years, and seem to have a great power in restoring delicate and exhausted constitutions, being rich in muscle and fat-producing elements. Their efficacy in certain conditions has been somewhat increased by combining them with cod liver oil, hypophosphate of lime, or pepsin. In some cases they have proved more beneficial than any other agent, so that some physicians now prescribe them altogether in place of cod-liver oil. The fault found with the malt extracts is, that they are so sweet that patients either soon tire of them, or cannot take them without nausea; but the Fairchild Brothers seem to have surmounted this obstacle by making them into a jelly which is very palatable, and tolerated even by the most irritable stomach. They have also prepared cod-liver oil in the same manner, and with equal success. Strong extracts of beef should, be prohibited; but, instead, we may allow as much meat as can be eaten, for this reason: that beef-tea, in its different forms, is found to cause or increase the colliquative diarrhoea of phthisical patients, and in this way to do them more harm than good.

Cod-liver oil, when it does not disagree with the stomach, is highly serviceable, owing to the fat which it contains. It should be given in small quantities, half to a whole teaspoonful three times per day, twenty minutes after eating. In this way, it can all be assimilated without any impairment of the digestive function, such as frequently results from taking it in larger doses. I believe the virtues of cod-liver oil are owing to its furnishing the system with an extra allowance of fat, and thus preventing a too rapid consumption of that article in the various organs. The hypophosphites which were added by Dr. Churchill may also render important curative aid during and after the second stage, by producing an excess of calcareous salts in the blood, these salts becoming depos ited in the small cheesy masses formed in the lungs, and transforming them into calcareous nodules, which being inert and incapable of further change, the progress of the disease is arrested. Taken as a whole, the food of phthisical patients should contain an abundance of salts, especially the carbonates, silicates and phosphates of lime in their organic combination with albumen; but great care must be taken lest it be subjected to too great a heat in cooking, as this will destroy the combination, thus rendering the salts insoluble, and consequently unfit for the action required of them. MEDICINAL TREATMENT — GENERAL. - Sulphate of quinine is the antipyretic chiefly relied on by the Old School in this disease, and it also exerts a powerful control over the night sweats. Not less than twenty grains are directed to be given daily, divided into two doses; the best time to administer them being about half an hour before the bodily temperature reaches its highest point in the twenty four hours. This course should be continued until the fever is greatly checked, but not to the extent of producing cinchonism. It reduces the pulse, arrests the progress of the bronchial catarrhs, and greatly limits the extent of the changes in the alveoli.

be allayed by belladonna, conium, hyoscyamus, hydrocyanic acid, etc., but opium must be used only as a last resort, and then only in the smallest doses that will give the desired results; it is also indicated in the same manner when there is a great loss of sleep. Very satisfactory results are often obtained by the inhalation of a little chloroform; it seems to check the cough and restlessness for the time being ; but you must carefully watch the patients, or they will become addicted to its excessive use.

The laryngeal troubles may be somewhat palliated by the inhalation of lime-water, tannin and various salts. If ulcerations be present, they ought to be touched with a mild caustic, as tannic or carbolic acid. Paracentesis and injection of the cavities with caustics has been accomplished, but without any marked results.

The pleurisy which is frequently present may be relieved by liniments, belladonna plaster and applications of ice; sometimes a little opium should be administered to relieve the pain.

In hæmoptysis, lead should be given internally, ergot by hypodermic injections, and ice appplied to the chest, and in severe cases dry cups to the feet; the inhalation of a solution of the chloride of iron is frequently useful by coagulating the albumen, and in this way putting a stop to the hæmorrhage. Dyspnoea may be relieved by inhalations of ethereal preparations. NIGHT SWEATS. The dilute mineral acids sometimes do a great amount of good, and can be given with astringent decoctions, such as sage tea. Small doses of atropine or external applications of astringents, as alum dissolved in spirit, will sometimes give relief.

mucous membrane.

Arsenic, sulphur, and iodine, in small doses, are sometimes quite beneficial.

