A concise and practical treatise on the principal diseases of the air-passages, lungs, and pleura

Front matter

CONCISE AND PRACTICAL TREATISE

ON THE

PRINCIPAL DISEASES

Preface

A concise treatise on the principal diseases of the Air-passages, Lungs, and Pleura, has been long considered a great desideratum. To stop, therefore, this gap in the medical literature of the country, I have taken up my pen, and trust that my labour will not be deemed by the profession, and the public generally, as wholly misspent.

In carrying out this design, I have endeavoured, in every instance, to adapt the language to the comprehension of the non-medical reader, and, as far as possible, to arrange the various subjects, so that they may be most easily understood, compared, and referred to.

In some few instances it will be seen that I differ in opinion from the distinguished inventor of the art of auscultation, in re-

VI

PREFACE.

ference to the value of certain local signs as a means of diagnosis ; and it will be also observed, that I consider Laennec's explanation of the phenomenon of bronchophony as totally incorrect.

When speaking of the remedies suitable for each disease, I have thought it advisable to append a few formulae, being fully convinced of their great practical importance.

21 Charles Square , Hoxton,

October ls£, 1841.

Chapter I. Catarrh

PACE

Definition. — Divisions into, ]. Acute Mucous Catarrh ; 2. Chronic Mucous Catarrh; 3. Acute Pituitous Catarrh;

4. Chronic Pituitous Catarrh ; 5. Dry Catarrh ; 6. Whooping-Cough, or Spasmodic Catarrh.

Acute Mucous Catarrh, Frequency of — Anatomical Characters— General, Functional, and Local Signs — External Causes : Cold, Moisture with Cold, Miasm, Noxious Gases, Impalpable Powders — Predisponent Causes — Treatment: Hot Spirits and Water, Vapour Bath, Emetics, Purgatives, Diaphoretics, Expectorants, General and Topical Blood-letting, Vesicatories, Mercury— Diet 1

Chapter I. Peripneumony

PAGE

Preliminary Observations — Anatomical Characters ; 1st Stage, Engorgement; 2d Stage, Hepatization Rouge;

3d Stage, Hepatization Grise; 4th Stage, Abscess of the Lung — Duration of Peripneumony — Resolution of Peripneumony — Part of the Lung most frequently Affected — State of the Bronchial Tubes — General, Functional, and Local Signs — External Causes of Peripneumony — Age — Temperament — Treatment : Blood-letting, Blisters, &c., Calomel and Opium, Potassio-tartrate of Antimony, Digitalis, Mercury —

Diet, &c 75

Chapter II. Gangrene Of The Lungs

Preliminary Observations — Anatomical Characters: Circumscribed Gangrene-; ct. Gangrenous Eschar; /3. Deliquescent Sphacelus ; y. Gangrenous Excavation: Non-circumscribed Gangrene — General, Functional, and Local Signs — Treatment 106

Chapter III. Emphysema Of The Lungs

Preliminary Observations — Anatomical Characters — 1. Vesicular Emphysema; 2. Interlobular Emphysema — General, Functional, and Local Signs — Causes — Treatment Ill

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CONTENTS.

Chapter IV. (edema Of The Lungs

PAGE

Preliminary Observations — Anatomical Characters — General, Functional, and Local Signs — Causes: Eruptive Diseases, Contraction of the Heart’s Aortic Opening, and some other Heart Affections ; Diseases of the Kidneys, Diseases of the Liver and Spleen, Compression of large Venous Trunks, Inflammation of the Cellular Membrane, Debility — Treatment — Diet, &c. 117

Chapter V. Apoplexy Of The Lungs

Definition — Anatomical Characters — General, Functional, and Local Signs — Common Causes — Predisponent Causes — Treatment — Diet, &c 135

Chapter VI. Asthma

Definition — Dry Asthma, Humid Asthma, Spasmodic Asthma, Nervous Asthma — Treatment, &c 142

Chapter VII. Pulmonary Consumption

Preliminary Observations — Anatomical Characters, Susceptibility of various Organs to Tubercle — Duration of the Disease — Age — What Part of the Lungs is first Involved in the Disease? — General, Functional, and Local Signs — Causes, Proximate, Predisponent, and Common Exciting Causes — Does Peripneumony ever give rise to Phthisis? — Is Phthisis Contagious? — Is Consumption Curable? — Treatment — Is it right to Check Diarrhoea in the latter Stage of Phthisis? — Diet — Change of Climate 144

CONTENTS.

