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cough, viscid or sanguinolent expectoration, pain in the chest and side, quickened or distressed breathing,-the abstraction of a little blood from the chest, followed by a large, warm, thin linseed poultice, covered with oiled silk; an effervescing saline draught every four or six hours, with fifteen or twenty drops of antimonial wine, and three or four of solution of morphia,--will be about as much as can safely be done in the antiphlogistic way in a phthisical subject; and the antimony may be withdrawn when the skin becomes moist; when also the time for blistering is come, if the breathing and cough require it.

Of the utility of blistering in inflammations of lungs or bronchi, after the skin has become moist, I have not the slightest doubt; and many thousands of facts, and the testimony of countless relieved patients, have made it to me a matter of certainty, in spite of all the modern denunciations against it. Neither is the practice so irrational as it has been represented; but I cannot afford space here to discuss its principle. And so far from their doing good by causing pain which disguises that of the disease, I find that they do most good when they cause least pain. I therefore recommend a good-sized blister, oiled on the surface, and kept on only a short timefrom six to eight hours-and followed immediately by a linseed poultice, as the first dressing. If the blister have not fully risen before, it will rise under the poultice, and discharge with little pain or irritation; soon healing, and leaving the part ready for a renewal of the remedy, if needed. This, for acute and subacute attacks, is preferable to the practice of keeping the blister open by irritating applications, which sometimes prove painful and unmanageable, and often fail in the desired result. In more chronic inflammations other modes of counterirritation may be preferable.

In acute bronchitis in a phthisical subject, attended with violent hard cough, with scanty or very viscid expectoration, croton oil liniment or ointment rubbed over the whole front of the chest, is sometimes more effectual than a blister. In the proportion of one part of croton oil to four of lard or soap liniment, it quickly produces a vivid erythema, which in a few hours breaks out in a crop of fine pustules: this eruption will sometimes altogether carry off the bronchial inflammation, and it generally considerably mitigates it.1

Of other aids useful in subduing inflammation, the most important is opium or morphia. Small doses are frequently required as palliatives to mitigate the cough, but from a quarter of a grain to a grain of opium or its equivalent in Dover's powder, or from one-sixth to onethird of a grain of acetate or hydrochlorate of morphia once or twice during the night, have considerable effect in subduing inflammation attended with much pain or other nervous disturbance. It is generally expedient to combine a grain or two of calomel to prevent the astringent effect of the opium on the biliary and other secretions. I have never found any evil effect from this limited use of mercury in phthisical subjects, and the combination also is less apt to check the expectoration than opium alone. It is of the greatest importance to do all we can to aid those secretions which have a natural tendency to relieve the inflammation-these are, the expectoration, the urine, and the perspiration. The free flow of these may not remove the inflammation, but it rarely fails to

'Patients or their attendants must be cautioned to wash their hands after rubbing in croton oil, otherwise its effects are apt to appear in other parts touched by the hands, where they are not wanted. When croton oil is combined in a liniment with turpentine or camphor, or other volatile matters, it rises in the vapour, and may cause an unpleasant eruption of the face. On this account the ointment is best,

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mitigate the acute forms; and if, at the same time, the attendant pain, cough, and other irritations are assuaged by the opiate, the best steps are taken towards a natural resolution or cure before the mischievous increase of phthinoplasms can take place.

Some other sedatives deserve mention as useful in helping to subdue inflammation and fever. Aconite, in tincture or extract of the root, has considerable power in lowering the pulse and diminishing inflammatory pains; but its use requires caution and watchfulness, as it may weaken the heart too much and cause dangerous syncope. The same may be said of hydrocyanic acid, which is, however, in small doses, a useful adjunct to a saline. The veratrum viride has a steadier influence in reducing both pulse and heat in inflammation: its chief inconvenience is in its inducing nausea. The same objection applies to digitalis, which, without any power over active inflammation, is sometimes very useful in steadying the pulse, and relieving the breath after the acute stage.

This brings us to the subject of the asthenic stage and form of inflammation, which is common in phthisical subjects; and, because it is so, they neither require nor bear any continuance of lowering measures. Whether the inflammation be pneumonic or bronchial, it throws out bioplasms or sarcophytes: which, if they languish and concrete, block up the tissues and interfere with respiration and circulation; but, if kept alive and active, may migrate and clear out of the affected tissues and membranes in the form of pus and mucuscells and other excretable matter. Now we may in some measure promote this result by the judicious use of stimulants and nutriment, in such forms and quantities as the patient will bear them. Often the stomach is weak and cannot digest much or solid food, and then beef tea and other soups and broths, in small

quantities and at short intervals, together with the diluted wine or spirit most agreeable to the patient. Some medicinal stimulants called diffusible, such as carbonate and other salts of ammonia, spirits of chloroform and ether, are also often beneficial in promoting the same end; tending to improve the flagging circulation and secretions, and aiding the processes of respiration and expectoration. Some medicines are supposed to have a special power in this way squill, senega, and serpentaria, for instance; but as they sometimes disorder the stomach, I do not rely much on them. And at this time it becomes an indication to improve the tone of the stomach by the milder tonics, such as the dilute mineral acids and light bitters; for by their help more substantial kinds of nourishment may be borne, and, together with them, that greatest of all aids to nutrition-cod-liver oil. After such attacks of inflammation as have required the use of antimony and salines, or even after those lower forms benefited by carbonate of ammonia, the operation of dilute mineral acids -especially the nitric-is often very grateful to the palate and stomach, cleansing the tongue and restoring the appetite and the power to take and digest solid food; and the sooner this can be effected the better. It may sometimes be commenced during a remission of the febrile symptoms in the morning, even when salines are still necessary in the evening and night; and if the remission increases to intermission of the fever, quinine, salicine, or calumbo may be added to the morning dose. This should be our aim to attempt as early as possible to change the treatment from the antiphlogistic to the tonic and sustaining, still retaining the aid of nocturnal soothing salines and moderate counter-irritation, to keep in check any remains of the inflammatory irritation. I feel quite sure that this is a much safer and more successful practice than that which has been much recommended of late, that of giving

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strong tonics, such as iron and quinine, boldly throughout an inflammatory attack without regard to their immediate effects of increasing pain, cough, tightness of breath, and heat of skin. I am equally opposed to the practice of keeping patients in pneumonia and bronchitis in a state of constant semi-intoxication with brandy in quantities much greater than are necessary merely to sustain the failing powers. No doubt patients do sometimes recover under this treatment, but their recovery is more tardy than that from a more moderate and rational plan; and convalescence and subsequent health are often impaired by the craving for, and indulgence in, stimulants which this practice produces. I have known several, and have heard of more, cases of dipsomania which dated their origin from this spirituous medication.

The subacute and chronic forms of inflammation occurring at the commencement or in the course of phthisis, require only the mildest antiphlogistic remedies. When the urine is scanty, high-coloured, or loaded with lithates, an effervescing saline once or twice in the evening and night, an occasional mercurial aperient if the liver be tender and full, and counter-irritation over the affected parts by acetum cantharidis, or croton oil liniment, or the nightly application of poultices of linseedmeal and mustard, are usually all the measures of this kind necessary; and in most instances the usual sustaining treatment for phthisis, with cod-liver oil and tonics, may be continued in the morning and noon; with a generous diet, and a moderate allowance of stimulants.

In the more persistent forms of chronic pneumonia, with extensive induration of the lung of the fibroid or contractile kind, iodide of potassium in doses of three or four grains, with fifteen of bicarbonate of potass, every evening and night, together with daily painting the chest with tincture of iodine, so long as the skin

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