CHEMICALLY PURE 
HYPOPHOSPHITES. 
THERAPEUTICAL INDICATIONS 
WITH 
CLINICAL DATA. 
EDITED BY 
R. W. GARDNER, Pharmaceutical Chemist, 
TWELFTH EDITION. 
158 WILLIAM STREET, 
NEWYORK. 
1895. •Copyright 1595, by R. W. Gardner, PREFACE. 
There seems to have been such a lamentable omission of scien- 
tific research and investigation of the therapeutic action of the Hypo- 
phosphites; the physiological effects of graded doses; the indications 
for the different salts, when administered singly;, so much disregard 
to the antagonistic and complicating, as well as the toxic results 
from combinations; and so little written and taught in the colleges, 
and in the text-books upon the clinical investigations of Churchill, 
that a necessity exists for more scientific and definite methods. 
Attention is called to the standing and eminence of the con- 
tributors to the medical literature contained herein. It will also be 
observed that the most influential of the medical journals of the 
country have been the medium through which these papers have 
been made known. 
Chemically pure salts, of neutral reaction, and greatly improved 
therapeutic value. 
In definite proportion, prepared only with distilled water, and 
chemically pure sugar, to protect against atmospheric oxidation. 
Put up only in sixteen and eight fluid ounce bottles to meet the 
requirements of physicians’ prescriptions. Each cork covered by a 
strip label, bearing fac-simile signature of the manufacturer, and 
attached to the cork by monogram seal (R. W. G.) in wax, uniting 
strip label to the bottle in such a manner that it cannot be removed 
without destroying the integrity of the package. The fac-simile of 
the signature of R. W. Gardner is also upon the label of each bottle. The elixirs of the Hypophosphite Saits are put up in the same 
manner but are not so reliable for therapeutic effect as the syrups. 
The amount of sugar is not so great, and the protection against oxi- 
dation not so complete. They were prepared, with a view to their 
use in cases where the sugar cloyed the stomach; but the syrups may 
be administered in milk, coffee, lemonade, and in such a variety of ways 
to overcome this difficulty, that probably no case will occur where 
they may not be used. 
The Hypophosphite of Quinine is prepared only as an elixir, as 
the vehicle is a better solvent for the salt and renders the prepara- 
tion more palatable. 
The Clinical Index which has been prepared with great care will 
be found valuable for quick reference. The diseases have been alpha- 
betically arranged in order to facilitate study and research. 
The therapeutic notes, made editorially, have been also carefully 
prepared, and are the outcome of considerable thought.. 
It is hoped that this matter may be of service, in indicating, or 
assisting to do so, the varied useful and valuable applications of these 
remedies. 
They have been arranged under the various pathologic headings, 
and frequently accompanied by an analysis of their therapeutic action. 
They are offered in the hope that they may prove serviceable in point- 
ing to special indications for these preparations. For much of the 
information, the writer is indebted to the experience of the many 
eminent writers who have contributed valuable papers, and he hasaiso 
ventured to enlarge upon the subject as a result of his own thought 
and observation. 
Every article in these pages by American authors, has been 
written with particular reference to, and after special observation of 
the action of Gardner's Preparations. 
They all refer to these preparations exclusively, and not imitations of 
them. The value of the Hypophosphites as therapeutic agents, and 
more particularly the great advantage of discriminating methods in their 
application, and the use of chemically pure salts, applied singly ac- 
cording to indications, ought to prompt to more careful observation 
and more frequent and painstaking reports of cases treated, for the 
benefit of medical science and humanity. 
The subscriber trusts that his labor in completing this matter, and 
the suggestions he has been enabled to contribute, will be received in 
the same generous and courteous spirit which has always character- 
ized his intercourse with the profession, during the many years he has 
endeavored to serve them. 
He cannot close without again expressing his deep sense of ob- 
ligation, to them for their kind appreciation and support. 
Respectfully. 
R. \V. Gardner. HYPOPHOSPHITES. 
CLINICAL INDEX. 
Page. 
Page, 
Anaemia 7 7-91 
Aphthae 57 
Nervous Insufficiency 105 
Neurasthenia 77-105-109 
Apex Catarrh 80 
Osseous and Nervous Systems, Mal- 
nutrition in. 106 
Bone Development in Children 106 
Bony and Periosteal Tissues, Sub- 
acute and Chronic Inflammation in. 106 
Phosphorus, Availability of the Ele- 
ment and Its Compounds, ... .24 to 55 
Bronchitis, Chronic 78 
Phosphorus the Most Combustible 
Element in the Organism 74 
Chlorosis gi 
Delicate and Weakly Children 112 
Dentition, Difficult or Retarded 77 
Phthisis Pulraonalis, History of Cases 
Treated by Churchill’s Method. .92-95 
Development, Imperfect, Incomplete, 
or Retarded 77 
.99-100-102-103-104-113-117 
Dysmenorrhoea gi 
Appetite and Digestion Considered 40- 
Phthisis, Clinical Notes. 
Free Phosphorus, Changed to Hypo- 
phosphite Before Absorption 32 
50-60 
Grippe, La m 
Arsenic 46 
Alcoholic Drinks 46 
Hip Joint and Pott’s Disease, to Avert. 107 
Hypophosphites versus Phosphates. 34-43 
Hypophosphites, General Action of.. 39 
Amenorrhoea 59-61 
Acute Phthisis 64 
Hypophosphites in Other Diseases 
Than Phthisis 77 
Apparent Aggravation Under Treat- 
ment 66 
Hsematosis, Diseases of . 77 
Accidental Inflammation Mistaken for 
New Tubercle Deposit 68 
Indications of Iron, Hypophosphite 
Arrest of Tubercular Deposit by Hy- 
pophosphites 46 
Indications of Lime, Hypophosphite 
of 55 
Bacillus, The 37 
Indications of Manganese, Hypo- 
phosphite of 55 
of 31-54 
Blood, The Effect of Hypophosphites 
on 51-72 
Indications of Quinia, Hypophosphite 
of 54-92 
Calorification 73 
Classification by Stages 49 
Indications of Potassium, 'Hypophos- 
phite of 77-78-91 
Cod Liver Oil 46 
Colliquative Diarrhoea 61 
Complications 56 
Combinations of Hypophosphites, 
Danger of 42-48 
Indications of Soda, Hypophosphite 
of 31-54 
Intra-organic Oxidation a Necessity to 
the Tissues 11 
Conclusions, Therapeutical, Churchill’s 69 
Condition of Results by Hypophos- 
phites 63 
Myelitis, Chronic 77 Contra-indications 46-47 
Page. 
in Phthisis 47 
Page. 
Contra-indicated Hypophosphites.... 47 
Cough 60 
Precautions 39 to 43 
Cure, Condition of 63 
Prophylactic Doses 49-68 
Prognosis.. 56 
Cure, Permanency of 48 
Danger from 111-considered Combina- 
tions 42 
Purity of Hypophosphites, Necessity 
for 52 
Diet ; 52 
Physiogenic Effects of the Hypophos- 
phites 35 
Diarrhcea 61 
Dyspnoea 60 
Pathogenic Effects of the Hypophos- 
phites 35—51 
Expectoration 60 
Epistaxis , 52 
Pyrogallic Acid in Haemoptysis. .... 57 
Quinia, Hypophosphite, Indications 
of . 54-92 
Failure, Cause of 44 
Fever 58-60 
First Signs of Improvement 41 
Relapse 67 
Rapid Softening 4° 
Hmmatosis 50 
Haemoptysis 52-57 
Shortness of Breath 48 
Sleeplessness 60 
Haemorrhage 41 
Heredity 47-48 
Soda, Plypophosphite, Indications of 
31-54 
Hypophosphites, Best Time to Ad- 
minister 42 
Summary of Argument on Theory of 
Tuberculosis 75 
Hypophosphites, General Action of.. . 39 
Iron 46-52 
Summary of Churchill’s Methods in 
Phthisis 27 
Iron, Indications of. 55 
Stethoscopic Signs, Misunderstood... 68 
Strength 61 
Intestinal Congestion, or Haemorrhage 
by Overdosing 52 
Theory of Tuberculosis, Churchill’s, 
Extracts from 72 
Laryngitis 59 
Lesions, Graduated Scale of 50 
Therapeutic Effects in 79 Cases, by 
Churchill, tabulated 60 
Lime, Indications of 31-54 
Manganese, Hypophosphite, Indica- 
tions of 55 
Urine 73 
Menstruation 61 
Venous Plethora 50 
Vomiting 58 
Metallic Salts 46 
Modification of Symptoms Under 
Treatment 61 
What Not to Prescribe ;.. .45 
Pleural Deposit.. 79 
Pregnancy . 77 
Narcotics . 42 
Necessity of Accurate Auscultation. . 64 
Reconstructive Action of the Hypo- 
phosphites io9 
Nervous Energy 50 
Night Sweats 58-60 
Richitis 77 
Scrofula 74 
Oedema 57 
Opiates 42 
Sub-acute and Chronic Inflammation 
in Bony and Periosteal Tissues. . . 106 
Overdosing 41 
Phthisis, Early Treatment of 78 
Uterine Catarrh 78 
Want of Co-ordination from Specific 
Tumor of Brain 108 
Potassium and Ammonium, Danger of WORLD’S COLUMBIAN EXPOSITION, 
Chicago, 1893. 
GARDNER’S 
SYRUP OF HYDRIODIC ACID 
Received Medal and Diploma 
OF THE FIRST CLASS. 
ONLY AWARD 
Granted Syrup of Hydriodic Acid Over all 
Competitors to 
R. W. GARDNER, of NEWYORK. INTRA-ORGANIC OXIDATION 
A NECESSITY TO THE TISSUES. 
It is well known that the human body is an oxidizing apparatus; 
all substances entering the organism, with rare if any exceptions, are, 
if such a change is possible, oxidized to their utmost extent before 
being eliminated; that the breath we draw is the source from whence, 
we derive our supply of this indispensable element; that bodily energy 
is derived from the decay of living material—the oxidation of various 
complex substances—resulting in muscular force and heat; that life, 
and death are so intimately connected with each other that the 
thoughtful mind cannot view the one without being confronted with 
the other, as we are continually dying while we live; a struggle be- 
tween the two, with the inevitable result of victory in the end to the. 
grim destroyer. 
We will pass by the complicated actions and reactions by which 
katabolic and anabolic changes are produced, except in so far as oxy- 
gen has to do with them. 
Without this element we should die. The importance of oxygen 
to the tissues is admirably illustrated in the almost instantaneous re- 
generation produced in the sloughing ulcer or cold abscess, when per- 
oxide of hydrogen is brought in contact with it; the pus and putrid 
matter disappear as if by magic, and the surrounding tissues are so 
stimulated, that if brought into contact and antiseptically dressed, 
the parts will heal as if by first intention. 
This wonderful local effect is but the expression of the great need 
of the entire organism for this element. 
The efficacy of chlorate and permanganate of potassium, both 
powerful oxidizing agents in putrifactive and germ diseases, like scar- 
let fever, diphtheria, etc., is thus explained. Septic matter, and the germs which accompany it, are destroyed 
when oxygen has full play; this is what keeps our bodies in an aseptic 
condition during life, and the lack of it is the cause of putrifaction 
after death; it is the sustainer and supporter of life, a necessity to 
animal existence; this is the reason we are endowed with breath. 
We know the carcass of a slaughtered animal shortly undergoes 
putrifaction, and its incidental accompaniment, spores and microbes 
appear. Why ? Because the circulation being cut off the tissue no 
longer gets its supply of this necessary element, brought from the 
lungs, and distributed through the organism; the blood, a fluid tissue, 
becomes pathologic, infective germs may then find in it a nidus for 
their development, while normal blood is a germicide. 
And this brings us to a consideration of the question; 
What proportion of the diseases afflicting mankind are caused by 
an insufficient supply, or a want of power to appropriate this vital 
element ? 
As to the supply, we may reasonably conclude that it is always 
sufficient inasmuch as the patient always breathes during life, and the 
composition of the air is such that the supply of oxygen is never 
absent. 
If it be true that oxygen is a destroyer of septic material, its 
presence in normal quantity in the organism would also prevent the 
formation of such material, and keep the tissues free, not only from 
septic matter, but also from those germs which find their habitat in 
and depend upon diseased pabulum for their existence. 
It is probable, that in cases where cell tissue is broken down, 
and becoming degenerate, where mal-nutrition and waste seems to be 
the tendency, where assimilation is inactive and vitality low, that the 
principal predisposing cause is that the organism is starving for oxy- 
gen, the breath of life; and if so, where shall we find the remedy, 
and how is it to be applied? It is a case of “water, water every- 
where, and not a drop to drink, ” 
It is stated that the proportion of carbonic acid excreted at each 
expiration is from three to six per cent., depending upon the length 
of time the air is retained in the lungs. 
The elimination of this waste product, after inspiration of at- 
mospheric oxygen, reminds one forcibly of the same reaction, oc- curring when the solution of peroxide of hydrogen is applied to the 
sloughing ulcer, when, as physicians all know, there is an efferves- 
cence of carbonic acid gas, resulting from the combustion of putrid 
matter, leaving only water and clean tissues, the extra atom of oxygen 
having been expended in the reaction. 
The atmospheric, oxygen, in like manner, after being conveyed 
by the respiratory process into the animal tissues, acts upon the 
proximate principles therein contained, goes through a certain num- 
ber of combinations, and is finally expelled in the shape of carbonic 
acid. 
The oxygen thus absorbed combines with the proximate ma- 
terials floating in the blood, and fits them for the formation of cell 
tissue; if deficiently oxidized in the lungs, the reaction is incom- 
plete, the normal bioplasmic material is not produced, and a patho- 
logic matter is substituted, which will not form healthy tissue. 
But why should this condition of things be? Why does not the 
blood take all the oxygen required during the act of respiration? 
Because, an element natural to the organism, and which is al- 
ways present as an ingredient in the tissue forming material of 
healthy persons, and one of the offices of which is to contribute by 
its presence the necessary chemical affinity to this material, to take 
up and combine with the oxygen at the lungs, is insufficiently supplied. 
This will explain why, when oxygen is inhaled, in cases requiring 
it, that the treatment is abortive; there being a lessened affinity for 
oxygen, owing to the lack of oxidizable phosphorus in the organism, 
the oxygen cannot be utilized, and the restorative effect looked for is 
not realized. 
This element is oxidizable phosphorus. 
This deficiency of the phosphide element has been variously ac- 
counted for; artificial methods of life, such as dissipation, sexual in- 
dulgence, want of out-door exercise, excessive mental wear, emo- 
tional and excitable temperaments, poverty and privation, unsuitable 
and insufficient food, etc., causing an undue waste and an insufficient 
supply from natural sources, of this essential requisite. 
“That there is a direct connection between the excretion of the 
phosphates and waste of nervous element, is proved by the fact that 
this excretion falls to its lowest point during the cessation of nervous 14 
activity; and that in the insane the excretion of the phosphates is 
considerably increased during paroxysms of excitement, while’on the 
contrary, it falls below par during the subsequent period of exhaustion. 
The consequences of the phenomenon or feeling of exhaustion 
do not, however, stop at the waste of the immediately available phos- 
phide element contained in the nervous system. As this element ex- 
ists in the albuminoid principles which constitute the bioplasm or 
histogenic stock from which all the organs and tissues of the system 
are formed; as there must be a balance between the proportions of 
this element contained in the different parts of the system, we have 
a right to infer that its decrease in one part must, after a certain time, 
produce a corresponding diminution in the rest; and, as we have found 
that the phosphide element is probably the exciting and initiatory 
agent of intra-organic molecular combustion, whatever produces a 
waste of the oxidizable phosphorus in the system must diminish gen- 
eral molecular oxidation and the amount of excreted carbonic acid. 
Every kind of activity, whether intellectual, emotional, locomo- 
tory, or sensual, is therefore conditioned, either directly or indirectly, 
by a wear of the phosphide element, as shown by the excretion of the 
phosphates; and whenever this activity exceeds a certain limit the or- 
ganism is no longer in a normal state.”—Churchill. 
It will thus be seen what an important part oxidizable phos- 
phorus takes in the system by seizing and storing oxygen for eco- 
nomic use; but its utility does not stop here; it is a direct stimulant 
and tonic to the nervous system, irrespective of its use in attracting 
oxygen; the fact that it is found in largest proportion in the grey 
matter of the brain, the throne of nervous power, would of itself be 
sufficient reason for the belief that it is an element of vital necessity. 
It can hardly be looked upon in any other light than as a neces- 
sary food supply, for it is an element in various foods of animal origin. 
It is particularly present in milk, that remarkable secretion upon 
which infant life is almost exclusively dependent during its earliest 
period, and during which time there is wonderful progress in devel- 
opment, and the greatest need for all necessary elements to sustain 
rapid growth. 
This phosphide element (oxidizable phosphorus) must not be con- 
founded with the phosphate; phosphates are burned out ashes, so to speak, in which the phosphorus has already combined with oxygen to 
saturation; it is therefore useless as an oxygen carrier, and useless as 
a means of promoting metamorphosis, as the compound leaves the 
body as it enters it, without change; it is a component of fully devel- 
oped, and consequently, stationary histological elements, and is taken 
as such into the system, like other permanent salts, such as the car- 
bonates, chlorides, etc. 
The phosphorus in the Hypophosphite is combined with one 
atom of oxygen only, while the phosphate has already combined 
with five atoms; so that in the phosphate the whole of the phos- 
phorus is already oxidized, while in the Hypophosphite four-fifths of 
the phosphorus is still in a combustible or oxidizable condition. 
In the treatment of disease by Hypophosphites the object sought 
is chiefly and primarily the assimilation of oxidizable phosphorus 
(the electro-positive element of the salt). 
This object is accomplished as well and as thoroughly by the 
exhibition of a single Hypophosphite as by the use of half a dozen; 
because when several are combined the dose is divided among the 
number used, and the aggregate quantity of oxidizable phosphorus 
contained in a dose of the mixture is no greater than the quantity 
contained in a dose of a single salt. 
Thus the main object for which the Hypophosphites are given is 
accomplished as well by the use of a single salt as by a mixture of 
several. 
It is being more and more acknowledged by the profession at 
large, that truly scientific treatment points in the exhibition of drugs 
to the use of such remedies only as are indicated by the condition of 
the patient. 
Medicines given when not indicated are unnecessary, and cannot 
fail to do injury, because all medication is productive of some kind 
of action in the system, and if this action is not favorable it must be 
unfavorable, and consequently embarrasses and complicates the 
situation, adding new troubles to those already present. 
This reasoning applies with peculiar force, in the use of the 
Hypophosphites, particularly in the treatment of phthisis, when 
vitality is low; the circulation is feeble, the patient is weak and 
emaciated; there is a fierce conflict going on in the organism, in the 16 
struggle for life against the elements of death, which have already 
become located in the tuberculous lung, and by absorption have 
poisoned the circulation in the production of septicaemia. 
The blood vessels are thin and liable to rupture because their 
substance has been appropriated, and owing to defective assimilative 
action have been deprived of their customary nutrition. 
Surely, the patient has already enough to battle against, without 
additional and unnecessary complications. 
Now the whole trouble and objection to the use of combinations, 
lies in the effects of the electro-negative elements, which produce 
secondary and complicating difficulties. 
Dr. Churchill has found that gastric troubles, such as indigestion, 
flatulence, diarrhoea, are a frequent consequence of the use of, as he 
terms it, “A jumble of different Hypophosphites and strychnia.” 
The danger attending the use of iron in phthisis is the produc- 
tion of haemorrhage. Churchill says: “Not only was haemorrhage 
produced in almost every instance in which I used the Hypophosphite 
of Iron, but in patients who have been previously taking ferruginous 
medicines, it will be found that it is very difficult at first to keep the 
effects of the Hypophosphites within the limits of their physiogenic 
action.” 
Potassium is a powerful resolvent of condensed and consolidated 
lung tissue, causing softening of tubercular matter with a rapidity 
that may be dangerous and alarming. 
The depressing action of potassium is also well exemplified in 
the observed effects of iodide of potassium, which, as physicians 
know, produces prostration, indigestion, loss of appetite, etc., which 
is solely due to the base, potassium. 
Manganese is similar in its action to iron, and produces similar 
results, though not quite to the same extent. 
Lime and soda; the Hypophosphites of these bases, while acting 
similarly in some respects, possess marked differences in action in 
others, which very often prevent their favorable action when 
combined. 
Hypophosphite of lime frequently checks expectoration too 
rapidly, resulting in increased cough; it also is more apt to produce 
the pathogenic effects of the Hypophosphites than the soda salt; thus the lime, in combination, might be doing a positive injury to 
the patient, which would have been wholly avoided if the soda were 
given alone; on the other hand, when the expectoration is too pro- 
fuse, the soda should be replaced by the lime salt; this will be 
sufficient to show that there are many instances when both salts, in 
combination, are contra-indicated, and will convince the careful 
physician of the desirability of discriminating according to symp- 
toms, using them singly or alternately as circumstances require, 
particularly when no advantage is to be gained by combination, and 
much may be secured in definite results by using them singly or in 
alternation. 
Statements that Dr. Churchill uses the salts of lime and soda in 
combination, and recommends them thus combined, are false, and 
misrepresent his views and practice, as every physician knows who 
has read his works. 
The pathological effects of over-dosing are disastrous. By 
increasing too suddenly the force of the circulation, without giving 
time for increased nourishment and strength to the texture of the 
weakened and impoverished blood vessels, the tissues of which have 
been appropriated by the urgent need of the general system, as from 
lack of proper assimilation of food, the patient has been living upon 
his own tissue—a haemorrhage ensues. The crisis is referable 
directly to the sudden and over stimulation of the circulatory system, 
beyond the capacity of the the blood vessels to resist. Another 
result of over-dosing is a too active disintegration of the tubercular 
deposit, causing a crisis by sloughing. This process, which is thera- 
peutically desirable, must not go on too fast, beyond the strength of 
the patient to bear. Time is a necessary and indispensable element 
in the recuperative process. It must not be forgotten that all the 
functions must improve together, for which time is necessary, as new 
tissues must form and metamorphosis must take place, and morbid 
and prurient matter must be eliminated; hence care should be taken 
to go slow, constantly watching for pathogenic phenomena, never 
running risks because the patient shows, at first, brilliant results by 
large doses, for he will soon cross the line upon dangerous ground, 
and the sudden relapse will remove him from the crest of the wave 
that seemed bearing him on to victory, to the dark valley of the 
shadow of death. While the smallest doses should, therefore, be administered at 
first, and gradually and watchfully increased as the patient is found 
to bear them without showing signs of pathological effects, the limit 
or maximum quantity to exhibit during twenty-four hours should not 
exceed seven grains, and in many cases, especially when the disease 
is far advanced, this quantity will be found too great. In fact it is 
unsafe to give alkaline Hypophosphites at all, in treating extremely 
advanced cases, the Hypophosphite of Quinine being far preferable in 
the initial treatment of those in this condition, until it is found prac- 
tical to use either the lime or soda salt, according to indications, in, 
at first, very small doses. 
It being borne in mind that the main object sought in using 
Hypophosphites is to assimilate oxidizable phosphorus (the electro-pos- 
itive element of the salt), and that this object may be obtained by 
the administration of any one of these salts, as well, as if a combin- 
ation of several were used, it becomes a matter of great importance 
to investigate the effects upon the patient of the several electro- 
negative bodies, that we may eliminate all those which are found to 
produce unfavorable effects, and to confine our use to such only as 
will best agree with the patient. Dr. Churchill has paid great atten- 
tion to this point, and he has found it inadvisable and dangerous to 
use Iron, Potassa, Manganese, or, in fact, any others than Lime, Soda 
or Quinine. He never prescribes combinations, even of these, but 
uses that one found to best meet the indications of each particular 
case in accordance with the symptoms of the patient, or the effects 
produced by the remedy, varying the dose as circumstances require. 
In Phthisis, complications must of course be treated by appropri- 
ate remedies, but during such treatment the use of the Hypophos- 
phite should be suspended. Unless during such crisis, no other med- 
icine should be given, reliance being placed entirely upon the Hypo- 
phosphites to relieve cough, night sweats, etc. Narcotics and stimu- 
lants should not be used if the Hypophosphite treatment is adopted, 
as they prevent the proper effect of the remedy, and lower the vital 
condition of the patient in the end, though they may apparently 
lessen some of the urgent symptoms. Neither should Cod Liver Oil 
be used for similar reasons. In a number of instances physicians have written, complaining 
that their patients were not progressing well under the treatment and 
it was found that they were using morphine to procure rest at night 
and to allay cough. Upon discontinuing this, the patients suffered 
more for a day or so, but afterwards improved right along and made 
good recoveries. 
Other instances have occurred where the dose was too large and 
the patients not only failed to improve but were actually suffering 
relapse, when the dose was discontinued for a few days and then 
resumed in much smaller quantity with the happiest results. 
If the patient is not progressing, be assured there is a reason for 
it, and, generally, one that can be controlled. Do not blame the 
remedy when the fault is because of its inconsiderate use. Either 
the wrong salt is being administered; or, what is worse, a combina- 
tion containing contra-indicated salts; or some other remedy is being 
used which prevents the favorable action of the Hypophosphite; or 
the dose is too large; or the patient is suffering from a complication 
which interdicts the use of the Hypophosphite for the time being; or 
the Hypophosphite is impure, and consequently unable to produce 
favorable results. 
Purity a Necessity.—All authorities are now practically unan- 
imous in the conclusion that to produce the therapeutic effect with 
the Hypophosphites, it is necessary that they should be chemically 
pure. 
It must be remembered, that if these salts are carefully prepared 
in this condition, but kept in the saline state, they rapidly deteriorate 
and become impure; that they cannot be kept, as salts, and remain 
fit for medicinal use. 
It is necessary, that as soon as they are prepared, they should be 
protected by sugar, in the form of syrup, from atmospheric oxidation. 
This is why Churchill insists upon the use of syrups containing 
chemically pure Hypophosphites; and why the writer in carrying out 
his views, prepares these salts only in the form of syrups, and also 
why they are only put up in small bulk, as a small quantity is exposed, 
in use, less to the air than a large quantity, and is very much more 
likely to retain its medicinal value, than if exposed in large bulk to 
constant new accessions of air while in use. 20 
It seems to have become a favorite remark with some manufactur- 
ers that their preparations are made with a “ slight alkaline reaction’’ 
as though this was a very important advantage, when, in fact, it is an 
open confession of impurity. With a little more chemical knowledge 
it would be seen that “alkaline reaction” means the presence of 
“free alkali” or its “carbonate,” which, not being a Hypophosphite, 
is manifestly an impurity, as the Hypophosphites of the alkaline 
bases, when pure, have a neutral reaction. Churchill claims that the 
presence of these impurities renders them next to useless by prevent- 
ing their favorable physiological action. He cites instances. Having 
obtained the favorable action of the pure Hypophosphites in several 
cases of Phthisis, he purposely added an alkaline carbonate when his 
patients at once began to lose ground, which continued while the im- 
pure salt was used. When, however, they were put upon the pure 
salt again, they improved as before. The experiment was tried again 
and again, until the cause of retrogression was fully demonstrated. 
Again, if the combination contains Hypophosphite of Iron, the pres- 
ence of free alkali will cause its precipitation. 
Indications, in Other Conditions than Phthisis.—Hypo- 
phosphite of Iron is indicated in Anaemia, Chlorosis and Dysmen- 
orrhoea. Hypophosphite of Potassium is recommended in Asthma. 
Hypophosphite of Quinia as a general nervous tonic and in Intermit- 
tent Fever. Both the Hypophosphite of Lime and the Soda Salt are 
indicated in disease characterized by insufficient nutrition, as maras- 
mus, and in convalescence from wasting disease of any kind, where 
the vitality is low, assimilation of food defective, blood depraved, and 
functional activity impaired. 
The combination of the Lime, Soda, Iron and Potassa Salts has 
been found very effective in obstinate Bronchial coughs, and in the 
impoverished condition which precedes and accompanies boils, ab- 
cesses, carbuncles, etc., in non-tubercular cases. 
Hypophosphite of Manganese is similar in its action to that of the 
Iron Salt, but is much less energetic. It has a special excitatory 
action upon the biliary secretion, and it has been found peculiarly 
useful, either alone or in conjunction with Hypophosphite of Quinine, 
in hepatic derangement, with deficient biliary secretion, subsequent 21 
upon prolonged residence in tropical climates, as also in cases of 
Anaemia and general debility depending upon the same cause. 
Hypophosphite of Ammonium resembles the Potassium Salt in its 
general therapeutic action. It has been used by Churchill with great 
advantage in hepatic derangement, owing to its special stimulating 
effect upon the liver. 
It is, however, contra-indicated in Phthisis, for the same reasons 
which forbid the Potassium Salt, and probably for the additional one 
that the Ammonium compounds all excite the circulatory system, 
which renders them dangerous in hemorrhagic states. The same 
writer considers this salt far superior to the muriate or carbonate as a 
laryngeal stimulant. As an expectorant, it is peculiarly active. 
It should be remarked that in diseases uncomplicated with pul- 
monary difficulty, not only may the dose be larger, but various com- 
binations may be prescribed, and the remedy continued with less 
necessity of watching the patient, the pathological effects of these 
remedies being far less liable to be produced than in cases of 
Phthisis, in which disease the susceptibility of the patient to their 
action is greatly increased by the diathetic state. 
Children of tuberculous parents who have inherited the diathesis, 
are wonderfully improved by the hypophosphite. (See case men- 
tioned by Dr. J. R. Fraker, Marlboro, N. Y., page 99. Also Dr. 
Wrightson’s case, page 113.) 
To those of the profession who, having previously tried the Hy- 
pophosphites without success, and who have consequently given up 
their use, the evidence of Dr. S. T. Lowrie, Lore City, Ohio, will be 
of interest. (See his letter, page 100.) 
Dr. William Porter, of St. Louis, Mo., gives some very con- 
vincing facts, drawn from his personal experience, as to the great ad- 
vantage derived from the use of these single, chemically pure salts 
over the various commercial salts in combination in tuberculosis. (See 
his paper, reproduced on page 100.) 
The late lamented Dr. W. F. Hutchinson’s opinions on the Hy- 
pophosphites in nervous diseases, a specialty in which he was an ac- 
knowledged expert, will be found in his paper (page 105). 
For a remarkable effect of the Hypophosphite of Lime in its in- 
fluence in cases of difficult and retarded dentition in children, see 
note from Dr. C. C. Stephenson, Little Rock, Ark. (page 106). 22 
In a case of syphilitic tumor, after treating the case specifically 
until the tumor was absorbed, it was found that the lesion had pro- 
duced loss of memory and power of co-ordination. The treatment 
at this stage of the disease by Hypophosphite of Lime at first, and 
subsequently with Hypophosphite of Manganese, with still more 
marked results, furnishes a remarkable illustration of the restorative 
power of these remedies in brain lesions. The case was reported by 
Lewis G. Pedigo, A. M., M. D., Crockett Springs, Va. (Page 106.) 
In the same paper Dr. Pedigo pays a high tribute to the efficacy 
of Syrup Hypophosphite of Lime in the sub-acute and chronic inflam- 
mations occurring in the bony and periosteal tissues of scrofulous or 
badly nourished patients, as a result of a blow or injury, which 
usually result in hip-joint, Pott’s disease, or some other grave lesion 
of this character. He gives the history of a case of this kind, with 
complete recovery, where from the unfavorable constitutional state 
and family history of the patient, the prognosis was bad. 
As reconstructives in cases of defective nutrition, loss of mental 
and physical vigor, nervous prostration, etc., there is probably no 
equal to the Hypophosphites, provided the properly indicated salt is 
used. This is very important. Dr. Bourn, of Providence, R. 1., 
contributes a valuable paper upon this view of their action (page 109). 
Q. C. Smith, M. D., Austin, Texas, publishes the result of his 
experience in the use of these syrups in cases of delicate and weakly 
children. (Page 112.) 
Abundant evidence, corroborating the conclusions of Dr. 
Churchill, as to the curative effects of the Hypophosphites in phthi- 
sis, is at hand. 
But this favorable result, it must be borne in mind, will not be 
reached, unless certain well-known methods are followed, which are 
fully explained in this brochure in the various quotations from 
Churchill, De Bremon, J. C. Thorowgood, and other eminent author- 
ities. 
The fact is that the methods of Churchill are so very different 
from the usual ones employed by the profession in the treatment of 
this disease, and differ so materially from those at present advocated 
and followed by the majority of medical men that the first thought 
of a physician is to rebel against its arbitrary ruling concerning the 23 
use of cod liver oil, stimulants, narcotics, etc. Now, if the methods 
in use had been found to be efficacious, and a considerable number 
had been found to recover under treatment, there would be good rea- 
son to cling to it. But physicians know that the contrary is the fact, 
and are obliged to acknowledge that the disease is practically incur- 
able, except about one per cent, of the cases, which cure themselves. 
If this is so, why not adopt a treatment, which in other hands has 
proven its superiority? This fact is proven by cases reported in this 
pamphlet. 
I would again remind the reader just here, however, that the 
details of methods enumerated by Dr. Churchill, must all be fol- 
lowed or disappointment will result. A physician cannot say that he 
has followed Churchill’s suggestions unless he has been willing to 
study and become familiar with them in their entirety and strictly 
carried them out. To facilitate this and make it easier to grasp 
most of the methods quickly, I have summarized the general plan 
under thirty heads. It will be found on page 27 of this pamphlet. 
