-  -1\
7V.

'l^?A
s/
&?' „
AN
HISTORICAL ESSAY
ON
MEDICATED INHALATION,  j

          AND LETTERS ON    •       j

CONSUMPTION, ASTHMA, BRONCHITIS, SORE THROAT, LOSS OF
     VOICE. NASAL CATARRH, WEAK LUNGS, ETC.      j

  BY 1ST. B.  WOLFE, M. IX
        Editor of I he Stethoscope, The Acorn, etc. etc.
:* :*#*,i 
Spiunt*   at   tp   jjjim.
From the Free Nation, Cincinnati, Pccember 7tli,
    IStil. Edited by the lirv. ('. 15. Boynton.
  CONSUMPTION.—We invite attention to
Dr. Wolfe's advertisement in to-day's paper.
A careful reading of it will  awaken  confi-
dence in his system  for treating Consump-
tion—for, to  us, it seems both rational  and
scientific.  Dr. Wolfe, we are informed, is  a
gentleman of high scientific attainments, and
has devoted  himself for many years to that
department of medical  science which'treats
of diseases  of The Throat and  Lungs.  In
this city he has affected many wonderful cures
of Consumption, which were thought to be,
by  other physicians, too far advanced for
.possible recovery.  He has authorized us to
say tlmttclergynien and their families  will
be treated at half the price indicated in the
published terms,
From the Central linpt^t Journal and Messenger,
        Cincinnati, December (ith, lftOl.
  CINCINNATI INSTITUTE.—We  ueg-  ,
lected, heretofore, to call attention to the  j
card of Dr. N. B. Wolfe, Physician to the
Cincinnati Institute, on Fourth Street, which  j
will be found in to-day's paper.  It speaks
for itself.   We are assured that Dr. Wolfe is
a scientific  man, and  has  given years of
study  to diseases of the Throat and Luny^
We hear of remarkable cures of Consump-
tion which he lias effected in this city. * *' *

Fioin the Presbyter, December .">th, ImH. Editul*1'.*
        KcV. J. C. MuNTFoRT ifc  \\ AMPLER.
   Dr.  N. B. Wolfe.—The general want of
success in  treating Pulmonary Consumption
should secure to Dr. Wolfe's card in to-day's
paper a candid reading.   His  method of
treating this disease is  to  introduce medi-
cine into the lungs  by  breathing  it; a sys-
tem which strikes us as being more rational,
 as well as scientific, than the one which pre-
 scribes mediciue for the lungs to be swallow-
ed into the stomach with the food we nit.  Dr.
Wolfe  has elfected cures in  this city of the
most advanced stages of Consumption, and
his practice, we are told, is generally suc-
cessful.

    From the Cincinnati Press, Dec. 10th, IS01.
  In our local  column will be found the pro-
fessional card  of Dr. N. B Wolfe, Physician
to the  Cincinnati Institute of .this  city, for
the treatment  of all diseases of the lungs,
throat, and air passages, by  means of inhal-
ing or breathing medical air into the lungs,
instead of  swallowing crude medicine iuto
the stomach.  As we  believe Consumption
to be essentially a disease of the lungs, and
not of  the stomach, this  system of Dr. Wolfe's
for introducing medicine directly to the seat
of the  disease, the lungs, commends itself  to
our judgment as  being both practical and
philosophical; and  we  have the  evidence
that it is so, from the many remarkable cures
he has  effected in  this city of cases of Consump-
tion, when all  other tried means proved ineffi-
cient in affording any permanent  relief.
   Dr.  Wolfe has been before the public as  an
enlightened   and  successlul Specialist  for
 many years in  this department of medical
 science, and is a graduated  physician of one
 of the most resp^-etable medical colleges in
 this  country.   As a medical  writer and
 progressive thinker, he  takes rank  properly
 with  Trall,  Dixon,  Hall, and  other dis-
 tinguished medical reformers, both in  this
 country and  Europe.
        From the Cincinnati Enquirer.
  Dr. N. B. Wolfe.—This  gentleman's ser-
vices are sought far and near.   *   * i *  *
In treating Consumption he very rarely gives
medicine to be swallowed into  the stomach,
but has them  prepared in such a way  that
they may  be  breathed into the  lungs.  His
cures are really astonishing. 
AN
HISTORICAL ESSAY
ON
MEDICATED  INHALATION,
          AND LETTERS ON


Consumption, Asthma, Bronchitis, Sore Throat, Loss of Voice,*
       Nasal Catarrh, Weak Lungs, etc. etc.

                 I
                 1
   BY N. B. WOLFE, M. D.
Editor of The Stethoscope, The Acorn, etc. etc.
-vW'
The Lungs feed on air, and digest it for the Spirit.   ^Sl:-1 ,-..'
SECOND EDITION
      CINCINNATI, O.

H. WATKIN, PRINTER, No. 140 THIRD STREET.

            1863. 
            Entered according to act of Congress in the year 18C2,
                        By N. B. WOLFE, M. D.
In the Clerk's Office of the District Court of the United States for the Southern
                             Distrist of Ohio. 
          AN   OUTLINE  HISTORY
                            OP

MEDICATED   INHALATION,

        For Treating Diseases  of the Lungs and Throat.


