A Clinical Report of Cases 
treated by Pneumatic 
Differentiation. 
BY 
HERBERT F. WILLIAMS, M. D. 
REPRINTED PROM 
SMie Neto York i-ttetucal Journal 
for September 11, 18, and 25, 1886. Reprinted from the New York Medical Journal 
for September 11, 18, and 25, 1886. 
A CLINICAL REPORT OF CASES TREATED BY 
PNEUMATIC DIFFERENTIATION* 
By HERBERT F. WILLIAMS, M. D. 
It is with a full appreciation of the danger of becoming 
wearisome that I feel compelled to give somewhat in detail 
my further clinical experience with the pneumatic cabinet. 
Such suggestions as I shall deem proper will appear with the 
report of each case, the history and study of which may be 
said to have prompted them. For the establishment of any 
new device or procedure in the healing art, practical inves- 
tigators are willing to accept the drudgery of compiling 
clinical results, for in this manner only can practical con- 
clusions he reached which must establish the utility of the 
matter in question. It is with satisfaction that I have re- 
ceived from prominent men who have had the opportunity 
to examine many of the cases that form the basis of my 
first report assurance} that my diagnoses were correct and 
my conclusions honest and not overdrawn. 
In my original report in the “ Medical Record ” for Janu- 
ary 17, 1885, results were recorded which have been termed 
“brilliant” by some enthusiastic believers in the differen- 
tial process. Some careful men have feared that the appli- 
* Read l>eforc the American Climatological Association at its third 
annual meeting. 
1 2 
A CLINICAL REPORT OF CASES 
cation to five advanced cases of phthisis of the term “ recov- 
ery ” might have created a feeling of incredulity concerning 
both the description and the describer, and endangered or 
delayed the development of this process. Had the con- 
tinued application of this process by myself and others 
failed to corroborate those results, 1 feel that the uncom- 
mon precaution of having my diagnoses and results in those 
cases confirmed by competent observers, together with the 
moderate statements that are found in the closing para- 
graphs, would have saved me from the righteous oblivion 
that is meted out to willful misrepresentation or unpardon- 
able incompetcncy and rashness. There seems to be no 
common understanding or agreement as to what constitutes 
a recovery in advanced phthisis, but the necessity for such 
a term sinks into insignificance when objective results arc 
fully recorded. My determination to adopt these measures 
of confirmation was greatly strengthened by the reading of 
a paper by Dr. Sidney A. Fox, of Brooklyn, before the 
Kings County Medical Society, entitled “A History of 
Sixty-nine Cases treated by Pneumatic Differentiation,” 
where in many instances I had the opportunity to examine 
his cases before and after treatment. 
In Case I of my first report (acute catarrhal phthisis, stago 
of softening) the patient has been in good health up to February 
1st of this year; weight 120 pounds. The last of January she 
attended a funeral on a cold and blustering day, and during the 
journey to the place of interment kept her feet warm by means 
of a heated foot-stove; was sufficiently imprudent to leave the 
carriage and stand by the grave during the recital of the burial 
service. A violent cold was contracted for which she did not 
seek relief until the latter part of February, and then on ac- 
count of a haunorrhage which occurred in the night, induced by 
great violence in coughing. 
The inheritance of phthisis in some is an inheritance of 
carelessness and indifference. Though this patient had a TREATED BY PNEUMATIC DIFFERENTIATION. 
3 
phthisical mother, she is the personification of carelessness, 
whether inherited or acquired. She again commenced 
treatment March 15th; her weight had declined to 115 
pounds; high evening fever, constant cough, and profuse 
expectoration which contained bacilli. Her physical signs 
gave evidence of acute phthisical degeneration. She took 
eight treatments, but the journey from her home in Brook- 
lyn to my office in New York seemed to exhaust her, in 
consequence of which she was placed under the charge of 
I)r. Fox and Dr. Brown, of Brooklyn, from whom she is now 
taking treatment; but her progress is slow, and there are 
grave doubts of arresting the phthisical process. 
On September 5, 1883, this young lady was considered 
to be in a hopeless condition by five careful physicians who 
then examined her. At this date her treatment by pneu- 
matic differentiation began, and as a result she has had over 
two years of immunity. 
Case II.—(Phthisis, third stage.) Patient remains in good 
health ; has had one or two colds this winter and coughed a 
little in consequence; has received no further treatment. 
Case IV.—(Abscess of left lung, producing extreme exhaus- 
tion, with primary changes taking place in right lung) Pa- 
tient in the same condition as last reported ; well, with exception 
of slight fistula in side. 
Case V.—(Acute bronchial catarrh with sub-epithelial ab- 
scess and peri-bronchial inflammation.) Patient was at last 
accounts driving an ice-cart about the city. lie has had one 
severe luemorrhage since last report, from which he fully recov- 
ered without serious lung change taking place. 
The seven patients with primary infiltration are well with 
the exception of two. Mr. F., whose family history is phthis- 
ical, remained well until June, 1885, a period of about eight- 
een months, when he was seized with a severe haemorrhage 
after prolonged exposure to the hot baths of Salt Lake City 4 
A CLINICAL REPORT OF CASES 
He returned to me for treatment in October, 1885, remain- 
ing a month, and is now living in Rondout in good condi- 
tion. Mr. M., the other, whose case was No. 3 of my origi- 
nal report, has been depressed by business disappointment 
and increased domestic responsibilities. He has taken 
seasons of pneumatic treatment under the care of Dr. De 
Watteville, of New York, who reports him at present in an 
improved condition, though he notes a steady decline from 
year to year. From June 12, 1885, up to the present time, 
I have treated forty-five additional cases of pulmonary dis- 
ease by this process. 
Of these cases I will give as concise a report as possible 
consistently with the particular phase that each represents, 
and the hints for treatment that each suggests. 
Cask I.—M. B., bachelor, gentleman, a high liver, aged sixty- 
one ; best weight 140, present weight 105; expansion one inch ; 
no history of phthisis ; in delicate health for two years. Pain in 
left scapular region ; slight exertion produces great distress for 
breath. Has traveled extensively in search of health. Expec- 
torates profusely and coughs incessantly. 
Physical examination shows respiratory movement in left 
side restricted ; emaciated, flatness of clavicular spaces; percus- 
sion shows high pitch in left side, most marked in upper por- 
tions, hut resonance defective throughout. Auscultation shows 
feeble respiratory sounds on right side. Left side broncho-vesi- 
cular, cog-wheel; prolonged expiration; deep-seated rales. 
Received nine treatments (iodine in spray), covering a period 
of one month, at the end of which time his expansion had in- 
creased to one inch and five eighths; cough relieved, expectora- 
tion easy and less; walks about with comfort; weight increased. 
Started for Denver, where in three weeks his weight had in- 
creased to 120 pounds. This case shows the benefit that follows 
a thorough expansion and the more marked improvement that 
follows climatic influence in consequence of increased respira- 
tory power. This patient is in a fair condition to-day, though 
incapable of recovery. TREATED BY PNEUMATIC DIFFERENTIATION. 
5 
Case II.—(Referred by Professor A. L. Loomis.) Mr. L., 
aged forty-four, married; best weight 125, present weight 110; 
family history clear; dyspeptic for several years; asthma for 
twelve years, slight at first hut increasing in severity every fall, 
when he has had attacks of acute bronchitis. One year ago 
had pneumonia with slow and imperfect resolution ; can not 
lie down at night, sleeps poorly, no appetite. 
Physical examination shows increased resonance in both 
lungs, with exception of scapular region of right, where it ex- 
tends to the axillary region; there is high-pitched percussion; 
increased area of cardiac dullness. On auscultation, the respira- 
tory sounds are not so strong as the percussion note would indi- 
cate. The inspiratory act of right lung is attended with fine 
crepitation, which is superficial. There are mucous and dry 
rales interspersed through both lungs. Treatment began June 
22d and continued at first tri-weekly, then once a week. He 
now appears occasionally; spent the fall and winter in com- 
plete comfort; his asthma is greatly relieved; his crepitation 
gone; a spray of chloride of ammonium with tincture of stramo- 
nium was generally used ; his weight to-day is 118J, within 5f 
pounds of normal; has taken in all forty-seven applications with 
an average rarefaction of T inch. At times he is simply al- 
lowed to inspire, at others to complete the act into the outside 
atmosphere. 
Case III.—(Referred by Professor Henry I. Bowditch, of 
Boston.) June 23, 1885.—Mrs. C., aged forty, married ; grand- 
father died of quick consumption ; best weight 115, present 91. 
Evening temperature 100° ; expansion 1J inch ; in good health 
until two years ago, when she had pneumonia from which she 
has never recovered. She has a hacking cough which prevents 
continued conversation; since January slight exertion provokes 
coughing; she can not go up or down stairs with ease; com- 
plains of great pain in left lung; expectorating freely; estimates 
quantity at one half cupful daily ; appetite poor ; menstruation 
scant. 
Physical examination shows emaciation and extremely feeble 
respiratory movements. The percussion note is normal in right 
lung; the left shows dullness in subclavicular region nearclavi- A CLINICAL REPORT OF CASES 
6 
cle ; tho note is of varying character in different regions of this 
lung, but there is a general absence of normal resonanco. Aus- 
cultation shows a fair vesicular murmur in right lung, but tho 
left is irregularly broken down, gurgles being easily demon- 
strated in the clavicular space; there are no respiratory sounds 
in the lower lobe. This patient took daily treatment covering 
a period of five weeks, taking in all thirty-two treatments; rare- 
faction increased from three tenths to eight tenths, and occupy- 
ing from fifteen to twenty minutes daily. Iodine and mercuric 
bichloride were used in spray; marked amelioration in cough, 
and diminished expectoration; increased ability in walking; 
reads aloud with comfort; expansion increased one half inch ; 
weight, ninety-six pounds. Physical examination shows in- 
creased circulation of air in the left lung, including the lower lobe, 
though tho upper portion remains the same as before, with the 
exception of diminished quantity of gurgles; this patient was 
last seen since January 1, 1880, when she professed a continued 
improvement, though no examination was made. 