XI

Chapter I. Acute Pleurisy

PAGE

Anatomical Characters : False Membranes, Membranous Bands, Fibro - Cartilage, Gangrene of the Pleura — General, Functional, and Local Signs — Double Pleurisy — Occasional Causes — Predisponent Causes — Treatment— Diet 179

Chapter II. Pleuro-peripneumony

Pleuro-Peripneumony, Varieties of — 1. Peripneumony complicated with a slight Pleurisy ; 2. Pleurisy complicated with a slight Peripneumony ; 3. Pleuro-peripneumony,in which both Affections exist nearly in an equal Degree — General, Functional, and Local Signs — Treatment . . 195

Chapter III. Hydrothorax

Hydrothorax, division into — 1. Idiopathic Hydrothorax;

2. Symptomatic Hydro thorax — Anatomical Characters — General, Functional, and Local Signs — Treatment. . 199

Chapter IV. Pneumo-thorax

Preliminary Observations — Anatomical Characters — Causes — General, Functional, and Local Signs — Treatment 202

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CONTENTS.

Chapter V. Pneumo-thorax With Effusion

Preliminary Observations — Signs: 1. Absence of the Respiratory Murmur ; 2. Hippocratic Fluctuation — Treatment

PAGE

ERRATA.

17, line 2, for adopted, read adapted.

40, — 25, for Lezione, read Lezioni.

41, — 22, for Pul vis, read Pulveris.

170, | ~ | for Pareira, read Pereira.

192, — 12, for rib, read ribs.

Chapter I. Catarrh

DEFINITION. DIVISIONS INTO : 1, ACUTE MUCOUS CATARRH ;

2, CHRONIC MUCOUS CATARRH ; 3, ACUTE PITUITOUS CA- TARRH ; 4, CHRONIC PITUITOUS CATARRH; 5, DRY CA-

TARRH; 6, WHOOPING-COUGH, OR SPASMODIC CATARRH.

Acute Mucous Catarrh, frequency of — Anatomical Characters — General, Functional, and Local Signs — External Causes : Cold, Moisture with Cold, Miasm, Noxious Gases, Impalpable Powders — Predisponent Causes — Treatment: Hot Spirits and Water, Vapour Bath, Emetics, Purgatives, Diaphoretics, Expectorants, General and Topical Blood-letting, Vesicatories, Mercury — Diet.

When a mucous membrane is attacked with common inflammation — I say common, to distinguish it from specific inflammation — a catarrhal disease is produced. The word catarrh is of Greek origin.

B

CATARRH.

derived evidently from the verb xccTccggza to flow down, and was originally intended to signify the disease which in ordinary language was called a cold . At the present day it is applied as a generic term to three distinct species of disease ; viz. catarrh of the conjunctiva, of the air-passages, and of the bladder. Its limitation by writers to the diseases here mentioned is unphilosophical, unscientific, and opposed to the principles of physiology, — principles on which nosological classification can alone be advantageously based. What reason, I may ask, is there for calling an inflammation of the mucous membrane of the vagina, leucorrhoea, while an inflammation of the same kind of membrane in the bladder is designated catarrh us vesicse ? — Certainly none. Again, What can be more absurd than Dr. Cullen’s arrangement with respect to diseases of mucous membranes, — diseases which have the closest affinity to each other ? The same sort of answer may be given ; for we find that this celebrated Professor, and those who followed in his wake, placed some of these affections in one class and some in another, apparently without due consideration — certainly without sufficient foundation. How much more in accordance with the present advanced state of science would it be to class diseases according to the nature of the tissue, or peculiar structure which they invade ! Were this plan universally followed, the study of diseases, and the therapeutic means necessary to

ACUTE MUCOUS CATARRH.

be adopted for their cure, would be much facilitated.

