Volume 2

The Clinique médicale, or, Reports of medical cases / by G. Andral ... Condensed and tr., with observations extracted from the writings of the most distinguished medical authors: by D. Spillan.

  • Andral, G. (Gabriel), 1797-1876.
Date:
1836
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Licence: Public Domain Mark

Credit: The Clinique médicale, or, Reports of medical cases / by G. Andral ... Condensed and tr., with observations extracted from the writings of the most distinguished medical authors: by D. Spillan. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    of a g-astro-intesliual iallammatioii, and consequently calls for quite a ditfercnt treatment. Real medical skill consists in being able to distinguish these different states, and in not wishing to reduce them all to one. In these latter times, the contra-stimulant treatment has been applied to pneumonia, and the preparations of antimony, in large doses, have been principally employed in the treatment of this affection. I have repeated these trials, and here are the results at which 1 arrived. I administered tartar emetic, from the dose of six grains to that of thirty-two in the twenty-four hours, and continued its employment for several successive days. I gave it either dissolved in four glasses (verres) of infusion of orange leaves, or concentrated in a five-ounce mixture. In none of these cases, except two, did I see any serious accident arise from this treatment: sometimes the patients manifested no sign of gastrie or intestinal irritation ; they had neither nausea, nor vomiting, nor diarrhoea, nor abdominal pain ; the tongue remained moist and free from redness ; sometimes the patients had nausea, which in some became so distressing, that it was impossible for them to continue the use of the medicine ; others, in fine, had vomiting and diarrhoea. But in all the cases which fell under my observation, nothing more was necessary to dispel the unpleasant symptoms but the discontinuance of the tartar emetic. From these facts it follows, that tartar emetic may be given in a large dose for several successive days, without its use being atttended, in the great majority of cases, with any unpleasant effects regarding the digestive passages. But is this medicine useful ? My answer is, that without meaning to deny what has been stated by others, in none of the cases observed by myself have I seen the pneumonia beneficially influenced by the use of tartar emetic in a large dose. This medicine has not appeared to me more effeetual against pneumonia in the cases where it was tolerated, than in those where it oceasioned painful nausea, vomiting, or diarrhoea. I also tried the white oxide of antimony in the treatment of pneumonia ; I gave it either generally, or in a five-ounce mixture, from the dose of a drachm (gros) to that of eight drachms in twenty-four hours. In no case have I seen this medicine, jirovided it was well washed, produce any appreciable disturbance in the digestive passages. I never saw, as some have stated, that the white oxide of antimony lowers the respiration and circulation. With respect to its therapeutic influence, it appears to me to be not at all marked, and 1 doubt very much, from what 1 have seen myself, that this agent was ever of any advantage in the diseases in which it has been enqiloyed *. * Rasori, ail Italian physician, was the first who introduced tartar emetic in the treatment of ])neumonia, in 1808, and that not for its emetic effects, but for its contra-stimulant, or anti- inflammatory properties ; his mode of giving it was as follows:—After one or more bleedings, and occasionally wlhout any bleeding, he gave from twelve to twenty-four gnuns, or in severe cases, from a scruple to half a drachm, during the day, and the same he repeated at night; these doses were daily increased, until they amounted to a drachm or several drachms in the twenty- four hours. The result of this practice was, on the whole, successful; the number of deaths being about '22 |»cr cent, in the civil hospital, and 14 per cent, in the military. Laennec's mode of giving it was thus:—Immediately after bleeding, he gave one grain of the tartar emetic, dissolved in two ounces and a half of cold weak infusion of orange leaf, sweetened with half ail ounce of syrup of marsh mallows, or orange flowers; this he repeated every hour for six times, after which, unless the symptoms were urgent, he suspended the use of the medicine for seven or eight hours. But when the case w;is urgent, he continued the medicine uninter- ruptedly until some amendment took place, sometimes increasing the dose of the tartar emetic to a grain and half, two grains, or even two grains and half, without at the same time increasing the quantity of the vehicle. For further particulars regarding the employment of tartar emetic in pneumonia, sec Dr. Forbes’ admirable translation of Laennec's work, 4th edit. p. 232, et seq.; also, a very instructive and interesting note by Dr. Forbes (p. 244), concerning the history of this medicine, in which note the reader will find the testimonies of different practitioners regarding its eflicacy. It may be well to mention that Dr. Forbes himself, non sordidus auctor, in giving the result of his own experience, says that, “in pure pneumonia, the tartar emetic, in