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The hypophosphites of soda and lime were recommended very strongly some years ago by Dr. Churchill, as a most potent remedy in phthisis; in fact, they were so vaunted as to have suffered prejudice from hyperbolical praise ; and in various trials in this country were pronounced to be altogether inert. On the other hand, Dr. Thorowgood, Dr. Radcliffe, and others, have found them to possess considerable power as restoratives in weak states of the system ; and I have been convinced of their utility as an aid to cod-oil and phosphoric acid in the treatment of phthisis. Like phosphorus, they are inflammable at a low temperature, and any virtue ascribed to phosphorus may be expected from them; and they certainly do not disagree with the stomach and liver, as I have found phosphorus to do in my attempts to exhibit it as a medicine. In two cases of paraplegia where I gave phosphuretted oil in very small doses, in a few days it produced jaundice with tenderness and enlargement of the liver. No such effect has followed the use of the hypophosphite of soda, and its beneficial effects have been shown in this way. Phthisical patients, generally with advanced disease, have long been taking the oil, with phosphoric acid and some tonic, and after improving much in flesh and other respects, come to a standstill, and get no better. Then the addition of the hypophosphite, in the dose of three or four grains to the usual mixture and oil, has produced a very marked improvement in the vigour and appetite of the patient, generally followed by increase of weight and strength. That is the empirical fact, whatever may be its rationale : and it has been proved too often to admit of doubt; and I am therefore very glad to avail myself of the hypophosphite as a supplementary aid in the treatment of phthisis.

In addition to the mineral acids, or independently of them, other more decided tonics are very useful to im



prove the appetite and digestion, and to increase the tone of the whole system. It has been already mentioned that the milder tonics or simple bitters, such as calumba, cascarilla, chiretta, gentian, and salicine are often preferable to quinine and iron, because they are borne better and for a longer time without disagreeing; whereas the stronger tonics frequently increase the cough and tendency to hæmorrhage, and sometimes interfere with the regular action of the bowels. But where they have none of these evil effects, and especially if there is much weakness, anæmia, or low febrile disturbance, quinine and iron are doubtless our most effective aids ; and they may conveniently be given in a pill after or before the dose of oil in its acid mixture, which ensures the solution of the quinine in the stomach. Their addition to the mixture would render it too nauseous to some tastes to be a fit vehicle for the oil. Of all the tonics for strengthening the stomach and preventing nausea with the oil, strychnia is by far the best; and as it has no heating property, its addition to the compound orange infusion supplies the most elegant and effectual form of oil-sauce that I have yet devised. It may save the need of longer descriptions, to insert in a note some of the combinations which I have been in the habit of prescribing as tonics to accompany the oil. I have

R Acidi Sulphurici dil. Jiij.

Tinct. Aurantii ziss.
Salicini Jij.
Syr. Zingiberis 3j.

Inf. Aurantii Comp. ad Zviij.
A tablespoonful with each dose of
the oil.

* Ro Acidi Nitrici dil. Zss.

Tinct. Calumbæ
Syr. Zingiberis kā 3j.

Infusi Aurantii Comp. ad žviij.
A tablespoonful to be taken twice
à day with a teaspoonful of pure
cod-liver oil, gradually increasing the
oil to a tablespoonful.
R Acidi Phosphorici dil. Zss.

Tinct. Cascarillæ ziss.
Syr. Zingiberis zj.

Infusi Aurantii Comp. ad Griij
To be given as the former.

R Acidi Phosphorici dil. 5ss.

Liquoris Strychniæ j.
Tinct. Aurantii
Syr. Zingiberis kā zj.

Inf. Aurantii Comp. ad gviij.
To be given as the former.

found by experience, that both acids and aromatics as well as bitters, effectually cover the taste of the oil and enable the stomach to retain it without nausea or eructation. The spicy flavour of ginger and clove in all these mistures is far more agreeable than that of ether and other volatile essences which have been recommended, and they just as effectually promote the pancreatic secretion, without causing eructations, as the latter generally do.

