Treatise on Opium  

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Treatise on Opium (1742) is a text by the Scottisch surgeon George Young (1692–1757).

The treatise was published as a response to an important paper on opium published in 1742 by Young's Edinburgh contemporary Charles Alston (1683–1760), professor of botany and materia medica. Alston described opium's history and its preparation from poppies he had grown, the first person in Britain to have done so. Young took exception to Alston's conclusion that 'opium does more honour to medicine than any other remedy whatever' and counters this by emphasising the risks '...that I may prevent such mischief as I can, I here give it as my sincere opinion... that opium is a poison by which great numbers are daily destroyed.' In 41 chapters he provides a comprehensive account of the indications for the drug including its complications. True to his reputation he is critical about writers whose knowledge of the drug is based on chemical or animal experiments rather than clinical practice. The treatise is a detailed, balanced and valuable guide to prevailing knowledge and practice.

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PREFACE. A FTER I had finifhed the fol- lowing fheets, I fhewed them to a friend, who was of opinion, that a treatife, wherein opium is re- commended in fuch a Variety of cafes, might be of bad confequence in the hand§ of the ignorant and un- experienced, unlefs fome more pofi- tive cautions and particular direions A 2 were Page 4 ( iv ) were given for the ufe of fuch rea- ders. But, though I am convinced of the truth of my friend's obfervation, I know not well how to remedy this evil. To lay afide the pen, and write nothing about it, will not mend the matter, for opium has already got into the hands of every preten- der to pradice, and is prefcribed every day, not only by many chari- table and well-meaning ladies, but even by the too officious and igno- rant nurfes; fo that we muft either affift the unskilful by our experience, or they will proceed boldly without us. If fhips will go to fea daily, where many of them are loft, we ought to fludy to improve the art of Page 5 (v) of navigation, and point out the rocks, the fhallows, and other dan- gers to be avoided; and, I hardly think, that a new book upon fo ufe- ful a fubje& would increafe the dan- ger of failing. I doubt not but this treatife may occafion fome fatal blunders, thro' the inadvertency and ignorance of fuch prefumptuous pretenders to fkill in phyfick; but, that I may prevent fuch mifchiefs as much as I can, I here give it as my fincere opinion, af- ter more than 30 years uninterrupted pradice, that opium is a poifon by which great numbers are daily de- firoyed; not, indeed, by fuch dofes'as kill fuddenly, for that happens very feldom, but by its being given unfea- A 3 fonal y Page 6 ( vi) fonably in fuch difeafes and to fuch conflitutions for which it is not pro- per. Every body knows that a large dofe of laudanum will kill, and, therefore, they need not be cauition- ed on that head; but there are few who confider it as a flow poifon, though it certainly is fo, when im- properly given. Here it is, that cautions are neceffary, and the ra- ther, becaufe its operation is fome- times fo flow and gradual, that the true caufe of the patient's death is not fufpeded, even by the prefcriber himfelf, who, therefore, perfifis in this fatal error. The danger of opium, as a flow poifon, flows often from two fources, which I will juft mention here: One Page 7 ( vii) On- of them is; that it is often the beft palliative, and gives prefent cafe, even in difeafes, which it ei- ther confirms or increafes: by this temporary relief, we are often de- coyed into mifiakes about its effets, and, indeed, it is no great wonder. I remember the cafe of one in the beginning of a fever, who told: me fhe thould be well if I could pro- cure her one night's reft: I gave o- pitium, and the lay quiet that night; her friends were pleafed with the fuc- cefs, and I continued it, 'till fymp- toms of danger made us take advice of one of more fkill and'much more ex- perience than I had had at that time; 'twas he, who firfi gave me the hint, which my latter experience hath al- A 4 ways Page 8 (viii) ways confirmed, viz. that opium may feem very beneficial in cafes where it does real hurt, efpecially in latent and flow fevers. Another confiderable fource of the pnifchiefs done by this drug, is, the commonly received notion, that opium fhould be given at any time, when watching or pain is exceflive; I am fo much of the contrary opi- nion, that, with me, it is almoft a rule not to give it when either of the two is immoderate, e. g. I never give it in obitinate deliriums, a phrenitis, pleuritis, violent gouts, rheumatifm, or great inflammations of any kind, whether from internal or external caufes, fuch as contufions, fratures, and diflocations, for it frequently in- creafes Page 9 (ix) creafes thofe fymptoms which it was intended to abate; and if it hap- pens to force fome difturbed flum- bers, they prove more intolerable than the watching, and are com- monly fucceeded by a greater ex- cefs of pain. I hope this caution will be of ufe to fuch as think o- pium ferves only to abate pain and procure fleep, without cohfidering when it is that it increafes the caufe of the pain. I own, there are fome excep- tions from this laft rule, but I forbear to mention them, becaufe they would involve me in dif- tin&ions too minute for any un- experienced reader. Page 10 (x) If thefe additional cautions may be of fervice in preventing fome of the mifchief done by the indif- creet ufe of laudanum, I fhall ob- tain. the end of writing this preface. / THE Page 11 (xi) THE CON TENTS. SECTION IL 0 F the methods that have been ufed to invefigate the virtues of opium. 4 SECTION II. Of the effes of ]eep. q SECTION III. 'ibhe efe&7s of opium and of fleep compared, including the author's obfervations on the uft of opium in the catarrh. 28 SECTION IV. Of the effels of Opium in a diarrhoea and somiting. 33 SECTION V. Of the effels of opium in the diarrhoea attending the weaning-illnfs ofnfants. 40r SE C Page 12 ( xii ) SECTION VI. Of the efedts of opium in the diarrhea attending the rickets and fcrophula. 44 SECTION VII. Of the effeats of opium in a dyfentery. 46 SECTIO N VIII. Of the effets of opium in the tenefmus. 53 SECTION IX. Of the effets of opium in the nephritis. 56 SECTION X. Of the efe6es of opium in pregnancy. 59 SECTION XI. Of the effts of opium in labour-pains. 6 i SECTION XII. Of the efets of opium in the milk-fever. 65 SECTIO N XIII. Of the efes of opium in a weed. 67 SECTION XIV. Of the efes of opium in the lochia. 73 SECTION XV. Of the effe&s of opium in the flux of the menfes. 76 SECTION XVI. Of the efeds of opium infpafms. 80 SE C- Page 13 ( xiii ) SECTION XVII. Of the effers of opium in the hamorrhoids. 82 SECTION XVIII. Of the effs of opium in the rheumatifm. 84 SECTION XIX. Of the ef3s of opium after operations in furgery. 87 SECTIONXX. Of the efeds of opium infraIures. 90 SECTION XXI. Of the ef $ds of opium in the phthifis pul- monalis. 9 SECT ION XXII. Of the efets of opium in lownefs of fpirits. Ior SECTIO N XXIII. Of the effels of opium in the melancholia and mania. i06 SECTION XXIV. Of the efets of opium after greatfatigue. 10 9 SECTION XXV. Of the eff's of opium in hyferics and ner- vous diforders. 1 o 8 ECTION XXVI. Of the effees of opium in the nervous afibma 115 SE C- Page 14 ( xiv ) SECTION XXVII. Of the efes of opium in the rickets and fcrophula. I17 SECTION XXVIII. Of tIe.effeds of opium in the tooth-ach. I 2 1 SECTIO N XXIX. Of the effedis of opium in the cancer. 125 SECTION XXX. Of the effe&s of opium in the flone in the kidneys. 3 0 S ECTION XXXI. Of the efe5s of opium in the lethargy, and other fleepy dfeafes. 13 2 SECTION XXXII. Of the effe&s of opium in the afthma fenile. 133 SECTION XXXIII. Of the effe5s of opium in the peripneu- monia notha of old men. 134 S E CTION XXXIV. Of the efets of opium in internal infam- mations. 14o SEC TION XXXV. Of the effeis of opium in the fmall-pox. 144 S E C- Page 15 ( xv ) SECTION XXXVI. Of the efe9 s of opium in the meafles. 155 SECT ION XXXVII. Of the effe'ds of opium in a falivation. I58 SECTION XXXVIII. Of the efe ds of opium in fevers. 159 S E C T I 0 N XXXIX. Of the contrary effeds of opium and vene- fetlion. 169 SECTION XL. Of the preparations of opium. J72 S E C TI ON XLL Of the theriaca Andromachi, mithridate and diakfordium. 177 Page 16 ERR ATA. P. 16. I. 1. read juices. P. 91. 17. for plethora, read pleura. P. 94. 1. 18. for inordinate, read moderate. P. 96. 1. 4. for when omit it, read when they omit it. Page 17 A TREATISE O N OP U M. INTRODUCTIO N. T H E writers on any particular part of the materia medica, have gene- rally thought themfelves obliged, not only to relate all they know of the fubjeft from their own experience, but likewife all they have read, or heard of it from others. They never fail to tell how, and in what places it is produced; in what manner it is prepared, improved, correfted, analyfed, &c. Yet it feems of as little conequence to a B prac- I _ _ _ L Page 18 (2) pra&ical phyfician, to know how opium, or indeed any exotic; is propagated, prepar- ed, or refined; as it is for us to be ac- quainted with the arts of refining fugar, or making chocolate cakes, before we fit down to breakfaft. A fyftematic writer thinks himfelf obliged to exhauft every fubje& that he takes in hand; the confequence of which is, that as no man has time, talents, or op- portunities fufficient to examine into all that may be thought neceffary himfelf, he muft oft-times collea and repeat what has been faid already by other authors. But as a knowledge of the virtues and ufe of medicines is of moRf importance to the pradice of phyfic, I hall confine myfelf chiefly to what my own experience has taught me of the ufe of opium, and refer the reader to fuch as have treated the materia medica at large for the other particulars re- lating to it. So great and valuable are the effe&s of opium in, curing difeafes, that the ftudy of its virtues deferves our fingular application and attention: and I have preferred it before all the other drugs for my prefent fubje&, not only Page 19 (3) only on that account, but becaufe at the fame time that it is of fuch important ufe in re- gular pradice, yet, in unfkilful hands, it is often attended with very fatal confequences; of which the reader will meet with many infances in the following iheets. I propofe, Firit, to enquire into the differ- ent methods that have been employed to inr- veffigate the virtues of opium. Secondly, To confider what are the effets of fleep, both when it is natural, and when it is brought on by opium; and to thew the analogy betwixt them. And, Thirdly, To enumerate the difeafes where- in I have moft experienced its effeats, whe- ther good or bad. SE C B 2 Page 20 (4) SECTION 1. Of the methods that have been ufed to invefli- gate the virtues of opium. IN order to difcover the medical virtues and properties of opium, a great variety of experiments have been thought of and tried. Some have examined it by a chemi- 'cal analyfis; others have either mixed it with the blood newly drawn, or have inje6ted liquid laudanum into the veins of living animals; a third fort of writers have formed conje6tures of its properties from its fmell and tafte ; whilft others have tried it upon their patients, and confined their obfervations to its effeas in the cure of difeafes. As to the firft way of difcovering the vir- tues of opium, viz. by a chemical analyfis, we find that Geoffroy has dtied that method of examination, both in this and the other fimples; and from thence concluded, that the foporific quality of opium was owing to its fulphur: but he does not tell us by what means he difcovered, that it was this principle which made it foporific; nor that ever he made Page 21 (5) made an experiment of this fulphur of opium upon any one patient. Writers in chemiftry are too apt to lead young ifudents into an opinion, that the vir- tues of drugs are difcoverable by chemical proceffes. They infenfibly blend what they learn in the pradice of phyfic, with what they learn by the chemical operations; and by join- ing the two together, the Tyro is induced to think that chemiftry will teach us, a priori, that mercury will falivate, fena purge, and ipecacoan vomit, tho' nothing is further from the truth. The medicinal virtues of drugs are their effects in the human body, and not in a re- tort, or ftill. It is therefore from the prac- tice of phyfic, and not from chemiffry, that we muff exped1 to be acquainted with them. And indeed we may with as much propriety think of analyfing the load-ftone, to difcover its effeats on iron, as expeat to find out the foporific quality of opium by any chemical procefs. The next method of inquiring into the virtues of opium, as well as other medicines, is that of mixing them with the blood newly B 3 drawn Page 22 ( 6 ) drawn from the arm. The authors of this feem to think, that whatever 4ffeas opium has upon the blood when out of' the veins, it muff neceffarily have the fame after it has entered the fubclavian, by the way of the flomach and inteftines. But they feem not to confider, that the blood, whilft in the courfe of the circulation, is perpetually get- ting and lofing fomething, every inch it moves, by means of the fecretions carried on in every part of the body; that it is never half a minute the fame liquor; and that from the firft moment we take in our ali- ment at the mouth, till it is fpent on the re- paration, or other purpofes of the machine, thefe uninterrupted changes in it are fo ne- ceffary, that without them the moft innocent food would become noxious. Thus, e. gr. new cow's milk, inje6ted into the veins of a dog, proves a mortal poifon. Blood in a tea-cup is no more like what it was,; whilft it made a part of the animal, than an amputated leg; fo that you may as reafonably expea that cantharides, or opium, will affed it in the fame manner before as af- ter its feparation, as think, by experiments with opium Page 23 ( .7 ) opium or other drugs on the blood newly drawn, to find out their medicinal pro- perties. Another way of inveffigating the virtues of drugs, is by injeding them into the veins of living animals; but this method has been fufficiently tried without fuccefs. If milk inje&ed into the veins fhould prove a poifon, would it follow, that it muff as certainly kill when taken at the mouth ? On the other hand, tho' transfufing the blood of one animal into the veins of another, fo far fucceeded as to cure difeafes, we muff not thence infer, that blood fwallowed down into the ftomach would have the fame effeft; for when taken at the mouth, and undergoing all the changes of our food, it muff be very different from what is received by transfufion. It is certainly by no means a light diet; bull's blood is much harder to digeft than their flefh: and we are told by fome writers, that criminals among the antients were condemn- ed to drink it as a poifon. Tho' transfufions of the blood of one live animal dire&ly into the veins of another, has been attended with fuccefs in curing fome B 4 dif- Page 24 (8) difeafes, it will not follow, that any other liquor in nature will fucceed the fame way, New milk, for example, tho' an animal liquor, and tho' juft feparated from the blood, yet is fp far from being fafe when inje&ed into the veins direaly, that it has often had fatal effe&s when, after being formed in the breafts, it has been again abforbed into the mafs of blood. As to thofe who judge of the virtues of medicines by their fmell and tafte, I muffll own, that thofe fenfes may give us informa- tion as to fome of their qualities, and confe- quently afford fuch hints as will ferve to fug- geft other ufeful experiments. It is the fmell and tafte that inform moft other ani- mals what is, and what is not their proper food; but we have not fo perfea an ufe of thefe fenfations, much lefs can we thereby know the virtues of medicines. We could not from hence predi& the effeas of argen- tum vivnm, calomel, vitrum antimonii and its infufions; we could not know that opium caufes fleep, and cafes pain; or that an ague ;nay be cured by the bark. Page 25 (9) Moft of the writers on the materia medica pretend to give us fome account of the vir- tues of drugs, deduced from praaical obfer- vations; and are not fparing in producing the tefimony of other authors; but how little fatisfadion do we find in reading their accounts ! How much are we difappointed when we come to compare thefe obfervations with our own experience! Nor is this fo much to be wondered at, when we refled, that no man by his own pradice can acquire a fufficient knowledge of the virtues of one tenth part of the fimples in ufe: life is too thort for fo great a work; therefore all the writers of the materia medica mufft copy from others nine tenths of what they give us on this fubjet : for which reafon, fhould they all agree that elks-hoof, for example, or the cranium humanum are good cepha- lics, yet you may reafonably fufpet, that an hundred fuch authorities are in reality but one; efpecially when we find, that moft of thefe writers copy verbatim from others. It is extremely difficult to afcertain the medicinal properties of drugs, efpecially of thofe we commonly efteem alteratives; for 4 the Page 26 S( I 10 ) the fame individual medicine has different effeAs, not only on different conflitutions, and in different difeafes; but alfo in different ftages of the fame difeafe: nor will lefs un- certainty arife from a variation in the dofe, and in the frequency of its repetition. In thort, there are fo many circumifances, to which we either do not, or perhaps cannot fufficiently attend, that vary their operation and effe&s," that we are daily difappointed in our expetations, even of thofe me- dicines with which we are beft acquainted. Thefe difficulties are not a little increafed by that abfurd, tho' fafhionable pradice, of blending, in one compound, a farrago of all the fimples which authors have claffed toge- ther for that difeafe. How impoffible is it for the prefcriber to know which ingredient was ufeful, which unneceffary or hurtful ? Yet fome phyficians not only feem to glory in this multiplicity of the ingredients, but put it frill more abfolutely out of their power to grow wifer from experience, by changing their prefcriptions almoft every time they vifit the fick, as if a day or two was fufficient 6 to Page 27 ( II ) to know the effets of an alterative. Add to this, that we are often deceived both by the patient and nurfe. I have more than once been thus prejudiced in favour of a medicine which I found, at lafi, had never been taken. Yet I have much oftner been de- ceived by thofe prejudices which I imbibed very early, and which, in fome degree, are unavoidable. In our firft ftudies, (however great our natural abilities) we have little or no experience of our own, and muft there- fore relie on that of our teachers; and befort we have gone through the feveral branches of fcience, we have ufually fwallowed fo many creeds implicitly, that we cannot af- terwards have time and opportunity to re-ex- amine the tenth part of them, till our pre- judices are fo deeply rooted, that no room is left to doubt, or to make any further enqui.. ries about them. Here and there a man of genius will get the better of many of thofe prejudices; but the far greater part of us are mifled for life. In the pratice of phyfic thefe prejudices are fometimes fo ftrong, that when our prefcriptions app tly do harm, we Page 28 ( we are apt to afcribe it to the malignity of the difeafe; and, on the other hand, when nature or chance cures the patient, as is often the cafe, we very readily give all the praife to our art: not craftily, as fome wits may furmife; but out of the pure fimplicity of our hearts, and blindnefs of our underltand- ing. From what has been faid we may con- clude, that the medicinal qualities of drugs are not to be difcovered either by chemical pro- ccfies, or by mixing them with blood newly drawn from the veins, nor by injeding them into the blood-veffels of living animals, nor by the tafte or fmell : and that the only way of knowing- what a medicine will do in a jaundice, e. gr. is by giving it to one that has that difeafe; and even this method will be attended with many and often infuperable difficulties: yet it is ftill not only the belt, but almoft the only means of difcovering the vires medicamentorum. I fhall therefore purfue this method in my prefent enquiry into the virtues and ufe of opium, by fhewing in what cafes and cir- cuMr- Page 29 ( r3 ) cumf~ances I have found it do good or harm; and from thefe faCts I thall endea- vour to deduce fome general rules concern- ing its ufe, efpecially fuch as may be ap. plicable to other drugs by a parity of reafoning. SE C. Page 30 ( '4 ) SECTION II. Of the EJJE& s of Sleep. M OST of the effets of opium may, for ought we know, depend on its foporific quality: i fufpe2 they do, and fhall therefore, before we proceed, take a view of the pheanomena and effeas of fleep ; which being known to every body, if they have a refemblance to thofe of opium, they will il, luftrate one another. And firft let us confider the common effets of fleep in health,and then compare them with thofe of opium, both in health, and likewife in feveral difeafes. Sleep makes us infenfible of a moderate flimulus, and perhaps many of the phano- mena attending it may be accounted for from this infenfibility. Hence perhaps it is, that moft of our excretions are abated or inter- rupted at that time; we neither cough, nor hauk, nor fpit, nor fneeze, nor evacuate by ftool or urine. It feems to be owing to this, that many of our focreted liquors, which tho' thin, when they arrive at the excretory duets, Page 31 ( 15 ) duas, yet by the remora there, in our fleep, become thick; witnefs the wax in the ears, the mucus of our mouth, nofe, fauces, and inteftines: thefe are all thicker after a pro- found fleep, probably by lying till the aque- ous parts are abforbed, or evaporated ;. and hence perhaps it is, that perfpiration, which is excreted without any flimulus, proceeds fully as well in fleep as when awake; nay, probably better, on account of the other ex- cretions being then leffened. That fleep oc- cafions this remora, and thereby accumulates our ferous juices, appears from a remarkale experiment, firfi publifhed by Mr. Waffe, in the Philofophical Tranfadions, and after- wards farther profecuted by M. de Fontenu *. The experiment fhews, that a man that ufes much exercife the preceding day, if he is meafured exaaly at night, will be found very fenfibly iforter than he will be next morning, after a good night's reft: the dif- ference will often amount to an inch, and fometimes more. This is accounted for by the cartilages of the fpine being full and diftended by the * V. Hill. de 1'Acad. R. des Sc. A. 172 . juices Page 32 ( 16 ) uices which are accumulated in the night during fleep; whereas thefe fame cartilages, by being compreffed by exercife in the day- time, are emptied of thofe juices, which