By these means the symptoms were quickly overcome, and future attacks prevented.

REMARKS. The attention of the profession was first directed to this species of asthma by my respected friend the late Dr. Bostock, who was a martyr to it. It is not unfrequently met with during the months of June and July, and appears to be caused by inhaling the pollen of some kind of flowers or grass which are at maturity at that period of the year. It may also be produced long after the hay season is over, by simply going into a barn where hay is stored, or by having hay brought to a stable near the house.

CASE XLIV. CONSUMPTION.-In the year 1852, a young lady, aged 18 years, was brought to me for consultation by her parents, who stated, with feelings of great emotion, that they had lost all their other children (three in number) from consumption. Notwithstanding they were now advised (as they unfortunately had been in the former instances) that medicinal treatment was useless, and that a change to a foreign climate was the only chance of prolonging life, they had determined upon keeping her at home-in accordance, too, with the expressed wishes of the patient herself—and trying my mode of treatment. They were the more induced to adopt this plan from the circumstance of my having successfully treated the case of a former schoolfellow, and friend of their child.

The patient had now a pallid appearance with occasional hectic flushes. The respiration was oppressed and hurried; the action of the heart much accelerated; pulse 120; animal heat, 102°; tongue coated and unnaturally red at the sides; little or no appetite; want of rest at night; bowels sometimes loose and sometimes constipated; catamenia suspended; profuse expectoration, occasionally streaked with blood; nocturnal perspirations; great emaciation, attended with so much loss of strength that she was obliged to be lifted out from the carriage.

The physical signs were as follows:-Defective motion and

dulness over the superior half of the right lung, with a combination of gurgling and pectoriloquy. The infra-clavicular spaces were flat and hollow on both sides.

An examination of the sputum by a powerful acromatic microscope unerringly showed that it contained tuberculous matter; and the existence of a cavity, as had been previously pronounced by her former physicians, was incontrovertible.

In reply to the inquiries of the patient's relatives, I informed them that the case was of a truly formidable nature and the result doubtful; but that I would not hesitate to undertake the management of it, knowing as I did, that a recovery, even under such unfavourable circumstances, was by no means of rare occurrence. With respect to her proposed removal to a foreign climate in her present precarious condition of health, I considered it to be a cruel, unwise, and most reprehensible measure.

Without entering into unnecessary minute details-suffice it to say that, for the local affection of the lungs, I prescribed local remedies-inhalations of chlorine in combination with sedatives; and for the improvement of the general health, occasional alteratives, laxatives, tonics (chiefly composed of steel and quinine), with strict hygienic discipline, and such other means ás appeared to be most appropriate to meet the varying conditions of the constitution.

Although there were many drawbacks and barriers to progress, caused by catching fresh colds, domestic affliction (including the sudden death of a near and dear relative from disease of the heart), and other discouraging circumstances, a most marked improvement in her appearance and health was speedily accomplished. After a steady and faithful perseverance in the treatment for sixty-three days, I find the following entry made in my Case Book:-" Nov. 22, '52. Miss visited me, having walked from Eaton Square. The improvement in this case has equalled, if not exceeded, my most sanguine expectations. She has now no cough; her appetite has improved; the night perspirations have wholly

ceased; gained 14 pounds in weight; pulse 85; can count thirty without taking a breath; marked 137 on the spirometer animal heat 98°."

The case continued to progress favourably, and the ultimate termination of it is thus recorded in my Diary :-" Miss's case. January 10, '53. This patient, by her perseverance, energy, and resolution, has nobly seconded my efforts, and she has received her reward—she is now perfectly recovered. The chest, which was formerly flattened, is materially expanded and well developed. The right lung presents all the signs of entire cicatrisation."

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I subsequently heard from the lady as follows:— My health in every respect--thanks to your skill and unremitting attention, aided by the Divine blessing-is in as satisfactory a condition as I could well wish it to be."

REMARKS.-It is not possible to conceive a more pointblank case than the foregoing presents of recovery from a very advanced stage of tuberculous disease, with perfect restoration of the general health.