This table, however, does not comprise the whole by any means, 
but lays down a large number of recommendations, which will assist 
the prescriber who wishes to test Churchill’s methods; the balance 
can only be obtained by a study of his writings, very much of which 
is quoted herein, (pages 35 to 80); and also the matter written by the 
late L. de Bremen, M. D., who was intimately associated with Dr. 
Churchill for many years as his clinical assistant, and who reports an 
experience in New York and vicinity of more than 150 cases treated. 
A case of a girl 16 years old with inherited phthisis, when the 
family, father and four children, (the father dying at 35, and the four 
children all died before reaching 17 years of age), had been swept 
away with the disease, is given by Dr. J. T. Wrightson, Newark, N. 
J. This child was completely cured, was married, and now has a 
family (page 113). 
See also case of tuberculosis reported by Dr. A. Ostertag, St. 
Louis, Mo. (page 113) 
Joseph M. Patton, M. D., Professor of Internal Medicine, Chi- 
cago Polyclinic, in a valuable and instructive address before the Chi- 
cago Medical Society, says: 
“In my own practice, both public and private, 1 have for a num- 24 
ber of years past treated cases (of phthisis) with Hypophosphites in 
the form of a syrup of whichever salt was indicated; I prefer Gard- 
ner’s syrups as being the most stable on the market. This must not 
be confounded with the combined Hypophosphites. The latter prep- 
arations I used for several years in a large number of cases, and be- 
came finally convinced of the truth of Churchill’s teachings, that the 
compound syrup of the Hypophosphites is distinctly injurious to phthi- 
sical patients. The Hypophosphite of Soda is generally the most 
useful, and is given in apyretic cases where there is not much expec- 
toration. 
The quinia salt is used temporarily when the temperature is over 
ioo° F., and the lime salt where there is too free expectoration, six 
or seven grains daily being the maximum dose.” (Page 113). 
For reports of additional cases of phthisis cured by Hypophos- 
phites, the reader is referred to papers of the following physicians, 
republished herein. 
(Three cases in the first, second and third stages, selected at ran- 
dom, to illustrate his method, by the late L. de Bremen, M. D., page 
92.) History of twelve cases of Phthisis Pulmonalis, treated by 
Syrups of Hypophosphites, eight recoveries, four deaths, by W. 
H. Bentley, M. D., Cold Spring, Woodstock P. 0., Ky. (page 
95); J. R. Fraker, M. D., Marlboro, N. Y. (page 99); Malcolm Gra- 
ham, M. D., Jonesville, Mich, (page 102); J. C. Willson, M. D., Morley, 
N. Y. (page 1:03); P- J. Bailey, M. D., Dawson, Ky. (page 104); Walter 
M. Darnell, M. D., Belton, Texas, (page 104). 
Richitis.—The Clinical Record is full of instances of cure of this 
condition by Hypophosphite of Lime. A. Springer, M. D., Lewiston, 
Me., gives experience at the “Home” for sick and needy children 
at that place. (Page 117.) 
PHOSPHORUS ASSIMILATION. 
THE ELEMENT AND ITS COMPOUNDS CONSIDERED AS TO AVAILABILITY 
R. W. GARDNER. New York. 
(Published by New York Medical Record, January 27, 1877.) 
When phosphorus is administered in a free state its irritant ac- 
tion forms the greatest objection to its use, and limits the quantity which may be given with satety; it is also necessary to give it upon a 
full stomach, as a precautionary measure, as otherwise it is found to 
attack mucous surfaces and produce irritation; the extent of such ac- 
tion depending upon the quantity administered or the length of time 
the remedy has been continued. The largest dose usually given is 
about one-twentieth of a grain, though one-twelfth has been admin- 
istered, but not until the tolerating power of the patient had been 
carefully tested. Given in doses of from one-hundredth to one- 
thirtieth of a grain, it often produces dyspeptic symptoms, and the 
remedy has to be discontinued. 
25 
Let us consider why this occurs. 
Phosphorus has such a powerful affinity for oxygen, that it must 
be kept under water, for when exposed to atmospheric air its union 
with oxygen is so violent that it inflames spontaneously. This explains 
its corrosive action to the stomach, modified, no doubt, by its sur- 
roundings, but nevertheless capable of producing the most serious 
results upon the delicate mucous surfaces which are directly exposed 
to its influence. 
Phosphorus cannot be absorbed in its pure, (elementary) state; 
a certain degree of oxidation must have taken place before it reaches 
a condition adapted for assimilation. 
When it has thus become partially oxidized, however, it has lost 
its corrosive action, and is then, and not until then, in a condition to 
fulfill its valuable agency in contributing to nerve power and vital force. 
The remedial action of phosphorus is doubtless exerted from the 
time it has become sufficiently oxidized for absorption, and during the 
whole of its subsequent oxidation, until it has finally reached its ulti- 
mate oxidized state, the phosphate. 
My reasons for forming this conclusion are, that the eliminations 
of phosphorus from the body are always in the condition of phosphate, 
and also that the phosphate is so firm in its chemical behavior as to 
lead naturally to the belief that for this purpose it is unavailable, or 
to use a vulgarism, it has “burned out” and having passed its period 
of usefulness, is eliminated. 
Phosphorus exists in the vegetable world in the condition of phos- 
phate only; in animal tissues and in fish, etc., in a partially oxidized 26 
state, constantly undergoing the oxidizing process, and finally being 
thrown off as effete matter. 
Does not this, at least partly, explain the superior vitality and 
nervous power of those who partake largely of animal food? 
It is also rarely the case that animal organisms appropriate ele- 
mentary substances directly. If we examine the matter, we will find 
that all articles of food, contain these elements in a condition of 
chemical combination, and by a reciprocal action nature discards 
useless or exhausted substances for such as she requires, each imme- 
diately forming new compounds, the one destined for elimination, the 
other for assimilation. 
These views naturally lead to the conclusion that phosphorus 
should be preferably administered in its lowest oxidized state, rather 
than in the elementary condition, and never, where its assimilation is 
desired, in the condition of phosphate. 
The next question is, how to get at it? 
Phosphorus, uncombined, passes directly to its highest condition 
of oxidation, unless retarded by chemical union with a base; this 
leads us to a second conclusion, viz.: 
That phosphorus in its most desirable form cannot be obtained 
except by such a chemical combination as will stay the oxidation at 
this point, and render it available for therapeutic action. In the 
search for such a compound, there seems none so well suited to the 
purpose as the several Hypophosphites. 
They embrace quite a range of salts, lime, soda, iron, 
potassium, manganese, quinia, etc., each capable of playing an 
important part in a subordinate capacity, while the phosphorus ele- 
ment becomes the most important. The phosphide of zinc has been 
suggested and used to some extent, but, this does not seem a suffi- 
ciently definite compound, producing irritant action and unpleasant 
results. The Hypophosphites, however, while entirely non-irritant, 
and held by such a feeble affinity as to be readily decomposed, not 
only contain oxygen in its least combining proportion, but represent 
a larger proportion of phosphorus, relatively, than any of its other 
compounds. 
It is found, however, that unfortunately their therapeutic value is 27 
much lessened by the impurities always found in the commercial 
salts and the ordinary preparations of them. 
It is very desirable that they be administered in a perfectly pure 
and neutral state, and unless they have been given in this condition, 
their medicinal value has not been properly tested. This is proven 
by the superior results attained by the use of such salts at the Euro- 
pean hospitals. 
The salts, being chemically pure and in solution, should be pre- 
served against putrifaction and atmospheric influence by conversion 
into syrups. 
Sugar is the best preservative agent, as it does not cause decom- 
position and excludes atmospheric air. Prepared in this manner the 
salts have been found much more prompt and assimilable. 
They should be almost wholly devoid of medicinal taste, except 
in the case of iron, and in this the ferruginous taste is only mildly 
perceptible. The syrups of lime, of soda, and of potassa should be 
entirely free from the alkaline taste common to these preparations, 
and should never let fall a precipitate, which is a sign of the presence 
of impurity. 
GARDNER’S SYRUPS OF CHEMICALLY PURE 
HYPOPHOSPHITES. 
Prepared in strict accordance with Churchill’s views, enabling 
physicians to follow his methods in the treatment of phthisis, by 
which thousands of authenticated cases have been cured. 
x. The Hypophosphites of Soda, Lime and Quinia are the only ones 
indicated. 
SUMMARY OF CHURCHILL’S METHODS IN PHTHISIS. 
2. The Hypophosphite must be chemically pure. 
3. They must not be combined for use in phthisis. 
Why not? Because they act in antagonism to each other, the 
different bases being indicated in different stages of the disease 
and the several salts differing in therapeutic action. 
Churchill never uses them in combination. 
All statements that he did or does are false and misleading. 28 
The proofs of the above are in this pamphlet. 
4. The Hypophosphite should be used only in the form of syrup. 
Why? Because as salts they will not keep in the proper condi- 
tion, the protective action of the sugar being necessary to 
prevent atmospheric oxidation. 
5. The pure Hypophosphites are neutral not alkaline. 
6. Soda is indicated in the incipient stage, as a rule, with exceptions. 
7. Lime is indicated in the second and third stages, as a rule, with 
8. Hypophosphite of Quinia is indicated in the initial treatment of 
far advanced cases, to be followed by the Hypophosphite of 
Lime, or Soda, later on, when it can be borne. 
exceptions. 
9. Lime reduces expectoration, frequently causing cough; the soda 
should then be used. 
to. Soda mildly favors expectoration; if too free, the lime should be 
substituted. 
11. The tendency of the Hypophosphite is to create plethora. 
12. While this condition is necessary to the cure, it favors hemor- 
rhage. 
13. Discriminating dosage is therefore necessary. 
14. Any Hypophosphite given too freely will produce pathogenic or 
toxic effects, such as a too rapid softening and expectoration 
of the tubercular deposit, lassitude, prostration, headache, 
giddiness, fever, indigestion, loss of appetite, colic or diar- 
rhoea, epistaxis and haemoptysis. 
These effects are produced more readily by some salts than by 
others. 
Of those used in phthisis, viz., lime, soda and quinia, the lime is 
the most apt to be productive of these undesirable results. 
15. If weak and emaciated, or if the case be well advanced, let the 
commencing dose be very small, even one grain in twenty-four 
hours in some cases, and, if well borne, gradually increase, 
keeping well within the physiological effect. 
16. The maximum quantity to exhibit in phthisis, during twenty-four 
hours, is seven grains. 
17. Do not give any other drug with a Hypophosphite. 29 
18. Lay aside the Hypophosphite when combating complications. 
19. Cod liver oil is contra-indicated in any stage of the disease. 
Why? Because it produces plethora; the Hypophosphite also 
produces plethora; when used together, such a plethoric state 
is produced that, to avoid hemorrhage, the Hypophosphite 
must be discontinued; the Hypophosphites, being the remedy 
for the diathetic state, must be continued, or the treatment is 
useless. 
20. All stimulants are contra-indicated. 
Why? They prevent the return of strength and bring on a re- 
currence or an aggravation of cough, fever and sleeplessness. 
As their effect upon the system consists in a stimulation of the 
circulation and a diminution of oxidation, it is directly contrary 
to that of the Hypophosphites. 
21. You should usually get results within two weeks. 
22. If not, look for the cause. 
It will, generally, be found to be one of the following: 
The Hypophosphite is impure and incapable of producing proper 
results. 
You are producing pathogenic effects by overdosing. 
You are using stimulants, which prevent the action of the Hypo- 
phosphite. 
You are giving anodynes or other drugs to allay cough, procure 
sleep or control night-sweats. 
You are using contra-indicated Hypophosphites, or combinations 
of them, the bases of which are therapeutically antagonistic, 
or produce pathogenic effects. 
You are giving cod liver oil along with the Hypophosphite. 
A complication has arisen which requires special treatment. 
The disease is so far advanced as to be hopeless. 
23. Continue the treatment within physiogenic limits, intermitting 
every third week, until the diathesis is removed, and then use 
occasionally as prophylactic. 
24. Gardner’s Syrup of Hypophosphite of Lime, and Syrup of Hy- 
pophosphite of Soda, each contain twenty grains of the chem- ically pure salt to the ounce. Each teaspoonful, therefore, 
represents two and one-half grains. 
This quantity three times a day is the largest amount that should 
ever be prescribed in phthisis. 
The average dose, in this disease, is much less. 
The physiological dose will vary with every case, and must be 
carefully sought and the patient frequently observed, lest the 
remedy produce pathogenic effects. 
The syrup may be given in milk, coffee, water, or in a little lem- 
onade, if it is found to be more acceptable to the patient. 
25. Gardner’s Elixir of the Hypophosphite of Quinia contains eight 
grains of the chemically pure salt in one ounce. 
26. Night-sweats will yield, in time, to the Hypophosphite alone. 
27. Complications must be treated as they arise, discontinuing the 
Hypophosphite in the meantime, but resuming it ,again when 
acute symptoms have subsided. 
28. In case pathogenic symptoms are accidentally produced, at once 
discontinue the Hypophosphite, and take it up again after ten 
days or two weeks, in smaller quantity. 
29. Much further information is contained in the body of this pamphlet. 
It will pay you to read it carefully. 
30. Physicians desiring to test this treatment will please bear in mind 
that the chemical purity of the salts is an absolute necessity 
for success; that they must be specially prepared and immedi- 
ately protected in syrup to preserve them in a proper condi- 
tion for medicinal use; that some unprincipled druggists do not 
hesitate to substitute preparations made by themselves or bought 
in bulk in the market, even when a particular manufacture is 
stipulated by the physician on his prescription. Obviously, 
then, the treatment has not been properly tested, unless the para- 
mount condition of purity has been observed. GARDNER’S SYRUP OF CHEMICALLY PURE 
HYPOPHOSPHITE OF SODA. 
Strength.—Twenty grains in one fluid ounce. 
Dose.—Variable in phthisis, and never more than one teaspoon- 
ful three times a day. 
In other diseases larger doses may be used, though one teaspoon- 
ful three times a day is an average dose. 
Indications— 
Phthisis.—ln the early stages of the disease, as a rule, unless 
contra-indicated; when expectoration is not sufficiently free; in any 
stage of the disease, as an alternative, when the lime salt, being indi- 
cated, disagrees. [Exception.—In the initial treatment of far ad- 
vanced cases, when the quinia salt would be indicated.] As a pro- 
phylactic in convalescence. 
Defective Nutrition.—Adynamic conditions of the nervous 
system, marasmus, amenorrhoea, functional inactivity, convalescence 
from low forms of disease, impoverished blood [boils, abscesses, 
pimples, etc.]; uterine fibroids, mental and cerebral diseases, sub- 
acute and chronic bronchitis, and in the sequelae of inflammatory 
diseases of the respiratory organs; convalescence from “la grippe” 
and pneumonia. 
GARDNER’S SYRUP OF CHEMICALLY PURE 
HYPOPHOSPHITE OF LIME. 
Strength.—Twenty grains in one fluid ounce. 
Dose.—Variable in phthisis, and never more than one teaspoon 
ful three times a day. 
In other diseases larger doses may be used, though one teaspoon 
ful three times a day is an average dose. 
Indications— 
Phthisis.—Second and third stages; when diarrhoea is present; 
if patient is pregnant; when expectoration is too profuse; in any 
stage of the disease, as an alternative, when the soda salt being in- 
dicated, disagrees. [Exception.—ln the initial treatment of far ad- 
vanced cases, when the quinia salt would be indicated. 
Defective Ossific Action. [Rickets, defective teeth in adults, 
difficult and retarded detention in children; broken limbs and frac- 
tures].—Adynamic conditions of the nervous system; defective nutri- 32 
tion; chronic myelitis; chlorosis; anaemia; functional inactivity; weak- 
ness during pregnancy arid lactation, and in all diseases depending 
upon incomplete and retarded development. 
FREE PHOSPHORUS INVARIABLY AND NECESSARILY 
CHANGED TO HYPOPHOSPHITE IN THE 
STOMACH BEFORE ABSORPTION. 
R. W. GARDNER, New York. 
(Published by New York Medical Record, February 22, 1879.) 
It is claimed that the chemical changes occurring to substances 
after entering the body, cannot be followed out intelligently owing to 
the complication caused by the modifying influences of vital and 
functional action, the presence of a multitude of substances, and the 
changed scene of action as compared to the laboratory, ren- 
dering it impossible to note changes as they occur; all of which, as a 
rule, with some exceptions, is doubtless true. 
One exception to this rule, I believe to be the changes undergone 
by free phosphorus from the time of its introduction into the stomach 
until by absorption it leaves it. 
My reasons for thus excepting phosphorus during the period 
mentioned are: 
That it is an element incapable, primarily, of chemical action in 
such locality, except in certain well-known directions, which change 
is a necessity with it, as a preliminary step to further combinations. 
The first change that occurs must be that it unites with some- 
thing else, because, being an element, it is itself ultimate; it there- 
fore exerts single elective affinity—its strongest affinity is for oxygen. 
Having proceeded thus far, I will state my reasons for the con- 
clusions heading this paper: 
Solutions of phosphorus are precipitated in the stomach previous 
to assimilation. 
Water precipitates phosphorus from its solutions, when it mixes 
with its solvent. 
Therefore, phosphorus must be precipitated from its alcoholic 
solution by the aqueous character of the stomach secretions. 33 
Phosphorus dissolved in ether, if given in this form, is left by the 
evaporation of the solvent; and the oleaginous solution, having under- 
gone pancreatic emulsification, is changed by that process to a con- 
dition which admits of union with aqueous secretions in any propor- 
tion, and as emulsification must have taken place before fats can 
be absorbed, the phosphorus, but sparingly soluble in the oil origin- 
ally, must be precipitated when the oil is not only emulsionized, but 
combined with aqueous secretions at the time of assimilation; hence, 
phosphorus, even if given in solution, reaches the condition of sub- 
stance in the stomach, before absorption can take place. 
Phosphorus being insoluble in stomach juices is incapable of 
endosmosis, until by chemical change, it is rendered soluble. 
Its natural and strongest affinity being for oxygen, an atom of 
phosphorus (P), unites with an atom of oxygen (O), two molecules 
of wates from the stomach secretions (2 H O) now unite with it, and 
the result is 2 H O, P O (Hypophosphorous Acid), and as the free acid 
cannot exist in the presence of bases without union, and as such bases 
are always present in the stomach, this union occurs naturally, and a 
Hypophosphite is produced, affording the first soluble condition of the 
phosphorus originally given—necessarily in very small proportion, 
from the limited quantity of phosphorus (y-J-y to of a grain) toler- 
ated by the patient. 
During the oxidation of the phosphorus in the stomach, phospho- 
retted hydrogen, is given off (a result always occurring during the 
primary oxidation of phosphorus), and this having an avidity for 
water, is taken up by the stomach juices, and being then in a con- 
dition favorable for such action, is absorbed. 
This accounts for the constitutional toxic action of phosphorus, 
evidenced by hasmatomata upon the heart, pleura, liver, kidneys, 
etc.,—for the odor of phosphorus pervading the body of a person 
poisoned by phosphorus, and also for the peculiar “match- 
like” eructations complained of by patients when taking free phos- 
phorus. HYPOPHOSPHITES VERSUS PHOSPHATES. 
R. W. GARDNER. 
(Published by New York Medical Record, December 17, 1881.) 
I have prepared a statement of the amount of phosphorus con- 
tained in Hypophosphites and phosphates, showing the superior 
power of the Hypophosphites over phosphates, as a carrier of this ele- 
ment, and accompanied by a brief statement, showing why Hypo- 
phosphites are the best assimilants of phosphorus. 
(0 = 8.) 
HYPOPHOSPHXTES. 
PHOSPHORUS, 
PHOSPHATES. 
PHOSPHORUS, 
IOO PARTS BY WEIGHT. 
PER CENT. 
IOO PARTS BY WEIGHT. 
PER CENT. 
36.47 
X3.46 
35.1° 
Soda (crystal, tribasic) 
8 61 
29. 7^ 
Pot. (neutral tribasic) 
Iron (ferrous salt) 
33-33 
Iron (ferrous tribasic) 
17.22 
Quinia (soluble) 
8-33 
Quinia (neutral tribasic) 
4.20 
essary to be absorbed by the phosphorus element of the Hypophos- 
Also a table, showing the percentage by weight of oxygen, nec- 
phites, to convert them into phosphates, while the latter, being 
already fully oxidized, absorb none. 
(0 = 8.) 
IOO PARTS BY WEIGHT OF HYPOPHOSPHITES MUST ABSORB OF OXYGEN. 
PER CENT. 
Lime to convert into phosphate, must absorb 
Soda, “ “ “ ‘ “ “ 
37-65 
36.24 
Potassa, “ “ “ “ “ “ 
30.71 
Iron, “ “ “ “ “ “ 
34-41 
Quinia, “ “ “ “ “ “ 
8.60 
phosphorus contained in the resulting compound becomes less by the 
As Hypophosphites become oxidized, the relative proportion of 
increase in weight of the substance, and the power to absorb oxygen 
(to which property the therapeutic value of these salts are mainly 
due) becomes less and less, until, when fully oxidized to the condi- 
tion of phosphate, their efficacy as phosphorus assimilants ceases. * * * 35 
CHURCHILL AND OTHER EMINENT AUTHORITIES ON 
THE THERAPEUTIC ACTION OF HYPOPHOSPHITES, 
IN PHTHISIS AND OTHER DISEASES. 
Physiogenic Effects.—Physiogenic action consists in the 
increase or decrease of some one, or several, of the natural functions, 
without their exceeding the physiological or their natural and health- 
ful limit, and consequently without the production of morbid phenom- 
ena. These may be classified as follows: 
Increase of nervous energy, with unusual feeling of ease and 
comfort. 
Increase of appetite, improved digestion, more regular action of 
the bowels. 
Increased activity of hematosis, or the blood-forming process. 
After a time, evident signs of venous plethora, shown in color of 
the face, redness of the mucous membrane of the lips and eyes, and 
the fullness of the superficial veins. 
Menstruation becomes easier, more abundant, and regular. 
Patient generally gains in weight, with, seemingly, at first, no 
increase in adipose tissue. 
This increase of nutritive action is sometimes remarkably mani- 
fest in development of hair and teeth.” 
[When given to teething children who are pale, peevish, sad, 
emaciated, without appetite or strength, suffering from fever and 
diarrhoea, loss of sleep, and apparently in imminent danger of con- 
vulsions, I have never seen a single case where the whole of these 
symptoms have not yielded to a few doses of Hypophosphite of Lime, 
and the evolution of the teeth afterward, proceed as if in perfect 
health.] 
Pathogenic Effects.—These include all effects produced by 
the remedy, different from those which exist in the normal state. As 
soon as there is any manifestation of a morbid phenomenon, the 
action must be looked upon as pathogenic. 
These effects are produced when the Hypophosphites have been 
taken too long, or in too large doses. 
Breathing may become short and uneasy; there are pains in the 36 
chest and aggravation of cough and expectoration, and at this period 
ausculation frequently shows increase of the local signs, consequent 
upon augmented hyperasmia of the lungs. 
If, in spite of these symptoms, the use of the remedy is per- 
severed in, haemorrhage takes place from the respiratory, or even 
from the digestive mucous membrane. This generally makes its first 
appearance in the shape of bleeding from the nose, after which there 
may be an attack of haemoptysis, perhaps for the first time. 
Persons kept in this condition for a time are affected with piles, 
and those which they formerly had, and which had disappeared, are 
reproduced; this may go to the extent of real intestinal haemorrhage. 
Most of the symptoms may show themselves from the very begin- 
ning of the treatment, if it is begun with too large doses. 
They are more easily and rapidly produced in proportion to the 
youth and sensitiveness of the patient, as in the case of women, chil- 
dren, and people of nervous or sanguine temperament. 
Among the different signs of this pathogenic condition, two 
deserve particular attention. 
Fulness of the face; and bleeding at the nose. 
The fulness of the face, as the name indicates, refers to a peculiar 
look of the patient, similar to what may be observed in delicate per- 
sons after a hearty meal, or after moderate exercise. There is often 
a flush on the face; which to the inexperienced observer resembles 
that of perfect health; the cheeks are less hollow, sometimes appear 
quite full, and when this state has reached its maximum, there is a 
slight swelling or puffiness of the malar region, and the lower eyelid. 
This peculiar aspect is not the same as the look of hectic fever. 
The redness of the facies is not sharply circumscribed to the cheeks, 
but spread over the whole face, as in a state of health. 
When once carefully observed it is not difficult to recognize again. 
The slighter the amouut of local lesion, the more strongly marked it 
appears, and the earlier it occurs; sometimes at the end of a few days. 
It is more apparent in persons of a lymphatic or sanguine, than 
those of a bilious or nervous temperament. 
This is a sign of great clinical value, for it indicates that the 37 
physiogenic action of the remedy is near or has already reached its 
maximum. 
It is therefore highly important that it should be recognized in 
time, as it enables the physician to forsee, and consequently by sus- 
pending or decreasing the treatment, to prevent the accidents or 
complications which would not fail to follow if it were injudiciously 
persevered in. 
This fulness of the facies marks the limit of physiogenic action. 
Epistaxis shows that the patient is entering the sphere of patho- 
genic phenomena. These latter are frequently preceded by this sign, 
which is, therefore, particularly worthy of attention. 
I have shown the necessity of distinguishing between the physio- 
genic action of a remedy and its pathogenic manifestations. In like 
manner it is indispensable that a distinction should be made between 
its therapeutic effects, and the curative result. 
As I have already explained, the therapeutical effects of a medic- 
inal agent are the result, either of its physiogenic or of its patho- 
genic action; but they are of a more complex order, while they are 
less complex than the curative result. 
Each step in these different orders of phenomena, therefore re- 
quires for its manifestation an increasing number of conditions, be- 
cause each step in the scale is more complex than the one which pre- 
cedes it. 
The cure will be the final term, the result of the different ante- 
cedent modifications produced in the system and can only be arrived 
at provided they are maintained within certain limits, and kept up for a 
sufficient length of time. Churchill. 
The discovery by Koch, of a micro-organism characteristic of 
tubercle, has induced some people to suppose that the new theory 
rendered all our previous knowledge of the subject useless. Let us 
see how far this is correct. 
The Bacillus.—-Upon this subject Dr. Churchill says: 
The ascertained facts may be summed up as follows: 
The cells of tubercle, particularly the giant cells, contain micro- 
scopic objects, having the shape of rods, which occur singly, in pairs, 
or in bundles. They are non-motile, they form spores, can be culti- 38 
vated artificially out of the body in different animal media, such as 
the serum of the blood, and these artificial productions may be inoc- 
culated and reproduce the original disease. 
How much of this knowledge of facts only comes to confirm our 
previous knowledge, and how much, is really an addition to it? 
First of all, as a means of diagnosis, some observers contend that 
the characteristic bacilli are always met with in tuberculosis; this, 
however, is not yet established beyond doubt. But even if it were, 
it would not carry us much further than we were before. The micro- 
scopic characters of tubercle are well known, and there are few cases 
in which it may not be recognized with the naked eye. 
So also with regard to the diagnosis of the disease. It is not 
very often that the history of a case, coupled with the local chest 
signs, will leave an experienced practitioner in any doubt as to the 
nature of the case he has to deal with. So far, therefore, it is in a 
small number of doubtful cases that the presence of the new bacillus 
would be important, provided always, that it be estabished beyond 
doubt, which is not the case, that the bacillus is the efficient cause of 
tubercle. 
Again, the upholders of this doctrine contend, that these bacilli 
may be inoculated, but this we already know to be the case with 
tubercle itself. 
The importance of the inoculability of the bacillus, and of its 
propagation by artificial cultivation, would thus be very much dimin- 
ished indeed, and we should be thrown back upon the old question of 
heterogenesis. 
Froedlander says he has produced tuberculosis in guinea-pigs by 
making them inhale a spray containing the tubercle bacilli, hence it 
has been hastily concluded that tuberculosis and phthisis was emi- 
nently a contagious disease; and from this hasty inference a number 
of equally unfounded and hasty inferences were as hastily drawn. * 
* * * 
Common sense and every day experience go but a very little way 
in this direction. Statistics show that nurses, physicians, and other 
persons in constant contact with consumptives, are not more liable to 
the disease than others. And if an individual instance could be of 39 
any value, I might say that for forty years I have been almost in daily 
contact, for hours together, with consumptive patients. 
Besides, whatever may be the fate of the new and important re- 
searches, concerning the micro-organisms, as connected with disease, 
the results of therapeutical practice are independent of them. Just 
as quinine was found to be an antidote for intermittent fever, centuries 
before the discovery of the marsh spirochceta, its characteristic bacillus, 
so I may say at the present day, millions of cases of consumption 
have been cured by the Hypophosphites, before the discovery of the 
tubercle bacillus, and will continue to be so, whether the microbe be- 
comes an established fact or not. Churchill, 1888. 
General Action of Hypophosphites.—The following state- 
ment by Churchill as to the general action of the Hypophosphites is 
so comprehensive, and covers indications in so many morbid condi- 
tions, that I quote it in this connection: 
“The effect of the Hypophosphites on the tubercular constitution 
depends upon a general action in the system, which at a future day will 
come to be recognized as of still greater importance than their effects 
in disease. In our present imperfect social state, there is a constant 
tendency to increased disturbance of the conditions of normal nutri- 
tion, which is effectually combated by the use of the Hypophosphites 
as an occasional and temporary nutriment. 
This result can be obtained by no other means hitherto known 
than the use of some one of the oxidizable phosphorus compounds,the 
best of which are the Hypophosphites. 
By means of these therapeutical agents, the functions of inner- 
vation or nerve power, of sanguification or blood-forming process, 
and of interstitial nutrition, which are the three primordial functions 
in the animal system, may be kept or gradually raised to the very highest 
degree of intensity of which the organic conditions of the subject 
will admit. 
Precautions.—The following precautions must always be ob- 
served. If tuberculosis depends upon the want of the oxidizable 
phosphorus in the system, it is clear that the introduction and as- 
similation of the Hypophosphites will supply this want, but this 
phosphorus does not exist in the organism in an isolated or free 
state. It is only one, although the most important and characteristic 40 
among several other principles which unite to make up the phos- 
phide, or oxidizable phosphorized proximate principles. These other 
elements must be provided by the organism, must combine with the 
new element medicinally supplied, and the resulting compounds must 
be built up in the system itself. This is a process of integration 
which depends, it is true, upon the presence in the system of the ele- 
ments required, without which it cannot take place, but which is in- 
fluenced by the activity of other functions, and above all by those of 
assimilation, respiration and sanguification. Now each of these three 
different functions may vary, and do vary, in every individual, so 
that even should the phosphorized element be always supplied in the 
same quantity, it will not be worked up in all cases with the same 
amount of activity. It is evident, for instance, that a patient in 
whom the appetite or digestive function is impaired will take less 
nutriment, even if he takes the same amount of phosphorus, and 
consequently build up less of the principles containing the phosphide 
element, than one in whom the digestive functions are sound. The 
same will be the case when the lungs are seriously damaged and the 
respiratory power considerably impaired. Here the activity of san- 
guification will be diminished, because all the elements of nutrition 
supplied by the digestive process must first pass through the lungs 
and be sufficiently oxidized before they become completely incor- 
porated in the blood, and are, so to speak, adopted by the system. 
It follows from this that the improvement of a consumptive patient 
under the Hypophosphites should be slow and gradual. The more 
advanced the disease, the more gradual should be the improvement 
and the more serious will be the induction of pathogenic symptoms. 
This last circumstance is the more important, because the existence 
of a relative state of plethora is the prime condition of cure, but it 
is also at the same time a predisposing cause of hyperasmia of the 
lung tissue surrounding the tubercular matter, consequently of in- 
flammation and of softening of the tubercular deposit. 
I have often seen cases in which the use of excessive or too pro- 
longed doses of the Hypophosphites has brought on rapid softening 
of the tubercular deposit and a fatal issue in patients, who shortly 
before had appeared in a fair way of recovery under the treatment. 
When there is any predisposition to haemorrhage, the action of the specific should be carefully watched. This, however, is not a 
counter-indication to the use of the Hypophosphites. It frequently 
happens, on the contrary, that the tendency to haemorrhage disap- 
pears under their influence, particularly when it depends upon the 
diathetic and spanhaemic condition, that is, upon the want of plastic- 
ity and vitality in the blood. I have published several cases in sup- 
port of this view, which have since been confirmed by other observers. 
As I have seen cases of softening induced by overdoses of the 
Hypophosphite, so likewise I have either known of, or have witnessed 
attacks of haemorrhage, evidently owing to the same cause, or to the 
concurrent use along with the Hypophosphites of Cod Liver Oil or 
of Iron; sometimes to the injudicious use, in lieu of the Hypophos- 
phite of Soda, or Lime, to the Hypophosphite of Iron, or even of 
free Hypophosphorous Acid, given by the physician on account of their 
greater activity; to the over excitement of the circulation by stim- 
ulating liquors; or, lastly, to the use of a heterogeneous jumble of 
different Hypophosphites; oftentimes, alas! for the poor patient, to a 
mass of powerful therapeutic agents dished up together. 
1 remember among many similar cases a consumptive child, nine 
years of age, who had been ordered to take every day a tablespoon- 
ful of Syrup of Hypophosphite of Iron, a large dose of cod liver oil, 
a powerful tonic and a glass of port wine. 