Although I have expressed my thorough belief in the necessity of the constant administration of antiphthisical remedies in the treatment of consumption, yet I am much opposed to the practice of overdrugging in this or in any disease. Therefore it is that I recommend all necessary tonics to be combined with the two inevitable doses of oil, and that no other medicines should be given, unless called for by the urgency of particular symptoms. Thus a great many phthisical patients go on very well for weeks and months together, with their two doses daily, and enjoying all the additional benefit to be gained from generous living, and health-giving air and exercise. And happy is it for them when they are also able to continue in their usual occupations, with proper caution and with a due regard to their invalid state. The antiphthisical treatment requires that there should be no fatigue,

R Acidi Sulphurosi 3vj.

Tinct. Calumbæ 5j.
Glycerini puri jiss.

Infusi Aurantii Comp. ad Zviij. A tablespoonful (with a little water if preferred) to be taken with each dose of oil.

R Acidi Phosphorici dil. Zss.

Ferri Sulphatis
Quinæ Sulphatis äā Oj.
Spiritus Myristicæ
Syrupi āā zj.

Aquæ ad žviij.
A tablespoonful with each dose of
the oil.
R Acidi Phosphorici dil. 3iij.

Acidi Hydrocyanici dil. 3j.
Tinct. Lupuli
Syr. Zingiberis Kā zi.

Inf. Aurantii Comp. ad Zviij. To be given with the oil as above, when the stomach is irritable.

R Acidi Phosphorici dil. Ess.

Sodæ Hypophosphitis 3j.
Tinct. Quinæ Comp. Ziss.
Glycerini puri zj.

Inf. Aurantii Comp. ad zviij.
A tablespoonful with each dose of
the oil.



no night work, no undue wear and tear, and an accumulation rather than an expenditure of strength from day to day; but a light congenial employment of body and mind is more invigorating and conducive to health than absolute idleness.

There is a class of agents which may be made useful as antiphthisical remedies in those stages or forms of con

sumption in which there is a manifest tendency to cor· ruption or even putrefaction in the system. I speak not

of gangrene or gangrenous abscess only, in which the ultimate decomposition of animal matter is obvious to our senses, and strongly calls for antiseptic remedies, but to those more numerous cases in which the expectoration is more or less offensive or disagreeable without being putrid. That which commonly occurs in ozena sometimes also takes place in the bronchial tubes or in phthisical cavities, and calls for the use of correctives used by swallowing, and also by inhalation. In other cases, the perspiration or the fæces have an unusually offensive odour, and give evidence of their containing corrupt or decomposing matter. In all such cases the strengthening or tonic plan may well be supplemented by the addition of certain antiseptics, which have no deleterious influence on the economy. The nitro-hydrochloric or sulphurous acid may be substituted for other acids, and may be given more largely if combined with glycerine, which sheaths the irritating property of the acids. Creasote and carbolic acid, which are pretty much alike in their nature and action, I have also found of great use, and may be used in emulsion with glycerine and mucilage. The latter may also be effectively used by inhalation with water, in vapour or in spray, two or three times a day; the spray will be found most agreeable in the summer, and the vapour in winter. The improvement in the character of the cough and expectoration, will be sufficient in

ducement to persevere ; and when, from weakness or disinclination, patients get tired of the process of inhalation, it may still be useful to diffuse the vapour through the air of the apartment by means of Siegles' or Maw's vaporisers. The attendants, as well as the patient, may be benefited by this measure. The diffusion of mere watery vapours in the rooms occupied by pulmonary invalids is of great use during the prevalence of an east wind, and, by similar means, an antiseptic agent or oil of wood pine may be added in case of excessive or offensive expectoration.

The only other antiphthisical remedy which it is necessary to mention is arsenic, which has recently been strongly recommended in France. I have tried it only to a limited extent; for, to say the truth, I have been afraid to interfere with the use of the oil and other remedies in which I have more confidence. The only cases in which it has seemed to me to be useful are those of a chronic kind, with some asthmatic complication, especially in conjunction with eczema or psoriasis (as in Case 102). In these both health and flesh seemed to improve under its use. Arsenic possesses tonic properties, allied to those of quinine, and other undetermined influences over respiration and nutrition, which render it well deserving of further experimental investigation.

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