2 £ S## ?-\V*©. "!^P ,S< ""> » > >> vJJ 3 j * ""^ ^ > > -4K ■ ■ "fc *v t * 1^ • *i "3 *■ -J? J> -' tm ■ ■* S£ -^K > -> * ^m™ -*^~ -* "■> ^^^ -- 3r -* > > J -> > > :> >^> ll Si » » »*" ..J8 k *>."'»> t V> "^ S 3® > > • ^ *»> 3 ?» ^ . » . • 3 ■ / ^ »^ > ■ J 5^ ? aws*. >3&S -3 >> ;> > ^ -J?*: . :> >. ■*?« ^$:-yiv:::$: 1 g^^ A: f mm Wii I I I f Surgeon General's Office B0 iQi^.HD^'Cf^ CSSS'ui fa 35 iSec&cn,................................... Q>GOjGQ>GOjGOjGaGQ>GQGGGQjOQJGQJGr m IE- i*SK. TREATISE • OX T H * i mm i<;i) i a t i<: ca list: A. Nil TIM S L»EC I FIC TREATMENT PULMONARY PHTHISIS, £ T U JBEHO U LA It DISE A SES. \i\ J. FRANCIS CHURCHILL D.M.R. I.UAIH ATK OK THE I ARIS BCHOOI. OP MKniCINE ; MEMBER OP THE IMPERIAL 10.VDE.MIK> 'M MKDICINBf AN1> SURNCKS. TRANSLATED FROM THE FRENCH BY A PHYSICIAN. FOURTH AMERICAN EDITION, WITH AITKN1MX. .1. WINCHESTER. PVIJI.IS1IKH, 36 JOI1N STREET. IS G 1. m j$ WINCHESTER'S GENUINE PREPARATIONS (n [ua:u: after the original formula of dk. churchill] Ara OiTv.-oi t> Vw Profession with ths fullest confidence that they will be fount!'" superior to all otlurs, " i.i chrraical parity,a id cojs:;qucnt t'ac.-a;)eutic efficacy, in the treatment of Pulmonary 1 hthisis Ant Tibercular diseases, as propcaeil by ths discoverer in his reports to tho Imperial Aculcnics of Modiciuo and Science, I'aris, ia 1857-'58. Moft of the ill success h-retoforo attending tic exhibition of the IlYPnpiiosPHrrEs, which has c i :sed th m t > fill into Uis.-e^utJ i.i many quarters, .'.an bo clearly traced to tho impurity of the Salts i.s 'd by thjpractitioner. Siys Vr. Churthi.l: " It is not very astonishing that tho Hypophosphites, iinuiorMrtariiysntd, * * bUj i'.Ji:otp .-esanUhat WR.VY,indispensable, tosvecessinthetreaim^nt. * * T> \>i use I with effect, t'n H.vop.i sPHirEs M(TST Bl PERFECTLY PURE; otherwise they may, in k nn j cisjs, appear altogether i.\i:rt or even injurious. In fivecas.s out of six the salts, usually sold i.i i'a.-is, uuiorthana;nj.of ihi-opu )sphitks, AUE TOTALLY UNFIT FOR MEDICAL USE." My Preparations of tho Hypophosphites have now been thoroughly tested for more than two years, by m.i-iy of tho Profossi n,a-.i I w.t'.i a vnifjrmi'.y of re;:dU,so remxr!;al>le,as to placo them in the highest rank of Scientific SUa lard Remedies. I take pleasuro in calliug attention to tho following IMPORTANT MEDICAL TESTIMONY. " Nomedicino I havo ever usTl,in tho treat- in -nt of Pulm i:vi:y disoas;s, has produce I any- thini Wet ine scum fa walle results as tho Hypo- p'4)sphit-!S. * * Afi;:r the u-a of tho Remedy fir »fw d'tys, th«ro takes placo a oeveral im- r:i )V!rMK\T i.v all t;iksympt >m i ; tho co.ighgrows c t«y, th 1 nijlil-suiea'.sc-as", tho Uia-rhoo i is check- ed, thoap;>etitj improves; an I thsro follows an increase of '.!^sh ai i str.-ngth, an 1 a healthful vivacity and choorfulness of spirits, which I HAVE NEVER SEEN AVY OTHER MEDICINE i'itOiiUCE."—11. II. HarrUon, M. D., Port Bich- mml, iV. V. '• I Livj no doubt, whxt^vor, of the superior cTiaicyf of th > Hypophosphites in tho treatment of Tub srcn'.osis, over all other medicine* and tnrlhoil* hitherto discovered, * * I know of iu m^dici :oor troatmout with which I Ii.ivj ever sj.-n c(T.ct*d i.v this fatal malady an>'tiiixo m 'ubtiux AMinGAni.v. Yet, in similar c»sos, n.Ujr thj usa of Chu:chill's H.pophos- ,1>UHjs, as prepared by yours .-If, I have seen many restorer! to tht'r it inn I h'al h and vlg-or.»-»\r. \V. Townunl, M. D., Cia.ham,, Pa. •• Uuvi iis;d ' WnchosUT's Hypopliosphitcs' \\ Phthisis, vJnrmia- an I Chlorosis, with maiko I success; curing a ease or Con- smnpiiou, where lUBiiRCLES, ko docbt, existed in the. second stage of development. I cured a case of Chlorosis at once, and several cases of wine mi a* where great debility existed."—Ira liar- rows, M. D., Pro'i levee, R. I. "I havo prescribed 'Winchester's Hypophos- phites ' in some forty or fifty cases of Cotim sumption. Chlorosis- Jtyspepsia, *Tlam rasmus, etc., with the liappn-st results, HAV- ING FOUND THEM SUPERIOR TO ALL OTHERS.'' —Sam tel If. Tew'cslury, SI. D., Physician to Vie Unit d S'a'es Marine Hospital, I'orlland, Me. " Whatever may bo tho estimate placed on Dr. Churchill's Theory of tho adaptation of thi.s class of Remedies to tho cure of Plitliisis, yet all will bo impressed with the importance of givinc; tii.:>[ A fair tkial. Tho announcement of Mr. \V Lich' ster will enable physicians to procure them prepareI strictly by Dr. CUurchill'smethod, and thus tost th-ir value. Mr. Winchester IS WORTHY OF ALL CONFIDENCE, and devotes himself, enthusiastically, to these preparations in all their variety of combination."—I). Mkreuith Rkbse, M. P., LL. D. [New Fork Medical Gazelle. "I have a pe.rsonal knowteilqe of .11 r, If*«/i- chester^a honesty antl Integrity* and can assure tho Profession and tho public that his Preparations of the Ifypophosphites can be relied on."—James tt. Chilton, M. !>., -•-•-♦- Wiitt©l!i)©8t©p*8 ©©mulct© l%pGpfrQspPut©sB PRICE LIST. TERMS CASH. LIME ANI> 80nA,(c<.Mi>iNsi>.)7-o7!. bot., $1 00 I 80I>.\, (purb solution.) T-««. bottlo*, - *1 00 .A.™ . " 16-o^. " 8 Oft I'OTASSA, " " " • - lOO LIME, (huku solution.) l-oi., " 100 ' MANGANESE, " T-07.. " .100 CS" A discount of thirty per cent, will be made to physicians, when ordering by the dozen. DR. CHURCHILL'S TREATISE ON CONSUMPTION fTHirin AM3RICA!f KDITI >.N, WITIJ APPENDICESl V.'dl b3 sont, prepaid, to all FhysicVns who wish to examine his Theory and the Reports of Cases. '•Mr. Winchester has, by his own enterprise, placed this valuable Treatiso within the reach of Ihn Me 75. Their power to increase nervous force.............' ..7.7. .7.7.7......... ' •>"> '75 Their use in Nervous Diseases and Paralysis......7.77.7.77.7.............. ' 22 Their use in arresting hemorrhage.............7.7.7.7.7. 7.77............. 37 Their influence in restoring the Catamenia........*.'.".'.'.7.7.7.7. ' 20 7.6 S3* 36 T> Their influence in checking Night-sweats..........[7.7! 77.77." '* ' 19 143 Their influence in check ing Expectoration...........'..'.'.'............7 that she cannot sleep upon that side, as it causes her to cough- coughs constantly, but most at night and morning; expectoration is 72 NOTES OF CASES. xnuco-p'urulent; her voice has oecome much more feeble for the past six months; has no pain, on pressure, over the larynx, but some pain in the throat, particularly when in the act of swallowing. There is dullness over the upper two thirds of the left side, both before and be- hind ; respiration is feeble, and varied by dry crepitation and some sibilant rales; there is resonance, on percussion, on the right side, with normal respiration. Diagnosis.—Tubercles in the first and second stages, occupying the upper two thirds of the left lung. Ordered ten grains of the hypophosphite of lime. September 1st.—She has steadily improved up to this time, and has gained so much in strength that she has been able to attend to her business, as before her Bickness; her appetite is good; there is no fever, night sweat, nor diarrhoea; at the end of July her catamenia returned as regularly as ever, but they did not appear at this period, owing, as she thinks, to a fatiguing walk which she took, and a cold which she caught at the same time; since then she has had headache, with slight fever and some sweating. Ordered a mustard foot-bath at bed-time. September 2d.—Catamenia appeared slightly yesterday. September 3d.—Catamenia were suppressed yesterday. September 6ft.—Cough and expectoration have been increased since the suppres- sion of the catamenia. Changed to ten grains of the hypophosphite of soda. September 10ft.—Gave five grains of the hypophosphite of lime. September 15ft.—Changed to ten grains of the soda salt. September 18ft.—Gave twenty grains of the same. September 2 2d—Cough has slightly increased. Reduced the dose to ten grains. September 29ft.—Catamenia appeared yesterday. October 4ft.—Sweat more than usual last night; had fever and chills at night; cough is frequent; no appetite. Gave four grains of the hypophosphite of am- monia. October lift.—Has had fever and chills every night, with headache; cough and expectoration somewhat diminished. Increased the dose to twelve grains of the ammonia, October 15ft.—Pain at the left side, on level with the seventh rib, when she coughs. Her aunt tells me that she attributes the aggravation of her symptoms to family troubles and care. October 17ft.—Gave twelve grains of the hypophosphite of lime. October 23d—Has had all the time more or less fever with the chills; pain in her throat, which makes it difficult for her to swallow; cough and expectoration less. Increased the dose of lime to sixteen grains. October 29ft.—Has had no fever since last date. Gave twenty grains of the hypophosphite of soda. • November 28ft.—Has continued in about the same condition; the difficulty in her throat gradually increasing; the fever, cough, and sweating were much less. | The patient did not visit me after this date and died at some time in the early part of January. REMARKS LTON THE CASKS COMPOSING THE THIRD SERIES. Deducting the first six cases, in which the disease had almost reached a fatal ter urination at the commencement of treatment, the following remarks will apply t« all the rest of those composing the third series. In the last seven cases there was a well-marked and persistent alleviation, espe- cially noticeable in the complete change in the attitude and physiognomy of the patients, in the disappearance or modification of the constitutional symptoms, and in the decided increase of the strength. Of these seven cases, it seems to mo that in four, (viz., Nos. 27, 29, 32 and 34), after this amelioration (especially remarkable in cases 27, 29 and 34), there was a renewed aggravation (immediately following in case 27), in consequence of re- peated walks of several hours' duration; and in case 29, of having remained ex- posed to a draught of cold air at the gate of the Tuilleries; where he had run for shelter from a shower. The subject of case 34 had recommenced her ordinary labor, as before her illness, and was even detained later than usual on account of the approach of New Year's day. Grief and domestic cares appear to have at least contributed to the sup- pression of her catamenia, the return of which was the extent of the improvement which she at first experienced. Tho aggravation in case 32 was especially noticeable at the approach of bad weather. In this case, as also in cases 28 and 31, there existed for sometime be- fore treatment a diarrhoea which resisted all remedies. In case 31, this complication Was increased at several different times by excesses in diet. It is reasonable to suppose, that, with regard to case 28, the variolous eruption, if it did not hasten the softening of the tubercular deposit, already far advanced, at least contributed, by its influence upon the intestines, to aggravate the already existing diarrhoea Finally, analyzing the details of these different cases, it seems to me their fatal issue ought to be directly attributed to the anatomical lesions existing before the treatment, and to the pathological consequences which these lesions would neces- sarily produce. Whatever may have been the influence of the treatment upon the diathesis itself, il could not act, except indirectly, upon the physical results already produced by the diathesis. For the same reasons that an anti-venereal treatment will not pre- vent a bubo from suppurating, whenever the local inflammation has attained a cer- tain severity; or the organic lesions of the viscera, resulting from malarious fevers, will not disappear directly under the influence of sulphate of quinine; so an anti- tubercular remedy, while removing the cause of the disease, cannot restore the local lesions which are the results of it. The maxim, sublata causa, tollilur effectus, in reality applies only to functional disorders; while organic lesions, once estab- lished will follow the course which is peculiar to them, and which, to a certain ex- tent, is independent of that which has produced them. This will be still more evident, if the cases of the third series are compared with those of the first, which resulted favorably. 74 ADDITIONS TO ADDITIONS TO THE PRECEDING REPORT. If the hypothesis, that all tubercular diseases arise from a dimina* tion of the oxydable phosphorus contained in the human system, shall be finally sanctioned by experience, it will naturally induce a modification, to a certain degree, of all the present ideas of the etiology, pathology, and even of the semeiology of these affections. It would be premature, at this time, to speculate upon these changes, until the fac's I have ad- vanced have been confirmed by a more extended series of experiments; but there is something to be gained, in my opinion, by examining cer- tain questions raised by the subject itself, and which it is necessary to solve before deciding what is the limit to the efficacy of the treatment I have proposed. How can it be expected, it is asked, that the hypophosphites of lime and soda should cicatrize a cavity, or cause the disparition of a bronchial dilatation ? To this I answer: we cannot always expect such a result; and dis- appointment will certainly follow if the treatment is looked upon as in- fallible. Indeed, clinical experience may, perhaps, demonstrate that this permanent relief occurs rarely. AH that we can reasonably ask is, that the treatment should dissipate the diathesis—that peculiar state of the body which has, as a consequence, the deposit of tubercular matter When once this condition has been modified, the deposition of fresh TUBERCULAR MATTER WILL CEASE. As to the morbid products existing anterior to treatment, two thino-s will happen: if they are fresh, they will in some cases be absorbed • If they are old, they must follow out the indications of their own inde pendent existence, and result naturally, either in calcification, iu becom- ing encysted, or in elimination by softening and suppuration Tins 18 a repetition of the two deductions I have before mentioned and upon which I now again insist: firstly, that the treatment will Ji wrth just so much greater rapidity, according as it is resorted to * an early stage in the progress of the disease ; a fact recognized under every form of treatment, and by all practitioners: secondly, that when tho local le sions have attained a certain degree, the prognosis depends entirely upon THE PRECEDING REPORT. 75 their gravity, their extent, the constitutional condition of the patient, and the position, as regards hygiene and climate, in which he happens to be. Under the.se circumstances, it is all-important for us to place the pa- tient in a hygienic and climatic position, which will, especially duiing the time occupied by the process of elimination of the tubercles, remove him as much as possible from the chances of those inflammatory com- plications to which he is so liable. The respiratory organs in all consumptives have an extraordinary sus- ceptibility to these troubles, whicli is easily explainable from the fact of their being already the seat of a pathological action, of which the prin- cipal feature is a hyperemia of all the tissues about the tubercular de- posit. Moreover, the patient is prostrated by his sickness, and conse- quently much less in a condition to resist meteoric influences. This specific treatment, by increasing materially the nervous power, places the patient under the most favorable conditions to meet the sud- den changes of temperature ; but on the other hand, as it also increases the quantity of the blood, it likewise augments the relative state of plethora, and renders him more liable to a development of inflamma- tion. In warm climates, where all inflammations of the respiratory organs are infinitely less severe, or frequent, than in Europe, the most simple precautions are sufficient, and the treatment can be employed at its maximum. In cold countries, especially during the winter, it is highly important not to go beyond the point of sanguification which, if I may so express myself, comports with the condition of the patient. Health consists, in reality, in a perfect equilibrium of all the func- tions : nevertheless, for a patient, a part of whose respiratory apparatus does not work, or in whom there is at the same time going on a process for the expulsion from the economy of some injurious element, there is a certain abnormal, or, as medical men call it, unstable equilibrium, whicli it is necessary to maintain. The art of recognizing, and treat- in every patient, this unstable equilibrium, constitutes medical lUGf skill. I therefore particularly recommend to all practitioners the necessity of watching that their patients do not abuse the state of improvement whicli this treatment superinduces, often in cases of the gravest charac- ter It is difficult to persuade a patient who is no longer troubled with nicr'ht sweats; who has no fever; who has regained his appetite and strength; who has only a slight cough and but little expectoration, lhat It is all-important for him to take the greatest precautions to 76 ADDITIONS TO guard his improved wealth. This is the more especially requisite when his social position, and the necessity for his earning his livelihood, im- pose additional reasons for giving heed to your advice. In one half the cases given in the third series, the fatal termination was at least hast- ened by the setting in of some inflammation, which seized the little pul- monary tissue still capable of performing its functions, in consequence of some act of imprudence in diet, or exposure to atmospheric change. This treatment of tuberculosis does not pretend to overturn all the theories hitherto furnished by pathology; but, on the contrary, it ex- plains and confirms them. These preparations have, and can only have, that conditional degree of power which all medical and human means possess. To demand more, would be to ask what is impossible and ridiculous. Whenever the truth of this hypothesis is settled ; when general ex- perience has demonstrated the value of the facts I have announced, every one will hasten to employ these medicines/rom the commencement of the disease, and even as a prophylactic in doubtful cases. It is in this way alone that we shall derive all the benefits they afford, and shall finally succeed in abolishing the greatest evil which afflicts hu- manity. But if this be so, some will say: if these preparations can only cause the absorption of recent tubercles ; if the tubercular deposits, when they have reached a certain age, can only disappear by a process of elimina- tion, your treatment can do no more than we already know how to perform. This objection is a reasonable one; yet, in truth, it ought not to be regarded as an objection, but rather as a confirmation of my theory; for it was the knowledge of this fact which induced me to en- gage in these researches and experiments. The pathological fact, and the treatment which I have discovered, cannot, it is true, do more than is done every day, and has been done for a long time ; but they effect it with this difference: that all the cases capable of being relieved, that is, those where the organic lesions have not passed a certain stage, will be cured by an agent, and in a manner, which we actually know about; while to-day, by all the means known to us, we can but rarely—very rarely, effect a cure ; and then only, as it were, blindly, and almost by accident. From this uncertainty in regard to treatment, arise the two opinions which exist among medical men as to the cure of phthisis. According to the pessimists* no one can cure consumption ; according to the op- * Pessimist: one who complains of every thing as being for the worst; as opposed to the Optimist, who holds the opinion that all events are ordered for the best. THE PRECEDING REPORT. 77 timists, it is sometimes cured : there are those, even, who say always. For my part, I must say that I agree with neither the one tior the other. Take a consumptive person in whom the disease is just commencing, and which presents only sufficient symptoms for us to form the diag- nosis ; the optimist will say, with reason, that by ordering an appropriate regimen, some well-known remedies, and above all, those hygienic rules which are in reality equivalent to a complete change in his manner of living, and the patient will have a good chance of recovery. On the other hand, the pessimist, with nearly as much reason, will declare him doomed to an almost certain death. One or the other will be right or wrong according to the period which he appoints for the realization of his prognosis. It is true, that the progress of the disease can often be suspended, and that in very rare cases the symptoms may disappear, especially if the patient is wealthy enough to avoid all the causes which reduce his vitality ; but in the large majority of cases, the disease will not retro- grade, and sooner or later the patient 'will succumb to the tubercular affection. The prognosis of phthisis has two characteristics, depending upon the two points of view from which it is formed. One is decided by the extent of the existing tubercularization, and the rapidity of its progress. This is the present prognosis. It is often favorable. It can exist but a short time, only at the outset of the disease, when we can lay aside all consideration of the diathesis. The other is the final prognosis. It is not only formed independently of all local lesions, but is based upon the nature of the disease itself; upon the almost absolute certaiuty that the first crop of tubercles will be followed by a second; that by a third, and so on, until the death of the patient ensues. In the present condi- tion of the healing art, and apart from my own theory, this prognosis should be a verdict of death in twenty-four out of every twenty-five cases. It is thus seen that the two opposing opinions in regard to the oura- bility of phthisis, are equally true in some respects, and that both of them are founded upon an incomplete consideration of the question. The objection against the specific powers of the hypophosphites, based upon the fact that phthisis is cured sometimes by other remedies, and sometimes without any medication whatever, is therefore of no value. The objection can be raised equally as well agaiust any princi- ple of therapeutics however well established it may be. The same argument may be advanced with equal force in regard to 78 ADDITIONS TO many other maladies. Patients suffering from intermittent fever some- times recover without the use of quinine ; those from chlorosis without iron ; so also may the consumptive without the hypophosphites. This however does not prevent quinine from being a specific against mala- rious diseases; nor the iron against anaemia; neither will it any more prevent the hypophosphites from being recognized as a specific against tuberculosis. The spontaneous cure of consumption is even a proof in favor of my hypothesis, since it finds in this fact a natural means of explanation. This theory, unless I am much mistaken, will account for the influence on phthisis of all the curative means of which experience has hitherto recognized the value ; above all, of the various hygienic agents, such as cod liver oil, arsenic, and antimony. I shall not enter upon an examina- tion of these points for the reasons already given, but shall take them up and consider them in the chapters entitled History, and Deduc- tions. The preceding report having been intended for reading before the Academy, it was necessary to compress it as much as possible; for which reason I only hinted at certain points to which I wish now more especially to call the attention of practitioners. I have employed the hypophosphites of lime and soda in the treat ment of phthisis because it has always seemed to me that the use of the salts with the bases of potassa or ammonia, was followed by an aug- mentation of the expectoration, and the signs evidencing a softening of the tubercular deposit: a fact which accords very well with those al ready known concerning the action of these two bases. In certain cases, however, the employment of these two last salts has seemed to me indicated; when, for instance, I wished to act upon old inflammations, whether in non-tubercular subjects, or in those where the phthisis should rather be looked upon as a complication than as the principal disease. » On a previous page I have mentioned a case of asthma, depending upon a chronic bronchitis, in which the hypophosphite of potassa was employed with success. In case No. 11 it was also given with advan- tage. The hypophosphite of ammonia has appeared to me to have an an- alogous action to that of potassa; but in addition, it seems to exercise a special influence upon the hepatic secretion. One or two trials made with the base magnesia did not furnish such sufficiently decided results, that I think it worth more than a mere men- tion. Its effects seemed very similar to those of potassa and ammonia. THE PRECEDING REPORT. 79 More extended observation will, without doubt, establish what is the difference between the modes of action of these various salts, and en- able us to determine to which of them we should decidedly give the preference. It will suffice for the present, I think, to use the salts of lime and soda. Generally I employ the first in preference to the latter, especially at the commencement of treatment. Later, when there are evidences of plethora, I replace it by the soda, which seems to me to have a less energetic action. The hypophosphite of lime appears also to have an especial influence over the expectoration, which it sometimes reduces too rapidly, as by it the cough is increased. When this is the case, it is necessary to change it for the salt of soda. Experience alone can decide whether the hypophosphites are the most efficacious remedies in existence, or whether they can be replaced by other combinations; for instance, by the organic alkalies, with the base phosphorus. These were the preparations I first thought of em- ploying. Before using them, however, it will be absolutely necessary to try their effects upon animals in order to discover whether they produce in the system phosphorized hydrogen, the action of which appears to be essentially deleterious. There is also an opportunity to investigate whether hypophosphorous acid alone wotild not, under certain circum- stances, produce a different therapeutic effect from these salts. The action of the hypophosphites, with iron for the base, should be experimented with, only with great care. In several cases where I have prescribed iron, in connection with the hypophosphites, its administra- tion has seemed to me to occasion, or at least to be followed, by hemor- rhages, or inflammation. The union of iron with hypophosphorous acid appears to be almost useless against the tubercular diathesis, for the reason that the amount of iron sufficient to saturate the ordinary dose of the acid, would probably be dangerous, and certainly could not be repeated as often as necessary. The same remark applies to all other bases whicli require to be ad- ministered in small doses. There is one, however, a medicine which can be given in quite large doses, which will present, I think, peculiar advantages by its union with hypophosphorous acid, namely, quinine. Rousseau Brothers, manufacturers of chemical agents, were kind enough, at my request, to prepare a specimen of this hypophosphite of quinine. It is an amorphous salt, of a yellow orange color, having the consist- ence 'of soft wax, burning readily, like resin, on exposure to heat. It is very soluble in water, and has the bitter taste of all the salts of quinine. There are two diseases for which I think it can be used with great ad- 80 ADDITIONS TO vantage—yellow fever and the cholera. I shall show elsewhere the reasons upon which I base this assumption. The hypophosphites seem to unite all the properties (wjth the excep- tion, perhaps, of the aphrodisiac), and none of the inconveniences, which are attributed to phosphorus by the old authors, and can be employed in all cases where that substance has seemed to possess advantages. My object, however, being simply the discovery of a remedy against tuberculosis, all the other theories which arose from my investigations received but subsidiary attention. I examined them only so far a I sup- posed they might favor a solution of my own problem. The question which I now submit for examination, is, whether the hypophosphites of lime and soda are specific remedies against tubercu- lar diseases ; especially, whether they are prophylactic. Whatever may be the result of the examination, I think that the therapeutic formula I have given, will be found necessary to explain the action of every ne\* remedy proposed as a specific against this disease, viz., that it must bi a combination of phosphorus in a state at once both assimilable and ox ydable. Hypophosphorous acid, and the hypophosphites, having remained, up to this time, unused in medicine, have been little studied, or manu- factured, even by chemists. The principal investigations are those of M. H. Rose, and Professor Wurtz, to be found in volumes 38, and 7 and 16, of the 3d series of the Annates de Chimie et de Physique. It :s not very astonishing, therefore, that the hypophosphites which are now ordinarily sold, and which have been prepared in consequence of the great demand created since the presentation of my report, should not always present that purity indispensable to success in the TREATMENT. According to the method now adopted for its preparation, the hypo- phosphite of lime can be mixed with the hypophosphites of magnesia or potassa. The salt of soda can contain the carbonate or sulphate of soda, or even the hypophosphite of baryta. Loth of them can be adulterated with lime in a free state, or with the carbonate or phosphate of lime. I have seen samples composed almost entirely of these two latter salts. It is easy to understand that their presence, even in very small quantities is very far from being an affair of no consequence. The salts of potassa and magnesia, and above all the uncombined lime and the salt of baryta, can be especially injurious. I wish to call the attention of physicians, especially of apothecaries, to this point, for the special reason that since I have made my treatment public, I have noticed in patients who have THE PRECEDING REPORT. 