Essay On A New Principle For Ascertaining The Curative Powers Of Drugs
Samuel Hahnemann, 1796
At the commencement of this century, the unmerited honour was conferred on chemistry, more especially by the Academy of Sciences of Paris, of tempting it to come forward as the discoverer of the medicinal virtues of drugs, particularly of plants. They were subjected to the action of fire in retorts, generally without water, and by this process there were obtained, from the most deadly as from the most innocent, very much the same products, water, acids resinous matters, charcoal, and from this last, alkali always the same kind. Large sums of money were thus wasted on the destruction of plants, before it was perceived that none of the important component parts of vegetables could be extracted by this fiery ordeal, far less that any conclusion respecting their curative powers could be come to. This folly, which was, with divers variations, perpetrated for nearly half a century, gradually produced an unfavourable impression on the minds of modern physicians, which had been in the mean time more enlightened respecting the chemical art and its limits, so that they now almost unanimously adopted an opposite view, and denied all value to chemistry in the search for the medicinal powers of drugs, and in the discovery of remedial agents for the diseases to which humanity is liable.
In this they palpably went too far. Although I am far from conceding to the chemical art a universal influence on the materia medica, I cannot refrain from alluding to some notable discoveries in this respect which we have to thank if for, and to what it may hereafter effect for therapeutics.
Chemistry informed the physician who sought a palliative remedy for the evils occasioned by morbid acids in the stomach, that the alkalis and some earths were their remedies. If it was desired to destroy in the stomach poisonous matters which had been swallowed, the physician applied to chemistry for the antidotes that should speedily neutralize them, before they should injure the alimentary canal and the whole organism. Chemistry alone could tell him that the alkalis and soap were the antidotes of acid poisons, of vitriol, of aquafortis, of arsenic, as well as of the poisonous metallic salts that the acids were the counterpoisons of the alkalis, of quicklime, &c., and that for speedily counteracting the effects of all metallic poisons, sulphur, liver of sulphur, but especially sulphuretted hydrogen, were effectual.
It taught him to remove lead and tin from a cavity of the body by living quicksilver, o dissolve iron that had been swallowed by acids, and ingested glass and flint by flouric and phosphoric acids, in the way it is seen to take place, with respect to the last substance, in the stomach of fowls.
Chemistry produced vital air in its purity, and when the physiologist and clinical observer perceived its peculiar power of maintaining and increasing the vital energy, chemistry showed that a part of this power lay in the great specific caloric of this air, and furnished a supply of it, which neither the therapeutic materia medica nor clinical experience could do, from many different sources, in greater and greater purity.
Chemistry alone could supply a remedy for those suffocated by fixed air, in the vapour of caustic ammonia.
What would the Galenic school have done in cases of suffocation from charcoal vapour, had chemistry not pointer out vital air, the second component of atmosphere, as the proper thing wherewith in inflate the lungs?
Chemistry discovered a means of destroying the remains of poisons which had penetrated the system, by administering sulphuretted hydrogen in drinks and baths.
What but chemistry taught us (with nitrous ether and acetate of potash) how to dissolve those gall stones that often give rise to so many most troublesome diseases?
For centuries, chemistry has been applied to by medicine for a remedy for stone in the bladder, and with what result? Those that applied it to know best. It has at all events done something, since it brought soda saturated with fixed air into thing, since it has brought soda saturated with fixed air into repute. A still better remedy will be found in the employment of phosphoric acid.
Were not all sorts of medicinal agents applied to mammae in which the milk had curdled and caused pain? This was a hopeless, fruitless way. Chemistry showed a true remedy in fomentations of hartshorn, which renders curdled milk once more fluid.
Chemical experimentation with Colombo root and morbid bile, showed that that vegetable substance must be a remedy in deranged biliary secretion in the human body, and medical experience has confirmed the accuracy of chemical induction.
Does the practitioner seek to know if a new remedy is of a heating description?
Distillation with water, by showing the presence or absence of an ethereal oil, will with few exceptions suffice to solve the problem.
Practice cannot always tell by sensible signs if a vegetable substance possess astringent properties. Chemistry discovers that astringent principle, sometimes of no small use in practice, and even its degree, by means of sulphate of iron.
The science of dietetics alone cannot tell if a newly-discovered plant possess anything nourishing in its composition. Chemistry shows this, by separating its gluten and its starch, and, can, from that quantity of these ingredients, determine the degree of its nutritive quality.
Although chemistry cannot directly point out medicinal powers, yet it can do this indirectly, by demonstrating the powerlessness of medicines, in themselves powerful, from being mixed or the noxious properties of mixtures of medicines, in themselves innocuous. It forbids us, when we seek to produce vomiting by means of tartar emetic, to add to it substances containing gallic acid, by which it is decomposed it forbids us to drink lime water when seek to obtain benefit from the astringent principle of cinchona bark, by which it is destroyed it forbids us, if we do not wish to produce ink, to mix bark and iron in the same potion it forbids us to make the Gourlard lotion powerless by adding alum it forbids the mixture of an acid with those laxative neutral salts having cram of tartar for their bases, which remove acids from the primae viae it forbids us to render poisonous, by admixture, those otherwise innocuous substances, diaphoretic antimony and cram of tartar it prohibits the use of vegetable acids during a milk diet, (whereby an insoluble curd would be formed,) and when acids are required for digestion, it points to the vitriolic acid.
It furnishes the tests for detecting the adulteration of remedies, extracts the deadly corrosive sublimate from calomel, and teaches the difference betwixt the latter and poisonous white precipitate which it so closely resembles.
These few examples may suffice to show that chemistry cannot be excluded from a share in the discovery of the medicinal powers of drugs. But that chemistry should not be consulted with respect to those medicinal powers which relate, not to hurtful substances to be acted on immediately powers which relate, not to hurtful substances to be acted on immediately in the human body, but to changes wherein the functions of the animal organism are first concerned, is proved, inter alia, by the experiments with antiseptic substances, respecting which, it was imagined that they would exhibit exactly the same antiputrefactive power in the fluids of the body, as they did in the chemical phial. But experience showed that saltpetre, for instance, which out of the body is so highly antiseptic, shows exactly opposite qualities in putrid fever and in tendency to gangrene the reason of which, I may mention, though out of place here is, that it weakens the vital powers.
Or shall we seek to correct the putrefaction of matters in the stomach with saltpetre? An emetic will remove them at once.
Still worse for the materia medica was the advice of those who sought to ascertain the medicinal powers of its various agents, by mixing the unknown drug with newly-drawn blood, in order to see whether the blood grew darker or lighter, thinner or thicker just as if we could bring the drug into the same immediate contact with the blood in the artery, as we in the test tube just as if the drug must not first undergo an infinity if changes in the digestive canal, before it can get (and that only by a most circuitous method) into the blood. What a variety of appearances does not the blood itself present when drawn from the vein, according as it is taken from a heated or a cool body, by a smaller or large opening, in a full stream or by drops, in a cold or warm room, in a flat or a narrow vessel.
But such paltry modes of ascertaining the powers of medicines bear on their face the stamp of their worthlessness.
Even the injection of drugs into the bloodvessels of animals is for the same reason a very heterogeneous and uncertain method. To mention only one circumstance,-a teaspoon full of concentrated cherrylaurel-water will most certainly kill a rabbit, when taken into the stomach, whereas, is injected into the jugular vein, it causes no change, the animal remains lively and well.
But all events, some will say, the administration of drugs to animals by the mouth will furnish some certain results respecting their medicinal action. By no means! How greatly do their bodies differ from ours! A pig can swallow a large quantity of nux vomica without injury, and yet men have been killed with fifteen grains. A dog bore an ounce of the fresh leaves, flowers, and seeds of monkshood what man would not have dies of such a dose? Horses eat it, when dried, without injury. Yew leaves, though so fatal to man, fatten some of our domestic animals. And how can we draw conclusions relative to the action of medicines on man from their effects on the lower animals, when even among the latter they often vary so much? The stomach of a wolf poisoned with monkshood was found inflamed, but not that of a large and a small cat, poisoned by the same substance. What can we infer from this? Certainly, not much, if I may not say, nothing. Thus much, at least, is a certain, that the fine internal changes and sensations, which a man can express by words, must be totally wanting in the lower animals.
In order to try if a substance can develope very violent or dangerous effects, this may in general be readily ascertained by experiments on several animals at once, as likewise any general manifest action on the motions of the limbs, variations of temperature, evacuations upwards and downwards, and the like, but never anything connected or decisive, that may influence our conclusions with regard to the proper curative virtues of the too obscure, too rude and if I be allowed the expression, too awkward.
As the above-mentioned sources for ascertaining the medicinal vitrues of drugs were so exhausted, the systematizer of the materia medica bethought himself of others, which he deemed of a more certain character. He sought for them in the drugs themselves he imagined he would find in them hints for his guidance. He did not observe, that their sensible external signs often very deceptive, as deceptive as the physiognomy is in indicating the thoughts of the heart.
Lurid-coloured plants are by no means always poisonous and on the other hand, an agreeable colour of the flowers is far from being any proof of the harmlessness of the plant. The special qualities of drugs, which may be ascertained by the smell and taste, will not allow us to form any trustworthy conclusions respecting untried substances. I am far from denying utility to both these senses in corroborating the probable properties of drugs which have been ascertained in other ways, but I would counsel, on the other hand, great caution to those who would for their judgement from them alone. If the bitter principle strengthens the stomach, why does squill weaken it?
If bitter aromatic substances are heating, why does marsh rosemary diminish the vital temperature in such a marked manner? If those plants only are astringent that make ink with sulphate of iron, how is it that the highly astringent principle in quinces, medlars, &c., cannot furnish ink?
If the astringent taste gives evidence of a strengthening substance, why does sulphate of zinc excite vomiting? If the acids are antiseptic, why does arsenious acid produce such rapid putrefaction in the body of one poisoned by it? Is the sweet taste of sugar of a lead a sign of its nutritive properties? If the volatile oils, and everything that tastes fiery on the tongue, are heating for the blood, why are either, camphor, cajeput oil, oil of pepperment, and the volatile oil of bitter almonds and cherrylaurel, they very reverse? If we are to expect a disagreeable odour in poisonous plants, how is it so inconsiderable in monkshood, deadly nightshade, and foxglove? Why so imperceptible in nuxvomica and gamboge? If we are to look for a disagreeable taste in poisonous plants, why is the most deadly juice of the root of jatropha manihot merely sweetish, and not the least, and not the least acrid? If the expressed fatty oils are often emoillient, does it follow that they are all so, even the inflammatory oil expressed from the seeds of the jatropha curcas? Are substances which have little or no smell or taste destitute of medicinal powers? How is that ipecacuan, tartar emetic, the poison of vipers, nitrogen, and lopez-root, are not so? Who would use bryonyroot as an article of diet , on the ground that it contains much starch?
Perhaps, However, botanical affinity may allow us to infer a similarity of action? This is far from being the case, as there are many examples of opposite, or at least very different powers, in one and the same family of plants, and that in most of them. We shall take as basis the most perfect natural system, that of Murray.
In the family of the coniferoe, the inner bark of the fir-tree (pinus sylvestris) gives to the inhabitants of northern regions a kind of bread, whereas the bark of the yew-tree (taxis haccifera) gives-death. How come the feverfew (anthemis pyrethrum) with its burning root, the poisonous cooling lettuce lactuca virosa, the emetic groundsel (senecio vulgaris), the mild scorzonera, the innocuous cudweed (gnaphalium arenarium), the heroic arnica (a. Montana), all together in the one family of the compositoe? Has the purging globularia alypum anything in common with the powerless statice, both being in the family of the aggregatoe? Is there any similarity to expected betwixt the action of the skirret root (sium sisarum) and that of the poisonous water-dropwort (oenanthe crocata), or of the water-hemlock (cicuta virosa), because they are in the same family of the umbelliferoe? Has the not harmless ivy (hedera helix), in the family Hederaceoe, any other resemblance to vine (vitus vinifera), except in the outward growth? How comes the harmless butchers broom (ruscus) in the same family of the sarmenttacoeo with the stupefying cocculus (menispermum cocculus), the heating aristolochia, and the asarum europoeum? Do we expect any similarity of effect from the goose-grass (galium aparine) and the often deadly spigelia marylandica, because they both belong to the stallatoe? What resemblance can we find betwixt the action of the melon (cucumis melo) and the elaterium (momordica elaterium), in the same family of the cucurbitaceoe? And again, in the family solanaceoe, how comes the tasteless great mullein (verbascum thapsus), along with the burning Cayenne pepper (capsicum annum) or tobacco, which has such a powerful spasmexciting action on the primae viae, with nux vomica, which impedes the natural motions of the intestines? Who would compare the unmedicinal perriwinkle (vinca pervinca) with the stupifyng oleander (nerium oleander), in the family contortoe? Does the watery moneywort (lysimachia nummularia) act similarly to the marsh trefoil (menyanthes trifoliata), or the powerless cowslip (primula veris), to the drastic sowbread (cyclamen europeoum), in the family of the rutaceoe? From the strengthening effects o the bear-berry (arbutus uva ursi) on the urinary apparatus, can we infer the heating, stupefying action of the rhododendron chrysanthum, in the family bicornes? Among the verticillatoe, can any comparison be made betwixt the scarcely astringent self-heal (prunella vulgaris) or the innocent bugle (ajuga pyramidalis), and the volatile germander (teucrium marum), or the fiery majoram (origanum certicum)? How can the powers of the verbena (v. Officinalis) be said to resemble those of the active hyssop (gratiola officinalis) in the family personnatoe? How different are the actions of the glycyrrhiza and geoffroya, although in the same family of the papilionaceoe! In the family of the lomentaceoe, what parallel exists betwixt the properties of the ceratonia silliqua and those of the fumatory (fumaria officinalis), of the polygala senega and the Peruvian balsam (myroxylon peruiferum)? Or is there any likeness in the properties amongst the nigella sativa, the gardenrue (ruta graveolens), the peony (poeonia officinalis), and the cellery-leaved crowfoot (ranunculus sceleratus), although one and all are in the family of the multisiliquoe? The dropwort (spiroea filipendula) and the tormentil (tormentilla erecta) are united in the family senticosoe, and yet how different in properties! The red currant (ribes rubrum) , and the cherry-laurel (prunus laurocerasus) , the rowan (sorbus aucuparia), and the peach (amygdalus pirsica), how different in powers, and yet in the same family of the pomaceoe! The family succulentoe unites the wall-paper (sedum acre) and the portulaca oleracea, certainly not because they resemble each other in effects! How is it that the storks-bill and the purging-flax (linum catharticum), the sorrel (oxalis acetosella), and the quassia (q. Amara), are in the same family? Certainly not because their powers are similar! How various are the medicinal properties of all the members of the family ascyroideoe! And of those of the dumosoe! and of those of the trihiatoe! In the family tricoccoe, what has the corrosive spurge (euphorbia officinalis) in common with the box (buxus semprevirens), which has such a decided influence on the nervous system? The tasteless rupture-wort (herniaria glabra), the acrid phytolacca decandra, the refreshing goosefoot (chenopodium ambrosioides), and the biting persicaria (polygonum hydropiper), what a motley company in the family oleraceoe! How dissimilar in action are the scabridoe! What business has the mild, slimy, white lily (lilium candidum) beside the garlic (allium sativum), or the squill (scilla maritima) what the asparagus (a. Officinalis) beside the poisonous white hellebore (veratrum album), in the family lilaceoe?
