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L'Institut a microfilm^ le meilleur exemplaire qu'il lui a eti possible de se procurer. Les details de cet exemplaire qui sont peut-* • INoiili'fiil : THE MONTREAL HOMEOPATHIC PHABMACY, 140 Mansfield Street. 1889, t^X $ /■i ,y4 Xext year I purpose celebrating TuE Centenary of Homceo- PATHY by publishing Hahnemann, the Discoverer of Homceopathy, being No. 7 of the Montreal Tracts. THOMAS NICHOL, M.D. 140 Mansfield Street, No^r. 11, 1889. FIRST ANNUAL REPORT OF THE MONTREAL HOMCEO- PATHIC DISPENSARY. (From October 1, 1888, to September 30, 1889.; Immediately on organizing, it was discovered that the original idea, namely, a Dispensary for children only, was too narrow, so adults were at once admitted. Then we found that Dispensary patients liked to come at any time that suited them, so they are now- seen at any hour of the day. Lastly, wre saw that an Outdoor Department was an absolute necessity, so since October last we have seen patients at their own homes regularly. During the year we saw 249 patients at the Dispensary and made 591 visits to patients at their own homes. Of course it will be distinctly understood that the Dispensary is NOT open to thosd who.a*e able toipa^^j'.- • .t'.- ; \\\ ..■.■..' TjrtbJf^'sklCHOL, M.D. ■:.,:[ .: ,;; • • WILLIAM NICHOL, M.D. The Montreal Homoeopathic Dispensary, 140 Mansfield Street, October 1, 1889. 1 1 "?">-:> i 4. JL X.X.JH X J OF HOMdO- Homce&pathy, OL, M.D. L HOMCEO- 189.; t the original 00 narrow, so t Dispensary they are now t an Outdoor tober last we jpensary and e Dispensary )L, M.D. [OL, M.D. CONGESTION OF THE LUNGS AND ITS DANGERS. No organ in the human body, with the single exception of the brain, is so frequently the seat of congestion as the lungs. In these all-imi)ortant organs it occurs in various degrees, some- times in the most insidious manr.er, sometimes developing Itself with extreme rapidity, and, in (he strong language of Itokitansky, it is " the anatomical basis of moat sudden deatlts:* And yet, strange to say, this most serious morbid state is but little mentioned in medical text books. It is wholly omitted in K-issell Reynolds' System of Medicine, the choicest product of the British medical mind of our day ; it is overlooked in Aitken's Scknce and Practice of Medicine, which is the text- book for the medical officers of the British army, though soldiers are notoriously prone to congestion of the lungs. Sir Thomas Watson— the Macaulay of British Medicine— does not mention it in his classic Lectures on the Principles and Prac- tice of Physic; it is unnoted in Dr. George B. Wood's Practice of Medicine, for many years the leading text-book in the medi- cal schools of the United States. It is omitted in Strttmpell's Text-book of Medicine, now the text in the Medicil Depart- ment of Harvard University; no mention of it is made in Dr. Charles Hilton Fagge's Principles and Practice of Medicine-i the best medical work of our day written by one author. It is unnoticed by Graves, Copland, Eberle, Good, Hooper, Forbes Tweedie, Da Costa. Brief and unsatisfactory notices of this morbid state are given by Eichhorst. Eoberts and Cammann, and the only really good articles on this important subject are the one by Dr. llertz in Von Ziemssen's Cyclopaedia of the Practice of Medicine, and iil 59354 142 that by the lamented Felix Von Niemeyer in his Text-look of Practical Medicine. ^ But, as a matter of conrse, the writers of special treatises on the lungs make up for the deficiencies of their brethren-the writers on the Practice of Medicine. They do nothing of ine kind It is not even mentioned by W. W. Gerhard. Wil- liam Stokes, Austin Flint. Germain Sde, A. T. H. Waters and Douglas Powell. Surely the writers on the diseases of children give full and exhaustive accounts of what even the laity begin to recognize as a grave morbid state. It is wholly unnoticed by Churchill. Elhs Sterner. West, Vogel. Condie, Bouchut, C. D. Meigs, J F. Megs Dewees Clarke, J. Lewis Smith, Eustace Smith. Co es. Underwood, Henoch, Hams. Day, Evanson and Maun- and Starr D'Espine and Picot; and the homc«opathic writers, who ought to know better, are just as deficient, for it is not mentioned by Hartmann, Minton. Duncan. Laurie. Guemsey, Edwards. Underwood Thomas, Hartlaub, Ruddock. Williamson or Teste Sc.dder. the eclectic writer, joins his homc^opathic brethren m this as well as in many other things As the natural result of this most culpable neglect on the part of medical teachers and writers, very many practitionei^ even when well educated and well-read. know'cuLusly li tie' about congestion of the lungs; and this very year, one of th! most brilliant medical writers on this contfnent /rankly e n- fessed that, "the asthenic pneumonias and passive congestions ^h.ch are so frequently found affecting the aged, have been conducive to mistakes in my practice to a shameful degree " Some of the chiefs utterly fail to gmsp even the nature of this morbid state. Thus a fe. years ago. when a lady made some remarks on this subject to the leading (allopathic) physi! replied , Y^ / v,\oi we used to call injtammation of the lunaa ZilT ?.f ^"'""•" ""'' '"^ ^P^^'^- -- ^ "-n of mo' decided ability, recogmzed by all as m««P<^«n« ,«.« .,7.= -v sr i -iaii^ I Text-look of al treatises on brethren — the lo nothing of GJerhard, Wil- '. Waters and give full and o recognize as l)y Churchill, B. Meigs, J. istnce Smith, n and Maun- iT, Goodhart ithic writers, . for it is not ie, Guernsey, , Williamson homceoputhic ?gleet on the practitionei-s, riously little r, one of the frankly eon- congestions, have been degree." le nature of lady made ithic) physi- al iurninary }fthelunga nan of most gifts in his calling. Now, if such a man held such grossly erroneous views, what must be the state of the rank and file of the profession ? A few years ago I had a conversation with a retired English practitioner, familiar with London Hospital practice, in the course of which I i-laced before him the modern views of con- gestion of the lungs. After a good deal of thought he remarked, that the morbid state I had just described to him amply ex- plained a immber of fatal cases which he had seen many