Book :._•_ Copyright . COPYRIGHT DEPOSrr. TREATISE ON Acology and Therapeutics. WITH SOME OF THE MOST PROMINENT PRINCIPLES AND RULES OF CHEMICAL AND MECHANICAL PHARMACY. BY J. G. WESTMORELAND, M.D., Professor of Materia Medica and Therapeutics in Atlanta Medical College. ATLANTA, GEORGIA. Plantation Publishing Company's Peess. 1873. ^ \H 5^ Entered, according to Act of Congress, in the year 1873, by JOHN G. WESTMORELAND, M.D., In the Office of the Librarian of Congress, at Washington. •ro WILLIS F. WESTMORELAND, M.D., rBOPESSOR OF SURGERY IN ATLANTA MEDICAL COLLEGE, AS A TESTIMONY OF ESTEEM FOR AN ONLY BROTHER, WHOSE LIFH HAS BEEN DEVOTED TO THE SCIENCE AND ART OF SURGERY; TO THE TRUE PRINCIPLES OF THE MEDICAL PROFESSION,. AND TO THE CAUSE OF HUMANITY, Cjfis Volvm IS AFFECTIONATELY INSCRIBED, BY THE AUTHOR, PREFACE As a text-book for the student of medicine the work now pre- sented to the public was in contemplation, and partially arranged, several years since ; but various circumstances prevented its ear- lier publication. The author has been for a long while impressed with the im- portance of a system of classification which would present to the learner, remedies grouped together, and classes named in accord- ance with their natural, direct physiological action. In the accomplishment of this object, it is believed that incalculable advantage is afforded in the study of remedies and their thera- peutic use. The increased facilities for learning and appreciating the direct action of medicine, will doubly compensate for the inconvenience and confusion arising from new names of classes, and the change of certain agents from their usual arrangement in works on Materia Medica. . The changes adopted in chemical nomenclature have been made more to harmonize with the United States Pharmacopoeia than for any practical advantage likely to be obtained by them. The late decennial revision authorized by the Convention of 1870, requires that the salts of alkaline bases be named with reference to the elementary substance, and not as heretofore in accordance with the oxide of the metal or metaloid. Thus, "nitrate of po- tassa" a name expressing the union of an acid with an oxide of potassium, has been changed to "nitrate of potassium," etc. These, with other innovations of the code, such as the adoption of new preparations and the rejection of some hitherto recognized, have been adopted in this work. N ; I'Kr.iAti.. It will be found thai in some of the classes, only a few articles :llv men tioned. This is owing to the fact that many remedies used in the treatmenl of disease have been given rather empiric- ally, with the expectation of certain therapeutic results without, however, any knowledge of, or regard for, the immediate action bad by them. There arc many of these about which nothing is certainly known, so far as their direct action is concerned, and which, therefore, cannot be arranged in a classification founded on physiological action. ^ In the adoption of names* for the classes, which indicate the action had, and the part affected by the remedies included, those in general use, denoting the functional changes likely to follow their use, have been also retained in some instances. For exam- ple, the names, " emetics" and "cathartics," are retained along with " inverse gastric excitants" and "enteric excitants." This course serves the purpose of directing the minds of those who have already studied them, to the groups of remedies which have the physiological actions indicated, and also of impressing the beginner with the results to be expected. While perfection is not claimed for the classification and arrangement adopted, it is believed that great advantages will be afforded the learner in directing his mind to the funda- mental principles of rational medicine. If in this he is success- ful, the author feels satisfied that his labors have not been in vain. TABLE OF CONTENTS. PHAKMACOLOGY. Introduction. — Materia Medica, Acology, Therapeutics, Remedies, . . 1 Psychical Influences. — Love, Anger, Hatred, Joy, Hope, Fear, Disgust and Sorrow, . . . . . . . . . .2 Somatical Remedies. — Pharmacological Substances, Physical Remedies, Drugs, Medicines, . ......... 7 Hygiene. — Light, Air, Water, Exercise, Sleep, Diet and Drinks, . . 8 Pharmacy. — Collecting Drugs: Roots, Perennials, Leaves, Flowers, Barks, Seeds. Collecting and Packing: Roots, Leaves, Flowers, Barks and Seeds of Annuals, Biennials and Perennials, . . . . . 13 Weights and Measures. — Troy or Apothecaries' Weight, and Wine or Apothecaries' Measure (U. S.) ; Weights and Measures (Br.) ; Relative Value of U. S. and French Weights ; Relation of British Weights to Measures ; Relation of British to Metrical Weights ; Relation of Brit- ish to Metrical Measures ; Relation of French to U. S. Measures ; Relation of French to U. S. Long Measure, . . . . .17 Pharmaceutic Chemistry. — Material Agents, Bodies, Simple and Com- pound, Elementary Bodies, Matter, Synthesis, Analysis, Chemical Equivalents, Nomenclature, Acids, ...:... 21 Mechanical Operations of Pharmacy. — Pulverization, Contusion, Ma- ceration, Digestion, Solution, Elutriation, Expression, Filtration, De- cantation, Despumation, Percolation or Lixiviation, Vaporization, Evaporation, Inspissation or Exciccation, Crystalization and Distilla- tion, 25 Forms of Preparation. — Solids: Pills, Powders, Lozenges or Troches, Suppositories and Plasters. Liquids: Tinctures, Decoctions, Infu- sions, Wines, Vinegars and Solutions. Semi-Fluids: Syrups, Cerates, Ointments, Liniments and Lotions, 29 Parts to which Remedies are Applied. — Stomach, Rectum, Skin, Nose, Lungs, 36 Vlll TABLE OF CONTENTS. BiODUl OrK.uANDi of Remedies. — Local Remedies, Elective Remedies; Ac- tion through Mechanical Process, Action through Chemical Process, and Action through Vital Process ; Primary Action, Secondary Ac- tion ; Direct Therapeutic Results, Indirect Therapeutic Results, . 43 Circumstances which Modify the Action of Remedies. — Climate, Age, Sex, Idiosyncrasy, Habit, Temperament, . . . . .49 Classification of Remedies. — Table of Physiological Classification, Or- ders, Sub-orders, Divisions and Classes, 55 ACOLOGY AND THERAPEUTICS. ORDER I. — Local Remedies. SUB-ORDEK I— Local Action through Vital Process. DIVISION I.— Remedies that Affect the Skin. CLASS I. — Rubefacients. Sinapis, Oleum Terebinthinae, Capsicum, Chlo- ral, Olea Aromaticus, Aqua Ammonise, Chloroformum, iEther, . . 63 CLASS II. — Vesicants. Cantharis, Aqua Ammonise, Caloric, ... 68 CLASS III. — Pustulants. JJnguentum Antimonii, Oleum Tiglii, . . 73 DIVISION 11.— Remedies that Affect all Soft Tissues. CLASS I. — Astringents. Plumbi Acetas, Geranium, Quercus, Galla, Ac- idum Tannicum, Acidum Gallicum, Rubus, Kino, Krameria, Catechu, Hgematoxylon, 75 CLASS II. — Catheretics. Iodinum, Acidum Carbolicum, Zinci Sulphas, Cadmii Sulphas, Argenti Nitras, Zinci Chloridum, Cupri Sulphas, Iodoformum, .85 CLASS III. — Aromatic Local Excitants. Cinnamon, Zingiber, Cary- ophyllus, Mentha Piperita, Mentha Viridis, Calamus, Cascarilla, Lav- andula, Anisum, Foeniculum, Pimenta, Piper, Myristica, Aurantii Cortex, Vanilla, Canella, Coriandrum, Cardamomum, . . .97 SUB-OKDER II.— Local Action through Ohemioal Process. DIVISION I. — Remedies that Affect Adventitious Substances and Structures. CLASS I. — Anthelmintics. Spigelia, Chenopodium, Azedarach, Granati Radicis Cortex, Pepo, Brayera, Rottlera, Hydrargyrum, Filix Mas, Santonica, 109 CLASS II. — Escharotics. Potassa, Cauterium Actuale, Acida Minerales, 121 CLASS III. — Antiseptics. Creasotum, Acidum Carbolicum, Calx, Chlo- rine, Carbo Ligni, . 123 TABLE OF CONTENTS. IX SUB-OEDEE III.— Local Action through Mechanical Process. DIVISION I. — Remedies that Affect Internal and External Surfaces. CLASS I. — Demulcents. Acacia, Linum, Ulmus, Chondrus, Cetraria, Sesamum, Sassafras Medulla, Amylum, Glycerina, Althaea, Symphy- tum, Oleum Olivas, Bismuthi Subnitras, 129 CLASS II. — Emolients. Pulvis Ulmi, Lini Farina, Symphytum, . 138 CLASS III. — Mechanical Counter-Irritants and Depletives. Hirudo, Cucurbitula, Acupunctura, Setaceum, Fonticulus. Moxiburium, . 141 jR ^IR,T III, ORDER II. — Elective Remedies. SUB-OEDEE I. —Elective Action through Chemical Process. DIVISION I.— Remedies that Affect the Blood. CLASS I. — FLematinics. Cibus, Ferrum, Oleum Morrhuse, Transfusio, 148 CLASS II. — Span-Emics. Blood-letting, Mercury, Low Diet, . . . 15G CLASS III.— Diluents. Infusions, ....... 157 CLASS IV. — Haemostatics. Plumbi Acetas, Ferri Chloridum, Argenti Nitras, Acidum Carbolicum, Ferri Persulphas, .... 158 CLASS V. — Catalytics. Hydrargyrum, Iodinum, Sarsaparilla, Stil- lingia, Arsenicum, Acidum Sulphurosum, Chloroformum, Ammonii Chloridum, Chimaphila, Antacida, ....... 168 SUB-OEDEE II.-Elective Action through Vital Process. DIVISION I. — Remedies that Affect the Alimentary Canal. CLASS 1. — Inverse Gastric Excitants or Emetics. Ipecacuanha, Gille- nia, Sanguinaria, Tabacum, Zinci Sulphas, Cupri Sulphas, Cadmii Sul- phas, Hydrargyri Sulphas Flava, . . . . . . . 185 CLASS II. — Enteric Excitants. Aperients, Purgatives, Drastics. Mild Enteric Excitants or Aperients : Olem Olivae, Manna, Magnesia, Pulveres Effervescent.es. Thorough Enteric Excitants or Purgatives: Hydrargyrum, Rheum, Aloe, Juglans, Oleum Ricini, Magnesii Sulphas, Sodii Sulphas, Senna, Cas- sia Marilandica. Violent Enteric Excitants or Drastics: Jalapa, Podophyllum, Scam- monium, Garnbogia, Colocynthis, Elaterium, Oleum Tiglii, Leptandra, 200 CLASS III. — Gastric or Digestive Tonics. Cibus, Pepsin, Calumba, Frasera, Gentiana, Gentiana Catesbaei, Quassia, Coptis, Sabbatia, Acida Mineral es, . - ' 229 X TABLE OF CONTENTS. DIVISION l\.— Remedies that affect the Heart. CLASS I. — Cardiac Stimulants. Capsicum, Oleum Terebinthinae, Am- monii Carbonas, . . . . . . . . . .251 CLASS II. — Cardiac Sedatives. Veratrum Viride, Depletio, Frigidus, Antimonii et Potassii Tartras, Potassii Nitras, ..... 250 CLASS III. — Cardiac Tonics. Digitalis, Prunus Virginiana, Acidum Hy- drocyanicum, . 209 DIVISION III. — Remedies that affect the Mucous Memhronw. CLASS I. — Blennymenal Stimulants. Oleum Terebinthinae, Copaiba, Bal- samum Tolutanum, Balsamum Peruvianum, Senega, Eucalyptus, Col- linsonia, Ammonia, Phellandrum Aquaticum, Styrax, . . . 270 DIVISION IV. — Remedies that affect the Nervous System. CLASS I. — Cerebral Stimulants. Opium, Chloroforum, Alcohol, Hyos- cyamus, Stramonium, Belladonna, VEther, Cannabis Indica, . . 2K7 CLASS II. — Cerebral Sedatives. Anaesthetic Cerebral Sedatives, Pros- trating Cerebral Sedatives. Anesthetics: iEther, Chloroformum, Nitrous Oxide, Chloral. Prostrating Cerebral Sedatives: Tabacum, Acidum Hydrocyancum, . .107 CLASS III.— Cerebral Tonics. Phosphorus, Zinci Sulphas, Cuprum, Argenti Nitras, Centaurea, Bromihum, 314 CLASS IV. — Excito-motor Stimulants. Nux Vomica, Arnica, Electri- city, 322 CLASS V. — Excito-motor Sedatives. Conium, Woorari, Physostigma, 320 CLASS VI. —Spinal Nervous Stimulants. Assafoetida, Moschus, Cerium, Oleum Succini, Castoreum, Caffea, ....... 329 CLASS VII. — Spinal Sedatives. Gelsemium, 330 CLASS VIII. — Spinal Tonics. Cinchona, Salix, Cornus, Impluvium, Cim- icifuga, 338 DIVISION V. — Remedies that Affect the Secernent System. CLASS I. — Hepatico-Salivary Stimulants. Hydrargyrum, . .347 CLASS II. — Hepatic Tonics. Acida Minerales, Taraxacum, . . 361 CLASS III. — Renal Stimulants. Oleum Terebinthinae, Cantharis, Co- paiba, Juniperus, Sabina, . . . ..... 354 CLASS IV. — Renal Sedatives. Potassii Nitras, Potassii Bitartras, Spir- itus /Etheris Nitrosi, . - 358 CLASS V.— Renal Tonics. Scilla, Uva Ursi, Tinctura Ferri Chloridi, Digitalis, Buchu, 361 DIVISION IV. — Remedies that Affect the Procreative Organs. CLASS I. — Genital Stimulants. Cantharis, Cannabis Indica, . . 307 CLASS II. — Genital Sedatives. Gelsemium, Lupulina, Camphora, . 309 CLASS III. — Uterine Stimulants. Ergota, Gossypii Radix, . . .171 CLASS IV. — Uterine Sedatives. Viburnum, Opium, . . . . 375 I iCOLOGY AND THERAPEUTICS IF> _A_ IR, T I. PHARMACOLOGY INTRODUCTION. The advantages to the learner, derived from elementary works on Acology, consist chiefly in the classification of remedies upon their known physiological action, and their modus operandi in the cure of disease. A treatise on this subject, therefore, should be devoted more to the selection and arrangement of agents having a particular action, than the association, in one item, of all the properties possessed by a single article. The latter plan is carried out in the alphabetical order of Dispensatories, which serve as reference for the full history of all known reme- dies. In a practical work on Therapeutics, the student of medicine expects to find grouped together the prominent articles of classes, forming the necessary resources upon which to draw for any given action. Works of this kind are found under the titles of "Ma- teria Medica," "Acology," "Therapeutics," etc., and with very different forms of classification. Materia Medica is the term usually applied to the branch of medical science which teaches the description and properties of medicinal agents. Strictly speaking, the name denotes material 1 '1 tCOLOGl agents alone, but, by the liberal definition allowed, i> made to in- clude remedies of every kind — their history, description, proper- ties, preparations and modus operandi. A.COLOGY- -Acofoffiti, from '//'C, a remedy, and /<>yi>:, a treatise or discourse, was suggested by Pereira, as a more appropriate name, and literally means what is understood by Materia Medica. The consideration of remedies will, of course, necessarily include all of every variety of means, used in the palliation and cure of disease, material and immaterial. Even mechanical agencies, described in works on Surgery and Obstetrics, may also, with propriety, be included. Therapeutics — from depaneua*, to cure — treats of remedies and their application in the treatment of disease. The extensive scope allowed by this term would naturally include the subjects connected with Acology and the Practice of Medicine. To cure disease requires a knowledge of remedies, and the nature of affections for which they are used. Remedies, consist of material and immaterial agents. The latter operate chiefly upon the mind, and are, hence, called psychical; the former upon !-he body, and are, therefore, termed somatical. Material agenffe are made up of ponderable and imponderable substances. The former are subject to preparation by phar-na- ceutic operations, and are termed pharmacological agents. Light, heat and electricity, belonging to the latter, are not only remedial agents within themselves, but are also used in the ope- rations of pharmacy. PSYCHICAL INFLUENCES. Psychical — from turr/r /} mind — is applied to operations or influences intended for their direct effects in mental disorders, or to affect physical structures, indirectly through the mind. The mental control exerted over certain functions of the body is notorious. Passions or emotions being excited in a high degree, are known to arrest, in some instances, and in others, to increase inordinately the action of organs, and modify the effects of reme- dies. PSYCHICAL REMEDIES. 3 The passions which thus disturb certain functions in health, and modify pathological conditions are, love, anger and hatred. The emotions are, joy, hope, jear, disgust and sorrow. Attachment for objects and persons tends, in various ways, to affect the organism of mankind. Confidence, the legitimate offspring of attachment, is an important means of insuring the full benefit of ordinary medication. Without it, medicines are administered with the greatest difficulty. In such case, promptness, in the time of administration and the quantity to be taken, is not likely to be observed; and, in consequence, the desired impression fails to be realized. And should these diffi- culties be overcome, that quiet, undisturbed condition of mind, so neeessrry to the restoration of diseased organs, is not obtained, while there is a dislike for. and want of confidence in, the attending physician. On the other hand, inordinate affection so changes certain sensations or functions, that manifest embarrassment is met with from this cause. The usual desire for food, under such circum- stances, is generally wanting, and the amount necessary to afford proper support will not invariably be taken. The soothing influence of this passion upon the nervous system, however, and through- it upon the whole body, is sometimes very marked. The etfept upon the mind, when not excessive, is that of a pleasurable sensation, and under its benign influence irritability of the ner- vous system is, to some extent, allayed. Tranquilizing influences of this kind not only modify appreciation by the brain of local nervous disturbance, but also tend to quiet it, by the direct con- trol over the great center. Anger, as a remedial agent, is rarely brought into requisition; but, on the contrary, is a fruitful source of mischief ordinarily. In some mental affections, however, and in nervous diseases, from which the imagination is morbidly active, the despondency, ennui and foreboding of coming evil, are sometimes greatly relieved by such irritating cause as temporarily stirs up the patient's ire. It acts as a kind of mental revulsive or counter irritant. The mind, which before was occupied by depressing thoughts, is aroused by the excitement, and for a time does not indulge 4 ACOLOGY. unwarranted conjectures. In hypochondriasis, and chronic organic disease, the mind often relapses iuto a state peculiarly suited to the remedial effects of such mental agitation, when prop- erly controlled. Hatred, a passion almost invariably indulged injuriously to the subject, is mentioned in this connection more with the view of guarding against its baneful influence. The object of this passion, when present, is likely to arouse the subject to anger. Jn this way the mental impressions before alluded to, as occa- sionally beneficial, in despondency, may be brought to bear, but it must be borne in mind that these instances are very rare, and that injurious effects more frequently follow. Joy, though detrimental in a high degree when excessive, is sometimes made the remedy for depressed conditions of the men- tal faculties, and through them an excitant of the general nervous energies. Hope, of all the mental influences, is, perhaps, most useful in the management of ordinary disease. Instances are constantly occurring, in which the vital energies are so depressed from des- pondency that the means of treatment instituted fail to accom- plish the desired end, until hope is inspired. In the absence of this necessary incentive, remedies prescribed are improperly taken and imperfectly retained, from the utter carelessness as to the means employed. Despair of recovery under any treatment leads to like difficulties in obtaining the full effects of remedial agents. The idea above advanced, touching the importance of confidence in the attending physician, is particularly applicable here. So important is it, that his usefulness is destroyed when it does not exist. To insure confidence and hope should be one main object of practitioners, on assuming the responsible duties of prescribing physician. On the other hand, false expectations should not usually be encouraged. "Hope deferred maketh the soul sick/' is the Patriarchal axiom, true in matters of Divine government, and no less so in "the healing art." Promises beyond what can possibly be realized shotdd not generally be made. In fact, though full disclosures of unfavorable prognosis are not called for, yet all positive statements to the patient should be made strictly in accordance with truth. rs\( IHICAL REMEDIES. 5 FearJ with many invalids, is the only moans by which to insure strict compliance with directions for the administration of remedies ; and the apprehension of danger, with them, is the only incentive to seek medical aid. The excessive exercise ol this emotion, however — beyond that necessary to awaken the proper degree of interest — is depressing and injurious from the violent mental agitation excited. Sorrow. — This emotion always interferes, more or less, with the comfort and wellbeing of the subject, and with the desired action of remedial agents. Facts calculated to produce it should, when practicable, be concealed from the subject of dangerous illness. A certain amount of buoyancy being necessary to sus- tain physical strength under violent afflictions, such depressing influences should always be avoided, if possible. It is not only necessary that facts calculated to produce prostrating grief should be kept from the sick, but the suspicion of sad news having been received, should be prevented by avoiding low, earnest conversa- tion between friends in sight or hearing of very feeble invalids. The various avenues through which the mind receives impres- sions, leading to the passions and emotions above alluded to, require some consideration. Through the five senses, connection with, and appreciation by, the mind, of external objects and circumstances, are effected. The organ of mind is intimately connected with the several organs of sense, and has endow r ed them liberally with special nerves. To this connection, and the exercise of mental faculties, perception is due. The mind is made cognizant of passing events, principally through hearing and sight. Feeling or touch, taste and smell, communicate to the sensorium the quality of bodies, and are, therefore, little concerned in the production of psychical influences, operating in the exercise of the mental fac- ulties to the modification of disease. Through the media of audition and sight, facts are made known. Not alone by oral or written language received through these avenues, but also by movement, gesture, etc., are surround- ing circumstances manifested. The morbid state of certain organs is sometimes aggravated through these senses. In cephalalgia, an ordinary degree of light 6 ACOLOGt. and sound increases (lie buffering, and when inflammation of the brain, or its meninges exists, tend- to aggravate it. Moreover, the therapeutic application of. remedies i> sometimes materially interferred with in the exercise of these organs of special -cus,.. Medicines having unpleasant odor or taste are taken with difficulty; and even the sight of certain preparations is sufficient to cause uncontrollable disgust for the remedy. The same organs, through which savory viands and fragrant spices produce a pleasurable sensation, also transmit the Impres- sion of disgust from unsightly objects and nauseous substances. in addition to the rational views of mental influences, enter- tained by therapeutist-, strange and inconsistent vagaries are indulged, which are not sustained by scientific investigation nor practical demonstrations. Somnambulism, a state which really occurs, is magnified by the marvelous into the power of appreciating objects without the exercise of the physical senses. Thus sleep-walkers arc said to shun obstructions in their course while unconscious, and witli the eyes firmly closed. Mesmerism and table-tipping arc terms used to denote the reputed psycological control possessed by some persons over the mental and physical actions of others, and even of inanimate substances. The latter of these so-called sciences is said to invest the operator with even the superhuman faculty of calling up, and consulting at pleasure, the spirits of departed friends ! These pretenders have even led their deluded and over-credulous fol- lowers into the ridiculous belief that, from the potency of their will, disease is cured, as if endowed with miraculous power. These things are too ridiculous to merit even a passing notice; yet, that there are some electrical, nervo-psychical manifestations, not satisfactorily accounted for, on any known principle of chemi- cal or psycological science, is altogether probable. Experimental investigation of these mysterious influences has yet to shed more light on this subject, before it is properly understood. The simi- larity of nervous power to electricity, in at least some of its manifestations, has already excited in the minds of investigators the conjecture of their identity. SOMATICAL REMEDIES. 7 SOMATICAL REMEDIES. Somatical Remedies — from v which health is preserved, as well as those to restore it when lost, HYGIENE — from 'jyesea, health — teaches the manner of pre- venting disease; and the means consist of mental as well as material influences. Exercise of all the organs is necessary to their natural vigorous condition. Mankind should always be employed. The accom- plishment of some object, requiring exercise of the mind as well as body, should be engaged in constantly, in order to general activity. The invigorating effects of mental enjoyment, upon the nervous and other systems of the body, are unmistakable. The varied scenes and pleasant associations brought to bear at fash- ionable watering places, are well understood by practitioners, who advise their wealthy patrons to seek the enjoyment of such visits. The benefits are realized without regard to chemical constituents of the water. Whether mineral, thermal, or other variety, the salutary influence is the same, while the true secret of success tbrever remains as a sealed book to the subject, The benefit is, of course, ascribed to the medicinal virtues, tempera- ture, etc , of the waters. Mental stimulus afforded in this manner, and by other methods, leads to more regular and healthful exercise, and thus, indirectly, becomes tonic to the muscular and other systems of the body. The awakening of lively sensations by these means gives zest and appetite for the amount of food necessary to sustain the body, which would not otherwise be relished. Moreover, the mental attractions presented in picturesque scenery tempt the delicate and over-cautious from their haunts of seclusion into the bracing air and sunshine, so important to the proper vigor of the whole organism. HYGIEN& 9 Besides these, psycology affords other instances in which restor- ative as well as hygienic advantages are found in mental influences. From the foregoing definition of hygiene, any means used for the preservation of health may be included under the general system, whether corporal or mental. Some of those acting upon the mind, and through it upon the physical structures, have been noticed. The direct effect of material agents for this purpose may also be considered. Light, incidentally mentioned in connection with the names of imponderable material agents, and, though not properly be- longing to any of the classes arranged for this work, plays, nevertheless, an important part in the perfection and preservation of health and vigor. It is a well known fact that vegetable growth is always imper- fect without the influence of the sun's rays. The frail and sickly plant, raised in a shady position, compares unfavorably with that in a more exposed situation. Not less so is the pale, feeble and delicate child, carefully kept within doors, contrasted with one who has the good fortune to be the object of less irrational solici- tude. The colorless cheeks of those spending the day-time in a darkened room, give unmistakable evidence of a want of vigor in the peripheral circulation. A white skin is secured in this way, at the expense of strength, sprightliness and vivacity. The constitution of man was not designed, mushroom-like, to grow and flourish in the dark, and wither into a sickly inactive state under exposure to light and heat. At early morn, the skin is more or less shriveled and pale. Mental and physical languor exists. This gives place to flow of spirits and bodily activity, after the sun's reviving influence has been received. Air. — The tonic, bracing effects of atmospheric air, beyond that received by oxygenation of the blood in respiration, cannot be denied. Air is the medium, also, through which the poison of infectious and epidemic diseases are transmitted, and its freedom from noxious substances is, of course, essential to salubrity. As a hygienic measure, therefore, it is necessary to ascertain its state of purity in this respect at any given locality. 1<> AtiOLOGtf. The debilitating effects of confined air, in which the oxygen has been partially exhausted, is made to appear when a large number of persons remain lor some time in a dose room, or when the air is respired over and over again until the quantity of expired carbouic acid gas becomes insupportably large. These facts being known, the avoidance of localities where the air is infected, and of confined situations where the oxygen does not maintain its healthful proportion, is a hygienic precaution that should not he neglected. The noxious effluvia emanating from slowly subsiding stagnant pools which have been rilled during the summer months, from the washing of fresh, fertile soil, is productive of disease. Xo chemical test has yet detected this malarious poison; and it is only by its effects in the production of disease that the existence of this subtle morbific agent can be determined. Whether or not it exists in the form of algoid spores, as supposed by some, the condition of things necessary to its production, and the gene- ral rule governing its transmission through the atmosphere, are understood. Exposed situations in the neighborhood of such production must, of course, be abandoned during the "ague season/' in order to avoid the disease. There is no purifier of such atmosphere but Time, and there are no means of preventing the production except by reduction of the temperature, entirely drying the pool, or deeply submerging substances within it. Tem- perature above 75° is said to be necessary for the production of malaria, and where it does not exceed this degree, as in portions of California, intermittent fever is unknown. Animal effluvia, arising from the subjects of infectious and contagious disease, is transmitted through the air, carrying with it the germ by which the same disease is propagated in others. Pure, invigorating air, uncontaminated by such productions, may be found in mountainous, uncultivated sections where Nature's purifier flourishes undisturbed. There it is that oxygen in abundance is exhaled from vegetable growth, and a limited amount consumed by animal respiration. Unlike the sites of crowded cities, the invigorating influence of pure air is readily- perceived by those coming from a less salubrious region. HYGIENE. 11 WatEr, when taken into the stomach as a diluent, or necessary beverage, has no special connection with hygiene. Investigation, however, with a view to determine the wholesome qualities of this fluid in particular localities, conies properly within its domain. The idea prevails in some communities that malarial fever is produced by water taken into the stomach. This, how- ever, is fast giving way to more rational views on the subject. The improper use of water as a beverage, like all errors in taking food or drink, may lead to unpleasant consequences and even violent disease. Excessive draughts of cold water while the body is exhausted from heat and fatigue, may disturb the equilibrium of the circulation, and lead to serious congestion and disease of some vital organ. From this cause the stomach itself my be subjected to violent spasmodic contraction, giving excessive pain for some time. Even fatal results have been known to fol- low its imprudent use in this way. Ablution, or bath, with water at a temperature to suit the circumstances and condition of the person, is an indispensable sanitary measure. A healthy condition of the skin, so important to the comfort and wellbeing of all, is promoted by this means. The remedial properties of water, and the manner of using it for different purposes, will be given, in connection with other articles of the classes to which it properly belongs. Exercise is essential to health from various considerations. It has a place in a class of curatives, and is mentioned now only in connection with its use as a hygienic means. This, as well as other agencies intended for the preservation or restoration of health, and even those essential to life itself, used in excess, leads to unpleasant results. Exercise is not an exception to this gene- ral rule. Muscular movement is necessary, not only to the healthy and active condition of this system itself, but also to the digestive and other organs whose functions are essential to life and health. When violent and long-continued, however, the effect is opposite to that desirable. Evidently, man is constituted for the regular and temperate exercise of the mental as well as physical organs. Employment, which gives exercise in proper degree and time of duration, is not less essential than rest when 12 Ecology. the organs have been over-taxed. The mere gratification of the appetites does not fill the purposesof our creation, and, therefore, not adapted to our physical structure. Ennui, restlessness, lethargy, etc., are the result of sedentary habits, and give evidence of functional, and the liability to organic, disease. Regular physical exercise, therefore, cannot be suspended for any length of time with safety to the digestive functions, while the usual amount of food is taken. The internal organs are adapted to the jolting and constant agitation to which they are subjected in prosecuting the common avocations of life; and, although con- stant habit, gradually introduced, may finally change, to some extent, the physical tendencies, yet disease is apt to follow a vio- lation of these natural laws. Sleep is the temporary suspension of certain functions. This rest of the organs concerned, is not only necessary to their own healthy condition, but that of the whole body. The cerebrum, whose active operation constitutes the mind, requires regular periods of rest. This, to the extent of destroying consciousness, is called sleep. Thought, the active exercise of our mental faculties, requires rest, even more than that derived from sleep. Relaxation from intense study is, therefore, found necessary while awake, in order to keep up the activity of these powers. The amount of sleep necessary for mental and physical invig- oration varies according to the amount of exercise taken. Bodily fatigue renders more sleep necessary than that of the mind; and young persons require more than those of mature age. Laborers, as a general rule, should sleep eight or nine hours in the twenty- four, while six or seven are sufficient for those of sedentary occu- pations. Frequent variations from this requirement of Nature, entail upon offenders the evil of hygienic error, depraved health. Diet is an important hygienic means, and is also an essential consideration in the treatment of many diseases. Redundancy and deficiency of food are alike injurious; and the quality is of prime consideration in the selection to suit particular cases. The appetite, or desire for food and drink, if unbiased by the habit of excessive indulgence, and other circumstances, is Nature's measure PHABMACY. 13 of the amount necessary to be taken. Epicurean indulgence, however, in savory viands, prepared with inviting and stimulat- ing condiments, so modifies the natural instincts that a proper limit of supply is materially changed. The consequence of excessive quantity or indigestible quality, taken into the stomach, is a failure in appropriating the nourishing ingredients, from a want of proper digestion. In this way, full diet of rich food may not only fail to give nourishment, but prove a source of embarrassment and depression to the whole economy. There are many circumstances which make the desire for food unequal to the amount required. The physician's judgment should then control the amount and quality used, though it should prove disgusting to the patient. Drinks, which temporarily excite the nervous system, and through it the digestive organs, are often used injuriously, and cor- responding depression is likely to follow. It may, therefore, be said that the unnecessary or excessive indulgence in drinks, which are highly useful in certain morbid conditions, as temporarv stimulants, is prejudicial to health, and sometimes lays the foun- dation for mental, moral and physical ruin. PHARMACY. In the operations of Pharmacy, as connected immediately with preparations for the dispensing apothecary, the manner of col- lecting, selecting, preserving and manufacturing for commerce and the use of druggists, is not directly concerned. All, how- ever, come legitimately under the notice of Pharmacologists. The purity and efficiency of drugs are greatly dependent on the manner of collecting and preservation, where vegetables are concerned, and in the observance of a definite system in the manufacture of mineral productions. In the collection of vegetable substances certain rules must necessarily be observed, in order to secure that efficiency of action which the article is capable of affording. Not less essential in this respect is their proper preservation. Many vegetable pro- ductions collected at the proper season, and selected with care, 14 ACOLOGY. may be rendered inert and useless from the failure to observe the rules for preserving. Certain varieties of articles require a very different course of management from that of others, in the modes of preserving as well as collecting. Some are volatile in their nature, while others are not; some bear well the sun's heat and exposure to the air for an indefinite time while drying; other- do not. Thus, it will be seen, that upon the manner of collecting and preparing of drugs, the efficiency of their preparations, in a good degree, depends. The Pharmaceutist should be sufficiently familiar with their sensible properties to determine from the ap- pearance of specimens, whether they have undergone the proper course of management to preserve their medicinal properties. Without this information, judicious selections cannot be made. The same may be said of inorganic substances. Certain evidences of correctness in their manufacture should be well understood, in order to insure the usual medicinal virtues. COLLECTING, not only requires care in removing dirt, other extraneous matter and impurities, but the rejection of decayed, dry and inactive portions. Moreover, in order to insure perfect activity of the article, certain rules, as to the season, state of per- fection, etc., should be observed. Roots should generally be collected when the plant has attained to its greatest perfection. Annual roots are in the most perfect state when the plant has arrived at its full growth, and before the leaves begin to wither, either from the natural limit of its growth or the approaching season of frost. Biennials are said to afford more perfection in the quality of their roots during the second year, and at this time, with the precaution above-mentioned for annual plants, they should be collected. Perennials afford sufficient maturity after the first year of their growth, and during autumn, after the leaves have withered, the roots may be obtained. In order to the preservation of roots they should, when suc- culent and of sufficient size to require it, be cut into transverse pieces to facilitate the drying. Generally, a few days' exposure to the sun and air will preserve them sufficiently to prevent mouldiness and decay. Artificial heat is sometimes necessary, in PHARMACY. 15 order to hasten the drying, particularly in damp weather, when the process would otherwise be too long delayed for their preser- vation. Leaves should always be collected when of full growth and before the period of decay. They should be gathered free from stems or branches and other impurities. The drying can usually be effected in the shade, with or without artificial heat, according to the state of the atmosphere. Exposure, on hurdles, to a free current of air, occasionally stirring, will be sufficient in dry weather. When properly dried, leaves retain their bright green appearance, to some extent, and in order to this the drying pro- cess must sometimes be hastened by artificial heat. This is best effected with stoves in the drying room, by which the tempera- ture can be readily raised to any required degree, say 90° to 100° Fahr. The same plan is applicable in the collection and drying of herbs, tops or branches, with their leaves. When the stalks or branches are not large, the drying may be more easily accom- plished, and with less stirring, as they are not so compact as the leaves alone. Feowers may be gathered when full blown, and before the petals commence falling. The same general rules for leaves will apply in drying flowers, except that more care and expedition are required, on account of their greater delicacy and the volatile character of their medicinal virtues. Bark, from the trunk or root, requires that the scurf or dark outer portion be removed, and the pieces cut or broken into con- venient size for drying and packing. As a general rule, bark is best obtained at that season when it is most readily separated from the wood. The summer, for that taken from the trunk ; and winter, for that from the root, will be found most convenient. The drying is accomplished in the same manner as with roots. In dry weather, no further trouble is necessary than the exposure to the sun for a few days. Should damp, cloudy weather super- vene, however, the drying room becomes necessary to complete the process. Seeds are not in a condition for use until thoroughly matured, and the time for their collection is generally indicated by the ten- L6 ACOLOGl dency to waste. They arc sometimes sufficiently dry for preser- vation when collected. Exposure to the sun, or to the tempera- ture and air of a drying room is, however, generally necessary, in order to insure them against mouldiness and deterioration in other respects. Packing is an important consideration in the preservation of drugs. In the first place, vegetables of any kind should be thoroughly dry when stored away. They should, also, l>e pro- tected from moisture by being kept in dry, airy room-. Some varieties of plants are affected by light; and, in the packing, due regard should be had to this fact. Boxes, barrels and earthen vessels are, therefore, preferable to glass. Exposure to the air beyond that necessary to bring them into a proper state for pres- ervation, is injurious to many vegetable productions. Not only to prevent the evaporation of essential principles is it necessary to avoid exposure, but to prevent the injurious effects of moisture, with which it is often loaded. For these reasons, in packing such substances, where they are to remain for any considerable length of time, they should be guarded in this respect. For protection against insects, it is also necessary to pack in closely covered, and sometimes impervious vessels. Various means have been suggested for the destruction of worms and other insects, which seem to result from ova deposited on the vegetable before or during the preparation for packing. Camphor, chloroform, etc., are said to be effectual in some instances. Drugs pass through various forms of preparation for their more perfect preservation, and convenience of transportation in commerce. This business is conducted by the wholesale general dealer, situated so as to receive crude articles from countries in which they are found, and make them a commodity of traffic. Extensive manufactories have been established for this purpose, in Europe and America. In these, their bulk is reduced by sep- arating extraneous substances and inert portions. Crude articles are thus brought into the forms of powders, extracts, etc. From articles in this state, pharmaceutic chemists obtain, separately, the active ingredients of certain vegetable substances containing alkaloid and other active principles. WEIGHTS AND MEASURES. 17 Foe these purposes, and for the manufacture of inorganic pre- parations, extensive chemical laboratories, with reagents, etc., are brought into requisition. Drugs require to be weighed in their commercial transfer; also in making pharmaceutic preparations and in dispensing. Hence, certain established tables of weights and measures are in use for these purposes. In the sale of drugs the same weights are used as in other commodities, the Avoirdupois pound of 16 ounces; but for the use of pharmaceutists and dispensing apothecaries, the U. S. Pharmacopoeia adopts the Troy pound of 12 ounces, and its divisions. The British Pharmacopoeia, now authoritatively fixed as the standard for the Dominions of Great Britain, recognizes tables differing materially from these. Much confusion arises, in the international exchange of medical literature from this, and the entirely different nomenclature and value of French weights and measures. Below will be found tables of all these standard weights and measures, with their relations to each other: WEIGHTS AND MEASURES OF THE U. S. PHAR- MACOPOEIA WITH THEIR SYMBOLS. TROY OR APOTHECARIES' WEIGHT. 1 pound lb i =12 ounces % xij 1 ounce 5 i = 8 drachms 5 viij 1 drachm 5 i = 3 scruples 9 iij 1 scruple Si =20 grains grs. xx The wine gallon and its divisions are used by pharmaceutists and apothecaries, in preparing and dispensing medicines. WINE OR APOTHECARIES' MEASURE (ll. S. D.) 1 gallon C i = 8 pints O viij 1 pint O i =16 fluidounces . . . . f § xvi 1 fluidounce f §i = 8 fluidrachms. . ..f 5 viij 1 fluidrachm f 5 i —60 minims min. lx Approximate measures, sufficiently accurate for dispensing ordinary medicines by physicians, will be found in every house- 2 18 ICOLOGY. hold. These are often necessarily brought into requisition, par- ticularly in the country, where practitioners have often to perform duties properly belonging to the apothecary. Such utensils and their capacities are as follow: An ordinary glass tumbler contains about eight fluidounces; a teacup, tour fluidounces; a wine glass, two fluidounces; a table spoon, half a fluidounce; a dessert spoon, two fluidrachms; a tea spoon, one fluidrachm. The capacities of these vessels vary so frequently that, in their use, no absolute certainty is arrived at. When of usual size, however, they approach the amounts specified, sufficiently near for ordinary purposes. A drop of average liquids is about one minim, but the size varies according to the density and other characteristics of the fluid, and nature of the vessel from which it is made. Some liquids, volatile in their character, and whose particles have very little cohesive property, form drops containing not more than half a minim, while those of the opposite qualities make at least two minims to the drop. Vessels with large mouths and thick edges form much larger drops than will be made from a vial with thin lip. In Great Britain the troy pound of 12 ounces is used, but, unlike apothecaries' weight in the United States, is divided into pennyweights instead of scruples and drachms. The pound, ounce and grain have the same value as those of this country. WEIGHTS AND MEASURES OF THE BRITISH PHARMACOPCEIA (Pereira.) •TABLE OF WEIGHTS. 1 pound ft). =12 ounces =576 grains. 1 ounce oz=20 pennyweights. =480 grains. 1 pennyweight dwt.= 24 grains. 1 grain gr.= 1 grain. MEASURES. 1 gallon C. =8 pints . . O viij 1 pint O. =20 fluidounces fl. oz. xx 1 fluidounce fl. oz. =8 fluidrachms. . . .fl. drs. viij 1 fluidrachm fl. drm.=60 minims min. lx WEIGHTS AND MEASURES. 19 The following tables, prepared from the French recognized weights and measures, are introduced in order to show their rel- ative value with those of the United States: The livre (16 onces) is indicated by the sign Sb The once (8 gros) " " " § The gros (3 scrupules) " " " . .5 The scrupule (24 grains) " " " . ., .3 The grain " " " g FRENCH DECIMAL AND METRICAL WEIGHTS—THE RELATIVE VALUE OF EACH, AND THOSE OF THE UNITED STATES. FRENCH WEIGHTS. tX S. WEIGHTS. Decimal Weights. Metrical Weights. Troy Weight. ft) S 5 3 g lb S 5 3 grs 10 centigrammes=l decigramme=0 1.84=0 1.53 10 decigrammes =1 gramme =0000 18.40=0 000 15.30 10 grammes =1 decigramme=0 2 1 16.00=0 2 1 13 10 decigram mes=l hectogramme=0 3 11 16.00=0 3 11 1 10hectogrammes=l kilogramme=l 15 7 1 16.00=2 7 7 In the above table exactness is observsd in the comparative value of each system, but the French Codex tolerates a variation from this, for the sake of convenience. In the following recog- nized practical estimates, only an approach to accuracy is obtained. The gramme, for instance, is set down as the equivalent of 18 grains French, when, in fact, as is seen in the above table, its true value is a little less than 18 J. The kilogramme is con- sidered equal to two livres, when, really, it lacks more than thirty grains. 5 centigranimes=l grain. 2 grains =1 decigramme. 18 grains =1 gramme. 4 grammes =1 gros. 8 gros =1 once. 16 onces =1 livre. 2 livres =1 kilogramme. 20 ECOLOGY. RELATION OF MEASURES TO WEIGHTS OF THE BRITISH PHAE- MACOP03IA, ( PEREIRA.) 1 gallon =The measure of H> pounds of water. 1 | > i lit The measure of 1.25 " u 1 fluidounce =The measure of 1 ounce " I fluidrachm =The measure of 54.68 grains " 1 minim =The measure of <>.91 " " RELATION OF BRITISH TO METRICAL WEIGHTS, (PEBEIRA.) 1 pound=453.5925 grammes. 1 ounce = 28.3495 grammes. 1 grain = 0.0648 grammes. RELATION OF BRITISH TO METRICAL MEASURES, (PEREIBA.) 1 gallon =4.543487 litres. 1 pint =0.567936 litres. 1 fluidounce =0.028396 litres. 1 fluidrachm =0.003549 litres. 1 minim =0.000059 litres. FRENCH MEASURES AND THEIR RELATION TO THOSE OF THE UNITED STATES. FRENCH MEASURES. U. 8 HBA8UKE8. 1 hectolitre =100 litres =24 gallons. 1 litre or pinte= 2 setier or chopins= 2 pints. 1 setier = 4 poissons = 1 pint. 1 poisson = 4 roquilles = 4 fluidounces. RELATION OF FRENCH TO U. S. LONG MEASURE. METRICAL MEASURE U S. MEASURE. 1 metre =100 centimetres=3.28 feet. 1 centimetre= 10 milimetres =0.39 inch. In the above table of French and United States measures, only an approximation to accuracy is claimed. The loose man- ner in which metrical and decimal weights and measures are reckoned, renders precision in these tables unnecessary, were it possible to arrive at it. PHARMACEUTIC CJtfEMtSTRV. ±[ PHARMACEUTIC CHEMISTRY. Material agents are composed of organic and inorganic sub- stances. The former arc derived from animal and vegetable productions, the latter from the mineral kingdom. Bodies are either simple or compound, and in order to deter- mine their character in this respect, as well as properly to pre- pare many of them for use, a knowledge of chemical laws and manipulations is necessary. A .simple body is that which cannot, by the most rigid scrutiny with chemical tests, be reduced to more simple elements, or be made to change its character — only in mere form — except by combining with some other substance. Elementary or simple bodies are of three kinds: aeriform, fluid and solid. Of the former, oxygen, hydrogen, etc., are represen- tatives, while iron, sulphur, mercury, and other metals and metaloids belong to the latter varieties. In the progress of chemical discovery the list of simple elements is being constantly increased, and now contains the names of about sixty-five arti- cles. These unite with each other, and with compound bodies, forming simple, double and tripple compounds, in accordance with fixed laws. The power by which such combinations are made is called chemical force or chemical affinity. This differs materially from the law of physics, by which the particles of homogeneous substances are held together, called cohesion or cohesive attrac- tion. Bodies have physical and chemical properties, by which they are known and made to answer the useful purposes for which they are employed. Consistence, color, evenness of surface, etc., are sensible or physical properties, with which their chemical constitutions have nothing to do. Chemical properties are seen in the relation they sustain to, and the reaction produced in, other simple or com- pound substances, when brought in contact. Iron, under favora- ble circumstances, is known to unite with oxygen, forming a compound, differing, in many particulars, from either of the constituents, yet the two elements exist in a changed state, and 22 ACOIAHW. on being again separated, each exhibits its characteristic chemical properties. Malta- is indestructible; but a change of state destroys the features by which it is known physically, so long as it thus re- mains. In such changes, with many substances, all the chemical and sensible properties are lost during the new state. For exam- ple, in the production of a salt, by the union of an acid with a base, both ingredients forming the compound, lose their identity. The salt does not exhibit the characteristics of either. SynthesiH — the combination, or union of elementary or com- pound substances, so as to form new compounds — is that which chiefly occupies the attention of pharmaceutic chemists. By it remedies are made to assume different and much more useful forms, and thereby, not only change their chemical and sensible properties, but, in some instances, their medicinal virtues. Analysis — the separation of elementary or other ingredients in combination — enables chemists to examine the components of substances, obtain a knowledge of their properties, and select or reject them, as may be desirable in forming medicinal compounds. Elementary bodies are represented by symbols, in giving for- mula3 of their combinations. Usually, a capital of the first letter in the Latin name is used for this purpose. In some, the second letter also; as O for oxygen, and Se for selenium. These elementary principles unite with each other in definite proportions called chemical equivalent, and upon this is founded the theory of atomic weights. The relative weight of the lowest combining proportion of each substance in combination is ob- tained, and this number represents its atomic weight. Combina- tions occur in different absolute amounts, but always in fixed relative proportions. They unite in the proportions of 1 to 1, 2, 3, 4, etc. Thus, the equivalent number, or atomic weight of hydrogen, the lightest elementary body, is taken as 1. Oxygen, whose lowest combining proportion weighs 8 times as much, has 8 for its atomic weight. If 1 atom each of oxygen and hydro- gen unite, the sum of their atomic weights will be, oxygen . 8, and hydrogen 1=9. This is the atomic weight of water, a compound of the lowest combining proportions of these elements. PHARMACEUTIC CHEMISTRY. 23 In formulae, showing the constituents of these compounds, when more than one atom of cither arc used, it is denoted by a small figure immediately following the symbol, as in the formula for bichloride of mercury, Cla Hy., which signifies two equivalents of chlorine and one of mercury. When a large figure precedes the symbol, it is understood to govern all that follow, to next comma or -J- sign. A bar through or under the symbolic letter, has the same signification as the figure 2 after each. When a symbol stands alone, it is under- stood to represent one equivalent. A table of the sixty-five elementary substances, with their symbols, and equivalent or atomic weights respectively, will be found in works on Chemistry. Besides the weight of combining proportions or atoms of the simple elements, their volume is also ascertained. The volume of hydrogen, whose atomic weight is 1, is double that of oxy- gen, whose combining weight is 8. Water, the result of a com- bination of one equivalent each of these two elements, has, when in the state of vapor, about the same volume as the amount of hydrogen entering into the composition. A peculiar nomenclature is adopted by chemists and pharma- ceutists, in which the name of a preparation or compound, indi- cates the ingredients entering into it, and the amount of each. A knowledge of this is indispensable, not only to the chemist, phar- maceutist and dispensing apothecary, but to the prescribing physician. The principal feature of this system consists in pre- fixes and terminations to the name. The termination ide to the name of the nonmetalic or metaloid element, indicates the Binary compound, made by the union of two elementary bodies without the presence of acid. The terms, oxide of zinc and chloricZe of mercury indicate the union of these simple substances, respect- ively. Combinations with cyanogen, a compound radical, are also named in the same way ; as, cyanide of potasium, etc. Acids are of two kinds; in one oxygen, in the other hydrogen forms the acidifying principle. Oxacids differ in the amount of oxygen they contain. The highest degree of oxidation is denoted by the termination ic; when containing a less amount, ous; as, sulphuric acid and sulphurous acid. SM AOOtOGY. Hypo — from urro, under — prefixed, as %/>osulphuric acid, In- dicates a little less than the usual quantity of oxygen, but still enough to authorize the termination in ic. Tli/per — from uxep, above — is applied in the same way, to de- note an excess of oxygen. The same prefixes are \\>vi\ also for the weaker acids ending in ous, and for the salts of both. Wydraeids are those which obtain their acid property from hydrogen, and have but one degree of acidification. These also have the terminal, ic, and are known by the prefix hydro, as hydrochloric acid, hydrocyanic acid, etc. When a compound is formed by the union of either an oxacid or hydracid with a base, the name of the resulting salt, not only indicates the acid and the base, but also the degree of acidifying property in the former. Thus, salts made from acid ending in ic and ous terminate in ate and ite ; as, sulphate of sodium, sul- ph//r of potassium, when sulphuric and sulphurous acids are u^vd. Not only are the ingredients composing different salts made known in chemical nomenclature, but also the relative quantity of each. Bi, a contraction of the Latin bis, two, and tei-, three, are pre- fixed to denote the equivalents of acid, when more than one is in combination with one of the base. For salts in which the base predominates, di and tri, contractions of the Greek o:^ and to-:-, are used when two or three equivalents or combining proportions of the base are united to one of the acid, as r//acetate of lead, ///nitrate of bismuth. Per, in reference to oxygen, for example, is a prefix that shows the oxide to contain the highest number of equivalents with which one equivalent of the base will combine, without regard to the number of atoms. A bichloride is, therefore, a perch loride when, as with mercury, two atoms of chlorine is the highest number that will combine with one of the metal. Proto — from -ow:o;, first — has been used as a prefix to denote the first degree or lowest combining proportion of oxygen, etc., with a base, as jorofoxide, ^rofochloride, etc. Scsqiii, signifying one and a half, is used to express the fact that the acid and base unite in the proportion of 2 to 3, assesguv- MECHANICAL OPERATIONS. 25 oxide, sesgtwsulphate, etc., denoting that two equivalents of the acid or acidifying principle unite with three of the base in the formation of the salt thus named. MECHANICAL OPERATIONS OF PHARMACY. In addition to chemical laws, by which the operations of pharmacy are conducted, certain rules must be observed, in order to effect the mechanical changes necessary to the thorough pre- paration of remedies. Some of these have already been alluded to in connection with the selection and preservation of drugs. We shall now notice briefly some of the contrivances, and rules for their use, by which mechanical alterations are made, render- ing the drug capable of being administered as a medicine. Me- chanical operations of various kinds are absolutely necessary, in many instances, for the effectual play of chemical affinities in the formation of compounds. Powders, solutions, etc., must neces- sarily be made of solid substances, before their particles, in suffi- cient numbers, can be brought in contact with the reagent intended to form chemical combinations. Definite terms are used to designate the various processes, and the forms of preparation which result from their operation. Pulverization is effected by different means, according to the nature of the substance to be acted on. Grinding by mills of stone or iron, or between rollers, is the most effectual mode of bringing certain substances into the form of powder. Trituration or pounding by mortar and pestle, is also used for this purpose. Those substances, which are dry and friable, may be easily reduced by grinding; others require pounding, rubbing, etc. When other materials are added to assist in the process, it is called mediate pulverization, as, in the preparation of Dover's powder, the sulphate of potassium, a hard salt is added, so that the other ingredients may be more readily pulverized and thoroughly mixed. Contusion — or bruising between rollers or by pounding with mortar and pestle — renders the particles of solid musses accessible to liquids, without being reduced to the state of powder. Fresh 26 iCOLOGl roots, barks and herbs arc treated in this way, in order to the action of liquids upon them, for the solution of their active prin- ciples, and also for the more ready expression of oils or juices from them. Special terms are applied to the processes for obtaining a solu- tion of the medicinal ingredients of solid vegetable substances. Maceration is the immersion of a heterogeneous solid, bruised or coarsely powdered, in a liquid at the ordinary temperature of the atmosphere, to remain the required length of time for the solution of its active principles. Digestion involves a similar process; carried on at an increased temperature, say 100° Fahr. This additional heat is necessary to the perfect solution of the active ingredients of some vegeta- bles, while it is not in others. Hence, in making liquid prepa- rations of certain drugs, it is important that artificial heat he kept up during the proeess of solution. Solution is the mechanical incorporation of the particles of solids between the globules of fluids, without destroying the solvent's transparency. Unlike chemical combinations, both the solid and liquid retain their original properties. Water, alcohol, ether, oil, etc., combine in this way with certain ingredients, and that fluid which thus unites with a particular article, is said to be its solvent. The pharmaceutic terms applicable to these forms of solution, are made in accordance with the name of the solvent and the substance dissolved, and are known as " Liquors" under the head of " Pharmaceutic preparations/' ElutHation is a term applied to the process of separating solids from each other, by sifting, etc. The finer particles of powdered substances are thus separated from the coarser. Fluids may be separated from solids by various processes: 1. Expression is a convenient mode for obtaining oils and juices from fruits and from bruised vegetables, after having im- bibed liquids during the process of maceration or digestion. 2. Filtration is the proper mode, when solids, in the form of fine powder, are to be separated from fluids intended for use. Miters of woolen cloth, paper and sand are made for this purpose. MECHANICAL OPERATIONS, 27 Charcoal is also useful in this way, and particularly so when the absorption of ammoniacal gases, or other putrescence, is desirable. 3. Decapitation — pouring off' — effects this object when the solid, though finely powdered, is of sufficient specific gravity to subside perfectly. Fine particles in liquids, which are not heavy enough to precipitate, may be rendered so by — 4. Despumation, or the clarifying of fluids by adding albumen in the form of isinglass, white of egg, etc., which, meeting with and adhering to the solid particles, subsides or rises to the top in the form of scum. Percolation or lixiviation is a short process for dissolving the active principles of vegetable substances, and separating the liquid from the solid portions, answering the purposes of mace- ration and nitration. This process is accomplished by moistening thoroughly the powdered drug with a portion of the solvent, and after remaining ten or twelve hours in this state, the mass is placed in a percolator, and the remaining liquid poured upon it. The liquid with which the powder was first moistened, having dissolved the active principles to saturation, is driven off by the fresh liquid, and passes through a filter attached to the Percolator in the form of clear solution. Tinctures are readily made in this way, and the process is termed displacement. Vaporization is the change of liquids to the aeriform state, by the application of heat. Substances not volatile in their charac- ter, dissolved in liquids and exposed to vaporization, remain in the vessel after the liquid is driven off, and are thus separated from their solvent. Evaporation is the change of liquids to vapor, by exposure in shallow vessels to the air, without artificial heat. By these processes of vaporization, dissolved ingredients are separated from their solvent, and the juices of plants are reduced to a state of dryness, making solid extracts. The latter is called inspissation or exciccation. Opium is the inspissated juice of the poppy ; manna, of the ornus Europsea, etc. Evaporation in the open air and sun is generally sufficient for such preparations, but when solid or fluid extracts are made from solutions of the active principles of plants, in water or alcohol, artificial heat is applied 28 AC0LOG1 . in order to hasten (lie process. Sand, water or steam bath is ased for these purposes, in order the more easily to regulate the temperature. This is necessary to prevent a degree of heat injurious to the preparation, which is likely to occur after evapo- ration has measurably ceased, on account of the increase of tem- perature above the boiling point. OrystaMzation results from the vaporization of certain solutions. When solid bodies, subject to the crystaline formation, are dis- solved or changed to the state of fumes, their particles arrange themselves it) definitely shaped masses, on returning again to the solid form. By their particular forms, the crystals of many substances arc readily recognized. There are some, however, whose crystals are found in two forms. These are termed dimor- phous, while those substances having crystals of the same shape — which is the case with a few — are called isomorphous. Those which cannot be made to assume the crystaline form at all, arc termed amorphous. Crystals are formed, as has been stated, from fumes, which are the result of sublimation; and from solutions of crystalizable substances by evaporation. In the former process, solid particles are formed by the fumes condensing on the sides of the vessel or retort ; in the latter, by the solvent being driven off in the form of vapor, while the ingredient dissolved is left to crystalize. Distillation is a process by which liquids are separated from each other, and includes some of the same principles involved in sublimation and vaporization. To separate any fluid from one less volatile than itself, the mixture is placed in a retort or still, and heat applied, so as to vaporize the fluid more easily changed to the aeriform state. Refrigeration is, at the same time, applied to the worm or stem, so as to condense the vapor into liquid. In this way essential oils, alcohol, etc., may be separated from their watery connections. Distilled water is obtained by subjecting ordinary spring, well or river water to this process, thereby ridding it of salts and other impurities which it contains in solution. These remain in the retort, while pure water passes over, in the form of vapor, into the condensing apparatus. FORMS OF PREFARATION. 29 FORMS OF PREPARATION. Tin: forms in which medicines are dispensed vary according to the nature of the remedy, the purpose for which it is intended and the part of the body to which it is to be applied. They differ in their consistence and are divided into 1. Solid preparations intended chiefly for internal administra- tion, either by the mouth or rectum. These consist of (a) Pilfc, which are globular masses, made of convenient size for swallowing. Some medicinal substances are of proper con- sistence and tenacity for ready preparation into pills, without the addition of other ingredients, but generally some tenacious sub- stance is necessary to preserve their rotundity. For important practical reasons, the adhesive article should be selected with due regard to the length of time the pills are to be kept, and the manner of preserving them. When intended for immediate use, crumb of bread or gum arable, with a little water, is all that is necessary; but, when to be kept for a length of time, if prepared in this way, they are liable to become dry and hard, so that they are not sufficiently softened by fluids in the stomach to have the desired effect. On the other hand, if prepared so as to keep moist, and should not be properly cared for, they become mouldy, and deterioration of the medicinal ingredient is the result. The great improvements in the art of pharmacy, not only as respects the separation of the active principles in vegetables from inert and sometimes injurious portions, but in preparing them for use, furnish the means of preserving pills for any length of time. This is done by a coating of sugar or gum, which protects them from the effects of air and moisture, and at the same time is readily dissolved in the stomach. Moreover, the substances with which they are coated being of agreeable taste, much difficulty in the administration of remedies is thereby avoided, making it desirable that they be thus coated, even when to be used at once. Convenience of administration is the chief advantage derived from this form of preparation. Indeed, remedies administered in this way are less speedy in their action, than when given in a state of solution or otherwise, favoring prompt absorption from the stomach. oO ACOLOGY. (J>) Powders constitute a form of preparation in which sub- stances have been reduced to minute division, by triturating, grinding, etc., as has been mentioned already in connection with the mechanical operations of pharmacy. This is not a form in which medicines arc often administered, but in which they are subjected to other extemporaneous preparation- before being taken. Of these we shall have occasion to speak hereafter. Medicines of which pills are to be made, when not already in this form, require to be pulverized in order to prepare the mass. Thus, it is clear that pulverizing is intended more for convenience in preserving and making other preparations than for immediate administra- tion. (c) Lozenges or Troches are composed of a solution of sugar, gum or tragacanth in water, incorporating such medicinal sub- stances as are desirable to be taken in this way, and evaporated to a solid consistence. When sufficiently firm they are cut into any desirable shape that convenience or fancy may dictate. This form generally contains substances intended to impress the throat and air passages, by the preparation slowly dissolving on the tongue. The mucous membrane of the mouth and throat is soothed by demulcent ingredients, and also the respiratory tube, through a supposed sympathy of continuity. In this way demulcent and anodyne substances are thought to allay irritation of the larynx, trachea, and even the bronchia, upon which troublesome cough sometimes depends. Anthelmintic, and other remedies intended for internal use, may be prepared in this form, for their more ready administra- tion to children. By this preparation the taste of unpleasant remedies may be, in a measure, concealed, and the preparation taken without inconvenience. Hence, various medicinal sub- stances, not required in large quantity, are used in this form. Troches, containing opiate, astringent, demulcent and aromatic ingredients are officinal preparations in the United States. (d) Sv/pposUories, intended principally to evacuate the bowels by the mechanical stimulus they afford, may incorporate sub- stances designed to effect a special local action. Any solid sub- stance introduced into the rectum for either of these purposes, is FORMS OF PREPARATIONS. 31 called a suppository. A piece of soap made into a conical form, and of the proper size for introduction into the bowel, answers well as an evacuant of the lower portion of the intestines. The advantages of producing catharsis by solids or fluids introduced into the rectum, are found in the promptness with which they act, and the certainty of not producing excessive evacuation. In the formation of suppositories containing: opiates, astringents, etc., for their special action upon the mucous membrane, soap, tallow or spermaceti answers as an excipient. The quantity introduced into the rectum, whether solid or fluid, when intended to remain and impress the mucous membrane, should be small, as a large amount is more likely to be rejected, by the contraction its presence excites in the bowel. (e) Plasters are solid preparations, intended for external appli- cation, and are composed of substances requiring to be heated or moistened, in order to their adherence. Wax, resin, litharge, gum, etc., incorporating such substances as are intended to make particular impressions on, or through the skin, form plasters. If iutended only for protection and support to injured parts, they contain nothing except the demulcent and adhesive substances. Thus prepared, the mass is heated or moistened to the consistence which will allow it readily spread on cloth or leather. When applied, moisture or artificial heat, according to the excipient used, is necessary to render the plaster sufficiently adhesive for its application. (/) Solid Extracts, like "powders," are not in a form for administration without further preparation, but are mentioned as forming solid masses, from which extemporaneous preparations, such as pills, etc., may be readily made. 2. Liquid preparations make up a large proportion of the forms for internal administration. The operations of Pharma- ceutic chemistry, in the separation of vegetable alkaloids, and the manufacture of innumerable chemical compounds of vegetable, mineral and animal substances, cannot be fully considered in the limits of this work. It has been astertained, by experiments, in what proportions, and length of time, saturated solutions can be made without waste of the solid or liquid material ; and Phar- macopoeias give exact formulae for reference. 32 IC0L0G1 In making any of the fluid preparation- from heterogeneous vegetable substances, they should be contused or powdered, so that the solvent may come in contact with every portion of them. Very tine powders, however, do not best elleet this object. They become firmly Impacted at the bottom of the vessel where they naturally subside, so that frequent agitation is accessary to expose all the solid particles to the liquid for its full action in making the solution. Substances, therefore, thoroughly bruised, or in coarse powder, arc preferable to the same, in the form of very minute division, for the preparation of tinctures, decoctions, etc. The solutions of medicinal ingredients, or their active princi- ciples, are named in accordance with the liquid engaged and the process used. (a) Tinctures. This term is understood to denote that form of preparation in which alcohol, diluted alcohol, ether or aqua ammonia is used as the menstruum. Most tinctures, however, are made with alcohol or diluted alcohol. Some are made of sub- stances whose active ingredients are not wholly soluble in alco- hol alone, but require .the addition of water in order to perfect solution. Two processes are in use for their preparation, viz.: maceration for fourteen days, and percolation, by which the object is accom- plished in as many hours. The comparative value of these modes of reducing crude vegetable substances to the form of tincture, depends upon various circumstances connected with their preparation. When ample time ean be allowed without inconvenience, the old process of keeping a definite proportion of the remedy immersed in the menstruum for one or two weeks may be adopted. On the other hand, when expedition is sought, and the ingredient is capable of being properly pulverized, much time may be saved, and an equally active 1 tincture obtained, by the system of percolation or displacement, and sometimes by diges- tion instead of maceration. Percolation, however, has been adopted by the standard of this country, as decidedly preferable, for most of the tinctures. In this form, medicines are not only more perfectly preserved from deterioration, but much more speedily produce their impres- FORMS OF PREPARATION. 33 sion upon the system. While solids require more or less time to dissolve, soften or become mixed with fluids in the stomach, so as to be absorbed, preparations in the liquid state, particularly such as volatile tinctures, are readily taken up by the veins. (b) Decoctions are made by boiling, in water, such substances as yield their virtues to it by this process. It is only when intended for immediate use, or for additional processes, whereby other preparations are formed, that decoctions are made. They cannot well be preserved for any considerable length of time, particularly in warm weather, owing to their tendency to fer- ment. The active principles of certain vegetables are soluble in water at the boiling heat, that are not so in this fluid when at the ordinary temperature of the atmosphere, or even above it. The solution, however, remains permanent after becoming cool. Decoctions, therefore, may be used at any temperature found most convenient and useful, in every respect. Certain articles, whose active properties depend upon essential oils, or other vola- tile ingredients, are not subject to this form of preparation. Cinnamon, cloves, sassafras, etc., are of this kind, and if subjected to boiling heat, would not retain the volatile oils upon which their activity depends. (c) Infusions may be made of those vegetable substances, whose medicinal ingredients are soluble in cold or moderately warm water. Even boiling water may be poured on such as contain volatile principles without dissipating them; as the temperature rapidly falls below the point at which they escape. This prepa- ration is made by macerating or digesting the vegetable remedy in water for a short time, and is intended only as extemporaneous form for immediate administration. (d) Wines are solutions of substances, or their active principles in the liquid giving name to the preparation. Several varieties of wine are used for this purpose; but Teneriffe, Madeira and Sherry are preferred. Vinous preparations are not always per- manent, owing to changes sometimes produced by principles abstracted from vegetable or other substances which lead to acetous fermentation, etc. Wine, however, has advantages, as a solvent, in some respects. Many articles do not yield their vir- 3 ■ \\ ACOLOGT tucs readily to alcohol, unless largely diluted; and as wine con- tains it in this state, becomes a suitable menstruum for such remedies. The same processes, in the main, are in use v such mechanical influence that catharsis results from the injection of any fluid in considerable quantity, or the insertion of a solid substance into the rectum. Moreover, the excitement thus produced extends above that portion containing the substance, through the sympathy of con- tinuity, or by reflex nervous impression. 3. Tlic Skin is a part to which applications are made in order to their direct local action upon the surface itself) and for the transmission of remedial agents into the circulation. Counter- irritation is thus effected, by which the condition of internal organs is modified. In the establishment of a new point of irri- tation, internal vascular and nervous disturbance is allayed, on the principle of M irriUdio ibi fluarus. Remedies introduced through the skin for their elective influence upon parts to which they are carried by the circula- tion, are conveyed with facility equal to that of any other mode of administration, when of suitable form. There are three modes by which medicine is transmitted to the circulation through the skin : (a) Epidermic — from eire, upon, and oeoujj.. the skin — is a mode by which the remedy is placed on the cuticle, and through it transmission of the remedy into the circulation occurs. On parts of the body least exposed to external influences, such as the arm- pits, inside of the arms, thighs, etc., the cuticle is thin, and from these absorption is more active. At best, it takes place to a limited extent through the epidermis, and scarcely at all, when the skin is irritated by the remedy. (6) The Endermie — from eu, in, and depfxa, the skin — is a plan of introducing redemies, which requires that the cuticle be re- moved by blistering or otherwise, so that the application may be made to the true skin. From this, absorption goes on more rapidly; and the salts of morphia, cVrc, applied to a recently de- nuded surface, dissolve in the moisture present, and are readily taken into the circulation. In this way the anodyne or other effects of the remedy will be speedily felt throughout the system. The usual quantity required by the stomach is not sufficient PARTS OF THE BODY TO WHICH MEDICINES ARE APPLIED: 39 when u§ed in this way, unless the whole amount applied should be dissolved and taken up by absorption, which is not very probable. (c) Hypodermic application — from otto, under, and dsp/jta, the skin — has of late attracted the attention of therapeutists, and is already a popular mode of administering certain remedial agents. Syringes for this purpose are in common use, and various reme- dies are thus administered in preference to any other way. The advantages claimed for it are, that owing to the rapidity of ab- sorption from the subcutaneous cellular tissue, the action is more speedily induced, and the occasional unpleasant effects upon the stomach avoided. For administration in this way, remedies re- quire to be perfectly dissolved, lest unpleasant irritation result from solid matter beneath the skin, which cannot be absorbed, leading to abscess, &c, as other foreign substances. Preference is given to this mode of medication, also, on account of the advantages supposed to arise from the introduction of remedies in the vicinity of local disease. If this be a correct conclusion, it stregthens the opinion that certain remedies act directly upon nerves, to some extent, without entering the circu- lation. The opinion that more permanent effect is realized from the hypodermic use of neurotics, than other modes of administra- tion, as promulgated by recent investigators, needs confirmation. The advantages above alluded to, however, enable the practi- tioner to continue their use much longer, without detriment to the digestive process, and thereby to gain more complete and permanent control of troublesome nervous affections. This is, by far, the most useful mode of introducing remedies through the external surface of the body; and when the article is soluble in water, and can be used effectually in small quantity, is decidedly preferable to administration by the stomach or rectum. The dose is about the same as when used by the mouth. 4. The Nose is sometimes made the receptacle for medicines, through which they readily make their impression upon the sys- tem. Absorption promptly takes place in the pituitary mem- brane, and finely pulverized soluble salts, and other substances 10 LCOLOOt. in this state, may be conveyed t<» the circulation through this surface, and are carried into the nares by the process of snuffing. Facial neuralgia, influenza and cephalalgia, are sometimes promptly relieved by the salts of morphia used in this way. 5. T/n Lungs till an important agency in the production of general anaesthesia. It is remarkable with what promptness and efficiency anaesthetics produce their effect when inhaled, while do such result follows their introduction into the stomach. Does this difference in the effects by the two modes of administration depend upon the difference in quantity entering the circulation, in a given time, owing to the greater rapidity with which it reaches the brain from the lungs? Agents enter the lungs in the form of gas, vapor, fumes and spray, hut only in solids and liquids are they used by the stomach. Nitrous oxide gas may he readily introduced into the alimentary canal, and the question, whether remedies in the same form, absorbed from the stomach and lungs, will produce similar effects, may thus be definitely ' settled, if doubt exists. The above applications of remedies to various parts of the body are mentioned in connection with their absorption and transmission through the circulation to the organs for which they have affinity, or upon which they act electively. All these parts are subject to local disease, and may require direct applications for their cure. Many such affections are successfully treated, only by local remedies. The lungs and air passages are not exceptions, but give decided proof that general or elective treat- ment is utterly useless in certain chronic diseases. Remedies are taken into the lungs for their local effect, in the liquid form, by insufflation; in the forms of fumes, vapor, spray and sometimes powder, by inhalation. Remedies are also used for local diseases of the mouth, and, when in the liquid form, are called coUutoriex. To the nose, remedies are applied for their local action; not only with the view of correcting a diseased state of the interior surface, but also to excite the membrane, when healthy, to increased secretion, as a means of local depletion and counter-ir- ritation. These are called errhines. TARTS OF THE BODY TO WHICH MEDICINES ARK APPLIED. 41 Washes, for the conjunctiva when inflamed or otherwise dis- eased, are called collt/ria. The skin, vagina, uterus and urethra also require such local action of remedies, sometimes, as the only means of successful treatment. Local remedies intended to cure disease, by coming directly in contact with it, are applied by various modes according to the parts affected. Whether solid or liquid, they may be applied in the concentrated state, or diluted in the forms of solution, cerate, cataplasm, etc. In order to impress diseased mucous membranes lining the vagina, uterus, urethra, bladder and respiratory tubes, mechanical contrivances are necessary. These vary to suit the particular part involved. The syringe, by which the vagina may be injected with facility, would not carry the medication into the uterus. Different plans are adopted for the latter purpose; the principal of which are, the probe, tent and uterine syringe. Instruments are in use for the application of solid and fluid preparations to the urethra and bladder. For the former, the port caustic has been a favorite, while an easy and convenient mode of using fluid preparations is that of injecting the remedy through a catheter carried down to the affected part; and in this way any portion of the urethra or neck of the bladder may be effectually impressed. The respiratory mucous membrane can be affected more per- fectly with local remedies by inhalation. While the fauces and larynx may be successfully treated with the spray of atomizers, and the nares with washing by the spritze, yet the bronchia can be thoroughly and safely reached only by inhaling the remedy. Fumes, impalpable powder and vapor are the forms in which reme- dies are used in this way, and will be considered in connection with the use of catheretics, in bronchial and nasal affections. The plan of injecting liquid preparations into the large bron- chia, proposed, and said to have been practiced pretty extensively some fifteen years ago, is extremely hazardous, and has been abandoned. The introduction of remedies into the stomach is often intended VI LCOtOGl solely to atlect diseased portions of the :i 1 im«iit:»r\ canal by contact wit 1 1 them. The form of preparation, under such circumstances, should be suited to the particular portion intended for Its action ; e. g. if the stomach i> to be impressed, fluid preparations are, perhaps, pref- erable, but it' the diseased part be lower down, absorption will probably prevent its reaching the diseased point. Pills, when hard and dry, are more likely to come in contact with disease thus situated. The stomach may be impressed by these ordinary forms of preparation, but in order to more perfect local action, the pump is recommended. In a paper from Dr. Sehliep, read before the Clinical Society of London, recently, the results of washing out the organ with various medications by the stomach pump, were very satisfactory. While the instrument was tested more partic- ularly in dilatation of the viscus, the report justifies its use in other forms of disease. In this way the stomach may be washed out and local remedies applied and removed without allowing unnecessary absorption. In order to avoid the supposed diffi- culty of drawing portions of the mucous membrane into the tube, he suggests the insertion of a short piece of thin rubber tubing, between the pipe and the pump, so that easy collapse of the rubber will prevent any considerable force on the stomach. {Medical and. Surgical Reporter.) Doubtless this mode of applying remedies, for their action upon the gastric mucous membrane, will be found efficient in the treat- ment of chronic inflammation of this surface. The most tormenting dyspepsia is that dependent upon chronic gastritis, characterized by red tongue, thirst, burning sensation, pain, etc., after taking exciting food. With the pump catheretic remedies can be applied for such length of time only as is desirable. Another, and still more simple mode of introducing fluids into, and discharging them from, the stomach has been proposed. A kind of syphon is formed, by attaching four feet of india rub- ber tubing to a stomach pipe; fill them with water, and hold the end of the rubber tube till the stomach pipe is introduced, then lower the tube so that its contents and the fluids of the stomach MODUS OPERANDI OF REMEDIES. 