The practice of emptying the stomach by means of a syringe, as proposed by Boerhaave, has lately been revived with all the confidence of a new invention. There are cases of narcotic poisoning in which there can be no doubt it would furnish the practitioner with a valuable resource, but I much fear that it will be found to be less successful than its more sanguine advocates have anticipated; for where the stomach has so far lost its power as to be insensible to the stimulus of a potent emetic, the chances of recovery are small; the practice, however, in such cases ought never to be neglected, for it cannot possibly do harm, and may perhaps be beneficial.
After all has been ejected, which the operations of art can effect, we are to proceed, without delay, to the fulfilment of the second indication; viz.
Where the substance is in a solid form, and acts by absorption, we should be very cautious how we favour its solution; while, if it exists in a liquid state, our object must be to render its active portion insoluble; this problem involves a series of questions which are wholly chemical. In order to prevent, or retard, the absorption of the active matter, we must, to a great degree, depend upon the agency of vital adjuvants; this latter indication however does not apply to Corrosive Sublimate and other substances which act upon the stomach locally, and are not absorbed; copious dilution also, in such cases, will frequently disarm the poison of its virulence,[226] but it should be followed as quickly as possible by vomiting. In cases where the poison requires to be absorbed, before it can display its energies, it would be generally unsafe to administer any solvent. Nothing therefore can be less true as an aphorism, nor more dangerous as a precept, than the unqualified assertion of Boerhaave, “Aqua omnia venena enervat, quæ cum aqua misceri possunt.” (Prælect. in Instit: T. vi. p. 289.) Alkaline solutions and Magnesia, in cases of the ingestion of arsenic, accelerate its fatal effects, by promoting its solution,[227] whereas Lime, or its Carbonate, has as an opposite tendency,[228] in consequence of the insolubility of Arsenite of Lime; so again, Orfila has shewn that the pernicious qualities of the Muriate of Baryta are counteracted by the administration of any soluble Sulphate, which renders the former substance insoluble. In cases where Verdegris has been swallowed, the administration of vinegar greatly increases its virulence, as M. Drouard has ascertained, by converting the substance into a soluble acetate of copper. This view of the subject will explain why the pure earth Baryta is so slow, and comparatively inert, in its effects upon the system, while its muriate is distinguished by the extreme rapidity and virulence with which it operates. The propriety of administering vinegar, lemonade, and different acid potations, in order to counteract the baneful effects of Opium, which has been so often questioned, will thus also receive ample explanation; it must appear that, if any quantity of the substance of opium remain in the primæ viæ, acid, or mucilaginous drinks will, by favouring its solution and absorption, accelerate its fatal effects;[229] but should it have been previously ejected from the stomach, that then the anti-narcotic influence of a vegetable acid[230] may remove the consecutive stupor and delirium, and thus realize the expectations which Virgil has so poetically raised.
Chardin, in his travels through Persia, informs us that when a Persian finds himself in a distressed situation, he has recourse to a piece of opium as large as the thumb, and that immediately afterwards he drinks a glassful of vinegar; by which he is thrown into a fit of laughter, terminating in convulsions and death.
With regard to the use of Antidotes, it has been already stated how little they are to be depended upon; in certain cases, however, we are bound to acknowledge their power, but they should be very rarely trusted, unless subsequent to, or in conjunction with, the operation of an emetic; in many cases the effects of this latter remedy may be promoted by the ingestion of liquids holding the particular antidote in solution, a practice which offers the double advantage of accelerating the elimination of the poison, and at the same time of decomposing any which may remain. Orfila has fully established the fact of Albumen being a counter-poison to Corrosive Sublimate; vomiting may therefore be very judiciously promoted in cases of such poisoning by water holding the white of egg in solution; with equal effect, where Verdegris has been swallowed, sugared water may be used as a diluent to encourage emesis; and Muriate of Soda in solution will be found the most efficient antidote to Nitrate of Silver; and Sulphate of Magnesia to Acetate of Lead. Where an emetic salt, like Tartarized Antimony, has been taken, copious dilution with common water will in general so provoke vomiting, as to render it its own antidote; but it may be useful to remember, that the Infusion of Galls, and according to Berthollet, the Decoctions of Bark, at the temperature of from 30° to 40° Fah. have the power of decomposing it; while Orfila considers milk the most efficient counter-poison to the Sulphate of Zinc.
Having ejected from the stomach all the poisonous matter we can by vomiting, and attempted to decompose what remains, we are to pursue such measures as may be calculated to prevent the absorption of the poison into the circulation; it has been already observed that on this account nauseating emetics should be avoided; the reader is now requested to refer to our exposé of the celebrated doctrine of Majendie, (page 86, note) and he will see that Venesection proves one of the most powerful means of exciting the function of absorption; hence in poisoning by arsenic, such an expedient should never be recommended,[231] while a particle of that substance remains in the body; where Corrosive Sublimate has been swallowed, the same precaution is unnecessary. The last indication which remains to be fulfilled is—
This is to be conducted on the general principles of Therapeutics; the treatment must necessarily vary in each particular case. Where the exhaustion of nervous energy is to be feared, as after poisoning by Prussic Acid, ammonia, and other diffusible stimulants, together with external warmth, will furnish the best resource; for the same reason Venesection should be performed with great caution and judgment after a narcotic poison. Where, on the other hand, inflammatory action is to be anticipated, it is unnecessary to detail the plan of treatment which may be adopted with the greatest chance of success. In cases where the nervous system is stupified, the symptoms may be combated by vegetable acids, infusion of coffee, &c. but where it is in a state of præternatural excitement, recourse must be had to opiates.
