The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 1).

Date:: 1849-59

Credit: The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (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.)

Title Page

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$Sometimes the digitalis maybe beneficially com- bined with otber diuretics, particularly the squill and the liquor ammonia? acetatis. A very power- ful diuretic, also, occasionally in this disease, is the spiritus colchici ammoniatus ; and we have often succeeded with this medicine in exciting the secretion of the kidneys, when we had failed with many others. It may, however, be remarked gen- erally of diuretics, that they bear, and even re- quire, to be united together more than any other medicines ; and we have often thought that their effect has been in proportion to the complexity of the prescription. Thus, perhaps, when neither squill nor foxglove has succeeded alone, they have acted when united ; and it will often be well to join them with others. The sulphate of mag- nesia, when combined with squills, paregoric, and the liquor ammonia? acetatis, has often a very decided effect upon the kidneys, and either does not act at the same time upon the bowels, or only in a very slight degree. The following formula? have been very useful in our own practice : — R Liquor, ammonix acetat. £.3ii. ; T. camphorx comp. f.5 i.; T. scillx f.^i.; Magnesix sulphatis 3ji.; Infusi Turaxaci f.^iv. ; a f.^ss usque ad {.5 iss tertia quaque hora. R Sp. colchici ammoniat. f.^ii.; Potassx subcarbon. gi.; Infusi genistx f.5 viii.; ab f.gss usque ad f.^iss tertia quaque hora. [Diuretics of the stimulating kind are not, how- ever, adapted for all cases of anasarca, and espe- cially for those that are dependent upon granular disease of the kidney. In ordinary cases, where no visceral disease contra-indicates their use, re- course may be had with full advantage to the infu- sion of juniper-berries, alone, or associated with the bitartrate of potassa. A solution of the bitar- trate may also be given for common drink ; and along with these a grain of squill and half a grain of the mild chloride of mercury may be given twice or thrice a day until the mouth is affected slightly. This course, along with the employment of a brisk cathartic, as the pulvis jalapa? com- positus twice a week, offers as well-grounded pros- pects of advantage in simple anasarca as any that could be devised. (Dunglison's Practice of Medi- cine. 2d edit., p. 649. Philad., 1844,)] When the anasarca has completely assumed a chronic form, and appears almost stationary, Ba- cher's pills are extremely valuable. In the original formula they contained powdered carduus bene- dictus, but this is perfectly inert. The formula is contained in Thomson's Conspectus, under the head Extractum hellebori nigri. Under their use the effusion often gradually disappears with- out any extraordinary increase in the secretions. Occasionally they act upon the bowels, producing, however, tenesmus much more frequently than actual diarrheca; their more manifest effect is in slightly stimulating the secretion of the kidneys. In some instances their exhibition, after a few days, is followed by the peculiar effects of poison- ing from hellebore, head-ach, giddiness, fainting, &c, together with irritation of the mucous coat of the intestines. Of course the medicine, under these circumstances, must be suspended; they may, however, be generally resumed again in a lew days without any ill consequences. In what is connected with the treatment of this disease, nothing has been said of those cases in which the effusion is preceded or accompanied by diarrhoea. Where this has an inflammatory ori- gin, as is generally the case after scarlatina and other repressed eruptions, blood-letting has been already recommended ; and the only question that remains to be considered is that of purging. Now, though diarrhoea may arise, in the first instance, from simple inflammation, or irritation of the mu- cous membrane of the bowels consequent to the preceding eruption, it will certainly be maintained and aggravated by any accumulation within them; and, consequently, to take care that such accumu- lation has not place, is a most important duty of the practitioner. Here, however, he will often be beset with difficulties ; for should the diarrhoea be violent, there will be such a general exhaustion of the system, that to purge at once will be to ensure a fatal result. The mode of proceeding, therefore, must first be, to maintain the system by opiates, and this even should leeches be employed at the same time ; for it is a curious circumstance, but we believe perfectly true, that patients will often better bear the loss of a small quantity of blood than the debility resulting from severe purging. When rallying has occurred, it will be proper to regard the state of the bowels ; and if accumula- tion be suspected, to administer a mild aperient, such as castor oil, or an infusion of senna com- bined with some carminatives ; thus simply en- suring the evacuation of the intestines, without exciting in any violent degree the secernents of the mucous membrane. After the diarrhoea has subsided, the treatment in no way varies from that which has already been laid down. In distinguishing inflammatory from asthenic dropsy, much stress has been laid by Dr. Blackall upon the presence of serum in the urine; but upon this point we have made no remark, having no dependence upon it as a guide of practice. That it is never present without inflammation is, perhaps, true ; but to make it really a test, the converse ought also to be true, viz., those dropsies in which it does not contain serum ought never to be conjoined with inflammation. This, how- ever, is by no means the case ; and our experi- ence accurately coincides with Dr. Crampton's. In many of those, says this author, which appeared to me to require the prompt use of the lancet, the urine did not coagulate. Under this impression, I ceased to draw any practical infer- ence from that appearance ; and he adds in a note, Dr. E. Percival, who was my predecessor as one of the physicians to the House of Industry, mentions that the result of his experience on this subject fully coincides with mine. After he had tried dropsical urine by the test of coagulation in a number of cases, he at length lost all confidence in the test, either as an invariable evidence of in- flammation, or as a guide of practice. His state- ment is likewise confirmed by the additional testi- mony of Dr. Reid, who acted as a clinical clerk at the House of Industry at the time those experi- ments were made. We would much rather, therefore, recommend that reliance be placed upo.i general symptoms than upon the state of the urine only, which, at the most, can only be regarded as an auxiliary to our diagnosis. The observations which have hitherto beeu$