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




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




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




A
RETROSPECTIVE VIEW
OF THE
ALL(EOPATHIC  MATER'IA  MEDICA,
AND
AN EXPLANATION OF THE ROMEVIOPATHIC LANW OF CURE.
IN giving to the public the result of some of the clinical
investigations, which I had undertaken for the purpose of
establishing the efficacy or the non-efficacy of the hom(eopathic method of treatment, I must expect to encounter various
kinds of opponents.
Some will assert that I have violated the laws of professional probity by treating as a serious science that which
they consider as'a system of despicable jugglery and charlatanism which should be severely interdicted by the laws.
Others will pretend:that I have acted without conscience
towards patients who apply in our hospitals for. help, by
subjecting them to a.method of treatment which our schools,
our academies, our most eminent practitioners have repudiated
and branded as an aberration of the human mind. They
cannot comprehend that:a public administration which owes
tothe poor all the:solicitude:that a father feels'for his children,
should have allowed a physician to subject the larger number
of his patient to a method of treatment which excites the
indignation of the most enlightened physicians.'Others again will say that medical freedom should be
respected, but that it should be rendered worthy of respect by
not subjecting to the crucible of experiment theories that are
evidently absurd.
Some will say that a trial of Hahlemann's method in our
public hospitals, favors the quackery of homeopathic physicians in private practice.
Others may feel disposed to assert that the value of the




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




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



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




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




ALLCEOPATHIC MATERIA MEDICA.             ix
6. Diaphoretics;
7. Anti-periodicals.
The second class, alteratives, comprises the drugs which
alter in an imperceptible manner the composition of the humors;*
of these we have eleven kinds:
1. Cephalics and aromatics;
2. Ophthalmics;
3. Stomachics;
4. Hepatics, splenetics;
5. Carminatives;
6. Astringents;
7. Detergents 
8. Aperitives;
9. Emollients;
10. Anodynes;
11. Refrigerants and incrassants.
The third class, specifics, comprises drugs which act no one
knows how; t of these we have four subdivisions:
1. Vulneraria;
2. Vermifuges;
3. Febrifuge;
4. Antiscorbutics.
Each of these subdivisions contained substances from every
kingdom of nature, especially since the reform of Paracelsus.
This list may show that, in our time, the classification of
drugs must have become much more arbitrary for a number
of physicians, without, however, having changed its basis.
Murray, in his apparatus medicarminum, which is the only
serious work on Materia Medica that we possess, drops the
traditional classification.  He classes drugs agreeably to the
order that was adopted in natural history; his plants, for
instance, the only part of his work that he has completed,
are arranged after the method of Linne.
Since Tournefort, this reform was demanded in our country
by the botanic physicians. It has not prevailed, however,
* Ib.
t Hippocrates.
As




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




ALLcEOPATHIC MATERIA MEDICA.          Xn
According to Galenus, the therapeutic indication shows how
and where art should interfere. Indeed, all the great physicians of all ages and countries, have acknowledged positive
indications as their supreme rule in the'selection of drugs.
Whosoever deviates from them, plunges into blind routine,
or into a dishonorable scepticism, dishonorable because it is
without any excuse.
According to Hahnemann, the totality of the symptoms
should determine the selection of the remedial agent.
This mode of selection may seem too absolute, and is
besides incomplete. It omits, for instance, to take notice of
the anatomical lesions which do not strike the senses; but
it is not an absurd mode.
4. On the mode of selecting a remedy according to Itahnemann.
The selection of a remedial agent implies in the first place
the acknowledgment and perception of a binding relation
between the natural symptom  and the medicine. This bond
between the symptoms of the disease and the remedial agent
has been expressed by Hahnemann in the general formula:
Similia similibus curantur, or "like cures like."  His own
observations and those of others led him to establish this
formula as the true therapeutic law.
Hahnemann discovered that more or less dangerous aggravations of the symptoms ensued, if his medicines were administered at'the usual doses agreeably to the principle of
similarity. In the place of the large doses which he employed at first, he was gradually led to administer infinitesimal
doses of theappropriate remedial agents.
In all this I do not see any thing that might be termed
absurd.
Hahnemann's method not being absurd, it cannot be onl
account of its absurdity that it has been condemned. What
are the real motives of this condemnation'? One motive may
be the strangeness and improbability of the facts and the
ideas which Hahnemann develops. These characteristics of
his doctrine cannot be denied; they strike every one who,
for the first time, studies Hahnemann'$ system..




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




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




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




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




Xvi          A RETROSPECTIVE VIEW OF THE
sense and logic. This mode of reasoning is sufficient to
justify the clinical investigations that we have instituted, and
their publication so far as it seemed to us' ecessary in order
to convince prejudiced minds. It now remains for mne to
explain the motives which haveinduced me to make a beginning of such investigations in.a public hospital, in spite
of all the prejudices which I had to encounter, all the interests which I had to hurt, in spite of all the little storms which
such a proceeding must raise against me, and which have
indeed been raised. But before explaining these motives,
let me say a few words of Hahnemann's errors.
Hahnemann's doctrine may be divided into two parts, his
pathology and his therapeutics. Considering each by itself,
it may be said that the one contains his errors, the other his
truths; his pathology is wrong, his therapeutics is correct.
Homeopathy is therefore a compound of fallacies and of
truths.
In pathology Hahnemann was a hippocratist.  Few  are
acquainted with hippocratism  and its dangers: the great
name of the father of medicine protects the vastest and the
most pernicious error in medicine.  It is very appropriately
expressed in this familiar saying: "There are only patients,
there are no diseases." This is indeed the result to which
the doctrine of Hippocrates leads us in pathology, and such a
result is simply destructive of all pathology, and indeed rejects
and denies it. If there are no diseases, what becomes of
diagnosis, of nosography, of nosology? Are. they not mere
chimeras?
This is not all. Hippocratism supposing all the time that
disease is the reaction of the vital forces against an enemy
located in the inmost depths of the organism, the mind is
compelled to seek for this enemy, and: is forced into the region of a fabulous etiology. A morbific agent is required to
excite a reaction, for reaction does not take place without
being called out by an opposing force.  Hence all these
imaginary causes of disease, such as alterations of the blood,
or bile, mucus, black bile, acridities, saccharine or saline
substances, serosities, invisible animalcules, miasms, unknown




ALL(EOPATHIC MATERIA MEDICA.          xvii
poisons; in one word, all the etiological mythology that
escaped from Pandora's box. These hypotheses are the
necessary results of the theory, that disease is a process of
reaction, and nothing but reaction, or that disease is something identical, an essential unit in principle.
Hahnemann was not aware of the falsity of the physiolo.
gical hypothesis upon which Hippocrates based the whole
edifice of medicine: he adopted the traditional errors of pathology, or rather he suffered himself to be deceived by them
in the same way as so many others do. Hippocratism be,
came the source of all his errors. Hence Hahnemann's pathology cannot be criticised or rejected, without at the same
time criticising or rejecting that of Hippocrates.
The rejection of all essential diseases, the psora-hypothesis, or the doctrine that the itch is the common cause of almost every chronic malady, are ideas in agreement with the
hippocratic doctrine. For psora substitute black bile; or for
black bile substitute psora, and the difference will be very
trifling. Such are, in my judgment, the chief errors into
which Hahnemann has fallen. From these general errors
result the isolated errors which we meet now and then in
his writings.
Let me now state the motives that prompted me to study
a doctrine which is contrary to all my past notions of pathology. What is the reason that I was not deterred from such
studies by this antagonism?
We want a reform in therapeutics and in materia-medica;
every practitioner has been proclaiming this truth: for fifty
years past. There is not a student of medicine nor a practitioner of ever so little experience that has not repeated these
words of Bichat: "An incoherent agglomeration of incoherent opinions, our materia medica is, of all physiological
sciences, the one where the aberrations of the human mind
are most strikingly depicted. What do I say? It is not a
science to a methodical mind; it is a shapeless assemblage
of inaccurate ideas, of observations that are frequently puerile,
of illusory means of cures of formulas that are as stra'ngely
conceived as they are pompously put together. It is said that




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




ALL(EOPATHIC MATERIA MEDICA.            XIX
Without this gigantic work, the formula similia similibus
curantur would have remained a trivial affirmation, such as it
had been from Hippocrates to our period. But vivified by
a knowledge of the pure effects of drugs, it leads to a therapeutic reform of the highest order. I will explain how.
It behooves us first to state very clearly what Hahnemann
understands by similia similibus curantur or by homceopathy.
We find in Hahnemann's writings several contradictory
theories which impart to the homceopathic formula various
meanings different from the natural sense of the words. What
can the literal formula mean, if not that medicines cure morbid phenomena similar to those which the same medicines
are capable of producing in a healthy person? Nothing can
be clearer and simpler than this idea. It is a general therapeutic formula which established with great precision the
relation of the morbid symptoms to the remedial agents.
The law of similarity, thus expressed, may be either true or
false, but it is lucid and precise, and presents a positive
ground for discussion and for clinical and experimental verification. And lastly, so far as pathology is concerned, his
formula neither denies nor affirms anything;. it agrees with
hippocratism just as well as with the doctrine of the essential
character of diseases.
The natural or literal sense of the formula is the one that
has been adopted by Hahnemann, and upon which all his
labors were based. Unfortunately the illustrious reformer
did not content himself with accepting the literal meaning;
he undertook to give us the reason of the law which had
at first appeared to him simply as a generalization of facts,
and which, in order to preserve its scientific character, should
never have been presented in any other light. Hahnemann
plunged into physiological hypotheses concerning the inmost
nature of disease, and arrived at the hippocratic conclusion
that disease is a reaction of the vital force. He explained
the formula similia similibus by substituting the artificial
reaction excited by the drug in the' place of the natural re.
action of the vital force against the. morbific agent. The
symptoms of the disease indicating in their totality the vital




XI         -A RETROSPECTIVE VIEW OF THE
reaction, he opposed to these symptoms, which he called
disease, a similar group of symptoms produced. by the drug
which'he termed drug-disease. Henceforth the term disease
acquired an arbitrary meaning, for a group: of symptoms does
not constitute a disease.  This led Hahnemann to a denial
of the essential nature of disease; each patient became a
special malady requiring a particular application of the therapeutic law.  Owing to this arbitrary interpretation of the
term disease, Hahnemann was enabled to proclaim without
inconsistency that he had discovered the real medicine of
specifics; but they were specifics with reference to patients,
and not with reference to disease, since he denies their existence.  Hence resulted a deplorable confusion, and legitimate occasions for attacking the homceopathic law. Indeed,
if we speak of specific treatment, every body understands by
it the specific treatment of some disease in all its possible
forms, not the specific treatment of each patient in particular.
Hence, by changing -the general formula expressing the
relation of morbid symptoms to the action of remedial agents,
which, as we said before, is the true meaning of the formula
similia similibus curantur, to a general formula of specifics,
Hahnemann transformed a real scientific law into an arbitrary
affirrma'io n.
But this is nm>3 all. After rejecting the doctrine of essential
diseases, which he considered a-s something purely nominal,
he admitted a certain number of acute and chronic diseases,
because they were due to some miasms, thus restoring, by
means of a hypothesis about acute and chronic miasms, the
natural sense of the term disease in the formula similia simii
libus.  Specifics no Tonger referred to patients but to diseases;
thus, Mercury is the specific or simile of syphilis; Sulphur
is the specific or simile of the itch; Thuja is the specific or
simile of sycosis; Belladonna is the specific or simile of
scarlatina; Arnica is the specific or simile of traumatic
affections, and so on for a certain number of other diseases.
Starting from these definitions, the true meaning of the formula similia similibus is this: diseases are cured by drugs
which produce similar diseases in healthy persons.  This




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



XXil        A RETROSPECTIVE VIEW OF THE
pelled to yield to evidence? This question of doses has therefore to be determined by observation. It may be asked,
however, how happens it that these medicinal aggravations
are never noticed by practitioners who prescribe their medicines agreeably to the posology of Galen or Sylvius? To
account for this, we have to observe two things, one general,
the other special: the first is, that things which we have
omitted to notice, finally cease to excite our attention; the
second is, that in the Old School method of practising, only
the primitive action of the drug is resorted to. In this practice the desired effect has to be produced without any delay;
the cathartic has to be at once followed by alvine evacuations,
the emetic by vomiting, opium by sleep, and so forth. To
effect these results, it is necessary to administer a considerable dose of the drug.  This is quite different in regard
to the secondary symptoms produced by the drug; these
secondary symptoms will be so much more marked the less
the organism had been disturbed by the primitive symptoms,
unless the dose had been so strong as to saturate the organism
with the drug, and to cause the secondary symptoms to follow
the primary. I know from experience that certain drugs if
administered according to Rasori's method, induced results
similar to those of infinitesimal doses, whereas the ordinary
doses of the common posology remained inert. But it is
useless to insist upon these points; no arguments can replace
personal experience in the matter of infinitesimal doses.
Upwards of five hundred trials which I have instituted with
them, have convinced me of their efficacy.
It is not difficult to comprehend, that in order to apply the
law of similaritJ, Hahnemann had to abolish the compounding
of drugs. Such compound prescriptions are in the way of all
certain and positive medication. To obtain this certainty,
the compound ought first to be tried on the healthy organism.
But no such provings have ever been instituted, and they
seem indeed unnecessary, since simple drugs are amply
sufficient.
Finally, an essential point in practice, is the duration of
the action of drugs. This question, which is entirely new;




AILIO PATHIC MATERIA MEDICA.         XX-iii
has been. opened by Hahnemann, and concluded by his
numerous and indefatigable disciples.
To resume, criticise as much as one may, homcopathy is
a scientific reform of therapeutics. Thanks to the labors of
this great man, what has been termed rational therapeutics,
has now become a system conformable to sound sense, and
what Bichat declared to be unworthy of a man of reason, now
constitutes a positive and regular science.
If we consider the formula similia similibus curantur as
the general formula expressive of the relation of the symptoms to the positive effects of the drug, the homueopathic
doctrine.becomes a development instead of a negation of the
science of medicine.  Seneca was right-in saying: eril veri
quod ab antique remotissimum; nothing is/true which is
absolutely contrary to tradition.  This is particularly applicable to medicine. If Hahnemann's ideas were not in harmony with the truths which have been established by succeeding generations of observers throughout a series of twentyfour centuries, these ideas would not, in my estimation, have
any serious foundation; they would be of the fantastic order
of the system of Asclepiades of Bithynia, capable of momentarily reducing enthusiastic imaginations, but unworthy of
taking rank among the regular and positive truths which
constitute the traditional basis of medicine.
Such are the reasons which have rendered it incumbent
upon me to verify the truth of Hahnemann's discovery. I
have done so with all the care that I am capable of. Nothing
has so far prevented me, and nothing, I trust, will prevent
me hereafter from fulfilling what I consider a duty. I shall
not be deterred from my course by the premature condemnations which some individuals have uttered against the
generous hospitality which I have accorded to Hahnemann's
doctrine. I should blush to have treated it with less respect.
If a theory seems' radically false, we may pass on without
paying any further attention to it; but when it seems pregnant
with useful truths, we are bound to treat it with becoming
attention; this is all I have to say in reply. to my opponents.
Re~onciled with the doctrine that there are essential dis



xXi.        A RETR0OSPECTIVE VIEW, &C.
eases, and that -there is truth in the traditions of the Old
School, Hahnemann's doctrine will become more and more
lucid and productive of practical good. The minds' of physicians will gradually become familiar with the new system
of'pharmaco-dynamics, and we will wonder, in a few years,
that even the most honorable men should have tried to
smother an important truth.
What may appear a sophism now, will then be considered
in its true light; those who, like myself, have had faith in
observation, and have -not sacrificed the only just and true
criterium of physicians to the danger of a few personal insuits and malevolent interpretations, will then have justice
accorded to them. So far-as the adniinistration of the hospitals
of Paris is concerned, it will redound to their honor not to
have interfered:in any degree with:the freedom of practice
in this grave business.  It -affords me pleasure to forestall
the judgment of the'future, and to express to the friends of
medical freedom all the esteem with which their liberality has
inspired me.
As regards those who'have censured the introduction of
homoeopathy into our hospitals, I am convinced that some
among them have done so:from motives of kindness for our
patients and of respect for our profession; these will be the
first to acknowledge that humanity having been the gainer,
the honor of the profession cannot have been tarnished by my
innovation.,




