I have already sought to show that the metallic substances which are used in the treatment of spasmodic disorders act in the blood, and tend to establish in it a set of actions of a peculiar kind. I am able to add little respecting the rationale of their action to that which I have said of the operation of Catalytic medicines in general. It is certainly very mysterious; and it is perhaps mainly on this account that some have been induced altogether to deny it. But a denial so grounded is disingenuous and wrong, for we must often be content to know and to receive many things that we do not understand.
Perhaps the most evident and characteristic of these agencies is that of Nitrate of Silver in the cure of Epilepsy. The Acetate of Lead, and the Ammonio-sulphate of Copper, have been used with advantage in the same disorder. Dr. Babington strongly recommends the Sulphate of Zinc, given at first in small doses, and then gradually increased, so that it may not produce vomiting.
In the treatment of Chorea, Arsenic is highly esteemed and recommended by Dr. Pereira.
In Hysteria these medicines are all probably more or less applicable; but on account of the obstinate and multiform nature of this disease, their use in it is less obvious than in Epilepsy and Chorea. Hysteria, too, is more under the influence of Nerve-medicines than are the other two diseases.
The great objection to Silver, in whatever form given, is that its salts are liable to be reduced in the system, and it thus tends to produce a permanent discoloration of the skin, either browning it or communicating to it a dull leaden hue. This naturally constitutes a strong ground of objection with the unfortunate patient, who would often prefer to be left alone with his fits than to be turned blue for life.
M. Georget supposes that the advocates for the use of Nitrate of Silver in Epilepsy employ it on the principle of counter-irritation, saying that they attempt to cure a diseased brain by cauterizing the stomach. (Physiology of the Nerv. System, vol. ii. p. 401.) But I am not aware that any English therapeutists have adopted this view of its mode of operation. The dose of the Nitrate of Silver, and the state of dilution in which it is given, would certainly prevent it from manifesting any such action. And we should not be warranted in supposing that any of the medicines of this or any other order of Catalytic remedies could act in so direct and so easy a way as that, even if it were thus possible.
Some have supposed that Nitrate of Silver cures Epilepsy by diminishing an irritable condition of the stomach. But it is observed by Dr. Pereira that the existence of this irritability in all cases of Epilepsy is a mere assumption. The solution of this salt exerts, according to its strength, an astringent or caustic action on all mucous surfaces, and thus improves their condition when they are relaxed, inflamed, irritable, or ulcerated. The occasional benefit which follows the administration of the preparations of Silver in Gastrodynia may be referred to an action of this kind. The action of Arsenic in some intermittent varieties of this painful affection has already been mentioned, and is explained in another way. Caustic substances probably act locally in these cases; but Arsenious preparations exert an Antiperiodic influence in the blood generally.
Tetanus is by far the most incurable of these convulsive disorders. Arsenic and other medicines of this order have been recommended in the treatment; but although some cases appear to be partly connected in their first origin with a certain condition of the blood, this disease is very little under the influence of blood medicines, or indeed of any medicines at all.