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He had suffered for some months from constant pain, and a feeling of restraint over the chest; palpitations; distressing cough, attended with copious expectoration of puriform matter, occasionally tinged with blood; disrelish for food; great debility; night perspirations; breathing 30; animal heat 97° (ascertained by the bulb of a properly constructed thermometer being placed under the tongue); the pulse usually beyond 100. These symptoms, which had been treated in a manner calculated to exhaust his general power -as by low diet, leeches, blisters, expectorants, &c.—appearing to become rather aggravated than relieved, my advice was sought. The complaint, it appeared, originated with spitting of blood, which occurred to the amount of about three ounces, and continued in smaller quantities for a few days, and then ceased altogether. On examining the chest by the stethoscope, and by percussion, I detected wellmarked pectoriloquism, and dulness at the right collar-bone, with a gurgling noise and a cavernous ring on coughing, extending downwards to the fourth rib; at the left side the respiration was imperfect, and percussion elicited a dull sound over the clavicular and sub-clavicular region, and posteriorly on the opposite part of the same side. The heart gave no abnornal indications, though its motions were accelerated and irregular. The former medical, attendant pronounced the child to have tubercles, and that the ulcerative process had commenced, and considered his recovery as hopeless. I coincided with this gentleman in his diagnosis, but not in his prognosis, or treatment. I directed that the patient should inhale chlorine and belladonna at a temperature of 120°, and take a mixture composed of sulphate of quinine and steel, with light and nutritious diet. This plan was attentively followed up, and with such success, that, in twelve days, the respiration was more natural, the cough much less troublesome, the appearance of the sputum greatly improved, and the night perspirations lessened. In another twelve days the results were still more satisfactory: the

circulation became fuller and firmer, the surface more florid, the spirits improved, and the severity of the cough and local symptoms were so much relieved by the influence of the inhalations that my patient was enabled to sit up several hours in an arm-chair, without experiencing fatigue or inconvenience; in fourteen weeks from the date of my first seeing him, his health was quite re-established, and he has had no relapse up to the present time.

REMARKS. In this interesting case it will be seen that the chief remedy consisted in the inhalation of chlorine, which is an elementary gaseous body, and was discovered by the illustrious Scheele in 1774, who, perhaps, pointed out more new and valuable substances than any chemist in ancient or modern times. Scheele named it diphlogisticated marine acid: this term, however, is incorrect; but if we substitute hydrogen for phlogiston, as many of our modern chemists have done, the views of the discoverer will be perfectly correct and intelligible; for it is now well known that when hydrogen is abstracted from marine (hydrochloric) acid, chlorine is obtained; and, on the contrary, when hydrogen is combined with chlorine, marine acid is produced. Shortly after the discovery of this gas Sir Humphry Davy instituted an examination of it, and on account of its green colour gave it the name of chlorine (from xλwpos), by which it has been known to the present time.

Chlorine is absorbed and dissolved by water, and when that fluid has been boiled it will take up twice its bulk of the gas at a common temperature and pressure. The aqueous solution has the taste and smell of the gas itself, and is the preparation I usually employ, taking care that the chlorine is extremely pure, of uniform strength, of one and a half volume of chlorine in solution, and carefully preserved from the action of the sun, which quickly decomposes it.

Besides the local applications of chlorine to the immediate seat of disease, which were so successfully adopted, it will be remarked that those remedies which were calculated to

restore strength and vigour to the system (which had been so lowered by bleedings and abstinence), and to improve the general tone of the constitution, were simultaneously employed.