I am far from denying, however, the many important hints the natural system may afford to the philosophical student of the materia medica and to him who feels it his duty to discover new medicinal agents but these hints can only help to confirm and serve as a commentary to facts already known, or in the case of untried plants they may give rise to hypothetical conjectures, which are, however, far from approaching even to probability.
But how can a perfect similarity of action be expected amongst groups of plants, which are only arranged in the socalled natural system, on account of often slight external similarity, when even plants that are much more nearly connected, plants of one and the same genus, are sometimes so different in their medicinal effects. Examples of this are seen in the species of the genera impatiens, serapias, cyctisus, ranunculus, calamus, hibiscus, prunus, sedum, cassia, polyonum, convallaria, linum, rhus, seseli, coriandrum, oethusa, sium, angelica, chenopodium, asclepias, solanum, lolium, allium rhamnus, amygdalus, rubus, delphinium, sisymbrium, polygala, teucrium, vaccinium, cucumis, apium, pimpinella, anethum, seandia, valeriana, anthemis, artemisia, centaurea, juniperus, brassica. What a different betwixt the tasteless tinder amadou (boletus igniarius) and the bitter, drastic boletus laricis betwixt the woody stone moss (lichen saxatilis) and the powerful Iceland moss (lichen Islandicus!)
Though I readily admit that, in general, similarity of action will be much oftener met with betwixt species of one genus, than betwixt whole groups of families in the natural system, and that an inference drawn from the former will have a much greater degree of probability attaching to it, than one from the latter yet my conviction compels me to give this warning, that, be the number of genera ever so many whose species resemble each other very much in their effects the lesser number of very differently acting species should make us distrustful of this mode of drawing inferences, since we have not here to do with mechanical experiments, but that most important and difficult concern of mankind-health. (Conclusions relative to similarity of action betwixt species of a genus become still more hazardous, when we consider that one and the same species, one and the same plant, frequently shows very various medicinal powers in its different parts. How different the poppy head from the poppy seed the manna that distils from the leaves of the larch from the turpentine of the same tree the cooling camphor in the root of the cinnamon laurel, from the burning cinnamon oil the astringent juice in the fruit of several of the mimosae, from the tasteless gum that exudes from their stem the corrosive stalk of the ranunnuculus from its mild root!)
As regards this method also, therefore, we come to the conclusion, that it cannot be considered as a sure principle to guide us to the knowledge of the medicinal powers of plants.
Nothing remains for us but experiments on the human body. But what kind of experiment? Accidental or methodical?
The humiliating confession must be made, that most of the virtues of medicinal bodies were discovered by accidental, empirrical experience, by chance often first observed by non-medical persons. Bold, often over-hold, physicians, then gradually made trial of them.
I have no intention of denying the high value of this mode of discovering medicinal powers- it speaks for itself. But in it there is nothing for us to do chance excludes all method, all voluntary action. Sad is the thought, that the noblest, the most indispensable of arts, is built upon accident, which always pre-supposes the endangering of many human lives. Will the chance of such discoveries suffice to perfect the healing art, to supply its numerous desiderta? From year to year we become acquainted with new diseases, with new phases and new complications of diseases, with new morbid conditions if then, we possess no better method of discovering the remedial agents around us than chance allows, nought remains for us to do but to treat these diseases with general (I might often wish with no) remedies, or with such as have seemed to be of service, in what we imagine, to what appear to us to be, similar diseased states. But how often shall we fail in accomplishing our object, for if there be any difference, the disease cannot be the same! Sadly we look forward into futures ages, when a peculiar remedy for this particular form of disease, for this particular circumstance, may, perhaps, be discovered by chance, as was bark for pure intermittent fever, or mercury for syphilitic disorders.
Such a precarious construction of the most important science resembling the concourse of Epicurian aroins to make a world could never be the will of the wise and most bountiful Preserver of mankind. How humiliating for proud humanity, did his very preservation depend on chance alone. No! it is exhilarating to believe that for each particular directly-acting remedies, and that there is also a way in which these may be methodically discovered.
When I talk of the methodical discovery of the medicinal powers still required by us, I do not refer to those empirical trials usually made in hospitals, when in a difficult, often not accurately noted case, in which those already known do no good, recourse is had to some drug, hitherto either untried altogether, or untried in this particular affection, which drug is fixed upon either from caprice and blind affection, which drug is fixed upon either from caprice and blind fancy, or from some obscure notion, for which the experimenter can give no plausible reason, either to himself or to others. Such empirical chance trials are, to call them by the mildest appelation, but foolish risks, if not something worse.
I speak not here, either, of the somewhat more rational trials, made occasionally in private and hospital practice, with remedies casually recommended in this or that disease, but not further tested. These, also, are performed, unless under the guidance of some scientific principle, to a certain degree at the peril of the health and life of the patient but the caution and practical skill of the physician will often avail to smooth much that is uneven in his half-empirical undertakings.
As we already possess a large number of medicines, which are evidently powerful, but concerning which we do not rightly know what diseases they are capable of curing, and moreover, others which have sometimes proved serviceable, sometimes not, in given diseases, and concerning which we have no accurate knowledge of the exact circumstances under which they are applicable, it may not at first sight appear very necessary to increase the number of our medicinal agents. Very probably all (or nearly all) the aid we seek lies in those we already possess.
Before I explain myself further, I must, in order to prevent misapprehension, distinctly declare that I do not expect, and do not believe, there can be a thoroughly specific remedy for any disease, of such and such a name, burdened with all the ramifications, concomitant affections and variations, which, in pathological works, are so often inconsiderately detailed as essential to its character, as invariably pertaining to it. It is only the very great simplicity and constancy of ague and syphilis that permitted remedies to be found for them, which appeared to many physicians to have specific qualities for the variations in these diseases occur much more seldom, and are usually much less important than in others, consequently bark and mercury must be much more often serviceable than not so.
But neither is bark specific in ague, in the most extended sense of the term, (Pity it is, that it was not observed why, for example, of the seven-fifteenths of all the so-called agues in which bark was useless, three-fifteenths required nux vomica or bitter almonds, another fifteenth opium, another fifteenth blood-letting, and still another fifteenth small doses of ipecacuan, for their cure! It was thought sufficient to say, "Bark was of no use, nut ignatia cured" the why was never satisfactorily answered. Were it is a case of pure ague, bark must be of service where there were complications, with excessive irritability, especially of the primae viae, however, it was no longer a pure case of ague, and it could not do good here now reasons for choosing as a remedy, or as an auxiliary means, ignatia, nux vomica, ot bitter almonds, according to the different conditions of the system and it could not and should not have been wondered at, that bark was not useful.)nor mercury in syphilis, in its most extended sense, they are, however, probably specific in both diseases, when they occur simple, pure, and free from all complication. Our great and intelligent observers of disease have seen the truth of this too well, to require that I should dwell longer on this subject.
Now, when I entirely deny that there are any absolute specifics for individual diseases, in their full extent, as they are described in ordinary works on pathology, (The history of diseases is not yet advanced so far that we have been at pains to separate the essential from the accidental, the peculiar from the adventitious, the foreign admixture, owing to idiosyncrasy, more of life, passions, epidemic constitutions, and many other circumstances. When reading the description of one disease, we might often imagine it was a compound admixture of many histories of cases, with suppression of the name, place, time, &c, and not true, abstractedly pure, isolated characteristics of a disease separated from the accidental (which might be afterwards appended to it, as it were). The more recent nosologists have attempted to do this: their genera should be what I call the peculiar characteristics of each this case, their species the accidental circumstances. Before all things, we have to attend to the chief disease its divergencies and concomitant circumstances only demand particular aid when they are serious, or offer obstacles to recovery they demand our chief attention and the primary disease may be less regarded, when the latter, by passing into the chronic state, has become of less importance, and is less urgent, whilst the former has gradually become the chief disease.), I am, on the other hand, convinced that there are as many specifics as there are different states of individual diseases, i,e, that there are peculiar specifics for the pure disease, and others for its varieties, and for other abnormal states of the system. If I mistake not, practical medicine has devised three ways of applying remedies for the relief of the disorders of the human body.
The first way, to remove or destroy the fundamental cause of the disease, was the most elevated it could follow. All the imaginings and aspirations of the best physicians in all ages were directed to this object, the most worthy of the dignity of our art.
But, to use a Spagyrian expression, they did not advance beyond particulars the great philosophers stone, the knowledge of the fundamental cause of all diseases, they never attained to.
And as regards most diseases, it will remain for every concealed for human weakness. In the mean time, what could be ascertained respecting this point, from the experience of all ages, was united in a general system of therapeutics. Thus, in cases of chronic spasms of the stomach, the general weakness of the system was first removed the convulsions arising from tapeworm were conquered by killing that animal the fever arising from noxious matters in the stomach was dissipated by powerful emetics in diseases caused by a chill the suppressed perspiration was restored and the ball was extracted that gave rise to traumatic fever. This object is above all criticism, though the means employed were not always the fittest for attaining it. I shall now take leave of this royal road, and examine the other two ways for applying medicines.
By the second way, the symptoms present were sought to be removed by medicines which produced an opposite condition for example, constipation by purgatives inflamed blood by venesection, cold and nitre acidity in the stomach by alkans: pains by opium. In acute diseases, which, if we remove the obstacles to recovery for but a few days, nature will herself generally conquer, or, if we cannot do so, succumb in acute diseases, I repeat, this applications of remedies is proper, to the purpose, and sufficient, as long as we do not possess the above-mentioned philosophers stone ( the knowledge of the fundamental cause of each disease, and the means of its removal,) or as long as we have no rapidly-acting specific, which would extinguish the variolous infection, for instance, at its very commencement. In this case, I would call such remedies temporary.
But if the fundamental cause of the disease, and its direct means of removal are known, and we, disregarding these, combat the symptoms only by remedies of this second kind, or employ them seriously in chronic diseases, then this method of treatment (to oppose diseases by remedies that produce an opposite state gets the name of palliative, and is to be reprobated. In chronic diseases it only gives relief at first subsequently, stronger doses do such remedies become necessary, which cannot remove the primary disease, and thus they do more harm the longer they are employed, for reasons to be specified hereafter.
I know very well that habitual constipation is still attempted to be cured by aleotic purgatives and laxative salts, but with what melancholy results! I know well that efforts are still made to subdue the chronic determination of blood of hysterical, cachetic, and hypochondriacal individuals, by repeated, although small venesections, nitre, and the like but with what untoward consequences! Persons living a sedentary life, with chronic stomachic ailments, accompanied by sour eructations, are still advised to take repeatedly Glauber salts but with what disatrous effects1 Chronic pains of all kinds are still sought to be removed by the continued use of opium but again, with what sad results! And although the great majority of my medical brethren still adhere to this method, I do not fear to call it palliative, injurious, and destructive.
I beseech my colleagues to abandon this method (contraria contraris) in chronic diseases, and in such acute diseases as take on a chronic character it is the deceitful by-path in the dark forest that leads to the fatal swamp. The vain empiric imagines it to be the beaten highway, and plumes himself on the wretches power of giving a few hours ease, unconcerned if, during this specious calm, the disease plants its roots still deeper.
But I am not singular in warning against this fatal practice-The better, more discerning, and conscientious physicians, have from time to time sought for remedies (the third way) for chronic diseases, and acute diseases tending to chronic, which should not cloak the symptoms, but which should remove the disease radically, in one word, for specific remedies the most desirable, most praiseworthy undertaking that can be imagined,. Thus, for instance, they tried arnica in dysentery, and in some instances found in a useful specific.
But what guided them, what principle induced them to try such remedies? Alas! Only a precedent from the empirical game of hazard from domestic practice, chance cases, in which these substances were accidently found useful in this or that disease often only in peculiar unmentioned combinations, which might perhaps never again occur sometimes in pure, simple diseases.
It were deplorable, indeed, if only chance and empirical apropos could be considered as our guides in the discovery and application of the proper, the true remedies for chronic diseases, which certainly constitute the major portion of human ills.
In order to ascertain the actions of remedial agents, for the purpose of applying them to the relief of human suffering, we should trust as little as possible to chance but go to work as rationally and as methodically as possible. We have seen, that for this object the aid of chemistry is still imperfect, and must only be resorted to with caution that the similarity of genera of plants in the natural system as also the similarity of species of one genus, give but obscure hints that the sensible properties of drugs teach us mere generalities, and these invalidated by many exceptions that the changes that take place in the blood from the admixture of medicines teach nothing and that the injection of the latter into the bloodvessels of animals, as also the effects on animals to which medicines have been administered, is much too rude a mode of proceeding, to enable us therefrom to judge of the finer actions of remedies.
