ACTION OF DOVER S POWDEIl AND PICKOTOXINE. 005 



health, Dover's powder is a powerful sudorific, but it frequently 

 arrests, in the most satisfactory manner, as Dr. Murrell has 

 shown, the night-sweating of phthisis.* 



This seems at first sight extraordinary, and yet it is quite 

 natural if the view which I have advanced regarding the patho- 

 logy of night-sweating in phtliisis be correct. For the opium,, 

 by lessening the irritation from cough, will tend to prevent the 

 exhaustion of the respiratory centre. At the same time ipecacu- 

 anha is a powerful stimulant to this centre, and thus we have 

 in Dover's powder two of the actions that we have already 

 observed in atropia, viz., a power of diminishing irritation from 

 the lungs, with a power of increasing the activity of the respira- 

 tory centre. Unlike atropia, it does not paralyse the peripheral 

 terminations of the secretory nerves in the sweat glands. 

 Picrotoxine, also, has been found to be useful in night-sweating. 

 It also is a powerful stimulant to the respiratory centre 

 (Biichheim, Arzneimittellehre, 3te Aufl.), and probably it is by 

 its stimulating action upon this centre that it arrests sweating. 

 Butw^hile it is probable that the night-sweats of phthisis chiefly 

 depend upon exhaustion of the respiratory centre, and are to be 

 arrested by stimulation of this centre, we must bear in mind 

 that this may not be the only cause of such sweats. They may 

 occur through stimulation of the sweating centres by increased 

 temperature as well as by increased amount of carbonic acid 

 in the circulating blood. In such circumstances quinine will 

 probably be the best remedy, as Dr. Murrell has pointed out 

 (op. cit). 



One of the great difficulties which we have to contend with 

 in medicine is that of choosing the best drug in each particular 

 case. Much may no doubt be done by very long experience,, 

 but it is hard, even for an old physician, and almost impossible 

 for a young one. The only way in which this difficulty can be 

 surmounted is by our obtaining an accurate knowledge of tlie 

 pathology of disease, and of the mode of action of the remedies 

 which we employ. In the night-sweats of phthisis atropia is pro- 

 bably the most powerful remedy which we possess, and we can 

 well see how it should be so, for it combines the power of 



* Fraciiiioner, vol. xxiii, p. 195, September, 1879. 