be- ing reftored in the morning, make them thicker and more elaftic. By the fame ex- periment we find, that fimple reft, without any fleep, had more or lefs the fame effed upon the increafe of ftature, as if the perfon had flept. And lally it was obferved, that as one quarter of an hour's exercife fenfibly diminifhed the ftature, fo a full meal of good nourifhment increafed it as fenfibly, and as fuddenly, but it did not continue. Our liquids are likewife rarefied, and perhaps even our bones become larger. I with the experiment had been tried after a full dofe -of opium. Exercife both abates and increafes fwellings in the legs, by propelling the fluids: for, when the fwellings of the legs are the effea of the weaknefs of the folids, then exercife does harm; but fometimes the vitiated fluids are the original caufe, and then exercife does good: e. gr. after a fradure, a bruife, or a ftrain in the ankle, if the patient walk too foon, or too much, that exercife will infal- libly Page 33 ( 17- ) libly bring -on a fwelling, by propelling the fluids through thofe weak fibres with more force than they are able to bear. Many by this means lofe their leg at laft. On the other hand, if the fwelling is a fymptom of a chlorofis, feurvy, or even a dropfy, a little exercife will often abate the fwelling and fliffnefs of the legs, by propel- ling the inert and half-ftagnating blood through its veffels. The patient finds his legs lefs fliff after a flort walk, therefore he concludes, that the more he walks, the bet- ter; by which miftake, he continues his ex- ercife till the weak fibres, by being overftrain- ed, lofe their tone, and the fwelling is there- by much increafed: fo that exercife, accord- ing as it is ufed in a greater or lefs degree, abates or increafes this fwelling. It is not improbable, that alternat~ eeft and exercife, which fo remarkably augment or di- minioh our vertebral cartilages, may, in the fame manner, have much influence on our growth and ftrength ; and that fleep, by the remora and accumulation of our juices, con- tributes to nutrition: whereas exercife may propel and evacuate what is ufelefs or fuper- C fluous, Page 34 (is ) fluous, and thereby make room for what further accumulation may be neceflary, Hence we fee, that, caterisparibus, la- bouring people, efpecially at fea, grow faflter and fitronger than others, who have no ex- ercife. The latter may become fat, but they do not grow firm and ftrong. Again, we fee all the fymptoms of a plethora are confequent to a found fleep, viz. A perfon who has flept too long, awakes with his eyes fwelled and watery ; if his eyes were tender before, the eye-lids are glewed together) if he is under a falivation, or at the acme of the fmall-pox, the faliva be- comes thicker, and the chops are more fwelled. Hence Sydenham obferved, that opium raifed and kept up the fwelling of the face in the fmall.pox. If fleep gives a remarkable remora to our ferous excretions, it is not fitrange that the faliva thould grow thick and fwell the glands; and perhaps this remora in fo many glands and excretory duas, contributes to an univerfal diftention and ilethora. If one is much difpofed to go to flool over night, he can eafily put it off till the next mornf- Page 35 ( 9 ) morning, provided he can but delay it till he falls afleep: for then he is infenfible of the flimulus, and in the mean time the fwces, by reft, are thickened and rendered lefs ftimu- lating, at leaft till they become either very hard, or are much accumulated. Juft at the time of falling afleep, we feel afupor and heavinefs over all the body. We have a feeling as if the parts were crammed and compreffed. All thefe fenfations goim- mediately off when we are fuddenly waked; but when we are more gradually diflturbed, they are not fo foon removed. When we fhake off drowfinefs in a morning, it is as if we were throwing away fo many weights and incumbrances. From there phanomena, it fhould feem, that our bodies are not only more plethoric, but even more obftru~ted in our fleep, than while awake. When we are half afleep, we feel ourfelves inert; but whea we are quite awake, there is an aaivity in every fibre. Another effet of fleep is, that it promotes heat throughout the whole body. Look at a fleeping infant, and you will fee the com- plexion remarkably florid, and the fkin feels C 2 hot, Page 36 ( zo ) bot, or elfe is moift with fweat; and it is defervedly reckoned a great defe& of the vis vitce, or natural ferment of the blood, if our feet continue cold all night. I think he&ic fits, fudden rarefa&ions of the blood, (efpecially in weak and watrycon- fitutioRs) colliquative fweats in a confumption, cramps, the night-mare, afthmatic fits, ve- nereal, pleuritic, and even labour-pains, are, cateris paribus, more increafed after fleep. I had once a fpitting of blood that feized me every night in my fleep, with an heat over the whole body. This obliged me at laft to fit up in a chair all night, to keep myfelf cool. Whilif awake, I was never troubled with this haemorrhage. If one fleeps after dinner, a glowing heat diffufes itfelf throughout the whole body. This pradice is therefore of ufe to aged and cold conflitutions, by promoting the natural ferment of their blood: for the fame reafon it does harm in full habits and hot conifi- tutions. Upon fleeping after dinner, I grow hot and high coloured, and my face appears fwelled. If I am foon awaked, I feel a conv- Page 37 ( 21 ) confufion attended with a fenfation of a fe- verifh kind; but if I have not been difturbed too foon, I awake eafy, without confufion, and in a breathing fweat, as if my dinner and fleep had brought on a fhort fever, ending in this moderate critical difcharge. If I am roufed out of my firft fleep after a full fup- per, I feel my fkin hot and dry, and my head confufed. I know, that as I am a valetudinarian, my patients are fometimes apprehenfive that I may catch cold in the night air; but at that time my blood is rarified, I am hot and dry, and catch no cold during that ftate. But if I am called out early in a morning, when the preceding heat has raifed a fweat, I am very liable to catch cold. When I have not eaten a full fupper, I am not fo hot in the night, and fweat lefs the next morning. This heat upon fleeping immediately'iaer eating, may be afcribed by fome to the new chyle getting into the blood; yet if that was the caufe, a man would find himfelf eually as hot upon ufing gentle exercife in the houfe after dinner, which is not agreeable to ex- perience. But if the accumulation of :oir C 3 juices Page 38 ( 22 ) juices in the vertebral cartilages be as fenfible after fleep, or reft, or a good dinner, as the experiments of Mr.Waffe and Mr. de Fontenu feem to evince, I would extend my theory fill further, and fuppofe that a like accumulation happens in moft of the glands and capillary veffels; which, like other infaraions, will pro- duce the heat, drought, and heavinefs which we ufually experience after a full meal. It is as certain, pn the other hand, that fleeping with an empty fomach warms much lefs than after a full meal ; therefore all who complain of being too hot in the night, thould go fupperlefs to bed. That fleep has different effe6ts, according- ly as it happens upon a full or an empty flo-' mach, is beyond difpute; but if any one doubts it, let him look at the face of a drun- ken man while he is afleep. Lommius has obferved, notum efi, fomnojejunum corpus con- Jumi. And Hippocrates has remarked the fame thing, fomni jejunum attenuant, humidum quod inefl vacuantes. If, by way of conje6ure, I may comment upon this paffage, I would fay, that from the time our food is fwallowed, a procefs begins gradually to change it into 6 chyle, Page 39 ( 23 ) chyle, then into blood, then to make it fit for fecretion, for nutrition, and all the pur- pofes of the machine. After this is done, as the fame procefs goes on, -tho' we receive no new nourifhment, the body muff be gra- dually drained by the ufual excretions, &c.; but without that kind of ferment, which new chyle always occafions more or lefs, when it enters the blood : i. e. the animal procefs, by fleep concoas and perfeas all our juices; after which, if there is no frefh fupply, the fame procefs wafles, diffolves, and renders them ufelefs. Therefore fleep both waftes and re- pairs the body. I need not mention what comfort a found fleep affords to the wearied, and thofe whofe fpirits are exhaufled; and how much they are invigorated and enlivened thereby. Every body knows, that fleep is fo neceffary in fuch cafes, that we cannot be without it; nay, that we cannot fupply its defet by the beft nou- rifhment or cordials, or by any degrees of reft either of body or mind: all are infufficient. One thould think, that proper food and a good digeftion would fupply fufficient ma- terials to recruit the fpirits; but experience C 4 4hews, Page 40 ( 24 ) thews, that fleep is alfo indifpenfibly necef- fary. It feems requifite in carrying on the con- co6tion and fecretion of all the animal hu- mours, and perhaps the fpirits are alfo gene- rated or perfeAed by fleep. It is very cer- tain, that without fleep life cannot long be fupported: we have no fuccedaneum to fup- ply its place. When it fails us, we have no better refource than to endeavour, by all pro- per methods, to reflore and promote it; and there are many things conducive to this end. A full mealwill often make us fleepy, and that immediately after eating: a found but plethoric conftitution difpofes to fleep: filence and repofe, with a freedom from every fen- fation of flimulus, are no lefs effedual in producing it. Moderate fatigue waftes thofe fluids which reft and fleep reflore; fo that exercife is a predifpofing caufe of fleep, in like manner as fafting gives an appetite and requires a re- cruit of food. In order to know what hinders fleep, we need but invert the caufes that promote it: thus Page 41 ( 25 ) thus for inftance, as a full fupper promotes it, faffting will prevent it; and fo of the reft. Sleep is likewife impeded by every kind offlimulus of the fenfes, or of the mind ; i. e. whatever affets the mind either with pain or pleafure. A paucity of good juices have the fame effea: And tho' moderate fatigue difpofes to fleep, yet, when exceffive, it often raifes a fever, attended with watchfulnefs. But all thefe rules are general, and muff be liable to many exceptions, from a variety of circumflances that will frequently occur, par- ticularly in thofe of different ages and con- flitutions. And this laft refletion (tho' too little attended to by moft pradical writers) is in no wife confined to the prefent cafe, it is no lefs applicable to every branch of pratice; for we are too much accuftomed to prefcribe by general rules, whereas general rules alone can never be of much ufe in a fcience that is chiefly made up of exceptions from them. I fhall now fum up in a few words the effeds of fleep. In our fleep we are infen- fible of a moderate fimulus, therefore thofe fecretions and excretions which are prom6ted by Page 42 ( 26 ) by any natural flimulus whilif we are awake, are retarded in our fleep. Moft of the ferous humours grow thick if they flagnate, or lie long upon the parts, after their excretion: thus we find, that the fal- va and mucus of the nofe, mouth, and fauces, are found more vifcid immediately after fleep than before it; and that after we have been fome time awake, thefe liquors become loofe and are eafily difcharged. In fleep the body is extended, the humours are accumulated and rarified, fo as to occa- fion a kind of plethora. Hence a recruit of fpirits, and an increafe of ftrength towards the morning, which we begin to be fenfible of even in our fleep, by our being engaged in pleafant dreams. All the fymptoms of a plethora are in- creafed by fleep. Hence we may derive the night-mare, cramps, or fpafms, flarting fud- denly out of our fleep in moft of the inflam- matory difeafes, in the meafles, fmall-pox, and rheumatic fevers; nay, afthmatic fits, pleuritic, venereal, and even labour-pains are often exafperated by fleep. An hcmoptoe comes oftner in the morning than at any other Page 43 ( 27 ) other time of the day; and the flarting of an amputated ftump is fo remarkably the effea of fleep, that the patients are afraid to com- pofe themfelves. to reft, left they burif the tied veffels. Thefe are all indications of fulnefs brought on by fleep. SE C- Page 44 ( 28 ) SECTION ]II. Ihe efeis of opium and of fieep compared, in- cluding the author's obfJrvaticns on the tfi of opium in the catarrh. IHave had occafion to feel many of the effeas of opium upon myfe'f, for I have all my life-time been very fubjed to a cough upon catching cold, which has frequently feized me when I was otherwife in perfed health. My common cure was opium, which ,.ufually had the following effedts. In the firft place, it commonly made me fleep, which is its moft conflant effea, ex- cept in fome particular conflitutions; or where fleep is impeded by other caufes, which was fometimes my own cafe: for one night a violent toothach, another a difmal piece of news, and a third night a fhort fever over- balanced the foporific quality of the opium, i and hindered me from fleeping. Thefe caufes were evident, and fuch as every one would expe6 might prevent the opium from taking effet; but it is alfo certain, that there are Page 45 ( 29 ) nre many imperceptible caufes, which hinder us from fleeping with fuch a dole as has been found abundantly foporific before: fo that opium will not always make us fleep, even when there is no apparent caufe to difturb us. By a moderate dofe, i. e. twenty drops of liquid laudanum, taken at bed-time, my cough was often cured the very next day, if mild and recent, and I was no otherwife indifpofed: all the effecas were fleeping better, and being cured. But if I took thirty drops inftead of twen- ty, then the next morning I found the drow- finefs continue longer, my face being a little fwelled, my fkin hotter and fometimes drier, tho' at other times a gentle fweat came on; my tongue was whitifh, and my breaft bound, till the effeCts of the laudanum ceafed. Thus I have often had my cough feemingly cured in the morning, by the laudanum which I took the preceding night; but it returned in the afternoon, when the effeCt of the opium was over: yet opium was ftill the cure, which was indeed fo often fuccefsful, and fo fuddenly, with many of my patients, that they remembered its virtues fome years after, and Page 46 ( 30 ) and have told me that I had formerly cured them of a cough with one dofe of a medicine that wrought like a charm. I tried laudanum afterwards upon myfelf, when plethoric; and as the ordinary dofe of twenty drops was too fmall, I took thirty, which made me hoarfe: and tho' my cough was indeed kept quiet, and became lefs fre- quent the next day by this means; yet I felt my breaft fo bound and ftiff thereby, that I was afraid to cough, and breathed with difficulty till after I had fpit fome blood. This made me lay afide my favourite medi- cine, and endeavour.to reftore a free cough by bleeding and abftinence, and the ufe of fperma ceti and honey. This experiment on myfelf may have been ufeful to my patients, fince I had too haftily adopted opium as a general cure for a catarrh. I remember likewife, that being feized with an inceffant dry cough, like that of the meafles, which kind of cough then raged at Edinburgh, and concluding it to be one of the catarrhous kind, I took forty drops of laudanum on the firft or fecond night, which ftopped the cough in an hour; but brought t on Page 47 on a great hoarfenefs, with a noire in my eats, and a giddinefs and confufion of my head. I fell afleep, but foon waked again, with violent flartings and confufion, attended with a fenfe of faintnefs or failing about the heart, that feized me as often as I was dropping afleep. To expel the opium I immediately took a vomit of white vitriol; and when that was over I flept well the reft of the night, and was well next morning; but on the evening following, I began to feel the effe&s of the large dofe of laudanum, by lofing almoft all the fenfe of feeling in my legs : and tho' I continued perfedly free from the cough, yet I was foon after feized with a fpafmodic afthma, accompanied with many other ner- vous fymptoms. I blooded twice for it, by which means, and the ufe of an hyfieric ju- lep, I recovered. This is a firong infiance of the power of opium in a catarrh; but at the fame time is a caution not to give it in large dofes. Perhaps that rheum which in this epidemic catarrh fell ufually from the lungs, or trachea, by means of the laudanum, was returned into the veffels, fo as to affed the Page 48 (32 ) the whole genus nervofumn; for when liquors once excreted, are re-abforbed into the blood, what are they not capable of producing? Surely, very different effets ; for they will fometimes kill, and at other times be affimi- lated, or expelled, if the vis vite is vigo- rous. Thus the gout fuddenly repelled, proves often fatal to old men. From thofe effeas, produced by different dofes of opium, we fee that it infallibly, more or lefs, thickens all the liquors in the mouth, nofe, and trachea; the body be- comes coffive, the tongue parched, and the mrine higher coloured than ufual ; every fe- ros fecretion is retarded, thickened, or di- mniifhed, except perfpiration. Hence an accumulation and rarefafion of the humours, and the body is fenfibly made more plethoric. All thefe fymptoms attending the ufe of opium, are likewife the effets of natural ileep; tho' perhaps in a lefs degree, and con- fequently lefs perceptible. SE C- Page 49 ( 33) SECTION IV. Of the Efeds of opium in a diarrhoea and veo- miting. IShall now proceed to enumerate the ef- fets of opium in' other difeafes befides the catarrh ; and firt in a diarrhea and vo- miting, proceeding from acrid humours in the bowels; for which, in my own cafe, I have ufed opium fuccefsfully. I am apt to be griped with the ufe. of ho- ney, thell-fifh, or vinegar; but a diarrhea always fucceeds, by which I have very often been extremely fatigued, and therefore oblig- ed to have recourfe to opium, which fre- quently cured me in a few hours. It feemed to abate the prefentfimulus till the acrimony was correaed ; tho' fometimes that was not accomplifhed before the firength of the opium was fpent, and then the gripes re- turned; but I was commonly cured without a fecond dofe. It is more than probable, that this acri- mony may on fome occafions be too copious, D or Page 50 ( 34 ) or too acrid to be fo foon corre6ed, or it may be too great to be fubdued by the chy- lopoetic vifcera. It may be fuch, that if it be not expelled, it would become fatal by its perpetualJfimulus. I remember I once in- dulged my palate, at a collation, to a degree that it brought on a cholera morbus. The wine turned four upon my ftomach, and in a few hours the vomiting and purging was excefflve. I thought myfelf in very great danger, and imnmediately took thirty drops of laudan dm, which flopped my vomiting for fome time; but made me fo exceffively fick, that I wifh- ed heartily for its return. A draught of warm water produced the effe6 I defired; the vomiting and purging both returned, and continued with fuch violence, that I thought myfelf again at death's door. I now judged (as is common in cafes of extremity) that the prefent evilwas the grcateft; and therefore re- peated the fame dofe of laitutanm, thinking the firft had been moftly thrown up again. This abated the evacuations, and gave me fome diflurbed reft, in which I moaned much. In about two hours I waked ex- tremely Page 51 ( 35 ) tremely fick, and vomited, whereby I was greatly relieved, and thought myfelf almoft well; but the ficknefs flill returning, I took a vomit of ipecacoana. I had a pain in my head, and a quick pulfe, and therefore thought it fafeft to evacuate the caufe now, whilft I was able to bear the operation of an emetic. After this I fell afleep, and was much better; which I took to be a fign, that the caufe was either corre&ed or expelled. By what paffed I could eafily fee the truth of that maxim, viz. That the acrimony in the prime vie may be fuch in quantity or quality, as muff be expelled, and cannot be corre&ted. Had I increafed the dofe of lau. danum, fo as to hinder all evacuation at the beginning, it muff have been fuch a dofe as would have deftroyed all fenfation; it muft have made me apople&ic, before it could have rendered the inteftines quite infenfible of fuch a fimulus. On the other hand, the ,flimulus may be fo great, and the evacuation fo violent, that nature may be overcome, convulfions may be brought on, and death enfue. Opium abates the vomiting for a time, and gives fome refpite, till the increaf- D a ing Page 52 ( 36 ) ing ficknefs renews the attack: for no dofe of opium, that can fafely be given, will prevent this ficknefs, or the return of the flinulus. However, it is not eafy to deter- mine in what dofe it would prove mortal in a cafe of this nature ; becaufe while we have fuch contents in the primea vie and inteffines, moft of it would be again difcharged, before it could get into the blood. I have given much opium in this difeafe, without being fenfible of any effet, till I had reafon to think all the acrimony was evacuated: but I confefs that my experience in my own cafe has hindered me from ufing it fo freely as otherwife I might have done; befides, the acrid contents are fo evidenly the caufe of the difeafe, that their expulfion is the principal indication. And I think it certain, when a large dofe of opium creates great fickaefs, that it is a fign there is flill fomething noxi- ous within. Upon the whole, I think opium Thould be very rarely given in this difeafe, and that after wa hing the flomach and in, teflines with plenty of warm water and chalk: at leaft it flhoild not be given in fuch dofes as quite to fupprefs the evacua- tions Page 53 ( 37 ) tions, whilit the acrid matter remains un- expelled. When the debauch which brings on the difeafe is very flight, or when the acrimony is little, a fingle dofe of opium, without a vomit, will often cure the gripes and loofc- nefs, by abating the flimulus till nature has corre&ed or expelled it; but a timely vomit is the fafeft way to prevent the crude juices entering the blood, and raifing a fever. Befides the cholera morbus above defcribed, there are other kinds and caufes of loofenefs, which require no fmall judgment in the ufe of opium. Some gluttons have an habitual loofenefs, becaufe they lay in fuch a load every day as muft prove purgative, on account of. the large contents of their guts, independent of any acrimony: fome conititutions are fo ftrong, as to continue to expel this load every day, for half a life-time. A few copious loofe ftools every morning is a very fenfible relief to them, and this keeps them in health. I remember one who had gormandized twenty years: he called a phyfician, and told him that he was of late grown weak, D 3 and Page 54 ( 38 ) and had no appetite for meat; yet notwith- flanding had a frequent loofenefs. The doc- tor knew not that he took in a load of fmall beer and brandy every day, that kept up a conflant.purging; he