Nothing then remains but to test the medicines we wish to investigate on the human body itself. The necessity of this has been perceived in all ages, but a false way was generally followed, inasmuch as they were, as above stated, only employed empirically and capriciously in diseases. The reaction of the diseased organism, however, to an untested or imperfectly tested remedy, gives such intricate results, that their appreciation is impossible for the most acute physician. Either nothing happens, or there occur aggravations, changes, amelioration, recovery, death without the possibility of the greatest practical genius being able to divine what part the diseased organism, and what the remedy (in a dose, perchance, too great, moderate, or too small) played in effecting the result. The teach nothing, and only lead to false conclusions. The everybody physicians held their tongues about any harm that ensued, they indicated with one word only the name of the disease, which they often confounded with another, in which this or that remedy appeared to do good, and thus were composed the useless and dangerous works of Schroder, Rutty, Chomel, Pomet, &c., in whose thick books are to be found a monstrous number of mostly powerless medicines, each of which is said to have cured radically this and at least ten or twenty other diseases.(To me, the strangest circumstance connected with these speculations upon the virtues of single drugs is, that in the days of these men, the habit that still obtains in medicine, if joining together several different medicines in one prescription, was carried to such an extent, that I defy Oedipus himself to tell what was the exact action of a single ingredient of the hotch potch the prescription of a single remedy at a time was in those days almost rarer than it is now-a-days. How was it possible in such a complicated practice, to distinguish the powers of individual medicines?
The true physician, whose sole aim is to perfect his art, can avail himself of no other information respecting medicines, than
First What is the pure action of each by itself on the human body?
Second What do observations of its action in this or that simple or complex disease teach us?
The last object is partly obtained in the practical writings of the best observers of all ages, but more especially of later times. Throughout these, the, as yet, only source of the real knowledge of the powers of drugs in diseases is scattered: there we find it faithfully related, how the simplest drugs were employed in accurately described cases, how far they proved serviceable, and how far they were hurtful or less beneficial. Would to God such relations were more numerous!
But even among them contradictions so often occur, one condemning in a certain case what another found of use in a similar case, that one cannot but remark that we still require some natural normal standard, whereby we may be enabled to judge of the value and degree of truth of their observations.
This standard, methinks, can only be derived from the effects that a given medicinal substance and poisons and such as have been purposely taken by persons, in order to test them or which have been given to healthy individuals, to criminals, &c probably also, those cases in which an improper powerfully acting substance has been employed as a household remedy or medicine, in slight or easily determined diseases.
A complete collection of such observations, with remarks on the degree of reliance to be placed on their reporters, would, if I mistake not, be the foundation tone of a materia medica, the sacred book of its revelation.
In them alone can the true nature, the real action of medicinal substances be methodically discovered from them alone can we learn in what cases of disease they may be employed with success and certainty.
But as the key for this is still wanting, perhaps I am so fortunate as to be able to point out the principle, under the guidance of which the lacunae in medicine may be filled up, and the science perfected by the gradual discovery and application, on rational principles, of a suitable specific (In this essay my chief object is to discover a permanently acting specific remedy for (especially) chronic diseases. Those remedies which remove the fundamental cause, and the temporary acting remedies for acute diseases which is some cases receive the name of palliative medicines, I shall not touch on at present.) remedy for each, more especially for each chronic disease, among the hitherto known (and among still unknown) medicines. It is contained, I may say, in the following axioms.
Every powerful medicinal substance produces in the human body a kind of peculiar disease the more powerful the medicine, the more peculiar, marked, and violent the disease.
We should imitate nature, which sometimes cures a chronic disease by superadding another, and employ in the (especially chronic)disease we wish to cure, that medicine which is able to produce another very similar artificial disease, and the former will be cured similia similibus.
We only require to know, on the one hand, the diseases of the human frame accurately in their essential characteristics, and their accidental complications and on the other hand, the pure effects of drugs, that is, the essential characteristics of the specific artificial disease they usually excite, together with the accidental symptoms caused by difference of dose, form, &c., and by choosing a remedy for a given natural disease that is capable of producing a very similar artficial disease, we shall be able to cure the most obstinate diseases (The cautious physician, who will go gradually to work, gives the ordinary remedy only in such a dose as will scarcely perceptibly develope the expected artificial disease, (for it acts by virtue of its power to produce such an artificial disease,) and gradually increases the dose, so that he may be sure that he may be sure that the intended internal changes in the organism are produced with sufficient force, although with phenomena vastly inferior in intensity to the symptoms of the natural disease thus a mild and certain cure will be effected. But if it is sought to go rapidly to work, with the other erwise fit and properly chosen remedy, the object may be certainly attained in this way too, though with some danger to life, as is often done in a rude manner by quacks among the peasants, and which they call miraculous, or horse cures, a disease of many years standing being thereby cured in a few days a proceeding that testifies to the truth of my principle, while at the same time it shows the hazardous nature of this mode of effecting it.)
This axion has, I confess, so much the appearance of a barren, analytical, general formula, that I must hasten to illustrate it synthetically. But first let me call to mind a few points.
I. Most medicines have more than one action the first a direct action, which gradually changes into the second (which I call the indirect secondary action). The latter is generally a state exactly the opposite of the former. (Opium may serve as an example. A fearless elevation of spirit, a sensation of strength and high courage, an imaginative gaiety, are part of the direct primary action of a moderate dose on the system: but after the lapse of eight or twelve hours an opposite state sets in, the indirect secondary action there ensue relaxation, dejection, diffidence, peevishness, loss of memory, discomfort, fear. In this way most vegetable substance act.
II. But few medicines are exceptions to this rule, continuing their primary action uninterruptedly, of the same kind though always diminishing in degree, until after some time on trace of their action can be detected, and the natural condition of the organism is restored. Of this kind are the metallic (and other mineral?) medicines, e. g., arsenic, mercury, lead.
III. If, in a case of chronic disease, a medicine be given, whose direct primary action corresponds to the disease, the indirect secondary action is sometimes exactly the state of body sought to be brought about but sometimes, (especially when a wrong dose has been given three occurs in the secondary action a derangement for some hours, seldom days. A somewhat too large dose of henbane is apt to cause, in its secondary action, great fearfulness a derangement that sometimes lasts several hours. If it is troublesome, and we wish to diminish its duration, a small dose of opium affords specifically almost immediate relief the fear goes off. Opium, indeed, in this case, acts only antagonistically, and as a palliative but only a palliative and temporary remedy is required, in order to suppress effectually a transitory affection, as is also the case in acute diseases.
IV.Palliative remedies do so much harm in chronic diseases, and render them more obstinate, probably because after their first antagonistic action they were followed by a secondary action, which is similar to the disease itself.
V. The more numerous the morbid symptoms the medicine produces in its direct action, corresponding to the symptoms do the disease to be cured, the nearer the artificial disease resembles that sought to be removed, so much more certain to be favourable will the result of its administration be.
VI. As it may be almost considered an axiom, that the symptoms of the secondary action are the exact opposite of those of the direct action, it is allowable for a master of the art, when the knowledge of the symptoms of the direct action is imperfect, to supply in imagination the lacunae by induction, i. e., the opposite of the symptoms of the secondary action the result, however, must only be considered as an addition to, not as the basis of, his conclusions.
After these preliminary observations, I now proceed to illustrate by examples my maxim, that in order to discover the true remedial powers of a medicine for chronic diseases, we must look to the specific artificial disease it can develope in the human body, and employ it in a very similar morbid condition of the organism which it is wished to remove.
The analogous maxim, that in order to cure radically certain chronic diseases, we must search for medicines that can excite a similar disease (the more similar the better) in the human body will thereby almost become evident.
In my additions to Cullens Materia Medica, I have already observed that bark, given in large doses to sensitive, yet healthy individuals, produces a true attack of fever, very similar to the intermittent fever, and for this reason, probably it overpowers, and thus cures the latter. Now after mature experience, I add, not only probably, but quite certainly.
I saw a healthy, sensitive person, of firm fibre, and half way through with her pregnancy, take five drops of the volatile oil of chamomile (materia chamomilla) for cramp in the calf of the leg. The dose was much too strong for her. First there was the loss of consciousness, the cramp increased, there occurred transient convulsions in the limbs, in the eyelid, &c. A kind of hysterical movement above the navel, not unlike labour pains, but more annoying, lasted for several days. This explains how chamomile has been found so serviceable in after-pains in excessive mobility of the fibre, and in hysteria, when employed in doses in which it could not perceptibly develope the same phenomena, that is, in much smaller doses than the above.
A man who had been long troubled with constipation, but was otherwise healthy, had from time to time attacks of giddiness that lasted for weeks and months. Purgatives did no good. I gave him arnica root (arnica montana) for a week, for I knew that it causes vertigo, in increasing doses, with the desired result. As it has laxative properties, it kept the bowels open during its employment, by antagonistic action, as a palliative wherefore the constipation returned after leaving off the medicine the giddiness, however, was effectually cured. This root excited, as I and others have ascertained, besides other symptoms, nausea, uneasiness, anxiety, peevishness, headache, oppression of the stomach, empty eructation, cutting in the abdomen, and frequent scanty evacuations, with straining. These effects, not Stollens example, induced me to employ it in an epidemic of simple (bilious) dysentery. The symptoms of it were uneasiness, anxiety, excessive peevishness, head-ache, nausea, perfect tastelessness of all food, rancid bitter taste on the (clean) tongue, frequent empty eructation, oppression of the stomach, constant cuttings on the abdomen, complete absence of faecal evacuations, and instead, passage of pure grey or transparent sometimes hard, white, flocculent mucus, occassionally intimately mixed with blood, or with streaks of blood, or without blood, once or twice a day, accompanied with the most painful constant straining and forcing. Though the evacuations were so rare, the strength sank rapidly, much more quickly, however and without amelioration, but rather aggravation of the original affection), when purgatives were employed. Those affected were generally children, some even under one year old, but also some adults. The diet and regimen were proper. On comparing the morbid symptoms arnica root produces with those developed by this simple dysentery, I could confidently oppose to the totality of the symptoms arnica root produces with those developed by this simple dysentery, I could confidently oppose to the totality of the symptoms of the latter, the collective action of the former. The most remarkable good effects followed, without it being necessary to use any other remedy. Before the employment of the root, I gave a powerful emetic, (without using the arnica root, the emetics took away the rancid bitter taste for but one or two days all the other symptoms symptoms remained, though they were ever so often repeated.)which I had occasion to repeat in scarcely two cases, for arnica sets to right the disordered bile (also out of the body,) and prevent its derangement. The only inconvenience resulting from its use in this dysentery as, that it acted as an antagonistic remedy in regard to the suppression of faeces, and produced frequent, though scanty evacuations of excrement it was consequently a palliative the effects of this was, when I discontinued the root, continued constipation. ( I had to increase the dose daily, more rapidly than is necessary with any other powerful medicine. A child of four years of age got at first four grains daily, then seven, eight, and nine grains. Children of six or seven years of age could at first only bear six grains, afterwards twelve and fourteen grains were requisite. A child three quarters of a year old, which had taken nothing previously, could at first bear but two grains (mixed with warm water) in an enema latterly six grains were necessary.)
In another less simple dysentery, accompanied by frequent diarrhoea, the arnica root might be more useful and suitable, on account of this later circumstance its property of producing frequent faecal evacuations in its primary direct action would constitute it a similarly acting, consequently, permanent remedy, and in its secondary indirect action it would effectually cure the diarrhoea.
This has already been proved by experience it has been found excellent in the worst diarrhoeas. It subdues them, because, without weakening the body, it is capable of causing frequent evacuations. In order to prove serviceable in diarrhoeas without foecal matter, it must be given in such small doses as not to produce perceptible purgation or in diarrhoeas with acrid matters, in larger purgative doses and thus the object will be attaine.
I was glandular swellings occur from the misuse of an infusion of flowers of arnica I am much mistaken if, in moderate doses, it will not remove such affections.
We should endeavour to find out if the millefoil (achillea millefolium) cannot itself produce haemorrhages in large doses, as it is so efficacious in moderate doses in chronic hemorrhages in moderate doses in chronic hemorrhages.
It is not to be wondered at that valerian (valeriana officinalis) in moderate doses cures chronic diseases with excess of irritability, since in large doses, as I have ascertained, it can exalt so remarkably the irritability of whole system.
The dispute as to the whether the brooklime (anagallis arvensis) and the bark of the misletoe (viscum album) possess great curative virtues or none at all, would immediately be settled, if it were tried on the healthy whether large doses produces bad effects, and an artificial disease similar to that in which they have been hitherto empirically used.
The specific artificial disease and the peculiar affections that the spottled hemlock (conium maculatum) causes, are not nearly so well describe as they deserve but whole books are filled with the empirical praise and the equally empirical abuse of this plant. It is true that it can produce ptyalism, it may therefore possess an excitement action on the lymphatic system, and be of permanent advantage in cases where it is requiste to restrain the excessive action of the absorbent vessels. (If employed in inactivity of these vessels, it will first act as a palliative afterwards do little one way or other, and lastly, prove injurious, by the production of the opposite condition to that wished for.) Now as it, besides this, produces pains (in large doses violent pains) in the glands, it may easily be conceived that in painful induration of the glands, in cancer, and in the painful nodes that the abuse of mercury leaves, it may be the best remedy, in moderate doses, not only for curing almost specifically this peculiar kind of chronic pains and all other narcotic remedies which act in a different manner, but also for dispersing the glandular swellings themselves, when they either have their origin, as above described, in excessive local or general activity of the lymphatic vessels, or occur in an otherwise robust frame, so that the removal of the pains is all that is required in order to enable nature to cure the complaint herself. Painful glandular swellings from external injuries are of this description. ( A healthy peasant child got, from a violent fall, a painful swelling of the under lip, which increased very much in the course of four weeks in hardness, size and painfulness. The juice of the spotted hemlock applied to it, affected a cure without any relapse in fourteen days. A hitherto uncommonly healthy, robust girl, had severely bruised the right breast, whilst carrying a heavy burden, with strap of the basket. A small tumour arose, which for six months increased in violence of pain, in size and hardness, at each monthly period. The external application of spotted hemlock juice cured it within five weeks. This it would have done sooner, had it not affected the skin, and produced there painful pustules, in consequence of which it had frequently to be discontinued for several days.)
