The Action of Medicines in the System

ake on this subject are divisible into Ten P

stomach, and before their passage into the blood. Some broad rules are laid down by which the cours

of the body. Of these, the fifth specifies their general course. The sixth states that they may undergo certain changes i

undamental rule of the action of medicines

obtain entry into the blood, or internal fluids o

roduction of its peculiar action. It will be seen that the only apparent exception to this rule consists of

nal fluids. In the great majority of instances it enters the blood directly. But we know that it would be sufficient for its operation if it were to enter through the chyle, or into the

and third propositions. What we have now to decide is, whether a medicine acts by mere contact with the stomach, its influence being propagated to distant parts by means of the nerves; or by passage then

em elsewhere acts in the same way a

by friction to the skin will produce salivation. Extract of Belladonna applied to the temples causes dilatation of the pupil of the eye; and tincture of Opium dropped on the eyeball causes the pupil to contract. Ammonia inhaled as gas into the lungs will relieve fainting in the same way as when swallowed. The breathing of Prussic acid, causing its vapour to be applied to the pulmonary surface, is sufficient to kill. Prussic acid, dropped in a concentrated state into the eye of a dog, causes speedy death. Solution of Aconitina, applied to the skin, will produce numbness, and tingling of distant parts. Injec

ry for the propagation of such effects

to a surface, it can operate on the remote part only by its contact with the superficial extremities of the nerves. For vascular connexion to be established, it m

pted, the action cannot be propagated along a nerve. If, on introducing poison into an extremity, a cord be tightened round the limb above it so as to intercept the flow of blood, no effect is produced. It takes effect after the ligature is relaxed. Sir B. Brodie introduced Woorara into the leg of a dog, which was connected with the trunk only by means of the principal nerve, carefully dissected out. No effect followed. M. Ehbert found that poison would not act when applied to an amputated limb connected with the trunk by a nerve only. Thus vascular connexion is necessary; whereas continuity of nerve is not necessary, neither is it sufficient by itself.[19] Woorara poison is a substance which acts with great rapidity on the nervous system; and if i

o account even for the operation of those poisons wh

Poisseuille, Dr. Blake found that a chemical substance traversed the whole circulation of a dog in nine seconds, and of a horse in twenty seconds.[20] The results of Hering were simila

es effect, allows sufficient time to elapse for the blood to conduct it to the brain. Blake made an interesting experiment upon it. He placed some on the tongue of a dog, having first fitted a tube into the la

point; that vascular connexion is required for this action; and that the r

some may object that no conclusions on this point can be drawn from trials made on isolated and exposed nerves. So we may imagine a person to be still incredulous as to the truth o

been detected in the blood, and fou

ly detected Chloroform in the blood. (Journal für Prakt. Chem. 1849.) Dr. Golding Bird observes that Indigo, when given for Epilepsy, has turned the urine blue; that Logwood also passes into it, and causes it to give a dark precipitate with solutions containing iron; and that during a course of Copaiba or Cubebs, a resin may be precipitated from it on the addition of Nitric Acid. If a me

ments made by Dr. Garrod and others on the action of animal charcoal as an antidote, furnish again an additional confirmation of this fact. He finds that if a sufficient quantity of this absorbing agent be introduced into the stomach before time has been allowed for the passage of a med

ed. It will be shown that medicines, having already passed into the blood, must

st be made on a subject which will be again refer

the affirmative. Suppose a Cantharides plaster be applied to the surface of the chest in a case of Pericarditis, so as to redden or blister the skin, absorption of the fluid in the pericardium may follow this application. But any other irritant would have done this. It is not the proper or peculiar action of Cantharides, but an operation of the nervous system which follows the local change. Such agents are said to act by Count

, e.g. Ophthalmia. This revulsive action, when carried to an extreme, so powerfully impresses the nervous system, that it puts a stop to all other actions, and produces Syncope or Death. This extreme action is called Shock. Powerful corrosive poisons may effect this by a sudden destruction of the mucous surface, operating like a surgical injury. But

estinal secretions, and pass without material change, by a process of absorption, through th

process to which the names of Absorption and Endosmosis have been applied. Immediately outside this membrane, and between the tubes and cells which are formed by its involution, is a close net-work of very small veins, having thin and delicate walls. Now the same forces, whatever they be, which conduct the medicinal solution through the mucous membrane, cause it to pass on through the fine walls of these vessels. The two membranes, lying in such juxtaposition, are to all intents the same as one.

tion, of the gastric and intestinal secretions. 2. The laws of this process of Endosmotic absorption, and how they are fulfilled in this case

e years by the decisive experiments of Spallanzani and Réau

t the reaction was due to free Hydrochloric acid. But it seems more likely that it is due to Lactic acid. Such at least is the opinion entertained both by Liebig and Lehmann. Now the result of the action of this fluid is to dissolve down the solid materials of the food, or other substances

is also said to be alkaline. That the stomach is absorbent may be proved by the experiment of placing a ligature round the intestine of a dog, just below the pylorus. It is then found that soluble substances placed in the stomach pass rapidly from it into the circulation. It is probable that all substances which are easily dissolved pass through the coats of the stomach.

ons. In the first place it appears from the researches of Bernard and others that the lacteal system is a special arrangement for the absorption of fatty substances, and that other matters, such as albuminous compounds, pass generally into the veins, and thence to the liver. Besides, it seems that these lacteal absorbents are only in action during the digestion of food, when the epithelium on the surface of each villus becomes loosened, in order to allow to the chyle an easier access to the lacteal within it.[21] So that it is likely that a small portion of a fluid or soluble substance would be insufficient to rouse them to action. An

soluble state certain medicines that are insoluble in the Gastric secretion, and may

to the manner in which this medicine gains admission into the blood. In the first place, it must be in a fluid state, or it canno

pass through an animal membrane, has been named by Dutrochet Endosm

o alcohol more rapidly than alcohol to water. 4. The motion of the fluid on one side promotes the passage through of that on the other, because it is carried off as fast as it permeates the membrane. This also will cause endosmosis in defiance of the first law. This may be proved by a simple experiment. Let a large vein, cleanly dissected, be attached at one end to the stopcock of a vessel containing pure water. Let it then pass through a basin containing a strong solution of Ferrocyanide of Potassium, and let the other end hang over a jar filled with a solution of the Sesquichloride of Iron. If the cock be now turned, and wate

bject to about the same physical conditions of absorption as those which are thus

so with the third, as the serum of the blood mixes readily with all watery fluids. The fourth, viz. the condition of motion, is of great importance; for by it the motion of the contents of the capillary vessels will tend powerfully to determine the passage through of the liquid on the other side. Fifthly, the influence of pressure on endosmosis is one which is certain

now seen where and how they are absorbed. But it still remains to be seen what particular substances or clas

go solution and absorption in the intestinal canal. They comprise t

bstances solu

bstances solu

stances solubl

products solu

substances rendered solu

nous substances s

een already stated. When solid they are first dissolved, when in a dense solution diluted down by the gastric fluid before they are absorbed. Thin watery liquids are quickly taken up. Motion on one si

that an ordinary saline purgative of greater specific gravity than serum (1.028) acted by causing the passage of this serum outwards into the intestine, producing a wat

former. Analogy is certainly against this theory. Other purgatives from the vegetable kingdom produce their effect when injected into the blood, and are yet often powerfully hydragogue. What effect on the process of endosmosis can be exerted by Castor or Croton oils, or by calcined Magnesia? On turning to what we know of the theory of digestive endosmosis, we find that the solid parts of the food are diluted down so as to be absorbed, and that the influence of pressure is to be taken into calculation. It was laid down by the great Boerhaave that a necessary requisite for the formation and absorption of chyle was the contractile force of the viscera. (Van Sweiten's Comment, vol. i. p. 290.) This, in fact, would press the fluid into the absorbent vessels, even if against the other endosmotic forces. Further, a fundamental principle was insisted on by Dutrochet-that even when the liquids on the two sides varied in density, they would both pass through to each other, though in d

. It contains in each pint 192.8 grains of solid matter.

nts are about 3.5 per cent. But Dr. G. Bird says that less tha

made the following experiments. As far as they are concerned, they seem to show that salines are in all cases absorbed, and that whether they ar

into a small vessel containing the solution of sugar, and arranged so that the height of the two liquids should correspond. After three days, the inner solution measured two drachms more, and the specific gravity had sunk to 1.050. The outer solution, after making up exactly the loss by evaporation, was found to have risen in density to 1.040. On adding a small quantity each of the solutions of phosphate of soda and carbonate of ammonia,

an. It produced, after some time, slight purging, and some diuresis. The urine, when tested, contained only a very little more than the usual quantity of ma

y purging. The urine did not seem to be increased, and contained no excess of magnesia. It seemed, that in spite of the dilution, the quantity of the salt was so l

The solution then contained about twenty per cent. of the salt. According to the endosmotic theory, it should have caused only slight purging, on a

y go, to cast discredit on the theory of Poisseuille. It will be ver

substance should not be absorbed-it being, moreover, proved, by repeated experiments, that they

e condition of a soluble one and thus absorbed. Now the gastric juice is acid. This secretion has been variously ascribed to free hydrochloric, acetic, phosphoric, and lactic acids; a

Iron and Silver, the carbonates of Lime and Magnesia, and other medicines of the same kind. They would be slightly modified, being absorbed in combination with the (lactic) acid of the stomach. In this they would differ somewhat from the substances already solubl

scape its influence, being propelled onwards by the muscular contraction of the stomach, it follows that insoluble substances of this kind are much less active as medic

hough insoluble both in water and in acid, yet, being soluble

ill be shown in the proof of the next Proposition, that they cannot do so without being first dissolved. Therefore, there must be in the intestinal canal something capable of thus dissolving them. For this purpose these two alkaline secretions are well adapted. As an example of such mineral bodies, of which there are not many, I may ad

en up in great part by the stomach. Some vegetable matters-as Lignine, or woody fibre, and Resins-are insoluble in water. Starch even is comparatively insoluble,

o performed in the stomach. By digestion and concoction, with or without the aid of acid, it is enabled to dissolve out these soluble and potent matters from the ligneous and bulky tissues which surround them. For though the alkaloids themselves are in general almost insoluble in water, yet their natural salts which occur in the vegetable kingdom are mostly very soluble. The most important of these salts are as follow. In Cinchona bark, the Kinates of Quina and Cinchonia. In Opium, the Bimeconates of Morphia and Codeia. In Nux Vomica, the Igasaurate of Strychnia. In Aconite, the Aconitate of Aconitina. In Colchicum and Sabadilla, the

is Creosote, 1.25 parts of which dissolve in 100 of water. But this may be absorbed in another way, as will be seen presently. Volatile Oils and Turpentine come also under this head. They are all slightly soluble in water. The former, when given in small

e, constitute an aggregate which is called the watery extractive of a vegetable p

tters, and some neutral acrid principles, which, before they can be dissolve

class of matters which ar

nto the stomach. But the action of the gastric juice which contains an acid, and a peculiar nitrogenous material called Pepsin, -together with the temperature of the body, which is about 100°,-causes at length the gradual solution of these previously insoluble matters. This is found to take place out of the body when the above conditions are imitated with an artificial gastric fluid. The result of the process is a viscid fluid, which is then absorbed. The hard Gelatine of gristle and bone is not soluble in water at th

these are very soluble. From the researches of Bouchardat and others, it appears that other fluids, as the Saliva, the secretion of Brunner's glands, and the Pancreatic juice, possess also this

mbustion and resolution into carbonic acid. Thus the nitrogenous compounds are called the nutritive, and the starchy mater

able and animal products which can only be rendered soluble by a similar agency. Fats and oils, resinous matters, and some principles resembling resins, come under this head. Fats and fixed oils consist of acids, as Stea

secretions. But, after they have mixed with them, a milky fluid, called chyle, is formed, which is then taken up by the lacteal absorbents. It passes thence into the T

He states that no milky chyle is formed when the Pancreatic ducts are tied in dogs. He considers it absolutely necessary that saccharine and albuminous matters should be absorbed by the capillaries of the Po

ile, by virtue of the alkali which it contains, is an indispensable agent in the absorption

onification and solution of the emulsified fats. If it were not for this, this alkali would seem without an object; and further, it is contrary to all we know

aid of the Bile, fatty matters are first emulsified, in order to undergo an increase

al economy, that those substances which are not acted upon by an acid fluid should be subsequently subjected to the action of a free alkali, so that by the successive action o

y in most cases absorbed. They have been found in the blood, and detected when passing out in the urine. From this last they may be precipitated by an acid, indicating that they are held in solution by an alkali. In large doses they may not be absorbed, but by irritating the surface of the intestinal canal, may act externally as Cathartics, and be expelled by the peristaltic action which they exci

tharidin, Piperin, Pyrethrin, Colocynthin, Elaterin, and Capsicin, obtained from Cantharides, Pepper, Pyrethrum, Colocynth, Elaterium, and Capsicum. But it should be o

vision. Creosote, not very soluble in water, is easily dissolved in a fr

themselves very sparingly soluble in water, may perhaps be dissolved after having undergone this chan

tine =

cid = C

n

3O = C20H

of three atoms of Oxygen, produces Pini

to pass through the system into the urine. It is not likely that a large quantity should enter in solution in water. It seems more probable that it may first in some w

ther solutions, through the mucous membrane

ly into the veins, but through the lacteal system. It seems that the sole purpose of these lacteal vessels is to absorb fats. Thus it appears that all soluble substances, whether in the food or given as medicine, and in whatever manner rendered soluble, whether by acid, by alkali, or by stomach digestion, are absorbed in the stomach and intestines. All of them, with the exception of fatty matters, pass directly into the blood, traversing the mesenteric and

insoluble in water, and in the gastric and intestin

n undissolved state. But this is not proved; and besides, whether dissolved or not, we know that they are solu

the intestinal canal. This so much reduces the list of perfectly insoluble medicines, that it is difficult to find any tha

when substituted for the carbonate in some lead works at Paris, proved fatal to the foreman, who died of colic. M. Flandin found that it poisoned a dog when rubbed into the skin as ointment. Even s

ubt that many substances which are slightly soluble in the intestinal fluids may i

the capillary or absorbent vessels, is merely to state what follows from an absolute physical law,

Rationelle Medizin, 1847.) To obtain these results the microscope was used, a far less certain test in such matters than chemical analysis. ?sterlen reasonably concludes that, if charcoal can so pass, so also can any other insoluble substance. The necessity of solution could then at once be done away with, and the blood continually liable to admixture with all kinds of heterogeneous

ich is to discover if some of the most insoluble of our known remedies, which are yet known to obt

pulverized. The result was boiled for some time in water, and the insoluble part collected. It was dissolved in a small quantity of aqua regia, and the clear acid solution placed in a test tube. A slip of zinc foil was folded round a narrow plate made of gold foil, and introduced into the solution. A galvanic current be

some oxide) were given to another dog. He was killed after the same time, and the Portal blood analy

hen boiled on the insoluble part. This would convert any silver into chloride. The acid was evaporated off as much as possible, and the solid remainder heated in a small porcelain crucible to dull redness. The result was powdered, and digested in liquor ammoni?. I

lysis in preference to blood, as more likely to contain any insoluble sulphur. Besides, the blood would be less satisfactory, on account of the large quantity of albumen and fibrine contained in it, both of them also containing sulphur. The insoluble part of the chyle was obtained in the same manner as with the blood. It was then boiled in a small quantity of a weak solution of caustic potash. By

estion which seems even à priori more philosophical and reasonable than that which he has adopted. I believe that no

he mucous surface, either before absorption, or without

itant

ach An?

