Signs on the left side unchanged. On the right there is less dulness, and some breath-sound with crepitus down to the lower third, and less bronchophony above.

He afterwards went to Sandgate, where his strength further improved; but the breath remained very short, with a little cough. The medical attendant then concluded that there was a cavity in the left lung. He died October 2, after a few days' illness with sickness, slight jaundice, and delirium.

On examination both pleuræ were found firmly adherent at diaphragm, and anterior and upper walls. Several ounces of serum in lower and posterior part of both pleuræ. Lower and posterior parts of both lungs (but most left) in a state of tough, red consolidation, or carnification; with crepitant tissue only on anterior surface. No trace of tubercle or cavity in either lung. Liver much congested and enlarged. Gall bladder contained a quantity of very dark bile.

CASE 33.-Chronic Peripneumonia. Fibroid Phthisis.

Thinks he strained him

A proctor in Doctors' Commons, æt. 39, February 18, 1845. Sedentary, and much occupied in writing; but lives well. In last two years breath has been getting shorter, with slight cough, worse in winter. Losing flesh and strength; but face red with acne. self two years ago by running, which brought on Lately pain in right hypochondrium. Pulse quiet. Dulness with wheezing in upper third right back; crepitus with weak breathsound at both bases.

severe pain in chest. Urine, scanty, dark.

Under regulated diet, diminished stimulants, and a course of iodide potass. with carbonate potass. and sarza., and occasional mercurial aperient, considerable improvement took place: but the breath was still short, and crepitus still in the back.

July 31.—A week ago, after exposure to cold, a pain came on in the right side, which has been only partially relieved by a mercurial dose. Is chilly, and feels ill.-Crepitus increased in both lower dorsal regions, which now are dull. Liver large and tender.-C.C. lat. dextro, ad 3viij. Pil. Hydrarg. scillæ et digitalis, bis die. Haustus sennæ o. m.

September 9.-Was relieved of the pain, and afterwards improved on a mixture of nitric acid, taraxacum and chiretta. Lately pain in right side has returned, with loss of flesh and breath.-Dulness, with contraction, in right interscapular region, and in both lower dorsal, with crepitus.

April, 1846.—Has had several attacks of low inflammation, affecting successively both lungs, with cough, mucopurulent expectoration, and much loss of flesh and strength. Has been repeatedly blistered, and had blue pill, squill, and digitalis, which gave temporary relief. In June some improvement took place, under iodide potass. and nitric acid three weeks. Increased dulness and contraction with crepitus in lower half of right lung, and lower third of left.

FIBROID PHTHISIS.

189

In 1847 he moved to Brighton, and gradually declined, with the ordinary symptoms of consumption, constant cough, and opaque expectoration, and progressive loss of flesh, strength, and breath. More than usual œdema preceded his death, which took place at the end of 1848.

His usual attendant, Mr. Ridout, informed me that, on examination after death, both lungs were found universally and firmly adherent, and their lower lobes in a state of dense, tough, reddish-grey consolidation. No cavities or tubercles.

These two cases are remarkable exceptions to the general degenerating tendency of phthinoplasms. The fibroid induration persisted without either caseation or tubercular formation. But the wasting process was still there, the decaying matter passing off in the purulent expectoration.

CASE 34.-Fibroid Phthisis after Pleurisy. Cavities.

Mrs. M., aged 20, seen October 18, 1842. Two and a-half years ago she had pleurisy of left side; since then has had slight cough, and breath has been short. In last year has had several recurrences of pain and cough, and is now much worse, after exposure to cold outside a coach three weeks ago. The cough is suffocating, with copious purulent expectoration, sweats, and extreme dyspnoea. Moist cavernous sounds under both clavicles. Extended dulness in region of liver.

The patient died the same night. On post-mortem examination the left lung was found to be closely adherent to the back and side of the chest wall. It was much shrunk, nearly the whole front being occupied by the heart. Texture of left lung was of dark colour, and very dense, with a few cavities. Right lung not condensed, but with several tubercles and cavities, chiefly in upper lobe. Liver large and fatty, floating in water.

CASE 35.-Phthisis after Pneumonia.