Catarrh affecting the air - passages may be divided into the following species : —

4. Chronic Pituitous Catarrh.

6. Whooping-Cough ; or, Spasmodic Catarrh.

Acute Mucous Catarrh . — Of all diseases, catarrh affecting the air-passages is the most common. It attacks persons of every age, even from the cradle to the grave ; both sexes, and all temperaments indiscriminately : those, however, of a bilious habit are, perhaps, more disposed to this variety of catarrh, or the acute mucous, than others. Unlike many other diseases, one invasion gives a predisposition to a second attack, and hundreds of individuals are to be found who suffer from this disease several times in the course of a year ; in fact they “ get a cold upon a cold,” and are scarcely ever quite free from catarrh.

Anatomical Characters . — Redness, more or less diffuse, and swelling of the mucous membrane, constitute the anatomical characters of this disease.

General, Functional, and Local Signs. — Acute mucous catarrh is ushered in by a sensation of

ACUTE MUCOUS CATARRH.

cold, sometimes confined to the back and loins, but more generally diffused throughout the body : in very severe cases, the onset very closely resembles the cold stage of ague ; the skin becomes pale, corrugated, and rough, producing the appearance commonly called “ goose-skin ;* the teeth chatter in the head, and the application of ordinary artificial heat seems to possess but little power in moderating the shivering. The pulse during this stage of the disorder is exceedingly weak ; the debility extreme ; the mind is remarkable for its listlessness, and the eye is dull and without expression. After a time, the sensation of cold gradually subsides, and is succeeded by a glow of heat. The heart beats with more force and frequency ; the temporal arteries throb, and delirium occasionally supervenes. The skin becomes hot and dry ; the mouth parched, and the urine high coloured.

It has been already stated, that every part of a mucous membrane may be attacked with catarrh ; for the convenience, however, of more accurately describing the functional and local signs of acute mucous catarrh affecting the air-passages, the disease may with advantage be divided into the following varieties : viz. Mycteritis, or cold in the head; Cynanche Pharyngea ; Cynanche Tonsillaris ; Laryngitis ; Trachitis ; and Bronchitis.

1. Mycteritis . — When the mucous membrane of the nostrils is examined after the cold stage has

ACUTE MUCOUS CATARRH.

subsided, it is found drier than usual from the suppression of the secretion, swollen, and red. It may be inferred that the mucous membrane lining the frontal, ethmoidal, sphenoidal, and maxillary sinuses, would present the same appearances could they be seen. There is a sense of weight in the head and eyes ; the patient is usually much harassed by sneezing ; the nostrils feel stuffed, and a particular kind of ophthalmia, viz. the catarrhal, is frequently produced. A slight difficulty of breathing supervenes, occasioned by the partial obstruction of- the nostrils, the result of the swollen state of its mucous membrane. After a few hours the skin is bedewed by a gentle perspiration, the heat of the body diminishes, and the nasal secretion, which was either very much lessened or totally suppressed, now flows freely, and is augmented in quantity : it is at first somewhat acrid, but afterwards becomes of a strictly mucous character ; the disease, in fact, gradually subsides, although a slight evening exacerbation and morning remission may be observed for several days.

2. Cynanclie Pharyngea . — In this form of the disease, in addition to the ordinary symptoms, there is a slight difficulty in swallowing, and sometimes a certain degree of deafness, from the swollen state of the inner membrane of the Eustachian tube.