Case IV.—Mr. P. This gentleman I knew personally for ten 
years, having been his family attendant during this time. On 
July 15th he appeared at my office and complained of symptoms 
which pointed to an enteric disturbance, which tho warm sea- 
son for several years has produced. For three years in succes- 
sion he has suffered from dysenteric symptoms that have con- 
fined him to bed from two to three weeks. To forestall this, I 
instructed him to go home and to bed, where I attended him 
for several days. He complained of little pain in his left sido ; 
his temperature was 102° every afternoon, and resisted my best 
efforts at reduction. We had succeeded in preventing his diar- 
rhoeal trouble, but his continued fever and growing weakness 
demanded a further examination, which was made July 25th. 
lie nover complained of a cough, and there was literally noth- 
ing but the slight pain in his left side to point to the disclosures 
of his left lung, which I found to give evidence of consolida- 
tion. Regarding this as suspicious of a low grade of pneumo- 
nia, or rapid and general tubercular infiltration, I made arrange- 
ments to give him the benefit of the pneumatic treatment, which 
were completed July 30th, at which time his condition was as TREATED BY PNEUMATIC DIFFERENTIATION. 
7 
follows: Mr. P., age<l forty-two, married, machinist, best weight 
150, present 136, temperature 101°, expansion one inch—all on 
right side. Father and two sisters died of phthisis; pale, anaemic, 
and emaciated ; respiratory movement of left side confined to a 
heaving movement of scapular region; no movement in the 
lower left thorax ; the percussion note showed good resonance 
in the superior portion of the left lung, extending to the third 
rib; the mammary portion and posteriorly, from the spine of 
the scapula, it was of high pitch and short duration; right side 
showed increased resonance ; auscultation gives normal vesicu- 
lar murmur in superior portion of the left lung, front and back ; 
breathing bronchial over lower portion of the scapular region. 
The sounds are indistinct below this point. 
He was submitted to treatment, using one-to-five-hundred 
mercuric bichloride in spray, and at his first application breathed 
easily against six tenths rarefaction, the major part of his breath- 
ing being done with his right lung. Auscultation showed no 
evidence of deeper penetration of air, and no diminution in the 
bronchial breathing. Auscultation while breathing in the cabi- 
net revealed a perceptible change in the character of the sounds, 
which were, at least, broncho-vesicular. The following day 
examination immediately before treatment revealed bronchia, 
breathing. Immediately after, the breathing for one or two 
respirations was broncho-vesicular, but rapidly changed to bron- 
chial during auscultation. It should not have required this 
demonstration to clear up my original diagnosis ; the left thorax 
was demonstrated to he at least half full of pleuritic effusion. 
The increased expansion of the lung by the normal air caused 
an even distribution of the effused fluid in the thorax, and the 
respiration became vesicular. Upon leaving the cabinet, the 
lung was quickly pressed up against the superior thorax, partly 
by its own contractility, but principally by the gravitation of 
the effused fluid. Now the respiration became bronchial. 
Ninety-six ounces of serum were withdrawn by aspiration, 
requiring throe operations at intervals of forty-eight hours. 
In two weeks from this time patient again commenced treat- 
ment. After ten applications there was an even expansion of 
the lungs. There still remained a deficient percussion note in 8 
A CLINICAL REPORT OF CASES 
the lower left axillary region. In October lie resumed his work, 
having gained nearly his normal weight and strength. On De- 
cember 25th he was seized with a chill while sitting near an 
open door. On December 30th a general pleurisy of the right 
lung was detected, for which he was actively treated. This 
attack was characterized by violent symptoms, and resisted every 
endeavor to control fever and conserve his strength. Forty- 
grain doses of quinine would reduce his temperature from 105° 
to normal, but only temporarily. January 28, 1886, his respira- 
tory sounds became coarse and harsh; cough had never been 
a prominent symptom, and he had scarcely any expectoration- 
Bacilli were now for the first time detected; ho was made to 
abandon all hope of being able to resume cabinet treatment. 
February 5th his condition was hopeless; but, as a last resort, 
ten minims of cultivating fluid, containing the sixth and seventh 
generations of Bacterium termo, were subcutaneously injected, 
the injection being repeated twice at intervals of six hours. A 
diffused redness about the points of puncture was the only dis- 
turbance noticeable. 
This procedure was justified by the absolutely hopeless con- 
dition of the patient, the certainty of an autopsy, and the hope 
that the latter might yield some further light upon the questions 
of bacteria therapy now exciting interest in foreign biological 
laboratories. 
On February 8th he died. On the 9th an autopsy was 
made by Dr. A. II. P. Leuf. The right pleura was covered 
with plastic lymph, with recent adhesions. The superior lobe 
was infiltrated with miliary tubercles ; the left lung was attached 
at its lower border by old adhesions and a thickened pleural 
sac containing about two ounces of fluid. The left apex con- 
tained tubercles, but less profuse than the right. No effusion 
in right thorax. Microscopic examination of lung shows enor- 
mous quantities of B. termo, but no apparent diminution of the 
specific bacilli. This case is given in detail for two reasons: 
First, it demonstrates the necessity of not allowing our precon- 
ceived conclusions to persist when careful physical exploration 
discloses their fallacy. Second, a pleurisy with such a history 
points to a tubercular dyscrasia, which a prompt and thorough TREATED RY PNEUMATIC DIFFERENTIATION. 
9 
disinfection arrested. This is proved by the comparative free- 
dom from tubercular infiltration of the left lung, which five 
months previous had been the seat of an inflammatory action 
similar to the subsequent attack on the right lung, where effi- 
cient disinfection could not be employed by reason of patient’s 
inability to get to the cabinet. 
Case V.—(Referred by Dr.Woodside, of Williamstown, Mass.) 
Miss A. D., aged twenty-four, unmarried, best weight 117, pres- 
ent 107, expansion two inches, immediate family history clear, 
paternal uncles and aunts died in early life. Sick since August, 
1884; early cough and hoarseness ; hemorrhage in November of 
same year, which was not controlled for a week. Sent South in 
January, 1885 ; remained four months, with improvement, which 
was maintained up to the latter part of August, when she caught 
a fresh cold, which has aggravated her symptoms. To-day, Sep- 
tember, 1885, her condition is as follows: Appetite poor; cough- 
ing, especially at night and morning; expectorating yellow mat- 
ter; shortness of breath; pale and anromic; chest tliin and 
emaciated; lack of normal motion left side; fremitus most 
marked right side. Percussion note high pitch ; in outer clavi- 
cular angle of left side, over right apex, front and back, the 
note is high pitched. On auscultation, both lungs in front the 
respiratory sounds are harsh; fine crepitation accompanies the 
first half of the inspiratory act; outer right pectoral region 
there is a prolonged expiratory murmur on both sides ; left side 
scapular region, respiration is broncho-vesicular, coughing pro- 
ducing fine crepitation in right clavicular space. 
This patient received thirteen treatments, with an average 
rarefaction of six tenths of an inch, using the mercuric bi- 
chloride in spray alternately with a solution of iodine. She 
was allowed to reside in Bloomfield, N. J., taking the train 
to New York, a distance of fourteen miles. There was no 
improvement, excepting in expansion and a slight diminu- 
tion in expectoration ; her weight decreased two pounds, 
and, under the above circumstances, further treatment was 
considered of doubtful value. On her return to Williams- 10 
A CLINICAL REPORT OF CASES 
town, Dr. Woodside noted a deeper and freer penetration 
of air. This case is reported to show the necessity of mak- 
ing proper arrangements as to access to the cabinet before 
commencing treatment. 
Case VI.—Mrs. B., aged thirty-five, best weight 135, pres- 
ent 122; expansion one inch and three quarters; one brother 
died of hasty consumption, aged thirty-five; trouble began in 
spring of 1885, with cough, rapid emaciation, and night-sweats ; 
was sent to the Catskills by her physician in June; remained 
eight weeks. The .month of September was spent in Morristown, 
N. J. Physical examination October 25,1885. Sallow, anaemic, 
ovident emaciation, feeble respiratory movements; can not go 
up or down stairs or walk fast; fever at night; expectoration 
profuse, but heavy and difficult to raise ; cough very trouble- 
some ; menses scant and irregular. Percussion, right side, nor- 
mal ; left, there is cracked-pot resonance, in middle of infra- 
clavicular space. Auscultation, right side, sounds are harsh, 
cog-wheel, with prolonged expiratory murmur; left, cavernous 
breathing in middle apex, with gurgles; the excavation extends 
to third intercostal space. This case has been under treatment up 
to March 31st of this year, taking in all forty applications with 
an average rarefaction of eight tenths of an inch, with sittings 
of from fifteen to twenty minutes; the treatment was sometimes 
supplemented by the method of artificial respiration (i. e., plac- 
ing the valves at D and vibrating the air from plus to minus the 
weight of the normal atmosphere). The mercuric bichloride 
was used for the first fourteen applications, afterward tr. iodine, 
five-per-cent, solution; her weight has increased to 133 pounds— 
within two of her best previous weight; no retraction has taken 
place in the left side; she has periods of coughing and expecto- 
ration, and small gurgles are still detected in cavity, which is re- 
duced in size and becoming irregular. 
It is too early to predict a recovery in this case. Yet, 
in the light of past experience, continued treatment should, 
I believe, produce ultimate quiescence of her symptoms. In 
justice to the cabinet, it may be noted that this patient has TREATED BY PNEUMATIC DIFFERENTIATION. 
11 
taken no other treatment except occasional prescriptions for 
relief of incidental symptoms not directly pulmonary. 
Case VII.—In this case I will give an exact transcript of ray 
examination notes. October 7th, Mrs. A. G. F., married, house- 
keeper, aged thirty-two, mother of three children. Best weight 
138 pounds, present weight pulse 112; temperature, 2.30 
p. m., 101°, expansion one inch. Family history: Mother died 
of uterine trouble; father living. Personal history : Two years 
ago commenced with hacking cough ; night-sweats ; has been to 
many physicians, Dr. Learning succeeding the symp- 
toms; last summer, after taking cold and attention to sick child, 
the trouble started afresh. At the present time has pain in left 
side, coughing, “raising phlegm ” with difficulty ; night-sweats, 
chilly toward evening; can not go upstairs; no appetite and 
dyspeptic; constipated ; menses irregular and scant; phlegm 
greenish ; cough so violent that vomiting is produced. Inspec- 
tion shows large full eye, with blue sclerotics; anaemic; flesh flab- 
by; emaciated, with clavicular depressions; tongue red; respira- 
tion 20 per minute, feeble respiratory movements. Palpation 
apparently normal on right side ; left absent. 
Percussion.—Lack of normal resonance in both supra-clavicu- 
lar spaces. There seems to be no abnormality excepting in the 
subscapular, axillary, and submammary regions of the left side; 
here the note is high pitched ; the point of greatest flatness is 
at the junction of the axillary and subscapular regions. 
Auscultation.—The inspiratory murmur in both infra-clavicu- 
lar spaces is harsh and wavy. Deep inspiration produces annoy- 
ing cough ; in the supra-clavicular spaces there is broncho-vesi- 
cular respiration; there arc moist rales on the left side in the 
subsonpular and axillary regions. Treatment began October 7, 
1885, and continued until December 19th, taking nineteen appli- 
cations. Bichloride of mercury was alternated with iodine. 
