glions of the stomach, which follows the continued excessive use of spirituous or vinous liquors, or of grief and the depressing passions, the seat of which seems to be in the ganglions of the stomach, or in its immediate neighbourhood. In such cases a stimulant taken into the stomach by rousing their action, and probably by increasing communication existing between them and the brain, act almost instantaneously in quieting the whole nervous system, and in enabling the brain to perform its intellectual functions. (See CORDIALS.) Increased sensibility of the nervous system is often attended with considerable depression of spirits or melancholy, with symptoms of indigestion and morbid secretions, particularly of the liver and kidneys. In this temperament the digestive organs are frequently so much disordered as to induce the patient, and his medical adviser, to refer the disordered state of the general health either to indigestion or some derangement of the liver; and in many cases the products or effects of indigestion keep up the general disturbance of the nervous system. In such cases the anodynes, as laudanum, henbane, prussic acid, &c., often act as cordials to the mind, and also as stomachics, by quieting the nervous system, which in cases dependant on debility or torpidity of nerves would have had a contrary effect. The varieties of indigestion arising from morbid sensibility or nervous excitement of the stomach, and from torpidity or relaxation, I particularly noticed in the Gazette of Health, about eight years ago, since which two or three works have been published on the former variety.

OPIATES.-Medicines which procure sleep.-(See SEDA

TIVES.)

PURGATIVES.-(See CATHARTICS.)

REFRIGERANTS.- Articles which reduce the temperature of the body. This class is divided into external and internal. The external are general and local. The general are the cold-bath, affusion of cold water, and exposure of the naked body to a cold air (termed, by the late Dr. Darwin, the cold-air bath). The cold-bath, by immersion or by an artificial shower (shower-bath), is used in cases of general debility or relaxation, to increase the cohesion of the body, in which case the warm tonic medicines are generally employed with it. It not only strengthens the muscular system, but generally allays morbid sensibility of the nervous system, and the re-action which follows its use rouses the vital powers, and tends to equalise the circulation. The application of cold water by affusion, that is, pouring it over the body, and also by sponging the surface of the body, has proved highly beneficial in cases of inflammatory and typhus fever, by reducing the degree of temperature, and allaying morbid excitement of the nervous system, and probably in typhus fever by increasing the cohesion of the

soft parts, so as to support the vital powers against its debilitating effects. When internal inflammation exists either in the lungs or any part of the abdominal viscera, cold affusion is improper. The external topical refrigerants are cold water, ice, spirituous lotions, solutions of lead, and the vegetable sedatives. The refrigerant effects of lotions are promoted by evaporation of its spirituous portion, as spirit of wine or ether. (See ETHER.) The addition of lead increases its operation by its sedative influence on the nerves, and in case of inflammation, by constringing the distended vessels. The anodynes, as morphine, belladonna, prussic acid, &c., by reducing the excitement of the nerves, also act as refrigerants. The internal refrigerants are, dilute solutions of neutral salts, as nitrate of potass, of acetate of ammonia (Mindererus's spirit), of citrate of potass (saline mixture), and certain vegetable and mineral acids, as lemon juice, tartaric acid, sulphuric and muriatic acid. The anodynes, as morphine, foxglove, henbane, prussic acid, reduce the heat of body by diminishing nervous energy and arterial action, and the sudorifics by keeping up evaporation from the surface of the body. Of the saline articles, the nitrate of potass (nitre) is the most powerful refrigerant. Notwithstanding its diuretic effect is attributed to its stimulating action on the kidneys, and its supposed influence in increasing the stimulating quality of the blood, it assuredly diminishes irritation and inflammation in the kidneys, bladder, urethra, and lungs; and although it does not act either as an aperient or sudorific, it reduces the temperature of the body and allays thirst. The effects of the vegetable acids in quenching thirst and cooling the body are well known. Dr. Murray attributes their modus operandi to less consumption of oxygen gas by respiration during their use. It is known, says the Doctor, that the animal temperature is derived from the consumption of oxygen by respiration, and that an increase in that consumption will occasion a greater evolution of caloric (the matter of heat) in the system, and, consequently, an increase of temperature in the body, while a diminution in the consumption of oxygen will have an opposite effect. If, then, when the temperature of the body is morbidly increased, substances be introduced into the stomach that contain a large proportion of oxygen, especially in a loose state of combination, we may succeed in reducing the general temperature. This (continues the Doctor) we accomplish in part by a vegetable diet, but still more effectually by a free use of acids." In the first place, I have ascertained by repeated experiments, that the inhalation of pure oxygen gas instead of increasing the temperature of the body reduces it, and also diminishes arterial action; and, in the second place, supposing the temperature of the body be increased according

