1

affect our treatment in the slightest. Indeed when we find so eminent a pathologist as Dr Henry Green asserting that "from a careful consideration of the histology and pathology of phthisis" he is "inclined to doubt the advisability of attempting, as has been done during recent years, to subdivide the disease into distinct pathological varieties; "2 when such authorities as Dr Wilson Fox and Professor Rindfleisch defend the old views regarding the tubercular nature of phthisis,-apportioning to tubercle a much. wider signification than it has received at the hands of Virchow and Niemeyer and their followers; and when, lastly, there seems as yet to be such a very wide difference of opinion among the greatest pathologists as to what tuberculosis really is and includes,3—I trust I shall not be considered unorthodox in classifying, under the name of phthisis pulmonalis or consumption, all chronic diseases of the lungs that present physical signs of consolidation, and for

1 Of course when a patient is suffering from syphilis and phthisis, we shall have specifically to treat the former disease with the view of benefiting the latter.

2 The Pathology of Pulmonary Consumption, by T. Henry Green, M.D. P. 97. London: 1878.

3 Dr H. Green, in answer to "What constitutes Tubercle?" replies, "From a consideration of the histological characters of the miliary lesions met with in the lungs in acute miliary tuberculosis, it seems to me difficult to frame a definition of pulmonary tubercle upon a purely histological basis."

the treatment of which koumiss has in so many instances been successfully prescribed.

But as the successful employment of fermented mare's milk for the relief of diseases of the lungs and air passages is so intimately associated in my opinion with the subject of climate, I shall have to reserve the consideration of koumiss in the treatment of pulmonary consumption for the next chapter, when the questions of where, when, and how koumiss should be drunk, will be fully discussed.

183

CHAPTER VIII.

STATISTICS OF THE MILITARY KOUMISS ESTABLISHMENT NEAR SAMARA-TABLE OF TWENTY-FIVE CASES OF CONSUMPTION TREATED BY KOUMISS-TABLE OF EIGHTEEN CASES OF PHTHISIS, PERSONALLY KNOWN TO THE AUTHOR, THAT WERE CURED BY FERMENTED MARE'S MILK-IN WHAT DISEASES THE EMPLOYMENT OF KOUMISS IS CONTRA-INDICATED -SHOULD IT BE AVOIDED WHERE THERE IS A TENDENCY TO HÆMOPTYSIS? THE MODE OF USING THE DIFFERENT KINDS OF KOUMISS-HOW, WHEN, WHERE, AND IN WHAT QUANTITIES IT SHOULD BE DRUNK-MORALE OR ETHICS OF THE KOUMISS CURE IMPORTANCE OF HORSEBACK EXERCISE AS PART OF THE TREATMENT-JOURNEY TO AND RESIDENCE IN THE STEPPES-CONCLUSION.

THE great difficulty in collecting a sufficient number of data, with regard to the influence of koumiss on the development or progress of pulmonary consumption, consists in the impossibility of being able to watch those who come under one's notice, from the commencement of the treatment to the arrest of the disease, or to the patient's death. Thus of many

scores-I might almost say hundreds of instances

of phthisis that I have seen undergoing the koumiss cure, on the six occasions that I visited the steppes, I have been able to watch the final result in twentyfive only.1 Even in three of these cases (Nos. XXII., XXIII., and XXIV. in table) I am not quite certain of the result: two, I am sure, must be dead; while the third (No. XXII.), referred to in a former chapter, is, I have every reason to believe, still alive.

Dr Polubensky has been no more fortunate in this respect than myself, although he is the only author I am acquainted with who has watched and given the results of a small number of cases of consumption (treated by fermented mare's milk) from the beginning of the disease to the date of publication of his highly practical and philosophical essay. With regard to the collection, on the other hand, of cases of phthisis and other wasting diseases that have been benefited and greatly relieved by the use of koumiss during a single season, I shall be able,

1 Patients who are willing and glad enough to consult a physician on the spot, and to pour a full history of their ailments, real or imaginary, into his ear, forget to write a few words to him afterwards. If they feel worse when they get home, they at once apply to their usual medical attendant; if better, they are even still less inclined to be grateful.

DRS NEFTEL'S AND ZEELAND'S CASES. 185

thanks to the kindness of Dr Kozloff, Director General of the Medical Department of the Russian Army, to place before the reader a record of the number of patients treated for several years past at the so-called "Military Koumiss"-a mare's milk establishment erected for soldiers in the vicinity of Samara.

These statistics, besides being extensive, are important as forming the only record where a number of patients had to undergo hospital discipline, and were placed under strict treatment; and they are also valuable because compiled by medical men (army surgeons) who started on their inquiries with no preconceived notions in regard to koumiss. To these must also be added the very interesting cases of Drs Neftel and Zeeland, which, though small in number, point out clearly the efficacy of koumiss in the treatment of the majority of cases of pulmonary consumption. Thus Dr Neftel had fifteen phthisical soldiers under his charge in the Orenburg Military Hospital in 1859; they all improved and gained flesh during their stay there. Moreover, he relates that the effect of koumiss in two other instances was marvellous one being that of a young lady aged twenty-five, with cavernous gurgling in one lung,