54 
PATHOLOGY. 
any Ample drink the patient prefers. It is ufual to begin 
with a final 1 quantity, increafing it more or lefs rapidly- 
according to the urgency of the fymptoms. However 
extraordinary thefe fads may appear, there are few Eng- 
!ifh praditioners who have not had opportunities of wit- 
neffing fimilar refults from the adminiftration of James’s 
powder. Indeed, fo great is the apparent caprice in the 
adion of this drug on the ftomach, and the variety in 
its evacuant effeds, that it would be almoft impoflible 
not to fufped an inequality in its preparation, without 
this key to explain the phenomena. Half a paper or a 
paper of the real James’s powder, repeated at ffiort in¬ 
tervals, has, in fome cafes of fever, appeared to be per¬ 
fectly inert, neither inducing vomiting nor perfpiration, 
though the tongue has been found moifter, and the fever 
abated, on the following morning. The author’s atten¬ 
tion was firft attracted to the faCt by the practice of a 
friend, who trufts efpecially to this remedy in the cure 
of fevers, notwithftanding the abfence of all fenfible ac¬ 
tion from it, except the very important one of the ame¬ 
lioration of the patient. 
The pofleffion of thefe faCts could not fail to have had 
a mod beneficial effeCt on the practice of phyfic, in a 
country whole climate developes inflammation with fo 
much intenfity and rapidity; but it has been far more 
extenfively ufeful in banilhing thofe dangerous errors of 
praflice which had crept in, through the Brunonian doc¬ 
trine of indirect debility, or of difeafes arifing in excef- 
five Itimulus being curable by ftill greater (limulation. 
In inflammatory difeafe, (no matter whether chronic or 
acute, no matter whether occurring in a vigorous or a 
debilitated fubjeCl,) excelfive ftinmlation is the caufe 
of malady; and the contra-llimulant remedies afford 
much more fuccefsful methods of cure than are to be 
hoped from wine, or ether, or any other ftimulant. 
Although the means employed by the contra-ftimulant 
phyficians may fomewhat differ from our own, yet the 
indications are generally the fame as are recommended 
by our bed authorities. There is a confiderable agree¬ 
ment between their views and thofe of Dr. Blackall, ref- 
peding the treatment of dropfy. In this fatal difeafe, 
the contra-flitnulant phyficians have to boaft of much fuc- 
cefs. It is a malady rendered very common in Lom¬ 
bardy by the prevalence of intermittents generated in 
the rice-grounds, and it feldom finds its way into the 
hofpitals till more or lefs extenfive disorganization has 
taken place: yet the mortality in the clinical wards of 
the Ofpidale Maggiore of Milan, during three years 
(1812, 13, and 14) that the contra-ftimulant practice 
was purfued there by profelfor Rafori, did not exceed -j^. 
A confiderable comparative fuccefs has refulted alio 
from the fame mode of treating confumption. The 
deaths in the regifter amount indeed to ; but, if the 
difeafe had been defined with any degree of accuracy 
in the entries upon the hofpital-journals, even this li¬ 
mited fuccefs is a matter of comparative triumph. 
The treatment of dyfentery is chiefly by camboge, 
given as a contra-ftimulant, the dofe being gradually in- 
creafed till it induces diarrhoea, which is confidered as a 
fign of the refolution of inflammation. 
With refped to acute difeafes, although the contra- 
ftimulant practitioners pufh their remedies further than 
was ufual under the other Italian fyftems, it may be 
doubted whether they do not yet flop fhort of a proper 
vigour. The average mortality of the clinical wards in 
the Ofpidale Maggiore, during three years, was lefs than 
11 percent, whereas in the other wards, where the older 
pradtice was followed, it amounted to 16 per cent. The 
total number of lick was 4853; that of the deaths, 520. 