I may here remark that I believe the foundation of consumption is oftentimes laid by the too great abstraction of blood. It is no uncommon thing to meet with young people who have been bled, purged, and salivated, for some imaginary inflammatory affection, to the utter destruction of the general powers of the system, and who, after a life of prolonged misery and suffering, have eventually sunk under tuberculous disease. Even in inflammatory cases, it is, in my humble opinion, a great mistake to suppose that it is necessary to take such large quantities of blood, or to bleed to such an extent as to occasion syncope, in order to check disease. Every day's experience has shown me the evil results of this "bold" line of practice. With respect to the employment of venesection in phthisical cases, I agree with Laennec, who observes, "Bleeding can neither prevent the formation of tubercles, nor cure them when formed. It ought never to be employed in the treatment of consumption, except to remove inflammation, or active determinations of blood, with which disease may be complicated. Beyond this, its operation can only tend to a useless loss of strength." The great object should be, while endeavouring to correct the local morbid action, not to reduce the strength by these or other excessive drains upon the system, but to augment the constitutional power, and overcome nervous irritability by the judicious administration of tonics, and the allowance of generous diet, with a moderate quantity of good beer or wine. It is only by such treatment, aided by quietude, proper clothing, and pure air, that the general health is to be improved, the absorption of tubercles promoted, and the tendency to fresh depositions counteracted -hoc opus, hic labor.

Relative to tonics it is necessary to add that their beneficial effects depend upon their mode of administration, and they

ought not to be given as long as the pulse is strongly agitated, and, at the same time, strained and hard; the cough very frequent, short, and dry; and the respiration uncommonly accelerated and short; as long, indeed, as there exists an inflammatory state of the lungs; the alimentary canal should also be free from irritation and irregular or disordered secretions. If these points be not attended to, their employment will tend rather to decrease than augment the general power. The selection of tonics, too, should be regulated by the character of the debility and the condition of the patient; of this important class of remedies I have generally found the preparations of steel and bark produce the most good in persons of feeble power, and of a scrofulous or consumptive habit. The use of stimulants requires the same caution as that of tonics, and must be greatly guided by the previous habits of patients; they are especially necessary to those persons who have been habitually accustomed to their use. I have frequently observed irreparable mischief occasioned by their being suddenly and incautiously withdrawn, and have found many chronic and pulmonary diseases yield much more readily when they were carefully given.

CASE II. CONSUMPTION.-A young lady about twenty years of age, of delicate aspect and lymphatic temperament, consulted me July 4th, 1838, in consequence of a very severe cough, attended with acute pains in the chest, from which she had suffered for several weeks. She had been treated by the usual remedies, but had obtained no further benefit than a mitigation of the symptoms. She was pallid, with occasional hectic flushes; much depressed in spirits; the circulation quick, but very feeble; the cough incessant, and attended with purulent expectoration; appetite indifferent; palpitations; catamenia irregular; bowels costive; nocturnal perspirations; inspirations 32 in a minute; animal heat 99°; very perceptible dulness on percussion at the right infraclavicular and mammary regions, and pectoriloquism at the

apex of the lung; the left side was very sonorous, with puerile respiration, and some fine mucous and sibilant râles: the action of the heart, when quickened, was accompanied by a slight bruit de soufflet, which disappeared so soon as that organ became quiet. I directed that the patient should be drycupped over the chest; and prescribed an inhalation of iodine. and conium at a temperature of 120°, iodine liniment, with a saline aperient mixture, and a soothing pill, composed of hydrochlorate of morphine, at bed-time: subsequently, in consequence of her exsanguined appearance, small doses of steel and quinine, with a good, nutritious, but plain diet. Treatment on this principle was continued for ten weeks, during which period an occasional change was made in the tonic remedy, and in the quantity and frequency of the inhalations. The dry-cupping-which was had recourse to three times-materially relieved the thoracic pains; the cough and local morbid action were overcome by the influence of the inhalations; and the general health was materially improved by a perseverance in the tonics. The progress was steady and satisfactory; uterine action became perfectly re-established; and, in eighty days from the commencement of my treatment, all the symptoms were removed, and her usual state of health restored.

CASE III. CONSUMPTION.-A gentleman, aged thirty-five, a solicitor, of feeble power and intemperate habits, consulted me, Sept. 2nd, 1839, and stated that he had, three years previously, an attack of pulmonary inflammation, with cough and spitting of blood, for which venesection, cupping, and mercurials had been prescribed. Since that time a constant irritating cough, attended with expectoration, had continued, and within the last month so much increased as to confine him to his bedroom. A physician of some note had to this date attended him, and pronounced the case to be a hopeless one.

When I first saw the patient he was pallid; much distressed, with an anxious look; suffered from a constant

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