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ON THE TREATMENT OF ACUTE RHEUMATISM.
472
surgeon" and " pure physician." I may also be an obstinate man, but under sickness myself, give me the aid of the steady and sound practitioner who has learnt what is known of his art beside the patient’s bed, and uses the means at his command under the control of that most valuable of all human gifts, common sense. Twickenham, June 3, 1844. CASE OF OPACITY OF THE CORNEA SUCCESSFULLY TREATED WITH THE
SULPHATE OF COPPER AND NITRATE OF SILVER.
By
GEORGE
JOHNSON, Esq., Berwick.
MARGARET CARR, has been blind of the left eye for years ; in fact, she was blind in both eyes eighteen years ago, when she went to the Royal Infirmary of Edinburgh, and was admitted under Mr. Gillespie. She remained under his care for six weeks and returned home with restoration of vision in one eye (the right one), but he refused to meddle with the other. I undertook the I may state that the treatment of it three weeks ago. appearance of the cornea resembled a piece of horn, being quite opake and of a dull pearl colour; in fact, it looked more like staphyloma than anything I can compare it to. I commenced touching it twice a day with the sulphate of copper ; at the end of a week she began to distinguish the outlines of objects, and told me she could see windows from doors in the street. I now touched it with the nitrate of silver, but could not touch it more than once in the day, on every other day, as it produced redness and slight inflammation of the conjunctiva, which disappeared in a few hours. The cornea became from day to day more transparent, and I think it derived more benefit from this application than from the blue-stone. With a view to excite the action of the absorbents of the eye I gave the following formula :R Chloride of mercury, twelve grains; opium, two grains. Mix and divide in six pills, one to be taken every night. I also ordered one drop of the wine of opium to be dropped into the inner angle of the eye twice a day. At present the eye has nearly assumed its natural appearance, and she can see my hand quite distinctly when I bring it forward to touch the eye with the nitrate of silver, and can distinguish colours and objects. I think this case will illustrate the success of the treatment tolerably well, and I have no doubt she will see perfectly in a little time, as my work is not finished yet. Hydrocyanic acid seems to be quite the rage at present in the treatment of diseases of the eye, but I must say, from my experience of it, that it is not likely to answer the many purposes to which it is applied. I have lately seen two cases tried with it, one was amaurosis and the other cataract-the patients were not benefited in the least. Indeed, I cannot see how it can cure these diseases ; it is more likely to succeed in opacities of the cornea. Notwithstanding I prefer the treatment which I used in this case, for there is a double effect produced, viz., a cauterising and a stimulating efiect, and it is only on the latter principle that the hydrocyanic acid can do good.
eighteen
ON THE TREATMENT OF ACUTE RHEUMATISM. By ROBERT BARNES, M.B. IT is with much pleasure that I observe that the attention of the readers of THE LANCET has been directed to this subject by a gentleman who has enjoyed such unexceptionable opportunities of observation as Dr. Henry Bennet. His article is calculated to throw light on two important and somewhat obscure points,-first, on the treatment of acute rheumatism ; secondly, on the therapeutical and toxicological effects of nitrate of potash. With regard to the first point, I am enabled to bear testimony to the efficacy of nitre in large doses. While following the practice of M. Gendrin I noted several cases in which the employment of this remedy was fully successful. Nevertheless, I do not think that the objections to it have been sufficiently dwelt upon. In one case I watched in the wards of M. Gendrin, alarming diarrhoea
supervened on the second day, together with vomiting and pain on pressure over the region of the stomach,
and increase of febrile movement. The remedy was, of course, suspended, and M. Gendrin did not think it prudent to recur to it. Another objection arises from the necessarily nauseous beverage a compound of nitre and ptisane makes, and the consequent almost insuperable aversion some patients evince to drinking it. This is so great that I have many times doubted whether the ounce a day was really taken or not, especially as its administration cannot be ensured like that of other remedies exhibited in definite doses at stated times. It is this circumstance which gives additional value to the observations of a gentleman who has occupied the position of Dr. Bennet. It is only an "interne" who can acquire a personal conviction upon a point of this kind; for, without disputing the fact of M. Martin Solon’s finding all the nitre in the urine, I know that sometimes it finds its way into the chamber-utensil by a passage more direct than through the kidneys. Still Dr. Bennet is, no doubt, in a position to maintain that in the majority of cases the remedy is well-borne, and some degree of diarrhoea. may be rather beneficial than otherwise. Dr. Bennet, as if foreseeing an objection that will be urged against a reliance on nitre, to the exclusion of bleeding, refers to the supposed predisposition to heart disease