tant Ca

mach, such a power would be ascribed to those stimulants and sedatives which, from the suddenness of their action, are called diffusible. Such are Hydrocyanic Acid and Ammonia. Their rapidity of action is to be ascribed to their volatility, whereby they spread over a large surface, and are almost suddenly absorbed and transmitted through the blood. But Hydrocyanic Acid may be absorbed from

a remote action of another kind might occur as the result of a change in the nervous system produced by a powerful local impression. I stated that the term Counter-irritation was employed to express this action, the nature of it bein

hey also drain away the serum of the blood. It is not now within my province to consider such an action on the skin, any further than for the pur

e local actions that medicines are c

case with mineral salts, with the bitter and astringent principles of vegetables, and with acrid and resinous matters. By irritating the stomach locally, they ca

. In the case of the first, some erosion of the mucous surface may occur. By both kinds violent vomiting and purging is apt

metics and Purgatives, to get rid of the poison; and chemical antidotes, to neutralize it or render it insoluble while in the stomach. With this last object, acids are given in alkaline, and alkalies in acid poisoning. The soluble salts

use, which are employed for the purpose of producing a local effe

tion of others at a distance, so does local irritation operate on the surface of the stomach. On the one hand the muscle of the stomach itself is caused to contract, so that, the pylorus being at the same time forcibly closed, it tends to expel its contents in the wrong direction. On the other hand, a large set of distant muscles is thrown into sudden actio

the stomach, co-operating with it, and resulting, like it, from irritation o

which is supplied to these organs as well as to the stomach, and to cause vomiting by deranging its functions. By this action on the Vagus while in the blood, they excite, in a special way, the same reflex contractions which are produced, in the case of an irritant emetic, by irritation of the extremity of that nerve i

rt by their influence over the Vagus nerve. Irritant emetics scarcely cause nausea, pr

t emetics. They cause, by contact and irritation, a large quantity of the gastric juice to be poured out. This, toget

tered in the early stages of inflammatory disorders, and have been known sometimes to cut them short. But such an effect is much more likely to be produced by a specific emetic, which adds to this counter-irritant action the production of nausea, by which the force of the heart is powerfully depressed, and the pulse reduced. Tartar Emetic, the most powerful of these sp

absorbed, yet, in order to exert this particular action, it is not necessary that they should pass beyond the substance of the stomach itself. They do not seem to have any special or peculiar tendencies towards the stomach nerves. But if introduced into the

ucous surface of the intestine, and is probably the only astringent which is not absorbed. Being insoluble, its action is quite confined to the mucous surface. It may be given safely in very large doses, (as ?ss, or even ?j.) and it is likely that its an?sthe

hartics act differently. They are truly Eliminatives. They exert no influence over nerves, but they operate by passing out of the blood through the intestinal glands. Like Specific Emetics, they must be first absorbed. I will not now enter into the theory of Elimination, which I shall have to consider afterwards, but I wish merely to distinguish between local action on a surface, and specific action on a gland, exerted from the blood. Many substances used as purgatives are capable of absorption, and are absorbed. But it seems that they are not fit to remain in the

tomach, or injected into the veins, or introduced into the system at any part, equally produce purging. So also do Rhubarb, Aloes, and Senna. The principles

om the blood. It has also been shown that both from actual experiment, and from a consideration of the laws of the

ritate the intestinal surface, from the violent griping which often attends their operation. Thus Scammony does not act so well, and does not gripe, when the bowels are lined with mucus. Gamboge and Euphorbium are irritant in an extreme degree, and are therefore too dangerous for general use. The powder of Euphorbium resin has been used as an Errhine, f

a pruriens, metallic Mercury, and Tin powder, cannot be absor

should generally be conjoined with a medicine that tends directly to kill the parasite; for after that it will be more easily dislodged. For this purpose the root of Male Fern, Kousso, and the b

es of this kind, being at once a poison to

ce of the intestine, although apparently incapable of absorption. It has been used with advantag

d when they act on the mucous glands of th

be attributed to a power of checking the process of endosmosis, said to be possessed by a solution of Mor

ces which seem to act locally on the mucou

the action of some few before absorption, the greater part of our investigation remains still to be accomplished. The actions of medicines

e Fifth is merely an extension of the First Proposition,-in which the same rule is applied to the blood which was there proved of a surface,-and indeed follo

ermeate the mass of the circulation, so far as may be

o possible except

f sensation or pain

muscular contractio

they affect by means of the circulation. The experiments, already quoted, of Magendie, Blake, Ehbert, and others, show that even those medicines and poisons which tend most powerfully to influence the nervous centres

le that in the latter case they reached the part in the blood. Thus Morphia, Hydrocyanic Acid, Chloroform, and Aconite, benumb the superficial

parts and organs which they influence. Thus Alcohol has been

t to that part of the nervous system over which their power extends, whether it be cent

act on the blood, and on blood disorders. Nearly all of these have been found to exist in

attempt to show that the majority of those medicines actually pass through and are excreted by the glands which they affect. When Mercury is chemically detected in the secretions of the liver and b

tion-apparently a chemical one-cannot operate at all without tou

s such that two actions can be conducted along it;-an impulse producing sensation, or an impulse producing muscular action, at a distant point. It is known that an impression on the terminal extremity of a sensory nerve is capable of producing either sensation or motion at a distance, by what is called reflex nervous action. Though this impression must pass through the brain

of unstriped muscle, that when one part of a muscular organ is caused to contract, a wave of contraction is propagated along the fibres; and this action may even be extended t

r separately the tw

isease; and in the right shoulder, in disorders of the liver; are examples. Certain impressions on the surface of the stomach may cause such a reflex pain. Swallowing a piece of ice will sometimes produce pain over the brow; and it is likely that the headache which follows over-eating, or a large dose of a tonic medicine, may result in a similar way from mere irritation of the stomach. Any irritant, as a solution of Iron, Arseni

from one muscle to another in its neighbourhood. The first of these never results from the action of a medicine while in the blood; but it may follow an impression on a surface. Thus we have already seen that th

ltic contraction,-whose action may thus be extended to the contiguous Uterus in the female, causing it also to contract. This renders the employment of such medicines dangerous in cases of pregnancy, as tending to produce abortion. In other ca

a remedy in the blood. Yet it would not be reasonable to deny the bare possibility of such a thing. But such instances are at all events rare, and, being cases of the manifestation of their vital

ndergo change, which in some cases may, in others may

Combin

econstr

Decomp

se changes may materially affect their action, and in all cases they have some bearing upon it. With a view to this point I have divided these changes, somewhat arbitrarily, into three kinds,-of which the first does not hinder the effec

nly way of detecting changes in medicines, is by taking no

utralization does not destroy their influence. But it evidently does not; for in being neutralized they diminish in the blood, and in the system generally, the quantity of basic or of acid matter, and thus tend to alter the reaction of the secretions. Though an acid may combine in the blood with Soda, or with salts of Soda, yet by so doing it causes an excess of some other acid, probably an animal acid, which, b

n of the blood, and thus, by remaining free, Sulphuric and other

s, are taken up in the soluble form, in which only they are capable of acting. But we are now concerned with medicines in the blood. And here I must protest against the idea that all chemical affinities have free play in that liquid. If it were so, many of our most valuable medicines would be decomposed and rendered insoluble there.

he saliva, cause the formation of Sulphuret of Iron, while chaly-beates are taken, which blackens the f?ces;

but only some isolated instances have been verified. Thus Tannic acid, acquiring Oxygen, changes into Gallic. Benzoic and Cinnamic acids are converted into Hippuric acid, which passes out in the urine. Turpentine ch

ch a disarrangement of elements as shall ne

most important change to which all organi

y elements of the food, and with those parts of the nitrogenous tissues t

changed in the blood into alkaline carbonates. From being first neutral, they become

d. Acida, Alkalia,

medicines in the blood. These are rec

f H?matics, acting p

urotics, passing from t

ingents, passing

Eliminatives, which pass out

lled H?matics, act while in the blood, which t

ct by supplying, or causing to be supplied, a

so as to counteract a morbid material o

o the blood, and circulates round with it, ther

nerves, or the glands, or muscular fibre, and may use the blood only as a vehicle by which most readily and easily to attai

ho would fain have classed all medicines as stimulants or sedatives, differing only in the kind or degree of their action on the nervous system, have in many cases been obliged to confess that there is a set of remedies which they call "Alteratives," whose action, though slower, is more certain and more durable than that of the former. It is allowed that they alter the condition of the blood. To suppose that they do so by

H?matics, a simple and expressive term

that a medicine of this

, whatever their subsequent action, they exert a primary and apparent influence on the blood itself. A little reflection

ive. But these are all at the best but temporary measures. Unless the exigency be also of a temporary character, the disorder may soon return with unabated violence; again is the patient bowed down by its strong hand; again is the fatal termination seen looming in the distance but too distinct

rove of use in the cure of disease, I shall next have to show, while attempting

But I must first lay down a broad distinction between the two divisions of H?matic medicines. The dis

some principle or constituent of the blood, whic

there is an abnormal oxidation of the Proteinaceous compounds, possibly arising, as we shall see hereafter, from a failure of some principles which are the proper food of the oxygen. In diseases causing urinary deposits there is a want of those principles which should naturally retain them in solution. In typhoid fever the

hall know more of such matters, be found to occur in all cases. This division of H?matics I have named Restoratives (Restaurantia.) Their action, as we shall see, is in some cases apparent, in others more obscure. They restore the blood directly to its proper condition, if there is only a deficiency, but they do not in general seem to have the power of counteracting any mor

ng its wants. Thus Restoratives may remain in the system, and are intended so to do; but these may not remain. They must pass out. In so doing they come under the head of Eli

only alleviate. But others, more in number, and more commonly met with, tend naturally to run on for an indefinite period, unless by any means we can arrest their progress. Some depend on a contagious virus, communicable from one person to another, as Syphilis. Some, as Ague, are dependent on atmospheric or te

s, something that shall destroy the morbid influence at work, and thus restore health. Medicines that are used with this intention f

this considered as more than hypothetical. I would not speak positively of the action of any one of t

and affinities that distinguish it from all others. I have not thought that I could arrange them more truthfully than by subdividing them according to diseases which they tend to counteract. How inadequately is the action of Mercury and of Iodine expressed by calling them special stimulants

ricted to it alone. I have already said that a Catalytic tends of itself to work out a peculiar process in the blood. For this reason their administration in health generally does harm. They have nothing in the blood corresponding to them; or if so, they are not introduced to suppl

emain there to supply a want; but just long enough t

uents of the blood, a Restorative may become of use to supply this defect. Thus a cancerous or scrofulous condition may cause a deficiency in the red colouring matter of the blood, which may be supplied by Iron. When, as in Gout and Rheumatism, there is an excess of acid in the system, partly due to an absence of that basic matter which should be present to neutralize it, this ma

rent ways in different cases. Thus Potash may be a Re

at the vegetable acids may act as Restoratives in fevers; and also to explain why, of those medicines

is imaginative observer. This partial resemblance is probably due to the fact that both disease and remedy produce a series of changes in the same set of particles in the blood. If it were not so, the remedy could not meet the disease. It would be out of its province, as not acting at all in the same sphere. But that the

y. For though we know that many cases of convulsive disorder, as of Hysteria, Chorea, and Epilepsy, may be reasonably accounted for by supposing the existence of a wrong in the blood, which has affect

ct of H?matic medicines, but I am now about to attempt a

ify this proof, that part of the Proposition which relates to Restoratives will be divided first into a number of minor propositions, which, taken together, imply the original one. Each must be shortly proved applicable to each order of Restorativ

onsideration of the first d

ORAT

tive to their action, which will be acknowledged of most that I have here included-n

, which are all distinct and chara

aura

1. Al

2.

3. Al

4. To

. Chal

. Solv

cines, it will be seen that what has been there stated with respect to the action of Re

n the blood, and that th

ly in the blood substances whic

of necessity excreted, bu

a disease depends on the want of

reted in all cases, it is evident that their Restorative action could not be lasting. An exception must be made in the case of those that are used to supply something which is necessary in order that a secretion may be properly elaborated. Medicines of the Sixth Order are particularly used with this i

Restoratives, it will be my object to prove that these

I. Al

medicines of this division. Out of the materials of the food the who

chemical conformation. The second kind alone contain Nitrogen. The last two are both called carbonaceous; but those of the fourth kind con

ater

ine = C4

ch = C1

ic Acid

various matters are dissolved and absorbed in the prim? vi?, and how they pass into the circulation; that Proteinaceous and Saccharine matters pass into the capillaries of the Portal vein, and thence onwards thr

hese matters are required in the system,

the body, excepting Fat. This waste is continually going on. It depends upon the fact that, after having lasted a certain time, the particles of all these tissues are gradu

d, it undergoes a further change, the nature of which is not so clear. It is supposed to be into Lactic acid (C6H5O5, HO7) whose equivalent number is just half that of anhydrous grape-sugar, so that one atom of the latter may become two of the former. This important compound was found by Berzelius, in 1807, to exist constantly in the juice of muscle, as well as in the urine and sweat. (Annuaire, 1848, p. 347.) Liebig at first controverted this, but in 1847 he assented to the statement of Berzelius, which had alr

ion of the adipose tissues; and may also, like the l

oper function in the system. The albuminous material cannot be dispensed with; and is also the only food which will suffice by itself to sustain life. The

to exist in the substance of the liver when none was to be detected in the blood of the Portal vein which proceeds to it. His results have been mainly confirmed by M. Lehmann. M. Bernard states further, tha

e a thing as might at first be imagined. The study of this process is of great importance; and it appears to

of the duties that devolve upon the medical man, it i

rding to the severity of the case. But in Typhus fever long abstinence would be dangerous; the patient is in peril from extreme weakness and inanition, an

luid secretions; as the urine, to render less likely the deposition of gravel; or

ble substances in their natural condition. It is recommended to restrict it in the management of gouty or pleth

has been separated by washing. It is thought that if no starch be given, no sugar can be formed; but it is found that, though both the amount of urine and the quantity of sugar in it are diminished by this plan, yet the latter does not wholly

; but as the contrary seems to be the case with albumen, and it being impossible to wi

use in maintaining the heat of the body. In some constitutions there is a peculiar tendency to an abnormal oxidation of these materials into Oxalic acid. It appears likely that Cane-sugar i

Pancreas; as in that case they are not rightly digested. This is a rar

d separately in Chap. IV., mention will be made of several theories which have been propounded to account for its mode of operation. Liebig's idea that there is in Phthisis an excess of Oxygen in the system, would, if sufficiently supported, serve to explain its action when con

erent diseases; for by this means we are enabled, within a certain limit, to regulat

in a different form from that in which they entered; at that time, developing into tissues of high organization, they now decompose and retrograde into simpler bodies; at first fitted for life, they are now shaping for destruction. The disease

