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[October 31. . . . . . ...; 273 ||November 7... . . . . . 28o March 1..........|November 30..... 275 || December 5. . . . . . . . 280 April 1...........|December 31......ſ 275 ||January 5. . . . . . . . . . 280 May 1.............January 31........] - 276 ||February 4........] 28o June 1............}February 29...... 273 ||March 7... . . . . . . . . 280 July 1.............|March 31..........] 274 |April 6... . . . . . . . . .] *o August 1..........|April 30...........! 273 |May 7... . . . . . . . . . 280 September 1......|May 31...........! 273 ||June 7... . . . . . . . . . . 280 October 1. . . . . . . . . June 30...........] 273 ||July 7... . . . . . . . . . . . abo November 1......|July 31............! 273 ||August 7... . . . . . . . abo December 1.......|August 31........| 274 ||September 6. . . . . .] abo Important incompatibles. i. Acacia (gurn), with alcohol, tºon, iead-water and n " ral acids. **ch 2 hrnrºº as chir. Les and ºf.-3 ; , , , * *- Alkalics, with acids and with relatively weak salts. ' ' . Antipyrin and antifebrin should be given with alcohol or water only. Arsenic, with tannic acid, salts and oxide of iron and time and magnesia. Bitter infusions and tinctures, with salts of iron and lead. Bromides, with acids, acid salts, or alkalies. Calomel, with alkalies, lime-water, salts of iron and lead, and iodide of potassium. Caraphor (spirit of), with water. Carbonates, with acids and acid salts. Chlorides, with silver salts, lead salts, and alkalies. Chloroform (except in minute quantity), with water. Cerrosive sublimate, with alkalies, lime-water, salts of iron and lead, iodide of potassium, albumen, gelatine and vegetable astringents. (It may, however, be advantageously combined with the tincture of the chloritie of iron and the liq. acidi arseniosi of the new Pharmacopoeia, or, in spite of the chemical reaction, with iodide of potassium, as in the famors Gilbert's syrup.) Digitalis, with iron and preparations containing tannic acid. , Iron (salts), with anything containing tannic acid. Tincture of the chlo- ride of iron, with alkalies, carbonates, mucilages, and preparations contain- ing tannic acid. Mucilages, with acids, iron salts, and alcohol. Potassium (iodide of), with all strong acids and acid salts. (See Cere rosive Sublimate.) Spirit of nitrous ether, with sulphate of iron, tincture of guaiacum, and most carbonates. Vegetable preparations holding tannic acid, with salts of iron and lead. Alkaloids are precipitated or destroyed by tannic acid, alkalies, and chlorinous compounds. The Hypophosphites Comp. (Lime and Soda} with Liq. Arsenii et Hydrarg Iodidi, Liq. Potasai Arsenitis, Hydrarg Chlor. Corros., Silver Salts, Soluble Sulphates and Carbonates, Tinct. Ferri Chlor. SF E. Acids (mineral), * h alkalies and relatively wea' sales of other acidº... - ** This Obstetric “Ready Reckoner” consists of two coiumns, ºne of Cal- endar, the other of Lunar months, and may be read as follows : A patient has ceased to menstruate on the first of July; her confinement may be ex- pected at socnest about 31st of March (The end of nine Calendar months), or at latest on the 6th of April (the end of ten Lunar months). Another has ceased to menstruate on the 20th cf January ; her confinement may be expected on the 30th of September, plus ao days (the end of nine Calendar. months), at soonest, or on the 7th of October, plus ao days (the end of ten . Lunar months), at latest. s t Troy or Apothecaries’ Weight. so grains (gr.) - 1 scruple (9) - 20 grain; 3 . = 1 drachm (3} = 6o º 8 d dachma * 5 ounce f {} = 489 * , ~ *::= - --> ------—- . . s ridiand ****, * * **** º • wine, or Apothecaries’ Measurie. 60 minims (m) 8 fluidrachms. (fildr.) I fluidrachm. I fluidounce. 16 fluidounces (floz.) 1 pint. a pints (O) I quart. * 1 gallon (Cong.)= 4 quarts } 231 cubic inches. A miniºn equals a drop of water, but varies in different liquids." See in U. S. Dispensatory table exhibiting the number of drops in fluidrachms of different liguida. The Metric System. Comparison of English with Metrio Weights and Measures. WEIGHTS. 1 gramme 15% grains, aearly. 1 kilogramme = 35 oz. Iao grains. 1 grain IG .oë48 gramme. 1 CME, * 28.3495 grammes. I lb. = 453-5825 66 A teaspoon holds about 5 cubic centimeters. A tablespoon about zo cubic centimeters. A Troy ounce equals about 30 grams, and an eight- ounce bottle holds about a 40 cubic centimeters, NY Me ARTHUR's. ////6.2 ////4T * | A CHART OF m"-- i –A- - “. . . . . . . 2 ( . t ~ -- Diseases of the Lungs, Pleurae, Bronchi, Trachea and Laimº-{ PUBLISHED BY THE McARTHUR HYPOPHOSPHITE CO. ANSONIA, CONN. = (Copyright, 1901, by The McArthur Hypophosphite Co.) | A COPY OF THIS CHART WILL BE MAILED FREE TO ANY PHYSICIAN, UFON APPLICATION TO THE McARTHUR HYPOPHOSFHITE CO., ANSONIA, CONN. * NAME. CAUSES AND OCCURRENCES. INSPECTION. PALPATION. PERCUSSION. ACTIVE CONG ES- TION OF LUNGS. Over-action of heart, violent exertion, inhalation of irritants, extreme heat or cold, alcohol. Respiration more frequent than normal ; often collateral edema. Increased tactile fremitus. Slightly defective resonance; |rarely dullness. PASSIVE CONGES- TION OF LUNGS. (Mechanical, Hy- postatic.) Cardiac valvular disease and dilation of right ventricle; tumor pressure, cerebral injury, low fevers, and other adynamic States. More or less venous congestion and cyanosis; old persons begin to sleep with mouth open in incipient hypostatic congestion. - Increased tactile fremitus over lower lobes. Slight dullness at bases (right particularly) in hypostatic form. EDEMA OF LUN G.S. Congestion or inflammation of lungs, new growths, infarcts, tubercles, emphysema, chronic renal, hemic or cardiac disease, cachexias, cerebral injury. Orthopnea, cyanosis; rapid, noisy breathing with inspiratory retraction of base of chest; often dropsy elsewhere. Vocal and tussile fremitus may be present; extremities cool. Defective resonance at bases posteriorly; front of chest hyper- resonant. - - LOBAR PNEUMONIA. Infection by diplococcus pneumonia. Old age, over-work, debility, alcoholism, trauma, typhoid, measles, influenza, bronchitis, dia- betes, tuberculosis, ether anesthesia, chronic visceral disease, cold and weather changes and previous attacks predispose. All ages, but usually 20 to 40; four times as frequent in men as women. Left or right lower lobe commonly. Sudden onset (insidious in aged); ends by crisis in 5 to 9 days. Anxious expression, bright eye, dilated alae nasi, labial herpes, pale face, or cyanosed with mahogany flush on cheeks; breathing hurried (30 to 60), but regular and noiseless, usually abdominal (wavy in grave cases); deficient expansion on affected side— posture often on this side, tongue dry and thickly Coated; early jaundice common. Lack of respiratory expansion Over area involved; vocal and tac- tile fremitus increased on consoli- dated side (absent if pleurisy or bronchorrhea, or main bronchus oc- cluded); sometimes pleural friction fremitus; may be deep-seated, ten- derness on pressure; dry, burning skin followed by profuse critical Sweats. - Sharply defined woody dullness (rarely tympanitic over upper lobe) by second or third day over consol- idation (most marked posteriorly); Skodaic (high - pitched tympany) or cracked-pot sound in stages of engorgement and resolution and above hepatized area. BRONCHO-PNEU- MONIA. |Capillary Bronchitis.) Extension of bronchitis — pneumococci or mixed infection. Infectious fevers (espe- cially measles), pertussis, scarlatina and diphtheria, aspiration of food and drinks, tuberculosis, rickets and diarrhea, predis- pose. Most frequent in aged persons and children under 5. Bilateral. Gradual onset; often lasts for weeks, ending by lysis; relap- S1 VG. Rapid, shallow and difficult breathing (maybe 60 to 80 per minute), with grunting expiration; anxious, distressed countenance and dilating alae nasi; gradually increasing cyanosis, with inspira- tory retraction of base of sternum and lower costal cartilages. Increased vocal fremitus if large area involved; skin surface hot, covered later with clammy perspi- ration. Resonance not impaired for forty- eight hours, and then not marked (unless collapse of lung), or may be semity mpanitic; changes most marked in lower lobes posteriorly; patches of impaired resonance more sharply localized than in edema; compensatory emphysema of upper lobes. ACUTE PN E U - MONIC PHT HISIS. Infection by tubercle bacilli or spores through inhalation, or by blood-vessels from focus in body, glands or joints. Most com- mon in Women and young girls. Pallor and rapid wasting, hectic flush, hunted expression, quivering nostril, wide-open eye, fre- quent respiration, deficient expansion, and sinking in at apex. • Dryness of hair and skin; in- creased fremitus over one lobe or lung. • ‘ upper) or lung; later may be gaver- nous or amphoric resonaneč. ACUTE BRONCHO- PNEU MONIC PHTHISIS. Tubercular infection. In children com- monly follows infectious diseases, measles, pertussis. f \ * y * Frequent respiration; may be apical retraction and impaired expansion. l JDry, brittle hair and skin; dif- fused sweats. ſº . ~! - - - f * Areas of impaired resonance, usu- ally atºex. , - - - ——ſ. ---, MILIARY BERCULOSIS OF L UN G.S. -º- º } Autoinfection from pre-existing tubercu- lar focus. All exhausting diseases (measles, pertussis) predispose. DIFF USE CHRON- IC INTERSTI- TIAL PNEU MO- NIA. Acute lobar pneumonia, acute broncho- pneumonia, chronic dry pleurisy, congenital syphilis. FIBROID PHTHI- SIS. Clinically identical with above, plus tuber- cle bacilli. CHRONIC ULCER- ATIVE PHTHISIS. Infection with tubercle bacilli. Heredity, dyspepsia, anemia, bronchitis, pleurisy, and all exhausting conditions predispose. Most common in thin, tall people, with winged Scapulac and long, narrow chests, flattened from front to back, and sloping ribs. EHurried respiration (maybe 50 or 60 in adults); cyanosis generally marked, choroidal tubercles rarely seen. - ! Fine, soft rubbing ; spleen en- larged in very acute cases. May be defective resonance at bases in children. - Affected side more or less immobile and grad- ually shrunken; intercostal spaces obliterated, heart drawn over to affected side; spinal curvature; shoulder drawn down. º Increased vocal fremitus over affected area unless masked by retraction and pleuritic complica- tions; apex beat displaced toward affected area. May be persistent absolute dull- ness, with woody resistance at base or apex; flat tympany or amphoric sound over sacculated bronchus; hyper-resonance on sound side. Depression above or below one clavicle with defi- cient expansion at corresponding apex; may be local Superficial engorgement; often wide area of cardiac impulse; short breathing, confined mainly to lower third of chest, retracted belly wall; wide- open eye (recurrent unequal mydriasis an early sign), quivering nostrils and hectic flush, general flushing on slight excitement, chloasma and pity- riasis versicolor; red line around border of gum, multiple ulcers of tongue; clubbed finger-ends with incurved cracked nails in very chronic cases. Fluoroscopy shows early diminution in apical transparency, enlarged bronchial glands, local opac- ity from pleural thickening, and restriction of diaphragm motions. . Local defective expansion, usu- ally apical; tactile fremitus may be increased, particularly in later stages, with cavity formation — unless pleura also much thickened; sometimes rhonchal fremitus; often soreness to touch over diseased parts; swelling of cervical lymph glands; skin and hair often dry, Warm and harsh. IEarly impairment of resonance beneath and above one clavicle (rarely in lower lobes), especially after full inspiration; may be tym- panitic if consolidation around bronchus or near trachea; amphoric or cracked-pot sound over large thin-walled cavities (usually higher and louder when mouth open — dullness over cavity filled with fluid); tubular or tympanitic in recent caseous pneumonia; woody dullness with chronic extensive fibroid change ; flatness over insid- ious pleural effusions. ACUTE AN ID SU B- ACUTE