Reprinted from the New York Medical Journal 
for October 2 and 9, 1886. 
TEN MONTHS' EXPERIENCE WITH 
PNEUMATIC DIFFERENTIATION* 
By VINCENT Y. BOWDITCH, M. D., "V 
ATTENDING PHYSICIAN TO THE CARNEY HOSPITAL AND BOSTON DISPENSARY ; 
INSTRUCTOR IN THE BOSTON POLYCLINIC. 
Mr. President and Gentlemen of the American 
Climatological Association : At the request of our sec- 
retary I appear before you to-night to give you the results 
of my experience in the last ten months with the " pneu- 
matic cabinet " or " pneumatic differentiator " which Dr. 
Herbert F. Williams has introduced to the profession, and 
in asking your attention for a short time I shall endeavor to 
give you such thoughts and suggestions as have a practical 
bearing upon the use of the instrument to which our atten- 
tion has been called so much of late. 
We have had earnest and able discussions upon the 
physical properties and physiological effects of the cabinet, 
and it is now time for the profession at large to investigate 
the clinical results of this new method of treatment and to 
determine slowly and with fairness the position which it is 
finally to take in pulmonary therapeutics. 
In giving my results, I bring before you no brilliant 
* Read before the American Climatological Association at its third 
annual meeting. 
1 2 
TEN MONTHS' EXPERIENCE WITH 
array of " cures," and to some the record may perhaps ap- 
pear to be rather discouraging when compared with others 
in which the results obtained are apparently so much more 
successful than my own, but, when I tell you that my experi- 
ence has encouraged me to continue the use of the cabinet 
in its improved form, it may convince you more strongly 
than mere words that I believe the instrument will find its 
place as a valuable addition to our methods of treatment in 
pulmonary diseases. Its true place can not be established 
until the experience of careful observers has been given to 
us years hence, and I wish to add my voice in urging the 
profession to investigate the matter fairly, and time alone 
will show whether the hopes of the strongest advocates of 
the cabinet are to be realized or not. 
It will be impossible to give you detailed reports of my 
cases this evening, for I should consume too much of your 
time and weary you unnecessarily, but I shall endeavor to 
give as brief a resume as possible of what has been accom- 
plished, leaving the detailed accounts to be published with 
this paper, to be read by those who may feel interested in 
judging of the justice of my conclusions. 
The usual meagerness of description in printed records 
of cases, and the consequent inability of the reader to judge 
of the fairness of the author's conclusions, must be my apol- 
ogy for publishing what may seem to some too detailed ac- 
counts of my own cases. 
Since June 30, 1885, I have treated twenty-seven cases 
with the pneumatic cabinet, the various affections being 
classed as follows : Pulmonary tuberculosis in its acute and 
chronic forms ; phthisis, both non-tnbercular and of ques- 
tionable tubercular origin ; bronchitis in its acute and 
chronic forms, with and without emphysema and asthma, 
and retraction of the lung from long-standing pleuritic effu- 
sions. PNEUMATIC DIFFERENTIATION. 
3 
In this classification I have used the term tuberculosis in 
those cases only in which bacilli have been found in the 
sputa. 
Of two cases of well-advanced acute tubercular disease (Nos. 
1 and 2), there was marked alleviation of symptoms in one, and 
in the other no benefit at all was noticed. 
Of three cases of incipient pulmonary tuberculosis, o (Nos. 
5 and 7) received, in four and eleven treatments respectively, no 
benefit, and one (No. 24) was cured. 
Of three cases of chronic bronchitis, one (No. 20) took but 
one treatment, another received no benefit (No. 18), and the 
third (No. 23) received moderate benefit. 
Of ten cases of chronic pulmonary tuberculosis, two, not far 
advanced (Nos. 9 and 11), received such benefit that for varying 
periods they could have been called "well" except for the phys- 
ical signs which proved the contrary, two (Nos. 3 and 22) re- 
ceived little or no benefit, four (Nos. 4, 6, 12, and 15) received 
marked benefit for several months, and one case (No. 21) re- 
ceived slight benefit in a few sittings. 
Of three cases of well-advanced phthisis, probably tubercu- 
lar, one (No. 8) received temporary benefit, another (No. 14) 
little or no benefit, and the third (No. 17) marked benefit for 
several months. 
Of three cases of simple bronchitis varying in intensity and 
duration (Nos. 16, 19, and 27), great improvement was noticed 
immediately after treatment was begun, and two may be said 
to have been cured, although I have not tabulated them as 
" cures." 
Of two cases of retracted lung from either long-standing em- 
pyema (No. 10) or serous pleuritic effusion (No. 25), marked 
benefit was noticed. 
In one case of non-tubercular phthisis (No. 13) great benefit 
was noticed. 
In one case of tubercular bronchitis which has only lately 
begun to take treatment (No. 26), temporary benefit can cer- 
tainly be noticed. 4 
TEN MONTHS' EXPERIENCE WITH 
Table showing the Proportion of Cases of Benefit from the 
Use of the Cabinet. 
None. 
Very slight, 
moderate, or 
temporary. 
Marked for 
varying 
periods. 
Remarkable. 
Cures. 
Treated but 
once, and 
not taken 
into calcu- 
lation. 
Nos. 2, 3, 4, 
5, 7, and 
18 (5 in 
all). 
19+ % of 
whole num- 
ber treated. 
Nos. 8, 14, 
21, 22, 23, 
and 26 (6 
in all). 
23+ % of 
whole num- 
ber treated. 
Nos. 1,4, 6, 
10, 12,13, 
15, 16,17, 
19,25, and 
27 (12 in 
all). 
46 + $ of 
whole num- 
ber treated. 
Nos. 9 and 
11 (2 in 
all). 
7+ % of 
whole num- 
ber treated. 
No. 24. 
3 + % of 
whole num- 
ber treated. 
No. 20. 
In thus tabulating my cases in regard to the compara- 
tive number which have been benefited by the treatment, 
I think I can in justice say that, if I have erred in either 
direction, it is in not giving the cabinet sufficient credit for 
what has been accomplished. As an instance of this, I can 
cite the three cases of bronchitis (Nos. 16, 19, and 27) 
which I have included with those in which "marked bene- 
fit " was noticed, and not with those in which " remarkable 
benefit " followed the treatment, and yet even with a dis- 
ease of this nature, which we know usually is cured in time 
without medical aid, the sudden cessation of marked symp- 
toms after the first or the second sitting was something 
which the most prejudiced observer could hardly have failed 
to notice. 
You will remark that out of the twenty-six cases of vari- 
ous pulmonary diseases treated, I have recorded but one as 
a " cure," and this leads me to say I can but think that in 
many of our records of cases we are more hasty in giving- 
such results than justice would allow. "Arrest of disease," 
in which symptoms apparent to the eye and ear have ceased 
completely for a time when morbid signs still exist in the PNEUMATIC DIFFERENTIATION. 
5 
body, is a very different thing from " cure " in which every 
morbid sign, both objective and subjective, has disappeared. 
We so often read of "cures," and upon strict inquiry find 
that a renewal of morbid symptoms has begun soon after 
the reported favorable termination, and the oftener we hear 
of these cases the more skeptical we become in reading of 
the successful experiences of physicians who neglect to give 
sufficient data in their records, and are too hasty in coming 
to positive conclusions. To illustrate my meaning, allow 
me to read the records of two of my cases, Nos. 9 and 24. 
In case No. 9, for four or five weeks, as far as external 
appearances were concerned, one would have been perfectly 
justified in discharging the patient as " cured," but the sub- 
sequent history proves the injustice of such a claim. In 
the other, however, the complete disappearance of every 
morbid sign, both subjective and objective, is sufficient 
ground for me, I think, to allege a " cure " even in the short 
time which has elapsed since treatment ceased. To allay 
possible doubt in the minds of some as to the presence of 
bacilli in the sputa in this case, I will merely add that they 
were found by my assistant and their presence corroborated 
by Dr. W. W. Gannett. 
In giving treatment with the cabinet I formerly used 
from 0-8 to 1 inch depression of the barometer (that is to say, 
of course, from 0'4 to 0'5 of an inch as marked on the U-tube 
of the cabinet), but I now rarely go beyond 0'6 of an inch, 
as it seems to accomplish its purpose as well, and is not so 
apt to weary the patient. In every case except one I have 
exhausted the air always, but in one case of chronic bron- 
chitis with slight emphysema I have reversed the process 
as an experiment for six sittings by compressing the air in 
the cabinet, but resumed the former treatment, no special 
difference in the general signs being noticed in the change. 
I have had no cases of very marked emphysema, and there- 6 
TEN MONTHS' EXPERIENCE WITH 
fore am unable to say from my own experience whether 
rarefaction or compression of the air in the cabinet should 
be used. It certainly seems rather paradoxical that an em- 
physematous lung should be benefited by breathing into an 
atmosphere denser than that surrounding the body, but Dr. 
Williams has had two or three cases which have neverthe- 
less improved under this treatment. We can not suppose 
that the elasticity of the lung will be increased when the 
elastic tissue has diminished or disappeared, as in the case 
of emphysema, and improvement can only be explained, I 
think, by the tonic effect which the treatment seems to 
have. The treatment by alternate rarefaction and compres- 
sion I am unable to speak of, as the cabinet in my possession 
at present is not constructed like the more recent ones. 
The various medicaments which I have used in the 
spray are as follows : 
1. 3 Tincture of iodine utxlviij; 
Gardner's pine-needle extract H,xv; 
Glycerin . . 3 j ; 
Water iv. 
Mix and use as a spray. 
