The inveterate disease called lupus is very successfully treated by the application of an arsenical caustic. They allow the part to form a crust, before they apply a poultice or any emollient dressing.
Neither expence nor trouble is spared in making the artificial medicated baths. The alkaline bath, prepared by dissolving the subcarbonate of soda in the proportion of two pounds to the necessary quantity of water, is extremely useful when the skin is affected with scales.
The douche de vapeur affords great benefit in some obstinate local affections of the skin, when it is necessary to stimulate the vessels so as to bring about an entire change of action. This description of douche often proves useful in chronic rheumatism, and in sciatica, when existing in the chronic form.
I had the opportunity of witnessing the administration of tartar emetic in large doses, as a daily medicine, to patients under the care of M. Laennec. His method is to begin with one, two, or four grains, as the total quantity for the twenty-four hours.
A solution is made in the proportion of half or the whole of a grain, to half an ounce of simple or some lightly aromatic water, sweetened; and it is given every two hours. The patient is desired to drink very sparingly; for without this caution, the medicine would most probably produce too much of emetic effect. In the first instance, this result very commonly happens; but it is remarkable how soon the stomach accommodates itself to large doses of this active medicine. When its continued use produces sickness, syrup of white poppy is added, in the proportion of an ounce to half a pint of the antimonial solution; or, as an equivalent, a grain of extract of opium. The total quantity of the tartar emetic is very commonly increased to twenty grains and upwards in the twenty-four hours. I saw an elderly man, who had, in this space of time, on the preceding day, taken sixty grains without having experienced nausea, or any other inconvenience.
M. Laennec considers that the tartar emetic, when administered with the freedom which I have described, exerts a highly useful power in diminishing inflammatory action in continued fever, and in the phlegmasiæ; and he is most satisfied with its action, when, after the first day or two, it ceases to produce any sensible effect on the stomach.
Reflecting on the extraordinary circumstance of the exhibition of this active medicine in such immense quantity with seeming impunity, I thought it probable that the French preparation might be weaker than our own; but on comparing the crystals which I procured at Paris, with those prepared according to the London Pharmacopœia, I could not discover any difference; nor is there the least essential distinction in the mode of preparation, as directed by the London Pharmacopœia and the French codex. I have lately had many opportunities of prescribing tartar emetic on the principle of treatment which I have described; and I have been perfectly satisfied with its useful agency; but I have usually commenced with one grain, and never exceeded two grains, for the first twenty-four hours; nor found it necessary to go beyond eight in the progressive quantity; except in one case of insanity, in which sixteen grains were given daily for a short time, with the greatest advantage. In the quantity of two grains, it has usually produced considerable sickness for the first day or two; but afterwards, even the increased doses have seldom caused any nausea.
With some persons, however, the first dose of a quarter of a grain produces active sickness. It appears to me probable that the maximum of usefulness[7] is to be found in a moderate range of doses; and that it is desirable to avoid trying how much the stomach and the constitution will possibly bear. Have we a security that the accumulation of a very large quantity might not produce violent effects? Indeed, I am informed of an instance in which the amount of sixty grains was taken in divided doses in a short time; the direction being given that the medicine should be repeated till vomiting was produced. At length, such severe sickness did take place, as could not be restrained for many weeks.
In the treatment of active inflammation, I have usually joined nitre in moderate doses, with tartarized antimony, in a saline draught; and when the inflammatory action has so far yielded, that I have had confidence in not requiring the further use of the lancet, and therefore not apprehended the inconvenience to which I have adverted at page 27, of disguising the disease, I have added digitalis to the draught occasionally; thus obtaining a combination of sedative medicines of great efficacy; and, according to my experience, not disagreeing with the stomach during the active state of the disease.
We must always keep in mind that the effect of medicine is in the greatest degree relative to the particular disease for which it is administered, and to the force of such disease. The doses of active medicines are to be diminished as symptoms abate.