Of thefe cafes, 1302 were pneumonies, confumptions, 
tabes, dropfy, typhus, and patients received in articuio 
mortis, of whom died 428. The deaths in pneumonies 
were an< ^ i' 1 typhus, This exceeds the deaths 
in the worft epidemics that have occurred of late years 
in England: That 22 per cent, in pulmonary inflamma¬ 
tions fliould be thought a fmall proportion, (every al¬ 
lowance being made for the ftimulating qualities of the 
climate,) feems to indicate an inefficiency of praClice, at 
lead as compared with that of England. It is not there-- 
fore improbable, that the employment of contra-ftitnu- 
lant drugs may have led to a partial abandonment of 
blood-letting, or, at leaft, to a confidence in fmaller ef- 
fufions of blood than are neceflary to cure the difeafe by 
a coup-de-main. The aCtion of tartar-emetic, however 
powerful, is flow; and, in acute difeafes, the firft twen¬ 
ty-four hours are moft important. It is not therefore 
impoflible, that this valuable time may be loft in the em¬ 
ployment of drugs, which, if given to a cure by the 
abllraClion of blood, might, in fome cafes, have faved 
lives, not fufceptible of refcue by the fame means when 
employed at a later period. From all I could gather, 
in repeated con verfations with Dr. Rafori, he feemed in¬ 
deed to be fufficiently alive to the importance of blood¬ 
letting; and I fliould make this remark with more he- 
fitation, if that phyfician did not feem to me to (land 
alone among his countrymen for boldnefs and decifion. 
Throughout the fouth of Italy, wherever I had the op¬ 
portunity of dired obfervation, 1 found the blood ta¬ 
ken, in inflammatory difeafe, lefs in abfolute amount 
than is now ufual among Englifli phyficians; and it is 
taken by fmaller and more frequent bleedings. It is 
not therefore improbable, that when the mind has been 
pre-occupied by another idea, the fame error may have 
occurred in the practice of more efficient phyficians. 
Of the contra-ftimulant theory, the part which feems 
the leaft perfedly developed, and concerning which there 
is the leaft unanimity, is that which relates to the action 
of particular drugs; indeed, there is no branch of me¬ 
dical inquiry more contradictory and obfcure among the 
phyficians of all feds and all countries : of this, the 
endlefs difputes on the adion of digitalis, in the medi¬ 
cal writings of the Britiffi praditioners, afford a ftriking 
inftance. Among the contra-ftimulant remedies are in¬ 
cluded, by fome perfons, all the mineral remedies, va¬ 
rious bitters, and (mirabile didu) the bliftering-fly it- 
felf. Rafori totally rejeds from the materia medica the 
clafs of diuretics, whofe adion heconfiders wholly con¬ 
tra-ftimulant : for, he fays, not only do droplies, cura¬ 
ble by fuch remedies, likewife get well by the ufe of 
other contra-ftimulants, not diuretic ; but thefe very diu¬ 
retic medicines do not provoke the fame difcharges in 
other difeafes; while, on the other hand, opium and 
ether produce diuretic effeds in dropfies, which arife 
from a real debility of the living fibre. From thefe fads, 
judging empirically, we niuft come to the moft oppofite 
and contradidory conclufions : but, in adopting the 
contra-ftimulant dodrine, the philofophical indudion 
is, that diuretics, and other fpecifics for dropfy, derive 
all their efficacy, and their fuppofed fpecific adion, from 
their relation to the general diathefis or conftitutional 
difeafe. 
One of the moft obfcure parts of the new medicine is, 
that which diftinguifhes between the irritative and con¬ 
tra-ftimulant effeds of drugs. Several of the contra- 
ftimulant drugs are, in certain dofes, of the moft acrid 
and irritating adivity: (not to mention cantharides,) 
nitre, the bitter purgatives, and moft mineral fubftances, 
excite, when taken in over-dofes, immenfe irritation, 
followed by fevere and fatal inflammation of the intefti- 
nal canal. Upon the fubjed of irritation, the theorifts 
have run into the niceft diftindions; one aflerting the 
exiftence of a' peculiar diathefis, produced by irritative 
flimulation ; while another denies the exiftence of fuch 
a diathefis. Some perfons, again, confider the irritation 
as a phenomenon fui generis, removable only by the 
removal of the caufe; while others hold the firft effed 
of irritation and of all pain, to be purely contra-ftimu¬ 
lant. In all this logomachy, there feems to be more in¬ 
tellectual fubtilty than pradical obfervation; and per¬ 
haps alfo no little precipitation in the claffification of 
3 particular 