43 may flow out. When this is effected, place the end of the tube in water or other liquid, and raise the vessel above the patient's head, stripping- the air from the tube, so that the stomach may receive 1 the contents. In this way the organ may be emptied and tilled at pleasure. (St. Louis Medical and Surgical Journal, 1870.) MODUS OPERANDI OF REMEDIES. The physiological action of remedies, and the changes thereby effected in diseased parts, called therapeutic results, are subjects deplorably neglected in medical education. To practice successfully any branch of the profession, their study is indispensable. The tempting tendency to learn only the therapeutic uses by rote, is a sad difficulty in the progress of rational medicine, and leads to the empirical idea of specifics for the cure of disease. Under this facinating delusion the names of remedies and the diseases to which they are applicable, are care- fully studied, to the exclusion of their special properties — their physiological action. Medicines, as well as poisons, affect particular organs or tis- sues to the exclusion of others. Opium acts on the brain, strychnia on the spinal cord, and turpentine on the mucous mem- branes. These are specific or elective physiological actions, and are produced in health or disease. If used in quantities beyond the point of prudence and safety, the effect is called poisonous; if in debility of these parts, and to the extent only of restoring the normal activity, the result is therapeutic. Again, if some organ or part becomes the subject of derange- ment, in consequence of inactivity of the brain, spinal cord or heart, and should be relieved by restoring such controlling cen- tral organ to its normal condition, the result is direct in giving relief to the radical disturbance in the brain, but indirect toward the consequential derangement. In a fit of muscular spasm, originating in nervous perturbation, for example, the painful contractions, &c., are relieved by the calming effect of increased nervous influence sent out from the nervous centre, under the exciting action of opium or other cerebral or spinal stimulants; 11 U50L0G*. the neurotic acting physiologically upon the brain or spinal cord, and giving this indirect therapeutic result in the muscular teni. To this we shall more Billy allude hereafter. The question, whether all remedies affecting the nervous sys- tem, enter the circulation before doing so, has elicited no small amount of investigation. Headland, in his work on "The Action of Medicine," discusses this subject thoroughly, and arrive- at the following conclusion: No influence is transmitted to the centres along- the nerves with which the remedy come- in contact; but, in order to impress the brain or spinal cord, it must first be absorbed and taken into the circulation. In proof of this posi- tion, he gives the experiments of Magendie, Brodie, Blake and others upon animals, in which it was found that the nerves of a limb, into which woorari was inserted, were not necessary to its action on the nervous centres, but that the veins are indispensable. Experiments on this subject seem to prove conclusively that the ar- ticles used make their impression on the brain, to the extent of very decided action, only by being taken into the circulation. This docs not prove, however, that no impression is made upon the nerves themselves, which are distributed to the part where the poison is applied. The nerve may be acted on, and its function to some extent modified, without transmitting to the centre suffi- cient influence to produce in it symptoms of the elective poison- ous effect. That the nerves of a part are, to some extent affected in this way, seems to be proven by the soothing effect of opium applied to structures in an irritable and painful condition. It is thought that when thus used, the control exerted is more speedy and effectual than when otherwise administered; and, yet, there is, perhaps, no transmission of effect along the nerve to the brain. The very speedy development of convulsive move- ment, from placing a few drops of prussic acid upon the tongue of a cat, allows an almost incredibly short time for the absorp- tion and entire round of the circulation. This, however, is met by the assertion, founded on the experiments of Dr. Blake upon larger animals, that substances make the entire circuit of the cir- culation in nine seconds. As the circulation of a cat would probably require still less time, the few seconds necessary to de- MODUS OPERANDI OF REMEDIES. 45 velop symptoms of poisoning by prussic acid may be sufficient for the brain to receive it in this way. From the present state of progress in these investigations, it is perhaps safe to conclude that remedies making decided im- pression upon the nervous centres, do so by direct contact ; that the substance is carried thither through the circulation ; and that the nerves distributed to the point of introduction are affected by it ; yet, it is not likely that speedy and powerful impressions are made through them upon the centres, as some have supposed. It has been stated that the physiological action of remedies depends on specific or elective affinity for an organ to the exclu- sion of others. Why it is that this preference exists is not satis- factorily determined. Theories have been promulgated on this subject, but not being sustained by verified facts, probably should be considered as useless conjecture. One suggestion is, that the remedy having molecules corresponding, in some of their physical properties, with those of the structure acted on, so changes the molecular arrangement of the living tissue, by the affinity thus existing, that its functions are modified. While this is, perhaps, plausible enough, facts are wanting to sustain it. Attempts have been made to ascertain the physiological action of substances by their sensible properties, and the botanical characteristics of plants from which they are obtained; but, while, in some instances, a similarity in some respects between articles having the same medicinal properties has been discovered, yet in a large majority there is no resemblance whatever. The salts of salicin and quinia, for example, have the same medicinal, and similar sensible properties, but sulphate of copper and sulphate of zinc — almost identical in medicinal virtues — have no physical resemblance at all. Again, sulphate of mag- nesium and oxalic acid, having similar sensible properties, differ widely in their effects upon the system. Moreover, in the botan- ical order solanacire, in which striking physical resemblance of plants exists, the inocuous esculent is found alongside of the most virulent poisons. According to the plan of this work there are two organs or grand divisions of remedies, viz. : local and elective. in ICOLOGY. Local R* medies make their impression on a part by being placed in contact with it. Substances applied to the skin, in order to affect that integument itself, are said to act locally, and are called local remedies. Medicinal agents are also introduced into the stomach for their topical effects upon its surface; as in the useof astringents and demulcents, when the mucous membrane of this visens requires their impression. r I nns it will he seen that elec- tive and local remedies may be administered in the same way — applied to the same part — but with very different objects. While one is intended to be absorbed, the other is designed to affect the surface with which it comes in contact. Some articles, such as tartarized antimony, have both local and elective properties, im- pressing the surface with which they come in contact, and being absorbed into the circulation, affect some other organ also. Elective Remedies are taken into the circulation in order to action upon the organ of their selection. The term applied to this grand division or order, indicates a preference for particular orsrans to the exclusion of others, and is here substituted for the more common names, constitutional, and general reme- dies, which convey the erroneous idea of action upon the whole body. While many elective remedies act upon several organs at the same time, there is, perhaps, no known agent that exerts direct influence upon every part. It is true that a remedy which acts upon one organ may, through this action, modify every structure, but only as a result of the action on a vital controlling organ of the body. Remedies act through mechanical, chemical or vital process. Mechanical process is that through which any substance, by coming in contact with a surface of the body, serves to protect it from the air, or other irritating causes; or by its uneavenness and roughness, tends to irritate or inflame the part. Cerates applied to a denuded surface externally, demulcent drinks in gastritis? and wheat bran, and pulverized charcoal, in sluggish peristaltic movement of the stomach and bowels, all act through process purely mechanical. Chemical Process is seen in the local disorganization by the reaction and play of chemical affinity between concentrated acids, MODUS OPERANDI OF REMEDIES. 47 caustic potash, etc., and the fluids of tissues to which they arc applied. In this way, also, changes are wrought in the circulat- ing fluid, by remedies intended to modify its quality. Vital Process is that in which the capillary circulation or vitality is modified, without mechanical irritation or chemical combination with the fluids or solids of the part. Astringents, rubefacients, &c, act through this process. Also, most of the elective remedies affecting solid structures. It may, then, with propriety be said, that all physiological actions are made either by local or elective remedies; and that these actions are produced through vital, chemical or mechani- cal process. There are two actions of remedies, primary and secondary. Primary Action is the first impression, or the first change effected in the condition of a part. This may increase or depress the function of an organ more or less permanently, but gives place to a state differing from it, and also from that condition existing previously to the administration of the remedy. From the action of some remedies no such second condition ensues, and they, therefore, have no secondary action. Most stimulants of the circulatory and nervous centres, leave the organs correspond- ingly depressed after the primary or exciting effect passes off. Secondary Action thus succeeds and is the result of the pri- mary. After the exciting effect of opium declines, stupor and inactivity ensue. The first action of a cauterant, one of the local remedies, is that of unusual excitement, but this is followed by less vigor than that which existed before the application, and even the death and sloughing of tender structures is sometimes found to occur. Thus, it seems that two actions are had by local as well as those called elective or general remedies. As above described, secondary action seems to be the result of pri- mary impression on the same part, and by the same dose. The therapeutic results of these physiological actions are called direct and indirect. Direct Therapeutic Results are found in the part upon which the physiological action is exerted. This is seen in diseased structures to which local remedies are applied for relief. The IS LCOLOG action of renal stimulants, a class of elective remedies, also gives direct therapeutic results in the sluggish inactivity of the kid- neys. The result is, therefore, direct when the physiological action is exerted upon the diseased part Indirect Therapeutic Results, or curative effects, are brought about in organs not acted on by the remedy. Thus, an inflamed pleura is relieved by an elective cardiac sedative, acting on the heart, and a local counter-irritant affecting the skin. By this it will be understood that indirect results are obtained, in disease, by remedies acting directly on sound parts. Physiologically Speaking, all remedies have direct action-; vet, while ipecacuanha, from its elective influence upon the stomach, induces the phenomenon of vomiting, the ultimate or therapeutic result upon an inflamed pleura, by the relaxing and sedative in- fluence of nausea, is by no means direct. When, however, the emetic is given to relieve the stomach of oppressive contents, the effect is called direct, since the physiological action is exerted upon the deranged organ in giving relief. Again, mercury, when given to restore normal action in a torpid liver, does so by its elective influence upon the organ dis- eased, and has, therefore, a direct therapeutic result; but if, in consequence of such hepatic derangement, enteritis should exist and should subside from this change effected in the liver, by the mercury, the curative effect in the bowel is indirect. The same may be said of the action of cinchona in the peculiar disordered condition of the spinal cord, leading to the develop- ment of the phenomena called malarial fever. The relief is direct so far as the nervous center itself is concerned , but indi- rect in the control exerted over febrile action. The local influence of astringents, demulcents, emolients, cau- terants, &c., lead to direct results when applied to diseased parts. Thus, the action of nitrate of silver in the cure of inflamed mu- cous membranes may be said to induce direct results. Other local remedies, such as counter-irritants, effect therapeutic changes internally, indirectly, as above stated. These various terms, denoting the actions and therapeutic results of remedies, are unfortunately used differently by different MODIFICATION OF ACTION. 49 authors. Siu'h confusion is likely to embarrass the learner, and should be avoided, if possible. Dp. Wood, principal author of the United States Dispensatory, and one of the best recent works on Therapeutics, uses the terms primary and secondary action in the sense which we employ direct and indirect therapeutic results. No allusion is made in his work to those actions we describe as primary and secoiirfa ry, while the direct and indirect thera- peutic results are referred to as physiological actions. It will be observed, that in the example of opium, given in the definition of primary and secondary actions, both are physi- ological actions, and have no reference whatever to curative effects, while direct and indirect indicate the manner in which therapeutic changes are brought about. CIRCUMSTANCES WHICH MODIFY THE ACTION OF REMEDIES. The ordinary action of remedies is varied by many eircu in- stances, some of which are not of frequent occurrence, nor of sufficient importance to be mentioned under separate heads, in a general view of this subject. The following only it is thought necessary systematically to consider: 1. Climate. — This is generally believed to be an important influence in the modification of constitutional susceptibility to the action ot certain remedies, and to disease. The elective or constitutional effects of mercury is supposed to be much more readily induced in Northern than Southern latitudes. Hence the quantity recommended in New Orleans is much larger than in Philadelphia; particularly when the object of its administra- tion is to increase the excitement of the liver. The reverse is practiced in the use of calorifics. The depressing influence of cold climates makes it necessary to use a large amount of animal diet, particularly the fatty varieties, in the management of ordinary disease, and as a hygienic measure. Low temperature tends not only to the development of diseases resulting from strumous diathesis, but leads to this unfortunate constitutional conforma- tion, where, otherwise, it would not exist. The means, which, in Southern latitudes might prove sufficiently invigorating, will 50 ECOLOGY, fail to do so very far North. While this advantage in the treat- ment of tuberculous disease Is derivable rrooi warm climate, the sole reliance should not be placed in it. Though, in Northern latitudes, a greater amount of fatty substances, and other invigo- rating means, are strenuously demanded, yet, even in tropical regions, they should not be discarded. Many pay dearly tor neglecl in this important particular. It is too often the case that invalids visiting the South, to cure a consumptive habit, rely exclusively upon a change of climate. Cohabitants of the frigid zone, who indulge freely in fat meats, are infinitely less subject to such affections than those of temperate regions, who sedulously avoid contact of pure, bracing air, and the use of such lood and medication as above suggested. The effects of opium and other neurotics, affecting the brain itself, are, to some extent, modified by climate. A tropical sun impresses this organ with an amount of excitability which sub- jects it to be more readily influenced by such remedies. Hence, opium, under such circumstances, is required in smaller quantity than in less heated situations. Climate, or variations of temperature in the same locality, manifestly influence the action of eli mi natives, operating through certain emunctories of the body. The skin and kidneys, whose depurating office is very much affected by temperature, are, to some extent, vicarious of each other. The latter respond readily to the action of their elective stimuli, when, from low tempera- ture, the skin is contracted and exhalation measurably arrested. When, however, the relaxing influence of warm weather upon the integument makes easy the cutaneous transpiration, nothing short of repletion of the blood vessels with watery ingredients, is likely to insure activity of the kidneys. In temperate regions, where the cold and hot seasons regularly appear, it will Ix 1 found that diuresis increases as the cool season appears; and, to promote perspiration, it is necessary to be kept in a warm room, or well covered in bed. On the approach of spring the order in the functions of these emunctories is again reversed. 2. Age has a decidedly modifying influence on the effects of remedies, independently of the proportionate quantities for differ- ent periods of life under the adult age. It is very well known MODIFICATION OF ACTION. 51 that the nervous susceptibilities are more decided in very young persons. With less than the usual proportion of neurotic agents, therefore, a child may be thoroughly impressed, and, sometimes, even unpleasant narcotism may result from the ordinary quantity of opium. The nervous impressibility at this period of life is proven by the convulsions resulting from the irritation of worms and other sourees of intestinal disturbance; and, also, by the coma attend- ant upon the latter stages of cholera infantum, dysentery, &c. Some substances, however, make their impression less perfectly on young subjects. Mercurials, for example, often fail to pro- duce any perceptible elective effect on children, even in large doses. Whether this depends upon a want of susceptibility in the parts to be acted on, a deficiency of solvent material in the stomach, or a want of activity in the absorbents, is not very clear. It is evident, however, that therapeutic changes are effected in enteric disease, referable to the improvement in the portal circulation by mercurial excitement of the liver, in chil- dren. Ptyalism, notwithstanding, is rarely produced by large and repeated doses of mercury, even in quantities that would inflame the gums of adults. In addition to these modifying influences, there is a delicacy of all the structures, particularly of the alimentary mucous membrane, which forbids the use of irritating cathartics in any quantity. Thus, croton oil, gamboge, etc., are not suitable cathartics for children. So, also, in old age, when the powers of life are waning, and the physical structures have lost their tone and vigor, violent remedies must be used cautiously. Medicine, which in the buoyancy of youth only tends to ally abnormal excitement and restrain diseased action, may so depress the vital energies in the aged, that hopeless collapse may follow. Circumstances in life, and peculiar physical conformation, lead to weakness and irritability of certain organs, in advance of others. The kidneys and blad- der in some, while the bowels or nervous system in others, give evidence of senile debility, before other parts show symptoms of decline. In some old persons inactivity of the bowels, and a general want of susceptibility to the action of remedies upon 52 ACOLOGY. them, are constant difficulties, dependent upon advanced age. The opposite state of these organs exists with others. Excessive enteric irritability sometimes Is found, due, perhaps, to sluggish circulation through the portal veins, and a consequent capillary engorgement of the bowels, in which violent remedies may lead to serious consequences. The urinary apparatus is subject to similar state- <»t* imperfect functional action, and requires due consideration in the application of remedies. 3. Sex. — Male and female are, in the main, similarly impressed by many remedies in common use. While the latter, in her deli- cacy of structure, exhibits less strength and vigor of frame, -he nevertheless possesses, in many respects, greater power of endu- rance than males. This fact was demonstrated by a company of emigrants in quest of Western homes, beyond the Rocky Mountains, several years ago, who formed an expedition for this purpose. The party consisted of males and females, alike exposed to extreme suffering from cold, hunger and fatigue. It is stated of them, that while, men fell by the way, exhausted from these causes, females were found pressing forward, and many of them succeeded in reaching a point in the journey where their wants could be supplied. The greater ability of females to bear up under disease and suffering, is often witnessed by physicians. Notwithstanding these superior powers, the greater suscepti- bility of females to impressions from mental influences must be acknowledged. Upon this sex, love, joy, grief, etc., make more powerful and lasting impression. The same may be said in regard to the effects of many neu- rotic medicines. Their nervous sensibilities being more acute, the action of such remedies is more prompt and powerful. That state of the system, dependent upon the peculiar functions of the uterus, in various ways, modifies, not only the action of remedies, but the course of treatment to be observed in the cure of ordinary disease. The use of ergot, with either sex, under certain circumstances, is followed by no perceptible effect, while upon the gravid uterus its impression is often prompt and decisive. Exciting diuretics, violent emetics, cathartics, etc., with pregnant females are decidedly objectionable in the treatment of diseases. MODIFICATION OF ACTION 53 which, under other circumstances, would require such remedies. The action of all medicinal agents, whose elective influence is exerted upon the uterine system, is modified, not only by the sex, but by the particular condition of the womb at the time of their administration, as above stated. These various modifying influences, dependent on female pe- culiarities, exist only, to any considerable extent, between the ages of puberty and final cessation of the menses. Besides those already mentioned, the general constitutional disturbance inci- dent to the commencing and decline of menstruation, must be kept in view, during the treatment of ordinary diseases at these periods. Remedies, which, at other times of life, and under some circumstances at the same period, are expected to produce favorable results, must often be withheld at these stages of life. 4. Idiosyncrasy. — This peculiarity is met with often, and sometimes as an embarrassing difficulty in the use of important remedies. It is a constitutional variation by which the usual action of remedies is prevented. The peculiarity generally con- tinues through life, and must always be considered, when pre- scriptions are made. Such anomalous manifestations are ascer- tained only by experience in the use of articles thus producing unnatural effects. The person with whom a remedy is found to "disagree" rarely forgets the fact, and his report on the subject in subsequent illness should always be duly considered by the medical attendant. Cases have come under our observation in which serious inconvenience resulted from inattention to what was considered a " whim of the patient." Opium, administered for its usual anodyne effect, is sometimes found to increase the difficulty intended to be relieved. Ipecac, which usually produces relaxation, and thereby relieves local congestion, spasm, etc., in some persons, brings on suddenly a violent paroxysm of spasmodic asthma. These peculiar constitutional defects are manifested even through the organs of sense. Certain odors, which are not at all disagreeable to most persons, produce very unpleasant effects upon others; and objects not generally disagreeable, prove dis- gusting to some. 5. Habit— This, as the adage goes, " becomes second nature/' 5 1 ACOLOGt. and truly works Important changes in the susceptibility of the system to impressions. Physiological peculiarities, more or less permanent, are brought about by a regular course of regimen, or medication. These changes greatly influence the action of certain remedies. By the habitual use of some remedies, tolerance ofj or lessened susceptibility to, their action is induced, while with others the opposite is found to result. Cerebral excitants, par- ticularly opium and alcohol, belong to the former, while mercury and certain emetics are said to increase the irritability of organs upon which they act. One who has often been brought under the sialagogue effect of mercurials, to the extent of ptyalism, requires less of the medicine to renew the impression. So, with the daily use use of lobelia, ipecac and tar tar i zed antimony, in their emetic effect. This is not, under all circumstances, the result, however; for tartar emetic, when given in full doses, and repeated every few hours, is known sometimes to induce toler- ance; so that no emesis whatever is had from it. This does not apply, however, to the changes made from habit, but is brought on by the sedative effect of large doses, impairing sensibility for the time. If given daily in moderately emetic portions, no such tolerant influence will be exerted, but, on the contrary, the sus- ceptibility will probably be increased. Arsenic and opium are agents with which the effect of habit, in their use, has been thoroughly tested. Immense quantities of these are taken with impunity by persons in the habit of using them regularly. In this country, the former is rarely, if. ever, used in this way, nor the latter, to the extent it is in Asia and other parts of the world. The sad reality, however, of the destructive habits of "opium eating" and "whisky drinking," are witnessed, alas! too frequently in America!! Habits of life have such controlling influence over the physical conformation of man, that much depends upon them for the natural condition of parts to be acted on, and consequently for the ordinary physiological action of remedies. 6. Temperament. — This, in the main, is an inherited style of physical conformation, but may be modified to some extent In- habits of life, climate, etc. Be this as it may, there is no doubt that temperament should be taken into the account in order CLASSIFICATION OF REMEDIES 55 definitely to calculate the degree of physiological action to be effected by certain medicinal agents, and the therapeutic changes obtained from them. In lymphatic subjects, antiphlogistic meas- ures are borne badly, while in the bilious and sanguine, depletion to any desirable extent may be resorted to without inconvenience. When the nervous influences predominate, exciting neurotics must be used with caution, lest excitement beyond the normal standard be suddenly induced. So with other forms of natural constitution. Those organs whose strength and influence predominate, bear up better under depressing influences; and to the extent the nat- ural energies of the system are concentrated in them, will other organs be found deficient in physical and functional powers. In order to pursue the study of therapeutics advantageously, these physiological subjects must be first understood. The usual operations of organs in a healthy condition, and the variations, from causes above recited, not amounting to dis- ease or deformity, should be well studied. Works on physiology give full information on these points, and should be carefully read by the student of therapeutics. The quantity of medicines must necessarily be modified by the various circumstances enumerated, but by none so much as age. Dose for Children. The dose mentioned in connection with the description of remedies must always be understood as the proper quantity for adults, unless otherwise stated; and in order to arrive at the proportion for a given age under eighteen, various rules have been suggested. Perhaps the most convenient, and one sufficiently accurate, is the following by Dr. Young: Take the age of the child for the numerator, the age added to 12 for the denominator, and the fraction thus formed will indi- cate the proportion of an adult dose for the particular case. Thus: 2+12=14, 2-14=1-7, the fractional part of the adult dose, proper for a child of two years old. ( U. S. D.) CLASIFICATION OF REMEDIES. The paramount objects of scientific writers and teachers are to facilitate the learner in the acquisition of knowledge, and to insure its lasting impression upon the mind. They are more effectually accomplished by the correct manner in which subjects iCQLOGl arc arranged and presented i«>r study. Groups made of those similar in certain respects may be learned with almost as much ease as one taken separately. A proper classification of remedies Is particularly useful to the student of Acology and Therapeutics. Remedies are studied only with the prime object of making practical use of them, and, in order to this, their arrangement for study must be made with reference to their medicinal prop- erties. On actions, not botanical or sensible peculiarities, Bhould classification be based. Classification founded on botanical origin, chemical similarity or physical resemblance would not, therefore, meet the requirements of the learner. In the most important, and yet difficult item of study, no advantage could he derived from such arrangement, Worse still is that empirical system of grouping together articles according to imagined ulterior results in the specific cure of particular diseases, without regard to their physiological action. Nothing so completely blights the pros- pects of ambitions students, and turns the rising genius from the path of rational medicine, than the tempting fallacy of ther- apeutic classification, Were it true that every disease had its specific, never-failing remedy, irrespective of surrounding cir- cumstances, then should we dispense with the toil of physio- logical and pathological research, and seek perfection in the healing art, by the knowledge of a true specific for each disease to which mortals are subject. Then, truly, could the weary practitioner cease his tiresome watchfulness over pathological changes taking place during the progress of disease. But such blessing has not been our lot, nor have we even a prospective hope ol its realization. All good, all safety, that can come of medicine must flow through philosophic, rational investigation. Extensive works on Materia Medica, embracing articles about which little is known, further than their sensible properties, can not well be arranged to carry out the system of classification best adapted to the practical study of remedies. General divi- sions, such as vegetable, mineral and mechanical agencies, with an alphabetical order for the individual articles, are all that can be made, including the large number of articles treated of under such an arrangement. Until the effects of a remedy are prop- CLASSIFICATION OF REMEDIES. 57 erly known, it cannot with propriety bo included in a classifica- tion based on the action produced in the system. Pereira's world-renowned Materia. Medica, and the United States Dispensatory are of this description. Although the forms of classes are given with very many useful suggestions on the subject, yet, in the general description of agents, no such system is observed, for the reason, just given, that a large number of articles would necessarily be left out of it, for the want of relia- ble accounts of them, sufficient to fix upon their action and proper classification. Such works are essential to the preserva- tion of the facts that are known concerning all remedies individ- ually, and for this purpose are best arranged for reference in alphabetical order. In books, however, intended to present the student of thera- peutics with facilities for learning readily the means of combat- ting disease, those articles only are important whose medicinal properties have been thoroughly established. Such remedies are subject to systematic classification, based on the known physio- logical properties they possess; and in such arrangements facility is afforded the learner to acquire a knowledge of them. Simplicity and system are necessary to a useful classification. Eberle, Pereira and Wood take nominally the physiological action of remedies for the basis of their arrangement, but from their tables the learner cannot obtain a clear idea of a complete system. In fact, such is not claimed for them by the authors. There is not in any of them that strict adherence to the principle upon which they are intended to be founded, which is necessary to make a systematic arrangement. Prof. Wood, than whom no writer in America has done more to promote the advancement of rational medicine, adopts a somewhat complicated system, and admits its imperfection, in certain respects. The difficulty exists in failing to observe strictly a physiological basis of classification, a rule by which his system is partially governed. If physiological action is to govern the classification in one instance, it must do so in all. The ultimate or therapeutic results should not control, in the least, the arrangement and names of classes. In his plan, neurotics arc set down as remedies having general action, thereby .basing their classification on the therapeutic results manifested ECOLOGY. in various portions of the body. Emetics and cathartics arc recognized by bis classification as local remedies, when in truth each of them affects the whole animal economy, as does opium, by its elective action upon a particular organ. Ipecac or gam- boge, in its therapeutic results may, and generally does indirectly affect the whole system. As one of the learned authors, above referred to, has remarked many of our valuable remedies are not sufficiently understood, in their modus operandi to he properly classed. While this is true, and while, as above stated, what is known of them should be preserved in suitable works for this purpose, there is a sufficient number of them whose effects are known, to furnish complete classes tor systematic text books. Such collation is essential to students commencing therapeutic investigations. In the arrangement we have adopted, harmony, in many par- ticulars, with the systems referred to, will be discovered. To these authors, particularly the great American Pharmacologist, Dr. Geo. B. Wood, the director of our studies in early life, are we indebted for much that will be fbuud in the pages of this work; not only concerning the properties of remedies and their arrangement into classes, but for views connected with their modus operandi and application in the treatment of disease. To carry out strictly a system of physiological classification, new names must necessarily take the place of those by which classes of remedies are generally known. This innovation i s pardonable only as the means of consistency in arrangement and great practical benefit to the student. The acknowledged definition of physiological action must be kept in view, viz. that which is invariably had by a remedy upon an organ, whether diseased or healthy. Blennymenal stimulants, enteric excitants, cerebral stimulants, etc., etc., denote direct physiolo- gical action, and should take the place of names such as "expec- torants," "cathartics," "anodynes," etc., which indicate the functional modification that may occur from their action, under a proper state of circumstances. Therefore, certain remedies whose action is exerted directly upon the mucous membranes generally, upon the brain, bowels or other parts, should be asso- ciated under the name indicating this influence, without regard CLASSIFICATION OF REMEDIES. 59 to the result of such upon the function of the organ acted on. These and other excitants of particular organs may promote their functions when below the ordinary state of excitement. No remedy will invariably increase the function of an organ, but any of them will always, when they act at all, have the • same physiological action of stimulation, depression or tone. When, therefore, it is desirable to restore a function that has been disturbed by abnormal excitement of the organ, remedies having a sedative effect upon it are selected ; but when the fail- ure depends upon depression, excitants will be more likely to restore it. It may be set down, then, as an established tact, that remedies of opposite action may promote the function of an organ in different states, and that all remedies which act elect- ively through vital process excite, depress or give tone to the organs upon which they act, or for which they have affinity. When the excitement is of temporary character, the remedy is called a stimulant ; when permanent, the term tonic is applied. The impression is had without regard to the condition of the organ at the time, but the result of the action upon the function often depends upon the degree and character of disease which may then exist. If hepatic excitement already exists to the extent of inducing that state called inflammation, and the function is, in consequence, so far disturbed as to arrest the secre- tion of bile, it is not likely that additional excitement by a hep- atic stimulant will lead to favorable change in the function; and even when of ordinary vigor, mercury and other excitants may lessen the secretion by over-excitement. If, however, the liver be below the ordinary standard of excitement, and the function is deranged in consequence, restoration of the secretion may be expected from the stimulant. The same remedy, therefore, may prove cholagogue or anti-cholagogue, according to the condition of the organ leading to the deranged function. Hence, the term cholagogue applied to a class of remedies necessarily leads to erroneous conclusions and unfortunate practical results. The enlightened medical mind no longer tolerates the idea of specific mysterious curatives. No one can now, with safety to his reputation as a rational physician, content himself short of a knowledge of the modus operandi of remedies. In order to this, 60 aCOLOGT. the student of medicine should not be taught by the use of terms which lead to routine practice. u Alteratives," "diaphoretics," "antispasmodics," etc., are terms applied to classes of* remedies, which, though they express the occasional and uncertain func- tional changes or results following the actions of certain remedies, lead the learner to rely upon that in which he is doomed to vexa- tious disappointment. Diluents of the blood, excitants of the brain, general refrigerants, cardiac sedatives, etc., may lead to cutaneous transpiration, under the proper state of circumstances. The same may be said of remedies acting exactly the opposite of those mentioned. So that if a class of diaphoretics be recognized, the catalogue should rightfully include every means used in the arrest of inflammatory and febrile affections. The error now entertained by some that diaphoretics finally produce copious perspiration, and thereby "cool the fever," is similar to that of practitioners half a century ago, in regard to the alteraticc effects of mercury in the treatment of malarial fever. The theory of that day, upon which was founded the extensive use of mercury in the treatment of remittent fever, was, that the production of ptyalism cured the disease, when in truth the fever from self limitation abates before salivation is likely to occur. Many an unfortunate victim of the salivating and sweating theories can bear testimony of their evil consequences. Alteratives, known as the mysterious curatives of various chronic diseases, and general debility of unknown pathological origin, are each given with the uncertainty of " bread cast upon the waters," which may or may not "be gathered many days hence." This mysterious class is made up of remedies, now known to act as catalytics of various morbific and natural ingredients in the blood, such as syphilitic and scrofulous matter, fibrin, etc. The name catalytic, which indicates the action had, seems preferable. Writers agree on the importance of physiological classification, but all alike doubt the possibility of making it systematically. The interests of the profession and the public weal, in the educa- tion of medical students, demand an effort. If in the attempt, the author fails to impress the profession with the propriety of his course, he will not tail, at least, to excite thought and arouse a la- tent feeling of interest in the fundamental principles of rational, PHYSIOLOGICAL CLASSIFICATION. 61 practical medicine. Empirical devotees to one-ideal systems find much of comfort and encouragement in their course, from the therapeutic classifications and specific curatives of the adherents of rational scientific medicine, and the learner should be taught, early in his course of study, to shun the breakers of empiricism. PHYSIOLOGICAL CLASSIFICATION. ( 1 R f 1 Remedies that af- | „ y feet the Skin 1 Local action thro' Vital Process. 2 Local action thro' Chemical Process. 3 Local action thro' Mechanical Pro- Rub efaci en ts. « ** Vesicants. (3 Pustulants. 2 Remedies that af- fect all Soft Tissues 1 Remedies that af- fect Adventitious Substances and Structures. 1 Remedies that af- fect internal and external Surfaces 1 Astringents. 2 Catheretics. 3 Aromatic Excitants. J 1 Anthelmintics. j 2 Escharotics. j 3 Antiseptics. 1 Demulcents. 2 Emolients. 3 Mechanical Counter Irritants. f 1 Hsematinics. f 1 Elective Action j 1 Remedies that J, , «j . .1 t>i 1 3 Diluents, affect the Blood. } . „ . *• 4 Haemostatics. through Chemi- cal Process. [' 1 Remedies that af- fect the Alimen- tary Canal. 2 Remedies that feet the Heart af- f [ 5 Catalytics. 1 Inverse Gastric Excitants. 2 Enteric Excitants. 3 Gastric Tonics. 1 Cardiac Stimulants. 2 Cardiac Sedatives' 3 Cardiac Tonics. 3 Remedies that af- fect the Mucous Membranes. 2 Elective Action j 4 Remedies that af- through Vital j feet the Nervous I Pr. System. 1 Blennymenal Stimulants. f 1 Cerebral Stimulants. j 2 Cerebral Sedatives. 3 Cerebral Tonics. 4 Excito-motor Stimulants. 5 Excito-motor Sedatives. 6 Spinal Stimulants. I 7 Spinal Sedatives. [ 8 Spinal Tonics. (1 Haspatico-Salivary Stimulants 5 Remedies that af- | 2 Hsepatic Tonics, feet the Secer--] 3 Renal Stimulants. nent System. | 4 Renal Sedatives. [ 5 Renal Tonics. 6 Remedies that af- f 1 Genital Stimulants. j 2 Genital Sedatives, tect tne JTocrea ^ g Tj ter i n e Stimulants. I tive Organs. [4 Uterine Sedatives. 62 ACOLOGY While fertile foregoing arrangement perfection is not claimed, vet Itv it the student is enabled to take a concise view of a clas- sification founded on the physiological action of* remedies. Only two genera] orders are recognized in the plan adopted; one including those medicines having elective tendency toward certain organs, when taken into the blood; the other, those purely local, affecting only the parts to which they are topically applied. Of these, three sub-orders are made and named, in accordance with the vital, chemical or mechanical process through which action is produced. Each sub-order includes all the remedies which have their effect through one or another of these processes respectively. Each division is made up of remedies which act upon a par- ticular organ or system of organs; and the name given to each class, distinctly shows upon what particular part the action of remedies included in it, is exerted, and the character of that action, whether exciting, depressing, tonic or soothing. Thus, in the division of "remedies that affect the nervous sys- tem/' are included all agents treated of in the work, impressing any one of this system of organs; and the class "cerebral stimu- lants/' for example, includes the articles which excite the brain to increased energy. ORDER I. LOCAL REMEDIES. SUB-ORDER I. THROUGH VITAL PROCESS DIVISION L REMEDIES THAT AFFECT THE SKIN CLASS I. RUBEFACIENTS The name of this class denotes the kind of action produced. Usually a -prefix to the name indicates the part acted on, but to this, such is unnecessary, since the reddening produced by these remedies is universally understood to be on the external surface. The term rubefacient — from rubefacio, to make red — may be applied to any means having this effect, whether acting through vital, mechanical or chemical process, but those only which act through the former can be properly considered under this, our first sub-order. The physiological effects of this class are rarely, if ever, exerted upon the part diseased, and such articles are generally, therefore, indirect therapeutic agents. The objects of their use are, counter- irritation and revulsion. By the first, an existing inflammation, irritation or pain is relieved, through the establishment of excitement in a contiguous sound part; the irritation thus artificially made giving increase r»i L0OLOG1 of blood in the surface on the principle, thai "where there is irritation there is a flow," and to thai extent counteracts existing internal derangement. In this way the pain and excitement in- ternally are temporarily abated by the new irritation of a rube- facient on the surface. By revulsion is meant that general modification of the circu- lation in which the head, for example, is relieved from supera- bundance of blood by rubefacient measures applied to the lower extremities. Thus the circulation is equalized, the peripheral vessels being made to carry more blood, while distant parts are relieved to that amount from engorgement. These are the most speedy and transitory of the counter-irri- tants. Their effects are not sufficiently powerful nor lasting to be exclusively relied on in violent local disease or serious circu- latory disturbance; but their promptness makes them important preliminaries and auxiliaries to more effective means. Catalogue of Rubefacients. Sinapis. Olea Aromaticus. Oleum Terebinthinse. Aqua Ammoniac. Capsicum. Chloroform urn. Chloral. .Ether. Sinapis — Mustard. The seeds of Sinapis alba and Sinapis niger, well known herbaceous plants, cultivated extensively in Europe and America for the seeds. Their color gives name to the species of the plant from which they are derived. Mustard is a valuable rubefacient, and is used also as a condi- ment, for its exciting effects upon the stomach. Pulverized sinapis, for its local application to the skin, is mixed with water or vinegar, and used in the form of cataplasm, called sinapism. This is made by spreading the mixture, of semi-fluid consistence, on cloth or paper, of suitable dimensions for the particular case, and applied to the skin over the affected part. Thirty minutes are required usually to redden the surface sufficiently. AND THERAPEUTICS. 65 The mustard may bo placed directly in contact with the skin, or included in a fold of well moistened old linen, and allowed to communicate its properties through the meshes. By being mixed with syrup, a more adhesive cataplasm may be made, which, though sufficiently effective, requires more time for its action. The burning sensation is sometimes exceedingly painful, when the mustard is mixed with water or vinegar and applied directly to the skin, and on this account may be advantageously prepared in this way. It is not only painful in its action, but sometimes, when applied to young subjects or delicate females, and suffered to remain too long, may produce vesication, which sometimes leads to unnecessary and painful sores. A sinapism is found useful- in various forms of local disturb- ance. For the treatment of malarial fever, in order to insure the arrest of an expected paroxysm, by quinine, or such other ner- vous tonic as may be used, mustard applied over the spinal column is often salutary. It should be used when the antiperi- odic is administered, so that the engorgement and irritation of the spinal cord, which sometimes exist, may be relieved at the time the tonic eifect is being produced. Failure to arrest an approaching paroxysm is often met with, from neglect in affording timely counter-irritation over the spine. In that state of the cord causing reflex nervous manifestations, such as hysteria, etc., counter-irritants are indispensable to prompt relief; and mustard generally answers well for this purpose. Charta Sinapis — Mustard Paper. This preparation is made by mixing mustard with a solution of gutta percha in chloro- form, to a syrupy consistence. It is a very convenient mode of using the remedy, and may be prepared for application by dip- ping in warm water, for a few seconds, a piece of such dimensions as may be required, placing it at once upon the surface. Oleum Terebinthixje — Oil of Turpentine. This is the distilled oil of the oleo-resin or juice which exudes from the wood of Pinus pedustris and other species of Pinus and Abies. The former are stately trees, found abundantly in South- 5 66 ACOLOGY ern portions of the I nited States. The oil found in commerce is distilled from the turpentine of the species of Pinus princi- pally, but turpentines and balsams from the Abies afford an equally pure and useful oil. Oil of turpentine is a transparent, colorless, thin liquid, and, owing to the process by which it is obtained from turpentine, and the want of oily appearance, it is called Spirit of Turpentmie. It will be again referred to in the classes of " cardiac stimulants" and "blennymenkl stimulants." When placed on the skin in a way to prevent its evaporation, or with friction, turpentine acts as an effective rubefacient. The effect is also temporary, but less painful than that of mustard. The skin may be reddened in a tew minutes by friction with the fingers dipped' in the oil, or by the application of a pledget of lint or fold of linen saturated with it. In children, the skin over the larynx and tonsils may be reddened in this way without excessive pain, when affected with croup and tonsilitis; and the effect may be kept up any desired length of time. So with the spine, chest or abdomen, when a temporary counter-irritant is desirable for internal disease of these parts. It is also found a useful ingredient in anodyne and rubefacient liniments, intended for the spine and the surface along the course of painful nerves. Capsicum — ( hyenne Peppt a ■. The fruit of Capsicum anum, an annual herbaceous plant, cul- tivated extensively in Europe and America. This well-known fruit is in variously-shaped pods, according to the different vari- eties of the plant from which they are derived. Like most vegetables and animals, the pepper plant, as well as the charac- ter of its fruit, is changed by climate and the various circum- stances connected with the plaee of its growth. Pepper is gathered, when ripe, dried in the shade, pulverized and preserved in well-stopped bottles. The taste is excessively pungent, and it excites a burning sensation in the mouth and throat when swallowed. Cayenne, or red pepper, as it is sometimes ealled, is a local AND THERAPEUTICS. 67 stimulant of considerable powers, and acts well as a rubefacient when applied to the skin. Pulverized capsicum may be prepared in the form of cata- plasm, as directed for mustard, and used for the same purposes. The pain from it is perhaps less severe, while its eifects are more permanent, leaving the skin, sometimes, in an inflamed condi- tion for several days, yet without vesication. A pediluvium, made with infusion of pepper, or a mixture of mustard and pepper with water, is supposed to effect important revulsive action in congestion of the brain and other vital organs. There are many other means of reddening the skin, some of which will occasionally be found more convenient than those already mentioned. It is not deemed necessary, however, to give them a prominent position and separate description in this class. One of these, friction, will be noticed under the head of "mechanical counter-irritants," in the sub-order of remedies act- ing through mechanical process. Chloral, a recent addition to the catalogue of remedies, and described under the head of " cerebral sedatives," has been highly recommended as a rubefacient by a neighboring physician, whose experiments with it, in this way, proved highly satisfactory. A kind of sedative or anodyne influence was thought to result from its application, allaying pain and nervous irritability of internal organs more effectually than by ordinary counter-irritation. More experience in its use, however, is necessary to confirm this opinion. For local application chloral is moistened with water, rubbed into the form of paste and smeared upon the surface. The Essential Oils of cinnamon, peppermint, doves, etc., when rubbed upon the skin, act promptly as rubefacients, equally effi- cient with mustard, and without more pain than results from the action of this popular counter-irritant. Ammonia, Chloroform and Ether act as rubefacients, and will vesicate when applied to the skin if continued sufficiently long and protected from evaporation. A piece of cloth, corre- sponding in size with the part to be impressed, saturated with any of these liquids, placed upon the surface and covered with a folded napkin, affords the means of reddening the skin promptly. 68 IC0L0G1 With ammonia, particularly, a short time only is required to produce this effect; and if continued for twenty minutes, will cause vesication. It' suffered to evaporate freely, however, these substances produce refrigoration instead of redness and excitement. CLASS II. VESICANTS. Irritants of a peculiar kind, and more powerful than rube- facients, causing a separation of the cuticle from the true skin and an effusion beneath the former, produce what is known as a blister or reside. Their mode of operation in counteracting internal disease is similar in some respects to rubefacients. The most important differences being the degree of action and its permanence. Blisters also produce a kind of local depletion, not obtained from less powerful counter-irritants, and which is sometimes important in the treatment of inflammation. Vesicants, then, may be said to allay internal irritation, engorgement and inflammation by counter-irritation, depletion and re nils ion. The first of these modes is not limited, in its benefits, to the modification produced in the circulation. By any degree of irritation upon the skin, whether only to the extent of rubescence, or to full vesication, a state of irritation is set up, which counteracts a like condition in an adjacent diseased part. This state of the nerves -in an irrita- ble or inflamed tissue is a fruitful source of pain, and tends greatly to. aggravate existing inflammation. Indeed, it is not unlikely that in this way the timely use of counter-irritants may prevent its establishment, by allaying nervous irritability. The general rule applicable to the use of this class, is, that in excessive permanent irritation, acute or chronic inflammation or congestion of internal organs, blisters are beneficial. The part selected for the application is that immediately over the affected organ, or as nearly so as practicable 1 , when counter- irritation is sought. If, however, revulsion be the object in view, the blister should be applied to parts remote from that in which the engorgement exists; as, in fullness of the brain or abdominal and thoracic viscera, the wrists and ankles are the points selected. AND THERAPEUTICS. 69 Inflammation in certain organs seems to be more under the influence of blisters than that of some others, equally near the surface. Disease of the eerous and mucous membranes connected with the respiratory organs appears to be more controllable by the remedy than when located in the parenchyma of the lungs. Hence, it is prescribed with more confidence in pleuritis and bronchitis than in pneumonia. Blisters are indispensable in enteric affections, particularly that of obstinate colo-rectitis or dysentery, when general remedies fail to alleviate the paroxysms of pain and frequent discharges. Under these circumstances a blister, applied to the hypogastrum gives efficiency to anodynes, astringents and other internal remedies. As an auxiliary to quinine in the treatment of rheumatism, a blister to the spine is sometimes indispensable Cases of acute articular rheumatism are met with, which, at the onset of the disease, yield readily to these agencies combined, after having resisted quinine alone; and, as in intermittent fever, all cases are, perhaps, more certainly relieved by associating counter-irritants' of this kind with other treatment. The practice of treating rheumatism by a succession of blisters to different parts of the body, indiscriminately, has been recom- mended ; but the reports of cases thus treated, do not give suffi- cient evidence of certainty and promptness of reliefj to warrant the use of such painful treatment. Indeed, the fact that severe attacks sometimes recover as soon without blistering in this way, leads to doubts of its efficacy. The extent of surface that should be blistered safely is an im- portant point to be considered in the use of this valuable remedial means. As a general rule, it may be proper to state that the blister should be commensurate with the extent of dis- eased surface within, when used for the counter-irritant effect. Circumstances, however, may make a variation from this rule necessary. Something more than the mere extent of internal disease must be considered in deciding upon trie amount of coun- teracting influence to be used. The degree of irritation and in- flammatory excitement must also enter into the account. It has, 70 \^■i)\^H)\ therefore, been proposed, as the better rale, thai the amount of irritation produced by the Mister should exceed thai existing in the diseased organ. Even this may lead to -rave error when carried to an unwarrantable extent. The blister itself, when ex- cessively large, may prove a source of nervous and vascular dis- turbance sufficient to prostrate the vital energies. Doubtless children and delicate adults, with irritable state of the nervous system, are sometimes subjected to injury from this cause, less controllable than the disease itself. Catalogue of Vesicants. Cantharis. Aqua Ammonise. Caloric. Cantharis — Cantha rides. The dried insect or beetle, cantharis vesicatorm. This fly abounds in Spain, and hence the common name, Spanish flies. The insect is a little less than an inch long, one-fourth of an inch broad, and of a beautiful greenish color, particularly Fig 1. Cantharides. the legs and wings. They have an unpleasant penetrating odor, and acrid disagreeable taste. The principle upon which their vesicant property depends is called eantharidin. Ceratum (\ndhandk— Cerate of Cantharides.. This, like other cerates, is composed of wax and lard, in proportions to insure adhesion to the surface without heat or moisture, in which is thoroughly mixed the pulverized Hies. It is spread upon cloth, AND THERAPEUTICS. 71 paper or leather when required For use, or kept in the shops in largesheets so as to be cut into the proper size and shape required. Spanish Hies afford the only vesicant in very general use; being certain and efficient for this purpose. Occasionally, how- ever, vesication is demanded more speedily than it can be had from this substance, and other means, to be noticed hereafter, are brought into requisition. From four to eight hours are required to produce full vesica- tion by cantharides in this form. Unpleasant effects sometimes follow its use from the absorption and elective action of cantharidin upon the kidneys and bladder, and the most distressing strangury is, in some persons, occasionally produced. It is said that this tendency may be, in a great measure, counteracted by previously bathing well the part to which the blister is applied, with tinc- ture of camphor. If security be thus afforded against this troublesome difficulty in the use of cantharides as a blister, the manner in which protection is given has not been ascertained, positively, but probably by arresting the usual amount of absorption. Several other preparations of cantharides are used for the purpose of blistering. Charta Epispastica — Blistering Paper, sometimes called Blis- tering Tissue — is used for this purpose, and made by spreading on paper a mixture of cantharidin and wax. This is said to be less liable to produce strangury than the cerate, and less active as a vesicant. It is, therefore, preferable for children and sensitive females, in whom the skin is more susceptible to vesicant action. Collodium Cum Cantharide Cantharidal — Collodion — is a mixture of the etherial tincture of eantharides with collodion, and is spread upon the part intended for the blister with a brush or camel's hair pencil. The ether evaporates rapidly and leaves cantharidin, the active principle of flies, with the gun-cotton firmly attached to the skin. The process may be repeated, if necessary, till the requisite amount of cantharidin is in contact with the surface to produce full vesication. This is, perhaps, still less active than the blistering paper, but is free from the inconvenience of compress and bandage, required for the other preparations mentioned. 72 ACJOtOGl Acetum Cantharidis — Vinegar of Gantharides — is an officinal preparation of flies intended for vesication. The solution of cantharidin, the active principle of the drug, in acetic acid re- quires a temperature nearly up to the boiling point of water, and it' digestion at about the temperature of 200' Fahr. is not had, the strength will not be sufficient to insure the full activity of the remedy. A blister may be formed speedily by applying it with a brush repeatedly for several minutes. It is said that one or two hours will be sufficient to produce the full effects with the vinegar of cantharides, while the ordinary cerate requires five or six hours to effect this object. Other means are sometimes resorted to with the view of pro- ducing- vesication more speedily than it can be effected with the preparations of cantharides. Am mould, mentioned under the head of rubefacients, will vesicate when applied to the skin, if evaporation be prevented. A cloth, the size required for the blister, may be saturated with this liquid, applied to the surface and covered by a compress so as to retain it in contact with the surface. When required only of small size, a watch-glass placed over the part to which the ammonia is applied, will effectually prevent evaporation and secure the vesicant action in a very few minutes. Cases occur, in which it is important that counter-irritation, such as is pro- duced by blistering, be had without delay; and under such cir- cumstances, this article may be found useful. Caloric may be used as a powerful counter-irritant; and although it acts by a kind of chemical process, and is not, there- fore, appropriately considered in connection with remedies having vital action, yet practically it is, perhaps, better that it be alluded to in this connection. The Actual Cautery is highly esteemed by some, when the emergency is such as to require immediate vesication. By this means powerful counter-irritation is speedily produced, but cases are rarely met with in which remedies less alarming and painful will not prove equal! effectualy. It is true that iron heated to a de- gree which will produce complete destruction of the tissues, may AND THERAPEUTICS. 73 be rapidly passed over the skin in a manner to induce vesication only, and with less pain than when of lower temperature, but will always prove a source of terror to patient and friends. Hot Wafer may be used for this purpose, and though speedy and effectual, is liable to the objections urged against the hot iron. It may be applied by a towel saturated with the hot water, and requires but a moment to effect the object intended. The ex- tremities or any portion of the body can be promptly blistered in this way, if such application should be demanded. CLASS III. PUSTULAXTS. Certain substances affect the skin, when placed upon it, by slow process, so as to form, pustules. To the class now under consideration belong such articles; and their action, though not so powerful as that of blisters, is more permanent, and gives less annoyance to the patient. They are, of course, applicable to chronic diseases only, in which long continued counter-irritation is demanded. Several days are required to establish pustules, but they may be perpet- uated for any desired length of time, and without much pain to the patient, by renewing the application as they begin to disappear. Chronic disease of the liver, lungs, stomach, spine, kidneys and uterus often require permanent counter-irritation of this kind. It is not alone to the irritation produced by this class, that all their benefits are due, for the constant drain established by them serves as a kind of revulsive and depleting measure, highly useful in relieving chronic engorgement and inflammation. Catalogue of Pustulaxts. Unguentum Antimonii. Oleum Tiglii. Ungeunttjm Antimonii — Aatimcmial Ointment. The double salt, tartrate of antimony and potassium, forming the active ingredient of this ointment, has a prominent place in 7 1 ACOLOCfl the classes of "inverse gastric excitants " or emetics and "cardiac sedatives/' in a subsequent pari of this work where a more accu- rate description will be found. Its local action, when given internally is thai of an irritant, and, as will be seen, it must l>e given with caution on this account. The ointment is made by mixing two or three drachms of tartarized antimony with an ounce of lard; and may he used by rubbing a small portion on the skin three times a day until pus- tules appear, which may be expected in two or three days. These run their course in less than a week, usually, and in order to keep up the impression a renewal of the application should be made as the pustules decline. Sometimes, though rarely, furunculous collections of pus take place from the pustulation, giving uneasi- ness to the patient, and require to be evacuated by the lancet. Tartarized antimony, though an irritant to the internal and external surfaces of the body, has a peculiar action upon the skin, and makes its impression slowdy. When used in this way, it is not absorbed in sufficient quantity to produce its elective effects upon the stomach ; as nausea, which results from its intro- duetion into the rectum and other parts, in which absorption occurs, is never produced by its application to the external surface. The use of this ointment on the epigastrum in chronic gastritis, or the chest in pulmonary disease, causes pustular eruption which may be continued for weeks or even months without seri- ous inconvenience to the patient, and with great advantage in the treatment of these effections. Unpleasant nervous symptoms from reflex nervous impressions and from actual disease of the spinal cord, may be allayed by a crop of pustles along the spinal column, during the direct treat- ment of uterine or other organic disease, upon which such nervous perturbation depends. Oleum Tiglii — Croton Oil. The expressed oil from the seeds of Croton Tigliwm. This is an excessive irritant, with whichever of the soft structures it may come in contact. Hence, it acts as a powerful irritant cathartic; and under this head is more minutely described. AND THERAPEUTICS. 75 When croton oil is rubbed upon the skin, at intervals of six or eight hours, a pustular eruption makes its appearance in a day or two, with more or less general inflammatory excitement of the surface. The pustules require several days to run their course, during which considerable irritation is kept up, resulting in the discharge of small quantities of pus. It compares favorably with tartar emetic, as i counter-irritant, and is,- perhaps, preferable in most cases, owing to the promptness of its action and the freedom from unpleasant furunculous swellings. Being a violent drastic cathartic in small quantity, the natural impression is that, when applied to the skin, absorption, to the extent of producing catharsis, should occur. Such, however, does not seem to be the case; and the failure to do so may be ac- counted for in a knowledge of the fact that an irritant to the surface may interfere with absorption from the part, and also by the supposition that its action as a cathartic is not elective, but local. The oil is usually applied in full strength, but when used upon delicate subjects may be diluted with olive or some other bland oil. Such mixture, doubtless, constitutes the German nostrum used in connection with acupuncturation by an instru- ment called lebens weaker — life-waker. Numerous small pustules result from the application of croton oil, and, as they disappear, may be renewed by reapplication of the oil. DIVISION II. REMEDIES THAT AFFECT ALL THE SOFT TISSUES. This division is also made up of classes containing local remedies. It is, however, true that articles in some of them are also found under the head of elective remedies, which are taken into the circulation in order to their action. The class of astrin- gents, for instance, contains several remedies which also have 7(5 AC0L0O1 prominent places amongst "cerebral tonics" and "haemostatics." Their astringent tonic and styptic effects, however, differ widely from each Other. That action upon the solid structures by which they arc const ringed — made firm and compact — is called astrin- gency, and the impression made on the blood by them, rendering it more coagulable, is termed styptic or haemostatic. Acetate of lead may be usefully applied to relaxed or inflamed parts, and hence belongs properly to a division of local agents under the head of astringents; and the same article is administered so as to enter the circulation in order to its action npon the blood itself, as other elective remedies, included in the class of haemostatics. CLASS I. ASTRINGENTS. The name of this class — from ad, to, and stringo, to bind — is intended, as nearly as possible, to describe the aetion of the arti- cles it contains. They eonstringe or contract, condense and make firm any of the soft tissues to which they are applied; thereby lessening the amount of capillary circulation and the tendency to effusion of blood or other fluid through the surface thus affected by them. By this impression, superficial inflammation or relax- ation of the surface, with which they are in contact, may be re- lieved. A large number of vegetable and mineral substances are included in the class, affording every degree of action from a slight roughness to the most powerful constringency. The more active articles, which destroy tender and fungous granula- tions, and answer the purpose of mild cauterants, constitute, when diluted, a considerable proportion of the most useful astrin- gents. These may be denominated Gathereties, and will occupy a separate class under this name. The milder variety, which will be considered under the head of astringents alone, are useful internally as well as for external application, in order to produce contraction and condensation of the surfaces. Diarrhoea, from relaxation, or inflammation of the mucous membrane lining the bowels, may often be controlled by the internal use of mild astringents. The existence of acute AND THERAPEUTICS. 77 inflammation and general febrile excitement, are not, as has been supposed, circumstances which contra indicate their use, but their action above described will, evidently, tend to correct this abnor- mal state. In a class comprising so many articles it is not necessary that all of them be described in a work oi this kind. If is only important to name some of each variety, so that every peculiarity of action may be represented. Catalogue of Astringents. Plumbi Acetas, Rubus, Geranium, Kino, Quercus, Krameria, Galla, Catechu, Acidum Tannicum, Hasmatoxylon, Acidum Gallicum. Plumbi Acetas — Acetate of Lead. This is a heavy crystaline salt, of sweetish astringent taste, and soluble in water. All the preparations of lead produce poisonous effects if given in excessive dose, or continued too long in moder- ate quantity. Sugar of lead is considered one of the best mild astringents, as a local application for the relief of inflammation in delicate structures. As a collyrium in conjunctivitis, a solution of two or three grains to the fluidounce of sassafras or elm mucilage, it is used with much benefit. A perfect solution is necessary, however, when applied to delicate and sensitive tissues, in order to avoid the irritation likely to occur from undissolved particles of car- bonate of lead which may remain in the solution. The addition of a few drops of vinegar, or subjecting it to filtration will, perhaps, prevent this difficulty, by removing the irritating cause. In chronic disease, when the action of an astringent is required for a considerable length of time, lead is not an appropriate remedy, and should not be used, lest the quantity absorbed may induce the poisonous effects upon the nervous system, A singular 78 ACOLOGY paralysis of the upper extremeties is said to result from the long (•out i lined use of very small quantities, introduced into the stomach, or other parts, from which absorption readily takes place. Two or three grains to the fluidounce of water make the proper strength .for internal or external use. The dose of this is, from a half to <( fluidounce, when taken into the stomach. Alumen — Alum. This, aeeording to the Pharmacopeia 1 revision of 1870, is sulphate of aluminum and ammonium. It is in the form of white octohedral crystals, slightly efflorescent, soluble in water, and of sweetish .astringent taste. Alum is powerfully astringent, and employed externally in diseased conditions for which very decided astringent action is required, and as a wash in affections of the throat, vagina, urethra, etc. An ounce to the pint of water makes a solution of proper strength for these purposes; but should vary according to the organ affected, and the nature of the disease for which it is used. Alum, administered internally for the ordinary astringent effect, in disease of the stomach or bowels, must be limited in amount to the dose which will not affect the peristaltic contraction of the canal. A drachm of the salt is necessary to the emetic effect, while ten or fifteen grains are sufficient to impress any part with its astringency. It has been employed for its styptic effect on parts which can be reached only by absorption into the circulation, but is, doubt- less, inferior to acetate of lead for this purpose, particularly as a haemostatic, in uterine hemorrhage and hematuria. Many other mineral astringents may be mentioned. Sulphate and chloride of zinc, sulphate of copper, nitrate of silver, sulphate cadmium and chloride of iron are highly astringent, and when properly diluted, answer the purposes for which other articles of the class are used. They are capable of effecting more powerful action, however, and it is thought proper to consider them only in the class of catheretics. AND THERAPEUTICS. 79 A large Dumber of vegetable substances have astringent prop- erties, with which it is unnecessary to encumber a work of this kind, intended more for the establishment of a system of practieal study, than for thoroughness as a book of reference. In a class having so large a number of substances, it is only necessary for this purpose, as above stated, that representative articles of each peculiarity of action should be mentioned. This is not intended as a record of botanical facts connected with medicinal plants, nor a Dispensatory in which the history, preparations and dose of every medicinal agent can be found. The number of astringents are so large that it would require an unreasonable space, to do more than mention the most impor- tant articles, and give the peculiarities they possess. These are principally used in relaxation, and other diseased conditions of the alimentary mucous membrane, leading to diarrhoeal and dys- enteric symptoms. Geranium — Cranesbill. The root of Geranium Maculatum or Spotted Cranesbill, an indigenous herbaceous plant with perennial root, found abund- antly in the rich alluvial soil of low, moist situations. This root, though imparting to the mouth the roughness of ordinary astringents, is comparatively free from the unpleasant bitter taste of most other vegetables of the class, and on this account is more readily taken, and more acceptable to the stomach, than most astringents. It is a convenient remedy for the treatment of bowel affections in children, and for this purpose is sometimes boiled with milk, constituting a preparation that affords, at the same time, nourishment and astringency; by which the tendency to diarrhoea and relaxation may be counteracted, and general in- vigoration afforded. A decoction, made by boiling an ounce of the root in a pint and a-half of water down to a pint, may be used in the dose of two fluidounces every three or four hours. Two extensive families of indigenous plants belong to the class of astringents, and afford all that is absolutely necessary for the full action of vegetable astringents, viz,: Quercus and Bubus. 80 ICOLOGl Besides these, we have not only many other indigenous astringents, but a long list of foreign origin, to say nothing of the numerous mineral preparations having this property. Quebcus Al.HA — WhiU Oak. The hark of Quercus alba, an indigenous tree attaining im- mense size, and found abundantly on fertile soil in low situations throughout the Southern States. This is a useful astringent, being readily obtained, effective as an astringent and not unpleas- ant to the taste. Decoct um Querelas AlUe — Decoction of White Oak — is the only officinal preparation of this bark, and may be given with benefit when astringents are necessary, in the dose of two fluidounces. Quercus Tinctoria — Black Oak. This is the inner bark of Quercus tinctoria, an indigenous tree, which, in many portions of the country, constitutes almost the entire forest growth. There are various other species of oak, but these are the most important, and the only two recognized by the United States Pharmacopoeia. Querents Infectoria is the name given to that species from which the nutgall is obtained. Galla — Gall* — are the result of injury to the branches of this species of the oak by an insect that pierces the bark. From this an excrescence or tuber arises, which forms the (jail, or nutgall. An Infusion of the various species of oak and of the nutgall is a preparation by which their astringent action may be obtained. This is made by pouring a pint of boiling water on an ounce of the contused bark, or coarsely powdered galls. Tu:o or three fluidounces of the infusion may be taken three times a day, or more frequently, if required, in bowel affec- tions, etc. For internal use, the infusion, made from the bark of Quercus alba, is preferable to that of other species of the oak, on account AND THERAPEUTICS. Fig. 2. 81 Qitercits Infectoria. a. Branches with male flowers. c. A male catkin. b. Branch with female flowers. d. Nut (acorn), and capsule. of its mildness and less disagreeable taste. The virtues of these productions of the oak depend upon two crystalizable principles, viz.: Acidtjm Tannicum and Acidum Gallicum — Tannin, or Tan- nic Acid, and Gallic Acid. The latter is produced by a kind of fermenting process in tan- nin, so that gallic acid is made at the expense of tannic acid. These active principles are soluble in water, and answer all the purposes for which the oak can be used. Tannin may be given in the dose of five grams, while gallic acid is required in double this quantity. Rubus — Blackberry. The root of Rubus Canadensis, R. Villosus, R. Trivialis, and, perhaps, various other species of rubus. It is supposed that not 6 82 \< OLOGY less than twenty of these indigenous species have been discovered. The "blackberry" "dewfjerry" and "raspberry" are the familiar name- of those mentioned above, and constitute the most prominent species of the plant. The roots of all these have rough astrin- gent taste, and yield their virtues to water. A decoction, made by an ounce of the bruised root, to a pint and a hull' of water, boiled down to a pint, contains the activity of the remedy, and may be given in thecfo.se of three fluidov/nces. There is no very important difference in the medicinal proper- ties of these indigenous plants, so far as their astringency is con- cerned, and any special application made of a particular plant has been suggested by convenience, or other circumstances con- nected with the patient's comfort. Kino. The inspissated juice, from incisions made in the bark of Pterocarpits Marmpium, an inhabitant of Africa. Pterocarjrm Mar^njn u/» . Several varieties of kino are found in commerce, derived from different sources, the main features of which do not differ mate- rially from each other. ANT) THERAPEUTICS. 83 Kino is in small angular masses of dark brown color, bitter astringent taste, easily pulverized, and partially soluble in water. It is an efficient astringent, and may be given in substance in the dose of ten or fifteen grains. An Infusion is made by pouring a pint of hot water upon half an ounce of kino. Of this, one or two fluidounces may betaken. It has been highly recommended in menorrhagia, and for this purpose should be repeated every two or three hours, till an impression is made. As a styptic, for this purpose, it is, per- haps, inferior to other haemostatics. Tinctura Kino — Tincture of Kino- -is an officinal preparation and will be found a convenient and reliable astringent for bowel affections, in the dose of two fiutdraehms. Objection has been made to this and other tinctures on account of the alcohol they contain, but the doses above mentioned is not likely to prove injurious in this way. K rameei a — Eh atany. The root of Krarneria Triandria, a shrub found in South America. Rhatany is somewhat tonic and powerfully astringent. It is suited to the treatment of acute or chronic enteritis, relaxation, etc., manifested by diarrhceal discharges. The Infusion and Decoction are convenient preparations, but the quantity to be taken may sometimes interfere with its ad- ministration, particularly when irritation of the stomach exists* Of these, two or three fluidounces may be given for the astrin- gent effects of the remedy, and repeated according to circum- stances. Solid Extract and Tincture of Rhatany are less bulky and in- convenient. These can be readily given for any desirable length of time in the treatment of bowel affections, combined with solid or liquid preparations of other remedies; the former, in the dose of fifteen grains; the latter, two fluidrachms. Catechu. Extract from the wood of Acacia Catechu, a small tree found in both Indies, and for some time unknown, generally, as the 84 LCOLOG source of commercial catechu. Ii is perpared from a decoction of the wood, evaporating partly by artificial heat, and then by exposure to the air until of solid consistence. The choice of these vegetable astringents is merely a matter of preference from familiarity or habit in their use. There is, per- haps, no article amongst those we have mentioned which might not, with propriety, be substituted for any other; and yet this i.^ a favorite astringent with many practitioners. Catechu in sub- stance may be given in the dose of ten grains. The Tincture is in very common use, and will produce full as- tringent effects in the dose of two fluidrqehms. While, as above stated, there is no good reason for preferring this to other vege- table astringents, at the same time there is, perhaps, more exten- sive use made of it by some, than most other astringent remedies. 1 1 . E M ATO X YX.0 N — Log WOOt I The wood of Heematoasyfon ( hmpelf arornatics is desirable. Cinnamon may be advantageously used in this way to improve the taste and make more acceptable to the stomach unpleasant remedies, ex-en when do other object exists. The pulverized hark may be given in the dose of fifteen (/reins; and in this form makes a very agreeable and effective gastric stimulant, in spasm of the stomach, or nausea. The virtures of cinnamon reside in a volatile oil, which is ob- tained separately by distillation. Oleum Cinnamomi — Oil of Cinnamon — is an aromatic pungent fluid, and may be given alone in the form of emulsion, made with gum or sugar, or mixed with preparations of tonic, cathartic or other remedies. The pungency of the oil is such as to render its use impracticable without such preparation. Undiluted, it is, indeed, a powerful local irritant, and not only excites the mouth, tongue and stomach unpleasantly, but when applied to the sur- face, acts promptly upon the skin as a rubefacient. The dose is one or two drops, rubbed up with surgar and tem- porarily suspended in water. Tinctura Cinnamomi — Tincture of Cinnamon — sometimes called Essence of Cinnamon, is made from the coarsely pulverized bark, and may be conveniently used [done or with other fluid prepara- tions, in which an aromatic excitant is desirable. Nausea, not dependent on gastritis, flatulent or spasmodic colic, and other painful conditions of the stomach and bowels, may be greatly relieved by this tincture in the dose of about hvo Jiuidrachms. Zingi BE R — Ginger. The root or rhizoma of zingiber officinale, an annual plant, with perennial root, native of Hindostan, and cultivated in many of the tropical islands, particularly the West Indies. The root, which is dug as the stem commences to wither, is first scalded to prevent germination and consequent decay, and dried quickly. These processes of preparation form the black ginger, so called, from the dark color of the surface. White ginger, or Jamaica ginger is manufactured from the same variety of the AND TIICRAPKUTICS. 101 drug, but changed in color by having the epidermis removed, and then subjected also to a bleaching process with acids, etc. This improvement in the appearance of the root does not add at all to the strength, but, perhaps, lessens its activity. Ginger, when deprived of the epidermis, is yellowish-white, has an aro- matic, not disagreeable odor, and pungent, pleasant taste. Zingiber officinale. Ginger is a popular aromatic carminative, used extensively for its local exciting effects upon the alimentary canal, in the condi- tions above described, requiring remedies of the class. It may be given in substance alone, or mixed with solid preparations of other medicines, with which an association is desirable, in the dose of fifteen grains. The root of ginger is sometimes collected before maturity, and of it is made, while in this tender state, a conserve by boiling with syrup. The virtues reside in a volatile oil and resinous substance, which constitute about five per cent., by weight, of the dried root, 102 AC0L0G1 and, when Beparated, form one of the officinal preparations of srineer under tin* name of Oleoresina Zingiberis — Oleoresin of Ginger, This concen- trated preparation possesses, in a high degree, the odor and pun- gency of ginger, leaving* the residue almost tasteless, [t should be well diluted lor administration, in order to prevent excessive irritation; and in the dose of one drop will produce the full effects of ginger. Tinctura Zirigiberis — Tincture of Ginger — is a convenient form for administration separately, or with other liquids, in conditions which require the action of aromatics, and may be given in the dose of forty drops. It is used more extensively, however, in the preparation of" Syrupus Zingiberis — Syi^up of Ginger — which is a very agreea- ble and useful preparation for administration with cathartic and tonic remedies, and may be given in the dose of one or two fluidrachms. Extra etum Zingiberis Fluidum — Fluid Extract of Ginger — is a concentrated solution of the active principles of ginger in alcohol, and differs from the tincture in being evaporated to greater con- centration. It may be used for the ordinary effects of ginger, in the dose of thirty drops. Infusum Zingiberis — Infusion of Ginger — is an extemporaneous preparation, and, though officinal, is made only when required for immediate use. Half a troyounce of the bruised or coarsely pulverized root, to the pint of water, affords the proper strength, to be taken in the dose of about tiro fluid ounces. This, like other aromatics, whose active properties depend wholly, or in part, upon volatile oil, should not be subjected to the process of boiling, which will dissipate the active ingredient, and leave a comparatively inert preparation, CA RYOPH YLLUS — C/ores. The unexpanded flower-buds of Caryophyllm aroniaticus, a small, beautiful tree, native of India, and found in most of the West India islands. In the preparation of cloves, the buds are AND THERAPEUTICS. 