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be borne to the same extent as at an earlier stage; and if it fail in checking the onward progress of the pulmonary disease, it may, nevertheless, relieve the thoracic pains, the cough, or the dyspnoea, which are apt, at this time, to be particularly

distressing.

There are but one or two symptoms which can be said to belong particularly to this stage. The oedema, which now and then supervenes, is open only to palliative measures, and even these are feeble and oftentimes unsuccessful. Rest in the horizontal position, tepid, spirituous, or Goulard lotions, and light bandages, are the only things required, or even admissible; and by their use relief is frequently afforded.

For the delirium which attends the last hours of the sufferer very little indeed can be done. Occasionally it seems to be connected with the exhibition of opiates given for the relief of some particular symptom; in which case small doses of morphia, together with ammonia, wine, or other stimulants, may be of service. But when there is no reason to believe that it is due to such a cause, but rather to the declining functions of the brain, opium, in a small quantity, may be taken with advantage; and even if it should fail in the object sought, it may, in some degree, tranquillize the sufferer, and render the closing scene less painful both to himself and those around him. But, at this solemn period, neither opium nor any other

narcotic should be given to an extent that might interfere with that mental life which, in bidding adieu to this world, sometimes presents a brilliancy which, however transient, is sometimes usefully employed by the dying, and thankfully remembered by the living. The duty of the physician extends no farther than in diminishing that morbid mental irritability which renders the few last hours of the patient doubly agonizing; and we should studiously avoid doing anything which can either shorten or weaken intellectual existence.

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CHAP. IV.

TREATMENT OF THE VARIOUS FORMS OF CONSUMPTION.

THE preceding observations upon the treatment of phthisis are applicable to every chronic case, whether it assume the florid or the languid type; but very different measures are required in the acute form of the disease.

Acute Phthisis.-The question of bleeding in this disease is a very delicate one, and open to much variety of opinion. When active pneumonia or bronchitis constitutes the chief feature in its early symptoms, and when, at the same time, the patient's strength is considerable, moderate depletion may be desirable; but even this should be rather of a local than a general kind,-by cupping or leeches. But whenever it is manifest that the inflammatory complication is more of a secondary character; or, when the physical powers are but small, the slightest loss of blood is evidently contra-indicated. In the majority of these cases, there is more to be apprehended from early exhaustion of the system, than from excessive action. As the acuteness of the first symptoms passes away, blisters, or a milder form of counter-irritation are likely to prove useful.

Antimony may be necessary when the attack sets in with great severity; but mercury should never, in my opinion, be resorted to:-in the few cases which have fallen under my own observation, neither of these remedies was indicated, and their use would certainly have been rather prejudicial than otherwise. Generally speaking, perhaps, but little can be done by any medicinal agents, beyond relieving the urgency of the cough and feverish disturbance by simple expectorants and salines, and keeping up the strength by ammonia or other diffusible stimulants. The diet should not be much reduced, but carefully adapted to the particular requirements of the patient; wine or brandy being freely given so soon as there is the slightest threatening of exhaustion.

But it would be impossible to lay down any precise rule for the treatment of acute consumption, since it must be entirely governed by the peculiarities of each individual case. To subdue inflammatory action without inducing physical exhaustion, in persons who can seldom endure even the least active treatment, is the general principle upon which it must be based, and at once exhibits the difficulty which has to be encountered.

Laryngeal phthisis being nothing more than a complication of the ordinary form of chronic consumption, requires precisely the same treatment as the latter disease, except in the employment of some few additional remedies devoted to the larynx.

When the voice becomes hoarse, or from other symptoms there is reason to suspect that the laryngeal mucous membrane is implicated, local applications to the upper part of the respiratory passages are immediately necessary, since, at this early period, there is much hope of checking, and perhaps even of curing, this most distressing complication. Such applications may be made externally or internally. Externally, the caustic solution of iodine already spoken of, or the croton oil liniment, or small and frequently repeated blisters, or, indeed, any form of counter-irritation, may be usefully applied, and will often check the local symptoms in a most decided manner. The use of applications internally, involves a practice upon which there is much difference of opinion, both as regards its practicability and success,-I allude, of course, to what has been called topical medication of the upper part of the respiratory passages.

I should here remark, that my own views upon this subject differ from those I formerly held, and have even expressed; and that I owe this change to the kindness of Dr. Horace Green, of New York, the justly celebrated advocate of this treatment, who, during a recent visit to our metropolis, convinced myself and others, not only of the possibility, but of the safety and usefulness of the practice.

I had long been in the habit of using a solution of nitrate of silver to the pharynx and upper sur

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