Musk was unknown to the ancients, and is said to have been introduced into Europe by the Arabians. It may be used for the general purposes of the nervous stimulants already detailed; and probably exercises their peculiar influence in a higher degree than any other of the class. It would appear to be specially applicable to cases in which severe spasm, or great nervous disturbance, is associated with a prostrate circulation.

Low Fevers. It was formerly much used in low fevers, with subsultus tendinuin, nervous tremors, and hiccough; and, so far as these nervous phenomena were concerned, it was no doubt useful; but its stimulant powers are inadequate to the demands of such cases, and it is now little employed.

Adynamic Pneumonia. M. Recamier has recommended musk in a certain condition which occasionally supervenes upon pneumonia, and is charactrerized by the occurrence of delirium, with a general failure of the vital forces, and dangerous prostration. MM. Trousseau and Pidoux have tried it, in similar cases, with favourable results, and are disposed to prize it highly under these circumstances. (Ibid., p. 223.) The condition alluded to is not that debility which attends typhous pneumonia, and may be supposed to depend on a depraved state of the blood. Neither is it that which comes on after the occurrence of the suppurative stage of the disease. It is one in which the nervous power appears to fail at once, and the general powers of the system to give way with it, as happens in sudden attacks of the pernicious state in our remittent miasmatic fevers. The last-mentioned writers have found it to occur in pneumonia of the upper lobe of the lung, which seems to be a preferable seat of the disease in adynamic cases. A few successive doses of musk have been sufficient to raise the patient out of this adynamic state, and to remove the delirium, after which the disease has followed a regular march towards health.

Pernicious Fever. It has been stated that the condition of pneumonia just mentioned was analogous to the pernicious paroxysms which sometimes supervene on miasmatic fever, in which the prominent Symptoms depend on vast prostration or disorder of the nervous power. From the experience of the highly authoritative practitioners above mentioned in these pneumonic cases, I would suggest the use of musk in the stage of collapse of our miasmatic pernicious or congestive fevers, in which the pathological state certainly affords a fair indication for its use. Though stimulant to the circulation than some of the medicines employed in this affection, it is very powerful in its influence on the nervous centres, which are probably specially in fault. It might be used in conjunction with the other remedies, and certainly, I think, could do no harm.

Gouty Spasms in the Stomach. Dr. Cullen speaks in very strong terms, from his own experience, in favour of musk in gout attacking the stomach; and there can be no doubt of its efficiency in spasmodic cases of this kind, whether retrocedent or original. If the spasm is accompanied with coldness of the skin and depressed pulse, and resists ordinary measures, recourse should always be had to musk, which should be given freely. Cullen recommends it in other cases of retrocedent gout; and, whenever the affection is spasmodic, or purely nervous, and the same depressed condition of the circulation exists, it may be employed with propriety; but it is contraindicated in the internal inflammatory attacks of that disease, and might do serious injury.

Painful Spasms of the Involuntary or Semivolunlary Muscles. In all cases of painful spasm of the muscles of organic life, as of the oesophagus, stomach, bowels, bladder, ureter, and gall-ducts, or of those conjointly of animal and organic life, as of the diaphragm, if attended with collapse of the circulation, and especially when other measures fail, musk may be used as one of the most powerful antispasmodics at command. But, as in the case of gout in the stomach, it must be given freely.

Infantile Convulsions from Intestinal Spasm. The late Dr. Joseph Parrish employed musk in this affection with great success; and, following his practice, I have found it extremely useful in similar cases of a very threatening character. A proper diagnosis, however, is all-important. In many of the convulsive affections of children, with strong determination to the brain, it would be not only useless, but injurious. In the cases referred to, the convulsions are frequently preceded by a sudden stiffening of the body, as if the child were in great pain, and sometimes by a quick piercing scream; and, if the abdomen be examined, it will generally be found more or less tympanitic. These convulsions are also strongly characterized by a sudden return of intelligence after they have ceased, instead of the protracted coma which is apt to follow those in which the brain is actively congested. The effect depends on a sudden impression made on the cerebral centres by the painful spasm of the bowels; and, under the disturbance of these centres. before time has been allowed for the occurrence of vascular irritation, the convulsive movements take place. In many cases the convulsions return frequently, from hour to hour, or even at shorter intervals, and the life of the child is in imminent danger. The musk may be given, in these cases, by enema; two or three grains being administered to children a year old, and repeated every two hours, if necessary.

Hiccough. Within my experience, there is no remedy or combination of remedies so efficacious in hiccough as musk; and, were its only recommendation the almost certain command which it has over this affection, it would be a highly valuable medicine. Ordinary hiccough is quite trivial; but sometimes, whether as an apparently original affection, or as an attendant on other diseases, it is extremely obstinate and troublesome, racking the patient, preventing sleep, and wearing out the strength by its constant agitation. I have known it to continue in this way for a week, resisting all ordinary measures, and reducing the patient almost to despair. So far as my observation has gone, and it has been somewhat extensive, musk has never failed to put an end to the affection, and in general very promptly. The only instance in which it did not effect an entire cure was an intermittent attack of the spasms, occurring in paroxysms at regular intervals. Musk always controlled the paroxysms, but they returned at the stated period, and were finally arrested by quinia. In another case, of an extremely obstinate character, I had used the remedy for twenty-four hours without effect; when, on examining the musk, I found it very feeble. Another parcel was sent for from a different quarter, and promptly arrested the affection. It was used in the ordinary dose.

Various Nervous Diseases. Musk has been commended in hysteria, chorea, epilepsy, tetanus, eclampsia, mania, and even hydrophobia, and has been employed also in asthma, hooping-cough, palpitations, cholera, and colic. It may no doubt be useful in most of these affections, under circumstances calling for the nervous stimulants; but it is probably in no case more efficacious than some other articles of the class, might under many circumstances prove injurious if not used with great discrimination, and has been abandoned generally by the profession after a fair trial. I need not say that it is altogether useless in hydrophobia. Its enormously high price when pure, and the great uncertainty as to the degree of its purity as it is kept in the shops, are also strong objections to its am, and have, no doubt, very much contributed to the neglect into which it has fallen. I would, however, urge its use upon the profession, in the affections in which it has been recommended above; namely, in obstinate hiccough, and the convulsions of infants from intestinal spasm, from my own experience; in painful spasms of the involuntary muscles with collapse of the system, especially when gouty, upon the authority of Cullen, and general experience; in the peculiar condition of pneumonia referred to, on the authority of M. Recamier and of MM. Trousseau and Pidoux; and in the collapse of the first stage of pernicious fever, upon the ground of reason and analogy.

Administration

Musk is given in substance; all officinal liquid preparations of it having been generally abandoned. The dose is from five to thirty grains; but the least quantity which should be given to an adult, as the drug is usually found in the shops, is ten grains; and this should always be increased, if found to produce no observable effect on the system. Should the dose occasion a feeling of weight, vertigo, or pain in the head, it ought to be somewhat diminished. It may be given in pill, or emulsion; in the latter form, being suspended in peppermint water or diluted cinnamon water, by means of gum arabic and sugar. Great care should be taken that no particle should be spilled when it is exhibited; as it will long scent the apartment disagreeably, and to some perhaps injuriously.