BRONCHIAL. INJECTIONS: A REPORT, WITH A STATISTICAL TABLE, OF ONE HUNDRED AND SIX CASES OF PULMONARY DISEASES TREATED BY BRONCHIAL INJECTIONS. 1/ BY HORACE GREEN, M.D., LL.D., President of the Faculty, and Professor Emeritus of the Theory and Practice of Medicine, of the New York Medical College, $*c. FROM THE AMERICAN MEDICAL MONTHLY. NEW YORK: EDWAED P. ALLEN, 9 SPRUCE STREET. 1856. BRONCHIAL INJECTIONS. BY HORACE GREEN, M.D., LL.D. It is one year ago last month since I brought before the pro- fession of this country, in a paper read before the New York Academy of Medicine, the subject of the direct medication of the lungs, by means of catheterism of the bronchial tubes. The reading of that paper occasioned the appointment, by the Academy, of a Scientific Committee, which was charged with the duty of investigating and of reporting upon this subject. The reports of this committee, consisting of a majority and minority one, were submitted to the Academy, and these, together with the discussion which followed, have been, through the Monthly, all laid before its readers. As this method of treating thoracic diseases has now been continued a twelvemonth longer, during which period a large number of patients have been subjected to this plan, and as the results of the treatment have been in a high degree satisfactory, I have deemed it incumbent on me to state these results to the members of the profession, many of whom have evinced much in- terest in this subject. The histories of all these cases have been kept by my assistant. Dr. J.W. Richards, and the statistical table which is here appended has been prepared with much care by him from his notes of the cases, taken during the time of their treatment. It is perhaps] proper, also, here to state that the examination of many of these, by auscultation and percussion, was made before treatment, not only by myself, but likewise by Dr. J. Hancock Douglas, of whose skill as an auscultator I shall hazard nothing by saying that it is unsurpassed by few, if by any of the profession, in this country. An examination was also made by Dr. D. in many instances during the progress and 4 at the close of the treatment, and in all such cases the physical signs, as observed by him, are given in the cases reported. It will perhaps be remembered that the history of several cases, presenting all the physical and rational signs of tuber- culosis, were given in the paper read before the Academy, which cases had been treated with apparent benefit by injec- tions into the bronchial tubes. To those who have been inter- ested in this subject—and it is only for those of the profession who regard progress in practical medicine as a desideratum, that I write—it will be a gratification to learn what has been the result in these instances, after a period of twelve or fifteen months. The first case described is that of a patient (a lady) who, having a large vomica in the right lung, was, in fact, in an advanced and hopeless stage of tubercular consumption.* The injections were employed, not with the expectation of curing, but With the hope of relieving the patient. During a period of some fifteen days, " the elastic tube was introduced into the left bronchial division seven times, and on each occa- sion from one and a half to two drachms of a strong solution of the nitrate of silver was injected into the lungs. Her Cough and expectoration were greatly diminished, she breathed with more freedom than before, and she grew stronger and gained flesh in this period." While she remained under treat ment, her symptoms improved constantly, but being obliged to return to her home in Connecticut at the end of the above period, she soon after became worse, and died about two months after leaving New York. The three other patients, whose cases are described on pages 17-22, and who exhibited—certainly two of them—une- quivocal signs of early tuberculosis, are all not only alive at this present time, but are in the enjoyment of a much better state of health than when the treatment was commenced. One of these, indeed, Miss V. (see p. 20), called on me eight months after the treatment, and was then in the enjoyment of most ex- cellent health. In a paper, which I had the honor to read before the State Medical Society, at Albany, in February last, and which * Am. Med. Monthly, Jan., 1855, p. 15. 5 may be found printed in the published Transactions of this Society,* I reported several other cases of thoracic disease of much interest, which appeared to have been successfully treated by this plan of tracheal injections. As the previous history and sanitary condition of these patients, on coming under my care, were well known to other medical men, it cannot fail to interest the profession to know the result, after the termination of nearly a twelvemonth, in these cases also. Allusion is made in that paper to twelve cases, in the treatment of which cathe- terism of the air-passages, for a greater or less number of times, was employed. Of this number of patients, seven " manifested distinct physical signs of the presence of tuberculosis." Five were affected with chronic bronchitis. The history of one or two of these cases, abridged from the paper to which allusion has been made, I shall give. December 4th, 1854—J. B. Minor,t Professor of Law in the University of Virginia, came to New York for medical treat- ment. He was accompanied by his friend and colleague, Dr. Davis, the distinguished Professor of Anatomy of the Univer- sity. Prof. Minor, as I learned from Dr. Davis, had suffered from thoracic disease, following chronic follicular disease of the pharynx for nearly a year before I saw him. Enfeebled by the journey, the patient was unable to leave his room for a week after his arrival in New York. A severe cough, with great debility, emaciation, and occasional hsemoptysis. were the rational signs most prominently manifested in his case. At the top of the right lung, there is dulness on percussion, and a less degree of expansion of the chest during inspiration is observed, at this point, than in the corresponding portion of the other side. Expiration is also prolonged on this side, whilst the respiratory murmur is augmented in force under the left clavicle. Bronchial rales are heard on both sides, while a severe cough, with large muco-purulent expectoration, which is occasionally streaked with blood, is present. Evidence of the presence of long-continued follicular disease exists, for the mucous crypts of the pharynx * Transactions of the State Medical Society of the State of New York 1855 p. 233. t lb., p. 246. 