A faint but distinct view of the blood-vessels and
of the glia cells is given in the original photographs,
which were taken by Dr. \V. C. Borden, U. S. A., from
gold-stained sections (Golgi-Obregia) nride in the St.
Peter State Hospital pathological laboratory, from
the corte.\ of the motor area on the left side.
DISEASES OF THE TRACHEA, BRONCHI,
AND LUNGS, TREATED BY INTRATRA-
By JOSHUA LIXDLEV B.\RTON, M.D.,
ATTENDING PHYSICIAN TO THE DEPARTMENT OF OUT-DOOR ciprofloxacin and tinidazole tablets POOR, BELLEVL'E
HOSPITAL ; PHYSICIAN TO THE LL'NG DEPARTMENT OF THE NEW YORK
THROAT AND NOSE HOSPITAL.
Standard authorities upon diseases of the nose and
throat make almost no allusion to the trachea, nor to
the frequency with which cough and changes in the
voice, for which the laryngologist is so often con-
sulted, originate in this organ.
The consensus of opinion seems to be that diseases
of the trachea should be classed with diseases of the
A study of the subject has, tinidazole giardia however, convinced me
that the diseases of the trachea present so many anal-
ogies and are so closely related to those of tinidazole tablets 500mg the larynx,
that the separation of tracheal fronV laryngeal diseases
is not altogether practicable.
On the other hand, the intimate connection between
the trachea and bronchi and the pulmonary paren-
chyma renders it difficult to separate them wholly from
diseases of the lungs. We are therefore forced to the
conclusion order tinidazole that the laryngologist should also be a
pneumologist and be an expert in diseases of the
whole respiratory tract.
The special physiology of the trachea was elabo-
rately studied by Mr. Nicaise in 1889, and a resume of
his work presented to the Paris Academy ciprofloxacin and tinidazole of Sciences.
He showed that " in the state of normal calm respira-
tion the trachea remains slightly contracted and order tinidazole online does
not change its volume appreciably. The posterior ex-
tremities of the annular cartilages are almost in con-
tact and the membranous portion lies in a linear fold.
During strong respiration, in crying, groaning, sing-
ing, etc., the trachea is dilated and lengthened while
the larynx rises; in inspiration the trachea shortens
and contracts again."
There occurs therefore a rhythmical change in the
calibre of this tube, the exact degree of which can be
measured. The dilatation is in proportion to the
force of the expiration, and is greatest in the upper
part. The dilated trachea acts as an elastic tube,
compressing the contained air. By virtue of this
property it serves an important use in the production
of the voice, modifications of which may be caused by
pathological changes in this organ.
The tracheal nerves are derived from the great sym-
pathetic and from the pneumogastric and its recurrent
branches, filaments of which extend into the mucous
membrane of both the trachea and the bronchi.
Experimental, physiological investigation tinidazole norfloxacin seems to
have definitely decided that cough may be produced
by direct irritation of either of these nerves or of their
branches, or of the mucus membrane supplied by them.
Clinical experience proves that the converse is also
true, viz. : That cough may be alleviated if not entirely
prevented by appropriate medication applied directly
to the irritated mucous surface.
To the late Dr. Horace Green, of this city, must he
awarded the honor of being the first to advocate intra-
In 183S he succeeded in passing a small sponge
saturated with a solution of nitrate of silver through
the glottis into the trachea. In 1840 he brought the
subject before the New York Medical and Surgical
Society, and reported fifteen cases of severe laryngeal
and bronchial diseases which had been cured by this
means. In October, 1854, he adopted the plan of
passing an elastic tube through the larynx into the
bronchi in a patient suffering with phthisis, and of in-
jecting from one and a half to two drachms of strong
nitrate-of-silver solution into the lungs. " This process
he repeated seven times in fifteen days, with the result
that tinidazole tablets the patient's cough and expectoration were greatly
diminished, she grew stronger, breathed with more
freedom, and increased in weight."
In Feburary, 1855, he read a paper on the subject
before the New York Academy of Medicine. His
statements were received with incredulity and by many
he was branded a charlatan and his practice a hum-
bug. The paper was referred to a special committee
of seven, who were to investigate Dr. Green's method
and report their conclusions to the academy. This
committee took six months to consider the subject
and then sent in a majority report unfavorable to Dr.
Green and a minority report fully sustaining him.
Through it all Dr. Green never lost his faith, but re-
iterated his belief that this practice was but the ini-
tiatory step to a plan of treatment that would ulti-
mately result in positive good to suffering humanity.