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




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




THERAPEUTIC INDICATIONS.            8
bleed the patient. A sanguineous depletion, if properly applied, brings about in this disease, in most cases
at least, a well-marked remission, characterized by a
decrease of the fever, and a. profuse perspiration with
softening of the epidermis on the hands and fore-arms.
Afterwards we have to remove the pulmonary hepatization which we accomplish by means of Tartar-emetic
and blisters. It would not be safe to leave the remaining inflammation of the lungs to itself; the fever would
return, the treatment would have to be recommenced,
and the lungs would either pass into a state of suppuration or pseudo-membranous induration. In a case
where a venesection had established a remission, I
ventured to administer Phosphorus instead of giving
Tartar-emetic which I was in the habit of doing. The
patient got well without the least rise of the disease.
I repeated this experiment in several other cases with
the same success.
I might have attributed these results to the energetic
use of antiphlogistic means at the commencement of the
disease. All that I could legitimately infer from these
first trials is, that I had not done any harm, if I had not
done any good, afterwards I determined to diminish the
number of sanguineous depletions, and not to wait for a
remission before resorting to the Hahnemannean treatment, reserving to myself the right of at once returning
to the ordinary treatment if an improvement should not
promptly set in. In every succeeding case I diminished
the number of depletions by one, two, three or four, and
began to use the new remedies more nearly to the com~
mencement of the disease. I commenced by a dose of
Aconite, followed in twelve or twenty-four hours by a
dose of Bryonia, after which I gave Phosphorus. The
less I bled my patients the more speedily were they
relieved by the small doses. At last I made up my
mind not to bleed any longer, and to give the homwo,




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




THERAPEUTIC INDICATIONS.           5
cases precisely as they were handed to me by the
physicians employed in my wards. They bear a stamp
of authenticity which I prefer to the embellishments of
style. I have a right to say: Here is what well-informed ant conscientious young physicians have seen
under my eyes: they had no other interest than that of
the truth; I might even say that our common interest
consisted in shutting our eyes, and condemning Hahnemann's method as inefficacious and illusory; what insults, what disgust I should have saved myself! would
that the persecutions might not go beyond my own
person! But alas! they have already gone farther.
What a courage these young gentlemen must have
possessed to risk all the brilliant prospects which their
future career held out to them, by assisting me in my
investigations. However, I am not concerned about
them; I place their zeal under the safeguard of the
honor of their colleagues. All that I can personally do
for them, is, to testify to them publicly my affection and
my gratitude.... I may add: Forsan et hac olim meminisse juvabit, one day perhaps they may be glad to
think of this testimony.
The patients whose cases we are now going to report
have been subjected to the following treatment:
Their beverage was water sweetened with a little
sugar, from one to three quarts a day, and of a temperature to suit their taste.
They took one or two mixtures of the medicine indicated in twenty-four hours; this depended upon the intensity of the disease and its stages.
A mixture was composed of four ounces of filtered
water without sugar, in which from four to six globules
of the appropriate remedy were dissolved.  Aconite
was sometimes administered in drop doses of the sixth
attenuation. All the other drugs and all attenuations
above the sixth were given in globules.




6                   PNEUMONIA.
A tablespoonful of such a mixture was given every
two-or every three hours.
An attenuation contains one-hundredth part of medicinal substance mixed with-ninety-nine parts of Alcohol;
if a solid, the proportion is one grain of medicinal matter to ninety-nine grains of Sugar of Milk.
Hence the 3d attenuation is equivalent to 1003 or
one-millionth of a drop of the original medicine.
The 6th to 1006, or a unit with 12 cyphers.
"9th to 1009,   "        "  18   "
" 12th to 10012, "  "    "  24   "
"18thto10018, C  "  36   cc
" 24th to 10024, CI  CC   "  48   "
" 30th to 1008~, A  "    "  60   "
Or:
The first attenuation 1_ drop or grain,
"third   "  o 1    drop or grain,
"C sixth   I" 100000 00000 0o  drop or grain, &c.
The remedies that have been made use of most frequently, are Aconite, Bryonia, Phosphorus, Sulphur,
Belladonna, Arsenicum, Iodine.
The attenuations that have been made use of are the
6th, 12th, 15th, 18th, 24th and 30th.




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




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




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




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




CASES TERlMINATING IN RECOVERY.      11
Dec. I.-Pulse 130, violent oppression and dyspnmea.
Marked stomatitis; tongue red at the edges, whitish
on the upper surface, but irregularly.  Constipated
since Nov. 28; no vomiting nor nausea.
Respiration rather stertorous; slightly crepitant rattle at the base of the right lung.  Cough frequent
and painful; sputa somewhat rusty and tenacious.Bryonia 6 in solution, diet.
Dec. 2. —Crepitant rattle continues at the base of the
right lung and in the axilla. Dyspncea. Stomatitis
worse; constipation.-Phosphorus 12 in solution.
Dec. 3.-Pulse 128. No headache. Jaundiced complexion. Stomatitis; dyspncea; stertorous breathing;
paroxysms of painful cough; white and frothy sputa,
not rusty. No more rattle; murmur at the apex of the
lungs; no vesicular murmur in the right lung; rattle
and engorgement in the left lower lung.-Bryonia 15
in solution.. The patient is somewhat delirious.
Dec. 4. —Better. Pulse 105, softer. A slight rattle
at the top of the right shoulder-blade; friction-sound
on the left side. Slightly delirious.-Bryonia in solution.
Dec. 5.-Pulse 105. Mind somewhat confused. Considerable oppression; the patient does not raise as much
as he would like; no bellows'-murmur on the right side;
the resolution proceeds on this side from above downwards. On the left side a slight and very fine crepitant
rattle, and a slight bellows'-murmur; raises pretty
easily.-.Belladonna 6 in solution; Sulphur 18 in solution, alternately.
Dec. 6.-Pulse 105, resolution on the right side;
on the left side bellows'-murmur on -a level with the
shoulder-blade.-Bryonia 12 in solution.
Dec. 7.-Pulse 95. Skin moist and cooler. Stomatitis. Bryonia 12 in solution. Takes some milk and
water.




12                  PNEUVMONIA,
Dec. 8.-Pulse 80. —Crepitans redux on the left
side.-Bryonia 12 in solution
Dec. 10.-Pulse 70. Increase of strength; the icteric complexion continues; the appetite is good; expectoration good; full resolution. —Two soups and broth,
gum-water.
Dec. 13. —Complete resolution; the patient feels well,
rather weak.
Dec. 14.- -Two allowances.
Dec. 21. -Continued weakness.- China 6 in solution.
Dec. 30.-The patient feels well, except a pain in the
ear.-Belladonna 6 removed it.
Discharged January 2, to resume his work.
These two cases took place at the close of the epidemic influenza which prevailed in Paris in 1847. Are
they to be considered as cases of influenza complicated
with pneumonia, or simply as cases of catarrhal pneumonia?  Owing to the existence of the epidemic, I
incline to the former opinion. I do not base this opinion
on the facts only, for in catarrhal pneumonia the catarrhal irritation precedes for some days the inflammation of the pulmonary parenchyma, and it likewise
differs from the true pulmonary catarrh by tile intensity
of the febrile motions.
In these two cases the pulmonary inflammation ought
therefore to be looked upon as a mere symptom, or at
most as a complication of epidemic influenza. Be this
as it may, inflammations of the pulmonary parenchyma
being exceedingly dangerous when complicated with influenza, I have deemed it of sufficient interest to report
here these two cases, where the action of the remedial
agents is perfectly evident. I am inclined to doubt, at
this period, that, in the second case, the indications
were correctly noticed at the commencement of the
disease, or in the first case, in regard to the subsequent
intercostal neurosis.




OASES TERMINATING IN- RECOVERY.      13
It seems unnecessary to draw attention to the fact
that, in this case, the pneumonia showed itself successively on the right and left side, and that the disease
was a very serious one.
CASE 3.-Pneumonia of the left lung.
Eugene Ducerf, 28 years, wheelwright, admitted Dec,
Ist, 184T, ward St. Benjamin, No. 11.
INCIPIENT STAGE. —Had a chill last Sunday evening, Nov. 28th. No catarrh or bronchitis; the chill did
not last long. The patient went to bed, and had- a fever
all night; felt a stitch in the side during the night,
Next morning the patient tried to get up, went out; he
did not cough, nor raise anything; the stitch and the
fever got worse, dyspnoea and oppression supervened.
Had some diarrhoea.
Dec. 1.-Pulse 124, full and soft; headache, op.
pression, dyspnoea especially in a vertical position.
Auscultation revealed a crepitant rattle at the base
of the left lung; no sputa. General color somewhat
yellowish; no symptoms on percussion.  Diarrhceal
considerable stomatitis; tongue coated white, with red
edges; gums inflamed and covered with a whitish lining.
The patient complains of having had cold feet for
some days past.-Bryonia 12 in solution.
Dec. 2.-Pulse 112; diarr-hea and stomatitis continue, the oppression is somewhat less.  Crepitant
rattle to the level of the shoulder-blade; viscid, add
hering, rusty sputa. —-Bryonia 2 in solgtion.
Dec. 3. —-Pulse 108; diarrhoea stomatitis and op"
pression less; no more crepitant rattle at the base;
bellows'-murmur on a level with, and above the shoulder-blade; crepitant rattle in the axilla. The sputa
continues the same, is less copious.-Bryonia 15 in
solution,
Dec. 4.- Pulse 100, soft; patient feels very weak;




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




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




16                  PNEUMONIA.
the chest and in the axilla. —Continue Bryonia and
Phosphorus.
Dec. 18. —No fever,  Less murmur; the sputa is
still a little rusty  oat times a little crepitans reducx
— Continue Bryonia and Phosphorus.-Broth.
Dec. 20,-Slight murmur; very fine crepitans redux. Pulse 60. —Continue Bryonia and Phosphorus,
Good appetite, Two soups and two broths.
Dec. 21.-Continued murmur at the top. —Iodine 12
and Phosphorus 12, alternately.
Dec. 22. —-Some murmur..-Continue Iodine, An alb
lowance,
Dec. 23 and 24. —The same treatment; two allowancesb
Dec. 27.-Complete resolution.
Dec. 30.-Feels well, Three allowances, Some wine6
-Discharged January 3d, 1848.
REFLECTIONS. —- This case was not very serious; since
the patient was able to remain eight days without any
other treatment than diet and rest without the disease
getting much worse.  The cure was effected without
much difficulty, But could it be asserted that, if left
to itself, the disease would not have terminated in sups
puration? If pulmonary hepatization has been allowed
to run its course for a week, does it then disappear so
very easily?  I think not.
I will mention another series of phenomena. In this
as well as in the preceding cases, we have observed a
more or less general icteric tinge, a common sign of
pneumonia. This sign does not belong exclusively to
pneumonia; it is common to all parenchymatous infiammations.  G endrin insists above all other cotemi
poraneous authors upon this icteric color in pneumonia,
its extreme frequency or rather its constant occurrence
in this disease,  This phenomenon, observed disconnectedly from the other symptoms, and badly under



CASES TERMINATING IN RECOVERY.       17
stood, has been considered as a sign of bilious pneumonia, which is an unmeaning disease unless we understand
by it an extension of the pulmonary inflammation to the
liver, in cases of inflammation of the lower lobe of the
right lung. This ingenious theory agrees very badly
with the presence of this icteric tinge in pneumonia of
the upper lobes.
CASE 5.-Compound pneumonia.
Louis Alfred Charron, 14 years old, admitted Dec.
14th, 1847, ward St. Benjamin, No. 13.
The patient came to the hospital for a bronchitis that
had distressed him a good deal for several years past,
and attacked him at intervals. No signs of phthisis.
The patient sleeps in a cold room, which is in a part
of the building known as the barracks.
Dec. 21.-Chill, violent fever.
Dec. 22. —Sub-crepitant rattle in both sides of the
chest; normal expectoration; pulse 120.-Broth, Aconite 6 in solution.
Dec. 23.-The rattle is finer, more towards the left;
rusty sputa; pulse 120.-Bryonia 6 in solution.
Dec. 24.-Bellows'-sound on a level with the left
shoulder-blade; pulse 110.-Continue Bryonia.
Dec. 25.-Bellows'-murmur and crepitation on both
sides.-Continue Bryonia.-Pulse 80.
Dec. 27.-Pulse 70; bellows'-murmur on both sides.
principally on the left; sputa almost normal.-Bryonia
15 in the day-time; Phosphorus 15 at night.
Dec. 29.-Pulse 70. Less murmur.-Continue Bryonia and Phosphorus.
Dec. 30.-Murmur almost gone, the boy feels smart.
-Bryonia in solution; two broths.
During the following days perfect convalescence.
The patient remained'with us as sick-nurse.
REFLECTIONS.-I will simply notice the rapid sinking of the pulse under the action of Bryonia, in spite of




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




CASES TERMINATING IN RECOVERY.       19
Discharged Janu~ary 3d, 1848.
In this case the patient was bled on the third day;
after bleeding him, he was attacked with the stitch in
the side. When he came to the hospital, the influence
of the bleeding had entirely disappeared. We had to
deal with a case of genuine pneumonia. The symptoms
decreased as soon as we commenced to treat him, and a
few days were sufficient to restore this man to his work.
This is certainly not the course of a pneumonia of the
whole left lung, nor is this the effect of a bleeding resorted to in the very commencement of the disease. If
this bleeding had done the patient any good, he would
not have caused himself to be taken-to the hospital on
the day after the bleeding. In my estimation the action of Aconite and Bryonia in this case is self-evident.
CASE 7.-Pneumonia of the right side.
Bottellier-Despoir, aged 18 years, porter, admitted
January 10th, 1848, ward St. Benjamin, No. 17. His
constitution was of the common order, his temperament
lymphatic; had never been sick before.
January 6th, in the evening, after working hard, he
stood in a draught before the door of a house to which
he had taken a heavy load, and was immediately taken
with a chill followed by fever and other symptoms of
illness. Spent a restless and sleepless night, and next
morning experienced dull pains in the right side of the
chest, with labored breathing, frequent cough and bloodstreaked expectoration. In this condition the patient
kept his room for two days, without doing anything for
himself, and-not feeling any better on the tenth, he was
brought to us.
Jan. 10.-Intense fever, with frequent pulse, hot and
parched skin; face flushed and anxious;. a slightly
delirious state of mind scarcely permits him to return
precise answers to our questions. Prostration of strength.