Substances whose application to the animal solids, erodes, or decomposes them.
The operation of these bodies may, in general, be considered chemical; for having destroyed the life of the part to which they are applied, they cause, as if by a species of resulting affinity, the elements of the animal matter to enter into a new state of combination; this is well exemplified in the action of caustic potass, where the nascent elements thus disengaged by the decomposition of the animal substance, reunite in proportions to generate an oily matter, which may be observed to form a film over the ulcerated surface, while the excess of nitrogen and hydrogen constitute ammonia, which is disengaged during the action of the caustic; and may be rendered sensible by inverting over the surface, a small jar moistened with muriatic acid, when the fumes of Muriate of Ammonia become visible.[233]
Their surgical value consists in their power to remove excrescencies, to establish an ulcer, or to convert an ulcerated surface into a simple sore.
This subdivision includes those classes of remedies, whose operation depends entirely upon mechanical principles; and we must agree with Dr. Murray in considering them as the least important of all the articles which we have enumerated, and which cannot therefore constitute objects of elaborate inquiry.
Remedies which expel worms[234] from the intestinal canal.
It has been already stated, (page 90) that certain bodies have the power of increasing the peristaltic motions of the intestinal canal, by operating as mechanical stimulants upon its fibres; in this manner the filings of tin and iron, or the irritating down which covers the pods of the Dolichos Pruriens, are supposed to act in dislodging and evacuating the worms from the intestines. But there is a variety of remedies employed as vermifuges, which must owe their effects to a very different mode of operation; Bitters for instance appear to prove an absolute poison[235] to these animals, while they, at the same time, give an increased tone to the organs of digestion; from whose debility the generation of worms would seem to arise. Other remedies, again, obviously depend upon their simple cathartic property, for the powers which they possess in the evacuation of worms. See Terebinthinæ Oleum—Cambogia.
In the cure of Ascarides the local application of the remedy becomes necessary, in the form of glyster, and which acts both mechanically in washing out the gut, and medicinally in proving obnoxious to the animals. According to the experience of some of our best practitioners, a strong decoction of the Semina Santonici proves most efficacious upon these occasions.
Medicines which are capable of shielding sensible surfaces from the action of acrid matter, by involving it in a mild and viscid medium.
It cannot be denied that where these remedies admit of direct application, considerable benefit may arise; in the progress of a catarrh, we have all experienced the relief that may be occasioned by lubricating the fauces with demulcents, which, by soothing the top of the trachea, quiets, by a kind of contiguous sympathy, the whole pulmonary structure; in certain states of intestinal irritation, the same remedies have furnished considerable benefit, and in ophthalmia, relief has been obtained by the application of a demulcent to the inflamed conjunctiva, by which it is defended from the irritation of the tears; see also Formula 61; but in parts beyond the reach of the first passages, and to which no fluid can arrive but through the medium of the secretions, it is very difficult to explain the principle upon which their beneficial operation can depend; and it seems indeed highly probable that they act in such cases as simple diluents, for the process of digestion must necessarily deprive them of their characteristic viscidity. The administration of demulcent drinks in gonorrhæa is probably of no farther service in assuaging the ardor urinæ, than an equivalent quantity of pure water; although Dr. Murray observes, “it is sufficiently certain, that many substances, which undergo the process of digestion, are afterwards separated in their entire state from the blood, by particular secreting organs; and there is, continues he, no gland which has this power more particularly than the kidneys; substances received into the stomach and digested, afterwards passing off in the urine with all their peculiar properties.” This is undoubtedly very true, but mucilaginous substances rarely or never pass off in this manner; if they evade the assimilative functions, they pass through the alimentary canal, and are thus eliminated. I can state, as the result of experiment, that the urine undergoes no change except in the relative proportion of its water, by the copious and repeated administration of mild mucilages. Dr. Saunders has very justly remarked that the long list of Ptisans, Decoctions, &c. usually prescribed upon these occasions, generally owe their virtues to the watery diluent itself.
The pharmaceutical applications of this class of medicines constitute, perhaps, not the least part of their value, by which we are enabled to introduce acrid substances into the stomach with safety and effect; but such services will more properly fall under our notice in a future part of the work.
Watery liquors, which increase the fluidity of the blood, and render several of the secreted and excreted fluids less viscid.
