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PAPERS
*

ON THE

ifinttrtahitg ai

tjje

materia

Jjjebiea,

READ BEFORE THE MEDICAL SOCIETY OF SAN FEANCISCO,

By CHAS. W. BRINK, M.

"v>

...

*,

15.5x3

D.

1854,

PAPER
ON THE

UNCERTAINTY OE THE MATERIA MEDICA,


READ BEFORE THE MEDICAL SOCIETY OF SAN FRANCISCO,

BY CHAS. W.

Mr. President

D.

I am not ambitious of intruding upon the atten-

tion of the Society, nor

moments

BRINK, M.

1S51,

would I now ask

indulgence for a few

its

some hastily written reflections upon the


Materia Medica, were not the subject an inte-

whilst I read

Uncertaintrj

resting one

of the
and further, that

I think it the duty of

members

to

contribute something, from time to time, for our mutual benefit.


Feeling, however,
instruction,

it

is

more willing

to receive,

than able to impart

with great deference that I submit the following

desultory thoughts.
It

is,

I believe, generally conceded that learning, pedantry,

and

scholastic egotism, are as often the direct objects of medical con-

troversy, as the elucidation of principles, the improvement of practice,


or the development of truth.

Physicians too often study abstractions, overlooking that which


practical

that which

As

that which amuses the


is

intellect, or

is

wins eclat neglecting

useful to the sick.

an example of what I mean, we

find, in

medical literature,

most eminent physicians even those


who have the reputation of being " most practical men'' expounding
theories, and elaborating abstractions, even tosatiety and exhaustion;

and

in scientific s-ocieties, the

and

at the bed-side of the sick,

watching for opportunities

roborate their own, or overthrow another's

theories,

to cor-

and entirely

neglecting to study the more immediate and operative agents of the

healing art, and their effects upon disease.

This ought not so

The substances

to he.

that

as medi-

we give

-which, in judicious hands, are powerful for good, are also

cines,

capable of producing incalculable mischief.

The Materia Medica

To

owes

is

application, for

its

birth; and

its

branches of what we

the great engine of power in our profession.

the relief of

were
call

it

human

science

suffering, our

not in constant operation,

other

all

medicine (except as they were cultivated as

matters of general learning), would cease to be of interest to the


world, and be abandoned to the professed scholar.

No

other department of our science can reach, to cure, or by mal-

The profession depends for existence


who would employ physicians, if they were without

administration, cause disease.

upon

it

for

means to relieve disease ?


The agents of the Materia Medica decide the
(unless, indeed, as has been said,

of

but

fate of the sick,

" our patients recover, not because

them the practitioner

in spite of our remedies,") and upon

depends, when danger threatens.

Other departments of study


Chemistry, et

cet.

although

of

Anatomy,

Physiology, Pathology,

immense importance

to the

medical

philosopher, and indispensable to the student, are less necessary to

They are mere matters of dead learnwhen galvanized into life by the application of thera-

the practitioner of medicine.


ing, except

and whilst the theorist

is

weaving flimsy sophistries to

explain their obscurities, disease

is.

progressing, and fatal changes

peutics

are produced

in

means employed

the complicated
to repair

of science are fixed

and save

machinery of man, by the very


it.

Besides, most other branches

upon secure foundations

their resources

been thoroughly explored, their details made plain, but

" Artium Medendi"

"thick darkness:" a
which, if properly cultivated, would yield abundant harvests,
comparatively neglected and barren.

What

is

shrouded

in

have the labors of three thousand years resulted

discovery of two or three specifics

in,

have

this

the

field,
is left

but the

For every disease, we have a

hundred prescriptions, but few or no certain remedies. Instead of


facts, our Materia Medica is filled with histories of drugs, salts and
acids,

and directions

for their administration,

founded often upon

faulty analogies and groundless speculations.

In corroboration of this statement, I may be allowed to quote


from a learned author, who says " there are very few remedies, the

3
which are well known

effects of

the greater

number disappoint

expectations of the practitioner, because their true virtues are

the
still

Indeed, Boerhaave in the preface


knows of nothing which can be

concealed in Democritus' well."

to his Aphorisms, professes that he

Dr. Cullen says, "

termed a remedy.

fitly

ria

Mcdica abound with numberless

is

the

state of this matter, that

The

writers on the Mate-

Such indeed
nobody can consult those writers
false conclusions.

with any success or safety, unless he

provided with a great deal

is

Let us take as farther illustration


of this absence of certain knowledge, the opinions which have been
published upon the character and effects of some of those remedies

of skepticism upon the subject."

which have been longest and most extensively used, and we


the imputation of uncertainty

Among

is

will find

not without foundation.

writers upon mercury a most puzzling contrariety of opinion

According to Thompson and Edwards it is an excitant. CulChapman and Eberly say it is a sialogogue. Conradi, Bertoli

exists.
len,

and others suppose


sicians declare
class it

among

it

to be a sedative

and while the Italian Phy-

and

as a contra-stimulant, Brousais

it

revulsives

and Opium

his disciples

the Hercules of the Materia

animal
over
powerful an
which
Modern
economy, and
numerous compounds
have been
Medicine has
many characters assigned
study.
authors who have made
distinguished
testimony
Dr. Bird speaking
" According
nnrcotine says
Pharmacologists

Medica

is

the catholicon of

as

it,

it

as there

their

of

of the conflicting

in

Derosne

it

relation

stimulant narcotic.