In true cancer of the breast, where an opposite state of the glandular system, a sluggishness of it, seems to predominate, it must certainly do harm on the whole (it may at first soothe the pains), and especially must it aggravate the disease when the system, as is often the case, is weakened by long-continued suffering and it will do harm all the more rapidly, because its continued use produces, as a secondary action, weakness of the stomach and of the whole body. From the very reason that it, like other umbelliferious plants, specifically excited the glandular system, it may, as the older physicians remarked, cure an excessive secretion of milk. As it shows a tendency to paralyse the nerved of sight in large doses, it is comprehensible why it has proved for service in amourosis. It was removed spasmodic complaints, hooping cough, and epilepsy, because it has a tendency to produce convulsions. It will still more certainly be of use in convulsions of the eyes and trembling of the limbs, because in large doses it develops exactly the same phenomena. The same with respect to giddiness.
The fact that fools parsley (oethusa cynapium), besides other affections, as vomiting, diarrhoea, colicky pains, cholera, and others for the truth of which I cannot vouch (general swelling, &c.), produces so specifically imbecility, also imbecility alternately with madness, should be of use to the careful physician in this disease, otherwise so different of cure. I had a good extract of it prepared by myself, and once, when I found myself, from much mental work of various kinds coming upon me in rapid succession, distracted and incapable of reading any more, I took a grain of it. The effect was an uncommon disposition for mental labour, which lasted for several hours, until bed-time. The next day, however, I was less disposed for mental exertion.
The water hemlock (cicuta virosa) causes, among other symptoms, violent burning in the throat and stomach, tetanous, tonic cramp of the bladder, lockjaw, erysipelas of the face, headache, and true epilepsy all diseases for which we require efficient remedies, one of which, it may be hoped, will be found in this powerfully, acting root, in the hands of the cautious but bold physician.
Amatus the Portuguese observed that cocculus seeds (menispermum cocculus), in the dose of four grains, produced nausea, hiccough, and anxiety in an adult man. In animals they produced a rapid, violent, but when the dose was not fatal, a transitory stupefaction. Our successors will find in them a very powerful medicine, when the morbid phenomena these seeds produce shall be more accurately known. The Indians use the root of this tree, among others things, in malignant typhus (that accompanied by stupefaction).
The forx-grape (paris quadrifolia) has been found efficacious in cramps, The leaves cause, in large doses at all events, cramp in the stomach, according to the still imperfect experience we possess of the morbid phenomena they are capable of developing.
Coffee produces, in large doses, headaches it therefore cures, in moderate doses, head-aches that do not proceed from derangement of the stomach or acidity in the primae viae. It favours the peristaltic motion of the bowels in large doses, and therefore cures in smaller doses chronic diarrhoeas, and in like manner the other abnormal effects it occasions might be employed against similar affections of the human body, were we not in the habit of misusing it. The effects of opium in stupefying the senses, and irritating the tone of the fibres, are removed by this berry in its character of an antagonistic palliative remedy, and that properly and effectually, for here there is no persistent state of the organism, but only transitory symptoms to be combated. Intermittent fevers, too, where there is a want of irritability and inordinate tension of the fibres, precluding the employment of otherwise specific bark, it apparently suppresses in large doses, merely as an palliative remedy its direst action, however, in such large doses, lasts for two days.
The bitter-sweet (solanum dulcamara) produces, in large doses, among other symptoms, great swelling of the affected parts and acute pains, or insensibility of them, also paralysis of the tongue and of the optic nerves?). In virtue of the last powerful action, it is not to be wondered at that it has cured paralytic affections, amaurosis, and deafness, and that it will render still more specific service in paralysis of the tongue, in moderate doses. In virtue of the two first properties, it is a main remedy in chronic rheumatism, and in the nocturnal pains from the abuse of mercury. In consequence of its power of causing strangury, it has been useful in obstinate gonorrhoea, and from its tendency to bring about itching and shooting in the skin, it shows its utility in many cutaneous eruptions and old ulcers, even such as arise from abuse of mercury. As it causes, in large doses, spasms of the hands, lips and eyelids, as also shaking of the limbs, we may easily understand how it has been useful also in spasmodic affections. In nymphomania it will probably be of use, as it acts so specifically on the female genital organs, and has the power of causing (in large doses) itching and pains in these parts.
The berries of the black nightshade (solanum nigrum) have caused extraordinary convulsions of the limbs, and also delirious raving. It is, therefore, probable that this plant will do good in what are called possessed persons (madness, with extraordinary, emphatic, often unintelligible talking, formerly considered prophesying and the gift of unknown tongues, accompanied by convulsions of the limbs), especially where there are at the same time pains in the region of the stomach, which these berries also produce in large doses. As this plant causes erysipelas of the face, it will be useful in that disease, as has already been ascertained from its external employment. As it causes, to a still greater degree than bitter-sweet, by being used internally, external swellings, that is, a transient obstruction in the absorbent system, its great duiretic power is only the indirect secondary result and hence its great virtue in dropsy, from similarity of action, is plainly perceptible a medicinal quality of so much the greater value, as most of the remedies we possess for this disease are merely antagonistically acting (exciting the lymphatic system in a merely transitory manner), and consequently palliative remedies, incapable of effecting a permanent cure. As, moreover, in large doses it causes not only swelling, but general inflammatory swelling, with itching, and intolerable burning pains, stiffness of the limbs pustular eruptions, desquamation of the skin, ulcers, and sphacelus, where is the wonder that its external application has cured divers pains and inflammations? Taking all the morbid symptoms together that the black nightshade produces, we cannot mistake their striking resemblance to raphania, for which it will, most probably, be found to be a specific remedy.
It is probable that the deadly nightshade (atropha belladonna) will be useful, if not in tetanus, at least in trismus (as it produces a kind of lockjaw), and in spasmodic dysphagia (as it specifically causes a difficulty of swallowing) both these actions belong t its direct action. Whether its power over hydrophobia, if it do possess any, depends on the latter property alone, or also on its power of suppressing palliatively, for several hours, the irritability and excessive sensitiveness that are present in so great a degree in hydrophobia, I am unable to determine. Its power of soothing and dispersing hardened, painful and suppurating glands, is owing, undeniably, to its property of exciting, in its direct action, boring, gnawing pains in these glandular swellings. Yet I conceive that it acts antagonistically, that is, in a palliative and merely temporary manner, in those which proceed from excessive irritation of the absorbent system (with subsequent aggravation, as is the case with all palliatives in chronic diseases) but, by virtue of similarity, that is, permanently and radically, in those arising from torpor of the lymphatic system, (Then it would be serviceable in those glandular swellings in which the spotted hemlock (conium maculatum) cannot be usedm and the latter will be useful where the former does injury.) as, however, its continued employment (by reason if its indirect secondary action) exhausts the whole body, and when given in too large, to too often repeated doses, has a tendency to produce a gangrenous fever, its good effects will sometimes be destroyed by these secondary bad consequences, and fatal result may ensue (especially in the case of cancerous patients, whose vital powers have been exhausted by the sufferings of many years), if it be not cautiously employed. It produces directly mania, (as also, as above described, a kind of tonic cramp) but clonic cramps (convulsions) it only produces as a secondary action, by reason of the state of the organism that remains after the direct action of belladonna (obstruction of the animal and natural functions.) Hence its power in epilepsy with furor is always most conspicuous upon the latter symptom, whilst the former is generally only changed by the antagonistic (palliative) action of belladonna, into trembling, and such-like spasmodic affections peculiar to weakened irritable systems. All the spasmodic symptoms that belladonna produces in its direct primary action are of a tonic character true, the muscles are in a state of paralytic relaxation: but their deficient irritability causes a kind of immobility, and a feeling of health, as if contraction were present. As the mania it excites us of a wild character, so it sooths manias of this sort, or at least deprives them of their stormy nature. As it extinguishes memory in its direct action, (It will, therefore, be useful in weakness of memory) nostalgia (home sickness) is aggravated, and as I have seen, is even produced by it,
Moreover, the increased discharge of urine, sweat, menses, faeces, and saliva, which have been observed, are merely consequences of the antagonistic state of the body, remaining after an excessive exaltation of the irritability, or else sensitiveness during the indirect secondary action, when the direct primary action of the drug is exhausted, during which, as I have several times observed, all these excretions are often completely suppressed by large doses for ten hours and more. Therefore, in cases where these excretions are discharged with difficulty, and excite some serious disease, belladonna removes this difficulty permanently and completely, as a similarly-acting remedy, if it be owing to tension of the fibres, and want of irritability and sensibility, I say purposely, serious disease, for only in such cases is it allowable to employ one of the most violent of medicines, which demands such caution in its use Some kinds of dropsy, green sickness, &c., are of this nature. The great tendency of belladonna to paralyse the optic nerve, makes it important, as a similarly-acting remedy, in amaurosis (I have myself seen the good effects of it in this disease.) In its direct action it prevents sleep, and the deep sleep which subsequently ensues is only in consequence of the opposite state produced by the cessation of this action. By virtue, therefore, of this artifical disease, belladonna will cure chronic sleeplessness 9from want of irritability) more permanently than any palliative remedy.
It is said to have been found beneficial in dysentery probably, as in its direct action it retards the stool, in the most simple cases of diarrhoea, with suppressed faecal evacuations, and rare motions, but not in dysentery with lienteric diarrhoea, where is must do positive harm. Whether, however, it is appropriate for dysentery, by reason of its actions, I am unable to say.
It produces apoplexy and if it have, as we are told, been found serviceable in serious apoplexy, it is owing to this property. Besides this, its direct action causes an internal burning, with coldness of external parts.
Its direct action lasts twelve, twenty-four, and forty-eight hours. Hence, a dose should not be repeated sooner than after two days. A more rapid repetition of ever so small a dose must resemble in its (dangerous) effects the administration of a large dose, experience teaches this.
The fact that henbane (hyoscyamus niger) in large doses diminishes remarkably the heat of the body and relaxes its tone for a short time in its direct action, and therefore is an efficacious palliative remedy when given in moderate doses inwardly and outwardly in sudden when given in moderate doses inwardly and outwardly in sudden attacks of tension of the fibres and inflammation, does not fall to be considered in this place. This is not the case, however, with the observation, that this property only enables it palliate very imperfectly, in any dose, chronic affections with tension of the fibre in the end, however, it rather increases than diminishes them by its direct secondary action, which is exactly than diminishes them by its primary action. On the other hand, it will help to assist the power of the strengthening remedy in chronic relaxation of the fibres, as in its primary action it relaxes, and in its secondary action it tends all the more to elevate the tone, and that in a durable manner. In large doses it likewise possesses the power of producing haemorrhage, especially bleeding of the nose, and frequently recurring catamenial flux, as I and others have ascertained. For this reason it cures chronic haemorrhages, in small doses, in an extremely effectual and lasting manner. The most remarkable thing is the artificial disease it produces in very large doses, suspicious, quarrelsome, spitefully-calumnious, revengeful, destructive, fearless, (the subsequent indirect secondary action is a kind of faint-heartedness and fearfulness.) mania (hence, henbane was termed by the ancients altercum), and this is the kind of mania it specifically cures, only that in such cases a tenseness of fibre sometimes hinders it effects from being permanent. Difficulty of moving, and insensibility of the limbs, and the apoplectic symptoms it produces, it may also ver probably be capable of curing. In large doses, it produces, in its direct primary action, convulsions, and is consequently useful in epilepsy, probably also in the loss of memory usually accompanying it, as it has the power of producing want of recollection.
Its power of causing in its direct action sleeplessness with a much more permanent remedy than the frequently merely palliative opium, especially as it at the same time keeps the bowels open, although only by the indirect secondary action of each dose, consequently in a palliative way. It causes dry cough, dryness of the mouth and nose, in its direct action it is, therefore, very useful in tickling cough, probably also in dry coryza. The flow of mucus from the nose, and the flow of saliva observed from its use, only belong to its indirect secondary action. The seeds cause convulsions in the facial an ocular muscles, and by their action on the head, cause vertigo, and a dull pain in the membranes lying under the skull. The practical physician will be able to take advantage of this. Its direct action lasts scarcely twelve hours
The thorn-apple (datura stramonium) causes extraordinary waking dreams, unconsciousness of what is going on, loud delirious talking, like a person speaking in sleep, with mistakes respecting personal identity. A similar kind of mania it cures specifically. It excites very specific convulsions, and has thus often proved useful in epilepsy. Both properties render it serviceable in the case of persons possessed. Its power of extinguishing recollecting should induce us to try it in cases of weak memory. It is most useful where there is great mobility of the fibre, because its direct action in large doses is increased fibrous mobility. It causes (in its direct action?) heat and dilatation of the pupil, a kind of dread of water, swollen, red face, twitching in the ocular muscles, retarded stool, difficult breathing in its secondary action, slow, soft pulse, perspiration, sleep.
The direct action of large doses lasts about twenty-four hours of small doses, only three hours, vegetable acids, and apparently citric acid in particular, suddenly put a stop to its whole action. (A patient, who has always violently affected by two grains of the extract of the plant, once experienced not the slightest effects from this dose. I learned that he had partaken of the juice of a large number of red currents a considerable dose of pulverized oyster-shells at once restored the full efficacy of the thorn apple.)The other species of datura seem to act in a similar manner.