6 have disappeared, and the right tonsillary gland is entirely destroyed, and its place, between the anterior and posterior columns, is occupied by a large deep ulcer. Applications of a strong solution of nitrate of silver were first made directly to the ulcerated portion of the throat and the pharynx, and at the third application the sponge-probang was passed into the larynx. These operations, combined with appropriate general treatment, were repeated daily until the eleventh of December. Under this topical medication, the ulceration in the throat was healed, and the cough to some extent diminished ; but this symptom was still severe, and the bronchial expectoration and other thoracic symptoms remained about the same as at first. At this period (Dec. 11th), in the presence of Prof. Davis and several other physicians, I introduced a flexible tube down to the right bronchial division of the trachea, and injected one and a half drachms of a solution of nitrate of silver through this tube into the lung. On the 12th, the injection was re- peated, and this operation of cathetcrism of the air-tubes, alter- nating occasionally with the use of the sponge-probang, was continued until the 25th of the month. Under this treatment, the cough and expectoration of the patient rapidly diminished, his appetite returned, and his strength and general health im- proved daily. He had in this time gained several pounds of flesh, his cough and expectoration, which had harassed him for months, had disappeared ; and from an enfeebled condition, which prevented him from walking the distance of a block without assistance, he had regained so much in strength and vigor, that, for several days before he left New York, he walked daily two or three miles without fatigue or inconvenience. On the day of his departure for home, which was on the 25 th of December, an examination of his chest was made, not only by myself, but by several other good auscultators, when it was found that the physical signs which were present at first had ' quite disappeared. One year has now elapsed since Prof. Minor returned home to resume his duties as lecturer in the University of Virginia. In a letter received from Dr. Davis, some time after his return, he thus writes : " It will be gratifying to you to know that Prof. Minor has not been compelled to suspend his lee- 7 tores, or to omit his daily exercise, since his return, for a single day." These duties, I believe, he has been enabled to discharge unremittingly up to the present time. This case of Prof. Minor's is one of great interest, and as it was seen before and during treatment by many intelligent members of the medical profession, I do not hesitate, in view of this fact, to declare that it was one of those cases of thor- acic disease, in the successful treatment of which general reme- dies have hitherto utterly failed. I shall only allude to one other patient, whose case is recorded in the paper to which I have referred. John Moore* aged thirty-five, came under treatment Sept. 24, 1854. For several years this patient has suffered occa- sionally from chronic pharyngeal disease and enlarged and diseased tonsils. One year before, debility, with emaciation, cough, &c, came on, which symptoms continued to increase during the winter and spring of 1854. When first seen, a very troublesome cough, a free muco-purulent expectoration, with dyspnoea, emaciation, and great debility, were the promi- nent symptoms in his case. The physical signs were corres- pondent. Dulness on percussion, with crepitating rales, were observed over a part of the right lung. Near the upper por- tion of this lung, strongly-marked signs of a tubercular exca- vation were present. These physical signs were observed by several good auscultators. The same plan of treatment as that employed in the preced- ing case was followed in the case of Mr. Moore. Topical applications of the nitrate of silver were first made to the pharynx, and subsequently into the larynx and trachea, and these were continued until the 13th of November, when the use of injections into the bronchial tubes was commenced. These operations, together with appropriate general treatment, were continued until the 15th of January. Within twenty-four hours after the first injection, both the cough and the expector- ation of the patient began to diminish. He soon commenced to regain flesh and strength, and every unfavorable symptom continued steadily to decrease. On the 6th January, 1855 • Trans. State Med. Society, p. 248. 8 along with my colleague, Prof. E. H. Parker, I made a careful examination of the patient's chest. The respiratory murmur could be heard full and clear on both sides ; prolonged expira- tion in one location was the only abnormal sign present. January 25th—Mr. Moore called and reported himself " quite well." He has no cough or expectoration except some slight raising in the morning. He is quite strong and hearty, can walk any reasonable distance, and attends constantly to his ordinary business. Nearly a twelvemonth has passed since this patient was dis- missed. During this period, he has been able to attend constantly to business, and still coutinues in the possession of an ordinary degree of health. This was one of the patients seen by the Committee ap- pointed by the Academy to inquire into this plan of treatment, and in whose presence the tube was introduced into the tra- chea, " and an injection of a solution of nitrate of silver of the strength of thirty-five grains to the ounce was thrown in."