Ingenious: Delight Inferiority Require

commend, we answer, not because we feel any delight in oppo-
sition, nor because we were insensible of our inferiority to the

ingenious author ; but because wewished to call the attention of
the public to points which arc doubtful and require further elu-
cidation.
An Inaugural Dissertation on the medical virtues of the white

oxide of Bismuth, &c. submitted to the public examination of
the Faculty of Physic, under the authority of the Trustees
of Columbia College, in the state of New York, &c. for the de-
gree of Doctor in Physic. By Samuel W. Moore, A. B. New
York; 1811. pp. 39.
Am this pamphlet is related, in a modest manner, all that has
hitherto been published, together with the results of Dr. Moore's
own experiments on the medicinal properties of the oxide of
Bismuth. The American public will feel itself indebted to this
gentleman for his attempts to introduce into more general notice
a medicine, which in some of the principal affections accompa-
nying dyspepsia, is perhaps superior in operation to any of the

class of permanent stimulants most usually prescribed. The ac-
tion of this substance on the stomach is that of a mild and effec-
tual tonic ; and from our own experience of its virtues, we do
not hesitate to affirm with Odier, Marcet, Bardsley, and Moore,
that in pyrosis, cardialgía, and more particularly gastrodynia, it
operates more speedily and with more certainty, than any other
article of the materia medica. In the course of the last five
years, we have frequently prescribed it in these forms of dyspep-
sia with almost uniform success ; and although a medicine pos-
sessing such active properties might be supposed occasionally
to produce some unpleasant effects on the system, we have ne-
ver known any injurious consequences to result from its exhi-
bition. A substance which discovers such qualities ought to be
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more known and more frequently administered ; for
generally
even on the supposition that it is capable of producing no grea-
ter effects than those of the medicines usually prescribed in these
complaints, its use will be attended with the advantage of dis.
carding, in some measure, from practice, the long continued
employment of alcohol and bitters, which ultimately lessen the
activity of the digestive organs, and cither prolong or perpetu-
ate the disease they were intended to relieve.
The white oxide of Bismuth is prepared for medicinal pur-
poses, by pouring water into a saturated solution of this metal in
diluted nitric acid, a decomposition is immediately effected, a
white ponderous substance is precipitated, which is afterwards
collected and dried. As the nature of the precipitate and the
purity of the medicine arc influenced by the relative proportion
of the two fluids, the whiteness of the oxide, which is consider-
ed as the criterion of its goodness, depending in a great measure
on the quantity of water employed in this decomposition,we shall
here insert the process recommended by the author for that pur-
pose.
"
The bismuth to be dissolved should be previously reduced to powder
in an iron mortar. Let three parts of nitric acid for one of bismuth be di-
luted with an equal weight of pure water. To this menstruum contained
in a glass vessel, add the bismuth at intervals, and let it stand till it is all
dissolved. Let the clear solution be decanted from the sediment, and a
few ounces of it be poured into a glass vessel, capable of containing half as
many gallons as there have been measured ounces put in ; the vessel is
then filled with pure ((¡¡stilled) water, when a copious and perfectly white
precipitate will be instantaneously formed, giving to the liquid the appear-
ance oRmilk.
"After this has subsided.the clear fluid must be decanted, and fresh wa-
ter thrown on the precipitate to wash it. This operation must be repeat-
ed several times, till no acid taste is discoverable in the decanted wa-
ter. This precipitate, which is pure white oxide of bismuth, should be
suffered t) dry without heat, or indeed light, for the attraction between
oxygen and bismuth is so weak, that if the oxide while drying be exposed
either to a moderate artificial heat, or the direct rays of the sun, it parts
with a portion of its oxygen, and loses its whiteness."*
*
It is questionable whether the term oxide be equally correct as tha*.
of sub-nitrate applied to this precipitate. If the results of the researches
Having thus given the process for preparing this medicine
in a state of purity, Dr. Moore proceeds to the history of its in-
troduction into practice, and to the diseases to which its exhibi-
tion has been confined.
It appears that its medicinal uses were first made public by
Dr. Odier, of Gencva,\vho published a memoir on the subject in
the volume of the Journal de Medicine for 1786 They were
afterwards cursorily adverted to in the Medical and Physical
Journal for 1799, and more fully described in a paper inserted in
the 6th volume of the Memoirs of the London Medical Society,
by Dr. Murcet, physician to Guy's hospital. A year or two af-
ter this, Dr. Bardsley, of Manchester, published his "Reports,"
and among other cases records the salutary effects of this medi-
cine in the various forms of dyspepsia.
'' The
particular affections," says Dr. Moore, " to the relief
of which this medicine appears peculiarly applicable, are those
diseases of the stomach, which proceed from want of tone in its
musculur fibres, and more particularly spasmodic pains in that
organ ;" and farther on, " Bismuth appears to have a local ope-
ration on the stomach in relieving spasm and counteracting a
of Berthollet on the forces of
affinity be considered correct, and they ap-
pear be adopted as such by many chemists, it will follow, that as a
to *
portion of the nitric acid is abstracted by the water, or as the proportion of

