9. The manner, in which arsenic acts in curing intermittent fevers, cannot be by its general stimulus, because no intoxication or heat follows the use of it; nor by its peculiar stimulus on any part of the secreting system, since it is not in small doses succeeded by any increased evacuation, or heat, and must therefore exert its power, like other articles of the sorbentia, on the absorbent system. In what manner it destroys life so suddenly is difficult to understand, as it does not intoxicate like many vegetable poisons, nor produce fevers like contagious matter. When applied externally it seems chemically to destroy the part like other caustics. Does it chemically destroy the stomach, and life in consequence? or does it destroy the action of the stomach by its great stimulus, and life in consequence of the sympathy between the stomach and the heart? This last appears to be the most probable mode of its operation.
The success of arsenic in the cure of intermittent fevers I suspect to depend on its stimulating the stomach into stronger action, and thus, by the association of this viscus with the heart and arteries, preventing the torpor of any part of the sanguiferous system. I was led to this conclusion from the following considerations.
First. The effects of arsenic given a long time internally in small doses, or when used in larger quantities externally, seem to be similar to those of other great stimuli, as of wine or alcohol. These are a bloated countenance, swelled legs, hepatic tumours, and dropsy, and sometimes eruptions on the skin. The former of these I have seen, where arsenic has been used externally for curing the itch; and the latter appears on evidence in the famous trial of Miss Blandy at Chelmsford, about forty years ago.
Secondly. I saw an ague cured by arsenic in a child, who had in vain previously taken a very large quantity of bark with great regularity. And another case of a young officer, who had lived intemperately, and laboured under an intermittent fever, and had taken the bark repeatedly in considerable quantities, with a grain of opium at night, and though the paroxysms had been thrice thus for a time prevented, they recurred in about a week. On taking five drops of a saturated solution of arsenic thrice a day the paroxysms ceased, and returned no more, and at the same time his appetite became much improved.
Thirdly. A gentleman about 65 years of age had for about ten years been subject to an intermittent pulse, and to frequent palpitations of his heart. Lately the palpitations seemed to observe irregular periods, but the intermission of every third or fourth pulsation was almost perpetual. On giving him four drops of a saturated solution of arsenic from a two-ounce phial about every four hours for one day, not only the palpitation did not return, but the intermission ceased entirely, and did not return so long as he took the medicine, which was three or four days.
Now as when the stomach has its action much weakened by an over-dose of digitalis, the pulse is liable to intermit, this evinces a direct sympathy between these parts of the system, and as I have repeatedly observed, that when the pulse begins to intermit in elderly people, that an eructation from the stomach, voluntarily produced, will prevent the threatened stop of the heart; I am induced to think, that the torpid state of the stomach, at the instant of the production of air occasioned by its weak action, caused the intermission of the pulse. And that arsenic in this case, as well as in the cases of agues above mentioned, produced its effects by stimulating the stomach into more powerful action; and that the equality of the motions of the heart was thus restored by increasing the excitement of the sensorial power of association. See Sect. XXV. 17. ClassIV. 2. 1. 18.
10. Where arsenic has been given as a poison, it may be discovered in the contents of the stomach by the smell like garlic, when a few grains of it are thrown on a red-hot iron. 2. If a few grains are placed between two plates of copper, and subjected to a red heat, the copper becomes whitened. 3. Dissolve arsenic in water along with vegetable alcali, add to this a solution of blue vitriol in water, and the mixture becomes of a fine green, which gradually precipitates, as discovered by Bergman. 4. Where the quantity is sufficient, some wheat may be steeped in a solution of it, which given to sparrows or chickens will destroy them.
VII. Absorption of the matter from venereal ulcers. No ulcer can heal, unless the absorption from it is as great as the deposition in it. The preparations or oxydes of mercury in the cure of the venereal disease seem to act by their increasing the absorption of the matter in the ulcers it occasions; and that whether they are taken into the stomach, or applied on the skin, or on the surface of the ulcers. And this in the same manner as sugar of lead, or other metallic oxydes, promote so rapidly the healing of other ulcers by their external application; and probably when taken internally, as rust of iron given to children affected with scrophulous ulcers contributes to heal them, and solutions of lead were once famous in phthisis.
The matter deposited in large abscesses does not occasion hectic fever, till it has become oxygenated by being exposed to the open air, or to the air through a moist membrane; the same seems to happen to other kinds of matter, which produce fever, or which occasion spreading ulcers, and are thence termed contagious. See ClassII. 1. 3.II. 1. 5.II. 1. 6. 6. This may perhaps occur from these matters not being generally absorbed, till they become oxygenated; and that it is the stimulus of the acid thus formed by their union with oxygen, which occasions their absorption into the circulation, and the fever, which they then produce. For though collections of matter, and milk, and mucus, are sometimes suddenly absorbed during the action of emetics or in sea-sickness, they are probably eliminated from the body without entering the circulation; that is, they are taken up by the increased action of one lymphatic branch, and evacuated by the inverted action of some other lymphatic branch, and thus carried off by stool or urine.
But as the matter in large abscesses is in general not absorbed, till it becomes by some means exposed to air, there is reason to conclude, that the stimulus of this new combination of the matter with oxygen occasions its absorption; and that hence the absorption of matter in ulcers of all kinds, is still more powerfully effected by the external application or internal use of metallic oxydes; which are also acids consisting of the metal united with oxygen; and lastly, because venereal ulcers, and those of itch, and tinea, will not heal without some stimulant application; that is, the secretion of matter in them continues to be greater, than the absorption of it; and the ulcers at the same time continue to enlarge, by the contagion affecting the edges of them; that is, by the stimulus of the oxygenated matter stimulating the capillary vessels in its vicinity into actions similar to those of the ulcer, which produces it.
This effect of the oxydes of mercury occurs, whether salivation attends its use or not. Salivation is much forwarded by external warmth, when mercury is given to promote this secretion; but as the cure of venereal complaints depends on its absorbent quality, the act of salivation is not necessary or useful. A quarter of a grain of good corrosive sublimate twice a day will seldom fail of curing the most confirmed pox; and will as seldom salivate, if the patient be kept cool. A quarter of a grain thrice a day I believe to be infallible, if it be good sublimate.
Mercury alone when swallowed does not act beyond the intestines, its active preparations are the salts formed by its union with the various acids, as mentioned in the catalogue. Its union with the vegetable acid, when triturated with manna, is said to compose Keyser's Pill. Triturated with gum arabic it is much recommended by Plenk; and triturated with sugar and a little essential oil, as directed in a former Edinburgh Dispensatory, it probably forms some of the syrups sold as nostrums.