Mr. C., aged 30, February 12, 1856.-Four years ago had inflammation of the right lung, and ever since has had cough, with yellow expectoration, and lost much flesh and strength. Taken oil for two years. Dulness; deficient and obstructed breath-sounds throughout the right chest. Large tubular sounds and crepitation in upper portions. To continue the oil, with a tonic of nitric acid, hop, &c., and occasionally use acetum lyttæ.

January 25, 1867.-Has taken oil on and off ever since, but always in the winter. Is wonderfully improved in all respects, but never quite free from cough with expectoration, which has lately been worse, and accompanied by pain in the right side. Bowels costive. Suffers from piles. Has several times expectorated calcareous matter. Dulness and tubular sounds above both scapule; no crepitus, and chest clear elsewhere.-To continue oil and acid: senna confection with sulphate of potass.

March 29, 1870.-Pretty well, and attending to business. Flesh and

strength good; but always some cough with yellow expectoration, and purulent coryza. Sometimes bilious, and liver now tender.-Dulness, and whiffy inspiration and long expiration at and below right scapula.-To take a blue pill occasionally, and the oil once daily.

CASE 36.-Pleurisy ending in Phthisis.

Master H., aged 10, June 26, 1863.-Delicate, but pretty well till, a fortnight ago, fainted at church; after which slight pain of chest, and cough, but not laid up till last two days with increasing shortness of breath and swelling of left breast. Whole left side quite dull and motionless. Dulness extends to right of sternum and spine, and heart displaced to right of sternum. Intercostal spaces bulge, especially near left mammilla. A mixture of citrate and nitrate of potass was prescribed, but arrangements were made for tapping the chest next day. On the morrow, however, the dyspnoea was less, and the swelling less prominent; so a blister was applied, and the saline continued. He gradually recovered, the fluid dispersing, and weak breathsound and resonance returning to the left side; but considerable dulness and contraction remained in August. Cod-oil with tonic, iodine tincture externally, and country air were prescribed. This treatment was carefully pursued, and in 1865 he was considered quite well, having nearly outgrown the contraction of the left chest, which was, however, still apparent.

August 3rd, 1867.-Has been well, and is now at Harrow. Three weeks ago caught cold, and has since had pain in left side, wheezing, and cough. Looks ill. Pulse 100.

Deficient motion and percussion, and croaky rhonchi through left lung.—To resume the oil and have iodine painted.

February 17, 1869.-Improved, and lost cough soon. Has been pretty well since, but grows fast, and requires care. In the last three weeks has again had cough and short breath, and appetite has been failing.

Dulness and tubular sounds now at and above right scapula.-Left lung more free.

June 26, 1869.-Improved with constant treatment and care; but there is still some cough, and lately a little blood has appeared in the expectoration. Bowels not free; and he has been taking quinine pills as well as the oil and mixture.

Dulness and tubular sounds at right scapula, rhonchi at left.-Oil to be taken with phosphoric acid and hypophosphite of soda. Bowels to be carefully regulated, and iodine regularly used.

July 29, 1869.-Much better, cough gone, and signs diminished.—Con. tinue same.

November 2, 1869.--Continued better till return to Harrow, when cough again, with pain in chest and increasing weakness. To go to Ventnor. Croaky crepitus at and above left scapula. Tubular sounds above right. April 18, 1870.-At Ventnor, taking oil, &c., and better till January 7,

FIBROID PHTHISIS, WITH CAVITY.

191

had severe cold, cough became worse, and spit 2 oz. of blood; since expectoration opaque, appetite bad, bowels costive.--Oil has been left off three weeks, and he has taken iron.

Much dulness and croaky obstruction through left lung; tubular or cavernous in upper part.-To resume oil, with phosphoric acid and strychnia mixture. Bowels to be kept regular. Tinct. iodine to be regularly applied.

June 7, 1871.-Continued pretty well during the summer, and in December went to Madeira, and, as advised, steadily persevered with the oil and tonic, and rode regularly up the hills; so he kept fairly well. On voyage home, a fortnight ago, encountered cold winds, and cough much increased, with yellow expectoration. Left chest rather contracted. Heart beats at fifth rib. Moderate dulness, and crumpling subcrepitus through left lung. No cavernous sounds, but tubular above scapula.

CASE 37.-Fibroid Phthisis, with cavity, arrested 15 years. Emphysema.