2. 3 Phenyl gtt. xxx; 
Glycerin 3 ij ; 
Water 1 viij* 
3. 3 Creasote gtt. v-x-xx; 
Glycerin q. s.; 
Camphor-water §j. 
4. 3 Corrosive sublimate 1 gramme; 
Glycerin q. s.; 
Water 1,000 c. c. 
5. 3 Comp, tincture of benzoin, 
Tincture of cubebs, 
Tincture of hops 
Carbolic acid (pure) 3 ss.; 
Glycerin 3 iij. 
Mix and use as spray. 
aa 3ij; PNEUMATIC DIFFERENTIATION. 
7 
Camphor-water has been used alone also, and " tere- 
bene," a preparation of oil of turpentine with sulphuric acid, 
has been used by pouring a few drops on a cloth tied over 
the end of the inhaling tube in one case of chronic bron- 
chitis. Of these I give no special preference to any one, but 
I rarely use the iodine spray now, as it seems more irritat- 
ing and causes more cough in the cabinet than the other 
solutions. Phenyl seems often to have a soothing effect 
upon the throat, and its deodorizing power was very marked 
in one case with offensive sputa. The compressed-air spray 
has been used in every case except in those of retracted 
lung from old pleuritic effusions in which no spray was 
used, and in one case of chronic bronchitis (No. 23) in 
which I tried the steam spray, with the benzoin solution 
(No. 5), without marked effect. 
Of the germicidal effect of any of these inhalations in 
the lungs themselves I am very skeptical, and the only sup- 
position which seems to me at all plausible is that they may 
possibly make the unaffected portions of the lung an un- 
favorable bed for the bacilli. Even in the case of the cor- 
rosive-sublimate solution in strength of 1-1,000, we can 
not calculate possibly how much of the spray had been 
made inert by its contact with albuminoid matter before it 
reaches the lungs. 
As to the amount of spray carried into the lungs, I can 
not help thinking that even five per cent, of the whole 
amount used is a generous estimate. By a set of experi- 
ments I have been led to believe that not more than five or 
six per cent, is carried into the mouth, and of course it is 
impossible to calculate how much of this is deposited in the 
oral cavity, the pharynx, larynx, and trachea. Having re- 
corded the results of treatment and the methods pursued, I 
will now speak of the unpleasant or dangerous symptoms 
which may have occurred at any time while the patients 8 
TEN MONTHS' EXPERIENCE WITH 
have been in my care. The first and most important is that 
of hcemorrhage. 
In the twenty-seven cases which I have treated, apart 
from the mere occasional expectoration of bloody sputa, 
which is of such frequent occurrence in all phthisical pa- 
tients, I have had four cases of haemorrhage, none of them 
occurring during treatment. Of these, one only was very 
severe in a case (No. 7) of incipient tuberculosis combined 
with acute bronchitis, in which the cough had been one of 
the most distressing I have seen, and the haemorrhage oc- 
curred three days after the use of the cabinet and immedi- 
ately after a long and severe fit of coughing. 
In the second (No. 4), a long-standing case of chronic 
tuberculosis, in which there had been slight haemorrhages 
before I saw the patient, there was a moderate haemorrhage, 
occurring several hours after treatment, followed by two or 
three slight ones in the succeeding fortnight. After cessa- 
tion of treatment for about a month, it was again begun, 
and no further trouble has been experienced, and improve- 
ment has again been noticed. 
In the third (No. 15), a long-standing case of chronic 
tuberculosis, in which there had also been slight haemop- 
tysis before the patient visited me, a mouthful of blood was 
raised fourteen hours after treatment, and coincident with 
acute congestion of the lower part of one lung, followed by 
acute pneumonia, which terminated in the death of the pa- 
tient four days later, the attack being attributed to fatigue 
and exposure to wet. 
In the fourth (No. 11), a case of chronic tuberculosis 
not far advanced. There was a very slight haemorrhage 
(about one third of a tumblerful of blood) forty-eight hours 
after treatment, and no ill effects noticed. 
From the records of these cases I can not believe that 
we are justified in attributing the cause of the haemorrhages PNEUMATIC DIFFERENTIATION. 
9 
to the use of the cabinet, and certainly, from my experience 
thus far, the amount of benefit derived from its use greatly 
exceeds its possible disadvantages. The only symptoms 
complained of occasionally in the cabinet have been slight 
fullness of the head, or headache, when beginning treatment, 
and of weariness; but these sensations are exceptional. The 
exhilarating effect of the treatment, on the contrary, has 
been frequently spoken of by the patients. 
I can not help hoping that the cabinet may yet show 
that its largest sphere of usefulness will be in those cases 
where the morbid process has only just begun. In my se- 
lection of cases I have refused none, no matter how far 
advanced, provided they could accommodate themselves 
reasonably to my demands, and in some cases, where all 
other treatment seems to have failed, the cabinet has been 
of assistance. I believe, too, that good effects are some- 
times seen after patiently giving the treatment for several 
weeks under the most discouraging circumstances, and I 
therefore advise that, unless marked deleterious effects are 
noticed, treatment of chronic cases should not be abandoned 
too early, and the good effect may be then noticed after 
the cessation of treatment. On the other hand, I now 
refuse all cases which can not be within reasonable traveling 
distance of the cabinet, for long journeys are apt to coun- 
teract all the possible good effect of the treatment. 
In all records of cases it is impossible to convey to the 
reader by words the same picture which the writer has in 
his mind after watching patiently, it may be for months, 
the condition of the patient under his care. Possibly it 
may seem to some who read the records of my cases that I 
have claimed too much, in which case I can only ask those 
who doubt to make a fair trial of the cabinet themselves, 
and to give their results to the profession, for in this way 
only can we arrive at just conclusions. 10 
TEN MONTHS' EXPERIENCE WITH 
My opinion, then, of the ''pneumatic cabinet" may be 
thus briefly stated : That, although in my hands it has not 
accomplished perhaps all I had been led to hope, yet I still 
feel that it has, at least, shown itself to be a valuable aid to 
us in pulmonary therapeutics, and I look with hope to see 
what it can accomplish in the future. I feel strongly that 
it is not yet safe to intrust it to any other than a physician's 
care, or to that of an intelligent assistant, for we are not 
yet sufficiently sure of its power for good or possible harm, 
and therefore, while I believe it should be thoroughly tested 
in hospitals and in private practice, the greatest care should 
be taken not to allow it to fall into the hands of unreliable 
persons. 
If the future should possibly show that the treatment 
of pulmonary diseases by means of " pneumatic differentia- 
tion " has not accomplished all that has been asserted for it, 
we have at least the proof that the cure of phthisis is not 
to be accomplished by means of antiseptic inhalations as 
thus far used, for it is hard to conceive of any more thor- 
ough method than this of bringing vapors into direct con- 
tact with the lung tissue, and for this result alone the pro- 
fession would owe a large debt of gratitude to the origina- 
tors of the pneumatic cabinet. 
In conclusion let me say that, while I have been pleased 
with the tone of the medical press in many cases in the 
criticisms of this new method of treatment, I have regretted 
the ungenerous and rather ill-natured remarks which have 
occasionally appeared in articles during the past year. 
Honest criticism from those whose desire is to do their 
share in the progress of medical knowledge should be en- 
couraged as freely as unjust fault-finding, from whatever 
cause it may arise, should be condemned by our profession. 
Of my belief in the sincerity and single-mindedness of 
the originators of " pneumatic differentiation " in their de- PNEUMATIC DIFFERENTIATION. 
11 
sire to have its merits thoroughly and fairly tested, and its 
true position determined by the profession at large, I am 
glad thus publicly to give my testimony. 
Case I.-June 30, 1885. Mrs. F., aged twenty-three; mar- 
ried one year; no children; father died of consumption ; mother 
and one brother living and well. Patient perfectly well up to 
six weeks previous to first visit; never had had the least cough 
before; took cold, had headache, two weeks later cough began 
with yellowish sputa, both symptoms increasing steadily, fever- 
ishness, vomiting; once copious night-sweat; pain at first in 
right shoulder; none since; at times much dyspnoea and sense 
of oppression on chest; marked loss of flesh (twenty pounds); 
constipation; amenorrhcea for two months. 
Physical Examination.-Face pinched, dusky, with a very 
phthisical look; chest emaciated and rather hollow ; gait stoop- 
ing; dyspnoea very marked; percussion shows slight inelastici- 
ty in the right chest compared with left; in back, dullness 
throughout right. Auscultation reveals less distinct respiration 
on right than left front, and after cough faintest possible " crum- 
pling" in the lower part of right; voice nearer on right, but 
not bronchial. On the back, faint "crumple" with cough and 
full inspiration, most marked in lower part of right; voice 
nearer and rather bronchial in character; expiratory murmur 
more marked ; respiration throughout right of rather bronchial 
character; pulse 116; temperature 100*2°; examination of spu- 
ta reveals bacilli. 
Diagnosis.-Acute pulmonary tuberculosis. Patient was ex- 
amined by Dr. II. I. Bowditch and later by Dr. Herbert F. Will- 
iams, and a grave prognosis given. In the following four weeks 
the patient took twelve or thirteen treatments in the cabinet, 
using iodine alone or iodine with G-ardner's pine-needle extract 
as an inhalation, and, although the physical signs showed a 
steady increase of the disease, the most distressing symptoms- 
viz., cough, loss of sleep and appetite, and dyspnoea-were great- 
ly relieved. The expectoration became more profuse, but the 
voice grew stronger and the general condition improved. 