BRON- CHITIS. “‘Catching cold,” influenza, measles, ty- phoid, whooping-cough, asthma, tubercu- losis, cardiac lesions, thoracic aneurysm, nephritis, malaria, secondary syphilis, dia- betes, gout, rheumatism. May be rapid breathing, especially if fever high. Rhonchal fremitus with thin chest walls or much secretion. Clear resonance unless complica- tions; dullness over collapsed areas; hyper-resonance if emphysematous. CHRONIC BRON- CY } ITIS. Chronic pulmonary, cardiac or renal dis- ease, dust and smoke, exanthems, gout and rheumatism. Winter cough common in aged. Chest usually distended and movements limited. Diminished vocal fremitus if em- physema. Clearness may be impaired slightly and temporarily by exces- sive secretion; may be hyper-res- onance if emphysema. THE WALUE OF HYPDPHOSPHITES IN TREATING CONSUMPTION. Barella (Le Scalpel, Deçember, 1899) observes that there is not a single French or foreign medical journal that has not published cases conclusive as to the therapeutical value ºf ;the flyºophosphites in every stage of consumption. Many of these cases are from reports of public hospitals. In the present state of science no physician of experience will deny that such treatment produces remarkable, sometimes almost immediate beneficial effects in many instances. This is true in spite of the fact that consumption is quite generally regarded as incurable, and is known to be the direct or indirect cause of the death of one-third Dullness over one lobe (usually- _ " NAME. cAUSEs AND occuRRENCEs. INSPECTION. PALPATION. - PERCUSSION. FIBRINO US OR PLASTIC BRON- CHITIS. Cause unknown (rarely diphtheria). Usu- ally in males, 20 to 40, during Spring. Chronic form recurrent; usually follows or- dinary bronchitis. May be deficient expansion or retraction of chest wall in affected area; cyanosis in severe attacks. May be fremitus on affected side. Sometimes localized dullness over collapsed portion of lung; oft- en compensatory emphysema. BRONCHIECTASIs. Chronic bronchitis, emphysema, phthisis, catarrhal and interstitial pneumonia, chronic pleurisy, congenital atelectasis, foreign bod- ies in or external pressure on air tubes. Cyl- indrical or sacculated. Contracted rigid side, if extensive sacculation; cyanosis on exertion; clubbed finger-tips and in- curved nails in advanced cases. Vocal fremitus sometimes sup- pressed, but generally increased; may be rhonchal fremitus. Cavernous, cracked-pot or am- phoric, or limited area of impaired resonance if filled with secretions — usually in lower or middle part of one lung (right as a rule). BRONCHIAL ASTHMA. Neurotic heredity; nasal, gastro-intestinal, renal or genital reflexes; dust, pollen, animal odors, emotions. Usually in adults. Attacks sudden and rapid. Face pale, staring and anxious, or dusky and covered with sweat during paroxysms; thorax looks enlarged, barrel-shaped and fixed; diaphragm moves but slightly, with retraction of intercostal Spaces and epigastrium. IRhonchal fremitus sometimes present; vocal fremitus diminished or obscured; apex beat diffused and heart laboring; impulse may be in epigastrium; body surface cold and moist. Sometimes marked hyper-reso- nance, especially in chronic cases, extending over cardiac space and lower than normal. - STENOSIS OF MAIN BRON- CHUS. TRACHEAL STEN- OSIS. Cicatricial contraction of ulcer (usually syphilitic), sclerosis of bronchial sheath, ma- lignant growths; pressure by enlarged glands, tumors, hydatics or aneurysm. Impaired mobility, followed by shrinking of affected side. - Vocal fremitus lessened on af- fected side, with marked thrill of thoracic wall. Becomes less resonant, and usu- ally higher pitched over affected lung; dull if secondary atelectasis. Goitre, thoracic aneurysm, mediastinal tumor, new growths or foreign bodies in trachea. - Long drawn inspiration and expiration; very slight motion of trachea; epigastric retraction; laryngoscopy. Vocal fremitus more or less di- minished. - Clear pulmonary resonance. ENLARGED BRON- CHIAL, GLANDS. Tuberculosis (infants and children), malig- nant growths (old age), syphilis (middle age). ty’ May be emaciation, hectic flush, or cyanosis; deficient expansion on affected side; patients com- monly under size and profoundly anemic. - Occasionally interscapular ten- derness near fourth or fifth rib. Dullness over glands if much enlarged; unilateral dullness from occlusion of main bronchus caus- ing atelectasis. PERTUSSIS. EMPHYSEMA, -ºf .*-- Infectious epidemic, directly contagious, most common from two to six; measles pre- disposes; begins like ordinary bronchial cold, becoming paroxysmal in a week or so. In paroxysmal stage, face and eyelids dusky, Swollen, puffy; injected, protruding eyeballs; ex- pression of terror during coughing fits; wasting, 3b110]]]]&l. - Negative unless from complica- tions. - Depends upon complications. Chronic bronchitis; violent straining of lungs, as in whooping cough, asthma, heavy lifting, or in glass-blowers, blacksmiths and Jplayers of wind instruments; harrowing-of air pāşşâgés by new growths; heredity pre- disposes. Vesicular (hypertrophic, compen- satory, atrophic or senile) or interstitial. Extreme cyanosis, even while patient is able to get about; face swollen, eyes bulging, shoulders rounded; uniform bulging (local bulging in com- pensatory; contraſted and flattened chest in atrophic); barrel-shaped chest; respiration slow, with forced expiration, mainly abdominal (chest elevated ratsier than expanded); inspiratory reirac- tion Oi 30ft parts; expiratory bulging; transverse curve across abdomen at twelfth rib; wide inter- costal spaces, marked epigastric pulsation; dila- bed, sometimes pulsating, cervical veins; marked prominence of accessory respiratory muscles; clubbed finger-tips; anxious facies. * Vocal fremitus usually feeble epigastrium; marked shock – in lºwer sternal region; enlargement and displacement downward of liver and spleen; dry, harsh skin; neck in interlobular form. (absent in subcutaneous); apex beat weakened and at ensiform or yielding crepitation under skin of Gradually gº tending druń-like hyper-resonance (reach lower than normal); cardiac dull- ness commonly obliterated. PNEUMOCONI- OSES. Continuous exposure to coal-dust (anthra- cosis), soot, lampblack, stone dust (chalico- sis), working in iron grinders (siderosis), brass, bronze, clay (kaolinosis), flax, cotton or grain (millers). Like emphysema and chronic bronchitis. Like emphysema and chronic bronchitis. Hyper-resonance of emphysema. PULMONARY AB- SCESS. Always secondary: Prieumonia, infectious embolism (septicopyemia), empyema, trauma, chronic phthisis (cold abscess in struma), aspirated discharges, perforating abscess of liver. t Quickened and shallow respiration; chest wall sometimes depressed; may bulge during cough; may be pallor and emaciation. Fremitus decreased at first—in- creased over large, superficial, free- ly communicating cavity. Localized dullness (except in embolic form), giving place later to tympany if cavity large (generally in upper part of lung). }*ULMONARY GAN- GRENE. Pneumonia, bronchiectasis, abscess, em- physema, tubercular cavities, foreign bodies, pulmonary embolism, mediastinal growths, aneurysm, esophageal diverticulum, pyemia, exhausting fevers. • . & Very pale face; chest aspect varies with cause; great wasting. & i Fremitus generally increased un- "|less pleura involved. Dullness or cracked-pot sound, if extensive destruction of tissue (generally in lower part of lung). PULMONARY AP- OPLEXY. Embolism or ruptured aneurysm of pul- monary artery or branches; usually depend- ent on heart disease, phlebitis, septicopyemia Or trauma. Cyanosis; may be retraction of chest walls. Increased vocal fremitus, sharply localized; limbs cool, often clam- my. Circumscribed area of moderate dullness arising suddenly, usually in lower lobe; rarely exaggerated I'êSOIla,D.C.C. * PULMIONARY COLLAPSE, OR ATELECTASIS. Capillary bronchitis; pressure on or stric- ture of bronchus, foreign bodies, pleuritic effusions, pneumothorax, exhausting condi- tions generally; congenital form from inhala- tion of mucus or meconium. Suddenly hurried and shallow breathing, with inspiratory retraction over affected area (usually lower chest); pallor, with livid lips; emaciation. Tactile fremitus variable, but generally increased; skin cool. Slight, limited dullness, most marked below scapula; usually symmetric; may be changed during respiratory percussion; surround- ing hyper-resonance; cardiac dull- ness extended to right. PLEURAL AND PULMonARY NEOPLASM.S. Encephaloid, Scirrhus, epithelioma, sarco- ma, enchondroma, colloid, Osteoma, hydatid Generally secondary and bilateral Slow and in- cysts. (primary usually unilateral). sidious development. Irregular distention or retraction of one side of thorax, with immobility and obliteration of inter- costal spaces by circumscribed edema; often, liv- idity of face and upper extremities, and dilated cervical veins, anemia and emaciation. Lymph glands (especially clavic- ular) enlarged and indurated on affected side; tactile fremitus ab- sent over growth (diminished in cyst, with fluctuation); sweats and higher surface temperature on one side. Complete circumscribed dullness Over tumor (usually upper or mid- dle lung) the rule, with loss of elasticity, close to zones of reso- nance (Skodaic over clavicle and part of sternum). MEDIASTINAL TUM(ORS. Cancer (after middle life), sarcoma (before middle life), lymphoma (young persons), fib- roma, dermoid and hydatid cysts. Duration of growths, usually six to eighteen months. Rapid respiration; may be bulging or erosion of ribs or sternum; congestion of superficial mam- mary and epigastric veins; edema of arm; slightly staring and anxious countenance; dilated or con- tracted or unequal pupils; cyanosis and flushing of skin of face and neck, followed by brawny edema; finger-tips may be clubbed; one or both sides of chest may not move in respiration. Heart impulse may be obscured or out of place; absence of fremi- tus over tumor touching wall; may pulsate much like aneurysm, but usually without forcible expansive heaving or diastolic shock; en- larged glands in axilla or root of neck. - - -º-º- Extensive area, often irregular and varying, of dullness over tumor, markedly resistant, and not chang- ing with position—behind, and on each side of sternum in anterior mediastinal—if posterior, may be roundish or oval dull area, in in- terscapular region. Since their introducting...the Hypophosphites have firmly maintained their hold on professionäränd:#6pulàr confidence, and to-day are prescribed alone and in combination by more physicians than any other remedy. This is strong testimony to their superior worth, because of their fine tonic and constructive properties, which have been, and will continue to be, a means of relief and bilaveral t ... W AUSCULTATION. COUGH. PAIN. DYSPNEA. EXPECTORATION. VOICE. MISCELLANEOUS. ~ * tion at º … . . . . . Feeble, usually bilateral, broncho-vesicular Moderate. In side. Proportionate *...**** sudden onset, with initial chill; * *'. } . - with acceleration. Frothy, bloody. hurried. ‘e grº * * * * * * O O breathing — sometimes bronchial with fine rales. of breathing. temperature 101° to 103°. g. Feeble or blowing murmur with crepitant rales * e -> Most marked - e e ..] Oft, en-l. Pulse frequent and feeble; no (basic in hypostatic form); sometimes bronchial º, . ad Slight, if any. subjective feature biºiº 70,777, O7 rejºi fever unless associated inflamma. breathing with liquid bubbling rales. ges. of disease. 5 o tion. - º e • * e - Always present - Fine bubbling, Jouble rales at bases (especially • r * ~ * º e 'l Abwndant, thin, watery lse rapi º «U J - posteriorly); feeble or suppressed vesicular mur. e."