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meter ranges between forty and fifty-five. Handkerchiefs and wrappers of wool or other fabric, are an inadequate substitute; since they act by confining the expired air, and thus re-introduce air unfit for respiration.
Of the causes illustrated in this lecture as inducing or aggravating consumption, some are under our own control. That source of many plagues, contaminated air, is not essential to our apartments and workshops. Open fire-places, with Arnott's ventilators of sufficient dimensions, or even a zinc pipe communicating with the chimney, would to a great degree correct the evil ; and some hundreds of lives might probably, by a few such simple precautions, be annually saved in this metropolis.
In addition to the benefit of free exercise in the open air, much good would, I believe, accrue from attention to the power with which the will is endowed over the respiratory muscles. I cannot but think that some of the evils incident to intense study might be obviated, by occasionally pausing to practise breathing.
The unfavourable influences noticed in this lecture may be regarded as producing their effect, first, by deteriorating the blood ; secondly, by occasioning congestion in the lungs. Mental depression and bad air are not without analogy in their action ; for both, in all probability, retard the respiratory act.
Among the mental causes of disordered health, few are more operative than that continual source of disquietude, and physical exhaustion,-ambition beyond the extent of power. It is difficult to estimate the amount of evil which might be prevented, if individuals could attain a correct estimate of their powers, and avoid attaching themselves to offices for which they are not adapted. Unhappily, the selection of occupations among the lower orders usually depends on circumstances quite irrespective of special adaptation ; and, in the upper classes, motives of gain too often overrule considerations of health, or moral fitness. It is the duty and privilege of the medical practitioner, to take every opportunity of impressing truths so important to the health of the community ; to exert his influence against that inordinate estimate of lucre, which leads so many to forget that health is property of the highest value; and to demonstrate, as opportunity occurs, that health would be essentially promoted, if education were so conducted as to train the mind for tranquil superiority to passing cares, and to qualify for the exhilarating occupations of a useful life. I will not apologize for having introduced on such an occasion as the present, what may be considered as one of the moral aspects of professional science ; for you will agree with me that a medical man is never more in his vocation than when fulfilling the offices, and impressing the lessons of an enlightened philanthropy.
Distressing incidental symptoms of phthisis-Night perspirations
-Cough-Results of consumption-Apparent cure-Contraction of cavities-Unfavourable cases—Acute phthisis-Progress of decay-Phosphatic concretions in the choroid plexuses -Mental condition of the dying—Conclusion.
In proceeding, gentlemen, to conclude this course for the present session, it occurs to me that among the more distressingincidentalsymptoms of consumption, are some which have been only cursorily noticed, and on which it might have been profitable to dwell. There is only timé, to-day, to revert to one or two of these symptoms. One of these is night perspirations. You have had numerous opportunities of observing how often, without any treatment specially directed to control the perspirations, they have ceased under the employment of means calculated to improve the general constitutional condition. Such a result, however, is by no means constant. You have seen that various medicines have been administered, with a view to diminish this cause of distress. Sometimes it has been relieved by small doses of opium, as contained in compound kino powder, or Dover's powder, sometimes by mild aperients ; but the remedies usually thought appropriate are acids,
such as the sulphuric and the gallic. The diluted acetic acid, given in drachm doses" with cascarilla or any other bitter infusion, three times a day, has appeared to me to be the most effectual of this class of remedies; and the object is promoted by administering in addition, every night at bedtime, five grains of gallic acid, and an eighth of a grain of hydrochlorate of morphia, made into a pill with mucilage. Sponging the body occasionally with a tannic acid lotion is a useful auxiliary in the treatment. Of late I have given, with most satisfactory results, four grains of oxide of zinc, with four of extract of henbane. No remedy which I have as yet employed has exercised so uniformly favourable an effect, in moderating the night perspirations. I have occasionally substituted the sulphate of zinc in doses of two grains, with advantage; but, generally speaking, the sulphate proves less efficient. The preparations of zinc occasionally fail to accomplish the object, and in some instances, after succeeding for a time, lose their power; but this is unfortunately still more common with other medicines used for the purpose; and I am particularly anxious to direct your attention to the valuable properties of zinc, because the preparations of this metal have been disparaged by some writers of authority. Ratier* observes that zinc is no longer much esteemed in therapeutics; and the late Dr. Pereira asserted that the sulphate, although checking pulmonary and urethral catarrh, had no power of checking cutaneous exhalation. As respects the oxide, I am not aware that the existence of such a property has been even surmised by the profession.
* Dictionnaire de Médecine et de Chirurgie, 1836,
An instance is recorded by Dr. Busse of Berlin,* of a gentleman who, after taking a scruple of the oxide daily for some months without success for the treatment of epilepsy, became cold and shrivelled, and his skin like parchment, but no practical deduction appears to have been made from this observation ; and I am happy to refer to the right source a practical suggestion for which the public are much indebted. The remedy was first used at this hospital at the suggestion of Dr. Robert Dickson, whose acuteness of observation led him to detect this property of the oxide in some patients, to whom he had administered it as a general tonic. I hope Dr. Dickson will pursue his investigations, and be able to discover the cause of the peculiarity in this medicine, which seems to render its administration singularly efficient in checking the perspirations connected with the hectic of phthisis.
You may have been struck with the variety of medicines given with a view to moderate cough; especially as I have not said much on the principles which have guided their selection. Perhaps there is no symptom of which consumptive patients complain so urgently as of cough; and there is scarcely any which so often baffles our efforts for its relief. This subject is far too wide to be treated systematically in a single lecture; for the severity of the cough is doubtless modified by a variety of circumstances, such as the amount of bronchial irritation, the quantity and kind of expectoration, the constitutional irritability, and the condition of the skin. If any degree of bronchial inflammation be present, small doses of antimony are indicated; and in
* Wochenschrift für die Gesammte Heilkunde, 1837, No. 19.