II. A

ic, and Phosphoric Acids. Vegetable:-Ac

super-salts of the alkalies,

an them, yet in their proximate effects they are similar. They are all soluble in water, and, when given as medici

anal, yet that they enter the blood as salts. He considers that they combine with free alk

s immediately increase the amount of acid in that fluid. The action of acids in the blood is very different from that of their salts. Sulphuric acid does not act like the sulphates of Soda and Magnesia, nor is the action of Hydrochloric acid the same as that of common salt. Again, we must remember that

lood. The mineral acids exist there in combination, an

c matter in the system, and an increase in that of acid. Thus a free acid may act as a Restorative in cases where there is an excess of alkali in the blood. It may either remain in the blood after entering into combination, or it may pass off by the urine, supplying there the place of a natural acid, which i

d may also occur in diseases of the nervous centres; or it may be caused by a decomposition taking place in the bladder, as in chronic inflammation, or in the case of retention of urine from any cause. In the former case the acid may act as a corrective to

tains an acid in excess. Now an acid medicine would set free in the blood more of this acid which it is the business of the stomach to furnish, and thus prove useful in that kind of dys

us vegetable acids act as diuretics; and mineral, as astringents to the glands generally. The latter, when given in excess, may prove hurtf

e remembered that its reaction is liable to great variations in health. The whole amount passed during a day should be examined together. Dr. Bence Jones states that

as Astringents; and I must now add a few words on that use of the

effects on the blood, would seem to belong simply to my division of Catalytics. But the effect of these vegetable acids seems to be to restore the blood to a more natural condition, and this independently of the action of the diluent with which they are administered. Now of this effect there is no certain explanation, but a theory,

the proper food of oxygen in the system. This, as we have seen, being the step between grape-sugar and Carbonic acid, must either be Lactic acid, or something similar to it. It must be remembered that no food is usually taken in fever; this would at length quite cut off the usual source of this lactic acid, which is the starch and sugar of the food, and render it necessary that

e = C40

acid =

cid = C8H4

ould probably be an exceptional case. Lactic acid, the natural fuel, being deficient, the alkali with which it should combine must be present in some excess; so it seems likely that a free vegetable acid would combine at once with this alkali as the Lactic acid would have done, and thus be burnt or oxidized instead of the latter. Its action would then be simply Restorative. Requiring less Oxygen than the Proteine would need to transform it into Carbonic acid, it would thus diminish the nu

converted into carbonates or bicarbonates, and thus reacting on the secretions as alkalies. And so in the same way it seems that the natural lactate of soda is formed into a carbonate, the carbonic acid being afterwards freed from the base, to be excreted by the lungs. But by this natural process the quantity of alkali in the blood would not be increased, nor would it be augmented

parently opposed in nature have proved useful in these complaints. On the Restorative plan, alkalies are the remedies required; for they neutralize the acid. But in spite of this excess of acid, some of the free vegetable acids have been used with advantage, particularly in rheumatic cases. We shall have hereafter to consider how far

s simple Restoratives; but Alkalies certainly operate as Catalytics in some d

II. Al

sia;-their Carbonates, and neutral

ating of those cases only in which they are used to rest

ty, and their appearance in the secretions; and that they

st said that it seems likely that certain conditions of the system may determine this oxidation, even in the case of the free acids.) Thus it may be easily shown how the neutral

+ 10 O=2 KO

___

O2) + (4 C

with eight of Oxygen, will make one equivalent of the bi

+ 8 O=KO +

__

2 + (2 CO

hese salts fulfil a double function. They may supply the respiratory process, as has

the secretions neutral and alkaline by increasing the quantity of basic matter in the system. Alkalies being more stable than acids, and being more invariably secreted by the kidneys, it is more easy to render the urine alkaline than to make it acid. Alkalies are thus of use in a tendency to lithic acid deposit. The bicarbonates are probably the best for this purpose, for they ma

y of bile. This is quite hypothetical, and depends upon a theory which has been shaken by M. Bernard. The same eminent authority states that Ammonia invariably enters the blood as a salt, and thus can exert no peculiar action beyond

ocess seems especially to have fixed itself. If we may receive a certain theoretical explanation of these two kindred diseases, still more light will be thrown on the advantage attending the employment of alkaline restoratives. To this I s

The most difficult case is that of the medicines used in ague and other periodic diseases; of these, for certain rea

eatment of ague, as Alkalies to Colchicum in gout; the former, in each ca

may render it again respirable by adding fresh oxygen; bu

IV. T

he bitter principles of vegetables. The ch

les.-Quina, Cinchonia, Bebeer

ba, Chiretta, Centaurium, Menyanthes, Rhubarb, Hops, Elm

petite, increase the muscular strength and powers of digestion, and improve the general health. In the second place, they have all, more or less, a curative power in Ague and other periodic disorders, caused by Marsh miasm. Many explanations have been given of this curious and double action of vegetable bitters; and some erroneous theories have been assumed, and false analogie

substances in the blood which resemble them? May they remain in the blood, or are they always excreted? If acting in th

ve done rightly in classing Tonics among Restorative medicines; for they coincide wi

ark comes nearest to the Cinchona alkaloids in its anti-periodic action. It is worthy of remark, that some common bitters which owe their e

able which contains them, if not by simple water, at all events by such an acid liquid as we find in the stomach. We possess positive proof

ut it does not seem to be so. Tonics, as we know, have the power of communicating health and strength in debility produced by various causes, and also of arresting the progress of intermittent fever. Do they effect these thing

the motor system of nerves, and through them on the muscles. But in a subsequent account of Quina, he states that its action is quite inexplicable,

at is more consonant with general experience, i.e. that a moderate dose of a tonic has little or no effect on a man in perfect health. Dr. Neligan admit

s edition of Dr. Hooper's Physician's Vade Mecum,) considers that Stimulants and Tonics should rightly b

ted in this way. Some too are met with who bear Tonics worse than others, on account of an idiosyncrasy or peculiarity of constitution. But this irritation, and the headache and febrile symptoms which succeed to it, do not surely constitute the proper action of a t

stimulants; quoting Strychnia as an example of a stimulant which gives tone to the muscular system. But, in the first place, this alkaloid is quite exceptional among stimulants; and further, the com

e head, ringing in the ears, and vomiting, seem to me to mark its action as an

tances which neither immediately nor sensibly call forth actions, like stimulants, nor repress them, like sedatives, but

s, that the supposed stimulant action of Tonics in some cases should either be attributed to the operation of the disease, or of some other medicine administered along with them; and that though in larg

aying that they act on the nervous system, have started with a mistaken notion; and I am more of the opini

re. It requires no particular state, but takes place in health: thus Alcohol stimulates and intoxicates both healthy and sickly, and Digitalis would subdue a Hercules. Most Neurotics are capable of acting without entry into the blood at large; mere contact with the nerves, as when they are app

idenced in health as well as in disease? Do they act on the superficial nerves, when applied to them? In each case the answer must be a negativ

ect any permanent improvement without first acting on the blood, if we may argue from known analogies. For Neurotic

before the presumption thus estab

rs in which Tonics are used are blood-dis

, scrofulous, scorbutic, and dyspeptic habits, the blood may be deteriorated by a fault in the assimilative processes. When in these instances there is marked An?mia, iron may be of most service; but when the blood is poor without any apparent deficiency of red colouring matter, then are bitter Tonics needed to improve its condition, and form a valuable adjunct to the special remedies that the case may require. They ought not, as a general

blood; and is to be cured by improving it. By so doing we may communicate tone

, and which produces regularly recurring paroxysms of a peculiar kind. There is apparently some disturbance in the great calorifacient process, in which the blood is concerned, and not the nerves. Each fit commences with shivering; there is then a hot stage; and finally sweating. The attack then goes off, seemingly as if the poison that caused it were eliminated in the perspiration. But it is not all gone. After working in the blood for a

nected with their origin. It can hardly be supposed that Goitre or Scrofula is ever caused by a derangement of the nerves. And yet Baron Alibert relates an authentic case of a French lady who had a large goitre, which for a long time resisted all treatment, but which never

remedies which influence the nerves directly, and that the diseases in which they act beneficially are ess

which treat of their action as Restoratives; to ascertai

fficulty, when it is considered how little information we have actually obtained respecting the chemical compos

t whereas the alkaloids Quina and Morphia resembled the brain substance in their chemical constitution, they were therefore enabled to exert a direct control over that organ by influencing its nutrition. But it is impossible to accept this explanation. The composition of the brain has been since more accurately investigated, and it has been shown to consist mainly of

inally excreted with the f?ces. He has found that if an enema of bile be injected into the rectum, it becomes absorbed there, and does not afterwards pass out into the urine.[33] (Animal Chemistry, p. 77.) What the exact function of the bile may be, is as yet undecided. Its most important constituents are, a non-saponifiable fat, Cholesterine; a neutr

loids. Of these he has singled out Caffeine, the peculiar principle of Tea and Coffee, as most analogou

e = C4

ne = C

to 9 of water and 9 of oxygen, will form two at

nd other constituents of this complicated fluid, certainly contain sulphur. But even if Sulphur be combined with Taurine, it is not clear that it enters with

ment of the bile is intended for re-absorption into the circulation. And without theorizing at all on the subject, it may readily be demonstrated that, with the existence in the blood of such a material as Taurine, we cannot say that we have not in that fluid an analogue to substa

tances which enter it are liable, it is certainly the process of oxidation. Fr

toms of oxygen, we could make out of it one atom of Tau

O = C4H7NO10

y does occur; but if it were to take place, we might gain, in this oxidation of Quina, some clue to the production of that quickening of the pulse and increase of the general temperature, which are affirmed by some to follow the ingestion of the alkaloid, even in smal

to Tonics as Restorative medicines, we pass on to the third. Are

number of careful and elaborate experiments on the passage of medicines into the urine have been made by M. W?hler, and in the long list of substances detected by him in that secretion, Quina is not mentioned. Neither has it be

ebility, ague, and remittent fevers. It appears that it has also been successfully used of late by Dr. R. Dundas, in large doses, in the treatment of typhoid or continued fever. Supposing it to be prove

e generally unnatural to the blood, and are excreted because they cannot remain in it. Besides, a Catalytic has generally some peculiar action on the blood in health; but a Restorative

pends evidently on some want in the system, and not on any morbid agent. Arsenic, on the contrary, is of use in Lepra, which, like other skin diseases, must be caused by some morbid agency

y be said to be liable to Ague, and none protected from its assault. But it is not the case with Ague as it is with Syphilis and Small Pox, which diseases most persons inevitably catch who are exposed to the virus for the first time in their lives. For, of a number of persons exposed to the same malarious influence, only a part take the disorder; some escape.

not Catalytic in their action; that they supply, or cause to be supplied, a material wanting in the blood. How this material is enabled to

I may venture to bring forward a speculation concerning their action, which I would not

g that among the natural constituents of the blood there is a substance which chemically resembl

d and other fevers. In these fevers the function of the liver is always more or less interfered with, though more obviously in some cases than in others. In strumous habits, in which generally bark is of signal service,-and was very strongly recommended by Cullen,

n Gout, in which the liver is

e admitted in the case of Dysentery, and of the Remittent and Yellow fevers of the tropics. It is also true of Ague. It seems even likely that the enla

t not unfrequently pass into continued fever, which seems to point to some analogy between the two. Ague even may pass into Typhoid fever.

e intermittent which occurs there, that it is known among the inhabitants by the

esemble Taurine; they tend to cure certain diseases; and these diseases depend on deranged hepatic functions. Does not this suggest the possibility that they may be of service by actually forming the Taurine,

roduct, the supply of which has been cut off by the hepatic disea

Mercury; used in remittent and yellow fevers; of the first importance in dysentery; employed by Dr. Baillie in Ague, and pronounced by him to be in some cases superior even to Quina. In small doses it is frequently of use in cases of debility and scrofula. And Mercury is a Cholag

Catalytics, is to deteriorate the blood. Even in scrofulous and enfeebled cases, small doses of blue pill or of Calomel are often signally useful; and not prejudicial, as is sometimes stated by those who confound their application with that of Mercury given in salivating doses. Under such a course, when judiciou

of so doing. I am very far from asserting that it is proved, or from supposing that it is at all likely to be so in the present state of our knowledge of the subject; but I think that if not evidently true, it appears at least reasonable. And it may be observed, that e

. Chal

the Carbonate; Protosulphate; Persulphate; Phosphate; Pernitrate; Perace

of the stomach; and we find that both are most active when given in the form of hydrate, which is most easily soluble in such a menstruum. Thus Chalybeat

ey are wanting in all the characters which distinguish nerve-medicines. They

that the red colour of H?matosin does not depend upon the iron which it contains. But however improbable this may be, it matters not here whether it be proved so or not; for it is sufficient that it is

the analysi

n = C44H

of the blood; for when it is deficient, as evidenced by the paleness of the tissues in

case in illustration of this is given by M. Simon, of Berlin. (Anim. Chem., vol. i. pp. 310, 313. Syd. Society.) The solid constituents of the blood, in a case of Chlorosis, had increased, under the use of iron, from 128.5 to 193.5 in 1000 parts; the Globuline from 30 to 90; and the H

age. The Ammonio-citrate of Iron was prescribed, in five-grain doses, three times a day. After it had been continued for a month, the blood was again analyzed, and the amount of corpuscle

in a fit and proper form, are not known. All the known soluble compounds of Iron, except the Ferrocyanide and Ferridcyanide of Potassium, possess this Restorative power. In most Chalybeates the Iron acts the part of a base; but in some, as the Ammonio-citrate and Potassio-tartrate, it exists in a peculiar c

ertain whether Iron given in small quantities is excreted by the kidneys, I have tested the urine of a patient who had been for some

s membrane of the intestines, and combine in the cavity of the bowel with Sulphuretted Hydrogen. The resulting Sulphuret commu

ain under the head of Astringent medicines. The tincture of the Sesquichloride has obtained the reputation of being diuretic. But this constitutes no exception to the rule o

for neither in debility nor in Ague is it of any service, unless there is at the same time An?mia. In some cases, even of An?mia, Iron will not effect a cure. This must

lled by exosmosis of their contents, may be in a fitter condition to absorb the "ferriferous chyle." And yet, if so, the drinking of a single glass of water would probably be sufficient to swell out the corpuscles again, and thus put a stop to the process. It is just

these disorders, when they are unattended with An?mia; nor even then is it to be preferred to the other remedies specially appropriate in each case, but ought rather to be conjoined with them. Cancer, and granular kidney disease, may perhaps be alleviated, but are seldom cured. In Chorea, Arsenic or Quinine may be used, with or without Iron. Aloetic pu

s diet, with good air and exercise should be comb

I. Sol

ilit

utral salts with vegetable acids. Biborate and

hosph

getable acids.

