Page images
PDF
EPUB

violent cough; and expectorated about a pint of purulent matter in the course of the day-presenting all the qualities of phthisical sputa; hectic fever prevailed to an extreme degree, attended with great emaciation and profuse night perspirations; pulse, 100; inspirations, 28; animal heat, 110°; tongue much furred; diarrhoea; had lost a brother from consumption. Pectoriloquism, cavernous respiration, and a gurgling râle in the right sub-clavicular region and in the axilla, gave conclusive evidence of the existence of ulceration in the superior lobe of the lung of that side; and dulness on percussion at the left side denoted the presence of tubercles in the left lung: the heart beat regularly, and with a natural sound, only with too great frequency. A chalk mixture, with the addition of catechu, was prescribed, and inhalations of chlorine and belladonna at 110° temperature; and subsequently, when the tongue became clean, and the secretions regular, a mixture composed of quinine and infusion of roses, with excess of acid, and a little solution of the hydrochlorate of morphine; nutritious and generous diet, with a small quantity of the stimulus he had been accustomed to. He soon experienced the beneficial effects of this mode of treatment; for, in three weeks, the cough and night perspirations had become much diminished, and the expectoration was slight and free; the excessive purgation had ceased; strength improved; and the symptoms generally so much mitigated, that he was enabled to reach his sitting-room. At the end of eight weeks more the cough was very slight, and of no inconvenience; the sputum very trifling, and consisting of mucus only; there were no longer night-sweats or indications of fever; and he had gained both flesh and strength, and, by wearing a respirator, could take out-of-door exercise. The patient experienced two or three slight relapses from sudden changes of temperature and derangement of the stomach and bowels; but got perfectly well in the course of fourteen weeks from the commencement of my treatment,

during which time the above remedies were steadily persevered in, with some slight modifications.

The gentleman has since paid more attention to his general health, by preserving habits of regularity and temperance; by which he has maintained a proper degree of constitutional power, and has not at the present time the slightest trace of pulmonary disease.

REMARKS.-One of the first symptoms in this case was spitting of blood (hæmoptysis), which is too often the harbinger of much and, if neglected, irreparable evil; hence the absolute importance that the least token of its presence should be promptly and effectually met. The common plan of bleeding, as was here practised, I believe to be, generally speaking, injudicious and dangerous—not, perhaps, in its immediate, but in its ultimate effects. When we find the pulmonary circulation become embarrassed during convalescence from acute disease, whilst all the other functions have re-acquired their healthy characters, I am convinced that the occurrence of this symptom is not so much to be attributed to the disease itself as to the treatment. These repeated bloodlettings not only diminish the mass of blood in circulation, but also alter its constitution; for, as Majendie and other physiologists have observed, aqueous drinks absorbed by the veins, being the sole means wherewith the patient is allowed to replace the blood he has lost, it follows that the fluid loses its proper share of viscidity and coagulability, and acquires, proportionably, a tendency to extravasation. The deteriorated blood which is thus extravasated in the labyrinth-like canals, coagulates, becomes solid, and produces pulmonary disease, similar to that which I have just described.

This case very satisfactorily shows that a cure of consumption may be effected even in the most advanced stages, and that, too, under the most unfavourable circumstances, for here the patient's constitution (naturally weak) was much broken down by intemperance. It bears out the assertion of the

great Laennec, "that the cure of consumption, when the lungs are not completely disorganized, ought not to be looked upon as at all impossible, in reference to either the nature of the disease, or of the organ affected."

