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to me. And here, gentlemen, let me impress upon you the importance of great circumspection in the adoption of any hypothesis not based upon the clearest and best-established physiological data; and more particularly allow me to insist upon the propriety of an important principle of our conduct in this respect, and that is, that we should use our hypotheses or theories to control and rationalize a treatment based upon experience, rather than form a treatment independent of experience.

But, gentlemen, I have said enough upon general pathology, and perhaps too much for a clinical lecture.

The local pathology of tubercular consumption of course will vary according to the stage of the disease. In the first stage it may be described as consisting of small rounded bodies of a cheesy consistence, (miliary tubercles,) deposited in the parenchyma of the lungs; that these little bodies are made up of an amorphous stroma and morphological elements of a protein origin, viz., abortive cells and nuclei, also more or less fatty granules and globules, and earthy phosphates and carbonates; that they are deposited in the air-vesicles and small bronchial tubes ; that when disseminated they constitute miliary tubercles, but when clustered they coalesce, and by compression destroy the vitality of the intervening tissue, and form larger nodules and masses of irregular shape and size; that blood vessels, and even smaller air-tubes, are not always obliterated by the deposit, but may at times be traced through the thick mass; that the differences in color, and other physical properties of tubercular matter, depend mainly upon the relative amount of the three constituent elements just noticed; as, for example, the yellow variety has a larger per centage of fat globules, whilst in some cases the earthy phosphates and carbonates are in such excess as to form the cretaceous tubercles.

In the second stage, or that of softening, besides the tubercular matter, local inflammation exists in the lungs around the surface of the nodules, tubercular infiltration or plastic exudation takes place, and occupies the tissue for some distance around the softening mass. If the exudation is tuberculous, the softening and corrosion will enlarge indefinitely; but if it be plastic, this destructive process will for a time, at least, be arrested.

In the third stage, or that of excavation, a cavity is formed at the seat of the previous tubercular deposit, and sometimes the plastic exudation will form a thick organized membrane, which neatly circumscribes the cavity, and prevents its further enlargement; and in some rare instances this cavity may be greatly contracted in dimension, and remain so for an indefinite period.

This, young gentlemen, is but a hasty and imperfect sketch of the local pathology of tubercular phthisis; but I must hasten on to the next topic,

or that of treatment, as the time allowed will not admit me to dwell long on one point.

TREATMENT.-In the treatment of this formidable disease we have three objects to keep in view : first, to arrest; secondly, if we cannot arrest, to retard its progress; and thirdly, to procure as much freedom from suffering as possible. The first two objects will require the same means, and


therefore be termed the curative indications, and the third may be termed the palliative indication.

In contemplating a line of treatment of consumption, however, we must not be governed by the stages alluded to in describing the progress of the local disorder; for it often happens that in the stage of pulmonary excavation the general symptoms are far from contra-indicating a curative line of treatment; indeed, I have often seen cases where there was complete excavation in much better constitutional or general condition than others in the second or even the first stage of the local condition. I have a case now under my treatment, (a negro man,) in whose left lung there has been a cavity for more than three years, and yet he has been hired to one of our tobacco-stemmeries, where he has done good labor during this whole time, and repeated examinations during this period indicate contraction of the dimensions of the cavity.

The curative indications of consumption, as I before remarked, must look to such remedies, medicinal and regimenal, as will best correct the depraved condition of the functions of nutrition and assimilation. Now

you will remember that I have presented to you two views of the general pathology of this disease, the one referring the first departure from health to the blood; the second to the nutritive force of the tissues. Now in either case the treatment will look to constitutional remedies, for we cannot well conceive how you can reach the local nutritive energies of the tissues except by first invigorating the general nutritive force.

Again, in either point of view one prominent fact stands out as a guide to our efforts, and that is, that the deposit is nitrogenous, and must be derived from the nutritive elements of the blood, and that therefore any means that will create a necessity for this nutritive matter in other directions, and at the same time improve its formative or vital properties, will seem hypothetically to hold out the best prospect for cure or arrest of the disease.

To this end, then, we would advise exercise in the open air, which, besides creating an active demand for plastic matter to supply the tissuewaste going on in the exercised muscular and nervous tissues, tends a lso

to invigorate the digestive powers, and improve the vital or nutritive qualities of the blood-plasma-a diet rich in fats and hydro-carbon, (as fat meats, butter, cream, sugar, syrups, etc.,) and poor in protein substances, (as lean meats, cheese, eggs, etc.,) which, besides affording elements for oxidation and the generation of animal heat, and intensifying the formative energies of nutrition, indirectly lessens the excess of plastic matter in the blood. The cod-liver oil, a remedy that has gained (deservedly too) so universal a preference over all others in the treatment of consumption, may be regarded as an aliment rather than a medicine; indeed, it is found useful only in such large quantities as will exclude an appreciable quantity of the nitrogenous principles of food; and it is yet a question in the minds of some if other oils and fats may not be equally beneficial. This, then, is a treatment, so far as regimen is concerned, suggested by the theory just now briefly advanced. But it is a treatment already established by observation and experience; and so long as we do not aim to create new lines of treatment on theoretical bases, but confine ourselves to efforts at rationalizing methods already approved by observation, our efforts are made at least in a safe direction to elevate the therapeutic art above the dominion of routine empiricism. The remedy that has next best succeeded in my hands to cod-liver oil in retarding the progress of pulmonary consumption, is French brandy, or good whiskey; but it should never be advised when the oil can be tolerated-remembering that at best it is barely possible that it may cure the physical, whilst it is quite probable that it will poison the moral constitution.