  We believe in the faith which is engendered, as well as in the
power which is gained, by knowledge ; and we have long enter-
tained the opinion that the public justly appreciate  every  effort
made to impart to them information in matters of vital importance
to their health, their mental and physical perfection.   When thus
informed, they do not fail to recognize the advantage of trusting
themselves for direction and management to those only who are
duly qualified to undertake  so  great a responsibility.  No better
safe-guard against the approach of  the empiric can be instituted
than by freely communicating  information to the public upon all
subjects thus unfairly represented.  The charlatan succeeds because
he is bold in his assumptions, dogmatic in his assertions ; and the
public, being uninformed of the subject of his pretentions, are
unable to discover the fallacy  and extent of his imposture.  The
eminence which the  employment of Medicated Inhalation has re-
cently attained in the estimation of the public, has afforded many
facilities for this class of impostors, who practice their deceptions
upon the sick and  uninformed.   If I can guard the public against
the imposition of such, I will not only have done them a service,
but also will have rescued the fair fame of Medicated  Inhalation
from unmerited reproach.
  Inhaling medicated  air, for treating disease of the respiratory
organs, is not claimed to  be a discovery of modern date, as the
reader will soon learn ; but to modern times belongs  the honor of
systematizing the  practice, and arranging its pharmacy.   The
idea of  reducing  medicines to vapors  has a  record in medical
science extending back as far  as the age in  which Hippocrates
lived.  It is alleged that this great teacher recommended the burn-
ing of various herbs  and  the  heating of various -minerals, the 
4
fumes of which he directed to be inhaled  by those laboring under
disease  of the lungs.   He states nothing,  however,  of so practical
a nature, or definite in  itself, as would be of any advantage in con-
structing a system upon his teaching.   The nearest approach to
specific instructions perhaps is to be found in his recommendation
to " use hellebore to drink, either alone or mixed with a decoction
of lentels, and inject the lungs with fumigations."  He also favors
" fumigations of hyssop of cilicia, sulphur and asphalt, to  be in-
haled through the nose to bring away phlegm in catarrh."
   The many theories which have obtained from time to time, and
even the Rational School which now  sheds so much  lustre on  the
science of medicine, there can be no  question, owe a large portion
of their  excellence to the doctrines and example of the old Grecian
instructor.   They were in his own day what the inductive  philo-
sophy of Bacon, as applied  to medicine, now is; and his  pupils
soon launched forth, by  the impetus received  from  his positive
mind, into a sea of theoretical  speculation, which resulted  in  the
establishment of various  schools  of medicine,  from which  are
transmitted the imperishable names of Aristotle  and Plato.
  In the writings of these illuminated minds is found much matter
for thought and investigation appertaining to our subject.  Among
the Problems of Aristolle, the question of  the communicability of
consumption is introduced in the following manner : " Is  it be-
cause,"  he  says, "consumption makes the  breath  corrupt and
offensive, that those who  approach the  diseased persons,  and
breathe the air, acquire the same malady, as if their system had be-
come  vitiated by their own respiration ? "   In this problem atten-
tion is directed to the communicability of consumption by inhaling
vitiated air ; and our observations  but  too strongly  confirm this
hypothesis, for we have seen those, who with tenderness wait upon
the expiring brother or sister, inhaling their impure exhalations,
that when the messenger came to guide the departing one through
the shadowy valley,  he bade  the  bereaved prepare  for  his next
coming, and painted a  blush upon their face that he  might know
them  when he came.
  Among the followers of these distinguished leaders, and  nearly
four centuries after the age of Hippocrates, one of the most illus-
trious scholars in the school of empirics was Diascorides, celebra-
ted as a botanist and pharmaceutist.  He lived in the first century
of the Christian era, and acquired great distinction for his learning 
5
and skill in curing disease.  In his Materia Medica,  " for coughs
of long standing, fumigations of colts-foot leaves, of native sulphur,
of sweet calamus with  turpentine resin, of dry squills, of water-
cresses, of oil of cedar, of centaury root, and of fennel seeds, to be
carried into the mouth through a hollow  reed inserted in a hole
perforated in the bottom of a small vessel, smeared over with arse-
nic and triturated sandarach, moistened with water,"  are highly
recommended.
   From the age of Diascorides, down to the present time, every
writer of distinction who has written on the treatment of consump-
tion, alludes  more or less to medicated inhalation.   Thus Cielius
Aureltanus, a pupil of the famous Asclepiades, writes very cor-
rectly of consumption under the name of Phthisis or Phthoe ;  and
makes the following observation respecting its treatment:  "Some,
in the case of patients  suffering from difficulty in the  upper parts
of the diaphragm, have exhibited, besides other remedies, fumiga-
tions  arising from the burning of hyssop, thyme, or origanum, or
sulphur; some sandarach, aloes, or styrax, having been placed on
the fire, have  ordered the patient  to  open the mouth, and by an
effort  at swallowing, to  devour the vapor ;" and  if the disease
beo-ins to increase, so  that Aphonia, or loss of voice, comes on,
then the patient must feed on slops, using at  the same time gargles
of warm sweet oil, cf water sweetened  with honey, or a decoction
of grapes,  of pine nuts, of fat figs, or of liquorice leaves, as well as
from wheat or from barley water, in  order that  he should Ireathe
the vapors rising from the evaporation or exhalation.
   Aritious,  a disciple of Thomison, the  founder  of the Pneu-
matic school of medicine, though he describes disease to errors in
the "spirit,"  writes floridly on the  subject of consumption, and
kindred diseases ; and  though he  makes no specific  mention of
the employment of vapors in their  treatment, he strongly recom-
mends sea voyages for the cure of  consumption, averring " that
the  saline particles inhaled in  the  sea air, appear  to dry up  the
ulcers in the lungs."
   Avicenna, a distinguished  Encyclopediast,  a  member of the
Eclectic School and follower of Galen, recommends  for the cure
of Asthma, a preparation of myrrh, spikenard, cassia,  and saffron,
and patwort, and storax, to be rubbed up and prepared with cows-
fat, and bolusses made  of them  of the  size of a nut, one drachm 
6
 of them to be used in fumigation, three times a day for ten days.
 He also gives various  prescriptions  for  cv/ra ulcereim pectoris et
 cura Phthisis, and remarks that " fumigations are administered in
 this disease, and certain dissiccutive and cleansing substances with
 which a fumigation is made, by means of -a tube or siphon."
   Both Celsus and  Pliny occupy a prominent place in the  litera-
 ture of medicine, though it is questionable whether either of these
 savans  devoted  much more  time to the science of medicine than
 was necessary to give them a knowledge of disease, merely as an
 adjunct to their general  education.  Celsus  speaks, however, of
 Phihisis,  (consumption) as beginning in the head, and descending
 to the lungs ; and describes  the  stage  of ulceration as being at-
 tended with fever, cough and expectoration of purulent  and bloody
 matter,  and says: when ulceration takes place in the  anterior part
 of the fauces, physicians apply cataplasms and moist fermentations
 externally, and hot vapors into the mouth.   Pliny, while enumera-
 ting a number of specifics for the cure  of  consumption, speaks
 particularly of the pectoral qualities of gum  amoniac,  and praises
 all the  woods  which  give an abundance of resinous  odor  while
 burning ;  the vapors arising from which, he says,  " are more benefi-
 cial to the consumptive,  than a voyage to  Egypt, or a course of
 milk in the mountains." He mentions, among other materials used
 in the composition of the  fumigating bolusses, " dried  cow-dung,
 bullocks'  horns  burnt and powdered,  the  fumes  to  be drawn
 through a reed."
   Among all the writers  in medical science, whose names have
 been transmitted  from ancient to  modern times, there has been
 none around which so many intellectual splendors cluster, as that
 of the immortal Galen ;  who, by the force of his genius, acquired
 an influence over  the minds of men, which has outlived the muta-
 tions  of time, and all the  revolutions  of opinion  which  have
 dawned  and died  in  the  empire of mind  for centuries.  Let us
pause before  his  impressive  shade, and digress but one moment
from our subject.   The range of his philosophic  and professional
studies was most  extensive ;  he traveled  through various coun-
tries in search of  medical  lore, but it was principally  at Alexan-
dria, in his day still the most  famous  school  of medicine,  that he
acquired his reputation as a scholar.   While residing in  Alexan-
dria, he was  invited to Rome by the Emperor  Aurelius, and  sub- 
7
sequently took up his residence in that city.   The mental  charac-
teristics  of  Galen were, a disregard  for  the opinions of others,
when investigating a principle, and an entire confidence in his own
resources.   Conditions  always yielded to the force of his charac-
ter ; and whatever circumstances surrounded, he rose superior to
them.   He acquired and  exercised a sway over public opinion in
all matters relating to medicine,  which had never been attained by
any other individual before him,  and has never since been equalled.
His writings are the most voluminous of any author,  extending to
two hundred distinct treatises  on different subjects.   His author-
ity was  undisputed, and  it would  seem to have been a sufficient
answer to any argument of theory or statement of fact, that it was
contrary to the opinion or assertion of Galen !
   In an early French translation of his works, is found a remark-
able passage, reasoning on the inutility of administering medicines
through the stomach  for  the  cure of pulmonary disease, and we
transfer it from Mr. Mellville's article on " Medicated Inhalation,"
to which we stand indebted for much useful and instructive matter.
 Galen says, " Consider how many parts or  members the medica-
ment  has  to  pass through before it reaches the lungs.   First, it
enters the mouth, passes down  the aesophogus and into the stom-
ach, then  to the  intestines, and from thence penetrates as  far as
the veins which are contained  in the messentary,  which  veins
carry it to the concave portion of the  liver,  and from  thence to
 the convex ; thence it  is carried to the vena cava, and from it to
 the heart.  We cannot deny that medicines thus administered will
 mingle in each of the parts above mentioned with some humor, and
 undergo some transformation or alteration, dependent on the nature
 of the viscera through which they pass;  thus what remains of the
 virtue of the medicament is  weaker, so that it cannot effect any
 relief to the wounded  part; because too the  remedies  suitable to
 them cannot touch the place where the  disease exists."  We find
 him, nevertheless, recommending  the  smoking of  arsenic, orpi-
 ment, with pepper  and  other  vegetable substances,  as well as
 burnt sponge, in treating ulcers of the trachea.
    With the exception of Rhazes, a follower  and commentator of
  Galen, who recommended as a fumigation, a mixture of arsenic,
 aristolochia, myrrh, styrax and galbanum,  to be inhaled for con-
 s mption,  we have no  traces of any  improvement being made in 
3
this method of treatment by the ancients, nor until  the beginning
of the present  century; though  all  along  the  annals of medical
literature,  Inhalation  crops  out  in the writings  of Kicoli  Piso,
Boerhaave, Scher.ck, Poterius Spigelius, Harvey,  Sydenham and
others.   Dr. Beddnes began to treat  disease of  the lungs, by the
employment  of various  gasses to  be inhaled from a bladder, in
the beginning of the present  century,  since which time, Inhala-
tion, as a system, has been " struggling into birth."
   The great error which has retarded its parturition, has been the
vain search by physicians,  after a specific remedy,  and their con-
tentions about the relative  merits of their discoveries.   This sel-
fish and unphilosophical  spirit  has always  operated to the preju-
dice  of science, and has resulted  consecutively in  the abrogation
of the use  of tar  water, chlorine gas, iodine vapors, and the host
of other  remedies claimed to be specifics, and put  forth at various
times as  bantams for  professional  fame, but always resulting in
disappointment.   Recently  another professional offspring  has  been
put forth by Dr. Churchill, who,  in the  exhuberance  of parental
pride,  exclaims,  "Eureka!"—which,  like its  elder   brothers,
claims to be a specific, only a little more so, as it is claimed to cure
the worst oases of consumption with more  ease, than the simpler
manifestations of  the disease ; but to put him right on the record,
we will quote Dr.  Churchill's own  words as they appear  in Galio--
nani's Messenger :  " Contrary to the  opinion generally  received,
the third stage of  Consumption is, all  other  circumstances  being
equal, more amenable to treatment than the second.'"   All this is
to be  done  by dosing  through the  stomach with  the hyporhcs-
phates of soda  and lime.  Rejoice, 0 invalid ! it is not  too late  ;
here is a medicine prepared by Dr. Churchill,  expressly for  late
cases  ; the more advanced the better  for the display of  his reme-
dies !   Benefactor !   Upon  the  same  pedestal where stands the
doctor who could  cure  nothing but " Fits," let him rest  his claim
for posthumous honors, who  treats the third stage of consumption
with mors complacency than he does the first.
  But trifling  aside.    Dr.  Churchill's treatment is predicated
upon  the supposition which has led the profession  astray for cen-
turies, that consumption, tabes and  mesenterica,  are constitutional
in their character, and  not  local;  that they  are  superinduced by
the undue waste or  insufficient supply of phosphorus  in the hu-
man system.  To  meet the ends  obviously  indicated, he has dis- 
9
eovered  that  hypophosphites  of lime  and soda,  really contain
phosphorus, and can be made  to assimmilate  with  the blood, and
supply this element to the system."   However theorists may spec-
ulate  upon  his premises, facts demonstrate  the  opposite of hia
assumption, that consumption is a constitutional disease.   We beg
leave to state, even to so illustrious a committee as Drs.  Serres,
Andral and Claude Bernard, the gentlemen to whom Dr. Church-
ill's paper has been  referred,  that a tubercle on  the  lung, or an
ulcer in the lung,  is as much  a local  affection, as a boil upon the
arm,  or an ulcer on the leg;  and that any system of  treatment
which ignores this fact,  must of necessity end in failure and dis-
appointment.  A boil  or an ulcer on  the  lung,  and a boil or an
ulcer on the leg, making  their  conditions equal, will be cured by
the same medicaments.   Further on we will give our views of the
constitutional treatment of consumptives, and for the  present will
again turn  to  Medicated Inhalation,  from which subject I have
 thoughtlessly digressed to pay my respects to Mr. Churchill.
   Dr. Beddoes having suggested a method for administering  gas,
the profession seemed to be stimulated by further experimentation,
by a paper  written by  M. Ballard, the  proprietor  of extensive
chlorine works in  Paris,  calling their  attention  to the fact, that
among his employees, numbering  several hundred, consumption
and its kindred diseases were  entirely unknown ; and that persons
apparently  laboring  under pulmonary disease,  on entering the
establishment, rapidly convalesced.   Not understanding how this
 information could  be made to subserve the interests of medical sci-
 ence, the faculty, whose  attention had been momentarily arrested,
 turned from the plane of facts, and relapsed again into theoretical
 speculations respecting the coloring matter that gives such bril-
 liant hues  to  the butterfly, at the same time giving M. Ballard
 permission to make the best use he could of the information he had
 communicated.   He accordingly set to work to invent an  inhaler,
 and after many efforts succeeded in constructing •' a pot," into which
 he put chloric acid, and after applying heat to it, directed pulmonary
 patients to inhale the fumes as they arose therefrom.   This Hippo-
 cratian method produced no satisfactory results, invalids in the man*
 receiving no benefit from the treatment    M. Ballard was jeenngly
 told to stick to his proper calling, and leave  matters  of that kind
 to the charge of  scientific savans.   Justice, however, must declare
 that the suggestions  thrown out by this gentlemen, attracted  atten- 
10
tion to the subject, which proved ultimately to be of great service in
establishing inhalation, for truth once uttered is never lost.  It was
the  starting point of a train of  thought,  which comes down to us
richly freighted with the best experiences of the past.  The fact that
his workmen had an immunity from consumption, he ascribed  to
their constantly inhaling chlorine gas, with which the air of his fac-
tory was constantly charged ; and hence he advocated the introduc-
tion of some  method, other  than  the " bladder,"  for  inhaling
chlorine gas as a  curative agent in disease  of the lungs.  This sug-
gestion started the train amoving in the right direction,  and upon
the car of reform but  few took passage  as its destination was
uncertain.   Among these  few, however, we  find the great Dr.
Mudge, of London, whose  benevolent and  comprehensive  mind,
dealt gently with the  dawning  idea  of inhalation, and warmed  it
into being.  He had watched with  anxiety the star of  M. Ballard
pale with uneffectual fire before the stronger  glare of science, and
as it expired seemingly in eternal night, his  own fame rose upon
the gloom, a planet of the  first magnitude  in the firmament of
Reform.
   Attributing M. Ballard's failure in his experiments with Inhala-
tion to  a want of proper knowledge of the hygienic  treatment
necessary to be employed to equalize the conditions of patients,
Dr. Mudge  soon  convinced the faculty,  that what  seemed to be
a failure palpably,  was no failure in fact, but was  unsuccessful
only because of the imperfect  views entertained  by M. Ballard
respecting the laws and  conditions  of health.  By  the  strength
and force of his logic, the beauty and elegance of his diction, and
the scope and comprehension of his intellect, he grasped the salient
points of Inhalation, and harmonized them into system.  He con-
centrated the energies of  his mind  in devising an instrument for
inhaling purposes,  and succeeded  in producing an Inhaler quite
superior to the " bladder " used by Dr. Beddoes, or the "pot " of
M. Ballard.   This Inhaler is still in use, and is thought by many
to be oiu faut for all practical  purposes; it is  called  " Mudge's
Inhaler," and being constructed of metal,  is  heavy as well as liable
to the action of the various acids which  enter into medicated va-
pors, on which account it has been  superceded by the substitution
of glass, and the  more  comely  Inhaler such as are now used by
Hunter, Dillenbach, and myself.  (See engraving on title page.) 
11
   The successful results  from the scientific  employment of the
Inhaler in treating  disease of the lungs and  throat,  inspired the
mind of Dr. Mudge with  the most  glowing prophecies of its fu-
ture achievements.   He fondly predicted that  Inhalation, as a sys-
tem,  would soon become a favorite child of science, which in its
growth  and developement would open up new fields for research,
and tend to happier results for humanity.  But the day that was to
usher in the success of Inhalation as a system, had only dawned
upon the vision of the prophet-physician, when his great humani-
tarian soul, exulting  in the splendors of the  morn, leapt into the
world of causation with a shout of triumph that still echoes through
the great brain of humanity its revelations of h/>pe to the invalid.
   In the death of Dr. Mudge, Inhalation lost a valued friend and
an able defender ; but men are but the  creatures of a day, while
truth is eternal.   Untoward circumstances  might retard the de-
velopment,  but could not destroy the vital element within  this
principle.
   About the year  1831,  Prof.  Fauquier, a teacher of clinical
medicine in the University of Paris, commenced a series of experi-
ments in the  Charity  Hospital  of the French Metropolis,  with
Medicated  Inhalation; his attention having  been more directly
drawn  to  the  subject by reading  the  writings of the lamented
Mudge.  These  experiments  were  conducted on a very extensive
scale, and  were witnessed by my late  colleague, Prof. S. C. Sewell,
who was at that time visiting the wards in  the  Hospital.   The
limited number of medicinal agents, and the imperfect  knowledge
of the properties of such  medicines  when  reduced to a condition
of vapor,  together  with  other unfavorable causes, which I will
hereafter notice,  operated against a favorable  result.   In fact, the
experiments, so far as success was aimed at for demonstrable pur-
poses,  resulted in blank disappointment.  The  Medical Faculty
now stepped forth and with characteristic generosity ridiculed most
bitterly the idea of treating so formidable a malady as consumption
by Medicated Inhalation  ; and among other things, they averred,
that medicines lost their active principles while reducing them to a
condition of vapor.   To both  these propositions I  will  in due time
pay my most respectful regards ; but for the  present must be in-
dulged  with a " back  lick  "  at the profession.
  When we reflect how  little  was known,  even at so late a day,
respecting the true pathology of consumption, and what erroneous 
12
opinions and pernicious  practices obtained among the Faculty in
relation thereto, we cease our astonishment at the failure of these
experiments, and almost become incredulous that ever any hope of
success was entertained.   Consumption was viewed in their diag-
nostics as an inflammatory disease, and as such, patients were con-
fined to ill ventilated  wards and extreme  poverty of diet, running
down the patient to an extreme condition oft incompatible with life.
This view of consumption  gave it a fatal  character, so universal
indeed, that many even  now  shake  their heads with incredulity,
when you speak of the curability of the disease,  notwithstanding
progressive science has forced such to change their  position, and
acknowledge, that consumption, like every other form of scrofula,
requires generous diet, fresh air, and plenty of out-door exercise.
It was ascertained that when Prof. Fauquier was engaged with his
 experiments at the Charity Hospital, the air was so very impure,
that the mortality, after severe surgical operations, was three times
as great as in the London Hospital; and that the patients were being
literally poisoned with mephitic  exhalations at the time these expert'
ments were being  conducted.   The  sanitary condition of this insti-
tution presents a striking contrast with  the  chlorine works of M.
Ballard, already spoken of.  But it is not our object to interpose a
special pleader between  Inhalation and its failure, for thus  far, as
a science reduced to a system, it must so be considered.   Perhaps
its friends were  over  sanguine,  and felt too keenly the disappoint-
ment at its results.  But if it has not flashed meteor-like athwart
the  sky of science to dazzle a moment with its splendor, and then
go out in  gloom  forever,  still it ha?, like the struggling  genius of
humanity, wended its way step by step, steadily  up the steeps of
time, with  a fleck of sunshine and field of storm upon its pathway.
Hitherto  Inhalation  seems to  have been  more an  experimental
idea than a great useful truth, to be made subserve the interests of
man.  Henceforth it takes a higher rank and gives better hope for
the fulfilment of its early promise.
  Development is that process  by which ideas are transmuted into
tangible being.  Modern arts and popular  sciences are but the ful-
