CLINICAL REMARKS
CONCERNING
THE  HOM0EOPATHIC  TREATMENT
oF
PNEUMONIA:
PRECEDED BY
A RETROSPECTIVE VIEW  OF THE ALLEOPATHIC MATERIA
MEDICA, AND AN EXPLANATION  OF THE
HOM(EOPATHIC LAW OF CURE.
BY
J.; P.'TESSIER, M.D.,
PHYSICIAN TO THE HOSPITAL SAINTE-MARGUERITE IN PARIS.
TRANSLATED
BY
CHARLES J. HEMPEL,  M.D.,
FELLOW AND CORRESPONDING MEMBER OF THE HOM(EOPATHIC COLLEGE OF
PENNSYLVANIA; IHONORARY MEMBER OF THE HAHNEMANN SOCIETY'OF
LONDON, &C. &C.
NEW-YORK:
WILLIAM RADDE, 322 BROADAWAY.
PHILADELPHIA: RADEMACHER & SHEEK.-BOSTON: OTIS CLAPP.-MANCHESTER, ENG.: TURNER, 41 PICADILLY.
1855.



Entered according to Act of Congress, in the year 1855, by
WILLIAM   RADDE,
In the Clerk's Office of the District Court of the United States for the Southern
District of New-York.
JBxIRY LvDWIt, Printer, 45 Vesey-st.



PREFACE.
THIS little work is translated from  the French of
Dr. Tessier, one of the most distinguished practitioners
of medicine in the capital of France, and enjoying
the confidence of the government as one of its accredited physicians to a public hospital of considerableimportance. As a conscientious observer Tessier felt
unable to withhold from homoeopathy the attentive
regard with which every new idea or theory that is
logically put forth, should be received; and the result has been his unqualified adhesion to the homceopathic method of treatment. His experiments extended over two important series of pathological facts,
Pneumonia and Cholera, which we publish in two separate volumes. The results contained in these works,
will excite attention in the minds of our alloeopathic
brethren, and may induce many of them to imitate
Tessier's noble example. They will not fail to be
rewarded for their honest devotion by a confirmation
of the great fact that the homceopathic treatment of
Pneumonia and of Cholera, and consequently of other
acute diseases is far more successful and certain than
the treatment which their own School advises for
such affections.
CHARLES J. HEMPEL, M.D.
NEW-YORK, July, 1855.



A.. 1WiOSPECTIvE. VIEW, &C.              v
homceppathi' treatment. has been: investigated. by. men equally
distinguishe~for. their science and professional honor; that
they have publicly condemned this method, and that, to..do
over again what they have done,. is. to cast suspicion-and
doubt on their intelligence.
Others, again will.. say that certain classes:of minds require
strange kinds of nourishment, as certain vitiated:stomachs
digest with a relish the most repulsive articles of food.
Others, finally, will maintain.that by setting-aside the. ruling
doctrines, and by repelling the wisdom of the highest a.uthorities
of the school, we fall into the most condemnable: extravagtapcea.
I have a right to-,believe.- that these objections- will be
raised, because: they have been raised- before with a violence
which I -need not characterize.  I shalL. endeavor to.answer
all these objections' and to put- a -stop  to: -all. such.lame~n
tations.
It. will be noticed that all these objections.flow from. the
same origin, namely-from. the assertion that the -doctrine of
Hahnemann is absiurd.-. Indeed, if his method of treatment
is not absurd, ho':far.is professionol honor violated by -applying the homeqopathic treatment in.:a hospita;l?  And by
what reasons- could,, in such a case, a wise. and enlightened
administration be actuated in prohibiting the. freedom of: me,
dical treatment, this palladium  of all scientific progress.?
If Hahnemann's method is. not absurd, the freedom of treatment is not abused by ascertaining, by means of clinical
observations, the degree of usefulness and. efficacy, of which
this method may be possessed. If this method is not absurd,
it should be tried, and, examined critically; and. nobody; has
a right to call those who exercise it in private. practice
quack4-,How far are they quacks. rather than those- who do
not examine the new doctrines?
If this method is not absurd, it is-quite possible that the
enlightened men who have tried it in practice, and have.condemned it as inefficient, have been mistaken in their investigations.  Is it an insult to suppose that they may have
been mistaken in spite of their acknowledged science and
good faith?



Vti          A RETROSPECTIVE VIEW OF THE
If the homceopathic doctrine is not absurd, it may be studied
even by those who do not belong to the order of erratic
minds.
And finally, if it is not absurd, the absurdity is entirely on
the side of its vehement calumniators.
All the previous objections can therefore be reduced to
one single affirmation, namely: homeopathy is an absurdity,
all the rest is sheer declamation launched by vulgar minds
against a species of literature which is unpleasant to them.
It behooves us therefore to inquire whether or no Hahnemann's
method is really absurd.
Theoretically it is indeed impossible to treat the subject
in another manner. Theory cannot convey to us any higher
information. Experience, or, as we now say, practice is the
only standard by which the usefulness of a system can be
tried. Theory and practice have their well-defined sphere
of action; the former shows whether a doctrine is generally
conformable to sound sense; and by. means of a practical
application we determine the value of a theory. This course
has always been pursued in medicine; and those who condemn homeopathy as absurd without a previous examination,:do so in accordance with preconceived theoretical prejudices.
tI shall pursue the course which has been pursued by the
opponents of homeeopathy, with this difference that I shall
guard myself against the misguiding bias of blind passion,
and shall endeavor strictly to adhere to the legitimate demands
of a scientific inquiry.
Hahnemann's doctrine pretends to constitute a general
reform of therapeutics; it must, therefore, furnish a new:solution of all therapeutic questions. The essential points
of every system of therapeutics are:
1. Scientific determination of the medicinal properties of
drugs;
2. Classification of drugs;
3, The mode of observing and classifying the indications
of disease;
4. The application of drugs agreeably to these indications.
(Therapeutics being the science of the indications of dis



ALLGOPATHIO  MATERIA MEDICA.            Vii
ease, of the application of drugs, and of the relation of drugs
to disease: it evidently follows that these four points comprize the whole doctrine of therapeutics.)
1. Scientific determination of the properties of drugs ae
cording to the method of Hahnemann.
Experience has shown from time immemorial that only
such substances as produce rapid and marked alterations in
the functions after their introduction in the human organism
in health, are possessed of curative virtues in disease: hence
their appellation of remedial agents. The complex of these
drugs constitutes the Materia-Medica. The first condition of
arriving at a knowledge of the curative virtues of drugs, is
the determination of the effects which they produce in the
healthy organism. How is a knowledge of thepe effects to
be obtained?
Nature only answers when interrogated, and only answers
correctly those who know how to interrogate her. In this
case man has not any thing to divine, he has to learn every
thing. We may apply here the words of the philosopher of
Geneva: I know that truth resides in the facts, not in my
mind which observes them; and that I shall be the nearest the
truth, the less I shall indulge in theories of my own. It is
observation alone that can teach us the effects of drugs in the
healthy organism. But it is evident that this must be experimental observation resulting from actual trials, otherwise
we should not learn much from it. Hence it is evident that
trials of drugs have to be actually instituted upon healthy
persons.  This is one of the cardinal points in Hahnemann's
doctrine, or rather its starting-point.  Is this absurd?  Can
any thing be more lucid, more logical, more conclusive?
Every sensible person will answer no: hence the startingpoint is legitimate.
But it is not sufficient to institute experiments; they have
to be conducted methodically, not arbitrarily. We must not
content ourselves with simply observing the phenomena which
make their appearance immediately after the introduction of
the drug in the organism; the prover has to watch every
symptom  which characterises the action of the drug, the



viii        A RETROSPECTIVE VIEW: OF THE
most trifling as well as the most striking; he has to observe
all the changes which the drug develops in the organism,
from the commencement to the termination of its action, and
has to furnish us an exact picture of the drug-disease.
Is it not evident that, in order to study the pure effects of
each drug, it should not be mixed up with other drugs during
the trial?
This is another. rule invariably followed by Hahnemann.
His Materia Medica comprises therefore a complete list of
the effects which the drugs'he has proved, are capable of
producing in healthy persons.  I ask again, is there any
thing absurd in this herculean labor of forty years?  To me
nothing seems more scientific, more methodical, more worthy
of,the respect of serious physicians.  Who had ever undertaken and carried out such a task?  It ill behooves our puny
and pitiful observers to declaim  against such an immense
work.
2. Classification of drugs according to Hahnemann.
Classifications are an admirable thing, provided varieties
are not mistaken for classes, but the classes are'arranged in
accordance with the analogies characterizing the varieties.
In medicine, both in pathology and materia medica, we have
always pursued a contrary route,, namely: arbitrary classes
were establishe~d l4,,tt and the varieties were nolens volens
adapted to the classes.
Drugs have been at all times divided into three classes:
evacuants, alteratives and specifics.  The first class, evacuants, is again subdivided with respect to the various routes
by which nature expels the heterogeneous humors, which, if
retained in the system, cause the various diseases; of these
subdivisions we have seven.: *
1. Purgatives and emetics;
2. Expectorants;
3. Errhines, sneezing medicines;
4. Uterina;
5. Diuretics;
* Chomel, Synoptical Description of the usual Plants, Paris, 1761.



X            A RETROSPECTIVE VIEW  OF THE
and the old arrangement, with the exception of some slight
modifications, has been continued.*
Hahnemann has given a very severe, but just criticism of
the old classification of drugs; he shows that every drug may
belong to most classes and species, and that, in each class, it
is possessed of vague and uncertain properties.
In his arrangement of the drugs of the various kingdoms,
Hahnemann follows the alphabetical order. This is the pure
and simple negation of the traditional order.  He aimed
above all things at showing the natural effect of each drug.
His disciples have observed the same method, except that
they adopt with Murray the natural order of classification;
they divide drugs into three classes: t
Drugs obtained from the mineral kingdom;
"         "  "  vegetable kingdom;
"       9 "  animal kingdom.
This method will undoubtedly be universally adopted, if
we may judge by the course of instruction which is now
pursued in the Paris School of pharmacy.  Guibourt, one of
the most distinguished teachers of the School, has adopted
this arrangement in his last edition of the Natural History -of
Simple Drugs. t
The alphabetical order adopted by Hahnemann is perfectly
reconcilable with the natural order, which is as simple as it
is wise. So far then, as Hahnemann's classification of drugs
is concerned, there is nothing absurd in his method.
3. On Hahnemann's mode of observing and classifying the
therapeutic indications.
What distinguishes the physician from the empiric, is this,
that the latter treats patients without inquiring into their
state, whereas the former never acts without a motive.
* Trousseau, traiti de matiere midicale et de thirapeutique; Paris,
1847, 2 vol. in 8.
t Jahr's Pharmacopoeia and Pathology, (translated by Charles J.
Hempel, M. D., and for sale by W. Radde, 322 Broadway, N. Y.)
t Histoire naturelle des drogues simples, ou Cours d'histoire naturelle
professe a l'Ecole de pharmacie, 4me edition, Paris, 1849-1850, 3 vol.
in 8, avec figures.



:xii        A RETROSPECTIVE VIEW OF THE
But a rejection based upon such causes, is not legitimateIndeed, according to the words of our poet: le vrai peut
quelquefois n'etre pas vraisemblable, truth may often seem
very little truth-like. Moreover, every unknown thing at first
appears strange, for the simple reason that it was unknown
when it wvas first brought to light. This in the common fate
of almost every great discovery when it is first announced.
It seems strange because it was a stranger to our minds;
this is the only reason.
True, strangeness and improbability have their degrees.
Auscultation, for instance, is less strange than the circulation
of the blood; this is less strange than microscopic entozoa,
and these again are less strange than Hahnemannian attenua.
tions. In these we pass at once from ponderable fragments
to divisions which no mathematical language is capable of
defining. Strangeness and improbability here seem to have
reached the highest degree.
One must lose sight of all the peculiarities of the human
intellect in order to be astonished at the opposition which a
method for which the members of the medical profession
were not all prepared, excited in their minds. Whether we
appeal to natural philosophy, to chemistry, to physiology, to
pathology, there does not seem to be any thing in any of
these sciences to enable us to account for the action of infinitesimal doses. On the contrary, every principle in these
sciences seems to oppose and conflict with the reality of
this action. In this respect the most eminent as well as the
most humble men in the sciences occupy the same rank;
both are impressed alike; the learned are even worse off
than the uninformed, for the former are perfectly aware of
the immense distance that separates Hahnemann from the
ruling doctrines, whereas the latter do not even suspect it.
I am therefore not astonished at the opposition which the
strangeness of Hahnemann's doctrines excites at first sight.
But this opposition is not any the more legitimate on that
account. Indeed, the Hahnemannian doses are not without
precedents in nature, and, provided we apply ourselves to
the task in good earnest, we discover a multitude of facts



ALLCEOPATHIC MATERIA MEDICA.           Xiii
and laws confirmatory of those which Hahnemann has
established.
In physics it is an axiom that bodies can be divided without
limit. Another axiom is that the molecule has all the properties of the original body.
In chemistry is it not a well known fact that combinations
take place the more readily the more bodies are divided?
In physiology all the phenomena of formation refer to
infinitesimal quantities.  The growth of the tissue is a
striking instance of this. How much does the retina or iris
of a child grow in the course of a day? Twenty-five or
thirty years are required for the full development of a finger.
Well! let us analyse the elements of a finger, the skin, the
cellular and fibrous tissue, the blood-vessels and nerves, and
then let us undertake to determine the quantity of increase
of these various constituents in the course of every twentyfour hours.
Chemistry does not inform us in what respect the most
virulent agent differs from the most simple. Does it explain
to us the nature of marsh-miasms? Does it account to us for
the infinite diversity of odors which certainly constitute infinitesimal emanations? And yet these phenomena do not
astonish anybody.
This shows that the facts which Hahnemann has pointed
out, do not justify the opposition which. has been waged
against them.  A first moment of surprise or hesitation may
be excusable in a thoughtful mind; but an absolute rejection
a priori is a proof of mental weakness and of ignorance of
natural phenomena.
Another cause why the doctrines of Hahnemann have been
rejected, is that their adherents are not always posted up in
the science of pathology. In one sense this argument is in
bad taste; I shall therefore view it in a more serious light.
It is fortunate for medicine that we have physicians of a
lower rank, pathologists who do not groan under the weight
of a title, who are not compromised by truth, and who can
offer to genius the hospitality of their intelligence, good will,
zeal and admiration, without running the risk of losing



xiv         A RETROSPECTIVE VIEW OF THE
their reputation, fortune- and influence.  There is a gulf
between the man of talent and the man of genius; but between
the obscure man and the slighted genius there is a bond, it
is obscurity: he is always ready to do homage to genius who
does not lay claim to any himself.
In such elevated and important arts as medicine, it is well
that the spirit of innovation should be opposed, enthusiasm
bridled, and error walled in. The men who occupy the
highest rank, are admirably adapted to opposing to the new
ideas the knowledge which they had acquired: this is their
mission.  Opposition and contradiction are the necessary
touch-stone of every truth: no truth is solidly established
until it has triumphed over serious resistance. The opposition
of our eminent pathologists, and the adhesion of obscure
physicians are not, therefore, a sufficient reason for a purely
theoretical rejection of Hahnemann's method: on the contrary, if it is to triumph, it can only do so by conquering these
two orders of antagonism.
A third cause of rejection consists in the errors which
Hahnemann has committed in several important particulars;
but this cause is no more legitimate than any of the former;
this can be shown quite easily. The vehement opponents
of Hahnemann do not know them,. for they have never pointed
them out. They have contented themselves with assailing
Hahnemann with shallow witticisms and Vulgar anecdotes.
Hahneinann's errors have been lucidly shown and energetically combated by his disciples. To be convinced of this,
read the work of Rau's: New  Organon. *  These errors
do not, therefore, constitute legitimate causes of rejection,
since they are combated by Hahnemann's own disciples, and
unknown to his -opponents.  His disciples adhere to the
doctrine while: combating its errors; hence these errors, not
being essential to the doctrine, are no legitimate cause of
a rejection 2 priori.  But, for the matter of that, let any one
name a book on medicine that is not filled with errors; what
* New Organon of the specific healing art, by Dr. J. L. Rau, translated
by Charles J. Hempel, M.DI, Rdde, 322 Broadway, New-York.



