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         TREATISE



              ON THE



  IMMEDIATE  CAU8E,



             AND the



     SPECIFIC  TREATMENT



               OF





PULMONARY  PHTHISIS,



              AND




   TUBERCULAR DISEASES.





          ___________/__

     BY J. FRANCIS CHURCHILL, D.M.P.
 GRADUATE OF THE PARIS SCHOOL OF MEDICINE; MEMBER OF THE IMPERIAL ACADEMIES
           OF MEDICINE AND SCIENCES.






           fil 71. *""•'

   TRANSLATED FROM THE FRENCH BY A PHYSICIAN.







          NEW-YORK:

  J. WINCHESTER, PUBLISHER, 43 JOHN STREET.

       AMERICAN AND FOREIGN AGENCY. 
          Entered, according to act of COngreBS, in the year 1859, by
                            J. WINCHESTER,
In the District Court of the United States for the Southern District of New York.
                     BUSINESS   NOTICE.

  The undersigned, having made arrangements for the importation of  Phosphorus directly
from the English and French makers; and having, also,  completed arrangements for  manu-
facturing the Hypophosphites upon a more  extended  scale than any  other Chemist  in the
United States, is now prepared to supply his Preparations to the Trade, the Profession, and
the Public, in any quantity, and at the lowest cash terms.
                              RETAIL  PRICES:
  "Winchester's Genuine Preparation" of Lime  and Soda  (a perfect solution in  simple
syrup, without the use of free hypophosphorous acid),  single bottles, $2 ;  three bottles for $5.
  "Winchester's Concentrated Solution" of Lime and Soda, in small bottles,  to be sent
only by mail, $2 each, postage paid.
  The Dry  Salts, viz., Lime, Soda, Potassa, Ammonia, Manganese, and Iron," seventy-five
cents per ounce.  The Hypophosphite of Quinine will be charged at the lowest price.
  N.B.—A liberal discount will be made to those who purchase to  sell again, which will
be made known by Trade Circular.
  Though experience  has demonstrated (what  science had previously announced) that the
Hypophosphites in the Dry, or crystallized form, will not  produce invariably favorable results
in Phthisis,  and other diseases in which their use is indicated,  on account of their rapid ab-
sorption of  oxygen upon the  slightest exposure to  the  air ; yet  the  undersigned has been
induced, by a disposition to advance  the cause of medical science, to meet the demand of
those members of the medical profession who  are desirous of making a comparative trial
of  the efficacy of the Salts, with the Solution which he more particularly recommends.
  The maximum prophylactic and curative power of the Hypophosphites depends upon
their being  kept  at their lowest possible degree of oxydation;  as also upon their complete
freedom from any excess of the alkaline carbonates.
   The undersigned trusts that those members of the medical profession who have been dis-
 appointed in the results  obtained from the use  of the Dry Salts, may be induced,  by this
incidental exposition of the causes of such disappointment, to test the efficacy of the Solution ;
 which,  being taken at the point of saturation, (and, therefore, before the process of crystalliza-
 tion has begun), is protected by the syrup from the deterioration to  which the Dry  Salt is
liable by oxydation.  The Solution  is unquestionably  the best form in which  the  Hypo-
 phosphites can be exhibited, so as to meet the essential condition of Dr. Churchill's Theory,
 viz., to preserve them at the lowest point of oxydation.
  tW  The undersigned is desirous of advertising  his " Genuine Preparation"  in all the
respectable newspapers throughout  the  United  States; and he would be  obliged to those
Druggists or Merchants who may desire to keep this invaluable Specific Remedy for sale,
to furnish him with information which will enable him to  select the very best ■media for his
purpose.   Those who order the "Preparation" will be specially named In the advertisements
published in  their vicinity.   Orders will be promptly filled, if addressed to any Wholesale
Drug House in New York, to Wholesale Agents, or to the undersigned.
                                                 J. WINCHESTER,
                               American and Foreign Agency, 43 John street, New York.
  * The Hypophosphite of Iron, which was decidedly rejected by Dr.  Churchill  on account
of its tendency to aggravate or induce the inflammatory condition in Phthisis  is offered because
it is  believed that it is a perfect substitute for the Protoxyd of Iron  and mav  be  uspd
whenever the latter is indicated.  So, it is believed, the Hypophosphite of  Quinine will uM.
riMtav Kiinerspflfi the nspi nf the Knlnhuta                        *     J  N6 »"»"«* WI" ulti-
mately supersede the use of the Sulphate. 
PUBLISHER'S   PREFACE.
  " Not only is chemical science capable of pointing out the exact chemical constitution of the
 body, and the changes and transformations which are constantly occurring, but it has proved
 competent to direct us respecting the proper methods by which certain elements, or agents,
 may be furnished when pathological symptoms indicate an insufficient supply."—Boston
 Medical  and Surgical Journal,

   The Treatise of Dr. John Francis  Churchill, announcing  to the world the most
 brilliant discovery of medical  scierjce during the  past century—that of the thera-
 peutical action  of the Hypophosphites  in Phthisis Pulmonalis—needs no com-
 mendation to insure for it a careful perusal and the earnest consideration of both
 the professional and non-professional public.
   That the translation will be found  to  contain errors, is probable.  These, how-
 ever, the good sense of the reader will correct.  In the " Notes of Cases," we have
 used condensation and abbreviation, where the  details were merely the  daily
 repetition  of treatment without  particular change  in the  symptoms.   In every
 case, the translator has faithfully preserved the  material facts connected with the
 specific treatment, so as to present a full view of the changes in the symptoms
 produced by the remedy.  As the translator of the work is himself a physician,
 we believe the abridgments  made by him in no respect impair the value of the
 record of the cases.
  The importance to the world of a discovery which promises to render Consump-
 tion amenable to medical science, so that, "instead of occupying the first place in
 the  causes  of mortality, it will  dwindle down to  a  comparatively insignificant
 item," must be manifest to  all.
  The results already obtained by the use of the Hypophosphites in tuberculosis,
 fully confirm the claim that it is  the specific  remedy against  the diathesis.
 Though on the first announcement of the discovery, it was received with  disfavor
 by many eminent members of the medical profession, opposition to the treatment
is rapidly disappearing under the accumulating evidences  of the  efficacy of the
remedy in every case in which it has been intelligently exhibited.
  Up to the period of Dr. Churchill's discovery, the Hypophosphites were pos- 
  iv                  PUBLISHER'S  PREFACE.
  sessed  of no commercial value, being known only as beautiful  specimens in the
  laboratory of the chemist   " It is not very astonishing," says Dr. Churchill, " that
  the Hypophosphites which are now ordinarily sold, and which have been prepared
  in consequence of the great demand created since my Report, should not always
  present that purity indispensable to success in the treatment. In five cases
  out of six, they are totally unfit for medical use."
    It is to this impurity, as well as to the many " crude formulas" that have been
  imagined by uninformed practitioners, that we must attribute any ill-success that
  may have followed the use of the remedy;  and it is against these impure prepara-
  tions and "crude formulas," that the profession and the public need to be protected,
  and the benefits of the discovery thereby secured to the sick.
    It was therefore an important consideration, in  undertaking the introduction of
  Dr. Churchill's treatment in the United  States, to guard the patient  from the dan-
  gers that threatened him from the ignorance or the charlatanry which never fails
 to seize upon and desecrate whatever is valuable.  Preparations of the most absurd
 and deleterious character have been palmed off even u;on the medical profession,
 under the name of the  Hypophosphites; and  others, containing inert, or injurious
 elements,  invented to satisfy the  greed of some  mercenary trifler with  the  lives
 of sufferers, have been successfully advertised and  sold, thus retarding the realiza-
 tion of the inestimable benefits which must result from the speedy  adoption of the
 authentic treatment.
   In no instance has any important fact  been withheld;  but we  have  followed,
 implicitly, the conditions, both in the manufacture  and the administration of the
 Hypophosphites, laid down by Dr. Churchill.  The chemical experience we have en-
 listed in the preparation of these salts, offers an absolute guarantee of their purity;
 and, to the end that all attempts to mislead may be rendered abortive, we place in
 the hands of the reader (in the publication of this work),  the means of forming a
 correct judgment, not only in regard to the new  treatment, but  also as  to  the
 means by which its full benefits may be secured.
   Phosphorus, in itself, is an active and deadly poison.  In combination with one
 equivalent of oxygen and two of water, it forms hypophosphorous  acid;  and this
 combined with a base-Lime, Soda, etc.,-forms the chemical salts known as Hy'
 pophosphites.  When taken into the system in this form, it is entirely harmless-
 and by the changes which result from its farther oxydation, it is rendered capable
 of entering into, a»d fulfilling its high design in the brain and  nervous system
 Upon tins well-established,  but beautifully simpie taction,  is founded Dr. Church-
ill's Theory of the Cure  of Consumption. 
        PREFACE   OF  THE  AUTHOR.

  "We are going to consider the most cruel enemy of the human race, and to consider the
means of contending against it with success."—Louis on Phthisis.
  " Taking as a basis the sum generally considered as that of the population of the globe, it is
fair to estimate that from eighty to one hundred millions of its inhabitants succumb, by a pre-
mature death, to some form of this disease. It destroys nearly a sixth of the population of
England."—Ancell on Tuberculosis.
  " England pays an annual tribute of nearly sixty thousand deaths from pulmonary phthisis.
  " Figures extracted from the bills of mortality of London, show that eighteen deaths (more than
one-sixth,) out of every hundred, depending on no matter what causes, arise from those tuber-
culous diseases."
  " The ratio  of mortality from phthisis, is very nearly the same in Paris as in London."—Bou-
din, Medical Geography.

  The circumstances which  induce  me to lay this book  before the pub-
lic, demand, in my  opinion, some  explanation.
  The Academy  having referred my  Report to a " Section," it  would
have been  equally in harmony with my interest and my wishes to have
waited, according to the usual custom, the result of its deliberations.
  Both science and humanity had  every thing to  gain by having my
pretensions, at as early a period as  possible, either  coincided in or con-
demned  by  such a recognized authority.  Unfortunately, the present
condition  of science,  or rather, I should  say, of medical opinions; the
singular prejudices which exist as  regards  questions  of therapeutics—
the very object of my book—and perhaps the means adopted in order
to solve the  problem  which  I had  undertaken :—all  these causes  con-
spired to convince me that it would be  in vain to wait for the official
judgment  of the Academy.   Assured of this fact by reliable informa-
tion, I decided to publish my Report, in  order that each  person  might
have an opportunity to judge of  and employ  my method of treatment
under the  conditions indispensably necessary for its success.
  A number of practitioners, both in France and England, have already
commenced to experiment, and many  have written to  me for informa-
tion upon  the subject.   The nature of the information sought for has
convinced  me that it was my duty to explain  my  plan  of treatment in
all  its details.  When the results  of  these  experiments shall become
known, I think that the Academy, itself, will not longer  delay an  exam-
ination of  the  facts established by a large number of  observers.  With 
6            PREFACE  OF  THE  AUTHOR.
 the exception of some few typographical corrections, I have reproduced
 my Report precisely as it was presented to the Academy.  I have also
 appended to it the  notes  of the cases upon  which it is based, compris-
 ing all the cases which have been submitted to my treatment, no matter
 what was the result; for  it is in this way only that the value of a rem-
 edy can be estimated.  A single case has been  kept back, it being still
 under treatment.
   Under the chapter entitled " Additions  to  the preceding Report,'"  I
 have replied to the  objections already made, and laid particular stress on
 certain points which I had only referred to in my Report.  In the his-
 torical sketch, I have pointed out the progressive steps in the investiga-
 tion  of  this subject, made by different experimenters, some  of them
 long anterior to me,  others very nearly contemporary.   In this I have
 endeavored, as far as is ever permitted to human weakness, to judge the
 merit of each one fairly.
   Finally, under the head of " Deductions," I have  indicated  certain
 consequences of my theory in  regard  to tuberculosis, of which I have
 not  yet  established the exact data; but which I hope  hereafter to be
 able to examine and determine more fully, especially in their chemical
 relations.  This book is, in truth, but a sketch of the  work which I had
 projected;  but the  state of my health, and above all the circumstances
 attending its production,  have prevented  me  from extending  it to a
 greater length.         »
   The causes which have  hitherto frustrated my efforts are, I think, of
 sufficient general interest to make it proper to detail  them here.   Hav-
 ing obtained, at  Havana, the notes  of the results of those  cases which
 comprise the first in  each of the series to  be hereafter given, I deter-
 mined upon returning to Europe in order to pursue  my researches and
 establish my discovery by  incontestable facts, outside  of the special in-
 fluences of climate,  etc.
   On my arrival, in May,  1856, I deposited with the Academy, on the
 3rd of June, a sealed packet containing full details  of my  method of
treatment, and of the  reasons  which had induced  me to  experiment
with it.  This constitutes very nearly the first ten pages of the following
Report.  The reason for not  at once publishing this note was, that on
such a subject, and after  the  numerous failures experienced by other
observers, it was certainly  allowable, even if it was not my duty to dis
trust myself.   Notwithstanding my own conviction that my theory was"
correct, I had not yet made it a scientific certainty
   Seeking, therefore, to  estimate the results,  which I had  already ob- 
PREFACE  OF  THE  AUTHOR.
7
tained from the point of view of an indifferent observer, I could not
conceal from myself their insufficiency, particularly when I remembered
that the subject to which I wished to call the attention of practitioners
and  obtain  their concurrence, was Consumption : and at a period, too,
when skepticism in therapeutics is  notoriously the  predominant senti-
ment of the professional world.  On the other hand, I confess that I was
ambitious, as was both  natural and  right, to finish what I had myself
commenced.
   The duty of every physician, as soon  as he  has arrived at a certain
practical conclusion, is to publish it,  because it interests both the health
and  life of  mankind.  For  the reason, also, that  the existence of his
fellow-beings depends upon  it, he should  advance nothing without due
consideration.  It is only when the truth  of  any  new hypothesis is
firmly established in his own mind, that he should endeavor to influence
its  adoption by others.   A different course results  only in discredit.
and reacts  injuriously upon the cause of  science.
   This  being my opinion, I addressed myself to several members of the
faculty  of the  college, as also to the physicians of the hospitals, ask-
ing permission  to attend some of their patients, and engaging to observe
the following conditions :
   Firstly—That I would establish to their satisfaction the safety of my
treatment.
   Secondly—That I would demand  the  opening of the note, deposited
with the Academy, as soon as the chief of the medical staff thought the
results obtained were sufficient to inspire confidence in the real value of
my plan of  treatment.
   Thirdly—That I would abstain, during the period occupied in  these
trials, from  any, except  a gratuitous, exercise of my profession.
   I proposed this last condition myself, and I have never deviated from
it from  the day when I commenced my experiments in the hospitals, up
to the time  when I made known the curative means which I employ.
My remedies also have always been furnished without remuneration from
any one.  This fact constitutes a sufficient reply to the insinuations of
certain  English journals.
   After I had applied in vain to several of my fellow-practitioners, as well
as to my former teachers, M. Charles Bernard, with a degree of moral
courage which does  him honor, consented to entrust to me some few of
his patients in  the wards of  the hospital  La  Charite.  These cases will
be  spoken  of hereafter.   Although  the  results, in consequence of the
advanced stages of  the disease, were far from  being as  favorable as  I 
8
PREFACE  OF THE  AUTHOR.
 should have wished, they nevertheless appeared sufficiently remarkable
 to M. Bernard, to induce a continuance of the investigations.
    It was, therefore, agreed that I should choose, at the office of admit-
 tance (bureau central), a certain number of patients from those which
 seemed to me to present the  most favorable chances for cures.  This I
 at once  proceeded to do; but at that very moment an order from the
 administration was received which forbid M. Bernard to continue longer
 the trial of my treatment.   M. le docteur Briquet, feeling confidence in
 me, proposed in his turn to entrust  me with one  of his patients.   This
 is the case numbered as the twenty-eighth.   The result of the treatment
 in this case was unfortunate,  for the reasons  which I have given in my
 notes.
   In this manner six months passed, and yet the number of cases which
 I had been enabled to  treat  in  the hospitals, during the  whole of this
 time,  amounted to only nine, of which  five were  in such a desperate
 condition that it was the  height of rashness on my part  to undertake
 them at all.
   Professor Bouillaud had also  the kindness to entertain my proposal,
 but a circumstance, unconnected with the subject, prevented me from
 profiting by the courtesy which he extended to me.
   This prolonged trial had, however, shown me one fact: that the hos<
 pitals  of Paris were, for the  most part, designed for the  treatment of
 acute diseases, and that persons suffering from affections  of the lungs
 were seldom admitted, except at a very advanced stage  of  their  disease,
 It would, therefore, have been difficult, if not impossible, for me to ob^
 tain more  than  one  or two  curable patients  from the list under the
 charge of any one physician; at the same time this would have almost
 indefinitely prolonged the time for my investigations.  I determined, in
 consequence, to go to London, in the hope of obtaining in  the hospitals
 especially designed for the treatment of consumption, a sufficient num-
 ber of  cases, especially of those in the  earlier  stages of the disease, to
 enable me to arrive at some solution of my hypothesis.
   I took my departure for London: but a long sickness, consequent on
 change of climate, and important domestic matters, prevented me from
 pursuing my plan until the month of  May. At that time  I forwarded my
 request to the board of direction of the Consumption Hospital at Bromp-
ton ; it was rejected.  Some communications, which I addressed to one or
two of the  medical journals  of London, for the purpose of explaining
the objects of my proposal and the reasons which influenced my  course
served  only to draw upon me  attacks as unjust as they were illiberal' 
PREFACE  OF  THE  AUTHOR.
9
In a personal interview  with one editor—having for its object certain
verbal explanations—I was received in so singular a manner that, taken
in connection with other circumstances which happened in  my inter-
course with some of my fellows, I felt so little encouraged that I deter-
mined to leave the country.   The treatment I experienced appeared to
me all the more unmerited, because, during the time of my stay in Lon-
don, I neither saw nor  attempted to see a single  patient.   The only
thing  which  can explain this  conduct of the English  medical  press
toward me, is my having said to two  or  three professional gentlemen
that I hoped  to establish, at  my  private  expense, a dispensary for  the
gratuitous  treatment of consumption.  I imagine that, to certain persons,
this project appeared incredible ; or that, supposing it to have been really
intended, they saw in it  a pernicious example.
   Convinced, moreover,  by  a careful examination of my collection of
facts, and  the general aspect of the whole  question, that the theory
which this work details, was correct, and believing  that I had done all
it was in my power to accomplish—since I had recoiled before no sacri-
fice or personal inconvenience to bring to a satisfactory conclusion that
which I  had commenced—I determined to offer my work for discussion,
even in its present imperfect condition.   For this purpose, in July, I re-
turned to Paris, and immediately presented to  the Academy the Report
which I  now give to the public.
   If  any  should  ask why  I  did not wait  for  the collection of a
greater number of  facts, before  declaring, as boldly as I have done,  the
truth of  what I advance, I reply : that it is not the number of favorable
cases, but their relative agreement, which gives weight.  I will recall to
their minds that Jenner proclaimed his discovery of  vaccination when
it was based  upon twenty-three  cases only.  Finally, I wish also to  re-
mind them that every new idea in medicine is not wholly acquiesced in
until the foundation upon which it rests has been established by the  ob-
servations of several independent experimenters ;—the discoverer himself
having no  other claim in the matter than that of being the first to indi-
cate the  facts from which he  formed his conclusion, and of fixing the
conditions  under which each individual should test  it, in order to be
able to verify for himself the truth of the doctrine propounded.
   It is true that I should have preferred not to have presented myself
to the  public, except well fortified with corroborative proofs, in order at
once to command  that degree of interest  which the  subject deserves.
I have already given the  reasons which prevented me from doing this.
If, therefore, there shall be some delay in diffusing the truth, some injury 
10
PREFACE  OF  THE  AUTHOR.
done to the reputation of our profession, some prolongation to the suf-
ferings  of many of our fellow-men, let the fault rest with those who
occasioned it.  I have already felt, to its fullest extent, the responsibility
of my position.   If some of those  with whom I have had intercourse
had experienced this feeling in  the  same  degree, this  question would
have been decided long ago.
   In addition, the cases which I have  examined up to this time, subse-
quent to the presentation of my report, (of which there are now twenty
under treatment either in my own practice, or in that of some friend,)
all offer such uniform  results, and are so much in accordance with my
theory, that I have no longer any hesitation in proclaiming, as an estab-
lished truth, that  a  specific remedy against  the tubercular  dia-
thesis IS FOUND.
   In conclusion, I desire to state that  all my relations with my French
professional  brethren have been characterized by generous  cordiality
on their part.  I have  often  encountered, at the preliminary statement
of my theory, a skepticism which was  natural, and up to a certain point
proper; but from most of  them I have received the warmest expres-
sions of sympathy, and on  every hand that true courtesy which can
come only from those*who themselves command respect.   The French
medical journals have, all of them, published the conclusions at which
I have  arrived; and several have particularly called the attention of
their readers to the subject.
  I regret that I can not say that a similar courtesy has been exhibited
towatd me in England;—for such has not been the case.   Time, the
beneficent antidote for all injuries done us, will show how much science
has sufftared by such  a  course towards me.   I wait, confidently, antici-
pating the period when justice will be  rendered where it is due.
   I have indulged  in these personal details only because they appear in
connection with an important question, involving in the highest degree
the future position  of the healing art; viz., whether we should not allow
each conscientious inquirer an opportunity  to investigate whatev r the-
ories may be proposed in therapeutics, precisely as  it is permitted in
every other branch of human labor, with such  restrictions only as are
demanded by a proper regard for humanity, and due care in experiment \
The search for the truth  iu medicine, is of  itself so difficult that we
should endeavor to avoid,  as much as possible, impeding it by obstacles
that do not depend upon the investigation of the subject itself.
  Paris, September,  1851. 
•
          ON   THE  IMMEDIATE   CAUSE

                                AND

   ON   A   SPECIFIC   TREATMENT
                                OF

             TUBERCULOSIS.

A. REPORT  PRESENTED TO THE IMPERIAL ACADEMY OF MEDICINE, PARIS,
                           JULY 21st, 185T.

Gentlemen, Members of the Imperial Academy of Medicine :
          I have the honor  of submitting for the consideration of the
Academy, the results at which I have arrived with regard to the Imme-
diate Cause of, and a Specific Treatment for, the Tubercular Diathesis.
   In the month of June, of  last year, the Academy received from me a
sealed package, containing an exposition of my views upon this subject.
I wished at that time to collect a greater  number of facts in support of
my discovery, in order to advance  nothing  which might seem  trivial
upon  so important a  matter.  Unfortunately, the  state of my  health
compelled  an interruption of my  labors ;  the proofs, therefore, which I
herewith present, are far from being as numerous as I could have wished.
I nevertheless hope  that, meagre as they are, they will  not  appear un-
worthy of your attention.
   The first idea which  I had upon this subject—that which induced me
to investigate it—and which, I conceive, furnishes a clue to that myste-
riously morbid  condition, entitled  Tuberculosis, dates from the month
of February, 1855, while I was engaged in the practice of my profession
at Havana.
   Occupied as  I have  been, since the commencement  of my medical
career, in researches upon the treatment of phthisis, my investigations led
me to believe that the  tubercular  diathesis depended wholly upon some
disturbance of the primordial functions of life; that, considering the in-
timate union  which exists between all parts of the body, this disturbance
must have, as a proximate cause, some important modification in tho 
12            REPORT  TO  THE  ACADEMY.
process of sanguification.   The works of various pathologists, especially
those of MM. Andral and Gavarret, the correctness of which has since
bfen confirmed by others, indicated that the variations in the composi-
tion of the blood, in pulmonary phthisis, had no peculiar and important
relation, as far as its  organic elements were concerned.   I was, conse-
quently, induced to believe that it was among the inorganic elements of
this fluid that we should look for the special cause of this diathesis.
   On this point the works of chemists were either incomplete or contra-
dictory.  I therefore decided that therapeutical experimentation  alone
could furnish a solution, and accordingly determined in that way to dis-
cover, if possible, the  influence upon the progress of consumption occa-
sioned by changes in the inorganic elements of the blood.
   As the phenomena of this disease, approximating to those of many
other morbid states of the body, and especially to chlorosis, appeared to
me to be attributable  to the loss, or diminution, rather than to the aug-
mentation of some essential  constituent, I  decided to  commence my
experiments  by  increasing, if possible, the  quantity of this element;
consequently, all that was left for me was to determine what substance
I should choose for experimentation.
   Medical science furnished a numerous collection of data going to show
the influence upon the economy of the greater portion of these chemical
elements : as, for instance, iron, sulphur, (whether in the state of a sul-
phuret,  or as a sulphate), and the chlorides.  The use of alkaline reme-
dies was an every-day occurrence—all, or nearly all, had been tried in
the treatment of tuberculosis;  and although each  one  of them, in  its
turn, had been extolled, neither of these agents had presented sufficiently
well-marked, or uniform effects, to establish its claim as possessing a
real curative influence  over the disease.   I therefore  deducted  these
substances from  those with which I designed to experiment, intending
subsequently to take them up, should I find it necessary.  I decided to
commence my investigations by the use of phosphorus.
   We know, gentlemen, that this  element is one of those most con-
stantly present in the human body, but that is the extent of our knowl-
edge : chemistry not  having yet been able to determine the state in
which it exists in the blood.  Does it enter into  its composition in the
form of phosphoric acid, or does it exist  simply as phosphorus mixed
in an uncombined state with the organic elements ?  At that time I had
never seen the experiments of Dr. Rees, published in the Philosophical
Magazine for 1848, and the position which he has there assigned this
element in the functions of  the blood globules;  but in addition to this 
• REPORT  TO  THE ACADEMY.            13
 work, which was then entirely unknown to me, I found the whole sub-
 ject examined and illustrated very clearly, up to a certain point, by the
 labors of others who had engaged in therapeutical inquiries.
    The phosphates, especially the phosphate of lime, had already been
 employed in the treatment of rachitis.  I knew also that Dr. Ben eke
 had proposed, in 1849, in Germany, the use of it as a specific  remedy
 against  the tubercular  diathesis, and  that other investigators, among
 whom was Dr. Piorry, had  also employed it.  On an examination, how-
 ever, of all the facts connected with its use, I became  satisfied that this
 remedy had not exhibited that immediate and decided action  upon the
 disease which I judged the element  to which it was analogous, viz.,
 phosphorus, really possessed.
    Is it in its original state, then, that  phosphorus  has its remedial ac-
 tion !  Looking over  the physiological effects which this substance is
 known to produce, as detailed in the Bibliotheque de Therapeutique of
 Bayle, I was impressed with the  idea that  the remarkable phenomena
 of stimulation which he describes, as well as its known action in various
 morbid conditions  of the body,  would  render it useful as a remedy in
 consumption.
   On the other hand, MM. Barthez and Rilliet, in  their  work on the
 diseases  of children,  after  citing two  cases  of tubercular meningitis
 cured by Coindet, in the year 1802, by means of phosphorus,  assure us
 that their trials  with it  have given "  no  favorable result, not even of
 momentary duration."  Again I  was arrested  in my inquiries  by nega-
 tive or contradictory reports.  On reflection, however, it seemed to me
 that these apparently opposite results were  capable  of being reconciled
 with each other.
   In fact, after admitting that the phosphorized element  of the blood,
 or of organic matter, exists in the body in some other form than that of
 phosphoric acid, it was evident to me that it performed the double part
 of an  eminently combustible substance, and at the same  time entered
 into molecular combination with the other elements of the body, in such
 a way as to become an integral portion of it.   But neither phosphoric
 acid nor  phosphorus can  fulfill this double indication.  The former is
 already at its maximum of oxydation : the latter, placed in contact either
 with the liquids in the stomach, or with any of the tissues of the body, must
necessarily,  before being  absorbed or  fitted for  assimilation,  become
transformed into phosphoric  acid,  or the phosphorous or hypophospho-
rous acids:  compounds next lower in the degree of oxydation.
  In the first case, the same results would be obtained as from  the em- 
14           REPORT  TO  THE  ACADEMY.
ployment of simple  phosphoric acid, with the addition of the  serious
inconveniences resulting from the local action of the phosphorus:  in the
second case, even allowing that the phosphorus, before  being absorbed,
should be transformed  into hypophosphorous  acid, this should at once,
on being brought into contact with the alkaline principles of the blood,
transform itself into two equivalents of phosphoric  acid  and one  of
phosphorous  acid (Phs 0,3=2  Ph 0& + Ph O3).   This last would fulfill
the two conditions which I have stated above, but with the disadvantage
of presenting, under the most  favorable  conditions, only a  portion  of
the phosphorus  taken  into the stomach; while  the remainder, by  its
transformation into phosphoric  acid, loses its  special power of action.
In this view of the case, as the  action of this preparation of phosphorus
upon the human organism would depend on the quantity of the element
capable of oxydation at the moment of absorption, or assimilation, the
efficiency and certainty of the  remedy would  be  subject to conditions
over which we could have no control : for instance, upon the liquid  in
which the remedy might be dissolved, the age of  that particular prepa-
ration, the nature of  the substances it might encounter in the economy,
the activity of its absorption,  <fec.
  These reasons  explain, to my mind, the causes  why the preparations
of phosphorus have proved so  untrustworthy ; and why, on the one hand,
Coindet was enabled to obtain certain  satisfactory results upon employ-
ing it in  large doses, while MM. Barthez and Rilliet, with  much less
doses, obtained only unfavorable or negative ones.
  Being satisfied that I have  discovered the reason for  these apparent
contradictions, I  believe I can  logically establish the following double
hypothesis :   " The tubercular  diathesis depends  upon a diminution  in
the system of the phosphorized element, and  which, having to act the
part of a combustible body, should be found at a  lower  degree of oxy-
dation than that  of phosphoric acid."
  After I had formed this mental induction, nothing remained for me
but to verify it by facts, and to  choose  which, among the various com-
binations of phosphorus  with oxygen, viz., the  oxide  of phosphorus,
the hypophosphorous, or  the  phosphorous acid, I  should use.  My de-
cision was based  upon the following considerations:
  The red oxide of phosphorus is insoluble and very inflammable ; the
yellow variety, although soluble, forms  combinations with bases which
are very slightly  so, and are, by no means, permanent.   In addition  to
this, there was an objection in the difficulty  of  its preparation undei
the circumstances in which I was then placed. 
REPORT  TO THE ACADEMY.           15
    I judged that phosphorous  acid would have an action much less en-
 ergetic  than hypophosphorous acid, it being less  combustible, since it
 contains three equivalents of oxygen, while the latter is combined with
 one equivalent only.   The salts formed from the former, which  are
 soluble, are those of soda, potassa  and ammonia,  while all the hypo-
 phosphites are soluble in water.  I therefore chose the hypophosphorous
 acid, and decided to use it combined with a base.  The use of the acid
 itself, uncombined, seemed to me to  offer no particular advantage, since
 at the moment it is absorbed it enters into chemical combination with
 the alkaline  carbonates  of the blood.   There  was also the additional
 objection that it was difficult to divide it into  doses;  for if used, it
 would be necessary to determine, each time, the degree of concentration
 of the acid.  From  preference I chose to commence my experimenta-
 tion with the hypophosphite of lime, on account of the important part
 which this base is supposed to  play in the system.
    But  then I was wholly ignorant  what were the effects  of  this salt
 when taken  into the  body.  The only  mention which I found in the
 works consulted, was, that according to  toxicologists  generally, (and I
 believe among them were included Orfila and M. Devergie,) the poison-
 ous effect of phosphorus is to  be attributed to its  transformation into
 hypophosphorous and phosphorous  acids.   It was  necessary that I
 should proceed in the use of this preparation with the greatest caution.
 I therefore  determined to try  its effects in the  first instance upon my-
 self.  For this purpose I commenced by taking half of a grain of hy-
 pophosphite of lime, which quantity  I gradually increased to six grains
 at a single dose, without  experiencing the slightest inconvenience from
 its effects.
   Convinced by this trial of the physiological safety of the agent, taken
 at that dose, I tried it for  the first time, on the 13th  of March, 1855,
 upon a  young woman of nineteen  years of age,  affected  with acute
 tuberculosis as a sequel to pregnancy.  Both lungs were completely in-
 filtrated  with tubercles at the commencement of the first stage of soft-
 ening.   There was also enormous distension of the abdomen, with acute
 pain on  pressure, a high  degree of fever, extreme prostration—in fact,
 all  the signs of peritonitis in full progress to a fatal termination.
  The first day the  patient took one grain of hypophosphite of lime ;
on the third day the dose was  increased to six  grains; on  the fourth
day, she  could raise herself in  bed, and asked  for some  nourishment.
The change in her condition  was so  rapid, the  amelioration of all her
general  symptoms, the night sweats, fever, prostration,  <fec,  was so 
16
REPORT  TO  THE ACADEMY.
 surprising; her  appearance,  above all,  was so  much altered  for the
 better, that I was completely astounded.   My patient continued steadily
 to improve every day until  the eighth, when  she  suddenly sank, and
 died with the symptoms of a perforation of the intestines.
   The second case submitted  to this treatment was a young lady six-
 teen years of age, also from  Havana, whom I had treated the year pre-
 vious for the incipient signs of consumption, but which symptoms had
 yielded  to  a  treatment of inhalations of atropine combined with  a
 strengthening regimen, and residence in the country.   In the month of
 February, 1855, the disease again  made its appearance, and resisted all
 the means previously tried for its relief, as well as the  cod liver oil and
 emetics  now used.   The  unfavorable symptoms  developed  themselves
 rapidly,  and at the commencement  of the month of April she presented
 the  following condition:  fever and chills at night, great emaciation,
 complete loss of strength  and appetite, profuse night  sweats over the
 chest and  about the neck, a constant cough which fatigued her  very
 much, slightly mucous expectoration with small striae of blood, and cat-
 amenia much less  abundant than  natural.  On percussion, I found a
 marked diminution of resonance in  the upper portion of the right lung,
 especially noticeable in front; much moist crepitation over  the same
 locality, heard quite distinctly during the cough ;—while over the other
 portions  of that lung the respiration was decidedly increased.   The left
 lung appeared healthy ; the voice presented nothing remarkable.
   The symptoms appeared to me  sufficient to justify the diagnosis of
 tubercles approaching the period  of acute softening,  and I  therefore
 commenced at once the treatment by ordering four grains each day of
 the hypophosphite  of lime, which  soon afterwards was increased to
 six.   Under the  influence of this  treatment, all  her  symptoms were
 rapidly ameliorated.   I continued this course with occasional intermis-
 sions, which I shall  speak of further on, until the close of the month
 of May;  and at the end of June I  established, to my own satisfaction
 the fact that no traces existed in  my patient either of general constitu-
 tional disease, or of  those  physical signs which I had discovered at the
 commencement of the month of  April.
   I will  not, at this  time,  occupy the attention of the Academy,  but
will reserve  for another occasion  all the details of my other observa-
tions, which I hold subject to  its examination, and will only present the
general result  which  I have  arrived at from the aggregation of  my
cases.
   The whole number of cases treated by me amounts to thirty-five ; of 
              REPORT  TO  THE  ACADEMY.          17