therefore ordered him as much tinaure of laudanum and diafcor- dium, as foon convinced him, that a loofenefs was neceffary, and that an habitual cramming required an habitual evacuation. Yet it is certain, that many men of good fenfe never attend to this rule: but we fhould never negled to examine both the quantity and quality of our patient's diet, before we prefcribe for a loofenefs; for to flop a purg- ing with laudanum in one that is continually furfeited with meat or drink, is an abfurdity no phyfician of any abilities can be capable of. Some children are crammed every day by their fond mothers with variety of jellies, fweet-meats, and preferves. To thofe, when their digeftion is quite fpoiled, we often add many ftomachic bolufes and draughts; and all this betwixt their meals, at which they are never flinted. A conftant loofenefs is the ufual effe&: in which cafe, if the mother 6 con. Page 55 ( 39 ) conceals the confe&ts and reftoratives from the knowledge of the do&tor, he will be too apt to prefcribe diafcordium or laudanum, when chalk and water, with a fpare diet, would be much more proper. Thus the child grows gradually more pale, thin, and lax: the mother blames the loofenefs alone, and will have it ftopped; more opium and white decotions are prefcribed by the phy- fician, and more refforatives by the mother : which the child being ftill lefs able to digeft, the loofenefs is renewed thereby as often as it is abated by the medicines; till fome new difeafe is brought on, or the phyfician dif- covers the mifmanagement of the mother, and corre6ts it. .SE C- D 4 Page 56 ( 40 ) SECTION V. Of the effeas of opium in the diarrhoea, attcnd- ing the weaning-illnefs of infants. T HE weaning-illnefs of infants is of- ten attended with a diarrhea, which is probably owing to their change of diet from breaft-milk to fpoon-meat: the beft. way of preventing it is, to accuftom the children, for fome months before theirtwean- ing, to fuch diet as differs leaft from breaft- mnilk, and to wean them gradually. But if notwithftan'ding a loofenes comes on, four or five drops of liquid laudanum, with the abforbent powders, given every night in any convenient form, will feldom fail, unlefs af- ter eating too much; for an opiate always difagrees with a plentiful meal. It is common to give to children the fyrup of white poppies inftead of opium, becaufe the mother apprehends lefs danger from a fyrup which the knows, than from a drug, which, as the has been told, proves fometimes fatal by an error in the dofe. We are certain, that both of them procure fleep i and that by prQ- Page 57 ( 41 ) proportionally increafing the dofe, their ef- feas will be equally dangerous ; but whether an ounce of this fyrup, or a grain of folid opium, have any different effeats in different difeafes and different coniitutions, is not fo eafy to determine: I muft confefs, that the difference (if any there be) has been hitherto to me imperceptible. I once thought, that the fyrup was not fo apt to give difturbed reft as the opium; and therefore, that it was more friendly to the genus nervofum, till I found, from a great number of cafes, that they both would produce good or bad effe6ts, according as circumftances differed. I found the fame opiate would to one perfon afford a calm and refrefhing fleep, which to another gave broken flumbers, with frequent ftartings and frightful dreams. Even the fame dofe of fyrup of poppies, or of opium, upon the fame perfon in different circumflances, will be no lefs different in its effeas: fo that he that prefers the one to the other upon his own experience, ought to do it with diffi- dence; for it would require very diligent and accurate attention to balance all thofe cone comitant circumfilances which render the ef- feas Page 58 ( 42 ) fe&s of opium fo various. The whole life- time of a man of little praaice would be hardly fufficient to make the neceffary expe- riments; and an eminent phyfician has nei- ther time nor patience to purfue fuch en- quiries. But to return to the fubje& from whence I have digreffed: I obferved, that fmall dofes of opium are of great ufe in that diarrhava which attends the weaning illnefs of infants; and yet if it is over-dofed, or given with too plentiful a diet, it will make the child fick, and the loofenefs will foon return. I imagine that it relieves by abating the fimulus in the intefftines, till nature and ab- forbents have deftroyed the acrimony; at leaft the child is daily recruited with fleep, which could not have been procured without opium: but even in the prefent cafe, if the acrimony is either copious or violent, forget not to abate it before the ufe of opium. Some indeed prefcribe rhubarb to be often repeated for that purpofe; but abforbents, even in the beginning, feem preferable to ei- ther rhubarb or ipecacoana, becaufe they eafe the child's gripes fooner than a flimulating men Page 59 ( 43 ) medicine; and it is as eafy to deftroy the acrimony by abforbents, as to remove it by evacuants. I muft own, that in cafes where the acrid contents are copious, one vomit, or one dofe of rhubarb, may be very proper; but I would not delay the prefcribing of the ab- forbents for the fake of the rhubarb, but give both the fame day. Children are likewife troubled with a diar- rha a at the time of cutting their teeth; and the fame fymptoms of acrimony in the prima vice attend this cae as in the laft. Opium is alike ufeful in both complaints, when given with the fame precautions. There are many fkilful pradtitioners, who do not ufe opium in the above difeafes: neither would I urge the ufe of it in mild cafes, but where the gripes hinder the child's reft; and even then I would never give it without abforbents, which may properly be confidered as the ra- dical cure. SE C- Page 60 ( 44 ) SECTION VI. Of the efe5ts of opium in the diarrhea attend- ing the rickets and fcrophula. VW EAKLY and ricketty children, or fuch as are come of fcrophulous parents, continue often in good health for the firf, fecond, or third years of their life; after which, the latent fcrophulous leaven be- gins to thew itfelf, and, among other fymp- toms, commonly brings on a diarrha, attend- ed often with a big belly, and figns of the rickets. There is another fet of children brought up in the country by the farmers fervants, whofe diet is four butter-milk and oatmeal; at leaft it is fo among the poorer fort: and fuch children have a pale or yellowifh com- plexion, a big belly, and unweildy habit of body. This difeafe is often attended with a loofenefs; but it is evidently the effeas of cramming them with heavy diet, at a time when they ufe no exercife to digeft it: for as foon as they are grown older, and are able to Page 61 ( 45 ) to drive the plough, their exercife proves an effeaual cure. Now it is almoft certain, that a good diet in fmall quantities would cure fuch children, whilft opium would be rather hurtful. But altho' I do not ufe it in this laft cafe, yet in the diarrhera of fcrophulous children, where I cannot fo much blame their diet, as the morbid ftate of the humours, I give four, five, or fix drops of liquid lauda. num every night at bed-time, chiefly if they complain of pains in the belly and want of reft. I cannot fay whether it operates purely as a pacific, or whether finall dofes aa as a cordial, by which the motion of the fluids is affifted; but I think, in fat, they are better for it. I would advife giving the liquid laudanum at leaft an hour after fupper: but if the diet of the child be not properly regu- lated, you will not be fenfible of the effeas. When fome weakly children of the above clafs were almoft killed with cold bathing, being fo weak, that they continued cold and chill to a great degree, and for a long time, after they came out of the bath; (for a glow- ing heat flould always fucceed, otherwife it brings on or increafes a loofenefs) I forbad the Page 62 (46) the bathing, and prefcribed with good fuc- cefs fome aromatic confeations, with a fmall proportion of fteel and liquid laudanum at night. Tho' I doubt not but that cold bathing has been often very ufeful to weak and rickety children; yet fome are often too weak for fuch a fhock as the cold bath muft give to the whole machine. SEC. Page 63 pr-perty of SECTION VII. 'The efe&s of opium in a dyfenery O PIUM is often very beneficial i-e 2 dyfentery, but much oftener hurtful. In this difeafe we always find a great acri- mony, a very fcetid fmell, and a mucous con- fiftence in the ftools, mixed with blood. The fimulus is abated for a time by opium ; but foon returns with more violence, as long as the acrimony continues. In a mild dyfen- tery, where the acrimony is little, that little is fometimes correaed, and the difeafe is cured by opium: but if the acrimony is great and copious, it cannot be correaed; and in that cafe opium does harm, efpecially if the patient is plethoric. It retains and accumu- lates the putrid feces, and though the patient may flumber a little, and be at cafe for a moment, he is afterwards more fick and more oppreffed than before: for my own part, when I refle& how commonly opium is ufed in this difeafe, without any caution, I fufpea its effeas are too often fatal, tho' we Page 64 ( 48 ) we afcribe our want of fuccefs to the malig- nity of the difeafe. I have feen a dyfenteric patient void fuch a quantity of vifcid mucus, and adhering to- gether in fuch a manner, that he was very much alarmed at the appearance, imagining it had been one of his guts that was come away. Before it was expelled, he had a per- petual uninterrupted inclination to go to ftool; and when it was paffed, it was found ex- tremely feetid. In this cafe the fimulus was fo great, that opium could not abate it; and if this putrid mucus could have been kept in, it would probably foon have proved mortal. When one in a dyfentery is plethoric, if his ftools are very fetid, vifcid, and in fmall quantities, opium will certainly increafe the diforder, and bring on great ficknefs and op- preffion; and in dangerous cafes, if it be given every night at the beginning of the difeafe, it will probably haften death. I know, that when the pain is very urgent, both the patient and phyfician are apt to fly to opium for prefent relief; but while they abate the prefent fenfation of pain, they are increafing the fimulus by detaining and ac- cumulating Page 65 ( 49 ) eumulating the putrefied contents of the bowels: and indeed I have held it as a rule, that opium is then moft improper when the patient calls for it with the greateft importu. nity; i. e. when the exceffive putrefadion and acrimony tlimulate moft conitantly and violently. But when nature is not able to bear the inceffant flimulus and evacuations, it may be neceffary to have recourfe to opium, to procure an abatement of the fymptoms and fome intervals of eafe. Whenever purgatives do good in this dif.. eafe, then opiates are always to be fufpeded. And it is certain, that the patient is relieved as oft as his ftools are copious; and it is com- mon to go to fool more frequently without purgatives than with them. Moreover, I have fo often obferved, that they who were fuddenly cured by opium, were fubje& to a relapfe; and that almoft all who ufed purga- tives were relieved by them, that I am in- clined to believe, that nine tenths of our dy- fenteries might be cured by a conflant ufe of laxative purges, emolient clyfters, and chic- ken-broth: but it muft be obferved, that E ananna Page 66 ( So ) manna agrees beft with fome, rhubarb with others, jalap, mercury, and toafted nutmeg with others, whilfi others are fooner cured with emollient clyftiers. Upon the whole, I am convinced from experience, that moft of the dyfenteries I have hitherto met with, might be cured by purging mildly, but con- flantly; and at the fame time abating the acrimony in the great guts by emollient clyfi ters, and in the fmall ones and ftomach.by plenty of abforbents, and a diet of chicken- broth. I ufe opium only when the difeafe is mild, or after its violence is abated by eva, cuants and emollients. At fuch times the pa,. tient is extremely well pleafed with the com- fort and eafe which he thereby enjoys. It is indeed the beit cordial in thefe circumflances; but by the continued and uninterrupted ufe of it, without intermediate purgatives, the recovery will be fo much the flower. In this difeafe opiates and purgatives have oppofite effets; and fince every copious toQol gives fenfible relief, even when pro. cured by medicine, it is a itron obje*tion ag.aing the free af of Ppiumn ; et I have qfteF Page 67 often given both at the fame time, and that with fuccefs; for provided the opium was not in fuch a quantity as to hinder the opera- tion of the purge, it was both an excellent anodyne and cordial. Neverthelefs, I have met with fome, who at the end of a fatal dyfentery, were fo exhaufted by the conti- nual fimulus and frequent evacuations, that tho' by the failure of the vis vit the bloody ftools and gripes were ceafed (as is conftant before death) yet they found themfelves fo excefively wearied and oppreffed, that they would have given all the world for a fouud fleep: but opium was not of the leaft fer- vice here; enfeebled nature is at this time unable to keep up the circulation to the ex- treme capillaries, and therefore both the pain and the purging ceafes, the morbific matter is reabforbed, and nature thereby fo much oppreffed, that at laft even the painful laffi. tude ceafes, and the dying perfon departs without a ftruggle. The dyfentery is fometimes attended with a fever, where opium would fill be more prejudicial than where the difeafr is con-. Ea fined Page 68 ( 52 ) fined to the inteftines; and indeed it fetms a general rule, that putrid and inflamma-. tory fevers are made much worfe by opium, unlefs where the crifis is an external fuppu- ration, fuch as the fmall-pox, SE C. Page 69 ( s53 SECTION VIII. The effe5s of opium in the tenefmus. HE tenefius arifes from a flimulus in the retum, which is fometimes mild, and eafily mitigated, correted, or expelled by flool. Opium will often make the fi- mulus lefs, or abate the fenfe of it, till the acrimony is removed, and the patient cured. Ex. gr. I have often feen a tenefmus occa- floned by a dofe of ftrong phyfic, immedi- ately cured by a dofe of opium. I knew one patient, who, for a violent chordee, rubbed in two or three ounces of unguentum Neapoli- tanum on the perineum in one night, and thereby brought on a fudden and violent te- nefmus the next morning; of which he was cured in a few hours by one large dofe of opium. It abated the fimulus on the re lum, whilft the mercury in the mean time entered into the blood, when the caufe being remov- cd, the effeC ceafed. E3 .. But Page 70 ( 54 ) But, on the other hand, if thisfimulus can neither be correted nor expelled; then, altho' you give opium and abate the Jfimulus for a time, yet the tenefmus will return as foon as the influence of the opium is over. Thus, for inflance, a plumb-ftone which had been fwallowed, became incruflated to fuch a fize and degree of hardnefs, that it could not pafs the fphinder ani; fo that it be- came a perpetual fimulus to the ret/um, till it was brought away by proper in- firuments. In another cafe, the internal coat of that intellftine feparated, and at laft came out at the anus, and was cut off; but before it was protruded, the patient was in conftant un- eafinefs from a tenefmus. Now it is eafy to difcern how ineffe&ual opium would have been in both the preceding cafes. It is not unufual for a tenefmus, coming on at the end of a dyfentery, to be cured by opium alone ; tho' in this cafe it is a com. mon pradice to give a brifk mercurial purge; my method is generally to give the pur- gative firft, and the opium immediately after it. x If Page 71 ( ss ) If both together do not fucceed, I give a fmall clyfier of about four ounces, made up of oil and the yolk of an egg, and in- jeaed fo gently, as but juft to pafs ihe fbinder and no further. SEC- Page 72 ( 56 ) SECTION IX. 'The efeE- of opium in the nephritis. M ONSIEUR Geoffroy, tho' he e - tolls opium in many cafes, lays down a maxim, which, if true, would make it al- moft ufelefs, viz. He fays, we fhould not fupprefs the efforts of nature tending to ex- pel what is noxious: thus opium thould not be given when there is a fmall ftone in the kidneys or ureters, becaufe opium will hinder nature from exerting herfelf in expelling it. But here he has both experience and theory againft him. We frequently fee the moft racking nephritic pains mitigated fo much by fifty or fixty drops of liquid lauda- num, that the patient has reckoned this in- terval of eafe an heaven, when compared to his former flate; and at laft the flone has cntered the bladder with very little pain. The exquifite torture which a fmall flone will fometimes give in its pafage to the blad- der, and the eafe with which the like ftones pafs at other times, make it probable, that the Page 73 ( 57 ) the pain is owing to the fpafmodic contrac- tion of the kidneys, ureters, or bladder. Such fpafmodic contraaions are increafed by every effort of nature to expel the flimulus. Thus I have known a ftone, not above half the fize of a raifin-flone, give as much pain in the neck of the bladder, and fupprefs the urine as effe&ually as one of the bulk of an hen's egg. I have put back fuch a fmall ftone by the catheter, and the patient has voided it with fo much eafe afterwards, that he knew not when it paffed the urethra. It is not improbable, that in nephritic pains a large dofe of opium may abate the pain fo much as to remove that conftrition of the ureter, which alone hindered fo fmall a ftone from paffing; after the removal of which, the ureter may eafily and gradually be dilated by the accumulated urine, fo as to allow the ftimulating ftone to change its unfavourable fituation, and flide down to the bladder. I own, that a moderate dofe of a paregoric does no good; perhaps it increafes the fpafm, as it often does in hyfteric cafes. Mr. Geoffroy fays, we hould not check the efforts of nature to expel what is noxious ; yet Page 74 ( ss ) yet when the neck of the bladder is fpafmos dically contra&ed by the fimulus of a fmall tone, the more nature exerts her efforts, the fhrther fhe is from her purpofe of expelling it; nay, the efforts of nature in this cafe are rather to retain than expel, to thut rather than open the mouth of the bladder. More- over, if Geoffroy's maxim held good, opium would be prejudicial in the catarrh, diarrbhea, dyfenteric and colic pains, and almoft in all the cafes wherein we find by experience it is molt beneficial; as I thall afterwards have occafion to obferve. SEC. Page 75 ( s59 ) SECTION X. Of the effets of opium in pregnancy. T HE naufea and ficknefs foon after con; ception cannot be afcribed to a pletho- ra, or accumulation of humours; but to fome change in the uterus, which we cannot explain: yet it is a change which, by fym- pathy, feems to affect the whole nervous fyftem. As the vomiting and natfea of pregnant women is not fo much owing to any accu- mulation of humours in the ftomach, or bile in the hepatic veffels, as to the fympathy of the vifcera with the uterus; and, like the fca- ficknefs, may be confidered as a nervous dif- eafe; I have made fome patients much th( eafier by giving five drops of liquidlaudanu frequently in mint. or cinnamon-water, or in claret boiled with fpices. This gives them a temporary relief, as fpirit of hartfhorni re- lieves them when faintifh; yet in a more advanced flate of pregnancy, I think opium is improper. Nothing then relieves them fo much Page 76 ( 60o ) much and fo often as repeated bleedings, go. ing abroad in the cool free air, when they can bear exercife, and living abifemioufly upon a vegetable diet; fo that reafoning from this experience and analogy, we may con- clude,-apriori, that becaufe the menfes are now ftopped, and they grow unadive, com- plaining of heat and wearinefs, having their veins fwelled, and their bulk and weight gradually increafed; and becaufe evacua- tions, efpecially bleeding, do them moft fer- vice, opium muff therefore do them harm: and I can likewife add from experience, that when I prefcribed by general rules, till I could learn the particular ones from praaice, it was a general rule with me, that opium was good for a vomiting; I therefore gave it to a'breeding woman, who vomited bile every morning for fome months. The re- medy was worfe than the difeafe; her fick- nefs continued, and increafed the more when the vomiting was flopped; which neverthe- lefs returned with more violence, after hav- ing fuffered much additional ficknefs. Blood- ing and half flarving, after all, was the belt palliative. SE C- Page 77 ( 6z ) SECTION XI. Of the efers of opium in labour-pains. LABOUR-pains are fenfibly promoted by opium. Some years ago we ufed. to give to women in labour, powders to pro.- mote the birth, of borax, faffron, myrrh, .