The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 2).

Date:: 1849-59

Credit: The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 2). 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.)

Title Page

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$as an excitant topical expectorant in the same diseases as that of chlorine. It has been strongly advised in phthisical affections. Sir C. Scuda- mere {Lond. Med. Gaz. Feb. 17, 1838, and Feb. 7, 1840) found the addition of a little tincture of coniutn beneficial in subduing the irritating quaU- ties of the gas. The writer—as elsewhere re- marked—has often used the iodine inhalations in phthisis, but his experience has not been favourable to it, and the same view has been entertained by- others. (Pereira, Elements Materia Medico, 2d edit. i. 29-5, Lond. 1842.) It would seem to be better adapted for chronic bronchitis.] The substances which operate topically, either by stimulating the pulmonary exhalents, or as se- datives relieving the constriction on these vess6ls, and thereby facilitating expectoration, are also few. In those unaccustomed to the use of the former, they undoubtedly excite coughing; but in such cases the spasmodic action is produced by their first impression on the glottis, for when they are admitted into the tracliea, no coughing is pro- duced. The first of these, the fumes of boiling tar, was recommended as a remedy in phthisis by Sir Alexander Crichton, who had seen it em- ployed in Russia. It produces in general much increase of cough; but this soon abates, and the expectorated matter is, in most instances, much improved. These effects seemed to promise the most salutary results; but like some other reme- dies which have been occasionally introduced to the notice of the profession, the vapour of tar suf- fered from being overpraised, and from too san- guine expectations being formed relative to its powers, and it fell into neglect. [Creasofe, like tar vapour, has been occasion- ally inhaled in the same pulmonary affections; five, ten, or fifteen drops, according to the degree of tolerance of the lungs, being dropped into hot water in an appropriate vessel, and the vapour be- ing inhaled through the tube of an inverted funnel, or by means of any of the inhalers in use.] Another vapour which operates nearly in the same manner as that of tar has been much em- ployed in America, the fumes arising from burn- ing undressed wool. The use of these vapours was first recommended by Dr. Physick, who had found them extreme!}' serviceable for stimulating and healing external sores, and concluded that they might prove equally beneficial if inhaled into the lungs. He conceived that he had established the fact of their utility in phthisis; but the experi- ence of a few instances in which they were tried by the writer of this article does not authorize him to pronounce very favourably respecting their employment. They excited great coughing when they were first used; but this rapidly subsided, and some degree of comfort was certainly experi- enced after each time of inhaling them; but nothing more resulted from their employment. The sedative topical expectorants are better known. Tobacco, when smoked, has been long employed for allaying the violence of the paroxysm in spasmodic asthma; but it is uncertain whether the benefit should be ascrihed to the nicotina or the volatile oil. The use of stramonium, in the form of smoke also, has been found highly useful, and was at one time a favourite remedy in asthma. It appears to produce its beneficial effect in two ways. In the first place, it is directly applied to the mucous membrane when this is in a state of great irritability, and by acting as a sedative and allaying this condition, it favours the slower and more perfect secretion of the mucus, which being thus brought into a more natural state, is conse- quently more easily excreted: in the second place, by influencing generally the nervous system, the spasmodic symptoms attendant on the paroxysm of asthma are allayed, and respiration proceeds in a calm and undisturbed manner. The powers of stramonium were, at one time, greatly overrated; but experience has sufficiently demonstrated that it is capable of mitigating the violence of the pa- roxysms, although it may not be able to establish permanent relief from their attacks. Dr. Bree has objected to the employment of stramonium on the supposition that it induces a tendency to apo- plexy ; but this is, at best, problematical. b. The second set of topical expectorants, those which operate by mechanically compressing the thoracic viscera, and thus induce a sudden and forcible expiratory effort, so as to affect the expul- sion of matters from the lungs, are emetic sub- stances. In the operation of vomiting, by the sudden and violent contraction of the abdominal muscles, in order to force the contents of the sto- mach upwards, an impulse is communicated to the whole bronchial system, and by this means the expiratory effort being rendered more forcible, the expulsion of the mucus is effected. The bene- ficial effect of emetics in clearing away mucus accumulations from the lungs is indeed well known; and frequent recourse is had to them in many of the pulmonary diseases of children with uniform advantage. It might be supposed that the best emetics to select for expectorant pur- poses, would be those which operate by directly stimulating the nerves of the stomach, and which call the muscles necessary in the mechanism of vomiting into immediate action; but experience has demonstrated that the antimonial preparations are better suited for this purpose than any other emetics. Besides aiding the expulsion of mucus from the bronchial tubes, they possess the power also of controlling inflammatory action. The employment of emetics for procuring expectoration was formerly in much vogue as a remedy in phthisis. The emetics for this purpose, however, were seldom selected upon any principle: at one time we find sulphate of zinc and sulphate of copper employed ; at another, antimonials, ipeca- cuanha, and other nauseating emetics. If the lungs be loaded with mucus, and little or no febrile action be present, the direct emetics are to be preferred ; for in this case the mechanical im- pulse only is required ; but if, in promoting expec- toration, we are desirous of maintaining nausea afterwards, then the best emetic is the vinous solu tion of the tartrate of antimony and potassa, given to the extent of f^vi for a dose, in a solution of the extract of liquorice. Squill and sulphuret of potassa have also been employed to excite vomit- ing to aid their expectorant properties. 2. General Sxpectorantst — These operati< cither by being received into the circulation, or through sympathy with the stomach : the fire$