From August 1st to September 23d (about seven weeks) the 12 
TEN MONTHS' EXPERIENCE WITH 
patient continued to come in from Cambridge three times a 
week with occasional omissions, but grew gradually weaker, 
although suffering very little from the previous symptoms, 
except vomiting. Physical examinations during this period 
showed increased consolidation of the right lung in the lower 
part and signs of the formation of cavities, marked by increased 
dullness, with coarse and fine bubbling rales, bronchial and am- 
phoric breathing in different portions of the lung. Temperature 
and pulse were usually slightly elevated. From September 23d 
to October 25th the patient was too weak to come in town, and 
at the last examination evidences of a large cavity in lower part 
of the right lung were found. Patient died October 26th, about 
four months after the first treatment. Patient took thirty 
treatments in all, using from 0'2 to 0'8 depression of the barome- 
ter. 
The compound tincture of cinchona in drachm doses was 
ordered at first and a cough syrup ; afterward " bovinine " was 
given, and a zinc and belladonna pill for night-sweats. 
Synopsis of Case.-Acute pulmonary tuberculosis in advanced 
stage. Treatment given thirty times. 
liesuit.-Marked amelioration of most distressing symptoms; 
death of patient in four months. 
Case II.-July 2, 1885. Miss F., aged fifteen; father 
healthy ; mother died of consumption. Patient was well until 
about one month before first visit; slept with her mother be- 
fore the latter's death; first had pain in left side, later a dry 
cough, scanty expectoration; once a small amount of blood; 
slight dyspnoea upon exertion; headache, loss of flesh and 
strength, appetite good, vomits when coughing, bowels regular, 
never flushed nor chilly, menses regular. All the unfavorable 
symptoms had greatly increased when I first saw her, and the 
cough was very troublesome. 
Physical Examination.-Patient thin and tall, bright-eyed, 
rather puny. Percussion reveals rather less resonance than 
normal in upper left chest; dullness in lower third of left back. 
Auscultation reveals a slight crepitus under left clavicle. In 
back, rather less vesicular respiration on left, with a slight 
" crumple " at the top and fine crepitation in lower third. PNEUMATIC DIFFERENTIATION. 
13 
Power of chest expansion, 33 to 34 inches; temperature 99'2°; 
pulse 84. Bacilli were found in moderate quantities in the 
sputa. 
Diagnosis.-Acute pulmonary tuberculosis. Patient exam- 
ined by Dr. H. I. Bowditch, and a very grave prognosis given. 
Between July 2d and August 10th, when the patient ceased 
coming, she took nineteen treatments, taking iodine with pine 
extract chiefly, and once or twice carbolic acid, 1 to 200, and 
HgCl2, 1 to 2,000, as an inhalation. From 0'2 to 0-8 inch de- 
pression of the barometer was used generally. At the last ex- 
amination, August 10th, the dullness in the lower left back 
persisted, the rales were of a coarser character, and in places 
the respiration was bronchial. 
With the exception of a slight increase of strength for a 
short time, I could not see the slightest benefit from the use of 
the cabinet in this case. The patient was imprudent, and never 
seemed to take the treatment easily. After August 10th I did 
not see her again, but heard that she died October 6th, about 
two months later, with all the symptoms of rapid consumption. 
The only medicine given was the compound tincture of cincho- 
na at first, and later Fellows's syrup of the hypophosphites. 
Synopsis of Case.-Acute pulmonary tuberculosis. Treat- 
ment given nineteen times. 
Result.-Little if any benefit obtained from the use of the 
cabinet. Death of patient in three months. 
Case III.-July 6, 1886. Mr. J., aged thirty-five, gas ma- 
chinist; family history negative; patient believes his mother 
died of consumption ; formerly strong and well; four years ago 
had what was called "slow fever"; has had much trouble with 
his stomach, unable to digest food, and often obliged to vomit 
it; had a cough all through the preceding winter; in March 
got chilled in a cold house; confined to bed three weeks, with 
almost constant vomiting; cough increased with copious, dark- 
ish sputa, then whitish, once streaked with blood; pain in left 
side occasionally; at first uight-sweats; dyspnoea; loss of strength 
and flesh; chief complaint is of cough and gastric symptoms. 
Physical Examination.-Patient does not look very ill; no 
emaciation; face florid, rather tired expression; percussion 14 
TEN MONTHS' EXPERIENCE WITH 
note dull at right apex. Auscultation reveals a " crumple " in 
the light apex ; voice nearer in this region; in the upper right 
back, a slight " crumple "; at left apex about spine of scapula 
somewhat prolonged expiration; no rale; temperature 100'1°; 
puLe 106 ; bacilli found in moderate quantity in sputa. 
Diagnosis.-Pulmonary tuberculosis. Examined by Dr. II. 
I. Bowditch, and grave prognosis given. Churchill's compound 
syrup of hypophosphites and a cough syrup were ordered. 
August 5th, one month later, no improvement was noticed, the 
gastric symptoms being very troublesome and not relieved by 
remedies used. The physical signs in the right side slowly in- 
creased, and about five or six weeks later an occasional rale 
could be heard in the upper part of the left chest. The cough 
increased. Pleuritic pains in the left side appeared, and on 
October 5th dullness was noticed below the third rib on the 
left side, and moist rales could be heard throughout the left 
side, most marked at the top, and respiration in the upper 
right chest was somewhat bronchial, with prolonged expiration. 
The patient was very much thinner and weaker. I advised dis- 
continuance of treatment, feeling that it was of no benefit. Pa- 
tient took thirty-two sittings in all, omitting one occasionally. 
Iodine and pine extract chiefly used in the spray. 
Synopsis of Case.-Pulmonary tuberculosis; treatment given 
thirty-two times. 
Result.-No benefit from the use of the cabinet. 
Case IV.-July 7, 1885. Sent to me from Dr. J. S. Greene, 
of Milton. Miss D., aged twenty-one, mill hand; father died 
suddenly; asthmatic; mother and four sisters all healthy; no 
history of lung trouble in family. Patient never robust. Has 
had cough for eight years, varying in intensity, with yellowish 
sputa occasionally streaked with blood. Cough became worse 
last autumn, with occasional pain in left chest. Palpitation 
at times. Feverish and chilly occasionally. Night sweats six 
months ago. Loss of flesh and strength in the last year. Easily 
fatigued. Appetite poor. Bowels regular. Menses regular. 
Obliged to give up work on account of weakness. 
Physical Examination.-General aspect, rather thin. Right 
clavicle more prominent than left. Percussion-note dull, in- PNEUMATIC DIFFERENTIATION. 
15 
elastic at upper left, most marked at apex. Auscultation re- 
veals numerous coarse and fine rales in the upper left chest, 
with prolonged expiration; fine rales most marked above clavi- 
cle. Slight "crumple" in upper right as.far as second rib. 
Voice nearer on left. In the back a " crumple " heard in up- 
per third of left side. Heart's action very rapid. Marked 
blowing diastolic murmur heard most distinctly at third left in- 
tercostal space, near sternum. Pulse 138, temperature IOS'S0. 
Diagnosis.-Phthisis, probably tubercular. Prognosis bad. 
Owing to the cardiac murmur, the treatment was used very 
cautiously for the first few times, 0'2 to 0'4 inch depression being 
used only at first, with iodine and pine-extract spray; later 
the pressure was increased to 0'8 and to 1 inch without the least 
difficulty three times a week, the patient being obliged to take 
a long journey in the horse-cars from her home each time. 
After seven treatments the patient felt very much better. The 
cough diminished, appetite improved, and the general strength 
increased, so that the journey, which caused great fatigue at 
first, was borne quite comfortably. 
August 6th.-One month after first visit physical examina- 
tion showed a marked diminution in the number of coarse rales 
on both sides, the finer rales still persisting. General condition 
much improved; patient much stronger, although a loss of two 
pounds of flesh was noticed. Temperature 100°, pulse 110. 
September 21st.-Still marked improvement, although a loss 
of four pounds of flesh was noticed since first visit. Dr. Greene 
wrote : " I do not see how the changes in her physical signs can 
be interpreted otherwise than very favorably. I remark now 
but very slight signs of irritation in the left lung, where such 
signs were plentiful when you began treatment. In that re- 
spect the improvement is very remarkable, and it corresponds 
to an almost complete disappearance of febrile temperature. . . . 
I observe she has lost weight, but her looks show improved 
health, and she says she feels very well." 
December 15th.-Improvement continues. Has gained six 
pounds since September 21st. Once or twice has expectorated 
small quantities of blood. 
February 25th.-Continued coming in town all winter to the 16 
TEN MONTHS' EXPERIENCE WITH 
cabinet, and, with the exception of a temporary gastric dis- 
turbance for a week or ten days, and occasional spitting of 
blood, has felt nicely. Occasional examinations of the chest 
revealed no marked change in the physical signs, except the dis- 
appearance of the prominence of the right clavicle. The morn- 
ing and evening temperature, as shown by a chart during this 
time, was almost always normal, only a slight rise being occa- 
sionally noticed. Late in the afternoon of this date patient had 
a slight haemorrhage, and two days later another. Did not 
come in for treatment from this time until April 10th, on ac- 
count of three or four slight haemorrhages. Lost three pounds 
in weight, and cough increased. Examination of chest showed 
again no marked change, except the " crumpling " noticed be- 
fore in left back extended possibly a little farther down. 
Since April 10th the patient has resumed treatment, and 
notices the beneficial effect of it again in increased strength 
The only tonic medicines given were at first bovinine, and after- 
ward Fellows's hypophosphites; but during the winter for nearly 
a month was taking no medicine at all. Is now taking tincture 
of chloride of iron. 
Examinations for bacilli in the sputa at various times re- 
vealed very few, or none at all. 
