PHTHISIS. 83 



mercury occurred about the same time, and without any mutual 

 communication, to Drs. Stokes, Graves, and Marsh. Dr. Stokes 

 observes — " For the last few years, these gentlemen and I have 

 treated with mercury several cases of incipient pulmonary disease, 

 which in all probability would have ended in phthisis. But a great 

 number of observations must still be made in order to establish the 

 actual value of this practice, and it must be recollected that, in the 

 cases thus treated, other and active mfeans were employed to remove 

 the local disease." 



When a tubercular excavation is formed, our art avails us but 

 little indeed ; in fact, all we can do is to palliate the concomitant 

 symptoms. True it is, that in many cases of this kind, judicious 

 treatment may prolong life for many years ; in the great majority of 

 cases, however, after a large cavity is formed, a fatal issue soon 

 succeeds. In some cases, a healthy action is set up in the cavern, 

 and the patient is saved, but, unfortunately, such an occurrence is 

 exceedingly rare. The patient's best chance, under such circum- 

 stances, is afforded by the use of setons, and travelling. 



The palliative treatment must be directed to the more distressing 

 symptoms, such as the hectic fever, cough, pain, diarrhosa, &c. 



Hectic fever in this disease must be regarded more as a measure 

 of the irritation than of the suppuration of the lung ; it is often alle- 

 viated by local depletions, by the cccurrence of an haemoptysis, or by 

 regulating the diet. The patient should stay as little as possible in 

 bed, and should sit during the day in a large airy apartment ; his 

 chest should be sponged with tepid vinegar and water; frequent 

 changes of linen are to be provided ; and the state of the digestive 

 system should demand our attention. Sulphate of quinine has been 

 rj^mmended, especially when the fever assumes an intermittent 

 character. 



The pains are best relieved by leeches, blisters, and anodyne lini- 

 ments. For quieting the cough, all the different forms of demulcents 

 and narcotics have been employed ; of the latter, the best are, the 

 different preparations of opium, henbane, conium, and belladonna, and 

 especially the old 'paregoric. When the cough resists these means, 

 a few leeches may be applied to the trachea ; in some chronic cases, 

 where even these means fail, inhalations of the vapour of water, 

 containing a narcotic extract, are frequently useful." 



The diarrhcea must be looked upon as proceeding from an enteritis, 

 and it is best treated by attending carefully to the regimen ; in the 

 early stages, it can generally be controlled by the ordinary cretaceous 

 and opiate medicines, but these soon lose their effect. In the more 

 advanced stages, the metallic astringents, with opium, and anodyne 

 enemata, are employed ; in cases where even these fail, decided 

 benefit is produced by the application of a blister to the abdomen. 



