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CHAPTER XXVII.

TREATMENT OF PULMONARY CONSUMPTION ANTIPHTHISICAL

MEASURES.

PaGE

Objects of Antiphthisical Treatment to sustain Vitality of Bioplasm,

and counteract Decay—Remedies, Medicinal, Dietetic, and Hygienic

—Of Medicinal, Cod-liver Oil the chief—Its beneficial Effects-

Mode of Action, as an Oil, on the Bioplasm and on the concrete

Sarcophytes; softening exudates and promoting resolution—To be

effectual must be given largely and constantly; to act on Phthino-

plasms and counteract Decline, which may exist before or after

Phthinoplasms—Notice of other Oils and Fats—Pancreatic Emul-

sion—Reasons for preferring pure Cod-liver Oil—Mode of preparing

it—Sources—Modes and Times of Exhibition—Cautions—Tonic

Medicines: best combined with the Oil—Mineral Acids—Nitric-

Sulphuric—Phosphoric—Sulphurous—Hypophosphites—Bitters and

other Tonies—Prescriptions—Doses to be few—Antisepties—Inha-

lations—Arsenic ....... 340

CHAPTER XXVIII.

TREATMENT OF PULMONARY CONSUMPTION.—PALLIATIVE MEASURES.

By Dh. C. Theodobe Williams.

Palliative Treatment useful, but subordinate to AntiphthUieal—Treat-

ment of the Varieties of Cough by Sedatives and mild Expectorants

—Cough Mixtures, Linctus, Lozenges—Time and form of Admin-

istration—Objections to their use—Pain in the Chest, how caused

and how relieved — Plaisters and Linimenta —Treatment of Haemopty-

sis—Stypties acting on the Blood—Gallic Acid—Tannic Acid—

Acetate of Lead: Dose and Method of Elimination—Turpentine—

Perchloride of Iron—Stypties acting on the Blood-vessels—Digitalis

—Ergot of Rye—External Treatment by Cupping and Blisters—

Restrictions in Diet and use of Ice—Treatment of Night Sweats—

Niemeyer's Conclusions—Tonies—Acid Sponging—Sulphuric and

Gallic Acids—Quinine and Iron—Success of Oxide of Zinc—Treats

ment of Diarrhoea, and its varieties—Bismuth—Iiogwood—Sulphate

of Copper—Combination of Astringents with Opiates—Opiate Ene-

mata—Tannic Acid—Acetate of Lead—External Applications—

Constipation—Importance of counteracting it by Diet or mild

Aperients — Treatment of Bed-sores—Prevention and Healing

measures—Treatment of Laryngeal Symptoms—Blistering—Inhala-

tions—Internal applications to the Larynx .... 363

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CHAPTER XXIX.

TREATMENT OF PULMONARY CONSUMPTION DIETETIC AND

HYGIENIC MEASURES.

By De. C. Theodoee Williams.

Page

Effects of good Diet on Consumptive Patients—Object of Diet—Impor-

tance of Meat—Exemption of Butchers from Consumption—Raw

Meat: when useful—Blood Drinking—Vegetables and Fruit—Ob-

jections to Pastry, Pickles, Salad, &c.—Cautions as to the use of Fatty

and Oily Food—Bread and Farinaceous Articles—Liquid Nourish-

ment—Stimulants—Mode of Administration and Uses—Varieties,

and Rules for their Selection—Brandy and Rum best combined with

Food—Cooling Drinks—Clothing—Best material for under-clothing

—Warm Wraps—Exercise—Its benefits—Active Exercise: its ob-

jects and varieties—Rowing—Swimming—Gymnasties—Walking—

Passive Exercise: its varieties—Carriage—Sailing: their effects—

Riding: its great advantages—Habitation—Soil—Site—Locality

and Shelter—Temperature—Ventilation and Drainage . . 375

CHAPTER XXX.

TREATMENT OF PULMONARY CONSUMPTION. CLIMATE.

Bt Db. C. Theodobe Williams.

