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.)

Title Page

26/394

will become a question how far the means which have been or still are in use may be continued, and in what they may be modified or changed, or what additions may be made to them. In this the physician will be guided by the peculiarities of each case ; but in the circumstances of most the same principles and means as have been dis- cussed should be continued, modified so as to meet prominent symptoms, and commencing or fully developed complications, or intercurrent af- fections. The softening of the tubercles in this stage is generally attended by an increase of cough and expectoration, of the hectic symptoms, and of the morning perspirations, with occasional attacks of diarrhoea or disorder of the bowels. One or more of these usually become more prom- inent as the disease advances ; or other phenom- ena are superadded, requiring the treatment to be directed more especially to them. 326. a. The cough generally suggests pallia- tives, in connexion with the other means which the state of the patient demands. Thus hydro- cyanic acid, or henbane,* or hemlock, or the com- pound tincture of camphor, may be added to mix- tures containing the liquor ammoniae acetatis, and any demulcent which may appear most ap- propriate to the nervous and vascular conditions of the case ; or they may be conjoined with bitter or tonic infusions or decoctions, when the states of the pulse, of the fever, and of the vital powers require them : these latter are often rendered more beneficial by the addition of the solution of the acetate of ammonia, and of the sweet spirits of nitre. Where there is much pallor of the sur- face, the pulse being either weak or but little ac- celerated, any of the anodynes above mentioned may be added to the mistura ferri composita, and the effects upon the cough and upon the hectic and other symptoms carefully observed. 327. b. The perspirations during the night or early part of the morning are always productive of great exhaustion, and are the most difficult to restrain or prevent. They have been very differ- ently treated by both ancient and modern phy- sicians, but most frequently by mineral acids, and by various refrigerants, astringents, and tonics, as shown in the historical sketch given above (§ 241, et seq.). Either of these may be prescribed in combinations suited to the case, with emollients, stomachics, or tonics, and may be made the vehi- cle, on the surface of which the recent cod-liver oil may be taken shortly after a meal, twice or thrice daily, and in sufficient quantity; this be- ing the substance most deserving of reliance for moderating this distressing symptom. Some of the medicines advised with this object have often disordered the bowels, or induced an attack of diarrhoea, and even augmented the suffering of the patient, without effectively diminishing the perspirations and their consequent exhaustion ; but these results rarely follow from the use of * [Great caution is necessary in regard to the use of hydrocyanic acid, henbane, or any other powerful seda- tive in tubercular disease, inasmuch as the vital powers, already prostrated, may be still farther reduced by the influence of the remedies. When there is great pallor of the surface with weak pulse, we have found the night sweats augmented by the use of the above-named drugs, as well as the veratrum viride, and the general prostra- tion aggravated, under which circumstances the disease invariably makes more rapid progress. We have, how- ever, used of late, with apparent advantage, Tildf.n's Fluid Extract of Hyoscyamus, with paregoric, which serves to allay the pulmonic irritation without causing any increase of debility.] this oil. The mistura ferri composita is some- times of service in allaying the severity of the hectic and the excessive perspirations, especially when there is no inflammatory complication pres- ent, and when it neither produces headache nor renders the cough harder or more severe. Dr. Watson has found the tinctura fern munatig successful in allaying the perspirations after other means had failed.* The dose he prescribes of this medicine is twenty minims thrice daily. I have likewise given this preparation with advantage in the infusion of calumba, with an additional quantity of the acid, and have sometimes made this combination the vehicle on the surface of which the cod-liver oil was taken. 328. c. When diarrhaza. occurs it is often in- duced by some purgative medicine, or by errors in diet, or by means employed to moderate the perspirations. The cause of it should be ascer- tained, and the medicines to restrain it be suggest- ed or selected accordingly. It is, however, fre- quently independent of either of these causes, and the result of indigestion—of the acidity and the accumulation of sordes in the prima via conse- quent upon the imperfect performance of the functions of primary assimilation. In either of these circumstances antacids and absorbents, con- joined with mucilages, anodynes, or narcotics, or with mild tonics, will prove of service ; as the cre- taceous mixture with the compound tincture of camphor, or the tincture of hop, &c, and with the tincture of catechu, or with other vegetable astringents, if they be required. But the bowels should not be confined by these or other medi- cines ; and when there is any risk of such an oc- currence magnesia may be given with sulphur or rhubarb, or with cascarilla ; or the compound de- coction of aloes may be prescribed with the tinc- ture or with other suitable medicines.—[Opium is well suited to such cases, and may be used freely with the best effects.] 329. d. In this stage of the disease emetics and bleeding are seldom beneficial, unless the states of the digestive and respiratory functions require a recourse to the former, and the occurrence of pain or the appearance of an inflammatory or con- gestive complication demand the latter. Ipecac- uanha is in most instances the best emetic, and local bleeding the most beneficial, especially when the embrocation prescribed above ($ 321) is after- ward applied and duly persisted in. Although it may be necessary to have recourse to these means, others of a restorative or even tonic kind —both medicinal and regimenal—maybe equally required ; often, however, in different cases, but not infrequently in the same case, and sometimes even soon after the more antiphlogistic measures have been employed. Generally, when local de- pletions are required, febrifuge medicines, chiefly such as the solution of the acetate ^>f ammonia, * [The oxide of zinc will be found one of the most effi- cacious remedies for the night sweats of phthisis. It may be made into a pill with extract of hyoscyamus, two gre. of each to a pill, of which one, and in some cases :°'?I,C iaken at bf:time- Dr. Barlow recommends one gr sulph. zmc and four grs. ext of hyoscyamus to be ctZln A°r?,Pl w bC/time' and ^nerally finds ?t suc- cessful As the oxide of zmc is insoluble, Professor Woon advises the use of the sulphate; but though the forme like calomel and many other mineral substances be in- soluble in water, they find their appropriate solvent in the stomach or intestinal canal; so that, in fact, the side is juat as efficient as the sulphate, and less irritating to the mucous membrane. We have found a combination o sulphate of quinine and morphia very useful for the night sweats of phthisis.] e

Licence and re-use

Contents