cessation of night sweats. The general impression produced on my mind was so favourable, that I began my more exact inquiries with much confidence. In my first cases, the ether had been given in water with hydrocyanic acid and bicarbonate of potash, twenty-minim doses of ether to each ounce of the mixture. The ether was afterwards added to cod-liver oil, the æther purus of the Pharmacopoeia being used, and about ten minims (9.259 m.) added to every two drachms of oil at first, afterwards fifteen and twenty minims were occasionally given in the same quantity of oil. In some cases the ether was administered in water alone, and taken a short time before the oil. The effects were similar in all cases; but for convenience sake, and on account of its power of masking the unpleasant properties of the oil, I now, generally, give ether mixed with cod-liver oil, in the proportions mentioned. In my second and systematic inquiry, I treated fifty cases taken as they presented themselves at the dispensary, each patient being carefully examined on admission and at least once every fifteen days during treatment. A brief record was kept of the progress of each case; but from former experience, I determined in this inquiry not to accept the statement of the patients themselves as evidence of improvement, but only to consider those patients better in whom the result of a physical exploration of the chest, in addition to decided increase in weight, confirmed the statements made. I therefore weighed every patient once a week. As it would be impossible to give a record of each case in a communication such as the present, I must confine myself to a brief statement of the results obtained in the fifty cases.

Sixteen were admitted in the first stage of the disease; nineteen in the second stage; and fifteen in the third.

Of the sixteen in the first stage (or stage of deposition) seven improved in general symptoms and in physical signs, gaining on an average over 7 lbs. each; five remained stationary, all gaining weight slightly; and only four became worse.

Of the nineteen cases in the second stage, six improved in all respects, gaining on an average about 8 lbs. each, two cases gaining 14 lbs. and 10 lbs. respectively; six remained stationary; and seven became worse.

Of the fifteen cases in the third stage, seven improved, gaining on an average, about 5 lbs. each; five remained stationary; and three became worse.

Of the total fifty cases, twenty improved, sixteen remained stationary, and fourteen became worse.

Six of the cases treated, in no instance for a less time than three months, and observed over a period of many months, retained their weight; were troubled by no symptoms, and maintained the improvement in their physical signs. Only one

of these were observed over a less period than fifteen months, three over two years, and two over eighteen months. These cases may be considered, I think, as examples of the arrest of the disease, for the patients have returned to their ordinary avocations, and are able to earn their livelihood untroubled by their former disease. The only other remedies used in those cases were croton ointment, as a counter irritant, Dover's powder occasionally to relief the cough, and, in a few cases, a little linctus morphiæ. But as cod-liver oil was administered as well as ether, the objection may very naturally be made that the improvement was due to the use of the oil. For my own part this objection has not much value, for I had long used oil largely without obtaining any results at all equal to those stated. In order, however, to meet this objection the ether was stopped in ten instances, and the oil continued; six times there was a fall in weight during the following three weeks. In one case the patient, who had taken ether for some two months, continued to gain weight. In the three other cases the gain ceased, but was again observed in these patients, as it was in all, when ether was again administered.

These results are not only instructive, as showing the effect of ether in increasing weight, but also as showing that the digestion of fatty food is restored to its normal state, in many cases, after a long course of ether. In the cases which have done best under treatment, that is, the cases which I think we may consider instances of arrested phthisis, the power of taking fats, which was at one time much impaired, has returned, and the gain in weight has been maintained over a period of many months. I may here also add that, in all the fifty cases there had been marked wasting before my treatment was adopted, in at least half the cases, cod-liver oil notwithstanding. Many of my patients have over and over again expressed their preference for the etherised oil; and many who have been unable to retain ordinary oil when taken, have been able to use etherised oil, not only without disagreeable symptoms, but almost with pleasure; "to drink it from the bottle,' as some have expressed it.British Medical Journal, Nov. 21 and 28, 1868, pp. 543, 570.

33.-RAWNESS OF THE TONGUE AND PAINFUL DEGLUTITION IN ADVANCED PHTHISIS.

By Dr. DOUGLAS POWELL, Physician to the Hospital for
Consumption, Brompton.

[The following is a note of the treatment which Dr. Powell employs with success in the above distressing complication.]

The combination of remedies most beneficial in these cases, which must be familiar to all and require no illustration, con

sists of chlorate of potash and glycerine in some syrup containing morphia. The proportions Dr. Powell commonly uses are -chlorate of potash, forty to sixty grains; glycerine, half an ounce; syrup to four ounces, with morphia, one grain and a half to two grains. A teaspoonful swallowed slowly acts locally on the parts affected, relieving at the same time the cough. Of course, in the latest stage of the disease this will but render the remaining hours of life more comfortable, or prolong life a little; but there are some cases where the disease of the lungs is considerable, though not incompatible with life, and the patient having been reduced very low by diarrhoea, vomiting, &c. this condition of tongue and throat will come on, and, rendering the taking of nutrients or stimulants almost impossible, the patient therefore dies from exhaustion. Indeed, the aphthous condition which follows this is usually considered a fatal sign in chronic disease; but it is not necessarily so. In these cases the above remedy relieves pain, cleanses the tongue, and enables the patient to take nourishment and remedies which greatly prolong life.-Lancet, Dec. 19, 1868, p. 799.