filment of ideals born  from the womb of past experiences, in which
view, Inhalation may be considered heretofore as struggling into
birth-hood.
  An occasional article in the  London Lancet, and other Medical
Journals,  both in Europe and  America,  on the subject of  inhal- 
13
ing remedies  for treating  consumption, gave  assurance  to the
friends of progressive science,  that  the  idea still lived and grew,
and would soon  developed  itself in a more practical phase than it
had  hitherto done.  Hopefully they waited for the " good time
coming," until the night of  sorrowing had passed for the  lamen-
ted Mudge, when his mantle fell  gracefully upon the shoulders of
that able  pioneer and gallant Medical Reformer, Dr. Elliotson,
who, in 1845, was elevated  to the headship of the Brompton Hos-
pital of London, for the cure of consumption, establishing a mem-
orable epoch in the history of progressive medicine.
   The  treatment of consumption up to this  period, as  already
intimated, had been  involved in the greatest  darkness and uncer-
tainty.   Among  all  classes of society, and with but few excep-
tions among the profession, it had  been regarded as incurable.
No power of medicine, it was  thought, could drive out or  destroy
this enemy of human life,  when once it had gained possession of
the lungs.  Thenceforward it was left to revel unrestrained among
the delicate air cells ;  to ravage  as it would the fine membraneous
surface of this exquisite organ of breath ; to choke with tubercles,
or corrode with ulcers,  this  inlet,  and gatherer of life.  In vain the
young, the gifted and the beautiful, turned their appealing eyes to
the physician, as to  "a priest of  the holy flame of life," to catch
a gleam of hope.  Daily he saw  them  sinking, unhindered by his
remedies, and unaided by his art.   Surrounded by the pale skele-
ton forms of this dreadful disease, and amidst the incessant sound
of hacking, gurgling, strangling cough, as a moral hero, Dr. Elliot-
son  fearlessly  entered upon  his responsible duties.   Passing from
ward to  ward, breathing an atmosphere laden with the poisoned
breath  issuing  from decayed  lungs, a thorough and vigorous re-
form in every department of the Institution requiringit, was atonce
instituted. One by one the old landmarks of practice were destroyed,
and new ones  substituted.   Air, Exercise and Food were the trinity
before which his genius bowed and offered up its homage.  Under
his patronage, Medicated Inhalation became the orthodox treat-
ment in pulmonary disease,  and has  ever since  maintained its po-
sition as being the most rational,  scientific and successful  practice
ever introduced  into the Brompton Hospital.   For the first time
after introducing this practice, a statistical  report of the Hospital
shows a very  large proportion of the cases of consumption in the
first and seoond stage, cured, and a significant  per centage  of even 
14
 the third stage fairly arrested.  These  reports contain the  first
 reliable  information ever  given to the public, of the successful
 results of any systemized mode of practice  for treating consump-
 tion, and to them I would respectfully refer my medical readers for
 much valuable information respecting the working results, and the
 superior merits of Medicated Inhalation.
   To Dr. Elliotson belongs the honor of having first demonstra-
 ted the curability of consumption, by means of Medicated Inhala-
 tion, as will be found in the  reports  above  alluded to.   Prior to
 this time, much was said about the  curability of consumption,  and
 notwithstanding the greatest physician  that had appeared in Eu-
 rope since the time of the Arabians, Sydenham affirms that he had
 cured Phthisis ;  still it was not an admitted dogma in the Profes-
 sion, and the declaration was considered  apocryphal.    Consump-
 tion does no longer appal the physician  with an incurable charac-
 ter.  Brave men have struggled with their might to  conquer this
 scourge of  humanity; and, unawed  by the  dicta  of  the schools,
and the jeers of their less laborious ~or  less  intelligent brethren,
have broken through the trammels of routine,  and  dared to follow
 the new path of science, which leads them to success.  Sir Charles
Scudimere, a physician of great eminence and deserved reputation,
published a work  about ten years ago, in which he earnestly calls
upon the medical  profession to adopt  Inhalation  as a method for
administering  remedies  in  diseases  of the  chest.  Many  liberal
minds responded  to the call, and enrolled themselves  as friends to
Inhalation.   Among these  were Dr. Marshall  Hall, Dr. Cotten,
 (successor to Dr. Elliotson), Dr.  Maddocks,  Dr. Piorry, and Dr.
Corriveaux, in Europe;  while in  America, Dr. Rush  gave  it an
unequivocal endorsement;  and Dr.  Coxe, in his work on pulmon-
ary consumption, considers Medicated  Inhalation as a treatment
well established.  Three years  after the introduction of Medica-
ted Inhalation in the Brompton Hospital by Dr. Elliotson, in 1848,
I commenced the practice in Upper  Canada,  attended with  very
gratifying results. My attention had been directed to the subject
by reading  the reports of Dr. Elliotson ; since which  time I  have
given it much of my attention.  Four years later, Dr.  Sewall of
Montreal, adopted the practice, and  has kept a record  of its results
under his management.   Several of his cases  were  pronounced
incurable, having advanced to the third  stage of  the disease, by
that accomplished stethoscopist, the  late Dr. Sweet of  N. Y.;  but 
15
thoy survive the Doctor Judge, and bear testimony  to the effi-
ciency of medicated  air as a  therapeutic agent.    Early  in  the
Spring of 1853, the Hunter brothers, Robert and  James,  gentle-
men of fine professional  abilities,  commenced  as  specialists for
diseases of the lungs  and  throat, in the city of New York, and
gave  to  Medicated Inhalation  a prominence  with  the  reading
public, before unattained in its history.   I should fail in my duty,
were I to omit the mention of  another name in this  connection, of
a gentleman whose mind is the receptacle of rich and varied stores
of information, and in whom Inhalation found a faithful friend and
defender :  I  allude to Dr.  Hmry Mellville, of New  York.
   I have now sketched briefly and very imperfectly, a general out-
line of the history  of  inhaling medicated air, as a  therapeutic
agent.   This has been done to disabuse the minds of the unin-
formed  respecting its parentage and claims to public favor, which
is frequently alledged  to  be Ignorance and Quackery.   I have
shown by a long  chronology of venerable  ancestors, extending
back to the illuminated brain of Hippocrates, that Medicated Inha-
lation is  a beautiful and legitimate child, born in the holy wedlock
of progressive science and mental  illumination, and whose mis-
sion on earth is to inspire hope in humanity, and confidence  in God. 
NOTE TO  THE SECOND EDITION.
  The collection  of Letters presented  in  the  following pages
originally appeared  in the public press of New  York, Philadel-
phia,  Boston,  St. Louis,  and  Cincinnati, and  were written at
irregular intervals of  time,  when the author was engaged in a
large  and  laborious practice.   Under  the circumstances  the
author could not give them that critical  attention and elaborate
finish which he might otherwise have done.
  As  a Second Edition of these Letters has been called  for,
they are again submitted to  the public, with  all  their imperfec-
tions,  and with the  hope  that they will receive that courteous
attention and  favorable consideration that has hitherto been
extended to them.
  We respectfully call attention to Dr. Wolfe's card on  the
fourth page of the  cover, by which it will be seen that he  has
opened an Institute in this city, for the treatment of all diseases
of the throat, lungs and  air-passages by his improved method
of inhaling vitalizing balms, etc.
                            GEO. C.  KING, Publisher.
  Cincinnati,  0. 1862. 
    CO 1ST SUM  PTIOIST
                          AND
MEDICATED    INHALATION.
[Note to the Reader.—Frequent  application  for back  numbers of my
  letters on consumption,  asthma, bronchitis, sore  throat, loss of voice, fyc. and
  my method of treating them by Medicated Inhalation, have been made, and
  being unable to comply with suca requests, I thought it best to publish
  them in a collected form, that the whole subject discussed could be pre-
  sented at once to the reader.  The hypercritical will perceive that they have
  been written without much regard to their taste, and fearless of their cen-
  sure ; but to the demands of the  invalid, I have given  my most earnest
  attention.—N. B. W.]
                        LETTER I.
        On the Anatomy and Physiology of the  Lungs.
  The true  physician, "appointed a priest of the holy flame of
life," has a higher calling and a more responsible duty to perform
than merely  to repose in the shade of his alma mater, cite  illustri-
ous names,  quote them as  authority, write long prescriptions for
patients in barbarous Latin, and hand both  over to the tender mer-
cies of the apothecary's clerk.  This may  answer the purposes of
conservatism, and be  very  professional in its character,  but the
claims of humanity are neglected,  and the public mind, in regard
to the laws of health, is left in Cimmerian  darkness. This should
not be so ; especially as the people are capable of receiving,  nay,
are asking for,  " more light."  Let the physician, then, take one
step forward at  least, and become a teacher of the  laws of health
and  the  principles of cure,  and soon the public  will  be  able to
discriminate  the scientific data of the educated physician from the
bold pretensions of the uneducated charlatan.  Do this,  and the
public will  not  only be protected  from the many impositions now
practiced upon the uninformed,  but the mental status of the pro-
fession will be raised, and much  of  the reproach  now cast upon
the medical faculty will be removed.
  Before entering upon a description of the diseases to  which the 
18
 lungs are liable, I will briefly call  the  attention of the reader to
 their anatomy and physiology.
   The lungs consist of two porous bodies, conical  in  shape, of a
 dark purple hue, composed of an infinite  number of air cells, and
 situated within the walls of the chest, which they completely fill,
 Physiologists have computed each lung to contain nearly two mil-
 lions of air cells, so that if their walls were  exposed upon a com-
 mon plane, they would cover a space of twenty  thousand square
 feet.  This extensive surface is fanned gently by every inspiration
 of air we  breathe, and as the constitution of the air may vary, so
 will its influence be felt upon the system.   Charge it with a noxious
 gas, and we become oppressed; inspire  it with  a salutary balm,
 and our spirits are elated ; soothe it with a narcotic odor, and  we
 yield at once  to its  drowsy  influence ;  inhale the  fragrance  of
 flowers, their love, and pleasure runs riot through our veins.
   The cells into which the air passes at each inspiration, and from
 which it is expelled at each expiration we make, may be compared
 in form to a cluster of grapes—the bronchia or  air tubes repre-
 senting the stems on which the grapes hang.   The bronchia form
 at the lower part of the windpipe is divided  into  two  grand divi-
 sions, one entering the right, the other the left lung.   These again
 sub-divide, the right into three, and the left into two tubes, corres-
 ponding with the number of lobes  in each lung,  which they sev-
 erally supply.   These again divide and ramify into an  almost infi-
 nite number of  smaller branches to every part of the   lungs, ter-
 minating each in a small  grape-like  cluster  of cells.   The inter-
 stices of these cells  form cavities  for the transmission of blood
 from and to the heart; and the  coats of these  vessels are so ex-
 tremely delicate that the air we breathe passes through them, and
mingles with  the blood of  the whole body every four minutes.
  The heart  throbs, and  every  vessel  is filled  with   blood ; we
breathe, and every air cell is filled  with air ; and thus by a beau-
tiful  law  of reciprocation—" give and take," the fires of animal
life are sustained.  Since, in the  same  manner, we  breathe com-
mon air, we can inhale or breathe a medicated vapor ; what can be
more  natural, more simple and  efficacious,  than  the treatment of
consumption by this method, by which remedies  are conveyed  di-
rectly into the lungs, and their  properties are brought to bear at
once on the seat of the disease, without resorting  to the uncertain,
and, alas !  too frequently, mischievous action of medicine taken 
                              19
into the stomach, from  which  it is blindly sent on a mission of
mischief  through  the  intricate channels  of humanity's  noble
temple.
                         LETTER II.
               Catabeh, or  Cold in the Head.
   There is, perhaps, no part of the  practice of medicine,  about
 which the mass of even educated physician know so little, or en-
 tertain such vague and erroneous impressions as they do in regard to
 the action and efficacy of medicated inhalation. This, however, is not
 strange, when we reflect how little has been written upon the sub-
 ject, and that, too,  of so  vague, indefinite and unsatisfactory a
 character.
   The basis upon which  this mode of practice mainly rests, may
 be explained in a few words.   The  air we breathe is more imme-
 diately  concerned in the production  of  disease than  any other
 influence to which we are exposed.   It is subject to change in its
 temperature, its  density, in its  electrical condition, and  in  the
 amount of impurities it contains, all of which  directly  affect  our
 feelings and  our  health.   Every change is thus impressed locally
 on the internal surface of the lungs, through which, by absorption,
 it acts  upon  the blood, and through the  blood on every organ,
 muscle, nerve and tissue of the body.  In  this  way we contract
 continued fever,  the plague,  yellow fever, cholera, ague, influenza
 and many other maladies, ascribed to some  radical change of the
 air itself, or to the poisonous gasses,  vapors or particles floating
 therein.   Through the same medium, the virus of small-pox, scar-
 let fever, and other common eruptive diseases is spread from house
 to house and from town to town, until nations become afflicted.
 Spasmodic asthma has unquestionably an  atmospheric origin,  and
 whoopmg cough  we  know to be transmitted from one child to an-
 other by the breath.
   Now,  in  these diseases  the excitinsr cause  is inhaled into the
 lungs, and  from  thence absorbed into the blood, which is thus
 vitiated and carried from organ to organ, depressing their vitality,
 until a chain of morbid  disturbance  is established,  involving the
 entire  system. Here we have  the  true  souroe  of  the so-called
 "idiopathic diseases."  There are other affections than those enu-
merated, which spring directly from the action of the air upon the 
20
 mucus membrane lining the air passages, such as catarrh, quinsy,
 laryngitis, bronchitis and pneumonia, of which I will speak seriatim
 in my future letters.  For the present, I will consider as briefly as
 possible the subject of " Catarrh," or " Cold in the Head," as
 a very common  disease in all countries where the  climate is sub-
 ject to many and sudden  vicisitudes of temperature.  From its
 great prevalency in this latitude, it is esteemed of little importance,
 and hence liable to neglect.   A more fatal and melancholy mistake
 seldom occurs, as it frequently masks  the commencement of that
 other malady, " consumption,"  whose  very  name awakens echoes
 of grief in a million hearts, and whose victims are more numerous
 than those of all  the  men-slaying conquerors  of earth.   The
 pathology of Catarrh is au inflammatory action of the mucus mem-
 brane lining the nose, which membrane extending downward, also
 lines the throat, larynx, windpipe and bronchial tubes.   This is to
 be noted  particularly, because it is a law of  inflammation,  that its
 tendency is to extend along the membrane  affected, and hence it is
 easily explained how a chronic catarrh may end in consumption.
   When acute catarrh begins to invade the  system, a sense of heat
 and stuffing in the  nose  is experienced, with  much difficulty to
 draw air through the nostrils.  At such times, exposure to sun-
 'ight, or breathing  cold air will  excite  violent  sneezing.   If the
 •rritation extends as far  as the frontal sinus, it will be known by a
 violent pain  in the forehead.  It may also extend through the
 lachrymal canal, which convey the tears from the eyes to the nose ;
 if so, the tears will flow down the face,  and being acrid, will exco-
 riate the skin.  A thin ichor  begins to  distil from the nose, which
 gradually becomes  a bland yellow  mucus, and  in a few days the
 complaint has subsided, or lost its acuJte character ; and if left to
 cure itself, it frequently terminates in  chronic catarrh.  Some-
 times a  simple cold  in the head will* proceed along the eustachian
 tubes and cause  deafness.  This is especially the case with those
 of scrofulous constitutions.
   Chronic catarrh is met with in  several forms, and may consist
 in " hawking," or cleaning the throat frequently through the day,
 of a yellow or straw-colored mucus, which accumulates behind the
 soft palate, and on  examining the throat, may be  seen hanging
down in festoons from the posterior nares.   Again, small  ulcers
form in the nose, and also scabs, which the patient cannot refrain
from picking.   In other  cases, false membranes exude,  which the 
21
patient removes from time to time ;  or the secretion may be puru-
lent, and dripping into the throat,  diseases that part,  creating a
disposition to " snuff"  or " hawk "  to remove  the offending mat-
ter.  Sometimes  ulcers penetrate  the bone, causing its  death,
when a thin, yellow foetid  discharge  ensues,  and  the sense of
smell is impaired or quite  destroyed.   Chronic catarrh, however,
derives  its importance from its tendency to descend to the throat,
thence along the  air passages, and  reaching the air cells, lay the
foundation of consumption, of which it is the usual precursor.
   Common sense will teach us, that remedies administered through
the stomach, cannot  reach the seat of this disease, and hence, un-
til the introduction of local  applications, it baffled the skill  and
science  of the profession to cure.  Its  formidability, however, has
been overcome by the combined use  of medicated  air, and the
showering syringes, and without these  appliances  as  local  reme-
dies, constitutional means alone must fail.
                         LETTER III.
                  Affections  of the Throat-
   In my former letters, I introduced to the  reader  the subject of
catarrh and its various modifications.  I now propose to call his
attention to some of the diseases to which the throat is liable, and
the treatment most proper to be observed.
   The throat, or  fauces, is  that cavity which is seen on looking
into the month when the tongue is  depressed,  below and behind
the curtain  of the palate, and is lined with a mucous membrane,
continuous with  the nose, oesophagus, palate,  tonsils and windpipe.
In health, this membrane is of a pale rose color, and is lubricated
with a bland transparent  secretion, which oozes from the delicate
mouths of  the follicles cropped over  all  its  surface.  This mem-
brane is subject  to a variety of diseases, superinduced by sudden
changes of  temperature—much loud speaking—the use of tobacco
and stimulating  drinks.   Its  integrity is  frequently  found very
much impaired in clergymen,  lawyers, singers, lecturers, actors,
auctioneers  and tobacco  chewers,  giving rise to a train  of most
serious maladies, pre-eminent among which we  have laryngitis, or
clergyman's  sore  throat, which is  distinguished by a partial or
total loss of voice.  We have also  a tickling in the throat, with a 
22
disposition to "hawk" frequently  through the  day, and an incli-
nation to swallow the secretion.  On looking into  the throat, little
red elevations from the size of a pin's head to a  pea, may be seen,
but of irregular shape; or the  blood  vessels may be  engorged,
and look like a scarlet net work spread over the back of the throat.
In scrofulous  persons we  find  circumscribed  forms or patches,
assuming a deep scarlet purple or violet hue,  frequently accompa-
nied with  considerable  tumefaction, the  result of a serous infil-
tration beneath the  subjacent  cellular  tissue, and not dependent
upon actual hypertrophy  itself.
  These various affections  of the throat, if early  attended to, can
in most instances,  by a judicious treatment,  be  arrested, and the
mucous membrane be restored to its original integrity ;  but if from
neglect or improper management the disease remains unchecked,
then it becomes  more  and  more  complicated,  transmitting  its
deadly influences step by step, from the throat to the larynx, from
the larynx to the trachea, thence to the bronchial tubes, and  last
of all,  the lungs themselves become involved, and we are left alone
to the silent meditations of  its fearful consequences.
  The usual recourse to bleeding, purging, counter-irritation,  etc.
in treating this  disease, exert  a  pernicious  effect  upon the  consti-
tution, by impairing its strength, and thereby giving inveteracy to
the character of the malady.    The better treatment is  to soothe
the parts with  expectorant and anodyne  inhalations, and  at  the
same time excite the diseased surface to  healthy action.   This  can
be done more effectually by topical applications, and inhaling med-
icated vapors, than any other means practiced by the profession.
                        LETTER IV.
       Lung,  Palate,  and Enlarged Tonsils.—Quinsy.
  I will now proceed to consider the abnormal conditions of the
Tonsils and Uvala, after  which we will be enabled to take another
and more important step in the progress of our investigations of
diseases of the throat and lungs.
  When diseased action has existed in the throat for any length
of time, such as follicular  development,  or degeneration of the
mucous membrane, incident to frequent colds, the immoderate use
of tobacco, loud speaking  or strong stimulating potations, we are 
23
pretty sure to find relaxation or elongation of the uvala consequent
thereto.   This condition, however,  is  not  dependent upon these
causes alone, as we frequently find it existing in persons innocent
of such  improprieties, but of anaemic  or scorbutic constitutions.
If neglected, the uvala becomes  elongated  to such an extent as to
hang down upon the root of the  tongue, where, by a mechanical
irritation, it produces a constant disposition or desire to cough or
clear the throat   The person so afflicted will frequently close his lips
and make an effort to swallow  something that  sticks in his throat
every few minutes.
   It is quite useless to make applications to an  inflamed throat,
so long as the uvula, or palate, is permitted to hang dangling about
the pharynx ; and it is surprising how much not only the comfort,
but the health is interfered with  by this simple affection.   Persons
lose flesh as rapidly almost as in  phthisis,  while the cough is  not
unfrequently supposed to be the  dreadful signal of the terrific con-
sumption.   The removal of the  uvula,  however, together with an
anodyne inhalation, soon dissipates these impressions ; and gener-
ous diet,  with plenty of out door exercise, again restores the patient
to his wonted plumpness.
   Immediately behind, and at the base  of the arch of the curtain
of the uvala, the tonsil  glands are situated, standing like sentinels
keeping watch  to the  entrance of the fauces.  These glands  are
subject to violent inflammation, by which they become so much  en-
larged, as almost to fill the passage to the throat.   This condition,
when not of a chronic  character, is called "quinsy," and in look-
ing into the throat, a red ball of  flesh may be seen jutting out from
either side, with a rough, uneven surface, seemingly  puckered or
fissured.  This disease  soon terminates, either  in  suppuration or
resolution, after  which it quickly subsides, and in a few days  the
patient gets well.  It is always heralded with the usual symptoms
of inflammation,  such  as cold rigors followed by heat,  increased
action of the heart, and a dull headache.  But when from frequent
inflammations of the tonsils, they become chronically enlarged or
