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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- CHEAL INJECTION. By JOSHUA LIXDLEV B.\RTON, M.D., NEW YORK, 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 chest. 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- tracheal medication. 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- tions. 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 injection. 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 152 MEDICAL RECORD. [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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