I will now examine successively two different kinds of results 
which may follow upon the use of the Hypophosphites. 
Supposing that the primary condition, that of purity of the rem- 
edy, has been secured, I find that when an improvement does take 
place, the first signs of it usually show themselves more or less dur- 
ing the first week. Sometimes the patient notices it from the very 
first day. It is seldom delayed beyond a fortnight, though in some 
exceptional cases I have known it not to become apparent till after 
the lapse of as long a time as six weeks. You must not, therefore, 
despair of the remedy if its action be not immediately manifest. 
Sometimes the improvement is apparent for all the symptoms at once; 
sometimes only for some; at times for a single one. The appetite is 
sometimes the first function to improve. At other times it is the 
strength, or it may be the cough, or sleep, or perhaps fever. The 
vounger the patient, the more limited and the more recent the 42 
disease, the shorter is the time usually required for the first reappear- 
ance of improvement. 
Narcotics, opiates and sedatives produce a contrary effect to that 
of the Hypophosphites. They prevent the return of appetite, they 
bring on 'or increase weakness and night-sweats. When, as is fre- 
quently the case, the patient has been under palliative treatment of 
this kind for some time previous to his taking the Hypophosphites, 
the action of the latter will generally be delayed thereby. When 
narcotics or sedatives have been used for the purpose of allaying 
harassing cough at night, it will frequently happen that their sup- 
pression will be attended with more or less distress to the patient. 
But it must be persisted in if we wish to obtain the effects of the 
specific treatment. 
Of late years several pharmaceutical preparations have been 
largely advertised, which consist of a heterogeneous jumble of Hypo- 
phosphites, most of which are positively injurious in consumption, as 
I have before said, and could only be prescribed by a practitioner 
who understood the matter, if it were wished with deliberate purpose 
that a patient should only improve for a time and ultimately not get 
well. These different Hypophosphites are usually associated with 
strychnia. A mere inspection of them suffices to show that in a 
pharmaceutical point of view they are utterly ridiculous, if the word 
monstrous would not be more deservedly applied in a case like this, 
where the lives of thousands of persons are at stake. It strikes me 
as wonderful beyond belief that such preparations should by per- 
tinacious quacking have received such acceptance among the profes- 
sion, and that a medical journal could have proposed that any such 
as these should be inserted in the British Pharmacopoeia. 
Not a week passes without my meeting with cases where con- 
sumptive patients are going to the bad after a temporary improvement 
derived from the use of these preparations. 
It is thus seen that there exists a number of serious causes of 
error which should be carefully avoided, as they may easily be, when 
they are once pointed out. It will occasionally happen that the 
patient will look upon certain disturbances following the action of 
the Hypophosphites as unfavorable, and be thus induced to give up 
the treatment. Such are the following: The morning is usually the best time to give the Hypophosphite, but in children and in delicate, 
highly nervous persons, if the remedy be taken in the morning, its 
stimulating effect will sometimes become apparent during the night, 
and the patient will complain of restlessness and want of sleep. This 
will usually be got rid of by changing the hour of administration. 
43 
By giving the remedy at bed time absorption and assimilation 
take place during the night, and its physiogenic effects of increased 
comfort, strength and activity will then manifest themselves during 
the day. 
Sometimes the patient’s appetite increases considerably, but the 
digestive power, owing to the still deficient supply both in the quan- 
tity and the quality of the blood, has not improved in the same ratio. 
The patient, therefore, complains of increased difficulty of digestion. 
This is attributed to the Hypophosphites, and they are struck 
out. By observing the very simple precaution of keeping at first to 
the same regimen, and the same amount of food, and only changing 
and increasing them by slow degrees, this apparently unfavorable ef- 
fect of the Hypophosphites will be seen to be a result of the efficacy 
of their action. 
Many cases, however, of gastric disturbance noticed by other 
observers have been undoubtedly due not to this cause, but to the im- 
purity of the salts used. 
In the use of these remedies one should never lose sight of the 
necessity of advancing slowly and gradually along the whole line of 
improvement. There must be no sudden spurt or burst, and no one 
function can be stimulated physiologically and usefully to the patient; 
unless the others are able to follow and keep up with it. 
Health is nothing but the equilibrium of all the functions of the 
system. Churchill, 1888. 
PHOSPHATES AND HYPOPHOSPHITES. 
THEIR DIFFERENT ACTION EXPLAINED. 
“The phosphates in the animal economy are probably either the 
components of fully developed, and, consequently, stationary histolog- 
ical elements, or the result of retrogressive metamorphosis; they are, 
therefore, the residue of the mole :ular processes, which constitute the 44 
phenomena of life, and are, so to speak, the ashes of the vital fur- 
nace. These ashes, which constitute what I propose calling the 
phosphatic element, are in part, if not in the main, produced by the 
oxidation or combustion of another phosphorus compound existing 
in the system, and which I propose should be distinguished from the 
former, by calling it the phosphide element. The latter, instead of be- 
ing a residue or a component of fully grown, and, therefore, already 
decaying products, is one of the primary principles of all morphotic 
or germinal elements; it is, therefore, one of the essential conditions 
of all /regressive metamorphosis,—perhaps of all vital action. 
“This broad distinction between these two biological elements— 
which had, until my researches upon the subject, almost entirely 
escaped the notice of physicians, and physiologists—will show at a 
glance that the views I profess with regard to the nature of tubercu- 
losis, and the action of the Hypophosphites are very different from the 
admitted ideas as to the function of the phosphates, to which most 
persons are continually endeavoring to refer them. In spite of what 
I have published on the subject for twelve years past, many practi- 
tioners still prescribe the phosphates or phosphoric acid, under the 
idea that they are using my treatment, and occasionally these salts 
may be found to produce some slight effect from the fact that com- 
mercial phosphoric acid almost always contains a certain proportion 
of oxidizable phosphorus in the form of phosphorous acid.” 
Cause of Failure in Treatment.—“In cases where no im- 
provement has shown itself within the lapse of time, I have men- 
tioned (fortnight from time of commencing the Hypophosphite treat- 
ment) it will generally be found that this is owing to some one of the 
following causes: 
Along with the Hypophosphites the patient is perhaps taking 
some other medicine or medicines, which counteract or destroy their 
effects. 
Most of the drugs used against phthisis are altogether incom- 
patible with the Hypophosphites. 
For instance, if along with the Hypophosphites, the patient is 
taking alkalies or mineral waters, there will generally be a persistence 
or an increase of cough, of expectoration, of night sweats, and of 
fever. 45 
If preparations of sulphur, or sulphuretted mineral waters are 
used with the Hypophosphites, there will often, beside these effects, 
be spitting of blood. 
Narcotics, opiates and sedatives also produce a contrary effect to 
that of the Hypophosphites. They prevent the return of appetite, 
they bring on or increase night sweats. When, as is frequently the 
case, the patient has been under palliative treatment of this kind for 
some time previous to his taking the Hypophosphites, the action of 
the latter will generally be delayed thereby. When narcotics or 
sedatives have been used for the purpose of allaying harassing cough 
at night, it will frequently happen that their suppression will be 
attended with more or less distress to the patient. But it must be 
persisted in, if we wish to obtain the effects of the specific (Hypo- 
phosphite) treatment. 
The same remark applies to the use of the large class of medi- 
cines included under the term of tonics, such as bitters, vegetable 
alkaloids, etc. 
The presence in a mixture containing the Hypophosphites, of 
metallic salts, or of salts with excess of acids, or of free acids, will 
frequently bring about the decomposition or the oxidation of the 
salts of phosphorus, and thus modify or altogether destory their 
effect.” (See remarks concerning the use of arsenic, iron, alcoholic 
drinks, cod liver oil, etc., page —.) 
“Dr. Williams gives a formula in which he prescribes a Hypo- 
phosohite along with phosphoric acid. This simply serves to form a 
phosphate and to set free the hypophosphorous acid, the dangers of 
which in its uncornbined state I have pointed out.” 
“What Not to Prescribe.—The following, which is a literal 
copy of a prescription by one of the leading London physicians, is a 
type of what the practitioner should most carefully avoid: 
9 
Calais Hypophos. - - 3 iss. 
Liq. Ferri Pernit. - - - 3 iij. 
Liq. Strychniae, - - 3 j. 
Quiniae Sulphatis, - - - gr. xviij. 
Syrupi Aurantii Floris, - | iss. 
Aquae Aurantii Floris, - - | vj, 
Aquae Distillatae, - - | xij.” 46 
“We thus see that there exist a number of serious causes of 
error which should be carefully avoided, as they may easily be, when 
they are once pointed out.” 
“Complications.—When death takes place in cases treated by 
the Hypophosphites, it is due either to the pre-existing lesions, or to 
the occurrence of some secondary or accidental complication. 
In no case after the employment of the Hypophosphites is death 
brought about by new tubercular deposit, unless the treatment is 
completely stopped while the patient is still exposed to the causes 
which produce tuberculosis.” Churchill. 
Iron.—“Iron and all its preparations should be most rigorously 
excluded, * * * except in some rare and exceptional cases.” 
Arsenic and Metallic Salts.—“Arsenic, which is frequently 
prescribed against phthisis, almost entirely destroys the beneficial 
action of the Hypophosphites. The same remark applies to all 
metallic salts in general. 
Alcoholic Drinks.—All alcoholic stimulants, strong wines, and 
beer, which are so often prescribed in cases of consumption, produce 
similar effects. They prevent the return of strength, and bring on a 
recurrence or an aggravation of cough, fever and sleeplessness. 
As their effect upon the system consists in a stimulation of the 
circulation and a diminution of oxidation, it is directly contrary to 
that of the Hypophosphites. 
Their use is to be more especially deprecated whenever there is 
any acceleration of the circulation, either owing to hectic fever, or to 
intercurrent inflammation, whether this latter be accidental or de- 
pendent upon softening of the tubercular matter. 
The patient must be restricted to the use, at most, of very weak 
claret and water; but it is even better to avoid fermented liquors 
altogether, and confine him to tea, coffee, milk, and slops of any 
kind. 
Cod Liver Oil produces a somewhat similar effect to that of 
alcoholic stimulants. It disturbs digestion, interferes with the ap- 
petite; by its local action on the1 lungs it hinders the elimination of 
tubercular matter, favors the fatty degenerescence of tissue, to which 
the patient is already prone; diminishes oxidation, thus increasing, 
without any beneficial effect, the plethora, which the Hypophos- 47 
phites themselves already tend to produce, and in this way frequently 
brings on formidable attacks of haemorrhage.” Churchill. 
“Having now been in the habit of using the Hypophosphites 
pretty frequently during the past five years (1863 to 1868), I am able 
to say that my faith in their remedial power becomes more and more 
confirmed, while I recognize the fact that they require to be given 
with discrimination and care; otherwise, not only no benefit, but 
actual mischief, will result from their administration.” Dr. Thorow- 
good, 1868. 
In pithisis, Dr. Churchill recommends the Hypophosphites of 
Soda, Lime, and Quinine only. “I have investigated experimentally 
the action of a great number of Hypophosphites. * * * I found 
that in the treatment of phthisis the Hypophosphites of Lime, Soda, 
and Quinine should alone be used.” 
Speaking of Hypophosphite of Potassium, Dr. Thorowgood says: 
“As a remedy I do not often employ it; it must be used with great 
caution, being a powerful resolvent of condensed and consolidated 
lung tissue; and if tubercles are present, it may cause these to soften 
with a rapidity that may be dangerous and alarming.” 
Upon the same subject, Dr. Churchill says that it “usually pro- 
duces an increase of expectoration, and symptoms indicating more 
active disintegration of the tubercular deposit. These phenomena 
are in accordance with the facts already known respecting the elimin- 
ative action of this base.” 
Since my discovery of their curative effects, I have had constant 
opportunity of observing their action in delicate children, born of 
consumptive parents, and 1 feel bound to state that I have never seen 
one single instance of such children becoming consumptive, when the 
remedy has been used in a proper manner. 
“Independently of this fact, I have demonstrated experimentally 
that the Hypophosphites exert a special action in promoting the 
growth of children and young animals, and thus show themselves to 
be the direct antithesis of that peculiar condition of weakness and 
low vitality, which is one of the characteristic morbid features of the 
present physical constitution of most classes of the population.” 
Dangers of Salts of Potash and Ammonia.—“ The salts 
of potash and ammonia are possessed of a special eliminative 48 
action. * * * This explains why some practitioners, * * * 
by the injudicious use of them in consumption, have seen 
the disease all the more rapidly run its course to a fatal termination.” 
Danger of Combinations.—“For the same reason most of the 
uselessly complex formulas, * * * containing a jumble of 
Hypophosphites of different basis, are evidently likely to do as much 
harm as good.” Churchill. 
Permanency of Cure.—“From what I have seen of patients 
whom I have treated three or four years ago, the permanency of the 
cures has, in numerous instances, been so remarkable, that I have 
doubted as to whether I correctly noted the symptoms manifested by 
the patients when actually under treatment, and have questioned 
them as to their own recollection of their past symptoms.” Thorow- 
good. 
Inheritance in Young Persons.—“It must always be re- 
collected, in the practical use of the Hypophosphites, that this 
sphere of action is to check the gradual invasion of the 
system by deposits of tubercle, and it is in the gradual 
development of phthisis in young growing people, coming of con- 
sumptive ancestors, where their remedial powers are most marked 
and most certain. This is a point on which my own experience en- 
ables me strongly to agree with Dr. Churchill. I may here remind 
my readers that these are the very cases in which something ap- 
proaching as nearly as possible to a specific remedy is so much 
wanted. It is, therefore, for the purpose of arresting the deposition 
of tubercle, and of eradicating the tubercular diathesis, that we are 
to have recourse to the Hypophosphites; hence, to insure anything 
like success we must be careful and exact in our diagnosis. Very 
often I have seen active consumption in its third stage arrested by 
Hypophosphite of Lime, cavities existing becoming quiescent for 
months, or even years, and the general health improving greatly.” 
Thorowgood. 
Shortness of Breath.—“A phenomena often noticed and often 
referred to in these cases (‘Consumption and Hypophosphites,’ page 
40, 2d Ed., London, 1868,) by the patients, in their great breathless- 
ness; they feel well, they say, ‘but for breath.’ This harassing dysp- 
noea I have now recognized as one of the phenomena of phthisical 49 
convalescence, when the destruction of lung tissue has been exten- 
sive.” Thorowgood. 
In Treating Phthisis;— 
Second.—Administer them as indicated. One salt at a time. Da 
not combine. 
“First. Use chemically pure salts only. 
Third.—Administer the Hypophosphite so as slowly to produce 
their physiogenic effects, and carefully watch that the action of the 
remedy does not enter the sphere of pathogenic phenomena. Should 
this occur, at once discontinue the remedy, and, after a few days, 
continue the medication in reduced doses. 
Fourth.—Keep the patient under the physiogenic action of the 
remedy as long as may be necessary to obtain the elimination of the 
morbid deposit in the lung. 
Fifth.—Combat by appropriate means the consecutive or acci- 
dental complications which exist or may show themselves during that 
time. 
Sixth.—Confine the doses between one and seven grains per day. 
“Originally, I was in the habit of prescribing for men from five to 
fifteen grains daily. Longer experience has led me to reduce the 
dose. Instead of beginning with five grains a day and gradually in- 
creasing up to fifteen, I now usually begin with one grain a day, and 
seldom go beyond six or seven.” Churchill. (See also remarks by 
Dr. L. De Bremon, page —, this pamphlet.) 
“When the local lesions have disappeared, or have cicatrized, the 
patient should continue to take one or two doses a week as a prophy- 
lactic. 
The main principle to be followed is to keep the remedy within 
the physiogenic sphere of its action; to leave it off for a time if there 
should be any pathogenic effects; but in no case, on that account, to 
abandon it altogether. 
CLASSIFICATION BY STAGES. 
First, or crude stage.—Characterized by a modification of the 
percussion or auscultatory sounds, without the production of any ab- 
normal signs. Second, or period of softening.—By the presence of abnormal 
crepitus in lieu of the physiological respiratory murmur. 
Third, or period of excavation.—By the existence of cavernous 
rales and sounds. 
GRADUATED SCALE OF LESIONS. 
Second.—Confirmed deposit confined to a portion of one lung, 
and in the first stage. 
First.—The diathesis with little or no deposit. 
Third.—Deposit in the second stage in one lung. 
Fourth.—Deposit in the first stage in both lungs. 
Fifth.—Deposit in the first stage in one lung, and in the second 
in the other. 
Sixth.—Deposit in the second stage in both lungs. 
Seventh.—The third stage; excavation, with only one lung af- 
fected. 
Eighth.—Both lungs affected; one in the third, the other only in 
the first stage. 
Ninth.-—One lung in the third stage, one in the second. 
Tenth.—The third stage in both lungs. 
Eleventh.—Complications, such as diarrhoea, laryngitis, etc. 
PHYSIOGENIC EFFECTS OF THE HYPOPHOSPHITES. 
Nervous Energy.—One of the first effects produced by the 
Hypophosphites is a general increase of nervous energy, with an un- 
usual feeling of ease and comfort. 
Appetite.—The second effect is an increase of appetite, which 
sometimes becomes enormous; as a natural consequence of this fact, 
digestion is much improved, and the bowels also become more regular 
in their action. 
Hsematosis,—These phenomena are soon followed by increased 
activity of haematosis; * * * both the quantity and color of the 
blood are so rapidly increased that the Hypophosphites are undoubt- 
edly the most powerful haematogens hitherto known. 
Venous Plethora.—After a time, which varies with the con- 
stitution of the patient, and the doses given, there are evident signs 
of venous plethora, as shown in the color of the face, the redness of 
the mucous membrane of the lips and eyes, and the fullness of the 
superficial veins. 51 
Sometimes this effect is so strongly marked that the persons who 
all their life-time have looked pale and delicate, put on the appear- 
ance of full and robust health. 
When this stage has been fully reached, if blood be withdrawn 
from the patient, or be lost by accidental hsemorrhage, it will be found 
much darker than the natural state; so much so that the patient’s 
attention is usually struck with this appearance. The same character 
is observed in the menstruation, which becomes easier, more abund- 
ant, and more regular. 
Growth.—If the subject be young, growth is notably excited, 
and children while taking the Hypophosphites, never show the signs 
of weakness and emaciation to which they are otherwise prone after 
too rapid development. 
Weight.—T he patient generally gains in weight. 
Teething of Children.—In the first teething of children, the 
Hypophosphite of Lime produces an heroic effect, and, if properly used, 
will act as a preservative against all the accidents of this difficult 
period of life. 
PATHOGENIC EFFECTS. 
Lassitude, Prostration.—When the Hypophosphites have 
been taken too long, or in too large doses, the first pathogenic effects 
generally show themselves in the nervous system. 
Patients, who up to that time had felt a gradual or permanent 
increase of strength, begin to complain of weakness, perhaps of a 
feeling of lassitude, of vague or wandering pains in the limbs, of 
somnolence. 
Sometimes lassitude may be carried as far as complete prostra- 
tion. 
Headache, Giddiness, Fever.—If allowed to proceed, it may 
be followed by headache or giddiness, disturbance of the eyesight, 
noises in the ears, and fever may finally supervene. 
Indigestion, Loss of Appetite.—Digestive function is 
equally disturbed; appetite, before increased, may fall away or be lost. 
Colic or Diarrhoea.—There may be colic or diarrhoea. 
Haematosis.—All these signs which point to some disturbance 
of the nervous system, seem to be directly connected with an exag- 52 
geration of the function of haematosis, and are accompanied or pre- 
ceded by disturbance of the circulation. The breathing may become 
short and uneasy, there are pains in the chest, an aggravation of the 
cough and expectoration, and at this period ausculation frequently 
shows increase of the local signs, consequent upon augmented hyper- 
semia of the lungs. If, in spite of these symptoms, the use of the 
remedy is persevered in, hemorrhage takes place from the respiratory 
or the digestive mucous membrane. 
Epistaxis and Haemoptysis.—This generally makes its ap- 
pearance in the shape of epistaxis, after which there may be an attack 
of haemoptysis. 
after being kept a certain length of time in this pathogenic condition, 
find that they are affected with hemorrhoids for the first time, or that 
those which they formerly had, and which had disappeared, are repro- 
duced. This may even go to the extent of real intestinal haemorrhage. 
Intestinal Congestion or Haemorrhage.—Some patients, 
Diet .—With regard to the patient’s diet it will not be found 
necessary, while he is taking the Hypophosphites, to prescribe or to 
forbid any special kind of food, provided the digestive powers be unim- 
paired; otherwise it may become necessary to order some special 
regimen. 
I find it far better to stimulate the patient’s appetite by the 
variety of his diet.” 
Purity of the Remedy.—The purity of these salts is an absolute 
necessity, as their medicinal activity is very much lessened, and in 
many cases entirely prevented, by the impurities always found in the 
commercial salts and the preparations made from them. 
Upon this point Churchill observes: “ When I stated years ago that 
the non-success of some practitioners in the treatment of phthisis with 
the Hypophosphites was owing to their impurity, I only expressed 
the conclusion to which I had been led by experimental investigation. 
I had found by repeated clinical experiments that, when a cer- 
tain proportion of alkaline carbonates was added to the pure Hypo- 
phosphites, the physiological and therapeutical effects were mani- 
fested but slowly and incompletely, or failed altogether.” 
Note.—This proves how fallacious is the claim of those who openly advertise as an advantage 
that their compounds have an alkaline reaction. R. W. G, 53 
“All physicians who have employed the Hypophosphites with 
success have pointed out the absolute necessity of employing them 
absolutely pure.” London Lancet. 
“I found the commercial Hypophosphite of Lime, as sold by the 
trade, to contain phosphite, phosphate, or carbonate.” Jansen, 
Repertoire de Clinic.. 
“The Hypophosphite of Soda and Lime must be perfectly pure; 
this is one reason of the advantageous results attained by me. In 
the treatment of phthisis, the Hypophosphites must be used alone 
and without any other drug, unless we wish to destroy their effect.” 
Dr. Maestre, Prof. Clin. Med., Univ. Granada, Spain. 
“At least one-half of the failures in the use of Hypophosphites 
are owing to no other cause than their administration in combination 
with Cod Liver Oil.” Churchill. 
“I must say that I have only been completely successful when I 
Avas certain that the remedy was perfectly pure.” Dr. Parrigot, 
Prof. Univ. Brussels. 
“The Hypophosphites used by me were perfectly pure; and this 
is absolutely essential to success in their administration.” Dr. J. C. 
Thorowgood, M. R. C. P., London, and Phys. to London Hosp. for 
Diseases of Chest. 
“ All observers are noAv agreed that the remedies discovered by 
Dr. Churchill, have a special physiogenic action upon the system. I 
must confirm Avhat has been stated by Dr. Churchill as to the abso- 
lute necessity of the Hypophosphites being perfectly pure. ”—“ Trat- 
tamento delle Malattie del Petto col mezzo degl’ Ipofosfiti, per il 
Dottor J. F. Churchill.” Dr. Fedeli, Rome, Italy. 
“I would Avish to warn practitioners against the use of any 
drug Avhatsoever along Avith the Hypophosphites, unless it be for the 
express purpose of fulfilling some temporary and Avell defined indica- 
tion. 
Many cases of gastric disturbance, noticed by other observers, 
have been undoubtedly due to the impurity of the salts used. 
The point of primary importance in the use of the Hypophos- 
phites is their chemical purity.” Churchill. 
“ Above all things, it is necessary that the medicine should be 
perfectly pure; so, I beg my brethren, before prescribing any salt 54 
of the Hypophosphite, no matter what, to assure themselves of its 
purity.” L. Deßremon, M. D., page 86. 
“ The Hypophosphites easily attract moisture from the atmos- 
phere, and then combine with its oxygen, and are first transformed 
into a phosphite, and afterwards into a phosphate. 
This is the reason why no reliance can be placed upon the hy- 
pophosphites as therapeutical agents, when kept for any length of 
time in the state of salts, and still less in solution.” Churchill. 
by Dr. Churchill. ‘ ‘Are always in the form of Syr tips, made from the 
recently prepared salt, chemically pure.” 
Preparations of Hypophosphites of Lime and Soda used 
Note—These are also separate Syrups, viz.: Syrup of Hypophosphite of Lime and Syrup of Hy- 
pophosphite of Soda. R. W. G. 
INDICATIONS OF THE DIFFERENT HYPOPHOPHITE 
SALTS. 
therapeutical action is very similar; but the soda salt is rather the less 
active; the Hypophospite of Lime appears also to have a more direct 
effect on the expectoration, which it sometimes diminishes somewhat 
too rapidly, thereby causing an increase of cough. In that case it 
should be replaced by the salt of soda. 
Hypophosphites of Soda and Lime contrasted.—“Their 
The lime salt should usually be preferred when there is diar- 
rhoea, as also for children and pregnant women. 
Hypophosphite of Quinia.—I have found the Hypophos- 
phite of Quinia useful in the incipient diarrhoea of phthisis, in that of 
young children, and occasionally to modify the nature of the expec- 
toration. 
The quinine salt * * contains the smallest proportion of 
the active phosphide element. 
It is useful when the other salts may be found too active. 
This is one of the reasons why it will frequently be found useful 
in cases of intercurrent inflammation, and other complications when 
the more powerful combinations (lime or soda) are found to be too' 
active and stimulating, and why it should often be preferred, at least 
in the beginning of the treatment, for certain cases, such as very ad- 
vanced phthisis, when the action is required to be small and slow. 55 
Hypophosphite of Iron.—In the first edition of my work on 
consumption, I stated that the action of the Hypophosphite of Iron 
should only be tried with great caution in cases of consumption, as 
in several for which I had prescribed ferruginous preparations simul- 
taneously with the Hypophosphite, their exhibition appeared to be 
followed by haemoptysis or haemorrhage in some shape or other. I 
also remarked that the association of iron with hypophosphorous 
acid appeared to me to be unlikely to prove of much utility as an anti- 
tuberculous medicine, because a sufficient quantity of iron to sat- 
urate the ordinary dose of acid would probably be dangerous, and 
could certainly not be given continuously without accident. Subse- 
quent experience has since fully confirmed these views. Not only 
was haemorrhage produced in almost every instance in which I used 
the Hypophosphite of Iron, but in patients who have been previously 
taking ferruginous medicines, it will be found that it is very difficult 
at first, to keep the effects of the Hypophosphites within the limits of 
their physiogenic action. 
But in cases of chlorosis and anaemia, as also of general debility, 
in female diseases, and in certain nervous disturbances it will be 
found far superior to ail other ferruginous compounds. 
Hypophosphite of Manganese.—Hypophosphite of Manga- 
nese acts in the same manner, but with much less energy. It has a 
special excitatory action upon the biliary secretion, and I have found it 
peculiarly useful, either alone or in conjunction with Hypophosphite 
of Quinine, in hepatic derangement, with deficient biliary secretion, 
subsequent upon prolonged residence in tropical climates, as also in 
cases of anaemia and general debility depending upon the same cause. 
dose of one grain of phosphorus in whatever menstruum (be it oil,, 
ether, fat, resin or anything else) is a dangerous quantity, and if it 
should be taken once or twice with impunity, would, if repeated, kill 
the patient in a very few days. 
Phosphorus and the Hypophosphites Compared.—A 
Ten grains of the Hypophosphites of Lime or Soda, which are 
equivalent to respectively three and four grains of phosphorus, ma’y 
be taken, not only without danger, but with evident advantage 
(when there is no organic lesion), for a considerable time, and doses of 
forty-five grains of pure Hypophosphite of Soda, prepared by my- 56 
self, equivalent to eighteen grains of phosphorus, have been given by 
me without any deleterious effects. 
The too prevalent idea that phthisis, if curable by the Hypophos- 
phites, is to be cured by any of these salts, given in any dose or at 
any time, shows the low state of medicine as compared with that of 
really exact sciences. 
Prognosis.—lf ten consumptives be selected in such a state 
that there can be no doubt of the certainty of the diagnosis, .and at 
such a stage of the disease that the pulmonary lesions shall be as little 
advanced as is compatible with such certainty, it is undeniable that no 
physician would pledge himself to cure a fixed proportion of them, or 
even any one single case selected beforehand, if he be debarred from 
the use of the Hypophosphites, or of some oxidizable compound of 
phosphorus. 
With every other resource at his command, the utmost he could 
do would be to promise that the life of some of them might be pro- 
longed; that one, or at most, two, might possibly escape, but without 
being able to tell who would be the fortunate exception, or who would 
prove victims to the disease. 
On the other hand, if any number of patients be taken in the 
conditions above indicated and subjected to the use of the Hypo- 
phosphites properly given, nine out of ten of them ought to recover, 
the tenth case being allowed for errors of observation. So that the 
prognosis of a given case of phthisis, either treated by the ordinary 
means exclusive of the Hypophosphites, or left to the course of 
nature, depends not on the state of the patient, but on the nature of 
the disease itself, and is nearly always fatal; while the prognosis of 
the same disease under treatment by the Hypophosphites is indepen- 
dent of the diathesis or constitutional cause, and rests altogether on 
the extent of the pre-existing lesions, that is, on the destruction of 
lung tissue already produced, or on the presence or absence of com- 
plications. 
Complications.—l now come to a very important point—that 
which relates to the influence which the existence or non-existence of 
complications exerts on the cure of phthisis by the Hypophosphites. 
The complications of consumption are of two kinds; some are 
secondary or tertiary consequences of the disease itself and are nearly sure to appear at certain stages of its development. Such are 
haemoptysis, diarrhoea, amenorrhoea, vomiting, fatty degeneration of 
the liver, disease of the kidneys, etc. 
57 
Others are distinct diseases, co-existing with the principal com- 
plaint. Such are accidental intercurrent inflammation of the different 
parts of the respiratory apparatus, bronchitis, pleurisy, pneumonia, 
laryngitis. The first kind of complications may be called consecu- 
tive; the second, accidental. 
(Edema.—Of the extremities, when not dependent on an accom- 
panying affection of the heart, is always a very serious symptom in 
relation to phthisis, since it indicates the existence of a considerable 
mechanical obstacle to the circulation, due either to the extent of 
the lesion in the lungs, to fatty degeneration of the liver, to disease 
of the kidneys, or to embolic disease of the veins, and is usually 
indicative of a speedy, fatal termination. In four cases, however, 1 
have seen the patients recover after well marked oedema. 
Aphthae, or Diphtheria.—Which are pathognomonic of a gen- 
eral failure of the nutritive function, are a still more fatal symptom 
than oedema. 
Haemoptysis.—In the prognosis of haemoptysis a distinction 
should be drawn between the result of a given attack and that which 
depends on the haemorrhagic tendency of a patient. The first varies 
with a number of circumstances which it would be too long to inves- 
tigate here. The second case, namely: The existence of the 
haemorrhagic predisposition, will render the prognosis less favorable 
than it might otherwise be, for two reasons: First, because the 
patient may be suddenly cut off by haemorrhage, and next, because 
there will be need of greater caution in the use or the Hypophos- 
phites. 
Pyrogallic Acid in Haemoptysis.—Since this was first written, 
in the year 1863, I have found a perfect specific for the arrest of 
haemoptysis. This is pyrogallic acid, chemically pure, given either in 
ofte grain pills repeated every hour, or above all, administered as a 
spray in a solution of two grains to the ounce and repeated as occa- 
sion requires from time to time. Since 1863, that is for upwards of 
ten years, I have only lost two patients by haemoptysis, while before 
that period I had the misfortune to lose several every year. 58 
Vomiting’.—Vomiting’ may depend upon two causes. At the 
beginning of the disease it is usually produced by the intensity of 
the cough and does not modify the prognosis, since, when this is 
favorable in other respects, the vomiting almost always disappears on 
the patient’s improving, and no necessity exists for any special 
treatment. 
When, however, the vomiting depends on the state of the 
digestive organs, the prognosis is less favorable, as it must be based 
not upon the simple existence of the symptom, but upon the whole 
morbid series, of which it is only one sign. 
These vomitings usually produce great weakness, because they 
directly interfere with nutrition, and have been heretofore looked 
upon by pathologists of the anatomical school as dependent upon 
softening of the mucous membrane of the stomach. This is an 
error which I pointed out many years ago. The softening found on 
post-mortem examination in cases of this kind is an effect of cadav- 
erous decomposition. 
The vomiting is always proportionate to the violence and fre- 
quency of the cough, and disappears as soon as the latter is reduced 
to its minimum by the action of the Hypophosphites. 
In some few cases, however, vomiting, or rather nausea, seems to 
be connected with renal or uterine complication. 
Fever and Night Sweats.—Hectic fever and nocturnal ephi- 
drosis are generally a consequence of the purulent resorption which 
takes place in the lung tissue. If the disease is recent, both 
symptoms usually disappear by the aid of the Hypophosphites alone, 
because they depend either upon the resorption of tubercular matter, 
or upon the general debility of the patient. When the disease is more 
advanced, when the tissues of the lung are deeply disorganized, and 
purulent secretion is fully established, perhaps by the formation of a 
pyogenic membrane, this result cannot be obtained, or can only be 
obtained very slowly by the Hypophosphites. * 
Diarrhoea.—Diarrhoea at the beginning or in the course of the 
disease, and not depending on ulceration of the intestines, nearly 
always yields to the action of the specific (Hypophosphite) alone, as 
is mostly the case in children, or to appropriate adjuvant remedies; 
it, therefore, calls for no modification of the prognosis. Yet, as this 59 
is a point which is often very difficult to decide, the prognosis in such 
instances depends chiefly on the intensity, and the persistence of the 
complication, whatever be its cause, since this always produces a dis- 
turbance of nutrition. 