ALLtEOPATHIC MATERIA MEDICA.             XV
matters it, if Hahnemann has committed errors, so long as
he is right in his general principles.
If Hahnemann' aoctrine is not absurd,-if the strangeness
and the improbable character of his ideas,-the inferior position of his disciples,-the errors which we discover in
Hahnemann's writings, do not constitute any legitimate causes
of rejection: how shall we' account for the vehement rage
with which his doctrine has been and is being assailed by
our most eminent men? I confess, I am.unable to explain
this fierce persecution, because I do not understand it if I
am to account for it simply with reference to the doctrine
itself.  I should think, though, that it is rejected a priori
simply because it is a doctrine, a theory, a systematic arrangement of ideas. The crime of this theory is to be a theory.
In the present age doctrines, theories, systems, are condemned a priori, become they are looked upon as the cause
of all our errors in medicine. The school which prevails
now-a-days -in our public colleges, academies, hospitals,
rejects in the most absolute manner all theories and systems.
This school does not admit that medicine- is a science, and
it pretends to construct this science upon new observations
and facts.  To admit the possibility of a great truth in
Hahnemann's theory, would be to give the lie to, and reject
that which had been believed, affirmed and professed during
a life-time.  It is much easier to condemn and ridicule
Hahnemann's doctrine.  It do not mean to refute such errors
for the present.  They are sufficiently serious to deserve
a special chapter, which we shall head: on the abuse of the
numerical method in medicine. At the same time I shall state
my reasons for having adopted this heading. *
So far I have confined myself to refuting objections by
answering the question: Is Hahnemann's method absurd, or
it is not? It seems to me that I have shown sufficiently that
this method is in no respect tainted with absurdity, and that
its claims to clinical experimentation cannot be denied by
any one who does not mean to violate every rule of sound
* See farther on.



XYlii:A RETROSPECTItE VIEW OF THE
the practice of medicine is repulsive; I go further and maintain that, in some respects, it is not the practice of a reasonable man whenever its principles are taken from most of our
materia medicas."
Pinel has been praised for having denounced the practice
of mixing up drugs; but these denunciations have proved so
little a reform, that at the present moment, the compounding
of drugs prevails more than ever.  Broussais was more
thorough; he proscribed at one blow the whole of the materia medica.  His pupils were a little more ignorant on this
account; that is all. Such means do not constitute any reform.
If therapeutics be the art of interpreting and prescribing in
accordance with the morbid indications; and if the materia
medica be nothing else than the totality of the agents by
means of which the therapeutic process is carried on,-it is
not difficult to perceive in what manner therapeutics and the
materia medica are deficient;- on the one hand, the morbid
indications are arbitrary, and on the other hand, the action
of drugs is imperfectly determined. Hence, a reform. in medicine should aim 1, at substituting positive for all hypothetical indications; and 2, at employing remedial agents whose
action has been correctly ascertained by provings upon the
healthy, and whose efficacy has been established by clinical
experience.
Hahnemann's labors seem to me to have realized the
therapeutic reform  that has been desired by all physicians.
What is particularly remarkable in his labors, are his immense
experimentations concerning the effects of. drugs; it is his
materia medica, this masterpiece of' observation, patience
and unsophisticated sense.  On first beholding this prodigious work, the mind becomes confused.`* We'are less
struck by the fact that all these phenomena were observed
and classed by a single man, than by the possibility of retaining them in their order in one's memory.
* We allude to Hahnemann's Materia Medica Pura and to his Chronic
Diseases, 9 vols., containing the effects of upwards of a hundred drugs
proved upon healthy persons. For sale at W. Radde, 322 Broadway, N.Y.



ALLCEOPATHIC MATERIA MEDICA.           XXI
formula almost implies an impossibility, for no drug is capable
of reproducing the phenomena of a disease in all their
totality and in the same order of succession and combination,
as they developed themselves in the orginal malady.'Notwithstanding these apparent inconsistencies, it is undeniable that Hahnemann has.offered a general formula expressive df the:relation of the pathological phenomena to the
action of the:drugs. This is, in my judgment, above all
criticism.  Moreover, the errors which we have pointed out,
are chargeable to the hippocratic philosophy, whereas the
truth which Hahnemann has established, belongs to him,
supposing, of course, that the homoeopathic law embodies a
highly important general truth, as I believe it does. What
matters it whether the treatment proposed by Hahnemann, is
termed specific, provided it is efficacious?
As regards infinitesimal doses, what argues in their favor
is the fact, that Hahnemann was led to them gradually by
experience.  Prescribing his remedies in conformity with
the law of similarity, which requires that the natural disease
should be combated by means of an artificial drug-disease
that -is as nearly as -possible analogous to the former, he
observed that the medicine as soon even as it was administered,
produced a considerable aggravation of the condition of the
patient; it became therefore necessary, in order to arrive at
a cure, to pass through an increase of the original symptoms
which was generally proportionate to the efficacy of the
remedy.  Every enlightened practitioner will comprehend
this. What prevents him from giving Opium in headache, or
Cantharides in affections of the urinary organs, for the purpose
of modifying the vitality of the affected parts, if not the fear
of aggravating the evil to an extent which it is not possible
to determine beforehand? This was the reason why Hahnemann diminished the dose. What seems incredible a' priori,
the more he diminished the quantity of the drug, the less
violent was the aggravation, and the more certain was the
cure when the remedy was well chosen. What is to be said
against experience, except that it ought to be confirmed by
facts so numerous and so precise, that the mind feels com



ON PNEUMONIA.
PNEUMONIA is a disease of frequent occurrence, acute,
serious, with well-defined characteristic symptoms; it
is on this account that I have selected it as the first
example of an application of Hahnemann's method to
the treatment of disease. No physician will dispute
either'the frequency or the acute nature of pneumonia;
if there be a difference of opinion regarding the gravity
of the disease, it is only concerning the degree of intensity which the disease exhibits. Pneumonia sometimes gets well without treatment, but nobody as yet
has maintained that pneumonia, if left to itself, does
not sometimes terminate in suppuration of the inflamed
parenchyma.  It is well known that suppuration is
tantamount to death: in this case it may well be said
that the exception confirms the rule.  The signs by
which this disease is recognized, are generally very
striking, and easily distinguished; and if I admit that
we might be mistaken on a first examination I make all
the concessions that can be legitimately claimed. No
physician can possibly mistake a case of pneumonia
when he sees his patient every morning and evening,
auscultates him carefully, and watches all the evolutions of the disease with the intention of determining
its true character. Is the treatment of this disease as
fixed and scientifically determined as the character of
the disease? I think not, and this doubt imposes upon
me the duty of being very cautious in my conclusions.
Thus, I shall not compare the results whichi I have ob1



2                   PNEUMONIA.
tained with the results that have been published by other
physicians; this would be premature. All that I desire to establish is, that infinitesimally small doses of
drugs and administered in conformity with the similarity of their positive effects to the symptoms of the
disease, exercise an evident influence upon the phenomena, the course and termination of pneumonia.Serious minds will infer from this that they ought to
study Hahnemann's method; I have no other object in
view than to provoke clinical and experimental investigations-on this subject. Here is the plan which I have
followed:
After studying the writings of Hahnemann and his
disciples, I read the records of a number of cases treated
by the new method. Having understood the meaning
of the formula "Csimilia similibus curantur," I had to
try the efficacy of infinitesimal doses. I devoted six
months to this clinical verification in such acute and
chronic maladies where these trials could not possibly
result in the least injury to my patients. In a few
days already I had-obtained the most complete evidence
of the efficacy of infinitesimal doses; nevertheless I
continued my experiments. At the end of six months
I set about investigating the merits of the new system
as a complete therapeutic method, and in this new investigation, proceeded with the the strictest precision.
My experimental treatment of pneumonia required the
greatest precautions. It is not by any means a slight
responsibility to substitute, in the treatment of an acute
disease, a new method for one that enjoys the sanction
of universal experience.  It was therefore necessary
not to expose the patients to any danger, or else to give
up the new method. It seemed to me that the-difficulty might be overcome with a little patience, in the
following manner:
The chief therapeutic indication in pneumonia is to



4                   PNEUMONIA.
pathic remedies from the first. Aconite seemed to have
little effect a few hours after its first exhibition; Bryonia seemed to act with great energy; Phosphorus was
useful in local inflammations that threatened to pass
into the stage of suppuration. The anxiety which I
endured in making these first experiments, is indiscribable. In spite bf my determination to bleed, if the
condition of the patient should get worse; in spite of
my frequent visits to these patients, it always seemed
to me that some catastrophe would take place. But
nothing of the kind happened. The first patients which.I treated homoeopathically, all got well, and some others
were speedily relieved.  In upwards of two years I
only lost one patient. Two other patients died, but
they were brought to the hospital in the last stage of
suppuration. If they are recorded in my list, they can
have no possible weight in deciding the therapeutic
merits of the system. Since then, I have pursued the
same treatment in a large number of cases of pneumonia, and my former apprehensions have gradually been
removed. I do not wish to say more, and shall let the
facts. speak for themselves. I beg the reader to remember that in the following cases I have neither
desired to furnish an exact description of pneumonia
and its various characters, nor a detailed list of the
symptoms of each case and the corresponding positive
~effects of the remedies employed. My chief aim has
been to show the nature of the disease, and the method
which has been pursued in treating it. Every physician
is sufficiently acquainted with pneumonia to recognize it
by the signs which we mention, and to appreciate the
influence which the treatment had upon the disease.
By revising the cases I might have perfected the record
somewhat; for whatever signs inay have been omitted
in the record, they were never lost sight of at the bedside of the patient. I have preferred publishing these



