Volume Ii Part 75
III. CATALOGUE OF INVERTENTIA.
I. Emetics, ipecacuanha, emetic tartar, antimonium tartarisatum, squill, scilla maritima, carduus benedictus, cnicus acarna, chamoemile, anthemis n.o.bilis, white vitriol, vitriolum zinci, foxglove, digitalis purpurea, clysters of tobacco.
II. Violent cathartics, emetic tartar, squill, buckthorn, rhamnus catharticus, scammonium, convolvulus scammonia, gamboge, elaterium, colocynth, cuc.u.mis colocynthis, veratrum.
III. Violent errhines and sialagogues, Turpeth mineral, hydrargyrus vitriolatus, asarum europaeum, euphorbium, capsic.u.m, veratrum, nauseous smells, nauseous ideas.
IV. Violent diuretics, nitre, squill, seneka, cantharides, alcohol, foxglove, tobacco, anxiety.
V. Cold sudorifics, poisons, fear, approaching death.
ART. VI.
REVERTENTIA.
I. Those things, which restore the natural order of the inverted irritative motions, are termed Revertentia.
1. As musk, castor, asafoetida, valerian, essential oils.
2. Externally the vapour of burnt feathers, of volatile salts, or oils, blisters, sinapisms.
These reclaim the inverted motions without increasing the heat of the body above its natural state, if given in their proper doses, as in the globus hystericus, and palpitation of the heart.
The incitantia revert these morbid motions more certainly, as opium and alcohol; and restore the natural heat more; but if they induce any degree of intoxication, they are succeeded by debility, when their stimulus ceases.
II. OBSERVATIONS ON THE REVERTENTIA.
I. The hysteric disease is attended with inverted motions feebly exerted of the oesophagus, intestinal ca.n.a.l and lymphatics of the bladder. Hence the borborigmi, or rumbling of the bowels, owing to their fluid contents descending as the air beneath ascends. The globus hystericus consists in the retrograde motion of the oesophagus, and the great flow of urine from that of the lymphatics spread on the neck of the bladder; and a copious salivation sometimes happens to these patients from the inversion of the lymphatics of the mouth; and palpitation of the heart owing to weak or incipient inversion of its motions; and syncope, when this occurs in its greatest degree.
These hysteric affections are not necessarily attended with pain; though it sometimes happens, that pains, which originate from quiescence, afflict these patients, as the hemicrania, which has erroneously been termed the clavus hystericus; but which is owing solely to the inaction of the membranes of that part, like the pains attending the cold fits of intermittents, and which frequently returns like them at very regular periods of time.
Many of the above symptoms are relieved by musk, castor, the foetid gums, valerian, oleum animale, oil of amber, which act in the usual dose without heating the body. The pains, which sometimes attend these const.i.tutions, are relieved by the secernentia, as essential oils in common tooth-ach, and balsam of Peru in the flatulent colic. But the incitantia, as opium, or vinous spirit, reclaim these morbid inverted motions with more certainty, than the foetids; and remove the pains, which attend these const.i.tutions, with more certainty than the secernentia; but if given in large doses, a debility and return of the hysteric symptoms occurs, when the effect of the opium or alcohol ceases. Opiates and foetids joined seem best to answer the purpose of alleviating the present symptoms; and the sorbentia, by stimulating the lymphatics and lacteals into continued action, prevent a relapse of their inversion, as Peruvian bark, and rust of iron. See Cla.s.s I. 3. 1. 10.
II. Vomiting consists in the inverted order of the motions of the stomach, and oesophagus; and is also attended with the inverted motions of a part of the duodenum, when bile is ejected; and of the lymphatics of the stomach and fauces, when nausea attends, and when much lymph is evacuated.
Permanent vomiting is for a time relieved by the incitantia, as opium or alcohol; but is liable to return, when their action ceases. A blister on the back, or on the stomach, is more efficacious for restraining vomiting by their stimulating into action the external skin, and by sympathy affecting the membranes of the stomach. In some fevers attended with incessant vomiting Sydenham advised the patient to put his head under the bed-clothes, till a sweat appeared on the skin, as explained in Cla.s.s IV.
1. 1. 2.
In chronical vomiting I have observed crude mercury of good effect in the dose of half an ounce twice a day. The vomitings, or vain efforts to vomit, which sometimes attend hysteric or epileptic patients, are frequently instantly relieved for a time by applying flour of mustard-seed and water to the small of the leg; and removing it, as soon as the pain becomes considerable. If sinapisms lie on too long, especially in paralytic cases, they are liable to produce troublesome ulcers. A plaster or cataplasm, with opium and camphor on the region of the stomach, will sometimes revert its retrograde motions.