under acute rheumatism. He asserts that heart disease rarely occurs in patients treated by nitre, and even doubts whether the complication be ever of frequent occurrence. Chomel, it is well-known, enters a decided protest against the reception of this doctrine. Since its first promulgation he has kept an accurate record of all the cases of acute rheumatism and of heart disease which have occurred in his practice. In but a few instances has he been able to trace the heart disease to antecedent rheumatism, and in the cases of acute rheumatism he has not observed heart disease to have arisen more frequently than in other inflammatory affections. The reason for the discrepancy between the conclusions arrived at by this comprehensive observer and other pathologists is this : he firmly denies that the bellows-sound is any proof of pericarditis; and there can be little doubt that that symptom has often been the sole ground for asserting the presence of this affection. As bearing upon this subject I may relate a case I witnessed some time back in the Marylebone Infirmary. A woman, about thirty years of age, of spare habit, and reduced by previous illness and bad living, revealed not only the bellows-murmur, but also the friction-sound. She was bled ; the sounds increased ; antiphlogistic treatment was persevered in, and the sounds continued unabated. At the end of a fortnight the physician, a gentleman of high and deserved reputation as an auscultator, confessed his doubts as to the accuracy of his diagnosis, changed his plan of treatment, and the patient mended. The frequency, then, with which heart disease supervenes in acute rheumatism has been exaggerated. Still, of the reality of the connection between the two diseases I am firmly convinced, from having observed several unequivocal cases of pericarditis followed by adhesions, palpitations, hypertrophy, and imperfect oxygenation of the blood. But, granting that in acute rheumatism heart disease is to be apprehended, it does not follow that the attack may be warded off with more certainty by depletion than by nitre. Indeed, I have heard more than one eminent physician declare, as the result of their experience, their belief that heart disease was sometimes induced, and often aggravated, by depletion. With regard to the second point, the therapeutical and toxicological effects of nitre, one essential distinction in the action of remedies has been overlooked by those who dread its poisonous action. They have argued from the physiological to the pathological action of nitre; they have presumed that being poisonous to a person in health, it will be so in similar doses to a person in disease. I need not remark that this conclusion is contrary to the science of therapeutics, or instance that the dose of opium which may be with safety administered in delirium tremens, or of tartar emetic in pneumonia, would probably be fatal if given to an individual in health. With reference to the use of nitre in other diseases, I may add
473 that I have used it freely in the febrile and inflammatory strength, and spirits, were better than they had ever preaffections of children, and with the most satisfactory viously been. On the 27th of May I saw him ; he told me he felt perresults. 1 have found no remedy, not even antimony, more effectual in lowering the circulation, and in profectly well, and on carefully examining his chest I found ducing moisture on the skin, a thing so difficult to accom- the respiratory murmur uniform and healthy, without rale or harshness, and the cardiac action, though stilt plish in children. In conclusion, I may be permitted to suggest that audible on both sides of the chest, was less distinct tham much of the uncertainty which prevails concerning the formerly. Though still thin and spare, he appeared in action of remedies, and the dread of excessive doses, thoroughly good health. Were our arises from a too contracted observation. If we can establish this as a case of phthisis, and I fellow-countrymen to extend the field of their observa- believe I am able to produce unquestionable evidence of tions beyond the wards of one or two hospitals, and the this, I think it is a fair instance of cure by naphtha, as practice of three or four physicians,-more especially were the patient’s mode of life was not changed, and the only they to spend a little time in studying at the incompa- auxiliary means were washing the chest daily with.. rably superior schools of the Continent,—many a bigotted vinegar and water, care as to dress, and taking a tumdogma imbibed from one man would be rejected if tried blerful of milk on waking in the morning. I cannotby the varied practice of many ; many an unfounded flatter myself that my patient’s strong hereditary tenprejudice would give way before the light of enlarged dency to consumption is eradicated, but I am fully persuaded that if it does return some length of time must experience. Bulmer House, Notting-hill, elapse ere the chest can be so disordered as to require him June 17, 1844. to seek medical advice on that score. This case is not the only one in which I have employed TREATMENT OF PHTHISIS BY NAPHTHA. naphtha with advantage, but as some of the patients are. still under treatment it would be premature to adduce By JOHN BUXTON, M.D., M.R.C.S. them, and in other instances the pulmonary affection wa& complicated with disease in other organs. THE successful treatment of phthisis is so uncommon, In some cases of bronchitis, in the chronic stage, it that I shall offer no apology for publishing the following has proved in my hands an irritant, so that I am led to case, in which naphtha, or pyro-acetic spirit, has been consider its action, as Dr. Hastings does in his « Treatiseon the Use of Naphtha in Phthisis," to be that of a sti-employed with most beneficial results. A. B., aetat. 