Charles Scudamore

“ The action between the medicine and the stomach must be mutual. If we take, for example, so innocent a medicine as the carbonate of iron, I expect more effect from the dose of a dram than half an ounce, which would incommode the powers of the stomach by its mass. The observation applies to all medicines which are of a very insoluble nature. I do not mean, in a general sense, that a small dose of a medicine has equal power with a large one, but that there is a point of increase, beyond which the efficacy becomes lessened. ”

“ The judgment, the discretion, and the humanity of the good physician, will be a sure protection to the patient against any abrupt decision, any gloomy opinion, and much more against unkind desertion, in the most hopeless circumstances of disease. ”

“ 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. ”

“ It is not intended that its use should supersede those established principles of our [Pg vii] art, which early and regular education, as well as experience, have pointed out to us; but that it should serve as an auxiliary in the investigation of obscure disease.
For my own part, I have no apprehension that the judicious employment of the stethoscope can, in any degree, tend to make us negligent in observing the symptoms of diseases, or indifferent to the study of the usual means of diagnosis. ”

“ In our ordinary means of investigation, it often exceeds our best powers of discrimination, to distinguish satisfactorily between functional and structural disease; and this difficulty, I apprehend, will not be removed by the use of the stethoscope, although I am well persuaded it will be very materially lessened. Both humanity towards the patient, and a regard for our own reputation, demand that we should use very great caution in forming our opinion on these occasions, and still greater in pronouncing it. ”

“ Gout never assails the husbandman who unites temperance with his labours; but he is not exempted from rheumatism in any of its forms. Gout is the disorder of peculiar constitutions, and of the adult age; but rheumatism occurs at every period of life, and to all constitutions.
On the assumption that gout is a gastro-enterite, with a developement of irritation in the joints, purgative medicines are prohibited, and the free application of leeches to the affected parts is recommended as the chief curative treatment. ”

“ Candour is most honourable to the educated mind; and to be sensible of our ignorance on any particular subject, is the first step to the acquirement of knowledge.
It has been said that the use of the stethoscope may be injurious, by leading the physician to know too much of the danger in a bad case; to make him despond and resign the patient to his fate too soon. [Pg 13] Such an observation scarcely requires refutation. In no instance of dangerous disease can the physician see his way too clearly ”

“ As it seemed probable that further general bleeding might be avoided, digitalis was added to the medicine. This becomes a valuable agent at the period when we may hope to have laid aside the use of the lancet. If employed during the height of inflammation, most probably it will not render the pulse slower; and even if it does have this effect, it rather masks than cures the disease, leaving us in doubt whether the abatement of the pulse be fairly due to the diminution of inflammatory action, or to the influence of the digitalis. ”

“ I admit that in some circumstances of the gouty paroxysm, the mucous digestive [Pg 77] membrane is affected with inflammatory irritation, requiring suitable and peculiar treatment; but, as a general principle of practice, I confidently advocate the use of alteratives and purgatives, and, with only occasional exceptions, disapprove of the employment of leeches as a remedy for the local part of the disease.
As in theory, so in practice, I believe that M. Broussais considers that rheumatism is to be viewed in the same light as the gout.
M. Laennec employs general bleeding in acute rheumatism ”

“ This author, in his Treatise on the Diseases of the Heart, constantly founds much of his diagnosis on the indications afforded by percussion.
The method consists in striking the respective parts of the chest, which return a hollow kind of sound, when the contents of this cavity are in a healthy state; but give a duller sound, when, from any cause, there is impediment to the free entrance of air into the cells of the lungs. When the obstruction is considerable, the perception is very much the same as when you strike upon the thigh. ”

“ In my own practice, I have derived the [Pg 18] utmost advantage from the use of the stethoscope in cases of pneumonia, with regard to local treatment. When we find a patient ill with severe symptoms arising from inflammation of the lungs, we do not require the aid of auscultation to determine us in employing the lancet as our first and most important remedy; but we may desire immediately to join with the general bleeding, local depletion; and, most commonly, the period arrives when we wish to use local treatment exclusively, by cupping or leeches, and blisters. ”

“ Under such circumstances, it is of the utmost importance that we should be able to ascertain the exact seat of the inflammation; and when, as commonly happens in pneumonia, the patient cannot direct us by any sensation of pain, but is labouring under a general sense of oppression and suffocation; we resort to the stethoscope as a positive and most valuable source of instruction. ”

“ 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. ”

“ The absence of the respiratory sound may arise from an impermeable state of the cells, or the bronchial ramifications, and have for its cause the presence of tubercles, or other matter of obstruction; or it may proceed from some secretion or effusion, the produce of disease. But the student, when he does not discover any sound of respiration, must be careful to avoid drawing false conclusions from his yet imperfect tact in the art; it so commonly happens, that calm respiration does not afford any distinct perceptions to the unpractised ear. ”