hypertrophied, so as to obstruct  respiration or deglutition, or per-
manently altering the voice, and producing deafness by pressing
upon the eustachian tubes—then there is  but one efficient rem-
edy, and that is, their prompt and speedy removal by means of  the
tonsilitome, an instrument which  divides, and secures the gland at
the same instant of time, scarcely requiring a second in the opera- 
24
tion.  The operation is very simple, and  is attended  with very
little  pain, and  no inconvenience ; and, except in the hands of
an actual bungler, gives  the patient an absolute immunity from
danger.
  Tonsilitis is a powerful ally to that greater malady, consumption
—by  obstructing the entrance to the windpipe, and  increasing the
liability to attacks of chronic disease of the mucous  membrane of
the fauces, extending to the larynx, and thence to the lungs.
                        LETTER V.
           Laryngitis—Clergyman's Sore Throat.
  In approaching the subject of the Laryngitis I have a disease of
a much more  formidable character than any hitherto  presented.
It was from an acute attack of this malady,  superinduced by ex-
posure to a drenching  rain, that the illustrious Washington died,
and few indeed,  there  are,  who  have been subjects of its attack,
that have not also been its victims.
  The larynx may be called the head of the trachea or windpipe,
and is situated immediately behind, and descending from the base
of the tongue.   It is in shape not  unlike an  inverted cone, the
apex being larger than the base, and is composed of four cartileges,
held firmly together by ligaments and muscles.   It varies  in
length from one and a half  to two inches, beginning at the base of
the tongue, and extending down below the prominence on the neck,
(jpomum Adami)  known as Adam's apple, and has two openings,
the upper one of which is called the glottis, situated at the base of
the tongue.  This opening is covered by a little  sensitive valve,
called "epiglottis" which,  like a faithful sentinel, on the approach
of food or drink,  shuts  down upon  the entrance to the  lungs, and
allows the  nutriment to pass into the stomach; for if the smallest
portion of solid or fluid obtains access to the windpipe, it excites
violent cough and  great  distress,  until  the  offending matter is
ejected.
  About three  quarters of an inch  below the glottis we have the
second aperture, resembling a slit, called  the  " rhimo glotidis,"
the sides of which are formed  by  ligaments known  as chordoe
vocales, or vocal chords, enclosed in a fold of mucous membrane.
The air we inspire and  expire through this aperture in the act  of 
25
 talking, renders these chords vibrative,  producing that infinity of
 tone by which language is made intelligible to express the indwell-
 ing thought of the soul.
   When the larynx is attacked with inflammation it is called " La-
 ryngitis," and if the attack is acute in its character the  danger is
 imminent,  frequently terminating in  death in a few hours.  The
 symptoms  characterizing this form of the disease are easily dis-
 tinguished, the patient complaining of sore throat,  with  an inde-
 scribable restlessness and anxiety of countenance.  The breathing-
 becomes laborious—almost stertorious—and there is much diffi-
 culty in swallowing.  The voice is at first husky, gradually becom-
 ing more  indistinct,  until it settles  into a low whisper.   The
 horrors of strangulation  then commence, the breathing becomes
 more difficult, the face becomes livid, the eyes stare and start, an
 indescribable sense  of oppression or  suffocation is felt, and  the
 patient grasps his  throat  convulsively,  as if he would tear  the
 obstruction from it, for he feels that  his vital powers are not  de-
 stroyed by  disease,  but  that he is strangling—dying for want of
 air, as a man dies who is gradually strangled with a rope, and his
 windpipe closing slowly, slowly, slowly—the damps of death now
 bathe the  forehead—the  eye grows  gradually dim—from every
 chamber of  the  brain springs an  electric  thought of  by-gone
 years, and that this trial is the last of earth.
   Cases like this make us deplore the impuissance of our art, but
 when we can save a victim of this " fell destroyer " from impend-
 ing death, then indeed have we achieved a victory more worthy  of
 monumental renown than all the victories of blood-stained soldiers,
 who burn cities, and desolate the land  by rapine and murder.
 Cicero says that " nothing brings men  nearer the gods than by giv-
 ing health to their fellow-men."
   The physician, to treat this disease, must have no coward spirit.
 He must be prompt in  his  decision, and act with energy.  If the
 usual antiphlogistic treatment fails, then no time should be  lost in
 making the local application, as advised by Drs. Belloc and Troas-
 seau,  with the probang, and using anodyne  and emolient inhala-
 tions.   This can be  done by depressing the tongue so as to elevate
 the epiglottis, and open the entrance into the larynx.  Repeat the op-
 eration every few hours, and if unattended with relief,  and the patient
is still sinking, then employ the knife and open the windpipe  below
the seat of  disease.   The relief is instantaneous, and  the effects 
26
almost mao-ical; the patient is surprised, and looks around him as
if he had actually arisen from the dead.
   Chronic Laryngitis is a modified type of the  disease we have
just attempted to describe, and though not so startling in its man-
ifestations, is more common, and often leads to quite as fatal  results.
Persons of scrofulous habits are very liable to its attacks,  though
none can claim exemption from it.  It is frequently  found among
clergymen, lecturers,  singers, actors and  others  who  make  any
forensic effort.   The disease is sometimes called " clergymen's sore
throat."  As a general thing, however, chronic Laryngitis  comes
on as a sequence to consumption, superinduced by the matter ex-
pectorated from the decaying lungs.   This matter, on being thrown
from the lungs,  adheres to, and produces more or less ulceration
about the vocal chords, beginning on the lower sides and gradually
extending upwards.   A neglected cold  in the head or sore throat
are also fruitful causes in producing it, for the very obvious reason,
that the unhealthy secretions from the head, are constantly drip-
ping into the throat from the posterior nares, producing an irrita-
tion which  extends rapidly into  the larynx, trachea, bronchi, and
finally  into the lungs,  all of them being connected by tlie same mem-
brane.
   The treatment depends  much  upon the cause and form of the
disease.  Where it is secondary to affections of the head or throat,
to much public speaking, or to the use of tobacco, it is perfectly
manageable in a  month or two, as all these faulty conditions may
be corrected, but medicines taken into the stomach will do no good.
When  the disease is primary, however, then there is but one  sen-
sible course  for the patient to  pursue,  and that consists in the
direct application of remedies to the internal surface  of  the larynx
itself;  and even  this, to premise  entire success, must be continued
in several months.   To make  this application the inhalation of
vapors is indispensable, as by them we can soothe, astringe, heal
or stimulate, the particular parts  diseased.
                        LETTER VI.
                      Acute Bronchitis.
  I have  already called attention  to  the  parts  involved in that
fearful disease, Laryngitis.   Next in order, as we pass toward the 
27
lungs, we have the trachea or throat  division of the windpipe, by
which, bifurcating at its lower part, the grand division of the bron-
chial tubes are formed.   One enters the right lung, and the other
the left, and each sub-divides again into innumerable smaller tubes,
until they resemble  the branches  of a tree in their ramifications,
which are as intricate and minute, as  the fabled  mazes of Mythos.
   The bronchial tubes, commencing at the  lower part of the tra-
chea, are entirely within the lungs; and  hence, an inflammation
of the membrane  lining  these  tubes is, per se, a disease  of the
lungs, and not of the throat, as is generally supposed.  This mem-
brane—a delicate, transparent  covering of  the  muscular fibre of
the air tubes, is  liable to disease  from a variety of  causes,  among
which are sudden  changes  of weather, impure  air, the  dust of
workshops,  inhaling noxious gasses, etc.   When  it  becomes in-
volved in inflammation its action is deranged, the character of its
secretions are altered, and a train  of  morbid  symptoms of a more
or less grave character, both local  and  constitutional, are set up.
If the inflammation  is  acute, we have a hard, dry, hoarse cough,
commencing like a common  catarrh,  attended with a sensation of
heat, dryness of the throat  and  nasal  passages, with  alternations
of chills and fever.   As it progresses, respiration becomes difficult,
the lips and cheeks  become  purple, changing to a livid paleness,
the countenance  grows anxious, the eyes stare wildly, a cold sweat
breaks out upon the face and hands,  delirium comes  on, and the
patient relapses into the stupor  of death, which result frequently
ensues in forty-eight hours after the attack first comes on.
   Generally, however, acute bronchitis is a mild disease,  and sub-
sides entirely at the end of a week or ten days, or having only the
cough and expectoration after the  fever has  disappeared,  constitu-
ting what is termed chronic bronchitis,  or what  was known to the
faculty formerly as  " tussis," " caltarahus senilis," " bastardperip-
neumony," and the "peripneumonia notha" of Sydenham.  Its dec-
adence is marked by the expectoration  of a thin, saltish,  irritating
water, scanty at first,  but  gradually  growing  copious,  whitish,
more thick, and finally yellow.  When the sense of chilliness sub-
sides, the  pulse loses its  frequency,  the oppression in  the chest
passes off,  and the patient  rapidly convalesces, or the disease set-
tles into chronic bronchitis.
   In treating this disease, I have  seen the  most happy and bene-
ficial effects of  Inhalation,  after a judicious anti-phlogistic treat- 
28
ment had been employed.  Emollient inhalations of march mallow,
conium and ipecacuana, will, if properly used, afford in an  almost
incredible short space  of time the  greatest relief.   By inhaling
these simple remedies, the difficulty of breathing and the oppres-
sion of the chest has been rapidly  removed, the heat and parched
condition of the skin became moist, the cough quiet, and the ex-
pectoration easy.  Who that has witnessed the soothing effects of
warm fomentations applied to the external surface of the body can
doubt the value and  superior  efficacy of warm,  soothing vapors,
properly  medicated, when inhaled and transmitted along  the in-
flamed membrane of  the bronchia  ?
                         LETTER  VII.
                     Chronic Bronchitis.
   When the lining membrane of the bronchial  tubes is inflamed,
 it is called  " bronchitis," of which  there  are two kinds,  distin-
 guished as  "acute " and "chronic bronchitis."   In my last letter,
 I directed your attention to  the  symptoms by which acute bron-
 chitis is distinguished, and will present now some of the charac-
 teristics of chronic bronchitis.
   By the inexperienced and  unskilled, the disease is  often mista-
 ken for consumption; for the  mucous  membrane, sooner or later,
 becomes altered in  structure, and pours  forth a matter which has
 all  the qualities of pus, when  the usual  hectic fever  supervenes,
 and the disease  tends  as certainly to a fatal termination as con-
 sumption.   Of the  chronic  form  of  bronchitis, there  are several
 varieties, one of which  we meet  as  a winter cough,  makino-  its
 appearance regularly as the winter season approaches,  and partially
 subsiding on the return  of spring.   This  form of bronchitis is
 incurable by any other means  than medicated inhalation ; and if
 neglected, will as certainly break down  the  structure of the  lungs
 in consumption.
  Another form of  bronchitis is distinguished by  an excessive hu-
moral discharge from the lungs, resembling gum water, ranging
from one to several  pints  during the  twenty-four  hours.  Usually
there are two fits of coughing in  the day—one  in the  morning,
and the other in the evening.  There is  considerable  difficulty in
breathing while  the coughing paroxysm lasts, but as soon as the 
29
visced secretion  has been  ejected, it subsides.   This disease en-
feebles  the  patient  very much ;  but he  may, however,  live for
years,  and be  able  to attend to light  duties;  but gradually the
countenance  assumes a pale, blueish  tint—the  body wastes—the
blood becomes thin, and death  ensues apparently from the  con-
stant drain upon the lungs.
   There is still another form of this disease, called dry bronchitis,
produced by  a thickening  of the  mucous  membrane of the air
tubes, by which they are very much diminished in size.   There is
a scanty secretion of a dense, glutinous  kind of matter, variously
tinted, sometimes greenish,  again  blue or white, and not  unfre-
quently, after a rasping  cough, striated  with  blood, or russety.
This affection is so common in this climate.,  that a careful exami-
nation of the chest would  doubtless  reveal  its existence in many
who are nursing the fatal delusion of  entireiexemption.
   The symptoms by which dry bronchitis is known, are not
marked by much severity, until it  has advanced to its later stages,
when a little  exertion will  produce  much  shortness of  breath,
arising  from  the obstructed bronchial capacity.   When a large
portion of the lung is  involved a sense of oppression is  felt after
meals on making slight  exertion,  which is frequently referred  to
as the result of a full stomach, or some other than the true cause.
After a time,  however, there is felt a tightness in the chest, with a
rasping cough, several times through the day,  which enables the
patient  to expectorate a tough, gelly-like substance to  clear the
throat.   If you ask  such whether they  have a cough, they  will
answer "no," and yet almost in  the  same breath,  they  will  hack
and  raise the  very substance  I have described.   If the stomach
is deranged, it is fashionable to ascribe this cough to the stomach,
or the result of nervous derangement, or liver disease—when these
are but the signals of the inroads  being made upon the system by
this  very condition of the lungs.   But .there is something so grati-
fying in being assured that there is no danger of consumption, that
the  physician  giving this  interpretation  to  the  anxious  enquiry,
yields to the persuasive look, and cries " peace,  peace, when there
is no peace ! "  Thus human life is tampered with, until the fear-
ful details of  death  are written indelibly in  the  hectic flush, the
wasting  frame and the enfeebled  step—until the silver chords are
loosed, and the golden bowl is broken at the fountain.   This is  no 
30
fancy picture, for we see daily around us men and women sinking
gradually under  such influences into premature graves.
  But we find  still another form of bronchitis, of a very  grave
character, mostly in old people, analagous to a type already enumer-
ated as  " humoral."   From its attacks being most frequent upon
those  who have passed the meredian of life, it is called " catarrhus
senilis''  and old man's cough.   The  symptoms are  marked by a
profuse expectoration, and  a feeble  and languid pulse ; there is
also a strong inclination to sleep, frequent complaining of extreme
weakness, and a  peculiar sense  of languor  pervading  the  entire
system.  Women who nurse their children  too long are subjects
of this disease.   It is distinguished from consumption by the face
assuming a pallid and livid  appearance, aud the  lips a purple hue ;
while in consumption the  lips are of a bright  red color, and the
cheeks more constantly  flushed.   The  respiration  is also very
different and well marked.
  We  could still enumerate  other forms of bronchitis, but being
rare in their occurrence, do not demand the important considera-
tion given to the foregoing.   Among these there is a form charac-
terized by a kind of  false membrane forming on the inside of the
tubes ; another form  is the  very opposite, and consists in dilatation
of the bronchia, which may  occur in one  lobe, or  a whole lung
may be  enlarged  uniformly, or  swollen  out at the extremity in a
globular form, or there may be alternate contractions and  dilata-
tions along the same  tube.
  In  the  treatment  of  this  class of diseases by  the  profession,
there has been nothing but a fruitless round of experiments  from
the beginning to the  present; and until  the  introduction of Medi-
cated Inhalation, treatment only  served to hurry on the fatal issue.
I will examine the treatment by Medicated  Inhalation in my next.
                       LETTER VIII.
                  Treatment  of Bronchitis.
  The reader who has closely followed me in the progress of these
letters, need not be told how inadequate all  treatment must be,
which does not penetrate the lungs where the disease itself  exists ;
and how utterlly inefficient—nay, mischievous,  all applications to 
31
the throat must be, while  the  fountain  of evil lies  beneath un-
touched.
   The application of nitrate of silver to the fauces as a remedy in
treating bronchitis, has doubtless had its origin in the erroneous
idea that bronchitis  was a disease of the  throat.  This opinion is
as untruthful as the practice is unphilosophical and injurious.  As
its name- implies,  bronchitis is  simply a disease of the bronchial
tubes, which, everybody should know, are not in the throat, but in
the lungs.   Hence, when they  become  diseased,  the lungs  must
also be more or less affected.
   The pathological condition of the bronchial tubes, when inflam-
ed, is frequently found  to consist in an alteration of the structure,
by a thickening of the  mucous membrane  lining them,  until  a
part or the whole  of  the smaller air-tubes become  completely
closed or blocked up.  This prevents the  transmission of air to the
parenchymical structure of the lungs,  and  as a sequence disease
sets in.  The veriest tyro in physiology understands that if suffi-
cient fresh air is not received into the lungs to arterialize or oxydize
the blood,  that the  circulation  will contain an excess of carbon,
than which nothing can  be more fruitful of disease  and death.
Upon this  principle Dr. Cullon founds  his carbon theory of the
formation of the  tubercles in  the lungs.   This  condition of the
blood frequently exists without  giving any warning other than the
usual bronchitic symptoms, of the  fearful change which is taking
place  in the system, until the  details of consumption are  made
painfully manifest.
   I have said that  the treatment of bronchitis  hitherto has  been
profitless of good, and often fraught with mischief.  The difficulty
has been in getting  remedies to act upon the parts affected  by a
direct and local  application.  Now, how can you get into the lungs
with remedies ?   Certainly not  by swallowing medicine  into the
stomach, for these never, only in a qualified sense, reach the lungs,
and  are more  frequently productive of evil than good.   Let us
look to nature  in this  dilemma, as we must in other cases, for  a
solution of  the difficulty,  and the method is at once indicated.  It
is to inhale, or draw in the medicine with the air  we breathe, into
the lungs.
   Inhalation simply means the act of inspiring or drawing a breath,
but when  applied to a mode of administering medicines it means
to breathe them.  Thus  I say, " / inhale a medicine" instead of " / 
32
take a medicine" the only difference  being that one is inhaled into
the lungs, and the other is swallowed into the stomach.  With this
explanation it is made plain that remedies must vary when adminis-
tered by inhalation  as much  as if they were swallowed.   I will
illustrate this  proposition still  further.   It is well known  that in
spasmodic asthma, inhaling the smoke of "jimson weed" (datura
stramonium) will relax the spasm and relieve  the patient; but this
remedy will not  check the discharge in humoral asthma, nor make
any impression whatever upon systems having idiosyncracy of habit
or constitutional  peculiarities.  Now, what has been said of asthma
is equally true of bronchitis and consumption,  and I only make
this explanation  because, that many who write to me respecting
treatment, have  got the erroneous idea  that inhalation, instead of
being a mode of practice, is some specific nostrum for the cure of
consumption.  To make it such is  to  degrade it to the level of
quackery, or stamp it with the pernicious character of the routinist.
   The  late Vice President of the United  States, Wm.  R.  King,
undoubtedly had his  death expedited by the ignorance and impru-
dence of his medical  advisers, who advised  him to use the "suo-ar-
house cure," by  inhaling  the  vapor of sugar.   At the  time this
advice was given, the Vice  President had extensive cavities in his
lungs, which were secreting a copious  and enfeebling expectora-
tion.  By inhaling the sugar vapors, this secretion was increased,
and after spending a winter in a  sugar-house  on the Isle of Cuba,
he returned to  Alabama, barely in time to  meet his friends before
he died.  Now,  sugar vapors are highly useful  in treating some
forms of consumption, but it is equally  injurious in others.   Had
the medical advisers of William R. King known how to distinguish
the various forms of  consumption, and prescribe  accordingly, it is
only fair to say that the pineries of Carolina or the balsam  groves
of Canada  would have been selected as recruiting grounds for the
Vice  President,  if it was at all necessary to go  so far, to  breath
balsam or gum exhalations.
  In treating bronchitis, the first object is to  cleanse the  air tubes
of the lungs, by the  use of expectorant inhalants, after which, the
irritation must be allayed upon  which the  secretion depended, by
soothing and healing the inflamed surface.  When I come to speak
of the treatment  of consumption,  I will  write  more in detail upon
this subject.
   Having  now  considered  briefly some of the  more prominent 
33
diseases of the throat and air-passages, and pointed out that Medi-
cated Inhalation is  the  only efficient mode of treating them, I
will next proceed in  like manner, to consider the more serious mal-
adies of the lungs, direct.
                         LETTER IX.
    Curability of Consumption by Medicated  Inhalation.
   While a large majority of the medical  profession entertain  the
 opinion that consumption cannot be cured, we cannot affect much
 astonishment that the mass of mankind should echo such a perni-
 cious oracle.  To  combat this opinion, before I enter immediately
 upon a description of the symptoms of consumption, I will adduce
 from  indubitable authority, as well as my  own  knowledge and ex-
 perience, evidence to show that consumption is perfectly curable,
 if properly treated.
   Sydenham, perhaps the greatest physician that has appeared in
 Europe since the time of the Arabians, affirms that  he had repeat-
 edly cured phthisis (consumption,) not only in its incipient stage,
 but after night  sweats  and diarrhea had  taken place.   The great
 Doctor Laennce, the discoverer of the  stethoscope,  and physician
 to the largest hospital in Paris, examined thousands of bodies after
 death, and he gave to the world as the result of his researches, that
 he had met many cases, in some of which, large portions of lung had
 been destroyed by consumption,  but the parts, nevertheless, had  en-
 tirely  healed.  Sir James  Clark,  physician to the Queen of Eng-
 land,  in his.great work an Climate and Consumption, admits fully
 the curability of the disease.
  Professor Graves of Dublin—than  whom,  while living, none
 stood  higher as a stethoscopist,—pointed  out  one  form  of con-
 sumption in which the tubercle could  be  entirely  dispersed by a
 gentle salivation,  which  statement is  corroborated by Professors
 Stokes, Bellingham, and others in the Lancet.   Dr.  Piorry, physi-
cian to one of the largest hospitals in Paris, is  renowned in France
 for his success  in curing consumption  by friction and  inhalation.
 Dr. Maddocks is at present celebrated for his success  in  curing
consumption, and has done much  to advance the science of inha-
 lation, which is his  principal  mode of treatment.  Both he and
 Sir Charles Scudimore  have written out very acceptable books, in
              3 
34