United with sulphur it seldom enters the circulation, as when cinnabar, or Æthiop's mineral, are taken inwardly. But united with fat and rubbed on the skin, it is readily absorbed. I know not whether it can be united to charcoal, nor whether it has been given internally when united with animal fat.
VIII.1. Absorptions in general are increased by inanition; hence the use of evacuations in the cure of ulcers. Dr. Jurin absorbed in one night, after a day's abstinence and exercise, eighteen ounces from the atmosphere in his chamber; and every one must have observed, how soon his sheets became dry, after having been moistened by sweat, if he throws off part of the bed-clothes to cool himself; which is owing to the increased cutaneous absorption after the evacuation by previous sweat.
2. Now as opium is an universal stimulant, as explained in the article on Incitantia, it must stimulate into increased action both the secretory system, and the absorbent one; but after repeated evacuation by venesection, and cathartics, the absorbent system is already inclined to act more powerfully; as the blood-vessels being less distended, there is less resistance to the progress of the absorbed fluids into them. Hence after evacuations opium promotes absorption, if given in small doses, much more than it promotes secretion; and is thus eminently of service at the end of inflammations, as in pleurisy, or peripneumony, in the dose of four or five drops of the tincture, given before the access of the evening paroxysm; which I have seen succeed even when the risus sardonicus has existed. Some convulsions may originate in the want of the absorption of some acrid secretion, which occasions pain; hence these diseases are so much more certainly relieved by opium after venesection or other evacuations.
IX.1. Absorption is increased by the calces or solutions of mercury, lead, zinc, copper, iron, externally applied; and by arsenic, and by sulphur, and by the application of bitter vegetables in fine powder. Thus an ointment consisting of mercury and hog's fat rubbed on the skin cures venereal ulcers; and many kinds of herpetic eruptions are removed by an ointment consisting of 60 grains of white precipitate of mercury and an ounce of hog's fat.
2. The tumours about the necks of young people are often produced by the absorption of a saline or acrid material, which has been deposited from eruptions behind the ears, owing to deficient absorption in the surface of the ulcer, but which on running down on the skin below becomes absorbed, and swells the lymphatic glands of the neck; as the variolous matter, when inserted into the arm, swells the gland of the axilla. Sometimes the perspirative matter produced behind the ears becomes putrid from the want of daily washing them, and may also cause by its absorption the tumours of the lymphatics of the neck. In the former case the application of a cerate of lapis calaminaris, or of cerussa applied in dry powder, or of rags dipped in a solution of sugar of lead, increases the absorption in the ulcers, and prevents the effusion of the saline part of the secreted material. The latter is to be prevented by cleanliness.
After the eruptions or ulcers are healed a solution of corrosive sublimate of one grain to an ounce of water applied for some weeks behind the ear, and amongst the roots of the hair on one side of the head, where the mouths of the lymphatics of the neck open themselves, frequently removes these tumours.
3. Linen rags moistened with a solution of half an ounce of sugar of lead to a pint of water applied on the erysipelas on anasarcous legs, which have a tendency to mortification, is more efficacious than other applications. White vitriol six grains dissolved in one ounce of rose-water removes inflammations of the eyes after evacuation more certainly than solutions of lead. Blue vitriol two or three grains dissolved in an ounce of water cures ulcers in the mouth, and other mucous membranes, and a solution of arsenic externally applied cures the itch, but requires great caution in the use of it. See ClassII. 1. 5. 6.
4. Bitter vegetables, as the Peruvian bark, quilted between two shirts, or strewed in their beds, will cure the ague in children sometimes. Iron in solution, and some bitter extract, as in the form of ink, will cure one kind of herpes called the ringworm. And I have seen seven parts of bark in fine powder mixed with one part of ceruss, or white lead, in fine powder, applied dry to scrophulous ulcers, and renewed daily, with great advantage.
5. To these should be added electric sparks and shocks, which promote the absorption of the vessels in inflamed eyes of scrophulous children; and disperse, or bring to suppuration, scrophulous tumours about the neck. For this last purpose smart shocks should be passed through the tumours only, by inclosing them between two brass knobs communicating with the external and internal coating of a charged phial. See Art.II. 2. 2. 2.
X.1. Bandages increase absorption, if they are made to fit nicely on the part; for which purpose it is necessary to spread some moderately adhesive plaster on the bandage, and to cut it into tails, or into shreds two inches wide; the ends are to be wrapped over each other; and it must be applied when the part is least tumid, as in the morning before the patient rises, if on the lower extremities. The emplastrum de minio made to cover the whole of a swelled leg in this manner, whether the swelling is hard, which is usually termed scorbutic; or more easily compressible, as in anasarca, reduces the limb in two or three days to its natural size; for this purpose I have sometimes used carpenter's glue, mixed with one twentieth part of honey to prevent its becoming too hard, instead of a resinous plaster; but the minium plaster of the shops is in general to be preferred. Nothing so much facilitates the cure of ulcers in the legs, as covering the whole limb from the toes to the knee with such a plaster-bandage; which increases the power of absorption in the surface of the sore.
2. The lymph is carried along the absorbent vessels, which are replete with valves, by the intermitted pressure of the arteries in their neighbourhood. Now if the external skin of the limb be lax, it rises, and gives way to the pressure of the arteries at every pulsation; and thence the lymphatic vessels are subject to the pressure of but half the arterial force. But when the external skin is tightened by the surrounding bandage, and thence is not elevated by the arterial diastole, the whole of this power is exerted in compressing the lymphatic vessels, and carrying on the lymph already absorbed; and thence the absorbent power is so amazingly increased by bandage nicely applied. Pains are sometimes left in the fleshy parts of the thighs or arms, after the inflammation is gone, in the acute rheumatism, or after the patient is too weak for further evacuation; in this case after internal absorbent medicines, as the bark, and opiates, have been used in vain, I have successfully applied a plaster-bandage, as above described, so as to compress the pained part.
XI.1. We shall conclude by observing, that the sorbentia strengthen the whole habit by preventing the escape of the fluid part of the secretions out of the body, before it has given up as much nourishment, as it is capable; as the liquid part of the secretion of urine, sweat, saliva, and of all other secretions, which are poured into receptacles. Hence they have been said to brace the body, and been called tonics, which are mechanical terms not applicable to the living bodies of animals; as explained in Sect. XXXII. 3. 2.