When diarrhoea is present, the prognosis ought, therefore, to be 
given with great reserve, until we are sure of being able to combat it 
successfully. 
Colliquative Diarrhoea is only one of the numerous symp- 
toms of organic lesions involving nearly every part of the body, and is 
necessarily fatal. I have, however, more than once been called in 
consultation to a case of phthisis with colliquative diarrhoea, and all 
the concomitant symptoms of an expiring patient, and have been 
told by the attending physician that he thought it an excellent oppor- 
tunity for trying the effect of the Ilypophosphites. 
certain extent, is also an unfavorable symptom, though I think it has 
not the importance which some pathologists have assigned to it. 
Fatty Degenerescence of the Liver, when it has reached a 
Laryngitis.—The prognosis of phthisis complicated with laryn- 
gitis under ordinary treatment, is, as is well known, almost always 
fatal. Of all the complications of phthisis, this is perhaps the most 
formidable, and tubercular laryngitis has hitherto been looked upon 
as absolutely incurable. It was observed in ten patients out of 
seventy-nine. (Cases subsequently cited, page 60.) 
There were four confirmatory (continued improvement during 
whole time of treatment) results, of which two were cures, and six 
negative results, including three deaths. In my private practice, the 
results with the Hypophosphites have been more favorable than this. 
Amenorrhcea, which shows itself at the beginning of phthisis, 
not yet under the specific (Hypophosphite) treatment, is usually not 
of much importance, as it may then depend on the general condi- 
tion, and on imperfect hasmatosis. 
When it appears in the course of the specific (Hypophosphite) 
treatment, it may be produced by different causes, such as the break- 
ing down of the pre-existing tubercular deposit, or intercurrent 
inflammation. 
In such cases, it is always a bad sign, though not necessarily 
fatal. THERAPEUTICAL EFFECTS OF THE HYPOPHOSPHITE 
TREATMENT, NOTED BY DR. CHURCHILL, IN SEV- 
ENTY-NINE PATIENTS IN THE SECOND STAGE OF 
PHTHISIS, TREATED AT HIS PUBLIC DISPENSARY, 
RUE LARREY, IN PARIS, DURING THE YEAR FROM 
DEC. 2, 1857, TO DEC. 2, 1858. 
Fever.—Forty-four patients suffered from fever. In 24, the 
fever diminished; in 37, it disappeared, but only permanently in 16. 
Total number of cases influenced, 41 out of 44. 
Night Sweats.—Night sweats were noted in 56 cases. They 
diminished in 9 and ceased in 44; but for 11 of these only for a 
time. For three patients the record is incomplete. Total number 
of cases influenced, 53 out of 56. 
Loss of Appetite.—Fifty-two patients had lost their appetite. 
Improvement in 11 cases; complete return of appetite in 39 cases, 
which for seven of these was only temporary; record incomplete for 
two cases. Total number of cases influenced, 50 out of 52. 
Vomiting.—Twenty-one patients complained of vomiting. 
Four improved; in 13 it disappeared, but afterwards returned for five 
out of that number, in one case the result was not noted. Total 
number of cases influenced, 17 out of 21. 
Sleeplessness.—Thirty-six patients complained of want of 
sleep. In 15 cases there was an improvement; 17 cases recovered 
sound sleep, but 3 of these only fora time; for 4 cases the record is 
incomplete. Total number of cases influenced, 32 out of 36. 
Dyspnoea.—Seventy patients complained of shortness of breath. 
In 25, the breathing improved; 38 recovered their natural wind, in 1 
case this was only temporary; in 5 more cases the change was not 
noted. Total number of cases influenced, 63 out of 70. 
Cough.—All the 79 patients had cough, there was an improve- 
ment in 43 cases; in 31 it ceased altogether, but in one of these 
afterwards returned; in one case the result is not stated. Total 
number of cases influenced, 74 out of 79. 
Expectoration.—Expectoration was noted in 76 patients. 
There was an improvement in 39; it ceased altogether in 27, but in 5 of these afterwards returned; in i case no record of change was 
made. Total number of cases influenced, 66 out of 76. 
Diarrhoea.—Ten patients were suffering from diarrhoea. It 
ceased in 8 cases. Total number of cases influenced, 8 out of 10. 
Meustruation.—Dysmenorrhoea was noted in 6 cases. Two 
patients improved; in the four other cases the function was restored 
to its normal state, but for two of these only for a time. Total num- 
ber of cases influenced, 6 out of 6. 
Amenorrhoea.—Existed in eight cases, and in six the function 
was restored. Total number of cases influenced, 6 out of 8. 
Strength.—As far as muscular power is concerned, 48 patients 
had been obliged to leave off work altogether; 27 were able to return 
to their occupations, but 4 only for a time. Total number of cases 
influenced, 27 out of 48. 
The above is a summary of the symptomatic modifications pro- 
duced by the use of the Hypophosphites. 
Modifications of Symptoms Under Treatment.—In nearly 
every case, one or several of the morbid phenomena were diminished 
or modified, at least for a time, so that there was at least an improve- 
ment, even if only temporary, in almost every case. 
The changes produced by the treatment in the percussion and 
auscultatory sounds may be of three different kinds; there may be a 
complete disappearance of the morbid sounds; there may be simply 
a decrease, or there may be a passage from one kind of morbid sound 
to another after an aggravation of greater or less duration. 
In many cases the local signs which are pathognomonic of tuber- 
culosis in the second degree, may disappear completely without 
leaving any trace behind, which authorizes the conclusion that this 
has been effected by resolution and absorption of the tubercular 
matter. Until my discovery of the Hypophosphites, this mode of 
cure had been observed so rarely in consumptives arrived at the 
period of softening, that most pathologists either denied or doubted 
its possibility. But there can be no doubt of the fact for those who 
have seen the curative action of the Hypophosphites. Out of the 
79 cases to which reference has already been made, this occurred for 
16 cases. But I have since then observed this result in thousands of 
instances. It will be found to have occurred in 7of the 20 cases in 62 
the third stage observed by myself, and which are given in Appendix 
111., Cases 1-24 (Churchill's Work, 1875). 
In these cases one lung was in the third stage, and the other in 
the second stage; the latter organ was entirely restored to health. A 
similar result will be found in several of those which have been pub- 
lished by other observers, and which are given in the same appendix. 
Sometimes, although recovery takes place, a portion of the lung, 
which had been the seat of the disease, remains indurated or con- 
solidated. 
There is probably either encystment, cretification, or incomplete 
elimination of the tubercular matter, or the lung tissues have perma- 
nently consolidated and indurated. 
In another class of cases recovery only takes place alter com- 
plete softening of the morbid deposit, with ulceration of the lung 
tissue involved, and the formation of an excavation. This occurred 
for 4 cases in the series of 79. 
This result was noted in 6 cases of the 79 already referred to. 
But in Appendix 111. (Churchill's Work), will be found another 
series of twenty cases of the same kind, collected from my private 
practice, in the course of little more than two years of my first use 
of the Hypophosphites in Paris. 
Although this mode of cure in consumption had been occasionally 
noted previously to the use of the Hypophosphites, it was of such 
rare occurrence that very few practitioners had been able to observe 
more than one or two cases in a long series of years. 
With the use of the Hypophosphites this mode of termination is 
one of frequent occurrence. I am probably under the mark in say- 
ing that I have now observed several hundred cases of this kind. But 
in instances terminating in this way, as also in the preceding one by 
induration, the final condition of the patient may vary in different 
cases. In some there will be no general symptoms at all left, not 
even shortness of breath; the patient will be able to undergo as 
much, or nearly as much, exertion and fatigue as before. There 
may be no cough, no expectoration, and the patient may enjoy robust 
health, while even here, the pectoriloquy and cavernous breathing 
will give undeniable proof of the existence of a cicatrized excava- 
tion. 63 
Condition of Cure.—In other instances the lung tissue, which 
has not been destroyed, may not have been so completely restored to 
its normal condition, or the cavity may be more extensive than in the 
former case; and then, although the arrest of the original disease 
may be as complete as in the former instance, though the tubercular 
diathesis—the fans et origo mali—may have entirely disappeared— 
though there may be no tendency to its recurrence, and consequently 
to a relapse, the patient’s health may not be so completely restored 
as in the first instance, and may present every intermediate shade of 
difference between perfect ease and comfort, except during violent 
exertion, and a very unstable degree of well doing, where the amount 
of vital and organic activity remains very low, and where the patient 
is a sufferer from every external variation, and where the lungs are 
in a constant state of accidental congestion or inflammation. This 
state of things will be more or less strongly marked, according to the 
amount of lung tissue, which has been destroyed, or more or less 
damaged by the disease. 
It will generally be found gradually to improve with proper care, 
and, above all, the avoidance of cold and exposure, particularly if 
the patient winters in a warm climate. This progressive condition 
usually lasts for two or three years, at the end of which period only, 
the patient may be said to have reached the full improvement of 
which his condition is susceptible. 
Conditions of These Results.—The question now occurs, 
when are these several results obtained by the use of the Hypophos- 
phites? Is it merely by chance—that is, owing to some undetermined 
cause—as in the cases of cure obtained by other means? No. It is 
in every case, where the remedy is properly used, and where the patients 
at the beginning of the treatment are in such a pathological con- 
dition that a cure is still possible. 
What these conditions are has been already explained, and there 
is no undue assumption in saying that the prognosis of no disease has 
hitherto been established upon a more accurate basis. 
I have shown that the primary condition for a cure depends upon 
the extent of the tubercular deposit. The second condition is the degree 
of evolution which that deposit has already reached. When that has not 
passed the second degree, and the disease is limited to one lung, a favor- 64 
able prognosis may be laid down with almost mathematical cer- 
tainty. 
A third condition is the acute or chronic type of the complaint. 
As regards the type of the disease, i. e., its more or less rapid 
progress, the prognosis depends on the fact that the Hypophosphites 
have a specific antagonistic effect on the development of the disease. 
The more rapid the progress, the more serious, other things being 
equal, will be the prognosis, since the greater in a given time will be 
the extent of the lesion. 
An amount of disorganization, which in ordinary cases would 
have required several months, sometimes in an acute case takes place 
in an equal number of days. Still, the principle already laid down, 
viz., that it is the extent of the lesion, which determines the prog- 
nosis, applies as correctly to acute phthisis as it does to chronic. 
The acuteness of the disease, that is, the intensity of the general 
symptoms, has no influence on the efficacy of the treatment, and this 
is a result of which no other treatment offers a single example; for I am 
not aware that there is a single case of recovery from acute phthisis 
on record. I had, up to the year 1862, obtained this result in six 
instances, by the use of Hypophosphites, and since then have observed 
a number of others.” 
Note.—Dr. Churchill here draws a distinction between acute softening and acute tuberculization. 
Hitherto, this distinction would have been of no importance, but becomes of the greatest value if the 
Hypophosphites arc the remedy for the latter, but not the former. R. W. G. 
A fourth and last series of conditions depends upon the existence 
or non-existence of complications. In a word, the prognosis of a 
case of phthisis, when subjected to the rational use of the specific treat- 
ment (chemically pure Hypophosphites, exhibited as separate salts, in 
accord with his suggestions), depends almost entirely on the patho- 
logical state existing at that moment, and a cure may be expected in 
all cases where the organic disease is not already sufficient to produce 
death, either directly by itself, or by the consecutive disturbance 
caused by its natural evolution. These are the limits of all real 
science, because all real science can only be conditional. To ask for 
more would be absurd, to pretend to do more would be an imposture. 
Necessity of Accurate Auscultation.—The importance of 
accurately determining the site, the extent and the degree of the 65 
local lesion, in order to find a sure basis for prognosis, requires that 
a new view should be taken of the local diagnosis. 
The full value of accurate auscultation now becomes apparent, 
and practitioners for the future, instead of simply auscultating a 
patient for the mere purpose of deciding whether he is or is not con- 
sumptive, must examine him with the same attention and minuteness 
as in a case of pneumonia, or pleurisy, or heart disease. Without 
the resource of the Hypophosphites, it is a matter of small moment 
to the patient and his friends to determine whether one or both lungs 
be involved, whether the deposit occupies a large or a small portion 
of these organs. The final result will in all cases be pretty much the 
same, and is merely a matter of time. 
It often happens that in examining a case of phthisis the auscul- 
tator will diagnosticate the tubercular deposit as extending no further 
than where the lung gives signs of softening, while in reality, a much 
more considerable portion may be invaded by tubercles in the crude 
state to such a degree that the respiratory process going on is barely 
sufficient to maintain life, as shown by the amount of dyspnoea. This 
latest deposit of tubercular matter may sometimes be so far advanced 
that it must necessarily go on to softening, or this process may be 
set up by the slightest amount of intercurrent inflammation. Not 
only therefore must the examination of the chest be made with all 
the care and accuracy the practitioner is capable of, but his diagnosis 
of the extent of involved lung must be based not upon the physical 
signs alone, but also upon all the rational symptoms which can throw 
any light upon the subject. As in the diagnosis of the nature of the 
disease itself, so also in that of the amount of physical lesion, the 
only sure basis is the concordance of both the physical and the 
rational phenomena. It may sometimes happen that even an experi- 
enced and skillful physician, by taking account exclusively of the 
auscultatory signs, will think the local mischief is but slight, when it 
may already be very serious indeed—perhaps even hopeless. This 
will generally be indicated by the want of that proportion and con- 
cordance between the local signs and the intensity of the general 
symptoms, and, above all, the amount of difficulty of breathing which 
I have just mentioned. This is particularly applicable to cases of 
rapid tuberculization. 66 
I have seen several cases of consumption where the most eminent 
auscultators have neglected accurately to state the extent of the local 
lesions in their diagnosis, even when given in writing. 
Two such cases will be found fully reported at pages 620 and 621 
of my French work (De la cause immediate de la Phthisic, etc., 
Paris, 1864). 
The subject of the first of these cases was a Russian Prince, 
who is now living, and has been in the enjoyment of perfect health 
for upwards of fifteen years, thanks to the use of the Hypophos- 
phites, and who, the day before he was placed under my care, had 
been examined by three of the most eminent physicians and auscul- 
tators, I may say not only in Paris, but in the whole world. There 
is not an auscultator of any fame in this country, who, like myself, 
has not sat at their feet, or at those of their disciples. One gave as 
his diagnosis—“softened tubercules at left apex;” another, “softened 
tubercles at right apex;” while the third stated, “softened tuber- 
cles at both apices.” On examination, I found these three state- 
ments were all correct, and that, moreover, there were a certain 
number of tubercles disseminated throughout both lungs. Now, 
what was the cause of these discrepancies? Simply that these gentle- 
men thought it sufficient to establish the nature of the complaint, 
that neither of them supposed there could, at this stage, be any doubt 
as to the ultimate prognosis, and the two first deemed it useless to 
alarm the family any more than was absolutely necessary. The dis- 
covery of the specific of phthisis now enables the practitioner to 
make the fullest use of Laennec’s wonderful invention and to lay 
down the prognosis of tubercular disease with an accuracy inferior to 
that of no other branch of medicine, or even of surgery itself. 
Apparent Aggravation.—The reader must not suppose that 
the results above described are attained smoothly and uniformly in all 
cases; sometimes, as already mentioned, it is only after a temporary 
aggravation of the auscultatory signs that the lung is freed from the 
tubercular deposit. In these cases these signs will be often found to 
undergo a gradual and progressive transformation from above down- 
wards, as if the lung were composed of different layers of diseased 
tissue exactly in the same order as we know the tubercular matter 
itself is deposited. For instance, moist or dry crepitus apex; lower down there may be dullness on percussion, and as yet nothing more 
than peurile, or bronchial, or diminished respiration. The crepitus 
may disappear at the apex, be succeeded by natural breathing, and 
then be found lower down, where previously there were no signs of 
softening. 
These in their turn may also disappear and again be reproduced 
for a while in a lower portion of the lung, so that for a time there 
may appear to be a local aggravation of the disease, although the 
patient is really on the high road to recovery. 
The circumstances which appear most to favor a cure by reso- 
lution are the recentness of the deposit, the incipiency of softening, 
the freedom during the treatment from accidental intercurrent bron- 
chitis, lastly, the youth of the patient. This last condition agrees 
with the well known fact that cavities are of a rare occurrence in 
young children. 
When these conditions do not exist the softening of the deposit 
must go on, and a cure can only take place after the formation of a 
cavity. 
Relapse.—What is the final value of the result obtained in a 
case of phthisis, when the lung has been completely healed, or when 
it has become cicatrized by the use of Hypophosphites? Is the patient 
safe, or is he at any time subject to a relapse? Several hundreds of 
patients who have been cured by me in the first or second stage by 
the process of absorption or elimination of the tubercular matter, 
and whom I have had an opportunity of examining since their 
recovery, have remained in perfect health by means of the occasional 
use of the Hypophosphites in prophylactic doses. 
Of the patients who had only recovered with the persistence of 
a greater or less amount of disorganization in the lung tissue, all 
those who have come under my notice for the last seventeen years, 
and who have been able to take proper care of themselves, and to 
avoid exposure to cold and over fatigue, have continued for years to 
enjoy nearly the same amount of health, if not more, as immediately 
after their recovery. 
Where health has not been maintained and there has been any 
return of lung disease, the relapse has always been owing to local, 
Some have since died of other and altogether different diseases. 68 
non-specific, non-tubercular inflammation (on this point I am par- 
ticular), of a catarrhal or bronchial nature, induced by the weather 
or other external causes. The practitioner who has had but little or 
no experience in the use of the Hypophosphites, and still less faith 
in their efficacy, is often ready to mistake these accidental inflamma- 
tory complications for a recurrence of the disease and a recrudescence 
of the tubercular deposit. 
The signs of accidental or incidental softening of tubercular 
matter, which was previously in a crude state, or else increased peri- 
tubercular hypersemia, which is one of the conditions of resolution 
and resorption, are also sometimes mistaken for those of fresh tuber- 
cular deposit. 
Occasionally accidental inflammation of incipient cicatrices, or of 
tissue that was only consolidated, or transient inflammation of new 
tissue, may equally be mistaken for a new tubercular deposit. 
More extended experience, a due regard to the rational symp- 
toms, and, above all, attentive stethoscopic examination, will, how- 
ever, usually lead to a more correct opinion. 
When the recovery is still recent, the stethoscopic signs, which 
may be those of congestion, bronchitis, or even of pleurisy, or pneu- 
monia of different extent and intensity, usually occupy the seat of 
the primitive local lesion, and may thus mislead the inaccurate and 
inexperienced, above all, the prejudiced, practitioner. 
I have seen several cases where accidental inflammation in an 
excavated lung, which had been cicatrized by the use of the Hypo- 
phosphites, has been mistaken for the very last stage of phthisis by 
the most distinguished physicians. 
One of the most delicate points for the physician’s decision is 
the true moment when it becomes advisable to resume the specific 
treatment after the occurrence of accidental inflammation. 
I therefore confidently repeat the assertion I made many years 
ago, that as long as the patient is kept in a proper physiological con- 
dition by the prophylactic use of the Hypophosphites, according to 
the rules which will be given further on, I have never witnessed a 
recurrence of a fresh attack of tuberculosis. Now all practitioners 
who have seen a large number of consumptive cases, know how fre- 
quently this happens, particularly in children, when the treatment is 69 
confined to the ordinary means, such as cod liver oil, tonics, etc. 
Even in the instances where, owing to the general condition of the 
patient, without any local signs in the lungs, there has only been a 
suspicion of phthisis, how often does it happen that after an apparent 
return to health, of greater or less duration, the disease shows itself 
a second time, too frequently in an unmistakable manner. The means 
which appear to have answered in the first instance are now seen to 
fail, and the disease runs its course to the fatal end. 
These are the instances where the Hypophosphites again and 
again show their wonderful efficacy. I could relate any number of 
cases, observed at my dispensary at Paris, among poor and ill-fed 
children, where, whenever the Hypophosphites have been omitted 
beyond a certain length of time, the disease has reappeared, and has 
each time been arrested with the same success as at first. Such 
cases are true experimenta crucis, and demonstrate beyond doubt the 
specific action of the remedy. 
CONCLUSIONS. 
I.—“One of the characteristic phenomena produced by Hypo- 
phosphites in the system is the production of venous plethora. 
ll.—This plethora is the condition of their therapeutic action 
against phthisis. 
Hl.—This therapeutic action must be limited to the physiogenic 
effects, which afford the measure by which we should be guided in 
the use of them. 
IV.—Beyond this limit their medicinal effects are either transient 
or incomplete, and are not followed by a curative result, even with 
the co-existence of all other necessary conditions. 
V.—The use of the Hypophosphites in too large doses, or for too 
prolonged a period, produces symptoms which I have called patho- 
genic, and is then apt to lead to accidental complications of variable 
degrees of intensity, which may bring on a fatal termination, owing 
to this mistake in treatment, even though the patient otherwise offers 
all the conditions necessary for a cure. 
Vl.—As happens for other cachexise, the local lesion, which is 
the result and the anatomical sign of the tubercular diathesis, when once it has overpassed a certain limit, pursues the usual course of its 
evolution by virtue of conditions which are to a great extent inde- 
pendent of the initial morbid constitutional state. 
Vll.—The cure of the diathesis is not, therefore, necessarily and 
immediately followed by that of the lesion, although that of the 
lesion cannot be permanent unless it be attended or preceded by that 
of the diathetic condition. 
VIII.—The recovery of a patient subjected to the Hypophos- 
phite treatment will therefore depend upon the extent of the pre- 
existing local lesion; that is, of the gravity of the disorganization, 
which has taken place previous to treatment. 
IX.—When the tubercular deposit has not gone beyond a certain 
stage of its natural evolution, it may be reabsorbed and entirely dis- 
appear. This re-absorption may take place not only when the tuber- 
cular matter is still in a crude state, but even when it has already 
reached the stage of softening. 
X.—This second stage, of softening, is sometimes one of the 
phenomena intermediate between the therapeutic action of the 
Hypophosphites and their therapeutic effect. Sometimes it simply 
precedes the re-absorption of the morbid deposit, at other times it 
will go on to produce ulceration, destruction of the surrounding tis- 
sues, and finally consolidation or a cicatrized excavation. 
Xl.—The cure of phthisis by the Hypophosphites may therefore 
take place in two different ways, either by the disappearance of the 
local lesions, and by a cessation of the physical signs which indicate 
their presence, or by the persistence during a variable period of time 
of less extensive pulmonary disturbance, which, however, does not 
interfere, or only partially interferes, with the general health, and 
which does not predispose the patient to a recurrence of the original 
diathetic condition. 
XII.—If during the persistence of the local signs in the lungs, 
the patient be kept in hygienic conditions proportionately adapted to 
the gravity of the persisting organic lesions; if he be maintained 
under the influence of the specific treatment at proper prophylactic 
doses; * * * the stethoscopic and plessimetric sounds will be 
found gradually to improve until they lose their pathognomic charac- 
ter, or even entirely disappear. Xlll.—Time is an indispensable element in the cure of a case of 
phthisis, and no other means can be substituted in its place. 
XIV.—An overdose of the specific remedy, instead of hastening 
the patient’s recovery, will often produce a contrary effect. The 
greater the extent, and the more advanced the stage of the pulmon- 
ary disease, the more important it is to keep this fact in view, because 
a contrary conduct will then, still more than at other times, produce 
accidental complications. 
XV.—As in almost all cases of phthisis the tubercular deposit 
takes place gradually and invades successive portions of the lungs, 
there is always a greater or less lapse of time during which the local 
lesion is of secondary importance; and until that point has been over- 
passed, every uncomplicated case of tubercular consumption may he cured 
with perfect certainty by the scientific use of the Hypophosphites. 
XVl.—Every practitioner who is called upon to treat a case of 
phthisis is therefore bound, not only for the sake of humanity, but by 
the rules of medical science, to have recourse at once to the Hypo- 
phosphites, instead of only using them as a last shift after the loss of 
irreparable tissue, and it may be of irreparable time wasted in admin- 
istering drugs, which are notoriously of no effect. 
XVII.—If the Hypophosphites be the specific of phthisis, they 
must a fortiori be its prophylactic or preservative remedy. 
XVIII.—As when rationally administered they never produce 
any unfavorable effect, they should immediately be had recourse to 
in every doubtful case, or even when there is only a suspicion of 
consumption. 
XIX.—AII these conclusions are now confirmed by the indepen- 
dent testimony of physicians living in all parts of the world. 
XX.—ln no instance have they been controverted, when the 
observer has carried out his experiment with care, and according to 
the rules laid down. Physicians who had been unsuccessful in their 
first attempts, have in later efforts and after greater experience in 
the use of the remedy completely confirmed my views. 
XXl.—The effect of the Hypophosphites on the tubercular con- 
stitution, depends upon a general action of the system, which at a 
future day will come to be recognized as of still greater importance 
than their effects in disease. In our present imperfect social state, 72 
there is a constant tendency to increased disturbance of the condi- 
tions of normal nutrition, which is effectually combated by the use 
of the Hypophosphites as an occasional and temporary nutriment. 
This result can be obtained by no other means hitherto known, than 
the use of some one of the oxidizable phosphorus compounds, the best 
of which are the Hypophosphites. 
XXII.—By means of these therapeutical agents the fmictions oj 
innervation or nerve power, of sanguification or blood-forming process, 
and of interstitial nutrition, which are the three primordial f unctions in 
the animal system, may be kept or gradually raised to the very high- 
est degree of intensity, of which the organic conditions of the subject 
will admit.” 
EXTRACTS FROM CHURCHILL’S VIEWS AS TO THE 
THEORY OF TUBERCULOSIS. 
“So far, all the facts of pathological physiology known with 
regard to tuberculosis concur in showing that the special character 
of the diathesis is a decrease of molecular or intra-organic combustion, 
from which may be inferred all the abnormal phenomena depending 
on diminished oxidation as evinced in the functions of respiration, 
sanguification, urinary excretion and calorification. This is in com- 
plete accordance with the theory of phospholigy, viz., that in tuber- 
culosis, the bioplasmic or proteic principles are incompletely oxidized, 
because they are deficient in their normal amount of the phosphide 
(oxidizable phosphorus) element, and are thus less combustible than 
in the healthy state.” 
“Tubercular matter is * * * bioplasmic albuminoid sub- 
stance, imperfectly developed on account of it having undergone 
incomplete oxidation, not, as was supposed by Beddoes and McCor- 
mack, because there is a deficiency of oxygen, but because the 
materials themselves have lost their affinity for it, in consequence of 
a decrease in their phosphide (oxidizable phosphorus) element. 
Color of the Blood.—It has long been a matter of observation 
by physicians, that the venous blood of consumptives is redder than 
in the natural condition. 
Now we know that the black color of the venous blood depends 
upon the presence of carbonic acid, for, as Longet states, there can 73 
be no doubt that the difference in color in the two kinds of blood in 
the veins, and in the arteries, is owing to the different proportions of 
oxygen and carbonic acid contained in the blood. 
Experiments on the glands and muscles have shown that the 
blackness of venous blood is owing to its having been already em- 
ployed in molecular metamorphosis; that the blackness is in propor- 
tion to the intensity of this molecular action, and that it increases or 
decreases with this intensity (Claude Bernard). We have just seen 
that redness is characteristic of venous blood of consumptives, and 
the use of the Hypophosphites darkens the color of the venous blood, 
not only up to, but beyond, its natural tint. 
Urine.—The fact of diminished oxidation is also shown by the 
deposit in the urine of consumptive patients containing an excess of 
uric acid, with a corresponding decrease of urea (Becquerel; Ancell). 
These urinary sediments usually diminish or disappear under the 
use of Hypophosphites. That this is due to an increase of oxidation 
will be apparent if we consider that the formula of uric acid is 
C 5H4N203HO; while that of urea is C 2H4N2,02; so that, as Leh- 
mann has shown, urea may be looked upon as formed by the partial 
or incomplete oxidation of two atoms of uric acid with formation of 
oxalic acid and allantoine. 
This has been shown to be really the fact by Wohler and 
Frerichs, who have by direct experiments upon dogs and rabbits, 
found that uric acid was decomposed in the system in the same way 
as when oxidized directly by peroxide of lead, and that after its 
administration the urine of those animals shows an increase of urea 
and of oxalate of lime. 
Calorification.—The lowering of the heat of the body in tuber- 
cular patients has been noticed by a number of observers, and has 
been specially studied by Bouchardat. 
Sidney Ringer found that where there is an elevation of the tem- 
perature in phthisis it was only while the deposit was taking place, 
and has shown that it then constitutes a valuable diagnostic sign. 
Finlayson found that in tubercular children the temperature was 
higher in the evening, after the excitement and fatigue of the day; 
but in the morning rather below the average. 74 
This decrease of heat accounts for the great sensitiveness to 
cold and atmospheric variations. 
If we class the combustible elements of the system according to 
their heat equivalent, that is to say, according to the quantity of 
water which they can raise one degree in temperature by combining 
with the same quantity of oxygen we shall find that they rank in the 
following order (Gavarret): 
Phosphorus 36.072, hydrogen 33.808, iron 33.072, carbon 23,696, 
sulphur 17.660. 
Heat is both a result and a constant condition of all molecular 
actions which take place in living beings, and above all in animals. 
So that phosphorus, among all the oxidizable elements of the system, 
will raise highest the temperature of the combining bodies. 
From what precedes, we shall be justified in inferring that of all 
the proximate principles in the animal system, those which contain 
the phosphide element, that is to say, phosphorus in an oxidizable 
condition, must have the greatest affinity for oxygen, and the greatest 
calorific capacity, and that they must influence more powerfully than 
any other compounds the two primary physical and chemical condi- 
tions of animal life, particularly among the warm-blooded animals— 
intra-organic combustion and the production of heat. 
Scrofula.—What is the real connection between scrofula and 
pulmonary tuberculosis?—a question which has much worried pathol- 
ogists and physicians in all ages. 
The phospholigic theory again affords a satisfactory solution. 
Organic materials must pass through a succession of metamor- 
phoses, characterized by a gradual series of successive oxidations in 
the lungs, in the capillaries and in the lymphatics. 
If this be the case, these successive oxidations must apply in 
turn to materials of decreasing combustibility. 
If the phospholigy be very intense, the materials offered to 
hsematosis in the lungs will be so refractory to oxidation that some 
of them will not be able to undergo even the initiatory stage of the 
process, and these will be at once deposited in the lungs in the form 
of tubercular matter. 
If the phospholigy be less strongly marked, there will be suffi- 
cient oxidizable principles to provide for pulmonary combustion, and 75 
a first degree of oxidation. But their affinity for oxygen will then 
be exhausted, and as they will be unable to undergo the subsequent 
oxidations required in the capillaries and in the lymphatic system, 
these are the points where oxidation will remain incomplete, and 
where the seconary deposit of tubercular matter will take place. 
Scrofula is thus an incomplete and less intense form of tuber- 
culosis than pulmonary phthisis affecting different histological ele- 
ments.” 
Note.—The following is a summary of Dr. Churchill’s argument, itself too lengthy to reproduce 
here, regarding the theory of tuberculosis. R. W. G. 
SUMMARY OF ARGUMENT. 
“I.—The animal system contains, as an essential constituent of 
the brain and nervous substance, of the blood discs, of the muscles, 
of the albuminoid compounds, of the spermatozoa, of the egg, in a 
word, of the most important parts of the organism, a phosph-ide ele- 
ment which has not yet been completely analyzed or isolated as a 
chemical compound, which has been called by many different names, 
but which, since my researches upon the subject, is now clearly recog- 
nized as distinct from the phosph-atic element. 
ll.—The essential characteristic of this phosphide element is, 
that the phosphorus is contained in it in a state of molecular com- 
bination with the other chemical principles, and is not yet completely 
oxidized, while in the phosphatic element (such as the phosphate of 
lime in the bones) it is completely oxidized. 
111.—This phosphide element is of all the materials of the sys- 
tem the one which has the greatest affinity for oxygen, and seems to 
be, in animals, one, if not the first, of the primordial initiators of 
vital activity. Its office is not only to become oxidized itself, but to 
promote the intra-organic combustion, and hence very likely to 
initiate the molecular metamorphosis of most of the other proximate 
animal principles. 
IV.-—The decrease in the system of this phosphide element, 
either from excessive waste, or from a deficiency in its reintegration 
constitutes a distinct and special morbid condition of the whole sys- 
tem which I call phospholigy. 76 
V.—This pathological condition leads to a decrease of oxida- 
tion; consequently of all organic metamorphosis, and of all vital 
action, and is characterized by the whole series of symptoms which 
precede or accompany a numerous class of diseases, and which have 
vaguely been called ‘deficient or lowered vitality.’ 
Vl.—When this decrease of the phosphide element attains a cer- 
tain degree of intensity, the oxidizability of certain compounds in 
the system is so much diminished, that they become incapable of 
sufficient combustion, either to proceed to a higher state of vitality, 
or to go through that process of disintegration which would lead to 
their excretion from the system. 
Vll.—Under such circumstances these compounds constitute an 
abnormal material, consisting of incompletely developed bioplasm or 
proteic substance, variable in its composition, forming the different 
pathological deposits known under the name of tubercles, which are 
the anatomical characteristics of phthisis and scrofula. 
