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An Introduction to the Study and Practice of Medicine. By JOHN DOWSON, M.D. London, 1834. 12mo. pp. 96.
THIS is a very harmless little book, probably intended for distribution among the author's circle of friends: should he reprint it, we would recommend him to enlarge it considerably, as ninety-six very tiny pages on such a subject leave no room for doing justice even to the most important points. The following passage, which our author quotes from Parkinson, is a curious example of a commonplace truth so distorted by exaggeration that the fact can scarcely be recognised amid the embellishments.
"You must have observed how late it is before a physician gets into full practice; and that few of them begin to derive any advantage from their profession until they have arrived at that time of life at which men engaged in business, or mercantile concerns, have generally acquired a handsome fortune. Indeed it almost seems that many think a physician too young for consultation, unless he has reached his dotage: I have myself known a physician, above fifty years of age, objected to for his youth.” (P. 64.)
These objectors to a younker of fifty must be very hard to please they would allow, perhaps, that a physician who had numbered threescore years and ten might be trusted with slight cases, but they would hardly give their full confidence to any but a Heberden in his ninetieth year, or a Glisson in his hundredth. We suspect, however, that the unfortunate quinquagenarian in the text must have been afflicted with a sleek and chubby face; though it is strange that the atrophy of the purse, the entire and absolute unconsciousness of a fee, which Mr. Parkinson affixes on our younger brethren, should not have planted a few wrinkles on the halest cheek. But some men are born stoics.
On the Classification, Administration, Modus Operandi, and Combination of Medicines. By J. STEVENSON BUSHNAN, F.L.S., Surgeon to the Dumfries Dispensary, &c.
1. Classification of Medicines in general.
THE medicines commonly employed in the treatment of diseases are derived from all the three kingdoms of nature, and may be conveniently classed according to the particular effects which they in general produce; while these classes may be further arranged in the order of the organs on which they appear severally in general to act. The chief classes of medicines commonly enumerated are the Errhines, acting principally upon the nostrils; the Sialogogues, upon the salivary glands; the Demulcents and Expectorants, upon the lungs; the Emetics, upon the stomach; the Purgatives and Carminatives, upon the intestines; the Diuretics, upon the kidneys; the Emmenagogues, upon the uterus; the Diaphoretics and Epispastics, upon the skin; the Astringents, upon any of the foregoing organs: and the Stimulants, Tonics, Antispasmodics, Sedatives, and Narcotics, upon the spinal marrow and brain. The Antacids and Anthelmintics, which act, the former in neutralizing acid matters in the stomach, and the latter in destroying intestinal worms, cannot, with propriety, be referred to any particular organ.
The above classification of medicines, although convenient for practical purposes, and to a certain degree precise, is at the same time quite artificial, and most indefinite and arbitrary. To say nothing of the long and violently agitated question respecting the primarily stimulant or sedative operation of certain medicines, and which, according to the different views which any two persons might choose to take of it, would appear to justify them in placing the same medicine under two diametrically opposite classes, there are numerous substances, such as ipecacuanha, assafoetida, digitalis, opium, antimony, and mercury, which, without any sophistry, may with equal propriety be referred to almost any class. Thus, ipecacuanha, according to the quantity in which it is given and other circumstances, is either an expectorant, an emetic, a purgative, a diuretic, a diaphoretic, a tonic, or an antispasmodic; and opium (though it belongs neither to
the class of purgatives nor astringents,) may be given to fulfil, not only very different but directly opposite indications, as that of opening the bowels in colic, and of binding them in cholera. Alum also, (a generally admitted astringent,) when given in large doses, frequently purges; and something similar may be said of almost every individual medicine; but it will sufficiently appear from these examples how abortive must be every attempt to make any thing like a precise classification of medicines on such principles, and how essential it is therefore to study the action of each in detail, without being much influenced by the place which it occupies in generalizations which nature refuses to acknowledge.
But, imperfect as these principles confessedly are, they are perhaps the best which the nature of the subject will admit, and certainly much better than those formerly adopted.
By the ancient physicians, the several articles of the materia medica were spoken of, in conformity to the system of pathology then in vogue, principally according to their supposed virtues of determining the fluids to and from certain parts, of promoting the desired concoctions of morbid matters, of drawing abscesses to an head, or evacuating their contents, of stopping hæmorrhages, uniting wounds, cleansing and healing ulcers, and so forth; and, even after the revival of letters, the same views prevailed among the early writers on the materia medica. At that time the majority of diseases was attributed to an "aparia," consisting in an inordinate flow to certain organs of the one or other of the four principal fluids of the body, the object of which was supposed to be to promote the concoction and subsequent expulsion of certain crude morbific matters, imagined to be collected in these organs, against which, as against an invading power, these fluids were detached by the conservative principle of the body. Hence arose the well-known axiom "ubi irritatio, ibi fluxus;" and it was only, or chiefly, for the purpose of co-operating with these supposed salutary operations of nature, that medicines in general were formerly administered.
