CONSUMPTION OF THE LUNGS. 



jcute attack, or of the exacerbation of the old inflammatory disorder 

 of the lung, be past. The fits of shivering, which come on regularly 

 every evening, in many cases of phthisis, and which sometimes actually 

 amount to rigors, have often been observed to cease if the patient re- 

 main in bed. And, upon closer observation, it has been found that not 

 only does the chill which heralds the evening access of fever, but all 

 the other febrile symptoms, especially the rise in temperature, undergo 

 marked improvement while the patient remains in bed for a few days. 

 There is nothing strange about this, if, instead of regarding the hectic 

 fever of consumptives as something peculiar, as an ens sui generis, we 

 look upon it as a fever due to chronic inflammation. The fever which 

 accompanies bronchial catarrh, pneumonia, or inflammation of any other 

 Drgan, increases and diminishes as the disease grows better or worse, 

 and it is just the same with the hectic fever of phthisis. Hence, if 

 resting in bed, such as we generally recommend in other inflamma- 

 tory disorders, have a beneficial effect upon the pneumonia of con- 

 sumptives, it will tend also to mitigate then* fever. 



The use of the alkaline muriate mineral waters, which is often so 

 beneficial in simple catarrh, is equally useful in some cases of consump- 

 tion. According to our view of the disease, this effect (which of 

 course all believers in the theories of Laennec will deny) is not more 

 enigmatical than that which these waters produce upon a simple 

 catarrhal inflammation, which does not involve the substance of the 

 lung. The idea, that the use of the waters of Ems and Obersaltzbrun- 

 ner is contraindicated by the presence of fever, is merely one of the 

 results of imperfect observation. It is not the mineral waters which 

 disagree with l^ie fever, but the journey to the watering-place, and 

 the promenades at the springs. As we have said before, a patient 

 with any appreciable degree of fever ought to be in his room or in his 

 bed. 



A continued abode in elevated regions, where, without any appar- 

 ent reason, consumption is rare, is also advisable for consumptives, 

 when their disease depends upon chronic pneumonia. I fully approve 

 of the customary practice of sending phthisical patients to spend their 

 summer at Heiden, Gais, Weissbad, Kreuth, etc., although I think but 

 little of the " curds and whey treatment " which is practised there. 



In tuberculous phthisis, and in secondary tuberculosis, it is out of 

 our power to meet the indications derived from the disease itself. 



Indicatio Symptomatica. Fever is the symptom which principally 

 demands treatment, whenever it persists at all severely, in spite of 

 the remedies directed against the main disease. Anti-pyretics very 

 properly play a most important part in the therapeusis of consumption. 

 It is not that these remedies exert any more direct influence upon 