From October, 1S54, to February, 1856, he had treated
one hundred and six cases. Of these seventy-one were
classed as cases of tuberculosis. Of these tubercu-
losis cases thirty-two were considered as cases of ad-
vanced tuberculosis and thirty-nine as cases of early
tuberculosis. Of the cases of advanced tuberculosis
twenty-five were more or less improved, their lives
being apparently prolonged ofloxacin tinidazole by this means of medica-
tion. Seven only were not improved by the injec-
Of the thirty-nine cases of incipient tuberculosis
twelve had apparently recovered at the time the report
was written and five more were nearly well. Of the
remaining twenty-two cases seventeen were greatly
improved, three were moderately benefited, and three
failed to receive any benefit whatever. Of the twenty-
eight cases of bronchitis sixteen were cured and all of
the others greatly benefited. In six cases of asthma
treated by this means, in all except one the disease
was entirely removed by the use of intrabronchial
December 22, 1859, four years after the reading of
his first paper upon this subject before the Academy
of Medicine, Dr. Green read a paper " On the Difficul-
ties and Advantages of Catheterism of the Air Pas-
sages " before the Medico - Chirurgical College, in
which he pointed out some of the errors of his early
practice and advised that for intrabronchial injection
milder tinidazole online solutions should be used. He further adds:
■■ Such has been the amount of success which has con-
tinued to attend this plan of treatment, that I am now-
ready to affirm, after an experience of man)' years in
a field of observation unusually large, that, if I were
required to relinquish all other known therapeutic
measures or topical medication, in the treatment of
thoracic diseases, I should choose the latter with hy-
gienic means alone, in preference to the entire class
of remedies ordinarily employed in the treatment
of these diseases. During tlie three or four generic tinidazole years
since my report of one hundred and six cases, I have
treated large numbers of patients afflicted with chronic
laryngeal and bronchial diseases, with asthma, and
with tuberculosis, and the success which continues to
attend this practice has sened to increase greatly my
confidence in this measure as a therapeutic agent."'
In addition to the testimony of Dr. Green, eminent
[August I, 1896
medical authorities ' in France, Germany, and Great
Britain agreed that norfloxacin and tinidazole as a therapeutic means intrabron-
chial injection merited more serious atter.tion.
Dr. Green asserted that the patient should be prop-
erly prepared before intratracheal or intrabronchial
medication should be attempted, and with this end in
view he painted the pharynx, epiglottis, and larynx
with a strong solution of nitrate of silver for several
successive days or weeks, in order to numb the sensi-
bility of the mucous membrane before attempting to
introduce either the sponge or the tube.
There is little wonder that this method seemed too
heroic, or that many eminent physicians looked upon
it with disfavor, or that with the introduction of power-
ful spray apparatus it fell into disuse. It must be
conceded that the use of the spray, the nebulizer, and
the pulmonary inspirator, is productive under certain
conditions of good results, but it is impossible by
their use to project into either the trachea, bronchi,
or lungs a sufficient quantity of the medication purchase tinidazole online tinidazole tindamax to ma-
terially alleviate the cough, to ciprofloxacin tinidazole soften the secretions,
or fasigyn tinidazole to protect the irritated mucous membrane.
A revival of intratracheal and of intrabronchial
injection in a modified form is therefore exceedingly
desirable, and buy cheap tinidazole this has been rendered possible by
laryngoscopy and the discovery of cocaine, facilitat-
ing as they do the easy insertion into the trachea of
the endolaryngeal tube, while the great advances
made in materia medica and therapeutics during the
last forty years have placed in our hands a large num-
ber of remedies well suited to the purpose.
Recent scientific research has fully confirmed the tinidazole vs metronidazole
observations of Dr. Green, and proved beyond a doubt
that substances injected into the trachea are not only
borne but are rapidly absorbed.
In the Medical Record of December i, 1883, it is
stated: "At a recent session of the French Associa-
tion for the Advancement of Sciences held in Rouen,
Dr. Bergeron presented a memoir on the subject of the
injection of medicated substances into the trachea, in
which he asserted that the injection of medicated
liquids into the respiratory passages below the larynx
was very well borne by cows, horses, and dogs.'' •
In the Medical Record of October 10, 1885, it is
stated that "some experiments made by Dr. Pernice
show that liquids injected to the trachea run down the
posterior surface and are thence buy tinidazole evenly distributed
through all the bronchial twigs. They are absorbed
by the pulmonary veins or by the lymphatic vessels
and thus exert both a local and a systemic action.
When the animal was placed in the supine position,
with the head elevated a little, no cough was e.xcited
by the operation."
Dr. Pernice used in his experiments distilled water,
milk, and defibrinated blood. Absorption was com-
plete and no respiratory trouble of any sort resulted.
He also used solutions of tannin, borax, benzoate of so-
dium, quinine, morphine, nux vomica, and lime water.^
Kirke's "Physiology," page 380, ed. 1892, states:
" It is a remarkable fact that not only is the epithe-
lium of the pulmonary mucous membrane able to allow
the passage through it of gases and volatile sub-
stances, but that under certain conditions fluids such
as water may also be absorbed, and besides this the
presence of carbon particles in the bronchial glands
and alveoli in connection with the lungs must point
to the pulmonary epithelium as the only possible
channel of absorption."
Again quoting from the Medical Record of Feb-
' Bennett, of Edinburgh; Watson, of Glasgow: Gallon. Has-
tings, .\lison, andMackness, of London ; Trousseau, of Paris, and
the French .\cademv of Medicine ; Rokitanskv, of Vienna. B.
P., 125 ; B. P., vol.'52.
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