RESULTS

Relief of gen.

symptoms.

Improvement.

Great benefit to the gen. sym.

Death.

Much relief to gen. symp.

Death.

Great relief to gen. symp.

Death.

Great relief to gen. symp. & improvement of phy. signs, with occasional relapses.

Relief to chest symptoms.

Died from dis.

brain.

Great relief to gen. symp.

— finallycure of both sym.

& phy. signs.

Relief of gen.

symp. & phy.

signs.

Relief to gen.

symptoms.

Great relief to the general symptoms.

Death.

Of these tvrenty-three patients six were under twenty years of âge ; three under twenty-five ; two under thirty ; three under thirty-five ; four imder forty ; one under forty-five ; two Tinder fifty ; and two under fifty-five, — tliat is between fifty and fifty-five. Eiglit cases occurred in males, and fifteen in females.

AU the patients snffered more or less froni bectic, witli paroxysms of evening fever. Hæmoptysis occurred witli greater or less severity in sixteen cases, and hæmatamesis (or liæmoptysis ?) in one. Goût also attacked one patient twice during the course of liis disease. Fourteen complained more or less of pleuritic pain in tlie slioulders whilst under treatment, with or witliout pain in tlie side of a spasmodic or ueuralgic character, or of pain in some otlier part of the cliest. Two patients complained of pain in the side (of the nature ah’eady mentioned), without pain in the shouldcrs. Cough, shortuess of breath, dyspncea and expectoration, were symptoms common to ail — varjdng in severity in different cases. Violent action of the heart was markedin one case only.

More or less dulness, with résistance on percussion, was présent in every case, over the diseased portions, also undue résonance of the heart sounds. The respiratory miumurs were harsh^ with prolongation of the expiratory, over some portions of the diseased lung in eleven cases; faint in three ; absent in one; caveruons in six ; bronchial in eight ; exaggerated in six, over some healthy part or side. The voice was unduly résonant over a larger or smaller portion of the affected side or sides in eight cases ; bronchial in niue ; whilst pectoriloquy existed in six cases. Plash on cough was very évident in two cases. Dry crépitant rhoncus with inspiration was marked in two cases ; the moist in two ; mucus rhoncus in two ; gurgling in eight ; sibilant rhoncus in three ; and sonorous rhoncus in two cases. Flattening of the chest, with more or less ffiminished motion in respiration, occurred in fourteen cases. A slight pleuritic friction Sound existed only for a short time in one case.

The right lung was affected alone in fourteen cases; the left in one ; both lungs in eight.

Five patients were treated by naphtha alone ; six by naphtha alone with counter-irritation ; thirteen by naphtha with

Hydro-cyanic Acid, Opium, &c., witli or -witliout counterirritation.

Oue patient remnined eight montlis under treatment ; threo for five montlis ; one four moutlis ; four for tliree months ; one for two montlis ; two for sevcn wceks ; tivo for six wceks"; two for one month ; and seven for less tlian a month.

Of tlie results of treatment seven patients were cured ; five received marked benefit botb to the general symptoms, and in tbe physical signs ; ten received mucli relief ; and six died, one of tbe six, liowever, from disease of tlie brain.

CHAPTEH VII.

CONCLUSIONS or THE AUTHOR EROM THESE FACTS.

The analysis of these twenty-tbree cases will be an amply sufificient answer to tbe question — wbetber tbis (tbe médicinal) napbtba could be considered as a valuable remedy in any genuine cases of tubercular pbtbisis ?

As regards tbe particular forms and stages of pbtbisis especially benefitted, it will be seen tbat cbronic forms are most amenable to treatment ; especially wbere tbe prédisposition to a pbtbisical deatb is not very powerful, and wbere tbe tubercular déposition is limited in extent. Tbe earlier tbe stage of tbe disease at wbicb treatment is commenced, tbe greater prospect is tbere of success, and tbe more speedily do tbey yield to its infiuences. Six, out of tbe seven cases of pbtbisis in an early stage, wbicb I bave narrated, reeeived a eomplete cure from napbtba, and tbe seventb bas been most remarkably benefitted. Tbere is little doubt tbat tbis ease would bave been completely and permanently cured bad sbe not omitted tbe remedy every time sbe got a little better.

Extensive and advaneed disease, previous to tbe softening of tbe tubercles, and tbe formation of caverns, are, as a general

rule, curable by naplitha. I bave given tbe particulars of a most remarkable case of tbis kind (Case 8, Donovan). Several of tbe otber cases were also so mucb benefitted iu tbeir general symptoms, and received sucb a material alteration in tbeir pbysical signs, tbat altbougb some remains of disease eould still be detected, tbey were, to ail intents and purposes, cured, or would bave been so by a steady continuanee of tbe reraedy, and by tbe most rigid attention to every circumstance préventive of relapse, and calculated to restore and preserve tbe tone and balance of tbe general bealtb. In some otber cases tbe patients were advaneing favourably, but no chance was afforded of completing a cure by tbeir absenting tbemselves prematurely.

I bave already made some remarks on tbe action of napbtba in pbtbisis, wbicb bas advanced to tbe stage of cavern. Witb tbe exception of some cases of limited disease, and small cavities, I believe, tbat in tbe présent state of our knowledge, pbtbisis, in sueb an advanced stage, does not admit of cure.

