A dictionary of practical medicine: comprising general pathology, the nature and treatment of diseases, morbid structures, and the disorders especially incidental to climates, to the sex, and to the different forms of life : with numerous prescriptions for the medicines recommended, a classification of diseases according to pathological principles, a copious bibliography, with references, and an appendix of approved formulae : the whole forming a library of pathology and practical medicine and a digest of medical literature (Volume 9).
- Copland, James, 1791-1870.
- Date:
- 1834-59
Licence: Public Domain Mark
Credit: A dictionary of practical medicine: comprising general pathology, the nature and treatment of diseases, morbid structures, and the disorders especially incidental to climates, to the sex, and to the different forms of life : with numerous prescriptions for the medicines recommended, a classification of diseases according to pathological principles, a copious bibliography, with references, and an appendix of approved formulae : the whole forming a library of pathology and practical medicine and a digest of medical literature (Volume 9). Source: Wellcome Collection.
Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)
![361. Where the laryngeal complication occurs in the advanced course of phthisis, this practice can prove only of temporary benefit. I have been consulted in many cases of this description where it had been said to have been resorted to, but ap- parently cither with no advantage, or with very temporary relief. However, in idiopathic or pri- mary cases, or when the complication occurs in an early stage of phthisis, for which a rational and an appropriate treatment is prescribed, this local medication of the laryngeal complication may be employed, by one capable of performing it, safely and satisfactorily. I do not, however, believe that the appliances here advised enter the larynx and trachea once in twenty times ; whatever ben- efit results arises from the applications to the under surface of the epiglottis and adjoining parts. I have, since the commencement of my practice, trusted much in those cases to the inhalation of the weak vapour of turpentine arising from the application ofihe embrocation so often mention- ed, either around the throat and neck, or to the chest, or between the scapulae. [In this connexion, we should bear in mind that diseases entirely located in the larynx or pharynx are often mistaken for pulmonary tuber- culosis ; that even when tubercles exist, the more prominent symptoms may be owing to the pha- ryngeal and laryngeal complications ; and that these complications may be greatly alleviated, or even removed, by local treatment, and in this way, as suggested by Professor Bennet, thus tend to arrest the pulmonary disease. Dr. Hor- ace Green has extended topical medication in pulmonary diseases to the injection of a solution of nitrate of silver into the bronchial divisions by means of a gum-elastic tube or catheter passed down the trachea. In the volume of Transac- tions of the American Medical Association for 1856, he has reported over one hundred cases of pulmonary and bronchial disease treated in this manner. Of these, 71 were stated to be cases of tuberculosis, and 32 cases of advanced phthisis, in which cavities were recognised in one or both lungs ; 39 were reported cases of incipient phthisis. Of the first division, advanced phthisis, 14 died, 25 were said to be more or less benefit- ed, and 7 not benefited by the injection. Of the 39 cases incipient tuberculosis, 12 apparent- ly recovered, and 5 convalescent at the time of making the report (May, 1856). Of the remain- lowing quotation from Messrs. T. and B.'s work (Am. Trans., p. 125): When we wish to cauterize the pharynx, the base of the tongue, and the trip of the larynx at the same time, v.-c take a whalehone at least a line and a half thick, that it may not bend readily; this is heated an inch or more frjm one end, and, when sufficiently softened, we curve it at an angle of 45°. To this end we fasten a spherical I ieice of sponge six lines in diameter; the sponge is to he moistened with a solution of nitrate of silver, the mouth and the tongue depressed. When the isthmus of the gullet is passed, there occurs an effort of deglutition •. l.ich elevates the larynx, and we seize this opportunity to draw forward the sponge, which had been at the en- trance of the oesophagus. By this manoeuvre we get at ; lie glottis, and then it is easy to express the solution in'o n.t; the cough which now occurs favours the in- r. iduction of the caustic, &c. Dr. Green, instead of a <>;. uses a broad spatula, bent at right angles, and in- stead of expressing the solution into the larynx, passes the sponge directly into the cavity. To him, therefore, undoubtedly belongs the credit of establishing the possi- bility and utility of the direct introduction of nitrate of silver into the laryngeal cavity; just as Dr. Morton the safety and advantage of the inhalation of sther as an anaesthetic, although it had been suggested and used occasionally by others for similar purposes.] ing 22 cases, 17 have been greatly improved, 3 moderately benefited, and 3 only failed to find relief Of the 28 cases of bronchitis, 16 were re- ported as cured ; all the others had been greatly benefited, though some were still under treat- ment.] 362. D. The Abdominal Complications of phthisis have been already partly considered, when remarking upon the treatment of the diar- rhoea (t) 328), and of the impaired digestion and assimilation (t) 234) so generally observed pre- viously to, and in the course of the malady. But the functions of the liver are also not sufficiently discharged in the course of the disease ; and due attention has not hitherto been directed to them. That this organ has been long disordered in cases of phthisis is shown by the nature of the organic lesions it generally presents after death (<J> 118). It has been insisted upon by an able and close observer of the causes and nature of disease (Dr. McCormac, of Belfast), that phthisis is not only caused, but is also perpetuated, by an imperfect supply, and an insufficient digestion and assimi- lation of pure air in and by the lungs ; conse- quently, the red globules of the blood are not oxygenated and assimilated to such an extent or amount as to supply the requisite materials by their waste for the elaboration of healthy bile : owing also to this cause, the carbonaceous and hydrogenous elements are not sufficiently com- bined with the oxygen of the respired air, so as to contribute to healthy assimilation and nutri- tion ; and they consequently, under the influence of life, form morbid or adventitious products, and give rise to the fatty enlargement of the liver so generally found after death (f) 118) 363. The great importance of promoting the digestive and assimilating processes from the very commencement of phthisis, whatever other means of treatment be adopted, will appear from what has been advanced above ; and I know of no surer means of attaining this end, than by improving the secretions and excretions by suitable medi- cines and food, and by removing the patient to a high, dry, and temperate air, where he may en- joy the advantages of sunshine and exercise, and avoid those causes which reduce organic nervous or vital power In general physicians have been, during the last half century, in which such won- derful advances have been made in the practical sciences, so much occupied in listening to sounds which they often could neither interpret nor re- fer to their proper sources—in splitting the diag- nostic hairs floating before their troubled, if not always dazzled vision, and in hearing what they believed even when not believing what they heard — as to be carried along by the pathology in fashion, neglecting those great views of physio- logical pathology which alone furnish the true basis of rational and successful practice. While a murmur, a bruit, a rale, a ronchus, and every sound for which a term could be coined, and then- various grades, cadences, &c , were observed, or were feigned to be observed, and were noted, and paraded and admired, on all occasions, the condi- tions of the vital powers and functions, upon which both disease and recovery from disease mainly depend, were entirely neglected. But at- tention to these latter, to the states of the secre- tions and excretions, to the manifestations of im- paired vital power, to the causes of this impair- ment, to the removal of those causes, and to the true means of restoring lost energy, as regarded](https://iiif.wellcomecollection.org/image/b21111078_0034.jp2/full/800%2C/0/default.jpg)
