fullness and weight in the epigastrium, the metallic, pasty taste in the mouth, were all relieved within ten minutes after taking the remedy. Shortly after this a patient, coming to the office for some local trouble, complained of the unpleasant effect of some cheese which he had taken a few hours before; and was also benefited within a few minutes by taking the crystalline phosphates. In several other instances has success been equally decisive; and in each case the patient declared himself relieved in a very short time.

Prompted by this favorable experience, I began the use of the remedy rather extensively in a number of cases in which gastric symptoms constituted a prominent feature, and, as a result of that test, have been led to the conclusion that we have, in the acid salts of phosphorus, remedies of fully equal value with either dilute nitric or hydrochloric acid; in many cases the phosphorus compounds will be found superior. I give a brief synops's of a few cases in which its effect has been very decided:

CASE I.-E. S., æt. 30, widow, servant; slender build; slightly below average size; somewhat anæmic; has been a sufferer for past four years. Occasional attacks of excruciating epigastric pain. Constant eructations of gas with offensive cdor. Almost total loss of appetite, frequent attacks of nausea, and irregular action of the bowels. Examination showed considerable dilatation of the stomach, the lower border being on a level with the umbilicus. Tenderness to pressure over epigastrium Has had attacks of vomiting, vomited matter consisting largely of bile.

Treatment.-Daily lavage of stomach with Oser tube; milk and beef diet; and one drop of a mixture of equal parts of carbolic acid and tinct. of iodine in half a glass of water. Later crystalline phosphate was substituted, and with decided benefit. The appetite improved, the patient gained weight, and the normal color returned to lips and cheeks. She left the city after about five weeks, and I have o subsequent record of the case.

CASE II.-Convalescent typhoid. E. S., æt. 25, married, mother of one child. Moderately severe attack of typhoid, with several very severe hemorrhages from the bowels, by which her strength was greatly reduced. Improved slowly. No appetite. Feeling of heaviness in stomach. Appetite returned in about three days after taking crystalline phosphate.

CASE III. Scrofulous disease of bone. L. L., æt. 20. Spent several years in piney woods of Georgia on business. While living in a swampy region contracted a severe fever of malarial type, lasting for six months, and followed by appearance of hard, diffuse swelling under axilla and on inner side of knee joint. Tumor of axilla suppurated and opened spontaneously; continued to suppurate for almost a year. Tumor near knee joint was opened and found to result from fungous periostitis. Bone scraped--drainage tubes-iodoform. Cod liver oil and crystalline phosphates internally. The improvement was very slow. Patient lost his appetite completely immediately after the operation. Following the use of the crystalline phosphate there was a very slight improvement in this respect, but the remedy seemed to have little or no influence on the healing process in the bone.

CASE IV.-Atonic dyspepsia. J. M., æt. 55, spinster. The patient is subject to hysterical manifestations, which never assume a violent form. Appetite poor and very capricious. Bowels irregular. Has some fullness in epigastrium. Ordered crystalline phosphate. Very decided improvement after two weeks.

CASE V.-Recurrent typhlitis. S. R., æt. 25, young man of regular habits; good physique; has had three attacks of acute typhlitis, last complicated with general peritonitis. These attacks always preceded by constipation lasting twenty-four hours or more. Since last attack very careful regulation of diet: buttermilk twice a day, crystalline phosphates, and regular exercise-walking and gymnastics. The crystalline phosphate was continued for about two months. Patient has had no trouble for more than a year past.

CASE VI.--Subacute gastritis. L. S., æt. 28. Has had pain over epigastrium for several days. Tenderness on pressure. Vomiting of considerable quantities of watery fluid mixed with mucus, and occasionally stained with bile. Does not drink liquors of any kind. Admits excessive use of coffee and tobacco. Bowels pretty regular. Complete loss of appetite. Pulse small and frequent. Face haggard. Rest in bed; milk diet; crystalline phosphates. After ten days, mixed diet. Recovery in four weeks.

CASE VII.--Acute indigestion. J. G., æt. 35, commercial traveler, generous liver. Following a late lunch and the taking of considerable wine the night previous, awoke

in the night with pain in the stomach, intense and persistent nausea, and a feeling of general discomfort and oppression. Ordered crystalline phosphate and a light diet. The distress was relieved after the first dose; remedy persisted in for two days longer, though patient declared himself well after the first day.

These cases represent but a very small fraction of the whole number of observations, but they may be taken as types of the variety of disorders in which the test has been applied. The experience gained from seventy-two cases, being the whole number in which the remedy was employed, would indicate that the best effect is obtained from the remedy when given about an hour after a meal, at the time when the normal acid element of the gastric secretion is being furnished by the mucous membrane. When well

diluted the solution is not only more palatable, but seems to act more promptly. Whether hot or cold water be employed is a point that may be left to the caprice of the patient, there being, apparently, no different results obtained with different temperatures.