According

stimulant nor narcotic, but

and according

it

says,

was an

li

to

According
to Prof.

to

Magendie

CTShaughnessy

it

it is

is

neither

powerfully sudorific and anti-purioiic,

to Bally or Orfilla it has

same author further


contradictory

to

a simple narcotic.

is

the

influence

exercises so

in its

The

no properties at all."

The

accounts of Iodine were equally

first

emetic, a cathartic, a diuretic, a sialogogue, an

inebriating stimulant, a stomachic, a gastric corrosive, and an hemorrhagic,

it

was

in fact everything,

and

tioners assert that they succeeded

of

it

It

it

in

was nothing,

for

some practi-

administering immense doses

without any effect appearing to follow."

was

in

view of the great mass of contradictory assertions and

foundationless

speculations which

Philosophic Bichat exclaimed, "

obscure this suDJect, that

To what

errors

the

have not mankind

been led in the employment and denomination of medicines.

The

same identical remedies have been employed, under different names,


according to the manner in which they were supposed to act." He
adds, speaking of the Materia Medica, It is a shapeless assemblage
of inaccurate ideas, of observations often puerile, of deceptive remedies

and

formulas,

fantastically

as

combined as they are tediously

arranged."

Another writer remarks, " Our Materia Medica

is

nothing else

than a careful collection of fallacious observations which medical

men

There certainly are among them a few valuable results,

have made.

founded on sound experience, but who will lose his time to search
for

those few

grains of gold, in the huge mass of rubbish which

Physicians have gathered up for thousands of years."


Brousais, speaking upon the same subject, says, "
seek a guide

whom

among authors esteemed

When

the most illustrious,

would

and

to

medicine confesses herself most indebted, I found nothing but

confusion

all

was mere conjecture."

Iiostan declares, that "errors so abound in the most recent formularies, that truths

are as thinly sown as gold upon the dunghill of

Ennius."

But if
we have

be objected that these are authors of a remote period,

it

the testimony of Pereira

whose Materia

Medica

the

is

most comprehensive treatise upon the subject in our language. He


says, " Pharmacologists are too imperfectly acquainted with Therapeutical
reality

agents,"

and that "

of medicines are

classifications

in

founded on the prevailing medical doctrines of the day, or on

the peculiar notions of the writer."

I might go on, and cite authority after authority to prove, not

only the uncertainty of that branch of medicine most essential to the


successful practice of our profession, but to

palpable

instances of
in

more

absurdity,

craft

human imposture and

show that there

and delusion, more

is

more

humiliating

credulity to be found in this, than

any other subject of the physician's study

but

is it

necessary

Does not daily experience and observation bring before us abundant


evidence of the fact

However much men may


(at least those

ments and

differ

upon other subjects,

most pre-eminently distinguished for

brilliant exertions in the

all,

I believe

scientific attain-

cause of medicine,) ao-ree as to

the imperfections of our Materia Medica.

Time, which destroys or improves

all

things else, seems to have

u varied
times,

From the remotest


his treatment," and made this worse.
when barbarians believed in the efficacy of amulets and incan-

tations to cure their diseases

from the earliest ages of civilization,

when physic was regularly practiced by priests in the temples of


Egypt and Greece, down to the enlightened period when the labors
of modern investigators commenced, the most pernicious fallacies
have been introduced into medicine

and

one age bequeathing to another

of them, principally,

is

composed our modern Materia

I repeat that the Materia Medica

is

paramount

its errors

Medica.

of medicine, because

it is

study deserves precedence over them

its

physician,

who ought ever

discharged

all

remember that

to

and reputation

is

branches

the

in

mind

the

of

his highest duties are

be won, not

to

to other

power we possess, and that

the only active

by explaining the

nature or course of disease, or the cause of death, but by curing the


sick.

Yet who has

so stated this

Do

writers in journals, or professors

in colleges, or physicians in practice, write, talk or act, as though


this

were true?

Indeed

the

entirely has

absurdities

good
its

Materia Medica

and

that

is

an almost prohibited topic.

been neglected, and

it

its

active energies

we shrink conscious

so

So

thoroughly debauched by

made agents

of evil instead of

stricken from the utterance even of

name, and tremble under apprehension of being brought to an


Would that we could see
for its abandonment and abuse.

account

blushes crimsoning the cheek of the profession, for we might then

hope

for reform,

and that some degree

of certainty

would be at

attained, to inspire confidence in the power of our art, to

promises of hope

it

gives to a suffering world.

last

the

fulfil

Enthusiasts

may

pretend, and the credulous believe that our knowledge of drugs


perfect

utterly powerless

To know
to

them

is

but we know how constantly our attempts are baffled, how

we

often are, to relieve suffering and save

the history and

describe

them

names

botanically,

in certain cases, is simple

of drugs,

and

life.

and modes of preparation

to give certain quantities of

enough

But

to

understand their

upon the living microcosm, when invaded by disease to judge


correctly of their combined results, and determine the advantage

effect

one possesses over another, and to distinguish its peculiar operations


under an almost infinite variety of circumstances all this requires

knowledge which we do not

at present possess.

Are not

numbers who

the

fall

victims to the uncertainty of our

the instinctive timidity with which we give or take them,


restoration
those who rely upon us
well
the duty we owe
are not these enough awaken
health and preservation of

medicines
as
to

for

to

as

to

life

physicians to a sense of

its

importance, and stimulate them to

greater exertions for the improvement of this branch of science

still

Certainty, in the operation of remedies, alone can give confidence.

