CHAPTER IV

VALUE OF MEDICINAL NAPHTHA IN MORE ADVANCED PHTHISIS PREVIOUS TO SOFTENING OF THE TUBERCLES.

I wiLL now pass on to consider the operation of Médicinal Naphtha in more advanced cases of phthisis, but still before the occurrence of softening.

Tuhermlar consolidation of the superior lobe of the right Iwig. Clive by Naphtha. — Case 8. Ellen Donovan, ætat 26, residing at No. 10, Carcy-street, Grange-court, was admitted under ray care at the Bleuheim-strcet Iiifirmaiy, on the 12th of Junc, 1844. lier father, mother, two sisters, and a brother hâve died of consuniption. Her mother, vvho had been apparently in the enjoyment of very good health previous to her father’s illness, was seized with plithisical symptoms, after a long and painful attendance on her father. She states that she has herself beeu ill about two months, that she had been alM'ays délicate and apt to suffer from cough. Two months ago she spit up “ two or three mouthfuls ” of bright florid blood, and the sputa has been more or less streaked with blood ever since. She has emaciated gradually during her illness, and the catamenia hâve become gradually suppressed. Her cough at présent is not very severe, but occurs especially in the early morning, and from any exertion, and she suffers from shortness of breath. The sputa are thick and opaque, viscid, and in small quantities. The puise are hahitually small and frequent, and she suffers from a state of hectic, Avith evening chills, followed by beat and nocturnal perspirations. She perspires freely from slight causes — such as excitement or exertiou — and is so feeble and breathless that she becomes fatigued almost without any exertion, so much so as to render her almost incapable of undertaking any thing which requires exertion. She complains of pain in both shoulders, and opjmsite the centre of the sternum, extending to the right side.

Physical signs. — Right upper and anterior part of the chest is flattened, and possesses less mobihty, on a deep inspiration, than the left side. The right sub-claAÛcular and scapidar régions and the sternal end of the right clavicle yield a very dull Sound,' Avith increased résistance on percussion. Breathing in the axilla and over the régions already mentioned bronchial -, voice highly résonant, amounting to diffused broncophony ; heart sounds very loud and clear over the dull portions. She was ordered xv of Naph. Med. in water three times a-day.

June 15th. Eeels considerably relieved ; her cough, but especially her breath, arc much better. To continue, and use an alum lotion with the fcmale syringe for leucorrhœa. 19th.

Contimics to improve in lier general healtli, but complains of pain in tlie région of tlic riglit scapnla. Auscultation discovered, in addition to broncliial brcatliing and broncopliony, occasional large moist crépitation (mucus rlioncus) over the whole of tbe infra-spinous division of tlie scapular région. Auscultatory phenomena in front as before. To continue.

June 22ud. Her breatli and cough^ &c., are very mucli relieved, but she feels very weak and low. She again spit up about a tea-spoonful of florid blood last evening, after taking a longer walk tlian usual. Tlie pbysical signs remain nearly as befoi’C; these being diffused bronchial breatliing and broncophony antcriorily, laterally, and posteriorly over tbe upper part of tlie superior psjyt of tlie riglit side of the chest. The large crépitation continued over the scapular région, vvhich at the inferior angle almost amounted to gurgling — having a hollow, somewhat metallic, character.

She continued to improve steadily, and was much better in her general healtli and chest symptoms on the 26th and also on the 17th of July. To continue.

July 27th. Is considerably better in her general health, breath very much relieved, cough and expectoration diminished ; bas no pain in any part of the chest. During the last week lias had an attack of bilious diarrhœa, which has now ceased. The riglit sub-clavicular, clavicular, and super-clavicular régions remain considerably flattened, with less l'espiratory play than the left side ; the upper part of the riglit side of the chest is still decidedly duller on percussion than the left, both anteriorly and • posteriorly ; murmurs harsh, with prolonged expiration ; voice and heart sounds unduly résonant, but by no means so much so as on the previous examination — especially the résonance of the heart sounds. Left side perfectly normal. To continue.

August lOth. Has not been so well during the week, which she attributes to getting her feet wet : during this time she spit up small quantities of blood, and sulFered from diarrhœa. She is now again much better. Pbysical signs nearly as before with some sibilant rhoncus on the left side.

August 28th. Has felt nearly well till a few days since, when lier throat bccame sore. Her throat is now well, but she

Couglicd up “ two moutlifuls ” of blood last cvciiing, and hcr si>uta havc contiiiucd to bc strcakcd witli blood to-day. On tlic Avhole, liowever, sbc feels both better and strongcr; tbc congb and brcatli niucb better — slie was almost as wcll as slie used to be befoi’e ber illness some few days since. Dulness on percussion bas nearly disappeared, and tbe respiratory murmurs are pcrfectly normal. Complains of pain on percussion over tbe inter scapulæ région, on tbc left side. To continue. To rub in tbe Ung. Ant. Pot. Tart. over tbe front of tbc ebest.

September 14tb. Feels quitc well.

September 21st. Is now, sbe states, in better bcaltb tban sbe bas been in for years, altboxigb tins is not robust; sbe bas neitber cougb nor difficulty in breathing, except occasionally from any unusual or violent cxei’cise. Tbe llattening of tbe superior part of tbe rigbt side of tbe ebest anteriorly continues, but tbe two sides arc equal in tbeir respiratory movements. Tbere is no dulness on percussion, and tbe respiratory murmurs Sound exactly alike on botli sides (expiration being audible on l)otb sides and sligbtly more prolonged tban usual — somewliere about one-tbird tbe lengtb of inspiration — instead of about two to tcn). Hcart sounds are not unduly audible on tbe rigbt side, but tbe voice is cousidei’ably more résonant over tbe upper part of tbe rigbt side, botb anteriorly and posteriorly, tban tbe left. Still to continue tbe Napbtba. Catamenia restored.

Case 9. Tubercular Consolidation of the superior lobe of both lungs : Great improvement in the general symptoms, and relief of the indurated portions of lung, as indicated by the physical signs ; relapse of the symptoms and occurrence of some laryngeal • diseuse. Elizabeth Cooper, ætat 39, a waistcoat maker, residing at 30, Uni ver sity- Street, was admitted at the Blenheimstreet Infirmary under my care on the Ist of June, 1844. Her father and sister both died of consumption. She has herself been ill five months, and her ailments commenced with severe cough, pain behind the centre of the sternum, &c., which attack she believed to be “ influenza.” Many of the same symptoms, although relieved, hâve continued to the présent time. She has spit “ two or three tea-spoonsful ” of pure blood this morning for the first time, and has continued to cough up small quanti-

tics with the spnta since. Slic lias emaciatcd mucli since tlic commeuceraeut of lier illiiess^ and lias felt veiy poorly, nervoiis, and breatliless.

At présent her cougli is veiy troiiblesorae, espeeially in tbe early niorning, and slie expectorâtes a yellow, sometimes a wliite^ mucus in tolerable quantity, whilst ber breatli is constantly difFicnit and vcry sliort. lier puise are sniall^ qnick, and feeble, and slie often snffers froin sliglit cliill, followed by beat, but rarely by perspiration. Slie bas, and continues to sufler occasionally from pleuritic pains in tbe sboulders, and sense of mucb external beat. Catamenia suppressed.

Physical signs. Flattening and diminisbed motion of tbe antero-siiperior portions of tbe left side of tbe cbest ; dulness on percussion witli increased résistance, of tbe sternal end of tbe clavicle and of tbe sub-clavicnlar région of tbe left side; increased résonance of tbe voice, and sonuds of tbe beart morbidly clearover tbe dull portions; respiratory murmurs barsband loud, ivitb greatly prolonged expiratory — being nearly as long as inspiratory. Slie was directed xv iq, of Napb. Med. in balf a wine glass of water tbree times a day.

June 5tb. Ail tbe symptoms are mucb relieved, and sbc feels mucb better ; tbe expectorated matters are diminisbed in quantity ; cougb less ; breatb mucb freer.

June 15tb. Continued to improve considerably till yesterday, wben from baving over exerted berself slie spit uji in cougbing about two table-spoonsful of brigbt blood, vrliicb continues to colour tbe sputa of a brigbt scarlet colour. Tbe dulness on percussion bas diminisbed, tbe respiratory murmurs arc less barsb, and tbe expiratory less prolonged.