years before in England, some of them very sudden, the true nature of which was not understood at the time. In fact, all of them were attributed to heart disease, which even to-day is vulgarly held to be the cause of almost all sudden deaths. I do not remember a single allusion to this morbid state in all the lectures of my student days, and even the lecturers on Clinical Medicine in Pennsylvania Hospital— Drs. George B. Wood and W. W. Gerhard, both distinguished for their knowledge of pulmonary disease— made no menti.m of it whatever ; and so it came to pass that when I commenced practice I knew nothing whatever of congestion of the lungs. I had a fair knowledge of congestion in general, and also of congestion of the brain°and other internal organs, but of pulmonary congestion I was grosp^ ignorant. Soon after I commenced practice, a medical friend, now deceased, belonging to the dominant school, requested me to see a case of his in consultation. The patient was a strong, athletic man in the prime of life, who had been suffering from delirium tremens, but who was now convalescent— at least from that disease. He had carelessly gone into his garden, insufficiently clad, and had evidently taken cold. We found him with a weak, fluttering pulse, cool skin, covered with cold sweat, cold extremities, difficult breathing, muffled cough. On examining we found that scarcely any air entered the lungs, while the tired heart tried in vain to propel the blood through these organs. It was an entirely new morbid state to me. and my friend, who was many years my senior, admitted that he had not noted it before. We turned the case thoroughly over in our minds in the light 144 of physiology and general pathology, and came to the conclusion that the lungs wore completely dammed up with blood, that, in •act the man had congestion of the lungs,. My friend i.re- »cnl>ed accoHmg to the light we had, but the man died in spite of very dose attention. We looked up all the hooks and journals ,n our libraries, but found no ray of light from what wns really a good collection of medical literature Not long after this case, which made a deep impression on my m.nd. I was called to see a young woman, who had been taken suddenly dl w.th what the messenger called a .evere cold on the lumjs. I fonnd that the morbid state was entirely similar though not so severe, as the fatal case I had so lat^aly witnessed I prescribed a remedy famous in our scl.ool for its power over congestion in general, giving it in a mtional dose, singly and alone, and had the satisfaction of seeing the formidable symptoms change with the rapidity of a scene in a theatre. The breathinsr became easier, the coldness of the hands and feet gave way to the natural warmth, the p.dse became fuller and firmer, a pro- fuse perspiration set in, and the patient was safe. Congestion of the lungs became to me, and also to my friend, a well-recog- nized morbid sUvte. calling for a well-defined treatment and emi- nently responsive to that treatment. In the following pages I intend describing the acute form of this morbid state, as well as the slower and more insidious one which eventually becomes chronic, and I think that I must des cribe jmlmonary catan'h, which is a closely allied and still more serious form of disease; and as I am writing for non- medical readers. I will do my utmost to place this important phase of disease before them in the clearest light and in the plainest language. There are. then, at least fourtolembly distinct phases of dis- ease which come under the general head of congestion of the lungs. Taese are: active congestion, passive congestion and obstructive congestion of the lungs, and. lastly, pulmonarv \ ! > the conclusion blood, that, in My friend pre- m dioil in spite ilio hooks and gilt from what i)res3ion on my ud bei'U taken .evere cold on iitirely similar, tely witnessed, its power over igiy and alone, jle symptoms The breathing t gave way to firmer, a pro- Congestion a well-recog. lent and emi- acute form of nsidious one 1 1 must des- ied and still ing for non- is important t and in the bases of dis- '3tion of the igestion and pulmonar'- 145 ACTIVR CONGESTION OF THE LUNGS. Virchow defines this to be "a rush of blcKxl " to these organs, and he considers that the arteries are chiefly affected. It "con- Slats m such a determination of blood to the lungs that breathing 18 more or less interfered with, together with cough, and at times hemorrhage. This state results from any cause capable of producing a fl.»w of blood towards the lungs. Exposure to cold is undoubtedly the chief cause, and it is directly responsible for many sudden deaths. Take the following case, reported in the Montreal Witness of Feb. 9th, 1889, and appropriately headed, " Frum exposure during Carnival " : " A fatality, which in a way was attributable to the Carnival festivities, was a\ZZTfr!"l7y " ^'°'-«"^''« .''"-y- Mrs. Mercier, a hale and hJar.y old lady of 76, had hitherto enjoyed the best of health. She ha.1, however, delayed too long on the streets watching the crowds of people which filled the thoroughfares ,n the West End. and was fatally seized with illness as she was eavmg the up-town branch of the Jacques Cartier Bank. Dr. Bouchard, who was called in, gave it as his opinion that death was atlribut- able to congestion of the lung-, brought on by exposure to the inclement t'lr'non ''" ^"'^ '^^""'^ * ^"'"°' '" accordance with the medical Violent exercise, loud and prolonged speaking, even mental emotion, the taking of cold drink, when the individual is heated and perspiring, running and d. . .ng are other exciting causes. All these act by causing a sudden recession of blood from the surface of the body, resulting in a concentration of that fluid in the pulmonary organ.g. Active congestion of the lungs appears, as a rule, in healthy, even plethoric individuals, but it must not be forgotten that this state is very common in persons in whom the mass of the blood has been greatly reduced by hemorrhage. A certain amount of active congestion always precedes in- flammation of the lungs, and, moreover, hemorrhage and dropsy of the lungs both imply a previous condition of congestion. In active congestion of