Gambar halaman

narrow alleys and damp basements for dwelling-places shall be forever prohibited.


There is probably no greater advance in practical medicine, and no improvement in our methods of treatment more useful and conservative, made within the last three hundred years, than that which we call antipyretic medication. Since the general adoption of this plan of treating acute disorders attended with fever, there can be no doubt that the death-rate has been most materially diminished; while our patients recover with far less loss of flesh and strength, and consequently convalesce more rapidly, than under the older destructive or spoliative plans, or even the purely expectant system. The success of this comparatively new method reveals to us what an important role fever played in protracting disease, as well as in determining fatal results. Under this plan even consumption, and other ultimately fatal diseases, are protracted in their course, the fatal termination postponed, and in some cases actual recovery secured ; and thus the aggregate duration of life increased.

Even that disease which we call rheumatism or rheumatic fever, long one of the opprobria of medicine, so much to be dreaded on account of the weeks of suffering involved in an attack, to say nothing of its terrible and fatal complications, is found to yield promptly to an efficient antipyretic. The fact is attested by thousands of observers, that this disease will yield promptly, often in a single day, to efficient doses of salicylic acid or its sodium salt. But it is found that this drug does not exert any peculiar or specific influence over rheumatism, as was at first supposed. It cures only by its antipyretic action, and any other substance capable of producing an equal antipyretic effect is equally as efficient in curative power. Thus salicin, quinia, and other alkaloids of cinchona, and many other antipyretics, are found to be equally efficacious as the salicylic acid. Advantage is undoubtedly derived by combining arterial sedatives and anodynes with the antipyretic. When thus combined, their action in relieving the pain and fever attending rheumatic inflammation is almost marvellous. Patients often say, after taking two grammes of sodium salicylate with one centigramme of morphiæ sulph. and thirty centigrammes of tinct. verat. viridi, that their sense of relief is absolutely indescribable.

This dose should be repeated every third hour for twenty-four bours, and at longer intervals for two days afterwards.

Sixty-five centigrammes (65 cg.) of quinia, or 75 eg. of any one of the other alkaloids of cinchona, will be found fully as effectual as the salicylic acid. If we had made no other advance than this in the last fifty years, it would establish our claim that medicine is a progressive science; for probably few other discoveries in that time, if we except anæsthetics, have contributed so much to the relief of human suffering.

My reason for bringing this subject, which can bardly be called uew, to your attention at this time, is that during the past winter I read a clinical lecture by a very eminent teacher in one of the oldest and most reputable medical schools in our country, in which it was most positively stated that we possess no means whatever of controlling or in the least shortening the duration of acute rheumatic inflammation. As it is morally certain that the gentleman alluded to has never given the antipyretic system a fair and honest trial in this disease (else it would be impossible for him to hold the opinions he expresses), and as his influence is great, and his standing high both among students and physicians, too strong or too public a condemnation of such teaching is hardly possible.

The great value of antipyretics (as distinguished from apyretics) in the treatment of all diseases attended with pyrexia, being established, every new addition to this class of medicines is valuable, since, with a large number to choose from, we are able to make a nicer adaptation to suit the varying conditions and complications with which we are often confronted.

Frequent accidents in the use of injections of solutions of carbolic acid into the peritoneal, thoracic, and uterine cavities, in which a notable fall of temperature along with symptoms of collapse were observed, have led to the conclusion that this medicine might be used in doses that were yet safe, in febrile diseases, to secure defervescence. Accordingly we find in the London Lancet a report of several cases of typhoid fever treated with this drug, in which a marked fall of temperature was noticed and the duration of the disease materially shortened. The dose used in these trials was six drojis of the glycerite of carbolic acid every three or four hours. As this dose is much smaller than any of the other antipyretics, and as it is less disagreeable to the taste than quivia or other cinchona salts, and less nause

ous than salicylic acid and its compounds, the remedy may prove a very valuable one in the pyrexial condition.