VIII.—The difference between phthisis and scrofula consists in a 
different degree of phospholigy. In scrofula, the phospholigy is less 
than in phthisis, so that the exhaustion of the phosphide element in 
the bioplasm only takes place during a secondary or subsequent phasis 
of its evolution. 
IX.—This theory of phospholigy enables us to account for nearly 
all the phenomena hitherto met with in tubercular disease. 
Such are the morbid physiological phenomena in the respiratory, 
circulatory, urinary and calorific functions: 
The elective preference shown by the tubercular deposit for 
different systems or organs. 
The affinity between tuberculosis, scrofula, spanhsemia and 
chlorosis. 
The antagonism .between tuberculosis and cancer, and between 
tuberculosis and cyanosis. 
The prevalence of tuberculosis in certain classes of animals, and 
its rarity in others. 
The mode of action of the different etiological causes, which 
promote or produce, and of the different cosmic or organic condi- 
tions, which aggravate or interfere with, and retard tuberculosis and 
tuberculization. 77 
X.—Not only does this theory of phospholigy thus account for a 
large mass of scientific facts, which have hitherto remained, many 
of them, comparatively unknown, and all of them unconnected and 
unexplained, but it points to a new and higher view of pathology, in 
which, most probably, the many ills which flesh is heir to, will be 
referable to a small and definite number of initiatory morbid states, 
themselves depending upon a modification either in the quantity or 
the quality of some few of the most essential or primordial proximate 
principles of the animal system.” 
DR. CHURCHILL ON HYPOPHOSPHITES IN OTHER 
DISEASES THAN PHTHISIS. 
£T have found the Hypophosphites particularly useful in the fol- 
lowing complaints, for most of which, my own experience has been 
confirmed by that of other observers. 
All adynamic conditions of the nervous system. Chronic myelitis. 
In these cases the Hypophosphites of Iron, Manganese, Lime, 
Potash, Quinia, and Baryta, will be found the most useful. 
In diseases of hsematosis, such as chlorosis and ancemia in all 
its forms. 
In these cases the preference should be given to the Hypophos- 
phite of Iron, Manganese, Quinia and Lime. 
The most inveterate cases of anaemia will be found to yield to 
this treatment, and the Hypophosphite of Iron has this particular ad- 
vantage over all other preparations of this metal, that in cases where 
tubercular anaemia exists and, as often occurs, has been mistaken for 
simple anaemia, it not only cures the blood disease, but wards off the 
effects of the constitutional predisposition, which as is well known, 
all other preparations of iron, have, on the contrary, a tendency to 
accelerate and aggravate. 
In all diseases depending on imperfect, incomplete, or retarded de- 
velopment', the Hypophosphites not only bear off the palm from all 
other remedies, but will be found to succeed when no other has been 
of any avail. 
Such for instance are difficult and retarded dentition in infants, 
rickets, ancemia, and weakness during pregnancy. 78 
The Hypophosphite of Lime for infants, to which may be added, 
more especially for adults, those of Iron and Quinine, will be found 
in these instances best to fulfill the therapeutic indications. 
In the difficult dentition of infants, I have seen cases where the 
little patient, reduced by suffering to the very last degree of emacia- 
tion, and either threatened or already attacked with convulsions, has 
been relieved in the course of a few days, sometimes with the very 
first dose, and very soon permanently cured by a few teaspoonfuls of 
Syrup of Hypophosphite of Lime. The whole apparatus of symptoms 
has literally been swept away at once. 
In chronic bronchitis and in the sequelce of inflammatory diseases of 
the respiratory organs, where there is debility depending upon anaemia 
and lowered nutrition, great benefit will frequently be derived from 
the use of the Hypophosphites, particularly the Hypophosphite of 
Potash. 
A mixture of the Syrups of Hypophosphites of Potash and Soda, 
will frequently be found more useful than either separately. In some 
cases of asthma, where nutrition has become greatly imparied, the same 
benefit will be derived from the use of these medicines. 
Dr. Gantillon, of Paris, in his work on “Uterine Catarrh,” [ 1868] 
states that in this complaint, he habitually prescribes the Hypophos- 
phite of Iron, and after continuing it for a fortnight, changes it for the 
Hypophosphite of Manganese. “This alternation of medicines,” says 
he, “is very beneficial, patients appear to be relieved by the change, 
and the use of the remedies may be continued for a longer time than 
with other preparations.” Churchill, 1888. 
From the British Medical Journal, October 17th, 1891, pp. 
836-37. Extract from an address on “The use of Drugs in the 
. Treatment of Early Phthisis,” by J. C. Thorowgood, M. D., 
F. R. C. P. Senior Physician to the City of London Hospital 
for Diseases of the Chest, Victoria Park. Read in the section 
of Medicine at the Annual Meeting of the British Medical As- 
sociation held in Bournemouth, July, 1891. 
“It is in cases of catarrh at the lung apex, due to cold caught, 
nr to respiration for some time of close vitiated air, that drug treat- 
ment appears to advantage. That peculiar catarrhal state of the apex, 
which has been described as pulmonary cachexia, and which is close 
on the borders of tubercle, and is due to a degenerated condition of the 79 
epithelium from constant respiration of bad air, improves rapidly 
when the patient is removed to pure air, such as that of Bournemouth. 
Where, however, we cannot give the patient the advantage of 
removal we have to do our best with drugs. Specially I would draw 
attention to the good results that may be obtained in such cases from 
the use of the Hypophosphites. The result of some twenty-five years 
experience in the use of the Hypophosphite Salts, has led me to the 
following conclusions based on records of cases: 
Hospital out-patients who came with cough and expectoration, 
perhaps blood-stained at times, and who presented rales at the lung 
apex, continuing there after some amount of bronchitis due to cold 
had been overcome by various remedies, improved in a way that sur- 
prised me on giving them five grains of Hypophosphite of Soda three 
times a day. The patients got better, and some would return in per- 
haps six months’ time with the same symptoms and signs again, and 
would again improve on the Hypophosphite treatment. In cases of 
persistent consolidation of lung after pneumonia, I have in very many 
cases seen absorption of effused products proceed speedily under 
treatment with Hypophosphite of Soda; this too, in cases where or- 
dinary treatment had been followed to no purpose for some time. 
Cases of this description that appeared doomed to a speedy death by 
phthisis, I have seen clear up and recover perfectly on five grains of 
Hypophosphite of Sodium given three times daily for five or six 
weeks. In cases of pleurisy with effusion, the Hypophosphite Salts 
seemed to me to have no effect whatever. 
In cases where the pleura appeared to have been roughened by 
deposit, so that friction sounds of loud and course character were 
very audible; I have seen all these sounds vanish and the patient do 
well under the Hypophosphite of Soda. 
Before the days of tubercle bacillus I had learnt that there were 
cases of phthisis attended with fever, and rapid in progress in which the 
Hypophosphite failed in a way that I could not understand. I believe 
from more recent observation, that these were cases where the tubercle 
bacillus was too strong to be overcome by a medicine whose action 
lay mainly in promoting the absorption of inflammatory products. 
Many years ago Dr. Graves, of Dublin, as well as Dr. Rush, of 
Philadelphia, and Dr. Munk, of London, laid stress on the use of mercury *s an absorbent in cases of phthisis. Mercury, says Graves,, 
is of use where the affection of the lung is local and the system not 
affected. 
In scrofulous pneumonia, rather than in tuberculous disease, the 
mercury is said to act with most advantage. How far this is true, I will 
not now stay to inquire; but the idea in giving mercury was to get rid 
of inflammatory deposit, and so prevent phthisis. We now say “get 
rid of inflammatory deposits, and so take away what may prove a nest 
for the growth of tubercle bacilli.” 
Whether it be phosphorus or a Hypophosphite that is given, I 
believe a process of fatty change and liquifaction of the effused pro- 
duct is set up and absorption follows. Sometimes the process seems, 
to me for a time attended with some amount of increase of tempera- 
ture, and when this is the case, it is well to reduce the dose of the 
drug, or give it at longer intervals. In recurring haemoptysis, too, 
the Hypophosphite must be used with care. The most active in liq- 
uifacient power is Hypophosphite of Potash; and I remember a prac- 
titioner telling me he had given, as he said, the Hypophosphite of 
Soda, and it caused such a rapid breaking down of the lung, that he 
determined to have nothing more to do with Hypophosphites in phth- 
isis. It turned out to be the Hypophosphite of Potash that he had 
been giving. The Lime Hypophosphite acts often remarkably well 
in cases where secretion is profuse. 
The daughter of a medical man was cured of bad diarrhoea by 
Plypophosphite of Lime. The lime salt checks profuse sweating and 
also diarrhoea. The dose should not exceed five grains. 
Very rarely indeed have I found when the Hypophosphite fails 
to remove an apex catarrh, or inflammatory deposit, that I have 
gained by changing to such medicines as tartarated antimony in very 
small dose, iodide of potassium, or some form of mercury. Once or 
twice a change of treatment has been eminently unsatisfactory; in one 
case clearly disastrous.” CLINICAL EXPERIENCES WITH THE 
HYPOPHOSPHITES. 
PHTHISIS PULMONALIS AND ITS TREATMENT WITH 
HYPOPHOSPHITES. 
By the late L. de BREMON, M. D., New York City. 
UNIVERSITY OP PARIS (FRANCE). 
Knight of the Legion of Honor; Member of the Order Imperial Ottoman Medjidie (sth Classl 
Member of the New York County Medical Society, the Neurological Society of New York, 
and the New York Medico-Legal Society; Late Clinical Assistant to 
Dr. J. F. Churchill, Paris; Etc., Etc. 
The Tubercular Diathesis Probably Depends on a Disturbance in the 
Haematosic Function.—Examination in Detail of the Organic and Inorganic 
Elements.—We believe that the tubercular diathesis can only depend on the dis- 
turbance of some one of the primordial functions of the economy. 
In view of the solidarity that exists between all the parts of the organism, this dis- 
turbance should have for its initial point one essential condition, a modification of the 
hsematosis. 
The labors of pathologists, and especially of Andral and Gavaret, since confirmed 
by other observers, show that in phthisis, while the composition of the blood varies, 
there is no particular or distinctive character in the change that occurs in its organic 
elements; we are then led to believe that it must be among the inorganic elements that 
we are to find the special condition of the diathesis. But which one? There is the 
difficulty. 
As the phenomena of this disease, considered in relation to those of some other 
dyscrasia, and especially to chlorosis, seem to show that they should be referred rather 
to the loss than the increase of some essential element, the question arises, which one 
is wanting? 
Science possesses numerous facts proving the effect of most of these influences on 
the economy. Thus iron, sulphur, the chlorides, the alkalies, are of daily use. All, or 
nearly all, of them have been tried in the treatment of tuberculosis, and no one of them 
has shown a sufficiently marked or lasting effect to be able to attribute to it any real 
influence in this disease. 
Now another element arrests our attention, viz., the phosphorus. 
We know, in fact, that this element is one of the constant principles of the 
economy. 
But our science is limited to that. Chemistry has not yet been able to demonstrate 
in what condition it exists in the blood; whether it is there as phosphoric acid or as 
phosphorus combined molecularly with organic matter, though Rees, in his work pub- 
lished in 1848, assigns it a part in the function of the globules. 
The phosphates, and especially the phosphate of lime, have long been employed in 
rachitis. 
Now to examine the facts. 
Should this medicine have the immediate action on the disease which would belong 
to the element which is its starting point? 82 
Now comes the element phosphorus, and if one reflects on the physiological effects 
of this substance as it is reported by Bayle in his Therapeutic Dictionary, it would seem 
that the stimulating properties which are attributed to it, that its action on the different 
morbid states of the system would make it a useful antagonist to phthisis. 
If we admit that the phosphorized principle of the blood or organism is found there 
in any other state than that of phosphoric acid, it follows that it must play the part of 
an eminently combustible body, and capable at the same time of entering into mole- 
cular combination with the other elements of the organism in such a way as to become 
an integral part of it. But neither phosphoric acid nor phosphorus fulfills this condi- 
tion. The first is already at its maximum of oxidation; the second, placed in contact 
with the liquids of the stomach or with the tissues, must, before being absorbed and 
rendered assimilable by the economy, be transformed either into phosphoric acid, or at 
least into hypophosphorous or phosphorous acid, the degree of oxidation immediately be- 
low that of phosphoric acid. In the first case the same effects are obtained as in em- 
ploying phosphoric acid itself; in the second, supposing that the phosphorus, before 
being absorbed, should be transformed only in to hypophosphorous acid, this latter must, 
in contact with the alkaline principles of the blood, be transformed or rather divided 
into two atoms of phosphoric acid and one atom of phosphorous acid: 
P3+Ol 3=2POg-f-P03 
This last would fulfill the two conditions enunciated above, but with the disad- 
vantage of only representing under the most favorable conditions but a third of the 
phosphorus taken into the stomach, the two-thirds transformed into phosphoric acid 
being lost for special action. 
Besides, from this point of view the action on the economy of the various prepara- 
tions of phosphorus depends on the quantity of substance which is formed in an oxi- 
dizable state at the moment of absorption. 
This efficacy would vary with a crowd of circumstances impossible to foresee, such 
as the vehicle the remedy might be dissolved in, the age of the preparation, the nature 
of the substance with which it might come in contact in the digestive tube, the activity 
of absorption in the tube, etc., etc. 
These conditions explain why preparations of phosphorus are so unreliable, and 
why on the one hand Coindet could obtain certain results in employing them in large 
doses, while on the other hand Bartez and Billet, with weaker doses, could only arrive 
at negative results. If, then, we think that we thus have found the reason for these 
contradictions, we can logically establish the double hypothesis enunciated by Dr. J. F. 
Churchill, viz; “The tubercular diathesis depends on a diminution in the economy 
of the phosphorized element, and this element having to fulfill in it the function of a 
combustible body, it must be found there in a degree of oxidation inferior to POg.” 
The hypophosphorous acid, combined with a base, seems to me to be the most 
appropriate form, though, however, Orfila and Bevergei say that the toxic effect of 
phosphorus is due to its transformation into hypophosphorous and phosphorous acid. 
An experience of many years has demonstrated to me that in spite of these opinions, 
the hypophosphorous acid is perfectly well borne without any toxic effect when combined 
with a base, as soda, lime, quinine, manganese, potassa, etc., etc. 
So, then, if we confine ourselves strictly to the above expressed theory, we must 
conclude that the salts to employ are the Hypophosphites. 
On the Mode of Action of the Hypophosphites.—On the Condition of their 
Curative Action.—Before indicating the mode of action of the remedies, we should 
briefly recall the different phases of the disease. 
Phthisis and tubercular affections are due to the presence in the different organs of 
certain morbid products to which we give the name of tubercles, and whose anatomical 
character, visible to the naked eye, are now perfectly well known. 
Neither microscopical research nor chemical analysis has succeeded in finding a 
constant and pathognomonic element or composition in the tubercle. Tubercles, once deposited, nearly always follow a regular evolution, in which we 
recognize generally three periods: 
First.—Crudity. 
Second.—Softening. 
Third.—Ulceration or excavation. 
In the period of crudity tubercles appear to influence the surrounding tissues only 
as foreign bodies, acting physically by their number, mass, and volume. 
In the period of softening their effect is to modify the organic conditions of the 
surrounding tissues, producing in them a state of hypersemia and even of local phlo- 
gosis, the result most frequently being the general phenomena which characterize the 
inflammatory state, and in addition, various troubles, either general or local, according 
to the location, nature, and function of the affected part. 
The third period, which is the immediate consequence of the preceding one, re- 
sults in the more or less extensive ulceration and destruction of the organ invaded by 
tubercular deposit. 
Such is the inevitable progress of tubercles. 
But in some cases the organism seems to desire to rid itself of the morbid product 
by a sort of intra-organic elimination, isolating it from the neighboring tissues by what 
has been called encystraent or cretation; finally—sometimes, though very rarely— 
when tubercles have followed their rational evolution, the tissues in which they have 
produced ulceration and partial destruction, cicatrize or cover themselves with an acci- 
dental membrane of new formation (fibro-cellular membrane, fibroid inodular tissue.) 
Now to the mode of action of the Hypophcsphites. 
It is twofold. 
On the one hand they increase the principle, whatever it may be, which constitutes 
nervous power. On the other hand, they are blood-makers of the best kind, more rapid 
and powerful than any heretofore known. 
The intimate connection observed between these two functions leads to the con- 
clusion that the primitive action of these salts consists in stimulating some primordial 
condition of the general nutrition, a stimulation which they produce either by modify- 
ing the elements of hsematosis, or by acting directly upon the nervous system of 
organic life. 
Physiogenic Effects.—The physiogenic effects are an increase in the power of 
general innervation, fullness and color of the face, increased weight, etc., etc: 
Pathogenic Effects.—The pathogenic effects are produced by a too long continued 
use or excessive doses of the medicine. 
Patients whose cheeks had become full complain that they are getting thin, they 
complain of dull pains all over the body and especially in the limbs, of headache, ver- 
tigo, enfeebled vision, and sometimes of fever. The appetite, which previously had 
improved, is considerably diminished; and sometimes there is diarrhoea; clearly then 
there is exaggerated haematosis. 
Auscultation sometimes reveals also, in this condition, signs of pulmonary engorge- 
ment; there is epistaxis, and often haemoptysis. 
So the fullness of the face will indicate the physiogenic effects, and epistaxis the 
commencing phase of the pathogenic phenomena. 
Therapeutic Effects.—The therapeutic effects of a substance, being the result, as 
we believe, of its physiogenic and pathogenic effects, are of a more complex order, but 
in their turn are less complex than the curative result. 
Each phenomenon of these divers orders requires for its manifestations some con- 
ditions more and more numerous, that is to say, more and more complex, and cure is 
the final expression. 
So then, a phosphoric medication administered in a given measure, and for a suffi- 
ciently long time, will put an end to the tubercular diathesis. But this cessation with- 
out which a cure is impossible, is not the cure itself; it is only the primordial and speci- 
fic condition. 84 
Whilst the action of the medicine is identical in all cases, in that which regards 
the general affection there will be as a secondary effect a different result with each 
patient, according to the pre-existing lesion before its use. 
As to the influence which the cessation of the diathesis will have on the local 
lesions; this, in the actual state of science, could n6t be established a priori. To know 
it we must have recourse to observation and assign it its true function, that of con- 
firming or disproving conditions deduced from theory, and above all of establishing 
their limits; that is to say the conditions under which these deductions are verified. 
This will teach us that the treatment of a diathesis by its specific, influences organic 
lesions already established merely in an indirect way, their ulterior evolution being sub- 
mitted to different conditions from those which give rise to them. 
Thus, for example, mercury cures the syphilitic diathesis, but does it at once cause 
a necrosis, or a caries, produced by the venereal virus, to disappear? 
Does it cause the pus formed by the suppuration of a lymphatic ganglion to be 
absorbed? 
Certainly not; the diathesis once eliminated, it merely restores the abscess which 
pre-existed the treatment to the condition of any other phlegmon, and subjects it to the 
same rules of treatment. 
Quinine, which prevents attacks of intermittent fever with a power that those who 
have not seen pernicious fevers in tropical climates can form no idea of—quinine, so 
heroic against the physiological troubles, is powerless against nearly all of the visceral 
lesions which result from it; and yet these very lesions, once established, cannot be, for 
the most part, successfully treated until the specific has put an end to the essential 
morbid state which produces them and which keeps them up. 
Finally, vaccine for a longer or shorter time destroys in the economy an unknown 
condition, but essential to the development of small pox. It is powerless against the 
disease once established, that is to say, it prevents but does not cure it. 
It is the same with the hypophosphites in phthisis; by the action of the phosphorus 
preparation on tuberculosis, the economy is brought back to its normal condition, from 
which all the organic disorders have sprung. But what influence can this return of 
the general equilibrium have on the local manifestations? What are the secondary 
circumstances necessary to effect a curative result? What are those which can hinder or 
retard the result? 
This is what observation alone can teach us. 
Supposing that one agrees with the author that phosphorus preparations are a 
specific against phthisis, it follows in no wise, as some practitioners seem to think, that 
the curative result should then be a very simple phenomenon, so simple that the first 
comer would bring it about with assurance and ease provided that he administered the 
Hypophosphite. 
It would be so in fact, if the medication should be employed from the very outset 
of the disease, when the pulmonary disorders are insignificant and circumscribed; and 
this it is which logic, science, and humanity together demand. 
Logic: because it is absurd to allow so fatal a disease as phthisis to progress, when 
there is a certain means of stopping it. 
Science: because it is acknowledged that we have no other medicine capable of 
surely resisting this diathesis. 
Humanity: because, even though he should not believe in the efficacy of the treat- 
ment, a physician should regard it as his duty to try it, in the acknowledged impotence 
of other medications. 
We shall now endeavor to explain the conditions of the curative action of the 
Hypophosphites. 
These conditions, as in all treatments, are of three kinds. 
First.—Those that relate to the patient, which are the pathological conditions. 
Second.—Those that belong to the medicine, as its chemical composition, its med- 
icinal form, etc., etc.; these are the pharmacologic conditions. Third.—Those that result from the action of the medicine on the patient; these are 
the therapeutic conditions. 
The pathological state is determined by examination, the result of which is the 
diagnosis. 
The pharmacologic condition will be made the subject of another chapter. 
Of the therapeutic conditions we shall try to make as brief an explanation as befits 
this essay. 
The rules ordinarily given to be followed in the administration of a medicine are 
often only a tissue of uncertainty and confusion. Not only is there no general principle 
which governs therapeutics as a whole, but if each medicine be taken in detail, nothing 
is more variable than the opinion of observers on the dose and mode of administration. 
This arises from the fact, that the action of a drug is an eminently dynamic 
phenomenon, which itself depends on two elements, both variable, but one (the drug)' 
varying with the will of the experimenter, the other (the organism) more often with- 
drawn from his influence. It is evident that a phenomenon, which is then a result of 
a relation established between two variable elements, one of which only is under one’s 
control, cannot be produced in a constant form, until we find the law which governs the 
series of results produced by the different relations which we have created between the 
generating elements. 
It is true that therapeutists make a distinction between the physiological action of 
a drug, and its therapeutic one; but this very distinction has been deduced not from its 
xeal relation between the medicine on the one hand, and the organism on the other; but 
from the normal or abnormal condition of the organism itself. 
In reality it can only be, as we have just said, the result of two elements, one of 
which only is capable of being determined exactly in advance. Hence follows the 
method adopted always in therapeutics of seeing only between the phenomenon of dis- 
ease and the idea of cure, but a single middle term. The administration of a drug in 
fixed doses, can only give results essentially varying and contradictory. 
Thus, for example, it is laid down that doses must be fixed according to the age, 
sex, and morbid condition of the patient - It is also true in certain medicines, which 
■distinguish what has been called the medicinal action of accidents which they may pro- 
duce. 
But in all this we find nothing exact, no general fact which may explain the medi- 
cinal action of every substance, no matter which. In one word, we have not yet under- 
stood the necessity of establishing an exact measure of medicinal action. 
Can such a measure exist? and, if it exists, when shall we find it? We believe 
that it is to be found in the graduation of the very effects produced by the medicine. 
Putting to one side the division heretofore admitted, let us look at the physiogenic 
and pathogenic effects of a medicine on the system which is in a state of health or disease. 
The first consist in the increase or diminution of normal functions without passing 
their physiological limits, and consequently without the production of any morbid 
phenomena. 
The second comprise all phenomena produced by the treatment other than 
those which exist in the normal condition. So long as there is only increase or 
diminution of function, its action is limited to the sphere of physiogenic phenomena. 
As soon as abnormal phenomena are manifested, it enters into that of pathogenic action. 
Thus mercury, in proper alterative doses, produces only physiogenic phenomena. 
When the dose is increased, salivation occurs among other effects, indicating to the most 
careless observer that the pathogenic action has been attained. 
Hydrocyanic acid, employed in the physiogenic dose, acts as a sedative; given in a 
larger quantity it produces, as pathogenic phenomena, nausea, respiratory trouble, head- 
ache, vertigo, and blindness. 
These two sets of phenomena correspond; one, the physiogenic action, with the 
stimulus and the contra stimulus of the Rasorian school; the other, the pathogenic 
effects, with the action of the “Similia” of Hahnemann. 86 
Thus, as the Rasorian teaches, every modification of the economy must consist 
either in an increase or diminution of the normal functions. 
But the distinction thus established is inexact, and can only be a criterion, inas- 
much as the change does not go beyond normal variations. 
Besides, the pathogenic effects produced by medicines are true diseases, as the 
school of Hahnemann professes, and as was understood before it; but it in no wise 
follows, as this school pretends, that a medicine has no curative action unless its patho- 
genic effects resemble the disease against which it is employed—an error as grave as the 
entirely opposite one of the masses, who measure the efficacy of a medicine by the num- 
ber and intensity of its pathogenic effects. 
Pharmacological Conditions.—Above all things it is necessary that the medi- 
cine should be perfectly pure; so, I beg my brethren, before prescribing any salt of the 
hypophosphite, no matter what, to assure themselves of its purity. 
I give Churchill’s method of ascertaining the purity of the different salts; 
“Hypophosphite of Lime.—“The presence of carbonate of lime is recognized when 
the hypophosphite, heated with distilled water, throws down a white deposit, soluble 
with effervescence in dilute nitric acid, forming thus a solution precipitated by oxalate 
of ammonia. 
“Hypophosphite of Soda.—“Carbonate of soda, being insoluble in alcohol, its 
presence is determined by washing the hypophosphite with concentrated alcohol; there 
remains a white deposit, soluble with effervescence in acids, whose solution is not pre- 
cipitated by oxalate of ammonium. 
“To recognize the presence of free soda, we can make use of a salt of lead; for 
this purpose the hypophosphite is heated with concentrated alcohol. If the salt does not 
dissolve completely it is evaporated to dryness and the residuum taken off with distilled 
water. If the hypophosphite is pure, the aqueous solution thus obtained gives no pre- 
cipitate by the addition of nitrate of lead to the sufficiently diluted liquid. If on the 
contrary, there is free soda present, we have a white precipitate of hydrate of plombique. 
“Sulphide of sodium is recognized by the salts of lead, throwing down a black pre- 
cipitate with an aqueous solution of the hypophosphite. 
“The sulphate of sodium is met with in the hypophosphite prepared by double de- 
composition with sulphide of soda and hypophosphite of baryta. The latter salt is 
generally obtained by boiling a solution of bisulphide of barium with phosphorus, so> 
long as any sulphohydric acid is given off; 
“BaS3+2HO+P=BaO,P(H 2HS. 
“But it is difficult to transform all the bisulphide into hypophosphite, so that by the 
addition of sulphate of soda we form a bisulphide of sodium, which is combined with 
the hypophosphite; 
BaO,PO-j-NaO,S03=Bao,S034-NaO,PO. 
BaS 2+NaO, SO 3 ==BaO, SO 3-|-NaS 3. ” 
We mention here only the two salts with which we are exclusively concerned in the 
treatment of phthisis. 
Of the Different Causes and the Different Accidents which may Produce 
Phthisis.—In the first rank is inheritance. 
It is by transmitting to their children special modifications of the economy, that par- 
ents give them the tubercular predisposition. This cause is so thoroughly recognized by 
all, that it needs only to be stated here. 
Secondly—Accidental causes. 
Some interesting researches made by Guy have demonstrated the influence of a 
deficiency of oxygen on the production of tubercles. He remarks that its development 
is intimately connected with want of space, and consequently with want of respirable 
air. 
In the printing offices which he visited he noted the following facts: 
In offices where the ratio of respirable air was under 500 cubic feet (English), the 
number of hasmoptoics was 12.5, and of catrrhals to 12.5 in a hundred. 87 
When the volume of respirable air was from 500 to 600 cubic feet, the number of 
haemoptoics fell 104.35, that of catarrhals to 3.48 per cent. 
Finally, when the amount of respirable air exceeded 600 cubic feet, the number of 
the first was but 3.96, and of the latter 1.98 per cent. 
This crowding of individuals seems, then, to be an accidental cause sufficient to 
determine tuberculization in those already tainted with the tubercular diathesis; that is 
to say, those who in our point of view are deficient in the phosphorous element. 
The great factories which contain hundreds of young girls, many of them of a lym- 
phatic or scrofulous temperament, are the principal cause of the development of this 
terrible malady, which carries off, in our good manufacturing cities, thousands of 
young girls, who, were it possible for them to be located where their lungs might find 
the necessary quantum of air, would not thus be a living holocaust, sacrificed to the 
God of money. 
flow many young girls, or young women too, who, to sacrifice to that other deity. 
Fashion, go to balls or parties scarcely clothed, and who, in going into the air, take at 
most no other precaution than that of carelessly knotting about the neck a lace hand- 
kerchief, which to them seems to be a sufficient guarantee against taking cold. 
“Taking cold,” with a subject affected with the diathesis, is evidently a cause of 
tuberculization, not only becauseit tends todiminish the intra-organicoxidation, already 
interfered with by the diathesic condition, but also because, to maintain the heat of the 
organism, the activity of the pulmonary function is increased, and a greater employment 
of the constituent elements of the nervous matter is required. 
But we must always bear in mind that by the word cold, we mean the cooling really 
experienced by the organism, and not the simple atmospheric lowering of temperature. 
Damp cold will act more energetically than dry cold, because damp being a better 
conductor of caloric than dry air, it will tend more powerfully to lower the temperature 
of the organism. 
If, as Fossion says, the influence of cold has a direct action on the pulmonary tissue, 
it must act with more force on subjects having a tubercular predisposition. 
Insufficient calorification is a constant phenomenon of the tubercular diathesis, but 
of itself it has a tendency to insufficient molecular reaction in the economy, which insuf- 
ficiency in its turn depends on the absence of the phosphorous element, which is one of 
its principal originators. 
Want of calorification in the tuberculous subject is then a secondary condition, an 
effect and not a cause. 
Respiration. 
The object of respiration being to bring organic matters into contact with the 
oxygen of the air, it is evident that in persons suffering from tubercular diathesis these 
matters will be incompletely oxidized, the result of their diminished affinity for this gas, 
and the incompletely oxidized products will be more abundant in proportion to the 
increased frequency of the respiratory act; because as the contact between the air and 
the successive and different materials to be oxidized is repeated, so much the more 
rapidly will the exchange between the pulmonary gases be effected, consequently the 
duration of the contact between the oxygen and the combustible matters contained in 
the lung will be diminished by reason of the frequency of the respiratory movements. 
Everything, then, which hastens pulmonary action favors tuberculization. 
Among women, according to Andral and Gavaret, menstruation is a sort of diver- 
ticulum to respiration; we can understand thus how amenorrhoea in diathesic subjects 
must be a cause of tuberculization, inasmuch as it increases pulmonary action. 
Composition of Blood: 
The composition of blood depends espeically on that of globules, whose functions 
according to all physiologists are most important, but of which we have not to a cer- 
tainty determined, either their true chemical composition, the part of the system in 
which they originate, nor even the difference they present in the various regions of the 
circulatory system as regards their quality and composition. Nevertheless from all the 88 
researches on this subject, whatever may be their difference on other points, there results 
this important fact, that their production in the system depends on two general conditions; 
the absorption of alimentary substances and the reaction of these matters with the 
oxygen introduced by respiration; in other words, the oxidation of assimilated sub- 
stances; this oxidation evidently depending on the affinity between the oxidizable matter 
and the combustible principle. 
Consequently every change of composition which diminishes this affinity will 
diminish by so much the activity of the organic reaction necessary to produce blood 
corpuscles. 
Their diminution would then be an immediate and necessary consequence of the 
tubercular diathesis. Because on the one hand phosphorus is the most combustible 
principle of the economy, and on the other, according to the analyses of Rees, Reich, 
Gobley, and Percy, venous blood contains a phosphorous element, and especially accord- 
ing to the latter who— 
“ Finds it in the blood as a highly organized oleo-hypophosphite, having as one of 
its bases an active nitrogenous element, which element is oxidized by the contact of 
pulmonary oxygen, and appears in arterial blood as a phosphatic element.” 
If the diminution Of the number of globules is a constant condition of tuberculosis, 
if their existence is necessary for the accomplishment of hsematosis, how does it happen 
that their diminution in chlorosis, for example, does not produce by the insufficient 
hsematosis and this incomplete oxidation, tubercular matter, which according, to the 
diathesic theory, should be its result? 
According to the lights which we possess to resolve questions of this nature, the 
objection will disappear when we reflect on the different functions of the two elements, 
iron and phosphorus. 
As we all know, according to the theory of Liebig, the function of iron is to 
absorb the oxygen in the lung, and to serve as a vehicle to carry it to the different parts 
of the system. 
Phosphorus always following Rees and Reich, is oxidized in the lung immediately, 
at least in part, to pass from the condition of a phosphide to that of a phosphatic ele- 
ment. 
Besides, in chlorosis, though the globules are diminished in quantity, yet each one 
possesses substances having their normal affinity for oxygen, so that the organic meta- 
morphoses which take place during the act of haematosis are fewer but not the less com- 
plete, so that the final result will be a variation in the quantity but not in the quality of 
the products resulting from the act of pulmonary respiration. 
The theory of the tubercular diathesis explains, then, the decrease of the corpuscles 
of the blood in phthisis, and the relation which exists between tuberculosis and chlorotic 
anaemia. 
Of the Different Medicines that have been Employed in Phthisis and of 
their Results.—These are innumerable, but no one of them has as yet brought about 
a certain cure. 
It is generally admitted that 4 per cent, of tubercular cases are cured with or with- 
out medication. 