The specific properties of Virginia tobacco (nicotiana tabacum) consists, among other things, in diminishing the external senses, and obscuring the intellect it may therefore be useful in weakness of mind. Even in a very small dose, it excites the muscular action of the prime viae violently a property which is valuable as a temporary oppositely-acting remedy (as is well known, though it does not fall to be considered here) and as a similarly acting remedy it is probably serviceable in chronic disposition to vomiting and to the colics, and spasmodic constriction do the oesophagus as indeed experience partially corroborates. It diminishes the sensibility of the primae viae hence its palliative power of lessening hunger (and thirst?) In large doses, it deprives of their irritability the muscles of voluntary motion, and temporarily removes from them the influence of the cerebral power. This property may give it as a similarly-acting remedy, curative powers in catalepsy but this very property makes its constant employment in large quantities (as with tobacco-smokers and snuff-takers) so injurious to the tranquil state of the muscles belonging to the animal functions, that a tendency to epilepsy, hypochondriasis, and hysteria, are in course of time developed. The remarkable fact, that the employment of tobacco is so agreeable to insane persons, arises from the instinct of those unfortunates to produce a palliative obtuseness in the sensibility of their hypochondria (To this belongs the feeling of insatiable hunger, which many insane persons suffer from, and for which they generally appear to use tobacco at least, I have seen some, who had no desire for tobacco, specially such as were affected with melancholia, who had no desire for tobacco, especially such as were affected with melancholia, who had very little hunger.)and brain (the usual seats of their complaints). But as it is here an oppositely-acting remedy, it gives them but temporary relief their desire for it increases, but the end for which it is taken is not attained,- on the whole the complaint is thereby increased, as it tenders no permanent service. Its direct action is limited is limited to a few hours, except in the case of very large doses, which extend to twenty-four hours (at the farthest).
The seeds of the poison tree (strychnos nux vomica) are very powerful but the morbid symptoms it produces are not yet accurately known, The most I know concerning them is derived from my own observation. The produce vertigo, anxiety, febrile rigour, and in their secondary action a certain immobility of all parts, at least of the limbs, and a spasmodic stretching, according to the size of the dose. Hence they are useful, not only, as is already known, in intermittent fever, but in cases of apoplexy. In their first direct action the muscular fibre has a peculiar mobility imparted to it, the sensitive system is morbidly exalted to a species of intoxication, accompanied by fearfulness and horror. Convulsions ensue. The irritability seems to exhaust it itself during this continued action on the muscular fibre, first in the animal, then in the vital functions. On passing into the indirect secondary action, there occurs a diminution of the irritability, first, in the vital functions (general perspiration), then in the animal, and lastly in the natural functions. In the latter, especially, this secondary action lasts several days. During the secondary action, there us a diminution of sensibility. Whether in the primary direct action the tonicity of the muscles is diminished, to be proportionately increased in the secondary action, cannot be accurately determined this much, however, is certain, that the contractility of the fibre is as much, however, is certain, that the contractility of the fibre is as much diminished in the secondary action, as it was increased in the direct action.
If this be true, nux vomica produces attacks similar to hysterical and hypochondriacal paroxysms, and this explains why it is so often useful in these complaints.
Its tendency to excite, in its primary direct action, the contracility of the muscles, and cause convulsions, and then again in its secondary action to diminish to an excessive degree the contractility of the muscles, shows such a resemblance to epilepsy, that from this very circumstance we must have inferred that it would heal this disease, had not experience already demonstrated it.
As it excites, besides vertigo, anxiety and febrile rigour, a kind of delirium consisting in vivid, sometimes frightful visions, and tension in the stomach, so it once quickly subdues a fever in a laborious reflective mechanic in the country, which began with tension in the stomach, followed by a sudden attack of vertigo, so as to make him fall, that left behind it a kind of confusion of the understanding, with frightful, hypochonodriacal ideas, anxiety, and exhaustion. In the morning he was pretty lively and not exhausted, but in the afternoon, about two oclock, the attack commenced. He got nux vomica, in increasing doses, which contained seventeen grains, there occurred great anxiety, immobility and stiffness of the limbs, ending in a profuse perspiration. The fever and all the nervous symptoms disappeared, and never returned, although for many years previously he had from time to time been subject to such attacks suddenly occurring, yet unaccompanied by fever.
Its tendency to cause cramps in the abdomen, anxiety and pain in the stomach, I availed myself of in a dysenteric fever(without purgings), in persons living in the same house with dysenteric patients. In these cases it diminished the feeling of discomfort in the limbs, the feverishness, the anxiety, and the pressure in the stomach it produced the same good results in some of the patients, but as they had simple dysentery without diarrhoea, it made the evacuations still rarer, from its tendency to cause constipation. The signs of deranged biliary secretion showed themselves, and the dysenteric evacuations, though rarer, were accompanied by just as great tenesmus as before, and were o as bad a character. The symptom of loss of taste, or perverted taste, remained. Its tendency to diminish the peristaltic movements was therefore disadvantageous in the true simple dysentery. In diarrhoeas, even such as are of a dysenteric character, it will be more serviceable, at least as a palliative remedy. During its employment, I witnessed twitching movements under the skin, as if caused by live animals, in the limbs, and especially in the abdominal muscles.
St. Ignatius bean (ignatia amara) has been observed to produce trembling of several hours duration, twitchings, cramps, irascibility, sardonic laughter, giddiness, cold perspiration. In similar cases it will show its efficacy, as experience has partly demonstrated. It produces febrile rigour, and (in its secondary action?) stiffness of the limbs, and thus it has cured, by similarity of action, intermittent fever, which would not yield to bark probably it was that less simple form of intermittent in which the complication consisted of excessive sensitiveness and increased irritability (especially of the primae viae). But the other symptoms it can produce must be more accurately observed, before we can employ it in those cases for which it is exactly suited from similarity of symptoms.
The purple foxglove (dignitalis purpurea) causes the most excessive disgust at food during its continued use, therefore, ravenous hunger not unfrequently ensues. It causes a kind of mental derangement, which is not easily recognizable, as it only shows itself in unmeaning words, refractory disposition, obstinacy, cunning, disobedience, inclination to run away, &c., which its continued use frequently prevents Now as, in addition to these, it produces in its direct action violent headaches, giddiness pain in the stomach, great diminution of the vital powers, sense of dissolution and the near approach of death, a diminution of the rapidity of the hearts beats by one half, and reduction of the vital temperature, it may easily be guessed in what kind of madness it will be of service, and that it has in fact been useful in some kinds of this disease, many observations testify, only their particular symptoms have not been recorded. In the glands it created an itching and painful sensation, which accounts for its efficacy in glandular swellings.
It produces, as I have seen, inflammation of the Meibomian glands, and is a certain cure for such inflammations. Moreover, as it appears to depress the circulation, so does it seem to excite the absorbant vessels, and to be most serviceable where both are too torpid. The former it assists by virtue of similarity, the later by virtue of antagonism of action. But as the direct action of foxglove persists so long (there are examples of its lasting five or six days), it may, as an antagonistically acting remedy, take the place of a permanent curative agent. The last observation is in reference to its diuretic property in dropsy it is antagonistic and palliative, but nevertheless enduring, and valuable on that account merely.
In its secondary action it causes a small, hard, rapid pulse it is not therefore so suitable for patients who have a similar (febrile) pulse, but rather for such as have a pulse like what foxglove produces in its direct action slow, soft. The convulsions it causes in large doses, assign it in a place among the anti-epileptic remedies probably it is only useful in epilepsy under certain conditions, to be determined by the other morbid symptoms it produces. During its use, objects not infrequently appear of various colours, and the sight be comes obscured it will remove similar affections of the retina. (Its tendency to produce diarrhoea, sometimes so adverse to the cure, is counteracted, as I have ascertained, by the addition of potash.
As the direct action of foxglove lasts occasionally several days (the longer its use is continued, the longer lasts the direct action of each dose a very remarkable fact, not to be lost sight of in practice), it is evident how erroneously those act, who, with the best intentions, prescribe it in small but frequently repeated doses, (the action of the first not having expired before they have already given the sixth or eight), and thus in fact they give, although unwittingly, an enormous quantity, which not unfrequently causes death. (A woman in Edinburgh got for three successive days, each day, three doses, each dose consisting of only two grains of the pulverized leaves of foxglove, and it was a matter of surprise that she died from such small doses, after vomiting for six days. It must be remembered, however, that it was the same as if she had taken eighteen grains at one dose.)
A dose is necessary only every three or at most every two days, but the more rarely the longer it has been used. (During the continuance of its direct action, cinchona bark must not be prescribed it increases the anxiety caused by foxglove, as I have found, to an almost mortal agony.)
The pausy violet (viola tricolor) at first increases cutaneous eruptions, and thus shows its power to produce skin diseases, and consequently to cure the same effectually and permanently.
Ipecacuanha is used with advantage in affections, but is too powerless to effect the desired object. In these ipecacuanha presents to the nerves of the upper orifice of the stomach, the most sensitive part of the organ of vitality, a substance that produces a most uncongenial disgust nausea, anxiety, thus acting in a similar manner to the morbid material that is to be removed. Against this double attack, nature exerts antagonistically her powers with still greater energy, and thus, by means of this increased exertion, the morbid matter is the more easily removed. Thus fevers are brought to the crisis, stoppages in the viscera of the abdomen and of the chest, and in the womb, put in motion, miasmata of contagious diseases expelled by the skin, cramp relieved by the cramp that ipecacuanha itself produces, their tension and freedom restored to vessels disposed to hemorrhage from relaxation, or from the irritation of an acrid substance deposited in them, &c. But most distinctly does it act as a similarly acting remedy to the disease sought to be cured, in cases of chronic disposition to vomit without bringing anything away. Here it should be given in very small doses, in order to excite frequent nausea, and the tendency to vomit goes off more and more permanently at each dose, than it would with any palliative remedy.
Some benefit may be anticipated in some kinds of chronic palpitation of the heart, &c., from the administration of the rose bay (nerium oleander), which has the power of causing palpitation, anxiety, and fainting. It causes swellings of the abdomen and diminution of the vital temperature, and seems to be a most powerful vegetable.
The morbid symptoms produced by the nerum antidysentericum are not sufficiently known to enable us to ascertain the cause of its real remedial powers but as it primarily increases the stools, it apparently subdues diarrhoeas as a similarly acting remedy.
The bears berry arbutus uva ursi) has actually, without possessing any acridity perceptible to the senses, not unfrequently increased the difficulty of passing water, and the involuntary flow of urine, by some power peculiar to itself, thereby showing that it has a tendency to produce such affections, and hence, as experience also testifies, it is capable of curing similar disorders in a permanent manner.
The golden-flowered rhododendron (rhododendron chrysanthum) shows, by the burning, formicating, and shooting pains it produces in the parts affected, that it is certainly fitted to relieve, by similarity of action, pains in the joints of various kinds, as experience also teaches. It causes difficulty of breathing and cutaneous eruptions, and thus it will prove useful in similar disorders, as also in inflammation of the eyes, because it produces lachrymation and itching of the eyes.
The marsh-tea (ledum palustre) causes, as I have ascertained, among other effects, difficult, painful respiration this accounts for its efficacy in hooping cough, probably also in morbid asthma. Will it not be useful in pleurisy, as its power of so greatly diminishing the temperature of the blood (in its secondary action) will hasten recovery? It causes a painful shooting sensation in all parts of the throat, as I have observed, and hence its uncommon virtues in malignant and inflammatory, sore throat. Equally specific is, as I have noticed, its power of causing troublesome itching in the skin, and hence its great efficacy in chronic skin diseases.
The anxiety and the faintings its occasions may prove of use in similar cases. As a transitory and antagonistically acting powerful diuretic and diaphoretic remedy, it may cure dropsies more certainly however, acute, than chronic.
On some of these properties depends its reputation in dysentery. But were they earl cases of dysentery, or some of those painful diarrhoeas so often taken for it? In the latter case it may, as a Palliative remedy, certainly hasten the cure, and even help to complete it but in true uncomplicated dysentery, I have never seen it of any use. The long-continued weakness it occasions was against its being used for a length of time, and it ameliorated neither the tenesmus nor the character of the excretions, though these became more rare. The symptoms of deranged biliary secretion were rather worse during its used than when the patients were left without medicine. It causes a peculiar ill-humour, headache, and mental confusions the lower extremities totter, and the pupils dilate. (Do both the latter symptoms, or merely the last, belong to the secondary action only?) An infusion of ten grains once a day was a sufficient dose for a child six years old.
The primary direct action of opium (papaver somniferum) consists in transitory elevation of the vital powers, and strengthening the tone of the blood-vessels and muscles, especially of those belonging to the animal and vital functions, as also in excitation of the mental organs the memory, the imagination, and the organ of the passions - thus moderate doses are followed by a disposition to work, sprightliness in conversation, wit, rememberance of former times, amorousness, &c., large doses by boldness, courage, revenge, inordinate hilarity, lasciviousness still larger doses by furious madness, convulsions. The greater the dose,, the more do the individuality, the freedom, and the voluntary power of the mind suffer in sensations, and in power of judgement and of action. Hence, inattention to external disagreeable circumstances, to pain, &c. This condition, however, does not last long. It is gradually followed by loss of ideas, the pictures of fancy fade by degrees, there supervene relaxation of the fibre, sleep, If the use of elevated doses is continued, the consequences (indirect secondary action) are, weakness, sleepliness, listlessness, grumbling, discomfort, sadness, loss of memory (insensibility, imbecility), until a new excitation by opium, or something similar, is produced. In the direct action, the irritability of the fibre seems to be diminished in the same proportion as its tone is increased in the secondary action, the latter is diminished, the former increased. (There occurs a marked sensitiveness, especially for things that produce disagreeable effects, for fright, grief, fear, for inclement weather, &c. If the mobility of the fibre which occurs secondarily is called increased irritability, I have nothing to object to the term its sphere of action, however, is but small: it is either that the fibre is too relaxed, and cannot contract much, to that it is in a too contracted condition, and is relaxed easily indeed, but not sufficiently, consequently us incapable of making any powerful effort. In this condition of the fibre, the tendency to chronic inflammation is unmistakable.)The direct action, still more than the secondary action, prevents the mind from taking cognizance of sensations (pain, sorrow, &c.), and hence its great pain subduing power.
