Зображення сторінки

separated, either swims on the mixture, or plexion, high-coloured lips, the upper one forms large flocci in it; whereas the pus swollen, white and transparent teeth, light falls to the bottom, and forms, on agitation, hair, and light blue eyes, with a dilated an uniform tarbid mixture. 3. Pus is dif- popil; there is great sensibility, uncommon fusible through a diluted sulphuric acid, acuteness of the understanding, and a pecuthough muens is not; the same occurs with liar gentleness and softness in their manwater, or a solution of the muriate of soda. ner; the immoderate use of venery; cer4. Nitrous acid dissolves both pus and mu- tain diseases, as the hooping.cough ; siphiens; water, added to the solution of pus, o lis, and various exanthemata, particularly produces a precipitate, and the fluid above the measles ; various employments, as stonebecomes clear and green, while water and cutters, needle-grinders, fax-dressers, and the solution of mucus form a dirty.colour all sedentary occupations, particularly those ed fluid. 5. Alkaline lixivium dissolves which require a considerable degree of (though sometimes with difficulty) mncis, stooping; the retrocession of eruptions ; and generally pus. 6. Water precipitates indulgence in intoxicating liquors, and, acpus from such a solution, but does not mu- cording to Dr. Beddoes, hyper-oxygenacus. 7. Where alkaline lixivinm does not tion of the blood. The exciting causes are, dissolve pris, it still distingnishes it from hæmoptysis; empyema ; catarrh, particularly mucus, as it then prevents its diffusion the influenza ; asthma, obstructions of the abthrough water. 8. Coagulable lymph is dominal viscera, particularly an enlarged and neither soluble in diluled, nor concentrated indurated state of the liver; calculi formed sulphuric acid. 9. Water produces no in the lungs; contagion and tubercles. The change on a solution of serum in alkaline proximate cause is supposed to be an ulcer lixivium, until after long standing, and then in the lungs. only a very slight sediment appears. 10. The prognosis in this disease depends The muriate of mercury coagulates mucus, upon the causes whence it originates, and but does not pus. From the above expe- upon the violence of the symptoms; if it yiments, it appears that strong sulphuric be in consequence of empyema or tuber. acid and water, diluted sulphuric acid, and cles, there is more danger than when it caustic alkaline lixivium and water, will arises from liæmoptysis or wounds in the serve to distinguish pus from mucus ; that chest, but every case of phthisis is always the sulphuric acid can separate it from coa- atteneled with danger ; the progress of gulable lymph, and alkaline lixivium from phthisis is often interrupted by pregnancy serum; and hence, when a persou has any and mania, the latter has produced a radi. expectorated material, the composition of cal cure, but in the former it almost always which he wishes to ascertain, let him dis- returns after delivery with increased vio. solve it in sulphuric acid, and in caustic al- lence. kaline lixivium, and then add pure water to In the treatment of this disease it will be both solutions; and if there be a fair preci. particularly expedient to avoid, and if in pitation in tach, le may be assured that our power, to remove the occasional causes some pus is present: if in neither a preci- mentioned above, by the proper methods, pitation occur, it is a certain test that the which are mentioned in other parts of this material is entirely mucns : if the material treatise ; if several of the premonitory cannot be made to dissolve in alkaline lix- symptoms, as a dry, short, troublesome ivillim, by time and trituration, we have also cough, occasional stiches in the sides, slight reason to believe that it is pris. To the dyspnæa upon using exercise, and a pulse above ingenious experiments may be fur- somewhat accelerated and hard, should at. ther added, the coagulation of pus by the tack a person of a phthi-ical babit, the muriate of ammonia, as observed by Mr. most powerful remedies must be employed Home, and its globular appearance through without loss of time: blood letting, in a the microscope; pns is also of the consis. moderate quantity, will be necessary, and tence of cream, of'a whitish colour, and has it should be repeated at proper intervals a mawkislı taste ; it is inodorous when cold, till those symptoms are relieved, taking and when warm it has a peculiar smell. care, however, not to reduce the strength