Symptoms considerably improved on tbe 22nd. Not quitc so well on tbe 29tb. Has spit blood in small quantities tbis morning, mixed witb sputa, wbicb still continues coloured, and complains of pain in tbe left sboulder. Sbe feels better since tbe occurrence of bœmoptysis. Tbe left antero-superior part of the cbest is ratber duller tban on tbe préviens examination, and percussion excites uneasiness and disposition to cougb ; respiratory murmui’s as before ; rigbt side normal.

July Ist. On tbe previous date sbc ivas siipplied witb tbe

Tion-mcclicinal naphtha (wlilcli I liavc rncntioncd as vcry closcly l’cscmhling thc médicinal) wlncli lias disagrccd considcralily witli lier eack time slie lias takcn it. It lias produecd paiu iii the cliest, severe cougli, great difficulty of breatliiag, and mucli expectoration of bloody mucus. To omit napbtlia, and to take ^i of Mist. Expect. tlirce timcs a day. Sbe improved gradually, and returned to thc napli. mcd.

August lOtli. Eecls mucli better; cougli and expectoration diminished ; breathing mucli freer and casier; lias taken Naph. Mcd. with Pot. Nit. and v iîl of Lig. Opii Sed. three timcs a day for tlie last fortniglit. To continue. Left side as beforc J riglit side sliglitly dull on percussion, with some harshness of murmurs, and increased résonance of voice and heart sounds.

15th. Symptoms much improved; émaciation continues. 24th. Improvement continues.

September 7th. Complains much of dyspeptic symptoms, Avith pain opposite the inferior angle of the right scapula. Complains also of pain in both shoulders. In other respects as before. Flattening of the left side of the chest anteriorly continues, and some of the right ; respiratory motions diminished ; dulness and résistance on percussion diminished on both sides ; murmurs normal both anteriorly and posteriorly ; a faint rubbing sound beneath the acromial end of the left clavicle. She was ordered two table spoonsful of the following mixture three times a day : (9î Napthæ Med. 5ij, Inf. Gent. Comp., Aquœ Menth Pip. ââ 3 iv, M.) and to rub in the Ung. Antim. Pot. Tart. over the front of the chest — Pii Saponis 6 opio, v grs. Omni Nocte.

September llth. The tongueis covered with aphthous ulcérations ; in other respects much better ; dyspeptic symptoms Icss troublesome ; cough and sputa less ; breath better. To continue mixture, and use an alum gargle, also to apply borax and honey to the ulcérations.

September 16th. Plas not had medicine for some days, and her breath is much worse in conséquence. Complains of considérable pain in both shoulders, with augmented heat of the parts. Dyspeptic symptoms very troublesome — especially flatulence ; longue better. Percussion elicits a sliglitly dullcr sound on the right side superiorily than thc left, but is very slight on

either sicle. Murmurs harsher on tlie right sicle tlian tl.e left ; a single dry click was lieard witli inspiration on the left side ; no rubbing sound; voice and heart-souuds very sligbtly more résonant than natnral. Flattening of botli sides and diminisbed motion, especially the left. Emaciation increases. To continue. Has badnigbts. To take nightly xviij of Liq. Opii.'Sed. witli 1 of Hydro-cyanic Acid, with of water.

September 19th. Erom liaving lost ber Infirmary paper she bas bad no medicine, and again feels’mucb worse. Tbe bectic, tbe cougb, expectoration, and difficulty of breatbing are ail more severe. 22nd. Tbe bad general symptoms continue, altbougb sbe obtains relief from flatulence, and tbe difficulty of breatbing by taking the mixture, and bas completely lost ail pain in tbe sboulders and chest. Has no appetite ; tongue red and sligbtly excoriated, •witb two or three ulcerated patcbes of small size ; no pain in any part of tbe abdomen. Has not continued tbe nigbt draughts as she experienced giddiness and confusion from tbem the next morning. During the two last nights she bas awoke more tban once witb pain about the glottis, and urgent sense of suffocation — the laryngeal dyspnœa continuing for some time — also dyspbagia, and sense of suffocation on attempting to swallow anytbing solid. Emaciation increases ; puise 110, feeble. The upper and anterior part of both sides of tbe chest are flattened ; respiratory motions nearly equal ; sound ou percussion alike on both sides — sligbtly duller tban the upper part of the mammary région. Inspiratory murmur over tbe dull portions anteriorly on the right side sligbtly harsher tban natural; no expiratory murmur to be heard ; a few moist crackling sounds beard over a limited space, beneath tbe claHcle near tbe sternum ; voice and heart sound not excessively résonant. Notbiug morbid to be beard on placing the stéthoscope over tbe larynx. 24tb. Laryngeal dyspnœa and dyspbagia increased : paroxysm cornes on during sleep. Occasional trachéal rhoncus. Tbe tongue continues very sore, and is covered with apbthæ. To continue, and to take three grains of Pii. Hydrarg. every other nigbt; ablister to the upper part of the tliorax.

Case 10. Rosina Bellilo, ætat 7, résides at 18, Cateatonstreet, City, was admitted undcr my care at the Blenbeim-strect

Infirmary, ou tlie 6tli of Mardi 1844. Shc has been rcmarkably subjected to catarrlis from birtb. She is a délicate looking littlc girl, witb a circurascribed flush on tlie clieeks. AU ber fi’iends are bealtby witb tbe exception of tbe motber, wbo is considered consumptivc. Her présent attack became worse about four • week s ago ; since wbicb time her cough has increased gradually. She bas cougbed up tbree or four times pure blood in quantifies of “ about a tea-spoonful,” and altbough so young expectorâtes an opaque mucus in considérable quantifies. She bas emaciated mucb during her illness, and suffers considerably from evening fever, nigbt sweats, and other indications of hectic. Puise small and rapid ; appetite déficient ; bowels regular and bealtby.

Physical signs. Flattcningj witb diminisbed respiratory motion, of tbe upper and anterior part of tbe rigbt side of tbe cbest ; dulness and increased résistance on percussion over tbe clavicular and sub-clavicular régions of tbe rigbt side ; bronchial breatbing, and dilfused broncophony, amounting in some places to Laennec’s imperfect pectoriloquy over tbe duU portions ; puerile respiration over tbe corresponding portions of left side. Sibilant and sonorous rboncus beard over tbe scapular and inter scapular régions. To apply a blister to tbe cbest, and to take x tq of Naph. Med. in water tbree finies a day.

April 17tb. Her general bealtb and cbest symptoms are very considerably improved. Parts less dull on percussion ; respiratory murmurs harsb, and expiratory prolonged ; rhonci bave disappeared. To continue.

May 18th. I was informed by her motber, wbo applied for her medicine, tbat sbe was almost well, and promised to bring ber for my inspection. I bave not seen her since.

Case 11. Tubercular consolidation of tbe superior lobe of tbe rigbt lung ; great benefit from Napbtba. — Robert Wilson, ætat 35, residing at 53, Castle-street East, Oxford-street, was admitted under my care at tbe Blenbeim-street Infirmary, on tbe 15tb of June, 1844. Has been an invalid, and suffered from cough and difiBculty of breatbing, witb occasional periods of improvement, for nearly tbree years. Tbree montbs since spit blood for nine consecutive days, in quantifies varying from one quarter to half

a pint on each day. His father died from consumption, and several near relations suffer from “ cougli.” He bas lately lost flesh, and lias felt liimself inadéquate to do anytbing requiring exertion. He sulfers much from shortness of breatli, and a distressing eougb — espeeially in tbe early morning. Sputa tbick and opaque ; puise quiek and weak ; suffers from nocturnal paroxysm of fever. He bas an occasional severe pain in tbe rigbt sboulder, and a, peculiar spasmodic muscular pain in tbe left bypocondriae région, -wliicb first came on during tbe violent straining of vomiting, and now prevents a deep inspiration, and free cougbing.

Physical signs. Flattening witb diminisbed motion of tbe upper part of tbe anterior surface of tbe rigbt side of tbe cbest. Rigbt anterior and superior portions of tbe cbest very dull, and resisting on percussion, espeeially over tbe second and tbird ribs near tbe sternum ; increased résonance of tbe beart-sounds and voice over tbe dull portions ; respiratory murmurs anteriorly and laterally barsb and loud over tbe superior part of tbe same side, expiration also mucb prolonged. Left side, corresponding to tbe diseased portion on tbe rigbt, sounds well, witb sligbtly exaggerated respiration.