3. Cynanche Tonsillaris . — When the mucous membrane of the tonsils is attacked by catarrh.

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the inflammation is very apt to spread to the glands themselves. If one tonsil be alone affected, deglutition may be but slightly impeded ; if both, it is sometimes rendered impossible from the tonsils touching each other. The swollen state of these glands then becomes almost as conspicuous externally as internally, and the inflammation usually terminates in suppuration; the epiglottis participates in the inflammation, and suffocation becomes imminent. The mucous membrane of the tonsils presents a very peculiar appearance, from its being studded with white specks resembling sloughs, and the tongue is usually covered with a dense fur of a yellowish-white colour.

Laryngitis . — This disease, when violent, is one of the most dangerous in existence, — the danger depending on the small quantity of air capable of being drawn into the lungs by each act of inspiration. Pain is usually felt in the larynx ; it is increased by pressure, coughing, speaking, and deglutition. When the epiglottis is involved in the inflammation, deglutition is performed only with the greatest difficulty, from the impossibility of completely depressing that organ. In some instances the attempt to swallow has proven suddenly fatal. The voice is always much altered in character ; generally hoarse, sometimes reduced to a whisper, and occasionally inaudible or lost. The cough varies much ; sometimes it is scarcely troublesome, at other times it is remarkable for its

ACUTE MUCOUS CATARRH.

severity. As the disease advances, the breathing becomes more and more difficult ; the ordinary muscles of respiration act with greater energy, and the extraordinary ones are called into play. The face assumes a purple or livid hue, and convulsions frequently put an end to the patient’s sufferings.

Trachitis. — In this disease the pain is confined to the middle and lower parts of the neck ; it is never severe, although, like the pain in laryngitis, it is somewhat increased by pressure. The voice is but little altered in character, but the breathing is more or less affected according to the state of the mucous membrane, and to the quantity of mucus in the tube. The stethoscope indicates a mucous rattle, which is entirely confined to the trachea, being inaudible in the lungs even at their very root.

Bronchitis. — The symptoms in bronchitis must vary according as the inflammation attacks one or more bronchial tubes. If one only be inflamed, and that a small one, scarcely any inconvenience will arise ; if, on the contrary, the principal tubes in both lungs suffer, death may ensue. There is usually a feeling of oppression and tightness in the chest, accompanied either by a dull pain or sense of heat. Under the head of Mycteritis it was observed, that when a mucous membrane is attacked with catarrh, the mucous secretion is either much lessened or totally suppressed during the first stage of the inflammation ; and that after-

ACUTE MUCOUS CATARRH.

wards, or during the second stage of the disorder, the secretion flows freely and is augmented in quantity. The same phenomena occur in all the other varieties which we have been considering. The cough is at first dry, tickling, and very troublesome ; on the establishing of the expectoration, however, the tickling and dry character of the cough disappear.

There is, perhaps, scarcely a disease in which percussion and auscultation give more important information than that which at present occupies our attention. Without their employment the nature and extent of the disease cannot accurately be determined, for the general and functional signs are common to some other diseases of the chest ; but with their aid, the signs become unequivocal, and the precise nature of the malady completely revealed.

Absence of the Respiratory Murmur . — On the application of the stethoscope to the chest, an absence of the respiratory murmur may sometimes, to a larger or smaller extent, be perceived. This sign by itself is not pathognomonic, for it occurs in some other diseases of the chest, such as hepatization of the lung, the presence of a tubercular mass, an effusion into the pleura, &c.

On percussing the part where the respiratory murmur is absent, a clear sound is elicited, which demonstrates that the cells of the lungs contain air ; for if a dull sound were produced it must

ACUTE MUCOUS CATARRH.

depend either on the absence of air from the air-cells, or pleuritic effusion. The respiratory murmur can be (in a case of acute mucous catarrh), for the most part, restored by the act of coughing to the parts from which it had disappeared, when the impediment is owing to an accumulation of mucus obstructing the bronchial tubes ; if, however, the absence of the murmur be caused by a thickened state of the bronchial mucous membrane, coughing, of course, will produce no such effect.