There are many symptoms that may arise in the course of this disease that you will have to attend to. Attacks of pleurisy are quite common, particularly where the deposit is near the pleural surface of the lungs. For this, when slight, dry cupping, with small doses of opium, will suffice; if the attack is more severe, however, blisters will have to be applied.

Hæmoptysis is another concomitant affection that is likely to show itself. When slight, however, no treatment is demanded; indeed, it is nature's own remedy to relieve the congested points of the lungs. At times, however, the hæmorrhage is quite active, and demands some attention. Quietude, acidulated drinks, and gallic acid in thin mucilage of gum arabic, is the best treatment that I know of. Diarrhea is another, and sometimes obstinate and grave complication. When it results from indigestion or some accidental irritation of the bowels, it will be easily remedied. But when it is the result of ulceration of the mucous folli. cles of the bowels, you have quite another affair to deal with, and remedies will be of much avail. I have usually had the best success with sulphate of copper, made up into pills with powdered gum arabic, or combined with extract of hyoscyamus. For night-sweats, although you may not expect to cure them, it will be well to sponge the body every night on going to bed with common whiskey, in which you have dissolved as much alum as it will take up. I have had good temporary results from this remedy.

When the disease assumes a form that no longer presents any hope of even temporary arrest, you should abandon all efforts at curative treatment, and at once institute palliative measures. This stage of the disease will readily enough make itself known to you without any description from me. The progressive debility, exhausting diarrhæa, and nightsweats, and rapid march of the local mischief, will plainly enough warn you when drugs will be a further torture. Under such circumstances, relief of pain by opiates, stimulating but palatable drinks to assist expectoration, and such attention to bodily and mental comfort as is in the reach of the sufferer, is all that will be proper for you to command.


By D. C. HIGBEE, M. D. [This paper is taken from the archives of the Montgomery County (Tenn.) Medical Society. From some oversight it was never published. The writer, Dr. Higbee, is now “no more;" he died in the city of Peoria, Ill., in the latter part of last winter, to which place he had recently removed to make it a permanent home. He was a graduate of the medical department of Transylvania University, was a ripe medical scholar, and a judicious and popular practitioner.

E. B. H.] GENTLEMEN of Montgomery Medical Society: Our President has honored me by an appointment to read a paper before you this day: in compliance, I beg leave to make a few remarks on what I am pleased to call the


Mammary Abscess is a disease which, for many reasons, we were all taught to dread; but I would as gladly treat it as almost any other abscess of like extent, wherever located. Indeed, I believe that it is as easily controlled as any other.

In the limbs, the neck, and in the parietes of the abdomen and chest, we are troubled with impeded muscular action, and extension of the sac, from the ease with which the muscles are dissected


per chance a skilful surgeon only can open it with safety; besides, it may be impossible to collapse it by mechanical means, as in psoas abscess, abscesses on the anterior regions of the neck, those of the abdominal parietes, etc. Not so with mammary abscess. Any veterinarian may lance it, any negress may bandage and cure it.

I do not pretend to offer any new principle: it is only a better application of one well known. Compression by means of the common roller, adhesive strips, etc., requires the skill of experience to adjust it properly; nor should the trouble, anxiety, and loss of time and comfort, be lost sight of. Should you use the common roller, or the adhesive plaster, you are debarred from the use of nearly all other local remedies which a peculiar case might require.

The first and the great indication in the treatment of abscesses, is to collapse them; and to do this they should be freely opened, if possible, that the pus may all find exit. I cannot suppose that we disagree here.

In May, 1843, I was called to attend Mrs. Lin Lexington, Ky.) for this disease. She was small, delicate, and scrofulous ; ætat. 22 ; second child, and second attack. My treatment accorded with that of (our fathers." Two months passed, and my patient greatly worse, notwithstanding I availed myself of experienced consultation.

At this time I stumbled on the treatment by MM. Trousseau and Contour. They recommended pressure by strips of adhesive plaster, the complicated application of which was nearly equal to Dessault's dressing for fractured clavicle. However, my bedridden patient was thus relieved in some four weeks more, but to me the only redemption was a long bill, whilst her consolation must have been that I did not kill her.

In such cases I generally used the resinous adhesive plasters, but I found it necessary to re-dress the mammæ very frequently, owing to the perspiration, pus, milk, etc., loosening them. Many of you, I doubt not, have been equally annoyed; if so, you know too well the pain inflicted on our patients.

The old method of treating this disease I will not detail, feeling assured you will all join me in saying that it is very unsatisfactory.

Having the principles of the bandage as taught me by that prince of the roller, (Dr. Dudley,) whose merits have been so justly won, and whose honors so justly crowned the praises of Transylvania, and having the hints of MM. Trousseau and Contour, I conceived the following simple method of treating this disease in all its stages:

Take a strip of strong cotton, woollen, or other goods, from ten to four

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