He was directed to rub in tbe unguent. Antim. Pot. Tart., and to take xv lit of Napb. Med. in water three times a-day.

June 19tb. Sligbtly improved; tongue coated witb a tbick yellow fur, and complains of an unpleasant bitter taste in bis moutb of a morning, witb uneasiness at tbe inferior angle of tbe rigbt scapula. To continue, and to take three grains of blue pill every otber nigbt. 22nd. Says tbat be does not feel better in bis general bealth, altbougb bs bas much better nigbts, and his breath is by no raeans so short as it was. Dulness on percussion and résonance of heart sounds less considérable than on previous examinations. To continue.

June 26tb. States tbat he feels much better, bis breath is mucb freer, bis eougb casier, and bis expectoration diminisbed and less purulent; sleeps very well. 29tb. Continues to improve, and bas lost ail pain in tbe superior part of tbe rigbt side of tbe cbest, and by tbe scapula ; pain in tbe left side easier and only occasional. Cougb and breatbing very mucb relieved ; expectora-

tiou ditninished. Chest sounds much better on percussion, thc heart sounds are less résonant, andtlie respiratory murmurs less harsh with less prolongation of tlie expiratory.

July 3rd. Chest symptonas and his general health continue to improve, but suffers much from hæmorrhoidal tumours, for which he consulted my colleague, Mr. Storks.

July 17th. The non-medicinal naphtha (most nearly resembling the médicinal) was given him on his last application for medicine, and he was very ill, with great increase of his chest symptoms during the few days he took it. Found himself so much worse after each dose that he omitted its use. Seing again supphed with White’s, is much better, but not so well as on the last date. There is some enlargement, of a firm nature, of the textures covering the second cartilage at its junction with the sternum. To continue.

July 20th. Feels better. 24th. Continues to improve. The swelling is much increased in size, being about four inches in circumference, and is circumscribed, hard, and painful The skin covering it is not adhèrent, but has an inflammatory blush. Respiratory murmurs of this side are nearly normal, slightly exaggerated on the left side ; complains of pain in the swelling. Ilis cough is less troublesome, breath improved, and sputa diminished. lias had two or three bad nights from the pain in the swelling, and his cough has also been very troublesome during the same time. To continue, also to hâve the tumid parts painted over with Tincture of lodine, and to take five grains of the Pii. Sap. e Opio. at bed-time.

J uly 27th. Chest symptoms improved ; swelling much diminished. To continue the lodine which has been applied every morning, also the drops, &c. Having obtained a recommendation, he became an in-patient of some hospital, since which I hâve lost sight of him.

Case 12. Tubercular consolidation of the superior lobe of the right Iwig, improvement from a weelds use of Naphtha. Eliza Foley, ætat 35, residing at 5, Brewer-street, Golden-square, was admitted under my care on the Ist of May, 1844. Her illness comraenced in October, 1843, when she was confined to her bed for some time, with symptoms w'hich she States were those of

“ inflammation of the bowels.” Her recovery was protracted, and she then became troubled with cough and difficulty of breath» ing, and bas never been well since. Several of her brotbers and sisters bave died of consumption. About two montbs ago sbe spit for some time small quantifies of brigbt blood mixed witb pblegm. Sbe now suffers from an evening paroxysm of fever, with profuse night sweats. Cough very severein the early morning. Catamenia suppressed.

Physical signs. — Dulness and increased résistance of the antero-superior part of the rigbt side of the cbest, increased résonance of the voice and heart sounds ; respiratory murmurs over dull portions very indistinct.

She was ordered xv of Naph. Med. three times a-day out of water.

May 8th. Has experienced much relief to her cough and breath from the drops^ especially soon after taking them, and passes much better nights. Pain in the right shoulder, which occasionally shoots from the front to the back, has been troublesome. In her general health does not feel better. Becoraes so exhausted from waiting with the otlier patients that she feels herself unable to attend.

Case 13. Tubercular consolidation of the superior lobes ofboth lungs ; relief from Naphtha. Mary Ann Paget^ ætat 18, residing at 195, Piccadilly, was admitted under my care on the 22nd of June 1844. She has been ill for three months. lier ailments commenced with cough and pain in the chest, which she thought “ a bad cold,^^ for which she had a blister applied, and took medicine with some relief. Her symptoms, however, continued, and she has gradually become worse and worse nearly up to the présent time. The first attack followed over-exertion, by which she was much heated. Shethiuks that she has felt better during the last day or two than she did a week previously. Dmûng Whitsun-week she spit up about “ a tea-spoonful” of brigbt, florid blood, after coughing, and the same has occurred seven or eight times since. Her mother died of consumption, and a brother in his eleventh year.

At présent she suffers from a severe and troublesome cough, attended by mucus expectoration and much shortness of breatln

so that she is incapable of any exertion. Her puise are rapid, full and soft ; perspires a good deal from sliglit excitement or exertion^ and lias evening fever, witli nocturnal perspirations. Sputa tliick and opaque ; breath and sputa possess a powerful odour of garlic and sulphuretted hydrogen. Catamenia suppressed.

Physical signs. — Upper and anterior part of tlie right side of the eliest considerably flattened, -witli diminished play during respiration. Dulness with increased résistance over tbe anterosuperior régions of the chest on both sides ; bronchial respiration and broncophony on the right side anteriorly, heard immediately beneath the clavicle, and as Ioav as the fourth rib at its junction with the sternum ; on the left side the respiratory murmurs are harsh and loud, and the expiratory prolonged ; voice and heart sounds unduly résonant over the dull portions on both sides. The sounds on percussion and the murmurs are normal posteriorly. Naphthæ Med. xv ni ter. die.

May 29th. Feels better ; cough and expectoration diminishedj breath less short and difficult ; pain in the shoulders (from which she previously suffered) has entirely disappeared. Physical signs essentially as before. Percussion over the affected parts produces irritation and cough. To continue.

The patient, unwilling to forego the benefits of the naphtha treatment, placed herself under the private care of Dr. Hastings^ during the author’s temporary absence from town.

Remaries. In the foregoing six cases the physical signs were essentially similar to those which were présent in the seven preceding ones — only more advanced, and extensively disseminated. AU the patients inherited a tendency to consumption ; in the ease of Donovan both parents, besides near relations, had died of phthisis ; Cooper had lost her father and sister from this disease ; Bellilo’s mother was consumptive ; Wilson had lost his father and near relatives from phthisis ; Foley, several near relations ; and Paget her mother and brother. Phthisical symptoms should always be regarded with appréhension in those having an hereditary tendency, and physical signs, which might be regarded as far from conclusive in some cases, are of much more weight when one or both parents hâve already died from consumption.

în tîie case of Donovan it was stated tliat lier fatlier died of consumption first, and tliat her motlierj wlio liad previously been in tlie eiîjoyment of excellent liealtli, became ill^ and died of plithisis, after a long and painful attendance on lier fatlier. Donovan lierself became ill after the attendance on lier mother. It is a question of vast practical inportance whether plithisis be infectious ? Whether, in fact, a previously healthy person, without any constitutional tendency to the disease, can, by prolonged and close attendance on those sutfering from phthisis — sleeping constantly as well as living in the vitiated atmosphère of the sick-room, and respiring the air which has previously been breathed by the patient — whether, under these circumstances, combined with grief, fatigue, anxiety, and déficient sleep, &c., the constitutional taint, necessary for the déposition of tubercle^ can be produced, and genuine phthisis excited ?

A connexion of my own, none of whose relatives were either consumptive or had died of phthisis, and who had himself never shown any tendency to the disease, became affected, and ultimately died from it, after a very close attendance on a friend ■who fell a victim to consumption.

