Device for applying electric shocks to a tumour.
Miss ——, a young lady about eight years of age, had a swelling about the size of a pigeon's egg on her neck a little below her ear, which long continued in an indolent state. Thirty or forty small electric shocks were passed through it once or twice a day for two or three weeks, and it then suppurated and healed without difficulty. For this operation the coated jar of the electric machine had on its top an electrometer, which measured the shocks by the approach of a brass knob, which communicated with the external coating to another, which communicated with the internal one, and their distance was adjusted by a screw. So that the shocks were so small as not to alarm the child, and the accumulated electricity was frequently discharged, as the wheel continued turning. The tumour was inclosed between two other brass knobs, which were fixed on wires, which passed through glass tubes, the tubes were cemented in two grooves on a board, so that at one end they were nearer each other than at the other, and the knobs were pushed out so far as exactly to include the tumour, as described in the annexed plate, which is about half the size of the original apparatus.
Inflammations of the eyes without fever are frequently cured by taking a stream of very small electric sparks from them, or giving the electric sparks to them, once or twice a day for a week or two; that is, the new vessels, which constitute inflammation in these inirritable constitutions, are absorbed by the activity of the absorbents induced by the stimulus of the electric aura. For this operation the easiest method is to fix a pointed wire to a stick of sealing wax, or to an insulating handle of glass, one end of this wire communicates with the prime conductor, and the point is approached near the inflamed eye in every direction.
III. Externally the application of ether, and of essential oils, as of cloves or cinnamon, seem to possess a general stimulating effect. As they instantly relieve tooth-ach, and hiccough, when these pains are not in violent degree; and camphor in large doses is said to produce intoxication; this effect however I have not been witness to, and have reason to doubt.
The manner in which ether and the essential oil operate on the system when applied externally, is a curious question, as pain is so immediately relieved by them, that they must seem to penetrate by the great fluidity or expansive property of a part of them, as of their odoriferous exhalation or vapour, and that they thus stimulate the torpid part, and not by their being taken up by the absorbent vessels, and carried thither by the long course of circulation; nor is it probable, that these pains are relieved by the sympathy of the torpid membrane with the external skin, which is thus stimulated into action; as it does not succeed, unless it is applied over the pained part. Thus there appears to be three different modes by which extraneous bodies may be introduced into the system, besides that of absorption. 1st. By ethereal transition, as heat and electricity; 2d. by chemical attraction, as oxygen; and 3d. by expansive vapour, as ether and essential oils.
IV. The perpetual necessity of the mixture of oxygen gas with the blood in the lungs evinces, that it must act as a stimulus to the sanguiferous system, as the motions of the heart and arteries presently cease, when animals are immersed in airs which possess no oxygen. It may also subsequently answer another important purpose, as it probably affords the material for the production of the sensorial power; which is supposed to be secreted in the brain or medullary part of the nerves; and that the perpetual demand of this fluid in respiration is occasioned by the sensorial power, which is supposed to be produced from it, being too subtle to be long confined in any part of the system.
Another proof of the stimulant quality of oxygen appears from the increased acrimony, which the matter of a common abscess possesses, after it has been exposed to the air of the atmosphere, but not before; and probably all other contagious matters owe their fever-producing property to having been converted into acids by their union with oxygen.
As oxygen penetrates the fine moist membranes of the air-vessels of the lungs, and unites with the blood by a chemical attraction, as is seen to happen, when blood is drawn into a bason, the lower surface of the crassamentum is of a very dark red so long as it is covered from the air by the upper surface, but becomes florid in a short time on its being exposed to the atmosphere; the manner of its introduction into the system is not probably by animal absorption but by chemical attraction, in which circumstance it differs from the fluids before mentioned both of heat and electricity, and of ether and essential oils.
As oxygen has the property of passing through moist animal membranes, as first discovered by the great Dr. Priestley, it is probable it might be of use in vibices, and petechiæ in fevers, and in other bruises; if the skin over those parts was kept moist by warm water, and covered with oxygen gas by means of an inverted glass, or even by exposing the parts thus moistened to the atmosphere, as the dark coloured extravasated blood might thus become florid, and by its increase of stimulus facilitate its reabsorption.
Two weak patients, to whom I gave oxygen gas in as pure a state as it can easily be procured from Exeter manganese, and in the quantity of about four gallons a day, seemed to feel refreshed, and stronger, and to look better immediately after respiring it, and gained strength in a short time. Two others, one of whom laboured under confirmed hydrothorax, and the other under a permanent and uniform difficulty of respiration, were not refreshed, or in any way served by the use of oxygen in the above quantity of four gallons a day for a fortnight, which I ascribed to the inirritability of the diseased lungs. For other cases the reader is referred to the publications of Dr. Beddoes; Confederations on the Use of Factitious Airs, sold by Johnson, London.
Its effects would probably have been greater in respect to the quantity breathed, if it had been given in a dilute state, mixed with 10 or 20 times its quantity of atmospheric air, as otherwise much of it returns by expiration without being deprived of its quality, as may be seen by the person breathing on the flame of a candle, which it enlarges. See the Treatise of Dr. Beddoes above mentioned.
V. Those passions, which are attended with pleasurable sensation, excite the system into increased action in consequence of that sensation, as joy, and love, as is seen by the flush of the skin. Those passions, which are attended with disagreeable sensation, produce torpor in general by the expence of sensorial power occasioned by inactive pain; unless volition be excited in consequence of the painful sensation; and in that case an increased activity of the system occurs; thus paleness and coldness are the consequence of fear, but warmth and redness are the consequence of anger.
VI. Besides the exertions of the system occasioned by increased stimuli, and consequent irritation, and by the passions of the mind above described, the increased actions occasioned by exercise belong to this article. These may be divided into the actions of the body in consequence of volition, which is generally termed labour; or secondly, in consequence of agreeable sensation, which is termed play or sport; thirdly, the exercise occasioned by agitation, as in a carriage or on horseback; fourthly, that of friction, as with a brush or hand, so much used in the baths of Turkey; and lastly, the exercise of swinging.
The first of these modes of exercise is frequently carried to great excess even amongst our own labourers, and more so under the lash of slavery; so that the body becomes emaciated and sinks under either the present hardships, or by a premature old age. The second mode of exercise is seen in the play of all young animals, as kittens, and puppies, and children; and is so necessary to their health as well as to their pleasure, that those children, which are too much confined from it, not only become pale-faced and bloated, with tumid bellies, and consequent worms, but are liable to get habits of unnatural actions, as twitching of their limbs, or of some parts of their countenance; together with an ill-humoured or discontented mind.
Agitation in a carriage or on horseback, as it requires some little voluntary exertion to preserve the body perpendicular, but much less voluntary exertion than in walking, seems the best adapted to invalids; who by these means obtain exercise principally by the strength of the horse, and do not therefore too much exhaust their own sensorial power. The use of friction with a brush or hand, for half an hour or longer morning and evening, is still better adapted to those, who are reduced to extreme debility; and none of their own sensorial power is thus expended, and affords somewhat like the warm-bath activity without self-exertion, and is used as a luxury after warm bathing in many parts of Asia.
Another kind of exercise is that of swinging, which requires some exertion to keep the body perpendicular, or pointing towards the center of the swing, but is at the same time attended with a degree of vertigo; and is described in ClassII. 1. 6. 7.IV. 2. 1. 10. Sup. I.3. and15.