A solution of caoutchouc dissolved in the spirits of turpentine and prepared as a confection has in some cases been of marked benefit. Expectorant remedies, as a rule, do more harm than good. The cough should

The gastric disturbances often baffle all efforts. The vomiting, etc., are sometimes relieved by taking champagne with the food, or pepsin, hydrocyanic acid, etc. ; or again, taking one-half a teaspoonful of raw scraped beef every half hour for forty-eight hours, and remaining in a recumbent position, will frequently give relief.

Diarrhoea can sometimes be checked by astringents and opiates. If unsuccessful, give ten grains of bismuth with one-twelfth of a grain of morphine after each movement. This is usually successful. If all other means fail, give an opium suppository. Bed sores are best treated by placing the patient on water or air beds. When the abrasion first shows itself, it may be prevented by using a hardening lotion, as dilute sulphuric or carbolic acid, in the proportion of one part to a hundred of water. If the ulcer has formed, we can strap it with adhesive plaster, or apply vaseline, balsam peru and carbolic acid, or aokum.

A FEW INDICATIONS (all of which have been verified more or less frequently by the writer) will now be adduced for the leading remedies in this disease, under the law "similia similibus curantur.”

Aconitum nap. -Short, dry cough, caused by a constant tickling in the larynx, which greatly disturbs the rest; on getting composed to sleep the cough commences, and this is repeated during the whole night; paroxysms of morning and evening cough without expectoration; cough frequently followed by a tingling sensation in the chest; stitching pains in the left lung; oppressed feeling in the chest, frequently so marked that it seems as if suffocation would ensue; given in this condition it very often prevents hemorrhages; pleuritic pains, aggravated on coughing or taking a long breath. Very useful for the acute symptoms resulting from some slight in liscretion; also sometimes beneficial in arterial hæmorrhages from the lungs, and frequently controls hectic fever; restlessness, with anxious expression of face; palpitation of heart; full, bounding pulse, which is compressible, with high fever.

Antimon. tart.-Loose, rattling cough, sometimes so violent as to cause retching and vomiting, or even severe headache. Yawning and coughing frequently alternate. Great rattling of mucus in the bronchial tubes, frequently audible to bystanders, aggravated on

reclining, especially at night, and sometimes so severe as to prevent lying down; in these cases the cough is usually followed by vomiting, dyspnoea, and dread of suffocation; expectoration of a glairy, tenacious mucus, which has the appearance of frog's spittle. When the expectoration becomes more purulent, on account of the breaking down and discharging of caseous matter and disorganized lung tissue, ant. tart. will not give a satisfactory reaction; although it has a great power over the hectic fever of the second stage when it makes its appearance at 3 P. M. The sputum is expectorated easily and in large quantities. This class of patients are usually weak and debilitated.

Arsenicum alb. -- Dry cough caused by a sensation of musk or sulphur in the chest, aggravated especially from 12 to 2 A. M.; sometimes, however, the cough has a loose quality. Stitching pains in the right lung; thirst very urgent; they want small quantities of water and that very frequently; this is often accompanied by violent burning pains in the stomach, with a yellowish or brownish diarrhea; prostration and restlessness are also marked. Sometimes when this remedy is apparently indicated, the patient seems to do grandly for about ten days, when quite suddenly a change takes place; the lungs break down rapidly; expectoration becomes very profuse and the patient begins to sink rapidly. I have had excellent results in this class of cases by substituting china for arsen., as recommend ed by Prof. A. K. Hills. If arsenicum is selected, it ought never to be given for more than one week at a time.