17, apprentice to an undertaker, was at- mulant tonic, exerting a specific agency in phthisical. tacked in October last with cold and cough, accompanied complaints. I would especially caution any one who may be disby haemoptysis, which, though slight, was continually recurring. In the winter preceding he had suffered from posed to give this remedial agent a trial, to see to it himcough and expectoration, which did not leave him till self that the naphtha is good, as I obtained, from an May or June, when he went for a short time to the sea- establishment deservedly celebrated for the general side. He now presented all the appearances of a person purity of their drugs, two quantities of naphtha, verybordering on the second stage of phthisis, tall, spare, different in nature and effects from that which has nownarrow-chested, very pale, and the nails very much in- so often been of service in the treatment of phthisis. curvated. He was very languid and dull, fully persuaded The simplest tests of its goodness are, that its odour isthat he could not recover from his illness, as several not strong nor very disagreeable, and particularly that it among his paternal relations had fallen victims to the mixes with water just as alcohol does, without causing same disease, and his father had died from it the previany milkiness or discoloration, and evolving some heat.. ous year. His business required him to be out in all (See Hastings’s Essay, p.50, 51.) weathers, and often to walk for a distance of eight or ten Brownlow-street, Bedford-row, June 1, 1844. miles. Another medical man, who formerly attended his We have inserted the above case more as a speci-** father, had seen him, and concurred with me in giving men of the manner in which the reputation of specifics his mother no hope of his recovery. Our belief was that he would not last longer than six or seven months if he is established than for its intrinsic value, for it possesses remained in this country, and as I doubted whether a none whatever. There is not the slightest particle of sea-voyage would prove a preservative to him, I obtained evidence to prove that the patient was labouring under the opinion of Dr. Fox, physician to the Infirmary for The stethoscopic signs, it is stated, were notDiseases of the Lungs. He agreed with me in consider- phthisis. marlced; "in the portions of the chest just below the very a warmer and that climate sea-air held some out ing prospect of success, and thought this a fair case for try- clavicle the vesicular murmur was rather harsh; lower ing naphtha, at least till he started. He also advised the down it was puerile, with mucous rale all over; thedaily washing of the chest with vinegar and water, care sounds of the heart were heard over a considerable part as to dress, and taking a tumblerful of new milk in the of both sides of the chest, especially under the clavimorning early. The stethoscopic signs were not very cles." All these symptoms, coupled with others more in of the chest below the portions the clajust marked; assist the diagnosis of phthisis, but alone vicles the vesicular murmur was rather harsh, and lower important, down it was puerile, with some mucous rale over the have little or no value, as they may exist in bronchitis as whole, and perhaps partly owing to the patient’s ema- well as in that disease. As to the general symptoms ciated condition, as well as to the tubercular deposit in are very frequently the result of conthe lungs ; the heart’s action was heard over a consider- enumerated, they in young subjects. Taking, therefore, firmed bronchitis under able part of both sides of the chest, especially the the absence of any decided symptoms. into consideration clavicles. When he awoke in the morning he generally found himself perspiring rather freely, and with cough- of pulmonary tuberculisation, and the presence of alL ing expectorated some white frothy mucus, which was the symptoms of chronic bronchitis, we have no hesitaoften streaked with blood. tion in saying that the case was one of chronic bronchitis’ To check the haemoptysis and ease the cough he had and not of phthisis. 14th oxymel of squills and diluted sulphuric acid, and on of November I began with ten minims of naphtha, three THE times a day, in water, which in a couple of days was increased to fifteen minims. He continued this tolerably PRINCIPLES AND PRACTICE OF MEDICINE. By CHARLES MACKIN, M.D. regularly till about the end of January, when, in consequence of having regained his health, he withdrew himself WHEN the moralists of ancient times made the subject from treatment, having from the time of commencing this remedy steadily improved in health in every respect. of baths a butt for the stinging darts of satire, these. He had lost his perspirations, cough, and expectoration latter were directed, not against the prudent and judinetrelv, had obtained some colour, and his appetite. cious use of such, but against effeminate abuse and .
