3140. In Haemorrhoids Or Piles, The Daily Practice Of Injecting Oss

of cold water proves highly serviceable. Under the use of this simple remedy, and a few grains of Rhubarb daily, I have seen long-standing cases yield completely.

3141. Expectorants are medicines or agents which increase the secretion of bronchial mucus, and promote its subsequent expulsion. They are divided into two classes, Topical and General.

1. Topical Expectorants include all those agents, the vapour of which, when inhaled, acts directly on the mucous lining membrane of the air-passages. They are of two kinds: - 1, Stimulants, as Iodine, Chlorine, Benzoic, and Acetic Acids, Tar, &c, the vapours of which stimulate the pulmonary exhalents; and 2, Sedatives, as Conium, Hyoscyamus, Stramonium, and the vapour of hot water, which allay irritability, relieve the constriction of the vessels, and thereby facilitate expectoration.

2. General Expectorants are medicines which are taken into the stomach, and which, after being absorbed into the system, operate on the lungs and their membranes. They comprise medicines of very diversified characters and qualities; and which are each adapted to some particular cases or stages of pulmonary disease. This class comprises - Nauseants, as Ipecacuanha and Tartar Emetic, which are chiefly applicable to those acute and subacute cases in which much vascular excitement exists; Tonics, as Senega, which prove useful in the advanced stages of Pneumonia and Pleuro-pneumonia; and Stimulants, as Ammoniacum, Assaftida, and the gum resins, which prove of the highest service in chronic cases of Asthma, Catarrh, &c. There is yet another subdivision, viz., Alkalies, sometimes termed Lique-facients, from their property of rendering the fluids of the body more liquid. As expectorants, they lessen the viscidity of the mucous secretion, and allow it to be more easily expelled from the air-passages. The Sesquicarbonate of Ammonia may be taken as a good example.

Their action is promoted - 1, by keeping the surface of the body moderately warm; 2, by emetics; 3, by the copious use of diluents; 4, by avoiding agents which increase the secretion of urine, or immoderate action of the bowels. Their action is retarded - 1, by opiates; 2, by diuretics; 3, by purgatives; 4, by keeping the surface of the body cool.

3142. Observations On Their Use

1. Expectorants of any kind are of little use, and may prove injurious during the early stages of acute sthenic inflammation, Croup excepted.

2. In such cases, depletion and antiphlogistics should precede their use; and then nauseants are preferable to the other classes.

3. Stimulant expectorants are contra-indicated in all cases where sthenic inflammation exists.

4. Stimulant topical expectorants, as the vapour of Iodine, should be discontinued if they produce much irritation.

5. Nauseant expectorants are inadvisable in purely nervous Asthma, when the patient is much debilitated, or the disease assumes a typhoid character.

6. The vapour of hot water is one of the best expectorants when it answers at all; but to some persons it proves irritating, and they derive no comfort from it. (Dr. Watson.)

Galvanism. See Electricity.

3143. Gargles are fluids intended to be retained in the mouth for a certain time, and to be thrown in contact with the uvula, tonsils, &c. For this purpose, the head should be thrown back, and the liquid agitated with the air issuing from the larynx. This is the usual method of application; but Sir J. Murray proposes another mode, which in many cases will be found preferable. He suggests drawing the gargle through the nostrils; it thus passes along the posterior nares, and reaches the pharynx, touching in its course the whole mucous surface. Sir J. Murray justly observes, that there are often untoward secretions of mucus, and sometimes an injected, relaxed, or turgid state of the coats and vessels of the posterior nasal passages; these troublesome conditions extend down the fauces, and cause sore throats, with an inflamed appearance over the glands and the entire surfaces. These conditions cannot, he observes, be removed by gargles applied in the usual manner through the mouth; but if the gargle be drawn through the nostrils, the source of irritation is healed, and the continuous surfaces soon partake of the same salutary influence.

Gargles may be made stimulant, astringent, or sedative, as the circumstances of the case may require. They are purely local in their action, and are chiefly employed in relaxed or ulcerated states of the tonsils, fauces, &c.

They should never be employed whilst active inflammation of the throat is present; for then they not only cause great pain, but increase the urgency of all the symptoms. In chronic cases, they prove of great service.