Immunity of Localities from Consumption not assignable to any one

Condition of Life—Objections to High Altitude Theory—Kirghis,

Icelanders and Feroese—Objections to 'Koumiss' Theory—Twofold

Origin of Consumption—Influences originating Inflammatory Attacks

—Septic Influences—Nature of the Disease dependent on its Causa-

tion—Knowledge of Countries where each class prevails: a guide to

Climatic Treatment—Objects of Change of Climate—Division of

Climates into Marine and Inland—Marine: their stimulating and

equable qualities—Caution as to Sea-port Towns—Cool and moist

British Coast Stations—Dry Climate of Mediterranean Basin—

Warm and moist Madeira group—Inland Climates: their great

diversity—Division into three groups—Calm and Soft—Dry and

Warm—Climates of elevated regions—Marine Climates suitable

for Consumption arising from Inflammation—Choice dependent on

degree of irritability of system—Inland localities best fitted for the

most irritable variety—Climate of elevated regions indicated for

Consumption of Septic Origin—Restrictions—Residence at high

altitudes important as a Preventive measure—Ordinary Chronic

Consumption best treated by warm stimulating climate in winter,
and cool bracing climate in summer—Importance of Exercise—In-
land Climates of North America—Sea Voyages: advantages and
disadvantages—Cautions—Certain Cases of Consumption unfit for
Change of Climate—Practice of sending Patients in advanced Con-
sumption abroad condemned ..... 385
OH

PULMONARY CONSUMPTION.

CHAPTER I.

DefinitionsIllustrations of degreesGalloping ConsumptionAcute TuberculosisScrofulous PneumoniaMore chronic and limited forms—Progress of the diseasePower of MedicineUnity but not uniformity of Phthisis.

The Disease, too well known to the public, as well as to the medical profession, as Pulmonary Consumption, is characterised by the symptoms, persistent cough, expectoration of opaque matter, sometimes of blood; a progressive loss of flesh, breath, and strength; often hectic fever, night sweats, and diarrhoea; and the common tendency of the disease is to a wasting of the body and a dedine of its powers, down to its termination in death.

Pathologically considered, pulmonary consumption is characterised by certain changes in the textures of the lungs, consisting chiefly of consobdations, granular or diffused, which irritate their functions and clog their structures, and which proceed to further changes, of degeneration, disintegration, and excavation of some parts, and of induration and contraction of others—all tending to a disorganisation of the lungs, and a wasting away of the flesh and blood of the body.

It is this tendency to degeneration and destruction, which stamps the consuming character of the disease; and the more strongly this tendency is manifested, the more irresistible and rapid will it be in its fatal course. In certain cases the disease is so acute and extensive as to carry off the patient in a few weeks or months. In others it is more limited and slow, and may not destroy life for five, ten, twenty, or more years. In the former cases medicine has little or no control over the disease; decay and death invade the frame so overwhelmingly, that there is neither sufficient power in nature to resist them, nor time for art to aid that power. One of the most vital organs of the body becomes suddenly invaded by a disease, changing its structure, obstructing its functions, and spreading through it the seeds of further decay, which not only in the organ itself, but by the blood and lymphatics, diffuse its destructive influence through the whole system.

Let us briefly sketch the two most terrible forms of the disease.

A man of middle age is attacked with fever, with pungent heat of the body, cough, viscid expectoration, extreme oppression, and overwhelming weakness, resembling that of continued fever; and the likeness sometimes appears also in the coated or dry brown tongue, sordes on the teeth, and occasional delirium. The vesicular breathsound is superseded everywhere by bronchial rhonchi and mixed crepitation. On percussion, the chest is dull nowhere, but less clear in the posterior than in the front parts. This case might be supposed to be one of universal capillary bronchitis, with general pulmonary congestion. So it is; but this is not all. In spite of blisters and other remedies, the breathing remains short and difficult; the pulse becomes more rapid and feeble; the lips, cheeks, and nails become livid; clammy sweats break out, and the patient dies in the third or fourth week from his first attack. The lungs are found congested, and the bronchi loaded with viscid mucus; but more than this, innu

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