We do not believe that any greater success has been obtained with any medicine 
heretofore employed (except with the phosphorous medication). 
Most in vogue of all, and especially in England and in America, is cod liver oil. 
First.—What action has this oil in phthisis? 
Second.—Does it retard its progress? 
Third.—Does it bring about a cure? 
To these three observations we answer; 
To the first: That in our opinion it has no direct action; it is only as a food that 
it can be useful. 
To the second and third observations we answer categorically; No! 
And here is one of the best proofs; 89 
C. J. B. Williams, one of the first to employ and recommend cod liver oil in 
phthisis, the eminent practitioner, has established numerically and in a clear and definite 
manner, that in an experience of twenty years in the treatment of phthisis, “of seven 
thousand patients treated by cod liver oil, the number of cures did not reach seventy.”* 
That is to say, in that considerable number of patients, treated by one of the most 
able English physicians of our time, the number of cures did not attain one per cent. 
This sad acknowledgement of the impotence of the remedy, stated officially, before 
the first medical society of England, has not met a single opponent, either in the med- 
ical press or elsewhere; and yet we see every day, thanks to the good old routine doctors 
who know, men whom the author recognizes as his masters, to whose decisions in many 
cases the medical world bows—we see, I say, these masters, in spite of the implicit 
avowal made by one of themselves, continue day after day, and in spite of all, to employ 
a medication which they know to be useless. 
When we see a professor of the skill of F. Hughes Bennett explaining the action 
of cod liver oil (because he admits, with certain micrographers, that the primordial cell 
is composed of fatty and albuminoid nuclei, and comparing this idea with the fact ob- 
served by Ascheron, that if oil be shaken up with an albuminous solution, globules are 
formed, having the same composition, resting besides on the symptoms of emaciation 
in phthisical patients), conclude from it: 
That fatty elements are wanting to constitute the nuclei of new corpuscles. 
What shall we answer? 
Do we not all know, as daily experience teaches us, that emaciation is not a con- 
dition but a consequence of the disease? 
Finally, the most recent micrographic results on this subject show that the nucleus 
or the blasterpa, around which the cells form, is not composed of fat.f 
lodine; 
For some time the action of cod liver oil was attempted to be explained by that of 
the iodine contained in it. But the action of iodine itself is completely negative against 
the tubercular diathesis. 
Prof. Piorry himself, who had vaunted its efficacy recognized afterwards its useless- 
ness. (Pathologic latrique,” t. iv. p. 52.) 
Conclusions.—The result of the ideas expressed in this work can be summed up 
in the following propositions: 
First.—There exists in the system, as a constituent element of nervous matter, 
blood, the muscular organs, and, in general, of the albuminoid compounds, a phos- 
phorous element not yet definitely isolated, and which is distinct from the now admitted 
phosphatic element. 
Second.—As such, it constitutes one of the substances of the economy which has 
the greater affinity for oxygen, and as such, its probable function is not only to be 
oxidized itself, but also to promote combustion, and consequently, perhaps, to initiate 
organic metamorphoses in other substances. 
Third.—The diminution of this phosphorous element in the system, whether as the 
result of its exhaustion or of a failure of reproduction, is one of the essential conditions 
of the tuberculous diathesis. In relation to the disease it plays a part of a direct or im- 
mediate cause. 
Fourth.—The immediate effect of the existence of this condition is to diminish the 
degree of oxidization, to which certain matters in process of transformation reach; con- 
sequently, to render them unfit either to continue to fulfill their functions in the system, 
or to be eliminated from it in an excremental form. 
Fifth.—The deposit of this abnormal matter under the form of proteic substances, 
-incompletely developed and of variable composition, constitutes the different pathological 
♦Williams’ Lumleian lecture before the London College of Physicians and Surgeons. (The 
April, 1862). 
■f'Micrographic Dictionary by Griffiths & Lanfrey. London, 1870, p. 125. products known under the name of tubercle, and which are the anatomical characteristics' 
of phthisis. 
We will close in a few words. 
We firmly believe that pulmonary phthisis is curable by an oxidizable and easily 
assimilated preparation of phosphorus, in all cases “ When the pre-existing lesion is not 
sufficiently serious to cause death” (Churchill). 
We give the preference to the Hypophosphites, as they seem to us to unite the best 
conditions. 
As we generally cannot rely on any salts that are at our disposal in drug stores, the 
aim is to find a reliable preparation; and I will take the liberty of giving to the profes- 
sion the result of my experience, after many trials of different preparations. 
I have found only two that fulfill the necessary condition for good therapeutic effect, 
viz, purity of the salts employed. 
Those to which I have given the preference, and the only ones that I exclusively 
employ,are the syrups of hypophosphite of soda and hypophosphite of lime, prepared by 
R. W. Gardner, chemist. New York City, and for the following reasons: 
First.—The salt used is perfectly pure, and keeps entirely unoxidized in the syrup. 
Second.—He alone has understood that the different salts have to be employed 
separately, according to the stage of the disease, hence his two different syrups—soda 
and lime. 
Third.—Because after many tests, at different periods, I have found them always 
the same, and the therapeutic effects obtained invariably good. 
In giving my preference to one preparatiion, when perfectly convinced of its con- 
stant purity, I have only followed Dr. Churchill’s example, who has never employed any 
other preparation than that made by Swan, RueCastiglione, Paris, after he had become; 
convinced, by repeated trials, of its purity. 
My reasons for not using other and combined preparations are twofold. 
The first, and not the least, is because the mixture of the two salts is entirely 
objectionable, and ought not to be used in that form by any physician understanding 
the therapeutic effects of the medicine. 
Dr. J. F. Churchill, the initiator of the treatment with hypophosphites, the greatest 
authority in this case, has sometimes alternated the two different salts with the same 
patient, according to the physiogenic or pathogenic symptoms produced by either, but 
he never mixed them, knowing too well that in many cases one or the other was contra- 
indicated. 
The second reason is that the hypophosphite salts, as sold, are always impure, and 
require careful chemical treatment to deprive them of dangerous impurities, which so 
interfere with their therapeutic action as to always modify, and frequently abort the 
result for which they are given. 
Another suggestion that I would offer to my professional brethren is that the doses 
that are recommended for general use are too large, and sometimes enormous, surpass- 
ing three times the doses that Churchill has given as a general limit to obtain good 
therapeutic effects. 
My own experience of more than twenty years in the treatment of the disease cor- 
responds entirely with his directions. 
It is true that at the beginning large doses will work marvels, but it will soon be 
shown that they aggravate in place of curing, and in the end will do more harm than 
good. 
The scope of this little work does not permit me to give cases that I have treated 
and cured or benefited by the syrups of hypophosphites; but later, as an appendix to it, 
and when the time will permit me, I will give a detailed record of more than one hun- 
dred and fifty cases that have been under my observation; but never have /, nor will I, 
use a combination of the two salts. In my opinion, and in my experience, they are- 
more injurious than beneficial. 
Make a careful observation of R. W. Gardner’s syrups, employed separately and 91 
according to the case in your hands, using the modified doses as herein suggested, and 
you will soon be convinced that while, a priori, the effects may not be so brilliant, yet 
the attainment of the end you have in view will be, at least, sure. 
In a letter Dr. de Bremen gives his opinion upon doses as follows: 
‘1 Having had a very long experience in the use of Hypophosphites, and having care- 
fully watched their effects in the treatment of phthisis, I take the liberty of giving you 
my views respecting the doses best adapted to the treatment of this disease. But while 
I differ with you in regard to doses, I must recognize that, as a chemist, you have done 
a great service to the medical profession. Your salts are pure; and the elimination by 
you of all impurities, many of them dangerous, has put in our hands preparations upon 
which we can rely for good therapeutic effects. But I consider it of great importance 
in this disease that certain doses should never be exceeded. I have observed that when 
given in certain definite quantities per day, the results are steadily and permanently 
favorable, though somewhat slow; but when the dose is increased beyond those 
limits, while the immediate effect is frequently surprisingly favorable, the ulti- 
mate result has been the production of certain pathogenic and physiognomic 
symptoms, epistaxis, and, frequently, haemoptysis, owing to an excessive absorption 
of the remedy. 
The salts to which I wish particularly to call attention, being those which I almost 
invariably use in this disease, are the salts of lime and soda. 
Hypophosphite of Lime is generally used only in the second and third stages of the 
disease. This salt produces with much energy the undesirable results I have alluded to 
when pushed too far. 
Hypophosphite of Soda is employed in the first stage of the disease; its effects are 
slower than the lime salt, but more sure when given in quantities of ten grains or fifty 
centigrammes per day; but in larger quantities it will produce the same effects as the 
lime salt, and instead of proving beneficial, will accelerate the process of softening by 
excessive activity. 
I would therefore discriminate, when the lime or soda salts are used in phthisis, 
between adult males, adult females, children (males and females), and infants. The 
following doses are those which I have found to act the most favorably: 
Adult males, 6to 10 grains per day. Adult females, 4to 8 grains per day. Children 
7to 15 years, Ito 5 grains per day. Infants, 1-5 grain per day. 
Now, as your syrups of these salts are each twenty grains to one fluid ounce, these 
quantities will be approximately met by the following quantities, viz: 
Adult males, one teaspoonful, two to three times a day. 
Adult females, one teaspoonful, two to three times a day. 
Children, 7 to 15 years of age, ten to forty drops, three times a day. 
Infants, two drops, three times a day. 
Dr. Churchill himself has tried greater doses than the above, but having found it 
too much, has never since exceeded ten grains, or fifty centigrammes, per day. I would 
also allude to the necessity for physicians to watch for spermatorrhoea as a result of a 
too free use of these salts. 
Hypophosphite of Iron.—The dose of this syrup mentioned by you (dessert 
spoonful) I consider normal, as it will be used by all competent physicians in cases 
where the combined action of phosphorus and iron is needed; for my part I have 
almost always been pleased with it in anaemia, chlorosis, and more especially in dys- 
menorrhoea, where the combined action of the two has a very direct influence upon 
menstruation. 
Hypophosphite ofPotassa.—As this salt is never employed in phthisis, and 
only for the resolution of old phlegmasias, the dose, one dessert spoonful (four grains), 
is good; nevertheless, it might be increased in the treatment of asthma to twenty and 
sometimes twenty-five grains per day, especially when the disease arises from chronic 
bronchitis, and no symptoms of tuberculosis exist. 92 
I am glad to notice that you are making an elixir of Hypophosphite of Quinia; 
'this is of great advantage in combatting intermittent fevers. It is used very effectually 
in the French colony of Algiers, and is given in nearly all military hospitals in prefer- 
ence to the sulphate, the doses required being less.” 
Note.—lt should be remarked that the Hypophosphite preparations used in the following cases 
were those prepared by R. W. Gardner, New York. 
THREE CASES OF PHTHISIS PULMONALIS, 
TREATED SUCCESSFULLY WITH HYPOPHOSPHITES. 
TYPICAL CASES SELECTED AT RANDOM TO ILLUSTRATE METHOD OF TREATMENT. 
By the late L. de BREMON, M. D., New York City. 
(Reprinted from the New England Medical Monthly, May, 1882.) 
Phthisis Pulmonalis in the First Degree.—Cure—Time of Treatment. 
Four Months.—Case 1. Mrs. L., aged 32, residence, Brooklyn. This lady was 
advised by her physicians to spend some time in Germany, her native country, in the 
hope that the change of climate would stop a beginning phthisis pulmonalis. She was 
absent accordingly from May, 1879, until October, same year. 
When she returned to America, there was no amelioration of her condition, on the 
contrary, her cough was more persistent, her appetite nearly gone, and she was much 
troubled with sleeplessness and night sweats. 
I saw her at the latter end of October for the first time. 
On examining her chest, I observed on the left side, in the supra and infraclavi- 
cular region, a well marked dull sound, and also a notable diminution of the respira- 
tory murmur, with slight crepitation (crackling noises). In the rest of the side the 
breathing was generally exaggerated (overstrained.) Pulse 90; temperature at the 
time of the examination. Amenorrhoea and very profuse leucorrhoea. 
The right lung was normal. 
Diagnosis.—Dry tubercles at the upper extremity of the left lung. 
Treatment.—Dessert spoonful of the syrup of Hypophosphite of Soda (five 
grains) twice a day at meal times. 
A week later, I saw my patient again. Her cough is less troublesome, her appe- 
tite has increased, she sleeps better, and her night sweats less profuse. Same treat- 
ment. 
In another week the amelioration was progressing without notable change. Same 
treatment for a fortnight. 
At the end of this period my patient called. She told me that her appetite had 
augmented notably, her cough was decreasing rapidly, and night sweats nearly disap- 
peared. Pulse 80; temperature normal. Same treatment for the next fortnight. 
Two weeks afterward, I saw her again; her general state had greatly improved; 
she was growing more fleshy. On examination I ascertained a very marked diminution in 
the crepitations which I had at first observed, the breathing was less exaggerated; the 
.dull sound, although weaker, still existed. 
Same treatment for a fortnight. 
At the end of this time the general condition was progressing, her cough had 
subsided, her appetite was good, and the night sweats had completely vanished. 
Same treatment for the next month. 
When my patient visited me again, her general appearance had undergone a com- 
plete change; her health was quite satisfactory, all the symptoms of the disease had 93 
disappeared; menstruation had become regular, although leucorrhoea still persisted, for' 
which I ordered: 
1$ Zinci sulph. pulv.; Acid Tannici, aa 3 ij. 
M. Ft. chart. No. xvj. 
One powder to be dissolved in one pint of tepid water, and 
taken by injection (per vaginam) morning and evening. 
On examination, the chest on percussion sounded well; all dullness had disappeared. 
On auscultation, I could find no more crepitation in the upper part, breathing had 
become normal, although a very slight noise was yet noticeable at the expiration. 
I ordered the treatment to be continued as a prophylactic, and reduced the dose to 
one teaspoonful (a| grains) of the syrup of Hypophosphite of Soda at each meal 
(breakfast and dinner). Five weeks later I saw my patient again. The general state 
of her health was as satisfactory as at the time of our last interview, and the slight 
noise noticeable at the time of expiration quoted above had entirely disappeared; no 
more leucorrhoea. 
My patient was discharged cured, but as a prophylactic measure I told her to take 
one teaspoonful of syrup of Hypophosphite of Soda daily, and continue for a period 
of about six months. 
I know that at the present moment Mrs. L. enjoys a perfect state of health. 
Phthisis Pulmonalis in the Second Degree—Cure After Six Months, 
Treatment.—Case n.—Mr. S., a resident of New York, set. ig, came to see me. 
His medical adviser, who occupies a prominent and well-deserved position in this city, 
had told him that one of his lungs was badly diseased, and that he was of opinion 
that his patient be treated with cod liver oil and phosphate of, lime, emulsified, for 
which he accordingly prescribed. 
Mr. S. tried hard to follow the directions given, but each time his stomach 
rebelled, and finally rejected the medicine. 
He was then sent to me. 
He had complained for about eighteen months of a harsh, dry cough, and for two 
or three months he coughed a great deal before going to and rising from bed; had lost 
a good deal of strength, and was becoming very much emaciated; he thought his 
mother had died from consumption. 
April 25, 1879—Cough every morning with expectoration of mucus, tinted with 
blood; night sweats; appetite sufficiently satisfactory; pulse 95; temperature 100J; the 
patient complained of a pain in the back, level with the angle of the right scapula, 
and a shortness of breath when walking. 
On examination, I ascertained a well-marked dullness under the right clavicle over 
a space of about three centimetres. 
The resonance of the left side was normal. 
When I performed a rather deep percussion on the right side, my patient com- 
plained first of a sudden violent pain, and then fainted, which state lasted five min- 
utes, his face turning pale and assuming an expression of terror, while thick drops of 
cold perspiration appeared on all its surface. I was compelled to put off my examina- 
tion until the next day. 
When I resumed it expiration was weak in the upper and fore part of the right 
lung. 
The voice of my patient echoed, especially in the region under the right clavicle; 
on the left hand side, fore region, his respiration was exaggerated; on the right side, 
towards the rear, the resonance was much less powerful, and breathing very weak in 
the infra spinal fossa. 
Level with the spine of the shoulder blade (e'pine de I’omoplate) I observed sev- 
eral crepitations of a humid character; in the rest of the lung, breathing was very faint,, 
and the voice sounded very strong. Treatment.—One dessertspoonful of the syrup of Hypophosphite of Lime (5 
•grains of the salt) at breakfast and dinner, daily, for eight days. 
At the end of this period the night sweats had greatly subsided. Same treatment 
for eight days more. 
On the 12th of May my patient was progressing favorably; he said he was less 
suffocated when walking. On the 19th, no change; general state was improving. On 
the 28th, on auscultation, I found that I could hear the expiration better in the right 
side, although the crepitation had not entirely disappeared and the voice was less 
sonorous. 
94 
To the right, under the clavicle and toward the external extremities of the latter, 
the resonance was somewhat less than on the left side. 
In the fore region it was nearly equal on both sides; however, to the right the 
voice was a little more sonorous than to the left. 
To the left, towards the rear, breathing was somewhat exaggerated; to the right, 
in the infra spinal fossa, I heard at intervals a few crepitations. In the rest of the 
lung it was normal. A faint echo was audible, however, level with the spine of the 
shoulder blade (epine de I’omoplate). 
I reduced the dose of syrup (this time of soda) to one teaspoonful, morning and 
evening, and advised my patient to spend a month in the country. 
When he returned to New York, in July, he felt all right; he was strong; no 
cough; no night sweats; no dyspnoea. All the general symptoms had vanished. 
I ordered for two months more the treatment above described, as a prophylactic, 
viz., one teaspoonful of the syrup of the Hypophosphite of Soda (2J grains). 
Mr. S. came to see me later on, calling my attention to a slight touch of sper- 
matorrhoea. 
As to his recent state, he told me he had never given it a thought since, as he had 
nothing to complain of. 
I have seen him since nearly every month in social relations, and his health is in 
perfect order. 
Phthisis, First Stage, Turning to Second.—Three Months’Treatment.— 
Cure.—Case hi. Miss S., aged ig,born in New York. Expectoration, cough, night 
sweats, dyspnoea, nearly complete loss of appetite, emaciated, no sleep, palpitation, 
amenorrhoea. She had begun coughing about four months before. 
The family physician had been sent for, had diagnosticated incipient tuberculosis, 
and had prescribed cod liver oil, cream and whiskey. This treatment had given no 
relief to Miss S.; her stomach rejected the oil. 
I was then invited to see her, and the following were the symptoms: Complexion 
generally pale; cheeks somewhat red; emaciation considerable; prostration intense; 
expectoration not very abundant, somewhat pearly and mucous, and totally different 
from that caused by bronchitis. 
Right lung in the fore region, to the right and in the upper part, the dullness on 
percussion was not very strong in the lung from its lower extremity up to the summit; 
breathing was weaker than on the left side; also several crepitations audible at its basis 
and right side. 
At the rear, in the inferior portion, I ascertained the existence of very notable 
crepitations of a hurried character; these were very strong and increased at the time of 
coughing. To the left, both in the fore and rear region, the respiration was a little 
exaggerated. 
Left lung perfectly healthy. 
I prescribed syrup of the Hypophosphite of Lime one teaspoonful in the morn- 
ing and one desert spoonful in the evening, at meals (about eight grains of the salt 
daily); added to this I prescribed a potion containing one-fourth grain of digitalis to 
the teaspoonful, in mucilage, to be taken only when palpitations were too trouble- 
some. 
This treatment commenced on the Bth of March, 1890. 95 
I saw my patient on the 15th; her appetite was better, cough had decreased; night 
sweats less abundant, and respiration easier. 
Same treatment during eight days. 
On the 23d.—No change worth mentioning. 
On the 29th.—Appetite restored; sleep quite satisfactory; no more palpitation. 
Same treatment for one week, omitting the potion with the digitalis. 
April 9th.—Progressing condition; hardly any more cough. I reduced the daily 
dose of syrup of the Hypophosphite (this time substituting soda for lime) to a tea- 
spoonful morning and evening. 
I was called April 13th.—Less satisfactory state; cough somewhat stronger. 
Miss S. confessed that she had imprudently gone out on a wet day and had her feet 
soaking wet. 
I increased the daily dose to one dessert spoonful of syrup of Hypophosphite of 
Soda, morning and evening, for one week. 
April igth.—Patient better; no bad results from her imprudence; good appetite 
prevails; no night sweats and sleep satisfactory; reduced the dose of the syrup to a 
teaspoonful morning and evening. 
April 26th.—Menstruation, which had been suspended, was recovered. Same 
treatment. 
May 3d.—No alteration worth mentioning. 
The examination which I performed then set forth the following evidence: All 
the general symptoms of the disease had disappeared; there was no more dullness; no 
more crepitation at the basis of the right lung, the respiration, however, was still some- 
what -weak at the front, under the clavicle; no bellows sound in the heart, but the “first 
sound” was still dead. Same treatment. 
May 10th.—Progressing sanitary conditions; Miss S. begins to grow more fleshy, 
and was able to help her father in his business. 
Same treatment. 
May 17th.—On examining my patient, I could no longer discover any difference in 
the respiratory function on either side. 
My patient told me that she felt very well. 
I advised her family nevertheless to send her in the country, if possible, and to go 
on with the treatment as a prophylactic, viz.; one teaspoonful of syrup of Hypophos- 
phite of Soda, daily for two months more. 
In regard to the diagnosis in the present case, it would certainly, in some respects, 
be doubted; the crepitations, of a hurried character, were limited to the basis of the 
right lung, but there was, besides, in all the rest of this organ, a very great diminution 
of the respiratory murmur, without any hissing sound, or ronchus, and there was also 
dullness in its upper portion. The considerable anaemia, the night sweats so intense, 
and the cough and expectoration relatively so insignificant, could not, however, be 
attributed to plain bronchitis. 
TWELVE CASES OF PHTHISIS PULMONALIS, 
TREATED WITH HYPOPHOSPHITES. 
W. H. BENTLEY, M. D., LL. D., Cox,d Spring, Woodstock P. 0., Ky. 
(Reprinted from the Med. Summary, June, 1885.) 
I have been engaged in the practice of medicine for more than a quarter of a cen- 
tury. During this period my efforts to manage disease and relieve my patients have 
been crowned with reasonable success, and been, as a rule, very satisfactory. This has 
not been the case, however, in the treatment of pulmonary consumption. In this 
disease, most of my patients succumbed. Cures were the exception, death the rule. 96 
Even then my success was equal to that of any of my neighboring physicians in similar 
cases—better than that of many—yet I was not satisfied. I all the while felt that 
there should be, and really was a better method of treating the disease than I had pur- 
sued—better remedies than I had prescribed. 
The trouble with me was, I did not know them, and did not know how I was to 
find them out. I sought information in all directions and from every supposed avail- 
able source. I tried all the remedies and plans popular with the profession, but to lay 
them aside, leaving me disappointed and sometimes disgusted. 
Under the stimulus of such names as F. Hughes Bennett and C. J. B. Williams, I 
stuck to that huge delusion, cod liver oil, carefully testing its therapeutic properties 
during a period of five years. This experience of cod liver oil in consumption of the 
lungs was sufficient. I never could find a good result from its use. On the contrary, 
its interference with digestion and appetite, and its tendency, likewise, to interfere with 
elimination of morbid matter, and to create fever and fatty degeneration, are sufficient, 
in my view to positively contraindicate it use. I never saw any good result from 
arsenic, and iron is nearly always mischievous, Alcoholic stimulants nearly always do 
harm, and the extract of malt rarely does good. Soured milk (koumis) is positively 
unworthy of notice. 
After the brilliant results obtained by Dr. J. F. Churchill in the Parisian hospitals 
under the use of the Hypophosphites, it seemed that the key to the successful treat- 
ment of phthisis pulmonalis had at last been found. High hopes were engendered in 
the minds of physicians in regard to the treatment and cure of the disease. These 
hopes, however, were doomed to many disappointments. These disappointments arose 
from several different causes. 
First.—Many manufacturing chemists, either through ignorance or through care- 
lessness, failed to produce chemically pure salts, and the Hypophosphites to be avail- 
able, must be absolutely chemically pure. 
Second.—The Hypophosphites, as salts, are easily and rapidly injured by age. 
Nearly all the commercial Hypophosphites are worthless either from age or defective 
preparation. The writer recently tested eleven samples, purchased at random, all of 
which were found unfit for use. 
To be suitable for exhibition in phthisis, the Hypophosphites should be entirely 
pure, and they should be incorporated into a syrup as soon as manufactured. Many of 
the syrups of the Hypophosphites on the market are prepared from imported salts for 
the sake of economy. In most cases, these salts, if ever pure, have deteriorated by 
age, hence the prescriber may look for disappointment. 
Third.—Manufacturers have mostly furnished syrups composed of from two to half 
a dozen different Hypophosphite salts, and we physicians have frequently been so 
inconsiderate as to prescribe them. At any rate, I have, and I have known many other 
physicians to act equally as unwisely. We did not stop to consider the different actions 
of the various bases of these salts, as lime, potash, soda, iron, etc., upon the human 
system, and thus we prescribe a compound of heterogeneous and contradictory constitu- 
ents, the constituents antagonizing one another. Yet, we would laugh at the fellow 
who would attempt to lift himself over the fence with the straps of his boots. 
Fourth.—When the physician prescribed these preparations with due regard to the 
physiological effect of each, he was frequently unable, from the great distance hiter- 
vening between him and his patient, to give the case the necessary attention. Thus, 
the prescribed dose might have been too small or, what is more usual, too large, or the 
patient might have an intercurrent attack of some other disease. The last category is 
quite frequent. One of the great elements of Dr. Churchill’s success was due to his 
continued oversight of his cases, his patients being mostly in hospital. Prior to December, 
1883, I had not entertained the views here expressed in regard to the Hypophosphites. 
Through the winter of 1883-84 I devoted all my available time to the study of 
the disease, reviewing, with great care, the various theories respecting its etiology, 
pathology and treatment. 97 
The result was a determination to thoroughly test the “ Hypophosphite treat- 
ment.” Dr. J. F. Churchill was the originator of this treatment, and it was on the 
plan pursued by him and his illustrious pupil, the late Dr. L. De Bremen, that I 
resolved to conduct my experiments. 
I opened a correspondence with R. W. Gardner, pharmaceutical chemist, 158 
William street, New York, and by April 1, 1884, was in possession of a liberal supply 
of his various chemically pure Hypophosphite syrups. With these lat once set to 
work. Before the close of the year (1884) I had treated twelve cases of known con- 
sumption of the lungs, mostly taken from the cases of other physicians. 
Of this number four died and eight recovered. 
Theseeight are all alive and well to-day (May, 1885). [Still so, November 25, 1885.] 
Three of the cured cases were in the excavation stage. 
I kept notes of all these cases and had written out a history of each to accompany 
this paper, but I find that these reports will fill a space twice the size of one number 
of the Summary, and hence, interesting as it might be to both the writer and the 
reader, the publication of this matter must be deferred. 
I have still continued to use the remedies with equal success up to this time. 
The results of my experiments may be briefly summed up as follows: 
First.—Nearly all cases of phthisis pulmonalis can be cured by the Hypophos- 
phites, if taken in time and properly managed. 
Second.—But one of these salts (used in syrup) should be given at a time. By 
this I mean to say, never give a compound syrup, or other preparation containing more 
than one of these salts. 
Third.—I have found but two of the salts, namely, the Hypophosphite of Lime 
and the Hypophosphite of Soda, necessary or even appropriate in phthisis. 
Fourth.—Watch the cases closely, and be sure not to go beyond what Dr. 
Churchill calls the physiogenic action. 
When symptoms of “overdosing” present, suspend the remedy for a few days, 
and resume in diminished doses. 
Fifth.—Treat any complications that may arise according to indications.” 
November 8, 1885, the doctor writes: “Thus far I have treated thirty cases dur- 
ing this year (1885); twenty have gotten well and have been dismissed ‘cured.’ Eight 
of the remaining cases will get well; one, an old lady, set. 6g, will die, and another 
may die. lam sure the Hypophosphites are the proper medicines in consumption, 
but their use requires care and sound judgment.” 
November 28, 1885, the doctor writes; “In a communication to you under date 
November 8, 1885, I stated that I had treated thirty cases of consumption with your 
syrups of the Hypophosphites during the year; that twenty had been dismissed ‘cured’; 
that eight of the remaining cases would get well; that an old lady aged 6g would die, 
and that another case might die.” 
Well, the old lady, Mrs. H., did die on the 15th inst, I considered her case 
incurable on my first visit, July 20, 1885. She was a tall, lean, thin and dark visaged 
old lady of highly nervous and excitable temperament, and had been confined to her 
room, and most of the time to her bed, for ten months. There was an entire absence 
of appetite; all she had eaten for some months had to be, as she expressed it, “forced 
down.” In other words, she had no relish for food. She had diarrhoea, her food 
being passed in nearly the same state in which it had been swallowed. She had had 
several severe pulmonary haemorrhages; her tongue was fiery red; there were exhaust- 
ing night sweats; and her weak, thready pulse beat 150 a minute. 
Ausculation revealed purulent cavities in both lungs, and her cough was almost 
continuous. She raised, from her lungs, large quantities of purulent matter. Her 
husband, a chaffy, conceited old fellow, who had read a part of Gunn’s “Domestic 
Medicine,” and, withal, had been an army hospital nurse, had been her phy- 
sician. She had used gallons of whiskey and “bitters,” to say nothing of Slocum’s 
thirty dollar invoice of his miserable nostrum. 98 
I prescribed Gardner’s syrup, Hypophosphite of Lime before meals and Parke 
Davis & Co.’s Lactated Pepsin after meals. The patient rallied, and was able to be 
about the house. Late in October* she attempted to bring- some dried fruit from a 
scaffold in the yard. This resulted in a fatigue and a severe “wetting,” for a heavy 
rain fell during the time. She relapsed and gradually sank until death occurred, as 
stated, on the 15th of November. 
The other patient, alluded to as the one that “may die,” has so far recovered as to 
attend regularly to her household duties. She has nearly her usual strength, and has 
regained her normal weight with an addition, Her cough has also quite ceased. 
This case is so remarkable that I desire to give you the details, which I wish you 
to incorporate in your forthcoming pamphlet, even at the expense of space. 
Mrs. A., married, aged thirty-eight, is the mother of four children, the oldest 
twelve years old, the youngest four. Since the last birth, the mother has been in ill 
health, the first troubles being amenorrhcea and leucorrhoea. In January, 1884, she 
began to cough, the cough being more troublesome on retiring at night and arising in 
the morning. The expectoration was scant and a kind of “frothy mucus,” as 
described. In March, 1884, she had haemoptysis, afterward frequently repeated. 
Her father-in-law wasaself constituted doctor, who had not even read “Gunn.” He 
assumed charge or the case, and gave her gallons of whiskey bitters, the “roots and 
yerbs,*” as he called them, being a medley of nearly everything bitter and repulsive 
that the forest afforded. Of course this was wholly unavailing. In the winter of 
1884-85 she fell in with the advertisement of some city sharper, who said, “I cure 
consumption,” and got fleeced to the tune of forty dollars. Seeing that she grew 
rapidly worse under the use of this unscrupulous swindler’s “stump water,” or what- 
ever it was, she abandoned its use. In March, 1885, she had an attack of intermit- 
tent fever in the regular daily “shaking ague” variety. She then called in an ignor- 
ant Swede, whose meagre medication was of the Homoepathic “persuasion.” He 
treated the case, without benefit, until August 1, 1885. On that day I was called to 
the case. 
I found about the following conditions: 
Bowels extremely irritable, every morsel swallowed acting as rapidly as a brisk 
cathartic. Tongue fiery red and creased toward the base; tip sharp and pointed— 
thickened vertically; pulse 140, and quite weak. (Did not take temperature.) 
Daily “shake” from intermittent fever. The fever generally went off by a sweat 
about two o’clock P. M., and there was likewise a profuse colliquative sweat at night. 
Leucorrhcea very profuse and extremely offensive, necessitating semi-daily change 
of linen; patient extremely weak—could not sit up alone. 
Lungs.—Percussion sounds extremely dull—amounting to only a mere “thud.” 
Ausculation: The breathing was chiefly bronchial, vesicular mumur nearly inaudible 
In left supra-mammary region, over a circular space about an inch in diameter, both 
inspiration and expiration gave a muffled blubbering sound, revealing a large abscess 
filled with pus. On the right, exactly corresponding in position, was a similar sound, 
covering a circular space the size of a silver dime. Over the left posterior surface 
there was bronchophony, and over the right, egophony. Expectoration was alarm- 
ingly profuse. 
Pulmonary consumption in the excavation stage was my diagnosis in this branch 
of the case, and my prognosis was—“INCURABLE.” 
My first treatment was directed toward the intermittent, the indigestion, and the 
leucorrhcea, giving only an anodyne cough mixture for the lung trouble. By the 
end of the tenth day the three first were controlled, and I then gave my attention to 
the pulmonary difficulty. I prescribed Gardner’s Syrup Hypophosphite of Lime, in 
dessertspoonful doses,* during the ensuing ten days, to be taken after meals—continu- 
*While in the above case, dessertspoonful doses seemed to have worked well, it is much larger 
than Churchill recommends. It would be advisable to limit the dose to from one-half to one tea- 
spoonful in such cases. R. W. G. 99 
mg the cough mixture, so as to control violent paroxysms of coughing, to which she 
was subject. After ten days of this treatment, the doses of syrup were reduced to 
one-fourth. She improved continually and rapidly. I saw her on the 27th inst., 
November, 1885, and she is to all appearances well. Her appetite and digestion are 
both good, bowels regular, no cough, and her weight is greater by a few pounds than 
ever before. 