From six to eight tenths rarefaction was maintained for fifteen 
minutes at each sitting; for the last six* applications artificial 
respiration was used. On December 19th every symptom had 
abated. All her functions normal; weight 128 pounds. March 
11, 188G, has caught a fresh cold and returns for treatment. 12 
A CLINICAL REPORT OF CASES 
Her improvement since December 19th lias been phenomenal; 
she now weighs 154£ pounds; has remained in the city all win- 
ter in perfect health ; thinks herself in the third month of preg- 
nancy. 
On April 28, 188C, I called on Dr. Learning with refer- 
ence to this patient. He authorizes the statement that, when 
he last examined her in July, 1885, he found an extensive 
inter-pleural plastic exudate of the left lung, and that the 
diseased process had extended into the lung tissue. 
Cask VIII.—Miss M., aged twenty-five, unmarried; best 
weight 120; present 101; father died of phthisis and Bright’s 
disease, aged fifty-eight; mother, of phthisis, aged thirty-nine, 
lias been sick two years with the usual symptoms of progressive 
phthisis ; has been taking cod-liver oil, hvpophosphites, and gen- 
eral tonic treatment. She is now coughing and expectorating, 
has evening tever, emaciation, marked clavicular and intercostal 
depressions. Percussion shows high-pitched note in outer suh- 
clavicular space of right lung;, over left apex, extending to the 
second intercostal space, the note is high pitched. Auscultation 
shows broncho-vesicular respiration in the right apex. Left 
apex near sternum gives irregular respiration with gurgles and 
surrounding bronchial respiration. Microscopic examination 
shows bacilli. Treatment began October 81, 1885, and has con- 
tinued up to April 19, 1886, coming every day for first ten ap- 
plications, then thrice weekly. At present once a week. The 
stronger antiseptics were used. She has maintained her weight 
during the winter, and now weighs 103 pounds. The ausculta- 
tory sounds show sonorous r&les and rhonchi, but the former 
evidence of small cavities is wanting. Her sputum shows ab- 
sence of bacilli for the last two examinations, covering a period 
of four weeks. Enormous quantities of bacteria that can not he 
distinguished from B. termo are found. 
Case IX.—(Referred to me by Dr. Mary Putnam Jacobi, No- 
vember 6,1885.) G. P. S., aged thirty-nine; one sister and one 
paternal aunt died of phthisis ; has been under Dr. Jacobi’s care 
for some time, using, with other treatment, the compressed-air TREATED BY PNEUMATIC DIFFERENTIATION. 
13 
method of Waldenburg. The necessity for this was a severe 
congestion of the right lung in February, 1885, which confined 
patient to the house for three weeks. Dr. Jacobi’s notes of the 
physical examination are as follows : 
“Right lung superiorly, relative percussion dullness from 
clavicle to third rib, ordinary respiration feeble; in forced respi- 
ration, inspiration is suddenly checked at close, then weak sound 
during expiration, not like tubular breathing, but suggesting the 
forced expansion of an adherent pleura. Posteriorly, supra- 
spinous space, inner half, ordinary respiration gives wavy inspi- 
ration ; forced respiration gives soft tubular expiration. Outer 
half, soft pleural crackling, which extends down to outer half of 
the scapular region, encroaching a little on the axillary space, 
heard distinctly at ordinary respiration, more at forced respira- 
tion ; heart is normal, though pulse easily 87. There is sugar 
intermittently in the urine ; patient was a week ago in the midst 
of an acute bronchial catarrh, from which undoubtedly your 
treatment should give relief, whatever may be done for the 
chronic pleurisy.” The treatment was begun November 10th, 
and was continued uninterruptedly tri weekly until December 
10th ; rarefaction was the force employed, and six to eight tenths 
the amount maintained for fifteen to twenty minutes. Tr. 
iodine, five-per-cent, solution, diluted with extract of pine 
needles, and glycerin sprayed. 
My notes of this case show a rapid improvement of the 
symptoms, which are further confirmed by a note from Dr. 
Jacobi dated December 7, 1885 : “ I find the patient much im- 
proved. The bronchitic attacks really seem entirely cured, and 
more air enters the upper part of the lungs under the clavicle. 
I still find the traces of the chronic pleurisy, and indeed should 
not expect that to disappear.” On February 2, 1885, Dr. Jacobi 
writes as follows : “ The patient you treated for me, I think, in 
November, 1885, and who rapidly improved under the use of 
the cabinet and spray, seems now entirely well. Has been liv- 
ing in the country; has used the Waldenburg at home to con- 
tinue the effect of compressed air, and a respirator in the city to 
avoid the irritation of the city dust; has had no cough since, 
and I find to-day that the pleural crackling has about disap- 14 
A CLINICAL REPORT OF CASES 
peared. lias resolved, in case of a fresh attack of either bron- 
chitis or pleurisy, to return to you at once, and this I have ad- 
vised.” 
Case X.—(Case referred by Dr. Fowler, of New York, I)r. 
Loomis concurring.) Mr. W. S., clerk, aged twenty-eight; best 
weight 150, present 124|; pulse 110, temperature 101°, expan- 
sion one inch. Early mortality in seven paternal and five ma- 
ternal aunts and uncles, but no satisfactory evidence of phthisis 
Three years since was ill with pleurisy, lett lung; one year 
ago pleurisy right lung. 
March 20, 1885.—Had croupous pneumonia, right lung; this 
has never resolved, now coughing and raising; hectic; no ap- 
petite, extremely weak, progressive emaciation, respiratory 
movement extremely feeble, nil on right side, fremitus in- 
creased right side. Percussion over middle and lower lobe of 
right lung extremely high-pitched (fiat); careful percussion in 
clavicular spaces fails to give a full normal note. Auscultation 
shows on right side a loss of vesicular element in clavicular 
spaces; respiratory acts are short, and, the lower down wo 
listen, the less distinct they become. The inspiration is faintly 
bronchial and attended with fine crepitation over the lower 
posterior border and axillary space; left shows sibilant rales in 
upper lobe. 
Treatment began November 12, 1885, with two tenths rare- 
faction, but, on account of the great weakness of the patient, it 
became necessary to use the artificial respiration ; by the 18th 
he was able to maintain a rarefaction of six tenths, inhaling 
a solution of ammonium chloride, glycerin, and carbolic acid; 
afterward the tincture of iodine and pine-needle mixture was 
used; he averaged four to five treatments a week, and up 
to December 30th had taken twenty-five applications; his ex- 
amination now shows a freer expansion of his right lung, and 
the bronchial respiration had become more pronounced; his 
expansion had increased to two inches and a half, and there 
was some diminution in the number of moist rales in the right 
lung; his weight declined two pounds, but he was stronger and 
took a walk of three quarters of a mile on January 1, 1886; his 
improvement was temporary, however, for be was confined tg TREATED RY PNEUMATIC DIFFERENTIATION. 
15 
his room for the month of January. In February he com- 
menced treatment again, taking nine treatments, but no im- 
provement followed; his sputum had shown at all times bacilli 
in enormous numbers. 
Cask XI.—Dr. J. D., of New York, has kindly sent me a 
report of his own case, which I submit verbatim: 
“ Ago twenty-seven ; physician ; father and two cousins on 
paternal side died of phthisis. Healthy until July, 1880, when 
I suffered from pneumonia, being at that time in a run-down 
condition due to over-work. Pneumonia was very slow in re- 
solving; during fall and winter of 1880 had three attacks of 
haemoptysis; by spring of 1881 all symptoms^of lung disease 
had disappeared, and until the early part of 1884: I was entirely 
free from pulmonary troubles. At this time I contracted a 
cold, and the cough persisted in spite of treatment. During 
the following winter I had two very slight attacks of ha3inopty- 
sis; chest was examined at this time, and gave evidence of 
catarrh of smaller bronchi; spent February and March at Ham- 
ilton, Bermuda, but did not derive the expected benefit which 
I sought, and suffered from the enervating effects of the cli- 
mate. During August and September, 1885, sojourned in the 
White Mountains and gained but a few pounds in weight; re- 
turned homo somewhat discouraged ; having heard a paper on 
the treatment of phthisis by pneumatic differentiation, read by 
Dr. II. F. Williams at the meeting of the American Climato- 
logical Association, I determined to try the method. In Octo- 
ber, 1885, I called on Dr. Williams, who kindly put the appa- 
ratus at my disposal. At the time of commencing treatment a 
physical examination showed some catarrh of the finer tubes; 
a small area of diminished respiration at the upper portion of 
the left lung. I coughed all day ; cough accompanied with ex- 
pectoration. 
“For the first few weeks used tho cabinet three times a 
week, and later once a week. After the first few seances the 
cough diminished, and in three months had stopped entirely. 
In a month from beginning treatment had gained five pounds 
in weight. 
“ Preliminary and subsequent examination was made by Dr. 16 
A CLINICAL REPORT OP CASES 
J. II. Ripley, of New York. Latter examination shows nothing 
but small area of diminished respiration and slight emphysema. 
The latter condition was noticed beforo this treatment was 
commenced. 
“Verytruly, J. D.” 
The doctor omitted to state that for his emphysema he was 
subjected to two inches pressure in the cabinet and expired into 
the normal air, from which he frequently experienced relief and 
benefit. 
Case XII.—Miss E., aged twenty; host weight 135, present 
117; temperaturo 102°, r. m. ; expansion inch; spirometer 
30; is iguorant of any phthisical history; father and mother 
dead. One year ago took cold, from which did not recover. 
Has been under treatment, using spray, etc., since hoarseness 
commenced, which was an early symptom; at present voice is 
very husky, coughs constantly; expectorates yellow and green- 
ish matter, sometimes mixed with blood; averages two cold 
sweats per week ; very short of breath ; percussion note is high- 
pitched in clavicular region of right lung; point of greatest in- 
tensity at junction of sternum; note is also high-pitched at 
outer clavicular angle of left side; auscultation gives a bron- 
chial, harsh, and wavy respiration in upper anterior lobe of 
right lung; moist rales in profusion on coughing. There are 
sibilant and sticky rales below point of bronchial breathing; in 
the left lung the respiration has lost its vesicular element; there 
is also evidence of pleuritic attachment. Treatment began De- 
cember 1, 1885, and continued every other day up to December 
18th, taking in all ten applications; tincture of iodine sprayed; 
five to eight tenths rarefaction used. Patient professed improve- 
ment at the fifth application, and the respiratory sounds seemed 
clearer, but the cough, expectoration, and fever did not abate. 
