Remarks on the Treatment of Pneumonia. By JOHN T. METCALFE, M. D., Prof. Inst. and Practice of Medicine, University Medical College.

DURING my term of service at the New York Hospital, extending from the 1st of January, 1855, to the 1st of April, there entered the Medical wards twelve cases of pneumonia, abstracts of which I here append.

CASE I.-Thos. Cassidy, æt. 23, seaman; entered the Hospital February 2d, having, four days previously, been taken with chill, stitch in left side, and cough, followed by febrile reaction, dyspnoea, thirst, and anorexia. Symptoms marked on admission :-Pulse 116; respiration 28; skin hot; cheeks suffused. With the cough there was free expectoration of viscid mucus, stained brownish by blood. Percussion over the lower portion of each lung was dull. On the right side, near the middle of the chest, there were bronchial respiration, broncophony, and crepitant rhonchus. Wet cups to the right side; mixture of Spts. of Mindererus and Ipecac.

Feb. 5.-Pulse 72; furred coat disappearing from the tongue, which is moist; skin cool; soft, perspiring; dullness on percussion less marked; expectoration of aerated whitish mucus in abundance. Subcrepitant rhonchus; bronchial respiration indistinct; appetite good. Cease medicine. From this time there was no impediment to recovery, which was complete in two weeks from the time of admission.

CASE II.-Feb. 5. John Tierney, æt. 25, seaman. Admitted for malarious cachexia, consequent on chronic remittent fever, contracted while working on the Isthmus of Panama. He suffered from great debility, had a white, waxy skin, and enlarged spleen. The usual treatment by quinine, iron, and nourishing food, was prescribed.

Feb. 11th. Without obvious exposure, was taken with the usual prodromata of phlegmasia, with cough, dyspnoea, and pain in the side. 12th. At visit his tongue was dry and coated; pulse 96, respiration, 36; skin hot. There was but little expectoration. On percussion, the left chest was dull over its lower three-fourths, posteriorly, were crepitant rhonchus, bronchial respiration, bronchophony. To have wet cups to the side, and Stoke's Expectorant. 13th. Persistance of the above phenomena, with presence of well-marked, rusty-colored sputa. Dyspnoea increased; prostration, as from the beginning, very considerable. For four days there was not much change in the symptoms, except that the expectoration became very abundant, amounting to a pint in the course of the night, and being of whitish, aerated mucus, without the pneumonitic tinge. The physical signs, after this, changed to those of universally diffused bronchitis; the dullness subsiding, and the rhonchi noted being replaced by the sonorous, sibilant, and subcrepitant. On several occasions he was threatened with suffocation by the profuse bronchial secretion, nothing seeming to relieve him but strong emetics of sulphate of zinc and sulphate of copper. These had the effect of unloading the air-tubes, and of removing the great dyspnoea which had preceded their administration. During this time he was supported by milk punch, beef tea, and occasionally by the carbonate of ammonia.

Feb. 20. General condition much improved, but still suffers from occasional paroxysms of dyspnoea, and has, constantly, a pulse of more than a hundred; takes his food and stimulus very well. Feb. 22. About this date, there was an aggravation of the symptoms, and a change in the expectoration, which became again rusty-colored and viscid. He was put upon the use of Plummer's Pill, of which he took one every four hours. Counter-irritation to the left chest was applied, but there was no material amendment in the case. Although the pneumonitic expectoration ceased in a day or two, the excessive secretion from the bronchial tubes continued, and on the 5th of March, twenty-two days from the origin of his pneumonia, he died. Permission was not given to inspect the body.

CASE III.-Feb. 6. Charles Coates, æt. 19, currier. Four days before admission, had been attacked with the symptoms detailed in Case I. visit, skin hot and dry; tongue coated; pulse 120; respiration 32; cough, attended with pain in side, and expectoration of viscid, rusty The pneumonia, as shown by dullness on percussion, bronchial respiration, and broncophony, existed at the lower posterior half of the

mucus.

left lung. Wet cups to left side, Spts. of Mindererus and Ipecac. Feb. 8. Pulse 108; respiration 48; tongue moist, coated; skin soft, and slightly perspiring; expectoration as above. Feb. 12. Dullness on percussion less marked; broncophony and bronchial respiration replaced, almost entirely, by sibilant and subcrepitant rhonchus. Expectoration bronchitic; appetite good. Convalescent.

CASE IV.-Feb. 8. William Straup, æt. 19, butcher. Six days before admission was taken ill with symptoms and expectoration such as have been already described in the last case. At the visit, his pulse was 96; respiration 34; skin warm and perspiring; tongue moist and coated; not much cough, and but little expectoration, which latter was viscid, but not rusty. Dullness on percussion, posteriorly, over middle third of left lung, where were also heard bronchial respiration, and broncophony. Wet cups to left side, over seat of dullness. No medicine. Feb. 20. Discharged cured.

CASE V.-Feb. 10. William Smith, æt. 22, pilot. Eight days previously had been seized, after exposure to cold and wet, with the symptoms described in Case I. On examination, pulse 84, weak; respiration 44; skin warm and dry; great debility; cough; pain in side; viscid, rusty expectoration; dullness, posteriorly, over nearly the whole of left chest; bronchial respiration, and broncophony, with coarse, crepitant rhonchus. Wet cups to left side, tartar emetic, gr. every 3 hours.

