A treatise on materia medica, pharmacology, and therapeutics / by John V. Shoemaker ... and John Aulde.

  • John Veitch Shoemaker
Date:
1889-1891
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on materia medica, pharmacology, and therapeutics / by John V. Shoemaker ... and John Aulde. Source: Wellcome Collection.

    399/426 (page 349)
    tissues 'vvliicli are within the range of the general circulation, and Avould nut appl}' with equal force to parts that are in some respects isolated, such, for instance, as the extremities, or to congestions affecting the organs of vision. Here it would he requisite, to obtain local effects, that local blood-letting should be practiced, and experience is full}' in accord with these conclusions. In this connection it will be useful to note that the principles just outlined are more especially applicable to wluit are known as sthenio cases, in which acute congestions ma}' be relieve<l without seriously em- barrassing the vitality of the patient. The force and frequency of the pulse are lessened, and an artificial anaemia is thus created, which, in the asthenic, might result disastrously to the patient. The convulsions which are liable to follow in these cases are supposed to be due, in part, to a want of oxygen when the progress of active inflammation begins to sub- side, although we must not forget that the accumulation of carbonic acid in the system has the effect of partly subduing the pain. After free venesection has been practiced there is a notable impairment of all the functions except that of absorption, which is largely augmented, although this depression is but temporaiy; and it is under these conditions that we are able to observe the marked benefits which attend upon the exhibi- tion of certain remedies,—for example, stimulants. The relation which venesection bears to transfusion will be apparent from a study of the uses which may be made of these two methods in the case of poisoning. By the first Ave are enabled to rid the economy at once of a considerable portion of a poison which affects the nervous sys- tem through its presence in the blood, and thus the alternate use of venesection aiid transfusion Avill at times enable the physician to carry his patient over a critical iieriod Avhich could not be fully met b} the administration of physiological antagonists. Substitutes have been offered for general blood-letting in the treat- ment of the initial period of various affections, notably that of pneu- monia, and, Avithout trenching upon the contagious character of this disease, some of them may be referred to as folloAvs: Ergot has been strongly recommended because of its property of contracting the smaller blood-vessels, and thus ])reventing the congestion and engorgement of the capillaries of the delicate pulmonary tissue. Upon the same prin- ciple, barium chloride has been given, as aa'cII as digitalis, but it is doubt- ful if these remedies alone, in Avell-marked cases, can control and counter- act the progress of the disease, because their successful use depends upon their power over the heart. Whenever the effect of the drug is such that the vis a frontis is suffcient to overcome the v,is a tergo^ then the activity of the circulation Avill subside; but so long as the poAverful