*. Depends on pri- . frothy; may be "tenacious Varies with * ºl. #º mur—broncho-vesicular or bronchial if extensive; arv disease p mary cause. CI’e º §. . * and pinkish (from conges-|cause. more or less collapse } second pulmonic sound accentuated. y º disease primary tion) in acute. * tº - * Abrupt, primary onset, with dis. Inspiratory crepitant rales followed in a few hours Scanty, glairy, viscid, be- tinct chill in adults, and vomiting by typical bronchial breathing (provided large - coming blood-tinged rusty or convulsions in children; fever bronchi are patulous), and later in stage of reso- U. m . lateral- sputum within twenty-four rises quickly to 104° to 105°, fall. lution, all sizes of moist rales; inspiration short Short, dry, pain- usually at nipple| Respiration pant-hours; more copious and ing by crisis in five to nine days; and suppressed expiration grunting: ironchophonyful and restrained. axilla, often ag-ling and frequent, liquid during resolution; Hurried pulse full and bounding (100 to (most marked at lower level dullness) in second at first; may be ab- onizing and aggra-|but really less dysp-purulent or like prune juiceland feeble||120), becoming weaker; pulse res- Statre : pectoriloquy or egophony above hepatized sent in old people. wated by cough or nea than in bron-in low types; grass-green in speech. piration ratto two to one or less; area: } exaggerated vesicular murmur in normal deep inspiration;|cho-pneumonia. Subacute; sputum some- leucocytosis (absent in grave p ortions of lun g; second pulmonary sound accen- diffuse Soreness. times absent in children and cases), Severe headache, delirium tuated in sthenic type old people; microscope (cerebral symptoms may be marked º shows pneumococci. in children and drunkards); chlo- ** 7°ides in wrime diminished or absent. Lengthened harsh, jerky, grunting expiration; • * e • * ~~~~ * => diffuse or basic vesiculo bronchial breathing (apical E[ard and dis- º, º }..."...'...º.º.º.ºing sº i.;;... Mucoid, mugopurulent, speechsweats, ending by lysis (persists in cases, by large mucous rales); undefined mucous clicks on forced inspiration; maybe patches of tubular breathing; increased vocal resonance; sharply localized signs of exudation in tubercular C3,S6S. pressed and muf- fled if pain), subsid- ing with carbon di- oxide narcosis. Pleuritic pain Often associated. prominent (dilating nostrils) but less apparent toward fatal end. glairy and viscid; may be streaked with blood; ceases with failing strength. short if asso- ciated pain. tubercular); weak, rapid pulse; drowsiness or restlessness; deliri, um, coma or convulsions toward fatal end; signs of bronchitis pre- dominate over those of pneumonia. Murmur feeble or suppressed, then bronchial; crepitant, mucous, cavernous or amphoric sounds; In side. May become ex- treme with exacer- bations. Scanty, mucoid, thenrusty, mucopurulent or purulent; tubercle bacilli; elastic tissue; may be hemoptysis. Abrupt onset, with chill and re- mittent fever and frequent pulse; grows worse at wswal time of crisis; may be hectic sweats; no leucocy- tosis. distinct pectoriloquy in advanced cases, first per- Short. ceptible at angle of Scapula. - Breath sounds harsh or tubular, with many sub- Usually severe Often pleuritic. Fre q u e n tº ly marked to w a r d Purulent, blood-stained, nummular; elastic tissue and High, irregular fever, frequent pulse, rapid emaciation; may be chills and profuse sweats or ty- ‘epitäht-Pales, ma . . . . . . . . . . . . . and paroxysmal. i ll: • * ~ *- º t *IT ~~~ - - - f end. * hºmoptysis, **º- - phoid State. º • 3 l . . * w • n-ovº. 3 * * • 2noon ºf Mucopurulent; occasion- Repeated chills, fever (102° to J) iſ use, sibilºn; or ongºon; ºne or crepiº Marked, often Usually marked Veru prominent ally rusty; may contain tu- 103°); very rapid, feeble, irreguſal tant rales; subpleural tubercle friction murmur, history of previous in . from owtSet without bercle bacilli; rarely hemop puise; profuse sweats; often vomit. X * † ºn f \ it tº ºn he tº ~34-3 e º ; I cult - finer and softer than pleuritic. Cough. apparent cause. tysis. ing at Onset. } - - Usually copious, muco- © 1 - Cavernous or amphoric breathing at apex — e * te * * **** e Very gradual emaciation and loss blowing or feeble (even suppressed), with bubbling Chronic, parox- º ...sº .*. º; etſi º of strength; slight, continuous * ºn I ºn - - - e * tº • Al *- º e º } * e } - • Atº ** © - º: ºy bronchophony; cardiac mur-ysmal. cially on exertion. Isis common; Charcot–Ley- . or none; pulse 100 or up Ill Ull lºll,C IIl Cil S@: US 62. den crystals. e e Farly dry and - hacking (noticed on Barly slight fever in afternoon, Signs w8wally apical at first; early feeble (or going to bed, or Slight or absent at first; or following eacertion; later contin- harsh and rude), higher pitched breath Sounds, withs light morning frothy, mucoid and homoge: uous, remittent or intermittent (fre- prolonged expiration ; jerky or wavy cog-wheel hawking and clear- neous (viscid, gelatinous if quently subnormal mornings); early rhythm on deep inspiration; vesiculo-bronchial,ing of throat), be- much pneumonic disturb- amorea'id; gradually increasing de- then whiffing and bronchial breathing with con-coming paroxys: ance), becoming more copi- bility and loss of weight ; pulse fre- solidation; localized subcrepitant, sibilant, and mal, looser and Sharp stabbing Dyspnea not usu- ous, opaque, and purulent, Ho a r S e- quent and soft, but full; chloroan- clicking rales, becoming bubbling and gurgling, blowing, tubular, cavernows or amphoric — rarely metallic tinkling; bronchophony and whispered peetoriloquy over deposits and cavities; pleuritic friction sounds; often early diffuse cardio-respira- tory whiffing systolic bruit (heard best during in- spiration); pulmonary and subclavian systolic mur- murs common; second pulmonic sound accentu- ated; heart sounds heard at posterior apex with undue distinctness. more constant; dis- tressing at night, and on rising in the morning (from accumulated spu- tum) in advanced stage; most marked when lying on af- fected side in early stage — on sound side in advanced stage. felt near nipple; or constant, persist- ent, indistinct sore- ness and aching about apex. ally prominent un- til very advanced Stage; gradually increasing hyper- prlea. greenish yellow, nummular, often blood-tinged, and with Sweetish stench; most abun- dant on rising ; hemoptysis Common, often early; cheesy particles contain twbercle ba- cilli, elastic tissue and cocci (mixed infection), and many red corpuscles. ness or aph- onia when larynx af- fected. emia, early vasomotor disturbances (chilly sensations and flashes of heat), venous and capillary pulsa- tion; drenching sweats at night, or during sleep (most marked after cavity formation), late, obstinate diarrhea; often albuminuria; pe- culiar hopefulness; rarely Cursch- mann's spirals in sputum; eosino- phile cells in Sputum of favorable import. Harsh broncho - vesicular breathing; bilateral, diffused, piping, somorows or sibilant ratles, shifting and affected by couſ/himſ/, becoming mucows and bub- bling; double subcrepitant rales if finer bronchi involved; breathing suppressed over collapsed 2, l’ 623.S. P (t ) 0 a y s m a l, rowſ/h, ringing, hard, cutting, Sore — dry at first, becoming loose in a few days. Tight oppression and rawness be- neath sternum; pains in bones and back, and along diaphragm, aggra- vated by coughing. Marked only when smaller tubes involved, and in infants, aged and feeble. Clear, frothy at first, abun- dant in a few days, muco- purulent, then purulent, with lumps of dried mucus; Sometimes streaked with blood. Deepened, sometimes hu sky or suppressed. Coryza, tickling in throat, lassi- tude, creeping chills, fever (101° to 103°) in severe or complicated cases; sometimes Charcot - Leyden and fatty acid crystals in sputum. S h or t n e s s of May be absent, but usually abundant; watery in bron- * , e. º Variable spells º g More Ol' - Expiration prolonged and feel)le or wheezing, * Q \{y r : Post-sternal sore-breath, especially chorrhea serosa; fetid, gray- • º * tº e with diffuse, bilateral, piping and snoring rhonchi º . ness provoked by on exertion; op|ish white (ittle yellow|ºd º: aft ºnaciation or moist rales of all sizes (often crepitant at bases). SOme at º ght cough. pression under plugs) in putrid; sparse,...}. d T I Iſl.- y ºl. V-P. L. e. S C 8-- - - Sternum. tough, grayish in cardiac palred. form. of the adult population. The benefit of treatment with hypophosphites is always B. Syrup of Hypophosphites Comp. (McArthur)... . . . Oi greater in proportion as the disease is less advanced. Tinct. Gentian............ • e e s e g a e e º e º e a e º e º e s e e s e º 'º 3 iſ In this country, physicians have found the following a most agreeable and M. effective mode of administering a pure, bitter tonic in the earlier stages of con- Sig. One dessertspoonfu; before eagh: dºgly - - - , , ~ ; ; , T: – 7 S. - meal in a little wakers :::: sumption ... — 2: ; ; } ºf 3 J • ** * * * * * * * --~~~~ AUSCULTATION. COUGH. PAIN. DYSPNEA. EXPECTORATION. VOICE. MISCELLANEOUS. * At first hard and Urgent in severe. Whitish, hollow balls, e sº g ut Breath sounds in affected area may be weakened dry, followed by Severe subster-attacks; relieved made up of moulds of smaller|... . gº º: º j ‘. or suppressed; sometimes loud crowing, whistling troublesomestrain-nal constriction in at once by dis-bronchi; Curschmann's spi-Unimpaired. Klebs - Loeffler bacilli if diphthe- or flapping sounds. ling, expulsive par-acute attacks. charge of bronchial rals, Charcot - Leyden crys- ritic. . . . -- . - - - Oxysms. CastS. tals. Severe paroacysms * > at long intervals, Varies with de- Copious, gray-brown fluid, May be moderate fever; night Local diminished vesicular murmur and vocal mornings usually, Only from com-lè% of bronchial mucopurulent, acid or fetid sweats, diarrhea, emaciation, rare- resonance; cavernous or amphoric sounds in af-so met im e s on li 㺠obstruction and (Dittrich's plugs); separates ly hemoptysis; metastatic ab- fected area, with mucous rales after coughing fit. change of posture; p & condition of heartlinto three layers—frothy, scesses in brain and elsewhere. - loften ends in vom- and lungs. . Watery, granular. iting. Inspiration short and quick; ea piration greatly Paroa-ysmal, pe- C º prº. and low-pitched wheezing in both acts; Tigl.u. and dry at . ... riodical, e a pir a- alº. . ‘. No fever; pulse always quick, innumerable faint or lowd sibilant and Somorows beginning Of y | Usually initialſtory, generally noc-. lati ii ts: Cursch- Suppressed|Small, and often irregular during * * * • • or led v, r- or Paſ-feel; *QS = | Tºp")* e gelatinous pellets; Uwrsch •: 4- e ting or standing pos- musical squeaking and creaking rales, followed by oxºs DOlS ‘ī, ecoming feeling of oppres-ſtwrmal, lasting *lmann' Sspirals; often Charcot- during se-attack; sitting or st g pos moist cooing sounds; vesicular murmur nearly in- ySms, *|sion about chest. few minutes to 5 were attack. |ture; associated chronic bronchitis audible, and of harsh, cog-wheel type; heart sounds rapid and feeble. . . . . . . , - . 1OOser. hours; may recur several nights. Leyden crystals and eosino- philes; rarely fibrinous casts. and emphysema. Relatively feeble, harsh or blowing breathing over wpper interscapular region of side involved — Sonor- ous rales later; vocal resonance also diminished; TJ sually spas- modic; sometimes Pleuritic pain as Collapse pro- Sometimes severe Thick and viscid; profuse in later stages. Affect ed if coincident May be signs of thoracic tumor. numerous rales in acquired form. in acquired. anterior portion of lung. fants. al’OXVSInS. laryngeal in- e gº laryngeal. gresses. paroxy . Č | §3 ºc t compensatory.exaggeration on other side. VOIV621 O €Iltj. f . Paroxysms of noisy breathing; lowd wheezing May be subster-| Mainly expira- . Mucoid; sometimes blood- Slightly, over constriction; vesicular murmur feeble or ab- Usually present. |nal pain, Sorenesstory; constant withltinged (streaked in aneu-if at all im- S62D . . - - Or Oppression. exacerbations. rysm). paired. ‘. . --- - - f b I bsent ! . . . - Family history of tuberculosis Yºr .. ºi...