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sulphide of sodium and chloride of sodium, of each five grains in twenty-four ounces of water. Through this, solution they pumped the carbonic acid gas, driving off from the sulphurous water the hydrogen sulphide through a tube into the rectum. The carbonic acid gas is not only a vehicle, but is an anesthetic to the bowel and probably to a limited extent prevents colic.
Dr. Taylor, one of the internes of the hospital, who gave me every opportunity to witness and assist in the treatment, stated they had used from ten to fifteen grains each of the sulphide and chloride of sodium to twenty-four ounces of water, but that they were inclined to think the five grain solution was to be preferred.
In this hospital the results of treatment were given to me by the appearance and by the words of the patients. I examined the patients myself, and found some with cavities and others with disintegrating lung tissue. I paid special attention to a series of twenty-five cases which had been under treatment for nearly six weeks. They had all gained in weight from three to thirteen and a half pounds, and all retained this gain except one. He had gained three pounds and then lost in weight, and thought the treatment was the cause of the loss and refused further treatment. Uniformly in these cases the night sweats were controlled, the cough and expectoration largely relieved, the tongue cleaned off, appetite improved, the temperature became normal, or if not normal was of a lower grade, and the pulse and respiration became less frequent. In one case where diarrhoea was a troublesome symptom, the enemata seemed to control it. I was told that where the lung was broken down from fibroid phthisis, the results of the treatment. seemed to be better than in tuberculosis proper.
I attended the meeting of the College of Physicians of Philadelphia, the first Wednesday evening in April, when Dr. J. Solis Cohen presented to the society two forms of apparatus to be used in this treatment, both very similiar. In the discussion that followed, Dr. Horatio C. Wood said that Bergeon advocated the use of natural mineral waters in preference to artificial sulphurous water, but that he thought the artificial was as good and probably better than the natural.
Dr. J. Solis Cohen said that he was using the treatment in hospital and private patients with encouraging results, and that Berg
eon had claimed to cure not only pulmonary lesions, but pharyngeal and laryngeal tuberculous ulcerations also, without any topical applications whatever, simply from the contact of the gas in its elimination from the lungs.
Dr. Osler, of the University of Pennsylvania Hospital, related to the society one case in which he had serious symptoms of asphyxia, not from the poisonous effects of the gas, but on account of the large quantity of gas crowding the intestines up against the diaphragm and lungs, interfering with respiration, both lungs being greatly deficient in respiratory power.
When both lungs are badly crippled, the gas should be given slowly and with care. They have trained nurses in the Philadelphia hospital, but only the resident physician administers the gas. Since returning from Philadelphia I have been treating seven or eight cases. One, œt. 22, has the left lung partially broken down and has night sweats and cough with expectoration very profuse, appetite gone, losing rapidly in weight, and has most of her meals brought to her. Her temperature was 101°, pulse 110. She gained slightly in weight the second week of treatment, but lost it. Her appetite has been better from the start, her strength has improved so that she goes down stairs to her meals regularly. She has at times diarrhoea, and again vomiting of food, although there is improvement of most of her other symptoms. The first patient I treated, a young man, œt. 24, was treated only five or six times, because there was great swelling of lower limbs, œdema of lungs, and a pericardial effusion which greatly interfered with respiration, and for this reason he was not treated for about ten days before his death.
Another patient, cet. 28, with one lung badly diseased, gained in strength and increased in weight three pounds within seventeen days. Another patient, with incipient phthisis at the apex of the right lung, gained one and three-quarter pounds within eleven days. Several patients have gained slightly, about one-half pound, and some have improved in no way except the cough has been lessened one-half and expectoration and night sweats decreased.
In the last number of the Medical News, of Philadelphia, is an article by Dr. A. C. Hugenschmidt, of Paris, France, on "Inhala
tions of Sulphuretted Hydrogen in Pulmonary Tuberculosis." Dr. B. Niepce has been making the observations at the mineral springs of Allevard, and the gas inhaled is obtained from these springs, each litre of the water containing sulphuretted hydrogen, 24.75 c. cm.; carbonic acid, 97 c. cm.; nitrogen, 4 c. cm. In many cases cures of phthisis in the first stage have been reported, and even in the second stage. Whatever may be said of treatment of phthisis by the above inhalation, or by Bergeon's method, it can be said, certainly, that we can ameliorate the distressing symptoms by this treatment when all other remedies have failed. We should not be sanguine as to a cure and claim too much, but let us claim only what the facts will show from day to day, as we test the remedy.
