Lectures on the theory and practice of physic (Volume 1).

  • William Stokes
Date:
1845
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Licence: Public Domain Mark

Credit: Lectures on the theory and practice of physic (Volume 1). 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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    haps not more than fifteen grains, infused for ten minutes in six ounces of boiling water; after the interval of an hour, if no effect has been produced, it maybe repeated in the quantity of twenty grains, and so on, until such effects are produced, in slight giddiness and muscular relaxation, as show that its peculiar action is taking place upon the system. It may then be repeated at intervals of one or two hours, a great many times, if the case do not speedily yield ; and, with the precautions now mentioned, I have never seen any unpleasant effect from a free use of this powerful remedy. Even the cautious and skeptical Heberden speaks without drawback of the curative powers of the injection of tobacco smoke and tobacco infusion in ileus ; but, on the other hand, hoth in surgical and medi- cal practice, we have many cases on record in which speedy death was the result of the administration of this powerful medicine as an enema. I shall recur to this point when the subject of ileus is before us. Resuming my sketch of the treatment of stercoraceous colic, I have to direct your attention to a state of things of very probable, I may say common, occurrence, not adequately dwelt on by writers and practitioners. It is the gradual coming on of the constipation and morbid state of the intestinal canal, of which this is often a symptom merely, or one of the effects ; and the strong probability of inflammation, not very acute, indeed, but still quite decided, having been established before the patient was laid up in bed and had sent for the doctor. The more immediate and pressing uneasiness with the sick man himself is costiveness, with its concomitants, heat and ful- ness of the part, and some flatulence ; and to its removal he directs himself with domestic prescriptions. These being found ineffectual, the physician is sent for, who, not seldom, too readily adopts the erroneous pathology, and with it the purgative practice of his patient; and persists in administering purges, one after another, or in combination, and enemata of the same nature. Mere spas- modic colic with fecal accumulations will every now and then be removed by these means; but if, as I have just intimated, there be inflammation, we ought to lose no time, after the initial and pro- bationary steps of giving some purgative medicine by the mouth and ])cr an ion have been tried without effect, to draw blood from the arm, even though the pulse be not frequent and the pain of the abdomen be inconsiderable. After venesection, calomel, in a dose of ten grains with one grain of opium or four or five of hyosciamus extract, may be given, and the patient made to take a table-spoonful, every half hour, of a solution of one ounce of sulphate of magnesia in four ounces of water. The passage of fla- tus downwards and per a num. indicate that the bowels are about to yield and to discharge the matters accumulated in them, and at the same time the propriety of giving an enema, either simple or pur- gative. But if, in twelve hours after venesection, the bowels are not moved; if the pain and restlessness return, or the stomach is nau- seated, or bilious and other matters are ejected from it ; and, also if the pulse is hard, even though of its common frequency, and there is thirst, we must not hesitate to draw blood again from the arm ;