2. A continued use of bitter medicines for years together, as of Portland's powder, or of the bark, is supposed to induce apoplexy, or other fatal diseases. Two cases of this kind have fallen under my observation; the patients were both rather intemperate in respect to the use of fermented liquors, and one of them had been previously subject to the gout. As I believe the gout generally originates from a torpor of the liver, which instead of being succeeded by an inflammation of it, is succeeded by an inflammation of some of the joints; or by a pimpled face, which is another mode, by which the disease of the liver is terminated. I conceive, that the daily use of bitter medicine had in these patients prevented the removal of a gouty inflammation from the liver to the membranes of the joints of the extremities, or to the skin of the face, by preventing the necessary torpor of these parts previous to the inflammation of them; in the same manner as cold fits of fever are prevented by the same medicines; and, as I believe, the returns of the gout have sometimes for two or three years been prevented by them.
One of these patients died of the apoplexy in a few hours; and the other of an inflammation of the liver, which I believe was called the gout, and in consequence was not treated by venesection, and other evacuations. From hence it appears, that the daily use of hop in our malt liquor must add to the noxious quality of the spirit in it, when taken to excess, and contribute to the production of apoplexy, or inflammation of the liver.
III.Catalogue of the Sorbentia.
I. Sorbentia affecting the skin.
1. Acid of vitriol, of sea-salt, lemons, sloes, prunus spinosa, crabs, pyrus, quince, pyrus cydonia, opium.2. Externally calx of zinc, of lead, of mercury.
1. Acid of vitriol, of sea-salt, lemons, sloes, prunus spinosa, crabs, pyrus, quince, pyrus cydonia, opium.
2. Externally calx of zinc, of lead, of mercury.
II. Sorbentia affecting the mucous membranes.
1. Juice of sloes, crabs, Peruvian bark, cinchona, opium.2. Externally blue vitriol.
1. Juice of sloes, crabs, Peruvian bark, cinchona, opium.
2. Externally blue vitriol.
III. Sorbentia affecting the cellular membrane.
1. Peruvian bark, wormwoods, artemisia maritima, artemisia absynthium, worm-seed, artemisia santonicum, chamomile, anthemis nobilis, tansey tanacetum, bogbean, menyanthes trifoliata, centaury, gentiana centaurium, gentian, gentiana lutea, artichoke-leaves, cynara scolymus, hop, humulus lupulus.2. Orange-peel, cinnamon, nutmeg, mace.3. Vomits, squill, digitalis, tobacco.4. Bath of warm air, of steam.
1. Peruvian bark, wormwoods, artemisia maritima, artemisia absynthium, worm-seed, artemisia santonicum, chamomile, anthemis nobilis, tansey tanacetum, bogbean, menyanthes trifoliata, centaury, gentiana centaurium, gentian, gentiana lutea, artichoke-leaves, cynara scolymus, hop, humulus lupulus.
2. Orange-peel, cinnamon, nutmeg, mace.
3. Vomits, squill, digitalis, tobacco.
4. Bath of warm air, of steam.
IV. Sorbentia affecting the veins.
1. Water-cress, sisymbrium nasturtium aquaticum, mustard, sinapis, scurvy-grass cochlearia hortensis, horse-radish cochlearia armoracia, cuckoo-flower, cardamine, dog's-grass, dandelion, leontodon taraxacon, cellery apium, cabbage brassica.2. Chalybeates, bitters, and opium, after sufficient evacuation.3. Externally vinegar, friction, electricity.
1. Water-cress, sisymbrium nasturtium aquaticum, mustard, sinapis, scurvy-grass cochlearia hortensis, horse-radish cochlearia armoracia, cuckoo-flower, cardamine, dog's-grass, dandelion, leontodon taraxacon, cellery apium, cabbage brassica.
2. Chalybeates, bitters, and opium, after sufficient evacuation.
3. Externally vinegar, friction, electricity.
V. Sorbentia affecting the intestines.
1. Rhubarb, rheum palmatum, oak-galls, gallæ quercinæ, tormentil, tormentilla erecta, cinquefoil potentilla, red-roses, uva ursi, simarouba.2. Logwood, hæmatoxylum campechianum, succus acaciæ, dragon's blood, terra japonica, mimosa catechu.3. Alum, earth of alum, Armenian bole, chalk, creta, crab's claws, chelæ cancrorum, white clay, cimolia, calcined hartshorn, cornu cervi calcinatum, bone-ashes.
1. Rhubarb, rheum palmatum, oak-galls, gallæ quercinæ, tormentil, tormentilla erecta, cinquefoil potentilla, red-roses, uva ursi, simarouba.
2. Logwood, hæmatoxylum campechianum, succus acaciæ, dragon's blood, terra japonica, mimosa catechu.
3. Alum, earth of alum, Armenian bole, chalk, creta, crab's claws, chelæ cancrorum, white clay, cimolia, calcined hartshorn, cornu cervi calcinatum, bone-ashes.
VI. Sorbentia affecting the liver, stomach, and other viscera. Rust of iron, filings of iron, salt of steel, sal martis, blue vitriol, white vitriol, calomel, emetic tartar, sugar of lead, white arsenic.
VII. Sorbentia affecting venereal ulcers. Mercury dissolved or corroded by the following acids:
1. Dissolved in vitriolic acid, called turpeth mineral, or hydrargyrus vitriolatus.2. Dissolved in nitrous acid, called hydrargyrus nitratus ruber.3. Dissolved in muriatic acid, mercurius corrosivus sublimatus, or hydrargyrus muriatus.4. Corroded by muriatic acid. Calomel.5. Precipitated from muriatic acid, mercurius precipitatus albus, calx hydrargyri alba.6. Corroded by carbonic acid? The black powder on crude mercury.7. Calcined, or united with oxygen.8. United with animal fat, mercurial ointment.9. United with sulphur. Cinnabar.10. Partially united with sulphur. Æthiops mineral.11. Divided by calcareous earth. Hydrargyrus cum cretâ.12. Divided by vegetable mucilage, by sugar, by balsams.
1. Dissolved in vitriolic acid, called turpeth mineral, or hydrargyrus vitriolatus.
2. Dissolved in nitrous acid, called hydrargyrus nitratus ruber.
3. Dissolved in muriatic acid, mercurius corrosivus sublimatus, or hydrargyrus muriatus.
4. Corroded by muriatic acid. Calomel.
5. Precipitated from muriatic acid, mercurius precipitatus albus, calx hydrargyri alba.
6. Corroded by carbonic acid? The black powder on crude mercury.
7. Calcined, or united with oxygen.
8. United with animal fat, mercurial ointment.
9. United with sulphur. Cinnabar.
10. Partially united with sulphur. Æthiops mineral.
11. Divided by calcareous earth. Hydrargyrus cum cretâ.
12. Divided by vegetable mucilage, by sugar, by balsams.
VIII. Sorbentia affecting the whole system. Evacuations by venesection and catharsis, and then by the exhibition of opium.