Iodine, with pine extract, was used for inhaling for the first 
two months; later, for three months, phenyl, and from De- 
cember 29th to February 25th camphor-water and creasote 
( f j-gtL x)- Lately only camphor-water has been used. 
Synopsis of Case.-Chronic tuberculosis of both lungs of 
several years' standing. 
Result.-Very marked improvement for six months. In- 
crease of symptoms upon omitting treatment for a month. Im- 
provement with renewal of treatment up to present time. 
Case V was one of incipient phthisis, with a sharp attack 
of bronchitis, in a poor woman living in a dispensary district. 
Bacilli in small quantities were found in sputa. Patient only 
took four treatments, and then ceased to come. Four months 
later was seen, and the disease had evidently advanced rapidly. 
No effect was noticed in the four treatments given with iodine 
and pine extract. PNEUMATIC DIFFERENTIATION. 
17 
Case VI.-June 9, 1885. Mrs. B., aged twenty-seven. Ad- 
vised by Dr. II. I. Bowditch to try the cabinet as a last resort. 
Family history excellent. The personal history was the usual 
one of phthisis, dating back eight or ten years, with slowly in- 
creasing symptoms. Loss of voice for five or six months pre- 
vious to first visit. Night-sweats, harassing cough, copious 
sputa (occasionally bloody), and dyspnoea were the chief symp- 
toms complained of. 
Physical Examination.-Pale, pinched face. Emaciation. 
Increased vocal fremitus at right apex. Decided dullness in up- 
per right. Resonance less than normal in upper left. Pro- 
longed expiration at upper right, rather bronchial respiration, 
and bronchophony with "crumpling," and an occasional sonor- 
ous rale throughout right chest. In upper part of left a "crum- 
ple" after cough and full inspiration, with occasional sonor- 
ous rale. In the back about the same. Pulse 114, temperature 
99-6°. 
Diagnosis.-Advanced phthisis, probably tubercular. Prog- 
nosis very bad. 
Fusel-oil (gtt. v, t. i. d.) was ordered. 
After the third treatment in the cabinet there was " decided 
improvement in breathing." After the tenth treatment (three 
weeks later) patient felt much stronger and better generally, 
and one month after first visit both the patient and her husband 
noticed marked increase in strength, improvement in appetite, 
less cough and expectoration, less fatigue in talking. 
September Bfyth.-Examination showed the dullness at the 
right apex to be less marked than before, and the whole char- 
acter of the respiration on this side was drier and freer than 
before. From this time on the patient continued to come into 
town from Wellesley Hills, about twelve miles from the city, 
and was always convinced of the beneficial effect of the cabinet 
in relieving her of any sense of oppression in the chest. Her 
strength gradually failed, however, and about the middle of 
January she suffered severely from sore throat, and the inability 
to swallow food caused rapid loss of flesh and strength. One 
inhalation of camphor and creasote gave great relief, and there 
has been no return of the sore throat since that time. 18 
TEN MONTHS' EXPERIENCE WITH 
About February 1st the patient suddenly was able to speak 
aloud, and not in a whisper as before, although still hoarse. No 
special change noticed in the larynx. The last physical exami- 
nation was made February 24th. Percussion revealed nothing 
new. The respiration in the right apex down to the second rib 
was harsh, bronchial, and dry, with scarcely any rale. Bron- 
chophony. Below this an occasional dry " click " was noticed. 
In the left apex a dry "crumple" was heard, rather increased 
after cough. In both apices behind the same signs, but less 
marked than in front, were noticed-all of which seemed to 
indicate a less active process going on in the lungs. The tem- 
perature chart during January and February showed a less 
febrile condition than before. Both my father and I felt pleased 
with the result when considering the condition of the patient 
nine months previously. Soon after this the patient's strength 
failed rapidly, the cough and expectoration increased, and at 
last accounts she was unable to leave her bed. The patient 
had about sixty-five sittings up to March 17th, which was 
the last time she was able to come. Iodine with pine ex- 
tract, phenvl, camphor with creasote, were the inhalations 
chiefly used. Examination of the sputa at different times 
showed the presence of bacilli in varying quantities, from none 
at all to many. 
Synopsis of Case.-Chronic tubercular disease of both lungs 
of many years' standing, in the last stages. Treatment given 
sixty-five times. 
Result.-Great alleviation of most distressing symptoms for 
nine or ten months. 
Case VII.-July 11, 1885. Mrs. M., aged twenty-eight; dis- 
pensary case; married four months; family history generally 
good ; great-grandfather died of consumption. 
About six weeks before first visit began to cough after se- 
vere hoarseness; yellow, copious sputa; no blood; pain between 
shoulder-blades; vomiting; no special fever; night-sweats; 
anorexia; bowels regular; menses regular; sleep destroyed by 
harassing cough ; much loss of flesh and strength; feels very 
miserable. 
Physical Examination.-Patient does not look ill, but tired. PNEUMATIC DIFFERENTIATION. 
19 
Increased vocal fremitus in right apex. No dullness in front or 
back. 
Auscultation reveals " crumpling " down to second or third 
rib in right apex ; voice a little nearer. In upper right back, 
just above spine of scapula, expiratory murmur prolonged ; a lit- 
tle tubular in character. No rale. Pulse, 94; temperature, 
99-2°. 
Examination of sputa reveals numerous bacilli. 
Diagnosis. - Acute pulmonary tuberculosis with general 
bronchitis. Prognosis grave. 
July 1st.-Sonorous rales were heard in both lower backs, 
and percussion-note in right apex behind was slightly higher in 
pitch. 
Patient took twelve sittings in two weeks and a half. After 
the first she " slept better than for three weeks previously," and 
at the end of the week felt much better. Had severe fits of 
coughing at times, however, and sputa became bloody. After 
July 30th (two and a half weeks from first visit) the patient did 
not come again, and three days after the last treatment, after 
violent coughing, expectorated a large quantity of blood. Great 
weakness followed. Later the patient moved from town, and is 
now in a home with marked signs of phthisis, although stronger 
again. 
Patient tried cod-liver oil, bovinine, and quinine at different 
times. 
Synopsis of Case.-Acute tubercular disease of right lung. 
Result.-Slight temporary benefit from twelve sittings. 
Case VIII.-July 16, 1885. Mr. N., aged twenty-five, gro- 
cer. (Transferred to me by Dr. H. I. Bowditch.) Family his- 
tory perfectly good ; personal history, usually well and strong 
until the middle of May, 1884 (fifteen months ago), when he had 
two or three heavy colds with cough in succession. At the end 
of two weeks had a chill with fever; worked until June 16, 
1884, when a very slight hemorrhage from the lungs occurred. 
Was in Florida from October, 1884, until the May following. 
Cough was benefited, but patient acquired dysentery and ma- 
larial fever, and has had more or less diarrhoea since. No real 
pain in chest, but at times a " crumpling feeling " in left chest. 20 
THE MONTHS' EXPERIENCE WITH 
Night-sweats; loss of flesh and strength; dyspnoea at times; occa- 
sional chills; no marked feverishness; appetite poor; vomits 
occasionally ; more or less diarrhoea; no trouble with water; 
has done no work for a year; chief complaint is of cough, diar- 
rhoea, and general weakness. 
Physical Examination.-Decided emaciation of face and 
body; languid manner; slightly increased vocal fremitus in 
right apex. 
Percussion-note slightly dull and inelastic in right apex and 
in right back; somewhat high in pitch. Auscultation reveals an 
indistinct " crumple " in right apex, although vesicular murmur 
can be heard also. Signs more marked toward the lower part 
and in axillary region. On the left front, about the second or 
third rib, murmur vesicular, and once or twice a " click " heard. 
In both lower backs and in the upper right a squeaking sound 
with inspiration. No marked bronchophony, but voice sounds 
nearer in right apex in front. Temperature, 100*3°; pulse, 120; 
expansion of chest, 30 to inches. Sputa examined once for 
bacilli and none were found. 
Diagnosis.-Phthisis, probably tubercular. Prognosis bad. 
The patient lived forty miles out of Boston, and was obliged 
to take a fatiguing carriage and railroad trip three times a week. 
Five sittings, with iodine and pine-extract inhalations, were 
given in the cabinet from July 16th to August 1st, and for a 
week I saw nothing of him, and I supposed the treatment was 
not satisfactory, as he seemed to think the cough had increased, 
and he complained of fullness in the head. On August 1st he 
appeared looking much better, and expressing himself as much 
encouraged. Since the last visit had coughed and raised very 
much less, and the diarrhoea ceased. A sharp pain near the left 
nipple prevented him from making the journey for a week, but, 
apart from this, patient felt much better. Examination of the 
chest showed a distinct friction-sound near the left nipple, but 
the sonorous rales noticed before in both backs had entirely dis- 
appeared. Temperature, 99*2°; pulse, 100. 
From August 1st to August 24th the patient appeared only 
three times, and wrote that after visit on August 6th he had a 
chill and fever with increased cough, " which was always the PNEUMATIC DIFFERENTIATION. 
21 
case when malarial attacks appeared." On the 19th the diar- 
rhoea had begun again with consequent prostration. 
August 2Jfth.-A one-grain opium pill was ordered, and as 
a tonic a mixture of Fowler's solution and Fellows's syrup of 
hypophosphites in the proportion of three drops to one tea- 
spoonful. 
September 21st.-The patient wrote that he had been in the 
White Mountains and had improved wonderfully. Gain of 
strength and flesh. No chills nor bowel disturbance since he 
began the medicine. 