the lungs there is an abnormaUy active cireulation la the part, together with an increased quantity of 14« Hood. At firat the nilimte Moml-vcsBcln, called cftpillnrioa, contract, and this contraction is accoiniwinied by au increased How of blood to the part. But soon the contraction ceases, and the capillaries beconio much larger than in health. A greotly lucsreased amount of b](K>d now passes through these capillaries, and the increased number of blood-disks gives the att'ected part a ruddy hue. A slight congestion is accompanied by increased function of the part, while a decided congestion is accompanied by increased heat and increased ennoivation. In all cases the action of the heart is increased, and the arteries are the chief seats of the morbid state— as a rule the aflected vessels are relaxed. Acute congestion of the lungs may insensibly change into the passive form, and this is by no means uncommon. The latest view bf this morbid state, and one which the pre- sent writer most firmly upholds, is that in congestion of the lungs, and, indeed, in all congestions, a kind of paralysis affects the walls of the blood-vessels. The vaso-motor nerves, the nerves which control the dilatation of the blood-vessels, are para- lyzed, ond the enlargement of these vessels is the natural result. To the French pathologist, Andral, belongs the credit of having first (1829) described the general character of congestion of the lungs, and for many years the French had a kind of monopoly of knowledge in this morbid state. Still another Frenchman Woillez, demonstrated (1851) that congestion of the lungs pro- duces an enlargement of the chest. Generally speaking, it may be said that congestion of the lungs is most frequent in young men, also in speakers, singers, and performers on wind-instruments. Congestion of the lungs usually begins suddenly, and is pre- ceded by a chill. This preliminary chill may be a mere feeling of coolness, or it may be a true shaking chill like that of inter- mittent fever. This initial stage may extend over several days, the chilly ff .3ling alternating with flushes of heat, or it may be merely a vague but very real feeling of discomfort. Then comes a pain in the lungs, generally in the side. At times this 147 ed cApillaries, y au increased iun censes, and l». A greatly use cnpillariest i att'ected part I by increaHed i accompanied In all cases 8 are the chief iid vessels are Y change into ion. I'hich the pre- festion of the ralysis affects • nerves, the sels, are para- latural result. i3dit of having [estion of the of monopoly Frenchman, lie lungs pro- istion of the kers, singers, ', and is pre- mere feeling bat of inter- jeveral days, or it may be ifort. Then Lt times this pain may be so slight as only to be felt on making very deep inspirations, and I have seen ranny cases in whi ;h pain was wholly absent. It is often accompanied by rheumatic pains in the muscles uf the chest, and at times the pain is distinctly neuralgic, following the course of the nerves — the pain is always made worse by breathing. Fever is now present, generally slight, and never lasting longer than forty-eight hours. The pulse is small and thready, running 90 to lOU to the minute, seldom higher. I have never noted the thermometer to register more than 102^'', and the tem- perature is often much lower. Difficulty of breathing is one of the leading symptoms, and this varies from a very slight feeling of uneasiness to an oppres- sion so severe that the patient can hardly breathe at all. The respimtions run 40, 50, or even 60 to the minute, and in one extreme case they numbered no less than 180. Curiously enough, the pulse is not coirespoudingly rapid, and hence con- gestion of the lungs has often been mistaken for asthma. Cough is often entirely absent, and it seems to depend more upon bronchial irritation than on the pulmonary (jongestion. It is quite certain that the greater part of the lungs may be con- ' gested without causing any cough whatever, and I look upon a, cough as a favourable indication. Expectoration is absent in the beginning of the attack ; later it resembles the sputa of an ordinary bronchial cough. Probably Virchow's view is correct, that the expectoration simply conveys away from the congested lung a great part of the noxious mat- ters with which it is clogged. The expectoration is sometimes streaked with blood, and hemorrhage is by no means rare in sudden congestion of the lungs — the blood simply bursting through the distended vessels. This often gives rise to a sus- picion of consumption, but by good homoeopathic treatment the vast majority of these patients are restored to health. But if the hemorrhage is extensive, organic disease of the lungs is prob- ably present. There is a violent form of congestion of the lungs, whioh 148 develops rapidly, and threatens life with most unexpected sud- denness. The hurried breathing cannot be counted with accu. racy, and the fulness of blood in the lungs causes choking with fear of death. Blood is often coughed up. The heart beats furiously, and the arteries throb as if they would burst The serum of the blood passes through the walls of the blood-vessels and fills up the air- vesicles, so that the blood is soon loaded with carbonic acid. On February 15th, 1889, I was telegraphed to go to a lady, residing in one Of the suburbs, who was said to be very ill. I found 1 J „ coml collapse. The face, an^ especially the nose and ears, were as cold a a corpse and covered with a cold sweat. The limbs, too, were cold, and this e^ded even to the upper part of the thigh. The lungs were so fiired wi h ZlZ, '?""