Dr. Hibberd—I do not like, Mr. President, to have the discusion wait, and I will speak against time, with your permission. I myself did not desire to make any remarks on this subject, but I was anxious to hear the remarks of some one who had made an actual trial; I have not done so myself. It looks upon its face as if it was one of those ebullitions that come up in the medical world and that seem to go right into every man's affections, so that we all go wild over it and think that we have a panacea for all man's ills, and in the end fades down either gradually or suddenly and goes out of use entirely, or becomes one of the standard means of combatting disease, and I am not prepared to say whether it is one or the other. My idea in relation to it is just this: That the theory on which it is supposed to act does not accord with my previous knowledge, and while I can not accept it I am not prepared to deny it. The testimony has accumulated from so many and reliable sources that in various stages of consumption it has given so much relief, and in some, alleged cure, that it seems to me that we are not doing our duty to our patients if we neglect to make use of it. I shall undertake to make use of it very carefully and cautiously. I have given attention to the methods of its administration, the ingredients which are used and the proper times and occasions for its administration and I shall not feel that I am doing my duty unless I give my patients the alleged benefit of it. I
go into this matter doubtingly; I shall hope to do no harm; I confess, while I do look for certain benefits in the way of amelioration, I do not expect to cure patients. The testimony is such that we can not ignore it; whether it is one of those ephemeral bodies that come suddenly and go suddenly, or whether it is to come down into one of the standard means of combatting disease. If any gentlemen here have had personal experience in this matter— Dr. Maxwell said he had to a certain extent, and I have no doubt there are others-I think it would be profitable if we had an account of their experience and the conclusions they have arrived at.
Dr. Elder-Mr. President, I have been using this treatment for some four or five weeks in three cases. I placed my first patient under the use of this treatment about a couple of days before Dr. Maxwell went to Philadelphia. The first one was a man 39 years old. He went into the army when a boy, was captured and taken to Andersonville. In escaping from there he was about three months in the swamps, and came out with chronic pneumonia. Since then he has had several severe hemorrhages. It was not hereditary; but was of the fibrous form of phthisis. He had been unable to work for the last two or three years, and spent some time in Carolina or Florida. His temperature at the time of commencing the treatment was 10240, his pulse was 115; he had diarrhoea, incessant coughing, complete loss of appetite and sleeplessness; in fact he was very near dead, as he expressed it himself. He has been placed upon the pension list as totally disabled. Upon his own request I placed him under the treatment. The man's temperature last night was 100°, his appetite is good, his diarrhoea is entirely controlled, he has no night sweats, and the cough is almost relieved. There is a cavity in each lung, and it looks almost impossible for that man to get well; yet he is evidently improving. He was so weak that we were not able to get his weight, but he has increased some in weight. This case has been, to my mind, phenomenal. I had very little confidence in the treatment, but the results are as I have given them. He is of a very hopeful disposition, and we have the advantage of a good mental condition in his case. He is very much better than I ever expected to see him, and better than the consulting physicians expected he would be; he thinks he will get well, but of course that is something that belongs to all consump
tives. The decrease in his temperature, and in the heart's action, the decrease in his cough, the improvement of his rest, the increase in his appetite have proven the treatment beneficial in his case.
Another patient that I placed under this treatment against her own will, suffering from acute phthisis, has died since the treatment was instituted, but in her case her temperature was 1023°; she had complete loss of appetite and she was almost dead.
Dr. Hibberd-Did the treatment do any harm?
Dr. Elder-No, sir. Her appetite improved and her temperature decreased, but subsequently she lost her appetite, the temperature came up and she failed. In the other two patients they both appear benefited; they are not so far reduced. In both cases there is a reduction of temperature, increase of appetite and decrease in cough. Now, I have no theory in regard to this, but my judgment is that this line of treatment has a place in our therapeutics. Of course, there will be disappointments. It will be given to patients hopelessly diseased. I think it will be valuable, not only in phthisis pulmonalis, but, I believe, in dysentery and diarrhoeas it will prove beneficial. In regard to the administration: When I began the administration of the gas I pursued the course mapped out, filling the rubber bag with carbonic acid gas and passing it into and through the sulphuretted hydrogen into the patient. It occurred to me afterward that it was unnecessarily cumbersome; so, at my suggestion, Dr. Hurty mixed the gases in his laboratory. He generated the carbonic acid gas and passed it through the sulphuretted hydrogen, and that passed into and filled the rubber bag with the mixture; that bag is taken and the gas is administered directly from the bag to the patient. I think it is very much the best way of administering it. By mixing the gases in the bag they become more uniformly mixed. In the administration of the gas, it should be administered after the bowels have been evacuated an hour or two previously. I have found that about three quarts is as much as the patient would bear well the first two or three times; after that run it up to six quarts. Administer slowly at first. Of course, you distend the large bowels first; if it brings up colicky symptoms withhold it for a few minutes; the gas will soon be carried up into the small bowels. Then, another