CA ES TERMINATING IN RECOVERY.        7
FIRST SERIES.
CASES TERMINATING  IN RECOVERY.
CASE  1.-Influenza of 1847.-Intercurrent pneumonia. —Bronchitis previous to the invasion of pneumonia.
Joseph Croare, 23 years old, tailor by trade, admitted on Nov. 19th, 1847, ward St. Benjamin, No. 16.
Nine or ten days ago the patient took cold. He
coughed a good deal, but did not raise anything; had a
fever but nio headache.
Nov. 17th, while the fever had been increasing all
the time, the patient was taken with a, chill, which
lasted an hour and was followed by a stitch in the left
side, anteriorly. On the same day the sputa became
yellowish, rusty. He had no sleep, but no dreams or
delirium. No diarrhoea or constipation, no vomiting or
nausea.
Nov. 20th, the patient was examined, had a stitch
in the left antero-lateral region of the chest.
On auscultating the chest, no respiratory murmur is
heard at the base of the chest. Below the shoulderblade a very strong bellows-murmur; higher up a rasping respiration. There is bronchotomy, a slight crepitant rale in the axilla.  On the opposite side, the
respiratory murmur is stronger than usual; on percussion a dull sound is discovered at the base of the left
lung.
Oppression of breathing, the patient coughs frequently; the sputa is copious, viscid and rusty.
The complexion is somewhat jaundiced; the malar
region is flushed, the skin hot and dry. No headache;
pulse 120, not hard, but soft and full.



~~~8    ~      PNEUMONIA.
Abdomen not painful; a diarrhoea set in to-day for
the first time. The mouth and throat are not painful,
but a stomatitis has developed itself, with a whitish
coating on the gums and tongue; the lips were cracked.
The tongue is broad, white on the upper surface, not
very much inflamed on the edges.
ANTECEDENT CONDITION.-A few days previous to
being taken ill, the patient, being over-heated, had exposed himself to a cool draught. Until now he had
never been very sick. He drank and ate well, had a
good room, and was moderate in all his habits.
TREATMENT. —-Aconite 15 in solution, a tablespoonful every hour.
Nov. 21.-Pulse 100. - The patient feels a little better; less oppression; the murmur under the shoulderblade is less, but stronger above. A little diarrhoea.
Aconite 6, as above.
Nov. 22.-Pulse 100. The patient feels very weak;
strong murmur at the top of the lungs; a little diarrhoea (one stool). Stomatitis worse; less jaundice. The
stitch is more in front; this morning the patient has
coughed a good deal, and has had some slight nausea.Bryonia 30 in solution.
Nov. 23.-The pain extends over the whole chest;
pulse 100; face pale, and stomatitis still continuing;
four loose stools last night.  Yesterday the patient
committed the imprudence to rise and go to the watercloset. The murmur continues, is very loud at the
apex of the lungs; on a level with the shoulder-blade a
somewhat crepitant rale is heard; it is likewise heard
at the base, but less distinctly.-Bryonia 30.
Nov. 24.-No stool; urine thick and cloudy; pulse
70; murmur less distinct at the apex; crepitans redux; sputa not rusty.-Phosphorus 30 in solution.
Nov. 25.-The murmur is only heard at the apex,
and but slightly; the crepitans redux is distinctly



CASES TERMINATING IN RECOVtRVie 
heard on a level with the angle of the shoulder-blade;
fever and dyspncea have ceased; no rusty sputa, no
diarrhcea.-Continue Phosphorus.
Nov. 26.-No more murmur at the apex. —Broth. —
Continue Phosphorus.
Nov. 27. —The improvement continues, No fever, no
murmur, no medicine.
Nov. 29. —Complete resolution.
Dec. 1.-An allowance.
Dec. 3 —The pulse down to 50.
Dec. 4.-A slight stitch in the left side; pulse 70.Scilla 6 every day.
Dec. 14. —The. stitch continues. —Continue Scilla,
Dec. 16.-Stitch continues; plaster on left side.
Dec. 21.-:-Feels well; the stitch is not quite gone. —
Discharged.
Reftections. —This case was a very serious one. This
may be inferred from the number of the pulsations,
1i20, from the icteric color of the face, and from the
sudden supervention of the weakness.
It has been said that the pulse was not hard, but
soft and full. At this period I again noticed the softness of the pulse which Boerhaave points out in pneumonia, an important sign, since it prevented the great
Leyden physician to bleed his patients as much as they
ought to have been bled. This character of the pulse
in pneumonia, which. is not a constant, but a very frequent symptom, is not a mere curiosity, There are
authors in our day, who recommend depletions in pneumonia as long as the pulse is hard; it is difficult to follow this advice, if one knows how to feel the pulse.
The stomatitis is another noteworthy symptom,
Concerning both this phenomenon and its explanation, Davasse has published an interesting memoir to
which I refer my readers.
Aconite does not seem to have produced any other



1                    INREUt1MONItA
effect in this case than a diminution of the pulse from
120 to 100. I have scarcely ever seen any other effect
from Aconite in pneumonia in the full stage of the
disease. It is asserted that this remedy will sometimes
cut short a pneumonia in the very beginning. I have
never seen this result. It should be stated) however)
that, in hospitals, pneumonia are scarcely ever treated
from their commencement.
If we compare the action of Bryonia and Phosphorus
to that of Aconite, we find that the difference in favor
of the former remedies is very striking.  And yet,
these drugs were exhibited in the 30th attenuation)
from four to six sugar-globules in a tumblerful of water,
each globule of the size of a mustard-seed, impregnated
with a small portion of the liquid attenuation which
contained only a decillionth fraction of the original drop)
or a fraction represented by the unit followed by sixty
cyphers.
I trust I shall not be called upon for an explanation
of these phenomena; all I can say is: read these cases
with a becoming attention and earnestness of mind.
CASE 2. —Influenza of 1847. —Intercurrent pneumonia. —Bronchitis previous to the invasion of pneumonia.
Joseph Lami, 36 years old, day-laborer, admitted
Dec. 1st, 1847, ward St. Benjamin, No, 385
INCIPIENT STAGE. —On the 24th of Novi after carrying a heavy load, and sweating a good deal) the patient
exposed himself to a cool draught. Next morning he
felt unwell) but not chilly. He coughed and raised a
good deal; went to bed and kept warm; drank a good
deal of cider and tried to eat; after eating, he vomited
up his meal. No diarrhoea.
Nov. 26 and 27) the oppression on the chest was
much worse) and the breathing more embarrassed, The
sputa was neither shining nor rusty. No headache,
violent fever.



14                  PNEUMONIA.
less oppression; bellows'-sound at the apex, with slight
crepitant rattle. —Bryonia 15 in solution in the morning; Phosphorus 15 in the evening.
Dec. 5. —Pulse 70; expectoration good, not rusty;
no bellows'-murmur, scarcely a slight rasping respiration on a level with the shoulder-blade, less oppression;
stomatitis almost gone, weakness continues. —Phosphorus 15 in solution.
I Dec. 6.-.-Rasping respiration at the internal angle of
the shoulder-blade; pulse 70.-Continue Phosphorus.
A little broth.
Dec. 7. —Pulse 60; the rasping breathing continues
some.-Iodine 12 in solution.
Dec. 9. —Pulse normal; rasping respiration.  Yesterday the patient had taken Phosphorus, to-day again
Iodine.
Dec. 11. —Pulse perfect; good expression of countenance; good appetite; no stomatitis. Auscultation still
reveals a little rasping at the internal angle of the
shoulder-blade. An allowance. —-Iodine 12 one spoonful only.
Dec. 13.-.-The rasping is disappearing, —Iodine in
solutions
Dec. 14.-Complete resolution.
Dec. 15. —No medicine.
Dec. 17.-The patient complains of a little difficulty
in the chest when coughing or drawing a long breath;
he feels some je!king pain in the chest. Plaster on the
chest in front and behind. Three allowances.
Dec. 21.-Some pains in the side.
Dec. 22.-IHepar-sulphuris in solution, for the stitch
in the side.
Dec. 24.-Feels a little better. —Continue Hepar.
Dec. 29. —Complete recovery.-Discharged, January
8d, 1848.



CASES TtRMINATINt IN RECOVEfRY,       15
This is a very simple case of pneumonia, I come
menced the treatment with Bryonia in consequence of
the little good which Aconite had done me in former
cases, On the seventh day the pulse came down to 70,
After the tenth day it was no longer noticed. At this
period we had not yet sufficiently observed the decrease
of the pulse under the action of Bryonia, to bestow upon
this phenomenon all the attention it deserves.
CASE 4. —Pneumonia of the right upper lobe.
August Plet, 36 years old, worker in zinc, admitted
Dec. 14th, 1847, ward St. Benjamin, No. 17.
Dec. 7. —In the evening the patient was taken with
a chill. Previous to this, the patient had felt well, did
not cough, but he had been hoarse for a long time previously. For six days past he had been raising a yel'
low, saffron-colored matter,  Had had a fever since
then, and had not been able to work. Had an oppression on the chest, and pain in the right side; some
nausea; no vomiting, but a little diarrhmea.
Had got wet some days ago) and had kept on his wet
clothes for some time.
Dec. 16. —Pulse 100, very soft; face red, bloated,
yellowish. A little stomatitis, Hoarse; no diarrhoea,
no vomiting, embarrassed respiration,  Auscultation
reveals a bellows'-sound at the apex of the right lung 
no vesicular murmur in the remainder of the lungs;
dulness in all the right breast) and an acute pain in
this side of the chest,  Sputa thick, viscid, rusty. —
Aconite 6 in solution.
Dec. 16. —Pulse 100, very soft; jaundiced complexion;
stomatitis worse; gums swollenm  Bellows-sound on a
level with the right shoulder-blade and above it.-.
Bryonia 30 in solution during the day, and Phosphorus at night.
Dec. 17.-Pulse 75; bellows2=murmur at the top of



18                  PNEUMONIA.
the intensity of the local affection which yields, itself,
very speedily. Is it common to see the fever decline
while the hepatization is going forward?
CASE 6.-Pnleumonia of the left lung.
Jules Despeaux, aged 18 years, painter on china, admitted Dec. 21st, 1847.
Dec. 18.-The patient was taken with a violent chill,
he could not get warm. He went to bed and perspired
profusely. No stitch, but oppression, and rusty sputa.
Dec. 20th the patient was bled; Dec. 21st was brought
to the hospital.
Dec. 22.-Pulse 110, soft and frequent. Slight stitch
in the left side since yesterday evening. The patient
is strong, plethoric; face red, bloated. Stomatitis, with
whitish coating; tongue white, swollen, red at the edges,
with indentations.  Auscultations reveals a bellows'murmur in the whole of the left side," increasing from
below upwards as far as the shoulder-blade, and most
distinct above it. The cough is not frequent dyspncea
considerable. Rusty, shining, almost sanguinolent sputa.-Aconite 6, a tablespoonful every hour.
Dec. 23.-Pulse 90; less murmur, but continuing
from below upwards; no stitch; stomatitis nearly the
same.-Bryonia 30 in solution.
Dec. 24.'-Two or three nose-bleeds.  Pulse 70;
tongue less'swollen; stomatitis less. Crepitans reduxz
below; scarcely any murmur above, more in the middle.
The sputa has scarcely any color.-A little thin broth.
-Continue Bryonia.
Dec. 26.-White sputa, scanty; a little murmur.Brybnia in solution in the day-time, Phosphorus at
night.
Dec. 27.-A little rasping, but neither murmur nor
crepitation.-Broth and soup; Bryonia one spoonful a
day.
Dec. 30. —Perfect recovery.-Two allowances.



20                  PNEUMONIA.
Frequent cough, with sputa of the color of the juice of
prunes, viscid and copious. Breathing short and frequent. Percussion reveals a dulness in the whole extent of the posterior and right portion of the chest, and
in front under the clavicle.  Posteriorly no abnormal
murmurs are perceived, except perhaps a rasping and
puerile respiration; but in front and superiorly, from
the fourth rib to the clavicle, an intense bellows'-sound
both during inspiration and expiration, with crepitation
at the close of an inspiration only, and during the paroxysms of cough.-Water and sugar, two pitcherfuls.
Jan. 11.-Same as before with increased dyspncea,
but no pain in the chest. Posteriorly, from the base to
the apex of the lung, the bellows'-murmur had set in,
with crepitation towards the base, perceptible at the
close of an inspiration (bronchotomy).  In front the
bellows'-sound is less intense.-Bryonia 12 in solution.
Jan. 12.-Hurried breathing; sputa continues viscid
and brownish. Pulse 124; skin dry and warm. Stethoscopic phenomena the same as before.-Bryonia 12 in
solution.-Towards evening the pulse becomes less frequent and less strong; the skin becomes moist. About
ten at night the cough begins to decrease, the dyspnoea
is less distressing, the sputa, which continues viscid
and bloody, is covered with a frothy serum. Pulse 96.
Improvement.-Continue Bryonia.
Jan. 13.-Pulse 84. The sweat continues; sputa
less viscid, thinner, of a lighter color.  Stethoscopic
signs: bellows'-murmur posteriorly at the base of the
lungs. and large vesicular crepitation in the spinal depression and on its borders. In front and superiorly
the bellows'-murmur has disappeared and has given
place to a rasping respiration without rattle. In the
evening the patient feels still better. Breathing easy,
sputa full of air-vesicles and gummy. —Bryonia 24 in
solution.



CASES TERMINATING IN RECOVERY.        23
respiration small, frequent, stitch in the side more acute
than the day before; the patient has to lie on the left
side, any other position being painful.
Cough loose, with copious rusty sputa, not very tenacious, and a copious greenish, frothy serum floating on
top of it in the chamber.
Dulness of percussion posteriorly, and, in the same region, bronchophony, and very loud bellows'-murmur from
the base of the lung to the spine of the shoulder-blade.
At the latter point, and in the sub-spinous depression, a
fine and copious crepitation is heard at the close of an
inspiration. At the base of the lung -the bellows'-sound
is intermingled with a large vesicular mucous rattle
which is particularly distinct during a paroxysm of
cough.:From time to time, on a level with the spine of
the shoulder-blade, a rasping, dry noise is heard, like
the rustling of silk, whence Dr. Bazin who is present at
the examination, infers the existence of local and partial pleurisy.- Water and sugar, two pitchers full; Aconite 6 in solution, and Bryonia 18 in solution, alternately.
Evening: same symptoms, prostration increased.
Jan. 26.-No sleep in the night, cough more frequent
than in the day-time.
Headache and facial congestion less.  Pulse large,
soft, 80; intense thirst; temperature of the skin like
that of the breath.
Breathing frequent but equal; expectoration the same.
The stitch in the axilla is less painful.
Bellows'-sound and bronchophony the same; the mucous rhonchus, which was at first limited to the base of
the lung, reaches the middle third; crepitant rattle
less dry in the sub-spinal depression.-Water and sugar; Bryonia 18 and Phosphorus 30 in solution, alternately.



CASES TERMINATING IN RECOVERY.       25
tion has ceased, in the place of which a mucous rattle
is heard, little or no dulness of sound.-Two broths.
Feb.. —Same. The bronchial respiration reappears
in the sub-spinal depression; copious expectoration.Sulphur in solution, diet.
Feb. 2.-The bellows'-sound continues, and the mucous rattle posteriorly.  Mucous expectoration, with
frothy serum. -Continue Sulphur.
Feb. 3.-Yellowish expectoration in small quantity;
a good deal of serum; the bellows'-sound above the
spine of the shoulder-blade continues; but it has lost of
its roughness.-Two broths and soups.
Feb. 6. —The bellows'-sound is almost entirely gone.
Serous expectoration. —Sulphur in solution, an allowance.
Gradual disappearance of the bellows'-sound and expectoration. Discharged Feb. 28.
