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■ Lyon Medical. October 7, 1SS3. ^11 Movimento, No. 12, 1885. ruary 8, 1896, Dr. C. G. Coakley, in a series of experi- ments conducted at the Loomis Laboratory, made a solution of India ink, filtered it, and then injected ten cubic centimetres of the filtered solution into the trachea of rabbits, and the animals were killed in from fifteen minutes to two hours. It was found in every case (whether fifteen minutes or two hours had elapsed) that not a trace of the pigment could be found in the trachea, bronchi, or alveoli, but all had been absorbed. Fjccept where a few lymph cells had ruptured there was no free pigment in the lymph chan- nels, but was all contained within the lymph cells or phagocytes, which were scattered through the lymph channels of the lung, underneath the pleura, and in bronchial glands. Dr. Joseph Muir, of this city, who has perhaps had the largest experience in recent years of any American physician in this method of treatment, in a paper read before the Medico-Surgical Society, January 6, 1896, and since published in pamphlet form, claims that "A process analogous to that of pneumo-koniosis is in- duced. Substances are taken up by Vasotec 5mg the lymphatics, transported downward and inward to be deposited in tissues more or less remote, even sometimes as far as the thicker connective tissues of the lungs." It follows therefore that if absorption of injected liquids by the lymphatics of the Enalapril Vasotec tracheal, bronchial, and pulmonary mucous membrane has been fully demonstrated by competent observers who have also added their testimony to the ease with which such injections are borne, we are justified in resorting to intratracheal and intrabronchial medication both as a palliative and as a curative measure. 'l"he technique is simple. A syringe with an endo- laryngeal tube, de\ised by Dr. Muir and Iv Vasotec manufactured by Ermold, holding four drachms answers the pur- pose perfectly. The larynx having been sprayed with a two-per-cent. solution of cocaine, the patient is in- structed to grasp the tongue with the right hand, to draw it forward, at the same time throwing back the head and opening the mouth as widely as possible. The operator, with the laryngeal mirror in one hand and the syringe in the other, then proceeds as though he were about to make a laryngeal application. As soon as the tube enters the cavity of the larynx the epiglottis is pulled slightly forward, the patient is in- structed to breathe, the cords separate, the lube enters the trachea, and the syringe is emptied of its contents. By pointing tlie instrument to either side the bulk of the medication may be made to Buy Vasotec enter either the left or the right bronchus. If care is taken when inserting the tube to avoid touching the glosso-epiglottic or the aryteno-epi- glottic folds or the inter-arytenoid space, each one of which seems to act as a cough centre, the irritation caused by this procedure will be found to be surpris- ingly slight. It is in fact so non-irritating that after a little preliminary training the cocaine spray may be discontinued. The remedies employed should be soothing and the vehicle non-irritating. For this purpose olive oil, cod- liver oil, glycerin, mucilage, or any one of the petro- leum oils may be used. Of the latter the one sold under the name of benzoinol is probably the best. It is tasteless, non-irritating, and is said to Vasotec 10 Mg contain an ounce of benzoin to the pint of oil. Solutions con- taining benzoinol, europhen, and menthol, or benzo- inol, guaiacol. and menthol, have proved veiy effica- cious in my hands. From one per cent, to two and one-half per cent, of europhen and from one per cent, to fifteen per cent, of menthol, or two per cent, of guaiacol in place of the europhen, will be found to be quite strong enough. The strength may, however, be increased or dimin- ished to suit each individual case, or other remedies, Aufjust Generic Vasotec I, 1896] MEDICAL RECORD. 153 such as ichthyol, may be substituted. From one-half a drachm to one drachm may be injected at each in- sertion of the tube. And this may be repeated at one sitting until from two to four drachms have been used. This method of medication has many advantages, viz. : 1. The remedy is applied directly to the irritated mucous surface. 2. It immediately alleviates the most distressing symptoms, adding at once to the comfort of the pa- tient. 3. In a certain number of cases the antiseptic effect of the medicine is very pronounced, as shown by the longer internal between the febrile attacks and by their lessened intensity when they do occur. 4. The tracheal and bronchial mucous membrane rapidly absorbs the medication, so that we may expect a general as well as a local effect. 5. We avoid disturbing the patient's stomach with nauseating doses and the shattering of his nervous system with opiates. 6. This method of alleviating the most distressing and annoying symptoms does not interfere in the slightest degree witli any other line of general treat- ment which may be deemed advisable. 