The medicine was continued for two days, when he was ordered to abstain from every thing but food. His appetite returned, convalescence commenced and went steadily on, so that he was discharged, cured, on the 20th February.

CASE VI.-Feb. 13. John Rample, æt. 35, oysterman. Eight days previously, had suffered from an attack of delirium tremens, with pneumonia, for which he had been copiously bled. I could not learn what medicines he had taken. At visit, he was found suffering greatly from dyspnoea; pulse rapid and very weak; wandering in mind, but able to give an account of himself when sharply spoken to; the whole right chest, anteriorly and posteriorly, was flat on percussion; crepitant rhonchus, bronchial respiration, and broncophony everywhere audible on this side; puerile respiration and subcrepitant râle on left side. With the cough, occasional rusty-colored sputa. Ordered milk punch, beef tea, and carbonate of ammonia. On the day after, he died. At the autopsy, there was found complete solidification of the right lung, the upper portion being of an ashy gray color, the lower lobe red.

CASE VII.-February 15.-Barney Lynch, æt. 22; boatman. Eight days before entrance had been taken with cough, pain in side, headache, fever, dyspnoea, and loss of appetite. There had been some expectoration with the cough, but of its character he could not give an account. At visit, pulse 96, respiration 36; dyspnoea marked; skin hot; cheeks injected; tongue moist and coated. On percussion, lower three-fourths, posteriorly, of left lung were dull; over whole chest to base, on this side, bronchial respiration and broncophony very near the ear; no crepitation; on right side, posteriorly, there was dullness at lower portion of lung, with feeble vesicular murmur; anteriorly, the respiratory murmur puerile.

In a

Spirits of Mindererus.-No other medicine was necessary. week his appetite returned and he was able to sit up. From this time his convalescence was uninterrupted, and in a month from admission he was discharged cured.

CASE VIII. February 17.- John McFarland, æet. 47; peddler. One week previously had been seized, after a chill, with pain in right side, fever and cough with rusty viscid expectoration. At visit, pulse 96; respiration 40; skin warm; tongue dry, brown; troublesome cough with but little expectoration not characteristic in appearance; much prostrated; over lower half of right lung, posteriorly, dullness on percussion, crepitant rhonchus, bronchial respiration and broncophony. Wet cups to right side. Stoke's Expectorant. February 22.-Pulse 80; respiration 28; tongue moist and cleaner; expectoration of viscid, rusty colored sputa, copious. Physical signs as above. It was found necessary to continue the treatment of this patient, by giving nutritious food and stimulus to meet the prostration which increased for some days. No medicine was prescribed, except the expectorant, with an occasional Dover's Powder, at bed time, to relieve the distressing cough. Milk punch, with carbonate of ammonia, seemed to promote expectoration. His pulse kept below 70 after the 26th. As the pneumonia subsided at the base of the lung it extended towards the summit, where it was well recognized on the 20th March. With this extension there was no constitutional excitement. The patient sleeps well, has an appetite for his food, which is well digested, and is generally gaining strength. March 30.-Better and stronger; cough nearly gone; convalescent; is able to sit up all day, and to take his meals with the other patients at the common table.

CASE IX.-February 22.-Pietro Barili, æt. 33; organ-grinder.

Eight days before entrance was taken with chill, pain in side, cough, and febrile symptoms. The cough was accompanied by the rustycolored, viscid expectoration, which was marked at the time of the first visit. His pulse was then 92; respiration 32; the face of a dusky livid hue; the lips covered with herpetic eruption; prostration very great. Over the lower posterior portion of each lung, more marked on the right than on the left side, were dullness on percussion, crepitant rhonchus, bronchial respiration and broncophony. No medicine was deemed necessary. He was freely supplied with milk punch and beef tea, with the stimulating expectorant mixture, and in one week was so well as to be able to sit up in bed. His appetite returned to its natural condition, and no symptom of disease other than a slight amount of debility remained.

CASE X.-February 22.-John Coughlin, æt. 19; 'longshoreman, had been seized, five days before admission, with a chill, followed by fever, pain in side, cough and expectoration. On admission, tongue moist and furred; eyes suffused; skin hot and dry; pulse 108; respiration 24; cough with aerated mucous expectoration, mixed with rustycolored, viscid sputa; over lower half of left lung there was dullness on percussion, crepitant rhonchus, bronchial respiration, very marked in character, and broncophony. On account of the great debility of this patient and the considerable febrile reaction, he was put on small doses of the spirits of Mindererus and ipecac., for three days, with farinaceous diet. At the end of this time his symptoms had improved by the diminution of fever, of cough, and of dyspnoea. He was then allowed more nourishing food, with the expectorant mixture, and on March 5th was discharged cured.

CASE XI.-March 2.-Richard Welsh, æt. 38; boatman. Six days before admission had been seized with rigors, followed by stitch in left side, dyspnoea, fever and cough, with rusty colored, viscid sputa. At visit, pulse 96; respiration 36; cough troublesome, attended with aerated bronchitic expectoration, and an occasional brownish, pneumonitic sputa; skin hot and dry. Over lower half of left lung, percussion dull; abundant, crepitant râle, with well-marked bronchial respiration and broncophony. Solution of tartar emetic, containing one-eighth of a grain, every two hours. March 8.-Medicine has been discontinued for last three days. All the symptoms have nearly disappeared, except cough and expectoration, which have diminished so as to be trifling; sits up;