 which many cases of consumption  are  cited, that have been per-
 fectly cured by medicated inhalation, which  treatment  they une-
 quivocally recommend to the  profession, as being the very best.
 The reports of the Brompton  Hospital, under Dr. Elliotson, show
 more favorable  results  from  this practice  than was ever attained
 before ;  while Professors Sweet and Periora pronounce medicated
 inhalation the most scientific as well  as  the most successful prac-
 tice ever employed in treating  consumption.  Similar opinions to
 the  foregoing could be quoted from  many others, eminent in  the
 profession, all attesting the curability of consumption ; but I must
 omit them, to make room for a few expressions  in favor of Medi-
 cated Inhalation.
   Our own great physician, Dr. Rush, says, in reference to " inha-
 lation,"  that "too much  can  not be said in favor of this simple
 system  of conveying remedies to the  lungs.   / have frequently
 seen patients  snatched from  the jaws  of death by it;  and whether
 all the  beneficent results that may be justly considered possible
 to result from the inhaler will  be realized, must be determined by
 future observation ; but it is hoped that  the general want of suc-
 cess which attends the present mode of treating  consumption, will
 induce medical men to give  inhalation a fair  trial  as a remedial
 measure."   Dr. Coxe, of New York, in  his work on Pulmonary
 Disease, says :   " I now consider the curative power of medical
 inhalation well  established ; and those who labor  under consump-
 tion,  have certainly a right to demand of their medical advisers
 a fair trial of its powers, before  they  are urged to leave  their
 homes for changes of climate, or the  uncertain consequences of a
 sea voyage."   Dr. Carrigan, of Dublin, says:  " There can be no
 doubt that  medical  inhalation  exerts a most powerful  influence
 over diseased actions, and that as it is only  in this  form that  we
 can administer  remedies  to act locally upon diseased  tissue of the
 lungs, it merits our most respectful attention."
   Br. Melville,  the  intellectual colleague  of Dr. Hunter, of  New
 York, grasps with his  comprehensive mind the whole subject  of
 Inhalation, and reduces  it  to this  simple  proposition :  " If  we
 would cure consumption,  we must treat the disease—not the symp-
toms; and if we would  treat  the  disease, we  must inhale;  for
there is  no  other means of reaching its  seat—the  lungs.   No
treatment by the stomach can  be  more than  palliative, while by the 
35
lungs  it  is  always  radical—it gets  at  the  very  root of the
disease."
  Having cited briefly a few authorities recognizing the curability
of consumption,  and the  claims of medicated inhalation in the
scientific attainment  of  that result, I would now suggest to those
who are still professional Sadducees, that if they  cannot present
the record of a practice  equally  successful, to get  out of the way
of Inhalation, and let it work.   We know  that by the old prac-
tice, thousands,  hundreds of thousands, die annually, and will con-
tinue to die, until the treatment is changed.  But as the new prac-
tice  becomes  better  understood,  and  medicated   inhalation  has
enlarged and improved its pharmacy, then  this appalling fact will
cease to be.
  Already some master minds, unawed by the dicta of schools,
or the  sneers of their less laborious  or  less intellectual brethren,
have broken through the trammels of routine,  and  grappled  with
gigantic strength this fearful disease, and  dared to follow the new
path of inhalation, which, though still  only in the  adolescence of
its usefulness,  has  achieved results in the cure of consumption
hitherto  deemed unattainable.   Give it, then,  a fair trial; and in
the hands of the scientific  practitioner  it  will  be   found  a source
of blessing to the .invalid,  though  when employed and degraded
by the charlatan, whether  he be a priest or layman in the profes-
sion, the result  must always be equivocal.    One consideration,
however, connot be too  strongly impressed upon the minds of per-
sons afflicted  with  consumption,  who  propose to  use medicated
inhalation, and that is, that  the  certainty  of cure  is greater, the
earlier the  case  comes  under treatment;  and  that success grows
proportionately less the longer treatment is deferred, and the dis-
ease approaches its fatal termination.
                         LETTER X.
                  Symptoms of  Consumption.
  It gives a startling  importance  to the  subject  upon  which I
write,  when we  reflect  that of  the  crowd of men,  women  and
children we daily see thronging our streets, one-fifth will fall vic-
tims to the fell  destroyer, consumption,  unless rescued by appro-
priate treatment.  In my former letter, I have presented  incontes- 
36
tible proof that consumption may be cured by medicated inhala-
tion, and now let  us in candor  ask, what promise  have  we to
lessen  this  frightful  mortality by  the  old  system of treatment?
Take up any practice  of  medicine—Watson,  Wood  or Eberle ;
Hahneman or Thompson—or any standard  works  in  our medical
schools, and they all  alike  candidly avow,  that no treatment of
consumption to them known, has been more than palliative. Watch
the practice of two  physicians of equal  eminence, and see how
opposite  their mode of proceeding ; but each lands his patients
equally in death.
  So sure are they of the  fatal result, that they invariably deceive
their patients at the  beginning, by saying it is " only a mere cold,"
or "slio-ht bronchitis;" and if the patient  spits blood, " it comes
from the throat," and thus the precious opportunity when the disease
is most easily controlled, is allowed to slip by, never to be redeemed.
The very treatment, while it soothes the most  distressing symp-
toms, masks the disease,  and in many  instances hurries on  the
catastrophe.   When the disease  has so far advanced that the pa-
tient almost  dispairs  himself, he  is  then  advised to go south or
take a sea voyage, in  most  cases  deprived  of the  oriental  bene-
diction of "dying  among his kindred."   Why patients intrust
themselves to physicians  who  openly  proclaim  in  their books,
and in  their conversation,  that they  can do nothing for consump-
tion, is an incomprehensible infatuation.   If the  physician has no
faith in his ability to cure  consumption, it is the hight of folly for
the. patient to trust him, and every dose he  swallows  should be as
a sacrament  taken,  accompanied by a profound  meditation  upon
death.
     In my  last letter I cited a  number of names, eminent in the
profession, favorable to medicated inhalation  as a therapeutic agent
in treating consumption,  which  presents a striking contrast  to the
opening  paragraph  of this letter.   I will now  consider a few of
the more prominent symptoms which herald consumption, and by
making them perfectly understood, will apprise the patient of dan-
ger in time to avert  it.
  The  earliest  symptom  that  commonly  attracts attention  is a
slight,  dry cough, occurring in the morning, and perhaps repeated
two or three times a day.   This  gradually increases in a few weeks
or months in frequency, and a ropy, saliva-looking mucus is spit
up, most ab*undant in the morning, and  usually  supposed to come 
37
only from the throat; but it is secreted from  the air tubes, which
are irritated by  the neighborhood  of the tubercles.   Gradually
yellowish specks appear in the  expectoration,  which  ultimately
becomes entirely yellow  or  green.   The expectoration is not al-
ways a criterion of the amount of disease in the lungs, though it
generally is.   But I have seen persons die, from  the blocking up
of the lungs by tubercle,  and  neither cough nor spit the whole
time.
   It is of the utmost consequence, that coughs should be attended
to early, for although every cough is  not the  premonition of con-
sumption, most are ! and it is a golden rule,  that the earlier it is
attended to, the greater the probability of cure.  Spitting blood,
or bleeding from the lungs, is sometimes  an early symptom, but
always a serious one in consumption.   This symptom, says Henry
Melville,  possesses a fearful interest, from  the  melancholy  truth
that it rarely happens,  except as a consequence  of serious  disease
within the chest.   The  loss  of blood is an indication  of  the  pres-
ence of tubercle within the lungs ;  and from  these  tubercles will
arise, sooner or later, all those changes and  symptoms which con-
stitute consumption.  On this point there is much error.  It is by
no means unfrequent for physicians to cheer their  patients by the
assurance  that  " the blood has only  come from the throat."   Let
me warn you against being deceived.  The  throat rarely bleeds !
In nine hundred and ninety-nine cases out of a thousand, when you
cough up blood, however  small the quantity, that blood comes  from
the lungs, and speaks a terrible warning.   Bleeding, however, does
not always accompany consumption, but when you have it, if you
value health, if  you prize life, if  you have any object that renders
existence desirable, begin at once to earnestly  resist the progress
of this  fearful malady, the seeds of which are sown  in  the  most
vital part of your body.
   Shortness of  breath is an early symptom, and is felt most on
exertion ; on ascending hights, going up hill  or up stairs.   It is a
mark of such importance, that when it exists, an immediate exam-
ination  of the lungs should be had by a competent and truthful per-
son.  If, along  with shortness of breath, there is a wasting of the
body and quickness of the pulse,  it amounts to a certainty that
there is disease  going on  in  the lungs.   When  the pulse ranges
above a hundred beats in a minute, the case is very grave.   Some
few cases are seen in which the pulse  is preter-naturally  slow, 
38
 and yet end fatally.   The natural pulse is 70 to 75 in the minute ;
 the respiration 15 to 18.  Above this, announces  disease.  Wast-
 ing is always to be looked  on with  suspicion, when  there is no
 evident cause for it.  Shooting pains through the  collar-bones  and
 shoulders, or dull, burning  pain in the chest, are  fearfully signifi-
 cant.  If the disease has advanced, hectic  fever comes on toward
 evening,  and  goes  off toward morning in a perspiration  called
 " night sweat," which  is often  enormous in amount,  occasioning
 great distress to the patient, and accelerating the catastrophe from
 the rapid wasting of the tissues,  and  the  exhausting  debility it
 produces.  Hectic is gradud in its approach ; at first a little creep-
 ing chill felt for a few  moments  in the afternoon, followed by a
 slight pink of the cheek  and slight  sweat at  night ;  but  as  the
 disease advances, these symptoms  are all aggravated and intensi-
 fied.   I have known it to be mistaken  for  ague,  when the chill
 was decided.
  In persons over twenty-five it sometimes occurs  that the first  de-
 posit of tubercle  is accompanied not with a cough, but with dys-
 peptic symptoms, such as uneasiness in the stomach after eating,
 or heart-burn  and indigestion.   The end  approaches, when  the
 physician mistakes the  disease, and purges  his patient for bil-
 iousness.
   In  females,  the suppression  of the periodic  excretions often
 occurs in an early period of consumption,  and the  younger the pa-
 tient, the more rapid the  fatal  termination.   When supp-ession
 occurs either in the young, the middle-aged, or the change of life,
 attended  with a cough,  sore throat,  palpitation of the  heart,  on
 walking briskly up stairs, with a flattening of  the  chest under  the
collar bones, and a tendency to stoop, then  indeed  disease  in the
lungs becomes  too manifest to tolerate a doubt for one moment the
existence of tubercle.   And if, in addition to this, we observe the
white  of the eye  become  pearl-gray,  with a  slight  spasmodic
twitching of the upper lip and  nose  when  speaking, it is only to
add confirmation to conviction, that the seeds of  death are there.
  If under such circumstances, drastic emmenagogues are resorted
to, to restore  the  impaired  function, we only  too surely hasten
death by producing a rapid failure of the vital power. 
39
                         LETTER XL
         Symptoms of  Consumption—Spitting Blood.
  In my last letter I called  attention to some of the most promi-
nent symptoms which herald the approach or indicate the presence
of consumption.   As I then stated, I did this to apprise  persons
of danger in time, that they might address the proper remedies to
avert its fatal consequences.  Among the early symptoms  of con-
sumption I noticed, I mentioned a hacking cough, with a ropy-like
saliva in the morning, and more or less frequently through  the day.
In the  early  stage of consumption, we also have " short  breath"
in walking up hill  or  ascending  stairs—palpitation of the  heart
when using a little extra exertion—shooting pains  through the
breast  and  sides—night  sweats and spitting blood.  To  this last
symptom I wish to call  your attention more particularly  ; espec-
ially so, as it is one of great importance.
  Many persons  spit  blood years  before  any symptoms of eon-
sumption are noticed, and when by general  observation they would
be pronounced healthy.   To agree with this opinion, such persons
when they approach the auscultator,  thump themselves on the
breast, and say,  " There is nothing the matter here, doctor,"  and
expect a good-natured acquiescence.  In others, the first attack of
hemorrhage dates  the  commencement of the  disease,  and the
cough, the  short breathing, and the  expectoration, are all  referred
and ascribed to the bleeding.   Some again  do not raise blood until
late, and in a few instances, consumption  runs its entire course
without even a tinge of blood in the expectoration.   But as a gen-
eral thing, whenever blood is spit, whether it is only a few streaks
in the  expectoration, or mouthsful, remember that  it rarely hap-
pens except as a serious disease within the chest, though the patient
may be unconscious of it.   Spitting blood  is almost a sure  indi-
cation of tubercles within the lung, and from these tubercles will
arise sooner or later all those changes  and sjmptoms which con-
stitute  consumption.
  Henry Melville,  says:  " It cannot be  too widely known that
spitting blood is a thing of fearful interest, as pointing out the si-
lent, treacherous progress  of a deadly disease  within the lungs.
The  loss of blood  is an  indication of the presence of tubercles,
from which arise consumption.  Physicians frequently cheer their
patients by the assurance that  the  blood has only come from the 
40
 throat.   Let me  warn you not to be deceived.  In  nine  hundred
 and  ninety-nine  cases out of a thousand, when  you  cough up
 blood, however small the quantity, that blood comes from the lungs,
 and  speaks  a terrible warning; and if  you  value  health—if
 you prize life—if you have any object that renders  existence de-
 sirable, begin at  once to resist the progress of  this fearful malady."
   Professor Walsh, in his work on Diseases of the  Lungs, says:
 " In those cases of bronchitis where blood  is present in the ex-
 pectoration, tubercles may always be expected in the lungs."
   The celebrated Dr. Sweet, in his work  on Diseases of the Chest,
 says : " Though  bleeding from the  lungs  does not always occur
 in consumption,  yet, whenever it does occur, it almost certainly
 indicates the disease."
   Professor Latham, in his lectures on  Clinical  Medicine, in St.
 Bartholomew, thus  speaks  of Hemorrhage of the Lungs :  " Spit-
 ting blood  always gives  fearful  intimation of the presence of tu-
 bercles, which are only the  egsjs of consumption."
   In twelve hundred, cases  of bleeding  from the lungs, Dr. Louis
 did not meet a single instanc-e where it was not preceded or followed
 by consumption.  And thus it is that " spitting blood " is  consid-
 ered so sure a precursor of  consumption,  that  life insurance com-
 panies refuse to grant policies upon any  man's life, who has been
 so affected.
  Hemorrhage from  the  lungs  seldom proves  fatal in its imme-
 diate consequences.   Years sometimes elapse before its fatal effects
 are produced.   Indeed, we frequently hear persons who have had
 bleeding at the lungs,  remark that they feel decidedly better, and
seemingly do improve, but this is only a temporary  relief, and it is
a fatal mistake  to regard it as a removal  of the difficulty ;  for the
same causes that  produced  the  bleeding  still  remain, and if not
arrested or removed, will end in death.
                        LETTER  XII.
                    Chronic Consumption.
  In my last  letter I pointed out that spitting of blood  is, with
few exceptions, the precursor  or  companion of consumption, and
that the smallest quantity mixed with the expectoration, is as sig-
nificant as though there were pints coughed up ; and therefore, on 
                              41
 the appearance of this symptom, immediate recourse should be had
 to measures calculated to eradicate its deadly companion, Phthisis.
   Consumption is divided into Chronic, Latent,  Infantile, Sub-
 Acute and Acute, which I propose to describe seriatim.  Chronic
 consumption runs  its  course in a  period  varying from  a few
 months to  several  years ; the average  time  being  about  twenty
 months.   At first, a slight,  hacking cough  comes  on, which is
 most frequent in the morning when rising.  It is dry at first, but
 after a variable interval, a little  thick, saliva-looking mucus is spit
 up, which, as it becomes more abundant, often deposits a greyish
 sediment resembling barley water, which is only seen in consump-
 tion.   The cause of this cough, which  at  first is only a hack, is
 the irritation occasioned by the existence of tubercles in the lungs,
 too often not suspected until too late.   Sometimes  the first symp-
 tom observed is the spitting of blood, often in very small  quanti-
 ties.   In other  cases a sore  throat,  or catarrh, comes on  from a
 slight exposure to cold, which, on subsiding, leaves  the  dry hack
 just spoken of.
   Sometimes consumption is ushered in by a succession of chills
and fever, that comes on with  the regularity of ague, for which it
is  often mistaken.   Others, again, first  betray the fatal taint by a
sense of heat in the hands and feet,  and a slight flush on the cheek
most marked in the evening.   A wasting  of  the  body  is often an
early and always a serious symptom.   Perspiration is increased at
ni"ht,  until at length the bed is fairly saturated  in the latter sta-
ges.   The  wasting and debility  keep pace with   the  amount
of night  sweat.  As a general rule,  the appetite remains good,
but  in the second  stage  the  food  is  frequently  vomited after
couohino-.  In  women,  the  monthly sickness  is generally sup-
pressed ; and the  mistake is often  made of  attributing the lung
disease to  this, instead of referring to the  consumption  as the true
cause of suppression.    Pain is often present, but not always.  As
the disease  progresses the spits  become streaked with  yellow—
chan^ino- into yellowish or grayish  green, consisting of pure mat-
ter, mixed  with  specks of tubercle.   When thrown into water they
 assume a round, flattened shape, covered with a ragged,  woolly
 surface, and  sink in the water.   When  cavities are developed in
 the lungs, they lose their rounded shape and are expectorated in
large, shapeless masses.
   In this form  of consumption, the patient does not always run a 
42
 uniform course, but in some the patient  appears to improve every
 now and then; he  may  be apparently  well  even  for  weeks  or
 months, and then be again prostrated  totally, and this for several
 successive intervals.   But this improvement is deceptive ; how, I
 will proceed to explain.   A crop of tubercles are deposited upon
 the lungs; they soften and are expectorated,  during which the
 patient is prostrated ; after which  he rallies until  a new crop is
 sown or softened, which  goes  through the same routine, and this
 is repeated until the patient is exhausted.   At every successive
 softening of a batch of  tubercles,  a  portion of lung is  broken
 down and expectorated,  and  the  patient  spits  pus—has  hectic
 fever, night sweats, loss of flesh and strength, and often of appe-
 tite, aud  coughs  very much at night.   Then  the symptoms im-
 prove, the cough  disappears,  and he  regains flesh  and strength.
 Now his  friends think he is well, and  he flatters himself that  he
 is quite restored, but in a short time all the  bad symptoms return.
 It is the  occurrence of  these intervals of temporary  health  that
 has given an ill deserved reputation to Cod Liver Oil,  and a thou-
 sand villainous nostrums  for the cure of consumption,  and upon
 which,  also,  the  reputation  of testimonial publishers depend ;
 health being  established  for  the time by nature herself,  which
 they refer to the last drug taken, or to  the last quack employed.
   The most eminent  physicians content  themselves with telling
 their consumptive  patients to live well, take out door exercise,  be
prudent, and take very little medicine.  This is  all very good ad-
 vice.   It is better than helping on the fatal result of the disease by
 preparations of morphine  to  soothe the cough  at the expense of
 the digestion ;  making a sore on the  outside of  the  chest, to help
 the ulcer  inside to finish   the patient ; purging,  to aid the  disease
 to exhaust the sufferer, and the other fashionable modes of slaugh-
 ter.   This plan of leaving the case to nature, is  the better of two
evils, as the patient has a chance of  a longer lease of life, although
death is almost the invariable result.
   It was my intention to here speak of treatment; but apropos of
what I have just written : In attempting to cure consumption it
can only be done by absorption of the tubercles, and  their remo-
val, without breaking down the structure of the lungs.   This is
the mode  by which dropsies, enlarged  scrofulous glands, tumors,
etc. are removed ;  and this is  what we assert is effected by Medi-
cated Inhalation, when resorted to in time.   The tuberculous mat- 
43
ter thus absorbed into tne blood, is thrown off from the system by
the skin, kidneys, bowels and other emunctitories.
                       LETTER  XIII.
                     Latent Consumption.
  In my last  letter, I described chronic  consumption, and  shall
now take up the latent form.
  Latent  consumption is characterized  by  an absence of cough,
expectoration, pain  and  spitting of blood, although the lungs be
loaded with tubercles.  These symptoms in not a few cases, are
absent even till death results;  but in  the  majority,  after a long
period of ailing health, spitting of blood, cough or pain set in sud-
denly, and the disease runs a rapid  course.   The  tubercles  exist-
ing in the lungs, often work out their ill  influences  by secondary
changes in the blood, and other  diseases are set up, which  des-
troy the patient, and from the absence of the prominent symptoms
of lung disease, the physician and patient are both led astray, and
attention is directed towards  removing the diseases, which are the
effects, instead of attacking the cause.   Or,  if the physician knows
the cause, he  conceals it for the patient's  sake, because he knows
no remedy.   In such cases, the patient goes  about with less alac-
rity than when in health; business is an exertion ; he complains of
various dyspeptic symptoms, heartburn, pain in the stomach, water-
brash, uneasiness  during  digestion,  pains in liver or  right shoul-
der,  costiveness alternating with  diarrhea, disturbed rest,  and
emaciation more or less.   The urine will even present the chemical
and microscopic changes observed  in functional  or  organic affec-
tions of the stomach and liver.  Fistula in  ano occurs almost exclu-
sively in such cases, and appears to keep the  tuberculous disease
in  check, as  does  also chronic inflammation  of the  peritoneum,
(investing membrane of the  intestines,) which often masks latent
consumption,  and  is  most frequently  in  females, while fistula is
more  common to men.   Besides these, various other symptoms
are complained of, indicating a diseased state  of the body, and
often  puzzle the medical attendant.
   The observant physician will generally see marks in the coun-
tenance of the patient, that will make  him  suspect the existence
of tubercles—such as the delicate appearance, the  pearly hue of 
44
the white of the eye, varying in tint  from yellowish white in the