 this number, nine were completely cured; eleven experienced an essen-
 tial amelioration ; fourteen died, and one still remains under treatment.
   Of  the nine cases in the first series, eight were in the second stage,
 that is, presented tubercles in process of softening ;  in the ninth, there
 was a large  cavity situated in  tho  superior portion of the left lung.
 Three cases had acute symptoms ; one of these, that of a child of seven
 years  of age, showed  also well-marked symptoms of cephalic disease;
 one alone of these was perhaps doubtful, because the  physical  signs
 were confined to the base  of the lung.  All  the symptoms in the cases
 in the second stage, both rational and physical, entirely disappeared, and
 the lungs, I am satisfied, were restored to their normal healthy condition.
   In the ninth case, that of the patient with the cavity, all the general
 symptoms disappeared, while  the  physical signs were  also  notably
 improved.  There  still remains, however, some cavernous respiration,
 but no rales or crepitation; the  cough having  also ceased, and the ex-
 pectoration being scarcely  perceptible and perfectly transparent.  A year
 after the discontinuance of treatment, he wrote to tell me that his health
 continued unchanged, and  that he felt himself well enough to undertake
 the drudgery of a brisk business.  I have also heard from two of my
 other  patients, whose  health remains perfectly established.  From the
 others I have no information.
   Of  the eleven cases which I have spoken  of as simply relieved, fom
 were in the third stage, and presented large-sized cavities.  In one of
 the patients these cavities  occupied portions of both lungs.   In view of
 the  results  obtained from these cases, and  especially from the well-
 marked and prolonged amelioration which existed in two of them which
 had cavities, I have every reason to believe that unless some complica-
 tion had  intervened, both  would have recovered under a continuance
 of the treatment. The seven other cases presented a well-marked alle-
 viation of symptoms, which was maintained without interruption during
 the  course of treatment.   One case  alone, in which  there were some
 abdominal complications, presents an  exception.  In one  case, where
 there was a cavity occupying a large portion  of  one lung, the diarrhoea
 which  existed disappeared, and did not again  make  its appearance as
 long as the treatment was continued.
   I  wish now to speak of the  fourteen  cases  which resulted  fatally.
Before commencing the treatment, I looked upon them as nearly hope-
less.  In six, there were cavities  either of immense size  or several in
number; in three of them, in both lungs at the same time.   One other
was, in addition, attacked  with  peritonitis.   Eight were affected with 
18          REPORT  TO  THE   ACADEMY.
diarrhoea, and most probably with ulceration of the intestines ;  in two,
the tubercular mass occupied  more than a half of each lung ; in three,
it extended through the whole of one lung; in one, the upper lobes of
both lungs were affected; and finally, in one, the  tubercles were con-
fined to  the  apex of one lung, but there  existed, in addition, a severe
laryngial affection.   Seven of these patients  were  in such a condition
that they died  in one  month after the commencement of treatment,
four others within two months and a  half, while three only lived over
three  months.
  This simple statement is sufficient to show that nearly all these pa-
tients were in such a condition, when treated by me, that they could do
no less than  bring discredit upon  my theory, and  upon myself, as  its
originator:  notwithstanding  which, I deemed it my duty,  under the
circumstances, to lay aside all personal  feeling, as  I was anxious to in-
vestigate the difference, if  any  existed, between the results obtained
under the climate  of Europe,  and  those which I had noted under the
tropics,—where, I am satisfied, several of these cases would have experi
euced a more decided, as well as persistent, amelioration.
  I will now pass to a consideration of the proper doses to be given, and
the physiological and therapeutical effects of this new remedy.   I have
employed the hypophosphites of lime, of soda, of potassa, and of ammonia.
  The last two  were  tried but  a few times only, for  their action  seemed
different from that of either lime or soda.  The  first  two seemed to be
of very nearly equal efficacy.   I have  used them either alternately, in
the same case, or one wholly, to the  exclusion of the  other,  without
discovering any perceptible difference in the result.  One of the cases
of acute phthisis, which recovered, was treated entirely by the hypo-
phosphite of  soda.   The most effectual dose I have found to be twenty
grains, taken  at a  time, once  each  day.  Generally, I commence with
ten grains, and gradually increase from day to day by from two to four
grains. In some few cases, I have given as much as  a scruple and a half,
repeated twice each day.  Every ten or fifteen days, I suspend the treat-
ment for a day  or two, and then again recommence.  In  the cases of
two children,  both  under seven years  of age, I employed the salts at a
dose of from  one to two grains each day.
  The physiological effects, proved both  by trial on my own person and
on my patients,  are of two classes :
   There is a well-marked increase of nervous force, often manifesting
itself from the first day, accompanied with a most remarkable sensation
of strength and  health.   At the same time  the nervous troubles, if there 
REPORT  TO  THE  ACADEMY.           19
are any, disappear, as well as all functional disturbances, such as oppres-
sion of the stomach.  The appetite increases often at the most extraor-
dinary rate. The evacuations from the bowels become regular and more
abundant.  The night sweats, if  there are  any, cease; and  the sleep
becomes calm and profound.  The effect produced upon the nutritive
functions,   are equally decided:  the features will change  completely,
often in the space of a few days;  acquiring both fullness and color.
   Sometimes the teeth and hair show this nutritive stimulation.  In one
patient whom I treated at La Charite, a boy seventeen years of age, of
a feeble, lymphatic constitution, who was cured of a tuberculous infiltra-
tion of the whole of the  right  lung—in  the first stage, but in process
of softening at the  apex—the beard commenced growing  rapidly  two
months after placing him under  the treatment.  A young girl placed
under my charge by Dr. Lemaire, in a fearful  state of marasmus, with
cavities occupying more than a half of one lung, experienced not only
decided amelioration of all the  symptoms, but during the treatment her
four wisdom-teeth made their appearance.
   A treatment of six weeks by the hypophosphite of potassa, completely
dissipated  all  the  symptoms in an old man sixty-five years of age, for
two years a sufferer from the most violent attacks of asthma, depending
upon a chronic bronchitis.   He was so  reduced that he could scarcely
visit me even in a carriage, but rapidly acquired the strength and ap-
pearance of a man of fifty.  About fifteen  days after the cessation of
treatment,  he was attacked with a carbuncle on the neck, for which he
was treated by Dr. Michon.  His  recovery  was long and difficult,  and
yet he was finally fully restored to health.   I think that this was ntore
than a simple coincidence.
   All these peculiar symptoms  seem to depend on, or at least correspond
with,  a decided  stimulation in  the powers of  sanguification.    The
quantity and color of the blood increase  so rapidly that I do not hesi-
tate to say that the preparations of hypophosphorous acid are the most
valuable blood-creating agents known.   Every case has shown, within a
very brief time after the commencement of treatment, well-characterized
symptoms of plethora; and I have every reason to believe that, in some
cases  of advanced disease, this state would stimulate the development
of that pulmonary inflammation, unhappily  so frequent and fatal among
consumptives.
   Hemorrhoids will bleed under  its influence, for the first time, or re-
commence  if once the hemorrhage  has been stopped.   In one case  I
made  them bleed at pleasure, for  the experiment was tried at three dif- 
20
REPORT  TO  THE ACADEMY.
 ferent times.  One patient was troubled by marked symptoms of cerebral
 congestion.  Four had an abundant epistoxis.   In one alone  was there
 hemoptysis, and this but  of one day's duration,  which stopped immedi-
 ately on the cessation of  treatment.
   Finally, in all females in whom the disease was not too far  advanced,
 the catamenia became more abundant and highly colored.  I have not
 noticed that this remedy possesses any effect  over the functions of gene-
 ration other than that which might be attributed to its general stimula-
 tion of the system;  but this is a point which I have not yet examined.
   The following are the principal therapeutical phenomena which I have
 noticed in the patients who have submitted  to  this treatment.   When
 the  remedy is given in the proper doses, the patient  feels on the second
 or third, and  sometimes from  the first day,  a decided  increase of
 strength and appetite. I am satisfied, by repeated and careful trials upon
 myself, that these phenomena are by no means  chimerical.  The pains
 over the chest, which many patients feel so acutely, either cease, or very
 considerably diminish within a few days.  The  night sweats, however
 copious they may have been, almost always disappear at the end of seven
 or eight days.  When, however, the intestinal canal is affected,  and
 there is persistent diarrhoea, this is not always the  case; the  sweating
 then remains obstinate, particularly toward the close of the disease.
   At the same time  the strength  and appetite return, the patient gains
 flesh ;  the features, especially after the first  fortnight  or three  weeks *
 presenting a striking improvement.  The influence of this treatment
 upon the cough and  expectoration, has been equally rapid, and  has often
 caused their disappearance or alleviation within a very short  space of
 time, frequently in even two or  three days.   In this respect there is,
 however, in the various  cases, a very  decided  difference,  which  has
 appeared to me to have an intimate relation  to the extent and gravity
 of the lesions as shown by auscultation and percussion.
   There is one fact which I wish  especially to be noticed ;  for I think
 it is universally true, that all else being equal, the  local  lesions  are
relieved  by this treatment  with  much greater rapidity  when  the
disease is of more recent  date.   For  instance, in many patients of  the
first  series, physical signs  more marked  and  covering a greater space,
have disappeared, while they have obstinately remained, or were  much
more slowly alleviated, in  others of the  second  series, although at  the
commencement they were  much  less  formidable.  In all cases this  dif-
ference  coincided  with the difference  in the  time  the disease had
existed, and it seems  to me can be explained in no other way. 
REPORT  TO  THE  ACADEMY.           21
     The intestinal troubles have  proved generally rebellious to treatment
  when they possess a certain degree of severity, and a persistent diar-
  rhoea has always brought a fatal termination.
     The fever  has given a more  various result,  according as it seemed to
  depend upon the general diathesis, or the pulmonary lesions themselves.
  From what I have now stated,  I think I am justified in drawing the fol-
  lowing  conclusions,  upon  which the Academy is  requested to pass its
  judgment:
     THE  IMMEDIATE CAUSE, OR  AT  LEAST ONE  ESSENTIAL CONDITION  OF
  XHE TUBERCULAR DIATHESIS,  IS  THE DIMINUTION IN THE SYSTEM  OF
  PHOSPHORUS WHICH IS FOUND IN IT IN A FORM CAPABLE OF OXYDATION.
     The  SPECIFIC REMEDY  FOR  THIS DISEASE  CONSISTS OF A PREPARA-
  TION OF PHOSPHORUS WHICH PRESENTS THE DOUBLE CHARACTERISTIC OF
  BEING  IMMEDIATELY ABSORBED OR ASSIMILATED, AND WHICH AT THE
  SAME TIME IS AT THE LOWEST POSSIBLE DEGREE OF OXYDATION.
     The  hypophosphites  of soda and lime, up  to this time, seem to me
  the most completely to unite these requisites.
     This treatment has an immediate effect upon the tubercular diathesis,
  so called, and causes the disappearance, with a really marvellous rapid-
  ity, of all those symptoms which generally typify its existence.   When-
  ever the morbid  deposit whieh is  at the same time the special result
  and the pathological evidence of this diathesis, is of  reeent date; when-
  ever the softening has only just commenced, and proceeds slowly, the
• tubercles are absorbed and disappear, leaving no  trace.  When the
  deposit is of an older date, or  when the softening has reached a more
  advanced degree, it  will sometimes remain in spite of the treatment; in
  which case the result of the disease will  depend  upon the anatomical
  characteristics  of the lesion, and  above  all upon its extent,  and the
  presence or absence  of complications.
     Numerous trials  made  by me  to  remedy  the  local condition, by a
  direct medication by means of the inhalation of  various substances,
  have, up to this  time, produced no satisfactory result which could not
  be attributed to the improvement consequent upon the specific treat-
  ment.  Nevertheless, if we can now arrest the progress of tuberculariza-
  tion, there is every reason  to hope that we shall  ultimately discover a
  rational and efficacious treatment of tubercles already deposited,  espe-
  cially of the  inflammatory complications.  This, however, will become
  much less necessary as the experience of Cach shows, which there is every
  reason  to believe it will, that these hypophosphorous remedies  are also
  prophylactics to tuberculous diseases. 
22           REPORT  TO  THE  ACADEMY.
   The hypophosphites have a double action on the system : on the one
hand they increase the principle, whatever  it may be, which constitutes
nervous force;  on the  other hand, they are the most powerful blood-
generating agents, infinitely superior to any thing which we are now in
the habit of employing.
   In consequence, it seems as if they could be employed to advantage
in all those cases where it is wished to increase in the system either the
one or the other of these two properties.
   These hypophosphorous preparations will  occupy, without doubt, the
most important place in the list of therapeutical remedies, as far as their
powers of relieving nervous prostration, or any disturbance of the blood-
generating processes are concerned.
   For this double character, they  should be employed in nervous dis-
eases, in cases of paralysis (where their use is not contra-indicated by the
existence of congestion), in protracted convalescence, and in the adyna-
mic  period of acute diseases.   It would be well to try them  in the cold
stage of cholera, and in the last stage of yellow fever, etc.
   It is time, gentlemen, that  I should close my remarks.   I am well
aware how prone we are to deceive  ourselves,'—how easy and pleasant it
is to be deceived,—as  to  the  results of our own labors ; therefore, I do
not hesitate to acknowledge the incompleteness of the paper which I
have now the honor of presenting  to you.  I  simply ask for  it your
consideration.  It is the consciousness  of its imperfections that has in-
duced me to  defer its presentation until this day.
   May it prove for the well-being of the human race and for the benefit
of science, that your judgment, and that  to be  given by  experience,
shall confirm the results which I have announced. 
NOTES
                                      OF

 CASES  SUBMITTED  TO  THIS TREATMENT

                        FIRST  SERIES.

     CASES  WHICH  RESULTED  FAVORABLY.

                                CASE NO. L

   Dona Isabel de S----, 16 years of age, born at Havana, unmarried.   This pa-
 rent first consulted me in the month of ApriL 1854, complaining of a slight, though
 persistent cough, which had annoyed her for about two months, with perceptible
 .oss of flesh.   There was a moderate expectoration of a limpid and transparent
 luid.   There had never been any hasmoptysis, but she had lost both appetite and
 strength.  She was  also troubled  with excessive leucorrhoea.   The  quantity as
 well as the color of the catamenia had diminished at each of the last two menstrual
 periods.
   On examination,  I found a decided rudeness of the respiratory murmur just be
 low the right clavicle, with prolonged expiration, but no crepitation even during a
 cough,  and without any diminution  of the sound under percussion, and with very
 slight vocal resonance.
   In the supra-scapular-fossa of the  same side, there was merely a slight feebleness
 of the respiratory murmur.
   I ordered the treatment to consist of inhalation of air, charged with moisture by
 its passage through water, in which  had been dissolved a grain of atropine to each
 ounce, a system of treatment which I was experimenting upon at that time.  In ad-
 dition to this, she was ordered a preparation  of iron, a strengthening diet, consist-
 ing principally of roast meats and milk; walks early in the morning, and a resi-
 dence in the country.  Under this regimen,  but  above all perhaps on account of
 the favorable weather, her appetite and strength returned; her catamenia increased
 both in abundance and color; the cough  and expectoration  ceased  entirely; and
 the rudeness of the respiratory murmur at the  apex of the left lung, gave place
 to the softness  of the natural respiration. There remained, however, still a little
 dullness of the  respiratory murmur in the supra-scapular-fossa.
   This favorable state of things  continued during  the whole summer and early
 part of the winter;  but in the month of February, 1855, my patient commenced
 anew to cough,  to grow thin, and to  lose her strength and appetite.  On the 4th
 of March, I made the following note  of her condition:  Countenance pale and de-
 jected ;  well-marked loss of flesh; eyes languishing, and, as it were, swimming in
moisture;  cough frequent, especially  in the night; slight expectoration of a trans-
parent, but not mucous fluid; no  night sweats, but only a slight moisture of tho 
24                     NOTES  OF  CASES
body when in bed; no fever in the evening; catamenia at the last period less
abundant than usual; very little appetite;  says she is very feeble, and appears
anxious about her condition.
   On examination of the chest, I found in the right supra-scapular-fossa well-marked
diminution of the respiratory murmur, but without crepitation or prolonged  expir-
ation.  The resonance over the back was about the same on each side.  In front,
it seemed a little diminished under the right clavicle, where I also found a decided
rudeness  of the respiratory murmur, with slightly increased sound of the voice.
The expiration over the same spot seemed notably prolonged.
   I recommended the former treatment, viz.:  inhalation of atropine; iron reduced
by hydrogen, one grain each day;  roast meats and a milk diet, together with a
moderate  amount of exercise on foot each day.
   March \Uh.—My patient does not find herself improved; her cough  is more
frequent, and fatigues  her excessively; the moisture  of the body at night has in-
creased ;  her appetite and strength have diminished still more.   She was ordered
to continue the same treatment, and  in addition to take to-morrow morning as an
emetic two grains of  tartarized  antimony,  dissolved  in three  wine glasses of
warm water,  to be divided  into three doses, and  taken at intervals of a quarter
of an hour.
   March 11th.—The emetic acted very powerfully; she rested  better last night,
and has coughed less.   This morning she feels a little more appetite, but complains
of a pain  in her throat and  a sensation of  constriction over the whole chest;  she
is also, as she says, very weak.   Continue  the inhalations and the iron.
   March 18lh.—Has passed a rather wakeful night; has coughed a little less than
during the few preceding days, but has been grievously troubled with night sweats.
She complains of being excessively weak, and has no appetite whatever; the ex-
pectoration is a little more abundant; she  still has the pains over the chest;  the
stools are  natural;  she has  some little leucorrhoea.  To continue the inhalations,
and the iron increased to two grains  each day.
   March   I9ih.—Still continues in the same condition; her strength is still more
diminished, and she has perspired copiously during the past night.   Auscultation
shows the same signs as at  the first examination; but there is some slight crepita-
tion just below the right clavicle.  The dullness seems to be more decided and ex-
tended, and can now  be found equally as well over the back.   To continue tho
same treatment, and in addition to take each day a table spoonful of cod liver oil.
   March 20th.—Condition as before—to continue the same treatment.
   March 2 6th.—Coughs very frequently, which prevents her from sleeping.  I find
her very much alarmed because she  has seen a few streaks of blood in her expec-
toration.   Her catamenia, which have appeared within a few days, have been much
less abundant than ordinary, and also deficient in the proper  color;  the leucor-
rhoea has  much increased;  the  night sweats  continue  excessive, especially about
the head.   Stop the iron, and take every day two table spoonfuls of cod liver oil.
  March 21th.—Same condition.
  March 29th.—She has again raised blood, and this time in much greater quan-
tity: in consequence,  she is very much alarmed and dispirited; there are some
mucous sputa in the midst of the limpid  expectoration; the night sweats have
been still  more troublesome, and  her cough fatigues her much  during the nio-ht. 
WHICH  RESULTED  FAVORABLY.        25
Continue the same treatment, and order another emetic of antimony  to-morrow
morning.
  March 31st.—The paroxysms of vomiting have fatigued her very much; she com-
plains more particularly of pains in the throat  and chest, notwithstanding which
she  has slept better, and coughed less during the night   The  expectoration is
more abundant, and  the amount  of mucous increased, but without any show of
blood.
  April 1st.—Same condition: she complains of the sensation of constriction in the
chest which the act of vomiting causes  her;   the perspiration was profuse last
night;  the  expectoration  contains a little more mucous; the cough still fatigues
her  very much, and she has very little  appetite;  her strength has  diminished
since the commencement of the preceding month.  Continue the cod liver oil.
   April Zd.—There are still occasional streaks of blood in what she raises.  Last
evening she had  a chill, followed by  an  increase of fever.  She has  perspired a
great deal while sleeping, and the cough has kept her awake the greater part of
the  night.   Continue the same treatment.
   April Ath.—Last evening she had another chill, followed by fever; the sweating
has been excessive, especially about the head; there are some  streaks of blood
in the expectoration. The patient is greatly prostrated, sad, and dispirited, and has
almost  lost her appetite.   Sfop the cod liver oil.
   April 5th.—Made a careful examination of her case, and found the general condi-
tion to be such as stated in the preceding notes.   On percussion, I found a di-
 minished resonance below the right clavicle over a space of three fingers breadth
 in width;  the  same condition was also found behind, but in a less decided degree.
 On  the left side the resonance in front as well as behind seemed normal.  Auscul-
 tation showed  moist crepitation in the same .region, which did not disappear while
 she coughed.  Over the rest of the right lung tho respiration was more increased
 than over the  left.  The voice seemed a little resonant, but only in a slight degree.
 The left lung shows nothing abnormal.
   Diagnosis.—Tubercles at the summit of  the right lung at the stage of acute soft-
 ening.
   Encouraged by the trial on the subject  of the twenty-first observation, I deter-
 mined  to employ  the hypophosphite of lime, and therefore ordered her, to-day, four
 grains  of that salt.
   April 6th.— Last evening she had a slight chill, followed by heat, but she finds
 that she has coughed less and slept better; otherwise she is in the same condition,
 except that she seems  a little less prostrated, and there is  no blood in the  expec-
 toration.  Treatment, five grains of the hypophosphite of lime.
   April 1th.—Last evening she had a slight sensation of cold, followed by heat.
 She says that she has perspired less, and slept better;  she seems less  sad, and the
 cough less frequent than day before yesterday.  Her  mother  and sisters say that
 they think she has sensibly improved.  Treatment, six grains of the hypophosphite
 of  lime.
   April 8th.—My patient finds  herself  much better.  She says that the night
 eweats have been less; that she has slept weU; feels herself stronger; that her
 cough has much  diminished, and that her appetite is improving.  Treatment, seven
 grains of the  hypophosphite of lime. 
26
NOTES   OF  CASES
   April 9th.—Her  countenance looks infinitely better; she is almost gay;  saya
 that she has slept very well; that her cough awakened her only twice during the
 night;  the  expectoration is diminished, and contains only a few mucous  clots,
 swimming in a transparent hquid, but without  traces of blood.  Treatment,  eight
 grains of the hypophosphite of lime.
   April 10th.—Has sensibly improved; says that she perspires but very slightly;
 coughs very little, and sleeps well nights.  This morning she went out of doors for
 a walk, and took breakfast with considerable zest.  Gave nine grains  of the hypo-
 phosphite of lime.
   April Ulh.—Continues to improve.   Ordered ten grains of the salt, to be con-
 tinued at that dose for the following days.
   April 15th.—My patient tells me that she does not sweat at all; that she coughs
 very little, and raises scarcely any thing. Her countenance has completely changed;
 her features have filled out; she is cheerful and animated.  She has a good appe-
 tite ; her evacuations are natural, and  the leucorrhoea has almost disappeared.
   April 26lh.—Has continued  to improve from day to day.  Within the past few
 days her catamenia have appeared as  abundantly and naturally colored as before
 her sickness.  During this period her cough has slightly increased, but her  appetite
 and strength have continued good; the  expectoration is very  slight.  The hypo-
 phosphite of lime has been taken every day since the last note, except yesterday
 and to-day.
   On examination, I found the crepitation at the summit of the right lung  is much
 less than at the time of my last examination on the 5th of this month; it seems
 to me that the dullness has also diminished,  and that  the exaggerated respiratory
 murmur at the inferior portion of the lung has almost disappeared.
  April 21th.—Her cough has returned to what it was before the access of her
 catamenia.  It consists of but little more than one or two coughs at morning  and
 night.   Ordered her to commence again with the hypophosphite at the dose of six
 grains.
  May 8th.—The treatment has been  continued as at last date.  Since the 1st of
 this month the dose of the  medicine has been  carried to ten grains.  My patient
 would hardly be known for the same person, so  much has she improved in the past
 month.  Nearly all the general  symptoms have disappeared, and nothing remains
 but a slight cough, principally in the  morning, but without expectoration.  She has
 nearly regained her usual amount of  flesh, and her healthy appearance.
  Percussion shows that the dullness of the right side has nearly disappeared • the
 crepitation is very slight,  as well in front as behind;  she can take  a long walk
 every morning without being in the slightest troubled for breath.  Suspend treat-
ment for two days.
  May im.-Same condition.   Commence  again with the salt at a dose of ten
grains.
  May 25ft._My patient has not coughed any  for the past  fifteen days- there is
no expectoration whatever; she is stouter than before her sickness, and says that
she never felt so well in all her life.  She now eats more than  any other member
of the family.   Suspend  treatment for  two days.
  May 21th.-On examining my patient I find that the general symptoms  have
disappeared for the last fifteen days.  As to the physical signs,  I find  still behind 
<►
           WHICH  RESULTED  FAVORABLY.         27

in the right supra-scapular-fossa, little feebleness of tho respiratory murmur, espe-
cially during inspiration; but the crepitation which was heard both in this region,
and under the clavicle, has completely disappeared.
  Return to the former treatment,  and take the salt in a dose of ten grains.   This
Bhe continued until the 1st of June, when by my directions she went to reside in
the country.
  At the close of the month of June I saw her again; she was then fatter and hi
better  health than she had ever been.  Auscultation showed me no difference be-
tween the right lung and the left.
  My patient continued to enjoy perfect health during the whole of the following
winter.  On my departure from Havana in April, 1856, she was making preparations
for her marriage, and presented the appearance of the most perfect health.  I made
another examination at this time, and found the respiratory sounds natural on both
sides.
  Any remarks  upon this  case will be superfluous: but I assure the reader that
however much astonished or even skeptical he may be, he can not be more so than
I was myself.
  I  had evidently discovered, and  had at my control, a new and powerful method
of treatment.  But I asked  myself—will it fulfill  all  the indications  which  I
wish from it—all  which, at the outset, it seems to promise me ?   Perhaps I am
only deceiving myself, and this result, which  I  have seen, is only the coincidence
of a fortunate train of circumstances.   We shall see, further,  how well my other
experiments answered these questions.
                          CASE  NO.  II.

  Miss C----, six years and a half old, horn in Canada, but living in Havana for
the past two months, was brought  to me for the first time on the 7th of February,
1856, by her mother, who gave me the following particulars:
  Her child commenced to cough in  October of the year before; the cough was
dry and recurred in paroxysms.  At the same time she lost her appetite and flesh,
and  became much depressed in  spirits.  She was attended by an uncle,  who
ordered her cod  liver oil and  other remedies; but the cough, as well as the other
symptoms,  becoming more  aggravated, he advised her  parents to carry  her  to
Havana,  where they arrived in December.   For a short time after her arrival, her
cough  seemed  to mend, but the change  was very slight.   There had never
been any expectoration.
  The child continued to grow  weaker each  day until  her visit to me, when she
could scarcely walk,  and required  to be held constantly in the arms of some one.
She had  almost wholly lost her appetite ;  complains much of her head, and  says
that it  pains her in  front; her disposition has become capricious and variable;
she changes suddenly from sadness to laughter, and often bursts into fits of violent
weeping;  she perspires  very freely,  especially  about the head  and neck; she
sleeps badly at night, and  in the  morning will often  start up suddenly, uttering
piercing cries, after which she will relapse  into a species of syncope, become quite 
28
NOTES  OF  CASES
 pale and cold.   This last phenomenon  has only developed  itself since her arrival
 at Havana, but within the past two weeks it has occurred four or five times.
   On  examination, I found the abdomen neither tumefied nor tender on pressure.
 Latterly she has been almost constantly constipated, and only has an evacuation
 «vhen she has taken a purgative of magnesia.
   The face of my little patient was pale and sad.   Her  eyes were preternaturally
 large and deep set, with a haggard, wild stare, and the  pupils much dilated.   She
 either heard with difficulty the questions which I put to her, or obstinately refused
 to answer.  She told me that her head pained her, and carried her hand to her
 forehead to indicate the locality.
   Her mother stated that her skin was alternately burning  and cold.  I found it,
 by examination, warm.   The pulse was 110.   She has never passed any worms.
   On  examining the chest, I found above and below the clavicle on the  left side a
 sensible  dullness, and over the same spot a marked diminution of the respiratory
 murmur, but no rales or crepitation;  over the rest of that side, the respiration was
 slightly exaggerated; there was  nothing peculiar  in the cough or voice; on the
 right side resonance and the respiration appeared normal.
   Diagnosis.—Bronchial, and probably cerebral turbercular deposit.  I commenced
 her treatment by ordering half a grain of the hypophosphite of lime.
   February 8th.—This morning she again awoke suddenly from her sleep, shriek-
 ing, after which she became pale and seemed to lose consciousness.  I was sent
 for, but was out In other respects she remains the same. Continue the treatment.
  ^ February 9th.—Yesterday she  seemed less depressed, and passed a tranquil
 night.   This morning she awoke quietly,  and breakfasted better  than usual.   Or-
 dered the dose to be increased to three-fourths of a grain.
   February 10th.—Perspired less last night; awoke calmly;  yesterday had a
 natural evacuation; her face is less haggard, her disposition less sullen than a few
 days ago.
   February Uth.—Coughed much less yesterday, and  during the night  perspired
 very little;  her appetite is better,  she is stronger, and can even walk a little when
 carried into  the open air.   Increase the dose to one grain.
   February  13^.-This morning she awoke  suddenly, crying,  and with a frightened
 air;  after which she became pale,  but did not lose consciousness.  Condition about
 the same, but seems stronger.
   February 15th—All her symptoms continue to amend; has nearly as good an
 appetite as before her sickness ; the cough has diminished;  she  has scarcely any
 night sweating, and does not now complain  of her head.  The treatment was  sus-
 pended for two  days.
   February  ^.-Continues to  improve.   This morning  she started  suddenly
 from her  sleep with a frightened air, but did not cry out,  and  although she became
 slightly pale, did not lose consciousness.   Dose reduced to three-fourths of a grain
   February  mh.-Getting better  and better;  is quite lively, and laughs occasion-
 ally;  coughs very little, and has  merely  a moisture of the skin at  night-  has a
 natural evacuation nearly every day; walks  about freely; she has  filled out, lost
 hat sad look, and from her appearance, would never be judged to have been sick.
Increased the hypophosphite to one grain.
  March  4^.-The change in the  appearance of the child is  so CTeat as  to *twt
theatric of CTer7oMwho saw her Wore ,ta co^enL^X^T 
WHICH  RESULTED   FAVORABLY.
29
 All the symptoms—cough, sweating, feebleness,  etc., have disappeared, and her
 mother says she has never seemed better in her fife.  From this time the dose of
 the salt was increased to a grain and a half each  day.
   March 8th.—Examined her chest, and found still a little feebleness of the vesic
 ular breathing at the apex of the  left lung; but the  resonance, on percussion,
 seemed to me about equal on each side.  Suspended the treatment for two days.
   March 10th.—[The  patient was attacked with  a severe dysentery, from  over-
 indulgence in fruit, and a cold taken during the night.   Under  proper  treatment,
 during which  the hypophosphites were discontinued, she recovered in a few days.]
 —Trans.
   March IMh.—Says she is well and wishes to get up.  Yesterday had a natural
 evacuation; no pain  over abdomen; no  fever; pulse 100.  Gave soup, and rice
 and milk.
   March 16th.—Sleeps well; does not cough, and has no sweating.
   March 11th.—Auscultation shows still a little feebleness of the respiratory mur-
 mur at the apex of left lung.  Resonance equal  on  the two sides.  Commenced
 again the use  of the hypophosphites at a dose of three-fourths of a grain, which I
 increased by the addition of a quarter of a grain each day until I had reached two
 grains.
   March 22d.—Seems perfectly well.  Her mother assures me that she has never
 seemed so strong  and lively since she was  born.   Her appetite is excellent.  By
 auscultation I found still a little feebleness of the respiratory murmur at the apex of
 the left lung;  but much less than a short time ago, and perhaps not more than the
normal difference  between the two sides.   The treatment was continued up to the
 26th of the  month.  I did  not see her after this,  because, being necessary for me
to leave the city, her mother decided on returning to New York.  I have had no
further tidings from her.
                            CASE   NO.  III.

   Don F----P----:  42 years old ; native of Havana.   This gentleman, whom I
 have been attending nearly a year, visited me on the 9th of June, 1855.  He has
 suffered  for several  years.  There is a large-sized  cavity occupying nearly two-
 thirds of the left lung,  surrounded, especially at its  inferior side, with tubercles in
 process of softening.
   The disease has been slow, but constant, in its progress.  The weakness, diffi-
 culty of breathing, cough, and expectoration, have little by little increased.  I have
 tried various remedies in his  case, but without  obtaining any satisfactory result.
 The treatment from which he  has seemed to derive the most relief, and  has  been
 employed the longest, consists of inhalations of atropine, after the  plan spoken of
 in the first case, with small doses of iron and the tincture of digitalis.
   He has taken at various times  cod liver oil, as well by my direction, as before
his coming to me, by advice of one of my friends; but the use of this occasioned,
after a  short time, severe  hemoptysis, which compelled him to discontinue it  I
wish here to state that  this remedy has never seemed to produce, in warm climates, 
  30                      NOTESOFCASES

  any advantageous effects which I have sometimes observed from its use in Europe.
  Few persons can continue its use  beyond a few days,—it often  causing either  se-
  vere hemoptysis, or such a trouble in the intestinal canal as to forbid its use.  I
  am satisfied, by repeated trials, that these phenomena  do not, in the slightest de-
  gree, depend upon the character of the oil used.
    Encouraged by the results of the use of the  hypophosphites in the other cases,
  I finally decided to employ them in this case also.   The  condition of the patient is
  now as follows:—Great emaciation; his face pale and peaked; considerable weak-
  ness; bad appetite;  digestion slow and laborious; no diarrhoea; cough frequent
  and annoying, often preventing his sleeping at night; expectoration muco-purulent.
  and copious enough to three-quarters  fill a tumbler in twenty-four hours.   Has
  night sweats, especially over chest and neck; is obliged to sleep mainly upon the
  right side, as he cannot rest  at all upon the left, nor remain upon his back longer
  than a few moments.
   Nearly every  three or four weeks he has a  more or less profuse hemorrhage
  lasting  four or five days; the two last times  to an alarming  extent.  He was
  formerly troubled with hemorrhoids,  but  they have disappeared for the past three
  years.
   On auscultation, I discovered the following conditions:—On the right side, both
  in front and behind, the resonance  and the respiration were about normal,  though
  the latter may have been slightly increased.  On the left side, and at about an inch
  below the clavicle, there was  a decided  diminution of resonance.  Over the same
  spot there was moist crepitation, and lower down a cavernous rale and pectorilo-
  quy.  Sound of the heart increased, but with nothing abnormal about it.  Behind,
  in both scapular-fossas, there were  marked cavernous  r&les, with  great vocal reso-
 nance.  The resonance, on  percussion, seemed about the  same as upon the right
 side.  Behind, the respiration was increased at the base  of  the left lung.  Ordered
 him to take four grains of hypophosphite of lime, which was to bo increased each
 day after by one grain.
   June 15^.—My patient feels stronger; has more appetite; slept last night upon
 his back, and for a short time upon his left side.  Ordered the dose  increased to
 ten grains.
   June 20th.—Is decidedly improved, and although very thin,  has lost his appear-
 ance of suffering and prostration.  His appetite,  he  says, is better that it ever was
 before; has no night sweats;  sleeps as he  pleases, upon his back, or either side;
 coughs much more rarely; the expectoration has diminished more than a half, and
 is more transparent.   Suspended the treatment for two days.
   June 30th.—Commenced the use of the hypophosphite on the 23d, at the dose of
 six grains.  Yesterday he had a slight hemoptysis, it  being about the time it has
 usually occurred.   In consequence, I suspended  the treatment.  The  hemorrhage
 was  merely a few striae  of blood in the matter expectorated,  but my- patient is
 much alarmed, as tho last one was so  profuse.  In order to tranquillize him I or-
 dered ten drops of the ethereal tincture of digitalis three times a day.
  July 2d-The hemorrhage  has ceased, and the patient  continues  to improve
By auscultation, I found the  mucous  rales much less abundant, and mixed with
sibilant rhonchus.  There is also a slight sound, as of friction at some distance 
            WHICH  RESLLTED   FAVORABLY.         31

  July 3d.—Ordered the dose at six grains.
  July 18ih.—My patient feels better than at any period since the commencement
of his illness.  He coughs and raises very little;  has no sweating; has  a good
appetite, and is much  stronger.   Suspended  treatment  for two days,  and then
commenced with the dose at six grains, which was gradually increased to ten.
  July 20th.—My patient says that he passed a little blood yesterday at stool. In-
creased the dose to fifteen grains.
  August 3d.—Lost more blood yesterday.  Ordered the salt at the dose  of twenty
grains.
  August A,th.—The hemorrhoids bled again yesterday.  They protrude and trouble
him very much.   Suspended  treatment, and ordered an injection of infusion of
rhatany.
  August 5th.—Bleeding has diminished.
  August 6th.—Bleeding has ceased.
  August 10th.—Commenced with the  hypophosphite  at  six grains, which was in-
creased by a grain a day to ten grains.
  August 14tth.—Discovered,  by  examination,  the  following condition:—On the
right side, the  resonance and  respiration perfectly  normal.  On the left, marked
dullness below the clavicle, over a space of an inch in width.   Over the same spot,
intense cavernous respiration, pectoriloquy, a sound of dry rubbing, but no rales.
On the back, in the supra-scapular-fossa?, the same cavernous respiration, but more
distant from the ear than in front. There is resonance of the voice, but no crepi-
tation.
  September 25th.—Continued the treatment steadily up to this time.  My patient
has gained flesh, although still quite thin; his appetite and strength are good;
has had no more hemoptysis, and has only  one slight coughing  fit in the morning,
and raises a little transparent  mucous; sleeps well on either  side, or  upon the
back.
  Auscultation shows inlront, in the upper part of the left lung, intense cavernous
respiration, with pectoriloquy, but no r&les  or crepitation.  Behind, the same phe-
nomena is manifested, but less marked ; over the rest of that side, tho respiration
is slightly rude.  The right side seems normal.
  My patient passed the following winter with no perceptible change.  He was
attacked with a slight bronchitis,  which seemed to have  its  location in the cavity
and base of the left lung.   Since  sibilant and  ronchus rales were heard  there, I
continued an expectorant  treatment,  and in  the course of about two weeks it
wholly disappeared.   In March, 1856, I examined him anew, and found the lungs
in the same condition.  Since then he has written to inform  me  that his health
remains unchanged.
                          CASE  NO.  IV.