º. je". Dry, ringing, par. In side on slight| 9”Y.P* or history of exposure to this dis- vocal and respiratory sounds. laii i ºp y- Y, l ging, p xertion ***|ent; asthmatic at- ease; proneness to catch cold; neu- inspiration: may cause to º; usual ...” OxySmal. CDXI62I o tacks. rotic disorders; chronic diarrhea. moist, rales or wheezing or whistling respiration. Or constipation. Signs of complicating broncho-pneumonia, atel- Recurrent parox- | Epistaxis; frenal ulcer; fever ectasis, emphysema, phthisis, pleurisy, pneumo-ysms, quick, sharp, Substernal sore- Marked during Tenacious, stringy mucus, No hoarse usually slight; sometimes coma º e g & & C * * e ge thorax, or enlarged tracheal and bronchial glands;|metallic, followed|ness from straining|p a roxy s m s of expectorated or vomited; Ile SS or convulsions; whoop may be ab- venous hum over upper bone of sternum when by loud inspiratory|cough. cough. hemoptysis common. g sent in young children or in severe head bent horizontally backward. whoop. - complications. Vocal resonance wsually diminished; inspiration - º: º º : #. º * - Fapiratory, on Gradual loss of flesh and -- #. j #. (hars ** . ar: ** É's norcasſaics. Bronchitic, ge slight effort or per-| Frothy and viscid; usually strength; temperature usually sub- 10.62 º bling #. j f i. º erail Il C. wºe sº §ºse of cºnstric-siteåtly; grady very slight; may be profuse Enteebled normal; pulse may be feeble but º º ing soun º ero . º º, *tion below ribs. ally becomes moreland purulentif chronic bron- *|not frequent; stooping posiure; 3. . O . 3. 1On; i. intº d . ** - tº urgent; sometimes|chitis. * cardiac hypertrophy; dropsiesº sound accentuated; apex sounds dum, , often asthmatic attacks. dilated right ventricle. ~=== with fine systolic murmur; crackling sound in interstitial form. * Often profuse; usually - e Chronic paroxys- On expiration: mucopurulent; reddish in Insidious onset of failing health: Wheezy breathing mal, with difficulty exp 'Isiderosis, black in anthraco- e e “, g … e Sometimes asthma..!. ::::: little fever; favors tuberculosis. - in expectoration. sis; silica crystals under microscope in chalicosis. Aggravation of symptoms of . . . - . - Pain in side in j.ºº#6%º primary disease; chills and irregu- Enfeebled bronchial breathing; gurgling, or cav- Chronic, irrita-lacute type, fol. From compres- i. or offensive fra ‘ments lar fever; persistent leucocytosis; ernous rales in all forms but embolic; pleural fric-|tive, often worsellowed by chill and Sion p lung tissue, elastic gº. | anorexia and loss of flesh in cold tion sound if perforation. in morning. fever. tº herint oidin.'ch di esterin. abscess; sputum like anchovy * & * , - ~. } sauce in amebic form; ea:ploratory blood, fat, cocci. . * puncture. º, P.º Variable, sometimes hectic, usu- Bronchial respiration and rales; gurgling and # s: ... * º !/ ally moderate fever (most marked gº * e ſº * tº gº º - e More or less|fetid; three layers — frothy, • n : & •x - ~~~~~ * amphoric rales if extensive destruction of tissue; Bronchitic In side. troublesome Water reenish brown, tis- when drainage bad); very rapid generally in lower portion of lung. g Slle ºft blood. fat &rys pulse; Severe prostration; metastatic º 1. 3 1C º abscesses; maybe fatal hemoptysis. tals, bacteria. ; may be Iata pty Sls . . . . . e - * } g - . Sudden, sever lStv. o. & e ſº Indistinct vesicular murmur with localized crep- Usually super-l. Sudden, severe;;. Spira. tº: º º º o,"; ſº Syncope, convulsions, wheon- º •o wº * tº ºº “ºve e * in or * , , ºl”TICOmm. vior } e 3. C & e iousness; seldom fever; small. fre- ..", and ºales: bronchial breathing VeneS — irritative. j only on right great mental anxi-cells; profuse hemoptysis in *:::: juise. ; Small, fre and pronchop y e & ety. *º- diffuse form. Cl l § Sudden, intense; e tº º te a, unds in af- Absent in - •esmiration freoniem º º Diminished vesicular and voc 1 sou * S 1 Il 3 * b 1: con respiration frequent W.e a k . Prostration and wasting; no fe- fected area (may become normal after cough);|genital; depends on (60 to 80), and As in primary disease whining cry ver; pulse Small, rapid and feeble: sometimes bronchial if large area is involved; primary condition Absent. mainly in upper } ary e in young in- ; O all, Taj y drowsiness or muscular twitching. Breath sownds over tumor generally diminished or absent (sometimes loud and blowing if commu- nicating with bronchus); laryngo-tracheal murmur distinctly transmitted to superjacent regions; bronchophony or feeble vocal sounds. Dry and painful or moist; often par- Oxysmal. Constant and se- were, e s p e ci ally When pleura in- volved (stitch-like); Sometimes brachial neuralgia. Sometimes urgent (large hydatids may asphyxiate); paroxysmal when from pressure on trachea, or main bronchus. Mucoid or dark (“prune juice”), or rarely grass- green; Occasionally hemop- tysis; currant-jelly clots in carcinoma. Cacheſcia in malignant, with new growths elsewhere; sometimes fe- ver and night sweats; patient lies on affected side; pleural fluid thick and hemorrhagic (mitotic forms in sarcoma), containing va- cuolated epithelium. Usually silence over dull region; feeble respira- tion on affected side; sometimes stridor or friction sounds of tumor and chest wall; vocal resonance generally absent; cardiac sounds distant, feeble and rapid; sometimes very slow venous hum at root of neck. Dry, spasmodic and teasing, with husky, clanging tone—often severe. Continued lanci- nating pain or sense Of uneasiness and weight behind ster- nu m, reflected around chest or to back, head, shoul- der or arrºn. Early and con- stant, gradually in- creasing; may be Orthopnea; much a g g r a V at ed by slight exertion. Slight and viscid, or thick, purulent, currant-jelly clots in cancer; may be hemop- tysis also in benign; thin, limpid fluid, containing ech- inococci from hydatid cysts. |FIoarse Or aphonic if re- Current lar- yngeal nerve pressed on. Dysphagia (in posterior); low temperature; tumors elsewhere in body; hypostatic pneumonia; pleu- ritic effusions; cachexia if cancer- Ous; ascites and edema of lower extremities if inferior vena cava pressed on; pulse regular, small, and easily compressible — irray dif- £er on two sides; late chills and night sweats. strength to thousands. simply a tissue builder, a permanent tonic, - e • a ~. McArthur's Syrup Hypophosphites (Lime and Soda) may add it. It isn’t there when you do indtººd #as McArthur's Syrup ié Comp. is a reliable preparation worthy of trial. If a stimulant is needed you * * * * NAME. CAUSES AND OCCURRENCES. INSPECTION. PALPATION. PERCUSSION. Sometimes swelling at border or notch of ster- ſ! d. } *:andº... -> tº -> • * * g f one or two dorsal spines; Sweſling, if palpable, red, hot, . * sº Septic trauma, spinal caries, syphilis. num, or prominence o ~ ; * • --. } } "interscapular dullness; increased MEDIASTINAL 3. º * * - ABSCESS. Generally in males. Acute onset and rapidlº, 4% wlar fullness; more or less superficial º: º, º: area of precordial duliness upward COUll'SC. edema; pupils unequal if pressure on sympathetic; abdominal dropsy when inferior vena cava pressed OD1. º ened or lost. and to left (may partially disappear on lying down); heart may be dis- placed. FIBROUS MEDI- ASTINITIS. Chronic pericarditis, pleurisy, bronchitis, pneumonia or adenitis. Quickened breathing; jugular fullness, increased by inspiration, decreased by expiration; cyanosis extending upward from neck. Weakened or wanting apex beat; radial pulse small, rapid, soft, Com- pressible, disappearing during in- Spiration. Precordial dullness increased up- ward and to left. --- ACUTE JPLEURISY. Tuberculosis (often bilateral; other forms usually unilateral), pneumonia, rheumatism, syphilis, infarctions, pericarditis, typhoid, scarlatina, and other infections; chronic renal and hepatic affections; cancer (often hemorrhagic); debility, childhood, pyemia, and trauma predispose to empyema; chy- lous form from injury to thoracic duct, fila- riasis or fatty metamorphosis of epithelium. Fibrinous, serofibrinous, purulent (empy- ema), tubercular, hemorrhagic, chylous, dia- phragmatic, encysted, interlobular and pul- Sating forms. Onset often very insidious. Decubitus on healthy side before effusion—on affected side after much effusion; countenance anxious and pale, particularly in empyema, yet cy- anotic; immobility, or delayed and interrupted breathing, and uniform increase of volume (if large effusion) of affected side, with obliteration (rarely bulging) of intercostal spaces, and pale, shining, tense skin; apea beat pushed toward sownd side and downward (may be invisible); edema and venous engorgement or erysipelatous blush over ribs in empyema; perforation of chest wall in empyema necessitatis; respiration short and tho- form (Litten's sign obscured and depressed by any effusion); rarely inspiratory retraction of in- terSpaces. - pyema (to left of normal course of º - - * e º 9-|aorta); spleen or liver may be dis- racic, with fixed diaphragm, in , diaphragmatic placed downward; Dryfriction rubbing in early stage; vocal fremitus greatly diminished or absent in stage of effusion (un- less slight, or sometimes in chil- dren if large; fremitus also along lines of adhesion in encapsulated); slight fluctuation may sometimes be elicited; may pulsate internally or externally synchronous with heart, especially in left-sided em- abdomen at tenth rib very sensitive, but not distended in diaphragmatic form. Percussion painful at first; usu- ally gradual impairment of reso. nance, becoming flat and resistant from base of lungs (most marked posteriorly; often absent in chil- dren) upward; Skodaic resonance or cracked-pot sound just above limits of effusion, upper line of dullness wavy or sigmoid (convex upward in small — concave in very large effusions), higher behind or in axilla than in front, movable with changes in postwre if effusion mode- rate; normal resonance in Traube's semilunar space usually abolished in left-sided effusion; limited and irregular area of flatness in encap- sulated form, not changing with posture; may be marked displace- ment of liver, heart or spleen. CHRONIC PLEURISY. Acute pleurisy, tuberculosis (very insidi- ous), chronic pneumonia, pneumothorax. Dry or effusive. HYDROTHORAX. General anasarca of cardiac, renal, hemic or hepatic disease; chronic emphysema. Nearly always bilateral (cardiac commonly unilateral). Effusive form like acute pleurisy with effusion; bulging often marked; dry form shows more or less flattening or retraction of chest wall (most marked after perforating empyema), and deficient expansion of affected side; healthy side distended, with heart often drawn to this side; lateral spinal curvature; shoulder depressed, stiff and fixed during respiration; epigastric and hypochondriac inspiratory retraction if diaphragmatic adhesions; occasional dilatation of one pupil, or flushing or Sweating — especially in tubercular cases — of one cheek. Vocal fremitus normal, exagger- ated, or only slightly diminished; apex beat displaced; liver some- times displaced downward. In effusive form, lower part of chest dull or flat, upper border not sharply defined, and often atypical; in dry form dullness more marked than in acute pleurisy; often em- physema of opposite lung. * Same as pleural effusion, plus general dropsy, and often cyanosis and profuse perspiration. Same as pleurisy with effusion. Same as pleural effusion, but upper limit of dullness responds more quickly to changes in posi- tion. H B MOTHORAX. Trauma, leaking aneurysm, ulcerating blood vessel (phthisis), carcinoma, sarcoma, nephritis, Scurvy, purpura, pernicious ane- mia, leukemia, icterus. May be pallor. Same as pleurisy with slight effusion, Same as pleurisy with effusion, but usually less marked. PNEU MOTHORAX. (Hydropneumotho- rax, Pyopneumotho- rax). Perforating chest wounds, neighboring malignant disease, rupture of air vesicles by strain; perforalion due to local disease of lung, particularly tuberculosis; pleurobron- chial fistula from empyema, Unilateral. Usually adults. Very sudden onset as a rule. DIAPHRA GMATIC H E R N I.A. A CUTE CATAR RH - A L LARY N G 1 TIS. CHRON 1 C LARY N - Usually congenital; also from contusions. Catching cold, irritating dust or gases, overuse of voice, trauma, acute infections. Constant overuse of voice, or inhalation of tobacco smoke or bad air; alcoholism, nº * º e G] TIS, scrofula, acute infections, Warty growths. TU BER C U L AR Nearly always secondary to pulmonary LARYN GITIS, tuberculosis. teen to thirty. Usually in males from eigh- LU P US OF LAR 4 YN X. J’robably tubercular. SY PHILITIC LAR- YN GITIS. Syphilis, acquired or inherited (usually in first six months). Mucous patches three to nine months after infection. Anxious, alarmed expression; slight lividity; marked enlargement and immobility of affected side; bulging intercostal spaces (unless offset by cavity — flat chest); raised shoulder; marked dis- placement of apex beat to opposite side; patient usually lies on affected side; respiration sixty or more per minute. Tactile fremitus greatly dimin- ished or abolished; succussion fremitus if fluid present; liver sometimes greatly displaced down- ward. Amphoric or tympanitic Skodaic or hyperresonant (rarely muffled, toneless, almost dull when tension great) on most of affected side, with movable dullness at base (up- per line straight, horizontal, chang- ing with posture) if fluid present: sound side hyperresonant. displaced heart. Unilateral (usually left side) distension of chest; Tympany over ectopic stomach or bowels. - glands in subglottidal form. Laryngeal mucous membrane symmetrically swollen, bright red, sometimes streaked with mucus; cords inactive, rose red and ventricular bands swollen; may be oval glottis; inspiratory retraction of thoracic walls; enlarged cervical Symmetric swelling and slight redness of laryngeal mucous membrane; imperfect adduction of grayish-red vocal bands; glands of ventricles and epiglottis distended in granular form. enlarged cervical glands. Early local anemia; numerous, bilateral, pale, round or pointed eminences soon becoming broad, shallow, irregular, ill-defined, slow, painful ulcers, with gray bases and raised edges (interarytenoid ridging); vocal cords and epiglottis infiltrated, thickened and paralytic; moderate gray, thick, ropy, mucoid secretion; local soreness on pressure; often present in mouth, pharynx, and skin of face. Isolated or grouped nodes flowing together into patches, especially on epiglottis; mucous membrane injected, with little or no edema; discharge slight or absent; ulceration and scar formation rare, slow and late; lesions also usually sure, with deep ulceration. Usually unilateral — any portion of larynx: Superficial whitish ulcers in secondary; small, rounded, symmetric gum- mata, rapidly forming deep, punched-out, dark-red ulcers (somewhat indurated; mucopurulent secretion and necrosed tissue) or deformed cicatrices (stenosis); mucous membrane hyperemic and injected; more or less tenderness on pres- In the treatment of Nervous Diseases and General Debility, McArthur's The organic powers of the system are already taxed to their utmost ability to Syrup H ypophosphiteśe iºnist;ages its restorative powers. Here it is not carry on the physiological processes of life. The hypophosphites of lime and soda j,he stimulating action of the Feničdies usually classed as tonics that is needed. give the much-needed effect in these conditions — not that of a stimulant by AUSCULTATION. COUGH. PAIN. DYSPNEA. EXPECTORATION. VOICE. MISCELLANEOUS. Sense of weight k - increasing to con- º Husky or º tº Tracheal breath sound prominent; heart sounds. Usually present; stant, throbbing pain Present in pro- When present varies from suppressed Hectic fever, chills and sweats obscured but regular; sometimes systolic pressure murmur; rapid and shallow wheezing respiration if pressure on trachea, or bronchus. paroxysmal, laryn- geal, dry and irri- tating, or moist. behind sternum. Or between shoulders, enhanced or pro- voked by coughing or Sneezing. . portion to size of abscess; may suffo- cate from pressure on trachea. thin to blood-stained; puru- lent if rupture into bronchus or air vesicles. if pressure on left recur- rent laryn- geal. in acute; may be dysphagia or para- doxic pulse; rapid emaciation and prostration; vomiting and palpita- tion if pneumogastric pressed on. IIeart sounds faint but regular. Usually present to some degree. Sense of constric- tion or post-ster- nal pain radiating to side of chest, shoulder, back, neck or brachial plexus. Usually more or less constant; in- creased by slight exertion. Mucous. May be swelling of liver, ascites and dropsy of lower limbs. Jerky, cog-wheel or suppressed breathing, with Superficial, grazing, grating, leathery, creaking, friction sounds (sometimes moist, resembling crep- itant) in early stage—usually basic and double, unaffected by cough, often best heard in axilla (cease on holding breath); vesicular murmur feeble and distamt (blowing), or suppressed (in some hours) from effusion; exaggerated or bronchial, but dif- fuse and distant respiration above upper line of dullness; sometimes loud and tubular or pseudo- cavernous sounds, particularly in children, and at points of adhesion; vocal resonance generally di- minished or absent; bronchophony or egophony just above line of effusion, most marked at angle of Scapula; whispered voice said to be transmitted through serous, but not ordinarily through puru- lent, exudation; systolic cardiac murmur if heart displaced; sometimes pleuro-pericardiac friction murmur (fine grazing, synchronous with heart's motion) or bronchial rales. Early, dry, irrita- ting; often brought On by change of posture; chronic loose morning cough when empy- ema ruptures into bronchus. E a r l y, s h a r p Stitch in side, severe or slight, strictly localized, usually referred at first to nipple or axilla (SOmetimes to ab- domen or opposite Side), aggravated by cough or deep breathing; relieved On effusion; pain often absent in emp y e ma; c e r- tain spots or en- tire side may be tender to touch; pain in zone of dia- phragm, increased by pressure in dia- phragmatic. Iſsually moder- ate at first (exces- sive in diaphragm- atic) from pain and fever;increased Absent at first; usually slight, mucoid, occasionally streaked with blood; sudden, copious, purulentatirregular intervals if rupture of empy- Chilly feeling for several days, followed by quickened pulse, and moderate, continuous fever (100° to 103°), ending by lysis in a week or ten days; purulent form usually insidious, with increasing pallor, emaciation, weakness, sweats, re- current chills, irregular fever and albumosuria; troublesome hic- cough, vomiting, and grave deli- Like acute pleurisy with effusion in wet form; breath sounds exaggerated and bronchial or di- minished and emphysematous in dry form. Usually slight cough. TT"--— — —- Occasional stitch in side, or constant dragging pain at base of lung. - - - - -"- - - Diminished or absent vocal resonance and breath sounds over effusion; no friction sounds; may be crepitant rales. Irritative cough. Absent. Diminished vocal resonance and breath sounds over area involved. Irritative cough. De p end s on CallS6. en sudden and se- Vere. Serous if pulmonary edema. later if much effu-lema into bronchus (very Of- hº b e jº ##. Sion, . from com-fensive breath); scolices buminou ) or us āli ºsterii pression of lung-hooklets and laminated mem- in tuber º pus (usu % * hyperpnea. º in Sputum of hydatid i. .." º: cu) 3 CySUS. less than 400 c. c. in adults, or 120 c. c. in children, does not give rise to definite physical signs (perceived earliest in posterior axillary line, just below and external to angle of Scapula). - - - - May be slight fever and general More or less Tubercle bacilli seldom C a n n ot mi. j it." rapid shortness of breath found in effusion of tuber-talk long or uise and sweats (es ecially intu. ‘lcular cases. loudly. j D y Varying, but oft- No fever or inflammation; aspi- ration yields seruſº (below 1.015; slightly albuminous). De p end s CallSC. O Il Symptomatic shock (feeble, rapid pulse) if hemorrhage profuse; ex- cessive thirst; large size needle should be used to aspirate. Breath sownds greatly diminished or suppressed (sometimes amphoric if Open perforation) on af- fected side — exaggerated on opposite side, and feebly bronchial near spine; may be metallic tin- kling on coughing or deep inspiration; ringing A i r u s u a l l y breaks into pleural Sudden, intense, in side at time of Swdden and wr- gent, remaining in- temse; may be a feel- ing of “something May be very offensive in Small and General distress and restlessness; shock — very rapid and feeble amphoric voice (rarely feeble or absent if opening|cavity during par- accident giving way,” with later stage. Whispering. |pulse; exploratory puncture nega- closed); whispering voice transmitted; diathoracicloxysms of cough. e peculiar cold trick- * tive in air Space. coin sound very clear; succussion splashing sound ling sensation or if liquid present; may be metallic echo to cardiac palpitation. sounds. Metallic º: when, º not. º Present if stran. Interm it tent; Fecal vomiting and collapse if mingled with borborygmi; normal vesicular mur- gury Sudden appearance Strangulation; thirst; sometimes mur above. and disappearance. Symptoms of peritonitis. Inspiration may be wheezy or whistling. brazen barks; may.” ...”...”...] very slight, mucoid. m et a 1 lic, Tickling in larynx; coryza; mod- be distressing Singing, or SWal-ficult; spasmodic 8-> ** ~ * Whispering,|erate fever. b • l º Or -b º º 8-5 ) OWing. exacerbations. or lost. Frequent, short, º tickling, ineffectual Sense of tickling Glairy, or yellow is h Gradually May be Loisy breathing if much thickening of bar king; oftenland distress, ex- Opaque; may be streaked rough, mucous membrane or ulceration. worse at night; morning hawking Of mucus. cited by singing or Speaking. Slight, if any. With blood; often in little balls or crusts. h o a r S e, or nearly lost; easy fatigue. Tickling and dryness of throat; no fever. Signs of phthisis pulmonalis in great majority of instances. Irritable, short, frequent, husky, in effectual, dis- tressing if ulcera- tion extensive. Frequently se- vere, increased by Swallowing; local dryness; early par- esthesia. Marked if edema; SOmetimes suffo- cation on swallow- ing. Tubercle bacilli may be found in mucoid secretion. Early weak- In e S S a n d lack control; hoarse, hus- ky, aphonic. Dysphagia and cough on taking food, often followed by vomiting; edema of glottis; irregular fever; emaciation. S 1 i g h t - - * e e May be present in 8, I S 6 Local Soreness and some dys- Stenosis slight. Slight. Absent. lat º: Scanty. § º plagia; very slight impairment of aphonia. 'general health. Sense of laryn- - Syphiliti ifestati • * * * * * Free mucopurulent dis- yphilitic manifestations else- Inspirati olonged and noisy if stenosis Little or no #.