Stimulants and narcotics, their mutual relations: with special researches on the action of alcohol, aether, and chloroform on the vital organism

Preface

The purpose of this work is, of necessity, imperfectly represented by its title-page. No sentence of moderate length would have expressed the whole scope of the inquiry ; a few prefatory words are therefore particularly needed, in order that the reader may appreciate the objects aimed at.

These objects are two — to destroy and to reconstruct ; or rather to show, in some degree, how reconstruction may be possible in the future.

The historical chapter on the origin of the doctrine of stimulus makes no attempt at an exhaustive treatment of its subject, my only aim being to prove clearly that the source of the Vitalistic notions on which our classification of remedies is based is to be found in certain metaphysical theories. The dynamical terms which many modern writers employ ought not to be permitted to deceive us ; they are, in fact,

X PREFACE.

but the artificial clothing of a mode of research which is unconsciously but purely metaphysical, and, as such, extremely unfitted for the purposes of the physiologist or the physician. It is the mixture of a phraseology based on this kind of speculation with a perfectly skeptical empiricism in practice, which has brought the science of therapeutics into the extraordinary state of confusion in which we see it at the present day. It is the profound conviction that a complete review of our principles of classification is necessary, if experimental inquiry is to bring us any advantage, which has induced me to write the first two hundred and forty pages of the present volume.

The special researches which make up the latter part of the work are intended as the first of a series of pieces justifieatives, which I hope to publish as evidence that the views promulgated in this book are not without solid foundation in observed fact. They by no means include all my researches on the properties of alcohol, chloroform, and aether, but only such of them as bear more directly on the questions treated in the other parts of the volume. If fault be found with their arrangement or the manner of their relation, it must be remembered that the difiiculty was great of select-

PREFACE. XI

ing, from a large quantity of material which I had collected, such portions as would best illustrate my subject within the compass which a work like the present affords.

For the special use of the word Hypnotism, which I have employed as signifying the production of natural sleep, and not in its modern and very inaccurate application to the phenomena of mesmerism, I think I need hardly make any apology.

On another matter I must say a word. In one or two instances, owing to the progress of science during the writing of this volume, an author is quoted only partially in the early sheets, and more fully in the later ones (this was unavoidably the case with regard to the opinions of Dr. E,adcliffe). A glance, however, at the table of contents will enable the reader to follow with so much ease the general course of the work, that I believe no serious misapprehension will arise from it.

One feature in the work is sufficiently important to justify my calling the reader's attention to it; namely, the presence, among the notes at the end of the volume, of two biblio-

XU PREFACE.

graphical indexes, which may be of considerable use, I believe, to any one who desires to follow up the line of thought developed in my book.

To my numerous friends who have helped me, my warmest acknowledgments are due. To Dr. Eeynolds the book may be said to owe its birth, since his kindness enabled me to solve the most serious preliminary difficulties as to its form and publication. To Dr. RadclifFe's writings I am indebted (in a degree which the pages of my book will testify) for materials of thought and experiment, and to his kindness for many additional hints, and one or two valuable cases. Dr. Buzzard, my colleague Mr. H. Power, Dr. Way, J. C. Whitehorne, Esq., and other valued friends, have wearied themselves in advising and in correcting ; and last, not least, I have to thank H. Chandler, Esq., of Pembroke College, Oxford, Dr. Meryon, and the Rev. H. Wace, for suggestions as to the sources of the necessary information, on many historical points, which were invaluable. For everything in the book, however, I am solely responsible.

Introduction

Reasons for reinvestigating the subject of this work "» Plan to be followed , . . /

TABB

25-39

Chapter I

HISTORY OF THE DOCTRINE OF STIMULUS AND ITS PHILOSOPHI- CAL ORIGIN IN THE VITAL THEORIES OF THE ANCIENTS.

Plato . . . .

. 41

Aristotle .

Hippocrates . .

Democritus, Epicurus, and the Methodists

The Pneumatists and Aretseus

. 43

The Stoics and Galen ...