  Don Juan C----;  29 years old; born in Havana,  married.
  November 6th, 1855.—This gentleman called upon me for  a slight spitting of
blood, which he has noticed for the past three weeks.   About a fortnight before 
32
NOTES  OF  CASES
 this hemorrhage, he commenced to cough; has also lost strength and appetite, and
 sweats much at night.  Two sisters have died of consumption.
   On examination, I found the following to be his condition:
   Nothing peculiar in his general appearance; his  cough is quite  troublesome;
 the expectoration slight, containing some mucous and a quantity of blood, sufficient,
 perhaps, to fill half a wine-glass in the course  of the day.   He is very feeble, so
 that he has not been able for the past three weeks to go out to attend to his
 business.   The resonance, on percussion, is about equal  on the two sides, as well
 in front as behind, but perhaps slightly diminished in the left supra-scapular-fossa.
   By auscultation,-1 found at the apex of the left lung, both  in front and behind,
 moist crepitation which did not disappear when coughing.  At the lower front por-
 tion of the same lung, the respiration was increased in a marked degree.   Nothing
 peculiar in the sound of the heart.   The respiration was normal over  the right
 side.
   Diagnosis.—Tubercles at the apex of the left lung, commencing to soften.
   Ordered at once six grains of the  hypophosphite of lime and sulphuric acid  in
 sweetened ice water.
   November 1th.—A few streaks of blood only in the sputa,; complains of colic
 having troubled him in the night. Suspended the acid and ice;  gave eight grains of
 the hypophosphite of lime.
   November 8th.—Coughs, sweats, and raises less.  Gave ten grains of the hypo-
 phosphite.
   November 2Uh.—My patient attends to all his out-door affairs; feels as well as
 ever; has a good appetite; no sweating; coughs and raises very little.  Suspended
 treatment  for two days.
  November 28th.—Commenced the treatment in a dose of ten grains.  Examined
 his chest, and found the crepitation much diminished; the other signs as at the first
 examination.
  January 15th, 1856.—At the  examination, with my utmost care, I could discover
no difference between the two lungs.   The respiration seemed as normal on the
left as on the right  side.   My patient continued  perfectly well up to the time of
my departure, three months afterwards.
                           CASE  NO.   V.

  Maria R----: a negress; 19 years old ; Unmarried; free, ana supporting herself
by washing.
  January 2d, 1856.—This patient came to consult me for a cough which she has
had for about three weeks.  During this time she has lost much flesh, and become
so very weak that she has been compelled to stop washing;  she has fever att night,
and sweats a great deal, especially about the head.   At the  last period, menstrua-
tion was  much less abundant  than natural;  she has very little appetite, but no
diarrhoea;  the cough is frequent and dry; what little is raised, consists of a clear
fluid, entirely salivary in appearance, with no trace of mucous;  she is so troubled
in breathing that she can scarcely walk.
  Her face, and especially her  general appearance, presents in a hisrh deeree  th.-u 
WHICH  RESULTED  FAVORABLY.           33
look which seems to be a peculiarity of all consumptives, but which is much more
Btriking in colored people than the whites.
   On examining her chest, I found over the  front of the left side, a diminution of
resonance  under the clavicle, and at the  same  point a marked rudeness  of the
respiratory  murmur,  with marked resonance of the  voice.  Behind, in the left
supra-scapular-fossa, dry crepitation,  especially perceptible at a deep inspiration.
These signs, added to the severity of the general symptoms, enabled me to form,
without difficulty, the following diagnosis:
   Tubercles deposited at the apex of  the left  lung, just commencing to soften.
   Ordered immediately eight grains of the  hypophosphite of lime.
   January 3d.—Feels better and coughs less.  Increased the dose to ten grains.
   January ith.—Less fever and sweating last night; this morning  has a little
appetite.  Gave twelve grains of the  hypophosphite.
   January  5th.—Night sweats  still more diminished and cough lighter;  this
morning feels  stronger,  with better appetite.  Ordered fifteen grains of the salt.
   January 13lh.—She informs me to-day that the night sweats  have ceased, that
she eats well,  and feels sufficiently strong  to again commence work; she coughs
very little :  requested her to remain quiet for a short time longer.
   I  found, on examination, a little dullness  under the left clavicle, and marked
rudeness of the  respiratory murmur,  although  it seems to me much improved.
There is still resonance of the voice.  The crepitation which I had  noticed over
the back has disappeared.  Suspended treatment for two days, when it was again
commenced with the dose at ten grains.
   February  2d.—Has been working for the past two days; has no  cough; hai
gained flesh and  strength; has no shortness of breath, even when working hard,
her catamenia have become as profuse as natural.  I found, by auscultation, th»
respiration on  the left side  almost normal, but on percussion, still a little dullness
below the left clavicle, with slight vocal resonance. Increased the dose to  fifteen
grains, at which it was kept until
   February  20.—When an examination showed no perceptible difference between
the two sides.   I  then ceased my visits.
   March 12th.—Has returned, because  she has been troubled for the  past four or
five days with very slight sweating: she also  coughs a little; otherwise is well.
   Found on examination a few  sibilant rales over both lungs. Ordered  some
slight remedies, and by the 2 2d all the symptoms had disappeared.
   April 3d.—A  few  days before my departure I visited her, and found  her per-
fectly well.
                          CASE  NO.  VI.

  Mr. M----: 22 years old;  born in the United States; unmarried.
  March 15th, 1856.—The patient gave me the following history:  Commenced
coughing in October last; in November he raised, for several consecutive days, a
quantity of blood;  has taken  various remedies without relief.  In  January, by
tho advice of his physician, he came to Havana  for the  benefit of a  change of
climate, but has experienced no improvement from it; has become more emaciated 
34                     NOTESOFCASES
 since his arrival, and completely lost his appetite.  His mother died of consump-
 tion.
   His present  condition is as follows:  Moderate degree of emaciation; face pale;
 great weakness and depression of spirits;  cough frequent, especially nights and
 mornings;  sweats at night, principally about the neck and chest.
   Expectoration is slight, and composed of perhaps a dozen muco-purulent sputa;
 has little appetite; digestion good; evacuations natural;  gets out of breath easily,
 especially while walking, or going up stairs.
   Percussion of the chest showed a diminished resonance on the left side, extend-
 ing from the  clavicle to the level of the fourth rib,  but most perceptible below the
 clavicle.  Behind there is dullness, principally in the  supra-scapular-fossa.   On the
 right side the resonance was normal.
   Auscultation showed on  the left side, in front, great feebleness of the respiratory
 murmur.  Under the clavicle, for a space of the width of a finger,  there was none
 whatever.  Behind, on  the  same side, in the supra-scapular-fossa, especially upon
its inner side, there  was moist crepitation;  in the sub-scapular-fossa, it  also ex-
isted, but slighter;  the respiratory murmur was quite feeble at the base of the lung;
 the respiration, both  in front and behind, was much  increased over the right side,
 which seemed normal.
   I noticed over every part of the left lung great weakness  of the respiratory mur-
 mur, as well as increased resonance of the voice; but this was much less in degree
than I expected.
   The sounds of the heart  were somewhat stronger, but otherwise offered nothing
peculiar.
   Diagnosis.—Tubercles in  the first and second stages, occupying a great extent
of the left lung.
   At this time I had but a small amount  of the  hypophosphite of lime left, and
as I was intending to leave for Europe in fifteen days, I was forced to order a con-
tinuance of the treatment prescribed by his physician in the United States; at the
 same time, giving  him  every degree of encouragement in regard to his case.  On
my explaining  the reasons  which called me to Europe, the parents of the patient
decided to accompany me there, in order that he might continue my treatment.
   On his arrival at Paris, on the  10th of May, he was in the following state:  The
crepitation increased in the sub-scapular-fossa; the general constitutional disturbance
greater;  cough worse,  and expectoration  more  abundant, with night sweats.
 Emaciation had advanced rapidly, and he had become very  feeble and despondent.
 Commenced with the hypophosphite of lime  at the  dose of ten grains.
   May 11th.—Increased to  twelve grains.
   May 12th.—Cough,  expectoration, and night sweats lessened.  Increased to
 fifteen grains.
   May 30th.—The treatment has been continued at the same dose.  There is now
 no expectoration whatever,  and  but  little  cough in the morning;  no sweating; a
 good appetite; strength and spirits completely restored.
   His lineaments  have changed so completely, that he would  scarcely be known
 for the same  person.  From being pale, he has acquired a full, fresh color.
   His chest  shows the same signs as at the commencement of the month, except
 that the crepitation has diminished in the sub-scapular-fossa 
WHICH  RESULTED  FAVORABLY.      35
  Suspended treatment to June 4th, and then commenced again with the dose of
twelve grains.
  June  19th.—Patient  has  not coughed  for the past fifteen days; raises in the
morning a mucous clot,  not larger than a filbert; was never stronger than at pres-
ent ; is  still short-winded, but much less so than at first; has gained flesh.
  Found,  on examination, the crepitation of the  sub-scapular-fossa had completely
disappeared, but that a Uttle still remained in the supra-scapular-fossa.  Respiration
on the right side is heard better, both in front and behind;  there is  yet a differ-
ence in regard to the left side, especially below the clavicle, but it can be heard
everywhere.
  The treatment was suspended for four days, and then again commenced at the
dose of twelve grains, which was successively increased, two grains at  a time, until
twenty grains were given.
  August  9th.—Find a  sensible alleviation  of the local symptoms; the constitu-
tional ones having  long since disappeared.  The respiration is heard better over the
whole lung.  In the sub-scapular-fossa but slight crepitation can be heard, and that
only under the influence of forced inspirations.  Under the left clavicle, the respira-
tion has always been more feeble than on the right side.  Suspended treatment for
six days and then  commenced again with fifteen grains.
  August  30th.—All crepitation has  disappeared in the left  supra-scapular-fossa;
and upon  the inner side, where it was heard most freely, it sounds as if there was a
slight cavity;  no  vocal resonance;  no cough  whatever; the patient can take
long walks without inconvenience.   From this cause, and for certain other reasons,
all treatment was suspended until
   October 28th.—The patient seems  about  the same, except that he has lost his
appetite a little.  Commenced the treatment again with a dose of ten grains.
  November Uh.—General health good;  still feebleness of the respiratory murmur,
below the left clavicle;  no crepitation over the back; no cough or  expectoration.
Increased  the dose to twenty grains.
  December Iteh.—Found, on examination to-day, no difference between the two
sides, unless it might be a slight diminution of the respiratory murmur, below the
left clavicle; no vocal resonance.
  Up to this time, he did not seem to have been affected by the cold.  I wished
him to pass the winter at Paris, in order to test the permanence of his cure, but he
preferred going to Egypt  He left in  a few days, and since then I have not heard
from him.
                          CASE  NO.  VII.

  Victorine J----: 25 years old ; boot-stitcber;  born at Melun;  but has lived at
Paris for the past twelve years;  unmarried.
  November 2Uh, 1856.—Catamenia  regular, but less abundant at the last  period
than ordinarily; has had a cough every winter for the past six years, but none in
summer until the three past ones;  once raised blood which continued a month.
  One of her  sisters died  of consumption, at the  age  of 14;  now coughs a great 
36
NOTES  OF  CASES
deaL so as often to cause vomiting;  raises a little mucous, but no blood;  has pro-
fuse night sweats; is too short-winded to walk, and at the slightest exertion her
heart palpitates violently; is troubled with constipation; has little appetite; sleeps
badly; is'emaciated ; and her face is sunken and pallid, but with a hectic flush.
  Nothing abnormal, either in front or behind, was discovered on percussion.  The
respiration  over the whole of the right lung is  more feeble than on the  left side.
At the base there is slight crepitation;  over the inferior third of the lung, behind,
the moist trepitation is well defined, especially during a cough; but there is no re-
sonance of the voice.
  The  diagnosis in this case offered some  doubts.   The  moist crepitation was lim-
ited to the base of the right lung, but then there was a great diminution of the re-
spiratory murmur, both in expiration and inspiration, over the whole  of it; and
there  were no  sibilant rales.  On the other hand, although there had been no
hemoptysis for some time, the intensity of the constitutional symptoms, their rapid
aggravation, the loss of strength and appetite, the state of aneemia which had super-
vened in so short a time, and the copious  night  sweats,  could none  of them, in my
estimation, be attributed to a simple bronchitis.   Her own antecedents, and those
of her  family, were also in favor of the  existence of tubercles, in  the first  stage, at
the summit of the right lung, with  congestion of the base.   Ordered the patient
to take ten grains of the hypophosphite of soda.
  December 15th.—All the constitutional  symptoms have disappeared.   No crepi-
tation can be  heard, but the respiration  is still feeble in front, under the clavicle.
  December 20th.—Has returned to work.  Catamenia natural.
  January 12th.—Examination shows no difference between the two sides.   Says
she feels better than ever before.
  Have not seen her since the last date.
  Judged by  itself, this case would be of Uttle value; but taking into consideration
the antecedents, I think I am borne out in the diagnosis  made:  nevertheless, I
give it with the greatest reserve.
                        CASE  NO.  VIII.

  Joseph Coupier: optician; 26 years old; born at Montmartre;  Uving in Paris;
unmarried.  Entered La Charite under M. Charles Bernard, June 21st, 1856.  The
patient says his parents are aUve and well; states that fifteen  days before his en-
trance he began to cough, and feel weak and short of breath; was troubled with a
constant headache, with bleeding at tho nose;  has lost  flesh enormously; no
appetite; sweats at night.  On the eighth day after the commencement of these
symptoms, he began to raise blood, which continued for five days.
  Since his entrance into the hospital, the  hemorrhage  has never  been suspended
for eight consecutive days, and he has become still weaker;  is covered at night
with a cold perspiration, especially on the chest and hands.
  The treatment prescribed by M. Bernard consisted of cod liver oil, with opiates
and astringents.  Under this his appetite slightly improved.
  ^u^S^-Examination shows  dullness under the right clavicle, for a space 
            WHICH  RESULTED  FAVORABLY.         37

of about an inch.  Respiration on the  same spot is a Uttle more feeble than on
the right side.  Under  the inner side of the supra-scapular-fossa there is dullness^
and some pain from the percussion.  At the same  point the ear  can detect moist
crepitation, and rude respiration; also great resonance of the voice.
   On the left side of the back, at the apex of the lung, the expiration is prolonged,
and in the sub-scapular-fossa there is moist crepitation.  Over  the rest of the lung
the voice  and respiration are normal.  Pulse 76 ; respiration 20.
   Diagnosis.—Tubercles in the first and  second stages at the apex of the right
lung;  and probably  tubercles at the apex of the left lung.
   August lOtli.—The hemorrhage, at about two drachms each day, continues.
   Commenced with  the hypophosphite of soda, in a dose of four grains.
   August 11th—Increased the dose to ten grains.
   August liih.—Have  been myself sick  for the past two days, so that the treat-
ment was suspended.  On the night of the 12th,  a most violent hemorrhage set in,
which has continued up to this time.  I judged it prudent, therefore, to  suspend
the administration of the hypophosphite, not because I thought it dangerous,—for
I beheve it useful, in doses of four grains,  in arresting the bleeding—but on account
of the great responsibility in case it should happen to terminate fatally.  He was
ordered ice, astringents, etc.
   August 19th.—Only a few striae of blood now observable in his  sputa.  Last
evening, he complained of a  sharp pain  in the right knee,  which is excessively
sensitive to  the touch, especially over the internal Ugament.  There is, however,
neither redness nor swelUng.  Pulse 72;  respiration 32.
   August 28th.'—Before commencing the treatment again,  M. Bernard examined
the patient with me. I copy the notes made by the assistant, M. Gufllot:—
   Pulse 72; respiration 32.  Mucous expectoration,  but not very  abundant; is
very weak;  has not been able to raise himself for two days; cannot  sleep nights;
sweats excessively,  especially about the  head and neck;  has very little appetite;
tongue natural; no diarrhoea; has one evacuation each day; rests upon the right
side, from inabUity to Ue upon the other.
   The physical signs are:  dullness under the right clavicle, with great rudeness
of the respiration; moist crepitation over the  two lower thirds of the  lung, espe-
cially after a cough; marked resonance of the voice; rudeness of respiration over
nearly the whole of  the left lung, with  crepitation, but less  marked  than on  the
right side;  diminution of resonance, on percussion, over  nearly the whole  of  the
right side of the back, particularly in both scapular-fossae, with moist crepitation
This, which exists also along the spinal column, is especially noticeable  after a
cougli.  Under the axiUa it is even more  decided, so as to approach to  a fine sub-
crepitant rale.  The respiration is rude over the whole of the left lung, but par-
ticularly in  ttie sub-scapular-fossa.   In  the  supra-scapular-fossa there is some
crepitation.                    •
  By this it wiU be seen that the disease has made rapid progress since the 9th.
  Ordered five grains of the hypophosphite of soda
  September 1st—Feels stronger, sweats  less, and  has a better  appetite.    Pulse
60, perspiration 24
  Gave five grains of the hypophosphite of soda
  September 2d.—Increased the dose to eight grains. 
38
NOTES   OF   CASES
   September 3d—Increased to ten grains.
   September 6th.—Has  beSh constantly improving; the cough and expectoration
have almost disappeared;  there is no sweating; he sleeps and eats well; is getting
stronger, and can rest well on his left side.  Increased the dose to fourteen grains.
   September 9th— Continues to improve, but  complains of a severe pain in  the
supra-scapular-fossa, on bending his body.  Reduced the dose to ten grains.
   September 13th.—Increased to twelve grains.
   September Uth.—Says  that he ate some  cabbage, which disagreed with him;
rose from bed, but felt so cold that he was obliged to return  to it.  Reduced  the
dose to ten grains.
   September 15th.—Increased the dose to sixteen grains.
   September 16th.—Ordered twenty grains.
   September 19th.—Says that his hair has been falling  out very much  for the last
three weeks.   Suspended  the treatment.
   September 21st.—Ordered five grains of the hypophosphite to be given.
   September 23d.—Asked permission to go out for a walk.
   September 24th.—Walked more than a mile yesterday.
   September 25th.—At my request, M. Bernard made a second examination with
the following  results:  Diminution  of resonance on percussion, under the  right
clavicle, for a distance of  more than an inch; rude respiration, with vocal  reso-
nance in the same place,  but no crepitation;  lower down there  is a spot where
there is  diminution in vesicular breathing, but no crepitation. On the left side
there is some rudeness  of the respiratory murmur ; the resonance over the back
on percussion, is about equal on the two sides.  On the right side, in both scapular-
fossae, there is  slight  feebleness of the respiratory murmur, but no crepitation or
resonance of the voice.
  It will be seen by this  condition of the patient what a  change for the better  there
has taken place since the commencement of treatment.  Ordered five grains of the
hypophosphite.
  September 30th.—For  the past two days he  has coughed more; last  night the
attendant found him feverish; with a pulse at 96; with mucous rales over the  su-
perior third of the right  lung.  Gave eight grains of the hypophosphite.
   October 2d.—Less fever; is otherwise improving.
   October 4th.—Was obliged to suspend  treatment upon all the patients confided
to me by M. Bernard.
   October 8th.—An examination was  to-day made by M. Axenfeld, who forwarded
me his result, viz.: some crepitation on the right side in front; behind it is  more
marked,  and  almost reaching a cavernous rale;  over the  same point  there  is
diminished resonance of the voice.
   October 16th.—The patient  entered the hospital  St. Louis,  under the charge of
M. Briquet.  He states that since giving up  my treatment he has lost flesh and
appetite,  and has sweated  and coughed more.
  He was examined by  M. Briquet, who found the following symptoms: in both
scapular-fossae, on the right side, gurgUng; a little cavernous respiration, and dull-
ness.   Nothing abnormal on the right side, in front.
  The left lung seemed healthy, both over the front and back   Ordered ten graina
of the hypophosphite of  Ume. 
           WHICH  RESULTED  FAVORABLY.        39

   October 11 th.—Increased it to twelve grains.
   October 20th.—Has been steadily improving.  Decreased the dose to eight grains.
   October 23d.—Pain and difficulty in breathing in the  left supra-scapular-fossa.
 Omitted treatment.
   October 24th.—Says the pain is greater.  Ordered eight grains of the hypophos-
 phite to be given.
   October 25th.—Says the pain has been so great that he could not sleep,  and has
 been obliged to sit erect aU night:  otherwise feels well  enough to work.  This I
 recommended him to do, for I suspected that his pain arose from a state of pleth-
 ora, and that it would be dissipated by exercise: a fact which  I  had noticed in
 several other cases.
   October 30th.—Having left the hospital, he  walked to my house to visit me.
 Gave eight grains of the salt.
   November 6th.—The plethora or  fuUness (dyspnoea) has disappeared for several
 days.  Cough is much less; no expectoration; appetite good; no sweating, and lias
 gained flesh.  Increased the  dose to twenty grains.
   November 1th.—Says he has rambUng pains  over the  whole body.  Suspended
 treatment.
   November 11th.—Was obliged to call upon him, as he could not leave his house.
 Found  sub-acute rheumatism in both knees.  There was  swelling, redness, pain to
 the touch, high fever, with a foul tongue.
   November 25th.—Has recovered, under treatment, from  his rheumatism.  Ordered
 ton grains of the hypophosphite to be given.
   November 28lh.—Coughed  and perspired a great deal  last night.   Changed to
 twelve  grains of the hypophosphite of  soda.
   November 29th.—Ordered  twenty grains of the same salt.
   December 2d.—Was obliged, from causes independent of his sickness, to suspend
 treatment.
   December 6th.—Gave twenty grains of the hypophosphite.
   January  10t7i.—Before leaving Paris I made another examination, and found his
 condition as follows: Some  difference in  the  respiratory murmur under the left
 clavicle from that on right side ; but this is scarcely greater than is often found in
 the normal state.  With this exception, no one could teU which  of the lungs had
 been affected.   The respiratory murmur and  resonance were everywhere  normal.
 The patient is in better flesh than ever before, has gained  his full strength, can take
 long walks without fatigue, and mount to his room in the sixth story without loss
 of breath.
   This  case seems to me not only one of the most  remarkable, but also the most
 important,  from the fact of the symptoms having  been  satisfactorily determined
 before the commencement of  treatment, by several persons, none of whom were in
 favor of my method.   The rapid progress of the disease; the sudden arrest of all the
symptoms under the  treatment; their  commencement on its suspension, and their
sudden  disappearance when it had been again renewed; the attack of acute rheu-
matism, all  certainly showed  some  active agency in the  treatment.  Besides, the
patient  was in the best  state to show  the  effects of this therapeutic agent.  The
disease  was just commencing, and although acute, had produced no permanent dis-
turbance.  The  constitutional symptoms were  intense, yet there appeared to be 
40
NOTES  OF  CASES
no complications;  and lastly there was no uncertainty in the diagnosis.  I now
regret exceedingly not having remained at Paris a month longer, in order to have
shown the change  to those who had seen him when first  treated.   I can not say
whether he is now well, or had a relapse during the foUowing winter: for notwith-
standing he might  be looked upon as  cured, I think it was  important  to watch
over his health, and for several months afterwards to occasionaUy continue  the
use of the remedy.
                          CASE  NO.   IX.

  Eugene Maitre:  17 years old;  jeweler's apprentice; unmarried; living in Paris;
entered La Charite, June 22d, 1856.
  His mother, whose case is given at No. 15, has had her lungs affected ever since
his birth.  Three months  ago, after catching cold, he began to cough and raise
blood in small quantities.  About a fortnight ago he had an attack of fever which
lasted  for twenty-four  hours without  cessation.   Since then he  has lost flesh,
strength, and appetite, and perspires much at night;  raises very little, and has no
diarrhoea.   At first he was placed by M. Bernard upon a treatment of cod Uver oil,
under which he seemed to improve.
  July 4th.—The following is the present cpndition of the patient: Feeble, lym-
phatic  constitution; not much cough or expectoration ; night sweats; no fever;
appetite and digestion good; diminution of resonance  on percussion under tho
right clavicle;  on the left side it is normal; on the right side, in front, the respira-
tion is  feeble over the  whole lung, with considerable vocal resonance, especially
below the clavicle;  on the left side  respiration  is increased and the voice normal.
Over the  whole of the right back, there is notable duUness;  the respiration is
quite feeble in the  supra-scapular-fossa, with  moist crepitation;  over the rest of the
lung the respiration is feeble, and the voice resonant; over the left back, the re-
spiration and resonance seem  about normal
  Diagnosis.—Tubercular  infiltration, in the first  stage, of the whole right lung,
with induration of  its tissues: commencement of softening at the apex.
  These symptoms, and the  diagnosis, were  confirmed by MM. Charles Bernard,
Brochin, and Lebled.  M.  Bernard added, that the intensity of the vocal resonance
made him suspect a cavity at  the level of the spine of the scapula.
  July 5th.—Commenced the treatment by ordering eight grains of the hypophos-
phite of lime.
  July 6th.—Increased to  ten grains.   To-day M. Empis examined the patient and
formed the same diagnosis.
  July 8th.—Gave fourteen grains.
  July 9lh.—Increased the dose to fifteen grains.
  July 10th.—Increased to twenty grains.
  July 30th.—The patient has been steadily improving; no cough or expectoration.
Changed the hypophosphite, and ordered twenty grains of the soda salt.
  August 6th.—M. Bernard examined the patient and found aU the constitutional
symptoms dissipated.  Under the right clavicle a little more duUness was perceived 
WHICH  BESULTED  FAVORABLY.          41
 than on the right side; the  respiration in front about equal on the two sides;
 slightly  greater  resonance  of the voice on the right side;  over the left  back,
 Blightly  increased respiration, and also of crepitation  in the supra-scapular-fossa;
 elsewhere the respiration normal;  some vocal resonance on a level with the  spine
 of the scapula.   In consequence*of these ameUorations, he acknowledged that the
 patient showed a notable change for the better.
   August 18th.—Left the hospital  and went to work.
   August 19th.—Suspended the treatment.
   September 1st.—Commenced again with ten grains of the hypophosphite oi
 lime.
   September 1th.—Suspended the treatment for eight days.
   September 22d.—Continues  to improve.   Ordered twenty  grains of the hypo-
 phosphite of soda.
   September 29ih.—Suspended treatment.
   October 1st.—Ordered eight grains of the hypophosphite of lime.
   October 6lh.—No treatment.
   October 8th.—Gave twelve grains of the  hypophosphite of lime.
   October 16th.—The patient  was examined by M. Bernard, who  found, at  the
 right apex, in front, a decided vocal resonance, with slightly prolonged expiration;
 nothing abnormal over the  back; over the left front, respiration normal but be-
 hind  he  thought he discovered  slight crepitation, which neither I nor M. Potain
 were able to hear.  It is possible th#t the  excitement of the patient may have in-
 fluenced, in some degree, the respiration.
   Continued tho  treatment  for the sake of security, and gave eight grains of the
 nypophosphite of lime.
   October 18th.—Have just learned from the father of my patient, who is himself
 consumptive, that his  brother died of phthsis  eighteen months ago; that his wife
 has coughed for ten years, and that her mother died of consumption.
   November 21th.—Examined  the patient, and could discover no difference between
 the two sides either by percussion or auscultation.  Stopped treatment.
   In January, a few days before my departure from Paris, I saw the patient again,
 and  found  a complete absence  of aU signs of consumption.  As to  his general
health, it not only seems to be perfectly good, but in  appearance he is robust, and
of a ruddy countenance. 
42
NOTES  OF  CASES
                 SECOND    SERIES.

CASES IN WHICH THERE WAS AN ALLEVIATION, BUT NO DECIDED
    RESULT, IN CONSEQUENCE OF CESSATION OF  TREATMENT.
                           CASE  NO.  X.

  Mrs. T------:  26 years old; born in the United States, but living in Cuba for
the past year;  husband is Uving.
  March 6th, 1855.—This lady has been sick for the past eighteen months.  At
the outset, she began to cough, and once or twice raised blood.  She has lost
flesh, strength, and appetite.  She was recommended to go to a warm cUmate, and
came to Havana, where she  has  been living in  the  vicinity until  a month ago.
There has  been no perceptible change for  the better since her arrival.  None of
her family  have been consumptive.
  For the  past six months her cough has increased, the expectoration become more
abundant;  the sweating is profuse, especially about the head and neck; her cata-
menia have been suspended for four months.
  I now find the following to be her condition: Muco-purulent expectoration, com-
posed of a transparent fluid in which there are yeUow lumps of mucous, some of
which sink to the bottom in a vessel of water; great debility, and emaciation;
very little  appetite;  bowels constipated; the face pale and sharp; the eyes hoUow;
the attitude peculiarly characteristic.
  By percussion, I discovered a decided difference between the  two sub-clavicular
regions; the sound is the clearest on the left side, behind;  the  resonance is about
equal on the two sides.
  Auscultation showed  moist crepitation, occupying the superior third of the right
lung, both in front and back; over the rest of that side great exaggeration of the
respiratory murmur,  especiaUy marked in front,  with decided resonance  of the
voice;  on  the left side,  both under the clavicle and in the supra-scapular-fossa,
there was  also crepitation, but no vocal resonance.
  Diagnosis.—Tubercles in the second stage, at the summit of both lungs, far ad-
vanced in  softening, especiaUy on the right side.
  The patient has taken cod liver oU several times, but  with no decided benefit.
I also ordered it, but in a few days was obliged to discontinue its use, as it was so
repugnant  to her.  I then tried a variety of remedies, such  as inhalations of iodine
atropine, the alkaline carbonates, and sulphuret of lime, none of which seemed to
produce the slightest good.   For a few days the bicarbonate of potassa seemed to
diminish the cough, but it occasioned such a diarrhoea that I was obliged  to dis-
pense with its use.
  April 28th, 1855.—Commenced with four grains of the hypophosphite of Ume. 
WITHOUT  DECIDED  RESULT.           43
  April 30th.—Patient says she sleeps better, her  appetite is improved, and she
cougha less.  Increased the dose to six grains.
  May 3d.—Has been riding out for two days past;  is much stronger; has a good
appetite; sweats very Uttle.   For two  days  past she has  had a regular evacua-
tion.
  May 15th.—Increased the dose to ten grains.  AU the constitutional symptoms have
disappeared; the appearance of the patient has changed, so that she would scarcely
bo known ; there are no  night sweats;  the cough has diminished, as weU as the
expectoration ;  the appetite and strength are good, and the  bowels regular.
  May 29ih.—The improvement has  continued to this time.  Fearing to remain
through the summer, on  account of the yeUow fever, and feeling, besides, almost
weU, she has decided, against my earnest wishes,  to return to the United States.
  Examination shows less crepitation on the  right  side;  under the left clavicle it
has entirely disappeared,  but can stiU be heard in  the supra-scapular-fossa.
  What would have been the final result of this case ?   I have no hesitation in be-
lieving that had  she  remained at Havana, the tubercles would have  been slowly
eliminated,  and that  perhaps she would have entirely recovered.   I have had no
news from  her;  but I fear that the change of climate, and  suspension of treatment,
have induced afresh the symptoms which were disappearing, and that the disease
foUowed its fatal course.
                          CASE  NO.  XI.

  Don Carlos B----:  42 years old;  born at Havana; married.   His disease com-
menced four years ago, during the winter, with cough, and slight bloody expecto-
rations.  Since then it has  slowly, but surely, progressed.   He was attended by
mo during several months, two  years ago, at which time I found several  tubercles
at the  summit of the left lung, slowly softening;  emphysema at the base of the
same lung, with contraction of the aortic orifice.
  June 5th. 1855.—The patient tells  me that his strength  has been constantly
diminishing, the  cough is more frequent, and that  he has  paroxysms of asthma
nearly every night; he is very short of breath when he walks, so that he has been
compeUed to give up his employment;  has not had  any hemoptysis since the out-
set, but has lost much flesh,  and his appetite entirely; he perspires  at night, prin-
cipally about  the head and neck; the expectoration  is muco-purulent, in great
quantity, and mixed with much bronchial sputa.
  His  appearance is that  of a  man  attacked with  severe heart disease.   He is
emaciated; his eyes are hollow; his Ups purple,  and his breathing anxious and
noisy.
  Percussion shows duUness over the  upper  third of the right lung, both in front
and behind.   Below this spot, the resonance is,  on the other hand,  increased, and
the same idiosyncracy exists over the whole  of the leftside.
  By auscultation, I found, below the right  clavicle, and in both scapular-fossa},
moist crepitation,  having almost the character of mucous rales.  Below this the
respiration, both in front and behind, is quite feeble, and also over the whole of the 
44
NOTE S  OF  CASES
left side where it is mixed with a few sibUant rales.   The expiratory breathing on
both sides is quite loud; whfle,  on the contrary, the inspiration is weak.
  The first sound of the heart  is replaced by a harsh souffle, [a blowing sound,]
followed  by a softer one, which, however,  does not completely hide  the  second
sound.  These sounds have their maximum at the base, and are prolonged in the
direction of the arch of the aorta  The pulse is small and irregular.
  The diagnosis of this case was somewhat difficult: but after  reflection, I made
up my mind that the only way of explaining both the physical and constitutional
symptoms, as weU as the progress of the disease, was by adopting the foUowing
definition:
  Tubercles in the second stage, occupying  the whole of the  apex of the right
lung,  with emphysema and constriction of the aorta.
  Commenced treatment with  the  hypophosphite of potassa, in a dose  of four
grains;  gave also ten drops of'ethereal tincture of digitalis three times a day.
  Juae 19th.—Paroxysms  of asthma have diminished in intensity and frequence;
in every other respect is improving.  Increased the dose to ten grains.
  August 21th.—Looks better in the face, but his  lips are stiU purple; is weU
enough to attend to his business.  On examination, I found the inspiratory murmur
stiU very feeble, with prolonged  increased expiration.  The  sounds of the heart
stiU accompanied with a double souffle.  The crepitation seems greater at the sum-
mit of the right lung, and sound  stiU more like a mucous rale.
  December 21th.—My patient has been absent to this date.  The physical signs
are now about as they were in August, but the constitutional ones are less satisfac-
tory.  With the coming  of cold weather, his cough has increased, his breathing
become  more embarrassed, the  asthma resumed its intensity.  Commenced again
with  the hypophosphite  of potassa, which was continued up to my departure in
March, 1856.
  At  this date, the paroxysms of asthma were quite rare, his cough was slight,  his
strength  and appetite good.  The tubercular deposit at the apex of the right lung
was slowly softening;  while  the symptoms of asphyxia, evidenced  by the blue
color of his Ups, and  the rapidity of his respirations, were  more increased.  The
sounds of the heart were about as before.   There is no oedema.*
  The only observation which  I have to make upon this  case, and one which I
have  made in several others, is, that the hypophosphite of potassa seems to have a
Bpecial influence in increasing the expectoration, and hastening the softening of  the
tubercles.  In this respect it resembles  the salt of ammonia.  The constitutional
effects seem about the same as those of the hypophosphites of lime and soda.
                         CASE  NO.  XII.