-"' ."" "'"="^^' '"""^' '^y '^-'^ -'--ted. tL gen us of Hahnenmnn. ,^nd .n two hours the patient was safe. The death-like coLness passed away, a certain amount of blood passed out of the pulmonary . Si'T ' ^y ^'"■' '''''"''^ "^ ^""'="°"«' "«t»ral respirations suZ ceeded the gurghng choking. I saw the pafent but five times, and dis- missed her on the 2l8t. Stmi/h Simibus Curantur. Not all of these cases terminate so fortunately, for the blood may burst in very large quantity into the substance of the lungs, completely filling them, and almost certainly causing ueatn. Many years ago, a medical friend of mine got just such a case, of such a threatenmg aspect that he prudently requested a consultation. We ound lf'th"is"!S r""' r'''\ '"" ''''''''^^ ^'^^' «"^ «•« -ere quite certain of th>8, although no hemorrhage had taken place. Within an hiur an enor- mous gush of blood took place, and the man died at once. As in the case of Mme. Mercier, already quoted, acute con- gestion of the lungs may prove fatal in a few hours. As a rule, however, it lasts from two days to a week, and very much depends upon the prompt recognition of the disease and upon the treatment adopted. If the morbid state is recognized at once, and an enlightened homeopathic treatment instituted without delay, then the cure is prompt and latisfactory. If the disease is overlooked till it has reached an advanced stage, then 149 nexpected sud- ted with acciu s choking with he heart beats d burst. The B blood-vessels is soon loaded • Ia ; that of con- gestion is evanescent and rarely exceeds 102«'. Lastly in pneumonia the signs obtainable by auscultation are almost in- variable; m congestion they vary almost infinitely. Under efficient homoeopathic treatment, the prognosis of acute congestion of the lungs is extremely favorable. In thirty-six years I liave seen but two fatal cases under homoeopathic treat- ment, and both had been grossly neglected. But it must be under- stood that repeated attacks modify this favourable statement very much, for they are serious matters in children, especially when scrofulous, knd in young people, especiaUy in young women. A history of consumption in the patient's family makes a gloomy prognosis, for consumption often follows re- peated attacks. Poverty is a serious hindrance to rapid and permanent recovery. It is most astonishing to read in the Reference Hand- hook of the Medical Sciences (vol. iv., p. 589), a practitioner of Dr. Donald M. Cammann's eminence recommending the foUow- mg treatment :_" Cupping should be practiced over the seat of the hypersemia or over the whole chest, for the purpose of dniunishiiig the supply of blood to the lungs. Dry cups should be applied if the patient is feeble and gives evidence of exhaus- tion, but wet cups should be used for plethoric patients. Hydra- gogu cathartics are beneficial. The dyspnoea and feeling of anxiety may be relieved by steam inhalations and the applica- tion of mustard to the extremities. A hot-air bath relieves the overloaded pulmonary vessels, and often gives relief from dis- tressing symptoms." How different from this cumbrous and antiquated treatment is the prompt simplicity of the homoeo- pathic therapeutics 1 1 In pneumonia ored in hue, and cup, even when (parent, and only f pneumonia is 5" ; that of con- '2". Lastly, in 1 are almost in- Jgnosis of acute In thirty-six oeopathic treat- must be under- able statement Iren, especially ally in young atient's family ten follows re- to rapid and ivence Hand- practitioner of ing the follow- ver the seat of le purpose of y cups should ice of exhaus- ients. Hydra- md feeling of d the applica- h relieves the lief from dis- umbrous and " the homoeo- 161 While I write this (Oct. 7th) I am attending a case which affoide an admirable illustration of this fact. On the afternoon of Oct. 6th, I was called to fee Alice B., aged nine years, residing in the upper part of the city. I found an undoubted case of acute congestion of the posterior part of the left lung, a typical case with all the physical signs and vital symptoms. The temperature was 101°, though the mother, who possesses the gift of a knowledge of homujopathic treatment, had given the correct remedy pending my arrival. On the forenoon of the 6th the amendment was so marked, that keeping the patient in bed was a mere measure of precaution, and the patient was dismissed fifty-two hours afier the commencement of treatment. A patient suffering from acute congestion of the lungs should be put to bed, for absolute rest is essential to recovery. I know of several instances in which death resulted from a neglect of this precaution. He should speak as little as possible, for speaking brings more blood to the lungs, and there is too much there already. A milk diet should be the rule for the first few days, after which beef-tea is in place. The sick-room should be well ventilated and yet free from draughts, for ventilation and draughts are not by any means synonymous terms. The patient should be very cautious about resuming out-door avocations. PASSIVE CONGESTION OF THE LUNGS. This may be defined to be an incomplete stagnation of blood in the lungs ; indeed Virchow simply defines it to be a stagna- tion of blood. It arises from deficient tone in the veins and capillaries of the lungs, permitting an accumulation of blood in them, the result of which is a languid and retarded circulation. It is rarely a primary affection. It is often found in young women, and also, just as often, in persons advanced in life, especially if of inactive habits. Disease of the valves of the heart is a well-known cause, but failure of heart power— an inability to force the blood through the lungs— is unquestion- ably the principal agent in the production of this morbid state. This failure of heart power, little recognized but quite common, often supervenes in the utter exhaustion which sometimes follows typhoid fever. Passive congestion is not rare in extreme old age, and it is a frequent cause of death after serious surgical r ' ■ i ; I M 162 operations. Then the blood-vessels lose their tone, and the blood naturally gi-avitates towards the most dependent parts of the lungs. In passive congestion there is an increased amount of blood in the affected part, and the blood moves slower than in health. Debility of the veins and capillaries is the essential element and the blood simply stagnates in these enlarged and feeble vessels. This debility is accompanied by impaired nutrition, and, as a matter of course, the impaired nutrition causes im- paired function. Death of the affected part is the necessary result of extreme congestion, and the dead part is not renewed. The importance of this fact will be fully understood when we discuss the relation of consumption to this form of congestion and to pulmonary catarrh. In very many cases the vitality of the blood is low- ered. ' i.?':.