&c. but no medicine that I ever tried or faw tried, is to be compared to opium, tho' even. that often fails; as indeed every thing muft do, when the birth is retarded by an unfa. vourable pofition of the child, &c. It may feem a kind of paradox, that the medicine, which in the opinion of the world is thought to be chiefly ufeful, as it abates a fjimulus, fhould yet be the beft promoter of that fimulus which excites labour-pains. But this will appear lefs ftrange if we con- fider, that in the prefent care the flimulus arifes from the bulk of the faetus; and. as opium rarifies the blood, and makes the cav pillaries more plethoric, it muft ftimulate the . uterus, which is a!ready too much firaitened, sad bas its neck compreffed by the fatus. Thus Page 78 ( 62 ) Thus opium may increafe the naturalfimu- lus, and perhaps at the fame time facilitate the birth, by abating falfe pains, and fuch ir- regular tumults of the nerves, or fpafms, as might retard the dilatation of the os tince. The dofe of laudanum that I prefcribe to a Woman in labour, is thirty drops in an gviii. mixture, with ;i. fyr. papav. alb. three or four fpoonfuls of which is to be taken immediately, and the reft in fmaller dofes, fo as to ufe the whole in a few hours. When this dofe does not fucceed, I do not repeat the prefcription for twelve or fourteen hours, that I may not over.dofe a perfon who is to undergo fo great a change, as happens after the birth. Altho' I commonly prefcribe this anodyne julep as foon as I think nature requires fuch affifiance; yet if I find that the child prefents fo unfavourably, that no pains will be fuffi- cient till its pofition be changed, I omit the julep, and have recourfe to manual opera. tions: neither do I perfift in the ufe of the opiate, if I find it has not fucceeded, or if pature is doing weU without it. Page 79 ( 63 ) I think, in fa&t, that labour-pains are moft apt to come on in the night, or after a found fleep, which is very agreeable to the theory already explained. It was obferved, that in our fleep, all our veffels are more diftended than while awake, and of confequence the labour-pains muft be then increafed; fince they arife from the too great firaitnefs of the uterus, in proportion to the fize of the ftes. After delivery moft women have what- they call grinding-pains in the belly; for which opium is the beft cure that I know. Before I was acquainted with its effe£s in this complaint, I was quite out of conceit with hyfteric plaifters applied to the navel; and rather preferred a hot linnea napkin, folded and dipped in camphirated fpirit of wine, or Hungary-water, in which was dif- folved olei macis per exprejonem 3i. to lviii. of the fpirit. This was laid over the belly whilft warm, and I thought with fuccefs : but it was attended with one great inconve- nience, which was, that it dried too foon, a4d te wettin; it often was improper in cafes Page 80 ( 64 ) cafes of this nature, efpecially if the patient fweat plentifully. At prefent, I think, opium anfwers the end much better than any thing elfe. Women in laying in of their firit child are not fo liable to thefe grinding-pains as af- terwards ; becaufe perhaps the fibres are then more elattic than after many births. SEC. Page 81 ( 65 ) SECTION XII. Of the efe s of opium in the milk-fever. A LT HO' the grinding-pains after de- livery require opium, yet the milk- fever, which comes about the third day, will not admit of the continued ufe of it. This fever feems to be the effe6t of a dif- tenfion in the breafts, occafioned by a greater quantity of blood than ordinary being fent at that time to thofe parts. The conflux of blood to thofe glands puts every fibre on the ftretch, and thereby raifes a fever: opium will not leffen this conflux, nor diminifh the diftention; therefore if this fymptomatic fever is fo great as to deferve our attention, I would always omit the ufe of opium till the fever was abated, even tko' the patient com- plains much of wanting reft. When this fever is mild, you may give opium: fafely, and not otherwife. I have often obferved lying-in women fenfibly relieved by opiates, foraday ortwo; but they foon after left it off, becaufe it had not fo good effects when con- F tinued: Page 82 ( 66 ) tinued: fome of them laid it afide the very night when the milk-fever abated, and were furprized to find how much better they had flept without it; not animadverting to the favourable turn which their fever had taken, which before hindered them from reft, SE C- Page 83 ( 67 ) SECTION XIII. Of the effegs of opium in a weed. A Weed is another ailment to which women in child-bed are liable, and opium is the beft cure; but this is by no means a rule without exceptions. Women after delivery are under much the fame circumfitances as one who has loft a great quantity. of blood from a wounded ar- tery. The great and fudden evacuation makes them eafily difordered by an irregu- larity in the non-naturals. Their blood is much diffolved, and foon rarified; their nerves are delicate, and eafily irritated by the paffions of the mind; their pores are very open, and a floppage of perfpiration gives rife to moft of their complaints; for the fup- preffion of the lochia is either the effea of cold, or paffions of the mind, or too hot a regimen: and it is well known, that an ob- ftruaion of this neceffary difcharge is very dangerous. If a lying-in woman, by any mifmanage- ment, is fuddenly feized with cold fhiver- F 2 ings, Page 84 ( 68 ) ings, pains in the head, and ficknefs, as irn the beginning of an ague fit; and if this is fucceeded by a hot fit, and then a critical fweat, which fets aM to rights again; this we commonly call a weed: the technical term is an ephenera, or a fever of one day. From the delicacy of their nerves, a trifle will fometimes begin this horror febrilis, even when we fuppofe their blood in a healthy tfate; therefore any thing that brings on a critical fweat, will foon prove a cure. This is with lefs difficulty brought about, becaufe their blood is not viciated, and by their prefent habit of body they are eafily thrown into a fweat which proves critical. Opium will haften this effet, and bring on a crifis be- fore the blood is further changed a for if the perfpiration has not been long flopped, it will certainly produce a fweat and a fpeedy cure: or if fome tranfitory paffion of the mind has raifed a fudden fever, a large dofe of opium will do more good at the beginning than any other medicine. As women in child-bed are more fufcep- tible of fuch febrile ferments than others, fo the diffolved Rfate of their blood makes them tore Page 85 ( 69 ) more eafily cured by a critical fweat. But there are alfo exceptions to this rule; for fometimes the caufe is permanent, and can neither be immediately expelled nor corret- ed; or perhaps the febrile ferment has al- ready ehanged the crafis of the blood to fuch a degree, that opium will either not prove at all fudorific, or elfe brings on a clammy fweat, which exhaufts the ftrength inftead of relieving the patient. Blooding is moft pro- per here, and opium will do harm; as is always the cafe when we attempt to force a crifis before nature has prepared the morbific matter. I always give opium on the firfl attack, and judge by its effets if I fhould continue it or not; for if it is not of fervice at the be- ginning, no good is to be expeted from it; and where it does no good, it often does harm. Almoft every fever, which feizes a lying-in woman from fome error in the nonnaturals, puts on the appearances, which I have juft now defcribed ; and therefore is called a weed at the beginning: but if it continues, they call it only afever; altho' there is no differ ence, but in its lhorter or longer duration. F 3 The Page 86 ( 70 ) This fhort fever has a flight caufe, and is eafily brought to a crifis; the other is quite the reverfe, and often proves mortal: fome- times it depofites a critical fluxion, of more or lefs confequence, according to the nature of its fituation. It frequently caufes a fup- puration, and fometimes a cbhirrus in the breafft. Very great caution and attention is requifite in the ufe of laudanum in this con- tinued fever, and the belt rule of judging how far. it may be of fervice, is to note its effe6ts at the beginning. A lady, for a cold fhe had catched on the fourth day after delivery, took laudanum as foon as the found the weed begin, and by mitake took eighty drops of it in twelve hours, without being difpofed to fleep; and remembering that I had formerly faid a weed was to be cured by fweating, the made ufe of a warm hyfteric julep, and took white wine in her poffet drink, and panado too freely; by all which means the fever was continued; and the died of it in feven days. In this cafe, the heat of her medicines and diet were fufficient to account for her death. She Page 87 ( 71 ) She procured the opium from three dif- .ferent perfons, who knew not what each other had given. A greafy kind of fweat was forced out, which the faid would kill her if continued; but the foon found by ex- perience, that fhe could neither bear to fweat, nor to be without it. She was vafftly op- preffed, and moaned and fighed continually, without any figns of an approaching crifis. No one can be pofitive what would have been the event, if the had only taken one dofe of laudanum; but we may lay it down for a rule, that there is always danger in the ufe of it when it does not operate as a pacific, un- lefs when the patient has been accuftomed to it ; for a long continued ufe of it will make it ceafe to have that effect. I have made it like- wife a fixed rule, not to continue the ufe of it when it forces fuch a fleep, as the wearied patient would rather be without. In the above cafe it did not difpofe her to reft; but occafioned a fort of anxiety and univerfal reftleffnefs, more than fhe had before. It is a common maxim, that fweating or purging hould not be promoted, when they exhauft or over-fatigue thofe whom we ex- F 4 peted Page 88 ( 72 ) pedted fhould have been relieved by them; and I fufpea that the fame maxim will hold as often good with regard to the ufe of opium. Wifeman, in fpeaking of the fevers after child-bed, gives us a terrible idea of them, as apt to poifon the mafs of blood; and brings fome inftances of their ending in abfceffes, with caries and fatal gangrenes, yielding to no method of cure. Therefore, upon the whole, when I recommend opium in a weed, I mean a fhort flight fever, where the mor- bific matter may be foon concoted and ex- pelled by fweat, which is the cure of the greateft part of them. To this crifi I think opium contributes very fenfibly, efpecially if a flopped perfpiration brought on the pa- roxyfm: and in this weed opium will often quiet fuch nervous tumults as might difturb or prevent the natural crifis, fo as to convert a mild ephemera into a putrid fever. I fuf-, pe& that many weeds have been changed into putrid fevers by the hot regimen pre- fcribed by the nurfes, whofe maxim it is, that one who has loft fo much blood muft be fupported by cordials, i. e. plenty of wine. S E C- Page 89 (73 SEC TION XIV. Of the effels of opium in the lochia. T HE immoderate flux of the lochia is oftener abated by opium than by any thing elfe; e. g. If we find one whofe conftitution is weak, who has already loft much blood, with cold extremities and great languor, and yet the lochia flowing excefflively, without any ex- traordinary caufe, opium affords the beft cure. Perhaps the uterine veffels have lot much of their elafticity, and opium reftores it; but whatever be its way of operating, all other medicines, that I have tried, are not worthy to be compared to it. Again, if a long continued hard labour has occafrined an exceflive flooding, calm and undiflturbed reft fets all to rights again; and we find opium contributes more to this, than any other medicine. An extraordinary flux of the lochia is fometimes the effet of part of the placenta, or Page 90 ( '4 ) or tome coagulated blood left in the uterut but which foever of them it be, if the inter- nal orifice is fo fhut, that they cannot be brought away by the hand, all muft be left to nature; for no internal medicine can dif- folve or expel them: all that can be done, is to procure intervals of eafe, which is beft done by opium; to be continued or not, ac- cording to.its effeas, which will be various. The good women will always infift, that you muft expel what is retained; as if we could contrat the womb, and make it difcharge its contents at pleafure. And it muff be owned, that all our fyftematic writers are full of pre-- fcriptions for expelling a dead fatus, a mole, a broken placenta, or grumous blood; from them we learn to prefcribe copioufly a farago of ufelefs, if not hurtful drugs; and by this pratice, I think, we have feldom, if ever, done good, but often mifchief. What con. vinced me the more of this is, that frequent- ly when I have been told that fomething re- mained in the womb, I found by the event my informer had been miftaken; for my patients grew well, tho' nothing was thence ex- Page 91 ( 75 ) expelled: and I have met with fuch cafes twenty times for once that I have been right- ly informed. Therefore be not too forward to prefcribe, for time will often cure with- out medicine. SEC- Page 92 ( 76 ) SECTION XV. Of the ejTis of opium in theftux of the menfes. W OMEN are many times fubje& to an immoderate flux of the menfes from a conflantfiimnulus, which opium abates. Here indeed it is only palliative, and the dif- eafe returns when the ufe of the opium is dif- continued; but a palliative cure will often prove a perfet one, by allowing nature time, opportunity, and ftrength to exert herfelf. A. B. had a violent pain in her belly and back, with too frequent returns of her menfes, and in too great a quantity. She took opium, and was better again: (he tried to do with- out it, becaufe the found it was only pallia- tive; but the return of her pain and flooding made her glad to have recourfe to it again and again, for almoft any exercife brought back her complaints. At laft the abifained from all exercife, and gave over the ufe of opium gradually; but tho' the flux was mo- derated, fhe continues at prefent very infirm, and it is now five years fince the was firft in- dif- Page 93 ( 77 ) difpofed: however, the opium gave her at leaft miny intervals free from pain. I fome- times fufpeted, that during thofe intervals the flux was only fufpended and accumulated, but that it was not upon the whole abated; yet even upon this fuppofition, the,opium feemed to be of great fervice to her, by fre- quently fufpending the pain, and allowing nature time to recruit, and giving her fpirits and ftrength to bear the evacuation. I remember fome, who about the time that their menfes left them, had their laft periods unequal, and fometimes a flooding with great lownefs of fpirits : opium was to fuch a cordial extremely grateful and feafon- able. One Mrs. --- , that was weakly, with a very delicate habit, a flow funk pulfe, cold extremities, and a defponding mind, received more benefit from opium alone than I could well believe: it not only fufpended her men- ftrual flooding, but all her fears and gloomy ideas. All her friends advifed her to lay alide the ufe of opium, left it fhould by ha- bit become neceffary ; but the whifpered me privately, that fhe would rather lay afide her friends. However the proved with child, and Page 94 (78 ) and after fhe felt it quick, fhe was then able to be without her opium, and not before: now the keeps it by her for a day of diftrefs, i. e. for defponding fits. When I confidered how fmall and how flow her pulfe was, I tried a variety of hyfteric juleps, as a fucce- daneum to the opium, but in vain. After all, I am ftill doubtful whether opium does diredly abate the immoderate flux of the menfes or lochia at any time. I am fatisfied, that if opium increafes a ple- thbora, as I think it does, it muff of confe- quence have a direa tendency to promote that very hemorrhage which indirectly it abates; but this is no paradox. When a woman is in perfed health, the uterine he- morrhages ceafe of themfelves; but if a lan- guor, a nervous weaknefs, or want of elaf ticity continues that hmorrhage, opium will flop it by curing the languor: at leaft I am pofitive that when the languor has been fo great, that the patient found her head and memory confufed to a degree which made her apprehenfive of a difmal melancholia, I have given to one in that cafe thirty drops of liquid laudanum at night, and ten in the a morn- Page 95 ( 79 ) morning, with very great benefit; and ad- vifed the ufe of ftrong ale pretty freely, to prevent a relapfe into this defponding condi- tion, altho' fhe was very averfe to it, left it thould promote her flooding, which fhe fup- pofed the caufe of her low fpirits; whereas I thought it the effea of her weaknefs, be- caufe fhe had all the figns of a feeble and flow circulation during the haemorrhage: and it was in fa6t better after the opium and fitrong ale than at any other time. Yet ftill I own, that neither ftrong ale nor any other cordial that I know, can fupply the place of opium when the circulation is flow and feeble, the extremities chilled, the nerves unftrung, the heart beating for fear of they do not know what, the mind prefaging and appre- hending every thing that is bad, SEC- Page 96 ( 80 ) SECTION XVI. Of the effes of opium in fpafms. SPafmodic contraaions do fometimes in- creafe and fometimes abate the lochia or menfes; on the other hand, opium does increafe or diminifh fpafms: no wonder then if opium has very different effeAs at different times, as we fee it cures either an excefs or fuppreffion of the uterine fluxes. I will not pretend to fay what fpafms it can or cannot cure; but in general, I think opium very hurtful in all fpafms from a plethoric habit, whether with or without inflammation; and therefore it feetns probable that it will do good in all fpafnis from languor or inani- tion. If any exceptions occur to me as I proceed, I fhall take notice of them. Mr. F. had a cough, for which he was advifed to take Matthews's pills ; but being of a plethoric habit, and taking them after a plentiful fupper, and his ufual load of liquor, in about two hours he complained of a moft violent contradion in his fomach, fo that he Page 97 he thought himfelf at the point of death. I blooded him immediately till he fainted; af- ter which he vomited, and was perfeafly well. This I took for a fpafm in the fto- mach, brought on by the opium and the load of meat and drink with which it was overcharged. SEC- G Page 98 ( 8i SECTIO N XVII. Of the efeats of opium in the hdmorrhoJidL I N the hxmorrhoids opium apparently does harm, in as much as it makes the patient coftive, and hardens the faces in the colon and reaum ; whereby thofe inteffines become more heated and ftimulated, and the return of the blood in the hamorrhoid veins is im- peded, and mufft confequently caufe a further dilatation of the piles. It likewife is evident, that if opium increafes a plethora, it muft alfo increafe the piles. The internal and external haemorrhoids are fometimes fo diftended, that the patient has a conftant tenefmus, with unfufferable pain. This was once my own cafe, after applying fome balf traumat. to the part. It gave me the fame fenfation as if a hard fuba- itaice was thruff up the anus, and was at-. tended with a conflant provocation to flool. A great dofe of opium abates this flimulus, but makes it return with more violence than before, by increafing the diftention> and if the Page 99 ( 83 ) the lenefmus is greati it does not even prove a palliative. The cure confifts in applying as many leeches as will enter, and letting them dra* blood as long as they will; then we fhould ufe emollients or refltrihgents outwardly, ac- cording to the prefent ftate of the part affe&.. ed and age of the patient. Opium is ftill more improper for that de- gree of the procidentia ani called verticillum, which cannot be put up again till the part is in fome degree emptied by evacuations. Sca- rifications and leeches are the firft part of the cure, and refltringents applied outwardly comrn- pleat it: if the evacuation by leeches or fca.. rification has been fufficient, emollient poul- tices do harm, and fomentations are but trifling. Coftivenefs makes it worfe, yet clyfters do no good; but in as much as they remove the prefent compreflion on the veins in the reelum. SE C G 2 Page 100 ( s ) SE CTIO N XV Ir. Of the efeEts of opium in the rhumatifktf W HAT I have faid of opium in the cure of fpafms, is further illuftrated by its effeAs in rhumatic cafes. Give opium to a rhumatic patient in the beginning of the difeafe, and it will make him fall afleep; but he will foon awake with a violent and pain- ful flart, which to me is an indication for more blooding, and no opium. It is true, that this ftarting is likewife brought on when the fleep is not caufed by opium, and is fo painful and furprifing, that the patient cries out wildly, like one in a fright; but it is as true, that the opium increafes this fymptom, which is as much of the fpafmnodic kind as a cramp. Give to the fame patient the fame dofe of -opium at the end of the difeafe, and it occa- fions no flarting. Both fleep and opium dil- tend the veffels, already too much upon the #retch from the difeafe itfelf; and I have often thought my rhumatic patients a little eafed Page 101 ( 85 ) eafed of their pains till they went to fleep, after which they awaked in more pain, had fome of the joints more fwelled, and com- plained of more heat upon the ikin. There. fore if opium and natural fleep have the fame effcds, as I have endeavoured to fhow, it will follow, even a priori, that opium will do harm in the beginning of a rhumatifm : perhaps this difeafe is chiefly feated in thofe veffels and fibres which opium makes full and turgid; perhaps it gives fome remora to the contents of the ferous veffels, and thereby thickens theftrum, as it does the mucus in a catarrh: in which cafe it will be apt to coo- vert an acute rhumatifm into a chronic one, if it does no worfe. From the effeds I have obferved after opium hath been given in rhumatifms and fevers, I think it as likely to be hurtful in al fpafms from infartion, as to be ufeful in convulfions from inanition, and forne hyftce- ric fits. Hence it is that it increafes cramps in pregnant women, on account of their ple- thoric ftate. Altho' I allow that op!um may be fafely given in the end of a rhumatifin, yet that is G 3 faying Page 102 ( 86 ) flying little more, than that it is fafe when the' difeafe is gone; but leaft we fbould mif- take fo far as to think the difeafe gone. when it is not, the fureft courfe is to ufe no opig~r, 4ven at the end of this difeafe. , . ' ' . I 1 .1 S . . . S E C. I.. I -- 1 Page 103 ( 87 ) SECTION XIX. Of the effes oJ opium after operations in furgery. E VERY confiderable chirurgical opera- tion in a timorous delicate perfon is apt to raife a tumult in the nerves, and fometimes convulfions, during the operation. Opium taken two or three hours before the operation gives courage and fteddinefs both of body and mind, by which means fuch convulfions are prevented: it does not abate the pain of the operation, as the patient ex- peded; but it makes him better able to bear it. On the other hand, we find, that after an amputation, the fiump begins to fwell, and gradually grows more and more tenfe; and if very tenfe, it ftart& as foon as they begin to fleep, and the flarting feems fo violent to the patient, that he is much afraid that the. pew-tiod arteries will burat open again, There was a time when I thought opium good for every irregular motion of the fpi- 4 4 rits, Page 104 ( 88 ) rits, I therefore gave it in the above cafe, but the ftarting was fo much increafed by it, that the patient begged to be kept awake. I mention this the rather, becaufe I know fome give laudanum after every operation; and tho' it is more fafe at fir(l, yet when the inflamed flate comes on, and all the parts are fwelled, hot, and tenfe, or when even fleep itfelf does harm, opium mufi doubtlefs increafe the inflammation. Blooding and a cool regiren, an eafy pofition and flack bandage, are the proper means of cure. This ftarting is at the time when the flump is moft inflamed, and abates as foon as plenty of pus is formed, which is the natural crifis of the inflammation. If you let blood, or give the cortex or opium immediately before the pus appears, the patient will find himfelf foon better, and then the medicines have the credit of it; which they are far from merit- ing, how much foever they may deferve for promoting fuppuration at other times, Some furgeons are nQt only very cautious to prevent the lofs of much blood in every amputation, but they are as careful to force kep in the inflamed flate whigh fucceeds it i Page 105 ( 89 ) both which pra&ices are very wrong: for as to the latter, it is adding fuel to the febrile fire ; and fince it is of ufe that the patient lofe a moderate quantity of blood, it is of little confequence whether it be during the operation, or foon after it: tho' I muft own the patient fhould not fee it in the time of the operation, becaufe it may alarm and difcourage him. SEC. Page 106 (90 ) SECTION XX. Of the efectls of opium in fralures. T HERE is another cafe wherein opium is often prefcribed, but with no better fuccefs than in the former, viz. After any confiderable fraaure, when the adjacent parts begin