On December 18th there was no substantial benefit noted, when 
I advised the suspension of the treatment. Two weeks later 
she was visited at her home; her lungs were congested, bron- 
chial respiration was more marked than ever, and her fever had 
increased. 
Whether the fever was increased by the use of this 
method or not, the coincidence at least was striking. There TREATED BY PNEUMATIC DIFFERENTIATION. 
17 
may be conditions where the accidental point of breaking 
down is in close proximity to the pulmonary lymphatic sys- 
tem, and any considerable force exercised, as in this case of 
six tenths rarefaction, would tend to more rapidly dissemi- 
nate the particular virus into the general circulation, and 
thus more rapidly bring about the necessary conditions to 
infect the nervous centers that control bodily heat. This 
is a fair conclusion in this case, though it may be an incor- 
rect one. 
Case XIII.—Mrs. L., married, aged thirty-three; best weight 
150, present 138£; temperature normal; expansion If inch; 
spirometer 150; no history of phthisis; had uterine trouble 
before marriage; a cough first developed shortly after the birth 
of a child, one year ago, which has never entirely disappeared; 
has recently recovered from a severe prostration consequent 
upon a hemorrhage following a retained placenta of a three 
months’ miscarriage; has been up and around for the last 
month; her general condition improving, but her cough grow- 
ing more severe and expectoration increased; very anemic, 
sallow ; exertion produces dyspnoea; fremitus increased on right 
side anteriorly ; percussion on right side reveals high-pitched 
note in clavicular spaces extending to fourth intercostal space. 
The note is not full in axillary region of left side. Ausculta- 
tion, right lung; the respiratory sounds are feeble. Forced, 
they become bronchial with moist rAlos; in the left upper lobe 
in front the respiratory sounds are harsh and cog-wheeled in 
character. Treatment began December 10,1885, and continued 
with great regularity up to January 26, 1886, taking in all thir- 
ty-one applications. Rarefaction from four to eight tenths. 
The agents used in this spray at different times include mer- 
curic bichloride, carbolic acid, ammonium chloride, tincture of 
stramonium, cocaine, morphine, and iodine. A steam spray was 
used for a time instead of the compressed air-blast. Artificial 
respiration usually supplemented the sitting, which averaged 
from fifteen to twenty minutes in duration. My daily notes 
show various and conflicting statements, but no steady improve- 18 
A CLINICAL REPORT OF CASES 
inent is recorded. At times she would complain of sharp pleu- 
rodynia, and, strange to say, sought the cabinet for relief of 
this. The mornings after inhaling the iodine the sputum gave 
a blue reaction upon her handkerchiefs. Her weight, up to 
January 26th, had not declined, and her temperature remained 
normal, yet her cough continued, and the result of the treat- 
ment has been negative. 
Case XIV.—(Referred by Dr. D. 0. Dellenbaugh, of Cleve- 
land, Ohio, who in his letter records a morning subnormal tem- 
perature and cites the case as a “typical example of phthisis 
following upon pneumonia, involving nearly the whole of the 
right lung”): 
R. 0., aged twenty-seven, single; best weight 138 pounds, 
present weight 120]; no phthisical history; “cold one year 
ago ”; confined to bed ; coughed ever since; expectoration very 
free and heavy. For last six months night-sweats; coughs so 
violently that ho vomits; can not take exercise without loss of 
breath, feeling very weak; abnormal blueness of face and 
hands, emaciated, deep temporal fossoa, retracting right chest 
almost a deformity; intercostal depression. On percussion of 
right anterior upper and outer angle, the note is woody in 
character; in the scapular region it is of higher pitch than on 
the corresponding side; the left supra clavicular space fails in 
normal resonance. 
Auscultation.—Cavernous respiration in right outer apex, 
extending toward the axillary border; large gurgles; inspira- 
tion accompanied with fine rales in mammary region; sputum 
contains bacilli. Began treatment January 25, 1886, and has 
continued up to April 17th, taking in all thirty treatments. 
Took treatment every day for first ten applications, gradually 
declining in frequency until finally be came once a week. The 
mercuric bichloride was used (l to 500), varied at times with the 
iodino solution, to which eucalyptol was added. Examined 
April 17th ; the cavity has become nearly quiescent; there are 
no moist rales in mammary region; he estimates the quan- 
tity of sputum at two thimblefuls a day; his weight is 
pounds. 
Case XV.—Sent by his physician, Dr. Guild, of Ware, TREATED BY PNEUMATIC DIFFERENTIATION. 
19 
Mass., who kindly appends the following history: Mr. G., aged 
forty, unmarried, temperate; one uncle afflicted with asthma; 
five or six years ago, after a succession of colds which were 
easily contracted, he complained of shortness of breath ; suffered 
with hay fever from 1870 to 1879; after this and at the time 
of the beginning of the asthmatic seizures the hay fever did 
not appear; can not go near a stable without exciting an 
asthmatic attack; generally free from asthma while in New 
York. He is convinced that the locality of his native town 
(Ware, Mass.) is prejudicial to his case, which is strengthened 
by his uncle’s experience, who could not reside in comfort at 
home. The physical signs show extreme resonance; ausculta- 
tion shows absence of vesicular murmur with sibilant rales; 
heart-sounds heard with great difficulty. There are bronchial 
and some moist rfdes. 
First treatment February 22d ; rarefaction four tenths, with 
ammonium chloride, for the relief of the bronchial catarrh. The 
sitting ended by artificial respiration. For the last fifteen ap- 
plications compression was carried to two inches in the cabi- 
net and the patient allowed to expire into the normal air, inhal- 
ing tho air of the cabinet. In this way he repeats this act ten 
to fifteen times a minute, lie has taken twenty-eight appli- 
cations in all; has increased his respiratory power; his heart- 
sounds are audible; has had no attack since commencing treat- 
ment; is now in Ware to determine the effect of the treatment. 
Cask XVI.—T. F., aged thirty-nine, physician, gives tho 
following history of his own case, and the benefit he derived 
from a few treatments with tho pneumatic cabinet: 
“Was attacked with acute pleurisy in July, 1883, slight 
effusion, etc., followed by cough and prostration, and was con- 
fined to the house until May, 1884; then began to improve rap- 
idly, and, by the advice of my physicians, spent the summer in 
tho Adiromlacks, and the following winter in southern Georgia; 
again last summer wont to the Adirondack lakes, and in the 
autumn resumed practice. As far as I knowr, my only trouble 
has been pleurisy with its sequels; family history very good; 
in April, 1884, my chest had contracted four inches (from 38 to 
34inches); weight reduced from 160 to 146 pounds. 20 
A CLINICAL REPORT OF CASES 
“In December, 1885, at the suggestion of my physician, Dr. 
T. A. McBride, of New York, I applied to Dr. Williams to try 
the effect of ‘pneumatic differentiation’ upon my contracted 
chest. During the time from May, 1884, to December, 1885, 
my chest measurements only increased one inch, although my 
weight increased ten pounds; with this condition of my chest 
T had relatively limited expansion and accelerated respirations, 
with more or less pain constantly. I think T received in all ten 
treatments; at first two a week, later one only every week. 
The result of these treatments has been an improved respiratory 
mobility; respirations less rapid and deeper; am able to sleep 
equally well on either side (previous to my first visit I was un- 
able to sleep on my left side), and almost entire freedom from 
pain in thorax. 
“ I think that the thorough expansion of the lungs by differ- 
entiation has been of great therapeutic benefit, and with the 
start this measure has given me I have been able to take a large 
amount of out-door exercise, and a steady iinprov«ment has re- 
sulted. Yours truly, T. S.” 
In these sixteen cases rational auxiliary treatment lias 
not been withheld, nor has it been essentially different in 
any case from that which had been instituted before com- 
ing under my care. In most of the cases I have advised an 
occasional return for treatment, and an immediate return in 
the event of taking cold. While these results are largely 
due to the benefit of expansion and thorough blood aera- 
tion, and the consequent stimulation of appetite and assimi- 
lation, I think the undoubted influence of deeply introduced 
medicinal agents in some of the cases must claim a share of 
the credit. 
I can not longer trespass by an extended reference to 
the remaining twenty-nine cases. Many of these would 
furnish data like those reported; while none can show a 
gain of thirty-two pounds, as in Case VII, none have as 
signally failed as Case XII. TREATED BY PNEUMATIC DIFFERENTIATION. 
21 
In response to an invitation from me, many of those 
physicians using *the cabinet have forwarded me reports 
and conclusions gained from their experience with it. With 
their permission I append them. 
From Dr. Classon and Dr. Clarke, of Albany: 
“ We send you a report of one case in which we expect re- 
covery by cabinet treatment. We expect favorable results in 
two other cases, but it is too early to say decidedly yet; im- 
provement has followed in three others. G. L., aged nine- 
teen, clerk; weight 13'J pounds; single; one sister died of 
phthisis, aged eighteen; had a haemorrhage one year ago, fol- 
lowed later by two slight ones accompanied by cough, loss of 
weight, and recently by night-sweats; expectoration mainly 
mucous. 
“ Examination.—Percussion; slight dullness over upper half 
of both lungs, extending a little farther down on right than left 
side; more marked on upper right side; increased resonance 
over lower part of both lungs. 
“ Auscultation.—Fine mucous rales over same portion ot 
lungs as dullness; respiratory murmur diminished over upper 
half of both lungs, and exaggerated over remaining area. 
Broncho-vesicular respiration over circumscribed area in pos- 
terior upper half of right lung (infra-scapular region). 
“Treatment.—After fourth treatment, began to improve; 
after sixth, marked improvement, coughing only in the morn- 
ing; rales clearing up, dullness disappearing, and respiratory 
murmur becoming more distinct. At the end of the fortieth 
treatment the left lung was nearly normal; the right still gave 
the same sign, though less marked in the extreme upper por- 
tion—that is, in the supra-scapular region. The remainder of 
tho lung was normal; respiration in the cabinet at first treat- 
ment twenty-seven, gradually decreasing to twelve at the sev- 
enth, to eight at the ninth, to six at the twelfth, to fivo at the 
twrenty-second, to four at the twenty-fifth, and remained there 
up to the present time. Began at two tenths rarefaction, in- 
creasing to three tenths at the fourth, four tenths at the sixth, 
six tenths at the eighth, eight tenths at the twentieth, and the 22 
A CLINICAL REPORT OF CASES 
same throughout. Began with one treatment every other day, 
and kept that up for thirty-seven treatments; then dropped to 
one a week, and has continued that to the present. 
“Treatment commenced November 2d; took the last April 
10th. Diagnosis, acute phthisis. 