103 plucked and quickly dried, sometimes after having been scalded in hot water. In shape, cloves resemble small nails, are of dark color, fragrant odor and permanent pungent aromatic taste. Cloves are sometimes pulverized, and in this form may be used in the dose of ten grain*. Thus prepared, they are easily mixed with other medicinal agents in the pulverized form, such as cathartics or tonics, and given in substance or infusion. The active principle resides in a vo- tile oil obtained by distillation, and called Oleum Garyopkylli — Oil of Cloves. This amounts to one-fifth, in weight, of the cloves from which it is obtained. When fresh, the oil is a colorless li- quid, but becomes brownish-red, and thicker by time and exposure. The taste is aromatic and acrid, inflaming the mouth when taken undiluted. In the dose of three or four drops, rubbed with sugar or gum, and suspended in water, the oil may be administered for its aromatic stimulating action upon the stomach and bowels, in cases of debility of these organs, causing flatulence, etc. The oil of cloves has been a popular remedy for toothache, and, like other local irritants, it has the effect of destroying the sen- sibility of the exposed nerve in carious teeth, when applied by means of a saturated pledget of lint in the cavity. Mentha Piperita — Peppermint. The w T hole herb of Mentha Piperita, an annual, indigenous plant, cultivated in various parts of this country, and used in the fresh state for its aromatic properties. The virtues of the plant are obtained from the stem, branches and leaves. An Infusion, made by pouring water upon the fresh or dried herb, is sometimes used in nausea and other slight disturbances in the dose of two fluidounces. CavyophyUus aromatic us. 104 A.C0L0G1 The aromatic virtues reside in a volatile oil culled Oleum Mentha Piperita — Oil of PeppermvrU — and fehis, orsome of its preparations, is the form in which peppermint is usually administered. The oil may be taken in the done of two drops, rubbed up with sugar or gum and suspended in water. A more convenient form is that of the following preparation of the oil : Tincture Olei Mentha Piperita — Tincture of fin OH qf Pepper- mint, or Essence of Peppermint, as it is sometimes called. Tin's is a preparation which mixes readily with water, and may he con- veniently administered in the dose of fifteen or twenty drops. This is a popular remedy in ordinary nausea, and, when it depends on a relaxed and enfeebled condition of the stomach without local excitement, is, doubtless, a useful remedy. Mentha Viridis — Spear Mint. The herb of Merit I \a Viridis, a native of Europe, but cultivated in this country; growing wild, also, in various portions of the United States, in rieh, shady situations. In its botanical char- acteristics, this differs somewhat from the peppermint, but in all essential particulars the drugs are similar. It is recognized simply as mint, and has, perhaps, less pungency than pepper- mint. The active ingredient, forms of preparation and use are about the same as the preceding article, and, perhaps, requires no further separate description. Calamus — Sweet Flag. The root or rhizoma of. Acorus Calamus, an indigenous plant, and found, also, in various parts of Europe. It grows in low, moist situations, near small streams; and should be collected late in autumn or early in Spring. By drying, the root diminishes much in size, but is said to exhibit more of the aromatic proper- ties than when fresh. The odor is fragrant, and the taste pun- gent and aromatic, but in less degree than those already men- tioned. The root contains an essential or volatile oil and resin, upon which its virtues depend. AND THERAPEUTICS. 105 An i) fusion, made with a pint of boiling water to a troyounce of the bruised root, may be used in the dose of two fluidounces. Calamus has the exciting influence of other aromatics upon the stomach and bowels, and is useful in painful conditions from flatulence and spasm of the alimentary canal. It is a popular remedy for the treatment of colic in young children, and may be readily and successfully given in the form of infusion, sweetened with sugar, to children of any age. Many other substances, not coming under the term aromatics, stimulate the stomach and excite temporary activity. Sinapis — Mustard — one of these, is used extensively as a con- diment for this purpose, and, also, to excite the appetite to the relish of nourishing food in sufficient quantity. Its local excite- ment upon the mucous surface of the stomach makes it a valu- able means with the therapeutist in arousing the organ to activity, when, from general torpor, its susceptibility to the influence of emetics is lost. Alcoholic drinks also have these effects. Brandy or whisky, taken before meals, increases the appetite, and in connection with or after the food, temporarily, promotes the function of digestion. This practice is, however, objectionable, on account of the liability to form a habit which often leads to moral and physical degre- dation. Cascakilla. The bark of Crotou Eleuteria, a shrub found in the Bahamas, aad native of the West Indies, whence the bark is obtained. This remedy is believed to possess a tonic action upon the di- gestive organs, in addition to the usual local effect of aromatics. The opinion once prevailed also that its tonic influence extended to the nervous system, as may be inferred from its having been substituted, in certain localities, for Peruvian bark, in the treat- ment of intermittent fever. It seems to be the settled opinion that some tonic effect is produced by it, yet without definite con- clusion as to the particular organ affected in this way. Infusum Cascarillw — Infusion of Cascarilla — may be prepared 106 ACOLOG1 alone, or with some gastric tonic, for its more speedy influence upon digestion; and given in the dost of about two fluidounoes. Lavandula — Lavender. The flowers of Lavandula vera, a small shrub, native of Eu- rope, and cultivated in this country. Lavender has, to some extent, the property of producing local excitement and warmth in the stomach and bowels, as other aromatics, but, being less active than many other articles of the class, is seldom used except as a deturgenl and vehicle for the administration of other remedies. Spiritus Lavandula — Spirit of Lavender — serves as a gentle gastric stimulant in painful spasmodic conditions of the stomach and bowels, but more particularly as a menstruum for elective remedies intended to affect the nervous system, in a manner to quiet painful spasmodic contractions. The seeds of Anise and Fennel, with their essential oils, are local excitants, and have the usual action of other aromatics. In a practical point of view, it would seem unnecessary to ex- tend the list of aromatics already given. Many other articles might be mentioned, whose carminative effects are undoubted, but with a short notice of those used more particularly for culi- nary purpose, the consideration of this class will be concluded. Condiments. Quite a number of aromatic local stimulants are used almost exclusively as condiments in the preparation of food. They not only improve the taste, so as to make it more palitable, but, by stimulating the stomach to increased activity, aid in digestion. Not only so, but when, taken freely they serve as apetisers, in- creasing the desire and relish for food. The propriety of their use in health is, therefore, questionable; for, if not embarrassing to the stomach when goaded into activity, may lead to unpleasant and even dangerous plethora. Pimenta — Pimento — Allspice. The unripe berries of Eugenia Pimento,, a moderately sized tree, native of the West Indies, and AND THERAPEUTICS. 107 other tropical countries. Pimento may be taken, as other aro- matics, to excite gastric and intestinal activity, in the dose of thirty grains, but is used more frequently in the preparation of food and drinks. Piper — Black Pepper — the berries of Piper nigrum, a peren- nial climbing plant, and a native of India. Fig - 7 ' Black pepper, like common salt, is used almost invariably as a condiment, but may be given as a local stimulant of the stomach and bowels in the close of fifteen grains. Piperin, a crystalizable ingredient of pepper, has been lauded as the active principle of the drug; but there is now Piper nigrum. no doubt that upon the oily constituent depends the local stimulation produced by the remedy. Myristica — Nutmeg — the kernel of Myristica fragans, a native of the Molucca islands, is rarely used medicinally. Nutmeg, and Mace, the inner covering of the fruit, are mild aromatics, and used extensively for culinary purposes and drinks. An elective tendency to the brain follows the absorption of the active principle, and serious disturbance of its functions has been reported as the result of excessive quantities of these substances. In the dose of ten or fifteen grains they will be found to produce decided gastric excitement. Oleum Myristicce, a volatile oil upon which the exciting property of nutmeg depends, may be more conveniently and profitably used as a gastric or other local stimulant. The close is about tiro drops, and may be given by rubbing with sugar so as temporarily to suspend it in water, as in the use of other oils. Aurantii Cortex — Orange Peel — rind of the fruit of Citrus Au- rantium, has the property of gently exciting the gastric surface, but is rarely used except as an aromatic stimulant to conceal the taste and prevent the nauseating tendency of less pleasant reme- dies. The virtues depend mainly on a volatile oil, and it is not, therefore, subject to preparation by the boiling point of heat. 108 ECOLOGY Vanilla. The prepared unripe capsules of Vanilla aromatioa, a climbing plant, native of the Wot [ndies, and other tropical regions. While vanilla possesses the local stimulating property in com- mon with other aromatics, and may be administered for the same purposes, it is more generally used to flavor ice cream, acidulated drinks, etc. It is supposed to possess also elective properties, by which the nervous system and, perhaps, the heart are excited to increased activity. Infusion is a form in which vanilla may be given. It is made with half a troyounce to the pint of boiling water. The do.se is half to a jiuidounce. Canella — the bark of Canella alba — a tree found in the West Indies, and, like other aromatics, may be used alone or with tonic and cathartic remedies, when local stimulation of the alimentary canal is desirable. This is sometimes necessary in order to pre- vent irregular painful contractions of the bowels during the operation of cathartics. It is used as a condiment by natives of the islands on which the tree is found. Goriandrum — Coriander — the fruit of Coriandrum sativum, a native of Europe. Coriander, though only moderately exciting to the stomach, may be used for this effect in the dose of thirty grabvi. Its chief use is in the preparation of food, to improve the flavor, etc. Cardamomwn — Cardamom — the fruit of Elettaria cardamo- rnwm; is extensively used in compound tonic and cathartic prepa- rations, and in culinary operations. Alone, as a gastric stimu- lant, for its carminative effects, cardamom is rarely used. AND THERAPEUTICS. 109 SUB-ORDER II. LOCAL ACTION THROUGH CHEMICAL PROCESS. DIVISION I. REMEDIES THAT AFFECT ADVENTITIOUS SUBSTANCES AND STRUCTURES. CLASS I ANTHELMINTICS This term — from avrc, against, and £//^vc, a worm — is, in- tended to express the aetion of medicinal agents that destroy parasites inhabiting the alimentary canal, called worms. The result is generally brought about by a local influence upon the animal itself, without regard to any impression the remedy may make upon the human subject. Anthelmintics, however, in- clude certain mechanical means which are said to destroy worms; and, also, the remedies by which their expulsion, while living, is effected. Moreover, even the digestive tonic, which corrects a depraved condition of the alimentary secretions, in which the entozoa is said to take its origin, is included in the extended sig- nification of the term which heads this article. Cathartics, which may remove worms from the canal, and thereby cause their destruction, cannot, of course, strictly speak- ing, be called anthelmintics, and treated of as such. Their effects or results in this particular are altogether accidental. The same may be said of tonics, whose action is exerted upon the canal and its secretions, and incidentally destroy the elements in which the parasitic germ is nurtured. Either by chemical or vital affinity certain agents act upon the vital organs of the parasite, or chemically change the life-sus- taining element, so as to paralyze or otherwise cause its destruc- tion. 110 &COLOI Anthelmintics thus acting upon the Living organism may justly be termed poisons to the entozoa, and the toxical Influence i- generally effected through chemical process. Worms which Inhabit the human Intestines arc of three principal species, viz.: tenia, lumbricoides and ascarides, with different varieties, partic- ularly of the former two species. All of these are said to be more or Less affected by the remedies known as anthelmintics; while, at the same time, it is conceded that certain articles arc better adapted to the destruction of particular species. Tenia — from valuta, a ribbon — are of two varieties, viz.: taenia solium, or long tapeworm, and tamia lata, which sometimes attain the immense length of a hundred feet or more. The tapeworm is made up of regular articulations, two lines thick, four wide, and from a fourth to half an inch in length; and it has been said that each is capable of maintaining independent existence. It is doubtless true, at any rate, that a number of articulations may be detached and discharged from the bowels, along with the caudal extremity, while the head and a portion of the body not only survive, but the latter actually increases in length by the reproduction of additional articulations. This worm inhabits alike the whole alimentary canal. The lumbrieoides — from lumbricus, the earth-worm, and eido:, likeness or form — found most frequently in children from one to six or eight years old, but sometimes in adults at any age. It attains the length of eight or ten inches, and inhabits the small intestines principally. The stomach and large bowel, however, are not exempt from its ravages. The ascarides — from aoicapi^a), to leap or kick — a very small, white, active worm, is not more than half an inch in length, and rarely found higher in the bowels than the rectum and lower part of the colon. The ta?nia and ascarides are found most fre- quently in adults. To determine symptoms by which the existence of worms may be known, is an important point connected with the consideration of this subject. There are many evidences of irritation in the alimentary canal, but unfortunately it is more difficult to ascer- tain its cause. Worms irritate the bowels and lead to certain AND THERAPEUTICS. Ill symptoms; undigested food and other irritating matters passing along the canal have the same effects. Those generally mentioned as indicative of worms, are: in children, tumid abdomen, irregu- lar appetite — sometimes voracious, at others delicate — disturbed sleep, picking the nose, grinding of the teeth, and convulsions; all of which may arise from intestinal irritation dependent on other causes than that of worms. The tapeworm and lumbri- coides produce somewhat similar symptoms in subjects of the same age, and those just given may be produced by either species. The ascarides, confined as they are to the lower bowels, rarely lead to other symptoms than the titillation and itching sensation felt in the rectum and anus. The observance of certain rules connected with the administra- tion of anthelmintics is considered important to their successful use. The addition of saccharine substances to all anthelmintic preparations is supposed to insure their being seized by the worms; and hence solids are given in the form of electuary, and infusions, decoctions, etc., well sweetened with sugar or syrup. A thorough purgative cathartic should follow the use of the worm poison, in order to rid the canal of putrid remains. This course is urged also under a belief that the worm often revives, after being stupefied by the remedy, if not carried out of the bowels while in this state. Catalogue of Anthelmintics. Spigelia, Bray era, Chenopodium, Rottlera, Azedarach, Hydrargyrum, Granati Radicis Cortex, Filix Mas, Pepo, Santonica. Spigelia — Pinkroot. The root of Spigelia Marilandica, an indigenous herbaceous plant with perennial root, found abundantly in Southern portions of the United States. Numerous fibrous roots are attached to a 112 ICOLOGY Pig. B. oommoD caudex, from which arise several stem- to the height of one or i wo feet. The flowers, which somewhat resemble the pink, give name to the plant. Pink root is an efficient and sale anthelmintic for the treat- ment of lumbricoides in chil- dren ; the taste not being such as to interfere particularly in its administration, nor the pois- onous effects upon the child, attributed to it, at all to he feared. A small yellow root, not so large as the spigelia, is sometimes gathered with the drug, and is believed to be the source of all unpleasant effect- ever witnessed in the use of pinkroot. Tt may be given in substance by mixing the pul- verized root with syrup, in the dose of sixty grains to an adult, and to children in doses pro- portionate to the age. Tafi is 1 1 m Sp igelke — // \ fi c s io 1 1 of Spigelia — made by pouring a pint of boiling water on half a troyounce of the root, is a common extemporaneous prep- aration. A pint may be taken during the day, followed by- castor oil, or some other purga- tive, to discharge the worms while under the poisonous in- fluence of the anthelmintic. Extractor SpigeMa FluMum--Fhrid Extract ! of Spigelia— when properly prepared, contains all the activity of the drug, in much smaller bulk than the infusion. This is sometimes an important Sj/ir/etia. AiND THERAPEUTICS. 113 consideration, owing to the difficulty found in administering a sufficient quantity of more bulky preparations. The dose is half a fluidounce every three or four hours, till two fluidounces have been taken, and followed as usual by some purgative. Chenopodium — Wormseed. The seed of Chenopodium Anthelmintic win, a common herba- ceous, indigenous plant with perennial root, found abundantly in most parts of the United States, and familiarly known as "Jerusalem Oak." The whole plant is said to possess anthel- mintic properties. The seeds only, however, are officinal, and afford one of our most popular indigenous remedies for the round worm in children. The pulverized seeds may be given, mixed with syrup, in the dose of sixty grains, and repeated once or twice during the day. Oleum Chenopodii — Oil of Chenopodium — a volatile oil, ob- tained from the seeds by distillation, contains their vermifuge property, and may be readily given in the form of emulsion, made by rubbing the oil with sugar and adding a little water. The dose is about half a fluidrachm, repeated as recommended for other articles of the kind. AZEDAEACH. The bark of the root of Melia Azedarach or China tree, a native of India, and cultivated as an ornament and shade in the southern portion of this and other countries exempt from severe frosts. Azedarach is highly esteemed as a domestic remedy in the treatment of worms; but its narcotic effects as a poison in over-doses deter many from its liberal use. A decoction — the form in which it is usually given — is made by boiling three or four troyounces of the bark from the root in a quart of water down to a pint. Of this, two or three fluidounces may be taken three times a day. Granati Kadicis Cortex — Bark of Pomegranate Root. The bark of the root of Punica Granatum P a small tree, native 8 114 ECOLOGY of China and the West-Indies, and cultivated in this country for its fruit ami the beauty of its flowers. The pomegranate is more celebrated as a remedy for tape- worm, though perhaps equally useful iu the treatment of other species. Not liable to produce alarming poisonous effects, and the fresh bark being generally readily obtained, it is surprising that more general use is not made of it, particularly since the vermifuge property is undoubted. A decoction, made by boiling two troy ounces of the bark in a quart of water down to a pint, is the form of preparation pre- ferred; and is given in the dose of four fluidounees, repeated three or four times a day, and followed by a purgative cathartic. Pepo — Pumpkin seed. The seed of Oacurbita pepo, or common pumpkin. The kernel of pumpkin seeds contains a fixed oil, upon which their active properties doubtless depend. They have gained some celebrity in the treatment of tapeworm, and may, probably, be used with equal benefit also for other species of worms. Being pleasant to the taste, they may be eaten without inconvenience when deprived of the outer covering or shell, and in this way patients mav be induced to take sufficient quantity to produce the anthelmintic effect of the seed. The pulp is sometimes rubbed up with sugar and water in the form of an emulsion, and taken in the done of tiro troyoimces, while fasting, and followed by castor oil or other purgative. Oleum Pepo — Oil of Py/mpJdn seed — is obtained by expression and, as has been said, probably contains all the anthelmintic virtues of the pulp. It has been used successfully in the treat- ment of taenia, in the dose of half a ffuidouncc, repeated in a few hours, and followed by a thorough purgative. Brayera — Koosso. The flowers and unripe fruit of Brayera anthelmintica, a small tree, native of Abyssinia, and growing on elevated situations where the flowers are gathered, dried and packed for shipment. They AND THERAPEUTICS. 115 are pulverized and neatly bottled in France and other countries; and from Paris most of our supply is obtained. Koosso has a fragrant odor, and somewhat acrid, unpleasant taste. Fig. 9. Br ay era anthelmintica, Kunth. A. Flowering Branch. B. Bunch of Female Flowers. C. Flowers seen laterally D Fe- male Flowers ; a, b, c, d, e, the five outer segments of the calyx. Various attempts have been made to obtain the active princi- ple upon which its anthelmintic virtue depends, but without satisfactory results ; nor has the profession fixed upon any form of preparation for convenience of administration. It is cele- brated for its poisonous effects upon both varieties of tamia, and 116 ICOLOGY although, until recently, very little used in this country, has !>een known ;i> a valuable remedy in tapeworm for more than the fourth of a century. The test- to which it has been sub- jected in this country for the lasl ten years, rally confirm the statements of Europeans, niosl enthusiastic in its praise. As no convenient preparation is afforded by pharmacopoeias, the powder is used in the form of simple mixture with water. Eight flu id ounces of hot water may he poured on half uu<-< of koosso, to form the usual extemporaneous preparation. After standing fifteen minutes, portions should he sweetened and swal- lowed at short intervals until all is taken, stirring well before each draught. -The effect upon the patient is sometime^ very unpleasant. Nausea and vomiting, with free catharsis, often fol- low its administration, and this effect upon the bowels, when produced, obviates the necessity of using purgative medicine to discharge the worm. ll( )TTLERA — Kameela. The fine granular powder obtained from the fruit capsule of Rotthra tindoria, a small tree, native of Hindostan and the East India Islands. The powder is collected by gently brushing the capsules, to which it adheres, and is of a reddish-brown color, without odor or taste. It is sold in commerce as a dye, and has attracted considerable attention on account of its anthelmintic virtues, reported by British Army Surgeons in India. Being an active cathartic and nauseant, in addition to its an- thelmintic property, like koosso, it may answer the 1 purpose of removing the worm after destruction by the poison. The use of kameela seems to have been confined, principally, to the treatment of tapeworm, and has long been known in India as a remedy for this parasite. Observations of its effects by practitioners in Great Britain, seem to have confirmed the testi- mony of army surgeons in regard to its value as a remedy, equal at least to koosso. \t may be given in the dose of about eighty grains, mixed with water or syrup. This quantity is considered sufficient to destroy the worm, and should be given in one portion. AND THERAPEUTICS. 117 A (metwre is proposed, made by macerating six troyounces of the powder in a pint of diluted alcohol. This is said to be more certain as a vermifuge and less unpleasant in its effects upon the patient. Hydra rg y r um — Mercury. Mercury, the subject of notices under the heads of Cathartics, Hepatico-salivary stimulants, and Catalytics, is also a valuable anthelmintic. It is poisonous to other parasites than those which inhabit the alimentary canal ; and may be truly called an anti- parasitic. So far as tested, it proves poisonous to every kind of vermin, insect and worm infesting the human body. Vermin which prey upon the surface; the acarus, sarcoptes hominis, Fig. 10. Sarcoptes Hominis.— (Ra*pail.) or itch mite, which burrows in the skin ; and the several species of worms which inhabit the bowels, are alike destroyed by this remedy. Reasoning from analogy, the trichina may be also subject to this poison, could it be made to reach its location in sufficient quantity. Authors have expressed the opinion that the destructive action of certain preparations of mercury upon entozoa is due more to other ingredients which enter into the preparation than to the mercury itself. To the lard, for instance, of mecurial ointment, US ICOLOGl has been attributed its destructive effect upon vermin and the itch insect. The theory of* [t8 action was predicated upon the reputed fad that oily substances destroy certain insects and worms, by occluding the respiratory tubules opening on the sur- face, through which the animal receives oxygen. If no other than oily preparations of mercury proved effectual, as an anti- parasitic, the theory would appear more plausible. Such, how- ever, is not the ease. All the preparations, so far as tested, pos- sess this property, and have been used successfully for the de- struction of all the parasites above mentioned. Hydrargyri Chloridum Mite — Mild Chloride of Mercury — Cal- omel — is valuable as a vermifuge, not only on account of its poisonous effects upon the worm, but also from its cathartic ac- tion, and its supposed sedative influence over nervous irrita- bility. Alarming nervous symptoms are sometimes produced in children, leading to convulsions, by reflex action from the irritation of worms in the alimentary canal; and sedative doses of calomel, it is thought, not only put a quietus to the irritating cause, but also allay nervous susceptibility, by a sedative influ- ence on the brain. It is, therefore, selected as a vermifuge under such circumstances, and used in large doses. For this purpose, from twenty to thirty grains should be given in syrup or sugar and a fluidounce of castor oil in a few hours thereafter, should the bowels not be thoroughly evacuated by the calomel. Ungaentum Hydrargyri — Mercurial Ointment — may be used successfully for the destruction of internal and external parasites. The several varieties of lice and itch insect are readily destroyed by a few applications of this ointment, to parts of the body in- fested by them. Though not usually given internally for any purpose, it has been known to have very happy effect in destroy- ing the round worms when thus administered. An account is given of sixty or eighty grains having been taken through mis- take, and followed by the discharge of a large quantity of worms from the bowels. Hydrargyri Chloridum Corrosiruin — Corrosive Chloride of Mer- cury — Corrosive Sublimate. This preparation is not suited to internal use as a vermifuge, on account of its irritating proper- AND THERAPEUTICS. 119 tics. Injury may be done the mucous membrane of the bowels by it, equal to that produced by the worm. Applied to the sur- face, however, it proves an efficient remedy in scabies, and, although not generally used for the destruction of lice, will probably answer well for this purpose. Two or three daily ap- plications of a solution, in the proportion of two grains to the fluidounce of water, to parts affected with acarus, or itch insect, are generally successful in their destruction. Filix Mas — Male Fern. The rhizoma of Aspidium Filix Mas, an annual plant, with perennial root, native of Europe and America. It consists of several leaves or fronds, rising to the height of a foot or more, Aspidium filix mas.— Fresh rhizome entire. a. Spirally-coiled young frond, bhb. Foot-stalks of the older fronds, c c. Root-fibres. and a caudex with the remains of former leaf-stalks. This con- stitutes the drug in question, and comes to us in fragments of the scathe along with the root. L20 ACOLOG* Fern has long been considered a valuable remedy in tapeworm, and extensive use of it for this purpose, in Europe, furnishes ample testimony of its value as an anthelmintic. Other and more recently discovered remedies for this formidable worm have almost superseded it, however, in this country; more, perhaps, from the enchantment of novelty than otherwise. The powder may be given in the dose of one hundred and twenty grams, in the form of electuary. Extr actum FilicLs Liquidum — Liquid Extract or Oleoresin of Fern — is the only officinal preparation in this country, and may be given in the dose of about forty drops. x Santonica — Levant Worrnseed. The unexpanded flowers of Artemisia Cina. The name would seem to imply that the seeds, instead of the flowers, constitute the drug in question, but it is found composed of the radicles and unexpanded dried flowers of the plant. The dose in sub- stance is thirty grains, in the form of electuary. It may be given also in the form of non-officinal Infusion. Santoninum — Santonin — the active principle of the flowers, is in colorless, inodorous and nearly tasteless crystals, soluble in chloroform, sparingly so in alcohol and ether, but insoluble in cold water. The physiological action on the human organism is not posi- tively ascertained, but, from certain symptoms known to follow its use, such as derangement of vision as to colors, and narcot- ism, it is supposed to act powerfully on the brain in large doses. As an anthelmintic, santonin is supposed to possess all the vir- tues of santonica, and is considered one of the most valuable articles of the class. Its insolubility prevents ready absorption, and allows its passage along the canal, where it comes in contact with the worm and poisons it. It is used only as an anthel- mintic, and the dose is about fire grains, with syrup or sugar, and proportionately less for children. Santonin is a popular remedy with German families of this city, and is now considered one of the most reliable anthelmin- tics, by many of our American as well as German physicians. It is used more particularly for lumbricoides in children. AND THERAPEUTICS. 121 CLASS II. ESCHAROTICS. Articles of this class, as the name implies, are intended to produce complete destruction of the parts to which they are ap- plied — the sound as well as unsound tissue. Their use as a means of counter-irritation, however, though formerly practiced, is now measurably discarded. Issues made by setons, blisters, and the like, being considered preferable to the moxa, caustic, etc., are generally selected for this purpose. Escharotics — from sayapoco, to scab over — are more particu- larly useful in the destruction of fungous granulations on ill- conditioned ulcers and unhealthy wounds; and also the eradica- tion of cancerous tumors, and various other adventitious growths. Catalogue of Escharotics. Potassa, Cauterium Actuale, Acida Minerales. Potassa — Caustic Potassa. This caustic alkali is, chemically, a hydrate of the protoxide of potassium, dry potassa being simply a protoxide of this metal. It is found in solid sticks of grayish color, deliquescent, dis- solving in less than its weight of water, and very caustic. In order to its preservation in the solid form, it is necessary that it be kept in well-stopped bottles. Caustic potash is a powerful escharotic, rapidly destroying the vitality of even healthy structures, when placed in contact with them ; and has been used as a counter-irritant in the formation of issues by the destruction of sound tissue. Fungous granulations and other unnatural growths may be destroyed effectually by the application of the solid caustic. Care, however, is necessary in order to protect contiguous sound parts from its action, as it readily dissolves by contact with moist tissue, and runs along the surface to neighboring parts. After 122 ACOLOGl touching the structures t<> be destroyed, therefore, the part should be washed, or wel with vinegar to neutralize the caustic Cauterium Actualb — Actual Cautery. Heat applied in any way may be termed actual cautery, but it is only when in a degree sufficient to cause death of the part, at once, that it comes properly under this title. Hot metals, or substances in a state of combustion, destroy Living tissues, and are, therefore, escharotics. Iron at a red heat causes death of a part instantly, with less pain than when applied at a lower temperature; and although great dread of its application is en- tertained, the actual cautery is less objectionable than any caustic or mineral acid, for the destruction of unhealthy tissues. The effect is prompt, decisive, and the action limited to the point of application. Hemorrhage, which may result from the use of the knife or other escharotics, need not be feared from it. The fact is known, also, that hot iron gives less suffering than other articles of the class ; and, as it may be used without affecting contiguous sound parts, seems to have advantages over other escharotics. The tough fibrous, insensible structure so trouble- some in hospital gangrene, may be effectually removed without injury to the surrounding sound tissue, liable to occur from the application of fluid escharotics. The aversion, however, on the part of patient and friends, to so formidable a remedy, often in- terferes with its use. Acida Mixerales — Mineral Acids. Concentrated mineral acids are powerful escharotics, destroy- ing organized structures promptly and perfectly. They arc used in chronic and phagedenic ulcers, gangrene, etc., to remove the unhealthy and irritating mass found in them. Hemorrhoidal tumors and unnatural growths may also be destroyed in this way. Acvdum Nitricum — Nitric Acid — is generally preferred, and almost exclusively used for the immediate destruction of soft tissues. It is applied by means of saturated lint placed in con- AND THERAPEUTICS. 123 tact with the part to be acted on. Care is, however, necessary in order that injury be not done to neighboring sound structures. Acidum Arsenicum — Arsenic Acid — included under the above head, is an escharotie of considerable power. Unlike that of the mineral acid above named, its eifects are produced slowly, causing pain, swelling, and other inflammatory symptoms. For its destructive action upon tumors of every variety, falling into the hands of certain charlatans, this substance is used, and forms the basis of most secret cancer remedies. In its action for this purpose, though effective in the destruction of tumors when introduced into them, it is more tedious and painful, and less certain than extirpation by the surgeon's knife. Acidum Chromicum — Chromic Acid — chemically the teroxide of chromium, is in the form of red, deliquescent crystals of metal ic taste and soluble in water. Chromic acid is a powerful escharotie, penetrating deeply but slowly, without producing much pain. It is used in the form of solution in the strength of about eighty grains to the fluidounce of distilled water, for the destruc- tion of organized tissues in the form of morbid growths, phage- denic ulcers, gangrene, etc. CLASS III. ANTISEPTICS. Substances which prevent decomposition or putrescence are called antiseptics — from avzc, against, and a/jmo, to putrefy. There are many articles said to have this effect; some of which are used, not so much to prevent putrefaction, as to destroy the unpleasant odor and supposed contaminating influence of exha- lations from the bodies and excrements of those affected with malignant disease. These are used extensively as disinfectants in hospitals, water closets, sewers, etc. It is supposed that cholera, typhoid fever, and other epidemic infectious diseases, are restricted in their ravages by the proper use of this, with other sanitary means. A tendency to putrescence in the blood is, by some, supposed to exist in certain forms of adynamic fever, and antiseptic remedies, m 4C0L0G1 therefore, required in their treatment. The correctness of this theory, however, we are not prepared to admit. It i^ a fad no- ticed by the most casual observers, that patients Buffering from any malignant disease, with great nervous prostration, emit through all the emnnetories — the skin, bowels, Lungs and kidneys — odors more or less fetid. In such eases the breath, perspiration, al vine evacuations, and sometimes the urine exhibit this peculiarity. Dark fur upon the tongue, and sordes around the teeth and gums are but the deposit of putrid pulmonary transpiration. Under such circumstances antiseptics would seem to be called for, and doubtless will, in a great degree, change the character of these discharges; but all such facts do not, by any means, prove that a morbid condition of the blood itself is the origin of such dis- eases. Putrescence is the result of decay or decomposition of organized auimal structures, and when it commences in a part, whether from a want of nervous or sanguineous support, absorp- tion of fetid gaseous principles, extricated by this process, also commences. The blood, though healthy, receives these impuri- ties by absorption, and depuration occurs through the emuncto- ries. Hence the odor of discharged fluids in diseases destroying the vitality of certain structures. Malignant scarlatina is a striking example of this kind of disease. From destructive in- flammation of the tonsils and other parts, putrifaction results; the blood becoming loaded with decomposed tissues, and the ex- halations fetid, from the depuration of this offensive material. The same symptoms, in these respects, occur after serious injuries from which gangrene or putrifaction results. Black tongue, sordes and putrid odor of exhaled fluids, are not uncommon in extensive gangrene from this cause. Adynamic fevers, in which vital or nervous po\ver is deficient, probably leads to decomposi- tion of certain structures and the evidences of putrescence pro- duced thereby, instead of having primary origin in the blood. In typhoid fever perhaps lesions always exist, when the above symptoms of putrescence ensue — lesions which originate not iu a morbid agent in the blood, but in a want of energy in the nerves of organic life, by which the decomposition of solid tissues occurs. From what has been said, it cannot be inferred that any deci- AND THERAPEUTICS. 125 dedly curative effect need be expected from antiseptic remedies. By their use, however, structures may be afforded greater power to resist the putrefactive process, and thereby more time given for the restoration of vitality in the part. Catalogue of Antiseptics. Creasotum, Chlorine, Acidum Carbolicum, Carbo Ligni, Calx. Creasotum — Creosote. Creasote — from tcpea<;, flesh, and crco^co, to save or preserve — is of vegetable origin, being obtained from wood-tar, and is entitled to a prominent position in the class of antiseptics. The name ? literally implies to save flesh, but the remedy may, from its pun- gency and penetrating odor, only prevent any impression upon the organs of taste and smell, by less exciting substances. In this way putrid gasses may be rendered inoffensive, without being neutralized by chemical combination. The power to prevent decomposition, however, is unquestion- able. It is nothing more nor less than the action of vegetable creasote that is sought in the practice of smoking meats for their more perfect preservation, after having undergone the salting process. Creasote being a powerful local irritant to the alimentary mu- cous membrane, has been considered a dangerons remedy used internally in quantity above the ordinary dose of one or two drops ; but in hospital practice during the late war, it was ascer- tained that in the dose of thirty and even forty to fifty drops, the remedy was not only tolerated, but proved salutary in protracted cases of enteritis. Much of its good effect in this condition is doubtless due to local action upon the relaxed and inactive state of the mucous surface, but w 7 e must not loose sight of the fact that in low forms of protracted disease septaemia is likely to occur, requiring antiseptic means carried into the circulation. The or- dinary dose is two to five drops rubbed up with gum or sugar and suspended in water. 126 ACOLOGV Acidi'm Carbolicum — Carbolic Acid. This substance, already mentioned as a prominent catheretic is obtained by distillation from coal-tar, and is possessed of deci- dedly antiseptic and disinfectant properties. The present system of embalming dead bodies by the injection of antiseptics into the arteries may he carried out with perfect success with this article. ( hie troyounce of the acid to half a gallon of water, injected so as to fill the arteries, and repeated in twelve hours, will effectually prevent decomposition. A body treated in this way may be preserved for any number of years, and if kept immersed in liquid, without perceptible shrinking or loss of bulk. If exposed to the air it becomes hard and firm from des- iccation, but without putrefaction or loss of tissue. Doubtless much of its effects in ulceration, attributed to cather- etic action, is due to antiseptic power, in preventing decomposi- tion of fibrin and formation of pus. In the dose of two grains three or four times a day, the fluids of the body become suffi- ciently impregnated with the remedy, for its general antiseptic effect. Calx — Idme, ' This alkali, treated of under the head of antacid catalytics, is also antiseptic, and used extensively as a disinfectant in privies, sewers, and other filthy locations from which noxious and un- pleasant gasses emanate. Calx Chlorinata — Chlorinated Lime — called also Chloride of Lime — is a combination of the two valuable antiseptics, lime and chlorine. This is in the form of a moist grayish mass, and is celebrated for its bleaching and disinfecting properties. Chlorine. This elementary gaseous fluid, whether dissolved in water, in the form of chlorinated water, united with hydrogen in the form of muriatic acid, or combined with metalic and alkaline bases in the form of chlorides, is a universally acknowledged and highly prized antiseptic. AND THERAPEUTICS. 127 Aqua CMormii — Chlorine Wafer — is made by the solution of chlorine gas in water, and may be used internally in the dose of two or three fluidrachms. It may be applied locally as an anti- septic or disinfectant, to cancers and other foul ulcers, and as a gargle in malignant sore throat. Acidam Muriaticnm — Muriatic Acid — in the dose of three or four drops, well diluted, may be used internally as an antiseptic, but is generally given in the following combination with iron : Tlnctura Ferri Chloridi — Tincture of Chloride of Iron. It may be applied to putrid ulcers, gangrene, etc., in full strength, and, internally in the dose of twenty drops diluted with water, for its antiseptic effects on putrescence in the alimentary canal. Sodii Chloridum — Chloride of Sodium — common salt, though universally selected in domestic use, and by packers for the pre- servation of meats, is rarely given as an antiseptic in medicine, but its disinfecting property is made available in the liberation of chlorine by decomposition with sulphuric acid. In this way it is used in sick rooms for the purpose of destroying unpleasant odors emanating from the subjects of malignant disease. Liquor Sodas Chlorinates — Solution of Chlorinated Soda. This solution is a popular antiseptic, as a local application for various unhealthy and offensive wounds, ulcers, etc., and as a disinfectant to destroy putrid and unpleasant vapors of the sick room. It is used for these purposes, ordinarily, in the full strength of the preparation. Zinci Chloridum — Chloride of Zinc — is useful as a catheretic and antiseptic in its local application to ulcers and chronic in- flammation, in the strength of five grains to the fluidounce of water. For the preservation of dead bodies, in the manner above de- scribed, in the use of carbolic acid, chloride of zinc is successfully introduced, in the proportion of sixty grains to the pint of water. Carbo Ligni — Chctrcoal. Charred wood, by its absorbent property, is rendered valuable as a disinfectant for external application. Poultices, composed in part of charcoal, applied to gangrenous parts, and foul ulcers, 128 LCOLOGl destroy their fetid odor by the absorption of offensive gases emanating from deseomposed tissue-. Putrid liquids may also be purified by filtering through charcoal, which retains the septic principles and unpleasant gases contained in them, and allows the clear liquid to pass into the vessel below. Various other substances possess antiseptic property, but these constitute the most prominent articles of the class. AND THERAPEUTICS. 129 SUB-ORDER III. LOCAL ACTION THROUGH MECHANICAL PROCESS. DIVISION I. REMEDIES THAT AFFECT THE INTERNAL AND EXTERNAL SURFACES. CLASS I. DEMULCENTS This is an important class of remedies, and yet they produce no chemical or vital action whatever. Demulcents — from demulceo, to soothe — are bland, unirritating substances, and used for their mechanical influence in protecting denuded and inflamed surfaces — externally and internally — from contact with irritating causes. The skin, when deprived of its cuticle, is liable to excessive irritation from exposure to the atmosphere, and by being covered with demulcent substances an artificial cuticle is formed, which temporarily protects it from injury. The same may be said of an irritable or inflamed mucous surface ; and though the applica- tion cannot be made so satisfactorily, as to the skin, yet the class affords our best means of relief in such condition of the alimen- tary mucous membrane. The treatment of gastritis and enteritis should be commenced and terminated with the liberal use of demulcent drinks. They are used not only in disease of the mucous membrane lining the alimentary canal, and the denuded surfaces externally, but also of those to which they cannot be directly applied, as that of the bronchia and urinary organs. Hence, in nephritis and bronchitis, demulcents are administered by the stomach, and it is thought with decided advantage. It is not reasonable to suppose, how- 9 130 LCOLOGI ever,tha1 any very decided influence can be exercised in this way after the demulcent has been absorbed into the circulation. Pro- bably all the benefit is derived from the diluent with which it is given. A plausible explanation of its effects upon the respiratory tube is, that the remedy coming in contact with the mucous mem- brane of the mouth and throat impresses it, and from sympathy of continuity the membrane in the larynx, trachea, etc., is also soothed. Whether to this extent such influence be exercised or not, it is quite certain that demulcent substances held in the mouth, and suffered constantly to pass into the throat, do allay the tickling ssensation and cough, from irritation of the larynx. While the mechanical effects upon the kidneys, from their inter- nal use, is doubtful, the fact cannot be denied that large draughts of demulcent infusions tend greatly to allay irritation in the urinary passages. This may depend, as above suggested, upon repletion of the blood vessels, causing an increased amount, and consequent dilution of the urine, which lessens its acrimony and tendeney to irritate the mucous membrane in its passage from the kidneys. Catalogue of demulcents. Acacia, Amylum, Linum, Glycerina, Ulmus, Althaea, Chondrus, Symphytum, Cetraria, Oleum Olivse, Sesamum, Bismuthi Subnitras, Sassafras Medulla. Acacia — Gum Arabic. The concrete exudation from the branches of Acacia Vera, and several other species of acacia. Most of these species are trees of medium size, and inhabit various parts of Africa. The juice exudes spontaneously from the branches, and concretes upon their surface. Incisions, however, which are sometimes made, facili- tate its discharge. There are several varieties of gum in com- AND THERAPEUTICS. 131 riaerce, taking' their names principally from the place of exporta- tion. They do not differ in any essential particular, and all, or nearly so, furnish the gum of commerce. Gum arabic, as received by Druggists in this country, is in small, irregular shaped masses or fragments, differing in shades of color, from nearly white to brown, without decided odor or taste, and is soluble in water, forming a viscid mucilaginous fluid. The pulverized gum is white, and when exposed to the atmos- phere, for some time, absorbs moisture, and on drying becomes hard. In order, therefore, to preserve it in the form of powder for any length of time, it must be excluded from the air. Mucilago Acacice — Mucilage of Gum Arabic — according to the United States Pharmacopoeia, makes a solution too thick for a demulcent drink, but having the gum dissolved in this strength, one fluidounce is sufficient for half a pint of water, or other liquid with which it is desirable to administer the mucilage. A drink for ordinary demulcent purposes may be made by stirring till dissolved, sixty grains of pulverized gum in half a pint of water. With this may be mixed any anodyne or astringent ne- cessary to the treatment of dysentery, gastritis, etc., and the mixture can be used by the rectum or stomach as may be neces- sary. It is a valuable vehicle for the application of catheretic and astringent remedies to local diseases generally. The fact must, however, be borne in mind that, subacetate of lead and alcohol precipitate the gum from its solution, and borax coagu- lates it. They are, therefore, incompatible. Dilute acacia mu- cilage, or gum water, cooled with ice, is an agreeable and useful drink in gastritis, or inflammation of any portion of the mucous membrane lining the alimentary canal. If rejected immediately, it should be repeated until the excitement of the stomach is allayed. In acute enteritis, the drink should consist almost ex- clusively of this or some other demulcent. Linum — Flaxseed. The seed of Linum usitatissimum, or common flax, an annual plant, native of Egypt, and cultivated in this and most other 132 ACMl.Ml.Y countries. These well known seeds are of a glossy brown ap- pearance, covered with gummy substance, soluble in water, and upon which their demulcent property depends. Flaxseed can be \i><-d profitably in the various diseases for the treatment of which demulcents are servicable, but in nephritic and bronchial inflammation this particular agent is considered most appropriate. When obtained free from litter, the mucilage is soothing, and protects denuded surfaces from contact with the atmosphere, and other irritating causes. An Infusion of Flaxseed may be made by pouring a pint of hot water on half a troyounce of the seed. After macerating an hour, stir and strain. This, though not officinal in the United States, is the preparation in general use as a demulcent. In nephritis, cystitis and urethral inflammation, large draughts of this infusion moderate the irritation of the mucous membrane, perhaps by diluting the urine, more than from demulcent protec. tion. Kenal sedatives given under such circumstances are generally administered in this infusion. It is thought that in bronchial inflammation, also, the remedy, taken in small quantity, fre- quently, is decidedly beneficial in relieving the irritability of the respiratory mucous membrane, perhaps by sympathy of continuity. Infusum Lini Compositum — Compound Infusion of Flaxseed — is an officinal preparation of flaxseed and Liquorice root, in which is afforded one of the most useful demulcent drinks in an irritable or inflamed condition of the alimentary mucous mem- brane. Ulmus — Slippery Elm Bark. The inner bark of Ulmus Fulva or Slippery Elm, an indig- enous tree, growing in swamps and other low situations in most of the Southern States. Slippery Elm imparts to water its mucilage, forming an agreeable and useful demulcent drink in all manner of bowel affections, connected with the mucous surface, and may be used, ad libitum,, in enteritis as manifested by dysenteric or diarrhoeal symptoms, either alone or as a vehicle for the administration of other fluid remedies, by the mouth or rectum. AND THERAPEUTICS. 133 The Infusion or mucilage may be made by adding a troyounce of the bruised bark to a pint of water. The constant use of this infusion not only soothes and protects the mucous surface of the bowels from injurious contact with fiecal and other matters, but aifords a species of nourishment, from which support to the sys- tem may be derived for a time, it is said, without other food. Hence the importance of this drink, in liberal quantity, during the progress of bowel affections, when ordinary food cannot be properly digested, and by passing along the canal, in this state, leads to aggravation of the disease. Infusion . of elm may be used as collyria, containing such other ingredients as may be re- quired, except acetate and subacetate of lead, which are incom- patible, causing the mucilage to precipitate from its solution. Chondrus — Irish M< OSS. The lichen, chondrus crispus, found on the coast of Ireland, and also of the United States, bordering on New England, is collected from rocks, or the beach, where it is drifted during v=na stormy weather, and dried in the sun. This lichen, called also carrageen, is demulcent and nutritious. Carra- geenin has been proposed as the name for the demulcent ingredient, which differs in some respects from gum. Fig. 12. Chondrus malillostis. Portion of the channelled frond hear- ing the pedicellate capsule*. Cetraria — Iceland Moss. The entire Lichen of Cetraria Islandica, found in this country and various parts of the world, in northern latitudes. To the mucilaginous aud nutritious principle it contains, the name IAchenin has been given. These Lichens are adapted to the treatment of low forms of disease, in w T hich the bowels are the principal point of disturb- ance. Epidemic dysentery, diarrhoea and typhoid fever, gen- erally require demulcent fluid diet, which affords the greatest 1:5 1 ICOLOGl amount of nourishment, without leaving irritating faecal matter. These articles, it Is believed, afford considerable nourishment, in the mucilage prepared from them. A decoction of either of these lichens may be made by boiling half a troyounce of the moss in ;i pint and a half of wa- ter or milk, down to a pint. When the milk is used for the decoction, no other nourishment is necessary in prostration from bowel affections. The amount to be taken must, of course, he determined by the capability of the stomach to retain and digest it. Sesamum — Benne. Cetraria islandica. The apotJiecia on the- larger lobes of the thallus. The leaves of Sesamum Tndicum, an annual plant, four or five feet high, na- tive of the West Indies, and cultivated in Asia, Africa and the United States. The leaves contain a gummy substance, which they communicate to water, forming a viscid infusion and valuable demulcent drink. • Three or four fresh leaves from the plant, stirred in a pint of cold water, afford the proper strength of infusion, which may be taken ad libitum, in bowel affections, as an ordinary drink, to assuage thirst and dilute the blood.' The soothing demulcent influence is, at the same time, beneficial to the inflamed mucous membrane. It has been extensively used in domestic practice, with children having dys- entery, cholera infantum, etc. Sassafras Medulla — Sassafras Pith. The pith of the branches of sassafras officinale, a small indig- enous tree, found in all parts of the country, and, it is said, also in South America. The pith is white, spongy, light, and con- tains a gummy substance, which it yields to water, forming a clear mucilage. It is one of the best demulcent applications to delicate sensi- tive structures, and is, therefore, highly beneficial in the treat- AND THERAPEUTICS/ 135 ment of ophthalmia, for which it is extensively used in practice. As a vehicle in the application of other remedies, in acute or chronic conjunctivitis, it serves a valuable purpose. Even alone, with the exclusion of light, the soothing influence of this demul- cent acts favorably in sore eyes. The Iiifitsion is made by pouring a pint of hot water on one hundred and twenty grains of the pith. Mascerate an hour — stirring occasionally — and strain. This preparation may answer well for the usual purposes of demulcents, as above stated, as an application to the inflamed conjunctiva. Amylum — Starch. The fecula of the seed of Triticum Vulgare, or common wheat. This article, of such general use in laundries, and as a chemical test, is also nutritious and demulcent; and although not exten- sively used for these properties, is sometimes given by enema, with opiate and astringent preparations in dysentery. It is readily dissolved by hot water, and in this way is prepared for medicinal use. Glycerina — Glycerin. A sweet principle obtained from fats and fixed oils, (Br.) Glycerin (from y/jjfcuz, sweet) is a clear, unctuous fluid, of sweetish taste, and almost without odor. Although discovered nearly a century ago, it has only recently been brought into gen- eral use as a remedy. Its demulcent property, and great solvent power, render it a valuable addition to the list of material agents. Like other new remedies, however, its virtues have been exag- gerated, particularly, in the attempt to substitute it for calorific nutrient means, used in tuberculosis. As a demulcent for internal use, glycerin is in general use only when combined with catheretic, and other remedial means in the form of glycerole, a French term applied to the solution of any substance in glycerin, or glycerite, as expressed in the United States Pharmacopoeia. The glycerites of carbolic acid, tannin, etc., not only answer the purposes of catheretics and'astringents, 136 .\ THERAPEUTICS. 137 Fig. 14. Olive oil, sometimes called sweet oil, is an unctions liquid of greenish-yellow color, and sweetish, not unpleasant taste. It is a soothing, unirritating oil, and used to lubricate instruments in- tended to be brought in contact with sensitive parts, as well as for the general soothing and protecting purposes of demul- cents. It is also an aperient, and referred to again in that class of remedies. Bismuthi Sttbnitras— Suhni- trate of Bismuth. This salt of bismuth is a white, inodorous, almost taste- less powder. Its physiological action is not very satisfactorily determined by the profession, and hence the modus operandi in giving relief from certain irritable and painful conditions of the stomach and bowels is not definitely settled. It has been considered a mechanical agent only, by which the tender mucous membrane is coated over, soothed and protected, after it has been deposited on the surface so as to form a pasty coating. Some writers have con- ceived the idea of a kind of local alterative effect not well un- derstood; others, that the only direct influence exerted is its absorption of accumulated fluids, and thus it tends to lessen the frequency of diarrhoeal discharges. The first of these theories seems most plausible, and is that upon which it has been given a place in the class of demulcents. Bismuth evidently is compara- tively inert, so far as any very active local or elective medicinal properties are concerned ; for very large doses are frequently ad- ministered to children much enfeebled by exhausting diarrhoea, without any violent impression. The dose, therefore, is not definite, ranging from five to thirty grains or more. It may be Olea Europcea. 3, Fruit. 138 A00L0G1 given in the form of temporary suspension, by being stirred with water; and has been used with decided advantage in this form, by inject ion into t lie urethra and vagina, in irritable and inHamed condition of these parts. In addition to the demulcents already mentioned, as suitable for internal use, there are many other substances which have similar effects when applied to diseased parts externally. Oleum Lini — Linseed Oil — being unirritating, serves as pro- tection to the surface when denuded, and in some respects supe- rior to olive oil for this purpose. When from heat or other cause the cuticle is removed from a considerable portion of the surface, linseed oil is a favorite application, with some practitioners, either alone, or with cotton or flour. Collodion, and the solutions of Shellac, Grutta Perclia, and all protecting cerates applied to ulcers, and injuries of any kind, afford a permanent and impervious protection to such parts, and, not having irritating qualities, are useful for this purpose, as demulcents. CLASS II. EMOLLIENTS. Tins class is comprised of such preparations as soften and re- lax the surface when applied to it, known as poultices. Sub- stances containing warmth and moisture produce these effects, and even moisture alone, with the acquired heat from the body, is usually sufficient for this purpose. A wet towel, folded and applied in the form of a compress, soon attains the temperature of the body, and affords the two ingredi- ents — heat and moisture — necessary to emollient effect. That article or mixture which retains moisture for the greatest length of time, is the most efficient emollient. Articles, therefore, should be selected with a view to this property. Emollients or poultices are used to soften and relax inflamed, swollen and painful parts, after cooling applications are no longer necessary. By this means relief is given from pain during the suppurative process, and the collection of pus allowed a better chance of making its way to the surface. \\|. THERAfcEtJTtCS. 139 Poultices, used even in the active stage of inflammation, may often moderate its violence by their relaxing effect, notwithstanding the increase of temperature, which may occur when the applica- tion is continued without removal for some time. Until the poultice becomes dry, however, the evaporation from its upper surface is sufficient to prevent any very great increase of heat; so that by removing and wetting occasionally with cool water, the heat of the inflamed part, may not only fail to increase, but ac- tually subside to some extent. Emollients are used with great benefit in the treatment of wounds, ulcers, etc., when in an irritable and sensitive condition, with hemorrhagic tendency from slight touch. Also, when in- jured parts become dry, hot and painful, the application of a cool, soft poultice will renew the effusion of lymph, and hasten the suppurative process, or prompt adhesion. Great benefit is expected by some practitioners from poultices applied to the surface of the body for disease of internal organs, but beyond the relief afforded by relaxation of the skin, muscles and other tissues, forming the parieties, thereby lessening the pressure, perhaps no advantage is derived from them. When, however, the diseased part is situated in, or connected with, such superficial structure, the relaxing influence may affect directly the local inflammation, as in pleurisy, tonsilitis, etc. Catalogue of Emollients. Pulvis Ulmi, Lini Farina, Symphytum. Pulvis Ulmi — Pulverized Elm Bark. The bark of Slippery-Elm, which has been already noticed under the head of demulcents, is used, in the form of powder, extensively as an emollient. It answers equally well for ordinary purposes, whether coarsely or very finely powdered. When ap- plied directly to the surface, without intervening layer of cloth, the coarser powder, perhaps, is more conveniently used. 140 ACOLOG1 For inflammation of the eye, from injury or disease, slippery- elm affords the most appropriate poultice. In this case, it serves not only the ordinary purposes of the class, but protects the eye from light, and affords, in the dissolved gum, which exude- from the poultice, all the advantages of a demulcent applied to the in- flamed part. For this, and perhaps all other applications of the bark as an emollient, it may be prepared in the following manner: A little sack made of soft, old linen, should be one-fourth rilled with the pulverized bark, well stirred with water to a semi-fluid consistence, and applied to the inflamed part. It should afterwards be dipped occasionally in cool water, as it be- comes warm and unpleasant. By this mode of preparing the poultice much inconvenience may be avoided, and greater efficacy of the remedy secured. Lixi Farina — Flaxseed Meal The meal prepared from the seed of Linum Usifcdigrimwm, already noticed in the class of demulcents. Pulverized flaxseed is more generally used for ordinary poultices than, perhaps, any other substance. The mucilage made from the gummy ex- terior of the seed, described under the head of demulcents, gives to the powder when moistened, an unctuous consistence that adapts it well to the purposes for which articles of the class are used. In preparing a poultice from the flaxseed, they should be mixed with warm water in a proportion that will leave the mass sufficiently firm to maintain its form after being spread on cloth. The surface of the poultice should then be moistened before being applied, and afterwards, as often as may be necessary, to keep the part on which it is placed perfectly moist. When intended for a raw and sensitive part, a piece of gauze should intervene so as to prevent coarse particles of the meal from contact with it. This also prevents portions of the poultice from adhering, and thereby facilitates the removal and reapplication when necessary. Symphytum — Comfrey Root. The root of Symphytum officinale, mentioned as a demulcent, serves also the purpose of an emollient. The cultivation of this AND THERAPEUTICS. 141 plant being so general in gardens for private families, there is little difficulty in readily obtaining the fresh root when required. In preparing a poultice, the root should be bruised and rubbed up with warm water to the proper consistence. This, when properly prepared, makes a suitable emollient for cases in which such applications are necessary; its mucilaginous character ren- dering it soft and unirritating even to sensitive parts. Warm water, or even cold water, applied so as to prevent evaporation, and to assume and retain the temperature of the body, will answer, in some cases, all the purposes of an ordinary poultice, according to the acknowledged modus operandi of the class. Warmth and moisture, as already stated, are said to be the essential qualities of emollients for ordinary purposes, and whatever, therefore, possesses these, and is not irritating, or otherwise injurious, constitutes a poultice. Soft cloth, folded into several layers, dipped in warm water and applied to the body, affords the essential properties, when confined to the part by a thick, dry bandage or covering. One article is preferred above another only for its bland, soothing qualities, and greater capability of retaining moisture. For very irritable and sensitive parts, mucilaginous substances, such as slippery-elm, etc., are preferable, on account of their demulcent effect upon the raw surface. When applied to sound parts however, this quality is not so essential, and may be dispensed with. By means of folded cloth, wet with warm water, a very extensive poultice may be readily applied. In this way, the sur- face of the whole trunk may be softened and relaxed, modifying to some extent, the cutaneous circulation. This process is empirically practiced extensively under the one-idea system of hydropathy, and is called "the pack." CLASS III. MECHANICAL COUNTER-IRRITANTS AND LOCAL DEPLETIVES. Local depleting measures produce more or less counter-irrita- tion, and are sometimes used for both effects. By the more active and enduring means a drain is established, which eventually 1 \-2 LC0L0G1 brines about results similar to the local abstraction of I»I<1, ><> ■ far as regards the relief to internal organs, in a -latent' engorge- ment. Leeches, cups and scarification are oftea made to precede these mean-, in Long-standing chronic affections, and are used alone in less permanent local disease, when eonnter-irritation and depletion arc required for a shoii time only. Catalogue of Mechanical Counter-Irritants and Local Depletives. Hirudo, Setaceum, Cucurbitula, Fonticulus, Acupuncture, Moxiburium. H i R u do — Th e Leech . This aquatic animal, hirudo decora, is three or four inches in length, of dark-greenish color, and has a round suction disk at each extremity, in the anterior of which the mouth is situated; having jaws armed with several sharp teeth. By this arrange- ment the skin is punctured and suction made, so as to abstract blood from the part on which the leech is applied. The Euro- pean leech, hirudo medicinal is, does not differ very materially from the American variety above described. It is believed, however, that the former attach themselves more readily, abstract more blood, and are, therefore, preferable. It is estimated that a large leech will draw half a fluidounce of blood, and perhaps as much more will exude after it drops off. Leeches can be applied advantageously to various parts, in a state of local engorgement or inflammation, which will not admit of cupping; and, as a means of local depletion in children, is prefer- able to cups and scarification, even when the latter can be effected without difficulty. Leeching had almost gone into disuse, in many parts of this country, until advancement in the pathology and treatment of uterine affections made it necessary to renew the practice. It has been ascertained that much suffering is pre- vented by the timely use of a few leeches, in that engorged con- dition of the uterus which leads to the development of various AND THERAPEUTICS. 143 uterine lesions. Chronic metritis, endo-metritis, ulceration and their complicated ever-harassing results — prolapsus, leucorrhoea, and the innumerable pains and aches from reflex disturbance of the nervous system — often commence in simple engorgement. Even when chronic inflammation has been established, and en- gorgement with increased weight of the organ has passed away, the duration is very decidedly shortened by premising the treat- ment with the use of two or three leeches. This number will generally affect all the depletion necessary at one time; and a cylindrical glass speculum introduced in the vagina, including the os uteri in its extremity, affords convenient means of apply- ing them. The os should be well cleansed with a moist sponge, and if the leeches fail to take hold, slight scarification, so as to discharge a drop or two of blood, generally induces them to draw. Leeches also afford the best means of depletion in hemorrhoidal tumors, furuncle, carbuncle, orchitis, etc. A leech applied to an incipient boil will be likely to abort it completely. In this way local depletion can be had with less pain and injury to the struc- ture than by any other mode. The hemorrhage from leech -bites sometimes, though rarely, is troublesome, continuing after the desired amount of blood has been abstracted. Pressure w r ith the finger, or a compress upon the orific for a few moments, will generally arrest the flow when it is desirable to do so. When, however, from the loss of plasma in the blood or tone in the tissues, the bleeding obstinately con- tinues, a pledget of lint saturated with a solution of perchloride of iron, or the application of lunar caustic, may become necessary. Cucurb i tula — Cupping Glass. Cupping may be practiced with or without scarification. Counter-irritation, to the extent of rubefacient action, may be had by dry cupping ; but when local depletion is also desirable, the part should be scarified before the cup is applied. Blood is thus forced to the surface and abstracted, by partial exhaustion of the cup and the consequent suction induced. The most convenient cupping glass is that attached to a hollow rubber bulb, which being exhausted by pressure of the hand, the Ill ACOLOGY cup will firmly adhere to the skin, when pressure cease-, the elasticity of the rubber producing a sufficient amount of suction. This form of cup has superceded the more inconvenient mode of exhausting by a pump attached, or bya Lighted taper to consume the oxygen. Scarification is generally performed with an instrument for the purpose, called scarificator; but the incisions may he made with a bistoury, razor or lancet, in absence of this instrument. Cups may be readily applied along the spinal column, to the chest, temples and abdomen. The spinal cord, when the subject of irritability from direct or reflex impressions, may he relieved by this means. In chronic uterine disease, cups to the sacrum not only counteract reflex irritation of the cord, but act favorably upon the engorgement and irritation of the womb itself. Periodical cephalalgia, or sun pain, and cranial or facial neu- ralgia are sometimes relieved by cups applied to the temples; and ophthalmia yields readily to treatment after cupping in the tem- ples, which otherwise proves intractable. Like many other valuable remedies, cupping fails of success often from being improperly performed. In order to be effectual, in certain cases, the abstraction of a certain amount of blood is necessary. The cups fail to fill, sometimes, on account of press- ing so firmly against the cranium, that blood does not enter the part upon which suction is made; and by slightly raising that side of the cup which presses on the artery supplying this portion of the scalp, the blood at once flows freely. This operation can, sometimes, be made to answer all the pur- poses of counter-irritation, general and local depletion, in menin- gitis and other local inflammatory diseases, particularly in young subjects. Acupunctura — Acupuncture. This process consists in piercing the skin with needles, and has long been known as a remedial means. The punctures may be made by a single needle, or an arrangement by which several are thrust into the skin at the same time. Puncturing with needles has been had for other effects than \Nl> THERAPEUTICS. 145 that of counter-irritation. Nsevi materni, and other varicose tu- mor.-, are relieved by piercing them with needles, thereby excit- ing inflammation and consequent adhesions, which break up the unnatural circulation of the part. Surgeons resort to acupuncture for this purpose, but in this case the needle is thrust through the tumor instead of merely pricking the skin, as in counter-irrita- tion. The irritation produced in the skin by needles is greater and more durable than that by ordinary rubefacients, but less so than the action of vesicants. The operation is not attended with excessive pain, and produces an impression which remains for a day or two. An instrument, perhaps of German invention, is in use for acupuncture, called Lebens-weeker. It is so constructed, that, by a spring, some dozen or two of needles are made to pierce the skin, in the space of an inch in diameter, and being thickly clustered together, they do not pass through the skin, even when applied with considerable force. Acupuncture over the spinal column when in an irritable condition, and along the course of nerves, which are the subject of painful disease, may be usefully employed, if repeated every two or three days, and kept up for some weeks. Setaceum — Seton . The most certain and permanent counter-irritation is that pro- duced by the seton. Being purely mechanical, its action may be kept up from the same operation for any desired length of time, and without excessive pain or unnecessary destruction of tissue. Slight hemorrhage from the wound made by the introduction, though generally inconsiderable, may sometimes amount to local depletion, but suppuration, which is soon established, affords a constant drain from the part, and answers the same purpose, to some extent. Setons, like other counter-irritants, are applied to that part of the surface opposite or near the affected organ ; as, for instance, on the chest in bronchial, pneumonic or pleuritic disease; and back of the neck, or on the temple for affections of the eyes and 10 l 16 AOOLOG < 'a i->. Diseases of a chronic nature alone are subjecl t<> benefit from this remedy, for, in acute affections, the reason for its use will have ceased before the lull effect can be established. Silk, cotton, flax, or any substance which keeps up irritation, introduced into or under the skin, forms a seton. Through a fold of skin, held between the fingers, a seton needle, armed with thread, a pit ribbon or slip of cloth, may be carried, leaving the seton in the track of the needle. An eyed probe, carrying a piece of ribbon, may be passed through an opening made by a lancet, and answers the same purpose. From the presence of this foreign substance sup- puration is soon established in the sub-cutaneous celluar tissue, which is increased by occasionally drawing a fresh portion of* the seton into the sore. The seton is used in a surgical operation, having for its object the relief of false joint, from ununited fracture. For this pur- pose thread or other foreign substance is passed between the frac- tured ends of the bone, and is intended to excite the deposit of callus, an object entirely different from that under consideration. Fontk !ULUS — Issue Pea. On the same principle upon which the seton acts, the issue pea also produces counter-irritation, and establishes a local drain. A bean, pea, pledget of lint, or other solid substance, inserted within or under the skin, forms the issue in question. While the local irritation and issue formed in this way may be found use- ful, it has been almost entirely superseded by the more conveni- ent mode of producing these effects by the seton. Jfoxiburium — Moxa — and other escharotics used for their counter-irritant effect, produce general results on local disease, similar to those of the seton, but with less regularity and per- manency of action. They are considered, in the division of rem- edies affecting adventitious substances and structures, under the head of escharotics through chemical process. Friction and Dry-cupping, mentioned as rubefacients, belong- properly to the class of mechanical counter-irritants, but having only the effect of slightly reddening the skin temporarily, are not entitled to a prominent notice here. PART III ORDER II. ELECTIVE REMEDIES. SUB-ORDER I ELECTIVE ACTION THROUGH CHEMICAL PROCESS. DIVISION I. REMEDIES THAT AFFECT THE BLOOD. This division is dispensed with by some writers on Thera- peutics, and the remedies properly belonging to it are considered under the various heads of " Alteratives/' " Tonics/' pass through, in order to replenish the blood. Under such cir- cumstances, the medicinal agent, or other means which will af- ford the blood such required ingredients without the process of digestion, etc., may be introduced into the circulation directly, by absorption from the alimentary canal. Catalogue of JLematinics. Cibus, Oleum Morrhure, Ferritin, Transfusio. Cibus — Food. This natural means of furnishing all the essential ingredients of the blood, is also considered under the head of gastric or di- gestive tonics. In that connection, solid and fluid, irritating and unirritating articles of food are properly considered with reference to derangement of the stomach, but in this place it is proper to notice it as a haematinic or blood-maker, in regard, particularly, to its capability of furnishing necessary ingredients for a healthy AND THERAPEUTICS 145) or natural condition of the blood itself. When this fluid is im- poverished, and the organs which prepare food for haematosis or blood-making, properly perform their functions, oily and album- inous substances, such as butter, eggs, meat, milk, etc., form ap- propriate hsematinics. These, with such articles as afford water, salts and sugar, give to the blood the elements necessary to afford material for every tissue of the body. The selection must be made according to the deficiency which may exist in the blood, the necessity or desire that may be felt for particular ingredi- ents. When, from loss of blood by hemorrhage, or when failure on the part of the digestive organs to replenish, the proportion of watery ingredients greatly increases. Absorption is rapid under these circumstances, from the ease with which the absorbents discharge their contents into the depleted blood vessels. In this case the blood, though sufficient in quantity, becomes thin, pale, innutritious, and requires an increase of the red corpuscles and plastic material. Flour of meat, as advised by Dr. Hassal, of London, is pref- erable to any other preparation, on account of its containing all the nourishing ingredients of which meat is posseesed. The extracts prepared by Liebig, Bellat, Martin de Lignac, and others, are deprived of the most important nutrient and calorific elements for which meat is useful. Albumen, fibrin and fat are not found in the various extracts, juices and teas of beef, about which so much has been said in praise, and as these principles are essential in giving that vigor necessary to raise the ca- chectic and strumous constitution above the scrofulous and tuberculous development, we can see no good reason for prefer- ring preparations in which none of these useful ingredients are preserved. Flour of meat is prepared by drying the meat at a low heat, so as to deprive it of all the water, and then grinding to a ver} fine powder. In this form it is preserved for any desirable length of time, and may be used for making soup, beef tea, meat biscuit, or any other form of meat diet. This is suited particularly to children and aged persons not supplied with effective teeth. One pound of the Hour of meat is equal to about five pounds of ordinary meat (U. S. D.) 150 A< ni.ncv FeRRTTM — Iron. Iron is, by all, considered a tonic. Some sj x-n k of it a> n tonic to the blood, some to the nervous system, while others use and recommend it as a tonic to the digestive organs. In one thing all agree: that it is an invigorator, and in this are doubtless correct. A mistaken view as to the cause of debility may not only lead to error in therapeutics, hut in explaining the modus operandi of remedies, empirically or accidentally given, and found useful in its treatment. If, from imperfection in the di- gestive organs, anaemia and debility result, and iron alone he ad- ministered tor their relief, in all probability the practitioner will not realize the desired permanent benefit. Again, if these symp- toms exist in consequence of a deficiency, from any cause, of prin- ciples in the blood, which iron supplies, they may permanently give way under its use, though it be prescribed with the erroneous view of correcting deranged functions of the stomach or the ner- vous centres. If the physician concludes that inactivity of the latter organ exists as the cause, the remedy is set down as a ner- vous tonic; if the former, he insists upon its tonic power on the digestive organs. In this way, perhaps, many erroneous proper- ties are ascribed to remedies. While it is not at all certain, iron may possibly have some direct tonic influence over the nervous system. The fact of ner- vous debility being relieved by it is not, however, evidence of its truth. The nervous centres may fail to afford the necessary amount of influence, owing to deficiency in the invigorating in- gredients of the blood. If this deficiency be restored to the blood by iron, a careless observer would very readily conclude that the direct action was exerted upon the brain and spinal marrow. The blood is evidently affected directly by the prepa- rations of iron. When the watery constituents of this fluid arc excessive from any cause, manifested by paleness of the skin, general debility, hemorrhage, or dropsical tendencies, iron, which it is supposed increases the red corpuscles, and thereby lavs the foundation for increase of plasma, improves the quality of this fluid, and relieves these symptoms. It is, therefore, pre- AND THERAPEUTICS. I6l scribed with confidence of benefit, in eon junction with other ap- propriate remedies, in dropsical effusions, anaemia in cachetic or chlorotic subjects, purpura hemorrhagica, etc. Uncombined iron is insoluble, and even in the forms of oxide and carbonate, only partially so, in water. When taken in any of the forms which are insoluble in water, the remedy is depend- ent, for its absorption and activity, upon the acid with which it meets in the stomach. When in fine particles, the metal readily oxidizes, and in this state is easily converted into soluble salts by the acids met with. Ferri Subcarbonas — Siibcarbonate of Iron. This is a brown- ish-yellow powder, inodorous, of earthy taste and insoluble in water. The preparation is generally supposed to possess nervous tonic properties, and is usually selected when the remedy is given for inactivity of the nervous system. Why it should be more effi- cient than the more soluble preparations, is not very clear, yet even for its direct effect upon the blood, the carbonate is often prescribed. It is given in hysterical nervous derangement, and probably with advantage in chlorosis, and other forms of anaemia, dependent upon functional organic derangement of the uterus, but in this state of the organ, its effects are temporary. It is also frequently given with quinine in chronic intermittent fever, after the system is worn down and the blood impoverished by long-standing disease. The dose is five grains, three times a day, in the form of pills, or made into an electuary with honey or syrup. Ferrum Redactmn — Reduced Iron — Iron by Hydrogen. This preparation is said to consist of metallic uncombined iron in the state of very fine powder, and is obtained from the carbonate by passing hydrogen over it in a heated tube. It is of grayish color, inodorous, tasteless, and insoluble in water. Powder of iron, fifteen years ago, was the most popular of all the preparations. This, like other sensations, has had its run, passed away, and now the preparation ranks as others, which are soluble only by contact with acid in the stomach. It may be used for the ordi- nary purposes for which iron is found beneficial, and in the same dose and form of administration as the carbonate. 