  Dofia E. R----: 19 years old; born in Santiago de Cuba; married.  Visited mc
first at Havana, on
  December 1st, 1855.—She then gave me the foUowing  statement:  Her  father
   The infiltration of serum into the tissue of tho lung, carried to such an extent as to diminish
its permeability to air.  Dropsical swelling produced by the accumulation of serous fluid  in
the interstices of the areolar texture. 
WITHOUT DECIDED  RESULT.           45
and mother both  died of consumption:  she  has no brothers or  sisters;  has
always  been feeble and delicate.   Two years ago, as her  friends  were alarmed
about her health, she went to Europe, and passed a year with benefit. She u> oried
about twelve months ago, and a few months after, began to feel the first  signs of
her disease.  This began with a slight cough, to which were soon added the other
symptoms.  For four months she has taken cod liver oil without any benefit, and
for the past two months  has vomited each time she has taken it.  Her catamenia
have been suppressed for five months.
   Her attitude  shows great prostration; the emaciation is extreme; is very pale,
and can scarcely walk;  her voice  is almost lost, but more from extreme debility
than from disease; she has each  day a severe chill, followed by cold, which lasts
often for two hours, and is succeeded by heat; cough frequent, which fatigues her
very much, and prevents her  sleeping; there is scarcely a half hour in the day or
night without a paroxysm; the expectoration profuse, muco-purulent, and mixed
with  mummular*  sputa,  which would fill three wine glasses in the course of the
day.   She is constipated, has no appetite, and  sweats profusely at night  about the
chest and neck.
   I found, by an examination of the chest, on percussion, great resonance, which
Beemed  about  equal over both sides, but most perceptible in front.   Auscultation
showed  cavernous rales occupying the  whole of  the left lung, both in front and
behind.  In one part of it free respiratory murmur could be heard.  The same rales
occupied about equally, in front and "back, about a third of the upper part of that
side.   It was only in the inferior third that the respiratory murmur could be heard,
and then very  exaggerated and rude.   The voice was so feeble that I could dis-
cover nothing peculiar from it.   The cough,  in some places, sounds cavernous.
   Diagnosis.—Tubercles  in the second stage, and several cavities  occupying the
whole of the left lung and the apex of the right.
   December 10th.—Began treatment with five grains of the hypophosphite of lime.
   December 14th.—Has  a slight diarrhoea.  Ordered eight grains of the lime salt,
and ten grains of bismuth.
   December 19th.—Diarrhoea  has  stopped; has a Uttle fever  each  evening.   In-
creased  the dose to fifteen grains.
   December 26th.—Has  graduaUy improved.  Have been gradually increasing the
dose, so that now she is taking thirty grains of the hypophosphite of lime twice each
day, morning and night.
   December 21th.—Was troubled in breathing;  vomited twice in the night.   Sus-
pended treatment.                                              /
   December 29th.—The  difficulty in breathing  has disappeared.  Ordered twenty
grains of the hypophosphite to be given.
   March 8th, 1856.—My patient  has taken, with slight intervals, twenty grains of
the  hypophosphite each  day.   She has been  steadily  improving.   Her husband
being obliged,  by his business, to  return to Santiago de Cuba, has decided to take
her back with him.
   Her condition at departure was as foUows:  general appearance much improved ;

   • An epithet  applied to  epuia, in phthisis, when they flatten  at the bottom of the vessel,
 like a piece of money. 
46
NOTES  OF  CASES
is stronger;  has a better appetite ;  digests her food well;  has no fever nor  night
sweats; the cough and expectoration are slight.
  Auscultation and percussion showed over the whole of the left lung great weak-
ness of respiration, with sUght friction sound, and marked  resonance of the  voice,
but no rales.
  Under the right clavicle, in both scapular-fossas, there was dry crepitation, mixed
with sonorous rhonchus, which disappeared for a moment, after a cough.  There was
also vocal resonance.
  This case  has impressed me more  than any I have treated.   In presence of such
lesions, I could not hope for a cure; but on seeing  the  improvement continue for
more than three months, the  constitutional and local signs disappear, I had every
reason to regret the interruption to the treatment.
  She  died  about six weeks  after  her  departure from Havana  But as to the
subsequent symptoms I know nothing.   I heard that she was found dead in her
bed.
                         CASE   NO.  XIII.

  Pauline L----: 15 years old;  carpet worker.
  July 26th, 1857.—This patient was sent to me by Dr. Lemaire, who at the same
time addressed to me the following note :
  " I send you the young woman about whom I spoke to you this morning.  Unfortunately,
since I have seen her, the disease has made fearful progress. The cavity, which was limited at
the beginning of the winter to the apex of the right lung, has  now extended below the nipple.
There is dullness over the whole anterior part of the right side, the cavernous respiratory mur-
mur being very great. She is much emaciated; has slight fever at night only; coughs constantly,
especially at night, and cannot sleep."
  On examination, I found all these symptoms, with the foUowing additional ones:
Great rudeness of respiration over the whole lung, both in front and behind; some
sibilant rales over the back; excessive night sweats;  the catamenia suspended for
nine months; appetite bad; has  had diarrhoea up to two months ago; extreme
weakness; pulse 112.   Ordered  at once eight  grains of the hypophosphite of Ume.
  September  1st.—No night  sweats;  less cough and expectoration; good appe-
tite.  Increased the dose to ten grains a day.
  September 16lh.—Increased the dose to fifteen grains.
  September 25th.—For the two past  days has had  hemoptysis.   Increased the
dose to twenty grains.
   October 8th.—Decreased to twelve grains.
   October 13th.—No headache nor fever; no night sweats; no cough, and but little
expectoration; appetite  and strength good; pulse 120.    Decreased to eight
grains.
   October 18ih.—Took a very long walk yesterday.  Changed to the  hypophos-
phite of ammonia, at the dose of eight grains.
  November 26lh.—Up to this time she has remained in about the same condition.
  In December I lost sight of her. At this time she was living under most unfavor-
able  circumstances, being obliged to watch with a younger sister who was burned. 
WITHOUT  DECIDED  RESULT.           47
  If this young girl  had Uved in a different, above all, in a cUmate less liable to
produce inflammations of the respiratory organs, I do not hesitate to say that I think
the result might have been favorable.   The treatment lasted four months, during
which time she was seen once or twice by M. Lemaire, who will bear witness to
the great improvement which took place.
                           CASE  NO.  XIV.

   Madame G----: 31 years old; living in Paris.
   September 30th, 1856.—Commenced coughing four  years ago ;  her mother died
 of consumption three months ago; has lost flesh, especially  during the  past six
 Jionths;  her appetite is bad; has been taking  cod liver oU without benefit; has
 jad no diarrhoea, but has lost her  strength; has no night sweats,  but some  fever
 in the morning; the menstrual discharge  is excessive, so as to constitute some-
 times a hemorrhage; there is ante-version of the womb, but no leucorrhoea;  is
 generally constipated; has  a persistent, painful cough, with  copious, slightly mu-
 cous expectoration;  pulse 84.
   October 1st.—The  patient was  seen by M. Charles Bernard, who, as well as my-
 Belf established the following facts :
   Diminution of resonance,  on percussion, in the right supra-scapular-fossa ; feeble-
 ness of the respiratory murmur in both scapular-fossae;  moist crepitation  over the
 same region;  slight  resonance of the voice;  in  front, under the right  clavicle,
 sUght dullness; feebleness of the respiratory murmur;  moist  crepitation.
   Diagnosis.—Tubercles at the summit of the right lung, especially behind, in pro-
 cess of  softening.
   October 2d.—Commenced with eight grains of the hypophosphite of lime.
   October 1th.—Feels much better; all the symptoms—the  expectoration,  fever
 and cough—have much diminished ;  is stronger, and has a  good appetite.   In-
 creased the dose to twelve grains.
   October 13th.—Formerly, at the approach of her catamenia she suffered intensely
 below the clavicles.   This time she did not know of  their approach untU  their
 appearance.
   The treatment was followed unti1 the end of November, and then was suspended
 up to  January, 1857.  When examined  at this  time, she was found in a much
 more satisfactory condition, as far as concerned the constitutional symptoms,  than
 beforo the commencement of treatment.
   Tho local symptoms were about the same: or rather,  I should say, very slightly
 relieved,  for it seemed to me that there was less  crepitation.
   At this time I left Paris, and saw no more of her.
   It is to be noticed, in this case, that the  disease was of long standing, and  that,
as far as prognosis was concerned,  it had been sufficiently slow to  give hopes of  a
favorable issue; but on the other  hand, the severity of the lesions precluded the
belief of any very prompt modification under the influence of the treatment.
   The fact held good  in this case, as in aU others, that the time required to  produce
a favorable change was inversely, in ratio,  to the anterior duration of the disease.
In this respect, it much resembles case No.  16. 
48
NOTES   OF  CASES
                         CASE   NO.   XV.

  Henri Maitre: 35 years old; jeweler's clerk; married;  Uving at Paris.
  His brother died of consumption eighteen  months ago;  is the father of the pa-
tient mentioned as case No. 9.
  October 11th,  1856.—Began to  cough four months  ago; for the past eighteen
months his appetite  has diminished;  he has  coughed much and lost flesh; his
strength is good, but he  loses his breath easily when walking, or mounting the
stairs;  has no night sweats.
  Was examined yesterday by M. Charles Bernard, who discovered the foUowing
additional points: For the past month he has given up drinking, and  finds his ap-
petite in consequence a Uttle increased, but he stiU loses flesh;  no diarrhoea; food
agrees  with him; has one evacuation  each day;  sleeps weU enough, but is often
awakened by his cough; profuse expectoration of mucous.
  Over the right front there is sensible duUness, on  percussion, for an inch below
the  clavicle, with resonance  of the voice, and rude  respiration.  Over the right
back, a diminution of resonance, on percussion; moist crepitation in both scapular-
fossae ;  vocal  resonance.  In  the left sub-scapular-fossa there was crepitation, but
no resonance  of the voice.
  Diagnosis.—Tubercles in the second stage at the apices of both lungs.  Ordered
ten  grains of the hypophosphite of lime.
  October 18th.—Increased the dose to twelve  grains.
  October 21th.—Cough and expectoration less; appetite and strength better; in-
creased to sixteen grains.
  October 29th.—Increased to twenty grains.
  The great degree of improvement which this patient had exhibited was contin-
ued through the  whole of the month of November.  On the 28th of that month I
made an examination, and found that on the left side there was no longer either
crepitation or vocal resonance in the sub-scapular-fossa, but the respiration was  a
little obscure on the  right side.  There was duUness under the clavicle, and be-
hind I  found slight crepitation in the sub-scapular-fossa.  The patient, through the
whole of his treatment, which lasted six weeks, did not give up his employment.
At the close of November, I gave up attendance upon him.  I do not know what
became of him afterward.
                       CASE  NO .   XVI.

  Denis Delmotte: 25 years old; lemonade seller; born at Vertun (Pas-de-Calais);
living at Paris; married.   Entered at La  Charite under M. Charles Bernard, June
13,  1856.
  June 21st.—Good constitution; parents both living and healthy, as also brothers
and sisters.   Symptoms commenced a year  ago by an obstinate bronchitis, but
with no constitutional derangements.   The actual  disease began six weeks ago,
first manifested by a great and sudden loss of strength, general Ul feeling, and in-
crease of the cough.  About a month ago there was a eUght hemoptysis.  There is 
WITHOUT  DECIDED  RESULT.            49
now a general  paleness of the body, the skin, lips, and conjunctiva; great weak-
ness, although  he is  able  to  sit up a Uttle each day; tongue clean; smaU appe-
tite ; digestion good;  no  diarrhoea;  urine  normal; nothing noticeable over the
abdomen;  respiration easy, except there is a little difficulty of breathing when he
is up; chest is weU  formed, with no external signs of disease;  cough  frequent,
increased mornings and evenings.
   Percussion shows dullness under the right clavicle, and  also in the right supra-
scapular-fossa
   Found by auscultation, under the right clavicle, a drier respiration than natural,
and by strong inspiration, slight crepitation.  In the supra-scapular-fossa, very rude
respiration, and the sound of bubbles, very sharp, unequal, and loud, over the whole
region.
   In front, resonance of the voice equal on each side, though perhaps a little  more
marked on the right   In tho right supra-scapular-fossa it was decidedly stronger,
and there was also bronchophony.
   The diagnosis left  no room for doubt as to the nature of the disease, which was
agreed to by MM. Bernard, Depaul,  and Blain Descormiers.
   Tubercles at the apex of the right lung, in the second stage.
   Ordered the hypophosphite of lime to be given in the following manner:  On the
22d of June, three grains;   23d, five grains;  25th, eight grains;  29th, ten grains;
30th, twelve grains;  July  1st, fourteen grains; July 2d, twenty  grains; July 7th,
twelve grains.   On all the days not named the dose was to be the same as on the
preceding one.
   July 8th.—M. Bernard states the general condition to be improved; appetite and
strength  good, and no night sweats.
   The resonance, on  percussion, below the right clavicle,  a Uttle less than on the
left side,  but scarcely perceptible;  respiration a Uttle rude; in both scapular-fossae,
moist crepitation;  slight resonance of the voice;  some duUness in the supra-scap-
ular-fossa, and pain on percussion.  In the lower  two  thirds of the  lung the res-
piration is normal, as also over the left front.  In the supra-scapular-fossa, slight dry
crepitation; over the resfr of that lung, respiration normal.
   July 9th.—Gave fifteen grains of the hypophosphite.
   July 10th.—Increased the dose to twenty grains.
   July 11th.—Reduced to fifteen grains, and kept it at that dose.
   July 30th.—Increased to twenty grains.
   August 5th.—General condition the same; some crepitation on the right side,
over the  whole of the upper part of the lung.
   August 14th.—Treatment has been suspended for two days.
   August 18th.—Ordered four grains of the hypophosphite of potassa.
   August 19th.—Gave sixteen grains of the same salt
   August 20th.—Reduced the  dose to ten grains.
   August 23d.—Changed the dose to ten grains hypophosphite of lime.
   August 31st.—Changed to ten grains of the hypophosphite of soda
   September 4th.—Went out, and remained all day, without fatigue; cough con-
stant ;  streagth and appetite good; auscultation shows a great deal  of crepitation
in the right scalpular-fossa.
   September 1th.—Found at the base of the right lung, and over  the whole of the
                                       4 
50
NOTES  OF  CASES
  mammary region, a very distinct friction sound, not disappearing at a cough. Sus-
  pended treatment, and ordered blisters.
    September 13th.—Left the city to remain two weeks in the country.
    M Bernard examined him, with the following results:
    Slight  dullness under the  right clavicle ; moist crepitation for an extent of
  about an inch in the same region; crepitation in both scapular-fossae of that side,
  and also a slight rubbing sound at the lower part of the back.
    December 15th.—The patient remained in the country two months.
    There is now extreme oedema of  the face and lower  extremities; has Uttle
  cough and expectoration.  He states that on his journey by raUroad from Paris, the
  weather being stormy,  he  caught cold.  On arriving at his  destination, he was
  seized with headache, chiUs, and pain in the loins,  vomiting and constipation, and
  total inabUity to urinate. The physician who was summoned, ordered, among other
  remedies, purgatives.  From that time he began to  swell up.
    Passing over the other signs which I discovered,  I will only state that his urine,
  clear and frothy, was almost solidified  by heat;  otherwise, he was tolerably weU;
  coughed and raised little, and had a good appetite.
    The resonance and percussion on the left side  are  normal;  on the right side
  there is diminution for  about  an inch below the  clavicle; over the same point,
  both in front and behind, there were sibUant and sonorous rales, mixed with some
  friction sound;  nothing abnormal at the base.  Ordered opium and iron, and that
  he be kept warm.
    December 21 th.—The  quantity of albumen in the urine has much diminished.
  As at this time I left Paris, I can not say what afterwards became of him.
   In this case, as in the twentieth, there are the following peculiarities worthy of
 notice:
   The constitutional and local symptoms, before the commencement of treatment,
 were severe and weU defined.  There was an improvement, and finaUy complete
  disappearance of the former, while the latter  showed that a process for elimination
 was going on.   The aUeviation of the constitutional symptons was sustained, es-
 pecially of the strength and appetite, in spite of the local organic difficulty.  It is
 evident to me that, at the time I last saw him, there  was an attempt  being made to
 throw off the morbid deposit   The acute inflammation  of the kidneys (nephritis),
 was evidently due to his exposure to the cold.  It is also evident that, without this
 the albuminuria would not have existed;  but the question arises, whether the
 state of plethora existing at his exit from the hospital would not predispose him
 to  an attack.  I am the more inclined to regard this to be the fact, from the case
 of  a weak, deUcate woman to whom I gave, for two consecutive days,  twenty grains
 of  the hypophosphite of soda;  and who, also, had an attack of acute albuminuria
 It seems to me that in these two cases there is more than a mere coincidence.
   I am aware that I  am exposing myself  to more  than a single objection as re-
 gards this case; but I  opposed, with all my power, the journey of the patient into
jthe country, offering to furnish him with the  means  which  he  needed in order to
 remain in  Paris.  Although I  had no reason to suspect the albuminuria  or any
 other inflammation, my opposition was also  based  upon the unpropitiousness of
 the season of the year for traveling.  To-day I hear that he has completely recov-
 ered. 
WITHOUT  DECIDED  RESULT.           51
  The use of any new remedy, or one of great power, is always attended with
some danger.  This constantly happens from the employment of quinine, mercury,
and many other medicines.   In  every case where I have employed my treatment,
I have been guided by the symptoms of the patient; and wherever my own ex-
perience has not told me the proper dose, or the action of the salt with a different
base, I have first tried it upon myself.   Thus, in addition to my first experiments
with the lime, I  have also taken either this  salt, or the soda, in doses of from
twenty to forty grains in  the twenty-four hours.  I have also tried the hypophos-
phite of ammonia in doses as high as twenty grains, although I knew that its ac-
tion was unfavorable to the hepatic trouble with which I am yet affected.  The
reason for my mentioning these facts, is, because they are the best justification for
the course I have pursued; and because I think this method the only way in which
any reaUy valuable discovery in therapeutics can be established.
                         CASE  NO. XVII.

  Ambrosine L----: aged 3 years and 9 months.
  July 29th, 1856.—Nineteen months ago her brother died of a cough at the age
of 4 years and 9 months.  She has coughed for the past fifteen months; has little
appetite; has lost flesh, and sweats at night, especiaUy about the head and neck;
she has no  diarrhoea, but complains of abdominal pains.  Sleeps badly at night,
and wiU start up suddenly, much agitated.
  Resonance, on percussion, normal; respiratory murmur diminished over the whole
of the right lung, especially at its apex;  in  the supra-scapular-fossa, there is some
crepitation, especiaUy during a cough -, the  respiration of the left lung diminished,
especiaUy over the back  and at the apex; the  abdomen is enlarged, hard, and
tender on pressure;  pulse, 136; respirations, 38.
  Ordered one grain of the hypophosphite of lime.
  August 2d.—Has coughed less; is in much better spirits.  Increased the  dose to
two grains.
  September  3d.—The treatment has been continued at the  same  dose.  Her
general condition is now much improved, and her appetite is good;  she  has no
night  sweats;  coughs less, and is quite gay; her stomach is no longer hard, nor
painful on pressure ;  she has gained flesh, and her mother says is as strong as be-
fore her sickness; pulse, 130.
  September 10th.—Her mother did not bring her to me after this date, so that I
am ignorant what became of her.
                        CASE  NO.  XVIII.

  M. G----: medical student.
  August 1th, 1856.—The memoranda of his case, which this patient gave me, I
have lost.   My own were as foUows; 
52
NOTES  OF  CASES
   Has coughed every winter for the past five or six years;  this year it has contin-
ued into the summer.   A month ago he had a profuse hemoptysis.
   Found the resonance in front almost normal except a very slight diminution on
the right side.  The respiration on that side is also a Uttle feeble, with crepitation,
and a few sibUant  rales below  the clavicle.  On  the left side the respiration was
feeble below the clavicle.
   Resonance, on percussion  over the  back, about normal; respiration on left side
healthy ; on the right, moist crepitation in both scapular-fossae, with feebleness of
the respiratory murmur over the rest of the lung.
   Diagnosis.—Softened tubercles at the  apex of the right lung;  tubercles in the
first stage over  the remainder of that lung; on the  left  side,  tubercles at the
apex, in the first stage.  Ordered ten grains of the hypophosphite of lime.
   October 11th.—By  the  advice of  MM. Trousseau  and GrisoUe,   my  patient
left for the Eaux  Bonnes a few days after my  last note.   He continued my
treatment there  for twenty-five  days, and  then  gave it up, by the advice ' of M.
Gueneau de  Mussy, on account of the  appearance of a Uttle blood in the sputa
He has experienced a notable change  for the better; his appetite increased; has
no fever, but coughs a great  deal.  Ordered eight grains of the salt.
   October 28th.—The dose has been increased and continued at twenty grains.  At
this time, his strength and appetite have returned to their normal condition; he has
gained a great deal of flesh; there is  stiU some  dullness at the apex of the right
lung, but seems  to mo  much  less than before treatment.  In front,  I  can  hear
neither  rales nor crepitation below the clavicle.  In the supra-scapular-fossa, there
are a few  sibilant rales, but  only heard at  the end of a deep inspiration.   Over
the rest of the lung, the respiratory murmur is heard almost as weU as over the left
lung, where it seems to be normal.  He has scarce any cough or expectoration.
   Treatment was now suspended for three weeks.   At the beginning of January,
he told  me that his cough  had increased whUe he had lost strength and appetite.
On the 8th I recommenced the treatment at a dose of twenty grains, and by the
20th I  found that his condition was  even better than at the close of November.
He was in this condition when I left Paris.
                        CASE  NO.  XIX.

  Eugene Leroy: 17 years of age; printer; Uving at Paris; entered La CharitS
under M. Bernard.
  July 13th, 1856.—His disease  commenced six months ago by a cold, but with-
out fever or chUL  Since then his cough has not ceased.  About a month ago, for
two days, he spit blood, which was repeated two weeks later.  From  the com-
mencement he has  been troubled with night sweats;  gave up work about a month
after his Ulness began; has some appetite;  has taken cod liver oiL but gave it up
yesterday, because  it produced vomiting; has fever and chUls, especially when he
tries to raise; pulse 112 ; respiration 36.  His mother is alive; father  died, of a
cold which he neglected;  has no brothers and sisters. 
               WITHOUT  DECIDED  RESULT.            53

   There  is excessive debUity  and emaciation; expectoration of seven or eight
 characteristic mummular sputa, almost purulent;  has not  been up for fifteen
 days.
   Over the right front of the cheat, there is duUness  from the  clavicle to the fifth
 rib; intense cavernous respiration; pleuritic and friction sound, and great resonance
 of the voice; over  the  left front, rude respiration, difficult  expiration, and some
 erepitation.
   Over the  right back, diminution  of resonance, on percussion, in both scapular-
 fossa ; cavernous respiration  and rattling in the sub-scapular-fossa;  considerable
 vocal resonance; over the left back,  slightly diminished resonance, on percussion,
 in the supra-scapular-fossa where there is rude  respiration, and moist crepitation;
 at the base of that lung the respiration is stiU more rude.
   Diagnosis.—Large cavity at  the apex of the right lung;  tubercles in the left
 lung, in the first and second stages
   July 11th.—M Bernard has found  the same signs, but in addition, moist crepita-
 tion over the rest of the right lung from behind.  Ordered the hypophosphite of
 lime in a dose of ten grains.
   July 21st.—Increased to twelve grains.
   July 23d.—Increased to fifteen grains.
   August 6th.—At  the  base of the right lung, behind, the rales have disappeared,
 and been replaced  by a very rude respiratory murmur; in  front, there is strong
 cavernous respiration; on  the  left side, the  respiration  is feeble behind and ex-
 aggerated in front
   August 19th.—Has seemed to improve; his strength  and appetite are better,
 but is much troubled by his night sweats, which are excessive;  cough and  expec-
 toration moderate in amount  Changed to the hypophosphite of potassa at the dose
 of seventeen  grains.
   August 20th.—Auscultation shows same state; but at the base of the left lung, in
 front,  the respiration is feeble;  at the apex, both in front and back, there is great
 rudeness.
   August 28ih.—Sputa  are highly colored with blood.   Treatment has been sus-
 pended for two daj-s.
   August 31st.—Changed to hypophosphite of soda at a dose of five grains.
   September 6th.—Has  had two watery evacuations,  with coUc  aU  night, which
 prevented his sleeping; no appetite; cough and expectoration  much  diminished;
 pulse 108.  Ordered fifteen grains of the soda
   September 1th.—Reduced to ten grains.
   September 14th.—Has had no night sweats, but complains  of having had chilla
 aU day and night; the cavernous  respiration is less marked on the right side, and
 is replaced by a rude respiration and moist crepitation; behind, a mucous rale can
 be heard over the whole extent; on the left side, in front, the respiration is rude;
 behind, there  are some sibUant rales,  and moist crepitation.  Ordered sixteen grains
 of the hypophosphite of soda.
   September  18th.—Sweating a Uttle less; expectoration  a Uttle increased, with
 some blood.   Increased the dose to twenty grains.
   September 21st.—Feels well enough to go out
'  September  22a—Complains that he cannot sleep upon the left sido;  no more 
54
NOTES  OF  CASES
 blood in sputa; no chiUs;  sweats very Uttle;  has a good appetite, but the cough
, and expectoration are muoh increased.   Reduced the dose to five grains.
   September 14lh.—Auscultation  shows numerous  rales over the whole of the
 right back; some crepitation at the base, and at the left back.  Suspended  treat-
 ment.
   September 30th.— Been troubled with diarrhoea;  has had three liquid stools
 to-day;  no sweating last night; less cough.  Commenced again with  eight grains
 of the hypophosphite of lime.
   October 5th.—Has had some diarrhoea up to this date ; pain on his right side,
 increased by coughing;  raises some bloody sputa.  Discontinued treatment
  I  did not see this patient again.   He died, I believe, in December.
                           CASE  NO.  XX.

  Louis Dnprez:  21 years old; type-founder ; born at LUle; living at Paris ; un-
married ; entered La Charite, under M. Charles Bernard; is a foundling.
  August 23d, 1856.—Has suffered for the past three years  with abdominal pains,
but has never had lead colic; has been wretchedly poor for some time, and  often
suffered from hunger; says that his disease commenced six weeks ago, by cough
and abundant expectoration of a transparent fluid; has had headache and difficulty
in sleeping  upon the right  side.  Three weeks ago, as  a  sequel to one of these
headaches, and bleeding at the nose, he spit some blood.
  August 29lh.—Has Uttle appetite;  no diarrhoea; tongue is white; has great
thirst; no hemorrhage ;  the abdomen is enlarged and tympanitic; no blue Une on
the gums; pulse 70.
  There is dullness under the right clavicle;  in the same spot the inspiration is
very rude, and the expiration rude  and prolonged;  there is also marked resonance
of the voice  ; behind, there is the same dullness in the external part of the supra-
scapular-fossa, as also the same  changes of the respiration and voice, with the
addition of moist  crepitation; in front,  on the left side, the resonance is normal •
the respiration, above, is a Uttle increased; behind, on the same  side, after a cou°-h,
can be heard dry crepitation in both scapular-fossae, and the  voice in the same
locality is strongly resonant
  Diagnosis.—Tubercles at the apices of both lungs, commencing to soften on the
right  side.
  August 30th.—Commenced  treatment with the hypophosphite of soda at a dose
of five grains.
  September 1st.—Increased to six  grains.
  September 5th.—Increased to ten  grains.
  September 6th.—Increased to fifteen grains.
  September 8th.—My patient tells me that two hemorrhoids have appeared, which
trouble him  very much;  he says he never had any before.  I examined and found
two of the size of a smaU nut.  Decreased to five grains.
  September 9ih.—Increased to ten grains.
  September 14th.—Increased to sixteen grains. 
WITHOUT  DECIDED  RESULT.            55
   September 15lh.—Increased to twenty grains
   September 18th.—Was seized suddenly in the night with a violent hemorrhage,
which has now nearly stopped.  Suspended treatment.
   September 21st.—The moist crepitation in the supra-scapular-fossa cannot  now
be heard.  Commenced again with four grains of the hypophosphite.
   October 2d—No diarrhoea;  less cough; expectoration smaU; sweats very Uttle,
and only on the back; appetite  is good.   Changed the dose to eight grains of the
hypophosphite of Ume.
   October 3d.—Under the right clavicle there is duUness, cavernous respiration,
crepitation,  and pectoriloquy; on  the left side, rude respiration, and some vocal
resonance ;  over the  right back, moist crepitation in the supra-scapular-fossa and
resonance of the voice; in the sub-scapular-fossa rudeness of the respiratory mur-
mur, and some crepitation at its  inner angle ; on the left side, the supra-scapular-
fossa there is rude respiration, and moist crepitation  more marked than upon the
right side; in the sub-scapular-fossa,  nearly the same symptoms, but the  amount
of crepitation is less;  the respiration is increased over the whole  chest.
   October 6th.—Treatment ceased from this date.  It is evident that there was an
attempt going on in this patient to eliminate the morbid  deposit formed before the
commencement of treatment.  The persistence of the diarrhoea depended probably
upon some lesion of the intestine, which would create a doubt as  to the probability
of a favorable result.  Nevertheless, at the  close of treatment, the  patient was
stronger and in a much better general condition than before, notwithstanding the
symptoms had made such progress.
   Under this head, the present case should be compared with No. 16.
   The patient remained at the hospital untU  February, when  he returned to his
own part of the country.   As I  was not in Paris at that time,  I can  not speak
with certainty as to his condition, or what became of him subsequently.
   Since that period, on further reflection upon this case, it has seemed to me  that
the hypophosphite had not been given in sufficiently large doses,  and that the  lime
was preferable to the soda  The dark color of the blood vomited up, the manner
in which it made its appearance, four days after the  disappearance of the hemor-
rhoids, and its spontaneous cessation,  also  seems to me of sufficient importance to
be mentioned. 
56
NOTES  OF  C ASES
          THIRD    SERIES.
CASES  WHICH  RESULTED  FATALLY.
CASE  NO.   XXI
   Dona Josefa P----: 19 years old; married; bom in Havana.  Her disease com-
menced two months ago, soon after chUd-birth.
   March 10th, 1855.—The patient is in a state of extreme prostration; her breath-
ing is quick; face anxious; has a  hectic flush in the cheeks; pulse is rapid and
thready; skin burning;  stomach very much distended, and painful on pressure;
cough and expectoration considerable;  no appetite.
   Auscultation shows numerous rales, but of various degrees, over the whole of
both lungs, both behind and before;  the normal respiratory murmur can be heard
nowhere; night sweats profuse; with diarrhoea
   Diagnosis.—Acute tuberculosis of the lungs and intestines.
   March 13th.—Ordered one grain of the hypophosphite of lime.
   March 14th.—Four evacuations;  increased to four grains.
   March 15th.—Diarrhoea less; increased to six grains.
   March 16th.—Says she has slept better;  perspired and raised less; has had two
evacuations;  wants to eat, and dress, and get up;  breathing seems to be easier,
and the face has lost, in a great degree, its peaked and restless appearance.
   March 18th.—Much improved; sat up more than four hours yesterday; says she
coughs less; had two stools, exhibiting some consistency.
   March 19th.—Increased to eight grains.
   March 21st.—Was sent for in the afternoon, and on arrival found  my patient  in
a complete state of prostration, covered with sweat; her features pinched, and with
a continual hiccough;  pulse almost imperceptible; stomach enormously distended,
tympanitic, and excessively tender to the touch.  She complained very much of a
sharp pain in  the right Uiac and hypochondriae-fossae.
   Died in the course of the night  No autopsy.
CASE  NO.   XXII.
  Dona A. 0----: 31 years old;  married;  born in Havana; has been sick eight
months.
  November 3d, 1855.—Face is pale and  dejected;  emaciation is extreme •  cough
continual,  and very fatiguing to her; expectoration purulent, and so copious that
she fills a tumbler and a half each day; has great  difficulty in breathing • no an-
petite; there is fever, with chills at night; diarrhoea, and profuse ni<*ht sweats
  Physical examination  discovered a marked augmentation of the resonance over 
WHICH   RESULTED   FATALLY.           57
the whole of the left side, especially over the back; rattling over the upper portion
of the left lung, most  noticeable behind; at the base, moist crepitation, most de-
cided on the back, with great resonance of the voice; on the right side there was
increased respiratory murmur.
  Diagnosis.—A cavity at  the apex of  the left lung, with  tubercles in the second
stage at the base.  Ordered four grains of the hypophosphite of Ume.
  November 5th.—Feels  stronger; has less difficulty in breathing.  Increased the
dose to six grains.
  November 1th.—Increased to ten grains.
  November 10th.—Continued improvement; has been able to make quite long ex-
cursions on foot and in a carriage.
  November 13th.—The weather has suddenly grown cold; to-day there is  great
dyspnoea, and  the cough and expectoration have increased.   Auscultation shows
excessive rattling over the whole of the posterior portion of the left  lung.   Sus-
pended treatment.
  November 14th.—The patient was suddenly seized in the  night with a violent
pain in the left side; the respiration is quick;  face  anxious;  auscultation shows
strong cavernous respiration, occupying the whole left side of the chest, with great
resonance on percussion.
  Diagnosis.—Pneumo-thorax.  [An accumulation of air in the cavity of the pleura;
a complaint generaUy sudden in its invasion, and fatal in its character.]—Trans,
  Patient died on the 17th.  No autopsy.
                        CASE   NO.   XXIII.

  Mr. A----: 32 years old;  born in England;  unmarried.
  Has been sick seven  years; came to reside in Havana six years ago, by advice
of various physicians in London, who informed him that the disease then existed
in his lungs.  After his arrival, his cough  diminished, although it never wholly
stopped;  he has lost flesh and strength continuaUy since his landing;  has never
been treated here ; but last year, finding  himself weaker and more ill, he, by the
advice of his physician, tried a change of air by returning again to his own coun-
try.   After his arrival in England, aU the symptoms of his disease increased, and he
was obliged hastily to take passage for Havana which place he reached at the end of
October.  Since then he has been constantly growing worse;  has never had hemop-
tysis.
  February 2d, 1856.—There  is now excessive emaciation,  with a deadly paUor;
his debiUty is so great that he can scarcely take a few steps, even in his own room;
constant and fatiguing cough ; expectoration purulent, and amounting in quantity
to nearly a quart and a half each day; appetite very slight; alternate constipation
and diarrhoea; constant fever, increasing at  night; night sweats  so excessive,  that
he is forced to change his clothing several times during the  night; great wakeful-
ness;  pulse, 110.
  On  percussion, I found decided duUness below the right clavicle, for a space of an
inch in breadth; below, however, the sonorousness was  increased beyond that on 
58
NOTES   OF  CASES
the left side.  The same difference was perceptible in the corresponding positions
behind.   On auscultation, I found at  the  summit of the right lung, both at front
and back, stong cavernous respiration,  with great resonance of the voice ; over the
rest of the lung, lower down, starting from the upper edge of the second  rib, cav-
ernous rales, replacing completely the respiratory murmur; the vocal resonance
varied according to the spot to which the ear was applied, but it was especially
noticeable at the lower angle of the scapula; over the left side, both in front and
behind, the respiration was increased; but  there were  no rales, crepitation, nor
vocal resonance; sounds of the heart normal.
  Diagnosis.—A. large cavity at the  apex of the right lung; lower down, several
multiple,  but smaUer cavities; one of them, however, at the base of the back, seems
larger.
  Ordered ten grains of the hypophosphite of Ume.
  February 4th.—Has sweat less, and  slept better;  the pain over the right side of
the chest has nearly disappeared.  Increased to fifteen grains.
  February 5th.—Increased to twenty  grains.
  February 9th.—Continues  to improve; has ridden out several hours each day;
his  appetite has returned;  the expectoration is diminished one  half, and has  lost
its purulent appearance;  no night sweats.   Auscultation shows the same cavern-
ous respiration,  but the rales have nearly disappeared, and are replaced  by a rub-
bing sound, intermixed with sibilant rales.   Changed to thirty grains of the hypo-
phosphite of soda
  February 10th.—In consequence of over-eating, he was seized  with symptoms
of indigestion, followed by colic and four or five free stools.
  Stopped treatment, and gave ten grains of  bismuth  every two hours, three times,
and at night twenty drops of laudanum.
  February 13th.—Ordered ten grains  of the hypophosphite of Ume
  February 14th.—Changed  to twenty grains of the hypophosphite of soda.
  February 11th.—Changed  to hypophosphite of lime, at a dose of thirty grains.
  February 20th.—Decreased to twenty grains.
  March 2d.—The weather has been so unfavorable for  the  past fortnight,  that I
was obliged to prevent his going out.  To-day he requested  me to discontinue my
visits • because, as he said, he did not wish to continue the treatment longer, and be
obUged to remain at home, regulate his diet,  and above all give up smoking.
  March 9th.__Was again summoned;  had eight or ten liquid stools since morning,
in consequence  of having day before yesterday indulged too much in eating; the
cough and expectoration have  increased ; in consequence, he says, of having gone
out in the cold.
  March 9th.—Evening.—The  diarrhoea has  slightly stopped, but he is stUl exces-
sively weak.   Commenced with ten grains of hypophosphite of Ume.
  March 10th.—Died during the night: no autopsy.
  It would hardly have been reasonable to hope that this patient should recover,
or tliat the organic lesions should be so modified that life could be continued in a
quasi-normal manner;  but at the same time, when  it is noticed  that the  improve-
ment was continued as long as the treatment was kept up:  when this case is com-
pared with No.  13, which was fuUy as  serious as this, and moreover was not so
favorably situated in regard to climate;  and especially, if it is compared with No. 
WHICH  RESULTED  FATALLY.           59
12, where the disease was much more advanced, it seems to me not unreasonable
to conclude, that with more docility on the part of the patient, his life would, at
least, have been prolonged for some time.
                       CASE  NO.   XXIV.