º. i. f jºy be ii. º charge from iºd Slight im where; slight fever; painful swell- STOII 3,010 Il OT e * II): TOIIl SW6111D.C. Of T. C *1831 - e ~ * 4: Tº YY IT ºr nº ºr nSp1 D © y cough. slight pain on .. cords. * * with blood or blackened paiºt." |ing of glands; food may enter lar- irritation, but that of a true nutriment to the starving tissues. are permanent, as they are the effects of a richer blood supply, bringing healthy his normal condition. lowing. Its tonic effects | food and oxygen to the tissues. shreds. ynx; rapid improvement under io- dides. Thus #he :page:#;is gradually brought up to v *— -- NAME. CAUSES AND occuRRENCEs. - - INSPECTION. : PALPATION. - PERCUSSION. ME M BRANO US I)iphtheria, scarlatina, measles. Epidemic of children from two to seven; onset. grad-| Patches of membrane—thick, yellow, tenacious, necrosed if diphtheritic—thin, bluish white, translucent, non-tenacious ******** |ual, preceded by local symptoms. Attack if not diphtheritic; lips and fingers livid; early swelling of cervical glands; inspiratory recessions of soft parts. usually nocturnal. - Laryngeal catarrh, catching cold, enlarged * SPASMopic tonsils. Six months to five years old. Onset Redness of rima, epiglottis and aryepiglottidan folds; inspiration much prolonged; face dusky and livid during attack; CROUP. and exit abrupt — usually recurrent noctur-suprasternal and infrasternal inspiratory recessions. nal — lasting a few minutes to an hour. Newrosis excited by acute catarrhs, teeth- LARYNGISMUs ſing, worms, overloaded stomach, mediasti: Sudden arrest of respiration (often as child awakes) from closure of glottis for a e © STRIDULUS. nal affections, hysteria, tabes dorsalis, en- ºrifi #% !p ( & ) e or glorus tor few seconds; struggle for breath; con- - e gested, terrified face. larged bronchial glands, aortic aneurysm, 7°ickets. Nephritis, acute infections (especially diphtheria), general paresis, angioneurosis º * •r, wri ri i-fºr- e e & ~~~~~ - ... EDEMA of GLOT-scalds, wounds; tumor or aneurysm press. º§§º defined, grayish yellow, semi-translucent swelling of epiglottis and aryepiglottic folds (usually readily TIS. ing on cervical veins, trachea or larynx. e w |Usually adults. A B S C E S S E * e ~. … . . - º * S S E S O F Circumscribed red swelling, often with yellowish apex; retropharyngeal abscess recognized by touch as pseudo-tumor PHARYNX AND| (ſoº-q}; • * ~ o $ - º - - Cervical caries, infectious fevers. in posterior wall of pharynx. . . . LARYNX. Benign : (Circumscribed.) - - Papilloma : Usually on anterior part of cords; often multiple, pink or white, like mulberries. Myxoma : Usually on cords; same as papilloma degenerated. - Fibroma : Usually on cords; smooth or mulberry, hard, rounded, pedunculated, areolated, pale to light red or spotted; commonly in middle life. Angioma: Usually on cords; deep red, rough or smooth; pea to hazelnut in size; rare. 2. Cystoma: Usually on epiglottis; round, smooth, semi-transparent, mobile, compressible; may be as large as small marble. Enchondroma: Posterior laryngeal cartilages, projecting inwards; always bard, sessile, irregular; hyaline very small to very large. Lipoma : Loose tissues; broad, deeply lobed, with finger-shaped projections. Lymphoma : Epiglottis and aperture of larynx; whitish spherical segments; general leukemia. Malignant: Diffuse, with ulceration, and early cervical glandular enlargement. Epithelioma: Irregular, nodular or broadly infiltrated ulcerating mass, larger than sarcoma; very rare. - I near cricoarytenoid articulation; forms variegated — generally rigid, with ragged edges, and LARYNGEAL TU- MORS. Carcinomatous Ulcer : Unilateral, true vocal cord, epiglottis, O bleeding surface; males over forty; very rare. Sarcoma: Semiopaque, irregularly rounded, soft grayish or pink, W ith thick deposit of mucopus; up to walnut in size; usually primary; 600 times as fre- Quent as cancer. t - After an attack of the grip the patient finds himself in a state of extreme former good health. Remedies which stimulate his exhausted nerves too vigor- press and prostration, from which condition he is tediously brought to his ously do so at the expense of his general condition. Then comes the relapse. ANSONIA, CONN. Poctor: We beg again to invite your atten- tion to the therapeutic value of our CHEMI- CALLY PURE Syrup of Hypophosphites. Our Hypophosphites have already received the endorsement of the medical profession as being the best known remedy in pulmonary and other wasting diseases. If you have not already done so, we trust you will give them a full and fair trial in your practice, fully believing you will find them more satisfactory than any remedy you have hitherto used in the treatment of tuberculosis. We are not unmindful of our obligations to the profession who have so generously given us their support, and do hereby tender them our grateful acknowledgments. We shall esteem it a favor if any member of the profession should desire to correspond with us upon the subject of the “Aypophos- //lites,” such correspondence to be used only in accordance with the code of medical ethics. One regular $1.00 bottle of McArthur's Syrup will be sent free to any physician or dentist who will send us forty-five cents in stamps to cover the express charges. THE McARTHUR HYPOPHOSPHITE CO A DYSPNEA. AUSCULTATION. COUGH. PAIN. EXPECTORATION. VOICE. MiscellAN EOUS. Pro dro m a 1, H us k y, Fever usually moderate (normal Laryngeal stridor and greatly weakened vesicu- .# 6. º. %. Mainly inspira- Portions of false membrane smothered, or subnormal in septic cases); stu- lar murmur during attack; may be vibrating, rat- º #: C ... Slightsorethroat.ſtory; paroxysmal, may be coughed out whis pering|por, asthenia, albuminuria, paral- tling sound over larynx or trachea. . l # e then continuous. ay g e or sup- |ysis in diphtheritic cases; great ...” Iſle U2,111C IIl pressed. restlessness. Loud, brazen, ring- Sudden, intense, M a y be Hard, stridulous breathing with prolonged in- ing, barking, with with abrupt inter- More or less abundant fol-ſh.u 8 k Y, spiration. sudden awakening; slight brassy dur- ing the day. Slightsore throat. mission, and com- plete relief in a few hours. lowing attack. lost. h o a r S e, or, Fever 'slight, if any; tetany and general convulsions. High-pitched inspiratory crowing sound on relax- ation of spasm; reedy, or croaking, or Wheezing sound in congenital malformations. Absent in purely nervous type; may be paroxysmal lar- yngeal cough in re- flex. Absent. S h or t spasms often on waking, day or night (con- tinuous if malfor- mations). None, unless dependent on other laryngeal disease. M a y be hoarse in re- flex form. Carpopedal spasms or general convulsions; incontinence of urine and feces; no fever; most common in rachitic children from one-half to three years. Noisy, hissing, labored inspiration. Violent but in- effectual or absent. Pain on swallow- ing or Speaking. Sudden, rapidly progressive ; most noticeable on in- Spiration. Expir, tion may be noiseless. Irritative, pain- ful. Severe, increased by pressing back- ward or swallow- ing. Increased in hori- Zontal posture, and by swallowing, or pressure against larynx. May be rattling sound during phonation or res- piration if tumor movable. Slight irritative or prominent; most marked in ulcera- tive cancer. Discomfort Or fullness in, benign; slight or severe lan- cinating pain and pronounced sensi- bility in malignant. Steadily increas- ing inspiratory dyspnea, with sud- den attacks of suf- focation if mobile. Sensation of foreign body in lºy *lthroat and dysphagia; chills and C - fever if infectious. * * ...] Nasal or - Dysphagia; stiff neck, especially tº: . when rupture guttural and in retropharyngeal form; irregular place. indistinct. fever. - H o a r s e, Sanious and fetid in ma- lignant, and sometimes in benign from erosions. gruff, weak, e a sily fa- tigued; may be aphonia or do u b le voice. Emaciation, late cachexia, fetid and offensive breath, and may be dysphagia in carcinoma (profuso Salivation in epithelioma). Syr. Hypophos. Comp. McArthur conveys to the tissues the revivifying and the true vitality of the nerve structure is restored by renewing the nutrition of vitalizing agent phosphorus in its most oxidizable and assimilable form. Thus - the tissues theiaselves. McARTHUR's syRUP HYPOPHOSPHITES is kept in stock by the wholesale drug- gists throughout the United States, to whom all orders for less than gro SS lots should be Sent. COMP : C. P. TO PHYSICANs. BEWARE OF SUBSTITUTION. We cannot guarantee the genuineness of our Hypophosphites except when purchased in original bottles. Then, if desired, the trade label may be removed and prescription directions substituted in its place. As it is made ONLY for physicians there are no printed wrappers or advertisements about the bottle. Prescribe a whole bottle wherever it is possible, and then there will be no danger of substitution. - - - THE McARTHUR HYPOPHosphire co., Ansonia, conn. : . º : : : syRUP HYPOPHOs: NicARTHUR. --- - - - - c H E M Lc ALLY FURE. General Directions for Use, Dose, Etc. There is no fixed or invariable dose. My Syrup of the Hypophosphites of Lime and Soda combines with a neutral syrup twelve and one-half cen- tigrammes of the hypophosphites to each teaspoonful. As a general rule, for an adult, begin with two teaspoonfuls morning, noon and night, before, after, or with the meal, and increase gradually to a tablespoonful three times daily. - In case of females of very delicate constitutions, leading a sedentary life, and not used to much physical exertion, the above dose should be reduced from one-quarter to one-half. For children, from eight to thirteen, the dose is the same as for delicate females. For a child, from two to seven years of age, the dose should be from one-third to one teaspoonful. For teething infants the dose should seldom exceed one small teaspoonful in twenty-four hours, and be so divided as to give one-quarter every sixth hour. The dose should be regulated, however, by the careful advice of __ the physician.-- Phe-Syrup, if given as above to children cutting their teeth, will be found to produce a most beneficial effect. The Syrup is free from any medicinal taste whatever, and may be taken alone, or mixed with any of the patient's usual beverages, such as milk, tea, coffee, cold Water, etc. In all cases where alcoholic stimulants are indicated, any kind of pure spirituous liquors (except acid wines) may be added to suit the taste and requirements of each case. The Syrup should be taken three times a day, before, after or with the meal. - A very agreeable, refreshing drink may be made by adding lemon juice and water to the Syrup. - Many physicians recommend this method to their patients, particularly those to whom sweet is an objection. The lemon is not incompatible with the action of the hypophosphites. Physicians, when prescribing, will please write thus : — B. Syr : Hypophos : Comp : McArthur, one bottle. Suggestions. It is not reasonable to expect that a remedy which acts through the functions of nutrition by promoting the building-up of new and healthy tissues, and by eliminating those which are diseased, should, in all instances, manifest its action in a few days. When the lungs are only slightly affected, or when the disease is of recent origin, this early and immediate action will often be met with. Such, for instance, is the case in acute phthisis or catarrhal pneumonia. Otherwise, when the local disease is extensive, or has already lasted some time, the action of the remedy must be chronic like the disease itself. 4 As there is very great variability in the immediate effect produced upon different patients, the physician should therefore carefully feel his way, increasing the dose every second or third day until some apparent effect is produced either upon one, several, or the whole of the symptoms. When once this has been obtained, and the treatment has been continued for about a week, it will often be found advisable to omit the treatment for one or two days, and see how the patient fares without it. After this it should be resumed, either in the same or in a smaller or larger dose, according to the indications presented. The interval may be gradually increased with improvement in the patient's health, and his showing signs of physiogenic plethora. When all the general symptoms (weakness, emaciation, etc.) have disappeared, and nothing remains but those depending upon the local condition, such as cough, expectoration, etc., two or three doses — sometimes even only one dose — a week will be found sufficient to keep the patient in the state of | physiogenic plethora necessary for the completion of the cure. But, as already said, this will vary with every individual case. Some— patients require a daily dose of three or four teaspoonfuls, and cannot da with less; others feel better with even one teaspoonful. When the cure is once complete,_ when the local lesions have disap- peared, or have cicatrized,—the patient should continue to take one or two doses a week as a prophylactic. Many patients find that they cannot leave off the treatment altogether for a longer time than three or four weeks without feeling the want of it, and getting below par, particularly if they remain in the same hygienic conditions (such as overwork, etc.) as those which originated the complaint. I have even met with some who could not leave it off for a single day without feeling the want of it. - Dr. Barella, in an article in Le Scalpel, December, states the current opinion on the Continent with regard to the