81 purchased the remedy from various laboratories in the city, effects dif- fering from those produced by the hypophosphites which I have myself prepared. I have also had sent to me from England some specimens of the salts of lime and soda which were excessively impure. I wish, therefore, that all practitioners, who obtain only negative re- sults, or who notice different phenomena from those I have stated :— for instance, if there is increase of expectoration, or a sudden onset of diarrhoea, when none existed before, would carefully examine whether the medicine is pure. The mode of administration is very,simple, as the medicine has very little taste, it being not much unlike common salt. Twenty grains of it dissolved in half a tumbler of water, or milk, can be taken without being noticed by the patient. I have already stated, in another place, the doses which I have found to be the most advantageous. In each case, however, the physician must be guided by the progress the disease is making: by the consti- tution of his patient; but, above all, by the change occasioned by the treatment in the general symptoms,—such as the weakness, sweating, loss of flesh and appetite, fever, etc. The best rule I can give is this: in every case where the local lesion is not very severe, increase the dose at the rate of two grains each day, until the general constitutional symptoms bave disappeared ; then keep at this amount until the first signs of plethora manifest themselves. For a description of which see cases 8, 9, and 10. The best dose to obtain this result, in adults, is from fifteen to twenty grains. In cases of greater severity it is sometimes impossible to employ so active a treatment, in order not to predispose the patient to inflamma- tory, complications, especially if he is treated during the winter, and is obliged to expose himself to atmospheric changes. It should never for a moment be forgotten, that any exposure, however slight,—the simplest chiH—evcn a draught of air, may suddenly induce a fatal result, at the very time when there was every reason to hope for a favorable termina- tion. This point cannot be too strongly insisted upon. It is indispensable, in every case apparently cured, to continue the treatment for some time after the disappearance of all the constitutional and local symptoms:—for a premature suspension is almost uni- formly FOLLOWED BY THE RETURN OF ALL THE SYMPTOMS IN A SHORT TIME. The leno-th of time during which the remedy should be continued, will vary for each case; but, in general—all other things being equal— 6 82 HISTORY. it will he in direct ratio to the age of the affection ; and to the amount of nervous impressibility which characterizes the tubercular predisposi tion. [See chapter entitled " Deductions."'] HISTORY. I have given in my Report the reasons why I was induced to con- sider the tubercular diathesis as a modification of the normal phos- phorized element in the system ; and have also stated why I chose the preparations containing hypophosphorous acid, as the agents to be em- ployed against it. I have also mentioned the works upon the subject which I knew existed anterior to my experiments, and which served to facilitate and shorten my labors, or change their direction. My object in giving these details was to make known the process of reasoning by which I arrived at my conclusions, attaching all the more importance to them, because it is by the means used that science is dis- tinguished from art. I am willing to avow, without any affectation of false modesty, that I am not indifferent to the idea that, if the results I have given are confirmed by experience, Medicine, properly so called, (by which I mean the art of healing,) will take rank among the induc- tive sciences. When I commenced my experiments with the hypophosphites, I sup- posed I was the first person who had examined their action upon the animal economy. But when it is considered that the medical profession is scattered over the whole globe, it would be difficult, not to say impos- sible, to keep any of its members cognizant of all scientific investiga- tions. Especially is this the case when they have, for a long time, been removed from contact with each other. Since my return to Europe, I have occupied myself with looking up and examining all the works bearing upon the subject written anterior to my investigations. I will mention what I have discovered,—first, in order to pay the tribute of respect to truth, and the efforts of those who have preceded me;—sec- ondly, in order to show how little foundation there is for the almost universal opinion, that experiment is the only source of medical pro- gress. Isolated facts no nnre constitute a science, than a pile of stones constitute a building. I will give the medical history of phosphorus and phosphoric acid, HISTORY. 83 in so far as they relate to the tubercular diathesis, and after that, the facts I have discovered relative to the three acids in an inferior degree of oxydation. I stated in my report, on page 13, that as early as the year 1802 phosphorus was employed with success in two cases of tubercular meningitis by Coindet, which fact may be found on page 211 of his work, uMemoire sur V Hydrencephale," published in 1817. The av- erage dose which he gave was three grains dissolved in oil, in the twenty-four hours. His remarks upon the subject were concluded in the following words: " This remedy demands too much attention in its preparation and administration ever to become of daily use in medicine. That well-known passage of Boerhaave seems to apply particularly to it: *■ At prudenter a prudente medico, si methodum nescis, abstine.' " Barthez and Rilliet, in their work, Maladies des Enfants, (vol. iii., p. 526,) state that they have employed this substance at the maximum dose of forty grains, without obtaining any, even temporary effect; but they give no details on the subject. I have given on page 14 the ex- planation of this apparent contradiction. But the most remarkable suggestion was made by Dr. Theophilus Thompson of London, physician to the Brompton Hospital for Con- sumption : an establishment for the exclusive treatment of phthisis. On page 123 of his work, Clinical Lectures on Pulmonary Consumption, (American edition,) Dr. Thompson suggests that phosphorus might be useful in the treatment of consumption, because, according to Dr. Rees, (to whom I alluded on page 12,) that element plays an important part in sanguification. The idea of Rees, according to a paper published in No. 219 of Brewster's Philosophical Magazine, entitled: On a Func- tion of the red Corpuscles of the Blood, and on the Process of Arteri- alization, is as follows : The phosphorus exists in the globules of the venous blood, combined with fatty matter aud hematosine. It is oxydized in the pulmonary vesicles by contact with the air, and transformed into phosphoric acid ; which, in its turn, combines with the salts of soda in the serum, and thus produces the change of color which characterizes arterial blood. Dr. Thompson remarks, in addition, that, as cod liver oil contains phosphorus, it perhaps owes its efficacy to that element. He even goes so far as to look for an explanation of its method of action, in the sug- gestion, that as this element has a great affinity for oxygen, it may serve to diminish the action of this gas upon the lungs, and thus pre- rent the formation of pus and a tubercular deposit. He cites several 84 HISTORY. cases in which he employed a solution of phosphorus in oil, and from which he obtain* d satisfactory results ; but as, in the majority of such cases, the alleviation was sustained but a short time, he seems not. long afterwards to have abandoned his experiments. Dr. Thompson, as was the case with Barthez and Rilliet, was able to employ the phosphorus only in small doses ; less than a grain each day. This, as I have before stated, furnishes the reason for his ill success. His work, printed in 1854, is a reproduction of the clinical lecture* which were published in 1851, in Vol. II. of the Lancet; but when I commenced my investigations I had not seen it. It is only necessary to read this book in order to be convinced that the author is a shrewd and conscientious observer, and one who possesses a logical, well-disci- plined mind. Yet how strangely it happened, that although he held in his hand the solution of the problem—although he was fully aware of the remarkable work of Owen Rees, he did not advance one step towards discovering under what form phosphorus entered the system, and what was its method of action when there. It is true, that the idea of Rees was not generally adopted ; that even to-day it is rejected by the most distinguished physiologists and chemists, among whom is Professor Milne Edwards, who states on pages 479 and 480, Vol. I., of his work, Lecons de Physiologie Comparee : "These experiments are not given with sufficient numerical detail to inspire confidence in the results which the author has deduced." But the idea of Rees appeared to the mind of Dr. Thompson suffi- ciently well based, for he has admitted it: besides, he could have—he even should have—given it the value of an hypothesis, and-used it as the initial point for his own experiments. As in science consecutive truths have only a relative value, depend, ing upon the stand-point from which they are examined, so every hy- pothesis is legitimate from the moment it points to some practical conclusion. But to-day hypotheses and theory in medicine—but more especially in therapeutics—are tantamount in the minds of many to dreaming, and every thing chimerical Among others who have treated of the subject of phosphorus Doctor Turck, in an article entitled Du phosphore et de quelques phosphates aux points de vue physiologique et therapeutique, published in the num ber for January, 1857, of the Revue de Therapeutique Medico-Chirur- gicale, after mentioning the various theories of authors upon the action of phosphorus, expresses again the opinion that this substance would prove useful in phthisis, as well as in many other diseases. In the ex- HISTORY. 85 planation which he gives of its probable action, he agrees with Rees; whose work he docs not seem to have been acquainted with ; and also with certain ideas of my own, which I have stated more fully under the chapter headed " Deductions:' Ihese are all the facts which I have been able to collect upon the employment of phosphorus in phthisis. It is beyond the province of my subject to mention here the other therapeutical uses of this sub- stance. In 18 19, Doctor Beneke, in a work entitled Der phosphorsaure Kalk m physiologischer und therapeutischer Beziehung, published at Gotten- gen, starting with the supposed action of the phosphate of lime in the formation of the elementary tissues, has endeavored to find, in the amount of this substance, the cause of tuberculosis. This work was known to me at my first trials, from a review or notice of it which ap- peared in No. 24 of Braithwaitt1 s Retrospect, and I have already ac- knowledged the information I derived from this source. Since the presentation of my report to the Academy, Doctor Larcher has advanced a claim to priority in the suggestion of this idea, having announced, as he declares, as early as 1824, that the tubercular diathe- sis depended upon a diminution of the calcareous elements of the bones. He does not, however, state in what publication this idea of his can be found. Other practitioners have, no doubt, employed this substance ; but as it seems to me that their experiments have no relations to the special treatment of tuberculosis, I think there is no ground for discussion upon the subject. I will now pass to the consideration of those combinations of phos- phorus which contain less amounts of oxygen. The action of phosphorous acid upon animal life has been examined by a large number of experimenters, but wholly in a toxicological point of view. The first, in point of time, was Hunefeld, who, in the September and October numbers of Horn's Archiv fir Medicinische Erfahrung, for 1830, on page 861, has given the result of two experiments upon a rabbit. The animal was first given twenty-five grains of hydrated phos- phorous acid, without any appreciable effects. A dose of eighty grains of the same acid, given twenty-four hours later, caused death in about twelve hours. In 1844, Weigel and Krug, wishing to discover the difference be- tween the relative actions of pure and impure phosphoric acid, gave a rabbit forty-five drops of phosphoric acid, containing a tenth of phospho* 86 HISTORY. rous acid, in three d>ses, with intervals of half an aour between each. The animal died an hour and a half after the last dose. A second rab- bit, to whom he administered thirty drops of the same acid, died in about four hours. (Casper's Medicinische Wochenschrift, 1844, p. 455.) • Finally, Woehler and Frenichs, by the aid of this substance, killed '" several animals. A pigeon, to whom they administered a solution con- taining ten grains of anhydrous phosphorous acid, lived an hour; and a cat, to whom was given a solution representing twenty grains of the acid, died in thirty-six hours. These results are contradicted by those obtained, in 1854, by Doctor Basilius Sawitsch, as given in his inaugural dissertation, published at Dorpat, and entitled, Meletemata de acidi arsenicosi efficacia. The object of his experiments was to determine the difference between the action of the combinations of arsenic and those of phosphorus. He injected into the stomach of a cat twenty grains of phosphorous acid dissolved in a little less than two drachms of water, which represented about ten grains of the anhydrous acid. The animal vomited several times, but other- wise seemed to suffer no inconvenience. The next afternoon he gave the same animal double the quantity of the same solution of the acid without producing any other effects than slight vomiting, and foaming at the mouth. On the 3d of May, 1854, Sawitsch himself took forty-four grains of phosphorous acid (equivalent to twenty-two and one-fifth grains of an- hydrous acid), dissolved in sweetened water, in two doses, with an in- terval of a quarter of an hour. On the 5th of May he took, in the same manner, fifty-four and a half grains (equal to thirty and seven-tenths grains of anhydrous acid). In each case he could discover no change whatever in his health. The same experimenter tried, also, upon cats, the phosphite of soda. Professor Buckheim, of the University of Dor- pat, under whose suggestion and direction the scholars of that univer- sity have, since 1848, undertaken and published a series of most remarkable original researches upon all medical substances, has also tried upon himself the action of the phosphite of soda. I regret, very much, not haying been able to procure the thesis of Dr. Sawitsch, in order to examine the details of his experiments. The re- marks which I have made upon it are founded upon extracts from a work of Bernhardt Schuchardt of Gottingen, which appeared in 1855, in Henle and Pfeufer's Zeitschrift far Ratinelle Medicin, (VII Band i heft. p. 235,) under the title of Empoisonnement aigu par \e phosphore. Dr. Schuchardt, himself, made experiments upon rabbits with the HISTORY 87 phosphorous acid in doses of from ten to twelve grains, which gave the same results as those of Sawitsch and Buckheim. lhese are all the toxicological facts I have been able to discover con- cerning phosphorous acid. The only observation which I know of rela- tive to its therapeutic effects, is one recently published in the Lancet for July 18th, 1857, (three days before I presented my Report to the Academy), which we owe to Dr. Rowbottom, of London. It gives the treatment of a case of asthma by the use of this substance at the amount of eighty grains daily. The author, however, not having stated the degree of concentration of the acid, the real proportion of anhydrous acid taken joy the patient cannot be known. On pages 288 and 289, volume V., of the Dictionnaire deMatere Med- icale of Melat and Delens, it is stated that the action on the system of the different preparations of phosphorus should be attributed to the hypophosphoric acid. This is the same result which I have reached by another route. [See page 13 and 14.] In the Pharmacopoeia Universalis, of Geiger and Mohr, page 24, vol." II., the directions are given for the preparation of this acid, which, in their opinion, is useful in malignant fevers. The facts relative to hypophosphorous acid and its salt, are even less numerous, They consist of four experiments only, made by Sawitsch, and giver, also in his thesis. The first two were made upon a cat, to whom he gave at the first trial twenty grains of the acid (equivalent to two and a half grains of the anhydrous acid), and on the second double the quantity. A slight vomiting was the only effect experienced by the animal; and this was probably due rather to its action on the sesophagus than to the acid. On the 7th of May, 1854, Sawitsch himself took a solution contain- ino- ei«ht and one-tenth grains of the anhydrous acid, and two days later, another containing twelve and two-tenths grains,—without any perceptible result. Dr. Buckheim also tried, upon his own person, the effects of the hypophosphite of soda;—but I have no information in re- gard to the result of his experiments. It appears, however, by a passage in his work, (Lehrbuch der Arznei- mittellehre, page 320, Leipzig, 1854,) that he had conceived the iden- tity, as regards physiological action, between hypophosphorous, phospho- rous and phosphoric acids. The following is the passage referred to: " It is evident that it is not by parting with its oxygen, that the phosphoric acid acts upon the economy, for it does not produce the same functional modifications is phosphorus. It has been generally believed that the phosphorus transformed 88 HISTORY. itself into one of ts combinations with a less degree of oxygen: fcr example, into hypophosphorous, or phosphorous acids; and that it was under this form that it produced its effects. "Woehler and Frenichs, basing their opinion as much upon their own experiments as upon those of Weigel and Krug, have concluded that phosphorous acid has a poisonous effect analogous to arsenic. The investigations, however, of Sawitsch, show that phosphorous acid, as well as hypophosphorous acid, in their pure state, act upon the economy exactly like phosphoric acid; and become injurious only under the same circumstances as that acid. The same holds good, also, with the salts of soda. Taken even in very large doses, they occasion no appreciable disturbances in the system. It is fair, therefore, to conclude from this, that it is highly probable the effect of phosphorous upon the system depends upon its action as a simple body, and not to its transformation into one of its oxydized combinations." It would be premature to decide in a positive manner, at this time, upon the question as to what particular form phosphorus assumes in order to act upon the system; but Dr. Buckheim seems to me to have deceived himself, by concluding that the sub-acid forms of phosphorus have the same action upon the system as phosphoric acid, because, ac- cording to his reasoning, they are not poisonous at the doses employed by M. Sawitsch. If, instead of confining himself to one or two trials, ■ this investigator had employed the different combinations successively,' he would, I think, have reached a different result, and would have' formed the conclusion that the byphosphosphites were especial agents destined to supply one of the greatest wants in medicine. ^ In closing this cursory glance at the history of this medicine, I will give the only therapeutic,—or rather pharmseological fact,—which I have been able to discover concerning hypophosphorous acid and its salts. It must be taken for just what it is worth. On page 290, vol. II. of the Pharmacopee Universale, of Jourdan 2d edition, is the following formula: HYPOPHOSPHITE OF POTASSA. Tincture of salt of tartar. Granulated phosphorus, q. s. Saturate in the cold, decant and preserve. Jourdan places this preparation among the combinations of potassa He gives neither the doses, the properties, nor the uses ; and states the source of the formula to be the Pharmacopee Usuelle of Van Mons published at Louvain in 1821 and 1822. It is to be found on pa^ 562, vol. I. of that work, under the title of Hydrophosphure de potassa hqmde; and also on page 437, of vol. II., under that of Teinture phos- phoree de set de tartre. Neither the properties, doses, nor origin of this HISTORY. 89 formula are given oy Van Mons. It is possible that it may never have been used, and that it is merely an illustration of those numerous new preparations which are scattered through his work, and which are imagined rather in view of a chemical or pharmacological, than a thera- peutical utility. What makes me incline to this opinion, is, that in ad- dition to the hypophosphite of potassa, this preparation ought to con- tain, if we can judge from its strong phosphorized odor, some one of the combinations with hydrogen. It seems to me, therefore, probable that its use would present the same dangers as all the other preparations of phosphorus prepared in a druggist's store. It was my intention to try it upon animals; but up to this moment I have had neither the time nor opportunities. It will be seen by the preceding pages, that if medicine—if thera- peutics, especially—consists, as many persons pretend, merely of facts; if the verifying and registry of phenomena is the sole duty of a physi- cian ; if by them alone new truths can be discovered; then there is enough, and more than enough, material to have reached long ago the result which I have attained. If, up to this time, this result has remained undiscovered, it was neither owing to want of skill, nor of enteq>rise on the part of experimenters; but solely, I think, because the method which they employed was incomplete and erro- neous. It would be the height of ignorance, and what is worse, ingratitude, for a graduate of the Medical School of Paris to deny the impulse which the school of'anatomy has exerted upon the art of healing. Es- tablished by Bichat, it has given a vitality to surgery which animates it still. In medicine, it has given us Laonnec and other learned men, who alone by their works—happily for us of the present day—have im- mortalized the epoch : whose profound researches in pathological ana- tomy and semeiology have placed diagnosis upon an immovable basis. Unfortunately, by continued identification with its work, this school has finished by seeing nothing beyond it. For it, the study of disease has ceased to be an examination of an abnormal condition, which is modifying the principles of life, and which, when it has passed certain limits, breaks down existence itself; but is simply a means of verifying the effects resulting from it—effects beyond which this school never seeks to pass. ' .-,.••,*• Medicine is not for it the art of preventing, of relieving, and of curing disease ; but only that of determining,—of foreseeing, during the life,— q.e lesions which will bo found, subsequently, upon the dead body. Foi 90 HISTORY. it, in a word, the study of organic disorders, which ought novel to be but a means, has finished by absorbing everything, and by becoming the sole object. It results from this, that the process especially appropriated to this kind of research, namely, that of observation, or verification—a process by itself essentially secondary and barren, has been the only one em- ployed, the only one extolled. On the other hand, the process of in- vention, or induction—the only really fruitful one, the one alone which is progressive—has been neglected, or even formally proscribed. Ap- plying to the living, acting, suffering, human mechanism the means which it has employed in studying the dead body, it has ended, in path- ology, by a localization of diseases and a description of their results ; in therapeutics, it has led to skepticism and folly. What especially proves this, is the fact that the sole real discoveries made during its reign—vaccination, the use of iodine, and anaethesia—were made out- side of its influence ; and are so far from being consequences of its suggestions, that it can neither explain nor understand them. It is simply because it has been sought to adopt in therapeutics the processes employed in anatomy, and to restrain every thing within the limits of observation—or, as it is facetiously called, simple and practical observation, (without doubt because it leads to nothing)—that the art of healing, to-day, is in such a state of confusion and inferiority, compared with the other sciences. It was a grand mistake to adopt completely into one range of knowledge the technical processes proper only to another ; for if the means which are used in the* different sciences are identical as regards basis, they are modified in each according to a cer- tain end to be attained. There is about the same difference betweeu the processes of patho- logical anatomy and those of therapeutics, as there is between those of mineralogy and those of chemistry. One of these sciences employs only examination and description; the other can only advance by ex- perimentation and induction : for whoever employs one must necessarily use the other. It has not been by waiting humbly and silently that Pathology and Chemistry have spoken their last words; that Therapeutics has fulfilled the task which has devolved upon it. These two sciences will only fur- nish it the materials, the germs, from which it must, itself, produce def- inite results. Already, on every side, are to be seen evidences that some bold spirits have appreciated this trulh ; that some few, even still less in numbers, have always recognized it. DEDUCTIONS. , 91 Let us hope, therefore, that after we have had a School of Anatomy and of expectant medicine, the day will come when we can raise, not upon the ruins, but upon the foundations, a school of Therapeutics and of Specific Remedies. DEDUCTIONS. The character or office of every true scientific principle is, to agree with facts already well established ; to manifest, clearly, its own reasona- bleness and aims; and finally, to lead to such conclusions as will enable us to examine many new, and perhaps unexpected, correlative subjects. I propose to present, in this chapter, some few of the deductions which I think legitimately flow from my own investigations; the correctness of which it is my intention satisfactorily to establish. The circumstances previously referred to having heretofore prevented it, I must even now content myself with barely mentioning the conclusions I have arrived at, hoping at no distant day, that I shall be able to examine the subject more fully, especially in a chemical point of view. Some of these deductions, in my estimation, are novel; and most of them are confirmatory of the facts heretofore stated by other observers. In physiology, it will always remain an established truth that the inorganic elements of all fluids constitute an essential part of them. The nature and proportions of these elements influence, in the most impor- tant degree, the constitution and function of all organic matter. It would be a good comparison to say, that they act, iu relation to liquids, an analogous part to that of the osseous system in its relation to all the other solids of the body ; that they are, so to speak, the skeleton of the fluids. It must be admitted that phosphorus is found in the system in a combustible form. It is probable that it is in this form that it exists in the blood globules, and that its oxydation constitutes one of the essential phenomena of sanguification. It also exists in nervous matter; and certain facts would seem to indicate that every act of innervation has, as a condition or a consequence, its oxydation. There is an opportunity to examine whether this element is inti oduced directly into the economy, or whether it is not the result of- a chemical reduction. If the latter, the seat and conditions of this action must be sought for. In pathology, it will be shown that many diseases—above all, many 92 , DEDUCTIONS. diatheses—have, as an essential condition, the modification, in some way, of the fluids of the body anterior to the anatomical lesions which are peculiar to them ; that these lesions, once established, have a prog- ress pathognomonic to them; and that, consequently, every diathesis offers a double problem : one including the phenomena, symptoms and progress of the diathesis itself; the other, the phenomena, symptoms and progress of the lesions which result from it. In all chronic diseases, it is probable that the primitive alteration consists, above all, in a modification of the proportions of the inorganic constituents of the fluids of the body. The etiology of tuberculosis can be summed up in the single word, prostration, chronic or repeated, which embraces all the conditions in- dicated as the starting-point of this disease. The hereditary predisposition, which is one of the prominent charac- teristics of this affection, finds, by this hypothesis, a satisfactory explan- ation. This predisposition depends upon that singular impressibilitv which exists in all consumptive subjects; who are, if such an expression can be used, machines employing large amounts of phosphorus in com- bustion. If it should finally be demonstrated that not only the phosphorus is oxydized, but also deoxydized in the system, there will be an opportu- nity to discover how prominent a place in the production of the disease is held by whatever can produce any disturbance in this process of re- duction of the phosphorized element. Perhaps, on the ground of simple conjecture, we have a right to hazard the opinion that eventually the different varieties of disease can be explained in this way. In therapeutics, the most important problem to solve, in the present condition of science, is to conclusively determine the influence exercised over the different morbid states, either by the augmentation or diminu- tion of each of the approximate principles of the human economy, or by changes in the properties of the inorganic elements of the blood. Chemistry will furnish, by analysis, important facts upon this point, if not direct conclusions. In default of this, however, it will be often possible to reach a solution of the problem by the single route of thera- peutic experimentation, starting from the facts already known. The physiological and therapeutical action of the majority of medici- nal agents, when that action is neither mechanical nor chemical, could be explained, in some degree, by a species of substitution, analogous to the law of substitution in chemistry; each of the constituents of the system being replaced by an homologous substance. In the same DEDUCTIONS. 