  Madam T----:  2 5 years old; Uving in Paris;  sick for the past two years.
  July 4th, 1856.—Over the whole of both lungs, both at back and in front, mu-
cous rales can be heard, which in some places have a cavernous character.  This
patient is nearly in extremis.   Ordered ten grains of the hypophosphite of lime.
  This dose, continued for the three  foUowing days, produced no change in her
condition.  I therefore discontinued it.  I should  not  have consented  to  the trial
had  it been possible to resist the demands and importunities of her famUy.  She
died a few days afterwards.
                        CASE   NO.   XXV.

  Pierro Rostollin:  30 years of age;  paper-maker; unmarried; born at Damencey,
in Savoy; now living in Paris; entered La Charite
  June 21st, 1850.—Two years ago had bronchitis and pneumonia;  otherwise has
been weU  to last January;  his father died at 60 years of age, of some pulmonary
trouble; a brother,  12 years old, died of a scrofulous abscess; has lived  at  Paris
12 years, and always regularly; in January, after a sudden  exposure to  cold, was
seized with chiUs and a cough, which has been increasing ever since; has had con-
stant diarrhoea, with progressive emaciation and weakness; says there  has been
no hemoptysis; since February the night sweats have been excessive, especially
about the head and chest;  his nails  are  curved, and hair faUs out; the voice is a
little hoarse, but otherwise natural.
  On the left side, in front, there is a little dullness  towards the shoulder, with
moist crepitation from the clavicle over the whole front of the left lung;  the vocal
resonance is somewhat increased.
  In various localities of the right lung, but  especiaUy below the clavicle, the re-
spiration is very rude, and everywhere there is moist crepitation; under the clavicle
there is small crepitation, almost approaching a crepitant rale; the resonance of the
voice seems nearly equal on both sides.
  Over the left back, the sonorousness is diminished in the supra-scapular-fossa; and
there, especially,  is rude respiration, and moist crepitation,  but less abundant than
in front; below the spine of the scapula there is slight crepitation.
  The crepitation on the right side is most marked in the sub-scapular-fossa but
the respiration is badly performed below this, and there is a distant murmur, which
seems as if it might come from a cavity; the respiration in the lower two thirds of
each lung is well enough performed.
  Diagnosis.—Tubercles, occupying the wholo anterior portions, and the  apices at 
60
NOTES  OF  CASES
back of both lungs, in process of softening;  on the left side there are evidonces of
a cavity; the diarrhoea probably depends upon the  presence of ulcerations of tho
intestines.
  June  23d.—Pulse 105; respiration 36; skin hot; cough frequent;  expectora-
tion muco-purulent,  of a  yellowish-green color;  constant thirst;  Uttle appetite.
Ordered five grains of the  hypophosphite of Ume.
  June 24th.—Increased to ten grains.
  June 21th.—Diarrhoea aU night; pulse 116.
  July 3d.—The. diarrhoea, which has continued, has now much increased.   Death
ensued during the night of the 5th of July.
  The autopsy revealed a  complete tuberculous infiltration of both lungs.  In the
left lung there was a cavity of the size  of a  large hen's egg;  in the left, three or
four much smaUer.  In the large intestine there were five or six ulcerations, occu-
pying nearly the whole circumference for a space of some three or  four  inches in
length.  The other organs were not examined.
  The only effect produced by the treatment was to  render the night  sweats less
profuse.  If, however, the lesions exhibited at the autopsy are remembered, it wUl
be conceded that the treatment, no matter how efficacious it may be, could not, in
such a case, produce any favorable change.
                       CASE  NO.  XXVI.

  Alphonse Hure: 22 years old; unmarried; wine merchant's assistant; born  at
La PaUsse (Mayenne); now Uving in Paris; entered La Charite June 13, 1856.
  July 5th.—Parents, brothers and sisters aU weU;  disease began eight days be-
fore entrance at hospital; after ao- exposure, he was seized with a cough, and raised
more than a pint of blood; this  was  stopped  by appropriate remedies for  three
days, when it recommenced and continued until eight days after his admission; has
profuse  sweating;  has lost strength; and since his admission  has not been able  to
rise from his bed on account of the difficulty of breathing;  appetite is poor; no
diarrhoea;  cough moderate; pulse 116;  fever at night.
  On examination, found,  over the right front, the sonorousness normal;  the respi-
ration rude; with well-marked vocal resonance ; over the left front, the sonorousness
normal, with mucous and sibilant rales over the whole extent; with a resonance of
the voice; over the right back, diminution of sonorousness in the supra-scapular-fossa,
with total absence of respiration; rales and crepitation over the rest of the lung:
over the left back, the sonorousness was normal; there were r&les  over the whole
extent, having in some places the character of cavities, especially on a level with
the spine of the scapula, where there was also decided resonance of the voice and
in one spot pectoriloquy.
  Diagnosis.—Acute phthisis,  (it has made rapid progress since June  27 th) • tu-
bercles in the second stage over the whole posterior portion of the right lung with
perhaps a tuberculous mass at the apex; tubercles in  the second  stage over the
whole of the  left lung, with perhaps a cavity  on a  level with the spine of the
scapula 
WHICH  RESULTED  FATALLY.             61
  Treatment:  four grains of the hypophosphite of Ume.
  July 21st.—Respiration 50;  pulse 140.  His  condition has not been modified in
the shghtest by the treatment, except by the stoppage of the night sweats.
  July 24th.—Died yesterday evening.  On the post-mortem examination, numer-
ous resisting false membranes were found covering both lungs, and uniting the two
sides of the pleura.  At the apex of the left lung there were two cavities, one of
them as large as a hen's egg.   Both lungs were completely infiltrated with caseous
tubercles, except about an inch of the base of the right lung,  and about two inches
of the lower posterior portion of the left.  These two portions, by their cherry red
color, contrasted singularly with the  rest of the  organ.  These were found to be
completely hepatized.  The maximum dose was twenty grains ; increased from
four grains, at the rate of two grains each day,  and continued for eighteen days.
                                                                     1
                      CASE  NO. XXVII.

  Justine D----: 16 years old; unmarried; lace maker; born at Ivry-la-BataUle ;
living at Paris for the past seven years.
  Neither parents, brothers, or sisters, have  been troubled with pulmonary affec-
tions.  Had catamenia when 13 years old; is sometimes troubled with leucorrhoea;
has experienced pain between the shoulders for a year; began about two months
ago to cough; before  this was perfectly weU, although delicate ; has never raised
blood;  has had fever about four o'clock  each afternoon  since  being  sick, which
continues until bed-time ; has also been troubled with night sweats ; has no diar-
rhoea, but has been sometimes a Uttle free;  no colic;  digestion is pc*r, and gene-
rally vomits her dinner after  an attack of coughing;  has lost  strength, appetite,
and flesh  very  much;  her temperament is lymphatic; constitution feeble; face
pale and thin.
  July 9th, 1856.—Over the left front, for about an inch below the clavicle,  there
is decided duUness ; the sonorousness is sensibly diminished over the  rest of the
lung;  moist  rales and vocal resonance at the apex : over the right front the son-
orousness  is  natural,  but the respiration is  very feeble : over the  left back, the
Bonorousness is sensibly diminished in both scapular-fossae; in the supra-scapular-
fossa the respiration and cavernous rales are characteristic, and there is marked
pectoriloquy : over the right back, respiration and sonorousness about normal.
   Diagnosis.—Acute phthisis;  tubercles in the third stage at the apex of the left
lung, and  in the second stage in the remainder of that lung.
   Ordered ten grains of the hypophosphite of lime.
   July 13th.—Feels much better; the vomiting and sweating  have wholly disap-
peared, whUe the appetite and strength have returned; the cough has diminished.
Increased  the dose to twenty grains.
   July 31st—Auscultation shows an intense cavernous murmur in the upper two
thirds of the left lung, both in front  and back, but no nlles ;  at the base, feeble-
ness of the respiratory murmur in front,  and a few rdles behind; the respiration is
 much exaggerated over the right lung.
   From this day the treatment was stopped, and  on the 7th of September she 
62
NOTES  OF  CASES
died.   This patient, from the moment she felt the improvement, persisted in taking
long walks, (sometimes for two hours at a time); she also committed other impru-
dences which hastened the fatal result
                      CASE  NO.   XXVIII.

   A woman, (name unknown): domestic; 21 years old; under the charge of M.
Briquet; says her parents, brothers, and sisters are weU; was very strong up to
the commencement of her present sickness;  has had catamenia since  15 years of
age; disease began about three  months ago by a spitting of blood, which contin-
ued for eight days;  since then  she  has coughed  constantly; says she has lost
flesh;  has had diarrhoea for eight days;  can not sleep  upon the left side;  sweats
much at night; expectoration is  slight;  skin cool;  pulse 104.
   Chest well formed, with a slight projection over the  right false ribs ;  abdomen
normal in appearance ;  over the left back, there is  moist crepitation, through the
whole  extent of the lung, but its greatest degree is at the base ; it is increased by
inspiration;  in the lower two-thirds of that side there is marked resonance of the
voice ; over the right back, at  the  apex of the  lung, there  is some sUght crepita-
tion.
   Diagnosis.—MUiary tubercles in the whole  posterior portion of the left lung,
with considerable hyperaemia [congestion] ; the right lung nearly normal, but with
perhaps a few tubercles at the apex; acute tuberculosis, in process of softening.
Ordered ten grains of the hypophosphite of Ume.
   October 11th.—The eruption of varicella has  appeared; the diarrhoea continues.
Decreased to eight grains.
   October 25th.—The pustules are drying up; she sweats very little,  and has some
appetite.
   November 25th.—There was perforation of the lung during  the night, when death
ensued.
   Although the condition of this patient was such that I could  not hope for a dif-
ferent termination, it is probable  that if the variolous eruption had not appeared
there would have been a more decided improvement.   Even admitting  that the
eruption had no direct influence in the softening of the  tubercles, it is fair to sup-
pose that it had upon the diarrhoea; and this certainly  hastened the fatal result.
                        CASE  NO.  XXIX.

  M. Eugene P----:  26 years old; unmarried; born in the department  of Ar-
dennes ; living in Paris for the past twenty years.
  August 19th, 1856.—Has been sick since the middle of May, at which time he was
attacked with fever and chUls, spitting of blood, and pain in the lower posterior
portion of the right side.   Had a cough  before that for the  past  three or four
years.  His family is healthy, and was himself very strong and healthy • but now 
WHICH  RESULTED  FATALLY.            63
he has lost flesh and strength;  there  is no  appetite; a  frequent cough; profuse
perspiration,  but no  diarrhoea; nails curved; expectoration  muco-purulent and
profuse.
  In front, I found a slight increase of sonorousness in the right sub-clavicular re-
gion, over the left lung; respiration over the left front almost normal; on the right,
under the clavicle, there is a rude murmur, and moist  crepitation ; behind, the son-
orousness is normal;  in the right supra-scapular region there  is crepitation, with
considerable vocal resonance; in the axillary space, sibUant rales, extending to the
base of the lung.
  Diagnosis.—Tubercles on the right  side, in the second  and third stages, with
bronchitis.  Ordered four grains of hypophosphite of lime, to be increased gradu-
ally to ten grains.
  September 3d.—Patient  has gained  much flesh  and strength; his appetite is as
good as  before sickness;  the night sweats have  ceased; the  cough and expecto-
ration have diminished.
  September 5lh.—Changed to ten grains of the hypophosphite of soda  The  phys-
ical signs remain about as they  were previous to treatment.
  The patient continued the treatment until the beginning of October; but he con-
stantly committed imprudent acts, was wet one day in the rain, and several  times
exposed  himself to draughts.  After  each exposure,  or  act of imprudence,  there
was a change in his condition for  the worse.  He died about the middle of the
month.
  This case, as weU as cases 31 and 33, dated the commencement of the disease to
a syphilitic attack.  I could find no secondary signs, but  it is certain that each of
these three cases experienced less alleviation from the treatment than aU the others.
                         CASE   NO.   XXX.

  MarioHurel: 25 years old; singer; bornatVersaUles; family all healthy; has had
two children, who both died at two and three years of age, respectively, of inflam-
mation of the lungs, without  convulsions.  Disease  commenced a year  ago, with
cough, loss of flesh, weakness,  pallor, and  menorrhagia.   For the past four months
there has been an aggravation  of the symptoms, with hemoptysis, which  once con-
tinued a whole day.
  June 21st, 1856.—M. Empis, who examined her, drew up for me the  foUowing
notes:
  Great pallor, weakness and emaciation; tongue clean; no  appetite;  digestion
good;  has had no diarrhoea; abdomen slightly tympanitic, and  tender on  pressure;
the liver extends for an inch and a half below the false ribs.
  The catamenia had disappeared at the two previous epochs, but returned slightly
at the last; pulse 104;  increase of fever at night, foUowed by copious sweats;
respiration  short and quick; cough  frequent; expectoration abundant,  and com-
posed of characteristic muco-purulent matter.
  Percussion shows dullness under the right clavicle,  also especiaUy marked in the
supra-scapular-fossa of the same side.
  Auscultation  shows moist crepitation  under the right clavicle ; in the  right 
64
NOTES  OF  CASE S
Bub-scapular-fossa, a cavernous  souffle,  with bronchophonial  resonance of  tho
voice;  in the sub-scapular-fossa of the same side, some friction sound, which does
not disappear during a cough, and is  heard better during expiration  than during
inspiration.
  Diagnosis.—As given by M. Empis: Tubercles at the apex of the right lung, in
the second and  third stages, with  a cavity.
  The  condition of the left lung was not mentioned by him, for the reason, proba-
bly, that the notes of it were  forgotten.   The treatment was commenced with  five
grains of the hypophosphite of lime.
  June 23d.—Increased to fourteen grains.
  July 2d.—Increased to twenty grains.
  July 4th.—Increased to forty grains.
  July 5th.—Decreased to twenty grains.
  July 1th.—Decreased to fourteen grains.
  July 8lh.—Her condition has much improved; her strength and appetite have
increased; the night  sweats have ceased;  she gets up, and can walk down stairs,
and about the garden.
  M. Bernard examined her to-day, with the following results:
  No pain on percussion; no duUness under the right clavicle, but  the respiration
shows a slight rudeness, with sonorous rhonchus; over the left front, the respira-
tion is a little increased;  over the right back, the sonorousness is  diminished in
both scapular-fossae;  in the supra-scapular-fossa the respiration 4s feeble, and there
is also sUght  moist crepitation, which  is more marked in  the sub-scapular-fossa;
over the rest  of that lung there are some few mucous and sibUant rales; over the
left back the respiration seems almost  normal.
  July 10th.—Had a chiU last evening, which lasted for three hours, and was fol-
lowed by fever  and sweating.   Ordered twenty grains of the hypophosphite.
  July 21st.—The patient has continued at the  dose of the last date up  to  this
time, with marked improvement; to-day she complains of  a severe pain over the
heart, which  renders her breathing very difficult Stopped the iron, reduced by
hydrogen, which she had been taking at  the dose of one grain.
  July 26th.—No appetite; some diarrhoea.
  July 30th.—Diarrhoea stopped; pulse too frequent to be counted; cough has in-
creased to such an extent that she can not sleep.
  August 1st.—Expectoration very profuse, and almost entirely purulent; respira-
tion 40;  pulse 136.   Ordered thirty grains of the  salt.
  August 3d.—Pulse 92 ; respiration  22.  Ordered sixty grains of  the hypophos-
phite of Ume.
  August 4th.—Pulse 126; respiration 30.  Decreased the dose to thirty grains
  August 5th.—Respiration 36; pulse  very frequent; skin feels weU; no diarrhoea-
strength has increased;  says her appetite is better; general appearance much im-
proved.  Increased to forty grains.
  August 1th.—Pulse 120; respiration 36.   Auscultation shows mucous  and sibi-
lant rales occupying the back of both sides of the chest, especiaUy at  the base of
the  right lung; in  front, a cavernous murmur over the whole lung; on  the left
side the respiration is sufficiently clear, with the exception of slight, dry crepitation
at the base.  Increased to sixty grains of the lime. 
WHICH  RESULTED  FATALLY.          65
  August 9th.—Symptoms of asphyxia; nails and hps  are  blue;  considerable
dyspnoea.  Suspended treatment.
  August 13th.—Continued in about the same condition untU last night, when she
died. At the post-mortem examination, we discovered numerous adhesions between
the two sides; a large quantity of serum in the pericardium ;  a sniah cavity occu-
pying tho apex, and another almost the whole upper lobe of the right lung, with
complete tubercular infiltration of the  rest of the lung,  which was  also much
hepatized.  The tubercles did not seem to be softening.  The left lung contained a
large number of tubercles at the apex, with others scattered through about a quar-
ter of its substance.  These did not seem to be softened, nor suppurating, either at
their center or periphery.  The tissue of the lung was much hepatized; a small
piece, placed  in  a  glass of water, sank at once to the bottom.  The Uver was en-
larged, and had undergone a fatty degeneration.
  The body contained a  large quantity of blood, and presented none of those ap-
pearances of anaemia which are generaUy found in the bodies of those who have
died of consumption.
  Tho immediate cause of death in this case seems to me to have been an inflam-
mation  of those portions of the lungs which were not yet tubercularized.   The
question arises, was  not this encouraged by the large doses of the medicine which
were used? "  In  case No. 12,  doses nearly equal were employed with advantage.
It seems to me that in this case, as in  two others which I  have treated, the use of
iron, simultaneously with tho hypophosphites, has induced, almost  immediately,
symptoms of  congestion or of inflammation.  It is probable that under any treat-
ment the disease would have resulted fataUy; but with the experience I have had,
I think that this patient,  if she had been in a warmer cUmate, or in one less sub-
ject to atmospheric variations,  would have experienced  such decided benefit from
tho use  of this specific remedy as  to have prolonged life for a much longer period.
                        CASE  NO.  XXXI.

  Charles EL----:  33 years old;  unmarried; waiter;  born in the Grand Duchy o.
Baden; parents were never affected with pulmonary  complaints.
  August 1th, 1856.—Disease  commenced eight months ago with  cough, but no
pain or fever; has  lost much flesh; strength  and appetite have diminished; has
been troubled with night sweats for the past four weeks, which were most profuse
over the head, neck,  and chest;  about fifteen days ago his  expectoration became
bloody, but this continued for one day only;  for the past six weeks has had one
liquid evacuation each day: cough frequent and fatiguing; pulse 100.
  In front, the resonance is about normal on both sides; respiration  more feeble at
tho apex of tho left lung than at the right;  cough and voice  present no marked
characteristics: over the back, the respiration is much more feeble on the left side,
especially in tho supra-scapular-fossa, where there is  also some moist crepitation;
over the right back the respiration is about normaL
                                 5 
66
NOTES  OF   CASES
    Diagnosis.—Tubercles in the first and second stages, at the apex of the left lung,
  with probably some intestinal disease.
    Treatment:   Four grains of the hypophosphite of Ume.
    August 9th.—The patient says the cough and expectoration have both diminished;
  his appetite and strength improved; and that the night sweats have almost ceased.
  Increased to ten grains.
    September 1st.—Has been steadily improving up to this time.   About ten days
  ago he began to complain of pains in the epigastric region, especially after eating,
  with desire to vomit;  severe chUls, followed by fever, recurring regularly;  has had
  one or two attacks of bUious vomiting;  one Uquid evacuation each day; no dysp-
 noea.
   September 3d.—An eruption of psoriasis* has appeared over the back, which
 has a most suspicious copper color.
   Says that eight months ago he  had a  chancre, with running; the first was
 treated with a pommade, and was cured in eight days;  the running lasted three
 months, and was cured with injections.  It  was at this time the cough commenced,
 which has continued ever since.
   September 8th.—Had four liquid evacuations  yesterday, with considerable coUc.
 Changed to ten grains of hypophosphite of soda.
   September 13th.—No night sweats,  or chills; no  diarrhoea; cough and expec-
 toration diminished ; appetite and strength good.
   September 30th.—Gave eight grains  of the hypophosphite of lime; cough has
 increased considerably; has been  troubled with vomiting, induced by the violence
 of it.
   October 4th.—Pulse 120;  coughs and raises a great deal; one Uquid evacuation;
 no  vomiting; complains of sleeplessness; no headache, or pain over the chest;
 no night sweats, fever or chUls; strength has much diminished.   Changed to two
 grains of the hypophosphite of ammonia.
   October 6th.—Complains of pains in  the epigastric region;  no colic; two evacu-
 ations this morning.   Increased to four grains of the ammonia salt.
   October 1th.—Increased to eight grains of the  same.
   October 13th.—Changed to twelve  grains of the hypophosphite of lime.
   October 15th.—Had  an attack of bilious  vomiting yesterday;  no diarrhoea-
 coughs and raises less; sleeps better; has no fever, chills or night sweats; strength
 and appetite  better.
  He continued in this condition up  to the beginning  of November;  the  diar-
 rhoea during this time steadily increasing.   There were no noticeable changes in
 the lungs.   His death was due to  an aggravation  of the intestinal symptoms.
 Taking into consideration the probable  condition of the intestines, there can be no
 doubt that death  must have sooner  or  later ensued; but I think this result was
much hastened by his irregularities of diet.   In  this case, as also in cases 29 and
 33, the improvement was not as well marked as in  the  others.  All three dated
the proximate cause of their disease to an attack of syphiUs.
  * A cutaneous affection, consisting of patches of rough, amorphous scales ; continuous or of
indeterminate outline.  Dr. Willan gives names to  eleven varieties of psoriasis, some forms of
whieh are known as the Baker's Itch, Grocer's Itch, &c.—Note by Tkans. 
WHICH  RESULTED  FATALLY.            67
                        CASE  NO.  XXXII.

  Mademoiselle Amehe D----: sister of the patient mentioned as case 34; has
been sick since July, 1855.
  Her disease commenced with a  cough, accompanied with fever, from excessive
occupation.   The fever lasted eight days, when it diminished, in consequence, she
thinks, of taking cod Uver oil  The improvement continued untU March last, when
the cough returned with greater severity than before; she also, at the same time,
began to lose her strength and appetite.  In May she was attacked with a diarrhoea,
which has persisted up to the present time, although controUed in some degree by
narcotics  and astringents.
  August 9th, 1856.—Was examined on the 30th of June by M. Louis, who made
the foUowing notes: Resonance about equal on the two  sides; respiratory mur-
mur most developed under the right clavicle, accompanied on each side with a su-
perficial  sub-crepitant rale; the same rale exists over the back,  at the apices of
both lungs;  it  is strongest on the right  side, where there is also bronchophony;
the lesions have about the same degree of severity on each side.
  In addition, I discovered in the  right  supra-scapular-fossa, a cavernous respira-
tory murmur, with  sUght vocal resonance;  on  the  left  side, both back and front,
the same signs as on the right side.
  She is now very weak, thin and pale; has still a diarrhoea; has night sweats; a
chill and fever each  afternoon about four o'clock; her cough is frequent, and pre-
vents sleeping; catamenia did not appear at the last two periods;  appetite almost
gone.
  Diagnosis.—A cavity  at the apex of each  lung.  Ordered ten grains of  the
hypophosphite of lime.
  August 26th.—Has had no  diarrhoea for three days, but complains of chills, and
a pain on the right side, at the base of the lung.  Ordered a  blister, loco dolenti, to
be afterwards treated with powder of  digitalis.
  September  5th.—Pulse 100 ; no fever or night sweats; strength  and appetite in-
creased ;  no cough during day time, and but Uttle at night; no evacuation for two
days; came  to visit me on foot.   Changed  treatment to ten grains of the hypo-
phosphite of  soda
  September  10th.—Since the 8th has had fever and chills after her dinner, foUowed
by profuse sweating; has coughed a great deal at night.  Changed treatment to ten
grains hypophosphite of Ume.
  September  13th.—Complains of pain over the  whole body;  has  had fever, with
chills and sweating; some colic, but no diarrhoea  Changed to ten grains of the
salt of soda.
  September  16th.—Pulse 102 ; at  three o'clock yesterday she had violent chUls,
followed by fever and sweating through the whole night; no diarrhoea; has head-
ache ; coughs and raises a Uttle; considerable thirst, and Uttle appetite.  Increased
the dose of the salt of soda to fifteen grains.
  September  18th.—Increased the dose to twenty grains.
  September  19 th.—Pulse 100;  had fever all day yesterday, with chiUsand sweat- 
68
NOTES   OF  CASES
 ing; has coughed and raised a great deal; no pain in side, but some headache; no
 diarrhoea; appetite better.  Stopped treatment.
   September 23d.—Less of the fever and chills; headache still  continues; has
 coughed and raised as much as usual; since last evening, no pain in side on cough-
 ing, but the oppression in breathing remains; no diarrhoea; pulse 104.  Gave twenty
 grains hypophosphite of lime.
   October 2d.—The bad weather, and aggravation of her symptoms, have prevented
 her visiting me since the 24th;  she has had, all the time, fever at  night, and the
 night sweats worse than ever; pulse 100;  headache stUl continues; yesterday had
 diarrhoea; strength and appetite have much diminished.  Decreased the dose to
 eight grains  of the  hypophosphite of lime.
   October 4th.—Complains of  vague pains; headache; profuse night sweats; but
 has  no chiUs, fever, or diarrhoea.  Increased the dose to twelve grains of the Ume
 salt.
   October 8th.—No diarrhoea or colic; no chills or fever ; sweating has diminished;
 cough and expectoration about the same; no appetite; pulse 108 ; strength in-
 creased ; has pain in the throat.  Ordered sixteen grains of the hypophosphite of
 Ume.
   October 10th.—Diarrhoea; colic; chills; no appetite; but the sweating  has dimin-
 ished ; great pain in the throat,  with loss of voice; pain in the head;  cough 3nd
 expectoration increased.
   October 14th.—Diarrhoea has  been stopped,  and sleep obtained, by the use of
 laudanum; cough and  expectoration unchanged;  has sweat much; appetite and
 strength good; throat better;  had much fever yesterday, from three to six o'clock.
   October 11th.—Headache much worse to-day, especially in front;  no fever  or
 diarrhoea;  appetite  better; sweats and coughs much less, and the expectoration is
 also  diminished;  pulse 116; says she feels very much better;  and her face has
 much improved during the past few days.
   October 20th.—The headache  is still very severe, with pain in her limbs; had
 fever and chUls last night;  coughs and raises less; no diarrhoea, or pain in side;
 pulse 108.  Gave twenty grains of the hypophosphite of Ume.
   October 21st—Has again had diarrhoea.
   October 21th.—Diarrhoea has been checked; pain in throat, and cough, have in-
 creased ; no fever or sweating.   Decreased to twelve grains.
   October 29th.—Intense pain in throat.   Gave  twenty grains of the salt of lime.
  November 3d.—Had bleeding of the nose  yesterday; headache; no sweating or
 fever ; less pain in throat.   Decreased to eight grain's.
  November 6th.—Evacuation natural;  great desire to sleep; less cough and ex-
 pectoration ;  appetite and strength better; the nose bled again yesterday •  pain in
 throat stiU remains.   Ordered twenty grains of the hypophosphite of soda
  November 11th.—StiU coughs a great deal.  Stopped treatment.
  November 12ih.—No fever or sweating;  great  difficulty  in  breathing   Gave
twelve grains of the salt of soda
  November 11th.—Severe pain in the throat; otherwise entirely free from pain
  November 21th.—The weather has been so bad that she has not visited me for ten
days—during which treatment was suspended.  Ordered twenty grains of the salt
of soda.  No notes were taken after this date, and a short time afterwards she died 
WITHOUT  DECIDED  RESULT.             69
                      CASE  NO.   XXXIII.

   Sylvain Gabriel A----:  34 years old; carpenter; married; born in the depart-
ment de la Creuse.  His parents, brothers and sisters are all healthy.
   July 1th, 1856.—The patient can give but a very unsatisfactory account of his
antecedents.   According to his statement,  he was attacked, in January last, with
fever, which recurred every evening, accompanied with chUls.  In June, after hav-
ing been engaged in washing his  room, he  was seized with a violent  pain  in the
side, with cough, which  has  continued up  to this time; has also the fever every
evening, beginning at seven  o'clock and lasting untU four in the morning.  The
fever is not preceded by chills, but the perspiration moderate after it.  Says he has
never spit blood; is of a nervous-sanguine temperament;  very thin, and so exces-
sively weak as to be scarcely able to walk; has pain in the right side, on a level
with the lower angle of the. scapula, which is not stationary; cough is sharp  and
quick, and most troublesome  at  night; expectoration is mucous, and not very
abundant; appetite small; digestion poor;  is often troubled with colic pains.
   Resonance, on percussion, normal on both sides in front, except that the Uver
seems to extend from the level of the fifth rib, to about four inches below the false
ribs.   The respiration and sound of  the voice seem about normal over the front of
each  side  of the  chest; sounds of  the heart natural;  resonance, on percussion,
normal over the back; respiration not clear on either  side, especiaUy in the infra-
ecapular-fossa, where there is also dry crepitation, especially well-marked during a
cough, and marked resonance of the voice.   In the left sub-scapular-fossa at each
full inspiration there is friction sound.
   Diagnosis.—Is rather  uncertain:  probably pleuritic adhesions on the left side;
some softened tubercles on the right, on a level with the sub-scapular-fossa.
   July 14th.—Commenced treatment with ten grains of the hypophosphite of Ume.
   August 12th.—Since the  last note, the patient has very much  improved; he  is
stronger, and  has much less cough and expectoration.
   August 26th.—For several days this patient has had fever, and intense cephalal-
gia, occurring most frequently in the evening, but sometimes in the middle of the
day, and generally preceded by chiUs.   During this time digestion has been imper-
fect, although there has been no diarrhoea; the night sweats have been excessive;
so that yesterday he was obliged to change his shirt twice; his strength has much
diminished.
   August 29th.—Had  less fever, headache,  and pain yesterday; have suspended
treatment for the past eight days.  Made another physical examination, and found
decided diminution of resonance on  percussion,  in the whole right sub-clavicular
region; in the same spot, feeble respiration,  with dry crepitation, and some sibUant
rales.  At the base of that lung the respiration almost imperceptible, and some deep-
seated sibilant rales;  considerable vocal resonance under the right clavicle; on
the left  side,  the respiration rude in various locaUties.
   Over the right back, the  resonance, on percussion, about the same as on the left
side;  numerous moist rales in  both scapular-fossae, with great resonance  of the
voice;  under the scapular, tho respiration feeble; over the left back, the respiration
about normal, with no vocal resonance ; pulse 120; respiration 30. 
70
NOTES  OF  GASES
   September 4th.—Pulse 140; respiration 24; had chills yesterday; but no fever or
 sweating;  has headache each morning  on getting up.  The patient informs me
 that about  three years ago he had a chancre which lasted eight days, and was cured
 by cauterization.   He has nearly lost his hair, but this he says preceded the vene-
 real disease;  his fever dates from eighteen months back; his headaches for more
 than twelve years; there is no trace of an  eruption over his body, and he  says
 there has never  been any;  but  he complains of an itching, most troublesome at
 night, which he dates from five years ago;  that is, two years before the chancre.
   September  9ih.—Had two chills yesterday, one of which was foUowed by fever
 and sweating; his  strength does  not increase.  Commenced treatment by ordering
 ten grains of the hypophosphite of soda.
   September 13ih.—Came to see  me on foot; pulse 120; no chills ; has sweat and
 coughed a great deal; appetite is good; no headache or diarrhoea   Decreased the
 dose of soda to five grains.
   September 16ih.—Fever ; sweating; intense gastralgia and headache; no appe-
tite ; pains  in the arms and shoulders at night; does not cough or raise much.
   Stopped  the treatment.
   October 1st.—Is  in about the same condition; is excessively weak, and troubled
by his night sweats, having to change his shirt four or five times each night; has a
burning fever for about four hours  each morning, with violent headache ; palpita-
tion of the  heart; pain  in the right side, under the nipple; cough dry, and much
increased;  no diarrhoea; pulse 12Q.
  Auscultation shows decided duUness over the whole of the right  side, both at
back and front; respiration almost gone in the  whole of the right  lung, except by
a forced inspiration;  in various places, especiaUy behind, can be heard deep-seated
dry crepitation; voice and cough more resonant than on the right side; on the left
Bide the resonance, on percussion, seems  about  normal; the respiration is sUghtly
increased, and in the sub-scapular-fossa there is some  crepitation ; the voice  and
cough present no marked characteristics; the  pulsations of the heart can be felt
below and to the inner  side of the left nipple, having its point in the epigastrium;
its sounds are normal, but there is a slight souffle at the first moment.  Commenced
the treatment with ten  grains of the hypophosphite of ammonia.
   October 6th.—Increased the dose  to twenty grains.
   October 1th.—The patient has passed a wretched night; the fever and sweating
were excessive;  prostration is so great that he has much difficulty in  even sitting
up.  Decreased the dose to six grains.
   October 9lh.—Has improved somewhat.  Increased to ten grains.
   October 10th.—All the symptoms, general and local, have improved.
   October 11th.—Saw some streaks of blood, yesterday,  in bis expectoration • aus-
cultation reveals  tho same signs as before, but more marked on the ri»ht side • at
the base of the left  lung, behind, there  are some  rales; the friction sound  has
diminished; under the left nipple, a slight sibUant rale.
   October 11th.—Says he has passed a better day than for some time before •  has
had no fever or sweating; appetite is good;  has no headache or palpitation •  can
walk about his room; cough is the same; and there is stiU blood in his sputa.
   October 20th.—Fever and sweating the whole night; is much weaker; has no ap-
petite ; headache and palpitations havo returned. Decreased the dose to four grains. 
WHICH  RESULTED  FATALLY.            71
   October 21st.—Changed the treatment to eight grains of the hypophosphite of
 lime.
   October 26th.—Feels better;  has coughed and sweat less.   Increased the dose
 to twelve grains
   October 21th.—Decided improvement   Ordered sixteen grains of the hypophos-
 phite of lime.
   October 29^.—Reduced the dose to eight grains of the  lime  salt, with the addi-
 tion of twenty grains of  the hypophosphite of potassa
   November 6th.—For the past eight days he has been taking tweaty grains of the
 hypophosphite of potassa  The expectoration has increased; but the fever, chUls,
 and sweating, have  much diminished;  he has scarce any appetite or strength.
 Ordered ten grains each of the hypophosphite of soda potassa afld Ume.
   November 1th.—Has more strength and appetite ;  coughs and sweats very Uttle,
 but expectorates enormously.
   November 8th.—Passed a good night;  was  suddenly attacked this morning with
 a violent pain over the whole right side of the chest, with violent dyspnoea; cough
 frequent, with profuse purulent expectoration.  The resonance, on  percussion, is
 very great over that  side, with amphoric respiration.
   Died six days afterwards of pneumo-thorax.  No  autopsy.
   There was probably a complication in  this case of an old pleurisy with adhesions
 of tho pericardium.   For this reason the treatment was employed with hesitation,
 especiaUy at the outset   It seems to me, now, that the specific treatment was not
 decided enough at the commencement; that it was suspended too often, and that
 the doses were not large enough.
  The use of the hypophosphite of potassa and ammonia in this case, as in some
others, appeared to increase the expectoration and  other 6igns of tubercular soft-
ening.  The salt of ammonia likewise caused a discoloration or blackness of  the
b tools.
                       CASE  NO.  XXXIV.