(In cases where only the direct action as a cordial is necessary, it will be requisite to repeat the administration of it every three or four hours, that is, each time before the relaxing secondary action, which so much increases the irritability, ensues. In all such cases it acts merely antagonistically, as a palliative remedy.
Permanent strengthening powers are not to be expected from it used in this manner, least of all in chronic weakness. This, however, is a digression.)
But if it is wished to depress permanently the tone do the fibre, (I give this name to the power of the fibre to contract and relax completely), to diminish permanently the deficiency of irritability, as is the case in some cases of mania, in such circumstances we may employ opium with success, as a similarly acting remedy, given in elevated doses, and making use of its indirect secondary action. We must consider the treatment which consists in giving opium in true inflammatory diseases, e.g., pleurisy, to be according to this principle.
In such cases, a dose is necessary every twelve or twenty-four hours.
It appears that this indirect secondary action has been made use of on the principle of a similarly acting remedy which, as far as I am aware, is not the case with any other medicine. Opium has, for instance, been given with the greatest success, (not in true venereal diseases, for that would be a delusions,) but in the distrarous effects that so often arise from the abuse of mercury in syphilis, which are sometimes much worse than the syphilis itself.
Before illustrating this employment of opium, I must say something appropriate to the subject, concerning the nature of syphilis, and introduce here what I have to say concerning mercury.
Syphilis depends upon a virus, which, besides other peculiarities that it developes in the human body, has an especial tendency to produce inflammatory and suppurating swellings of the glands (to weaken the tone?), to make the mechanical connexion of the fibres so disposed to separation, that numerous spreading ulcers arise, whose incurable character may be known by their round figure and lastly, to increase the irritability. Now, as such a chronic disease can only cured by a remedy capable of developing a disease of similar character, no more efficacious remedy could be conceived than mercury. The most remarkable power of mercury consists in this, that in its direct action it irritates the glandular indurations as its secondary indirect action,) weakens the tone of the fibres and their connexion, and disposes them to separation in such a manner, that a number of spread form and lastly, increases uncommonly the irritability (and sensibility). Experience has confirmed it has a specific but as there does not exist any remedy similar to the disease, so the mercurial disease (the changes and symptoms it usually produces in the body0 is still very different from the nature of syphilis.
The syphilitic ulcers are confined to the most superficial parts, especially the deuteropathic ones, (the protopathic ulcers increase slowly in extent,) they secrete a viscid fluid in place of pus, their borders are almost level with the skin (except the protopathic ones), and are almost quite painless (excepting the protopathic ulcer, that arising from the primary infection, and the suppurating inguinal gland). The mercurial ulcers burrow deeper,(rapidly increase in size,) are excessively painful, and secrete sometimes an acrid thin ichor sometimes they are covered with a dirty cheesy coating, their borders also become everted.
The glandular swellings of syphilis remain but for a few days they are either rapidly resolved, or the gland suppurates. The glands attacked by mercury are stimulated to increased action by the direct action of this metal, (and thus glandular swellings from other causes disappear rapidly under its use,) or they are left in the state of cold indurations during the indirect secondary action. The syphilitic virus produces induration of the periosteum of those bones which are nearest the surface and least covered with flesh they are the seat of excessive pains. In our days this virus, however, never produces caries, notwithstanding all my researches to discover the contrary. Mercury destroys the connexion of the solid parts, not of the soft parts only, but also of the bones it first corrodes the most spongy and concealed bones, and this caries is only aggravated the more rapidly by the continued use of the metal. Wounds which have arisen from external violence are changed by the use of mercury into old ulcers, difficult of cure a circumstance that does not occur with syphilis, The trembling, so remarkable in the mercurial disease, does not occur in syphilis. From the use of mercury there ensues a slow, very debilitating fever, with thirst, and great and rapid emaciation. The emaciation and weakness from syphilis come on slowly, and remain within moderate limits. Excessive sensitiveness and sleeplessness are peculiar to the mercurial disease, but not to syphilis. The most of these symptom action, than to the direct action of the mercury.
I have been so circumstantial on this subject, because it is often very difficult (Stoll (rat. Med. Part iii, p.442,) doubts if there are certain signs of a perfectly cured syphilitic disease, i.,e., he himself knew not the signs whereby this disease is distinguishable from the mercurial disease) for the practitioner to distinguish the chronic mercurial disease from the symptoms of syphilis and thus he will be apt to consider symptoms ass belonging to that disorder, whilst they are only mercurial, and go on treating them with mercury, whereby so many patients are destroyed chiefly, however, because my object is to depict the mercurial disease, in order to show how opium can cure it, by virtue of similarity of action.
Opium raises the sinking forces of patients suffering from the mercurial disease, and allays their irritability, when its direct action is kept up, that is, when it is given at least every eight hours and this is does an antagonistically-acting remedy.
This happens, however, only when it is given in large doses, proportioned to the degree of weakness and irritability, just as it is serviceable only in large and oft-repeated doses in the excessive irritability of hysterical and hypochondriacal patients and in the excessive sensibility of exhausted individuals. The normal condition of the body seems thereby to be restored a secret metamorphosis seems to take place in the organism, and the mercurial disease is gradually conquered. The convalescent patient can only bear smaller and smaller doses. Thus the mercurial disease seems to be vanquished by the palliative antagonistic power of the opium but any one who is aware of the almost uneradicable nature of the mercurial disease, the irresistible manner in which it destroys and dissolves the animal frame when it is at its height, will be convinced that a mere palliative could never master this excessively chronic malady, were it not that the secondary effects of opium were very analogous to the mercurial disease, and that these tended to overcome the latter.
The secondary effects of the continued use of opium in large doses, increased irritability, weakness of the tone, easy separation of the solids, and difficult curability of wounds, trembling, emaciation of the body, drowsy sleeplessness, are very similar to the symptoms of the mercurial disease and only in this do they differ, that those of mercury, when they are severe, last for years, often for a lifetime whilst those of opium last but hours or days. Opium must be used for a long time, and in enormous doses, for the symptoms of its secondary action to last for weeks or longer. These brief secondary effects of opium, whose duration is limited to a short time, are thus the true antidote of the mercurial secondary effects in their greatest degree, which are almost unlimited in their duration from their alone, almost, can one expect a permanent, true recovery. These secondary actions can develope their curative power during the whole treatment, in the interval betwixt the repetition of the doses of opium, as soon as the first direct action of each dose is passed, and when its use is discontinued.
Lead produces, in its primary action on the denuded nerves (belonging to muscular action?) a violent tearing pain, and (thereby?) relaxes the muscular fibre to actual paralysis it becomes pale and withered, as direction shows, but its external sensibility still remains, thoughin a diminished degree. Not only is the power of contradiction of the affected fibres diminished, but the motion that still remains is more difficult than in other similar relaxations, from almost total loss of the irritability.(The convulsive vomiting and dysenteric diarrhoea which sometimes follow the ingestion of large quantities of lead, must be explained on other principles, and do not fall to be considered here neither does the vomiting that ensues from large doses of opium.)This, however, is observed only in the muscles belonging to the natural and animal functions, but in those belonging to the vital functions this effect occurs without pain and in a less degree. As the reciprocal play of the vascular system becomes slower, (a hard, slow pulse,) this satisfactorily explains the diminished temperature of the blood attending the action of lead.
Mercury also diminishes the mutual attraction of the various parts of the muscular fibres, but increases their susceptibility for the stimulus, so as too impart to them an excessive mobility.
Whether this effect be the direct or the indirect secondary action it suffices that it is very enduring and hence, even if of the latter character, it would be very efficacious, as an oppositely acting remedy in the lead disease if of the first character, however, it will act as a similarly-acting remedy. Rubbed in externally, as well as given internally, mercury has an almost specific influence over the lead disease. Opium increases in its direct action the contraction of the muscular fibre, and diminishes its irritability. By virtue of the former property, it acts as a palliative in the lead disease by the latter, however, permanently, as a similarly-acting remedy.
From the above idea of the nature of the lead disease, it will be seen that the service this metal (lead has afforded, when cautiously used in diseases, depends entirely on its antagonistic, though uncommonly long-lasting, action, the consideration of which does not belong to this essay.
The true nature of the action of arsenic has not yet been accurately investigated. Thus much I have myself ascertained, that it has a great tendency to excite that spasm in the bloodvessels, and the shock in the nervous system, called febrile rigour.
If it be given in a pretty large dose (one-sixth or one fifth of a grain) to an adult, this rigour becomes very evident. This tendency makes it a very powerful remedy as a similarly-acting medicine in intermittent fever, and this all the more, as it possesses the power, observed by me, of exciting a daily-recurring, although always weaker, paroxysm, even although its use be discontinued. In typical diseases of all kinds (periodical head-ace, &c.), this type-exciting property of arsenic in small doses (one-tenth to at most one-sixth of a grain in solution) becomes valuable, and will, I venture to guess become invaluable to our perhaps bolder more observant, and more cautious successors. As its action lasts several days, so, frequently-repeated doses, be they ever so small, accumulate in the body to an enormous, a dangerous dose if, then, it be found necessary to give a dose daily, each successive dose should be at least a third smaller than the previous one. A better procedure is, when we have to treat short typical diseases with, say, two days interval, always to prescribe a dose only for one fit two hours before it is expected, pass over the following fit without giving any arsenic, and another dose only about two hours before the third fit. It will be best to act so even in the case of quartan fever, and only commence to treat the series of the intermediate paroxysms when we have attained our object with regard to the first series of paroxysms. (In the case of longer intervals, as seven, nine, eleven, and fourteen days, a dose may be prescribed before each fit.)
The continued use of arsenic in large doses gradually causes an almost constant febrile state it will thus, as indeed experience has, to a certain degree taught us, prove useful in hectic and remittent fever, as a similarly-acting remedy in small doses, (about one-twelfth of a grain). Such a continued employment of arsenic, however, will always remain a masterpiece of art, as it possesses a great disposition to diminish the vital heat and the tone of the muscular fibre. (Hence the paralyses from a strong dose, or a long-continued and incautious employment of it.) These latter properties will enable it to prove of service as an antagonistic remedy in pure inflammatory diseases.) it diminishes the tone of the muscular fibre, by diminishing the proportion and cohesion of coagulable lymph in the blood as I have convinced myself, by drawing blood from persons suffering from the effects of arsenic, more especially such as had a too inspissated blood before the use of this metallic acid. But not only does it diminish the vital heat, and the tone of the muscular fibre, the sensibility of the nerves. (Thus, in cases of maniacs, with tense fibre, and inspissated blood a small dose of it procures quiet sleep, in its character of an antagonistically-acting substance, where all other remedies fail. Persons poisoned by arsenic are more composed about their state, than might be expected. Thus it generally seems to kill more by extinguishing the vital power and sensibility, than by its corrosive and inflammatory power, which is only local and circumscribed. This being borne in mind, the rapid decomposition of the bodies of those poisoned by arsenic, like cases of death by mortification, will be readily comprehended.) It weakens the absorbent system, a circumstance whence, perhaps, we may one day derive some curative power 9as a similarly or as an antagonistically-acting remedy?), but which must be always a powerful objection to its long continued use. I would direct attention to its peculiar power of increasing the irritability of the fibre, especially of the system of the vital functions. Hence cough, and hence the above-mentioned chronic febrile actions.
When arsenic is used for a length of time, and in pretty large doses, it seldom fails, especially if diaphoretics and a heating diet be used simultanously, to cause some chronic cutaneous disease (at least desquamation of the skin). This tendency renders it an efficacious remedy in the hands of the Indian physician, in that frightful skin disease, elephantiasis. Would it not also be serviceable in pellagra? If it be truly (as is confidently affirmed) of service in hydrophobia, it must act by virtue of its power to diminish (the influence of the nerves affirmed) of service in hydrophobia, it must act by virtue of its power to diminish (the influence of the nerves on) the attraction of the parts of the muscular fibre and its tone, as laos the sensibility of the nerves, therefore antagonistically, it produces acute, continued pains in the joints, as I have seen. I shall not attempt to determine how we may avail ourselves of this property in a curative point of view.
What influence the arsenic disease, the lead disease, and the mercurial disease, may have over each other, and if the one may be destroyed by means of the other, future observations can alone decide.
Should the accidents produced by a long-continued use of arsenic become threatening (besides the employment of sulphuretted hydrogen in drinks and baths to expirate what still remains of the substance of the metal), the free use of opium in the same manner as in the mercurial disease (see above) will be of service.