cting like a foreign body in these sensitive organs. This urine, naturally clear and limpid, contains in it several substances which are by their nature insoluble, but are held in solution by certain other materials. But in some morbid states these latter materials may be wanting, or else the insoluble bodies may be secreted in such quanti

he blood into the urine. Although we are ill-informed as to the nature of the ordinary urinary solvents, yet it is evident that they must be present, because substances which are by their nature insoluble occur in healthy urine. And

ber of apparently dissimilar medicines are grouped tog

Magnesia, and the Phosphate of Lime. These deposits are each known by their peculiar form under the microscope.[35] They may easily be separated from the urine, when in any amount, and tested chemically. The Lithic deposits, (i.e. Uric acid and Urate of Ammonia,) are entirely dispelled b

l reaction of the blood, causing these matters to be deposited, without being themselves in excess. (3.) The suppression of another

tion of Lithic acid. Sour drinks may cause a similar deposit, by rendering the urine acid; and sweet fruits, containing vegetable sa

y some matter of an alkaline nature.[36] When this alkaline matter is neutralized by an acid, the Uric acid precipitates. This may perhaps be caused in Rheumatic fever by an excess of Lactic acid. The Phosphates are held in solution by Phosphoric acid, or by that matter which gives to healthy urine its slight aci

ds and alkalies have already been mentioned as efficacious in these instances; the former in phosphatic, the latter in lithic deposits. They directly neutralize the disturbing cause; the alkali, or the a

acid, probably lactic or butyric; and when it is suppressed, the secretion of this acid is thrown upon the kidneys, and the urine is rendered

sits produced in the fourth way t

tity than in health. Now the system labours to excrete them in solution, even when in excess; and often succeeds in doing so. But frequently this can

we may adopt either curative or palliative remedies. We may aim at the cause of the disease, which is generally in the blood. An absolute excess of Lithates may be caused by dyspepsia, or by a gouty disorder. This is most surely controlled by a Catalytic medicine. (Vide Antiarthritics.) An absolute excess of Phosphates may be caused by an orga

e peccant matters, pass out with them into the urinary secretion, and hold them there securely in solution. Such an agent may often be advantageously combined with the Catalytic remedy, which tends to cure the systemic disorder. It is a blood-medicine. Its action is so far permanent, that it effects its object definitely, dissolving and carrying away a

water-drinkers are never afflicted with stone. All the urinary deposits are, to some extent, soluble in water, although comparatively insoluble. Whenever the

mineral acids, although Phosphoric has been recommended on theoretical grounds. Sulphuric is the least efficacious because it does not always pass out in the urine. (Vide Chap. IV.) Sour fruits, as Currants or green Gooseberries, may be useful in phosphatic cases; but ripe fruits have an opposite tendency. Acidulous drinks may be recommended, as Cider, Perry, and Rhenish wines. Of the free alkalies used to dissolve a lithic sediment, Potash is preferable to Soda, because it forms a more soluble compound with Uric acid. The Bicarbonates of the fixed alkalies are best, because least

r a condition of an opposite nature to that which they were intended to alleviate. An acid may at length cause a lithic deposit in the uri

se efficacy is a proof that the occurrence of a deposit in the urine is not a mere question of the preponderance of acid or of alkali in that secretion. The

een of Hippuric acid, be dissolved in a pint of hot water, and to this soluti

olving Uric acid, and has been recommended in the trea

ther the formation of the Uric acid in the blood is prevented, as supposed by Mr. Ure, or whether it is not simply held in solution by means of the Hippuric acid, is not clear. Dr. Golding Bird recommends also

increase the quantity of the fluid part of the urine. It is observed by Dr

n already observed, they require, even when successful, to be perpetually administered, or else the deposit will recur. For

rbid process by which they are continually produced. This cannot be done by a Restorative, but

rative medicines; all of which are seen to

st of all known medicines. And when a morbid process results in a diminution of the amount in the blood of some necessary constituent, then also may a Restorative

cure can only be effected by a Catalytic medicine, which shall be cap

action. The most important of these are Alkalies, which are of use in general inflammation, and al

of counteracting a disease, I have preferred to place it among Catalytics, rather than to includ

ency. Those which are treated by Restoratives are just as evidently remediable by th

ALY

s applied to them on the assumption that their operation in the blood resul

d-medicines have been stated at length in the remarks on H?matics in gene

ed Catalytics, act so as to counteract a morbid ma

in dim explanation which we may catch hold of, and strive to fix or to render definite, yet in many instances there is not even so much as this. How can we, for example, by any of the common terms which are made use of to designate the actions of Mercury, of Arsenic,

nsible, as the only secure foundation, in such a manner that it shall be incapable of being disturbed by the flimsy superstructure. Some philosophers have erred in this; that they have first, with much pains and labour, erected an airy fabric on a b

cial and peculiar kind, which I think will not be denied, I have grouped them in ord

aly

Antiphlo

Antisyph

Antisc

Antiar

Antisc

Antipe

Antico

Antisq

employed in Scrofula. The fourth, those that are found to be useful in the cure of painful affections of the joints, as Gout and Rheumatism; and also of Oxaluria, Lithiasis, Diabetes, and other disorders of secondary assimilation. The fifth order contains those that are useful in

re have less to say about them individually, and shall not go so much into particulars. That par

n the blood, and that th

f tends to work out a pecul

they are used depend on certain morb

ytic medicine is in some way to neutralize or cou

all unnatural to the blood, and mu

her to prove the disease to be a blood disease. And the evidence of counteraction will be rendered stronger if we can prove that the medicine employed is itself capable of setting up in the blood some peculiar process-of causing in it a change of some special kind. For, were it not to do so, we could hardly underst

he truth. In the second place, it will be convenient to enumerate the medicines contained in the orders named above, and to proceed to prove the minor propositions of Catalytics taken altogether. A considerable amount of difficulty attaches to this consideration;

who has reflected on the subject, but it is nevertheless true, that the majority of authors have taken no notice whatever of medicines acting in the blood, with the exception of Acids and Alkalies, which are grouped by some as chemical remedies. All other medicines

er and to pass through a fluid which is still more complicated and changeable in nature than themselves, yet that while so doing they produce no impre

wn as a rule that they produce, in the first place, an impression on the nervous system, and that this has subsequently the effect of altering the manif

ytics. The permanency of their effects, and the fact that the disorders which they cure ar

more lately, of Drs. Ballard and Garrod, the existence of a class of

h form the basis of mine. Thus he takes no notice of the questions of what their ultimate destination may be, or what their primary modus operandi, whether they have to remain in the blood, or to pass out of it, and whether they can act by supplying a material to it, or by neutralizing a material in it. The subsequent statements which Dr. Pereira has chosen as the basis of his subdivisions, founded often on therapeutical action, seem in certain cases to be somewhat problematical. Thus he calls Acids "adipsa," or thirst-quenching, which very imperfectly expresses their action. Alkalies are grouped with Salts, Iodine, an

en used in Syphilis, and considers that they must all operate in a similar way, both in this and in other disorders. Yet are all these medicines of use or advantage in Ague, in Lepra, in Chorea, and in Scrofula? But why is it not so, if all act in the same way? Their several actions should exhibit no difference in kind, but only in degree. It is the opinion of the same able authority that Mercury and Iodine diminish morbid growths by starving them; that they cut off the supply of blood

these disorders the capillary vessels are dilated. But let us even admit that it is so proved, and we are not then nearer to

els are not nearly so much under the influence of such agencies as Dr. Billing would seem to imagine. In these experiments the solutions were concentrated, and applied directly. But in the cases in point we might have two or three grains of Iodide of Potassium, one-tenth of a grain of Arsenite of Potash, or one-twentieth of a grain of Bichloride of Mercury, diluted down by about

me malady? that Iodine and Potash are each peculiarly adapted to scrofulous cases? or that Colchicum will often stop a fit of the Gout when other medicines have failed to relieve it? If we cannot deny it, we must admit such actions to be in some degree specific. To adopt this term is to a certain extent to confess our ignoran

ollectively, I must enumerate the chief remedies which I intend to include in the

s. Antimonials; Mercur

als; Preparations of Gold; Iodid

odine; Bromine; Chlorine; I

Colchicum; Nitro-hydroch

c Acid; Lemon-juice; Fresh Ve

ious Acid; Arsenite of Potas

eparations of Arsenic, Silv

. Preparations of Ar

dicines may cure some of these disorders, or at least alleviate them; either by acting as Restoratives, as in the case of arthr

s that they move, as it were, in the same sphere, for else one of them could not meet the other. However the operation of a medicine may sometimes seem to resemble that of a disease, it is always in effect contrary to it. The similarity is of a kind which does not concern us. An acid

f the second minor proposition, I shall attempt to show that each of these remedies has a peculiar action of its own on the blood, even in health; which cannot be said of Restorative medicines. Of all these Catalytics two things are known. When they cure a disease, they do so definitely, so that it does not in general tend to return; and when they only alleviate it, the improvement effected is more or less permanent. In the second place, they are found to produce, after being long administe

tself to work out a pecul

ch Catalytic medicine. It will suffice to demonstrate this if I condense into as few words as possible t

er which stamps them at once as likely to be us

h it in quantity. On this principle they were proposed and used successfully by Mascagni in acute inflammations. Their efficacy in retarding the formation of crude deposits in scrofulous and tubercular diseases may possibly be assig

one another. This may partly explain their action; for in inflammatory blood the corpuscles display

; and probably promotes absorption by preventing in this way a further deposit of lymph. If the blood be analyzed after the continued use of Mercury, it is found to contain less Fibr

es a pustular eruption; and M. Lepelletier gives a case in which it did this when administered only internally. Magendie found that when given to dogs it produced engorgement, and often inflammation of the lungs. Antimony seems to exert a blo

The divisions of H?matics differ in this: Restoratives act by being in the blood; Catalytics by worki

ten employed. But as far back as the commencement of the eighteenth century the administration of Gold in syphilis was strongly recommended by Dr. A. Pitcairn. He employed the pure m

Potash. This medicine is very active in causing the absorption of syphil

terative action in the blood; but this is not v

mptoms to which the collective name of Iodism has been applied. The most prominent are-coryza, itching, watering of the eyes, fever, and great constitutional depression. It

Bromine and free Chlorine are very a

xcretion of Uric acid. (Vide Antiarthritics, and Chap. IV.) Nitro-hydrochloric acid contains Chlorine, which is an oxidizing agent, and probably exerts in the blood an action of this kind. It is clear that it is capable of retarding the

the former in great excess. Now either of these by itself would, in cases requiring it, and given in small doses, act as a Restorative. In large doses, Citric acid would disturb the reaction of the secretions, and

ride, and the Arsenite of Potash, are the preparations most frequently employed. Arsenic produces an evident action in the blood. When given in slight excess, it is apt to bring on ?dema of the face, and redness of the conjunctiv?. Besides causing various nervous disorders when in large doses, its continued

of nervous symptoms, tends to bring on a kind of jaundice, with general wasting of the body. Chronic poisoning by Zinc and Copper resembles that by Lead. The symptoms of what is called "Zincal

llic medicines, gives a strong additional probability to the belief that these disorders, when o

n is not well made out, or understood. Sulphur, besides its use externally in Scabies, is administered internally with advantage both in this and some other skin diseases. It effects changes in the blood, inasmuch as

and affect the condition of that fluid. But I am very far from believing that this known operation is in all cas

. Catalytics may not remain beyond a certain time; their office is counteraction. The system then labours to excrete them. Before passing out of the body, one or two, as Colchicum, may act on the nerves. In the moment of excretion, the majority act as Eliminatives. But some, as the metals used as Anticonvulsives, are astringent, and diminish secretion

t the third min

se medicines are employed

ong, for in most cases the correctness

al or internal. It commences in the capillary vessels, and, if extensive, affects the blood generally, and produces fever. The blood then contains an excess of Fibrine, causing it, on coagulation, to exhibit the "buffy coat." There are also found in this, according to Mu

m of the infected person, if left alone and uncontrolled, it breeds and increases in quantity, works out all the mischief that it is capable of e

ble from parent to child; and it holds good as a general rule that hereditary diseases are seated in the blood.

fuse sweats, in which the natural acid of the perspiration is enormously increased in quantity. It is stated by Berzelius to be lactic acid. Either this, or some other acid like it, must be formed in excess in the blood. In Gout we have sometimes a deposit of urate of soda in the cellular t

ficiency in the amount of Fibrine and of salts. There is a general tendency to h?morrhage and ulceration all over the

Maremma and of the Pontine Marshes, in Italy, brings on very fatal fevers; while the remittents that are due to the exhalations from the ground on the West coast of Africa, and in the West

lesion. When this is the case, as in the instance of Tetanus, which may arise from a mere irritation of the end of a nerve, they are extremely intractable, and are not at all under the influence of those blood-medicines which are useful in other cases. Epilepsy, too, may sometimes be due to

a. Tetanus even depends very much on certain atmospheric conditions. There are sometimes, as it were, epidemics of Tetanus, in which the slightest abrasion will suffice to bring it on among the people residing in a particular neighbourhood. It is often rife in one district a long consecutive time. Facts like this must certainly be regarded as pointing to a condition of the blood as one, at least, of the caus

ificial illustration of this action. Lead, Copper, Mercury, and Arsenic, by their presence and operation in the blood, are capable of causing severe and chronic nervous disorders, particularly Paralysis and Epilepsy. Many of the vegetable Neurotics, after their passage into the blood, bring about transient nervous symptoms which are identical with those of disease. Thus Opium

the blood by employing one of these mineral Anticonvulsives; or we may simply apply our remedies to the ner

eous eruption is the most apparent, or the only obvious symptom. The true squamous disorders are Lepra vulgaris and Psoriasis vulgaris. The causes of Impetigo, Porrigo, and Scabies, are probably similar to those of the true squam?, for they are often curable by similar remedies. The actual eruption of Porrigo is accompanied by a parasitic fungus, which may sometimes be transmitted from one person to another

accounted for by a process in the blood. The fourth minor proposition will not be so

the neutralization or counteraction o

to be blood-diseases. Thus it is clear, that if the former counteract the latter, and have no action on the nerves, they must do it by some agency in that fluid, over the particles of which both exert an influence. They are

he latter may remain in the system, for if they did not do so, they could restore nothing to the blood. But Cataly

the blood, and must at len

in the system and act as Restoratives, when there is a deficiency in the blood of similar materials. But even these substances, when given in large quantity, as is the case when they are used for Catalytic purposes, are unnatural to the blood, and must be excreted from it. With respect to the other

rhaps, except the salts of lead, zinc, and copper. Doubtless some are excreted partially or entirely by the mucous membrane of the bowels, but this we cannot so readi

detected by chemical means, have actually been discovered in the blood. But the system will not, if it can be avoided, suffer them to remain there long. The glands are charged wi

e combined, so as to form salts; the vegetable salts are decomposed; Sulphur has changed into Sulphuric acid; and the metallic bases are found to be variously combined; but all the fixed inorganic materials remain essentially the sam

that I have ventured to affirm of this group of medicines is, t

cury also is a poison in the blood. But why does Mercury antagonize and annihilate Syphilis? The case is the same with Scrofula and Iodine; with Lepra and Arsenic. It is very humiliating to be baffled when we have

e working of the Catalytic may operate so as to counteract this already existing action, being so far similar to it, that it acts in the same department, an

e inmates of a large military hospital, with great apparent benefit, as it is said. These poisons are unlike in their results. So are Ague and Phthisis; and persons who have had Ague are said to be less liable to Phthisis than others. Again, we find that one attack of an eruptive fever pres

into the uncertain r

are, the change of albumen into fibrine; the changes which take place in the starchy matters of the food before they can be oxidized into carbonic acid; and the changes that must occur in nitrogenous substances before absorption, as well as those that accompany afterwards the downward progress of the same materials, from living tissue into Urea and U

a special fashion peculiar to itself alone, and the gradual elimination of certain products, also peculiar to this one operation, are circum

tation; or that it might simply determine the latter in a different direction, and thus bring it to a desirable end. Acting in health so as to pr

ulars. Are we in a position to be able to indicate the actu

wo kinds of fermentation. In one the ferment itself is undergoing change, and impresses a similar change upon a substance which is analogous in nature to itself.[39] The process caused by a contagious disorder w

atinum causes the combination of oxygen and hydrogen, and exerts generally a powerful influence over the affinities of gases and liquids, without ever itself undergoing any change. The influence of Emulsine, in

. The influence of contact is the one which they would be most calculated to exert. I may remark that I have used the term Catalytic without any reference or allusion to this sense, in which it has been frequently employed, but merely

alter and destroy a morbid process somewhat similar to that which they themselves excite; or they might, by simple contact, be able to resolve this process into a natural direction. We have seen that when introduced into healthy b

nsiderations that render such an idea

ws, and influences, such as we may meet with out of the body; but a very complicated mixture, which is ever circulating and being maintai

he chain of conditions of one of those inconstant bodies wh

mentous, which an organic body is capable of undergoing, if

brought in contact with water, becomes Bicarbonate of Ammonia. Two equivalents of Cyanic acid, uniting in one compound, produce Fulminic acid. This, if combined with the oxide of Silver or of Mercury, forms a compound which is caused by the slightest friction to explode with terrific violence. If to the elements of this dangerous acid be added those of two equivalent

produced among the elements of U

ulating blood, which is at a heat fit for such processes; in which also is a considerable quantity of free oxygen, as well as soda, ammonia, and other elements, in a state

