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the liver be not counteracted by the efforts of the constitution itself, never fail eventually to increase the mischief. The only effectual means are those which restore this organ, which is only to be here attempted by such as suit the debilitated state of the patient. "In many instances it may be effected by a few grains of the blue-pill, taken every second night, and gently carried off by the bowels on the succeeding morning, combined with means which prevent the return of the febrile symptoms, and such stimulants as the patient can bear without any tendency of this kind, or any increase of the restlessness and oppression. In the more obstinate cases such means fail; and then I know of none which will succeed, except the substitution of the minute and frequently-repeated for the occasional larger mercurial doses, combined with the other means just mentioned, and regulated on the principles I have explained. The existence of such a case as that I am describing is, I believe, always the effect of the state of the liver having been overlooked in the course of the fever; and its frequency points out in a striking manner the necessity of attending to the state of this organ in all diseases of prolonged excitement." (P. 100.)
The disorder of the liver here adverted to is, no doubt, a frequent cause of the protraction of fever: as far as we have observed, however, quite as common a cause of such protraction consists in irritation of the mucous membrane of the bowels, kept up by the injudicious use of purgatives. We have seen fever kept up for days, nay, for weeks, beyond its natural duration, by purgative medicines, given for the purpose of keeping the bowels regular. Let these be relinquished in favour of laxative enemata, should such be required, and the patient will very often become rapidly convalescent.
Dr. Philip has made an allusion to the use of minute doses ⚫ of mercury in chronic functional derangement of the heart, to which much attention is due. The case of Mr. Hobson is cited, which was published by that gentleman himself, in the Medical Gazette for the 22d of October, 1831.
"Mr. Hobson had for thirty-four years laboured under symptoms of diseased heart, to which all the powers of the constitution were yielding. He had become pale and oedematous, with habitually oppressed breathing, which in a great degree incapacitated him for all active duties, and rendered him subject to frequent attacks, that immediately threatened his life. Being a medical practitioner of the metropolis, he of course had the advice of many, and those the most skilful, and was regarded by all as labouring under confirmed organic disease of the heart; so that no attempt was made but with a view to present relief, and he had not for some years left his house without his name and address in his hat, fearing that he might not return alive. I was led from many circumstances, notwithstanding the severity and long continuance of the symptoms, to regard the affection of the heart as chiefly sympathetic. The function of the
liver was always more or less, and occasionally much disordered; and several of the symptoms led me to believe that if organic disease of the heart did exist, it was not in sufficient extent to cause the effects 1 witnessed. For many months he steadily pursued the plan of treatment which I have laid before the reader, taking half a grain of blue-pill three times a day, combined with such means as tended to restore the digestive organs, and relieve the occasional more severe attacks. This plan had not been continued for many weeks before symptoms of amendment appeared, and in the course of a twelvemonth I had the satisfaction to see him relieved from every symptom of diseased heart. His colour became healthy, the dropsical swellings left him, and he was restored both to the appearance and functions of health.” (P. 110.)
Our author adds, "I could mention several similar cases, though of less continuance; in one of which the symptoms of organic disease of the heart were quite as strongly marked, and which, after a continuance of many years, yielded as perfectly to the same means."
On the whole, we could have wished that a practical subject, like that treated of in the present publication, had been considered in a more practical manner. The truth is, that, extraneous matter apart, all that Dr. Philip had to say might have been very well communicated in a few pages of a journal, in which perhaps it might have found as appropriate a place as in a separate treatise.
Cases illustrating and confirming the Remedial Power of Inhalation of Iodine and Conium in Tubercular Phthisis, and various Disordered States of the Lungs and Air-Passages. By Sir CHARLES SCUDAMORE, M.D., F.R.S., &c. Second Edition.London, 1834. 8vo. pp. 227.
Or the occasional usefulness of inhalation in diseases of the lungs, we, in common with all who have witnessed such experiments, have no doubt; but the general testimony in favour of the practice is by no means so enthusiastic as that borne by Sir Charles Scudamore. Unprejudiced and competent judges still testify its utter inadequacy to do more than allay irritation in some cases; while in others it has proved a source of excitement that has been found highly injurious, and by no means controllable: in the majority of instances, however, its inertness in respect of permanent effects has been demonstrated to a degree deterring from repetitions deemed useless. "The rationality of applying some remedial agent in a direct manner to the seat of diseased action, in certain conditions of pulmonary and bronchial disease, has been admitted and acted upon for many past ages." many past ages." Thus says the
author: to whom it may be replied, that the difficulty of producing any enduring and beneficial effects has been admitted and acted upon for a good part of that time. In some bronchial affections, the advantages obtainable by such agents may reasonably be hoped for to a greater extent than in tubercular excavations of the lungs; for in those cases the disorganization, if any, is rarely to an extent incompatible with the patient's existence. While, in the cavernous ulceration of tubercular phthisis, the mischief is seldom confined exclusively to the cavity. Do we not continually see tubercles in every stage, from the miliary one to maturation, complicated with other diseases of the respiratory organs? There is no greater mistake, and no one more frequently committed, than the losing sight of the fact that phthisis is not merely a local disease. The tendency of this error may have retarded our advancement in the methodus medendi of this reproach to our art, which suffers as much from its supposed infallibility by one sect, as it does from the ignorant scepticism of another.
To many readers, Dr. Scudamore's formulæ for inhalation will be acceptable.
