more difficulty than the pulmonary disease; and after death, M. Louis found the stomach softened or partially destroyed in texture in about one-fifth of the fatal cases; and he supposed this change to be the result of inflammation. It is probable that he was mistaken in his opinion on this point, and that the solution of the coats of the stomach is effected by the action of the gastric fluid which has retained its digestive power after death. But can it be possible that burning, irritating draughts of alcohol even largely diluted, can exert any soothing or invigorating influence upon a patient affected with any of the symptoms just enumerated? See Vol. I., 668. 861.

.

The influence of Alcohol on the liver must not be overlooked. In all the commonest cases of phthisis in every stage, the liver is in a state of torpor or congestion; the blood which should flow rapidly through it from the stomach finds its course obstructed; the capillaries of the mucous membrane of the latter organ are congested; the appetite, though sufficiently craving, is capricious, morbid. If strong brandy can be taken without sensible and immediate injury, it is because the case is not a bad one. If it be long co tinued it must increase and render incurable the structural disease that already exists. If in large doses it does not intoxicate, it can only be that our patient has already reached that deplorable condition in which he finds it "impos sible to get drunk;" if it does intoxicate, it shows that the patient has already entered upon that downward course of physical and moral degradation in which recovery of health is impossible; and if it were possible, to the patient whose earthly existence is thus prolonged, life itself would be of little value.

In the effort to support the strength of a consumptive patient by stimulants, we encounter a danger which in acute diseases is not feared. The patient who has passed the crisis of an acute disease sustained by stimulants can bear to have the dose repeated at intervals for the purpose of keeping up uniform action, since we know that it will not long be needed. In chronic cases, if we attempt to avert the depression which follows the exhilaration of each dose, we may indeed effect it for a time; but the augmented reaction is increased in force each time it is postponed; and it becomes at last so painfully depressing that the patient can not resist the instinct that prompts to the effort to put it off again, though at the expense of rendering recovery hopeless. So decidedly has Alcohol been seen to produce injurious effects in all the febrile forms of the disease, that many authors have decidedly forbidden all stimulating drinks; as Dr. Epps (p. 237.) says, “Wine is poison in this disease and so is ale (in reference to the sick, pale ale) is deepdyed delusion."

*

Hæmorrhage from the lungs is supposed to occur in more than half * Brit. and Foreign Med. Chir. Review.

the whole number of patients affected with phthisis. When profuse, and the blood of a bright arterial color, we have almost uniformly relied on Hamamelis, alternated with Aconite. Millefolium is often effectual. In a case in which the life of the patient seemed endangered by mental excitement, we gave a solution of Tannate of Quinia 3; followed by almost instantaneous curative effects. See Vol. I., p. 800.

Aconite and Arnica are the medicines commonly prescribed, and these are our best remedies when the hæmorrhage is active.*

Acetate of Iron has given more prompt and marked results than any other remedy-a drop or a two-drop dose every twenty minutes; or less frequently, in proportion to the severity of the attack.

This preparation is an uncertain one, and subject to rapid chemical decomposition on exposure to the air, or on being united with water. The Per-chloride is more manageable and perhaps equally efficacious.

All the salts of Iron seem to be similar in their mode of action.
Ipecac. is often given with success.

Dr. Kidd says Turpentine, five or six drops every six hours, is a most efficient remedy.

Mr. Yeldham relies greatly on China. In the form of Tannate of Quinia, as mentioned above it acts almost instantaneously, and is unobjectionable in a patient saturated with ague poison, and in momentary dread of death.

The most absolute rest and silence; cold applications to the chest; a small piece of ice held in the mouth, are recommended as highly important.

Acalipha-indica.-Introduced to the profession in this country by Dr. Tonnicire, of Calcutta, in a letter to Dr. W. E. Payne. While taking it for jaundice it seemed to bring on cough and hæmoptysis; it was then used in consumptive cases with hæmorrhage; in three cases it promptly checked the bleeding.

Dr. W. H. Holcombe says, a negro had pneumonia for which he was treated by cupping and blistering, Aconite and Phosphorus. "He got up and about, but remained weak and spiritless, had no appetite, and was constantly hawking up mouthfuls of fluid red, blood. There was little or no pain in the chest, or cough, no night sweats, but some emaciation, and remarkable slowness of pulse." Ipec. 3. and Hamamelis 3. lessened the red blood for a day, but the next it was red as ever. "The crepitant rale was heard over the upper half of both lungs, and there was slight dullness on percussion." For three or four weeks the disease resisted all treatment devised, and was growing worse: "constant and severe pain in the chest, on distressing cough, pulse one hundred to one hundred and twenty, expectoration of liquid blood more profuse; dullness on per* Dr. Pope, p. 37.

cussion increased, emaciation progressing; the patient gloomy and despairing, though very unwilling to die; pains in the chest; nightly cough and the bloody expectorations were distressing. Gave Acalipha-indica, twenty drops of seventh dilution in a glass of water, a spoonful every two hours.

Next morning the bleeding had ceased, pain and cough greatly decreased. In a day more, pain, cough and expectoration all gone. Ten days later the man felt perfectly well, fine appetite, perfect secretions walked five miles home.

2. ACUTE PHTHISIS.-ACUTE CONSUMPTION.

GRANULAR PHTHISIS.-PHTHISIS GRANULEUSE.