152 ACOLOGl i'liri CUros — Citrate of Iron — is in the form of thin reddish scales, voluble m irate,-, and lias chalybeate taste. It has all the good effects of the less soluble preparations of iron, and at the same time much more certain of being speedily absorbed into the circulation. In the form of solution it may be administered, bu1 to conceal the taste, pills are made of it, with some adhesive sub- stance suitable for the purpose. The dose is five grains three times a day. On account of its solubility and mildness of act ion, the citrate is one of the most useful preparations of iron, to affect the blood. Ferri Sulphas — Sulphate of Iron — Green Vitriol. The com- mercial salt, known as copperas, is not sufficiently pure for me- dicinal purposes, having other metals combined with it. Pure sulphate of iron is in crystals of a greenish color, astringent, somewhat styptic taste, soluble in water, and readily efflorescent when exposed to the air, falling into a whitish powder. The astringent property possessed by this salt interferes with its use, to the extent desirable in some cases, while in others it is thereby rendered more efficient. In relaxation, chronic inflam- mation or ulceration of the alimentary mucous membrane, and hemorrhagic tendency, this property makes it a decidedly useful local remedy, while the blood receives, at least, some of its in- vigorating qualities through absorption. On the other hand, when it is necessary to use ferruginous preparations for a long time, and the alimentary canal be not in a conditition to bear well so active astringent, the preparation is objectionable as a ha3matinic. In overdoses, and even in quantity only sufficient to relieve anaemic conditions, irritation of the mucous membrane may be produced, and it is, therefore, less used in ordinary cases of impoverished blood than milder preparations. Sulphate of iron is given in the dose of tiro (/rains, made into pills or dissolved in water. The former is preferable on account of the unpleasant taste of the salt in solution. This article is supposed to act as a tonic upon the stomach, and it may prove to be such, on account of its astringent property, in cases where indigestion exists in consequence of a relaxed or otherwise unhealthy condition of the mucous surface, requiring this local action. And therapeutics, 153 Oleum Morbhtlss — Ood-IAver Oil. Oil obtained from the liver of Gadus Jforrhua, or eodfish, and other speeies of Gadus. The best oil is obtained from the fresh liver, by a heat below the boiling point of water. While gadus inorrhua affords most of the commercial oil, that from other species of the codfish is also found in market. The great demand for it leads to the sale of adulterated and spurious specimens; and, unfortunately, there is no certain test by which its purity may be known. As com- mon train-oil or lamp oil is, perhaps, more frequently substituted for the genuine article, a familiarity with the sensible properties of this, is the best means of guarding against imposition. Cod-liver oil is supposed to be superior to any other -fatty substances, in giving to the blood those qualities by which the greatest amount of healthy nutrition and vigor are given the tissues. There is no doubt that an impoverished condition of the blood, and general deficiency of heat and vigor in strumous constitutions, lead to the deposit of scrofulous and tuberculous matter, and that oleaginous food and medication tend greatly to increase the heat of the body and to replace those ingredients of the blood, which are necessary to the arrest of this morbid pro- cess. Oily food is, therefore, considered prophylactic against the development of tuberculosis or scrofula, in persons of strumous diathesis. The disgust felt by most persons for cod-liver oil, interferes, however, with its use in this way, and it is doubtful whether any advantage is afforded above those had by fit meats, butter, milk and cheese, for this purpose. Indeed, the stomach often fails to digest, and even sometimes rejects the oil; and in such cases reliance must be had in the less offensive and more easily digested articles of diet mentioned. This course is the more reasonable since such food affords not only a considerable amount of oil, but the elements necessary to support the muscular and fibrous struc- tures. All things considered, it is likely that more good may be effected in an impoverished condition of the blood from any cause, and even depraved constitutional tendency, by enjoining 1-) [ m oLocii liberal diet alone, than the regular use of lull doses of cod-liver oil, to the neglect of oily and albuminous food. Cod-liver oil may be taken three times a day in the dost of ull>, is at firs! filled, can- not, if of a proper temperature, do injury to the patient, and gives place in the tube to blood, which, by prompt action on the pari of the operator, is not at rest sufficiently long to favor coagulation. CLASS II. S1WN.KM1CS THIS class includes all the mean- used to render the Mood less exciting and nutritious. Spansemics — from <77ravoc, poor, and ac/ia, blood — are used, sometimes, with objects similar to those had in the admin- istration of cardiac sedatives; in fact, some of the same means have a place in both classes. In the treatment of inflammatory disease, it is found necessary to reduce the heart's action, in order to moderate the force of the circulation in the diseased part, and also to destroy the exciting quality of the blood. Blood-letting answers both purposes. By it a portion of the heart's stimulus is withdrawn; and though the absolute amount of the circulating fluid may soon be restored by absorption of watery ingredient, the proportion of nutrient principles, is, to that extent, lessened, and not only the heart, but the inflamed tissue is less excited by the blood. Moreover, when the circulating fluid is rich with fibrin, albu- men and red corpuscles, the circulation is sluggish in the capilla- ries, and, thereby, existing engorgement and inflammation is likely to be increased. From this cause, the brain, when there exists an apopletic tendency, is subject to injurious pressure, on account of effusion, or distension of the blood vessels. Spanseinics of every kind lessen the relative proportion of rich material in the blood, and thus fill the indications in the condi- tions above 1 named. Therefore, in adynamic diseases, they are, of course, injurious, and should not be used. As seen in the class of catalytics, certain articles destroy fibrin, one of the nourishing; ingredients of the blood; and by this catalytic action they, to this extent, become also spansemics. Some of these, by long use, destroy invigorating principles in the blood, and hence AND THERAPEUTICS. 157 are objectionable in certain diseases in which otherwise their catalytic action upon certian morbific agents would render them useful. Thus mercury, by its spansetnic or impoverishing effect upon the blood, in the catalytic action upon fibrin, renders it injurious in scrofula, though it should aid in the solution and elimination of morbific material; because impoverishing of blood favors the increase of such material in it. This spansemic effect of mercury makes it injurious in tuberculosis, adynamic fevers, etc. Its preparations, dose, etc., sufficiently dwelt upon in other diseases, needs no further notice. Low diet, not containing the elements of rich blood, leads to span semi a, and is, therefore, one of the means of impoverishing this fluid. The qualities and preparation of food, described in the class of gastric or digestive tonics, needs no further notice now. Suffice it to say, therefore, that food and drinks containing the smallest amount of albumen, fibrin and fatty matter should be selected. CLASS III. DILUENTS. This class is composed of such drinks as are readily absorbed by the veins and dilute the blood. The proportion of watery constituents is increased, as in the action of spanremics. When diluent drinks are taken without depletion, the absolute amount of circulating fluid is increased, but by catalysis, blood-letting, etc., the quantity is lessened to that extent, and absorption, which is thereby increased, supplies the deficiency with diluent fluids. It will thus be perceived that dilution is the result of depletion and the action of other span&emics, as well as the use of copious draughts of Avatery liquids. The last of these only come properly under the head of diluents. Cool water is the natural diluent of the blood. The economy is so constituted that thirst, the desire for drink, exists when heat, excess of salts or deficiency of serum prevails. In febrile affec- tions, the use of this beverage leads to decrease of temperature, by affording material for cutaneous transpiration and evaporation upon the surface. 158 ECOLOGY Certain liquids are more readily absolved than others, and arc, therefore, better diluents. Some <>(' them, when taken into the circulation, are more readily eliminated through the skin, others by the kidneys, and still others by the lungs and bowels. This difference consists in the different character of ingredients held in solution in the liquids. For example, a fluidrachra or two of the spirit of nitric ether, taken in a draught of water or simple tisan, tends to a copious flow of urine, while other substances are more readily eliminated by the skin, respiratory organs or bowels. Cold or warm Infusions or decoctions of simple substances, called Teas, act merely as diluents; some of which, from their tendency to elimination by the skin, are called " diaphoretics." ( 'hamoviili , sage, eupaJtoi'ivmi and balm infusionSy and saccharin* and acidulated drinks are some of the simple diluents. By dis- solving in these, medicinal substances whose properties promote the activity of certain organs, or favor elimination through par- ticular emunctories, the various forms of fluid discharges maybe facilitated. Infusion of flaxseed, or watermelon seed and the juice, form use- ful diluent drinks in urinary diseases, in which the acrid urine irritates the inflamed passages. The dilution of the urine in the greatly increased quantity, caused by the use of these drinks, destroys its irritating quality, and thereby allays suffering, and aids in the arrest of local inflammatory action in the urinary passages. CLASS IV. HAEMOSTATICS. This class of remedies, also called styptics, includes all the means used to arrest hemorrhage, whether proceeding from inter- nal vessels, to which they cannot be directly applied, or from those situated externally. While haemostatics proper, in the main, arrest the flow of blood by chemical changes wrought in that fluid, yet vital and mechanical measures are sometimes the most available means in this trying difficulty, and should not be overlooked in the study of remedial agents intended for its relief. The modes of mechanical procedure to be adopted by surgeon- AND THERAPEUTICS. 159 and obstetricians to staunch sudden and violent hemorrhage, are more properly considered in works on these respective departments of science, and need not be included in a description of medicinal agents. There are, also, many astringents, whose vital action upon the soft tissues involved in hemorrhage, tend to arrest the discharge, that cannot, with propriety, be arranged in this class. Hemorrhage is, perhaps, always the result of abnormal condi- tion of the capillaries or larger bloodvessels from mechanical or vital cause, or of a changed condition of the circulating fluid itself. Hemorrhage occurring on account of a relaxed and feeble con- dition of the capillaries and tissues connected with them, from enervation or other cause; or on account of depraved condition of the blood, is called passive; otherwise it is called active. The difficulty must be met always, of course, by means suited to the various causes of disturbance. When the blood is impoverished and the serum greatly predominates, it more readily escapes from tissues through which it could not otherwise pass; and to prevent or arrest hemorrhage in this case, means, by which the proper chemical constituents of the blood are restored, and its coagula- bility promoted, become necessary. Direct styptics — those acting immediately upon the blood or tissues from which the hemor- rhage proceeds — are temporary only, and sometimes entirely in- effectual where the hemorrhage is dependent, as some suppose, on a want of nervous influence, as in petechia, a form of purpura or capillary hemorrhage from internal and external surfaces. Moreover, should the impoverishing or depleting mode of treat- ment, sometimes useful in active hemorrhage, be adopted, under the circumstances just mentioned, the hemorrhagic tendency will probably be increased. The same may be said of haematinic, or blood-restoring means, when applied to the active form, though useful in passive hemorrhage. Haemostasia — from acjua, blood, and azaal^, stoppage or stand- ing — as above intimated, is the result of chemical change in the blood itself, effected by the remedy, causing ready coagulation. Clots form after the blood escapes, preventing further hemorrhage, by mechanical interference. 1G0 LC0L0G1 Moreover, when the circulating fluid has been thus acted on by the haemostatic, and made more dense, it probably docs not so readilj pass through the tissues. Catalogue of Hemostatics. Plumbi Acetas, Acidum Carbolicum, Ferri Chloridum, Ferri Persulphas, Argenti Xitras. Plumbi Acetas — Acetate of Laid. This salt lias already been described under the head of astrin- gents, and is to be noticed now only in connection with its haem- ostatic or styptic effects. In hemorrhage proceeding from parts internally, and to which remedies cannot be directly applied, the acetate of lead is con- sidered an efficient haemostatic. To affect discharges in such lo- cations, the salt must necessarily enter the circulation in order to modify the blood or the structures connected with the bleeding vessels. Considerable importance is attached to the contracting power of astringents when applied directly to the mouths of bleeding vessels externally, and it is natural enough, without due consideration, to infer that by a similar modus operandi internal hemorrhage is also restrained. It is rather unreasonable to suppose, however, that when only two grains of the salt are distributed amongst the whole circu- lating mass, the remedy can reach the tissues, from which blood escapes, in a state of sufficient concentration to have any decidedly constringing effect upon them. A more rational explanation is that already given, making the arrest of hemorrhage attributable to a chemical modification of the blood, promoting its coagula- bility. And it may be true that most of the styptic influence exerted by this and other astringents, when applied directly to external hemorrhage, is due to this effect upon the blood itself. At any rate, the speedy formation of coagula, leaving a clot at the point of hemorrhage, certainly favors the suppression of further discharge. AND THERAPEUTICS. 161 Acetate of lead is considered a valuable haemostatic in uterine hemorrhage, hsemoptisis and hematuria. It is usually given in connection with opium, and there is no doubt the desired result is rendered much more certain and decided by this valuable neu- rotic. Indeed, hemorrhage, dependent, directly or indirectly, upon the want of proper nervous energy, may be relieved by the preparations of opium alone. Sugar of lead may be given in the dose of two or three grains for this purpose, and repeated in an hour or two, if the desired effect is not produced. In cases, however, requiring such remedy for a longer period than a day or two, it should be substituted by some other haemostatic, lest the poisonous effects of the lead be brought on. Fekri Chloridtjm — Chloride of Iron. The chloride of iron, in the form of tincture, as noticed under the head of renal tonics, is identically the same combination of iron with chlorine, and in that form is often used as a styptic. "When chloride of iron is used internally, in hemorrhage, from depraved condition of the blood, the tincture is preferred ; and even for local application, it is, perhaps, equally serviceable. The solid chloride, or, as sometimes called, perchloride of iron, is in the form of small masses or fragments, having crystaline structure, yellow color and styptic taste. It is soluble in water, and may be used locally in a solution of any desired strength. Internally, the chloride of iron may be used in purpura hemor- rhagica, menorrhagia, hematuria, and all other varieties of hemor- rhagic tendency dependent upon a defibrinated and otherwise impoverished condition of the blood. In its action the density of this fluid is increased, by restoring essential ingredients, and also the tendency to coagulation of discharged blood promoted. For this purpose the tincture may be given in the dose of twenty drops, three times a day, well diluted with water. This preparation is used by surgeons in secondary hemorrhage from wounds or operations, with favorable results, when ligation proves unavailing. For this purpose lint, saturated with the tincture in full strength, or watery solution of the solid chloride, 11 162 ACOLOGI in the strength required, say eighty grains to the fluidounce of water, is applied in quantity sufficient to fill the wound leading to the bleeding vessel. In this way dots are formed in contact with the orifice from which the blood proceeds, and at the same time contraction of all the (issues connected with the wound occurs, leading to permanent arrest of the hemorrhage. Aneurysmal tumors are also obliterated, and serious hemorrhage prevented during the operation of artificially rupturing the tumor, by plugging up the opening with lint thus saturated with the tincture or watery solution. In order to he effectual as a styptic, in such cases, the remedy should be applied directly to the bleeding vessels, and the opening in the soft parts filled with cotton or lint, saturated with the solution. A (ID cm CARBOLICUM — Carbolic Acid. This remedy, which, during the last few years, has attracted considerable attention, now ranks high as a medicinal agent. It has been already mentioned in the class of catheretics. Applied locally in the strength of twenty to sixty grains to the fluidounce of water, it has been found to arrest hemorrhage from deep seated injuries very promptly. In order to this local action, cotton, saturated with the solution, should be forced into the wound, or pressed firmly to the bleeding surface. The general styptic effect of the remedy is that which gives it greatest importance. In monorrhagia, hematuria, etc., it affords the most certain and prompt relief. The author has seen pur- pura hemorrhagica, in which there was bleeding from the gums, tongue, kidneys and stomach, perfectly relieved in twenty-four hours by the internal use of this remedy. For these purposes it is given in the dose of tiro grains in three or four fluidounces of water, repeated in two to four hours. Menorrhagia is sometimes arrested by a single dose of the remedy. Besides these, and perhaps other prominent styptics that might be mentioned, the actual cautery, creasote, and the whole class of astringents, may be said to have haemostatic action. Some of these are often used topically for external hemorrhage. A solu- AND THERAPEUTICS. 163 tion of sulphate of copper, applied as has been directed for chlo- ride of iron, may be used with benefit in many cases. The Hot Iron is sometimes applied in persistent hemorrhage, with prompt relief, when the bleeding vessel can be readily reached, so as to sear the open orifice and connected tissues. Creosote has a contracting effect from its peculiar exciting in- fluence, and may be used to advantage in hemorrhage from relaxed and inactive condition of the soft tissues. Capillary exudation may be arrested in this way, by direct application of the remedy. Nitrate of Silver may also be used profitably as a local styptic. We can bear testimony to the efficiency of this article in obsti- nate epistaxis. A case of nasal hemorrhage, which had resisted other astringent applications, and the tampon, until the patient was in eminent peril, yielded promptly to a solution of lunar caustic. Sub-sulphate of Iron, an unofficinal preparation, serves a val- uable purpose in rendering the blood coagulable, and contracting the tissues surrounding the orifice of bleeding vessels. There is no doubt that the arrest of hemorrhage, with this preparation of iron, is effected through these influences combined, and may be relied on as a local styptic in slight superficial hemorrhage. Styptic Colloid is a preparation of tannic acid with collodion, made by digesting the acid with alcohol for- ^ few days, then add ether till the mixture is quite fluid, and gun-cotton to satu- ration (Dr. Richardson.) This forms a styptic coating for hem- orrhagic abrasions, ulcers, wounds, etc. The ether and alcohol, evaporating, leave the gun-cotton and tannic acid in contact with the diseased or injured surface. Hemorrhage may thereby be prevented, while protection is afforded the denuded surface. CLASS V. CATALYTICS. It will be seen from the catalogue of Catalytics, that the arti- cles usually denominated "alteratives" or "eutrophics" stand prominently in this class. Eemedies that are found decidedly useful in effecting important changes, and whose action and modus 164 kCOLOGI operandi are not well understood, making no visible impression at the time, have been called alteratives. For the reason that nothing was known of their direct action, the alteration or change in the general health and vigor of the system— »-the only visible effect — gave name to the class. A- the action of remedies become better understood, names, in accordance; with such discoveries, designating their direct effects, should be given the classes. "Eutrophics" is a term substituted for alteratives by Dr. Dunglison, which is expressive of the direct influence he supposed they exert in the improve- ment of nutrition. As their effects are now believed to be still more definitely understood, it is thought proper to call them catalytics, a name suggested by Dr. Headland, in his work on "The Action of Medicine." That author does not include under this head, most of the remedies known as alteratives or eutrophics, but the ac- tion he describes under the head of catalytics is evidently nearer that produced by these remedies, than any heretofore attributed to them. The name, catalytic — from tcaraXoat, to dissolve — implies the power to decompose, dissolve, eliminate or destroy. It is under- stood that the articles thus classed act upon the morbific agent by dissolving, decomposing or destroying it in some way. When placed in the group of remedies affecting the blood, the inference must be that the noxious material upon which they act is in this fluid, or intimately connected with it. Investigations, as to the nature of diseases relieved by this class, lead to the conclusion that, in some of them at least, certain substances are deposited from the circulation in various tissues and structures of the body, and that their existence and deposit constitute the leading feature in the pathology of those affections. The use of certain medi- cines is known to arrest further deposit, and the conclusion that these morbific agents are dissolved, decomposed or destroyed in some way, seems reasonable. It is not a great breach of pro- priety to group these as remedies affecting directly the blood, though they occasionally go further, and dissolve these substances in the alimentary canal, or other parts, before entering the circu- AND THERAPEUTICS. 165 lation, or after being deposited by it in the solid tissues. Some of them, for instance, destroy fibrin in the blood, and also tend to decompose, and prepare for absorption, semi -organized fibrinous growths ; others tend to destroy or neutralize scrofulous or tuber- culous matter in the blood, and, it may be, prepare it for absorp- tion and elimination after being deposited in masses ; and still others, which neutralize acids in the blood, the urine, or in the alimentary canal, before it enters the circulation. It will be seen that the several articles of this class act on substances very different in their nature from each other. When more than one affects the same morbific substance, they do not necessarily destroy it in a similar manner. Some destroy the virus of syphilis; others the degenerate matter of scrofula, etc.; and the destruction may consist in solution and elimination, or in forming innoxious compounds. It is enough to maintain the plan of our classification, that all the classes of this division act upon substances in the blood, and that all the remedies of this class act in the same general manner in relieving the blood of the particular substance each article tends to destroy. It will be remembered that the system of classification adopted in this work is founded on the physiological, not the therapeutic action of remedies. It would, therefore, be improper, under this ar- rangement, to name the class of "digestive or gastric tonics" in accordance with the ultimate result in the improvement of nutri- tion; and equally so with remedies affecting directly substances in the blood, by which the same therapeutic effect upon the function of nutrition is obtained. Nutrition is disturbed by numerous breaks in the chain of normal functions, but it would be folly to classify the various means used to restore them, with reference to this ultimate result upon the nutrient function. Nutrition may be interfered with by paralysis of the nerves supplying a part, but the means instituted to restore the nervous energies could be named only with reference to the action had upon the diseased nervous system, even in a classification based on therapeutic action. Hence, the term eutrophics, which sig- nifies improvement of nutrition, could not be applied to them- With no less impropriety is the class under consideration named !()() ACOLOG eutrophios. In a physiological classification, even some of the means applicable in nervous disturbances just alluded t<>, could not be said to haveany direct effect upon the nerves themselves. Coun- ter-irritants and revulsives applied to, and directly affecting the exterior and internal surfaces for their therapeutic results upon the nervOUS centres, must, physiologically, be classed with refer- ence to their effects upon these surfaces. Hence, drastic cathar- tics, epispastics, etc., become indirect therapeutic nervous ex- citants, and lead ultimately to the restoration of the function of nutrition. . Catalogue of Catalytics. Hydrargyrum, Acidum Sulplmrosum, Iodinum, Chloroformum, Sarsaparilla, Ammonii Chloridum, Stilliugia, Chimaphila, Arsenicum, Antacida. Hydrargyrum — Mercury. Mercury, though a metal, is fluid at the ordinary temperature of the atmosphere. Indeed, it becomes solid only at a point far below zero of Fahrenheit's thermometer, and is used for this in- strument on account of the long range between the boiling and freezing points. As a medicine, it is said to be useless in the purely metallic state, and yet some of the preparations consist of the mineral, only in a state of very fine particles, in which it doubtless be- comes oxidized, however, before being administered. Mercury, which is mentioned under the heads of cathartics and anthelmintics, does not seem to require solution and absorp- tion to effect some of the objects for which it is used. It is sup- posed that while as a catalytic these processes are essential, yet catharsis and vermifuge action are possibly more perfect without absorption. Indeed, there are good reasons for believing that when taken into the circulation, the effects upon the bowels and their contents, are, in a good degree, prevented. AND THERAPEUTICS. 167 In order to the catalytic effect of the remedy, it must enter the circulation, and, therefore, the more soluble preparations are better adapted to its use in this way, while they are not so useful as cathartics and anthelmintics. As a catalytic, the preparations of mercury are useful in several different forms of disease. In the phlegmasia, they form the sheet anchor with some practitioners. The explanations of the modus operandi for this purpose are various. In the treatment of acute inflammation, mercury was for a long time prescribed extensively, with the view of its being a powerful sedative to the circulatory organs, and nervous system. And while the latter is greatly under its influence, the antiphlogistic effect doubtless de- pends upon catalytic action on fibrin in the blood. Under its influence a kind of depletion is constantly going on ; and that of a kind which takes from the mass of circulating fluid the plasma and more nutritive ingredient, leaving it impoverished in this particular, as after blood letting. In croup, pleurisy, pneumonia, and other violent forms of in- flammatory disease, tending rapidly to disorganization of the structures involved, and effusion of fibrin, mercurials are used with happy effect. Large doses of calomel have been highly recommended in membranous or inflammatory croup in children. By its catalytic action on fibrin, obstruction to the passage of air through the trachea, by the formation of false membrane, is pre- vented ; and the large doses in use for this purpose give more certainty of a sufficiency being absorbed to effect this object. Cerebro-spinal meningitis, essentially an acute inflammation of the cerous tissues indicated by the name, is treated successfully by this and other antiphlogistic means. Ptyalism is rarely pro- duced under such circumstances, though the bowels be not moved for several days. In no disease, however, are the good effects of mercury so per- ceptible and certain as that of syphilis. The certainty with which it is supposed to relieve this malady has given it the ap- pellation of " anti-syphilitic." While it is, perhaps, not so in- fallible as to entitle it to such distinction, yet the catalytic action of mercury on syphilitic virus in the blood and tissues where it is deposited, is a fact well established. i«;.s mi .,m,v Nothing, perhaps, is known of the manner in which the syphilitic matter is acted on, whether neutralized simply, dis- solved or decomposed. All on this subjed positively known is, that the effects of the vims are no more visible after it has been acted on l>y this and other catalytic remedies. It may bo de- stroyed in the blood before the effects, or "secondary symptoms," make their appearance, and the local lesions and disturbance of nutrition, caused by its deposit in the tissues, thereby prevented. The system may be rid of the poison, however, and a healthy condition restored after being thus distributed, provided there be no irreparable loss of structure from the destructive process following the deposit. Any preparation of mercury for internal administration may be used for its catalytic effects. A sufficient amount will be ab- sorbed, however insoluble the preparation may be, after proper and regular administration. The elective effects of mercury upon the gums and other parts of the body, make it objectionable to introduce excessive quantity into the circulation at one time. Without caution in this particular, injurious effects may result from the remedy, equal sometimes to the disease itself. This effect, however, is rarely, if ever, produced, it is said, while the system is under the contamination of syphilitic virus. Pilula Hydragyri — Blue pill Mass — is a convenient preparation for use, and in the dose of five or six grains, once a day, will be borne readily by most persons, without unpleasant effect upon the gums. Hydrargyri Chloridum Mite — Mild Chloride of Mercury — Calomel — will produce about the same general effects as bine mass, in one-fifth the quantity; say, for the ordinary catalytic effect in syphilis, etc., one grain every day for several days. As these preparations are dependent, in a great measure, upon acid met with in the stomach, for their solution, they have not that regularity and certainty of action to be expected from more soluble preparations. In acute inflammatory diseases, such as membranous croup, cerebro-spinal meningitis, etc., this preparation is given advan- tageously, in the dose of forty to sixty grain*, as an anaplastic or AND THERAPEUTICS. 169 defibr mating agent. The cerebral excitement, leading to deli- rium, convulsions, etc., in the latter disease is also, to some extent, allayed at the same time, by what is supposed to be its sedative effect upon the brain, in large dose, as exhibited in delirium tre- mens, convulsions of children, etc. Hydrargyri Chhridum Corrosivum — Corrosive Chloride of Mer- cury. This preparation is not subject in its action to the contin- gency mentioned above. Being readily soluble, it is promptly absorbed from the stomach and enters the circulation at once. It is a local irritant, and requires dilution when the stomach is empty, in order to prevent injury to the mucous membrane. An eighth of a grain, dissolved in two fluidounces of water, once a day, is the proper mode of administration. In order to guard against salivation, with subjects easily impressed in this way, it is neces- sary, sometimes, to make two days interval between the doses. The above directions for the administration of mercury are applicable to the treatment of syphilis and other chronic affec- tions in which the action is to be kept up for some time. When used in acute inflammatory diseases, the dose must be much larger and repeated in a few hours, if necessary. In small children, and adults when high arterial excitement exists, salivation rarely results even from large doses. Iodinum — Iodine. This substance is found most abundantly in the ashes of sea- weed, and is obtained in the form of dark crystaline scales of metallic lustre. It is soluble in alcohol, very slightly so in water evaporates in the air and completely volatilizes by heat, rising in violet coTored fumes. Iodine stands preeminent as a catalytic in the destruction of syphilitic virus, after the disease has advanced to the develop- ment of " secondary 7 ' or "tertiary" "symptoms." In order to eradicate the morbific agent, before such progress has been made, the use of iodine should be continued for some time after mercury s suspended. The system may be freed from the poison by the latter remedy alone, but with much more certainty when iodine is freely given with, and after it. 170 A.C0L0G1 While this remedy has obtained great celebrity on account of the solvent or decomposing power it exerts on fibrinous tumors, certain forms of hypertrophy, etc., it has not been considered useful as a defibrinating agent, like mercury, in the treatment of acute inflammation. From this difference of the c litions of the system in which these two articles have been thought most useful, it would seem that they act upon and eliminate the same material, though in different states. The same ingredient is acted on by both, but mercury is preferred while the substance to he dissolved is in the circulation, and iodine more certainly effects the object after the morbific agent has been deposited in the solid tissues. The same seems to be true in regard to syphilitic virus. Mercury eliminates it while in the blood, but iodine is required when it is deposited in the solids. The catalytic action of iodine on tuberculous and scrofulous matter is believed to be sufficiently certain to warrant its use for this purpose, while mercury is not considered applicable in these diseases. This is, either on account of its being incapable of such action, or from the fear of its impoverishing influence upon the blood, which should always be avoided in strumous subjects. Unguentum Iodinii — Ointment of Iodine — Iodine Ointment. This preparation is used locally for tumors, fibrinous deposits, etc. The surface over the affected part may be rubbed with it once a day, or a saturated cloth applied to the skin. In this way, and by the internal use of iodine, a very inconvenient enlargement of the thyroid gland, called goiter, and other fibrinous deposits may be removed. The results of rheumatism, such as enlargement and stiffness of the joints are also properly treated by this means. Potassii Iodidum — Iodide of Potassium. This soluble salt of iodine has almost superseded all other preparations for internal use. In the treatment of primary syphilis, five to eight grains three times a day, dissolved in water, simple syrup, or some prep- aration of another catalytic remedy, is a favorite prescription in primary and secondary syphilis. When the disease is of long standing and has reached the secondary or tertiary stage, particularly the latter, much larger doses are used. Twenty, thirty, and even .sixty grains! three times AND THERAPEUTICS. 171 a day, may be necessary in tertiary syphilis; at the same time protecting the stomach from irritation, by copious draughts of water or flaxseed tea. In this way painful nodes and unhealthy ulceration are sometimes relieved as by a charm. It is believed, as above stated, that the pain and immobility about the joints from fibrinous deposits on the theca, etc., called chronic rheuma- tism, may also be relieved by this remedy, in the dose of ten to twenty grains. Tinctura Iodinii — Tincture of Iodine. Recent experiments made with the tincture and watery solution of iodine, seem to justify the opinion that these preparations are equal to the iodide of potassium in the treatment of secondary syphilis and other diseases, if given in correspondingly large doses, say twenty to sixty drops. Being much more economical preparations, there is no reason why they should not supersede the expensive iodide, should the above suggestion be verified by more thorough inves- tigation. Poisonous quantity may be avoided by gradual increase of the ordinary full dose. LugoVs Solution consists of forty grains iodide of potassium and twenty of iodine, to seven fluidrachms of water. This forms a concentrated watery solution, and may be used in the dose of ten drops for the ordinary effects of iodine ; and is preferable to the tincture for local application. Preparations, in which mercury is combined with iodine, afford convenient forms for the administration of both remedies at the same time, in cases which do not require large doses of iodine, nor its continuance longer than mercury can be taken with pro- priety. Hydrargyri Iodidum Viride — Protiodide of Mercury — Green Iodide of Mercury. This is a greenish-yellow powder, insoluble in water, and may be given in the dose of one grain, in the form of pill. Hydrargyri Iodidum Rubrum — Biniodide of Mercury. This is in the form of red powder, and is called the red iodide of mercury. It is insoluble in water, excessively irritating and poisonous to the alimentary mucous membrane, in excessive quan- tity. The dose is one-tweljth of a grain, and is more conveniently given in the form of pill. L?2 ACOLOGY These combinations do not allow very decided iodine effect, without the risk of injurious mercurial ization, and, therefore, no practical advantage can be derived from them beyond that of the remedies used separately. Indeed, failure to realize the lull benefit of iodine may depend upon its use in combinations of this kind. The union of iodine with iron is less objectionable, since both ingredients entering into the combination, may he given with impunity tor any desirable length of time. Ferri Iodidum — Iodide of Iron — is a greenish, deliquescent erystaline substance, with styptic chalybeate taste. This com- bination serves the purpose of ferruginous preparations, but it is not used in quantity sufficient to obtain the full effects of iodine that arc sometimes desirable, as in the compounds of mercury. There arc cases, however, of impoverished blood, containing at the same time morbific agents subject to the catalytic action of iodine, in which the combination is useful. Scrofula, tubercu- losis and depraved syphilitic constitutions are of this kind, and in which it is of the utmost importance to give the blood an in- crease of red corpuscles while the fluid is being rid of mor- bific matter. The done is one grain, in solution or made into pill. Syrupus Ferri lodidi — Syrup of Iodide of Iron. This is the best form in which to preserve from deterioration this compound preparation of iodine, and even it is liable to decomposition unless properly made. The dose is from twenty to thirty drops, diluted well with water at the time of taking, so as to prevent injury to the teeth and irritation of the stomach. Sarsaparilla. The root of Smilax Officinalis and Smilax Sarsaparilla. The former grows abundantly in, and is sent into commerce from, Mexico and the Central American provinces, particularly Hon- duras. The latter is indigenous, and is found in considerable quantity in many portions of the Southern States. Both are trailing plants, with long, slender grayish colored roots. The drug obtained from the two species is similar in appearance and AND THERAPEUTICS. 173 medicinal properties. Most of the root found in market is shipped from the Bay of Honduras, and is called Honduras Sarsaparilla. This is, doubtless, a valuable drug, but has been used exten- sively in the treatment of affections over which it has no control. Like other remedial means gaining celebrity in the cure of cer- tain diseases, its application is made too general. It has not only been used as an "alterative," so-called, from which it became a popular remedy, but as a digestive and nervous tonic, heematinic, etc. Its good effects, however, are perhaps realized only in its use as a catalytic in syphilis, scrofula, and the results of chronic rheumatism. It is a "purifyer of the blood/' only when this fluid contains morbific agents subject to its catalytic action. Syrupus Sarsaparilhe — Syrup of Sarsaparilla — is one of the most convenient and useful preparations of the drug. In the dose of half a fluidounce, three times a day, its impression will gradually be made. In this form it can be used readily in con- nection with iodide of potassium, by dissolving the latter in pro- portions suited to the amount of iodide requisite in the particular case. From a half to one troyounce or more of the iodide of potassium may be dissolved in a pint of syrup of sarsaparilla, according to the amount of iodide required, and a tablespocmftd given three times a day, The fluid extract is a more concentrated preparation, and may be used in the dose of a fluidrachm. Stillixgia — Queen's Delight The root of Stillingia sylvatica, an herbaceous plant, with per- ennial root, native of the United States, and found abundantly in the sandy portions of South Carolina, Georgia and Alabama, The root, which is thick and woody, sends up, in the Spring, stems to the height of two or three feet. Stillingia may be used alone or with sarsaparilla in the treat- ment of syphilis, scrofula, and other conditions in which the catalytics, already noticed, have been found useful. A syrup of sarsaparilla and stillingia, though not recognized 174 LCOLOGl by the Ias1 edition of the Pharmacopoeia, is a popular preparation, in which iodide of potassium is dissolved for the treatment of Syphilis, certain cutaneous affections, etc. ; the dose is a lia/f to <>n< fluidounce, regulating the quantity of iodide to -nit the particular case under treatment. A decoction is made by boiling a troyounce of the bruised root in twenty tluidounces of water, down to a pint. Doge, one or tiro fluidounces. The tincture maybe used in the dose of one fluid- nic/nn. Arsenk ;um — Arsenic. Arsenic is a grayish crystalline, brittle metal, having, when recently broken, a brilliant metallic lustre and granular appear- ance. It is tasteless, but emits a peculiar odor when rubbed. This metal unites with oxygen in proportions to form arsenic and arsenious acids. The latter is officinal and technically called Acidum Arseniosum — Arsenious Acid. This acid, when re- cently prepared, is in the form of a transparent mass and is readily soluble in water, but when exposed to the air for some time, falls in to an opake white powder, without odor or taste, and soluble in water only to a limited extent. In this form it is usually found in the shops, is called arsenic and may be mistaken for calomel or other substances of similar sensible properties. Arsenious acid, though a virulent poison of the narcotico- irritant variety, is a valuable medicinal agent, and may be used without the slightest risk of unpleasant or poisonous effects. Its raodas operandi, like most others of this class, has been very im- perfectly understood. From the want of facts as to the parts acted upon and the manner of that action, it has been called an " alterative," in accordance with the mysterious change effected. It has long been used as such in chronic cutaneous diseases, which are probably the result of some morbific material deposited from the blood in the skin. With this view of their pathology the, action of a remedy ridding the system of this irritating cause, can with propriety be called catalytic. Moreover, comparatively recent experiments with arsenic in the treatment of cancer seems to prove, beyond contradiction, its AND THERAPEUTICS. 175 catalytic influence on cancer cell. A test is now being made, tinder our immediate supervision, of its virtue in this respect, which promises very satisfactory results. Should this dreaded poison be found to control cancer, a disease of all others the greatest terror of mankind, a nation's gratitude is due the laborers in its discovery. Hunt, Feb ure, and more recent therapeutists have testified of its virtues in this disease, and in the absence of other constitutional means, why may not a trial be made in all cases where the destructive process has not advanced so far as to preclude the possibility of recovery? The local application of arsenic openly, and as the chief in- gredient in nostrums prescribed and vended by empirics, has for a long time been practiced in the treatment of cancer. There is no good reason for supposing, however, that any escharotic, however active, can supersede the knife in removal of cancerous tumors ; and for its catalytic action, if such it possess, certainly the internal administration is preferable. Its use for several months is necessary in order to test thoroughly its efficiency in cancerous constitution. • In the treatment of chronic intermittent fever, neuralgia and rheumatism, arsenic is a popular remedy. Its mode of action in the relief of these affections is not positively known. It cer- tainly is a neurotic as well as catalytic, and as these affections probably all depend on nervous disturbance, it is not strange that arsenic in their cure should be called a nervous tonic. On the other hand, it must be remembered that it is only in the chronic form of these diseases that arsenic is found particularly useful ; and if from a tonic property, similar to that exercised by quinine, in arresting their paroxysms in the acute form, why has it not been found useful for this purpose? Perhaps all is due to catalysis, for arsenic is not likely to prevent an expected paroxysm of intermittent fever, nor of the other diseases named. When, however, their recurrence is temporarily arrested by ap- propriate means, and from some seemingly latent cause there is proneness to a return, arsenic may be given with the expectation of counteracting this tendency. The peculiarity of intermittent fever, in its periodical par- 176 LCOLOO oxymSj is most remarkable, and the pathalogical condition upon which depends the liability to return after perfect freedom from all the symptoms for three week-, has eluded the vigilance of the most critical investigators. It is evident that the disease in question originates in poisoning of the cerebro-spinal nervous centre by what is called malaria; and whether this poison i- of cryptogamous, or other origin, it is not unlikely that a wander- ing ger in finds a nidus in the blood vessels or elsewhere, and that its period of incubation is measured by the length of respite from disease. According to this theory, the action of arsenic in the cure of chronic chills may appropriately be called catalytic. The dose of arsenious acid in substance is about one-sixteenth of a grain, gradually increased to an eighth. Liquor Potassii Arsenitis — Solution of Arsmite of Potassium. This preparation, also called Foivler's solution, from its originator, is in general use for the internal administration of arsenic. The combination with potassium does not change the medicinal prop- erties of the acid. The salt is expected to liberate the arsenious acid, by coming in contact with acid in the stomach. Half a grain of arsenious acid is contained in each fluidrachm of the solu- tion, and the dose is, therefore, about ten drops, gradually increased to fifteen. Various combinations of arsenic with iodine, quinine and iron are officinal, and may be used according to the indications in particular cases. Acidum Sulphurosum — Sulphurous Acid. It has been ascertained that this acid will destroy the micro- scopic sporules necessary to fermentation. When it is added to vinous or malt liquors undergoing this change, the process is ar- rested. This fact led to a test of its catalytic action on similar organisms in fluids of the human body. Diseases called zymotic are supposed to arise from the presence in the blood, and in other fluids, of fermenting germs; and it is thought that though the effects produced cannot be allayed at AND THERAPEUTICS. 177 once, yet the derangement in the fluids, upon which they depend, may be counteracted by this remedy. To this end the acid has been recommended in typhus, typhoid and malarial fevers scarlatina, cholera, etc. Favorable reports of its action in this way have been made. This acid, like arsenic, is preferred in the form of salt, from combination with one of the alkaline bases, sodium, potassium, lime and magnesium. Almost any acid met with in the stomach readly iunites with the salifiable base of the salt, and extricates the acid. These are called sulphites, and may be given in the dose of sixty , grains dissolved in water. Chloroformum — Chloroform, This liquid, described under the head of cerebral stimulants is known to produce catalytic action in uraemia. Chloroform has been successfully used in puerperal eclampsia, but, no doubt, with a misapprehension of its modus operandi. Being a cerebral stimulant, it is natural to conclude that through this action the convulsions are arrested. The correct theory, however, is doubt- less that which ascribes its usefulness to the catalytic influence upon urea, which accumulates from scanty diuresis, and consti- tutes the injurious ingredient of the blood. It is now considered a sufficient indication for its use to find, in the latter stage of pregnancy, greatly diminished quantity of urine even without the presence of convulsive symptoms. Albumen is generally detected, under such circumstances, in the urine. Does not the fact that chloroform forms a gelatinous combination with al- bumen warrant the experimental use of it in albuminuria ? It seems reasonable so to conclude. Ammonii Chloridum — Chloride of Ammonium. This is a tough fibrous, translucent salt, inodorous, of pungent taste, and soluble in water. It is said, by Dr. Wood, to act as a stimulant, and from its effects in certain forms of nervous disturbance, is supposed to be an excitant of the neryous centres. 12 [78 ECOLOGY As a catalytic, i( has been found useful in hypertrophy and independent fibrinous growths. Iir its tendency to the solution of fibrin, whether organized or not, there is a striking resemblance to the action of iodine and mercury. Its use is not limited to the removal of solid structures, but, like mercury, is recom- mended in inflammation, and probably proves useful by its de- structive action on fibrin in the blood. In the treatment of such tumors, its local, as well as internal use, has been resorted to. A cloth applied to the skin over the tumor, and saturated as it becomes dry, with a solution of this salt, at the same time taking it internally, is a favorite mode of treating such affections by some practitioners. It would seem, however, that of the quantity which niay be taken into the stomach with impunity, a sufficient amount may be used in this way, without depending upon its tardy absorption from the skin. The refrigeration, however, produced by its external application, may materially aid in the reduction of superficial growths, and to this probably is due most of the benefit derived from this mode of application. Muriate of ammonium has been, for a number of years, recom- mended in chronic bronchitis. Whether as an antiphlogistic, by its lessening the exciting quality of the blood, or as a catalytic of the tuberculous degeneration which sometimes leads to bron- chial irritation, is not certainly known. The latter is more likely, since defibrination and other antiphlogistic measures are not gen- erally useful in chionic inflammation, without some other com- pensating property they may possess, by which the cause of irri- tation is destroyed. May not its good effects in this condition depend upon the power of decomposing, or in some way destroying the tuberculous matter, which, from its deposit in the bronchial mucous membrane, leads to bronchitis? In hypertrophy of the uterus dependent upon long-standing engorgement, this remedy has been considered useful, and is rec- ommended by Dr. H. V. M. Miller in most cases of engorgement and irritation of this organ, which lead to the various forms of functional derangement. The dose of muriate of ammonium is from five to fifteen graim three times a day, dissolved in water. AND THERAPEUTICS. 179 Chimaphila — Pipsissewa. The leaves of Chimaphila umbellata, a small perennial ever- green, found in most parts of the United States, particularly the northern portion. The leaves, which are spear-shaped, have peculiar odor, and not unpleasant bitterish, astringent taste. The two species, C. umbellata and C. maculata, are known by the common name of wintergreen. Chimaphila (from y/lf w -> winter, and (pdsco, to love) has long been thought useful in scrofula, and doubtless acts as a catalytic upon the peculiar substance characteristic of this disease, in the blood vessels themselves, in the skin, cervical glands and wherever else deposited. It is used not only after the develop- ment of irritation and ulceration in these locations, but in order to prevent such results, so soon as evidences of the disease are manifested. In strumous subjects, this remedy, in connection with iron or other hsematinics, serves to prevent such developments. As before stated, prostrating causes, such as are calculated to impoverish the blood and enervate the system, tend to develop scrofula and tuberculosis in persons of strumous diathesis. To prevent these results, when the state favoring them exists, the course just suggested is eminently proper. The catalytic action of pipsissewa upon scrofulous matter that may exist, together with supporting and invigorating means, proves serviceable in arresting the disease. Decoction is the form in which pipsissewa may be conveniently used. The dose of this is about four fluidounces three times a day. A syrup has also been prepared for use, and given in the dose of about one fluidounce. We have now concluded the consideration of prominent cata- lytics, such as have generally been recognized as "alteratives" or "eutrophics." There are many other articles that have this action in some degree, a few of which we shall mention, without, however, an extended account of them or prominent position in the class. Amongst these, some may be found .to possess even more active qualities than those now mainly relied on, when 180 ECOLOGY thorough investigation of their properties shall have been had. Manganese, though the metal was discovered nearly a century since, is not very well understood, so far as the direct physiologi- cal effects of its preparations are concerned. PermanganaU of Potassium, judging alone from its powerfully disinfectant property, may be found eminently useful in the de- struction of morbific agents in the fluids and solid tissues of the body. Indeed, experience proves its catalytic action in ehronie rheumatism and certain forms of uterine disease. The dose is one or two grains three times a day. It is best kept in the form of solution for use, on account of its deliquescent character. Bromide of Potassium is said to resemble the corresponding preparation of iodine, and, by Ricord, thought to be inferior to it in the treatment of secondary syphilis, only in acting more slowly. As a discutient, in scrofulous tumors and goitre, its re- puted action is similar to that of iodine, and, like it, is also applied locally, in the form of ointment, in superficial tumors. So far as tested, this remedy seems to have catalytic power over the same substances acted upon by iodine, and besides this, has also a decided influence upon the nervous system. Galium aparine, Walnut leaves, Mezereon, Sulphur, Rumex Xanthoxylum and convallaria are mentioned in connection with alterative action by authors, but their reputation as catalytics will not warrant confidence in their use. Antacida — Antacids. This variety of catalytics, as the^name implies, destroys acids, and does so by combining with and forming neutral salts. They are intended to affect acids which may exist in the alimentary canal, in the blood and in the urine. Antacids have not hereto- fore been considered in works on Materia Medica, under the same head with the preceding articles, or those usually denomi- nated alteratives, but since all alike produce their effects by cata- lysis, according to our theory of their action, they should cer- tainly be associated in the same class. The substances which neutralize, destroy or eliminate acids AND THERAPEUTICS. 181 are alkalies, alkaline earths and their carbonates. The carbonates are equally effectual as antacids, since carbonic, the most cowardly of all acids, readily gives up the base with which it is combined at the approach of any other acid, and is set free in the form of carbonic acid gas. A state of the digestive organs consequent upon the existence of various diseases, pregnancy, etc., favors the accumulation of acid in the prima? vise, and sometimes in the blood. This leads to divers unpleasant symptoms and injurious results. Ex- cess of acid is inferred from its presence in the excretions of cer- tain emunctories. When it exists in the urine, antacid catalytics neutralize it in the blood, and relieve the unpleasant effects upon the bladder, urinary passages and the kidneys themselves. Not only so, but the formation of calculi is often the result of exces- sive acidity, and hence alkalies or catalytics of acid are, under such circumstances, useful antilithics. Lithia. Lithia (from ?J0oz, a stone) is the protoxide of Lithium, formed by a union of oxygen with this metal, and recognized as one of the fixed alkalies. The combining number of lithium with oxygen in forming lithia being lower than that of calcium, sodium or potassium, its salts are more readily decomposed, and hence make better antacids or neutralizing alkalies. The salts of lithium readily neutralize uric or lithic acid in the blood, when, from functional disturbance of the kidneys, urea accumulates, and they, therefore become catalytics of this sub- stance, which often leads to formidable and even fatal disturb- ance of the vital organs. It has been said that insoluble lithates, deposited in the bladder in the form of calculi, also giving trouble in gout, etc., are decomposed and excreted by this remedy. Lithia then, if this be true, serves, not only the ordinary purpose of alkalies in preventing the gastric, enteric, and renal irritation consequent upon the presence of acid, but proves to be a solvent and catalytic of solid formations. Litkii Carbonas — Carbonate of Lithium — is a white powder, sparingly soluble in water, and affords a preparation by which 18$ A-dOtOtf acid in the alimentary canal may be readily neutralized. The salt is so easily decomposed thai any acid met with in the stom- ach, at once unites with and decomposes it, the carbonic acid escaping in the form of • gas. The dose ia about five grama, and may be repeated every two <>r three hours, if necessary. Lithii Oitras — Citrate of Lithium — is a white inodorous pow- der, and soluble in water. This preparation may be considered preferable to the carbonate, when its catalytic action is to be effected through the circulation, as it is readily absorbed without decomposition, owing to its solubility in water. It is, however, less certain for the destruction of acid in the stomach, for the same reason. About ten grains may be given, dissolved in water and repeated at intervals of four or five hours. Magnesia — ^-Calcined Magnesia — is, chemically, the oxide of magnesium. This substance is never found in nature uncom- bined, and when separated from its connections and exposed to the air, readily absorbs carbonic acid, and becomes a carbonate. It is prepared, for commerce, from the carbonate by subjecting this salt to a red heat. In this process the carbonic acid is driven off in the form of gas, and the magnesia remains in a light, inodorous, tasteless, insoluble powder. Pure calcined or uncombined magnesia is a mild, unirritating antacid, and is extensively used by pregnant females to relieve acid stomach, which, with some in this condition, proves a source of great annoyance. It is more or less cathartic, as will be seen from a notice under the head of aperients, according to the char- acter and quantity of acid met with in the canal. When given, however, in greater quantity tharr is necessary to unite with ex- isting acid in the primse vise, it is liable to prove injurious by accumulating in masses, or forming a kind of coating to the in- terior of the bowels, consisting of the earthy substance with the mucus of the intestines. The quantity necessary for any given case must be determined by the necessity for its use; that is to say, the amount of acid to be neutralized. Thirty grains may be taken, stirred in water, and repeated if evidences of acid in the stomach still exist. Magnesii Carbonos — Carbonate of Magnesium — is in variously AND THERAPEUTICS. 183 sized masses, having, when pulverized, sensible properties simi- lar to those of uncombined magnesia, and may be used in the same doses, and for the same purposes. Its combination with carbonic acid is so readily disturbed by the presence of other acids, that its union with any of them found in the stomach, is as speedy and perfect as if given in the uncombined form. Calx — Lime — chemically, an oxide of calcium, is obtained to supply the large demands of commerce by subjecting the car- bonate, or limestone, to calcination. It is found abundantly in nature, perhaps never uncombined, and generally in the form of carbonate. Marble, common limestone, marl and chalk are all carbonate of calcium, but with different proportions of the acid and base. When the carbonate is exposed to heat sufficiently to expel the acid, it is called quick-lime, but remains hard until water is added, or until it has been exposed for some time to the atmosphere, when it falls into a white powder, and is then known as slaked lime or hydrate of calcium. Iu this form it is used as an antacid, and though sparingly soluble in water, is sufficiently so to be given in watery solution, called Liquor Calcis — Solution of Lime — Lime Water. This may be made by adding half a troyounce of lime to a pint of water. The clear solution can be poured off and taken in the dose of three or four fluidounces. Lime water is one of the most convenient and useful antacids in cases of ordinary acidity of the stomach • and in bowel affec- tions may be mixed with the food or remedies used in their treatment. The great tendency to the generation of acid in such diseases, and its injurious effects upon the inflamed mucous mem- brane, render the constant use of antacids necessary. An excel- lent preparation of food for children, under such circumstances, is made by adding one part of lime water to three or four of milk. With this the child may be sufficiently nourished, and the accumulation of acid prevented. Potassii Carbonas — Carbonate of Potassium. An impure car- bonate known in commerce as potash, is made by evaporating lye of common wood-ashes to a solid consistence. This, when partially purified by additional exposure to heat, is called Pearlash, 184 aoouhjv from which the officinal carbonate may be prepared. Some im- purities arc said to exist in what is called the pure carbonate, from pearlash ; and it is only when made from the bicarbonate or bitartrate of potassium that it is entirely free. It is then called Potassii Garbonas Pwra — Pure Carbonate of Potassium. Botli preparations are sufficiently pure for ordinary purposes, and alike consist of a white deliquescent salt. Potassii Bicarbonas — Bicarbonate of Potassium — has the ad- vantages of being permanent in the air, more pleasant to the taste and acceptable to the stomach. It is soluble in water, and in medicinal properties similar to the carbonate. These salts of potassium are useful catalytic antacids, and may be given in the dose of twenty to forty grains dissolved in water, for excessive acidity whether of the blood or alimentary canal. In diarrhoea and dysentery, or in duodenitis, leading to imperfect discharge of bile into the bowels, and consequent jaundice, the regular administration of this alkali is decidedly useful, in order to the destruction of the constantly accumulating acid, which tends to irritate the inflamed surface. It may sometimes be ad- vantageously combined with other remedies, not incompatible. It may be used in acid urine with the effect of changing the character of this secretion in a few hours, by its catalytic or antacid effect upon the blood. Soda and Ammonia are alkalies and may be used also as antacids. AND THERAPEUTICS. 185 SUB-OKDEK, IT. ELECTIVE ACTION THROUGH VITAL PROCESS. DIVISION I. REMEDIES THAT AFFECT THE ALIMENTARY CANAL. CLASS I. INVERSE GASTRIC EXCITANTS, OR EMETICS. Peristaltic, peristalticus — from TrepeaveXXo), to contract around — implies the force given by the muscular coat of the ali- mentary canal upon its contents. This, when exerted in the nat- ural way, carries the food downward from the stomach through the intestines, but when inverted, forces it in the opposite direc- tion, and leads to the result called emesis. The inverted peris- taltic force sometimes affects the small bowels, and, notwith- standing the valvular construction of the pyloric orifice, their contents regurgitate into the stomach. According to the generally accepted definition of emetics, the class includes only such articles as have elective action, exciting inverted or reversed peristaltic contraction. Hence, they are understood to be such remedies as produce this movement, with- out the stimulus of bulk, or the sympathetic influence of taste or smell. This definition excludes from the list the mechanical and other local means, used as adjuvants in the production of vomit- ing. Large draughts of warm water, salt water and mustard water are used in connection with the administration of emetic remedies, under particular circumstances, to aid in evacuating the stomach. When the usual sensibility of the organ has been obtunded from any cause, it does not readily respond to the natural impression of emetics, until aroused to activity by mechanical pressure, from repetition, or from the irritation of local 186 ACOLOGt excitants. Sometimes these alone, without the specific influence of true emetics, promote vomiting. In order to distinguish elective, specific or true emetics from those means which do not possess such property, i< is only neces- sary to determine whether a given medicine will affect the stomach in this way, when introduced into the rectum or any other part of the body. Vomiting is as readily induced by an emetic proper, when injected into the rectum as when admin- istered in the stomach. Absorption of it into the circulation is all that is necessary, in order to the inverted peristaltic action. Not so with mustard and other local excitants, which, though they lead to the same movement, do so indirectly by exciting first the mucous coat. The manner in which immediate influence is exerted by these upon the stomach, as well as the way in which all other elective agents affect the organs for which they have specific affinity, afford a subject for controversy. Some suppose the particular ganglia, or portions of .he nervous centre supplying an organ directly, receive the impression of the remedy, and that the phe- nomena exhibited in the functional modification of such organ are only the result of nervous changes. This view- seems to be made plausible by the fact that nervous impressions bring about results similar to those following the use of agents called elect- ive or specific upon the organ itself. Thus, a blow upon the head, or violent shock to the nervous system from serious in- jury to any part of the body, may lead to vomiting. Exces- sive mental agitation sometimes affects the functions of cer- tain organs in the same manner as remedies whose action is directed specially to them. Opium, which is known to affect directly the brain, often leads to nausea and vomiting after the primary or exciting impression upon the nervous centre has sub- sided. Such incidental disturbance is observed in various organs, not only from opium, but other neurotics. None of these exam- ples, however, come up to the regularity, promptness and certainty which characterize the action of elective agents; and, although, in the present state of our knowledge, we cannot understand the vital or physical changes produced in certain parts by contact of AND THERAPEUTICS. lg? the remedy, brought througli the circulation, yet that such im- pressions are made we are forced to admit. The mechanical influences brought to bear in the act of vom- iting are threefold. The abdominal muscles, the respiratory organs and the stomach itself are more or less concerned. Nausea accompanied generally with an increased secretion of saliva, is the premonitor of the act. Suddenly, in the midst of this dis- tressing sensation, the lungs are filled with air, the glottis is closed and the abdominal muscles contract violently. In con- nection with this effort, it is supposed that inverted muscular contraction of the stomach also takes place. This is inferred from the fact that vomiting sometimes occurs when no evidences of external force are manifested. "Spitting up the food/ 7 as it is called, evidently depends upon the inverted action of the stomach. This occurs often without nausea, and the amount discharged is more or less abundant, according to the extent and violence of the contraction. The respiratory organs aid in the evacuation, only by affording resistance to the pressure in that direction, from contraction of the abdominal muscles. The force thus exerted by them not only aids materially in evacuating the stomach, but, together with the inverted peristaltic action of the small intestines, often forces through the pyloric orifice, fluid contents of the duodenum, noth withstanding the valve-like open- ing through which it has to pass. Bile is frequently found in ejections from the stomach, particularly after several efforts to vomit, being driven through the orifice by these forces. The immediate effects of this class are : 1, evacuation of the stomach; 2, modification of the circulation, from pressure upon the organs and large blood vessels of the abdomen, in the act of vomiting; 3, sedative influence upon centres of the circulatory and nervous systems; and 4, general relaxation of the muscular and other soft tissues. The first two are the result of elective vital action, but purely mechanical in themselves ; the latter are therapeutic changes in the circulation, through the physiological action of a nauseant upon the stomach. The objects had, then in the use of this class are: to evacuate the stomach; to force the blood from the central vessels to the periphery ; and to cause relaxation and sedation. 18$ acotocrt For febrile ami inflammatory diseases, discharging the stom- ach of its contents is not so important as some suppose. In malaria] and other fevers this class is often used to advantage, and the benefit improperly ascribed by many to the mere evacu- ation of bile and other vitiated secretions. So far from this be- ing the true mode oi affording relief by them, under such cir- cumstances, the bilious discharges are doubtless forced into the stomach from the duodenum, mechanically, in the act of vomit- ing, and would probably never have found their way into the stomach at all, but for the contraction of the intestine and the pressure produced. While it is not denied that the secretions of the stomach, acid accumulations and improper quantities and qualities of food may, in fevers or other diseases, prove injurious, and should be evacuated, yet in a large majority of cases in which the benefit derived from these remedies is attributed to this, the equalizing effect upon the circulation and the sedative and relaxing influence are those to which the relief is due. The advantages derived are not, therefore, in proportion to the amount discharged, but, on the contrary, when least is evac- uated, relief is often more decided, the nausea and effort to vomit being greater. In malarial fever, particularly that form called "congestive" or " pernicious/' in which the circulation is feeble in the extremities, the surface of the body cool, with sense of great heat and oppression of the central organs, vomiting induced in any way, so as to bring to bear the mechanical press- ure necessary to force from the internal organs the accumulation of blood, tends to relieve this unpleasant and dangerous condi- tion. This cannot be relied on alone, however. That state of the nervous system upon which the congestion mainly depends, demands prompt attention. If the stomach be selected for the application of cerebral stimulants under such circumstance-, emetics are, of course, inadmissible, on account of the importance of having the neurotic remedy retained. The nausea accompanying the action of emetics, from its gen- eral relaxing influence and depressing effect upon the circulatory system, is made useful in the treatment of inflammatory diseases. AND THERAPEUTICS. 189 Their full benefit in this way may be obtained without vomit- ing, bv giving occasionally a quantity not sufficient to produce the full effect. Some of the articles belonging to this class have elective sed- ative properties, and in quantities insufficient to produce even nausea, may be given as arterial or cardiac sedatives. These, however, are named as such in their appropriate class, without any reference to the emetic property which they possess. The complete relaxation attending excessive nausea has been made useful in reducing strangulated hernia, and also in soften- ing the unyielding os uteri sometimes found in labor. Three or four practical divisions of these remedies may be made in describing the peculiar effects of articles belonging to the class. The arrangement of some authors, grouping together for description all those of vegetable origin as one variety, etc., has no practical importance; but when those having in common the same prominent medicinal peculiarity are associated together for study, the same advantages claimed for general classification are secured, to which we have already alluded. Some emetic remedies produce nausea and vomiting without any depressing influence upon the central organs of the circula- tory or nervous systems, further than that resulting naturally from nausea. Others prove not only sedative to one or both of these centres, but highly irritating to the stomach itself. There* are those also which, while they produce full vomiting much more promptly than ordinary emetics, do so without the usual attendant nausea to any extent. With the view of impressing these practical peculiarities of articles belonging to the class, they will be found, in the catalogue below, arranged in reference thereto, and in the order observed above. Catalogue of Inverse Gastric Excitants or Emetics. Ipecacuanha, Antimonii et Potassii Tartras, Gillenia, Zinci Sulphas, Sanguinaria, Cupri Sulphas, Tabacum, Cadmii Sulphas, Lobelia, Hydrargyri Sulphas Flava, 190 A.COLOG I i'i:( \< ianiia — Tpecac. The root of Cephaelis Ipecacuanha, a small shrub found in Brazil. The root is collected by the natives, and makes a com- modity in the commerce of South America. This root, when dried, is of an ashy-brown color, and has a peculiar wrinkled and contorted appearance, with transverse fissures in the hark so deep as to penetrate even to the small ligneous portion in the centre. These transverse fissures or sulci encircle the root near each other, and give to it the appearance of small blocks strung upon a cord. The activity of the drug resides in the cortical portion, and when pulverized, the remedy is more or less active accordingly as the woody portion is excluded from the powder. Ipecac, when pulverized, has a light ashy color and slightly bitter, nauseous taste. The odor is disagreeable to most persons, and becomes more so by associating in the mind all the unpleas- antness attending its operation, with the appearance and odor of the drug. An idiosyncrasy exists with some asthmatic subjects, by which a small portion of the powder exposed in a room, ex- cites in them a paroxysm of the disease instantly. The alkaloid principle upon which its virtues depend, has been separated and called ernetin. The physiological action of ipecac is ielt in the inverse peris- taltic contraction, and consequent reflex excitement of other mus- cles concerned, leading to nausea and vomiting, with their con- sequences ; and to these all therapeutic results are due. As it may be used safely where any other emetic is tolerated ipecac can be given effectively as an evacuant, nauseant, or for mechanical pressure on the abdominal viscera — the quantity to be administered being always modified by the object sought. Pulverized Ipecac is kept by druggists, and in this form, with- out further preparation, is often dispensed by the apothecary. It is administered by temporary mixture with water, and in the dose of twenty grains will usually produce nausea and vomiting in about thirty minutes. When it is desirable to protract the nausea, five grains may be given at intervals of an hour, and in this way the effect may. be continued without producing emesis. AND THERAPEUTICS. 191 Ten grain* will often excite free vomiting, and in this quantity it may be taken for its full effects. Vmum Ipecacuqnhce — Wine of Ipecac. — This is a more agree- able preparation, the taste being less offensive, and the quantity taken less bulky. The active ingredient is already dissolved by the wine, and is therefore more readily absorbed by the veins of the stomach. A less amount of the drug will probably, there- fore, effect the desired action, than is required by a crude prepar- ation. When, however, the alcoholic constituent of the wine is objectionable in any particular case — which is rarely, if at all, met with — some other preparation should be selected. Half a fluidounce, repeated in an hour, if necessary, is the proper quantity for ordinary purposes. In this amount the wine will have about the effect of fifteen grains of the powdered root. Xo very unpleasant result is likely to follow an excessive dose of any prepara- Fl &- lo - tion of ipecac ; and a repetition of this quantity of the wine, or even the ad- ministration of double the amount at once, would not be objectionable in cases requiring its full effects. The English and American Pharma- ^vjV^ copceias differ in their formulae for the V V preparation of this wine, and conse- \* quently make it of unequal strength. cephaelis ipecacuanha. According to the former code, a fluid- ounce has only twenty grains, while that prepared in this coun- try contains, as above intimated, the equivalent of about thirty grains of pulverized ipecac. Syrupus Ipecacuanhce — Syrujj of Ipecacuanha — affords an agreeable preparation for children, and, like the wine, a fluid- ounce contains the virtues of thirty grains of the drug. This is a very useful vehicle for the administration of anodyne, seda- tive or other remedies required along with a nauseant. For its emetic effect alone, the syrup will be found one of the most con- venient forms for the administration of the remedy. The adult dose as an emetic, containing the virtues of fifteen grains of 192 ECOLOGY ipecac, is half a fluidoimoe. A fluidrachm acts promptly with children one or two pears old. ( riLLENiA — Indian Fig. 16. GUlmia trifoliata,. Physic. The root of QHUma Trifoliate, an indigenous herbaceous plant, found abundantly in the north- ern portion of Georgia, in other Southern and many of the Northern and Western States. It very much resembles ip- ecacuanha, and is some- times called American ipecac. The resemblance is not confined to the sensible properties, but is found to be equally striking in their medi- cinal virtues. So much similarity exists, that the sensible properties, pre- parations, dose and phy- siological action of ipe- cac, as given above, will answer for gillenia. Doubtless an infusion, made in the proportion of half a troy ounce of the bruised fresh root, to a pint of boiling water, given in the dose of three or four fluidounces, will answer all the purposes of the officinal prepara- tions of ipecacuanha. AND THERArEUTICS. 193 Sanguinaria — Bloodroot. The rhizoma of Sanguinaria Canadensis, an indigenous plant, with radical lobate leaves. The root lies horizontally with, and is often so superficial as to be only partially beneath the surface. When fresh, it is of a blood-red color internally; when dried, it is pale, but readily assumes the original brilliant hue by being moistened with water on the cut surface. The odor is somewhat narcotic ; the taste bitter and acrid, leaving in the mouth an un- pleasant pungency. Powder is a preparation in which bloodroot may be readily used as an emetic in the dose of about ten grains, in the form of pills, or extemporaneous mixture with water. Infusion, made in the proportion of half a troyounce of the root to a pint of water, affords the active qualities of the drug ; the dose of which is about half a fluidounce. Tinctura Sanguinarice — Tincture of Bloodroot — an officinal pre- paration, may be used as an emetic, in the dose of two to four fluid- rachms. The action of sanguinaria is most prominently exerted upon the stomach, producing nausea and vomiting; but its depressing influence upon the brain, and local irritation of the stomach, must be remembered, in order to its administration safely. In over doses it acts as a narcotico-irritant poison. Simply as an emetic, it is rarely used, but in bronchial, and other pectoral affections, its supposed expectorant and sedative properties lead to its occasional administration. Tabacum — Tobacco. The leaves of Nicotiana Tabacum, an animal plant, first dis- covered in, and perhaps native of, tropical America, and now cultivated in most countries of the world. Tobacco, with one unaccustomed to its use, has an acrid, bitter taste, and narcotic odor, leaving in the fauces and oesophagus a burning, pungent sensation, when swallowed. Infusion, made with one hundred and twenty grains to the pint of water, is the form in which tobacco is most commonly 13 194 ICOLOGY. administered. The infusion, on account of its disagreeable taste in the month, is most frequently given by the rectum. Four fluidcnmces may 6< injected, and repeated if necessary. Tobacco applied to the skin is said to be effectual in bringing on the relaxation consequent upon nausea, and to this end the pulverized drug, called snuff, is moistened, spread on cloth, and applied to the bodies of children suffering with inflammatory and spasmodic diseases of the respiratory tubes. r riie uncertainty, however, of its action in this way, renders the mode of applica- tion objectionable. Of substances so powerful in their action as tobacco, the exact amount taken into the circulation should be known, which is impossible, when absorption from the skin is the mode of its transmission. The physiological effects of tobacco are protracted inverse per- istaltic gastric contraction, with irritation of the mucous sur- face, and sedation of the great nervous centre, leading to intense nausea, general relaxation and prostration of the vital energies. As a therapeutic agent, its powerfully relaxing influence is sought, when temporary suspension of contractile power is de- sirable, as in strangulated hernia, rigid os uteri in labor, illeus, etc., etc. Lobelia — Indian Tobacco. The herb of Lobelia inflata, an annual or biennial indigenous plant, found throughout the United States. The seeds and leaves are principally selected, but the whole herb possesses sim- ilar properties, and may be used in making the ordinary prepa- rations. The direct or physiological action of lobelia is exerted upon both the stomach and brain, in the production of results which follow its use. Nausea and vomiting, with nervous prostration, are evidences of such impressions. As an emetic, it is consid- ered one of the most powerful and dangerous, on account of the depressing influences exerted upon the nervous system, and local irritation of the alimentary mucous membrane. Its poisonous action seems to be expended especially on that portion of the cranial nervous centres supplying the organs of AND THERAPEUTICS. 195 respiration. Hence, in eases of fatal poisoning from lobelia, de- rangement of this function is a prominent symptom ; and an entire suspension of breathing, before other vital organs cease to act, is a common result, The author witnessed the death of a young man from this cause, in which pulsation at the wrist con- tinued several minutes after res- piration had ceased. Like other nauseants, lobelia tends to the reduction of ordi- nary local inflammation, by its relaxing effect upon the tissues generally, and its depressing influence upon vital energies of the system. The sedation is perhaps more perfect than from other emetics, on account of its peculiar influence upon the brain, rendering it particularly applicable in spasmodic condi- tion of the bronchia and other parts connected with respira- tion. Asthma, therefore, is es- pecially subject to the narcot- ico-nauseant action of lobelia, particularly when an inflam- matory condition of the bron- chia exists. Spasmodic and inflammatory croup, tonsil itis, pleurisy and pneumonia are also diseases in which the con- ditions exist favorable to its action, and for which it is ad- ■ vised as a use-ful remedy. Owing to the severity of its action, lobelia should not be used merely to evacuate the stomach, nor in slight affections when a less violent remedy will effect the object in view. In small doses, say a fluidrachm of the tincture repeated every hour, it is Lobelia injlata. 196 ACOLOGY said to relieve spasmodic asthma and croup, when no inflamma- tion exists, without producing any considerable nausea. Thia is probably effected by the control exercised over nerves of the parts, through the narcotic or cerebral influence of the remedy. Infusion of the leave- and stems 18 sometimes made for extem- poraneous prescription of the drug, but the permanent officinal preparations furnish more convenient forms for preservation and use. Tiiu'tura LobSa — Tmdhin of Lobelia — is more generally pre- ferred, and is equally as effective and convenient as any other preparation. In the dose of ha/f a fluidounee, full vomiting will usually occur; and for the nauseating effect alone, one or tiro fluidrachms is generally sufficient. Acetum Lobelke — Vinegar of Lobelia — is an officinal prepara- tion, and said to afford the advantage of holding in more perfect and permanent solution the active principle of the drug. It may be used in the same dose as the tincture, and with equal benefit as a remedy. Axtimonii et Potassii Tartras — Tartrate of Antimony and Potassivnt. This double salt, when fresh and properly prepared, is found in the form of transparent, colorless crystals, of unpleasant styptic taste, and readily soluble in water. As usually found in the shops, it is in the form of white powder, the crystals having effloresced by exposure to the air. It is incompatible with acids and alkalies; consequently, such substances should not be com- bined nor administered with it. This article is a decided irritant of the gastric mucous mem- brane, and occasionally produces dangerous effects. Although this local irritation doubtless adds to the muscular contraction excited by the elective physiological action of the remedy, and makes the vomiting more excessive, yet, on account of the gas- tric inflammation sometimes induced, less violent articles are preferable as mere evacuants of the stomach. Like other articles of the class, tartarized antimony is used in inflammatory and spasmodic diseases, on account of the nausea AND THERAPEUTICS. 197 and consequent relaxation induced. In addition to this, it ex- erts a sedative influence over the heart's action, and but for the danger of producing gastro-enteric derangement, in irritable subjects, would be universally applicable in pneumonia, and active inflammation of other vital organs. Notwithstanding this, however, it has been often used successfully in such cases. Tartar emetic enters into the preparation of important febri- fuge and expectorant compounds; and to it is due most of the sedative influence exerted by them. The refrigerant and seda- tive compound, called " nitrous powder," contains, besides calo- mel and nitre, one-eighth grain of this salt. Under proper cir- cumstances, it may be a useful auxiliary in the treatment of febrile and inflammatory affections. The compound syrup of squills, so extensively used in the treatment of croup, bronchitis, etc., in children, is dependent for its virtue almost entirely upon the tartar emetic it contains. For the emetic effect, tartar emetic may be given in the dose ofheo grains, dissolved in water or acacia mucilage; as a nause- ant and sedative, one-eighth to one-fourth of a grain. Half a grain , repeated every thirty minutes till full vomiting occurs, will usu- ally produce thorough evacuation. Zixci Sulphas — Sulphate of Zinc. This salt is described under the head of cerebral tonics, and is referred to now only in connection with its emetic effect. In the dose of ten grains, dissolved in water, sulphate of zinc produces vomiting promptly, and owing to the short time re- quired to act, and to the small amount of nausea it produces, poisons, and other substances requiring speedy evacuation, are discharged readily by it. Not more than fifteen minutes are required for the full effect, and it is, therefore, a suitable emetic when opium, or other poison likely soon to destroy sensibility, has been taken. Cupri Sulphas — Sulphate of Copper. Sulphate of copper is found in the form of large rhomboidal prismatic crystals, of a deep-blue color and unpleasant styptic 198 AOOLOGY metallic taste. The crystals, when exposed to the air, effloresce slightly, forming a powder in which the brilliant hue is lost. It is soluble in cold or warm water, and may be w^'d as an emetic in the dose of four grams, dissolved in water. Like sulphate of zinc, the blue vitriol is a prompt emetic, acting in fifteen minutes, or about half the time required for other emetics in common use. This differs from the preparation of zinc, however, in being more active and dangerous in its operation. The irritation produced by it in the alimentary mu- cous membrane, renders overdoses dangerous; and even in ordi- nary quantity, it should not be too frequently repeated. Ferro- cyanide potassium and albumen are incompatible with, and are, therefore, antidotes to the dangerous effects of this salt. While the only advantages likely to be derived from this agent, as an emetic, are the promptness and facility with which the stomach is relieved of its contents, yet it has obtained popu- larity as a remedy in certain inflammatory diseases Bluestone is a popular remedy in croup, and was used successfully in many cases of the pseudo-membranous variety, by a German physician. From the generally accepted modus operandi of emetics in the treatment of inflammatory diseases, it would not, however, seem to stand as a prominent remedy. To the nausea and sedation of this class are attributed most of the good effects in croup, and since less nausea is found to follow the sulphate of copper than tartar emetic, ipecac, etc., it seems just to conclude, on the recog- nized theory of their action, that the latter articles would be more appropriate remedies. As our knowledge of all the properties, even of remedies long in use, is not by any means perfect, nor our opinion of their mode of action always correct, it may not be amiss to test, within the proper bounds of caution, the correctness of this seemingly em- pirical course of treatment. Cadmii Sulphas — Sulphate of Cadmium. This salt resembles very mnch the sulphate of zinc, and like it, effloresces and becomes a white powder when exposed to the AND THERAPEUTICS. 