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will bear it, has proved beneficial in many instances; but always combined with the usual treatment with the oil and acid tonic once or twice in the earlier part of the day. Whatever may be its mode of operation, iodine certainly has some resolvent effect on lymphatic swellings and inflammatory effusions; but it is a wasting and depressing agent if its histolytic action be not counteracted, and this is most effectually done by codliver oil and generous living. The influence of iodine seems to be restricted to the living sarcophytes, the proliferation of which forms the bulk of soft lymphomata, bronchocele, and inflammatory swellings; it has less power over them in the purulent form, or when indurated, and none at all in a state of caseation. The action of mercury on inflammatory products seems to be still more limited to the early stages; and its destructive or histolytic operation on the gums and salivary glands rather favours the notion, which has been commonly entertained, that it tends to hasten the decay and softening of tubercle.1
1 The effect of mercury on the gums reminds me that these boundaries of our flesh claim close attention in all diseases affecting the nutrition of the body. The late Dr. Theophilus Thompson particularly directed the attention of the profession to the state of the gums as a symptom of phthisis. I have long observed this, that not only in phthisis, but in other diseases of malnutrition, the gums recede, and often become inflamed and spongy, independently of any cause in the teeth, before loss of flesh or strength attracts attention. The mere advance of age causes the receding of this flesh border, and this may be accelerated by anaemia or bad living; but in many phthisical cases, in addition to the recession, there is a redness and turgidity, and sometimes a partial ulceration of the margin, indicating an unhealthy congestion or inflammation. It is not usually attended with soreness, in fact, often patients are not aware of its presence. It is commonly diminished under tonic treatment, and generous diet; but the gums rarely become quite natural again. Mouth-washes or tooth powder containing tannic and carbolic acid, or other antiseptic astringents, are of some use, and correct the fetor often present in the breath.
Not the least important part of the antiphlogistic treatment of inflammatory varieties of consumption is rest of body and mind, and confinement to a uniform temperature. In all acute and febrile attacks, the repose and warmth of bed are required for some days at least; and it is remarkable how this simple nursing, with time, will sometimes soothe away acute symptoms without any active measures; and in all cases they make these measures more effectual, especially in cold seasons. The exercise of the voice must in like manner be limited. In a phthisical subject, to save the strength by avoiding its expenditure, is a wiser and safer course than to allow it to be wasted, and then to rely on regaining it through strengthening agents.
Its Objects 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 concrete Sarcophytcs, promotes resolution and ripening of Exudates—To be effectual must be given largely and constantly, to act on Phthinoplasms and counteract Decline, which may exist without Phthinoplasm—Cod-oil proper for Decline also—Notice of other Oils and Fats—Pancreatic Emulsion —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 Tonics—Prescriptions of various Forms—Doses to be few—Antiseptics—Inhalations—Arsenic.
Moke or less of the preceding measures may properly be brought into operation to remove or counteract various forms and degrees of inflammation which may usher in or accompany the course of Pulmonary Consumption; and they are more often required in cold and changeable seasons and climates, -which derange the circulation and cause colds and inflammatory congestions. But the paramount and most constantly required treatment is not antiphlogistic, but Antifhthisical—that directed against the consumptive element; that which may improve and sustain the vital activity of the bioplasm, and remove or counteract all blighting or hurtful agencies, which tend to pervert it from its proper fitness for the quickening and reparation of the body, into a dying and decaying matter, carrying with it waste and destruction.
It is pretty obvious that to do all this—to renovate the
life and material of the bioplasm and to remove or correct that which is already degraded, is not to be accomplished by any one remedy or any one class of remedies. Tonics, stimulants, antisepties, cod-liver oil, the best kinds of nourishment, pure dry air, regulated temperature, judiciously adapted clothing and exercise, are all needed to complete the antiphthisical measures; and their success will depend on their being so used, proportioned, and directed, as to restore and sustain the healthy functions of the body in their proper activity, and thereby to keep the protoplasm of the blood, lymphatics, and tissues in full life and vigour, and to promote the removal or quiescence of any that may have already degenerated into phthinoplasm. It is obvious, then, that no routine plan, or fixed course of treatment, can succeed in working out this complex problem. The leading indications are, to nourish the textures, and to sustain the several functions of the body; and experience has proved that certain i^eats have such power in this way that their use may be ■nsidered almost indispensable: but in the use of these and of all other means, much intelligent discrimination is constantly required, and success will depend in great measure on the care and skill with which this is carried on.
In the following sketch of the principal antiphthisical remedies, our time and limits require brevity; and we shall most concisely attain our end by considering them in succession, under the heads of Medicinal, Dietetic, and Hygienic measures.
Medicinal remedies include cod-liver oil and other fats, tonics, stimulants, eliminants, and antisepties.
Dieteties include food and stimulants.
Hygienic means refer to air, temperature, climate, habitation, exercise, and clothing.
Of all means hitherto tried for the relief of the consumptive, unquestionably cod-liver oil has been found the most successful. This I stated in 1849, after three years' trial of its use; and so I repeat, after a quarter of a century's experience, that it is the only agent in any degree deserving the title of a remedy in this disease. Its mode of action is still a matter of uncertainty; but we can at least offer some reasonable conjectures, in addition to those already proposed in the Summary of Treatment. That it is in itself a nutriment cannot be doubted; and that its nutritious properties go farther than to augment the fat in the body is proved by the well-ascertained fact, that the muscles and strength also increase under its use. In fact, it has been proved to increase the proteinaceous constituents of the blood, except the fibrin, which is diminished.1 In truth, the beneficial operation of cod-liver oil extends to every function and structure of the body. In case^ most suitable for its use, there is a progressive improvement in digestion, appetite, strength, and complexion; and various morbid conditions perceptibly diminish. Thus, purulent discharges are lessened, ulcers assume a healthier aspect, colliquative diarrhoea and sweats cease, the natural secretions become more copious, the pulse less frequent. It is difficult to comprehend how it can produce such marvellous and manifold salutary effects; but the extent to which it has been, and still is, administered, pretty well prove that it has properties which render it congenial to the animal economy.
Cod-liver oil forms an emulsion more readily than other oils, and leaves no greasy feeling in the mouth, and this corresponds with its easy digestibility and absorption
1 Simon's Animal Chemistry, by Day, vol. i. p. 280.