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durated fæces, nephritic complaints, &c.; and Everhard recommends the enema in ileus. In the practice of modern surgery the value of the Tobacco Enema is fully appreciated. In every species and degree of hernia, where medicine is required, it may be serviceable; but especially in that alarming and dangerous state when the protruded parts become inflamed and painful, and cannot be returned. In the Zoonomia there is a case of hæmorrhage from the rectum cured by an injection of tobacco-smoke.* Neither must it be forgot

strain Ibj. add hiera picra ss.; benedicita laxativa 3ij.; fresh butter and honey of roses each iss. oil of rue and dill each giss. ; common salt 3j. These are to be mixed to make an enema, the only efficient material of which is the Tobacco. The formula of Mr. Pott presents an admirable contrast. Pour a pint of boiling water on a drachm of Tobacco, is the plain recipe for the Tobacco enema of this celebrated surgeon.

*Mrs. had for twelve or fifteen years, at intervals of a year or less, a bleeding from the rectum without pain; which, how. ever, stopped spontaneously when she became weakened, or by the use of injections of brandy and water. Lately the bleeding continued above two months, in the quantity of many ounces in the day, till she became pale and feeble to an alarming degree. Injections of solutions of lead, of bark, and salt of steel, and of turpentine, with some internal astringents, and opiates, were used in vain. An injection of the smoke of Tobacco, with ten grains of opium mixed with the Tobacco, was used, but without effect the two first times on account of the imperfection of the machine; on the third time it produced great sickness, and vertigo, and nearly a fainting fit; from which time the blood entirely stopped." ZOONOMIA, ii. 69. In a pamphlet published in 1720, on the Use and Abuse of Tobacco," there is an instance recorded of this plant suppressing a hæmorrhage from the rectum. A leaf of Tobacco was thrust up the anus, and continued there some time: by this the discharge of blood was completely restrained. This case may suggest the propriety of employing the Tobacco Enema in other instances of hæmorrhage. So powerful are the effects of Tobacco, that whenever or however it is used, great caution is required. Those who have seen either the smoke or infusion thrown into the rectum, will not forget the symptoms of its potency. Perhaps some unfortunate events have followed the careless or improper use of this remedy. FULLER, who seldom wrote or spoke with reserve, hints at an unfortunate case where an unknown glyster, he conjectures of tobacco, was given. In the same paragraph he asserts, that one Mr. Osbeston, after an Enema of Tobacco infused in sack for a colic, "fell presently into horrid burning pains, convulsions, faintings, and so perished miserably upon the spot, as it were all in flames." And he cites from Etimuller, Clyster ex decocti Tabaci summe periculosus est, cum usum ejus (subitò ac modò applicatus fuerit) præcordiorum anxietates, lipothymias, vomitus, sudo, res circa frontem frigidos, totius feralem quasi pallorem, aliaque symp

tomata insecuta fuisse noverim."

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ten, that in cases of asphyxia, it has been employed to rouse the torpid system into action by the medium of the intestinal canal.

As the Tobacco injection produced such marked effects when thrown into the intestines, and was known to be destructive to insect life in many instances, the probability of its proving an active anthelmintic was an obvious conclusion. Many instances of its beneficial effects in cases of intestinal vermes are related, and also as the means of dislodging the larvæ of flies from other parts of the body. In obstinate cases of tape-worm, and where the patients are robust adults, this active remedy may, possibly, be used without hazard; but in children, who are the subjects most liable to vermes, it will be advisable to act with great caution, or, perhaps, to

eases.