to the quantity of oxygen that is received into the system, it surely can make no difference whether it be supplied by the lungs or received from articles taken into the stomach. The Doctor is an advocate for theorising, because theorising is only drawing inferences from reflections. There is, however, a great difference between theorising on facts and theorising on hypotheses. It is too much the fashion in medicine first to form an hypothesis, and then to bring forward a long train of theoretical fancies founded on it, and even to make facts by ingenuity of argument to bend to the theory, the grand object of which is notoriety! It is scarcely necessary to observe, that refrigerants, both external and internal, operate more certainly and effectually after abstraction of blood, and after the operation of a purgative medicine. In cases of inflammatory fever, with or without internal inflammation, the propriety of uniting the saline, diaphoretic, and sedative medicines is obvious. The constant application of cold water, or an evaporation lotion, to the head, considerably reduces the temperature of the body. Pure water, barley-water, &c., also cool the body, by diluting the serum of the blood and by keeping up perspiration. (See ATTENUANTS.)

ROBORANTS.-Remedies which increase the strength of the body. (See CORROBORANTS.)

RUBEFACIENTS.-Articles which applied to the skin excite considerable redness, heat, &c. The rubefacients in common use are, the ointment of tartarised antimony, liquor of ammonia, diluted muriate of antimony, spirit of turpentine, cajeput oil, bruised or ground mustard seeds, euphorbium plaster, gum plaster, Burgundy pitch, caloric, electric sparks, and nettles. They act beneficially in cases of internal inflammation, particularly the chronic kind, inflammatory excitement of membranes of joints, deep-seated rheumatic pains, &c. They are also employed to promote the suppuration of indolent abscesses, and to rouse the action of absorbents in cases of indolent tumours, and also to invigorate the nerves of paralysed parts, and increase the vis insita and the vis nervosa of muscles. (See DERIVATIVES.) SEDATIVES, ANODYNES, HYPNOTICS, OPIATES, NARCOTICS, SOPORIFICS, and PAREGORICS.-A class of medicines which diminishes nervous excitement, allays pain, and procures sleep.

The sedatives employed by practitioners of the present day are, opium, deadly nightshade, the wild and garden lettuce, meadow saffron, henbane, hemlock, stramonium, tobacco, prussic acid, and lead.

Some theorists suppose that the primary action of all the vegetable sedatives is a peculiar stimulant, which speedily occasions an extreme exhaustion of the vital powers, of which the

diminution or cessation of pain and sleep are the consequences. This supposed primary effect is only evident, and then but slightly so in very nervous subjects, and in such cases it may be attributed, as Professor Cullen observes, to an effort of the conservative power of the body to resist its action. We have very