* In this paper, read before the State Medical Society, allusion is made to ten other cases, in the treatment of which catheter- ism of the air-passages, for a greater or less number of times, was employed. Several of these patients manifested distinct physical signs of the presence of tuberculosis. Five of the number were affected with chronic bronchitis, in four of which the disease had continued several years, and was complicated with incipient tuberculosis. " These cases were all treated at first by cauterization of the larynx and trachea, and by ap- propriate general treatment, followed by the injection of the solution into the lungs. Some have already been dismissed cured, or materially relieved ; others are still under treatment, and the result, of course, cannot at present be given." Included in the tabular statement which follows at the con- clusion of this paper, will be found, not only a further history of these cases, but also a tabular record of all the cases which have been treated by tracheal injections during the last year, or since I presented before the New York Academy of Medicine * American Med. Monthly, July, 1855. p. 40. 9 my first paper on this subject. The whole number of cases in which this treatment has been employed since its adoption, in October, 1854, amounts to one hundred and six. These cases are given in their chronological order ; but they may be ar- ranged very appropriately into four principal divisions, namely, incipient tuberculosis, advanced tuberculosis, bronchitis, and spas- modic asthma. Although all the principal points in these cases, and the result of the treatment, so far as this can be known, are given in this tabular statement, yet I shall select from each of these divisions one or more cases, whose history and management will be more fully detailed, in order the better to illustrate that class of diseases for the treatment of which this form of topical medication is the most appropriate. /.—Cases Presenting the Usual Rational and Physical Signs of Incipient Phthisis. Case I.—R. L., of Springfield, Mass., aged thirty, of large frame, dark complexion, hair, and eyes, came under treatment November 3d. 1854. In September, 1853, he contracted a severe cold, which was followed by a hard, dry cough. Free expectoration of mucus at length took place, and this, together with the cough, continued through the following winter. These symptoms were abated somewhat during the summer of 1854, but the cough never entirely left him, and on the approach of cold weather all his unfavorable symptoms were greatly in- creased. Examined November 3d, 1854, his case presented the following symptoms :—He was emaciated ; sallow countenance, constant cough, which was now attended with muco-purulent expectoration; night sweats, frequent pulse, hoarseness, with chronic folliculitis. On examining the chest, there was dulness on percussion under the right collar bone, and auscultation revealed sibilant and crepitant rales, with prolonged expiration throughout the upper part of the right lung, and decided increase of the vocal resonance. On the left side, the respira- tory sounds were slightly augmented in force, but otherwise normal. His mother, who accompanied him, stated that the family was not supposed to have any hereditary tendency to consumption. At a subsequent visit, a few days later, Prof. E. 10 H. Parker and Dr. Douglas both examined this patient, and finding the above signs present, coincided with me in the opinion that tubercular exudation existed in the right lung. The treatment consisted of both local and general measures. Topical applications of the nitrate of silver were made first to the fauces and pharynx and aperture of the clottis, and subse- quently into the larynx and trachea, and the iodide of potas- sium, with the proto-iodide of mercury, was administered inter- nally. These measures were continued (the applications being made almost daily) until the 17 th of November, "when the tube was introduced, and a drachm and a half of the argentine solution injected into the right tracheal division. Between the above period and the 20th of December, at which time the patient left for his home, this latter operation of catheterism was performed fifteen times, and on each occasion from one to two drachms of the solution of the strength of from twenty to thirty grains to the ounce of water were employed. Under this treatment the patient improved gradually, but constantly; his cough and expectoration diminished; his strength increased ; he gained flesh ; and nearly all his un- favorable symptoms disappeared. A corresponding improve- ment took place in the physical signs. Before he left, Dr. Parker again examined this patient, at my request. Some dulness is still apparent at the upper portion of the right lung, yet much less than at first; but the crepitant rales have disap- peared, and the respiratory murmur can be heard throughout the whole extent of the right lung. The patient has an occa- sional slight cough, but with little or no expectoration. Says he has a good appetite and " feels well." This present month, December 13th, one year later, Mr. L., being in New York,, called at my office. He is looking well, has gained still more flesh and strength, has been able to attend to his business constantly, as a merchant, during the past year. At this time a minute examination of the patient's chest was made by my assistant, Dr. Richards, and myself, and a flatness, on percussion, over the right lung, was the only abnormal sign that could be detected. Remarks.