U

Nemesius

. 45

The Arabians

The Church in the Middle Ages

The Revival of Platonism ; Ficinus

The Rosicrucians . . .

. 46

Paracelsus

. ' 47

Van Helmont

47-50

Descart<!s . , , .

Bacon . ....

Willis ... . .

Glisson . . ...

Boerhaave . . .

Stahl

. 52

XIV

TABLE OF CONTENTS.

Hoffmann ,..•■••

Haller

James Gregory

John Brown . . ■

Darwin . . . • •

Vicq. d'Azyr . . •

Rasori and the doctrine of Contra-stimulus

Broussais ..... • •

John Hunter . • ' •

" Cellular " Physiology "Cellular" Pathology — Virchow

Dr. Hughes Bennett Dr. Todd . • •

Mr. Lister

MM- Bernard and Brown-Sfquard Dr RadclifTe Dr Radcliffe's views on Animal Electricity and Muscular Contraction (see

Reaction from the doctrines of Broussais, under Laennec, &c. . Dr. Harlcy on the action of strychnia Unfortunate consequences of the literal interpretation of the vital theories of

the ancients by their successors Modern writers on Therapeutics, and their definitions of Stimulus, e.g. Pereira .......

Neligan . . ...

Headland ... . .

PAGE 53

. 53

. 54 55 55 57 58 59

. 60 62

. 64 65

. 66 67

. 67 69 70

70 71

. 76 77 78 81

CHAPTEE II.

CRITICISM OF THE DOCTRINE OF STIMULUS.

This doctrine assumes that —

All mental excitement;

All increased sensibility, and pain;

All convulsive muscular action;

.AH considerable increase of secretion ;

All increase, whether of force or frequency of the heart's action. Are caused by, and the proofs of, a stimulant action upon the organism

TABLE OF CONTENTS.

XV i. — Mental excitement, however, is not a proof of stimulation.

Analysis of the inebriation produced by alcohol . 85

opium . , 85

hashish . . 86

Mental excitement rather implies cerebra} parali/sis . . 87

ii. — Increased sensibility and pain are no proofs of stimulation.

Pain of neuralgia . . . 88-92

myalgia . . . , . 92

certain inflammations . . 92-94 receding alcoholism .... 94

of mortification . . . .94

Sir "W. Hamilton's theory of Pleasure and Pain . 94

Objections to theory that pains are ever " the reflex of an overstimulated

Sir W. Hamilton's distinction between "perception proper" and "sensation

proper" . 97

iii. — Muscular convulsion does not prove antecedent stimulation 97

iv. — Increased secretion does not prove antecedent stimulation 98

Brown-Sequard, Bernard, Gairdner . . . 98

Author's case of unilateral flushing and sweating . 98-100

V. — Increased rapidity of circulation does not prove antecedent stimulation 101

vi. — Increased nutritive, or formative action, does not prove antecedent stimulation .,..-„.. 102-104

Chapter III. Suggestions For The Reconstruction Of The Doctrine Of

STIMULUS.

Figurative use of the word Stimulus to be retained

Necessity of realizing what we mean by "Life"

Dr. Inman on Vital Force .

Coleridge on Life

Grove on Correlation of Forces

Carpenter on Correlation of Vital and Physical Forces

Dr. RadclifTe on Correlation of Vital and Physical Forces

Mr. Lewes on Vital Principle

Life can only be properly defined as the "Individuation" of organized creatures 111 Genuine effects of stimulation ...... 112

XVI

TABLE OF CONTENTS.

i. — The relief of pain —

Action of food, in neuralgia, in inflammatory pain (case)

opium on pains of catarrh, hunger (cases), inflammations ammonia compared with that of opium alcohol in relieving pain (case) counter-irritants in pain food-tonics in relieving pain (case) ii. — Removal of muscular convulsion, &c , by stimulants. Action of chloroform in minute doses (case)

ammonia {cases, Dr. Reynolds and Author) alcohol (c.ise) Observations of Dr. Radclifle Action of food-tonics iii. — Reduction of unduly frequent circulation by stimulants iv. — Reduction of excessive secretion by stimulants V, — Relief of general debility, or special fatigue of brain, muscles, digestive

organs, Ac.