Yet, here
or

in

How

sick

is

the source from

often do

glowing

triumphs

man

If skepticism exists in the

minds of physicians, about the

uncertainty

and

uncertain.

all is

the

it

community,

medicine

this

upon the glories of medicine, and the


what will cure a certain

but when asked,

grow dumb, look wise, and timidly suggest the

of trying this

springs.

we hear men descant with most masterly research

eloquence,

has achieved

it

whence

utility of

or, despairingly

hoping that

may do good

propriety

or,

sud-

denly recollecting that they have seen the other thing cure, in just
exactly such cases

Yet

we neglect

still

to

study our remedies, and go guessing and

blundering on in doubt and darkness.


it

is

positively criminal.

guilty until men,

no more

to

Not

only

is this

I fear, however, that

who now addict themselves

we

wrong, but

will continue

studies which have

to

do with the practice of the healing art than has the law

of Moses, learn to devote their energies to this task


of opinion, the

until the pride

success of theories, and pursuit of fame, are less

cared for than the well-being of our fellow


of practical medicine

is

preferred by

its

men

until the perfection

followers to

mere

intellec-

tual display.

We

have a thousand books about the essence of fever, the nature

of contagion, the proximate cause of disease,


vital principle,
infinite

we have

and other things, known

to

God

wisdom has placed beyond the reach

of

dynamic

forces, the

and which
human ken where

alone

his

one, or not one, about what will cure disease

death, or upon the facility with

drugs may destroy

life,

and prevent
which the mal-administration of

shake the confidence of the physician in his

remedies, destroy the patient's trust in his physician, and thereby


perpetuate the opinion which reproaches ours as the most uncertain
of sciences.

To this may be attributed the slow march of improvement, and the


rapid growth of skepticism, with which ancient and modern, refined
and barbarous nations have opposed the progress of medicine.

Now,
physic

if
is

disease"

true,

is

it

as

an eminent author says, " that modern

the art of Amusing the patient, whilst nature cures the

our experience (and who's does not?) agrees with that

if

of Dr. Radcliffe,

who once said, " When I was young I possessed


twenty remedies for every disease, but when I advanced in age, I
found twenty diseases without a single remedy." If there is truth
in the authorities which I

have quoted upon

this

and

subject,

if

the

consciousness of their truth makes the frequent sarcasms on medicine


stinging to our ears, then, indeed, is there need that we strive to

remedy

the deplorable condition of our Materia Medica.

In proportion as

becomes our duty

to

it

has been neglected by our predecessors,

it

be active in invoking professional enthusiasm

an attempt to redeem it from chaos.


Theory makes science plausible ; experiment makes it certain.
Those who pursue the former guess at truths ; those who practice the

to

and demonstrate them.


True science is the legitimate child of experience

latter discover

we wish

to give that character to therapeutics,

therefore,

if,

we must

carefully

and patiently pursue the toilsome path of experimentation.


course alone can we hope to remove doubt and obscurity.

know how much Galen,

(than

whom

there never lived a

By

this

We

all

more accurate

observer of nature,) said respecting the necessity of correct experience,


in order to

know and

properly estimate the power of medicine.


no inherent impossibility in the subject no reason why
so much difficulty should exist.
Life and health are results of the

There

is

operation of vital laws


those laws.

Human

disease

is

a disturbance of the harmony of

reason has discovered in the mineral, vegetable,

and animal kingdoms, agents having power to restore that harmony


when disturbed and these agents, are our Materia Medica.

harmony in the relations of man to the objects around


him, than in the succession of the seasons, the movements of the
Is there less

tides, or the

No

mechanism of the heavens

effort of

man's, however, can confer upon any branch of science,

the unattainable attribute of infallibility

absolute certainty, there-

fore, is impossible

highest possible

standard.

then safe, and

highest objects attainable, in proportion to

tainty,

its

still it

ought

to be

our aim to elevate

The administration

and the Materia Medica be entitled

to

it

to the

of mediciue would
its

cer-

rank with the other

highly cultivated departments of Medical Science.

PAPER

ON THE

UNCERTAINTY OF OPIUM,
BY CHAS. W. BRINK,

Mr. President

In

M. D.

accordance with the invitation which the

Society kindly extended to me, to present a second paper


subject which I so imperfectly sketched
hastily thrown together a

when we

the uncertain operation of

few facts upon

Opium, gleaned from various

authorities,

upon a

met, I have

last

and from them have drawn

an inference or two that will, I think, prove our confidence in the


certainty of this remedy to be without

That

this

paper

is

much foundation

unworthy the subject

it treats, I

in truth.

am

well aware.

It claims to be merely a fragmentary prelude to a discussion, pre-

pared

in haste,

and presented

in

hope that

may be

it

followed by

others from abler pens.

For the desultory manner

in

which the subject

is

treated I have

only to plead incapacity and want of time to do better


is

but as mine

merely the duty of a herald, to introduce the combatants, I

may

be excused further exordium or apology. Respecting the opinions,


however, that I expressed in regard to our imperfect knowledge of
the agents which composed the Materia Medica, and the doubts I

which you did me


and those which I may now

entertained in the certainty of their operation


the favor to listen to at our last meeting
state

upon the subject of Opium',

may be

allowed to remark, that

I do not arrogate to myself superior scgacity in detecting fallacies,


nor plead guilty of greater skepticism than falls to the lot of those

who

carefully investigate the sources of error, and the speculative

doctrines promulgated

by writers upon medical agents

claim to have pondered their testimony, and

I merely

sought by experience

(that only certain test of the value of testimony) in this as in other

studies, to arrive at truth.