—If dependence is to be placed for a correct diag- nosis upon the admitted rational and physical signs of tuber- 11 culosis, then this patient's case presented at first the unequivocal indications of the presence of this disease ; and although we cannot yet positively aver that these abnormal symptoms have all disappeared, still it must be admitted that we have every reason to believe that an arrestment of the pulmonary disease, in this case, has been effected. Case II.—During the latter part of last summer, I received a letter from Prof. Bledsoe, of the University of Virginia, re- questing me to take under my care the daughter of a particular friend of his, (the Rev. Dr. S., of that State,) who was con- sidered by her friends to be suffering under pulmonary disease. It was proposed that she should visit New York as soon as the summer heat had subsided. September 10—Miss S. came to my office, and her case was examined. Eighteen months before, when about nineteen years of age, a slight cough came on, attended with emaciation, loss of appetite, and occasional haemoptysis. In May, a little over four months previous to her visit to New York, she became worse, her cough was harder and more frequent, and the ex- pectoration was frequently mixed with blood; these were among the symptoms that characterized her case at the time of her first examination. She is tall, has a narrow chest, a dark, sallow countenance, with considerable emaciation. On exam- ination of the chest, there was marked dulness under the right clavicle, with feeble respiration ; the expiration was prolonged, and crepitant rales were quite apparent throughout the upper portion of the right lung ; the left lung appeared normal. A severe cough, with muco-purulent expectoration and frequent haemoptysis, were the prominent rational signs. The patient and most of her friends had had no faith in any other but homoeopathic treatment, and she had been induced to seek for other aid only through the earnest solicitation of her father's friend, Prof. B. It will be unnecessary to detail minutely the measures adopted in the treatment of Miss S.'s case. The iodide of potassium in combination with the bitter vegetable tonics was administered. Topical applications with the sponge-probang were made to the aerial passages for several weeks, followed by the injection of the nitrate of silver solution into the right 12 bronchi, as in the preceding case. The phosphate of mangan- ese, with the tincture of cinchona, and a generous diet, were also ordered for the patient towards the close of the treatment. The topical measures were continued until the 29th of October —for a period of six weeks—when the patient left the city to visit some friends residing in Massachusetts. At this time her unfavorable symptoms had nearly all disappeared. She coughed but very little, and had but little expectoration, and no hsLMnop. tysis. Her flesh and strength had both increased, and her countenance and general appearance were both indicative of returning health. On the 16th of November this patient returned to New York, on her way to Virginia. At this time I made an exam- ination of her chest. A little flatness on percussion is per- ceived on the right side, but the respiratory murmur is heard distinctly throughout the entire lung; no rales can be de- tected. She has no cough, no expectoration ; has gained still more in flesh and strength, and says, with the exception of her chronic catarrh, she " feels quite well." She was directed to continue her tonic, to live well, and in appropriate weather to exercise in the open air. Miss S. returned to Virginia, and I heard nothing more of her case until the present month, when I received a letter, dated January 17 th, 1856, from which I extract the following : " My general health, since my return home, has been very good. I have discontinued the tonic which you gave me, be- cause it seemed to have fully accomplished its work. My appetite is good, I look well, and have fully my usual strength." Remarks.—In the discussion which took place in the New York Academy of Medicine on the employment of topical medication in the treatment of cases of pulmonary disease, it was asserted by a member of the committee that no reliance could be placed on the apparent improvement of patients under these circumstances, as it is well known that consumptives often made great improvement for a time, " under the hope in- spired by a new mode of treatment.'' The favorable change, however, which has attended the treatment of Miss S.'s case cannot be attributed to any " con- 13 trolling faith" in its efficacy, as may be seen from the following extract from the letter from Prof. B. to which I have referred: " Miss S. thinks you will do her no good, and her mother is entirely opposed to the experiment. * * * * I take this Btep in opposition to the wishes of every other member of her family, and of the family connexions. They all fear that con- sumption will follow. I am sure if it should, it will not result from your treatment; and feeling thus sure, I am determined to take the responsibility. If it should follow, I shall be blamed for the pertinacity with which I have insisted upon the abandonment of homoeopathic quackery, and on the necessity of applying to you. But I am satisfied ; for I know that I am doing right." Case III.