fair, to deep, blueish gray in the  dark complexioned, and a very
slight spasmodic twitch of the  corners of the mouth and nose in
speaking, which increases to a shiver  over the cheek as the deposit
in the lungs augments.
   On examining  the  chest,  depression  will  be  found  above or
below the collar bones, or both.   When the deposit is great, these
bones stick out, so to speak.   On tapping in the immediate neigh-
borhood of the collar  bones,  sounds are  produced, establishing
that tubercles  exist in various  stages of development—nay, even
cavities, although there has been no cough.   These cases are gen-
erally pronounced  bilious or dyspeptic, or anything but what they
really are, and the treatment of course cannot be  appropriate.  I
would  particularly  impress  the fact  that  active purging and the
use of mercurial preparations, are peculiarly apt to rouse  the tu-
bercles into activity, and to develop rapid  consumption.   At pres-
ent, the orthodox  practice for bilious and  dyspeptic  complaints is
calomel or blue pill, which  are rank  poisons in the  forms of  dis-
ease under consideration.  The obvious  practical inference is, that
in all eases at all  resembling  what I  have described, it  is abso-
lutely necessary to  have the chest examined by a competent and
truthful physician, before undergoing treatment, and if  tubercles
are present, Inhalation presents  the only  known means  for their
removal.
                        LETTER XIV.
                   Infantile  Consumption.
  In my last letter I described that insidious form of disease, latent
consumption, and pointed out how constantly it is confounded with
liver and other chronic conplaints, to the great danger of the  suf-
ferer.   I now enter on  the subject of  Infantile  Consumption.   It
is commonly thought that this disorder is very rare, under fifteen
years of age ; but the researches of Boudet  Papvoine, and Trous-
seau, prove that more than one-half of the children of the poor, and
of those in the infant hospitals of Paris die of consumptive disease,
and this is approximately true of all large cities, so that from three
years to fifteen, consumption is  more prevalent and  fatal  than  at
any other age. 
45
  The causes of consumption among children are usually the cir-
cumstances in which they are placed, and not to inheritance, as is
vulgarly supposed.   Among the poor,  impure  air  from  living in
narrow lanes, with  yards reeking with  filth  and  garbage ; dark
noisome rooms, whose windows are rarely opened ; personal and do-
mestic uncleanness further contaminating the air ; bad food, where-
by  healthy development is checked, and scanty clothing,  exposing
them to colds and inflammations, are the four great causes ever in
operation to develop consumption.
  Strange as it may appear,  the same causes are active among the
rich.  Cooped up for at least twenty hours out of the  twenty-four
in hot, ill-ventilated nurseries, instead of spending  half their  time
in exercising in  the open air, they are fretted by a tedious  operation
of dressing, and then sent out for stately walks along the sidewalks,
with Sally.   Being so finely dressed, they must not play : it  is—
Master Charles, don't rub   your  gloves along the wall—Master
Henry, don't walk  in  the dirt—and this is  to do them for air  and
exercise. The food, although not deficient, is nevertheless equally
pernicious from the quality.   Instead of being kept to  plain, nutri-
tious food, they are  too often indulged in all the varieties of the table,
and their digestion impaired by candies, sweetmeats, and cakes.
The clothing, although  expensive, is  too often deficient, the bare
arms and legs,  which imperious fashion exacts, are direct cause of
almost all the croups, colds  and inflammations children are attacked
with.   Consumption does not usually manifest itself in children by
active symptoms ;  wasting  is the most constantly present.  When
we find conjoined, with this, erruptions behind the ears, swelling of
the glands of the neck, soreness or running of the nose, erruptions
about the face with puffy, chapped lips, pustules about the edges of
the eyelids, or sore eyes with the greatest dread of the light, caus-
ing the child to bury its face even in  the pillow,  we may suspect
the existence of tubercles in the lungs, as these all  point to  a dis-
 eased state of the general system, with  deep seated complication.
   Although the causes enumerated above will develop  consump-
 tion in any child long enough exposed to them, yet there is a wide
 difference in the susceptibility of different children to contract it.
 Very intellectual children,  with ardent affections and  loving dispo-
 sitions, are remarkably prone to it, and the expression constantly
 used with regard to them is, that " they are too wise or too good to 
46
live."   A pale, pasty complexion, or a large head with  a narrow
chest, indicate the same predisposition.
  The symptoms in the consumption of children  are  very mild;
there is  no spitting of blood ;  the paroxysms of coughing  are  not
uro-ent or distressing ; and the matter coughed up from  the lungs
is invariably swallowed, and excites no alarm.   Night sweats exist
only about the neck and brow.  The  hectic fever  is slight,  and
generally attributed to worms, or deragement of the stomach.   Di-
arrhea is a usual attendant, and the  child, when asleep, is observed
to breathe faster than natural.  With all this, gradual wasting of
the body and strength is constantly present.  Change of air or  diet
may arrest the wasting for a few weeks,  but the  improvement is
only temporary.   Diarrhea or fever soon close the scene.
  Children under five years cannot be made to use the inhaler,  and
therefore the air of the nursery must be medicated,  thus  compell-
ing the child to breathe only a medicated air which acts most pow-
erfully on the diseased surface of the lungs.  Above the age o.f five,
children usually regard the use of the inhaler as high fun, and take
to it readily.  The changes in the system of the child are so rapid,
and the  vitality so great, that amendment is far more speedy than
in grown  people.
                       LETTER XV.
                     Sub-Acute Phthisis.
  My last letter contained a description of infantile consumption,
and next in order comes sub-acute phthisis.   This  form of  the
complaint runs its course in from six to fifteen weeks from the first
observance of the symptoms,  which usually resemble  those  of
chronic consumption already detailed, but  are much more rapid in
succession.—It is unnecessary to recapitulate them here.  Avery
large portion of the lungs  is rapidly  infiltrated with  tubercle and
rendered useless ; there are softenings and cavities, but these  are
small in extent, owing to the short duration of the complaint.   It
would appear that death takes place more  from the system  not
having time to accommodate itself to the speedy  diminishing cap-
acity of the lungs, than from the exhaustion of the prolonged dis-
charge of matter, thus differing from chronic phthisis.   Sub-acute
consumption is known by the name of "galloping," from its  early 
47
termination, and is often confounded with acute bronchitis, but an
experienced stethoscopist, would never make  the  mistake.  Even
this form is amenable to treatment;  I have several cases  reported
in mjr  book,  where the disease  has been  permanently arrested,
and the parties are now in good health.  It comprises but a small
portion of  the cases of consumption.   Acute phthisis  is of very
rare occurrence—I have seen only four eases  of it, running  its
course to a fatal termination in three or four weeks.   The lungs
become completely blocked up  in  that short  time, chiefly with
tubercles.
   The symptoms resemble those of low typhoid fever, with wan-
dering or delirium at night.   The cough is either dry,  or accom-
panied by expectoration of a clear, sometimes yellowish mucus.—
This, with the continually increasing frequency and difficulty  of
breathing,  should draw attention to the condition  of  the  lungs,
which the stethoscope will soon reveal.  This form does not  ap-
pear to be at all controlled by treatment.   In  my  next  letter,  I
shall explain how tubercles produce cavities and ulcerations in the
lungs.
                       LETTER XVI.
          Pathology of Tuberculous  Consumption.
  In my preceding letters I have pointed out the various forms of
consumption, and the  symptoms peculiar to each, and also the sym-
toms of nasal catarrh, sore throat, chronic  laryngitis, and bron-
chitis, demonstrating the important facts that the tendency  of these
complaints is to lay the foundation of consumption.   The mode in
which it would appear this is  produced,  is  by  the gradual exten-
sion of  the  inflammation  along  the  air tubes, until, reaching the
minute branches and the air cells, these are  blocked up with mu-
cus, thus preventing the air from reaching  the blood  circulating
through the air cells,  so that the change  from  venous to  arterial
blood does not take place.   The consequence of this  impediment
is, that  the tuberculous matter is deposited in the air cells, and the
smaller  branches of the air tubes.  At first,  the tubercles are very
small, resembling  millet seeds ; hence called  " miliary."  They
are grey and translucent, and  scattered  more or  less profusely
over the upper part of one or  both lungs.   It is a tradition in the 
48
profession, that the left  lung is much oftener  the  seat of disease,
first or solely, than the right.    But this is the result of imperfect
observation, promulgated by a high authority, and implicitly re-
ceived by the flock.   My experience, which has not been small in
this disease, has fully satisfied me, that there is little if any differ-
ence  in  the  liability of either  lung to  the deposit  of tubercle.
Again,  it  is a disputed question as to whether  the tubercles  are
deposited in the air cells, or in the  surrounding tissue.  Examina-
tion with the  microscope has convinced  me that in miliary  tuber-
cle the deposit takes place into the air cells and finer air tubes, and
that tuberculous matter is never found  in the substance  of  the
lungs, except in the  form of infiltrated tubercle,  the result of what
is now called " chronic pneumonia," or chronic inflammation of
the lungs—rather a misnomer.  The miliary tubercle, after a time.
undergoes a change in size and appearance, becoming larger, and
of a yellow, cheesy appearance.  The pressure of these little mass-
es  causes  absorption of the walls  of the  air cells, and a coales-
cing of  the tubercles into maps of various sizes.  In this state they
may  remain quiet for weeks or months, sometimes, though rarely,
even for years,  but  liable at any moment to be roused into  active
disease  by apparently inadequate, and often unknown, causes ;  so
that a person carrying  about with him a crop of tubercles  in  his
lungs, is at any  moment in danger of commencing  the downward
course that ends in the  grave.
   At first, these yellow tubercles are of the consistence of cheese ;
they then soften—become infiltrated with matter, and  finding their
way into the layer air tubes,  are expectorated, and a  small cavity
is thus left, secreting matter.   In the chronic form of  consump-
tion, patients often rally for a tifhe  after  this occurs—the cavities
are healed, or become livid with a kind of mucus membrane—the
fever and night  sweats  disappear,  and the  cough is  either absent
for a time or subsides into a hack, and the body acquires fat.  But
this is only temporary ; another series of cavities are formed,  and
the same routine is gone over  and  over,  till the patient sinks  ex-
hausted.   When several small cavities are contiguous, they grad-
ually enlarge, and, opening into each other,  form a large cavity.
I have seen them large enough to hold a pint.
   When tubercles are in the grey or yellow  stage, inhalation is of
the utmost service, by promoting their absorption without destroy-
ing the substance of  the lungs ; and hence  the  wisdom of apply- 
49
ing early for treatment, when  there  is  the  slightest suspicion of
such a state of things, while there is the most probability that the
disease may be overcome.   When  cavities are formed, the disease
is then said to be in the third  stage ;  and here  astringent inhale-
ments act upon the surface, secreting matter, and by constricting
the vessels, arrest it, and  promote  the  adhesion of the sides of
small, or the formation of a membrane, secreting  mucus  instead
of matter.   Such are the  ways in which  Inhalation arrests the
progress of this formidable malady.
                       LETTER XVII.
               Complications with Consumption.
  It is impossible to conceal from ourselves the appalling frequen-
cy and fatality of diseases of the chest in the United States,  and I
consider that I am fulfiling a public duty in contributing my mite
towards making their symptoms and treatment familiar to the mass
of the people, so that, early apprised of danger, they may address
themselves in time for relief.
  My last letter contained an explanation of the mode in which tu-
bercles are deposited in the air cells and finer air  tubes,  namely :
That any impediment to the free circulation of  blood in the air cells,
by preventing the due conversion of venous  blood  to arterial, is
the immediate cause.  Such changes  in the  structure of a vital
organ can not occur without the  system at  large  sympathizing,
and varions others become deranged, often  to such a degree  as  to
draw off the physician's  attention from the  real point of danger.
Under the head of Latent Consumption, it has been stated that the
complaint may  proceed to the utmost disorganization of the lungs
without cough  or expectoration  being present.  In such  cases
the prominent symptoms are derangements of some of the abdom-
inal organs.  Dyspepsia is the most common, and in ignorance of
the true state of things, the efforts of  the physician are too often
directed to removing the effect instead of the cause  of deranged
health.
  Many cases are treated for liver disease,  when  large cavities in
the lungs actually exist and hectic and night sweats  are excessive.
It is only three weeks  ago since  we were called to a patient, who
stated that he had  been treated, up to the time of our  visit, for
               4 
50
 liver disease.   The appearance of the patient, his emaciation, bis
 cough, excessive expectoration and sweating, indicated  too  surely
 phthisis as the enemy.   On removing his clothing we were horri-
 fied to see the unhealed sores of tartar emetic ointment, and scar-
 ifications of  cupping still recent over the region of the liver, show-
 ing that a frightful and inexcusable mistake had  been made as to
 the nature of his disease.   As it was important to  him  to know
 his true state, we were obliged to  tell him the melancholy truth,
 that he was  in the last  stage of consumption, and that his  life
 could not be prolonged beyond a few weeks.   Diarrhea often masks
 consumption ; this is found among adults, but it is still  more com-
 mon among  children.  The  investing membrane  of the  lungs,
 called pleura, is often the seat of chronic inflammation, and water
 or  matter  is infused into the cavity, constituting  hydrothorax or
 empyema.  The lung is sometimes perforated,  so as to  admit  air
 into the pleura,  when a chronic inflammation is set up  with  the
 same result as the preceeding ; this is called pneumothorax.  The
 larynx is often the seat of ulceration,  and completely  masks  the
 disease in the lungs to a superficial observer.  Such are  some of
 the complications of phthisis, and are the result of the blood  im-
 perfectly aerated in the diseased lungs, circulating  throughout  the
 body, and by its impurity provoking disease in the different organs;
 this is often described by the term sympathy.   It  will  not seem
 superfluous caution to warn the reader of the importance  of  pay-
 ing watchful attention, and not to rest content  with  a superficial
 or hastily formed opinion.  Few medical men possess any but  the
 most superficial knowledge  of the use of  the stethoscope, and  still
 fewer are competent to give an opinion worth a  rush in the earliest
 stages of consumption.  For an opinion to be of  any value, it can
 be so only after a careful and thorough examination.  As usually
 conducted, it is but an idle form, and  would-be  farce but  for  the
 important stake at hazard.
  I have  witnessed  the exploration   made through a  creaking
 starched shirt, or muslin collar, several  folds  of clothing,  even
 through solid, old-fashioned corsets.  Then to see the  pomposity
and parade of learning that this is done with,  is  enough  to  pro-
voke a laugh  or a tear.  There is one consolation, that tfiese  gen-
tlemen could  not discriminate any  more  if they did  examine  en
cuerpo.  The knowledge of the stethoscope requires a study apart,
a special devotion to it, and much experience in  a hospital.   So 
51
informed, the practised stethoscopist distinguishes all the sounds
of the lungs, healthy or diseased, as readily as a tuner  appreciates
the  condition of the notes of a piano.   A  man who practises  as
physician, surgeon and accoucheur, and honestly  and  laboriously
tries to master all the branches of his profession, can  never ac-
quire a tithe  of the proficiency in the use of the  stethoscope that
he will attain who devotes himself specially  to its use.
                       LETTER  XVIII.
                 Time  to Treat  Consumption.
  In discussing the question of treatment, upon the period of the
complaint at which a case of consumption presents itself for treat-
ment, will very much  depend  the  probability of a cure.  I  have
pointed out, that  the earlier a case is taken in hand, the greater
the certainty of a cure; and that  the  chances of this  favorable
result diminish in an almost arithmetical proportion, the more the
disorganization of  the lungs is allowed to progress before applying
for  treatment.   Unfortunately, the  largest proportion of these
cases, which have hitherto come under  my care, have  been in the
last stage  of confirmed consumption—cases in  which  part of one
or both lungs was not  only broken  down into  ulcerous cavities,
but the strength of the constitution exhausted  by the progress of
the disease,  and by the different kinds of treatment to which they
had been  subjected.   I need hardly  say,  that such cases are no
proper test of  the  efficacy of any system of treatment.  Human-
ity, with the desire to relieve, is the only influence that can induce
the physician to receive such as patients at all—since  many  seek
for treatment in an utterly hopeless state,  and can  but be made
comfortable by the highest skill within  the power of man.
  I have  been obliged to refuse several  applicants who were so far
gone, that even the poor  comfort of temporary relief seemed una-
vailable.  Yet, notwithstanding all  these  disadvantages and dis-
couragements, a larger  proportion of recoveries have  taken place
among this class, through  the  instrumentality  of Inhalation, than
has ever hitherto been possible to attain from any and every other
means of  treatment.  I have  cases now  under treatment, where
there are  cavities in one or both lungs,  which, humanly speaking,
I feel confident of restoring to health. 
52
  This, then, should be  firmly impressed on  the  mind, that the
earlier the presence of pulmonary  disease  can be  detected, and
the sooner the patient  comes  under treatment, the better chance
for deriving benefit, and stronger probability of ultimate cure; but
to insure this, the treatment must be  persevered in as long as the
least vestige of disease remains, for it would act  as an irritating
nucleus for the reproduction of the complaint.
  It will be recollected that the commencement of consumption, is
the deposit of grey tubercles in the lungs, and  that  this is  com-
monly synchronous with  the  little  hack  and short-windedness on
exertion, that are usually the first symptoms remarked by the pa-
tients or their friends.   In  the  second stage, these tubercles  un-
dergo a  change  of structure,  and become yellow and  cheesy.
Now the hack becomes a decided  cough, and a sticky, clear or
greyish mucus is expectorated chiefly in the  morning.  The  third
stage consists in the  yellow  tubercles becoming  infiltrated with
matter, softening down, breaking into  the  bronchial  tubes,  being
expectorated, and  leaving  cavities,  secreting  matter.   In this
stage, we have hectic fever, exhausting sweats and diarrhea, with
the other concomitants that  rapidly wear out the patient.
  The specific manner in which Inhalation acts upon these several
phases of disease, will form the subject of my next letter.  *
                       LETTER XIX.
           Treatment of Consumption—First Stage.
  It has been a desideratum with the  medical profession,  since
the days of Hippocrates, to discover some effectual mode of apply-
ing remedies directly to the diseased surfaces of the lungs,  for it
has always been received as an accepted  fact, that where  attain-
able, local applications  should always be employed along with the
constitutional remedies, which latter are often rendered  unnecessary
when the former can be used.   Accordingly we find in  the writ-
ings of  Hippocrates, and the chain of medical writers from his time
down to the present, traces of efforts to apply this method  to  the
diseases of the lungs, but all of the  crudest kind,  resolving- them-
selves into inhaling fumigations arising from burning gums, resins,
and herbs, the  fumes of heated cinnabar realgar, and other  sub-
stances volatilizable by heat.   These were received into  the throat 
53
by holding the nose and mouth over the  ascending vapors, and
drawing them into the lungs in inspiration.  Any one  curious  in
such matters will find a description of this method in  Boerhaav's
Commentaries, article " Consumption."  This was the condition of
the therapeutics of inhalation for 2500  years.   I think that Dr.
Mudge, of  London, is justly entitled to the merit of having taken
the first practical step towards the  modern  mode  of inhalation ;
although he was not aware of  the full extent of the reformation in
treatment of  the lungs, that he had initiated.   The philosophy  of
the treatment of chest diseases is apparent, when we consider that
the lungs and air-passages are the  parts affected,  and  that  if we
introduce air impregnated with  medicated  vapors,  we  thereby
brino- the remedial agent as directlv in contact with the diseased
surfaces as a wash to a sore on the leg.   But it may be objected
that we have no proof that medicines can act thus certainly on the
lungs, or on the system through the lungs.   To  developing this
portion of  the subject, I shall devote my letter to-day.   Inhalation
of chlorine will produce a temporary arrest of the  secretion of the
bronchial tubes, or, in other words, a dryness of the surface.  The
use of expectorant and emollient vapors will produce  the  directly
opposite effect, and in the first stage of acute bronchitis, when the
tubes are dry and tumid,  no remedy by the stomach will  produce
the resolution of  this state, with anything approaching  the  speed
with which such  inhalants act.  Is the patient sitting up at two in
the morning  choking in all the agonies of the worst fit of  asthma,
an anti-spasmodic inhalant will procure perfect relief for the night
in three or four minutes.   Is the case  one of chronic bronchitis,
where the  secretion is profuse  and  semi-purulent,  the  use of
balsamic and astringent inhalants  will soon diminish the  quantity
and improve the  quality  of the expectoration.  These are  facts
patent to the observation of every medical man,  who will take
the trouble to make the trial.   But it will serve to make the power
of inhaled  remedies over the general system more evident, if a few
examples be  given.  The power of chlorine and iodine over con-
sumption is proved by the exemption of workmen from this disease
who work in factories where the vapors are floating about  in  the
air, and by cures being effected upon the tuberculized by resorting
to such establishments for work.
   Piorry gained  his fame for curing consumption,  by pouring in
iodine in every way, by inhalation and  otherwise.   But he often 
54
left his patients, as Dr. Hingston said,  the  victim of iodism, a
scarcely less deplorable state  than  the  victims  of mercurialism.
This unhappy result is avoided by combining  the use  of various
vegetable discutients,  that aid the effects of iodine, and procure
salutary effects of their own.   A drachm of chloroform will  pro-