oxide is augmented, the affinities of the remaining acid and the oxide will
become more effective, till at length they may come to balance the force
exerted to separate them, and the decomposition of course will
cease, be-
fore the whole of the former is withdrawn A sub-nitrate therefore will
be produced ; or perhaps it may be explained on the supposition that,
by the effusion of water, the salt is divided into two portions, a super-
nitrate remaining dissolved, and a sub-nitrate being precipitated. The
latter of these opinions appears lobe confirmed by analogy. Some other
salts, as the nitrateof antimony and nitrate of quicksilver, made at an high
temperature, and a few of the metallic sulphates are decomposed by the
addition of water, and the precipitate consists not of a pure oxide, but of a
sub-salt, or of oxide still combined though not saturated with the acid.
In a medical point of view it is perhaps of little consequence whetherwe
regard this article as au oxide or a sub-nitrate of bismuth ; but it is of
some importance in pharmaceutical nomenclature, that we should
approach
as near as is
possible to chemical precision.
disposition thereto, quite peculiar to itself, and
not hitherto de-
rived from any other metallic substance with which we are ac-
is
quainted : and in cases where there a disposition the sto-
in
mach to generate acid, the oxide of bismuth has the property,
by giving tone to that organ, to effect a permanent cure when
alkalis and absorbent medicines produce but a temporary relief."
The usual dose in which this substance is prescribed is five
grains twice or thrice a day, mixed with any convenient vehicle,
such as gum tragacanth, gum arabic, sugar or starch, in the
proportion of one grain of the oxide to four or five of the powder
of either of these substances.
For those of our readers, who have not had an opportunity of
of perusing the cases brought forward by Murcet, Bardsley, and
Moore, to prove the efficacy of this medicine in chronic debility
of the stomach, we shall take the liberty of extracting from the
work under review an abstract of a case from each of these au-
thors.
Page 20. " Dr. Marcet prescribed the oxide first in the case of a woman,
who, probably from her ¡sedenlary occupation, had for two months preceding
been afflicted with a. very troublesome dyspeptic affection, where no matter
either solid or fluid was su allowed without exciting pain at the pit of the
stomach, followed by sickness and vomiting ; ' in short,' says he, ' it ap-
peared from her account that only an extremely small portion of the nour-
ishment which she took could be transmitted to the alimentary canal.'
This patient, for a month, made use of such tonic medicines as were
thought best adapted to her complaint, without deriving from them any
sensible benefit."
"Dr. Marcet ordered that she should take five grains of the oxide three
times a day, with fifteen grains of the compound pou der of gum traga-
canth. At the expiration of a week from the time she began its use, she
said, 'she was almost quite well,' and begged to have ' some more of the
powders that had produced such remarkably good effects.' At the end of
another week she declared herself free from complaint."
Page 23. " The first patient for whom Dr. Bardsley prescribed the
oxide of bismuth was a man who had become dyspeptic, probably from
the intemperate use of ardent spirits. He was troubled with gastrodynia,
frequent eructations, heartburn, griping, and alternate costiveness and di-
arrha:a. He twice became better, though at no time free from complaint,
and each succeeding attack was more severe than that which had pre-
ceded it. Dr. B. having at length met with Dr. Marcet's paper, prescrib-
ed five grains of the oxide with twenty-five grains of gum tragacanth, to be
taken three times a day. This patient found considerable relief after taking
nine doses In nine days from the time he commenced ils use, he was al-
most well, except some degree of anorexia, with a slight diarrhsea ; to re-
lieve the last symptom, gum kino and opium were given with the oxide,
and in a short time he was restored to excellent health."
From the original cases recorded by Dr. Moore, and which

were immediately under his observation, we shall insert the fol-
lowing-
" CASE II.
«New York, Sept. 9, 1810.

"
Mr. D—, aged 45, has for the last three years been afflicted with car-
dialgía, attended with extreme flatulence ; he has at no time during this