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




CASES TERMINATING IN RECOVERY.       21
Jan. 14. —Pulse 68. Temperature of the skin almost
natural; sputa still whiter and lighter. Slight diminution of the bellows'-sound posteriorly; the crepitans
redux is heard on a level with the spine of the shoulderblade.-Water and sugar, two broths.
Jan. 15.-Same symptoms, same treatment.
Jan. 16.-Restless night, cough worse. Sputa more
copious than the day before, but mucous and opaque,
floating in a quantity of serum. Sibilant rhonchus in
the whole left lung, and mucous rattle in the right.Sulphur 30 in solution.
Jan. 17. —The bronchitis continues.-Water and sugar, two broths, Sulphur as before. No fever.
Jan. 18.-No fever. Frequent cough with mucous
sputa, which has the same appearance as on the previous days, but is less copious.-Water and sugar.
Jan. 19.- Bronchitis improved; mucous rattle in the
right lung less.-Aconite in solution.
Jan. 20.-Convalescence continues very strikingly. —
Two broths, two soups.
Jan. 20-29.-A little cough, mucous expectoration,
but not much. —Ipecac. in solution. An allowance.
February l. —The bronchitis has ceased. Discharged
Feb. 7.
This case of pneumonia was at'first light, but continued to get worse until the patient came under our
treatment, which commenced six days after he had been
taken sick. On the evening of the 12th of January a
remission of the symptoms began to manifect itself, and
the resolution of the local and general phenomena went
on with marked rapidity.  On the fourth day of the
treatment, the pulse had come down to 68; the patient
was able to take a little broth.
January 16th a severe bronchitis broke out; bronchitis frequently sets in after pneumonia. Sometimes this
is simply a continuation of the bronchial inflammation




22                  PNEUMONIA.
which accompanies the inflammation of the pulmonary
parenchyma; sometimes this complication is owing to
some indiscretion on the part of the patient who leaves
his bed for some cause, gets cold, steps with his bare
feet on the floor, &c.
CASE 8.-Pneumonia of the left side.
Freillard, 53 years old, day-laborer, of a robust constitution and a bilious-sanguine temperament; has always enjoyed good health.
January 17th was suddenly taken with a chill, without any assignable cause, with acute pains in the loins;
the chill lasted two hours, and was followed by a violent
fever, cough, bloody sputa, and a painful stitch in the
side, during the cough, in the left axilla. Was a whole
week without treatment, had applied for admission in
some hospital day after day, and could not obtain leave
until this evening.
Jan. 24. —Moderate heat of the skin; pulse large,
soft, from 80 to 84. beats; face bloated; intense headache; tongue coated white, with red edges; intense
thirst. Respiration frequent, quick, arrested every now
and then, and painful when drawing a long breath, on a
level of and below the left axilla.  Cough frequent,
easy, followed by viscid, rusty and tenacious sputa.
Percussion yields a good sound in the right side of the
chest, and all over in front; on the left side, posteriorly, the sound is dull. No respiratory murmur in the
superior and posterior two-thirds of the left lung, and a
moist, large, vesicular rhonchus is heard towards the
close of an inspiration in the corresponding inferior
third; bronchophony in the same regions, more marked
in the axilla than elsewhere.  Puerile respiration in
front.-Aconite ini solution in the evening.
Jan. 25.-Face bloated, headache, tongue coated white
and red along the borders; skin hot and dry; pulse
full, from 80 to 84. Prostration of strength; no sleep;




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




24                  PNEUMONIA.
Evening; moist skin. Breathing fuller and less frequent, the serum which floats over the rusty sputa, becomes whitish.
Jan. 27. —Little headache; {pulse large, compressible,'76. Profuse sweat all night, the patient had to be
changed twice.  Tongue coated white; scarcely any
thirst.
Breathing easy, but continues painful in the axilla
during a deep inspiration. Raises easily; cough not
frequent, followed by copious expectoration, slightly
rusty, spreading and floating in a quantity of serum.
Bellows'-sound and bronchophony posteriorly as before; mucous rhonchus inferiorly, scattering; crepitation less dry'superiorly. — Continue Bryonia and Phosphorus.
Jan. 28.-No headache; feels well; slept four hours
the night before; skin naturally warm. Pulse 64.
Breathing easy; the painful stitch during the cough
continues; he coughs seldom and raises a yellowish substance, which spreads and floats in a quantity of serum.
A slight bellows'-sound posteriorly; no bronchophony.  Crepitans redux at the base of the lung, along
the inner border of the shoulder-blade and superiorly.
Mucous rattle in the sub-spinal depression, and exteriorly.-Continue Bryonia and Phosphorus.
Jan.,29.-No fever. Pulse 60 to 64.
Breathing natural; the painful stitch continues. Expectorates a puriform  mucus which is covered by a
quantity of thin and white serum.
Dulness of sound less.  Crepitans-redlux behind;
abundant mucous rattle during the cough.-Sulphur 18
in solution.
Jan. 30.-Same as yesterday; less crepitation.Sulphur in solution, two broths.
Jan. 31.-Same.. Expectoration the same. Crepita



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




26                 PNEUMONIA.
take place slowly, especially if the disease had been
progressing for a week without any treatment.
I am firmly of opinion that, without treatment, the
patient would have died of suppuration.
CASE 9. —Chronic affection of the heart.-Pneumonia of the left lung.
Daublet, cap-maker, admitted January 24th, 1848,
ward St. Benjamin, No. 26, aged 59 years, of pretty
good constitution, but weakened by toil and poverty;
had never been very sick until January, 1846, when he
was attacked with dyspnoea and palpitation of the heart,
which compelled him to abstain from work. Was never
treated consistently for this affection. Having grown
worse in the last fortnight, he applied to the hospital
for aid. On the day when he was admitted, he had no
fever, but complained of dyspnoea, palpitation of the
heart and pains in the praecordial region. Striking intermissions of the pulse every third or fourth beat; it
is hard and resisting. Dulness in the praecordial region over an extensive surface; considerable impulse of
the heart between the fifth and sixth ribs; dull sounds
heard at a distance. During the first sound, a loud and
harsh bellows'-murmur.-(Gum-water and sugar, two
pitcherfuls.)
During the night he was suddenly taken with diarrhoea, and went out of the hall to the water-closet; he
felt cold, and in the morning, a few moments previous
to my visit, he was seized with a violent chill, with a
painful stitch behind and on the left side. Percussion
and auscultation do not as yet reveal anything. About
ten o'clock, reaction takes place; a violent cough sets
in, at first dry, afterwards accompanied by a browish
expectoration floating in clear serum.
Jan. 25, Evening.-Expression of anxiety and depression of spirits in the countenance. The stitch in
the side is more painful, the breathing more hurried;




CAStS tERMINATING IN RECOVERYI.        27........ 
cough frequent, with easy expectoration of rusty sputa
in little quantity, and always floating in a large quantity of serum.  The whole body had a livid-yellow color.
The sclerotica especially exhibits this tinge. The pulse
is not so tense as it was in the morning; it counts from
112 to 116 beats; the intermissions have ceased entirely.  Dulness of percussion behind and on the left
side, in the sub-spinal depression; fine crepitations, especially at the base of the lung.-Aconite and Bryoniac
in solution alternately.
Jan. 26.-Scarcely any pain in the thorax, even when
coughing. Intense dyspncea; cough and expectoration
the same as before, Icterus more striking. Skin continues dry and parched; pulse large, less resisting,
104; tongue coated white; thirst mnoderate. Dulness
of percussion more extensive and more striking than
yesterday. A good deal of crepitation on a level with
the spine of the shoulder-blade, and in the axilla of the
same side; sub-crepitant rhonchus below, on a level
with the base of the lung; bronchial respiration along
the internal border of the shoulder-blade. —Bryonict
and Phosphorus 12 in solution.
Evening, 6 o'clock.- Same state.  Cough less fre*
quent, and the patient feels more comfortable; pulse
large and soft, from 90 to 94. Slight moisture on the
skin.
Jan. 27. —The patient slept two or three hours in the
night, and had to be changed twice. INo pain in the
chest. Breathing easy; cough less frequent, but with
saffron-colored sputa that was less copious than pre.
viously, and with less serum. Skin moist, with icteric,
livid tinge; the sclerotica seems to look clearer. Pulse
large, 90, with a few intermissions. Dulness of per,
cussion, and bellows'- sound posteriorly, in the region
where the crepitant rhonchus was heard, —Bryonia in
solutionx




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




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




30                  PNEUMONIA.
The patient raises a little rusty sputa. —Bryonia, two
tumblerfuls.
Evening.-Flushed face, the eyes shine and sparkle,
he answers hastily, and is restless.
Jan. 31.-Restless night, with slight delirium. The
pulse which was full and strong the'day before, has
become small, hurried, jerking, from 120 to 124; skin
continues dry and parched; tongue coated white in the
middle and moist.  Face animated, eyes staring and
sparkling; his answers are short, incoherent, or he does
not return any answers at all. At times the patient
hides his head under the clothes, and says he is well.
Pupils contracted; cough rare. Rusty sputa, in very
small quantity, viscid, and raised during the night.
Slight dulness of sound in the upper portion of the
chest, in front and behind.
Fine crepitation below the clavicle. No bronchophony or bellows'-sound behind, when the breathing seems
natural, but feeble.-Bryonia, two tumblerfuls; Belladonna in solution, for the evening; cold ablution.
Evening. —No cough, no expectoration, no abnormal
signs of respiration.
February 1.-Same condition. Delirium, fever with
complete suppression of every symptom of pulmonary
inflammation. Cold showering morning and night.
Feb. 2.-Same condition. —Ablution morning and
night; a potion mixed with one-fourth part of Moschus.
Feb. 3.-The delirium  is no longer constants the
patient has spent a few hours in the night without restlessness or crisis.,The heat of the skin is less. Pulse less rapid and
larger, 100; slight moisture on the hands and in the
face; the right pupil is more contracted than the left.
-Cold showering. Belladonna 6 in solution, during
the night.
Feb. 4. —No more restlessness or delirium; profuse




CASES TERMINATING IN RECOVERY.        31
sweat at night and in the morning; pulse large, rather
soft, 76; natural expression of countenance; dilatation
of the pupils; slowness of ideas.
Evening.-The improvement continues. Pulse down
to 68; skin has a natural temperature.  No sweat;
mind perfectly clear. The patient desires to eat.-Belladonna 18, in solution.
Feb. 5.-Improvement still more marked.  Pulse
continues to fall, down to 56. —Two broths.
Feb. 6.-Same condition. —Two broths; two soups.
Feb. 7 and 8.-An allowance. Perfect convalescence.
Discharged Feb. 26.
In this case the rapid resolution of the pulmonary
inflammation seems to be owing principally to the cerebral metastasis. I have controlled this meningitis by
Moschus in five grain doses and cold showering; the
Belladonna did not seem to reach this condition. I
resumed Belladonna as soon as the symptoms indicated
it distinctly, and it acted very promptly.
The combination of methods in this case shows that
it is more important as regards the nosography of disease than as an illustration of the method of Hahnemann.
CASE  11. —Pneumonia of the left lung, at the
commencement of acute phthisis.
Surbled, stone cutter, aged 61 years, of middling constitution, was admitted Jan. 29, 1848, ward Sainte-Ce'cile, No. 14.
At the age of 40 he had pneumonia of the right lung,
and was treated at the Pitie, with venesections and Tartar-emetic, and was discharged cured after a treatment
of two months. Since then his health has been good.
On the 18th of January last, he was taken with a
slight chill on rising, and a feeling of weariness all over,'which obliged him to keep his bed for two days. January 21st, feeling pretty smart, he went to his work; but




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




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




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




CASES TERMINATING IN RECOVERY.        35
Post-mortem examination.-Strong adhesions between
the costal and pulmonary pleura behind and in front.
The lower lobe of this lung is engorged, and has the
color of claret-sediment. The upper lobe contains in
its centre a vast tuberculous cavity filled with a greyish
fetid matter, and having sinuous borders.  The surrounding tissue presents a general infiltration of tuberculous matter.
This case is peculiarly interesting as regards the
pneumonia and the phthisis, and their mutual relation.
The pneumonia had been allowed to run on, or nearly
so, until the ninth day. For two days the treatment
was accompanied by a slight improvement; on the third
day of the treatment a crisis sat. in; the pneumonia
was broken. The fever disappeared and a general resolution took place, except in one point, where new symptoms show themselves, after the convalescence had continued for a fortnight. These new symptoms were the
signs of an acute phthisi's that took the patient off at
the end of three months and some days.
An acute phthisis after a pneumonia is not unfrequent in old people.  I have met it in some cases at
the Hotel Dieu, but always among men. I have never
seen it among old women, even at the Salpetri~re, although I had a good many cases of pneumonia in that
institution. This may only be an accident. This is
not the place to discuss this form of phthisis.
CASE 12.-Pneumonia of the left lung.
Koch, a teacher, 67 years old, of middling constitution, had been for some time in the ward St. Benjamin,
No. 2.
Feb. 6.-KIoch was taken in the night with an intense fever, without any precursory symptoms, and
without any assignable cause. Slight headache, flushed'face, intense thirst, red tongue, hot and dry skin, pulse
112'; frequent respiration; slight oppression and a dull




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




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




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




CASES TERMINATING IN RECOVERY.        39
only in the region indicated; harsh respiratory murmurs any where else. —Continue the same treatment;
two broths.
Feb. 21. —Gradual convalescence. Cough and diarrhoea cease. Feb. 24. —Has an allowance; still a little
dulness and harsh respiration, but decreasing every day.
In the beginning of March he had a fall on the left
trochanter major, which caused a considerable swelling
of the upper portion of the thigh, with inability to move
this limb (an intra-capsular fracture). At the end of
March the swelling had disappeared, and the motion of
the limb ceased to be painful. But the limb remained
so weak that the patient was unable to stand upon it;
he kept his bed and remained in the hospital for months
after, enjoying otherwise perfect health.
In this case, as in many other cases, Aconite does
not seem to have proved efficacious. An improvement
set in after the first dose of Bryonia.
The complete resolution of the hepatization was delayed by the indiscretions committed by this patient.
This poor fellow who was very timid, and was kept in
the ward on account of his poverty, dared not apply to
the nurses when he had to satisfy a call of nature, and
went into an icy cold corridor to the water-closet, in
spite of all our entreaties to the contrary.
CASE 13.-Pneumonia of the right side.
Nereu, day-laborer, 47 years old, was admitted Feb.
7th, 1848, in tke ward St. Ce'cilie, No. 11. This patient had a robust constitution, and had never been sick.
On the 4th of Feb. on going to bed, he felt ill, and
was taken with alternate chills and flushes of heat
which continued all night. In the morning, the fever
had fully set in, (with anorexia, thirst, headache, heat
all over,) and was soon followed by a dry, distressing
cough, with a dull sense of embarrassment rather than
any real pain in the right side of the chest.  Next




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



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



42                  PNEUMONIA.
cially above the outer border of the scapula. —Bryonia
in solution.
Feb. 12.-Skin natural, pulse 60. Mucous sputa.Bryonia two spoonfuls a day,
Feb. 13. —Perfect convalescence.  Crepitans redux
perceptible only at the close of an inspiration. Slight
bellows'-murmur above. Mucous expectoration less.
Feb. 14.-Same condition.-Continue Bryonia; two
broths.
Until Feb. 20th the bellows'-murmur is heard in the
sub-spinal depression, and the patient takes a solution
of Phosphorus every other day. Gradually resumes
his customary regime. Feb. 22, perfect recovery. Two
allowances; discharged March 4th.
This was a serious case of pneumonia. It terminated
in a discharge of critical urine on the seventh day, after
very alarming signs. The bleeding to which the patient
was subjected to in the commencement, had no effect.
The sinapisms which were applied on the evening of the
sixth day, are an important circumstance. By facilitating the diaphoresis and preventing a metastasis to the
brain, they contributed a good deal to the successful
termination of the disease.
During the course of this disease, Bryonia was never
given below the 24th attenuation. This was probably
too high. Nevertheless its action seems to me evident.
Under its influence, the pulse came down at once twenty
beats; on the ninth day it was down to 60, after having
been 120 on the fourth day. At this period we were
not yet in the habit of noting the successive decrease of
the number of beats after the resolution had set in. In
the following cases the effects of Bryonia in this respect
will be pointed out more fully.
CASE 14.-Cortial, porter, aged 39 years; ward St.
Benjamin, No. 8.
Had a good constitution, a sanguine temperament; is




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




44                  PNEUMONIA.
the armpit, where a crepitating rattle is heard.-Aconite 12 in solution, two tumblers full.
Feb. 16.-Fever the same as last night, except the
thirst, which had become more intense; the face was
less flushed and bloated; less headache. Pulse 104,
large and full.
Dyspncea not altered; respiration continues unequal,
and is more painful behind than on previous days. The
patient is better able to lie on the right side. Cough
more frequent, difficult and painful.
Expectoration more copious, sputa less red but more
tenacious. Part of the sputa is rusty; it is all mixed
up with a quantity of frothy serum which floats on top.
Stethoscopic signs not changed.-Bryonia 18 two
tumblerfuls. Water and sugar.
In the evening, violent rise of fever. Pulse quicker,
small, tense; dyspnoea with occasional interruption of
breathing. The patient is extremely anxious and restless; the tubular murmur is scarcely heard in the region where it was heard yesterday morning, probably
on account of the deficient dilatation of the affected
side of the thorax which is almost immoveable. Cough
and sputa are scarcely changed any.
Between 10 and 11 o'clock in the evening, the anxiety,
oppression and fever are less; the pulse is slower and
quieter; the cough is less painful, the expectoration
looser and more copious.
Feb. 17.-This improvement continued during the
night. Next morning the patient exhibited the following condition:
Scarcely any headache; tongue coated white and
moist; thirst moderate; pulse quick, but not resisting,
100; warmth of the skin mild; a little moisture on the
forehead.
No more dyspncea.  The respiration is quick but
neither irregular nor intermittent.