These views alone prevail in the writings of Bauhin, Columna, Fallopius, and the other early writers on the materia medica in modern times; nor was the system of things much improved by the addition of the antalkaline and antacid remedies of the chemists, or the inspissants and attenuants of subsequent pathologists. It was only gradually that medicines came to be arranged upon the principles now commonly adopted; the writings of Boerhaave, Gaubius, and De Gorter, and even those of Cullen, Vogel, Murray, Young, and others, being still considerably adulterated with the notions
so long before prevalent on the subject; but it is still chiefly to these authors that we owe the establishment of the principles which, imperfect as they are, are perhaps, as I have already said, the best of which the subject is susceptible. How utterly idle, however, must be every attempt at a perfectly precise arrangement of medicines "after their kinds," upon the basis of their supposed effects upon the body, is sufficiently obvious, not only from the nature of the subject itself, but from the discordant, unnatural, and unintelligible systems which many of the labourers in this visionary vineyard have left behind them. "Des moyens identiques," says Bichât, ont eu souvent des noms différens, suivant la manière dont on croyoit qu'ils agissoient. Deobstruent pour l'un, relâchant pour l'autre, refraîchissant pour un autre, le même médicament a été tour à tour employé dans des vues toutes différentes, et même opposées."
2. Administration of Medicines in general.
Medicines, whether solid, liquid, or aëriform, may be administered by numerous different avenues. They may be either snuffed up by the nostrils, or applied to the eyes in the manner of collyria, or to the mouth by chewing, gargling, fumigating, rubbing into the gums, &c., or inhaled by the lungs, or even injected into them by an opening made into the trachea; or they may be swallowed, or injected into the rectum as a clyster, or inserted into it as a suppository, or injected into the urethra or vagina; or they may be applied to the skin in the form of fomentations, poultices, lotions, baths, &c., or introduced through the skin by friction, or by continual contact; or, lastly, they may be applied to a blistered surface, or inserted into a wound, or injected into a vein.
The most ancient way of administering medicines is probably by the skin, to which they were applied in combination with oils, the external use of which was in the primeval ages so universal. The custom, also, so common among the ancient Egyptians, and their successors, of burning resinous and aromatic substances, as well in their religious ceremonies as for the purpose of purifying the air, would soon give rise to the use of fumigations by the mouth, and inhalations by the lungs. We find that, so early as the time of Homer, the vapours of sulphurous acid were in common request for purifying the air after sickness and death; and, during the celebrated plague of Athens, (430 years before Christ,) we are told that strong perfumes and immense fires were used as a chief prophylactic remedy; and it is to these practices that we must ascribe the early use, both by Egyptians and
Greeks, of the vapours of bitumens, pitch, sealing-wax, sulphur, and similar substances, in diseases not only of the fauces, but of the lungs; a practice revived in 1664 by Bennet, and continued by Willis, Mead, and many others, down to our own times. Similar fumigations were formerly often employed by the vagina as emmenagogues. The administration of medicines by the mouth is said to have been suggested to the ancient Egyptians by dogs and apes; the former having been observed to take grass as a vomit, and the latter the pulp of cassia as a purge, as often as their constitutions required these reliefs; and the first use of clysters among them is reported by Herodotus to have been merely an improvement upon the practice of the ibis, which is in the habit, when in the water, of clystering itself with its long beak. The use of masticatories, or local sialogogues, has from time immemorial been prevalent in all warm climates as a luxury-sometimes the betel leaf or areca nut, at others quicklime, being employed in this way—and such substances, therefore, would of course be sometimes used medicinally; and, although we do not hear of the habitual use of any kind of snuff before the introduction of tobacco, (and indeed the old prejudices against blowing the nose were incompatible with such a practice,) we know that errhines, and some antispasmodics, administered by the nostrils, were favourite remedies with Hippocrates. In like manner, gargles, suppositories, injections by the vagina, and medicinal pessaries, (a method of administering medicines at present almost entirely discontinued,) as well as baths of medicated waters and oils, and general fumigations of the body with the vapours of sulphur and various other substances, as recently recommended by Dominiceti, Gall, and others, were in common use among the ancients, together with certain other practices, such as that of pouring medicines into the ears, which is mentioned by Aretæus and Cælius; "quo per sensuales vias ad membranas cerebri recorporativa virtus adveniat," and the memory of which Shakspeare has immortalized:
"Sleeping within mine orchard,
My custom always in the afternoon,
The leperous distilment."―Hamlet, act i. scene 5.
Perhaps, therefore, the chief, or only new methods of administering medicines, are by friction upon the skin, injection into a vein, friction upon the gums, injection into the lungs. by the trachea, insertion into a wound, and application to a blistered surface. Of these, the practice of introducing