III. Violent catharsis, as in diarrhoea or dysentery, is attended with inverted motions of the lymphatics of the intestines, and is generally owing to some stimulating material. This is counteracted by plenty of mucilaginous liquids, as solutions of gum arabic, or small chicken broth, to wash away or dilute the stimulating material, which causes the disease.
And then by the use of the intestinal sorbentia, Art. IV. 2. 5. as rhubarb, decoction of logwood, calcined hartshorn, Armenian bole; and lastly, by the incitantia, as opium.
IV. The diabaetes consists in the inverted motions of the urinary lymphatics, which is generally I suppose owing to the too great action of some other branch of the absorbent system. The urinary branch should be stimulated by cantharides, turpentine, resin (which when taken in larger doses may possibly excite it into inverted action), by the sorbentia and opium. The intestinal lymphatics should be rendered less active by torpentia, as calcareous earth, earth of alum; and those of the skin by oil externally applied over the whole body; and by the warm-bath, which should be of 96 or 98 degrees of heat, and the patient should sit in it every day for half an hour.
V. Inverted motions of the intestinal ca.n.a.l with all the lymphatics, which open into it, const.i.tute the ileus, or iliac pa.s.sion; in which disease it sometimes happens, that clysters are returned by the mouth. After venesection from ten grains to twenty of calomel made into very small pills; if this is rejected, a grain of aloe every hour; a blister; crude mercury; warm-bath; if a clyster of iced water?
Many other inverted motions of different parts of the system are described in Cla.s.s I. 3. and which are to be treated in a manner similar to those above described. It must be noted, that the medicines mentioned under number one in the catalogue of revertentia are the true articles belonging to this cla.s.s of medicines. Those enumerated in the other four divisions are chiefly such things as tend to remove the stimulating causes, which have induced the inversion of the motions of the part, as acrimonious contents, or inflammation, of the bowels in diarrhoea, diabetes, or in ileus. But it is probable after these remote causes are destroyed, that the fetid gums, musk, castor, and balsams, might be given with advantage in all these cases.
III. CATALOGUE OF REVERTENTIA.
I. Inverted motions, which attend the hysteric disease, are reclaimed, 1.
By musk, castor. 2. By asafoetida, galbanum, sagapaenum, ammoniac.u.m, valerian. 3. Essential oils of cinnamon, nutmeg, cloves, infusion of penny-royal, mentha, pulegium, peppermint, mentha piperita, ether, camphor.
4. Spirit of hartshorn, oleum animale, spunge burnt to charcoal, black-snuffs of candles, which consist princ.i.p.ally of animal charcoal, wood-soot, oil of amber. 5. The incitantia, as opium, alcohol, vinegar. 6.
Externally the smoke of burnt feathers, oil of amber, volatile salt applied to the nostrils, blisters, sinapisms.
II. Inverted motions of the stomach are reclaimed by opium, alcohol, blisters, crude mercury, sinapisms, camphor and opium externally, clysters with asafoetida.
III. Inverted motions of the intestinal lymphatics are reclaimed by mucilaginous diluents, and by intestinal sorbentia, as rhubarb, logwood, calcined hartshorn, Armenian bole; and lastly by incitantia, as opium.
IV. Inverted motions of the urinary lymphatics are reclaimed by cantharides, turpentine, rosin, the sorbentia, and opium, with calcareous earth, and earth of alum, by oil externally, warm-bath.
V. Inverted motions of the intestinal ca.n.a.l are reclaimed by calomel, aloe, crude mercury, blisters, warm-bath, clysters with asafoetida, clysters of iced water? or of spring water further cooled by salt dissolved in water contained in an exterior vessel? Where there exists an introsusception of the bowel in children, could the patient be held up for a time by the feet with his head downwards, or be laid with his body on an inclined plane with his head downwards, and crude mercury be injected as a clyster to the quant.i.ty of two or three pounds?
ART. VII.
TORPENTIA.
I. Those things, which diminish the exertion of the irritative motions, are termed torpentia.
1. As mucus, mucilage, water, bland oils, and whatever possesses less stimulus than our usual food. Diminution of heat, light, sound, oxygen, and of all other stimuli; venesection, nausea, and anxiety.