—C. H., of Jersey City, aged thirty, an officer of the Customs, had shown some indications of thoracic disease, when about twenty-two years - of age, for which a change of climate was advised. In January, 1849, he sailed for Califor- nia, where he remained over two years, returning to New York in March, 1851, apparently in good health. In April, 1855, by exposure in a storm, he took cold,—a cough came on, fol- lowed by expectoration, night sweats, great loss of strength, haemoptysis, and emaciation. During a part of the summer of 1855, he was under homoeopathic treatment, but without any improvement. He then consulted a physician of this city, by whom his night sweats were relieved for a time, but his cough, emaciation, and other symptoms continued. " On the 15th of September," (I shall here quote from the record of my assistant, Dr. Richards,) " C. H. came under our care, with the following symptoms : countenance dusky, pale, wrinkled ; cough severe, particularly in the morning, when he expectorates large quantities of muco-purulent matter ; is very feeble, emaciated, weighing only ninety-four pounds; loss of appetite; skin dry and feverish; pulse 110. He has chronic pharyngo-laryngeal disease, with elongated uvula. " The physical signs indicate extensive bronchial disease of both lungs, complicated apparently with tuberculosis of the right lung. There was dulness on percussion under the right collar bone, moist crepitating rales, with prolonged expira- tion." 14 Treatment.—A portion of the elongated uvula was removed. Applications of a solution of the nitrate of silver were made once in two or three days to the pharyngo-laryngeal membrane, and the iodine, with vegetable tonics, was internally adminis- tered. The cauterizations were continued until the 20th of October, when the patient not improving in his general symp toms (although his cough and expectoration had in some de- gree diminished), the flexible tube was introduced, and a drachm of the solution injected into the bronchial divisions. The same result which had followed the employment of the tube in many other similar cases occurred in this instance, the cough and expectoration diminished more rapidly than before its use. These injections, alternating with the use of the sponge-pro- bang, have been continued up to the present time, January 1st, 1856, and the following is the patient's condition :—He has nearly regained his usual strength ; has very little cough or expectoration; pulse much diminished in frequency ; and his present weight is 115 lbs. Auscultation reveals slight bronchial irritation of the right lung ; no rales, no prolonged expiration ; the respiratory mur- mur is feeble, but distinct over the whole of the right lung. January 14th—Examined Mr. II. to-day, and find his pulse at 74. He has neither cough or expectoration except a little " clearing of the throat" in the morning. He feels quite well, and looks well, and is quite able now to attend to all his duties as an officer of the Customs. Case IV.—In December, 1853, A. Y. R., twenty-six years old, came to this city, with a letter from Dr. Smith, of Riga, by whom the patient was recommended to my care. Seven years before he had an attack of mumps, and, following that disease, had experienced more or less irritation in the throat, which was caused by an occasional cough and a disposition to clear the throat by frequent " hawking." About one year ago a cough came on, which has been promi- nent ever since. Four or five members of his family have died of phthisis. Present condition : The patient is emaciated has a phthis- ical aspect; the pulse is accelerated ; cough and expectoration considerable, and during the last year he has had an occasional 15 haemoptysis. Over the apex of each lung percussion elicited sounds slightly dull; respiration decidedly rude, with resonant voice on the right side, left, tolerably clear. Both tonsils were enlarged and diseased; the right gland had two large openings in it, through which pus oozed when the tonsil was pressed upon by the finger ; the uvula was elongated, and the pharyngeal membrane covered with enlarged and dis- eased follicles. The hypertrophied and diseased portions of the tonsillary glands were excised, the uvula truncated, and the applications of the nitrate of silver made to the fauces and pharynx, and subsequently into the larynx. The local, with appropriate general treatment, was continued about four weeks, or until January 9th, 1854, when the patient returned to his friends, considerably improved in health. His cough and expectoration were much improved, and he had regained flesh and strength. These favorable symptoms continued until some time in Feb- ruary, when, being exposed at night in an open carriage, he took cold, and all his unfavorable symptoms returned with in- creased severity. He came back to New York the 27th of the same month, and was again under treatment, both topical and general, for several weeks. He was once more greatly benefitted by the treatment, and although the cough was never entirely absent, and the haemoptysis occasionally recurred during the whole season, yet he increased in weight and strength, and was en- abled to attend to his ordinary mercantile business through the Spring and Summer of 1855. Sometime during this latter period, Mr. R., being in the country, had unfortunately an attack of influenza, by which his former symptoms of pulmon- ary disease were renewed with increased severity. He did not, however, return to the city until quite late in the Fall, so that a period of eight months intervened between his last treatment and the 5th of November, when he once more came under my care. He was now considerably emaciated ; had purulent expec- toration ; and the hastnoptysis, which had occurred moderately at intervals for three years past, was more copious, and more frequent in its recurrence. Auscultation revealed the existence 16 of a tubercular deposit in the right lung, and the rational signs present confirmed this opinion. Recourse was again had to cauterizations of the larynx and trachea, together with the internal administration of those general remedies, which had before benefitted the patient. Bot their use was not