The predisposing causes are, hereditary of the patient too much, as debility is the disposition; mal-conformation of the chest; most urgent symptom in the course of the sanguine temperament; scrofulous diathe disease: the bowels should be kept regular sis; whiclı is indicated by a fine, clear, and by gentle cathartics, as the calomel and sinooth skio, large veins, delicate' com. rhubarb. After these evacuations, the ipecacuanla, either alone, or with a small mended in these two stages in particidar, quantity of emetic tartar, should be given it certainly is deserving of a fair and impar. in the morning fasting, in such doses as tial trial, and appears to be a medicine will excite vomiting once or twice at most; well suited to this disease, more especially when the lieat, fever, cough, and pain in in the inflammatory stage, from its well the chest are considerable, small doses of known power of rendering the action of the nitre, or the saline mixture, with nau- the heart and arteries more slow than natuseating doses of the emetic tartar, should tal, a desideratum in phthisis, in which the be given three or four times in the course pulse ranges from eighty to one hundred of the day: in this stage of the disease, and twenty, or more; it also is very efficasmall doses of calomel administered at cious in exciting the action of the absor. bed-time, are of considerable service, ex. bents: the factitious airs may also prove cept there is a tendency to diarrhæa, as an useful auxiliary, or air impregnated with thie bowels, by its use, are not only kept the oxide of zinc, or manganese in their regular, but it, at the same time, acts as a most comminuted state, might be applied powerfil deobstruent, and, in our opinion, to the lungs by means of an apparatus, as an alterative course of mercury is of ad recommended by Dr. Darwin in lis Zoonovantage, in the incipient stage of phthisis, mia, or by that of Mr. Watt, of Birmingfor the removal of indolent tubercles : ham : the vapour of a saturated tincture of should the cough prove violent, opiates æther, impregnated with hemlock, may be may be given at bed-time, and in the night, inhaled; it is made by macerating for a if necessary, the extractum papaveris albi, few days from one to two scruples of the in doses of five grains or more, is particu- dried leaves of the hemlock in an ounce of larly suitable; if there be a fixed pain in the æther. The hectic paroxysm may be the breast or sides, increased upon congh- prevented, or cut short, by the affusion of ing, local blood letting, and small blisters tepid water at the commencement of the applied in succession about the thorax, will hot stage, or its effects may always be moafford considerable relief, or a seton may derated by moistening the palms of the he made as near the part affected as possi- hands and soles of the feet with vinegar or ble. In the second stage of the disease, cold water; it should always be resorted the employment of emetics, composed of to, when the burning heat mentioned above the ipecacuanha, with a few grains of the is present, it is not only perfectly safe, but sulphate of zinc, must be duly persisted in, highly refreshing. In the third stage, shonlu. in the morning fasting : when the morning the above plan not be adopted in time, sweats are very profuse, the infusion of roses and diarrhea has made its appearance, the or vitriolic acid, should be employed with gentle emetics before mentioned are recomfreedom; æther in the proportion of two mended to be administered, provided the or thee drachms to a pint of water, with strength of the patient is not too much some of the mucilage of quince-seeds, makes exhausted, mild astringents should at the a grateful and slightly tonic mixture, a glass- same time be employed, as the decoction ful of which may be taken frequentiy, or the of hartshorn, or logwood, angustura, co-, Bristol or Seltzer water may be drank; lomba, kino, and mucilaginous demulcent they are very efficacions in moslerating the liquors, combined with opiates and abthirst, burning heat of the palms of the sorbents. During the inflammatory pehands and soles of the feet, and the partial riod of phthisis, a vegetable diet, with might sweats: opiates must be given in such milk, is indispensably requisite; souins, doses as will quiet the cough and procure sago, barley, and rice, afford an agreeable sleep, taking care, however, to obviate cos- variety; the lichev islandicus is strongly tiveness, and if the patient feel a sickness recommended, and is deserving of a trial; in the morning after them, coffee will effec- the ripe subacid fruits may be indulged in tually remove it; mucilaginous fluids, com- at pleasure, attention must, however, be bined with small quantities of the sperma- paid to the state of the bowels : oysters, ceti, are also of service in allaying the irri- muscles, craw-fish, lobsters, and the testatation in the fauces. When the inflamma- cea in general, also founders and whitings, tory diathesis is subdue!, chalybeates, com- may be allowed occasionally, provided they bined with myrıh and carbonate of potash, do not disagree with the stomach, and do may be given with advantage ; lime-water not aggravate the symptoms. In the adis a suitable men-traum for dissolving the vanced periods, when the hectic is com. myerli. The digitalie is strongly recom- pletely formed, a enall portion of animal