I revert again to vegetable substances and first, I shall mention a plant, which in violence and duration of action, deserves to be placed alongside the mineral poisons I allude to the yew (taxus baccata). Great circumspection must be employed in the use of its various parts, more particularly of the bark of the tree when in flower the cutaneous eruptions, with signs of gangrenous decomposition of the fibre, which sometimes occur several weeks after the last dose, the fatal catastrophe that sometimes takes place suddenly, sometimes several weeks after the last dose, with symptoms of mortification, &c., teach us this. It produces, it appears, a certain acridity in all the fluids, and an inspissation of the lymph the vessels and fibres are irritated, and yet their functions are more impeded than facilitated. The scanty evacuations, accompanied by tenesmus, the dysuria, the viscid, salt, acrid saliva, the viscid foetid sweat, the cough, the flying acute pains in the limbs after perspiration, the podagra, the inflammatory erysipelas, the pustules on the skin, the itching and redness of the skin, underneath which the glands lie, the artificial jaundice, the horripilation, the continued fever, &c., it produces, are all proofs of this. But the observations are accurate enough to enable us to determine which is the primary, which the secondary action. The direct action seems to continue for a considerable time. A lax, unexcitable state of the fibres and vessels, especially of those belonging to the absorbent system, which seem partly deprived of vital power, appears to be its secondary action. Hence the perspiration, the flow of saliva, the frequent discharge of watery urine, the haemorrhages (a dissolved state of the red parts of the blood) and after large doses, or too long-continued employment, the dropsy, the obstinate jaundice, the petechiae, the gangrenous decomposition of the fluids. Employed cautiously in gradually-increased doses, it may, as indeed experience has partly shown, be employed with lasting advantage in a similar derangement of the fluids, and in a similar state of the solids in a word, in similar morbid states to those it is capable of producing. In induration of the liver, jaundice, and glandular swellings, with tense fibre, in chronic catarrh, catarrh of the bladder (in dysentery, dysuria, tumours, with tense fibre?), in amenorrhoea with tense fibre. (On account of its long-enduring, direct action, it may sometimes be of permanent service as an antagonistically acting remedy in rachitis, in amenorrhoea with relaxation, &c. But this does not belong to our subject.)
The monkshood (aconitum napellus) excites formicating, also acute tearing pains in the limbs, in the chest, in the jaws it is a prime remedy in pains of the limbs of all kinds (?) it will be serviceable in chronic tooth-ache of a rheumatic character in pleurodynia, in face-ache, and in the consequences of the implantation of human teeth. It causes chilling pressure in the stomach, occipital headache-ache, shootings in the kidneys, excessively painful ophthalmia, cutting pains in the tongue the practitioner will be able to employ these artificial diseases in similar natural diseases. It has a peculiar tendency to produce giddiness, faintings, debility, apoplexy, and transient paralysis, general and partial paralysis, hemiplegia, paralysis of particular limbs,- of the tongue, of the anus, of the bladder, obscuration of vision and temporary blindness, and singing in the ears. It is also just as serviceable in general and partial paralysis of the parts just mentioned, as experience has in a great measure proved as a similarly-acting remedy, it has in several cases cured incontinence of urine, paralysis of the tongue, and amaurosis, as also paralysis of the limbs. In curable marasmus, and partial atrophies, as a remedy capable of producing similar morbid symptoms, it will certainly do more than all other known remedies. Successful cases of this kind are on record. Almost as specifically does it produce convulsions, general as well as partial, of the facial muscles, of the muscles of the lips on one side, of the muscles of the throat on one side of the ocular muscles. In all these last affections it will prove useful, as it also cured epilepsies. It causes asthma how, then, can it be wondered at, that it has several times cured different sorts of asthma? It produces itching, formication in the skin, desquamation, reddish eruption, and is hence so useful in bad cutaneous affections and ulcers. Its pretended efficacy in the most obstinate veneral sufferings, was probably only founded on its power over the symptoms of the mercury that had been previously employed in that disease and this conclusions is justified by what we know of its action. It is valuable to know that monkshood, as an exciter of pain, cutaneous affections, swellings, and irritability,- in a word, as a similarly-acting remedy, is powerful in subduing the similar mercurial disease, and is even preferable to opium, as it leaves behind it no debility. Sometimes it causes a sensation about the navel, as if a ball rose up thence, and spread a cold feeling over the upper and back part of the head this would lead us to use it in similar cases of hysteria. In the secondary action, the primary coldness in the head seems to change into a burning sensation, In its primary action are observed general coldness, slow pulse, retention of urine, mania in its secondary action, however, an intermitting, small, rapid pulse, general perspiration, flow of urine, diarrhoea, involuntary faecal evacuation, sleepy intoxication. (Like several other plants that produce a cooling effect in their primary action, it resolves glandular swellings.) The mania it causes is a gay humour alternating with despair. As a similarly-acting remedy, it will subdue manias of that sort. The usual duration of its efficacy is from seven to eight hours, excepting in cases of serious effects from very large hours, excepting in cases of serious effects from very large doses.
The black hellebore (hellebore niger) causes, if used for a long time, severe head-aches, (hence, probably, its power in some mental affections, also in chronic head-aches,) and a fever hence its power in quartan fever, and hence also, partly, its efficacy in dropsies, the worst kinds of which are always accompanied by remitting fever , and wherein it is so useful, aided by its diuretic power, (Who can tell whether this belongs to its primary, or, as I am inclined to think, its secondary action? This power is allied to its property of exciting to activity the blood-vessels of the abdomen, rectum, and uterus.) Its power of causing a constrictive, suffocating sensation in the nose, would lead us to prescribe it in similar cases (as I once did in a kind of mental disease). The frequency with which it is confounded with other roots is the reason why we are only in possession of these few true data of its effects.
The boring, cutting pain that the internal use of the meadow anemone (anemone pratensis) causes in weak eyes, led to its successful employment in amaurosis, cataract, and opacity of the cornea. The cutting headache caused by the internal employment of the inflammable crystalline salt obtained by distillation with water, would lead us to employ this plant in a similar case. Most likely it is on this account that it once cured a case of melancholia.
The clove gilliflower (geum urbanum), besides its aromatic qualities, possesses a nausea-exciting power, which always causes a febrile state of body, and hence its service in intermittent fever, when used as an aromatic along with ipecacuanha.
The principle that constitutes the medicinal power of the kernel of the cherry (prunus cerasus), of the sour cherry (prunus padus), of the peach (amygdalus persica), of the bitter variety of the almond (amygdalus communis) and more especially of the leaves of the cherry-laurel (prunus laurocerasus), possesses the peculiar property of increasing the vital power and contractility of the muscular fibre in its direct action, as notably as it depresses both in its secondary action. Moderately large doses are followed by anxiety, a peculiar cramp of the stomach, trismus, rigidity of the tongue, opisthotonos, alternately with conic cramps of various kinds and degrees, as its direct action (if it sought to deny the primary action of the principle of bitter almond, which I have represented as producing the phenomena of increased power of contraction in the muscular fibre and exaltation of the vital power, on this ground, that in some cases of monstrous doses, death occurs almost instansteously without any perceptible reaction of the vital power or pain, as great a mistake would be made, as if all pain should be denied to death by the sword, and it should be affirmed that the stroke of the sword did not produce a peculiar condition different from the death that followed it. This pain will be just as intense, although perhaps less than momentary, as the sensation of anxiety and torment will be indescribable, which may and must follow a fatal dose of cherry-laurel water, though its action lasts scarce a minute. This is proved by the case recorded by Madden, of excessive anxiety in the region of the stomach (the probable region of the chief organ of the vital power) of a person killed in a few minutes by a large dose of cherrylaurel water. That in this brief space of time, the whole series of phenomena that follow a not fatal dose, can not make their appearance, is easily understood yet it is probable that changes and impressions, similar to those of the direct action I have described from nature, do actually take place in the animal organism, in this short time (until a few instants before death, i,e, the few instants that the indirect secondary action lasts.) Thus, electrical phenomena may be seen, when they can be gradually passed before the eyes but in the lightening rapidly flushing before us, we scarce can tell what we see or hear.)the irritability is gradually exhausted, (A small lizard (lacerta agilis), that had moved about pretty rapidly for a minute in diluted cherry-laurel-water, I placed in concentrated cherry-laurel water. The motions became instantly so excessively rapid, that the eye could scarcely follow them for some seconds then there occurred one or two slow convulsions, and then total loss of motion: it was dead.) and in the secondary action the contractility of the muscular fibre and the vital power sink in the same degree that they had previously be exalted. There follow cold, relaxation, paralysis,- which also, however, soon pass off.
(Cherry-laurel water has now and then been used as a domestic analeptic, in debility of the stomach and body, that is, as an oppositely-acting palliative, and, as might have been guessed, with bad effect. The result was paralysis and apoplexy.)
More remarkable, and peculiarly belonging to our subject, is the curative power of its direct action (which consists in a kind of febrile paroxysm) in intemittent fever, especially, if I mistake not, in that kind of intermittent depending on a too great contractility of the muscular fibre, which is incurable by bark alone. Equally efficacious has black cherry water proved in the convulsions of children. As a similarly-acting remedy, cherry-laurel water will prove efficacious in diseases from too tense fibre, or generally where the contractility of the muscular fibre far exceeds its relaxing power in hydrophobia, in tetanus, in the spasmodic closure of the biliary excretory ducts and similar tonic spasmodic affections, in some manias, &c., (Tonic (and clonic) spasms without an inflammatory state of the blood, and when the consciousness is little affected, appear to be the peculiar sphere of action of the principle of the bitter almonds, as it, as far as I know, does not elevate the vital temperature even in its direct action, and leaves the sensitive system unaffected.)as several observations have shown. In proper inflammatory diseases it also deserves attention where it would, to some extent, operate as a similarly-acting remedy. If the diuretic property observed from the bitter almond principle lies in its indirect secondary action, we may hope much from it in dropsy, with a chronic inflammatory condition of the blood.
The power of the bark of the sour cluster-cherry (prunus padus) over mittent fever lies likewise in the bitter-almond principle to contains, by means of which it comports itself as a similarly-acting remedy.
Of the sundew (drosera rotundifolia) we know nothing certain, except that it excites cough, and hence it has been if use in most catarrhal coughs, as also in the influenza.
The curative principle in the flowers and other parts of the elder (sambacus niger), appears to lie in its primary direct action of exalting the contractive power of the muscular fibres belonging chiefly to the natural and vital functions, and of raising the temperature of blood, whilst, in its indirect secondary action, it brings down the strength of the muscular fibre, lowers the temperature, relaxes the vital activity, and diminishes sensation itself. If this be the case, as I think it is, the good that it does in the true spasm of the finest extremities of the arteries, in diseases from a chill, catarrhs, erysipelas, is in virtue of its similarly of action. Have not the elder species the power of producing transitory erysipelatous inflammation?
Various kinds of sumach, considered to be poisonous, e.g., rhus radicans, appear to possess a specific tendency to produce erysipalatous inflammation of the skin and cutaneous eruptions. May it not be useful in chronic erysipelas, and the worst kinds of skin diseases? When its action is too violent, it is checked by elder, )a similarly-acting remedy?)
Camphor in large doses diminishes the sensibility of the whole nervous system the influence of the, as it were, benumbed vital spirits (if I may be allowed to use a coarse expression), on the senses and motion is suspended. There occurs a congestion in the brain, an obscuration, a vertigo, an inability to bring the brain, an obscuration, a vertigo, an inability to bring the muscles under the dominion of the will, an incapacity for thought, for sensation, for memory. The contractile power of the muscular fibres, especially of those belonging to the natural and vital functions, seems to sink to actual paralysis the irritability is depressed in a like degree especially that of the extreme ends of the blood-vessels, (The nervous power and its condition seems to have most influence on these, - less on the larger vessels, least of all on the heart.) that of the larger arteries less, and still less that of the heart. There occur coldness of the external parts, small, hard, gradually diminishing pulse, and on account of the different state of the heart from that of the extreme ends of the bloodvessels, anxiety, cold sweat. The above condition of the fibre causes an immobility of the muscles, e.g., of the jaws, of the anus, of the neck, that resembles a tonic spasms. There ensue deep slow breathing, fainting. (A proof, according to carminati, that Camphor, far from extinguishing the irritability, only suspends it so long as the muscles are in connexion by means of camphor, the heart, if cut out, continues to beat all the more strongly for hours afterwards.) During the transition to the secondary action, there occur convulsions, madness, vomiting, trembling. In the indirect secondary action itself, the awaken of the sensibility and if I may be allowed the expression, the mobility of the previously benumbed nervous spirit first commence the almost extinguished mobility of the extremities of the arteries is restored, the heart triumphs over the previous resistance. The previous slow pulsations increase in velocity and in fullness, the play of the circulating system attains, or in some cases (from larger doses of camphor, from plethora, &c.) surpasses, its former state,-the pulse becomes more rapid, and more full. The more motionless the blood vessels were previously, the more active of they now become the temperature of the whole body becomes increased, with redness, and uniform, sometimes profuse, perspiration. The whole process is ended in six, eight, ten, twelve, or at most twenty-four hours, of all the muscular fibres, the mobility of the intestinal canal returns latest. In every case where the contractile power of the muscular fibres, the mobility of the intestinal canal returns latest. In every case where the contractile power of the muscular fibres greatly preponderates over their power of relaxation, camphor, as an antagonistically-acting remedy, procures rapid but only palliative relief in some manias, in local and general inflammations, of a pure, of a rheumatic, and of an erysipelatous character, and in diseases arising from a chill.
As in pure malignant typhus, the system of the muscular fibre, the sensitive system, and the depressed vital power, presents something analogous to the direct primary action of camphor, it operates as a similarly-acting remedy, that is, permanently and beneficially, The doses must, however, be sufficiently large to produce the appearance of a still greater insensibility and depression, but given seldom, only about every thirty-six or forty-eight hours.