CASE XLV. CONSUMPTION.-In May, 1852, I professionally visited a lady, ætat. 28, the wife of a manufacturer in Staffordshire. She had been suffering for nine months from cough, attended with muco-purulent expectoration occasionally tinged with blood, general debility, irregularity of periodical health, and loss of appetite. I was told by her husband, that in consequence of having favourably heard of my mode of treatment by inhalation, he had suggested to the medical attendant some months previously that she should personally consult with me; but the gentleman considered that it was quite unnecessary that she should be subjected to so long a journey, inasmuch as he was well acquainted with my remedy, and both willing and able to employ it himself. Under such circumstances the contemplated visit was abandoned, and "my remedy" was then resorted to; but instead of mitigating the symptoms, it greatly augmented them. The spitting of blood increased from a few drops to

more than a tablespoonful per diem; there was also accession of fever, palpitation of the heart, with a feeling of constriction over the whole chest, and difficulty of breathing. The tongue was coated with a yellowish fur, with raised papillæ. The secretions were irregularly acted upon and vitiated, the motions assuming a clay-like appearance, and the urine depositing a lateritious and mucous sediment. Upon hearing the dose and form of the powerful medicament, which had been mixed with boiling water and used in a most rude and unappropriate apparatus, the real cause of this alarming aggravation of the poor lady's symptoms was but too painfully manifest.

By percussion and auscultation I discovered much bronchial irritation, combined with imperfect respiration in the summit of the left lung, and a general dulness of sound; but the physical signs were not so unfavourable as the general symptoms had led me to anticipate.

By a carefully regulated course of treatment by inhalation, and directing an anxious attention to the improvement of the general health by the cautious administration of alteratives, followed up by tonics, chiefly Ferri Citratis, c. Ol. Jecur. Aselli, the patient got quite well, and has remained so. Although I cannot regard this as a case of advanced phthisis, yet I have little doubt that, under ordinary treatment, it would have followed the usual course of the disease, and have sooner or later proved fatal.

REMARKS. The peculiar circumstances connected with the above case, demand that I should explain that by Inhalation is not meant a particular remedy, but a particular method of practice consisting of many remedies. That is to say, the medicines inhaled for the cure of consumption are not alike in all cases, nor in all stages of the same case; for similar trains of symptoms at its different periods, we shall find, require different, and sometimes even opposite, means of cure. Inhaled medicines are adapted to the condition of the lungs, in the same manner that we adapt those given by the stomach

We may

to the object to be accomplished by their use. swallow a purgative, an emetic, or an opiate, and though all are taken in the same manner and pass into the same organ, yet each produces a different effect. So is it with inhaled medicines. We prescribe one inhalation to soothe the lungs, another to expectorate the lungs, a third to stimulate the lungs, a fourth to promote absorption of tubercle, a fifth to astringe the mucous membrane, a sixth to allay spasm in the air-passages; and of each of these kinds a hundred different forms are made by increasing or diminishing the proportions of the ingredients of which they are composed, or by the substitution of other ingredients of the same class. Inhalation, then, as a practice, is a complicated system. Its principles are simple, but its practical adaptation to the cure of disease of necessity most intricate.

CASE XLVI. CONSUMPTION.-A gentleman, aged 29, a member of a mercantile firm in the City, of an exsanguined appearance and naturally nervous and somewhat impetuous constitution, applied to me for advice in the summer of 1858. He was suffering from extreme debility, chronic cough, difficulty of breathing, and wandering pains at the chest, extending up to the shoulders. The pulse was languid; the tongue furred; animal heat 97°. Below the right clavicle there was dullness upon percussion, and on the application of the stethoscope some sibilant râle was audible, and the respiration had a bronchial character. The sputum was opaque, abundant, and fell to the bottom when placed in water. His disorder had been described by his former physician as "pulmonary phthisis," and there could be no doubt of the correctness of this opinion.

Inhalations composed of Sol. Chlorinii Sat., with Suc. Conii, counter-irritants (but without actual blistering), gentle alteratives, followed up by tonics containing Ferri Sulphatis, Quinæ Disulph., &c., were employed in this case, and with such marked benefit that the patient considered himself quite well at the termination of six weeks; and no persua