food may be taken for an early dinner, if it however, be light and nourishing, and in
does not greatly increase the heat, and moderate quantity: the patient should
when the appetite becomes voracious, breathie a pure dry air, and should take
which it sometimes does towards the fatal snch exercise, particularly on horse-back,
termination, small quantities should be ta- as he can bear without fatigne, and should
ken frequently: the drink, in almost every nse the warm bath; and when the consti-
period of the disease, should consist of toast tution can be brought to bear it, he may
and water, Malvern water, milk and water, employ the cold bath or sea bathing.
butter-milk, rice water, or the juice of

ORDER V. ripe subacid fruits mixed with water, and

Profluvia. INSANGUINEOUS occasionally lemonade. Wine, spirits, and fer

FLUXES. mented liquors of all kinds must be strictly These are ordinally characterised, as conprohibited, and the practice of mixing rum sisting of pyrexy with an increased secreand other spirits with milk, cannot be too tion, naturally void of blood. The genera strongly reprobated; where, however, there are two: 1. Catarrhus, Catarrh. 2. Dysenis but little increased excitement, and the teria, Dysentery. This order might ea- . pain is inconsiderable, a more nourishing sily be suppressed, and the genera it comdiet, and a moderate quantity of wine may prises transferred to other situatious to be allowed, but the wine should be more which they more properly belong, even or less diluted with water, and in the puru- under the present nosology. Catarrh is delent stage, an invigorating diet always scribed as possessing pyrexy, frequently affords more or less relief. During the contagious ; an increased secretion of muwhole course of the disease, every irregu- cus, or at least efforts to excrete it. Dy. larity and all crowded places must be stu- sentery, as evincing contagious pyrexy, diously avoided. The patient should be ad- frequent mucus or bloody stools, while the vised to repair to Bristol in the early part alvine feces are for the most part retained, of the disease, and should make use of such gripes, tenesmus. exercise as his strength will bear, as swing. Catarrh will be distinguished from the ing, gestation in a carriage, or riding on measles by the greater mildness of the fehorse-back in progressive journeys, or the brile symptoms, by the state of the eyes, alternation of this last exercise, and gesta. by the absence of coma, and many of the tion in a carriage, but a sea voyage is the symptoms accompanying the eruptive fever most effectnal of all kinds of gestation ; the of measles. patient must by all means avoid the pierc- This disease is rarely attended with ing north-east winds in this country, it will danger, except there be great difficulty of therefore be advisable for him to visit a breathing, attended with a livid and bloated temperate southern climate doring the win. countenance, or it has been treated with ter and spring : the patient should be ad- negligence or impropriety, in which case it vised to lie on a hair mattrass, with slight often passes into pneumonic inflammation, coverings over his body, and should be attended with symptoms of the utmost earnestly requested to go to bed early, and danger ; in general, however, it is a slight to get up soon in the morning, even if and safe disease, unless it attack persons obliged, through debility, to lie down in of a phthisical habit, or those advanced in the course of the day : the feet shonld be life ; in the former it may occasion phthisis, kept dry and warm, and the patient shonld and in the latter, peripneumonia notha. wear flannel or cotton next to his skin, the For its cure, nothing more is requisite, in former, however, is far more salutary; in general, than abstinence from animal food the florid consumption, an elevated and in for a few days, keeping the body warm, land air is often of the most essential ser. and drinking freely of tepid mucilaginous vice. Should we be so fortunate as to sub. diluents; if there be, however, a considerdue this too fatal disease by the means able degree of excitement, blood-letting recommended above, it will be indispensa- will be necessary, but it must be employed bly requisite for the patient to persevere in with some degree of caution, as it is freemploying the regimen recommended in quently succeeded by depression of strength, the treatment of this complaint, for a con. particularly when catarrh is epidemic. If siderable length of time after every symp- there be much oppression and tightness tom of the disease bas disappeared, and be about the chest, occasioning a degree of must return to his former manner of living dyspnea, local blood-letting will be adviswith the utmost cantion ; the diet should, able, and blisters must be applied to the