Belladonna. Dry paroxysmal cough, or it may be dry, barking and spasmodic, aggravated afternoons, at night, and on moving about; relieved by perfect rest, also by internal and external cold. Cough is frequent ly produced by titillation in the trachea and bronchi; during the cough the face becomes red, eyes suffused and bulging, and after coughing there is frequently a taste of blood in the mouth; occasionally a little frothy sputum. Larynx very painful to pressure, with a sensation of constriction in the throat and difficulty in swallowing; aphonia is sometimes present in nervous, sensitive patients, with a beating and throbbing headache. Sensation of great fullness in the chest; sharp, stiching pains in the apex of the right lung, or shooting from mammary to scapular region. Great disposition to perspire, even when the skin is hot. This remedy is useful, especially in the first stage, and will relieve pains, cough, and other conditions, quickly. Bromine.-Dry, barking, croupy, or whistling cough, with scraping and titillation in the larynx, which is painful to the touch air seems cold when passing through it. The follicles in the mucous membrane of the posterior wall of the pharynx may be inflamed and indurated, but are rarely ulcerated; loose rattling of mucus in the larynx and larger bronchi. This remedy is frequently called for in phthisis commencing on the

vocal cords.

Bryonia alb-Concussive dry or hoarse cough; dry night cough, compelling one to spring upright in bed; when coughing there is frequently a sensation as if the head and chest would burst. After eating, the cough will sometimes produce vomiting. Sputum may be thin, blood-streaked and scanty, or it may be in round, jelly-like lumps, of a yellowish or soft brick shade; dryness and a sensation of soreness in the throat and under the sternum; breathing difficult and catching, from the stitch-like pains in the left infra-mammary region and back; all conditions greatly aggravated by motion; lips dry and cracked. This remedy has given very satisfactory results in the short, dry, harrassing night coughs as well as in the pleuritic pains.

Borar has a drawing or stitch-like pain passing through the central portion of the right lung to the scapula; this symptom is very characteristic.

Calcarea carb.-Dry, hacking cough, frequently producing headache, which is very troublesome at night;

short, spasmodic cough, in brief but frequent paroxysms; without expectoration during the evening and night, but in the morning and during the day there is a copious muco-purulent discharge, sometimes bloody, having a sour taste and offensive odor; cough aggravated on undressing, in damp cold air, from getting wet, from drinking, lying down, and during sleep; relieved in warm weather. Rattling of mucus in the chest mornings and evenings; pains in the left lung, but it acts more especially upon the middle lobe of the right lung; whole chest painful to the touch; dizziness and shortness of breath on ascending; dyspnora; a feeling of great exhaustion in the morning; excessive debility; walking produces great fatigue: a constant tendency to take cold. It is especially useful in commencing ulceration of the larynx; it acts best on pale, blonde, scrofulous, leuco-phlegmatic persons who assimilate their food imperfectly; with a dry, flabby skin; menstruation profuse and too freqnent, accompanied by more or less emaciation; restless and anxious about recovery; hair falls off; eyes weak, etc.

Capsicum.-Every cough is attended with an aching pain in the throat or ear; sometimes in distant parts, as the knee, leg, or bladder; the cough is excited by drinking coffee.

Causticum. Dry cough, aggravated after getting warm in bed, or when the natural warmth of the body has been recovered after being in a cold state; cough often accompanied with pain in the hips and great soreness and rawness under the sternum: during the cough the urine is frequently passed involuntarily; cough relieved by a cold drink; aphonia sometimes complete; loss of control over the voice: sensation of great internal cold running down the extremetics and back, yet the parts feel very hot to the touch; if the cough is loose they are obliged to swallow what is raised, as they cannot spit it out. The cough symptoms are sometimes accompanied by a sensation as if lime was being burned in the stomach.

Carbo reg-Dry, spasmodic, paroxysmal cough, with congestion of blood to the head and prominence of the veins of the neck; cough frequently followed by vomiting of food, or a moist, loose cough in greatly enfeebled persons; copious night and morning expectoration, of a yellowish or greenish color and very fetid; breath offensive; cough aggravated on going into a cooler room, taking cool drinks or food, and especially by butter or fat of any kind; hoarseness about 5 P. M. Icy coldness of the body, with a livid, purple look; sickly appearance; nails blue; great tendency of the chest to perspire; patients take cold from the least exposure: gums bleed easily. Frequent and easy epistaxis; generally worse at night, or in the forenoon, followed by pains in the chest and pale face; they want more air and to be fanned all the time. The most digestible food disagrees.