The patient in this case was not a young man of
eighteen, but a stout man of fifty-three years old, who
had been affected with pneumonia for eight days without having anything done for him. In his case the
frequency of the pulse, 84, was not at all proportionate
to the intensity of the other symptoms; the expectoration is easy and copious.  The mucous rattle, intermingled with the bellows'-noise and the bronchophony,
gave rise to apprehensions of suppuration, in these
parts. What rendered this case peculiarly dangerous,
was the absence of all treatment for the first eight days.
Two days after his admission in the hospital the improvement commenced; on the twelfth day of his disease, it was broken; on the thirteenth the fever ceased
entirely.
The complete resolution of the parenchymatous hepatization did not take place at once, and the bronchial
inflammation continued for some days; could this have
been otherwise? At the age of fifty-three, resolutions
2



28                  PNEtUMONIA,
Evening. The patient feels still more comfortable.'The icterus is decreasing,
Jan. 28.-Cough rare, with viscous, saffron-colored
expectoration, almost without serum, Breathing continues easy; warmth of the skin natural; the icterus
has disappeared. Pulse 80; the intermissions become
more marked again. Dulness of percussions behind;
crepitans redux at the close of an inspiration, only in
the axilla, and from the spine of the scapula to the base
of the lung  no bellows'-sound in this region, which is
only perceived, though slightly, along the internal border of the scapula. —Continue Rryonia.
Jan. 29.-Cough rare) with scanty, mucous sputa.
Pulse 80, intermittent; icterus almost gone. Only a
little vesicular crepitation here and there, without any
bellows'-sound behind, The patient desires to eat —Two broths.
Jan. 80.-Perfect convalescence, —-Two broths; two
soups.-The same until
Feb. 1.-An allowance.  The patient remained in
the room until Feb. 7, without dyspnoea or palpitation)
although the signs of his organic affection remained the
same as when he was first admitted,
Every body knows that a pneumonia which sets in
during the existence of an organic affection of the heart)
is a very serious disease, I had every reason to be
forcibly impressed with. the ease and quickness with.
which this patient was cured of his disease, I will not
dwell upon the interesting signs which characterized
the organic affection in this case, nor upon the changes
of the pulse during and after the pneumonia.
CASE 10.-Pneumonia of the left side.-Metastasis to the brain.
Violat, porter, was admitted Jan. 29th, 1848, ward
Saint Cecile, No, 7. This was his first sickness. Ho



CASES TERMINATING IN RECOVERY.       29
was tall, strong, of a bilious-nervous temperament;
aged 40 years.
The day previous to his admission, he woke in the
morning with a violent fever, not preceded by a chill,
and characterized by thirst, headache, heat all over, and
loss of strength; he had to remain in bed. Desirous
of resuming his work in the middle of the day, he went
out and was attacked with a violent chill in the street,
with pain in the inferior and left posterior region of the
thorax; a few turns of cough and expectoration of bloodstreaked sputa. After his return home, the fever increased, the cough and expectoration became worse,
especially at night; he did not sleep any.  On the
third day of his sickness he was admitted to the hospital.
Evening.-Violent headache, burning thirst, tongue
red and dry; skin hot and parched; pulse strong, full,
from 108 to 112 beats.
Breathing frequent, unequal, interrupted at times by
a violent pain in the left chest, opposite the nipple.
Cough not frequent; the patient tries to suppress it
in consequence of the pain; the patient raises with
difficulty a little rusty sputa, which is tenacious and
strongly adheres to the bottom of the vessel.
Percussion shows dulness of sound over a space of
four fingers' breadth below the left clavicle, and behind
in the super and sub-spinous depression; puerile respiration on the right side; a good deal of crepitation in
the region corresponding to the dulness, intermingled in
front, below the clavicle with slight, vesicular crepitation at the close of a deep inspiration. Bronchophony
trifling.-Aconite 18, two tumblerfuls.
Jan. 30.-Same as yesterday, except a striking diminution of the pain in the chest; the bellows'-sound is
heard only during an expiration on a level with the internal and superior border of the left shoulder-blade.



32                  PNEUMONIA.
he had scarcely commenced it when he was taken with
a violent chill, followed by heat, vertigo and general
weariness. His comrades gave him wine with sugar,
made him drink a few glasses of brandy, and led him
home. On his way home he was taken with a dry
cough and a stitch in the side. He went to bed, dieted,
wetted a couple of shirts, but did not feel any better.
On the days following, the fever and cough grew worse;
January 24th, the patient had a blood-streaked mucus.
They gave him hot elder-tea to drink, and kept him in
a constant sweat by covering him with an enormous
quantity of blankets.  But the patient continued to
grow worse, and he entered the hospital January 29th.
His face was red, head heavy.  He complained of
stitches striking from the left to the right supra-orbital
region, as far as the ears. Tongue coated white, moist;
thirst moderate; mouth bitter; skin dry and burning.
Pulse 104. A dull pain on a level with the left nipple
aggravates the breathing; frequent and distressing
cough, with a serous, vesicular expectoration, in the
centre of which one perceives a small quantity of the
characteristic reddish-brown sputa.
On percussing the left lower and posterior region of
the chest, one meets a complete dulness of sound. In
the same region, auscultation reveals a good deal of
sub-crepitant rhonchus, and higher up, towards the
spine of the shoulder-blade, a very harsh bronchial
murmur during an expiration, and less harsh during an
inspiration. Bronchophony. —-Aconite 6 in solution;
two pitcherfuls of water and sugar.
Jan. 30. —Scarcely any headache; tongue coated
white and moist; temperature of the skin like that of
the breath. Pulse large, dicrotus, 100 to 104.
The stitch is less; the breathing less painful; cough
frequent; the rusty sputa floats in a smaller quantity
of loosely coherent serum.



CASES TEVRMINATING IN RECOVERY.       33
The stethoscopic and physical signs are the same as
yesterday.
Bryonia and Phosphorus in solution, the former in
the day-time, the latter during the night.
Jan. 31.-Bad night. More fever and cough. The
heat, thirst and cough have proved very troublesome;
scarcely any serum in the spittoon; only rusty sputa,
mixed with a little saffron-colored expectoration; what
he raises, is very tenacious.
In the morning the skin is still dry and burning, no
headache, tongue coated white and moist; pulse large,
soft, down to 84. No stitch in the side, the breathing
is easy.
The dulness of sound behind has spread more upwards. In front, below the nipple, where the sound had
remained normal so far, it has become dull. Crepitans
redux, dry, frequent, striking the ear in large masses
at the base of the lung. Bronchophony in the super
and sub-spinous depressions, intermingled with subcrepitant rattle, which is only heard during an inspiration. Every now and then rhonchus is heard in these
regions.   The bronchophony is continual. —Bryonia
and Phosphorus in alternation.
Evening. —Restless and slightly delirious; the skin
is not abnormally hot, but is covered with a clammy
sweat.  Pulse small, quick, vibratory; tongue dry;
prostration of strength.  The expectoration becomes
very copious. Th& sputa is less tenacious and rusty.Sinapisms on the calves.
Feb. 1. —Has been restless and delirious all night.
Gummy expectoration which fills one-third of the spittoon.
Copious sweat at six o'clock in the morning; the patient has been changed three times.
During the forenoon the skin remains covered with
sweat; tongue coated white and moist. Putlse large,
2*



84                 ]PNEUMONIA.
undulating, down to 76. Crepitation in the whole posterior portion of the lung.-Phosphorus in solution.
Feb. 2.-Skin moist; pulse 64, soft; feels comfortable.
Profuse mucous expectoration.
Crepitans redux less frequent than the day previous.
A normal respiration is beginning to be heard at the
base of the lung. The bellows'-murmur on a level with
the internal and superior angle of the shoulder-blade
continues. —Two broths.
Feb. 3.-Same symptoms.
Feb. 4. —Same symptoms. Bronchial murmur in the
same region; mucous expectoration.
Feb. 5.-Same symptoms.-Sulphur 18; two broths.
Feb. 6, 7, 8, 9. —Bronchial murmur and copious mucous expectoration. —Sulphur and Ipecac. in alternation. An allowance.
Feb. 14.-The murmur has become harsh, and is intermingled with a little vesicular crepitation here and
there. Cough more frequent, especially in the evening.
The sputa becomes thicker; the dulness of sound has
completely disappeared below, and continues above. In
the night the patient feels oppressed. —Hepar-sulphuris 18 in solution.
Feb. 15 to 17.-These symptoms are growing worse.
Every evening a little rise of fever, not preceded by a
chill, but followed by night sweat.
Feb. 18 to 26. —Fever every evening, loss of appetite; emaciation; mucous sputa, homogeneous, floating
on top of a clear liquid. Dyspnoea increasing.
Complete dulness of sound, and cavernous rattle in
the specified region.i The phenomena of phthisis are
becoming more and more apparent. The hectic fever,
the night sweats, the expectoration, and finally the
diarrhoea, hasten the dissolution of the patient, who
died of rqn"&mus on the 19th of May, 1848.



36                   PNEUMONIA.
difficulty of breathing in the left side of the thorax.
No cough, no expectoration, no stitches. Dulness of
sound below the left shoulder-blade; striking diminution of the respiratory murmur, in the same region, but
-without their character being at all altered.-Aconite 6
in solution, diet.
Feb. 7.-The fever is the same; the pulse is softer.
Respiration frequent and small; oppression worse.
The dilatation of the thorax during an inspiration is
scarcely perceptible on the left side, although it takes
place without any local pain
Cough rare, dry.
Dulness of sound from the spine of the left shoulderblade to the base of the lung.
Complete absence of all respiratory murmur in the
two lower thirds of this region. In the upper third a
tubular bellow's-murmur is beginning to be heard towards the close of an expiration.
No rattle either dry or moist.-Aconite 6 in solution.
Feb. 8.-Sleepless night; tongue moist and covered
with a whitish coating; red edges.  Intense thirst.
Pulse large, soft, less frequent (about 100). Skin dry
and warm.
Respiration small, incomplete, but painless; the sick
portion of the chest is scarcely moved.
Cough rare, with expectoration on several occasions,
of a little saffron-colored viscid sputa strongly adhering
to the bottom of the vessel.
The dulness is more perceptible than the day previous.
At the base of the lung, behind and interiorly, towards the close of an inspiration, the crepitating sound
of a few fine vesicles is heard; and, on a level with, and
on the inner side of the sub-spinous depression the
tubular bellows'-murmur and bronchophony are very
striling,-Continue Aconite; water and sugar.



CASES TERMINATING IN RECOVERY.       37
Evening.-The skin is not so dry, the patient expectorates with difficulty a little rusty sputa.-Bryonia 18
in solution.
Feb. 9. —Less thirst; tongue coated white and moist;
skin moderately warm; pulse soft, 84.
Breathing fuller and slower.
Cough increased, but not frequent, with viscid, not
very copious sputa, some rusty, some saffron-colored.
Dulness behind.
Bronchial respiration in the whole posterior portion
of the chest. Imperfect bronchophony at the base, very
striking on a level with the spine of the scapula.
Complete absence of rattle.-Bryonia 18, two solutions.
Feb. 10.-No thirst; tongue coated white; warmth
of the skin almost natural; pulse soft, 80.
Breathing slow.
Cough rare, with viscid, saffron-colored sputa, mingled
with more copious thick mucous sputa.
Dulness continues.
The tubular bellows'-murmur is less harsh, intermingled at the close of a deep inspiration with a mucous
rattle at the base of the lung, and a fine, abundant
crepitation above.-Continue Bryonia.
Feb. 11.-Fever ceases entirely; temperature of the
skin natural; pulse 72.
Respiration normal.
Cough more frequent in the night, with expectoration
of a considerable quantity of thick sputa. Crepitans
redux in the two upper thirds of the affected lung; an
abundant mucous rattle in the lower third. Bronchophony ceases.-Continue Bryonia.
Feb. 12.-Continued improvement. Cough and expectoration the same.-Water and sugar, two pitcherfuls.
Feb. 13.-Return of fever; the patient had gone out



38                  PNEUMONIA.
of the room to the water-closet. Thirst, red tongu.e,
heat of the skin; pulse 80, resisting.
Cough not frequent, moist; profuse expectoration of
mucus. The dulness behind continues.
Harsh respiration, and large vesicular mucous rattle
in the sub-spinal fossa at the base of the lung. Puerile
respiration under the clavicle of the same side. —Bryonia in solution; water and sugar.
Feb. 14.-Profuse sweat at night. In the morning
the skin is moist, pulse large, expectoration less copious
and partly serous.
Respiration continues harsh, also the mucous rattle
behind.-Bryonia and Phosphorus in solution, alternately. Broth.
Feb. 15. —Sweat all night until this morning. Cough
and expectoration less. Diarrhcea over night. —Broth.
Feb. 16. —No fever. Cough and expectoration have
almost ceased; very little mucous rattle; diarrhoea continues.-Rheum. in solution; diet.
Feb. 17.-Two stools over night, the patient had
again left his bed; cough worse, with more mucous expectoration; abundant mucous rattle; reappearance of
bronchophony on a level with, and on the inside of the
spine of the left scapula.-Phosphorus in solution;
diet.
Feb. 18.-Rise of fever last evening; copious sweat
at nfght. Less expectoration.
Dulness continues, with mucous rattle and bronchophony. Water and sugar; diet..
Feb. 19. —No fever. Skin and pulse natural, 60;
diarrhoea reappears; the patient raises a little vesicular
mucus; no bronchophony; fine and circumscribed crepitans redux in the sub-spinal depression.-Rhe'um.;
water and sugar.
Feb. 20.-Diarrheea less. Scarcely any cough or expectoration; crepitation at the close of an inspiration,



40                  PNEUMONIA.
morning, these symptoms were still worse, and the
cough is followed by expectoration of a blood-streaked
sputa.  The patient was bled, and then came to the
hospital.
Feb. 7.-Violent fever. Headache, flushed face, dry
tongue and skin, with intense thirst; pulse 120, quick,
tense; slight trembling of the extremities.
Painful stitch in the side on a level with the edge of
the false ribs of the right side, aggravated by the cough,
which is frequent, short, with bloody sputa which is
surrounded with a clear serum and is difficult to raise.
Breathing painful.
Dulness of sound behind over the two lower thirds of
the right side, and in the axilla. Intense bellows'-murmur in the same region, and crepitant rattle at the base
of the lung which becomes particularly frequent during
a deep inspiration.  Marked bronchophony.-Aconite
18, two tumblers full; water-and sugar, two pitcherfuls.
Feb. 8.-Same as yesterday; the patient had a restless night, and distressing dreams when the momentary
cessation of the cough allowed him a short nap.
Skin less hot, pulse less tense, fuller and less frequent, 100.
Sputa more copious, less red, more viscid and rusty,
with a large quantity of serum floating above it.-Bryovia 24, two tumblerfuls.
About four o'clock in the afternoon, the skin becomes
slightly moist. The headache and cough are less.
Feb. 9.-Had a bad night; restless, slightly delirious; fatiguing cough.