IX. Sorbentia externally applied.
1. Solutions of mercury, lead, zinc, copper, iron, arsenic; or metallic calces applied in dry powder, as cerussa, lapis calaminaris.2. Bitter vegetables in decoctions and in dry powders, applied externally, as Peruvian bark, oak bark, leaves of wormwood, of tansey, camomile flowers or leaves.3. Electric sparks, or shocks.
1. Solutions of mercury, lead, zinc, copper, iron, arsenic; or metallic calces applied in dry powder, as cerussa, lapis calaminaris.
2. Bitter vegetables in decoctions and in dry powders, applied externally, as Peruvian bark, oak bark, leaves of wormwood, of tansey, camomile flowers or leaves.
3. Electric sparks, or shocks.
X. Bandage spread with emplastrum e minio, or with carpenter's glue mixed with one twentieth part of honey.
XI. Portland's powder its continued use pernicious, and of hops in beer.
I. Those things, which invert the natural order of the successive irritative motions, are termed invertentia.
1. Emetics invert the motions of the stomach, duodenum, and œsophagus.
2. Violent cathartics invert the motions of the lacteals, and intestinal lymphatics.
3. Violent errhines invert the nasal lymphatics, and those of the frontal and maxillary sinuses. And medicines producing nausea, invert the motions of the lymphatics about the sauces.
4. Medicines producing much pale urine, as a certain quantity of alcohol, invert the motions of the urinary absorbents; if the dose of alcohol is greater, it inverts the stomach, producing the drunken sickness.
5. Medicines producing cold sweats, palpitation of the heart, globus hystericus; as violent evacuations, some poisons, fear, anxiety, act by inverting the natural order of the vascular motions.
II.Observations on the Invertentia.
I.1. The action of vomiting seems originally to have been occasioned by disagreeable sensation from the distention or acrimony of the aliment; in the same manner as when any disgustful material is taken into the mouth, as a bitter drug, and is rejected by the retrograde motions of the tongue and lips; as explained in ClassIV. 1. 1. 2. and mentioned in Sect. XXXV. 1. 3. Or the disagreeable sensation may thus excite the power of volition, which may also contribute to the retrograde actions of the stomach and œsophagus, as when cows bring up the contents of their first stomach to re-masticate it. To either of these is to be attributed the action of mild emetics, which soon cease to operate, and leave the stomach stronger, or more irritable, after their operation; owing to the accumulation of the sensorial power of irritation during its torpid or inverted action. Such appears to be the operation of ipecacuanha, or of antimonium tartarizatum, in small doses.
2. But there is reason to believe, that the stronger emetics, as digitalis, first stimulate the absorbent vessels of the stomach into greater action; and that the inverted motions of these absorbents next occur, pouring the lymph, lately taken up, or obtained from other lymphatic branches, into the stomach: the quantity of which in some diseases, as in the cholera morbus, is inconceivable. This inverted motion, first of the absorbents of the stomach, and afterwards of the stomach itself, seems to originate from the exhaustion or debility, which succeeds the unnatural degree of action, into which they had been previously stimulated. An unusual defect of stimulus, as of food without spice or wine in the stomachs of those, who have been much accustomed to spice or wine, will induce sickness or vomiting; in this case the defective energy of the stomach is owing to defect of accustomed stimulus; while the action of vomiting from digitalis is owing to a deficiency of sensorial power, which is previously exhausted by the excess of its stimulus. See Sect. XXXV. 1. 3. and ClassIV. 1. 1. 2.
For first, no increase of heat arises from this action of vomiting; which always occurs, when the secerning system is stimulated into action. Secondly, the motions of the absorbent vessels are as liable to inversion as the stomach itself; which last, with the œsophagus, may be considered as the absorbent mouth and belly of that great gland, the intestinal canal. Thirdly, the class of sorbentia, as bitters and metallic salts, given in large doses, become invertentia, and vomit, or purge. And lastly, the sickness and vomiting induced by large potations of wine, or opium, does not occur till next day in some people, in none till some time after their ingurgitation. And tincture of digitalis in the dose of 30 or 60 drops, though applied in solution, is a considerable time before it produces its effect; though vomiting is instantaneously induced by a nauseous idea, or a nauseous taste in the mouth. At the same time there seem to be some materials, which can immediately stimulate the stomach into such powerful action, as to be immediately succeeded by paralysis of it, and consequent continued fever, or immediate death; and this without exciting sensation, that is, without our perceiving it. Of these are the contagious matter of some fevers swallowed with the saliva, and probably a few grains of arsenic taken in solution. See Suppl. I.8. 8. Art.IV. 2. 6. 9.
3. Some branches of the lymphatic system become inverted by their sympathy with other branches, which are only stimulated into too violent absorption. Thus when the stomach and duodenum are much stimulated by alcohol, by nitre, or by worms, in some persons the urinary lymphatics have their motion inverted, and pour that material into the bladder, which is absorbed from the intestines. Hence the drunken diabetes is produced; and hence chyle is seen in the urine in worm cases.
When on the contrary some branches of the absorbent systems have their motions inverted in consequence of the previous exhaustion of their sensorial power by any violent stimulus, other branches of it have their absorbent power greatly increased. Hence continued vomiting, or violent cathartics, produce great absorption from the cellular membrane in cases of dropsy; and the fluids thus absorbed are poured into the stomach and intestines by the inverted motions of the lacteals and lymphatics. See Sect. XXIX. 4. and 5.
4. The quantity of the dose of an emetic is not of so great consequence as of other medicines, as the greatest part of it is rejected with the first effort. All emetics are said to act with greater certainty when given in a morning, if an opiate had been given the night before. For the sensorial power of irritation of the stomach had thus been in some measure previously exhausted by the stimulus of the opium, which thus facilitates the action of the emetic; and which, when the dose of opium has been large, is frequently followed on the next day by spontaneous sickness and vomitings, as after violent intoxication.
Ipecacuanha is the most certain in its effect from five grains to thirty; white vitriol is the most expeditious in its effect, from twenty grains to thirty dissolved in warm water; but emetic tartar, antimonium tartarizatum, from one grain to four to sane people, and from thence to twenty to insane patients, will answer most of the useful purposes of emetics; but nothing equals the digitalis purpurea for the purpose of absorbing water from the cellular membrane in the anasarca pulmonum, or hydrops pectoris. See Art.IV. 2. 3. 7.