period been free from these complaints. He has frequent acid eructations,
which he says are also very acrid, occasioning his throat to feel as though
it had been scalded; sometimes also, though rarely, he is sick at his sto-
mach, and vomits up matter having the colour of coffee-grounds. He
has a number of times taken emetics, and since the commencement of his
complaint has been in the daily habit of taking magnesia, from the use of
which, although he has sometimes thought it afforded him temporary
relief, it is pretty evidentfrom the continuance of the disease, that very
little permanent advantage has resulted.
"
Daring the last winter and spring he had occasional attacks of severe
gnawing pains at the pit of the stomach, which warm applications would,
commonlv in the course of fifteen or twenty minutes, relieve. Throughout
the summer he has been generally free from these spasmodic pains ; but
for the last eight or ten days they have attacked him much more se-
verely, usually returning three or four times a day. These attacks are very
violent, occasioning great anxiety, succeeded by insufferable pain, throw-
ing him immediately into profuse perspiration. The warm applications,
from the use of which he had on former occasions found benefit, at this
time afford him not the 'slightest relief.
"
For the last two months he has been making use of very strong bit-
ters, and I think it probable he has injured his stomach by the large and
frequently repeated doses which he has taken. A very sparing use either
of spirituous or fermented liquors never fails to increase his cardialgía.
His bowels are quite regular, and his pulse feeble.
"
Mr. D— at this time sent for my father, who directed him to take,
three times a day, five grains of the oxide of bismuth, combined with an
equal weight of refined sugar, and twice its weight of starch.
"
Sept. 11. He has had no return of the pain in his stomach since he
commenced the use of the oxide, but feels well enough to-day, to take a
ride into the country.
"
Monday morning, Sept. 17. He still continues free from the spasmo-
dic pain of his stomach ; his cardialgía, though not well, is better than it
has been hitherto. He has taken none of the bismuth since the morn-
ing of the 13th, when he took the twelfth and only remaining dose he had ;
and being out of town, he had it not in his power to obtain another supply
until his return to the city to-day.
"Monday evening. He had this afternoon a return of that distressing
anxiety which has always hitherto preceded his attacks of pain in the sto-
mach. Fearing he was about to have another attack, and placing full re-
liance on the oxide, from his experience of its efficacy, he sent immedi-
ately for a supply of it ; but before the person returned with the medicine
he had taken forty drops of laudanum ; he however took directly a dose of
the oxide, and the pain did not, as he expected, succeed ; but as he had
taken laudanum previously, we should not be justified in attributing to the
bismuth alone the disappearance of his unpleasant symptoms.
"
Wednesday, Sept. 19. Our patient has not since had any return of
the spasms ; the cardialgía is infinitely less troublesome. I gave him
to-day twenty-four doses of the bismuth, each containing six grains of the
oxide, directing him to take one three times a day.
"
Sunday evening, Sept. 23. Mr. t-is now free from all complaint.
His heartburn, which was very troublesome till he began taking the bis-
muth, does not at present appear, unless it be brought on by the use of
wine or brandy ; he can, however, drink moderately of West India spirits
or gin, without experiencing the least inconvenience by so doing. On
Thursday last, after riding twelve or fourteen miles, he began to feel some
pain in his stomach, but was immediately relieved by taking his customary
dose of bismuth."
The which terminates the essay of Dr. Moore, is

appendix,
composed of extracts from various periodical works and others,
all tending to confirm the high opinion he has advanced of the
medicinal efficacy of the oxide of bismuth.
In the multitude of dissertations which annually issue from
the schools of medicine,we do not expect to find that originality
of observation and that display of new and useful facts, which
are the results only of an habitual discrimination, of unwearied
industry, and of extensive clinical experience. Such productions

are generally written more with an intention of showing to the
professors that their authors are well versed in the medical clas-
sics than with the expectation of adding much novel matter to
the fund of medical information. As the operation of the oxide
of bismuth had been sufficiently demonstrated in the cases of
Marcet and the "Reports" of Bardsley, the dissertation of Dr.
Moore would have been rendered more interesting and perhaps
more useful, by confining his experiments to its effects in cases
analogous to the diseases, for the cure of which it was already

celebrated ; and it is probable that such cases he might have
had at his command in the sphere of his father's practice. The
effects following its exhibition in a case of menorrhagia by Dr.
Stringham, and in the peculiar state of the stomach common to
the different periods of gestation, by Dr. Post, will, we have no
doubt, induce Dr. Moore to extend his researches still farther»
and to ascertain all the medical properties of this useful sub-
stance. This dissertation we consider as a very respectable pro.
duction ; the subject is important, and much industry appears
to have been exercised in the collection of its materials.
ARTICLE VII.
An Assay on the organic Diseases and Lesions of the Heart and

great Vessels. From the Clinical Lectures of J.N. Corvisart,
first Physician of their Imperial and Royal Majesties; officer of
the Legion of Honour, honorary Professor of the School of
Medicine of Paris, and of the Imperial College of France;
Physician in Chief of the Hospital of La Charit\l=e'\, &c. &c.
Published, under his inspection, by C. E. Horeau, Doctor in
Medicine, Surgeon of the Infirmary and House of the Emperor
and King. H\l=ae\ret lateri lethalis arundo. Virg. \l=AE\neid. Trans-
lated from the French, with Notes, by Jacob Gates, M. M. S. S.
Boston; Bradford and Read; 1812. 8vo. pp. 344.
In this quarter, the subject of organic affections of the heart

has received great attention for a few years past. It was firs1

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commend, we answer, not because we feel any delight in oppo-

sition, nor because we were insensible of our inferiority to the

An Inaugural Dissertation on the medical virtues of the white

nying dyspepsia, is perhaps superior in operation to any of the

portion of the nitric acid is abstracted by the water, or as the proportion of

From the original cases recorded by Dr. Moore, and which

«New York, Sept. 9, 1810.

dialgía, attended with extreme flatulence ; he has at no time during this

The which terminates the essay of Dr. Moore, is

industry, and of extensive clinical experience. Such productions

analogous to the diseases, for the cure of which it was already

An Assay on the organic Diseases and Lesions of the Heart and

In this quarter, the subject of organic affections of the heart

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