CASES TERMINATINO IN- RECOVftt.       45
Stitch in the side continues painful at the close of an
inspiration, and during the paroxysms of cough.
Cough very frequent and painful.
Easy and copious expectoration of viscid, rusty sputa,
surrounded by a serous liquid as previously.
Marked dulness at the posterior portion of the chest,
and in the axilla of the same side.  Percussion has
ceased to be painful.
Bellows'-murmur and bronchophony very distinct in
the same region and over the same surface. —Continue
Bryonia; water and sugar.
In the evening, the patient feels better. The stitch
is scarcely any longer painful; sweat had commenced
to break out at two in the afternoon, and at this moment it has become general, but not copious; pulse
large, soft, compressible,
Feb. 18.-Spent a good night; the patient had to put
on a dry shirt. No headache in the morning; tongue
moist and coated white; thirst moderate. Skin soft,
moist; pulse large, undulating, 90. The patient feels
well; no oppression; respiratory movements regular
and natural.
Stitch has almost ceased.
Cough easy, not very frequent; copious expectoration
of saffron-colored sputa, not so tenacious, and mixed up
with a quantity of serum.
Dulness continues.
The tubular murmur and the bronchophony have developed themselves under the right clavicle; behind
they are not very distinct, and the crepitans redux is
heard here during the cough and at the close of an in.
spiration.-Bryonia and Phosphorus 18 in solution,
alternately.
Feb. 19.-Skin soft and moist; since last night the
patient had to be changed twice. Pulse soft, 90; tongue
moist and white-coated.




46                  PNEBMONIA.
Respiration normal; stitch not very painful, and only
when coughing.
Copious sputa, either saffron-colored and viscidj or
mucous and opaque, with a little serum.
Dulness behind, not very distinct in front, under the
clavicle; bellows'-murmur in this region; abundant
crepitation in the whole posterior region.-Continue
Bryonia and Phosphorus.
Feb. 20. —No sweat; temperature of the skin natural; pulse 80 to 84.
Cough frequent, easy, expectoration the same, except
no serum, and decrease of the saffron-eolored sputa.
Dulness in the same region.
Crepitans redux in front, not very striking behind,
where the normal respiratory murmur is heard on a
level with the sub-spinal depression.
Feels quite comfortable. The patient desires to eat.
-Sulphur 18 in solution.
Feb. 21. —Copious mucous expectoration; mucous
rattle at the top of the lungs in front; respiration
feeble behind, and mucous rattle at the close of an inspiration.-Continue Sulphur.
Feb. 22.-Less expectoration; the sputa is of a
lighter color, and partially vesicular; pulse 70 to 72. —Continue Sulphur. Broth.
Feb. 23.-The expectoration continues to diminish.
Feb. 24.-Perfect convalescence. —An allowance. —
Discharged March 6th.
A case of true pneumonia; no treatment until the
sixth day. Aconite is given; not much improvement
on the morning of the seventh day. Bryonia is folb
lowed by an aggravation in the afternoon; in the evening a remission of the symptoms set in, which continues
to the end. Phosphorus is given alternately with Bryonia to hasten the resolution of the pulmonary hepati



CASES TERMINATING IN RECOVERY.        47
zation. On the sixth day of the treatment, the patient
feels quite well. Is not this testimony sufficient?
CASE 15. —Pneumonia of the right side.
Baudot, 48 years old, day-laborer, of a robust constitution, and a'sanguine temperament; admitted March
20th, 1848, in the ward Sainte-C6cilie, No. 11.
Has had a cold for a fortnight past; coughs a good
deal at night, in the morning raises a little phlegm.
No fever, but had to keep his room for a few days. The
bronchitis having got better after this period of rest, he
returns to his work.
On the 19th of March, while going to Alfort with
some of his companions, he perspired on the way, and
took cold after his arrival. He was suddenly seized
with a violent chill, followed by fever, a dry and violent
cough, and an acute pain on a level with the right nipple. In the night these symptoms got worse, and the
oppression and the cough became so violent that the
patient was afraid he might suffocate.
March 20, on coming to the hospital, bloated face,
dull headache, slight icteric color of the sclerotica. The
tongue is red, dry; thirst intense. Skin burning hot,
pulse hard, tense, 116 to 120; anxiety; cough dry, frequent and painful.. The patient tries to suppress the
paroxysms in order to avoid the aggravation of the
stitch in the side. The breathing is rapid, short, sometimes interrupted and irregular; the oppression very
striking.
Percussion yields an obscure dulness on a level with
the two lower and posterior thirds of the right lung.
In this same space there is a complete absence of the
respiratory murmur, and a slight diffuse bronchophony.
In front, on the same side, the respiration is feeble, but
on the opposite left side it is puerile,-Aconite two
solutions; water and sugar two pitchers full.
Feb. 21.- Restless night.  Cough less distressing,




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




CASES TERMINATING IN RECOVERY.       49
the base of the lung, along the internal border of the
bone. Sub-crepitant rattle low down.
Evening: moist skin. The patient feels better; discharges a large quantity of sedimentous urine.
Feb. 23. —Sweat in the night; copious discharge of
sedimentous urine.
In the morning, the tongue is coated white and
moist; no headache. Icterus ceases; only the sclerotica remains yellow. Pulse large, soft, down to 80 or 84.
Breathing easy; stitch in the side scarcely perceptible. Cough less frequent; scanty saffron-colored sputa.
Same dulness and over the same surface as on the
first day. The bellows'-murmur is only heard on a level
with, and interiorly to the spine of the scapula. Below,
a fine and abundant crepitans redux. Bryonia, three
spoonfuls a day, water and sugar.
Feb. 24.-The icterus has disappeared. Pulse soft,
compressible, 72.
Cough rare; mucous expectoration not very abundant.
Bellows'-murmur and crepitation the same as yesterday.-Continue Bryonia.
Feb. 25.-Bellows'-murmur less.  Crepitation scattered; tongue coated white; heat of the skin natural;
pulse 72.
The patient desires to eat.-Two broths.
Feb. 27.-Bellows'-murmur scarcely perceptible.Respiration at the base of the lung normal.-Two broths,
two soups.
Perfect convalescence on the following days.  The
patient remains for some weeks in the ward as a laborer,
and leaves it May 2d.
The remarks appended to the last case, equally apply
to this one. The exhibition of Bryonia was followed by
an immediate and continual improvement without, aggravation.
3




50                  PNEUMOINIA.
CASE 16.-Pneumonia of the right lung.
Calson, aged 33 years, locksmith, of ordinary constitution and nervous temperament; admitted in the
ward Sainte-Cecile, No. 13, April 18th.
Had been subject to epileptic attacks since his boyhood; first they consisted in a little momentary nervous
derangement, but, for the last ten years, having increased to characteristic paroxysms, setting in without
precursory symptoms, at irregular periods and long intervals. These paroxysms had not as yet affected his
intellectual or organic functions, and, except his disease,
Colson had always enjoyed good health.
Was attacked with small-pox at the age of 18 years.
Last week, at a period which he did not exactly recollect, he was taken with a sick feeling, loss of appetite, weariness in the extremities. Continued his work
nevertheless.
On the 4th of.April, in the afternoon, this indisposition assumed a serious character. Without any assignable cause, he experienced a difficulty of breathing,
with a few paroxysms of dry and distressing cough. In
the evening he had chills followed by heat, vertigo and
general soreness and weariness.
On the following days he kept his bed, with a hot
fever, an acute pain opposite the right nipple, and a
distressing cough followed by bloody expectoration. He
had not had any treatment.
Calson came to the hospital on the fifth day of his
sickness; he showed the following symptoms:
Pale face, sparkling eyes; staring look; sudden, but
correct and precise answers; dry tongue, covered with a
dry and yellowish coating in the middle, with red edges;
bitter taste; occasional nausea; not much thirst.
Skin warm but soft; moisture on the forehead and in
the palms of the hands. Pulse large, full, 112 to 116.
Dull pain on a level with the right false ribs, worse




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




62                  PNEUMONIA.
latter portion scatters more readily than the evening
previous. The respiratory movements are full and remarkably slow.
Large vesicular crepitation in front; behind it is finer
and more abundant; bellows'-murmur more circumscribed and softer.-Bryonia two solutions.
The sweating continues the remainder of the day.
The following night is a good one, and the delirium
gradually ceases.
April 11.-Tongue coated white and moist; skin
moist, without any great heat; pulse large, 76 to 80.
No more delirium.  The patient feels faint at the
stomach, and desires to eat.
Cough less and less frequent; scarcely a little mucous expectoration, streaked with rusty phlegm.
Fine and copious crepitans redux in front and behind. The bellows'-sound continues slightly below the
clavicle.-Continue Bryonia.
April 12. —The patient begs for food. Tongue coated
and moist; pulse slow, soft, compressible.
Respiration harsh below the clavicle, with crepitant
rattle perceptible only during the cough and at the
close of a deep inspiration, not at all behind, where the
respiratory murmur begins to become a little normal. —
Phosphorus in solution.
April 13.-Two broths.-14. The harshness disappears gradually.-17. Had an epileptic fit last night, in
consequence of which he remained in a state of apathy
the whole of the 18th.
Discharged cured May 7th.
In this case the improvement commenced promptly
after the exhibition of Bryonia, and the resolution took
place very speedily.
Shortly after it had commenced, the patient was
seized with an epileptic fit. Such attacks frequently




CASES TERMINATING IN RECOVERY.       53
recur in epileptic patients after an acute malady. I
have seen this frequently after various acute diseases.
CASE 17.-Compound pneumonia.
Berthelot, aged 32 years, street-sweeper, of ordinary
constitution, had fever and ague at the age of 19 years.
This fever resisted a whole month to Quinine, and terminated in ascitis, which ceased in a fortnight. Since
then his health had been good.
Last Friday, April 28th, while sweeping the street,
he was taken sick and had to go home. He had scarcely laid down when he was taken with a violent chill
which lasted for about an hour, and with a very severe
dull headache. In proportion as the reaction set in,
the headache became worse, a profuse discharge of blood
took place from the nose and ears, and he felt so oppressed that he fancied he would choke, and had scarcely strength enough to call a neighbor from the next
room to his assistance.
A physician was called who bled him profusely, after
which the haemorrhage ceased, the oppression gradually
decreased, and was followed by a sharp, frequent cough
with some bloody sputa.
During the night, he had a violent fever, cough with
bloody sputa, and considerable difficulty of breathing.
Next morning the physician had him sent to us, ward
Sainte Ce'cile, No. 4.
April 29. —Flushed face, frontal headache, some nosebleed; streaks of dried blood are seen from the external
meatus auditorii to the lobules.
Tongue red, dry; intense thirst, skin dry and burning; pulse 112; cough frequent, bloody sputa mingled
with air-vesicles on the surface.
Oppression; respiratory movements short, unequal;
painful stitch in the side on a level with the left hypochondrium.
Percussed throughout its whole extent, the thorax




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




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




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




CASEFS TERMINAATINO IN AtCOVERY.      57
May 16. —Was admitted to our hospital' the face is
red and bloated, Intense frontal headache, with buzzing
in the ears.
Tongue coated white and moist, thirst moderate;
Skin moderately warm. Pulse full, large, 116 to 120,
Respiration anxious and frequent; stitch in the side
not very acute during the ordinary respiratory mover
ments, but very painful during the cough,
The cough is very frequent, distressing, followed by
a sanguineous expectoration of a uniform red color, and
very tenacious.
Percussion yields a dull sound behind and on the left
side in the sub-spinous fossaj and in front, from the clavicle to the fourth rib. In this space, auscultation reveals crepitation with unequal bullTe, breaking in masses
during a paroxysm of cough. Between second and third
rib in front, the expirations are tubular. Aconite 6 in solution, two tumblerfuls; sugar and water two pitcherfuls,
May 17.-Same as yesterday. Skin continues moist,
Pulse 116; sputa of a lighter color, more copious.-.
Water and sugar; Bryonia 12, two solutions.
Evening: The patient is very restless. Breathing
rvery frequent, anxiousj with distressing cough and scanty
expectoration.
Pulse strong; skin less moist, intensely hot6
The whole night was spent in this condition, without
any sleep.
May 18. —ieadache less intense, and the expression
of anguish less. The buzzing continues, and incommodes
the patient a good deal.
Tongue coated white and moist; very little thirst,
Pulse large, 100.
Breathing less frequent the stitch, which in scarcely
felt any more in its original locality, has changed to a
sense of constriction at the base of the thorax, on the
left side6




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




CASES'TERMINATING IN RECOVERY.       59
CASE 19. —Pneumonia of the right lung.
Hermanns, aged 35 years, admitted July 7th, 1848,
ward St. Benjamin, No. 26.
This patient is of a thin and dry constitution, not very
strong; is frequently attacked with pneumonia. Had
the first attack when he was 20 years old, in Holland.
The right lung was diseased. This attack was not very
severe, and treated with emetics and cathartics; it was
cured in four days; but he was not quite well until at
the end of a month.
At the age of 30, in Paris, he had a second attack on
the same lung, and remained three weeks in the hospital
St. Antoine, with Dr. Kapeler. He was treated with
venesections, cuppings, blisters, during the ten days that
the real inflammation lasted.
At he age of 33, another attack, treated in the same
manner. Was sick eight days, and recovered rapidly.
At the age of 34, in 1847, fourth attack, treated by
Dr. Recurt with venesections and tartar emetic. This
time the patient had to remain in bed for three weeks,
laid up with fever, cough, rusty sputa and a stitch in
the side, which disappears previous to the other symptoms at the end of a fortnight.
Between the attacks, Hermanns enjoyed good health,
had neither a cold nor any other disease. These inflammations always set in in consequence of violent exertions, after working all night at his trade, cabinet-making. In this condition the least cold brought on the
attack. This exposure is so certainly followed by the
disease, that he asserts he can bring on an attack any
time he chooses.
Last Tuesday, July 4th, after moving, and covered
with perspiration, he drank cold water to quench his
thirst.- Immediately after he was taken sick, had a
fever, but no chill; he expected his customary attack,
and went to bed soon after a stitch in the right side in




60                  PNEUMONIA.
front was felt; he coughed, and spent a restless and
sleepless night. Next morning he raised blood. In
this condition he remained home without any treatment,
except herb-tea.
On the 7th he was brought to the hospital.
In the evening he showed the following symptoms:
Countenance expresses lowness of spirits; eyes dull,
malar regions flushed  no headache.
Tongue dry, whitish in the middle, with red borders;
thirst moderate.
Pulse quick, compressible, 120 beats.  Skin hot and
remarkably dry.
The patient in only comfortable when lying on the
back.
Stitch in the side not very acute, behind and on the
right side; the stitch is only felt during the cough.
Striking dyspnea. The right side of the thorax remains unmoved during the act of respiration. On the
right side the breathing is short, frequent, but regular.
Cough not frequent, not very fatiguing, and giving
rise to a viscid, brick-colored expectoration.
Percussion yields a dull sound behind in the sub-spinal
depression at the base of the thorax, extending outward
as far as the axilla.
Auscultation reveals bronchial murmur in the subspinal fossa during an inspiration and expiration. Exteriorly, along the border of the scapula, we have an
abundant and very fine crepitant rattle. Toward the
inferior angle of the same bone, the crepitating bullae
are unequal, larger, less numerous.
This first examination, which showed the true character of the perceptible phenomena of this case, was insti-,
tuted at 7 o'clock in the evening. The physician on
duty bled the patient immediately after his admission,
three basinfuls. —Aconite 12 in solution.