“Yours respectfully, 
“R. I). Ol.AKKB, 
“ F. L. Classon.” 
Dr. W. Everett Smith, of Boston, who lias had a cabi- 
net since December, 1885, reports: 
“ I do not feel justified in reporting as absolutely cured 
more than this single case, which I send. But this one case is 
valuable to mo, as showing what can be accomplished in treat- 
ment. I have others that might be reported, but they arc not 
so striking, nor should I feel justified in speaking so positively 
in regard to them. 
“ J. M. E., clerk, aged thirty, has been troubled with asthma 
constantly for about fifteen years; has always been subject to 
colds. In the early winter of 1884 had pleurisy in left side; 
strength and weight so reduced that he had to give up work 
and spend the winter in the South; was examined at this time 
by Dr. J. P. Oliver, of Boston, who said he had tubercular 
phthisis; has never had haemorrhage or night-sweats, but in 
December, 1885, when I first saw him, I found his daily wrork 
more than he had the strength to accomplish; slight cough and 
appetite; no bacilli; chest very fiat and emaciated, with a 
marked tender area in right infra-clavicular space; respiratory 
act feeble; patient gets out of breath easily; percussion re- 
vealed slight dullness at both apices. Auscultation showed in- 
spiratory murmur hesitating at both apices, with occasional 
slight rales; at the right apex in back were very distinct crack- 
lings; there was an abnormal transmission of heart murmur in 
right subclavian artery; over the third interspace and about 
two inches from sternum werestridulous rales; vocal resonance 
not clear over chest, clearer at apices; expansion one inch; 
diagnosis, incipient consolidation at apices. TREATED BY PNEUMATIC DIFFERENTIATION. 
23 
“The treatment has been chiefly in rarefied air, with oil of 
pine-needles, and later with a creasote and camphor mixture. 
“First treatment December 24, 1885. Between this date 
and February 10th had eighteen treatments; has not been 
treated since March 15th ; has had a total of twenty-three treat- 
ments. On April 19th I re-examined him, but can find absolutely 
no traco of dullness or abnormal respiratory murmur. Patient 
says he never felt or looked healthier in his life ; has not hesi- 
tated to be out in all weather this winter, even in night air, a 
thing he has never been able to do before; has had only one 
cold, and that very slight; lias had no asthma since January 
14th, although he has several times run for the cars very hard. 
Does not easily get out of breath now; feels that he is stronger, 
daily work does not tire him ; absolutely no cough, appetite 
hearty, chest thirty-one inches; but expansion the same; tender 
area in right infra-clavicular space absent. 
“ Yours very truly, 
“ W. Everett Smith.” 
Dr. C. B. Herrick, of Troy, N. Y., says : 
“I will attempt, by the following remarks on a few of my 
cases of pulmonary troubles which I have treated with the 
pneumatic cabinet, to give you an idea of what I have done in 
that line and with what success. Upon receiving my cabinet, 
I, of course, tried it upon myself as well as on my students and 
others who had perfect respiratory organs. I found after a 
few trials, in which we could not breathe against moro than 
four- or six-tenths pressure, that we were enabled easily to 
allow one inch to one inch and a half to bo applied. This extra 
amount of air thrown into our lungs certainly filled us up, and 
all tight clothing had to be loosened, and acceleration of the 
heart’s action was noticed and, perhaps with one-inch pressure, 
a redness of the face was apparent; but the more marked effect 
was the entire satisfaction of having plenty of air to breathe 
and no work to breathe it. This effect would continue for some 
time after coming out of the cabinet. Why, even in perfect 
health, this acceleration of the heart’s action, caused as it is by 
thw undue amount of air introduced into the lungs to be arto- 24 
A CLINICAL REPORT OF CASES 
rialized, its more ready arterialization, and with this all a gen- 
eral activity of all the functions of the body, would not this 
be a good general tonic, and, of course, a perfect immunity 
against permanent lung trouble? I think the time will como 
when people will take their treatment as they now do their 
Turkish and other baths, and the sooner the time comes the 
better. Now as to a few of my cases. 
“ Mr. Nathan M. is a machinist, aged forty-five, coming to 
me July 20, 1885, with the following history: His father died 
of phthisis; he contracted a cold some twelve months since, 
and had one slight haemorrhage. His physical condition is 
very weak; weight, 120 pounds; respiration, 80 a minute, very 
short and labored. His expanded chest is thirty-two inchos; 
ribs prominent; right chest revealed dull percussion through- 
out its upper half; remainder with left side normal. Auscul- 
tation shows a solid infiltration in the upper right lung; re- 
mainder and right side comparatively normal, save some bron- 
chitis. lie took his first treatment July 30, 1885, at a pressure 
of four tenths of an inch, using as spray iodine and iodide of 
potassium; his respirations while in the cabinet fell to eighteen 
a minute; and after ten minutes’ treatment he expressed him- 
self as being able to take a deeper breath than he had in three 
months; he continued with daily treatments under a gradually 
increased pressure, until at the sixth he had reached seven 
tenths; respiration outside,of the cabinet was now twenty- 
two; could walk along distance without winding. On August 
30th, after ten treatments, a re-examination was made. 
“A decided change in all the previous conditions; bron- 
chitis absent; percussion dull over left area, more crepitant than 
mucous rales, showing conclusively a deeper penetration of air 
in the lungs. lie continued daily and tri-weekly for forty-five 
treatments; his expansion gained one inch, and in weight 
twelve pounds. Is able to care for himself, and, although not 
cured, still gave up his treatment, and 1 have not seen him 
since. 
“Mr. A. G. T., aged twenty-four, weight 128, father and 
grandfather died of phthisis, lie has coughed two years, and 
has had two or three haemorrhages. Physical condition fair; TREATED BY PNEUMATIC DIFFERENTIATION. 
25 
slight build. Ilis symptoms have been raising of mucus, some- 
times heavy, and with a daily evening fever. Examination 
shows chronic bronchitis everywhere, and a muffled murmur 
on the right side. Percussion obscure; diagnosis, incipient 
phthisis. 
“First treatment July 15th, with two tenths rarefaction and 
with an iodine and iod. potass, spray; respiration fell two acts per 
minute while in the cabinet. After the fourth treatment the even- 
ing fever began to abate, and on the sixth day had entirely disap- 
peared. His expectoration became more frothy and very easy 
to raise. Ho took daily treatments, creeping up to seven and 
eight tenths, using iodine, bichloride, ammonium hydrochlo- 
rate, tolu, etc., as sprays. At the expiration of fifty treatments 
his respiration was normal, weight increased five pounds, 
gained one inch in expansion, and is working harder than he 
ever did in his life before, and without any return of his bad 
symptoms. Has passed the winter north, while that of 1884 
and 1885 had to be spent in Florida. 
“ Mrs. R., aged sixty-three; mother died of consumption ; four 
maternal aunts died of tho same disease. She contracted a 
cough twelve years ago, and coughed until five years ago, 
when she had an attack of pneumonitis; since then has been 
raising very little solid sputa, and been reduced in weight 
and strength until she is a shadow; has had a number of 
haemorrhages. 
“Six months since she had a second attack of pneumonitis, 
which laid her very low, and from which she had never recov- 
ered. I saw her during July. At this time the following con- 
dition was present: 
“ The upper lobe of right lung was solid on percussion, and on 
auscultation devoid of air. Tho lower lobes had rales of every 
conceivable nature present; the left side was filled with bron- 
chial rfiles and evidences of infiltration ; inspiration was jerky 
and accompanied with audible sound; respiration was thirty 
per minute ; her condition was very feeble; coughed hard ; ex- 
pectoration heavy, muco-purulent, with some blood. The first 
treatment was given her September 1st, with one tenth rare- 
faction; iodine was used for ten minutes; respiration fell to A CLINICAL REPORT OE CASES 
26 
twenty per minute ; daily and bi-daily treatments were kept up, 
she being very plucky, and breathing gradually up to six and 
seven tenths; remaining in the cabinet for from fifteen to thirty 
minutes. The medication was iodine, bichloride, ammonium 
hydrochlorate, and tolu; respiration in the cabinet was now, 
after fifteen treatments, sixteen a minute. In all sho took 
sixty-five treatments, and examination showed an entire absence 
of rales in the left lung, while those in the right were confined 
chiefly to the upper lobe. Septum is entirely frothy, no lumps, 
and diminished in quantity; she is 100 per cent, improved; can 
walk in the open air unassisted, and has gained five pounds; in 
expansion she has gained one inch. She left for her home in 
the country, and has remained in as good condition as when 
leaving off her treatments. This case especially speaks well for 
the cabinet. From a mere skeleton, a dying consumptive, she 
has been brought to look almost the picture of health, is able 
to care for herself and others as well, and all in a person of her 
advanced age, and with such a history behind her. 
“Miss T., aged twenty-six, came to me, December 21st, with 
the following condition: A history of pneumonitis from which 
she never fully recovered; evidence of it yet in upper lobe of 
right lung. I diagnosticated unresolved pneumonitis. 
“ This patient began with two tenths pressure and ten minutes 
at a time. She attained in five treatments a pressure of six 
tenths, and remained thirty minutes in the cabinet. She im- 
proved greatly in breathing and all her pulmonary symptoms, 
and after fifteen treatments she left me, being greatly im- 
proved. 
“ Besides these special cases I have had a number of others 
which have responded kindly to the influence of the differen- 
tiating process, and who were relieved by treatment. Some 
were in the last stages of phthisis, but the relief obtained was 
so great that they would come for treatment until physically un- 
able. In all I have been more than pleased with the effect of 
this truly remarkable scientific apparatus for the treatment of 
our most formidable disease, phthisis. 
“ Very respectfully yours, 
“ 0. B. IIekkiok.” TREATED liY PNEUMATIC DIFFERENTIATION. 
27 
Dr. W. A. De Watteville, of New York, writes as fol- 
lows : 
“ It would be desirable that reports of cases should be more 
objective in character than is usually the case. Instead of 
piling up statistics of cases which have been under my care, I 
prefer to lay before you three types of pulmonary pathological 
conditions, distinct in regard to their symptoms, and to note 
the changes produced by pneumo-differential treatment. 
