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.)

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$in the epidemic variety termed influenza. After bleeding moderately, and the administration of an emetic, the best results have followed the employ- ment of small doses of ipecacuanha, in combina- tion with squills and opium; but when the febrile symptoms have disappeared, and cough attended with a thin frothy excretion only remains, the balsams, gum-resins, and opium, administered in the evening and at bed-time, _prove generally highly beneficial. The same precautions are re- quisite in the administration of expectorants, in the commencement and in the advanced stages of phthisis. In the greatest number of cases of asthma of a recent date, some degree of inflam- mation is present; but from the progress of the paroxysm, and its termination in expectoration, an erroneous notion was entertained that the solu- tion of tlie paroxysm must necessarily follow its appearance; and, consequently, squill, ammonia- cum, and other stimulants, instead of the nau- seating expectorants, were inconsiderately pre- scribed, and often produced injurious consequences. In that variety of asthma, however, which appears to depend on a state approaching to that of para- lysis of the system of the par vagum, in which the bronchial cells, being deprived of their nervous energy, do not contract sufficiently to aid the ex- pulsion of the air in expiration, and, instead of aiding, prevent the necessary change of the blood in the pulmonary circulation, the nauseating ex- pectorants prove hurtful, by keeping up that state of diminished excitability which is the result of the morbid condition of the bronchial nerves. It is in such cases, and in the low stage of pneumo- nic inflammation, when the febrile symptoms as- sume a typhoid chai'acter and the lungs are loaded with mucus, that the inhalation of the expectorant gases, the internal administration of the balsams, and more especially of ammonia, prove undoubt- edly beneficial. [Almost every class of medicinal agents may become expectorant according to the precise con- dition of the system generally, or the pulmonary organs particularly ; and hence we find an expec- torant effect equally firom depletives, and from tonics and excitants; from narcotics and counter- irritants ; and from nauseants and emetics.] Under all circumstances there are three general rules to be kept in view in administering expecto- rants : 1. The surface of the body should be kept mo- derately warm, and even in a gentle or breathing perspiration. 2. Whatever determines to the kidneys must be avoided. 3. Purging is not only not to be promoted, but to be most carefully guarded against; for as the action of the secreting vessels of the lungs and those of the intestines are opposed to one another, expectoration is checked when purging occurs. A. T. Thomson. EXPECTORATION.—This word (from ex and pectus, strictly signifies the act of discharg- ing any matter from the chest, but by a figure of speech it is also commonly applied to the matters discharged from the lungs and air-tubes. The act of expectoration is one of the instances ot combined movement in the respiratory machine, which, by an admirable and harmonious consent between its numerous muscles, unerringly pro- duces such a variety of actions. The function of respiration is of such vital importance that accu- mulations or effusions which obstruct it endanger life itself. The structure of the bronchial tree contributes greatly to the easy removal of any superfluous matter in it that might cause such obstruction, for the sum of the area of its branches being considerably greater than that of the trunk, or of the trachea, the air commonly finds easy en- trance into the air-cells, and, on its more rapid return in expiration, carries with it the super- fluous matter. Thus ordinary respiration tends to prevent, in spite of gravitation, any accumula- tion in the air-tubes; but the excretion is more completely effected by coughing and special eflTorts of expectoration. These consist of a quick and forcible expiration, preceded by a deep inspiration, and accompanied with a constriction of the larynx and trachea, the effect of which is to bring any superfluous matter into positions from which the air, forcibly expired, drives it through the glottis. It is worthy of remark that expectoration cannot effectually take place without a previous full in- spiration, by which air is carried beyond the accu- mulating matter ; hence, when this is prevented, either by weakness of the respiratory powers, or by the impermeability of the bronchial tubes, the excretion is suppressed. The first of these causes of obstructed expectoration is exemplified in adynamic fevers, which may thus prove fatal : the second occurs in pneumonia in the stage of hepatization, and, if extensive, must lead to a fatal obstruction of the respiratory function. They probably occur together towards the fatal termina- tion of bronchitis, phthisis, and other severe dis- eases of the lungs. Expectoration in its other sense, namely, the matter expectorated, is a subject well worthy of a careful study ; for its characters often furnish signs of the greatest value in the diagnosis, prog- nosis, and treatment of diseases of the chest. It can scarcely be said that the examination of the sputa is entirely neglected in this country; but we have had frequent occasion to observe thai opinions are very loosely and vaguely formed from it, and of a nature quite inconsistent with the present state of pathological science. Thus the presence of pus in the expectoration is fre- quently looked upon as a sure proof that the lungs are diseased ; whilst the far more pathognomic sputa of peripneumony and the well-marked se- cretion of acute bronchitis are hardly recognized. The natural secretion of the bronchial mucous membrane is a colourless liquid of somewhat glu- tinous quality, like a thin solution of gum arabic. It does not greatly differ in chemical composition from the serum of the blood, and it owes its vis- cidity to an animal substance, which Dr. Pearson, (Phil. Trans. 1809,) Dr. Bostock, (Elementary System of Physiology, vol. ii.) and Berztliu.'' (Annals of Philosophy, vol. ii. p. 382) concur in considering an imperfectly coagulated albumen. This secretion is the basis of most of the varictiea of expectoration; but, unhappily, our knowledge of animal chemistry does not enable us to disco ver the precise nature of the changes in composi- tion which produce these varieties. All tl,\at we$