trachea are much affected, and in those attended with convulsive cough or offensive expectoration. I have generally found the use of inhaling instruments fatiguing and unnecessary. A quart jug of hot water, with a napkin from over the nose down to and around the jug to confine the steam, is all that is needed. To the hot water is added the drug to be inhaled; and creasote or carbolic acid, iodine, chloroform, oil of turpentine, and juice or extract of hemlock, are the articles which I have found most beneficial. A few drops of one, or of several of these combined, being put into the hot water, the inhalation is practised through both mouth and nostrils without restraint or difficulty, and may be continued for five or ten minutes every night, and, if need be, repeated once or twice in the day. Although the chief operation of this medicated vapour is on the guttural and bronchial surface, yet a portion penetrates into the lungs, and is absorbed into the system; for iodine and oil of turpentine can be detected in the urine within a few minutes of the inhalation being made. Still, although proving very serviceable in certain cases, I cannot rank inhalation higher than as a subordinate remedy in the treatment of consumption. I may add, that the practice of painting the chest with tincture of iodine every night, as a gentle counter-irritant, is not without a certain influence in the way of inhalation; for a portion of the iodine evaporates, and slightly impregnates the air around the patient, and this atmosphere of iodine may not be without its influence for good. In the advanced stages of phthisis, when much purulent and often decaying matter is continually thrown off, it is very important to keep the surrounding air as pure as possible; this may be done not only by a free supply of fresh air, not fast enough or cool enough to cause a draught, but also by the purifying influence of antiseptic agents. Condy's fluid, freshly prepared char MOUNTAIN CURE.-CLIMATE. 329 coal, or quicklime, kept in the room in open vessels, or the vapour of carbolic acid or creasote diffused through the air, would answer this purpose. It is hardly possible to compress into a summary the principles to guide us in the recommendation of baths and watering places for the benefit of consumptive invalids. As a matter of experience, we cannot report very favourably of the results of sending consumptive patients to the sulphur springs of the Pyrenees, or to the alkaline and saline waters of Ems and other German spas. The temporary ease to the cough and other symptoms of irritation, which they sometimes afford, is out balanced by the increase of weakness caused by the discontinuance of the oil and tonics, which these places of water-cure generally require. 6 There is much better evidence in favour of those establishments in which consumptive patients can breathe the pure air of lofty mountains without being exposed to extremes of weather and temperature common at those heights. The strong claims of the mountain cure' have been already favourably noticed (see p. 106), and will be again considered. It may suffice here to state that experience has already justified the sending pulmonary invalids during the summer to any Alpine abode between 3,000 and 6,000 feet in height in South Europe, where good accommodation can be had, and there is shelter from the coldest winds and security from damp. The advantage, or even safety, of such patients remaining at these heights during the winter, although strenuously asserted by several respectable authorities, is more questionable, and cannot be affirmed without larger experience. Probably it will be suitable only for certain cases. This has brought us to the subject of change of air and climate, which is of the highest importance in the treatment of pulmonary consumption. It is of the greatest consequence to the phthisical invalid that he should breathe as pure an air as possible, and that the influence of this pure air on the blood and on the body should be increased by such gentle and varied exercise in it as his strength and the condition of his organs will permit. This is the great object in sending him to a warm and sheltered climate in winter, and to a high and dry locality in summer. It is a great but common mistake to suppose that a hot climate has any power to cure consumption. On the contrary, it is more likely to hasten its course; and we have already noticed that the most rapid forms of consumption are more common in hot climates than in cold. (See p. 106.) We send patients south in the winter, not to extreme heat, but to avoid extreme cold and damp and changes, which, by causing inflammatory attacks, develope the disease, and hasten its course to avoid, therefore, the inflammatory causes of the malady;—whilst we also counteract the decaying or phthisical tendency by the invigorating influence of OPEN AIR, with its exhilarating and vivifying qualities of purity and freshness, and the attendant accessories of sunshine and beautiful scenery. VARIATIONS IN TREATMENT. 331 CHAPTER XXVI. TREATMENT OF VARIETIES AND FORMS OF PULMONARY Acute and Chronic, not synonymous with Inflammatory and Non-inflammatory-May be acute from rapidity of decay, as well as from Inflammation-Sthenic Inflammation only requires decided Antiphlogistic Measures- -Otherwise limited-Blisters very useful-Their managementCroton Oil-Opium and other Sedatives—Treatment of Asthenic Inflammation by Stimulants and Tonics-Cautions-Treatment of Sub-acute and Chronic Inflammations-Chronic Pneumonia-Rest and Quiet-Conservation of Strength. CASES of consumption may be divided into acute and chronic, according to the rapidity or slowness of their progress; and the distinction between the well-marked cases of the two classes, as regards both symptoms and treatment, is commonly well marked. Again, there is an equally appropriate division into the inflammatory and non-inflammatory forms, which we have traced in their pathological varieties. And so far are these (acute and chronic, inflammatory and non-inflammatory) from being convertible terms, they mean really quite different things; and both inflammatory and non-inflammatory consumption may be either acute or chronic. If we bear in mind, that the course of consumption may be accelerated either by an abundance of the phthinoplasms, or by their low vitality and tendency to decay, we can understand that either element in excess-inflammation, which produces them, or their dying nature, which decays them-may render the disease acute; and that the most galloping consumption of all must be that in which both the producing and the decaying elements go together—as in scrofulous pneumonia and acute tuberculosis. On the contrary, disease will be both slow and partial where the consumptive or decaying tendency is moderate, and where inflammation can be either averted or kept to a high standard. It is necessary, therefore, in the treatment of every form of consumption, to keep in view its consuming and decaying character, and yet to look out for inflammation, which, in some form or other, is in many cases concerned in developing or aggravating it. As before stated, the rule or leading principle of our practice should be to sustain the vital powers by all suitable and available means; the use of depressing or debilitating measures will be only exceptional and occasional, and limited to the short periods when acute inflammation supervenes, and calls for such restraint. For it is not every kind of inflammation that requires what used to be called antiphlogistic treatment. In these days we successfully treat patients under asthenic and erysipelatous inflammations with nutritious soups, various stimulants, quinine, and iron; and the low forms of pneumonia and bronchitis which usher in or complicate phthisis are best managed by a moderate application of the same plan. Iron and quinine, indeed, are apt to aggravate the cough and dyspnoea, and other stimulants have the same effect; but diluted stimulants, infusion of bark and senega, or serpentaria, with ammonia and chlorate or nitrate of potass., are generally well borne in asthenic pneumonia or bronchitis in phthisical subjects. It is only in the sthenic inflammatory attacks in consumption that antiphlogistic measures are called for. In case of hard as well as frequent pulse, hot dry skin, scanty high-coloured urine, together with tight hard |