to fwell, and to be inflamed, the pa- tient refts ill and awakes with a violent ftart, which will make a crackling noife in the fra6ured part. The patient believes the bone muft again be reduced; the furgeon is im. mediately fent for, and (if he wants kill himfelf) the patient perfuades him to exa. mine the frature; and to prevent for the future the difplacing the fraaured ends of the bone by fuch ftarting, he binds it up again fo much the tighter, and gives an opiate; by both which means he increafes the inflammation, and confequently the ftart- ing. The increafed inflammation makes thv parts fwell more than before, whereby the bandage becomes fiill tighter till at length a gangrene is brought on, If Page 107 ( 91 ) If a fkilful furgeon had been to'd that his patient had waked out of his fleeps with fuch ftartings, that the extremities of the bones were again mifplaced, he would conjea1ure there mufll be a great tenfion ~bout the part, either from a tight bandage, a wrong po- fition, or a plethora. He would therefore think of nothing but flackening the bandage or redifying the pofition, if needful, and letting blood plentifully; but he would no more give opium, than wine or firong drink, pxcept in a fratured rib: in which cafe, I own, if the patient has a catarrh or cough* from the irritation of the points of the rib, which gives him inceffant pain, and often makes the ends of the rib wrap upon one ano- ther; this cough may inflame the plethora, and by its frequent fhaking pievent the for- mation of the callus, i. e. hinder the bone from re-uniting. In this cafe I have given (audanum with great fuccefs: it abated the cough, and procured reft when the patients' were almoft quite exhaufted; but to prevent the bad effeas it is apt to produce in parts that are inflamed, blooding and purging will fy af neceffary, if they be plethoric, feverifh, por Page 108 ( 92 ) or have fiartings; thefe evacuations prevent a fluxion, while the opium abates the prefent .fimulus. I here fuppofe that the patient had no cough before the fradure, and has not catched cold, but has a cough from the irri- tation of the rib. This cough is not to be cured by pedoral tindures, ptifans, fquill- pills, white folution, or any of the balfamics. I remember one cafe, where I gave the pec- torals a fair trial: the patient had a fradure of his rib, where one end of the rib rode above the other, and occafioned fuch a cough as was likely to hinder the union of the bone; and after the pedorals, I had ordered him, were found of no fervice, his wife cured him with fyrup of poppies. However abfurd it was in me to exped that pedorals would cure a cough occa- fioned by the prickling points of the rib, yet even afterwards I flill retained fome confufed notion of petorals being good for a cough, without diftinguithing the different caufes of it; as if the fame pedorals would be equally good for a cough, whether in a pleurifie, pe- ripneumony, or broken rib; whether with or without a fevcr in a catarrh, chincough, oT Page 109 ( 93 ) or in a phlegmatic old man's afthma; whe- ther it was joined with a plethora, or atrophy, with dry tubercles, or a running ulcer in the lungs, with water in the breaft, or proceeded fiom fpafms: but when I came to confider more maturely there different caufes of a cough, I eafily perceived the abfurdity of an univerfal petoral, and of what prejudice it was for young fludents to be impofed on by technical terms, that feem to have fome meaning, tho' they really have none. Ne- verthelefs it muff be owned, that technical terms are of ufe, for avoiding tedious repeti- tions, tho' it is extremely difficult to prevent the abufe of them. SE C- Page 110 ( 94 ) SECTION XXIL Of the efefls of opium in the phthifis ptil- monalis. F I were afked whether opium is good ii a phtifis pulmonalis, I would fay, that the queftion was too general: for the term phthifis pulmonalis fignifies a difeafe confifling of many ftages, and attended with a vaft va- riety of different circumftarrces, at different times; fome of which require, and fome for- bid the ufe of opium; but if we defcend to particulars, it may be of ufe to obferve, that in the firft fRage of a confumption, the dif-. eafe is often a fimple catarrh, and eafily cured by opium, fo as to prevent the phthiis; but in the next ftage, if the lungs are much ob." fitruited or inflamed, opium will do harm: and inordinate evacuations, with a fpare, cool diet, are more properly indicated, efpecially if the cafe be attended with an hxemoptoe, afthma, or fever. In fuch cafes, after the ufe of opium they expetorate lefs; they feel a tightnefs and ftif- 4 nefs Page 111 ( 95 ) nefs in the breaft; what they cough up is more vifcid and thick, and has been detained longer than it ufed to be, before the ufe of opium. I own, that if you afk the patient next morning how .he is, he will very readily tell you, that he has had a fine night, and is much better as to his cough; that he is not fo languid as uual, altho' he has rather fweat- ed more. Ask him again the fame queftion, in the evening, when the opium no longer a6ts, and he will fay, he is no worfe, only that his cough has been accidentally worfe, on account of fome error he has committed; and here he will be fure to blame fomething that he has done, or taken, and indeed will be apt to affign any caufe but the true one. He would willingly deceive you, and him- felf likewife ; but if you fit by him for fome time, you will get out of him by degrees the real effeas of the opium. He will own that he had a truce which gave him fpirits, and new hopes; but that now he has a return of all his former ailments, with the figns of more infartion about the breaft. Again, in the ulcerated flate of thephthifis, the effcts of opium are very various, accord- ing Page 112 ( 96 ) ing to the greater or lefs fluxion upon the part, the degree of inflammation, or the diet made ufe of. Some cough inceffantly when omit it, yet are ftuffed up and uneafy when they take it : they can neither be eafy with it nor without it. They who continue its ufe find, that they fleep more and cough lefs, their fweats are increafed, they purge lefs, and have more ftrength to cough; but, on the other hand, their nurfes fay they moan and fpeak much more in their fleep than they ufed to do; their thirft is greater in the night, and they are more confufed immediately af- ter they are awake. Much moaning and fpeaking while afleep are bad figns in all chronic diifeafes: about the acme of acute fevers we expea nothing better. It is a firuggle betwixt nature and the difeafe, and we are fo made, that we cannot be without fleep, no more than we can be without meat or drink: both of them fupply us with a recruit that is abfolutely ne- ceffary, and if any difeafe altogether hinders us from fleeping, or eating, it muft foon ter- minate in recovery or death. This moaning and toffing in our fleep then, as it fignifies fome Page 113 ( 97 ) fome difeafe fighting againft our natural make or conifitution, muft, if it continue, impair and ruin it. I fay, if it continue; for I know that a heavy fupper will give fome perfons fuch difturbed reft, as I fpeak of, without any danger; yet if they continue fuch fup- pers as difturb them in this manner every night, thofe fuppers will prove mortal in the end. I have fit by patients in a confumption fleeping by the help of opium, and indeed it is fuch a pi6ture of nature agonifing, that the phyficians would need no other argument to put them out of conceit with it, than to be prefent at this fcene. I have likewife obferved, that altho' the patient by experience has found the inco- veniency of opium, yet he is more languid without it; he will again and again try it, to help him to pafs away a miferable night: tho'he expects no cure from it, yet he has been accuf- tomed to it. He coughs much more when he abftains from it, and has lefsvigour to enable him to bear the fatigue of it. He is flifled when he takes it, and miferably languid with. out it. The moft certain relief that he may Ii ex- Page 114 ( 98 ) expe& from it is, that it will ihorten his mi- fery with his life. I have feen many poor patients, who could not afford to pay for our fleepy draughts, un- dergo fome violent ftruggles with the cough for a certain time, till the matter made its way by expetoration; after which, tho' they continued to cough, yet they fpit eafily and plentifully. It is true, their confump- tion went on, and they died of it at laft; but they died flowly and gradually, with all their fenfes about them, like one only exhaufted. Whereas the people of rank, who muft have fomething prefcribed for every particular ail- ment, and believe that we have a cure for every fymptom, grow impatient if the phy- fician does not abate their cough, and give them fome reft in the night. Opium, and nothing but opium, will do this: they take it in many different thapes, and find it of fervice in making them cough lefs and fleep more; therefore they continue it, become flaves to it, and mufL have the dofe gradually increafed. They moan and fitruggle under its influencC all night, and in the day-time bav Page 115 ( 99 ) have their heads confufed. In their laft hours, or rather days, they are fruggling for breath, their memory fails, and they are half deliri- ous, and attended with a conflant diarrhba in fpite of the opium that has been taken to prevent it. The poor man, without opium, finks into his grave with eafe both of body and mind, if compared with thofe fplendid perfons, who commonly die deli- rious. I mufft obferve, that the above defcription of the effeas of opium would need many exceptions to make it accurate.; for the pa- tient's age, habit of body, the air, diet, &c. will have much influence, and make a variety in the above phenomena; however the repre- fentation is true in general. I had once fo good an opinion of opium, and that from experience too, that I thought no medicine equal to it, even in a phthifispulmona/is: for I was more fenfible, that the cough .was lef.. fened after opium, than after any other medi- cine; but from maturer obfervation, I am perfuaded that it does harm, radically or effentially, while it aas as a palliative. It H z. coA-, Page 116 ( ioo ) confirms the obfftru&ion in the lungs, while it abates theflimulus of the ulcer; it feeds the inflammation, but conceals its effeals till it is too late; it gives firength to bear the cough, but accumulates the caufe of it. Page 117 ( io ) S l C T I O N XXII. Of the effets of opium in lownefs of fpirits. T O fome opium gives a flow of fpirits, after once they are accuftomed to it; but they find them proportionally depreffed, after its influence is over. I flw one phthi- fical patient, who, by the exhilarating qua- lity of opium, would fing fongs, and deCpilf death; but ere twenty-four hours were elapf- ed, he would behave more like a true peni- tent: he fancied he was dying, and wanted the affiftance of a clergyman. Thefe two oppofite charaters he often alternately af- faumed; and when a clergyman could not be got, he was fo miferable from exceffive lan- guor, that he repeated his dofe of opium be- fore the ufual time; which fet his mind at eafe before the other confolation cOuld arnrie. Mrs. C. D. died of a confumption after fifteen months illnefs. She ufed no opium till within three weeks of her death; her diet had been cool and abftemious from the beginning, which probably preferved her fo H 3 long; Page 118 ( o ) long; for (he had been of a weakly difpofi- tion, and a bad habit of body a great while. I found her pulfe was flow and languid, and flhe complained of great laffitude; fo that life became a burden to her. A dofe of opium relieved her fo much, that the regretted fhe lad not begun taking it fooner: the faid it was a bleffed medicine for the prefent relief it gave, tho' it fhfould do no more good.. When the effeats of opium ceafed, her lan- guor returned, and the dofe was renewed. Some advifed her not to indulge herfelf in the ufe of opium. She anfwered, that the would take it, tho' the was certain it would haften her death; for it was better to have one eafy death, if it could be had, than fuf- fer an hundred of the miferable kind: for fuch fhe reckoned every fit of languor. Here I had a rnoft evident inftance of the power of opium, in giving a flow of fpirits when they were reduced to the loweft ebb. It was in the incurable Rfage of the difeafe, when advanced beyond all hopes, and when the cough feemed abated merely through a defedt of the vis vita. No wine or cordial would fcrvo Page 119 ( to3 ) ferve the purpofe in the prefent cafe, becaufe they difagreed with her itomach. Mrs. R. had been long accuftomed to li. quid laudanum, and took betwixt three and four hundred drops a day. Without it, the was greatly depreffed with a kind of melaa- choly; but with it, behaved like one in li- quor, being very loquacious, and apparently very happy. But the beft proof we have of this property of opium, is the effeas it pro- duces among the Turks. There a whole nation, or a great part of them, are accuf- tomed to take opium freely; and when the praaice is become habitual, it lofes its fopoa. rific quality, and is ufed to give courage in the day of battle. If a long and confirmed habit of taking opium can diveft it of its nar- cotic qual:ty, it will probably be found a va. luable drug, in fome cafes wherein it is often dangerous, by being too apt to caufe fleep. A certain furgeon always took fome opium, and gave of it likewife to his patient, when he had anysonfiderable operation to perform; but I muft own, that a glafs of generous wine had always a better effe6t upon me, when I wanted to excite courage. The rea- H 4 fon Page 120 ( I04 ) fon why it might not fucceed with me might be, that I had not been accuftomed to take it, except when indifpofed; and, as I hinted before, it is the habitual ufe of it that ren- -ders it ineffedual in promoting fleep, at leafi I can be pofitive, that it does not give a flow of fpirits to every one alike: and yet we are told, that the Turks doubt no more of its power to exhilerate and give courage, than we do of its foporific quality. I have at pre- fent one patient, who has ufed it for twelve years: he never finds that it difpofes him to fleep at all, tho' he takes four tea-fpoonfuls every day of the liquid laudanum. Some years ago, a failor came from the Eaft Indies with a very ill habit of body, after drinking rack-punch for fome years. He had .a large abfcefs in his thigh, which I was in hopes would have cured him. But after it broke, and had almoft fuffocated all in the room with the fmell, he found his fpirits in two days fo depreffed, that he defpaired of recovery : he told me, that he perceived na- ture gradually finking fince the opening of the abfcefa; for which I gave him twenty- five drops of lijuid laudanum. The next morn- Page 121 ( 105 ) morning he told me he was in heaven; and indeed the change which that fingle dofe had made upon him in one night was aftonifh- ing: for his lips and cheeks recovered their red colour; his eyes, which before were funk and lifelefs, were now fparkling and brifk. This was a remarkable inftance of the effedt of opium, in giving courage and curing a languor or exceffive wearinefs. He per- fealy recovered without any other medicine, and became fo much prejudiced in its favour, that he fwore it fhould go through the world with him, and nought but death fhould part them. Had he taken the opium while,the fuppuration was advancing, the inflammation and opium would have counteradted each other; the one tending to hinder, the other to promote fleep: the opium would have clofed his eyes, then immediately the inflam- mation would have made him moan, til lie awaked with a violent ftart out of a terrible dream. Thus he would have continued reft- lefs, betwixt fleeping and waking; fo differ- ent are the effeCts of opium, in the fame per- fon under different circumftances. SEC- Page 122 ( xo6 ) SECTIO N XXIII. Of the effets of opium in the melancholia and mania. W H EN firft I ufed opium for a melan- cholia, it proved a very fuccefsful re- medy; fo that I doubted not but that it aaed as a fpecific, and only failed in other peoples hands, becaufe they gave it in too fmall dofes. I gave fix grains in one night to a young gentleman, for a recent melancholy: he fell into-a profound fleep, and fweated much all night; yet without my orders, he was that morning put into the cold bath, and again laid in bed to fweat. This was bold, but blind prac- tice; however, he was well in eight days, tho' I could not determine whether the opium or the bath had the greateft fhare in the cure. I gave four grains of opium to a gentle- woman who loft the ufe of her reafon on a fudden, by the barbarous treatment of her hufband, and fhe was cured by that fingle dofe. Whether a cafe fQ recent would not have been eafily cured without medicines, or whether the profound fleep fhe fell into might cond- Page 123 ( 107 ) contribute totally to efface the incoherent fet of ideas which poffeffed her mind before the took the opium, I will not pretend to deter- mine; but foon after this, I had fome other inftances, as I thought, of the good effeds of opium in this difeafe, which made me fond of it as a fpecific in the like cafes. At length I had a patient labouring under a re- ligious melancholy, who talked of nothing but the unpardonable fin, &c. In thort, de- fpair had drove him mad. In one of his mad fits he took fuch a dofe of laudanum, without the knowledg, of his phyficians, as had almoft killed him. When we found him in that condition, we difcovered that he had taken laudanum by the fmell of his breath, but we knew not the quantity; his fleep was fo profound, that he could not be awakened , his breathing was high and laborious, attend- ed with a profufe fweat, moaning, a florid countenance, and frequent fpafms of the mufcles. Tho' he recovered of the opium, his melancholia continued. A larger dofe would probably have, made his florid com- plexion turn livid, his breathing unequal and interrupted, his fweat cold and vifci4, &c. This Page 124 ( 108 ) This one inftance made me more a fcep- tic than before, as to the fpecific quality of opium in this difeafe; but flill I thought the cafe was unfavourable, as the difeafe had been of long continuance, and had likewife long threatened ere it feized him. But fince that time I cannot boaft of its fuccefs, fince ithas often failed me for feveral years; and upon the whole of my experience, I begin to conclude, that it only does good where the pulfe is flow, and always feems to do harm where the patients are difpofed to be outrageous: both which conclufions will agree with what we have faid of its effe6ts on the mind, viz. that it gives courage and anxiety. I expeded to find it of general be- nefit to fuch as are very timorous and cow- ,ardly; and that it would be hurtful to the impudent, the felf-concited, and bold ma- niacs: but in fa&, I was fo frequently difappointed, that I cannot now iecommend or forbid it in general ; nor do I expe& any good from it when the difeafe has been of a long ftanding, when the patient is outra- geops, or the caufe fuill continues. Page 125 ( 109. ) SECTION XXIV. Of the efel/s of opium after great fatigue. O PI UM not only gives vaft relief in ex- ceflive languor, brought on by feveral different difeafes; but in that languor or ex- ceffive wearinefs arifing from too much ex- ercife. I happened once to be under a ne- ceflity of walking fo far, as to be fatigued moft immoderately; for which I took twenty drops of liquid laudanum. I lay all night in great tranquility and eafe, tho' it did not make me fleep. If one has been fatigued by riding polt, no meat nor medicine is equal to liquid laudanum, efpecially if you ufe a warm bath at the fame time; for without the bath. fome are over-heated with the exercife, and if they do not fweat the opium will not have fo good an effea: nay, it will increafe fome- times that heat, but fRill it is of great ufe if the perfpiration be free, Page 126 ( 1o ) SECTION XXV. Of the efe&/s of opium in kylerics and nervous dforders. O PIUM often compofes, and often ex- cites nervous diforders; and I mufi own, that on this head I am very undeter- mined in my opinion. I can neither pro- nounce any thing in general, nor can I re- duce the difeafes of the nerves, or their cures, to any particular claffes. As yet the fyflem of the nerves is to us a myftery, only we know that it is a part of our machine, of the utmoft importance. In general we fup- pofe, that moft of our difeafes are either ow- ing to fbme fault in the fyftem of the blood- veffels, and their glandular fecretions, or in the nerves; for we reckon that thefe two make up the moft variable part of the ma- chine, and of confequence, when the patients have complaints which we cannot confiftently afcribe to any fault in the fyftem of the for- mer, we immediately put them to the account of the latter, as if it was a fettled point, that all Page 127 ( I1I ) all difeafes muff either belong to the fangui- nary or to the nervous fyftem. And fince the complaints of fome patients are fo irre- gular and unaccountable that they cannot be- long to the fanguinary fyftem which we un- derftand, they muft confequently belong to the nervous fyftem, which we do not under- ftand, and therefore cannot account for. I will not at prefent examine whether this ge- neral divifion be right or wrong, or whether it does not fuppofe two fyflems to be inde- pendent, which are at all times intimately and infeparably conne6ed ; like thofe writers who perplex us with the difeafes of the folids and fluids, as two diftinat claf es, tho' there is not one moment of our life in which they do not mutually affe tone another. Neither fhall I pretend to limit or define ac- curately the fenfe of the term nervous difor- ders3 but I -muft obferve negatively, that I do not mean by nervous diforders, a palfy, epilepfy, apoplexy, vertigo, or other dif- eafes of the head, on which the fyflematic writers have defervedly beftowed diflinft and fparate chapters; and which are difeafes of the very origin of all th!e nerves. I take the 3 phrafe Page 128 ( 12 ) phrafe in the lax fenfe, in which it is com- monly ufed, however improperly; and even in this vulgar fenfe, nervous diforders fignify fach a number of difeafes effentially different, that it would be abfurd to fay, that opium is or is not good for them. Again, as to par- ticulars; I would obferve, that in thofe fpafms called a rifing of the mother, or hyfleric fits, neither a moderate nor a large dofe of opium always fucceeds. It is poffible that a very large dofe of it might do good, even where a moderate one would increafe the tumult; but I own I can fay nothing on that head from experience: in general, opium feldom fuc- ceeds, except where there has been a very fenfible inanition. I have fometimes found it cure hyfiteric fits like a charm ; but it has again failed or been hurtful fo often in cafes apparently fimilar, that I think they muft have been very different, tho' I tiiflook them for the fame. In general, it rather does harm than good, except in a very great dofe; but this i; a rule not without exceptions, and