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In affections of the larynx, of the trachea, and of the bronchi, the respiration is sibilant, because of the diminution. of the calibre of those passages, or because of a mechanical obstacle; there is either a nervous condition, or an exudation. In the former case, recourse must be had to antispasmodics and tonics, as hyosciamine and hydroferrocyanate of quinine; this is the case in croupal affections in general; in the latter case, emetics must be employed, and should these be insufficient, tracheotomy must be performed. I refer to what I have previously stated concerning stridulous affections.

Cough. Of all the organopathic phenomena, cough is that which annoys the patient the most, and which most embarrasses the physician. The latter ought to discover if the cough proceeds from the larynx, trachea, bronchi, lungs, heart, or stomach, or even from a still deeper source, and what is the nature of the lesion that causes it.

Laryngopathic cough is hoarse, shrill, and barking. (Vide Laryngitis. Neuroses.) The peculiar cough of syphilitic laryngitis is known. (For the treatment, vide Inflammations.— Diatheses.)

Dyspeptic cough is guttural. It is observed in affections of the pharynx, œsophagus, and stomach. (Vide the diseases of those organs.)

Pleuritic cough is dry, frequent and short. In parietal pleurisy, cough is excited every time percussion is practised. (Vide Pleurisy.)

Cardiopathic cough is dry, without expectoration. stricture of the mitral orifice, it is intense and frequent. (Vide Inflammations of the Heart.)

Pneumopathic cough exists in consequence of compression, obstruction, atrophy, effusion, hepatisation, tuberculosis, melanosis, or emphysema. It is painful when there is inflammation.

It is sufficient for the practitioner to be informed of the different kinds of cough, in order that his attention may be directed at once to the determining affection. Among the

sedatives of cough, whatever may be the cause that determines it, I will mention cicutine. It suffices to masticate a granule of it, and to let it gently diffuse itself through the saliva, in order to abate the cough momentarily. This operation may be repeated three or four times a-day, or during the night. Cicutine has not an acrid taste, and does not cause any constriction in the throat. If a slight degree of narcotism is perceived, the medicament must be immediately suspended.

A granule of iodoform may also be masticated, taking care to shut the mouth, in order that the saffron emanations may penetrate into the principal passages.

Dyspnoeas. Cardiopathic dyspnoea may be confounded with asthma, but it is distinguished from it by the signs of auscultation and percussion. There is, however, here a difficulty; when auscultation is practised during the paroxysms, the abnormal valvular sounds are absent, which, however, exist during the intervals. The true practitioner will not, however, be thus deceived. The contrary happens in widening of the left auriculo-ventricular orifice. Dyspnoea is also one of the symptoms of aneurism of the ascending aorta, but here there are symptoms of cerebral anæmia.

In these anhelations, strychnine must be administered, combining it with hyosciamine, if there is spasm at the same time. (Vide Asthma.)

It is necessary to proceed in the same manner in respiratory insufficiencies arising from weakness or paralysis of the respiratory muscles. This is the case in myelopathic and cerebral dyspnoeas. The physician must then act as in affections of the brain, and of the spinal marrow. (Vide those affections.) In anæmic dyspnoea, the blood must rather be acted on. (Vide Chloro-anamic Diathesis.)

Palpitations of the Heart.-These palpitations are connected sometimes with a plethora, sometimes with a purely nervous or neurotic condition, and sometimes with an organopathy.

They

In plethoric palpitations, the heart-beats are violent. resemble the blows of a hammer heard at a distance. After general bleeding, digitaline must be administered:

A granule every half-hour, until sedation.

Organopathic palpitations are especially peculiar to carditis, and are remarked more in dilatation than in hypertrophy. Consequently the treatment should be contracting: arseniate of strychnine :

A granule every hour, until cessation of the palpitations.