CASES TERMINATING IN RECOVIERY.      61
July 8. —No change except that the dyspncea was
much worse.-Bryonia two solutions.
At five in the evening, the patient became rather
restless and flighty. -The patient wants to go out.
July 9.-The night has been very restless, no sleep 
the cough is very frequent.
In the morning the fever and the general symptoms
are the same as on the previous days. The skin continues dry and parched.
Cough frequent; the patient raises with more ease a
copious viscid sputa, rusty and having lost its former
brick color; it is mixed with a little vesicular serum.
Dyspncea intense; stitch in the side scarcely felt.
The bellows'-murmur is spread over a larger surface,
It is perceived at the base of the chest and along the
external border of the capsula. Along the inner border
the murmur is less harsh. —Continue Bryonia 12.
July 10.-Pretty good night; not restless. About
10 o'clock in the evening a slight moisture shows itself
on the thorax, in the face and on the upper limbs, The
patient is henceforth quiet, but has no sleep.
In the morning, the face has lost its sinking expres~sion; the malar'region is no longer flushed.
The tongue is coated white and moist, Thirst more
intense.
Skin dry, but of a mild temperature.
Pulse compressible, but fuller, down to 100.
Respiration full and easy.
Stitch in the side almost gone. Cough increases in
frequency. The patient raises a rusty sputa, surrounded,
at the bottom of the vessel, by a large quantity of vesicular serum.
Continued dulness of sound.
The bronchial respiration is not harsh on a level with
the internal border of the spine of the scapula, and. durd
ing an inspiration, is intermingled with a few erepitating




82                  PNEUMONIA&
vesicles. Below and toward the axilla, it is scarcely
heard at the end of an expiration. Crepitation is likewise heard in this space. —Continue Bryonia.
July 11.-The patient slept from one to four o'clock
in the morning. On waking he has to discharge a large
quantity of urine.
In the forenoon the skin is moist. Pulse down to 76
or 80.
The tubular murmur is limited to the roots of the
bronchia. Any where else crepitans redux.
Less expectoration, scarcely colored; not much serum.
Feels comfortable.-Bryonia.
July 12.-All over crepitans redux; the murmur is
limited and distant.
Mucous expectoration, slightly mixed with air-vesicles.
Continue Bryonia.
July 13.-Pulse 60.  Distant murmur; crepitation
only here and there, and not heard unless the patient
coughs. Broth,
July 14.-Pulse 60. Murmur at the bronchial roots
diminishing. In other parts the respiration becomes
normal. Phosphorus in solution; two broths.
Convalescent; discharged July 18th in perfect health.
CASE 20.-Pneumotia of the left side in the same
patient.
August 30th, Hermanns returns to the hospital, ward
St. Benjamin,
Last night he was attacked with a dry cough an acute
stitch in the left axilla, without any assignable cause.
Went to bed, and, two hours after, was taken with wandering chills, alternating with flushes of heat. The cough
continued all night, dry, fatiguing and painful. At daybreak the skin became slightly moist and he raised some
blood-streaked phlegm,
On coming to the hospital, he showed the following.,symptoms: Face bloated, but not much headache.




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




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




CASES TERMINATING IN RECOVERY.       65
In the afternoon a slight sweat breaks out.
Next night, sound sleep and rest.
Sept. 4.-Skin natural; pulse 68 to 72.
Cough rare, with serous and mucous sputa not very
abundant. Crepitation and bellows'-murmur continue. —
Bryonia.
Sept. 5.-Pulse 64. Now and then a little cough.
Scanty serous and mucous expectoration. Crepitation
disappears all over. The bellows'-murmur is still heard
towards the middle portion of the inner border of the
scapula. —Phosphorus 12. in solution.
Sept. 6.-The tubular murmur is less distinct.Continue Phosphorus.
Sept. 7.-Tne respiratory murmur is heard in the
whole extent of the inflamed lung. The bronchial respiration is scarcely heard.-Two broths.
Sept. 8, 9, 10.-Bryonia, one solution every day; the
pulse comes down to 48 beats.
Sept. 12; discharged cured.
CASE 21.-Compound pneumonia.
July 10th, 1848, Lefevre, blacksmith, aged 51 years,
was admitted in the ward St. Benjamin No. 15.
This man was naturally feeble, and had been in bad
health for the last ten years. Ten years ago he was
attacked with pneumonia which was treated for about
twelve days with venesections and tartar emetic, and was
followed by a convalescence of a month's duration, at
the end of which period the patient was able to resume
his work. His health was not entirely restored; for
ever since he had this disease he had remained subject
to pulmonary catarrh, each attack of which was characterised by an obstinate cough, especially at night, and
followed in the morning by a profuse mucous expectoration.  These attacks recurred at irregular periods,
and were altogether regulated by atmospheric influences,
cold weather, rain &c.; they were never accompanied




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




CA:SES TERMINATING IN RECOVERY.       67
cough, which had generally been loose, suddenly became
dry, except that, on the first day; he raised a few
strings' of pure mucus; on the second day he raised
streaks of blood; and'this continued until the expectoration looked altogether bloody. At the same time a
constrictive pain, which was not very violent at first,
but increased in intensity, was felt all around the chest
on a level with the false ribs, and imparted a sensation
as if an iron band had'been applied round this part of
the body. A distressing dyspncea developed itself with
the other symptoms, and, after having suffered in this
way for six days, he applied for admission in the hospital,
on the 10th of July, where he showed the following
symptoms:
Countenance worn out; striking emaciation; livid
color of the skin. Marked debility; inability to sit up.
No headache. Tongue coated white, moist, withred
edges. Thirst moderate.
Skin dry, warm all over, except on the forehead and
in the palms of the hands, which are moist.
Pulse small, tense, 96 to 100.
Dyspncea intense; breathing short and frequent. The
patient complains more particularly of the feeling of
oppression and the circular constriction round the epigastric region.
The cough is constant and painful.  Expectoration
viscid, homogeneous, rusty, strongly adhering to the
bottom of the vessel, without any admixture of serum.
Percussion does not yield any dulness of sound any
where in the whole extent of the thorax. Behind and
below, on a level with the lower angle of the scapula,
the sound is a little dull on either side; but this dulness is not complete.
Auscultation furnishes the following signs: below
the clavicles, anteriorly to either side of the thorax, the
respiration is not disturbed either as regards the rhythm




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




CASES TERMINATING IN RECOVERY.       69
continued harsh bellows'"murmur with diffuse bronchophony; abundant crepitation of large vesicles below. —
B3ryonia 12, two solutions, Sulphur 6, in alternation.
July 13.-Frequent cough in the night,
The cough continues during the day. Profuse mucous vesicular sputa. Dyspnoea.
Scattering crepitation right and left. Bellows'-murmur less harsh and mingled with a crepitant rattle at the
close of an inspiration on the right side; bronchophony.
— Continue Bryonia and Sulphur.
July 14.-Cough, with mucous expectoration. —Two
broths.
July 15.-Less cough. —ulphur 12.
July 20. —-Little cough; mucous and frothy sputa.
Respiratory murmur normal on the left side, except at
the base of the lung, where some crepitation continues
to be heard. Mucous rattle on the right side. The
bellows'-murmur has ceased. —An allowance. —Discharged cured July 24.
CASE 22.-Pneumonia of the right lung.
Escaille, aged 35 years, weaver, of a feeble constitution and nervous temperament, admitted July 11th,
1848, ward St. Benjamin No. 28.
This man had injoyed good health until 1836, when
he was attacked with a quartan intermittent, while in
garrison in the South of France; he remained sick for
six' months, and, at the close of this period, he was
moreover attacked with ascites, which finally left him,
together with the fever, under the use of quinine and
diuretics. He was perfectly cured, and has never had
another paroxysm since.
Three weeks ago he commenced to complain of a bad
taste in his mouth, with loss of appetite and aversion
to food. Every morning, on rising, he was taken with
nausea; the least thing he ate in the day-time oppressed
his stomach, and in the evening he was distressed by a




70                  PNEUMONIA.
feeling of malaise, uneasiness and restlessness, without
any appearance of fever; these symptoms disappeared
at night, and he slept profoundly. Diet and cooling
beverages stopped the nausea and the bad taste in the
mouth in about a week; but the malaise, the loss of
appetite, and the weakness continued and even grew
worse.
On the fourth of July the feeling of weariness in the
extremities became so great that the patient had scarcely
left his bed, when he was obliged to return to it. From
this moment he commenced to cough and to complain of
a slight stitch in the right hypochondrium, with a few
wandering chills now and then in the course of the day.
In the evening, he was suddenly seized with a violent
chill, commencing in the loins and back, and gradually
spreading over the iest of the body. This chill, which
lasted about'an hour and convulsed the extremities and
jaw si made the patient apprehensive of a return of his
former disease. But a reaction having speedily developed itself, with a seated headache in the forehead, and
more particularly with oppression of breathing, a violent
cough and a stitch in the side that tormented him all
night; and not seeing any sweat, he sent for a physician
the next morning, who told him that he was suffering
with pulmonary catarrh, and ordered him a bottle of
Seltzers' water, and a cataplasm in the region of the
stitch.
From the 5th to the 10th of July the oppression and
fever continued and grew worse.  On the sixth, the
cough, which had been dry until then, was followed by a
little blood-streaked mucus. No treatment was pursued
except that above mentioned, cataplasms and a decoction
of marsh-mallow.
July 11th, having spent a very bad night, on account
of the cough and the oppression which had become excessive, he was taken to the hospital.




CASES TERMINATING IN RECOVERY.        71
Two hours after his arrival, he showed the following
symptoms:
The patient lies on his back; complete prostration of
strength; the patient is wearied by the questions that
are put to him, and is scarcely able to answer yes or no.
Countenance animated, with flushes on the malar region.
Little or no headache'
Tongue dry, wih a red tip and red borders, covered in
the middle with a dry and brownish coating. Thirst intense, he asks for drink all the time.
Skin dry, with a stinging heat.
Pulse small, 120 to 124.
Stitch in the side, scarcely painful and having shifted
from the hypochondrium to the right posterior thoracic
region, toward the base of the lung; it is only when
coughing that the pain becomes acute.
Marked oppression. Breathing short and frequent.
Cough rare; he had expectorated only three times, a
rusty, viscid sputa, strongly adhering to the bottom of
the vessel, and not containing any air-vesicles; behind
and on the right side the sound is completely dull from
the spine of the scapula to the base of the lung.
Auscultation reveals a feeble respiration at the anterior portion of the thorax. Behind, in the sub-spinal
depression, a little crepitation is heard at the end-of an
inspiration. Below, no rattle, but an intense tubular
murmur is heard during an inspiration and expiration.Aconite 6, and Bryonia 6 in solution, alternately.
Saw the patient again between 11 o'clock and midnight; he is very restless and prays to be relieved of
the oppression that suffocates him.
July 12. —In the morning, we discover a slight remission in the symptoms. The dyspncea is less; the
pulse, skin, cough and the stethoscopic signs are the
same.-Water and sugar, three pitcherfuls; Bryonia 6
and 12, two solutions.




72                  PNEUMONIA.
At 7 in the evening, general aggravation of the symptoms.  Countenance animated; restlessness and oppression are excessive; cough very frequent. The pulse,
which had been small and tense, had become full, 116
to 120.
The cough had been increasing in frequency all night,
Abundant saffron-colored and visctd sputa, with a little
lighter-colored, scattering and vesicular sputa floating
upon it.
July 13.-Face continues animated with flushed cheeks;
perspiration on the forehead and on the wings of the
nose. Tongue red at the borders, moist and covered
with a whitish mucus. Thirst intense; no headache.
Skin hot and dry, but the heat is no longer stinging;
perspiration in the palms of the hands. Pulse large, 100.
Stitch in the side almost gone, scarcely felt when
coughing.
Respiration fuller and less frequent; the respiratory
movements are not embarassed; the patient considers
himself saved, because, says he, he is able to breathe.
Cough very frequent; the spittoon is half full of the
previously described sputa.
Complete dulness of sound behind, especially low
down.
Tubular murmur only during an expiration, along the
inner border of the scapula. Diffuse bronchophony in
the same space.  Broncho-egophony quite low down,
where the dulness of sound is perfect.
During an inspiration, the crepitans redux is heard
in voluminous masses.
Harsh respiration and rhonchus in the subspinal
fossa.-Two pitcherfuls of water and sugar; two solutions of Bryonia, 12, 24.
It was not till this day that the patient was able to
relate the circumstances of his previous illness, which
have been mentioned at the beginning.




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




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




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




76                 PINEUMONIA.
to rest. They generally set in in consequence of hard
work or abuse of liquor. Except these indispositions,
he has never had any long or serious illness that required the interference of art. He has never had a
rheumatic disease, although he has often taken cold
while in perspiration. In such a case he felt somewhat
stiff and sore in the, limbs, but these symptoms passed
off again after sweating.
Sept. 14th, he took cold, and feeling very thirsty, he
went on a drinking bout with his companions in order
to dissipate his unpleasant feelings. At 11 at night he
was playing cards, when he was taken with a violent
chill and a shrill and frequent cough, that lasted all
night,
In the morning complete remission of the symptoms
and cessation of the cough. He only felt tired. Feeling so much better, he resumed his work.
Sept. 15th, in the evening, he was taken with another
chill, which was soon followed by heat, and cough in the
morning, with sweat and a little watery expectoration.
Saturday morning: apyrexia, but greater lassitude
than the day before, and wandering pains at the right
shoulder and arm, in the left hypochondrium and in the
loin; in spite of this feeling of illness he goes to his work.
Sept. 16th, about nine in the evening, he is again
taken with a chill, which was more violent than the last
one, followed by fever, dry and fatiguing cough, dyspncea, and a painful stitch in the left hypochondrium.
He keeps his bed, experiences a slight remission of the
symptoms in the day-time, and a violent aggravation in
the night from Sept. 17 to 18; on this day he was admitted in the ward St. Benjamin, No. 20.
Sept. 18, in the evening: Marked prostration; the
patient is unable to sit up; lies on his back.
Countenance sunken, eyes dull, and slightly jaundiced
color of the sclerotica.




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




78                 PNEUMONIA.
seems less; the face is less pale, the eye more animated.
Tongue dry and red; thirst intense.
Skin dry and parched, hot; pulse rapid, small, 116
to 120.
Oppression the same. The breathing is short, unequal, frequent.  The patient complains of a painful
spot under the left breast; the pain is increased very
sensibly-by the cough.
Cough very frequent but easier; profuse expectoration
of bloody sputa, mixed with a frothy serum.
The bellow's-sound is replaced posteriorly, at the base
of the lung, by a scattered crepitant rattle; but it has
ascended to the top of the lung, and it is now heard in
the sub-spinal fossa. In front, under the clavicle, the
respiratory murmur -is simply exaggerated. Bryonia
and Phosphorus 12 in alternation.
In the evening the pulse becomes full and large, but
remains compressible 116.
Sept. 21.-During the night, the restlessness and
delirium increased until midnight; the patient attempted
to escape. After midnight he became quiet and coughed
less; he perspired and had to be changed once.
In the morning, the delirium continues; but he was
cheerful instead of morose. The patient wants to know
what he owes his physician, and desires to leave.
His strength returns; he is able to sit up in bed,
and his features no longer depict sadness nor lowness of
spirits. The eye has become quick and sparkling.
The tongue continues red and dry.  Thirst more
moderate.
The dyspncea is much less, also the stitch in the side.
The breathing is fuller and more regular.
Cough still frequent.  Expectoration more easy;
bloody sputa very profuse, not very tenacious, with a
large quantity of frothy serum floating upon it.
The dulness has decreased at the base of the lung in




CASES TERMINATING IN RECOVERY.4       79
front, below the nipple, where the. respiratory murmur
reappears.  Posteriorly, scattered crepitation towards
the base of the lung. The bellows'-murmur in the subspinal fossa is less harsh. When coughing, a few large
moist vesicles are heard to crepitate. Intense bellows'murmur in the sub-spinal fossa.-Bryonia 12, two solutions.
Sept. 22.-Night middling fair; delirious and restless. The day is pretty much the same as yesterday.
Pulse down to 108.-Continue Bryonia.
Sept. 23.-Copious sweat all night; the patient had
to be changed four times.
The merry delirium continues. He asks for his bill
and wants to leave.
Tongue coated white and moist; thirst moderate.
Skin moist all day; has to be changed twice. Pulse
soft, compressible, 84.
Breathing easy; the stitch has ceased.
Cough frequent, with copious expectoration of the
same kind as yesterday.
Same stethoscopic signs. —Bryonia and Belladonna
12 in solution, alternately.
Sept. 24.-The delirium continues. Last night the
patient slept well.
Pulse large, soft, 84. Skin natural.
Cough easy, pretty frequent. Profuse expectoration
which is less bloody, more viscid, mixed with vesicular
serum.-Belladonna and Arsenic 12 in solution, alternately.
Sept. 25.-Continued delirium.  No thirst.  Temperature of the skin natural. Pulse 64.
Abundant crepitans redux below the sub-spinal fossa.
The bellows'-murmur in the super-spinal fossa continues.
-Same treatment.
Sept. 26. —No delirium. The patient desires to eat.
-Pulse 56.




