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some instances the application of a few leeches over the windpipe affords much relief. In allaying cough in irritable subjects, much advantage is often derived from the administration of four minim doses of tincture of aconite in spermaceti mixture; and counter-irritation may often be resorted to with advantage. When the When the urgency of the cough has more relation to the tenacious character of the expectoration than to nervous irritability, lemonjuice has sometimes seemed to me to be a useful remedy. In other similar cases the solution of potash does good, especially in combination with squill; although this latter remedy, in cases complicated with any degree of bronchial inflammation, would probably aggravate the symptoms.

Anodynes, such as hemlock, henbane, Indian hemp, &c., are occasionally useful, and there can be no doubt of the value of hydrocyanic acid. A draught, containing an eighth of a grain of cyanide of potassium, an ounce of aniseed-water, and some syrup of lemons, is perhaps more trustworthy than prussic acid in the usual form of administration. In a great number of instances, however, we are obliged to place our chief reliance on opium, or on some of the salts of morphia. An agreeable linctus may be composed of an ounce of conserve of roses, half an ounce of lemon-juice, and half an ounce of syrup of poppies; or a drachm of tincture of opium, and a drachm of diluted sulphuric acid, may be mixed with an ounce and a half of treacle or honey, and a teaspoonful given occasionally.

You have had an opportunity of observing the relief often derived from inhalation. An infusion of an ounce and a half of the strobiles of hop in a pint of hot water

sometimes proves very soothing. Some of our patients have derived still greater advantage from inhaling two grains of extract of opium, by means of the apparatus introduced by Dr. Snow. On the whole, however, no remedy has acted so promptly and satisfactorily in allaying cough, as the inhalation of fifteen or twenty minims of chloroform.

Were there time, it might be profitable to review some of the subjects which in these lectures have engaged our attention; such as the general aspect and movements of the chest, the indications furnished by auscultation of consumption, whether threatened, or commencing, or proceeding; modifications of the expectoration, and of the urine; altered constitutional condition, as evinced by disturbance of the laws which regulate the pulse; perhaps also, manifestations of change in the circulating fluid and bodily structure, as indicated by the gums. The plan adopted has necessarily partaken of a somewhat discursive character; but, with all the imperfections of its execution, I have the satisfaction of hoping that I have at least indicated some instructive lines of inquiry, and assisted you in cultivating the habit of observing and appreciating facts.

You have watched with interest the occasionally successful results of treatment on a disease, once considered almost beyond the reach of remedial measures. One or two further examples of this kind may here be introduced.

G. A., the patient now before you, came into the hospital some months since, with extensive gurgling, and cavernous breathing, in the subclavicular and suprascapular regions on the left side. There are still evi

dences of cavity in that situation, but it is dry, and must have materially contracted; for you see how greatly the left side of the chest is flattened, and the apex of the heart, quite irrespectively of any disease or other disturbance of that organ, is found, in consequence of the altered relations of the walls of the chest, beating close to the left nipple.

You recollect evidences of changes fully as favourable in S. G., E. M., M. A. B., and others; and may naturally inquire what changes in the pulmonary structure may be regarded as having occurred in such instances.

In one of these drawings by Dr. Carswell, you see the delineation of a cavity, which, it is evident from the puckered and depressed appearance of the lung at its surface, must once have been of considerable size, but which has been reduced to comparatively small dimensions; and a smooth, pale membrane is well represented as constituting its walls. Such cavities may ultimately cicatrize, or, having contracted to a very great degree, may have their original seat marked by the presence of a dry material looking like putty, probably the relic of tubercular deposit deprived by absorption of its serous and albuminous material, and having its earthy salts condensed.

I am indebted to the courtesy of my colleague, Dr. Quain, for the opportunity of showing you some lungs, which illustrate the extent to which the process of contraction of a cavity may proceed. Nearly the whole of the upper lobe of this left lung has, you see, been destroyed by tubercular disease. It is now little else than a cavity, about the size of a large walnut, containing half a drachm of thin whey-like fluid, inter

mixed with particles of pale coagula; its walls, formed by condensed pulmonary tissue, puckered and contracted, varying in thickness from a line to a quarter of an inch. This tissue contains small bronchi and air-cells, visible under the microscope, and separated from the contents of the cavity by a membrane of firm filamentous tissue, with granular cells, having much the appearance of mucous membrane. The cavity communicates with the left bronchus by an orifice as large as a goose-quill. This lung on immersion displaces only nine ounces of water; while the right lung displaces twenty-three ounces. Its upper part presents puckerings corresponding to short fibrous bands, intersecting softish, pale-yellow, tubercular spots. This lung contains several portions of condensed tissue, with yellow, firm tubercle, and some small calcareous particles, and in the centre of the upper lobe, an encysted mass of soft tubercle, of the size of a hazel-nut, consisting chiefly of fatty granules, and cells containing similar particles. The other organs were healthy.

You have here a specimen of lungs full of the results of old tubercular affection, but free from any evidence of recent tubercular deposit; and the cavity at the apex of the left lung has obviously been for a considerable time in process of contraction. As Dr. Quain cbserves, this case presents an example of the great extent to which the ravages of consumption may extend, and yet be stayed. The poor girl from whom these lungs were removed became an out-patient of the hospital in May, 1848, when thirteen years of age, presenting decided dulness and bronchial respiration at the apex of the left side; and feeble inspiration with pro

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longed expiratory murmur on the right side. In August, crepitation was heard at the left apex; in September, she expectorated much blood and pus; in October there was distinct pectoriloquy. She was treated chiefly with cod-liver oil, and solution of potash, and counter-irritation was occasionally employed. In July, 1849, she looked well, and coughed only in the morning; in August flattening was recorded, as proceeding in the upper part of the left chest. In February, 1850, her appetite, which had failed, was benefited by soda and gentian; and the cod-liver oil was continued, but in increased doses. During the winter of 1850-51, her appearance was healthy, her cough nearly gone, and her weight seven pounds above what it was two years previously. In the beginning of the present month she was attacked with influenza; which, rather remarkably, exhibited the gastric, not the pulmonary complication, and she sank in four days from bilious vomiting and diarrhoea. If the unfortunate complication of severe influenza had not occurred, it is not unreasonable to imagine that this patient might have lived for years, an example of what, in conventional language, may be termed a cure of consumption in the third stage. For further particulars of this case I may refer you to Dr. Quain's account, in the Transactions of the Pathological Society for 1850-51.

We must still acknowledge the fact, that in a majority of instances favourable results are not obtained; and that, in those cases especially in which tubercular material is extensively infiltrated rather than isolated or agglomerated, moist crepitation (clicking) followed by cavernulous rhonchus, soon indicates that

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