“ In examining the chest of a person whose respiration is calm, we should desire that it be made purposely quicker, and stronger; but not so audibly as to cause [Pg 17] confusion by that external sound. The perception afforded to the auscultator by healthy lungs, is that of air entering a cavity, as it were with a gentle stream of sound. If the pupil first apply his naked ear to the chest, he will have a clear idea of what he has to expect. As a general rule, in making our investigation of the state of the lungs, the stethoscope should be applied immediately under the clavicle, near the axilla ”

“ 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. ”

“ It is still a custom amongst the French physicians to employ tisanes, which are decoctions or infusions of roots, herbs, flowers, or grains, as medicinal remedies on which they seem to place considerable reliance. The “formulaire pratique des Hôpitaux civils de Paris” contains nearly ninety prescriptions of different kinds of tisane. With us, the Lisbon diet drink, or the simple decoction of sarsaparilla, is the only medicine which we direct to be taken in quantity as a drink. ”

“ A general notion is entertained that the water of Paris is deleterious to strangers, as producing disorder of the stomach and bowels. Not denying the fact of such indisposition occurring to those who visit Paris for a short time, I may still question the nature of the cause. ”

“ On applying the stethoscope over the upper part of the right side of the chest, at every point, and also over the whole of the right shoulder blade, I heard acute sounds similar to those produced by air strongly passing through a key-hole. I considered that these sounds indicated active inflammation in the whole ramifications of the bronchiæ of the right lung. A large quantity of blood was drawn from the right arm; and cupping was also freely employed, both on the chest and shoulder blade. A saline draught with tartar emetic and nitre was administered every two hours. ”

“ I do not doubt that much mischief is often produced by the solicitude of the practitioner to remove obstructed action of the bowels, instead of directing his treatment to the removal of inflammation, as the immediate and primary object to be fulfilled. ”

“ 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. ”

“ The lungs were removed from the chest, [Pg 11] and the expected evidence of disease did not appear. M. Laennec, making a closer inspection, discovered that a small part of the upper lobe had been left in the chest, and upon its removal, the ulceration was found exactly as he had predicted.
Some persons assert, that the discovery of the precise situation of an ulceration of the lung is merely a matter of curiosity, as when arising from tubercles, they consider it incurable; but surely this is not a good medical objection. Our art may improve so as to enable us to remedy these evils ”

“ In some severe examples, numerous tubercles acquire an active state of disease; [Pg 34] and the consequent irritation is so excessive, that death takes place without the usual process of ulceration.
The nature of the expectoration will guide us considerably in our diagnosis; but it is necessary to keep in recollection, that it should never be judged of separately from the other symptoms. It frequently happens that we witness the sputa of ill appearance and puriform, without danger in the patient ”

“ I found the following symptoms: the pulse frequent, hard, and rather full; the skin hot; cheeks flushed; the tongue much furred; the urine high-coloured, not depositing sediment; the bowels torpid; cough rather occasional than constant, but for the most part violent; the expectoration copious and muco-puriform. In the upper parts of the right and left sides of the chest, the indications afforded by the stethoscope were, very sharp and strong sounds, both in inspiration and expiration, conjoined with the mucous rattle. ”

“ 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. ”

“ He considers that all the essential fevers of authors are only various forms of sympathetic phenomena, arising out of a gastro-enterite; that all the pretended nervous affections of the stomach are the result of a chronic gastrite; that the various dangerous disorders of the brain, for the most part, owe their origin to the state of the digestive passages, irritated with chronic disease; that in all the febrile phlegmasiæ, the stomach and small intestines are irritated in the commencement, if not during the whole progress of the malady ”

“ It should consequently be the study of our art to favour the salutary efforts of nature; and invariably to cherish and encourage, in a judicious manner, those hopes of the patient, which in this destructive disease are always, to a remarkable degree, so fondly entertained. It is to be observed that if a solid cicatrix be formed, and the bronchial tubes terminating in the part be obliterated, the phenomenon of pectoriloquism cannot be found ”

“ Indeed the difference of regimen appears to me a sufficient explanation. I may here remark how very materially the action of mercurial medicine on the bowels is controuled by suitable preparation of the patient with mild mucilaginous drinks. If, on the contrary, the stomach and intestinal canal be charged [Pg 54] with acescent liquor, vinous, or of any other kind, acescent food, and fresh fruits, irritation and disorder, more or less painful, may be expected as almost a certain consequence. ”