10
Than Opium, and

the history of

its effects in

diseases, there is no

subject connected with medical science, that has presented a wider


field for observation,

and none,

facts,

none where knowledge finds fewer well attested

I think,

which more clearly illustrates the caprice

Though some say it was unknown


who condemed its

and willfulness of human opinion.

may be

to Hippocrates, it

use

and from the reign of Galen, through the darkest eras of medi-

down

cine

to the

time of Pereira,

it

has occupied the attention of

Identified with the healing art,

presence.

its

to aid the

endeavor of the

scientific physician

all

and nation, we

In the pages of medical writers, of every age

sects.

trace

clearly traced to Diagoras

ever invoked

it is

and indeed, beyond

the limit- of the profession, its wide-spread potency to kill or cure

Whenever

seen.

the sick chamber

presence of quackery,

Opium

is

polluted

presents itself in

is

by the unhallowed
lozenge, syrup

pill,

or pectoral.

To

the

study of this potent agent, have been devoted the most

consummate

skill,

and maturest judgments of men, as eminent


endowments.

for natu-

ral

qualifications, as for acquired

life-

long labors to determine the peculiar circumstances under which

Theirs have been

this

and other remedial agents may be given with certainty

they

have

failed

notwithstanding

thrown into the labyrinths of

this

the

light

subject,

labors

their
is

it

but

have

dark and

still

doubtful.

The testimony

of others, upon subjects in which

sufficient experience, is the

we

foundation of our belief;

are without

if,

therefore,

that testimony is conflicting, our belief is shaken.

Upon

this

worthless
ease

ground

not that

but, that, like

uncertain remedy.

it

can, I think, be shown

it is

all

To

not that

Opium

is

not indispensable in the treatment of disthe

artificial

this conclusion

agencies

we

we employ,

it is

an

are compelled, by the con-

tradictory testimony of observers.


I am aware, however, that mere* contradiction
does not always
prove uncertainty, in that opposite qualities, assigned by different
authors to a drug, may bear so much resemblance, as to corroborate

instead of contradict each other's statement

as in the character of

men, the vices and virtues, praised and blamed by friends or enemies,
often agree.
Thus, the courage and firmness of one, correspond to
the rashness and pride of the other. Collateral evidence is therefore
necessary to justify doubt.

11

But

is

it

Opium

not so with

agreed upon or certain, hut

there

is

almost nothing about

The sources

its uncertainty.

uncertainty are so numerous and sejf-evident,

even

that

it

of this

there

if

some of them.
The limited sphere of individual experience, from -which we draw

were time,

were unnecessary

it

our knowledge
wise

men

the fate, as

more than hint

to

would seem

it

at

to be, of writers, be

or blockheads, to reason fallaciously

they

upon the operation of

medicines, and particularly upon Opium, which enters into almost


every prescription that is written
the complicated nature of the

subject of investigation, the ever varying phases of disease, the idiosyncratic insusceptibility, or morbid sensitiveness of some

besides

the variable operation of this substance upon different races

ducing upon the Negro, Javanese, and Malay,

pro-

effects entirely diffe-

rent from those produced upon the European, Turk, or Persian


as well as the peculiar conditions of the nervous system, (as in Tetanus,) and habit, -which diminishes
all these are

make

it

its

influence over the system

circumstances which materially modify

its

and

action,

one of the most uncertain remedies with which we combat

disease.

So impressed with

fact

this

was an eloquent author, that he

exclaimed (speaking of the use of

"

It

is

this

remedy

in a certain

disease)

a fearful thing to strike a blow in the dark."

Without wearying you with


experience

which, were

would be but a drop

it

my

opinions, or the results of

much

more extensive than

in the ocean,

it

my own

has been,

compared with that of others

will at once present the testimony of those writers and teachers,

whose eminent
devotion

talents,

to science,

extensive opportunities, and

have made them our oracles

enthusiastic

unlike, however,

those of Delphi or Thebes, the priests of the temple of Esculapius

deal not in darkness and ambiguity, but their responses (upon this
subject at least) are clear and unequivocal.

From them, we

shall

find that, apart from dose, idiosyncracy, habit, conditions of disease,

and other acknowledged sources of uncertainty, the most anomalous


of opium ; and so indeed it
must ever be, until we can produce at will the conditions upon
effects often follow the administration

which

its

action depends.

In defining narcotics,

opium, and

is

(at

the type of

the

head of which of course stands

the class,)

Dr. Paris says

They

are

substances which, in moderate doses, occasion a temporary increase

12
of the

action of the

nervous and vascular systems, but which

is

followed by a greater degree of depression of the vital powers than


is

commensurate with the degree of previous excitement, and which

is

generally followed by sleep."

To

reconcile the primary stimulant effect of narcotics, with the

secondary or depressant
of pagan mythology)

effect,

was

an absurd hypothesis (reminding one

goddess, the " vis medicatrix naturae"


in the first instance,
for the stimulant

Now,
who

for

"

says,

and inability

of this

accounted

remedy.

by Paris, and so plausibly

so positively asserted

made extremely doubtful by Dr. Guy,


general rule, small doses of opium are succeeded by

by Cullen,

as a

is

both bodily and mental

excitement,

of a

invoked, whose protection,

is

to assist in the second,

and sedative powers

all that is

accounted

The guardian care

once, advanced.

large

To both

followed by symptoms of narcotism.

doses

are

generally

these rules there are

however exceptions, small doses being sometimes followed by narcotism without any previous excitement, and large doses by excite-

ment.

