The practitoner's handbook of treatment, or, The principles of therapeutics

Front matter

THE PEACTITIONER'S

THE PEACTITIONER'S

HANDBOOK OF TREATMENT;

Preface To The Second Edition

The comparatively brief time wliich has sufficed to exhaust a large edition of this work proves that it has been found acceptable by the profession. The London Medical Record said, "a work of this kind has long been urgently wanted " ; and the perusal of a systematic treatise on the Principles of Therapeutics will enable the student, all the more thoroughly and with advantage to himself, to study the works of Sidney Ringer, and H. C. Wood, Such a treatise gives him the broad lines upon which he must proceed in his therapeutic efforts; — the basis upon which he can rear a superstructure that will embrace minutiae, the importance of which may not be very comprehensible viii PREFACE.

without such underlying basis. The practitioner can compare his own practice with the lines here laid down, and note the points of agreement.

This rapid sale further demonstrates that nonteaching hospitals may be made, useful beyond their own immediate precincts.

In teaching hospitals, the energies are necessarily mainly bent towards teaching students the elements of diagnosis : where no students are present, the energies can be devoted to the study of each case from its therapeutic point of view, and the treatment of the patient be the main thing aimed at. That the experience so acquired may be made to have far-reaching consequences, the sale of this work here, and still more in the United States of America, amply testifies.

Some additions have been made to the matter in this edition, as, " When not to give Iron," " The Functional Disturbances of the Liver," "The Means of acting on the Respiratory Nerve Centres," "The Reflex Consequences of Ovarian Irritation," and

PREFACE. ix

"Artificial Digestion," which it is hoped will add to the practical value of the work.

The author begs to record his thanks to Henry Sewill, Esq., for some remarks on " the Hygiene of the Teeth " ; to Professor Austin Flint for his permission to reprint, verbatim, his remarks on " The Professional Conduct of Physicians," in his recent work on Clinical Medicine. These additions, it is hoped, will add to the practical value of the work.

His best thanks are also due to Dr. H. G. Orlebar for his friendly supervision of the proof sheets.

I

Preface To The First Edition

This work is not an imperfect Practice of Physic, but an attempt of original character to explain the rationale of our therapeutic measures. First the _ physiology of each subject is given, then the pathology is reviewed, so far as they bear upon the treatment ; next the action of remedies is examined ; after which their practical application in concrete prescriptions is furnished.

It is not essayed to give prominence to new remedies or new therapeutic measures, so much as to analyze and elucidate the modus operandi of the measures in common use. It is designed to furnish to the practitioner reasons for the faith that is in him; and is xii PREFACE.

a work on medical tactics for the bedside rather than the examination table.

For nine years the writer has been labouring with the definite design of producing the present work. In consequence of its original character much diJB&culty has been felt from want of some guide to indicate, not so much what to insert, as what to leave out and where to stop. A certain amount of repetition has been found unavoidable ; but the plan of Sections has been adopted to reduce this to a minimum. It is perhaps impossible to generalize broadly, and yet to be accurate in minutige : nevertheless the writer trusts that general principles have here been demonstrated without any violence to facts.

For advice and suggestions how to improve the work in future editions the writer will look to his critics, adverse as well as friendly — each alike valuable to him whose aim is strictly to advance knowledge.

The writer must here express his thanks to the Journal Committee of the British Medical Association

PEE FACE. xiii

for their kind permission to reprint sucli portions of tliis work as have appeared as leaders in the British Medical Journal.

He must also acknowledge his indebtedness to Dr. Lauder Brunton, F.E.S., for much friendly counsel ; to Sir Joseph E'ayTer, K.C.S.I., and to Surgeon-Major A. R. Hall, for information on matters more especially connected with India ; and lastly to Mr. Herbert Page for revision of the manuscript, and to Mr. E. 0. Bark for his co-operation in the correction of the proof-sheets.