[ocr errors]

sternum and serobiculus cordis ; gentle less degree, generally accompanies the laxatives should be ordered; the patient evacuation of the bowels, and it very rarely should take copions draughts of some muci- happens that the natural faces appear durlaginous acidulated liquids; a gentle dia- ing the whole course of the disease, and phoresis should be promoted by nauseating when they do, they are in die form of doses of tartar emetic, with spirit of mid- scybalæ, that is, small separate balls, which dererus, or by exhibiting the volatile alkali appear to have iain long in the cells of the in wine whey; the vapour of warm water, colon ; when these are voided, either by impregnated with vinegar, should be fre- the efforts of nature, or as solicited by niequently inhaled; mucilaginous oily demul. dicine, they procure a remission of all the cents should be given, and expectoration symptoms, more especially of the frequent should be promoted by the means pointed stools, griping, and tenesmus; with these out when treating of pneumonic inflamma. symptoms there is loss of appetite, great tion. If the congh remain troublesome, anxiety about the præcordia, frequent sick'after we have subdned the inflammatory ness, nausea, vomiting, and the inatter rediathesis, opiates, combined with the tar- jected is frequently bilious, watchfulness, tar emetic, or with ipecacuanha, may be and prostration of strength : there is always employed with safety and advantage; rub

some degree of symptomatic fever, which bing the nose externally with oil, some is sometimes of the remittent or intermit. ointment, or, with what is most commonly tent type; sometimes it assumes the syno. employed, warm tallow, is very often of chous, and very frequently the typhous great service, when the mucous membrane type: the tongue is white, and covered of the nose is much affected, which practice with tough mucus, or rough, dry, and somebas very frequently come under my obser- times black; the patient complains of a vation. In the treatment of the epidemic bitter taste in the mouth, and in the ad. catarrh (influenza), as being frequently at- vanced stage of the disease there is hiccup, tended with a considerable degree of debi- and aphthæ. If the small intestines only lity, the antiphlogistic regimen must not be be affected, the pain is described to be pushed too far, even though there may be most acute and excruciating about the um. some appearance of excitement : it will, bilicus, the bowels are not evacuated imin general, if blood-letting should be deem- mediately after the griping pains, the blood ed necessary, be more advisable rather to is mixed intimately with the fæces, and trust to local than to general blood-letting, the sickness, vomiting, and pain at the stoblisters, mild diaphoretics, and diluents; mach, are more argent. If the large intessometimes, however, a more liberal diet, tines be the seat of the disease, the pain and the moderate use of wine, will answer is more obluse, not so constant, is more disbetter. Might not the affusion of tepid, tant from the umbilicns, and is more immeor even cold water, be employed with diately followed by stools, and the părulent safety, if the heat of the surface be greater matter of blood, if there be any, is less than natural, and there be at the same mixed with the rest of the excrements, or time no tendency to asthma or phthisis pul- only floats upon them, and there is more monalis ?

