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ishness and discomfort, these will commonly subside under its continuance. Should the alcoholic stimulants be too exciting, they may be given in small quantities, or diluted; but there are few cases in which this is necessary, and the heat or flushing" which they may at first occasion, is productive of no harm, whilst the benefit consequent upon their judicious employment is oftentimes very marked. Unnitrogenized food, such as arrowroot, sago, and the like, given occasionally, are of much service in allaying the cough, and, as it were, respiting the stomach from heavier duties.

The chest should be properly protected with flannel, but other coverings, more especially leather and “warm plasters", are not to be commended, on account of their keeping the skin moist and clammy, besides often preventing the proper application of counter-irritants. Cold or tepid sponging of the chest may be sometimes employed with advantage, indeed, in many cases, I have seen it signally beneficial; but it cannot be used indiscriminately, requiring to be regulated according to the cough and physical strength of the patient.

Having included in the preceding remarks all that need be said upon general measures, we have now to consider to what extent phthisis and its many complications are under the control of medicinal agents. There are three different objects with which these may be employed.

(1.) To restore the health and vigour of the body.

(2.) To relieve the different symptoms as they

arise.

3.) To check the further progress of the local

or pulmonary disease.

(1.) The first of these is to be attempted by tonics and stimulants, amongst which, the animal oils, the different preparations of iron, the mineral acids, and vegetable bitters, are the chief. Of the animal oils, none deserve so much confidence as the now popular one obtained from the cod's liver, which is certainly more useful in this and every stage of phthisis, than any other substance taken singly. Of the preparations of iron, it matters little which is selected; but the union of iron with iodine in the form of the syrupus ferri iodidi seems peculiarly adapted to tubercular affections. Any of the vegetable bitters may be given with advantage, especially in conjunction with one of the mineral acids,

with ammonia; but I have usually seen the most benefit result from quinine and cinchona. Various combinations of these substances are also of much service: the citrate of iron and quinine; or, quassia or calumba united with some of the salts of iron; or, cod-liver oil with iron, or with a vegetable tonic, will be found more or less adapted to different cases. This subject, however, being so comprehensive, will be more particularly entered upon in a separate chapter.

(2.) The second object-that of attending to symptoms as they arise-is to be met with appro

priate medicines; but as there are none possessing any specific power, the choice between them must be left to the practitioner.

For the cough there are the various combinations of ipecacuanha or squill, conium or hyoscyamus, with tragacanth, spermaceti, or linseed, and, except when the symptoms are inflammatory, these will generally suffice: when there is bronchitic complication, the addition of small doses of antimony may be necessary, but in the purely tubercular cough, this, as well as everything of a depressing kind, should be carefully avoided. When the cough is very irritable, or of a spasmodic character, the diluted hydrocyanic acid may be taken with advantage. Nothing, however, so readily relieves the distressing cough which is often met with in phthisical cases, as morphia or some of the preparations of opium, which are usually borne very well, even when taken in considerable doses. Counterirritation of the chest by means of stimulating liniments, of which none answers better than that made of croton oil,—is often serviceable; and some cases are relieved by an occasional small blister. Inhalation is sometimes beneficial, and may be performed by means of any of the numerous inhaling vessels constructed for the purpose, but equally well by a common funnel inverted over a basin. The mere vapour of hot water is often sufficient, but the addition of a sedative may contribute to its efficacy from ten to thirty grains of the extract,

P

or from one to three drachms of the tincture, of conium or hyocyamus; or from five to fifteen drops of dilute hydrocyanic acid; or a handful of dried hops, may be used for this purpose. In some cases, chloroform may be used with advantage; but it requires much caution, as phthisical persons are not of that class who may be expected always to bear it with impunity. I have never seen the least injury result from these inhalations, but am free to admit that in the majority of cases they have done so little good, that the patients have generally been unwilling to continue them for any length of time. The subject of inhalation, however, will be treated of at greater length in a future chapter.

The thoracic pains in phthisis are often difficult to remove. When arising from local congestion or from inflammation, a few leeches below the clavicle, a small blister, or some stimulating liniment, may be employed with success; the choice between these depending upon the patient's strength, or other particular circumstances. When they are of a reflex character, or obviously of nervous origin, anodyne liniments, or moderate local counter-irritation, are more likely to be serviceable; dry cupping, also, sometimes succeeds, when other means have failed; and opium or belladonna plasters temporarily applied to the seat of pain are often useful.

Dyspnoea is a no less troublesome symptom to combat. When arising from pulmonary oppres

sion, owing to the accumulation of tubercle, it may be relieved by local counter-irritation, or by dry cupping; when depending upon secondary inflammation, it can only be attacked by such general measures as are likely to remove its cause; and when connected with nervous or hysterical symptoms, or when attributable to exhaustion, it is best treated by means of anodyne applications to the chest, and general stimulants.

Haemoptysis.-A moderate degree of hæmoptysis, in persons able to bear it, being, as already observed, far from prejudicial, generally needs nothing more than precautional measures to prevent its increase. When so small in amount that it exhibits itself only as a streaky discoloration of the sputa, the patient should be kept quiet, but there is no occasion for any departure from the treatment which is being pursued. And even when the blood is discharged separately, but in small quantity, tranquillity is still the chief remedy to be employed, more decided means being seldom required.

When the expectoration of blood is greater, or when it tends in the least to weaken the patient, further interference becomes necessary, and the previous remedies should be exchanged for some of the astringents usually employed to arrest hæmorrhage. Of these, the mineral acids, with alum and sulphate of magnesia, or the infusion of matico;*

R Fol. maticonis Zij; aquæ ferventis Oj. horas duas; et cola. Dosis 3j ad Zij.

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