I

i

Introduction

SKCT PAOE

1. The present position of therapeutics 1

2. Medicine as a science and an art . . ..... 2

3. The transmission of knowledge 4

4. Man as a man ; and as an individual ....... 6

5. Individual peculiarities 7

6. Systemic impairment from bad environment. — Imperfect organisms . 9

7. Health a balance of parts 11

8. Sequences in medical measures. — The building of a prescription . . 13 .

9. Combined prescriptions 15

10. Adjuncts 17

11. Hygienic arrangements (accompaniments) . . . . • .18

12. Dietetic arrangements (accompaniments) .19

13. The choice of remedies 19

Chapter II, A S ,s I M I L A T I 0 N

14. The necessitj' for physiological knowledge, — Forms of food ; thek desti-

nation .21

15. The effects of saliva ; of the gastric juice ; of pancreatine. — Intestinal

absorption. — The function of the liver 22

16. Sialagogues 25

17. Digestion, — Artificial aids.— Pepsine . . . . . . .26

18. Stomachics. — Alkalies. — Bitters ........ 27

19. Action of the pancreas. — Effects of ether. — Pancreatic emulsion . . 31

20. Intestinal action. — Purgatives ........ 32

21. Hfcmatics, — Lime. — Iron. — Combinations. — Specifics in .specific anaemia 33

22. Value of water. — Dilution, — Tissue. — Bathing. — Mineral waters . . 38

23. Tonics— mental, material. — Aromatic astringent. — Combinations of . 40

24. Change of air, — Cold water 44

When not to give Iron ......... 46 xvi

CONTENTS.

Chapter III, Excretion

SECT.

25. Characters of waste matters. — General excretory action of the surface. — Specialiiiation of parts during evolution. — Community of function in excretory organs 52

26. Tissue-growth a form of excretion

27. Compensatoi-y action of organs 57

28. The lungs and skin. — Cutaneous respiration. — Skin and kidneys. —

Urea in sweat. —Urfemic dian-hoea 59

29. Treatment of urwma 62

30. Effects of compensatory activity on the organs so engaged ... 64

31. Ana3mia from imperfect excretion. — Specific haematics . ... 65

32. Compensatory excretion of bile. — Lactic acid . . . . .67

33. Alteratives.- — Mercury. — Arsenic. — Iodine 69

34. Use of alteratives. — Hydropathy 72

Chapter IV

35, Glycogen, — Heat production. — Heat loss. — Regulation of body temperature , . 77

36. Normal temperature 80

37. Collapse temperature ; its treatment. — Catching cold . . . . 81

38. Febrile temperatures. — Fever. — The typhoid condition ... 84

39. Effects of high temperature on tissues . ...... 86

40. Effects of high temperature on the brain ...... 89

41. Treatment of the typhoid condition. — Apyretics. — Acids. — Salines. —

42. Depressants. — Antimony. — Aconite. — Veratrum. — Action of alcohol as

43. Quinine, and digitalis 100

44. Cold in various foi-ms. — Jaborandi ....... 103

Chapter V. Inflammation : Its Varieties

45. "What is inllammation ? as a morbid process ; as a means of cure. —

Excessive nutrition , . . . . . . . . .108

4G. The inflammatory jwocess. — Means of controlling it. — Vascular depressants Ill

47. Treatment of the stage betwixt the inflammatory rise and convalescence.— Therapeutic and dietetic management .... 114

CONTENTS.

xvii

SECT. PAOB

48. Calomel and opium. — Local applications .

49. Convalescenco ; its management .

50. Asthenic inflammation ; its treatment

51. Specific inflammations and their management

52. Tarenchymatous inflammations ; their course

53. Their treatment

54 Inflammatory products ; their indications .

CHAPTER VI. ANiEMIA.— PLETHORA. — CONGESTION

55. Ansemia ; its forms and associations ........ 133

56. Indications for treatment 136

58. Plethora ; its causal associations . . . . . . . .139

59. Therapeutic indications. — Dietetic measures.— Purgation . . . 142

60. Congestion ; its forms and causes 146

61. CEdema ; its' causation in relation to treatment ..... 151

118 120 124 127 129 130

Chapter VII. Uuowth And Decay

62. Disturbances of growth. — Dentition ....... 152

63. Troubles of digestion. — Infantile remittent fever . . . .166

64. Bronchitis in children. — Colds 168

65. Imperfect tissue growth. — Oil inunctions. — Struma. — Tubercle. — Syphi-

lis.— Indications for management . . . . . ... 159

66. Decay. — Senile decay ; its oucome and pathology .... 164

67. Indications for treatment. — Diet. — Alcohol. — Clothes .... 167

68. Nutrition, nervous and vascular 170

69. Fatty degeneration 172

70. Rheums 174

Chapter VIII. Abnormal Growths

71. Never truly heteromorphic.— Hypertrophy, or Hyperplasia— Dilatation

of the heart and hypertrophy 178

72. Connective tissue, normal and abnormal 181

73. Pathological but perfect connective tissue , , . . . .188 FO. ■ ' I

CONTENTS.