   Mademoiselle June D----: sister of the patient given as case 32 ; 25 years old.
   Was examined on the 1st of July by  M. Louis, who  made the foUowing notes
and diagnosis:
   Dullness under the left clavicle for some distance, with feeble or bronchial re-
spiratory murmur, accompanied  by sub-crepitant rales; same  condition over the
back, on that side;  but less marked; right side normal; the left lung only is tuber-
culous,..but is affected to a great extent
   July 8ih.—Saw her for the first time.  She says she was Ul four years ago from
an attack of pleurisy, but that  she recovered from this and  continued in good
health for a year and a half; two years ago, began to cough and lose flesh; cata-
menia have never been regular; has  had leucorrhoea; is  much weaker than for-
merly; never has spit blood ; sweats only at night, when fatigued; has a shifting
pain in tho left shoulder, so that she cannot sleep upon that side, as it  causes her
to cough; coughs constantly, but most at night and morning;  expectoration  ia 
72
NOTES  OF  CASES.
 muco-purulent;  her voice has become much more feeble for the  past six months;
 has no pain, on pressure, over the larynx, but some pain in the throat, particularly
 when in the act of swallowing.
   There is dullness over the upper two thirds of the left side, both before and be-
 hind ;  respiration is feeble, and varied by dry  crepitation and some sibUant  rales ;
 there is resonance, on percussion, on the right side, with normal respiration.
   Diagnosis.—Tubercles in the first and second  stages, occupying the upper two
 thirds of the left lung.   Ordered ten grains of the hypophosphite of lime.
   September 1st.—She has steadily improved up to this time, and has gained so
 much in strength that she has been able to attend to her  business, as before her
 sickness; her appetite is good; there is no fever,  night sweat, nor diarrhoea; at the
 end of July her  catamenia returned as regularly as ever, but they did not appear
 at this period,  owing, as she thinks, to a fatiguing walk which she took, and  a cold
 which she caught at the same time; since then she has had headache, with sUght
 fever and some sweating.  Ordered a mustard foot-bath at bed-time.
   September 2d.—Catamenia appeared slightly yesterday.
   September 3d.—Catamenia were suppressed yesterday.
   September 6th.—Cough and expectoration have been increased since the suppres-
 sion of the catamenia.  Changed to ten grains of the hypophosphite of soda.
   September 10th.—Gave five grains of the hypophosphite of lime.
   September 15th.—Changed to ten grains of the soda salt.
   September 18th.—Gave twenty grains of the same.
   September 12d.—Cough has sUghtly increased.   Reduced  the dose to ten grains.
   September 29th.—Catamenia appeared yesterday.
   October 4th.—Sweat  more than usual last night; had fever and chills at night;
cough is frequent; no  appetite.  Gave four grains of the  hypophoaphite of am-
monia
   October 11th.—Has had fever and chills every night, with headache r cough and
expectoration somewhat diminished.  Increased the dose to twelve grains of the
ammonia
   October 15ih.—Pain at the left side, on level  with the seventh rib, when she
coughs  Her aunt teUs me that she attributes the aggravation of her symptoms to
famUy troubles and care.
   October 11 th.—Gave twelve grains of the hypophosphite of lime.
   October 23d.—Has had all the time more or less fever with the chUls; pain in
her throat, which makes it difficult for her to  swaUow; cough and expectoration
less.  Increased the dose of Ume to sixteen grains.
   October 29th.—Has had no fever since last date.  Gave twenty grains of the
hypophosphite  of  soda
  November 28th.—Has continued in about the  same condition;  the difficulty in
her throat gradually increasing;  the fever, cough, and sweating were much less.
  The patient did not visit me after this date,  and died at some time in the early
part of January. 
REMARKS
   UPON  THE  CASES  COMPOSING  THE  THIRD  SERIES.

  Deducting the first six cases, in which the disease had almost reached a fatal ter-
mination at the commencement of treatment, the foUowing remarks wiU apply to
all the rest of those composing the third series.
  In the last seven cases there was a weU-marked and persistent aUeviation, espe-
cially noticeable in the complete change in the attitude  and physiognomy of the
patients, in the disappearance or modification of the constitutional symptoms,  and
in tho decided increase of the strength.
  Of  these seven cases, it seems to me that in four, (viz., Nos. 27, 29, 32 and  34),
after this amelioration (especially remarkable in cases 27, 29 and 34), there was a
renewed aggravation (immediately foUowing in case  27),  in  consequence of re-
peated walks of several hours' duration;  and in  case  29, of having remained ex-
posed to a draught of cold air at  the gate  of the TuiUeries, where he had run for
shelter from a shower.
  The subject of case 34 had recommenced her ordinary labor, as before her illness,
and was even detained later than  usual on account of the approach of New Year's
day.  Grief and domestic cares appear to have at least contributed  to the sup-
pression of her catamenia, the return of which was the extent of the improvement
which she at first experienced.
  The aggravation in case  32 was especiaUy noticeable at  the approach of  bad
weather.  In this case,  as also in cases 28 and 31, there existed  for sometime be-
fore treatment a diarrhoea which resisted all remedies.
  In  case 31, this complication was increased at several different times by excesses
in diet.   It is reasonable to suppose, that, with regard to case 28, the variolous
eruption,  if  it did  not hasten the softening of the tubercular deposit, already far
advanced, at least contributed, by its influence upon the intestines, to aggravate the
already existing diarrhoea
  Finally, analyzing the details of these different cases, it seems to me their fatal
issue  ought to be directly attributed to the anatomical lesions existing before the
treatment, and to the pathological consequences which these lesions would neces-
sarily produce.
  Whatever may have been the influence of the treatment upon the diathesis itself,
it could not act, except indirectly, upon the physical  results  already produced by
the diathesis.  For the same reasons that an anti-venereal treatment wiU not pre-
vent  a bubo from suppurating, whenever the local inflammation has attained a cer-
tain severity;  or the organic lesions of the viscera  resulting from malarious fevers,
wiU not disappear directly under  the influence of sulphate of quinine;  so an anti-
tubercular remedy, while* removing the  cause of the  disease, cannot restore the
local  lesions which are the results of it.  The maxim, sublata causa, tollitur effectus,
in reality applies only to functional disorders;  while organic  lesions, once estab-
lished will follow the course which is peculiar to them, and which, to a certain ex-
tent,  is independent of that which has  produced them.  This wiU be stiU more
evident if the cases of the third series are compared with those of the first, which
resulted favorably. 
74
ADDITIONS  TO
ADDITIONS TO  THE  PRECEDING  REPORT.
    If the hypothesis, that all  tubercular diseases arise from a diminu-
  tion of the oxydable phosphorus contained in the human system, shall be
  finally sanctioned by experience, it will naturally induce a modification,
  to a certain degree, of all the  present ideas of the etiology, pathology,
  and even of the semeiology of these affections.  It would be premature,
  at this time, to speculate upon  these changes, until the facts I have ad-
  vanced  have been confirmed by a more extended series of experiments •
  but there is something to be gained, in my opinion, by examining cer-
  tain questions raised  by the  subject itself, and which it is necessary to
  solve before deciding what is the limit to the efficacy of the treatment I
  have proposed.
   How can it be expected, it is asked, that the hypophosphites of lime
  and soda should cicatrize a cavity, or cause the disparition of a bronchial
 dilatation ?
   To this I answer:  we cannot always expect such a result;  and dis-
 appointment will certainly follow if the treatment is looked upon as in-
 fallible.   Indeed, clinical experience may, perhaps, demonstrate that this
 permanent relief occurs rarely.  All that we can reasonably ask is, that
 the treatment should dissipate the diathesis—that peculiar  state of the
 body which has, as a consequence, the deposit of tubercular matter.
 When once this condition has been modified, the deposition op eresh
 TUBERCULAR MATTER WILL CEASE.
   As to the morbid products existing anterior to treatment, two things
 will  happen: if they are fresh, they will in some cases be absorbed ■  if
 they are old, they must follow out  the  indications  of their own inde-
 pendent existence, and result naturally, either in calcification, in becom-
 ing encysted, or in elimination by softening and suppuration.
   This is a repetition of the two deductions I have before mentioned
 and upon which I now again insist: firstly, that the treatment will act
 with just so much greater rapidity, according as it is resorted to at an early
 stage in the progress of the disease; a fact recognized under every form
 of treatment, and by all practitioners: secondly, that when the local le-
sions have attained a certain degree,  the prognosis depends entirely upoa 
                THE  PRECEDING  REPORT.           75

  their gravity, their extent, the constitutional condition of the patient, and
  the position, as regards hygiene and climate, in which he happens to be.
    Under these circumstances, it is all-important for us to place the pa-
  tient in a hygienic and  climatic position, which will, especially during
  the time occupied by the process of elimination of the  tubercles, remove
  him as much as possible from the chances of those inflammatory com-
  plications to which he is so liable.
    The respiratory organs in all consumptives have an extraordinary sus-
  ceptibility to these troubles, which is easily explainable from the fact of
  their being already the seat of a pathological action, of which the prin-
  cipal feature is a hyperaemia of  all the tissues about the tubercular de-
  posit.  Moreover, the patient is prostrated by his sickness, and conse-
  quently much less in a condition to resist meteoric influences.
    This specific treatment, by increasing materially the nervous power,
  places the patient under the most favorable conditions to meet the sud-
  den changes of temperature ; but on the other hand, as it also increases
t  the  quantity of the blood, it likewise augments the relative state of
  plethora, and renders him more liable to a development of inflamma-
  tion.
    In  warm climates,  where all inflammations  of the respiratory organs
  are infinitely less  severe, or frequent, than in Europe, the  most simple
  precautions are sufficient, and the treatment can be employed at its
  maximum.   In cold countries, especially during the winter, it is highly
  important not to go beyond the  point of sanguification which, if I may
  so express myself, comports with the condition of the patient.
    Health consists, in reality, in a  perfect equilibrium  of all the  func-
  tions : nevertheless, for a patient, a part of whose respiratory apparatus
  does not work, or in whom there is at the same time going on a process
 for the expulsion  from the economy of some injurious element, there is
 a certain  abnormal, or, as medical men  call it, unstable  equilibrium,
 which it is necessary to maintain.  The art of recognizing, and treat-
 ing in every  patient, this  unstable  equilibrium, constitutes medical
 skill.
   I therefore  particularly recommend  to all practitioners the necessity
 of watching that their patients do not  abuse the state of improvement
 which this treatment superinduces, often in cases of the gravest charac-
 ter.  It is difficult to persuade a patient who is no longer troubled with
 night  sweats; who has no fever; who has  regained his appetite and
 strength; who has only a  slight cough and  but little expectoration,
 that it is all-important for him  to  take the greatest precautions to 
76                    ADDITIONS  TO

guard his improved health.   This is the more especially requisite when
his  social position, and the necessity for his earning his livelihood, im-
pose additional reasons for giving heed to your advice.  In one half the
cases given in the third  series, the fatal termination was at least hast-
ened by the setting in of some inflammation, which seized the little pul-
monary tissue  still capable of performing its functions, in consequence
of some act of imprudence in  diet, or exposure to atmospheric change.
  This  treatment of tuberculosis does not pretend to overturn all the
theories hitherto  furnished by pathology;  but, on the contrary, it ex-
plains and confirms them. These preparations have, and can only have,
that conditional degree of power which all medical and human means
possess.  To demand more,  would be to  ask what is  impossible  and
ridiculous.
  Whenever the truth of this hypothesis is  settled ; when general ex-
perience has demonstrated the value  of the  facts I have  announced,
every one will  hasten to employ these medicines/rom the commencement
of the disease,  and even as a prophylactic in doubtful cases.   It is in
this way alone that we shall derive all  the benefits they afford, and shall
finally succeed  in abolishing the greatest evil which afflicts hu-
manity.
  But if this be so, some will say: if these preparations can only cause
the absorption of recent tubercles ; if the tubercular deposits, when they
have reached a certain age, can only disappear by a process of elimina-
tion, your treatment  can do no  more than  we  already know how to
perform.  This objection is  a  reasonable  one; yet, in truth, it  ought
not  to be regarded  as an objection, but rather as a confirmation of my
theory; for it  was the knowledge of this fact which  induced me to en-
gage in these researches and  experiments.
  The pathological fact, and the treatment which I have  discovered,
cannot,  it is true, do  more than is done every day, and  has been done
for  a long time; but they effect it with this difference: that all the cases
capable of being relieved, that is, those where the organic lesions have
not passed a certain stage, will  be cured by an agent, and in a manner,
which we actually know  about;  while to-day, by all the means known
tO US, WE CAN BUT RARELY--VERY RARELY, EFFECT A CURE ;  and then
only, as it were, blindly, and  almost by accident.
  From this uncertainty  in regard  to  treatment,  arise the two opinions
which exist among medical men as to  the cure of phthisis.  According
to the pessimists* no one can cure consumption ; according to the op-
  * Pessimist: one who complains of every thing as being for  the worst; as opposed to the
Optimist, who holds the opinion  that all events are ordered for the best 
THE  PRECEDING  REPORT.
77
timists, it is sometimes  cured : there are those, even, who say always.
For my part, I must say that I agree with neither the one nor the other.
   Take a consumptive person in whom the disease is just commencing,
and which presents  only sufficient symptoms for  us to form the diag-
nosis ;  the optimist will say, with reason, that by ordering an appropriate
regimen, some well-known remedies, and above all, those hygienic rules
which  are in reality equivalent to  a complete change  in his manner of
living, and the patient will have  a  good chance of recovery.   On the
other hand, the pessimist, with nearly as much reason, will declare him
doomed to an almost certain death.   One or the other will be right or
wrong according to the period which he appoints  for the realization of
his prognosis.
   It is true, that the progress of the disease can often be suspended,
and  that  in  very rare  cases  the  symptoms may  disappear, especially
if the patient is wealthy enough to avoid all  the causes which reduce his
vitality ;  but in the large majority of cases, the disease will not retro-
grade,  and sooner or later the patient will  succumb  to the  tubercular
affection.
   The prognosis of phthisis  has  two characteristics,  depending upon
the two points of view from which it is formed.   One is decided by the
extent  of  the  existing tuberculization, and the rapidity of its progress.
This is the present prognosis.  It  is often favorable.   It can exist but a
short time, only at the outset of the disease, when we can lay aside all
consideration  of the  diathesis.  The  other is the final prognosis.  It is
not only formed independently of  all local lesions, but is based upon the
nature of the disease itself; upon  the almost absolute certainty that the
first  crop of tubercles will be followed by a second;  that  by a third,
and so on, until the death of the patient ensues.   In the present condi-
tion of the healing art, and apart  from my own theory, this prognosis
should be a  verdict  of death in  twenty-four out  of every twenty-five
cases.
   It is thus seen that the two opposing opinions in regard to the oura-
bility of phthisis, are equally true in some  respects, and  that both  of
them are founded upon an incomplete consideration of the question.
   The  objection against the specific powers of  the hypophosphites,
based upon the fact that phthisis is cured sometimes by other remedies,
and sometimes  without any  medication  whatever, is  therefore  of  no
value.   The objection can be raised equally as well against any princi-
ple of therapeutics however well established  it may be.
   The  same argument may be advanced  with equal force in regard to 
78
ADDITIONS  TO
 many other maladies.  Patients suffering from  intermittent fever some-
 times recover without the use of quinine; those from chlorosis without
 iron; so also may the  consumptive without the hypophosphites.   This
 however does not prevent quinine  from being  a specific against mala-
 rious diseases; nor the iron against anaemia; neither will it any more
 prevent the hypophosphites from being recognized as a specific against
 tuberculosis.
   The spontaneous cure of consumption is even a proof in favor of my
 hypothesis, since it finds in this fact a natural means of explanation.
 This theory, unless I am  much mistaken, will account for the influence
 on phthisis of all the curative means  of which experience has hitherto
 recognized the value ; above all, of the various hygienic agents, such as
 cod liver oil, arsenic,  and antimony.  I shall not enter upon an examina-
 tion of these  points for the  reasons already given, but shall take them
 up and consider them in the chapters entitled History, and  Deduc-
 tions.
   The preceding report  having been intended for reading before the
 Academy, it  was necessary to compress it as  much as  possible; for
 which reason I only hinted at  certain points to which I wish now more
 especially to call the  attention of practitioners.
   I have employed the hypophosphites of lime and  soda in the treat-
 ment of phthisis because it has always seemed to me that the use of the
 salts with the bases of potassa or  ammonia, was followed by an aug-
mentation of the expectoration, and the signs evidencing a softening of
the tubercular deposit: a fact which  accords very well with those al-
ready known  concerning the action  of these  two bases.  In certain
cases,  however, the employment  of these two last salts has seemed to
me indicated; when, for instance, I wished to act upon old inflammations,
whether in non-tubercular subjects,  or in those where the phthisis should
rather be looked upon as a complication than as the principal disease.
   On a previous page I have mentioned  a case of asthma,  depending
 upon a chronic bronchitis, in which the hypophosphite of potassa was
 employed with success.   In case No. 11 it was also given with advan-
tage.
   The hypophosphite of  ammonia  has appeared to me to have an an-
 alogous action to that of potassa ; but in  addition, it seems  to exercise
 a special  influence upon the hepatic secretion.
   One or two trials made with the base magnesia did not furnish such
 sufficiently decided results, that I think it worth  more than a mere men-
tion.  Its effects seemed very similar to those of potassa and ammonia. 
THE   PRECEDING  REPORT.           79
More extended  observation will, without doubt, establish what is the
difference  between the modes of action of these various salts, and en-
able us to determine to which  of them  we should decidedly give the
preference.  It will suffice for the present, I think, to use the salts of
lime and soda.  Generally I employ the first in preference to the latter,
especially at the  commencement of treatment.   Later, when  there are
evidences of plethora, I replace it by the soda, which  seems  to me to
have a less energetic action.   The hypophosphite of lime appears also
to have an especial influence over the expectoration, which it sometimes
reduces too rapidly, as by it the cough is increased.   When this is the
case, it is necessary to change it for the salt of soda.
  Experience  alone can decide whether the  hypophosphites are the
most efficacious remedies  in  existence, or whether they can be replaced
by other combinations; for instance, by the organic  alkalies, with the
base phosphorus.  These were  the preparations  I first thought of em-
ploying.  Before using them, however, it will be absolutely necessary to
try their effects upon animals in order to discover whether they produce
in the system phosphorized hydrogen, the action of which appears to be
essentially  deleterious.   There is  also  an  opportunity to investigate
whether hypophosphorous  acid alone would not, under certain circum-
stances, produce a different therapeutic effect from these salts.
  The  action of the hypophosphites, with iron for the base, should be
experimented with, only with great care.  In several cases where I have
prescribed  iron, in connection with the hypophosphites, its administra-
tion  has seemed to me to occasion, or at least to be followed, by hemor-
rhages, or inflammation. The union of iron with hypophosphorous acid
appears to  be  almost useless  against  the tubercular  diathesis, for the
reason that the amount of iron sufficient to saturate the ordinary dose
of the acid, would probably be dangerous, and certainly could not be
repeated as often as necessary.
  The same remark  applies to all other bases which require  to be ad-
ministered  in  small doses.  There is  one, however, a  medicine which
can be given in quite large doses, which will present, I think, peculiar
advantages  by its union with  hypophosphorous  acid, namely, quinine.
Rousseau Brothers, manufacturers of chemical agents, were kind, enough,
at my request, to prepare a specimen of  this hypophosphite of quinine.
It is an amorphous salt, of a  yellow orange  color, having the consist-
ence of soft wax, burning readily, like resin, on exposure to heat.   It is
very soluble in water, and has the bitter  taste of all the salts of quinine.
There are two diseases for which I think it can be used with great ad- 
80
ADDITIONS TO
 vantage—yellow fever and the cholera.   I  shall show elsewhere the
 reasons upon which I base this assumption.
   The hypophosphites seem to unite all the properties (with the excep-
 tion, perhaps, of the aphrodisiac), and none of the inconveniences, which
 are attributed to phosphorus by the old authors, and can be employed
 in all  cases where  that  substance has  seemed  to possess advantages.
 My  object, however, being simply the discovery of a remedy against
 tuberculosis, all  the other theories which arose from  my investigations
 received but subsidiary attention.  I examined them only so far a I sup-
 posed they might favor a solution of my own problem.
   The  question which I now submit for examination, is, whether  the
 hypophosphites of lime and soda  are specific remedies  against tubercu-
 lar diseases ;  especially, whether they are prophylactic.  Whatever may
 be the result of the examination, I think that the therapeutic formula I
 have given, will be  found necessary to explain the action of every new
 remedy proposed as a specific against this  disease, viz., that it must be
 a combination of phosphorus in a state at once both assimilable and ox-
 ydable.
   Hypophosphorous acid, and the hypophosphites,  having remained,
 up to this time, unused in medicine, have been Uttle studied, or  manu-
 factured, even by chemists.  The principal investigations  are  those of
 M. H. Rose, and Professor Wurtz, to  be found in volumes  38,  and 7
 and  16, of the 3d series of the Annates de Chimie et de Physique.   It
 is  not  very astonishing, therefore, that the hypophosphites  which  are
 now ordinarily sold, and which  have been prepared in consequence of
 the great demand created since the  presentation of  my report, should
not always present that purity  indispensable to  success  in  the
TREATMENT.
  According to the method now adopted for  its  preparation, the hypo-
phosphite of lime can be mixed with the hypophosphites of mao-nesia or
potassa.  The salt of soda can contain the carbonate or sulphate of soda
or even the hypophosphite of baryta.  Both of them can be adulterated
with lime in a free state,  or with the carbonate or phosphate of lime.  I
have seen samples composed almost entirely of these two latter salts. It
is easy to understand that their presence, even in very small quantities
is very far from being an  affair of no consequence.  The salts of potassa
and magnesia, and above  all the uncombined lime and  the salt of baryta,
can be especially injurious. I wish  to call the attention of physicians
especially of apothecaries, to this point, for the special reason that since
I have made my treatment public, I have noticed in patients who have 
                THE  PRECEDING REPORT.            81

 purchased  tho remedy from various laboratories in the city, effects dif-
 fering from those produced by the hypophosphites which I have myself
 prepared.  I have also had sent to me from  England some specimens of
 the salts  of lime and soda which were  excessively impure.
   I wish, therefore, that all practitioners, who  obtain only negative re-
 sults, or who notice different  phenomena from  those I have stated :—
 for instance, if there is increase of expectoration, or a sudden onset of
 diarrhoea, when  none existed  before,  would carefully examine whether
 the medicine is pure.
   The mode of administration is very simple, as the medicine has very
 little taste, it being not much unlike common  salt.   Twenty grains of
 it dissolved in half a tumbler of water, or milk, can be taken without
 being noticed by the patient.
   I have already stated, in another place, the doses which I have found
 to be the most advantageous.  In each case,  however, the physician
 must be guided by the progress the disease  is making: by the consti-
 tution of his patient; but, above all, by the  change occasioned by the
 treatment in the general symptoms,—such  as the weakness, sweating,
 loss of flesh and appetite, fever, etc.
   The best rule I can give is this: in  every  case where the local lesion
 is not very severe, increase the dose at the rate of two grains each day,
 until the  general constitutional symptoms have disappeared; then keep
 at this amount until the first signs of plethora manifest themselves.  For
 a description of which see cases 8, 9, and 16.  The best dose to obtain
 this result, in adults, is from fifteen to twenty grains.
   In cases of greater  severity it is  sometimes impossible  to employ so
 active a treatment, in order  not to  predispose the patient to inflamma-
 tory complications, especially if he is  treated during the winter, and is
 obliged to expose himself to atmospheric changes.  It should never for
 a moment be forgotten, that any exposure, however slight,—the simplest
 chill—even a draught of air, may suddenly induce a fatal result, at the
 very time when there was every reason to hope for a favorable termina-
 tion.  This point cannot be too strongly  insisted upon.
   It is  indispensable,  in every case apparently cured, to  continue  the
 treatment for some time after the disappearance of all the constitutional
 and  local symptoms:—for a  premature suspension is  almost uni-
 formly FOLLOWED  BY THE RETURN OF ALL  THE SYMPTOMS IN A SHORT
TIME.
   The length of  time during which the remedy should be  continued,
will vary for each case; but, in general—all other things being equal—
                              6 
82
HISTORY.
it will be in direct ratio to the age of the affection ;  and to the amount
of nervous impressibility which characterizes the tubercular predisposi-
tion.  [See chapter entitled " Deductions."]
                       HISTORY.

   I have given in my Report the reasons why I was induced  to  con-
sider  the tubercular  diathesis as a modification  of the normal phos-
phorized element in the system ;  and have  also stated why I chose the
preparations containing hypophosphorous acid, as the agents to be em-
ployed against it.  I have also mentioned the works upon the  subject
which I knew existed anterior to my experiments, and which served to
facilitate and shorten my labors,  or change their direction.
   My object in giving these details was to make known the process of
reasoning by which I arrived at my conclusions, attaching all the more
importance to them, because it is by the means used that science is dis-
tinguished from art.   I am willing to avow, without any affectation of
false modesty, that I am not indifferent  to  the idea that, if the results
I have given are confirmed by experience, Medicine, properly so called,
(by which I mean the art of healing,) will take rank among the induc-
tive sciences.
   When I commenced my experiments with the hypophosphites, I sup-
posed I was the first person who  had examined their action  upon the
animal economy.  But when it is considered that the medical profession
is scattered over the whole globe, it would be difficult, not to say impos-
sible,  to keep any of its members cognizant of all scientific invest!na-
tions.   Especially is this the case when they have, for a long time, been
removed from contact with each other.  Since my return to Europe, I
have occupied myself with looking up  and examining all the  works
bearing upon the subject written  anterior to my investigations.   I will
mention what I have  discovered,-—first,  in order to pay the tribute of
respect to truth, and the efforts of those who have preceded me;__sec-
ondly, in  order to show how little foundation there is for the almost
universal opinion, that experiment is the only source of medical pro-
gress.  Isolated facts no more constitute  a science,  than a pile  of stones
constitute a building.
   I will give the medical history of phosphorus  and phosphoric acid, 
HISTORY.
83
in so far as  they relate  to  the tubercular diathesis, and after that, the
facts I have discovered relative to the three acids  in an inferior degree
of oxydation.
   I stated in my report, on page 13, that as early as the year  1802
phosphorus  was  employed with success in* two  cases  of  tubercular
meningitis by Coindet,  which fact  may  be found  on page 211  of his
work,  "Memoire sur VHydrencephale"  published in 1817.   The av-
erage dose which he gave was  three grains dissolved in oil, in the
twenty-four hours.  His remarks upon  the subject were  concluded in
the following words:  " This remedy demands too  much attention in its
preparation and administration ever to become of daily use in medicine.
That well-known passage of Boerhaave  seems to  apply particularly to
it:  * At prudenter a prudente medico, si methodum nescis, abstine.' "
Barthez and Rilliet, in  their  work, Maladies des  Enfants, (vol. iii., p.
526,) state that they have employed this substance at  the maximum
dose of forty grains, without obtaining any, even temporary effect; but
they give no details on  the subject.   I  have given on page 14 the ex-
planation of this apparent  contradiction.
   But the most remarkable  suggestion  was made by Dr. Theophilus
Thompson of London, physician to the  Brompton Hospital for Con-
sumption : an establishment for the exclusive treatment of phthisis. On
pa^e 123 of his  wTork,  Clinical Lectures on  Pulmonary Consumption,
(American edition,) Dr. Thompson  suggests  that phosphorus might be
useful in the treatment of consumption, because, according to Dr. Rees,
(to whom I alluded on page 12,) that element  plays an important part
in sanguification.  The  idea of Rees, according to a paper published in
No. 219 of Brewster''s  Philosophical Magazine, entitled: On a Func-
tion of the red Corpuscles of  the Blood, and on the Process of Arteri-
alization, is as follows :
   The phosphorus exists in the globules  of the venous blood, combined
with  fatty matter and  hematosine.   It is oxydized  in  the  pulmonary
vesicles  by contact with the air, and transformed into phosphoric acid ;
which  in its turn, combines  with the salts  of soda in the serum, and
thus produces the change  of  color which characterizes  arterial blood.
   Dr. Thompson  remarks, in  addition, that, as cod liver oil contains
phosphorus, it  perhaps owes its efficacy to that element.   He even goes
so far as to look for an explanation of its method  of action, in the sug-
gestion, that as  this element has  a great affinity for oxygen, it may
serve to diminish the action of this gas  upon the lungs, and thus pie-
vent the formation of pus  and a tubercular  deposit.   He cites  several 
84
HISTORY.
 cases in which he employed  a solution of phosphorus in oil, and from
 which he obtained satisfactory results ; but as, in the majority of such
 cases, the alleviation was sustained but a short time, he seems not long
 afterwards to have abandoned his experiments.
   Dr. Thompson, as was the case,with Barthez and Rilliet, was able to
 employ the phosphorus only in small doses ; less than a grain each day.
 This, as I have before stated, furnishes the reason for  his ill success.
 His work, printed in  1854,  is a reproduction of the clinical lectures
 which were published in 1851, in Vol. II. of the Lancet; but when I
 commenced my investigations I had not seen it.  It is only necessary
 to read  this book in order to be convinced  that the author is a shrewd
 and conscientious observer, and one who possesses a logical, well-disci-
 plined mind.   Yet how strangely it happened, that although he held
 in his hand the solution of the problem—although he was fully aware
 of the remarkable work  of Owen Rees, he did not  advance one step
 towards discovering  under  what  form phosphorus entered the  system,
 and what was its method of action when there.
   It is true, that the  idea of Rees  was not generally adopted;  that even
 to-day it is rejected by the most distinguished physiologists and chemists,
 among whom is Professor Milne Edwards, who states on pages 479 and
 480, Vol.  I., of his work, Lecons  de Physiologie  Comparee :  " These
 experiments are not  given with  sufficient  numerical detail to inspire
 confidence in  the results which the author has deduced."
   But the idea of Rees appeared to the mind of Dr. Thompson suffi-
 ciently well based, for  he has admitted it: besides, he could have—he
 even should have—given it the value of an hypothesis, and used it as
 the initial point for his own experiments.
 '  As in science consecutive truths have only a relative  value, depend-
 ing upon  the stand-point from which they are examined, so every hy-
 pothesis is legitimate from the  moment  it points to some  practical
 conclusion.  But to-day hypotheses and theory in medicine—but more
 especially in  therapeutics—are tantamount in the  minds of many to
 dreaming, and every  thing chimerical.
   Among others who have treated of the subject of phosphorus, Doctor
 Turck, in  an  article  entitled Du phosphore et de quelques phosphates
 aux points de vue physiologique et therapeutique, published in the num-
 ber for January, 1857, of the Revue de Therapeutique Medico-Chirur-
gicale, after mentioning the various theories of authors upon the action
 of phosphorus, expresses  again the opinion that this substance would
 prove useful in phthisis, as  well as in many other diseases.  In the ex- 
HISTORY.
85
planation which he gives of its probable action, he agrees with Rees,
whose work he does not seem to have been  acquainted with ; and also
with certain ideas of my own, which I have stated more fully under the
chapter headed " Deductions"
  These are all the facts which I have been able to collect upon the
employment of phosphorus  in phthisis.  It is beyond the province of
my subject to  mention here the other therapeutical uses of this  sub-
stance.
  In 1849, Doctor Beneke, in a work entitled Der phosphorsaure Kalk
in physiologischer und therapeutischer Beziehung, published at Gotten-
gen, starting with the supposed action of the phosphate of lime in the
formation of the elementary tissues, has endeavored  to  find,  in the
amount of  this substance, the cause of tuberculosis.  This work was
known to me at my first trials, from  a review or  notice of  it which ap-
peared  in No. 24 of  Braithwaittfs Retrospect, and I have already ac-
knowledged the information I derived from this source.
  Since the presentation of my report to the Academy, Doctor Larcher
has  advanced a claim  to priority in the suggestion of this idea, having
announced, as he declares, as early as 1824, that the tubercular diathe-
sis depended upon a diminution of the calcareous elements of the bones.
He does not, however, state  in what publication  this idea of his can be
found.  Other practitioners have, no doubt, employed this substance;
but  as  it seems to me that  their experiments have no relations to the
special treatment of tuberculosis, I think there is no ground for discussion
upon the subject.
  I will now pass to the consideration of those combinations of phos-
phorus  which contain less amounts of oxygen.
  The action of phosphorous acid upon animal life has been examined
by  a large number of experimenters, but wholly in a toxicological point
of view.
  The first, in point of time, was Hunefeld, who, in the September and
October numbers  of  Horn's Archiv fur  Medicinische Erfahrung, for
1830, on  page  861, has given the result of two experiments upon a
rabbit.  The animal was first given twenty-five grains of hydrated phos-
phorous acid, without any appreciable effects.  A dose of eighty grains
of the same  acid, given twenty-four hours later, caused death in about
twelve hours.
  In 1844, Weigel and Krug, wishing to discover the  difference be-
tween  the relative actions of pure and impure phosphoric acid, gave a
rabbit forty-five drops of phosphoric acid, containing a tenth of phospho- 
86
HISTORY.
 rous acid, in  three doses, with intervals of half an hour between each.
 The animal died an hour and a half after the last dose.  A second rab-
 bit, to whom  he administered  thirty drops of the same  acid, died in
 about four hours.  (Casper's Medicinische Wochenschrift, 1844, p. 455.)
   Finally, Woehler  and Frenichs, by the aid of this substance,  killed
 several  animals.  A pigeon, to whom they administered a solution con-
 taining ten grains of anhydrous phosphorous acid, lived an hour; and
 a cat, to whom was  given a solution representing twenty  grains of the
 acid, died in thirty-six hours.
   These results  are contradicted by those obtained, in 1854, by Doctor
 Basilius Sawitsch, as given in  his  inaugural dissertation, published at
 Dorpat, and entitled, Meletemata de acidi arsenicosi efficacia.  The object
 of his experiments was to determine the difference between the action
 of the combinations  of arsenic and those of phosphorus.  He  injected
 into the stomach of a cat twenty grains of phosphorous acid dissolved in a
 little less than two drachms of water, which represented about ten grains
 of the anhydrous acid.   The animal vomited several times, but other-
 wise seemed to  suffer no inconvenience.  The next afternoon he gave
 the same animal double the quantity of the same solution of the acid
 without producing any other effects than slight vomiting, and foamino
 at the mouth.
  On the 3d of May, 1854, Sawitsch himself took forty-four grains of
 phosphorous acid (equivalent to twenty-two and one-fifth grains of an-
 hydrous acid), dissolved  in sweetened water, in two doses, with an in-
 terval of a quarter of an hour.  On the 5th of May he took, in the same
 manner, fifty-four and  a half grains (equal  to thirty and  seven-tenths
 grains of anhydrous  acid).   In each case he could discover no change
 whatever in his health.  The same experimenter tried, also, upon cats,
 the phosphite of soda.   Professor Buckheim, of the University of Dor-
 pat, under whose suggestion and direction the scholars  of that univer-
 sity  have,  since 1848, undertaken  and  published a  series of  most
remarkable original researches upon all medical substances  has also
tried upon himself the action of the phosphite of soda.
  I regret, very much, not having been able to procure the  thesis of Dr.
 Sawitsch, in order to examine the details of his experiments.   The re-
marks which I have  made  upon it  are  founded  upon extracts from a
work of Bernhardt Schuchardt  of Gottingen, which appeared in 1855
in Henle and Pfeufer's Zeitschrift far Ratinelle Medicin, (VII Band
 3 heft. p. 235,) under the title of Empoisonnement aigu par le phospkore
  Dr. Schuchardt, himself, made experiments upon rabbits  witk the 
HISTORY.
87
phosphorous acid in doses of from ten to twelve grains, which gave the
same results as those of Sawitsch and Buckheim.
   These are all the toxicological facts I have been able to discover con-
cerning phosphorous acid.  The only observation which I know of rela-
tive to its therapeutic effects, is one recently published in the Lancet for
July 18 th, 1857, (three days  before I  presented my Report to  the
Academy), which we owe to Dr. Rowbottom, of London.  It gives the
treatment  of a  case of asthma by the  use  of this substance at  the
amount of eighty grains daily.   The author, however, not having stated
the degree of concentration of the acid, the real proportion of anhydrous
acid taken by the patient cannot be known.
   On pages 288 and 289, volume V., of the Dictionnaire de Matere Med-
icate of Melat and Delens, it is stated that the action on the system of
the  different preparations of phosphorus should be attributed to the
hypophosphoric acid.  This is the same result which I have reached by
another route.  [See page 13 and 14.]
   In the Pharmacopoeia Universalis, of Geiger and Mohr, page 24, vol.
II., the directions are given  for  the preparation of this acid, which, in
their opinion, is useful in malignant fevers.
   The facts relative to hypophosphorous  acid and its salt, are even less
numerous.  They consist of four experiments only, made by Sawitsch,
and given also in his thesis.  The  first  two were made  upon a cat, to
whom he gave at the first trial twenty grains of the acid (equivalent to
two and a half grains of the anhydrous acid), and on the second double
the quantity.  A slight vomiting was the only effect experienced by the
animal; and this was probably due rather to its action on the sesophagus
than to the acid.
   On the 7th of May, 1854, Sawitsch himself took a solution contain-
ing ei"-ht and one-tenth  grains of the  anhydrous acid, and two days
later, another containing twelve and two-tenths grains,—without  any
perceptible result.  Dr. Buckheim also tried, upon his own person, the
effects of the hypophosphite of soda;—but I have no information in re-
gard to the result of his experiments.
   It appears, however, by a  passage in his work, (Lehrbuch der Arznei-
mittellehre, page 320, Leipzig, 1854,) that he had conceived the iden-
tity, as regards physiological action, between hypophosphorous, phospho-
rous, and  phosphoric acids.  The following is the  passage referred to:
  " It is evident that it is not by parting with its oxygen, that the  phosphoric acid
acts upon the economy, for it  does not produce the same functional modifications
as phosphorus.  It has been generaUy beUeved that the phosphorus transformed 
88
HISTORY.
 itself into  one of its combinations with a less degree of oxygen:  for example,
 into hypophosphorous, or phosphorous acids; and that it was under this form that
 it produced its effects.  Woehler and Frenichs, basing their opinion as much upon
 their own experiments as upon those of Weigel and Krug, have concluded that
 phosphorous acid has a poisonous effect  analogous to arsenic.  The investigations,
 however, of Sawitsch, show that phosphorous acid, as well  as hypophosphorous
 acid, in their pure state,  act upon the economy exactly like phosphoric acid; and
 become injurious only under the same circumstances as that acid.  The same holds
 good, also, with the salts of soda. Taken even in very large doses, they occasion
 no appreciable disturbances in the system.  It is fair, therefore, to conclude from
 this, that it is highly probable the effect  of phosphorous upon the  system depends
 upon its action  as a simple body, and  not to its transformation into one  of its
 oxydjzed combinations."