,
surgeon" and " pure physician." I may also be an obstinate man, but under sickness myself, give me the aid of the steady and sound practitioner who has learnt what is known of his art beside the patient’s bed, and uses the means at his command under the control of that most valuable of all human gifts, common sense. Twickenham, June 3, 1844. CASE OF OPACITY OF THE CORNEA SUCCESSFULLY TREATED WITH THE
SULPHATE OF COPPER AND NITRATE OF SILVER.
By
GEORGE
JOHNSON, Esq., Berwick.
MARGARET CARR, has been blind of the left eye for years ; in fact, she was blind in both eyes eighteen years ago, when she went to the Royal Infirmary of Edinburgh, and was admitted under Mr. Gillespie. She remained under his care for six weeks and returned home with restoration of vision in one eye (the right one), but he refused to meddle with the other. I undertook the I may state that the treatment of it three weeks ago. appearance of the cornea resembled a piece of horn, being quite opake and of a dull pearl colour; in fact, it looked more like staphyloma than anything I can compare it to. I commenced touching it twice a day with the sulphate of copper ; at the end of a week she began to distinguish the outlines of objects, and told me she could see windows from doors in the street. I now touched it with the nitrate of silver, but could not touch it more than once in the day, on every other day, as it produced redness and slight inflammation of the conjunctiva, which disappeared in a few hours. The cornea became from day to day more transparent, and I think it derived more benefit from this application than from the blue-stone. With a view to excite the action of the absorbents of the eye I gave the following formula :R Chloride of mercury, twelve grains; opium, two grains. Mix and divide in six pills, one to be taken every night. I also ordered one drop of the wine of opium to be dropped into the inner angle of the eye twice a day. At present the eye has nearly assumed its natural appearance, and she can see my hand quite distinctly when I bring it forward to touch the eye with the nitrate of silver, and can distinguish colours and objects. I think this case will illustrate the success of the treatment tolerably well, and I have no doubt she will see perfectly in a little time, as my work is not finished yet. Hydrocyanic acid seems to be quite the rage at present in the treatment of diseases of the eye, but I must say, from my experience of it, that it is not likely to answer the many purposes to which it is applied. I have lately seen two cases tried with it, one was amaurosis and the other cataract-the patients were not benefited in the least. Indeed, I cannot see how it can cure these diseases ; it is more likely to succeed in opacities of the cornea. Notwithstanding I prefer the treatment which I used in this case, for there is a double effect produced, viz., a cauterising and a stimulating efiect, and it is only on the latter principle that the hydrocyanic acid can do good.
eighteen
ON THE TREATMENT OF ACUTE RHEUMATISM. By ROBERT BARNES, M.B. IT is with much pleasure that I observe that the attention of the readers of THE LANCET has been directed to this subject by a gentleman who has enjoyed such unexceptionable opportunities of observation as Dr. Henry Bennet. His article is calculated to throw light on two important and somewhat obscure points,-first, on the treatment of acute rheumatism ; secondly, on the therapeutical and toxicological effects of nitrate of potash. With regard to the first point, I am enabled to bear testimony to the efficacy of nitre in large doses. While following the practice of M. Gendrin I noted several cases in which the employment of this remedy was fully successful. Nevertheless, I do not think that the objections to it have been sufficiently dwelt upon. In one case I watched in the wards of M. Gendrin, alarming diarrhoea
supervened on the second day, together with vomiting and pain on pressure over the region of the stomach,
and increase of febrile movement. The remedy was, of course, suspended, and M. Gendrin did not think it prudent to recur to it. Another objection arises from the necessarily nauseous beverage a compound of nitre and ptisane makes, and the consequent almost insuperable aversion some patients evince to drinking it. This is so great that I have many times doubted whether the ounce a day was really taken or not, especially as its administration cannot be ensured like that of other remedies exhibited in definite doses at stated times. It is this circumstance which gives additional value to the observations of a gentleman who has occupied the position of Dr. Bennet. It is only an "interne" who can acquire a personal conviction upon a point of this kind; for, without disputing the fact of M. Martin Solon’s finding all the nitre in the urine, I know that sometimes it finds its way into the chamber-utensil by a passage more direct than through the kidneys. Still Dr. Bennet is, no doubt, in a position to maintain that in the majority of cases the remedy is well-borne, and some degree of diarrhoea. may be rather beneficial than otherwise. Dr. Bennet, as if foreseeing an objection that will be urged against a reliance on nitre, to the exclusion of bleeding, refers to the supposed predisposition to heart disease under acute rheumatism. He asserts that heart disease rarely