After we have duly considered how far depletion may be indicated, and removed all local sources of irritation, we then proceed to the exhibition of sedatives, of which opium may be regarded as the prototype, and that which, for the most part, supersedes all the rest. The method in which this medicine operates, and the immediate effect which it produces, have been the subject of many volumes, and have formed the ground-work of some of the most violent and angry controversies of modern times. We have no space, nor indeed have we any in clination, for entering into these discussions ; we shall merely state our opinion, that the operation of opium is primarily upon the nervous system, and that it acts upon it as a sedative. Its agency is equally extensive with the nervous system itself, and it is consequently expe rienced through the medium of so many organs and functions, that we have seldom an opportunity of wit nessing its unmixed sedative powers, without, at the same time, observing some secondary effect, which may diminish, or even entirely counteract the primary ope ration. Thus, by lessening the sensibility of the intes tines, opium tends to produce costiveness, and this re tention of the fzecal evacuations may prove a greater source of irritation in certain cases, than the symptom for which the opium was administered. It is princi pally, perhaps, from this circumstance, that there is no remedy which is more uncertain in its effects than opium ; and besides this, different individuals have re markable idiosyncrasies with respect to it, which often interfere with the best regulated plans of the practi tioner, 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 individu als 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 deleterious properties. Hyosciamus, hop, the extract of lettuce, 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 opium.
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.
ternatural excitement ; mercury has been given under various forms, hut we know of no rational indication, either from theory or experience, which can lead us to expect any benefit from it, while lately very profuse bleeding has been employed, but we fear with a falla cious prospect of success. Besides these, which may he considered as the most powerful remedies that have been had recourse to, a great variety of palliatives, and a still greater number of nostrums, have been made use of; for in proportion to the violence and ur.tractable nature of the disease, so has the credulity of mankind led them to place confidence in the most gross and scandalous impositions. But, although we have had such little success in the cure of Hydrophobia, we have happily in our hands a preventative, which in most cases is of easy application, and of tolerably certain ef fect ; this is the excision of the wounded part, and the complete removal of every portion of the substance, which can be supposed to have been in contact with the saliva of the rabid animal. When, however, this has been neglected, when, from the situation of the wound, it could not be accomplished, or when, front any other cause, the disease makes its appearance, we cannot remain inactive spectators of so much misery, and naturally inquire what plan of treatment promise the least prospect of success, or may seem in any de gree calculated to relieve the sufferings of the patient. To this question we are not able to return a satisfactory answer ; we do not place the smallest reliance upon any of the numerous specifics that have been proposed. nor do we feel much more hopes from the effect of de pletion, from opium, or from mercury. Guided, how ever, by the faint analogy which presents itself, wa know of no treatment which is more promising, and therefore feel justified in beginning with a very copious bleeding, which is to be followed by a powerful mer curial purgative, and, when this has operated, by large doses of opium, combined with an equal quantity of calomel. We think it extremely important that perfect
quiet should be enjoined, that all motion should, as much as possible, be avoided ; and especially all unnecessary touching or handling of the patient. On this account, we conceive that frictions may be injurious ; and indeed we think that any remedy which is merely indifferent, and is not given to promote some definite purpose, ought to be abstained front, as likely to do mischief, from the cir cumstance of its exciting the patient, or giving him any unnecessary cause for the exertion either of his mental or his corporeal powers.
We have furmcd our second genus of the order Ere thismus of the Autalgix, those diseases which depend upon a primary affection of the nervous system, and which arc characterized by severe pain and uneasiness in the part affected. These are frequently symptomatic, but we are often unable to perceive any more general complaint to which they may be referred ; and even where this is the case, the violence of their symptoms require our attention to be immediately directed to the. local affection. The diseases w hich we shall enumerate under this genus are, Neuralgia. Cephalalgia, Proso phalgia, Otalgia, Odontalgi.t, Mastodynin, l'leurodyne, Gastrodynia, Arthopuosis, Sciatica, and Pruritus, to which we ought pet haps to add Lumbazo. Front a view Notwithstanding the acknowledged obscurity which exists respecting the nature of this disease, we do not hesitate to place it in the genus Hyperxsthesia, 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 commences by a peculiar feeling of anxiety, constant agitation, and unaccountable timidity ; to these succeed difficulty of breathing, pain and constriction in the re gion of the stomach, and all over the abdomen, together with the characteristic symptom of an inability to swal low fluids, which soon extends to deglutition generally, and becomes so distressing as to impress the mind with extraordinary terror at the very idea of renewing the attempt. As the disease advances the pulse be comes weak and quick, and a degree of irregular fever supervenes ; all the functions which depend upon the nervous power are rendered morbidly acute ; there is intolerance of light and sound, the sum face becomes ex quisitely sensible to the impression of cold air, while towards its termination there is a copious discharge of viscid saliva from the fauces, the mental faculties are deranged, and general convulsions, with a total destruc ion of all the actions, both animal and organic, are the immediate forerunners of dissolution. The disease is rapid in its course, and most dreadful in its symptoms and aspect, yet its real horrors have been exaggerated by the terror and superstition of those who have wit nessed it. The accounts which are met with in the older writers, of the violent fury of the patients, and of their attempts to sieze the bystanders, are probably al together fictitious ; and the dread of water, which has been viewed in so mysterious a light, is found to arise simply from the extreme uneasiness and difficulty which the unhappy sufferer feels in the act of deglutition.