The necessity of much exercise has perhaps been more insisted upon by physicians, than nature seems to demand. Few animals exercise themselves so as to induce visible sweat, unless urged to it by mankind, or by fear, or hunger. And numbers of people in our market towns, of ladies particularly, with small fortunes, live to old age in health, without any kind of exercise of body, or much activity of mind.
In summer weak people cannot continue too long in the air, if it can be done without fatigue; and in winter they should go out several times in a day for a few minutes, using the cold air like a cold-bath, to invigorate and render them more hardy.
III.Catalogue of the Incitantia.
I. Papaver somniferum; poppy, opium.
Alcohol, wine, beer, cyder.Prunus lauro-cerasus; laurel, distilled water from the leaves.Prunus cerasus; black cherry, distilled water from the kernels.Nicotiana tabacum; tobacco? the essential oil, decoction of the leaf.Atropa belladona; deadly nightshade, the berries.Datura stramoneum; thorn-apple, the fruit boiled in milk.Hyoscyamus reticulatus; henbane, the seeds and leaves.Cynoglossum; hounds tongue.Menispermum, cocculus; Indian berry.Amygdalus amarus; bitter almond.Cicuta; hemlock. Conium maculatum?Strychnosnuxvomica?Delphinium stavisagria?
Alcohol, wine, beer, cyder.
Prunus lauro-cerasus; laurel, distilled water from the leaves.
Prunus cerasus; black cherry, distilled water from the kernels.
Nicotiana tabacum; tobacco? the essential oil, decoction of the leaf.
Atropa belladona; deadly nightshade, the berries.
Datura stramoneum; thorn-apple, the fruit boiled in milk.
Hyoscyamus reticulatus; henbane, the seeds and leaves.
Cynoglossum; hounds tongue.
Menispermum, cocculus; Indian berry.
Amygdalus amarus; bitter almond.
Cicuta; hemlock. Conium maculatum?
Strychnosnuxvomica?
Delphinium stavisagria?
II. Externally, heat, electricity.
III. Ether, essential oils.
IV. Oxygen gas.
V. Passions of love, joy, anger.
VI. Labour, play, agitation, friction.
I. Those things which increase the irritative motions, which constitute secretion, are termed secernentia; which are as various as the glands, which they stimulate into action.
1. Diaphoretics, as aromatic vegetables, essential oils, ether, volatile alcali, neutral salts, antimonial preparations, external heat, exercise, friction, cold water for a time with subsequent warmth, blisters, electric fluid.
2. Sialagogues, as mercury internally, and pyrethrum externally.
3. Expectorants, as squill, onions, gum ammoniac, seneka root, mucilage: some of these increase the pulmonary perspiration, and perhaps the pulmonary mucus.
4. Diuretics, as neutral salts, fixed alcali, balsams, resins, asparagus, cantharides.
5. Cathartics of the mild kind, as sena, jalap, neutral salts, manna. They increase the secretions of bile, pancreatic juice, and intestinal mucus.
6. The mucus of the bladder is increased by cantharides, and perhaps by oil of turpentine.
7. The mucus of the rectum by aloe internally, by clysters and suppositories externally.
8. The mucus of the cellular membrane is increased by blisters and sinapisms.
9. The mucus of the nostrils is increased by errhines of the milder kind, as marum, common snuff.
10. The secretion of tears is increased by volatile salts, the vapour of onions, by grief, and joy.
11. All those medicines increase the heat of the body, and remove those pains, which originate from a defect of motion in the vessels, which perform secretion; as pepper produces a glow on the skin, and balsam of Peru is said to relieve the flatulent cholic. But these medicines differ from the preceding class, as they neither induce costiveness nor deep coloured urine in their usual dose, nor intoxication in any dose.
12. Yet if any of these are used unnecessarily, it is obvious, like the incitantia, that they must contribute to shorten our lives by sooner rendering peculiar parts of the system disobedient to their natural stimuli. Of those in daily use the great excess of common salt is probably the most pernicious, as it enters all our cookery, and is probably one cause of scrophula, and of sea-scurvy, when joined with other causes of debility. See Botanic Garden, Part II. Canto IV. line 221. Spices taken to excess by stimulating the stomach, and the vessels of the skin by association, into unnecessary action, contribute to weaken these parts of the system, but are probably less noxious than the general use of so much salt.
II.Observations on the Secernentia.
I.1. Some of the medicines of this class produce absorption in some degree, though their principal effect is exerted on the secerning part of our system. We shall have occasion to observe a similar circumstance in the next class of medicines termed Sorbentia; as of these some exert their effects in a smaller degree on the secerning system. Nor will this surprise any one, who has observed, that all natural objects are presented to us in a state of combination; and that hence the materials, which produce these different effects, are frequently found mingled in the same vegetable. Thus the pure aromatics increase the action of the vessels, which secrete the perspirable matter; and the pure astringents increase the action of the vessels, which absorb the mucus from the lungs, and other cavities of the body; hence it must happen, that nutmeg, which possesses both these qualities, should have the double effect above mentioned.
Other drugs have this double effect, and belong either to the class of Secernentia or Sorbentia, according to the dose in which they are exhibited. Thus a small dose of alum increases absorption, and induces costiveness; and a large one increases the secretions into the intestinal canal, and becomes cathartic. And this accounts for the constipation of the belly left after the purgative quality of rhubarb ceases, for it increases absorption in a smaller dose, and secretion in a greater. Hence when a part of the larger dose is carried out of the habit by stools, the small quantity which remains induces costiveness. Hence rhubarb exhibited in small doses, as 2 or 3 grains twice a day, strengthens the system by increasing the action of the absorbent vessels, and of the intestinal canal.
2. Diaphoretics. The perspiration is a secretion from the blood in its passage through the capillary vessels, as other secretions are produced in the termination of the arteries in the various glands. After this secretion the blood loses its florid colour, which it regains in its passage through the lungs; which evinces that something besides water is secreted on the skins of animals.
No statical experiments can ascertain the quantity of our perspiration; as a continued absorption of the moisture of the atmosphere exists at the same time both by the cutaneous and pulmonary lymphatics.
3. Every gland is capable of being excited into greater exertions by an appropriated stimulus applied either by its mixture with the blood immediately to the secerning vessel, or applied externally to its excretory duct. Thus mercury internally promotes an increased salivation, and pyrethrum externally applied to the excretory ducts of the salival glands. Aloes stimulate the rectum internally mixed with the circulating blood; and sea-salt by injection externally. Now as the capillaries, which secrete the perspirable matter, lie near the surface of the body, the application of external heat acts immediately on their excretory ducts, and promotes perspiration; internally those drugs which possess a fragrant essential oil, or spiritus rector, produce this effect, as the aromatic vegetables, of which the number is very great.
4. It must be remembered, that a due quantity of some aqueous vehicle must be given to support this evacuation; otherwise a burning heat without much visible sweat must be the consequence. When the skin acquires a degree of heat much above 108, as appears by Dr. Alexander's experiments, no visible sweat is produced; which is owing to the great heat of the skin evaporating it as hastily, as it is secreted; and, where the sweat is secreted in abundance, its evaporation cannot carry off the exuberant heat, like the vapour of boiling water; because a great part of it is wiped off, or absorbed by the bed-clothes; or the air about the patient is not changed sufficiently often, as it becomes saturated with the perspirable matter. And hence it is probable, that the waste of perspirable matter is as great, or greater, when the skin is hot and dry, as when it stands in drops on the skin; as appears from the inextinguishable thirst.
