my persuasion, that its use as a sedative to the circulation, in diseases of inflammation or excitement, might beneficially be much extended; superseding depletion in some cases, the use of narcotics in others. Regarding its employment in pulmonary consumption, I am unable to add any thing to the ambiguous recommendation it has heretofore received. It clearly has no power over tubercular deposits; and the only influence to be understood in such cases is that of abating the rapidity of circulation, where greater than is natural; an effect of less real moment than is generally supposed. In this, as in many other instances, the importance of a particular symptom as a test, leads to a wrong estimate of its relations to the actual disease. We think ourselves in the way towards cure, when merely lessening one effect of a specific disorder upon the natural functions of the body.

Respecting the several forms under which digitalis is used, there is some reason to believe the infusion, rightly prepared, to be the most certain and beneficial in its effects; and admitting of every combination with other medicines which can in any case be required. This, indeed, is an instance where, from the nature of the agent, it is singularly needful that the quality of its preparations should be equal and uniform. It is certain that many of the inequalities and seeming anomalies in the effects of digitalis are owing to neglect of this important precaution.

559

CHAP. XXXII.

ON ANTIMONIAL MEDICINES.

I ANNEX this subject to the preceding, having chiefly in view what is still the insufficient use in English practice, of those medicines expressly sedative to the actions of the circulation. I have noticed this in the instance of digitalis; and it is equally true as regards some of the antimonial preparations ; and the tartarised antimony especially. The opinions held in relation to the supposed sudorific effect of these medicines, has prevented due attention being given to their influence in allaying inordinate action; either of the brain, as in mania and delirium of different forms; or more generally in inflammation, or febrile states of the whole system. In France, and still earlier and more extensively in some of the Italian schools, the use of emetic-tartar is well known to have been carried much further than in England, and under systematic views, as a contra-stimulant, which we scarcely yet fully recognise. The appreciation of its powers is now, indeed, becoming more just and complete; but the progress is slow in relation to the assured benefits which may be derived from it in ordinary practice.*

The writings, as well as practice, of Professor Tomassini of Bologna, may be cited in proof of the extent to which the use of tartar-emetic may be carried; and also for the best account of the doctrines of the new Italian school on this subject, to which the names of Rasori and Borda, as well as his own, have given reputation. The work more recently published by M. Lapelletier, "De l'Emploi du Tartre Stibié à haute Dose dans le Traitement des Maladies," affords a complete history of all that is known on the subject.

In another chapter I have noticed the uncertain views which determine our employment of antimonials as sudorifics, and the probability that any such effect they have is due chiefly to their influence in abating the circulation and the febrile state. To this may be added a reasonable doubt regarding the efficacy of some of the antimonial preparations most frequently in use. My own experience suggests the conclusion which has occurred to others, that the antimonial powder of our Pharmacopoeia is perfectly inert in any ordinary dose; and that the original James's powder has held a reputation barely justified by any method of its use; certainly not by the trifling quantities in which it is now given. All the gain we derive from these medicines as sudorifics or otherwise, is obtained far more largely, and with much greater certainty, by use of the emetic-tartar in similar cases: and this, in fact, is the preparation of antimony which, by proper management, may be made to supersede any other; and which, whether considering its power or variety of application, may fairly rank amongst the most valuable remedies we possess.

any

Of these applications, that which depends on its sedative effect is perhaps the most important. Without referring to theories of this particular influence, or the mode in which it is exercised in the living body, it is enough to know that there is the power, directly or indirectly, of diminishing excess of action; and limiting thereby the degree, if not also the duration, of those conditions in which disorders of acute inflammation or inflammatory fever mainly consist.*

As a

*The reluctance shown by many to admit the phrase and idea of a direct sedative, may depend, in part, on too exclusive attention to the fact that augmented action is always followed by proportionate loss of power; becoming in this way the most frequent and familiar cause of sedative effect which is known to us. But the full admission of this general

febrifuge in the most distinct sense of the term, it may be doubted whether we possess any more direct or speedy in effect. It is impossible to have witnessed its effects, when adequately given, in acute pneumonia, or bronchitis, or croup, without recognising the same fact; and seeing that where it does not wholly supersede bleeding as a prior remedy, it at least abridges the demand for this; and comes in aid of it, by inducing the same state of the vascular system throughout the body. Its relation to mercury in these cases is that of most interest; the effect apparently the same, so as in many instances to make it doubtful which of the two remedies may best be relied upon for instant use; yet the mode of operation presumably very different.*

The evidence of Laennec, Louis, and other eminent French physicians, on many of these points, is more explicit than ours; as founded on larger use of the remedy, and more direct comparison of the cases of pneumonia so treated with those submitted to other means. I know not that its value has been equally attested in other forms of inflammation; but sufficiently so, and especially in affections of the brain, to show that the sedative action is not limited to one organ, but extends generally to the whole system. †

law by no means precludes the allowance of other actions upon the body, or certain of its functions, producing the effect at once, which indirectly results in the other case. Abstractedly considered, the notion of any part of vital action reduced below its average or natural state, is quite as intelligible as that of the same action raised above it.

* Dr. Stokes, in his work on Diseases of the Chest, remarks that the previous use of tartar-emetic in pneumonia seems to facilitate the further action of mercury in subduing the inflammation. He advises that in

typhoid pneumonia the mercurial treatment should be pursued in preference to that by antimonials. What I have seen would lead me to concur in both these points of practice.

The experiments of Sir B. Brodie, in the second of his valuable

Though the discussion as to the relative merits of the treatment by bleeding, and that by antimonials, in pneumonia, is not without use, yet it has perhaps placed the remedies too much in seeming opposition to each other. They come, in fact, in common aid towards the same object, and are often needed in conjunction; the bleeding first, in such cases, for more instant and powerful effect, and possibly also as giving more power to the action of the tartar-emetic;

the latter as sustaining the effect of the depletion, and often preventing the need there might otherwise be of its repetition. When the inflammation is slight, its relief may frequently be trusted to the antimonial alone. This appears to be the view by which the relative employment of the two remedies may best be guided in practice.

I infer, from my own observation, what is amply proved by that of others, that the sedative effects of antimony under this form are independent of all evacuation from the body. They may occur where there has been neither vomiting nor purgative action; and where perspiration, if happening at all, comes rather in sequel and effect, than as cause of the changes produced. We must consider the vascular system, either directly, or through the influence of the nervous system, to be the part concerned in, and the subject of, these changes. Some ambiguity exists here, as to the nausea brought on by the use of the medicine; and the relation of

The sug

papers on the Action of Poisons (Phil. Trans. 1812, p. 205.), render it probable that the brain chiefly is first acted upon by emetic-tartar so given, but with some evidence of direct action on the heart also. gestion of Magendie, that its fatal effects are due to an inflammatory state of the whole system, supervening upon absorption, does not seem warranted by any express fact; and is made less probable by the frequent absence of all inflammatory appearances on the coats of the stomach and intestines in such cases.