34. ON THE TREATMENT OF ASTHMA BY BELLADONNA. By Dr. HYDE SALTER, F.R.S., Senior Physician to Charing Cross Hospital.

[Dr. Salter in the introductory part of this paper states that he bas during the last two years used belladonna extensively in the treatment of asthma, and with very satisfactory results.]

If I were to express what appears to me to be the peculiar excellence of belladonna as a sedative in asthma, I should say it consisted in its power of diminishing reflex irritability —a power which it appears to me to possess in a degree greater, in proportion to its other sedative effects, than any other sedative.

My method of giving it will be best seen in the following cases. I do not know that the tincture has any advantage over other preparations, only it happens to be that which I have tried. I should think that the liquor atropiæ might, from its uniformity of strength, be even preferable.

Case 1.-R. G., a lady aged 25, who has been liable to hay fever for eleven years, and to asthma for seven, came to me on May 18th, 1868, for the cure of her bay asthma. She had been suffering for nearly a month, and had not had a single night's rest. She was not troubled with her asthina by day, but only with her hay-fever symptoms. As soon, however, as she went to bed on came her asthma, and lasted regularly all night. She was worn out for want of rest, and felt fagged and miserable. I ordered her ten minims of the tincture of belladonna three

times a day, telling her to increase the quantity, day by day, till the characteristic effects of the drug were produced. She gradually raised the dose from the ten minims to twenty. She felt better the first night after taking it. She took it for nine days, and had no asthma whatever. She then, thinking herself cured, and feeling her head very uncomfortable, omitted it for one day, and the following night got no sleep from asthma. She then resumed it, and has had no asthma since. She now regularly takes twenty drops three times a day. Her head is slightly affected, and her eyes decidedly so-misty, and she cannot read; but there is not a trace of asthma. She has never found anything else prevent the attacks. The belladonna seems to have no influence whatever over the other hay-fever symptoms; the sneezing, running at the eyes, &c., go on as before.

Case 2.-Sarah P., aged 46, has had asthma ever since she was nineteen years of age-that is, for twenty-seven years. For the last five months she has been worse than ever, and for some time past has had asthma regularly every night. It begins between two and three o'clock, and after that she gets no rest. I ordered her to take the tincture of belladonna every night on going to bed-to begin at ten minims, and gradually to increase the dose till her head and sight became affected. She came to me on the 29th of last July. On the 14th of August I find the following entry in my note-book :-"This patient came to me a fortnight ago yesterday. She has almost completely lost her symptoms ever since, having had uninterrupted good nights. She has gradually reached thirty drops of the tincture of belladonna, and now takes it every night. She looks wonderfully better, and is able to take long walks." From that time I have not heard anything of her.

Case 3.-Col. R., aged 40, has had asthma for sixteen years. For the last few years it has been gradually getting worse, and now he has it almost every night, commencing at from one to two o'clock a.m. He has tried various things without any success-Indian hemp, chlorodyne, ether, the inhalation of chloroform, dry cupping, coffee, iodide of potassium, abstinence, &c. I saw him on September 16th, and ordered him to try the belladonna at night in the usual way. On the 23rd I find the following note :-"He has gradually got the belladonna up to forty minims without any appreciable inconvenience. The nights have been very good. The two last mornings there has been no oppression whatever, nor any sitting up in bed; he has slept right through the night. He walked this morning, directly after breakfast, from his house at Blackheath to the station-a mile-in sixteen minutes, and

the same pace up from Charing-cross station here." I have not seen him since.

Case 4.-Wm. P., aged 38, has been asthmatic seventeen years. His attacks come on every morning on rising from bed, but often trouble him throughout the day as well. There is defective respiration at the right base, violent paroxysmal cough, and a good deal of expectoration. This patient came to me on Oct. 13th. A week after I made the following note:"Since coming to me this patient has taken the belladonna every night-twenty, twenty-five, and then thirty drops, to which last dose he has stuck. The result is that he is quite a different man. He has slept all through the night, dressed himself without any trouble or difficulty, and has walked half over London as quickly and well as ever he did in his life. When he arrived in town his breath was so bad that he had the greatest difficulty in getting from the Vauxhall station to the church near the bridge. He spits hardly anything. There is now a complete absence of all musical wheezing, and of any adventitious sound whatever respiratory murmur quite re-established at right base, and indeed perfectly natural everywhere. And this change has taken place in one week."

I believe one reason why belladonna has not had a greater reputation as a remedy for asthma is that it has not been given in large enough doses. I think that, like lobelia, it must be given in doses sufficiently large to produce its physiological effects, otherwise we have no right to say that it has been fairly tried, or to conclude that it has been a failure if it has not achieved a cure. I think to give ten minims three times a day in some mixture is simply worthless. I have seen now numberless cases in which both belladonna and lobelia have been consigned to the limbo of failures, when a fresh trial of them, on the plan of gradually increasing the doses till an ultimatum has been reached, has proved them to be perfectly successful remedies. Sometimes, but very rarely, belladonna will relieve asthma when given short of a physiological dose; sometimes, but still rarely, it fails to give any relief even when pushed to its full physiological effects; the common thing is for it to fail till so pushed, and then to succeed. When I find belladonna has only been taken in the ordinary small doses, without any increment, I always regard it as not having been tried at all.

The advantages of administering it in the way I have described are:

1. That, giving it at night, you bring the full force of the drug to bear upon the disease at the time at which it is most liable to come on, and thus, if you are successful, tide your patient over the critical time.