Morning visit.-The skin is very hot and dry, pulse
large, compressible, 90; tongue dry and red; little or
no headache.  The stitch is painful only during the
cough; this is less frequent, shorter, with profuse expectoration of viscid rusty sputa, without serum. Dul



CASES TERMINATING IN RECOVERY.        41
ness the same in quality and extent as on the previous
days.  Bronchial respiration continues harsh and labored. The crepitation at the base of the lung seems
to rise towards the upper portion, and to extend over a
larger surface. It is heard both during an inspiration
and expiration. In the right axilla the crepitation is
very fine and abundant. —Bryonia, two solutions.
In the evening, increase of fever; intense thirst and
headache. Pulse hard, tense, quick, about 100; dyspncea. Respiration hurried, panting; cough dry, hoarse;
no expectoration since this paroxysm commenced, which
was about two o'clock, About nine o'clock in the evening, the exacerbation of the previous symptoms decreases, the expectoration recommences; a slight moisture breaks out on the face and hands.-Sinapisms on
the legs.
Feb. 10.-Spent a better night. Tongue coated white
and moist; no headache; skin very warm but not excessively dry; pulse large, undulating, compressible,
84.
No stitch in the side; respiration normal; cough
easy, profuse expectoration of gummy sputa; the tubular murmur and bronchopho-ny are limited to the super
and sub-spinous depression. Fine Crepitans redux in
the remaining portion of the inflamed lung.-Bryonia
and Phosphorus in solution, alternately.
In the evening, the patient had three diarrhceic stools,
and filled the chamber half full with a red urine depositing a sediment.  The skin is moist all over, without
being exactly sweaty.
Feb. 11. —Had a quiet night, the patient says he feels
perfectly comfortable. Tongue coated white and moist;
warmth of the skin mild and pleasant.  Pulse large,
depressible, 80 to 84. Cough rare, easy; profuse mucous expectoration; general crepitans redux, with bronchial respiration without harshness all along, and espe



CASES TERMINATING IN RECOVERY.        43
not subject to any hereditary diseases, and has never
been seriously ill heretofore.
In the evening of the 10th of February, after working hard, he was taken with wandering chills mingled
with flushes of heat, weariness and restlessness. This
continued all night. In the morning had a fever, intense headache, thirst, without any other characteristic
symptom. Spent the whole day and night in this state,
without taking anything but water and sugar, until the
afternoon of the second day, when he was taken with a
dry and fatiguing cough, and causing a constantly increasing, acute pain on a level with the lower angle of
the right scapula. Gradually the cough became moist,
and was followed by yellow, viscid, blood-streaked sputa.
No treatment.
Feb. 15, evening, was admitted to the hospital. Violent fever, flushed face, tongue moist and coated white;
thirst moderate; skin dry and burning, except in the
palms of the hands, which are very moist; pulse strong,
full, 100. Prostration of strength, he is scarcely able
to give an account of his anterior condition.
Dyspncea; respiratory movements unequal, irregular.
Cough not frequent, painful.
Difficult expectoration of bloody sputa, not very tenacious and floating in an equal quantity of a whitish
loosely coherent serum.
Percussed in front, the right side of the thorax yields
a normal sound, behind, from above downwards, and in
the corresponding axilla, percussion yields a striking
dulness. A moderate percussion of the chest excites a
pain towards the base of the lung.
Auscultation reveals harsh tubular respiration, especially during the expiration, with bronchophony from
the lower angle of the scapula to the sub-spinal depression, being particularly striking along the internal border of this bone, and gradually decreasing in going to



48                  PNEUMONIA.
with a little red, viscid sputa, strongly adhering to the
vessel.
In the morning, the fever is intense; dull headache,
the face no longer bloated; a general icteric color has
developed itself.
Tongue red, skin burning and dry; pulse 116; prostration of strength; the patient is scarcely able to set
up.
Marked oppression; rapid, unequal respiration; the
right side of the chest almost remains unmoved. Cough
frequent, painful, with occasional expectoration of bloody
and very tenacious sputa. Stitch in the side continues
painful.
Behind, on a level with the lower angle of the scapula
a slight bellows'-murmur is heard; the bronchophony is
more distinct; during the cough, or at the close of a
deep inspiration, a crepitant rattle is heard scattered
over a surface. —Bryonia 18 two solutions, two pitcherfuls of water and sugar.
In the evening, the cough becomes more and more
moist; the sputa is of a lighter color, and more copious.
The bellows'-murmur is very distinct on a level with
the lower third of the lung; and quite low down crepitant rattle is heard.
Febr. 22.-The night has been pretty good.
Icteric color. The headache is much less. Tongue
coated white and moist; warmth of the skin like that
of the respiration; pulse large, strong, less frequent
(100).
Breathing easier; the respiratory movements are regular and uniform; but the right side does not dilate.
The stitch in the side remains the same.
Cough frequent and followed by easy expectoration
of copious, tenacious, rusty sputa.
Tubular respiration from the spine of the scapula to



CASES TERMINATING IN RECOVERY.        51
when coughing. Respiration easy, but frequent; expectorates a small quantity of viscid, saffron-colored,
opaque sputa.
Marked dulness under the right clavicle and decreasing gradually as far as on a level with the fourth rib,
where it ceases; behind, in the sub-spinal fossa, it is
only heard in consequence of the resonance from the
opposite side.
In the same space is heard the tubular murmur with
a few crepitating vesicles around the nipple and in the
axilla; behind none of these abnormal murmurs are
heard, even during a deep inspiration.-Aconite in solution.
April 9.-Restless and delirious all night.
In the morning, the face looks animated; his eyes
stare, his answers are short and sudden; he gets angry
at being taken for a sick person; he is constantly repeating that he is getting better, and he raises himself
suddenly to have his chest explored.
Tongue a little moister, scarcely any thirst.
Pulse 112. Skin warm. The patient does not complain of any pain in the side.
Cough rare; a little viscid sputa, of a yellow-brown
color.
Same physical signs.-Bryonia 12, two solutions.
The delirium continues in the day-time; the patient
uncovers himself constantly, and the force-jacket had to
be put on him. In the evening his face is covered with
sweat, likewise the lower extremities which are the only
ones that can be examined. During the night the delirium decreases.
April 10.-Less delirious. The jacket is drenched
with sweat, and the patient has to be changed. Pulse
large, soft, 88. Tongue ccated white.
Cough rare; scanty sputa some of which is mucous
and the rest preserves its yellow-brown color; but this



54                   PNEUMONIA.
yields a good sound in front, on either side; but behind
the sound is dull from the base to the top, and on both
sides at the same time.
In front the respiratory murmur is feeble but distinct, without any other abnormal murmur. -Behind,
and on the left side, on a level with, and interiorly to
the sub-spinal fossa, a very harsh bellows'-murmur is
heard, which, at its limits, especially below, is mingled
with a crepitant rattle that is heard only at the close of
a deep inspiration.  On the right side, and behind,
there is a complete absence of respiratory murmur, even
during ever so deep an inspiration. Bronchophony is
quite manifest.-Aconite 6 in solution; water and sugar, two pitcherfuls.
April 30. —No new symptoms. The nosebleed has
ceased.  The tubular murmur extends over a larger
surface of the thorax behind and on the left side. Behind and on the right side, there is a complete absence
of respiratory murmur.  The bloody sputa continues
copious, but less shining than the day before.-Bryonia 18, two solutions.
In the evening, the oppression gets worse; the patient is very restless, and slightly delirious all night.
May 1.-The restlessness and the delirium are less.
Intense headache, face bloated; tongue red and dry; a
good deal of thirst.
Skin hot and dry. Pulse large, not very resisting,
104.
Stitch in the side equally acute and in the same region. Cough frequent, distressing; expectoration easier;
bloody sputa more viscid and less filled with air-vesicles
than on the previous days; some of the sputa looks
rusty. The respiratory movements although short and
rapid, seem to be performed with ease. The oppression
is less.
The bellows'-murmur is less harsh behind and on the



CASES TERMINATING IN AECOVERY.        65
left side, and is intermingled with a crepitant rattle.which is no longer heard on its limits only. On the
right side, where no murmur had been heard until now,
a fine and copious crepitation is heard along the internal border of the scapula, with a slight bellows'-murmur
during the expiration. Bronchophony on both sides.Continue Bryonia.
May 2. —Spent a good night. About eleven o'clock
the patient fell asleep, and woke at two o'clock in the
morning covered with moisture.
In the morning, he had scarcely any headache, the
face is no longer fiushed, the tongue coated white and
moist.  Thirst moderate;  skin warm, covered with
copious perspiration (he has been changed three times).
The pulse is large, soft, undulating, down to 80. Cough
easy, rare, with copious expectoration of viscid and
rusty sputa, some of which is blood-streaked.'The
breathing is full, easy; the stitch in the side is scarcely
perceptible during the cough only.
Behind and on the left side, fine and copious crepitans
redux, the tubular murmur and the bronchophony being
scarcely perceived. On the right side; the murmur is
more distinct and over a larger surface than the evening
previous; crepitant rattle at the base.
The critical sweat ceases towards evening; the patient
says he feels quite well.
May 3.-Tongue coated white and moist; no thirst.
Skin natural; pulse large, soft, 76.
Cough rare, breathing easy; sputa not very copious,
less viscid, partly vesicular, somewhat blood-streaked.
On the left side, the breathing begins to be normal.
During the cough, and at the close of a deep inspiration,
a fine crepitant rattle is heard, scattered over a surface.
Slight distant bellows'-murmur.
On the right side, abundant and very fine crepitans
redux.-Bryonia in solution.



56                 TPNEUMONIA.
May 4.-Skin natural; pulse 60.
Cough rare, saffron-colored, diffuse sputa, somewhat
blood-streaked. Bryonia and Sulphur in alternation.
May 5.-Breathing on the left side normal; on the
right side, the crepitans redux is only heard at the end
of a deep inspiration.-Bryonia in solution; broth.
May 6. —Bryonia, and two broths.-Pulse 56.
May 7.-Bryonia, two spoonfuls; two broths, two
soups. Pulse 52 to 56.
Discharged cured May 17th.
In this case we have to notice the bleeding resorted
to on the first day. The Aconite which was administered
on the second day, seems to have quieted the patient
somewhat. On the third day, Bryonia was given. It
was followed by a striking aggravation, after which the
resolution gradually took place with rapidity; for on
the fifth day, instead of having an exacerbation of the
symptoms, the patient feels well. This compound pneumonia, which was an extensive and serious inflammation,
was terminated happily and speedily. The pulse came
down to 52.
CASE 18. —Pneumonia of the left lung, upper lobe.
Adnet, 29 years old, of the Republican guard, was
admitted May 16th, 1848.
He is strong, sanguine, and has always enjoyed good
health.
Last Saturday, May 14th, he was on duty, exposed
to the rain all morning; about four in the afternoon he
was seized with a chill, vertigo, and a violent pain in
the loins which lasted until 10 o'clock. Then came the
heat, an intense thirst, an intense headache with buzzing in the ears, and a seated pain in the praecordial region, which renders the breathing very difficult. Next
morning he is moreover attacked with a frequent cough
accompanied by serous and vesicular sputa which is
somewhat blood-streakedo



~ 8'~ ~        ~PNEUMONIA.
Cough frequent; easy and copious expectoration of
viscid and rusty sputa, floating in the -midst of a gumlike liquid, which fills the lower part of the vessel.
Dulness of sound in front and behind much lessg
Large masses of unequal crepitation in front, where the
bellows'-murmur is less harsh. The murmur is heard
in the sub-spinal fossaj where it had not been heard before.-Bryoniac 12, two solutions.
May 19. —During the night the patient was restless,
and the cough more frequent, The patient slept from
two to four in the morning, and woke in. perspiration;
he had to be changed three times.
In the morning, Dr. Tessier only felt of his pulse
which was down to 84; the patient says he feels quite
well.- Continue Bryonia 12 and 24.
Copious nose bleed about noon. In the evening the
buzzing ceases. Cough almost gone. The expectorated
substance resembles a solution of gum mixed with vesicular serum.
May 20.-Spent a good night. —Headache almost
gone. Temperature of the skin natural; cough rare
serous, scattering sputa, Pulse 72.
Crepitans redux in front and behind, perceived only
at the end of a deep inspiration. Dulness of sound almost
ceased.-Bryonia in solution.
May 21.-Unequal crepitant rattles scattered over a
surface, at the end of a deep inspiration.  Continue
Bryonia, Pulse 60.
May 22.-Pulse 60. Bryonia, broth.
May 23.-Pulse 48 to 52. Bryonia 24j two broths,
May 24. — Pulse down to 44. -Two broths, a sotlp,
Discharged cured May 27.
This case is conclusive as regards the efficacy of the
treatment. Under the influence of Bryonia, the pulse
came down to 44,



CAStS tRtMINATING IN -RECOtERRt       6a
Tongue dry, covered in the middle with a thin whitish
coating, with red tip and edges. Intense thirst.
Skin warm, moist all over, and a few drops of sweat
on the forehead.
Pulse large, soft, 112 to 116.
The oppression is not very great, the breathing
hurried.
Cough frequent, painful, and followed by difficult expectoration of serous sputa, mixed with air-vesicles and
slightly blood-streaked.
The stitch in the side is very distressing,
He is neither restless nor anxious, and does not feel
very sick.
Percussion yields a rather dull sound below the left
axilla in the space of four fingers'-breadth; and behind,
the dulness is perceived on the same side, in the same
space, in the sub-spinal fossa.
Below the axilla, complete absence of all respiratory
murmuri behind, at the lower part of the scapula, an
abundant crepitation is heard at the end of an inspiration, and a gentle, distant bellows'-murmur at the end
of an expiration. Scarcely any bronchophony in these
two regions;
In every other part of the chest the resonance is
normal and the breathing natural, perhaps a little labored and somewhat harsh under the left clavicle.- 
Two pitcherfuls of sugar and water; two solutions of
Bryonia,
Sept. 1.-Last night, about 6 o'clock, the skin, which
had been moist, became dryj and remained so until
morning.
Night pretty fair; the cough had been distressing
and had kept the patient awake  he would have slept,
if it had not been for the cough.
In the morning the skin was found moist and gently
warm. Pulse soft and large) 112.



64                   PRVNEtM oIA,
Cough frequent; -sputa not very copious, rusty, viscid3
without scarcely any serum of which it consisted almost
entirely before.
Stitch in the side very acute; no dyspnoea properly
speaking. The tubular: murmur is more marked, harsher, spread over a larger surface. The crepitation is