SKCT. PAOB

74. Dogi-ailod connective tissue. —Tubercle 184

75. Progress of tubercle. — Eelations to treatment 187

76. Importance of fat. — Food. — Cod-liver oil. —Climate .... 190

77. Hectic fever ; its treatment. — Effects of rest. — Preventive measures . 194

78. Malignant connective tissue. — Cancer; its varieties .... 203

79. Therapeutic indications 204

Chapter IX. Blood Poisons. — Specific Poisons

80. Nature of Wood poisons ; effects of 207

81. Remedial agents ; their action. — Antiseptics 210

82. Specific poisons. — Malaria ; its seat ....... 212

83. Quinine ; how to be given. — Malarial dysentery. — Ipecacuan . . 214

84. Cholera ; its nature and treatment . . . . . . .218

85. Specific fevers ; their general management ...... 219

86. Special points to be attended to 220

87. Diphtheria ; its indications ........ 222

88. Influenza ; its treatment 222

89. Dengue.— Yellow fever 223

90. Pertussis. — Treatment ......... 223

91. Erysipelas; its forms : their management 224

Chapter X. Acute And Chronic Disease

92. Acute disease. — The shock of pain. — Its treatment .... 226

93. Haemorrhage; its management.— Other discharges ; their treatment . 229

94. Syncope ; its treatment — Asphyxia ; its management . . . 232

95. The theory of stimulants .234

96. Circumstances modifying the action of stimulants. — Secondary effects

of excessive stimulation ........ 237

97. Medicinal stimulation ......... 238

98. Alcohol as a food ; its other actions ; its use in convalescence . . 239

99. The relations of acute and chronic disease. — Acute disease becoming

chronic ; its indications . . . . . . . .244

100. The balance of parts in power as well as in function ; in chronic

disease, and in convalescence 248

101. Chronic disease becoming acute . ....... 250

] CONTENTS. lix CHAPTEE XT.

DIABETES. — RHEUMATISM. — GOUT.

PAOE

102. ' Diabetes ; its origin ; fomis of; relation to Bright's disease . . 253

103. Treatment— hygienic, dietetic, and medicinal . . • ■ .206

104. Klieumatism ; what is it? 258

105. Acute rheumatism.— Principles of treatment.— After-management . 260

106. Chronic rheumatism.— Therapeutics of, general and local . . .263

107. Gout.— Lithiasis ^ • • -267

108. Origui and manifestations ' • • •

109. Treatment of lithiasis 272

110. Suppressed gout ; its management 2/6

111. Eheumatic gout 278

CHAPTEE XII.

DIATHESES AND CACHEXIA.

112. The constitution ; its outward indications.— Physiognomical diagnosis 280

113. Diatheses; their influence over ailments 284

114. The gouty diathesis 284

115. The nervous diathesis 285

116. The strumous diathesis 286

117. The bilious diathesis 289

118. The lymphatic diathesis . . 290-

119. The haemorrhagic diathesis. — Blends 291

120. Cachexia. — The sypliilitic cachexia ; its importance in treatment . 292

121. Lead-poisoning 294

CHAPTEE XIII.

ACTION AND INACTION.

122. Forms of neurotics ; their action 297

123. Opium ; its action on different centres ; on the vascular system ; on

the nervous system ; in the relief of pain ..... 299

124. ESect on motor and secretory actions . . . . . . 300

125. Hydrate of chloral 305

126. Bromide of potassium 307

127. The use of these several agents ... ..... 309

128. Astringents; their combinations with sedatives . . . . .311

129. Inaction. — Belladonna. — Cannabis Indica 814

130. Quinine and strychnine ; their use ....... 316

131. Combination of neurotics in ju-actico , . ... . . 319

1 32. Irritation and counter-imtation. — External use of sedatives . . 322

XX

CONTENTS.

CHAPTER XIV.

THE CIRCULATORY SYSTEM.

