8 MEDICINE. 



fnctiw. must also bear in mind, that there are cases in which 

 . "' they indicate some local affection of the part or or- 

 gan in which, although symptomatic, they are import- 

 ant, as indicating the existence of the primary affection, 

 or assisting us in ascertaining its nature. Thus, a mor- 

 bid increase of appetite, which is denominated Bulimia, 

 is sometimes merely a symptom of Diabetes, and can in 

 no degree be relieved by any palliative remedy ; while 

 at other times it originates from a disease of the stomach 

 itself, which may be either structural or functional, and 

 will of course acquire its appropriate mode of treatment. 

 In the rapid sketch of the practice of medicine which 

 we propose to offer to our readers, it will not be in our 

 power, nor would it accord with our plan, to examine 

 each of these affections in detail. 



TTMtmem. With respect to the method of proceeding in their 

 management, the first point is to ascertain how far the 

 disease is primary or symptomatic ; if primary, whether 

 it depends upon a local cause of a mechanical nature, 

 upon a visible alteration of structure, or upon an ef- 

 fect which operates through the medium of the system 

 at large. If they are symptomatic, we inquire whether 

 we are able to remove them by removing the primary 

 disease, or by remedies appropriated to the removal of 

 the nervous affection itself. It is not easy to lay down 

 any general principles of treatment in a class of affec- 

 tions, which are so various in their origin, and depend 

 upon such a diversity of causes. There is scarcely any 

 condition of the system by which they may not be ex- 

 cited ; and with respect to individual symptoms, they 

 bear so little relation to their cause, that our judgment 

 must be formed more from the general history of the 

 case, and from a number of circumstances connected 

 with it, than from any train of morbid actions which 

 can be 'detailed, as constituting the essential character 

 of the disease. The opposite states of plethora and in- 

 anition, of excitement and of quiescence, sometimes pro- 

 duce what appears to be the same complaint, and must 

 of course be combated in the individual cases, at one 

 time by depletion and by sedatives, and at another 

 by nutrients and stimulants. Generally speaking, how- 

 ever, we think that the modern practitioners have lean- 

 ed too much to the latter class of remedies, biassed by 

 their hypothesis of debility, which they have applied 

 with so little discrimination to such a variety of dis- 

 eases, and anxious to avoid the errors of the older wri- 

 ters, who ascribed nervous complaints to the affections 

 of a subtile fluid, the existence of which they unfortu- 

 nately neglected to ascertain before they assumed it as 

 the basis of their patholbgy. We shall farther remark, 

 that what are styled nervous diseases, are much more 

 frequently than is commonly supposed, symptomatic of 

 derangements of the digestive organs. Some remark- 

 able examples of the effect which peculiar states of the 

 alimentary canal produce upon the brain and nerves, 

 are generally known ; of which one of the most import- 

 ant is Hydrocephalus, and we are daily accumulating ex- 

 perience of the same kind, with respect to Epilepsy and 

 various kinds of convulsions, when not proceeding from 

 local or structural causes. Purgatives will therefore be 

 always indicated in the Hyperaesthesia?, if not by the 

 immediate symptoms, at least as a means which is to 

 be always tried, even although we proceed entirely 

 upon empirical grounds. 



F.iliil.hion After we have duly considered how far depletion 

 i XMU- may be indicated, and removed all local sources of irri- 

 tation, we then proceed to the exhibition of sedatives, 

 of which opium may be regarded as the prototype, and 

 tbat which, for the most part, supersedes all the rest. 



The method in which this medicine operates, and the Practice. 

 immediate effect which it produces, have been the sub- S ~ P "Y~~*' 

 ject of many volumes, and have formed the ground- 

 work of some of the most violent and angry controver- 

 sies of modern times. We have no space, nor indeed 

 have we any inclination, for entering into these dis- 

 cussions ; we shall merely state our opinion, that the 

 operation of opium is primarily upon the nervous sys- 

 tem, and that it acts upon it as a sedative. Its agency 

 is equally extensive with the nervous system itself, and 

 it is consequently experienced through the medium of 

 so many organs and functions, that we have seldom an 

 opportunity of witnessing its unmixed sedative powers, 

 without, at the same time, observing some secondary 

 effect, which may diminish, or even entirely counteract 

 the primary operation. Thus, by lessening the sensi- 

 bility of the intestines, opium tends to produce costive- 

 ness, and this retention of the faecal evacuations may 

 prove a greater source of irritation in certain cases, than 

 the symptom for which the opium was administered. 

 It is principally, perhaps, from this circumstance, that 

 there is no remedy which is more uncertain in its effects 

 than opium ; and besides this, different individuals have 

 remarkable idiosyncracies with respect to it, which of- 

 ten interfere with the best regulated plans of the prac- 

 titioner, and which cannot possibly be learned, except 

 by a previous knowledge of the individual constitution 

 of the patient. 



Opium, when given in too large a dose, in an impro- 

 per state of the stomach, or indeed to certain indivi- 

 duals under all circumstances, produces effects which 

 are very similar to those of the vegetable poisons ; and 

 on this account, it has always been a favourite subject 

 of inquiry to discover a medicine which might possess 

 the mere sedative effect of opium, without its delete- 

 rious properties. Hyosciamus, hop, the extract of let- 

 tuce, and other substances, have been proposed ; but it 

 may be doubted, whether every benefit may not be 

 gained by a sufficient reduction of the dose of the opi- 

 um. Various preparations of opium have also been 

 tried with the same intention ; and upon one of these, 

 called the black drop, in which the medicine is com- 

 bined with a strong vegetable acid, great commenda- 

 tions have been bestowed from sources of very high 

 respectability. 



SECT. II. Hydropliobia. Canine Madness. 



Notwithstanding the acknowledged obscurity which Hydropho- 

 exists respecting the nature of this disease, we do not bio- 

 hesitate to place it in the genus Hyperaesthesia, as we 

 think that the only consistent and probable hypothesis 

 of its pathology proceeds upon the supposition of its 

 originating in an increased sensibility of the nervous 

 system. The exciting cause is well known to be a 

 specific contagion, communicated by the bite of a rabid 

 animal, and it appears to be always produced by means 

 of the saliva being conveyed through the absorbents 

 into the circulation. We conceive that the disease 

 never originates in the human species from any other 

 cause, although certain symptoms, in some measure re- 

 sembling it, may have proceeded from other circum- 

 stances, but these we shall be disposed to refer to Hys- 

 teria. The question is not so easy to answer, whether 

 Rabies be capable of being produced in other animals 

 besides those of the dog and cat genus, although these, 

 when affected, may communicate it to others, as to the 

 human species, to horses, and to oxen. The disease 



