Volume 1

Diseases of the organs of respiration : a treatise on the etiology, pathology, symptoms, diagnosis, prognosis, and treatment of diseases of the lungs and air-passages / by Samuel West.

  • Samuel West
Date:
1909
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Diseases of the organs of respiration : a treatise on the etiology, pathology, symptoms, diagnosis, prognosis, and treatment of diseases of the lungs and air-passages / by Samuel West. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    438/450 (page 404)
    General management—^a^t of tlio body in general and of the respiratory organs ni particular is the chief guiding principle. ^ The patient must be kept in bed and all movement forbidden. He should not be allowed to get out of bed for any ]Mirpose whatever. If this is unavoidable or such strict rules are not thought necessary because of the slightness of the haemorrhage, the patient should be told to move slowly and gently Too ri-id adherence to the rule of absolute rest is not always advisablel for instance, the diaculty of passing water and motions while lying in bed, experienced by those unaccustomed to it, may lead to an amount of straining and excitement which may cause more effort than if the patient had been allowed to get up out of bed quietly for those purposes; but as movement accelerates both the respiration and circu ation, the more strictly the rules of rest are enforced the better • i'^ '^A^^''\ ^^''^'^ semi-recumbent position, with the shouldera raised and the head comfortably supported, the object being to keep the bleedin- parts as high as possible, so as to relieve them of the pressure of gravity This position IS the one the patient often spontaneously assumes, as being that in which he IS able to cough and expectorate with least exertion. All talking must be forbidden on account of the excitement and fatic^ue it causes as well as because of the respiratory effort it entails. Whatever the patient may have to say should be said quietly in a low voice or in a whisper Lough IS a necessary part of haemoptysis, and need not be checked unless it be excessive. This must be estimated by its relation to the expectoration In most cases the cough is short and easy, and the sputum is brought up without much effort. Sometimes it is paroxysmal and out of all proportion to the expectoration. Then it must be checked, and for this purpose nothing is better tnan a little opium, in a mixture with glycerine and chloroform. Where the paroxysms are very severe, a few drops placed upon the tongue often control The circulation must also be kept quiet. This is another reason why move- ment must be avoided. But as both respiration and circulation are easily affected by nervous conditions, all mental effort and excitement must be avoided or controlled. Hasmoptysis always causes great alarm, especially if it be a fii-st attack, or if, when not the first, it be unusually severe. The patient almost always thinks that he is going to die. An assurance that this is most unUkely IS a better sedative than any drug; but if a drug be necessary, the best for this purpose IS opium or morphia, administered as required either by the mouth or by a subcutaneous injection. The room in which the patient is lying should be kept cool, i.e., neither too Hot nor too cold; cold especially is to be avoided as so likely to increase cough. Ihe bowels should be assisted with a slight laxative, for the confinement to Decl IS likely to cause constipation and consequent straining. For this reason It IS usual to administer a mild purge at once, and to keep up the action of the bowels by small doses of some saline purge like Epsom salts. The diet must be carefully regulated. The food should be light and easily digestible It should be given cold, not actually iced but cool, for very cold food is, I think, worse than very hot. Stimulants must be entirely avoided, unless specially indicated by exhaustion, and then discontinued as soon as may be. ihe patient is therefore put at once on liquid food; but even this must not be given in unlimited quantity, for an over-distended stomach will embarrass the respiration so that the amount of liquid must be kept somewhat under the average. It is a mistake to let the patients slake their thirst with milk alone, tor this will not be digested in too large a quantity, but will lie fermenting in the stomach, and produce wind. For the thirst it is best to let the patient suck