   It would  be premature to decide in a positive manner, at this time,
 upon the  question as to what particular form phosphorus assumes  in
 order to act upon the system ; but  Dr. Buckheim  seems to me to  have
 deceived himself, by concluding that the sub-acid forms of phosphorus
 have the same action upon the system as  phosphoric  acid,, because, ac-
 cording to his reasoning, they are not poisonous at the doses employed
 by  M. Sawitsch.   If, instead  of confining himself to  one  or  two trials,
 this investigator had employed the  different combinations successively,
 he  would, I think, have reached a different result,  and would  have
 formed  the conclusion that  the hyphosphosphites were especial agents
 destined to supply one of the greatest wants in medicine.
  In closing this cursory glance at  the history of this medicine, I will
 give the  only therapeutic,.—or rather  pharmacological fact,—which I
 have been able to discover concerning hypophosphorous acid and its
 salts.  It  must be taken for just what it is worth.
  On page 290, vol. II. of the Pharmacopee  Universelle, of Jourdan,
 2d  edition, is the following formula :
                     HYPOPHOSPHITE OF POTASSA.
      Tincture of salt of tartar.
      Granulated phosphorus, q. s.
           Saturate in the cold, decant and preserve.
  Jourdan places this preparation among the  combinations  of potassa.
 He gives  neither the doses,'the properties, nor the uses ; and  states the
 source of the formula to  be the Pharmacopee Usuelle of Van  Mons
 published  at  Louvain in  1821  and 1822.   It is to be found on pao-e
 562, vol.  I. of that work, under the title of Hydrophosphure  de potassa
 liquide ;  and also on page 437, of vol. H., under that  of Teinture phos-
phoree de  set de tartre.  Neither the properties, doses, nor origin of this 
HISTORY.
89
formula are given by Van Mons.   It is possible that it may never have
been used, and that it is merely an illustration of those numerous new
preparations which  are scattered through his  work, and which  are
imagined  rather in view of a chemical or pharmacological, than a  thera-
peutical utility.   What makes  me incline to this opinion, is, that in ad-
dition to the hypophosphite of potassa, this preparation  ought to con-
tain, if we can judge from its  strong phosphorized odor, some  one of
the combinations with hydrogen.  It seems  to  me, therefore, probable
that its use would present the same dangers as all the other preparations
of phosphorus  prepared in a druggist's  store.   It  was my intention to
try it upon animals; but up to this moment I have had neither the time
nor opportunities.
   It will be seen by the  preceding pages, that if medicine—if  thera-
peutics, especially—consists, as many persons  pretend, merely of  facts;
if the verifying and registry of phenomena is the sole duty of a  physi-
cian ; if by them alone new  truths can be discovered;  then there is
enough,  and more than  enough, material to have reached  long  ago
the result which I  have  attained.   If, up  to  this time, this  result
has remained  undiscovered, it was neither  owing to  want of skill,
nor of  enterprise on the part of experimenters; but solely, I  think,
because the method which they  employed  was  incomplete  and erro-
neous.
   It would be the height of ignorance, and what  is worse, ingratitude,
for a graduate of the Medical School of Paris to deny  the impulse
which the school of anatomy has exerted upon the art of healing.  Es-
tablished  by Bichat, it  has given a vitality to surgery which animates
it still.  In medicine, it has given us Laennec and other learned men,
who alone by their works—happily for us of the present day—have im-
mortalized the  epoch :  whose  profound researches in pathological ana-
tomy and semeiology have placed diagnosis upon an immovable basis.
   Unfortunately, by continued identification  with its work, this school
has finished by seeing  nothing beyond it.  For it, the study of disease
has ceased to  be an examination of an abnormal condition, which is
modifying the principles of life, and which, when it has passed certain
limits, breaks down existence itself; but is simply a means of verifying
the effects resulting from it—effects  beyond  which this school  never
seeks to pass.
   Medicine is not for it the art of preventing, of relieving, and of curing
disease ;  but only that of determining,—of foreseeing, during the life,—
the lesions which will be found, subsequently, upon the dead body. For 
90
HISTORY.
 it, in a word, the  study of organic disorders, which ought never to be
 but a means, has finished by absorbing everything, and by becoming
 the sole object.
   It results  from this, that the  process especially  appropriated to this
 kind of research, namely,  that of observation, or verification—a process
 by itself essentially secondary and  barren, has been the  only one  em-
 ployed, the only one  extolled.   On the other  hand, the  process of in-
 vention, or induction—the only really fruitful one, the one alone which
 is progressive—has been neglected, or  even formally proscribed.   Ap-
 plying  to  the living, acting, suffering, human  mechanism the  means
 which it has employed in studying the  dead  body, it has ended, in path-
 ology, by a localization of diseases and a description of their results; in
 therapeutics, it  has  led  to skepticism and folly.   What  especially
 proves this, is the fact that the  sole real discoveries made during its
 reign—vaccination, the use of iodine, and anaethesia—were made out-
 side of its  influence ; and are so far from  being  consequences of  its
 suggestions, that it can neither explain  nor understand them.
   It is simply because it has been  sought to adopt in therapeutics the
 processes employed in anatomy, and to restrain  every thing within the
 limits of observation—or, as it is facetiously  called, simple and practical
 observation, (without  doubt because it leads to nothing)—that the art of
 healing, to-day, is in such a state  of confusion and inferiority, compared
 with the other sciences.  It was  a  grand mistake to  adopt completely
 into one range  of  knowledge the technical processes proper only to
 another ; for if the means  which are used in the different sciences are
 identical as regards basis, they are modified in each according to a cer-
 tain end to be attained.
   There is about the same difference between the processes of patho-
 logical anatomy and those  of therapeutics, as there is between those of
 mineralogy and those of  chemistry.   One of these sciences employs
 only examination and description;  the  other can only advance by ex-
 perimentation and induction : for  whoever employs one must necessarily
 use the other.
   It has not  been by waiting humbly and silently that Pathology and
 Chemistry have spoken their last words; that Therapeutics has fulfilled
 the task which has devolved upon it.  These two sciences will only fur-
 nish it the materials, the germs, from which it must, itself, produce def-
inite results.   Already, on every side,  are to  be seen evidences that
some bold spirits have appreciated this truth  ; that some few even still
less in numbers, have  always recognized it. 
DED UCTIONS.
91
  Let us hope, therefore, that after we  have had a School of Anatomy
and of expectant medicine, the day will come when we  can raise, not
upon the ruins, but upon  the foundations, a school of Therapeutics and
of Specific Remedies.
                    DEDUCTIONS.

  The character or office of every true scientific principle is, to agree
with facts already well established ; to manifest, clearly, its own reasona-
bleness and aims; and finally, to lead to such conclusions as will enable
us to examine many new, and perhaps unexpected, correlative subjects.
  I propose to present, in this chapter, some few of the deductions which
I think legitimately flow from  my own investigations; the correctness
of which it is my intention satisfactorily to establish.  The circumstances
previously referred to having heretofore prevented  it, I must even now
content myself with barely mentioning the conclusions I have  arrived at,
hoping at no distant day, that I shall  be able to examine the  subject
more fully, especially in a chemical point of view.
  Some of these deductions, in  my estimation, are  novel;  and most of
them are confirmatory of the facts heretofore stated  by other observers.
  In physiology, it will always remain an established truth that the
inorganic elements of all fluids constitute an essential part of them. The
nature and proportions of these elements influence, in  the most impor-
tant degree,  the  constitution and function of all  organic matter.  It
would be  a good  comparison to say, that they act, in relation to liquids,
an analogous part to that of the osseous system in its relation to all the
other solids of the body ;  that they are, so  to speak, the skeleton of the
fluids.
  It  must be admitted  that phosphorus is found  in  the system in a
combustible form.  It is probable that it is in  this form that  it exists in
the blood globules, and that its oxydation constitutes one of the essential
phenomena of sanguification.  It  also  exists in nervous matter; and
certain facts would seem to indicate that every act of innervation has,
as a condition or a consequence, its oxydation.  There is an opportunity
to examine whether this element is introduced directly into the economy,
or whether it  is not  the result  of a chemical  reduction.  If the latter,
the seat and conditions of this action must  be  sought for.
  In pathology, it will  be shown that many diseases—above all, in;my 
92
DEDUCTIONS.
  diatheses—have, as an  essential  condition,  the modification, in  some
  way, of the fluids of the body anterior to the anatomical lesions which
  are peculiar to them ;  that these lesions, once  established, have a prog-
  ress pathognomonic to  them;  and that, consequently, every diathesis
  offers a double problem : one including  the  phenomena, symptoms and
  progress  of the diathesis  itself; the other,  the phenomena, symptoms
  and progress of the lesions which result from it.
    In all  chronic diseases, it is probable that the primitive alteration
  consists, above all, in a modification of the proportions of the inorganic
  constituents of the fluids of the body.
    The etiology of tuberculosis  can be summed up in the single word,
 prostration, chronic  or repeated, which embraces all  the conditions in-
  dicated as the starting-point of this disease.
    The hereditary predisposition, which is one of the prominent charac-
  teristics of this affection, finds, by this hypothesis, a satisfactory explan-
  ation.  This predisposition depends upon that singular impressibility
  which exists in all consumptive subjects;  who are, if such an expression
 can be used, machines  employing large amounts of phosphorus in com-
 bustion.
   If it should finally be demonstrated that not only the phosphorus is
 oxydized,  but  also deoxydized in the system, there will be an opportu-
 nity to discover how  prominent a place in the production of the disease
 is held by whatever can produce any disturbance in this process of re-
 duction of the phosphorized element.   Perhaps, on the ground of simple
 conjecture, we  have  a  right  to  hazard the opinion that  eventually the
 different varieties of disease can be  explained in  this way.
   In therapeutics, the  most important problem to solve,  in the present
 condition of science, is to conclusively determine the influence exercised
 over the different morbid states, either by the augmentation or diminu-
 tion of each of the approximate principles of the human economy, or by
 changes in the  properties  of the inorganic elements of the blood. '
   Chemistry will furnish, by analysis,  important facts upon this point
 if not direct conclusions.  In  default of this,  however, it  will be often
 possible to reach a solution of the problem by the single route of thera-
 peutic experimentation,  starting from the facts already known.
   The physiological and therapeutical action of  the majority of medici-
 nal agents, when that action is neither mechanical  nor chemical could
 be explained, in some  degree, by a species of substitution, analogous to
the law of substitution  in chemistry;  each of the constituents of the
system being  replaced  by  an homologous substance.   In  the same 
DEDUCTIONS.
93
manner, therefore, that there are homologous substances in chemistry,
there would be homologues  in  therapeutics.  It is probably in some
such theory that an explanation of the incontestible influence of arsenic
and  antimony, in consumption, may be looked for.  These substances
are,  in chemistry, the  homologues of phosphorus.   The therapeutical
effects  of iodine  and bromine,  are  also the  chemical homologues of
chlorine and fluorine.
  In future, the rational treatment of a diathesis will presuppose a cog-
nizance of the morbid condition which is its point of departure, as well
as of the proper means to cause  its disappearance : and it will  be well
understood that the specific treatment of the diathesis will not influ-
ence, except indirectly,  the physical  lesions already established ; but
that  their ulterior evolution will depend upon  the  action consequent
Upon CHANGES IN THOSE CONDITIONS OF  THE  SYSTEM, WHICH GAVE
BIRTH  TO  THE DISEASE.
END  OF THE  TREATISE. 
IMPORTANT CONSIDERATIONS.
  Consumption is well known to be, in popular phrase,  "a flattering disease;"
and not untU the physical signs are manifested in wasting, debility, cough, hectic,
sweats, &c, does the patient or his friends awake  to a sense  of  danger.  None
seem  willing to admit  that  the  malady which  is  slowly, silently,  insidiously
sapping the foundations of Ufe, can  be that dreaded, fatal  scourge;  and so,
ignorant of their true condition,  they procrastinate,  waste away,  and in a brief
period, fill premature graves.
  Whatever may have  been  the iU-success  of former methods of treatment in
pulmonary affections, by which Consumption came to  be  regarded as incurable,
it is now made certain that the Cause and the Specific Remedy have been
made known  to the  world through  the  patient researches  of  Dr. ChurchiU.
If, therefore, sufferers refuse  to  avaU themselves of the  means  which science
now offers  for the  Prevention and  Cure of this  greatest scourge  of  the  hu-
man race,  they become  the victims  of their own  neglect and unbelief  In no
malady, so surely as in  Consumption, is delay fatal to the patient.
  An early resort  to the  use of the Hypophosphites wiU.  by changing  the
diathesis, prevent  a development  op pulmonary disease  in those predis-
posed to it, and produce  a  speedy cure  in  the  incipient  stage; whUe,  in
every case, however far advanced,  relief  to some  degree is  certain, and  in  a
large  majority  of cases, cure  is the  result op the treatment.
  In  all Nervous  Diseases, the Hypophosphites are equally  the Specific Rem-
edy.  From their  action in strengthening the nutritive  function, and from
" their power  of relieving nervous  prostration,"  no  one suffering from  dys-
pepsia or debUity should hesitate  a moment  in resorting to their use.
  The  Summer is the most propitious time for  the  employment of the treat-
ment at its maximum: 1st. Because  "the patient should be placed under the
most favorable  atmospheric influences during  the elimination of the  tubercles."
2.  Because the patient's predisposition to an  inflammatory  state is less likely
to be aggravated by sudden changes.  And 3. Because  the time  of  recovery
is  related to the progress of sanguification,  and this can be  carried  to the
proper  point with more safety than during the rigor and change of winter. 
APPENDIX,
                         MEMORIAL

 Concerning  the  Treatment  of  Pulmonary  Phthisis,  and  the
   physiological and therapeutical action of  the Hypophosphites,
   by J. Francis Churchill :  presented to the Imperial Academy
   of Sciences,  May, 1858.   {Extract by the author)

   I have the honor to  submit for the consideration of tho " Academy" several
memoranda, giving the results of the  treatment of forty-one cases of Phthisis, by
the Hypophosphites, since the publication of my work, a copy of which I now lay
before it.  These results fully confirm all that I have heretofore written concerning
the efficacy of these preparations  in pulmonary phthisis: and it would be easy for
me to show that the ill success of other practitioners, in such cases, was owing
either, 1st, To the lesions pre-existing to the treatment which were of themselves
sufficient to cause death;  2d, To the existence of compUcations; or, 3d, To  the
impurity of the salts employed, and which were administered without regard to
the conditions I have laid down, and consider essential.
   I have no hesitation  in  saying  that, when these conditions are complied with,
the cure  of Consumption in the second and third stages, (at a period, therefore, when
there can be no doubt as to the nature of the disease,) is the rule, while death is
the exception.  I am also prepared to assert that, contrary to tho opinions gen-
eraUy received,  the  third  stage  of Consumption is, aU other circumstances being
equal, more  amenable to treatment  than the second.  Hereditary predisposition
seems in no way to counteract the curative powers of the Hypophosphites, as the
patients in whom it was most strongly marked, recovered as rapidly as  the
others.  I therefore  ask the opinion of this Academy upon the cases of disease, of
which I now present the notes of observation, (made before any decided result was
observed), in order that it may be able to determine whether the cases in question
were actually attacked with pulmonary phthisis.
   It is not alone as a curative agent, but above all as a prophylactic, that the
Hypophosphites should be employed in combatting a disease which, (as M~. Payer
has shown) is almost entirely unknown among nations in a savage state, but which
has become tho  permanent scourge of civilized life.
   Independently of  its  influence upon the public health, the final decision of this
question is of the highest scientific interest.   If the specific efficacy of the Hypoplws-
phites against tuberculosis were once estabUshed, we  should,  I think,  arrive at a 
96
APPENDIX.
solution of a problem which has much occupied the attention of both chemists and
physiologists, viz., the determination  of the state in which phosphorus exists in
the system.  We might then be able to decide, definitively, that besides the phos-
phate of lime, there also exists a "principle,"  or "element" containing phosphorus
in a condition capable of oxydation—(a theory which has already been advanced
in the works of different authors, especially those of Vauquemel, and M. Fremy
on " The Brain")—which "element" plays an  important part both  in  regard to in-
nervation, and  to  hematosis, or sanguification; and which would, perhaps, also
explain the intimate union between this first  function and the phenomena of gen-
eral nutrition, such as  calorification, &c, which has been incontestably proved by
the experiments of several physiologists, especially by those of Claude Bernard.
   This conclusion, viz.,  that phosphorus exists in the economy in an oxydizable
state, is confirmed not only by the results I  have already published, but also by
the beneficial effects which the use of the Hypophosphites have produced in those gen-
eral morbid conditions depending upon a defect in the power of innervation, or of
nutrition; such as chronic  bronchitis, asthma, spermatorrhea, marasmus, anoemia,
rickets, as well  as in  cases  of debility or prostration common to women during
pregnancy and  the  period  of lactation.   My own  observations, and  the  experi-
ments  I  am now making upon the  growth of young animals, also  indicate the
soundness of this hypothesis.
  I believe I was the first to point out, nearly a year ago, the importance of this
phosphoric element, and the relation which probably existed between the varia-
tion of its proportions and  the different  morbid conditions of the  system, more
especially of the tubercular  diathesis.   It  is, at least, indisputable, that I was the
first to draw from the probable existence of this element, a pathological and thera-
peutical induction, and  to demonstrate, by experiment, that whenever there was
reason to suppose a deficiency of oxydizable phosphorus existed, we had a rational
mode of supplying this deficiency by the use of such a preparation of Phosphorus,
as unites the two conditions of being In a state capable of immediate  assimilation,
and, at the same time, at the lowest possible degree of oxydation.  These character-
istics are found to exist in the Hypophosphites of Lime and Soda in the most com-
plete manner.
  The  theories  which I thus but briefly refer to, are discussed more fuUy in my
work, now presented to the  Academy, and form the  starting point of this memo-
rial.   If I allude to them in this paper, it  is  only because they form a component
part of a general theory of Physiology and Therapeutics;  and also, in consequence
of the presentation here of certain  considerations on the subject, professing to be
original, which  are only a  reproduction, almost verbatim, of my own__with  this
difference, that the agents said to have been employed are substances  the compo-
sition of which and their mode of  preparation are unknown, while  the Hypophos-
phites are positive and defined combinations, hitherto of no commercial value  but
weU known  to aU chemists;  and which, since  my discovery of their therapeutical
properties, in the treatment of Phthisis,  are employed, or experimented with
throughout the whole of Europe. 
APPENDIX.                          97
      LETTERS   FROM   DR.   CHURCHILL.

  [The following extract from a private letter is published with a view to fulfill the desire of
Dr. Churchill, expressed therein, "to induce the medical profession to give his treatment a fair
and complete trial," on the conditions laid down by himself. It will be found to contain a
comprehensive view of the hypothesis proposed by Dr. C, upon the truth of which the judg-
ment of the world is demanded.]

                                                     Paeis, December 17,1858.
   My Dear Sir :  *  * I very much regret my utter inabUity to send you a
copy of my work on Phthisis.  The whole edition was sold off in less than six
months, and it  has now been  out of print since  February last.   *  *  *  I am
now engaged upon a second edition, which has been delayed with the hope of my
being able to settle the question of the existence or non-existence, in the economy,
of phosphonis in an oxydizable condition.  The chemical proof of its existence, in
such a state, I now confidently hope I shaU shortly be able to lay before the pro-
fession and the chemical world.  *  *   *
   My views with regard to Phthisis may be  summed up in very few words, and
are as follows:
   Phthisis  is a diathesis, or general disease, depending upon the want or undue
waste of the oxydizable phosphorus normally existing  in the animal  economy.
Hence, it foUows  that  the remedy consists in  supplying the deficient element by
the administration of any preparation of phosphorus which is at once assimUable
and oxydizable.  Now phosphorus itself possesses the latter quality, and has occa-
sionaUy been used with success;  but it  has not the first,  and is so dangerous a
substance that it has faUen into complete disuse.  Phosphoric acid is assimUable,
but not oxydizable.
   The Hypophosphites combine both qualities in the highest degree, being perfectly
soluble,  and nearly as oxydizable as phosphorus itself; for which latter reason I
originally preferred them  to the phosphites,  which  are less so.
   As to the cause of Consumption, my hypothesis leads  also to one or two other
consequences of the highest importance in practice, viz., although  the Hypophos-
phites are the Specific Remedy of the  diathesis, they cannot cure, by  their own
direct action, the local diseases which the diathesis may have produced in the lungs
or elsewhere, previous to the employment of the remedy.  To expect the contrary
would be just as reasonable as to think  that  the water thrown  upon a burning
buUding can do the work of the mason or the  carpenter.
   The repair of such local disorder is brought about by the special energy of the
parts affected, and wiU take  place in aU  cases in which the destruction of the
parts involved has not gone beyond a certain extent.   The degree of the disease I
hold to be of less moment than the extent, and incline to go so far as to look upon
Phthisis in the third stage as of a more favorable prognosis than in the second, all
other circumstances being equal.  The prognosis of each individual case will, there-
fore,  depend upon two points—the extent of the existing lesion, and  upon tie
presence or absence of compUcations. 
98
APPENDIX.
   Another consequence, which is, if possible, of stUl greater importance than the
 cure of the disease, is the following:
   If Consumption depends upon the waste of the oxydizable phosphorus, it follows
 that the hypophosphites not only have a remedial, but a preservative power.   In
 fact, they are a complete prophylactic.  Such, I am confident, will prove  to  be the
 case ; and the time wUl come, I hope, when Phthisis and Tuberculosis,  instead of
 occupying the first place in the causes of mortaUty, wUl, like smaU-pox at  the
 present day, form a comparatively insignificant item.
   My reason for this confidence is not derived  from my assurance of the correct-
 ness of my  general theory, but from the invariable  efficacy with which  I have
 found them act in aU incipient cases, even of the acute kind commonly called Gal-
 loping Consumption.
   I am anxious that aU these assertions  should be verified by the medical profes-
, sion throughout the world.  With them, and them only,  does it rest to establish or
 to deny their vaUdity.   Unfortunately, the past history of our art shows that every
 discovery in therapeutics has been met with a storm of prejudice and opposition
 such as finds no parallel except in the records of reUgious dissension.  I might
 have much to relate on that head in my own case, but prefer leaving such matters
 in the obscurity to which posterity is sure to consign them.
   If, as you say,  the people of the United States take  an interest in my discovery,
 the  only way in which I should wish them to show it would be by inducing the
 Medical Profession among  you to give my treatment  a fair and complete trial,
 which, I conceive, can only be done upon the following conditions  :
   1. That no case shaU be considered to have any bearing at aU upon the ques-
 tion at issue, unless it be expressly shown that aU the conditions which I have laid
 down as necessary have been complied with.
   2. That in each case  not only the degree, but also the extent, of the tubercular
 deposit, preexisting to the treatment, shall be recorded,  together with the symptoms
 upon which this diagnosis is founded.
   3.  That the treatment used  shall be the Hypophosphites as I ha ye em-
 ployed THEM.   I DO NOT CONSIDER MYSELF IN ANY WISE  RESPONSIBLE FOR THE
 ILL  SUCCESS OF  EVERY CRUDE FORMULA WHICH MAY  BE IMAGINED BY OTHER
 PRACTITIONERS.
   As soon as my new edition is through the press, I shall have much pleasure in
 forwarding you a copy of it, and, meanwhile, I remain,
                            Tour very obedient servant,
                           J. F. CHURCHILL, 17 Boulevart de la Madeleine.
   J. Winchester, Esq., 43 John st., New York. 
APPENDIX.
99
          HYPOPHOSPHITES  OF LIME AND  OF SODA.

  [From the latest letter written by Dr. Chubchill in regard to his discovery, published in
 April last, tho following copious extracts are made.  It will be seen that the Theory first pro-
 mulgated by him is sustained by a most remarkable degree of success in his  own practice, and
 it may now be considered as an established medical fact, that the Specific Remedy foe Con-
 sumption has been found.  The success  attained by this treatment in all the countries of
 Europe, as woll as in the United States, has established the therapeutical value of the Hypophos-
 phites  beyond all controversy, and already raised the discovery of  Dr. Churchill above " the
 mists of controversy and prejudice into the serene region of scientific truth."—Publishes.]

                               NO. 17 BOULEVART DE LA MADELEINE, PARIS.
  Sir : From several communications which have appeared  in  your journal, and
 from the  number of letters I myself have received, it would seem that the treat-
 ment of Consumption, by the hypophosphites, is at present attracting considerable
 attention in America.  I have,  therefore, thought that the foUowing remarks might
 appear of sufficient importance  to occupy a place in your journal.   *  *  *
  In publishing  my discovery of the specific cure of Consumption, I was weU
 aware of the natural repugnance of the medical profession to adopt any new remedy,
 particularly when so many hundreds had  already proved unavaUing; and I knew
 that nothing could be a greater obstacle to tho general adoption  of the means I
 proposed than  the idea that I was actuated, in recommending it, by  a motive of self-
 interest.  I have, therefore,  from the very first, rejected every proposal to connect
 myself  in any way with, or to derive  any pecuniary benefit whatever from, the
 manufacture or sale of the hypophosphites.  I have thus renounced all right to a
 large, and, in the opinion of most people, a legitimate source of profit, because I
 look upon the  discovery of their therapeutical effects as a trust confided to me, not
 for my own benefit, but for that of my fellow-creatures.  Whether the course I
 have followed is tho best, time alone  can  determine ;  but I shaU have at least the
 satisfaction of knowing, that from no one sufferer wiU this  great boon have  been
 withheld from any fault or for any advantage of mine.   What I am anxious for is,
 that the hypophosphites should be brought, as speedily  as  possible, into universal
 use,  as  I know that they will prove not only as sure a remedy in consumption  as
 quinine is in intermittent fever, but also as effectual a preservative as vaccination
 in small-pox.
  This assertion no longer rests upon the thirty-four cases with which my discovery
 was  ushered into the world in July, 1857.   I can now appeal to the  results of up-
 ward of one hundred and fifty detailed observations of the disease, coUected dur-
 ing the past year at my public dispensary, Rue Larrey, Paris, where any member
 of the medical profession who has wished to take the trouble, has not only been
at fuU liberty to examine both the patients and the records of their cases, but has
also  had every opportunity of becoming acquainted  with aU the particulars of my
treatment.   To these cases might be added almost  an equal number from my pri-
 vate practice ;  and iu no single instance have  I found  the  remedy fail to produce
every thing that could reasonably be expected from it.   In  most instances the
benefit  derived from it has far exceeded what could at first have been hoped for, 
100
APPENDIX.
when taking into account the degree  and extent of injury sustained by the lungs pre-
viously to the use of the remedy.
   Similar results have, since the publication of my discovery, been announced by
Professors Parigot of Brussels, and Maestre de San Juan of Granada, in  Spain;  as
also by Drs. Jacinto Le Riverend and Galvez of Havana, and ReinviUiers of Paris.
It is true that by others, in  stUl greater numbers, the remedy has been declared
useless,  or even  dangerous;  but, in every instance in which more than a bare as-
sertion has been pubUshed, it would be easy for me to show that not only have the
experimenters neglected the rules I had laid down as necessary to insure success,
but have, in fact, violated the most elementary principles of scientific observation.
I wUl mention but one instance.
  In February of last year, after a trial at the Brampton Hospital for consumption,
in London, the hypophosphites were declared to be utterly useless  upon the fol-
lowing grounds:  the  remedy was  used  for one fortnight in twenty cases, eight of
which it is admitted improved during that period.  It was assumed, however that
this improvement was to be attributed to change of diet and regimen;  because, after
leaving off the hypophosphites, the patients, it is said, were found to improve more
rapidly under the use of cod liver oil and tonics than they had done before.
  Now it wUl strike every one that the trial of a remedy for  consumption,  during
one fortnight only, looks very much like a sham;  and the  suspicion is confirmed by
the haste with which the experiment  is left off, not only in the cases which are
stated not to have improved, but also in those which  are  aUowed to have done so.
As if further to perplex the matter, no time is aUowed for the effects of the hypo-
phosphites upon the system to work off; but cod liver oU is administered, without
any interval, and is credited for  the continuance of the improvement which is said
to have been observed.
  As no dates, however, are given,  we are left in the dark as to how  long this im-
provement was kept up after the discontinuance of the hypophosphites.  The same
discreet  sUence has  also, up  to  this day, been  observed with regard to the final
issue of  the  investigation.  Not one of the patients is stated to have  recovered
under the use of the remedies employed after the abandonment of the hypophos-
phites.   Two  of them are aUowed subsequently to have died, and of the fate
of the rest, nothing is  said; whUe,  on  the other hand, one of the patients  felt  so
much benefited during the first fortnight, that, when the hypophosphites were dis-
continued, he refused  to take any thing else, and left the hospital.  Upon such
facts as these I feel that aU comment would be superfluous.   Tour readers will
find the original document in the London Medical Journal for February 13th 1858.
An answer to it was published in the London Medical Circular of the 7th of April.
  I can  confidently assert, and will prove in the forthcoming edition of my work
that every refutation of my views which has yet appeared, rests upon no better
foundation than the preceding; a fact which is mainly to be attributed to the pres-
ent unscientific condition of pathology and therapeutics.   No  astronomer, no nat-
ural phUosopher, no chemist would be aUowed to impugn the  results arrived at by
another  unless he were able to show that, in his own experiments or  observations
he  had  kept account  of all the conditions of the problem.   In medicine, on the
contrary, nothing is commoner than for a physician, who has  often merely ascer- 
APPENDIX.                         101
tained by hearsay that a given remedy has been used in a given disease, to suppose
that all he has to do is to make up his mind as to  tho  name of the disease, and
then get his patient to swaUW a certain dose of the  drug.  Such conduct wUl ap-
pear the more preposterous if we reflect that the phenomena of life, and stUl more
those of disease, are of a much more complex order  than those  of inorganic mat-
ter ; and, as such, require for  their production a much greater  number of condi-
tions, the neglect of any one of which wUl prove fatal to the result
   *  *  *  The subject is  one of considerable  difficulty, partly owing to the na-
ture of the question itself, and partly to the views at present  prevaiUng in pathol-
ogy.  I again, however, reiterate the  assertion with  which I first announced  my
discovery, viz., that in aU cases where a cure is not effected by the use of the hy-
pophosphites,  the reason of this Ul success wUl upon examination, be found to de-
pend on one of the following causes:  either the  salts are impure, or they are  not
administered according to the rules I have prescribed, or the patient is suffering
from a complication of some other disease; or, lastly, the extent of lung  already
involved by the tubercular deposit is  too great to aUow of recovery taking place.
   If neither of these last two considerations exist, the degree or  stage of the mal-
ady is comparatively of secondary importance.  Out of  twenty-two cases  in  the
third or last stage treated at my dispensary during the past year, eight have com-
pletely recovered, eight have died (owing in every instance to some one of the  last
two mentioned causes), and  six are stiU under treatment  Such a result  is alto-
gether unparaUeled in the annals of medicine, and I hope Bhortly to lay it before
the medical world, along with several  other  instances of the same* kind from my
private practice.  For the present, I wish to confine myself to a subject which is
not only, if possible, of more  general interest, but which may be sufficiently di-
vested of technical particulars to  be inteUigible to the general reader.   I mean the
prophylaxis, or prevention of consumption.
   The prevention of disease has,  of late years, been  the  object of a great^amount
of study; but this has chiefly been directed towards hygienics, that is,  the preser-
vation of health;  and not toward prophylactics, or the prevention  of  disease.
Progress in the former direction wUl be mainly dependenfcupon the spread of civ-
ilization, and upon improvements in the manner of Uving^ in the  latter, it can only
proceed from  the  advance of medicine itself as a science.  Although by far  the
most useful branch of it, prophylaxis, has  been as  yet  but  little cultivated, it is
chiefly because the physician is usually so entirely engrossed with  the phenomena
of actual disease, that he has  neither  time nor means to attend to any thing else.
The dominant views in medicine are also  almost completely opposed  to progress
of this kind • and to crown all, the interest of the profession Ues exactly the oppo-
site way. Thus, what ought to be the true aim of medical science is that to which
least attention is paid.   The greatest discovery of the kind  hitherto made—per-
haps the greatest discovery in medicine—is that  of vaccination, whose efficiency is
such that the ravages of smaU-pox are now, so to speak, only a matter of  history.
The time, too, wiU come, when consumption, instead of slaying, as  it now does,
nearly one-sixth of the whole  human race,  and  more than  one-half of the adult
population of most civilized communities, wUl dwindle  down to an insignificant
item in the causes of mortahty.   I am afraid, however, that it wiU not be until at 
102
APPENDIX.
 least two generations of the medical profession have passed away, that this result
 wUl be attained, and that  my discovery wiU rise above the mists of controversy
 and prejudice into the serene region of scientific truth.
   If, as I assert, the hypophosphites be the specific remedy of phthisis, because
 one at least of the  essential conditions of that disease consists in the want or the
 undue waste of the oxydizable phosphorus in the animal economy, it follows that
 consumption wiU be prevented simply by taking care to keep the system suppUed
 with a due amount of that element   Now, if there existed any certain signs or
 symptoms by which we might recognize either that phthisis is impending, or that
 the  phosphorized  element is deficient, the prevention of the disease  might be
 effected with perfect certainty.
   Unfortunately, such is not  the case.   The same  causes which have tended to
 keep physicians unacquainted with prophylaxis, also act to make them compara-
 tively ignorant of cetiology, or the science of causes, and of the premonitory signs
 of disease.  On the other hand, chemistry, although it has of late outstripped al-
 most all  the  other  sciences, is far from having  arrived at the degree of minute
 accuracy which would be requisite for the solution of the second form of the prob-
 lem.  Still, there are a certain number of signs by which the advent  of phthisis is
 usuaUy announced,  and when  the whole series of those I am about to enumerate
 is met with, there  can  seldom be any doubt of  the fatal nature of the disease.
 These symptoms are  frequently so weU marked as to draw the attention even of
 the uninitiated.  In  many instances, however, some of them may be but faint, 01
 they may be  latent for a time; most of them taken severaUy are  also to be met
 with in  other disorders.  I would therefore earnestly advise every sufferer,  in all
 cases where it is possible, to take the advice of a competent physician, and, above
 aU, of a practiced stethoscopist.  What  upon a superficial view may have seemed
 only a forewarning, wUl, upon due investigation, but too often be found to depend
 upon advanced lung disease, either  overlooked for want of examining the chest
 or undetected from a deficiency in the practice of auscultation.
  If, without any apparent cause, or under the  influence of causes which induce
 weakness or  exhaustion, such  as want, grief, overwork, excess, pregnancy, child-
 bearing, nursing, rapid growth, slow recovery from other diseases, a person begins
 to lose his .flesh, strength, color, or appetite—if he suffers from shortness of breath
 or sleeplessness, and experiences a general feeling of languor and depression—there
 is reason to fear that he is already predisposed to the complaint.  If to these symp-
 toms  be added a cough, however sUght, particularly if it has come on slowly, or
 during the fair season, the probability is stUl greater.  If with  all this, there is a
feverishness toward evening, with sweatings or clamminess at  night, particularly
about the head or neck,  if spitting of blood should occur, it is likely that  the dis-
ease has already reached the stage at which it shows itself by deposition of tuber-
 cular matter in the lungs.
  The import of these signs wiU be heightened should they occur about the period
of puberty, or between  the ages of fifteen and  thirty-five, especiaUy in a person
whose family has been simUarly afflicted.  Now, if, on the earliest appearance of
these symptoms, especially of those first enumerated, the patient takes daUy about
ten grains of  the hypophosphite of lime, or of the hypophosphite of soda, he wiH 
APPENDIX.
103
usuaUy see aU these signs disappear in a period varying from  a few days to a
month; and by continuing the occasional use of the  remedy he wUl speedily find
himself in the enjoyment of such health as he perhaps had never  known in his life
before.  Ten grains daily is the safest dose  for  an adult  male, though  sometimes
double that amount must be given to produce the proper effect   For females, par-
ticularly if deUcate, and for chudren, the dose must usuaUy be much smaller. The
younger and the more sensitive the patient, the  more readUy is he influenced, and
the dose should, therefore, decrease in higher ratio than the age of the subject
Thus for infants it should seldom exceed one-fifth of a grain every second or third
day.
  After the remedy has been used for about a week or ten days, it will be safer to
omit it for  three or four days together, then to  resume it, and again leave it off
after the lapse of another period Uke the first.  It should thus be continued from
time to time, as long as it may appear to be required, remembering, as the patient
improves, to diminish the frequency of the doses.  When he has regained his usual
state of health, it wiU be sufficient  for him to take one or two doses a week, unless
they should be found inadequate to keep him up to that condition.  The treatment
should be left off upon the first appearance of fullness of blood, with a determina-
tion towards the head, which wiU usuaUy be known by giddiness  or singing  in the
ears, and especiaUy by bleeding from the nose, however slight.   It should (except in
some few eases), never be used during the acute period of any inflammatory dis-
ease of the lungs, whether primitive or  supervening as a complication of phthisis
These directions wiU be found sufficient in the  great majority of instances,  but it
would  be impossible for me to go into the details necessary for the treatment of
different temperaments and constitutions, without trespassing upon your indulgence
to a greater extent than might be found convenient   *  *  * The best time for
administering it is at breakfast along with the food.  The pure hypophosphites have
a taste very simUar to that of common salt, and if given as  directed the dose is
nearly  tasteless.  No other drug or medicine should be  combined with them, or
used at the same time.   The  salts of lime and soda are the only preparations
which, for the present, I would recommend for  general use.   Lastly, as a general
caution, I would observe that if the hypophosphites have been  used for two  or
three weeks in sufficiently large doses without producing any improvement in the
patient's appetite, strength, or general appearance, this wUl, upon due  investiga-
tion be found to depend upon one of the  causes I have already  named
  I here close this over long  letter, which I would fain have shortened if I could;
and to conclude I would beg of the press generaUy throughout the United States
to urge upon the medical profession the vast social importance of  this question, of
which  I am  but a  weak  and far too  unworthy minister.  WUl my professional
brethren, on your side of the Atlantic, aUow me to remind them that in therapeu-
tics, as in every other department of experimental research, no number of negative
instances can outweigh one single  positive result, obtained under  certain determi-
nate conditions, unless it  be at the  same time  shown that,  in  the negative in-
etanoes all these conditions have been expressly complied with, or that  they have
been omitted because they are of themselves unattainable ?
  I submit, that in no single  case,  in which the  hypophosphites are stated to have 
104
APPENDIX.
been unsuccessful, has this fundamental principle  been observed, or appears even
to have been'understood.  In no negative case yet upon record have I been able
to discover that the investigator's  acquaintance with my views of the  treatment
of consumption extended beyond the mere fact, that the hypophosphites had been
used by me at a certain dose.
  WUl my brethren pardon me if I remind them that antimony, bark, ipecacuanha,
hemlock, vaccination, the ergot of rye, etc., were not  only neglected, but for years
(antimony for one whole century) condemned and proscribed by the mass of the
profession, not because their medical action was slight or equivocal, but because
FEW OR NONE WOULD BE  AT THE  TROUBLE TO  INQUIRE INTO, OR LEARN THE
CONDITIONS BY WHICH THAT ACTION WAS GOVERNED?
                            I remain, sir, your obedient servant,
                                      J.  FRANCIS CHURCHILL, M. D.
                   [FROM THE  LONDON  MEDICAL  CIRCULAR.]