In acrotism, there is suspension or momentary interruption of the movements of the heart. It is especially observed in dilatation of the left ventricle. Sudden death is then to be feared, the countenance is injected and bluish, and carbonic delirium terminates the scene. Bleeding would prove mortal in this case. Arseniate of strychnine, and arseniate of iron

must be administered:

A granule of each, every half-hour, during the entire duration of the accession.

When there is effusion into the pericardium,* digitaline must be added:

A granule, conjointly with the arseniate of strychnine, and the arseniate of iron.

ABDOMINAL ORGANOPATHIES.

I WILL first speak concerning mechanical hæmatemesis, as a transition between organopathies of the chest and those of the abdomen. When the blood meets with a permanent obstacle to its passage through the lungs and heart, as also through the spleen and liver, it accumulates in the gastroepiploic veins. Now, this venous plexus is voluminous. Hæmatemesis-of which the ancients have given an explanation in accordance with their humoral doctrines, that is to say,

* Capillary aspiration may be required.-H.A.A.

they attributed it to black bile-depends, therefore, upon obstruction, sometimes upon obliteration of the portal vein, or is caused by pressure upon or contraction of the vena cava inferior. Hæmatemesis rarely happens in organic diseases of the liver, but, on the contrary, it occurs in those of the spleen and of the heart, notably in stenosis, or insufficiency of the tricuspid valves. The quantity of blood vomited is more or less considerable, and there is a profound anæmia. It is against this latter that the treatment must be directed. Arseniate of iron and cicutine must therefore be given :

A granule of each, together, every hour, after having washed out the stomach with Seidlitz salt.

The same treatment must be applied in pultaceous and cancerous hæmatemesis.

Organopathic gastrodynia is accompanied with violent pains in perforating ulcer and scirrhus. Cicutine and quassine should be given :

A granule of each, together, every hour, until sedation.

Organopathic enterodynia, such as chronic catarrh and tuberculosis, requires hyosciamine, in order to calm the colics:A granule every half-hour, until sedation.

In typhlitis and perityphlitis, the pain which occupies the right iliac fossa is dull and interrupted by griping; later, in proportion as the serous membrane is invaded by the inflammation, the pain becomes violent, lancinating, and shooting, and is increased by movement and pressure. As there is organic lesion of the cœcum, especially after typhoid, the practitioner must be content with sedatives: cicutine and morphine :

A granule of each, together, every half-hour, until sedation.

In stenosic colic, due to an ileus, recourse must be had,

as long as the strangulation is not confirmed, to oils and atropine :

A granule every quarter-of-an-hour, with a spoonful of olive oil. But strangulation having declared itself, there is no other remedy than gastrotomy. I would remark that this operation is dangerous, precisely on account of the delay in performing it. Enterorrhagia is observed in typhoid and in cancer. It must be opposed by acidulated drinks and by tannic acid :A granule every half-hour.

Organopathic Icterus. It is connected with organic affections of the liver. In acute atrophy from hepatitis, there are dull, heavy pains in the right hypochondrium. Jaundice is not so pronounced, nor the stools so discoloured as in spasmodic or stenotic icterus arising from spasm, or obliteration of the biliary ducts. Recourse must be had to the antiphlogistics.

In cirrhosis, jaundice also is not complete. The liver no longer acting, the kidneys supply its place; therefore symptoms of denutrition or marasmus are seen rapidly to supervene. The fever is acute, and the disease runs a rapid course. Andral had previously observed, that in cirrhosis the animal temperature is elevated: 40, 41°c.* In this affection, arseniate of cafeine must be given :

A granule every hour.

The hepatic organopathies leave in the blood the elements. of the bile. (Vide Diatheses.) The blood must therefore be refreshed by the Seidlitz salt, and quassine must be given :Two or three granules before meals.

Renal Organopathy.-Organic diseases of the kidneys consist in a hyperplasy of the renal cells, or in granular fatty degeneration often the two combined. These organs no longer acting, infiltrations or anasarca result, and there is discharge of albumen in the urine.

* Were it not for alcoholic drinks, cirrhosis would very rarely be

seen.-H.A.A.

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