CASE IV. CONSUMPTION.-À young man, a groom of delicate constitution, who was placed under my care, March 27th, 1835, related that about a year ago he caught cold, by sitting in a crowded theatre with damp clothes on, which was followed by severe cough, with pains at the chest and head. The medical gentleman who attended the case bled him to faintness; which treatment it seemed rather aggravated than relieved the symptoms. The lancet was, however, again employed, and the like results ensued; subsequently, he was twice blistered. After this treatment he slowly rallied, but had ever since been constantly troubled with a hacking cough, and he had gradually lost flesh. At the time of his application to me he was so debilitated as to be incapable of undergoing the least bodily exertion: complained of severe palpitations; difficulty of breathing; profuse night perspirations; constant cough, accompanied with an expectoration, in which were discovered, by the aid of the microscope, distinct portions of globular, ragged, tuberculous matter. The countenance was anxious; the cheeks attenuated, and patched with a hectic flush; pulse varying from 100 to 110; total loss of appetite; animal heat, 100°; respiration, 30. Auscultation and percussion gave a cavernous rhoncus between the fourth rib and the right clavicle, with a metallic ringing, and pectoriloquy; at the left side there was dulness at the apex of the superior lobe; and there was an unusually deep depression under both clavicles, formed by the sinking in of the walls of the chest. The treatment consisted of inhalations composed of chlorine and belladonna, with occasional dry-cupping, sustaining diet, and febrifuges; and subsequently, when the tongue became clean, and the feverish symptoms were abated, steel and quinine tonics. By these means the more urgent symptoms were speedily relieved; and,

in three months from the commencement of my treatment, natural sounds were the result of stethoscopic examination, and he was sufficiently recovered to undertake a journey to Margate, where he remained for six weeks, and had the advantage of baths at the Sea-Bathing Infirmary. He returned quite well, and re-entered the service of his former

master.

REMARKS.-This case, while illustrating the remedial virtues of chlorine, also shows the pernicious effects of the abominable system of over-depletion. The symptoms which at first characterized this young man's illness evidently denoted it to be influenza, a complaint well known to be unaccompanied by inflammatory action; and hence the use of the lancet was both uncalled for and highly reprehensible. To bleed in influenza, more especially in old and debilitated subjects, is, I firmly believe, in most instances, to kill. The blood is, as Harvey describes it, the "primum vivens," and “ultimum moriens,”—the life of every part depending upon it. All the phenomena of life tend to prove this. Increase the circulation to the acme compatible with health, and increase animal power; diminish it, and you diminish animal power; abstract the whole of the blood, and you destroy life.

you

Recollecting, then, the loss of blood and sensibility produced by the withdrawal of this life-dispensing stream, the practitioner cannot be too cautious in prostrating the system by this dangerous plan of treatment; for by it, as I have too often witnessed, the most painful nervous irritability is produced, which counteracts the very end in view (more especially in consumption), by relaxing that which was already, most probably, too relaxed, and rendering the constitution more delicate, and more incapable of contending with the trying vicissitudes of this changeable climate, and frequently depriving remedial measures of all their efficacy. Local bleeding, by means of small relays of leeches, may be sometimes employed with great advantage in chronic inflammation; but in cases of extreme debility, from long-continued

disease, I have seen even that small loss of blood attended with bad consequences.

Much of the success which has attended my treatment of consumptive cases is to be attributed to having avoided depletion, debilitating medicines, or any measures calculated to impair the vital principle or power.

;

CASE V. CONSUMPTION.-A young man, a publican, aged twenty-seven, of naturally good constitution, but much broken down by intemperance, consulted me, November 2nd, 1836. It appeared that he had suffered for the last nine months from cough, shortness of breath, and pains at the chest; and that, having caught a severe cold by exposure to the night air, the cough had, within the last few days, much increased, and caused him suddenly to bring up half a pint of blood. Being alarmed at this new symptom, he sought my advice. Although complaining for so long a period, he had not placed himself under medical treatment, but had resorted to those injurious nostrums with which our newspapers abound. He was now much wasted in flesh; very pallid, with occasional hectic flushes; the countenance anxious, with a peculiar wild expression of the eye; pulse 100; animal heat, 103° breathing short and painful; night perspirations; copious expectoration of purulent matter, streaked with blood; the sound, on percussion, very dull on the upper part of the left side; pectoriloquism at the apex of the right lung, with a cavernous sound, demonstrating the existence of an ulcer; and, from the second rib downwards, a crepitating rhoncus was perceptible. I prescribed inhalations of iodine and belladonna; a vesicating liniment to the chest; and a mixture composed of gallic acid and Battley's sedative solution of opium. Under this treatment, the difficulty of breathing and cough were relieved, and the spitting of blood quite removed. A combination of steel with quinine was now administered, in conjunction with the inhalations; and, at the end of five weeks from the commencement of the treatment, the patient had so much improved that he declared

« ՆախորդըՇարունակել »