In enumerating the methods to be adopted for increasing the energies of a remedy, by rendering the system more susceptible of its action, it is right to know that, under certain circumstances, Venesection deserves a distinguished rank amongst the Adjuvantia. The fact is strikingly discovered in the exhibition of Mercurial[[252]] Preparations, and some other alterative medicines. Whether the “Vis Conservatrix,” which Nature, when in a state of health and vigour, opposes to the admission of poisonous substances into the circulation, be overcome by blood-letting, is a question which I shall leave others to decide; but thus much reiterated practice has taught me, that the system in a strong and healthy condition frequently is overcome the moment the stomach becomes deranged, the circulation languid, or the general tone of the system impaired. I have frequently seen this during my Hospital practice: if a patient who has been using mercurial friction, or taking the preparations of that metal without effect, be transferred into a close and unhealthy ward, his appetite soon fails, the tongue becomes furred, and the system instantly yields to the influence of the remedy. Nauseating doses of antimony[[253]] frequently repeated, or the accidental supervention of any disease of debility, will be attended with the same phenomena. My practice has also afforded me an opportunity of appreciating the debilitating effects of despondency in a case of this description; a patient had been taking mercurial medicines, and using frictions for a considerable period, without any apparent effect: under these circumstances he was abruptly told that he would fall a victim to his disease; the unhappy man experienced an unusual shock at this opinion, and in a few hours became violently salivated.[[254]]
Venesection, moreover, increases the effects of cathartic medicines. I have often noticed this fact in contending with a plethoric diathesis; whenever the bleeding preceded the purgative, the effects of the latter have been uniformly more speedy and considerable; in obstinate constipation the same fact has been observed, and mild remedies have been known to act more powerfully, when preceded by blood-letting, than potent ones have when exhibited antecedent to it. Venesection has certainly an extraordinary power in awakening the susceptibility of the primæ viæ to remedial impressions; in some diseases, as in the Cynanche Trachealis, or Croup, so great is the insensibility of the stomach, that Emetics frequently fail in their effects; and Dr. Hamilton has given as much as a hundred grains of Calomel in the twenty-four hours: in such cases previous venesection affords most extraordinary assistance. Dr. Fothergill also remarks that emetics are more beneficial after bleeding, (Dissert. Med. Inaug. de Emet. usu.) The effects of Bark, Steel, and other tonics, are certainly influenced in the same manner; whether in any case it may be prudent or judicious to have recourse to such a practice, is a question not immediately connected with the present inquiry.
Limited must have been the experience of that practitioner who has not frequently witnessed the utility of Venesection in producing a state of system favourable to the operation of various remedies. In acute diseases, how frequently does an opiate succeed in allaying irritation after copious bleeding, which could not be made to occasion any beneficial influence previous to that operation? In Pneumonia I have repeatedly seen such a plan of treatment act like a charm upon the patient.
Purgatives also awaken the susceptibility of the body to mercurial impressions, and it is remarked by Dr. Chapman that this practice affords a resource which rarely disappoints the practitioner. This class of remedies moreover seems capable of exalting the efficacy, and indeed of accelerating the benefit to be derived from many alteratives, when administered previous to the exhibition of these latter substances; the advantages of a course of Steel medicines are undoubtedly increased by such means. The febrifugous and antiseptic properties of diluted muriatic acid (see Form. 145.) are inconsiderable, unless its exhibition be accompanied with cathartics. I beg to refer the practitioner to some cases published by me in the Medical and Physical Journal for December, 1809, in further illustration of these views. Experience enables me also to state that Diuretics are considerably assisted by similar means, having many instances in my case book of the failure of these agents before, and their successful operation after, the exhibition of a cathartic. Dr. Darwin observes that “Absorptions are always increased by Inanition,” and in support of this position refers to the frequent advantage derived from evacuations in the cure of ulcers. I have certainly seen obstinate sores in the leg cured by small and repeated bleedings. Dr. Chapman arrives at the same conclusion, although by a different train of reasoning; he states that the blood-vessels and absorbents[[255]] are to a certain extent “antagonising powers:” instructed by this obvious fact, we ought, says he, in the exhibition of diuretics to regulate the state of the system by interposing purgatives, or even venesection, as the state of the circulation may indicate.
Emetics also, in certain conditions of the system, would appear to render the stomach more sensible to the impression of other remedies; Dr. Eberle, of Philadelphia,[[256]] has remarked such an effect with respect to the administration of the Peruvian Bark.
Change of Diet and of Habits may be also classed amongst the Ajuvantia, but the young practitioner must be warned that he is not to exercise his Caduceus as Sancho’s Doctor did his wand. I have seen a young disciple of Esculapius so vex his patient, that his food became more nauseous to him than his medicine, and I verily believe his Physician was more irksome than his disease. It was well observed by Dr. Percival that the prejudices of the sick should never be contemned with wantonness, or opposed with harshness; for, silenced by authority, they will operate secretly and forcibly on the mind, creating fear, anxiety, and watchfulness. And with regard to diet it may be here stated, that no function of the body is so materially influenced by mental impressions as that series of actions constituting what is termed Digestion—the unexpected communication of any distressing event destroys the keenest appetite,[[257]] and converts the sensation of hunger into one of disgust at the bare idea of food: a fact which did not escape the penetrating eye of our immortal Shakespeare, for he represents Henry dismissing Wolsey from his government with these words—
—— Read o’er this;
And after, this: and then to breakfast
with what appetite you have.
If feelings of disgust are excited by the repast, the stomach will never act with healthy energy on the ingesta; and in cases of extreme aversion, they are either returned, or they pass through the alimentary canal almost unchanged: on the other hand, the gratification which attends a favourite meal is in itself a specific stimulus to the organs of digestion, especially in weak and debilitated habits. Dr. Merriman has lately communicated to me a case which affords a striking illustration of the powerful influence of the mind upon these organs: a lady of rank labouring under menorrhagia, suffered with that irritable and unrelenting state of stomach which so commonly attends that disease, and to such a degree that every kind of aliment and medicine was alike rejected: after the total failure of the usual expedients to appease the stomach and procure relief, she applied to Miss Prescott, and was magnetised, when she immediately, to the astonishment of all her friends, ate a beef steak, and continued to repeat the meal every day for six weeks, without the least inconvenience! but the disease itself, notwithstanding this treacherous amnesty of the stomach, continued with unabated violence, and shortly afterwards terminated her life.