China-Dry, hacking cough, caused by a sensation of gas in the larynx, also from talking, laughing, eating or drinking; or the cough may be loose, with a large amount of mucus in the chest; aggravated about and after midnight, also when lying with the head low; relieved by raising it; cough accompanied by pains in the larynx and under the sternum; stiching pains in various parts of the chest. Expectoration of glairy mucus; frequent thirst for large or small quantities of water. Hectic fever, great prostration and debility, especially from hæmorrhages, or when the system is debilitated from the loss of vital fluids, or of semen, or by over-lactation; night sweats; leucorrhoea, etc.; all symptoms aggravated from motion or touch; diarrhea.

Conium mac --Dry, spasmodic, or tearing cough, caused by an itching or scraping in the throat and under the sternum; or a loose, rattling cough, with a great number of mucous râles in the chest; but the mucus cannot be expectorated; cough aggravated by night air, or reclining, especially at night, talking or

Hepar Sulph. -- Moist, mucus, rattling or choking cough; it seems as though the patient would suffocate while in the paroxysm; with scraping and irritation in the larynx; aggravated toward morning and after eat ing; paroxysms violent and suffocative, often followed by retching and vomiting; respiration anxious and wheezing; aggravated on lying down with attacks of suffocation, which force the patient to throw the head back in order to take breath; the least exposure of any part of the body produces a chill or increases the cough; easy perspiration; sweats day and night without relief, especially about the chest, which have a sour smell. Face turns pale on exertion, followed by burning redness, and heat of the palms of the hands.

Hyoscyamus niger. -Dry, spasmodic cough, aggravated at niht and on lying down, especially on the right side; relieved by raising up; for this reason they wish to be bolstered up in bed; or the cough may be violent, paroxysmal and exhaustive, with little or no expectoration; it also produces a hoarse, hard cough, aggravated about midnight, with expectoration of white, frothy mucus, and great rattling in the chest; dyspnoea upon the least exertion; appetite poor; warm night sweats; extremeties somewhat cyanotic.

Ipecacuanha-Spasmodic, suffocative cough, accompanied with rigidity and blueness of the face, and dyspnea; nausea and vomiting, or nauseous, albumenous expectoration at the end of the paroxysm. Chest seems full of mucus, which does not yield to coughing; great dyspnoea, coming on in paroxysms during the evening, and continuing with slight remission during the night, and intermitting during the day; loud, sonorous, mucous râles in the chest, with wheezing respiration.

Hydrastis can. - Loose cough, with great rattling in the chest, and expectoration of a tough, glairy, stringy, yellowish mucus.

Kaolin. — Dry, metallic, croupy cough; chest seems full of mucus, producing great wheezing and rattling; has given great relief to some cases in the third stage. Kali bich - Dry, titillating, or loose, hoarse cough; especially indicated when the larger bronchi are af fected; cough aggravated on rising in the morning, or first part of the night; sputum stringy, ropy, of a yellowish white color; sometimes it gets attached to the throat and causes a suffocative feeling; hoarseness; stitches in the sternum, darting through to between the scapulae, also across the chest and right infra-clavicu lar region. Frequent thirst for large quantities of

water. Tongue coated yellow, especially at the base; breath very offensive; great restlessness at night.

Kali carb. - Dry and sometimes spasmodic cough, tormenting the patients day and night, and often followed by retching and vomiting, with expectoration of a few lumps of grayish mucus; sputum, after being dislodged, frequently falls back into the stomach; cough aggravated at 3 A. M. and 5 P. M., also from lying on the right side and taking a deep inspiration; night cough followed by great exhaustion; cough relieved by warm, dry air; stiching pains in the lower portion of the right lung and back, worse in cold, damp weather and on motion; dyspnoea relieved by leaning the head forward.

