If, however, we would diminish exhalation, we should employ cordials and tonics to support the action of the extreme vessels which convey the blood back to the heart. In this way we may suppose mercurials of use; and, it has certainly happened, that, in cases where there was no suspicion of obstructed liver, calomel and mercurial frictions have been of great service. Where such obstructions do occur, the use of mercurials is less equivocal. The employment of warm tonics is referable also to this head; and perhaps the oleum terebin-thinae and the mustard, may produce, in part, their effect from their stimulus. The more modern French physicians usually combine tonics with their evacuants, perhaps with propriety, except in cases of hydrothorax. Dr. Magennis has published in our own language an account of his practice, which induces us to mention his name; but various observations occur in the Me-moires de Medecine of the same tendency. Dr. Magennis gave the myrrh and ferrum vitriolatum with the squills; and Cornette and others give with the evacuants, bark and cordials. Bacher's tonic pills are referable to this head. The basis was black hellebore, whose acrimony he attempted to correct by repeated affusions of spirit of wine, and afterwards by Rhenish wine. The latter was supplied in proportion as it was imbibed by the roots, so as to continue covered, nearly six fingers breadth above them, for forty-eight hours. The whole was then boiled for half an hour, and the wine pressed out. The process was repeated, and the fluids added, inspissated to the consistence of a syrup. One part of the extract is then mixed with two parts of boiling water, and the whole again inspissated. This preparation of the pills is, he thinks of great importance, as the substances combined to form a mass must be both inviscating and soluble in the stomach. For this purpose an ounce of the extract is united with an equal quantity of an inspissated solution of myrrh, and the whole made into a mass with three drachms and a scruple of powdered carduus benedictus. "The pills contain a grain and a half each of this mass. He calls them evacuant and tonic; but they seem to act chiefly as evacuants. In his hands, and in those of Dr. Daig-nan, they succeeded: with almost every other practitioner they have failed; and are now little used in this country, though they maintain their credit on some parts of the continent.
In fact, therefore, as we have said, our chief object is to increase the serous evacuations, in order to assist absorption. This is most successfully performed by increasing the evacuations from the mouth and salivary glands; from the skin; from the stomach; from the intestines, and the kidneys.
Some few solitary instances of spontaneous salivation proving a remedy for dropsy, have led to the use of mercury for this purpose. Yet as mercurial salivation is not only a severe remedy, but a frequent cause of dropsy, it has not been followed. When obstructed perspiration is a cause, sudorifics have been employed; yet these weaken the system, in general, too much, if persisted in for the time required in this disease. We have, however, before us a man who laboured under a dropsy twenty-five years since, from working in a river: all the remedies failed till he took Dover's sudorific powder, which succeeded, and he has had no return. In this long interval it is, however, a solitary case, though the same plan has been often tried.
Some instances also of water having been evacuated from the stomach, have led to the use of emetics. These are indeed remedies of importance for promoting absorption, independent of the evacuation they produce. In the general cases of dropsy, they are inadmissible from the debility of the patient, and from their preventing a proper supply of nourishment or cordials. We find few instances of their use, and fewer of their efficacy.
The discharge from the intestines we consider as of the greatest service in dropsy; and, indeed, we cannot say that the cure has in any case properly succeeded where this discharge has not accompanied the others. Sydenham advised purgatives every day, unless too great weakness prevented their use. In the operation of purgatives, however, this distinction must be made. If accompanied by violent colics, and an inconsiderable or a disproportioned discharge, weakness is the consequence, and the remedy must be discontinued; but if they operate without pain and inconvenience, and if the stools are watery, whatever the number may be, weakness does not follow. It should be the physician's business, then, to attain this end by his choice of the medicine. The saline purgatives are the most obvious ones; but in general the quantity necessary, and the large proportion of fluid to convey them, prevent their exhibition. The sal diureticus, the salt most generally employed, has been perhaps preferred from its name, and indeed seldom acts without assistance as a purgative. The cremor tartari is more common, and has been highly commended; yet, alone, the necessary dose is too large, and we have been induced to join with it a proportion of jalap, a medicine preferred as, in small doses, sufficiently mild, and as supposed to combine diuretic powers. Yet, with many persons, this medicine must be still further quickened; and a convenient addition is the gutta gamba.
In the list of cathartics, we find the more acrid kinds distinguished by the name of hydragogues, expellers of water. This is, indeed, the characteristic of many of the resinous purgatives; so that what we have said of the milder kinds is rather cautionary than strictly necessary. Of those hydragogues, the elaterium (the inspissated juice of the wild cucumber),the colocynth, the gutta gamba, are the chief; and next in order are the scammony, the jalap, and the seneka. A formula of Dr. Dover is powerfully hydragogue; it consists of four parts of scammony; crude antimony, and sulphurated steel, of each one part: and from a scruple to half a drachm is a powerful dose. Of these, the elaterium and the colocynth alone appear too stimulant. They have seldom succeeded in procuring watery stools with-sut greatly irritating and weakening the patient. Gutta gamba succeeds better; but this beyond a grain or two produces sickness, languor, and faintness: and it seems more useful in rendering other purgatives active than given alone. Scammony holds its rank as an ingredient in Dover's formula, and is not often employed alone. The seneka is highly recommended by Dr. Milman; but he proposes only half an ounce or six drachms of the root to a pint of the decoction, instead of an ounce formerly directed by the Edinburgh college; and his proportion is, in the late edition, adopted. It is an active purgative, and said also to be diuretic. The jalap is the remedy most commonly employed. It is remarked by Lewis that the watery infusion is diuretic, and the spirituous tincture cathartic; and this has been repeated by every author, without having tried the experiment. On trial we have found no such effect from the infusion; and the tincture of jallap, or its resin; has appeared to us the best preparation. Combined with soap, in pills, the resin has not appeared too virulent.