duce little or no effect, when taken into the stomach, but the  same
quantity inhaled into the lungs  will cause profound intoxication,
with total loss of sense and motion,  and even death.  A grain of
arsenuretted hydrogen swallowed has little  effect,  but the hun-
dredth part of a grain, inhaled into  the lungs, will cause  death,
with  all the symptoms of arsenical poisoning.   The  late pro-
fessor of chemistry in Calcutta College, was  exhibiting Marshe's
test to his  class, and an accidental draught blew the fumes toward
him, and he inhaled perhaps not the thousandth of a grain, cer-
tainly not the five-hundredth ;  he was seized with violent arsenical
poisoning, and his life was despaired of for some time.  Gen. Gates,
who introduced the use  of  stramonium  leaves when smoked, for
the relief of asthma, fell a victim to an overdose, and yet the quan-
tity of empyreumatic oil introduced  into the lungs must have been
very minute.  The preceding remarks have been thrown  together,
to prove that medicines  inhaled  into the lungs produce  not only
direct local effects, but  are  capable  of acting on  the system at
large, as alternatives,  narcotics, discutients, etc., and these in very
much smaller doses than by the  stomach.  They are  adduced as
specimens of the proofs upon which the practitioners of inhalation
relv for the  maintenance  of  their   assertions,  and these  proofs
might be accumulated ad infinitum.   With this preamble my read-
ers will be able to understand the rationale of the process  l>y which
a cure is effected in consumption through inhalation,  which  will
form the subject of my next letter.
                        LETTER XX.
            Treatment  Continued—Second  Stage.
  In my last letter, I explained the  principles upon which  the
cure of consumption, in the first  stage, or that  of gray  tubercu-
lization, is founded ; and that this result is certain  in the greater
number of cases,  by means of Medicated  Inhalation.  I propose
to discuss the mode in which the cure of the second  stage, or yel* 
55
low tuberculization, is accomplished.  The tubercles, from being
gray  and  glistening,  become  converted into a yellow, cheesy
matter ; they may exist  isolated, or they may coalesce and  form
masses of various sizes.   When  they soften, it is from the outside
to the center, which accounts for the appearances noted in the ex-
pectoration, in the second and  third  stages.  During the first pe-
riod, it is sticky,  and varies in appearance, from  transparency to a
dark, blueish gray.  When the yellow tubercles soften, this expec-
toration becomes  streaked with  yellow, and at last altogether yel-
low, and small specks of cheesy matter  arc  found  interspersed ;
these are the centers of yellow tubercles which  have escaped soft-
ening.   The  chemical  composition  is  changed  from that of the
gray tubercle, as  they are found to contain a considerable quantity
of carbonate  and phosphate of lime.   It is upon the  existence of
these insoluble salts, that the choice of inhalants is made.  If we can
introduce into the lungs, vapors which  possess the property of at
tacking these  insoluble  salts of lime,  and converting  them into
soluble ones, this will  produce liquefaction of the  tubercles, and
their consequent  absorption or expectoration.   Those familiar with
chemistry, will easily recall to their memories  several vapors cer-
tain to effect this chemical change.   Valuable papers on this sub-
 ject were written fifteen years ago by Mr. Murray, M. R.  C. S. L.
and Dr. Boudet,  of Paris, but seem most unaccountably  to have
been overlooked by the profession.  The local disease being thus
removed by inhalation, let it be the physician's care to  pay strict
attention to the removal of any  local  causes  that  may  have in-
duced the complaint, and to  adopt judicious, constitutional treat-
ment to remedy the depraved  state of  the blood, that favors the
deposit of tubercles.   A very few years ago, bleeding,  depletion
and low diet, were  universally resorted to for the cure (?) of  con-
sumption, with the effect of removing  every  chance  of a sponta-
neous healing,  and accelerating death.   The  folly  of this course
has at last been recognized by the profession, and the opposite plan
is now pursued.   It is by combining a  local and a  general treat-
ment, that Medicated  Inhalation is so successful; it  operates  di-
rectly on the seat of disease and removes the local affection, while
the general  treatment  puts  the  system  at  large in such a  state,
that the blood is  so improved as  no longer to deposit  fresh  tu-
bercle.   In this  stage, the proportion of recoveries is not so great
as in the first; but still a very great number recover by means of 
56
Inhalation, and of  course  the  earlier it is resorted  to, the better
the prospect of cure.   Those  who expectorate  most on rising in
the morning, and perceive yellow streaks in the spit, have reached
the second stage ; and when this becomes decidedly  yellow,  the
third stage is nigh  at hand, if not already  begun, when the chan-
ces of successful treatment are very much lessened.
   The next letter will contain  an exposition of the mode of cure
in the third stage of Phthisis.
                       LETTER XXL
            Treatment Continued.—Third Stage
  In my late letters I have  pointed  out the  mode in which inha-
lants act, in curing  the  first  and second  stages of consumption ;
and to close this part of  the subject, I shall do the  same in regard
to the third stage.   In this  case, masses of yellow tubercle soften
and are expectorated, carrying with them the  lung  tissue, so leav-
ing caverns lined  with a membrane,  secreting matter abundantly,
and accompanied  by  severe constitutional disturbance, indicated
by hectic fever, drenching night sweats, etc.
  In this state  of things, we employ  vapors  that  are  capable of
stimulating  the ulcerated  surface to set up a new action, and also
of diminishing, and finally arresting the secretion of  matter.  The
sides of  the cavity either become glued together, or it is lined with
a pseudo-mucous membrane.   This  is the true explanation of the
way  that Inhalation  performs a cure in consumption, and is so sim-
ple and reasonable,  as to convince every  unbiassed mind at first
sio-ht.   Until this mode  of treatment was introduced, consumption
in every stage was invariably fatal ; and it does seem the veiy acme
of infatuation for a  consumptive to put himself  in  the  hands of a
physician,  who confesses that he is powerless to do  anything to
avert the fatal termination of consumption.   It seems  more in  ac-
cordance with common  sense, that the patient should shun such a
Jack Ketch of a practitioner, and put himself in the hands of one
who follows a treatment that  has been proved to be capable of
effecting what  it professes, viz : to cure consumption; and   the
only  way  yet  discovered, seeing that the old mode  of practice
confessedly holds  out  death as the  inevitable  result of its treat-
ment.    It passes  comprehension,   that  any  one  afflicted with 
57
consumption can be found so foolish  as  to go  near  such ; they
should be carefully avoided.  Inhalation is daily  working its cures,
and raising patients from their beds, who, under the old treatment
would soon have been tenants of the cold and silent tomb.  It is
sad to see the young, the  lovely, the  gifted and the  loved mar-
shalled to the grave, in the grasp of the foul ogre—consumption,
when so many might be saved by a  timely resort to  treatment by
Inhalation.   The statistics of death by consumption, showed such
a marked diminution in  the  city  of New  York, when  Inhalation
was extensively introduced  there, by Drs. Melville, Hunter, Rob-
inson, etc. that the newspapers noticed the fact  with  enthusiasm,
and were unanimous in attributing it to  the  success  of the new
mode of practice.
                       LETTER XXII.
             Constitutional Medical Treatment.
  The constitutional  medical treatment of consumption resolvcn
itself into subduing certain derangements of the functions, which,
if not controlled would exhaust the patient, before  the local treat-
ment by Inhalation  could affect the healing of the lungs.   The
most prominent of these are  night sweats,  and colliquative diar-
rhea.  Defective composition of the blood, dyspepsia  and costive-
ness may also  demand treatment.   These  include nearly all the
circumstances calling  for general  remedies.   It must  be borne in
mind,  that consumption is a disease of debility,  and  all  means
that tend to depress the vital powers  must be avoided—such as
active purging,  calomel  and  other  mercurials, tartar emetic, and
bleeding.   Opium and its preparations  act  injuriously by impair-
ing the°digestion, lessening  the appetite  for food, deranging the
liver, causing costiveness,  and  producing  that very  condition of
the body  that  increases the depravity of the  blood.   It  is  un-
fortunate  that all advertised nostrums for  the cure of consump-
tion, and  the ordinary run of orthodox prescriptions, have opium
or  a salt  of morphia  as  their basis.   Temporary  abatement
of the couo-h is produced,  and  the expectoration seems  less in
quantity, because opium diminishes  the amount of water (not of
matter), secreted in the  lungs, thus thickening the spits without
really lessening the quantity of  matter, although the spittoon may 
58
take longer to fill, while  under  this apparent improvement, it re
rapidly  sapping  the  constitution, as may easily  be inferred from
the bad  effects just pointed out.
  In  my next letter I shall review the different modes  of treat-
ment that have been iu vogue for the last two  hundred years, and
show  that they were, and are, not only  useless, but positively mis-
chievious ;  and that no mode, except that of Medicated Inhalation,
has ever been discovered  capable  of  benefiting consumption  in
the slightest degree.
                      LETTER XXIII.
          Popular Modes of Treating  Consumption.
  It is proposed to  show in this letter that the usual modes of
treatment, other than  inhalation, are utterly  incompetent to  effect
any good in consumption, and to review the various plans advocated.
Seeing  that  the regular  practice, homeopathy, hydropathy—all
fail, it is no wonder that the public  have  a  deep-rooted  belief in
the incurability  of consumption.
  Blood-letting was recommended in this disease, some two hundred
years ago, by a Doctor Morton, on  this ground,  that  " consump-
tion, being the result of inflammation of the lung structure, bleed-
ings,  frequently  repeated, are  the proper remedy."   Upon this er-
roneous supposition, from that time to this, crowds of victims have
been hurried to the grave,  secundum artem, by bleeding,  leeching
and cupping, and that practice has been  recommended  by  such
high authorities as Dr. Mead,  Sir John Pringle, Dr. Hossack, etc.,
and it was in full blast as late  as  eighteen or  twenty  years ago,
but is now totally abandoned, except by some of the less talented
or informed of the profession,  who,  however, only venture to  re-
sort to blood-letting in the early stage, yet to the great injury of
the patient.   Consumption being essentially a disease of debility,
and being preceded always by a depression  of the powers of life,
it requires very little reasoning ability to perceive that so far from
lowering the system, by abstracting the arch principle of vitality,
the blood,  we should build up the strength of the body by all
the means in  our power.
  What shall I say of the cruel and ridiculous practice of giving
repeated emetics, even every  morning, to  cure  consumption, and 
59
this supported by the authority of men holding professors' chairs
in America, Britain,  France and Italy ?  Like cod liver oil, it  ex-
cited a furore some twelve or fifteen years ago, and, although  not
so prevalent, is still persisted in by many orthodox practitioners of
respectable reputation in this and other cities.   One  gives white
vitriol, another gives blue, a third prefers squills.   Tartar emetic
and ipecac, each have their friends.   Amidst this crowd, which is
most orthodox or regular it is hard to tell.  I have known many
cases,  where  white  or  blue  vitriol  has been administered a  few
hours before death.   What cruelty!  This  mode of  treatment is
only calculated to exhaust the strength  of  patients,  and destroy
the tone  of the  stomach,  while it  exercises no curative power
over the disease of the lungs, and is fast becoming obsolete—hap-
pily for the sufferers.
   Having extended this letter to a  sufficient length,  I shall con-
tinue the subject in my next, when I think I  shall succeed in show-
ing very conclusively that  every mode adopted  by  the  regulars
hitherto for the treatment of consumption have been only decorous
methods of  ushering patients surely and swiftly to the portals of
the tomb.
                       LETTER  XXIV.
   Popular Modes of Treating Consumption—Concluded.
  In my last letter, I pointed out the injurious results from blood-
letting, or courses of emetics, in consumption,  and  shall pass in
review some of the other fashionable treatments.
  Mercurial Treatment.—Some two hundred  years ago, this
mode was greatly in fashion, but gradually dropped  into  oblivion,
not only because it did  no good,  but  positive  harm ; and in the
opinion of many,  brought on consumption in those who would
never have  been  attacked, if mercury had never  been given to
them for other complaints.  Unhappily for mankind, Dr. Wilson
Phillips brought out a work twenty years  ago,  " On the influence
of small doses of mercury," and  it became fashionable to treat
consumption with  it.   Happily the  conviction has become im-
pressed on the minds of  the  profession, that it is injurious,  and
few physicians now use it except stealthily, and they do it in order
to be doing something, not from any  faith in its efficacy.   After 
60
 killing its thousands, let us hope it is buried never to be resus-
 citated.
   Tonics.—In opposition to those who  look upon consumption as
 an inflammatory disease,  and employ bleeding,  we  have physi-
 cians who regard it as a disease  of debility,  and rely on  tonics.
 Now each of these is regular, orthodox practice, and which is right ?
 It is an axiom in practice, that tonics  are  useless in organic dis-
 eases, and often  aggravate the disease.   Tonics have no power to
 cause absorption or removal of tubercles in the lungs, and conse-
 quently the tonic doctors have not been able  to sustain their posi-
 tion  any better  than  the  advocates  for the  modes of treatment
 already discussed.
   Digitalis and  Iodine have had  their days, and very flourish-
 ing days they were ; but now,  alas ! they  are  consigned with
 ignominy to the tomb of all the Capulets, by the most learned of
 the profession.
   Counter Irritation means, establishing a running sore on the
 surface of the body, in  the neighborhood of an inflamed, internal
 surface, with a view of  removing  the natural, by  an  artificial dis-
 ease.   With this view, poor consumptives  have had, and still un-
 fortunately  too often have, their  chests seared with  hot irons—
 covered with pustules from tartar emetic ointment—tortured with
 perpetual blisters, or other modes of effecting the  coveted object.
 The most learned now allow, that  counter irritation  has no effect
 in causing the absorption or removal of tubercles,  therefore it does
 no good.  But it does positive harm ; we know that the cause of
 hectic and night  sweat, is  to be found  where  there  are  surfaces
 secreting matter.   Now if  the ulcers in  the  lungs  cause  the irri-
 tative fever, it is only adding to the cause, by establishing a large,
 running sore  on  the  outside  of the chest, to  keep   those in the
 inside, company.   Counter irritation is only  of use to  relieve pleu-
 ritic pains ; and this can be best effected by a mild rubefacient ano-
 dyne liniment, or dry cupping.   This cruel, and  unphilosophical
 treatment, is abandoned by the leaders of the  profession,  but
 alas !  is too common among their humble followers.
   Cod  Liver  Oil.—This great quack  medicine—this panacea—
 this god-send to the stupid  physician, who  had no trouble in pre-
scribing while it was the fashion.   " Doctor, I have a bad cough."
"0, your lungs are weak; take  Cod  Liver Oil."  Alas  for the
tribe that this physic made easy has gone  out of fashion.  Who 
61
does not recollect the buckets full that were swallowed a few years
ago, and now how little ?   It is of no use, unless there is wasting
of the body.  It is not medicine but  food ; and like osmazome,
alcohol, coffee, tea, etc., possesses in a high degree the  property
of preventing the wasting of the tissues.  Instead of  being looked
upon  as a remedy for every consumptive, cases are selected that
are suited for its employment, just  as  with other curatives ; and
with the heads of the profession it is dying out.
   Change of  Climate.—That cheval  de bataille—that convenient
way of getting rid of dying patients, has received its coup de grace
from  the recent writers on the subject, and now  no  longer com-
mands the faith of educated,  medical  men, although many still
keep  up the cruel  farce of sending  moribunds in  search of that
health, which they will never recover  on this  side of the  grave.
The subject of climate, is too  extensive to enlarge farther on in
this letter.
   I might cite Stokes, Billings,  Louis, and  many others, to prove
that,  as  yet,  no  mode of treatment  they employed  was of  the
slightest use in curing consumption ; but they had not tried Inha-
lation.  I shall not detain you,  by going over again  the names of
men  of the highest standing in the profession who  tried Inhala-
tion, and have given it their unqualified approval.  The practice is
 still in its infancy and confined to a few, but its success is already-
 such, that in a few years it will supersede every  other  mode of
 treatment.   This it will not until the  great mass of the profession
 shall see the chest practice in the hands exclusively  of those  who
 follow the verv rational treatment by  Inhalation.
                       LETTER XXV.
           Asthma—Its  Pathology and Treatment.
  I propose to close this series of letters by giving a  description
of asthma, its pathology and treatment.
  There is no department of human knowledge  in which for the
last thirty years, such progress has taken place as in the practice
of medicine ;  but still there is just reason to deplore the mystery
which envelops many points connected  with the functions of or-
gans, the cause of disease, and the  action of remedies.  The dis-
covery of the stethoscope has  served  to  dispel much  that  has 
62
 hitherto been deemed mysterious in connection with the lungs and
 heart, while the introduction of  medicated inhalation, as a method
 for introducing medicine into the lungs, is another grand and im-
 portant step in the march of science.   Thus every year adds some
 new trophy to the unflagging energy of man, until  the whole  sys-
 tem of arts become auxiliary to  science ;  and  seem,  in reference
 to human life, to fraternize and hold each other by the hand.
   Hitherto all  knowledge of the nature and character of Asthma,
 both in and out of the profession, has been extremely  limited; and
 to labor under a difficulty of breathing, no matter whether it pro
 ceeded  from the tuberculous deposition on the lungs, or valvulai
 disease of  the heart, it was designated Asthma, whereby its appli-
 cation was made to denote a variety of  morbid  conditions, as
 different one from the other as the heart and lungs  are.  When I
 speak of asthma, I  mean a spasmodic disease of the  lungs  which
 manifests itself in successive paroxysms or attacks, coming on sud-
 denly, attended with great difficulty of breathing, and after an
 interval of time passing off again with free expectoration.  This is
 the usual course of asthma, though betimes its approach is more
 gradual, and is indicated by a feeling of lassitude and  indisposition
 to exercise, with an oppressive sense of fullness about the stomach
 and a  sensation about the chest.   Others again complain of  head-
 ach  and  dryness of the nostrils—sometimes attended  with violent
 sneezing, and a sense of chilliness and discomfort.   The attacks
 are  excited by various agencies;  sometimes strong  and peculiar
 odors, the smell of  a stable, close  rooms,  burning sulphur,  ipe-
 cacuana, particular conditions of the atmosphere, irritation  of the
 stomach or mental emotions, are all known to bring it on.    If the
 attack is  very severe, the patient  is  obliged to assume a remarkable
 and  very characteristic attitude with the body bowed forward, the
 arms resting on  the  knees, the chest  contracted with the feelings
 of a cord drawn  tightly around or  a heavy weight upon it; the
 face is suffused with  an expression  of great  distress, the  veins
 turgid and perspiration flowing freely.
  By applying the stethoscope to the chest during an attack there
 is only a weak respiratory murmur heard,  but  the  wheezing  and
 whistling of the air passing along the  vascular  bronchi into  the
aglutinated cells, conveys a faint idea of what a  Pandora's  box
might sound like.  The attacks generally come on  of an evening
or at night, but as no man, woman  or child, can claim an exemp- 
63
tion from them, so no part of the day  will grant an immunity to
the asthmatic.  I have a patient in this  city  who, hitherto,  was
regularly attacked three hours after lying down.  If he retired at
nine o'clock, he was sure to wake up at twelve ; if  at  ten  o'clock
he was seized at one, and during a period of years,  there was not
ten minutes variation in the time.   Some suffer as soon as  they
lie down, but the  majority are suddenly awakened  out  of  their
sleep in the middle of the night or towards  morning with  all the
usual symptoms attending.  The chest seems  as if  bound with an
unyielding girth—the patient gasps for breath—calls for the  win-
dows to be raised and the doors to  be  thrown open,  and  though
the weather is extremly cold, the patient is insensible to every  in-
fluence and every feeling, except the desire for air.  The  face  and
lips grow purple,  and the heart palpitates violently,  while  a sense
of suffocation is experienced, and the poor  asthmate  thus  suffers
for days, weeks and  months.   A gentleman of St. Jacobs, Upper
Canada, subject to asthma, instead  of having a desire for fresh air,
when the attack comes on, invariably closes the  doors, and fires
up the stove until the room is uncomfortably warm,  when a free pers-
piration makes its appearance—after which the  attack gradually
subsides.   An emetic of lobelia, also cuts  short  or modifies  the
paroxysm, especially when it has been induced (as is commonly
the case with him) by excessive eating.  This  case doubtless had
its origin  in  an irritation  of  the pneumo-gastric nerves,  though
it has terminated  in destruction of the  organic  integrity  of the
lungs.
  Happily for the victims of  this disease, the  suffering of the
present is ever lightend   by the conviction that nature will  soon
come to their relief—hope and confidence never flag for an instant,
and though friends may sympathize, the patient feels no  want  of
it, and as soon as  the spasm is relaxed, the paroxyms is at an end,
and the poor sufferer falls asleep.
  The causes of all this distress, and the reason why asthma comes
on so suddenly and passes off so mysteriously, I shall now proceed
to show.   The air-tubes have  a muscular coat, which gives them
the power of contracting or expanding.   Anything which irritates
the nerves  that  supply the muscular coat may  cause a spasmodic
contraction to take place  on the instant,  thereby  diminishing the
tubes so  much in  size  that it  is  impossible to force air  enough
through  them to purify the blood.    This contraction  of the  air- 
64
tubes may, like cramp, continue for several hours, and  then past
off in an instant.   From this it will be understood that whatever
irritates the nerves of the lungs may cause  an attack of asthma,
and whatever soothes that irritation relaxes the spasms and relieves
the patient.
   All forms of this disease arise  from causes which act directly
and primarily upon the lungs, thus showing that however theorists
may contend for the hereditary taint and constitutional  character
of consumption, they must all admit the purely local  character of
asthma, and its amenability to local treatment by Medicated Inha-
lation. 
M~4p 
^v
 