II. Violent cathartics.1. Where violent cathartics are required, as in dropsies, the squill in dried powder made into small pills of a grain, or a grain and a half, one to be given every hour till they operate briskly, is very efficacious; or half a grain of emetic tartar dissolved in an ounce of peppermint-water, and given every hour, till it operates. Scammony, and other strong purges, are liable to produce hypercatharsis, if they are not nicely prepared, and accurately weighed, and are thence dangerous in common practice. Gamboge is uncertain in its effects, it has otherwise the good property of being tasteless; and on that account some preparation of it might be useful for children, by which its dose could be ascertained, and its effects rendered more uniform.
2. In inflammations of the bowels with constipation calomel, given in the dose from ten to twenty grains after due venesection, is most efficacious; and if made into very small pills is not liable to be rejected by vomiting, which generally attends those cases. When this fails, a grain of aloes every hour will find its way, if the bowel is not destroyed; and sometimes, I believe, if it be, when the mortification is not extensive. If the vomiting continues after the pain ceases, and especially if the bowels become tumid with air, which sounds on being struck with the finger, these patients seldom recover. Opiates given along with the cathartics I believe to be frequently injurious in inflammation of the bowels, though they may thus be given with advantage in the saturnine colic; the pain and constipation in which disease are owing to torpor or inactivity, and not to too great action.
III. Violent errhines and sialagogues.1. Turpeth mineral in the quantity of one grain mixed with ten grains of sugar answers every purpose to be expected from errhines. Their operation is by inverting the motions of the lymphatics of the membrane, which lines the nostrils, and the caverns of the forehead and cheeks; and may thence possibly be of service in the hydrocephalus internus.
Some other violent errhines, as the powder of white hellebore, or Cayan pepper, diluted with some less acrid powder, are said to cure some cold or nervous head-achs; which may be effected by inflaming the nostrils, and thus introducing the sensorial power of sensation, as well as increasing that of irritation; and thus to produce violent action of the membranes of the nostrils, and of the frontal and maxillary sinuses, which may by association excite into action the torpid membranes, which occasion the head-ach.
2. A copious salivation without any increase of heat often attends hysteric diseases, and fevers with debility, owing to an inversion of the lymphatics of the mouth, see ClassI. 1. 2. 6. The same occurs in the nausea, which precedes vomiting; and is also excitable by disagreeable tastes, as by squills, or by nauseous smells, or by nauseous ideas. These are very similar to the occasional discharge of a thin fluid from the nostrils of some people, which recurs at certain periods, and differs from defective absorption.
IV. Violent diuretics.1. If nitre be given from a dram to half an ounce in a morning at repeated draughts, the patient becomes sickish, and much pale water is thrown into the bladder by the inverted action of the urinary lymphatics. Hence the absorption in ulcers is increased and the cure forwarded, as observed by Dr. Rowley.
2. Cantharides taken inwardly so stimulate the neck of the bladder as to increase the discharge of mucus, which appears in the urine; but I once saw a large dose taken by mistake, not less than half an ounce or an ounce of the tincture, by which I suppose the urinary lymphatics were thrown into violent inverted motions, for the patient drank repeated draughts of subtepid water to the quantity of a gallon or two in a few hours; and during the greatest part of that time he was not I believe two entire minutes together without making water. A little blood was seen in his water the next day, and a soreness continued a day longer without any other inconvenience.
3. The decoction of foxglove should also be mentioned here, as great effusions of urine frequently follow its exhibition. See Art.IV. 2. 3. 7. And an infusion or tincture of tobacco as recommended by Dr. Fowler of York.
4. Alcohol, and opium, if taken so as to induce slight intoxication, and the body be kept cool, and much diluting liquids taken along with them, have similar effect in producing for a time a greater flow of urine, as most intemperate drinkers must occasionally have observed. This circumstance seems to have introduced the use of gin, and other vinous spirits as a diuretic, unfortunately in the gravel, amongst ignorant people; which disease is generally produced by fermented or spirituous liquors, and always increased by them.
5. Fear and anxiety are well known to produce a great frequency of making water. A person, who believed he had made a bad purchase concerning an estate, told me, that he made five or six pints of water during a sleepless night, which succeeded his bargain; and it is usual, where young men are waiting in an anti-room to be examined for college preferment, to see the chamber-pot often wanted.
V. Cold sweats about the head, neck, and arms, frequently attend those, whose lungs are oppressed, as in some dropsies and asthma. A cold sweat is also frequently the harbinger of death. These are from the inverted motions of the cutaneous lymphatic branches of those parts.
III.Catalogue of Invertentia.
I. Emetics, ipecacuanha, emetic tartar, antimonium tartarisatum, squill, scilla maritima, carduus benedictus, cnicus acarna, chamœmile, anthemis nobilis, white vitriol, vitriolum zinci, foxglove, digitalis purpurea, clysters of tobacco.
II. Violent cathartics, emetic tartar, squill, buckthorn, rhamnus catharticus, scammonium, convolvulus scammonia, gamboge, elaterium, colocynth, cucumis colocynthis, veratrum.
III. Violent errhines and sialagogues, Turpeth mineral,hydrargyrusvitriolatus, asarum europæum, euphorbium, capsicum, veratrum, nauseous smells, nauseous ideas.
IV. Violent diuretics, nitre, squill, seneka, cantharides, alcohol, foxglove, tobacco, anxiety.
V. Cold sudorifics, poisons, fear, approaching death.
I. Those things, which restore the natural order of the inverted irritative motions, are termed Revertentia.
1. As musk, castor, asafœtida, valerian, essential oils.
2. Externally the vapour of burnt feathers, of volatile salts, or oils, blisters, sinapisms.
These reclaim the inverted motions without increasing the heat of the body above its natural state, if given in their proper doses, as in the globus hystericus, and palpitation of the heart.
The incitantia revert these morbid motions more certainly, as opium and alcohol; and restore the natural heat more; but if they induce any degree of intoxication, they are succeeded by debility, when their stimulus ceases.
II.Observations on the Revertentia.
I. The hysteric disease is attended with inverted motions feebly exerted of the œsophagus, intestinal canal and lymphatics of the bladder. Hence the borborigmi, or rumbling of the bowels, owing to their fluid contents descending as the air beneath ascends. The globus hystericus consists in the retrograde motion of the œsophagus, and the great flow of urine from that of the lymphatics spread on the neck of the bladder; and a copious salivation sometimes happens to these patients from the inversion of the lymphatics of the mouth; and palpitation of the heart owing to weak or incipient inversion of its motions; and syncope, when this occurs in its greatest degree.