7. In cases characterized by an Buy Vasotec Online atrophic condition of the tracheal mucous membrane or of pulmonary disease with cavitation leading to retention and Vasotec Uses de- composition of the secretions, intrabronchial injec- tion will remove the disgusting fetor of Purchase Vasotec the breath consequent upon this condition. I have treated during the past winter twenty-five cases by intratracheal injection, including cases of severe laryngo-tracheitis, bronchitis, and tuberculosis, and one case of asthma. The cases of laryngo-tracheitis and of bronchitis were rapidly restored to health ; the case of asthma was greatly improved, while every case of tuberculosis has been markedly Ijenefited. Report of Ten Cases — Fred. \V , aged thirty- five, cabinet-maker. Ill since November, 1895. Began to cough about December 15, 1895. Had lost twenty- five pounds in weight. He presented himself at my clinic at Bellevue Hospital, Out-door Poor Depart- ment, January 31, i8g6. Marked anamia of larynx, with great irritability of pharynx. Severe cough. Expectoration profuse. E.xamination of chest showed well-marked pulmonary disease. Gave intratracheal injection of benzoinol, europhen, and menthol. The alleviation of the cough was almost immediate. The injections were repeated Vasotec Mg upon February 7th, loth, 14th, and 19th, when the patient reported that Vasotec Iv Push his most distressing symptoms had been relieved, and Vasotec 2.5 that he could eat and sleep and enjoy himself. And like many another clinical patient he ceased his visits. Charles J. M , aged forty-two, waiter. General health good. Laryngo-tracheitis with bronchitis last- ing four weeks. Had been under treatment for the cough, which was severe, for nearly one month with no relief. January 15, i8g6, I began to treat him by intratracheal injection, using benzoinol, europhen, two and one-half per cent., and menthol, seven and one- half per cent. These were repeated five times in seven days, when the patient reported that liis cough was entirely well. George M , baker, aged twenty-five. General health good. Had had attacks of astiima every winter. I saw this patient first February igth. He was suffer- ing from an asthmatic attack of very great severity. I gave him an intratracheal injection of benzoinol, europhen, and menthol. The relief afforded was marked. Within ten minutes he could breathe freely and felt perfectly comfortable. This patient was under treatment for about ten days and was greatly improved. February i6th, Mrs. R , aged forty-five. Had la grippe about one year ago. Had not been well since. She stated that she had night sweats, had lost flesh, coughed a great deal, and expectorated freely. An examination of the sputum showed the presence of tubercle bacilli. This patient has been treated by in- tratracheal injections, Vasotec Enalapril receiving them three times a week: her appetite has improved, the night sweats have ceased, the severity of the cough has been re- lieved, and she has gained ten pounds in weight. She is still under treatment. George S , policeman, aged forty-five. Laryngo- tracheitis with cough lasting four months. During all of this time he was treated by sprays, inhalers, and expectorant mixtures, with slight relief. February 15th I began to treat him by intratracheal injection. He began to improve at once; the injections were re- peated from three to four times a week for about three weeks, with the result that the patient's Vasotec 2.5 Mg health is fully restored. Thomas K , aged thirty-seven, janitor. Had la grippe one Order Vasotec year ago. Severe cough since July, 1895. Had lost flesh. Expectoration profuse and tinged with blood. Evening temperature 102" F., with copious perspiration at night. Physical examination revealed Vasotec 5 Mg extensive pulmonary disease upon the right side, while the microscope showed the presence of tubercle ba- cilli. Notwithstanding the fact that this patient had been constantly under treatment for months, and had been three weeks in the hospital, his cough was with- out exception Vasotec Hctz of the most distressing and persistent character. February 22d I began to treat him by intratracheal injection: benzoinol, europhen, and menthol were used. The relief was immediate. The cough became soft and less persistent, expectoration easy. The fetor of the breath disapijeared. The ap- petite improved. The night sweats have ceased, and the temperature in the evening is normal. This pa- tient is still under treatment. February 21st, Miss Mary W , aged twenty-one, domestic. Atrophic rhinitis, with severe cough and huskiness of the voice, lasting for weeks and resisting the ordinary methods of treatment. Vasotec 20 Mg Diagnosis, la- ryngo-tracheitis. February 21st I treated her by intra- tracheal injection. The relief was immediate, the good effect of the first injection lasting for two days. Three Vasotec Iv injections removed the symptoms of which this patient complained. Mrs. W , aged fifty-five. Subacute tracheitis with feeling of tightness across the upper part of chest. Voice hoarse and cough persistent. March 14th she received an intratracheal injection. The relief in this case was simply magical. Within ten minutes the hoarseness in her voice had disappeared. The sense of constriction across the upper part of chest had vanished, and the desire to cough was gone. The injections were continued for one week and then three times a week until the present time. Result, tlie patient is practically well.

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