566 EEMEDIES 1\ BRONCHITIS AND PHTHISIS. 



the twenty-four hours is really more than equivalent to that of 

 many a man in a day's work. Nor is this all. Anyone who 

 watches the face of a patient during a violent fit of coughing 

 will see the skin become flushed, and then dusky ; the veins in 

 the forehead and in the jugulars swell up, and become so tense 

 that they seem as if about to burst; so that there is both 

 venous engorgement and interference with the respiration. 

 But what we see in the face takes place elsewhere. The same 

 tension which w^e see in the jugulars is also present in the right 

 side of the heart, in the vena cava, and in the portal system ; 

 for the portal vein has no valves, and the increased tension is 

 transmitted backwards to the veins of the stomach, spleen, and 

 intestines. By-and-by this all begins to tell upon the heart 

 and upon the digestive system as well as, to some extent, upon 

 the kidneys. The stomach becomes congested, and we have loss 

 of appetite, nausea, and vomiting. The patient, too, is kept 

 awake, and we have nervous exhaustion, or loss of sleep, added 

 to the weariness caused by the muscular exertion, and to the 

 depression occasioned by digestive disturbance. These are what 

 we have to fear : on the one hand, continuous coughing ; on the 

 other, we must avoid the digestive disturbance produced by our 

 sedatives ; and the duty of the physician is, so far as possible, 

 to relieve the cough without disturbing the digestion. Numerous 

 combinations have been devised, and are found to be, empiri- 

 cally, of very great service. If we take one of them and 

 attempt to analyse it, we shall find tliat its components are 

 such as to diminish the excitability of the respiratory centre, 

 and at the same time to lessen the injurious effect of the 

 sedatives upon the stomach. Such a one is the following 

 mixture: — Solution of hydrochloride of morphia and dilute 

 hydrocyanic acid, of each eighteen minims ; spirit of chloroform 

 and dilute nitric acid, of each one fluid drachm; glycerine, 

 three fluid drachms ; infusion of cascarilla or infusion of quassia, 

 two fluid ounces ; a sixth part to be taken three or four times a 

 day. 



In this mixture, which in its essence was much used by the 

 late Dr. Warburton Begbie of Edinburgh, to relieve the cough 

 in phthisis, we find the sedatives morphia, hydrocyanic acid, 