*^°Il" 5 ^'"'^^''' ^^ ^^"^^nnati, the able editor of the EcUchc Medical Journal, compares an active congestion to " a freshet m a rapid stream, .in which there is turbulence in the cuirent and a passing from side to side, and occasional eddyina of the floating material in addition to the forward movement" In congestion we are reminded of a sluggish stream when hlled by recent rains ; we see that the stream is full, but have difficulty in determining the direction of the current until after we have observed it for some time." If the blood-vessels rupture, hemorrhage from the lungs is the result; and the enfeeble dwalls of the capillaries favour the exudation of the watery part of the blood-this, of course is dropsy of the lungs. * This form of pulmonary congestion plays an important part in many diseases of the lungs, especially in bronchitis of children and of aged people. Passive congestion of the lungs always creates greater diffi- culty m breathing then the active form, and this difficulty is aggravated by the slightest movement. This arises from the fact that m passive congestion of the lungs the circulation of one, and the blood ident parts of the d amount of blood ^er than in health, essential element, larged and feeble mpaired nutrition, trition causes im- result of extreme The importance iscuss the relation md to pulmonary the blood is low- ble editor of the congestion to " a urbulence in the 3casional eddying ■ward movement, ih stream when is full, but have irrent until after I the lungs is the tries favour the lis, of course, is mportant part in litis of children tes greater diffi- ihis difficulty is arises from the tie circulation of 153 blood is greatly retarded, and in some parts of the lungs the blood is at a stand-stiU altogether. In the active form, as we have seen, the blood moves faster than in health. A great num- ber of heart-patients die of passive congestion of the lunag A sudden effusion of serum from the pulmonary vessels takes place, and the patient is gradually drowned. The breathing surface becomes less and less, the blood is imperfectly aerated" and the patient finally sinks. A patient suffering from this form' of pulmonary congestion is cool, livid and bluish, especially about the lips and fingers, and as the morbid state advances prostration becomes extreme. In a certain number of cases the effusion takes place suddenly, and the patient dies at once. But as a rule passive congestion of the lungs progresses very slowly and often improves under treatment, though at times this improvement is deceptive. The deaths from sudden effusion are usually due to some imprudence, such as running to catch the street-cars, but I have known death to result without any appa rent cause. '^^ I have invariably found the temperature in this morbid state below the normal. Percussion is always dull, and the ear detects more or less mtthng at the base of the affected lung, while the ordinary vesicular respiration is very incomplete. The base of the lung is the chosen seat of this form of pul- monary congestion, and the affected part is dark-red or purplish m colour, for the blood which dams up all the vessels is very dark, mdeed almost black. Minute hemon-hages into the sub- stance of the lung are even more common than in the active form. The diagnosis is very plain, and is entirely dependent on the group of symptoms already described. From obstructive con- gestion of the lungs it is distinguished by the absence of heart- disease, otherwise the two states are very similar. Curiously enough, passive pulmonary congestion has been confounded with typhoid fever, though the ensemble of symptoms is entirely dif- ferent. A couple of years ago, a lady, residing at the east end 154 il of Montreal, was taken ill with what her medical attendant, an experienced man from the centre of the city, said was typhmd fever. After the case had lasted many weeks, another physician was taken in consultation, who pointed out that the patient had all along been suffering from passive congestion of the lungs that the lungs wer^ full of the exuded serum, and that the issue would be fatal. And it was. Frequent hemorrhages make a gloomy look-out, and attacks of catarrhal bronchitis aggravate the morbid state very much. This form, if ill-treated, or not treated at all, often terminates in consumption, and even if this does not take place, it may .-esult in a permanent condensation of the lung tissues, which, in its turn, tends to disease of the heart. One of the iirst thoughts of the physician, when treating a confirmed case of; passive congestion of the lungs, fs to send the patient to the mountains. This is the secret of the good results of Colorado in pulmonary complaints, but I have found a resi- dence at Georgeville, in our own fair Province, even more effec- tive and vastly cheaper. The diminished atmospheric pressure stimulates the pulmonary tissues and thus induces contraction of the dilated vessels. Note, however,- that for this very reason patients subject to hemorrhage should not go to the mountains. In this phase of pulmonary congestion the diet should be nourishing, and I look upon a well-made beef-tea as being the sheet-anchor. The chest, back and front, should be sponged with cold water every morning and then dried with a coarse towel. Exercise shoulu only be taken under medical advice I have known death result from a neglect of ti is precaution. Perhaps in no form of pulmonary disease does homoeopathy show more brilli..nt results, and I have seen cures of apparently hopeless cases. It must be noted that active congestion of the lungs may be succeeded by the passive form. An individual is exposed to a draft of air, takes cold, and has a sharp attack of active conges- tion of the lungs. This is but partially cured, the arteries lical attendant, an , said was typhoid , another physician at the patient had 3tion of the lungs, and that the issue <-out, and attacks state very much. )ften terminates in lace, it may ,'esult sues, which, in its , when treating a gs, fs to send the f the good results lave found a resi- , even more effec- ospheric pressure duces contraction : this very reason the mountains. e diet should be f-tea as being the 3uld be sponged 3d with a coarse medical advice — ti-is precaution. •es homoeopathy res of apparently he lungs may be is exposed to a f active conges- fed, the arteries 156 ' recover their tone to a certain extent, but the capillaries and veins dilate, and passive pulmonary congestion is the result. OBSTRUCTIVE CONGESflON OF THE LUNGS. Obstructive congestion of the lungs differs essentially from tlie two varieties just described, inasmuch as its origin is purely mechanical — it is always a secondary form of disease. It results from any cause which prevents the return of blood from the lungs, such as constriction of the mitral valves of the heart or the pressure of a tumor on the pulmonary veins. Some writers incline to think that it is illogical to separate obstruc- tive congestion of the lungs from the passive form, but the existence of the mechanical cause is a sufficient mark of distinction. As in all other foims of pulmonary congestion, those suffering from the obstructive form have cough and difficulty of breath- ing. Palpitation of the heart is almost invariably present, with oppression of the lungs and a tightness across the stomach. Such patients often have bronchial catarrh with spitting of blood — the result of irregularity in the distribution of the blood. The pulse is very small and frequent, and the lips and fingers are blue and cool. In the obstructive form, progress is from bad to worse, simply because the morbid state frequently depends upon an incurable affection. Still, I have known such patients live for many years — but each paroxysm must be met by the appropriate homoeopathic remedy. The temperature of the body is low at all times, and particu- larly during a paroxysm. Examination, by means of the ear applied to the chest, shows very imperfect breathing, and, in places, no breathing at all. During a paroxysm a kind of collapse often takes place, the patient gets cold and bluish, and the heart needs some alcoholic stimulus to enable it to resume its functions. A chief characteristic of this variety is the enormously dilated i 156 capillaries, which, according to Rindfleisch, are often found to be expanded to three times the normal size. In colour the lungs are of a brownish hue, and they are larger, denser and heavier than in the normal state. The prognosis in this form is more serious than in either the active or passive varieties. Still, I have seen patients live many years in comfort, especially when the morbid state is dependent on simple constriction of the heart- valves. Speaking in general terms, it may be said that this form calls for the same management as the passive form. 'CONGESTION OF THE LUNGS IN CHILDREN. Congestion of the lungs, as we have seen, is one of the most neglected fields in the entire range of children's diseases, and yet it forms that initial stage of many maladies, the prompt meeting of which removes all danger. This morbid state is frequent in children, especially in delicate children inclined to be scrofulous. Even in babes in the arms it is by no means rare, and it increases in frequency to the age of five years. It is more frequent in boys than in girls, and this quite independent of any external cause, such as exposure to cold. Children with irritable hearts are most open to attacks, for such a heart is prone to send an increased quantity of blood to the lungs on but slight provocation, and when that increas«id quantity of blood encounters relaxed pulmonary capillaries, all the factors of congestion of the lungs are present. Such chil- dren are likely to have repeated attacks, all the more to be dreaded, as here the danger lies not in one single attack, but in repeated attacks, each more destructive than its predecessor. As to causation, any hereditary weakness of constitution would cause a predisposition to that irritability of heart, and to that half-paralytic condition of the pulmonary capillaries, which are the two factors of this morbid state. Then exposure to heat or cold would cause, by reflex action, that irritation of the respiratory tract which results in congestion. I have known violent and long-continued crying to have the same effect. 167 'e often found to colour the lungs nser and heavier lian in either the en patients live morbid state is alves. it this form calls .DREN. one of the most I's diseases, and dies, the prompt cially in delicate ibes in the arms lency to the age han in girls, and luch as exposure open to attacks, uantity of blood n that increased y capillaries, all nt. Such chiU the more to be le attack, but in predecessor, of constitution of heart, and to apillaries, which ixposure to heat pritation of the I have known ^me effect. The symptoms of congestion of the lungs vary with the violence of the exciting cause and the extent of the congested part, and a ccitain degree of congestion is almost within physi- ological limits, inasmuch as it produces no sympti»ms. As a general rule, the commencement is sudden, with shiverings, fever and oppression of breathing. The fever is rarely high, but in not a few cases I have noted that it was altogether absent, though usually the face is flushed, with violent pulsation of the great vessels of the neck. One of the most marked symptoms is difficulty of breathing, and this often develops with startling rapidity. The respiration is hurried, panting and very super- ficial, and often there are as many as fifty respirations to the minute, though the average does not exceed thirty to thirty -five. A good deal of cough is always present in the pulmonary conges- tions of children, for it is almost constantly associated with bronchial irritation. Acute pain is usually absent; generally speaking, the pain is dull and heavy. The feeling of weight and oppression of the lungs, so very prominent in the pulmonary congestion of the adult, can only be ascertained by physical ex- aminations, except in those cases in which the patient is old enough to describe its sensations. Hemorrhage can rarely be detected, though, according to Ernest "Wagner, it is almost invariably pre- sent. He writes : — " According to more recent experience, very small bleedings