occurs in patients treated by nitre, and even doubts whether the complication be ever of frequent occurrence. Chomel, it is well-known, enters a decided protest against the reception of this doctrine. Since its first promulgation he has kept an accurate record of all the cases of acute rheumatism and of heart disease which have occurred in his practice. In but a few instances has he been able to trace the heart disease to antecedent rheumatism, and in the cases of acute rheumatism he has not observed heart disease to have arisen more frequently than in other inflammatory affections. The reason for the discrepancy between the conclusions arrived at by this comprehensive observer and other pathologists is this : he firmly denies that the bellows-sound is any proof of pericarditis; and there can be little doubt that that symptom has often been the sole ground for asserting the presence of this affection. As bearing upon this subject I may relate a case I witnessed some time back in the Marylebone Infirmary. A woman, about thirty years of age, of spare habit, and reduced by previous illness and bad living, revealed not only the bellows-murmur, but also the friction-sound. She was bled ; the sounds increased ; antiphlogistic treatment was persevered in, and the sounds continued unabated. At the end of a fortnight the physician, a gentleman of high and deserved reputation as an auscultator, confessed his doubts as to the accuracy of his diagnosis, changed his plan of treatment, and the patient mended. The frequency, then, with which heart disease supervenes in acute rheumatism has been exaggerated. Still, of the reality of the connection between the two diseases I am firmly convinced, from having observed several unequivocal cases of pericarditis followed by adhesions, palpitations, hypertrophy, and imperfect oxygenation of the blood. But, granting that in acute rheumatism heart disease is to be apprehended, it does not follow that the attack may be warded off with more certainty by depletion than by nitre. Indeed, I have heard more than one eminent physician declare, as the result of their experience, their belief that heart disease was sometimes induced, and often aggravated, by depletion. With regard to the second point, the therapeutical and toxicological effects of nitre, one essential distinction in the action of remedies has been overlooked by those who dread its poisonous action. They have argued from the physiological to the pathological action of nitre; they have presumed that being poisonous to a person in health, it will be so in similar doses to a person in disease. I need not remark that this conclusion is contrary to the science of therapeutics, or instance that the dose of opium which may be with safety administered in delirium tremens, or of tartar emetic in pneumonia, would probably be fatal if given to an individual in health. With reference to the use of nitre in other diseases, I may add
473 that I have used it freely in the febrile and inflammatory strength, and spirits, were better than they had ever preaffections of children, and with the most satisfactory viously been. On the 27th of May I saw him ; he told me he felt perresults. 1 have found no remedy, not even antimony, more effectual in lowering the circulation, and in profectly well, and on carefully examining his chest I found ducing moisture on the skin, a thing so difficult to accom- the respiratory murmur uniform and healthy, without rale or harshness, and the cardiac action, though stilt plish in children. In conclusion, I may be permitted to suggest that audible on both sides of the chest, was less distinct tham much of the uncertainty which prevails concerning the formerly. Though still thin and spare, he appeared in action of remedies, and the dread of excessive doses, thoroughly good health. Were our arises from a too contracted observation. If we can establish this as a case of phthisis, and I fellow-countrymen to extend the field of their observa- believe I am able to produce unquestionable evidence of tions beyond the wards of one or two hospitals, and the this, I think it is a fair instance of cure by naphtha, as practice of three or four physicians,-more especially were the patient’s mode of life was not changed, and the only they to spend a little time in studying at the incompa- auxiliary means were washing the chest daily with.. rably superior schools of the Continent,—many a bigotted vinegar and water, care as to dress, and taking a tumdogma imbibed from one man would be rejected if tried blerful of milk on waking in the morning. I cannotby the varied practice of many ; many an unfounded flatter myself that my patient’s strong hereditary tenprejudice would give way before the light of enlarged dency to consumption is eradicated, but I am fully persuaded that if it does return some length of time must experience. Bulmer House, Notting-hill, elapse ere the chest can be so disordered as to require him June 17, 1844. to seek medical advice on that score. This case is not the only one in which I have employed TREATMENT OF PHTHISIS BY NAPHTHA. naphtha with advantage, but as some of the patients are. still under treatment it would be premature to adduce By JOHN BUXTON, M.D., M.R.C.S. them, and in other instances the pulmonary affection wa& complicated with disease in other organs. THE successful treatment of phthisis is so uncommon, In some cases of bronchitis, in the chronic stage, it that I shall offer no apology for publishing the following has proved in my hands an irritant, so that I am led to case, in which naphtha, or pyro-acetic spirit, has been consider its action, as Dr. Hastings does in his « Treatiseon the Use of Naphtha in Phthisis," to be that of a sti-employed with most beneficial results. A. B., aetat. 