“Great accuracy in statement, both as to primary diagnosis 
and to final results, is necessary, for the primary diagnosis is 
not so simple as to be free from possible error, and the enthu- 
siastic compiler of his own cases is sometimes apt to make a 
mountain out of a mole-hill, and record the recovery of a so- 
called primary infiltration, which, if only a simple catarrh, 
would have recovered with a week’s warm weather and a little 
cough mixture. If this is not so, how can we explain the won- 
derful results which appear so often in our journals whenever a 
new plan for the treatment of phthisis is described ? I shall, 
therefore, detail three cases which, I believe, are fairly repre- 
sentative of their type: 
“Case I.— Miss A. G., aged twenty-six, school-teacher, 
French nationality, has been in this country for three years; 
parents both dead, but no phthisical history; had to take a 
situation as teacher of French in a fashionable school. During 
the fall of 1884 was exposed to some hardship by overwork and 
cold room; developed late in the fall a chronic cold ; cough ; 
yellow expectoration; loss of appetite; evening fever; loss of 
flesh and voice; general weakness. Her weight declined from 
128 to 98 pounds. She held on to her position until the end of 
the winter session, and then came to New York to visit friends, 
and, as she said, to die in peace. She was sent to me to give an 
opinion as to her chances by pneumatic treatment. 
“ Examination.— Weight 98 pounds, general emaciation, 
breathing labored, complexion pallid, eyes surrounded by dark 
rings, temperature 99° to 101°, and pulse feeble. 
“ Inspection.—Expansion, two inches and a half—right side, 
one inch and three quarters; left side, three quarters of an inch. 28 
A CLINICAL REPORT OF CASES 
A distinct hollow under left clavicle; respiratory movement on 
left side very limited ; right side slightly defective ; general nu- 
trition and appetite exceedingly poor. Percussion note fair on 
right side, dull on upper third of left side, with exception of a 
circumscribed space below clavicle, where it is super-resonant, 
and changes its note on changing the position of the mouth. 
“ Auscultation.—Fine rales and rhonchi on right side, with 
more or less bronchial breathing ; on left side the same symp- 
toms more pronounced ; on upper third, expiratory sounds are 
weak; loud bronchial breathing in apex, with cavernous sounds 
and gurgling rfiles under the clavicle. Posteriorly the same 
symptoms are less distinct. 
“Treatment was begun on June 3d, and was repeated daily 
when the weather permitted it; internal medication was dis- 
continued. The patient was ordered a bottle of Dublin stout at 
dinner-time. June 10th, objective signs not much changed, a 
somewhat freer expansion being noticed; voice slightly im- 
proved. June 17th, is able to sleep on her back; coughing much 
diminished, free yellow expectoration, appetite increasing, and 
night-sweats absent. Kales are coarser in character, and often 
accompanied with sibilant rales. The respiratory sounds are 
considerably increased. June 21st, patient had to visit her 
dressmaker to have her dresses enlarged over shoulders and 
chest; voice much improved. Is able to take walks and make 
visits. June 28th, patient can not take treatment on account ot 
heat; appetite not satisfactory; more cough at night and dur- 
ing forenoon. July 5th, treatment has been omitted during 
heated term ; complains of her right side, and can not sleep on 
it. Appetite not satisfactory. 
“ Ordered tannate of quinine in five-grain doses three times 
daily. July 14th, was called to Brooklyn to see patient; sho 
suffered great pain on right side ; pulse high, temperature 101° ; 
find that dry pleurisy has developed over lower half of lung; 
the patient had that part of the thorax strapped with belladonna 
strips. July 24th, patient has resumed treatment and feels much 
better; appetite good. July 31st, improving rapidly; gaining 
weight fast; appetite excellent; sleeps comfortably on hot 
sides; hardly any cough ; voice strong; throat not sore at all i TREATED BY PNEUMATIC DIFFERENTIATION. 
29 
ordered to come bi-weekly. August 14tli, continued improve- 
ment; rules, with the exception of the space under clavicle, are 
absent. No difficulty in breathing. Patient leaves to return to 
her duties in school; her weight is 112, a gain of 14 pounds. 
November 4th, patient has come to New York on a visit; she 
is in excellent health; when very tired, she coughs occasionally, 
and her voice becomes hoarse. She teaches eight hours daily ; 
her weight is 130, general health excellent, appetite as great as 
ever. Auscultation still yields the bronchial and cavernous 
breathing under the clavicle. The heart-sounds are heard still, 
with equal distinction in the right axilla; a few coarse rales 
are occasionally mot with ; there is still the evidence of pul- 
monary lesion, but the patient is satisfied. March 10th, the 
patient visits at rare intervals; has followed her onerous duties 
during the winter, and feels stronger than she lias for three 
years. 
“Case II.—Miss A. B., aged seventeen ; weight 120. Exam- 
ined September 11,1886. Father died of phthisis. Ilad pleuro- 
pneumonia (?) six months ago, and has never felt well since; 
cough, fever, and night-sweats; no haemorrhage ; loss of appe- 
tite and flesh. Was sent into the mountains of New Jersey 
without benefit. Yellow expectoration; temperature 102° or 
103° in the afternoon. Florid complexion; no emaciation in 
face; thorax emaciated; clavicles prominent, scapulae also; res- 
piration is limited and almost entirely confined to lower thorax 
and abdomen ; the upper part of thorax is almost immovable. 
'■'•Percussion: The note in the supra-and infra-clavicular and 
scapular regions is wanting in resonance and is high in pitch ; 
no region of absolute dullness can be found, however. Auscul- 
tation shows sharp bronchial breathing, with undulatory expi- 
ration present at both apices. Fine crepitant rales accompany 
the end of inspiration and during the whole of expiration. 
These symptoms diminish as you descend the thorax ; the 
breathing in upper half on both sides lacks the vesicular char- 
acter. 
“Treatment was commenced September 11th and given four 
times until the 15th. It was then discontinued for ten days on 
account of hot weather ; was then resumed and continued three 30 
A CLINICAL REPORT OF CASES 
times a week until middle of October, when she left for home. 
The inhalations used were iodine, sublimate, chloride of ammoni- 
um, and salicylic-acid emulsion. The patient made very little 
pi'ogress during the twelve first treatments, and her condition 
was discouraging. A rarefaction of nine tenths inch was giv- 
en, when she suddenly began to breathe fully with her upper 
thorax. From this day steady improvement commenced and 
continued. State of health at period of dismissal: Free thoracic 
breathing; bronchial breathing still present, hut vesicular ele- 
ment more prominent; rales absent, and expectorates very little; 
no fever; appetite good; increase in weight not measured, hut 
considerable. Present state of health, as reported last week, is 
excellent. 
“Case III.—Mr. A. P., a transitory resident in New York 
city, has been sent on a sea voyage for the benefit of his health; 
aged thirty-three; phthisical history on his maternal side. Had 
a severe hamiorrhage three years ago and was sent to Corsica ; 
has been getting progressively worse; May 24th, he shows ab- 
solute weakness, unable to mount a stair, harassing cough; 
sputa thick, yellow, and streaked with blood; temperature 
102-103° in the afternoon. 
“ Examination.—Great emaciation ; hectic ; cheek-bones, 
clavicles, and scapulm prominent; on right side great depression 
in infra-clavicular spaces. Percussion-dullness in the apex on 
both sides; under clavicle there is cavernous resonance. Per- 
cussion was painful and had to be abandoned. 
“ Auscultation.—Rales of every character are present. Gur- 
gling sounds accompany cavernous breathing in right infra- 
clavicular space; treatment was administered with great cau- 
tion, sublimate and pine-needle oil being used. This was 
continued for six times at a rarefaction of four tenths inch. 
Patient derived a momentary benefit as his respiration became 
easier and the expectoration free. Treatment had, however, 
to be discontinued, as his temperature rose to 105° every even- 
ing of the day he had taken treatment, notwithstanding quinine 
was used in liberal doses. On discontinuance of treatment, the 
temperature went down to 101°; patient left for the south of 
Europe, where he died a few weeks after his arrival, I mention TREATED BY PNEUMATIC DIFFERENTIATION 
31 
this case as a corroboration of what I believe you have already 
published, that not only did the use of the cabinet in this case 
not reduce the temperature, but gave some cause of inference 
that the greatly induced circulation produced an increased tem- 
perature. “ Truly, 
“ W. A. De Watteville.” 
Dr. Robert II. Babcock, of Chicago, writes as follows : 
“ April 5, 1886. 
“ Herewith I send you a report of two cases which I have 
treated by means of the cabinet: 
“ I have used the pneumatic differentiator for three months, 
chiefly in the treatment of pulmonary tuberculosis, and, although 
my results have not been brilliant, they are to me encouraging. 
I shall speak of only two cases. These patients came to the 
Throat and Chest Department of the South Side Dispensary and 
were selected because of the hopelessness of accomplishing any- 
thing by internal treatment. At the same time the usual in- 
ternal remedies considered appropriate in such cases were not 
abandoned upon the resort to the cabinet, and in estimating 
results this fact must be kept in mind. 
“Case I.—Mary li. gave following history: Aged thirty, 
Irish, unmarried, a house servant, began to have a dry cough 
fourteen months ago, and two months later to expectorate. 
Eight months ago she ceased to menstruate. Her condition has 
grown steadily worse until present time. She is now tormented 
day and night by a hard cough and profuse muco-pmulent ex- 
pectoration ; is very weak, has daily fever and night-sweats, no 
appetite, and complains of much pain across the front of the 
chest; has no diarrhoea. Upon examination of t he chest, consoli- 
dation of both apices, particularly of the right, was discovered, 
together with considerable retraction of the anterior border of 
both lungs. The only rales heard were pleuritic friction-sounds 
at either side of the sternum. Her temperature was 100° F.; 
pulse 92, very weak ; respirations shallow, but only 20 to the 
minute. Treatments with the cabinet w'ere begun January 
80th, and continued almost daily except Sundays until the 17th 
of February. She then remained away until March 1st, when 32 
A CLINICAL REPORT OF CASES 
she reappeared with the statement that her menses had returned 
the 18th of February—that is, the day following her fourteenth 
treatment. The day of her reappearance her temperature was 
99f° F., respiration 18. March 9th, it is noted that she had 
gained one pound in weight. She now came very irregularly 
for treatments, receiving only seventeen between March 1st and 
the 24th of April. She reported considerable diminution in the 
frequency and severity of her cough, a lessened expectoration, 
slight improvement in appetite, and entire disappearance of the 
pain in the front of the chest. She was obliged to work far 
beyond her strength, sweeping, carrying coal, scrubbing the 
front steps, etc., all of which tended to retard improvement. 
