Volume 1

Treatise on therapeutics / A. Trouseau and H. Pidoux.

  • Trousseau, A. (Armand), 1801-1867.
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: Treatise on therapeutics / A. Trouseau and H. Pidoux. Source: Wellcome Collection.

    289/316 (page 281)
    Therefore, before using substitutive treatment, we ought to knowthe range of our vveapons. Some of the irritants hâve a very short range; they produce very transient effects; such are the nitrate of silver, sulphate of zinc, nitrate of mercury, calomel, and the alkaline chlondes ; of others the elïects are much less fleeting, as cantharides, tartarized antimony, arsenic, the strong caustics, mustard, the euphorbiaceæ, the ranunculaceæ, the colchi- caceæ. As it is alvvays necessary to proportion the intensity of the action of the substitutive agent to the inflammation, it would be absurd to attack superficial lésions with agents of the second sériés, which are suitable for grave, deep, or chronic lésions of tissue. Thus, malignant pustule and the variolous pustule are destroyed by a caustic; and superficial carci- noma of the skin, which is aggravated by superficial irritation, is destroyed by caustics that take off the whole thickness of the derma, or by irritants, like arsenic, which hâve a deep and prolonged action. Two mistakes must be avoided in proportioning the substitutive action to the exciting irritation; we must neither do too much nor too little. It generally does little harm to do too little; one may even, by follow- ing this prudent path, attain the same end, if the action is kept up and repeated. Suppose a blennorrhagia of the urethra, which we wish to cure with injections of nitrate of silver. Webegin with a weak solution; 1 part in 3,000 of distilled water produces a sliglit therapeutical irritation which will not control the syphilitic phlegmasia, but will substitute itself for a part of it, so that, to use an inexact représentation, we hâve a blen- norrhagie irritation represented by 10, and a substitutive represented by 2. The substitutive not being proportionate to the irritation, the latter remains 8; but if we prolong the contact of the irritant solution, we may make up for its weakness by time. This method is the more rational, as it is impossible to know before- hand the sensibility of the tissues, and as it is better to hâve to increase the irritation than to lessen it, when it has rashlv been made excessive. We said that each agent had its own range. The duration of action varies from a few hours to some days, according to the intimate nature of the modifier and the dose used. The morbid irritation, as pre-existent, and as having deeply modified the tissue by simple duration, has acquired a sort of right of domi- cile, and a great tendency to reproduce itself. If the substitute acts only six, twelve, or twenty-four hours, it may replace the inflammation for that period; but if it be left off at once, the primitive condition returns. In order to produce effective substitution, the action must be renewed before the effect of the former application is entirely gone, Thus, when dysentery is treated with injections containing nitrate of silver or neutral purgative salts, the pain, the colic and the bloody flow are lessened by the first injections; but they appear again in a week or