                    ON  THE HYPOPHOSPHITES.

   Sir,—In reply to the inquiry of your correspondent, " Dr. W. J.," I beg to in-
form your readers that the dose of the hypophosphite which I have found the most
manageable is ten grains at first, increasing it gradually up to one scruple dafly.
This quantity I seldom exceed, though in  some cases I have used larger doses with
benefit.  ChUdren, under four years of age, can seldom  take  more than from one-
fifth to two-fifths of a grain daily.  In aU  cases, however, with this  as with any
other remedy, the physician must watch  its effects upon the system, which vary
with the idiosyncracy of the individual.  To be used with effect, the hypophos-
phites must be perfectly pure; otherwise they may, in some cases, appear alto-
gether inert or even injurious.  In five cases out of six the salts usuaUy sold pure
in Paris, under the name of hypophosphites, are  totally unfit for medical use.  I
am sorry I have not time at present  to enter more  fuUy into  particulars, but shall
endeavor to do so completely in one of my earhest letters.  The hypophosphite of
soda having, when pure, nearly the same  taste as common salt, may be given in
any form.   I usuaUy prescribe each dose to be taken in a tumbler-fuU of sweetened
water, or sweetened milk,  or wine and water, or broth,  or any other drink that
can be taken at breakfast or dinner.   I use no other treatment of any kind unless
required by the existence  of complications, such as intercurrent  inflammation of
the lungs, diarrhoea, cardiac disease,  etc.               I remain, &c.
                                             J. FRANCIS CHURCHILL.
  17 Boulevart de la Madeleine,  Paris, AprU 24th, 1858. 
APPENDIX.
105
          THE  PHOSPHATES  AND  HYPOPHOSPHITES.

                           BY L. V. NEWTON, M. D.

   To the numerous inquiries addressed to us, in relation to these salts, we answer
 as foUows:  phosphates, as the name  implies, are  compounds of bases with phos-
 phoric acid.  This acid is a compound of 5 equivalents of oxygen, with 1 of phos-
 phorus, united with 1, 2, or 3 equivalents of water, the latter being the most com-
 mon form.  Bone consists in  part of phosphoric  acid combined with lime;  this
 phosphate of Ume constitutes the solid, or what is caUed the inorganic part of the
 skeleton.  Phosphates of iron, of soda, and of potassa, are also constituents of the
 system;  the two latter are much concerned in digestion.
   The salts of  hypophosphorous acid are very different in composition and proper-
 ties  from the foregoing; the acid  contains 1 equivalent  of oxygen to 1 of phos-
 phorus and 2 of water; instead of being so firmly united together as to resist the
 action of heat and chemical agents, these salts readUy change, giving off phospho-
 retted hydrogen, or, in contact with free alkaU, are decomposed into phosphates and
 hydrogen gas;  they thus seem to have the power of supplying the phosphorus in
 a nascent or spontaneous condition, which  so mysteriously enters into the compo-
 sition of the brain and nervous system.  The hypophosphites, taken as a class,
 seem to possess the power of increasing  nerve force, and promoting the function
 of nutrition.
   In supplying phosphates to the blood they act only secondarily, their  primary
 influence being  upon the nervous system.  Dr. Churchill,  who first brought them
 into  notice, lays claim  to them as specifics in pulmonary consumption, alleging that
 the progress of  this disease is altogether due to a waste of phosphorus.
   Whether this be true or not, there can be Utile doubt of the value of these rem-
 edies as tonics and alteratives.   Their anodyne effect is sometimes quite remarka-
 ble ;  when taken for sometime they tend to produce most refreshing and renovating
rest.
  The general health  of consumptive  patients is frequently greatly improved by
their use, and we  have no doubt they have,  in very  many instances, prolonged
life, and even restored  health to persons quite wasted by consumption.—Chemical
 Gazette. 
106
APPENDIX.
                               BRONCHITIS.

  [The following general remarks on this complaint are from a popular work by Dr. Samuel
 Fenwick, on the " Causes and Prevention of Diseases." The Hypophosphite of Potassa, for its
 stimulating and expectorant effects upon the mucous surfaces, as well as its constitutional ac-
 tion upon the nervous system, is particularly indicated in the treatment of this complaint We
 put up a special preparation of this salt in cases of Bronchitis and Asthma.]

   When the inflammation of the larynx, which produces the symptoms of a com-
 mon cold, extends downwards so as to affect the bronchi, or air tubes of the lungs,
 it receives the  name  of bronchitis.  It is very necessary that public  attention
 should be directed to this complaint, not only on account  of its great frequency,
 but also because, when it often recurs, it produces  other changes in the structure
 of the lungs  tending to destroy life.
  But it is not only from its fatality that it demands attention, but from its laying
 the foundation for subsequent attacks of asthma, heart  disease, and other com-
 plaints of a like fatal  character.   It is one of the most  common and distressing
 complaints of chUdhood; it  affects the  artisan in almost  every branch of trade,
 lessening his powers of labor, and often embittering his existence; whUst in old
 age it is of the most frequent occurrence, and very generally terminates fatally.
  Bronchitis consists in inflammation of the bronchial tubes, and the symptoms
 of the complaint chiefly arise from the air not getting free entrance into the lungs.
 The changes produced by bronchitis  vary according to the  stage of the disease.
 In its earlier  stages the mucous membrane is usuaUy of a red color, from its con-
 taining an unusual quantity of blood.   When  examined  by a microscope the ves-
 sels are seen to be enlarged  and  overloaded.   The membrane  itself is generaUy
 thickened, and the epithelium removed, either whoUy or in  part; the cavity of the
 tube is also filled with mucous.
  The symptoms of the complaint will be readily understood by the above descrip-
tion.  The expectoration, which takes place in the earUer stage, consists of the
epitheUum, which has  been  stripped  off by the inflammation.   Afterwards, how-
ever, it  is secreted by the raw surface of the mucous  membrane, and in  long
standing cases is often  as thick as that expectorated in consumption.  The loss of
the epitheUum readily  explains the feeling of soreness which the air often occa-
sions when it enters the chest; and as the natural use of the cilia is to move up-
wards any secretions in the tube, it wiU be readily understood that the expectora-
tion wUl be apt to  accumulate until expelled by coughing.  But if the  tubes are
thus blocked  up, it  is  plain that the air cannot be so easily forced into  them  as
when they are in their natural condition, and hence  the difficulty of breathing so
generaUy observed in this complaint
  In childhood  the effects of bronchitis differ  materially from those observed in
later periods  of life.  The lung is often seen shrunken and deprived of its air and
death consequently ensues.
  In older persons, bronchitis  often lays the foundation of  incurable disease • tho
powers of breathing being so  much stronger than  in  chUdren, there is but little 
APPENDIX.
107
danger of the tubes becoming so obstructed by the expectoration as to prevent aU
passage of the air.  It often  happens, however, that the tube is so narrowed that
the air escapes from the cells  with great difficulty ;  they therefore become unnatu-
rally distended, and, by the increase in their  size, the blood-vessels around them
are pressed upon, and partiaUy obliterated.   In this way is produced a disease
technically caUed emphysema, which forms a  large proportion of the cases  popu-
larly known as asthma.
  Occasionally the bronchial  tubes themselves become  greatly enlarged after an
attack of inflammation.  Their mucous membrane becomes  thickened, and a train
of symptoms is induced precisely  simflar to those of consumption.
  Bronchitis is so frequent in old age, that few persons reach an  advanced period
of life without suffermg in some degree from it.  Some are attacked as soon as the
winter commences, whilst in  others it  causes no  more  inconvenience than an in-
creased secretion of phlegm.
                                 ASTHMA.

  The term Asthma  is usuaUy applied to any case in which the patient suffers
from extreme or long-continued difficulty of breathing.  A person is said to have
asthma who is subject to sudden  and severe attacks of difficulty of breathing,
which, after a short time, disappear, and in the intervals  leave him in the enjoy-
ment of health.
  "Asthma," says Dr. Fenwick, "arises from violent  action of the muscles sur-
rounding the bronchial tubes.   The existence of muscles in this situation was long
doubted by physiologists; but experiments upon animals have satisfactorUy proved
their presence.   It wUl be easy to understand that if the diameter of the  tubes
leading into  the  lungs is suddenly diminished by the contraction of the muscles
surrounding  them, intense difficulty of breathing and a feeUng of suffocation is
the result.   Consequently, during an attack of the asthma, we find the unhappy
sufferer laboring for breath; fixing his hands on any object near him, so as to en-
able him to expand his chest to the uttermost; or often lying with  his head  out
of the window to catch every breath of cool air."
  Dr. Hyde Salter, in  a  paper  published in  the July number of the British and
Foreign Medico-Chirurgical Review for 1858, gives the foUowing graphic descrip-
tion of a paroxysm of asthma:
  "The asthmatic's breathing is what our forefathers  caUed  'strait,' what we caU
1 tight •' he  feels  as if a weight were on his sternum, as  if his chest were com-
pressed • as if a cord  bound  him; as if it would be the greatest  relief to him if
some one would cut his breast open and allow it to expand;  he rushes to the win-
dow to get air: he cannot tolerate people or curtains about  him;  his clothes  are
loosenel and aU the muscles of respiration tug and strain their utmost to fill his
chest.  But he can neither get  air in or out;  he  can neither inspire nor expire;
his  respiration  is  almost  at  a  dead-lock; he cannot  blow his nose, can hardly
cou"-h  or saeeze, cannot smoke a pipe, and  if his fire  is  failing, cannot blow it
ud •  he ha& l/asrdiy eir enough to produoe the laryngeal vibrations of speech.   The 
108
APPENDIX.
 chest is distended, indeed, to its  greatest possible limit; the cavity of the thorax
 is enlarged both in the costal and diaphragmatic directions;  the costal  distension
 is shown by the fact that a waistcoat that would ordinarily fit, wiU  not  meet over
 his chest by two inches, while the descent of the diaphragm  is  shown  by the in-
 creased girth of the abdomen, and by the heart being drawn down to the scrobic-
 ulus, where it is seen beating plainly ; such  are the violent  instinctive efforts of
 the respiratory muscles to overcome the obstruction to the access of air.  But they
 are unavailing.  The air that is  without  cannot get in, and  that which is within
 is locked up.  In spite of the violent muscular  effort, there is hardly any respira-
 tory movement; the parietes of the chest cannot follow the action of the muscles;
 on listening  to  the chest, the respiratory murmur is inaudible, even  when not
 drowned by the wheezing; respiration is almost nil.   *   *  *  Thus we see by
 evidence as certain as sight, that in asthma, bronchial spasm  must and does exist,
 and that no other conceivable supposition wUl explain the phenomena."
   Dr. Salter  states  that " Asthma is essentiaUy, if not exclusively, a nervous dis-
 ease ;" that the extent to which the nervous system is involved differs very much
 in different cases, being in some cases restricted to the nervous system of the air-
 passages themselves ; other cases, in which the source of irritation, giving rise to
 the asthmatic paroxysm,  appears  to be central—in the  brain.  The  causes of
 asthma are seen to be such as affect the  nervous system,  and which give rise to
 other diseases acknowledged on all hands to be nervous.   Asthmatics are very
 commonly dyspeptics,  and often exhibit symptoms of perverted and  capricious
 stomach action,  that suggest  the belief  that the innervation of the whole of the
vagus is vitiated, its gastric as weU  as pulmonary portion, and that the dyspeptic
and asthmatic symptoms are but parts of a whole.
   Dr. Churchill  states  that the hypophosphites " should  be  employed in aU ner-
 vous diseases," possessing, as they do, the "power of relieving nervous prostration,"
or whatever produces any disturbance in  the blood-generating processes.   It is evi-
dent, from the particular action of the hypophosphites in strengthening the nu-
 tritive functions, and in increasing the nervous  energy, that they may be
considered the most efficient remedy in dyspepsia, or indigestion, as also for asthma.
 The Hypophosphite of Potash is considered as more particularly indicated in the
treatment of this distressing complaint
           CHEMICAL PATHOLOGY  OF THE  BRAIN.

  Chemical and pathological research has established that in certain depressed and
deficient conditions of cerebral and mental power, there exists in the brain the
minimum amount of phosphorus.  The  brains of idiots have been found entirely
destitute of this chemical agent. A simUar deficiency is perceived in advance of
age, and in the early periods of life, when  the  encephalion is supposed to be en-
tirely in an inactive  condition, or not, as far as the intellect is concerned in a ma-
ture state of development.  When carbon exists to excess in the blood the cere-
bral power is depressed, owing, it is surmised, to the  excess of carbon  and soda
interfering with that union of phosphoric acid and the fatty matter of the blood 
APPENDIX.
109
necessary to the perfect organization of healthy nervous  tissue.  Nervous matter
is formed in a manner analogous to that in which bile  is produced, either, as Lie:
big suggests, by the separation of a highly nitrogenized compound from  the ele-
ments of the blood, or by the combination of a nitrogenized product of the vital
process with  a non-azotized compound—probably fatty body.   It is the  duty of
those especiaUy engaged in the investigation of idiocy, insanity, and  other affec-
tions  of the brain and mind, to ascertain, by a series of carefuUy executed  ex-
periments,  whether the alco-phosphoric acid and other essential  and important
brain elements do not, in certain conditions of nervous Ul-health, pass rapidly out
of the system in the various excretions.  Of the actual deposition of nervous mat-
ter in the urine, there can be no doubt.  The microscope at once detects  it.—Tri-
bune.
                            CONSUMPTION.

  From the report of the  Registrar-General of Great Britain, for 1856, we learn
that the total number of deaths were 390,506 ; of which, 94,407 were infants un-
der one year of age.  The deaths  from diseases of the respiratory organs were
116,740, nearly one  third of the total number.   Of these, consumption claimed
48,950; bronchitis 21,528; pneumonia,  22,653.   The Registrar remarks, in re-
gard to the great mortality of consumption :  " How many of the thousands of
deaths are to be ascribed severally to the fatal stays and the in-door Ufe of women
it is not easy to calculate.  Air  is the pabulum of Ufe, and the effects of a tight
cord around the neck and of tight lacing around the waist, differ only in degree,
in the time of their manifestation, and in some of their symptoms.   To wear tight-
laced stays is, k) many cases, to wither, to waste, and to die."
                      THE  HYPOPHOSPHITES.

  As a source from which to supply phosphorus to the system, the hypophosphites
must be regarded as of the highest importance.  What phosphoric acid may have
faUed to do, in supplying the waste of phosphorus, it is  almost certain that these
salts, containing a much less amount of oxygen, are  capable of accomplishing.
  Dr. ChurchUl, to whom we are indebted for calling  attention to them, is confident
that " they wUl  occupy one of the most conspicuous places in materia medica."
Although specifically prescribed for Phthisis  by Dr.  ChurchUl, it is evident that
their beneficial effects  are not limited to this one variety of disease.  They  would
seem to be most appropriate remedies in a large  class of affections resulting from
LOSS OF  nervous  force ; also in many of the diseases of infancy, where there is
want of vital action, and where the osseous system is'defective.
  These salts are more or less deliquescent,  and therefore rr is important they
should be combined in the form of syrup, and thus placed under the protection of
some agent capable of preserving them from change.—Boston Surgical Journal. 
                WINCHESTER'S

                        genuine  preparation  of the


 HYPOPHOSPHITES

                  OF   LIME   AND   OF  SODA.

          PREPARED ACCORDING TO THE FORMULA  OF  DR. CHURCHILL.

  The repugnance not only of the medical profession, but also of the community, to adopt a
new remedy, when so  many hundreds had proved unavailing in the treatment of consumption,
is obviously very great  As inquiries  are often made, whether I could point to reliable evi-
dences of the efficacy of itce hypophosphites, and as reports have been industriously circu-
lated, by parties interested  in producing a false impression, that the beneficial eesults  of
their use have been confined almost entirely to the practice of the discoverer, I have therefore
thought proper to submit to the unprejudiced consideration of the reader, the following extracts
from the medical journals of the  United States, from the letters addressed to me by physicians,
and from my general correspondence.
          EXTRACTS FROM THE MEDICAL JOURNALS.

  "The use of that class of salts known as Hypophosphites, offers the most direct and philo-
 sophical  means of supplying the phosphorus to the system. The  small amount of oxygen in
 combination with this element in the hypophosphorous acid which unites with the alkaline car-
 bonates, the bases of these  salts, is favorable to easy decomposition  in the economy.  By
 the changes which eesult from fuethee oxydation, nascent phosphorus and phosphorates
 are liberated.   The phosphorus thus set free is certainly in a condition most favorable to the
 fulfillment of its design and high office in the beain and neevous system."__Boston Medical
 ana Surgical Journal. (De. Nichols.)

  " Whatever may be our conclusions with reference to the  claims of  Dr. Churchill for  the
 Hypophosphites as sovereign remedies in tuberculosis, meee can he no doubt as to thb
 value of these  salts as  eemediax agents."—American Medical Monthly, (N. Y.)
  "We now see  the rationale of the employment of the Hypophosphites of Lime and  Soda,
 recommended  by Dr. Churchill, in the treatment of consumption—thky not only act as
 absorbents, but  eepaie oa eetaed the waste of tissue."—H. P. De Wees  M  D  New
 York {in  the American Medical Monthly).                                 '   '   "'

  " The recent recommendation, by Dr. Churchill,  of the use of the Hypophosphites in  the
 treatment of Phthisis, is now undergoing  a general test by the medical profession  *  *  *
 From my own  observation and inquiry, patients using  the hypophosphites have experienced
 marked relief from many of the annoying  symptoms attendant upon Phthisis."—J  Lawkev™
 Smith, M. D., Professor of Chemistry in the University of Louisville."   (From the Louisville
 Medical News).

  " This medicine is scientifically prepared, and reliable.  We have used it in our  own Draetire
 in phthisis pulmonalis, and  other forms of  disease, with very satisfactory results   *   *  *  In
 sixty-eight cases jp. which  this remedy was  given,  thirty-seven were in the inciDient and
 twenty-three in the second and advanced stages of consumption; the remainder were bevnr.,1
 hope.   With the  exception of the latter cases, which were much benefited  all but Tmwn
 which are still doubtful, eecoveeed perfectly."— North American Medical Reporter,.  [Dr!




     EXTRACTS FROM MY  MEDICAL  CORRESPONDENCE.

  "I learned that  a druggist in Springfield  had some of your preparation, and immediatoW t,™
 cured it, to use in two cases in which I had been using Parrish's. It is but iusr  t     +i.
marked improvement was the immediate result.  I have  one case of tuberculosis  ' tiay   * a
 stage, and, to use the patient's  own expression, he is  'coming out all right' mid   second
days' treatment with your medicines.  I learn of another in Springfield  an old  ™ aer a Tmf
 six years, who has been under many physicians, and, among the rest Dr Grepn  f   ^ome
notoriety.  He has used the Hypophosphites, and  pronounces n'mtr, „  .  '    ProDang
—A Physician,  at Rochester, III.                               himself a well man."

  " The hypophosphites, as  far as I have used them, have acted well  ver      y,
me, and curing my little boy, who was suffering from marasmus with a do™/,?1'!   relieving
thesis.  In the other cases in which I have  used the remedy, a marked improtlne^TalUhi, 
APPENDIX.
Ill
mpnpUmis has been noticed.  *  *  *  I am led to believe it one of the veby kest remedies
In Tuberculosis that we possess.  The night sweats cease, the appetite improves, the blood is
enriched in those constituents which are so essential to health, and which are deficient in those
persons predisposed to consumption, viz., organizable fibrine and healthy red corpuscles."
—A. Hued, M. D., Oxford, la.
  " I have used the Hypophosphites, principally in tubercular disease, but also in Chlorosis, and
in diseases attended with nervous debUity.  I consider them the most efficient blood-generating
agents with which I am acquainted, and believe they also exert an important influence directly
on the nervous system, of a tonic character.  They exert an important remedial influence over
tubercular disease, by improving  the neevous strength and invigorating toe nutritive
functions.  Combined judiciously with air and exercise, care  being taken to keep the bowels
and skin in proper condition, they  seem to me to be invaluable."—A Physician, Monistown,
N. J.
  " I have been superintending the use of your Hypophosphites in a well-marked case of incipi-
ent hereditary tubercular phthisis,  and  have never known a case of the  kind improve
MOBE EAPIDLY IN THE SAME LENGTH OF TIME."—F. H.  HAEWOOD,  M. D., RushvUle, N. Y.
  " Your preparation has not failed to benefit in a single instance in which I have used it."
—W. F. Claek, M. D., Lowell, Ohio.
  "A patient of mine, who has been  suffering with disease of the lungs for several years past,
has been using Churchill's Hypophosphites for some six weeks.   There has  been a marked im-
provement in his case, which was manifest soon after he began  the use of the medicine."
—J.  G. McPueetebs, M. D., Bloomington, Ind.
     EXTRACTS FROM  MY  GENERAL  CORRESPONDENCE.

  -' My wife has taken two bottles, and commenced on the third ; and has received such great
benefit that I am now of the opinion that it will effect a cure.  She is comfortable, rests weU at
night, has a good appetite, and is gaining strength and flesh, to the astonishment of
ALL THAT ABE KNOWING TO HEE SITUATION."—JOHN IlEFNEE, Delhi, Iowa.
  " My general health has undoubtedly improved since this remedy has been used.  *  * * The
cough is greatly abated, and the matter discharged is compaeatively trifling.  * * *  Un-
less some sudden turn should take place in my condition. I trust, by a continuance of your med-
icine, I shall be able once more to caU health mine."—Thos. Slussee, Evansport, O.
  "My worst feature was debility, with loss of flesh, attended with irregular pulse ; and these
certainly are regaining their former condition.  Also, I  had severe cough  during the day, and
worse at rising in the morning.  Now, I seldom cough during daytime, none in the night; for
I generally sleep  soundly, and very little in the morning."—Thos. J. Caldwell, Jackson-
ville, III.
            Extract from a letter dated " Washington, D. C, June 8th, 1859.
  " I gladly give my approval of yonr ' Preparation.1  *  *  *  I have taken six bottles; it has
produced a wonderful improvement in my health, not only in removing all irritation in
tub broniuial membrane, and the tightness in the upper part of my lungs, but  also in  thb
tone it has given to my whole system. I had, at first, a slight cough, and very  little expec-
toration.   This is all gone,  and my health now is as good as ever, so far as I can judge.  Still,
your preparation acts so beneficially on the bowels, keeping  the system in good order, and in
allaying nervous irritation, I shall continue its use occasionally."  [The name of the writer
is at the service of any inquirer.]
  "My appetite has increased to  a  great extent, my bowels become perfectly regular, and my
Bleep improved decidedly, so  that I do not hesitate to  say I  have rested with more comfort
during the last two months than I have before for more than  two years.  From the use of the
Hypophosphites I have been relieved of all foreign, unpleasant feelings in my chest and right
side.  I  now lie and sleep upon either side, with equal convenience, and my health 13 improv-
ing, beyond all doubt, in the most  rapid manner possible ;  and my many friends, 1 am sure,
will soon hear of' Richardson being himself again.' "—Nathan Richardson, Warren, Mass.
  "I must say it is doing all it is  recommended for, and much more than was anticipated
by those  who had faith enough to  give it a trial."—M. R. Knapp, North Stockholm, N. Y.
                Winchester's  Genuine Preparation

of the Hypophosphites is put up in larse bottles, with the  following words blown in thb
glass • " Dr. J.  F. Churchill's IIypophospuites of Lime  and of ^oda.  J. \\ inchestee,
New York."  Each bottle has my Fac-simile signature.  No other is genuine.
  KsF" The Phosphates, or " Chemical Food" (so called") are  radically different from the Hy-
pophospiiites, and CAN IN NO CASE  BE USED AS SUBSTITUTES.  Bear this fact in mind.
  &tf- Price $2 or three bottles for $5, with full directions for use.  A liberal discount to
physicians and the trade.  The Dry Salts furnished to the profession.   Single bottles in con-
centrated solution sent by mail, when specially ordered,  bold, wholesale and retail, at the
bole General Dep6t in the United States, 43 John street.
                                 Address,           J. WINCHESTER,
                              American and Foreign Agency, 43 John street New York. 
WINCHESTER'S  GENUINE  PREPARATION
CAN BE OBTAINED OF THE FOLLOWING AGENTS.
             NEW YORK.
Syracuse.—Geo. Dickinson,
          Farrineton A Marsh.
Rochester.—Geo. W. Allshouse, 150 State St.
           S. Kershaw, 196 State St,
           King & Co., 96 Buffalo St.
PouGhkeepsie.—Jas. G. Wood & Co.
Hornellsville—Bowen & Truesdell.
Hudson.—Rossman A McKinstry.
         II. J. Barringer.
Albion.—Nichoson & Paine.
Batavia.—Wilder's Periodical Depot.
Bath.—H. G  Donahe.
Clinton.—H. E. Barrows.
Db Ruytee.—Aaron Mitchell.
Goshen.—Wallace & Hemingway.
         N. D.  Rumsey.
Haverstraw.—J. & G. Sherwood.
Lockport.—A. Ralston.
Parishville.—\V. E. Hubbard.
Poet Richmond.—Dr. Gale.
Penn Yan.—Lyman Munger.
Oswego.—Butler, Gale, A Co.

          PENNSYLVANIA.
Philadelphia.—Callender & Co., 8d and Wal-
  nut Sts.
Pittsburg.—Geo. H. Keyser, M.D.
Johnstown.—Col. C. T. Frazer.
Alleghany City.—J. P. Fleming.
Easton.—Semple & Brothers.

          MASSACHUSETTS.
Boston.—P. H. Niles, General  Agent, for the
  States of Massachusetts, New  Hampshire,
  and Eastern Vermont, 3 Arch st.

                MAINE.
Portland.—D. L. Mitchell.
8aco.—S. S. Mitchell, T. Gilman.

             VERMONT.
Brattleboro.—Jos. Clark.
Burlington.—H. H. Doolittle.
CA8TLETON.—J. N. Northrup A Son.
Middleburv.—S. & W. S. Moody, J. M. Blade.
Montpelier.—L. F. Pierce.
Weybeidge Lower Falls.—S. L. Sprague.
Windsor.—D. A. Jones.
Woodstock.—Chas. Chapman.
St. Albans.—L. L. Dutcher & Sons.

           CONNECTICUT.
Fairhaven.—Geo. K. Maltby.
Hartford.—Allen & Uathbun.
Middletown.—Chas. Dyer.
New Haven.—Dr. J. W. Henry.
             Spencer & Clarke.
New London.—S. Denins.

             MICHIGAN.
Ann Arbor.—Maynard, Stebbins & Wilson.
            Eberbach & Co.
Adrian.—N. Bidwell.
Brighton.—S. R. Jones.
Detroit.—J. S.  Farrand.
Jackson.—Holland A Lattimer.
Kalamazoo.—F. W.  Willcox.
Saline.—F. 8. Northrup.
Ypsilanti.—Kinne & Smith.

            WISCONSIN.
Janesville.—L. J. Barrows.
Kenosha.—F. Robinson.
Milwaukie.—Henry Fess, jr.,  C. Harrington.
Madison.—Dunning, Jones, &  Co.
Racine.—II. & W. Smieding.
         Faulkner «fc Stone.
WinTBWATEB.—D. S. Cook.
              VIRGINIA.
Petebsburg.—Wilson A Allfnend.
             Wm. F. Spotswood.
Richmond.—Duval & Norton.

                OHIO.
Bucyrus.—R. T. Johnson.
Bellefontaine.—J. Frey.
Cleveland.—Wm. Fiske, Dr. Chas. E. Ames,
            Benton Brothers.
Coshocton.—Jas K. Johnson.
Columbus.—Roberts A Samuel, J. R. Cooke.
Dayton.—Dr. W. W. Stewart, J. W. Dietrich.
Delaware.—Cornell & Pumphrey.
Findlay.—Israel Green.
Fremont.—C. R. McCullough.
Lowell.—W. F. Clark, M. D.
Marietta.—E. Winchester.
Mansfield.—Stocking & Bigelow.
           E. Mark ward.
Massillon.—Jos. Watson.
Madison.—Horace Winchester.
Mt. Vernon.—S. W. Lippit.
Piqua.—A. K.  Roots, W. B. Ashton.
Sandusky.—Win. A. Graham, Adams & Fay.
           J. II. Enrich A Co.
Steubenville.—R. D. Morrison.
Springfield.—Brown A Rodgers.
Tiffin.—J. F. Woostov, I. L. St. John & Co.
Troy.—Robert Wright.
Toledo.—D. H. Miner.
Urbana.—Carter A Anderson.
Upper Sandusky.—Henderson A Ferns.
Wellington.—J. W. Smith.
Wooster.—J. II. Baumgardner & Co.
Xenia.—Murphy & McClellan.
Zanesville.—W. A.  Graham.

              ILLINOIS.
Bloomington.—Paist & Marmon.
              R. Thompson <& Co.
CniCAGo.—Bolles A Smith, Lord A Smith.
Decatur.—McCabe & Hildebrandt.
Jerseyville.—J. O. Hamilton.
La Salle.—S. Postlethwaite.
Rockforu.—E. H. Lansins.
Springfield.—E. Owen. "
Waukegan.—W. S. Pierce.

              INDIANA.
Bloomington.—W. C. McCalla.
              J. O. McCullough.
Crawfordbville.—T. D. Brown.
Fort Wayne.—Meyer & Bro.
Indianapolis__Robert Browing.
T  „          Perkins & Coon, Wm. Moffit.
La Porte.—L. C. Rose & Co.
La Fayette.—H. C. Lawrence.
Logansport.—H. B. Howes.
t>          i^A H; Bringnurst, J. B. Walker
Richmond.—E. G. Potts.
Terre Haute.—P. M. Donnelly.

                IOWA.
Eldoba.—S. G. Winchester.

              GEORGIA.
Augusta.—Spears & Hight
Savannah.—A. A. Solomon & Co
           S. D. Brantley.

         NORTn CAROLINA.
Charlotte.—E. Nye Hutchinson.
           F. Scan- & Co.
Tarboro.—Weddell <fc Hart
Raleigh.—Williams & Hey'ward.

          „   CANADA.
Cornwall, C. W.-A. R. & j. A. MacdonnelL
Sherbrooke, C. E.-W. E. Ibboteon,
                 Wm. Brooks. 
 
**'*
VA>V"
NATIONAL LIBRARY OF MEDICINE
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