Expectorant

“ Young and vigorous subjects suffer most, but almost always recover soonest.
4. The weak pulse, want of reaction, non-disappearance of the pneumonic consolidation, or its appearance during the progress of exhaustive diseases, are the unfavourable signs of pneumonia.
5. Continued exercise or work after the attack; low diet, large blood-lettings; depressants, such as tartar emetic and sedatives; expectorants, such as squills and ipecacuanha; mercury and violent purgatives, are opposed to the restorative treatment of the disease, and when not fatal, tend to prolong its duration. ”

“ According to Dr Good, true expectorants are “those medicines which rather promote the separation of the viscid phlegm with which the bronchiæ are loaded, than simply inviscate and dilute it; though these are also treated as expectorants by many writers.” Ammoniacum, antimonials, assafœtida, the balsams of Peru and tolu, benzoic acid, benzoin; the fumes of vinegar, tar, and several of the volatile oils; garlic, ipecacuanha, the oleo-resins, squills, tartarised antimony, and the smoke of tobacco and stramonium, are among the principal substances commonly called expectorants. ”

“ Dosage: 0.5 Gm. or 8 grains (U.S.P.) .
*Potassii Iodidum (Pot. Iod.) , Potassium Iodide, U.S.P.—KI.
Transparent, translucent or opaque crystals or white granular powder, with a pungent, saline, afterward bitter taste. Very soluble in water (1:0.7) and soluble in alcohol (1:22) . Incompatible with [Pg 173] mineral acids and oxidizing agents and should not be prescribed in solution with alkaloids or alkaloid-containing drugs.
Action and Uses: Saline expectorant, especially in asthma and chronic bronchitis; diuretic; antisyphilitic; “alterative” in rheumatic conditions, sclerosis, etc. ”

“ The chest symptoms continued so bad as to confine him to the house for three or four months; afterwards, he seemed gradually to recover under the use of tonics and cod oil, and the influence of a warmer climate, and when he came to me in January 1869 for the first time, he looked well; however, he complained of debility, of constant dyspnœa on exertion, and of exaggerated attacks of it occurring suddenly at times, of some cough and of glutinous expectoration; if he attempted to live well, as he had been told to do—meaning especially the taking of wine—he usually got an attack of epistaxis. ”

“ It is to be expected that a person with such an expectoration shall die on the fourteenth day, unless something favorable supervene. The following are favorable symptoms: to support the disease easily, to have free respiration, to be free from pain, to have the sputa readily brought up, the whole body to appear equally warm and soft, to have no thirst, the urine, and faeces, sleep, and sweats to be all favorable, as described before; when all these symptoms concur, the patient certainly will not die ”

“ These exacerbations may not rarely be traced to atmospheric influences or to trifling indiscretions on the part of the patient. The pain declines gradually; and the pulse-rate also falls, but even after the temperature has become normal some degree of rapidity of the pulse is apt to remain for a considerable time. The physical signs gradually disappear: the respirations, like the pulse, remain somewhat rapid, or at least are for some time readily accelerated; and there is apt to be some cough remaining, with gradually decreasing muco-purulent expectoration. ”

“ That debility should, under certain circumstances, dispose to excessive action, and that excessive [155] action should occur in one part of the body, at the same time that debility prevailed in every other, are abundantly evident from the history and phenomena of many diseases. Inflammatory fever, active hæmorrhages, tonic gout, asthma, apoplexy, and palsy, however much they are accompanied by excessive action in the arterial system, are always preceded by original debility, and are always accompanied by obvious debility in every other part of the system. ”

“ The temporary quick pulse attending some maniacal cases is simply a symptom of debility, and is the consequence of too great exertions; but a permanent quick pulse shews the presence of fever, and is frequently a salutary sign; because, if the life of the patient be safe, when the fever ceases, the insanity generally vanishes along with it, as mentioned above. In this case the kind of fever must direct the method of curing the insanity; which must consist of moderate evacuations and diluents, if the pulse be strong; or by nutrientia, bark, and small doses of opium, if the pulse be weak. ”