These hysteric affections are not necessarily attended with pain; though it sometimes happens, that pains, which originate from quiescence, afflict these patients, as the hemicrania, which has erroneously been termed the clavus hystericus; but which is owing solely to the inaction of the membranes of that part, like the pains attending the cold fits of intermittents, and which frequently returns like them at very regular periods of time.
Many of the above symptoms are relieved by musk, castor, the fœtid gums, valerian, oleum animale, oil of amber, which act in the usual dose without heating the body. The pains, which sometimes attend these constitutions, are relieved by the secernentia, as essential oils in common tooth-ach, and balsam of Peru in the flatulent colic. But the incitantia, as opium, or vinous spirit, reclaim these morbid inverted motions with more certainty, than the fœtids; and remove the pains, which attend these constitutions, with more certainty than the secernentia; but if given in large doses, a debility and return of the hysteric symptoms occurs, when the effect of the opium or alcohol ceases. Opiates and fœtids joined seem best to answer the purpose of alleviating the present symptoms; and the sorbentia, by stimulating the lymphatics and lacteals into continued action, prevent a relapse of their inversion, as Peruvian bark, and rust of iron. See ClassI. 3. 1. 10.
II. Vomiting consists in the inverted order of the motions of the stomach, and œsophagus; and is also attended with the inverted motions of a part of the duodenum, when bile is ejected; and of the lymphatics of the stomach and fauces, when nausea attends, and when much lymph is evacuated. Permanent vomiting is for a time relieved by the incitantia, as opium or alcohol; but is liable to return, when their action ceases. A blister on the back, or on the stomach, is more efficacious for restraining vomiting by their stimulating into action the external skin, and by sympathy affecting the membranes of the stomach. In some fevers attended with incessant vomiting Sydenham advised the patient to put his head under the bed-clothes, till a sweat appeared on the skin, as explained in ClassIV. 1. 1. 2.
In chronical vomiting I have observed crude mercury of good effect in the dose of half an ounce twice a day. The vomitings, or vain efforts to vomit, which sometimes attend hysteric or epileptic patients, are frequently instantly relieved for a time by applying flour of mustard-seed and water to the small of the leg; and removing it, as soon as the pain becomes considerable. If sinapisms lie on too long, especially in paralytic cases, they are liable to produce troublesome ulcers. A plaster or cataplasm, with opium and camphor on the region of the stomach, will sometimes revert its retrograde motions.
III. Violent catharsis, as in diarrhœa or dysentery, is attended with inverted motions of the lymphatics of the intestines, and is generally owing to some stimulating material. This is counteracted by plenty of mucilaginous liquids, as solutions of gum arabic, or small chicken broth, to wash away or dilute the stimulating material, which causes the disease. And then by the use of the intestinal sorbentia, Art.IV. 2. 5. as rhubarb, decoction of logwood, calcined hartshorn, Armenian bole; and lastly, by the incitantia, as opium.
IV. Thediabætesconsists in the inverted motions of the urinary lymphatics, which is generally I suppose owing to the too great action of some other branch of the absorbent system. The urinary branch should be stimulated by cantharides, turpentine, resin (which when taken in larger doses may possibly excite it into inverted action), by the sorbentia and opium. The intestinal lymphatics should be rendered less active by torpentia, as calcareous earth, earth of alum; and those of the skin by oil externally applied over the whole body; and by the warm-bath, which should be of 96 or 98 degrees of heat, and the patient should sit in it every day for half an hour.
V. Inverted motions of the intestinal canal with all the lymphatics, which open into it, constitute the ileus, or iliac passion; in which disease it sometimes happens, that clysters are returned by the mouth. After venesection from ten grains to twenty of calomel made into very small pills; if this is rejected, a grain of aloe every hour; a blister; crude mercury; warm-bath; if a clyster of iced water?
Many other inverted motions of different parts of the system are described in ClassI. 3. and which are to be treated in a manner similar to those above described. It must be noted, that the medicines mentioned under number one in the catalogue of revertentia are the true articles belonging to this class of medicines. Those enumerated in the other four divisions are chiefly such things as tend to remove the stimulating causes, which have induced the inversion of the motions of the part, as acrimonious contents, or inflammation, of the bowels in diarrhœa, diabetes, or in ileus. But it is probable after these remote causes are destroyed, that the fetid gums, musk, castor, and balsams, might be given with advantage in all these cases.
III.Catalogue of Revertentia.
I. Inverted motions, which attend the hysteric disease, are reclaimed,1. By musk, castor.2. By asafœtida, galbanum, sagapænum, ammoniacum, valerian.3. Essential oils of cinnamon, nutmeg, cloves, infusion of penny-royal, mentha, pulegium, peppermint, mentha piperita, ether, camphor.4. Spirit of hartshorn, oleum animale, spunge burnt to charcoal, black-snuffs of candles, which consist principally of animal charcoal, wood-soot, oil of amber.5. The incitantia, as opium, alcohol, vinegar.6. Externally the smoke of burnt feathers, oil of amber, volatile salt applied to the nostrils, blisters, sinapisms.
II. Inverted motions of the stomach are reclaimed by opium, alcohol, blisters, crude mercury, sinapisms, camphor and opium externally, clysters with asafœtida.
III. Inverted motions of the intestinal lymphatics are reclaimed by mucilaginous diluents, and by intestinal sorbentia, as rhubarb, logwood, calcined hartshorn, Armenian bole; and lastly by incitantia, as opium.
IV. Inverted motions of the urinary lymphatics are reclaimed by cantharides, turpentine, rosin, the sorbentia, and opium, with calcareous earth, and earth of alum, by oil externally, warm-bath.
V. Inverted motions of the intestinal canal are reclaimed by calomel, aloe, crude mercury, blisters, warm-bath, clysters with asafœtida, clysters of iced water? or of spring water further cooled by salt dissolved in water contained in an exterior vessel? Where there exists an introsusception of the bowel in children, could the patient be held up for a time by the feet with his head downwards, or be laid with his body on an inclined plane with his head downwards, and crude mercury be injected as a clyster to the quantity of two or three pounds?
I. Those things, which diminish the exertion of the irritative motions, are termed torpentia.
1. As mucus, mucilage, water, bland oils, and whatever possesses less stimulus than our usual food. Diminution of heat, light, sound, oxygen, and of all other stimuli; venesection, nausea, and anxiety.