. Neurotic medicines appear to act by their mere presence, contact and excitation. This may not always be the case with Catalytics. Their power cannot in all cases be clearly accounted for by a simple and direct influen

poisons of contagious fevers, each of which can reproduce itself out of the elements of the changing or fermenting body. For Antimony, Mercury, and Iodine could never make themselves out of blood, which does not contain them. Like the Emulsine in the production of Hydrocyanic acid out of the material of the bitter almond, they must b

forms no part of the Proposition in which I have defined their mode of operation. In the present state of our information on the subject, we ca

tances, be partly explained by certain chemical considerations

e individual modus operandi of the substances include

Proposition, it will not be found necessary to travel over again

Antiphlo

the circulating blood-exerts a powerful influence over the nervous system, and may, by

ate of things. We may produce an action on the nervous syste

d in its Neurotic action. Employing it in large doses, we may produce a powerful effect upon the nerves which supply the heart, and thus, by diminishing the impulse upon the inflamed parts, or on the vascular system generally, promote absorption and

ng the pain and nervous irritation which are so much to be dreaded, Opium may be employed to prevent a blood-medicine from passing out through the bowels. Antimony and bleeding are appropriate in

n Catalytic remedies belonging to the present order, are e

ions, but act indirectly on the heart, in the same way as the medicines last spoken of; and they probably also promote the passage of morbid or of peccan

t on the heart and circulation. Mercury exerts no such immediate influence. Diminishing the Fibrine of the blood, and having other operations of a peculiar kind in this fluid, it powerfully promotes absorption and counteracts effusion, in all inflammations. The blood

le to Mercury. But in Pleurisy-where there is generally no immediate danger to be dreaded, b

at it has taken sufficient effect; but it may sometimes be better to give such a dose as shall cause vomiting, especially when a violent counter-irritant action is to be desired. The increase in the qu

ey have sometimes been employed with advantage in fevers of the acute or sthenic kind. Exerting an influence over the inflammatory process considered per se, Alkalies and Mercurials a

y both exercise a solvent power over Fibrine, and keep asunder the corpuscles which tend to adhere together in inflammatory blood. This latter action has been observed by Mr. Gulliver. Salts are excreted, and act on the skin, or the kidneys, or the bowels. They are not so potent as Alkalies; for salts pass out of

Antisyp

he blood results in the counteraction or

ruptions,-as syphilitic Lichen, Roseola and Lepra,-also i

Mr. Hunt, in a treatise on Syphilitic eruptions, maintains that Syphilis has a tendency to go on without limit if left alone

d, followed by a leprous eruption. But it is more in accordance with common experience to say that the only contra-indications to the use of Mercu

in the blood, of whatever nature that action may be, will meet and neutralize the advance of the syphilitic virus, preventing its further manifestation in a secondary form. It is rarely necessary to push its action beyond the first symptom of salivation; for that will be evidence that the system is sufficiently saturated with it. Beneficial

medicinal as well as chemical similarity between these two metals and their compounds. Even the insoluble metal itself was used some time ago as an Antisyph

ct a cure; but this failure is often due to the omission of Mercury in the treatment of the primary disease. It would seem as if it were not so much the real secondary syphilis, but a certain smouldering action of a part of the poison which has escaped the operation of

pid absorption that follows its exhibition, are sometimes fully a

specific influence over it in old syphilitic cases. If it were so, we should have from the vegetable kingdom a distinct analogue to one of these mysterious mineral Catalyti

combats the local manifestation in the same way that it can counteract the general action in the blood. In other cases the Mercury may pass into the blood of the part, and, by exerting in its antiphl

. Antisc

blished itself-when it has descended through many generations of the same family,-it is very intractable and difficult to cure. Palliative and indirect remedies, aimed rather at the consequences than at the source of the disorder, are often adopted with benefit. Tonics, C

rove useless. So that the experience of many practitioners, thus frequently disappointed in their hopes of a cure, has led them to question altogether the efficacy of Iodine in Scrofulous disorders. But it is generally allo

ot until the present century that Iodine was discovered, and its efficacy in Scrofula, particularly in the cure of Goitre, pointed out by Dr. Coindet of Gene

n the blood, and there is no reason to suppose that any special stimulant action is exerted on the absorbent vessels. Those Catalytics which favour absorption are not all useful in the same cases, but some are most useful in one disorder, some in another. Thu

n known to cause the absorption of hea

ours, but further meet and neutralize the poison which is working in the system, and effect a more or le

self had frequently taken a scruple, and sometimes a drachm at a time, without any effect. Other men are readily affected by very small quantities, and quickly experience the s

fulous children, who commonly suffer under An?mia, as

by consumptive patients. It is probable that part of the efficacy of sea-side air and sea-voyages in scrofulous cases may be due to the free Chlorine which is given off in small quantities from the salt water of the ocean. The powers of Iodine and Bromine are shared by their compounds; and probab

of Iodine in Scrofula, but it is almost impossi

influence. It may act by holding in solution fibrinous and fatty matters, and preventing their abnormal deposit in a crude form in the shape of tubercular matter. I

ofulous constitutions. They appear to act simply by stimulating the to

isease has been explained by some as depending on the Iodine which it contains in small quant

Antiart

d nutrition. The chief of these diseases are, Diabetes; Oxaluria; Lithic deposit in the urine; and the true Arthritic disorders, i.e., Gout and Rheumatism. Most of those blood

the right direction is essential to health. When one of these processes is di

the other hand, in the gradual change and conduction out of the body of the products of the waste of those tissues. But when any process goes on in a wrong direction, it results in the formation of various prod

rors in the assimilative processes may sometimes arise in the first instance from a deficiency in the blood of some substance whose influence was necessary to the proper conduct or control of the natural series of changes. Some of these conducting materials may be formed by the liver; for it is

s process, or of diverting it into a right direction, is by the employment of one of the Catalytic medicines contained in this order. Some stages of these

medicines may be employed, which tend in vari

lan, to meet and neutralize the morbid material or process in the blood. And sometimes Eliminatives are made use of, which seem, by acting on the secretions of

the influence of Catalytic remedies. Diabetes and Lithiasis

fourth order of Catalytics

to a less degree that of Rheumatism also, is generally admitted, although various

in this disorder, but also in some cases of lithic deposit. The Oxalate of Lime rarely occurs alone in the urine; there is generally along with it some Urate of Ammonia. The causes of the two deposits appear to be i

re very few Catalytic actions in which such an explanation can be attempted, but a degree of plausibility appears to attach to

in the system; and this acid, which we have many reasons for supposing to be lactic acid, is occasionally excreted by the skin. In Gout we meet with another Arthritic affection, in which there is urate of soda in the blood, and an excess of uric acid and urea in the urine. A simple excess of uric acid in this secretion constitutes Lithiasis. There is an obvi

to the series of changes in the blood which are associated with the respiratory proces

. First, assuming two equivalents of water, it becomes grape-sugar; next, this changes into lactic acid, which is isomeric with it; and this again combines with twelve atoms of oxygen, to form carbonic acid and water. This

ted as fast as formed. There is an excess of urea in the whole quantity of urine passed in the day; probably because the nitrogenous food and tissues are undergoing combustion instead of the starch. Before becoming grape-sugar, starch undergoes a transitional change into Dextrine, a gummy

roduced by a stoppage of the process at the next stage. Lactic acid has been formed; but, for some reason unknown,

thout passing first into lactic acid. By this oxalic acid wo

he action of some useful remedies might be elucidated. It is not at all unlikely that the accuracy of

nd always aggravated, by over-indulgence in animal food. Now if we may suppose that some of the lactic acid, instead of oxidizing directly into carbonic acid, oxidizes i

here being in both disorders an impediment to the proper oxidation of lactic into carbonic acid. These things may be illustrated by a di

ar

ugar (D

\+

c acid. (

cid (Rhe

Urea

10 aq. (Gout,

onic

er by its deviation. These deviations and stoppages may result from a failure of some natural principle which is gifted with the c

e distinctly expressed by

al pr

+ 2 HO =

C6H5O

O12 = 6 C

lur

O18 = 6 C2

nd Lit

Urea + O5 = Ur

n may be thus pr

. C10H

8O4

H1

-- -

N4. = C10

ch has thus been sketched out can be applicable to the matter in which we are more

e to do is to convert diabetic sugar, i.e. grape-sugar, into lactic acid. This acid probably exists in the gastric juice. And some such substance as Pepsin, or the de

gas. This is stated by Mr. Brande to go on until the liquid is saturated with this gas. The result of the presence of Chlorine is, that from the affinity of this gas for Hydrogen, by which, under certain circumstances, it is enabled to set free the Oxygen of water, this compound acid becomes the most powerful oxidizing agent

s action may depend up

c acid to be oxidized into carbonic

+ O =

formed as it should be, but then stops short, and proceeds no f

ibrium, I have supposed that lactic acid and urea are changed together into uric acid. If we adopt this hypothesis, it will be evident

O + 4 HO = 2

y thus b

H4N

4H8N

4 C6

--

16 = C10

g lactic acid to exist in excess in Rheumatic blood. This by itself may have no more tendency to oxidize into carbonic acid, than so much vegetable acid would have. In ordinary cases a free vegetable acid passes out into the urine without undergoing any change in the system. But it has been proved by W?hler that the same vegetable acid becomes oxidized when given in combination with an alkali. So that if we

etable acids may act as refrigerants in simple fever; how they may then supply the place of the natural lactic acid in the blood, and become oxidized instead of the Proteinaceous compounds. (Vide Acids.) But Rheumatic fever is a very different case, for there is here apparent

O11 +

ppears to be decomposed in the system, for Dr. Rees has never known it in these cases to increase the acidity of the urine. The matter is obscure; b

, which we can only indicate, but cannot further comprehend. It is generally best to give

but more especially in Gout. They seem to act by virtue of their power in eliminating and producing Bile. And it is likely that some constituent of

is a very interesting fact. If there should be any truth in an idea which I have explained at length in the article on Tonics (vide p. 142,) it would seem that these Ton

es. There are six different modes of operation by which the same beneficial result may follow the

s in the blood is a correct view of the case, then this explanation of the action of the various remedies used in such diseases would acquire an additional probabi

h advantage to the treatment of these kindred disorders, tending to counteract the morbid conditions by

isturbed by various causes, simply manifest itself by causing acidity of the stomach, flatulence, impairment of digestive power, and general lassitude. Different Antiarthritic remedies are applicable in different cases. Colchicum o

Antisc

or condition of the blood, together with a deficiency in the amount of albumen, fibrine, and the solids generally; a tend

occurrence of this morbid action, or to control it when it has been set up. The worst forms of Scurvy occur among sailors in long voyages, who have been depriv

there are certain constitutions which are more disposed to it than others; and that when these systems are deprived of some articles

contained in the food eaten by those who are commonly attacked with Scurvy. The food of the sailors who are thus afflicted consists mainly of salted beef and sea-biscuit. Both contain salts of Potash; neither contain Citric acid. So that from this consideration it would seem as if the free acid must be the remedial

stem of the natural amount of the salts of Potash; he therefore treats it with salts

blood a material in which it is deficient. But Citric acid could not remain in the blood; and if it cures

ished by containing an abundance of the salts of Potash, but that the reverse is the ca

of potash obtained from one ounce of

bread .2

eal

beef

potatoe

juice

e of the chief articles of diet among sailors. And if this deficiency of Potash were the sole cause of Scurvy, then it should be unknown in Ireland, where quantities of Potatoes are eaten,

ve agent in these antiscorbutic vegetables. It seems to exert a purifying power over the blood in this disorder, of the exact nature of which we are not aware. It is probably not only

. Antip

atalytic division are employed in

duce in it a number of effects of a particular kind. One part of this operation is that it is capable of antagonizing the poisons of intermittent disorders, as also of certain convulsive affections and

ts operation and that of the malarious poison, by virtue of which it may perhaps exert a corrective power over the working of the latter in the blood. (Vide page 166.) Such an analogy could only exist

poisons. Some of them have been used externally as Caustics, especial

imes a day, and gradually to increase the quantity; from the idea that the system will thus be enabled to tolerate the remedy better, and that irritation of the stomach will be avoided. Mr. Hunt deprecates this practice, and recommends regular doses of three to five drops or more. It may be safely continued during the paroxysm of Ague, which is a plan that is generally considered to be unadvisabl

ieties of intermittent pulse, which are not due to organic disease of the heart. Dr. Darwin cured a case in which the beats of the heart intermi

tomach generally assumes an intermittent form. It has been supposed by some that Arsenic in such disorders acts directly upon the nerves; but it a

uinine, for the treatment of Ague. Iron is employed with advantage in old chronic cases attended with An?mia; but it

e very efficient. In his opinion it is more efficacious than Arsenic, and second only to Quinine, in the cure of this disorder. The s

nded in Ague. It also appears to act on the Cat

i. p. 206.) He supposes that substances as Arsenic and Mercury may be able to arrest contagious and other disorders in the system in the same way that they control putrefaction out of the body. The use of Salt and Alum in Ague might seem at first sight to countenance such a hypothesis as applicable to the treatment of

all morbid processes. But this is far from being the case. Many substances which are distinguished for their antiseptic powers are found to have no influence whatever on the progress of these disorders. Are Acetic acid and Creosote of any use in Ague? Does Alcohol prevent the dr

. Antico

able to add little respecting the rationale of their action to that which I have said of the operation of Catalytic medicines in general. It is certainly very mysterious; and it is perhaps mainly on thi

e of Lead, and the Ammonio-sulphate of Copper, have been used with advantage in the same disorder. Dr. Babington strongly reco

Arsenic is highly esteemed a

ate and multiform nature of this disease, their use in it is less obvious than in Epilepsy and Cho

uce a permanent discoloration of the skin, either browning it or communicating to it a dull leaden hue. This naturally constitutes a stron

. System, vol. ii. p. 401.) But I am not aware that any English therapeutists have adopted this view of its mode of operation. The dose of the Nitrate of Silver, and the state of dilution in which it is given, would certainly prevent i

ngth, an astringent or caustic action on all mucous surfaces, and thus improves their condition when they are relaxed, inflamed, irritable, or ulcerated. The occasional benefit which follows the administration of the preparations of Silver in Gastrodynia may be referred to an action of

commended in the treatment; but although some cases appear to be partly connected in their first origin with a certain con

I. Antis

ool lotions. Or they may even be connected with some external organization, of a vegetable or animal kind, as Porrigo and Favus are traceable to a parasitic fungus, and Scabies is accompanied by the development of a species of Acarus. Other

The eruption may constitute one only among many symptoms of the action of this poison, or it may be the chief or only s

es the eruption-Elimination and Counteraction. The first may someti

se diseases. The eruptive disorders alluded to are all connected together both in their symptoms and treatment; but because the squamous di

are not syphilitic in their origin. Besides Lepra and Psoriasis, it is found useful in Eczema, Impetigo, and Lupus. In the last disorder it has been used both externally and internally, seeming to be in both cases spe

20 grains. It has been recommended for employment in some of the other skin diseases, but its advantage in them is not so obvious. When it is applied to the skin, some on

the urine, and have sometimes appeared to succeed in so doing. But in this, as in many other cases, counteraction is both easier and more certa

forms of those eruptions, which are treated best by Mercury, or by other medicines of the second order of Catalytic

and internal administration are preferable, as the ointment is apt to increase the existing irritation. In the cure of Lepra the mineral waters of Harrowgate and other places, containing Sulphuretted Hydrogen gas, have been much recommended. Thus we h

Scabies has long been attributed to an external cause, an insect, or, more correctly, an arachnid, which, by burrowing in the skin, is thought to produce the vesicular eruption. The Acarus Scabiei, or Itch insect, was discovered in 1179 by Abenzoar, the Arabian. In 1687 Dr. Giovanni Bonomo wrote a