“ No pain of chest; cough much increased; now very frequent and accompanied with copious expectoration; pulse 136.
15th. Cough more frequent; expectoration purulent and mixed with blood; pulse 126.
17th. Expectorates a larger quantity of purulent matter, mixed with a larger proportion of blood; pulse 102.
20th. Pectoral symptoms unchanged; strength extremely depressed; countenance pallid; skin cool; three stools partly passed in bed; pulse 84; mind confused; almost constant moaning; extensive sloughing ulcers on sacrum and hips.
21st. Pectoral symptoms the same; powers extremely depressed ”

“ It must be admitted that, to a certain extent, expectoration is a voluntary operation, connected with the action of a variety of muscles, which in a state of extreme debility are not easily excited into action: every practitioner must have noticed this fact during the treatment of the coughs of exhausted patients, and have witnessed the distress necessarily arising from it; in this condition, the exhibition of a stimulant may so far renew the exhausted excitability of these organs, as to enable them to undergo the necessary exertions. ”

“ Thus in cold fits of agues, in hysteric palpitations of the heart, and when the body is much exhausted by hæmorrhages, or by fatigue, as well as in nervous fevers, the pulse becomes quick and small; and secondly, in all those cases if an increase of stimulus be added, by giving a little wine or opium; the quick small pulse becomes slower and larger, as any one may easily experience on himself, by counting his pulse after drinking one or two glasses of wine, when he is faint from hunger or fatigue. ”

“ Periods of diurnal fever, hectic fever, quotidian, tertian, quartan fever. Periods of gout, pleurisy, of fevers with arterial debility, and with arterial strength, Periods of rhaphania, of nervous cough, hemicrania, arterial hæmorrhages, hæmorrhoids, hæmoptoe, epilepsy, palsy, apoplexy, madness. IV. Critical days depend on lunar periods. Lunar periods in the small pox. I. If any of our muscles be made to contract violently by the power of volition, as those of the fingers, when any one hangs by his hands on a swing, fatigue soon ensues ”

“ When the patient is weakened a blister on the head, and after further exhaustion five or six drops of tincture of opium.
4. Peripneumonia. Inflammation of the lungs. The pulse is not always hard, sometimes soft; which is probably owing to a degree of sickness or inaction of the stomach; with dull pain of the chest; respiration constantly difficult, sometimes with erect posture; the face bloated and purplish; cough generally with moist expectoration, often stained with blood.
When the difficulty of respiration is very great, the patient is not able to cough ”

“ Expectoration is largely dependent on imitation, sometimes conscious, of course, but often quite unconscious. In the recent crusade organized to prevent the spread of tuberculosis the question of expectoration as a diffusing agent of the bacilli has given a new importance to observations on this subject. ”

“ Taking the extracts for too long a time without intervals may, at times, produce disagreeable symptoms, such as palpitation of the heart, nervous excitability, sleeplessness, etc.; so that during the course of the treatment the patient should be examined every three or four days as to the condition of the heart and urine; and if the pulse rises above 90, if it were lower before, the treatment should be suspended for a few days; much meat, alcohol, strong tea or coffee, should be avoided. ”

“ Whenever there is difficulty of expectoration, especially when expectoration is abundant as in certain of the chronic bronchitises, and above all in dilatation of the bronchi, the advantage of position should be taken to aid in the expectoration. ”

“ The expectoration at first is merely mucus, but after a time it assumes a characteristic appearance; it has a roundish, flocculent, woolly form, each portion of phlegm keeping, as it were, distinct; and if the expectoration be stirred in water, it has a milk-like appearance. ”

“ The low pulse and temperature, the sound sleep, and the freedom from cough and expectoration were indications of a very low state of vitality, and can not be considered as favorable symptoms. If he grows stronger, there will be a rise in the pulse and temperature, and his cough and expectoration will return. ”

