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

It has been discovered by M. M. Pelletier and Caventou, that the nux vomica, the bean of St. Ignatius, and the upas poison, owe their active power over man and animals, to two particular vegetable alkalies, the strychnine and brucine.

Strychnine is procured in the state of crystals, by a complicated chemical process, from the nux vomica. Its action on the animal economy, as proved by experiments on dogs, is so extremely powerful, that one would conceive it to be inadmissible as a medicine; but M. Magendie relates that he has administered it in paralytic cases with good effects. From an eighth to a quarter of a grain is the usual dose. Brucine has been found combined with strychnine in the nux vomica. In St. Ignatius’s bean, and in the upas, brucine bears a similar relation to that which cinchonine has to quinine in the cinchona barks, the strongest of which (cinchona cordifolia) contains the largest relative proportion of quinine. In the same manner the bean and upas, which are much more active substances than the nux vomica, contain little of the brucine, and much of strychnine. In the upas, strychnine is almost pure[10].

For medicinal purpose, brucine is procured from “la fausse angusture” (angustura ferruginea). The process is in most respects similar to that employed for strychnine. It is administered in pills, and has been employed in paralytic cases with reported success by M. Magendie, and by M. Andrals fils, in doses from half a grain to five grains; and it is assuredly a much safer preparation than strychnine.

The active properties of ipecacuanha have been found by M. M. Magendie and Pelletier, to reside in an immediate principle which they have called emetine. They consider that it may be advantageously substituted for ipecacuanha, as an emetic, it being divested of the offensive odour and taste of that substance, and which M. Caventou found by experiment to be foreign to the emetic qualities of the medicine. As an emetic, from a quarter to a whole grain in solution may be first given, and a quarter or half a grain repeated every twenty minutes till the due effect be produced.

Veratrine is an alkali procured by a long chemical process from the plants of the family of veratrum. It appears to be the chief active principle residing in the colchicum autumnale, and in white hellebore. M. Magendie states that the dose of a quarter of a grain usually affects the intestinal canal rather powerfully. In a case of apoplexy, he prescribed two grains in the twenty-four hours without producing much effect on the bowels. He comments on this result, as proving how much the state of the nervous system influences the action of medicines.

M. Magendie suggests that the use of veratrine might be preferable to the tincture of colchicum and the eau médicinale (which latter medicine he considers to be substantially veratrine), on account of the greater uniformity of the preparation.

In the treatment of gout, I am induced to avoid the active preparations of colchicum entirely; and in employing the acetum colchici, which is very mild, I use it only in combination with other medicines, and desire to procure from its agency rather an auxiliary operation, than that of colchicum distinctly. I have endeavoured to explain my sentiments fully on the subject in my Treatise on Gout and the disordered State of the Digestive Organs.

With these observations, I shall now conclude my summary view of the nature of the principal new medicines, which have been added to our list of remedies by the science and industry of our continental neighbours[11].

It would lead to an interesting field of inquiry, were we to examine the general customs and the habits of living in different countries, in relation to health; and to trace the influence of climate, soil, political and civil institutions, laws, religion, &c. But the subject would demand a volume, rather than a few pages, and be foreign to my present limited purpose.

According to what I have learned from others, and from my own personal observation, I should state that the diseases which arise from repletion, as apoplexy and gout, occur more frequently in this country than in France. I am persuaded also, that the latter disease has increased amongst the middle classes of society in this country, with the progress of luxury and refinement.