limited to the base of the lung, and is only heard during an attack of cough or a deep inspiration.
No respiratory murmur in the axilla. —Continue the
same treatment,
Sept. 2.-BSame as yesterday, almost. Pulse down to
96; the stitch is less painful and the cough less distressing;i viscid and rusty sputa.  Stethoscopic signs
the same.
Sept. 3.-Slept two or three hours in the night, the
cough being less frequent and less distressing,
In the morning the patient feels quite comfortable.
The face is no longer bloated; the thirst, which, until
now, had been intense, is scarcely felt, Tongue coated
white and moist.
Skin of the temperature of the breath, Pulse soft
and compressible, down to 84.
Cough unfrequent; expectoration easy and copious,
consisting partly of serous and vesicular sputa, partly
of rusty sputa in small quantity.
The stitch in the side is almost gone; it is scarcely
felt during the cough.
Continual dulness in the above mentioned spaces.
Under the axilla, an abundant crepitation is heard,
with unequal vesicles. Behind it is heard from the spine
of the scapula to the base of the lung, being of the same
character. Bronchial respiration is not very distinct
on a level with the sub-spinal depression; it is harsh
and intense only on a level with the bronchial roots,
where bronchophony is likewise distinctly heard, —
Bryonia in solution; water and sugar.



06                  PNEUMONIA.
by fever, nor was the patient obliged to quit work during
the attack.
But at the beginning of spring, and at the close of
fall in every year, the attacks were always worse and the
cough more distressing than at other times; and at these
periods the expectoration was more copious, and a fever
accompanied the attack, obliging the patient to keep his
bed for eight or ten days, at the end of which period his
health became good again, and he was able to return
to his business. The patient had no other treatment
during the attack than diet and herb-teas.
Last April, after having had a cough and fever for
three or four days, as usual in the spring, this fever and
cough became very intense, and the patient raised blood.
A very painful stitch in the side attacked him, and the
patient was treated for this cold on the chest, as it was
termed, by Dr. Belhomme, doubtless with bleeding and
tartar emetic. For about ten days the disease was very
serious; and after the characteristic signs of pneumonia
had been dispersed, his convalescence was still long and
distressing, or, rather, he had never been perfectly restored to health. He lost flesh; his strength decreased
from day to day; a slight fever, with heat, restlessness,
and moisture in the morning, troubled him every night.
His cough never ceased, and distressed the patient more
particularly after a meal, even ever so slight; it came
in paroxysms which terminated in the raising of a
whitish mucus. Every morning, on waking and after
the sweat ceased, the paroxysms of cough lasted longer
and were more distressing than during the remainder of
the day, and he then raised a yellowish matter.
While troubled with this chronic malady, for which
he did not pursue any treatment, and during which he
even pursued his ordinary work as much as he was able,
the cough and fever suddenly became continual, and he
had to go to bed. This was on the fourth of July. The



68                  PNEUMONIA.
or the murmurs, it is harsh behind; bronchial bellows'murmur on both sides, along the inner border of the
scapula, harsh on the right side, less on the left. Subcrepitant rattle abundant, moist at the base of the left
lung during an ordinary inspiration; on the right side,
the crepitation is very fine, and heard only during the
cough. Diffuse bronchophony on both sides.-Bryonia
12 and Carbo veget. 12, in solution,: alternately; water
and sugar.
July 11.-Same as yesterday except the following
modification:
Copious sputa during the night, but viscid and rusty.
Pulse less tense, 100.
Skin less dry: The hands are moist. The face is
covered with sweat.
Stethoscopic signs the same.-Bryonia 12 and 24,
two solutions.
At two o'clock in the afternoon, a slight moisture
broke out all over. At 6 in the evening, the constriction
was much less; the respiration is filller, less hurried;
oppression still very considerable.
July 12.-No sleep. The skin remains moist, but
not much sweat. Three copious diarrheeic stools during
the night.
In the morning, the countenance has a good expression.
Feels comfortable.
Tongue coated white and moist. No thirst. Skin
moist, of a mild temperature. Pulse 68.
The constriction is only felt during the cough and a
deep inspiration.
Respiration still frequent. Dyspncea continues.
Cough rare; scattering sputa like dissolved gum,
mixed with frothy serum. No dulness.
Bronchial murmur scarcely heard behind and on the
left side; sub-crepitant rattle from the sub-spinal depression to the base of the lung. On the right side,



CASES TERMINATING IN RECOVERY.      73
July 14.-Slept and perspired last night. Skin warm
and moist; breathing free. Pulse 76. Cough frequent
and easy; profuse mucous sputa containing air-vesicles.
Bellows'-murmur, crepitans redux; broncho-egophony
at the base of the thorax. Dulness of sound in this
region.-Continue Bryonia.
July 15.-Pulse 60.-Bryonia 12.
July 16.-Pulse 44.-Bryonia.
July 17.-Pulse 40.-Bryonia; an allowance. The
stethoscopic signs disappear. Discharged cured July
21st.
CASE 23.-Pneumonia of the left side.
Baudoin, aged 26 years, of a robust constitution, was
admitted July 14th, 1848, in the ward St. Benjamin,
No. 29.
Last Sunday, July 9th, he was obliged to walk to
Clichy, and was exposed to the rain for two hours. He
had to keep his wet clothes on until late in the evening.
Next morning he rose with a feeling of soreness and
weariness, headache, complete loss of appetite. In the
night following he was restless, had no sleep, and on
Tuesday morning he had not yet left his bed when he
was taken with a violent chill and an acute stitch in the
side, that prevented him from breathing. The remainder of the day he had a violent fever. In the night
following he commenced to cough and complained of
great difficulty of breathing.
July 12.-Fever, frequent cough, sanguineous expectoration, stitch in the side, oppression. He was bled
copiously, and eight leeches were applied to the stitch.
July 13.-Same symptoms. No change of treatment.
July 14.-Came to the hospital, sense of prostration,
lies on the back.
Dull headache; tongue moist and moving about easily;
thirst moderate.
Skin warm and dry; pulse large, 116 to 120. Breath4



74                  PNEVMONIA.
ing frequent and harsh; the patient complains of oppression, and of a stitch opposite the left nipple, that
renders his cough distressing and fatiguing.  Sputa
scattering, of a greenish-red color. Thorax sounds well
in front; dulness in the left posterior portion, and below the left axilla. Intense bellows'-murmur in the subspinal fossa, less intense below, where it is mingled
with abundant mucous rattle.-Bryonia 12, 24, two solutions.
July 15. —No sleep in the night, restless; frequent
cough.
During the remainder of the day the symptoms remain the same as yesterday. The countenance is expressive of prostration. The sputa, which remains of a
greenish-red color and scatters, is less.-Continue
Bryonia.
July 16.-No sleep at night. The cough has become
very frequent, but is less distressing; less oppression;
raised a good deal in the night; the spittoon is filled
with a sputa, that looks the same and scatters as on the
preceding days; it is mixed with a little yellow, vesicular mucus.
Pulse large, soft, 100. Tongue coated white, moist,
moving easily; no headache. Temperature of the skin
almost natural. General moisture.
No stitch in the side during an ordinary inspiration;
it is still felt a little during the cough. Dulness of
sound; mucous rattle throughout the whole extent of
the posterior portion of the thorax. Bellows-murmur
without harshness, and only heard during an expiration.
Continue Bryonia.
Such is the condition of the patient in the morning.
During the day, cough and expectoration continue the
same. The moisture on the skin changes to sweat, and
about noon the patient had to be changed.



CASES TERMINATING IN RECOVERY.       7'At six o'clock in the evening, he says he feels pretty
comfortable.
July 17. —Refreshing sleep from midnight until four
o'clock. The sweating continues.
In the morning the tongue is moist and coated white.
Pulse large, soft, 80 to 84. Skin feels natural.
No dyspncea; cough rare; scanty mucous expectoration, filled with air-vesicles.
Dulness, crepitans redux. Bronchial bellows'-murmur during an expiration. —Continue Bryonia.
In the evening, return of the heavy frontal headache.
Pulse vibratory, rises to 100.-Aconite 12 in solution.
July 18. —Sleepless and restless nights. The patient
had been flighty, and had complained of his headache
all the time.
In the morning, frontal headache; hot skin; pulse
96, undulating; cough and expectoration almost gone;
stethoscopic signs the same as yesterday.-Bryonia 24
and 12, two solutions.
At 8 o'clock in the evening,  had a copious nosebleed.
July 19. —Very good night.
In the morning the patient feels very smart; desires
a broth; pulse down to 64. Skin normal. Mucous expectoration.
Dulness of sound, mingled with a little crepitation
and bronchial murmur. —Diet.  Bryonia 12 in solution.
July 20.-Two broths. Dulness and murmur decrease.
July 21.-The patient leaves his bed. —Two broths,
a soup; discharged cured July 24.
CASE 24. —Pneumonia of the right side.
Togn6, glazier, 42 years old, tall, thin, dry, and with
a constitution shattered by misery and toil, had been
subject since his childhood to temporary indispositions,
which lasted two or three days, and were characterized
by a sense of weariness and a little fever, and yielded



CASES TERMINATING IN RECOVERY.        77
Tongue dry; intense thirst.  Anxiety and slight restlessness.
Skin very hot and dry; pulse 120, rather hard.
Respiration difficult, anxious, intermittent.
Cough almost constant, fatiguing, and giving rise to
a watery, vesicular, blood-streaked expectoration.
Dulness on the right side, below the nipple, in front,
and also behind, below the sub-spinal fossa. Any where
else the thorax yields normal sounds.
In front, low down and on the right side, complete
absence of the respiratory murmur; behind, at the inner
portion of the sub-spinal fossa, a harsh and dry bellows'murmur.
The patient does not exactly complain of a painful
stitch in any particular locality:; -he only complains of
a general painful constriction around the lower part of
the thorax from one side to the other, especially during
the cough.-Two pitcherfuls of sugar and water; Aconite 6, and Bryonia 12 in alternation.
Sept. 19. —Restless night; oppression and- anxiety
worse; delirium has set in, during which the patient
rose twice.-Mustard-plasters to the feet.
In the morning, same as yesterday, except the delirium, which had set in. The face is pale and looks Bsad;
the patient is morose, frighteied.  Sputa more abundant, tougher,,slightly viscid, and entirely bloody. —
Bryonia 12, two solutions.
In the evening,: about 5 o'clock, the delirium and restlessness are still worse. While raising the patient in
bed and placing him in a sitting position, his forehead
becomes covered with a cold sweat and he faints away
for a short time.
Sept. 20.-The restlessness, anxiety and delirium
have- been less violent than the preceding night. The
patient has made no attempt to escape.
In the morning: continued-delirium, the prostration



%82                Pf~NEUMONXIA,
The expectoration, which is scanty, yellow, viscid, resembles apricot-sauce.
Pulse down to 108 to 112, but continues strong and
full.  The dulness which was at first limited to the
lower portion of the thorax, is heard over a larger surface. In the sub-spinal fossa the sound is dull. Tubular murmur without rattle quite low down; fine and
abundant crepitation above, towards the upper portion
of the lung.-Continue Bryonia, and same beverage.
Oct. 1.-'The  sweat and diarrhoea continue.  Red
urine with sediment,
The stitch is less. Dyspnoea more violent; the difficulty of breathing is very distressing to the patient,
The breathing, however, is not any more hurried than
the evening previous.  Pulse 108.  Skin continues
moist.
Complete dulness in the whole of the posterior portion of the right side of the thorax. Fine crepitation
in the super-spinal fossa, and in the space below, harsh
tubular murmur, without rattle.-Two pitcherfuls of
water and sugar. Bryonia and Sulphur 12 in solution, alternately.
Between 7 and 8 o'clock in the evening, a copious
nose-bleed sets in.
In the night, the patient has a few naps and alterhate waking spells. The patient had to get up three
or four times on account of his diarrhoea.
Oct. 2.-Countenance natural, no headache.
Tongue coated white and moist; thirst moderate.
Skin hot; no sweat. Pulse large, soft, 96.
The stitch in the side is only felt during the cough.
Oppression and hurriedness of breathing.
Cough increases in frequency; easy expectoration of
the same color, but less tough, and more vesicular and
transparent.
Dulness of sound the same.



CASES TERMINATING IN RECOVERY.-  83
Tubular murmur less dry and harsh in the sub-spinal
fossa, and below, intermingled with a little scattered
crepitation at the end of an inspiration and during the
cough. On a level with the super-spinal fossa, and especially towards the internal border of the scapula,
bronchial respiration intermingled with moist rattle.
-Two pitcherfuls of water.. and sugar.  Sulphur in
solution.
Oct. 2. —Slept well in the night; had to rise at midnight, on account of the diarrhoea.
Cough rare; scanty expectoration of a serous mucus.
Skin natural. Pulse 64.
Dulness of sound; bronchial murmur only heard
during an expiration.  General crepitation during a
common respiration.-Water and sugar. Bryonia and
ISulphur 12, alternately.
Oct. 4.-Same symptoms: tubular respiration during
an expiration; less crepitans reduxs. Pulse 56 to 60.
Same beverage. Bryonia 24.
Oct. 5.-Pulse 44. Bryonia; two broths.
Oct. 6.-Pulse 44.- Two broths.
Oct. 7.-Gradual disappearance of all the stethoscopic signs. Discharged cured Oct. 14th, 1848.
CASE 26.-Pneumonia of the left side.
Corsin, aged 43 years, rag-picker, had small-pox at
the age of ten years, and served in Africa where he was
for a long time laid up with fever and ague. Since his
return in France he has always felt well. Towards the
end of last August he commenced to complain of malaise and weakness, so that he was unable to work with
the same vigor as previously.  This state lasted for
about a month, during which period he remained without any kind of treatment. On the 21st of September,
after a long walk and a severe fatigue, during which he
had perspired a good deal, he took off his clothes, and
was suddenly attacked by a chill, followed soon after by



CASES TERMINATING IN RECOVERY.        89
Had to be changed three times during the night; the
sweat was cold, according to the patient's statement.
Marked dulness at the summit of the thorax, posteriorly, on the right side; it continues alike as far as the
lower angle of the scapula, and decreases from this point
to the base of the chest.
Auscultation reveals in the supraspinal fossa a bronchial murmur, mingled with a fine crepitant rattle in the
whole upper part of the lung. From the spine of the
scapula to the lower angle of this bone, we have bronchial
bellows'-murmur, bronchophony, and a little crepitation
only around the space where the murmur is most strongly
heard. Low down the murmur disappears gradually.
At the base there is neither murmur nor crepitation.
On the left side the sound is clear, respiration puerile.
-Bryonia 12 in solution, and two pitcherfuls of water
and sugar.
Oct. 20.-Pulse less frequent; skin continues hot and
dry; intense thirst; tongue coated white; mouth sticky,
bitter, urine copious and frequent; icterus the same;