Lachesis. -Dry, tickling, croupy cough, with sensation of a lump in the throat, which is the cause of much hawking and swallowing; after a paroxysm of dry cough there is a profuse expectoration of frothy mucus; cough comes on as soon as one falls asleep, and suffocation seems inevitable; also excited by even light pressure upon the larynx, consequently the clothing must be loose about the neck.

1 ycopodium.—Constant dry, tickling cough day and night. In emaciated patients, loose, full, deep cough; seems as though the entire parenchyma of the lungs was softened; sputum raised by the mouthful, of a light rust color, somewhat stringy and easily separated; or it may be grayish yellow, or greenish; tough and salty; loose, rattling cough, aggravated from 3 to 4 P. M., with great difficulty in breathing during the paroxysm, but when the cough ends, the respiration becomes normal. The mucus in the chest seems very loose, but is raised with great difficulty, as if it stuck to the lungs; cold, clammy night sweats; perspiration only on the head and chest; great disposition to take cold at every change of weather; great debility; fan-like motion of the ale nasi; hectic fever; circumscribed redness of the cheeks: great emaciation of the upper part of the body. The lower lobe of the right lung is principally affected by this remedy.

Laurocerasus. - Constant short, irritating cough, which may be dry or loose in character, aggravated on lying down, and accompanied with some dyspnoea; it frequently gives relief in the rattling, difficult breathing which comes on for a few hours before death; sputum dotted and specked with blood.

Myrtus com. -Coughing, with burning, aching. throbbing pains in left lung; stiching pains in the left infra-clavicular region, passing through to the scapula.

Mercurius-Dry, rough, concussive cough, which is very exhausting, with roughness and burning under the sternum, and a sensation as if the chest would be all racked and torn in pieces on coughing; the roughness and soreness are also present in the throat; each paroxysm of cough is preceded by an anxious oppression, which is very debilitating; cough aggravated in the evening, at night, on getting warm in bed, from rapid motion, on lying down, especially on the right side, and in cold, damp air. Expectoration of a ropy, muco-purulent, or watery, foul material, frequently streaked with blood; stitching pains running from the left scapula to the breast; hoarseness; all conditions greatly aggravated at night; much perspiration, exhausting night sweats, diarrhoea.

Nux Vomica. Rough, dry, scraping cough, with roughness and irritation in the pharynx and upper sternal parts; aggravated at 3 A. M., and preceded by an acrid sensation in the throat; tough mucus expectoration; sore feeling all through the chest, with sharp pains from side to side, especially indicated in those who have used liquors to excess.

Naphthuline.--Dry, spasmodic, paroxysmal cough, aggravated on lying down, especially in patients with emphysema; worse in the morning and after sleeping: cough frequently terminates in vomiting; during the paroxysm the patients can scarcely get their breath; face and eyes are the seat of a mechanical congestion; expectoration tough, stringy and yellowish.

ceps may be used with advantage to all concerned in the great work of parturition :

is a real danger, and should always be remembered, but with ordinary care and skill no undue force need be used, and the fœtal head need not be subjected to a compression greater than that caused by the contracineum. This is true of ordinary cases. In cases of disproportion between the head and pelvis, from any cause, compression may be necessary in order to effect delivery at all.

(a.) In case of convulsions with a dilated, or dilatable os, the vertex presenting.

(b.) In some cases of placenta prævia, when the vertex can be seized and delivery by the forceps is quicker and safer than podalic version.

(c.) In disproportion between the foetal head and the maternal pelvis-either when the pelvis is normal and the head large, or when the head is normal and the pelvis contracted.

(d.) In some cases of faulty presentation, as, for instance, the occipito-posterior, when the forceps may be used to bring down the head to the perineum and then trust to nature to bring the occiput to the pubis; and also in some cases of presentation of the face or brow.

(e.) In inertia of the uterus, other means failing. (f.) In rupture of the uterus the forceps may sometimes snatch the child from the jaws of death.

(9.) In that large class of cases when the labor is prolonged with the head in the pelvis, it may be resting on the perineum, with fruitless efforts on the part of the unhappy woman for hours and still no progress, we can hardly tell the reason why, the forceps will prove a boon of inestimable value to the suffering mother and child.

