Page:Treatise on poisons in relation to medical jurisprudence, physiology, and the practice of physic (IA treatiseonpoison00chriuoft).pdf/41

 poison,—just as it gradually acquires an increased facility in digesting some alimentary substances which are at first very indigestible.

8. The last modifying cause to be mentioned comprehends certain diseased states of the body. The effect of disease, like that of habit, is in general to impair the activity of poisons. But it is only in the instance of a few diseases that this diminution is so strongly marked as to be important in relation to medical jurisprudence.—In the continued fever of this country there is a diminished susceptibility of the constitutional action of mercury; and this peculiarity is very strongly marked in the yellow fever, as well as in the bilious fevers generally of tropical climates. In some varieties of typhoid fever there is obviously a diminished sensibility to the action of wine and other spirituous liquors; but this diminution in a great majority of cases is much inferior to what some physicians have represented.—In severe dysentery the susceptibility of the narcotic action of opium is so much impaired, that a person unaccustomed to the use of that drug, may continue to take daily, for several days together, a quantity which might prove fatal to him in a state of health. In the severe form which dysentery occasionally puts on in this coontry I have known a patient take from twenty-four to thirty grains of opium daily, and retain it all, without experiencing more than a mild narcotic action.—In epidemic cholera the same insensibility has been remarked to the operation of opium.—It also occurs in the instance of excessive hemorrhagy.—According to the doctrines and practice of the present dominant school in Italy, there is an unusual insensibility during inflammatory dropsy to the irritant action of gamboge, so that sixty or eighty grains may be taken without harm.—There is no disease, however, in which the power of mitigating the action of poisons is more remarkably exhibited, than in tetanus: It is often scarcely possible to bring on the narcotic action of opium by any doses which can be administered; calomel, too, acts with much less energy than usual; and even common purgatives must be administered in doses considerably larger than those required in most other disorders.—Mania is similarly circumstanced: almost all remedies must be given in increased doses, narcotic remedies in particular. But there is good reason for believing that the impaired susceptibility of the action of poisons remarked in this disorder is far from being always so great as some have alleged.—Another disease allied to the last, where the diminution of susceptibility is often great, is delirium tremens. It has in particular been often found, that to produce sleep in this disease opium must be given in frequent large doses,—so large indeed, that they would undoubtedly prove fatal to a person in health. At the same time it is worthy of remark, that in some cases of delirium tremens, even violent in degree, the peculiarity now specified, as I have myself several times witnessed, is far from being strongly marked.—Hydrophobia always, and hysteria sometimes, impair the activity of poisons. I have seen cases of hysteria, more particularly those assuming the form of tetanus, where very large doses of opium were required to produce a calmative effect and sleep; and in hy