A merchant, aged 45, first consulted Dr. Williams July 13, 1855. Was well till eight months ago, when he caught a severe cold, with cough and yellow expectoration, which have continued, with much loss of flesh, and lately with very short breath. Took oil in the winter, but soon sickened of it. Extreme dulness on left side of chest, mostly in upper front, where there are large tubular sounds, and some liquid rhonchus, almost gurgling. Less dulness behind, but tubular sounds and mucous rhonchus.-Ordered oil in a tonic of nitric and hydrocyanic acids and strychnia, and counter-irritation with acetum cantharidis.

April 19th, 1856.-Wintered at Hastings, and very much improved under the above treatment. Now walks six miles. Still marked hard dulness and obstructed breath in left front; but voice less tubular. Coarse crepitation in parts.

November 28th, 1856.-Passed summer well, but six weeks ago brought up half a pint of blood, and was largely leeched. Has taken oil regularly, except during six weeks, and is quite stout. Breath still short, Cough has increased in last ten days. Physical signs the same, except the addition of loud tubular breath above right scapula.-To continue oil, but in tonic of nitric and hydrocyanic acids, with iodide of potassium and tincture of

orange.

Breath short,

April 28th, 1857.-Continues well, and fatter than ever. but walks six miles. Just now has headache and increase of cough.

December 7, 1859.-Passed last winter at Hull, and pretty well; but breath short, and had morning expectoration. No oil for one year. Has lately had more cough and slight hæmoptysis. Dulness, cavernous croak and voice in upper left chest.

February 21, 1861.-Has taken oil, but was shut up at Hull all the winter. Lost flesh, and lately appetite and strength. Cough increased,

and occasionally streaked expectoration. More cavernous sounds in upper left, front and back.—Ordered strychnia, with oil.

March 29, 1862.-At Hull through the winter, and not confined to the house; but breath shorter, and losing flesh since August. Three weeks ago had pain in left side, increase of cough and expectoration, which was more opaque. Symptoms relieved by blisters, and patient has resumed the oil and strychnia since. Large tubular sounds and crepitation in upper left front and back. Cavernous sounds below clavicle.

March 24, 1864.-Again recovered, and has been generally well. Has little cough, but breath very short. Weighs twelve stone. Attends to business. No oil for one year. Less dulness, no cavernous sounds, but breath weak and subcrepitant. Tubular voice, and little breath at and within left scapula. Large tubular sounds above right scapula.-Ordered nitric acid, tincture of nux vomica, and glycerine.

March 7, 1865.-Fatter, and pretty well; but breath always short. Six weeks ago had hemiplegia of left side, and confused state of mind; but, after leeching and blistering, was relieved. Moderate dulness, crepitation, and croaky sounds over whole left chest. No large tubular sounds, except above right scapula.

June 1, 1866.-Pretty well; but lately palpitation, and pain in left arm. Breath-sounds feebly audible throughout left lung, only tubular in back.

April 15, 1868.--Was pretty well; but during last year breath has become shorter, and palpitation has increased. Has little cough, with only transparent expectoration. No oil for two years and a half, and has spent the last winter at Hull. More dulness in left front, and upper back, and large tubular or carvernous sounds above left scapula and immediately below left clavicle; dulness and obstruction sounds in lower part of left lung, with some sibilus; more tubular sounds in upper right chest. Heart's apex drawn up, and beating at left mamilla; action weak.

March 4, 1869.-Wintered at Hull pretty well, with little cough, but breath very short on exertion, and some palpitation, Still moderate dulness and defective breath and motion throughout left chest, but no cavernous sounds, and tubular only at and above scapula. Heart-sound and impulse, high and feeble. To take three drops of liquor arsenicalis and two grains of hypophosphite of soda in a gentian and glycerine mixture, twice a day.

February 26, 1870.-Improved much in strength, and somewhat in breath during the summer, complaining only of his breath. Lately has suffered from fluttering at heart. Four months ago, for three days, had difficulty of articulation, but it passed off; only he complains of his memory failing. Lately closely confined to the house, and has indigestion, and become paler. Urine high coloured and scanty. Physical signs much the same. Liver rather full and tender.-To take iodide of potassium and digitalis, with tincture of calumba, and a few mercurial pills.

May 26, 1870.-Health and appetite better; but breath very short, and