followed by that improvement which had attended their earlier employment, for the cough and expec- toration continued, and the attacks of haemoptysis, which for three or four months had occurred at very regular intervals— once in two weeks—had become severer than ever. The tube was now used, and injections of a solution of nitrate of silver were thrown into the bronchi every second or third day, for several successive weeks. Improvement began with the adop- tion of this treatment, and continued constantly to advance during its employment. There was no return of the hajmor- rhage after the first bronchial injection ; the cough and expec- toration rapidly decreased, and the patient gained daily in strength and weight. On the 30th of November, this patient was examined in the presence of several medical gentlemen who had watched the progress of his case during the treatment. His countenance has lost its phthisical aspect; he has increased several pounds in weight in the last six weeks. His cough and expectoration have nearly disappeared. The dulness over the right lung is barely perceptible, the respiratory murmur is present, but neither rales nor prolonged expiration can be detected. He returned to his home in better health than he has had for years. II.—Cases exhibiting the Effect of Catheterism of the Lungs in the Advanced or Confirmed Stage of Tuberculosis. Since the proposition was made to employ injections in the treatment of advanced phthisis, the question has frequently been asked, whether it is claimed that the tubercular cavities may be injected, or what is the therapeutic object proposed to be obtained by this treatment ? " When these cavities com- municate with bronchial tubes, and are not seated in the upper portion of the lungs," it is undoubtedly possible that this oper- ation may be performed, although its positive accomplishment 17 has never been claimed ; but this is not the end desired, Re- cent histological observations have fully established this patho- logical fact, that in all cases of tubercular deposit, there occurs in the immediate vicinity of the exudation more or less of an inflammatory action, in which all the adjacent structures are involved. The bronchial membrane, and the pulmonary par- enchyma, become at once congested, and subsequently inflamed. The terminal extremities of the bronchi, says Prof. Bennett, are among the first structures affected, and as the tuberculosis proceeds, all the appearances characteristic of chronic bron- chitis are produced, and are constantly going on in the prog- ress of a case. " Consequently," he observes, " the great problem to be worked out, in the treatment of pulmonary tuberculosis, is that, while on the one hand, it is a disease of diminished nutrition and weakness, and consequently requires a general invigorating and supporting system of treatment, on the other it is accompanied by local excitement, which demands an antiphlogistic and lowering practice." * It is to meet this last indication—to subdue the local inflam- matory action in the immediate vicinity of the exudation—an action which, if continued, will not only effectually prevent the disintegration and absorption of the tubercular mass, already formed, but which will tend to augment the mass, that appli- cations of the nitrate of silver solution to the congested and inflamed membrane, are advised in early as well as in advanced tuberculosis. The following cases will illustrate the effect of this treatment, when employed late in this disease. Case V.—B. M., aged thirty-six years, from Pittsburg, Pa., in height over six feet, with fidl chest, dark eyes and com- plexion. Has had an occasional cough, with chronic follicu- litis, for four years ; until 1854, was always better in Summer. In June of this year, haemorrhage from the lungs occurred, and again in October, his cough also increased, and emaciation and night sweats followed. Accompanied by a younger brother, who for several months had suffered under symptoms similar to his own, he came to New York in October, and both placed themselves under a doctor, whose newspaper advertisements * The Pathology and Treatment of Pulmonary Tuberculosis. By John Hughes Bennett, Professor, > San Francisco. 20 New Jersey. 40 New York. i 30 .Brooklyn , 36 New York i 40 New Orleans 25 \V. New York. 45 Connecticut. Advanced Phthisis. Phthisis following fol- liculitis. Phthisis, complicated with bronchitis. Phthisis. Female. | 35 New York " : 32 Orange Co. 30 New York. Pougokeepsie. Niagara. Duration Duration; prior to of treat- First effort of treatment. | ment. treatment. Hotel keeper. Phthisis. Phthisis. Broker Machinist. Merchant. Wid. pbys'n. laryngeal phthisi-. Phthisis following fol- liculitis. Bronchitis with bron- chial dictation. laryngeal phthisis. Phthisis, with small cavity in right lung. Bronchitis. Advanced phthisis Bronchitis, complicat- ed with phthisis. Advanced phthisis. Advanced phthisis. Advanced phthisis, complicated with syphilis. Bronchitis, with signs of tubercles in one lung. ! Severe bronchitis, with emphysema. 1 year. 3 years. 2 years, 1 yea?. 6 months. 6 months. 9 months. 18jnonths. 5 years. 1 year. 3 "vears. 10 months. 6 months. 2 years. 18 months. 4 years. 1 vear. 1 year. 20 vcar- :} mos. 2 mos. 1 mo. 8 mos. 3 mos. 2 mos. 2X mo: 2 mos. ! 12 mos 8 mos. 8 mos. 1 mo. 1 mo. 2 mos. 3 mos. 2 mos. 1 mo. Improved Not improved. Improved. I Not improved. I ! Improved. | Not improved. 