sickness than griping; but it frequently Dysentery is most commonly preceded bappens, that boin the large and small by costiveness, unusual flatulence, acid intestines are affected, which renders it eructations, and wandering pains in the very difficult to determine, with any cerbowels; in most cases, however, from the tainty, the seat of the disease. The remote commencement, griping pains are felt in causes are, cold alternating with heat, dethe lower part of the abdomen, which often rangement of the primæ viæ, and contagion. arise to a considerable degree of severity; The proximate cause is supposed to be a the bowels are irritated to frequent eva. preternatural constriction of the intestines, cuation, in indulging which, but little is more particularly of the colon. This dis. voided, and the rectum often becomes ease will be readily distinguished from diarexquisitely painful and tender; the matter rhæa, by the absence, or less degree of evacuated is often very fætid, and the fever in the latter; the less degree of grip. stools are frequently composed of mucus, ing and tenesmus, the appearance of the pus, blood, membranous films, aud white stools, and the other symptoms in diar, lumps of a sebaceous nature, the mucus is rhea will further assist us. generally mixed with a watery fluid, and is Treatment. When the patient is of a often frothy: tenesmus, in a greater or robust and plethoric habit, and the disease is attended with acute pain in the bowels, some tinctura opii sprinkled on the stupes : with a strong full puise, blood-letting will stranguary is not an uncommon symptom, be necessary, but it must be practised with independent of cantharides, it will be effeccaution, especially in warm climates, where tually relieved by fomenting the pubes and the employment of powerful antiphlogistic perinærm : mucilaginous demulcent liquids measures is often succeeded by a sudden must be given freely, for the purpose of and dangerous degree of debility ; gentle defending the intestines against the acri. emetics should be administered, they are mony of their contents, and mucilaginous, not only useful in emptying the primæ viæ, and oily clysters should be employed once but they also determine to the skin; they or twice a day, or more, they are very serwill be more efficacious when given in such viceable for the same intention as the muci. small and repeated doses, as not to excite laginous liquids, and act also as a fomentaimmediate vomiting, upless the oppression tion; they should consist of a strong decoce at the stomach is urgent; the emerics gene- tion of linseed or starch, or they may be rally employed in dysentery are ipecacu- composed of milk and oil, onited by means anha and tartar emetic, and, at the early of mucilage. In the advanced and chronic periods of the disease, they will be more stage of the disease, as aridity of the stoefficacious when combined: the morbid mach chiefly prevails at that period, absorand noxious contents of the intestines, the bents will be useful, as the mistura cretainost pernicious source of irritation in dy. Cea, aqua calcis, pulvis cretæ compositus, sentery, must be expelled by cathartics, &c. combined with opiates; astringents those most generally celebrated are, the will also, at this period of the disease, be ipecacuanha and tartar emetic, the former proper, as the kino, hæmatoxylum, cateche, is, however, most frequently employed, it &c. and if the powers of the stomach be may be given either alone, or in combina. much weakened, they may be combined tion with the crystals of tartar, in suel with chalybeates. The tone of the bowels doses as will produce some degree of nau. will be restored, by administering qnassia, sea, and repeated wlien the nausea abates ; bark, angustura, or colombo; an infusion of the calomel is an excellent remedy where gentian and cinnamon in port wine is rė. there is a tendency to inflammation, but it commended; it will always be advisable to should never he given alone, its operation joiu aromatics with bitters : a purgative of is rendered both more easy and certain, by the calomel and rhubarb should be given combining it with other catharties; the from time to time in this form of the dis. most effectual remedy, however, in general, ease, and when it reinains obstinate, we is a simple solution of Epsom salts, or Glau- may always suspect visceral obstruction ; ber's, or it may be given in a diluted infu- should this, upon examination, be the case, sion of senna, with a considerable propor- mercnry, either internally, or by friction, tion of manna; the cream of tartar with should be employed until some sensible tamarinds, the phosphate of soda, and cag. effect is produced in the mouth. The diet tor oil, will make an useful variety; after in the first stage should consist of milk, the operation of the cathartic is finished, sago, panada, salep, Indian arrow-root (ma. it will be advisable to administer opiates, ranta arundinacea), and rice, the quantity and they will be more efficacious if given being regulated by the appetite ; the sweet with nauseating doses of emetics ; the pul- and subacid fruits may be allowed, and vis ipecacuanhæ compositus is a good medi- they are particularly serviceable when there cine; the hyoscyamus, by its anodyne and is much bile in the primæ viæ. In the gently laxative qualities, seems entinently more advanced stages, the ripe fruits are adapted to this disease. The warm bath is condemned, but it does not, however, often used with advantage; fomentation of appear, on sufficient gronds, that they the abdomen is more frequently service- should be so ; together with the farinacca, able, but the most effectual remedy is a a small quantity of animal food may be large blister applied over the abdomen; in allowed in the chronic state of the disease, mild cases, however, so severe a remedy is provided it does not disagree with the pati. not necessary; the addition of strong pep- ent. The drink at the commencement pers to the fomentations, may, in such should be either barley or rice water, boil. cases, answer our intentions: the pain at- ing water ponred upon toasted bread, or tending the tenesmus will be allayed by burnt biscuit, whey, or the decoction of fomenting the anus with hot water, or with hartshorn, and the like; in the advanced the decoction of chamomile flowers, with stage of the disease, Port Wine or Madeira,

[ocr errors]
« НазадПродовжити »