hypophosphites: “There is not a single organ of the French or foreign medical press which has not published cases conclusive as to the therapeutical value of the hypophos- phites in every stage of consumption. Many of these cases have been collected in the public hospitals. In the present state of science, and although we have to deal with a disease which has been looked upon as incurable, and which carries off one-third of the adult population, it is a fact, which nobody will now deny, that the treatment by the hypophosphites produces remarkable, and in some cases immediate, effect. The cases of cure are the more numerous in proportion as the disease itself is less advanced. Discussion has been exhausted as to Dr. Churchill's doctrine, which, as we know, is founded on the principle of stoechiology, that is to say, upon the study of the constituent elements of the proximate principles of which our system is built up. Dr. Churchill does not pretend, as has been asserted, to cure those who are already dying. His treatment (by the hypophos- phites) is the specific remedy for the diathesis or general condition, and not for the local disorganization to which it leads. He therefore pretends to cure only under certain conditions, and by following certain rules which he has minutely explained in his work on the subject.” THIRTY POUNDS IN THREE MONTHS. ALLENTown, PA., Dec. 28, 1894. I have been using your preparation since 1887, when I first prescribed it in a case of phthisis (third stage), in a patient who:ºy:yeighed eighty-seven pounds. In three months I had all the diseased vesicles sealed, and the patient gained in weight to 117 pounds. Have used it in chronic bronchitis and other pulmonary affections, with the best results. I cannot speak too highly of your preparation, and in affections of the lungs or bronchial tubes I first and last prescribe “McArthur's,” always in the original package, as I have learned a lesson, since a druggist dispensed “Stock" hypophosphites, instead of your preparation, when I had particularly specified “McArthur's.” , º W. N. POWELL, M. D., 936 Hamilton Street. 5. .dence, Marblehead; December, 1875. for several months with mucopurulent expectoration, great debility, and Has had several frequent, and some diarrhea. Had taken various emulsions of of lungs. auscultation, on left, sharp cracklings in the infra-spinous fossa. REPORT OF CASE BY DR. McARTHUR. For obvious reasons I have refrained from reporting any cases treated by myself with the Syrup Hypophosphites; but, as the following so nearly concerns me, I venture to copy it from my note-book: — - Patient, my brother, E. R. McArthur, aged thirty-eight years; resi- Has had a cough, and been ailing considerable emaciation, with excessive night sweats. attacks of hemoptysis; one very severe; thinks a pint or more of blood. His voice is hoarse, and has tickling in his throat. Suffers from dyspnea, and is obliged to desist from business; no appetite, digestion bad, vomiting cod-liver oil, malts, tonics, etc., but without finding any relief. . . Local Signs.—Expansion of two sides of thorax unequal, the left side hardly rising at all during inspiration. Front, dullness on percussion over the whole left side; diminished resonance on the right side for three fingers' breadth below clavicle. - clavicle, blowing respirations, with gurgling, and moist crepitus; cavernous Auscultation revealed on left, above cough, and pectoriloquy ; below clavicle, same signs, i. e., moist cracklings extending down to base. Above clavicle, on right, jerking respiration, with moist rales, increased vocal resonance, exaggerated respiration in the rest Behind, on percussion, dullness in left supra-spinous fossa. On -—— º - _ “ - - . - Diagnosis.—Cavity at apex of Teft füng, with tubei'eleg over-tha whole of its front aspect; also softening at front of apex of right lung. I prescribed : — B. Syr: Hypophos : Comp : McArthur. Dose : A dessertspoonful, gradually increased to a tablespoonful, after each meal, in a little port wine and water. - - - - February Ist. Has begun to improve; cough somewhat diminished; less perspiration at night and better digestion. Continue a tablespoonful of the Syrup three times daily, with liberal diet and wine. February 15th. Improvement continues. March 1st. Stethoscopic signs considerably improved; less dullness and fewer rales. Continue treatment. March 20th. Manifest improvement; has gained seven pounds in weight; feels better and stronger than at any time since the commencement. of his illness. As stomach and digestion were now good, ordered cod- liver oil, a tablespoonful two or three times daily, one hour after the meal, and continue the Hypophosphites in whiskey and water. • May 1st. General condition greatly improved; slight cough in the morning, with a little expectoration; appetite good; voice recovered its natural tone. diet with porter or ale. June 9th. . Reports cough ceased almost entirely; no expectoration; has gained flesh and sleeps well; no thoracic pains or difficulty in lying down; no fever or night sweats; hoarseness has disappeared; can sing as well as ever; appetite good, and can attend to his business as well as before his sickness. - - He took the Syrup at intervals for the next two years, as he said he felt better by doing so. He continues to enjoy perfect health, and says, “I never felt better in my life.” He is, at the present time (November 1, 1899), in charge of my laboratory. . . or hemorrhage in some shape or other. fully confirmed these views. every instance in which I used the hypophosphite of iron, but in patients who have previously been taking ferruginous medicines it will be found that it is very difficult, at first, to keep the effects of the hypophosphites | rhagic diathesis. Omit Syrup Hypophosphites for a time, and take liberal In connection with this case I wish to call the attention of physicians to One very important consideration as to the therapeutical action of the dif- ferent hypophosphites. I have experimented with a number of these salts, particularly those of soda, lime, iron, potash, manganese, etc., and am con- Vinced that in the treatment of phthisis the hypophosphites of lime and soda should alone be used. ' ' . - - Twenty years ago Churchill wrote: — * Extended experience has now shown me that in the treatment of tuber- culosis the practitioner should confine himself to the use of lime and soda. The effects produced by these two salts, when properly combined and administered in phthisis, have such a character of constancy that I have seldom thought myself justified in intermitting them or supplying their place by any other.” He further says: “In the first edition of my work on Consumption, I stated that the action of the hypophosphite of iron should only be tried with great caution in cases of consumption, as in several for which I had prescribed ferruginous preparations simultaneously with the hypophosphites, their exhibition appeared to be followed by hemoptysis, Subsequent experience has since Not only was hemorrhage produced in almost within the limits of their physiogenic action. For this reason I have entirely given up the use of the hypophosphite of iron in phthisis, and confine - myself almost entirely to the use of the CHEMICALLY PURE SYRUP of Lime and Soda.” - My own observations entirely coincide with Dr. Churchill's remarks, and it was during the administration of a well-known Compound Syrup of Hypophosphites, which I subsequently learned contained iron, manganese, Strychnia, etc., that my brother had his first attack of hemoptysis, and subsequent observation has convinced me of the highly dangerous character of these compounds in phthisis when there is the least tendency to a hemor- I could copy from my case-book many instances to verify cases that have occurred, not only in my own practice, but in A. the above, the service of other physicians with whom I have been called to consult. case in point occurred but a few months ago, and is briefly as follows: I was called in consultation to see a young lady who was suffering from not profuse, but, nevertheless, troublesome and persistent hemoptysis which | had lasted a number of days, and could not be controlled by any of the usual remedies. On inquiry I found that she still continued to take, three times daily, a Compound Syrup of Hypophosphites, which, on examination, proved to be an impure article, containing, among other drugs, iron, strychnia, etc. This medicine was ordered to be discontinued, and in two days the hemorrhage ceased. At the end of one week, she was ordered a dessertspoonful of McArthur's Syrup Hypophosphites of Lime and Soda in port wine and water three times daily, with the meal; one tablespoonful of cod-liver oil one hour after breakfast and tea, and liberal diet. There was no more bleeding, and she is now making a good recovery. * %iº.2 - PHILADELPHIA, PA., Dec. 8, 1894. It gives me much pleasure to testify to the usefulness of your Syrup of Hypo- phosphites, since my attention was called to it. I have used the Syrup in laryn- geal and pulmonary tuberculosis and strumous diathesis, so common in children. ...” f & J. A. IRWIN, M. D., Late Assistant Children's Department, and Assistant Gymecological Department, Jefferson College Hospital. \ t © * * * > TREATTIENT OF TUBERCULosis. The history of modern therapeutics shows a tendency among medical men to oscil- late between extremes, like the pendulum, until finally the mean, or practical “point of rest '' is reached. This tendency is particularly noticeable in the treatment of the tubercular diseases. On the one hand we have had the “Gavage” or over-eating system, in which the patient is compelled to endure passive stuffing and absolute rest, in order to combat the so-called “waste of tissue” of the disease. The fallacy of that theory having been demonstrated by its continued failure in actual practice, we seem to have swung to the opposite extreme of considering the patient as an indifferent receptacle of disease germs, into which it is sufficient to simply inject the appropriate germicide to effect a cure. So we have the various lymphs, anti- septic fluids, and othér purely germicidal methods of treatment. But the results are showing that the patient refuses to be ignored as a factor in the case. The dead germs and the dead patient are buried together. We see that the principle is as sound in medicine as it is in philanthropy, that the true help is that which enables the person to help himself. This is the principle upon which the treatment with the hypophosphites of lime and soda is based. Each individual patient is composed of a collection of cells possessing vital powers. In tuberculosis these vital powers of the cells, and hence of the patient, are weakened. But by administering this remedy judiciously we gradually restore the cells again to their normal condition, enabling them to battle successfully with the invading bacilli, to repair gradually the damage done to the tissue structures. Thus the organism acquires additional strength with each step in advance, and the cure is finally complete. Many, no doubt, have at some time in their experience touched upon the hypo- phosphites. They have given them in oil, in malt extract, in some acid mixture, or in a compound with a half a dozen “tonics” added to it, and have been disappointed. The illustrious founder of this successful mode of treatment, Dr. Churchill, did not recommend any such heterogeneous mixtures of foreign substances, and his remedy should not be held responsible for the consequent failures. He simply urged that the chemically pure hypophosphites of lime and Soda should be administered with judg- ment, perseveringly, until a permanent cure resulted. Pharmacists, ambitious of getting up rival preparations, have made the attempted improvements. It is needless to say that, wherever these innovations have been adopted, failure has resulted, and the entire treatment has been brought into disrepute and abandoned. With the pure hypophosphites of lime and Soda you can score success time and again. The results are