Tbe bénéficiai action of napbtba is seen in tbe relief of tbe breatblessness of tbe patient, tbe cougb, and expectoration ; also in tbe relief of tbe bectic, tbe profuse sweating, diarrbœa, &c. Its action on tbe pbysical signs is first manifested in tbe diminution of tbe dulness on percussion, diminution of tbe inereased résonance of tbe beart-sounds and voice ; a softening down of bronchial breatbing into simple barshness of tbe respiratory murmurs, witb a prolongation of tbe expiratory ; then a graduai diminution of tbese morbid States, and a steady return to tbe normal murmurs of bealtb.

As regards tbe modus operandi of napbtba, tbere is little doubt tbat it is taken into tbe eirculation, and passes oflf mainly by tbe bronchial mucus membrane. Tbis is proved by tbe fact tbat tbe peculiar odour of tbe medicine is imparted to tbe breath and sputa, and sometimes to tbe urine passed sbortly after its use. Hence it is brougbt into immédiate contact witb tbe tubercles already deposited, witb tbe air cells and bronchial tubes affected, and circulâtes tbrougb tbe pulmonary vessels ready to separate fresh portions of tuberculous plasma.

Tbe appréciable eflects of napbtba seem to dépend mainly on tbe bénéficiai infiuence wbicb it exerts on tbe local disease

—being secondary to this local action. In sorae of the cases I bave given, the cataménial sécrétion was restored, and iu others profuse perspiration and undue sécrétions repressed.

Naphtha may be used in every form and stage of consomption, except, perhaps, where déposition of tubercles excite acute inflammation, and Tvliere the progress of the symptoms is exceedingly rapid and severe — not, however, as I hâve already stated, with an equal chance of snccess in each, but with almost certainty of great relief. The naphtha should be, in some cases, combined with such other plans of treatment and medicines as the peculiarity and spécial indications of the disease may suggest — especially counter-irritation.

I do not believe that naphtha by itself overcomes the tendeney to consomption, but that it is capable of arresting and curing the déposition of tubercle in the long, and I should therefore recommend ail consumptive patients — especially where there was a powerful constitutional prédisposition, to continue the medicine for some time after ail signs and symptoms of consomption had disappeared, and to return immediately to its use on the reappearance of any threatening symptoms. Inasmuch as naphtha will not ensure the patient against some future attack, it becomes him to act as if his life depended on his own discrétion, and to seek to re-establish a permanently healthy vigour in his improved constitution, by every means in his power.

Those patients who omit the naphtha before every trace of the disease, capable of being removed, is removed ; who, in fact, consider themselves well, whilst they are only convalescents, and every now and then leave off ail medicine and act as if endowed with the vigour and résistance to disease of a thoroughly healthy man, are sure to remain wretched invalids, and to relapse after every such act of folly or madness. Such individuals do not give the remedy a fair chance, and therefore, in estimating the value of naphtha in their cases, it is necessary to make fair allowance for this fact.

I believe that those patients who are wise enough to continue the naphtha for some time after the complété cure of their disease, and who will attend carefully to their own health, and are not very powerfully predisposed to a phthisical death, run but

little risk of a rcturn of tlie affection. Should any be so unfortunate as to relapse under these circumstances, they would be again speedily cured by a return to tbe remedy.

No one of a properly disposed and balanced mind can refuse to give naphtba a fair and unprejudiced trial, and attend most strictly to ail tbose circumstances essential to success, especially tlie clioice of a médicinal remedy. Confinement to tbe bouse seems in some cases to be préjudiciai. In certain quarters tbe employment of Napbtba bas been regarcled merely as a piece of quackery and imposition, and I felt disposed to regard it as sucb myself before I convinced myself of its real value. No mystery bas been made of tbe matter, and it is but an act of justice to Dr. Hastings to give bis treatmeut an unbiased trial, and to State publicly tbe results. Even if tbe wbole arose from a mere spirit of quackery (allowing it for tbe sake of argument) tbe judicious practitioner will not scruple to reçoive a valuable bint, merely because it was proposed by Mr. A. or Dr. B. ; be will examine carefully into every practical suggestion, no matter tbe source from wbence it springs, and will endeavour from bis own expérience to separate tbe good from tbe bad, tbe valuable firom tbe refuse, tbe practical from tbe tbeoretical.

Tbe opinions wbicb I bave seen expressed in some quarters, appear to me to be identical witb tbose formerly entertained of tbe value of mercury in syphilis, only vice versâ, viz., tbat if a disease believed to be sypbilitic got well under any otber plan of treatment tban tbat of a mercurial one it was not sypbibs, wbilst every similar disease wbicb was cured by mercury was syphilis, making mercury, in fact, a test of tbe disease ; so in like manner some would bave us believe tbat remedies act as a test in diseases believed to be pbthisieal, and tbat if sucb a disease got well under napbtba, or any otber plan of treatment, it was not pbthisis, but if tbe patient progressively got worse and died, tbe disease was pbthisis. So much for logical argument !

I may state, in conclusion, tbat I bave used naptba in several cases of disease of tbe cbest wbicb resembled pbthisis in tbeir general symptoms, but differed most essentially in tbeir pbysical signs. In most of tbese cases it bas proved a bighly valuable remedy.