80                 PNEUMONIA.
A little mucous expectoration.
Crepitans redux less abundant. The bellows'-murmur continues. —ulphur 24; broth.
Sept. 27.-The murmur gradually disappears the
next three days.-Two broths.-The strength returns
very speedily; pulse remains at 56. Discharged cured
Oct. 5th, 1848.
CASE 25. —Pneumonia of the right side.
Pot, porter, 36 years old, of an athletic constitution,
was admitted in the ward St. Benjamin, No. 16, on
the 28th of September, 1848.
The day previous he had worked hard all day, and
had several times exposed himself to a cool draught of
air while in perspiration. Towards evening he felt stiff
and weary in his limbs, and had to quit work. As soon
as he had lain down in bed, he was seized with a violent
chill that shook the whole body for about an hour, and
caused the teeth to chatter. After the chill a fever
gradually set in, and the whole night the patient was
tormented by an unquenchable thirst and a burning
heat that rendered all covering intolerable.
This morning a stitch in the side on a level with and
a little below the right breast. From the first, it was a
seated, stitching pain, accompanied by oppression and
cough. A physician was called, who at once advised
him to go to the hospital.
An hour after his admission, Pot exhibits the following symptoms:
Face animated, bloated; acute frontal headache; he
lies on the i~1ght side, the only side on which he is able
to lie comfortably.
Tongue moist, covered with a whitish coating; thirst
intense.
Skin burning. Pulse strong, 120.
Stitch in the side, which is painful only during an inspiration, when the patient is lying on the affected side,




CASES TERMINATING IN RECOVERY.        81
very unpleasant in any other position, and aggravated
by pressure,
Not much dyspncea. Breathing hurried. Only the
inspirations are short and imperfect.
Cough rare.  The spittoon contains a little bloodstreaked, sero.us, vesicular expectoration.
The thorax, percussed with care, yields a normal
sound, except behind, below and on the right side, where
the sound is slightly dull.
Auscultation: discloses a clean-respiratory murmur on
the left side, normal in front and behind. On the right
side, in front and under the clavicle, the respiration is
puerile; behind it is somewhat exaggerated in the subspinal fossa. From the spine of the scapula to the base
of the thorax on the same side, there is a complete absence of respiratory murmur even during a deep inspiration. —Three pitcherfuls of water and sugar.-Two
solutions of Aconite 6.
Sept. 29. Moist all night; four copious diarrhoeia
stools; red urine;with sediment.
In the morning: bloated countenance; intense supraorbital headache.
Tongue coated white, humid; thirst intense.
Same position in bed.
Skin moist, very hot, but not pungent.
Pulse strong, 116 to 120.
Cough more frequent than the day previous, painful.
Serous, bloody sputa. Oppression, hurried breathing.
Dulness behind, below and on the right side; fine
crepitation in the same space, heard in masses.-Same
beverage. Bryonia 12, two solutions,
Sept. 30,-The perspiration and diarrhoea have continued all night, with sleeplessness, but no restlessness.
Otherwise the symptoms are the same, except the
cough which increases in frequency, and the expectoration, which has changed in color and consistence.
4*




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




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




~84            F~PNEUMONIA.
heat and a little perspiration. At the same time his
breathing was embarrassed, he coughed a good deal, and
on the following morning, he raised a little blood.
Sept. 23 he entered the ward St. Benjamin, No. 18.
Skin warm like his breath; tongue covered with a
whitish coating; thirst intense; pulse middling full,
100.
No stitch in the side, but the breathing was embarrassed by a sense of constriction of the base of the
thorax, on the left side.
Cough rare; easy expectoration of rusty sputa in
small quantity, and very viscid.
No respiratory murmur in the whole of the left side,
except behind, towards the middle of the axillary border
of the scapula, where a slight bellows'-murmur is- heard,
accompanied by crepitation, as often as the patient
coughs or draws a long breath.
The thorax sounds well above and below the space
where the tubular murmur and the rattle are heard.
Here percussion yields a dull sound over a surface of
about three inches sideways.-Aconite and Bryonia in
solution, alternately; water and sugar.
Sept. 24.-Had a good night. The temperature of
the skin remained the same, without any actual perspiration; cough and fever the same. In the morning,
the symptoms were the same. —Bryonia in solution.
Sept. 25. —Tongue coated white and moist; pulse
soft, undulating, 92.
Skin moist.  The patient has to be changed three
times.
Scarcely any difficulty of breathing.   Cough decreases in frequency.  A  little viscid, rusty sputa,
mixed with a little whitish mucus.
The respiratory murmur is heard in front of the
thorax, and behind below the stitch; in this region a




CASES TERMINATING IN RECOVERT.        86
faint murmur and crepitation in large masses are heard,
Dulness of sound circumscribed.-Bryania 12.
Sept. 26. —Skin natural; pulse 72. No cough; mucous expectoration.
Less crepitans redux. —Bryonta.
Sept. 27. —Feels perfectly well, A little more crepi.
tation at the end of a deep inspiration or during the
cough.-Phosphorus in solution; two broths.
Sept. 28.-Two broths and soups.
Sept. 29.-The same. Discharged Oct. 2, 1848.
CASE 27.-Compound pneumonia.
Oct. 14th, 1848, Mrs. Bizet, a day-servant, aged 69
years, was admitted in the ward Sainte Annd, No. 4.
She had a sound and strong constitution, had never
been very sick, and had been free from accidents or ins
firmities until recently.
Yesterday, Oct. 13th, without any assignable cause,
she was seized with a chill which lasted about two
hours; it was not very severe, and was followed by
moderate heat and a violent oppression of breathing.
In the evening, she had another- chill, accompanied
with a stitching pain on a level with the false ribs of
the right side, a dry cough, not very frequent, and aggravating the pain, and finally dyspncea.  Soon after
she felt hot and perspired.  This condition lasted all
night without any aggravation. Next morning the patient felt a little better, except the oppression, and she
came to the hospital Oct. 14th,
An hour after her admission, she showed the following symptoms'
Lies any way; face pale and slight circumscribed redness of the malar region; eyes sparkling but moist; a
little headache; lips and tongue dry; thirst intense,
Had not perspired for the last three days; moderate
heat and dryness of the skin. Pulse frequent, but no;
hard, from 100 to 104.




86                  1~nt7UMONI A.
Violent dyspncea, unpleasant sensation of heaviness
over the whole thorax, and stitching pain on a level
with the lower extremity of the sternum which is aggravated by cough and by a deep inspiration.
Cough dry, not very frequent; it excites a feeling of
roughness in the fauces, which. is followed by nausea,and a momentary bitterness in the mouth, that disappears again as soon as the patient drinks something.
Percussion yields a marked dulness of sound at the
lower and posterior portion of both sides of the thorax;
on the right side, from the sub-spinal fossa to the base
of the lung; on the left side it is -only felt over a space
of about four fingers'-breadth, quite low down -at the
base. Any where else, the resonance is normal.
Auscultation reveals a very harsh bellows'-murmur
on the right side along the inner border of the scapula,
from its spine to the lower angle; from the boundaries
of this murmur towards the axilla, an abundant crepitation is heard. On the left side, in the space which
corresponds to the dulness of sound, the respiratory
murmur is not heard at all during the ordinary respiration; but during the cough, or at the end of a deep inspiration, large masses of a fine crepitant rattle strike
upon the ear. —Two pitcherfuls of water and sugar;
Bryonia 12 in solution; an emollient injection.
Oct. 15.- Bad night. The cough, which had been of
moderate frequency until now, had been frequent and
distressing until morning. Towards morning the patient had expectorated a little liquid serum; had had
two copious stools; urine with a sediment.  In the
forenoon, same symptoms as last night; except that
the pulse is full, soft, down to 84.-Bryonia 12, two
solutions.
About three in the afternoon, a slight moisture is
seen on the skin, and continues during the whole of
next night, during which the patient rests; she has to




CASES TERMINATING IN RECOVRYV.        87
be changed, and discharges a large quantity of red,
sedimentous urine.
Oct. 16.-Peels quite comfortable. Countenance has
a natural expression. Tongue moist and coated white;
no thirst; neither headache nor nausea.
Temperature of the skin normal; pulse soft, comr
pressible, down to 68.
Breathing free and easy, although she still complains
of a dull sense of constriction over the whole thorax,
especially around the false ribs. The stitching pain
behind the sternum has ceased.
No cough, no expectoration.
Dulness of sound in the above-mentioned space.,
The bellows'-murmur on the right side has become
fainter and more distant; a crepitant rattle is heard on
its limits, and likewise on the left side at the base of
the lung, only when coughing. —Bryonia in solution;
broth.
Oct. 17. —The patient desires to eat.  Pulse slow
and soft, 64.
Dulness continues, bellows'-murmur faint and distant,
with scattered crepitation behind and on the right side;
on the left side no abnormal murmur, the respiratory
murmur -is heard again. — Bryonia 24, three spoonfuls;
broth.
Oct. 18.-Pulse slow, compressible, down to 52.
Bellows'-murmur scarcely heard. —Continue Bryonia;
two broths and a soup.
On the following days the resolution became perfect;
discharged cured Oct. 31st, 1848.
The cases which have been reported so far, seemed to
me to appeal so eloquently to the judgment of the
reader, that I have not deemed it necessary to offer
any comment.
The sinking of the pulse after the exhibition of Bryonia has been seen.  This phenomenon occurs almost




88                  PNEUMONTA.
regularly. The sinking is generally less when Phosphorus is given either after, or alternately with, Bryonia.
CASE 28.-Pneumonia of the tight side.
Lucas, 44 years old, shoemaker, admitted on the 18th
of Oct., 1848, ward St. Benjamin, No. 18.
The patient had an attack of pleurisy in 1824; he is
not subject to colds, enjoys good health in general, is
strong and has a good constitution. Eight days ago,
after moving, he exposed himself to a cold draught while
drenched with sweat; he felt this exposure keenly,
During the three subsequent days, he did not experience any untoward symptom. But on the third day,
having gone to bed early, he was: seized with a violent
chill towards midnight, and had cold sweats which
lasted until morning. At the same time he felt a headache,'a pain in the side, dyspnoea, and was attacked
with a cough that aggravated the stitch in the side, and
which he sought to suppress on this account; he complained of intense thirst and general weariness. During
the following five days the symptoms became worse, but
the patient declined treatment.
On the 19th of Oct., the day after his admission to
the hospital, he showed the following symptoms:
Skin warm and dry; pulse frequent  thirst intense;
tongue covered from the tip: to the root with a whitish
coating; mouth sticky, with. bitter taste; costiveness
since he was first taken sick; copious discharge of
urine; frontal headache; slight icterus, particularly
marked on the cunjunctivae. Moderate anxiety;  stitch
in the whole right side of the thorax, going from before
backwards, and particularly painful at the base of the
thorax; cough frequent, followed by scanty expectoration of gummy sputa that adheres to the vessel, is filled
with air vesicles on the surface, and mixed with a viscid
substance of a yellow-brown color.e




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




90                  PNEUMONIA.
Oct. 21.-Pulse regular, normal; skin moist, sweat
slightly warm, like the breath; thirst pretty violent;
tongue the same as yesterday; mouth a little sticky, not
so bitter. No stool; frequent and copious discharges
of urine; icterus of a lighter color; no anxiety; cough
much less frequent; sputa clear, ropy, without any abnormal color.
In the night the patient had to be changed three times;
bled a little from the nose.
Dulness of sound in the super- and sub-spinal regions
of the right side. Sound clear at the base.
Crepitation in the super- and sub-spinal spaces, larger
and moister than the previous day. The bellows'-murmur is less intense; the voice is not so shrill.
Same treatment.
Oct. 22.-Pulse normal; skin natural; thirst moderate; tongue natural; mouth without bitterness;
appetite; no stool; urine not very copious; scarcely
any headache; no icterus; no anxiety; no stitch in the
side, except. during a deep inspiration; cough pretty
frequent; expectoration easy, not copious, only a little
ropy phlegm. No sweat.
Dulness of sound a little less in the super- and subspinal regions; crepitans redux; bellows'-murmur still
heard in these regions. —Bryonia 24 in solution.
Oct. 23.-Feels quite well, generally as well as locally.
A-little dulness in the super- annd sub-spinal regions.
Respiration in the super-spinal region harsh, but without
any rattle. In the sub-spinal fossa, the respiration is
normal, but a little harsh; during a paroxysm of cough
a few large vesicles are still heard to crepitate.
Treatment discontinued. Broths.
On the subsequent days, the strength returned, and
the convalescence took place without any untoward




CASES TERMINATING IN RECOVERY.      91
symptom; the patient was discharged cured on the
6th of Nov. 1848.
CASE 29. —Pneumonia of the left side, second
stage.
Oct. 25th, 1848, Billon, 16 years old, paper-hanger,
was admitted in the ward St. Charles No. 6; the patient
is of middling constitution, has never been subject to
ganglionic engorgements, nor to any derangements that
generally point to a scrofulous taint.
He is not subject to cough; except that, three months
ago, he went to the hospital St. Antoine, where he remained a whole month under treatment for a cold. His
cough was frequent, distressing, and sometimes accompanied by vomiting. No stitch in.the side, but a tearing pain along the sternum. He did not expectorate;
according to the statement of the patient, the breathing
was just as oppressed then as it is to-day. He was bled
once.
He had not felt any of this illness for some time, when
he was suddenly taken ill last Saturday.  The day
previous he felt well; he had done several errands,
without feeling any unpleasant symptoms; he was in
the habit of walking barefooted, but he does not recollect having taken cold previous to his illness. He did
not cough any.
Saturday morning, on rising, he felt well as usual,
ate his breakfast, and went to his work. Three or four
hours after this, he was taken with a stitch in the side
and a dry and distressing cough. He had neither headache nor precursory chill. He continued his work all
day, and ate his meals with a pretty good appetite. In
the evening the stitch and the cough had grown worse.
He had no chill. The cough was dry. Had a pretty
quiet sleep.
Sunday morning he was about the same as Saturday
evening; the stitch and the cough continued. He went




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




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




94                  PNuEUMONTA.
stools, one copious, the other less so, he discharged some
urine twice, which was not examined. Very little sweat,
which continued in the forenoon.  Pulse 92, respirations 36.
Skin burning and slightly moist; fanxiety as yesterday; the stitch in the side is less acute. Dyspnoea less
than last evening at 9, but about the same as in the
day-time. No expectoration. Same treatment and diet.
In the evening, the patient is about the same as in
the morning. The general symptoms are not much less
intense.  The bronchial murmur has shifted to the
middle of the sub-spinal fossa; it has almost disappeared
low down, where a few vesicles are heard to crepitate
during the ordinary inspirations. Where the bellows'murmur terminates, crepitation is heard during the cough
and during a deep inspiration.
Pulse 84 to 88; 36 inspirations.
Oct. 28 —Slight sweat in the night, sound sleep.
Feels much better to-day. The general symptoms have
ceased almost entirely; the patient's countenance is
almost natural; the previous depression has disappeared,
and has given place to a feeling of ease; the patient sits
up in bed, and says he feels well. Pulse down to 56.
Skin warm, like the breath; no oppression; a little
cough without expectoration.
The bronchial murmur is limited to the space previously indicated; all around one hears, like yesterday,
the crepitation of moist, large, unequal vesicles.
Pulse 56, inspirations 32. —Two solutions of Bryonia;
water and sugar. Diet. In the evening, same symptoms.
Pulse 44.
Oct. 29.-The improvement continues; the dulness
decreases.
Pulse 44; inspirations 28.
Same treatment. Broths.
In the evening, same pulse; moisture.




CASES TERMINATING IN RECOVERY.        95
Oct. 30.-Pulse regular, 40; inspirations 24.
Countenance cheerful; the patient had eaten his broth
with an appetite.
Cough not frequent, easy, dry.  No sweat in the
night; no stool; the urine no more copious than natural;
a little thirst and appetite; skin dry, mildly warm.
Complete disappearance of the dulness; bellow's-murmur
and crepitation during the ordinary inspirations have
disappeared; but, when coughing or drawing a deep
breath, the crackling of large moist vesicles is heard,
especially in the sub-spinal fossa; it is less abundant in
the lower portion of the chest. The respiration is rather
harsh on a level with the spine of the scapula. Here
the voice has as yet a more powerful resonance than on
the right side.
Feeling of ease, no anxiety.  Good sleep; stool
regular.
Same treatment; broths and soups.
Nov. 1st.-Same symptoms. —Two pitcherfuls of water
and sugar; Bryonia 12, in solution, one spoonful only;
broths and soups.
Nov. 2 and 3.-Same treatment and regimen.
Nov. 4.-Two allowances; no medicine.
Nov. 5. —Same treatment; a little dry cough, but
very seldom; the patient gets stronger every day; keen
appetite. Pulse regular, 56.
Nov. 6.-A little bronchophony about a quarter of an
inch from the spine of the scapula. No rattle. Pulse
48; inspirations 20.
This case, which has been related with the greatest
care by Dr. Duhamel, attending physician under my
respected colleague Dr. Valleix, offers a very peculiar
interest. The patient was transferred to, me by Dr.
Yalleix at the request of his pupils, who considered this
case a fair criterium of the efficacy of homceopathic
treatment.