93 manner, therefore, that there are homologous substances in chemistry, there would be homologues in therapeutics. It is probably in some such theory that an explanation of the incontestible influence of arsenic and antimony, in consumption, may be looked for. These substances are, in chemistry, the homologues of phosphorus. The therapeutical effects of iodine and bromine, are also the chemical homologues of chlorine and fluorine. In future, the rational treatment of a diathesis will presuppose a cog- nizance of the morbid condition which is its point of departure, as well as of the proper means to cause its disappearance : and it will be well understood that the specific treatment of the diathesis will not influ- ence, except indirectly, the physical lesions already established; but that their ulterior evolution will depend upon the action consequent Upon CHANGES IN THOSE CONDITIONS OF THE SYSTEM, WHICH GAVE BIRTH TO THE DISEASE. END OF THE TREATISE. IMPORTANT CONSIDERATIONS. Consumption is well known to be, in popular phrase, "a flatter'ng disease;" aid cot until the physical signs are manifested in wasting, debility, cough, hectic, sweats, &c, does the patient or his friends awake to a sense of danger. None seem willing to admit that the malady which is slowly, silently, insidiously sapping the foundations of life, can be that dreaded, fatal scourge; and so, ignorant of their true condition, they procrastinate, waste away, and in a brief period, fill premature graves. Whatever may have been the ill-success of former methods of treatment in pulmonary affections, by which Consumption came to be regarded as incurable, it is now made certain that the Cause and the Specific Remedy have been made known to the world through the patient researches of Dr. Churchill. If, therefore, sufferers refuse to avail themselves of the means which science now offers for the Prevention and Cure of this greatest scourge of the hu- man race, they become the victims of their own neglect and unbelief. In no malady, so surely as in Consumption, is delay fatal to the patient. An early resort to the use of the Hypophosphites will, by changing the diathesis, prevent a development op pulmonary disease in those predis- posed to it, and produce a speedy cure in the incipient stage; while, in every case, however far advanced, relief to some degree is certain, and in a large majority of cases, cure is the result of the treatment. In all Nervous Diseases, the Hypophosphites are equally the Specific Rem- edy. From their action in strengthening the nutritive function, and from "their power of relieving nervous prostration," no one suffering from dys- pepsia or debility should hesitate a moment in resorting to their use. The Summer is the most propitious time for the employment of the treat- ment at its maximum: 1st. Because "the patient should be placed under the most favorable atmospheric influences during the elimination of the tubercles." 2. Because the patient's predisposition to an inflammatory state is less likely to be aggravated by sudden changes. And 3. Because the time of recovery is related to the progress of sanguification, and this can be carried to the proper point with more safety than during the rigor and change of winter. APPENDIX. MEMORIAL Concerning the Treatment of Pulmonary Phthisis, and the physiological and therapeutical action of the Hypophosphites, by J. Frakcis Churchill : presented to the Imperial Academy of Sciences, May, 1858. (Extract by the author) I have the honor to submit for the consideration of the " Academy" several memoranda, giving the results of the treatment of forty-one cases of Phthisis, by the Hypophosphites, since the publication of my work, a copy of which I now lay before it. These results fully confirm all that I have heretofore written concerning the efficacy of these preparations in pulmonary phthisis: and it would be easy for me to show that the ill success of other practitioners, in such cases, was owing either, 1st, To the lesions pre-existing to the treatment which were of themselves sufficient to cause death; 2d, To the existence of complications; or, 3d, To the Impurity of the salts employed, and which were administered without regard to the conditions I have laid down, and consider essential. I have no hesitation in saying that, when these conditions are complied with, ttie cure of Consumption in the second and third stages, (at a period, therefore, when there can bo no doubt as to the nature of the disease,) is the rule, while death js the exception'. I am also prepared to assert that, contrary to the opinions gen- erally received, the third stage of Consumption is, all other circumstances being equal, more amenable to treatment than the second. Hereditary predisposition seems in no way to counteract the curative powers of the Hypophosphites, as the patients in whom it was most strongly marked, recovered as rapidly as the others. I therefore ask the opinion of this Academy upon the cases of disease, of which I now present the notes of observation, (made before any decided result was observed), in order that it may be able to determine whether the cases in question were actually attacked with pulmonary phthisis. It is not alone as a curative agent, but above all as a prophylactic, that the Hypophosphites should be employed in combatting a disease which, (as M. Payer has shown) is almost entirely unknown among nations in a savage state, but which has become the permanent scourge of civilized life. Independently of its influence upon the public health, the final decision of this Question is of the highest scientific interest. If the specific efficacy of Hie Hypophos- phites against tuberculosis were once established, we should, I think, arrive at a 96 APPENDIX. solution of a problem which has much occupied the attention of both chemists and physiologists, viz., the determination of the state in which phosphorus exists in the system. We migh" then be able to decide, definitively, that besides the phos- phate of lime, there also exists a "principle," or "element" containing phosphorus , m a condition capable of oxydation—(a theory which has already been advanced in the works of different authors, especially those of Vauquemel, and M. Fremy on " The Brain")—which "element" plays an important part both in regard to in' nervation, and to hematosis, or sanguification; and which would, perhaps, also explain the intimate union between this first function and the phenomena of gen- eral nutrition, such as calorification, &c, which has been incontestably proved by the experiments of several physiologists, especially by those of Claude Bernard. This conclusion, viz., that phosphorus exists in the economy in an oxydizable state, is confirmed not only by the results I have already published, but also by the beneficial effects which the use of the Hypophosphites have produced in those gen- eral morbid conditions depending upon a defect in the power of innervation, or of nutrition; such as chronic bronchitis, asthma, spermatorrhea, marasmus, ancemia, rickets, as well as in cases of debility or prostration common to women during pregnancy and the period of lactation. My own observations, and the expert meuts I am now making upon the growth of young animals, also indicate the soundness of this hypothesis. I believe I was the first to point out, nearly a year ago, the importance of this phosphoric element, and the relation which probably existed between the varia- tion of its proportions and the different morbid conditions of the system, more especially of the tubercular diathesis. It is, at least, indisputable, that I was the first to draw from the probable existence of this element, a pathological and thera- peutical induction, and to demonstrate, by experiment, that whenever there was reason to suppose a deficiency of oxydizable phosphorus existed, we had a rational mode of supplying Tins deficiency by the use of such a preparation of Phosphorus as unites the two, conditions of being in a state capable of immediate assimilation' and, at the same time, at the lowest possible degree of oxydation. These character- istics are found to exist in the Hypophosphites of Lime and Soda in the most com- plete manner. The theories which I thus but briefly refer to, are discussed more fully in mv work, now presented to the Academy, and form the starting point of this memo- rial If I allude to them in this paper, it is only because they form a component par of a general theory of Physiology and Therapeutics; and also, in consequence of the presentation here of certain considerations on the subject, professing to be original, which are only a reproduction, almost verbatim, of my own -with this difference, that the agents said to have been employed are substances the com J sition of which and their mode of preparation are unknown, while the Hypophos- phites are positive and defined combinations, hitherto of no commercial value but well known to all chemists; and which, since my discovery of their therapeu'tica properties in the reatment of Phthisis, are employed, or experimented with throughout the whole of Europe. ' APPENDIX. 97 LETTERS FROM DR. CHURCHILL. [The following extract from a private letter Is published with a view to fulfill the desire of Dr. Churchill, expressed therein," to induce the medical profession to give his treatment &fair and complete trial," on the conditions laid down by himself. It will be found to contain a comprehensive view of the hypothesis proposed by Dr. C, upon the truth of which the judg- ment of the world is demanded.] Paeis, December IT, 1S58. My Dear Shi: * * I very much regret my utter inability to send you a copy of my work on Phthisis. The whole edition was sold off in less than six months, and it has now been out of print since February last. * * * I am now engaged upon a second edition, which has been delayed with the hope of my being able to settle the question of the existence or non-existence, in the economy, of phosphorus in an oxydizable condition. The chemical proof of its existence, in such a state, I now confidently hope I shall shortly be able to lay before the pro- fession and the chemical world. * * * My views with regard to Phthisis may be summed up in very few words, and are as follows: Phthisis is a diathesis, or general disease, depending upon the want or undue waste of the oxydizable phosphorus normally existing in the animal economy. Hence, it follows that the remedy consists in supplying the deficient element by the administration of any preparation of phosphorus which is at once assimilable and oxydizable. Now phosphorus itself possesses the latter quality, and has occa- sionally been used with success; but it has not the first, and is so dangerous a substance that it has fallen into complete disuse. Phosphoric acid is assimilable, but not oxydizable. The Hypophosphites combine both qualities in the highest degree, being perfectly soluble, and nearly as oxydizable as phosphorus itself; for which latter reason I originally preferred them to the phosphites, which are less so. As to the cause of Consumption, my hypothesis leads also to one or two other consequences of the highest importance in practice, viz, although the Hypophos- phites are the Specific Remedy of the diathesis, they cannot cure, by their own direct action the local diseases which the diathesis may have produced in the lungs or elsewhere previous to the employment of the remedy. To expect the contrary would be just as reasonable as to think that the water thrown upon a burning building can do the work of the mason or the carpenter. The repair of such local disorder is brought about by the special energy of the narts affected, and will take place in all cases in which the destruction of the Tr involved has not gone beyond a certain extent. The degree of the disease I ITto be of less moment than the extent, and incline to go so far as to look upon PMhWs in the third stage as of a more favorable prognosis than in the second, all 0Zr "circumstances being equal. The prognosis of each individual case will, there- lore depend upon two points-the extent of the existing lesion, and upon the presence or absence of complications. 98 APPENDIX. Anoiher consequence, which is, if possible, of still greater importance than the cure of the disease, is the following: If Consumption depends upon the waste of the oxydizable phosphorus, it follows that the hypophosphites not only have a remedial, but a preservative power. In fact, they are a complete prophylactic. Such, I am confident, will prdve to be the case; and the time will come, I hope, when Phthisis and Tuberculosis, instead of occupying the first place in the causes of mortality, will, like small-pox at the present day, form a comparatively insignificant item. My reason for this confidence is not derived from my assurance of the correct- ness of my general theory, but from the invariable efficacy with which I have found them act in all incipient cases, even of the acute kind commonly called Gal- loping Consumption. I am anxious that all these assertions should be verified by the medical profes- sion throughout the world. With them, and them only, does it rest to establish or to deny their validity. Unfortunately, the past history of our art shows that every discovery in therapeutics has been met with a storm of prejudice and opposition such as finds no parallel except in the records of religious dissension. I might have much to relate on that head in my own case, but prefer leaving such matters in the obscurity to which posterity is sure to consign them. If, as you say, the people of the United States take an interest in my discovery, the only way in which I should wish them to show it would be by inducing the Medical Profession among you to give my treatment a fair and complete*^ which, I conceive, can only be done, upon the following conditions : ^ 1. That no case shall be considered to have any bearing at all upon the ques- tion at issue, unless it be expressly shown that all the conditions which I have laid down as necessary have been complied with. 2. That in each case not only the degree, but also the extent, of the tubercular deposit, preexisting to the treatment, shall be recorded, together with the symptoms upon which this diagnosis is founded. 3. That the treatment used shall be the Hypophosphites as I have em- ployed them. I no not consider myself in any wise responsible for the ILL SUCCESS OF EVERY CRUDE FORMULA WHICH MAY BE IMAGINED BY OTHER PRACTITIONERS. "uim As soon as my new edition is through the press, I shall have much pleasure in forwarding you a copy of it, and, meanwhile, I remain, Your very obedient servant, . w ,, J" F' CHURCHILL, 11 Boulevart de la Madeleine. J. Winchester, Esq., 43 John et., New York. APPENDIX. 99 HYPOPHOSrillTES OF LIME AND OF SODA. [From the latest letter written by Dr. Churchill in regard to his discovery, published in April last, the following copious extracts are made. It will be seen that the Theory first pro- mulgated by him is sustained by a most remarkable degree of success in his own practice, and it may now be considered as an established medical fact, that the Specific Remedy for Con- sumption has been found. The success attained by this treatment in all the countries of Europe, as well as in, the United States, has established the therapeutical value of the Hypophos- phites beyond all controversy, and already raised the discovery of Dr. Churciiill above "the mists of controversy and prejudice into the serene region of scientific truth."—Publisher.] NO. 11 BOULEVART DE LA MADELEINE, PARIS. Sir : From several communications which have appeared in your journal, and from the number of letters I myself have received, it would seem that the treat- ment of Consumption, by the hypophosphites, is at present attracting considerable attention in America. I have, therefore, thought that the following remarks might appear of sufficient importance to occupy a place in your journal. * * * In publishing my discovery of the specific cure of Consumption, I was well aware of the natural repugnance of the medical profession to adopt any new remedy, particularly when so many hundreds had already proved unavailing; and I knew that nothing could be a greater obstacle to the general adoption of the means I proposed than the idea that I was actuated, in recommending it, by a motive of self- interest. I have, therefore, from the very first, rejected every proposal to connect myself in any way with, or to derive any pecuniary benefit whatever from, the manufacture or sale of the hypophosphites. I have thus renounced all right to a large, and, in the opinion of most people, a legitimate source of profit, because I look upon the discovery of their therapeutical effects as a trust confided to me, not for my own benefit, but for that of my fellow-creatures. Whether the course I have followed is the best, time alone can determine ; but I shall have at least the satisfaction of knowing, that from no one sufferer will this great boon have been withheld from any fault or for any advantage of mine. What I am anxious for is, that the hypophosphites should be brought, as speedily as possible, into universal use, as I know that they will prove not only as sure a remedy in consumption as quinine is in intermittent fever, but also as effectual a preservative as vaccination in small-pox. This assertion no longer rests upon the thirty-four cases with which my discovery was ushered into the world in July, 1857. I can now appeal to the results of up- ward of one hundred and fifty detailed observations of the disease, collected dur- ing the past year at my public dispensary, Rue Larrey, Paris, where any member of the medical profession who has wished to take the trouble, has not only been at full liberty to examine both the patients and the records of their cases, but has also had every opportunity of becoming acquainted with all the particulars of my treatment. To these cases might bo added almost an equal number from my pri- vate practice ; and in no single instance have I found the remedy fail to produce every thing that could reasonably bo expected from it. In most instances tho benefit derived from it has far exceeded what could at first have been hoped for, 100 APPENDIX when taking into account Hie degree and extent of injury sustained by the lungspr* viously to the use of the remedy. Similar results have, since the publication of my discovery, been announced by Professors Parigot of Brussels, and Maestre de San Juan of Granada, in Spain; as also by Drs. Jacinto Le Riverend and Galvez of Havana, and Reinvilliers of Paris. It is true that by others, in still greater numbers, the remedy has been declared useless, or even dangerous; but, in every instance in which more than a bare as- sertion has been published, it would be easy for me to show that not only have the experimenters neglected the rules I had laid down as necessary to insure success, but have, in fact, violated the most elementary principles of scientific observation. I will mention but one instance. In February of last year, after a trial at the Brompton Hospital for consumption, in London, the hypophosphites were declared to be utterly useless upon the fol- lowing grounds: the remedy was used for one fortnight in twenty cases, eight ol which it is admitted improved during that period. It was assumed, however that this improvement was to be attributed to change of diet and regimen ; because, after leaving off the hypophosphites, the patients, it is said, were found to improve more rapidly under the use of cod liver oil and tonics than they had done before. Now it will strike every one that the trial of a remedy for consumption, during one fortnight.only, looks very much like a sham; and the suspicion is confirmed by the haste with which the experiment is left off, not only in the cases which are stated not to have improved, but also in those which are allowed to have done so. As if further to perplex the matter, no time is allowed for the effects of the hypo- phosphites upon the system to work off; but cod liver oil is administered, without any interval, and is credited for the continuance of the improvement which is said to have beeu observed. As no dates, however, are given, we are left in the dark as to how long this im- provement was kept up after the discontinuance of the hypophosphites. The same discreet silence has also, up to this day, been observed with regard to the final issue of the investigation. Not one of the patients is stated to have recovered under the use of the remedies employed after the abandonment of the hypophos- phites. Two of them are allowed subsequently to have died, and of the fate of the rest, nothing is said; while, on the other hand, one of the patients felt so v much benefited during the first fortnight, that, when the hypophosphites were dis- continued, he refused to take any thing else, and left the hospital. Upon «uch facts as these I feel that all comment would be superfluous. Your readers will find the origmal document in the London Medical Journal for February 13th 1858 An answer to it was published in the London Medical Circular of the 1th of April' I can confidently assert, and will prove in the forthcoming edition of my work that every refutation of my views which has yet appeared, rests upon no better foundation than the preceding; a fact which is mainly to be attributed to the pres- ent unscientific condition of pathology and therapeutics. No astronomer no nat- ural philosopher, no chemist would be allowed to impugn the results arrived at bv another unless he were able to show that, in his own experiments or observations ho 'iad kept account of all the conditions of the problem. In medicine on the contrary, mthiug is commoner than for a physician, who has often merely ascer APPENDIX. 101 tamed by hearsay that a given remedy has been used in a given disease, to suppos* that all he has to do is to make up his mind as to tho name of the disease, and then get his patient to swallow a certain dose of the drug. Such conduct will ap- pear the more preposterous if we reflect that the phenomena of life, and still more those of disease, are of a much more complex order than those of inorganic mat- ter ; and, as such, require for their production a much greater number of condi- tions, the neglect of any one of which will prove fatal to the result * * * The subject is one of considerable difficulty, partly owing to the na- ture of the question itself, and partly to the views at present prevailing in pathol- ogy. I again, however, reiterate the assertion with which I first announced my discovery, viz., that in all cases where a cure is not effected by the use of the hy- pophosphites, the reason of this ill success will, upon examination, be found to de- pend on one of the following causes: either the salts are impure, or they are not administered according to the rules I have prescribed, or the patient is suffering from a complication of some other disease; or, lastly, the extent of lung already involved by the tubercular deposit is too great to allow of recovery taking place. If neither of these last two considerations exist, the degree or stage of the mal- ady is comparatively of secondary importance. Out of twenty-two cases in the third or last stage treated at my dispensary during the past year, eight have com- pletely recovered, eight have died (owing in every instance to some one of tho last two mentioned causes), and six are still under treatment. Such a result is alto- gether unparalleled in the annals of medicine, and I hope shortly to lay it before the medical world, along with several other instances of the same kind from my private practice. For the present, I wish to confine myself to a subject which is not only, if possible, of more general interest, but which may be sufficiently di- vested of technical particulars to be intelligible to the general reader. I mean the prophylaxis, or prevention of consumption. The prevention of disease has, of late years, been the object of a great amount of study • but this has chiefly been directed towards hygienics, that is, the preser- vation of health; and not toward prophylactics, or the prevention of disease. Progress in the former direction will be mainly dependent upon the spread of civ- ilization, and upon improvements in the manner of living; in the latter, it can only proceed from the advance of medicine itself as a science. Although by far the most useful branch of it, prophylaxis, has been as yet but little cultivated, it is chiefly because the physician is usually so entirely engrossed with the phenomena of actual disease, that he has neither time nor means to attend to any thing else. The dominant views in medicine are also almost completely opposed to progress of this kind; and to crown all, the interest of the profession lies exactly the oppo- site way. Thus, what ought to be the true aim of medical science is that to which least attention is paid. The greatest discovery of the kind hitherto made—per- haps the greatest discovery in medicine—is that of vaccination, whose efficiency is such that the ravages of small-pox are now, so to speak, only a matter of history. The time too, will come, when consumption, instead of slaying, as it now does, only one-sixth of the whole human race, and more than one-half of the adult copulation of most civilized communities, will dwindle down to an insignificant ^cm in the causes of mortality. I am afraid, however, that it will not be until al 102 APPENDIX. least two generations of the medical profession have passed away, that this result will be attained, and that my discovery will rise above the mists of controversy and prejudice into the serene region of scientific truth. If, as I assert, the hypophosphites be the specific remedy of phthisis, because one at least of the essential conditions of that disease consists in the want or the undue waste of the oxydizable phosphorus in the animal economy, it follows that consumption will be prevented simply by taking care to keep the system supplied with a due amount of that element. Now, if there existed any certain signs or symptoms by which we might recognize either that phthisis is impending, or that the phosphorized element is deficient, the prevention of the disease might be effected with perfect certainty. Unfortunately, such is not the case. The same causes which have tended to keep physicians unacquainted with prophylaxis, also act to make them compara- tively ignorant of cetiology, 6t the science of causes, and of the premonitory signs of disease. On the other hand, chemistry, although it has of late outstripped al- most all the other sciences, is far from having arrived at the degree of minute accuracy which would be requisite for the solution of the second form of the prob- lem. Still, there are a certain number of signs by which the advent of phthisis is usually announced, and when the whole series of those I am about to enumerate is mot with, there can seldom be any doubt of the fatal nature of the disease. These symptoms are frequently so well marked as to draw the attention even of the uninitiated. In many instances, however, some of them may be but faint, 01 they may be latent for a time ; most of them taken severally are also to be met with in other disorders. I would therefore earnestly advise every sufferer, in all cases where it is possible, to take the advice of a competent physician, and,'abovo all, of a practiced stethoscopist. What upon a superficial view may have seemed only a forewarning, will, upon due investigation, but too often be found to depend upon advanced lung disease, either overlooked for want of examining the chest or undetected from a deficiency in the practice of auscultation. If, without any apparent cause, or under the influence of causes which induce weakness or exhaustion, such as want, grief, overwork, excess, pregnancy, child- bearing, nursing, rapid growth, slow recovery from other diseases, a person begins to lose his flesh, strength, color, or appetite—if he suffers from shortness of breath, or sleeplessness, and experiences a'general feeling of languor and depression—there is reason to fear that he is already predisposed to the complaint. If to these symp- toms be added a cough, however slight, particularly if it has come -on slowly or during the fair season, the probability is still greater. If with all this, there is a feverishness toward evening, with sweatings or clamminess at night, particularly about the head or neck, if spitting of blood should occur, it is likely that the dis- ease has already reached the stage at which it shows itself by deposition of tuber- cular matter in the lungs. The import of these signs will be heightened should they occur about the period of puberty, or between the ages of fifteen and thity-five, especially in a person whose family has been similarly afflicted. Now, if, on the earliest appearance of these symptoms, especially of those first enumerated, the patient takes daily about ten grains of the hypophosphite of lime* or of the hypophosphite of soda, he will APPENDIX. 