25th.-Returned, feeling nicely. Cough about the same, but 
expectorates freely. No pain in chest. No diarrhoea. Exami- 
nation of chest showed a slight " crumpling " near left nipple, 
and in the lower right back slight dullness, and respiration rather 
fainter here than on left. Otherwise, signs about as before. 
Power of expansion about the same. 
28th.-Patient came saying that since the last treatment he 
had had almost constant headache, dizziness, vomiting, loss of 
appetite, and once a slight return of diarrhoea. I ordered the 
medicines discontinued, and since then have not seen the patient; 
but on October 6th he wrote that his friends wished him to go 
to Colorado, although I advised his coming nearer to Boston in 
order to take the treatment more regularly without the fatigue 
of a long journey. 
Patient took ten treatments at irregular intervals, with iodine 
and pine extract for inhalation at every sitting except the last, 
when phenyl was used. 
Synopsis of Case.-Phthisis, probably tubercular. Seat of 
disease: right lung chiefly and a circumscribed space in left. 
Complications: attacks of chills, followed by fever of probable 
malarial origin. Diarrhoea. 
Result.-Marked benefit at first under unfavorable condi- 
tions for treatment, although fullness of head after treatment 
was complained of often. At the last sitting, questionable in- 
jurious effect of treatment, which was given ten times in two 
months and a half. 
Case IX.-July 18, 1885. Mr. M., aged eighteen, clerk. 
(Transferred to me by Dr. H. I. Bowditch.) Family history 22 
TEN MONTHS' EXPERIENCE WITH 
excellent. Personal history: always well until September, 1884, 
when he had a slight cough, with yellowish sputa once or twice, 
slightly streaked with blood, for about a month, when the cough 
ceased. Was well all winter. About the middle of April cough 
began again and grew steadily worse. No special pain except 
occasionally in lower part of left chest at night; dyspnoea; loss 
of flesh (seventeen pounds) and strength; yellowish sputa ; ap- 
petite fair; occasional distress from food; bowels not quite 
regular ; loss of sleep from coughing; no marked fever. 
Physical Examination.-Face and body rather emaciated; 
no special dullness in front or back; possibly the percussion- 
note is a little higher in upper left chest. Auscultation reveals 
an explosion of rather fine rales above and below both clavicles 
down to about second or third rib ; no bronchophony ; sibilant 
rales in both backs toward the top. Respiration pure below, 
although rather exaggerated. Pulse, 118; temperature, 101'4°; 
expansion of chest, 29 to 29| inches. 
Diagnosis.-Phthisis; apices of both lungs affected. 
Patient was advised to leave his home, a sea shore town, 
and came to Wellesley Hills, near Boston; treatment was given 
three times a week, using iodine with pine-extract inhalation 
and Churchill's hypophosphites internally. The improvement 
in this case was wonderful. After the first treatment the cough 
lessened. In three weeks he had gained seven pounds; could 
take a long walk without the least fatigue, slept soundly all 
night, and looked so much better that a friend who had not seen 
him for three weeks was amazed at his great improvement. 
August 22d.-After eighteen or nineteen treatments he had 
gained eleven pounds. The expansion of the chest had increased 
from seven eighths of an inch to an inch and a quarter; chest 
looked fuller and rounder; patient held himself more erect. 
Temperature was 99'3° ; pulse 114. 
September 3d.-He had gained seventeen pounds and weighed 
as much as he ever had before. At this time there was scarcely 
any cough or sputa. 
23d.-No cough at all. Slight clearing of throat two or three 
times a day. No sputa whatever. Feels perfectly well. From 
the general aspect of the patient and from his account of him- PNEUMATIC DIFFERENTIATION. 
23 
self, he could have been called perfectly well at this time, but 
several examinations at different times showed a persistence of 
the abnormal sounds in both lungs, and 1 therefore recommended 
his not returning home. In November there was a slight return 
of cough and sputa and a slight decrease in weight. Rather 
against my better judgment, the patient returned at the end of 
November to his home, where he was detained by severe weather 
about two weeks, and he returned looking not nearly so well, 
the cough and sputa having increased again. Treatment was 
resumed, the patient having moved to the city, and daily horse- 
back exercise wasordered. Improvement immediately followed. 
The cough lessened. Up to the present time the patient has been 
taking treatment six days a week, and, although not so well as 
last summer, is much stronger than when he first returned to 
Boston, and has endured a very cold winter remarkably well. 
The temperature chart showed a decided rise in the evening 
during December and January, but lately has not been so high, 
and at one time in January slight night-sweats appeared for a 
short time. In March a slight pleuritic friction-sound was heard 
in lower right axillary region, only lasting a day or two. Sputa 
has been at various times slightly bloody. 
Examination now reveals possible lack of elasticity in both 
apices. The rales noticed in apices at first examination persist, 
and on left chest extend possibly a little farther down. Occa- 
sional sonorous rales in lower portions of chest on each side. 
No bronchophony, but expiratory murmur is more marked in 
upper right, and voice is nearer in this region. 
Churchill's hypophosphites were given for three or four 
months, later the compound tincture of cinchona, and about 
two months ago Scott's emulsion of cod-liver oil. For night- 
sweats, zinc and belladonna pill or aromatic sulphuric acid. Ex- 
amination of sputa for bacilli at various times has shown vary- 
ing quantities from none at all to a moderate number, the last 
two examinations showing very few. 
Synopsis of Case.-Tuberculosis of both lungs. Two hun- 
dred sittings given since July 18, 1885. 
Result.-Very great improvement, and cessation of nearly 
all morbid signs for several months. Renewal of symptom 24 
TEN MONTHS' EXPERIENCE WITH 
after omitting treatment and upon returning to sea-shore climate. 
Subsequent improvement upon resuming treatment, which is still 
continued. General condition very much better than when he 
began. Termination doubtful. 
Case X.-September 15,1885. Mr. N., aged forty (?). (Case 
sent me by Dr. M. H. Richardson.) Empyema of several years' 
duration; a permanent opening had been made in left side many 
months before, and in the spring of 1885 three or four ribs had 
been resected in the left side with the hope of reducing the large 
cavity, and treatment with the cabinet was recommended in 
order to forcibly expand if possible the lung bound down by old 
adhesions. At this time respiration could not be heard at all 
below the spine of the left scapula. Treatment was begun three 
or four months after the operation, the patient coming three 
times a week, and at the end of six weeks the respiratory mur- 
mur could be heard by Dr. Richardson, Dr. H. I. Bowditch, and 
myself much more plainly in the lower left back than on the 
previous examination, and, although the discharge from the 
cavity was about the same, Dr. Richardson pronounced the cav- 
ity itself smaller. The patient felt much stronger and was de- 
sirous of keeping up the treatment, which was continued until 
March 12th, and at this time a very faint respiratory murmur 
could be heard one inch below angle of left scapula. 
Treatment was not continued after this, as it was thought 
wiser to perform another operation later. 
Synopsis of Case.-Long-standing empyema; lung held down 
by old adhesions. 
Result.-Expansion of lung increased by use of cabinet; 
treatment given about four months three times a week. 
Case XL-July 29, 1885. Dispensary case. Miss W., aged 
thirty-seven, tailoress. Family history: four brothers died of 
consumption; father died of heart disease; mother, disease of 
liver. Personal history: delicate when young, but since fifteen 
has been well. During the winter previous to first visit had a 
cough for two months which entirely disappeared, but reappeared 
June 17th after taking cold. Grew rapidly weak, unable to 
walk. Cough harassing, causing loss of sleep. Sputa whitish, 
occasionally streaked with blood; copious. No pain nor night- PNEUMATIC DIFFERENTIATION. 
25 
sweats ; feverish and chilly ; dyspnoea after talking or exercise; 
much loss of flesh (twenty-one pounds) ; menses rather too fre- 
quent. Chief complaint was of cough, and loss of sleep and 
weakness. 
Physical Examination. - Pale, looks tired and languid; 
slightly increased fremitus to hand in right apex. In right 
apex in front, slight dullness; in back in left apex, note higher 
pitched, slightly dull. Auscultation reveals sonorous rales 
throughout both chests, lasting through inspiration and expira- 
tion, front and back, but more marked in the upper left back. 
Just above spine of left scapula, through the sonorous rales a 
" crumpling " heard, and voice in this circumscribed space has 
a bronchial character. Temperature, 99'5° ; pulse, 100 ; expan- 
sion of chest, 28| to 29| inches. 
Diagnosis.-Acute bronchitis ; incipient phthisis(?). 
Treatment with iodine and pine extract for inhalation and 
iron internally was begun, and the patient still comes three or 
four times a week to the cabinet. The relief from the first 
treatment was very great, as she slept all night without cough- 
ing. She remained in St. Luke's Convalescent Home about two 
months, then resumed her work, and has been able to work up 
to the present time while taking the treatment. 
The sonorous rales in both chests entirely disappeared in 
October (three months later), but the finer rales noticed before 
in the left chest, front and back, persisted, although the patient's 
general condition had greatly improved. 
January 15, 1886.-Careful examination revealed no rale 
anywhere in chest, and the spot of bronchial breathing near the 
spine of the left scapula was replaced by pure vesicular sound, 
although rather more obscure than on the right side, and the 
voice sounded a little nearer at this point. The cough at this 
time amounted to almost nothing, and the patient gained in 
weight and looked quite rosy, and from this time to February 
3d (two weeks) she declared she did not cough once. 
Later a slight pleuritic pain in left side wras complained of, 
and a very small spot in lower left axillary region was found 
where very fine rales could be heard after cough, 26 
TEN MONTHS' EXPERIENCE WITHj 
Patient has not been feeling quite so well of late, but keeps 
at work, coughs, and raises very little. 