It is a curions fact also that those who hâve rendered themselves eminent by their close attention to, and successful investigation of the diseases of the lungs, hâve themselves often ultimately fallen victims to consumption — for example, Laennec, Fournet, &c. It is true a prédisposition may hâve existed in some or ail such cases, however little tendency there may hâve been manifested pre'viously ; but such facts should suggest caution— especially in those who possess an hereditary prédisposition to the disease, to avoid a too close and too constant attention on those dying of phthisis. That phthisis may be, and constantly is excited, in those predisposed, by close attendance on near and dear relations will be proved by the expérience of ail those who hâve seen much of the dreadful ravages of consumption.

Hæmoptysis was a prominent symptom in every case, and was renewed from every aggravation of the symptoms. Pain in the shoulder or shoulders also was a painful featm’e in ail, with the exception of Bellilo. Moreover the catamenia were sup-

\)rcssecl in ail the womcn, being restored in tliose wlio benefittcd considerably from tbe naphtba.

Percussion over tbe diseased parts produced the peculiar sense of irritation and cough, in most of thèse patients which I hâve already spoken of, and which, taken with other symptoms, is of some value in diagnosis.

Abscesses and fistula by the side of the rectum occurred in none. Wilson, however, suffered from hæmorrhoidal tumours, and Sly (among the seven cases first described), had abscesses form between the vagina and rectum, with superficial ulcération of the mucus membrane of the vagina, and short fistulous passages in the sphincter. M. Reynaud met with one case of ulcération of the vagina at the Hospital of La Pitié, where softened tuberculous matter cscaped into the vagina from the utérus. A tubercle of the size of an ordinary pea was found in the substance of the body of the utérus, underneath the tubercvdous stratum. M. Reynand observes that the fact of iilcerations existing in the most dépendent part of the vagina — in that part which was incessantly bathed with tuberculous matter, escaping from the utérus, is in ail repects similar to that noticed in respect of ulcérations of the air-passages, and their relation to the discharge from cavities.

Only one suflPered from laryngeal complication, which commenced several months after the patient came under my care. The stethescope in this case (Cooper) discovered nothing more than could be heard at some distance from the patient — viz. an occasional rhoncus in the trachea. The general symptoms were paroxysms of dyspnœa, laryngeal respiration, and difficulty in swallowing.

The case of Donovan is an example of undoubtedly genrdne tubercular phthisis, occurring in a powerfully predisposed state of constitution, which had extensively involved the superior lobe of the right lung, and had advanced to a stage which would hâve speedily terminated in softening, and the formation of caverns. In my own mind I hâve not the slightest doubt that the patient was rescued from a speedy grave by the bénéficiai operation of the médicinal naphtha. Some softening and the formation of a

sniall caverii, dicl I présumé form opposite the inferior angle of the riglit scapula — being clenoted by the large moist crépitation, and very limited gurgling, whicli occurred in tliat situation.

The case of Cooper is still doubtful, but will probably terminate fatally. There is evidence, nevertheless, of benefit having been elfected by naphtha even in her case. AU her symptoms hâve been invariably alleviated by the remedy, till the occurrence of some laryngeal complication ; whilst at the same time the physicai signs hâve on the whole steadily improved. The sudden relapse which has lately occurred lias a most unfavourable aspect. Doubtless among the classes of phthisis where médicinal naphtha is generally successful, exceptions will be found who die under the use of the medicine — ^just as treatment sometimes

fails in other diseases of a more curable nature, which will suc-

ceed in the majority of cases. Still naphtha may be employed, even in these very unfavourable cases, with almost a certainty of being bénéficiai, and of prolonging life.

In the child Belliio the napththa was very efficacious ; although an opportunity was not afforded me of ascertaining the physicai signs at a sufficiently advanced period after its employment, to speak positively of the issue of the case.

In Wilson, both the general symptoms and physicai signs had undergone a most important change for the better, when he ceased attending. His case also may be quoted as an example of the extraordinary powers of the médicinal naphtha in suspending the advance of tubercular disease in the lungs, and setting up action of a curative nature.

Bo th Foley andPaget were benefitted during the short time they remained under my care. Neither of them, however, attended sufficiently long for me to form any opinion of their cases. I understand that Paget has relapsed lately under Dr. Ilasting^s care.

In the cases of Cooper and Wilson the injurions influence of a liquid which closely resembled the médicinal naphtha is well shewn. Previous to its exhibition they had been, both of them, much benefitted by the médicinal naphtha, and were again so on returning to it. They both of them suflfered a seiere aggravation of their chest symptoms wliilst taking the

non-medicinal — tlic symptoras proving tliat it was not raercly from tlie omission of a bénéficiai agent, but from the action of sometliing wliich proved in tbeir cases injurious or even poisonous. In Cooper it produced pain in the chest, sevcrc cough, grcat difficulty of breathing, and expectoration of bloody mucus — which symptoms were much relieved by simply omitting the nou-medicinal naphtha. Wilson found himself so much worse after each dose of the non-medicinal, that he, of his own accord, omitted to take it. Should not these facts suggest a caution to those who hâve so loudly and unscrupulously condemned naphtha as an injurious, worthless, and disgusting medicine (without proper investigation), to be quite certain that they hâve used the remcdy which was intended. If they are not certain on this point, their evidence appears to me to be of about the same value as his would be Avho employed the bichloride of mercury instead of calomel, in similar doses, in the treatment of disease, and then in the full tide of éloquence declaimed against it (under the name of calomel) for poisoning his patients. If they are not sure of this, their past expérience is not worth tlie ink they hâve shed in recording it.

CHAPTEU V.

VALUE OF NAPHTHA IN ADVANCED PHTHISIS PULMONALIS.

Cavities existed in ail the cases (10) which I hâve still to narrate. When phthisis has arrived at this stage it does not admit of cure, except when the tubercular déposition is comparatively limited, and the cavity or cavities small.

Case 14. Tubercular consolidation of the superior lobes of both lungs ; empty cavern of small size in the right ; small gurgling cavern in the left. Marhed improvement in the general symptoms and physical signs. — John Kensley, ætat 50, residing at No. 5, Hollon-street, was admitted under my care on the lOth of

January, 1844. At the time of his application he was suffering from severe cough, mucli sliortness of breath, and trifling expectoration. There was mucb dérangement of tbe liealtb, liectic, and émaciation. His présent symptoms had corne on gradually during the last two years, with occasional periods of severe illness and improvement. Six months ago he spit up considérable quantifies of pure blood, and the hæmoptysis bas recurred slightly several times since ; at présent also his expectoration is streakcd Avith blood.

Physical signs. — Flattening of the antero-superior parts of the right side of the chest, with diminished motion in respiration ; considérable dulness and résistance on percussion over the clavicular, sub-clavicular and scapular régions of the right side of the chest ; bronchial breathing and broncophony heard over the dull portions anteriorly, laterally, and posteriorly ; cavernous respiration and pectoriloquy Avithout any rhoncus, over a space about tAvo inches in circumference anteriorly^ in the sub-cla\icular région, near the sternum ; exaggerated respiration on the left side superiorly.

He was ordered tAvo table-spoonsful, three times a-day, of the following mixture : — Naphthæ Med. 5ijj Træ Hyosciami ^iij, Aquæ 3viij M. ; also five grains of Compound Squill Pill every night.

January 24th. His chest symptoms are relieved, and his general health is much improved. 31st. Cough lessened, breath much freer ; he expectorâtes easier ; liectic and night-

sweats much less severe : the émaciation lias not increased since

he commenced the naphtha. February 7th. The improvement lias increased steadily. To increase the quantity of naphtha to twenty drops three times a-day. 17th. Feels, in comparison, nearly well.

From this date he discontinued his attendance till the 27th of March' — having occasionally taken the naphtha in the interval. He had considered himself nearly well, but the bad symptoms were now returning.

March 27th. The physical signs remain very similar to what they were on his admission, with the exception of the signs of cavern. The récurrence of bad symptoms seemed to

dépend on a fresh crop of tul)ercles being depositcd in the left lung (superior lobe). The flattening of the right antei-iosnperior part of the chest, with diminished motion, continues as before ; dulness "with increased résistance on percussion over the antero-superior portions of the right side of the chest, also posteriorly ; slight dulness of the sternal end of the left clavicle, and over the left suh-clavicular région, especially near the sternum; bronchial respiration and^ broncophony hcard over the dull portions on the right side, but the cavernous respiration, and pectoriloquy bave entirely disappeared ; harsh loud respiratory murmurs on the left, with prolonged expiration ; undue résonance of the lieart-sounds and voice.