133. Groups of maladies 323

134. Blood pressure ; effect of agents upon 328

135. Compensatory cbanges in valvular lesions ...... 329

136. Cardiac faUure 332

137. Treatment of cardiac adynamy. — Rest and removal the causes of

irritation 333

138. Cathartics. — Diaphoretics.— Diuretics. — Hot poultices . . . 334

139. Means of acting directly upon the heart. — Digitalis ; its action and its

use 336

HO. Apparent objections to its use explained. — The so-called " cumulative

action " 337

141. Relief of consequential ailments.— Dropsy. —Diuretics ; their action ;

combinations of 340

142. The dietary 341

143. Secondary affections of the heart. — Angina pectoris ; imperfect forms

144. Neui-osal affections of the heart. — Palpitation ..... 346

145. Ansemic disturbances ......... 351

146. IiTitable heart . .353

147. Importance of accurate diagnosis in treatment ..... 354 147a. Aneurysm ........... 355

CHAPTER XV.

THE RESPIRATORY SYSTEM.

1 48. Respiration, in relation to disease ; to mechanical irritants ; to temperature.— Catarrh . . . . . . . . .357

149. The treatment of catarrh 360

150. Affections of the air-tubes. — The theory of expectorants. — Forms of

bronchitis. — Its treatment 362

151. Bronchitis and asthma ......... 368

152. Affections of the lung stracture.— Pneumonia ; its management. —

Asthenic pneumonia 369

163. Localized pneumonia. — Nutrition 371

154. Treatment, general and special ........ 374

155. Broncho-pneumonia . 375

156. Affections of the serous coverings. — Pleurisy ; its management . . 376

157. Pleuritic effusion ; its treatment 378

158. Cough ; its varieties and their treatment 378

159. Dyspnoea, forms of, and treatment 383

160. Hcemoptysia 384

CONTENTS.

xxi

CHAPTEE XVI,

THE DKiKSTIVE SYSTEM.

SECT. PAOE

161. Dyspepsia, how occasioned 387

162. The theoiy of emetics, direct and indii'ect 393

163. Food in gastric afifections. — Medicines. — Opium, in bulimia. — Alkalies.

— Bismuth. — External applications ...... 393

164. Points in diet. — Distant irritation 397

165. Liver affections. — The action of mercury. — Superfluous bile . . 399

166. Tropical biliary disturbances (Sir Joseph Fayi-er's remarks). — Intes-

tinal acidity of Prout . . . . . . . . .411

167. Constipation. — Purgatives — gentle, cathartic; points in each. —

Mercury 413

168. Purgatives in intestinal stricture, in the aged, and at the menopause.

— Purgative waters ......... 416

169. Diarrhcea ; its varieties and their treatment. — From irritant matter:

— From a chill. — Catarrhal. — Dysenteric. — Nervous. — Keflex. — From portal congestion. — Tubercular. — Urpemic diarrhoea. — Colliquative.— Thermic . . . . . . . . .419

170. Enteritis. — Opium in 426

CHAPTER. XVII.

THE URINARY SYSTEM.

171. Function of the kidneys. — Formation of urea. — Effects of sustained high functional activity 428

173. Diuretics. — Hydrogogue diuretics.— Simple diuretics. — The use of each 431

174. Acute nephritis ; its treatment . . . . . . , . 434

175. Albuminuria ; its management 436

176. Blight's disease (chronic) . . 439

177. Its treatment. — Action of the skin 443

180. Picniedial measures .......... 448

181. In valvular disease of the heart 45O xxii

CONTENTS.

CHAPTER XVIII.

THE hepkoductive system.

SECT, PAGE

183. Importance of the ailments of women 453

184. In relation to the nervous system 454

185. Anaphrodisiacs 455

186. Blenorrhagia in both sexes. — Its management 457

187. Puberty in girls. — Points in practice 459

189. Araenorrhoea ; its forms, their treatment ...... 468

190. Menorrhagia ; its varieties and treatment 469

191. Dysmenorrhoea 474

CHAPTER XIX.

THE CUTANEOUS SYSTEM.

192. Function of the skiu. — Diaphoretics and anhydi'otics . . . . 476

193. Skin diseases ; their causation and general management . . . 482

194. Their relations to the stomach, uterus, liver, and kidneys . . . 484

195. Sypliilidfe.— Their treatment 487

196. Neurosal skin affections ......... 488

197. Injuries and parasites. — Their treatment . . . . . .489

198. Corns.— Warts 491

199. Ulcers. — Principles of treatment 492

Note. — Foetid feet.

CHAPTER XX.

THE LYMPHATIC SYSTEM.