199 air. It is very soluble in water, and has an astringent, slightly sour taste. In the rlose of about ten grains, dissolved in water, it acts promptly as an emetic, but in excessive quantity, the poisonous irritation brings about similar results to those following the inju- dicious use of sulphate of copper. In its administration, there- fore, some caution is necessary, particularly, since its use has not been sufficiently extensive to fix, with unerring certainty, the exact quantity generally required as an emetic. It belongs to that class of emetics which act speedily, and is therefore useful in evacuating the stomach of recently-swallowed poisons, etc. Hydragyri Sulphas Flava — Yellow Sulphate of Mercury — Turpeth Mineral. This salt of mercury is a yellow powder, imperfectly soluble in hot, and less so in cold water. The taste is acrid, and when applied to the pituitary membrane, it acts as a powerful errhine. Yellow sulphate of mercury is an irritant emetic, and in over- quantity is likely to produce poisonous irritation of the gastric mucous membrane. In the dose of 'about jive grains full vomit- ing will be had. The promptness with which it acts, and the freedom from any cathartic tendency, renders this article partic- ularly serviceable in the speedy evacuation of poisonous and other injurious contents of the stomach. That tendency, in the action of ordinary emetics, to carry the contents into the bowels, by their emeto-cathartic effect, from which a poison, not dis- charged at once, is subjected to the absorbent surface of the whole canal, does not exist in its operation. Turpeth mineral, on account of its exciting effect locally, and its hepatic and catalytic action, may be advantageously used to evacuate the stomach of its contents, when, from insensibility of the organ, a less active agent would not answer the purpose; or when the elective actions, above referred to, be also desirable. It must, however, be borne in mind that, like other mercurials, this salt may, when not ejected from the stomach, sometimes lead to unpleasant salivation. 200 ACOtOOt CLASS II. ENTERIC EXCITANTS, OR CATHARTICS. There is perhaps no class of remedies having a larger number of articles, nor one more extensively used than cathartics. They are in the hands of the charlatan, the nurse, and even pa- tients themselves; each prescribing liberally, and often greatly to the injury of those who swallow them. Cathartic pills, a few years since, were as common in families as household utensils, and now are frequently met with. The sluggish bowels of the dyspeptic are made doubly so by the habitual use of aperients and purgatives, taken until the ar- tificial becomes the only excitant to which the bowels respond. Enteric excitants, or cathartics, are remedies which promote evacuation of the bowels. In the main, discharges are pro- duced directly by an increase of the peristaltic motion of the intestines. Some articles have an elective tendency to the mus- cular coat; others affect the mucous surface; while a third variety causes only an exhalation into the canal, which not only so alters the consistence of the contents as to allow them to pass readily and briskly along the canal, but, from the stimulus of bulk, this excessive quantity of fluid also excites mechanically the muscular fibre to increased contraction. Cathartics, as regards the manner in which evacuation is in T duced, are also of three kinds: local, elective, and catalytic. To these may be added a variety which act mechanically, and they are of two kinds, viz: the means giving agitation, such as exer- cise, etc., and rough substances, causing mechanical irritation when placed in contact with the lining membrane of the intes- tines. Local irritation through vital process may be induced by the substance coming directly in contact with the mucous mem- brane, after passing from the stomach into the bowels, or by ab- sorption into the circulation, and transmission to this surface, upon which it exerts elective action. Certain substances entering the blood favor the exhalation of its watery constituents from various surfaces and outlets of the Attn THERAPEUTICS. 201 body, lessening the amount of circulating fluid and carrying off deleterious solutions from the mass of blood. This is called effu- sion, and that substance whose exhalation or transpiration is effected through the mucous membrane of the bowels is called a cathartic, because the effusion leads to catharsis as a result. Cathartics affect the canal, not only in these various ways, but some of them exert their influence upon particular portions of the tube, to the exclusion of others. Thus, certain articles act more upon the duodenum, some upon the rectum, whilst others, and especially those that affect the muscular structure, seem to influence alike the whole of the large and small intestines, and perhaps also the stomach. The degree of action varies materially with the different means producing catharsis, and so important is this difference to the learner, that the articles of the class are generally arranged into sub-classes, which are named, with reference to this fact, aperi- ents, purgatives and drastics. Mild enteric excitants, aperients or laxatives gently excite the bowels to peristaltic action, without increasing materially the or- dinary healthy function. The mechanical means for producing catharsis generally afford about this degree of movement, and are resorted to in habitual torpor of the intestines. Thorough enteric excitaMs or purgatives act more forcibly, pro- ducing copious discharges, and evacuating the bowels more thor- oughly. These usually cause several evacuations, yet without any very great irritation or watery exhalation, and are resorted to for the dislodgment of hardened faeces, worms, other accumu- lations or injurious substances in the canal. Violent enteric excitants, drastics or hydragogues are more vio- lent and powerful in their action, producing more or less irrita- tion and watery discharges, often attended with pain. These are used with the view of producing counter-irritation, revul- sion or depletion, and require some caution and prudence in their administration. The objects of the class are: relief of habitual constipation, unloading the bowels of accumulation, counter-irritation, revul- sion and depletion. From what has been said, these, to some 202 ACOLOo extent, may be understood. The restoration of lost natural function of the bowels, by remedial agents, sometimes becomes necessary, and a particular variety of cathartics is used for this purpose. To effect this object, mild cathartic remedies may oc- casionally be serviceable, yet, as has been said, their habitual use is often injurious in aggravating the very evil they are in- tended to remedy. Exercise, and other mechanical means of restoring energy to torpid 1 towels, are not, however, subject to the same objection. Then, one of the objects of catharsis is to relieve habitual con- stipation, brought on by sedentary habits, indigestionj etc., so as to restore and keep up the healthy function and prevent the ac- cumulation of hardened and irritating faeces. The second object, the fulfillment of which requires an in- creased degree of purgation, is that of relieving the canal of any fecal or useless and injurious contents. In ordinary disease, whether inflammatory or otherwise, unloading the bowels by a thorough cathartic not only gives comfort to the patient, but more perfect circulation in that region of the body, thereby less- ening oppression in other parts. The constant daily purging, often adopted by some practi- tioners, when but little food has been taken, and that of a qual- ity to leave very little fecal accumulation, is, to say the least of it, entirely unnecessary. Moreover, injurious effects often follow the practice of this useless custom. The other objects, viz: counter-irritation, revulsion, and de- pletion, are all filled by the same variety of cathartics. Drastic articles, such as produce considerable irritation along the track of the canal and watery discharges, are those selected for these purposes. The excitement thus set up lessens existing engorge- ment, or inflammation in neighboring organs or parts, on the principle expressed in the phrase, ubi irritatio ibi fluxus. By the same means revulsive action is had, necessary to re- lieve engorgement in the brain. Such articles tend also to the production of hydragogue catharsis, thereby relieving the blood vessels of a considerable amount of the circulating fluid, and afford a form of depletion. The catalytic effect of certain hy- AND THERAPEUTICS. 203 dragogue cathartics is relied on by some practitioners to relieve the economy of noxious substances taken into the circulation ; and, while this view is perhaps hypothetical, wanting in well established facts to sustain it, the theory is worthy of more thorough investigation. It is well known that sedentary habits lead to inactivity, more or less, of the whole alimentary canal ; also, that a regular system of exercise is the best means of restoring the natural healthy vigor of the organs. Any means of agitating the stomach and bowels, such as frequent and sudden pressure, may be used for the same purpose, but horseback or foot exercise gives the addi- tional influence of gravitation, in promoting the movement of the contents. Exercise, therefore, though not properly consid- ered under the head of vital agents, is mentioned as a means of preventing a necessity for pharmacological excitants. A form of dyspepsia, accompanied with constipation, is often the result of deficient exercise. Such being subject to the agitating system of treatment, a class of empirics at one time made great to-do as dyspeptic doctors, whose treatment consisted entirely in "punch- ing" the patient, with the closed hand, in the abdomen, perhaps without a knowledge of the modus operandi, and consequently ig- norant of the cases subject to this treatment. Exercise, though useful in relieving habitual constipation, is so only w T hen the difficulty depends upon inactivity of the muscu- lar coat of the bowels, and even then, to be effectual, must be kept up regularly. Car bo Ligni — Carbon of Wood — Wood Charcoal — though a remedy for internal administration, is, nevertheless, as purely mechanical in its operation as that of exercise, and therefore ir- regularly considered under this head. Charcoal, not too finely pulverized, generally excites and irritates the mucous membrane of the stomach and bowels, by the roughness of its particles, and from the sympathy of contiguity, increase of peristaltic motion is promoted. Aside from this mechanical influence, it has no special medicinal virtues other than the disinfectant property it possesses, and by which gasses, etc., with which it may come in contact, are absorbed and neutralized. Upon the degree of pul- 204 ACOLOGY verization, doubtless, depends it- cathartic property, and, there- fore, this effect cannot reasonably be expected from very finely pulverized charcoal. To the difference in this respect, which may exist in different specimens of the remedy, may, in all probability, be attributed the contradictory reports of its cathar- tic action. For habitual constipation, ten or fifteen grains may be taken half an hour before each meal. Other mechanical excitants of the bowels might be mentioned, such as wheat bran, bread baked of wnboUed flour, etc., but as these are most frequently used to affect the stomach particularly, (and as they do not properly belong under the head of vital agents) their consideration is not important in this connection. To syrup, molasses, and the various saccharine fruits and con- fections, is attributed cathartic property, and when used by the proper subjects, and under suitable circumstances, their laxative effects may be relied on. As articles of diet, they are sometimes selected by those with sluggish condition of bowels, in order to insure daily evacuations. Fruits containing a large amount of sugar, such as figs and grapes, may be used without additional saccharine substances, whilst the more acidulous have their ape- rient property increased by being made into the form of con- fection. Catalogue of Mild Enteric Excitants or Aperients. Oleum Olivae, Magnesia, Manna, Pulveres Effervescentes. Oleum Oliv^e — Olive Oil — Sweet Oil. The expressed oil of the fruit of Olea Europma an evergreen cultivated in France, Spain and Italy. It is a bland, unirritat- ing oil of sweetish taste, used in pharmacy, and described under the head of demulcents. Olive oil is a convenient, mild and safe excitant of the bowels, in the (lose of one or two fluidounces. It is a useful remedy for children when an irritable condition of the alimentary mucous membrane exists, and at the same time evacuation of the canal AND THERAPEUTICS. 205 is required. The bland, soothing influence of the oil in contact with the surface allays irritation, while peristaltic action is gently excited in the muscular coat of the intestines. Manx a. The concrete exudation from the trunk and branches of the several species of Ornus and Fraxinus. Saccharine substances resembling manna, though perhaps rarely sold in commerce for this article, are obtained from various other plants. These are called false manna, and are wanting in mannite and other chem- ical constituents of the drug. The principal species of the two genera are Ornus Europoea and Fraxinus Ornus. There are three varieties of true manna in commerce, which differ from each other on account of the season of the year collected, and the part of the tree from which they exude. Flake manna flows from the upper portion of the tree during the heat of Summer, and is in firm, flat flakes of a yellow color. Common manna, is collected later in the season, and is, there- fore, not so solid in consistence, bright in color, nor regular in form. Fat manna is collected still later in the season, and is found in dark, imperfectly concreted, impure masses. Manna has a sweetish, not unpleasant taste, and is soluble in water. It may be used in substance or solution, in the dose of one or two troi/ounces, as a laxative; but the large quantity re- quired often precludes the possibility of using a sufficient amount, alone, to produce decided effect. Used with other and more active agents, it improves the taste and modifies their action. Children may be readily induced to eat a sufficient quantity of flake manna to induce sufficient movement of the bowels, should only slight impression be required. Magnesia— Calcined Magnesia. This substance, already mentioned under the head of antacids, is found uncombined, only, in the well-corked bottle of the phar- maceutist. 206 ECOLOGY Magnesia may be given as a laxative, in the dose <>f about sixty grainsy triturated with water or milk, and taken in the form of temporary mixture while being agitated. As this sul>- stance uncombined i.s very slightly aperient, and is more or less active according to the particular acid met with in the prima? via*, it is difficult to estimate the quantity necessary to produce a given degree of action under all circumstances. We have, therefore, % very great uncertainty in its operation as to cathartic result. If but little acid be found in the stomach and bowels, the medicine may pass along the canal, adhering to the surface in a pasty consistence, and interfere with, rather than promote, catharsis. Magnesia is selected as an aperient in cases of cephalalgia, and other nervous disturbance from reflex influence, originating in the irritation of acids upon the alimentary mucous membrane. The double purpose of neutralizing these and evacuating the bowels would lead to its administration under such circumstances. There are three salts of magnesia, two of which are used for their laxative effect, and will be considered under this head. The sulphate — common epsom salt — producing more thorough ac- tion, will be noticed in its proper connection. Magnesii Carbonas — Carbonate of Magnesium. This is pre- pared from the sulphate of magnesia, and consists of irregular shaped masses of white color, insoluble in water and of an earthy taste and odor. Like calcined magnesia, it may be triturated with water or milk, and given in the dose of thirty to sixty grains. It differs very little from magnesia in its general action and uses, the carbonic acid giving up the base to any acid it may come in contact with, makes it subject to the same uncer- tainty as a cathartic, and answers equally well as an antacid. Liquor Magnesii Oitratis — Solution of Citrate of Magnesia. This solution is prepared by pharmaceutists from the carbonate, and, in addition to aperient result, the grateful influence of free carbonic acid gas is realized in its use. In order to preserve this ingredient, it is necessary to keep the solution in a well- stopped bottle with confined cork. It has the advantage of being pleasant to the taste and acceptable to the stomach. AND THERAPEUTICS. 207 A solid citrate of magnesia, prepared by Dorvault, is perma- nently soluble in eight times its weight of water (U. S. Dis.) The dose of solution of the citrate of magnesia as an aperient is four jiuidounces. Pulveres Effervescentes Aperientes — Aperient Eferves- eing Powders — Seidlitz Powders. These powders are in pairs, intended to be dissolved in sepa- rate portions of water, and consist, respectively, of tartaric acid in one paper, and tartrate of potassa and soda (rochelle salt) and carbonate of soda in the other. These powders, dissolved in separate vessels and poured slowly together, make an agreeable effervescing draught, cooling and aperient in its effects. It is suited particularly to febrile conditions, in which great heat and thirst are present, and in which less acceptable articles would not likely be retained. Sometimes two powders are required to pro- duce the desired effect. Thorough Enteric Excitants or Purgatives. Most of the mild peristaltic excitants which have been noticed under the head of aperients, produce their cathartic effect by di- rect influence, exciting increased action in the muscular coat of the intestines ; and the same may be said of thorough excitants now under consideration. As will be seen in descriptions of the several articles, the larger proportion of them seem to act by this elective influence on the muscular fibre. A few, perhaps? cause catharsis by their tendency to exhalation into the canal. Thorough peristaltic excitants, or purgatives, serve as thorough evacuants in cases of fecal or other accumulations in the bowels, and are necessary when such become troublesome. Following anthelmintic remedies, they are useful in carrying along with ordinary contents the parasite, rendered inactive by the worm- poison. This becomes necessary soon after the impression has been made upon the worm, lest it revive and again become able to resist the force of cathartics. Purgatives should be given to females twelve hours after giv- 2i >8 ACOLOCi V ing birth, if the bowels be not freely moved previously, in order to present unpleasant febrile excitement, at the establishment of lactation, three days after delivery. At this period, symptoms of peritoneal and metritic inflammation are Sometimes found, and, as the most prompt and certain relief is afforded by cathar- sis, it may be justly inferred that a soluble State of the bowels tends greatly to prevent this very painful and sometimes danger- ous condition. There are several articles belonging to the class of cathartics whose action is uncertain, being, like magnesia, governed by circumstances, and also by the quantity administered. Some of the more insoluble preparations of mercury, for instance, are dependent on the character of fluids met with in the stomach, for their susceptibility to absorption. Agahvthe degree of action is greatly modified by the quan- tity administered. Rhubarb and other cathartics may be made gently aperient or thoroughly purgative by varying the amount. These will be considered first under the head of purgatives, and the proper dose will be stated for each degree of catharsis. The articles next coming in order for consideration, in the purgative variety, produce thorough evacuation in any dose which is likely to act at all. Catalogue of Thorough Enteric Excitants, or Pur- gatives. Hydrargyrum, Magnesii Sulphas, Rheum, Sodii Sulphas, Aloe, Senna, Juglans, Cassia Marilandica. Oleum Ricini, Hydrargyrum — Mercury. This metal, described under the head of catalytics, is said to be inert in the pure or uncombined state, but is found to act promptly when reduced, by mechanical division, into minute particles. It is supposed that oxidation occurs when thus treated, and that it is thereby rendered soluble and capable of being ab- AND THERAPEUTICS. 209 sorbed. In order to its cathartic effect, however, absorption does not seem to be necessary. Indeed, there are good reasons for believing that this effect depends upon its presence in the bowels. Mercurials introduced into the circulation in any way except through the alimentary canal, have no cathartic effect, but have elective action on the liver and salivary glands. More- over, it is well known that such glandular excitation does not take place when free catharsis follows its internal use. Now, if absorption be as necessary to the cathartic, as to the hepatic or glandular impression, both would occur under the same cir- cumstances. Pihda Hydrargyri — Pill of Mercury — Blue Pill — is a dark bluish mass, of suitable consistency for the ready formation of pills. It consists of metallic mercury, triturated with confection of rose and pulverized liquorice root till no globules are visible. Blue pill is seldom given for its cathartic effect alone, and is uncertain as to the time required, and the amount of purgation produced. In constipation, the result of a sluggish state of the liver, both difficulties may be met by the use of this prepara- tion. In the dose of twenty grains, blue mass will occasionally, under favorable circumstances, produce thorough purgation; but the uncertainty attending its operation, and the liability to unpleas- ant salivation, prevent its frequent use for this purpose. Five grains will sometimes produce aperient effect. Hydrargyri Chloridum Mite — Mild Chloride of Mercury — Calomel — is a white, inodorous, tasteless powder. Like other preparations of mercury, it is uncertain as a cathartic. Under favorable circumstances, however, thorough purgation may be expected from large doses. Not only so, but nausea and vomit- ing sometimes attend its action. In the dose of four or five grains a laxative state of the bowels is produced, and twenty grains will often cause free catharsis. Sometimes, however, the bowels remain quiet until other means are used, even after this amount has been taken. Large doses,, in cases of worms, may sometimes effect three important results, viz: poisoning;; and destruction of the parasite, allaying 14 210 ECOLOGY symptoms of nervotii derangement, such ,-is convulsions, etc., :iikI expulsion of worms, with other contents of* the bowels. Rheum — Rhubarb. The root of Rheum Palmatum f Rhewm Compactum, and Rheum Undulatum, herbaceous plants, growing spontaneously in Asia, China, and other countries, and cultivated in Europe and Amer- ica. These species of the rhubarb plant differ from each other in the shape of their leaves, but all alike have large, branching roots. Other species are alluded to by authors, as the plants from which certain varieties of the drug in commerce is proba- bly derived. Great confusion in the statements and reports of botanists often arise, and doubtless from the fact that specimens of the same species of any plant, cultivated in different regions of the earth, differ widely from each other, and give rise to the contradictory statements as to the botanical origin of certain vegetable drugs. Plants, like animals, are changed by climate, soil, etc., so much so, indeed, that not only the species, but the genus itself, can scarcely be recognized after a succession of crops or generations, being subjected to en- tirely different influ- ences. Hence, plants from the same species, cultivated in China, Europe and America, would probably, after the lapse of years, as- sume verv different bo- tanical characteristics. A species of rhu- barb is culivated in this country, principally for culinary pur- poses. The petioles, or leaf stalks, have an agreeable acid taste, and are used as an article of diet in the form of tarts, etc. Rheum palmatn-m. AND THERAPEUTICS. 211 There are three principal varieties of the drug known in com- merce : Chinese Rhiibarb, Russian Rhubarb, and European Rhubarb. These being derived from different species of the plant in some instances, and subjected to different modes of pre- paration, necessarily differ in appearance, and sometimes in their chemical constituents. After the plant attains the age of five or six years, the root is dug, deprived of its cortical portion, and dried. The Chinese variety gives evidence of the outer covering having been scraped off, while the Russian specimens show that the bark has been sliced by longitudinal incisions with a knife. By these charac- teristics alone, the two varieties can be distinguished. In this form, the roots are thoroughly dried, and pass into commerce. When pulverized, rhubarb is of a bright yellowish brown color, bitter and slightly astringent taste. It has sufficient ten- acity, when moistened, to be made readily into pills, and in this form is most conveniently administered. Rhubarb is one of the articles that may be relied on as a gen- tle laxative, in the dose of ten grains, and in double this quantity will usually produce thorough purgative action. It doubtless has an elective influence upon the muscular fibre of the intes- tines, and therefore evacuates them without increasing the effu- sion which leads to watery discharges. In addition to this exciting property, it is astringent and tonic. The astringent and cathartic properties seem to be blended in such happy proportions that the latter is not interfered with by the former, as is often the case when astringents are given along with peristaltic excitants. The function of digestion seems to be promoted by the same influence upon the alimentary canal, which causes the contents to pass more briskly along the tube, resulting in catharsis. There are several officinal preparations of rhubarb, by which its administration is facilitated, and its effects on the system modified. Syrupus Rhei — Syrup of Rhubarb — contains, it would seem from the formula, the strength of about eight grains in each fluidrachm of the syrup, and has, in addition, the laxative influ> 212 ECOLOGY ence of the saccharine constituent. As there is always, however, more or less waste of the active principle of drugs in such pre- parations, it would not be proper to estimate the dose by the full amount used in the preparation. About two fluidrachma may therefore be given as a laxative, and half a fluidounce as a purgative dose. Syrupus Rhei Aromaticus — Aromatic Syrup of Rhubarb — has the strength of about two grains of the rhubarb to the fluidrachm of syrup, and contains aromatic substances which render it more agreeable to the taste, acceptable and stimulating to the stomach. In the dose of half a fluidounce, this syrup affords one of the most agreeable and useful aperients belonging to the class under consideration. Lxtractum Rhei Fluidum — Fluid Extract of Rhubarb. This, judging 'from the formula, is the most concentrated form in which rhubarb is found. Each minim of the extract seems to contain the virtues of one grain of the drug; and if there be no loss of the active principle in the process, ten minims will be sufficient as a laxative, and half a fluidrachm the full purgative dose. Other preparations, such as tincture, solid extract, etc., are officinal, but those already described are considered the most im- portant and entirely sufficient for all practical purposes. Aloe — Aloes. The inspissated juice that exudes spontaneously from the leaves of at least three species of Aloe, viz: Aloe Vulgaris, Aloe Sjjieata, and Aloe Socotrina. They are natives of Africa and Europe, and cultivated in the West Indies. Other species are said to yield the drug, but most of that found in commerce is probably derived from these. There are four varieties of aloes in market : the Cape, Socotrine, Barbadoes and Hepatic. The difference in appearance and quality is perhaps, to some extent, dependent on the species of the plant from which they are ob- tained, but more particularly upon the mode of preparing and the care with which the juice is collected and inspissated. AND THERAPEUTICS. 213 Fig. 19. Aloes, as found in the shops, is in irregular shaped, greenish- black masses, and of a shining, resinous appearance when broken. In the pulverized form, the color is yellowish. The taste is ex- cessively bitter, leaving a peculiar, pungent, disagreeable sensation in the fauces for some time after being swallowed. During the heat of Summer it becomes soft, and the pieces running together become a solid mass. Aloes yields its virtues readily to alcohol and water, and in the form of tincture we have an officinal preparation in which the alcohol serves the purpose merely of preventing precipitation or decomposition. The extreme bitterness of the preparation, however, renders the taste so intolerable that it is rarely used. Aloes, being tenaceons when warmed or moistened, may be made readily into pills ; and this is the most convenient and agree- able mode of administration. As a cathartic, it is regarded as a re- liable laxative in the dose of jive to ten grains, and may be used as a thorough purgative in the dose t of fifteen to twenty. Like rhubarb, it probably in- duces catharsis by its exciting in- fluence upon the muscular coat of the intestines, and also proves thereby a useful tonic to the stom- ach in debility of that organ with constipation. The impression made upon the muscular fibre is doubtless an elective action, and 1 in addition to this, a special elective influence is exerted on the mucous surface of the rectum, which doubtless adds to the purgative effect. At any rate, the rectum itself is excited to more thorough evacuation of its con- tents, expelling ascarides more thoroughly than other cathartics, aside from any poisonous influence the aloes may exert upon the parasite. This excitement of the rectum may be used to advantage not Aloe Socotrina. ■2\\ LCOLOGtf. only for these purposes, l>ut for its revulsive influence in en* m« iit of the brain. Not only bo, but the excitement may extend, through the sympathy of contiguity, to other of the pelvic viscera, giving vigor to the litems when inactive from anaemic state of the organ. Hut on this account the remedy is inadmissible when the womb is already irritable, over-excited and engorged, or when impregnated. The rectum itself is liable to painful disease from the protracted use of this remedy. Te- nesmus and other dysenteric symptoms, with the production of hemorrhoidal tumors, may he expected from large and repeated doses of alo< Juglans — Bvttern ut. The inner bark from the root of Juglans Qinerea, or White ]V(il nut, an indigenous forest tree, growing on fertile soil, in va- rious parts, of the country. Butternut seems to exert an elective influence upon the mus- cular coat of the alimentary canal, without irritation to the mu- cous surface; giving vigor, tone and regularity to the peri- staltic movement. Its action is reliable, and leads to thorough purgation in full doses. Unlike irritating cathartics, it leaves the bowels in a healthy and vigorous condition, it is said, when used for habitual constipation. It may be given in the form of decoction, but on account of the unpleasant taste, and the quan- tity required, this form of preparation is objectionable. Extraction Juglandis — Extract of Butternut — is the only offici- nal preparation of white walnut, and being of proper consistence, pills are readily made of the extract. This is a convenient form for administration, and they may be prepared from this prepara- tion, as required for use. The quantity given may be so varied as to produce gentle laxative effect or full purgation. Ten grains will answer as a certain and prompt aperient, while in the dose of about twenty grain* it affords an easy and thorough purgative. Oleum Ricini — Castor Oil. The expressed oil from the seeds of Ricinu.s Communis or Palma Chrixti. The plant is a native of the East Indies and Africa, AND THERAPEUTICS. 215 where it attains the magnitude of a tree, and is perennial. It is cultivated in Europe, America, and other countries, in latitudes where it can exist only as an annual plant. The oil, as expressed from the seeds, is almost colorless, and has very little odor when fresh, but a disgusting, nauseous taste. When freed from the acrid, emeto-cathartic principle, which ex- ists in the seeds, castor oil is a mild and efficient purgative, free from griping and other unpleasant effects. It is, at the same time, a thorough evacuant, acting probably upon the muscular coat of the bowels electively. In order to this, it must necessa- rily be emulcified and absorbed into the circulation. As a rea- son for objecting to this manner of operation, it may be stated that the oil is found to pass through the bowels in its natural state. This fact does not, however, disprove the theory. A sufficient amount to produce catharsis may have been taken into the circulation, while a surplus, unemulcified, passes through the bowels. We have no evidence of its irritating the mucous membrane, or causing exhalation into the canal ; and hence, in the absence of proof to the contrary, we presume it operates, by elective ac- tion, on the muscular coat. In the dose of half to a fluidounce, castor oil will evacuate the bowels freely. Various modes of administration have been sug- gested with the view of concealing the taste, but, after all, per- haps the best is that of holding in the mouth alcohol, cologne, some aromatic tincture, or other pungent liquid, until its sensi- bility is obtunded, then, by warming, make the oil fluid as pos- sible, administer without admixture, and again rinse the mouth with the pungent liquid. Cabtor oil ranks high as a purgative, when the object is sim- ply to evacuate the canal of accumulated fa3ces, worms, etc. It is also considered the most useful evacuant when the system is under the influence of opium, as the oil is supposed to operate more promptly under such circumstances than other cathartics. Though perhaps in some degree restrained by the opiate, it will generally purge freely when given at the same time with lauda- num, morphine, etc. Hence, for colic, or other painful affec- 216 AC0L0G1 tions of the bowels in which anodynes are of urgent necessity, it is preferable as an excitant of peristaltic movement. Magnbsi] Sulphas — Sulphate of Magnesium — Epsom Salt This salt is found in the form of colorless, transparent crys- tals, which slowly effloresce when exposed to the air. It is without odor, lias a hitter, unpleasant taste, and dissolves readily in water. The activity is not materially affected by exposure, notwithstanding it loses the crystaline form, and falls into a white powder. In efflorescing, the water of crystal ization is lost to the salt, and to that extent it is lighter. Therefore, instead of requiring- a larger dose, when having been for some time ex- posed, it probably requires less by weight. This differs materially from the preparations of magnesium al- ready described under the head of aperients, both in degree and manner of action. While Epsom salt may increase the peris- taltic movement to some extent, by direct elective influence upon the muscular coat, yet we know that exhalation to a considera- ble extent is the result of its use, and on this mainly, its cathar- tic effect may possibly depend. For, as has already been stated in remarks on cathartics generally, the presence of an unnatural amount of fluid, poured suddenly into the bowels all along their extent, mechanically excites contradiction, and also reduces the consistence of their contents, so that they pass the more readily along the canal. In the close of a troyounee, sulphate of magnesia is a prompt and safe purgative, causing copious, watery discharges, without irritation to the mucous membrane of the intestines. By its ac- tion not only are the bowels unloaded of their contents, but the blood vessels are depleted, particularly those connected with the bowels; and hence, Epsom salt serves a valuable purpose in per- itonitis. No purgative, therefore, is better suited to the treat- ment of puerperal peritonitis, or more appropriate as a purgative just after delivery, in anticipation of such trouble. The same may be said of its modus operandi in the treatment of sporadic dysentery. With some practitioners, it is the chief AM) THERAPEUTICS. 217 reliance in this affection, and doubtless mav be profitably em- ployed at an early period of the disease. Without adding to the inflammation by any irritating property, it disgorges the con- gested capillaries of the intestines, by causing the exhalation of a portion of their contents into the alimentary canal. Total re- liance, however, should not be placed in this purgative. There is a point beyond which the practitioner should not go, in the use of any cathartic. Restraining and nourishing means should take its place at the proper time, and in many instances the treat- ment must commence in this way. Sodii Sulphas— Sulphate of Sodium — Glauber's Salt. Sulphate of sodium is a transparent, colorless salt when fresh, but by long exposure effloresces, falling into a white powder, by which it loses nearly half its weight. It is readily dissolved in water, and is taken in solution in the dose of a troyounce, but on account of its nauseous, unpleasant taste, is seldom adminis- tered. The effect upon the bowels is similar to that of sulphate of magnesium, and, like it, requires less amount by weight when in an effloresced state. An extended notice is not necessary, since the Epsom salt, being less disagreeable, has almost entirely superseded it. Senna. The leaflets of three species of Cassia constitute the senna of commerce. These take their names from the shapes of the leaves. Thus, we have Cassia obovata, Cassia elongata and Cas- sia acutifolia. Two, at least, of these are natives of Africa, where they exist as shrubs two or three feet in height. There are four varieties of senna found in commerce : the Al- exandria, Tripoli, India and Mecca Senna. These take their names from the commercial history of the drug, and are not products exclusively of any particular species of the plant. Senna has an unpleasant odor, slightly bitter and nauseous taste, and yields its virtues to water and diluted alcohol. The leaflets, stalks and legumes have purgative properties, but the former only are officinal, being more effective. The legumes are milder in their action, and may be used as a laxative. 218 ECOLOGY Senna is an elective cathartic, acting physiologically upon the muscular coal of the intestine-, so as to increase their peristaltic movement. This lias been sufficiently proven by the injection of an infusion into the veins, by which catharsis is readily pro- duced. Griping is a characteristic symptom in the operation ol' senna, yet it would seem to be the result of violent contraction in the muscular coat, caused by the direct influence of the remedy upon it, rather than any irritating effect upon the mucous membrane, such as follow the use of drastic cathartics. The pain accompa- nying its action may be measurably prevented by combining with the preparation, or administering separately, some aromatic substance, such as cloves, cinnamon or spice. Senna, compared with other cathartics, will be found more active than most of the purgatives, and less so than the milder drastics. The activity of senna depends upon the two constituents, cathartin and volatile oil, but to the former most of the peristal- tic excitement is due. There are several officinal preparations of senna, besides the compounds with other substances, and we shall name them in the order of their practical importance. Infmum Sennw — Infusion of Senna — is prepared by pouring a pint of boiling water on one troyounce of senna and sixty grains of bruised coriander; macerate for an hour in a covered vessel, and strain (U. S. P.) It will be observed that this ex- temporaneous preparation of senna contains also an aromatic, which is intended to counteract the griping tendency of the remedy, and at the same time improve the taste of the infusion. Thirty grains of bruised ginger will answer equally well as a carminative, and may be conveniently substituted for the cori- ander. Senna may be prepared in this way readily when re- quired for use. The dose is about four fluidounces, to be repeated in four or five hours if necessary. Extractwn Semue Fluidum — Fluid Extract of Senna. This is a concentrated preparation of the drug, without admixture with any aromatic substance, and requires the addition of cloves, ginger or some such substance to prevent the griping effect be- fore alluded to. It has the advantage of producing the desired AM) THERAPEUTICS. ^19 purgative effect in much smaller bulk than the infusion, and may, therefore, be administcied in eases where a larger quantity would not be acceptable to the stomach. In this form senna is prepared by the pharmaceutist, and kept ready for use at any time without the delay necessary to prepare the infusion. The dose, as a purgative, is about half a fluidounee. Tinctura Sennce — Tincture of Senna — is not officinal in the United States, but recognized by the British Pharmacopoeia. It contains the virtues of coriander, an aromatic, and has the ca- thartic principle of senna in such a degree of concentration as to require only the dose of half a fluidounee as a purgative. In some instances, though not usually, the amount of alcohol taken may make this preparation objectionable. Syrupm Sennce — Syrup of Senna — though not officinal in the United States, is a convenient form for the administration of senna to children. With it, anthelmintic remedies can be read- ily administered, and the expulsion of worms effected while inactive, from the poison given to destroy them. For this and other purposes, the preparation may be given to children in the dose of half a fluidrachm. The purgative effect upon adults may be obtained in the dose of half a fluidounee. This is a convenient form for the administration of senna with such other remedies as may be desirable with the purgative. Cassia Marilandica — American Senna. The leaves of Cassia Marilandica, an indigenous, shrubby, perennial plant, five or six feet in height, growing in various parts of the Southern States. The leaves should be gathered in the latter part of Summer, and dried in an airy shade. Ameri- can senna possesses all the virtues of true senna, yet in less de- gree. It is perhaps subject to the same forms of preparation, but requires to be given in doses one-third larger. There seems to be no very good reason why this may not be substituted for the foreign varieties. Violent Enteric Excitants, or Drastics. This variety of cathartics not only evacuates the bowels, but serves other important therapeutic purposes. We have already 220 ACOLOGY alluded to the counter-irritant, depletory and revulsive effects of cathartics, in giving the objects for which the class is used. Drastics are given for these effects, and not to answer the pur- of mere evacuation, since they are unnecessarily active and prostrating for this purpose. It is true, however, that drastic articles are employed sometimes along with laxative remedies when no other object than alvine evacuation is in view. Yet, in this association, the drastic loses its violence and a medium degree is obtained) amounting only to purgative action. Enteric excitants of this kind perhaps generally irritate the alimentary mucous membrane, and on this depends the counter- irritation and revulsion obtained. Exhalation also is probably the result of this effeet upon the inner surface of the bowels, and depletion, therefore, is had at the same time. Certain purgatives, already referred to, eause the discharge of fluid into the canal, by their catalytic, or some such influence upon the circulatory fluids. Drastics, however, produce hy- dragogue catharsis by irritating the mucous surface, and are more or less dangerous according to the condition of the patient and quantity administered. Even when given to robust subjects, many articles of this variety, used in large and frequently re- peated doses, prove poisonous, by the inflammatory excitement set up in the stomach and bowels. Catalogue of Violent Enteric Excitants, or Drastics. Jalapa, Col ocyn this, Podophyllum, Elaterium, Scammonium, Oleum Tiglii, Gambogia, Leptandra. Jalapa — Jalap. The root or tuber of Ip&mcea Jalapa, a twining plant, native of the State of Vera Cruz, Mexico, and found abundantly near the city of Xalapa, from which the name is derived. The root is imported to this and other countries from the port of Vera Cruz, in the form of irregular, roundish and pear-shaped AND THERAPEUTICS. 221 tubers, which are pulverized by manufacturing pharmaceutists and kept by apothecaries in this form for use. Pulverized Jalap is of a yellowish-brown color, fainty odor, and sweetish, nauseous taste. The activity of the drug depends principally upon a resinous substance soluble in alcohol. Jalap, a leading article in this variety of peristaltic excitants, is, with proper caution, a safe and effective drastic. It is somewhat irri- tating to the mucous surface, but not sufficiently so, in moderate quantity, to induce very serious derangement of this kind. It doubtless has some direct elective influence upon the muscular coat of the intestines, and tendency to exhalation, aside from its irritating effect upon the mucous membrane. The rational inference, from what has been said, is, that the indications in peritonitis, congestion of the brain, spinal irrita- tion, etc., may be filled, to some extent, by this remedy when existing circumstances will admit of any drastic cathartic. Before quinine was relied on as a certain and safe cure for malarial fever, jalap was a popular remedy in the treatment of this affection. In its action, not only was the discharge of em- barrassing fecal contents secured, but counter-irritation and de- pletion of the engorged and irritable spinal cord, so constantly present in the remittent and intermittent forms of this fever. At the present day, however, it is believed that the action of quinine is greatly interfered with by catharsis, and that impor- tant time may be lost by giving this or any other cathartic, so as to be acting on the bowels at a time when the nervous system should be impressed with the tonic. Jalap may be given in powder by temporary mixture in wa- ter, in the dose of fifteen to twenty grains, or in less quantity, re- peated pro re nata. Extradum Jalapce — Extract of Jalap (U. S. D.) This consists almost exclusively of the gummy substance found in jalap. It is officinal, but as there is no practical advantage in its use over that of the pulverized drug, there is no necessity for extended notice of it. Resina Jalapce — Resin of Jalap — is in the form of dark-brown, opake masses or fragments, breaking with a resinous fracture. 222 ICOLOGY It is soluble in alcohol, hut insoluble in water. It may be made into pills or powders, and given in the dost of about fiw grains, for the usual effects of the drug, as its activity depends mainly on this resinous ingredient. Tinctura Jalapce — Tincture of Jalap. — This is a concentrated preparation, and will he found convenient for administration when desirable to use a cathartic of this character in the liquid form. The dose is about half a fimdounce, and in this amount there is not a sufficient quantity of alcohol to make the prepara- tion objectionable. There are officinal compound preparations of jalap, hut the simple forms above mentioned can be very readily used with other remedies and in proportions to suit more perfectly the par- ticular case under treatment. Podophyllum — May Apple The root of Podophyllum Peltatum, an indigenous herbaceous plant, ten or twelve inches high, growing abundantly in many parts of the country. The root is perennial, and grows to the length of several feet. When pulverized, podophyllum resembles jalap in most of its sensible properties, and in this form is usually kept by apoth- ecaries. Equally striking is the resemblance between these arti- cles in their medicinal virtues, and the preparations to which they are subject. Some writers believe podophyllum is likely to produce nausea, while others deny that it has more tendency to disturb the stomach than other active cathartics. The powder may be administered in pills or mixed with water, in the dose of twenty grains. Resinia Podophylli — Resin of Podophyllum — is the principal ac- tive ingredient of podophyllum, and in this also a striking re- semblance to jalap is found. Under the name of podophylHn this resin of May apple has been for some time used by the ec- lectics as a colagogue cathartic. The resin of podophyllum is a convenient form for using the remedy, affording the essential ingredients in a much smaller AND TITERArEUTICS. 223 hulk than the powdered root. It is now, therefore, the only form in which podophyllum is usually administered. The dose of this resin is ((bout half a grain to a grain repeated, if necessary, in a few hours. It is readily made into pills, and may he conveniently given in this form. Sc ammonium — Scamm any. The concrete juice which flows from incision made in the living root of Convolvulus Scamm oniinn, a native of Syria and neighboring countries. It is a gummy, resinous exudation, and, when inspissated, forms a dark, solid mass, which breaks with a waxy, resinous fracture. Scammony is often adulterated with various impurities, such as sand, ashes, flour, etc., and when free from these is generally combined with the expressed juice of the leaves and stems of the plant, so as to render it inferior to the true drug obtained as above described. The remedy, as found in our shops, is in the form of plano-convex cakes, of dark color, unpleasant odor, and bitter, disagreeable taste. In commerce, there are three varieties of scammony, viz: Aleppo, Smyrna, and Montpelier. These are named from the place of their exportation. The first-mentioned variety, and perhaps the purest, rarely reaches this country. Smyrna scam- mony is that which is most frequently met with in America, and answers to the above description of the commercial drug. The other varieties are said to consist of irregular masses, packed in drums, or otherwise for transportation ; and factitious specimens are said to have been detected in commerce, bearing very little resemblance to the true drug in its essential properties. Scammony, as a cathartic, resembles others of the drastic va- riety. In full doses, it sometimes acts violently, causing griping and watery discharges from the excitement set up by it in the ali- mentary mucous membrane. The varied degree of action found at different times is doubt- less attributable to the difference in susceptibility of the mucous membrane to irritating impressions. 224 ACOLOGY Id the dose of five or six (/rains, scam mo ny generally acts freely, sometimes violently. Used conjointly with milder cathartics, it becomes a useful ingredient in forming a mild and thorough purgative. ( rAMBOGiA —Gamboge. The concrete exudation from the broken branches of Garcmia ibogia, a native of Siam and Cochin China. Murray, Gra- ham and other botanists differ as to the plant from which true gamboge is derived. Doubtless several tropical plants yield a yellowish fluid resembling gamboge in many respects; hence the undetermined botanical origin of this drug. Gamboge is in cylindrical pieces several inches in length, one or two thick, and hollow in the centre. It is of a dull, yellow- ish color, as seen in the roll, but forms a bright yellow powder, the odor of which is scarcely perceptible, but a slightly acrid taste is perceived after being kept in the mouth for some time. It contains a peculiar resin, soluble in alcohol, upon which the cathartic property of the drug depends. Gamboge is a drastic cathartic, producing, in full doses, nausea and sometimes vomiting. It is perhaps less irritating to the mucous surface than others of the variety, but acts more upon the upper portion of the canal, and hence the nausea produced by it. Copious hydragogue catharsis is the result of its action, and in large doses griping and other violent and unpleasant symptoms attend. Being readily pulverized, it may be given with aperients or mild purgatives, the activity of which is in- creased, while the harshness of the drug is lessened. This is an important ingredient in compound cathartic pills, intended to deplete the blood vessels for the indirect influence exerted thereby upon dropsical collections, such as anasarca, ascites, etc. The full dose of gamboge is about Jive grains, but, in combi- nation with rhubard, calomel, or butternut, two grains, repeated every three or four hours, will induce copious watery discharges, without very great prostration, or other unpleasant symptoms. To robust patients, of plethoric habit, gamboge may be given alone, in full doses, with great benefit in acute peritonitis. The AND THERAPEUTICS. 225 relaxation and depression consequent upon the nausea produced, together with the depletion from the hydragogue effect, make gamboge peculiarly applicable in this dangerous inflammation. Colocynthis — Colocynth. The pulp of the fruit of Cltrullus Colocynthis or Bitter Cu- cumber. This is an annual trailing plant, resembling the com- mon watermelon, and bears fruit the size of an orange, whose medulary portion constitutes the drug under consideration. The bitter cucumber is a native of Turkey, and is found in Asia, Africa, and islands of the Archipelago. As found in the shops, colocynth is in whitish, spongy balls, the outer covering or rind having been removed previously to drying. It has slight odor, but nauseous, bitter taste. The activity depends upon a bitter principle, called colocynthin, first obtained by Vauquelin. Colocynth, in substance, may be given in the dose of five or six grains; the active principle, colo- cynthin, in the dose of about one grain.. The officinal extracts afford no advantage in point of concen- tration above the pulp in substance, requiring about the same dose. As, however, these preparations facilitate the administra- tion, they are usually selected when colocynth is required. Where remedies in large bulk cannot well be administered, the colocynthin may be found preferable to other forms. Colocynth is a violent drastic, and when care be not exercised in its administration, dangerous inflammation of the inner sur- face of the intestines may result from its use. The officinal compound cathartic pill of the United States Pharmacopoeia takes its promptness and activity from the amount of colocynth which enters into its composition, and under proper circumstances, answers well as a cathartic. The loose manner of using combinations of remedies already made into convenient forms, however, often proves extremely in- jurious, and as the ingredients, and their proportions to suit any particular case, can only be determined at the bedside, it is cer- tainly more advantageously done to suit the case under treat- ment at the time required for use. 15 226 ACOLOGY Colocynth answers all the purposes of a hydragogue cathartic, producing depletion, counter-irritation and revulsion. Elaterium. A deposil of the juice which exudes spontaneously from the fruit of Momordica Eloterwm, or Squirting Oucumber f & perennial trailing plant, native of the south of Europe. 'Hie fruit resem- bles the ordinary cucumber of small size, and when mature, opens at the stem extremity, ejecting the seeds and juice to a considerable distance; hence the name. The juice is obtained by slicing the fruit before maturity. It flows without expression, is collected, and the sediment or deposit, which forms at the bottom of the vessel, constitutes true elaterium. The juice thus ob- tained is sometimes evaporated by artificial heat, and in order to increase the quantity the fruit is subjected to pressure, thereby rendering the imperfect extract still less active. The British Pharmacopoeia recognizes, to some extent, these imperfect varieties; hence, specimens obtained from London are comparatively inactive. Elaterium, when pure, is in very thin grayish cakes or frag- ments, not thicker than from a sixteenth to the twelfth .of an inch. It has very little odor, but an acrid, bitter taste. The active principle of the drug resides in a crystalizable substance called elaterin, of which pure elaterium contains about forty per cent. This substance is soluble in alcohol and has a very bitter styptic taste. Elaterium is a very powerful hydragogue drastic cathartic, and acts principally by its irritating effect upon the mucous structure of the intestines. Being much more active, and used in smaller quantity than any preceding article of this variety, it is preferable in cases of insensibility, in which remedies are with difficulty introduced into the stomach, and where the impressi- bility of the canal requires more than ordinarily active remedies. Care is necessary, however, in its administration under any cir- cumstances, lest too active impression be made, and violent inflammation should lead to prostration and fatal consequences. The dose of commercial elaterium, obtained by evaporating AND THERAPEUTICS. 227 the juice and expressed fluid, is about two grains; of the deposit, which subsides from the spontaneous dripping of the fruit, about one-eighth of a grain ; and of elaterin, from the sixteenth to the twelfth of a grain. The active principle being soluble in alcohol, this liquid is a suitable menstruum for the administration of elaterium in any form. It may be conveniently given in pill, alone or combined, with other less active cathartics. Oleum Tiglii — Croton Oil. The expressed oil from the seeds of Oroton Tiglium, a shrub or small tree, native of India. The fruit, containing two or three seeds, is the size of a filbert, and also possesses purgative properties. The leaves, bark and wood, when chewed, have a burning, pungent taste, and irritate the mouth exceedingly. When swallowed, they produce the same effect in the stomach and bowels, leading to drastic catharsis. Croton oil is of bright-yellow color, peculiar odor, and burn- ing taste. Its effects upon the mouth are excessively irritating and painful. It is more or less so when applied to any part of the body, according to the impressibility of tissue with which it comes in contact. The skin itself is not exempt from the irritant effect, and it is frequently applied to the surface for its local ac- tion as a counter-irritant. Upon this property, no doubt, its cathartic effect depends, for, when taken into the stomach in a fluid form, the mouth, throat, and even the stomach, give evi- dences of its local impression upon them. On this account, the remedy is generally given in the form of pills. As a cathartic, it has been considered the most active and prompt of all the arti- cles belonging to this class of remedies. At the same time, the quantity in bulk is smaller than that of any other. It is said that a drop placed upon the tongue of a comatose subject may produce catharsis in an hour, without the effort of swallowing required for solid and more bulky prescriptions. The oil may be taken in the dose of two or three drops for its full cathartic effect. By rubbing it up with crumb of bread into a pill, the unpleasant effect upon the mouth and 228 ACOKXiV throat is avoided, and at the same time its action upon the intes- tines seemed. Although a powerful cathartic, there are cases of obstinate constipation in which the difficulty is only aggravated by it. In intussusception, spasmodic contraction of the bowel and circumscribed irri- Fig. 20. tation or inflammation, the local excitement up- on which the obstruc- tion depends is increased by the irritant, and the symptoms made more violent. It would seem that this remedy is more par- ticularly applicable to cases of great insensi- bility requiring the re- vulsive and depletive effect of an irritant hy- dragogue. Paralysis from apoplexy of the brain, and diseases and injuries of the medulla spinalis, may be prop- erly treated in this way. By the following plan it has been proposed to detect croton oil when combined with other substances : " The sus- pected oil is agitated with an alcoholic solution of soda or potassa, and the solution, having been evaporated, is then saturated with hydrochloric or sulphuric acid. If croton oil be present, its acrid principle, crolonol, will rise to the surface in the form of an oil, which, when applied to the skin, will produce, in three or four hours, not only inflammation, but the peculiar eruptive affection excited by croton oil." (Maiche.) Croton Tiglium. AND THERAPEUTICS. 229 Leptandra — Quiver's Root. The root of Leptandra Yirginica, an herbaceous perennial plant, found in most parts of the United States east of the Mis- sissippi. It has an erect stem rising to the height of three or four feet. Leptandra yields its virtues to alcohol and water, and, under the name of Culver's Root or Veronica, is used as a domestic remedy in portions of Tennessee and Georgia, in the form of imperfect tincture. The taste of the root is bitter, some- what acrid, and has a feeble, not very disagreeable odor. The virtues of the root are said to reside in a crystal izable, resinous substance, improperly called leptandrin. Leptandra is a drastic cathartic in full doses, and has been used as a chola- gogue. That it has any more influence upon the liver, however, than other cathartics acting upon upper portions of the intes- tines, is not at all certain. Owing to the violence of its action, there might be found much more appropriate hepatic excitants, should it possess this property. The dose of the powdered root, as a cathartic, is about thirty grains; of the impure resin, about two grains, which may be made into pills and taken without inconvenience. * CLASS III. GASTRIC OR DIGESTIVE TONICS. Tonic, when applied to the action of a remedy, signifies the power of giving permanent vigor to the organ or tissue upon which it acts; and in order to a rational and practical under- standing of the term, the name of such structure should always be coupled with it. There is, perhaps, no such thing as a gen- eral direct tonic, acting upon several or all dissimilar tissues at the same time. It is nevertheless true, that general debility may be relieved by one remedy, for all parts become inactive from a want of power in any controlling organ of the body, and what- ever gives energy to that organ indirectly modifies the state of all others, and gives general activity. For example, debility of the nervous centres entails the same on the whole animal economy, because a proper amount of nervous influence is necessary to the 230 ACOLOCY vigor of every part. Under such circumstances, tonics, calctM lated to restore nervous energy, Beera to be general in their effect, yet their action is exerted upon the nervous system alone. The same may be said of the class under consideration. Universal inactivity is the result of debility in the digestive organs. The blood becomes impoverished from failure of the digestive appa- ratus to manufacture from food the material by which this fluid can furnish nourishment neeessary to the support and invigora- tion of every structure. Then, to save confusion, and to bring about important practical results, the classes of tonics, as well as all others mentioned in this work, are named with reference to their direct physiological action upon the particular parts im- pressed. It is not unusual to consider blood-tonics in connection with those acting on the digestive organs, since both tend to restore deficient ingredients in the circulation. It must be remem- bered, however, that while the former do so by affording directly the required material, the latter restore the circulating fluid to its normal condition, indirectly, by promoting the digestive pro- cess. Gastric or digestive tonics, then, are understood to be remedies which act directly upon the stomach or other digestive organs, giving permanent vigor or tone. Some doubt exists as to the manner in which the functions of the stomach are affected by the use of these tonics. We know that particular influences are concerned in chymification, and it is not always clear whether one or all have failed in a given case of imperfect gastric digestion. The solvent fluid and contrac- tion of the viscus upon its contents are indispensable to the proper preparation of the food, and it is not always certain, in imperfect chymification, which of these is deficient. General symptoms, however, attending cases in which ordinary digestive bitter ton- ics are serviceable, lead to the conclusion that imperfect muscular contraction of the stomach is a serious difficulty. It is some- times plainly discoverable in such cases, that a general want of peristaltic motion in the whole alimentary canal exists. The food finds its way slowly from the stomach into the intestines, and equally tardy is the fecal portion in traversing the entire AND THERAPEUTICS. 231 canal. It is also clear in other cases, where meats, and other articles of solid food, pass from the stomach in an imperfectly chymified state, that the solvent has not been secreted in sufficient quantity. It is believed that the correction of both difficulties is effected by gastric tonics, and in some instances, perhaps, by the same remedy. It is not, however, by any means acting the part of wisdom to drug all dyspeptics with bitter tonics; for the most deplorable cases of dyspepsia are only ag- gravated by the means calculated to excite this organ in any way. Chronic inflammation of the mucous coat leads to the most distressing form of indigestion, by the arrest of the secre- tions, and the irregular spasmodic contractions induced by the contact of solid food with the irritable inner surface of the vis- cus. Under such circumstances, bitter tonics are not only not called for, but prove decidedly injurious. It is well known that the gastric juice is indispensable to the proper change of food in the stomach, and it must be understood from the foregoing, that bitter tonics certainly act directly upon the stomach, and proba- bly in such manner as to give increased vigor, not only to the muscular coat, but also to the parts concerned in the manufac- ture of the gastric fluid. Indeed, it is not improbable that a want of this indispensable fluid may lead to the symptoms at- tending cases of ordinary inactivity of the stomach. And it is by no means unreasonable to conclude that a sufficiency of it may afford the organ its natural and accustomed stimulus, there- by restoring that activity necessary for the proper kneading of the food. So that, after all, the theory attributing the good ef- fects of gastric tonics to their direct action upon the follicles affording the gastric juice, is equally, if not more plausible than any other. Indeed, the fact that the introduction of pepsin, an essential ingredient of the gastric fluid, affords temporary diges- tion in ordinary inactivity, goes very far towards establishing its truth. In addition to the pharmacological digestive tonics, which, as we have said, promote the function by their direct stimulus to the muscular coat, or to the parts producing the gastric juice, or both, there are mechanical means by which digestion is greatly 232 ACOLOGY facilitated. The agitation of any organ is likely to increase its activity. The peristaltic movement of the whole alimentary canal becomes sluggish from sedentary habit of life, and it would seem that even the secretions, poured out upon the mucous sur- face, (perhaps the gastric and pancreatic fluids included) and the exhalations into the canal are lessened by the want of proper bodily exercise. This is proven by the hardened and dry lieces discharged under such circumstances. Exercise is, therefore, an important means by which the therapeutist seeks to restore the functions of these organs when deranged. Certain manipulations connected with the region of the stomacli come properly under this head, and, when carefully conducted, may prove useful. The system of punching the epi- gastrum, however, once so extensively practiced by a set of em- pirics, mentioned under the head of enteric excitants, was used without tfny knowledge of the true source of trouble, and too indiscriminately, to prove otherwise than injurious in many cases. General exercise, to be effectual, should be practiced, contrary to the opinion of some, while the stomach is comparatively empty. It is a pretty well established physiological fact, that exercise of mind or body, or the indulgence in sleep soon after food has been taken into the stomach, retards and interferes with the pro- cess of digestion. Composure or very gentle exercise for an hour or more is decidedly preferable. Exercise, which should never be so excessive as to cause very great fatigue, is better taken in the early part of the day, before the first meal, and late in the afternoon. Walking in the open air, and horseback riding, are perhaps the best modes. These give, not only the agitation necessary to excite the stomach and other organs to increased activity, but afford new T objects for contemplation, thereby reliev- ing the mind from ennui and tormenting imaginations. Another variety of mechanical tonics, which, though purely of this character, are subject to pharmaceutic preparation, and therefore considered under the head of pharmacological remedies. These are composed of rough substances, such as charcoal, etc., which titilatcthe surface of the stomach, and though their action is local, having no elective tendency to any particular structure, they excite the parts with which they come in contact. AND THERAPEUTICS. 233 Cibus — Food. Food, though not, strictly speaking, a tonic, has been called the "great tonic/' or invigorator, and has very much to do in the production and cure of the condition in which digestive ton- ics are useful. Food itself leads to embarrassment of the di*2;es- tive organs, not only from the improper quantity and quality, but the manner of its preparation. It is notorious that an over- quantity taxes the organs beyond their - capacity, and not only leaves them enfeebled by over-action, but also embarrasses the whole canal with that portion that could not be digested. Thi s is a prolific cause of indigestion, a serious difficulty in the way of effecting a cure, and should be kept in view in our attempts to prevent, as well as relieve, this troublesome affection. The quality of food, with respect to the ease with which it is di- gested, is considered equally important. The necessary quantity, indeed, can be determined alone by its digestible quality. Some descriptions of food can be digested in double the quantity in which other varieties prove embarrassing to, and pass undigested from, the stomach. This difference does not depend at all upon the difference in the amount of nutriment each may contain. Some of the most nutritious articles are most, easily digested, and vice versa. Experiments have determined the amount and variety of nutrient principles contained in the several articles of food, and experience in their use has led to a knowledge of their digestible character. The several articles differ from each other, not only in these respects, but in, their local effects upon the surface of the alimentary canal. While some are bland, soothing and unirritating, others are exciting, rough and injuri- ous when coming in contact with an irritable or inflamed mucous membrane. This difficulty, however, to a large extent, may be obviated by the culinary process.es to which they may be sub- jected. The two main divisions of food, recognized in culinary operations, are solid and liquid. Each of these forms may be made either of nutritious or meagre articles of diet. That is to say, oleaginous, albuminous and saccharine substances may be used in fluid forms, such as soup, broth, milk, chocolate, etc. In 234 ACOLOGV meats, bread, cheese, butter, etc.; the same tissue-making and calorific ingredients exist. Fluid preparations arc not only more easily, but more speedily appropriated, and are hence selected in eases of great prostration, emaciation and anemia. Milk, which contains all the necessary ingredients for the nourishment of every structure in the body, is more digestible and nourishing than other fluid or solid food, and may be used exclusively, with benefit, in cases taking no exercise, and having imperfect diges- tion, with great want of nourishment. Some of the nutrient principles contained in meat are sepa- rated from the coarser portion in the form of soup extract, essence, beef tea, etc. In this way food is not only made less consistent, but more concentrated, so that the same amount of nourishment is obtained from much less bulk, and with less tax upon the di- gestive organs. A concentrated preparation of meat is found in market in the solid form, and may readily be prepared for use by dissolving it in hot water. This preparation, as generally manufactured, however, is deprived of albumen and fat, useful elements in food, and may be substituted, profitably, by an ex- temporaneous preparation, made by cutting in small pieces a pound of beef, and, after putting it in a bottle, boil in a vessel of water a few hours ; then gently compress the meat, pour off the extract and season to the taste. Milk, soup, and other fluid preparations of food, are not only desirable on account of the less tax upon the digestive organs in preparing them for assimilation, but, irom the small amount of effete particles left in the bowels, they are indispensable in enter- itis, and diseases in which there is even a tendency to irritation of the alimentary mucous membrane, such as typhoid fever, etc. Indeed, when food is taken in the fluid form alone, the amount of fecal matter passing through the bowels is small, and alvine evacuations are seldom necessary. When solid articles, particu- larly meat, are used in the diseases mentioned, great injury may result, not only on account of the rough substances in contact with the inflamed and irritable surface, but from the frequent disturbance in their evacuation. The flour of meat, noticed under the head of " ha^matinics," on ANT) THERAPEUTICS. 235 page 149, unlike extracts, contains the entire elements, and is preferable for the purpose of thorough invigoration. This, with farinaceous and milk diet, will restore general vigor after pros- trating disease much more certainly than ferruginous, bitter and other tonics. Indeed, when food can be digested and appropri- ated, no digestive tonic is necessary. Gastric tonics are called for only when the stomach needs artificial energy by which it may be enabled to do the work. This, however, is less frequently the case than is generally supposed. Wholesome food is understood to be the kind most appropri- ate in health. That only is wholesome in disease which suits the particular case, and no general rule can be made applicable to all. In addition to the suggestions above, touching fluid and nu- tritious diet, it may be stated that the existence of inflammatory conditions forbids the use of food abounding in albumen, fibrin, and fats. In such cases the plasma of the blood and heat of the body require to be reduced, and their increase, by the use of such articles of food, aggravates the prevailing inflammation. While this is a rule that should be observed strictly during the first stages of acute inflammations, there arrives a period in their progress when the opposite becomes necessary. The common sense of practitioners must determine the point when the waning energies of the system require the change from meagre to nutri- tious and invigorating food. That stage' is not always marked by depressed state of the circulation, pale and cool skin. The pulsation often becomes more frequent, accompanied by a flushed face, and thirst. These are the usual symptoms found in ady- namic fevers, and they increase under the use of scant or poor diet. In health, wholesome diet consists of such articles as con- tain the ingredients necessary to replenish the waste of tissue, and keep up the necessary heat. For this purpose, in violent disease, milk is most desirable, containing all essential ingredients and at the same time easily digested. Under such circumstances, nourishing and digestible articles are more pressingly demanded, and in a form to insure their ready preparation and transmission into the circulatory system. Like the fallacy of purging away 236 ACOLOGY the unhealthy secretions of the bowels in enteritis, the practice of combating the irritable, frequent pulse and ho1 skin, in low forms of fever, by depletion and poor diet, (ails to effect the ob- ject, and hasten- a fatal termination. Gastric Juice — Solvent of Food. This is a liquid secretion of follicles connected with the gastric mucoUs membrane of man and inferior animals, in whom diges- tion is promoted by its solvent power on certain nitrogenous articles of food. The fluid affords about one and a quarter per cent, of pepsin, the active principle upon which its virtue de- pends. It may be obtained from the stomach of animals recently killed, and by filtering deprived of mucus and aliment which may be found mixed with it. Reference has already been made to the different pathological conditions found in dyspepsia or indigestion. It is there inti- mated that deficiency of gastric fluid exists in each of the oppo- site states of the stomach, irritability and inactivity. Lesion of the mucous membrane will certainly interfere with its secretion, while lethargy of the organ may occur for the want of this natural stimulus; and the secretion may fail also from mere gastric debility. So, it will be perceived, there is uncertainty and difficulty in determining the primary disturbance in these respects. Moreover, when gastric irritation exists, the digestive process may be interfered with by unusually violent peristaltic contraction, even with a supply of gastric fluid, giving great pain and hurrying the unprepared contents into the small intes- tines. A normal condition of the two influences, contraction and solvent fluid, is then evidently necessary to perfect chymifi- cation. The latter is doubtless essential, and must be artificially supplied when deficient. In order to prevent the spasmodic contraction and consequent unpleasant symptoms, and also aggravation of the local disease itself, in gastric irritation, confinement to bland, unirritating fluid diet is of the highest importance. It is not contended that pepsin will tend in the least to coun- teract, directly, local disease of the stonVach, but is intended only , AND THERAPEUTICS. 237 to promote digestion for the time. Other means, sueh as eoun- ter-irritants externally, bland demulcent drinks, catheretics, etc., must be instituted to relieve the chronic inflammation or ulcera- tion, before digestion can take place even with this artificial sol- vent of the food. Gastric juice as obtained from the stomach, and filtered as before stated, is rarely given in this form, as it cannot be pre- served for any length of time Half a fluidounce, taken just after a meal, however, will answer the purpose of a solvent in the digestion of substances containing fibrin and albumen. There are preparations of this fluid in which the active principle is afforded in a more concentrated form. Rennet is an infusion or wine made of the dried stomach of animals, and contains pepsin in solution. It is prepared by macerating the gently-washed stomach of the pig, sheep or calf in wine or water. When of ordinary activity, a teaspoonful of rennet will curdle a pint of milk in five minutes. Rennet, to be effectual, must be recently prepared and kept secluded from the air. In order to its ready preparation when required, the stomach of a calf, after being cleansed of its contents without interfering with the secretion attached to the mucous surface, may he dried and preserved for use. It should be given in the dose of a teaspoonful, just before or after each meal, when the remedy is required to promote digestion. Pepsin — Pepsine — is the active or solvent principle upon which the virtues of gastric juice and rennet depend. It may be pre- pared from rennet made of the dried stomach, or an infusion of the mucous membrane alone, by precipitating the pepsin with acetate of lead. The pepsin and oxide of lead thus precipitated are mixed with water, and the lead precipitated with sulphureted hydrogen, leaving the pepsin in solution. This is evaporated to the consistence of syrup by a heat not above 100° Fahr., and made solid by the addition of starch. Fifteen grains of pepsin thus prepared is the proper quantity to be taken immediately before or after each meal, in order to temporary digestion, when the process fails from deficiency of gastric fluid'. This amount, in half a fluidounce of water, will dissolve eighty grains of finely chopped meat or white of egg. 238 ACOLOGY Ordinary bitter tonics are not applicable in an irritable state of the stomach, and, to say the most for them, do do good under such circumstances. The action had by them certainly tends to- ward excitement of the stomach, and when this is already exces- sive, nothing but evil can result from increasing it. It is only, then, in eases of indigestion, dependent upon inactivity of the stomach, but without lesion of the mucous membranoe, that bit- ter tonics are useful. Under such circumstances, a sluggish con- dition of the whole canal is generally found, and, possibly, to some extent dependent on a want of the accustomed stimulus from the seeretions, gastric juice, pancreatic fluid and bile. Catalogue of Gastric Tonics. Calumba, Quassia, Frasera, Coptis, Gentiana, Sabbatia, Gentiana Catesbaei, Acida Minerales. Calumba — Columbo. The root of Cocculus Palmatus, a twining plant with peren- nial root, and native of Mosambique. The stem is near half an inch thick, proceeding from a caudex w r hich sends off into the earth several tubers, one or tw r o inches thick. The root is gath- ered in March, and being cut into transverse slices of half an inch thick, is dried in the shade. The pieces, when dry, have a brownish, wrinkled epidermis surrounding the external firm cor- tical and internal medullary, or spongy portions. The cut sur- face has a bright yellowish color, and the whole root has a not very nnpleasant taste. The medicinal virtues of the drug are supposed to reside in two active principles, columbin and berber- ina. The latter is thought to be identical with that obtained from frasera. Columbo is a mild, unirritating tonic, and was once supposed to possess slightly laxative property. In debility of the stom- ach from exhausting disease, or in ordinary dyspepsia, columbo is a useful tonic, when such remedies are called for. AND THERAPEUTICS. 239 Investigations and experiments have not given satisfactory ex- planations of the modus operandi of this and other bitter tonics, in restoring the function of digestion when impaired. Fig. 21. Coccidus palmatus. a. Male flowers, b. Calx. c. Stamen, d. Petal, e. Bract. As has already been said in our general remarks upon this class, it is not always positively known what radical difficulty exists in cases where such tonics are useful ; whether the defi- ciency of gastric fluid, or inactivity of the muscular coat of the stomach alone, disturbs the function primarily. It is not im- probable that the difficulty at first consists of imperfect secretion 240 lOOLOOT of gastric juice, and the sluggish action of the organ results from a want of this natural stimulus. II* this conjecture be correct, which is not by any means an established fact, the sole benefit derived from this variety of tonics probably depends upon the increase given to this secretion. Pulverized columbo may be used in substance in the dote of twenty grains, but is more conveniently administered in some fluid form of preparation. Infusum ( '<>/uiiib* rubefacients. Spirits of turpentine is a highly inflammable volatile, trans- parent thin liquid, of peculiar odor, and somewhat sweetish, pungenl taste. As a cardiac stimulant, it has been found useful in low forms of disease, particularly typhoid fever, and the pros- tration of acute bronchitis and pneumonia. Being an excitant of the mucous membranes generally, the stimulation given to the alimentary and bronchial surfaces is highly useful in the latter stages of these diseases, when increased action of the heart is also desirable. It is, of course, inadmissible during the active state of inflammation in these membranes, not only on account of the direct excitement given to them, but also the injurious effect of increased action of the heart under such circumstances. In ty- phoid fever, when the tongue is red and clean, indicating exces- sive excitement of the alimentary mucous membrane, turpentine is generally injurious. On the other hand, when it is dark, cracked, or clearing off in patches, with pale edges, the remedy may be given with marked benefit. In chronic irritation, and other unhealthy conditions of the mucous membrane of the uri- nary organs, turpentine is an efficient remedy, from its direct ac- tion upon the mucous surface, even when increased activity of the circulation ib not called for. Bronchorrhcea, dependent upon relaxation and debility of the lining surface, and even in some forms of chronic inflammation of the respiratory mucous mem- brane, it may be directly applied to the part by inhaling the va- por. Evidences of acute excitement, however, afford good rea- sons for witholding it. This special action of the remedy upon the mucous membranes has no connection with its effect upon the heart, but is irregularly introduced at this place to show under what circumstances it is contra-indicated, even when the heart may require its action. Its blennymenal action is more particularly described under the proper head. As a cardiac stimulant and excitant of the mucous membranes, AND THERAPEUTICS. 255 it is used in the dose of about twenty drops, rubbed with sugar or gum, and suspended in water. Ammonii Carbon as — Carbonate of Ammonium. This salt is made by subliming a mixture of muriate of am- monia and chalk (carb. lime). Thus made, carbonate of am- monium is in the form of hard, translucent, crystaline masses, very volatile, of pungent taste, and penetrating odor. When exposed to the air it effloresces, falling into an inodorous, inert ? tasteless, opake white powder. In order, therefore, to preserve its active properties, it should be kept in well-stopped glass bottles. The several preparations of ammonium diifer so essentially from each other in their medicinal and chemical properties, that care is necessary in order to avoid the use of incompatible sub- stances at the same time. Any free acid or salt, whose acid has more affinity for ammonia than the base with which it is com- bined, decomposes carbonate of ammonium. Hence, all alkaline carbonates, amongstthem carbonate of ammonium, may ordinarily be used as uncombined bases, when the alkaline or antacid effect is desirable. This circumstance, it seems, would make it necessary to give large doses repeatedly, in order to insure the stimulant action of carbonate of ammonia upon the heart. This is one of the few articles supposed to afford direct cardiac stimulation — giving increased vigor, without irritability. The pulsations under its influence are fuller and stronger without un- natural frequency. In the latter stages of bowel affections and protracted fevers, particularly when complicated with irritable or inflamed bowels, it proves a valuable stimulant to the circulation. Under such circumstances, the benefit derived from neutralizing any collec- tion of irritating acid, is not less important than its action upon the heart. The dose is about five grains, made into pills, or dissolved in water and taken at once. The unpleasant ammoniacal taste makes the solution objectionable, yet in this form its effects can be more promptly realized. 