"As, by mixing the tincture of iodine with water, the iodine itself separates into flakes which become precipitated, and as 7000 parts of water are required for its solution, I found it expedient to form a preparation which should be uniform, and preserve its transparency when united with water in any proportions. This admixture is effected by adding together iodine, hydriodate of potash, distilled water, and alcohol. The following is the formula which I prefer on commencing with the tincture of iodine inhalation:
"I found it expedient to use the smallest proportion of the bydriodate which would serve the purpose of rendering the iodine soluble, and not enough to engage much of the iodine itself. addition of the tincture of conium is important; as, together with its distinct operation as a sedative, it softens the action of the iodine; and this property of diminishing the sharpness of the iodine, during the process of inhaling, is more effectually produced by the previous combination of all the ingredients; but the mixture should not be long kept, as in that case the iodine would undergo considerable change, and its power become too much reduced.
* "A saturated tincture."
Also, when it is desired to have the iodine solution in the most active state, the conium, if mixed with it at all, should be added only at the time of using the inhalation.
"The following are the other medicinal substances which I have used for the purposes of inhalation:
'A saturated solution of pure chlorine gas in distilled water. "A saturated tincture of stramonium, prepared from the dried leaves and stalks.
"A saturated tincture of belladonna, prepared from the dried leaves.
"A saturated tincture of the lobelia inflata.
"A spirituous tincture of ipecacuanha, prepared from the roots. "A saturated tincture of digitalis.
"Hydrocyanic acid, of the specific gravity ·992. "The pure sulphuric æther." (P. 8.)
The following observations are judicious:
"For the relief of severe pain I should give tincture of opium, or the powder or extract, to a patient with whom opium did not disagree, in preference to any other preparation; having most reliance on all the properties of opium combined, where I wish to prescribe this medicine as an anodyne. We well know also in how remarkable a degree great pain modifies the effects of opium; so that an individual who would be disordered in the most inconvenient manner by opium, if taking it for the purpose of procuring sleep, could have recourse to it in free doses, with every good result, when using it as a remedy for severe pain." (P. 52.)
Ignorance of these points well explains the odium which opium often unjustly incurs for "disagreeing." Numerous opportunities and ample observation have convinced us that opium never produces any but the best effects, when administered in efficient doses for the relief of severe pain, or as an auxiliary to bloodletting in inflammation.
We copy one of the cases added in the present edition, as a fair sample of our author's style and method of treatment: "CASE III. Very irritable cough; much soreness of the larynx on pressure, and which, in conjunction with the nature of the expectoration, rendered it probable that there was ulceration of the mucous membrane.
"A lady, aged fifty-six, of slight figure and delicate constitution, had been out of health for two years, occasionally affected with an intermittent, and always complaining of much debility. She caught a severe cold; this was speedily followed by cough, which fixed itself in a very troublesome manner. I found her complaining of much soreness and tenderness to pressure on the larynx, just below the thyroid cartilage. She stated that her troublesome cough had continued, without relief from any treatment, for six months. Eight blisters at least had been applied over the affected part, and
various medicines administered. Every afternoon, at about the same hour, a paroxysm came on of incessant cough, attended with the most remarkable difficulty of breathing, suspending the power of all bodily exertion; and this state of suffering continuing till evening, she was rendered absolutely prostrate with languor. She had a quick, weak pulse. Her nights were restless, and, towards the morning, perspiration was considerable. There was much expectoration, of decidedly purulent appearance, frequently mixed with blood; and the tests which I employed convinced me of the fact of purulent secretion. I thought that there was strong evidence of an ulcerative process having been established in the mucous membrane of the trachea.
"I directed, at first, an inhaling mixture composed of the saturated tincture of conium, tincture of ipecacuanha, and hydrocyanic acid; of the first medicine thirty minims, of the second twenty, and of the last two, for each inhalation, adding two of the hydrocyanic acid, for the latter part of the process; this agreed perfectly and was useful. After a few days, having more confidence in the curative agency of the iodine than any other remedy, and as the tracheal irritation was diminished, I did not delay longer the trial of the compound iodine mixture as at p. 9. Of this, 3iss. was, as usual, divided into two doses, and this was used three times a day. It was gradually increased to five drachms for each inhalation. She considered that the blisters weakened her without rendering her any countervailing benefit. I applied the cantharides solution (p. 90,) with an excellent effect, and it was repeated occasionally. I prescribed the sarsaparilla mixture with alkali to be taken with milk, and this was afterwards changed for the sulphate of quinine draught. Acetate of morphia was given at night, in small doses, with great advantage. The diet was supporting, and the dinner beverage consisted of port wine and water, or sherry and water, as she might choose. The case prospered from the first moment. The inhalation invariably agreed, and the occasional aggravation of cough during the process was fully compensated by the increased freedom of expectoration, and the subsequent comfortable relief of the cough and the breathing. The appearance of the expectoration gradually improved, and at the end of two months the cure was complete.
"Observations. It is probable that practitioners not acquainted with the useful properties of the iodine and conium inhalation, would have apprehended injurious irritation from the direct application of this stimulant; but I entered on the treatment with confidence, and happily was not disappointed by the result. This lady had so much despaired of relief, from the failure of all previous means, that she had almost resolved to avoid any new measures, when I was consulted. The direct action of the iodine changed the function of the mucous membrane of the trachea, and induced healthy action. If not in a state of actual ulceration, it was bordering on this condition. The effect of the liquid preparation of