opinions  of the  press.
 From the Wrightsville Star, York county, Pa.
                April, 1>61,   .
  At Home.—We  learn  from  the  Spy  of
Saturday last, that Dr. X. B. Wolfe is now
on a visit to Columbia, his native place, and
has met with a most cordial reception by his
many warm  personal  friends.  It  will  in-
terest our readers to  know  that Dr. Wolfe
has attained a distinction in medical science
for curing Consumption,  by a process pecu-
liarly his own.   In Boston,  where  he  has
been located  for some time, he is said to
have cured  Consumption, Bronchitis, and
other diseases of the air-tubes, where War-
ren Bowditch and other distinguished phy-
sicians  had   failed.   The' Boston  Medical
Journal fully endorses Dr. Wolfe's practice as
being scientific and reliable.
    From the Bostou Journal, March 13th, lsiil.
   Commissioner to  India —We learn  with
pleasure the selection of Dr. N. B. Wolfe, of
this city, by the  Chief of the Agricultural
Bureau of the Patent Office, at Washington,
as  Commissioner to British  India.  The ob-
ject of the commission  is  to introduce for
home culture the various agricultural product
and garden shrubbery of the Orientals into
the United States—to gather information re-
specting the timber trees of India—its choice
fruits, and materials  for  fabrication,  and
various applications  in the arts ; and also to
give special  attention to the rare vegetable
products  in use  of the  Eastern  Materia
Medica, with a  view to their  introduction
into the Materia Medica of the United States.
  Of Dr.  Wolfe's peculiar fitness  for this
mission all who know him will at once as-
sent : but there are many who will sincerely
regret his acceptance  of it.   For  fourteen
years he  has made a Specialty of treating
diseases of the Lungs and Throat, and per-
haps to-day he is  the most accomplished and
successful  Specialist  iu  this department of
medical science, to be found  in  this or any
other country.  In this city he has been em-
inently successful in curing consumption  in
its most advanced stages, by a method prac-
tised only by himself, but which he is pre-
paring to make public for the good of the
world.  His  tour through the eastern world
will enable him to acquire valuable stores of
information,  to be turned to good account in
the future.  He has  our best wishes in his
journeyings,  and we hope  to be among  the
first of his  friends  give him a " welcome
home again."
 From Forney's Press, Philadelphia, January, 1S61.
    Consumption :  Its  Symptoms,  Curability
 and Treatment.   By N.  B. Wolfe, M.  D.,
 Editor of the Medical Stethoscope ; Author
 of  Letters on  Diseases  of the  Lungs  and
 Throat, §c.  Boston :  Rand & Avery, Corn-
 hill, Publishers.
   In this particular treatise,  which is terse
 and to the purpose, Dr. Wolfe describes the
 nature and symptoms of Consumption,  a
 complaint extremely  common and  fatal in
 this country.  Next he shows, that  the dis-
j ease is curable, by proper treatment, and in
j this he is sustained by the ablest writers on
j the  disease, in  England, France, Canada,
 and the United States.  Lastly, he speaks of
 the curative treatment to be employed,  the
i method systematized by  Er. Elliotson in the
 Brompton Hospital,  England,  of Medical
 Inhalation; the theory  being  to reach  the
 seat of the disease, the lungs, directly, as med-
 icines swallowed into the stomach do not reach
 the lungs,  Dr.  Wolfe,  who has  long suc-
 cessfully treated Consumption, has devised
 a plan for vitalizing  the lungs  and throat,
 the  results of which  have been invariably
 satisfactory.  Dr. Wolfe's practice in treat-
 ing this  disease is very extensive,  and  he
 has  been gratifyingly successful.  He is a
 man of marked ability. 
A  LADY  INHALING  VITALIZING  BALM
                  TO  CURE CONSUMPTION,
      To Strengthen  Weak Lungs.
To  Cure  Hemorrhage  of  the  Lungs.
DR.  N".   B.   WOLF\E9   Physician  to  the
               PULMONARY    INSTITUTE,
        86   EAST  FOUKTH  STREET,  CINCINNATI,  OHIO.
  My method of treating Consumption  is to prepare medicine so as to be volatile at the
temperature of the atmosphere, which is inhaled or drawn into the lungs, where the disease exists,
with every breath we. breathe.  To enable my patients  to do this, I furnish each with a small
glass Inhaler, that can be, carried about the person ready at all times for use, and which is
so compact as to occupy no more room than a watch, or a pocket knifet  This enables the
patient to take out-door exercise at the same time he is inhaling.  Tlie most weak and delicate
females find much comfort from the use of the Inhaler,  a'nd thousands, who had been pronounced
hopelessly incurable, live to attest the efficiency of my treatment in curing Consumption,and strength-
ening weak lungs.                                              ,  .
  To those persons who wish to avail themselves of this mode of treatment, and who live at a
distance from the city, and wio cannot visit the Institute in person, I would say that I can
send them treatment to any part of the United States or Canadas through the Post Office,
or  by Express conveyance.  The package containing the Inhaler and medicines to be breathed
into the lungs, which I send, will not exceed one pound in weight, and carries quite safely through
the mail to any place desired, where there is a post-qffiee ; so that every person may receive treat-
ment through the nearest post-office to them at home.  If, by accident or otherwise, in the transmis-
sion of the package through the mail, it should, be lost, or sustain any injury, I will in all  cases
make good the loss without extra charge to the patient.  When persons order treatment in this
way, they should  either write me a short history of their disease, or send to me first for a
circular of printed questions, containing such as I should ask tliem in person if they were present.
To these questions they write replies, and forward to my address.
  My terms  for treating persons laboring under any weakness of the lungs, throat or air
passages,  so  as to require iuhalation  of medic.ated air, is  ten dollars per month, and one
dollar for postage, if the treatment is sent by mail
  If the treatment is to be forwarded by mail, the whole fee must  accompany the order  ; if sent by
Express conveyance, half the fee may be sent with the order, and the balance paid  to the  Express
agent when the-package is delivered.
  Full directions accompany the package, so that  any ordinarily intelligent person may
pursue the treatment at home with as much success as if  residing in this city under ray
protessional  charge.  I always  correspond with  my patients once  a week,  so  that all
changes may be noted, and advice from time to time be given.

          All letters should be addressed,         DR. N. B. WOLFE,
Box 399 Cincinnati, Ohio.