256 &00L0G1 From what has been -aid of the peculiarities possessed !>v each article of this class, it will In- perceived that oil of turpentine is preferable as a cardiac excitant, in diseases connected with the mucous surfaces, on account of it< blennymenal stimulation. Capsicum, by its peculiar local invigoration to the month, throat, etc., is rendered useful in passive condition of these parts, with general vascular inactivity. And the antacid properties of car- bonate of ammonia give it the preference in conditions above named. A knowledge of these various properties enables the practitioner to make a judicious selection when cardiac stimu- lants are required. As already intimated, this class is seldom called for. In most cases of depressed circulation, the prime difficulty exists in the nervous system, requiring neurotics to restore healthy arterial action. CLASS II. CARDIAC SEDATIVES. Contrary to what might seem the most rational theory of re- storing healthy vigor, this class of depressing agents are more potent and generally applicable in the treatment of disease than the antagonistic class of stimulants just described. The tendency to functional disturbance of healthy organs in morbid conditions of the system, and the aggravation of those conditions by such disturbance, are facts to be remembered in the treatment of inflammations. Local disease excites the heart to increased activity, which in turn drives an excessive amount of blood into the part, and increases the existing difficulty. To prevent this, and facilitate the cure, even when the heart's action is' not unnatural, cardiac sedatives are highly useful. Cardiac tonics have been recognized in the class now under consideration, because by them the heart's pulsations are reduced in frequency. The irritable, frequent pulse, however, from de- bility, must be distinguished from the excitement of inflamma- tion, in order to the proper use of the remedies. As before intimated, cardiac sedatives are useful in the treat- AND THERAPEUTICS. 257 ment of inflammatory diseases; and we may add, particularly so for such disturbance in the respiratory organs. Pneumonia is often treated exclusively by remedies of this kind, and although it is not always aborted, nor even shortened in its ordinary cours e by them, vet the patient is conducted safely through a regular term of eight or en days, and secured against the destructive inflammatory action and fatal termination which otherwise might occur. Catalogue of Cardiac Sedatives. Veratrum Viride, Antimonii et Potassii Tartras. Depletio, Potassii Nitras, Frigidus. Veratrum Viride — American Helebore. The root of Veratrum Viride, an annual plant with perennial root. It grows to the height of three or four, feet, and is found in low, moist situations throughout the Northern and Middle States. The root is dug in autumn, and dried for use. It is dark on the surface, and of ashy-white color internally. The taste is acrid and bitter, leaving an unpleasant sensation in the fauces for some time after being swallowed. In the crude state it soon deteriorates, and should therefore be preserved in some suitable form of preparation. Veratrum has attained to more celebrity as a cardiac sedative in the treatment of inflammatory diseases, particularly pneumo- nia, than any article of the class. Whilst some are more perm- anent in their effects, other peculiarities render them less safe in violent disease. Although nausea and great prostration of the vital energies sometimes follow full doses of the remedy, yet no local irritation is produced, and the timely administration of a little brandy and opium arrests these symptoms promptly. It is a singular fact that, under its influence, inflammatory symptoms seem to subside almost entirely, but return to the full extent if the sedative effect be suffered entirely to subside. The regular administration is necessary, therefore, to prevent injurious results from the local inflammation, and must be continued the 17 258 ECOLOGY usual duration of 'any particular disease under treatment, or until Fig. 24. Veratrum viride. the heart's pulsations Cease tO increase be- yond their ord inary frequency. In pneumonia, for example, an ordinary quantity should be re- peated every two to four hours, until the pulse is reduced to, or below, the normal standard ; then at long intervals and in proper amount to keep the circulation at this point. This course will secure comfort to the patient, and pro- tect the lung from dan- gerous results, likely to follow the inflam- matory process. In combination with some preparation of opium, it is a useful sedative in catarrhal fever, bronchitis, and other local develop- ment of irritation aris- ing from influenza. While the opiate does not materially inter- fere with the produc- tion of cardiac seda- tion, it prevents the unpleasant nausea of AND THERAPEUTICS. 259 veratrum, and allays for a time the irritation upon which de- pends the distressing cough so annoying under such circumstances. Tindura Veratri Viridis — Tincture oj Veratrum Viride. This is the most important preparation of veratrum, and that in which the remedy is generally used. It consists of a saturated solution of the active principle in alcohol, is a convenient form for ad- ministration, and may be kept for any length of time without risk of deterioration. The administration may be commenced in the dose of about four drop* every two hours, and increased or diminished as may be found necessary. Some subjects are more readily affected than others, and it is only after testing the effect in any particular case that the exact amount, and length of interval to be observed between the doses, can be positively determined. Extractum Veratri Viridis Fluidum — Fluid Extract Veratrum Viride. This is perhaps a more concentrated preparation than the tincture, but being somewhat uncertain as to the strength, it has no advantages, and is not, therefore, preferable on any ac- count. In commencing its use in a particular case, the dose should not exceed two or three drops, but may be increased, if necessary, as directed for the tincture. Depletio — Blood-Lett ing. In order to appreciate properly the sedative effects of blood- letting, its physiological influence upon the heart and other or- gans must be understood. The two cavities in each side of the heart are filled alternately with blood. During the diastole, it is received from the auricle into the ventricle, whence it is thrown into the arteries by the systole, or contraction of the ventricles. The blood itself is doubtless the natural stimulus for the heart, by which, in part at least, these movements are regularly performed. The increased frequency and force of the pulsations, when blood accumulates in the heart from deficient peripheral circula- tion, may be thus accounted for. This state of the circulation is called general congestion, in which the blood, failing to pass from the large arteries through the capillaries, retards the circu- 2G0 AOOLOGY latum, and leaves a larger amount in the heart's cavities, exciting more violent contractions. Whilst the loss of this direct stimulant of the heart is suffi- cient to account for the sedative influence of blood-letting, it is known that, by lessening the quantity sent to the brain, by this depleting measure the heart's action is also indirectly modified, Temporary cessation of its pulsation — ayncopi — may be in- duced by suddenly depriving the brain of the necessary amount of blood. In proof of this, it may he stated that when fainting occurs from sudden abstraction of blood, while in the erect pos- ture, resuscitation is readily produced by changing the position so as to favor gravitation toward the brain. When, therefore, blood is drawn from a subject in the horizontal position, to the extent of producing faintness, recovery from it is slow, and, to one already enfeebled by disease, may prove hazardous. So far as the practical result is concerned, it matters little whether the impression of blood-letting be made directly upon the heart or through the brain, so that the violent contractions are subdued and the quantity of circulating fluid lessened. By the latter, however, independently of the former, inflammatory action may be arrested in plethoric subjects, and hence blood- letting under such circumstances may do what other cardiac sedatives fail to accomplish. General blood-letting consists in the abstraction of blood from a vein or artery so as to lessen decidedly the amount of circu- lating fluid. Venesection or phlebotomy, the opening of a vein longitudinally with a lancet, is the mode usually adopted when full bleeding is recp-iired. The median cephalic vein is generally selected for this purpose, and should be freely opened in order to allow full discharge, and also to prevent swelling and soreness from extrav- isation in the cellular tissue. A strip of tape or cloth being passed around the arm above the elbow, and tied so as to intercept the passage of blood toward the heart, the vein becomes prominent, and may be readily opened, with a spring or thumb lancet. Arteriotomy is the abstraction of blood from an artery, by AND THERAPEUTICS. 261 partially or entirely severing it. The temporal artery is gener- ally preferred, being superficially located and lying in close con- tact with the unyielding cranium. With the heel of an ordinary thumb lancet the artery may be very readily cut. When only partially divided, the hemorrhage continues unnecessarily, with- out constant pressure upon the cardiac portion of the artery for some time. If, however, the artery be completely severed, so as to allow its contraction within the cellular tissue, the discharge often ceases, even before a sufficient amount of blood escapes. The principles already laid down must be observed, in order to accomplish the object intended by venesection and arteriotomy. Reaction from syncope is often so violent that the heart's pulsa- tions are even more active than before the bleeding. This, of course, interferes with the main object of blood-letting. In order to avoid syncope, and at the same time prevent difficulty attend- ant upon free bleeding in the lying posture, the patient should occupy a semi-recumbent or sitting position. When the pulse is sufficiently reduced, or when yawning, thirst or giddiness in- dicates approaching syncope, the horizontal position should at once be assumed. The effect upon the heart, and not the absolute quantity of blood drawn, should determine the time to arrest the flow. About sixteen fluidounces is generally required to make sufficient impression, and to cause the necessary depletion for other pur- poses. The quantity of blood discharged at a given time, and the po- sition of the patient, have much to do with the sedative effect of blood-letting; hence, when it is desirable to produce syncope for its powerfully relaxing influence in strangulated hernia, disloca- tion or rigid os uteri, the erect position is selected, and a large orifice made, or a vein in each arm opened at the same time. On the other hand, when depletion to the greatest extent, without sudden prostration, is desirable, the sitting posture should be taken, and the blood abstracted slowly. Several of the phlegmasia? require this depletory antiphogis- tic treatment. Cerebro-spinai meningitis, pleuritis, peritonitis, pneumonia and orchitis are among the most prominent. 2()2 ACOLO< In pneumonia, when the inflammation is extensive and vio- lent, so as to prostrate the vital energies from shock, or when greatly depressing influences surround the case, bleeding, (<> any extent, cannot be safely practiced. By watching closely the efleel during the flow, however, it may be tested during the early Stage of any case, as some benefit may be derived from the loss of a few ounces only. The ruling character of disease prevailing at any particular time, or special locality, may require a modification in the treat- ment of all affections, particularly in regard to depletion of any kind. When adynamic fever prevails as an epidemic, all diseases oc- curring within the bounds of its influence partake, more or less, of the general tendency to prostration, and will not allow active depletory measures. This was particularly observable while ty- phoid fever prevailed in Georgia during the decade commencing in 1850. So decided was the tendency to depression in ordinary inflammatory diseases during this period, that blood-letting and drastic cathartics were almost entirely abandoned. Perhaps these means of treatment were too generally proscribed, for the abstraction of blood and other depletory measures, even under these circumstances, were doubtless sometimes necessary. Now, since this influence no longer exists, they are certainly useful, and yet the professsion is slow in returning to this rational mode of treatment. The adynamic tendency caused by throwing to- gether large numbers, under the hospital arrangement heretofore adopted, is similar to that just referred to, and therefore the active treatment by which inflammatory diseases are promptly cured, when isolated and in airy situations, cannot be safely adopted in the crowded hospitals of Europe. Bennett's expectant and supporting plan for the treatment of pneumonia may do very well under the depressing influences con- nected with the situations in which his statistics were made, but will avail nothing in the private practice of this country. Ap- parent debility does not always amount to exhaustion, and de- pletion may sometimes afford the best means of relief. Cerebro-spinal meningitis often exhibits symptoms of the most AND THERAPEUTICS. 263 complete prostration at the very outset, and would seem to for- bid the lancet, yet recent experiments, induced by alarming mor- tality attending the tonic treatment, prove that an antiphlogistic course of treatment is eminently useful. A statistical report of cases, made by the author to the Georgia Medical Association in 1873, establishes this fact, and that blood- letting may be resorted to when very great prostration exists. Even when the circulation is so feeble that the blood will scarcely flow without being stripped from the arm, reaction seems to have been promoted by the discharge. Faintness is not likely to occur in meningeal inflammation, however great the depression may be, because the brain is then greatly engorged, and it would be dif- ficult to deprive it of blood in sufficient amount to produce syn- cope by opening a vein in an extremity. Indeed, the prostra- tion depends, in a good degree, upon mechanical pressure on the centre of nervous power by the congestion; and, instead of faint- ness, greater vigor will follow the abstraction of a portion of this source of oppression. Peritonitis, whether puerperal or otherwise, is very much under the control of blood-letting, as well as other depleting and coun- ter-irritant means. Full, bounding pulse, the usual criterion for bleeding, does not exist, and should' not govern the practitioner in this disease. Though frequent and small, there is not that want of unyielding firmness found in the rapid pulsations of exhaustion and nervous irritability. Pleurisy and orchitis usually exhibit that state of the circula- tion which all admit should authorize copious bleeding. But for the practice having gone measurably into disuse, few would hesitate to relieve the pain, and other symptoms of high inflam- matory excitement, by venesection. Members of the medical profession are too prone to adopt systems of practice which ignore the labor of discriminating thought, the exercise of judgment in diagnosis, and the physical exertion incident to the application of successful treatment. One- ideal systems have their origin in this indolent tendency of the profession. No mental or physical effort is required to use sugar granules, steam or water indiscrimately in all cases. It is also v Jiil ACOlOGl easy and ii«» less injurious to adopt the supporting or depleting treatment, regardless of circumstances or conditions. The indus- trious exercise of reason, judgment and physical power are essen- tial to the success of practical medicine always. Local blood-letting is the abstraction of blood from the skin or other surfaces, by cups, leeches and scarification, and is intended to deplete contiguous parts in a state of engorgement or inflam- mation. In anaemic or very young subjects, this will effect suffi- cient general depletion to produce cardiac sedation, and hence, may, with propriety, be considered in this connection. ] [initio — The Leech — described under the head of "mechan- ical counter-irritants and local depletives," are preferable to other modes of depletion in some cases of local congestion or inflam- mation. Certain localities do not admit of cupping and acu- punctration, while leeches may be applied to- any part of the body subject to ocular inspection. A fluidounce of blood may be obtained from each leech, by encouraging the flow after it falls off, and when placed directly upon the diseased part, two or three will draw a sufficient amount for ordinary purposes. The ex- tent and intensity of the derangement, and the direct or remote application made of them, however, are circumstances which vary the quantity required in a given case. If applied directly to the uterus, for example, more benefit will be derived from two leeches than from half a dozen placed over the hypogastrium. When drawn from the temples, in congestion or excitement of the brain, nothing short of an amount of blood sufficient to de- plete the general circulatory system decidedly will give percepti- ble relief. This may be effected, in children or aduts easily im- pressed by bleeding, with six or eight leeches. Cupping, as a depletory measure, consists in scarification and the application of cups made of glass, tin or horn to the skin, by partially exhausting them of air. The process is described under the head of "mechanical counter-irritants and depletives," to which the reader is referred for further information. A sufficient amount of blood may be abstracted from the temples to affect the general circulation in cephalic and menin- geal disease, and at the same time act as a temporary counter- AND THERAPEUTICS. 265 irritant. This last effect makes cups preferable to leeches when applied externally and only contiguous to the diseased part. A fluidounce of blood, and sometimes more, may be taken from one scarification. This depends upon the vascularity of the part, and the depth of incisions made with the scarificator. In a case of cerebro-spinal meningitis, to which the author was called in consultation, with Dr. E. L. Connally, not less than fifteen fluidounces of blood were drawn by cups to the temples, back of the head and neck, the patient in his semi-delirium ob- jecting to venesection and arteriotomy. Scarification, independent of cups, is an efficient means of re- lieving engorgement and inflammation of the tonsils, and by some considered preferable to leeches, for similar conditions of the uterus. Incisions made with a bistoury or gum-lancet at several points on the gland, lead to considerable hemorrhage and to the arrest, sometimes very promptly, of acute tonsilitis. A spear-pointed, delicate instrument is in use for scarifying the uterus, by which the os and neck are pierced in several places for the relief of local congestion. Fmgidus — Cold. The temperature of the whole body, or a part only, may be reduced, so as to cause general or local sedation. Various appli- cations may be made for this purpose. Cold Water poured on the body, changing from one part to another in quick succession, or sponging the surface in febrile excitement, lessens the heat, and has a decided control over the circulation. The application of cold in any manner to the head, particu- larly the affusion of water, proves decidedly sedative to the •heart. In this case, however, the effect is probably indirectly brought about by reduction of the temperature and consequent depressing effect upon the brain, and therefore may be found more decidedly useful in radical lesions of this organ itself. The paroxysms of heat and delirium that sometimes attend meningitis, after the usual depletory measures have been adopted, are greatly relieved by pouring cold water upon the head for 266 a< lotOGl half an hour, with two or three intermissions of five minutes. The patient often becomes calm and inclined to Bleep during the affusion. Ic<\ swallowed in small pieces, not only allays irritation and inflammation of the stomach itself, but by the refrigerating in- fluence upon this great central organ of the body, a more or less general sedation is secured, through the vascular and nervous connections with other parts. Crushed ice, in oil-cloth or rubber bags, may be advantageously applied to the head when it is desirable to reduce excitement and heat in meningitis, en- cephalitis, etc. For local refrigeration, the application of very volatile liquids, such as ether, chloroform and alcohol, to the uncovered surface, may be used with advantage. Caloric is abstracted, and the temperature reduced by them in proportion to the rapidity of evaporation. This is facilitated greatly by the 'atomizer, an in- strument used to apply liquids in the form of spray. Rigoline, the most volatile of known liquids, is used in this way for the most speedy and perfect refrigeration. Not only is ordinary sedation, by reduction of temperature, produced, but- local anaesthesia readily induced, so that surgical operations for affections connected with superficial structures may be performed without suffering to the patient. As a means of controlling inflammation situated internally, and of preventing its occurrence in external injuries, refrigera- tion in the various modes above alluded to is justly entitled to confidence. Wounds of every description are treated with cold water dressings, in order to prevent the development of inflam- matory action likely to ensue. This plan of treatment, however, should not be adopted to the exclusion of emolients when required. Antimonii et Potassii Tartras — Tartrate of Antimony and Potassium. This salt has already been described under the head of emet- ics. In that class it stands as a prominent article, and is now mentioned only in connection with its direct influence upon the heart. AND THERAPEUTICS. 267 It has already been stated in the remarks upon emetics, that nausea, from any cause, depresses the vital energies generally. Cardiac sedation is thus brought on by all nauseants, as one of the indirect temporary results. The action to which we now call attention is not dependent upon, nor does it have any particular connection with nausea. Tartar emetic produces each of these effects bv a separate elective action upon the heart and stomach. Sedation is more perfect — at any rate, more permanent — when no nausea exists. Hence, when tolerance of its effects upon the stomach can be obtained, the greatest amount of cardiac sedation is secured. If the stomach, by repeated doses, can be made to lose its susceptibility, and tolerate one grain, the heart's action may be controlled to any extent desirable. In the dose of one-eighth to the fourth of a grain, repeated every hour or two, tartarized antimony has a controlling influence over the heart's action, so as to lessen its force and frequency percep- tibly. The property, however, of irritating the gastric mucous membrane before mentioned, renders this valuable sedative inad- missible in many cases which would otherwise be greatly bene- fited by it, and on this account caution in its use is necessary. When it can be used in pneumonia and other inflammatory affec- tions, without decided irritation of the stomach and bowels, it proves one of the most efficient sedatives at the practitioner's command. Its effects are more permanent than those of vera- trum and blood-letting; so much so that when symptoms are once controlled, they do not readily return. In order, as far as possible, to protect the alimentary mucous membrane against irritation, the salt should be given in some demulcent fluid, such as acacia, flax-seed, or elm mucilage. Potassii Nitras — Nitrate of Potassium. Nitre, or Saltpetre, as this salt is sometimes called, is in small crystaline masses, soluble in water, and not unpleasant to the taste, leaving in the mouth a sense of coolness. The natural ten- dency to irritate the alimentary mucous membrane renders its use, like that of tartar emetic, objectionable in cases liable to injurious disturbance of this part. 268 ACOLOGV Nitre is doI generally used as a Bedative in the treatment of inflammatory diseases, but doubtless might be given with advan- tage in peritonitis, pnemonia, etc. In the treatment of perito- neal inflammation, the irritation it produces in the mucous sur- face, so far from making it objectionable, would seem to favor its use, as a kind of counter-irritation is thus afforded. In this way it is supposed that drastic cathartics act favorably in peri- tonitis. In acute nephritic inflammation, nitre is also peculiarly appli- cable, on account of its renal sedative property, but the most fre- quent -use made of it as a sedative is in the treatment of certain forms of chronic cardiac derangement, leading to hydrothorax, and other dropsical collections. While its sedative influence upon the heart tends to lessen effusion, the depleting effect of increased diuresis, which often follows its use, makes the absorp- tion of dropsical fluids more active. As a gentle refrigerant, renal and cardiac sedative in febrile conditions, requiring at the same time increased excitement of the liver, a combination of nitre, tartarized antimony and calo- mel, called nitrous powder, has been used with advantage. The amount of nausea produced by the eighth of a grain of antimony, as found in a dose of this preparation, also aids in the produc- tion of cardiac sedation. Nitre is given in the dose of ten to fifteen grains, dissolved in water or flaxseed tea. Acid Drinks are more or less sedative to the circulation, and always prove refrigerant and grateful to the stomach in febrile disturbance. The Effervescing Draught, composed of a solution of ten grains citric acid in one glass, and a like quantity of bicarbonate of soda in another, poured together and drank while effervescing, is decidedly refreshing, and calms arterial excitement. Xausea and a sense of heat in the stomach are often allayed by this draught. Lemonade, particularly when cooled with ice, and sweetened to taste, is also an agreeable and useful beverage for these pur- poses. This is also useful in allaying the tormenting nausea fol- lowing the use of opium. AND TIIERArEUTICS. 269 CLASS III. CARDIAC TONICS. That peculiar condition of the heart in which the pulsations are frequent and sometimes forcible, depending upon organic lesion and irritability, is favorably affected by certain remedies known as arterial sedatives, but now recognized by some of the best therapeutists as tonics. Practically, this action has been admitted, so as to limit the application of these articles to the treatment of chronic organic functional disturbance of the heart, in which a want of tone is evident. Experiment has proved their value in these conditions, and the author's opinion of their modus operandi places them in the class of cardiac tonics. It is not certain that cardiac tonics or sedatives influence the circulation entirely by direct action upon the heart. Some arti- cles of each class are known to affect the brain, and it has not been ascertained how much of the control over the circulation may be thus indirectly brought about. Indeed, the direct action of many remedies, whose effects are first prominently manifested in certain organs, and hence considered direct, may hereafter be proven to result from elective influence upon the nervous centres. Classifications are made, however, with reference to the opinion now entertained of their direct elective action, founded upon ex- perience in* their use. Other facts, leading to different conclu- sions, may hereafter be made known, when changes in accordance therewith must be had. Perfection in a progressive science must not be expected. But for the advancement made in physiology and therapeutics within the last twenty years, innovations upon the arrangement of former works on these subjects would not now be called for. A like period in future will, in all probabil- ity, make other changes equally necessary. Catalogue of Cardiac Tonics. Digitalis, Prunus Virginiana, Acidum Hydrocyanicum. 270 ACOLOGY I ) ! ( ; ita i i 1 8 — FoxgloVi . The [eaves of Digitalis Purpurea, an herbaceous plant, with biennial root, native of Europe and cultivated in the United State-. The leaves should be gathered in the second vear and during the flowering period. Care is necessary in collecting and drying them, and to a neglect of this perhaps the occasional failure of its action upon the system is due. It is recommended that they be dried by a geutle heat, stirring so as to prevent their adhering to each other. Digitalis is supposed to deterio- rate by time, though properly dried. The remedy is preferable, therefore, when kept in the form of such preparations as are likely to preserve the active virtues more perfectly. No article in the Materia Medica has been so imperfectly un- derstood as the one under consideration. Evidence of this is found in the very contradictory statements of its physiological action and therapeutic results. It was once universally consid- ered a sedative to the circulation, and yet in the treatment of inflammatory diseases has not been found useful. The remedy has been considered effectual in controlling the circulation only when the central organ is irritable from debility after exhausting chronic disease, in which the pulsations are frequent and some- times feeble, requiring excitants or tonics to restore normal action. Hence, digitalis has proved satisfactory in its impression upon the circulation in the exhaustion of inflammatory disease, phthisis, etc., in which hectic irritability exists, and in organic cardiac disturbance. With respect to the action of digitalis, grave errors have been entertained, not only as to the class in which it properly belongs, but in regard to the degree of action and cumulative tendency it possesses. Fifteen years ago it was supposed to be poisonous, not only in large or overdoses, but in moderate quantity given for some time. Violent symptoms were expected to appear sud- denly from the pent-up or cumulative effect in the system. This was the settled opinion of its properties for half a century, and until experiment proved it not only safe but efficient in the dose of half a fluidounce for the treatment of delirium tremens, it was given with caution in the ordinary amount. AND THERAPEUTICS. 271 It is one of the articles usually classed with arterial sedatives, but is considered useful only in derangement of the circulation dependent upon chronic car- v a? *• u Fie- 25. diac affections, such as we think are benefited, as above intimated, by tonic instead of sedative action. The pulverized leaves may be given in substance, but are sometimes inactive from deterioration. In the form of pills this powder is often associated with other agents having similar or other pro- perties necessary in the par- ticular case. More durable preparations are, however, preferable. In substance, digitalis may be given in the dose of one to three grains. The opinion, heretofore entertained, of its dangerously cumulative tendency, led to the restriction of the dose to one grain, but since it has been ascertained that five times this amount may be taken with impunity, it is not unrea- sonable to suppose that more decidedly beneficial results may be obtained from its use as a cardiac tonic. Tinctura Digitalis- -Tincture of Digitalis — is perhaps the best form of preparation, for convenient administration, and for per- fect preservation from deterioration by time. About ten drops of the tincture correspond with one grain. It may be given, therefore, in the dose of ten to twenty drops. An Extract and Infusion are officinal, but in the forms of powder and tincture, all that is necessary for convenience of administration and for the full effects of digitalis may be ob- tained. Digitalis purpurea. 979 ACQ LOGY Pbuhus Vlegeniana — Wild Cherry, The hark of Cerasus 8erotma f or WUd Cherry, a forest tree, Dative of the Tinted Slates, and found abundantly in most parts oi' the country, North and South. The invigorating effects of wild cherry has been so marked in prostration from chronic dis- eases that the article was supposed to ad as a tonic upon the di- gestive organs. Containing a bitter principle, it is easy to imag- ine that it possesses the properties of digestive bitter tonics, and therefore stands as a prominent article in that class with most authors. Unfortunately for its position amongst them, however, such observers as Pereiraand Wood have ascertained that, in full doses, so far from promoting digestion, this function is actually embarassed by it; and, though receiving from them a quasi re- cognition as a bitter tonic, is recommended only in such cases as we have described for the action of cardiac tonics. Like digi- talis, it lessens the number of pulsations only when, from irrita- bility, the frequency becomes excessive. In the hectic of con- sumption, and other forms of debility, from extensive suppora- tion, etc., its good effects are exhibited. Wild cherry contains prussic acid, or volatile principles con- vertible into this acid during the process of preparation. Upon this its tonic property in all probability depends, and in order to insure the full effects of the drug, such preparations only should be used as have not been subjected to a degree of temperature much above 100° degrees, Fahrenheit. Infusum Pruni Virginiance — Infusion of Wild Cherry. This may be prepared extemporaneously by the immersion of half a troyounce of the bruised fresh or dried bark in a pint of water. By percolation on the displacement plan, the preparation may be made from the powdered bark, avoiding always the use of very warm water. The dose is two or three fluidowices three times a day. Syrupus Pruni Virginiance — Syrup of Wild Cherry — is offi- cinal, and affords an agreeable preparation. The dose is half a fluidounce three times a day. AND THERAPEUTICS. 273 Acidum H ydrocyanicum Dilutum— Diluted HydrocyanieAeid. This is a transparent volatile liquid of peculiar odor and taste and should be kept in well stopped bottles protected from the light. The direct action of this very powerful remedy and virulent poison is not satisfactorily determined. By some writers it is supposed to exert its influence upon the heart, and, as evidence, they mention the short time required to develop symptoms of its effects. On the other hand, physiological investigations have established the fact, as stated on page 44, that the rapidity with which volatile substances may be carried to the brain through the circulation renders altogether possible the theory of its neu- rotic action. Indeed, some of the symptoms of its poisonous action seem to be the result of nervous disturbance. In connec- tion with the action of this acid, it has been said that proof is afforded to sustain the theory that impressions are made upon the nervous centres and this system generally, by the action locally on a nervous filament to which it is applied. This opinion, however, is not sustained by experiments. That neurotics generally affect the system only through the impression made upon the centres, is a fact well established by physiological investigations. It is at the same time believed that certain powerful neurotics do, to some extent, affect the. nerves themselves when applied to them. Such impressions, however, are not conveyed to and do not affect the brain, as was once supposed. In what is known of its action, there is certainly evidence of special impression upon the heart, as well as the nervous centres, by prussic acid. Some of the seemingly contradictory opinions in regard to the particular organ upon which this substance acts directly, may be readily reconciled by considering it capable, like many others, of acting directly upon more than one organ at the same time. It is evidently a cerebral sedative, and in poisonous quantity destroys the functions of this vital organ. It is also known to modify the heart's function, but not as a sedative, for experiments prove that the heart's action is the last of three im- portant functions lost under its influence. From this and other 18 274 ACOLOGY fuels connected with its action upon the heart, the reasonable conclusion must be that normal vigor is given that organ, under the circumstances above described, in which cardiac tonics prove useful. The dose is two to six drops, commencing always with the min- imum quantity, so as to avoid unnecessary action. A gradual increase may be made until the maximum quantity is arrived at or until the desired effect shall have been produced. Half a fluidrachm of the diluted acid, in two fluidounces of water, makes a proper strength to be taken in the dose of a teaspoon/id, gradually increased to two or three, or until the desired impres- sion is made. In this way the unpleasant effects of overdoses may be avoided. Potassii Cyarridum — Cyanide of Potassium. This salt of po- tassium possesses properties similar to those of hydrocyanic acid, and also requires care in its use to prevent unpleasant poisonous effects. It may be given in the dose of an eighth of a grain, three times a day, dissolved in water. DIVISION III. REMEDIES THAT AFFECT THE MUCOUS MEMBRANES. This new division is introduced with some misgivings as to the propriety of making such decided innovation on long-estab- lished arrangement of classes. The necessity for it is more par- ticularly deplored on aecount of the fact that the division is made to supersede one that has long been considered important in the classification of remedies. In order to carry out the plan of this work, however, it is absolutely necessary to do so. Divisions of medicinal agents must be made with reference to the organ, system of organs, structures or fluids upon which the direct physiological action of remedies thus associated is exerted # It will be seen that the most prominent articles of this division have usually been designated as agents affecting the respiratory AND THERAPEUTICS. 275 and urinary organs, and classed as "expectorants" and "diuret- ics," in accordance with the* uncertain functional changes some- times resulting from their action. As an apology for this radical change, it may be stated that the recognition of well-established, practical facts is sought, in preference to theories of very questionable soundness. It is an undeniable fact that a number of articles in the division of "remedies affecting the respiratory organs," and classed "expec- torants," have an elective stimulant action upon the mucous membranes generally. By such, the function of expectoration is modified only through this direct, exciting effect upon the mucous tissue. The same may be said of certain "emmena- gogues" and "diuretics," whose therapeutic effects, as such, are dependent upon the excitement produced in the mucous mem- branes of the uterus and kidneys. The fact that such stimulants add to the difficulty, when dependent upon over-excitement of the organs, may be stated as a practical objection to this careless mode of classifying remedies. Expectorants, so-called, consisting of remedies whose elective action is that of excitement of the respiratory mucous membrane, increase the difficulty when deficient expectoration depends upon an excited or inflamed condition of the organs of respiration or their lining surface. N#w, since inflammatory excitement is generally the cause of deficient expectoration, excitants of the mucous membranes called "expectorants," prescribed as such, without reference to their direct action, may cause injurious re- sults. But when the name of a class indicates the kind of action and the part acted on, there will be no difficulty in prescribing them properly when the true pathological condition is understood. As another reason for discarding the division of "remedies that affect the respiratory organs," we mention the fact that "expectorants," the only legitimate class belonging to the divi- sion, is a term implying an action which really has no existence except as the result of different and sometimes opposite actions. 276 ACOLOGY CLASS I. BLENNYMENAL STIMULANTS. This class, as the name implies, is made up of articles which excite the mucous membranes. The tissue is affected, not in one organ exclusively, but in all, wherever found, by a direct elective influence, recognized as a physiological, action of the remedies. Blennymenal — from ■iliyyu., mucus, and u/jqv, a membrane — indicates the part upon which the remedies now under consider- ation act. While all articles of the class tend to excitement of this structure, their effects difFer essentially in degree. Some make very slight impression; others cause a high state of excite- ment, amounting to inflammation. They difFer also, it is be- lieved, in their tendency to affect the mucous membrane of one organ more than that of another. There are reasons for believ- ing that some articles of the class impress the urinary more de- cidedly than the bronchial, uterine or gastro-enteric mucous membrane. The benefit derived from this class is sometimes exhibited in the membrane itself when diseased, but frequently it is acted on when healthy to affect contiguous parts through its connection with them. For example, when the kidneys, bladder or uterus are in a state of inertia^ their activity may be restored by ex- citing the mucous memorane, and thus establish vigor in the whole organ through contiguity of structure. The membrane itself is also the subject of disease, and requires the action of excitants in its restoration. Even after acute in- flammation, a state of relaxation and debility ensues, which is relieved by exciting increase of activity. Ordinary chronic inflammation and ulceration are generally benefited by these elective excitants. In typhoid fever, disturb- ance of the alimentary lining membrane is of common occur- rence, and the appearance of the tongue will generally indicate the character or degree of irritation sufficiently to decide as to their applicability. If red and firey, we have evidence that the excitement is already too high, and are admonished to refrain AND THERAPEUTICS. 277 from the use of such means; but if dark or pale, and accompa- nied with diarrhoeal discharges, the condition of the canal is likely such as to require their use. Catalogue of Blennymenal Stimulants. Oleum Terebinthinae, Eucalyptus, Copaiba, Collinsonia, Balsamum Tolutanum, Ammoniacum, Balsamum Peruvianum, Phellandrum Aquaticum, Senega, Styrax. Oleum Terebinthin^: — Oil of Turpentine. This is obtained by distillation from the oleoresin which ex- udes from the bark and wood of Pinus Pahcstris, and other spe- cies of Pinus, and described under the head of rubefacients. It is now considered only in connection with its action as a blenny- menal stimulant. The action of spirit of turpentine upon the mucous membranes generally is very decided and conspicuous. The urinary appa- ratus is painfully excited by full doses of the remedy, even when in a normal condition; and when affected with acute inflamma- tion, serious aggravation of tl*e symptoms occurs. The same may be said of its action upon the alimentary mucous membrane during the existence of boAvel affections. In acute enteritis, which may generally be determined in part by redness of tip and edges of the tongue, the remedy proves injurious; and even in chronic inflammation of the alimentary mucous membrane, when the tongue exhibits the appearance just mentioned, turpen- tine will not be tolerated. It has been greatly lauded by practitioners in the treatment of typhoid fever, without regard to symptoms or circumstances. It will be found, however, that without attention to the evidences of excitement in the canal, such as above given, great injury may result from its use. In this fever there is tendency to irritability of the mucous membranes generally. In the bronchia it is of frequent occurrence, and when of an 278 ACOLOGV indolent character, the action of this remedy may prove benefi- cial. A relaxed condition, with copious discharge from the tubes, is not uncommon in this disease, and is the condition suited to the favorable action of turpentine. Iii gonorrhoea] inflammation, after the acute stage lias passed away, and an unhealthy, debilitated state of the urethra exists, the stimulus of this remedy is effectual in arresting the copious discharge which is found under these circumstance The dose, as a blennymenal stimulant, is from fifteen to twenty drops, made into emulsion with gum or sugar, and taken three or four times a day. In this quantity, blennorrhoea of some months' standing has been entirely relieved by it. When such discharge results from chronic inflammation of the kidneys, it is perhaps the best means of relief. Copaiba — Copaiva. An oleoresin, which exudes from Copaifera Multijuga, and other species of copaifera, stately trees found in various pro- vinces of South America. Balsam copaiva, as sometimes though improperly called, is obtained by making incisions into the trunk and branches of the tree. It is about the consistence of olive oil, of peculiar odor, pun- gent, unpleasant taste, and consists principally of oil and resin. The medicinal effects of this remedy resemble those of turpen- tine, except that it is less exciting. The mucous membranes generally are stimulated by it, and that connected with the uri- nary apparatus may, by large doses, be excited to the degree of strangury and unpleasant heat along the course of the urethra and in the kidneys. It may be used in chronic inflammation of the mucous sur- faces in cases where the more exciting effects of oil of turpentine would be injurious. In gonorrhoea, for example, copaiva is used with impunity, and perhaps advantageously in the most excited stage of the disease, when turpentine would not be tol- erated. The action is more of a soothing and local alterative stimula- tion than of irritation, and, in moderate quantity, may be found AND THERArEUTICS. 2?9 useful in ordinary acute inflammation of the mucous membranes, by promoting healthy capillary circulation of the tissue. In chronic gastro-entritis the effects of this blennymenal stim- ulant is more decided in its action, and, when not offensive to the stomach, may be used with great advantage in the form of emulsion with gum arabic. While the mucilage soothes and protects the irritated surface, the ^opaiva comes in direct contact with the membrane to be acted on, without having to enter the circulation. The tardiness of absorption in such condition of the stomach, so far from interfering with the action, actually fa- cilitates it, by allowing the remedy to come in contact with the diseased surface as it passes through the stomach and bowels. The dose is from a half to one fluidrachm, given alone or in the form of emulsion with gum arabic or sugar. Oleum Copaibce — Oil of Copaiva — is obtained from copaiva by distillation. Its effects upon the mucous membranes are the same as those produced by the oleoresin, from which it is ob- tained, and may be used for the same purposes in half the quan- tity, or less, say from ten to thirty drops. Balsamtjm Tolutanum — Balsam of Tolu. The concrete juice obtained by incisions made in the trunk of Myrospermum Toluiferum, a tree found near Tolu, in Cathagena. This balsam, when fresh, is somewhat soft and tenacious, but becomes hard and brittle by exposure. It is of a yellowish brown color, aromatic, pleasant odor, and pungent, agreeable taste. While balsam of tolu possesses the faculty of exciting the mucous membranes generally, it is supposed to act more es- pecially upon the bronchial surfaces. Its effects, however, are less decided than those of the terebinthinates already described. In medicine it is used only as an exciting expectorant, making a useful ingredient in cough mixtures intended to relieve slight affections of the bronchia, etc. For the treatment of catarrh chronic bronchitis, or any affection of the respiratory organs not attended with high inflammatory action, a mixture composed of some preparation of tolu, simple syrup, or syrup of squills, opium and mucilage, allays the irritation upon which the har- 280 ACOLOGV assing cough depends. Tola may be given in substance in the do» of twenty grains in the form of emulsion. Tim-turd Tohdanum — Tincture of Tobu — is the mosl convenient form for administration, particularly for fluid cough mixtures, in which this balsam forms an Ingredient. The doee is abovt one jlnidrachm, three or four times a day. Balsamum Peruvian i \\i — Balsam of Peru. The prepared juice obtained by incisions made in the bark of Mijrospermuni Pcruiferiun, a beautiful tree, found in Central America, and now being grown in the West India islands. Balsam of Peru is about the consistence of honey, of yellow- ish-brown color, fragrant odor and not unpleasant taste, leaving, when swallowed, a prickling sensation in the throat. The medicinal virtues of this balsam do not differ materially from those of the preceding article. Like it, the most prominent effect is manifested in the respiratory mucous membrane, andj like all others of the class, impresses the mucous tissue wherever found. The dose is twenty to thirty drops, given in the form of emulsion. Senega — Seneka. The root of Polygala Senega, an annual plant, ten or twelve inches high, with perennial root, irregularly branching, rough and tortuous. In the cortical portion reside the virtues of the root, the internal ligneous structure being inert. Seneka snakeroot, as this drug is sometimes called, has not been heretofore recognized as a general blennymenal stimulant. Its effects, however, on all the principal organs which have mucous membranes are known and admitted. The respiratory, uterine and urinary systems are excited by it. Hence, seneka is considered an emmenagogue, expectorant and diuretic of the stimulating vari- ety. Moreover, the fact of its having exciting influence upon the alimentary mucous membrane has been well established. It is said to be, "in large doses, emetic and cathartic." These re- sults of its action on the canal are doubtless produced by the physiological excitement given the lining membrane, which, AND THERAPEUTICS. 281 Fig. 2G. from moderate doses, is not sufficient to bring about decided con- traction of the canal. Practical benefit is derived from classifying this and other remedies according to the direct physiological action they pro- duce. Give this article, for ex- ample, according to the usual classification of the remedy, as an "expectorant," and in many cases when expectoration is de- ficient, the difficulty will be in- creased. In the usual classifica- tion, it is a prominent "emmena- gogue" and "expectorant." Sup- pose the functions to be promoted .by it are deranged from a phlo- gotic condition of the organ; would not the difficulty be in- creased, and the functions suffer still further derangement by this remedy, which, by exciting the mucous structure connected with the organs, causes an increased flow of blood to them ? When found, however, in a class, the name of which indicates the di- rect physiological effects to be expected from it, nothing would be more natural than -to use it to promote the functions above mentioned, when the difficulty in their performance depended on a want of sufficient excitement in the organs, and to withhold it when the opposite condition exists. Seneka is much esteemed in pneumonia and other pulmonary diseases, after the decline of inflammatory excitement, when an enfeebled condition of the organs, and general debility exists. Whether expectoration be increased or lessened, the gentle stim- ulus given to the mucous surfaces of the respiratory apparatus tends to restore that healthy vigor necessary to the proper func- tion of the organ. The same may be said of its use in diseases of other organs having the tissue upon which this elective action Polygala Senega. 282 ACOLOGV is exerted. It is an efficient emmenagogue when menstruation is suppressed on account of an exsanguineous condition and want of excitement in the eterus. Jt acts as a diuretic in a similar condition of the kidneys. Seneka may be given in substance in the dose of fifteen to twenty grains, three times a day, or more frequently in the debility of acute disease, but in less quantity. Decoctum Senegce — Decoction of Seneka — is a common extem- poraneous preparation, and may be given in the dose of two fluid- ounces three times a day, or half a fluidounce every two hours. Extraction Senegce — Extract of Seneka — is a concentrated pre- paration, and has the advantages of convenience of administra- tion and freedom from unpleasant taste, as it can be readily made into pills. The dose is two or three grains. Syrupus Senegce — Syrup of Seneka. This is a pleasant prepa- ration, and one well adapted to the treatment of pectoral dis- eases requiring the action of this remedy, on account of the sooth- ing influence of syrup within itself in irritable eonditions of the air passages from sympathy of continuity. The dose is two or three fluidsrachms. Eucalyptus — Blue Gum. The leaves of Eucalyptus Globulus, or Blue Gum tree, a tall, evergeen tree, found abundantly throughout Australia and Van Dieman's Land and recently cultivated in Europe. The leaves emit a fragrant, balsamic odor, impregnating the air of eucalyptus forests, which enthusiasm for the remedy has perhaps magnified into an imaginary prophylactic against the rav- ages of malarial fever. Two important active principles are found in the leaves, viz: a fragrant, balsamic volatile oil, and a bitter resinoid substance. These have very different medicinal properties. According to the experiments of M. Fernand Papillon and others, the physi- ological action of the essential oil is that of blennyinenal stimu- lation, giving increased excitement of the mucous membranes generally, and to the organs with which they are connected, AND THERAPEUTICS. 283 while the bitter principle gives tone to the spinal nervous centre, and consequently relief from malarial fevers. Oku hi Eucalypti — Oil of Eucalyptus — "is a limpid, almost col- orless fluid, of fragrant, aromatic odor, resembling somewhat that of camphor, and boiling at 170° cent." (306° Fahr.)— [Pa- cific 3Ied. &' Surg. Jour.) The fresh leaves -are found to yield about 2.75 per cent, of the oil, while more than 6 per cent, is obtained from recently dried leaves. (J/. Cloez.) The oil, being a stimulant to the mucous membranes, has been used successfully in the treatment of blennorrhoeal discharges from the respiratory, urinary and uterine organs, dependent upon the relaxation, irritation, and debility consequent upon chronic inflammation of the lining mucous membranes. The dose is about twenty drops in the form of emulsion. Eucalyptus has recently attracted the attention of therapeu- tists, and we predict for it a prominent place in the catalogue of remedial agents. Collinsonia — Heal-All. The root of Collinsonia Canadensis, an indigenous herbaceous plant, about two feet high, growing w 7 ild in various parts of the country from Canada to the Carolinas. The active principle being volatile, the fresh root is consid- ered preferable, and for the same reason the decoction is objec- tionable. An Infusion, made by pouring a pint of boiling water on half a troyounce of the bruised fresh root, may be used in the dose of two to four fluidounces three times a day, in catarrh of the blad- der, bronchorrhoea, leucorrhoea, etc., from chronic inflammation of the mucous membranes lining the various surfaces from which these mucous discharges emanate. Being an excitant of the mucous membranes, collinsonia may prove ineffectual and even injurious in acute inflammation of the mucous surfaces, and should therefore be used only in relaxed and enfeebled condition, from long-continued irritation and dis- turbance of the capillary circulation. 284 ACOLOGY A mmoxiacum — A mmoniac. The concrete exudation from the stem of Dorema Afiimonior cum, an umbelliferous plant, six or eight feet high, growing abundantly in several provinces of Persia. Ammoniac is in yellowish brown tears and masses, of pe- culiar odor, and bitter, somewhat acrid, taste. It is partially soluble in water and alcohol. This drug, though much less used than formerly, is said to pos- sess properties somewhat similar to those of seneka. It evidently excites the mucous membranes, and while usually classed as ex- pectorant. only, may be found useful as a stimulant to the mucous membranes generally in blennorrhcea from rilaxation and debil- ity of the circulating vessels of the part. In similar conditions of the uterus, bronchia, and urinary organs, it will probably be found alike useful. Ammoniac may be given in substance in the form of emulsion or pill, in the dose of about twenty grains. Phellandrium Aquaticum — Water-Hemlock. The seeds of this plant, though not officinal, doubtless possess virtues which may be made useful in the treatment of disease. The usual stimulant effects upon the mucous membranes, had by other articles of this class, may be expected of this remedy, but it is not sufficiently well known to decide upon its value com- pared with those already mentioned. The seeds may be given in substance in the dose of two or three grains. A Tincture has been prepared, of which about one fluidrachm is the dose. Styrax — Storax. This is now recognized as the prepared juice of Liquidambar orientate, but heretofore known as the balsamic exudation from the branches of Styrax officinale, a small tree, fifteen or twenty feet high, a native of Syria, and naturalized in Spain and other countries. Liquid Storax, as found in market, is considered unfit for use until purified by dissolving in alcohol and evaporating to a- solid consistence. AND THERAPEUTICS. 285 Storax, though not extensively used at present, is known to possess sensible and medicinal properties similar to Peruvian balsam, and has been given with benefit in diseases of the ure- thral and bronchial mucous « Fig. 27. surfaces. In the form of fumes, it has been inhaled for its effects in bronchial affections; and in the dose of fifteen grains, adminis- tered by the stomach, for its general elective blennymenal impression. Storax somewhat resembles benzoin in some of its sensible and medicinal properties, and has been supposed to have some connection with it in botanical origin. These substances are associated in the compound tinc- ture of benzoin, a preparation found useful in chronic dysen- tery, catarrh, etc. Other articles may be mentioned, which, in some degree, act as blennymenal stimulants, but not enough is known of them to warrant a prominent place in the class. Naptha, benzoin, asclepias and Dracontium have been found useful under circumstances which prove their stimulant action upon the mucous membranes; but not having occupied a prom- inent place as stimulating "diuretics" or "expectorants," per- haps do not produce very powerful blennymenal stimulation. Sty rax officinale. 280 ACOLOGY DIVISION IV. REMEDIES THAT A.PPECT Till; NERVOUS SYSTEM. This is perhaps the most important division of remedies to be found in the study of acology; not only on account of the large number of classes it contains, but from the universally control- lino- influence exerted by the system of organs upon which they act. The articles included in this division are called neurotics, and have been divided by authors into classes which receive names according to some symptom of their effects, without re- gard always to their primary direct influence. For instance, the term "narcotics" has been applied to certain agents, and is still known as the name of a prominent class, the articles of which lead to narcotism only as a secondary effect or result of their primary action. In order to preserve that system in nom- enclature which is necessary to impress the learner with the phy- siological action of remedies, we think they should be named "cerebral stimulants/' in accordance with the primary effect; because the first physiological change produced by the class called "narcotics" is that of cerebral excitement or stimulation. The same may be said of "antispasmodics," the name given to a class on account of the supposed control of spasms, which is only an occasional result of their action as a stimulant to the spinal nerves. This, in order to convey a definite idea of the direct effect should be named in accordance with the physiological action produced — the stimulation of the spinal cord. An imperfect knowledge of the complications of the nervous system, and of the different actions of remedies upon it, tends naturally to the errors alluded to ; but as the progress of science discloses new facts, appropriate terms should be substituted for those known to have originated in error. It is no valid objection to say that a multiplicity of terms leads to confusion. This is more likely to result from retaining those in direct contradiction of recently established facts. Such names, then, as impress the truths sought to be inculcated, and that favor the progress of rational, practical medicine should be adopted. Indeed, physiological AND THERArEUTICS. 287 classification exists in the recognition of direct primary action, and necessarily requires names for the classes differing entirely from those of a classification founded on therapeutic results. CLASS I. CEREBRAL STIMULANTS. The remedies of this class, while they exert a general influence indirectly, act directly upon the nervous centre within the cra- nium alone. Being a central organ of the great controlling nervous system, of course all parts of the body are affected by any modification of its functions. To the proper amount of ner- vous influence, is healthy action of the whole organism due. Derangement of the general nervous energies is often the result of deficient nervous influence, while some particular organ may exhibit more decided evidences of depression, and may be restored by cerebral stimulants. Moreover, the derangement of the general nervous system from local organic disease, causing reflex influence from the nervous centres, may be temporarily allayed by exciting the brain to increased energy, so as to afford, for the time, an increased amount of nervous fluid, by which the local irritation is resisted, and the nervous influences established. In this way hysteria, and other forms of reflex nervous dis- turbance, are temporarily quieted by cerebral stimulants. In like manner general irritability of the nervous system, and pain- ful condition of any part, from injury or other cause, may be allayed. Local irritation of any of the soft structures, which often results in inflammation of the part, is favorably impressed by cerebral stimulants. This class, as before intimated, is generally known as " nar- cotics and nervous stimulants." But, while narcotism and gen- eral nervous energy are the results of their action upon the brain, these ultimate or indirect effects are by no means the primary and direct action of these remedies. The classification that seems best adapted to the study of rational medicine is based upon their physiological action, and the names given to the several classes are understood to denote 288 ACOLOOY that action. Hence, inasmuch as the known physiological, di- rect and primary action of the articles included in this class is that of stimulation of the brain, the proper name of the class is that which we have adopted. The author has not originated the change, if an innovation in nosology it may be called. The learned Dr. George B. Wood, than whom no more accurate thinker has written on materia mediea, used this term thirty years ago in connection with the class under consideration. Narcotism is one of the secondary and unpleasant effects of these remedies, but should not by any means be entitled to such importance as to give name to the class. The stimulation to the nervous system generally is, of course, a consequence of the phy- siological action upon the centre of that system, and does not consist of direct impression upon the nerves themselves. The remedies of this class have also been called " anodynes," and properly too, when reference is had to their therapeutic effect. Relief of pain in any part is the result of action had upon the brain, as we have said, but this relief is not afforded by the direct or elective influence on the painful part. It can- not, therefore, in a physiological classification, be recognized as the direct action of the remedy. We have learned from ex- perience that cerebral stimulation leads to anodyne influence upon the nervous system generally in the manner before de- scribed, and therefore recognize the result or therapeutic effects by the terms " anodyne, antispasmodic," etc. Cerebral stimulants are considered palliatives only, by many who prescribe them, and hence are not relied on for any curative influence. That temporary relief alone is all that can reason- ably be expected in many instances"in which they are used, is certainly true, but it is equally so that, were it not for the invig- oration afforded to the brain, the vital energies of. the system could not be sustained through protracted violent disease. More- over, noxious influences upon the nervous centres, such as pois- onous vapors, etc., which ultimately exhaust themselves and cease to disturb the nervous functions, would more frequently prove fatal but for the timely and constant use of cerebral stim- ulants. These sustain the functions of the brain till the effects AND THERAPEUTICS. 289 of the poison have passed away. Life itself is in this way pre- served, when no antidotal or permanent impression is at any time made by the remedy. Many known material agents thus affect the brain, and would destroy life without this artificial ex- citement afforded the organ. Unknown causes operate upon the nervous system in the same manner and lead to a train of symptoms in which fever is prom- inent. "The fever" is a term applied to febrile manifestations of certain morbid impressions upon the nervous system, and the descriptive appellations, typhoid, yellow, remittent, etc., are pre- fixed to denote various characteristics, which depend upon the different qualities of poison taken into the system, and the dif- ferent portions of the nervous centres disturbed by them. When the brain itself, or that portion of the nervous centres in the cra- nium, is the part upon which a poison exerts its elective action, more constant is the fever, and greater the tendency to general and complete prostration of the vital energies. Under such cir- cumstances, cerebral stimulants and tonics form the sheet anchor of treatment. Catalogue of Cerebral Stimulants. Opium, Stramonium, Chloroformum, Belladonna, . Alcohol, iEther, Hyoscyamus, Cannabis Indica. Opium. The concrete exudation from incisions made in the capsules of Papaver Somnijerum, or common poppy, an herbaceous plant, two to four feet high, and cultivated in various parts of the world for the beauty of its flowers, for the opium obtained from the capsules, and for the oil of the seed. There are two varieties of the poppy, named from the color of the seeds. The white poppy has large capsules, affording greater amount of the juice, and therefore cultivated for the opium which it yields. It has white flowers, and whitish colored seed. 19 290 ACOLOGY The black /><>/>i\i/ bas black >vn\, and red, white and variegated flowers. This variety affords opium perhaps equal in quality, but owing to the small size of the capsule.-, the quantity ob- tained will not warrant its cul- tivation for this purpose. The process of making opi- um is simple, and requires very little art, ingenuity or experi- ence. The pods or capsules, at the time of shedding the flow- ers, are cut with superficial longitudinal incisions. From these exude a milky fluid which, after remaining twelve to twen- ty-four hours, is scraped from the surface, and placed in an airy, shady situation to dry. It may then be packed away, and is ready for use. Opium has a bitter, unpleas- ant taste, dark- brown color, and narcotic odor. It is of the proper consistence for making pills, and may be administered in this way without other preparation. Opium, in point of importance, stands properly at the head of cerebral stimulants. In bringing about the therapeutic ano- dyne effect so desirable in painful conditions, its action upon the brain is prompt and effective. The whole mass of the organ seems to be excited by it. Scarcely a function of these centres within the cranium escapes the exciting influence of the remedy. The symptoms of its primary effects are flushed face, increased activity and exhilaration of the mental faculties; those of the secondary are stupor, headache, nausea, etc. The unpleasant secondary effects may be greatly palliated by the use of acid fruits or drinks. The manner in which the anodyne effect of opium is brought about, upon certain painful or irritable parts, is not very well understood. It is evident that sensation or per- Papaya Somniferwn. AND THERAPEUTICS. 291 oeptiOD by the brain of a local injury or irritation is not so dis- tinct under the influence of this drug; nor is the pathological reflex nervous action that results from chronic inflammation or other local cause so prominent. May not, then, the additional amount of nervous fluid passing out from the brain, under the action of this stimulus, retard the return of impressions along the nerves of sensation to the brain ? Thus, the nervous fluid may interfere with perception from its own accumulation, and allay irritation by affording sufficient nervous power to reestab- lish healthy capillary circulation in the diseased part. In this way the sensation of pain may be lessened, and the increased excitement of the part, to a considerable extent, prevented. Opium arrests excessive discharges from the bowels, and even leads to constipation in a healthy condition of the organs. This effect so nearly resembles that of astringents that a similar prop- erty has been attributed to the drug. This, however, does not seem to be the case. It has the peculiar power of suppressing the follicular secretion constantly poured out upon the mucous membrane of the alimentary canal, as shown in the dryness of the mouth, throat and hardened fseces while under its influence. Doubtless the exhalation or transudation into the bowels of the watery constituents of the blood is also interfered with, while, as a kind of vicarious depuration, the cutaneous transpiration is promoted by it. In this way, lubrication of the alimentary canal is prevented, the consistence of the contents increased, and alvine evacuations restrained. While irregular spasmodic contractions of the bowels, exhib- ited in the tormina of enteric affections, is allay ed by the ano- dyne effect of opium, in the manner described above, it is certain that the natural peristaltic contraction of the muscular coat is not arrested by it, as evidences of these movements in health are quite perceptible while under its influence. The extraordi- nary contractions from the irritation of disease or cathartic rem- edies are doubtless restrained, the secretion and exhalation of fluids into the canal suppressed, and to these changes perhaps alone are the constipating effects of opium due. The cutaneous transpiration so perceptibly increased by opium 292 ACOLOGY seems to be, as just stated, a kind of vicarious discharge for the enteric exhalation. Hence opium, as justly as any article in the Materia Medica, may be ranked as a diaphoretic. And while we do not think that this or any other article in our knowledge has any direct influence over the follicular secretion or transpiration of the skin, yet in the modification of the cap- illary circulation in it, and of the circulating fluid itself, produced by neurotics, diluents, nauseants, etc., cutaneous exha- lation is often greatly increased. This discharge is promoted by opium when, from feeble circulation of the capillaries, it is defi- cient; for a prominent result of cerebral stimulation is an in- creased activity of the cutaneous circulation, as is exhibited in the flushed face and general warmth of the surface. Increase of nervous power is thus shown to induce more active peripheral and capillary circulation. Irritability being one of the main constituents of inflamma- tory action, opium, by its control of this, in a good degree, is a valuable antiphlogistic, particularly when situated in the mucous membranes. It is therefore useful in mucous enteritis, on ac- count of the constipating influence, and anodyne, soothing effect upon the irritable, inflamed surface. In nervous exhaustion, and prostration from the shock of violent injury or exhausting dis- ease, this cerebral stimulant gives valuable support. Adynamic fevers, which doubtless depend upon primary de- pression of the cranial nervous centres, are restrained, in their exhaustive effect upon the nervous energies, by the regular use of opium. Its daily administration not only allays the irritation of the bowels so common in typhoid fever, but keeps up, to some extent, the necessary activity of the brain during the time of its usual course. It is believed that, by its timely use, much of the structural lesion in the alimentary and bronchial mucous mem- branes may be avoided. The capillaries of these parts are prone to derangement on account of deficient nervous influence from the depressed condition of the nervous centres involved in the primary disturbance of this disease, and this leads to structural lesions in the form of ulceration, etc. It is only in the cold or congestive stage of malarial fevers AND THERAPEUTICS. 293 that opium is specially useful, and then does no more than shorten this particular stage. In malignant intermittent fever, the congestion is so complete and protracted that reaction some- times fails to occur. Under such circumstances, this, with other cerebral stimulants, are relied on to arouse the nervous energies sufficiently to reestablish the peripheral circulation. Life may sometimes be preserved in this way, when otherwise a fatal term- ination would be inevitable. Opium may be given in substance, in the shape of pill or elec- tuary, in the dose of one grain. When not too dry from expo- sure, it is sufficiently adhesive, and makes a very suitable mass for pills. The active principles of this drug, the most important of which are morphia, narceia, and opiania, are obtained separately, and used in the form of salts made by combinations with different acids. Svapnia, the name given by Dr. Bigelow to a preparation of opium made by himself, is said to contain the useful active prin- ciples, without the narcotine and others having unpleasant taste. The dose is one grain. Morphine Acetas — Acetate of Morphia — as found in the shops, is a light-brownish powder, the very fine crystals having lost their form. This preparation of morphia is in very general use, and on some accounts preferable to other salts of morphia. While its acetic combination may, to some extent, prevent the unpleas- ant secondary effects of morphia, the form is more convenient for dispensing than the light flocculent sulphate. It may be taken in solution, or, by placing the salt upon the tongue, where it readily dissolves by the moisture of the mouth, and passing down the oesophagus, its absorption is in part effected before reaching the stomach. In this way it is more rapidly taken into the circulation than when dissolved and carried at once to the stomach, particularly when a meal has just been taken, with which the solution mixes, and comes slowly in contact with the gastric mucous membrane. The endermic application to a blis- tered surface allows absorption to a limited extent, and in this way the nervous centre may be sufficiently impressed by the 294 ACOtOGV remedy. The most effectual and practical mode of administering any of the Baits of morphia, however, is the hypodermic applica- tion. With a syringe for the purpose, a concentrated solution may be injected beneath the skin without difficulty, when i( per- meates the cellular tissue, is dissolved and rapidly absorbed. The effect of morphine is more rapidly produced in this way than even by taking it undissolved in the mouth. Nausea, head- ache and other unpleasant secondary effects of opium are thought to be less troublesome when it is used in this way. A perfect solution should be made, however, in order to prevent the local irritation which is liable to result from undissolved portions of the salt-remaining in the cellular tissue. This is effected by the addition of a drop of acetic acid, or two or three drops of vine- gar, to a fluidrachm of water, in which two grains of the acetate of morphia are dissolved. The solution, which at first looks muddy, at once clears and becomes transparent when the acid is added. The dose, when taken by the mouth or hypodermic in- jection, is one-fourth of a grain; and of the solution just de- scribed, six or eight drops make the proper quantity to be injected. Morphkv Sulphas — Sulphate of Morphia — has been in more general use, until recently, than any of the salts of morphia. It is in needle-like crystals, forming a light flocculent mass, of white color, and is more soluble in water than the acetate. The gen- eral effects are about the same as the last mentioned preparation, with the exception of the supposed advantage possessed by the acetate, in the comparative freedom from unpleasant after-effects of the remedy. Morphias Marias — Muriate of Morphia. This is in the form of white flocculent crystals, resembling somewhat that of the sulphate. The properties and dose are the same as this salt, and though very seldom used in this country, may be given in the same dose and for the same purposes. Tinctura Opii- -Tincture of Opium — as the name implies, is a solution of the active principles of the drug in alcohol. Pure alcohol, however, not being a perfect solvent of all the active principles of opium, diluted alcohol, the mixture of equal por- tions of alcohol and water, is used for this tincture. The dose AND THERAPEUTICS. 295 of laudanum, a name by which the tincture is familiarly known, is about twenty-five drops. Water dissolves only a part of the active ingredients of opium, leaving in the residue some of the principles which produce nau- sea, and other unpleasant secondary effects, and hence the watery extract of opium is comparatively free from them, particularly if exhausted of narcotina by ether. Denarcotized Opium is the extract thus prepared, and may be used in half the quantity of opium, say half a grain for the dose. Denarcotized Laudanum is simply a tincture of the extract thus deprived of narcotina, and is known officinally as Tinctura Opii Deodorata — Deodorized Tincture of Opium. This will be found sufficiently free from narcotina, and other princi- ples which affect unpleasantly persons with idiosyncrasy against opium, to make it acceptable. The dose is ticenty to thirty drops, or about the same as simple tincture of opium. McMunn's Elixir of Opium is said to differ from the deodor- ized tincture only in having less alcohol in its preparation, and perhaps more thorough exhaustion of the odor and narcotina of the crude opium. Tinctura Opii Acetatis — Acetated Tincture of Opium — was. once a popular preparation, and doubtless is followed by less headache, stupor, etc., than the simple tincture. This may be in part ow- ing to the controlling influence acetic acid is supposed to exert in preventing and allaying these symptoms. The dose is about ticenty drops. Tinctura Opii Camphor ata — Camphorated Tincture of Opium — Paregoric. This preparation contains carminative and soothing ingredients, which add greatly to its anodyne effect. On this account a less quantity of the active principles of opium is re- quired in the control of nervous derangement than is necessary to induce the narcotic symptoms. To children, therefore, and those unpleasantly affected by other preparations of opium, pare- goric may be advantageously administered. Half a fluidounce contains the strength of less than one grain of opium, but this quantity of the tincture is equal in its anodyne effects to a larger amount of the crude drug. 296 acolo' ( 'iiloroformum — Chloroform. Chemically, this is the terchloride of formyl, a colorless, heavy volatile liquid, of agreeable odor and plea-ant taste. Unlike mosl other volatile Liquids, chloroform is very heavy, having the specific gravity of 1.49 j and, when poured into water, falls in transparent globules to the bottom of the vessel without mixing at all with that liquid. A test is thus afforded of its purity, the water becoming milky when the remedy is not of proper quality. Chloroform is a prompt and powerful cerebral stimulant, giv- ing that amount of nervous energy necessary to control pain, irregular* spasmodic contractions, congestion, etc. So decided and prompt has it been found iu giving relief to the last named condition that chloroform is by some considered a curative rem- edy in intermittent fever. The conclusion arrived at, however, after systematic investigation on this subject, is, that the cold stage may be shortened — indeed, arrested at once — but that the paroxysms are liable to return at the regular period afterwards. In colic and other painful conditions of the bowels, chloroform is equal, and in some instances greatly superior, to opium. This cerebral stimulant has been considered the very best an- tispasmodic in puerperal convulsions, but although a valuable remedy in the disease, doubtless proves so by an action very different from that under which we are now considering it. We have already alluded, under the head of catalytics, to the recently suggested pathology of eclampsia of the puerperal state, and of the catalytic effect of chloroform in the prevention and cure of such convulsions. While it is possible that some restraining in- fluence may be exerted upon the spasm by the neurotic effect, it is not probable that anything more than slight temporary re- straint, such as is had from other cerebral stimulants, will be afforded by this action of chloroform.. In mania a potu, chloro- form proves to be an efficient remedy, but of its modus operandi there is ground for discussion. The true pathological condition leading to the production of such nervous derangement is not well settled. Some suppose the cerebral excitement so constantly kept up by alcoholic drinks leads to the mania in question, while AND THERAPEUTICS. 297 others attribute the hallucinations to a sudden suspension of the accustomed stimulus. The latter seems most reasonable, since it is generally after the use of spirituous liquors has been sus- pended, being refused by the patient or rejected by the stom- ach, that such symptoms are developed. This theory of its pa- thology would make it reasonable to expect benefit in the treat- ment of the affection from the cerebral stimulation of this active remedy. On the other hand, it is difficult to imagine how a stimulant to an organ can relieve a condition dependent directly upon over-stimulation of the same part. The true theory no doubt is, that the brain, when constantly stimulated for a time, like all other organs thus preternaturally excited, fails to perform its ordinary functions when the stimulus is withdrawn, and re- quires the same or some other excitant judiciously administered. During the late war, chloroform was used, it is said, with ben- efit in that intractable disease, tetanus. Indeed, the experiments made with it by Dr. Joseph Jones, in the hospitals of Richmond, Virginia, would seem to justify the opinion entertained of its curative powers. One case at least recovered under its use, and the record of its symptoms and treatment is calculated to give confidence in the remedy. So rarely do confirmed cases recover, that whatever has been used in any terminating favorably is sought after with great anxiety, without regard to the known physiological action, or modus operandi of the agent. Chloro- form has the usual anodyne and vivifying effects of other cere- bral stimulants, and may be used in restlessness, neuralgia and other painful conditions. The dose is thirty to sixty drops, rubbed up with sugar or gum, and agitated briskly before taking. The difficulty of mixing chloroform with, or dissolving it in, other fluids, and its volatile character, render the administration some- what difficult. Chlorodyne, a preparation now substituted for an empirical chlorodyne of London, is composed of chloroform, oil of pepper, extract of cannabis, morphia and some other unimportant ingre- dients. In this mixture, the proportion of chloroform is too small for its full effect, being, in the dose designated, not more than fifteen or twenty drops. This, however, with the eighth of 298 acoloc.y a grain <>f morphia, fche proportion id a dose of the preparation, insures a gentle anodyne effect, and answers very well for this purpose. Alcohol. This Liquid results from what is called vinous or alcoholic fer- mentation of saccharine substances, or those capable of being changed into sugar. In this process, which is conducted at a temperature of from 60° to 90° Fahrenheit, sugar is converted into alcohol and carbonic acid. The latter escapes in the form of gas, with a small portion of glycerine and succinic acid. Grapes, apples, peaches, and other fruits subject to fermentation, contain sugar, which is changed into the ingredients above named, in this process. Grain and potatoes, which contain starch and gluten, readily take on this fermentation and yield alcohol. These, however, require a double fermentation, or a change first from starch to sugar, which is called spontaneous change, or sugar fermentation. Thus it will be seen that, though alcohol may be made from substances which contain no sugar, yet before vinous fermentation occurs it must be present. In these fermented liquors alcohol exists in a diluted state, the larger proportion being water. They are named according to the fruits and other substances from which they are prepared. Thus the malt liquor from grain is called beer ; the fermented juice of the apple, cider; that which results from the grape, wine, etc. These liquors afford, by distillation, the various forms of ardent spirit soon to be mentioned as preparations of alcohol. Alcohol, being more volatile than water, passes over, on the application of heat to the still, comparatively free at first. Water, however, gradually vaporizes also, so that, in ordinary distillation, the spirit consists of water equal in amount to alco- hol. Ordinary alcohol is obtained by redistillation, and arrest- ing the process before a sufficient amount of water passes over to dilute it excessively. Perfectly pure, dry or anhydrous alcohol is obtained only by the addition of quick lime, which, having great affinity for water, leaves the alcohol free. AND THERAPEUTICS. 