108 usually see all these signs disappear in a period varying from a few days to a month ; and by continuing the occasional use of the remedy he will speedily find himself in the enjoyment of such health as he perhaps had never known in his life before. Ten grains daily is the safest dose for an adult male, though sometimes double that amount must be given to produce the proper effect. For females, par- ticularly if delicate, and for children, the doso must usually be much smaller. The younger and the more sensitive the patient, the more readily is he influenced, and the dose should, therefore, decrease in higher ratio than the age of the subject. Thus for infants it should seldom exceed one-fifth of a grain every second or third day. After the remedy has been used for about a week or ten days, it will be safer to omit it for three or four days together, then to resume it, and again leave it off after the lapse of another period like the first. It should thus be continued from time to time, as long as it may appear to bo required, remembering, as the patient improves, to diminish the frequency of the doses. When he has regained his usual state of health, it will be sufficient for him to take one or two doses a week, unless they should be found inadequate to keep him up to that condition. The treatment should be left off upon the first appearance of fullness of blood, with a determina- tion towards the head, which will usually be known by giddiness or singing in the ears, and especially by bleeding from the nose, however slight. It should (except in some few cases), never be used during the acute period of any inflammatory dis- ease of the lungs, whether primitive or supervening as a complication of phthisis. These directions will bo found sufficient in the great majority of instances, but it would be impossible for me to go into the details necessary for the treatment of different temperaments and constitutions, without trespassing upon your indulgence to a greater extent than might be found convenient. * * * The best time for administering it is at breakfast along with the food. The pure hypophosphites have a taste very similar to that of common salt, and if given as directed the dose is nearly tasteless. No other drug or medicine should be combined with them, or used at the same time. The salts of lime and soda are the only preparations which, for the present, I would recommend for general use. Lastly, as a general caution, I would observe that if the hypophosphites have been used for two or three weeks in sufficiently large doses without producing any improvement in the patient's appetite, strength, or general appearance, this will, upon due investiga- tion be found to depend upon one of the causes f have already named. I here close this over long letter, which I would fain have shortened if I could; and to conclude, I would beg of the press generally throughout the United States to uro-e upon the medical profession the vast social importance of this question, of which I am but a weak and far too unworthy minister. Will my professional brethren on your side of the Atlantic, allow me to remind them that in therapeu- tics as in every other department of experimental research, no number of negative instances can outweigh one single positive result, obtained under certain determi- nate conditions, unless it be at the same time shown that, in the negative in- «t•uiees all these conditions have been expressly complied with, or that they have oeen omitted because they are of themselves unattainable ? I submit that in no single case, in which the hypophosphites are stated to have 104 APPENDIX. been unsuccessful! has this fundamental principle been observed, or appears even to have been understood. In no negative case yet upon record have I been able to discover that the investigator's acquaintance with my views of the treatment of consumption extended beyond the mere fact, that the hypophosphites had been used by me at a certain dose. Will my brethren pardon me if I remind them that antimony, bark, ipecacuanha, hemlock, vaccination, the ergot of rye, etc., were not only neglected, but for years (antimony for one whole century) condemned and proscribed by the mass of the profession, not because their medical action was slight or equivocal, but because FEW OR NONE WOULD BE AT THE TROUBLE TO INQUIRE INTO, OR LEARN THE CONDITIONS BY WHICH THAT ACTION WAS GOVERNED? I remain, sir, your obedient servant, J. FRANCIS CHURCHILL, M. D. [FROM THE LONDON MEDICAL CIRCULAR.] ON THE HYPOPHOSPHITES. Sir,—In reply to the inquiry of your correspondent, " Dr. W. J," I beg to in- form your readers that the dose of the hypophosphite which I have found the most manageable is ten grains at first, increasing it gradually up to one scruple daily. This quantity I seldom exceed, though in some cases I have used larger doses with benefit. Children, under four years of age, can seldom take more than from one- fifth to twc^-fifths of a grain daily. In all cases, however, with this as with any other remedy, the physician must watch its effects upon the system, which vary with the idiosyncracy of the individual. To be used with effect, the hypophos- phites must be perfectly pure; otherwise they may, in some cases, appear alto- gether inert or even injurious. In five cases out of six the salts usually sold pure in Paris, under the name of hypophosphites, are totally unfit for medical use. I am sorry I have not time at present to enter more fully into particulars, but shall endeavor to do so completely in one of my earliest letters. The hypophosphite of soda having, when pure, nearly the same taste as common salt, may be given in any form. I usually prescribe each dose to be taken in a tumbler-full of sweetened water, or sweetened milk, or wine and water, or broth, or any other drink that oan be taken at breakfast or dinner. I use no other treatment of any kind unless required by the existence of complications, such as intercurrent inflammation of the lungs, diarrhoea, cardiac disease, etc. I remain, &c. J. FRANCIS CHURCHILL. 17 Boulevart de la Maleleine, Paris, April 24th, 1858. APPENDIX. 105 THE PHOSPHATES AND HYPOPHOSPHITES BY L. V. NEWTON, M. D. To the numerous inquiries addressed to us, in relation to these salts, we answer as follows: phosphates, as the name implies, are compounds of bases with phos- phoric acid. This acid is a compound of 5 equivalents of oxygen, with 1 of phos phorus, united with 1, 2, or 3 equivalents of water, the latter being the most com mon form. Bone consists in part of phosphoric acid combined with lime; this phosphate of lime constitutes the solid, or what is called the inorganic part of the Bkoleton. Phosphates of iron, of soda, and of potassa, are also constituents of the system; the two latter are much concerned in digestion. The salts of hypophosphorous acid are very different in composition and proper- ties from the foregoing; the acid contains 1 equivalent of oxygen to 1 of phos- phorus and 2 of water; instead of being so firmly united together as to resist the action of heat and chemical agents, these salts readily change, giving off phospho- retted hydrogen, or, in contact with free alkali, are decomposed into phosphate's and hydrogen gas; they thus seem to have the power of supplying the phosphorus in a nascent or spontaneous condition, which so mysteriously enters into the compo- sition of the brain and nervous system. The hypophosphites, taken as a class, seem to possess the power of increasing nerve force, and promoting the function of nutrition. In supplying phosphates to the blood they act only secondarily, their primary influence being upon the nervous system. Dr. Churchill, who first brouglit them into notice, lays claim to them as specifics in pulmonary consumption, alleging that the progress of this disease is altogether due to a waste of phosphorus. Whether this be true or not, there can be little doubt of the value of these rem- edies as tonics and alteratives. Their anodyne effect is sometimes quite remarka- ble ; when taken for sometime they tend to produce most refreshing and renovating rest. The general health of consumptive patients is frequently greatly improved by their use, and we have no doubt they have, in very many instances, r rolonged ufe and even restored health to persons quite wasted by consumption.— Chemical Gazette. 10(5 APPENDIX. BRONCHITIS. [The following general remarks o l this complaint are from a popular woik by I r. Samuel Fc-nwick, on the 'Causes and Prevention of Diseases." The Hypophosphite of Potassa, for its stimulating and expectorant effects upon the mucous surfaces, as well as its constitutional ac- tion upon the nervous system, is particularly indicated in the treatment of this complaint. We put up a special preparation of this salt in eases of Bronchitis and Asthma.] When the inflammation of the larynx, which produces the symptoms of a com- mon cold, extends downwards so as to affect the bronchi, or air tubes of the lungs, it receives the name of bronchitis. It is very necessary that public attention should be directed to this complaint, not only on account of its great frequency, but also because, when it often recurs, it produces other changes in the structure of the lungs tending to destroy life. But it is not only from its fatality that it demands attention, but from its laying the foundation for subsequent attacks of asthma, heart disease, and other com- plaints of a like fatal character. It is one of the most common and distressing complaints of childhood; it affects the artisan in almost every branch of trade, lessening his powers of labor, and often embittering his existence; whilst in old age it is of the most frequent occurrence, and very generally terminates fatally. Bronchitis consists in inflammation of the bronchial tubes, and the symptoms of the complaint chiefly arise from the air not getting free entrance into the lungs. The changes produced by bronchitis vary according to the stage of the disease. In its earlier stages the mucous membrane is usually of a red color, from its con- taining an unusual quantity of blood. When examined by a microscope the ves- sels are seen to be enlarged and overloaded. The membrane itself is generally thickened, and the epithelium removed, either wholly or in part; the cavity of the tube is also filled with mucous. The symptoms of the complaint will be readily understood by the above descrip- tion. The expectoration, which takes place in the earlier stage, consists of the epithelium, which has been stripped off by the inflammation. Afterwards how ever, it is secreted by the raw surface of the mucous membrane, and in long standing cases is often as thick as that expectorated in consumption. The loss of the epithelium readily explains .the feeling of soreness which the air often occa- sions when it enters the chest; and as the natural use of the cilia is to move up- wards any secretions in the tube, it will be readily understood that the expectora- tion will be apt to accumulate until expelled by coughing. But if the tubes are thus blocked up, it is plain that the air cannot be so easily forced into them as when they are m their natural condition, and hence the difficulty of breathing so generally observed in this complaint. In childhood the effects of bronchitis differ materially from those observed in later periods of life. The lung is often seen shrunken and deprived of its air and death consequently ensues. ' In older persons, bronchitis often lays the foundation of incurable disease- the powers of breathing being so much stronger than m children, there is but'little APPENDIX. 107 danger of the tubes becoming so obstructed by the expectoration as to prevent all passage of the air. It often happens, however, that the tube is so narrowed that the air escapes from the cells with great difficulty; they therefore become unnatu- rally distended, and, by the increase in their size, the blood-vessels around them are pressed upon, and partially obliterated. In this way is produced a disease technically called emphysema, which forms a large proportion of the cases popu- larly known as asthma. Occasionally the bronchial tubes themselves become greatly enlarged after an attack of inflammation. Their mucous membrane becomes thickened, and a train of symptoms is induced precisely similar to those of consumption. Bronchitis is so frequent in old age, that few persons reach an advanced period of life without suffering in some degree from it. Some are attacked as soon as the winter commences, whilst in others it causes no more inconvenience than an in- creased secretion of phlegm. ASTHMA. The term Asthma is usually applied to any case in which the patient suffers from extreme or long-continued difficulty of breathing. A person is said to have asthma who is subject to sudden and severe attacks of difficulty of breathing, which, after a short time, disappear, and in the intervals leave him in the enjoy- ment of health. "Asthma," says Dr. Fenwick, "arises from violent action of the muscles sur- rounding the bronchial tubes. The existence of muscles in this situation was long doubted by physiologists; but experiments upon animals have satisfactorily proved their presence. It will be easy to understand that if the diameter of the tubes leading into the lungs is suddenly diminished by the contraction of the muscles surrounding them, intense difficulty of breathing and a feeling of suffocation is the result. Consequently, during an attack of the asthma, we find the unhappy sufferer laboring for breath ; fixing his hands on any object near him, so as to en- able him to expand his chest to the uttermost; or often lying with his head out of the window to catch every breath of cool air." Dr. Hyde Salter, in a paper published in the July number of the British and Foreign Medico-Chirurgical Review for 1858, gives the following graphic descrip- tion of a paroxysm of asthma: " The asthmatic's breathing is what our forefathers called 'strait,' what we call ' ti°-ht •' he feels as if a weight were on his sternum, as if his chest were com- pressed ; as if a cord bound him; as if it would be the greatest relief to him if Bome one would cut his breast open and allow it to expand; he rushes to the win- dow to get air: ho cannot tolerate people or curtains about him ; his clothes are loosenoi, and all the muscles of respiration tug and strain their utmost to fill his 1 est But he can neither get air in or out; he can neither inspire nor expire; h's respintion is almost at a dead-lock; he cannot blow his nose, can hardly rh or sneeze, cannot smoke a pipe, and if his fire is failing, cannot blow it •°be has hardly air enough to produce the laryngeal vibration? of speech. The 108 APPEND I X. chest is distended, indeed, to its greatest possible limit; the cavity of the thorax is enlarged both in the costal and diaphragmatic directions; uhe costal distension is shown by the fact that a waistcoat that would ordinarily fit, will not meet over his chest by two inches, while the descent of the diaphragm is shown by the in- creased girth of the abdomen, and by the heart being drawn down to the scrobic- ulus, where it is seen beating plainly; such are the violent instinctive efforts of the respiratory muscles to overcome the obstruction to the access of air. But they are unavailing. The air that is without cannot get in, and that which is within is locked up. In spite of the violent muscular effort, there is hardly any respira- tory movement; the parietes of the chest cannot follow the action of the muscles; on listening to the chest, the respiratory murmur is inaudible, even when not drowned by the wheezing; respiration is almost nil. * * * Thus we see by evidence as certain as sight, that in asthma, bronchial spasm must and does exist, and that no other conceivable supposition will explain the phenomena." Dr. Salter states that " Asthma is essentially, if not exclusively, a nervous dis- ease ;" that the extent to which the nervous system is involved differs very much in different cases, being in some cases restricted to the nervous system of the air- passages themselves ; other cases, in which the source of irritation, giving rise to the asthmatic paroxysm, appears to be central—in the brain. The causes of asthma are seen to be such as affect the nervous system, and which give rise to other diseases acknowledged on all hands to be nervous. Asthmatics are very commonly dyspeptics, and often exhibit symptoms of perverted and capricious stomach action, that suggest the belief that the innervation of the whole of the vagus is vitiated, its gastric as well as pulmonary portion, and that the dyspeptio and asthmatic symptoms are but parts of a whole. Dr. Churchill states that the hypophosphites " should be employed in all ner- vous diseases," possessing, as they do, the "power of relieving nervous prostration," or whatever produces any disturbance in the blood-generating processes. It is evi- dent, from the particular action of the hypophosphites in strengthening the nu- tritive functions, and in increasing the nervous energy, that they may be considered the most efficient remedy in dyspepsia, or indigestion, as also for asthma. The Hypophosphite of Potash is considered as more particularly indicated in tho treatment of this distressing complaint. CHEMICAL PATHOLOGY OF THE BRAIN. Chemical and pathological research has established that in certain depressed and deficient conditions of cerebral and mental power, there exists in the brain the minimum amount of phosphorus. The brains of idiots have been found entirely destitute of this chemical agent. A similar deficiency is perceived in advance of age, and in the early periods of life, when the encephalion is supposed to be en- tirely in an inactive condition, or not, as far as the intellect is concerned in a ma- ture state of development. When carbon exists to ex cess in the blood the cere- bral power is depressed, owir g, it is surmised, to the excess jf carbon and soda interfering with that union of phosphoric acid and the fatty matter of the blood APPENDIX. 109 necessary to tho perfect organization of healthy nervous tissue. Nervous matter is formed in a manner analogous to that in which bile is produced, either, as Liebig suggests, by tho sep- aration of a highly nitrogenized compound from the elements of the blood, or by the combina- tion of a nitrogenized product of tho vital process with a non-azotized compound—probably fatty body. It is the duty of those especially engaged in the investigation of idiocy, Insanity, and other affections of tho brain and mind, to ascertain, by a series of carefuhr executed Bxperimcnts, whether tho alco-phosphoric acid and other essential and important braia elements do not, in certain conditions of nervous ill-health, pass rapidly out of ti.e system in the various excretions. Of the actual deposition of nervous matter in the urin<. jhere can be no doubt. The microscope at once detects it.—Tribune. COD-LIVER OIL—WHAT IS ITS VALUE IN CONSUMP- TION 1 Undoubtedly the more advanced of the medical profession now regard Cod-Liver Oil exclu- sively in the light of a food. The disgust and loathing, however, whicli its exhibit.on certainly creates in nearly all cases, have latterly caused it to be regarded, even for this purpose, with decided disfavor. The HTroi'nosrniTES, on the other hand, act with a prompt and radical energy upon the debilitated digestive functions ; they are almost tasteless,and, of course, produce no nausea ; and speedily enable, or rather compel, the patient to use those customary articles of diet which are natural and necessary to the healthy economy. It should be borne in mind that the lungs of tho tuberculous invalid are already overloaded with carbonic poison, and that to add to the sources of this destructive agent, is to pursue a course which is tho very reverse of rational or scientific. I submit to the reader's consideration the latest professional opinions upon this subject : Pav* tho celebrated Doctor Lindsay, of Edinburg : << Cod-Liver Oil frequently produces an acrid burning sensation in the throat; it ta extremely difficult of digestion by many stomachs ; by others it can not be borne at i\l without generating disagreeable and even serious gastric symptoms ; and in general, nausea and purging are very frequently results of its use." Dr Cell • " Ho could not express any definite opinion of Cod-Liver Oil. In common with other practitioners, he had prescribed it, and urged a persistence in its use, but he has .not SEEN A CAM OF PHTHISIS CURED BY TUB ADMINISTRATION OF IBIS MT1CLE."-Phil. Medical and Sur- gical Reporter. Dr Condie ■ « In respect of the curative powers of the Cod-Liver Oil in cases of tubcrculo- ' sis in'th«- adult subject, lean not bear any favorable testimony. I have employed the article from its first introduction in nearly every cose of tubercular consumption that since then has fallen under my notice, and that fully and faithfully ; but I can not say that I have found it to cause tho^e beneficial effects, either in the arrest of the progress of the disease, or ,n the de«- dld amcliora^L of its symptoms, that hav? been ascribed to the article in cases of pulmo- nary consumption."'—Hid. W V Alcott M D.. in his able lectures upon Health and its Preservation, says : « Much W . A. Alcott, m. , Cod-Liver Oil in Consumption ; but in all my t:z cir:u^r:r;r.™ -——«- «~ - <->• *- benefited by its use." pr Gerhard, of Philadelphia, believes that there is no decided advantage to be gained r om Cod Liver Oil when the disease is much advanced. It is by no means a spoc.Do against r°T It is apt ... prod.uo purging. He admits that he never met a case in which the ": S,S,' „ls h-.v« disappeared under its use., On tho contrary, tho local signs prove tho physical siyw i. ^ ^ ^ ^ that u .g progressing. He recommends E'^'-ott alf, It be used « ratiibr as a food t„a* a msdicixk.-X T. Jour, of Medicine 110 CHEMISTRY OF THE HYPOPHOSPHITES. The HypopnospnrrES are preparations formed by tho union of hypophosphorous acid (PO) with the alkaline and other bases. They arc more or less deliquescent, and have an affinity for oxygen second only to phosphorus itself. They meet the indications of the tubercular diathesis—as understood by Dr. Churchill—because they furnish phosphorus to the economy at the lowest possible degree of oxydation—or the " element " which is pathologically deficient iu the diathesis, in a form capable of rapid oxydation, and certain assimilation. The Phosphates are preparations formed by tho union of phosphoric acid (P05.) with various bases. They arcno< deliquescent, and have no further affinity for oxygen. They fail to meet the indications of the tubercular diathesis, because they furnish phos- phorus to tho economy only at the highest possible degree of oxydation; so that tho element (oxydizable plwsphorus), which is pathologically deficient, is not furnished by their adminis- tration. The Hypophosphites are designated by the chemical signs " PO." The Phosphates are designated by the chemical signs " P05." In popular language, the difference is expressed by saying j that the former contain onepart of phosphorus to one part of oxygen ; the latter, one part of phosphorus to five parts of oxygen In the one, the phosphorus is oxydizable; in the other, it is already oxydized. In a word, tho Hypophosphites differ from the Phosphates almost in the manner, and to the extent, that flame diners from ashes. It may be observed here, that the Hypophosphites are what are called, by the chemists ''neutral salts ; " that is, salts in which none of the properties either of the acid or the base are pereeptibU What is true of the salts, is also true of their solutions. If the reader will bear this in mind, ho will have a simple and efficient test for the numerous preparations purport- ing to be solutions of tho Hypophosphites. The slightest sour or acid taste will at once reveal the imperfect or adulterated preparation; and if to this there is added the taste of iron or any drug, it should be avoided. (Seo p, 73. Also, tho remarks of Trousseau before the Academy of Medicine, p 141) The IlYPopnospmxES being neutral salts, it is of importance to notice here that the Hypophosphite cflron is not amongst the exceptions to the law. Those syrups or solutions therefore which purport to bo compounds of the Hypophosphites cf Iron, &c, fcc, and which distinctly reveal the Iron base to the taste, contain, not the Hypophosphite, but the Phosphate or some other cf the various preparations of Iron. It is further stated that these salts have an affinity for oxygen second only to phosphorus itself, and that it is of vital importance to preserve them from oxydation The question arises How can this be effected ? We answer • By arresting the evaporation of the solution at the point of saturation, and tkus avoiding the liability to partial decomposition into phosphates or carbonates in the process of crystallization, It is thus evident that the dky salts must bo discarded from general practice, before the world can realize the beneficent revolution to be wrought in the Treatment of Consumption by Dr Churchill's discovery. Experience, happily, has confirmed tho a priori conclusions of tho chemist, and has demonstrated that the crystalline hypophosphites (dry salts), even when free from any excess of the alkaline carbonates, will not produce results invariably favorable in Phthisis, because there must always be present fcn excess of oxygen, superinduced by the ex posurcs attending their preparation and exhibition. The maximum efficacy of the Hvpophos' phitcs depends upon their preservation at the lowest point of oxydat.on, and we have already explained the only method by which this desirable result can be attained Free solutions, from the dry salts which have been exposed to oxydation are onlv partially attainable ; unless we employ an excess of acid as a solvent. Solutions so t,reDarP/ are necessarily imperfect, and should be rejected. ' In this popular account of the Chemistry of the Hypophosphites, I have made no mention of the water cf crystallization, because it could only confuso the mind of the unscientific read*/ To tho scientific reader, indeed, all that is here written, as well as that which is omitted as familiar as his alphabet, and is not needed to protect him against impositions But the™ is a large class that requires tho protection which is here proffered, and to this ri,™ t Scularly address this chapter, ' ClaSS * P"" APPENDIX TO SECOND EDITION SECOND REPORT OF THE BROMPTON HOSPITAL. A second report from the Brompton Hospital for Consumption, " On tht v.se of the Hypophosphites in the treatment of Phthisis," which appeared in the London Lancet (Monthly Part, June, 1800—American Elition), is reprinted below. The former report, declaring the results " unsatisfactory," but conceding a certain value to the hypophosphites "as tonics," was made by Dr. Cotton. The second report, sustaining the "unsatisfactory" conclusions of Dr. Cotton with respect to their use in phthisis, but which goes to the extent of pro- nouncing an unqualified judgment against the use of the salts, in any case, emanates from Dr. Quain.the chief of Dr. Cotton's colleagues in the hospital. Elsewhere (Appendix, p. 100), Dr. Churchill has thoroughly discussed the first of these reports, and has clearly pointed out the ignorance, the miscon- ceptions, and the malign spirit of its author. I propose doing a like service for the report of Dr. Quain. I have taken the liberty of italicizing the more material portions of the report, and have, by this method, indicated a few objections which are no* particularly pointed out in the strictures. A few irrelevant paragraphs have likewise been omitted. ON THE USE OP ITYPOPHOSPHITES OF SODA AND OF LIME IN THE TREATMENT OF PHTHISIS. BY IUCHARD Qt'AIN, M. D. The treatment of phthisis, by the hypophosphites of soda and of lime, was brought into notice by Dr. J. Francis Churchill, of Paris, in a communication read before the French Acade- my of Medicine, in July, 1857. I was at that time induced, by the representations made as to the value of these agents, to administer them to some of the cases under my care in the Hospital for Consumption at Brompton ; but as the results were not encouraging, and as the drugs were then obtainable in limited quantities, I did not continue tho experiments. One of mv colleagues, Dr, Cotton, about tho samo time, or soon after, made some observations on the subject, and published tho results, which were unsatisfactory Dr Churchill subsequently brought his memoir, with additions, before the profession. A sal of ti,is treatise* and inquiries addressed to mo from time to time by professional * De la Cause Immediate et du Traitemeut Spccifiquc Le la Phthisic Pulmonaire. Par J. (r. Churchill,' D. M. V. Paris : Masson. 