vi. — Removal of delirium, maniacal excitement, and coma, and production of natural sleep by means of stimulants — State of brain circulation during sleep, according to Mr. Durham Extreme anemia favors delirium and coma, according to Todd In sleep the brain naturally tends to recover from the disorganization

produced by exertion In delirium there is no such tendency, e.g. delirium tremens Injurious influence of true narcotics in delirium Delirium requires to be treated with stimulants, especially with food " Delirium ferox :" Dr. Murchison's opinion (case) Production of natural sleep by food and other stimuli Objections to Mr. Durham's theory, as to the cause of certain forms of insomnia vii. — Support of the organism by stimulants in the absence of common articles of nutriment Objections to the ordinary explanation of this phenomenon Food action of coca

tobacco

alcohol . ,

opium . ...

viii, — Local increase of nutrition, caused by stimulants — By opium By strychnia The stimulant action of atmospheric oxygen shown to be an epitome of

the above described "genuine effects" of medicinal stimulation Objections to the common arguments for a complete physiological distinction between stimulants and foods.

"Temporary' character of stimulant action Stimulus is not followed by a " recoil," as usually stated Fallacious appearances which give plausibility to the common opinion rAQB

131 131

131 132 132 132 133 133

146 147 147

TABLE OF CONTENTS. XVll

PAdB

Counter-irritation, when beneficial, not followed by any recoil . 148 Tobacco-smoking, when moderate, not followed by any recoil , 148 Small doses of opium not followed by any recoil , 149 Foods are not all transformed in the body 149 Proposals as to the use which shall in future be made of the word "stimulant," &c. ... . 150

CHAPTEE IV.

THE DEFINITION OF NARCOSIS.

Origin of the word (Hippocrates, Erotian, Aristotle, Homer, Plato, Galen) 151.*

Sir W. Hamilton's opinion as to the ancient sense of the word Narcosis; and

objections to this opinion 153

Proper distinction of the words "Nepenthes," "Anodyne," from "Narcotic"

by the ancients, especially Galen . 154-157

Discussion of the distinction commonly made between "Narcotics" and "Sedatives," and rejection of the same . 157-159 Hypnotism is no part of true narcosis . 159 Definition of narcosis proper . 160 General symptoms of narcosis . . 161 Variations in the course which the symptoms of narcosis may take, illustrated by the action of opium in varying circumstances (experiments on animals, &c.) . . 102-167 Physiological significance of various symptoms of narcosis 167

Chapter V. Symptoms Of Narcosis

Mental phenomena.

Inebriation . - . = • I'^l

with alcohol . - - . . 171

with chloroform . . 172

with hashish ... - . 173

Involuntary reminiscence —

Produced by alcohol (case) . _ . 174 chloroform . ... 174

opium (De Quincey) . . . 175

hashish (De Luca, O'Shaughuessy) . 175

XVni TABLE OF CONTENTS.

PAGE

Narcotic reminiscence compared witli that which occurs during the dohrium

of fever, of epilepsy (Coleridge, Radcliffe) • . i/o

Narcotic reminiscence, compared with the powerful memor}-, for certain subjects, of the mentally deficient (cases) ^ ' ' Involuntary fancy (hallucinations, illusions) —

De Quincey, Von Bibra, &c., &c. .... 17o

Author's experience with belladonna ■ ^°^

Sensory phenomena.

General course of the paralysis of sensory nerves • ■ 1^3

Special paralytic affections of the fifth cranial nerve . . • 183

Illustrative experiments. I. Aconitine administered to a kitten. II Jlorphia administered to a cat. III. Aconitine administered to a rat, IV. Morphia administered to a dog. V. Alcoholic spirit, in full dose, administered to an adult man, in the morning, fasting 183-187

Pain and heightened common sensibility are occasional results of narcosis:

this is not inconsistent with the devitalizing nature of that process . 188

Discriminative sensory power always diminished, even in cases where common

sensibility is heightened . 189

Experiments and cases illustrative. Exp. A terrier poisoned with strychnia. Cases. 1, 2, 3, and 4, accidental slight poisoiilngs with strychnia in the human subject . . . . . 190-193

Muscular phenomena.