Hence Dr. Alexander found, that when the heat of the body was greater than 108, nothing produced sweats but repeated draughts of cold water; and of warm fluids, when the heat was much below that degree. And that cold water which procured sweats instantaneously when the heat was above 108, stopped them as certainly when it was below that heat; and that flannels, wrung out of warm water and wrapped round the legs and thighs, were then most certainly productive of sweats.
5. The diaphoretics are all said to succeed much better, if given early in the morning, about an hour before sun-rise, than at any other time; which is owing to the great excitability of every part of the system after the sensorial power has been accumulated during sleep. In those, who have hectic fever, or the febricula, or nocturnal fever of debility, the morning sweats are owing to the decline of the fever-fit, as explained in Sect. XXXII. 9. In some of these patients the sweat does not occur till they awake; because then the system is still more excitable than during sleep, because the assistance of the voluntary power in respiration facilitates the general circulation. See ClassI. 2. 1. 3.
6. It must be observed, that the skin is very dry and hard to the touch, where the absorbents, which open on its surface, do not act; as in some dropsies, and other diseases attended with great thirst. This dryness, and shrivelled appearance, and roughness, are owing to the mouths of the absorbents being empty of their accustomed fluid, and is distinguishable from the dryness of the skin above mentioned in the hot fits of fever, by its not being attended with heat.
As the heat of the skin in the usual temperature of the air always evinces an increased perspiration, whether visible or not, the heat being produced along with the increase of secretion; it follows, that a defect of perspiration can only exist, when the skin is cold.
7. Volatile alcali is a very powerful diaphoretic, and particularly if exhibited in wine-whey; 20 drops of spirit of hartshorn every half hour in half a pint of wine-whey, if the patient be kept in a moderately warm bed, will in a few hours elicit most profuse sweats.
Neutral salts promote invisible perspiration, when the skin is not warmed much externally, as is evinced from the great thirst, which succeeds a meal of salt provisions, as of red herrings. When these are sufficiently diluted with water, and the skin kept warm, copious sweats without inflaming the habit, are the consequence. Half an ounce of vinegar saturated with volatile alcali, taken every hour or two hours, well answers this purpose; and is preferable perhaps in general to all others, where sweating is advantageous. Boerhaave mentions one cured of a fever by eating red-herrings or anchovies, which, with repeated draughts of warm water or tea, would I suppose produce copious perspiration.
Antimonial preparations have also been of late much used with great advantage as diaphoretics. For the history and use of these preparations I shall refer the reader to the late writers on the Materia Medica, only observing that the stomach becomes so soon habituated to its stimulus, that the second dose may be considerably increased, if the first had no operation.
Where it is advisable to procure copious sweats, the emetics, as ipecacuanha, joined with opiates, as in Dover's powder, produce this effect with greater certainty than the above.
8. We must not dismiss this subject without observing, that perspiration is designed to keep the skin flexile, as the tears are intended to clean and lubricate the eye; and that neither of these fluids can be considered as excretions in their natural state, but as secretions. See ClassI. 1. 2. 3. And that therefore the principal use of diaphoretic medicines is to warm the skin, and thence in consequence to produce the natural degree of insensible perspiration in languid habits.
9. When the skin of the extremities is cold, which is always a sign of present debility, the digestion becomes frequently impaired by association, and cardialgia or heartburn is induced from the vinous or acetous fermentation of the aliment. In this disease diaphoretics, which have been called cordials, by their action on the stomach restore its exertion, and that of the cutaneous capillaries by their association with it, and the skin becomes warm, and the digestion more vigorous.
10. But a blister acts with more permanent and certain effect by stimulating a part of the skin, and thence affecting the whole of it, and of the stomach by association, and thence removes the most obstinate heartburns and vomitings. From this the principal use of blisters is understood, which is to invigorate the exertions of the arterial and lymphatic vessels of the skin, producing an increase of insensible perspiration, and of cutaneous absorption; and to increase the action of the stomach, and the consequent power of digestion; and thence by sympathy to excite all the other irritative motions: hence they relieve pains of the cold kind, which originate from defect of motion; not from their introducing a greater pain, as some have imagined, but by stimulating the torpid vessels into their usual action; and thence increasing the action and consequent warmth of the whole skin, and of all the parts which are associated with it.
II.1.Sialagogues.The preparations of mercury consist of a solution or corrosion of that metal by some acid; and, when the dose is known, it is probable that they are all equally efficacious. As their principal use is in the cure of the venereal disease, they will be mentioned in the catalogue amongst the sorbentia. Where salivation is intended, it is much forwarded by a warm room and warm clothes; and prevented by exposing the patient to his usual habits of cool air and dress, as the mercury is then more liable to go off by the bowels.
2. Any acrid drug, as pyrethrum, held in the mouth acts as a sialagogue externally by stimulating the excretory ducts of the salivary glands; and the siliqua hirsuta applied externally to the parotid gland, and even hard substances in the ear, are said to have the same effect. Mastich chewed in the mouth emulges the salivary glands.
3. The unwise custom of chewing and smoking tobacco for many hours in a day not only injures the salivary glands, producing dryness in the mouth when this drug is not used, but I suspect that it also produces schirrhus of the pancreas. The use of tobacco in this immoderate degree injures the power of digestion, by occasioning the patient to spit out that saliva, which he ought to swallow; and hence produces that flatulency, which the vulgar unfortunately take it to prevent. The mucus, which is brought from the fauces by hawking, should be spit out, as well as that coughed up from the lungs; but that which comes spontaneously into the mouth from the salivary glands, should be swallowed mixed with our food or alone for the purposes of digestion. See ClassI. 2. 2. 7.
III.1. Expectorants are supposed to increase the secretion of mucus in the branches of the windpipe, or to increase the perspiration of the lungs secreted at the terminations of the bronchial artery.
2. If any thing promotes expectoration toward the end of peripneumonies, when the inflammation is reduced by bleeding and gentle cathartics, small repeated blisters about the chest, with tepid aqueous and mucilaginous or oily liquids, are more advantageous than the medicines generally enumerated under this head; the blisters by stimulating into action the vessels of the skin produce by association a greater activity of those of the mucous membrane, which lines the branches of the windpipe, and air-cells of the lungs; and thus after evacuation they promote the absorption of the mucus and consequent healing of the inflamed membrane, while the diluting liquids prevent this mucus from becoming too viscid for this purpose, or facilitate its expuition.
Blisters, one at a time, on the sides or back, or on the sternum, are also useful towards the end of peripneumonies, by preventing the evening access of cold fit, and thence preventing the hot fit by their stimulus on the skin; in the same manner as five drops of laudanum by its stimulus on the stomach. For the increased actions of the vessels of the skin or stomach excite a greater quantity of the sensorial power of association, and thus prevent the torpor of the other parts of the system; which, when patients are debilitated, is so liable to return in the evening.
3. Warm bathing is of great service towards the end of peripneumony to promote expectoration, especially in those children who drink too little aqueous fluids, as it gently increases the action of the pulmonary capillaries by their content with the cutaneous ones, and supplies the system with aqueous fluid, and thus dilutes the secreted mucus.