often witnessed the immediate sedative effect of opium taken into the stomach, even in a part remote from the stomach, and also of its topical application to a painful ulcer. We are therefore inclined to believe, that the sedative effect of all the articles enumerated above is primary. A French chemist, after analysing opium, and making a few experiments with the constituent parts separately, supposes that he has discovered the cause why opium sometimes excites the system, and disorders the brain and nerves. One article he obtained (to which he has given the name of narcotine) he ascertained to possess the power of disordering the nervous system, and this he therefore supposes to prevent the anodyne operation of another constituent, which he denominates morphine. Whether this be the case or not I cannot say from experience, but certainly it is a fact that morphine, and particularly the acetate of it, is more certain in its action as an anodyne than opium; and the sleep it produces is also more natural and refreshing, nor is it followed by the nervous affection of the head, &c., which generally succeeds a dose of opium. The effects of the different anodynes are noticed under the heads of ANTISPASMODICS and NERVINES. Some of the class of anodynes seem to act more powerfully on the nerves of some parts of the body than on others. Opium particularly evinces its anodyne effects on the head, lungs, stomach, intestines, bladder, and extremities, but it has no effect on irregular action of the heart; and although it will allay pain in the stomach and intestines, it generally increases the contractile power of the muscular fibres of the intestines, and diminishes that of the heart. The inspissated white juice of the wild or of the garden lettuce allays morbid irritation and inflammation in the membrane lining the windpipe and bronchial vessels, and reduces the power of the heart. Meadow-saffron acts as a powerful sedative on the nerves of the uterus, and on the extreme ramifications of nerves in the extremities, the seat of gouty inflammation, and of the membranes of joints and bones. The cicuta acts on the nerves of secreting glands and on secreting membranes. The henbane is a general anodyne, allaying irritation or nervous excitement in the brain itself, and at the same time increasing the action of the muscular fibres of the intestines. Tobacco and stramonium diminish the irritability of the respiratory muscles, but disorder the nerves of the stomach. prussic acid is a general anodyne, but has no effect on the muscular fibres of the intestines, either in increasing or diminishing

The

the peristaltic motion. The fox-glove allays the irritability of the heart, and increases the action of the absorbent system, but does not possess the power of allaying pain, either when taken internally or when applied externally. Hence all the anodynes have their peculiar advantages, which may be promoted by such remedies as the state of the general health or the temperament of the body may indicate.

In cases of acute inflammation, an anodyne very seldom succeeds till the vessels have been unloaded by abstraction of blood. In inflammation, the nerves of the part are more affected than the blood-vessels; and after the latter are unloaded by scarification or leeches, or by general bleeding, the next object is to reduce the morbid excitement of the nerves, by the use of an anodyne, and by a derivative, as a blister, rubefacient, &c.—(See DERIVATIVES.) In cases of inflammatory fever, opium or laudanum will often increase the excitement of the nervous system, if the blood-vessels are overloaded, and the skin be hot and dry. In the latter case, the addition of a sudorific, as ipecacuanha powder, antimonial wine, or Mindererus's spirit, generally succeeds in promoting its quieting effect. A combination of the henbane and colchicum in such cases generally succeeds better than opium, and at the same time has the important advantage of subduing irritability, and acting gently on the bowels.

The opiate medicines, by which I mean the preparations of poppies, and those vegetable substances which approach in their medicinal and chemical properties nearest to opium, may be introduced into the system by external friction, or by means of warm water or vapour, through the medium of the skin, and by inhalation of vapour, impregnated with their anodyne property, so as to quiet the whole nervous system, and even to subdue deep-seated pain. An eminent surgeon of Manchester was in the habit of ordering external friction with hog's lard, well mixed with opium, in cases of internal pain or spasms, either in the chest, abdomen, or lower extremities. The ointment of morphine (morphine mixed with hog's lard) and the ointment of belladonna (see UNGUENT, fol. BELLADONNE, in the New Medico-Chirurgical Pharmacopoeia,) have been used for this purpose, and the latter, with an addition of the white calx of mercury, has proved very beneficial in cases of inflamed glands, and in true scirrhous tuIt is a curious fact, that articles which invigorate the absorbent vessels, when topically applied, act more efficaciously when combined with articles that diminish the nervous energy. Anodyne vapour, as that of the decoction of poppy heads or opium, enters the system in such quantity as to disturb the head, and in this manner the vapour impregnated with the anodyne property of the hop, and even the air with its volatile parts, will succeed in