Pharmacologia / Fourth American, from the Seventh London Edition

by John Ayrton Paris

The diet of a sick person ought never to combine too much nutriment in too small a space;[^[258]] when so given it will even in health be followed by fermentation instead of digestion; and although we may admit the expediency of that domestic maxim, “a little and often,” yet this is to be received with limitation; no one, for instance, who possesses any philosophical knowledge, will adapt his practice to the notions of Sir William Temple, who asserted that “the stomach of a valetudinarian was like a school-boy, always doing mischief when unemployed,” and that we should therefore not allow it any interval of repose: to this I answer, that the conversion of aliment into blood is effected by a series of elaborate processes, several of which are only perfectly performed during the quiescence of the rest: it would seem, for instance, that the process of chylification is incompatible with that by which the first changes are produced in the stomach; this is evident from the well-known fact, that our appetite for food ceases when the former process commences, although the repast should, at the time, have been insufficient to satisfy the craving of nature; whereas, in diseases of imperfect, or depraved digestion, as in Diabetes, Tabes Mesenterica, &c. we find that the appetite for food is never satisfied by the most nutritive meals. It merits notice also, that whenever the stomach be called into action during the assimilating stages of digestion, the process will, in weak persons, be much disturbed, if not entirely suspended. These views have long since confirmed me in the propriety of treating mesenteric affections in a manner very different from that which is generally pursued; and I may add that the result has been very satisfactory. The plan to which I allude, consists in enforcing longer intervals between each meal, which should be scanty, and in quantity short of what the appetite may require; in this way are the unwilling absorbents induced to perform their duties with greater promptitude and activity; but it is a practice which, from the extreme anxiety of friends and relatives, the feelings of craving and hunger expressed by the patient, and the mistaken but universal prejudice respecting diet, it is always painful to propose, and generally impossible to enforce; where, however, circumstances have given a full and unreserved controul, the advantage of the plan has been most decisive.

There is still another remark which I am desirous of offering, in this place, on the subject of Diet; viz.—that in all cases of feeble or imperfect digestion, the Valetudinarian ought never to take his principal meal in a state of fatigue—and yet let me ask, whether there is a habit more generally pursued, or more tenaciously defended? Aye, and defended too upon principle—the invalid merchant, the banker, the attorney, the government clerk, are all impressed with the same belief, that after the sedentary occupations of the day, to walk several miles to their villas, or to fatigue themselves with exercise before their dinner, or rather early supper, will sharpen their tardy stomachs, and invigorate their feeble organs of digestion. The consequence is obvious,—instead of curing, such a practice is calculated to perpetuate, and even to aggravate the malady under which they suffer; by calling upon the powers of digestion at a period, when the body is in a state of exhaustion from fatigue. Often have I, in the course of my practice in this town, cured the Dyspeptic invalid, by merely inducing him to abandon so mischievous a habit.

II.
TO CORRECT THE OPERATION OF THE BASIS, BY OBVIATING ANY UNPLEASANT EFFECTS IT MIGHT BE LIKELY TO OCCASION, AND WHICH WOULD PERVERT ITS INTENDED ACTION, AND DEFEAT THE OBJECTS OF ITS EXHIBITION.

A. By Mechanically separating, or Chemically neutralizing, the offending Ingredient.

The scientific physician, from his knowledge of the chemical composition of a medicine, and of the principles upon which its different qualities depend, is enabled to remove or render inert the element which imparts to it a deleterious operation; thus it has been found that the peculiar principle in the Spanish Fly, which so frequently irritates the urinary organs, is soluble in boiling water; ebullition in water therefore offers the means of depriving it of the power of thus acting upon the kidneys, while it does not effect any alteration in its vesicatory properties. It is upon the same principle that many vegetable substances of a very acrid nature, become harmless by boiling, or by chemical manipulation, and some of them might even in times of scarcity and want, be introduced as wholesome and nutritious articles of diet. The experiments of Westring shew that the bitterness of the Lichen Islandicus may be entirely removed by maceration in an alkaline ley, and a tasteless, but highly nutritious fecula be thus obtained; in the same manner the Æsculus Hippocastanum (Horse Chesnut) may be deprived of its bitterness, leaving a residuum which will afford a kind of bread; and according to Parmentier (Recherches sur les vegetaux nourissans,) excellent starch may be also made from it. Dr. Darwin observes, that if the roots of White Bryony be rasped into cold water, and agitated with it, the acrid juice of the root along with the mucilage will be dissolved, or swim in the water; while a starch perfectly wholesome and nutritious will subside, and may be advantageously used as food; by a similar species of address the French prepare from the acrid Arum the harmless, but highly prized cosmetic, called Cyprus powder.

There are many substances which receive a much pleasanter mode of operation by having their solubilities increased or diminished; thus the griping occasioned by several drastic purgatives is obviated by the addition of some alkali: and the nauseating tendency of Camboge, which arises from its too easy solubility, is prevented by incorporating it with some insoluble body; as in the Pilulæ Cambogiæ Comp: but the farther consideration of this question will be resumed in the fourth section of the Analysis. (iv. c.)

