Expectoration

“ 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. ”

“ 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. ”

“ 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. ”

“ 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 ”

“ Skin again hot; tongue again red and dry; no sleep; some delirium; pulse 84, of more strength.
27th. Skin more cool; tongue less red and more moist; pulse 66; some return of appetite.
28th. Cough much diminished; expectorates less; tongue moist, clean, and nearly of natural colour; pulse 72, stronger; countenance more animated.
35th. Cough nearly gone; expectoration much diminished; tongue clean; one stool; countenance improving; strength increasing; wishes for meat; two ounces were allowed.
40th. Sloughs on sacrum and ilium doing well; pulse 90, of more power; still noisy during sleep. ”

“ In the circulating system the symptoms will alike vary. One degree will produce a quick, strong and hard pulse; another, a quick, small and feeble pulse; another, a slow and intermittent pulse. A similar diversity will be found in the temperature of the body: in one, the heat will be little changed; in another, it will be below the natural standard; in a third, it will be intense, and the organs of secretion and excretion will equally vary in the extent of their morbid changes. ”

“ It is greater when the temperature is low, than when it is high; and during digestion the consumption has been found one half greater than when the stomach was empty.
483. Can it be ascertained with accuracy how much air is taken into the lungs at each inspiration? Why not? What is the probable quantity that an ordinary sized man inspires? How much can be thrown out of the lungs at a forcible expiration, and how much remains in the lungs? From these calculations, how much may they contain in their quiescent state? 484. In whom is respiration most frequent? How in disease? How in health? ”

“ It is estimated that the normal man in a state of rest will breathe sixteen times per minute. Any radical departure from the rate will indicate disease. An increase of two respirations per minute is supposed to indicate a rise of one degree F. in the body temperature, though this rule is subject to variations. Inspection of the bare chest tells the trained physician much regarding the condition of his patient and even the layman can glean much knowledge from that source. ”

“ I would observe however in regard to the last, that its variations are not so great as those of many of the other functions. Compare, for example, the ordinary quantity of secreted and exhaled fluids, with the increase that takes place under certain circumstances, the common state of the pulse with its exacerbations in many fevers, &c. you will see that between the natural and the morbid state there is often an enormous difference. The heat on the contrary, is never raised but a few degrees above the temperature of the body. ”

“ The intaking of air is termed by physiologists inspiration, and its expulsion expiration, the whole process being respiration. Expiration takes a very little longer than inspiration, and the rapidity of respiration depends on the needs of the body. The more active the exercise, the more rapidly vital processes go on, the more ventilation of the tissues is required and the more is actually effected. When one is at rest breathing takes place at the rate of from 14 to 18 inspirations and expirations in the minute ”

“ In any case temperature is merely a symptom of the conditions within, and, whether high or low, it denotes that there is in progress a fight for life that has scarce need to be suppressed. No thermometer is necessary to read the severity of disease, and, if pulse and temperature are above or below normal at the beginning of the fast, they will descend or ascend to natural register when disease disappears, or perhaps while some of its symptoms are still in evidence. ”

“ The pulse of all very weak patients increases in frequency when they sit up; because the expenditure of sensorial power necessary to preserve an erect posture deducts so much from their general strength; and hence the pulse becomes weaker, and in consequence quicker. See Sect. XII. 1. 4.
In this fever time must be allowed for the absorption of the matter. Very large and repeated quantities of the bark, by preventing sufficient food from being taken, as bread, and wine, and water, I have thought has much injured the patient ”

“ The more usual indication of disease as it affects body temperature is fever, but it is guite frequently the case that in anaemic subjects, shortly after the beginning of a fast, the temperature drops to a degree or so below normal. This is caused by the absence of food stimulation, for a fast never lowers temperature. The latter is always below register in instances of long-standing debility, and it is high in proportion to the severity of acute disease. The fast tends to restore temperature and pulse to normal, be they high or low at its inception. ”

“ Hurried breathing occurring independently of exercise, heat of the atmosphere, or distension of the abdomen, is indicative of fever, especially if associated with rapid pulse and increased heat of the body. ”

“ But when the febrile symptoms have disappeared entirely, and at the same time local congestions dissipated, a little thin broth may be allowed.
A certain sensation of hunger is felt, especially towards the end of the first period; but the desire of the patient must be resisted, although the pulse maybe less frequent and less full. Often at the first touch, the pulse seems regular, but the attentive physician will find something abnormal, and he will soon be assured, that the improvement is more apparent than real. ”