Muscular phenomena of narcosis cannot be explained on ordinary theories of

the cause of convulsion 193

Muscular paralysis is not physiologically opposed to muscular convulsion, at

any rate in narcosis . . . 195

Illustrations of the manner in which various interruptions of the Vital Individuation, which is effected by the nervous system, may give rise to varying results, without any real opposition existing between the agents which produced them . .... 196-199

Secretory phenomena.

Difficulty of appreciating the exact influence of individual narcotics on secretion. Some increase, and others diminish, the total amount of secreted fluids from particular glands; nearly all change the quality of the secretion 199 Morphia chiefly eliminated by kidneys; in man, however, this takes place with difliculty, the quantity of urine passed being very small. In dogs it is otherwise 200

Alcohol in narcotic doses always increases watery element of urine . 200

Alcohol, 3?ther, and chloroform eliminated by breath 200

Elimination of tartar emetic in pneumonia 200

■Tolerance" of the system for antimony . 201

The above-mentioned actions are all truly narcotic, or poisonous . 201

Poisonous action of a narcotic beneficially employed in certain cases 201

Circulatory phenomena.

Heart's action is ordinarily quickened and weakened in the early stafjes of narcosis; later, the action becomes slow and irregular, while the weakness

TABLE OF CONTENTS. xix increases. But in the case of large doses, suddenly absorbed, both force

and frequency may be depressed from the first . , . 202, 203

Paralyzing effects on the heart in gradual narcosis follow a parallel course to that of the muscular paralyses generally. Sudden and complete cardiac palsy in particular cases . .... 203

Flushing of face- due to palsy of sympathetic nerves governing facial vessels 204

Changes in pupil: in the author's opinion due also to various modes and

degrees of paralysis of the sympathetic nerves . . 204

Mistaken inferences frequently drawn from the condition of the pupil in

narcosis .... 204

Doubtful utility of counter-poisoning with belladonna against opium 207

Respiratory phenomena.

Great variability of these effects. In gradual narcosis no increase of rapidity of breathing, only gradual weakening of it from the fii^t, and progressive retardation; finally stertor, gasping, and actual suspension of respiratory movements. In rapid narcosis, breathing often very hurried till near the close.

All the respiratory changes in narcosis are due to nervous depression 207

CHAPTER VL

ON CERTAIN BODILY CONDITIONS WHICH ARE UNFAVORABLE TO THE PRODUCTION OF NARCOSIS.

1. Influence of the state of health of the patient. Shifting of the "poison-line"

of certain narcotics — in fever — in tetanus. Ordinary explanations of this

fact untenable . ... 210

The unusual stimulant action of doses which would be narcotic in health is

due to a kind of food action on the nervous system . . . 212

Analogous action of large doses in hsemorrhage . . 213

of digitalis in delirium tremens 213

2. Influence of habit.

Physical damage done to nervous tissue by each narcotic dose . . . 214

Physical degeneration probably results in the great majority of cases of continued excess . . . . . 215

Anomalous cases in which a diSerent result occurs . . . 215

Majority of victims of narcotic excess only gradually impair the health of the

nervous system . . . 216

Sudden fatal catastrophes (from white softening, &c ) are due to general malnutrition of the organism . . 216

Degradation of nervous elements (especially vesicular) renders narcosis more

difficult .... 216

Physical necessity for periodical increase of the dose when this point has once been reached ... . 216

XX

TABLE OF CONTENTS.

Moral temptation of the desire for unreal sensations

In the rare cases where patients live chiefly on narcotics without moch damage, narcosis is not produced .