299 Its specific gravity is 0.79, (U. S. D.) and in this state of con- centration or purity is seldom used in pharmacy, and never as a medical agent. Alcohol, called also Spiritus Bectificatus— Rectified Spirit — has a specific gravity of 0.85. It is used in the preparation of tinc- tures, and for various other purposes in pharmacy and the arts. Diluted Alcohol, or proof spirit, is made by mixing equal parts of alcohol and water, or by a certain process of distillation by which a spirit is obtained of about 0.91 specific gravity, water being 1. Alcohol and diluted alcohol are used only in phar- macy, and need no further notice in this place. The various diluted alcoholic liquors, such as brandy, whisky, rum, etc., having the specific gravity of about 0.95, and the fer- mented undistilled liquors, such as w T ine, beer, ale, etc., furnish the therapeutist with a valuable agent. Unfortunantly for hu- manity, however, they are the source of great misery in the land? from their intemperate use as a beverage. Alcohol, as a cerebral stimulant, differs in some respects from those already mentioned. While that portion of the braiu pre- siding over the mental faculties is excited more powerfully than by opium or chloroform, the organic system of nerves are by no means affected to the same extent. Hence the anodyne effect of brandy is inconsiderable compared with that of opium. In cases of adynamic disease, and powerful shocks to the ner- vous centres, its use is demanded in connection with other cere- bral stimulants, that a more thorough control may be exercised over the nervous energies. In typhoid fever, therefore, and in the cold stage of malignant intermittents, brandy or whisky be- comes necessary. They have perhaps no efficacy in warding off a paroxysm of congestive fever, but may be used to prevent that fatal nervous depresssion which sometimes ensues. Mental or physical exhaustion from excessive exercise, partic- ularly in warm weather, requires the use of spirituous liquors. While this is true, the use made of them to keep up the warmth of the body in cold weather is often injurious. Rich meat diet, in full quantity, will be found more successful for this purpose. The preparations of distilled spirit are, as has been said, named :;<>() aCOLOGT according to the fruii or grain Prom which they are obtained. Whiskies are made of rye, corn and potatoes; brandies^ of grapes, peaches and apples; and rtem, of cane sugar. Spirit made from -rain and rectified with juniper is called gm. Some of these are more acceptable and agreeable to the stomach than others. Generally, however, their purity and age have more to do in this respect than the particular variety of spirit. When of about 0.95 specific gravity, containing "about 50 per cent, of pure alcohol, the dose is two fluidounces diluted with water. The vinous or malt liquors, from which spirit is distilled, con- sist of port, madeira, teneriff and claret, as the principal wines; and ale, porter and beer, as the leading malt liquors. Some of these have other properties than that of cerebral stimulation. Hops, and perhaps other bitter tonic principles, are contained in them, which act as digestive tonics. Alcohol exists in these fer- mented liquors, and they prove as efficient cerebral stimulants, when given in full quantity, as distilled spirit diluted to the same degree. They also, from the carbonic acid gas retained in them, prove more grateful to the stomach than distilled drinks. In debility of the stomach, therefore, at the same time ner- vous invigoration becomes necessary, these preparations afford suitable means of relief. By them a delicate appetite is im- proved, and the activity of the stomach promoted. These fa- vorable changes are effected in the stomach, not only by the direct tonic influence upon the organ, but by increasing the ner- vous energies, which often decline under such circumstances, to the still further embarrassment of digestion. Wines have peculiarities of action, on account of the acid and astringent qualities which some of them possess. Port wine, for instance, contains an astringent principle which is some- times useful in connection with the alcoholic stimulation of the wine. Claret is a tart wine, and affords a grateful drink in febrile affections requiring stimulation. Wine may be given in the dose of about four fluidounces, ale porter and beer in double that amount. AND THERAPEUTICS. 301 Fig. 29. Hyoscyamus — Henbane. The leaves and seed of Hyoscyamus niger, an herbaceous bi- ennial plant, sometimes annual. The annual variety is smaller, and in other respects differs from the biennial, but is similar in medicinal properties. It is a native of Europe, but grows abun- dantly in many parts of the United States. Hyoscyamus is a cerebral stim- ulant, but less active and not so certain in its effects as opium. Unlike the latter article, it has no tendency to constipation, but, on the contrary, is somewhat laxa- tive in full doses. It also differs from opium in its effects on the pupil. While the latter dimin- ishes the size of the opening in the iris, hyoscyamus enlarges it, and is often used for the purpose by oculists. From these facts it must be inferred that entirely dif- ferent effects are produced upon the same part, or that different parts are affected by the two rem- edies. We have already noticed the difference between the action of chloroform, alcohol and opium, and attributed it to the particu- lar portions of the nervous centre upon which each acts. This may also account for the peculiarities of the drug under consideration. It is w T ell known that all of them increase the activity of certain functions of the brain. While some give in- creased energy to the mental faculties, to the extent of percept- ible exhilaration and even intoxication, others, more power- ful in their excitement to the nerves of organic life, seem not to affect the mind. Hyoscyamus acts as an anodyne in painful and irritable con- ditions of cancerous or other local disease, and in painful affec^ Hyoscyamus niger. 302 ACOLOGY fcions dependent on derangement of tin- nervous system, such as gout, rheumatism, neuralgia, etc. In chronic affections, which require remedies constantly for a long time, opium and brandy lay the foundation for an uncontrollable, injurious habit. Under these circumstances, hyoseyamus, less objectionable in this par- ticular, should be at least occasionally substituted for them. The seeds of henbane are said to be more active than the leaves, and are given in somewhat less quantity. The dose is about jirr grains, in the form of powder. The leaves may also be used in substance in the dose of six or eight (/ruins. Extractiim Hyoscyami — Extract of Hyoseyamus. This is the most convenient solid preparation of the drug, and that which is generally used. It is of consistence suitable for pills, and in this form can readily be administered. The dose is about two grains, gradually inereased till the full effects are realized. The want of certainty and promptness in the action of any prepara- tion of henbane, owing to carelessness in its preservation and other causes, renders the increase absolutely necessary to its full action. Tinctura Hyoscyami — Tincture of Hyoseyamus. Like tinctures of most drugs, this is less liable to uncertainty of strength from improper preparation or deterioration from time than the extract. It is specially the case with this article. Hence, the tincture will probably be found more reliable. The dose is one fluidrachm, gradually increased to two or more. Stramonium — Thornapple. The leaves and seed of Datura Stramonium, or Thornapple, an annual plant, native of Europe, but found now in most parts of the United States. It is called Jamestown weed, and is said to have received this name from being first discovered in America at the old town of this name, on James River, Virginia. Stra- monium, as an anodyne for the alleviation of pain, is less effective than any article of the class, but is an active remedy, producing powerful impression on the nervous centre, amounting in over- doses to poisonous action, AND THERArEUTICS. 303 In chronic painful affections, when there is a want of regu- larity and energy in the nervous influences, stramonium has been found useful. Mania, epilepsy and rheumatism are said to have been greatly benefited by it. When, with or without pain, the uterus fails to perform its function from irregular or deficient nervous energy, its activity may be promoted by this remedy. The seeds are more active than the leaves, and may be pulver- ized and given in the dose of one grain, two or three times a day. The leaves, when powdered, can be readily administered, in pill or electuary, in the dose of two or three grains. Extractum Stramonii — Extract of Stramonium, This may be given in the form of pill, in the dose of half a gram, and will be found the most convenient way of using the remedy in the solid form. Tinctura Stramonii — Tincture of Stramonium — is a convenient form for administering the remedy in a fluid state. Dose, half a jiiddrachm. Belladonna — Deadly Nightshade. The leaves of Atropia Belladonna, (Belladonnce Folia) and the root of Atropia Belladonna, (Belladonnce Radix) an herbaceous plant, native of Europe and cultivated successfully in the United States. While the physiological action of belladonna seems an- tagonistic, in some respects, to opium, the leading article in the class of cerebral stimulants, its powerfully exciting influence upon the brain is beyond question. Stramonium and hyoscya- mus have, to some extent, the same antagonism to opium and calabar bean, in their effects upon the pupil, which is so mani- festly the case with belladonna. That both opium and belladonna are cerebral stimulants, and that their antagonism and other peculiarities of action depend on the different portions of the nervous system acted on, there need be no better evidence required than the fact of neuralgia in certain nerves being under the control of opium, while in others bella- donna proves more effectual. Cranial neuralgia, cephalalgia, tic douloureux, etc., will sometimes be found to yield readily under the administration of belladonna^ while the disease in other parts 304 ECOLOGY is speedily quieted by opium, temporarily. The peculiarity of belladonna on the erectile tissues seems to extend to the sphinc- ters generally. The <>s uteri, neck of the bladder, etc., are said to be under its influence. Hencej its local application to the mouth <>(' the womb in tedious labor, from a want of activity in the longitudinal fibres of the os and neck, is believed to be ben- eficial in hastening the delivery. It is also found to relieve in- continence of urine, probably by giving vigor to the contractile tissue of the neck of the bladder. Belladonna, though inferior to opium, chloroform, and perhaps hyoscyamus, as an anodyne, in the speedy relief of acute pain, yet, in neuralgia, strangury and other diseases in which it is useful, more permanent action may be expected. Like other cerebral stimulants, it is bene- ficial in local disease with great irritability of the part. The spasm consequent upon irritation of the rectum in dysentery is no doubt greatly benefited by it, and there are reports of its sal- utary influence by local application on the hypogastrinm. Oc- ulists find belladonna an indispensable agent in enlarging the pupil for surgical operations, and also to prevent its permanent obliteration in inflammation of the iris, from natural or traumatic causes. The dose of bellabonna, in the form of the pulverized leaves, is about two grains. Atropia, the active principle of belladonna, is a more conve- nient form for the local application of the remedy, particularly when used to enlarge the pupil. A drop or two of a solution of the sulphate placed on the conjunctiva will, in half an hour, produce this effect. It may also be used internally, with the same results as those obtained from the drug in substance, but, owing to the great activity of minute doses, other preparations are used for this purpose. The dose is one-thirtieth of a grain, gradually increased. Exiraetum Belladonnas — Extract of Belladonna. This prepa- ration of belladonna is most generally administered when the remedy is used in the solid form. The dose is one-fourth of a grain, and can be easily made into a pill of small size. linctura Belladonnce — Tincture of Belladonna — is a form adapted to fluid preparations in which belladonna enters. The dose is about twenty drops. AND THERAPEUTICS. 305 JEther — Ether. This ether is obtained by distillation from a combination of alcohol and sulphuric acid, and is a transparent, very volatile liquid. Commercial or impure ether has the specific gravity of 0.75, while the stronger or purified ether is only 0.72. The exciting effect of ether upon the brain is prompt, at the same time giving a glow of heat from the warmth communicated to the stomach before absorption occurs. It proves useful as an anodyne in colic, and other spasmodic conditions of the stomach and bowels. In paroxysms of hysteria, and other forms of re- flex nervous derangement, ether, by its speedy and powerful ac- tion upon the brain, gives temporary relief from general nervous derangement by the great increase of nerve force. Mixed with the tincture or some other liquid, or soluble preparation of opium, it affords a very convenient and effectual anodyne for the pur- poses above mentioned. The dose is one fluidrachm, diluted with water, and taken im- mediately after being poured out. It is referred to in another part of this work, under the head of anaesthetics. Cannabis Indica — Indian Hemp. The dried flowering tops of Cannabis Indica, native of India, and hence the name. It is however ascertained that the common hemp of this country, Cannabis Sativa, is identical in its main features with the India plant, particularly as regards its medici- nal properties. Various and contradictory reports of the physiological action of hemp have been made. In Asia, results differing widely from those following its administration in England and this country have been reported. Delirium, intoxication and cata- lepsy were the almost constant effects of full doses of the remedy in India, while they are rarely discovered here. Difference in the temperament of the races, and inequality in the strength of the preparation in the two countries, have been mentioned in explanation. There is no doubt that the preparations of hemp, 20 306 ACOLOGY Cannabis sativa Like those of many other plants, arc of uncertain strength, owing, first, to the imperfect manner in which the collection or preserva- tion is conducted; secondly, to the im- proper mode of preparation ; and thirdly, to deterioration from exposure or other- wise, after being put up for use. Notwithstanding the discrepancy in the reports of experimenters, the fact that cannabis possesses the property of cerebral stimulation, in a high degree, is well es- tablished. In gout, rheumatism and neu- ralgia its anodyne effect will be exhibited. Its action as a stimulant upon the whole cerebro-spinal nervous centres has been inferred from the relief afforded by it in tetanus and hydrophobia; particularly the former, in which, from the statistical re- ports of authors, its curative effects seem probable. In order to a proper test of its virtues, the remedy must be given so as to produce visible impression, and continued sufficiently long to insure its full influence. Powerful remedies, in the use of which the practitioner has but little experience, may be unjustly condemned from a want of boldness and perseverance in their use. On the other hand, the want of judicious caution may lead to still more unfortunate re- sults. The established physiological action of cannabis makes it, beyond question, a valuable therapeutic agent, and as its poisonous effects from large doses have not been found alarming, a rational application of it should be made in the treatment of tetanus, chorea, mania, delirium tremens, etc., when occasion demands. Extractum Cannabis — Extract of Indian Hemp. This is the only form of preparation in which the remedy is used. It is a resinous, alcoholic extract, made by evaporating the tincture to a solid consistence. The dose is one grain, repeated every three hours, and increased, if necessary, till the full effects are realized. When a subject is thoroughly impressed by it, several hours are AND THERAPEUTICS. 307 required for its effects to pass off. By commencing with less than the full dose, and regularly increasing the quantity until symptoms of the anodyne or exhilarating effects appear, there is no risk of excessive action. Tinctura Cannabis — Tincture of Hemp. This preparation, from which the extract is made, may be used with conveni- ence, in the dose oj about thirty drops. It is necessary, however, to dilute it with sweetened water, instead of plain, as other resinous tinctures, lest the resin, in which the virtues of the remedy reside, precipitate and adhere to the vessel from which it is given. CLASS II. CEREBRAL SEDATIVES. Depression of the vital energies occurs from various and seem- ingly very different causes. Some of the means which, under certain circumstances, lead to complete suspension of some func- tions of the brain, seem, under a different state of things, to have an exactly opposite effect. Chloroform, for example, when taken into the stomach in the dose of a fluidrachm, is absorbed slowly, and excites the brain merely to increased activity; but when inhaled in the same quantity, disturbance of function and a tendency to inactivity of the portion presiding over the intel- lectual faculties, is the result. A plausible explanation of these results is, that the remedy is rapidly absorbed from the lungs, making a powerful but transitory impression upon the brain, and that excessive excitation suddenly produced leads to the ar- rest of its functions as perfectly as the action of sedatives. This is also the result of poisonous doses of other cerebral excitants taken into the stomach; the absorption continuing so as to keep up this destructive excitement for hours after being swallowed. Sedatives lessen the activity of an organ, and thereby modify its functions to the same extent. Several varieties of cerebral sedatives may be mentioned, each acting upon different portions of the nervous centres within the cranium. Some, as above stated, act primarily as powerful excitants temporarily, but in- duce depression and suspension of function very soon, if taken 308 ACOLOGY in large doeee or absorbed rapidly. So prompt, indeed, is the depression, stupor, or anaesthesia, that it could hardly be termed the secondary action of the agent. Opium and other cerebral stimulants, in ordinary doses, leave as a result, or secondary ac- tion, stupor or depression, but only after the exhilaration has lasted for a considerable length of time — long enough for the remedies to have expended their foree. Cerebral sedatives are used for very different purposes. The variety which leads to general depression of most of the vital functions, and consequently to general relaxation and sedation without arresting the intellectual and sensory functions, is given with very different object from that had in the use of remedies which produce unconciousness without any general functional depression throughout the body. We shall, therefore, designate them by the terms "prostrating" and "anaesthetic" cerebral se- datives. Anaesthetic Cerebral Sedatives. The means of producing insensibility to pain in surgical and obstetrical practice were not used till a comparatively recent date in the history of medicine; and the honor of the discovery is claimed by American surgeons. Anaesthesia is useful, not only to prevent suffering and thereby afford comfort to the patient, but as a means of lessening the liability to fatal shocks of the nervous system from violent surgical operations. The irritabil- ity which leads to high inflammatory action after painful opera- tions is, in a great degree, prevented ; and the parturient female is spared much suffering, and sometimes danger, by this discov- ery. It is rarely indeed the case that uterine contractions are in the least suspended by anaesthesia. On the contrary, in irritable subjects, with unusual susceptibility to pain, such remedies may not only lessen the amount of suffering, but even facilitate the progress of labor. More than partial insensibility is rarely, if ever, necessary in obstetrics. Unless the labor be very painful and of short duration, it is not proper to keep the patient even partially under its influence the whole time, and, in many cases, anaesthetic agents should not be used at all. AND THERAPEUTICS. 309 Catalogue of Anesthetic Cerebral Sedatives. JEther, Nitrous Oxide, Chloroformum, Chloral. JEther — Ether. This liquid has been described in the class of cerebral stimu- lants, and is now referred to only in connection with its anaes- thetic property. Ether was the first article of the class used to produce insensibility during surgical operations, and, on account of being less dangerous, is now considered by some surgeons superior to any other. Comparatively few reports of fatal results from it have been made, and yet, because of its unpleasant odor, and the nausea which sometimes follows, it is not in very gen- eral use. A fluidounce or more is necessary to produce insensibility, and may be inhaled from a napkin or sponge — care being taken to keep it a sufficient distance from the nose to admit the air also. Chloroformum — Chloroform. This prominent cerebral stimulant is in general use also as an anaesthetic, and is made to induce these opposite conditions by the modes of administration. It was discovered by chemists in the United States, France and Germany about the same time (1831), but the credit of its first application to prevent pain in surgical operations is said to have been claimed by Dr. Simpson, of Edinburgh, in 1847, one year after ether had been used for this purpose in Boston. The pleasantness of its taste and odor, the promptness with which it acts, and the quantity required, were some of the advantages over ether claimed for it by Dr. Simpson, and which have no doubt led to its supplanting the latter. On account of these properties, the fatal results attend- ing its use have not been sufficient to deter the profession from making it the chief anaesthetic. Doubtless the danger to be ap- prehended from it is magnified in the minds of those who care- fully treasure up the reports of fatal cases, without calling to 310 ACOLOGY mind the fact that hundreds of thousands are taking it safely while one dies under its influence. A mixture of ether and chloroform is supposed to be less dangerous, and has been pro- posed as a substitute for either of them separately. Surgeons and obstetricians, however, who have used chloroform by inhala- tion for twenty years without a serious casualty, are not likely to abandon it. Two or three fluidrachms will generally destroy sensibility, and may be used as directed for the inhalation of ether. Nitrous Oxide — Laughing Gas. This, in chemical language, is the protoxide of nitrogen, and has long been known as capable of producing exhilaration or intoxication when inhaled. More recently, its anaesthetic power has been sought by dentists, in the extraction of teeth. For this, and other painful operations requiring only a few moments for their performance, the nitrous oxide makes an appropriate an- sesthetic. The difficulty attending its use in extended operations is, that the state of insensibility from one inhalation is not suffi- ciently long, and volition, which cannot always be commanded again in a reasonable time, is necessary to its repetition. Recent experiments with it in surgery lead to these conclusions. It will, probably, therefore, be used as heretofore, only as a source of amusement and for dental purposes. Chloral. Uncombined or anhydrous chloral is in the form of an oily fluid, and is made by the action of chlorine on alcohol. In this state it is difficult to preserve its purity for any considerable length of time. Chloral Hydrate — Hydrate of Chloral — is formed by a combi- nation of chloral with water, in which we have the very rare occurrence of a solid resulting from the mixture of two fluids. Beautiful crystaline masses are thus formed, and, though volatile, may be kept safely in glass-stoppered bottles. It is of peculiar odor, sweetish taste, and is readily soluble in water. Its decom- position by contact with an alkali is said to result in the produc- AND THERAPEUTICS. 311 tion of pure chloroform, and some of its effects are probably ascribable to the action of this agent, formed by an alkali met with in the blood. The ordinary action of chloral upon the brain leads to a tem- porary suspension of some of its functions in the production of that state of rest called sleep. The rest, though natural, is said to be so profound sometimes as to resemble imperfect anaesthesia, and affords immunity from suffering in painful conditions, inju- ries and slight surgical operations. Hydrate of chloral has been found useful in wakefulness from general irritability or other cause. Mania a potu affords that condition of the brain in which its good effects are readily seen. Sleep is promptly induced, and a general sedative and quieting influence exerted. The physiological action of chloral hydrate, according to the reports of practitioners in this country, does not observe that uniformity expected from the same preparation of any remedy. Chloral with alcohol forms a solid, resembling very much that of its union with water, and this alcoholate is supposed to be mistaken for the hydrate, in the cases of failure to produce the usual effects of the remedy. Two German chemists have experimented in making combin- ations of it with alcohol and with water. They determine that the two preparations differ materially in their medicinal, not- withstanding the similarity of sensible properties. These experi- menters make known a test by which imposition in the sale of an improper preparation may be detected. The pure hydrate of chloral boils at 95° C. (203° Fahr.), while the alcoholate re- quires a temperature of 115° C. (239° Fahr.) {American Jour- nal of Pharmacy, 1870.) Chloral, though a local irritant, may be given safely by the stomach when properly diluted. In the proportion of ten grains to two fluidounces of water, no unpleasant local irritation will occur; and in this quantity restlessness and cerebral excitement is often allayed, notwithstanding the remedy is frequently re- quired in three times this amount. The dose, therefore, is from ten to thirty grains, repeated in an hour or two if necessary. 312 ACOLOGY From reports made to the Atlanta Academy of Medicine by members who had used chloral as an anodyne and hypnotic in various conditions, it would seem that unpleasant and sometimes dangerous results are likely to occur when it is given in bron- chial and pneumonic diseases. Alarming prostration was wit- nessed by two intelligent physicians Prom its use in dilli-rent aifections of the respiratory organs. Prostrating Cerebral Sedatives. Since the promotion of health, strength and vigor is the ulti- mate object of therapeutics, it seems somewhat unreasonable to induce the opposite condition in order to obtain these results. As in the use of cardiac sedatives, this course is however some- times pressingly demanded. It is necessary, not only to insure the general relaxation and sedation by which inflammatory affec- tions are relieved, but to allay irritable and excited states of the brain itself. Our arrangement of remedial agents is founded ex- clusively on physiological action, and no article will be found in this or any other class, which is not supposed to act directly upon the organ indicated by the name of such class. Indirect de- pressing influence is exerted upon the cranial nervous centres, by nausea, depletion, etc. Such, however, do not properly be- long to the class now under consideration. Catalogue of Prostrating Cerebral Sedatives. Tabacum, Acidum Hydrocyanicum, Tabacum — Tobacco. The leaves of Nicotiana Tabacum, an annual herbaceous plant, native of Central America, but cultivated in several States of the Union as a commercial commodity. For the gratification of the artificial taste contracted by habitual use, tobacco undergoes various forms of preparation to suit each particular mode of using it. From any of these the usual pharmaceutical prepara- tions can be made. AtiD THERAPEUTICS. 313 The physiological effects of tobacco are nausea and cerebral depression. As already stated, the former, whether produced by tobacco or other inverse peristaltic excitant, leads to more or less nervous depression, but this drug, although a nauseant, and to this extent an indirect cerebral sedative, has also a direct de- pressing influence, which is generally termed its narcotic action. This term perhaps is not inappropriately applied to this effect of tobacco, for the inactivity and stupor is one of the primary and direct actions of the article. Though seldom, it sometimes becomes necessary to depress the vital energies to the lowest pos- sible extent consistent with safety. To do this, it is necessary that direct sedative or narcotic action upon the brain be resorted to. In strangulated hernia, the passage of renal and biliary calculi, and in certain forms of tonic spasm of muscular struc- tures, it sometimes becomes necessary to allay the excessive and even ordinary rigidity of the part. The arrest of vitality or nerve force by the direct and indirect sedative action of tobacco induces the most perfect relaxation, and may be used with advan- tage under such circumstances. Infusum Tabacum — Infusion of Tobacco. This is the usual preparation for medicinal purposes, and answers well for admin- istration by the mouth or rectum. The latter mode is preferable on some accounts, and equally effectual in making the desired impression. The dose, when taken into the stomach, is one or two fluidounces, and about three times this amount, when taken by injection, to be repeated in an hour, if necessary. Acidum Hydrocyanicum Dilutum— Diluted HydrocyanicAcid. Prussic acid is a deadly poison, destroying life more speedily than most other destructive agents. The physiological actions of the remedy are exerted upon the heart as a tonic, and upon the brain as a sedative. This impression upon the nervous centre, when in moderate degree, may be made to subserve valuable therapeutic purposes, but caution is required in its use, to prevent excessive or poisonous action. It has been found useful in the irritable, spasmodic cough of asthma, and that attending phthisis, by 314 ACOLOGY which the patient is agitated, and disturbed from sleep during the night In delirium, mania, and general convulsive and spasmodic disease, dependent upon excitement of the greal ner- vous centre, its application would seem more rational. The dose 18 three orfour drops, given in syrup or gum water. Potmsii Oyanidum — Oyanide of Potassium. This, when pure, is in white opake masses. It is soluble in water, and slightly deliquesces in moist atmosphere. The salt acts as a poison and medicinal agent in every respect similarly to hydrocyanic acid. It is, however, preferable as a medicine on account of its uniform strength and less liability to decomposition. The dose is one- eighth of a grain, dissolved in a little water. CLASS III. CEREBRAL TONICS. In pursuance of the plan of this work, it becomes necessary to collect in this class all the remedies whose known physiologi- cal action affords tone or permanent energy to the brain. To do this requires innovation upon the popular classifications of au- thors; regrets for the existing necessity for which have already been expressed. In making these material changes in classification, we do not wish to be understood as intimating that they are founded upon new properties discovered by the author. On the contrary, the opinion of authors, to whose classification we object, is, we think, in the main correct in regard to the physiological action of rem- edies. On this point all pretty nearly agree. The practical advantage to the learner, which we seek, is the arrangement of all known remedies into classes, the names of which denote the part of the body acted on, physiologically, and the kind of action exerted — whether stimulating, tonic or sedative. The remedies which we shall place under the head of cerebral tonics have been variously arranged, as "nervous stimulants," " neurotics," " nervous tonics," etc. It has been thought suffi- ciently explicit to give them the latter name, since they are known to act as tonics upon some portion of the nervous system. AND THERAPEUTICS. 315 The practical error, we think, consists in conveying the idea of their applicability to derangement of any portion of this system requiring tonic action. This would lead to as grave error in practice as if they were denominated digestive tonics; for, in all detailed reports of the successful application of these remedies, the brain itself is the acknowledged seat of the affections. Thus, the preparations of zinc, copper, etc., have been found useful in epilepsy, mania, and other diseases giving evidence of a de- ranged condition of that organ. Other neurotics, known to act on the spinal centre, have not been found useful in these ailments, but in affections dependent on a morbid condition of the spinal cord and its nerves. The articles of this class are applicable more particularly in chronic diseases, and their impression, being made slowly, is durable when induced. Catalogue of Cerebral Tonics. Phosphorus, Argenti Nitras, Zinci Sulphas, Centaurea, Cuprum, Brominum. Phosphorus. This is a substance found variously combined with alkaline bases, in animal, vegetable, and mineral productions, in the forms of phosphates and phosphites, according as phosphoric or phosphorous acid enters into the combination. As found in commerce, phosphorus is a translucent, solid substance, and has such an affinity for oxygen that it is liable to spontaneous com- bustion unless kept immersed in water. It is a powerful irritant poison, giving rise to intense local irritation and inflammation of the alimentary mucous membrane when swallowed in substance. It has been considered a power- ful general stimulant to the circulatory as well as to the nervous system. This general excitement may, in part at least, arise from the excessive local irritation above described. At the same time, the brain itself may be temporarily excited. The most important action, however, of phosphorus is that of 316 ACOUMJV increased permanent vigor communicated to the nervous centres by what is supposed the increase of aeurine, or nerve substance. This is the explanation of its tonic effect, and there are reasons tor admitting its correctness. It is known that phosphorus is a constant ingredient in the brain, and is therefore supposed to be an essential element in its structure. The fact of its tonic effect also being well established, it is natural to suppose that, the necessary ingredient being directly afforded, leads to this result. Phosphorus has been lauded greatly by Dr. Churchill as a remedy for constitutional tuberculosis, seemingly under the im- pression that it exercised catalytic action upon tuberculous matter. With other practitioners, the reputation given it by this author has not been sustained, and it is at least doubtful whether any such action can be justly attributed to it. It is very well known that tuberculous subjects are more certainly protected against accumulation and disastrous results of this substance by the in- crease and constant support of nervous force. Hence, alcohol, opium, bracing air, etc., are universally acknowledged as useful for this purpose. Phosphorus, acting not upon the deposit, but upon the brain, as a tonic instead of stimulant, gives more perm- anent nervous power than these. Would that some certain catalytic could be found for this de- stroyer of mankind ! Let not experiments in this direction be abandoned. He who shall make this discovery will be hailed as the great protector of his race, and have his name inscribed on the scroll of fame, along with that of Jenner and other ben- efactors of mankind ! ! Phosphorus may be given in substance in the dose of one- twentieth of a grain dissolved in oil or ether. A solution of cod- liver oil has been suggested and practiced as a means of intro- ducing a celebrated calorific, so renowned in phthisis, along with the cerebral tonic, >ov promoter of nerve force. Phosphorous acid, in combination with alkaline bases in the form of hypophosphites, is now a popular means of introducing phosphorus into the system, and in this form has given rise to flattering accounts of its use in phthisis. It is supposed, aud AND THERAPEUTICS. 317 doubtless correctly, that the phosphorous acid is set free, before or after absorption, and, by its deoxidizing property, is converted into phosphoric acid, In this way the salt is made to answer the same purpose as phosphorus given in substance, while all the un- pleasantness and difficulty of administration is avoided. Hijpophosphite of Calcium is of pearly whiteness, is readily soluble, and given in the close of ten to twenty grains, three times a day, dissolved in water. Combinations of phosphorous acid with sodium and potassium, making the hypophosphites of these bases, are in use for the same purposes as the preparation with calcium. Indeed, all of these are sometimes mixed in the same solution, but perhaps without any practical advantage. The full effects of the remedy may be obtained from any one of them ; and the dose of each is the same, say about fifteen grains ordinarily. Zinci Sulphas — Sulphate of Zinc. This salt resembles somewhat the sulphate of magnesium, having transparent prismatic crystals. It is soluble in water, has a very unpleasant styptic taste, and effloresces when exposed to the atmosphere, falling into a white powder without losing its active properties. Alkalies, acetate of lead and vegetable astrin- gents are incompatible, and should not be administered with it. While this preparation has been considered more particularly useful in chronic nervous disturbance, such as epilepsy and other forms of permanent convulsive disease, yet there is reason to be- lieve that its tonic action is serviceable in acute disease of the great nervous centre, such as typhoid and other forms of adynamic fever. Its astringent property also makes it useful in this dis- ease, when, as is often the case, the attending diarrhoea requires such action. It is not, however, in general use, in the treatment of typhoid fever, either for its astringency or its tonic effect upon the nervous centres; but the favorable result of a case, witnessed by the author, in which this salt was given for its astringent effect, induced the belief that the nervous system was also favorably impressed by it. In the convulsions of young subjects, even when there is no 318 ACOLOGY reason to suspect confirmed epilepsy, the salt will be found use- ful. At this age convulsions are often the result of irritation in the alimentary canal, for which the astringency is useful, while its tonic property serves to relieve the nervous susceptibility. The dose, as a cerebral tonic, is one or two grains, given in watery solution or in the form of pill. Cuprum — Copper. The preparations of copper have been much praised for their good effects in the treatment of epilepsy. Cupri Sulphas — Sulphate of Copper. This preparation of copper has been noticed under the head of emetics, and its sen- sible properties given. While this salt possesses the general tonic properties of the metal, yet other preparations have been preferred in affections requiring the action of cerebral tonics. It may be given in epilepsy, mania, and other forms of chronic nervous disease dependent on a want of healthy vigor of the brain. The dose is one-fourth of a grain, gradually increased to two or more. Cuprum Ammoniatum — Ammoniated Copper. This prepara- tion is preferred by some, in the treatment of epilepsy, to any of the mineral cerebral tonics. Repeated experiments with it prove its value for this purpose, and incurable cases of epilepsy are often greatly benefited by lengthening the period between paroxysms of the disease. Ammoniated copper may be given in the dose of one-fourth of a grain, in the form of pill, gradually increased to two or three grains three times a day. Argentt Nitras — Nitrate of Silver. This is in the form of flat, transparent crystals, of styptic, metallic taste, and soluble in water. Its local action is that of cauterant, catheretic or mild astringent, according as it is more or less diluted.* Of these properties, the reader will find a more extended account under appropriate heads. In this place it is proper to notice it only in connection with AND THERAPEUTICS. 319 its internal use as a cerebral tonic, and in the crystaline form above described, it should be given for this purpose. It is said that, when taken for a long time, it imparts a dark color to the skin, but no such effect need be apprehended when used only the ordinary length of time required to effect the usual objects of its administration. No cerebral tonic has been more generally used in the treat- ment of epilepsy than the nitrate of silver; but its tonic effect upon the great nervous centre has also been sought in diseases less permanent in their character. Dr. Mitchell, of Philadel- phia, found very satisfactory results from its regular use in the treatment of typhoid fever, and others speak favorably of it in this disease, but attribute its good effects principally to the cath- eretic action of the salt upon the irritable alimentary mucous membrane. Although its invigorating effect upon the brain may prove beneficial, exclusive reliance on this or other nervous tonics to keep up the nervous energies is not, perhaps, justifiable; for tonics whose effects are slowly produced will not always meet the emergency in this fever. Angina pectoris and chorea are also said to be favorably impressed with the neurotic action of this remedy. In order to preserve the activity of the remedy, it is necessary to bear in mind the fact that common salt, an ingredient in most kinds of food, is incompatible with it, and should not be used to any extent immediately before or after it is taken. A want of care in this particular doubtless leads often to complete failure in producing the ordinary effects of remedies. If salt food should be taken at all during the use of this remedy, the admin- istration should be made at a period intermediate between the regular meals. The dose is one-fourth of a grain, gradually in- creased to two grains or more, three times daily, and solution or pill. Centaurea — Thistle. The leaves of Centaurea Benedicta, or Blessed Thistle, an her- baceous annual plant, native of Europe, and cultivated in the United States. It grows to the height of one or two feet, with 320 ACOLOGY numerous, rather slender branches, which, at the time of flower* in-, fail to maintain the erect position and become tangled on the ground, giving somewhat the appearance of a twining plant. The leaves, on their edges, have -harp points, making it diffi- cult to handle them without pricking the fingers, as with the ordinary thistle, which it resembles very much in many respects. Fit Weed, as it is vulgarly called, has gained some notoriety in Georgia as a remedy for epilepsy. The plant has heretofore been considered useful only as a diaphoretic ptysan, but from experiments made by Dr. W. F. Westmoreland, in the treat- ment of epilepsy during the late war, it bids fair to become a popular remedy for this dread malady. The difficulty of ob- taining the plant, or seed from which to raise it, since the war, interferes with further experiments for the present. Decoction is the form of preparation in which it has been used in this city, and is made by boiling sixty grains of the dried leaves for a few moments in a pint of water. Of this three or four fluidounces are taken three times a day. A species of thistle, resembling very much the centaurea bene- dicta is found abundantly on the commons and in various places in the neighborhood of Atlanta. This is known among the people of the neighborhood in which it is found as the Canada TJ uxtle, and differs from fit weed only in having a stouter stem, and maintaining the erect position. A case of epilepsy is now under treatment with this plant, in the same form of preparation and dose as above named for centaurea, and with flattering pros- pects of success. Brominum — Bromine. This is an elementary substance in the form of a volatile liquid^ of dark red color, found in salt waters, and in some respects re- sembles iodine and chlorine. In the operation of marine and spring salt-works it was discovered. Uncombined, bromine is rarely used internally, and hence its physiological action has not been very satisfactorily determined by the profession. Its re- semblance to iodine, and some experiments made with it, have induced writers to class it with alteratives; and yet, while it may AND THERAPEUTICS. 321 have useful catalytic effect upon fibrinous and other deposits, there is not sufficient evidence of such action to warrant this classifi- cation of the remedy. Potassii Bromidum — Bromide of Potassium^-is one of the lead- ing preparations of bromine, and has attracted very considerable attention as a medicinal agent for the last ten years. It has been used almost exclusively for its neurotic effect in giving increase of energy to the great controlling nerve centres, and as a stimulant is less useful than in cases requiring permanent tonic influence. In epilepsy, chorea, and other chronic nervous affections, has the remedy been more profitably employed. . The usual dose is about ten grains dissolved in water, but in epi- lepsy, where the intervals between the paroxysms are short, and the convulsions violent, thirty to forty grains, three times a day, may be given. Ammonii Bromidum — Bromide of Ammonium — though differing perhaps very little in its medicinal virtues from the above prep- aration, has been preferred by certain practitioners. Doubtless, in the main, the same general effects are produced by both, and habit, or some fancied peculiarity of action, perhaps leads to the preference entertained for this. The dose is about ten grains, dissolved in water, and repeated three or four times a day. Twenty grains, and even more, may be used if a more powerful impression be demanded. Lithii Bromidum — Bromide of Lithium. This combination of bromine and lithium, though not officinal, is probably superior to the compounds of bromine with potassium, ammonium, etc. If the efficacy of these preparations depends upon the bromine in them, this should certainly be preferred, since it is ascertained that about 90 per cent, of it consists of bromine, while in the compounds of potassium and ammonium it does not reach 80 per cent. Like other preparations of bromine, this seems to give in- creased vigor to the great nervous centre at once, affording ano- dyne influence, but, from experiments made with it in epilepsy is more valuable as a cerebral tonic. In the dose of ten grains, gradually increased to twenty or 21 322 ACOLOGY more, three times a day, epilepsy lias been entirely arrested; and when a cure is not effected, great relief is afforded by the tem- porary arrest of convulsions. CLASS IV. EXCITO-MOTOR STIMULANTS OR SPASMODICS. The system of motor nerves, which govern muscular contrac- tion, excites the objects of their distribution to inordinate action by impressions made upon their nervous centre. Certain agents are known to have such direct or physiological action, and hence are arranged in the class under consideration. Their application is easy. When the nervous force necessary to the motor func- tions is deficient, causing partial or complete paralysis, these ex- citants would seem to be demanded, and will generally prove permanently effectual, provided no structural lesion still exists in the centre to be acted on. Unfortunately for the general suc- cess of the class, however, this physical incapacity often inter- feres. Sometimes, when such organic derangement has ceased, there remains functional inactivity, which may be remedied by this class of agents. Catalogue of Excito-Motor Stimulants. Nux Vomica, • Arnica, Electricity. Nux Vomica. The seed of Strychnos Nux Vomica, a branching tree, native of the East Indies. The fruit, which is the size of an orange, contains several seeds embedded in the pulpy substance. The virtues of nux vomica depend upon two alkaloid principles, called strychnia and brucia, residing in these seeds. The former being required in one-tenth the amount of the latter, to produce the same effect, is used exclusively. Strychnia uniformly excites to increased activity the motor system of nerves, and perhaps every therapeutic effect of this rem- AND THERAPEUTICS. 323 eclv which has been witnessed may, with propriety, be attributed to this physiological action. Although it has been found useful in dyspepsia, and hence called a digestive tonic, this result may be justly attributable to its direct action upon the nervous sys- tem. In a certain form of indigestion, the prominent difficulty consists in a want of peristaltic motion — i. i Fig. 31. torpor of the alimentary muscular struc- ture, and it requires no far-fetched reason- ing to show that an increase of motive power may accomplish the end desired. In accordance with this theory of its ac- tion, strychnia has been given and found useful in paralysis, and permanently so when no organic lesion exists. Also in general or local muscular debility, not , i • /> i Strychnos mix vomica. amounting to complete paralysis ot the motor nerves, such as indigestion from torpor of the alimentary canal, etc. In over doses strychnia is a deadly poison, and should be administered cautiously. The dose is one-sixteenth of a grain, gradually increased to one-tenth, if the desired effects are not produced by less quan- tity. With this precaution, no fears need be entertained of ill- consequences from its use. A Tincture and Solid Extract of nux vomica are officinal, but 'the uncertainty of strength, owing to want of uniformity in the amount of active ingredients in different specimens of the drug from which they are made, renders them less reliable than strych- nia. The tincture may be given in the dose of twenty to thirty drops; of the extract, one grain is sufficient to commence with. Arnica — Leopard's Bane. The flowers of Arnica Montana, or Leopard's Bane, a peren- nial herbaceous plant, about one foot in height, and native of Europe. The whole plant may be employed, but the flowers being pre- ferable, are generally used. While arnica, like nux vomica, is 32 1 ACOLOGY found useful when increased action of the excito-motor system is indicated, it has the additional properties, of local irritant to the stomach and general excitant of the brain. In the main, how- ever, they arc called for under the same state of circumstances. In amaurosis, or any other variety of partial or complete paral- ysis, dependent upon functional cause, whether the result of vio- lence or other origin, the effect of these remedies may be called for. It may be given in substance in the dose of about ten grains; and of an infusion, made in the proportion of a troyounce to the pint of water, half a fluidounce, every two or three hours. Electricity. The similarity of electric fluid and nervous force is so striking, that attempts have been made to prove them identical; and, although all the phenomena and laws connected with their pro- duction, transmission and effects do not sustain this proposition, yet, the vital force necessary to excite muscular contraction is afforded by both. While one of these subtle fluids is brought into play by chemical or mechanical means, the other seems to be the result of functional operations of a chief nervous centre, the brain. As a remedial agent, electricity is used to supply the place of nervous fluid, when deficient, and differs from the motor stimu- lants, already described, in that of furnishing a fluid similar, in some essential respects, to the natural fluid produced by the ner- vous centre, instead of promoting an increased production of the latter. Electricity is, therefore, applicable in the same forms of disease for which excito-motor stimulants have been recom- mended. The permanence of its effects must, of course, depend upon the freedom from organic disturbance which originally produced the paralysis. If lesion, compression or other organic disturbance of the nerves or nervous centre still exists, the mus- cular activity given by the remedy will, of course, be temporary, and of no permanent benefit until such local difficulty be removed. Electricity and galvanism, although generated by very different means, are identical in medicinal and other properties. The AND THERAPEUTICS. 325 former is evolved by friction between non-conducting bodies, and certain relations of metals with magnets, while the latter results from chemical reaction between acids and metals. Electro-magnetism is electricity intensified by polarized or mag- netized iron. A current generated by a suitable friction appara- tus is passed through a coil of wire, around a bundle of iron rods, and makes of them temporary magnets, which, in return, add immense force to the electric current. When coils of wire are made to pass rapidly, in close proximity to the poles of a horse-shoe magnet, a current of electricity may be started equal to that produced by friction. Instruments operating on these principles are used for remedial purposes. Galvano-magnetism requires similar arrangement, except that the fluid is produced by the operation of a snugly-arranged, portable galvanic battery, attached to the apparatus. In this way a current of sufficient force for ordinary use can be obtained with a very economical consumption of acids and metals. The shock, which seems to be necessary to muscular excitation, is the result of frequent short interruptions of the current, made by a proper adaptation of the apparatus to this end. To cases requiring its use, this electro-magnetism or galvano-magnetism should be applied for about five minutes daily, for several days, or until its powers of relief are thoroughly tested. The current should be made to traverse the feeble part, by placing one pole on the surface opposite that portion of the spine supplying the affected part with nerves, and the other at a point toward the peripheral extremities of these nerves. In this way the current can be made to pass along the whole length of the affected nerves. Recently, electricity has been used for the treatment of surgi- cal diseases. Tumors of various kinds are absorbed, it is said, after having been subjected to a regular course of electricity. Electrolysis is the term applied to this system of treatment, and decidedly curative effects are claimed for it by those engaged in experiments on such diseases. Cancer of the breast is thus treated by Dr. A. D. Rockwell, of New York, and his reports of cures are certainly entitled to consideration. Needles are inserted 32<> acologV at opposite points in the tumor, and the current made to pass through it. He has improved instruments which he usee for this purpose. CLASS V. EXCITO-MOTOR SEDATIVES OR ANTISPASMODICS. This class, as will be seen, does not include all neurotic reme- dies which have been called "antispasmodics," and which, under certain circumstances, relieve spasm. This condition may exist in certain parts of the body from irregular and feeble nervous influence, and requires for its relief a cerebral or nervous stimu- lant, when dependent upon reflex nervous derangement or origi- nal inactivity of the centre. Thus opium, chloroform, etc., by affording additional nervous force, overcome such derangement arising from inactivity of the brain, and sometimes temporarily even when other cause of derangement exists. The class of remedies under consideration act, physiologically, as sedatives to that portion of the nervous centres which presides over the sys- tem of nerves called excito-motor, and are applicable in an ex- cited state of the centre of this system. Catalogue of Excito-Motor Sedatives. Conium, Woorari, Physostigma. Coni UM — Hemlock. The leaves of Conium Maculatum, an umbelliferous herbace- ous plant, with biennial root, and branching stem, four or five feet in height. It is a native of Europe, and cultivated in the United States. The drug is dependent for its virtues upon an alkaloid principle called conia. Hemlock is a virulent poison in over quantity, producing death by arresting the functions of the excito-motor centre, gen- eral paralysis being a common result of poisonous doses. It has, from the earliest history of medicine, been the subject of occa- AND THERAPEUTICS. 32? sional laudation, and as often abandoned by the profession as worthless. The peculiar and powerful sedative effect exerted upon the great nervous centre of motion is certainty very rarely, if ever, called for in treatment of cancer, phthisis, and other diseases in which it has been most frequently used. With its known effects upon the nervous force, it is difficult to conceive of any benefit that could result from its use in the diseases men- tioned, unless from other property it may possess. A more ra- tional application of the remedy, it would seem, could be made in diseases dependent upon abnormal excitement in that portion of the nervous system upon which the remedy exerts its sedative influence, such as tetanus, chorea, hydrophobia, etc. Extractum Conii — Extract of Conium. This is an officinal pre- paration, and one in which the remedy may be readily adminis- tered in the form of pill. The dose is two grains three times a day, very gradually • increased till evidences of its action are observed. Tindura Conii — Tindure of Conium. In this form the remedy can be safely preserved, and conveniently administered in the dose of a half to afluidrachm three times a day. WOORARI. . A vegetable production of unknown origin, discovered by the aborigines of a British province of South America. In appear- ance, it resembles vegetable extracts, and has been found, on an- alysis, contrary to what was once supposed, to contain no animal remains. Its effects are much more prompt and violent when introduced into the cellular tissues, than when given by the stomach or rectum, though, in larger doses, the poisonous action is readily developed by the latter modes of introduction. It is a violent poison, paralyzing the excito-motor nervous centre, and experiments with it on animals prove its direct antagonism to the action of strychnia, a fact in contradiction of the opinion once entertained, that it is the product of strychnos. In some instances of poisoning from it the heart's action continued some minutes after respiration ceased. This symptom, however, is 1528 ACOLOGY not constant, as, in other cases, these vital functions ceased at the same time. From experiments made, the physiological action of the drug is very well established, and some experiments carrying out a rational course in its application, have tested its virtues in the excessive motor-excitement of tetanus, and with favorable results. Much time would be saved, and many lives preserved, should therapeutists, in their experimental investigations, always labor to ascertain, first, the true physiological action of remedies, and also the pathological origin of symptoms present. The exces- sively poisonous nature of woorari, and the want of information as to the origin, mode of administration and dose, have thus far interfered with its general use. There are reasons, however, for believing that in it may yet be discovered the means of controll- ing the heretofore unmanageable affections, tetanus and hydro- phobia, particularly the former. Chorea, and other spasmodic diseases from excessive nervous excitation, may also be benefited by the action of this remedy, at least temporarily. Physostigma — Calabar Bean. The seed of Physostigma Venenosum, a perennial, climbing plant, with ligneous stem, mounting on contiguous trees. This plant is a native of Africa, and was unknown to botanists till about the year 1859. The fruit, or seed, which has a shining, brittle exterior, is the size of a large horse bean, and of brown- ish-gray color, the kernel of which is white, pulverizable, and without disagreeable taste or odor. The active principle upon which its virtues depend is soluble in alcohol, and imperfectly so in water. Calabar bean has a powerful sedative influence upon the motor nerves, the most prominent symptom of which seems to be that of muscular prostration and general lethargy. Its impres- sion upon the iris leads to a condition opposite that made by belladonna — the pupil contracting to small size under its action. This seeming antagonism leads to the supposition that one may serve as an antidote for poisoning by the other — which, how- ever, is by no means certain, since the two substances exert their And therapeutics. 329 principal action upon different portions of the nervous system ; and though the abnormal condition of the pupil may be relieved, yet other important disturbance may still exist. The rational application of this remedy, as suggested by its known physiological action upon the motor nerves, is in the treatment of spasmodic affections, such as tetanus, hydrophobia, etc.; and for which it will doubtless be found equally effectual with any remedy used for the treatment of these hitherto incu- rable affections. CLASS VI. SPINAL OR REFLEX NERVOUS STIMULANTS. A peculiar form of nervous disturbance, dependent on local organic irritation, sometimes exists, and is called reflex nervous derangement. The stomach, bowels, uterus or other organs be- ing the subject of chronic inflammation or irritable disease of any kind, the impression, irritability or sympathy is often trans- mitted, through the nerves which supply the diseased part, to the spinal cord and sometimes to the brain. In this way temporary disturbance or irritation is set up in the nervous centres, and also retransmitted or reflected, through the same nerves or others arising from the irritated portion of the cord or brain, to such parts as are supplied by these nerves. This reflected derange- ment gives rise to various forms of functional disturbance, evinced by pain, cramps, palpitation, indigestion, dyspnoea — symptoms resembling so nearly organic lesion of the parts, that they are sometimes mistaken for permanent structural disease. For example, an irritable uterus, in which ulceration or endo-me- tritis may exist, transmits not only to the cord of the lumbar spine, but to that of the dorsal also, an irritation so perceptible that it is exhibited in tenderness to the touch along that portion of the vertebral column. Under such circumstances, various reflex symptoms appear. Globus hystericus, palpitation, flatu- lence, and other evidences of functional gastric disturbance, with every conceivable pain and ache, may from time to time torment the unfortunate sufferer. These are the results of reflex action, 330 acologY from which spinal nervous stimulants give temporary relief. The stomach, bowels, kidneys, etc., of both sexes may be the origin of a similar stale of the nervous system, but the female seems to be more subject, and the uterus a more prolific source than other organs. Often, before evidences of diseased womb have been discovered, the reflex symptoms are mistaken for biliary, gastric or cardiac disease, and when their nervous character is under- stood, remedies of the class under consideration are too often relied on for permanent relief. While it is true that such a state rarely proves fatal, yet it is perhaps equally so for recovery to result from any general treatment, directed to these reflex symptoms. Reference is made to the means of permanent cure of the radical cause, under the head of cat heretics. For the temporary relief of nervous derangement thus in- duced, the remedies under consideration, which we denominate spinal stimulants, may be successfully used. The relief thus afforded can only be temporary, because the local disturbance, if not removed, still continues to operate on the spinal cord and ganglionic system of nervous centres, so as again to develop these symptoms. In disturbance existing primarily in the spinal cord, embar- rassing its functions, the articles of this class have not been con- sidered applicable, but since they restore activity to these cen- tres when depressed by indirect or reflex impressions, it is rea- sonable to suppose they will be found useful, temporarily, in such general nervous derangement as results from the poison of malaria and other causes operating on the spinal cord directly. Catalogue of Spinal Stimulants. Assafcetida, Oleum Succini, Moschus, Castoreum, Cerium, Caffea. Assafcetida. A concrete exudation from incisions made into the living root of Narthex Assafcetida, an herbaceous plant with perennial root, native of Persia. It is a gum resin, found in brownish masses, AND THERAPEUTICS. 33i made up of portions exhibiting different degrees of consistence and shades of color, the odor and taste of which is, to most per- sons, decidedly unpleasant. The volatile oil and resin, which constitute its active principles, are soluble in alcohol. Fig. 32. Extraction of Assafoetida. Assafoetida has long been considered an antispasmodic, and may, with equal propriety, be called an anodyne or carminative. We have already mentioned the fact that reflex nervous derange- ment may be manifested in abnormal muscular contraction, pain, etc., and it is in such cases that the remedy, through its stimu- lating influence in relieving this state of the nervous system, be- comes, therapeutically, an antispasmodic and anodyne. It is a 332 ACoLOdi popular remedy iii that form of reflex nervous derangement con- stituting hysterical paroxysms, which, as the name implies, orig- inate in uterine irritation. So universal is its use iu this way, that the odor of assafoetida at once suggests the idea of hysteria. It is equally applicable in a similar state of the nervous sys- tem, originating in local disease elsewhere, and perhaps in radical disturbance of the spinal cord. The stomach and bow- els are subject to irritation of various kinds, which are transmit- ted to, and reflected from, the nervous centre upon the canal itself, leading to spasmodic contractions at various points, with collec- tion of gas, producing painful tension of the part. Under such circumstances, the spinal stimulant will be found to relax the spasm and promote flatulent eructations and dejections. Palpi- tation and dyspnoea not unfrequently result in this way from gastric irritation, and may be temporarily counteracted by this remedy. The unpleasant odor tends greatly to curtail its use, and other articles not more reliable have, in a measure, superseded it. As- safoetida may be given in substance in the form of pill or emul- sion, in the dose of jive grains, and repeated as becomes necessary. Tinctura Assafvetidm — Tincture of Assafoetida — contains all the activity of the drug, and affords a convenient form for adminis- tration alone, or in connection with other fluid preparations. The dose is one fluid radii a, diluted with sweetened water, as the presence of plain water relieves the resin from its alcoholic solution, and allows its precipitation and adherence to the vessel. Oleum Suocini — Oil of Amber. The volatile oil of Succinum, or Amber, a resinous substance found in alluvial deposits on the sea coast in various parts of the world, and is probably the fossil remains of some extinct race of animals. The oil is obtained by destructive distillation from amber, and is of yellowish color, strong, unpleasant odor, and acrid, disagreeable taste. The oil of amber possesses the properties of the class to an extent sufficient to make it a useful reflex nervous stimulant, and has, to some extent, supplanted assafoetida. It is used in AND THERArEUTICS. 333 hysteria, hiccough, palpitation, etc., with benefit. In a case of troublesome and persistent hiccough, existing on account of a sympathetic or reflex nervous derangement the result of colo- rectitis, for which the author was called on to prescribe a few years since, the most decided and prompt relief was afforded by this oil. Not being soluble in water, the usual mode of administration is that of temporary mixture or suspension, by first rubbing the oil with sugar or gum, and then stirring briskly in water. The dose is fifteen drops, repeated as may be necessary. Moschus — Musk. A concrete secretion from the follicles on the prepuce of Moschus Moschiferus, or Mush Deer, an inhabitant of Asia. From the scarcity and consequent high price of musk, it is so frequently subjected to adulteration that uniformity of action from it is scarcely to be expected. Musk is of a dark brown color, having a granular appear- ance, strong, peculiar odor, and bitter, somewhat acrid taste. It is a valuable spinal reflex nervous stimulant, and if found al- ways pure, so as to warrant more certainty of action, its use would be much more extensive. For the purposes mentioned, in connection with the application of assafoetida and oil of am- ber, musk will be found an effective stimulant. The dose, in substance, is about ten grains, given in the form of pill or emulsion, and repeated according to circumstances. Castoreum — Castor. The concrete secretion of follicles on the prepuce of Castor Fiber, or beaver. Castor is of light color, streaked with red, strong, peculiar odor, and bitter taste. It possesses properties somewhat similar to those of musk, and may be used for the same purposes. None of these articles are very extensively used in medicine for the permanent cure of disease, as they afford only temporary relief from nervous derangement. 334 ACOLOGY In sabstance, cantor is given in the dose of ten to fifteen grams. Tmctura Oastorei — Tinctwre of Castor — is an officinal prepara- tion, and may be given in the dose of one fluidrachm. Cerium. The use of this metal as a medieine has been so recent and limited that its preparations have been recognized only by the last revision of the United States Pharmacopoeia. There are, however, such well attested facts touching its value as a medi- cinal agent, that it has been used as a spinal or nervous stimu- lant before such recognition. Oerii Oxalas — Oxalate of Cerium. This is a tasteless, inodor- ous white salt, of granular appearance and only partially soluble in water. It has attracted attention as a nervous stimulant, in a form of functional derangement which seems to be the result of reflex impression. The vomiting of pregnancy, that most unmanageable variety of sympathetic or reflex disturbance, has been treated successfully with it. In chorea, its use has proved satisfactory, and, although this affection has been supposed to arise from radical disease of the nervous centres, and that the means of cure must act as cerebral or spinal tonics, yet it is not unlikely that a point of irritation exists in the stomach or else- where, and is reflected from the centres upon the muscular sys- tem. Until its usefulness in the treatment of diseases known to depend upon actual disturbance of the brain or cord has been made to appear, there is no certainty of its tonic action. The dose k one grain three times a day, more conveniently used in the form of pill. Caffea — Coffee. The seed of Caffea Arabica, a small evergreen tree, fifteen to twenty feet in height, native of Arabia and Africa, and culti- vated in various parts of the world, where the climate is suffi- ciently warm and of uniform temperature. The fruit, which is harvested twice a year, consists of a berry the size of a cherry, containing two small seeds, which, when deprived of their coverings, constitue coffee. AND THERArEUTICS. 335 Although used as an article of diet almost universally through- out the civilized world, coffee possesses important medicinal prop- erties. Much difference of opinion exists in the medical world as to its prime physiological action, and the therapeutic results to be ex- pected from it. That it gives very decided increase of nervous Fig. 33. Caffea Arabica. excitement, none will deny; but upon what particular portion of the nervous system its action is mainly exerted directly, admits of some doubt. If this question is to be determined by the various reports of its effects in the treatment of nervous derangement, the conclusion is inevitable that the brain, spinal cord and general 336 ACOLOGY nervous system are all excited by it. Vivacity and disinclination to sleep, being constant results of its action, lead to the conclusion that the brain receives direct impression; and experimenters are equally confident of giving increase of energy to the spinal cord and of counteracting reflex functional disturbance in the form of hysteria, by the use of coffee. In addition to the nervous impression, there are good rea- for believing that direct loeal influence is exerted also upon the stomach, so as to facilitate digestion, by a cup of coffee taken immediately after a meal. In view of all these facts, the proper place for coffee in a phy- siological classification is not readily determined; and in deciding to place it in the class under consideration, its direct action also upon the brain is acknowledged. Its seeming antagonism to opium, in having antidotal effect in poisoning by this drug, does not afford a reason to doubt its cerebral stimulation; for, although opium in therapeutic doses is an active stimulant to the brain, yet, in poisonous quantity, it proves dangerously sedative, and requires a stimulant of the organ in order to support the vital energies. Coffee may be used profitably in nervous headache, hysteria and to promote digestion temporarily. It is also valued highly as an antidote for the poisonous effects of opium, and the un- parched pulverized seeds have been reported as successfully used in the treatment of intermittent fever. Caffein, the principal active ingredient, of coffee may be used uncombined, or in the form of Citrate of Caffein, for the purposes above mentioned, in the dose of one or two grains, repeated in an hour, if necessary. CLASS VII. SPINAL SEDATIVES. Sedative neurotics, which act on a portion of the cerebro- spinal nervous centre below the encephalon, are rarely met with. Cerebral sedatives have long been known, but until a compara- tively late date no article was found to act as a sedative directly AND THERAPEUTICS. 337 upon the spinal cord. It may be said that cerebral sedatives, acting as they do upon the great, governing nervous centre, im- press the spinal system as perfectly as would be possible to do by agents acting directly upon the cord. Sufficient evidence, how- ever, to disprove this position is obtained in the investigation al- ready had in the use of cerebral and spinal tonics, and also of cerebral and spinal stimulants. Spinal sedatives give indirectly more or less impression to the organs supplied with nerves from the cord. At the same time it would seem that certain functions are promoted by such ac- tion. For example, particular emunctories or exhaling surfaces, through which the more watery portions of the blood escape, such as the bowels, skin and lungs, may transmit fluid much more freely ; but it must be remembered that these are passive, not active, functions, and the result of depression. The kidneys also sometimes allow, under such depressing influence, a kind of passive discharge of watery urine. The state of the general system thus induced is favorable to the relief of inflammatory and febrile diseases, and for these pur- poses spinal sedatives are used. Catalogue of Spinal Sedatives. Gelsemium. Gelsemium — Yellow Jasmine. The root of Gelsemium Sempervire7is, a perenial climbing plant, growing wild and cultivated as an ornament in most southern portions of the United States. It rises to considerable height, attaching itself to trees and other objects, and has numerous beautiful yellow flowers, which in part give rise to the name, and for which it is greatly admired. The root is bitter and un- pleasant to the taste, and yields its virtues to alcohol and water. Yellow Jasmine, as it is familiarly known, is a powerful rem- edy, and may produce death in excessive quantity. Its physi- ological action is that of a sedative, having depressing influence on the spinal cord, prostrating the nervous energies and the body generally, without stupor or other evidences of cerebral disturb- 22 338 ACOLOGY ance. Like thai of some other valuable remedies, the virtue of gelsemium was discovered by accident. In the management of malarial fever, its control over excitement was ascertained, and though not likely to supersede other remedies for the disease, this fact led to its successful use in nervous agitation and inflam- matory affections. While it may not have any directly sedative effect upon the heart, the control over the circulation through the nervous system answers a similar purpose. A Tincture, made with a troy ounce of the root to a pint of di- luted alcohol, may be given in the dose of twenty di^ops, and re- peated pro re nata. CLASS VIII. SPINAL TONICS. The action of this class is somewhat peculiar. Most tonics require to be given several days, and some of them even weeks, before the tonic effect is exhibited in the organ upon which they act. This is not the case with spinal tonics in some of the dis- eases for which they are given. In one, at least, of the affections for which they are celebrated, the curative effect is experienced the first day of their administration. Malarial fever, for in- stance, is cured sometimes in twelve hours with quinine, and yet it is not such relief as stimulants afford, being decidedly more permanent. This anomalous action of remedies, which excite the nervous system with the promptness of a stimulant and the permanence of a tonic, might be supposed to remove some mor- bific agent in the blood by catalytic action, but for the fact that neuralgia, and other diseases, not dependent upon the same cause, are also relieved by them. Indeed, reflex impressions may be, to some extent, allayed, not so speedily, yet more permanently by them than spinal stimulants. It is also a remarkable fact that fevers, dependent upon impressions made by morbific cause upon the cranial nervous centres, are not subject to the con- trol of spinal tonics. Typhoid fever is one of these, and though often subjected to the treatment of such means, is now consid- ered beyond their influence. Fevers dependent on primary dis- AND THERAPEUTICS. 339 tnrbance of the spinal centre, and other acute diseases in which tonics are useful, generally observe periodical paroxysms, while those seated within the cranium are usually, though not always, of continued character. Catalogue of Spinal Tonics. Cinchona, Impluvium, Salix, Cimicifuga. Corn us, Cinchona — Peruvian Bark. The bark of Cinchona Calisaya, and other species of cinchona, stately trees of South America. There are three principal com- mercial .varieties of the bark — the yellow, or calisaya; the pale and the red cinchona. These differ in no essential particular, having about the same alkaloid active principles, except that calisaya is said to contain a larger proportion of quinia, and is, therefore, more valuable. Peruvian bark is the most active and prompt of the spinal tonics yet discovered. Indeed, its action is so speedily produced that, but for the permanence of its effects, it would not come within the definition of tonic. As a general rule, it is useful in fevers and painful affections of a periodical and permanent character. These, as above stated, generally de- pend on primary derangement of the spinal nervous centre, or of the nerves themselves. Malarial fevers, rheumatism, certain forms of neuralgia, and such as result from reflex impressions, have such pathological origin, and are, therefore, subject to the influence of this remedy. Cinchona contains two principal alkaloids upon which its vir- tues depend, quinia and einchonia. Of these, the former is con- sidered the most important, and has almost entirely superseded the preparations of bark in substance, and even the other alka- loid principles also. Decoction, Infusion and Tincture of the bark are liquid prepa- rations, which may be used in the dose of two fluidounces of the decoction and infusion, and hoo fluidracfyms of the tincture, every two or three hours, until three or more potions have been taken. 340 Cinchona Calisaya, var. vera. a. Fruit-bearing branch, b. Flowers (natural size.) c. Coroila laid open {magnified.) d. Capsule {magnified.) e. Seed {magnified ) f. Leaf of var. Josephiana, from a specimen gathered in the province of Bungas, Bolivia. AND THERAPEUTICS. 341 An Extract of bark is officinal, and may be conveniently used in the form of pills, in the dose of twenty grains. Quintal Sulphas — Sulphate oj Quinia — Quinine. This prepa- ration of the chief alkaloid principle of cinchona, is now almost universally relied on for the tonic effects of the drug upon the spinal cord. It is a light crystaline white salt, of bitter taste, and only partially soluble in water. By the addition of a small quantity of sulphuric acid, it is completely dissolved in eleven times its weight of water. In solution, quinine is doubtless more prompt and efficient than the salt in substance, on account of its more ready absorption, a portion of which is liable to remain undissolved for some time in the primse vise. This difficulty is greatly increased by the form of pills, particularly when suffi- ciently old to become dry and hard. A characteristic symptom produced by quinine, and one by which evidence is afforded of its thorough impression, is that of ringing in the ears. This sensation is, with some subjects, very painful, particularly when a large quantity has been taken. The amount necessary to be given at one time, and the proper inter- val to be observed between the doses, must be determined by the nature of the case, and stage of the disease when treatment is commenced. In malignant intermittent fever, when serious con- sequences are feared from an approaching paroxysm, thirty, forty, and even sixty grains, may be given before the hour it is ex- pected. If the time is short, however, say only three or four hours are allowed to quininize the patient before the cold stage will probably come on, thirty grains should be administered at once, and in solution, so that the effect may be realized at the earliest possible moment. When, from the history of a case, it is satisfactorily determined that a period of ten or twelve hours will be allowed, the amount necessary to prevent the chill should be divided into two or three portions, and one given every two, three or four hours. As a general rule, in all grades of inter- mittent and remittent fevers, quinine should be commenced on the decline of fever, so as to make sure of the full impression before the next exacerbation. The latter will generally present the least degree of fever from one to six o'clock in the morning, 342 ACOLOGY and [f twenty "grains be given from twelve to three, fche rise may be prevented. The plan of delaying until toward the time (bra paroxysm to appear, in order to have the full effect at that junc- ture, is hazardous in dangerous cases, and proses ineffectual in milder forms. In tertian intermittent, it is sufficient to impress the nervous system thoroughly with the remedy on the "well day." These general rules are also applicable to the treatment of periodica] neuralgia, but in those eases irregularly paroxysmal, and in rheumatism, a disease in which quinine is the most efleet- ive remedy, it may be given at convenient periods until the full effects are realized. Twenty grains, divided as above and given on the decline of pain, are sufficient to impress the system in ordinary cases. The use of opiate preparations in connection with quinine should depend upon circumstances connected with the particular case under treatment. If the bowels incline to move freely, some opiate preparation should be given with the quinine. Much of the good effect of this tonic is lost by purging during its operation. Opium may also precede it, if pain, nervous depression, or other symptoms indicating its use, be present. Greater security may be obtained against a threatened paroxysm of intermittent fever by an opiate given so as to impress the ner- vous system at the time of its onset. Statistical reports, said to have been carefully made in a London hospital, seem to justify the impression that these remedies are antagonistic in their ac- tion. This, however, is not verified in general practice. Acute articular rheumatism is probably more certainly cured by using some preparation of opium with each portion of quinine; and these, with blisters to the spine, have been my reliance in its treatment for many years. Cinchonicjc Sulphas — Sulphate of Oinchonia. This is a crystal- ine salt, of very bitter taste, and sparingly soluble in water, but rendered completely so in half its weight, by the addition of a small quantity of diluted sulphuric acid — elixir of vitriol. The preparation is said to produce the same effects as sulphate of quinia, but requires somewhat larger quantity. Its use is very limited, compared with that of quinia, but may with propriety AND THERAPEUTICS. 343 be sriven in the treatment of all diseases for which this article is so generally prescribed. The quantity necessary to be given be- tween the paroxysms of fever is about thirty grains, and may be divided into portions for administration at intervals of a few hours, as recommended for quinia. Salix — Willow, The bark of Salix Alba, or White Willow, a small tree, grow- ing on low, moist situations in most parts of the United States. The bark is bitter, though not very unpleasant to the taste, and possesses properties somewhat similar to cinchona. The flatter- ing accounts of its use as a substitute for this bark, given by certain practitioners, are not confirmed by others equally zealous in their investigations on this subject. Willow bark may be given in substance and decoction in the same quantities as named for cinchona. Salicin is supposed to constitute the active ingredient of salix, and has been suggested as a substitute for quinine. Though doubtless useful in malarial fevers and other paroxysmal diseases, in which quinine is relied on, it evidently is greatly inferior to this celebrated nervous tonic. The amount of salicin to be used between the paroxysms of intermittent fever is forty grains. Corxtjs — Dogwood. The bark of Cornus Florida, zl small tree, growing abundantly throughout this country. The branches, root and trunk afford bark having the active properties, but that from the root is said to be preferable. The taste is bitter and unpleasant. Cornine is the name suggested for a crystalizable substance thought to constitute the active principle of the bark, but chem- ists have failed to obtain it in a solid form. Dogwood is supposed to have properties similar to cinchona, and has been used successfully in the treatment of intermittent fever, but its use will probably not become general while quinine can be obtained. As an ingredient in tonic bitters, for feebleness from chronic chills, it is said to be useful. It may be given alone, in the form of decoction, in the dose of two or three fluidounces. 344 ACOLOGY impluvium — Shower Bath. Water, as a remedial agent, produces different, and sometimes exactly opposite effects, by a change of temperature and mode of application. It has already been referred to as a refrigerant arterial, or cardiac sedative. To produce this effect it must be cold, and "fresh portions applied constantly. It serves also as a diluent when taken freely as a drink, and as an emolient, relax- ing agent, when applied locally by cloths dipped in it when warm. These effects are noticed under proper heads in other parts of this work. As a spinal nervous tonic, , svater serves an important purpose, and requires to be applied in a particular manner to effect this object. The general rules for its use as a tonic are, that it must be cool, must be suddenly applied but a moment to the nude body, and the patient quickly dried and dressed. The application should be made early in the morning, and followed by exercise in the open air, if the patient's strength will permit. For the first application, the quantity of water and its tem- perature must depend upon the strength and susceptibility of the subject. The bath should not be used in a manner to produce chilliness and depression afterwards, else the opposite effect from that desired will be produced ; therefore, until the patient becomes somewhat accustomed to it, the water should be used in small quantity and, if necessary, the temperature may be slightly raised. A tin or wooden vessel, with perforated bottom, and sufficiently large to sprinkle the whole body, will answer in the absence of regular arrangement for the purpose. The shower bath, when properly applied, is an effective ner- vous tonic in debility from reflex local irritation, or inactivity of the nervous centres from other cause. Though strictly a tonic, the effect of shower bath is not permanent, of course, when the prime cause of nervous debility still exists, and requires that radical treatment be had in connection with it under such cir- cumstances, in order to prove permanently curative. Paralysis, languor, general nervous inactivity, and hysterical symptoms, are greatly relieved by this means. AND THERAPEUTICS. Cimicifuga — Black Snaheroot. 345 The root of Cimicifuga Racemosa, an indigenous herbaceous plant, six or eight feet high, with perennial root, and found in most parts of the United States, growing in shady situations. ' Fig. 85. 346 acologV Cohosh, as it is sometimes called, yields its virtues to water* and alcohol. A resinous substance is precipitated (ruin the tinc- ture by adding water, which has been by the Eclectics improp- erly called ('(iiiicij'u(/iii, and used in the dose of one or tiro grains, Cimicifuga, from numerous experiments made with it, is con- sidered useful in rheumatism, chorea, and other conditions de- pendent upon a deranged state of the spinal nervous centres. Its action seems to be that of a tonic, and hence it is arranged in the class of spinal tonics, notwithstanding the promptness of its ef- fects has led practitioners to recognize it as a stimulant. Extractum Cimieiftigte Fluidv/m — Fluid Extract of Cimicifuga — is an officinal preparation, and may be conveniently used when the remedy is required. The dose is half a jiuidrachm to onefluid- rachm three times a day, or more frequently if desirable. The Tincture is kept in the shops, and may be used in the dose of one jiuidrachm, repeated every four to six hours. The preparations of this remedy are supposed to give increase of power to the nerves of organic life, and vasso-motor nerves especially, and therefore tend to promote nutrition and capillary circulation. {Medical and Surgical Reporter.) DIVISION V. REMEDIES THAT AFFECT THE SECERNENT SYSTEM. The system of glands which are affected by this division of remedies is not extensive, yet important in the animal economy. Another system of glands (lymphatic), which differ materially in their function from those under consideration, is profusely distributed throughout the body. These do not belong to the secernent or secreting system, but seem to serve as a kind of sieve to rectify certain fluids which pass through them. A third variety consists of imperfect glandular bodies called follicles, which are abundantly distributed beneath the mucous membranes, upon whose surface their secretion is poured out. These rudi- AND THERAPEUTICS. 