The more acute cases show a more decided relief than cases of longer standing; and the most satisfactory results are obtained in the very common cases of epigastric distress occasioned by a single indiscretion in diet. In these the effect is truly surprising, particularly so to the patient, the transition from a feeling of intense discomfort to the normal state taking place with great rapidity, and not being followed by any return of the symptoms.

Abscess of the Lung Following the Retention of a Nail in the Bronchus for a Year.

BY HOBART CHESSMAN, M. D., INSTRUCTOR IN VENEREAL AND GENITO-URINARY DISEASES.

Read before the Manhattan Medical and Surgical Society, December 1, 1888, and reported at the Clinical Society of the Post-Graduate Medical School and Hospital.

GEORGE B., three years of age, was brought to me on September 25, 1888, having coughed up a nail the evening before. He was pale, emaciated, and feeble. The skin was hot and wrinkled, but moist with perspiration; the breath was very offensive, and there was being constantly coughed up a very fetid, purulent secretion, most of which

was swallowed. Physical examination showed dullness in the middle and lower portions of the right lung, and numerous moist rales of various volume, together with tubular breathing, were audible in this region. The mother gave the following history, which was afterward corroborated by the father, as well as by several of the neighbors. About a year ago she had given, one day, the child a hammer and a nail, like the one coughed up, to play with. He was thus sitting on the floor when, beginning to cry and cough, she discovered that the nail had disappeared and that the child was struggling with something in its throat. The coughing and gagging continued for some time, and quite a little bloody matter was coughed or vomited up. After a few minutes the coughing mostly ceased for the time; but from this date the child began to be troubled with a cough which never entirely left him. At times it would continue very severe for days or weeks, and then there would be an interval of comparative relief and the general health would be good. After six or eight months had thus elapsed, it began to be noticed that the breath and sputa were offensive, and fever and sweating were also observed. Since then the patient had grown by degrees more emaciated and feeble, and the paroxysms of cough had become very violent and distressing. While the child was in one these paroxysms the father lifted it by the legs, the head dependent, slapped its back between the shoulders rather vigorously several times, and with some impatience and desperation at the constant annoyance, and with a vague idea of aiding the child in what appeared to be an effort to expel something from the lungs. Upon putting him down the child appeared to be struggling with something in his throat, and the father inserted his finger, extracting from it a nail, which was covered with a thick coating of iron rust and mucus. It was originally tin plated. It measured an inch and a half in length, was cylindrical, with a sharp pencil point, and a circular head five lines in diameter.

After the expulsion of the nail the paroxysms of cough were less violent, but pus continued to be expectorated in connection with symptoms of septicemia, and at the end of three weeks the patient died. The case is, unfortunately, incomplete from lack of autopsy.

Poulet quotes an autopsy by Leuret on a lunatic, in which the right lung was normal except that there were some adhesions to the costal pleura. The left lung, however,

was extensively adherent to the costal pleura, and was hepatized and filled with tubercles, the majority of which were softened, and the lining membranes of the bronchial tubes were red and thickened. The trachea contained a nail an inch and a half long, the head of which was engaged in the left bronchus. The wall of the bronchus, which had been in contact with the head of the nail, was ulcerated and its inner layer destroyed; the nail was covered with mucus and oxidized.

Autopsies in other cases in which foreign bodies of different kinds have lodged in the trachea and bronchi, and remained for considerable time, have shown that, in consequence, hepatization and cavities have resulted without the presence of tubercles; the cavities being simply abscess cavities. Such, probably, was the conndition in this case. In many cases, supposed to be lof this nature, after expulsion of the foreign body either spontaneously or by surgical operation, recovery has taken place. But in other cases of this character, where extensive local changes and profound constitutional disturbances have occurred, as in this case, death has resulted, notwithstanding the removal of the original cause.

It is not very uncommon, as is well known, for foreign bodies, such as pieces of bone of considerable size, to remain in the trachea or bronchi for many years, tolerance in the course of time having been established, after which very little disturbance was occasioned by their presence. Sometimes in such cases, after years of tolerance, symptoms have recurred, resulting in the expulsion of the foreign body or in death. This is explained by supposing that the foreign body which, during the period of tolerance had become embedded or fixed, is again freed by ulceration of the enclosing tissues. Whether in the case before us the nail had all the time remained free, and was only waiting the classical procedure, to which accidently the father finally resorted, to expel it, is more or less a matter for conjecture.

Foreign bodies, primarily embedded in the esophagus, have been known to find their way by ulceration into the bronchi (Poulet); but such instances are rare and are accompanied by œsophageal symptoms. No such symptoms occurred in this case. The patient continuing to have a good appetite most of the time for several months following the disappearance of the nail, swallowed solids and fluids without appreciable difficulty from first to last. From this