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By De. C. Theodoee Wflliams.
Palliative treatment useful, but subordinate to Antiphthisical—Treatment of the varieties of Cough by sedatives and mild expectorants—Cough mixtures, linctus, lozenges—Time and form of administration—Objections to their use—Pain in the Chest, how caused and how relieved—Plaisters and Liniments—Treatment of Hamop'ysis—Styptics acting on the Blood—Gallic Acid— Tannic Acid—Acetate of Lead, dose and method of elimination— Turpentine—Perchforide of Iron—Styptics 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—Tonics—Acidsponging—Sulphuricand Gallic Acids—Quinine, and Iron—Success of Oxide of Zinc— Treatment of Diarrhaa and its varieties—Bismuth—Logwood — Sulphate of Copper — Combination of Astringents with Opiates—Opiate Enemata—Tannic Acid—Acetate of Lead—External applications—Constipation—Importance of counteracting it by diet or mild apirients—Treatment of Bed-sores—Preventive and healing measures—Treatment of Laryngeal symptoms—Blistering—Inhalations— Internal applications to the Larynx.
In the preceding chapters the general treatment of Consumption in its antiphlogistic and antiphthisical aspects has been discussed, and we will now say a few words on the palliative treatment of the disease. Measures for improving the general health and strength of the patient and counteracting the consumptive cachexia are of far greater importance than those directed to the mere alleviation of the symptoms; but as these, by the irritation they cause, often induce sleeplessness, feverishness, vomiting, etc., and thus interfere with the general progress of the patient, it is obvious that we must use all means in our power, to allay them, always taking care that our palliative measures do not interfere with the constitutional ones.
Cough is usually the most prominent and troublesome symptom; if loose and slight in amount, it had best be left alone, but when it is hard and frequent, and interferes with the patient's rest at night, it should be allayed by the use of narcotics, the choice of which and its combination with other drugs, must depend on the nature of the cough and the amount of expectoration. When the cough is hard, and the expectoration, though free, only slight in amount, linctuses, containing opium or its salts, codeia or morphia, combined with such simple expectorants as lemon-juice and chloric ether, are most useful. When the cough is very violent, and ends in retching and vomiting, dilute hydrocyanic acid may be added with advantage ; and when the expectoration is offensive, glycerine of carbolic acid, or sulphite of soda goes far to correct the foetor, and at the same time assists the expectoration.1 Sometimes the cough is convulsive, and accompanied by a great deal of wheezy breathing or stridor, it may then be relieved by belladonna, stramonium, or Indian hemp, in doses of a quarter or half grain in a pill at night.
In some kinds of convulsive cough, with difficult expec
COUGH MIXTURES—WHEN USEFUL. 365
toration, we have found a combination of bromide of ammonium with chloral hydrate very efficient.1
Strong expectorants, equally with the old-fashioned emeties, are, as a rule, to be avoided as tending to upset the stomach; but when the expectoration is difficult, or if there be temporary bronchitis and increased bronchial secretion, small doses of squill or ipecacuanha are indicated. When the cough is very hard and troublesome at night, a few drops of laudanum, liquor opii sedativus, or bimeconate of morphia, in an effervescing saline, generally allay the irritation and induce sleep.
Lozenges of morphia, or morphia and ipecacuanha, or opium, are recommended as portable cough sedatives; but it is advisable to restrict the use of these and of the cough mixtures to the night, so as not to upset the stomach, and thus interfere with the antiphthisical treatment pursued during the day. Apart from this objection to their use in the daytime, they are more required at night, their great use being to ensure to the patient a certain amount of refreshing slumber, and thus increase his strength and appetite.
Pain in the chest is another symptom which sometimes requires direct treatment. It is referred to various parts of the chest, but very often to the sub-clavicular spaces. When it is of a dull aching kind and not markedly localized, belladonna or opium plaisters generally give relief. If more poignant, mild counter-irritation with either tincture of iodine, or one of the turpentine liniments, of which the Linimentum Terebinthinas Acetium answers best, is advisable. If more severe, and es
1 r)t, Ammonii Bromidi
Chloralis Hydratis, aa Jiss.
pecially if physical examination detects any decided cause for it in the existence of dry pleurisy, or pleuro-pneumonia, then let recourse be had to vesication, either by means of a small blister, which is perhaps the least painful process, or by means of the liquor epispasticus, which generally acts very rapidly, or again by either the liquor iodi or the strong iodine liniment; the last being rather painful in its action. A good form of mild vesicant is composed of three parts of a strong acetum cantharidis to one of spiritus camphorae. This has been largely used in Dr. C.J. B. Williams's practice with success ; the object being to create slight vesication on a large surface from time to time, but not to cause a permanent sore. And this reminds us that we should not omit a mention of setons and issues, which were formerly in high repute among physicians, and there is little doubt that much good was obtained from their use, but now that we have at our command such a variety of means of counter-irritation, most of which are more agreeable in application, and at the same time as efficacious in action, it is not wonderful that the seton, with its attendant discomforts, has fallen into disuse.
Hcemoptysis when so slight as not to amount to a teaspoonful, hardly requires the use of styptics, but may be treated by rest, by avoiding excitement and alcoholic stimulants, and by mild counter-irritation. Where, however, the quantity expectorated exceeds that amount, or continues to recur, it should be promptly checked; and there is the more reason for doing so if a cavity is known to have formed, or to be forming, in either lung; as such haemorrhage is likely to be more profuse, and it' not checked, may end fatally. A common, and generally a very effectual styptic, is gallic acid, given in powders either alone or combined with acid tartrate of TREATMENT OF HAEMOPTYSIS. 367
potash,1 and continued every three or four hours while the bleeding lasts. These powders are a convenient and portable form of medicine ; and as but little harm follows from their being taken frequently, they can be safely left in the patient's hands; which is more than can be said of some of the more potent stypties.
Tannic acid is a stronger remedy, which we have found more useful in other kinds of hemorrhage, as epistaxis, hcematemesis, and hsemorrhoea; but in haemoptysis it is useful to combine it with gallic acid,* if the latter prove insufficient to check the blood flow.
A more powerful styptic is the acetate of lead, but the dose and mode of administration require some care and attention. In order to produce decided effect on the bleeding, it should be given, not in two or three-yrrain doses, as many practitioners are in the habit of doing, but in doses of five grains at a time, in the form of a mixture with a little excess of acetic acid, every three or four hours, and where the haemorrhage is very profuse, it may be given every two hours, or indeed every hour. To prevent the constipation, cholic, and the cachexia consequent on the accumulation in the system of so large a quantity of lead, a draught of sulphate of magnesia and sulphuric acid, should be administered every morning. With these precautions large doses of lead have been given for several
1 9> Acidi gallici
Pulv. Sacchari aa gr. x.