34? mental glands secrete the mucus which lubricates the lining membrane of all open cavities, and are more or less influenced by direct impressions made upon the mucous membranes; but, so far as is known, have no elective action exerted upon them- selves. Thus it will be seen that the secernent system, to which this division of remedies applies, is limited to the salivary glands, the liver, kidneys and testicles. The lachrymal and mammary glands are not included, for the reason that the pro- fession is in possession of no well-established facts going to show any elective action exerted upon them by remedies. Mechanical irritation, the stimulus of cool air, and bright objects, as well as mental influences, increase the quantity of tears. The secretion of milk by the female mammae is also subject to modification by natural causes, and remedies have been proposed with a view to their physiological action in this way, but the result of their use is by no means satisfactory. The pancreas may be the subject of influences supposed to be exerted upon other of the chylopoietic viscera, but of such nothing is known definitely. CLASS I. HEPATICO-SALIVARY STIMULANTS. The union of hepatic and salivary stimulants is made a prac- tical necessity, from the known fact that the most purely elective agents having this physiological action upon the liver, excite also the salivary glands to increased secretion. It is true that an increased flow of bile into the bowels, by means not directly affecting either of these systems, is caused by evacuating the duodenum of the impacted contents with cathartics, and this is erroneously attributed to an exciting influence of the remedy upon the liver. Under such circumstances the bile, though se- creted in sufficient quantity, is prevented ingress to the bowels by the accumulated contents, and engorges the receptacle and ducts, causing painful distention of these parts. Emetics and cathartics, when this state of the organ exists, merely give evi- dence of the abundance of bile, instead of promoting its secre- 348 ACOWXJtt tion, further than the mechanical relief given to the functional disturbance <>(' fche liver from obstruction to the escape of its se- cretion. The absorption of l>ile is not uncommon in this condi- tion, and an icterus line of the albuginia and skin is the result. Hence, m malarial autumnal fevers, when torpor of the bowels, from depressed nervous energies, <>r duodenal irritation interferes with the flow of bile, the above symptoms being prominent, the patient is said to be "bilious," and the disease is called "bilious fever." Obstruction to the passage of bile into the bowel occurs sometimes simply from congestion or inflammation of the duo- denum, and produces a train of symptoms known as "jaundice;" and for its relief hepatic excitants are given by those who believe the difficulty arises in failure of the liver to secrete bile, and its consequent retention in the blood. These pathologists forget, however, that bile does not exist till secreted in the liver, by the peculiar function of that organ, and would find much more speedy relief to their patient by counteracting the duodenal irri- tation and congestion by counter irritation, etc. The effect of this class upon the salivary glands is not gener- ally, if ever, desirable in the treatment of disease, yet a knowl- edge of this impression is necessary to the proper and safe use of the remedies. When an article is administered with the view of deriving benefit from its cholagogue effect, the fact that it may excite also the salivary glands, and, under certain circumstances, even to inflammatory action, should certainly be known. To salivation from mercury has been attributed the cure of the con- stitutional effects of syphilis, upon the theory that the remedy sets up a disease in the glands also, and that two diseases cannot exist in a person at the same time. It has been ascertained, however, that the cure is effected by the remedy just as readily without salivation, and that, in all probability, the action is wholly catalytic. Indeed, some of the best practitioners in the treatment of venerial diseases declare that salivation will not readily, if at all, occur until the syphilitic virus is eradicated. The cure of malarial fever has also been ascribed to the coun- ter-irritating, depleting or revulsive effect of mercurial saliva- tion, and, in proof of the theory, instances are given in which no AND THERAPEUTICS. 349 excessive exacerbation of fever occurred after salivation is ef- fected. This error has been exploded by a knowledge of the tact, that salivation rarely occurs while fever runs high, and that on its decline the effect of mercury extensively given, will be manifested in this way. With the same propriety, the decline of fever may be attributed to the perspiration which breaks out at this time, when in truth, its abatement leads to the cutaneous transpiration. Hepatic stimulants, or remedies promoting the secretion of bile, sometimes called cholagogues, are useful in functional de- rangement of the liver leading to various forms of disease in the digestive organs. Colo-rectitis, or dysentery, and enteritis, man- ifested in ordinary dysenteric or diarrhceal discharges, often re- sult from this form of biliary derangement — from obstruction of the portal circulation — and hence hepatic stimulants become val- uable therapeutic agents in their treatment. Imperfect diges- tion, giving rise to numerous unpleasant symptoms, is often the result of inactivity of the liver, and may be remedied by pro- moting the hepatic secretion. Catalogue of Hepatico-Salivary Stimulants. Hydrargyrum. Hydrargyrum — Mercury. Upon the preparations of this metal do therapeutists mainly rely for the speedy production of the physiological action in question. The drug and its preparations have previously been noticed, under the head of cathartics and catalytics. All of its preparations capable of being absorbed have an elective action on the liver, and a perceptible impression on the organ is induced by less amount than is required to produce ptyalism. As the latter action is perhaps never called for, the patient should not be annoyed with inflamed gums in order to get the desired chola- gogue result. Recent investigations, made with the view of determining the cholagogue effect of mercury, satisfied the investigator that the amount of bile is not perceptibly increased by the remedy, and 350 * ACOLOGY that this long-cherished theory is a fallacy. A report of* thesi experiments was made at the annual meeting for 187-5 of the Medical Association of Georgia, in which a conclusion is based on experiments made with a healthy animal. Now, the want of adherence to a proper classification of remedies — that which re- cognizes only their physiological action- -leads to much confusion and error. If we consider mercury a hepatic stimulant, without regard to circumstances or condition of the organ, the result of said experiments are perfectly consistent with the old theory. They were made while the liver was in full vigor and activity, and, of course, when the function was at its greatest perfection. Whatever excites it beyond this already healthy point, must of necessity interfere with the normal function by over-excitement, as in ordinary irritation or inflammation. Hence, as should be expected of a hepatic stimulant, it was found that the quantity of bile was not increased, but even lessened by mercury. Had the test been made on a liver deficient in the secretion, from want of sufficient excitement — the pathological condition in which the remedy is required — the result would doubtless have been different. A cholagogue result may be expected from the action of such remedy, only when the liver is below the normal standard of excitement. In all acute diseases, the treatment of which requires this physiological action upon the liver, mercury in some form is generally relied on. It is unnecessary again to describe the various preparations. Suffice it to say, the milder simple forms are preferable for this purpose. Pilula Hydrargyri — Pill of Mercury — Blue Mass — is in a convenient form for administration, and answers the purpose of a hepatic stimulant, in the dose of five or six grains. In general disturbance of the digestive organs from torpid liver, it may be repeated two or three times at intervals of four to forty-eight hours, according to the susceptibility of the patient. The same may be said of chronic affections of any kind requiring its use. / For the treatment of acute disease, originating in hepatic torpor and functional derangement, the same quantity may be given, AND THERAPEUTICS. 351 but repeated every four to six hours. Other preparations answer for this purpose in doses proportioned to their activity. Protochloride of Mercury — Calomel — in the dose of half a grain to a grain, excites the liver to the secretion of bile, in proper quantity, when the function is deranged from want of vigor and activity in the organ. This quantity, however, given repeatedly in enteritis, is likely to aggravate the disease, particularly when the liver no longer requires the stimulating effect of mercury. This may depend upon chemical changes produced in the remedy by coming in contact with free chlorine, so as to form the bichlo- ride, a local irritant. Enough chlorine or hydrochloric acid, however, is not likely to be met with in the canal to form this irritating salt, when a much larger quantity of calomel is given, and hence no such effect is had by twenty or more grains. CLASS II. HEPATIC TONICS. This class bears the same relation to hepatic stimulants that other tonics do to temporary excitants of the same organ. The former promote speedily the secretion of bile, but from them the liver receives no permanent energy; but the tonics now under consideration give lasting vigor, necessary to a healthy state of its function after their use has been suspended. They are too tardy in making their impression to be relied on in acute disease, dependent on hepatic debility, and the more speedy action of a stimulant is necessary first, even though the tonic be advised afterward or in connection with it. Catalogue of Hepatic Topics. Acida Minerales, Taraxacum, Acida Minerales — Mineral Adds. These have been described under the head of digestive tonics, a class intimately connected in their therapeutic results with that now being considered. It is there stated that digestion is rarely 352 ACOLOQY found deranged without hepatic disturbance also, and vice versa. Therefore these acids, being digestive and hepatic tonics, are gen- erally given with an eye t<» therapeutic results in both of these organs. Their action upon the liver is tonic with cholagogue results, slow in inception, and permanent when had. They are useful, therefore, only in permanent or chronic functional de- rangement of the liver. Whether the most prominent result of that derangement be chronic dysentery, diarrhoea or dyspepsia, the acids are equally applicable. Acidum Sulphuricum — Sulphuric Acid — is perhaps less used with a view of affecting the liver than any of these agents, but, as stated in a previous part of the work, is peculiarly service- able in certain conditions of the stomaeh. The form of Acidum Sulphuricum Aromaticum — Aromatic Sulphuric Acid — Elixir of Vitriol — is that in which it is most conveniently and profitably given. The dose of this preparation is ten drops, well diluted with water to prevent injury to the teeth, the enamel of which is likely to be corroded by it. Acidum Nitricum — Nitric Acid — is better adapted to the treat- ment of torpid liver, and may be given in the dose of two drops, well diluted with water, for the reason just given. Acidum Muriaticum — Muriatic Acid — also a valuable tonic, gives invigoration to the liver in the dose of six drops three times a day. A combination of the last named acids is perhaps the most valuable hepatic tonic, and is known as Acidum Nitromuriaticum — Nitromuriatic Acid. In this form the two acids are given internally, and applied to the surface also. The dose is about four drops, diluted with two fluidounces of water, and as an external application the proportion of a fluid- ounce or two to the gallon of water, answers the purpose of a foot-bath and sponging. This mixture has the most salutary effect in chronic debility of the biliary apparatus when used in these various modes. A deep narrow vessel, of size sufficient to contain only the feet and legs, answers well for the foot bath, which should be used for a few moments morning and night, and at the same time, if desirable, the whole body may be sponged with this diluted acid. AND THERAPEUTICS. 353 For the internal use of any mineral acid, dilution and other precautionary measures are necessary to protect the teeth against its destructive action. A want of care in this particular, has led to very unpleasant effects, in depriving the invalid of very important means connected with the process of digestion. Taraxacum — Dandelion. The root of Taraxacum dens-leonis, is an herbaceous plant, with perennial root, found throughout this country. The leaves spring from the upper part of the root, and from their midst the flower stem shoots to the height of six or eight inches. The root should be gathered in autumn to insure its activity. Fig. 36 Taraxacum -leonis. Dandelion is represented by observers as a valuable tonic chol- agogue — useful in deficient biliary secretion, with debility of the digestive organs proper. So far as is known of it, this article is an exception to the rule that hepatic stimulants and tonics act also upon the salivary glands. It has been used in the various diseases connected with the digestive organs, of a chronic character, when the probable origin is in functional hepatic derangement. It may be given in the form of Infusum Taraxaei — Infusion of Taraxacum — made by macer- ating or digesting, for two hours, two troyounces of the root in a pint of water. The dose is two fluidounces. 23 354 ACOLOGY Exbraxstwm Taraxad — Extract of Taraxacwm — is an officinal preparation, but subject to deterioration from time, and there- fore not reliable after being kept a year (U. S. D.) The dose is about tliirty grains three times a day. CLASS III RENAL STIMULANTS. All agents that tend to increase the secretion of urine in any condition of the kidneys, have been usually arranged in a class called diuretics, but it is only such as affect these organs by an elective stimulant action upon the kidneys themselves, directly, or through the mucous membrane, that come properly under the head of renal stimulants. Some articles of the class of remedies acting as excitants to the mucous membranes gener- ally, already described, stimulate the kidneys through their inti- mate connection with this membrane, increase the quantity of urine under certain circumstances, and are usually termed diuretics. The diuretic result of any action is, of course, conditional. De- mulcent drinMfe, given during the suppression of this secretion by inflammatory action in the kidneys, moderate the over-excite- ment, and thereby promote their function. Counter-irritation, depletion, etc., have the same effect under similar circumstances, but cannot, of course, be termed invariable diuretics. In a strictly physiological classification, remedies which act directly and electively upon the mucous membranes, and by con- tiguity excite the kidneys to functional activity, could not, with propriety, it would seem, be called renal stimulants; yet, as this membrane upon which they act is so intimately connected with the structure of these organs, they may be said to act on the kidneys themselves, and therefore may also be mentioned in the class under consideration. From what has been said, there would seem to be a practical necessity for a division of the remedies called diuretics, into as many classes as there are physiological actions produced by them. We find three of these, viz: renal stimulants, sedatives, and tonics. AND THERAPEUTICS. 355 The articles which we place in the class of stimulants are not physiological or direct diuretics, and only under particular cir- cumstances will this result or therapeutic effect follow their action. Renal stimulants are only applicable when a want of excite- ment exists, leading to deranged function of the kidneys, and consequent functional and structural disturbance in other parts of the body. The necessary excitement afforded by such remedies under these circumstances, causes increased diuresis. When, however, the function ceases to be performed on account of in- flammatory excitement, the class of renal stimulants will only tend to aggravate the disturbing cause. Not only is the func- tion of the kidneys disturbed by a want of circulation and en- ergy in them, but relaxation and ill-conditioned lesions occur not only in the organs but in the excretory canals, from this cause, and the excitement produced by renal stimulants proves useful in such conditions of these parts also. While all the articles which act upon the mucous membranes do, to some extent, affect the kidneys, yet those only are included which give evidence of decided action in this way. Only a part, therefore, of general blennymenal stimulants are placed in the class of renal excitants. The stimulation given by the articles we shall arrange in this class may not depend entirely upon their elective action upon mucous membranes generally, but perhaps to some extent upon a special elective influence exercised over the kidneys and their appendages. Catalogue of Renal Stimulants. Oleum Terebinthinse, Juniperus, Cantharsis, Sabina, Copaiba. Oleum Terebinthin^ — Oil of Turpentine. This has been noticed as a leading article in the class of blen- nymenal stimulants, and doubtless its elective action upon the extensive surface of mucous membrane connected with the kid- 356 ACOLOC.Y neys, excretory can:. Is, Madder and urethra, affords a larger por- tion of the stimulation given these organs by turpentine. The function of the glands, however, is bo materially influenced by it, that a place in the class of agents affecting them directly is not inappropriate. The kidneys are always more or less excited by this remedy, and, when below the normal standard of activity, may he stimulated by it to the proper degree; but when already above the healthy point, the abnormal condition is aggravated. Chronic nephritis, denoted by functional depression, blenorrhua, etc., may be greatly relieved by the healthy vigor given by this stimulant. The dose is about twenty drops three times a day, or more frequently, if necessary. Cantharis — Cantharides. The body of Cantharis Vesicatoria, or Spanish Flies, described under the head of vesicants. Cantharides constitute one of the most powerful renal stimu- lants, in large doses, exciting the urinary organs to dangerous inflammation. Their poisonous effect consists of this state, which, when excessive, may lead to fatal results. On account of the high excitement created by this remedy in the urinary organs, and also in the genital apparatus, the functions of the latter are greatly heightened in degree. Its effects in this way, however, have been greatly magnified, and base persons, with the view of exciting lascivious desires in the opposite sex, beyond the control of ordinary prudence, have contrived to have cantharides taken in amount sufficient to produce the poisonous effects. When taken in substance, the irritating properties are also visible on the surface of the alimentary canal, from its local action on the mucous membrane in passing over it. Its usefulness as a stimulant of the urinary organs consists in the excitement given to the kidneys, bladder and urethra, in disease connected with relaxation and debility. Feebleness in the contractile power of the bladder, from debility in the organ, leading to retention of urine, and sometimes incontinence, is greatly benefited by this stimulant. The latter symptom, how- AND THERAPEUTICS. 357 ever, must not be mistaken for that arising from excessive irrita- tion and inflammation in the neck of the bladder. A mistake of this kind may lead to aggravation and prolongation of the symptoms. Spanish flies are perhaps never administered in substance. Tiiictura Cantharis — Tincture of Cantharides — is the proper form for internal use, and may be given in the dose of twenty drops three times a day, till slight strangury appears, as evidence of of its elective effect upon the organs. Juniperus — Juniper. The fruit of Juniperus Communis, an evergreen shrub, native of Europe, but cultivated in this country. The berries are of warm terebinthinate taste, and somewhat aromatic, peculiar odor. They are stimulating to the kidneys, exciting them, when given in moderate quantity, to increased secretion of urine, which, under the action of the remedy, emits a peculiar odor, compared to that of violets. In overdoses, juniper creates high excitement in the kidneys and urinary passages, amounting to inflammatory action, though not to the extent of that from cantharides. Its virtues reside in a volatile oil, obtained from the dried berries by distillation. They may be given in substance or in- fusion, but the effects may be had from Oleum Juniper i — Oil of Juniper — and in this form the activity is effectually preserved for any desirable length of time. The dose is fifteen drops three times a day. S abina — Savin. The tops of Juniperus Sabina, an evergreen shrub, native of the south of Europe, and is said to grow also in the northern part of this country. Savin is an excitant of the urinary and procreative organs, and is also an active local irritant, and may, therefore, lead to more serious consequences from its action upon the stomach and bowels, in overdoses, than from the elec- tive action upon the urinary organs. Its activity depends upon a volatile oil, and in this form is most conveniently given. 358 AcoLoar Oleum SabincE — Oil of Sarin — is obtained by distillation, and may be given in the dose of three or four drops. Copaiba — Copa int. The juice or oleo-resin obtained from Copaifera Mullijuga, and other species of copaifera, native of South America (U. S. P.) This balsamic exudation is obtained by making incisions in the trunk of the tree, and is, when fresh and pure, a clear, trans- parent fluid, of peculiar odor, and somewhat warm, unpleasant taste. It is gently stimulating to the urinary organs, and in irri- table condition of the kidneys or bladder may lead to painful excitement. This stimulant is supposed to exercise special remedial power over gonorrhoea, and has, for a great while, and until the last few years, been looked upon as the sine qua non in its treatment. It is now somewhat uncertain whether benefit is derived from it other than the increase and consequent dilution of the urine, which causes less injury to the irritable mucous membrane of the urethra than when of small quantity and acrid. Like other ex- citants, it doubtless changes the nature of the existing specific inflammation when applied to it, but will certainly effect more in this way by its local application to the part, and when used with the view of making any direct impression, should certainly be injected into the urethra. The dose is half afluidrachm three times a day, alone or in the form of emulsion. CLASS IV. RENAL SEDATIVES. Another variety of "diuretics/' so-called, affect the urinary organs in an opposite manner to that of the preceding class; and although having direct antagonism with renal stimulants, are usually associated with them in a common class called diu- retics. In a physiological classification, sedatives and stimulants cannot be placed in the same class, and the practical advantage of this course to the learner is obvious. To learn the names of AND THERAPEUTICS. 359 renal stimulants, sedatives and tonics merely as a class of "diu- retics" may, as we have seen, lead to an improper conception of their action, and to grave errors in practice. For example, if, in deficient diuresis from over-excitement of the renal organs, cantharides, turpentine, and other stimulating articles be given, the difficulty will evidently be increased. The same may be said of sedatives, when used in the opposite condition of the organs. Renal sedatives tend to allay heat and excitement of the kidneys and urinary passages, and thereby promote their function, when deranged from this cause. In nephritis, cystitis, and like condi- tions of the passages, the cooling, sedative and soothing influ- ence of renal sedatives are often salutary in their results. The urine is generally scant and acrid under such circumstances, and as the excitement of the kidneys is allayed by them, it becomes more abundant and less irritating to the inflamed excretory ducts. They indeed become useful diuretics in such cases. The same may be said of their use in febrile affections, when the kidneys and their appendages, along with other important organs of the body, are in a state of preternatural heat and excitement. Catalogue of Renal Sedatives. Potassii Nitras, Potassii Bitartras, Spiritus iEtheris Nitrosi. Potassii Nitras — Nitrate of Potassium. A description of this salt has been given in the class of car- diac sedatives, and its general sedative and refrigerating influence on other parts also alluded to. Although, according to observ- ers, nitre increases the secretion of urine in a normal condition of the kidneys, yet its effects in this way are doubtless more de- cided when they are in an irritable or inflamed condition. Dur- ing the exacerbation of autumnal fevers, when functional dis- turbance, heat and excitement pervade the whole organism, it serves as a general refrigerator and diuretic. In the dose of Jive to ten grains every two or three hours, nitrate of potassium has a 360 ACOLOGY refrigerating effect upon the urinary apparatus, causing incr of urine in excitement of the organs. Potassi Bitartras — Bitartratc of Potassium. Crude .tartar is deposited in the fermentation of wines, and this, when purified, forms the salt in question. Cream of tartar, as it is familiarly known, has, in addition to its sedative influ- ence upon the kidneys and consequent escape of fluids in that direction, a decided tendency to promote enteric exhalation and watery alvine evacuations. The acid taste of the salt, being grate- ful to the patient under febrile excitement, serves as a beverage, while its sedative and refrigerant influence over the kidneys and other organs, makes it a useful remedy. In nephritic inflamma- tion, it is peculiarly applicable, on account of the hydragogue catharsis which results from large doses, in addition to the direct effect upon the diseased organs. The diuretic effect which gen- erally results from its action, and the watery discharges from the bowels, have a kind of depleting influence highly favorable in ascites, anasarca, and the like, on account of the demand in the blood vessels, caused by these drains upon the circulation, favoring absorption and retarding effusion. Its effects in this way are particularly desirable in plethoric subjects, or when fe- brile excitement exists. It may be given in the dose of a drachm or two, three times a day, dissolved in water. Spiritus iETHERis Nitrosi — Spirit of Nitrous Ether. This is a volatile, slightly yellowish colored fluid, of agreeable odor and sweetish, rather pungent taste. It is often found adul- terated with water and alcohol to a degree that interferes with its usual medicinal effects. In addition to the soothing sedative action of this remedy upon the urinary organs, it is supposed to possess decidedly anodyne properties, and is, therefore, extensively used in febrile affections for its general quieting effect and sooth- ing diuretic action. Temporary irritability in the neck of the bladder, causing dysuria in the form of strangury, is generally very promptly AND THERAPEUTICS. 361 relieved by sweet spirit of nitre. This is particularly the result, when used with paregoric or other fluid preparation of opium ; and not only in strangury is this preparation soothing, but pain- ful inflammatory conditions of the urinary organs generally are relieved by it. Spirit of nitre may be given in the dose of one fluidrachm, di- luted with a little water, and repeated every two or three hours, if necessary. CLASS V. RENAL TONICS. The articles of this class increase the vigor of organs upon which they act — not only when in a state of debility, but even in a healthy condition, the ordinary amount of urine secreted may be sometimes increased. They are, therefore, elective rem- edies, acting upon the kidneys neither as a stimulant or sedative, but in a way to give direct energy to the organs in the perform- ance of their function. These may, with some propriety, be called diuretics. Inasmuch as the term tonic, when applied to the action of remedies on an organ, is always understood to mean the power of giving energy, more or less permanent, to its func- tion, it certainly, in this case, carries with it the idea of increased diuretic action. When, however, by the name of a class the particular action is described, and the organ upon which it is exerted, evidently the result, which is never positively certain, need not be included. Renal tonics are often used in a normal state of the kidneys, in order to reach, by a chain of indirect influences, a therapeutic result on dropsical accumulations. These, involving the circu- latory and absorbent systems, have already been alluded to, en passant, under the head of sedative diuretics. They are used as direct therapeutic agents in the treatment of chronic renal disturbance dependent on functional debility. At the conclusion of acute or organic disease of the kidneys, and even during its progress, support to the secreting power often becomes necessary. These means do not, to the extent of exci- 362 AOOLOG tants, aggravate existing inflammatory notion, and may be used with advantage where the latter would be highly injurious. Catalogue of Renal Tonics. Scilla, Digitalis, Uva Ursi, Buchu, Tinctura Ferri Chloridi. Scilla — Squill. The bulb of Scilla Maritima sliced and dried (U. S. Br.) It is kept in this form, and also that of powder, which requires to be protected from moisture of the atmosphere, for which it has great affinity. It is only as a renal tonic that any very decided results are expected. From its reputed action upon the organs, connected with the three great mucous surfaces of the body, a kind of blennymenal influence might be inferred, more particu- larly on account of its popularity as an expectorant; but squill, like many other remedies, has doubtless been used more for the convenience of its preparations than any emetic or expectorant effect ever observed in it. Into all the syrups taking its name, other ingredients enter, and to them doubtless are due most of the relaxing and expectorant effects attributed to the squill. The irritable bronchia are soothed and a distressing cough allayed by the different syrups of squill with certainty when, and only ichen, morphia or some other opiate preparation is added. For its effect as a renal tonic these additions are not necessary. As a means of augmenting the function of the glands to effect some ulterior therapeutic result, squill is considered valuable, and free from liability to injurious action in either depressed or excited state of the organs, or of the system generally. When given alone, or incorporated with other solid substances, the pulverized squill may be given in the form of pill, in the dose of one or two grains. Syrupus Scillce — Syrup of Squill. This is a convenient and pleasant preparation when the remedy is used alone or in con_ nection with other fluid preparations; and may be given in the dose of one or two fluidrachms. AND THERAPEUTICS. 363 Digitalis. The leaves of Digitalis Purpurea, which, with their preparations, have already been described in the class of cardiac tonics. As there stated, erroneous views have been entertained in regard to the physiological action of this remedy, and of its cumulative poisonous effects in ordinary doses. Its calming influence upon the heart when in an irritable condition, led to the belief that its action was purely sedative, such as would entitle it to a place in the class of "arterial" or "cardiac" sedatives, but while it was not, like other cardiac sedatives, found useful in inflammatory diseases, the chief reliance is in general debility. As a diuretic, its use is also confined to cases of asthenic char- acter, in which tone or permanent vigor to the organs generally is required. Digitalis has been found useful therefore when, from an impoverished state of the blood, anasarcous and other dropsical collections occur. These effusions are particularly lia- ble to take place when the kidneys fail to perform their func- tion, and by restoring vigor to these organs the accumulations are not only prevented, but the amount already effused is less- ened by the depleting effect of diuresis. While depletion of the blood vessels prevents, the opposite condition facilitates, ab- sorption, and this drain upon the blood vessels makes a demand for fluids which the absorbents readily supply from the dropsical collections. Digitalis is slow in making any functional change in the kid- neys, but, when possessed of its usual activity, does so more cer- tainly and powerfully than any renal tonic used for this pur- pose. In hydrothorax and other dropsical effusions, it is usually given in connection with squill, for their combined tonic impres- sion upon the kidneys, with such other remedies as may be found necessary to remove the prime cause of disturbance. This often exists in the heart, and digitalis frequently serves to counteract the results, and also affords radical relief to the diseased organ primarily at fault. When the secretion of urine is deficient from disease of the kidneys themselves, leading to various forms of constitutional disturbance, digitalis may also be found serviceable. 364 ACOLOGY The dose, in substance, is one or two grains of the pulverized leaves made into the form of pill. T/nrfurii Digitalis — Tmctwre of Digitalis — may be given in the dose of ten to fifteen drops three limes a day. Uva Ursi. Fig. 37 The leaves of Arctostaphylos Uva Ursi, an evergreen shrub, native of Asia, Europe, and the northern part of this country. (U. S. D.) The dried leaves are astringent and bitter, with very little odor; are said to have digestive tonic properties, and to this has been attributed, doubtless improperly, all the tonic action supposed to be exerted upon the kidneys. The tonic effect produced by uva ursi, possessed as it is of de- cided astringency, proves particu- larly serviceable in chronic in- flammation or ulceration of the kidneys and urinary passages, leading to catarrh of the bladder or blenorrhcea. It is also re- commended in diabetes, with a view of giving proper tone to the deranged function of the kid- neys. Debility of the organs from any cause would seem to author- ize its use, since no injurious ex- citement is given by it even in inflammatory condition. Uva ursi is rarely used in sub- stance, but the powdered leaves S iwns. aUther ' Sh ° WiUg ma ) r be taken in the dose of twenty to thirty grains. Decoctum Uvaz Ursi — Decoction of Uva Ursi — is prepared so that an ounce of the bruised leaves shall make a pint of decoc- tion. The dose of this is two or three fluidounccs three times a day. Arctostaphylos uva ursi 1. Anthers. 2. AND THERAPEUTICS. 365 Eviractum Uvce TJrsi Fluidum — Muid Extract of Uva TJrsi — is a very convenient preparation of the remedy, and that in which it is generally used. The dose is from a half to afluidrachm. Buchu. The leaves of Barosma crenata, and other species of Barosma, growing at the Cape of Good Hope (U. S. D.) The leaves are about an inch long, and half an inch broad. They have strong aromatic odor and bitter taste. Buchu, although a tonic to the kidneys, increasing their secre- tion of urine and invigorating the organ when depressed from any cause, has been considered more particularly useful in debil- ity of the bladder from disease leading to strangury, inconti- nence of urine, blenorrhoea, etc. Nostrum venders acquire princely fortunes from the sale of their lauded preparations of this remedy. While extravagant praise has thus been bestowed upon it for mercenary purposes, the practitioner should not be so disgusted as to disregard the just claims of buchu as a reme- dial agent, and suffer an article of so much reputed value to fall into professional disuse. Thirty grains of the powdered leaves may be given when used in substance. An Infusion, made with a troyounce of the bruised leaves to a pint of hot water, may be given in the dose of two or three fluid- ounces three times a day. Extractum Buchu Fluidum — Fluid Extract of Buchu — is in common use, and answers well for administration of the remedy. The dose is half a fluidrachm in water. Tinctura Ferri Chloridi — Tincture of Chloride of Iron. This tincture answers well as a form in which to preserve permanently the chloride of iron. In the solid form it is sub- ject to deliquescence, and in watery solution to decomposition. The tincture has the odor of chloric ether, an acrid, styptic taste, and is of a reddish-brown color from reflected, and yellow- ish from transmitted light. While tincture of the chloride of iron has the usual effects of 366 ACOLOGY other preparations of iron upon the system, and is thus used, it is supposed, to have also special tonic action upon the urinary organs, [ts known powerfully astringent and styptic properties arc not unfavorable to the opinion entertained of its restoring and tonic effect upon the kidneys and bladder, when in a state of relaxation and debility from chronic inflammation and ulceration. Moreover, its decided tendency to promote diuresis being a well established fact, its characteristic property, above given, leads to the belief that the effect upon the kidneys is that of tonic. It may be used in all cases of mucous discharge from the bladder, kidneys or urinary passages from debility or chronic disease of any kind. The dose is fifteen to twenty drops, gradually increased to a fluidrachm three times a day, well diluted. A w r ant of attention in its administration may lead to caries of the teeth from destruc- tion of the enamel, as by mineral acids. DIVISION IV. REMEDIES THAT AFFECT THE PROCREATIVE ORGANS. Some difficulty is experienced in arranging the classes of this division, owing to the dissimilarity of the male and female or- gans of generation. While both sexes contribute material to- ward the production of a new creature, the organs in each, which directly supply it, differ in their conformation and the manner of action in affording such material. In them, however, there are points of similarity. Though, in the male, regularly consti- tuted glands exist, differing from the germ producing organs of the female, yet in both they are in pairs and furnish, by a pro- cess resembling secretion, and convey through tubes to a recep- tacle in each, their quota toward the living germ of a new being. In the female, this is periodical, and in the male, only at times and under circumstances favoring a union of the two ingre- dients. The genital organs are immediately concerned in the AND THERAPEUTICS. 367 production of these materials and their conveyance to the com- mon receptacle in the female. The classes of remedies acting upon these genitals are named accordingly; while those acting on the receptacle or womb, an organ only passive in the above process, have the term uterine prefixed. CLASS I. GENITAL STIMULANTS. The control exercised by certain medicinal agents over the venereal organs of both sexes, has long been recognized by med- ical writers; and while it is evident that the incentive to venery is increased by some and lessened by other remedies, there is no doubt that highly wrought pictures of uncontrollable propensity have been made from actions purely imaginary. Remedies which cause an increase of blood to the genital or- gans, and consequent heat and excitement, also give increased activity to the function of the testicle of the male, and have hence been called aphrodisiacs. Some of them, although they have no elective action specially upon the glands or ovaries them- selves, but upon the genitals generally, in the manner just stated, may, with some degree of propriety, be called genital stimulants or excitants. These stimulants rarely subserve any valuable therapeutic purposes. Occasionally, however, when from disease excessive venery, self-pollution, etc., a want of vigor in these parts exists, they may prove beneficial. In cases of impotence, arising from the latter cause, their use may be unprofitable and even in- jurious, unless the enervating and degrading habit be suspended. If it be continued, the remedies only afford the means of more complete moral and physical destruction ultimately. Moreover, should the patient cease the actual commission of excesses, with- out the observance of general rules for mental, moral and physi- cal invigoration, genital stimulants answer no valuable purpose. The class of renal stimulants is said to excite also the vene- real or genital organs, but this influence is not very decided, except in the action of one or two articles only. 368 ACOLOGY Catalogue of Genital Stimulants. Cantharis, Cannabis [ndica. CANTHAJU S — Cantharides. This drug, noticed as one of the most powerful renal stimu- lants, is also a leading article of this class. It not only affects parts intimately connected with the urethra of both sexes, but the organs directly concerned in the production of a living germ for the new being. Whether this is the result of urethral irri- tation and excitement from "sympathy of contiguity," or from direct elective influence, is a question of doubt. The fact, how- ever, that cantharides affect the venereal as well as the renal portion of the urinary apparatus, is generally admitted. If it be not a genital stimulant, physiologically speaking, upon what grounds can it be claimed as a renal stimulant? If, as has been suggested, its elective direct action is exerted upon the mucous membrane alone, why should it not be called a procreative as well as renal stimulant, and why should it not be found to affect the respiratory mucous membrane also ? The renal and procreative organs, being closely connected in both sexes, are alike affected by this remedy. The womb itself is not exempt from the gen- eral excitement given these organs; for, while it does not seem to influence directly the function of contraction, yet the heat and excitement produced, will lead to contraction in the gravid uterus, with the expulsion of its contents. The Tincture, as stated under the head of renal stimulants, is the usual preparation for internal use, in the dose of twenty drops three times a day till slight strangury is produced. Turpentine, savin and copaiva have, in some degree, this effect upon the organs of generation, but so slight as not to warrant a prominent place in the class. Cannabis Indica — Indian Hemp. As to the aphrodisiac effects of hemp, different observers agree, but of the manner in which such symptoms are produced, there AND THERAPEUTICS. 369 may be some difference of opinion. Its action upon the nervous system has already been described, and to this some attribute all the excitement produced in the genital organs by hemp; but un- less the nerves supplying these parts be specially impressed by the remedy — of which we have no evidence — there is no good reason to suppose that these would be more aifected than other organs by this general neurotic. The same preparations and doses may be given as laid down for cerebral stimulants. Phosphorus is believed to have invigorating influence upon these organs, but its tonic effect upon the great nervous centre is perhaps sufficient to account for this, as all other parts of the body are equally affected by its use. CLASS II. GENITAL SEDATIVES. Diseases connected with the organs of generation, of a sthenic character, are more frequently met with than those of the oppo- site variety, and hence genital sedatives are demanded more frequently than excitants. Indeed, that state of debility follow- ing acute disease, and for which stimulants ultimately become necessary, may be prevented by the timely use of such sedative measures as are necessary to arrest the inflammatory action before its injurious results have been produced. Gonorrhoea, orchitis, etc., when unrestrained, lead not only to protracted functional derangement, but to a train of annoying and tedious organic lesions. Catalogue of Genital Sedatives. Gelsemium, Lupulin. Camphora. Gelsemium — Yellow Jasmine. The root of Gelsemium Sempervirens, a climbing plant, de- scribed under the head of spinal sedatives. Yellow jasmine, as stated under the proper head, is a spinal or nervous sedative, and as such, of course, indirectly depresses the 24 370 ACOLOGY functions of organs generally, with a few exceptions. Of this depression the genitals partake in a large degree; indeed, to the extent of warranting the conclusion that gelsemium has some special elective influence over these organs independently of the influence exerted upon the spinal nerves. Hence, its position in the class under consideration. It will be found useful in excessive excitement of the urethra, ovaries and testicles from any cause, and observers of its effects mention favorably the use made of it in gonorrhoea. Doubtless venereal excitement, and even orchitis and ovaritis, come more directly under its control, and for these the remedy may be given with prospect of benefit. The Tincture, as recommended in the class of nervous sedatives, may be used for its anaphrodisiac effect and general sedative in- fluence upon the genital organs, in the dose of twenty drops, re- peated according to circumstances. Lupulina — Lupulin. A granular powder obtained from the strobiles of Humulus Lupulus, or Hop Vine, a twining herbaceous plant, with peren- nial root, cultivated extensively in many parts of the United States and Europe, for the hops of which beer is made. Lupulin is collected by threshing or rubbing hops and sifting the powder through a sieve. It is of yellow color, peculiar odor and bitter taste. The ancients entertained extravagant ideas of the soporific and anodyne effects of hops, but at this day the profession recognizes them only as a gentle gastric stimulant. Lupulin, however, although believed to possess some anodyne property, is appre- ciated only as a genital sedative, leading to anaphrodisiac effects. Its use in the treatment of gonorrhoea has proved satisfactory, particularly when given with the view of allaying the excite- ment leading to nocturnal priapism, and the consequent laceration of the engorged corpus spongiosum. It may be given with advan- tage in preternatural heat and excitement of the organs from any cause, or to allay even the usual fervor when it becomes neces- AND THERAPEUTICS. 371 sary to do so in the management of depraved functional disturb- ance, such as spermatorrhoea, etc. Lupulin, in substance, may be given in the dose of ten grains, made into the form of pill; and in order the more certainly to give freedom from pain and irritability of the genital organs, some preparation of opium is usually given at the same time. 1 in dura Lupulinoe — Tincture of Lupulin. The virtues of lup- ulin to the full extent are contained* in the tincture, and in this preparation may be given alone or with other liquid preparations, in the dose of two jluidrachms. Camphora— Camphor. A concrete substance obtained from Camphora Officinarum an evergreen tree, native of China, and found also in eastern Asia. Camphor, when purified by sublimation, is in the form of white, brittle mass, and can be readily pulverized by the addi- tion of a little alcohol or common spirit. It has been used for the supposed anodyne effect, but more particularly as a venereal sedative, in connection with lupulin and opium, for the treatment of gonorrhoea, spermatorrhoea, etc, in the dose of five grains, made into the form of pill. CLASS III. UTERINE STIMULANTS. The uterus, though intimately connected with the venereal organs, is not always affected in common with them by remedies. This organ is affected by excitants of the procreative system, through the sympathy of contiguity, when a neighboring part is excited, or by elective influence exerted directly upon it. The class now under consideration answers to the latter, and tends more to functional than structural excitement. That is to say, heat and irritation from th'e afflux of blood to the viscus, such as may be communicated to contiguous organs, is not produced by the action of remedies in this class. The natural functions of the organ are : menstruation, pro- 372 ACOLOC.Y tection and nourishment to the new being, and its expulsion at maturity. The last, more particularly, is affected by uterine excitants. These remedies are required when, in parturition, the contrac- tions are not sufficiently active for the ready termination of labor, and after delivery, when sufficient firmness does not exist to pre- vent hemorrhage, and other unpleasant results from want of vigor in the organ. Articles of the class are useful also, and become appropriate emmenagogues in relaxed and debilitated condition of the womb leading to retention or suppression of the catamenia, or dysmenorrhea. Catalogue of Uterine Stimulants. Ergota, Gossypii Radix. Ergota — Ergot. The defective grains of Secale Cerate, or Common Rye. Ergot is supposed to result from fungous growth taking the place of the grain in rye. Other cereals are perhaps subject to this form of degenerate growth, which probably also possesses similar med- icinal properties. It is of dark-brown color externally, yellowish within, and has putrid odor and unpleasant, somewhat acrid taste. The only reliable medicinal property known to ergot is that of uterine stimulant, by which the uterine muscular fibre is made to contract. The action seems to be an elective influence exerted upon this particular structure of the organ, without causing unusual heat and excitement of the womb or neighbor- ing organs. This is called abortive effect, and is called for in tedious labor from feeble contractions of the uterine fibre, or other conditions such as hemorrhage, etc., dependent upon a want of normal con- traction. For amenorrhea, from debility and relaxation, it proves also valuable from what is termed its emmenagogue prop- erty, but this result doubtless proceeds from the elective action of And therapeutiOs. 3?3 the remedy on the contractile fibre of the uterus. Caution is advised in its use as a parturifacient, lest rupture of the womb should occur from violent contractions when the os uteri is un- yielding. Fig. 38. Full-grown Ear of Rye, strongly infected loith Ergot (nat. size.) a a. Mature Ergot. Serious results may doubtless follow the injudicious use of the remedy, but when the contraction is already vigorous, a prudent 374 ACOLOGY practitioner would not, of course, see any necessity for its use ? and with such caution, no danger need be apprehended. Con- traction in the circular fibres, disproportionate to that of the lon- gitudinal, is that which retards dilation of the os, and, according to the experience of the author, is readily overcome by ergot, which is supposed to act more directly upon the longitudinal fibres, and thus promote dilation. Pulverized ergot may be given in the dose of fifteen grains, and repeated in thirty minutes if the effects are not produced. Vinum Ergotoz — Wine of Ergot — is a convenient and agree- able preparation, one in which the activity of ergot may be more perfectly preserved from deterioration by time. The dose is half a fliddounce, repeated as above advised for the ergot in substance. Tinctura Ergotce — Tincture of Ergot — is officinal, and may be used with propriety when the remedy is required. In this form also the virtues of ergot may be preserved, and since failures to realize the benefit of this drug are doubtless often due to deteri- oration of the article from being too long kept in substance, this is an important consideration. The dose is one or two fluidrachms and repeated, as with other preparations, every thirty minutes for its parturient effects, and less frequently for ordinary inac- tivity of the womb. Gossypii Radicis Cortex — Bark of Cotton Root. The bark from the root of Gossypium Herbaceum or Cotton Plant. The discovery of medicinal virtues in this plant is of comparatively recent date. Indeed, so little was known of it in 1860, that the United States Pharmacopoeal revision for that year gave no officinal preparation of the drug. There is now, however, sufficient evidence of its stimulating action upon the uterine fibre, from those who have repeatedly witnessed its effects, to authorize a reliable preparation in the revision of 1870. Gossypium is considered equally prompt and reliable, and a much safer remedy than ergot as a parturifacient, and is much prized on account of the favorable results obtained from it in the treatment of amenorrhea from uterine inactivity. AND THERAPEUTICS. 375 A Decoction may be made with four troyounces of the bark of the root to two pints of water, boiled down to a pint ; two or three fluid- ounces of which may be taken every thirty minutes till its effects are experienced, when required in labor. For its invigoration in feeble menstruation, it is given only three or four times a day for several days. Extraction Gossypii Radicis Fluidum — Fluid Extrcuct of Cot- ton Root This is the only officinal preparation of cotton root, and may be relied on for the full effects of the drug, as stated for other articles of the class, in the dose of one or two fluidrachms. In addition to these direct uterine stimulants, there are many indirect excitants of the womb, which, under favorable circum- stances, influence its contractions, and may sometimes bring about desirable therapeutic results. The more active renal and genital stimulants are of this description. With no other direct action by them than the irritation, heat and excitement produced in the urinary apparatus, the uterus, from participation in the afflux of blood thus invited to neighboring organs, is, in consequence, the subject of more or less excitement, which may result in greatly increased functional activity. Hence, cantharides, savin, etc., may, when given to a pregnant female, sometimes bring on abor- tion. In the same manner, the derangement in menstruation, occurring from inactivity of the womb, may be corrected. Sim- ilar effect upon the uterus is produced by the action of excitants upon the rectum; and aloes, or other elective or local irritant of this part, gives indirect stimulus to the womb, and should be used with a knowledge of this fact. CLASS IV. UTERINE SEDATIVES. The remedies heretofore relied on to arrest abnormal contrac- tion of the womb are, for the most part, indirect agents. Opium afforded, for a long time, the chief reliance in threatened abor- tion and in uterine hemorrhage from the gravid womb. Its ac- tion as a sedative in allaying excitement and expulsive contrac- tion is not exerted upon the uterus, but the nervous system, 376 acoloc; v through which irritability, and the contraction dependent thereon, arc controlled. Within the past few years direct sedative action is claimed for at least one remedy — black haw — hut its reputed anodyne effect in neuralgia, etc., leads to the suspicion that it, too, is an elective neurotic. Catalogue of Uterine Sedatives. Viburnum, Opium. Viburnum — Black Haw. The bark of the trunk, branches or root of Viburnum Pruni- folium, or Black Haw, a small branching tree, found in the southern portion of the United States, and until recently un- known as a remedy possessing any very important medicinal virtues. The medical profession is indebted to Dr. Fares, of Mississippi, for the discovery of valuable uterine sedative prop- erties in the bark of this tree. Physicians of this city, who have used it as directed by Dr. Fares, declare their preference for it, as an antiabortive^ above that of opium or other means used for the purpose. It has also been found useful in neuralgic pain and general uneasi- ness from irritable condition of the womb; acting sometimes very promptly as an anodyne in such cases. Black haw may be used in the form of decoction, made by two troyounces of the bark to two pints of water boiled down one- half. Of this, one or two fluidounces may be taken every thirty or forty minutes till the sedative effect is had. A Fluid Extract is kept by druggists, of which a fluidrachm is the proper dose. Opium. The preparations of this important remedy have for a great while been used as the only reliable anti-abortive means at our command. Not until the discovery of the quieting influence of viburnum was any other special agent relied on to control irritabil- AND THERAPEUTICS. oil ity of the uterus; and now, the practitioner would not feel that his whole duty had been performed in a case of abortion for which no opiate had been given. There is a feeling of greater security in threatened premature delivery, when this remedy is administered in due time. While confidence in its restraining influence over premature contractions is felt, no fear is now entertained that labor, appear- ing regularly at the full period, will be retarded by decided doses. Indeed, effective pains are apt to succeed the distressing, irregu- lar suffering allayed by opium in the commencement of labor at the full time. Full doses of morphine early in threatened abor- tion generally prove effectual. INDEX Ablution, 11. Acacia, 130. Acacia Catechu 83. Acacia Vera, 130. Acarus, 117. Acetate of Lead, 77, 160. Acetate of Morphia, 293. Acetated Tincture of Opium, 295. Acetum Cantharidis, 72. Acetum Lobeliae, 196. Acida Minerales, 122, 245, 351. Acid Drinks, 268. Acids, 23. Acidum Arsenicum, 123. Acidum Arseniosum, 174. Acidum Carbolicum, 93, 126, 162. Acidum Chromicum, 123. Acidum Gallicum, 81. Acidum Hydrocyanicum Dilutum, 273, 313. Acidum Muriaticum, 127, 248, 352. Acidum Nitricum, 122, 247, 352. Acidum Nitromuriaticum, 249, 352. Acidum Sulphuricum, 247, 352. Acidum Sulphuricum Aromaticum, 247, 352. Acidum Sulphurosum, 176. Acidum Tannicum, 81. Acologia, 2. Acology, 2. Acorus Calamus, 104. Action, Modifying circustances of, 49. Actual Cautery, 72, 122, 162. Acupunctura, 144. Acupuncture, 144. ^Ether, 305, 309. Age, 50. Air, 9. Alcohol, 298. Alcoholic Drinks, 105, 299. Alexandrian Senna, 217. Aloe, 212. Aloes, 212. Aloe Socotrina, 212. Aloe Spicata, 212. Aloe Vulgaris, 212. Allspice, 106. Althaea, 136. Althaea Officinale, 136. Alum, 78. Alumen, 78. Amber, 332. American Centaury, 245. American Columbo, 240. American Helebore, 257. American Senna, 219. Ammonia, 67, 72, 184. Ammoniac, 284. Ammoniacum, 284. Ammoniated Copper, 318. Ammonii Bromidum, 321. Ammonii Carbonas, 255. Ammonii Chloridum, 177. Amorphous Crystals, 28. Amylum, 135. Anaesthetic Cerebral Sedatives, 308. Anaesthetic Cerebral Sedatives, Cata- logue of, 309. Analysis, 22. Anger, 3. Animal Effluvia, 10. Anise, 106. Annual Roots, 14. Antacida, 180. Antacids, 180. Anthelmintics, 109. Anthelmintics, Catalogue of, 111. Antimonial Ointment, 73. Antimonii et Potassii Tartras, 196, 266. Antiparasitic, 117. Antiseptics, 123. Antiseptics, Catalogue of, 125. Antispasmodics, 326. Aperient Evervescing powders, 207. 379 380 INDEX. Aperient--. 201. Apothecaries' Weights, I 7. Approximate Sfeasures, 17. Aqua Chlorinii, 127. Aqua Portis, L22, 2 17, 852. Aqua Elegia, 2 19, 252. Arctostaphylos Uva Ursi, 364. Argent i Nitras, 90, L68, 818. Argent i Nitras Fusa, 90. Arnica, 328. Arnica Montana, 323. Aromatic Local Excitants, 97. Aromatic Local Excitants, Catalogiu of, 98. Aromatic Sulphuric Acid, 247, 352. Aromatic Syrup of Rhubarb, 212. Arsenic, 17 1. Arsenic Acid, 123. Arsenicum, 174. Arsenious Acid, 174. Artemisia Cina, 120. Arteriotomy, 260. Asclepias, 285. Aspidium Felix Mas, 119. Assafcetida, 330. Astringents, 76. Astringents, Catalogue of, 77. Atomizer, 41, 88, 91. Atropia, 304. Atropia Belladonna, 303. Attachment, 3. Aurantii Cortex, 107. Azedarach, 113, Balsam of Peru, 280. Balsam of Tolu, 279. Balsamum Peruvianum, 280. Balsamum Tolutanum, 279. Bark, 15. Bark of Pomegranite root, 113. Barosma Crenata, 365. Beef Tea, 149, 234. Belladonna, 303. Belladonna Folia, 303. Belladonna Radix, 303. Benne, 134. Benzoin, 285. Berberina, 238. Bicarbonate of Potassium, 184. Biennial Roots, 14. Biniodide of Mercury, 171. Bismuthi Subnitras, 137. Bitartrate of Potassium, 360. Bitter Cucumber, 225. Blackberry Root, 81, 82. Black Ginger, 100. Black Haw, 376. Black Oak, 80. Black Pepper, 107. Black Poppy, 290. Black Snakeroot, 8 16. Blennymenal Stimulants, 276. Blennymenal stimulants, Catalogue of, 277. Blessed Thistle, 319. Blistering Paper, 71. Blistering Tissue, 71. Blisters, 68. Blood-Letting, 156, 25!). Bloodroot, lit.'!. Bloodroot, Powder of, 193. Blue Gentian, 243. Blue Gum, 282. Blue Pill, Mass, 168, 209, 350. Bodies, Simple, 21. Bran, 250. Brayera, 114. Brayera Anthelmintica, 114. British Weights and Measures,, 18. Bromide of Ammonium, 321. Bromide of Lithium, 321. Bromide of Potassium, 180, 321. Bromine, 320. Brominum, 320. Buchu, 365. Butternut, 214. Cadmii Sulphas, 96, 198. Caifea, 334. CafFea Arabica, 334. Caffein, 336. Calabar Bean, 328. Calamus, 104. Calcined Magnesia, 182, 205. Calomel, 118, 168, 209, 351. Caloric, 72. Calumba, 238. Calx, 126, 183. Calx Chlorinata, 126. Camphor, 371. Camphora, 371. Camphora Officinarum, 371. Camphorated Tincture of Opium, 295. Canada Thistle, 320. Canella, 108. Canella Alba, 108. Cannabis Indica, 305, 368. Cannabis Sativa, 305. Cantharides, 70, 356, 368. Cantharides with Colodion, 71. Cantharis, 70, 356, 368. Cantharidin, 70. Cantharis Vesicatoria, 70, 356. Capsicum, 66, 253. Capsicum Anuum, 66. Carbolic Acid, 93, 126, 162. INDEX. 381 Carbo Ligni, 127, 203, 250. Carbonate of Ammonium, 255. Carbonate of Lithium, 181. Carbonate of Magnesium, 182, 206. Carbonate of Potassium, 183. Carbonate of Sodium, 207. Carbon of Wood, 203. Cardamom, 108. Cardamomum, 108. Cardiac Sedatives, 256. Cardiac Sedatives, Catalogue of, 257. Cardiac Stimulants, 251. Cardiac stimulants, Catalogue of, 253. Cardiac Tonics, 269. Cardiac Tonics, Catalogue of, 269. Carageen, 133. Carageenin, 133. Caryophyllus, 102. Caryophyllus Aromaticus, 102. Cascarilla, 105. Cassia, 217. Cassia Acutifolia, 217. Cassia Elongata, 217. Cassia Alarilandica, 219. Casia Obovata, 217. Castor, 333. Castoreum, 333. Castor Fiber, 333. Castor Oil, 214. Catalytics, 163. Catalytics, Catalogue of, 166. Catechu, 83. Cathartics, 200. Cat-heretics, 85. Catheretics, Catalogue of, 86. Caustic Potassa, 121. Caustic Potash, 121. Cauterium Actuale, 122. Cayenne Pepper, 66, 253. Centaurea, 319. Centaurea Benedicta, 319. Cephaelis Ipecacuanha, 190. Cerasus Serotina, 272. Cerate of Cantharides, 70. Cerates, 35. Ceratum Cantharidis, 70. Cerebral Sedatives, 307. Cerebral Stimulants, 287. Cerebral Stimulants, Catalogue of, 289. Cerebral Tonics, 314. Cerebral Tonics, Catalogue of, 315. Cerii Oxalas, 334. Cerium, 334. Cetraria, 133. Cetraria Islandica, 133. Chalk, 183. Chamomile, 158. Charcoal, 127, 203, 250. Charta Epispastica, 71. Charta Sinapis, 65. Chemical Equivalents, 22. Chemical Nomenclature, 23. Chemical Process, 46. Chenopodium, 113. Chenopodium Anthelminticum, 113. Chimaphila, 179. Chimaphila umbellata, 179. China Tree, 113. Chinese Rhubarb, 211. Chloral, 67, 310. Chloral Hydrate, 310. Chloride of Ammonium, 177. Chloride of Iron, 78, 127, 161. Chloride of Lime, 126. Chloride of Sodium, 127. Chloride of Zinc, 78, 94, 127. Chlorinated Lime, 126. Chlorine, 126. Chlorine Water, 127. Chlorodyne, 297. Chloroform, 67, 177, 296, 309. Chloroformum, 177, 296, 309. Cholagogue Cathartic, 222. Chondrus, 133. Chondrus Crispus, 133. Chromic Acid, 123. Cibus, 148, 233. Cimicifuga, 345. Cimicifuga Racemosa, 345. Cinchona, 339. Cinchona Calisaya, 339. Cinchonia, 339. Cinchonioe Sulphas, 342. Cinnamomum, 99. Cinnamomum Aromaticum, 99. Cinnamomum Zeylanicum, 99. Cinnamon, 99. Citrate of Caffein, 336. Citrate of Iron, 152. Citrate of Lithium, 182. Citrullus Colocynthis, 225. Citrus Aurantium, 107. Classification of Remedies, 55. Classfication, Table of, 61. Climate, 49. Cloves, 102. Coal-Tar, 93. Cocculus Palmatus, 238. Cod-Fish, 153. Cod-Liver Oil, 153. Coffee, 334. Cohosh, 346. Cold, 265. Cold Infusions, 158. Collinsonia, 283. Collinsonia Canadensis, 283, INDEX. limn cum Cantharide. 71. OoUutories, 4<>. Colly ria. 41. Collyrium. Colocynthiu. 22 Colocynt! .> _ Colambin, 2 - Colurabo. 2 B. Comfry. 136, 140. Common Flax. 131. Common Mum;i Common Poppy. \ Common Salt. 127 Compound Infusion of Flax-See Compound Tincture of Gentian, 243. Condiments, 106. Conia, 326. Conium, 326. Conium Maculatum, 326. Contusion. 25. Convaluh. - Convolvulus Scammonium. 223. Copaiba, 278 M Copaiba Multijuga, 273, ■: Copaiva. 278. 358. Copper, 318. Coptis. 244. Coptis Trifolia. 244. Coriander. Coriandrum, 108. Coriandrum Sativum, 108. Cornine. 343. Cornus, 343. Cornus Florida. 343. Corrosive Chloride of Mercury, US. Corrosive Sublimate, 118, 169. Cotton plant, 374. Counter Irritation, 63, 68. Cranesbill. 79. Cream of Tartar, 360. Creasote, 125, 163. Creasotum. 125. Croton Eluteria, 105. Croton Oil. 74. 227. Croton Tiglium. 74, 227. Crystalization. 28. Cueurbita Pepo, 114. Cucurbitula, 143. Culver" s Root, 229. Cupping. 2'.'4. Cupping Glass. 143. 264. Cupri Sulphas. 95. 197. 318. Cuprum, 318. Cuprum Ammoniatum, 318. Cyanide of Potassium, 274, 314. imonium, 302. Decani Decimal Weights and Measures, 19. Decoction-. Decoction of Azedarach, 113. ion of Bla Decoction of Cetrnii. L34. Decoction of Chondrus. 1 Decoction of Cinchona. Decoction of Cotton Root. Decoction of Geranium, Decoction of Krameri . Decoction of Logwood, B4. Decoction of Peruvian Bark, 339, Decoction of Pipsissewa, 1 ~ Decoction of Pomegranate Root, 114. Decoction of Rhatany. 83. Decoction of Rubus. 82. Decoction of Sabbatia, 245. Decoction of Seneca. 2 Decoction of Stillingia, 174. Decoction of Thistle, _ Decoction of White Oak, 80. Decoction of UV« Crsi, 364. Decoctum Senegie. 2 H L'. Decoctum Uva Ursi, 304. Demulcents, 129. Demulcents. Catalogue of, 130. Denarcotized Laudanum. L Denarcotized Opium. 2 Deodorized Tincture of Opium, 2 Depletio, 259. Depletion, 68. Despumation. 27. Dewberry Root, Diet, 12. Digestion. 2 Digestive Tonics. 229. Digitalis, 270. 363. Digitalis. Purpurea, 270, 363. Diluents. 157. Diluted Alcohol. 2 Diluted Hydrocyanic Acid, 273, 313. Dimorphous Crystals. 28. Direct Therapeutic Results, 47. Displacement. 32. Distillation. 28 Distilled Water. 2 Divisions. 2 Dogwood, 343. Dorema Ammoniacum, 2 C 4. Dose for Children, 55. Dracontium. 286. Drastics. 201. 219. Drastics. Catalogue of, 220. Drinks, 13. INDEX. 383 Drugs, 7. Dry Cupping, 146. Dry Potassa, 121. Effects of Medicine, 43. Efferfescing Draught, 268. Effluvia, 10. Elaterium, 226. Elective Action through Chemical Pro- cess, 147. Elective Action through Vital Process, 185. Elective Remedies, 46, 147. Electricity, 324. Electrolysis, 325. Electro-Magnetism, 325. Elementary Bodies, Properties of, 21. Elettaria Cardamomum. 108. Elixir of Vitriol, 247, 352. Elutriation, 26. Emesis, 185. Emetics, 185. Emetin, 190. Emolients, 138. Emolients, Catalogue of 139. Endermic, 38. Enteric Excitants or Cathartics, 200. Enteric Excitants, Objects of, 201. Epidermic, 38. Epsom Salt, 216. Ergot, 372. Ergota, 372. Errhines, 40. Escharocics and Catalogue of, 121. Essence of Cinnamon, 100. Essence of Meat, 149. Essence of Peppermint, 104. Essential Oils, 67. Ether, 67, 305, 309. Eucalyptus, 282, Eucalyptus Globulus, 282. Eugenia Pimenta, 106. European Rhubarb, 211. Evaporation, 27. Excito-Motor Sedatives, 326. Excito-Motor Sedatives, Catalogue of 326. Excito-Motor Stimulants, 322. Excito-Motor Stimulants, Catalogue of 322 Exercise, 11, 203, 232. Expression, 26. Extract of Belladonna, 304. Extract of Butternut. 214. Extract of Conium, 327. Extract of Digitalis, 271 . Extract of Hyoscyamus, 302. Extract of Indian Hemp, 306, 369. Extract of Jalap, 221. Extract of Logwood, 84. Extract of Nux Vomica, 323. Extract of Peruvian Bark, 341. Extract of Rhatany, 83. Extract of Seneka, 282. Extract of Strammonium, 303. Extract of Taraxacum, 354. Extractum Belladonna?, 304. Extractum Buchu Fluidum, 365. Extractum Cannabis, 306, 369. Extractum Cimicifuga Fluidum, 346. Extractum Conii, 327. Extractum Filicis Liquidum, 120. Extractum Gossypii Badicis Fluidum, 375. Extractum Hyoscyami, 302. Extractum Jalapse, 221. Extractum Juglandis, 214. Extractum Bhei Fluidum, 212. Extractum Senegse, 282. Extractum Sennas Fluidum, 218. Extractum Spigelige Fluidum, 112. Extractum Stramonii, 303. Extractum Taraxaci, 354. Extractum Uvae Ursi Fluidum, 365. Extractum Zingiberis Fluidum, 102. Extractum Veratri Viridis Fluidum, 259. • False Manna, 205. Fat Manna, 205. Fear, 5. Fennel, 106. Ferri Chloridum, 161. Ferri Citras, 152, Ferri Iodidum, 172. Ferri Persulphas, 163. Ferri Sulphas, 152. Ferrum, 150. Ferrum Redactum, 151. Filix Mas, 119. Filters, 26. Filtration, 26. Fit Weed, 320. Flake Manna, 205. Flax, 131. Flaxseed, 131. Flaxseed Meal, 140. Flour of Meat, 149, 234. Flowers, 15. Fluid Extract of Black Haw, 376. Fluid Extract of Buchu, 365. Fluid Extract of Cimicifuga, 346. Fluid Extract of Cotton Root, 375. Fluid Extract of Ginger, 102. Fluid Extract of Rhubarb, 212. Fluid Extract of Sarsaparilla, 173, 38 1 INDEX. Fluid Extract of Senna, 218. Fluid Extracl of Spigelia, 112. Fluid Extraotof Uva Ursi, 866. Fluid Extract of Veratrum Viride, 259. Fontioulus, L46. Food, 148, 283. Forms of Preparation, 29. Fowler' s Solution, 170. Foxglove, 270. Frasera, 240. Frasera Walteri, 240. Fraxinus, 205. Fraxiuus Ornus, 205. French and United States Weights, Relative Value of. 19. Friction, 140. Frigidus, 265. Fumes, 40. Fused Nitrate of Silver, 90. Gadus Morrhua, 153. Galium Aparine, 180. Galla, 80. Gallic Acid, 81. Galls, 80. Galvanism, 324. Galvano-Magnetism, 325. Gamboge, 224. Gambogia, 224. Garcinia Gambogia, 224. Gastric Juice, 236. Gastric or Digestive Tonics, 229. Gastric Tonics, Catalogue of, 238. Gelsemium, 337, 369. Gelsemium Sempervirens, 337. General Blood-Letting, 200. Genital Sedatives, 309. Genital Sedatives, Catalogue of, 309. Genital Stimulants, 307. Genital Stimulants, Catalogue of, 308. Gentian, 242. Gentiana, 242. Gentiana, Catesbtei, 243. Gentiana Lutea, 242. Geranium, 79. Geranium Maculatum, 79. Gillenia, 192. Gillenia Trifoliata, 192. Ginger, 100. Glauber's Salt, 217. Glycerina, 135. Glycerin, 135. Glycerite, 135. Glycerole, 135. Gold-Thread, 244. Gossypii Radicis Cortex, 374. Gossypium Herbaceum, 374. Graham Bread, 250. Granati Radicis Cortex, 11.°.. Green Iodide of Mercury, 171. Green Vitriol, 152. Gum Arabic, 180. Gum Water, 181, Gutta Percha, 138. Habit, 63. Hsematinics and Catalogue of, 148. Basmatcxylon, 84. Ila'inatoxylon Campeachianum, 84. Hsesmostasia, 169. 1 hemostatics, 158. Hemostatics, Catalogue of, 100. Hatred, 4. Heal-All, 283. Hemlock, 320. Henbane, 301. Hepatico-Salivary Stimulants, 347. Hepatico-Salivary Stimulants, Cata- logue of, 349. Hepatic Tonics, 351. Hepatic Tonics, Catalogue of, 351. Hirudo, 142, 204. Hirudo Decora, 142. Hirudo Medicinalis, 142. Honduras Sars aparilla, 173. Hope, 4. Hops, 370. Humulus Lupulus, 370. Hydracids, 24. Hydragogues, 201. Hydrargyri Chloridum Corrosivum, 118, 109. Hydrargyri Chloridum Mite, 118, 108, 209. Hydrargyri Iodidum Rubrum, 171. Hydrargyri Iodidum Viride, 171. Hydrargyri Sulphas Flava, 199. Hydrargyrum, 117, 100, 208, 349. Hydrate of Calcium, 183. Hydrate of Chloral, 310. Hydrate of Potassium, 121. Hydrate of the Protoxide of Potas- sium, 121. Hygiene, 8. Hyoscyamus, 301. Hyoscyamus Niger, 301. Hypodermic, 39. Hypophosphite of Calcium, 317. Hypophosphites, 316. Ice, 266. Iceland Moss, 133. Idiosyncrasy, 53. Immediate effects of Emetics, 187. Impalpable Powder, 41. Impluvium, 344. INDEX. 385 Imponderable Substances, 2. Indian Hemp, 305, 368. Indian Physic, 192. Indian Tobacco, 194. Indirect Therapeutic Results, 48. Infusions, 33, 158. Infusion of Bloodroot, 193. Infusion of Calamus, 105. Infusion of Capsicum, 253. Infusion of Cascarilla, 105. Infusion of Chamomile, 158. Infusion of Cinchona, 339. Infusion of Collinsonia, 283. Infusion of Columbo, 240. Infusion of Coptis, 244. Infusion of Digitalis, 271. Infusion of Flaxseed, 132, 158. Infusion of Gentian, 242. Infusion of Gillenia, 192. Infusion of Ginger, 102. Infusion of Heal- All, 283. Infusion of Kino, 83. Infusion of Lobelia, 196. Infusion of Logwood, 84. Infusion of Nutgalls, 80. Infusion of Oak Barks, 80. Infusion of Peppermint, 103. Infwsion of Peruvian Bark, 339. Infusion of Quassia, 244. Infusion of Rhatany, 83. Infusion of Sabbatia, 245. Infusion of Sassafras Pith, 135. Infusion of Senna, 218. Infusion of Slippery Elm, 133. Infusion of Spigelia, 112. Infusion of Taraxacum, 353. Infusion of Tobacco, 193, 313. Infusion of Vanilla, 108. Infusion of Wild Cherry, 272. Infusum Cascarillge, 105. Infusum Calumbse, 240. Infusum Gentianae, 242. Infusum Lini Compositum, 132. Infusum Pruni Virginianae, 272. Infusum Quassias, 244. Infusum Sennae, 218. Infusum Spigeliae, 112. Infusum Tabacum, 313. Infusum Taraxaci, 353. Infusum Zingiberis, 102. Inhalation, 40. Inspissation, 27. Insufflation, 40. Introduction, 1. Inverse Gastric Excitants or Emetics, 185. Inverse Gastric Excitants, Catalogue of, a89. 25 Iodide of Iron, 172. Iodide of Potassium, 170. Iodine, 86, 169. Iodine, Fumes of, 87. Iodine Ointment, 170. Iodinum, 86, 169. Iodoform, 96. Iodoformum, 96. Ipecac, 190. Ipecacuanha, 190. Ipomaea Jalapa, 220. Irish Moss, 133. Iron, 150. Iron, hot, 122, 163. Isomorphous Crystals, 28. Issue Pea, 146. Jalapa, 220. Jalap, 220. Jamaica Ginger, 100. Jamestown Weed, 302. Jerusalem Oak, 113. Joy, 4. Juglans, 214. Juglans Cinerea, 214. Juniper, 357. Juniperus, 357. Juniperus Communis, 357. Juniperus Sabina, 357. Kameela, 116. Kino, 82. Koosso, 114. Krameria, 83. Krameria Triandria, 83. Laughing Gas, 310. Lavender, 106. Lavendula, 106. Lavendula Vera, 106. Laxatives, 201. Laxatives, Catalogue of, 204. Leaves, 15. Lebens Wecker, 75. Leeches, 264. Lemonade, 268. Leopard's Bane, 323. Leptandra, 229. Leptandra Virginica, 229. Leptandrin, 229. Levant Wormseed, 120. Licheriin, 133. Light, 9. Lime, 126, 183. Lime Water, 183. Lini Farina, 140. Liniments, 36. Linseed Oil, 138. 386 tm>i:x. Linam, 181. Linum (Jsitatissinuun, 181, 1 li>. Liquidambar Orientale, 284. Liquid Extraot of Fern, 120. Liquid Preparations, 81. Liquid Storax, '284. Liquor Calcia, 188. Liquor Magnesii Citratis, 200. Liquor Potassii Arsenitis, 1 7 ' > . Liquor Sodas Ghlorinatae, 127. Lithia, 181. Lithii Bromidum, 821. Lithii Carbonas, 181. Lithii Citras, 182. Lixiviation, 27. Lobelia, 194. Lobelia Inflata, 194. Local Action through Chemical Pro- cess, 109. Local Action through Mechanical Pro- cess, 129. Local Action through Vital Process, 63. Local Alteratives, 85. Local Blood-letting, 264. Local Depletives, 141. Local Depletives, Catalogue of, 142. Local Remedies, 46, 63. Logwood, 84. Lotions, 36. Love, 3. Low Diet, 157. Lozenges, 30. Lugol's Solution of Iodine, 88, 171. Lumbricoides, 110. Lunar Caustic, 90. Lungs, 40. Lupulin, 370. Lupulina, 370. Mace, 107. Maceration, 26. Magnesia, 182, 205. Magnesii Carbonas, 182, 206. Magnesii Sulphas, 216. Male Fern, 119. Malt Liquors, 300. Manganese, 180. Manna, 205. Mannite, 205. Marshmallow, 136. Materia Medica, 1. Material Agents, 2, 21. Matter, 22. May Apple, 222. McMunn's Elixir of Opium, 295. Mecca Senna, 217. Mechanical Counter-irritants, 141. Mechanical Counter-irritants, Cata- logue of, I 12. Mechanical Process, •}•'». Mechanical Operations of Pharmacy, 26. Medioines, 7. Melia Azedaraoh, 113. Mentha Piperita, 103. Mentha Viridis, 104. Mercurial Ointment, 118. Mercury, 117, 166, 208, 349. Mesmerism, 6. Mezereon, 180. Mild Chloride of Mercury, 118, 168, 209. Mild Enteric Excitants, 201. Mild Enteric Excitants, Catalogue of, 204. Mineral Acids, 122, 245, 351. Modus Operandi of Remedies, 43. Molasses. 204. Momordica Elaterium, 226. Morphia, 293. Morphise Acetas, 293. Morphias Murias, 294. Morphias Sulphas, 294. Morphine, 293. Moschus, 333. Moschus Moschiferus, 333. Moxa, 146. Moxiburium, 146. Mucilage of Gum Arabic, 131. Mucilago Acacias, 131. Muriate of Ammonia, 177. Muriate of Morphia, 294. Muriated Tincture of Iron, 249, 365. Muriatic Acid, 127, 248, 352. Musk, 333. Musk Deer, 333. Mustard, 64, 105. Mustard Paper, 65. Myristica, 107. Myristica Fragrans, 107. Myrospermum Peruiferum, 280. Myrospermum Toluiferum, 279. Naptha, 285. Narthex Assafcetida, 330. Nicotiana Tabacum, 193, 312. Nitrate of Potassium, 267, 359. Nitrate of Silver, 90, 163, 318. Nitre, 267. Nitric Acid, 122, 247, 352. Nitromuriatic Acid, 249, 352. Nitrous Oxide, 310. Nomenclature, 23. Nose, 39. Noxious Effluvia, 10. INDEX. 387 Nutmeg, 107. Nux Vomica, 822. Oil of Amber, 332. Oil of Chenopodium, 113. Oil of Cinnamon, 67, 100. Oil of Cloves, 67, 103. Oil of Copaiva, 279. Oil of Eucalyptus, 283. Oil of Peppermint, 67, 104. Oil of Pumpkinseed, 114. Oil of Savin, 358. Oil of Turpentine, 65, 254, 277, 355. Ointments, 35. Ointment of Iodine, 170. Olea Europcea, 136, 204. Oleoresin of Eern, 120. Oleoresin of Ginger, 102. Oleoresina Zingiberis, 102. Oleum Caryophilli, 103. Oleum Chenopodii, 113. Oleum Cinnamomi, 100. Oleum Copaibas, 279. Oleum Eucalypti, 283. Oleum Juniperi, 357. Oleum Lini, 138. Oleum Menthae Piperitse. 104. Oleum Morrhuse, 153. Oleum Myristicse, 107. Oleum Olivse, 136, 204. Oleum Peponis, 114. Oleum Ricini, 214. Oleum Sabinse, 358. Oleum Succini, 332. Oleum Terebinthinse, 65, 254, 277, 355. Oleum Tiglii, 74, 227. Olive Oil, 136, 204. Opium, 289, 376. Orange Peel, 107. Orders, 62. Ornus, 205. Ornus Europaea, 205. Oxacids, 23. Oxalate of Cerium, 334. Oxide of Calcium, 183. Oxide of Magnesium, 182. Packing Drugs, 16. Palma Christi, 214. Papaver Somniferum, 289. Paregoric, 295. Parts of Body for Application, 36. Pearl Ash, 183. Pediluvium, 67. Pepo, 114. Pepper, 107. Peppermint, 103. Pepsin, 236, 237. Perchloride of Iron, 96, 161. Percolation, 27, 32. Perennials, 14. Peristaltic Action, 185. Permanganate of Potassium, 180. Persulphate of Iron, 96, 163. Peruvian Bark, 339. Petroleum, 93. Pharmaceutic Chemistry. 21. Pharmacological Substances, 7. Pharmacology, 1. Pharmacy, 13. Phellandrium Aquaticum, 284. Phlebotomy, 260. Phosphorus, 315. Phosphorous Acid, 316. Physical Remedies, 7. Physiological Action, 43. Physiological Classification, 61. Physostigma, 328. Physostigma Venenosum, 328. Pill of Mercury, 168, 209, 350. Pills, 29. Pilula Hydrargyri, 168, 209, 350. Pimenta, 106. Pimento, 106. Pinkroot, 111. Pinus Abie-, 65. Pinus Palustris, 65, 277. Piper, 107. Piperine, 107. Piper Nigrum, 107. Pipsissewa, 179. Plasters, 31. Plumbi Acetas, 77, 160. Podophyllum, 222. Podophyllum Peltatum, 222. Polygala Senega, 280. Ponderable Substances, 2. Poppy, 289. Potash, 183. Potassa, 121. Potassii Bicarbonas, 184. Potassii Bitartras, 360. Potassii Bromidum, 321. Potassii Carbonas, 183. Potassii Carbonas Pura, 184. Potassii Cyanidum, 274, 314. Potassii Iodidum, 170. Potassii Nitras, 267, 359. Poultice, 138. Powders, 30. Powder of Bloodroot, 193. Preparations, 29. Primary Action, 47. Properties of Bodies, 21. Probe, Uterine, 41. Proof Spirit, 299. 388 INDEX. Prostrating Cerebral Sedatives, 812. Prostrating Cerebral Sedatives, Cata- logue of, 812. Protoohloride of .Mercury, 861. Protoxide of Lithium, 181. Protoxide of Nitrogen, 810. Protoxide of Potassium, 121. Prunus Virginiana, '2~2. I'ru^sic Acid, -.'513. Psychical Influences, 2. Pterocarpus Marsupium, 82. Pulveres Efl'ervescentes Aperientes, 207 Pulverization, 25. Pulverized Columbo, 240. Pulverized Digitalis, 271. Pulverized Elm Bark, 139. Pulverized Flaxseed, 140. Pulverized Ipecac, 190. Pulverized Jalap, 221. Pulvis Ulmi, 139. Pumpkinseed, 114. Pump, Stomach, 42. Punica Granatum, 113. Pure Carbonate of Potassium, 184. Purgatives, 201,207. Purgatives, Catalogue of, 208. Pustulants, 73. Pustulants, Catalogue of, 73. Quassia, 243. Quassia Amara, 243. Quassia Excelsa, 243. Queen's Delight, 173. Quercus Alba, 80. Quercus lnfectoria, 80. Quercus Tinctoria, 80. Quick Lime, 183. Quinia, 339. Quinise Sulphas, 341. Quinine, 341. Raspberry Root, 82. Rectified Spirit, 299. Rectum, 37. Red Iodide of Mercury, 171. Red Pepper, 66. Reduced Iron, 151. Reflex Nervous Stimulants, 329. Reflex Nervous Stimulants, Catalogue of, 330. Remedies, 2. Remedies that Affect Adventitious Sub- stances and Structures, 109. Remedies that Affect the Alimentary Canal, 185. Remedies that Affect the Blood, 147. Remedies that Affect the Heart, 251. Remedies thai A.flPeoi the Internal and Externa] Surfaces, L29. Remedies thai Effect the .Mucous Mem- branes, 27!. Remedies that Affect the Nervous Sys- tem, 286. Remedies that Affect the Procreative I Organs. ; !*i'i. Remedies that Affect the Secernent System, 846. Remedies that Affect the Skin, 68. Remedies that Affect all Soft Tissues, 75. Renal Sedatives, 358. Renal Sedatives, Catalogue of, 359. Renal Stimulants, 354. Renal Stimulants, Catalogue of, 355. Renal Tonics, 361. Renal Tonics, Catalogue of, 362. Rennet, 237. Resina Jalapae, 221. Resina Podophylli, 222. Resin of Jalap, 221. Resin of Podophyllum, 222. Revulsion, 63, 68. Rhatany, 83. Rheum, 210. Rheum Compactum, 210. Rheum Palmatum, 210. Rheum Undulatum, 210. Rhubarb, 210. Ricinus Communis, 214. Rigoline, 266. Roots, 14. Rottlera, 116. Rottlera Tinctoria, 116. Rubefacients, 63. Rubefacients, Catalogue of, 64. Rubus, 81. Rubus Canadensis, 81. Rubus Trivialis, 81. Rubus Villosus, 81. Sabbatia, 245. Sabbatia Angularis, 245. Sabina, 357. Salicin, 343. Salix, 343. Salix Alba, 343. Salt, 127. Saltpetre, 267. Sanguinaria, 193. Sanguinaria Canadensis, 193, Santonica, 120. Santonin, 120. Santoninum, 120. Sarcoptis Hominis, 117. INDEX. 389 Sarsaparilla, 172. Sassafras Medulla, 134. Sassafras Officinale, 134. Sassafras Pith, 134. Savin, 357. Scammonium, 223. Scammony, 223. Scarification, 144, 265. Scilla, 362. Scilla Maritima, 362. Seaton, 145. Secale Sereale, 372. Secondary Action, 47. Seeds, 15. Seidlitz Powders, 207. Semifluids, 34. Senaga, 280. Seneka, 280. Senna, 217. Sesamum, 134. Sesamum Indicum, 134. Setaceum, 145. Sex, 52. Shellac, 138. Shower-bath, 344. Simple Bodies, 21. Simple Syrup, 35. Sinapis, 64, 105. Sinapis Alba, 64. Sinapism, 65. Sinapis Niger, 64. Skin, Application to, 38. Skin, Remedies for, 63. Slaked Lime, 183. Sleep, 12. Slippery Elm, 132, 139. Slippery Elm Bark, 132. Smilax Officinalis, 172. Smilax Sarsaparilla, 172. Soda, 184. Sodii Chloridum, 127. Sodii Sulphas, 217. Solid Extracts, 31. Solid Extract of Logwood, 84. Solid Extract of Rhatany, 83. Solid Preparations, 29. Solutions, 26, 34. Solution of Arsenite of Potassium, 176. Solution of Chlorinated Soda, 127. Solution of Citrate of Magnesium, 206. Solution of Lime, 183. Solvent of Food, 236. Somatical Remedies, 7. Sorrow, 5. Spansemics, 156. Spanish Flies, 70, 356. Spasmodics, and Catalogue of, 322. Spear Mint, 104. Spigelia, 111. Spigelia Marilandica, 111. Spinal Sedatives, 336. Spinal Sedatives, Catalogue of, 337. Spinal or Reflex Nervous Stimulants, 329. Spinal Stimulants, Catalogue of, 330. Spinal Tonics, 338. Spinal Tonics, Catalogue of, 339. Spirit of Lavender, 106. Spirit of Nitrous Ether, 360. Spirit of Turpentine, 66, 277, 355. Spiritus iEtheris Nitrosi, 360. Spiritus Lavendulse, 106. Spiritus Rectificatus, 299. Spotted Cranesbill, 79. Spray of Iodine, 88. Spritze, 41. Squill, 362. Squirting Cucumber, 226. Starch, 135. Stillingia, 173. Stillingia Sylvatica, 173. Stomach, 36. Stomach Pump, 42. Storax, 284. Stramonium, 302. Strychnia, 322. Strychnos Nux Vomica, 322. Styptic Colloid, 163. Styptics, 158. Styrax, 284. Styrax Officinale, 284. Subcarbonate of Bismuth, 250. Subcarbonate of Iron, 151. Sublimation, 28. Subnitrate of Bismuth, 137, 250. Sub-Order, 62. Subsulphate of Iron, 163. Succinum, 332. Sugar of Lead, 77, 160. Sulphate Aluminum and Ammonium, 78. Sulphate of Cadmium, 78, 96, 198. Sulphate of Cinchonia, 342. Sulphate of Copper, 78, 95, 197, 318. Sulphate of Iron, 152. Sulphate of Magnesium, 216. Sulphate of Morphia, 294. Sulphate of Quinia, 341. Sulphate of Sodium, 217. Sulphate of Zinc, 78, 95, 197, 317. Sulphur, 180. Sulphuric Acid, 247, 352. Sulphurous Acid, 176. Suppositories, 30. Svapnia, 293. Sweet Flag, 104. r>oo INDEX. Sweet Oil, 204. Sweel Spirit of Nitre, 360. Symbols of Weights and Measures, 17. Symphytum, 1 86, 1 to. Symphytum Officinale, 136, 140. Synthesis, 22. Syphon. Stomach, I-!. Syrup, '204. * Syrup of Ginger, 102. Syrup of Iodide of Iron, 172. Syrup of Ipecacuanha, 191. Syrup of Sarsaparilla, 173. Syrup of Sarsaparilla and Stillingia, 17;:. Syrup of Seneka, 282. Syrup of Senna, 219. Syrup of Squill, 362. Syrup of Rhubarb, 211. Syrup of Wild Cherry, 272. Syrups, 35. Syrupus Ferri Iodidi, 172. Syrupus Ipecacuanhne, 191. Syrupus Pruni Virginianas, 272. Syrupus Rhei, 211. Syrupus Rhei Aromaticus, 212. Syrupus Sarsaparilla, 173. Syrupus Scillas, 362. Syrupus Senegas, 282. Syrupus Sennas, Syrupus Zingiberis, 102. Tabacum, 193, 312. Table Tipping, 6. Taenia, 110. Tasnia Lata, 110. Tasnia Solium, 110. Tapeworm, 110. Tannic Acid, 81. Tannin, 81. Taraxacum, 353. Taraxacum dens-leonis, 353. Tartaric Acid, 207. Tartarized Antimony, 74. Tartrate of Antimony and Potassium, 196, 266. Tartrate of Potassium, 207. Tartrate of Sodium, 207. Temperament, 54. Tents, 41. Teroxide of Chromium, 123. The Pack, 141. Thistle, 319. Thornapple, 302. Thorough Enteric Excitants, 201, 207. Thorough Enteric Excitants, Catalogue of, 208. Therapeutics, 2. Tinctura Assafoetidas, 332. Tiiicttira Belladonna. Tinctura Cannabis, 807. Tinctura Cantharis, 857, ■■ Tinctura Capsici, 258. Tinctura Castorei, 38 1. Tinctura Cimicifugffi, 36 1. Tinctura Cinnamomi, loo. Tinctura Conii, 327. Tinctura Digitalis, 271, 364. Tinctura Ergotffi, '■'>' I. Tinctura Ferri Chloridi, 127, 365. Tinctura Ferri Muriatis, 249. Tinctura Gentians Composita. 243. Tinctura Hyoscyanii, 302. Tinctura Iodini, 88, 171. Tinctura Jalapse, 222. Tinctura Kino, 83. Tinctura Lobelias, 196. Tinctura Lupulinas, 371. Tinctura Olei Menthas Piperita?, 104. Tinctura Opii, 294. Tinctura Opii Acetatis, 295. Tinctura Opii Camphorata, 295. Tinctura Opii Deodorata, 295. Tinctura Quassias, 244. Tinctura Sanguinarias, 193. Tinctura Sennas, 219. Tinctura Stramonii, 303. Tinctura Tolutanum, 280. Tinctura Veratri Viridis, 259. Tinctura Zingiberis, 102. Tinctures, 32. Tincture of Assafcetida, 332. Tincture of Belladonna, 304. Tincture of Bloodroot, 193. Tincture of Cantharides, 357, 368. Tincture of Capsicum, 253. Tincture of Castor, 334. Tincture of Catechu, 84. Tincture of Cimicifuga, 346. Tincture of Cinchona, 339. Tincture of Cinnamon, 100. Tincture of Chloride of Iron, 127. Tincture of Conium, 327. Tincture of Digitalis, 271, 364. Tincture of Ergot, 374 Tincture of Gelsemium, 387, 370. Tincture of Ginger, 102. Tincture of Goldthread, 245. Tincture of Hemp, 307. Tincture of Hyoscyamus, 302. Tincture of Iodine, 88, 171. Tincture of Jalap, 222. Tincture of Kameela, 117. Tincture of Kino, 83. Tincture of Lobelia, 196. Tincture of Lupulin, 371, Tincture of Nux Vomica, 323. INDEX. 391 Tincture of Opium, 294. Tincture of Peruvian Bark, 389. Tincture of the Oil of Peppermint, 104 Tincture of Quassia, 244. Tincture of Rhatany, 83. Tincture of Senna, 219. Tincture of Stillingia, 174. Tincture of Stramonium, 303. Tincture of Tolu, 280. Tincture of Veratrum Viride, 259. Tincture of Water-Hemlock, 284. Tincture of Yellow Jasmine, 338. Tobacco, 193, 312. Transfusio, 154. Transfusion, 154. Triticum Vulgare, 135. Troches, 30. Troy Weight, 17. Turpeth Mineral, 199. Ulmus, 132. Ulmus Fulva, 132. Unguentum Hydrargyri, 118. Unguentum Iodinii, 170. Uterine Sedatives, 375. Uterine Sedatives, Catalogue of, 376. Uterine Stimulants, 371. Uterine Stimulants, Catalogue of, 372. Uterine Syringe, 41, 89, 93. Uva Ursi, 364. Vanilla, 108. Vanilla Aromatica, 108. Vapor, 41. Naporization, 27. Venesection, 260. Veratrum Viride, 257. Veronica, 229. Vesicants, 68. Vesicants, Catalogue of, 70. Vesicle, 68. Viburnum, 376. Viburnum Prunifolium, 376. Vinegar of Cantharides, 72. Vinegar of Lobelia, 196. Vinegars, 34. Violent Enteric Excitants, 201, 219. Violent Enteric Excitants, Catalogue of, 220. Vinum Ergotae, 374. Vinum Ipecacuanhae, 191. Virgin Oil, 136. Vital Process, 47, 63. Walnut Leaves, 180. Water, 11. Water, Cool, 157, 265. Water, Distilled, 28. Water-Hemlock, 284. Water, Hot, 73, 141. Water, Warm, 141. Weights and Measures, 17, 18, 19, 20. Wheat Bran, 204. Whisky, 300. White Ginger, 100. White Oak, 80. White Poppy, 289. White Walnut, 214. White Willow, 343. Wild Cherry, 272. Willow, 343. Wine of Ergot, 374. Wine of Ipecac, 191, Wines, 33, 300. Wood Charcoal, 203. Woorari, 327. Wormseed, 113. Xanthoxylum, 180. Yellow Gentian, 242. Yellow Jasmine, 331. Yellow Sulphate of Mercury, 199. Zinci Chloridum, 94, 127. Zinci Sulphas, 95, 197, 317. Zingiber, 100. Zingiber Officinale, 100. LIBRARY OF CONGRESS ■II! 0002^0^3^0