She says: “I am not quite so strong as I was before my sickness, and I am a 
little short of breath in going up hill or up stairs.” I give her words. 
I feel that in placing your “chemically pure syrups” in the hands of the medical 
profession, you are a real benefactor, and I want to aid in bringing them into general use. 
Dr. Aureliano Maestre, de St. Juan, Prof, of Clinical Medicine, Univ. Grenada, 
Spain, gives the following as his conclusions, after testing the Hypophosphites inphthisis: 
First.—“The Hypophosphite of Soda or Lime must be perfectly pure. This is 
ole of the causes of the advantageous results I have obtained. 
Second.—The Hypophosphites must be given when tuberculosis is, so to speak, 
in an isolated state. 
When it is complicated with an accidental inflammatory state of the respiratory 
apparatus, this treatment, as we have seen, aggravates the condition of the patient, 
In such cases it must be immediately omitted, and again resumed as soon as the com- 
plication has disappeared. 
Third.—ln the treatment of pulmonary phthisis the Hypophosphites should be 
given alone, and without any other pharmaceutical preparation, otherwise their action 
will be impaired or prevented. 
Fourth.—The dose of Flypophsphites must not exceed a certain limit, beyond which 
they are likely to produce unfavorable results. The alkaline Hypophosphites are the 
best preparations hitherto known for the treatment of tubercular phthisis.” 
Dr. Parigot, Prof. Univ. Brussels, says in “Journal de Medicine de Bruxelles.” 
“I must say that I have only been completely successful when I was certain that 
the remedy was perfectly pure. * * * When the effects of the treatment have 
been once established, and the improvement of the patient has become well marked, I 
have often left off the use of the Hypophosphite of Lime for a few days, and have tried 
other modes of treatment, such as antimonials, opium, cod liver oil, either alone, or 
alternating with the Hypophosphites, but I have always been compelled to revert to 
the specific treatment, and have found the patients the better for my so doing. 
So far the treatment has not failed me in a single case.” 
Dr. Reinviilier, Paris, Courrier de Parie,’) says: “In the presence of the ad- 
mitted inefficacy of all former modes of treatment, I wished to make my experiments 
according to the rules laid down by Dr. Churchill, and to my great joy, almost against 
my own expectation, I succeeded in my first two attempts.” 
Six months later the same author writes: 
“Some months ago I mentioned the success I had obtained in the treatment of 
consumption by means of the alkaline Hypophosphites, and stated that I had undertaken 
a series of experiments upon a large scale, and would make known the results. lam 
now able to redeem that promise. 
I have collected a large number of observations, some of cases treated by myself, 
the rest from the practice of other physicians, and I may state that the phosphorized 
treatment, has been found useful in almost every instance. Not only have consumptives 
been cured in the first period of the disease, but also a large number of those who have 
gone through all the stages of this terrible malady.” 
J. R. Fraker, M. D., Marlboro, JV. V., under date of April 1, 1884, writes: 
“Through your kindness I obtained one single bottle of your syrup of Hypophosphite 
of Lime, with the view of securing its effects upon a boy eighteen months old, who had 
the peculiar eruption and enlarged lymphatic glands from birth, which were entailed 
from tuberculous parents, and said to have resisted every effort at amendment both in- 
ternal and external. On coming under my care, I forbad the use of all other remedies. and began the use of syrup of Hypophosphite of Lime prepared at your laboratory in 
doses equivalent to half a grain of the salt, three times a day. Before the bottle was 
half used, the boy had lost the characteristic shiny, pinched and pale expression, his 
appetite returned, the drowsiness disappeared, and cell nutrition had so improved that 
the eruption gave way to the healthy appearing cicatrix. No untoward complications 
were suffered from its administraton, as might be apprehended from discutients in 
matastasis to the lungs, brain, peritoneum, or any cerous tissue. On the whole, I 
regard the Hypophosphite of Lime as among the most valued combinations of phos- 
phorus.” 
On Oct. Bth, 1884, the same gentleman writes:—l will now add that I have had 
the Hypophosphite of Lime on trial since April, 1884, in numerous cases of lung diffi- 
culty, and in all, so far, have found it eminently satisfactory. 
I am now using it in both acute and chronic pulmonary diseases, and where the 
lung is not broken down by intense ulceration and suppuration, and tuberculous mat- 
ter, it seems to arrest the morbid process. I believe it to act as a powerful promoter 
fo tissue change, and when it fails to accomplish the restoration of the lung, it may be 
due to deficient excretion of waste products when the retention acts injuriously, pois- 
oning the system through absorption. This indication might be met by a diuretic 
eliminator to aid its removal. With this, the power of tissue change would be in- 
creased, multiplying the products of meta-morphosis, which result from the oxidizing 
effect of the remedy, giving increased appetite and fresh nutriment for the tissue, and 
thus act as a true tonic. 
Of the twenty-eight or thirty phosphorus compounds, I regard the Hypophosphite 
of Lime as decidedly the more efficient in its physiological effects. * * * * Hop- 
ing to give you many pleasant reports, I am yours, with many congratulations for your 
therapeutic success.” 
S. T. Lowrie, Lore City, Ohio, May 28, 1884, writes: 
“I received a small pamphlet from you some few weeks ago, in regard to Dr. 
Churchill’s modes of using Hypophosphites, and also in regard to the necessity for 
their purity, etc. 
Having abandoned the use of Hypophosphite compounds as worse than useless in 
tubercular diseases, I nevertheless concluded to try your preparations. 
The result has been so satisfactory that I am perfectly delighted over their use ” 
ARE HYPOPHOSPHITES OF VALUE IN TUBERCULOSIS ? 
The discovery of the characteristic bacillus of tuberculosis and the acknowledge- 
ment of its importance as a factor in the progress of the disease, has led many practi- 
tioners into a mistake. Their error is this. They have concluded that, since tubercle 
is a specific disease, depending upon the presence of the bacillus, therefore to kill the 
bacillus is to cure the patient. Hence the long array of germicides and the different 
methods of introducing them into the system, some of them valuable, but not suffi- 
ciently so, to justify entire dependence upon any one or all of’them. 
Away back of the specific germ—long before the bacillus has had the opportunity 
to invade and multiply in the tissues, we have a letting down of vital force—a depre- 
ciation of the power of resistance, or, as we are now told, a cell deterioration. I fully 
agree with Cohen, that, “The condition which makes the human tissues a receptive 
‘soil,’ a favorable ‘culture medium’ for the tubercle bacillus—that condition which of 
old was called ‘diathesis,’ and now ‘susceptibility,’ is itself a disease, a departure from 
the norm; and I believe it to be the most important element in the morbidcomplexus, 
WILLIAM PORTER, A. M., M. D., St. Louis, Mo. termed tuberculosis. It is the element requiring the greatest care in prophylaxis, the 
most intelligent and faithful treatment. Independently of the invasion of the microbes 
associated with tuberculosis, there is a disease to be treated, and if this disease be 
successfully treated, the microbes will come and go harmlessly.” 
Jaccoud has condensed the idea of this physical degeneration—or defective nutri- 
tion into one word, “hypotrophy,” “a defect in the constructive or tissue buildingpow- 
ers of the system.” Upon its recognition much depends. Certainly to antagonize the 
specific germ and ignore the fact that the tissues are in a receptive condition for a new 
invasion is a poor practice—yet we believe, a practice that is earnestly followed by some. 
Dennison, in a paper in a recent number of the Philadelphia Medical News, 
while advocating the use of tuberculin, insists that the action of the healthy living cell, 
is in exact harmony with the tuberculin, and that one directly antagonizes the bacilli— 
the other prevents their .reproduction and effects repair. 
Without fear of contradiction, it may be asserted that tissue building—the estab- 
lishing of healthy cell life—is the foundation treatment of every case of tuberculosis, 
not only in the incipiency, but in the advanced stages as well. 
This proposition is not antagonistic to the germ theory; rather has the knowledge 
of the existence and important role of the bacillus, led us to a better understanding of 
the necessity of proper nutrition . 
Nutrition is a sine qua non in all cases of tuberculosis. In some cases its neces- 
sity is more evident than in others; in acute cases, other needs may be more urgent, 
but the rule holds good, the tuberculous must be nourished. In “thin living and 
thick dying” we find tuberculosis a connecting link. Many accept this theoretically, 
but put it in practice but poorly. 
Feeding is not nutrition. The best of diet may not be assimilated—may do 
harm rather than good. The practice of stuffing, so honestly advocated by some 
authors not long ago, has been rapidly abandoned. Years ago every case of phthisis 
got a bottle of cod liver oil; now it is given only to selected cases. Nutrients are 
chosen which can be appropriated and food is given in such a manner and of such 
kinds as may easily induce complete assimilation. 
There must be a demand for nutrition before assimilation can be satisfactorily 
performed. There must be the ability to appropriate food that is taken, else the defec- 
tive cell in a remote part of the system will profit little thereby. Just here, I believe 
is an important point in the treatment of tuberculosis. The best of food and the 
most reliable nutrients are taken, and still the waste in many cases goes on. There is 
either want of assimilation or a want of gain from the process. 
There is need for “respiratory food” as well as that in the alimentary tract. 
Oxygen must be taken into the system and the cells empowered to use it in the nutri- 
tive changes which we aim to accomplish by proper feeding. Deep breathing—pneu- 
matic devices, and the inhalation of oxygen may do much to support this element of 
nutrition, but not infrequently the system seems as unable to appropriate oxygen as 
it is to utilize the food which passes through the stomach and intestines. Whether 
the lessening of tissue oxidation is due to a diminution of oxidizable phosphorus 
[Churchill], or to cell change, or to some other cause, the lessening of nervous 
energy is certainly a factor in the hindrance of oxidation and consequently of assimi- 
lation. Indeed, some authors (Holland and others) claim that pulmonary consump- 
tion is a neurosis. At any rate, if oxygen gets no farther than the alimentary tract, 
there can be no assimilation, no building up and tearing down, no hindrance of 
destructive change and repair of injury. 
To meet the conditions clearly indicated by poor assimilation and loss of energy 
so often found even in incipient tuberculosis, and for the reasons suggested above, I 
formerly prescribed one or another of the several preparations of the Hypophosphites. 
In some instances the result was good, and in others I was disappointed. My experi- 
ence led me to believe that the Hypophosphites as ordinarily used, did not constitute 
a very reliable remedy. 102 
I am now sure I made a mistake. For two years I have been using the single 
salts, chemically pure, as prepared by Mr. R. W. Gardner, and am convinced of this 
•—that while oftentimes in non-tubercular cases, the different salts may be given 
together for tonic effect, their combination should be avoided in phthisis. Quoting 
from “Hare’s Therapeutics, Yol. i, p. 847:” “The Hypophosphites of Lime and 
Soda are of service (in tuberculosis) as general tonics. The various wonderful com- 
plex proprietary Hypophosphites are less useful.” 
I would go further than this and use the Hypophosphite of Soda alone in cases 
where a direct tonic is needed, especially if the expectoration is tenacious. In com- 
bination with a suitable nutrient, it is especially applicable where there is destructive 
change going on in the lung. I have failed to notice increased temperature or excita 
bility from the administration of this salt, a result not infrequent when the compound 
salts are given. 
Where the expectoration is very free and exhausting, I have fancied that it was 
lessened when the lime salt was substituted for the soda. Be this as it may, it is well 
recommended to use the Hypophosphite of Soda for tonic effect, where the expectora- 
tion is not too free, and to replace it by the lime salt if the expectoration is excessive. 
The indications for the other salts are equally plain. The Hypophosphite of Potas- 
sium, where a tonic resolvent effect is wanted, but it must be remembered that in 
phthisis, rapid resolution is sometimes dangerous. The Hypophosphites of Iron or 
of Manganese may be safely used in incipient cases, especially where there is marked 
ancemia. 
I endorse the proposition made by many authors, that the Hypophosphites are 
valuable aids to oxidation and assimilation in tuberculosis, but submit that one salt 
when properly selected, accomplishes more than when a combination is used, in 
addition to which it is safer and its use more rational. I might cite a number of 
cases from my note book confirming the conclusions above given; indeed, these con- 
clusions have been made from the evidence offered by these cases. They must be 
taken for what they are worth. To me they suggest a better method of administering 
a class of remedies of known merit and in general use. 
NOTES OF A CASE OF INCIPIENT PHTHISIS SUCCESS- 
FULLY TREATED WITH GARDNER’S SYRUPS 
OF HYPOPHOSPHITES. 
MALCOLM GRAHAM, M. D., Jonesville, Mich. 
Mrs. B. American, aged thirty years, mother of several children—has gradually 
failed in health since the birth of her last child. Has a bad cough, night sweats and 
entire loss of appetite; has lost many pounds in flesh. There is some dullness at apex of 
right lung. The liver is three fingers wide, and there is constipation alternating with 
diarrhoea. 
I immediately put her on Gardner’s syrups of Hypophosphites, with such inter- 
current remedies as the system demanded. 
There was an immediate change for the better. The first improvement noticed 
was in her cough, then her appetite increased and there was no more loathing of food. 
In a short time she had ceased to sweat at night. Indeed, there was such a steady and 
permanent improvement in this, and in similar cases treated since, that I feel it my 
duty to recommend these Hypophosphite syrups in all cases of consumption, but 
especially in the incipient stage. 
Let me speak of the further use of these syrups of Hypophosphites in coughs, 
not ordinary coughs, but those racking, nervous ones, with little or no expectoration, except early in the morning. They upset the patient’s stomach, spoil his sleep and 
are the bete noir of the medical profession—at least I have found them so until I used 
Gardner’s syrups of Hypophosphites. 
July 5, 1890. 
PHTHISIS. 
J. C. WILSON, M. D., Morley, N. Y. 
I must say that I am greatly pleased with results obtained from treatment of a 
number of cases of phthisis with your syrups of Hypophosphite of Soda and Hypo- 
phosphite of Lime. 
Several cases of phthisis in first stage have come under my observation in the past 
few months, and in every case there has been no failure as far as I could learn; and, at 
any rate, there was so great improvement at once that most of them went from my 
care apparently cured. 
“Was called to attend Mrs. L in premature child-birth January 26th. 
Had never seen this woman before; was requested to examine her lungs on Feb- 
ruary Ist. At this time she was greatly emaciated, had an exceedingly bad cough, no appe- 
tite, with sleepless nights on account of cough. She told me that she had been cough- 
ing for over a year, and had gone through the usual treatment for phthisis and been 
“given up” by several physicians. My examination showed excavation occupying 
nearly the whole left lung, slight dullness over and just below right clavicle, other 
signs normal in right lung. 
At this time, February Ist, there was, as mentioned, extreme emaciation, profuse 
expectoration of a muco-purulent character, no rigors or night sweats, some fever 
with loss of appetite and extreme prostration. 
One-eighth grain doses of morphia at night were given at this time, which allowed 
some rest from the harassing cough. Hypophosphite of Soda (Gardner’s syrup) was 
commenced in dessertspoonful doses three times a day. 
February gth—Considerable improvement in strength of patient, but no gain of 
appetite, and the morphia was taken away from her this day. Patient passed two 
dreadful nights, but on the third day appetite returned, and she has had a good one 
ever since, to date, June 26th. 
February 14th—Says cough and expectoration are less, a little stronger, able to sit 
up in a chair for an hour or two, sleeps well and appetite good; treatment same. 
February 20th—She says she feels stronger, but sees no change otherwise; cough 
and expectoration same as at last visit. 
February 26th—No change in symptoms, and this day the syrup Hypophosphite 
of Lime was substituted for the Soda, dessertspoonful doses. 
March 1st—Found her in a greatly improved condition as to strength; able to sit 
up all day, with strength to take considerable exercise about the house; cough and 
expectoration much less, no great gain in weight. 
April 1st—Seems to have been a steady gain since last visit in all symptoms except 
no increase in weight. Treatment, Hypophosphite of Lime (Gardner’s syrup) one 
teaspoonful three times a day. 
June 26th—Examination of lungs to-day shows continued excavation of left lung, 
no abnormal signs about right lung, ail dullness having disappeared. 
Results of Treatment.—Nearly entire cessation of general symptoms, though 
from her being from a child frail, we could not hope to make a strong woman of her. 
She now goes some distance away, so that she will be out of my observation for some 
time. She is directed to continue same treatment, viz., teaspoonful doses of syrup of 
Hypophosphite of Lime three times a day. She has within the last two weeks gained several pounds in weight and has some 
courage, the lack of which has been a sad drawback all through the treatment of the 
case.” 
October 29, 1891, Dr. Wilson writes: “Had I known that my notes would have 
been of use to you, I could have saved the record of many interesting cases treated 
in the last few years with your preparations. 
One was a case of undoubted tuberculosis—pulmonary—which was treated with 
the syrup of Hypophosphite of Soda, the case being in the first stages. 
This young lady was cured of the lung trouble, but after two years of good 
health the disease comes back on her in the form of a tubercular disease, affecting the 
lower end of the left humerus and the lower part of the spinal column. 
Had I made notes of the case, it would have been interesting for many reasons; 
one, especially, the certain character of the lung trouble, and that both from the 
symptoms and the family history, viz., death of the father from tuberculosis and of 
one sister since the time I first saw this case.” 
PHTHISIS, ASTHMA. 
P. J. BAILEY, M. D., Dawson, Ky. 
I have been using your syrup of Hypophosphite of Soda and syrup of Hypo- 
phosphite of Lime in cases of phthisis pulmonalis, and your syrup of Hydriodic Acid in 
asthma, with success. I have at this time five cases of phthisis pulmonalis, all im- 
proving when last seen. 
Case i.—ls about well; he is going about attending to his ordinary duties. This 
was a case of four years’ duration. He is well except a little cough in the morning 
and a slight shortness of breath when walking up hill. 
Previous to treatment he had five or six haemorrhages from the lungs, and has dis- 
tinct cavity in right lung. I have never given more than seven and a half grains per 
day, and but one salt at a time, and have never produced pathogenic effects as yet, 
Case 11.—Asthma. Lady aged 23 years; duration, from childhood; worse when 
catemania appeared; disease of a spasmodic character; attacks about every two weeks, 
and lasted from one spell to another, but very bad only for two or three days. 
She has had only one slight spell since treatment and is now quite well, has gained 
eighteen or twenty pounds in weight and gone to work after being helpless for four or 
five years. I consider your syrups, used according to Churchill’s methods, the only 
treatment offering the slightest hope of success in consumption. 
I shall use your syrups and no others unless they fail me in the future, for I have 
nothing to fall back upon that would afford even temporary relief. I congratulate you 
upon the high character and chemical purity of your preparations.” 
PHTHISIS. 
“I have used three bottles of your syrup of Hypophosphite of Soda in a case 
(phthisis) and am glad to report steady improvement under its use, though it has not 
Seen used long enough to say with certainty what amount of benefit will finally 
be derived. 
WALTER M. DARNELL, M. I)., Belton Texas. 
I have used three bottles of syrup of Hypophosphite of Lime in an old chronic 
case in my practice, and I must say with the most flattering result, the patient having 
gained fifteen pounds in weight in ninety days.” NERVE FEEDING. 
the hate WILLIAM F. HUTCHINSON, M. D.. Providence, R. I. 
(Published by the New England Medical Monthly, December, 1892.) 
I am desirous of placing on record the experience of a few years past in that 
branch of therapeutics which I have for some time designated by the title of this 
paper. 
If the nervous system is sufficiently normal in status to assimilate for ordinary 
food its special pabulum, and waste is duly balanced by repair in the correct way, 
there is nothing to say. Were this specially happy condition common to modern 
mankind, neurologists would forthwith adopt some other way of earning a livelihood, 
and their example would be followed by a large majority of their colleagues. 
Unfortunately, such delightful prospect is nowhere in existence; on the contrary, 
human nerves grow more and more demanding, respond more slowly to treatment, 
and grow old faster with each ten years of advance in the push and hurry which 
characterizes the epoch in which we live. So we are compelled to seek in every direc- 
tion for such forms of artificial or concentrated food, as will supplement that ordi- 
narily consumed, so as to make up deficiency in nervous supply, and keep our patients 
going. ■ 
They will not lead normal lives; to rest they are not inclined; to stop and be still 
for a year is simply out of the question. 
In every case of nervous insufficiency, a term which I prefer to Beard’s word 
“neurasthenia,” there is a failure of digestion. Certain foods do fairly well; but they 
are void of principles needed for nervous supply. There is even a steady increase in 
weight wuth many of these sufferers; and some of the most hopeless of my patients 
who are nervously insufficient, are fine looking, buxom persons, who get no credit 
from friends as invalids, and who suffer almost as much from the derision of those dear 
to them, as with their physical disease. 
All the time there is a steady loss of resisting power; resiliency is more and more 
impaired, and while no actual organic disease of centres can be detected, there is a 
profound malaise, an increasing lack of tone, which subjects the unfortunate invalids 
to more severe discomfort than many whose days are numbered by organic central 
decay. 
I have of late found it best to direct the diet of these patients with rigid care, and 
to arrange it in such proportions of oxygen and nitrogen that the former shall be con- 
siderably in excess, watching excreta carefully to learn if one or both are assimilated in 
excess, and supplying deficiencies that arise by addition of what is needed. While 
kidneys continue to eliminate phosphates largely, and the patient steadily loses 
ground, for example, it is necessary to supply phosphorus, or stop waste thereof. I 
have more than one case at present where I have vainly attempted to arrest such large 
proportion of Jirinary phosphates, and have been forced to supply the loss by adding 
phosphates to daily food. In one of these patients, there had been for years a steady 
loss of nerve fpne, an increasing insufficiency, accompanied with sciatica and general 
.debility, without loss in weight and careful measurements fail to show any decrease of 
muscle strength. Yet there is a sense of inability to conduct business, a feeling of 
fear of unknoym or impossible occurrences, and steady mental depression which is far 
harder to bear, than actual organic disease, and Mr. 8., is an object of pity. Urinary 
analysis gives a specific gravity of 1008, and the sole abnormality present, a steady 
■excess of earthy phosphates. 
Now it is my opinion that when such waste cannot be arrested, and I have thus 
far failed to do so with Mr. 8., the only other way of meeting the loss is by artificial 
supply, and the question arising was what preparation of phosphorus to employ. I 
have found the element itself so difficult of combination in stomachs weak in oxygen, that I have abandoned its use, and for years was in the habit of employing 
metallic phosphides, until I discovered that these two were rarely well borne, and have 
finally decided upon preparations of Hypophosphites as at once most agreeable, most 
readily assimilated and most efficient. It is only necessary to have them fresh, for all 
these oxygen compounds decompose more readily than most other preparations. This 
quality of stability I have found more to be depended upon with Gardner’s syrups of 
Hypophosphites than with any other, and am so contented with results obtained with 
his goods, that I use no other. 
They are palatable, efficient and reasonable in price. lam amused sometimes at 
the remarkable swiftness of their physiological action. One of my patients, a nervous 
lady from Georgia, comes to my rooms daily in depths of despair; “Doctor” says she, 
‘‘ I might as well give up and go home, I have been worse than ever, and want to cry 
all the time. Oh! what shall I do?” 
My assistant brings her a dose of Hypophosphites, she drinks it, and in half an 
hour is smiling, bright and quiet again, ready for her electrical seance, and all right 
for another day. 
And this is not a singular case. 
I am glad to say these few things to my colleagues who are not specially familiar 
with the action of Hypophosphites in nervous diseases, and heartily recommend them 
to give the remedy a trial. 
DENTITION. 
“I have used your syrup of Hypophosphite of Lime in the case of Little Effie 8., 
who has suffered greatly with difficult dentition. Cutting teeth has been slow and 
painful to her, but since taking the lime her teeth have come through without any 
trouble. The diarrhoea attendant with dentition, I find is no trouble while taking 
the lime. The therapy of your lime is undoubtedly as you give it.” 
C. C. STEPHENSON, M. D., Little Rock, Ark. 
THE SINGLE HYPOPHOSPHITES IN DEFECTIVE NUTRI- 
TION OF BONE AND NERVE TISSUES. 
By LEWIS G. PEDIGO, A. M., M. D., Crockett Springs Sanitarium, Va. 
Of all the varied uses of the Hypophosphites, none are more interesting to me 
than their employment to meet certain faults of nutrition in the osseous and nervous 
systems. I group these two departments of the human organism roughly together 
here, because my attention was directed to them in this connection by certain rational 
considerations. In the chemical constitution, the growth and maintenance of both, 
phosphorus plays a very important part. So it was inferred that in certain pathologi- 
cal conditions of either, especially when characterized by defective nutrition, the use of 
phosphorus in some convenient and easily assimilable form, is the primary and essen- 
tial indication of treatment. 
(Reprinted from Journal American Medical Association, Jan. 20, 1894.) 
The various clinical trials of this opinion in practice for several years, has amply 
justified and sustained the inference. My readers are probably familiar with the use 
of these remedies in cases of delayed teething in children. Aside from this familiar 
use, my cases have embraced instances of defective bone development in children and 
a certain low type of subacute and chronic inflammation, occurring in the bony and 
periosteal tissues of scrofulous or badly nourished patients, as the result of a blow or 
injury. It must be borne in mind, in these cases, that the predisposing cause is the 107 
state of defective or perverted nutrition. The same traumatism which in such a con- 
stitution, would cause a troublesome, tedious and prolonged inflammation, would pro- 
duce a very slight local effect in a vigorous, healthy subject. The course of such a case 
under the usual treatment is very unsatisfactory. The periostitis shows little tendency 
to recover, and the bony tissues, so dependent on healthy action of the periosteum, 
manifests a tendency to disintegrate. As a result, we have a case of hip-joint disease, 
or Pott’s disease, or some other orthopoedic affection, with the prospect of a long 
special treatment, and an endless array of plaster jackets, splints, &c., &c. 
Recognizing and appreciating all the good to humanity and to science that has 
been accomplished by the modern orthopoedic surgeon, (and it is much,) it is plainly 
the duty and province of the general practitioner to arrest the progress of these cases 
in the earlier stage, if possible. In my own experience, the Hypophosphites offer the 
best means of relief in this incipient period, and, in some cases, almost the only hope 
of resolution of the imflammatory process. If I might be pardoned the presumption of 
making a suggestion to a specialist in his own field, I would say to the orthopoedic sur- 
geon, that he could not do a better thing, even after this ugly inflammation has reached 
that stage in which the tissues break down and deformity results, than put his patient 
on Hypophosphite of Lime as adjuvant to his special surgical measures. Judging by 
its effects in other fields, and in the first stages of the class of cases under consideration, 
it would impart more vitality to a failing system, furnish some much needed elements 
to the organism, and promote healthier action and a tendency to repair in the affected 
tissues. For obvious reasons the Hypophosphite of Lime is the particular salt to be 
used in all injuries and inflammations of bone and periosteum. 
With no intention of entering into an elaborate review, I recall one case suffi- 
ciently typical to exemplify my meaning. 
A girl, thirteen years of age, was thrown from a horse, falling on her side, so that 
the left thigh struck the apex of an angular rock. Some lameness resulted—obviously 
associated with an injury to the femur near the great trochanter. A slight depression 
in the bone could be felt at this point. Inflammation, swelling, redness, followed, 
with considerable deep-seated tenderness and pain on walking. This condition was 
temporarily improved by counter-irritation—use of iodides and various other remedies. 
Sut there was a constant tendency to relapse, especially in damp, depressing weather, 
with east winds. The case was becoming chronic, the general health failing, the 
affected parts threatening a chronic abscess, with more or less disastrous effects upon 
the integrity of the bone and the future usefulness of the limb. The parents were 
justly and reasonably alarmed, because one bad case of hip-joint disease had occurred 
in the family, as a result of a similar injury. A scrofulous taint was suspected. The 
patient was directed to take a teaspoonful of Gardner’s syrup of Hypophosphite of 
Lime, three times a day, with no other treatment, except rest, suitable diet and 
hygienic precautions. Improvement began with surprising promptness—considering 
the peculiar nature of the tissues affected and the usually slow processes which charac- 
terize them. The most striking feature was the control of the pain which the remedy 
seemed to exercise. Of course this was not a direct anodyne influence, but was effected 
through a modification of the imflammatory processes. The case went on pretty 
steadily to a good recovery. It is significant that the patient observed the pronounced 
change in the case as co-incident with the change of treatment, and expressed herself 
as feeling safe, so long as she was taking this remedy. 
As to the other class of cases alluded to above, I shall present the essential history 
of only one—which is sufficiently typical of a large number, to answer the purpose of 
illustration. 
A child, male, aged sixteen months, was suffering with diarrhoea and indigestion— 
associated with difficult and delayed dentition. The gums were red and swollen; 
teeth were developing slowly which should have appeared about the seventh month. 
The anterior fontanelle was very large,relatively larger even than it should have been at 
birth, showing retarded and defective development of the parietal and frontal bones and indicating a general faulty nutrition especially of osseous tissue, both in the foetal 
and infantile periods of life. The general appearance of the child was extremely bad. 
It was ill-nourished, emaciated, pale, feeble and irritable, with loose, easily wrinkled 
skin, and a bad complexion. A treatment was adopted for the temporary relief of the 
dental irritation and diarrhoea, and a prolonged course of syrup of Hypophosphite of 
Lime was directed, with no other medicinal treatment. I did not see the patient again 
for six months. (The family lived some distance away). At the end of that time the 
mother brought the child to me, not for any professional service, (which was obviously 
not needed,) but for exhibition. The improvement was beyond all anticipation. The 
fontanelle was almost entirely closed, the teething process had gone on without irrita- 
tion of any consequence, and had progressed much more rapidly, and the gereral con- 
dition was so much better, that no one could have identified the child. It was plump, 
well nourished, of good, clear, rosy complexion, and evidently felt comfortable and in 
a good humor with the world— a symptom of great significance in these cases. 
I have spoken of this case as a typical one, meaning that it represents a class of 
cases which in my experience have been conspicuously benefited by the use of the 
Hypophosphite of Lime. 
I must say, however, that the brilliant results of treatment in this instance, must 
not be expected in every case. It is somewhat above the average in this respect, and 
therefore not strickly typical in this sense. But its history exemplifies and illustrates 
principles of treatment that will hold good in all of the class of cases to which it belong. 
Under the second division of my subject, viz.—the use of the Hjqpophosphites as 
nerve nutrients, it is my purpose to confine myself to one case, viz., a specific gum- 
matous tumor of the brain. 
The patient, a bright mulatto, aged twenty-six, stout and generally healthy in 
appearance, gave a distinct history of syphilis. At the time he came under ray obser- 
vation he was troubled with aphasia, with partial paralysis on the right side, walked 
imperfectly—scraping the floor lightly with the sole of the right shoe. He could be 
sent to take a note,(not a verbal message,) could go to any portion of the town, find 
his way without difficulty, but could not remember the names of the streets. He was 
sent after cows on the commons, and he would get the right ones, but could not tell 
their names, and if he attempted to throw a stone at any of them it dropped within two 
or three paces of his feet. The left hand and arm were much stronger than the right. 
He was obstinately constipated. 
The case was vigorously treated with large doses of iodide of potassium, and small 
doses of mercury biniodide, with some attention to digestion and state of the bowels. 
The iodide was given in increasing quantities until a dose of sixty grains, three times 
a day was reached. This was continued for a period of about a week or ten days, alter- 
nating with short periods of suspension of the remedy. 
The effect was good, and improvement began and continued for months; the 
paresis was better, the mind was clearer and more vigorous; the strength and power of 
endurance increased, and the aphasic symptoms yielded perceptibly. After some 
months of this treatment, the case seemed to come to a standstill—the improvement 
reached a limit. Now it was considered safe to begin a restorative treatment, on the 
theory that the iodide had done its work of liquefaction and absorption of the tumor faith- 
fully and well. The patient was placed on q. small dose of tincture of nux vomica, 
(ten drops) thrice daily before meals, and the effect carefully watched. It produced 
some irritation of the brain—cerebral hypersemia and evident aggravation of all the 
symptoms. It was withdrawn promptly and the former treatment resumed for another 
month—with a few doses of bromide of sodium at first, to control the untoward effect 
of the nux vomica. After a month the nux vomica was again cautiously tried, and this 
time with good effect. 
The symptoms—mental and physical—all improved somewhat, and no irritation 
supervened. After a few days another measure was added to the treatment, viz., the 
use of a teaspoonful of syrup of Hypophosphite of Lime, thrice daily, after eating. 109 
The effect of this step was perceptible in the decided improvement of all the 
symptoms. I continued the use of the Hypophosphites in this case for several 
months, watched the effects carefully and with intense interest. I had dispensed 
from my office only two ounces of the syrup of the lime salt in the first place, so it 
was soon exhausted. When the patient returned I found I had no more of that prep- 
aration, but had a remnant of syrup of Hypophosphite of Manganese. I substituted 
this and found, to my surprise, that it seemed to act more favorably than even the 
Hypophosphite of Lime. When this remnant was exhausted, I returned to the use 
of the lime, however, and the patient noticed the difference in his condition. 