Some have recommended oil externally around the chest, as well as internally, to promote expectoration; and upon the nose, when its mucous membrane is inflamed, as in common catarrh.
IV.1. Diuretics. If the skin be kept warm, most of these medicines promote sweat instead of urine; and if their dose is enlarged, most of them become cathartic. Hence the neutral salts are used in general for all these purposes. Those indeed, which are composed of the vegetable acid, are most generally used as sudorifics; those with the nitrous acid as diuretics; and those with the vitriolic acid as cathartics: while those united with the marine acid enter our common nutriment, as a more general stimulus. All these increase the acrimony of the urine, hence it is retained a less time in the bladder; and in consequence less of it is reabsorbed into the system, and the apparent quantity is greater, as more is evacuated from the bladder; but it is not certain from thence, that a greater quantity is secreted by the kidnies. Hence nitre, and other neutral salts, are erroneously given in the gonorrhœa; as they augment the pain of making water by their stimulus on the excoriated or inflamed urethra. They are also erroneously given in catarrhs or coughs, where the discharge is too thin and saline, as they increase the frequency of coughing.
2. Balsam of Copaiva is thought to promote urine more than the other native balsams; and common resin is said to act as a powerful diuretic in horses. These are also much recommended in gleets, and in fluor albus, perhaps more than they deserve; they give a violet smell to the urine, and hence probably increase the secretion of it.
Calcined egg-shells are said to promote urine, perhaps from the phosphoric acid they contain.
3. Cold air and cold water will increase the quantity of urine by decreasing the absorption from the bladder; and neutral and alcalious salts and cantharides by stimulating the neck of the bladder to discharge the urine as soon as secreted; and alcohol as gin and rum at the beginning of intoxication, if the body be kept cool, occasion much urine by inverting the urinary lymphatics, and thence pouring a fluid into the bladder, which never passed the kidnies. But it is probable, that those medicines, which give a scent to the urine as the balsams and resins, but particularly asparagus and garlic, are the only drugs, which truly increase the secretion of the kidnies. Alcohol however, used as above mentioned, and perhaps great doses of tincture of cantharides, may be considered as drastic diuretics, as they pour a fluid into the bladder by the retrograde action of the lymphatics, which are in great abundance spread about the neck of it. See Sect. XXIX. 3.
V. Mild cathartics. The ancients believed that some purges evacuated the bile, and hence were termed Cholagogues; others the lymph, and were termed Hydragogues; and that in most each cathartic selected a peculiar humour, which it discharged. The moderns have too hastily rejected this system; the subject well deserves further observation.
Calomel given in the dose from ten to twenty grains, so as to induce purging without the assistance of other drugs, appears to me to particularly increase the secretion of bile, and to evacuate it; aloe seems to increase the secretion of the intestinal mucus; and it is probable that the pancreas and spleen may be peculiarly stimulated into action by some other of this tribe of medicines; whilst others of them may simply stimulate the intestinal canal to evacuate its contents, as the bile of animals. It must be remarked, that all these cathartic medicines are supposed to be exhibited in their usual doses, otherwise they become drastic purges, and are treated of in the Class of Invertentia.
VI. The mucus of the bladder is seen in the urine, when cantharides have been used, either internally or externally, in such doses as to induce the strangury. Spirit of turpentine is said to have the same effect. I have given above a dram of it twice a day floating on a glass of water in chronic lumbago without this effect, and the patient gradually recovered.
VII. Aloe given internally seems to act chiefly on the rectum and, spincter ani, producing tenesmus and piles. Externally in clysters or suppositories, common salt seems to act on that bowel with greater certainty. But where the thread-worm or ascarides exist, 60 or 100 grains of aloes reduced to powder and boiled in a pint of gruel, and used as a clyster twice a week for three months, has frequently destroyed them.
VIII. The external application of cantharides by stimulating the excretory ducts of the capillary glands produces a great secretion of subcutaneous mucus with pain and inflammation; which mucaginous fluid, not being able to permeate the cuticle, raises it up; a similar secretion and elevation of the cuticle is produced by actual fire; and by caustic materials, as by the application of the juice of the root of white briony, or bruised mustard-seed. Experiments are wanting to introduce some acrid application into practice instead of cantharides, which might not induce the strangury.
Mustard-seed alone is too acrid, and if it be suffered to lie on the skin many minutes is liable to produce a slough and consequent ulcer, and should therefore be mixed with flour when applied to cold extremities. Volatile alkali properly diluted might stimulate the skin without inducing strangury.
IX. The mild errhines are such as moderately stimulate the membrane of the nostrils, so as to increase the secretion of nasal mucus; as is seen in those, who are habituated to take snuff. The stronger errhines are mentioned in Art.V. 2. 3.
X. The secretion of tears is increased either by applying acrid substances to the eye; or acrid vapours, which stimulate the excretory duct of the lacrymal gland; or by applying them to the nostrils, and stimulating the excretory duct of the lacrymal sack, as treated of in the Section on Instinct.
Or the secretion of tears is increased by the association of the motions of the excretory duct of the lacrymal sack with ideas of tender pleasure, or of hopeless distress, as explained in Sect. XVI. 8. 2. and 3.
XI. The secretion of sensorial power in the brain is probably increased by opium or wine, because when taken in certain quantity an immediate increase of strength and activity succeeds for a time, with consequent debility if the quantity taken be so great as to intoxicate in the least degree. The necessity of perpetual respiration shews, that the oxygen of the atmosphere supplies the source of the spirit of animation; which is constantly expended, and is probably too fine to be long contained in the nerves after its production in the brain. Whence it is probable, that the respiration of oxygen gas mixed with common air may increase the secretion of sensorial power; as indeed would appear from its exhilarating effect on most patients.
III.Catalogue of the Secernentia.
I. Diaphoretics.
1. Amomum zinziber, ginger. Caryophyllus aromaticus, cloves. Piper indicum, pepper. Capsicum. Cardamomum. Pimento, myrtus pimenta. Canella alba. Serpentaria virginiana, aristolochia serpentaria, guaiacum. Sassafras, laurus sassafras. Opium. Wine.2. Essential oils of cinnamon, laurus cinnamomum. Nutmeg, myristica moschata. Cloves, caryophyllus aromaticus. Mint, mentha. Camphor, laurus camphora. Ether.3. Volatile salts, as of ammoniac and of hartshorn. Sal cornu cervi.4. Neutral salts, as those with vegetable acid; or with marine acid, as common salt. Halex. Red-herring, anchovy.5. Preparations of antimony, as emetic tartar, antimonium tartarizatum, wine of antimony. James's powder.6. External applications. Blisters. Warm bath. Warm air. Exercise. Friction.7. Cold water with subsequent warmth.
1. Amomum zinziber, ginger. Caryophyllus aromaticus, cloves. Piper indicum, pepper. Capsicum. Cardamomum. Pimento, myrtus pimenta. Canella alba. Serpentaria virginiana, aristolochia serpentaria, guaiacum. Sassafras, laurus sassafras. Opium. Wine.
2. Essential oils of cinnamon, laurus cinnamomum. Nutmeg, myristica moschata. Cloves, caryophyllus aromaticus. Mint, mentha. Camphor, laurus camphora. Ether.