112 APPENDIX. friends as to my opinion of the value of tho hypophosphites in the treatment of phthisis, have lei me to re-examine fully into their asserted efficacy, and ia this communication I propose to give briefly the results of the inquiry. It will, perhaps, be fair to say, in the first instance, that Dr. Churchill states that ho was led to adopt the use of the hypophosphites in consequence of his belief that the tuberculous diathesis depended on some disturbance in tho process of sanguification ; that this disturb- ance, which affected the inorganic and not the organic elements, was due to a deficiency and not to an excess of somo one or other of these elements. He argued with himself, that it could not be the sulphur, the iron, the chlorides, or the alkalies, for these substances were daily used as remedies, without any real offset on the disease. Eliminating, then, the elements first named, ho concluded that the failure was in phosphorus as a constituent of the body. It should here be noticed that these propositions of the author can only bo regarded as theo- retical speculations, inasmuch as they are unsupported by either chemical or physiological observations. By a similar course of reasoning, but one more in accordance with physiological facts, Dr. Churchill arrived at tho conclusion that phosphorus, the missing element, could be best sup- plied by tho administration of this body in its lowest state of oxidation, as it was thereby given in a form more capable of assimilation. With that view, he administered the hypo- phosphites of soda and of lime, which he declared to be prophylactic, and to be curative in every stage of the disease. Ho says : " I know that they will prove, not only as sure a remedy in consumption as quinine is in intermittent fever, but also as effectual a preservative as vac- cination in small-pox." Encouraged by statements like this, and by a lengthened catalogue of tho phenomena of improved health, which, it was said, resulted from the use of these remedies in Dr. Churchill's hands, I determined on giving them a fair trial in a certain number of cases. They were, therefore, administered in twenty-two cases, taken without selection from amongst the ordi- nary in-patients of the Brompton Hospital. Of this number (twenty-two), twelve were males and ten were females. The Stage of thz DUj.se.—Two cases wore in the first, tan ia the second, and ton ia tho ■" third stage of phthisis. The Dose of the Rcm»dy.—T)r. Churchill recommends ten to thirty grains as the dose of cither the hypophosphite of soda or of lime, daily, in any simple fluid. The dose to be'in- creased until the general symptoms disappear. In some cases, he prefers one salt to the other. For example, he thinks that the salt of lime checks the expectoration, and thereby increases the cough ; whilst the salt of soda is less energetic i.i its action. I met with nothing confirmatory of this impression. The dose given to the patients at Brompton was, in tho first instance, ten grains, three times a day, except in the case of a child, when only fivo wore given. The disease progressing, or being stationary, or the effects of the remedy being nil, the dose was gradually increased. Thus, in four cases, it was increased to a drachm (CO grains) three times a day ; in ten cases, the doso reached two scruples (40 grains) or more -in eight, the dose remained under half a drachm. It will thus be seen that the remedy was g.vcn freely. In no case, let me add, was there any abearance of the troublesome symptom, indicated by Dr. Churchill as following large doses. Tlie Duration of th, Treatment.-Ctoc case was under treatment for six months one for four months, six for three months, nine for two months, fivo for ono month. During Urs lengthened course of treatment, I looked anxiously, but in vaia, for those marked phvsiolo gical effects d„eribelby Dr. Churchill There were no evidences of the « improved powers of innervation ; • • ■< the hair and nails did not grow more rapidly ; " there was no « appearance of plethora or of fulness ; » the patients did not describe « an unaccustomed sensation of feel- ing better and stronger after a few doses of the remedy." Say, I would say that there was nothing more felt by the patient, nor noticeable by the physician, than if so many grains of carbonate of soda or prepared chalk had been taken. J llie Zesults.-^To return, then, to the more immediate object for which these agents were admi^tero:'—vi;:., to ascertain their value in the cure of consumption-I have tosta'e that APPENDIX. 113 of the twenty-two cases, six were more or less improved while under treatment. Of these six, three wore improved in but a slight degree, and only for a short time ; ia three the improve- ment was marlced, but in one only of the latter has the improvement been permanent; of the twe other cases, one continued using tho hypophosphite for three months after leaving the hos- pital, during which time she grew gradually weaker, and finally died ; the other, a man, after leaving the hospital,continued the treatment for some time, but gradually grew worse, and is now dying. All tho other sixteen cases steadi'.y lost ground whilst using the hypophosphites in the hospital. Happily, in six of these cases, the treatment by hypophosphite was sus- pended, and the usual treatment by cod-liver oil, tonics, &c, being substituted, a decided improvement ia each was the result. PHTHISIS IN THK FIRST AND SECOND STAGES OF THE DISEASE ; TEMPORARY IMPROVE- MENT WHILST TAKING HYPOPHOSPHITE OF SODA ; FINAL RESULT FATAL. Case 1. A. B----, aged twenty-two, a dressmaker, admitted on Nov. 17th, 1858 ; height, 5 ft. 2j.< in. ; weight,8st. 7>i lb. Being predisposed,on hermother's side, she had had cough for three months, with very slight expectoration ; no haemoptysis ; no night-sweats ■ and had no other illness. The catamenia, absent since the commencement of her illness, were previ- ously regular. Digestive organs regular ; pulse 112. Tho physical sijns were dulness and crepitation at the right apexof the chest anteriorly, with dulness, and loud, harsh expiration at the left apex posteriorly. Treatment__Jlypophosphite of soda, dissolved in gum mucilage, was given three times a day, commencing with doses of ten grains, and gradually increasing to half a drachm by tho 17th December. Result.—After twelve weeks' treatment in the hospital, there was evident improvement in health and strength; she had gained half a stone {sevenpounds) in weight, coughed less, and the crepitation at the right apex was heard only after coughing; no expectoration. The catamenia had not returned, and the pulse was still above 100. Tho like treatment was subsequently continued, as an out-patient, until April; at which time she was stated to bo very ill, and she died soon afterwards. rilTHISIS IN THE FIRST STAGE ; IMPROVEMENT WHILST TAKING HYPOPHOSPHITE OF LIME. Case 2. It. C----, aged 21, a shipwright, admitted Nov. 23d, 1858 ; height, 5 ft. 8 in. ; weight, 8 sj. 10}£ lb. Being predisposed to consumption on his mother's side, his illness com- menced with an attack of haemoptysis to tho amount of half a pint whilst he was at work. This continued for three or four days to a slight extent, no has been losing uteight and strength ever since. He stated that he had had no cough until ten days before admission, and his ex- 'pectoration, which was muco-purulent in character, was in very small quantity. He had had no haemoptysis since the first attack, and suffered no pain ia his chest. His appetite was not good, and his bowels were costive ; pulse 90. The physical signs were dulness and bronchial breathing at the right apex. Treatment.__For ten weeks ho took the hypophosphite of lime, in doses of ten grains, gradu- ally increased to a drachm, three times a day, dissolved in an infusion of gentian ; after which he had cod-lioer oil alone, for two weeks, in place of the mixture. Result.__Underthe hypophosphite he improved in health and strength, and gained eleven pounds and a half. His condition then became stationary. Whilst taking the oil, he did not increase further in weight, though he felt equally well. His cough was trifling, with only slight expec- toration in the morning, but he still experienced some dyspnoea on exertion. His appetite was very Qood and pulse 92. The physical signs were much the same as on admission, the dulness being perhaps, less marked, and the respiration less bronchial in character. Dec 1853. —This patient hasnottaken any medicine since he Itft the hospital. He has retained ... imvroc£ in. ; weight, 9 st. 11 lb. He had no hereditary predisposition to phthisis, but had coughed for five months after taking cold. His expectoration was purulent but he had never had haemoptysis. He had had no night sweats; his appetite was good; pulse, 92. The physical signs were dulness, bronchial respiration, and crepitation at the apex- with dulness, deficient inspiration, and loud expiration on the left. Treatment.—For six weeks he had the hypophosphite of lime, ten grains which was then increased to fifty, three times a day, dissolved in gum mucilage and infusion of gentian ; after which the treatment was changed to cod-liver oil, which he took for seven weeks. Result.—Under the hypophosphite he did not progress satisfactorily—felt weaker, coughed more, and lost two pounds ia weight; while the disease rather advanced in the lungs, tho APPENDIX. 115 crepitation being still heard at the right apex, and some coarso crepitation also at tho left. Soon after commencing tho oil ho began to improve, gaining strength and weight—fivo pounds and a half in all; his appetite improved ; and ho coughed and expectorated less. PHTHISIS IN THE SECOND STAGE ; NO IMPROVEMENT FROM HYPOPHOSPHITE OF SODA J SUBSEQUENT IMPROVEMENT UNDER OTHER TREATMENT. Case 6. A. M. S----, aged twenty-seven, a ladies' maid, was admitted on Feb. 3d, 1859, height, 5 ft. 4 in.; weight, 7 st. 7 lb. With predisposition on her mother's side, she had had cough for three years, brought on by sleeping in a damp bed. Her expectoration was muco- purulent, but not in very great quantity. She never had haemoptysis, pains in the chest, or much dyspnoea. Her appetite was variable. She had lost very much in weight; and the catamenia had been absent for four months ; pulse about 100. The physical signs were dulness and extensive coarse crepitation on tho right side. The left apex presented similar signs of disease, but with less dulness and less crepitation before and behind. Treatment.—She had the hypophosphite of soda for three weeks in doses of ten grains. It was then increased to forty, three times a day, dissolved in gum mucilage. Result.— Under this treatment there was no sensible improvement. She did not gain strength, and she lost half a pound in weight. Her appetite was bad, and latterly sho com- plained of epigastric pain, unrelieved by suspending the use of tho remedy. Tho treatment was changed to a mixture of infusion of gentian, carbonate of soda, and diluted hydrocyanic acid, and continued for three weeks. She also took some purified cocoa-nut oil. Under this plan sho certainly improved, especially during the last fortnight, ncr cough was dry, but sometimes troublesome. No crepitation could be heard on the left, and only a little at the right apex. Her appetite was much better, and she gained strength and two pounds in weight. The catamenia also returned. PHTHISIS IN THE FIRST AND THIRD STAGE ; NO IMPROVEMENT FROM HYPOPHOS- PHITE OF SODA. Case 7. C. B----, aged twenty, a shopwoman, was admitted on Nov. 3d, 1S5S ; height, 5 ft. 1 in. ; weight, 6 st. 10 lb. Without family predisposition to consumption, she had coughed for more than a year, with purulent expectoration, and had had hcemoptysis on three or four occasions ; the catamenia were irregular; she had lost a good deal of flesh, and her appetite was bad. The physical signs were dulness, with cavernous respiration and crepitation on the right side, with loud, prolonged expiration on the left. Treatment.__For tho spaco of three weeks she took the hypophosphite of soda, in doses of ten grains three times a day, in mucilage or infusion of gentian ; for five weeks before this, and for three months and a half after, sho had ordinary tonic treatment, with a little cod-liver oil. Result.__She gained a little strength throughout, and the catamenia appeared regularly; but there was not much alteration in tho cough. Whilst taking the hypophosphite, she lost three pounds in weight; whereas, during the whole of the rest of the time, she maintained her weight without loss. Cimilusions.—Reviewing the cases, of which the preceding may be said to be types, we see that of twenty-two individuals laboring under phthisis, submitted to the hypophosphite treatment, sixteen derived no benefit whatever ; in three the benefit was so slight and tem- porary ns scarcely to deserve notice ; in two the improvement, though marked, was tempo- rary • and in one case the result has been satisfactory and permanent. Small as the thera- peutical powers of the hypophosphites are shown to be by these facts, are we justified in assigning to them even thus much? I think not. For we cannot forget that our cases are h snital cases ; that, oppressed by sickness, care,and anxiety,they come from close, unhealthy l'tics • that they were more or less destitute of good food and good air. When they enter hospital they begin to feel tho influence of hope ; they live in warm, airy, and well-venti- lated wards find agreeable occupations, and have plenty of good food. Under such circum- 116 APPENDIX. stances, the patients frequently improve in health, without the application of any medicinal agents. It would therefore be as fair to attribute the slight temporary improvement which took place in some of these cases to hygienic as to therapeutical agencies. A review of the preceding facts has led me to form a most unfavorable opinion of tho value of hypophosphites in the treatment of phthisis I believe them to be comparatively, if not absolutely, useless. I have been induced to take some little pains in investigating tho sub- ject, because of the unhesitating confidence with which their value is asserted and their use rocommended in certain quarters, and I have also seen in tho cases of somo patients who have visited Paris how much time has been thrown away by substituting the use of these salts for itmedics of undoubted efficacy in controlling the progress of phthisis. ANALYSIS OF THE PRECEDING REPORT. It is a lamentable circumstance when the narrow spirit of bigotry intrudes itself upon the councils of science ; but it is more lamentable when it mixes its pernicious shade with questions deeper than science, and which involve the well-being of the race. To the man of catholic views and philosophical culture, the spirit of medical bigotry is, of all others, the most incomprehensible, because it so manifestly outrages the very nature and conditions peculiar to medical science, and substitutes irrelevant and impertinent assumptions in the place of inductive experiment. The intelligent reader, who has carefully exam- ined the preceding report, cannot have failed of observing how this spirit, inspiring the whole, darkens in self-contradiction and unconscious perver- sions ; nor with what ungraceful reluctance it permits the confession of benefits of the most unmistakable and significant character. In my analysis of Dr. Quain's report, I do not think it necessary to make an exhaus- tive re-statement of Dr. Churchill's theory ; but it may be well to sketch, succinctly, certain distinctions not generally recognized by the profession, and which appear to have escaped the attention of Dr. Quain especially. Dr. Churchill adopted the use of the hypophosphites simply as the first of a series of inorganic remedies, with which he proposed experimenting; intending, subsequently, if these should fail, to use others. But observe, their failure would not have disproved the correctness of Churchill's general hypothesis. The essential and original feature of his theory being, simply, that it is to the inorganic constituents of the fluids that we must look for the special cause of the tubercular diathesis, and of all diatheses, he '' concluded to begin his experi- ments, towards determining this question, with phosphorus." (p. 12.) He had not yet" concluded that the failure was in phosphorus as a constituent of the body." Hypothesis, of course, preceded experiment, but experiment confirmed hypothesis; and it was not till then that he asserted the therapeutical superiority of phosphorus, in the particular form of the hypophosphite, over the usual treatment. That phthisis is proximately caused by some aberration in the processes of sanguification and nutrition, is an old doctrine, by no means original, nor claimed to be original, with Dr. Churchill. Its recogni- APPENDIX. 117 tion is universal. To deny it, is to charge empiricism upon the very treatment pursued in the Brompton Hospital! The problem, therefore, was : whether is the special cause of the tu- bercular diathesis to be found in the excess or waste of some inorganic, cr m"the excess or waste of some organic, constituent of the blood ? Already, as he states, (p. 12), and as all intelligent practitioners know, MM Andral, Gavarret, and others, had demonstrated that the variations in the composition of the blood, so far as its organic constituents are concerned, have no peculiar relation to pulmonary phthisis. Dr. Quain characterizes these propositions as "theoretical speculations;" but the reader will observe that experiment had already taken them out of the misty region of "speculation," and had established them upon the solid ground of demonstration, before Dr. Quain interposed this objection ; and he will also see, I trust, that, however unsupported by chemical observation in their inception, they were yet, even then, not without negative confirmation from the physiological observations cf the authorities just cited. Dr. Quain is not very clear in his statement, but he seems to say that phosphorus was exhibited in a low state of oxydation, chiefly because, in this condition, it is " more capable of assimilation." Assimilation is certainly important, but it is the oxydation of the phosphorus in the economy which is the essential fact, because its '' oxydation constitutes one of the essential phenomena of sanguification" (p. 91). In looking critically over the particulars of the cases reported by Dr. Quain, the conviction is irresist- ible, that his "conclusions" are not only unsupported by his facts, but that they arc in direct and obvious conflict with them. I doubt if any capable reader could reflectively examine this report- divested of the interested special pleading of its author—without concluding that the hypophosphites exhibited, in these cases, most remarkable and ener- getic therapeutical powers, notwithstanding their undoubted impurity. But let me indulge in a few general strictures, before I animadvert upon the particular characteristics of the report which I have yet to consider. Of the cases reported, and which are said to have been taken, " without selec- tion, from amongst the ordinary in-patients of the hospital," the first was admitted on the 3d November, 1858 ; the second, fourteen days after—on the 17th ; two were admitted twenty days after—on the 23d ; one, thirty-seven days after—on the 10th December; one, eighty-nine days after—on the 31st January, 1859 ; and one, ninety-two days after—on the 3d February. The general statements of the report, even the very words, "without selec- tion," convey the impression that the twenty-two cases were treated simul- taneously. But if the fifteen unreported cases were taken in the same manner as the reported cases, after long intervals, it would be interesting to know when Dr. Quain's "experiments" began and when they ended! Treatment was commenced in the seventh case—admitted November 3d, 1858—on the 8th December, and was continued three weeks. The result was most unfavorable. Thus by the 31st December it was known to Dr. Quain, according to his own showing, that the hypophosphites were " absolutely useless." Of course, 118 APPENDIX. then, he straightway abandoned their use ? Oh, no ! He still continued his remorseless '' experiments'' upon the unsuspecting twenty-two, during periods of from one tj six months, and thus wasted precious time *' in the use of these salts," when he was in possession of "remedies of undoubted efficacy in controlling tlie progress of phthisis !" * But if it is said that the patients were not put under treatment by the hypo- phosphites directly upon their admission to the hospital, the question arises : What treatment was employed during the long period between the first and the last cases ? And were they not rather manifestly taken, at last, because of tlieir hopeless condition ? I think this last question must be answered affirmatively. Any other an- swer is inadmissible, not only because it is impossible fairly to deduce any other answer from the report, but because any other answer would make us blush for Dr. Quain's humanity. It is better to be classed with the unfair and disingenuous, than with the reckless or heartless experimentalists. But this conjecture is negatively sustained by the consideration that not one of the cases, in which the hypophosphites are said to have failed, subsequently recovered by the use of the "remedies of undoubted efficacy." It cannot be doubted, I think, that if the cod-liver or cocoa-nut oils, or the "tonics," had cured a case in which the hypophosphites had failed, so conclusive a fact would have been circumstantially set forth in the report. But no such fact is found. I now pass to a consideration of the doses. One hundred and eighty grains of hypophosphite are said to have been administered to each of four patients daily, for several consecutive weeks ; enough to have endangered or des- troyed the life of the patient, if the salts had been pure, in half that period. This is a simple question of chemistry, and every chemist knows that oxy- dizable phosphorous cannot be safely used in these very large doses. There is, therefore, but one possible deduction from these facts : the salts used by Dr. Quain, in some of these cases, must have been excessively impure. Upon this vitally important point, however, the report vouchsafes no light. The author appears, indeed, not to have considered it of the slightest import- ance to the character of his experiments, or to his own character as an ob- server, that he should ascertain the purity of the salts by some satisfactory test; notwithstanding that their manufacture requires great delicacy of manipulation, and their commercial value holds out strong temptation to adulteration. No physician who has himself taken the pure hypophosphites, experiment- ally or otherwise, or who has exhibited them in his practice, can have failed of observing just those " troublesome symptoms, indicated by Dr. Churchill, as following large doses." The "improved powers of innervation ;" the' decided " stimulation of the functions of nutrition ;" the increased vigor of the appetite ; the cessation of the night sweats of phthisis ; the " unusual feel- ing of comfort and strength ;" and, after a time—according to the idiosyn- cracyof the patient—the "plethora," are phenomena of familiar and un- doubted occurrence. I can only wonder at the reckless audacity of the man who ventures upon APPENDIX. 119 their denial. But Dr. Quain ventures even beyond this. He has, assuming the purity of tho salts he employed, declared that the hypophosphites, as such, are "absolutely useless," and that they possess no more therapeutical power than "so many grains of carbonate of soda or prepared chalk." (!) Upon the truth of this extravagant proposition depends the whole value of Dr. Quain's report. Let the profession, then, submit its truth to a personal test—to such a test as it was not submitted by Dr. Quain. I have no fear, no doubt, of the result. I knoio, rather, that it will convict Dr. Quain of wanton ignorance and insincerity. There are many things in this report which I cannot critically notice, without danger of prolixity, and of fatiguing the patience of the reader ; but there is a particular paragraph which, in connection with what has just been said, so clearly discovers the spirit of its author, that I cannot forbear an allu- sion to it. The original treatise, from which Dr. Quain pretends to quote the passage : " I know that they will prove not only as sure a remedy in con- sumption, &c," contains no such language. The reader will find the passage in the Appendix to the translation (p. 99), which was compiled by the Ameri- can publisher, and which was not embraced in the French edition. At page 100, there will be found, in the same letter, Dr. Churchill's strictures upon the repen-i of Dr. Quoin's colleague—Dr. Cotton—a circumstance which is carefully ignored by Dr. Quain. Surely, then, the presumption is not strained nor unfair, that the present report was written for the very purpose of vindicating the conclusions of the other, and of supplying its designated deficiencies ; and the presumption be- comes almost a certainty when the reports are examined in the light of Dr. Churchill's letter : for an ingenious attempt is made to escape the particular objections urged by Dr. Churchill against the first report. Committed to a cause without merit, the advocate and the special pleader take the place of the man and the philosopher. Remarks on the Cases.