only to be ufed by thofe who are not apt to miftake cafes. In treating hyfteric diforders all young phyficians give opium a place in their Page 129 their ptatice, becaufe they would mitigate 'the hyfteric pain where ever it is; and fome ;times to abite an hyfteric vomiting. But I have feen fome women feized with an hyf- teric vonliting, or colic, as often as they were -under any difappointment, anger, or vexa- tion, tho' the minute before in perfet health both of body and mind; yet one flight affront has fet them immediately a vomiting, with great difliculty of breathing, and the whole train of hyfteric rymptoms. What can opium do here ? What will bur juleps do, and draughts of al. abfynt. and fuc. limon. ? What will all our flinking or heating nervous medicines avail ? To fuch patients we are often called, and we go through the fathionable pratice till their paffion of mind flibfides i and then, but not till then, the difeafe is cured, and we come off with the applaufe both of ourfelves and others. Paffions of the mind alone will as fuddenly bring on hyfleric fits, as fear and modefly will occafion trembling and blufhing; but on the other hand, I fufpe&, that as we cannot by medicines hinder the blufhing or trembling, I with. Page 130 ( x41 ) without preventing thofe pafflons upon which they depend; neither can we cure fuch hyf- .teric fits as are owing to anger or pride, till the pafTions fubfide. I confefs I have, thro' ignorance, given hyfteric pills, when I might as well have given pills to purge folly and make my patient wifer. By what I have faid, I do not mean, that when the patient complains grievoufly of a pain in her head, fhe fhould be told that the has none; for the really feels it, but miftakes the caufe, when the thinks it independent of her anger. She will not be fatisfied unlefs the phyfician prefcribes; and he may do it 'with this comfort, that whatever innocent thing he orders, it will generally fucceed: for the paffions will fubfide in time, either with or without medicine. SE C- Page 131 C Its ) S E C T 1 O N XXVI. Of the efets of opium in the nervons afibma. B Y a nervous afthma I do not mean any pofitive affe&ion of the nerves, but that kind of afthma that has no figns of any pre- ternatural huniour in the lungs or trachea; in which refpe6t it differs from the humoral afthma. There is indeed a difficult breathing, and fenfe of obftrudion about the lungs but without any expeaoration, even when the fit goes off, as if the whole was a fpafm in the lungs. Mifs R. was feized with a dry cough, which was inceffant, with a ihort and difficult breathing; but without any flck- nefs, wheezing, defluxion, or expedoration, We thought her lungs were loaded with fome vifcid humour, which fhe could not cough up. She was ordered repeated bleedings, blifters, g. ammoniac, fquills, and fpt. min. direri in plenty, without producing any ex- pedtoration, arid without relief. At lafi we tried, with great caution, what at firft we thought might have rivetted the difeafe; I I 2 mean Page 132 mean opium; and contrary to all our ex- petatioas, it cured both the cough and afth- ma, without any fenfible evacuation. This I called .a nervous afthma, becaufe it was not humoral; neither was it Floyer's 'ajihma flatulentum: it feemed entirely fpaf.. .nodic. At firft the dry inceffant cough made mre fufpe& a tubercle in the lungs, for which I thought opium improper; but it is now ten years fince fhe was cured, during which time the has ufed the opium every night; becaufe without it the is in pain throughout all her body to an intolerable degree, but has no cough, or afthma, nor any fign of a tubercle. After all, I muft own, I neither know what made her afthmatic, nor how opium cured her. SE C- Page 133 ( i7 ) SECTION XXVII. Of the effei1s of opium in tk, rickets and. fcrophula. T HES E are two very diftin& difeafes, yet in both, the children are weak, and of a moift conflitution; both of them, begin to attack children commonly betwixt the time of weaning and the fixth year of.- their age, and in both difeafes the effe of. opium is the fame;, for this reafon I fliall, fpeak of them under the fame head. . I have feen many fcrophulous and rickety children, who, after weaning, and rarely be. fore, became weak, pale, and chill; and they, commonly had a violent diarrhwa at the time of breeding their teeth: but tho' therew ast a variety in their cafes, their ages, and regi- men, yet from experience I was convinced,i that four or five drops of liquid l~adanum, or more, given every night, was-of very great' fervice to them; efpecially if they had pains; in the .blly with loofenefs, as is often the. ca fe. . 13 Page 134 ( Is ) I am fo confident of my fuccefs in the ufe of liquid laudanum in the above cafes, that if I had children that were threatened with either of thefe difeafes, I would begin early the ufe of liquid laudanum every night, thQ' they had neither pains or loofenefs. It is true, that I have failed in the cure of Many children; but few of them ufed liquid laudanum longer than the loofenefs or gripes obliged them to it, and fome that did ufe it were quite irregular as to their diet. In or- der to keep weakly children in tolerable health, Reel and Peruvian bark are ufeful, and their diet and regimen muft be carefully attended to; their diet fhould be hearty, yet light; it ifould confift in part of flefh-meat, but fo finall in quantity as not to be burthen- fome to the fomach nor over heating; and the drink fhould be chalk and water mixed with wine: the quantities muft beregulated by the difcretion of the phyfician. I will not pretend to determine whether opium does good in thefe difeafes as a cordial, or only becaufe it procures reft, or becaufe it promotes that inteffine motion of the blood, 9f which cold o~ftitutions Rand fo much in need a Page 135 need; but I think by the fame means as it prevents a diarrhaia, 'it may invigorate thi folids, and prevent ferous fluxions upon the glands; it may corre& the watery blood as it does in a catarrh. In fhort, all my cure f'r the above difeafes, confifts in liquid laudatium, abforbents, ftee, bark, and a hearty diet well digefted. I know the mothers, who fee their children difpofed to fluxions, cannot be per- fuaded, that any thing is fo much indicated as purging; and what they fay on this head is fo plaufible, that the purging method has been adopted and tried almoft by every prac- titioner, and prefcribed by every fyftematic, tho' always without fuccefs. I was formerly myfelf of the fame opinion, till experience got the better of my theory ; and now I am fully convinced, that evacuations are rather hurtful, unlefs when ufed fparingly, and that both their diet and medicines fhould be fub- affringent; among which I reckon the beft medicine is an ele&uary of conferv. rofar. cynoJat, fal. mart. diafcord. and the cortex Peruvianus, as foon as children can be pre- vailed on to take it. There is a cure prefcrib- ed for the diarrhaa, which fometimes does I 4 good, Page 136 ( 120 )k good, but oftener harm; I mean burnt claret with fpices: when too much is prepared at a time, it turns four ere it can be all ufed; or if given to very young children with a full meal, it grows four on the ftomach; other, wife it does good, when given with toafte bread inflead of a meal of other diet, SE C- Page 137 ( 121 ) SECT ION XXVIII. Of the fes of opium in the tooth-ach. T HE tooth-ach is a difeafe which opium often cures in one night, but it oftener fails, and fometimes does harm ; and no won. der, for the tooth-ach is a more complex dif. eafe than we may at firit imagine. Some- times it is a fimple catarrh on the gums, and cured by opium in one night; at other times the conflitution is plethoric, and evacuations are proper before the ufe of opium. Some, times there is a local pletbora, and fcarifica- tion, orleeches, or blifters are neceffary. There is likewife one kind of tooth-ach from a rot. ten tooth, or a fuppurating gum; another from a fmall fluxion, eafily ftopt or repelled i and others from fluxions that are great, pro- ceeding from caufes which opium cannot conquer; fuch as pregnancy, for many wo, men have rheums at that time and at no other: opium may abate their tooth-ach for # night, but whilft the caufe is permanent, it .ill qnly a.cumulate the rheum. Repeated eva- Page 138 evacuations or conftant drains are the pro- pereft methods of cure. Some cachochymic patients have febrile paroxyfms, efpecially if they are plethoric, or of delicate nerves, in- fluenced with every change of weather: fuch patients muft have the cure of their tooth.. ach fuited to their eacochymia, or plethora; after which opium will often prevent- a re- laple, if ufed every night for Come time, as a medicine fit to prevent catarrhs. Tho' I am certain it will often cure this difeafe, yet I do not know when, fo as to tell my pa- tient pofitively, now it will fucceed. I can often determine in what cafes it will not do good: for example, when the gums will fuppurate, or a rotten tooth murt be firft ex- tra&ed, or when the fluxion is too great to be repelled or prevented without proper eva. cuations. Many are cured by cutting off a great load of hair, and bathing the head every day in cold water. Yet even this we cannot rely upon, it fo often fails from fome accidental caufe, which we are not aware of: arid fome are cured as readily by bathing the head in warm water. In a word, the caufes and cures of this difeafe are fo many and fo 7 fal. Page 139 ( t23 ) fallible, that I have often thought no difeafe deferved to be called the opprohrium medico- rum more juflly than the tooth-ach. It is a difeafe in which we have all the advantages of theory, and where our theory is as fatis- fadtory as in any difeafe whatfoever. We have the greateft advantages of experience; becaufe few of our patients efcape the tooth- ach, fooner or later; and its phanomena are fuch as we can perceive, and examine by our fenfes like a chirurgical cafe. It is a fluxion. upon -a part we can get at, to evacuate the prefent, and prevent, by derivation, ftrengthen- ers, or repellents, fucceeding rheums: yet notwithftanding all thefe advantages, it is per- haps a difeafe as often cured by a quack, as by the regular phyfician; i. e. it is as often cured by chance as by the rules of art: for the molt famous quacks difagree in their prac- tic, andvery often fail. SEC" Page 140 ( 124 ) SECTION XXIX. SOf the eh;ts of opium in the cancer. A Cancer is a topical difeafe, frequently curable by extirpation; but if that is delayed too long, the difeafe fpreads its ve- nom through the whole body, and particu- larly occafions pains in the limbs; for which opium is prefcribed with apparent fuccefs, for it abates thofe pains as evidently as it caufes fleep: but they as certainly return as foon as the opium has done operating. Mrs. M's pains were on all that fide where the. breaft was cancerated; Mrs. S. had them throughout her whole body; Mrs. L. com- plained chiefly of pains in her legs, and an univerfal laffitude, Mrs. B. had a conftant fciatic pain, which could not be removed " all thefe took opium, and received great re- lief; but it was only temporary, and during the ufe of it, their cancers grew quickly worfe, and they all died. They tried to leave it ff, btit either pain, or cough, or both, con- tinually obliged them to take it again; and Page 141 ( 125 ) gradually to increafe the dofe, as the difeife advanced. Their fleep became more and more laborious, being attended with a con- ftant moaning, like one oppreffed with fick- nefs. The great temporary relief procured by opium, at a time when nothing elfe did any fervice, made me then fix it as a rule, that opium, and nothing elfe, was of fervice in a cancerated breaft; and the immediate good effeas of it eafily convinced others, that the obfervation was right: but one old lady, who was prejudiced againft opium, would neither take it, nor indeed any other medi. cine. She abflained from all cordials, and lived upon chicken-broth; yet tho' the was old, infirm, and of a fluggifh habit of body, the lived twelve months longer than I ex- pe6ted. She had comparatively no pain, and at laft died in tranquility: whereas they who ufed the opium, were firong and young, and, I may fay, died a violent death, compared with the old lady's. This cafe made me doubt of my old maxim, and upon refleaion, Ifufpea, thatopium made them die fooner than they would have done withoutt i ; and that by taking it, they were every Page 142 ( r26 ) every day over-heated, and their moaning every night feemed to fhew, that nature was oppreffed thereby. The cancerous humour was probably accumulated, and rendered more acrid; for the pains foon returned with more violence; and in Mrs. S's cafe, when the opium abated her pain, it increafed her ficknefs. If to all this, we add our general charader of opium, it will confirm my con- je&ure of its irritating quality in cancers. If it is a property of opium to obftru& and diftend the ferous veffels and glands, and to fwell the whole body; if it particularly caufes tumefaaions in the falivary glands; and if it thickens our mucus, increafes the heat, thirit, &c. no wonder it does harm to a fchirrous or cancerous breaft, which is already indifa. folvably hard, and whofe humour is already Lo acrid, that it often excoriates any other part of the (kin upon which it falls. , That the pains in the limbs, &c. above mentioned are the effe6t of the cancerous hu- mour in the blood, feems probable from hence, that when the breaft is cut off, the pains are abated, while the fuppuration is plentifulj but return again when the fuppuration ceafes: fo Page 143 ( 127 ) To that it is to be wifhed that it could be kept open like an iffue. From what I have hinted, I fufpet that there is no hopes of curing a cancer by am- putation, after the patient is affliCed with pains in the extremities; if there pains are the effet of the cancerous humour circulat- ing through the body, as I think is very probable. Moreover, if it is owing to the plentiful fuppuration after the operation, that there pains ceafe, then, tho' the patient entertains great hopes upon this event, the phyfician ought not to flatter himfelf that the danger is removed; for the beflt he can make of it is, to keep the wound as large and as long from healing as poffible, and to prognofficate a relapfe if ever it is cicatrifed. If this be the true ftate of the cafe, it hews us the impro- priety of the common praftice, in making ufe of aftringents and all endeavours to cicatrife the ulcer, either before or after the extir- pation. In an open cancer, aifringent applications make it extend its roots, and emolient cata- plafms extend its branches. Aftringents feal up Page 144 -p the rhouths from which the cancerois htt mour conftantly oozed forth, and when it & Thut up at one pafTage, it muff dire6 its pro- grefs fome other way i. e. it muftf enlarge its bafis: but afiringents are fkill more ina. proper for cicatrifing the wound after atnpu4 tation. One thing that has brought aftrin- gent applications more in ufe is, that relaxing medicines very much increafe the fungus of a manifeft cancer; but when the ulcer and quantity of cancerous matter are increafed, part of it is abforbed, and therefore the pa- tient dies he&ic. So that, in truth, aftrin-. gents and relaxing medicines both very fen- fibly do harm. The fuppuration which I would propofe to encourage, is not from the cancer itfelf, from which no good pus can ever be produced; but I would promote the generation of that good pus, which comes from the wound after all the cancer is cut away. There afiringents do harm, by cica- trizing what thould always be kept open, if poffible. To conclude, it is univerfally agreed, that a cancer is irritated by every thing that heats and Page 145 t f29 ) tnd quickens the circulation, or diflurs the irnd; i. i. by too vehertierit eceetife, too hearty diet, ftrong drink, or violent paffions. If this be true, and I am fuilly perfuaded it is, then opium muff be bad for a cancerj and t cool fpare diet nriift be good. E SC g Page 146 ( 130 ) S ECTION XXX. Of the efeds f opium in the fone in the .kidneys. A Small ftone in one of the kidneys, on its entering the ureter, if rough and angular, or unfavourably fituated, may fo ir- ritate the parts as to make them contrad and hinder its paffage. This contration I call a fpafm, by which the flone is griped and held the ftraiter the more it is preffed forward. The fame thing may happen in any part of the ureter, efpecially where the paffage is firaitened; as at its entry into the bladder, or even in the bladder itfelf; and that from a very fmall ftone, provided it be angular and falls upon the neck of the bladder, fo as to flimulate and make the fphinter contra&t. In this cafe, the more the patient endeavours to force away his urine, the lefs he is able to do it, anid the fpafm arid pain are the greater. But a catheter will eafily pufh back the flone into the bladder, and the patient is imme- diately relieved. But 7 Page 147 But this cure cannot be applied to a flone in the ureter. Here the indication is to take off the fpafm of the parts, which might be done, if we could change the fltuatlon of the flone by a vomit, or any other violent tno- tion: but as that is not very pra6ticable, the beft method is to try a femizcupiam, and a draught with forty or fifty drops of li~uid laudanumnt; for the ordinary dofe of twenty drops will rather do harm. A feinicpinu commonly gives eafe while the patient is in the bath, but no longer; but a great dofe of laudanum, if it makes the patient fleep, takes off the fpafm, gives time fdr accumulating as much urine as will dilate the ureter, and thereby changes the unfavourable pofitibn of the ftone before the patient awakes. They who are afraid to give a large dofe of lauda>. num may give it by degrees, till it caufe fleep; but they may begin fafely with forty drops to an adult. Blooding till the patient faint will alfo take off the prefent fpafm. S EC4 k; Page 148 1( J3:S SECTION XXXi. Of the efects of opium in the lethargy, and other fleepy defeafes. T HI S is a clafs of difeafes where I think opium has not been tried; and there- fore when I fay it does harm in fuch cafes, J do not fpeak from experience, but conclude from analogy, that immoderate fleeping does not require medicines that force fleep; and that a drug which flupifies the brain and nerves, will not be good. for a praeternatural fiupr or- infenfibility. In this clafs I take in the apoplexy, lethargy, carus, pally, giddi- nefs, water in the head, and fuch like; in all which I think opium as improper as a full. bumper to a man that is drunk. Page 149 ( i33 3 SECT ION XXXIL Of the effels of opium in the afthma fhile; A Sthmatic old men are fenfibly the worfe for ufing opium. It makes them breath with more difficulty, and complain of a tightnefs acrofs the breaft; which is no wonder, becaufe at that time of life they abound with phlegm, which grows more thick and vifcid as they grow older; and they find that opium renders their phlegm till more vifcid and thick, which is itp-cmmon effet; nay, it is even dangeros to old men in a catarrh. SEC. Kg Page 150 ( 134 ) S ECTION XXXIH. Of the fds of opium in the peripneumonia notha of old men. M OREOV ER, if an old man is feized with a pripneumonia ntbha, opium is a danggero remedy. Repeated bliflers an4 frequent fmall bloodings, with fweet oranges i. e. the reverfe of opium, is the cure. I think old men in a peripneumonia nota bear blpqding extremely well, and far better then any, unexperienced praditioner would believe. One indeed would naturally imagine, that old men had little blood to fpare, and on that account might be apt to omit venefec- tion even in this difeafe; but in fo doing we thould omit the principal means of cure. Again, if we judge by the pulfe of an old man in this difeafe, nothing is more indicat. ed than to let blood, and omit opium and every thing that heats or rarifies the blood; for the pulfe at this time is as full and as firong in a man of fourfcore, as it is wont to be in the pleurify of a vigorous young man. Add Page 151 ( 135 ) to this, that the more the pulfe fwells, the greater is the danger; and the tronger it is, the lefs ftrength they have. The firft old perfon I had feen in this difeafe, had in i - termifflion in her pulfe, with great weaknefs and difficulty of breathing. I thought fuch Weaknefs required a codial, therefore I ga plenty of fpirit of hartfhorn in a julep with gum ammoniac. This made the pulfe regu-. lar, tho' more quick and ftrong. I Was vain of my fuccefs, yet the lady was lefs pleafed: fhe found herfelf more fick, and more op- preffed, when I thought her pulfe fironger and more regular. The next day fhe declar- ed pofitively againft taking any more medi- cine; and I left her unwillingly to fall a fa- crifice to the ftubbornefs of her own temper. She abftained from every thing, except water' gruel and new butter-milk, by which means the recovered. A man of eighty-four was twice blooded in this difeafe, and eat ftrawberries inftead of fquill-pills, and recovered. Were it mypur- pofe to treat of this difeafe, I could give many in fances to illuftrate this maxim, viz. That the cure of the p*eripneumonia notha in old K 4 men. Page 152 ( 136 ) ren requires the fame cure with the pleurify in young ones; that is, evacuations and a cool regimen: anc~1 conclude, that whatever dift cafe requires evacuations and cooling, will difagree with opium. But I would not de- pend upon this conclufion, if I could not like- wife fay from experience, that opium is in fai dangerous in this difeafe ; for tho' I have faid in general, that thofe difeafes which re- quire. the cool method -and evacuations, difa-- gree with opium and cordials i yet there are exceptions, which I fhall mention afterwards. I have advanced that opium is not good for an afthna, but if it be of that kind which is occafioned by a catarrh, it is then a good remedy; and is the principal ingredient of the. elixir-paregoricum, in the new London difpen- fatory. This elixir I make ufe of with fuccefs, at any time when I have got a repet cough, to which I am very fubjeA, from flight caufes; but this is not properly what is called an afth. ma it is a catarrh, that does indeed fluf the lungs and hinder breathing, by a plentiful fe- ;retion of rheum in the branches of the tracbea, Wvich you mull not increafe by fquills, vine- gar Page 153 ( x37 ) gar, and emolient tin&ures., for the more you endeavour to expe6torate it, the more you bring in its place; neithermuft you flop this flux of rheum in the lungs by opium: both extremes are dangerous, and fmall dofes of opium repeated cautioufly, till you find the effea, is the middle and the fafedf way. I have erred both ways: I have had a flux of rheum that made me cough and fpit incef- fantly, with a fenfation of weight and obftruc- tion in the breaft. Lintfeed-tea, and peaQ.. ral deco&ions or lindufes, increafe this afth- ma, and moderate dofes of opium cure it. In fuch cafes I am fully perfuaded, that the pa- regoric elixir will deferve the praifes which QTncy beftows upon it. The paffages through which the phlegm which I dif. pharged