Rale Sonore, Rale Sibilant , Rale Muqueux. — The rale sonore and the rale sibilant usually appear very early in this disease, but the rale muqueux only during its second stage. The character of the rale sonore is extremely variable ; sometimes it resembles the snoring of a person asleep ; at other times the cooing of a wood-pigeon, or the sound produced by the fourth string of a tenorviolin ; occasionally a deeper sound is heard, which has been compared to the third string of a violoncello.

The rale sonore, when once completely established, is permanent for a considerable length of time, as it depends either on a tumefaction of the mucous membrane of the bronchial tubes, or an alteration in their form, by which a contraction of their calibre is produced. The degree of contraction may, generally, be pretty fairly estimated by the sharpness or flatness of the sound ; for instance, if the sound be sharp, the tubes them-

ACUTE MUCOUS CATARRH.

selves, or their inner lining, are but little altered ; if, on the other hand, the sound be flat, we may be certain that the change from their normal condition is considerable. Again, the intensity of the sound is found to vary much : it may be so feeble as to be heard only with difficulty, and in the immediate vicinity of its site ; or it may be so loud as to be heard even at some distance from the patient.

When the rale sonore occupies the tubes of both lungs, danger is to be apprehended. The rale sibilant very frequently exists with the rale sonore ; it is heard only at the beginning or termination of inspiration : the character of its sound, like the rale sonore, varies much. It is usually a slight though prolonged hissing sound ; sometimes it is like the chirping of birds ; at other times, the click of a small valve ; and occasionally it resembles the sound produced by triturating an unctuous substance in a mortar. This rale is evidently seated in the smaller bronchial ramifications. The hissing sound was considered by Laennec to be occasioned by a local contraction of the smaller bronchia, from thickening of their inner membrane. The other sounds are probably owing to the presence of a minute quantity of thin and viscid mucus obstructing, more or less completely, the smaller bronchial tubes. When the hissing sound is once fairly established, it usually persists for some hours : the clicking, chirping, and

ACUTE MUCOUS CATARRH.

unctuous sounds are, however, not at all of a permanent character ; for they often appear, disappear, and reappear in the short space of a few minutes, especially after a fit of coughing. Should the rale sibilant occupy the greater part of both lungs, the danger would be imminent, from the small quantity of oxygen which could arrive at the air-cells to arterialize the blood.

The rale muqueux is, in bronchitis, produced by the passage of air through mucus accumulated in the bronchial tubes. It is only heard when the secretion, which was at first suppressed, is again re-established. This rale, like the two former, is subject to great variation ; it may be exceedingly feeble and audible only from time to time, or it may be so loud that it can be heard with distinctness many feet from the bed in which a patient is lying. It is then called “ gargouillement.”

If the mucous rattle be only heard at a few points of the chest, and the sound be feeble, it portends a favourable issue ; if, on the contrary, the “ gargouillement ” supervene, it indicates the greatest danger.

External Causes . — The word “cold,” employed to express this disease, would seem to signify that it always arose from cold. That cold is an occasional excitant cannot, for a moment, be doubted ; but it would lead us to very erroneous notions to suppose that catarrh invariably, or even most frequently, derived its origin from this source : for.

ACUTE MUCOUS CATARRH.

were this the case, the disease, common as it is, would certainly become far more common. If I were asked whether sudden changes from heat to cold, or from cold to heat, were the general exciting causes of catarrh, I should say no ; otherwise men employed in gas-manufactories, glass-houses, and type-founderies, &c., would be the very persons most subject to the disease : there seems, however, very little evidence to prove that this is the fact. Again, the inhabitants of Newfoundland and of some other countries, for example, where in certain seasons the range of the thermometer varies in the course of twenty-four hours from 40° to 50° Fahr., would never be free from catarrh ; while the truth is, the inhabitants of these parts do. not suffer more from catarrhal affections than the natives of regions apparently more favourably located. Once more, how often are the citizens of far-famed London obliged to fly, in the course of a few seconds, from the torrid to the frigid zone ; or, in other words, to leave a drawing-room, heated to nearly 70° Fahr., to occupy a bed-room cooled down, perhaps, to a temperature some way below the freezing point ! As this frequently happens during severe frosts without injurious effects, we are compelled to look for other external causes, the chief of which are moisture with cold, miasm, noxious gases, and impalpable powders.