2. Those things which chemically destroy acrimony, as calcareous earth, soap, tin, alcalies, in cardialgia; or which prevent chemical acrimony, as acid of vitriol in cardialgia, which prevents the fermentation of the aliment in the stomach, and its consequent acidity. Secondly, which destroy worms, as calomel, iron filings or rust of iron, in the round worms; or amalgama of quicksilver and tin, or tin in very large doses, in the tape-worms. Will ether in clysters destroy ascarides? Thirdly, by chemically destroying extraneous bodies, as caustic alcali, lime, mild alcali in the stone. Fourthly, those things which lubricate the vessels, along which extraneous bodies slide, as oil in the stone in the urethra, and to expedite the expectoration of hardened mucus; or which lessen the friction of the contents in the intestinal ca.n.a.l in dysentery or aphtha, as calcined hartshorn, clay, Armenian bole, chalk, bone-ashes. Fifthly, such things as soften or extend the cuticle over tumors, or phlegmons, as warm water, poultices, fomentations, or by confining the perspirable matter on the part by cabbage-leaves, oil, fat, bee's-wax, plasters, oiled silk, externally applied.
These decrease the natural heat and remove pains occasioned by excess of irritative motions.
II. OBSERVATIONS ON THE TORPENTIA.
I. As the torpentia consist of such materials as are less stimulating than our usual diet, it is evident, that where this cla.s.s of medicines is used, some regard must be had to the usual manner of living of the patient both in respect to quant.i.ty and quality. Hence wounds in those, who have been accustomed to the use of much wine, are very liable to mortify, unless the usual potation of wine be allowed the patient. And in these habits I have seen a delirium in a fever cured almost immediately by wine; which was occasioned by the too mild regimen directed by the attendants. On the contrary in great inflammation, the subduction of food, and of spirituous drink, contributes much to the cure of the disease. As by these means both the stimulus from distention of the vessels, as well as that from the acrimony of the fluids, is decreased; but in both these respects the previous habits of diet of the patients must be attended to. Thus if tea be made stronger, than the patient has usually drank it, it belongs to the article sorbentia; if weaker, it belongs to the torpentia.
II. Water in a quant.i.ty greater than usual diminishes the action of the system not only by diluting our fluids, and thence lessening their stimulus, but by lubricating the solids; for not only the parts of our solids have their sliding over each other facilitated by the interposition of aqueous particles; but the particles of mucaginous or saccharine solutions slide easier over each other by being mixed with a greater portion of water, and thence stimulate the vessels less.
At the same time it must be observed, that the particles of water themselves, and of animal gluten dissolved in water, as the glue used by carpenters, slide easier over each other by an additional quant.i.ty of the fluid matter of heat.
These two fluids of heat and of water may be esteemed the universal solvents or lubricants in respect to animal bodies, and thus facilitate the circulation, and the secretion of the various glands. At the same time it is possible, that these two fluids may occasionally a.s.sume an aerial form, as in the cavity of the chest, and by compressing the lungs may cause one kind of asthma, which is relieved by breathing colder air. An increased quant.i.ty of heat by adding stimulus to every part of the system belongs to the article Incitantia.
III. 1. The application of cold to the skin, which is only another expression for the diminution of the degree of heat we are accustomed to, benumbs the cutaneous absorbents into inaction; and by sympathy the urinary and intestinal absorbents become also quiescent. The secerning vessels continuing their action somewhat longer, from the warmth of the blood.
Hence the usual secretions are poured into the bladder and intestines, and no absorption is retaken from them. Hence sprinkling the skin with cold water increases the quant.i.ty of urine, which is pale; and of stool, which is fluid; these have erroneously been ascribed to increased secretion, or to obstructed perspiration.
The thin discharge from the nostrils of some people in cold weather is owing to the torpid state of the absorbent vessels of the membrana sneideriana, which as above are benumbed sooner than those, which perform the secretion of the mucus.
The quick anhelation, and palpitation of the heart, of those, who are immersed in cold water, depends on the quiescence of the external absorbent vessels and capillaries. Hence the cutaneous circulation is diminished, and by a.s.sociation an almost universal torpor of the system is induced; thence the heart becomes incapable to push forwards its blood through all the inactive capillaries and glands; and as the terminating vessels of the pulmonary artery suffer a similar inaction by a.s.sociation, the blood is with difficulty pushed through the lungs.
Some have imagined, that a spasmodic constriction of the smaller vessels took place, and have thus accounted for their resistance to the force of the heart. But there seems no necessity to introduce this imaginary spasm; since those, who are conversant in injecting bodies, find it necessary first to put them into warm water to take away the stiffness of the cold dead vessels; which become inflexible like the other muscles of dead animals, and prevent the injected fluid from pa.s.sing.
All the same symptoms occur in the cold fits of intermittents; in these the coldness and paleness of the skin with thirst evince the diminution of cutaneous absorption; and the dryness of ulcers, and small secretion of urine, evince the torpor of the secerning system; and the anhelation, and coldness of the breath, shew the terminations of the pulmonary artery to be likewise affected with torpor.
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