3226. In Tetanus, The Use Of Stimulants Was First Proposed By Dr

Rush,* who, considering that the disease was essentially one of debility, advised Brandy, Wine, Ammonia, Bark, &c. In America, this treatment has been much followed, and cases which recovered under their use are recorded by Drs. Hossack, Wright, Currie, Bright, and others. In one case recorded by Dr. Currie, the patient took 140 bottles of wine, besides ale and brandy, in less than a month. The man recovered. Notwithstanding these successful cases, the unsuccessful ones far overbalance them; and stimulants are rarely trusted to alone, at the present day. They have also been recommended in Hydrophobia, but no reliance is to be placed upon them.

3227. In Delirium Tremens, the cautious use of stimulants is often not only advantageous, but necessary. In old habitual drunkards, the total withdrawal of spirituous liquors is almost certain to be followed by an increase of all the symptoms, and in some cases by great and even fatal debility. The quantity must be regulated by its effect; and that stimulant should be preferred which the patient has been in the habit of taking. When the attack, however, comes on in young men in whom the habit of drinking is not confirmed, or if it supervene after a single debauch, the employment of stimulants is not so necessary, and must be left to the judgment of the practitioner.

3228. Dissection Wounds, when the attendant fever, &c, assumes an adynamic form, require a liberal use of stimulants, Wine, Bark, Spices, &c. If the tongue and mouth be parched, Camphor or Turpentine should precede the use of these stimulants, and it will be necessary to administer these in forms of combination suited to the circumstances of the case, chiefly with the view of rousing and supporting the energies of life, changing the state of morbid action, and thereby preventing the extension of the local mischief, and the tendency to contamination of the fluids and solids of the frame. The diet should be nutritious and stimulant. (Dr. Copland.) In Snake-bites, the free use of stimulants is most important; the quantity should be regulated solely by the effects produced. In America, we are told by Dr. Addy,§ alcoholic stimulants are given to the extent of intoxication - a state which is regarded by the practitioners there as evidence of the effects of the poison being overcome. Dr. Addy relates a case in which the patient was entirely relieved by the free use of Whiskey.

* Trans. of Amer. Philosoph. Soc., vol. ii. Med. Reports, vol. i. p. 148.

Dict. Pract. Med., vol. i. p. 306. § Dub. Med. Press, March 30,1859.

3229. Styptics are agents which, locally applied to bleeding surfaces, possess the power of arresting the hAemorrhage. They are to the external surface what astringents are to the internal. They include a large number of substances, as Alum, the Sulphate of Copper, the Nitrate of Silver, Matico, Liq. Ferri Per-chlorid., &c. Ice is a powerful styptic; and cold air, allowed to have free access to the bleeding surface, all coagula being carefully removed, is stated to be no less efficacious. Mr. Skey* relates numerous cases in which the last measure was successful, after a variety of other styptics had been applied in vain. Its simplicity is a great recommendation to its adoption. (See also Astringents.) They act either by constringing the blood-vessels, or by coagulating the albumen of the blood.

3230. Suppositories are medicinal substances, of a pillular consistence, introduced into the rectum, and there allowed to remain until dissolved. They demand a short notice, as there are one or two points connected with their employment which are of practical value.

1. Care should be taken that the substance is properly inserted into the rectum, otherwise it will increase instead of diminish the sufferings of the patient. If it be only placed within the anus, under the influence of the sphincter muscle, it will produce an aggravation of all the symptoms; while if it be passed into the bowel, above the sphincter, it will speedily produce the desired soothing effect. (Mr. Bransby Cooper, ) The best way of introducing it is by means of a hollow tube, with a moveable rod inside; the bolus can thus be introduced high above the sphincter, which cannot be conveniently done by the finger.

2. Suppositories, whether opiate or purgative, should always be combined with soap, which facilitates their solution, and renders their operation more speedy, certain, and mild.

3. They will occasionally be retained, if properly inserted, when enemas are instantly expelled; although, in the majority of cases, they are of inferior efficacy.

3231. Tonics are medicines which improve the tone, not only of the muscular system, but of the digestive organs, the nerves, and the constitution generally. Their operation is in all cases gradual. They hold a middle place between Alteratives and Stimulants. From the latter, however, they differ in producing a comparatively slight amount of excitement, unaccompanied by subsequent depression, and producing a more permanent tonicity in the system. In some respects, they approach nearly to astringents, but are slower in their action.

* Brit. For. Med. Rev., April 1851.

Lectures, Med. Gaz., Nov. 24, 1848.

Their mode of operation is various. Some, as the pure vegetable bitters, act upon the stomach, and by improving the tone of the digestive organs, exercise a beneficial action on the system at large. Others, as the salts of Iron, act specifically upon the blood, enriching it with hAematin and globulin, and thus invigorate the muscular tissues; whilst a third class appears to act specifically upon the nerves. Their immediate operation is obscure, but we have good examples of their efficacy in the Nitrate of Silver, the Oxide of Zinc, and Ammoniated Copper, in Epilepsy, Chorea, and other nervous affections. Strychnine and Brucine, although often classed as tonics of the nervous system, more properly belong to stimulants.

They are indicated - 1, in all cases of debility unattended by inflammation; 2, in Dyspepsia; 3, in anaemia; 4, in many convulsive diseases; 5, in convalescence after fevers.

Contra-indications. 1. Plethora. 2. Active Inflammation. Dr. Paris observes of tonics, that, if given when the powers of the system are at their maximum, they will assume the character of excitants, and that their administration will be followed by collapse.

S232. Water. In the article Baths, many of the effects and uses of water, hot and cold, have been considered; but there are other important therapeutic uses to which it is applied, which deserve separate notice.