But we must not deny the existence of special agents, simply because we cannot understand their operation; for it is apparent in too many instances. And from the circumstance that Sulphur has proved beneficial when given internally in Scabies, as well as the fact tha

in its application. It often happens that when this remedy entirely fails, the eruption is connected with a constitutional taint of Syphilis. When there is a suspicion of this, such a remedy as Donovan's solution, containing both Arsenic and Mercury, i

r irritation of the conjunctiv?, symptoms which denote the saturation of the

and because there are some ideas respecting their action which I have thought it worth while to work out and to investigate at some length, I have devoted more space to its elab

led Neurotics, act by passing from the blood to t

mulants, act so as to exalt nervou

lt nervous force, and then to depress it; and have also

ives, act so as to depress nervous

we now commence the consideration of another class of remedies,

use it is evidenced in the blood; and a change in the blood pr

as the cause of the action cannot remain, the effect also soon passes away. Whereas H?matics, durable agents in the blood, are used to counteract the causes of inveterate and chronic disorders; these Neurotics, which produce a transitory, but more or less forcible impression on the nervous system,

of nerve-medicines is of a far more incomprehensible kind. When we consider that little or nothing is known, or can be known, about the ultimate causes of sensation,

it impossible to state with certainty how they act. And the field of inquiry being so limite

e blood, belong to this class. Their action in most points of

emical change in them; no h?morrhage, or vascular disease; no rupture of nerve-fibres. Whence, then, could death have arisen? How could the mere presence of a few atoms in the blood,-half a grain, one-twen

for their different actions on different nerves? How is it that Opium contracts the pupil, and Belladonna dilates it?-that Digitalis affects the heart, and Stramonium

inute in size. And as these compound bodies have each a peculiar chemical constitution, so must each of their ultimate parts be composed of a peculiar arrangement of simpler atoms, and thus have a certain shape of its own more or less different from the shape of every other compound atom. Both the substance of a nerve, and the active part of a nerve-medicine, consist of a number of definite compound atoms. And it is possible that the atom of a stimulant medicine may be of such a shape as that it shall be unable to coincide with, or to fit into, the series of atoms forming the sensitive surface of the nerve, a

cisely alike in the shapes of their particles. This various dissimilarity might throw some light upon the many shades of distinction between the operations of Neurotic medicines on different parts. Thus, as a general rule, both Morphia and Atropia are paralyzers of motor nerves. But they do not act alike on the Ciliary nerves by which the motions of the Iris are controlled. We may

of proof, nor is it even possible to inquire into it. And I have only thought it worth while to explain it at length because it is desirable that

s should remain in the blood, they therefore pass out of the blood through the glands, and in so doing generally act as Eliminatives. This, their secondary action, will be subsequently considered. It is generally of less importance than the

each side. On the one hand, nerve-medicines are more numerous and more powerful than blood-medicines, and thus in the control of symptoms they are wielded with more immediate certainty than the others in the counteraction of diseases. On the other hand, the symptom that i

as improbable, because affording too easy an explanation of a naturally inscrutable operation, it would still seem likely that these medicines may take effect by exerting some minute and imperceptible influence on nerve-fibre, or producing in it some inappreciable disorganization or change,

o divide the Proposition in which their more obvious action has been stated into a number of minor proposit

cs are medicines whic

a change in one or more of those functions

uld pass from the blood to that part of the

in an over-excited or depresse

ansitory in action, and c

were included some things that are not universally acknowledged; but the above account of the action of Neuro

blood is proved by the fact that many of them have been detected there, as well as found in the secretions into which they must have entered from the blood. Ammonia, Hydrocyanic acid, Antimony, Assaf?tida, Turpentine, Alcohol, and Camphor,-all of which are Neurotic agents,-have been chemic

er this absorption, and not by contact with the mucou

e, caused by a weakness or failure in power of the nerves of the heart; and Aconite is prescribed to relieve pain caused by an over-excitement of the sensory nerves. Though in these examples Ammonia acts on the centre, and Aconite on the peripheral nerves, yet they are both capable of exalting or of depressing nervous force in general. But neither Stimulants nor Sedatives, as defined by me, exert any marked influence on the intellectual part of the brain. They do not affect the phenomena of mind, or of the fou

t that passage in the circulation is necessary; that the course of the latter is sufficiently rapid to account even for the action of Hydrocyanic acid; and that, however near a medicine be introduced to a nervous organ, it does not affect it unless it be allowed to reach it. The nerves are not naturally constituted for the conduction of medicinal impressions, but only for the passage of impulses of volition, sensation, or emotion. And this evidently

re not employed in slow or long continuing diseases. Their applications depend on their known physiological tendencies, already stated. Abnorm

s may perhaps be roused by a strong Stimulant, and maintained by its repeti

at control it so excited, as to place life in peril, we may do good by the administration of a Sed

to quiet mental irritability. Both these and Sedatives

actions, powerful though they may be, are transitory. The effect produced on the nerve is not a lasting one, and no essential change in the blood is effected by true Neurotics. They a

inct account of the three divisions into wh

MUL

more or less to the whole nervous system, having a general tendency to communicate nervous energy; or they may confine their action to particular departments of this system, having no manifest infl

ULAN

imulantia

imulantia

he term applied to the others on that ground could not consistently be withheld from them, although their action is more limited and local in its nature, being co

eneral St

-Ammonia and its Car

ances.-Musk,

Cloves and Nutmeg. Cinnamon, Cassia, Sassafras. Rue, Barosma. The Aurantiace?. Canell

ga. Horseradish. Serpentary. Cascarilla. Pep

Myrrh, Elemi. Copaiba. Peru, Tolu. Assaf?tida, A

e owe their power are intermediate in nature between volatile oils and resins. Some of them are volatile, like the former; others fixed, like the latter. Some of the

e circulation. They are not, for the most part, very powerful medicines; and their action is seldom so violent as to be succeeded by much reaction. They improve digestion for a time, by a stimulation of the sympathetic nerves of the stomach and other viscera. In large doses

act on parts supplied by the sympathetic system of nerves. But this view of their operation

at once into the cerebral circulation. Dr. Pereira thinks that when administered in the liquid form it can only pass into the blood as a salt, being neutralized by the stomach-acid. In this case it could only act before absorption. But it is probable that it is too diffusible and too rapidly absorbed to be entirely so neutralized; and besides, its

ic fits, being given just before their expected occurrence. It co

fest this action on the brain

of the organic nerves. Cajeput oil has been used in Hysteria; employed to control various spasmodic movements; and administered in Typhoid fevers and Asiatic Cholera, to communicate nervous power. The fetid gum resins are well known as Antispasmodics. The spasms which these medicines reliev

is not generally used for its Neurotic powers, but as a Purgative or a Diuretic; or else it might have been classed among Inebriant

le action. It is used as a Special Stimulant to t

e mind; but stimulate the organic and merely animal function o

e power of exalting nervous force in general, we have still

s. But if this were the case, then the reaction, or subsequent failure of nervous power, ought to be exactly equivalent to the first temporary increase of that power; assuming this increase

denly and powerfully manifested. I believe that a Stimulant is able actually to produce nervous action; perhaps by an irritative operation upon nerve-fibre. So by continually repeating the

vital power. But there may be no such failure of vital energy, and yet a sudden or accidental deficiency of nervous force may serve to peril the continuance of health, or even the tenure of life. For a certain degree of this nervous force is necessary both for life and health. When it is diminished, all the functions must suffer; when it fails entirely, th

This is in direct contradiction to the rule given above. True Stimulants are only of use by counteracting that failure of nervous force which hinders the manifestation of the vital strength which is stored up somew

stion, by acting on the nerves of the stomach and intestinal canal. They increase most of the secretions in passing through the glands in the blood. In both cases they ex

t vital debility, Tonics or blood-medicines are required. But in such a case as Syncope, or stoppage of the heart on account of a sudden nervous shock, Stimulants are particularly appropriate; also in the latter stage of Typhoid fever, or of asthenic

e remedies belonging to the order of General Stimulants. Those of the next order exert

Special S

Toxicodendron; Ergot

rgy of particular nerves or sets of nerves. They do not affect the whole nervous system, but they operate on

n hinted that they may perhaps be partly accounted for by the differences in chemi

ed from a motor nerve to a muscle, and is kept up for some time. In small doses it is useful in certain cases of paralysis. Two things are necessary in order that it may act efficiently. The muscles of the part must be whole and sound; for if destroyed by excessive atrophy or fatty degeneration, they cannot be roused by any stimulus. The nerve, too, and the centre from which it originates, must

It exalts sensibility as well as irritability, but not so powerfully. It is a special Stimulant to the motor and sensory nerves throughout the body. Acting upon the spinal cord, it ten

-and the leaves of the Rhus Toxicodendron,-resembl

s of the female, but to no other nerves in any marked degree. B

n result from bringing on contraction, Ergot supplies us with a ready and effectual means of doing this. It is also efficacious in cases o

pe. But this is not the effect for which it is employed, and is altogether distinct from its operation as a Special Stimulant,

not an excitor of the heart and circulation. Its

COT

different from both of them. Narcotics are defined to be medicines which pass from the blood to the nerves or nerve-centres; which a

primary stimulation. In the second place, Narcotics depress nervous influence. This depression is not in a direct, but in an inverse ratio to the primary stimulation. The less the one, the greater the other. Thus the depression cannot be considered as the mere re-action from the stimulation,

r of Narcotics would approach very nearly to Stimulants, and those of the third order to Se

nd, through the body, is connected with external things. These intellectual properties, the centre of which is the brain, are more or less affected by Narcotic medicines. The first action of the latter is, to exalt these functions, just as they first exalt nervous force in general. The degree

divided Narcotics into the three orders to which I have alr

cot

. Ineb

. Somn

. Deli

impaired and deranged; in sleep they are lulled or extinguished for a time; and in delirium they are excited and led astray. The several actions of these orders w

to be quite correct. Narcotics exert in the first place a stimulant, and in the second place a sedative action; but these actions have no relation in degree, for one of them always exceeds the other, as we have just se

ons to this. The medicines of the third order, and some of those in the second, tend on the whole to diminish the quantity of nervous force, and are thus akin to Sedatives. A correct under

. Ineb

hloroform; Camphor; India

rants; slightly quickening the pulse, and enlivening the mental faculties. When given in large doses, this stimulating action on the heart and mental powers occurs first, and is now more intense; but it is soon succ

d may exist in various degrees. The mind itself is confused and bewildered; volition is impaired, so that the man staggers in his walk; and the powers of the senses are disordered or lost. This

e; Tobacco and Lobelia, in the least. Though varying in degree, yet, as far a

d an anodyne influence; to which also, in the case of Indian Hemp, may be added a very curious imitation of Catalepsy. Ether and Chloroform have at this t

ead of that they both exert a particular sedative action on the heart and circulation. This is accompanied with nausea, a

cases of the inhalation of Ether and Chloroform. These

otics and Sedatives, will be considered at the close of the section treating of Neu

I. Sop

ctuca. Hop

cotics. It causes in the first place a slight quickening of the pulse, and some excitement of the mental

mind itself, but also the powers of volition and sensation, by which the mind is connected

functions of volition and sensation, and the special senses of Sight, Hearing, Smell, and Taste, are entirely suspended in perfect sleep. So that while Inebriants affect similarly both the mind and the natural functions with which it is connected, Soporifics may leave the first untouched, but they entirely subdue the latter. The condition of sleep differs also in another important

tion between the operations of

ensation. Thus a mere Soporific, if effect

the whole catalogue of medicines. It also produces relaxation of the muscular system, and is thus a powerful antispasmodic. In excessive dose it produces a marked sedative e

nts dilate the pupil. Inebriants and Deliriants act on the glands as Eliminatives, being mostly diuretic. Opium has a contrary action; it diminishes all the secretions except that of the skin, which it increases in amount. Most particularl

n its action, but is neither so powerful nor so efficient. Nut

the lot of the physician; and in either case Opium, or one of its preparations, may be said to be indispensable. But a cer

I. Deli

Belladonna;

rest to Sedatives. Their only stimulating action is to produce at the very first a slight and evanescen

ion. For this double action they are employed in medicine, being used in painful disorders, fevers, and inflammations. As anodynes

control the respiratory nerves, and is thus used in Asthma, where there is a spasmodic circular contraction of the smaller bronchial tubes. Lobelia, a medicine of the first order,

th volition and the senses, but may leave the mind alone. In delirium these functions are not thus impaired and held in subjection, but they are excited and led astray. The mind is occupied intently upon imagina

order of Narcotics bewilder and impair the powers of the mind; those of the second order

remens, and great despondency of mind; as also often a chronic inflammation of the liver. The continued smoking of Tobacco is found to exert a tranquilizing influence over the mind. And the

ATI

ress nervous force. Some affect nervous force in general; others confine their action to particular nerves. They are

on of Narcotics, that there are two ways in which a Sedative action on nerve may be

lungs the sensation of want of breath, and thus decrease the number of the respirations; and at the same time it would repress the irritability of the pulmonary mucous surface. Further, it would in some way derange

e motor nerves of the cerebro-spinal system, convulsions or paralysis may be produced. By an influence on the nerves of sensation; pain, or an?sthesia. By an affection of the organic nerves of the heart, or of the brain which controls them; palpitation, or syncope. By an action on the nerves of the lungs; cough, or apn?a. By th

mind. In poisonous doses, they kill by producing syncope, which is a suspension of the action of the heart. Hydrocyanic acid causes at the same time convulsions. These convuls

ording to the extent of their action; in t

ant

edantia G

edantia S

the nerves and nerve-centres in the body, the

order of Special Stimulants, they are peculiar and exceptional agents. All those with w

ive simply depresses the same. But a Narcotic first does one thing and then the other; and according to the degrees of these two actions, so do some Narcotics resemble Stimulants, and others approach very nearly to Sedatives. But we have seen that Narcotics have also a peculiar an

iant Narcotic with a Stimulant, for their actions resemble each other so much, that they are able to work together. And Deliriants, which stand at the other end of the Narcotic scale, may often advantageously be give