200. Its distribution and function 495

201. Theory of absorbents. — Iodine. — Mercury. — Their applications in

practice 497

202. Intiammation of the lymphatics 601

203. Glandular .suppuration 502

204. Inflammations of the lymph spaces (serous sacs). — Their treatment . 602

205. Passive accumulations 605

CONTENTS.

xxiii

CHAPTER XXI.

THE NERA''OUS SYSTEM.

SECT. PAGE

206. Importance of accurate diagnosis. — Anatomical ari'angements of the

blood supply 506

207. Hyperemia. — Its treatment 509

20S. Vascular cerebral hyperffimia. — Its management . .... 511

209. Cerebral anremia. — Points in practice .... . . 513

210. Local cerebral aneemia. — Vaso-motor arrangements .... 515

211. Insomnia. — Its management ...... . 517

212. Delirium. — Its varieties, — Their treatment. — Moral management. —

Eemedial measiu'es ......... 531

213. Headache, forms of — Their treatment ...... 633

214. Cerebral paralysis. — Indications in each case . ... . . 535

215. Sunstroke.— Treatment of . 637

216. Affections of the spinal cord. — Varieties of. — Treatment of each . 638

217. Epilepsy. — Its production and treatment. — Night-terrors . . . 539

218. Chorea.— Its forms 543

219. Hysteria. — Its varieties and their management ..... 544

220. Neuralgia.— General lines of treatment 546

Electricity. — Its use .......... 549

The therapeutic instinct 549

CHAPTER XXII..

PUBLIC AND TRIA'^ATE HYGIENE.

221. Public hygiene. — Its importance 561

222. Our houses. — ^^Ventilation 552

223. Water. — Effects of impure water 554

224. Sewage. — Sewerage. — Earth closets 555

225. Pythogenesis. — Disinfection. — Sewer gas.— Special disinfection . . 557

226. Infection.— Medical men. — Nurses 661

227. Fever hospitals, cottage and other , 563

228. Private hygiene. — The healthy and the sick 664

229. Bathing resorts 567

230. Mineral waters. — Their varieties and uses . . , , ' , , 569

231. Baths. — Cold, warm, hot, sand, mud, peat, &c 572

232. Health resorts. — For the consumptive 574

233. Change of air in India (Sir Joseph Fayrer) 578

234. Change of air in America — Tours 683

XX iv

CONTENTS.

CHAPTER XXIII.

FOOD IN HEALTH AND IN ILL-HEALTH.

SECT. _ Pjins

235. Respiratory and plastic foods. — Nitrogenized food .... 585

236. Hydrocarbons. — Force-producing material. — Effects of foods. — Forms

of diet 588

237. The relations of food to disease. — Bautingism . . • . . 594

238. The diet in lithiasis 596

239. In combined lithiasis and diabetes ....... 699

240. Drinks. — Milk, beef-tea, rice-water, &c 601

241. As stimulants 604

242. As beverages. — As water 606

243. As a means of affecting temperature 608

244. Diet cures. — Grape, strawbeiTy, milk, whey, and koumiss cures. — Sub-

stitutes for milk. — Artificial digestion ...... 609

CHAPTER XXIV.

CONCLUSION. — THE MEDICAL MAN AT THE BEDSIDE.

245. The examination of the patient 615

246. What to observe 622

247. The manner of the examination . 623

248. Our social conduct 625

249. The natui-al history of disease 628

250. As instanced in the relation of Bright's disease to the circulation . 631

251. To be fore-warned is to be fore-armed ...... 634

252. The future, and our duty 636

THE

PRACTITIONER'S HANDBOOK OF TREATMENT.

§ 1. The ultimate aim of all medical research is the treatment and prevention of disease. It is eminently desirable .that a medical man be generally well-informed ; but what is to be still more devoutly wished for is that he shall be a skilful practitioner. It is quite possible to be the one without being the other. The combination is what we hope to see commonly accomplished. The tendency of recent teaching has been rather to produce the first, leaving the second quality to develop itself, or to remain in a condition of imperfect evolution, as might fall out. This is not an individual opinion, in which case it would have little weight, but a general comment. We constantly hear it asserted that the highly-educated medical men of the present generation are not more successful in practice than their less accomplished but more practical predecessors. Even members of the profession are to be found who assert that the man under whose treatment they would place themselves, if seriously ill, is the old-fashioned general practitioner. This is a very serious reproach to all our recent advances in scientific medicine ; to our modern instruments of precision in diagnosis ; and even to our progress in rational therapeutics, with the remedies added to our armamentarium in late years.

FO. B