1. Moisture with Cold . — I should, perhaps, not be far from the truth, were I to assert that moisture

ACUTE MUCOUS CATARRH.

with cold produced not only more catarrhal affections than all the other exciting causes put together, but that they were the chief cause of other inflammatory disorders ; they act evidently by checking perspiration, inducing in this way congestion in internal organs, and at the same time exerting a sedative action on the nervous system.

2. Miasm . — This word is derived from the Greek verb (aiccivu , to pollute, and in medical writings means a subtle poison. Its nature, even in the present day, remains involved in the same profound obscurity in which it was hundreds of years ago ; we can only judge of it from its effects. That it possesses properties varying according to the source from which it derived its origin cannot be denied, for we see that it produces in some, epidemic catarrhs ; in others, typhus fever ; in others, cholera ; in others, ague ; and lastly, in others plague.

The influenza, or epidemic catarrh, which raged in London in the year 1675, and which has been so elegantly and graphically described by the immortal Sydenham, most assuredly arose from a specific poison ; and the same may be said of the epidemic catarrhs which produced such fatal effects in the years 1732, 1762, 1782, 1803, 1834, and 1841. In some respects the miasm giving rise to influenza, resembles the miasm producing Indian cholera ; for instance, it travels in the very

ACUTE MUCOUS CATARRH.

teeth of the wind, and appears to act in every state of the thermometer and barometer.

3. Noxious Gases. — Several gases, such as ammoniacal gas, chlorine, &c., when inhaled in a somewhat diluted state (I say somewhat diluted state, for in the undiluted form they are irrespirable), are productive of acute mucous catarrh. M. Nysten has related a remarkable case of this disease, caused by the application of ammonia to the nostrils, which terminated fatally.* A case strongly resembling that just referred to may be found in the fourteenth volume of the “ Edinburgh Medical and Surgical Journal,” p. 642. A lad recovering from fever was seized with epilepsy, for which his nurse applied ammonia under his nose, “ with such unwearied but destructive benevolence that suffocation had almost resulted ; as it wras, dyspnoea, with severe pain in the throat and breast, immediately succeeded, and death took place forty-eight hours afterwards.” Acute mucous catarrh in this case evidently supervened, although not distinctly stated in the report. Chlorine gas, like ammoniacal gas, cannot be inspired in the pure or concentrated state, in consequence of its producing a spasmodic closure of the glottis, as was proven by the following accident : — A friend of mine being engaged in some chemical investigations re-

* « Bulletins de la Soc. de Med. 1815,” No. VIII. t. iv. 352.

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pecting the properties of this gas, unfortunately broke a jar containing it. He was instantly seized with a sense of suffocation, being unable to dilate the lungs, even to the smallest extent, in consequence of a spasm of the glottis ; death probably would in a very short time have been the result, had he not immediately been removed to a pure air. As it was, he remained in a state of alarming debility for a considerable length of time. If a person should inhale chlorine gas diluted to an extent just sufficient to enable it to pass the glottis, most violent catarrh would supervene, which would almost always have a fatal termination. When chlorine gas is mixed with a large quantity of common air, as happens in certain chemical works and bleaching-houses, it seems not to exert any injurious influence on those accustomed to it; on the contrary, it appears occasionally to have benefited those who have first been employed in works of this description, when suffering from chronic catarrh, or some peculiar forms of asthma.