If a stone only generally

to

fell

the ground, or

day only

generally followed the rising sun, the grand laws of nature would be
uncertain.
1 need not recall the sweeping denunciation of

that

De Quincy pronounced

the subject of

Medicine

Opium, by

against

all

that

"

lies, lies, lies,"

had been written upon

Turkey, or by Professors of

travellers in

nor remind the admirers of this profound logician, and

eminent scholar, of his positive denial, "that the elevation of spirits

produced

is

necessarily followed

Indeed, he contradicts almost

all

by

of our

proportionate

depression."

dogmas upon the

subject,

and says that " even those who have written expressly on the .Materia
Medica, make it evident that their experimental knowledge of its
action is none at all" a

remark not

less true of

many

other reme-

dies than of opium.

After citing a whole catalogue of authorities, no two of


agree upon

its

mode

of action, Pereira says

" These

lected out of inaDy opinions, will be sufficient to prove


really

known

ourselves

of the real action of opium, and I believe

much time and

whom

examples, se-

how
we

little is

shall save

useless speculation by at once confessing

our ignorance on this point."

Driven to hypothesis
says,

for explanation, at last, the same author


" There are but three kinds of changes compatible with life,

13
which medicines can

effect in the vital

actions of an organ, viz: an

increase, a diminution or alteration of activity.

change

in the

intensity or energy merely of the vital actions of the nervous system

would not give

a satisfactory explanation of the effects of opium.

"We arc obliged, therefore, to assume that opium changes the qualities
of actions."

The dependence
conditions

of this remedy for

themselves

variable

than others, a relative agent

which

it

its

proves

it

operation upon
to be,

and the arbitrary

the fact of

its

admi-

to

obtain

Whatever explanation, however, may be

offered,

another reason of our frequent failures

is

expected results.

to

classifications

has been subjected, and which too much controls

nistration,

certain

more eminently

great want of uniform action stands, challenging con-

its

troversion.

Of

its

influence

" The mind

is

upon the nervous functions, an able author says

usually exhilarated, the ideas flow more quickly, a

pleasurable condition of the whole system

is

experienced."

Yet we

know many who use it, never experience the pleasurable sensations
described by De Quincy and others, nor when taken as an article
of luxury is Opium always unfavorable to longevity.
"We are told that

means uniform

its

effects

upon the vascular system are by no

that for some of

appropriate remody, while for others


'

and

is

its
it

diseases Opium may


may prove an injurious

be an
agent,

hence " not to be relied upon."

its effect upon


As
" Authors do not agree

to

serting that

it

the Urinary system, the same writer says


as to its effect upon the kidneys

increases, others

that

it

some

as-

diminishes the quantity of

urine secreted." In the very phraseology employed by its historians


as well as the extreme caution necesary to be observed in its admin-

urged by authors, which pervades our literaand also


the parent of the expectant practice of many

istration, so constantly

ture,

and

is

the incompatibles with which it is often given

read unmistakable evidences

of the

in

all

these

may be

uncertain character of " the

pernicious drug."

Dr. Watson's assertion that ptyalism has been produced by it


which is only equalled by a statement made by another " that Ep-

have been known to act like opium, and opium to have proeffect," arc instances of its want of uniform operapurgative
duced a
convince the most credulous sticklers for its
might
which
tion

som

salts

14

Wc

certainty.

have

all

heard of Dr. Gregory's unlucky anodyne

a dose of opium was given to a patient, who, supposing he had taken


a cathartic

The

was most thoroughly purged by

pill,

history of the Royal

Academy

it.

of Sciences furnishes an anec-

unworthy of conwoman, tired out by the protracted dropsy under


which her husband labored, charitably administered to him a very
dote, which proves this to be an agent peculiarly

"

fidence.

large dose of opium, with the intention of despatching him, but the

medicine immediately produced such a copious sweat, that

him

it

restored

to health."

There
than

no

is

effect of

this

article

more universally agreed upon,

power, when long used, to produce constipation

its

Christian, says

<

Constipation

Dr.

yet,

by no means a general

is

effect of

the continued use of opium."


of London, tells us to give

Castle,
liver ;

it,

upon the skin and

to act

yet, another author assures us that the

constipation which

always follows the use of opium, " depends upon the diminished secretion of bile."

Now
us,

if, as an eloquent writer on the


principles of medic iue, tell
" Opium relieves obstinate constipation, as well as obstinate

and

diarrhoea,"'

if,

for its effect in the

not upon any intrinsic virtue of

and

phlogistic treatment,"

and diabetes, surely

There

is

no

its

if

its

one or other case,

own, but upon "

it will

open

bowels,

,the

less difference

whilst

Miller

among

says,

"

it

given by the rectum, a larger dose


istered

by the mouth

anti-

in lead

colic

authorities, as to its effect,

is
is

and

In that mode, " larger

doses must be given, than when given by the stomach,"


;

depends

operation must be very variable.

the dose proper to be given, per rectum.

opinion

it

sufficient

an error

to

is

Pereira's

suppose that when

necessary than when

the dose should be

the same,

admin-

certainly not

greater."

Even
there

is

'about its local use

which one would suppose

a variety of opinion.