The American Journal of the Medical Sciences for October, 1879, gives an account, taken from the Berliner Klinik. Wochenschrift, No. 19, 1879, of the experimental observations of Dr. F. Penzoldt, of Erlangen, on both man and animals, with a new drug, the bark of the Aspidosperma quebracho, obtained from Brazil. The form of preparation used was a watery solution of an alcobolic extract of the bark; ten parts of the latter being percolated with one hundred of alcohol for several days, and the liquid filtered, evaporated, dissolved in water, again evaporated to dryness, and the residue dissolved in twenty parts of water. Four grammes or one teaspoonful of this solution were given three times a day to persons suffering from both pulmonary and cardiac dyspnoea with very marked relief to that symptom. Afterwards Drs. Berthold of Dresden, and Picot of Carlsrühe, also used Dr. Penzoldt's solution in various diseases, as asthma, emphysema, bronchitis, phthisis, and preumonia in which dyspræa existed, and always with great benefit in relieving the dyspuæa. Dr. Picot experimented also upon himself with the drug, and found that he could climb mountains with much less excitation of respiration and pulse, with, than without the drug. Prof. Skoda, of Vienna, also relates in the Wiener Medicinische Blatter (No. 41, 1879), that he not only found benefit himself from the use of quebracho, but prescribed it for others with success. Without exciting the pulse; the medicine reddened the previously livid and cyanosed lips and face, and in a patient whose nose was the seat of acne lıypertrophica, the ordinary violet-blue color of the organ became fiery red. It would seem that the medicine acts by increasing the capacity of the blood to absorb oxygen, since it was observed that the addition of quebracho solution to blood in the presence of oxygen caused it to assume a bright red color. If this is found to be true, the medicine will have a very wide range of usefulness; since many diseases attended with impaired nutrition and mal assimilation might be benefited by such an agent. But even should this expectation fail, it will, if further trial confirm the good accounts we already have of it, prove a precious boon to patients suffering from emphysema, asthma, advanced phthisis, and heart disease; relieving the dyspnoea and

orthopnæa so distressing in advanced stages of those diseases, and enabling them to sleep comfortably in the recumbent position, which they are sometimes unable to do for months before death terminates their sufferings.

Aconite has long been regarded as a useful remedy in neuralgia and rheumatism; and some observations by Dr. Oulmont, published in Le Progrès Meilical of Dec. 6, 1879, translated in the American Journal of the Medical Sciences for April, 1880, with the alkaloid aconitia, would seem to confirm our previous estimate of its value. In those forms of facial neuralgia commonly called congestive, and those arising from exposure to cold, it seems to be specially useful, while in the intermittent or distinctly periodic forms, it is inefficient or only valuable as an adjuvant to quinine. As the drug is so powerfully energetic, its tolerance should be tested at first by doses of one-fifth milligramme three times a day, and increased one fifth milligramme per day. In acute rheumatism it is said to be also very effective, but as in this disease it probably only cures by reason of its antipyretic action, its use would seem to be superseded by other safer and more active medicines of that class.

This meagre account, gentlemen, embraces all that I have been able to collect from current medical literature which is new, and at the same time of sufficient importance to bring to your attention. It is little, but we must remember that it has been by slow accretions our science has built up the enduring edifice which constitutes the temple in which we worship. It must be remembered, too, that our progress within the past century has been so great, and every field of inquiry has been so carefully and laboriously explored, that little has been left for the workers of to-day to discover. During this period medicine has made more advances towards a perfect science, and bestowed more boons on suffering humanity than in all the previous centuries of its history.

Within this brief time, medical chemistry, by isolating the active principles of medicines, and discovering new compounds of inorganic substances, has furnished us with nicer and more pointed weapons with which to wage warfare against disease.

Anesthetics have lifted the primeval curse from woman, and deprived the surgeon's knife of all its horrors.

The operation of ovariotomy, invented by our countryman, McDowell, has redeemed thousands of women from certain death;

while the invention of the metallic ligature by Le Vert has enabled Sinis and his followers to rescue other thousands from abject wretchedness and loathsomeness by the cure of vesicovaginal fistule.

Auscultation and percussion bave, by opening up to us a new method of investigating diseased organs, added to man another sense; and by the application of their principles the merest tyro of to-day can pronounce with certainty upon diseased actions that would have baffled Sydenham or Cullen in the meridian of their powers.

The thermometer has again been called in to aid in the correction of diagnosis; and by its aid we can now pronounce at once upon the nature of diseases, where formerly we were compelled to wait many days for the slow, perhaps fatal development of symptoms.

The ophthalmoscope and laryngoscope have opened to our inspection, living organs never before revealed. to human vision; and the treatment of their diseases, thanks to the aid furnished by these instruments, has become as exact and scientific as it was before uncertain and empirical.

The hypodermic injection of medicine has enabled us to bid defiance to nausea, and relieved us of all doubt and uncertainty as to the effect of our remedies.

The microscope has thrown a flood of light upon the nature of those finer pathological changes which formerly lay beyon! our vision, and has revealed the secret of many physiological processes; and by making possible the cellular pathology, as expounded by Virchow and improved by his pupils, Cohnheim and Recklinghausen, has added another to the long list of obligations under which in this century it has placed the science of medicine.

This list of its solid advances, and of the obligations under which medical science is placing the human family, might be almost indefinitely lengthened, for every year is adding some new gift of science, some new boon conferred. But I have said enough to show you that we have constructed a temple imposing in its dimensions, grand in its proportions, venerable in antiquity, and glorious in beauty.

"See where aloft its hoary forehead rears,
The towering pride of twice a thousand years.
Far, far below the vast incumbent pile
Sleeps the gray rock from Att's Ægean isle ;

« SebelumnyaLanjutkan »