17, apprentice to an undertaker, was at- mulant tonic, exerting a specific agency in phthisical. tacked in October last with cold and cough, accompanied complaints. I would especially caution any one who may be disby haemoptysis, which, though slight, was continually recurring. In the winter preceding he had suffered from posed to give this remedial agent a trial, to see to it himcough and expectoration, which did not leave him till self that the naphtha is good, as I obtained, from an May or June, when he went for a short time to the sea- establishment deservedly celebrated for the general side. He now presented all the appearances of a person purity of their drugs, two quantities of naphtha, verybordering on the second stage of phthisis, tall, spare, different in nature and effects from that which has nownarrow-chested, very pale, and the nails very much in- so often been of service in the treatment of phthisis. curvated. He was very languid and dull, fully persuaded The simplest tests of its goodness are, that its odour isthat he could not recover from his illness, as several not strong nor very disagreeable, and particularly that it among his paternal relations had fallen victims to the mixes with water just as alcohol does, without causing same disease, and his father had died from it the previany milkiness or discoloration, and evolving some heat.. ous year. His business required him to be out in all (See Hastings’s Essay, p.50, 51.) weathers, and often to walk for a distance of eight or ten Brownlow-street, Bedford-row, June 1, 1844. miles. Another medical man, who formerly attended his We have inserted the above case more as a speci-** father, had seen him, and concurred with me in giving men of the manner in which the reputation of specifics his mother no hope of his recovery. Our belief was that he would not last longer than six or seven months if he is established than for its intrinsic value, for it possesses remained in this country, and as I doubted whether a none whatever. There is not the slightest particle of sea-voyage would prove a preservative to him, I obtained evidence to prove that the patient was labouring under the opinion of Dr. Fox, physician to the Infirmary for The stethoscopic signs, it is stated, were notDiseases of the Lungs. He agreed with me in consider- phthisis. marlced; "in the portions of the chest just below the very a warmer and that climate sea-air held some out ing prospect of success, and thought this a fair case for try- clavicle the vesicular murmur was rather harsh; lower ing naphtha, at least till he started. He also advised the down it was puerile, with mucous rale all over; thedaily washing of the chest with vinegar and water, care sounds of the heart were heard over a considerable part as to dress, and taking a tumblerful of new milk in the of both sides of the chest, especially under the clavimorning early. The stethoscopic signs were not very cles." All these symptoms, coupled with others more in of the chest below the portions the clajust marked; assist the diagnosis of phthisis, but alone vicles the vesicular murmur was rather harsh, and lower important, down it was puerile, with some mucous rale over the have little or no value, as they may exist in bronchitis as whole, and perhaps partly owing to the patient’s ema- well as in that disease. As to the general symptoms ciated condition, as well as to the tubercular deposit in are very frequently the result of conthe lungs ; the heart’s action was heard over a consider- enumerated, they in young subjects. Taking, therefore, firmed bronchitis under able part of both sides of the chest, especially the the absence of any decided symptoms. into consideration clavicles. When he awoke in the morning he generally found himself perspiring rather freely, and with cough- of pulmonary tuberculisation, and the presence of alL ing expectorated some white frothy mucus, which was the symptoms of chronic bronchitis, we have no hesitaoften streaked with blood. tion in saying that the case was one of chronic bronchitis’ To check the haemoptysis and ease the cough he had and not of phthisis. 14th oxymel of squills and diluted sulphuric acid, and on of November I began with ten minims of naphtha, three THE times a day, in water, which in a couple of days was increased to fifteen minims. He continued this tolerably PRINCIPLES AND PRACTICE OF MEDICINE. By CHARLES MACKIN, M.D. regularly till about the end of January, when, in consequence of having regained his health, he withdrew himself WHEN the moralists of ancient times made the subject from treatment, having from the time of commencing this remedy steadily improved in health in every respect. of baths a butt for the stinging darts of satire, these. He had lost his perspirations, cough, and expectoration latter were directed, not against the prudent and judinetrelv, had obtained some colour, and his appetite. cious use of such, but against effeminate abuse and .
,