gradual, steady and certain, if the remedy is persevered with faithfully until the cure is complete. None but chemicals of known genuineness and absolute purity should be used. McArthur's Syrup is prepared on the principle laid down by Dr. Churchill. It contains the chemically pure hypophosphites of lime and soda, uncomplicated with other drugs, in a pure and wholesome syrup. - - - NUTRITION IN TUBERCULosis. Supposed discoveries ar, the treatment of consumption follow each other like the sweep of the billows on the shores of a troubled sea. But success will not come to those who wait for an accidental discovery. It rewards those who faithfully and patiently apply the already well-known principles of scientific treatment based upon the established pathology of the disease. Let us examine into these principles of treatment. An observer once inoculated ten rabbits with tuberculous virus. Five of them were kept in confinement, and all but one died in a short time of tuberculosis. Five were turned loose to have the advantage of proper food, fresh air and exercise; of them all but one recovered. The significance of this observation is startling. It points to the fact that proper nutrition alone is sufficient to combat the disease. But the principal obstacle met with in the disease is that the digestive organs are weakened, and hence are unable to convey the proper amount of the ordinary forms of nutriment to the tissues. Just here is where medical science comes to the rescue. The hypophosphites of lime and soda constitute the most potent form of artificial nutriment known in nature. . It is a reliable general tonic. It diminishes slight pyrexia. It checks the night- sweats. It aids the fatty degeneration of effete products, and thus hastens their removal from the system. By the aid of this agent the tissues are supplied with rich, pure blood — not only the most desirable antiseptic agent in the world, but a tissue-builder as well. Thus it may be seen what an important part it plays in the nutrition of the patient, and in healing the lesions of the disease. - You need not send your patients away for this treatment. It has been well said that it is not of so much importance where a patient lives as how he lives. Pure air, nourishing food, scrupulous attention to the skin, and other eliminating organs of the system, with the timely administration of McArthur's Syrup, will do all that can be done for the patient. The extreme importance of this subject cannot be overestimated when we reflect that this disease destroys, every year, over five thousand persons in New York City alone, and over one million in Europe, and that more than one-seventh of the human race finally succumb to its ravages. But that which is a useful treatment when once the disease is recognized, is of the utmost importance as a prophylactic in those conditions which predispose the indi- vidual to its inception. It has been demonstrated that, in almost every instance, the attack begins at some time when, by some cause, the tissues have become more or less devitalized. Thus, one person will have relaxed tissues, with unhealthy secretions, following an acute disease or inflammation; another will have a system weakened from unusual work, care, exposure or other debilitating causes; another, from the excessive * : º O O º & : Q tº Q : : drain of pregnancy or lactation; another, a child, will have excessive rapidity of growth, resulting in tissues that are weak, flabby and non-resisting. To guard against any temporary period of reduced vitality, the hypophosphites must be given by a watchful physician, whenever there exists any devitalizing cause, and as long as such cause persists. HYPOPHOSPHITES IN NERVoUs DISEASEs. In the treatment of nervous diseases it is important to find a remedy that will not be transient in its effects, and subject to violent reaction, thus requiring constantly increasing doses, until the system finally fails to respond to it. The true remedy must be a radical one, restoring to the nerve tissues themselves their former integrity of structure and hence their normal functions. Consider how logical it is in cases of degeneration of nerve tissue to give stimulants that will only hasten the degenerative process, or in case of functional nervous debility and exhaustion to administer irri- tating tonics or “nervines” that will whip up the tired nerves to increased activity without increasing their strength, until, finally, they are unable to respond to the most heroic goading, and the patient finds himself permanently broken down. - There is a better way than that. When, from the whirl of society, or the unremit- ting cares of business, by wild excesses, or a long strain of necessary toil and vigilance, the patient is brought to the verge of nervous prostration, the proper treatment, besides rest, sleep and recreation, is a remedy which will impart the proper nourish- ment to the system, and thus restore it to its normal tone again. This remedy is the chemically pure hypophosphites of lime and soda. A recollection of its well-known tissue-regenerating power will suggest to the mind of every physician the value of its action in this condition. In obstetrical practice often the patient’s nervous system is kept irritable by the impoverishment consequent upon nourishing the developing embryo. The nutritive hypophosphites (lime and soda) should be given in interrupted periods throughout the course of gestation. - In gynecological practice there are many patients suspected of having diseased conditions of the pelvic organs to account for their obscure nervous troubles, but who, after the most skillful local treatment, are found to be suffering from a general condi- tion which is aptly termed “nerve-starvation.” In addition to rest, sleep, nourishing food and hygienic habits, they should take the hypophosphites. By this means the nervous system may be regenerated, and the hysterical irritability will be greatly improved. - Try it also in intractable cases of neuralgia, and in functional impotence. Try it wherever you have troubles arising from impoverishment or malnutrition of nerve structure. --- A--------- Bear in mind titat it is not the phosphates (that have undergone their final changes, and hence are ready to be rejected at once by the system) that we recommend for this purpose, but the hypophosphites, which, in the process of assimilation, undergo the changes into phosphites, and finally phosphates, and, while undergoing those changes, unite with the Organic cell elements. These will be found beneficial. In McArthur's Compound Syrup of the Hypophosphites of Lime and Soda you have these salts in their absolute chemical purity. A REFRESHING TONIC AND RECONSTRUCTIVE. While the most prominent use for the hypophosphites of lime and soda is in the treatment of consumption and scrofula, in which its tonic and tissue-building proper- ties render it particularly efficacious, yet it has other and quite varied uses based upon these same properties. One of the most marked of these is its use as a tonic recon- structive in hot weather. Many persons have fair health during the cooler months of the year, yet suffer greatly from debility during the long, hot summer. The relaxing effects of the heat itself, besides the loss of the salts of the tissues, through the excessive colliquative perspiration, prove exceedingly depressing to the vital powers. Not only is this con- dition of extreme debility very depressing in itself, but it also predisposes the victims to attacks of disease which they would otherwise be able to resist. Thus, towards the latter part of the heated term, we have a long list of protracted, exhaustive fevers, for the fatal issue of which the extreme debility of the patients is largely responsible. In all this we may see another demonstration of the value of the phosphorus salts' of lime and Soda as tonic and vitalizing agents in the animal economy, and also a definite clue to the proper remedy for the condition described, as these tissue-salts are largely wasted in excessive perspiration. This remedy is the pure hypophos- phites of lime and Soda. By its tonic properties, refreshing, revitalizing, and invigo- rating the entire System, it restrains the excessive perspiration, and the consequent waste is checked. But it alsó furnishes the system with healthy tissue-food to replace with new and vigorous cells the necessary waste incident to the ordinary physiological processes. Thus the System is kept all the time up to a prime condition of physical strength and mental exhilaration, and germs of disease find little encouragement for invasion. - It would be advisable that those who “do not bear hot weather well” should resort each year to a course of the hypophosphites of lime and soda, and thus fortify the system against certain exhaustion, and possible malignant disease. Direct them to put a teaspoonful of McArthur's Syrup occasionally in a glass of cold water, as a drink, and the “insatiable thirst" will be more easily relieved. Recommend this, also, to your consumptive and Scrofulous patients, and those afflicted with diseases character- ized by exhausting discharges and great debility, and they will report the summer as the most refreshing season they have ever passed. 4 tº/yr Jºhould a Tentist Prescribe * Hypophosphite, 2 plishing results which his skill should achieve merely because his patient is lack- ing in those elements of blood and bone which es- tablish repair and maintain stability; or, having rendered thoroughly skilful service, he finds his work lacking permanency because the tissues upon which his work must depend become dis- organized and break down. º When are Hypophosphites ... Indicated in Dentistry?... Tº: dentist is often prevented from accom- : ThREGNANCY--It is a too common idea that L” with the birth of each child the mother must lose one of her own teeth. This, of course, is fallacious, though the result may be noted all too frequently. The fact is, that the un- born infant extracts so much of the vital elements from the mother that caries of the teeth is invited because vital resistance is impaired. The free use of McArthur's Syrup of Hypophosphites during gestation not only maintains the mother's physical equilibrium, but furnishes the foetus with means of acquiring fine teeth. - ing babyhood result disastrously to the perma- nent set, which, of course, at this age are but pulpy masses, calcification being in progress; any impairment of nutrition at this time must interfere with this calcification, the result being teeth de- fective either in form or in enamel, or both. The rational treatment, therefore, in rickets, infantile scorbutus and similar affections is to nourish the child with food rich with lime and easily assimi- lated. McArthur's Syrup Hypophosphites is ex- actly the preparation required. A GRIPPE.-It is frequently noticed, after all L attack of La Grippe, dental patients present alveolar abscess. What is the explanation? Such patients prior to the attack may have fillings which closely approach the pulp. In the state of perfect health the vitality of these pulps may en- able them to endure the shacks ºf thernia, whalīges induced by the proximity of these masses of reefa. But La Grippe weakens the physical organisºn and depletes the nervous energy, leaving the pa- tient in a condition requiring tonic and nourish. ing treatment. Lacking these, the weaker parts of the body suffer most. The pulp in filled teeth dies, and abscesses follow. Nourish such a patient during convalescence with McArthur's Hypophos- phites and the general health and vigor will be rapidly restored, and there will be no such results as dead pulps and consequent alveolar abscesses. | NFANCY.—Many of the diseases occurring dur- Upon reogist of forty-five cents in stamps, we shall be pleased fo forwara, express pakſ, one regular ſhottle, one dollar sizes &msall sample and liferature FREE, The McArthur Hypophosphite Co. ANSONIA, CONN. Misérºup's Syrup of Hypophesºsh'ſſes eam le had at all Drug Stores, BEwARE ... OF .. Filmed by Preservation 1990. sues.TITUTION.