April Ist. Chest sympto ms considerahly improved ; attack of goût in the right v'rist and hand. To take xv iq of Vin. Colch. three times a-da3^ His symptoms continued to improve steadily on the lOth, and 17th, and on the 8th of May.

May 8th. Dulness on percussion over the superior part of the right side of the chest much diminished, increased over the antero-superior portions of the left side of the chest; respiratory murmurs harsh and loud on the right and left sides over the dull portions ; increased résonance of the heart-sounds and voice ; an occasional dry crackling sound on the left side.

Ma)^ 18th. Chest symptoms improved ; considerahly better in his general health. 25th. Not so \vell. Grcat improvement in the physical signs on the right side ; increase on the left. Dulness on percussion on the right ride superiorly has nearly disappeared ; respiratory murmurs less harsh than ou previous examination ; heart-sounds and voice much less résonant. The dulness on percussion is increased on the left side, with some flattening and diminished motion; bronchial breathing and résonance of voice, occasional large moist crépitation ; gurgling over a limited space in the sub-clavicular région, corresponding to the second rib, about an inch from the sternum. He complains of much pain in the left shoulder. To take xx of Naph. Med. with j iil of Hydro-cyanic acid (Scheele's strength) three times a-day, and to rub the Ung. Antim. Pot. Tart. on the front of the chest.

J une 5th, Cough, shortuess of breath and pain in th

slioulder mucli relievecl; quantity of sputa diminished ; hectic and niglit STreats less severe ; feels mucli better. Cavernons respiration, and occasional cavernons rboncns lieard over the limited situation wliere gurgling alone was lieard on tbe previous exainination. To continue.

June 12th. Percussion improved, and breatliing less bronchial; cavernons rboncns lias disappeared ; general symptonis very mucli improved.

J une 22nd. Improvement continues. The cavernous rlioncus and gurgling, witb ail signs of cavern, bave disappeared ; dulness less considérable, murmurs barsb, and expiratory murmur prolonged.

August 31st. Silice tbe last date lie bas beeii nearly well, and discontinued bis attendance, baving left off bis medicine for nearly two inonths. Latterly some unfavourable symptoms baie again niade their appearance. He complains of cougb, sbortness of breatb and bectic, ivith pain in tbe bypocondriac région ; also of headacbe and pain in tbe tracbea ; tbe cougb bas a trachéal Sound. The rigbt aiitero-superior part of the chest is more flattened and duller on percussion tban tbe left, tbe murmurs of respiration are also again somewbat bronchial witb diffused broncopbony; increased résonance of tbe beart sounds. Tbe murmurs on tbe left side are normal. Tbe stéthoscope, applied over the larynx and tracbea, discovers no raorbid sounds. To continue tbe napbtba and tbe Ung. Antini. Pot. Tart.

September lltb. The cougb, breatb, and hectic, &c., are again mucb relieved. Pbysical signs sligbtly ameliorated. Tbe tarsus and metatarsus of tbe left foot are attacked by goût. To continue, witb the addition of x Trt of Vin. Sem. Colchici. tbree times a-day.

Case 15. Tubercular consolidation of the superior lobes of botli lungs ; caverns on both sides ; great relief of the general symptoms from Naphtha : death. Henry Bonnar, ætat 45, residing at 18, Gynn’s-place, Lisson-grove, was adinitted uuder my care on tbe 13tb of January, 1844. He bas suffered for nearly two years from cougb, difficulty of breatliing, occasional bæmoptysis, cmaciation and bectic. At présent lie is greatly reduced in strengtb, extremely emaciated, and suffers from severe cvening fevcr and iiight sweats.

Physical siyns. — Considérable llattcning of the npper and anterior past of tlic cliest j veiy considérable dnlness and résistance on percussion of tlie clavicular, sub-clavicular, and upper portion of tlic maramaiy régions of tlie riglit and left sides, and of tlie riglit scapular ; cavernons respiration, pcctoriloquy and cavernous rlioncus on tlie left side anteriorly and laterally, broncliial breatliing and broncopliony posteriorly ; plasli on cougliing anteriorly; gurgling over a considérable space anteriorly on tlie left side ; exaggerated respiration posteriorly.

He was ordered xv of Naptli. Med. in water tliree tiines a-day, and five grains of tlie Extract of Hyosciamius at bedtime.

January 27tli. Fcels mucli stronger and better to-day, and lias acquired an appetite sinee lie coramenced tlie drops, wliilst liis digestive powers are increased. The cougli and diflSculty of breatliing are mucli relieved, and the quantity of the sputa diniinished, wliilst he suffers less from the paroxysm of fever in the evening, but perspires as profusely as ever.

January 31st. Ile lias continued to improve. To increase the quantity of naphtha to xx iq ter. die., and to rub a stirnulatiug liuament over the front of the chest every evening. (The linament was ordered from his complaining of some pain in the trachea, 'which especially came on at night).

Eebruary 3rd. Ail his symptoms are much improved and he feels much stronger and better ; he no longer suffers from profuse night sweats, nor from trachéal pain. Eeb. „7th. The improvement continues, and his cough and breathare much better, and the quantity of expectorated matters diminished. Eeb. 17th. As before. To continue.

Eebruary 21st. The profuse night sweats hâve recurred, in other respects the great improv^ement in ail his symptoms continues. On the riglit side cavernous respiration and pectoriloquy supply the place of the gurgling previously heard ; the gurgling continues on the left, but the cavern appears more réverbérant and empty.

Mardi 23rd. Improvement continues. Some of the uonmedicinal naphtha, very nearly resembling the médicinal, was given him to-day.

Mardi 27th. Has been extremcly iil cvcr since hc commcnced tlie last stipply of drops. Ilis coiigli and difficulty of breatliing are as bad as ever^ loss of strengtb and émaciation bave proceeded rapidly, and tlie profuse sweats bave increased. To take 5ss of Napb Med. tbreetimes a-day in water^ five grains of tbe pii. Saponis c opio every nigbt, and two table-spoonsful of tbe following mixture tbree times a-day $1 Acid. Sulpb. Dil. 5iss Inf. Gentianæ Comp. 3viij. M.

Mardi 30tb. His symptoms bave again improved. April 3rd. Felt very exbausted but comfortable. He died in tbe course of tbe day.

Case 16. — Tubercular consolidation of the superior lobe of tbe right lung ; close, firm adhesions of the entire right pleura ; empty cavity of moderate size ; great improvement of the health and chest symptoms from Naphtha : death from diseuse of the brain . Thomas Clieston^ ætat 16, residing at 6, Fitzroy-place, New-road, was admitted under my care on tbe 5tb of June, 1844. He states tbat be bas been ont of bealtb, from a variety of causes, for tbe last two years, but be lias suffered from cougb and ditïiculty of breatliing especially during tbe two last montbs. Fie was in tbe first instance (two years ago) seized witb severe, acute pleuritic pain in tbe rigbt side, and sbort, dry cougb, from wbicb be was ill a long time ; subsequently a swelling formed in tbe lumbar région, but was dispersed by treatment ; and tbree montbs since be began to suffer from bis rigbt knee, wbicb is at présent diseased, and for wbicb be is under tbe care of my friend and colleague, Mr. Storks. Noue of bis immédiate friends bave died of pbtbisis, but bis sister suffers from consumptive symptoms, and is attended by Mr. 'VVbidborne, tbe Surgeon-accoucber of tbe Institution.

At présent be complains of cougb, witb trifling expectoration, wbicb is most troublesome at nigbt and in tbe early morniug, mucb sbortness of breatb, pain in tbe rigbt sboulder, occasionally sbooting down tbe arm, and in tbe left bypocondriac région, wbicb is of a spasmodic nature, and prevents bim from drawing a deep breatb ; also of occasional severe beadacbe and giddiness generally attended witb violent action of tbe beart. II e suffers from

Ijalpitation also, by exercise, and often after eating. Sputa are tliick, opaque, and yellowisli, and in small quantitics. He is pale, fceble, and incapable of cxertion, but u itliout inucb émaciation, and sufFers from evening fever, wbicli consists of a cbill, followed by beat, and nocturnal perspiration. The puise are frequent and feeble. There is an ii’regular, ’puckered cicatrix (resembling a strumous cicatrix) over the inferior angle of the left scapula.