—My first objection to the reports of the cases is that they arc characterized by a diplomatic vagueness of statement, as if the language were used with reference to its capacity for concealing the truth. This vagueness is out of place in a scientific paper, such as this report is de- si""ned to be. When exact statements are possible, hypothetical statements arc an impertinence. My second objection is to the extreme meagreness, and the inconsist- encies even, of the record of the physical signs. If the reader will take the trouble to compare the careful and elaborate records of Dr. Churchill's cases with those of Dr. Quain, the "meagreness" will be clearly illustrated ; the " inconsistencies" I will show by citations, in the proper place. My third objection is, that in only one of the cases—the sixth—(and this incidentally) is there any account made of the complications. Case I- The physical signs, in this case, are stated with an approach to ticularity, but the result reported, as to these signs, ia not very clear. It is • 1 that "the crepitation at the right apex was heard only after coughing;" nothinq is strirf as to the "dulness and harsh expiration at the left apex poste> 120 APPENDIX. riorly." This is an example of the "inconsistencies" I have charged upon the report. Is it unfair to infer, then, that these signs had disappeared ? If they had not, why did not Dr. Quain make his case stronger by saying so ? The improvements in strength, weiglit, and "health," together with the dis- appearance of several of the unfavorable symptoms, do not sustain Dr. Quain's extraordinary conclusion, that "there was nothing more felt by the patient than if so many grains of carbonate of soda, &c, had been given." But it is said that the termination was finally fatal. The reader will notice, however, that Dr. Quain does not say whether or not the patient died:of phthisis. He probably did not know, since he only affirms that it "was stated" to him that the patient was " very ill." Of what ? Could anything be more vague ? Case II. This case is, in many respects, the most remarkable of the series ; but it is chiefly remarkable as an illustration of Dr. Quain's manner of giving the hypophosphites "a fair trial," and of the "vagueness" with which I have charged him. Nothing could be more satisfactory, certainly, than the final result in this case ; ' 'for ten weeks [the patient] took the hypophosphite of lime,'' and gained eleven and a half pounds in weight, while his strength and "health" are acknow- ledged to have " improved." But this appears to have alarmed Dr. Quain, and accordingly we find him substituting " cod-liver oil for two weeks.'" But alas! the patient's "condition became stationary" under the oil—doubtless much to Dr. Quain's chagrin ; for if he had continued to improve, the oil might have been credited with the happy result. Then follow characteristic examples of vagueness: "the physical signs were much the same, the dulness perhaps was less marked, and the respiration [perhaps?] was less bronchial." Now, all this is unworthy—to use no harsher word—even of Dr. Quain; the "physical signs" were, or were not, the same; the "dulness" was, or was not, "less marked;" the "respiration" was, or was not, "less bronchial." Why use such obscure phrases as " much the same" and "perhaps," where exactness of statement is not only possible, but natural and necessary? If Dr. Quaia had exhibited thirty grains of a pure hypophosphite once a day in the place of sixty grains three times a day, of the hypophosphite whicli he did exhibit, he might, perhaps, have furnished us with a more decisive record Case III. This case is marked by comparatively unimportant discrepan- cies between the record of the physical signs and the results, but still it is marked. The conceded improvements in the general condition "during the whole time," the remarkable accumulation of flesh and the entire disappearance of the "crepitation at the apex of the lung in front," are results which can- not be pettifogged away-not even in favor of the balmy airs and the unctu- ous diet of the hospital! Amongst the physical signs enumerated, no mention is made of any diffi- culty in the left lung ; but in December, 1859-when the patient "began to wfine"7Dr;QUain T^0118' f°r ^ fiTSt Un£' a "pressing disease in the eft lung! It is said, also-and I request the reader's particular attention to this point-that the patient left the hospital < ' with the means at his disposal of APPENDIX. 121 continuing the remedies." As the man was " a laborer," it must be supposed that the "means at his disposal" were furnished by the hospital; and thus we have Dr. Quain in the singular act of permitting the hospital's means to be used in the purchase of remedies "absolutely useless," instead of fur- nishing the patient with the "remedies of undoubted efficacy in controll- ing the progress of phthisis!" But Dr. Quain did, or did not, know whether the patient " continued the remedies." If he did know, he should have said so, and thus have added the force of a positive statement to his report; if he did not know, randor requires that he should have mentioned so material a circumstance. Again : If Dr. Quain was dissatisfied with the progress made by his patient under the hypophosphite, it is not a little mysterious that he did not insist upon a change of treatment while the patient was still under his personal care ; since this seems to have been a case in which the " tonics and cod-liver oil" ought to have vindicated their vaunted superiority. Case IV. A "little improvement" is confessed in this case, of which the reader can judge. It will be observed, however, that nothing is said about the final result, nor are we told whether t'.ie patient was subsequently treated with the " tonics and cod-liver oil;" nor, if so, with what benefit. Case V. Wc arc left in similar darkness about the ultimate issue of this case. Neither are we told what interval occurred, if any, between the suspension of the hypophosphite and the administration of the oil. The oil gets cred- ited, though, with the subsequent improvement, notwithstanding that the exhibition of the hypophosphite might have been a material condition prece- dent to such improvement. The obscurity of the phrase, " did not progress satisfactorily,'' and the omission of any specific reference to some of the pre- viously-mentioned physical signs, justify the inference that, in spite of the loss of weight and an apparent aggravation of some of the symptoms, a favorable change had been effected in the diathesis. Case VI. This is the only case in which any reference is made to complica- tions. The patient "complained of epigastric pain "—is the brief chronicle of Dr. Quain upon this point. The objections urged against the fifth, may be repeated against this case, a fortiori. Case VII. In this case, also, the same "discreet silence," mentioned by Dr. Churchill, and pointed out in the preceding strictures, is observed as to the final issue of the disease. It is characterized by the same want of clearness, by the same disingenu- ousness, by the same manifest pre-determination of judgment, which so conspicuously appear throughout the whole report. We have the incompatible statements that, whilst taking the hypophos- phite (for three weeks only), the patient " lost three pounds," and yet that she '' gained a little strength ihrouglvout.'' We arc told, likewise, that, '' during the whole of the rest of the time," her weight " was maintained ;" but we arc left to conjecture whether "the rest of the time" includes the previous five weeks or only the subsequent three months and a half. If the decline •ommcncccl__as is most probable—during the first period, it was scarcely 122 APPENDIX. reasonable to suppose that a three weeks' treatment with a hypophosphite of doubtful purity would fully arrest it; and it 1; impossible to determine (as there was no interval, remedy immediately succeeding remedy) the extent to which the hypophosphite contributed to the subsequently " maintained " condition. We arc now prepared to estimate the '' conclusions'' of Dr. Quain at their true value ; and it will be conceded, I think, that they are not only unauthor- ized, but that they are contradicted, by his facts, and that, therefore, the report is absolutely valueless, so far as its opinions are concerned To the final eulogy upon the advantages of the Brompton Hospital—its airy and well-ventilated wards, its agreeable occupations, its plethoric dietary, and its copious rose-water, I have nothing to object. I have nothing to object to the truism, that when the sick have the best care they recover most rapidly ; nor that much credit is due, generally, to hygienic influences, as well as to therapeutical agencies ; but I do object to the very illogical application which Dr. Quain makes of all this. Let this be made clear. In a general statement of his " conclusions," embodying, as I have cheerfully admitted, much truth, Dr. Quain would seem to claim that the whole improvement in the cases was due to the advantages of the hospital ; but he carefully avoids making the claim specific. It was easy, and indeed his duty, to say, if he thought it true, that the particular cases, 1, 2, and 3, for example, were benefited solely by these advantages. But such a statement would have been obviously untrue. Accordingly, the reader is left with a gene- ralization, true in itself, but false when applied to the facts before him, and with the apparent hope that it will be so applied. I cannot conclude these strictures without calling the reader's critical at- tention to the singular account which Dr. Quain gives, in his closing para- graph, of the motive that prompted him to enter upon his investigation of the claims of the hypophosphites: singular, in that he assigns, as his°sole rea- son, " the unhesitating confidence with which their value is asserted, and their use recommended, in certain quarters." It would be interesting to 'know just what Dr. Quain means by " certain quarters." He cannot mean Dr. Churchill, for he has referred to him by name. He cannot mean te refer to the obscure old ladies who have such unlimited faith in sage tea, and who furnish those wonderful "testimonials" to the nostrum-mongers, for that would be be- neath the dignity of Dr. Quain. But if he means, as he plainly does, to refer to respectable members of his own profession, it would be of some advantage without doubt, in making up an impartial judgment upon this controversy' to know upon what grounds they established their conclusions. Perhaps it might appear that they are as competent to conduct such an Inquiry as Dr Quain; perhaps it might appear that the investigations, which resulted in impressing upon them so favorable an opinion of the value of the hypo- phosphites, were conducted with at least as particular a regard to the various conditions of success—with quite as unselfish and impartial a devotion to the interests of science and humanity—as were the experiments which led Dr. Quain to so unfavorable a conclusion. APPENDIX. 123 I cannot better bring this article to a close than by calling the attention cf the reader to the abundant and authoritative evidences—to be found in another Appendix—of the success of the hypophosphites in the hands of the profession of this country ; or than by entreating him to remember the words of their distinguished discoverer, addressed to his brethren on this side of the Atlantic—but more needed on the other side of the British Channel : "In therapeutics, as in every other department of experimental research, no number of negative instances can outweigh one positive result, obtained under cer- tain determinate conditions, unless it be at the same time shown that, in the negative instances, all these conditions have been expressly complied with." (p. 103.) J. WINCHESTER. 43 John Street, N. Y., June, 1860. [From Brailhwaile's Retrospect: JYo. A'A'A'VII] FIRST REPORT OF THE BROMPTON HOSPITAL.* ON THE "SPECIFIC" ACTION OF CERTAIN SALTS OF PHOSPHORUS IN PHTHISIS. DY DR. RICHARD FAYNE COTTON. My experience of this remedy is based upon carefully-made observations upon twenty < if my own in-patients at the Hospital for Consumption. Copious notes were taken by Dr. Walker and Mr. Ford, the resident clinical assistants, and arc open to the inspection of those who may be desirous of obtaining more information than I am able to offer in the present communication. Dr. Churchill's rules for administering it were carefully attended to ; five grains dissolved in water, with the addition of a small quantity of syrup, being given three times a day. The cases consisted of nine males and eleven females, all of whom were adults. Three were in the first stage of consump- tion, five in the second, and twelve in the third. All were affected with the disease in its simple form, there being no other than the ordinary complica- tions The remedy was administered for a fortnight, notes being regularly taken • if at the expiration of this period no improvement was observable, it was discontinued ; but if the patients expressed themselves relieved, other medicines were prescribed with the view of testing whether such relief was fairly attributable to "specific" agency, or to other circumstances-such as improved diet, rest, &c, which should always be taken into account in esti- mating the effect of medicinal agents upon hospital patients. Of "the three patients in the first stage of the disease, two were not per- ce tibly influenced by the hypophosphites, but afterwards improved consider- * Sco Dr. Churchill's letter, p. 100. 124 APPENDIX. ably under tonic treatment and cod-liver oil; the other considered himself much stronger, but before admission to the hospital he had been almost starved, so that good diet, &c, may reasonably claim a fair share of the credit; and he left before other medicines could be tried. Of the five patients in the second stage of the disease, two were not in any way influenced by the hypophosphites, but subsequently expressed them- selves as feeling "much better" under tonic treatment, with cod-liver oil; two slightly improved, but one of those afterwards advanced at a much more rapid rate under steel and oil, and the other seemed to get on quite as well under steel and quinine ; the remaining one became much worse from a gradual advance of the malady. Of the twelve patients in the last stage of the disease, one felt herself bet- ter under the hypophosphite than under any other remedy ; one improved greatly, but not more than under the subsequent use of other tonics ; three improved slightly, but afterwards progressed much more rapidly under steel and cod-liver oil; two were not at all benefited, but found themselves " much better" under a change of treatment; in two cases no effect was observed, and in spite of all treatment the disease ran on ; one of the patients became worse, but subsequently gained strength under the oil and quinine ; the re- maining two died. Thus, in only two instances could this remedy be said to act with any marked benefit, and in one of these its good effect was very equivocal, the patient previ >us to admission having been in an almost starving condition, and leaving the hospital before the comparative trial could be made with other medicines. In all the rest it acted certainly in no way as a ' specific;" in most, it seemed to be inert; and the few cases which slightly improved during its administration were evident]}- instances of the post, and not the propter hoc, since some advanced equally, and many of them more rapidly, un- der the subsequent use of steel or quinine with cod-liver oil. It is very possible that the compound of phosphorus proposed by Dr. Churchill may, in some cases, have a tonic and beneficial influence ; but to any " specific" action upon tuberculosis it seems to have no claim. The employment of phosphorus in the treatment of phthisis is by no means novel. For the last eight or nine years I have been in the habit of using a mixture consisting of the dilute phosphoric acid with the phosphate of iron ; and at my suggestion it has been inserted in our hospital pharma- copoeia. In many cases much good has attended, and I think I may say heen produced, by its administration; but I attribute it to no specific action I believe it is a simple tonic, adapted to certain depressed states of the svs- tem. J Phosphorus is a well-known and apparently necessary constituent of all healthy nerve structure ; and, in some conditions of low nervous vigor its medicinal employment may be of great service. Wc find that it enters largely into the ccmpcsiticn of the most nutritive kinds of grain- and we may be quite sure that it is not placed there without a purpose. APPENDIX. 12-3 [From the iV. T. Medical Press, March 31, 1S63.] THE HYPOPHOSPHITES IN SOME CONDITIONS OF DISEASE IN YOUNG CHILDREN. EY 0. C. GIBBS, M. D. Every physician who has been called upon to prescribe for young chib dren, has frequently seen cerebral symptoms suddenly occur, thus complica- ting the case, and often disappointing his most sanguine hopes of a favor- able issue. Symptoms, not unlike those which characterize acute hydroceph- alus, occasionally supervene in the progress of other diseases, which, unless promptly and appropriately met, terminate a case fatally that might other- wise have recovered. It is of the first importance that this complication, which is pathologically antagonistical to meningitis, should be promptly dis- tinguished and correctly diagnosed from hydrocephalus. In the complication under consideration, the thoughtful and observing physician has doubtless felt the need of a more promptly efficient brain- stimulant and tonic. It is often the case that death could be averted if the , nervous energies could be aroused and temporarily sustained. A case, illustrative of the above remark, came under our observation a few months ago, and it may not be uninteresting to briefly allude to its more important features. November 15th, 1859, we were called to see a female child, aged eleven months. The child was of a decidedly scrofulous habit; had from the first few weeks of life been troubled with scrofulous sores and cutaneous erup- tions, but at present it was suffering from an attack of pneumonia. The general and physical symptoms were all well marked. We ordered syrup of ipecacuanha, spirits of nitre, and paregoric, in appropriate doses, for internal remedies, and applied mustard to the chest. The patient was closely watched, yet the'symptoms gradually increased in severity. On the third day, syrups ipecac, and liquorice were given in combination, and powders, composed of Dover's powder, quinine, and small doses of the chalk and mercury mixture, were added to the treatment. The symptoms still in- creased in severity ; though the skin was moist, the cough was troublesome, the rml^ ^ in the flrst case in rCmi«ent fever : but, judging from its I™^£™Aperiodic powers, and think it which it was administered, I would have' -«° ^ of co^titutional iaiosyncrasy, or m chrome cases wh P ^^ ^.^ ^ ^ ^ t acute diseases ^^1^,regime, this new preparation might bo used withmuchad- a .-ccssary^ ^_______________________________________ vantage.—-.""11'___._____________________-—-------------- ; ■------------rroneral Circular, on the use of Cod-liver oil ia Consumption. #5co page 3, uniru firto tit ft^--#Uito! §qmi$f H THE HYPOPHOSPHITES IN CONSUMPTION AND COG- NATE DISEASES. There can no longer remain a reasonable doubt of tho therapeutical value of the Hypophos- phites ia the treatment of Consumption and cognate diseases, since the very general test to which they have been subjected duAg the past two years, and their rapidly extending ap- preciation by tho profession, both in the Old World and in the New, establish them amongst the most important contributions which have been made to Materia Medica during the last century. It will not have escaped the attention of the careful reader of the Treatise, that, in all cases where pure preparations of these salts have been used, their effects have been prompt and radical, so that the physician who has most extensively exhibited them in his practice, has commended them with most enthusiasm, and has been most astonished by the happy re- sults of his experiments. It is a complete answer to the cavilers at " new things," to point to these numerous cases. as they so fully establish the extraordinary power of the Hypophosphites, when pure, over the tubercular condition, that they cannot fail of impressing upon all minds the manifest truth, that the failures which have been imputed to the remedy, are due solely to the meretricious compounds prepared by ignorant or mercenary apothecaries and chemists. The c sea em- bodied in this appendix, it should be stated, are but types of several hundreds which are con- tained in an extensive business and professional correspondence. An exhaustive statement of the evidence from this single source, would fill a considerable volume by itself; but, as Dr. Churchill has observed (Ante p. 9)," it is not so much the num- ber of favorable cases as it is their relative agreement which gives weight." But it is not strange that unfavorable results should sometimes get reported to the journals, when wo consider the shameful circumstance that, in Boston, New York, Philadelphia, Cin- cinnati, Chicago, St. Louis, and New Orleans, and in many places of less note, some of the most prominent apothecaries have not only made combinations of the Hypophosphites, which are explicitly condemned by Dr. Churchill (Irox especially), but they have, with a wanton ignor- ance of the authority which they thus repudiate, printed it upon their labels that the remedy was " discovered by Dr. Churchill OF DUBLIN ! ! " Dr. Churchill " of Dublin" is a distinguished writer upon Obstetrics, but he is not entitled to the distinction of having made the new discovery in Therapeutics. In the light of such disclosures (which may be verified by the reader with little trouble), it ceases to be matter for surprise that the treatment whiGh was supplied from such sources, failed of that consummate success which has uniformly attended the exhibition ofareliablo preparation. The attention of the reader is called, in this connection, to tho statements of Dr. Churchill, at pp. 80, 81,95, 96, and 101. These citations will show of what vital necessity the Author esteems the purity of the salts, and this necessity can not be too frequently nor too deeply impressed upon the mind of the profession. It explains every apparent failure, and shows that no negative conclusion, based upon experiments in which so essential a condition of success has been neglected, is of the least value. The failure to observe this condition, indeed, would have afforded a sufficient reason for rejecting the Reports of the Brompton Hospital, even if there were no other grounds (such as APPEXDIX. 131 have been shown), for regarding them as utterly without weight in determining the value of tho new remedial agents proposed by Dr. Churchill. REPORT OF CASES BY W. W. TOWNSEND, M. D. Chatham, Pa., 3d Month, 26th, 18C0. Friend J. \Vi.\-chestkr :—At tho time of receiving your letter, requesting a report of the cases in which I had used the IlYPornosrHrrES, I was very much engaged both night and day. We have an epidemic ot typhus fever, commencing last July, which has occupied all my time and attention. Many of tho persons who have taken the Hypophosphites have not been under my immediate care • but most Df the cases I havo had an opportunity of examining, previous to their commencing the treatment A detailed account ot each case would be very interesting and instructive. This, however. I am anabie to give, except in very few cases Thirty-six persons have obtained tho medicine from me, twelve ot whom have been under my own care. Fivo of them were, in my opinion, and in tho judgment of other physicians, Iwpclcss cases cf phthisis, with irritable cough, copious expectoration or a purulent character, night-sweats, and emaciation 2 liese cases were from one it- three years' standing Auscultation and percussion developed sounds, which, taken in connection with other symptoms, gave evi- dence of a condition from which I HAVE NEVER, in seventeen years' practice, SEEN A SLVGLE CASE RECOVER BY ANY OTHER TREATMENT. Tho usua. dose was from five to ten grains a day None of them have taken over three of tho largo bottles. Under the use of the Hypophosphites, all Die bad symptoms ceased, they have gained flesh, and strength, and health—some of them hetter than they had e.vjoyed for seven years previously. The other cases under my care were in the incipient stage, and, in these, all symptoms or traces of the disease have disappeared. Of those who were not under my care, I have not heard of a single pat.cut who did not express himsel, benefited by the use -,f the Remedy, although in somo ot them tb.3 dlsoaso was too far advanced to admit tho possibility (if recovery. I presume I am as skeptical ia medicines or specifics as most physicians ; yet, from the experience I have had .a the use of Dr J. F. Churchill's Remedy for Tuberculosis, I would say to aU who have any tendency to that disease: Take ix, axd the »«™^™ ^ there is disorganization, * * * »• • ■ P. S.-If the foregoing, or any part of it, is of any use to you, you may publish it in con- ncction with my name, if you seo proper. FURTHER REPORT FROM DR. TOWNSEND. Additional C:.*«-s---Remarkable Results. Chatham, Pa. , 6th Mo. 12th, 18C0. mirvn I AVin-chesteu :-IIaving obtained from thee a considerable quantity of Dr. Church- lniEM) J. i- ^ Coxsumittov, which I have used to some extent in my ownprac- ill's Remedy for the _ ■ - ^ dM t0 thc coramunity to state the results, so far TtC^lC: Cre u^ my own immediate notice, or I have my information from re.i- able sources. a,ed 47 married • born in Chester county. Had a decided tubercu- C.VSL. 1. , ° . brothers and sisters, died of phthisis. During the * inu-r u xoo , Spline Toole cold on the slightest exposure ■ cough u.c hmHh hn.q bocu on tno aeciiuc. j.w». v © which time his health nas d frequent chills; pains of a neuralgic tor-ition • pain in tho .eft siac oi im i-uv.» -i , . . - andCX1KLt° "'rious parts of the.y.tem . pulse becoming more and more frequent; loss of character in w incivasing dyspnoea [difficulty of breathing? on tho slightest exertion ; fl,sU and strong ' ysia rbteedmg of the lungsl , percussion elicited a dull sound, and , ,-equent attacks ^^ ^^ indistinct. Although a very activo business man, he had been 132 APPENDIX. Diagnosis.—Tubercles in the first stage of softening ; which was conflrmod by the opinions of two eminent physicians of Philadelphia. i directed him to take the Hypophosphites, commencing with one teaspoonful in the morn- ing, and gradually to increase the dose He was not able to increase the doses to more than ten grains, or to continue the use o f the remedy constantly without increasing the hemorrhage. The exact length of time ne remained under treatment, or tho total quantity he has used, I am not able to state, as 1 did not see mm regularly. But (Ms 2 know: HE HAS REGAINED HIS HEALTH, and is now engaged in a laborious and fatiguing occupation. CASE II---------, married aged about 40 This patient had, in February, 1858, a severe attack ot pneumonia, from which lie did not wholly recover , ieft lung duh on percus- sion, and the respiratory murmur scarcely audible. During the following summer, he was subject to frequent chills took cold on the slightest exposure, or change of weather ; cough very troublesome, especially in the morning In tho course ol the following winter fl859). he commenced to expectorate a substance of a mucopurulent character ; lost liesh and strength ; pulse quick and jerking ; night-sweats ; with a slight rhonchus, or sub-crepitous sound upon auscultation. Diagnosis —Tubercles in the first stage of softening He now commenced tho use of your " Preparation of the Hypophosphites," in doses of five grains, twice a day, which was continued; with short intervals, until ho took nearly two bot- tles of the large size, when not a vestige of the bad symptoms .'before stated) could be discov- ered, ALL PHYSICAL SIGNS HAVING ENTIRELY DISAPPEARED. Over a year has now elapsed, and he still retains his health and strength. To use his owv> language ■ " I have better health since I took that medicine than for several years previously 1 AM WELL. There is Blood in that Medicine " CASE IH.—----; aged 25 years unmarried. This patient came to me from a dis tance. He was pale and emaciated, frequently clearing out his throat; said his cough troub led him very much at night; that he had pain in his breast and under his shoulder-blades and was often very hoarse . that his health had been rapidly declining for about six months; was of a consumptive family ; has had several attacks of hemorrhage. very short of breath on the least exercise ; pulse 120, and weak. Upon examination, I found a sub-crepitant rhon- chus throughout the bronchial tubes ; percussion dull. Diagnosis —Tubercles in both lungs ; and that he was about to have an attack of hemor- rhage—which soon after occurred. After the bleeding had ceased, I advised him to take tho Hypophosphites. I did not see him again for three months, when he again called upon me. He had used, during this period, one large bottle of the Hypophosphites, and hadgained twenty pounds in flesh. Pulse 80 . per- cussion and auscultation discovered no unhealthy nor discordant sounds. He said his appetite was good, and that he felt as well and as strong as he ever did before. His appearance fully corroborated the truth of this assertion. He has passed the winter since I saw him and I leara that he still retains his lieallh. I might extend my report by the statement of many more cases of (to myself) equally surprising recoveries from tho use of this Remedy; but it would be simply useless to repeat what is already given. I have no doubt, whatever, of the superior efficacy of the Hypophosphites, in the treatment of Tuberculosis, OVER ALL OTHER MEDICINES, OR METHODS, HITHERTO DIS- COVERED. 