3. Volatile salts, as of ammoniac and of hartshorn. Sal cornu cervi.
4. Neutral salts, as those with vegetable acid; or with marine acid, as common salt. Halex. Red-herring, anchovy.
5. Preparations of antimony, as emetic tartar, antimonium tartarizatum, wine of antimony. James's powder.
6. External applications. Blisters. Warm bath. Warm air. Exercise. Friction.
7. Cold water with subsequent warmth.
II. Sialagogues. Preparations of mercury, hydrargyrus. Pyrethrum, anthemis pyrethrum, tobacco, cloves, pepper, cowhage, stizolobium siliqua hirsuta. Mastich, pistacia lentiscus.
III. Expectorants:
1. Squill, scilla maritima, garlic, leek, onion, allium, asafœtida, ferula asafœtida, gum ammoniac, benzoin, tar, pix liquida, balsam of Tolu.2. Root of seneka, polygala seneka, of elicampane, inula helenium.3. Marsh-mallow, althæa, coltsfoot, tussilago farfara, gum arabic, mimosa nilotica, gum tragacanth, astragalus tragacantha. Decoction of barley, hordeum distichon. Expressed oils. Spermaceti, soap. Extract of liquorice, glycyrrhiza glabra. Sugar. Honey.4. Externally blisters. Oil. Warm bath.
1. Squill, scilla maritima, garlic, leek, onion, allium, asafœtida, ferula asafœtida, gum ammoniac, benzoin, tar, pix liquida, balsam of Tolu.
2. Root of seneka, polygala seneka, of elicampane, inula helenium.
3. Marsh-mallow, althæa, coltsfoot, tussilago farfara, gum arabic, mimosa nilotica, gum tragacanth, astragalus tragacantha. Decoction of barley, hordeum distichon. Expressed oils. Spermaceti, soap. Extract of liquorice, glycyrrhiza glabra. Sugar. Honey.
4. Externally blisters. Oil. Warm bath.
IV. Mild diuretics.
1. Nitre, kali acetatum, other neutral salts.2. Fixed alkali, soap, calcined egg-shells.3. Turpentine. Balsam of Copaiva. Resin. Olibanum.4. Asparagus, garlic, wild daucus. Parsley, apium. Fennel fæniculum, pareira brava, Cissampelos?5. Externally cold air, cold water.6. Alcohol. Tincture of cantharides. Opium.
1. Nitre, kali acetatum, other neutral salts.
2. Fixed alkali, soap, calcined egg-shells.
3. Turpentine. Balsam of Copaiva. Resin. Olibanum.
4. Asparagus, garlic, wild daucus. Parsley, apium. Fennel fæniculum, pareira brava, Cissampelos?
5. Externally cold air, cold water.
6. Alcohol. Tincture of cantharides. Opium.
V. Mild cathartics.
1. Sweet subacid fruits. Prunes, prunus domestica. Cassia sistula. Tamarinds, crystals of tartar, unrefined sugar. Manna. Honey.2. Whey of milk, bile of animals.3. Neutral salts, as Glauber's salt, vitriolated tartar, sea-water, magnesia alba, soap.4. Gum guaiacum. Balsam of Peru. Oleum ricini, castor-oil, oil of almonds, oil of olives, sulphur.5. Senna, cassia senna, jalap, aloe, rhubarb, rheum palmatum.6. Calomel. Emetic tartar, antimonium tartarizatum.
1. Sweet subacid fruits. Prunes, prunus domestica. Cassia sistula. Tamarinds, crystals of tartar, unrefined sugar. Manna. Honey.
2. Whey of milk, bile of animals.
3. Neutral salts, as Glauber's salt, vitriolated tartar, sea-water, magnesia alba, soap.
4. Gum guaiacum. Balsam of Peru. Oleum ricini, castor-oil, oil of almonds, oil of olives, sulphur.
5. Senna, cassia senna, jalap, aloe, rhubarb, rheum palmatum.
6. Calomel. Emetic tartar, antimonium tartarizatum.
VI. Secretion of mucus of the bladder is increased by cantharides, by spirit of turpentine?
VII. Secretion of mucus of the rectum is increased by aloe internally, by various clysters and suppositories externally.
VIII. Secretion of subcutaneous mucus is increased by blisters of cantharides, by application of a thin slice of the fresh root of white briony, by sinapisms, by root of horse-radish, cochlearia armoracia. Volatile alcali.
IX. Mild errhines. Marjoram. Origanum. Marum, tobacco.
X. Secretion of tears is increased by vapour of sliced onion, of volatile alcali. By pity, or ideas of hopeless distress.
XI. Secretion of sensorial power in the brain is probably increased by opium, by wine, and perhaps by oxygen gas added to the common air in respiration.
I. Those things which increase the irritative motions, which constitute absorption, are termed sorbentia; and are as various as the absorbent vessels, which they stimulate into action.
1. Cutaneous absorption is increased by austere acids, as of vitriol; hence they are believed to check colliquative sweats, and to check the eruption of small-pox, and contribute to the cure of the itch, and tinea; hence they thicken the saliva in the mouth, as lemon-juice, crab-juice, sloes.
2. Absorption from the mucous membrane is increased by opium, and Peruvian bark, internally; and by blue vitriol externally. Hence the expectoration in coughs, and the mucous discharge from the urethra, are thickened and lessened.
3. Absorption from the cellular membrane is promoted by bitter vegetables, and by emetics, and cathartics. Hence matter is thickened and lessened in ulcers by opium and Peruvian bark; and serum is absorbed in anasarca by the operation of emetics and cathartics.
4. Venous absorption is increased by acrid vegetables; as water-cress, cellery, horse-radish, mustard. Hence their use in sea-scurvy, the vibices of which are owing to a defect of venous absorption; and by external stimulants, as vinegar, and by electricity, and perhaps by oxygen.
5. Intestinal absorption is increased by astringent vegetables, as rhubarb, galls; and by earthy salts, as alum; and by argillaceous and calcareous earth.
6. Hepatic absorption is increased by metallic salts, hence calomel and sal martis are so efficacious in jaundice, worms, chlorosis, dropsy.
7. Venereal virus in ulcers is absorbed by the stimulus of mercury; hence they heal by the use of this medicine.
8. Venesection, hunger, thirst, and violent evacuations, increase all absorptions; hence sweating produces costiveness.
9. Externally bitter astringent vegetables, earthy and metallic salts, and bandages, promote the absorption of the parts on which they are applied.
10. All these in their usual doses do not increase the natural heat; but they induce costiveness, and deep coloured urine with earthy sediment.
In greater doses they invert the motions of the stomach and lacteals; and hence vomit or purge, as carduus benedictus, rhubarb. They promote perspiration, if the skin be kept warm; as camomile tea, and testaceous powders, have been used as sudorifics.
The preparations of antimony vomit, purge, or sweat, either according to the quantity exhibited, or as a part of what is given is evacuated. Thus a quarter of a grain of emetic tartar (if well prepared) will promote a diaphoresis, if the skin be kept warm; half a grain will procure a stool or two first, and sweating afterwards; and a grain will generally vomit, and then purge, and lastly sweat the patient. In less quantity it is probable, that this medicine acts like other metallic salts, as steel, zinc, or copper in small doses; that is, that it strengthens the system by its stimulus. As camomile or rhubarb in different doses vomit, or purge, or act as stimulants so as to strengthen the system.
II.Observations on the Sorbentia.