The last examination reveals free respiration in both sides in 
front of chest, although there is a suspicion of a " crumpling " 
heard in left apex ; no dullness. 
In left back near spine of scapula faint but distinct 
" crumple " heard also above and below this point. In right 
apex one or two medium rales heard. 
The patient has taken at different times tonics of iron, Fel- 
lows's hypophosphites, cinchona, and has had about 160 sittings 
in the cabinet. 
Repeated examinations of the sputa reveal varying quanti- 
ties of bacilli from a good many to none, the number usually 
corresponding to the condition of the patient, being more nu- 
merous when the trouble seemed more active. The patient ex- 
pectorated blood several times, and on April 15th raised about a 
quarter of a tumblerful. The temperature chart shows scarce- 
ly any rise above normal in the last two months until the last 
week, when it has once or twice reached 100-5°. 
Synopsis of Case.-Severe bronchitis supervening in the 
course of tuberculosis of the left lung. Very great improve- 
ment after many discouraging symptoms, with almost complete 
disappearance of all morbid signs for a short period, six months 
after treatment was begun. Slight renewal of symptoms later. 
Patient still continuing treatment. Termination doubtful. 
Case XII.-August 12,1885. (Sent me by Dr. F. M. Welles, 
of Chelsea.) Mr. D., aged twenty. This gentleman had a phthis- 
ical history, with occasional haemoptysis for several months, 
the disease being far advanced when I first saw him. Excessive 
cough, copious sputa, great dyspnoea upon exertion, pains in 
the lower left chest, loss of flesh and strength, lack of sleep 
from cough, and occasional epistaxis, were the chief symptoms 
complained of. 
Physical Examination.-Inspection shows much freer move- 
ment of right side than of left during respiration. Palpation 
shows slightly increased fremitus in upper part of left chest. 
Slightly higher pitch in left chest, and in left axillary region, 
about eighth rib, dullness, increasing downward to flatness, no- PNEUMATIC DIFFERENTIATION. 
27 
ticed. In back, flatness from one inch below spine of scapula. 
Auscultation revealed a "crumple" throughout left front. Ab- 
sence of respiration in extreme lower part. No bronchial respi- 
ration nor bronchophony. In back, " crumpling " in upper left; 
absence of respiration in region of flatness. Heart in normal 
position. Temperature lOO'l0, pulse 94. Sputa contained nu- 
merous bacilli. 
Patient took twenty-nine treatments from August 12th to 
September 25th, and was at the time a most discouraging case, 
for, although the first treatment was followed by a perfect 
night's sleep, the first in many weeks, the patient coughed 
badly in the cabinet, complained of great pain in left side 
excessive expectoration, vomiting, epistaxis, and seemed to be 
getting no benefit at all. Finally, on the 21st of September, 
he discontinued the treatment, and I considered it an unsuccess- 
ful case. Three months later Dr. Welles wrote me that, imme- 
diately after stopping the treatment, a very marked improve- 
ment showed itself; the cough ceased almost entirely ; the sputa 
became thin, like mucus; the night-sweats ceased ; the patient 
gained nine pounds in weight; he had no pain in the chest; 
and whereas he had been unable to go up two steps without 
taking breath previous to beginning the treatment, he could run 
up two flights without stopping; the appetite became voracious, 
and his general strength vastly improved. The expansion of the 
chest showed an increase of one inch and a quarter, and his 
friends, who had been most anxious to have him stop the treat- 
ment before, were now greatly pleased with it. It is reasona- 
ble to suppose that the pain arose largely from the forced ex- 
pansion of the lung clogged with secretions, the removal of 
which and the subsequent absence of fatigue from the exercise 
of the cabinet caused the improvement in the general symptoms. 
December 23d.-Three months after the last treatment, ex- 
amination showed marked improvement in the genera] aspect. 
Much less difference in the movement of the sides. The flatness 
in the lower left chest had disappeared, but evidences of con- 
solidation of the upper lobe of the left lung were present-viz., 
dullness, bronchial breathing, with fine dry rales, and broncho- 
phony in the upper left chest. The patient had three or four 28 
TEN MONTHS' EXPERIENCE WITH 
more sittings, but, about a month ago, Dr. Welles wrote that the 
symptoms were increasing again, and that the patient's strength 
was rapidly failing. Iodine with pine extract, and corrosive- 
sublimate solution, 1 to 2,000, with carbolic acid, 1 to 200, were 
used in spray in this case. Cod-liver oil and quinine used as a 
tonic. 
Synopsis of Case.-Advanced tubercular disease of left lung, 
with slight pleuritic effusion. Twenty-nine sittings in a period 
of about six weeks were used, in spite of very discouraging 
symptoms. 
Result.-No benefit during treatment apparently, but imme- 
diately afterward remarkable improvement in general symp- 
toms, lasting three or four months, with great comfort to the 
patient. Subsequent renewal of symptoms. 
Case XIII.-August 19, 1885. Miss O., aged forty-four. No 
history of lung trouble in family. Patient has a history of 
phthisis for twenty years. Chief complaint is of cough and 
expectoration of copious dark-green, purulent, offensive matter. 
Unable to lie down long, owing to choking sensation from con- 
stant secretion. Before beginning treatment was feeling rather 
weak. Examination showed dullness and high-pitched note in 
upper left chest. Loud bubbling rales throughout the left chest, 
most marked at top. No rales in right chest detected. Tem- 
perature 99'2°, pulse 92. 
After a month's treatment three times a week, using phenyl 
as a spray, the cough lessened, and the sputum, which was for- 
merly offensive, lost its odor and was much less copious, the 
patient declaring that "she raised in twenty-four hours what 
she used to in two." Could lie down at night without feeling 
choked, etc.; general strength improved. 
December 28th.-The patient had gained six pounds and a 
half in weight, and her favorable symptoms continued, although 
not always feeling equally comfortable. Was troubled with 
Vertigo during the winter a good deal, which was explained by 
some aural difficulty, and did not seem to be connected with the 
use of the cabinet. Lately has not been feeling so well again, 
and has not come so regularly for treatment, although always 
asserting that it has been of great benefit to her. Repeated Pneumatic differentiation. 
29 
examinations of the sputa show an entire absence of bacilli in 
this case. The compound tincture of cinchona, Murdock's liquid 
food, and the tincture of chloride of iron are the only medicines 
which have been used in this case. 
Synopsis of Case.-Chronic non-tubercular phthisis of left 
sung of twenty years' standing. 
Result.-Marked amelioration of some of the most distress- 
ing symptoms. 
Case XIV.-September, 1885. Miss S., aged twenty-one. 
Patient in Hospital of Good Samaritan. 
Mother died of consumption, and one brother ill with same 
disease. 
This case was one of marked signs of phthisis of nine or ten 
months' standing in both lungs. The patient did not come very 
regularly, but had forty-seven sittings between September and 
the middle of December without material benefit, except an im- 
provement in the shortness of breath and a slight increase in 
strength. At one time gained three pounds and a half, possibly 
attributable alone to cod-liver oil which she was then taking. 
A single examination of the sputa failed to reveal the presence 
of bacilli, but I think, from the character of the case, they would 
have been found later. As I was unable to have full control of 
the case, I discouraged her coming for further treatment. 
Synopsis of Case.-Well-advanced disease (probably tuber- 
cular) of both lungs. Very slight relief from excessive dysp- 
noea by the use of the cabinet; otherwise little benefit noticed. 
Case XV.-September 25, 1885. Mrs. E. (sent me by Dr. 
W. E. Smith, of Framingham, Mass.), aged forty, widow. No 
history of pulmonary disease except the maternal grandmother 
and grandfather, and one aunt, who died of consumption. 
Personal History.-Usually strong, but subject to severe 
cough for years. Fifteen years previous was thought to be in 
consumption, but " recovered entirely." Five years ago had 
what seemed like whooping-cough. Six months later had a 
haemorrhage (slight), and occasional slight ones since. Bloody 
sputa at times during the year previous to first visit. For ten 
months had not been free from cough, with muco-purulent 
sputa. Lost eighteen pounds of flesh and much strength ; more 30 
TEN MONTHS* EXPERIENCE WITH 
or less dyspnoea; pain not noticed; variable appetite; diges- 
tion normal; menses regular; inability to lie on left side owing 
to cough; chief complaint was of harassing cough and conse- 
quent loss of sleep ; dyspnoea upon the least exertion, and lack 
of strength ; had tried every kind of medication in the six 
months previous to first visit without the least benefit, and was 
thoroughly discouraged. 
Physical Examination.-Patient rather thin and spare, but 
not looking very ill. Ribs prominent, but no marked emacia- 
tion. Increased vocal fremitus in left apex, front and back. 
Percussion shows resonance less than normal in both apices, 
and slight dullness at the upper left. In back, throughout the 
left side, dull compared with right. 
Auscultation revealed "crumpling" heard in upper part of 
right and left chest. No special difference in voice. In back, 
"crumpling" throughout left; very marked at base. No ve- 
sicular breathing throughout left. In upper half of right back 
a " crumple " heard. In base, respiration free. In lower right 
back, where respiration is free, the voice is very distant, al- 
though no dullness there. No bronchophony. Temperature 
99'3°; expansion of chest, 28-30J inches. Examination of 
sputa shows presence of numerous bacilli. 
Diagnosis.-Tubercular disease of both lungs. Prognosis bad. 
After five treatments, the patient declared that she felt 
much stronger in spite of the journey in the cars from her home 
twenty miles distant. From this time on, although the patient 
spoke of increased strength and of ability to lie on left side, 
which she had not been able to do for six months, the case was 
a most discouraging one to treat, from the constant interrup- 
tions owing to bad weather, to the presence of a spasmodic 
cough, and muscular rheumatism, which were always aggra- 
vated by cold weather. The patient, however, was so pleased 
with her gain in strength that she desired to keep on. 