2. Those things which chemically destroy acrimony, as calcareous earth, soap, tin, alcalies, in cardialgia; or which prevent chemical acrimony, as acid of vitriol in cardialgia, which prevents the fermentation of the aliment in the stomach, and its consequent acidity. Secondly, which destroy worms, as calomel, iron filings or rust of iron, in the round worms; or amalgama of quicksilver and tin, or tin in very large doses, in the tape-worms. Will ether in clysters destroy ascarides? Thirdly, by chemically destroying extraneous bodies, as caustic alcali, lime, mild alcali in the stone. Fourthly, those things which lubricate the vessels, along which extraneous bodies slide, as oil in the stone in the urethra, and to expedite the expectoration of hardened mucus; or which lessen the friction of the contents in the intestinal canal in dysentery or aphtha, as calcined hartshorn, clay, Armenian bole, chalk, bone-ashes. Fifthly, such things as soften or extend the cuticle over tumors, or phlegmons, as warm water, poultices, fomentations, or by confining the perspirable matter on the part by cabbage-leaves, oil, fat, bee's-wax, plasters, oiled silk, externally applied.
These decrease the natural heat and remove pains occasioned by excess of irritative motions.
II.Observations on the Torpentia.
I. As the torpentia consist of such materials as are less stimulating than our usual diet, it is evident, that where this class of medicines is used, some regard must be had to the usual manner of living of the patient both in respect to quantity and quality. Hence wounds in those, who have been accustomed to the use of much wine, are very liable to mortify, unless the usual potation of wine be allowed the patient. And in these habits I have seen a delirium in a fever cured almost immediately by wine; which was occasioned by the too mild regimen directed by the attendants. On the contrary in great inflammation, the subduction of food, and of spirituous drink, contributes much to the cure of the disease. As by these means both the stimulus from distention of the vessels, as well as that from the acrimony of the fluids, is decreased; but in both these respects the previous habits of diet of the patients must be attended to. Thus if tea be made stronger, than the patient has usually drank it, it belongs to the article sorbentia; if weaker, it belongs to the torpentia.
II.Water in a quantity greater than usual diminishes the action of the system not only by diluting our fluids, and thence lessening their stimulus, but by lubricating the solids; for not only the parts of our solids have their sliding over each other facilitated by the interposition of aqueous particles; but the particles of mucaginous or saccharine solutions slide easier over each other by being mixed with a greater portion of water, and thence stimulate the vessels less.
At the same time it must be observed, that the particles of water themselves, and of animal gluten dissolved in water, as the glue used by carpenters, slide easier over each other by an additional quantity of the fluid matter of heat.
These two fluids of heat and of water may be esteemed the universal solvents or lubricants in respect to animal bodies, and thus facilitate the circulation, and the secretion of the various glands. At the same time it is possible, that these two fluids may occasionally assume an aerial form, as in the cavity of the chest, and by compressing the lungs may cause one kind of asthma, which is relieved by breathing colder air. An increased quantity of heat by adding stimulus to every part of the system belongs to the article Incitantia.
III.1.The application of cold to the skin, which is only another expression for the diminution of the degree of heat we are accustomed to, benumbs the cutaneous absorbents into inaction; and by sympathy the urinary and intestinal absorbents become also quiescent. The secerning vessels continuing their action somewhat longer, from the warmth of the blood. Hence the usual secretions are poured into the bladder and intestines, and no absorption is retaken from them. Hence sprinkling the skin with cold water increases the quantity of urine, which is pale; and of stool, which is fluid; these have erroneously been ascribed to increased secretion, or to obstructed perspiration.
The thin discharge from the nostrils of some people in cold weather is owing to the torpid state of the absorbent vessels of the membrana sneideriana, which as above are benumbed sooner than those, which perform the secretion of the mucus.
The quick anhelation, and palpitation of the heart, of those, who are immersed in cold water, depends on the quiescence of the external absorbent vessels and capillaries. Hence the cutaneous circulation is diminished, and by association an almost universal torpor of the system is induced; thence the heart becomes incapable to push forwards its blood through all the inactive capillaries and glands; and as the terminating vessels of the pulmonary artery suffer a similar inaction by association, the blood is with difficulty pushed through the lungs.
Some have imagined, that a spasmodic constriction of the smaller vessels took place, and have thus accounted for their resistance to the force of the heart. But there seems no necessity to introduce this imaginary spasm; since those, who are conversant in injecting bodies, find it necessary first to put them into warm water to take away the stiffness of the cold dead vessels; which become inflexible like the other muscles of dead animals, and prevent the injected fluid from passing.
All the same symptoms occur in the cold fits of intermittents; in these the coldness and paleness of the skin with thirst evince the diminution of cutaneous absorption; and the dryness of ulcers, and small secretion of urine, evince the torpor of the secerning system; and the anhelation, and coldness of the breath, shew the terminations of the pulmonary artery to be likewise affected with torpor.
After these vessels of the whole surface of the body both absorbent and secretory have been for a time torpid by the application of cold water; and all the internal secerning and absorbent ones have been made torpid from their association with the external; as soon as their usual stimulus of warmth is renewed, they are thrown into more than their usual energy of action; as the hands become hot and painful on approaching the fire after having been immersed some time in snow. Hence the face becomes of a red colour in a cold day on turning from the wind, and the insensible perspiration increased by repeatedly going into frosty air, but not continuing in it too long at a time.
2. When by the too great warmth of a room or of clothes, the secretion of perspirable matter is much increased, the strength of the patient is much exhausted by this unnecessary exertion of the capillary system, and thence of the whole secerning and arterial system by association. The diminution of external heat immediately induces a torpor or quiescence of these unnecessary exertions, and the patient instantly feels himself strengthened, and exhilarated; the animal power, which was thus wasted in vain, being now applied to more useful purposes. Thus when the limbs on one side are disabled by a stroke of the palsy, those of the other side are perpetually in motion. And hence all people bear riding and other exercises best in cold weather.
Patients in fevers, where the skin is hot, are immediately strengthened by cold air; which is therefore of great use in fevers attended with debility and heat; but may perhaps be of temporary disservice, if too hastily applied in some situations of fevers attended with internal topical inflammation, as in peripneumony or pleurisy, where the arterial strength is too great already, and the increased action of the external capillaries being destroyed by the cold, the action of the internal inflamed part may be suddenly increased, unless venesection and other evacuations are applied at the same time. Yet in most cases the application of cold is nevertheless salutary, as by decreasing the heat of the particles of blood in the cutaneous vessels, the stimulus of them, and the distention of the vessels becomes considerably lessened. In external inflammations, as the small-pox, and perhaps the gout and rheumatism, the application of cold air must be of great service by decreasing the action of the inflamed skin, though the contrary is too frequently the practice in those diseases. It must be observed, that for all these purposes the application of it should be continued a long time, otherwise an increased exertion follows the temporary torpor, before the disease is destroyed.