General

ote. Aconite. Conium. Co

om the blood they pass to the nerves and nerve-centres, and on all of them alike exert a depressing influence. Some of them are much more powerful than ot

doses it is anodyne, and antispasmodic. It is considered especially to influence the reflex spinal system, and by this means may allay convulsive coug

ter. Moreover, it is a true Astringent, which cannot be said of Turpentine. It is not powerful as a Sedative, but its peculiarity of action often renders it useful i

mbness. It is thus a most valuable topical remedy in true irritative Neuralgia. Other Sedatives and Narcotics have the same power as topical anodynes, but not in so marked a degree. In large doses Aconite is a General Sedative; producing tingling of the extremities, vomiting

latter. He found that it produced swiftly-spreading paralysis of the motor nerves; and he considers it to act par

to be authenticated, and shown to be the invariable result of the action of this medicine in large doses, then it ought certainly to be classed among Narcotics. Dr. Pereira considers it likely that the plant contains more than one acti

e. It may possibly act indirectly by quieting the action of the heart, and controlling an irritable state of the nervous system. In the same way Opium often appears to act as a resolvent. And it is certain that Hemlock, when used for this purpose, very often fails altogether. It has been wrongfully extolled as a panacea in Phthisis; but is in fact of no gre

s been, I think, erroneously ascribed. For in fact it seems to act best in this disorder when it causes no purging, and scarcely any action on the nerves. When it has been long used, it causes a great depression of the spirits, like that which may be caused by some undoubted blood-

lis, and other nerve-medicines, there are two peculiarities which

duce very dangerous symptoms. This cumulative action is especially observed of Digitalis, and therefore considerable care is required in the exhibition of that medicine. This medicine is a Special Sedative, and will be presently considered as such. In other cases we find that the nervous

universally adopted. They are, in fact, almost indispensable to the daily existence of civilized man, with whom a continual energy of mind is a necessary of life. Infusions of these substances, or of materials similar to them in medicinal nature, are adopted as a daily beverage by all civilized nations. By diminishing congestion of the brain, Tea and Coffee have not only the effect of clearing the mind, but in large quantities they induce wakefulness. This is particularly the case wi

ilarants; but they only become so indirectly, by r

obable that their Neurotic action is not so much owing to thi

Special S

. Ipecacuanh

he nervous system as a whole, but only on certain parts of it. So far they resemble Special Stimulants; but

cute inflammations than could be exerted by any slow-acting blood-medicine. It is also Eliminative. Passing out of the body through the glands of the skin, it becomes a Diaphoretic. This may be its only action when it is given in doses too small to act upon the nerves. It must not be confounded with the diaphoresis which acco

at any part. Thus Tartar Emetic or Ipecacuanha, when injected in solution into one of the veins, will cause vomiting. M. Magendie has found that in the case of dogs they also produce Pneumonia. The mere inhalation of the dust of Ipecacuanha has been found to act upon the lungs so as to cause Bronchitis. These actions, as well as the various effects which are found to follow the introduction of these medicines int

the Sympathetic nerve, for these are the only nerves which supply the parts influenced by these medicines. They cannot act upon the Sympathetic, for two reasons. If they did so, we might reasonably expect that the other parts of this nerve would be influenced at the same time. But this does n

is exerted upon the Vagus nerve and its branches. They affect

n similar grounds, Tartar Emetic, injected into the veins, may produce Pneumonia; and Ipecacuanha, introduced as dust into the lungs, causes Bronchitis or Asthma; and yet Tartar Emetic is advantageously employed in the cure of Pneumonia, and Ipecacuanha is a remedy for Bronchitis. When the function of the healthy nerve, or that part supplied to the lungs, is deranged to a certain degree, an inflammation of the mucous membrane or su

medicines affect the functions of

ted to the pulmonary organs. It allays the sensation of want of breath, and diminish

often very desirable to cause nausea in acute inflammations and fevers. It is kept up by the careful administration of Tartar Emetic. It may not be so desirable to produce vomiting; for this is accompanied with great vascular excitement and active congestion of the brain. And yet it is found that the more Antimony we can get into the blood, the more potent and durable will its antiphlogistic influence be. For this medicine appears to possess a blood-action as well as an action on nerve. Experience has shown that if the dose of Ta

mes the rapidity of the beat is slightly increased at the first, but the pulse at the same time is weaker. It soon becomes slower and sometimes irregular. This action is characteristic of derangement of the Vagus nerve. For it was found, in some experiments on animals made by M. Weber, that when the function of this nerve was disturbed by mechanic

tion of the heart, it relieves that congestion of the vascular system which is the cause of the effusion of serum. But it

nerve. It is not clear whether they affect that nerve at its origin

rt they cut off the natural supply of blood to the brain, and may, by so doing, produce delirium and convulsions. They tend obviously to kill by syncope. Some m

egarded as a Special Sedative, or considered simply as an irritant Emetic and Eliminative. It is a valuable Expectorant. It is also a Diuretic; and fr

roaches nearest of all to the recognised nerve-medicines. After existing for some time in the blood, it produces local palsy, particularly of the muscles about the wrist; and it sometimes affects the sensory nerves, causing sharp shooting pains in the limbs. These nervous sy

en found in the brain after death; but it also exists at the same time in other parts of the body. In cases of Lead-colic there is generally a pa

without exerting any direct effect upon the nerves. They are never discharged upon the nervous system except after they have for some time existed in the blood in such quantity as materially to vitiate its healthy

The views of their operation which I have wished to substantiate are in many cases the same as those which are generally adopted, i

of the dose, by which a transitory action may be constantly renewed and kept up. In other cases a mere transitory action may produce a cure. This may be the case in a sudden and dangerous emergency, which will pass over if the system can be supported through it, but which threatens life while it lasts. Or

ions subdued. Sleep may be substituted for wakefulness, or activity for torpor. By these powerful remedies we are enabled to exert an immense control over the varied manifestations of nervous force; and may often, when we wish it, substitute one conditi

by violent outward manifestations, but is nevertheless working fatally within, we must then c

d Astringents, act by passing from the blood to

ion. They do not necessarily act in the blood, although many H?matics are also astringent. They do not pass from the blood to the nerves. They do not always act by passing out of the body through the glands. Their operation i

through the walls of the capillaries to the muscular tissue. By inducing the fibre of the voluntary muscles to contract, Astringents may brace the system, and simulate the action of Tonics. But as the contraction of voluntary muscle is short and brief, it requires for its maintenance a continual excitation, and unless the medicine is thus continually repeated, the tonic effect subsides. But astringents further contract involuntary muscle. This contraction is slower, and more durable and important in its results. Unstriped muscular fibres exist in the middle coat of arteries, in the walls of capillary vessels, in the lining of the ducts of glands generally, and in the substance of the

ay now proceed to prove the Proposition in which it is

are medicines which

ave the power of cau

fibre, liv

operation is to di

hage, and to g

lar s

results are to be ac

ar fibre, to whi

bl

understanding of the latter. Their proof is comparatively easy and simple. It is not supposed to be a certai

ction is, however, of so simple a kind, that it may be exerted on the external surface in the same way as in the interior of the

inge

tringentia

ringentia V

en noticed as H?matic medicines. They are all soluble in water. They are absorbed in the stomach and intestines, and pass into the blood. Many of them pass on into the secretions. The astringent parts of the vegetables o

nnic acid, Turpentine, and Creosote, coagulate albumen. Tannic acid precipitates Gelatine too. The dynamical property, which is common to all of these substances, is a power of causing the contraction of muscular fibre. It s

position. This web is traversed in all directions by minute ramifying capillaries; and these are found gradually to diminish in caliber. In the same way as the mechanical irritation of a small artery will act upon the unstriped muscular fibre contained in its coat, and thus cause the vessel to contract at one point; so it seems that an A

results of their operation are stated.

Tannic vegetables are given in diarrh?a; Nitrate of Bismuth is administered in Pyros

sis; Creosote and Uv? Ursi are used in h?morrhage from the stomach o

he solid fibres on account of any depressing cause, by exciting the muscles to a mor

bre; inasmuch as they are found to diminish the caliber of certain tubes and cavities, and these owe the contractility which they possess to the muscular fibre which i

d the most rational explanation of

ineral As

of Lead; Sulphate and Sesquichloride of Iron; Alum; Sulphate of Zi

ion on muscle is of much less moment than their important operations in the blood. Neither is it theoret

orm peculiar insoluble compounds both with albumen and fibrine, and it is probably by virtue of their action on the latter that they are able to cause the contra

ing blood. They are no doubt constrained by various forces from operating there, or else the consequences of such a disturbance of the condition of the elements of the blood would be dangerous in the extreme. (Vid

ly in their applicability for internal use. They must be given in such quantity that, after absorption and dilution by the whole mass of the blood, they may still be ca

cases be given internally with advantage. For being comparatively innocuous, they can be safely prescribed in the quantity require

an Astringent. We might indeed have supposed it to be inapplicable, from the fact that it forms soluble

remain in the system, but must be excreted from it by the glands. In passing through them it tends to act as an Astringent by corrugating and diminishing in caliber their minute ducts, and thus decreases the amount of the secretion. But it does not act on all glands alike. Dr. Bence Jones has found that it seldom passes out into the urine. It therefore does not sensibly diminish the secretion of urine. It is probably excreted partly by the skin, and partly by the bowels; for it diminishes the amount of the sweat in profuse perspiration, and of the f?ces in diarrh?a. Sulphuric acid is free before entrance into the blood, and after expulsion from it into the secretions. Thus at these periods it

required. It does not seem to be impaired in power while in the blood, as is the case with Sulphuric acid; and is therefore applicable in all h?morrhagic cases. It has been

ds. But in cases of h?morrhage they are particularly appropriate, for in addition to their astringent action they tend to restore the deficient red col

t has been for some time prescribed, the blue line at the edge of the gums, which is characteristic of a saturation of the system by the poison of lead, will indicate that its further administration is unadvisable. The Acetate

nal Astringents, but can seldom be prescribed internally so as to act in this way, because they are poisonous

ese solutions may be applied to any part of the surface of the skin or mucous membrane, when relaxed, inflamed, or ulcerated. Their operation is simple and obvious. When one of them is applied to an inflamed eye,

diarrh?a. It acts both by mechanically absorbing irritating fluids, and protecting the surface of the bowel, and by chemically neutralizing an acid matter by which the irritation is maintained. And when appli

id state, as caustics, must not be confounded with their astringent power. Its eff

egetable A

od; Oak-galls; Rhatany; Bistort; Pomegranate-ri

e first two the vegetable substances above enumerated appear to owe their efficacy. All

Astringents are required. When applied externally, Tannic Acid is the most powerful; but for internal administration Gallic Acid is the best. The reason of this will pre

very much upon their chemical affinities. Tannic Acid precipitates both Albumen and Ge

ppears likely, from the researches of M. Braconnot, that Tannic is a compound acid consisting of Gallic Acid in combination with the elements of grape-sugar. Three atoms of Tannic Acid are together equivalent to six atoms of Gallic Acid and on

Acid loses weight by the decomposition, it follows that a dose of Gallic Acid produces a greater effect as a medicine than an equal amount of

equivalent in composition to a combination of Gallic Acid with a saccharine matter, is a valuable external Astringent. A further chemical discovery has been made, which appears to be

likely that Gallic Acid may act along with this saccharine matter in the blood, and by this acquire chemically an astringent power, which it is not able to exert on ex

t is not decomposed into its constituent parts until

inish sweating, Tannic is inferior to Sulphuric Acid; but to act as a remote Styptic, it is preferable to the other. Tannic and

lly on the surface of the stomach in a double way, diminishing the h?morrhage by its astringent power over the vessels, and quieting the

he list of Astri

the several mucous surfaces which they affect: while so doing, they stimulate the healthy function and secretion of the gland, and cause it to displace the morbid one. Dr. Williams thinks that they first cause dilatation of the vessels of a gland, and that this is followed by contraction. There is no apparent reason why the latter effect should succeed the former. But supposing contraction

eally an Astringent, Turpentine has been often prescribed as a remedy for h?morrhages in different part

e, when relaxed and bleeding on account of an atonic condition of th

s albumen, and it may thus act as a t

the bowels. Attempts have been made to explain this by an influence possessed by Morphia on the process of Endosmosis, but they are not satisfactory. Some li

tives, act by passing out of the blood through the glands

cretion. They have received various appellations: some authors have called them special Stimulan

and its consideration will require us first to make some inquiry into the character and

egard to its essential nature, and its immediate bearing on the cure of disease, the subject has been generally understood with tolerable clearness. From the time of Hippocrates downwards, the use of Evacuants in the treatment of fever

in Fevers. These both had observed that fevers and other disorders had mostly a particular tendency to pass off with an increase in one or more of the secretions; and they drew from this, and from the results of the

the amount of secretion have often an important bearing on the cure of disease. We have only to inquire into their manner of action. As a preliminary step, there is one general law of secretion which it i

-has to pass out, it prefers to pass by some glands rather than by others. It must be remembered that the glands afford the only means by which a substance can mak

age through to itself of any substance that was not like it; just as when a sheet of paper is steeped in oil, oil only will pass through it, and not water. A second party, called the Chymical party, supposed that there must be in the immediate neighbourhood of each gland a subtle fluid or ferment, whose tendency and office it was to form and separate from the blood the materials which that gland had to secrete. A third set of physicians armed themselves with mathematics a

all open mouths, always circular, but differing in diameter in different glands, so that each would only admit the passage of a particle whose diameter approached a certain sum. Thus

ls with open mouths, and of glands which are riddled with holes like the buckets of the Naiades; but we must after all confess that if at the present day we have swep

pass out of the body, tends to pass out through some particular glands; that it is the particular function of the kidneys to excrete water, urea, uric acid, and certain salts; that it is the e

But in the excretion of water there exists a compensating relation between the skin, kidneys, and bowels,-particularly between the two former. So that when water is not properly excreted by the kidneys, it may pass out by the skin, and vice versa. It is well known that this change may be de

m it, but also to other matters which have been, as it were, accidentally introduced from without, and which, being in the system, cannot properly remain there. Thus it

regard this as a needless complication of the subject, and a thing which is wholly without proof. In fine, I am brought to the opinion which I have laid do

atives are medicines

oo

cannot remain there

he b

o doing, they tend

re than b

sult of their passag

ase its

are of use when the

he function of

d or pr

on; that each eliminative medicine has a tendency towards particular glands, and increases the secretion of those glands; that thus, as far as our information on the subject extends, we find that Cathartics are excreted from th

rachm of Urea be dissolved in water, and injected into the veins of a dog, it causes copious

a woman who was never purged by Castor-oil, but in whom the oil exuded from the skin, and acted as a Diaphoretic. And it is, as I have said, well known that the conditions of cold and exercise will

cretions they augment; and, on the other hand, that when they do not pass through them, they do not, as a ge

-i.e. that all medicines which are secreted at the same time increase secretion,-though it holds good in th

amount of the urine, although it sometimes does the opposite; in which case the eliminative may be said to surmount the astringent tendency. So also Catechu, Kino, and

hat congestion, however caused, diminishes the secretion of a gland. Thus congestion of the liver produces jaundice; congestion of the kidney, ischuria. After scarlatina, w

ry, with an almost total suppression of the secretion. The explanation of such an action is obvious. Congestion is caused by the excessive action. In the same way we fi

medicine is secreted by the gland which is stimulated by it, and, in most cases, tha

ticular and detailed proof. I will treat in turn of the above minor propo

V. Elim

. Sial

Expect

. Cath

. Chol

Diapho

. Diur

human body. I have not enumerated Errhines, because the medicines which are used t

acting from the blood on the nervous system; other are

cs. Most of them act by causing a determination of blood towards the organ. Cathartics do

they pass into the blood. This has already been in great part proved; for most Eliminative medicines belo

ulants. So also Alcohol and Ether, as well as Camphor and others, are found among Narcotics. Colchicum, Digitalis, Creosote, and Ipecacuanha, are Sed

later leave it. If they remained, they could not pass through the glandul

with all medicines except the Restorative H?matics. And those Restoratives which act as Eliminatives, such as Acids and Alkalies, do so because t

they tend to pass out by some part

e six orders, to show that many of the medicines included in them have actually been found in the secretions of the glands towards which they tend. The first consi

on may be divided chemically under the following six heads, of all of w

le mineral

ls,-i.e. Acids, A

a and vol

ed acr

neutral acri

vegetable

ed during the process of absorption, as they have to be reduced to a soluble condition. They stimulate secretion generally; but Mercury particul

y fluid when the skin is kept covered and very warm. In other cases the choice lies between the kidneys and the bowels. The kidneys are the grand purifiers of the blood, so that most of the substances which st

e in any quantity. We find too that when a certain quantity of a saline is administered, too great to pass off readily by the kidneys, it prefers to act on the bowels. It is more likely to be diuretic if much diluted with water; but this is not the only directing cause, for a very large quantity of a saline will prove

s they have a tendency towards the aeriform secretions. These are,-the expired air, or the secretion of the air-cells of the lungs,-and the ordinary cutaneous transpiration. While passing through the air-cells, these matters stimulate the secretion of the lining mucous membrane. They cause a morbid secretion of this su

tor and Croton Oils; they are Pur

e stomach or injected into the veins. Such are the resins of Scammony, Jalap, and Gamboge, and the principles of Colocynth and Elaterium. Some few of them are Diaphoretic, as Gu

is, Tobacco, and Colchicum. So also are the principles of Broom and Sarsaparilla. The Emetine in Ipecacuanha, and the Morphia

to increase. Whenever we are in a position to inquire into the facts by chemical or other means, we find that the Eliminative medicine is itself contained in the secretion which is augmented by its action, and that when the secretion upon which it usually acts is not augmented, the m

ive medicines, which must pass out of the blood, tend to pass out by some glands more than

he nervous functions; but they operate on those obscure v

use when it is requisite that the function of a gland should be restored or promoted. There is scarcely any d

ed. With this view, Cathartics are employed in constipation, Diaphor

obably is the rational explanation of the use of Diaphoretics and Diuretics in Feve

ish it by stimulating the formation of another. In other cases the reverse condition may occur; one of the secretions may be diminished or suppressed by a cause over which we have no control, and the matters which should be contained in it

by an action on the skin or the kidneys, we may cause a copious evacuation of water, holding in solution saline matters. By increasing the secretion of the intestinal glands, we may cause the albuminous serum of the blood to be poured out into the cavity of the bowels. Thus it is that all Eliminatives are more or less an

which are included in this division. Those substances can alone be properly included in these groups which really act on the principle

