ON A CASE OF MEDIASTINAL TUMOUR SIMULATING AORTIC ANEURISM
274 the use of the hypophosphite of soda, one grain twice a day, and a teaspoonful of cough mixture night and morning. 10th.-Has improved a little; appetite beginning to return. Discontinued the cough mixture, and increased the dose of the hypophosphite to three grains daily. 20th.-A little dry cough at times; hardly any expectoration ; appetite good; night perspirations ceased. Sept. llth.-Has again brought up some purulent matter, much less in quantity, though still offensive. The attack came
... on quite suddenly, without any previous constitutional disturbance. I persevered wi'h the hypophosphites until February, when the child had become quite fat and healthy-looking. Her cough having ceased, I therefore discontinued all treatment. I have seen her several times since, and her health appears very good. In this case a continued improvement followed the use of the hypophosphites. CASE 2.-Mrs. D-, aged thirty-eight, consulted me in December, 1862. She had had four children ; nursed the last for thirteen months; was obliged to wean it last October, on account of her bad health. Three months previously she had ha2moptysis for a week; since October the cough had been incessant, the spitting abundant; she perspired at night, and had no sleep ; catamenia absent. Dulness on percussion under the right clavicle, with pain there at times; large crepitant rhonchi. Respiration feeble, but natural, on the left side. Began the treatment with the hypophosphite of soda on the 21st December; she took four grains a day, and a tablespoonful of cough mixture every four hours. A week afterwards her appetite had slightly improved, the tongue was cleaner, the cough had diminished, and she could I sleep a little at night. Ordered to continue the hypophosphite ' , of soda; the cough mixture to be taken night and morning only. Jan. 6th, 1863.-Much better; the cough had diminished, the expectoration was easy and less in quantity; the appetite had returned. She had not touched any meat for months, and now she could eat it readily. At the end of January I saw her again : the improvement continued; she was much stronger; appetite good; tongue clean ; she only coughed in the morning ; had ceased for some time to take the cough mixture; was going on with the hypophosphite. In February she called to tell me she was quite well; had no cough at all; slept well; catamenia had returned. In this case it seems to me that the beneficial action of the hypophosphite is quite evident, as no other medicine was exhibited ; and during the whole time she remained under treatment she was following the laborious occupation of schoolmistress. CASE 3.-F. C---, aged twenty-nine, brassfounder; first seen Nov. 29tb, 1862; died March 15th, 1863. Had been ill for five months. Began by spitting a large quantity of blood ; night perspiration ; troublesome cough ; expectoration copious; tongue clean ; appetite good ; great thirst. Had been confined to bed for three weeks when I first visited him. He was living in great poverty, and unable to provide himself with necessary food. A medical friend who saw him with me did not think he could live a fortnight. I administered the hypophosphites with the view of watching their action in this extreme case. There was great emaciation, flattening of the chest, and a large cavity at the apex of each lung. He was ordered one grain of hypophosphite of soda three times a day, and a cough mixture every four hours. Three days after his first taking the medicine, he told me that if he continued to improve daily as much as he had already done he should be able to resume his occupation in a week. Two grains of the hypophosphite were now ordered three times a day, and one grain of quinine before meals twice a day. The improvement continued for a month; he could sit up for several hours in the day, and walked about the room. But he went out without my permission to see a friend and over tired himself, took to his bed, and never left it, though he lived for two months. In the above case I think the immediate effect of the phosphatic salt is undeniable, and verifies the statement of Dr. Churchill, that "from the very first day there is frequently observed a remarkable increase of nervous power." Although the specific action of the drug may be questioned, yet it must have exercised some powerful influence in stimulating the vital energies of this patient under very adverse circumstances. CASE 4.-Mrs. T-, aged twenty-eight, married, without children, applied to me Nov. 18th, 1862. She had suffered from a cough for nearly two years; had had haemoptysis several times; night perspirations; no sleep; no appetite; had lost flesh, and become very thin and weak. She had great pain between the shoulders, and had been told by her last medical attendant that she was consumptive. On examining her chest, there was dulness on percussion under both clavicles, the extent of which was larger on the right side than on the left; the respiration was short and hurried, with suberepitant rhonchus; she could not take a. deep breath. On the left side the breathing was short and harsh, with prolonged expiration. Ordered one grain of the hypophosphite of soda thrice daily, and a cough mixture to allay the irritation of the cough and procure sleep. Nov. 28th.-Cough less troublesome. She was in better spirits, but still complained of night perspirations and want of sleep; had no appetite for meat. No change in the medicines. Dec. 8th.-There was some improvement; the cough and expectoration had greatly diminished ; she could sleep at night, and only perspired a little towards morning. One grain of quinine twice a day was added to the above treatment. Jan. 6th, 1863.-Had been to a ball, and fancied she had caught cold; cough much increased; pains in the chest and between the shoulders. Had not taken the medicine very regularly of late. Same treatment without the quinine. 14th.-Better; regaining strength and appetite. To continue the phosphatic salt as before, with one grain of quinine twice a day; cough mixture at night only. I saw her every week until the llth of March. The improvement was gradual and steady; she had discontinued the quinine for some time, but had persevered with the hypophosphites; had no cough, no perspiration at night; the catamenia regular. I called upon her in May: she had no unfavourable symp. toms, and expressed herself as being quite well. In this case the patient had been ill for nearly two years, and under the care of several medical men. She had taken all sorts of medicines without any benefit. The disease was progressing in spite of treatment until she took the hypophosphites. After using this remedy for four months, she felt so much better that she considered herself well. Whether this reappearance of health will last or not, is a most important question; but there must be something in a drug which has produced such results. I shall abstain from making any further remarks on the above cases, and leave them to speak for themselves. But I must say that I fail to see with Dr. Cotton why steel or quinine or any other medicine should not be given at the same time as the hypophosphites. The drug appears to me to stimulate the "nervous power," and certainly a tonic treatment in combination with it is not there contraindicated, nor can it tend to depreciate the remedial action of the salt. Dr. Churchill's own statement is, that the hypophosphites are " a specific remedy for the tubercular diathesis, and prevent new tubercular de-posits." Assuming this to be the case, it is no reason why the existing lesions or the many complications of phthisis should not be treated by the appropriate remedies. One might almost as well say that a simple cough mixture or wine given during the said .. specific treatment" renders its ultimate success inconclusive. Without claiming a specific action for the hypophosphites, I have, however, often prescribed them at the French Dispensary with very satisfactory results.