If camphor actually removes the strangury caused by cantharides, it does this as a similarly-acting remedy, for it also causes strangury. The bad effects of drastic purgatives it removes, chiefly as a suspender of sensation, and a relaxed of the fibre (consequently an antagonistic, palliative, but there, admirable remedy). In the bad secondary effects of squill, when they are chronic a too easily excitable action of the contractile and relaxing power of the muscular fibre it acts only as a palliative, and less efficaciously, unless the doses be frequently repeated. The same may be said with regard to its effects in the chronic symptoms caused by the abuse of mercury. As a similarly-acting remedy, it is eminently serviceable in the long-continued rigour of degenerated (comatose) intermittent fevers, as an adjunct to bark. Epilepsy and convulsions dependent in relaxed fibre deprived of its irritability, are rapidly cured by the similar action of camphor, it is an approved antidote to large doses of opium, in which it is chiefly an antagonistic palliative, but efficacious in consequence of the symptoms being but transitory. In like manner, opium is, as I have ascertained, an excellent antidote to large doses of camphor, The former raises the sunken vital power and diminished vital temperature caused by the latter antagonistically, but in this case effectually. A curious phenomenon is the action of coffee in relation to the direct action of large doses of camphor it makes the stomach, whose irritability was suspended spasmodically mobile there occur convulsions, vomiting, or when given in clusters, rapid evacuation but neither does the vital power become raised, nor do the nerves become relieved from their stupefied state, they rather become more stupefied, as I think I have observed. As the most striking effect of camphor on the nerves consists in this, that all the passions are lulled, and a perfect indifference to external things, even of the most interesting character, occurs, as I have ascertained, it will according be of a service as a similarly-acting remedy in manias, whose chief symptom is apathy, with slow, suppressed pulse, and contracted pupil,-also, according to Auenbrugger, retracted testicles. It is by no means advisable to use it in manias of every description . Used internally, camphor removes acute general and local inflammations, and also such as are chronic, in few hours but in the former case, the doses must be very often repeated to admit of anything efficacious being performed, i. e., always a new dose before the secondary action comes on. For in its secondary action, camphor does but the more strengthen the tendency to renewed inflammation, makes it chronic, and predisposes the organism chiefly to catarrhal diseases, and the bad effects of a chill. Used externally for a length of time, it can do more good, and its bad effects may be easily remedied in another manner.
The patrons of new medicines generally commit the error of carefully but injudiciously concealing the disagreeable effects of the medicines they take under their protection. (Thus we often read, that this or that powerful medicine has cured so many hundred cases of the worst diseases, without causing the slightest bad effects. If this last be correct, we may certainly infer the perfect inefficacy of the drug. The more serious the symptoms it causes, the more important is it for the practitioner.) were it not for this suppression of the truth, we might, for instance, from the morbific effects the bark of the horse-chestnut (aesculus hipposacastanum) is able to produce, form a just estimate of its medicinal powers, and determine if, for instance, it is suitable for pure intermittent fever, or some of its varieties and if so, which. The sole phenomena we know belonging to it is, that it produces a constrictive feeling in the chest. It will accordingly be found useful in (periodical) spasmodic asthma.
The symptom produced on man by the phytolacca decandra deserve to be particularly described. It is certainly a very medicinal plant. In animals it causes cough, trembling, convulsions.
As the bark of the elm, (ulmus campestris), when exhibited internally, produces at the commencement (In order to draw a favourable induction from the aggravating action of a drug in a disease, this aggravation must occur at the commencement of its use, that is in its direct action in such cases only can it be considered a similarly acting efficacious remedy. The morbid aggravation occurring so often subsequently (in the indirect secondary action) prove the contrary in ill-chosen remedies.) an increase of cutaneous eruptions, it is more than probable that it has a tendency to produce such affections of itself, consequently, that it will be serviceable in them, which is amply proved by experience.
The juice of hemp leaves (cannabis sativa) is, it would seem, a narcotic, similar in action to opium. This is only in appearance, however, and owing to the imperfect accounts we have of its pathogenetic action. I am much mistaken if it do not possess differences indicative of peculiar medicinal powers, if we but knew it sufficiently. It produces dimness of vision and in the madness caused by it there occur many phenomena, generally of an agreeable character.
It appears as if saffron (crocus sativus), in its direct action, brought down the circulation and vital heat. Slow pulse, pale face, vertigo, exhaustion, have been observed. In this stage most probably occur the melancholy and headache that have been observed from its action, and in the second stage (the indirect secondary action), occur the senseless, extravagant gaiety, the stupefaction of the senses, the increased action in the arteries and heart, and lastly, the haemorrhage which have been observed from its use. For this reason it may be useful in restoring flows of blood that have been checked, as a similarly-acting remedy, as its power of increasing the circulation occurs first in the secondary action consequently, the opposite must take place in its direct action. It has been found useful as a similarly-acting remedy in vertigo and headache, with slow pulse. In some cases of melancholia with slow pulse, and in amenorrhoea, it appears also to be of service as a similarly-acting remedy. It has (in its direct action) produced death by apoplexy, and is said to have proved efficacious in similar affections (probably in relaxed organisms). The phenomena of its secondary action point to much increased irritability of the fibre, hence probably the cause of its readily producing hysteria.
The darnel (lolium temulentum) is such a powerful plant, that he who knows its pathogenetic action must congratulate the age when, for the benefit of humanity, its application shall be known. The chief phenomena of the direct action of the seeds acre cramps, apparently of a tonic character (a kind of immobility), with relaxation of the fibre and suspension of the vital spirits, great anxiety, exhaustion, coldness, contraction of the stomach, dyspnoea, difficult deglutition, rigidity of the tongue pressive headache and vertigo (both continues longer than is known from any other drug, in the greatest degree, for several days), noises in the ears, sleeplessness, insensibility, or weakness of the external senses, red face, staring eyes, sparks before the eyes. In the transition to the secondary action, the cramps become clonic, there occur stammering. Trembling, vomiting diuresis, and (cold) perspiration (cutaneous eruptions, ulcers on the skin?) yawning (another kind of cramp), weak sight, long sleep. In practice, cases of obstinate vertigo and cephalalgia present themselves, which we are inclined to avoid treating, from their incurability. The darnel appears to be made expressly for the worst of such case, probably also for imbecility, the opprobium of medicine. In deafness and amaurosis something may be hoped from its use.
Squill (scilla maritina) appears to possess an acrid principle that remains long on the body the mode of operation of which, from want of accurate observation, cannot be very well separated into primary and secondary action. This acrid principle possesses a tendency to diminish for a long period the capacity of the blood for caloric, and hence to establish in the organism a disposition to chronic inflammation. Whether this power can be applied to useful purposes, instead of being, as hitherto, a stumbling-block to the use of the drug itself, I am unable, on account of the obscurity of the subject, to determine. As, however, this power must certainly have its limits, at least in the commencement, it has only an acute inflammatory action, and afterwards, especially after long-continued use, leaves behind it the slow chronic inflammatory action so it seems to me to be rather indicated in pure inflammations with tense fibre, when its use is otherwise required, than in a cold or hectic inflammatory condition of the fluids and mobility of the fibre. The incomparable aid derived from squill in inflammation of the lungs, and the extraordinary injury inflicted by its continued employment in chronic purulent consumption of the lungs, as also in pituitous consumption, prove this satisfactorily, there is no question here of a palliative relief. This acrid principle puts the muscous glands in a condition to secrete a thin, instead of a viscid mucus, as is the case in every moderately inflammatory diathesis. Squill causes a great degree of strangury, shewing thereby that it must be very useful in restoring the secretion in the suppression of the urine accompanying several kinds of dropsy, as daily experience confirms. Rapid, acute dropsical swellings appear to be its chief, because it can of itself cause cough.
That most incomparable remedy, white hellebore (veratrum album), produces the most poisonous effects, which should inspire the physician who aspires to perfection with caution, and the hope of curing some of the most troublesome diseases that have hitherto usually been beyond medical aid. It produces in its direct action a kind of mania, amounting from larger doses to hopelessness and despair small doses make indifferent things appear repulsive to the imagination, although they are not so in reality. It causes in its direct action, a. Heat of the whole body b. Burning in different external pats, e.g., the shoulder-blades, the face, the head c. Inflammation and swelling of the skin of the face, sometimes (from larger doses) of the whole body d. Cutaneous eruptions, desquamation of the skin e. a formicating sensation in the hands and fingers, tonic cramps f. Constriction of the gullet, of the larynx, sense of suffocation g. Rigidity of the tongue, tough mucus in the mouth h. Constriction of the chest i. pleuritic symptoms k. Cramp in the calve l. An anxious, (gnawing?) sensation in the stomach, nausea m. Gripes, and cutting pains here and there in the bowels n. Great general anxiety o. Vertigo p. Headache (confusion of the head) q. violent thirst. On passing into the indirect secondary action, the tonic cramps resolve themselves into clonic cramps there occur, r. Trembling s. Stammering t. Convulsions of eyes u. Hiccough v. Sneezing (from the internal use) w. Vomiting (when at its height, black, bloody vomiting) x. Painful, scanty evacuations, with tenesmus y. Local, or (from large doses) general convulsions z. Cold (from large doses, bloody) sweat aa. Watery diuresis bb. Ptyalism cc. Expectoration dd. General coldness ee. marked weakness ff. Fainting gg. Long profound sleep. Some of the symptoms of its direct action, l. m. n. p. q., would lead us to use it in dysenteric fever, if not in dysentery. The mania it causes, together with some symptoms of its direct action, e., f. g. g. h. n. q., would lead us to employ it in hydrophobia, with hopes of a good result. A dog to which it was given had true rabies, lasting eight minutes, The ancients speak of it with approbation in hydrophobia. (In tetanus?) in spasmodic constriction of the gullet, and in spasmodic asthma, it will be found specific on account of f. and h. it will prove of permanent advantage in chronic cutaneous diseases, on a count of c. and d. As experience has already shown with regard to herpes. In so-called nervous diseases, when they are dependent on tense fibre or inflammatory symptoms, (a. q.) and the symptoms in other respects resemble the veratrum disease, it will be of benefit so also in manias of like character. The landlord of a country inn, a man of firm fibre, robust make, red blooming countenance, and somewhat prominent eyes, had almost every morning, soon after waking, an anxious feeling in the stomachic region, which in the course of a few hours involved in the chest, producing constriction there, sometimes amounting to complete loss of breath in the course of a few hours the affection attacked the region of the larynx, and suffocation became imminent (swallowing solids or fluids being impossible) and as the sun declined it left these parts, and became confined to the head, with timorous, despairing, hopeless suicidal thoughts, until about ten oclock, when he fell asleep, and all the morbid symptoms disappeared. The mania resembling that peculiar to veratrum, the firm fibre of the patient, and the symptoms f. g. h. l. n., induced me to prescribe three grains of its every morning, which he continued for four weeks, with the gradual cessation of all his sufferings his malady had lasted four years or more. A woman, thirty-five years of age, after having had many epileptic attacks during her pregnancies, was affected a few days after her last delivery, with furious delirium and general convulsions of the limbs. She had been treated for ten days with emetics and purgatives, without effect. At midnight every night she was attacked by fever, with great restlessness, during which she tore all the clothes off her body, especially what she had about here neck. Cinchona bark always made the fever a few hours later, and increased the thirst and anxiety the expressed juice of stramonium, used according to Bergius'method, soon quelled the convulsions, and produced some rational hours, in which it was ascertained that her worst symptom (except the fever) was the suffocating feeling in the throat and chest, besides pain in all her limbs. More, however, it could not do on the contrary, its continued use seemed rather to increase the last mentioned serious symptoms the face was swollen, the anxiety infinite, the fever greater. Emetics did no good opium caused sleeplessness, increased the restlessness the urine was dark-brown, the bowels much constipated. Blood-letting, which was evidently not adapted to this case, was, moreover, contra-indicated by the excessive weakness. The deliria returned, not with standing the extract of stramonium, with increased convulsions and swelling of the feet. I gave her in the forenoon half a grain of veratrum powder, and a similar dose in the afternoon at two oclock. Deliria of another kind made their appearance, along with viscid mucus in the mouth, but no fever returned, the patient slept, and in the morning passed white cloudy urine. She was well, quiet and rational, except that the great weakness continued. The suffocating sensation in the throat was gone, the swelling of the face fell, as also that of the feet, but the following evening, without her having taken any medicine, there occurred a constrictive sensation in the chest. She therefore got another half grain of veratrum the following afternoon this was followed by scarcely perceptible delirium, tranquil sleep, in the morning copious discharge of urine and a few small evacuations. For two more days she got half a grain of veratrum in the afternoon. All her symptoms disappeared, the fever vanished, and the weakness yielded to a good regimen.
I shall on a subsequent occasion record a case of spasmodic colic still more rapidly cured by it. As a producer of mania and spasms it has shown itself useful in cases in persons possessed. In hysterical and hypochondriacal attacks, dependent on tense fibre, it will be useful, as it has been practically proved. Inflammation of the lungs will find in it a powerful remedy. The duration of its action is short limited to about five, at most eight or ten hours, inclusive of the secondary action except in the case or ten hours, inclusive of the secondary action except in the case of serious effects from large doses.
Sabaduilla seed causes confusion of the intellect and convulsions, which it can also cure the peculiarities of its action, however, are not yet known. It also causes a creeping sensation through all the limbs, as I have experienced, and is said to produce pain in the stomach and nausea.
The agaric (agaricus muscarius) produces, as far as I can ascertain, a furious and drunken mania (combined with revengeful, bold resolves, disposition to make verses, to prophesy, &c.), exaltation of the strength, trembling and convulsions in its primary direct action and weariness, sleep, in its secondary action. It has therefore been employed with benefit in epiplepsy (caused by fright), combined with trembling. It will remove mental affections and possession, similar to those it causes. Its direct action lasts from twelve to sixteen hours.
The nutmeg (mysterica aromatica) diminishes the irritability of the whole body, but especially that of the primae viae, for a considerable time. (Does it not increase the contractile power of the muscular fibre, especially of the primae viae, and diminish its capibility of relaxing?) In large doses it causes an absolute insensibility of the nervous system, obtuseness, immobility, loss of reason, for its direct action headache and sleep for its secondary action. It possesses heating properties. May it not be useful in imbecility, combined with laxness and irritability of the primae viae? - against the first as a similarly, against the second as an antagonisically-acting remedy? It is said to have done good in paralysis of the gullet, probably as a similarly-acting remedy.
Rhuburb is useful in diarrhoeas without faecal evacuations, even in the smallest doses, more in consequence of its tendency to promote the action of the bowels, than on account of its astringent power.
The topical pain-producing applications, as catharides, mustard plasters, grated horse-radish, spurge-laurel bark, crushed ranunculus acris, the moxa, allay pain often permanently, by producing artificially pain of another kind.