Chronic narcosis resembles a retarded recovery from acute narcosis Chronic narcosis from the abuse of tea and coffee

PAOB

218 219 220

Chapter VII

ON THE EELATION WHICH STIMULATION AND NARCOSIS BEAR TO EACH OTHER, IN THE ACTION OF THOSE SUB- STANCES WHICH ARE CAPABLE OF PRODUCING BOTH 221-224

Chapter VIII. On The Acro-narcotics

225-226

Chapter IX. General Conclusions

Fundamental unity in all the symptoms of narcosis. They all depend upon the devitalization of the nervous system

Devitalization of the nervous system destroys that harmonious action of different bodily organs on which the life of the higher animals is especially dependent

Suggestions as to the probable course of future inquiries into nervous action. Further development of Dr. Radcliffe's views . . 229-

Tendency of modern physiology, and of the author's experiments, toward a phi/sical explanation of muscular contraction, especially of convulsion

Complete separation of the phenomena of Stimulation from those of Narcosis. It is probable that all narcotics have the same kind of action upon the blood Reasons for according to stimulants the rank of foods.

of the present definitions of "food " e.g. Beclard's Rational view of the nature of aliments Alimentation in disease

Unsatisfactory nature

234 235 236

TABLE OF CONTENTS. XXI

FAOB

Toleration of alcohol in acute disease: Br. Beale's explanation . 237 Vices of this argument . . .... 238-240

The idea of a modified alimentation is the only intelligihle explanation of the

facts of stimulation in disease, starvation, &c. ... . 240

True foods, when administered in excess, are eliminated like poisons 241

Discussion of M. Bernard's view . . . 241

Physiological chemistry has no right to dogmatize on this question . . 243

Conclusions . . . ... 244

Direction in which future inquiries should tend ... 245

SPECIAL RESEARCHES.

Introductory remarks ....:. 249

Researches on the physiological action of sulphuric aether . , , 253

PAET I.

.^THEE-NARCOSIS.

Points of novelty in the author's researches . . . 253-256

Experiments on the human subject . . 256-259

Phenomena of "excitement" not prior to, but a part of, the narcotic process . 259

Effects of Eether on pulse and respiration . , 260 Experiments on animals —

A. Inhalations .... 262-265

E. Injections into the peritoneal cavity ..... 265-275

Conclusions from foregoing experiments . . 275 Analysis of the paralytic effect produced on the sympathetic system —

Paralysis of cervical sympathetic . .... 276

cardiac branches of sympathetic , . . 277

hepatic sympathetic and production of diabetes; discussion of

the views of Bernard and Harley . 277-285

PAET II.

STIMULANT ACTION OF ^THEK.

A. On man —

Author's experiments on himself ..... 285-287

Cases in medical practice ..... 287-290

B. On animals —

Experiments on the modification of the conyulsions of strychnia poisoning hy ecther .... . . 290-292

XXll TABLE OF CONTENTS.

RESEARCHES ON THE ACTION OF CHLOROFORM.

PAET I.

THE PHENOMENA OF NON-FATAL CHLOBOFOEM-NAECOSIS.

PAOB

1. Successful chloroform-narcosis in man .... 299

A. Effects on the pulse in 100 patients . 300-302

B. Effects on the respiration in 100 patients . 302 c. Effects on various parts of the nervous system . . 303-309

Conclusions as to the effects of chloroform in narcotic but not fatal

doses . . 309

Narcosis from chloroform taken into the stomach . 310-311

2. Complete non-fatal chloroform-narcosis in animals —

A. Experiments on the effects of inhalation of different mixtures of chloro-

form and air . . . 311-314

B. Injections into the peritoneal cavity . . . 314-316 General resemblance of the action of chloroform injected into serous

cavities to that of chloroform inhaled . . 316

Identity of the action of chloroform on mammalia generally, with its

action on man . . 316

Diabetes produced in chloroform-narcosis (Author, Pavy, Reynoso) 316-318

PAET II.

PHENOMENA OF FATAL CHLOROFOEM-NAECOSIS.

1. Experiments on animals —

A. Death caused by comparatively small doses 318-320

B. Death caused by concentrated doses .... 320

2. Fatal narcosis in man —

A. One death witnessed by Author ...... 323

B. Analysis of twenty-one cases in which life was endangered . 324-328 Conclusions as to the narcotic action of chloroform generally . 328-330