilicus 574 Spurred rye 622 Squill 569 Starch 694 Statice Caroliana 543 Staphysagria ,385 Stavesacre 385 Stillingia, oil of , 478 sylvatica 478 Sticta 294 Stramonium 329 PAGE. Stimulants - 340, 420 action of. 341 therapeutic indications 348 contra-indications 351 Strychnia 381 Strychnos nux vomica 381- ignatia 384 tieute 385 toxifera 385 Styrax 575 Sugar 696 Sulphurous acid 592 Sulphate of cinchonia 437 of magnesia 183 of quinia 435 of zinc 532,599 of soda 185 manganese 181 Sulphur 186, 495 Sulphite of soda 424, 590 magnesia 591 Sulphide of calcium 497 Sulpliui'ot of potash 496 Sulphuric acid 51G elher 402, 6.-;6 Sulphurous acid .. 424, 592 Sumach , 547 Suppu rants 510 Suppurant revellants 524 Sweet fern 558 Sycamore 213 Tabacum 302, 332, 659 Tannic acid 543 Tannin .543 Tapioca 694 Tar 581 488 .651 514 370 503 369 590 52 7 705 560 500 302 580 Taraxacum 252, Tela arancae Terobinthitije oleum Thea Thuja occidentalis Thyme 217, Thymol Tiglii oleum Till I glabra Tinctura ferri chiOridi 267, Tincture of muriate of iron. ,.267, Tobacco Tolu, balsam of 573, 748 INDEX. PAGE. Tolutanum 573 Tonics 427 action of. ;429 therapeutic indications 430 Tormentilla 549 Traijacanth 690 Trillium cernuum 131 pendulum 547 Triosteum perfoliatum 180 Tulip-tree 451 Turpentine 358, 514 Tussilago farfara. 692 Typlia latifolia 705 Ulmus fulva 691, 703 Ustilago niaidis 626 Uvedalia 500 Urtioa Dioica 549 Uva ursi 244 Vaccinum frondosum 248 Valerian 643 Vapor-bath 223 Veratrum album 662 viride 278, 419 Verbascum thapsus 245 A'crbena hastata 127 urticifolia 128 Vernonia prealta 489 Vesicants 507 Viburnum 630, 647 Vioia odorata 129, 704 pedata 129, 704 tricolor 129, 704 PAGE. Vinum 373 Virginia snakeioot 202 Wahoo 452 Walnut, black ...491 white 491 Warm air 221 bath 224 vapor bath 223 Water avens 550 Water-cure treatment 26 Watermelon , 245 Wax, myrtle ....G99 Wet-sheet pack ..22G White ash 455 Wild cherry 442 indigo 593 Willow 441 Wine 373 Winteri 36G Wintergreen 488 Witch hazel 558 Worm oil —657 seed .....Gbl Xanthoxylum fraxineum..214, .353, 659 Yellow dock 482 Yellow parilla 4 52 Yeast 599 Zinc, chloride of. 553 sulphate of. 532, 599 phosphide of. 469 Zincum 531 Zingiber officinale...,, 215, 354, 659 S p f,N ?^2 1'^^'