In cases of the character mentioned the natural powers unaided will seldom prove sufficient to deliver the woman. Here the resources of our art are demanded, and it is criminal to sit idly by and wait for "Nature to take her course ;" and I know of no means to be compared with the forceps either in efficiency or in safety to both the mother and her offspring. Danger is averted, disproportion and faulty presentation overcome, hæmorrhage arrested, suffering assuaged, and the labor quickly, pleasantly, and safely terminated.

II. How shall the forceps be applied? The directions of the older authors to ascertain, first, the exact position of the presenting part and then carefully apply the blades of the forceps to the sides of the head is now happily discarded.

The opinion of the best obstetricians of to-day is, that the application of the forceps should be pelric and not cephalic. Practically this is the only rule. With the head at the brim of the pelvis, it is almost, if not quite, impossible to make any other than the pelvic application; and when the vertex is resting on the perineum, the blades of the instrument, if allowed to seek their own course, will invariably take the sides of the pelvic cavity. Barnes, Playfair, Ramsbotham, Scanzoni and others are emphatic in support of the pelvic method.

III. What are the dangers 'attendant upon the use of the forceps?

(c.) The maternal passages may be so injured by the blades of the instrument as to result in recto or vesicovaginal fistula. This accident can never happen when a properly-formed instrument is used with even ordinary care. The danger from prolonged pressure is much greater than from the forceps. Such a knowledge of the mechanism of labor and of the parts involved, as every accoucheur should have, will effectually prevent the wounding of either rectum or bladder.

(d) A too rapid depletion of the uterus predisposes to uterine inertia and consequent hæmorrhage. Upon this point let me say, that no child should be delivered by forceps or otherwise without the hand of an assistant, properly instructed, upon the abdomen of the mother, to follow the retreating uterus, and by carefully grasping the emptied organ, thus to secure and retain contraction. In no other way is hæmorrhage so surely prevented or arrested when already present. Be sure and get firm contraction of the womb is the golden rule of the obstetrician.

IV. Some of the dangers avoided by the use of the forceps. And here a bare enumeration must suffice: (a.) Sloughing of the vaginal walls from prolonged pressure of the head in the pelvis in tedious labors. (b.) Shock, the result of severe and long-continued pains.

(c.) The danger to both mother and child is diminished, and the frequency of craniotomy lessened.

Professor Barker, in an article in the American Journal of Obstetrics for January, 1878, says, when giving a summary of the reports of the Rotunda Lying in Hospital of Dublin, as follows: "These reports demonstrate that the mortality to mother and child is lessened as the instrument (forceps) is more frequently used, while the more repulsive and dangerous operation of craniotomy is reduced to a minimum.”

V. Frequency of use by the profession at large.

Dr. F. Barker says, "That in my private practice, during the past twenty-five years, I have used the forceps in one case in fifteen. For the last ten years my average has been one in twelve cases.'

Dr. George Johnson, Master of the Rotunda Lying-in Hospital of Dublin, in the seven years from November, 1868, to November, 1875, in 7,027 deliveries, the forceps were used in 639 cases, averaging one in eleven cases, In the last year of his mastership the forceps were used in one in nine cases.

Dr. G. Hamilton, of Falkirk, Scotland, gives the result of his vast experience in five series:

"In the first the ratio of mortality to the child was one in 317, in which the forceps were used in about

every eighth case. The second and third series aggregate 1,147 children delivered alive, with only the loss of one child (a breech presentation).

The fourth and fifth series aggregate 1,500 cases without a single still birth, the forceps having been used in about one case in five"

(b.) Another danger that may be urged is, that the child's head is liable to injury by the instrument. This

In conclusion let me say, that with a clear and welldefined case, demanding interference, the obstetrician who does not bring to his aid the forceps in proper cases does not do his whole duty, and is not acting in accordance with the views of the best medical men of the age,