comes into the wind pipe, are with- Put doubt preterpaturally dilated, otherwife fuch a quantity of vifcid matter could not pafs in fo fhoyt a time. After opium I cough and fpit lefs, but find that what I expeto- fate is thicker, more yellow, and comes up freer; i. e. it is better concogted. I imagine, that by the fitruture of my lungs, I am na- tqrally difpofed to this kind of catarrh; and that Page 154 ( 138 ) that the above paffages are eafily dilated by a flight cold, which probably fuppreffes the per- fpiration, and produces a fluxion on the part that is molt fufceptible of it, and beft adapt- ed for fuch a difcharge. I will not pretend to determine, whether this dilatation is owing to a lax itruaure of the parts, which is na- tural to me, or whether it is an effet of the frequent catarrhs, to which I have been long fubjeA, and which may have gradually di- lated the parts affeted, as repeated fluxions ufually do; but I have remarked, that this cough has been troublefome to me and my neareft relations, for many years, except in the fummer months when I am free from it; tho' I find that the older I grow, this inter- val is ihorter, and what I fpit up is more yellow. It may not be amifs in this place to take notice of the ufelefsnefs of thatfarrago of pec- torals, with which many in my condition are fatiated to no purpofe; and likewife to take notice how often the yellow mucus fpit up by fuch is miftaken forpus; and particularly, that when fuch patients die, they are very com- monlythought to have died with ulcerated !ungs, Page 155 139 ) lungs, even tho' they are opened after deathy and no ulcer appears. What deceives the furgeons is, that in open,. ing the lungs they find purulent-like matter every where in the branches of the trachea, tho' in fa6t there is no real pus, ulcer, or ab- fcefs. This miffake muft leffen the credit of Bonetus's colledion of fuch catfes, in his fe- pulchretum anatoamicum. s gC Page 156 ( 40 ) SECTION XXXIV. Of the effe5s of opium in internal infammations. T is certainly a good general rule, that opium does harm in all internal inflam- mations, fuch as the phrenitis, pleuritis angi- na, peripneumonia vera, and notha, hepatitis, inflammation of the tomach, intetines, or any other internal part, This I think is a fad which I have had the misfortune to learn from too frequent experience, and is not only agreeable to our theory of opium, and of the difeafes above mentioned; but to the opinion and pradice of every phyfician that I have had opportunities of confulting on this fubje&. According to our theory of opium, it fills and diftends the capillaries, and at the fame time heats and dries the fkin ; for altho' large dofes of opium ufually prove fudorific, yet when it is given in fmall quantities, it heats and dries the fkin, as moderate drinking of fpirits, ftrong drink, or volatile falts do: but if you increafe the dofes of opium, brandy, fAropg drink, or volatile falts, they all become Page 157 ( 141 ) fudorific; i. e. they produce a thort ternpdO rary fever, whofe natural crifis is a fweat.. Opium likewife dries the fauces and tongue # it makes the fibres more tiff, the glandular fecretions more thick, vifcid, and more flowly excreted : and doubtlefs, if it produces thefre effets in a healthy ftate, it cannot fail of be- ing prejudicial in internal inflammations. Altho' I have condemned the ufe of opium in inflammations, yet I would not have it ir. ferred, that every fmall dofe will have a fen-* fibly bad effe&, efpecially when the inflam.. mation is not confiderable. I think that in very great inflammations, opium evidently does harm ' and therefore I prefume, that it may be proportionally hurtful in flighter in-& flammations, even tho' we do not perceive it. I have obferved, that in confiderable inflam.- mations opium will not eafily procure fleep, and what it does procure is hurtful; but it is alfo certain, that in thofe inflammatory dif- eafes, even natural fleep is fure to make tho patient worfe than he was before its coming on: not that fleeping is a bad fign in fuch in- ward inflammations ; but, on the contrary,. C is a fign that the difeafe is milder than: when. Page 158 t p eant could not flep. In all infammnri tions there is a diftention and obftru6ion, which is increafed by fleep, whether natural or caued by opium; and in mortal inflame mations the patient wifhes to be kept awakes rather than have fach difturbed reft, or fuch frightfil images as his fhort flumbers prefent him with& If he is quite wore out with watching, and yet fays he is more miferable if he falls afleep, it feldom fails to be a mortal fign in what ever difeafe it occurs, if the time of its crifis is already paft. Hippocrates fays, if Ieep diftrefs a patient much. it is a mortal fign; and vice verfa. I have feen many ex- ceptions to this maxim, yet I think it.true, if the inflammation is part its crifis. As a fur ther confirmation of this dofrtint w: may ob. ferve, that a wound is more hot, more fwelled, and more inflamed after fleep: alfo a ftump after amputation, if the patient falls afleep, is apter to ftart and burit the veffels than it would have been if he had continued. awake, A rheumatic patient often thinks his pain abated, till he begins to fleep, and then he awakes with a violent farting, and the pain is in." creafedi Page 159 ( 143 ) creafed, or a new one is felt in fome other part. How many patients in other difeafes are worfe in the night than in the day, only becaufe they either flumber, or are difpofed to it? And many people in health find them. felves more difordered, both in body and mind, when newly awake, than at any other time. I experience this moft fenfibly myfilf every morning, till I have been out of bed for fome time; and I think it probable, that this is moft perceptible in old men and phlegma- tic cor(titutions: becaufe fleep gives a re-i mora to the ferous juices in our capillaries, and at the ampe time increafes the internal heat. I own there are many exceptions, and perhaps fuch as are oot eafily accounted for: thus in the gout, the pain is often moft violent be- fore I ep, and we are eafier throughout the day, till the evening comes on, when the pai becomes more, violent, Page 160 ( i44 ) E C TION XXXV. Of the efes oJ opium in the fmall-p ox SYD ENHAM extols opium inthe fmalls pox above all other medicines, and per- haps juftly !but the very reafon why opium is proper in the fmall-pox would be an ob- jetion to its ufe in other fevers and inflam- mations. I have condemned the ufe of opium in all internal inflammations, becaufe it promotes their further progrefs, and confequently may bring on a fuppuration in thofe parts, fronm whence the pus can have no exit, and muft therefore prove mortal: thus, fuppofe any part within the abdomen or thorax is inflam- ed, all our art fhould be employed to prevent a fuppuration, and opium thould be avoided as poifon ; but in the fmall-pox, a fuppura- tion on the fkin is the only way by which this difeafe can be cured, to which opium may often contribute, both as it promotes the fxppuration, and as it expells noxious humours to the extremities and furface of the body. Wheis Page 161 ( t4 5 ) When opium promotes the inflammatin and fuppuration on the fkin, it fo far co-operates With nature in perfe&ing the crifis of the dif: eafe; and this it does moAi fenfibly when the fever is mild: but tho' I have been charmed with the fuccefs of opium where the opera- tions of nature feemed too fluggifb, I have been miferably difappointed when the inflam,- mation and fever were already tQo great. I have at other times thought nature wore out with want of fleep and food, with a cnitant pain upon the whole urface pf thebody, and the vis vita failing, when one dofe of opium turned the fcale and faved the finking patient. Perhaps any other cordial would havf done the fame: Morton was of that opinion, and therefore extolled the ufe of cordials in the fmall-pox; and they are often the beft cures if we know the proper fLafons when they ought to be given; otherwife .they are vey dangerous remedies. I am convinced, that fometitiles .ip the itiall-pox opium does much Qgoo, and,oft~ faves the patient's life; tho' at other ti es it is no lels hurtfol, and nay ean ,pro.e rpr- tal: and it is alfo prohable, that thoiands L have Page 162 ( 4.6 ) have tirfed it without being fenfibly either bet- ter or worfe. If I could tell diftinly, and with certain- ty, when opium will do good and when not in the fmall-pox, it would be a difcotrery of great benefit to mankind, particularly in the treatment of children; and not only in this difeafe, but in other fevers where there is any analogy. In general, I think opium is and mullt be prejudicial, when the fever is too great; i. e. where the circulation is too ftrong .and too quick, when the fluids are all rarified and the folids tenfe, when the capillaries are all dif.. tended and the juices infpiffated, while the febrile ferment is gradually increafing and the tenfion on the fkin obftru1as perfpiration., There is fcarcely any difeafe in which we can fee with our eyes fo many external figns of the vis vita finking, as in a fatal fmall-pox. We may clearly difcern, that the blood does not then reach the outward fkin, that the li- quors in the capillaries retire into the larger veffels; the puftules are no longer tenfe and full, but thrivelled or dimpred at the top; their interflices become pale ; the fwelling of 7 the Page 163 ( 147 ) the hands, face, and falivary glands fubfides the falivation is topped, and the fkin itche" from the perfpiration's being obftruded,: all which effe&s are produced by the weaknefi of the circulation. At the fame time the li- qiuors that did fwell the face, faices, and puf- tules feem to have retired into the blood, or elfe their rarefa&i6n has cea'fed; tho' if a full pock becomes dimpled at the top, I rathet fufpe& that it is owing to abforption. If thefe are fymptoms of the vis vita fail- ing, nothing is more certain than that opiuri will often refftore it for a time; .for it raifes the fwelling, fills the pock, and reffores the colour and fpitting. And it is no wonder it hould produce thofe effes, fince even in health it always tends to fwell the face and fauces, and to accumulate and thicken the f- liva; but it is more apt to do this in the fmall- pox, and efpecially if the vis vita has beeti impaired by a preceding diarrhba. There are two kinds of fore throats in the end of the fmall-pox in both the patiehts are hoarfe, and fwallow with difficulty ; but bne of them is attended with a confiderable feflling, ftiffnefs, pain, and vifcid defluxion, L2 a Page 164 ( 148 ) a rattling in the throat, with all the figns o a local pldhorn. Opium increafes ,all thofe fymp:oms, even to fuffocation ; and the pa- tients die pcripneumonic. Blitering, bleed- ing, and friend's method of cure by purg- ing, are ufualy fuceefsftil, if applied in time. In the other kind, where there is no. wel- ling, opium is the beft medicine,; but if upon looking into the throat, which is eafily done in this, tho' not in the other kind, you fee the uvula and the neighbouring parts pale and thri- velled, andthisgbe attended with a low voice, or rather a whifper, the patient will die; .tho"for a while reftored by opium as a palliative. Opium has fome advantages beyofid other cordials, viz. when the patient is quite har- raffed with a ftiffnefs, heat, and paia of the fkin, it procures immediate eafe, which no other medicine can do, and at the fame time difpofes them to fleep. As for other cordials, tho' they are often very proper on fome accounts, they are hurt- ful on others. Thus when the fick, 'in the decline of any acute difeafe, is low and moft -exhaufted, and feems mofft to want wine; syet at ach times he can leaft ear it, as it foo n Page 165 ( 149 ) foon turns four upon the' lbmach, and gives the heart-burn: this appears from tbh- acid erudations. Now whatever cordial hafuch aneffec, it muff be pernicious: I have often been furprized to. find what reflefs nights have proceeded from fi flight a cauGe; which I fhould not have fufpeed, had not the fick perfon vomited the four hot fluff in.the morn. ing, and been much relieved thereby. 1 amu therefore convinced, that numbers fAffer morp or lefs by unfeafonable cordials in acute dit- eafes ; for as nothing is more certain, thaq that nature, when exhaufted, fiands in need of fome fupport ; there is no prejudice more common than that cordials are neceffary for this purpofe, and the, fironger they are, the more efficacious: without confidering, that plain water is often the bet. cordial, and not liable to turn four ; fo that in. fa& the weakek cordial will fometimes prove the beft. I have obferved, that when my patients have- been very much depreffetd with languor in the. end of a fever, wine gave them no relief, much lefs if warm: water was found a better cr- dial, efpecially when.cold; hut a.fweet orange was found fdill more reviving, as it gave re- L 3 lief, Page 166 ( 150 ) lide, whllft but yet in the mouth. I once attended a gentlewoman, whom I thought at the point of death, in the advanced flate of a low or nervous fever, with a pulfe fcarcely to be felt, and fpeechlefs; fo that there was no place for any medicine but a cordial; but before one could be procured, i put her hands in cold water, which fo re- vived her, that the recovered her (peech, and told us how refrefhing the cold water had been to her; neverthelefs, it was re. markable that the could not bear the cold- nefs of the water long. I have infifed the longer upon this fubjet, as young practitioners are fo apt to be miflled by the term cordial; and, therefore, to prefcribe caftor, aromatics, and volatile (alt's, even to thofe who need nothing fo much as chalk and cold water. Great num- hers fuffer by caftor and falts, though, in many cafes, they may be the bet cordials. ' When I come off a journey, faint and fatigued, and drink a glafs of wine, it be: comes' four, and I am worfe for it; but if wait a while, or drink tea initead of wine, am always refrefhed. Page 167 ( '5' ) I obferved, that opium reflores the vis vita, that fuch a medicine is often wanted about the crifis of the fmall-pox, and that the defe6 of the vis vita is vifible in this diftemper from external figns. But it may be neceffary to diftinguifh betwixt nature ex- haufted by evacuations, and nature oppreffed by a load of putrid humours. In the laft cafe, opium is certainly pernicious, unles after proper evacuations; but in the firft, opium is the principal indication of cure. After the compleat maturation of the fmall-pox, I have feen the difeafe terminate in a phrenitis, angina or peripneumony; in which cafes, opium would certainly be ex- tremely dangerous. And I have often feen Children die of the fmall-pox with the above- mentioned fymptoms, when the faliva has been fo vifcid, that it could not be brought out of the mouth, In all fuch cafes, as well as in ardent fevers, opium is pernicious, even though the vis vitae fails; for nature is al- ready overcharged with accumulated and ra- rified putrid humours. which opium neither. correts nor evacuates. Here a cordial adds fuel to the flame. Moreover, we find, that L Syden- Page 168 ( 152 3 8ydenhant was fuccefsful in frie defperate cafes, when omitting opium he ufed a con- trary method, and made the children be ex.. pofed to the cool air, to drink cooling li- quors acidulated with fpiiit of vitriol, and fometimes be blooded. And how remarkably, fays Friend, have fome in the fmall-pox been refcued from the jaws of death, by a brifk dofe of phyfic, after being coftive through- but the difeafe ? whereby a load of putre- fa&ion was difcharged. If putrid flteams offend, then purging mutl relieve. Had they taken opium inflead of this cathartic, the confequence muff have been fatal; and I very much fufped, that Sydenham's pane- gyric upon opium has mifled many into blunders, for want of proper diftinaions and exceptions. The fum of Sydenham's dotrine is, that the cool regimen faves the patient, and the contrary kills. I have obferved, in general, that opium is improper, where the cool regimen is neceffary; but the one is of- ten neceffary in the beginnin and the other in the end of the fame difeafe. In the fmall- pox, opium removes, for the time, many trouble- Page 169 ( r33 ) troublefome fymptoms, and thereby acquire# great praife: thus, it abates for a time, the itching on the fkin, it reftores the loft colour and fwelling of the face, even in a dying perfon; but foon after, the fwelling fubfides, and the red colour leaves the interftices for ever: even a beginning jaglatio, though a fatal fymptom, is fometimes, for a while', abated thereby. From the preceding hints, as well as daily experience, it is probable, that opium may be fafely prefcribed in the fmall-pox with a mild fever, and that it may be ufeful in pro.. moting fuppuration, when the vis vita fails, and that it may likewife recruit the ftrength, by giving fome intervals of eafe, when the patient has been long fatigued with pain; but that in many cafes, it may, or may not, be given, and in others may do harm, even when there is no fufpicion of its having done fo. When all the humours of the body are tending to a ftate of putrefaaion, when the veffels are full, and all the fibres tenfe, and the perfpiration flopt, where one blooding, a clyfter, or a purge would give the greateft relief, there opium is as bad as poifon. Syden- Page 170 ( 154 ) Sydenham has obferved, that, when therq is a vaft load of confluent puffules, attended with a violent fever, thoufands have been killed by flopping the diarrhoea, which is common in the confluent fmall-pox of chil' dren; i. e. that thoufands have been killed by opium, for I make no diftiRaion betwixt it and the fyrup of poppies. In general, I fufpea, that opium muft do harm in all athletic conftitutions, or where the vis vite is ftrong and the difeafe near its acme. At that time, I would always confider it as an edged tool, and, therefore, for further fe- curity, if it be then neceffary, would advife bleeding at the fame time. After the fup. puration is compleated, removing the pu- tredo and fupporting the vis vita, are of equal importance, and require pfoper evacua- tions, frefh air, and mild fubacidulated li- quors, with opium and the peruvian bark. After all, I muff own, that there are many exceptions to thefe general rules, con- cerning the ufe of opium in the fmall-pox, but it would be beyond my purpofe to defcen4 to particulars. SE C.1 Page 171 ( 155 ) SECTION XXXVI. Pf the efeTs of opiut in the neales. Shall have the lefs to obferve on the ufd of opium in the meafles, becaufe much pf what I have faid, concerning its ufr in ;he fmall-pox, will be applicable to this difeafe, as well as to many other dangerous fevers; but there is one fymptom in thq meafles, which is as infeparable as the e- ruption itfelf, (I mean the dry tickling cough) for which opium is an excellent me- dicine, though only a palliative; indeed a palliative is all that can be required, becaufq this fymptom is not to be cured 'till the meafles are gone: it may, and ought to be abated, and opium, bleeding and bliftering are the only means worth the trying, that I know of. Opium gives comfortable inter- vals betwixt the fits of coughing, and no thing elfe is neceffary when the difeafe is ,mild. In the year. 1750, I feldom gave, hny thing elfe; fometimes this cough is fo mild as to need no cure, but at other times, Page 172 ( r56 ) the patient fays, he is fhaken to pieces by it. I have feen fome fo fpent with the conftant fatigue, that the eruption has turned pale before the due time, and nature has began to yield to the difeafe, when one dofe of opium has changed all for the better in an hour's time. It has difpelled the pains or ftitches, called back the eruption to the fkin, and the loft luftre to the eyes, the faint voice has re- covered its tone, and the fond mother her hopes again. Although opium is the beft cure for thofe fymptoms, which are brought on fimply by the conflant fhaking of the cough, yet, if the fever is threatening or the patient plethorick, or opium has been tried without fuccefs, it will be then very dangerous; fo dangerous, that I never at- tempt to conquer this cough by firong dofes, if the mild ones prove ufelefs; I have im- mediate recourfe to blkeding and bliftering to prevent a peripneumony: a large dofe of opium might bring on that inflammation, which we ftould guard againit with the utmoft care. For which reafon, if there is a fufpicion of danger in the end of the meafles, and the cough is urgent, I always would let blood Page 173 ( 157 ) blood before I give the opium. I have often fufpeded, that opium binds the breaft, for which reafon I firft prefcribed pedorals be- fore I gave opium; and -upon trial, though I think they don't make the cough lefs fre- quent, yet thofe of the emollient kind make the cough more eafy, when the fever is gone, and the itiffnefs and forenefs of the bredft remain; but while the fever continues, what abates that, is the beft pe6oral. Blood- ing and bliffers are then indicated, and afterwards affes-milk, as a reftorative. SEC- Page 174 ( s15 ) SECT ION XXXVI.: f thk efeas of opium in a falivation. F one has got cold in a falivation, a diar- rhaea with gripes, or pains throughout the body, ori perhaips a Iomiting fucceeds, and commonly the fymptoms being violent; require a fpeedy cure. Opium, with a full glafs of warm wine and fpices, is the belt cure. We may give thirty drops of liquid laudanunm for a dofe, and cover the patient up very warm in bed; to provoke a fweat 4 as the fweat comes on, the fymptoms begir to abate, and fon after altogether difappear. This vomiting and purging in a falivation ire not always the effeas of cold fome- times they are brought on by eating or drink- ing food that is improper, or in too great a quantity. In this cafe, a vomit is neceffary, and opium hurtful. Page 175 ( 159 ) S E C T ION XXXVIII. Of the ef ets of opium in fevers. I Have already confidered the effe&s of opium in fome fevers, attended with con- fderable inflammation, fuch as the pleurify, peripneumony, &c. it may, therefore, be expeted, that I fhould take notice of its ufd in other continued fevers; but fevers being of a very complex nature, and very different one from another, no general rules can be laid down relating to them. Whoever attends to the different kinds of fevers, their different flages, the variety of conflitutions, climates and other circum- flances of confequence in the cure, will be convinced how difficult it muff be to deter. mine the effe&s of opiates in fuch cafes. Little can be faid in general, and, therefore, I fhall mention a few of its particular efd feds. In very bad fevers, the patient often gets no teft, and, therefore, calls for opium; the effo~1 of it is, perhaps, to force a very tromtt blofomc Page 176 ( 60 ) blefoime, unrefrefhing fhort fleep, out of which he wakes either with a violent flartj or in great diforder from a terrifying dream, wifhing that he could be kept awake, ra- ther than fleep under fuch circumftances. Opium, with fuch effe6ts, muff be perni- cious in any difeafe, but ftill more fo in a