3. Impalpable Powders . — The inhaling of many powders when in a state of minute subdivision, gives rise to catarrh of different kinds. If the powders be very acrid, acute mucous, or acute pituitous catarrh are produced ; if more bland, the disease will be trifling. They act for the most part either chemically or mechanically.

Predisponent Causes . — Whatever tends to debilitate the body, such as the immoderate indul-

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gence in “ the good things of this life,” violent exercise, long fasting, insufficient clothing, &c., may prove a source of catarrh.

Treatment . — The grand object in the treatment of acute mucous catarrh is to cut the disease short at its very onset. There are three ways by which this may sometimes be effected : viz. by hot spirits and water, by the use of the vapour bath, and by emetics.

1. Hot Spirits and Water . — Nothing is more common than to hear non -professional people recommend a glass of hot spirits and water for a cold, immediately before going to bed ; and certainly nothing answers better, if the catarrh be unaccompanied by any other disease and not violent. The celebrated Laennec tried this plan in almost innumerable cases, and with the happiest results. His prescription consisted of an ounce or an ounce and a half of brandy mixed with double the quantity of infusion of violets, made very hot and sweetened with syrup of marshmallows. The draught was usually succeeded by perspiration ; sometimes, however, the disease disappeared without it.

2. Vapour Batli . — It is generally supposed that vapour baths are very expensive, and can only be used by the affluent. Nothing is more erroneous than this idea, for a complete bath can be purchased for the small sum of thirty-five shillings. A set of curtains, a spirit lamp, and a tin for boiling water.

ACUTE MUCOUS CATARRH.

form the whole of the apparatus. Probably a boiler adopted to a common fire-place, with a movable tube attached and communicating with the bath, is to be preferred ; for the requisite degree of heat can by this means be always obtained, either by augmenting or diminishing the fire as the case may demand. The temperature of a vapour bath when a person first enters it should not exceed 80° Fahr., otherwise he will experience very unpleasant effects; from this point it ought gradually to be raised till it reach the degree of heat required, which will probably range between 100° and 120° Fahr. The first action of the vapour always produces some difficulty of breathing, but this after a time ceases, the eyes smart, the pulse becomes full and frequent, the skin reddens, and a copious perspiration then breaks out. When a considerable degree of languor is felt, it is a sign that a further continuance of the action of the vapour would be injurious. Suppose that a person should enter the bath while labouring under the first, or cold stage of acute mucous catarrh — that stage in which the blood is propelled from the surface of the body to the central organs— it is obvious, from what has been stated, that in a very short time the equilibrium, or balance of the circulation, would be restored ; when this much - desired object is achieved, the disease may be said to be cured. Confinement to bed for a day or two, and the employment c

ACUTE MUCOUS CATARRH.

of diluents, will be necessary, to prevent a relapse.

3. Emetics — Emetics might be divided into two classes, viz. those which induce immediate vomiting, by acting on the nerves of the stomach, — such as the sulphate of copper, the sulphate of zinc, &c. — and those which cause vomiting after having entered the circulation, — such as ipecacuanha, squills, tartarized antimony, &c. The emetics contained in the first of these classes are seldom employed, except to empty the stomach of a poisonous substance which may have been swallowed ; but those of the second class, particularly ipecacuanha and tartarized antimony, are constantly resorted to in the treatment of disease.

The time which elapses after an indirect emetic has been swallowed, before it produces any very perceptible effect on the system, varies much in different individuals ; sometimes it vomits in the space of a few minutes, at other times not till after the lapse of a considerable interval. The act of vomiting is usually preceded by nausea ; the face becomes pale, and the circulation feeble and irregular : but as soon as vomiting commences the whole frame is concussed, the face flushes, the action of the heart is augmented, and the blood is propelled, with great force, through the arteries ; local congestions are removed, and the skin perspires freely. A suitable emetic, for an adult, may consist of a scruple of ipecacuanha in