One

says,

easily settled

" respecting the external

Opium, " authors seem not sufficiently agreed." Some


when applied to the skiu it allays pain and spasm, pro-

application of
allege that

cures sleep, and produces

all

result from its internal use ;"


little

or

operation

no effect."

when given

the salutary or

dangerous

effects

while others say, " thus applied

The same author, speaking


in too small a dose, says,

of its

which
it

has

anomalous

"it often produces

15
disturbed sleep and other disagreeable consequences, and in some
cases

it

As

seems impossible to be made to agree in any dose or form."


which appear in medical works

to the irreconcilable opinions

upon the use

of this

uncertainty

its

is

remedy

in particular diseases, the evidence of

as conclusive, as the

amount

is

As

overwhelming.

evidence often regulates the decision of practitioners in

this

employment, I may be permitted


important diseases

About

in

glance at some of the

which the propriety of giving

the year 1779,

specific in Syphilis,

to

Opium acquired

it is

its

most

questioned.

a great reputation as a

yet, notwithstanding the favorable reports pub-

lished by different practitioners,

many denied

its

efficacy,

and the

profession gradually lost confidence in it as an anti-venereal remedy.


Mr. Pearson, who made a long trial with it, says, " The result of

my

experiment was very unfavorable to the credit of

Mr. Grant has written a book


as earnestly, that

Opium

the

is

remedy

Fordyce did that a cure could only be


It

is

this

for Syphilis, as Sir.

effected

is

Wm.

by sarsaparilla.

as an antidote to the mercurializa-

more probably of value

tion so often produced in the attempt to cure S}q)hilis.

son

new remedy."

and maintains

in favor of its use,

of opinion that experience has demonstrated that

Yet Thomp" Opium can-

not be relied upon, even for this purpose."

celebrated authority

tells

us that in " some diseases of the

cerebro-spinal system great benefit arises from Opium, whilst in


others injury only can result

that in all

convidsive diseases

it is

notoriously variable?''

it

Speaking of cases of Tetanus, reported by Mr. Curling, in which


says, " the confidence of the profession

was used, the same author

in its efficacy is greatly diminished."

says, speaking of certain conditions of Small-pox,

Watson

Gregory

proper remedies are opiates."


tbus fevers let Opium be avoided."

tells

us " in

all

" the

exanthema-

In Bronchitis and Pneumonia it has been objected to as being, in


such cases, the cause of danger and death.
Doctor Thompson says " much difference of opinion exists respecting the employment of opium in hemorrhages ; and also, " that in no
has this remedy been more frequently employed than in

disease

dysentery

but there

is

much

difference of opinion as to the pro-

priety of this practice."

Enough testimony

of this kind, proving the uncertainty of the

16
remedy under consideration, might be cited to fill volumes
employment
after examining a few more witnesses upon its
febrile affections, I will

flammatory and

There are no diseases,

constantly given, than in the extensive class

delhium and

in the

cularly

its

in-

have done.

the treatment of which

in

and,

in

known

opium

more

is

as fevers, parti-

attend, and

symptoms, which

so

seriously complicate the most grave varieties.

Here we would expect

some certain indications

find

to

for its

but
and agreement among authors, as to its
which
testimony
met
by
instead of unanimity of opinion, we are
challenges the most sagacious and penetrating judgment for an
utility

exhibition,

impartial decision.

" I have seen," says Pereira, " opium

fail

to relieve the delirium

when given under apparently favorable circum-

even

of fever,

stances."

Even

in cases

which are marked by

most imperatively demanding


questionable.

On

wild delirium, long

symptom

Latham

it

is

" there are cases

says,

employment of opium are doubtful

for the

v,

akefulness,

Yet he

objects to

sometimes result, says

sleeplessness, (the

use) the propriety of giving

Dr.

this point,

where the indications


rable dose."

its

" but

&c, &c, seem


it,

to call for a

conside-

and although he has seen good

I have also seen the

same quantity

produce fatal coma, from which the patient has never been roused."

Upon

its

exhibition in inflammatory diseases, Dr. Holland, speak-

ing of the extreme caution necessary to be observed in employing so


uncertain an agent, says

"

to stupify the

sensibility to pain,

suspend any particular disorder of function, &c.,


interpose a veil between our

it

produces that

effect,

or to

often but to

judgment and impending danger."

Thus, as an agent to allay pain,

when

is

its

which

it

operation

is

uncertain

and

often fails to do, its utility is

more than doubtful.


.

To

narcotize a patient,

is to

disguise the symptoms, and without

them, what guide has the physician to

much

diagnosis and indications

an attempt to subdue the storm, instead of


striving to steer the ship safely until danger is past.
It

is

too

like

Dr. Chambers, of London, (whose


Observations

on

Disease

entitle

his

67 quarto Ms. Volumes of


opinions, upon a practical

question, to great respect) did not approve of narcotization.


opinion, pain depends upon

inflammation, and to give

In his

Opium would

17
be to place a mask between the physician and the disease, behind

which the

latter

might destroy the patient unperceived

to deal with pathology openly,

he preferred

and not remove pain, as a palliative

measure, but rather by quelling the inflammation which was its cause.
We are sure," says his biographer, " the plan of Dr. Chambers

"

was the bold and right one


Nelson did towards the enemy
and abide the result."

Now, notwithstanding

was acting towards disease, as

it

to

the difficulties which attend the

common and

of this drug, in diseases the most


find it resorted to with as
liable to

much

make more dangerous

or essential to

them

place himself fairly alongside,

employment
our race,

fatal to

recklessness as though

it

we

were not

the complications which are incidental

as though

it

the conservative efforts of nature

never opposed, instead of aiding


as if

it

were incapable of oppress-

ing the vital powers, when they languish and

fail

as though it

never extinguished, instead of reilluming the flickering flame of life.