1 mo. j Improved. T.eneral Results For several weeks the patient was much improved, I but died after a few months. ! First six months remained nearly the same, but I gradually declined, and died a few months lator. Did not improve during the first week ; afterwards | improved rapidly. Recovered. Has since been constantly engaged in practice. Was greatly benefitted by treatment—able to attend i business" until this Winter. Advised to go South. Improved a little at first, but died subsequently. Left without being improved. Greatly improved. Left for California, apparently | well. ! Left much improved. [Greatly improved. Was nearly well, when an at- tack of fever increased his malady. Again Im- I proved, and left for Mexico. Much improved by treatment. This ladv, when first seen, with her attending phy sician|was confined to her bed. She has quite recovered. Greatly benefitted. Leftforbome, feeling quite wll Improved under treatment. Obliged to ret urn home Ix>ft without any decided improvement. i | Improved for a time, but disease continued. Di"«l. Greatly improved, and continues so. Died following Winter. Entirely recovered. s greatly improved by the tri-ntim •ntinues improved. CO Table of One Hundred and Six Cases of Pulmonary Disease, Treated by Bronchial Injections,-(Continued.) Date. N< 1854. Nov. 20 Male. 22 Male. 23 Residence. Occupation. Form of I incase Dec. 1855. Jan. 25 Illinois. 30 New York. 28 Massachusetts '— Virginia. Duration Duration' prior to of treat- First effect of treatment. ment. | treatment. (ieneral Results 24 : Female. 17 New York. 26! Female 27 Male. 34 Female. 35 Male. 36 I 25 New York. 130 '• ! 40 Yirginia. i ; 50 Maine. i 30 Kentucky. 40 New York. 34! « 45 Conneclicnt. 261 Ohio. ] 35: New York. 50 Indiana. Advanced phthisis. 2 year- Laryngeal phthisis. 1 3 years. with asthma. Incipient phthisis. 1 year. j Phthisis, with aphonia 1 year. Severe bronchitis. 8 mos. 12 mos. 8 mos. 2 mos. 5 years. 1 Y* mos. Professor of I .aw. Surveyor. Phthisis, with bron- 6 month. chitis. Phthisis. Bronchitis, with bron- ' 1 year. chial dilitation. | Bronchitis, complicat- '. 9 months. ed with tubercles, j Advanced phthisis. 1 year Merchant. j Advanced phthisis. \% year.- Blacksmith. , Advanced phthisis. 3 years. Mechanic. I Bronchitis. I 5 years. Farmer. ; Bronchitis, with tu- , 2 or 3 yrs. berclos. ] ! Bronchial asthma. ; 2 years. I : Merchant. Phthisis. : 2 years. 1 ; I Phthisis. ; 3 years. Improved. 1 Much improved. Left for the South, got worse, | and died. ! Had ulcerations of trachea. Greatly improved by | cauterizations of the part. Remains better. i; . Recovered. I For a time improved, but not permanently. Gone i South for the Winter. Improved slightly under use of sponge-probang. which was continued twice a week for six weeks; then one injection was employed, followed by great bronchial irritation, after which the patient recovered perfectly. 2 mos. Was greatly benefitted. Returned home after two or three weeks, appearing quite well. (lot worse in the Fall, returned, and was again much im- proved by treatment. 2 mos. 1 " Remains about the same. 4 mos. <■ Dismissed cured. lmo. '" Dismissed cured. ] }i mos.1 Improved for a time, and returned home, and died some months after. 11 mo. Greatly impr'd Not improved ultimately. for a time, j 81110s. Impr'd at first. Died in the Spring. 14 mos. Improved. I Continues much improved. 2 mos. j '' Returned home. Got worse the following Spring, and died. 11 mo. " Retimed. Treatment continued by her physician; \ 1 and she ultimately recovered. lmo. '• ; Fourth operation produced severe spasms, and pa- ! 1 tient refused further treatment. !2 weeks. '• Returned to Indiana greatly improved. Not heard 1 I / from since Table, of One Hundred and Six Cases of Pulmonary Disease, Treated by Bronchial Injections.—(Continued.) Date. No Sex. a; be <, 42 Residence Occupation. 1855. Jan. 37 Female. New Jersey • "( 38 '• 391 '• j 30 30 Choctaw Nat'nJ Teacher. Connecticut. \ Feb. 40 Male. 41 " 28 30 \ Kingston. N New York. Y Merchant, Broker. March1 42' " " 1 43 Female. 20 25 Wheeling. \ 1 Connecticut '11. Student. i '• 44' " 43 New York. May. 45 Male. '•' 1 46 " '• 47 Female. " ; 48 Male. April. 49 Female. •■ '50 Male. 2S 26 54 28 30 48 Vermont. New York Maine. Minnesota. Physician. Farmer. Physician. Merchant. l 51 30 New York. Form of Disease Duration .Duration,: j prior to or treat | First effect of j treatment. ; ment. treatment. General Result- Larvnuiti- with bron- i2 years ciiitis. ! Phthisis. 1>£ years. 3 mos I»irvngitis. with bron- 4 years. 3 mos oiiitis. Phthisis. 4 years. 2 mos Advanced phthisis. 2 years. 3 mos Phthisis. ,1 year. j 2 mos Advanced phthisis, I'nkuown. 1 mo. with aphonia. I Bronchitis, with asth 5 or 6 yrs. ! 2 mos ma. ' Phthisis. 2 years Advanced phthi-is. . 1 year. Bron.. with asthma. | 5 years Advanced phthisis. ' 6 montl Advanced phthisis. j 1 year. Advanced phthi-is. ' 1 year. 3 mo=. Improved. 2 mos. I '• 2 mos. | " 2 weeks. I '■ 2 mos. I lmo. ' 3 mos. ■ Much iinprov'd Advanced phthisis. 2 year.- 3 mos. 52, '• 45 1. Advanced phthi i- I 18 months. 4 mos. " 531 •■ 54; •• 56 Female 26 26 Maine. Ftica. Haverstraw. Mechanic. Merchant , Phthisis. Phthisis. Advanced phthisis. f> months. 1 year. 2 years. }£ mo. 4 mos. 2nii)-. 1 Improved. 56 Male 571 » |25 Indiana. Virginia. Farmer. Student. Advanced Phthisis. pliilnsLs. 1 year 11 year 1 mo. 2 mos. Much improv'd 5S *• 40 <• Planter Advanced phthisis. 2 years l'a mo. Improved. 59 30 i. I'hthi-is 1 1 >; years. 1 m". Much improv'd Remained nearly the same through Summer. Gone South the present Winter. I,oft for Arkansas greatly improved. Continues greatly improved. Recovered. Improved under treatment. Went South. Died some months after. Left for home greatly improved. Not heard from. Regained voice, and left much improved. Not heard from. ; Recovered. I'Himateiy not much improved. Not improved ultimately. Died. Much improved Much improved at first. Went home and died. No permanent improvement. Left for the country greatly improverl. Continued better for so\eral months. Got worse the fol- lowing Winter, and died. Greatly improved. Spent the following Summer at I-ake Superior, and returned the present Winter. Still better. Has continued greatly improved since the occur- rence of cold weather. Returned home much improved. No report since > Ix-ft in apparent health. Not since heard from. Appeared better for some time under treatment Went home, and died several months after. | Left for Indiana greatly improved. No ro[>ort miioo Went home much better. Since heard he is still better. Not much improved ultimately. Nearly the same at la-t rejiort. Was greatly improved, and *till continue* better. CO 00 i - '■ Table of One Hundred and Six Cases of Pulmonary Diseast i .'Duration nrior to , Treated IHiFatioii; of treat- by Bronchial i oj First effect of Date. No Sex. ho < 23 Residence. [ Occupation. Form of Disease. i treatment. 