* M. DESGRANGES, M. D. has enquired, with much research, into the use of Tobacco-smoke Enema in different species of asphyxia, particularly that of submersion, and in the treatment of many other disHis work is extremely valuable in that part of it which treats on the various kinds of asphyxia. Journ. de Medicine, 1791. The old writers on this plant seem to have been aware that it had the property of curing diseases in the lower part of the intestinal canal. "The powder of tobacco alone, or mingled with other lenitives, is a present remedy for the Emrods: for it perfectly cures them.". Panacea, 29.VITET, who is a determined enemy to Tobacco, is compelled to allow that-La fumigation des feuilles introduite dans l'anus, calme les coliques venteuses, convient dans l'apoplexie pituiteuse, la léthargie pituiteuse, l'asphixie hystérique, l'asphixie par les passions de l'ame, l'asphixie des noyés, la tympanite sans inflammation ni disposition inflammatoire; et favorise l'expulsion des matières fecales. L'infusion des feuilles en lavement, est indiquée dans les mêmes especes des maladies, lorsque la fumigation n'a été d'aucun secours; elle produit une évacuation, beaucoup plus abondante des matiere sfecales, elle irrite d'avantage l'intestin rectum. Pharmacopéé Medico-Chirurgicale, 4to a Lyon. 1783. p. 198.-The powers of the Tobacco Enema are so remarkable, that they have arrested the attention of practitioners in a remarkable manner. Of the effects and the method of exhibiting the smoke of Tobacco per anum, much has been written. Beside the writers of our own country, I refer to ROZIER, Observations sur la Physique.—JEANANDRE STISSER, de Machinis fumiductoris curiosis, sive, fumum impel lende intra corpus instrumentis, eorumque in praxi Medica adhibendi ratione et usu. 4to. Hamb. 1686.-SCHAEFFER, Gebrauch und Nutzen des Tobacksraus-clystier.-DE HAEN, Rat. Med.-GAUBIUS, Adversariorum varii argumenti. 4to. Leyd. 1771.-Jos. JACQUER GARDANE, Avis au peuple sur les Asphyxies. Paris. 12mo. 1774.-FELLER, De enematibus, atque nova, fumum Tabaci inferendi, methodo. Leips. 1781. -PIN, sur le succès de l'établissement à Paris en faveur des personnes noyées

reject

reject it altogether, except where there may be peculiar and urgent danger from the discase.*

FROM the internal use of Tobacco more has been expected than any individual remedy will ever perform. Apoplexy, asthma, consumption, dropsy, rheumatism, and gout, have submitted to its powers, if we can believe the records of medicine.

That Tobacco has been employed for various affections of the brain is not to be denied. In apoplexy, coma, vertigo, and epilepsia, it was once thought to be a remedy of importance; but in the shifting of medical opinions, it has at length become more suspected of producing this class of diseases, than believed to cure them. We have, however, a well-authenticated instance of its curative powers in epilepsy and convulsions, (vid. Curry); and one of the most learned and judicious physicians of the latter end of the 17th century, says, "though I know many have an opinion of its (Tobacco) being narcotic, or otherwise injurious to the brain, and consequently disposing to apoplexies; yet (to say nothing of my having used it, and not sparingly, for many years, without finding any such effect of it) the very common custom of taking it for so many scores of years since it began to be in vogue, must have made such a quality, if it had it, evidently taken notice of; and consequently common prudence would have obliged people to have left it off long ago, as deleterious, if experience did not evidence the contrary: for there is no man but if, laying aside prejudices, he will give himself the trouble to observe, may easily find, that very many live to great years, and in as great a state of health as those who take it not, that have long used it, even immoderately. My sense of it is, that in those persons with whom it is found to agree, 'tis a very good drainer of humours, and may supply the place of fontanels, or at least that fewer of these may be necessary to those who abound with moisture. But there seems another reason why Tobacco may be useful to those who are disposed to apoplexy (under a supposition of its agreeableness), viz. that by reason of the vellication the

The juice of the leaves of Tobacco clarified, and with sugar made into a syrup, and taken in a morning in a small quantity, drives forth stomach and belly worms; yet you must bruise the leaves and wrap them in a cloth, and lay them to the navel of the patient, and give him a glyster of sugar and milk, Panacea, p. 2. 29. Magnenus says nearly the same. De Tabaco Exertitationes, 247. A long string of authors might be quoted in evidence of the anthelmintic properties of Tobacco. It is, however, sufficiently certain, that it has vermifuge powers, but great caution is required in the employment of them.