Physical siyns. — Considérable contraction of the left side of the chest gcnerally, and flattening, in particular, of the anterosuperior régions, with much diminution of the respiratory play ; marked dulness on percussion with increased résistance of the clavicular, snb-clavicular and upper part of mammary régions ; right side generally duller than left; percussion over the subclavicular région, about an inch from the right edge of the sternum, produces pain, sense of irritation and cough ; bronchial breathing and broncophony heard generally over the superior régions of the chest ; sounds of the heart almost painfully audible ; cavernous respiration and pectoriloquy in the sub-clavicular région, over the portion where percussion produces cough ; exaggerated respiratory murmurs on the left side anteriorly, and posteriorly ; violent action of the heart.

He was directed to take xiv ni of Naph. Med. inwaterthree times a day.

June 8th. Feels considerably better and stronger ; breath and cough much casier ; hectic less severe. To continue. 12th. The physical signs remain precisely as on the last examination. His general symptoms are ail much improved. 32nd. Improvement continues ; dulness on percussion somewhat diminished ; other signs as before. To continue.

26th. Does not feel quite so well, and complains of pain in the right shoulder and arm ; action of the heart very troublesome, with headache and giddiness ; to omit naphtha till next visit, and to take ^i of Mist. Expect three times a day. 29th. Is again slightly improved — especially his headache and action of the heart, but his breathing is more difficult. To return to the naphtha. He was supplied with the non-medicinal naphtha by

tlie dispenser. AU liis symptoms were immcdiately aggravated by tbe cliange. His medicine was changed after a day or two’s trial^ and tlie médicinal furnished to hini again,

July 17th. Has been taldng tbe médicinal napbtlia till last Saturday, and ail bis symptoms bave been mneb relieved. On tbe 13tb tbe dispenser again gave bim some of tbe non-medicinal (from tbe supply of tbe médicinal baving failed) sincc wbicb time be bas been very ill. Tbe drops invariably disagree witb bim, causing sickness, violent beadacbe, and faintness. To return to tbe médicinal napbtba.

Jnly 22nd. Cbest symptoms mucb improved, tbe violent beadacbe continues. To apply Hirudines vi to tbe temples, and to continue tbe drops witb Hydrocyanic Acid and Liq. Opii. Sed. v 111^. 24tb. His cougb and breatb are not now at ail

troublesome, but tbe beadacbe and nausea, especially on motion, continue. 27tb. Tbe cbest symptoms are perfectly quiescent ; but be bas passed most of tbe day in a state of imperfect coma, and talks very incoherently. Wben aroused be complains of bis bead. Tbe bair to be eut off, and iced water to be applied on clotbs, as long as tbe bead feels bot to tbe toucb ; to apply a large blister to tbe back of tbe neck, and to exbibit a full dose of Compound Jalap Powder immediately. During a temporary absence from town lie was attended by Mr. Whidborne, of Queensquare. The delirium increased, ^and be passed into complété coma, in wbicb state be died on tbe 2nd of August.

Thomas Cheston was seen by several pbysicians of deservedly bigb réputation, and tbe diagnosis formed by each was identical, or essentially tbe same, as my own, witb one exception, This gentleman attributed ail tbe symptoms to diseased heart, but subsequently admitted tbat be bad examined tbe patient in a very burried manner, and bad been misled by tbe violent action of tbe beart wbicb I bave mentioned. As a doubt, bowever, has been expressed of tbe accuracy of my diagnosis, I subjoin an account of tbe post mortem examination of tbe thorax, made on tbe morning of tbe llth of August (on my return to London)^ witb tbe assistance of Mr. Whidborne, and bis pupil Mr. Bowe.

Post Mortem eæamination of the ihoracic viscera. — Soft parts covering tbe thorax emaciated, but not mucb decomposed. On

layiug open the cavity the viscera were found forced upwards by considérable flatuleat distention of tbe stoinacli and bowels — the centre of tlie diapbragm reacliing as lûgli as tlie level of tbe fourth rib. The left lung was firraly and closely adhèrent by the pleura pulmonalis to the pericardium, also in a few limited spots to the pleura costalis, When the lung was removed from the chest it was found to be perfectly healthy and crépitant throughout its entire structure,

When the pericardium was opened the heart was found tobe of its natural size (certainly not so big as the fist of the subject); the serons lining of the pericardium, and investment of the heart, being also, quite unadherent and perfectly normal. When the ventricles, auricles, and great vessels were opened, nothing morbid was discovered about the valves, or the muscular structure of the heart, unless iiideed the left ventricle were hypertrophied (being nearly four times the thickness of the right).

Right lung. — The right lung was most firmly, closely, and iiniversally adhèrent by the opposed pleural surfaces — the adhesions being evidently of old date, so that it was removed with much difficulty, and only by careful dissection. The lung removed from^the chest was found to be itself diseased only in its superior lobe ; this portion of the lung contained a cavity of moderate size, with irregular walls, which were covered with a thin stratum of puro-tubercular matter. The cavern communicated freely with three or four large bronchi, and was empty.

Case 17. Tubercular consolidation of the vpper parts ofhoth lungs ; gurgling cavitij of considérable size in the left ; great relief to the chest sijmptoms and general healthfrom Naphtha : death. — Thomas Brison, ætat 50, was admitted under my care on the 31st of July, 1844. He resided at 9, Eichmond-street, Soho. Has been ill, more or less, since October, 1843, with cough, shortness of breath, and expectoration, but has been much worse within the last two months. During this time he has emaciated considerably, and during the last three or four weeks has been unable to retain food in the stomach. He has had a sister die of consumption.

At présent he suffers from severe cough, especially at night.

mucli difficulty and shortness of breatliing, pain in botli slioulders, and beliind tbe middle third of tbe sternum. The sputa are tbick, opaque, yellowish, and abundaut. He sufters from a chill tovvards evening and sometimes in the middle of tbe day, followed by beat and perspiration, especially at nigbt. His puise are feeble and rapid, and he is greatly emaciated. He was directed by Mr. Whidborne (beiug myself ont of town at tbe time) Mist. Expect. sj ter die, and to rub in tbe Ung. Ant. Pot. Tart. over tbe front of tbe chest.

August lOth. I saw bim for tbe first time, and found bis symptoms to be tbose already deseribed.

Physical signs, — The antero-superior régions of botb sides of tbe cbest are mucb flattened, with comparatively little motion during respb’ation ; marked dulness and résistance on percussion of botb sides auteriorly and superiorly, especially of tbe left, and of tbe scapular région of tbe rigbt side; percussion over tbe left sub-clavicular région produced cougb and irritation ; bronchial breatliing vritb broncojibony existed over tbe axillary région on tbe rigbt side and tbe sub-clavicular adjoining it ; absence of respiratory murmurs over tbe rigbt scapular région, with bronchial résonance of tbe voice and increased résonance of tbe beart-sounds ; gurgling over tbe sub-clavicular, upper part of mammary, and axillary régions j exaggerated respiration over tbe left scapula.

I directed for bim tvvo table-spoonsful tbree times a-day of tbe folio wing mixture, Napb. Med. 5ÿ- Acid. Hydro-cyan (Scheele’s strengtb) viij ni. Pot. ISit. 5ss> Aquæ 3viij M. To continue tbe ointmeut.

August 14tb. The ointment (owing to tbe patienPs using it too zealously) bas acted very powerfully on tbe integuments of tbe thorax, producing several slougbs and mucb inflammation and pain. In otber respects be feels mucb better and stronger. His breatb is relieved, and bis cougb, as well as tbe quantity of sputa, diminished ; bectic less troublesome. To continue tbe mixture, to omit tbe ointment, and to apply a bread and water poultice to tbose parts of the cbest wbicb bave beeu acted ou by it.

August 17tb. Tbe condition of tbe éruption from tbe oiutinent is better, and bis cougb somewbat casier. Auscultatory pbenomena as before. To continue.

August 21st. Feels botli better and stronger ; brcatb as before, cougb casier, quantity of sputa diminislied. Slouglis are separating well, and tlie cbest is inucli better. Pbysical sigiis nearly as before — tlie rigbt side not souuding qnite as dull on percussion as on tbc last examination.