no anguish; oppression is only felt when the patient is
placed in a sitting posture; cough nearly as frequent as
the day before, dry, hacking, short; expectoration of
various kinds, vesicular and ropy, or adhering to the
vessel and light colored, or some of the color of an apricot. No sweat in the night or during the day.
Percussion. —Dulness of sound as yesterday; scarcely perceptible from the lower angle of the scapula downwards. Bronchial bellows'-murmur, and bronchophony in
the supra-spinal fossa, with unequal crepitation; in the
sub-spinal fossa, the bellows'-sound is intense, the bronchophony very loud; unequal large vesicles crepitate over
the whole space of this fossa. Below the lower angle the
respiration is heard easily; it is' louder than in a normal
condition, but without any particular murmurs.-Bryonia 12 and 24, two solutions; beverage the same.



92                  PNEUMONIA.
to church, and then staid home all day. The stitch
grew worse during the walk; the appetite was less;
night pretty good.
Monday morning he attempted to go to his work, but
at eight o'clock he had to lie down again. He felt on
acute pain in the left side of the chest, cough, violent
oppression, heat, intense thirst, and complete loss of
appetite. No expectoration, no chill.
Tuesday, same symptoms. Same nausea and vomiting.
Oct. 25.-Came to the hospital, and showed the
following symptoms:
No headache, no buzzing in the ears or dizziness.
Face red, moist; eyes sparkling; striking depression
of strength and spirits. Lies on his back. The patient
remains in the position in which he is placed. When
sitting' up, he experiences a violent oppression; his
countenance is expressive of suffering, and his speech
is broken and distresses him.
Skin burning hot and dry.
Respiration frequent, labored; violent oppression;
anxiety; pain towards the seventh, eight and ninth left
intercostal spaces, in the middle thereof; the pain is
somewhat aggravated by pressure, but more particularly
by cough and a deep inspiration.
36 inspirations in a minute.
Cough frequent, dry, distressing. No expectoration.
Auscultation reveals dulness of sound in the lower
half of the left lung posteriorly.
Bronchial murmur from the lower portion of the subspinal fossa to the base of the lung, heard only during
an inspiration. During a deep inspiration a crepitation
of small, dry vesicles is heard on the sides of the space
where the bronchial murmur is located.
Loud resonance of the voice to the ear, marked bronchophony.



CASES TERMINATING IN RECOVERY.        93
In the axilla, bronchial murmur is likewise heard, also
a crepitant rattle.
On the right side and behind, the natural inspirations
are rather strong.
In front, neither murmur nor rattle is heard on the
left side.
No dulness of sound.
Pulse large, regular, resisting.  Striking sounds of
the heart.
Pulse 96.
The tongue and gums are covered with whitish pellicles; the velum is free from them. Anorexia, intense
thirst.
No nausea, nor vomiting.. Abdomen a little distended,
painful; no stool since yesterday.
No treatment. Water and sugar.
Previous to his admission in the hospital, ten leeches
had been applied to him.
Oct. 26. —Same as yesterday. Facered and burning;
skin burning and dry. No sleep. Intense dyspnoea.
Speech labored.
Stethoscopic signs the same as yesterday. The bronchophony is more marked; loud resonance of the voice.
Spit up a watery, vesicular mucus three or four.times,
without any streaks of blood.
Pulse 92, inspirations 36.
No treatment. Dr. Valleix hands him over to Dr.
Tessier. —-He was ordered two pitcherfuls of water and
sugar; Bryonia 12, in solution, and also Bryonia 24,
another solution. Diet.
At 6 in the evening, same as in the morning. Pulse
the same. General and local symptoms the same.
At 9 o'clock, another paroxysm  of fever, a little delirium; he gets up. Considerable oppression.
Pulse 116.-This condition continues until midnight.
Oct. 27, —After midnight, the patient had two liquid



CASES TERMINATING IN RECOVER V.        99
vious days; but the greenish color of the sputa is lighter,
and some of the expectoration is of a pale yellow color;
it is equally adhering and tough.
Dulness in the sub-spinal fossa, decreasing towards the
base of the thorax; during an expiration a bellows-murmur is heard in the sub-spinal fossa.; but less intense
than on the preceding days; likewise a crepitant rattle;
a sub-crepitant rattle is heard toward the base, especially
in the neighborhood of the spinal column.
Same treatment..Nov. 24- Pulse 92; cough less intense; the sputa
contains large air-vesicles; it is of a lighter color than
before, preserving however the greenish and pinkish
tinge; a-copious -sweat broke out last night; this morning the temperature is about naturaJ. The stitch extends across the forepart of the chest, and is not very
acute.  Tongue slightly coated white, moist; thirst
moderate; the patient had a scanty stool last night.
Slight dulness in the sub-spinal fossa; at the base
of the chest the sound is slightly obscured.
Bellows'-murmur and crepitation in the sub-spinil
fossa; sub-crepitant rattle at the base.
Much less restless than previously; towards evening,
the patient again became drenched with sweat, which
had a marked acid smell.- Bryonia 12.
Nov. 25.-Pulse 104; cough slight and not frequent;
sputa partly tough, partly vesicular; their greenish
tinge is growing lighter; some of it continues bloodstreaked and of a pink color, and strongly adhering; it
is much less profuse.
The patient has lost his cerebral irritation, and now
feels rather weak in the limbs; has had a good night;
the tongue is a little red; feels somewhat thirsty, and
the skin is rather hot; the stitch has left him.
Dulness of sound in the sub-spinal fossa; otherwise
the sounds are normal all over the chest.



102                 PNEUMONIA.
chest. In the lower half, a sub-crepitant rattle is heard.
Countenance looks better.
Bryonia and Sulphur 12 in solution, alternately.
From 11 o'clock in the forenoon until 3 in the afternoon, the patient suffered a good deal of pain in the
side, with much difficulty of breathing.
Dec. 14. —The patient is much better; he is quieter;
the skin continues warm and moist. Pulse 72; sputa
no longer blood-streaked. The patient had some refreshing sleep; a faint bellows'-murmur continues to be
heard in the sub-spinal fossa.-Bryonia in solution.
Dec. 15.-No sleep last night; no pain, pulse 64. No
oppression; he only shows a little bellows'-murmur and
sub-crepitant rattle on a level with the spine of the scapula. The sputa is mucous and vesicular. Continue
Bryonia.
Dec. 16.-Sputa continues viscid. The murmur has
disappeared, only a sub-crepitant rattle remains on a
level with the spine of the scapula. The patient had
some sleep, feels better; the skin is warm and moist;
pulse 68. Bryonia and Phosphorus in solution, alternately.
Dec. 1T.-Only a little sub-crepitant rattle high up.
Phosphorus in solution.
Dec. 18. —Respiration perfect in the whole extent of
the lungs; pulse 60; the skin continues a little warm;
the patient has an appetite. Bryonia; broth.
Dec. 19.-The patient feels very well; is still unable
to draw a long breath.-Broths, soups, and Phosphorus,
three spoonfuls a day, until Dec. 25.-Respiration perfect; the patient eats a little piece of chicken.
Dec. 29.-Two meals; his strength returns very
speedily; he remains in the ward as a laborer until
January 29th, 1849.
CASE 32. —Pneumonia of the right side.
Ward Sainte-Anne, No. 7. Dore, 72 years old, a
day-servant, admitted Dec. 30th, 1848.



CASES TERMINATING IN RECOVERY.      103
Dec. 24, the patient was attacked with a violent chill,
which lasted two hours; she felt a painful stitch in the
right side, opposite the breast. Soon after a hot fever
set in, with cough, and an expectoration that was not
very clearly described by the patient.
This woman had been in a room without fire during
the extremely cold weather of this season; she remained
in her room until the 7th day, without any attendance.
Had enjoyed good health previously; in spite of her advanced age, this woman had retained a certain degree
of vigor.
Dec. 31.-Dulness of sound in the whole right side
of the chest; bellows'-murmur in the same region. Painful stitch in the side, dyspnoea, fever, cough, bloody
sputa.-Bryonia 12, in the day-time; Bryonia 24 at
night.
January 1st, 1849.-General expression of debility;
dyspnoea; short, frequent, sobbing respiration; flushes
at the malar region, tongue coated blackish, thick, dry;
eyes full of gum.  Intense fever, pulse 92, small.
Yellowish lumpy sputa, with a few streaks of blood.
Acute pain around the right breast. No sleep.
Dulness in the whole right side; auscultation does
reveal any signs; the lung does not perform the act of
respiration; only bronchophonic resonance is heard
when the patient talks. —Bryonia, two solutions.
Jan. 2. —Increased prostration; the patient lies on
her back. Respiration short and slow; speech short
and broken; skin warm; pulse feeble, 92; tongue dry;
fuliginous; acute pains in the side. No sleep.
Stethoscopic signs the same, except a few crepitating
vesicles here and there; in the other parts of the lung,
a marked bellows'-sound.  Not much expectoration;
lumpy, thick sputa, without blood.-Bryonia 12; Phosphorus 12, alternately.
Jan. 3.-General appearance improved; breathing a



104                 PNtUMONIA.
little fuller; the tongue became moist; is less coated.
Slept three hours last night. Pulse up to 100, fuller.
The skin is cooler and moister; the stitch is still very
painful; less prostration; the patient commences to
stir about.
A stool; stethoscopic signs the same.
The patient complains of pains at the sacrum; two
large red patches are discovered at this place, one of
which exhibits two dry black sloughs.-Two broths.
Bryonia 12, Phosphorus 12 in solution, alternately.
Jan. 4. —General condition much better; had a good
sleep last night. The patient feels much more comfortable, raises herself in bed with a certain vigor, talks
and jests. The breathing is less frequent and deeper;
the cough is less; sputa thinner, rather frothy, in short
fragments, blood-streaked. The stitch is not so constant,
and is scarcely felt, except during the cough; skin of the
temperature of the breath; pulse 86.
Crepitans redux at the summit of the lung. —Two
thin soups.-Bryonia 24 and Phosphorus 12 alternately.
Jan. 5.-Sputa in flakes, thinner, frothy, vesicular:
pulse 80; increase of strength.-Continue the medicine.
Jan. 6.-Feels stronger; had some sleep. Skin cool;
pulse 80, tongue moist; appetite; cough less frequent,
sputa vesicular; the respiratory murmur is heard in the
whole right side of the chest, but less distinctly than in
the opposite side. The resonance is restored; the pain
is only felt when coughing, and is then much less than
before; general appearance very good; the two scabs
on the sacrum fall off, the redness is less. The patient
lies alternately on her back and on the side. Two light
soups, milk.-Bryonia and Phosphorus alternately.
Jan. 7.-Gradual improvement; the patient begs for
food.-Same treatment.
Jan. 8.-Long paroxysm of cough in the night; the



106                 PNEUMONIA.
been more exposed, and took a cold which he kept for
about two months, when, in the night of the 24th of
January, he was suddenly taken with a chill followed
by fever. At the same time he felt a pain which first
shifted about in the chest, and finally localized itself
near the left nipple, where it became very acute.'The
cough which had not been very frequent until then,
and gave rise to a mucous expectoration, increased, and
became painful and distressing. Headache, fever. Five
days previous, the patient experienced a feeling of
sickness, which he described as a sense of weariness and
lameness; nevertheless he had worked all day in his
shop on the 23d.
Jan. 29.-Considerable dyspncea; respiration frequent;
speech broken; acute pain in the side which caused a
distortion of the features at every inspiration. This
pain was seated opposite the left nipple, and is aggravated by percussion. Cheeks flushed, violent headache;
hot skin and frequent pulse; frequent cough; viscid,
adhering sputa, of a bright pale-yellow color; some of
the expectoration contains a little blood which is, however,
well mixed up with it. No appetite, dry tongue, coated
a thick yellowish fur; stool natural.
Auscultation of the left side reveals a loud bellows'murmur, specially on starting from the lower angle of
the sternum; resonance of the voice; above, starting
from the superior half of the scapula, a few crepitating
vesicles. Dulness of sound over the whole lower half.
On the right side the sounds are normal; respiration
without any abnormal murmurs, but weaker than in a
state of health; the chest does not dilatefully; the pain
prevents a full dilatation. —Bryonia 12 and 24, two
solutions.
Jan. 30. —This morning, a quantity of sputa of the
color of barley-sugar,- viscid, the'lower part strongly
adhering to the vessel; the other portion the more tena



CASES TERMINATING IN RECOVERY.       107
cious the greater the quantity. Fever, hot skin, pulse
100; same symptoms, same physical signs.
Evening:-The'patient has coughed less than before,
feels a little better, has had several short naps. Skin
covered with perspiration, the shirt is wet. A stool.
No other change.-Bryonia 12 and Phosphorus 12 in
solution, alternately.
Jan. 31.-Profuse sweat all night; the patient had
to be changed once. Sleep, less cough, viscid sputa of
the color of barley-sugar. In the morning, cool skin,
pulse 64, regular, soft; inspirations deeper and easier.
The stitch in the side is much less;- is only felt during
the cough and on percussing the chest, whereas it was
constantly felt previously. The headache is less; the
patient feels better; the general appearance is very
satisfactory, tongue moist. No stool.
The physical signs'are the same, except that the
breathing is fuller, and that on the left side the bellows'murmur, and on the right side a normal respiration
are more distinct.-Continue Bryonia and Phosphorus.
Feb. lst.-Last night the cough was more frequent
than the day previous; three or four times the patient
raised rusty sputa; at other times phlegm. Pulse 60,
warmth like that of the breath, respiration deeper. The
headache is much less; the pain in the side is slight,
and is only felt during the violent paroxysms of cough.
The tongue continues a little dry, the appetite returns.
No more sweat.
The dulness of sound is gone; a little more bellows'murmur on the left, low down.  Respiration feeble,
without any abnormal murmurs.-Bryonia 24.
Feb. 2. —General condition pretty fair; tongue moist,
face natural; the flush is gone, respiration almost normal;
pain in the side very slight. Pulse 60; raises only
mucus.



114                 PNEUMONIA.
tution, of good health generally, regular menstruation,
was taken sick July 10th.
For two days past, she had not felt well, had no appetite, felt tired, had a little diarrhoea, but continued her
work. On the 10th, towards evening, she felt worse,
had. a chill, fever, headache, and from time to time an
acute pain under the right breast; cough set in. Kept
her bed for four days without any treatment.
July 14, she showed the following symptoms: flushed
face, frontal headache, tongue moist with a thin white
coating; intense thirst, loss of appetite; watery sweat
with great heat, pulse soft and large, 95.
Respiration hurried, high'up, constantly interrupted
by frequent and distressing paroxysms of cough; profuse viscid, rusty sputa, of the color of barley-sugar,
over which floats a mucous, vesicular, frothy liquid;
acute pain under the right breast, aggravated by the
cough.
Since her sickness, the patient has had two diarrheeic
stools every day.
No symptoms in the left side of the chest; in the
right side we find: marked dulness in the whole upper
part of the lung; expiratory murmur very distinct;