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smoke of it impresses on the nerves of the mouth, it makes them contract themselves, and so by consecution the whole brain comes to be analogously affected. So that if the brain happen to be more lax than ordinary, and thereby disposed to receive an afflux of blood and serum, as I take it to be, especially after a person has had and escaped one fit, as well indeed as in many other cases of preceding nerval indispositions, I see nothing but it may prove a very useful administration toward restoring the tone of it."*

Notwithstanding the evidence of men who daily smoke largely without inducing apoplectic symptoms, which Dr. Cole uses in support of his opinions on the effects of Tobacco, there are many facts to be produced of its having occasioned somnolency, and at length fatal coma.+ But this species of dangerous operation of Tobacco, in direct opposition to Dr. Cole's conclusion, can only arise in systems accustomed to its use, and with which it appeared to agree when taken in moderate quantity. The brain is only endangered when use permits an excessive dose to be taken without disturbance, and allows its soporific principle to act silently on the sensorium. In those unaccustomed to its use, its operation is always on the prima viæ; it then seldom manifests narcotic properties, but the whole frame is thrown into violent commotion. An attention to this double principle of action will, perhaps, enable practitioners to manage this plant with more success, and in very different trains of diseased action. When employed as a narcotic with a view to appease irritation, the dose must be small, and prepared in a particular

*Physico-Medical Essay concerning the late frequency of Apoplexies. By WILLIAM COLE, M. D. 8vo. Oxon, 1689. It may be observed, en passant, that Dr. Cole deduces the increase of apoplexies and convulsions in 1684, from the continued intense cold of 1683.

+ Ephem. Nat. Cur. Dec. 2, Ann. 10.-HELLWIG, Obs. Phys. Med. give instances of this effect. Hellwig, in particular, has two instances of coma from smoking eighteen pipes of Tobacco. But a much larger quantity has been smoked without producing this deleterious effect. In the Prax. Mayern. there is recited an instance of the whimsical practice of Dr. W. Butler, about the year 1600. For a defluxion on the teeth, Dr. Butler directed a patient to smoke Tobacco without intermission until he had consumed an ounce of the herb. The man was accustomed to smoke, and took twenty-five pipes at a sitting. This first occasioned extreme sickness, and then a flux of saliva, which, with gradual abatement of the pain, ran off to the quantity of two quarts. The disorder was entirely cured, and did not return for seventeen years. The observation of Butler, " that a hard knot must be split by a hard wedge," shews that he considered this to be a desperate remedy.

way:

way: when intended to rouse the system from asphyxia, the mode of employing it is well understood. Tobacco has another degree or mode of action, intermediate between the preceding, partaking of both, but being exactly neither. When employed to relax spasm the quantity should be sufficient to excite nausea, debility, and the approach to syncope. If it is ever useful in apoplexy it is, when acting with the full energy of its stimulant powers, it rouses the brain from torpor through the medium of the stomach and intestinal canal. From observing in many cases, and perhaps in the greater number, that as soon as the stomach and bowels are acted upon, especially the stomach, persons come out of the apo plectic paroxysm; a conclusion is formed favourable to the employment of this remedy. If apoplexia is to be considered with Nosologists as a genus containing many species, this remedy can hardly be considered as equally proper in all of them. In apoplexia sanguinea it cannot be admissible until the vessels are emptied by the lancet. In apoplexia-serosa, venenata, mentalis, cataleptica, suffocata, immersorum, hysterica, epileptica, cerminosa, ischuriosus, there is reason to expect it may be serviceable, if managed with sufficient expertness. The apoplexia hydrocephalica is an hopeless case. In the apoplexy, or asphyxia, arising from narcotic poisons, (among these is tobacco itself) and from excessive drinking of spirits, it seems peculiarly proper either in enema, or in cataplasm to the scrobiculus cordis. In many of these cases it is impossible to get remedies into the stomach, the power of deglutition being lost how valuable then is one of certain action, when applied externally, or thrown into the bowels per anum. In the apoplexy that arises from a deleterious dose of the narcotic poisons, and in the fatal asphyxia consequent to the excessive drinking of spirits, there is no yomiting. When vomiting does occur, persons recover, or

* A portion of the active part of Tobacco may be dissipated by long boiling; and we are of opinion that the preparation in extract, as prescribed in the Wirtenberg Dispensary, may be employed in pectoral cases with more advantage and safety than the simple infusion or decoc tion made by short boiling.-CULLEN, MAT. MED.

It can hardly be necessary to recal the reader's attention to the cases of suppression of urine treated by Dr. Shaw, with the tobacco bougie.

I am certainly aware that a tube may be passed by the esophagus into the stomach, and that medicines may be conveyed by this means into that organ, when the power of swallowing is lost. But the appli- cation of the Nicotiana either to the bowels by enema, or in some form to the region of the stomach, seems far preferable.

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