from the uninjured walls of vessels occur in every congestion even of short duration. But also somewhat greater capillary bleedings take place, probably very often in congested parts, but for the most part present no symptoms because the blood exuded is carried away as soon as it reaches the origin of the lymphatics." One of the most striking features of pulmonary congestion in children is its tendency to disappear suddenly, leaving hardly a tmce behind, and not less remarkable is its tendency to recur on very slight exposure indeed. The temperature suddenly falls, the difficulty in breathing disappears, the child recovers its strenorth and spirits, and health ia restored. When death takes place it is usually sudden, and many e so-called " de^^ths from 158 heart-disoase " are really fovulroyante cases of pulmonary con- gestion. ^ Congestion is often as short in its duration as it is sudden in its attack. If promptly treated it does not lust over sixty hours, though neglected cases would run a week or even more. Chronic cases— and all neglected cases are in danger of becoming chronic— run on indefinitely, and are both tedious and diHiciilt 01 cure. MeyholJer says that the mean duration of an acute case, without medicinal interference, is three to four days. In children the temperature of congestion of the lungs rarely exceeds 100° ; I have seldom lonnd it as high as lu2''. "lowarda ■-.he close of the illness the temperature often falls as low as 96p. The percussion sound iu this morbid state is not very char- acteristic. Usually it is abnormally clear, iu fact quite tym- panitic during the early course of the congestion, but further on dullness is present, especially at the base of the lung. Meyhoffer remarks that a congestion, which does not materially lessen the ability of the lung to hold air, will not present any appreciable diminution of sound. Auscultation furnishes equally unsatisfactory results, for there are no absolutely distinctive sounds in this morbid state. The respiratory murmur is either absent or else masked by the copious rales, often loud enough to be heard at some distance from the patient. The enfeebled respiratory murmur arises from the insufficient expansion of the air-cells, already oppiessed by the swollen capillaries and later by the sero-raucous exudation. I have detected bronchophony in some few extreme cases in which the sero-mucous exudation was very groat. The motions of the lungs, which form such a notable feature in their physiological action in children, are notably diminished in congestion. On post-mortem examination the lungs are found to be of a deep-red colour, which in extreme cases is purple or blackish- red. A frothy bloody fluid flows from the cut surfaces, and the .lung-tissue itself is moist, relaxed and heavy; crepitation is diminished, but pieces of congested lung float iu water, unless ^ 4 1 of pulmonary con- )n as it is sudden in lust over sixty hours, 3ek or even more, danger of becoming tedious and diHicult ion of an acute case, )ur days. of fhe lungs rarely haslf2'^. Towards ten falls as low as te is not very char- in fact quite tym- tion, but further on ihelung. Meyhoffer aterially lessen the ent any appreciable )ry results, for there morbid state. The isked by the copious e distance from the r arises from the oppressed by the 30US exudation. I •eme cases in which The motions of the their ph)'siological congestion. e found to be of a Durple or blackish- it surfaces, and the ivy; crepitation is it in water, unless 159 indied the effusion has been very great. Owing to the swelling of the walls of the air-cells and of the interstitial tissue, the vesicular structure of the hiiigs is hardly i.pparent, and the mucous membrane of the bronchial tubes is almost always injected and coated with blood-streaked mucus. Congestion of the lungs is most likely to be confounded with the early stage of pneumonia, and it is quite certiiin that the diagnosis is rarely sharply drawn between the two diseases. Pneumonia, however, has a • inch higher temperature, wliich is rarely under 103°, while the rise is sudden and the elevation persistent. In congestion of the lung, on the contrary, the tem- peratine rarely exceeds 100**, while the rise is tnore gradtial and the elevation very transitory. The fever of pneumonia lasts from eight to ten days, while that of congestion disappears in two or three. Well-marked bronchitis is a frequent accompaniment of pneumonia, but well marked bronchitis is rarely present in congestion. Finally, the physical signs of pneumonia are almost unvarying, while in congestion they vary very .Tiuch. Bronchitis usually affects both lungs, while congestion is generally unilateral. Bronchitis has copious rales all over, the bronchial tract, while the respiratory murmur is exaggerated ; in congestion crepitation and sibilant r^les are the rule, while the respiratory murmur is either very feeble or is altogether absent over the congested part. The prognosis of simple cotigestion of the lungs in children is eminently favourable ; in the vast majority of cases, a really serious state entirely disappears in a few days ; repeated attacks give rise to a more unfavourable prognosis, for, whtn associated with scrofula and poverty, they are often the precursors of con- sumption. A fatal result is very rare, even when both lungs are congested, unless indeed the little one has been grossly neglected, or has been a sufferer from valvular disease of the heart or some other dangerous malady. The child should be kept quiet in bed, and the head should be somfiwhat elevated. Talking should be discouraged, and the patient must be kept in good humour at all costs* The diet 160 should be liglit but iv»itritiou8, and no wine or other stimulus ahould be given, as all sL.rnuli tend to increase the morbid state. When convalescent the patif nt shotild not go out too soon, and deep insidrations are of great value in restoring a healthful action of the lungs. PULMONARY CATAHRH. Pulmonary catarrh, also called catarrhal pneumonia, is not strictly a congestion of the lungs, but it is so often associated with it that any account of pulmonary congestion would be in- complete without some account of it. The