I.1. As there is great difference in the apparent structure of the various glands, and of the fluids which they select from the blood, these glands must possess different kinds of irritability, and are therefore stimulated into stronger or unnatural actions by different articles of the materia medica, as shewn in the secernentia. Now as the absorbent vessels are likewise glands, and drink up or select different fluids, as chyle, water, mucus, with a part of every different secretion, as a part of the bile, a part of the saliva, a part of the urine, &c. it appears, that these absorbent vessels must likewise possess different kinds of irritability, and in consequence must require different articles of the materia medica to excite them into unusual action. This part of the subject has been so little attended to, that the candid reader will find in this article a great deal to excuse.
It was observed, that some of the secernentia did in a less degree increase absorption, from the combination of different properties in the same vegetable body; for the same reason some of the class of sorbentia produce secretion in a less degree, as those bitters which have also an aroma in their composition; these are known from their increasing the heat of the system above its usual degree.
It must also be noted, that the actions of every part of the absorbent system are so associated with each other, that the drugs which stimulate one branch increase the action of the whole; and the torpor or quiescence of one branch weakens the exertions of the whole; or when one branch is excited into stronger action, some other branch has its actions weakened or inverted. Yet though peculiar branches of the absorbent system are stimulated into action by peculiar substances, there are other substances which seem to stimulate the whole system, and that without immediately increasing any of the secretions; as those bitters which possess no aromatic scent, at the head of which stands the famed Peruvian bark, or cinchona.
2. Cutaneous absorption. I have heard of some experiments, in which the body was kept cold, and was thought to absorb more moisture from the atmosphere than at any other time. This however cannot be determined by statical experiments; as the capillary vessels, which secrete the perspirable matter, must at the same time have been benumbed by the cold; and from their inaction there could not have been the usual waste of the weight of the body; and as all other muscular exertions are best performed, when the body possesses its usual degree of warmth, it is conclusive, that the absorbent system should likewise do its office best, when it is not benumbed by external cold.
The austere acids, as of vitriol, lemon-juice, juice of crabs and sloes, strengthen digestion, and prevent that propensity to sweat so usual to weak convalescents, and diminish the colliquative sweats in hectic fevers; all which are owing to their increasing the action of the external and internal cutaneous absorption. Hence vitriolic acid is given in the small-pox to prevent the too hasty or too copious eruption, which it effects, by increasing the cutaneous absorption. Vinegar, from the quantity of alcohol which it contains, exerts a contrary effect to that here described, and belongs to the incitantia; as an ounce of it promotes sweat, and a flushing of the skin; at the same time externally it acts as a venous absorbent, as the lips become pale by moistening them with it. And it is said, when taken internally in great and continued quantity, to induce paleness of the skin, and softness of the bones.
The sweet vegetable acids, as of several ripe fruits, are among the torpentia; as they are less stimulating than the general food of this climate, and are hence used in inflammatory diseases.
Where the quantity of fluids in the system is much lessened, as in hectic fever, which has been of some continuance, or in spurious peripneumony, a grain of opium given at night will sometimes prevent the appearance of sweats; which is owing to the stimulus of opium increasing the actions of the cutaneous absorbents, more than those of the secerning vessels of the skin. Whence the secretion of perspirable matter is not decreased, but its appearance on the skin is prevented by its more facile absorption.
3. There is one kind of itch, which seldom appears between the fingers, is the least infectious, and most difficult to eradicate, and which has its cure much facilitated by the internal use of acid of vitriol. This disease consists of small ulcers in the skin, which are healed by whatever increases the cutaneous absorption. The external application of sulphur, mercury, and acrid vegetables, acts on the same principle; for the animalcula, which are seen in these pustules, are the effect, not the cause, of them; as all other stagnating animal fluids, as the semen itself, abounds with similar microscopic animals.
4. Young children have sometimes an eruption upon the head called Tinea, which discharges an acrimonius ichor inflaming the parts, on which it falls. This eruption I have seen submit to the internal use of vitriolic acid, when only wheat-flour was applied externally. This kind of eruption is likewise frequently cured by testaceous powders; two materials so widely different in their chemical properties, but agreeing in their power of promoting cutaneous absorption.
II. Absorption from the mucous membrane is increased by applying to its surface the austere acids, as of vitriol, lemon-juice, crab-juice, sloes. When these are taken into the mouth, they immediately thicken, and at the same time lessen the quantity of the saliva; which last circumstance cannot be owing to their coagulating the saliva, but to their increasing the absorption of the thinner parts of it. So alum applied to the tip of the tongue does not stop in its action there, but independent of its diffusion it induces cohesion and corrugation over the whole mouth. (Cullen's Mat. Med. Art. Astringentia.) Which is owing to the association of the motions of the parts or branches of the absorbent system with each other.
Absorption from the mucous membrane is increased by opium taken internally in small doses more than by any other medicine, as is seen in its thickening the expectoration in coughs, and the discharge from the nostrils in catarrh, and perhaps the discharge from the urethra in gonorrhoea. The bark seems next in power for all these purposes.
Externally slight solutions of blue vitriol, as two or three grains to an ounce of water, applied to ulcers of the mouth, or to chancres on the glans penis, more powerfully induces them to heal than any other material.
Where the lungs or urethra are inflamed to a considerable degree, and the absorption is so great, that the mucus is already too thick, and adheres to the membrane from its viscidity, opiates and bitter vegetable and austere acids are improper; and mucilaginous diluents should be used in their stead with venesection and torpentia.
III.1. Absorption from the cellular membrane, and from all the other cavities of the body, is too slowly performed in some constitutions; hence the bloated pale complexion; and when this occurs in its greatest degree, it becomes an universal dropsy. These habits are liable to intermittent fevers, hysteric paroxysms, cold extremities, indigestion, and all the symptoms of debility.
The absorbent system is more subject to torpor or quiescence than the secerning system, both from the coldness of the fluids which are applied to it, as the moisture of the atmosphere, and from the coldness of the fluids which we drink; and also from its being stimulated only by intervals, as when we take our food; whereas the secerning system is perpetually excited into action by the warm circulating blood; as explained in Sect. XXXII.
2. The Peruvian bark, camomile flowers, and other bitter drugs, by stimulating this cellular branch of the absorbent system prevents it from becoming quiescent; hence the cold paroxysms of those agues, which arise from the torpor of the cellular lymphatics, are prevented, and the hot fits in consequence. The patient thence preserves his natural heat, regains his healthy colour, and his accustomed strength.
Where the cold paroxysm of an ague originates in the absorbents of the liver, spleen, or other internal viscus, the addition of steel to vegetable bitters, and especially after the use of one dose of calomel, much advances the cure.
And where it originates in any part of the secerning system, as is probably the case in some kinds of agues, the addition of opium in the dose of a grain and half, given about an hour before the access of the paroxysm, or mixed with chalybeate and bitter medicines, ensures the cure. Or the same may be effected by wine given instead of opium before the paroxysm, so as nearly to intoxicate.
These three kinds of agues are thus distinguished; the first is not attended with any tumid or indurated viscus, which the people call an ague cake, and which is evident to the touch. The second is accompanied with a tumid viscus; and the last has generally, I believe, the quartan type, and is attended with some degree of arterial debility.