From tliis date be became worse, was confined to bis bed, and died on tlie 8tb of Septeml)er.

Case 18. Tuhercular consolidation of the upper part of the riyht lung ; gurgling cavity of considérable size ; relief from Naphtha. Mary Parnicott, œtat 32, residing at 7, Marylebonecourt, was adinitted under niy care on tbe 20tb of April, 1841'. Sbc suckles an infant wbo is nine montbs old, and sbortly after tbe birtb of tbe cbild slic suftered from milk abscesscs and swelled ancles. About tbree montbs ago sbe first began to bave cougb and nocturnal fever. Her fatber is suliject to cougb.

At présent sbe suffers from severe cougb, wbicb is worse at niglit, evening cbill followed by lieat and nocturnal sweating, difficulty of breatbing, pain in tbe rigbt sboulder, especially in tbe scapula, and expectoration. Tbere is considérable émaciation présent, and great debility and sense of fatigue.

Physical signs. Marked dulness and résistance on percussion over tbe wbole of tbe upper part of tbe rigbt side of tbe cbest ; cavernous respiration, pectoriloquy, and cavernous rboncus in tbe axillary and scapular régions of tbe rigbt side ; broncbial respiration and résonance of tbe voice in front ; beart soumis nnduly résonant.

Sbe was directed to take xv ni of Napbtbæ Med. in water tbree times a-day, and to apply a blister to tbe front of tbe cbest.

April 23rd. Pemains very nearly in tbe same state. May Ist. Ratber improved. To continue, and to take five grains of the Pii. Conii. Comp. every night. May 8tb. Herbreath and cougb are rebeved and sbe feels better, but passes very bad nigbts ; always feels much relieved immediately after taking the drops. They occasion warmth of stomach, freedom of breatbing, and relief from cougb.

îilay 15tb. Improvement continues, but bas very bad nigbts. Sbe was directed to continue, and take five grains of the Pii.

Sapoii. c Opio. every night. Feels vcry cxhausted from atteu» dance. The patient continned her medicine for some time, since Avliich I hâve lost sight of her.

Cask 19. Tubercular consolidation of the vpper part of the riylit limg ; giirgling cavity of considérable size. Mary Ann Stainsby, ætat 36^ residing at 103^ Cromer-street^ was admitted under my care on the 23rd of April, 1844. She lias heen ill about six months with cough and fever. She is much emaciated, and lias an attack of chillness about the middle of the day and towards evening, followed by beat but not persph'ation ; and suffers from cough, difficulty of breathing and expectoration, lier puise are habitually weak and quick, and she is incapable of any exertion from iveakness and breathlessness.

Physical signs. Flattening with diminished motion of the antero-superior parts of the right ride of the chest; dulnessand increased résistance on percussion of the superior part of the right side of the chest ; cavernous respiration, gurgling, pectoriloquy, and plash on cough in the sub-clavicular and axillary régions ; exaggerated respiration on the left side ; heart sounds iinduly résonant over the dull portions. Heart sounds heaîthy.

She was directed to take xv iq. of Napth. Med. three times a-day in water, and to apply a blister to the thorax.

She spit blood in the commencement of her illness. She did not re-apply, and I am therefore unacquainted with the effects of the medicine and the progress of the disease.

Case 20. Tubercular consolidation of the upper part of both lungs ; extensive cavities on both sides ; considérable relief from Naphtha. Jane Davis, ætat 24, residing at 10, Cambridgestreet. Golden-square, was admitted under my care on the Ist of May, 1844. AU her immédiate relatives are healthy, with the exception of her father, who is “ asthmatic.” She has been ill two years, her aliments having commenccd after the birth of a dead child. A discharge of blood from the utei’us succeeded her conlinement, and did not finally leave her for a twelvemonth. She has also spit up pure blood in’quantity more than once.

At présent she suffers from severe cough, considérable dyspnœa, and profuse expectoration. She is considerably emaciated, and isin an advanced stage of hectic, sufferingfrom very profuse

perspirations and constant diarrliœa. She is cxceedinglj'^ fceble and exliansted, and lias iatterly lost lier appetite for food.

Physical sigas. — The npper parts of both sides of tlie cbest are mucli flattened, and ndtb little motion during respiration ; marlced dulness and résistance on percussion ; gurgling, pectoriloquy, cavernous respiration and plasli from cougli heard over the wbole sub-clavicular, axillary, and scapular régions of tlie right side; gurgling, cavernous respiration, and pectoriloquy over the siib-clavicular région of the left side j cavernous respiration and pectoriloquy in the axillary and scapular of left side.

She was directed two table-spoonsfid of the following mixture three times a-day — Ça Naphthæ Med 5ij^ Liq- Opii. Sed. 5jss, Aquæ 3viij M.

May 9th. Feels better; the diarrhœa is much diminished, breath rclieved, cough as before, expectoration profuse. She has slept better at night since she commenced lier medicine. Has had several attacks of an acute pain in the left mamma and side, which interfères with respiration during its continuance. This pain cornes on at irrcgular intervals, and lasts for an hour and longer. She invariably feels much relieved soon after taking the medicine. To iucrease the naphtha to xvi H three times a-day.

May I6th. Continues as before. The neuralgic pain in her side is very troublesome. Physical signs remain as on the last examination.

To continue, and to apply a mustard poultice to the left side ; the naptha to be increased to xx iq three times a-day.

IMay 22nd. She is free from pain in the side, but coraplains of pain in the left foot and ancle, with some œdema of the parts. Perspirations are less severe. To continue, and to rub in the Lin. Terebinth over the front of the chest. 30th. Spits less than before, and has felt much better till two days since, when slie sat for some time in a current of air from the door. Auscultatory phenomena remain as before. To continue. She died on the 4th of June.

Case 21. Tubercular consolidation of the upper part of the left lung ; large cavern; great relief from Naphtha : deuth. Margaret

Phillips^ ætat 38, resicling at 1, Marlborougli-row, Cross-street, was admitted under mj care on the 18th of May, 1844. She lias been more or less unwell witli pulmonary attacks for tbree years. Her présent illness commenced (slie bas been worse) about tbree montbs since, and sbe bas several times lately spit up small quantities of blood. None of ber relatives bave died of consumption.

At présent sbe sulfers from severe cougb, wliicb is always most troublesome at nigbt, and often terminâtes in vomiting, dyspnœa and expectoration. Tbe sputa consist of a muco-purulent matter, and amount to about a pint in tbe tvventy-four bours. Sbe suffers from severe bectic, rapid puise, evening cbill followed by beat but not perspiration. There is but little appetite for food. Sbe is considerably emaciated, but does not suflFer from any pain, except in one spot beneatb tbe rigbt mamma. Catamenia regular; profuse leucorrbœa.

Physical signs. — Considérable flattening of tbe upper and anterior part of tbe left side of tbe cbest, ivitli considerably diminisbed motions; marked dulness and résistance on percussion; gurgling "witli plasb on cougb over tbe wbole sub-clavicular région ; puerile respiration on tbe rigbt side.

Sbe was directed to take two table-spoonsful tbree times a-day of tbe folio wing mixture — Napb. Med. 5ij, Acid Hydrocyan (Scbeele^s strengtb), viij iq, Aquæ 3viij M. ; five grains of Pii. Sapon. c Opio. every nigbt ; a blister to tbe cbest.

May S2nd. Peels mucb better; sbe bas sufFered mucb less from cougb and difficulty of breatbing since sbe commenced tbe medicine. A few minutes after taking it sbe invariably expériences mucb relief, and bas recourse to it on getting out of bed in tbe morning, irbereby sbe is enabled to dress in comfort. Sbe bas also bad several bours of refresbing sleep at nigbt, wliicb sbe bad not bad for weeks preidously. She continued her medicine for some tirae, and tben baving obtained a recommendation for an hospital I lost sight of ber. Her friends inform me tbat she died in August.