“ METHODS OF ARTIFICIAL RESPIRATION.
Sylvester’s Method.—Lay the patient upon his back; kneel above the head, take firm hold of the arms above the elbow, and move them horizontally—first away from the body, then over the head until the hands touch behind; pull them backward for a few seconds. This process expands the chest cavity, and the lungs are filled with air, inducing inspiration. Return the arms to the first position, and make strong pressure on the sides of the chest and epigastrium to expel the air and effect expiration. Movements should not be too rapid ”

“ 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. ”

“ This stage is various in duration in different persons, and in the different intermittent types. Nature at length rallies its powers with success, and with the expulsion of the cold, the second or hot stage is kindled up with undulating flushes of heat, and its preternatural increase over the body; the cutaneous blood{82} vessels are dilated with suffusion of the countenance, redness, and burning heat; the pulse becomes strong, full, and more regular; the respiration continues oppressed, and is accelerated; with headach, throbbing of the temporal arteries, and sometimes delirium. ”

“ Care must always be taken to lay the head considerably higher than the extremities, and to place the body on the right side. The lungs should be inflated with a pair of bellows, not forcibly, but gradually, so as to imitate the action of respiration.
Do not place the body in a high degree of heat; (below 98 degrees of Fahrenheit's scale is the best temperature,) clear the apartment of all supernumerary persons, and let the windows and doors be open, to admit a free circulation of air. ”

“ A difficult question here occurs; why does it happen, that in fevers with weak pulse the contractions of the heart and arteries become at the same time more frequent; which also sometimes occurs in chlorosis, and in some hysteric and hypochondriac diseases, and in some insanities; yet at other times the weak pulse becomes at the same time slow, as in the exhibition of digitalis, and in paresis irritativa, described in Class I. 2. 1. 2. which may be termed a fever with slow pulse? ”

“ This apparatus functionates very satisfactorily, raising the man or lowering him upon the knife-edges of the balance with the greatest regularity and ease. [Pg 95]
PULSE RATE AND RESPIRATION RATE.
The striking relationship existing between pulse rate and general metabolism, noted in the fasting experiments made with the earlier apparatus, has impressed upon us the desirability of obtaining records of the pulse rate as frequently as possible during an experiment. Records of the respiration rate also have an interest, though not of as great importance. ”

“ 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. ”

“ Exercise increases the number, while rest diminishes it. In standing, the rate is more than when lying at rest. Mental emotion and excitement quicken the rate. The number is smallest during sleep. Disease has a notable effect upon the frequency of respirations. In diseases involving the lungs, bronchial tubes, and the pleura, the rate may be alarmingly increased, and the pulse is quickened in proportion.
210. The Mechanism of Breathing. The chest is a chamber with bony walls, the ribs connecting in front with the breastbone, and behind with the spine. ”

“ Fever is a general condition of the animal body in which there is an elevation of the animal body temperature, which may be only a degree or two or may be 10° F. The elevation of the body temperature, which represents tissue change or combustion, is accompanied with an acceleration of the heart's action, a quickening of the respiration, and an aberration in the functional activity of the various organs of the body. ”

“ But in the misplaced states of fever, the pulse, like folly in old age, often points at a different mark from nature. In all such cases, we must conform our practice to that which has been successful in the reigning epidemic. ”

“ The next attack of fever, which I beg to assure you cannot be prevented, will be his last, I fear. His temperature is now as high as any man can bear and live; his pulse is galloping and his lungs are under the maximum tension. ”

“ From twenty-five to thirty-five pounds may be considered an average estimate in a healthy adult of medium size. The time in which the blood courses through the body and returns to the heart, is different in different individuals. Many writers on physiology unconditionally limit the period to three minutes. It is undeniable that the size and health of a person, the condition of the heart, lungs, and brain, the quantity of the circulating fluid, the amount and character of the inspired air, and the amount of muscular action, exert a modifying influence. ”

“ The patient becomes suddenly and completely insensible, and falls to the ground, the face is flushed, the breathing is noisy and difficult, the pulse is strong, and the thermometer placed in the bowel registers 107°, 108°, or 110° F., or rarely higher. ”

“ A full and quick pulse, indicates a fever; for by the irritation of the nerves, the vibration of the arteries are accelerated. If a gentle perspiration attends it, it may be deemed salutary; and with this pulse it appears, that nature makes a vigorous effort to expel what is obnoxious: therefore in such a pulse, a gentle perspiration generally gives relief.
3dly. A full, quick, and hard pulse, denotes great irritability in the nerves, and a redundancy of blood; this is the pulse of a fever; and here bleeding, if timely applied, is very requisite, as also medicines which promote perspiration. ”

“ 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 ”