ON THE NATURE AND TREATMENT OF PULMONARY CONSUMPTION
613 require other means. For him the apparatus in question is the very thing. After crushing, this large catheter is introduced, and the fragments are sucked out by the action of this powerful india-rubber bottle which is attached to it. The process is rather trying, however, for the bladder; and it costs rather more pain and time than an ordinary sitting for lithotrity. One troublesome thing that very rarely happens is the impaction of a fragment. If you adopt the system of lithotrity which I
... lithotrity which I have shown you, it is remarkable how seldom that happens. I have never had to open the urethra to remove a fragment in my life. I have occasionally had to remove one by the forceps, but that is very rare; and among all the complicated inventions for the purpose, I know nothing so good as the common long forceps which I show you here. During the last year, certainly, I have not even had occasion to use them. The more thoroughly you crush the stone, the less use there will be for forceps. Here is a bottle containing what I call a well-broken stone. You see it is almost powder : a very different sort of thing from that in the other bottle, where you see a large number of big fragments that were probably passed with difficulty. It is an old saying, " a carpenter may be known by his chips:" certainly the skill of the lithotritist may be known by the debris he makes. In my next lecture I shall take the subject of lithotomy, and give you a general sketch of the different modes which have been practised, and which are being used at the present day. Three years ago, after great exertion of voice and close application to work, he became hoarse, and had remained so ever since. Cough came on five months ago, with expectoration and shortness of breath, but no wasting. Wintered at Ventnor. Physical signs: Dulness and cavernous sounds in upper part of right side of chest. Breath rough below left clavicle. Sputa opaque and heavy. Was ordered a combination of nitric and hydrocyanic acids, iodide of potassium, and sarsaparilla, and to use iodine ointment. Lost cough at Ventnor, and went to Bridgewater, which did not agree with him. Aug. 21st.-Has been at Minehead, taking cod-liver oil regularly, using salt friction three times a day, and keeping a blister wound open. Has improved except in breath, and expectoration is still ramiform and opaque. Physical signs diminished : slight and irregular dulness in upper part of right chest; tubular sounds above and below right clavicle and scapula. June 10th, 1848.-Wintered first at Malta, which he found too irritating to his chest; next at Pisa, where he grew weaker, but was improved by the voyage. Physical signs : Still slight dulness; loud bronchophony and irregular breath-sound below right clavicle, but much good vesicular breath-and strokesound. Breath rather irregular below left clavicle. Ordered iron in combination with the oil, on which he gradually improved, wintering generally in Devonshire during the following years. January, 1868. -Quite well and active; conducting a large school, which he has done for the last twelve years. Can walk, preach, and bear exposure to any extent; and has no cough. Physical signs: Still dulness and tubular sounds in upper right chest, most above scapula. Marked tubular sounds above left scapula. Although the physical signs have not entirely disappeared, they are greatly diminished since the first examination twenty-two years ago, and may be supposed to indicate contraction and obliteration of the cavity. In fact, they may be considered signs of the vestiges of disease, rather than of actual disease, as the patient has enjoyed excellent health for the last twelve years; and upwards of twenty-two years have elapsed since the first symptoms appeared. CASE 6.-An unmarried lady, aged eighteen, first consulted Dr. Williams Dec. 13th, 1845. Always delicate; often pain in left side; and once had hysterical paralysis. Slight cough for one year, increased in last two months. Great superficial and spinal tenderness on left side. Physical signs : Slight dulness and tubular expiration in right interscapular region. August, 1849.-Has been generally better for iron, zinc, and open air. Has wintered at Ventnor or in some mild climate. Latterly had more cough, and lost flesh; but regained it by riding. Dulness and tubular expiration in upper right chest. Ordered oil, with an acid tonic. June, 1850.-Wintered at Ventnor, taking oil regularly, and much improved ; yet there are dulness and cavernous sounds in right upper back. April 26th, 1852.-Continued the oil a year, and taking regular rides; was well, except slight cough and expectoration, and short breath. Less dulness ; no cavernous sounds, but tubular above right scapula. To continue the oil in tonic of nitric and hydrocyanic acids, and tinctures of' hop and orange. Sept. 7th;-Left off the oil, and since has been taking porter with meals. No cough since May; but has had an itching, papular eruption, ending in slight desquamation, which has in the last week spread over the whole body, accompanied by smart fever and scanty high-coloured urine. These soon subsided under cooling treatment; and from this time the patient had little cough, but more symptoms of rheumatism and palpitation. Jan. 2nd, 1864.-During the last ten years has suffered little in the chest; but lately had congestion and enlargement of the uterus, and was obliged on that account to leave off riding. Spent the last two winters at Mentone, where she was leeched and cauterised fifty times. Now better, but cannot walk. Has taken oil and hypophosphite of soda, and gained flesh. Often has attacks of catarrh and cough, with pain and tenderness in right chest, as at present. Some dulness and tubular sounds in upper right. Collapse below clavicle. Ordered oil in phosphoric acid and tincture of nux vomica, and tincture of iodine externally. March, 1866.-Was much better till last six months, when after much anxiety and exertion has had more cough and expectoration, occasionally tinged with blood. Pain in right chest, and occasional palpitation. Took oil four months; none during the last month, but hypophosphites twice a day. Loud tubular sounds in upper right. Ordered oil, with phosphoric acid, hypophosphite of lime, and tincture of quassia. May, 1867.-Chest symptoms soon relieved. In end of summer had a severe pain in left knee, for which a blister was applied, and brought on violent inflammation ; and was laid up all winter at Ventnor, supposed to have disease of the joint. A surgeon from London negatived this. Joint still painful, but not swollen. Has much super-.ficial tenderness down the spine, and other neuralgic pains. Feb. 1868.-Under valerianate of zinc, iron, and strychnia, the hysterical neuralgia was sufficiently relieved to enable her to walk and ride a little during the summer. Lately confined to the house, and more ailing ; but chest remains quiet. Still signs of partial consolidation and contraction at right apex. The lung-disease was distinctly arrested in this case under the treatment; was further superseded by the occurrence of the cutaneous and rheumatic affections at one time, and more recently by the uterine and neuralgic disorders; and may be considered now as quite quiescent, twenty-four years after the first symptoms. CASE 7.-A gentleman aged thirty. Height, six feet. Two sisters died of phthisis. Nov. 6th, 1845.-Quite well and active till, six weeks ago, after wading in water and repeated chills, he had congestion of the left lung, with pain, a little cough, and extreme weakness. He was treated by blisters, iodine internally and externally, and was now much better. No cough or pain, but weak and thin; appetite good; pulse weak; easily excited. Physical signs : Slight general dulness and deficient motion and breath in the left chest. Some tubular sounds within the scapula. Systolic murmur to the left of mid-sternum and a little upwards, heard in the left back, but not in carotids (pulmonary). He was ordered a mixture of iodide of potassium and nitric acid, with orange infusion ; and an iodine liniment.