After a discontinuance of treatments for a few days she invaria- 
bly complained of increase in the severity of symptoms, not- 
withstanding faithful adherence to cod-liver oil and tonics. Per 
contra, she as invariably and emphatically testified to a feeling 
of relief and amelioration of symptoms after each resumption of 
treatments with tbe cabinet. In her case a rarefaction of four 
tenths was tbe highest she reached. A spray of the mercurial 
bichloride of the strength of 1 part in 1,000 was administered, 
and each treatment lasted about fifteen minutes. A physical ex- 
ploration of her chest the latter part of March showed no improve- 
ment in the physical signs. Although in this case the environ- 
ment of the patient was so very unfavorable and her treatments 
were from necessity so intermittent, I am yet of the opinion 
that the use of the cabinet kept her from losing ground, to say 
the least. Indeed, it is not beyond bounds to assert that as a 
whole her condition manifested slight improvement. That this 
was largely due to the cabinet is rendered probable by tbe fact 
stated above, that she always came back complaining of an ag- 
gravation of her cough and expectoration after an omission of 
treatments for several days, while after each return to the cabi- 
net her symptoms became less troublesome. 
“Case II.—Matilda J. gave the following history: Aged 
thirty-three, Swede, unmarried, domestic, no family history of 
tuberculosis; was in good health until five months ago, with 
exception of some acute abdominal affection two years ago, for 
which she was in a hospital. Last fall she developed a cough TREATED MY PNEUMATIC DIFFERENTIATION 
33 
while sleeping in a damp basement. Since then she has lost 
weight and strength, and is now unable to work. The cough 
is troublesome and expectoration is copious—muco-purulent. 
Examination of the chest disclosed slight dullness in the lelt 
supra-scapular and supra-clavicular regions, with broncho-vesi 
cular respiration ; no rales. Over the right side the resonance 
was impaired, except under the clavicle, where it had a vesicu- 
lo-tyinpanitic ring. Below the angle ot right scapula, and pass- 
ing forward into the infra-axillary region, the percussion note 
was duller than elsewhere. Here the respiratory sounds were 
faint and bronchial, being ulmost obscured by plastic exudation 
rales. Over other parts of the lung the respiratory sound was 
broncho-vesicular. Vocal resonance over this side was slightly 
exaggerated. Her temperature at 2.30 1*. m. was 96J°, pulse 78, 
and respirations 21. The diagnosis was plastic exudation upon 
the pleurae, with slight induration of right lung and slight tuber- 
cular induration of the left apex. Treatments with the cabinet 
were begun March 4th, while at the same time cod-liver oil and 
tonics were continued. March 15th, after eight treatments, 
each of fifteen minutes’ duration, together with a spray of Lu- 
gol’s solution, five per cent, the patient’s cough had lessened 
considerably ; she felt better generally, with less sense of con- 
striction iu the chest. By March 27th, after nine more treat- 
ments, she no longer complained of auy trouble with her breath- 
ing, and her expectoration had become mucous. Her appetite 
had improved somewhat. At the date of this writing, April 
6th, after eight more treatments, her general condition is 
manifestly improved, and she reports a gain in weight of 
one pound. Examination of the chest, however, reveals no 
apparent improvement in the physical signs, except that her 
ability to expand the chest is greater than a month ago, and 
the respiratory sounds are more audible. The rales remain as 
before. 
“ These two are the only cases in which the treatments were 
continued by the patients with any degree of faithfulness, and 
hence they are the only ones 1 report. As said already, the 
results are not brilliant, possibly not more favorable than it 
might be claimed would be obtained by proper hygienic and 34 
A CLINICAL REPORT OF CASES 
therapeutic management. Nevertheless, from these and my 
limited experience in my other cases I derive considerable en- 
couragement. I should not think of relying on the cabinet to 
the exclusion of all other measures; it is in my opinion a valu- 
able adjunct, and, indeed, it will help the patient acquire what 
he can not get alone—viz., the ability to inflate his lungs to an 
extent previously impossible. The benefit of this alone is too 
apparent to need discussion. This is of very great service in 
exactly thoso cases of plastic exudation upon the pleura) to the 
disastrous consequences of which Dr. Learning has called atten- 
tion, and in which he recommends that the patients be directed 
to breathe as deeply as possible. In every instance of pulmo- 
nary phthisis I have noted the decided effect of this treatment 
in lessening cough and expectoration where the former was due 
to collection of secretions within the bronchi and not to laryn- 
geal complications. Whether this be due to the increased force 
of the respiratory act alone or to the efficient administration of 
atomized solutions, which this method renders possible, this 
influence over cough and expectoration is of such marked 
benefit as to alone recommend the method. Without wishing 
to depreciate the value of the topical medication so efficiently 
achieved by means of sprays used with the cabinet, I am yet 
inclined to think that the benefit is mainly due to the mechan- 
ical effect of the treatment in causing a more active intra pul- 
monary circulation, combined with the stimulation of the mu- 
cous membrane of the larger bronchial tubes, caused by the 
more rapid passage over it of the air-current. Not only is the 
circulation within the pulmonary arterioles accelerated, thus 
bringing more blood into contact with the oxygen of the in- 
spired air, but that in the bronchial and nutrient vessels is also 
hastened, a tendency to stasis within them is diminished, the 
bronchial mucous membrane is kept in a healthier state, the 
absorbents perform their function more actively, and the 
nutrition of the lung structure is improved. Were this 
alone and nothing more the result of treatments with the 
pneumatic cabinet, this were enough to recommend it to the 
profession. 
“ Robekt II. Baboook.” TREATED BY PNEUMATIC DIFFERENTIATION. 
35 
Dr. E. L. Trudeau, of the Cottage Sanitarium, Saranac 
Lake, says: 
“So far as I have gone I can bear testimony to the use- 
fulness of this inode of treatment in certain forms of pul- 
monary diseases. It has seemed to me most beneficial in 
those phthisical cases where most good might he expected 
from expansion and consequent improved pulmonary nutri- 
tion, and that the results are much less satisfactory where 
localized antiseptic treatment has seemed the first indication to 
he fulfilled. Briefly, in incipient phthisis with apical lesions 
and slight constitutional disturbance, and in the various forma 
of chronic phthisis, hut especially where malnutrition, debility, 
and dyspnoea are principally dependent on the evil effects of the 
contraction of connective tissue in the lung, its most brilliant 
field of usefulness is to he found. In rapidly advancing excava- 
tion and in scattered tubercular lesions it is of little avail. Most 
patients coming under the head of incipient and chronic phthisis 
treated by this method at the Saranac Lake Cottage Sanitarium 
showed more or less marked improvement. In one case a gain 
of seventeen pounds weight with an entire disappearance of all 
moist sounds in the lung occurred. Under its use, weight, 
breathing power, digestion, and occasionally cough improved; 
it had less effect on the fever and expectorations; slight haem- 
optysis occurred in one case only. Very numerous observa- 
tions show'ed that the tubercle bacillus and the putrefactive 
bacteria in the expectoration were generally unaffected by in- 
halations of 1 to 1,000 bichloride of mercury and five-per-cent, 
solutions of carbolic acid even when such treatment was con- 
tinued for several months. In one case the tubercle bacillus dis- 
appeared temporarily. The study of this case, however, is still 
uncompleted. 
“ E. L. Tbudkau.” 
Dr. Fernald and Dr. Cutts, of Washington, D. C., who 
have been using a cabinet for the past three months, write 
that, while they have treated a number of cases, sufficient 
time has not elapsed to justify them in making a general 36 
A CLINICAL REPORT OF CASES 
report. They have had one case, however, which they re- 
port in full: 
“Sophie S., white, aged eighteen, single; seen by us for the 
first time March 16th, witli following history: Has been losing 
flesh and strength for six months, during which time she lias 
had an annoying cough, night and day ; considerable expectora- 
tion, muco-purulent in the morning, at other times frothy and 
white; five months ago had one slight attack of haemoptysis; 
slight daily hectic for last few weeks ; night-sweats every night 
for past week ; about middle of .January applied at a dispensary 
for treatment for amenorrhcea; appetite fair; digestion good; 
sleep restless. 
'•'•Family Hintory.—No phthisis; one uncle has asthma; 
father died of pneumonia. 
“Inspection.—Fairly nourished; complexion sallow; under 
left angle of jaw an old cicatrix from scrofulous glands; no de- 
pressions or deformity of chest; both sides alike; heart normal; 
pulse, 90; respiration, 25 ; temperature, 99*8°, 4.30 p. m. ; weight, 
102. 
“Palpation.—Slight increase of vocal fremitus below the left 
clavicle as far as upper border of second rib, and within mam- 
mary line. 
“Peretisnon.—Slight dullness over the above-mentioned area 
and above the clavicle in addition. 
“Auscultation.—Slight increase of vocal resonance over the 
dull area ; jerky respiration (both inspiration and expiration) 
over whole upper third of left lung; abundant fine mucous riles 
and an occasional sibilant rale in same lung, in supra- and sub- 
clavicular space and in supra-scapular region. 
“ Treatment.—In addition to the treatment by the cabinet, 
she had been taking phosphatic emulsion for two months before 
coming to us, and continued to do so for two weeks later; by 
our advice she has taken a simple bitter before meals; at one 
time, early in the treatment, quinine was thoroughly tried to 
eliminate intermittent fever as a cause of the daily rise of tem- 
perature, but it had no controlling effect, and was afterward dis- 
continued. TREATED RY PNEUMATIC DIFFERENTIATION 
37 
“ She has had daily sittings except on a few occasions, when 
kept away hy rain ; has had thirty sittings to date; from the 
fourth to the twelfth sitting a preliminary rarefaction was made 
of two and a half inches for five minutes; since the twelfth, 
two inches for five minutes. Oreasote was used in the spray 
for first nineteen sittings; since then Lugol’s solution, either 
alone or with creasote; and on several occasions a few drops of 
pine needle extract have been added. Patient breathed against 
one tenth of an inch for three minutes at first sitting ; at each 
time after this the rarefaction was gradually increased until, at 
the eighth sitting, was able to breathe against four tenths for 
eight minutes; for the last eleven sittings, eight tenths for 
twelve to fifteen minutes, which seems to be as much as she 
can endure. Her condition began to improve from the first; 
has had no night-sweat since the third sitting; after the eighth 
sitting, has had practically no cough or expectoration; fever 
has gradually diminished, and for last ten days has had none; 
at no time since treatment began has temperature been found 
by us, at time of sitting, above 99‘8° ; at the eighteenth sitting 
she had gained two pounds, was sleeping and eating better, and 
in fact was better in every way. Her condition continued to 
improve, and at the twenty-seventh sitting her weight was one 
hundred and ten pounds, having gained eight pounds since her 
first treatment. Her complexion is clearer and her whole ap - 
pearance is brighter and healthier. An examination of chest 
was made on the 24th instant (thirtieth sitting). Both sides of 
chest normal in every respect, except that jerky respiration at 
the upper part of left lung remains, but is now heard only on 
inspiration, and is confined to a more limited area. 
