Observations on M. Laennec's method of forming a diagnosis of the diseases of the chest by means of the stethoscope, and of percussion; and upon some points of the French practice of medicine

by Charles Scudamore

As an occasional remedy, this practice is most useful and important; and, in certain cases of great delicacy of constitution, it may be a very advisable substitute for aperient medicine, however regularly it may be required: but under ordinary circumstances, as a habit, it appears to me as objectionable in other respects as it is inconvenient. When the bowel becomes much accustomed to this artificial distension, it often fails to act without receiving such solicitation; and hence a mechanical necessity is established for this peculiar stimulus[5].

When the digestive powers of the stomach are unhealthy, and particularly when the functions of the duodenum and of the liver are also in error, as we usually see in established disorder of the chylopoetic viscera, the propagated influence which may take place from the lower bowel being stimulated to discharge its contents by means of the lavement, is insufficient to remedy the functional error existing so much higher up in the canal, and I have witnessed examples in which serious complaint in the liver has made insidious progress, from the circumstance of the patient having placed reliance on this palliative relief, and neglected the employment of an effective course of medicine.

The application of leeches, with a view to derive blood from the vessels which communicate with those of the lower bowels, is a practice quite common in France, and seems a favourite measure, whatever viscus of the body may be affected. I have no doubt of the utility of this mode of obtaining blood, when the lower part of the intestinal canal is in a state of congestion; and, I may add, in many cases of irritation. A gentleman had been troubled with diarrhœa, which was often painful, for two or three months. It had resisted the usual treatment by medicine. By one application of leeches near the rectum he was cured.

Nature often points out the propriety of relieving the overloaded circulation of the intestines, by the discharge of blood from the hemorrhoidal vessels, and when, therefore, the indications for such a mode of evacuation are presented, without any spontaneous relief having taken place, the use of leeches is important. Also in certain states of congestion of the uterine vessels, this method of local depletion will be attended with advantage.

In all cases of inflammation near the surface, in which the detraction of blood is proper, the application of leeches is a very eligible mode of treatment. I apprehend that blood is drawn from a greater number of capillary vessels by this method than by any other; such abstraction being favoured also by the gradual and protracted evacuation of the vessels. It remarkably relieves inflammatory action, either of the acute or chronic kind, in the stomach and bowels. It is by no means so effectual in maladies of the head and chest, in which cupping is a better mode of taking away blood; although occasionally, even in those complaints, the use of leeches may be more convenient, and even more appropriate.

Comparatively speaking, the practice of taking away blood by cupping is very rarely resorted to by the French, and they appear to prefer, in principle, the mode of bleeding by leeches, which they call derivative; thus for the relief of the head, they apply them in the neighbourhood of the rectum. That free cupping at the neck or behind the ears, or opening the jugular vein when the vessels of the head are in a state of congestion and increased action, is a far more efficacious treatment, appears to me most unquestionable.

I consider it to be an important principle of treatment in regard to the detraction of blood, in local inflammation, that we should make it from the system, when the action of the heart is much increased beyond the natural standard. When we have sufficiently reduced the pulse, or, if in the first instance the general circulation do not appear to be affected, it may be preferable to use cupping or leeches only.

In active inflammation of any of the important organs of the body, the decided conduct of the English practitioner in using the lancet as his chief remedy, promptly and boldly, and persisting till the dangerous force of the disease is conquered, demands, in my opinion, an undoubted preference over the more tardy, and I must add, the inefficient methods of the French. This leading difference in the method of treating dangerous inflammations, appears to me to constitute the most remarkable distinction in the practice of the English and the French physician.

I believe that severe and dangerous diseases are much less frequent amongst the French than the English. There are physical and moral causes to explain this fact. Their climate is less variable, and less humid, than ours. They use a lighter diet; much more bodily exercise, and they are a more cheerful people, constantly cultivating amusement. Hence, probably, the general plan of French practice is simple; and the use of tisanes and lavemens emolliens is generally preferred to the employment of active medicines.

The pharmacien is not in any case permitted to prescribe; and no one can open a shop for the sale and preparation of medicines, without the permission of the authorities.