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).

James Copland

Date:: 1834-59

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.)

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while they distress the patient and even augment the constitutional disturbance in some cases. 320. Issues, made sufficiently large, have proved most beneficial in my practice. I have always prescribed them when I have seen the patient in the first, or even in the second stage, and sev- eral persons are now alive who had recourse to them from twenty to thirty years ago, as I ad- vised them. I have generally recommended them to be made near the margins of the ribs, when the patient is not much emaciated; or in any other situation which may be preferred. The chief objection to them is the preliminary measure of destroying the integuments for the lodgment of the peas. Where setons appear preferable, as re- spects the state of the patient, or the situation in which they may be inserted, so as least to incom- mode him, care should be taken, in respect of them as well as of issues, that they should be suf- ficiently large to be effective, and that a free pu- rulent discharge be uniformly procured from them. When both issues and setons are object- ed to, especially the formation of an issue in the usual way, then the inner bark of the mezereon, previously moistened, may be placed on a part of the surface of the extent of a crown-piece, and confined there by means of a larger piece of ad- hesive plaster spread on paper or leather, the bark being renewed from time to time. This lat- ter plan, however, is not preferable to a blistered place of this extent kept open and discharging by the usual means ; but neither the one nor the other is so effective as an issue or a seton, the benefit being derived chiefly from a uniformly co- pious discharge. When this is procured, the internal treatment and regimen of the patient should be more restorative and generous than in other circumstances of the disease ; tonics, cha- lybeates, animal food, restorative beverages, &c., being allowed, according to the peculiarities of the case, especially as respects the vital and vas- cular conditions. 321. I have, since 1819, never neglected to prescribe an embrocation to the chest, in phthisis and in some other diseases, which acts less as an external irritant and derivative than as a source from which a salutary agent is inhaled into the lungs in so mild a form as neither to irritate nor to stimulate, while it is slightly absorbed. This embrocation I have employed in many internal diseases, in various forms or modifications, as a liniment, or as an embrocation or epithem—sprin- kled on folds of flannel, or on spongio-piline, and covered over by a napkin, or otherwise—and va- ried as respects the constituents, the principal one being always present. No. 353. R Linimenti Terebinthinte, Linimenti Cam- phorm compositi, aft, |jss.; Olei Olivae, Jss. ad 3VJ.; Olei Cajtipuli, jj. ad vjss. Misce et sit embrocatio. Xo. 354. R Linimenti Terebinthina?, Linim. Saponis cuiii Opio, ful^ij. ; Linim. Camphors comp., fjss.; Olei Cajuputi, 3JssT Misce. 322. When it is desired that external irritation should follow the first of these, the olive oil may be omitted. Either of these should be renewed every night, the vessel being previously shaken, and applied, by the means already mentioned, to a sufficiently large surface, either of the front, or of the back of the chest, or of the side, where pain or uneasiness is most felt. It should be kept ap- plied all night, or the following day, and even be renewed again in the morning, the quantity sprin- kled over the surface of the flannel or spongio-pi- line being sufficient to moisten, or more complete- ly to wet these substances, according to the ef- fect we wish it to produce, whether by inhalation of the fumes proceeding from it, or by the extern- al derivation it may occasion, in addition to the former mode of action. 323. Blisters, mustard poultices, the cauteries, urtication, and dry-cupping have severally been resorted to as derivatives in this stage. Blisters are often of much service, especially when ap- plied after local depletions ; and when a discharge ha3 been procured from them for some time. The others, excepting the cauteries, are seldom pro- ductive of much or permanent benefit. The tar- tarized antimonial ointment and liniments with croton oil have deservedly fallen into disuse. The actual and potential cauteries were not infrequent- ly employed in former times for this disease, a discharge from either having always been promo- ted. They are now never resorted to in phthisis. 324. c. In this, as well as in more advanced stages of the disease, the inhalation of medicated vapours, and of certain fumes, effluvia, and odours, has been recommended and been adopted. I have, however, very rarely observed much benefit de- rived from it, especially as commonly employed by means of an inhaling apparatus. The substances, also, generally prescribed for inhalation have been used in so concentrated a form, or are so acrid or stimulating, as often to increase the existing irri- tation in the bronchi, or the morbid action in the substance of the lungs, and in the seats of vom- icae or of cavities. It is also very questionable whether or no the inhalation of vapours—whether watery, emollient, or anodyne, or narcotic, or pos- sessed of all these properties—is actually benefi- cial in phthisis, more especially at an early period of the malady. The inhalation of these may be useful as palliatives at an advanced stage, especial- ly when an irritable cough, a sense of constric- tion in the chest, difficult expectoration, &c., are much complained of; but, in other circumstances and stages of the disease, they only tend to ob- struct or impair the functions of the lungs, by in- terrupting the progressive metamorphosis and ox- ygenation of the globules of the blood, and by fa- vouring congestion or a partial collapse of the or- gan. The modes of inhalation, or of having re- course to the respiration of the effluvia of sub- stances which are calculated to prove beneficial in this disease, will be considered in the sequel.* 325. C. Treatment of the second stage of the common form of Phthisis.—At the commencement of this period, or when the symptoms, especially the appearances of the expectoration, and the character of the febrile action, indicate the recent supervention of this stage on the first, then it * [We unhesitatingly concur in the truth of these re- marks, as will doubtless every practical physician who has had much experience in regard to inhalation in this disease. That it may palliate the cough, when harass- ing and of an irritative character, when proper sub- stances are used, is a matter of common observation; but we cannot admit that it exerts any decided curative power. Forcible inspiration, which expands the air- vesicles, is far more efficient than the local contact of aerial or vapoury medical agents; for a more perfect ox- ygenation of the blood aids materially the nutritive function, primary and secondary assimilation. It is possible that certain substances, such as chlorine and iodine, which act as stimulating and tonic alteratives, when introduced into the circulation, may exert the same curative influence as when taken into the stomach. But these are few in number, and it is very possible that the local irritant effects exerted on the lungs may overbal- ance any good effects which they otherwise might pro- duce. We reserve farther remarks on this and other allied topics to the Attendix.—Ed.]

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