2 years. ment, j treatment. 1855. May. 60 Female. New York. 1 1 Advanced phthisis, 1 1 mo. Much improv'd with aphonia. ii " ■ > 61 Male. 28 14 11 Carpenter. Bronchitis. 1 year. 6 mos. i Improved. June. 62 " 30 Canada. Merchant. Bronchitis, with apho- 2 years. 1 mo. 1 63 u 20 Brooklyn. Mechanic. nia. Severe bronchitis. 1 year. 1 4 mos. I Much improv'd Not improved. Much improv'd " 64 Female. 35 Baltimore. Advanced phthisis. 2 years. 1 mo. j 65 19! New York. Phthisis, with bron- 2 years, i 4 mos. 66 28 Virginia. chitis. | Advanced phthisis, j \% years. 1 ino. 2 mos. Not improved. Improved. 67 i Male. 25 Pennsylvania. Mechanic. Phthisis. 1 year. July. 68 ! Female. 28 Virginia. Phthisis. 2 years. 3 mos. k 69 " 26 Indiana. Advanced phthisis. 1 year. 1 i-a mos. 70 ! 71 ; Male. 45 26 Alabama Buffalo. Clerk. Phthisis. Advanced phthisis. 2 years. li£ years. 1 mo. 4 mos. Not imiiroved. Improved. 72 18 Long Island. Student. Advanced phthisis. 6 months. 2 mos. t( u 73 u 30 Virginia. Merchant. Advanced phthisis. 3 years. l}£mos. " Aug. 74 Female. 35 Connecticut. Severe bronchitis. in" months. ^mo. l( 75 22 Massachusetts Phthisis. 1 year. 1 mo. (( 76 Male. 28 New Jersey. Clergyman. Phthisis, complicated with bronchitis. 1 year. 4 mos. 77 u 32 Virginia. Planter. Advanced phthisis. \y„ years. 2 mos. . »:,., 78 79 d 26 32 Pennsylvania. Ohio. " 1 Farmer. j Laborer. Severe bronchitis. \ Phthisis, with disease 3 years. 1 year. 1 mo. 12 days. Not improved. 80 « 35 New York. Teacher. of the heart. Advanced phthisis, 1 year. 1 mo. No change. l with mesenteric ul- ■ < 81 | •' 22 Alabama. Student. ceration. Advanced phthisis. 1), years. 1 mo. Improvod. .. 82 u 35 Staten Island. Merchant. ■ Phthisis. 3 years. 4 mos. " ■' 83 Female. 24 Ohio. Long-standing bron-chitis, with asthma 15 years. 2 mos. -(Continued.) General Results Continues decidedly improved. Cured. Left nearly well. Cured. Left without improvement. Dismissed apparently cured. Returned home not improved. Returned home greatly improved. Left much improved. Since writos she is well. Greatly improved. Cough nearly gone whon leav- ing for home. Not heard from. But little change from the treatment. Was greatly benelitted. Continued improved when last heard from. Much improved at first, but failed, and died four months later. Left much better. No report since. : Improved, and left for home. Left greatly improved, and has so continued. Is greatly improved. Preaches every Sunday. Returned home improvod. No report I Left nearly well. Died. I,cft, no better. No report. Improved slightly at first. Left, really no better. Since died. Continues greatly improved. Had only three injections, but has much improved. CO Table of One Hundred and Six Cases of Pulmonary Disease, Treated by Bronchial Injections.—(Continued.) Date. No j Sex. 1855. Oct. 85 Male. 86 Female 87 88 Male 90 91 '• 92 Female 93 Male. 94 " 95 96 '• 97 i '• 98. •■ 101 102 Male 103 Female. 104 Male. 105 I Ofi Florida. Tennessee. Massachusetts. New York. Jersey City. New Jersey. Virginia. Now York. Virginia. Ohio. New York. Kingston. New York. Florida. Brooklyn. New York. Kentucky Virginia. New Jersey New York Williamsburg! Occupation. Custom of- (leer. | Mechanic Physician. I ! Author. Student. 1 Conductor. Merchant. Merchant. Firmer Carpeuter. Form of Disease. i Duration . Duration i | prior to I of treat- First effect of treatment. I ment. I treatment. General Results Severe bronchitis, with emphysema, &c. | Phthisis, with aphonia j \\i years. ; 1 mo. ! Phthisis, with aphonia i 2Ji years. 3 mos. two years. ] ' Extensive bronchitis, ■ 1 year. 3 mos. with emphysema. ' Severe b'noh'itis. with 6 months. 3>£mos.i incipient phthisis, i Bronchitis. | 6 months, i^mos. Bronchitis, with in-11 year. l'^mos. cipieut phthisis. | Phthisis. , 2 years. 4>£ mos. Earlv phthisis. I1, years. 2 mos. Phthisis. 6 months. 11 mo. Bronchitis, complicat- 10 years, j l.J£ mos. ed with epilepsy. ' Advanced phthisis. 4 years with bronchitis. 3 years. . 2J£ mos. Improved. Considerably improved under treatment. ! Phthisis, with apho- nia. Advanced phthi-is. Phthisis. Advanced phthisis. 1 year. 3 years 1 year. Severe bronchitis. i 2 \ ears. with asthma. Bronchitis. j 2 years. Early phthi-U, with 11 year. bronchitis. I Advaneod phthisis. . 2 years. Bronchitis, with bron- ; 5 years. cbial dilitation. - laryngeal phthi-is. ' 6 months. l'btiust- wltb aphonia 1 year. I 3 mos. 3 mos. !l>i mos. 2 mos. 1 mo. 5 mos. 3 mo=. 2 mo-. 1 mo. 5 mos. 10 days. \yi mos. Left much better. Voice restored. Remains greatly improved. Voice partially re- stored. Improved rapidly at first. Still occasionally treated. Greatly improved. Quite well. Greatly improved. Much improved. Went to Florida for the Winter. Very much improved. Ix>ft greatly improved Left much improved. Went home greatly improverl Is much improved. Still much improved. Writes she is - quite well." Voice restored. Greatly improved. Improved very much. •• improved at lirst. Declined rapidly ultimately, and died last of November. : Cored. Greatly improved. Is quite well. Ix-ft appearing well. Not improved. I Left, not improved. No report. Improved. Continues improved. " Improved. Obliged to return hom<>. " Greatly improved.