truth is that puhnon- ary catarrh complicates a majority of cases of all the forms of con- gestion of the lungs, adding "rcatly to the present danger, and still more to the future. It is almost always the result of catanhal bronchitis— the morbid process simply extending from the bronchial mucous membrane to the air-cells of thelungs. Taking cold is, of course, the first step in the bronchial affection, and a fairly correct idea of pulmonary catarrh may be obtained by reflecting that the same process goes on in the air-cells of the lungs as obtains in the nasal mucous membmne when one is suffering from a cold in the head. It is more frequent in children and young people than in adults, and it adds greatly to the danger of measles and whoop- ing cough. Felix von Niemeycr goes so far as to say that "it may very properly be called a disease of childhood," but it is almost as common and even more fatal in yoang \i .men. I feel quite certain that in a majority of caser .^♦"con jnitption in young women pulmonat^j catarrh ia of tfte essence of the disease. Pulmonary catarrh, then, is always a secondary disease, and so it3 symptoms are mingled with the symptoms proper to the • idtig >r other morbid state, by which it was preceded. 'i.; ch.;;cEer of the fever and of the cough are the chief data i'>v 'le diagnosis When pulmonary catarrh supervenes upon a cataiThal bronchitis the temperature always rises. During the attack of broneliitis let us say that the temperature stood 161 e or other stimulus the Tijorbid stute. n out too aoon, and itotiug a healthful pneurnoTiid, is not so often nssociuted stion would be iu- ith is that pulmon- 1 the forms of con- resent danger, and aya the result of ly extending from 3ell3 of the lungs. >ronchial affection, I may be obtained :he air-cells of the i-aue when one is g people than in sasles and whoop- is to say that *' it idhood," but it is oni;; \i imen- I ^" J /n ;'M ption in 6 essence of the y disease, and so 13 proper to the it was preceded, re the chief data supervenes upon 3 rises. During smperafcure stood at 101**, or a little lower; then as soon a« pulmonary catarrh develops, the thonnometer marks 104° or even higher. The jmlse becomcH full and fre(iueut, the face reddens, the eyes glisten, and the jnitient becomes restless and anxious, or, in very severe Lilies, aputl.otic and somnolent. The cough, which has been iiioist and easy, now becomes painful, so that the patient fears to cough. On examining the chest it gives forth a dull sound, that is, if the new morbid state extends over a considerable space ; but if it is limited, then physical examination reveals nothing or next to nothing. On examining well-developed cases, it will be noted that the breathing is rough and ditticult, and the rattling of mucus in the lung is very characteristic. In acute cases the disease marches on very rapidly, especially if the patient is a child, young and feeble. The flushed face becomes pale and livid, the lips bluish, the eyes dull and heavy, the restlessness changes to somnolence, constantly increasing. This state is the residtof the incomplete oxygenation of the blood and of its overloading with carbonic acid. Pulmonary catarrh rarely terminates suddenly, and it is more likely to become subacute or chronic, and this is most frequently seen wlien the pulmonary catarrh follows whooping-cough or catarrhal bron- chitis of long standing. When pulmonary catarrh ends in resolution, the inflammatory products are absorbed after undergoing certain changes. After quiie a fight the [)atient slowly recovers health and strength. But the termination is frequently of a less favorable nature. The thick and tenacious mucus may infiltrate the lungs, flood- ing all their cavities, constituting what is known as caseous or cheesy infiltration. The fever moderates somewhat, but it still rises towards evening, aud by andby is followed by night sweats. The cough and difficulty in breathing become worse, and the strength fails day l)y day. Physical examination at this stage shows a condensation of the tissues of the lungs, together with the cheesy infiltration. Then, atier a longer or shorter delay, the infiltration dissolves, cau.^ing a vast destructjoa of the lung, aud \ 1 ii^- consumption is now fully developed. Virchow wtiteS t— " Upon examining the point which has been ihe leading one in the doch trine of tuberculosis recently advanced, namely, tubercular infiltration of the lungs, we readily arrive at the result which Eeinhardt has set down as the final one, namely, that tubercu- losis is nothing more than one of the forms presented by inflammatory products when undergoing transformation, and especially that all tuberculous matter is really inspissated pus. In fact, what has been termed tuberculous infiltiution can with few exceptions be traced to bu originally inflammatory puru- lent or catarrhal mass, which has gradually, in consequence of incomplete^ absoiption, fallen into the shrivelled and shrunken state in WKich it afterwards remains." In order that such a catastrophe should take place it k not necessary thut the individml should be of consumptive tenden- cies. All that is needed is that pulmonary catarrh should be developed and that it be neglected— and this often happens even with robust men. This evening (Nov. 4th) a gentleman was in my consulting room, and in the course of conversation he remarked that a year ago" he and a young friend, a medical student, got wet during a walk round the mountain ; that he attended to M'" cold, while the medical student neglected his, consumption developed, and he died. Of course, not all cases of pulmonary have this sad ending, but its possibility should be constantly kept in view. I fcV.., ■ • « 3 ' «• ■" • / I •':■.■■ *Mv ow wtiteS : — " Upon ding one in the doo- namely, tubercular at the result which imely, that tiibercu- brms presertted by transformation, and nnspissated pus. In ifiltration can with inflammatory puru- ', in consequence of elled and shrunken take place it is not onaumptive tenden- r catarrh should be often happens even a gentleman was in srsatioii he remarked uedical student, got he attended to Ire* I his, consumption cases of pulmonary lould be constantly I