3. After immersion in cold water or in cold air the whole system becomes more exciteable by the natural degree of stimulus, as appears from the subsequent glow on the skin of people otherwise pale; and even by a degree of stimulus less than natural, as appears by their becoming warm in a short time during their continuance in a bath, of about 80 degrees of heat, as in Buxton bath. See Sect XII. 2. 1. XXXII. 3. 3.
This increased exertion happens to the absorbent vessels more particularly, as they are first and most affected by these temporary diminutions of heat; and hence like the medicines, which promote absorption, the cold-bath contributes to strengthen the constitution, that is to increase its irritability; for the diseases attended with weakness, as nervous fevers and hysteric diseases, are shewn in Section XXXII. 2. 1. to proceed from a want of irritability, not from an excess of it. Hence the digestion is greater in frosty weather, and the quantity of perspiration. For these purposes the application of cold must not be continued too long. For in riding a journey in cold weather, when the feet are long kept too cold, the digestion is impaired, and cardialgia produced.
4. If the diminution of external heat be too great, produced too hastily, or continued too long, the torpor of the system either becomes so great, that the animal ceases to live; or so great an energy of motion or orgasm of the vessels succeeds, as to produce fever or inflammation. This most frequently happens after the body has been temporarily heated by exercise, warm rooms, anger, or intemperance. Hence colds are produced in the external air by resting after exercise, or by drinking cold water. See ClassI. 2. 2. 1.
Frequent cold immersions harden or invigorate the constitution, which they effect by habituating the body to bear a diminution of heat on its surface without being thrown into such extensive torpor or quiescence by the consent of the vessels of the skin with the pulmonary and glandular system; as those experience, who frequently use the cold-bath. At first they have great anhelation and palpitation of heart at their ingress into cold water; but by the habit of a few weeks they are able to bear this diminution of heat with little or no inconvenience; for the power of volition has some influence over the muscles subservient to respiration, and by its counter efforts gradually prevents the quick breathing, and diminishes the associations of the pulmonary vessels with the cutaneous ones. And thus though the same quantity of heat is subducted from the skin, yet the torpor of the pulmonary vessels and internal glands does not follow. Hence during cold immersion less sensorial power is accumulated, and in consequence, less exertion of it succeeds on emerging from the bath. Whence such people are esteemed hardy, and bear the common variations of atmospheric temperature without inconvenience. See Sect. XXXII. 3. 2.
IV. Venesection has a just title to be classed amongst the torpentia in cases of fever with arterial strength, known by the fulness and hardness of the pulse. In these cases the heat becomes less by its use, and all exuberant secretions, as of bile or sweat, are diminished, and room is made in the blood-vessels for the absorption of mild fluids; and hence the absorption also of new vessels, or extravasated fluids, the produce of inflammation, is promoted. Hence venesection is properly classed amongst the sorbentia, as like other evacuations it promotes general absorption, restrains hæmorrhages, and cures those pains, which originate from the too great action of the secerning vessels, or from the torpor of the absorbents. I have more than once been witness to the sudden removal of nervous head-achs by venesection, though the patient was already exhausted, pale, and feeble; and to its great use in convulsions and madness, whether the patient was strong or weak; which diseases are the consequence of nervous pains; and to its stopping long debilitating hæmorrhages from the uterus, when other means had been in vain essayed. In inflammatory pains, and inflammatory hæmorrhages, every one justly applies to it, as the certain and only cure.
V. When the circulation is carried on too violently, as in inflammatory fevers, those medicines, which invert the motions of some parts of the system, retard the motions of some other parts, which are associated with them. Hence small doses of emetic tartar, and ipecacuanha, and large doses of nitre, by producing nausea debilitate and lessen the energy of the circulation, and are thence useful in inflammatory diseases. It must be added, that if nitre be swallowed in powder, or soon after it is dissolved, it contributes to lessen the circulation by the cold it generates, like ice-water, or the external application of cold air.
VI. The respiration of air mixed with a greater proportion of azote than is found in the common atmosphere, or of air mixed with hydrogen, or with carbonic acid gas, so that the quantity of oxygen might be less than usual, would probably act in cases of inflammation with great advantage. In consumptions this might be most conveniently and effectually applied, if a phthisical patient could reside day and night in a porter or ale brewery, where great quantities of those liquors were perpetually fermenting in vats or open barrels; or in some great manufactory of wines from raisins or from sugar.
Externally the application of carbonic acid gas to cancers and other ulcers instead of atmospheric air may prevent their enlargement, by preventing the union of oxygen with matter, and thus producing a new contagious animal acid.
III.Catalogue of Torpentia.
1. Venesection. Arteriotomy.
2. Cold water, cold air, respiration of air with less oxygen.
3. Vegetable mucilages.
a.Seeds.—Barley, oats, rice, young peas, flax, cucumber, melon, &c.b.Gums.—Arabic, Tragacanth, Senegal, of cherry-trees.c.Roots.—Turnip, potatoe, althea, orchis, snow-drop.d.Herbs.—Spinach, brocoli, mercury.
a.Seeds.—Barley, oats, rice, young peas, flax, cucumber, melon, &c.
b.Gums.—Arabic, Tragacanth, Senegal, of cherry-trees.
c.Roots.—Turnip, potatoe, althea, orchis, snow-drop.
d.Herbs.—Spinach, brocoli, mercury.
4. Vegetable acids, lemon, orange, currants, gooseberries, apples, grape, &c. &c.
5. Animal mucus, hartshorn jelly, veal broth, chicken water, oil? fat? cream?
6. Mineral acids, of vitriol, nitre, sea-salt.
7. Silence, darkness.
8. Invertentia in small doses, nitre, emetic tartar, ipecacuanha given so as to induce nausea.
9. Antacids.—Soap, tin, alcalies, earths.
10. Medicines preventative of fermentation, acid of vitriol.
11. Anthelmintics.—Indian pink, tin, iron, cowhage, amalgama, smoak of tobacco.
12. Lithonthriptics, lixiv. saponarium, aqua calcis, fixable air.
13. Externally, warm bath, and poultices, oil, fat, wax, plasters, oiled silk, carbonic acid gas on cancers, and other ulcers.
Page 625, line 1, after 'number' please to add, 'except when the patient has naturally a pulse slower than usual in his healthy state.'
Page 197, after line 8, please to add, 'Where the difficulty of breathing is very urgent in the croup, bronchotomy is recommended by Mr. Field.' Memoir of a Medical Society, London, 1773, Vol. IV.