Though ordinary consumption is eminently a chronic disease, lasting several months or more, we frequently meet with cases which pass rapidly through all its different stages, and end fatally. Dr. Flint says, one patient had been in good health when he was attacked by hæmorrhage from the lungs. He passed rapidly into confirmed phthisis, and died in seventeen days from the first attack. But in these cases there is perhaps always a predisposition and often a latent tubercular deposit already existing, as in that same case, in which there had also been a slight hæmorrhage several months before, though the subsequent hacking cough without expectoration was so slight as to excite no appre hension.

In true acute phthisis there is no known or suspected tubercular deposit till the acute disease begins; but, after that time, the deposit is remarkably abundant, extensive, and it undergoes the changes of softening and expectoration with great rapidity.

More correctly still is this name given to the form of the disease, in which there is an accumulation in great numbers of gray semi-transparent granulations, either remaining isolated, or coalescing, and giving rise to a species of infiltration. This is thought to be essentially distinct in its nature from ordinary phthisis. The granular deposit may effect both lungs, and death may ensue before there is time for softening and excavation.

DIAGNOSIS. The tubercular deposit being developed in both lungs so equally, the dullness on percussion is not so distinctive as in chronic phthisis. Auscultation may only furnish such phenomena, as the vibrat. ing and bubbling sounds, and sub-crepitant rale, belonging to acute bronchitis. There are not the exaggerated resonance, broncophony and fremitus that denote tuberculous solidification.

SYMPTOMS.-Chills, followed by some degree of fever; pulse rapid with heat and dryness of the surface; great muscular prostration;

notable increase in the frequency of the respirations, with or without great suffering from dyspnoea; lividity of the prolabia; towards the end of the disease, quiet delirium; subsultus tendinum and sometimes incontinence of urine may occur before death; pain in the chest not severe; cough more or less violent, dry, or with small expectoration, sometimes bloody. The progress is so rapid that emaciation does not occur to the extent it does in chronic phthisis.

Acute Phthisis is less strongly marked than chronic phthisis. If the positive symptoms of the latter form of disease are present in an inferior degree, but the case is progressing rapidly, then acute phthisis may be suspected.

From the frequency of respirations, dyspnoea, lividity and rapidity of circulation we might infer disease of the heart; but the latter ought to be positively known by conclusive physical signs, and thus distinguished.

Acute phthisis is distinguished from pneumonitis by the latter having physical signs which show solidification over the whole lung (in adults) commonly the lower lobe, and it travels from lobe to lobe. In the former the disease is developed simultaneously in both lungs, the upper portions of the lungs being most affected.

TREATMENT. Our main reliance must be placed upon the following remedies in this malady: Aconite, Phosphorus, Stibium, Bryonia, Stannum, Mercurius-hydriodicum, Ammonium-carbonicum, Kalihydriodicum, Digitalis, Lobelia-inflata. For the most part, we prescribe these medicines at the first attenuations.

TUBERCULOSIS OF THE BRONCHIAL GLANDS.-BRONCHIAL PHTHISIS.

Enlargement of the bronchial glands is a common accompaniment of pulmonary tuberculosis, though the symptoms during life do not always suggest this condition. In the cases in which tuberculosis is limited to these glands they may increase considerably in size; they may go through processes similar to those which they undergo in the lungs, producing cavities communicating with the bronchia, or the oesophagus, or even the pleural cavity. The glands primarily affected are those situated near the bronchia; thence the disease extends to the glands imbedded in the lungs, in the direction of the bronchial subdivisions, also to those in the pericardium, the oesophagus, and the large vessels in the anterior mediastinum.

It is only when the bronchial glands are the seat of tuberculous deposit, when at the same time tubercles are not present in the lungs, that the disease gets the appellation of bronchial phthisis. It is a disease peculiar to childhood, and is rare then, for generally cases beginning in this form soon run into true pulmonary phthisis.

VOL IL-17.

PROGNOSIS. Recovery takes place in a few cases only: the rest are fatal, generally by progressing into confirmed phthisis pulmonalis.

DIAGNOSIS. This is difficult, as explorations of the chest are with difficulty made in children's cases; it is difficult in them to distinguish this disease from true tubercular consumption.

Bronchial Phthisis is common after bronchitis, and its symptoms continue to appear. The cough assumes a paroxysmal character like that of whooping-cough. There may be oedema of the face and swelling of the veins of the neck, arising from the pressure of the bronchial glands on the vena cava. Respiration more or less hurried; loss of flesh observable, but with great fluctuations in degree.* Lymphatic glands of the neck frequently enlarged.

PHYSICAL SIGNS.-Pressure of enlarged bronchial glands on one of the bronchi may produce feebleness or suppression of the respiratory sound on one side. Dullness in the interscapular region on percussion; broncial respiration remains in its ordinary site, the interscapular space behind, and in the neighborhood of the sterno-clavicular junction in front, and there it may be exaggerated. Mucous rales, and perhaps gurgling sounds in the same vicinity. If phthisis pulmonalis exist it will be recognized by the persisting cough, cinneration, night-sweats, &c., characterestic of that disease.

In simple acute bronchitis there is generally disparity of resonance between the two sides on percussion; and the bronchial rales are less marked, but more manifest at the summit of the chest; less abundant expectoration; dyspnoea and increased frequency of respiration, greater than in ordinary acute bronchitis, but less marked, less dangerous, and the course of the disease longer than acute general capillary bronchitis.