3. This class of absorbent medicines are said to decrease irritability. After any part of our system has been torpid or quiescent, by whatever cause that was produced, it becomes afterwards capable of being excited into greater motion by small stimuli; hence the hot fit of fever succeeds the cold one. As these medicines prevent torpor or quiescence of parts of the system, as cold hands or feet, which perpetually happen to weak constitutions, the subsequent increase of irritability of these parts is likewise prevented.
4. These absorbent medicines, including both the bitters, and metallic salts, and opiates, are of great use in the dropsy by their promoting universal absorption; but here evacuations are likewise to be produced, as will be treated of in the Invertentia.
5. The matter in ulcers is thickened, and thence rendered less corrosive, the saline part of it being reabsorbed by the use of bitter medicines; hence the bark is used with advantage in the cure of ulcers.
6. Bitter medicines strengthen digestion by promoting the absorption of chyle; hence the introduction of hop into the potation used at our meals, which as a medicine may be taken advantageously, but, like other unnecessary stimuli, must be injurious as an article of our daily diet.
The hop may perhaps in some degree contribute to the production of gravel in the kidnies, as our intemperate wine-drinkers are more subject to the gout, and ale-drinkers to the gravel; in the formation of both which diseases, there can be no doubt, but that the alcohol is the principal, if not the only agent.
7. Vomits greatly increase the absorption from the cellular membrane, as squill, and foxglove. The squill should be given in the dose of a grain of the dried root every hour, till it operates upwards and downwards. Four ounces of the fresh leaves of the foxglove should be boiled from two pounds of water to one, and half an ounce of the decoction taken every two hours for four or more doses. This medicine by stimulating into inverted action the absorbents of the stomach, increases the direct action of the cellular lymphatics.
Another more convenient way of ascertaining the dose of foxglove is by making a saturated tincture of it in proof spirit; which has the twofold advantage of being invariable in its original strength, and of keeping a long time as a shop-medicine without losing any of its virtue. Put two ounces of the leaves of purple foxglove, digitalis purpurea, nicely dried, and coarsely powdered, into a mixture of four ounces of rectified spirit of wine and four ounces of water; let the mixture stand by the fire-side twenty-four hours frequently shaking the bottle, and thus making a saturated tincture of digitalis; which must be poured from the sediment or passed through filtering paper.
As the size of a drop is greater or less according to the size of the rim of the phial from which it is dropped, a part of this saturated tincture is then directed to be put into a two-ounce phial, for the purpose of ascertaining the size of the drop. Thirty drops of this tincture is directed to be put into an ounce of mint-water for a draught to be taken twice or thrice a day, till it reduces the anasarca of the limbs, or removes the difficulty of breathing in hydrothorax, or till it induces sickness. And if these do not occur in two or three days, the dose must be gradually increased to forty or sixty drops, or further.
From the great stimulus of this medicine the stomach is rendered torpid with consequent sickness, which continues many hours and even days, owing to the great exhaustion of its sensorial power of irritation; and the action of the heart and arteries becomes feeble from the deficient excitement of the sensorial power of association; and lastly, the absorbents of the cellular membrane act more violently in consequence of the accumulation of the sensorial power of association in the torpid heart and arteries, as explained in Suppl. I.12.
A circumstance curiously similar to this occurs to some people on smoking tobacco for a short time, who have not been accustomed to it. A degree of sickness is presently induced, and the pulsations of the heart and arteries become feeble for a short time, as in the approach to fainting, owing to the direct sympathy between these and the stomach, that is from defect of the excitement of the power of association. Then there succeeds a tingling, and heat, and sometimes sweat, owing to the increased action of the capillaries, or perspirative and mucous glands; which is occasioned by the accumulation of the sensorial power of association by the weaker action of the heart and arteries, which now increases the action of the capillaries.
8. Another method of increasing absorption from the cellular membrane is by warm air, or by warm steam. If the swelled legs of a dropsical patient are inclosed in a box, the air of which is made warm by a lamp or two, copious sweats are soon produced by the increased action of the capillary glands, which are seen to stand on the skin, as it cannot readily exhale in so small a quantity of air, which is only changed so fast as may be necessary to permit the lamps to burn. At the same time the lymphatics of the cellular membrane are stimulated by the heat into greater action, as appears by the speedy reduction of the tumid legs.
It would be well worth trying an experiment upon a person labouring under a general anasarca by putting him into a room filled with air heated to 120 or 130 degrees, which would probably excite a great general diaphoresis, and a general cellular absorption both from the lungs and every other part. And that air of so great heat may be borne for many minutes without great inconvenience was shewn by the experiments made in heated rooms by Dr. Fordyce and others. Philos. Trans.
Another experiment of using warmth in anasarca, or in other diseases, might be by immersing the patient in warm air, or in warm steam, received into an oil-skin bag, or bathing-tub of tin, so managed, that the current of warm air or steam should pass round and cover the whole of the body except the head, which might not be exposed to it; and thus the absorbents of the lungs might be induced to act more powerfully by sympathy with the skin, and not by the stimulus of heat. See Uses of Warm Bath,Art.II. 2. 2. 1.
IV.1. Venous absorption. Cellary, water-cresses, cabbages, and many other vegetables of the Class Tetradynamia, do not increase the heat of the body (except those whose acrimony approaches to corrosion), and hence they seem alone, or principally, to act on the venous system; the extremities of which we have shewn are absorbents of the red blood, after it has passed the capillaries and glands.
2. In the sea-scurvy and petechial fever the veins do not perfectly perform this office of absorption; and hence the vibices are occasioned by blood stagnating at their extremities, or extravasated into the cellular membrane. And this class of vegetables, stimulating the veins to perform their natural absorption, without increasing the energy of the arterial action, prevents future petechiæ, and may assist the absorption of the blood already stagnated, as soon as its chemical change renders it proper for that operation.
3. The fluids, which are extravasated, and received into the cells of the cellular membrane, seem to continue there for many days, so as to undergo some chemical change, and are then taken up again by the mouths of the cellular absorbents. But the new vessels produced in inflamed parts, as they communicate with the veins, are probably absorbed again by the veins along with the blood which they contain in their cavities. Hence the blood, which is extravasated in bruises or vibices, is gradually many days in disappearing; but after due evacuations the inflamed vessels on the white of the eye, if any stimulant lotion is applied, totally disappear in a few hours.
Amongst absorbents affecting the veins we should therefore add the external application of stimulant materials; as of vinegar, which makes the lips pale on touching them. Friction, and electricity.
4. Hæmorrhages are of two kinds, either arterial, which are attended with inflammation; or venous, from a deficiency in the absorbent power of this set of vessels. In the former case the torpentia are efficacious; in the latter steel, opium, alum, and all the tribe of sorbentia, are used with success.
5. Sydenham recommends vegetables of the class Tetradynamia in rheumatic pains left after the cure of intermittents. These pains are perhaps similar to those of the sea-scurvy, and seem to arise from want of absorption in the affected part, and hence are relieved by the same medicines.
V.1. Intestinal absorption. Some astringent vegetables, as rhubarb, may be given in such doses as to prove cathartic; and, after a part of it is evacuated from the body, the remaining part augments the absorption of the intestines; and acts, as if a similar dose had been exhibited after the operation of any other purgative. Hence 4 grains of rhubarb strengthen the bowels, 30 grains first empty them.