He insisted that I give him “the same medicine that he got the other time,” 
which I did, and with the same result. His neighbors and friends remarked upon 
the mental improvement—-the family reported that he could begin to work better and 
remember messages more accurately, and the patient said he could “learn and recite 
his Sunday school lesson better.” I had ample opportunity to watch this case closely, 
and to differentiate the effects of the various remedies used at different times, and my 
conclusion is that the single Hypophosphites were decidedly efficacious in the latter 
stages of this case. 
The theory which led me to their use may be stated as follows; 
In cases of gummata of long standing the contiguous parts of the brain are sub- 
jected to constant pressure, interfering seriously, not only with their functional activ- 
ity—but with the nutrition of the cells and fibres which enter into their structure. 
After the gummata have been partially or fully absorbed under the influence of the 
heroic doses of iodide of potassium, so that the brain tissue has the opportunity to 
expand again to something like its normal size and shape—these depressed, starved 
and dwarfed fibres and cells need some restorative remedy, some special nerve 
nutrient, to assist in this development. Nothing so naturally suggests itself to the 
medical mind, for this purpose, as phosphorus in some available form. As the single 
Hypophosphites is my favorite preparation of phosphorus for almost all its uses, I 
prescribed them in this case, with the results recorded above. 
I have reason to believe the effects can be duplicated in other similar cases. 
In an old case, as this was, even when it first came to me, the physician must 
not expect too much of any remedy. Parts of brain structure have been absorbed 
under the long continued pressure. Other parts, even though remaining, have been 
so damaged that their integrity cannot, probably, be fully restored, or their functions 
rendered strictly normal. In conclusion, let me warn any reader who feels sufficient 
interest to test the matter—not to begin the restorative treatment too eaily in the 
development of the case. 
ARTIFICIAL RECONSTRUCT IVES 
By C. E. BOUM, M. D., Providence, R. I. 
(Published by New England Medical Monthly, January, 1893.) 
It may seem strange that a term like this should be chosen as title to a paper 
upon the simplest and most obvious forms of chemical foods. 
All reconstructives are in a certain sense artificial, when not obtained in the 
ordinary diets, by which the human race is accustomed to avert the results of destruc- 
tive metabolic change. 
In another sense no reconstructive is artificial when either or any of its basic 
compounds enters into the normal structure of our tissues, yet, while the accustomed 
food contains a sufficiency of what is necessary to prolong life, there are times when 
certain elements in normal combinations cannot be assimilated and a demand is made 
for extraneous aid. It is then that the judgment of a sagacious practitioner is called 
upon to decide what portion of the system needs this assistance, needs, in fact, to be 
reconstructed. Among the elements that are wasted faster than supplied when the system is 
below par, are chiefly to be found those which are absorbed with difficulty in normal 
condition and contained in small quantities in normal food. I refer to the mineral 
constituents of the blood, which are lost with ease, regained with difficulty. In order 
that a healthy balance may be reached after it has once been disturbed by disease, it 
has been ascertained by experience that the lacking material must posses certain qual- 
ities in the remedies given in order to assure digestion and assimilation. 
These are first, agreeableness to the palate, since nothing is more repugnant or 
less to be borne than distasteful, nasty medicine. Next, stability of combination, for 
in what form we administer artificial food it may be kept up for a long time in order to 
do much good. It must be in concentrated form, as when medicines are to be con- 
tinued, the smaller the dose the better. 
Now let us see for a moment, which of the mineral constituents of the blood are 
soonest lost and remain longest absent, when the stomach and digestive tract are de- 
barred their use by disease. The rich rose-color of the healthy cheek indicative of free 
circulation of blood well loaded with iron, slowly gives place to sickly pallor as that 
metal is withdrawn, while bleached lips and colorless ears bear witness to the loss. 
Slow, sluggish movements of the body once so agile, of lethargic mental processes in 
the brain once so quick to respond, together with neuralgic pains flying here and there 
like red hot arrows, from a heated bow, signal loudly and plainly, disappearance from 
the economy of its chief vitalizer—phosphorus. 
We have essential need of two of our artificial reconstructives, iron for the blood, 
phosphorus for the nerves. 
It is very true that iron is by no means the only constituent of the blood that is 
withdrawn when disease begins, but it is almost alone in being easily abstracted and 
slowly replaced. Each inspiration of pure air that fills the lungs oxidizes this metal 
with which it comes in contact by endosmotic action in large quantities and more 
rapidly that it can be supplied when absorbents refuse duty or are sluggish. With 
phosphates the case is somewhat different, they are poured out from the system in 
increased quantities whenever a slight deviation from normal disturbs equilibrium. It 
is a common thing to find phosphates in large excess in urine after so small a disturb- 
ance as that of a slight cold, their union with the blood being unstable. It is therefore 
necessary in medicating patients who are anaemic to give such remedies as are properly 
proportioned, if compound, to the lack of vital stimulants that we believe to exist. 
Now phosphorus alone has been found by experience to be illy fitted for continued 
use, it is neither easily absorbed nor pleasant to take and must therefore be combined 
with oxygen and water. It is thus that our good friend, Mr. Gardner, prepares his 
famous syrups of Hypophosphites of alkalies and metals. 
llypophosphorous acid consists of one equivalent of phosphorus, one of oxygen and 
two or three of water, with a strong affinity for more oxygen, which property it carries 
with it when administered as a medicine. 
By its great power as a deoxidizer it retards cellular combustion and permits vital 
processes to proceed regularly. Dr. Churchill, Paris, called attention to these salts 
in 1856, and claimed that they were of infinite advantage in the treatment of consump- 
tion, even long before Mr. Gardner had discovered his valuable method of combining 
them. 
These new preparations at once assumed a leading position in modern pharmacy, 
and stand to-day unrivaled among its products for effectiveness, stability, and elegance 
of form. 
They number more than twenty different combinations so that it is practically out 
of the question that a practitioner should not find in one or the other the elements of 
tissue building which he seeks. 
For more than a year past I have followed with interest and care, the administra- 
tion of Gardner’s preparations and with a single exception, to be hereafter noted, the 
results have been good and their administration effective. So much so indeed, that I "have arrived at the conclusion that no better form of nerve food or artificial reconstruc- 
tive need be sought. It is my purpose to close this paper with a series of pictures of 
cases whose only medical treatment was by Gardner’s syrups. 
Case i.—Miss D., aged 52. In April of 1891, had an attack of grippe which 
lasted about three weeks, again in October of the same year, had another slight attack. 
In June of 1892, was taken with rheumatism in the knees, which steadily increased. 
Appetite good, slept well, no pain in back, but considerable headache over brows. 
With electrical treatments was ordered Gardner’s Hypophosphite of Soda which was 
continued for about two months with steady improvement. At the end of that time 
the soda was changed for Hypophosphite of Iron which was kept up until her dismissal, 
a comparatively well woman, in April of 1893. 
Case ii.—Mr. H., aged 34. About a year ago, upon examination of inner right 
thigh a slight tumor was found, about the size of a hen’s egg, movable under the skin, 
with occasional acute pain following nerves down to and around the knee, starting from 
the groin. The growth increased up to last March, when it had attained the size of a 
child’s head, and was removed by Dr. L. P. Pilcher, of Brooklyn, who pronounced it a 
semi-malignant tumor, containing a certain amount of fluid. Since the operation he 
has been gradually losing tone. Suffers some from pain in line of incision, with stiff- 
ness of muscles increasing with exercise. In May last was ordered Gardner’s syrup of 
Hypophosphites of Lime and Soda, taking for one month syrup of Hydriodic Acid. In 
June the enlargement in line of scars absent, and the general conditions were much im- 
proved. Changed the compound to Hypophosphite of Iron. The progress has been 
rapid, the stiffness is giving way, and strength is increasing. 
Case hi. Mrs. M., has never been strong since marriage and within a year has 
broken down with mental overstrain. Has great weakness and general nervous 
debility. Appetite poor, sleeps fairly, hands and feet cold, pulse fair. Has been since 
May taking syrup Hypophosphites of Iron and Quinine with excellent results. Later 
a uterine trouble come up for which a solution of white oak bark and glycerine is being 
used as a tampon while the syrup of Hypophosphites of Iron and Quinine is still being 
taken as a tonic. 
Case iv. Master L., aged 11. A little over two years ago, while at breakfast, 
had a convulsion which lasted some ten minutes, followed by sleep, and after an hour 
or two, vomiting of undigested food. No aura epileptica of any kind. Pallid face and 
pale lips covered with hot scabs. Epilepsy, minor form of indigestion. A careful 
diet list was ordered, laxative antiseptic pills and the bromides. After about one 
month of this treatment Gardner’s syrup of Hypophosphite of Iron with syrup of figs 
was given. The improvement has been rapid, incurring but two or three convulsions 
since he began treatment, and these being caused by not carefully following the diet given. 
Case v. Miss R., had some three months ago caught a severe cold and had a 
sharp attack of grippe. Upon presenting her case to her physician he prescribed 
Gardner’s compound of iron and quinine, a tablespoonful to be taken four times a 
day. After taking twelve ounces of the syrup, she returned for more, saying, “Doc- 
tor that medicine seemed to be the right thing. I have not eaten as much at my meals 
for a year and I feel like anew woman,” which she certainly looked, with her bright 
eyes and glowing cheeks. 
Another bottle was given her and after she had taken four she was entirely free 
from all effects of the health-destroyer grippe. 
Case vi. Only one case do I call to mind where the Hypophosphites have not 
done good. 
Mrs. 1., a pretty little woman of twenty, came from New Hampshire, in April of 
1893, for medical care. Two months before had neuralgia in the head and was under 
the care of a charlatan, steadily growing dizzy and deaf. 
After three days of sharp electrical work she could hear very faintly a watch tick 
at a distance of two or three inches from her ear. At the end of a week she could 
hear it at a few paces away, the dizziness had gone but she had very little strength, no appetite and was constipated. Gardner’s syrup of manganese was ordered but the 
dizziness and deafness returned and she began to feel great nausea. After two or 
three days she could keep no food whatever upon her stomach and a diarrhoea set in. 
In place of the manganese, Hypophosphite of Iron was given with scarcely better 
results. 
Again the syrup was changed, this time to iron and quinine; the results were 
almost magical when combined with electrical treatment, and by the first of June she 
left the city a happy, well woman. 
I hear from her occasionally and she always speaks of “Gardner’s syrup” and 
“electricity” as being the cause of her restoration to health. 
Case viii. Master Willie L., age 15, from his boyhood had been lame, owing to 
undeveloped flexor of thigh muscle. 
He had been under electrical and other treatments by different physicians ever 
since. Last winter he came to me for electrical treatment and in combination with 
the sittings has taken the syrup of Hypophosphites with good results, gaining strength 
and weight rapidly. 
Enough has been said, I think, to show some of the good the syrups of Hypo- 
phosphites, manufactured by our friend Gardner, is doing. 
THE VALUE OF THE ALKALINE HYPOPHOSPHITES IN 
BUILDING UP THE HEALTH OF DELICATE 
AND WEAKLY CHILDREN. 
Q. CINCINNATUS SMITH, M.. D., Austin, Tex. 
That this class of patients should receive the benefit of the best food and hygiene 
obtainable goes without saying. However, it often occurs, in the care and treatment 
of delicate and weakly childien, we feel impelled to invoke the aid of drug-remedies. 
We have been often called to prescribe for delicate and feeble children, many of 
whom do not assimilate food in sufficient quantity to grow strong and vigorous, as they 
naturally should. In many of this class of cases, (after relieving urgent symptoms, if 
such be present,) we have learned of no better remedies than the Hypophosphites of 
Lime and Soda. These we prescribe, one to three grains, in the form of well made 
syrup,* three times a day, at meal time. We never give but one of the Hypophos- 
phites—for any medicinal purpose—at one time. 
The mixing of the Hypophosphites is a grave therapeutical error committed by 
many well educated physicians. We often alternate the use of the Hypophosphites 
of Lime and Soda in this class of cases; gice the soda salt two weeks, then withhold 
the remedy one week, then give the lime salt two weeks. 
And if the patient be strumous or syphilitic; as such patients often are, the syrup 
of Hydriodic Acid should be given—half to one small teaspoonful, three times a day, 
half hour before meals, during the intermediate week—when the Hypophosphites are 
not being adrainisteied. 
Should an acute attack supervene during the chronic treatment of this class of 
cases, the use of the Hypophosphites should be discontinued until convalescence is 
established, then the Hypophosphites resumed and continued until the patient is well 
and strong; which will require, in many cases, diligent use of the remedies for several 
months. 
(Reprint from Texas Courier and Record of Medicine, Dec. 1893.) 
*Dr. Smith has used Gardner’s syrups of Hypophosphites, exclusively for many years. R. W. G. These remedies are all very pleasant to take, when given in the form of well-made 
syrup, and will, in many cases of chronically delicate, weakly children, produce bene- 
ficial results that cannot be so surely and pleasantly secured by an)’ other class of drug- 
remedies. These remedies, when given in proper doses, do not perturbate the system 
in the least, and can be taken for long periods of time without becoming distasteful to 
even the most delicate patients. 
PULMONARY TUBERCULOSIS. 
Dr. J. T. Wrightson, Newark, N. J., writes giving the following interesting par- 
ticulars of an undoubted case of inherited pulmonary tuberculosis. 
“ Father died (tuberculosis) at 35 years. Four children died before 17 years of 
age. Last child came to meat 16 years of age. Had all the symptoms of phthisis, 
none missing. Her stomach in irritable condition. Could not take the syrups. Pre- 
scribed the elixir Hypophosphite Lime, Soda, Iron and Potassium (Gardner’s) which 
was borne readily by the stomach, and patient immediately commenced to improve. 
She eventually recovered completely, married, moved to Connecticut, and now has a 
family.” 
Dr. A. Ostertag, St. Louis, Mo., February 27, 1889, writes: “I must say thatl 
have been very much pleased at the change it (Gardner’s Syrup Hypophosphite of Lime) 
has worked in the physical signs in the lung in a case of chronic tuberculosis, following 
a severe chronic diarrhoea of four years’ duration, and in his cough, which harassed 
him day and night and was draining the life out of him.” 
THE TREATMENT OF PULMONARY TUBERCULOSIS. 
JOSEPH M. PATTON, M. D. 
Professor Internal Medicine Chicago Polyclinic. 
(Reprint from Chicago Medical Recorder, May, 1893.) 
On an occasion of this kind, consideration of such a question as the therapeutics 
of pulmonary tuberculosis must necessarily be brief. 
The great amount of experimentation and discussion devoted to this subject 
during the past two years, renders a thorough review of the subject at this time 
impossible. 
The discovery of the tubercle bacillus as a specific element in the etiology of 
this disease, taken in connection with the inoculation experiments of Pasteur with the 
cholera germ; Charrin with the bacillus pyocyaneus; Roux and Yersin with the 
Loeffler bacillus of diphtheria; Brieger and Fraenkel’s experiments with the same 
bacillus; Hankins and Sidney Martin with the toxines of anthrax cultures, seemed to 
furnish good ground for the enthusiasm which greeted Koch’s announcement of his 
antidote to the tubercle bacillus. The practical failure of tuberculin so far, as a 
specific remedy for tuberculosis has confirmed the doubts of those whose actual clinical 
experience in the management of phthisis caused them to hesitate before accepting 
the claims made for this agent. 
It is claimed by some that the reaction against tuberculin has gone too far, and 
Klebs, Plunter, Kinnicut, Beach, Dennison, Thorner and many others have reported 
results with tuberculin or some modification of it which are more or less favorable. 
Read before the Chicago Medical Society. Nevertheless it does not appear that their results are any better than can be obtained 
by other methods of treatment, and until such is the case, no special claim can be 
substantiated for this remedy. It is, however, yet too early to pass judgment in this 
matter. 
The introduction into the system of substances which inhibit chemically the life 
of the specific bacillus of the disease, and antagonize the effect of the toxines result- 
ing from the life activity of microorganisms, is theoretically an inviting method of 
therapeusis. The observations of Armand Ruffer relative to the action of lymphocytes 
and microphages, bring up the question as to what extent such chemical treatment may 
be carried without interfering with the natural therapeutic effect exhibited by the 
biological processes of these cells. Specific effects from agents of this class introduced 
into the system, must be obtained in one of these ways; by destruction of the bacillus 
by antagonizing the evil effects of the bacillus, or by stimulating cell activity, and 
possibly by increasing the germicidal power of the bodily fluids to convey immunity 
against gross pathological changes in the lungs, or by such cell stimulation inducing 
connective tissue changes in the pulmonary tissue. In the light of the experiments of 
Roemer and Buchner, which open the question as to whether protein extractives 
derived from other sources that the tubercle bacillus, may not be able to produce 
irritation, inflammation, and necrosis; also the experiments of Frudden to the effect 
that an element of the protoplasm of dead bacilli possesses great cell stimulating 
power, the resulting lesions not having the active tendency to necrosis exhibited by the 
tuberculous lesions, together with the opinion of most observers that the practical 
failure of tuberculin is due to its tendency to produce tissue necrosis, we are still 
justified in hoping that further experiment will eliminate the peculiar destructive ele- 
ment from this agent, and will leave us a substance capable of producing definite 
therapeutic results. It seems most reasonable to expect these results through the 
induction of connective tissue changes through cell stimulation, at least in those 
instances where gross tissue changes have resulted from the action of the bacilli. 
Klebs insists on the fact that tuberculocidin does not induce any inflammatory or 
necrotic process, and acts only through its germicidal qualities. 
When any considerable tissue change has taken place in the lung, the term cure 
can only be used in a relative sense, the lung can never return to its former condition, 
and the respite from further destruction depends on the extent to which nature will 
limit the process by connective tissue organization. These cirrhotic processes in 
tuberculous lungs, must be regarded as nature’s efforts to limit the disease. 
Councilman’s view, that because bacilli are found in the inflammatory tissue 
surrounding tuberculous masses, this tissue must therefore be part of the tuberculous 
process, does not seem to be well taken. 
There is less tendency to necrosis in tubercular nodules where fibroid develop- 
ment has been marked, providing the blood supply has not been cut off, as shown by 
the better vitality in these nodules where Cornil and Ranvier were able to demonstrate 
blood vessels. 
The fact that lungs have undergone fibroid development from other than tuber- 
culous causes, are especially liable, in some instances, to secondary tubercular infec- 
tion, does not militate against this view of the protective nature of these indurative 
processes. Cardiac hypertrophy is nature’s remedy for insufficient force, and yet this 
very hypertrophy entails of itself in time, insufficient nutrition and degeneration; so 
in the lungs sclerotic processes compromise the circulation, nutrition, oxidation and 
elimination, consequently the resistance of a lung under such conditions must always 
be such as to invite the invasion of the tubercle bacillus. 
The impossibility of the limitation of tuberculous processes without the develop- 
ment of connective tissue changes, directs our therapeutics in the line of combating 
the tendency to necrosis in such processes until such changes can be developed, and all 
methods of treatment are found directly beneficial in so far as they favor such develop- ment. In consideration of the general acceptance of the tubercle bacillus as the 
specific cause of tuberculosis, also that the majority of medical men at present agree 
with Koch and Virchow, that it is not the disease which is inherited, but a condition 
of vulnerability of the tissues, preventative medicine becomes of the greatest impor- 
tance. i 
It is surprising what an apathetic state exists not only among t*he general public, 
but among medical men also, in regard to this feature of the subject. On the part of 
the public it is the result of ignorance largely, though the average citizen considers it 
as a violent infringement on his personal rights, any attempt to regulate his great 
American prerogative of expectorating when and where he chooses. 
If the course adopted by the anti-tuberculous league of France, or some modifi- 
cation of it as suggested by the editor of the Universal Medical Journal, be adopted 
in this country, and the excellent set of rules and instructions adopted by this society 
be made public property, much good might result therefrom. 
If the claims of Grancher and Martin should prove true, i. e., that it is possible 
by inoculation to establish a prolonged resistance to fatal forms of tuberculosis, and 
also to produce an immunity from infection, of a greater or less duration, it might be 
possible to attain some definite results in this department of medicine. 
Next in order I would place the climatic treatment of tuberculosis. The results 
obtained by the use of remedies alone, in a climate like this, cannot compare with the 
results obtained by the judicious use of climatic and medicinal means combined. The 
many difficulties in the way of the practical application of climatic treatment need not 
be dwelt upon. As far as the medical adviser is concerned, it appears the chief fault 
lies in a want of proper knowledge of the geographical and meteorological conditions 
of various localities, ancl the specific requirements of the individual case. In regard to 
the former it is to be hoped that the work of the American Climatological Association 
may result in more general and definite knowledge. In regard to the latter, and the 
special adaptation of certain localities, the contributions to the literature of this part of 
the subject by resident practitioners, while recognizing the special features of their 
particular locality, adapting it to the special forms of the disease, the general features 
of the region are so enlarged upon that the locality in question would seem to be the 
Mecca of all tubercular pilgrims. 
The general features of climate which are beneficial are equable temperature, dry- 
ness, elevation, and in some instances warmth. 
In some localities an ozonized atmosphere is credited with the good effects. The 
recent observations of Ohlmuller, of Berlin, go to prove that ozone has a powerful des- 
tructive action on various bacilli, in an inverse ratio to the amount of organic matter 
present, and the dryness of the bacteria and ozone. 
Schoenheim’s opinion, that ozone in the atmosphere is a powerful disinfecting 
agent, is supported by the observations of Wolffhilgel and Fox. Dr. Henry S. Norris 
reported in the New York Medical Journal for November 5, 1892, a series of cases 
treated by the administration of ozone with beneficial results. It is probable that the 
good effects of climate in some localities in the lower altitudes is due largely to ozone. 
The general effect of climatic treatment is to stimulate oxygenation, oxidization and 
elimination, and the stimulant effects of ozone on these functions cannot but be beneficial. 
The writings of Williams, Copeland, Taylor, Burney Yeo, Huggard, Fisk Ander- 
son, and others give a fairly unanimous view of the effect of climate, and the class of 
cases likely to be benefited. The chief discrepancy one finds in the papers on this 
subject is the varying opinions regarding altitude in hemorrhagic cases. There is no 
doubt that with proper sanitaria with modern hospital regulations, located in the 
various health regions, and with the cases properly selected according to the nature of 
the location, that much better results should be obtained than by the haphazard way 
of allowing patients to go to these regions and take care of themselves. 
Nicaise, Flerman Weber, Leyden, Detweiler, Kretszschmar and others advocate the 
hospital treatment of tuberculosis in special institutions. The promiscuous association of cases which are in an infections condition, and those which are not, at health 
resorts, is to be discountenanced. 
The tendency of the present is to avoid warm climates, especially those of moder- 
ate moisture. Williams has shown that some cases of catarrhal nature do the best in 
such a climate. 
In indicating the altitude for a given case the following factors must be kept in 
mind: Age of patient, stage of disease, rapidity of development, presence of pyrexia, 
amount of tissue involved, condition of general bodily functions, condition of heart 
circulation, course of infection if it can be determined. 
The available lung space, the absence of emphysema, and the condition of the 
heart are important factors in estimating the effect of a dry rarefied atmosphere. 
Cases showing rapid development, considerable involvement of tissue, pyrexia; 
cavities showing tendency to rapid necrosis of lung tissue, absence of connective tissue 
development, tendency to hemorrhage after disease has existed six months, emphysema, 
bronchiectasis, dyspnoea and cardiac weakness are unsuitable for an elevation of over 
1500 feet. 
Cases of fibroid phthisis with much shrinking of the lung are not suited for high 
altitudes, even though pyrexia be absent, as these cases eventually suffer from cardiac 
degeneration and failure. Eight per cent, of markedly tuberculous patients discharged 
from Brehmer’s institute at Goerbersdorf remained relatively cured after fifteen 
years. 
The only remedy which has held its own in the medicinal treatment of tuberculosis, 
is creosote; this medicament after falling into disuse for a number of years, again 
revived, chiefly owing to the abiding faith and advocacy of Supimerbrodt of Breslau, 
who asserts its specific influence by resisting the development of bacilli. Guttman 
concludes that if the blood could be made to contain one four-thousandth part of its 
quantity of creosote, bacilli would cease to develop. He calculates that this would 
require over twenty grains, which he thinks impossible because we cannot determine 
the necessary quantity for administration. Summerbordt however, believes it possible 
to administer the necessary quantity. Wm. H. Flint claims the best results are 
obtained by pushing the remedy to the point of toleration by mouth, rectum and by 
inhalation. 
Tortensson exhibits three to four grammes daily of the drug, by intramuscular 
injection of guaiacol in sterilized olive oil, and by rectal injection of creosote. 
Cornet, from experiments, concludes that the favorable effect of creosote results 
from its improving the appetite and diminishing bronchial secretions. This view is 
also taken by some clinicians. Recent experiments go to prove that creosote in the 
blood combines with certain albuminoids forihing combinations which are without any 
particular germicidal influence. Experiments on animals have not borne out the 
theory of Bouchard and others, that creosote induced connective tissue growth. 
Personally, I entirely agree with the opinion that any such influence is exerted only 
through its ability to stimulate nutrition. I have never been able to convince myself 
that directly it affected the process in the lung in any way. My own experience with 
creosote has been indifferent. The appetite generally improves, and some weight 
may be gained, with general improvement in all the symptoms, but it does not appear 
to me to have any effect on the tubercular process in the lung. I have used it gen- 
erally in capsule or in emulsion with hydroleine. The substitution of guaiacol or 
some of the other substitutes for creosote is much pleasanter for the patient and 
appears to be about : s efficacious. 
It is possible that in this country we have been administering too little creosote to 
obtain as good results as are claimed by continental observers, but the gluteal injection 
of from six to eight grammes of a mixture in the morning, and the rectal injection of 
a pint or more at night, is a form of treatment hardly adapted to the disposition of 
the average American, especially when this must be continued for two years or more. 
The use of intratracheal injections and inhalations while they may relieve seme 117 
symptoms as curative means, will probably, in time, be placed in the same category of 
failures as the more unscientific hot and cold air treatments of Worms and Krull. 
The cantharidin treatment of Liebreich has not been largely accepted; theoreti- 
cally it is a reasonable method, and experiments have not been altogether without 
results. It seems very doubtful, however, if practical results can be obtained by this 
method, though when we consider the practical immunity from infection, afforded by 
the greater amount of serum in the lungs from insufficiency of the mitral valves, the 
theory of Liebreich does not seem visionary, taken in connection with the experi- 
mental proof already afforded of the germicidal properties of the bodily fluids. 
The treatment by dogs’ serum, and local injection of chloride of zinc, have so far 
failed of any practical results, and need not be specially commented upon. 
The Gibb’s-Shurley treatment has died a natural death, if indeed, it was ever 
born, the practical inutility of this method of treatment impressed itself early upon 
me, and experimentation with it has only served to confirm my first impression. In 
my own practice, both public and private, I have for a number of years past treated a 
number of cases with Hypophosphites in the form of a syrup of whichever salt was 
indicated; “I prefer Gard?ters syrup as being; the most stable on the market." This 
must not be confounded with the combined Hypophosphites. The latter preparation 
I used for several years in a large number of cases and became firmly convinced of 
the truth of Churchill’s teaching, that the compound syrup of Hypophosphites is 
distinctly injurious to phthisical patients. 
The Hypophosphite of Soda is generally the most useful, and is given in apyretic 
cases where there is not much expectoration. 
The quinia salt is used temporarily when the temperature is over loo° Fahrenheit, 
and the lime salt where there is too free expectoration, six or seven grains daily being 
the maximum dose. I believe I have had fully as good results from this method, as 
by any other, if not better. 
In advanced cases I have found no mixture so efficient in quieting the cough and 
loosening the sticky mucus as one-eighth of a grain of morphine with ten drops of 
dilute hydrobromic acid given in syrup of tolu. For troublesome night sweats atropine 
and camphoric acid are the most useful. The latter is free from the disagreeable 
effects of the former, and may be given in capsules of five grains each, three of these 
at 6 in the evening and three at 9, and increased if necessary; the effect may last for 
two or three nights. 
In closing I wish to deplore the fact that there is in this city, so bountifully sup- 
plied with charitable institutions for the supply of medical and surgical relief to the 
needy, not one devoted to the care of the most fatal malady of our time. With the 
general recognition of the infectiousness of tuberculosis, hospitals which have always 
admitted such cases are becoming very reluctant to do so, and the indigent sufferer 
from tuberculosis literally has nowhere to lay his head. A special institution for the 
treatment of such cases is a crying necessity, and it is hoped that Chicago will not 
much longer remain behind other large cities in this respect.” 
Richitis.—A. Springer, M. D., physician in charge, State Home, for sick and 
needy children, Lewiston, Me., writes: “We have found the syrup of Hypophosphite of 
Lime, of great value in richitis and similar diseases. A number of children, unable to 
walk, have been cured by that treacment. Several cases outside the Home’ are taking 
it with benefit.” 
“The Hypophosphites have been largely used and highly extolled by Dr. 
Churchill in the Ireatment of pulmonary consumption, especially the alkaline Hypo- 
phosphites, which should be perfectly pure, like those of R. W. Gardner, of New York.” 
“Materia Medica, Pharmacology and Therapeutics.” Shoemaker, vol. 2, page 
812, 1891. 
Phthisis.—A. U. Evarts, M. D., special examiner surgeons pensions, La Porte 
City, lowa, July 17, 1886, writes; “Our druggists have ordered your syrup, and I 
am satisfied that through it alone I have saved one consumptive’s life, and probably- two. The positive case was the worst one,—in the third stage of phthisis Patient 
confined to bed—fever, cough, night sweats, and hemorrhage that presaged imme- 
diate dissolution of patient. Right lung cavernous, and almost wholly hepatized— 
left lung partially implicated. After a thorough examination, I gave the patient 
about three weeks to live. Put patient permanently upon Gardner’s syrup Calcis 
Hypophos. Improved slowly but surely for a year and a half; occasionally patient 
has return of bad symptoms. On an average of once in three months for two years, 
this case, a woman, has had a formation and rupture of pelvic tumor. 
Have had a number of other cases, first and second stages, and have been obliged 
to prescribe different makes of the syrups, and have found disappointment resulting 
from their use. To be brief, I will say I look for mathematical precision when I use 
your syrups of lime or soda. I get better results in treatment since following Dr. 
Churchill’s mode. Hereafter I will record my cases for the benefit of the profession. 
These general facts will suffice to awaken the interest of the true physician in the 
treatment of phthisis.” LIST OF GARDNER’S 
Special Pharmaceutical Preparations 
(Put up in 16 fl, oz., 8 fl. oz., and 4 fl. oz. bottles.) 
Gardner’s Syrup of Hydriodic Acid. 
6.66 grains lodine in one fluid ounce. 
HYPOPHOSPHITE PREPARATIONS. 
All of the following preparations are put up in 16 fl. oz., and 8 fl. oz. bottles. 
(No 4 oz. size.) 
Gardner’s Syrup of Hypophosphite of Lime. 
20 grains in one fluid ounce. 
Gardner’s Syrup of Hypophosphite of Soda. 
20 grains in one fluid ounce. 
Gardner’s Syrup of Hypophosphite of Iron. 
4 grains in one fluid ounce. 
Gardner’s Syrup of Hypophosphite of Potassium, 
16 grains in one fluid ounce. 
Gardner’s Syrup of Hypophosphite of Manganese. 
4 grains in one fluid ounce. 
Gardner’s Syrup of Hypophosphites of Lime and Soda. 
20 grains in one fluid ounce. 
Gardner’s Syrup of Hypophosphites of Iron and Quinia. 
4 grains Iron and 1 grain Quinia in one fluid ounce. 
Gardner’s Syrup of Hypophosphites of Lime, Soda and Potassium. 
17 grains in one fluid ounce. 
Gardner’s Syrup of Hypophosphites of Lime, Soda and Iron. 
17 grains in one fluid ounce. 
Gardner’s Syrup of Hypophosphites of Lime, Soda, Iron and Potassium 
17 grains in one fluid ounce. Gardner’s Elixir of Hypophosphite of Lime. 
20 grains in one fluid ounce. 
Gardner’s Elixir of Hypophosphite of Soda. 
20 grains in one fluid ounce. 
Gardner’s Elixir of Hypophosphite of Iron. 
4 grains in one fluid ounce. 
Gardner’s Elixir of Hypophosphite of Potassium. 
16 grains in one fluid ounce. 
Gardner’s Elixir of Hypophosphite of Quinia. 
8 grains in one fluid ounce. 
Gardner’s Elixir of Hypophosphites of Lime and Soda. 
20 grains in one fluid ounce. 
Gardner’s Elixir of Hypophosphites of Lime, Soda and Iron. 
17 grains in one fluid ounce. 
Gardner’s Elixir of Hypophosphites of Lime, Soda and Potassium. 
17 grains in one fluid ounce. 
Gardner’s Elixir of Hypophosphites of Lime, Soda, Iron and Potassium 
17 grains in one fluid ounce. 
Note.—The undersigned wishes to state that the combinations of different 
Hypophosphites quoted in the above list have been prepared at the request of 
physicians to meet an inevitable demand. They are distinctly discountenanced and 
never employed by Churchill in phthisis. Some of them have been used with much 
advantage in other conditions. But the multiplication of remedies in combination, 
where many of them are not indicated or are therapeutically antagonistic, ought 
certainly to be avoided. R. W. Gardner. 
Prepared by ROBERT W. GARDNER, 
Pharmaceutical Chemist, New York. 
W. H. Schieffelin & Co., New York, sole wholesale agents. And sold by the 
Wholesale and Retail Trade generally throughout the United States.