The only advantage that arises from the unlimited trust physicians

have in

this

and other potent drugs, and from

their reckless

admi-

Indeed,

that it keeps down


Mr. Mai thus had been a physician, he would never have
promulgated his doctrines. He should have read Medical College

nistration,

I believe

the excess of population.

is,

if

Statistics of

the United States, and both his labor and his fears

would have been spared.

Of my own experience, which has been limited, I do not care to


One case, however, which came under my notice in New
York City, in 1847, that seemed to me remarkable, I will mention.
speak.

lady, residing in

Grand

street, suffered slightly

from odontalgia,

which disturbed her rest, and her physician administered a moderate


Almost immediately after taking it,
dose of opium as a sedative.
she was seized with a sense of suffocation and anxiety, which she
referred to the heart, dyspnoea, and in fact all the symptoms (even
the

pain

Pectoris

many

and numbness in the arm) which characterize Angina


and it was indeed so called by her physician. She had,

years before, taken opium, and, as I learned, once subse-

quently, and on both occasions a similar effect followed.


As a farther illustration of this subject, the testimony of
tren

may be

cited.

Upon

Dupuy-

the use of opium, by the stomach, in

state, following
traumatic or nervous delirium, as he styles a peculiar
its
character be
if
which,
and complicating injuries, a condition in

18
certain,

"

some suppose,

as

ought

it

to

he

favorably,

act

opiates of every kind, and of every form, have

says,

always appeared

ineffectual in this disease, as they neither diminish its severity nor

and he adds, as a physiological reason to


l
f that the stomach is destined

arrest its progress ;"

explain this want of proper action,

and contains juices which more or

to elaborate a digestive power,

change the substances with which they are in contact/'

less

This imputation does not apply alone to Opium, but to other re-

medies of the same


been known often

Billings tells us that "

class.

to

rium-tremens even, instead of

As

Hyoscyamus has

disappoint the practitioner, by inducing delisleep.'"

a final illustration, which merits notice for its practical value,

I give the opinion of Maunsell, on the use of this

remedy

in rigidity

and inertness, both of which conditions are so trying


" Opium," he says, " has been
the patience of the accoucher.

of the os uteri,
to

much recommended

as a relaxant

but

it is

a medicine, the effect of

which in parturition we cannot accurately measure

and

effects,"

suspend pains, in place of expediting labor, by

totally

he says, "

for inertness,

large doses, but

Opium

Again,

it

may

relaxing

has been recommended

when thus given, I have known

uterus completely."

and
its

it

paralize the

puerperal convulsions, those who-

in

suppose this disease depends upon irritability of the nervous system,


(in order

to be

Speaking of

consistent with

general theory or practice, this

man

their theory,)

give opiates freely.

I have above quoted, says, " as a

author

the

this,

is

decidedly wrong.

Professor

Gril-

assures us that " the use of opium, in large or long continued

doses,

is

Yet we

very certain to destroy

all

know

and

failed

the

ovum.

foetal life,

and produce abortion.''

has been given, again and again for that purpose,


death being often produced by it, without destroying
it

We

find,

too,

that

full

doses

are

recommended

in

threatened abortion.

With what remarkably


must think Opium

is

discriminating intelligence practitioners

endowed,

abortion in one case, and prevent


to
all

to
it

destroy the foetus, and produce


in another

to limit its operation


the cervix-uteri, now, and then act upon the entire organ
and

to

answer indications, which they imagine

procedure

as though

to exist, as rules of

were a well trained lackey, ever obedient


and willing and able to perform, with undeviating regularity, its
prescribed duties.

it

19
Is
all

true that

it

the world,

mal beings

that

conditions which

prove

Opium

like the atmosphere, or light, can

and adapting
causes

it

destroys, and cure

Belief in the possibility of

the purest faith, hut

it

emhracc

most contrary states of ani"

can produce diseases which

it
it

itself to the

all this,

may

does not indicate the profoundcst

reason.

As to the means for correcting the uncertainty of which I have


adduced so much testimony, and of the causes which produce it it

does not, of course, come within the design of this dissertation, to

touch them. I believe, however, that one of the most


of doubt and error,
in the

is

power of opium

standing

its

prolific

parents

the almost unlimited trust practitioners have


to cure disease.

Resorting to

it,

(notwith-

acknowledged uncertainty,) with as much


Abernethy did to his eternal Blue Pill and Senna

pertenacious

invariability, as

Tea

they become

so familiar with

it,

as

to

results. Its too frequent exhibition also arises

activity

(one

of the

As

it is

to the

its

from that mischievous

greatest errors in practice,) growing out of

professional willingness to

whether

neglect to observe

humor popular

prejudice, and do something,

necessary or not.

grounds I have

for skepticism,

none can deny that the

upon the variableness of the operation of


this potent proteus of the Materia Medica, are reliable, nor that the
facts and illustrations I have offered, are appropriate and incontroauthorities I have cited,

vertible.

I have not quoted obscure

authors, whose

means of observation

were few or limited, but eminent writers and teachers, whose intellects have illuminated some of the darkest paths of our science. And
I ask whether their conflicting testimony does not justify doubt in
almost universal applicability to the cure of disease, and prove

its

the impropriety of too

much dependence upon medicine

generally, and

particularly upon Opium.