bronchophony.  Crepitating vesicles high up.-Bryonia 12 in solution.
July 15. —Same symptoms.-Bryonia 12 and 24 two
solutions.
July 16. —Less headache; face less animated; skin
warm, moist; pulse 90, same as above. The stitch is
less constant, aggravated by the cough, which remains
the same. The patient complains of the cough tiring
her; she is unable to sleep; the characteristic sputa is
much less; the expectoration consists almost entirely of
the clear, frothy liquid.
Tongue moist, slightly coated white; one liquid stool
in the twenty-four hours; no pain in the bowels; thirst
moderate; no appetite.



116                 PNEUMONIA.
July 24.-No trace of pneumonia, but long and frequent paroxysms of cough followed by a mucous, clear,
abundant expectoration. This cough fatigues the patient; it breaks out again from the least cause, wakes
her at night. The general condition, however, is good;
no fever, no abnormal murmurs of any consequence.
The appetite is good; the patient recovers her strength.
This cough continued the same until the beginning
of August; it was removed by Belladonna and Aconite.
-Discharged cured, Aug. 8th.
CASE 37.-Pneumonia.
Mallez, aged 36 years, admitted in the ward St. Benjamin, No. 35, August 21st, 1849.
In the month of June last, this patient had been
treated in our hospital for a very severe attack of cholera; after which he resumed his work.
August 16th, he experienced without any assignable
cause, a feeling of illness, anorexia, weariness; Aug.
17, he was taken with a chill, fever, acute pain in the
left side, cough. Kept his bed until the 21st, without
treatment.
We found the following symptoms: Face red, animated; breathing short and frequent; frontal headache; tongue moist and white-coated; intense thirst.
Skin hot and dry; pulse large, soft, 110. Painful
stitch in the side, like neuralgia, located in the seventh
intercostal space, with painful stitches in front and
behind. The pain is so violent that the patient tries
to suppress his cough. Breathing frequent and suppressed; cough comes by paroxysms. Moderate expectoration of viscid sputa of the color of barley-sugar.
Percussion yields a dull sound on the left side, in the
lower portion of the thorax, from the spine to the shoulder blade. On the right side, the sound is normal.
On the left side, auscultation reveals a short bellows'murmur during an expiration, rather distant from the



118                PNEUMONIA.
Thirion, 43 years. Admitted Sept. 6th, 1849, ward
St. Benjamin, No. 9.
Sept. 3d, the patient was employed in unloading a
wagon; two men placed on his shoulder a bag when
one of them let go of his hold, and the bag fell heavily
upon Thirion's shoulder.  At the same moment the
patient experienced a severe pain in the front part of
the chest, opposite the attachment of the pectoral muscles
and the serratus major; nevertheless he carried his load
to the third story, but was obliged to quit work. The
whole of this and the following day, he felt a pain,
malaise; he spit a little blood; he kept quiet without
going to bed.
Sept. 5, in the morning, he was taken with a chill,
followed by fever; he commenced to cough; next day
he came to the hospital with the following symptoms:
Face red, bloated; respiration frequent, marked dyspnoea. Tongue moist, coated white; intense thirst; no
appetite.
Skin warm; pulse large, soft, 115.
The pain was not confined to one spot like a stitch,
but spread over a portion of the front part of the left
lung. The pain is aggravated by the breathing and
coughing.
Expectoration profuse, viscid, resembling a thick solution of gum, which is covered by a little characteristic
blood-streaked, not yet properly mixed sputa.
Dulness of sound all over the left anterior thoracic
region, and a portion of the lateral region.  Every
where'else the sound is normal. Over the same space
a loud and clear bellow's-murmur is heard, especially
during an expiration; it hides in a great measure the
sounds of the heart, which can only be perceived by an
attentive ear and offer no abnormal sign. The murmur
is heard in the whole of the axilla, and left side. Where
the lateral and posterior portions unite, a crepitant



120                 PNEUMONIA.
Sept. 13.-No fever, pulse 60, skin cool; slept some
last night. Cough and expectoration the same.
Crepitation of scattered vesicles. Appetite.-Bryonia.
Sept. 14.-Skin cool. Pulse 56. Raises some mucus; respiration normal. Appetite.-Broths. Bryonia.
Sept. 15.-Pulse 56. Complete convalescence. Appetite. Soups. No redicine.
Sept. 16.-Pulse the same. 17. —Pulse 48. 18.Pulse 46.-An allowance.  19 and 20.-Pulse 46.Discharged Oct. 10.
SECOND SERIES.
CASES OF PNEUMONIA THAT TERMINATED FATALLY.
CASE 39.-Pneumonia.
Roman, 43 years old, painter, was admitted on the
22d of March. Was of a feeble and nervous constitution, but had always enjoyed good health. Since the
revolution of February, being without work and without
means, he had to suffer all sorts of privations, even hunger; to gain a livelihood, he had to work at the embankments of the Champ de Mars. Smarting under
the infliction of his moral sufferings much more than
from his physical misery, he grew weaker from day
to day, until March 17th, when he was attacked with
a feeling of lameness in consequence of having been exposed to the rain all day. Next morning, he woke with
a burning fever, a stitch in the side, and cough without
expectoration. In this state he remained without any
treatment from Saturday to Wednesday, on which day
l.o vas lece':ved at the hospital.



CASES TERMINATING IN DEATH.         123
are of a uniform, bright-red color, which does not disc
appear by washing, in an extent of about two centimeters
on the right, and about three on the- left side. Along
the boundaries of this congestion, these same membranes
present an arborescent appearance of injected vessels,
which gradually becomes less and less, until it disappears in the healthy tissue.  The subjacent cerebral
tissue in the centre of these lesions is injected and
softened at the surface.  Otherwise there is no effusion
either of serum  or pus in these parts, nor is there any
where else in the cavity of the skull.
When I saw this patient for the- first time, on the
morning of the seventh day of the sickness, I looked
upon the suppuration as imminent, or perhaps as having
already set in, and I deemed the patient's life as good as
lost.
On the night before he died, he had been prescribed a
solution of Aconite, and one of Bryonia, which he took
alternately. The Bryonia was continued for thirty-six
hours longer. Its inefficacity having become apparent,
we had recourse to Tartarus-emeticus, and applied a
large blister on the right side. This treatment was likewise without any avail,'andthe patient died on the
twelfth day.
In my opinion this patient would have died under any
treatment. To judge from previous cases, where Bryonia
had had a good effect in spite of the advanced stage and
the intensity of the disease, it seemed to me that this
remedy might likewise prove useful in the present case.
Owing'to the fact that this drug frequently occasions a
momentary'aggravation, which is succeeded by a remission of the symptoms, the medicine was continued next
day. Instead of a remission, the disease continued to
progress towards a fatal termination.  Tartar-emetic
and blisters were resorted to on the same evening. I
discontinued the strictly Hahnemannian treatment be



CASES TERMINATING IN DEATH.         125
was admitted in the ward St. Benjamin, No. 2. He was
60 years old, of a strong constitution, and habitually in
the enjoyment of good health. For the last eight' days
he had been sick. From the commencement of his sickness he had had a violent fever with cough, bloody sputa,
and a painful stitch under the axilla. Not considering
himself very sick, he had not sent for any physician,
and had simply dieted himself, had kept his bed, and
had only commenced last night to take some gum-water,
on account of feeling worse than usual. This is all we
could gather from the incoherent and incomplete answers
that this patient returned to our questions an hour after
his admission.
He was very weak. Face pale, forehead covered with
a clammy sweat; tongue dry, with a blackish coating,
fuligo on the lips and teeth; skin dry and burning;
pulse quick and small.  Breathing embarassed; distressing sense of oppression, especially in the left chest.
Cough not frequent, difficult; sputa scattering, of the
color of prune-juice. To examine the patient, he has to
be supported while sitting up in bed, after which he falls
back like a dead mass. Percussion yields a perfect dulness of sound in the posterior and inferior two-thirds of
the left thorax. Auscultation reveals a bellows'-murmur
in the same region, intermingled with large and humid
mucous rattle, especially at the base, and bronchophony.
-Water and sugar; Bryonia 12; and Carbo-veget. 12,
in solution, alternately.  Large blister behind, in the
region of the lungs.
About 10 o'clock at night, the oppression became
worse; the hands were cold and the nails blue; face
hippocratic, with cold sweat on the forehead and temples.
On the rest of the body the skin was dry and hot; pulse
small and very rapid.
Cough rare; no expectoration; delirium, and next
morning, death.



128                 rNEUMONIA.
do this at a later period after having accumulated all the
facts upon which such a comparison should be based.
Even if I had intended to institute such a comparison,
the data for it do not exist. Most of our statistical
tables are intended to demonstrate the superiority either
of blood-letting, or tartar-emetic, or blisters.  Every
author simply wished to express his predilections or antipathies in numbers.
To compare the two methods satisfactorily,.each ought
to be employed with all its means and resources and all
its conditions of success. Where. do we find a statistical
table of pulmonary inflammations treated in this manner?
Those who treat them well, do not count them.
I shall content myself with calling the attention of the
reader to one point. Might not the cure of my cases
be attributed to a natural tendency inherent in pneumonia to get well, provided the course of the disease
were not interfered with?
At first sight, this objection seems specious. It is the
last refuge of the opposition, and it is incumbent upon
the opponents to prove the truth of our denial. I ask,
therefore, upon what grounds could one claim such constant and brilliant success for the expectant method, in
other words, attribute them to a complete absence of all
treatment, except e few very simple hygienic conditions?
Upon the ground of tradition? But the experience of
the past is uniformly in favor of energetic treatment in
pneumonia, if we wish to avoid fatal terminations. No
sane man will deny that a pneumonia will sometimes get
well of itself. b But this is only an exception which confirms the rule.
Upon the ground of experience?  The expectant
method has not as yet, to my knowledge, any experience
in its favor i'n regard to the treatment of pneumonia.
I have seen some cases where pneumonia was systematically treated by mild means; such as purgatives, gentle



CASES TERMINATING IN DEATH.        129
blisters. &c.; and I have been present at the post-mortem
examinations of a few patients thus treated. I have seen
patie'nSts? who objected to any active treatment; these
patients died almost without an exception, whenever the
dfisease. was  well defined both locally and constitutionally.
ho'-'does' not know these facts?'pon the nature of the disease?  But all authors
consider pneumonia as a parenchymatous inflammation,
which, if left to itself, and frequently in spite of all the
efforts of art, terminates in suppuration or white hepatization, Is the termination in suppuration a fiction?
Is the termination in induration a rare occurrence in our
dissection-rooms?  Are the clinical cases of Lennec,
Andral, Louis, Chomel, lists of mortality that were
drawn up on purpose to frighten patients and physicians?
Upon the treatment? There is no more energetic
treatment than that which is generally puued in pneumonia; venesection after venesection, massive doses of
tartar-emetic, blister after blister. It cannot be said
that such a treatment simply aids the efforts of nature.
We should have to explain in the first place in what way
these repeated bleedings and the tartar-emetic aid
nature, and which of these healing agents acts upon such
vast functional derangements.
The objections drawn from the expectant method are
unworthy of the scientific physician. Is it not evident
that such objections fall with a crushing weight upon all
the various modes of active treatment that htave: been
pursued in pneumonia 2 What! you pretend to say that
pneumonia is curable with pure water, and yet you treat
this disease with bleeding after bleeding, with massive
doses of tartar-emetic which are repeated day after day,
and with blisters which render it impossible for the poor
patient to lie on his bed without pain, and which cause
sores, that cannot be dressed, without inflicting suffering?
Is not this species of medicine, this kind of healing art
the most cruel deception 2 These inferences necessarily



130                 PNEUMONIA.
follow from your assertions that my cases got well without any treatment.
What do the facts which I have related, show?
1. In all my patients the disease: got worse until the
treatment commenced.
2. Immediately after the treatment had.been commenced, an aggravation that was previously expected, set
in for about 24 hours, after which the symptoms decreased either partially or in their totality. From this
moment the disease hastened towards a favorable termination. In some cases the improvement commenced
without any previous aggravation, and continued without
interruption.
3. Bryonia caused a remarkable decrease of the
number of pulsations, from 20 to 30 in one day; and at
the period when resolution commenced, the pulse came
down from 1JN  or 120 to 60, 56 and even 44. In one
case which I have not related, it fell to- 36. I have seen
it come down from 120 to 80 between thee morning- and
evening-visit, and from  120 to 60 between the two
morning-visits.
4. In old persons who had been a whole week without
any treatment, and in whom the termination in induration
(chronic pneumonia) seemed inevitable, this termination
did not take place in a single case. Only the physical
signs of hepatization did not scatter as rapidly as in the
other cases.
5. Suppuration did not set in in a single case where
it did not already exist at the commencement of the
treatment. In some cases it seems to have been arrested
by the treatment; only in a single case it was either not
prevented or not arrested; (the two patients who were
brought to the hospital dying, cannot be counted, in my
judgment.)
I am willing to make every possible allowance for
crises and critical days; I do not say that the homceo



CASES TERMINATING IN DEATH.           131
pathic treatment has such a perfect control over the disease, that its stages cease to be distinctly observable.
But I know very well that, at the critical period, the
crisis may be incomplete or false; I know that suppuration is also a crisis, and that it terminates fatally. I
admit therefore that the homoeopathic treatment does not
remove the crises, but it substitutes successful and complete crises for false and incomplete ones.
If critical periods happened in most of the cases which
I have related, we must not forget that the crisis which
determines the final result, generally takes place nearest
to the period when the treatment was commenced. This
truth is another confirmation of the efficacy of the treatment which we have pursued.
CONCLUSION.
The Hahnemannian treatment of pneumonia seems to
exercise a most happy influence over the symptoms,
course and duration of this disease.
Hence I affirm that this mode of treatment should be
nade a subject of scientific analysis and observation.