90                 PNEUMONIA.
I am  aware that no serious conviction can be based
upon an isolated case. But in this instance the cases
which preceded, and those that will follow it, render such
evidence as the above case involves, unimpeachable.
CASE 30. —Pneumonia of the right lung.
Lambert Cesar, aged 60 years, carpenter, of a nervous
temperament and a good constitution, and who had never
been seriously sick, was, about a month previous to his
admission in the hospital, attacked with a paroxysm
during which he lost his senses, and for which he was
bled at the arm.  This paroxysm did not leave any
disagreeable consequences behind, except an acute supraorbital neuralgia which frequently disturbed his sleep.
Since the events of February this man had undergone
violent exertions and many privations. In the midst
of these debilitating circumstances he was attacked with
dysentery for which he was treated at the hospital
Sainte-Marguerite, ward Sainte-Cecile No. 18, for about
a fortnight, to date from Oct. 5th, 1848. On th 18th of
Nov. he was fully convalescent, when he descended
into the yard to wash his hands and face; on this day
the weather was colder than usual; while he was washing himself, he did not feel any unpleasant symptom;
but at breakfast, an hour or two after the washing, he
felt ill and lost- his appetite; soon after a violent chill
ran over him, an intense heat broke out about his head,
thence spread all over his body, giving rise to prickings
and uneasiness in the extremities. Soon after he was
taken with a violent headache and an acute stitch in the
side, which deprived him of sleep. In the night an
obstinate cough with bloody sputa, and an intense thirst,
tormented him with the other distresses. Next morning
these symptoms remained about the same with an equal
intensity and without any other change supervening.
Nov. 20th the following symptoms were noticed: face
red and animated; eye lively; the patient lies on his




CASES TERMINATING IN RECOVERY.        97
back, slightly turned to the left side; in other respects
neither prostration nor nervousness. Pulse 120; cough
frequent, dry, in paroxysms, hacking; expectoration
copious, resembling in color the juice of prunes, a little
blood-streaked, rather tough, adhering to the vessel
like liquid glue; headache pretty acute; had to be
changed once last night on account of the sweat. Tongue
looks natural. No nausea; no vomiting. Had not had
any stool for two or three days past; urine less copious
than usual; the stitch is located opposite the right
breast; not much anxiety.
Percussion yields a dull sound over the whole of the
right chest, posteriorly; in front the sound is normal;
nothing remarkable on the left side.
Auscultation reveals an intense bellows'-murmur over
the whole surface of the right chest, posteriorly; but the
point where it is most intense is opposite the spine of
the scapula; here a very fine crepitation was heard, but
only during the cough.-Bryonia 12 and 24, two solutions.
Nov. 21.-Pulse 112; skin rather moist, a little
warmer than naturally; cough less frequent, sputa partially bloody; of a reddish-brown color, and partially of
a green color like a marmelade of green prunes; the
sputa is viscid, not vesicular; the stitch, as painful as
yesterday, has shifted to the edge of the false ribs;
sleepless night, with headache, and very restless. Tongue
covered with a whitish coating, without any redness at
the borders; thirst intense; no nausea; no vomiting.
The supra-spinal fossa yields a good sound; the sound
in the sub-spinal fossa is rather dull; at the base of the
chest the sound is incomplete.
Auscultation reveals the following signs: No rattle,
no bellows'-murmur in the supra-spinal fossa. Bellowsmurmur and crepitant rattle in the sub-spinal fossa.
5




98                  PNEUMONIA.
At the bas~, the bellows-'murmur is less intense than in
the last-na taed space; sub-crepitant rattle.
The celebral functions seem  slightly irritated; his
speech is short, his movements sudden and quick, but
his mind perfectly clear.
No change of treatment.
Nov. 22. —Pulse 112, hard and full; copious perspiration all night, quiet and a little sleep; skin moist,
heat normal; face rather animated, celebral excitement
the same, the patient seems even a little flighty; the
supra-orbital neuralgia is very distressing, which might
perhaps account for his restlessness and delirious irritation, Cough not very frequent, sputa remains the
same as regards color and quantity, except that some of
it assumes a yellow-brown color, and becomes bloodstreaked and bloody; tongue natural, thirst not very
great.
Marked dulness from the spine of the scapula to the
lower angle of this bone; from this point to the base of
the thorax it gradually disappears.
Loud bellows'-murmur in the sub-spinal fossa, esp(cially during an expiration; fine and very even, vesicular
crepitation in the same region.  The murmur grows
fainter in proportion as one approaches the base of the
thorax, but in the neighborhood of the vertebral column,
from the base of the chest to the spine of the scapula,
the crepitation is unequal.
The stitch in the side is less acute, the patient is able
to blow his nose, and to cough without much trouble.
Same treatment.
Nov. 23.-Pulse 112; face less red and the countenance less animated; the skin remains covered with a
slight moisture; tongue coated white, thirst intense,
stitch much less. The neuralgia remains very acute;
the patient had a stool this morning.  Cough not very
frequent; the expectoration as copious as on the pre



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




100                 PNEUMONIA.
Loud bellows'-murmur in the region of the bronchial
roots, crepitation in the sub-spinal fossa, sub-crepitant
rattle towards the base. —Bryonia 24.
Nov. 26.-Pulse 80, hard and full; perspired a good
deal last night; herpes labialis on both lips; tongue
coated whitish; not much thirst; cough rare; the expectoration is of a lighter color and not very copious.
Had a good night.
Neither dulness, nor bellows'-murmur any where in
the chest; in the sub-spinal fossa, especially towards
the vertebral column, a sub-crepitant rattle with unequal humid vesicles is heard.
Nov. 27.-No marked change in the condition of the
patient.
Nov. 28. —Pulse 80; skin naturally warm; a little
cough; the sputa is greenish, scanty, and resembles nasal mucus in color and consistence; the appetite reappears;-broth.
In the sub-spinal fossa the sound is slightly obscure;
respiration a little harsh, with a few vesicles of crepitant and mucous rattle.
Nov. 29.-Pulse 80; sputa of a light-yellow color;
no cough; some dulness of sound interiorly to the scapular spine, with a little bellows'-murmur during an expiration; no rattle.-Broths and soups.
Nov. 30.-Pulse 76; sputa of a lemon-color, vesicular, ropy, not very copious; slight obscurity of sound
interiorly to the spine of the scapula; a little bellows'murmur during an expiration.
During the following days the resolution takes place.
The patient leaves the hospital on the 11th of January,
1849, after having completely restored her strength.
CASE 31.-Pneumonia of the right side.
Wach, aged 33 years, tailor, was admitted Dec. 9th,
1848, ward St. Benjamin, No. 27.
Was taken sick on the 3d. First he was taken with




CASES TERMINATING IN RECOVERY.      101
a violent pain in the right side, chill, and intense headache; frequent paroxysms of cough distressed him; he
raised something, but did not see any blood until the
7th. Lost his appetite from the commencement of his
illness. Applied three times for admission in some hospital, and had to wait until the 9th, during which time
his disease kept growing worse. On the day of his admission, he showed the following symptoms:
Constitution pretty sound; skin warm and covered
with sweat; if he sits up in bed or talks, he trembles
a good deal; breathing hurried; complains of an acute
pain in the right side, which he has had from the commencement of the attack. Percussion yields a marked
dulness in the middle third of the percussed lung.
Auscultation reveals a loud bellows'-murmur; the sputa
is opaque, bloody, adhering to the sides of the vessel;
pulse 104. Tongue coated; the patient complains of a
bitter taste in the mouth; he has no appetite, but a good
deal of thirst; has no pain in the bowels, and goes to
stool regularly; head heavy and painful; face pale,
livid; the symptoms show that there is serious danger
of suppuration. Before coming to the hospital, he had
contented himself with drinking Linden-tea, In the
evening he was ordered two pitcherfuls of water and
sugar, and two solutions of Bryonia, one 12, the other
24; strict diet.
Dec. 11.-The patient is found in nearly the same
position; he does not feel less pain; the bellows'-murmur is a little worse, heard over the three upper fourths
of the lung; pulse 108; Bryonia 12, two solutions.
Dec. 12.-Pulse 104; no improvement; the murmur
continues; sputa bloody.  Same treatment. In the
evening the patient feels better, and raises more easily.
Dec. 13. —Pulse 96; upon the whole, the patient feels
much better than before; sputa less red, the murmur is
much less; it is only heard in the upper,half of the




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




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




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




CASES TERMINATING IN RECOVERY.       105
patient says she never had a catarrh previous to this
sickness.-Bryonia and Ipecac. in solution alternately.
Jan. 9.-Pulse 84; cough in the night. —Bryonia and
Belladonna in solution, alternately.
Jan. 10. —Skin cool, pulse down to 76; increase of
strength, better appetite; cough less frequent; easy expectoration; the respiratory murmur becomes stronger;
no abnormal sounds.-Bryonia in solution, two spoonfuls; Belladonna in solution.
Jan. 11. —Two small ulcers remain in the places where
the scabs have sloughed off; the rednesses have disappeared from the sacrum.-Ipec. in solution.
Jan. 12 to 20.-No medicine was given; every now
and then the patient had an attack of cough in the night;
she went on improving, however, and recovered her
strength. On the 20th, all the stethoscopic signs had
ceased; the cough gave place to a clear, -vesicular expectoration. The convalescence took place with extreme
ease. The patient was permitted to remain in the ward
for some time as an act of favor.
This case shows that one ought not to despair too
readily. This pneumonia, which had been so long neglected, had not yet passed into the stage of suppuration
when we commenced the treatment. Hence the conclusion was that the patient might still be cured, and she
was cured with a surprising promptitude.
CASE 33. —Pneumonia of the left side.
Rouel, 70 years old, carpenter, was admitted in the
ward St. Benjamin, No. 8, Jan. 29th, 1848.
Had a pretty good constitution. Twelve years ago
he had an attack of pulmonary catarrh, which he describes
pretty accurately. The left lung was affected. At the
age of 30, this lung had likewise been inflamed. Nothing
else of consequence to be related concerning the former
life of this patient.
He had never had a cold before; but this year he had
5~.



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



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




108                 PNEUMONIA.
Inspiration a little harsher than on the sound side,
but expansive and general.
Appetite. —Broth. Bryonia 24.
Feb. 3.-Inspiration increases in volume; same signs.
as above. Pulse 60. General condition good. Broths,
soups.-Bryonia only a few spoonfuls.
Feb. 4.-Full convalescence.
Now and then a few turns of cough, and a few dull
pains shifting from one part of the thorax to the other,
and from the shoulder to the thorax; but they do not
trouble the patient. In a few days the breathing became
as full on the left as on the right side; no abnormal
murmur in the whole extent of the chest.
Feb. 24.-The patient expects to be discharged from
day to day. Leaves March 13th, 1848.
CASE 34.-Pneumonia of the right side.
A young man of 25 years, whose name has been forgotten, was admitted on the 24th of April, 1849, ward
St. Benjamin, No. 31.
April 20th, about 4 o'clock in the evening, without
any assignable cause, without any precursory symptoms,
he was taken with a feeling of sickness; he left his
work, went home, felt chilly; soon after a fever set in,
with a stitch in the right antero-lateral portion of the
thorax. In the night the breathing became more difficult,
more hurried; sweat broke out. He remained without
any medical treatment until the evening of 24th of April.
We found the following symptoms: Face flushed,
expressive of suffering. Respiration frequent, not very
full. Tongue flat, moist, covered with a thin whitish
coating. Cough loose, not very frequent; raised some
viscid coherent sputa, strongly adhering to the vessel,
of a beautiful apricot-color, and mixed here and there
with fine streaks' of blood. Acute fever; skin hot,
equally covered with sweat all over; pulse frequent,
large, soft, 120. Frontal headache; loss of appetite,




CASES TERMINATING IN RECOVERY.       109
intense thirst.  Has not had any passage from the
bowels for two days; only one stool since the commencement of his sickness.
Percussion yields dulness of sound in the upper portion
of the right lung; the left side yields a good sound.
Auscultation discloses a bellows'-murmur in the whole
extent of the right lung,'without rattle; on the left side
the respiration is normal, only not so full as in a state
of health; the inspirations are frequent and not very
deep; the lung is only imperfectly dilated. Painful stitch
below the right nipple, preventing the expansion of the
chest.-Bryonia 12, in solution.
April 25.-Same symptoms in the morning; profuse
sweat, hot skin, pulse frequent, 118, 120. —Bryonia 12.
April 26.-Same sweat, affording no relief. Had no
sleep.
Frontal headache; flushed face, tongue moist, flat,
coated white; thirst intense.
Respiration frequent; stitch not so painful. Same
physical signs, except that the respiration is a little
deeper; the bellows'-murmur in the whole right lung is
more distinct; it might be considered typical of this class
of signs., On the left side the vesicular murmur is heard
more plainly. The expectoration is not excessive, but extremely characteristic. Pulse 115. No stool.-Bryonia
12 and Phosphorus 12 in solutiorn alternately.
April 27.-Skin moist, sweat less copious. Pulse 115.
Cough not very frequent.; sputa less colored.  No
headache.
In the night, painful exacerbation of the stitch in the
side; for two hours, pain in the whole of the right side,
as far as the shoulder; anxiety. No pain this morning.
Same physical signs.- Same treatment.
In the evening a few crepitating vesicles at the right
middle portion. Pulse 108.
April 28.-Perceptible improvement; breathing easier;




110                PNEUMONIA.
cough not frequent, expectoration almost free from blood,
but continues viscid. The stitch is only painful during
the cough and when drawing a long breath. No headache.
Tongue moist, and a little coated; thirst less. Skin
moist, heat milder; pulse 104. The patient feels well,
slept some.
Crepitans redux at the middle portion of the lung.
No stool.-Same treatment.
April 29. —Skin gently warm, pulse down to 62. No
stitch; cough rare; raises only phlegm.
During a turn of cough, auscultation discloses crepitation in the whole extent of the lung; some bellows'murmur in the sub-spinal region, near the axillary border
of the scap4. —Bryonia 24.
April 30.-Temperature of the skin and pulse the
same. —Confluent miliaria on the chest, abdomen,
forehead.
Cough rare; raises a little mucus. No stitch in the
side. Resonance; a few crepitating vesicles here and
there. No bellows'-murmur.
Slight stomatitis; tongue thickly coated yellowish,
with red edges; gums with a whitish border around the
teeth.-Broth. Bryonia in solution.
May 2.-The miliaria is disappearing.  Skin cool;
pulse 62. Stomatitis.
Cough very trifling, not painful, no expectoration.
The respiration on the affected side is a little harsher
than in health; no abnormal noises.
No stool. Appetite.-Broth, soups. Bryonia.
May 3.-The eruption is gone. Complete convalescence. An allowance. Discharged May 10th.
CASE 35.-Pneumonia of the right side.
Delormey, a man of 59 years, small stature, worn-out
and thin constitution, admitted July 10th, ward St.
Benjamin, No. 5.
July 5th he was taken with illness in the evening'; he




CASES TERMINATING IN RECOVERY.      111
threw up his dinner, went to bed; he felt chilly, fever set
in, and afterwards an acute pain near the right nipple.
The patient begins to cough, and next morning he raises
a viscid, rusty substance. No treatment; only quiet
in bed.
July 10th, the day of his admission, the patient presented the following condition: Flushed and animated
face, rather thin; tongue moist and lined with a thick
yellowish-white coating; thirst, loss of appetite, constipation.
Skin hot and dry; pulse soft, large, 95. Respiration
frequent, short, hurried; speech broken, exciting the
cough; the cough is frequent, in short paroxysms, giving rise to a scanty expectoration of small quantities,
viscid, blood-streaked phlegm. The stitch under the
right nipple is very painful, aggravated by cough; while
coughing the patient holds this part with his hands.
Percussion yields a complete dulness of sound in the
lower half of the thorax; in the upper portion the resonance is good.  Above the spine of the scapula a
few crepitating vesicles are heard, and above it a
loud bellows'-murmur, especially during an inspiration;
bronchophony. Above the spine, frequent crepitations
in the whole summit of the lung.-Bryonia 12 in solution; water and sugar.
July 11.-Same symptoms; pulse 100, —Bryonia 12
and 24, two solutions.
July 12. —General condition the same. Warm skin,
pulse 95.  Dyspncea the same; frequent cough; expectoration scanty, but characteristic. The stitch in the
side is a little less, painful only during the cough. In
the lower portion of the lung the crepitation is more
frequent; but in the lower portion a loud bellows'-murmur continues to be heard. Dulness of sound. Resolution has commenced low down. High up the bellows'-murmur is pretty loud, with a few crepitating
vesicles during the cough.