There are certainly few remedies whose operation is more simple, obvious, or important; and yet there are scarcely any whose value has been more mistaken, or whose application has been so frequently perverted through the suggestions of false theory; water is the universal beverage of animals, and the necessity of its supply is indicated by thirst, a sensation which in excess, is borne with less tranquillity even than that of hunger; in certain morbid states of the body its presence is to be regarded as indicating the necessity of copious potation; and yet how often has the prejudiced physician, under such circumstances, aggravated the pressure of disease, by adding the sufferings of Tantalus. In febrile affections, the irritation of thirst tends to keep up the disease, and hence diluents, besides the other beneficial effects which they may produce, must be regarded as important remedies. There are also diseases of the alimentary canal which may be removed by the same agents; when water is conveyed into the intestines it will have a tendency, by mixing with, and diluting the biliary secretion, to diminish its acrimony, and thus to obviate a source of morbid irritation; the dilution of the chyme and chyle may also have a salutary tendency, and favour the absorption of the finer and more nutritive parts of the lacteals; and by increasing the fluidity of the mass, expedite the numerous combinations which it is destined to undergo. The blood itself is also thus modified in its fluidity; although it has been very truly observed that in healthy bodies, or such as are without any obstruction of the excretions, an unusual distension of the vessels cannot be produced, or at least long subsist; for it is evident that such an increased quantity of water in the blood will immediately pass off by one or other of the excretions; this effect, however, in itself, renders the operation of diluents of signal service in the treatment of the disease; in consequence, for instance, of their disposition to pass off by urine, they furnish valuable resources in diseases of the urinary organs, allaying the pain of strangury, and the irritation from an inflamed bladder. From these observations, the practitioner will be led to appreciate the value of diluents; and many of the beneficial effects which are daily experienced from the copious potation of mineral waters, are, without doubt, to be wholly attributed to simple dilution. See Aqua.
It is here necessary to say a few words upon the misapplication of this order of remedies. Dr. Davy found by experiment that when an animal is bled to death, the last portions of blood that flow are of a much lower specific gravity than that which flows first, in consequence of the former containing more water, which it may be inferred was derived by the increased activity of the absorbents, exerted chiefly on mucous and serous membranes. Since then venesection promotes and accelerates absorption,[236] it is clear that, in inflammatory diseases, where we have recourse to blood-letting, in order to diminish the volume of circulating fluids, we ought not to suffer the patient to indulge in an unrestrained use of liquids, which he eagerly demands to satisfy a thirst which, in all probability, is the natural consequence of increased absorption. In such cases, it is often better to take liquids in small divided doses, which will have the effect of moderating the thirst, without overloading the arterial system, and bringing on that tension and plenitude which are liable to be produced by swallowing too large a proportion of liquids.
In the use of water upon such occasions, it may moreover be observed, that its temperature ought to be attended to; as a general rule it may be laid down, that in the cold stage it should be hot, in the hot, cold, and in the sweating, tepid.
With regard to the value of diluents, as capable of promoting the operation of other remedies, many observations of great practical importance might be adduced; but this subject will be more properly elucidated when we come to consider the influence of solubility in modifying the activity of medicinal substances, and which constitutes a very curious and interesting object of chemico-medical enquiry.
While speaking of Diluents it may be cursorily noticed, that water appears, under certain circumstances of the body, to suffer decomposition, and to have its elements appropriated to new combinations. Count Rumford has endeavoured to prove, that the surprisingly small quantity of solid food which is sufficient for nourishment, when converted into rich and palatable soup, is owing to the culinary process having prepared the water for chemical decomposition,[237] and that this is ultimately effected during the act of Digestion.[238] It cannot be denied that the exorbitant potation of water has a tendency to produce fat, but this may depend upon the vascular distention which is thus occasioned. Gin drinkers, before they become materially injured by the habit, grow extremely corpulent, as may often be witnessed in unfortunate cyprians of the lower orders. Can the hydrogen of the spirit contribute to this effect?
Substances whose application diminishes the force of cohesion in the particles of the solid matter of the human body, and thereby renders them more lax and flexible.
According to this definition, which we derive from Dr. Cullen, the primary operation of emollients would appear to be purely mechanical, for they are insinuated into the matter of the solid fibre, and either diminish its density, or lessen the friction between its particles; this explanation will undoubtedly apply to those emollients which consist of unctuous bodies, and which are introduced into the animal fibre by friction; but it is evident that the beneficial effects of Cataplasms and Fomentations cannot be so explained; for in these instances, none of the materials can be absorbed through the entire cuticle; and yet the relaxation and consequent ease which such warm applications produce on inflamed surfaces is very considerable, but it must be wholly attributed to the relaxing effects of warmth and moisture upon the extreme vessels of the surface, propagated by contiguous sympathy to the deeper seated organs.
The operation of those substances which afford relief to excoriated surfaces by their bland qualities, as mucilaginous lotions in erysipelatous affections, is too obvious to require explanation.
Having thus investigated the manner in which medicinal substances produce their effects upon the living system, we shall be better prepared to appreciate the advantages which are to be derived from their combination with each other, and to escape the too common error of uniting in one formula, remedies which are rendered adverse by the incompatibility of their physiological actions.