" In the early ages of medicine," says Dr. Gregory, " when descriptions of disease were imperfect, when pathology was in its infancy, and statistics were unknown, Physicians arrogated to themselves

a,

power of controlling, by drugs, the course of diseases, which

to be wholly unwarrantable."
Notwithstanding the contradictory testimony we have about remeas Old Burton
dial agents, I am not without faith in their virtues

we now know

20
has

it,

my

for

am

part, I

well persuaded of physic, and can dis-

tinguish the use from the abuse."

Nor do
as

I advocate that " hard-headed

Dougald Stewart

calls

as implicit confidence

is.

it,

which

is

I believe skepticism should

not occupy the palace of the mind.

Pyrrhoic Philosophy

is to

apothegm, that " Doubt

is

Who

We

be preferred.
torch

the true

Did not

doubt, there truth

the pioneer

ries of truth

by doubt

is

'tis

recollect

of science."

the portal,

the

French

Descartes

never doubted, never half believed

Where

guard

Indeed, in our profession, the

asserted that all philosophy begins in doubt


"

skepticism,"

or unlimited

as great a proof of imbecility

her shadow."

of Philosophy, in Greece, begin his discove-

Was

not Harvey skeptical about the exist-

ing theory, before he discovered the circulation of the blood

and

has not distrust in old doctrines, always been the precursor of new
It

was said by Volney, that the proper state of mind

of history, was that in which

we " hold the judgment

meaning, I presume, we should be in

To no study

will this

a-

for the

in

study

suspense,"

state of doubt.

remark apply with more propriety, than to

the Materia Medica.

When thus prepared, attention is aroused, we industriously examine, and carefully weigh facts as they are presented, and do not
allow them to glide unquestioned into the memory.
By

pursuing this plan of investigation in medicine, we become

humbug

proof.

Almost by intuition we are enabled

detect the improbable, and grasp at the true

at a glance to

and we thus become

rich in wisdom, won by stern conflict, from the fields of observation


and the honored possessors of trophies which perish not by the

cbarnal touch of time.

Truth can only be elicited by a careful analysis of facts. For


we depend upon testimony. We have seen that, in whatever

facts

direction inquiry has wandered, it has been

by contradictory statements and

met and overwhelmed


and we know

conflicting testimony

it is

logical to entertain suspicion concerning

fact,

when

the witnesses contradict each other.

any matter of supposed

Out

of the conflicting

mass of testimony that I have presented, from authorities equally


eminent, and equally well armed with facts, to what conclusion are

21
we compelled but

that

to

prove which, I

am

contending, viz

of our Materia Medica ?


If I have succeeded in this sketchy paper

in

an uncertain remedy, I have accomplished

all

the uncertainty

is

That

The

it

must remain

so,

seems to

necessity for uncertainty

and depends upon an

The ever-varying

brain and nervous systems, upon which opium


its

influence

conditions,

I have attempted.

a self-evident proposition.

intrinsic,

is

almost infinity of circumstances.

me

showing that Opium

is

conditions of the

supposed

to exert

under the control alike of the gentlest

may

emotion, or most powerful passions, which a sight or a sound

change, and which are almost never alike in any two individuals,

nor in the same individual, two hours at a time

system over

others

all

and excretory, and of


of their functions

their

dependence upon

the rapid,

and what we

it for

the performance

call,

but improperly,

spontaneous translation of disease, from one

another

administer,
disease

so

and,

as to render

the

finally,

agent available in the

this

inexperience

rashness of others, and the difficulty

aggravated

evils

all

some

of

of

the

observers,

which they intended, and believed themselves able

upon

its

effects

all

and numerous others, which cannot now be named, are

these,

sufficient reasons for

want

and of our knowledge of


tions

to

cure

have to believe they have

to cure, tending to invalidate their testimony

must

system or organ to

amount of discrimination and judgment required

the

the control of that

over the circulatory, secretory, digestive

it

of uniform operation of the

its effects

in disease

drug

we can create at will the necessary condiwe can change climate alter habit correct idiosyn-

so remain, until
until

cracy, and regulate the sensibilities of the nervous system

we can

itself,

and I repeat, ever

until

increase or diminish the assimilative power of the stomach,

prevent or promote nervous transmission, neutralize or decompose


incompatible substances, and control, by mere varieties of dose, the

complicated chemico-vital operations, which are constantly at work


in the living organism.

or antimony (agents

Opium,

We

may

ecpually

to obtain one result,

and have some

reliable

ground

then hope, by combining mercury

uncertain in

for belief, that

nations according to imaginary indications,


different,

new and modified

their

operations)

with

and by adding Ipecacuana another,

results,

by varying the combi-

we can

obtain

totally

and never cause an unfavorable

22
one.

When we

other

potent

c:m do

all

agents of the

unlimited confidence which


.

But

to

is

this,

and not

till

then, will

now given

to

the

to

them by practitioners.

conclude this paper, already too lengthy, I repeat the

conviction, that I before expressed, that the Materia

included

Opium and

Materia 3iedica be entitled

among

boast of our age

Medica

is

not

the great improvements in medicine which are the


;

although chemistry has analyzed old and in-

for,

troduced new remedies

discovered incompatibles and revolutionized

nomenclature, (and thereby introduced a new element of confusion


into this branch of science),

still,

respecting the curative power of

drugs, and their effects in disease, the same uncertainty that


over the darkest eras of the past

now envelope

us in doubt whether the nineteenth century


ninth

whether our
and whether

circle

all

hung

the subject, and leave

is to

be preferred to the

boasted advances have not been

made

in a

that symbol of the Egyptians, which points to

an eternity of doubt, ought not

to

be

made our own.

TU