In the case of a gentleman suffering from enlargement of the liver, and with whom mercury in any form acted very unfavourably, I obtained the most satisfactory results from the use of tartar emetic as an alterative; this medicine never occasioning that nervous irritation which invariably attended the use either of calomel or the pilula hydrargyri.
The practice which I have here related, of administering large doses of tartar emetic, and that recommended by Dr. Hamilton, of the free use of purgatives, appear very opposite to the doctrines of Broussais, which inculcate such a tender regard to the susceptibility of the stomach and intestinal canal, as almost to discountenance the use of emetics and purgatives, from the apprehension of producing gastrite, or gastro-enterite.
We are greatly indebted to the ingenuity and industry of the French chemists for many important results in vegetable chemistry; and as the most valuable of all the discoveries made, I may mention the separation of the essential principle of the yellow bark (cinchona cordifolia) called quinine; which, for medical use, is afterwards combined with sulphuric acid, forming the now well-known medicine, sulphate of quinine[8].
I do not consider it to be proved, that the sulphate of quinine embraces all the useful qualities of the entire bark; although, from its power in curing intermittent fever, we may conclude that it possesses the most important. Two of the principles which are removed by the process for obtaining the sulphate, namely, the quinic acid, and resin, must not be disregarded.
I have sometimes found the decoction of bark more acceptable to the stomach, and more useful, than the sulphate of quinine, and particularly grateful when given with the carbonate of potash and lemon juice in effervescence, adding also some tincture and syrup of orange peel.
Bark in substance very often oppresses the stomach, and seems to impair both the appetite and digestion, which in general become improved by the influence of the sulphate of quinine. Indeed, formerly, when in the habit of directing large and frequent doses of the powder of bark for the cure of ague, I found it expedient almost to forbid food, seeing that the stomach was sufficiently occupied with the presence of the bark. It is scarcely necessary to observe, that, in some cases of ague, where the digestive organs, and the liver especially, are in fault, bark, in any form, is not the appropriate medicine for the cure.
The sulphate of quinine is unquestionably a powerful and excellent tonic, and at the same time does not stimulate unfavourably. I am accustomed to prescribe it with great success to patients convalescent from gout; to whom on all former occasions, bark in its other forms had proved unsuitable, tending to re-excite the gouty action.
The acetate of morphine is another of the new medicines derived from the French chemists, which we can administer advantageously to those individuals who are too much stimulated by the ordinary preparations of opium. The process[9] employed for the separation of morphine from opium, removes the resin, the narcotine, and meconic acid.
The black or Lancastrian drop owes its useful quality to the circumstance of its containing a larger proportion of acetate of morphine than the other principles of opium; but it is not so pure a preparation as the acetate of [morphine], prepared as I have described.
It appears to me that half a grain of the acetate of morphine is about equal to a grain of the extract of opium.