Sialago

as remedial agents; for the excretion of saliva is constant and very rarely suppressed, and it is so small in quantity, and so great a source

alone,-will suffice to bring on the secretion of saliva. An irritant substance, as Ginger, or Pyrethrum, tends especial

on the counter-irritant principle in obstinate cases of head-ache, ear-ache,

d other substances, is frequently found useful by sailors on long voyages, and is adopted as a preservative against the dysentery and diarrh?a with which they are so often affected. This advantage is to be attributed to the increase in the salivary secretion. On the other hand, we

produce salivation. These are Sedatives. Hydrocyanic acid, Digitalis, and nauseant medicines, may act locally so as to paralyze the muscular fibre

siderable extent, it causes soreness and redness of the gums, and profuse salivation. It probably increases the amount of saliva even before this soreness is produced. It is not given for the purpose of producing salivation, but in cases where the

nic poisoning by Lead. In cases of salivation by these Eliminative medicines, the substance which has caused the incr

. Expec

at cause the evacuation of mucus from the secreting surface of the respir

of hot water. Special Sedatives, which control the function of the Vagus nerve, are especially notable as indirect Expectorants. Such are Antimony and Ipecacuanha. By diminishing the morbid irritability of the pulmonary surf

edicines similar to them. Opium in small doses allays irritability and diminishes spasm, and is then an indirect Expectorant; but in lar

edicines add to their neurotic influence a true eliminative agency. We are as yet unable to decide whether or not they are ever secreted by these mucous glands, because n

ere should be on the other side of this membrane something which is capable of dissolving them. Diuretics are soluble in water, and they pass through into a watery fluid. But these Expectorants, whether they p

gh the glands of the mucous membrane of the lungs secrete mucus, yet the chief object of the terminal portion of that membrane is to absorb and secrete the gaseous matters of the blood. The following are the chief volatile Expectora

hrough they stimulate the latter to a right performance of their function. When, as in the case of Bronchitis, the secretion of mucus is incr

medicines than other glands whose proper office is one of general elimination. And yet we find that the effete gases which should be excreted by the bowels are sometimes voided by the lungs in case of aggravated dyspepsia, causing tainted

of to produce a wholesale evacuation from the blood, Expectorants are of no use as gene

nchitis the stimulant volatile Expectorants are the most applicable. Tartar Emetic and Ipecacuanha are appropriate in acute and inflammatory cases, because they exert a nauseating and depressing action. They

I. Cath

he contents of the intestinal tube. Of these two operations the first only is an action of elimination, and the second is an accompaniment

physiological purpose, it appears that we can act upon this intestinal function with ease and certainty in the great majority of cases. The surface of the intestine, covered as it is with a closely packed glandular apparatus, forms in the aggregate the largest secreting organ in the body. From the measurements made by Meckel, it appears that it covers a space of 1400 square inches. By the administration of a medicine of this sort, we are enabled to act upon this surface, producing simply an increase

stances which, after being taken into the stomach, are not absorbed, which are thus pushed onwards along the inner coat of the intestine, and by their mere accumulation excite its muscular contraction, must operate more or less as indirect purgatives. Of such a nature are the ligneous fibres of vegetables,-the bulky pulp of fruits, as in Prunes, Tamarinds, and Cassia,-and the husk of wheat in brown bread,-all of which are known to act as laxatives. Very different from these in the intensity of their action are the

purging by augmenting their natural secretion. When given as a medicine, the Cathartic is first received into the stomach. It is capable of absorption,-whether it be soluble in water, or in acid, or be of an oily or resinous nature,-as was ascertained in the consideration of Proposition II. It is absorbed; and passes along i

rease all secretions; 2. Some resins, oils, and acrid principles, which tend especially to t

hen given to act on the bowels, a Mercurial is generally conjoined with anothe

ile states of the system. Of the resins, Jalap is comparatively mild, and may be given to children without risk; while Scammony, Colocynth, and Gamboge are more drastic. Of the oils, Olive-oil is merely laxative; Castor-oil may be given in all cases without danger; but Croton oil is a dangerous hydragogue Cathartic. Of the medicines which owe their efficacy to acrid principles, there are some which are mild in operation, and whose principles are soluble i

skin to be very largely increased, or rendered fluid. Suppose, then, a soluble saline, as the Sulphate of Soda or Magnesia, or Tartarized Soda, to have obtained entry into the blood, it has the choice of being excreted by the kidneys or the bowels. The alternative appears to depend mainly upon the amount of the dose. A small quantity may pass in the urine, and will not produce purging. But a large

bumen of the blood may be purged away along with this. This may also take place with the drastic resinous Cathartics. But the latter are much more violent in their action, producing a degree of griping and irritation which is dangerous in febrile cases. Salines, on t

decomposed into carbonates while in the system. This does not appear to be the

ter in the urine is not materially increased. Castor-oil is seen in the evacuations, sometimes little altered, at other times in the form of a solid fatty substance. M. Lehmann has detected Mercury in the f?ces, whenever it was given as a Purgative, and whatever the colour of the evacuation. When combined with a sufficient amount of Opium, it neither acts as a Purgative, nor does it pass out by the bowels; and it has therefore in that case a better opportunity of exerting its operation in the blood. We always find

this intestinal function, the continual maintenance of

the f?cal matters consist in great part of excrementitious substances which are separated by their means from the blood. The excretion of f?ces continues when no food is taken. It is known to go on with starving men, and with patients in fever. Liebig argues for the secretion of the greater part of the f?ces, on the ground that they contain nitrogenous matters, whereas all the nitrogenous parts of the food should be absorbed for the purposes of

rently discharged from the body through the follicles and glands of the intestines. We find that this decomposition is promoted and accelerated by heat, in the same way as with dead animal matter. For this reason it appears that the natives of warm climates excrete a much larger quantity of f?ces than the dwellers in colder latitudes; and they are also more subject to Dysentery, Diarrh?

nal surface may be established. In this way the diarrh?a and ulceration of the glands in Typhoid fever may be accounted for. The air of a dissecting-room, or the neighbourhood of a noxious sewer, is apt to bring on diarrh?a by exciting a putrefaction of t

every description of morbid action. It is by cleaning such matters out of the blood, as well as by their antiphlogistic or evacuant action, that Cathartics become useful in so many diseases, and particularly in disorders of the brain. It would seem that the substances which

ither there is constipation, in which case there is a danger of the f?cal matters being retained in the blood; or there is diarrh?a, which is probably due to an over-formation of these materials in the system, and an attempt of nature

those hitherto taken. Dr. Hamilton, in his work on Purgative Medicines, states that when they are given in constipation he has found that they become more and more powerful, and may be taken in smaller and smaller doses the longer they are continued. This is probably the case with such as Castor-oil, Scammony, and Jalap, which are simply cathartic in their action. B

symptom depends upon the fact of something being formed in the blood which ought to be excreted from it. Probably it is an excess of that material which is ordinarily excreted by the bowels. Its passage out by a natural effort causes at first a simple increase of the usual evacuation. It is at this time that we should give a Purgative, to favour the natural excretion, and thus, if possible, to put an end to the disturbance. But sometimes it fails to do so. The matters to be excreted are irritating, and such an exc

the Purgative cannot take place, for it has no opportunity of passing out of the blood through the glands of the bowels. In such instances it is well to combine the Cathartic with a small dose of Tartar Emetic or Ipecacuanha, which by its na

. Chola

he action of the liver, and to promote the

t organ, which, when allowed to remain in the blood, as in the case of jaundice, are found to be hurtful. Also it appears that certain other parts of the bile are secreted or formed by the

on in the hepatic ducts. In such cases it is worse than useless to urge the liver to an extra formation of a secretion which can find no outlet. But other cases, in which the discoloration of the skin is in general incomplete, may be due to torpidi

resent concerned with medicines which tend immediately to increase the secretion of bile. They are more or less applicable in all the disorders which have just been enumerated. All Cathartic medicines act as indirect Cholagogues. This is particularly the case with the drastic purgatives. There appears to be a vital connexion between the action of the intestinal canal and that of the liver, so that any process going on in the one will excite the function of the other. Thus the bile is poured out during the process of digestion; and the peristaltic motion and extra-secretion, produced in the bowel by the action of a purge,

of their action on the liver, we might almost have affirmed that they especially increased the secretion of bile, from the obvious way in which bilious symptoms yield to their action. But we have a direct proof of this. M. Buchheim has made some careful experiments on a dog. Having given it Mercury, he cut down upon the hepatic duct, observed and collected the secretion, a

n cases as true Cholagogues, for they are both contained in the

Mercury may act efficiently as tonics, by stimulating the func

Diapho

s only given off in sufficient amount to prevent the skin from becoming over-dry, is secreted by the sudoriferous glands, whose ducts terminate in large numbers on the surface at every part. There is in the third place an oily material, formed for a similar purpose by the sebaceous glands, which are widely distributed, but fewer in number than the last. Diaphoretics seem to increase only the first two kinds,

nditions absorption is favoured, and the amount of fluid in the blood increased. At the same time the muscular system is relaxed, and the sudoriferous ducts being thrown open by the diminished contraction of the involuntary fibre that surrounds them, the excretion of the sweat

e divisions may be made:-1. Salines and diluents, under certain conditions; 2. Volatile substances which are soluble in air, as Ammonia, vol

secretion of sweat, like that of the lungs, cannot be considered as a common emunctory. There are hardly any solid matters in it which are not also contained in the urine, and commo

promotes the aeriform transpiration, by favouring evaporation. Moist air, which hinders evaporation, promotes liquid sweating. Very active exercise, with the surface warmly clad, produces liquid perspiration. Moderate exercise, with a cool surface, favours diuresis. The recumbent posture, and sleep, promote diaphoresis; the erect posture and wakefulness, diuresis. Thus when it is requ

s are nearly opposite. But this is not the case

mer. Diluent drinks are indispensable adjuncts to a Diaphoretic regimen. Salines also tend naturally to pass off in the urine, when in small doses; but when in large amount, by the bowels. A saline, being soluble in water, cannot pass out except into a fluid secretion; so

of being carried away by it, they therefore tend especially to the two aeriform secretions, i.e. those of the lungs and of the cutaneous surface. (Vide pp. 278, 285.) Ammonia and

f the skin. So also do certain Narcotics, among which Opium is conspicuous as the most certain Diap

system to a soluble state. When Tartar Emetic is given in small doses, its only apparent action is slightly to increase the perspiration. It is probable that it then passes out through th

ly in it. It has happened, when a course of Mercury has followed the administration of Sulphur, that parts of the skin have turned black, from the formation of Sulphuret of Mercury. So it

y, or the consequences may be hurtful. It may be remarked that cleanliness of the surface, by which th

, as Gout and Rheumatism, which are apt to improve or to pass off with an increase of perspiration, and in which it often seems likely that some morbid material may be eliminated by this channel, the same medicines are constantly necessary. When another secretion is unduly copious, an increase in the sweat may cause it to diminish. Thus in

I. Diu

ich tend to increase t

s regards water, and that the surplus fluid which is daily added to it should be removed. Secondly, this water is required in the urine as a vehicle, to hold in solution there certain soluble matters which are continually forming in the blood, or being received into it, but which have to be excreted from it by means of the kidneys. These matters

ver, Lead, and Copper, are Astringents, and tend to diminish rather than to increase the amount of urine. But the urine is so necessary and so constant a secretion, that it is very diffic

ble for more urine to be formed. This necessary absorption of water depends again upon the pressure of the circulation; when this is too great, it cannot go on, and the urine is diminished. A large increase in any other of the secretions, as that of the bowels,-but particularly of the skin, as in warm dry weather,-hinders diuresis. The secretion of the urine is favoured by those co

gh they often diminish both of these secretions. Both are assisted by a relaxed state of the circulation, which favours the absorption of fluids. Thus venesection, purging, Antimony, or any thing that diminishes a febrile reaction, will help diuresis in such cases. In cases of congestion on account of cardiac disease, Digitalis, which, by powerfully weakening the force of the heart, both dimi

ot always true. Thus the astringent mineral salts pass frequently out of the system in the urine, but seldom affect its amount in either way. And for t

stances, i.e. acids, alkalies, and salines under certain conditions; 2. Acrid matters of var

y of water into the system. This, therefore, should be avoided. The free acids, both mineral and vegetable, with the exception of Sulphuric acid (vide p. 262,) pass into the urine, and act as Diuretics. So also do the mineral alkalies. But as these medicines have important agencies in the blood, and tend further, by altering the reaction of the urine, to produce in it deposits of different kinds (vide p. 151,) they can seldom be safely

oils: as Juniper, Turpentine, Cajeput, Copaiba, Horseradish. These volatile oils may act upon the skin instead of the kidneys, under the conditions which ar

ain volatile oils, and sometimes a vegetable acid, acts on the kidneys when drunk in any quantity. The diuretic effect

f urine. Iodine particularly is said to be diuretic. Mercury and Antimony are most efficacious as indirect agents; the former

he Iodide of Potassium, have been found there. So also have the mineral acids-the vegetable acids-Magnesia-Mercury,[46] in combination-and Iodine, in the form of Hydriotic acid. Among vegetables, the principles of Chimaphila and Uv? Ursi-the oils of Turpentine an

eat the object for which it was intended. For congestion of a gland is invariably followed by a diminution or stoppage of its secretion. So a lar

y are medicines which can ever be much relied upon. For not only are the remedies themselves uncertain in actio

nate solid materials from the blood; (2.) to promote absorption, by diminishing the amount of fl

cine for this purpose, and all Diuretics that are given with such an object should be freely diluted with water. In Gout and Rheumatism, remedies of this order may be of service by promoting the excretion from the blood of the uric or lactic acid formed there. They may also be used as El

by renal congestion, the attempt is so hopeless that it is better to resort to Diaphoretics. In obstruction on account of heart disease, or congestion of the liver, we may sometimes gain our point by combining other Diuretics with Digitalis or Blue-pill, remedies which tend to remove the causes by which the diuretic action is hindered. (Vide p. 304.) Even then we can often produce a much more copious and effectual drain of fluid from the blood by an action on the bowels, as by a dose of Jalap or Elaterium. When a Diuretic is required to eliminate fluid from the system, the dose should not be much diluted with wa

of the actions and uses of the s