“ Respiration reduced to twenty on outside and eighteen in- 
side cabinet. 
“ Yours very truly, 
“ II. M. Cutts, 
“ F. C. Fernald.” 
Dr. J. II. Blanks, of Meridian, Miss., sends a tabulated 
statement of twenty-seven cases, with diagnosis and result, 
and a sketch of two cases as follows : 38 
A CLINICAL REPORT OF CASES 
No. of 
cases. 
Recov- 
ery. 
Im- 
prove- 
ment. 
No im- 
prove- 
ment. 
Deaths. 
Bronchitis 
12 
9 
2 
1 
Asthmatic bronchitis 
] 
1 
Acute phthisis, first stage 
3 
1 
1 
1 
“ second stage... 
1 
1 
“ “ third stage .... 
4 
4 
Chronic phthisis 
4 
3 
1 
Unresolved pneumonia 
2 
1 
1 
Total 
27 
11 
8 
4 
4 
“ The cases reported in the death-list were all advanced. The 
patients were unable to walk unaided, greatly emaciated, with 
large cavities, and an evening temperature from 103° to 105°. 
One of them was under treatment four days only. The throe 
others were greatly benefited. They expectorated freely after 
each application, could breathe easily, and were very much 
aided in procuring sleep. They were always greatly disap- 
pointed when they were prevented from any cause from receiv- 
ing treatment, as they said they could breathe and sleep so much 
better. 
“The history of one case of phthisis, under head of improve- 
ment, is as follows: 
“ Mr. M., aged twenty-two; best weight one hundred and 
fifty-eight; present weight one hundred and seventeen. Two 
brothers died of consumption and one of supposed pneumonia. 
Patient contracted measles sixteen months ago, since which has 
had a cough. Eight months ago had several haemorrhages, and 
lias rapidly declined since. lie was first seen by me December 
15, 1885, when the following notes were recorded : 
“Inspection.—Shows marked depression in left subclavicular 
space. 
“Palpation.—Increased vocal fremitus left side. 
“ Percussion.—Leftside: forcible percussion shows tympa- 
nitic quality about third intercostal space; posteriorly there is 
dullness. 
“Auscultation.—Left lung anteriorly shows marked am- TREATED BY PNEUMATIC DIFFERENTIATION. 
39 
phoric respiration in subclavicular region, and gurgles heard at 
forced expiratory effort. His temperature was 102°; pulse, 100; 
respiration, 30. 
“ Treatment.—He was placed in tlio cabinet, and breathed 
against two tenths of an inch fall of the barometer for fifteen 
minutes, inhaling a one to one thousand mercuric bichloride 
solution; next day, three tenths of an inch pressure, and was 
gradually increased daily till eight tenths was reached, at which 
he continued throughout the course of treatment. 
“ December 19th.—Temperature, 102°; pulse, 100; respira- 
tion, 28. 
“ 23d.—Temperature, 100° ; pulse, 90; respiration, 20. 
u 28th.—Temperature normal; respiration, 24; pulse, 80. 
“January 20th.—He feels ‘as well as he ever did in his 
life.’ 
“ He now weighs one hundred and twenty-five pounds—a 
gain of eight pounds in thirty-five days. 
“February loth.—Continued improvement, hut still has a 
4 slight cough.’ 
“ Physical examination now discloses absence of moisture in 
the cavity. Posterior dullness cleared up. 
“March 1st.—Expresses a desire to resume his work as a 
laborer. Treatment now to he three times a week. 
u April 1st.—Cough more troublesome, hut feeling well. 
“ 12th.—Left for southwestern Texas, to engage in work as 
a laborer. 
“ The case of acute phthisis reported as cured had the fol- 
lowing history : 
“Mr. J., aged thirty-four; best weight, one hundred and 
thirty-five; present weight, one hundred and fifteen. Mother 
died of consumption. Had cough about two months, accompa- 
nied by free expectoration and slight fever in afternoons, rapid 
emaciation, general weakness, etc. For several weeks had an 
evening temperature of 101°. He was first seen by me Decem- 
ber 24, 1885. His general appearance was that of anamiia; 
slight depression of infra-clavicular region left side. Increased 
vocal fremitus, slight dullness, puerile respiration on right side, 
etc. Thirty applications were made, when his cough ceased, 40 
A CLINICAL REPORT OF CASES 
dullness cleared up. He is now (April 25, 188G) perfectly well, 
and has regained his normal weight.” 
Dr. A. S. Houghton, of Chicago, says: 
“The report of cases treated by me in the pneumatic cabi- 
net, as published in the ‘Journal of the American Medical 
Association,’ November 7, 1885, is amended to read as follows: 
No. of 
cases. 
Recov- 
ery. 
Im- 
prove- 
ment. 
No im- 
prove- 
ment. 
Deaths 
Chronic bronchitis 
9 
5 
i 
3 
Asthmatic bronchitis 
2 
1 
i 
Spasmodic asthma 
2 
1 
i 
Acute phthisis, first stage 
12 
6 
6 
1 
“ “ second stage... 
4 
1 
1 
2 
“ “ third stage.... 
6 
1 
1 
1 
3 
Clironic phthisis 
1 
1 
1 
3 
2 
Unresolved pneumonia 
1 
1 
Total 
43 
15 
12 
9 
1 
“ Of the nine patients unimproved, seven took less than three 
treatments. The three reported as recovered last November 
are in perfect health to-day. No. 3, about whom there was 
some dispute, called on me January 4th, reporting herself as 
having been free from cough since September; able to sing 
every day, as required by her profession, and weighing 140 
pounds, a gain of twenty-one pounds since I first saw her. She 
wrote me April 18th as follows: ‘I am still enjoying good 
health; weigh 140.’ That is what I understand by the term 
recovery. The two other patients are discharged and are in good 
health, one gaining seventeen and the other eleven pounds. Of 
the five improved, three are in California. 
“ A. S. Houghton.” 
Professor James T. Whittaker, of Cincinnati, in closing 
the discussion upon the paper recently read by me before 
the American Medical Association, informally reported on 
cases treated by him with this process. He had found its 
effects pronounced and satisfactory, lie spoke of patients TREATED BY PNEUMATIC DIFFERENTIATION. 
41 
with tuberculosis who had recovered, lie declared that 
patients incapable of recovery became fascinated with the 
treatment, and it was necessary in many instances to restrain 
their demands for its administration when unwarranted, ex- 
cept by their desire. lie declared himself an enthusiastic 
adherent of the pneumatic differential process, which he 
considered of inestimable value. 
Dr. Whittaker is reported as having said, in a discus- 
sion before the Kentucky State Medical Society, that pneu- 
matic differentiation had, he thought, entirely changed the 
prognosis of tuberculosis.* 
Recognizing first the importance of systematic micro- 
scopical examination of phthisical sputum, secondly the 
wide numerical variation of bacilli on two slides of the 
same material, and third the difficulty of expressing their 
numerical value for comparison, Mr. Ketchum, who has 
conducted these examinations, has adopted the following 
system : 
A comparatively equal distribution of bacilli is accom- 
plished by a thorough trituration of the sputum for ten 
minutes in a sterilized mortar. Each examination consists of 
the thorough survey of six slides, three of which have been 
stained by the Ehrlich method as a test, and three by a 
modification of the Rindfieisch method. Exact values, 
based on number of individuals to given areas after the 
blood-corpuscle method, are impracticable, owing to the 
time necessary, and the impossibility of getting all bacilli 
in a given field in the same optical plane; consequently a 
table of estimated values has been established as follows: 
One, is occasional; two, medium; three, numerous; four, 
large quantities; five, en masse. Specimens have been 
identified by numbers and not by name of donor, so that 
an unprejudiced estimate could be made. 
* “ Gaillard’s Med. Jour.,” Aug., 1886, p. 208, 42 
CASES TREATED RY PNEUMATIC DIFFERENTIATION 
These examinations have shown increase, decrease, or 
absence of bacilli coincident with progressive symptoms, 
improvement, or absolute quiescence. In Cases IV and 
VIII of my report the evidence is corroborative of an 
ipherent antagonism between the Bacterium termo and the 
bacillus of tuberculosis. So far as they go, they substanti- 
ate the advanced reports of Professor Cantani, of the Turin 
biological laboratory. 
I am sensible of the incomplete manner in which I am 
obliged to record interesting data in many of these cases. 
Taken in conjunction with my previous report, they will 
be seen to supply some deficiencies there existing. My 
original position with reference to the pneumatic differen- 
tial process seems substantiated. Numerous possibilities 
will demand close attention and prove a fruitful source of 
study and application. Some of these I have pointed out 
in a paper which I had the honor to present recently to the 
American Medical Association in St. Louis.* Certain facts 
have been demonstrated. Let them stimulate us to further 
accomplishment. 
252 Madison Avenue, New York. 
* “ Jour, of tho Am. Mod. Assoc.,” Auer. 14, 1885. REASONS WHY 
Physicians siioald Subscribe 
- FOR - 
The New York Medical Journal, 
Edited by FRANK P. FOSTER, M. D., 
Published by D. APPLETON & CO., 1, 3, & 5 Bond St. 
1. BECAUSE : It is the LEADING JOURNAL of America, and 
contains more reading-matter than any other journal of its class. 
2. BECAUSE : It is the exponent of the most advanced scientific 
medical thought. 
3. BECAUSE : Its contributors are among the most learned medi- 
cal men of this country. 
4. BECAUSE: Its “Original Articles” are the results of sci- 
entific observation and research, and are of infinite practical 
value to the general practitioner. 
5. BECAUSE: The “Reports on the Progress of Medicine,” 
which are published from time to time, contain the most recent 
discoveries in the various departments of medicine, and are 
written by practitioners especially qualified for the purpose. 
6. BECAUSE : The column devoted in each number to “Thera- 
peutical Notes ” contains a resume of the practical application 
of tho most recent therapeutic novelties. 
7. BECAUSE : The Society Proceedings, of which each number 
contains one or more, are reports of the practical experience of 
prominent physicians who thus give to the profession the results 
of certain modes of treatment in given cases. 
8. BECAUSE : The Editorial Columns are controlled only by the 
desire to promote the welfare, honor, and advancement of the 
science of medicine, as viewed from a standpoint looking to the 
best interests of the profession. 
9. BECAUSE : Nothing is admitted to its columns that has not 
some bearing on medicine, or is not possessed of some practical 
value. 
20. BECAUSE : It is published solely in the interests of medicine, 
and for the upholding of the elevated position occupied by the 
profession of America. 
Subscription Price, $5.00 per Annum. Volumes begin Is January 
and July.