Case 23. Tubercidar consolidation of the superior part of the right Jung; large gurgling cavern; relief of the symptoms from Naphtha : death. Eliza W rigbt, ætat 41, residing at G2, New Compton-

Street, was adniitted iindcr my carc on tlie lOtU of Apvil, 18-1-X. Slie lias been ill silice the commencement of Jannaiy, 1843, at wliicli time slie was prégnant. Slie was seized, slie states, suddeuly ivitli violent cougb, difficulty of breatliing, and mueb swelling of tlie abdomen ; and tliat tbese symptoms were mneb relieved by medical treatment in a fevv bonrs. Sbe bas been ill ivitb cungb, sliortness of brcatli, and expectoration ever sincc. About seven montbs ago sb6 spit blood two or tbree times in small quantities, and the sputa were streaked witb blood for two or tbree days subseqnently. lier sister died of pbthisis.

At présent sbe sutfers from troublcsome cougb, and difficulty of breatliing, wbicb is worse at nigbt — also profuse expectoration. Sbe is mucb emaciated, is very weak, and incapable of exertion. The puise are rapid and feeble, and sbe bas evening cliill, followcd by beat and iiocturnal sweats.

Physical slgns. — Tlattening ivitb diminished motion of tbe antero-superior parts of tbe riglit side of tbe cbest ; considérable diiliiess of tbe superior régions of tbe rigbt side of tbe cbest witb iucreased résistance; gnrgling over tbe wliole sub-clavicular région, also the axillary, and scapular; mucus rboncus, witb some sibilant and soiiorous rlionci over tbe infra-scapular région. Ou tbe left side of tbe cbest tbere is puerile respiration witb some sibilant and sonorous rbonci.

Sbe was ordered five grains of Componnd Squill Pill tbree times a day, witb two table-spoonsfiil of Mist. Tonie. (Iiif. Gent. Comp. Avitb an alkali). 20tb. Pii. Coiiii Comp. v grs. every nigbt ; a blister to tbe front of tbe cbest.

May lltb. Quiiiæ Desulpb. j grn. twice a day.

May 22nd. Bronchial complications relieved; physical signs (wâtb tliis exception) as before. To take xv IH. of Napb. Med. ill water tbree times a day. Ail ber symptoms are mucb relieved ; sbe feels botb better and stronger ; breatb and cougb easier; quantity of sputa diminished. Physical signs remaiu as before.

June Ist. Sbe bas improved steadily. 6tb. Hectic relieved, cbest symptoms less severe. Physical signs nearly as before, tbe cavern evidently less full of fluid. To continue.

June 13tli. Her general symptoms continue mucb relieved,

but she feels very exliausted, and perspires a good deal. Died on the 19tli.

Cash 23. Tubercular consolidation of upper part of lhe right lung ; cavern ; laryngeal disease ; [probable) death. Susanna JoneSj ætat 45, residing at 3, Somers-street, ^Paddington, was admitted under œy care on the 20th of January, 1844. She sutFers from severe cough, attended by spasm of the larynx, with expectoration occasionally streaked with blood. Her voice is in a whisper, and she lias occasional attacks of severe spasmodic breathing. There is great constitutional dépréssion and hectic, feeble, rapid puise, and occasional profuse night-sweats. She complains of pain in the larynx, and upper part of the chest.

Physical signs. — Considérable flattening of the antero-superior part of the right side of the chest, with diminished motion j considérable dulness on percussion, and increased sense of résistance ; cavernous respiration and pectoriloquy (the whispering voice of the patient, passing with a reverberating metallic clearness along the stethescope) heard in the sub-clavicular région of the right side, over a space of about three inches in circumference.

History. — In May, 1843, she was attacked with profuse menorrhagia, which iasted nine weeks, and on its subsidence she began to suffer from cough, attended by hæmoptysis. For seven days she brought up in gushes, during coughing, quantities of pure blood varying from “ half a pint to a pint,^’ and has had occasional attacks since. The laryngeal disease set in after the subsidence of the hæmoptysis.

She was directed to take tAvo table-spoonsful of the following mixture three times a day : — 9^ Naph. Med. 5ij, Vin Ipecac Ixxx iq Liq. Opii. Sed. 5ss, Liq. Potassæ 5ss, Mist. Acaciæ gi, Aquæ 3vij M ; to apply the Emp. Canth. to the front of the chest.

February 17th. AU her symptoms much improved; to increase the quantity of naphtha in the mixture to 5üj- March 2nd. Improvement continues ; larynx troublesome, with tenderness on manipulation, and much difficulty in breathing.

March 9th. Continues the same. Physical signs without alteration.

March 30th. Not nearly so well ; perspiration very profuse ;

mucli dépréssion. She attributes tlie increase of lier syraptoms to the omission of lier mixture for nearly a week. Her liusband informed me that she had a slight epileptie fit in the night of the 29th.

She did not re-apply, but there is little doubt that her case terminated fatally.

Remarks. — I exhibited naphtha in these ten cases with little hope of effecting any permanent good in the majority. I feel persuaded, however, that if the tubercular déposition be limited, and the prédisposition to a phthisical death not very powerful, a small cavern will not deprive the patient of ail chance ofrecovery. Those forms of chronic consomption, where limited crops of tubercles form, become softened, and are expelled before a fresh crop are again deposited, often extend over a course of years before they terminate fatally. In such cases naphtha will prove a most valuable remedy not only in relieving and curing the disease actually présent, but will also check the formation of fresh tubercles, and allow the operation of appropriate measures to improve the constitution, and overcome the tendeucy to the disease, provided the patient give the remedy a fair chance, and assist the practitioner by every means in bis power.

The case of John Kensley is a remarkable illustration of these assertions, and although bis disease is not cured, still I believe that it would hâve been in one who was willing and able to continue the medicine and consider himself an invalid. From the commencement of the naphtha treatment, John Kensley lias not scrupled to omit the medicine altogether as soon as he felt himself nearly well, and has continued throughout to expose himself to the vicissitudes of weather and fatigue — having, as he States, a family dépendant on him for support, which compels him to act so injudiciously.

Very probably the empty cavity, which existed when he first presented himself as a patient, was naturally tending to a cure, providedthat his constitutional powers couldhave proved suflicient to hâve accomplished it. It undoubtedly cicatrized under the use of naphtha, as the physical signs of its presence were completely removed, in conjunction with a corresponding improvement in the general symptoms. The déposition of a fresh but limited

crop of tubercles on thé left side liad obviously commenced dui’ing tlie time be so foolislily abstained from attendiug in tbe early treatment of bis case (from February to tbe end ol Mardi) and was tbe cause of a renewal of ail bis bad symptoms. Tins disease of tbe left side seems to bave increased witb a corresponding diminution of tbat on tbe rigbt. Some few tubercles softened, and a small gurgling cavity was formed, but became empty and bealed ; tbe signs of tbe tubercular consolidation being also considerably lessened.

In tbe bistory of bis case it will be seen tbat be again omitted tbe napbtba before it was eitber désirable or even rational, and tbat tbe évidences of tubercular disease again made tbcir appearance on tbe rigbt side, but were again ameliorated by tbe remedy. Some tracbeal symptoms also made tbeir appearance witb tbe last relapse. Tbe occurrence of goût tbi’ougbout tbe course of tbe disease is also wortby of note.

It would not surprise me if tbe man ultimately fell a victim to bis owij folly and négligence.

Tbe case of Thomas *Cbeston (case 16) is an example of tubercular pbtbisis, of limited extent, followiiig an attack of acute pleurisy, wbicb resulted in contraction of tbe side. Tbe cavern was empty wben I first saw bim, and, as I believe tbat tbe prédisposition was not powerful, tbere is no reason wby^ it sbould not bave terminated in recovery, bad be not died from anotber disease ; indeed tbe benefit wbicb bis cbest symptoms received lead to tbe probability tbat sucb would bave been, under more favourable circumstances, tbe final issue of tbe case.

Altbougb tbere was not tbe sligbtest probability of napbtba effecting any permanent good in tbe otber cases of extensive and adv^anced disease I bave narrated, it will be seen tbat it alleviated tbe symptoms witb more certainty and speed tban any otber medicine, especially tbe difficulty of breatbing. In some of tbe cases it is true tbat otber medicines were combined wdtb it, aud part of tbe benefit might (and perbaps justly) be attributed to tbem, and to tbe counter-irritation used at tbe same time. I bave no doubt of tbe value of counterirritation, of bydro-cyanic acid, or of opium, but still tbey do not give tbe same kind and amount of relief as tbe napbtba eflfects.