112                 PNEUMONIA.
The patient coughed a good deal in the night; slept
only a few moments. Constipation. Bryonia in solution
12, and 24, as above.
July 13. —Less fever; the skin is softer, pulse 75.
The breathing is easier; the stitch is only felt during
the cough; the patient raises a little viscid, bloody
matter.
Crepitation more frequent low down; the bellows'murmur is only distinctly heard above the spine of the
shoulder-blade.-Bryonia and Phosphorus in solution,
alternately.
July 14.-Same symptoms. A stool during the day.
Tongue coated the same. Same treatment.
July 15.-Skin soft and a little moist; face less
flushed; no headache; the patient has grown thinner;
pulse 70.
Breathing easier; cough less frequent; a little characteristic sputa. The stitch has almost ceased. The
patient feels better; had a few naps in the night.
Tongue coated; thirst moderate; no appetite. A passage.
Resolution is fully going on in the lower portion of
the lung; crepitation prevails in this part; slight bellows'-murmur during an expiration, and here and there
very distinct. In the upper portion dulness of sound,
loud murmur.-Same treatment.
July 17.-Skin warm, pulse 65. Dyspnoea; cough
rare, scarcely any expectoration; expectoration more
mucous, less viscid, more scattering; a few streaks of
blood. The patient slept some last night. Tongue still
coated. Same appetite.
Same physical signs. Same treatment. Broth.
July 22.-General condition good; no fever; pulse
60. In the evening, a little exacerbation. The patient
feels well, the breathing is not hurried but not so full
as in health. The stitch has disappeared. Cough rare;
raises scarcely any mucus.




CASES TERMINATING IN RECOVERY.      113
Tongue continues thickly coated; the secretions are
restored. Same appetite.
The resolution has been somewhat wavering, and has
not taken place with the some regularity as in other
cases. In the lower portion, crepitation prevails; all this
time only a bellows'-murmur was heard; now the crepitant rattle is more frequent and more distinct; a little
murmur is heard here and there.
July 30.-Convalescent. The patient eats well and
leaves his bed; the cough has ceased; the chest dilates
perfectly. He is kept in the ward on account of his
poverty, but he is a very troublesome and refractory
inmate. He eats every thing that he can lay hold of,
and has several attacks of indigestion. Every morning,
early, he goes down in the yard to smoke his pipe.
August 15th, he was attacked with erysipelas of the
nose and an acute inflammation of the nostrils, which
were filled with dry crusts. In spite of this attack, and
contrary to all our warnings, he continues to go down
in the morning and smoke. On the third day the nose
became red, and the tip livid; a double bronchitis sets
in, with difficult catarrhal expectoration, mucous rattle
on both sides of the chest, extreme oppression, acute
fever, prostration, delirium, aphonia. These symptoms
continue to grow worse; marasmus sets in; Aug. 22d
colma, and death on the 24th.
Post-mortem examination: The bronchia were completely obstructed with a thick mucus; the mucous membrane was red and injected; no pneumonia.
The parenchyma of the right lung, which had been inflamed, was perfectly sound and crepitating, there were
a few very fine cellular adhesions between the two
pleuree.
CASE 36. -Pneumonia.
Gruel, a woman of 27 years old, having a good consti



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




CASES TERMINATING IN RECOVERY.       115
Dulness of sound in the lower portioh of the lung
much less; the bellows'-murmur is intermingled with
a large number of moist crepitating vesicles. The respiration is fuller, less frequent in the upper portion of
the lung; loud bellows'-murmur below the scapular
spine.-Bryonia 12 and Phosphorus 12 in alternation.
July 17. —General improvement, skin less hot, pulse
70; no headache; breathing not very quick, but the
paroxysms of cough continue to fatigue the patient.
The expectoration is only composed of a quantity of
frothy liquid; the stitch is much less painful during
the cough; tongue moist, scarcely coated; appetite; a
liquid stool in the twenty-four hours.
The resolution is taking place very fully in the lower
portion of the lung; the bellows'-murmur has ceased;
the crepitation is more scattered almost over the whole
upper portion of the lung; a little bellows'-murmur is
still heard near the scapular spine, in the neighborhood
of the axilla.-Continue Bryonia and Phosphorus.
July 19.-Skin of the temperature of the breath, face
natural, no headache; pulse 60.  General condition
good; -slept some last night.  Cough continues frequent, distressing, with mucous, vesicular, clear expectoration; thirst natural; tongue good; appetite; another
liquid stool.
The lower portion of the lung respires less freely
than the sound lung, but without any abnormal murmur;
crepitation in the upper portion; no bellows'-murmur.
-Bryonia; broth, soup.
July 20.-Same condition; the stitch has returned,
causing an acute pain near the breast; cough less, less
long and distressing; mucous expectoration; less crepitation with smaller vesicles, in the upper portion of the
lung.-Arnica in solution, soup.
July 22.-Complete disappearance of the crepitant
rattle; convalescence.-Bryonia and diet as before.




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




CASES TERM'INATING IN RECOVERY.      117
ear and located in the larger bronchial tubes. No very
distinct rattle high up; on the right side, the respiration is feeble; the chest dilates hardly.
Constipation; no pain any where else. —Bryonia 12
in solution.
Aug. 22.-Same symptoms in the morning; the patient has a good deal of fever, did not sleep any. Pulse
110.-Continue Bryonia.
"Aug. 23.-Considerable improvement; skin softly
warm; pulse 60.  No headache, moist tongue, not
much thirst. Stitch less painful; occasional dartings.
Little cough; expectoration viscid, continues a little
colored.
Inspiration feebler, quieter, full on the right side;
on the left side, numerous crepitating vesicles in the
lower and posterior portion of the lung; same bellows'murmur. A passage.-Bryonia 24.
Aug. 24.-Same state; pulse 52; skin cool. Stitch
still painful at times; has all the character of neuralgia.
Cough rare; does not raise much; scattered crepitation
in the left lung; no bellows'-murmur; vesicular respiration on the right side much fuller.-Continue Bryonia.
August 25.-Complete resolution; respiration less
quiet and expansive on the left side; normal on the
right side; skin cool, pulse 48. Intercostal neuralgia
continues; appetite.-Broth. Bryonia.
Aug. 26.-Regular convalescence; pulse 48.
On the days following the neuralgia attacked him several times. On the first of September the patient took a
walk which fatigued him; he had a fever all night, pulse
60.
Sept. 9-17.-The neuralgia has left him.  Discharged cured.
CASE 38.-Pneumonia of the left luntg in front,
(a remarkable circumstance, so far as the cause and seat
of the disease are concerned.)




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




CASES TERMINATING IN RECOVERY.       119
rattle is heard; all over behind, vesicular respiration;
no abnormal sign on.the right side.-Arnica 6; Phosphorus 12, in alternation.
Sept. 7 and 8.-Same symptoms and physical signs.
Pulse 115 to 120. Pain in the side, headache; cough
frequent and painful; expectoration characteristic and
profuse.  No sleep; thirst, anorexia; constipation.
Sept. 8 took Bryonia.
Sept. 9. —Headache; tongue dry, with whitish coating, red edges; slight stomatitis. Skin still hot, but
rather moist; pulse large, soft, 106.
Breathing labored; dull pain, cough, profuse expectoration with sputa of the color of barley-sugar.
Same physical signs; a few vesicles are heard to
crepitate here and there in the anterior middle portion
of the, left lung.-Bryonia.
Sept. 10.-No headache, tongue moister. Skin moist,
not so hot; pulse 96. Cough less frequent; slept some
last night; less rusty sputa.  Pain in the side, or
rather the lameness less.
Crepitans redux almost over the whole lung, with
numerous vesicles; the sounds of the heart are more
distinct than when they were disguised by the abovementioned bellows'-murmur. A little appetite; a passage.-Diet. Bryonia.
Sept. 11.-Yesterday the patient who was rather
contrary, exposed himself to a current of air. To day,
the dyspncea, fever and cough are worse; rusty sputa,
viscid and copious.  The bellows-murmur has reappeared in the whole forepart of the lung. —Bryonia
and Rhus-t. 12, in alternation.
Sept. 12.-Co'nsiderable improvement. No headache.
Tongue moist, scarcely coated. Skin moist; pulse 80.
Cough rare, expectoration less and more mucous.
The secretions are restored.-Bryonia in solution.




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




CASES T]RMINATING IN DEATH.        121
On the evening of his admission to the hospital he
showed the following symptoms': Burning fever; skin
dry and hot; tongue thickly coated, dry, red; intense
thirst. Pulse small, tense, 110. Countenance expressive of depression of spirits; prostration of strength;
lies in any position; no headache; slightly flighty.
Marked dyspnoea; respiratory movements frequent
and small.
The cough is frequent and distressing, with a sensation of constriction along the base of the thorax, as if it
were laced with a band of iron. He raises a little gummy sputa which strongly adheres to the bottom of the
vessel.
Percussion yields a good sound every where, except
at the posterior and inferior portion of the right side,
where the dulness is, however, very faint. But in this
region a loud bellows'-murmur is heard, without crepitation or mucous rattle, and a diffuse bronchophony extending to the axilla. —Water and sugar; Aconite and
Bryonia 18, in alternation.
March 23.-Fever the same, pulse more frequent,
120. Increased prostration; anxiety. A little flighty.
Oppression, respiration rapid and small.
Cough less frequent, but distressing, and followed
by expectoration of viscid, gummy sputa, not very
abundant.
The dulness behind is more distinct; bronchial murmur very harsh, and mingled with a few isolated vesicles
of mucous rattle. The murmur has spread over a larger
surface, as far as the spine of the shoulder-blade; the
bronchophony likewise.-Bryonia, two solutions.
In the evening, the oppression is much worse, the
cough and expectoration become much less. Delirium.
March 24.-Skin dry, burning; tongue thickly coated,
red, covered in the middle with a little brownish and
dried-up mucus. Pulse small, filiform, hurried. Coun6




122                 PNEUMONIA.
tenance sinking; look staring, extinct. Delirium. The
patient is unable to sit:up in bed without support.
Breathing irregular, unequal.
No cough, no expectoration.-Belladonna, in solution;
a solution of twenty-five centigrammes of tartar-emetic.
Blister.
No auscultation was employed, because the patient
was too weak.
March 25.-Same as yesterday.  Auscultation reveals mucous rattle, with large vesicles behind and in
front below the right nipple. On the left side, under
the clavicle, bronchial murmur is heard.-Tartar-emetic,
in solution, two blisters.
March 26. —Pulse still smaller, filiform, hurried. Fuligo on the lips and gums. Twice last night the patient
was comatose.
Breathing intermittent;,- tracheal rattle.
Mucous rattle in the right side of the thorax, very
distinct below the nipple; bronchial murmur, mingled
with mucous rattle under the left clavicle.-Tartaremetic.
March 27.-Tracheal rattle, coldness and blueness of
the extremities. Face covered with a clammy sweat.March 28th, death.
Post-mortem examination, 36,hours after, his death:
1st, white hepatization of the whole right lung, with a
small quantity of purulent effusion in the corresponding pleural cavity and false membranes, which cause
strong adhesions between the posterior portion of the
lower lobe and the pleura costalis. 2d, similar hepatization of the upper portion of the left lung in a space of
four fingers'-breadth; the remaining portion Qf the
lungs is Only congested, of a dark color, similar to that
of a sediment of claret wine. No alterations in the pleura.
The arachnoid, and the pia-mater of the two anterior
lobes of the brain on a level' with the frontal eminences,




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



124                 PNEUMONIA.
cause its continuation in the present case would have
seemed to me no better than pure empiricism, which I
do not approve of. Will it be objected that a continuation of the homoeopathic treatment would have rendered
its want of success still more'striking? This want of
success seemed to me to have been sufficiently manifest
to authorize me to discontinue the treatment.
I have asked myself: Could this patient have been
cured under any kind of treatment?
Let me remind the reader of Roman's antecedents,
his privations, his misery, his grief, his progressive debility, until the moment when he was taken sick, of the
absence of all, care and treatment until the sixth day of
his pneumonia, and lastly, of the intensity of his disease
at the time when he arrived at the hospital, and the termination in suppuration both in the right and left lung
will not seem surprising.
I should like to be told what treatment will, in a similar case, result in a cure without fail. I confess I am
ignorant of any such treatment. I am willing to admit,
however, that, when I saw the patient for the first time,
the suppurative process may not yet have commenced.
I might be told that I have reported cases of other
patients who remained eight or nine days without any
treatment, and who got well nevertheless. This is true;
but not one of these patients, on their admission to the
hospital, was as low as Roman, nor had they been exposed to influences that were as favorable to suppuration
as was the case in the present instance.
Considering all things I am disposed to believe that
the homoeopathic method failed in the present case.
When the tartar emetic was resorted to, the patient
was past all chances of recovery; this agent cannot,
therefore, be held accountable for the failure.
CASE 40.-Pneumonia of the left lung.
On the 15th of July, 1848, the man Causse, nightman,




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




126                 PNEUMONIA.
Post-mortem examination 36 hours after death: Puru
lent effusion of about a quarter of a pound in weight
in the left pleural cavity. The lower lobe of the left
lung was found covered with false membranes, and the
whole parenchyma was infiltrated with pus.
CASE 41.-Pneumonia of the right lung.
The widow: Letandin, 58 years old, a fleshy and robust
woman, was admitted in the ward Sainte-Anne No. 17,
on the 8th of September, 1848.
She was delirious, and no information could be obtained from  her concerning  her previous state.  A
patient who knew her, told us that she was addicted to
drinking, and that she had been in good health on the
29th of August last.
The following were her symptoms: Countenance
sunken; icteric color of the skin, with pungent heat;
anxiety, restlessness, and plaintive cries.
Pulse small, 120. Tongue dry and covered in the
middle with a brownish coating, intense thirst.  The
patient begs for drink all the time.
Excessive oppression; short and hurried breathing;
the patient who is scarcely able to articulate, complains
of a dull pain in the right breast.
Coughs but seldom, without raising any thing.
Dulness under the right clavicle, and on a level with
the supra- and sub-spinal depressions.
Bronchial respiration in the same region, with large
and humid crepitation in front, and behind only in the
supra-spinal depression.-Bryonia 12, in solution.
Sept. 9. —Constant restlessness and delirium during
the night.
In the morning the face was yellow and blueish, the
sclerotica and the skin of the body yellow.
Pulse smaller and more hurried.
Breathing short, with cold breath.




CASES TERMINATING IN DEATH.         127
No cough, nor any expectoration.-Bryonia and 1odine 3, in alternation.
In the evening the patient tried to get up several
times. The restlessness continued to increase; coma set
in in the night. The eyes are sunken and wandering,
the hands and lips blue and cold; colliquative diarrhcea.
-Death.
Post-mortem ex.:-Purulent infiltration of the superior
lobe of the. right lung. At the base of this lobe a thin
layer of red hepatization is seen; the middle lobe is
similarly hepatized; the lower lobe is congested.
I have related these two cases, in order to substantiate
my previous assertion: that two patients who died in
my wards, could not properly be counted in the number
of my cases. I do not think that any treatment ought
to be expected to raise the dead.
REFLECTIONS.
I have thus related forty cases of pneumonia.  It
might be observed, perhaps, that I ought to have related
all the cases which I have treated, in order to furnish a
complete statistical series.  I have not adopted this
method for the simple reason that I have not yet felt
authorized to place the old-school treatment of pneumonia in such an evident position of inferiority, as it
would undoubtedly have occupied, if I had related every
case. For it would have been found that all the patients
who came to my wards before suppuration had set in,
were cured except one. Even if I had-not directed particular attention to this fact, others would have done it
for me, and the result would have been the same. I have
been desirous' of avoiding a premature conclusion, and
collecting a great number of data before pronouncing
imy final verdict.
I shall not yet compare the result of Hahnemann's
method with those'of other methods of cure, I s11all




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




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




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



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












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