November 15th.-About eight weeks after first visit, Dr. 
Smith wrote that patient was able to walk better than for 
months, and that there had been a gain of about three pounds 
and a half in weight; increase of about half an inch in power of 
chest expansion. PNEUMATIC DIFFERENTIATION. 
31 
30th.-In spite of adverse circumstances, examination showed 
a better percussion-note in both apices, and the respiration was 
freer than before, although not purely vesicular, and at end of 
inspiration a "crumple" was heard. Elsewhere the signs were 
about the same, except that the voice, in lower right back, was 
no longer distant to the ear as before. The same date Dr. Smith 
wrote of his surprise at the improvement in the physical signs, 
and remarked : " This is positively the first time since last April 
that I could say, in judging by the physical signs, there was the 
slightest improvement in her case." 
The temperature chart from November 21st to December 
10th showed a normal condition. 
January Jfh, 1886.-In spite of spasmodic cough and rheu- 
matism previously, the patient reported at this date scarcely 
any cough or sputa. A gain in weight of four pounds and three 
quarters since first visit. Ability to sleep well all night. Much 
encouraged. 
From this date to February 9th, with the exception of a 
heavy cold taken when trying the experiment of living in town 
for a few weeks, patient was feeling much better. 
February 9th.-Felt rather tired before and after treatment, 
but went shopping, went home in damp clothes, and in the 
middle of the night woke with blood in her mouth and a severe 
pain in lower part of right chest; felt very ill. Dr. Smith was 
called and detected no increase in the signs in the chest until 
the next day, when marked symptoms of an acute pneumonia in 
the lower lobe of the right lung appeared, as corroborated by 
Dr. Adams, of Framingham, and on February 13th the patient 
died. Forty-five sittings were used from September 25th to 
February 9th. The only medicine given internally was the 
compound tincture of cinchona for a short time. 
Phenyle, iodine with pine extract, and creasote with cam- 
phor-water, were chiefly used for inhalation. 
Synopsis of Case.-Chronic tubercular disease of both lungs. 
Forty-five sittings given in a period of four months and a half. 
Result.-In spite of most discouraging symptoms, in addi- 
tion to spasmodic cough and muscular rheumatism, marked im- 
provement in many symptoms for several months up to time of 32 
TEN MONTHS' EXPERIENCE WITH 
onset of acute pneumonia, which terminated in the death of the 
patient in four days. 
Case XVI.-October 1, 1885. Miss W., aged sixteen. 
Patient was a delicate girl, subject every winter to constant 
severe colds and coughs. Treatment was tried with the cabinet 
chiefly, in order to expand the chest. Patient complaining of 
severe coryza and oppression in chest. No dullness or rales de- 
tected in chest. 
Diagnosis.-Subacute bronchitis and coryza. 
Between October 1st and 12th six treatments were given. 
After first treatment the oppression in chest was entirely re- 
lieved, and the mother remarked at the end of treatment "that 
it was remarkable there had been no cough with this cold, 
which had always been the case before." 
As the patient took the syrup of hydriodic acid as well, 
I can not attribute the entire benefit to the use of the cabi- 
net, of course, but merely state it as a fact that the young 
girl has been almost entirely free from the heavy colds and 
coughs from which she has suffered for several years in the 
winter time. 
Synopsis of Case.-Subacute bronchitis. 
Relief of oppression in chest after one treatment. 
Case XVII.-October 8th. Mrs. C., actress. 
Patient suffering from advanced disease of left lung, and had 
received marked benefit from the use of the cabinet in New 
York when under Dr. Williams's care. 
Patient took treatment October 8th and 9th, and November 
3d, 4th, 5th, and 6th, with much comfort to herself, and then 
was obliged to leave the city. 
No examination for bacilli was made. 
The patient appeared again May 3, 1886, saying that she had 
been traveling throughout New England and New York State 
all winter, and her cough was much better, although her strength 
was not so great and her appetite was poor. Convinced, how- 
ever, of the benefit of the treatment, she returned to Boston for 
a week for the purpose of trying the cabinet again. 
Synopsis of Case.-Phthisis, probably tubercular, of three 
years' standing. PNEUMATIC DIFIERENTIATION. 
33 
Amelioration of symptoms; patient returning at various 
times for treatment. 
Case XVIII.-October 20, 1885. (Sent me by Dr. F. II. 
Hooper, of Boston.) Mr. C., aged thirty-one, single; drawing- 
teacher. 
Family History.-Father living and well. Mother has al- 
ways had delicate lungs and throat, and grandfather died of 
consumption. Patient never robust, but usually well. 
About four years previous to first visit, when at the mount- 
ains, first noticed a curious wheezing noise in throat. Sore 
throat afterward. Since that time had cough with occasional 
intermissions. Sputa more or less copious; obliged to wake at 
night to clear throat. Once, about three weeks before first 
visit, sputa tinged with blood ; none of these symptoms were 
very troublesome, and otherwise the patient complained of 
nothing abnormal and felt very well, but wished, if possible, to 
rid himself of the cough, fearing something more serious. Had 
been under Dr. Hooper's care for laryngeal trouble, which had 
improved, but, as the other trouble did not yield to various reme- 
dies, Dr. Hooper wished him to try the cabinet. 
The patient looked perfectly well, with the exception of 
slight sallowness of complexion. Chest full, well formed. 
Percussion-note revealed good resonance everywhere, possi- 
bly a little exaggerated. In the right apex behind, a little less 
elastic and higher pitched than on left, but not very pronounced. 
Auscultation reveals in both chests in front at the end of 
expiration a wheezing sound, which seems more marked after 
cough; occasionally heard with inspiration also. Respiration 
more marked in apices than in the lower part of back, where it 
is rather indistinct. Rales not so noticeable behind as in front. 
No bronchial breathing nor bronchophony anywhere. 
Pulse, 78; temperature, 99'3°; expansion of chest, 33|-35| 
inches. 
Diagnosis.-Chronic bronchitis. Prognosis favorable. Ex- 
amination of sputa revealed no bacilli. 
Between October 20th and December 25th the patient took 
about fifty-five sittings, using chiefly iodine with pine extract 
and a small amount of bicarbonate of sodium as a spray. At 34 
TEN MONTHS' EXPERIENCE WITH 
other times a solution of resorcin, with borax and phenyl. 
Several examinations of the chest revealed no special change in 
the signs, except that once or twice there seemed to be fewer 
rales. The cough and amount of sputa continued about the 
same, and the general condition about the same-that is, com- 
paratively well. 
As no special benefit was noticed from the use of the cabi- 
net, a permanent change of climate was advised. 
About the middle of January the patient came back com- 
plaining of a curious sensation in the lower right chest; a 
stuffed feeling, " as if he missed the cabinet." Examination 
showed the respiration to be freer than at any previous time, 
but the slight cough and sputa continued. 
Soon after this the patient went to Florida. The only medi- 
cines used were Fellows's hypophosphites, and afterward, at 
the patient's request, Ayer's cherry pectoral; 0-6 to 0'8 inch 
depression of the barometer were used in this case. 
Synopsis of Case.-Chronic bronchitis. Fifty-five sittings 
given. 
Result.-No benefit from the use of cabinet. Change of 
climate recommended. 
Case XIX.-Mr. F., aged nineteen. October 24, 1885. Se- 
vere acute bronchitis of two or three days' duration. Cough 
and wheezing; oppression on chest. No dullness anywhere, 
but sonorous and sibilant rales were abundant throughout chest. 
Four treatments were given. After the first, with phenyl as 
a spray, the cough and oppression wTere much relieved. After 
the last treatment (four days later), the examination of chest 
revealed only slight roughness of respiration, and two faint 
sonorous rales. The cough had disappeared. Five days later 
the patient said he felt better than for two or three months 
previous to the attack. Examination showed pure respiratory 
murmur throughout chest. 
Synopsis of Case.-Acute bronchitis. Relief to cough and 
sense of oppression after one treatment. Cessation of cough 
after fourth treatment. Phenyl and resorcin with borax used, 
each twice. 
Case XX.-Mr. Q., aged twenty-nine. November 3, 1885. PNEUMATIC DIFFERENTIATION. 
35 
Chronic bronchitis. Patient only came once, and took very 
short treatment. Not willing to take the journey from his 
home, therefore nothing further was done. 
Case XXI.-November 19, 1885. Mrs. S., patient in Chan- 
ning Home. Advanced tubercular disease of both lungs, with 
harassing cough and severe oppression of chest. Numerous 
bacilli in sputa. Treatment was given as an experiment to try 
and relieve the oppression of the chest. The patient came 
ten times between November 19th and December 11th, and 
experienced marked relief from the oppression and tickling 
in throat. Could expectorate more freely. Bad weather and 
weakness from excessive diarrhoea prevented further treatment. 
Synopsis of Case.-Advanced pulmonary tuberculosis. In 
ten treatments, marked relief from some of the symptoms. 
Case XXII.-December 12, 1885. Mr. H., aged twenty- 
nine. Family history shows no phthisical tendency. Patient 
gave phthisical history of about two years' duration. Evidences 
of well-advanced tubercular trouble throughout right lung, 
marked by dullness, non-vesicular respiration, with marked 
"crumpling" throughout that side. Nearness of voice in right 
apex in front and behind. Repeated examinations of sputa 
showed presence of numerous bacilli. Pulse rather rapid. Con- 
tinued elevation of evening temperature, as shown by chart. 