2. The earthy salts, as alum, increase the intestinal absorption, and hence induce constipation in their usual dose; alum is said sometimes to cure intermittents, perhaps when their seat is in the intestines, when other remedies have failed. It is useful in the diabætes by exciting the absorbents of the bladder into their natural action; and combined with resin is esteemed in the fluor albus, and in gleets. Lime-stone or chalk, and probably gypsum, possess effects in some degree similar, and increase the absorption of the intestines; and thus in certain doses restrain some diarrhœas, but in greater doses alum I suppose will act as a cathartic. Five or ten grains produce constipation, 20 or 30 grains are either emetic or cathartic.
3. Earth of alum, tobacco-pipe clay, marl, Armenian bole, lime, crab's eyes or claws, and calcined hartshorn, or bone ashes, restrain fluxes; either mechanically by supplying something like mucilage, or oil, or rollers to abate the friction of the aliment over inflamed membranes; or by increasing their absorption. The two last consist of calcareous earth united to phosphoric acid, and the Armenian bole and marl may contain iron. By the consent between the intestines and the skin 20 grains of Armenian bole given at going into bed to hectic patients will frequently check their tendency to sweat as well as to purge, and the more certainly if joined with one grain of opium.
VI.1. Absorption from the liver, stomach, and other viscera. When inflammations of the liver are subdued to a certain degree by venesection, with calomel and other gentle purges, so that the arterial energy becomes weakened, four or eight grains of iron-filings, or of salt of steel, with the Peruvian bark, have wonderful effect in curing the cough, and restoring the liver to its usual size and sanity; which it seems to effect by increasing the absorption of this viscus. The same I suppose happens in respect to the tumours of other viscera, as of the spleen, or pancreas, some of which are frequently enlarged in agues.
2. Hæmorrhages from the nose, rectum, kidnies, uterus, and other parts, are frequently attendant on diseased livers; the blood being impeded in the vena portarum from the decreased power of absorption, and in consequence of the increased size of this viscus. These hæmorrhages after venesection, and a mercurial cathartic, are most certainly restrained by steel alone, or joined with an opiate; which increase the absorption, and diminish the size of the liver.
Chalybeates may also restrain these hæmorrhages by their promoting venous absorption, though they exert their principal effect upon the liver. Hence also opiates, and bitters, and vitriolic acid, are advantageously used along with them. It must be added that some hæmorrhages recur by periods like the paroxysms of intermittent fevers, and are thence cured by the same treatment.
3. The jaundice is frequently caused by the insipidity of the bile, which does not stimulate the gall-bladder and bile-ducts into their due action; hence it stagnates in the gall-bladder, and produces a kind of crystallization, which is too large to pass into the intestines, blocks up the bile-duct, and occasions a long and painful disease. A paralysis of the bile duct produces a similar jaundice, but without pain.
4. Worms in sheep called flukes are owing to the dilute state of the bile; hence they originate in the intestines, and thence migrate into the biliary ducts, and corroding the liver produce ulcers, cough, and hectic fever, called the rot. In human bodies it is probable the inert state of the bile is one cause of the production of worms; which insipid state of the bile is owing to deficient absorption of the thinner parts of it; hence the pale and bloated complexion, and swelled upper lip, of wormy children, is owing to the concomitant deficiency of absorption from the cellular membrane. Salt of steel, or the rust of it, or filings of it, with bitters, increase the acrimony of the bile by promoting the absorption of its aqueous part; and hence destroy worms, as well as by their immediate action on the intestines, or on the worms themselves. The cure is facilitated by premising a purge with calomel. See ClassI. 2. 3. 9.
5. The chlorosis is another disease owing to the deficient action of the absorbents of the liver, and perhaps in some degree also to that of the secretory vessels, or glands, which compose that viscus. Of this the want of the catameniæ, which is generally supposed to be a cause, is only a symptom or consequence. In this complaint the bile is deficient perhaps in quantity, but certainly in acrimony, the thinner parts not being absorbed from it. Now as the bile is probably of great consequence in the process of making the blood; it is on this account that the blood is so destitute of red globules; which is evinced by the great paleness of these patients. As this serous blood must exert less stimulus on the heart, and arteries, the pulse in consequence becomes quick as well as weak, as explained in Sect. XII. 1. 4.
The quickness of the pulse is frequently so great and permanent, that when attended by an accidental cough, the disease may be mistaken for hectic fever; but is cured by chalybeates, and bitters exhibited twice a day; with half a grain of opium, and a grain of aloe every night; and the expected catamenia appears in consequence of a restoration of the due quantity of red blood. This and the two former articles approach to the disease termed paralysis of the liver. Sect.XXX. 1. 4.
6. It seems paradoxical, that the same treatment with chalybeates, bitters, and opiates, which produces menstruation in chlorotic patients, should repress the too great or permanent menstruation, which occurs in weak constitutions at the time of life when it should cease. This complaint is an hæmorrhage owing to the debility of the absorbent power of the veins, and belongs to the paragraph on venous absorption above described, and is thence curable by chalybeates, alum, bitters, and particularly by the exhibition of a grain of opium every night with five grains of rhubarb.
7. Metallic salts supply us with very powerful remedies for promoting absorption in dropsical cases; which frequently are caused by enlargement of the liver. First, as they may be given in such quantities as to prove strongly cathartic, of which more will be said in the article on invertentia; and then, when their purgative quality ceases, like the effect of rhubarb, their absorbent quality continues to act. The salts of mercury, silver, copper, iron, zinc, antimony, have all been used in the dropsy; either singly for the former purpose, or united with bitters for the latter, and occasionally with moderate but repeated opiates.
8. From a quarter of a grain to half a grain of blue vitriol given every four or six hours, is said to be very efficacious in obstinate intermittents; which also frequently arise from an enlarged viscus, as the liver or spleen, and are thence owing to the deficient absorption of the lymphatics of that viscus. A quarter of a grain of white arsenic, as I was informed by a surgeon of the army, cures a quartan ague with great certainty, if it be given an hour before the expected fit. This dose he said was for a robust man, perhaps one eighth of a grain might be given and repeated with greater safety and equal efficacy.
Dr. Fowler has given many successful cases in his treatise on this subject. He prepares it by boiling sixty-four grains of white arsenic in a Florence flask along with as much pure vegetable fixed alcali in a pint of distilled water, till it is dissolved, and then adding to it as much distilled water as will make the whole exactly sixteen ounces. Hence there are four grains of arsenic in every ounce of the solution. This should be put into a phial of such a size of the edge of its aperture, that sixty drops may weigh one dram, which will contain half a grain of arsenic. To children from two years old to four he gives from two to five drops three or four times a day. From five years old to seven, he directs seven or eight drops. From eight years old to twelve, he directs from seven to ten drops. From thirteen years old to eighteen he directs from ten to twelve drops. From eighteen upwards, twelve drops. In so powerful a medicine it is always prudent to begin with smaller doses, and gradually to increase them.
A saturated solution of arsenic in water is preferable I think to the above operose preparation of it; as no error can happen in weighing the ingredients, and it more certainly therefore possesses an uniform strength. Put much more white arsenic reduced to powder into a given quantity of distilled water, than can be dissolved in it. Boil it for half an hour in a Florence flask, or in a tin sauce-pan; let it stand to subside, and filter it through paper. My friend Mr. Greene, a surgeon at Brewood in Staffordshire, assured me, that he had cured in one season agues without number with this saturated solution; that he found ten drops from a two-ounce phial given thrice a day was a full dose for a grown person, but that he generally began with five.