“ In the vast majority of cases, however, this lull in the symptoms is deceitful, and lasts only from a few hours to a day, when the gravest stage of the disease sets in. The pulse soon becomes small and thready, beating only thirty or forty to the minute, and the heart often works vigorously after the pulse can no longer be felt at the wrist. The nausea and vomiting return and become constant, the respiration is often embarrassed, the tongue becomes dry and brown, the skin is cool and dry, there is often a distressing hiccough, and the thirst is insatiable. ”

“ The cycle commences with the strongest beat during or immediately after the act of expiration, and the succeeding four or five beats are less and less forcible until the chest is fully expanded when there is a quiescent interval corresponding to the period of one beat. In many such cases there is no other indication of heart disease and the phenomenon appears due to the interference with the circulation by the hepatized lung, to the impaired nervous energy of the heart and to its compression between the distended lungs. ”

“ Those die whom the fever does not leave, or when appearing to leave them it returns with an exacerbation; when they have thirst, but no desire of food, and there are watery discharges from the bowels; when the expectoration is green or livid, or pituitous and frothy; if all these occur they die, but if certain of these symptoms supervene, and others not, some patients die and some recover, after a long interval. But from all the symptoms taken together one should form a judgment, and so in all other cases. ”

“ The expectoration which terminates the disease in health, is always the effect of effusions produced by a general disease, and even the vomicas, which sometimes succeed a deficiency of bleeding, always depend upon the same general cause. From this view of the analogy between pneumony and pulmonary consumption, it would seem that the two diseases differed from each other only by the shorter or longer operation of the causes which induce them, and by the greater or less violence and duration of their symptoms. ”

“ If the expectoration be easy, and the breathing free, if his sides be free of pain, and if the fever be gone, he may take the ptisan thicker, and in larger quantity, twice a day. But if he do not progress favorably, he must get less of the drink, and of the draught, which should be thin, and only given once a day, at whatever is judged to be the most favorable hour ”

“ In the cold paroxysm of fever with weak pulse the part first affected I believe to be the stomach, and that it has become torpid by previous violent exertion, as by swallowing contagious matter mixed with saliva, and not by defect of stimulus, as from cold or hunger. The actions of this important organ, which sympathizes with almost every part of the body, being thus much diminished or nearly destroyed, the sensorial power of association is not excited; which in health contributes to move the heart and arteries, and all the rest of the system; whence an universal torpor occurs. ”

“ Symptoms.—In the worst cases these are sudden loss of appetite, small and frequent pulse, haggard eyes, the conjunctiva inflamed, the mouth open, red, and filled with foam, the respiration laborious, plaintive cries, convulsions, palsy of the hind limbs, and involuntary discharge of highly fetid fæces. Death here is the inevitable termination, and that in a short time. But where the progress of the disease is less rapid, the symptoms assume a milder form, and medical aid is available and often beneficial. ”

“ Whence it appears, that in fevers with weak pulse, if the action of the heart, arteries, and capillaries could be diminished, or stopped for a short time without occasioning the death of the patient, as happens in cold bathing, or to persons apparently drowned, that a great accumulation of the sensorial powers of irritation or of association might soon be produced, and the pulse become stronger, and consequently slower, and the fever cease. ”

“ The patient feels weak and is often giddy, but is not always obliged to go to bed the first day. Nausea and vomiting are among the earliest symptoms, and distress at the epigastrium, with tenderness, may attend or even precede the chill. Fever quickly follows; the pulse runs up from 110 to 130 in a few hours; the temperature reaches from 103.5° to 106° by the end of twenty-four hours; the pains increase, and there are insomnia and great restlessness; appetite fails; thirst is extreme; the tongue is moist and furred, and the bowels quiet. ”

“ The prognosis is favorable in proportion as the action of the heart is but little disturbed, the temperature of the body non-febrile, the appetite and digestion but little affected, the complexion not much changed, and the nutrition of the body fairly maintained. The inference under these circumstances is that the disease does not tend to progress, and that the existing pulmonary affection is well tolerated. The ground for encouragement is greater the less in amount the pulmonary affection ”