Numerous attempts have been made to correct the inconvenient effects of Opium, such as nausea, head-ache, and costiveness, by removing the resinous element, upon which such evils have been supposed to depend, and we have accordingly been at different times presented with a variety of Formulæ for the accomplishment of so desirable an object; (see Opium). More recently, opium has been discovered to possess two active principles, viz. Morphia and Narcotine, which would appear from the researches of M. Majendie to exert very different powers upon the animal system; the former imparting to opium its soporific, the latter, its exciting property; whence it is proposed to remove this latter principle in order to render the operation of opium milder, and at the same time to divest it of those objectionable properties which so greatly limit its medicinal utility. See Opium.

B. By adding some substance capable of guarding the stomach, or system, against its deleterious effects.

The virtues of our most important remedies are frequently lost, or much invalidated, for want of proper attention to the circumstances comprehended in this section. It may be almost admitted as an axiom that whenever an ALTERATIVE medicine acts with violence upon the primæ viæ, its energies are uselessly expended, and the object of its exhibition defeated. So again, Diaphoretics, Diuretics, and many other remedies, suffer a diminution in their effects, whenever they stimulate the stomach or bowels to excess. Guaiacum thus loses its anti-arthritic, Squill its diuretic, and Antimony and Ipecacuan their diaphoretic, virtues; the action of these substances may therefore require correction, and a medicine must be selected capable of fulfilling that intention. Opium has very extensive powers as a corrigent. See Form. 57, 100, 106, 110. Dr. Mead combined alkaline salts, when intended to act as diuretics, with opium, in order to prevent their action upon the bowels. Acetate of Lead, when administered in cases of hæmopthysis, or uterine hemorrhage, should also be guarded by the addition of a small portion of the same narcotic. Dr. Sutton, of Greenwich, has lately written a paper to shew, that where we wish to limit the operation of an emetic to the stomach, and to prevent its action on the bowels, we should add five or six drops of laudanum to the emetic draught, which in his experience has answered the purpose in question.[^[259]] The griping and nauseating tendency of some remedies receives correction by the addition of Aromatic stimulants, or Essential oils, (69, 71, 78, 84, 85, 92,) or by small portions of a corresponding tincture, (70, 76.) It has been already stated, that the griping from Senna and resinous purgatives may be, in a great degree, obviated by the addition of alkalies; it remains to be observed, that the same remedies are also mitigated in severity, by saline purgatives, (77.) I learn from Sir Henry Halford, that in his practice he has found the addition of Extract of Hyoscyamus render the operation of the compound extract of Colocynth much more mild, and no less efficacious. Of the value of such a combination, I am myself able to bear ample testimony. Alum is corrected in its tendency to disturb the bowels by the addition of Nutmeg, (Form. 53,) or some aromatic; and the drastic operation of Colocynth may be mitigated by trituration with Camphor. There are several substances which are deprived of their acrimonious qualities by trituration with mucilage, milk, barley-water, &c. The tendency which mercurial preparations possess of affecting the bowels, is, with the exception of Corrosive Sublimate, corrected by Opium, but the acrid operation of this latter salt is more securely guarded against by the decoction of Guaiacum or Mezereon, or by the plentiful exhibition of mucilaginous drinks and broths. In certain diseases of the uterus and vagina, astringent lotions are indicated, but it may happen, as in the cauliflower excrescence, or in the oozing tumour of the labium, that such applications are too irritating; in such cases the effect of the lotion is corrected by the addition of mucilage. The enfeebling influence of Digitalis, Tobacco, and some other narcotics, is successfully opposed by aromatics and stimulants. It has already been stated that several attempts have been made to correct the operation of Opium by the application of mechanical and chemical resources; it would, however, appear that, for obviating its effects upon the intestinal excretions, the judicious addition of some purgative will offer the most effectual corrigent; and, according to my own experience, the Aloetic preparations are to be preferred upon such an occasion, as in Form. 11, 12, 13. In some cases, I have found that a combination of the watery infusion of Opium with some bitter, will secure the narcotic virtues without those consecutive effects upon the alimentary canal, which we are always so desirous to obviate; the Decoctum Aloes compositum also furnishes upon such an occasion a very appropriate adjunct. Let us remember that one of the effects of opium is to paralyse, for a time, the muscular fibres of the intestines: now experience has taught us that the remedies above directed have a peculiar tendency to augment the peristaltic motions of the primæ viæ. Upon the same principle the addition of calomel will prevent the paralysing influence of this narcotic upon the biliary functions. I have known several patients who could never take opium unless in such a form of combination.

In general, a formula contains but one corrigent; but circumstances may occur, where two different ingredients are required to obviate two very different effects, as in Form. 16, in which the Nitric acid is introduced for the purpose of counteracting the deleterious effects of the opium upon the nervous system, while the Aloetic preparation is calculated to obviate its particular tendency upon the alimentary canal.