fever. In other difeafes, a fmall dofe of opium may bring on-thefe difagreeable fymp- toms, which a large one would overpower, while it procured a comfortable fleep. But 1fill I fufpet, that even this large dofe will confirm and rivet the difeafe, Mr. G. G. of a full habit of body, had a fever, with a pain in his head, and no reft he defired me to prefcribe opium, but I re, fufed it, left it fhould increafe the pain of the head, and, perhaps, bring on a delirium: next night, he again called earneft!y for opium, but his wife would not confent to it, becaufe the was afraid of the above con- fequences ; however, by the advice, of fome body elfe, fhe was prevailed on to give him the fyrup of poppies, which the reckoned fafe.enough, becaufe it was given to chil- dren: that very night he .became delirious, and Page 177 ( 161 ) ahd never grew better, but he died in a few days. Hitherto, I have reprefented opium as a medicine apt to heat, rarefy the blood, and increafe obftrufions, and, in general, to augment all the common fymptoms of a fever. But, on the other hand, however abfurd it may appear at firft fight, to fay that a fever may be cured by increafing its force; yet they, who recommend cordials in a fever, muff imply no lefs. Wherefore, though opium excites the heat, drought and other febrile fymptoms, and provesoften fa' tal in inflammations,; yet it is no lefs cer- tain, that it has frequently faved many lives in the fmnall-pox, meafles, and that feverifh diforder which we have called a weed. So that if it does promote the feverifh fymptoms, yet, otherwife, its good overbalances its bad effe6s. I have often obferved about the crifis, that when one has been quite re- duced by the long continuance of the fe- ver, attended with watching, pains and re-. peated evacuations, great benefit has arifen from an anodyne and cordial draught, For the fick are often in the fame condition at thel, SM crifis Page 178 ( 16, ) crifis of fevers, as in the decline of the fnall- pox or meafles, when the vis vita fails too foon, and the eruption fuddenly difappears. In fuch cafes, I obferved, that opiun was an excellent medicine, nor will it be 4els ufeful here, if feafonably given. About the acme of a fever, the vis vite often fails before the crifis is compleat, that is, before a due cofion can be brought about. For every critical evacuation requires, that the humour to be difeharged, be firf pre- pared to pafs the fecretory veffels: this pre- vious preparation, I dall co&ion, which is the work of nature and the effect of the animal procefs, which endeavours to expel whatever is noxious or fuperfluous. But if nature finks, before cotion and critical eva- cuation caa be accomplifhed, the ftrength mufit be fupported by opium and other cordials. The vis vita and vis morbi are fometimes fo eqtully ballanced, that one dofe of opium will fave the patient, when bleeding would be fatal. I am perfuaded, that opium, and even other cordials, have frequently had this goodcffca in the fmall-pox and meafles; and, Page 179 ( x6 ) and, that upon fuch fats, Sydenham has n- tertained fo good an opinion of it; and that Morton, for the like reafons, was as much prejudiced in favour of cordial juleps. It was from Sydenham's commendation of opium in the fmall-pox, that I took the hint of ufing it about the cris of other fever s. To conclude, opium is ufeful in promot- ing the crifis of fevers, when the vis vite fails, or in weeds and fhort fevers proceed- ing from cold, provided it be given 'ere the humours are much vitiated; but, on the other hand, if it be given too late in the laft cafes, or at the beginning of a con- tinued malignant fever, when it is miftaken for an ephentera, opium is then prejudicial, and fometimes fatal. I have not tried it often, but I fhould expet little or no ad- vantage from its ufe, where all the fluids are in a preternatural ftate, or very much core rupted, e pecially as the head is commonly fo much affeted, that the patient knows no thing of what paffes. I think opium fucceeds often, where wine, or fuch-like cordials, are ~feful; but with this advantage, it does M 2 not Page 180 ( 164 ) not turn four. I cannot omit one obfer- vation, that ferves to confirm what I have faid of opium, viz. that many times the crifis has been brought on with wine, when the patient feemed expiring; at other times, the common cordials, epithems to the head and ftornach, alfo warm irons or live pidgeons applied to the foles of the feet, have recovered fome, when almoft at the the laft extremity, by giving new force to ihe circulation, when almoft at a hfand; whereas opium does not feem very fit for this purpofe, for it is not a proper cordial, where the patient is infenfible or delirious; yet, I know none better, when he is ex- haufted and too fenfible of the fatigue he has undergone, or when there is a delirium Wvith a flow pulfe. It may not be an ufelefs digreffion, to give one inifance of a delirium fuddenly cured by opium.. It was in a perfon, who was fo far recovered of a peripneumony, as to be quite free of the fever; fhe had been very much exhaufed by abtinence, evacuations and the difeafe, and continued to cough up a great quantity of greenith mucus; 'till one 3 day, Page 181 ( 165 ) day, fitting up too long, the catched cold'; and the fpitting entirely left her; at which, I was not a little alarmed, and becaufe the complained of great debility, and of that kind of wearinefs and languor, which opium often cures, I ordered her immediately twenty-five drops of liquid laudanum: but before the could take it, fhe became deli- rious; fo that I thought it now contrary t6 my theory to give it, fufpe&ing a meaftafis from the branches of the tracbea to the brain; Upon examining her pulfe attentively, I found it flower than in health; her tkin was alfo cooler, and her looks extremely languid I wherefore, I ventured to give her the opiate. She flept fix hours and awoke quite free from the delirium. After this, the opiate was re- peated every night, and the recovered with- out a relapfe, and without a return of the fpitting. It feems probable, by the fudden flopping of expedoration, and its not return- ing, that the matter was re-abforbed and affimilated, and that the delirium was a kind of vacillatio in the efforts of nature, brought on by the-metaflafis of 'what formerly was expetorated. This vacillatio was evidently: M 3 cured, Page 182 ( i66 ) cured, upon reftoring the vis vita, by a found fleep. If a purging clyfter had been pre- fcribed at this time to make a revullfion from the'head, it might have proved fatal, by di, sninifhing the vis vite, and leaving the brain unfupplied with proper juices, through a de- fet in the force of the circulation. This inflance of a delirium cured with opium, was the firft afe of that kind where- in II had ventured to prefcribe it, except in the fmall-pox. I foon after had a patient in a low continued fever, who, about the four- teenth day, had a longing for orange-wine, when the was fcarcely able to tell us fo; fhe was indulgd, in the ufe of it as a cordial, tho' we thought her life very precarious, and dranka pint of -it the firf. night ; the next day the was fAnfibly better, and. gradually recovered. It feerned as if nature and the diceaf were in equilibrio and that the wine, here given, had caft the ballance. I have heard of a variety of things, which people have been fond of, and have taken with ad- sirable fuccefs, about the end of lingering fevers; they* were generally cordials, fpiri- tious, ftimulating, well fekfoned or of a high Page 183 ( 7 ) high relith. Nevcrthcles, though I believe a cordial would frequently fve the patient's life, if feafonably given, yet it is no lofs cer- tain that they often do harm, even in the end of fevers, when. improperly applied; but opium, and all fuch! heating things, are much more prejudicial in the increment of a fever, however faintilh or languid the pa- tient may find himfelf; and I fufpe, that the common bolufes of caftor and falfuccini are often given. no lefs un(cafonably: I the rather mention thefe bolufep, in as much as I myfelf once thought them a valuable re- medy in many fevers, without making any diffindion of their different flages, much lefs did I fufpe&, that they wore hurtful 'ftill many of my patients had an uncommon jatatio after taking them, and, at laft, took them with fuch reludance, that they firug- gled with their utmoft efforts to avoid thema and that, at a time, when I thought they had not fenfe to know what was offered, nor ftrength to repel the hand that gave it; fome, who were more fenfible than the reft, complained that thefe bolufes fcalded their ftomach and it is well known, that M 4 what Page 184 ( 6 8 ) what overheats the ftomach in a fever, oc- cations a jatatio and univerfal uneafinefs. If I am not miftaken in this remark, it is of no little importance, for fuch bolufes are frequently adminifered by the hands of thofe who cannot diftinguifh the proper fea- fon, or even don't fufpe, that they are at any time hurtful. There are alfo fome who would not allow the fick a fingle drop of brandy, and yet indulge them freely in the ufe of compound waters, in their cordial juleps, as if fpiced brandy was lefs heating than when fimple, or more diluted in the apothecary's (hop than when made into punch. That fuch as are paft recovery, are often the worfe for cordial juleps, even at the time when nature feems to ftand moft in need of a fupport, is (I think) a fa&, which I recommend to the obfervation of thofe who have let it hitherto efcape their no. tice, 8 E C, Page 185 ( 169 ) SECTION XXXIX. Of the contrary effels of opium and venefelion. IHave often obferved, that opium dillends, infar&s, heats and rarefies, fo that our fibres are more tenfe, and our body more fwelled after, than before we ufe it. Bleed- ing, on the contrary, evacuates, cools and fenfibly relaxes. It generally abates the ra- refa&ion of our fluids and tenfion of our fo- lids; fo that opium and bleeding anfwer in- dications that are dire6cly contrary. From this view of their different effe&s, I' had eftablifhed it as a general rule, that opium was improper in all thofe difeafes in which bleeding was neceffary; and, I\ think, it holds good for the moft part, and has the concurring teftimony of moft pratical au- thors to confirm it; in as much as they pre- fcribe blooding in all kinds of inflammations both external and internal, and almoft in all fevers, but efpecially in the very acute or violent kind, whether they be fymptomatic pr cffential. They prefcribe bleeding in all difeafes Page 186 ( 170 ) difeafes occafioned by, or attended with, a plethora-or rarefaion of our fluids. Bleed- ing is found beneficial, and, therefore, is re- commended by every author in the paruritis, phrenitis, angina, ery/ipelas and moft inflam- matory fevers; in all which difeafes they do not prefcribe opium. Again all authors pre- fcribe opium in a diarrhcea, catarrh or dy- fenterie, and that with a defign to flop thofe evacuations. But this rule, like moft others, is not without exceptions; for inflance, I both let blood and gave opium freely to a woman in labour, and I give the opium fo much the snorefreely, if I have firfi let blood, and, szce versa, I take away the more blood, when I intend to give the opium imnmediately afterwards, This J do with general fuccefs, and probably the reafon of this fuccefs is: women in labour are, in fome fort, plethoric about the region of the uterus, where all the fibres are on the ftretch, and this attended with heat and rarefation, and fometimes with fpafms; all which circum- flances are fomewhat abated by bleeding; perhaps even the paffage for the fetus is made eafier by this evacuation, and the fibres more Page 187 ( 171 ) more dilatable and pliable, and the flood, ing after delivery will thereby be leffened; fo that the change, made by the fudden e- vacuation of the uterns, will now be more gradual and fafe after delivery. It is true, that opium feems likely to undo all, that bleeding has done, and therein lies the feem- ing abfurdity of ufing both at the fame time yet, however, abfurd this pracice may appear, I often find it ufeful not only in the cafe juft mentioned, but alfo in a catarrh, in the meafles and a cough with a broken rib; in whic,<h cafes I ufually let blood, becaufe I am afterwards to give opium for the cough, that I may abate the fimulus without in- creafing the plethora. I muff here take no- tice, that if theflimulus, which I would abate, is owing to a plethora, either local or univer- fal, opium would be improper. Thus, in any confiderable fraCture with inflammation or a plethoric conftitution, I would not en- deavour to abate the pain or ftarting of the limb by opium, but by venefeion and ab-. ftinence. The fame is to be faid, if a rheu- matic fever caufes violent ftartings, pains and fwelling in any of the joints. 9 SEC- Page 188 ( 172 ) SECTION XL. Of the preparations of opium. P ERHAPS, it will be expected that I take fome notice of the different pre- parations of opium, and of the feveral com-. pofitions into which it enters. Firit, as to the different preparations; I know that the extrad is commonly preferred to the crude opium, but, I think, the difference betwixt them too minute to deferve our notice; but, if I mufft make any difference, I would pre- fer the crude opium, becaufe, I think, the extract has more chances of being adul- terated or fpoil'd in its preparation. The fyrup of poppies is by fome elfeemed a fafer medicine than opium, efpecially for children and in nervous complaints; but I much doubt of the truth of this opinion ; and whoever fhall think that he perceives this difference in his pratice, I would have him refled" how many accurate obfervations would, in cafes altogether fimilar, be necef- fary to determine the queftion; let him re- fle6t Page 189 ( 173 .) fle& how various we find the effeas of fimple opium at different times, and on different patients; and how many ways we may miftake the effets of the difeafe, or fome other caufes not attended to, for the effeas of opium, and, vice versd, it will be eafy to conceive, that opium fimply has as different effeas at different times, as thofe of opium and fyrup of poppies when com- pared together, which effets are probably occafioned by fome other circumfiance to which they did not attend. There are two other objetions which I have againft this fyrup, viz. it eafily ferments even in the fhops, but the fbaking it, when carried to the patient, or letting it fland for any confi- derable time in a warm room, makes it turn four. In the fecond place, I think it ex- tremely difficult to afcertain the jufi dofe of a fyrup fo precifely as I can do a dofe of opium; for which reafon, I never ufe the fyrup when I would have a precife quantity of the paregoric, but, in its place, I take liquid laudanum and fyr. fJimplex, though even the drops of laudanum are not equal. I likewife keep an uncommon preparation of Page 190 of opium, which was highly recommended to me in cafes of great haemorrhages, even though attended with a viol"nt fever. The re. ceipt is as follows : take of clean crude opium half an ounce, beat it and put it into an iron ladle, fet it on a flow fire, flirring it with a fpatula, and moiftening it from time to time with ftrong wine that it may not burn, keep it thus flirring till half the opium is evaporated, take it off the fire, beat it a- gain in a mortar, then, with the firongeft vinegar, reduce it to the confiffence of an oint- ment upon a marble flone or in a glafs mor- tar, then dry it, powder it, and keep it in a glafs. The dofe to begin with, is three or four grains, but I have gradually increafed it to i at bed time, and fifteen grains in the morning. This medicine I thought fuccefsful at firit, and, therefore, kept it always ready prepared for hemorrhages ; but I have often been difappointed in the ufe of it fince; for which reafon, I fhall befow no panegyric on it, 'till I can be more particular and more pofitive about its effe&s. At prefent I think, that hamorrhages ought feldom to be ftopt, and Page 191 ( 1i5 ) and then the antimon crud. cerat, tnd the *vitrum antimon. cerats are both more effeeual than the above preparation of opium; yet, hmarrhages, continued or increafed by a fimulus, will be often more effeaually abated by opium, any how prepared, than by any other medicine; fo that it is, at leaft, the beft palliative, which probably made me miftake the above preparation of opium for a radical cure, though, in reality, it only abated the evacuation, in proportion as it abated the flimulus, which occafioned it; and, in faa, I thought that the longer the uterine hamorrhages were fopt by it, they returned with more violence, and greater quantities of clotted blood came a- way, as if the opium had done n ing but retained it in the uterus. Extravaaited blood in the uterus, like other extraneous bodies, provokes it, by its fimulus, to ex- pel it, but the opium abates this finmulus, fo that the blood has time to coagulate, and the patient thinks herfelf better, 'till the accumulated load and irritation overbalance the anodyne quality of the opium; then the pains return with more violence, 'till the caufe . Page 192 ( 176 ) caufe is expelled with a nifus, like child- bearing pains; after which, the flooding ftops of itfelf, though, at that time, I afcribed it to the effet of a larger dofe of my fpecific opium. s EC'- Page 193 ( 177 ) SECTION XLI. Of the theriaca Andromachi, mithridate, and diafcordium. IN confidering the effeas of opium, I thought it not improper to look into thofe receipts wherein this was the principal ingredient, viz. the theriaca Andromachi, mi- thridate and diafcordium. Moft of thofe compofitions have been in great reputation, and more efpecially the theriaca has been much efteemed in all ages; yet there are fome practitioners of great experience, who own that they never could perceive any fenfibly different effeds from the ufe of this compofition and that of thephi- lonium or mithridate. From whence they have concluded, that the effe6ts of them all were tobe afcribed to the opium and a few fpices. The ingredients of the theriaca are fo many, and the virtues of fome of them, fo little known, that, I think, no body will pre- tend to afcertain what fhare each fimple has N in Page 194 ( 17S ) in the effeas produced by the whole to- gether. Perhaps, it is for this reafon that the col- leges of phyficians have been fo fcrupulous in reforming this compofition, that all their amendments have terminated in giving us another theriaca, which they think will ferve all the good purpofes of the venice treacle, and is not liable to many of thofe in- conveniences, which embarafs the apothe- cary. in making up the latter: but, yet, out of deference to many of our brethren, who may be of a different opinion, they have likewife retained the old original receipt, that every man may be at liberty to make ufe of which he thinks beft. All who know the diffi- culty of afcertaining the virtues of fuch fimples, as compofe the tberiaca wilf be eafily convin- ced, that the firft inventor of it muft have been very deficient in that refpe6; it is probable, his choice was direaed by his theory angl prejudices, which would be of a fafhion with the philofophy and phyfiology of thofe times. It was then a prevailing notion, that fimples often contained fome noxious, as well as falutiferous qualities, and, there- fore, they compounded them with a variety of Page 195 ( 179 ) of antidotes correfponding to the different poifons they were fuppofed to contain ; to thefe, they added other ingredients, to exalt their virtues, and others, as condudors to direa their influence to the head, the heart, the liver, or any part of the body, where it was moft neceffary. This was the theory of fome, and it is not improbable, that the compilers of fuch prefcriptions, as the the- riaca and mithridate, were influenced thereby. From whence, I fhould be apt to con- clude, that thefe receipts have not a juff title to all that reverence which hitherto has hindered their reformation; efpecially as there is one reafon for altering them; which I think unanfwerable, viz. that the apothe- caries do it daily without telling the phyfi- cians, who prefcribe them, that they have made any fuch alteration. Surely, it is more reafonable that fuch a medicine fhould be changed by the college of phyficians, (fince it muft be changed) than left to be varioufly altered by every apothecary, according to his different theories or prejudices, not to mention other motives, by Which they may be fometimes influenced. Would any be fo N z abfurd Page 196 ( s80 ) abfurd as to alledge, that the theriaca thus altered by different apothecaries, and pre- kcribed by different phyficians, has ftill de- fervedly kept its reputation ? or that the ef- feAs may be the fame, however you vary the compofition? it is much more rational to allow, that there can be no great danger in abolifhing a formula that has feldom been obferved, or in reforming a prefcription by the authority of the college, which other- wife will be found different in every fhop. The diafcordium is another compofition, wherein opium is a principal article ; and as this is likewife loaded with too many ingre- dients, the fame objedions, which were urged againft the theriaca will be alfo appli- cable here: the college have confidered this, and, without fcruple, have given us a new prefcription, much better than the former; but ftill, as the very judicious author of the Pharmacopria rejormata obferves, they have retained both the tormentil and biltort-roots, though we ought to prefume, that, as they are both of the fame nature, either of them would ferve, as, likewife, bole alone would be fufficient without the terra lemnia; and as Page 197 ( I8I ) as to the flyrax, galbanum and ditF7amnus creticus, it is difficult to affign any o her rea- fon for continuing them in the pxrci.r-ption, than a reverence for our predecffo, s. I have commonly ufed dia/cordinm as a reflringent and gentle paregoric, and fouad that it made the body coffive,- and difpolfed the patient to fweat; but I muff own, that there purpofes are as well, and as often, an.- fwered by opium alone; at leaft, I think it would be extremely difficult, and would re- quire a vaft number of experiments, to di- ftinguifh the effeds of opium from thofe of diafcordium in its ordinary dofe; indeed, the other ingredients of the diafcordium nimuft have effets different from thofe of opium, yet, I never could, from experience, be able to tell what they were, though I have ufed both medicines very often; and, for this reafon, I doubt, if the fpecies, with-. out the opium, according to the new London difpenfatory, will be able to main- tain a reputation equal to that which the former diafcordium had acquired. It is re- markable, that, in this prefcription, the femen acetofe is prefcribed in the fame pro- portion Page 198 ( x82 ) portion with the opium, as if it was no lefs powerful and dangerous. By this means, half a grain of it will rarely be taken in one dofe; from which, I fhould exped fo little effe&t, that I would rather chufe to leave it out of the receipt.