1 repeat what I said in a former communication, that I know of no medicine or treatment with which I have ever seen effected in this fatal malady anything more than a mitiga- tion. Yet, lv similar cases, under the use of Churchill's Hypophosphites, as prepared by your- self, I HAVE SEEN MANY RESTORED TO THEIR USUAL HEALTH AND VIGOR. I do not wish to be understood as saying that this Remedy will cure in all cases or stages of Consumption. It is not, as many suppose, merely necessary to obtain the medicine, and take it under all and every circumstance. On the contrary, d ought to be administered under the direction and care of an honest, intelligent physician, who is the best judge as to tho quantity, and also when to take the remedy and when to cease. Without this intelligent super- vision, many cases will fail to be benefited that otherwise might have a different result. APPENDIX. W-i 1 would here remark, that I have met with several invalids who told me they had been taking Churchill's medicines, whofailedto receive any benefit whatever. Upon examination 1 round that one obtained a preparation made in Cincinnati, Ohio, and another in Wilmington, Del , both of which were entirely different from your « Genuine Preparation." One of these spurious articles, proved to be Prof. Jackson^s Phosphates of Lime, d-c., and the other had. a combination of Iron, of which the patient took a table-spoonful three times a day, without the least visible effect 1 I mention these facts, within my own knowledge, to GUARD PATIENTS AGAINST IMPOSTURE. In conclusion, I repeat that I might report many additional cases, or which those given are a fair type, of the results obtained by your Hypophosphites. 1 can state that over sixty per- sons have obtained the remedy from me, and of the entire number, / cannot turn to a single casethat has not been benefited by their use. Several were in the last stage ot disease, when no curative progress could be looked for : yet, even in these tho patients expressed themselves relieved. In thosa which terminated fatally, there was an improvement of strength, increase of nervous force, stoppageof night-sweats, and amelioration in the general symptoms ; so much so, in some instances, that both the patients and their friends were disposed to hope against my certain conviction and better judgment. 1 have had many letters addressed to me, from different sections of the country, since your publication or my first brief report, and patients have come from considerable dis- tances to consult me in regard to the treatment. ************ I am, very respectfully, your friend, W.W. TOWNSEND, M. D. REPORTS FROM NEW ENGLAND PHYSICIANS. New England Agency Office, Boston, June 22, 1S60. Dear Sir : Dr. Benjamin Weeks, of this city, who has taken a very deep and patient inter- est in collecting the opinions of his numerous professional friends in New England, as to the value of the I lypophosphites in Phthisis and Tuberculosis, has generously permitted me to abridge a portion of the following report from his note-book. For the most part, the notes of Dr Weeks were collected, ho informed me, during the months of January and May last; and are chiefly a record of informal verbal communications, divested of technical precision : and, though freely given, not designed to be presented as scientific reports of the cases to which they refer. Perhaps on this very account, they are the more valuable, as embodying unreserved ex- pressions of professional opinion. Too frequently, also, it is the case, that a report designed for the Scientific Convention is so overlaid with exceptions and qualifications, as to make it difficult to discover precisely what are the real opinions of its author upon the subject which ho discusses. I trust therefore that whatever may be the supposed deficiencies of the report, the gen- tlemen named in it will not be held responsible for them. Boston Mass.—Dr. Benjamin Weeks, recently used " Winchester's Preparation" in two cases of Laryngeal and Bronchial Phthisis: The first—a scrofulous and feeble patient, still more debilitated by a recent abortion, with attending hemorrhage and harassing cough—was cured by the use of a single largo bottle. The second case—affecting the upper portion of the lung, accompanied with severe cough, hectic, dysmenorrhcea, a general nervous debility and prost ration—has greatly improved, and is nearly recovered under the use of the second bottle Dr Sunderland has prescribed tho Preparation in several cases. He reports two cases of * ervous debility and prostration. One was accompanied with chronic inflammation of grC • -is which had long resisted other treatment, under different physicians. Both patients ™!77 in a short time by the use of the Hypophosphites. wore cureu iu "• •= Wold of Jamaica Plain, is using it extensively " with success." 7 Morri^ Mattcson has used the remedy in his own case, and is " highly pleased" with it. 134 APPENDIX. Many of the leading physicians in Boston hive obtained "Winchester's Preparation," most, if not all, of whom, are now using it in their practice in preference to any other prepa- rations of the Hypophosphites. Among these, I may mention Drs. Thayer, McFarlane, Ware. Garret, Warren, Smyth, Pinkerton, Fuller, Goulet, Lee, and others. And in the vicinity of Bos- ton, are Drs. Parker, of Melrose , Swan, of Dorchester ; Fenlon, of Newtonville : Salisbury, of Brookline ; Thinney, of Melrose ; Babbitt, of Quincy ; Warfield, of Holliston ; Whitney, and others, of Framingham. Lawrence, Mass.—Dr. Geo. W. Garland states that he commenced by using the Hypophos- phite of Lime. He at first gave it in a case of Tubercular Phthisis, far advanced in the stage of softening ; with frequent hemorrhage, purulent expectoration, and great emaciation. The case had resisted the ordinary treatment, and was considered hopeless. He commenced using th remedy m January last, when an improvement was soon perceptible, and now (23d May, 1860) the patient has every appearance of perfect health. Dr. G. also states that he pro- scribed it in the case of a lady, who had recently aborted, who had profuse hemorrhage, and win had also an alarming and harassing cough, was anemic, and exhibited great emaciation and debility. Under the use of the Hypophosphites she perfectly recovered, Mr. H. M. Whitney druggist and apothecary, at Lawrence, gives the case of a young man in the last stage of Consumption, who had taken./h-e bottles of Xichols' Hypophosphites (containing iron, &c ), with no benefit, and who, by tho advice of Dr. Howe, has since used " Winchester's Preparation," " with decided benefit." Thinks he will recover under its use. Though the case was considered hopeless, the remedy has had a " wonderful effect." E. G Frothingham, Jr., druggist and apothecary, of Haverhill, writes,under date May 4th, 1860 : " I am fully convinced of the great value of Winchester's Hypophosphites in Pulmonary affections, both from accounts given me by several physicians, and by several cases which have come under my own observation, two of which were considered hopeless, and both of which are now improving." Wist Amesbury, Mass.—Dr. Pattee reports a case of Phthisis and Marasmus, of long stand- ing. The patient, a girl of twelve years, was reduced almost to a skeleton. Various remedies were used with no beneficial results. Five bottles of other Hypophosphites had been administered, but they seemed only to increase the hectic symptoms. Dr. P. finally ordered " Winchester's Hypophosphites of Lime and Soda," and, under the use of two bottles, she was entirely cured. Soura Royalston, Mass.—Dr. J. B. Gould writes, under date January 9, 1860 : " I have used the Hypophosphites somewhat in my practice, but not Winchester's Preparation. I wish now to compare his vnth other preparations." And again, as to the result, under date February 6, I860, he writes : " It is giving a high degree of satisfaction." Portland, Me.—Samuel H. Tewksbury, M. D., Physician to the United States Marine Hos- pital , says he has prescribed " Winchester's Hypophosphites " in some forty or fifty cases of Consumption, Chlorosis, Dyspepsia, Marasmus, &c, with the happiest results—having found them superior to all others. He speaks with enthusiasm of this Remedy, and is still using it, with increasing confidence in, all the diseases for which it is specially recommended by Dr. Churchill. Dr. Eliphalet Clark, also of Portland, has prescribed " Winchester's Preparation" in a large number of cases of Tuberculosis, Chlorosis, Anemia, &c., with very satisfactory results. He refers to one case in particular—a clergyman—who had been laid up for two years ; a severe cough, great emaciation, night-sweats, and all the more prominent symptoms of the last stage of Phthisis, fully developed. All the usual remedies had been resorted to without effect. Under the use of the Hypophosphites his improvement was decided—night-sweats ceased appetite increased, and gained in flesh at the rate of two and a half pounds per week ■ with a fair prospect of final recovery. Dr. Clark says the Remedy has not failed to stop the night- S ,'EATS IN A SINGLE INSTANCE. Dr. J. T- Dana, another eminent physician or Portland, has also prescribed Winchester's Hypophosphites in about fifteen or twenty cases, and is well pleased with their therapeutical effects. He gives them a decided preference over all other preparations of the kind__having tried them all. APPENDIX. 135 New Bedford, Ma?s.—Dr. Cha3. M. Tuttle states that he knows of no remedy equal to the Hypophosphites in Pulmonary diseases, Chloro^, Anemia, kc. Has been prescribing it for several months, and should be " unwilling to do without it in his practice." Fall River, Mass.—Drs. Fiske and Clarke aro using " Winchester's Preparation," and ro- port it " working well." They are not yet ready to report ia detail. TAtrjJTON, Mass.—Dr. S. P. Hubbard is using it a good deal. He formerly prescribed another preparation, but now considers Winchester's superior. Grafton, Mass.—Dr. F. A. Bosworth has used it much " with invariably satisfactory re- sults." Concord, N. H.—Dr. James E. Sargent says the preparation answers his most sanguine expectations.' He relates a case of Abcess in lower part of right lung—a case of Phthisis Pul- monalis. It was long in developing, but finally discharged profusely. The patient was much emaciated, with severe cough, hectic, and all the symptoms of Phthisis. Immediato im- provement was manifest under the use of the Hypophosphites of Lime and Soda Dr. S. re- ports tho patient now in perfect health. Dr. Geo, Warren Smith, of Concord, writes under date May 28,1860: "I have used ' Winchester's Hypophosphites' in several cases or Phthisis. In each case the cough subsided, the respiration improved, and tho bulk or the body was in- creased I have also used them in Chlorosis with marked success." Dr. A. Morrill, Concord, is u-ing them with good effect. He is now prescribing it in two cases or phthisis far advanced. He thinks thoy have prolonged the lives of these patients through the winter, and both aro now improving, with a fair prospect of recovery. Dr E G Moore also of Concord, has prescribed tho preparation in many cases of pul- monary and other affections, « with very good results ;" especially so in a case of Phthisis Pulmonis, with abcess, which is fast recovering. He will report this and other cases. He holds the remedy in " high estimation." Dr J M Graves Concord, has prescribed it generally/'with satisfaction." Ho mentions a severe case or Tuberculosis, where the remedy gave relicr, but rears the disease is too far advanced to admit of recovery. n,. . Drs. Timothy Haynes, Ezra Carter, and others, or Concord, are using it with excellent reSUDovER N H.-Dr. Chas. H. Horsh has prescribed the Hypophosphite of Lime in two cases of Tubercular Consumption, both too far advanced to anticipate a cure. In one case, the remedv gave considerable relief: in the other, but little-thinks the lives of both patients were prolonged by its use-but both died. Also administered it in two cases of chlorosis- „naccompanied with profuse Leucorrluza, Dyspepsia, and Gastralgia. Both patients were muchlaciated, both immediately improved under its use, and both entirely recovered in a Tor short time. Dr. H. has used it in several other cases of more or less seventy, and be- eves the remedy " an important addition to the Materia Medica." r, 7 I H Buzzell of Dover, is using the preparation in a marked case or Tuberculosa .' 11 ' The ratient has been under the treatment rotir or five weeks ; has rapidly '" 7 nd nlw has a ti prospect or recovery. Drs. A. Bickford, P. A. Stackpole, L. G. ZZS'^^™1^^""*^'^"ThcyintendtestiDsitfur- ther and will report. x- tt nr, F & E. Colburn are using the Remedy, and think well of it. Dr. J. Nashua N. H.-l._-i satisfaction." Dr. Woodbury is " well pleased with its G. Graves ,s using.t with C°"P „ f GeQ Gray has prcscribed it» in many cases ;" effects.both upon hunself, and 1 ati.uv.. ,; an excellent remedy for that class of Dis- nas several now under treatment ana d - rcscribi and £eIlil)g the Remedyi ^Z^^ZZL NeaHy or quite al, the Physicians in Nashua are using and speaWs decidedly as to* ^ thejr beneficial t,,rocts. « Winchesters Hypophosphite.-,, ano. abseil, mK N H _Pr chas. T. Elliott gives Winchester's HYPOFHOsrnrrES great praise. (;REATl'rV,tinseveralcasesoiratera//on,,"withcntireBuccess." He mentions one case, Has prescribed i ^ u,1,lu^ll.r, wnere he was called in consultation. The case was m particular, in ^^ rcaKHlies having failed. Dr. E. advised the Hypophos- rniisuk're.l incuraui>- 136 APPENDIX. phites—'•' Winchester's Preparation." The patient began to improve, and, to the surpriso of all, both Physicians and friends, is now well. Dr. E. reports him "entirely recovered." Dr. E. has also used it in Chlorosis, Anemia, kc, with like results. He will report these, and other interesting cases, in full. Dr. Chas. H Shackford, of Great Falls, is prescribing it ex- tensively, and with "satisfactory results." Drs J. C. Hanson, Frank Tuttle, Edward H. Pratt, and others, of Great Falls, speak in flattering.terms of the effects or the Remedy in Phthisis, and cognate Diseases. Franklin, N. H.—Dr. K. L. Knight thinks it " the best remedy he can prescribe in Pulmo- nary Diseases." Mason Village, N. H.—Dr. Edwin Schofield is using it, " with the desired effects." As the above report is intended to embrace only the opinions or medical men, I omit tho numerous cases of private persons, within my personal knowledge, who have been either cured or benefited by the remedy. Yours, kc, WM. M. MASON. J. Winchester, 43 John street, N. Y. ------------g» * »■ ALCOHOLIC TREATMENT OF DISEASE. Dr. Higginbottom finds that the Nottingham Board of Guardians have spent £130 during the past year in wines, spirits, and ale, and he thereupon remarks :—''I cannot look upon that expenditure, in any light, but as a sinful waste of the rate-payers' money , and it has been the means of perpetuating intemperance, and producing poverty, crime, disease, and death, as a general result.'' He then goes on to say :—"I have particularly had my attention directed to alcohol, in the form of wines, spirits, ales, etc., for many years, with its effects on the human system, both in health and disease, and have endeavored to gain a thorough practical knowledge of the subject. I prescribed those stimulants, for the first twenty years of my practice, as cus- tomary with my Medical brethren. I have relinquished their use altogether Lor the last twenty-seven years, from a full conviction or their inefficiency, and their dangerous qualities as a medicine, even before the Temperance Societies had any existence ; this has been corrobo- rated by my subsequent practice, from the above period to tho present time. I have found, by abandoning alcoholic stimulants altogether, acute disease has been much more readily cured, and that chronic disease has been much more manageable. I have never seen a patient injured by the disuse of alcoholic fluids, and have not heard from my professional brethren, or patients, that it has been the cause of a single death. I have no hesitation in affirming that the old system of blood-letting has destroyed hundreds of valuable lives, and I have loss hjpsitation in affirming that the present plan of alcoholizing patients is destroying its thousands." The views held by Dr. Higginbottom are, I believe, held by many a venerable Practitioner or our Art; and are, therefore, worthy of our serious consideration.—London Medical Times and Gazette. EFFECT OF ALCOHOLIC STIMULANTS IN CONSUMPTION.— Dr. John Bell, of New York, is the author of an able essay upon tho effects of alcoholic liquors in tubercular disease, or in constitutions predisposed to such disease, which secured to him the Fiske Fund prize of two hundred dollars. It displays great research upon a sub- ject of very grave interest. We have space only for the conclusions. " 1. The opinion, so largely prevailing, as to the effects of the use of alcoholic liquors, viz., that they have a marked influence in preventing the deposition of tubercle, is destitute of any solid foundation. " '2. Oa the contrary, their use predisposes to tubercular deposition. '■ 3 Where tubercle already exists, alcohol has no effect in modifying tho usual course run oy that substance. '■ 4. Neither does it mitigate the morbid effects of tubercle upon the system, in any stage of tht Utease." APPENDIX. 137 RELATION OF ALCOHOL TO DISEASE.-Chcmical experiments have demonstrated that tho action of Alcohol on the digestive fluid is to destroy its active principle- ihe pepsin; thus confirming the observations of physiologists, that its use gives rise to the most serious disorders of the stomach, and the most malignant aberrations or tho entire economy. It is evident that, so far from being the conservator of health, Alcohol is an active and powerful cause of disease. Interfering, as it does, with the respiration, the circulation, and the nutrition, how is any other result possible 1 Nothing can bo more certain than that : It is a powerful antagonist of the digestive process. It prevents the natural changes going on in the blood. It impedes the liberation of carbonic acid—a deadly poison It obstructs the Nutritive and Reparative functions. It produces disease of the liver. It has a powerful affinity for the substance of the Brain,—being, indeed, essentially A Brain- Poison. [Alcohol and the Constitution of Man, by Professor E L. Youmans.] Published by D Appleton & Co , New York. DANCER OF IRON IN CONSUMPTION AND CHLOROSIS. In a succeeding edition of tho Treatise, wo design publishing—if by any means it can be obtained—a full report, or synopsis,of the discussion, in the course of which M. Trousseau pronounced his remarkable opinions. No doctrine has been announced, during tho present century, that deserves, or that will receive, profounder attention from tho profession, than that which is hero published : " M. Trousseau has just given utterance to an authoritative and positive statement, which will, no doubt, surprise the profession everywhere. He declares that iron, in any form, give:i in chlorotic affections, to patients in whom tho consumptive diathesis exists, invaria- bly fixes that diathesis, and hastenstJie development of thelubercles. The iron may induco a fac titious return to health , the physician may flatter himself that he has corrected tho chlorotic condition of his patient ; but, to his surprise, he will find tho patient soon after fall into a phthisical state from which there is no return. This result, or at least its hastening, M. Trousseau attributes to tho iron. The assertion is a most startling one M Trousseau is nevertheless, so certain of what he says, that ho denounces tho administration of iron in chlorosis as criminal in the highest degree."— Med. Correspondent oftlie N Y Times, in Paris. ON THE HYPOPHOSPHITE OF MANGANESE. BY W. ELMER, M. D. Olje functions of the glandular system, as well as the lymphatics, are at fault in Consump- tion ; and hence tho necessity of agents capable of influencing these functions. For this reason, Manganese is an important agent in the treatment of Consumption. In its action, Manganese stimulates the glandular system, and quickens tho functions of the lymph- atics and lacteals. He,,,-,., in our opinion, thotlypophosphite of Manganese is most valuable in the treatment of Phthisis and Tuberculosis. This salt, combined with others [Lime and Soda?] is peculiarly advantageous, especially there aro irritating cough and fever, and, wo will add, is the most valuable preparation known iu the cure of recent coughs and incipient Phthisis, and may be used in any stage of the ,. ,e Wuh beneficial results. disc ^„„i,i.,>c«r T.imnon,! \in^»n™ have crcat merit. Wo have used them not Tho Hvpophosphitcsor Lime and Manganese have great ment. W. ._.:.,„ hut in ppcent coni-hs with much satisfaction.—A"< only in Reporter, Consumption, but in recent coughs with much satisfaction.— North American Medical 138 APPENDIX. THE TESTIMONY OF ENGLISH PHYSICIANS. Remarkable Evidence of tho Efficacy of the Hypophosphites. [At the very moment of going to press with this Edition of the Treatise of Dr. Chlbchill, I had placed in my hands, by the politeness of the Publisher Mr W. A. Townsend, the proof sheets of the forthcoming number ol ' Brailhwatte's Retrospect of Practical Medicine"for July, I860, from which 1 republish the following highly interesting and instructive Reports. These Reports at once sustain the correctness and illustrate' the fairness, of the strictures i-pon the Reports of the Brompton Hospital. Indeed each of them as specifically contradicts the absurd assumptions of Drs. Cotton and Quain.as if it had been particularly designed tor that purpose But while these medical gentlemen are explicit and unequivocal in the testimony which they bear to the extraordinary therapeutical powers of the Hypophos- phites, they reveal a cautious conservatism in their conclusion; which will make their evidence all the more valu- able to the profession; because this very conservatism is a guaranty of the independence, and an evidence of the. integrity, of their observations.] The Hypophosphites in Tuberculosis, Debility, Strumous Dyspepsia, Loss of Appetite, &c. [Reported to the London Medical Circular.] I have now prescribed the Hypophosphites in about twenty cases. They were in various stages of the disease, chiefly in tho first and s3cond stages ; two were in the third stage. One case has taken tho remedy twelve months ; all tho others about six months They are still under treatment. So far from no physiological effect being produced, I have generally found, in each case, the following effects : A great increase of appetite ; increase of animal heat (in some cases, not in all) ; a marked diminution of the expectoration, in every case ; the patients also expressing a feeling of improvement in their breathing power—that they could fill their chest better with air. On making an examination of the chest with the stethoscope, I have found the moist clicks to diminish in number ; in one instance, they disappeared entirely, and were replaced by vesicular breathing, perhaps somewhat harsher than natural ; this was an instance where the disease was of limited extent, in the upper part of the right lung, but, nev- ertheless a well-marked case. The hypophosphites appear to act as respiratory excitants ; and I should certainly be disappointed, upon testing their breathing power with the spirome- ter, if the volume of air inspired at each act of inspiration was not increased. I have not a spirometer, and, therefore, have not made the experiment; but, judging from the respiration becoming almost puerile in some portions of the lungs, when, before its administration, the respiratory murmur was so feeble and indistinct as to bo scarcely heard, and also from the loss of breathlessness experienced by the patients themselves, I certainly should, from a con- sideration of the above phenomena, expect to find that such would bo the case Physicians connected with public institutions could easily settle this point. In October last, I gave a young man, set. 20, fivo grains, three times a day Ho had all the symptoms of phthisis , had diarrhoza ; was drenched with morning perspirations ; had no appetite ; and his loss of flesh and strength was so rapid, that it threatened to be a case of galloping consumption—there was unmistakablo evidence of crude tubercle in tho lungs When he had taken tho hypophosphites for a month, his appetite became voracious; he gained weight at the rate of three pounds a weelc, for three successive weeks, and felt so strong and well that he resumed his work as a factory operative, and has continued at it until the present time. I saw him again last Saturday (February 25th) , he is now losing flesh, and has a dry cough, with partial aphonia—no night sweats • I advised him to rest, and resume the hypophosphites—with what results, time will show. No other remedial agent was used in this case, except nutritious diet. • A sister, aet. 25, of the last patient, has persevered with the hypophosphites for twelve months. She has had chronic phthisis for five years ; it had been kept in abeyance by cod-liver oil, until twelve months ago, when, from some unexplained cause, her digestive organs would not tolerate the oil any longer, when she rapidly declined in health. I then gave the hypophos- phites. The improvement was more marked and permanent than in her brother's case I saw her again on February 25th, when she expressed herself as being QrrrE well ^-xever better in her lite. She had a robust appearance, and was very stout. All the general symptoms Jiavc disappeared. I had* not an opportunity of examining the chest APPENDIX. 139 So far from ao offset being produced, lam in Ute habit of prescribing kypophotphiles in any exhausted condition of the system where loss of appetite and debility are the most prominent symp- toms. The following caso briefly illustrates their utility in strumous dyspepsia, attended with de- bility : 0n7une 14th, 1859, tho treatment with hypophosphites began , his weight was 137 pounds; no appetite, and weak. June 20lh, 14L pounds. August 13th, 145 pounds—his appetite and strength keeping pace with his Increasing weight. On January 14th. I860,1 gave the hypophosphites to a farmer, oH. 43, who had taken various tonics for a month, with no improvement to his appetite and strength On making an examination of his chest, I found evidence of a slight deposit In the upper part of the loft lung Ho had gradually lost flesh, and had been troublod with dyspeptic symptoms for six months On the administration of the hypophosphites, his appetite gradu- ally returned, and he began to gain weight, having gained four pounds in a fortnight. Surely here is evidence of some physiological power? The largest dose I have given has been half a drachm [30 grains; a day, in doses of ten grains each. Very few of my patients can take more than five grains three times a day, without producing headache and unpleasant feelings of fullness about tho head In ono case, epistaxis came on AL my patients lock plenty of out-door exercise when tho weather permitted. No very satisfactory improvement took place in a less period than three weeks. I should bo afraid to give a drachm-dose [60 grains] three times a day To recapitulate • I claim for the hypophosphites a power of stimulating the appetite for food—silica has taken place in every case . a power of rapidly diminishing the expecto- ration in ait. r^a under my observation, and, in some, completely arresting it : a power tjincreasinn the expansion of the chest; and, theoretically, of being respiratory excitants : and they present us, at the same time, with « very efficient blood-generatmg agents ■ My expe- rience docs notenablo me to say thoy cure phthisis ; but that they retard rrs proceeds, par- ticularly th,t of softening, I am quite convinced ; and that they are a ustful auxi.iary m the treatment of phthisis, whatever other power they may possess, has iimen estabushed to m, SATISFACTION. Testimony of Dr. Dickson, of Jersey. His Visit to Dr. Churchill. [Reported to the London Medical Circular.] la tho month of October last, while in Paris,I visited Dr. Churchill's Dispensary, and being satisfied from what I saw that there was something in his treatment of consumption, by the use of hypophosphites, on my return to this place I put the treatment in practice, and hava "und U so beneficial in the majority of the cases so treated, that I am induced to persev re. JZo tried it in about thirty cases, in every stage of the disease, and in the majonty-say two- ££2 i-Provement has been very marked. My experience has prove , tha i is deci^ cdlv beneficial in the earlier stages of the disease, although one very material effect of the m dicincs vL: their power of checking night sweats, makes them very useful in all s ao.3 medicines viz >~ ca=eslsaw under Dr. Churchill's care, was tho fact that What convinced me most in the ca c.*™ u ^ ^ ^^ those who presented thems^es at ^ °^J 77^ ^y auscultation and percussion) or society ,^^^^Z^^^^^^^^^^^ and who ^^^^^^^oV^to work for that food-therefore, I reasoned, the time, perhaps, nearly starved), ana oni. treatment Since my return from ir tf>ese cases improve there "^^^^T^L. on thei/patients, and Paris, I have requested several medical fronds to try Zr U —-— ™^ ™T^ TSZSt anTth" bkompton T^T^™-N dltl ^whowfar the improvement maybe perm, M- IVS "c\^rCe however, satisfies me, that in tho hypophosphites wo have apo^ n<3nt- !, th onTh'e Boore of humaaity alone, they ought to have a fair and .mpartial tnaL «*■"' ^ „nCt the results of the treatment on a near relate of mine, who has been I may mention ^ ^ ^ Churchill's care, is as satisfadcry as His graUfying. foI- somo meiu-is "" 140 APPENDIX. EXTRACTS FROM MEDICAL JOURNALS, &c. " HvpopHospniTES.