The patient had been given up by physicians, and, as he 
wished to try the treatment, it has been given him up to May 
1st, either three or six times a week, with occasional interrup- 
tions, and, although a variety of inhalations have been used, I 
can not say that the least benefit has been obtained from the use 
of the cabinet, with the exception of an improvement in the 
shortness of breath during the first month. 
Synopsis of Case.-Well-advanced tubercular disease of right 
lung. No appreciable benefit from treatment of about three 
months' duration. 
Case XXIII.-February 10, 1886. Miss B., aged fifty-five 
(Sent to me by Dr. Elbridge G. Cutler.) In father's family there 
was a tendency to lung trouble, but none on the mother's side. 
Patient subject to coughs and colds all her life. For eight years 
since the menopause has suffered with constant harassing cough, 36 
TEN MONTHS* EXPERIENCE WITH 
with copious yellow expectoration. General strength fairly 
good, and no marked loss of flesh. No fever. Never has asth- 
matic attacks. Chief complaint is of constant cough and sense 
of stricture across the lower part of the chest. Has tried every 
kind of medicine and every form of inhalation, with nothing 
but temporary relief in some cases, and Dr. Cutler wished her 
to try the cabinet. 
Examinations of the sputa revealed no bacilli. Percussion 
of chest shows possible slight dullness at the right apex, but not 
marked. In lower backs a slight increase in pulmonary reso- 
nance and deep tone. 
Auscultation reveals numerous sonorous and sibilant rales 
throughout. At the right apex, front and back, the rales are 
more numerous and of medium quality. Heart-sounds are nor- 
mal. 
Diagnosis.-Chronic bronchitis, with slight emphysema. 
Prognosis.-Unfavorable for permanent cure. 
For the first three weeks treatment was given six times a 
week, using camphor-water and creasote ( § j-gtt. x) as an in- 
halation. At the end of this time the action of the cabinet was 
reversed, the air within being compressed instead of rarefied ; 
but at the end of a week the rarefied air was again used, and a 
steam atomizer, with a spray containing benzoin, was substi- 
tuted for the cold-air spray. Treatment was then given three 
times a week up to April 17th, after which an inhalation of 
" terebene " was used, the terebene being poured upon a cloth 
which was tied over the end of the inhaling-tube. Fougera's 
Iceland-moss tablets were used at first, later Blancard's iron 
pills, then the syrup of hydriodic acid, and, finally, terebene in- 
ternally has been given (two drops on a lump of sugar three 
times a day), and the patient is now using terebene' in a small 
inhaling cylinder in her home. 
Great benefit can not be claimed in this case from the use 
of the cabinet, and yet the patient feels that she can walk rather 
better, that the cough is not so incessant as before, and that the 
sputa are less solid and more easily expectorated. She, more- 
over, feels that the cabinet has enabled her not to remain 
housed all through March, when our climate is usually at its PN EUM AT IC DIFFE R E N TI AT ION. 
37 
worst. The power of taking higher pressure while in the cabi- 
net has increased, the patient now taking from 0'4 to 0'8 
inch rarefaction, while at first 0'4 was managed with diffi- 
culty. The last examination shows a diminution in the number 
of sonorous rales, although rilles of a less coarse character can 
be still heard, especially in the right back and in the right apex 
in front. 
Synopsis of Case.-Severe chronic bronchitis of eight years' 
duration. Cabinet used as a last resort. Fifty sittings given. 
Slight improvement in some of the symptoms most com- 
plained of. 
Case XXIV.-March 4, 1886. Miss M., aged eighteen. 
Mother and one sister subject to cough, but otherwise family 
history excellent. Patient had been under my care for about a 
year for general debility, following her removal from her home 
in the provinces to Boston. For ten months had suffered from 
amenorrhcea, and occasionally from violent attacks of gastralgia, 
which latter symptom improved by the use of hydrochloric 
acid. About one month before the beginning of treatment, 
when much debilitated and after exposure, was seized with 
severe cough, with copious yellowish sputa; hoarseness; pain 
across the chest; fever; loss of flesh and appetite. Inability to 
sleep on account of cough. General feeling of malaise and dis- 
comfort. 
Patient pale, with exception of bright-red spots on cheeks. 
Palpation and percussion revealed at first nothing remarka- 
ble. 
Auscultation showed numerous sonorous and sibilant rales 
everywhere, front and back, especially on left. Temperature 
100°, pulse 120. 
Sputa contained a few bacilli. 
Inhalation of camphor-water was given in the cabinet. 
After the first sitting the patient slept with scarcely any 
cough all night, and after the second declared she " had not been 
able to breathe so well for six months." After the third the 
cough disappeared completely, although there was a slight 
amount of expectoration for a few days longer. 
After the third sitting, three days after beginning treatment, 38 
TEN MONTHS' EXPERIENCE WITH 
examination of the chest revealed scarcely any sonorous rales, 
even after cough. In the right apex in front, however, the per- 
cussion-note was slightly higher in pitch, a "crumple" could be 
heard with inspiration, and the voice sounded nearer. Hoarse- 
ness of voice still noticeable. 
At the end of a week all expectoration ceased, and patient 
felt very much better. The compound tincture of cinchona was 
given for the appetite, and from this time on the patient steadily 
improved. From the fact that occasionally a sonorous rale 
could be faintly heard from time to time in the chest, and on 
account of the presence of the bacilli in the sputa, I advised 
continuing the treatment for four weeks, even though the 
"crumpling " noticed in the right apex soon disappeared. 
On March 29th, about three weeks after beginning treat- 
ment, the menses, which had been absent ten months, ap- 
peared. 
The patient moved out of the city, and on April 9th careful 
examination of the chest revealed perfect respiration every- 
where, and the patient was feeling perfectly well. 
The temperature, which had been rather elevated for the 
first three weeks, became normal, although the pulse remained 
rather rapid ; the weight increased, the whole aspect was one 
of health, and the good account continues up to the present 
date. 
Synopsis of Case.-Severe bronchitis, with incipient tuber- 
culosis, as shown by presence of bacilli in sputa. Complete 
cure after eighteen sittings in four and a half weeks. 
Case XXV.-March 25th. Miss B., aged thirty. This was 
a case of long-standing pleuritic effusion which had very slowly 
been absorbed, leaving the left chest-wall greatly retracted and 
the lung evidently drawn up toward the apex. 
Treatment was tried as a means of relieving the patient from 
the inability to take a long breath with comfort and to see if 
the lung could be forced downward. 
Treatment was given six times weekly for three weeks with 
marked benefit to the patient in her sensations. After the fourth 
treatment she was enabled to take a deep breath without a sense 
of constriction across the prsecordium. Her power of walking PNEUMATIC DIFFERENTIATION. 
39 
improved steadily, and, although at first the treatment tired her 
a good deal, she noticed a marked improvement in her general 
symptoms. 
The expansion of the lung was shown by increased resonance 
toward the lower back with very faint respiration, where for- 
merly none could be heard, and, by the measurements of the 
chest, the left side showing an increase from 13J to 14| inches 
and the right side from 15£ to 16J inches. 
Seventeen sittings were given, and from 0*2 to 0'7 inches 
rarefaction used. 
Synopsis of Case.-Contraction of chest from slowly absorb- 
ing pleuritic effusion. Marked benefit from use of the cabinet. 
Seventeen sittings used. 
Case XXVI.- April 15, 1886. Mr. H., aged eighteen. 
(Transferred to me by Dr. H. I. Bowditch.) This case is still 
under treatment, and I am as yet unable to state what the 
chances of permanent benefit are. A diagnosis of chronic 
bronchitis with asthma and slight emphysema was made at first 
from the presence of a tympanitic quality to the percussion-note 
throughout chest and back; sonorous rales, not very marked, 
heard in both apices without dullness or peculiarity of voice 
in any part of the chest, and from the presence of cough 
with copious sputa. The patient has been taking treatment 
for about two weeks, using chiefly a 1-2,000 solution of corro- 
sive sublimate with from 0'4 to 0-5 of an inch rarefaction (that 
being the highest point yet reached), and the father reports 
improvement in strength, cough, sleep, and in the amount of 
the sputa. 
The discovery of numerous bacilli in the sputa changes the 
character of the diagnosis, and it only remains for further treat- 
ment to show if still greater benefit will come from the use of 
the cabinet. 
Synopsis of Case.-Chronic tubercular bronchitis of several 
years' duration. Improvement in certain symptoms in two 
weeks of treatment. Patient still using the cabinet. 
Case XXVII.-April 20, 1886. Mrs. Q., aged twenty-seven. 
A case of severe cough with scanty sputa for about seven weeks; 
loss of flesh and strength ; general debility ; no marked fever ; 40 
EXPERIENCE WITH PNEUMATIC DIFFERENTIATION. 
examination reveals slight dullness, with " crumpling " in lower 
left back and axillary region. 
The case was one which could easily be considered the be- 
ginning of an acute phthisis. The examination of sputa twice 
shows no bacilli whatever; therefore I judge it to be a severe 
acute bronchitis. Ater the third treatment the patient declared 
herself feeling much better. The cough lessened, the soreness 
in left chest disappeared, and sleep improved. 
Examination after the thirteenth treatment in two weeks 
showed a return of the normal respiration and percussion-note 
in the left back and axillary region, with the exception of one 
sonorous rale at that point. Cough scarcely noticed ; appetite 
improved ; gain of one pound in weight. 
Synopsis of Case.-Severe bronchitis. Thirteen treatments 
given, with marked benefit after the third, and almost entire ces- 
sation of morbid signs after thirteenth treatment.