—Whatever may be the estimate placed on Dr. Churchill's theory of the adaptation of this class of remedies to the cure of Phthisis, yet all will be impressed with the importance of givino theji a fair trial. The announcement or Mr. Winchester, in our advertising columns, wiL enable physicians to procure them, prepared strictly by Dr. Churchill's method, and thus test their value. Mr. Winchester is WORTHY OF ALL CONFIDENCE, and devtes himself enthusiastically to these preparations, in all their variety of combinations." —D. Meredith Reese, M. D., I.L. D., Ed. N. Y. Med. Gazette. ' There is no disease in the long list that human nature is subject to, the treatment of which has occupied the minds of physicians so constantly, and for so long a period, as that of pulmonary phthisis Time after time the discoveries or remedies have been announced. The compounds or iron, sulphur, iodine, cod-liver oil, etc., have been arrayed before the pe.blic, and had fair and persistent trials, and they all have failed to establish the virtues claimed for them, although we admit that many of them are exceedingly useful in palliating some of the distressing symptoms of this disease. ' At this point wo find Dr J Francis Churchill, a physician well known to the medical profession, taking up the study of tuberculosis in 1855, while engaged in the practice of medicine at Havana. * * * Dr. Churchill, ia his first statement, gives very de- tailed statements of thirty-four cases, nine of which were thoroughly cured, eleven relieved, and fourteen appeared to receive no benefit. If these relative numbers are to express what future practice is to be in the case of the Hypophosphites, these compounds would certainly be said to possess great virtue. * * With those facts before us, it certainly be- comes the medical profession to give the Hypophosphites a fair and persistent trial.''—Drs. S. M. Bemiss and J. W. Benson, Eds. Louisville Medical News. ' The use or that class or salts known as Hypophosphites offers the most direct and philo- sophical means of supplying the phosphorus to the system. The small amount or oxygen in com- bination with this element in the hypophosphorous acid which unites with tho alkaline car- bonates, the bases of these salts, is favorable to easy decomposition in the economy. By the changes which result from further oxydation, nascent phosphorus and phosphorates are liberated. The phosphorus thus set free is certainly in a condition most favorable to the fulfill- ment of its design and high office in the brain and nervous system. "—Boston Medical and Surgical Journal. " Whatever may be our conclusions with reference to the claims of Dr. Churchill for the Hypophosphites as sovereign remedies in tuberculosis, there can be no doubt as to the value of these salts as remedial agents.;'—American Medical Monthly (N. Y.). " We now see the rationale ot the employment or the Hypophosphites or Lime and Soda, recommended by Dr. Churchill, in the treatment of consumption—they not only act as ab- sorbents, but repair or retard the waste of tissue."—II. P. De Wees, M. D., New York (in Vie American Medical Monthly). " The recent recommendation, by Dr. Churchill, of the use of the Hypophosphites in the treatment of Phthisis, is now undergoing a general test by the medical profession. * * * From my own observation and inquiry, patients using the hypophosphites have experienced marked relief from many of the annoying symptoms attendant upon Phthisis."—J. Lawrence Smith, M. D., Professor of Chemistry in the University or Louisville. (From the Louisville Medical Netos.) '•This medicine is scientifically prepared, and reliable. We have used it in our own practice, in Phthisis Pulmonalis, and other forms of disease, with very satisfactory results * * * In sixty-eight cases in which this remedy was given, thirty-seven were in the in- cipient, and twenty-three in the second and advanced stages of consumption , the remainder were beyond hope With the exception of the latter cases, which were much benefited, all but three, which are still doubtful, recovered perfectly "—North American Medical Reporter " On every side we see our brethren take hold of tho Hypophosphites, for the purpose of giving them a fair trial: and, as far as we know, Tire results seem to be entirely favorable, confirming those already obtained by Dr. Churchill.»-Drs. J. L. Kiernan and W. O'Meagher. Eds. N. Y.Med. Press. * AJPIPEISTDIX TO Til THIRD EDITION. REMARKABLE CURE OF SPASMODIC ASTHMA, COMPLI- CATED WITH SEVERE PULMONARY DISEASE. Tho attention of the reader, and especially of all suffrrers from a most distressing malady —Spasmodic Asthma—need hardly be called to the following graphic letter from W. W. Townsend, M. D., reporting his own experience in the use of " Winchester's Preparation of the Hypophosphites. " It may well be regarded as one of the most remarkable cases ever reported : Chatham, Pa., 7th mo., 1st, 18e0. Friend J. Winchester : Having been afflicted with Spasmodic Asthma for more than twenty- five years, and suffering as much as mortal man could bear—for I cannot believe there is an individual living who has suffared more than I have—and having at last been relieved nay CURED, by tho use or Churchill's Hypophosphites, I deem it a duty I owe to suffering hu- manity to give publicity to my case. This .. shall do in as fow words as possible ; for, togiva a foil account or tho scenes through which I havo passed, and the various remedies and treat- ment to which I have been subjected, would require a volume. I am a descendant or long-lived and healthy ancestors, and, during my minor'ty, wax robust and athletic—weighing, in my twenty-first year^l75 pounds. During that year, J contracted a 6ovcro cold, for which I used no remedies whatever, and which terminated iq Asthma. For several years, though able to attend to business, I lost flesh, and had severe exacerbations spring and fall. The winters of 1842-3, and 1843-4, I spent in Philadelphia, and was partially exempt from severe paroxysms. After my removal from tho country, in the spring of 1814, the attacks were renewed with greater severity than I had ever before experienced ; and, for fifteen years following, I never laid down to sleep, and awoke, without a severe spasm. I becamo emaciated, and reduced in weight to 113 lbs. For many years, during this period, I do not believe I slept more than four hours in each twenty-four, and never laid down without having Stramonium leaves, tobacco, apipe, and nitrous paper within my reach ; for, after trying every remedy ot which I could avail myseir, I settled upon these as giving the most speedy reliel—having long ceased to look for anything permanent. In the month of May, 1859, after being much exposed, I was attacked with chills, followed by fover, pain in the right side or my chest, and, in a fow days, I commenced to expectorate profusely a substance of a muco-purulent character. Alarming symptoms rapidly developed themselves—such as shortness of breath, night-sweats, hectic fever, &c. while I was becom- ing moro and more debilitated and emaciated every day. At this tims I commenced taking the Hypophosphites, at tho dose of one tsaspoonful morn- ing and evening, while eating, increasing gradually to two teaspoonfuls at each doso. By the time I had used one large bottle the cough, expectoration, hectic fover, and night-sweats had all ceased I slept soundly all night ; appetite good, and in one month I gained twenty-five pounds. I am now twenty pounds heavier than I have been for sixteen years. Over a year has elapsed since I began tho use or the Hypophosphites, and I P.EMAIN WELL, having had no reiurnofthe Asthma, although greatly exposed to the inclemencies of the weather >oth night and day. The disease may return—I cannot but fear it; but, if it should, I shall foel that the release I have had for ono year from its terrible paroxysms is entirely attribut- able to the Hypophosphites, and that I am amply repaid, and will try again. i am awaro that most asthmatics get better or worse about tho ago of 45. I grew worse. lam now in my 521 year. W. W. TOWNSEND, M. D. 142 APPEEXDIX. Additional Cases. I have heard from other cases of Asthma, the details of which I do not here give. 1. This case was of thirty years' standing—very much relieved, but not cured. 2. Of thirty-five years'standing—with same result. 3. A case of G years, the greater part or which time the patient was confined to the house and treated for Consumption. H3 had taken three bottles of Phosphate of Lime without any benefit. At my suggestion this patient began the use of the Hypophosphites. He soon grew better, and able to attend to the management of his farm, doing as much work as any of his neighbors—looks well, and has gained flesh as well as strength. It is now over a year since he took the remedy, and HE IS STILL WELL. 4. A lady, subject to hay Asthma, or acute attacks, during the haying season, for many years. She commenced the use of the Hypophosphites the present summer, previous to hay- ing, and, although exposed to the odor of new hay the whole season, has not only escaped an attack, but has experienced a great improvement in her general health, and gained several pounds in weight. She left the neighborhood soon after harvest, and I have not heard of her since. 5 This is a case put under treatment within the past month. The patient, a male about 80 years of age, has been an asthmatic the greater part of his life, and had tried various reme- dies. He says : " I never took any medicine in my life that gave me so much and such prompt relief. I am entirely relieved since I took it the first day. " W. W. T. EXTRACTS FROM MEDICAL CORRESPONDENCE. West Amesbury, Mass., Oct. 13,I860.—" I have been using your Preparation of the Hypo- phosphites : the effect is all I can desire or expect from any Medicine. I find my patients improving when taking the remedy : would they have improved in the use of any other modi- cine, other things being equal? I think not.—A. F. Pattee, M. D. Platea, Erie Co., Pa., Aug. 29, I860.-" I have used your Preparation in about every case treated by me, with nearly uniform success; and, in some cases, with marvelous Errecr when it seemed hope had almost fled. In Nervous Debility, it is all-potent, acting like a charm. I could mention cases that would astonish the most credulous."—J. S. St. John M. D. " The Hypophosphites, as far as I have used them, have acted well, very much relieving me, and curing my little boy, who was suffering from marasmus, with a decided strumous dia- thesis. Iu the other cases in which I have used the remedy, a marlced improvement in aU the symptoms has been noticed. * * * I am led to believe it one of the very best remekes in Tuberculosis that wo possess. The night-sweats cease, the appetite improves, the blood is enriched in those constituents which are so essential to health, and which are deficient in those persons predisposed to consumption, viz., organizable fibrine and healthy red corpuscles »-A Hurd, M. D., Oxford, Ia. '• I have used the Hypophosphites, principally in tubercular disease, but also in Chlorosis and in diseases attended with nervous debility. I consider them the most efficient Uood-generat- x*4 agents with which I am acquainted, and believe they also exert an important influence directly on the nervous system, of a tonic character. They exert an important remedial in- fluence over tubercular disease, by improvlng the nervous strength and invigorating the nutritive funotlons. Combined judiciously with air and exercise, care being taken to keep the bowels and skin in proper condition, they seem to me to be tnvaluable.'W Physician Morristown, N. J. jr»«v««™, DR. Carter of Vrbana, Ohio, was for six weeks afflicted with fever, exhausting night- sweats, hurried respiration, loss of flesh and appetite, and a distressing cough-all the signs, indeed, of Consumption. He used all the resources of his own skill, without avail and wm supposed by himself, and pronounced by his medical friends, to be in the first'stage of phthisis. He began the use of -Winchester's Preparation" of the Hypophosphites. ml few days his appetite returned, his pulse was greatly reduced, his respiration was unobstructed and his cough had entirely disappeared. In a little more than a fortnight,!* had gained eight pounds ot flesh I * 6 APPENDIX. 143 GENERAL REPORT OF THE RESULTS OF THE HYPO- PHOSPHITES IN OVER THREE HUNDRED CASES. [It is with peculiar satisfaction that I call the attention of the professional reader to the following communication from Dr. Harrison. When it is known that Dr. H. was, probably, the first physician iu the United States who tested the Hypophosphites by the treatment of him- self, when in a hopeless stage of tubercular consumption, and that he has since prescribed the remedy in many hundreds of cases, with almost invariably favorable results, the value of the testimony will be conceded by all unprejudiced minds. When professional men, eminently conservative in their opinions, and careful in their observations of tho effects of the Hypo- phosphites, give them so unqualified an approval, as Dr. Harrison and others have done, the universal adoption of this treatment, in pulmonary diseases and other morbid conditions of the system,(to the exclusion of all previous methods, le and most $ afflrauatcl cases, over which it has ompletely triumphed : and this, too, without administering ) other medicines than wero absolutely necessary to keep tho bowels in a healthy condition. In \ some) iastances where the patient has been given up by the attending physician as incurable ; and, ) in a great number of cases whero all the remedies placed before the public for the euro of Rheumatism had been faithfully employed, without the least effect, this EMBROCATION HAS PR A'ED ITS TRANSCENDENT SUPERIORITY. The Proprietor has never, in a sin,jle iastince, ha 1 occasion to resort to blood-letting, mercury, or opium ; or, indeed, to any of tho usual means tried ia that complaint." " It wi.l allay the pain an I soreness, and reduce tho swelling in a much shorter time than can possibly bo effected by any other means : ia fact, it WILL RELIEVE WIIKN ALL OTHERS FAIL ; nor cau any injury result from exposure after its application. The patient will also be less liabb to another attack when cured by this remedy, tha:i by other appliances, as it does not affect the constitution iu the slighest d grce, nor imair the parts innn Mi itelv involved ; but, on tho contrary, IT RESTORES THEM TO THEIR ORIGINAL HEALTHY CuNDITloN AND L\SL.1'ULNI->S." " Oa7of t'.ie most important advantages this EMBROCATION possesses over all other remedies, i? that uhn it is properb/ appliel, no caNTRAunovs of the tendons can possibly ensue ; and whero contractions already exist, they aro elect tally removed: thus preventing any distortion of the extremities, aud securing tho patient against tho danger of becoming a cripple for life, as is tin case in thousands of instances when other modes of treatment aro adopted.'' From the numerous and highly respectable testimonials placed in my hands by the ^ discoverer, and from a long personal acquaintance with him as my family physician, I havo no )> hesitation in asserting that DR. VAN BUREN'S Rheumatic Embrocation is a Never-Failing Cure ! in all tho various forms of RHEUMATISM (Chronic and Inflammatory), GOLT, etc., etc., when faithfully and perseveringly employed. It is, also, equally prompt and certain in Nervous Headache, Neuralgia, etc.,,tc., aud in every case IT IS WARRANTED TO GIVE SPEEDY RELIEF. PRICE : $1 per Bottle ; Six Bottles for $5. 0Gj» Orders for the •• EMBROCATION " may be addressed to either of tho Wholesale Drug Houses of New York ■ to my General Agents, or to tho undersigned, Sole Proprietor. The most liberal Discount to the Trade. Terms Cash. In ordering, address, or refer to, J. WBNCHESTER, :*0 John Street, IV. Y. v^-^Ol---------—ii^£^----------€<^>T^y I (2) TESTI3IONIALS. ^ Brooklyn, Nor. 2llh, 1S60. J. Winchester.—Dear Sir: As you expressed a desire, at the time I gave you tho Formula for the preparation or my RHEUMATIC EMBROCATION, for some testimonials in regard to its efficacy, I now inclose a fow of tho many presented to me at various times, showing the surpris- ing results of the use of the Embrocation iu Rheumatic affections. Although certifying to remark- able cures, these statements fall short of what I have witnessed during a practice of more than thirty years : during which period I have depended solely upon this remedy, and with almost INVARIABLE SUCCESS. In very many instances, I have effected cures, after all other l.nown appliance* lux I proved abortive; anil, in a few cases, when the patient had B2en pronounced incurable by the attending physician. This, I assure you, is no exaggerated statement of my experience in the use or the Embroca- tion, designed for effect, but is strictly tho truth —of which, should any one doubt, you are at liberty to rcrer them to me. Yours, most respectfully, M. VAN BUREN, M. D, i 97 Middagh St., Brooklyn, Nov. 6/A, 1844. Dr. Van Buren,—Hear Sir: I wish to make known to y< u, and, if possible, to all who may be suffering under that most terrible disease, Rheumatism, with which I have been sorely afflicted, tho great and immediate benefit I received, and the cure effected, by the use of your Rheumatic Embrocation. I was attacked with Rheumatism in April last, which soon became so severe as to confine me to the bed, without the power in the least to help myself; my attendants being obliged to lift nic out aud in the bed. when necessary to rise. For a number cf days I suffered the most intense agony, during which time I had medical advice, but without affording me any relief. I tried the Medicated Vapor Baths, but received no benefit. My suffering became so great, that I despaired of ever getting relief ; and, at times, thought I could not long survive it. Hearing of tho many cures effected by your Embrocation, I resolved as a last resource to try it. A bottle was procured, aud in fifteen minutes' use of it I experienced relief, and declare. positively, that in two hours, to the astonishment of myself and attendants, I was entirely free from pain, having used the Embrocation four or five times within the two hours ; and in a few ,,JT) days I was able to walk out. It was the belier or many, before ushigyour Embrocation, that it f-J would be months before I should be able to attend to my business, or go about. Four or live bot- [\) t'es etr.-cted a perrect cure ; nor have I had the slightest symptom or it since. I consider your C|s LI) Embrocation invaluable, and am satisfied that,were it properties as well appreciated by others, (ij ^\ no one would be without it for any length of time. /y As statements of a similar kind to the above are so often laid before the public, and no depend- ence placed therein, believing them to be fictitious, you are at liberty to refer as many as you dcrm proper to me, as it will aflbrd me the greatest pleasure to state to them the particulars or mv case ; and, to further satisfy, will produce abundant evidence to corroborate what I have above stated. Yours, most sincerely. D. W. SMITH. Brooklyn, Feb. Sd. 1845. • Dear Sir : From feelings of gratitude to you, and for the benefit of ail afflicted with Rheuma- tism, I am anxious to make known the very valuable properties of your Rheumatic Embrocation. About six week? ago my son, aged seven years, was so severely attacked with Rheumatism as to deprive him of the use of his legs. They were so sore and painful, that it was impossible for him to stand on, or use, them in the least. I had a physician in attendance, but without any benefit that I could discover. Anxious to see him relieved from the severe pain he was suffering under, and had been for some days, I was induced, from the high recommendation given or your Embroca- tion, to try it, without believing at that time that any material benefit would resu.t from its use, ns I had known so many remedies to fail which had been recommended in such cases. But, to the , i astonishment and gratification of myseffand family, he experienced almost immediate relief, and \\ iu two days was able to run about the room, apparently as well as ever, and has continued so. c1 This is no exaggerated statement, of which I will satisfy the most incredulous, should they think (/ proper to call upon me. Yours, respectfully, M. SWANEY, Corner of Pearl and Nassau Sts. New York, May 23d; 1845. Dear Sir: I should be wanting in common gratitude, were I not to express my thanks to you. for the relief afforded tome by your invaluable Embrocation. I was attacked last February by that m< st terrible disorder, Rheumatism, extending to all parts ot my body : and for four weeks I tried a variety of remedies (many ot them certain cures, or recommended as such), but found no relief. Fortunately for me, I heard or your Embrocation, which was obtained and applied ; and I may safely say that from that day the pain gradually left me, and I felt myself once more regaining the health and strength I had lost. Anxiety to attend to my business caused me to leave the house too soon, and being caught in a storm, and getting very w< t, I had a relapse. I again applied tho remedy, and in a few days was well; and from that time to this have felt no return of pain. You are welcome to make use of this as you think proper, and to refer any person to me who may not bo thoroughly convinced. Yours, respectfully, To Dr. Van Buren. GEORGE CLARK, 134 Canal Street WD ?$^y jw vi- w w >■'■>■■ vl- vt v-v 79 ""^V!*^ 'i '■'(■ 'b'' mwmm$wmww®m\ LADIES MORNING PILL: A prompt and positive specific for " Morning Sickness," or the Nausea None or n,„ Pregna,ncy' and other Female Complaints. n« h, ,7,?! «• m;l"v comPhx*tions <>> Pregnancy is more distressing, and, hitherto, none tiivwn h . °f c?,UroI'as the so-callod •< MORNING SICKNESS." Heretofore, the ,, >C7h i ''oen.s"?lply /><*"ta«i>-dircctod only to tho temporary mitigation or susyenicn \tX„n \ ,' Us radical cure; because, among all the powerful agents cf the old iriiuiiil, ,„'; ,"•""'J'^.w-re known to possess the .specific power of subduing the Uterine Irri- tability which is the chvf proximate cause of the disturbance. v„,«»!' iwP'^''l'"'MS llllse(l on tuis clearer understanding o. the. causes wnich produce tho iti Vn V rc^iyu-v' and of tno requiremcutsof the general economv while under thatccn- uial ierm > I '"'"'^ U a~w'iU'therefore. is not superficial and fugitive, hut fundamental Hi '^ ?!'E(mf Acn '-v ot" tho Morning Pill is to allay uterine irritation, not to stimulate it; in 'i More its administration is not attended with the danger of aborting, even in the most deli- cate and sensitive organizations, or at any period of the pregnancy. In Amenorrhea, or suppressed menses (when not the result of pregnancy), this pill is me salcst and most effectual Remedy known to medical science. It acts kindly, ccrtain'y, ana without excitement—restoring the menstrual flow in a manner so natural that the pa- tient is scarcely conscious or being under the influence or medicine. In Menorrhagia, or Excessive Menstrual Flow, tho " Morning Pill " acts fovorab'y in ar- resting the discharge, when too long continued or too profuse, bv csta" ":shing a oropcr and natural secretion. * "kick : ONE DOLLAR PER BOX : SIX BOXES FOR FIVE D0LI.AR3. SENT BY M;iIL. THE SPECIFIC PILL: A prompt, radical, and Specific Remedy for Spermatorrhea, or Seminal Weakness, and Genital Irritability, in either Sex. This latest application or Medical Science to the treatment and cure of a distressing and ''bstiuate nvilady has proved an inkstoiaule boon to the thousands who were rapidly declin- ing, in bodily and mental powers, from tho DEBILITY OF EXHAUSTION which is the inevit- able coNSK-iUuxcB of the drain upon tho system. Eil'ects the. mo.-t terrible resu't from a long continuance of tho emissions: pallor, emaciation, sunken eyes, pains in tho head, lowncss ot spirits, aversion to bodily or mental effort, languor, nervous'prostration, impotence, insanity or mental weakness, paralysis—death ! There seldom occurs a case of True Spermatorrhea, which one to three boxes of these Pills will not comj-Ietely cure. MEDICAL TESTIMONY. " We beLeve it to be, in the treatment of Spermatorrhea,as near a specific as any meci- c.no can be. We have cured many severe cases with from six to ten doses."—B. Kuriii, M. D. \.lm. Jour. Indie/enous Mat. Midica. Price : ONE DOLLAR PER BOX ; SIX BOXES FOR FIVE DOLLARS. SEN" BY MAIL. DR. VAN BUREN'S RHEUMATIC EMBROCATION: For the Cure of Rheumatism, Gout, Lumbago, Nervous Headache, Contracted Tendons, Weak Joints, Sprains, &c. This Preparation is not tho result of an accidental or hasty thought ; b' t of many years, praclicoaud experience. Tho relief it affords, in the m st violent and distressing cases cf Rheumatism, is as speedy as it is certain. It has been tried in the worst possible and mo.-t ag- §3 •3 Important testimony of Dr. Van Buren. J. Winchester—Dear Sir: In presenting yon tho formula for preparing my RHEUMATIC EMBROCATION, I also give you some testimonials, showing the surprising results of its use. Although certifying to rema/'/,aW<.'cu)-es. these statemi ntsfall short of what I have wj-ne^kij during a practice of more than thirty years : during which period I havo depended s.ile y upon this remedy, and with almost INVARIABLE SUCCESS. In very many instances, I jiavk KFFECTEDcwe-.-, after all other known appliances had proved abortive; and, ia a few cases. whe:i tho patient had bixv pronounced incurable by tub attending physician. * * * * Brooklyn, N. Y., Nov. 30th, 1860. M. VAN BUREN, !I. D. Price —ONE DOLLAR PER BOTTLE ; SIX BOTTLES FOR FIVE DOLI.ABS. J8SJ- The usual Discount to Physicinns and Druggists. Terms, Cash. & -^ W I -NT C II K S T E 1.1' ?r5 genuine preparations or to:: HYPOPHOSPHITES / ARE SOLD AT PROPRIETOR'S PRICES BY, AND MAY BE ORDERED FROM, ALLTHEWHQ'ESALE DRUG HOUSES OF NEV/YORK. ALSO BY THE FOLLOWING WHOLESALE AGENTS : NEW ENGLAND. Boston—WEEKS & POTTER ; G. C. GOODWIN & CO.; REED, CUTLER & CO.; M. S. BURR & CO., Wholesale Druggists. Providence—.T BALOI & SONS Portland— W. F. PHILLIPS. PENNSYLVANIA. Philadelphia—S. C. UPHAM, 310 Chestnut st. Walnut; DYOTT & CO , 218 North Second. Pittsburg—GEO. H. KEYSER, 140 Wood st. INDIANA. Indianapolis—ROBERT BROWNING. Lafayette—H. C. LAWRENCE. MISSOURI. St Lot is—■ -'THONG &. CO., corner 5th and Locust. OHIO. Cincinnati—SUTRE, ECKSTEIN k CO. Cleveland—STRONG & ARMSTRONG. DR WILLIAM FISKE. Columbus—ROBERTS & SAMUEL. ; NEW YORK. Auburn—C W. TUTTLE, Agent. i Buffalo—O.H.P ('TIAMI'lJN,Ar.a\nn,M.iiii st I Rochester—POST k BRITF, 4 Exchange st ! Syracuse—KEN YON & POTTER, Druggists ! Utica—DICKINSON, COM-TOCK k CO., II' ! Geneseost. ; SMITH & HALL, 158 Genesee | street. ILLINOIS. Chicago—LORD .<: SMITH, 43 Lake street. .1. H. REED & CO. CANADA WEST. Toronto—S. F. URQI n.\RT, M.D., 104 Yon:■> street. Montreal—KENNETH CAMPRI-ILL k CO Kingston—G. F. LA SEBBE, 76 King street. MICHIGAN. DiTi'-oir -FARIUND &SHELEY,Wooi!w;n\: rv. CALIFORNIA. San Francesco—REIUNGTON & CO MARYLAND. Baltim >ru—THOMPSEN & BLOCK. *^ Ami at Retail by all respectable Druggists throughout tho Country. r --~-- [ HYPOPHOSPHITE OF MANGANESE, For Liver Complaints, Influenza, Catarrh, and all Recent Coughs. \ Manganese has a specific action upon the liver, producing an extraordinary secrf tioi if bile : It also stimulates theglanular system aud lii:o;>!w'.i'-s, quickening their functions. ]t Is the most valuable Preparation known, for tho CLiIK OK RELENT COUGHS, win:-her arising from ordinary colds, or existing as an indication or incipient Consumption This Preparation y is most effective in many complaints of women, such as Chlorosis. Amenorrhea, L-ei-orrh in connection with the •'MOP.NING PILL,'' and as a substitute for Clinlybcates generally l£Jj~ Prick : In 7 •>■/.. Bottles r.mf),rii with Lime and Soda), $1 ; Six Bottles for $."■ THE STYPTIC PILL: •A prompt Remedy for Bleeding from the Lungs, Uterine Kcmor-!. rhage, &c. | THE STYPTIC PILL is precise')- what its name imports—a. Pill having the j>.....,•.- r/V -,e-; 'ping or controlling Hemorrhages; but,apart from its specific application to ibis purpose, it i-x-V j ercisrs a prompt and energetic action in quieting Nerrons Initobility and Esi-itiinent, Itifiali..-': ' ing the Ciicnlah'in, and Rectifying various Morbid Secretions. The Styptic Pill produces neither I ' nausea,vomiting, nor purging. ! j The attention or the Medical Profession is particularly invited to tho Styptic Fill, as t will |i» found an t'wa/uaiiZe adjuvant in their p'-msnil practice. Pi.ick; FIFTY CENTS PER BOX, BY MAIL. Full directions accompany each box. tyjy The i..-,uill Discount to Physicians uu«l Druggist?;. Terms, CASH. ^V «c^<: NATIONAL LIBRARY OF MEDICINE c<: CC c < NLM032061927