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diff --git a/.gitattributes b/.gitattributes new file mode 100644 index 0000000..d7b82bc --- /dev/null +++ b/.gitattributes @@ -0,0 +1,4 @@ +*.txt text eol=lf +*.htm text eol=lf +*.html text eol=lf +*.md text eol=lf diff --git a/LICENSE.txt b/LICENSE.txt new file mode 100644 index 0000000..6312041 --- /dev/null +++ b/LICENSE.txt @@ -0,0 +1,11 @@ +This eBook, including all associated images, markup, improvements, +metadata, and any other content or labor, has been confirmed to be +in the PUBLIC DOMAIN IN THE UNITED STATES. + +Procedures for determining public domain status are described in +the "Copyright How-To" at https://www.gutenberg.org. + +No investigation has been made concerning possible copyrights in +jurisdictions other than the United States. Anyone seeking to utilize +this eBook outside of the United States should confirm copyright +status under the laws that apply to them. diff --git a/README.md b/README.md new file mode 100644 index 0000000..3bd9637 --- /dev/null +++ b/README.md @@ -0,0 +1,2 @@ +Project Gutenberg (https://www.gutenberg.org) public repository for +eBook #68772 (https://www.gutenberg.org/ebooks/68772) diff --git a/old/68772-0.txt b/old/68772-0.txt deleted file mode 100644 index 29e4d0a..0000000 --- a/old/68772-0.txt +++ /dev/null @@ -1,2082 +0,0 @@ -The Project Gutenberg eBook of An inaugural dissertation on pulmonary -consumption, by Edward Delafield - -This eBook is for the use of anyone anywhere in the United States and -most other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms -of the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you -will have to check the laws of the country where you are located before -using this eBook. - -Title: An inaugural dissertation on pulmonary consumption - -Author: Edward Delafield - -Release Date: August 16, 2022 [eBook #68772] - -Language: English - -Produced by: Sonya Schermann and the Online Distributed Proofreading - Team at https://www.pgdp.net (This file was produced from - images generously made available by The Internet Archive) - -*** START OF THE PROJECT GUTENBERG EBOOK AN INAUGURAL DISSERTATION ON -PULMONARY CONSUMPTION *** - - - - - - AN - - Inaugural Dissertation - - ON - - PULMONARY CONSUMPTION. - - BY EDWARD DELAFIELD, A. B. - - ----For want of timely care, - Millions have died of medicable wounds. ARMSTRONG. - - _NEW-YORK_: - - PRINTED BY JOHN FORBES & CO. - 78 WALL-STREET. - - 1816. - - - - - TO - - SAMUEL BORROWE, M. D. - - ONE OF THE SURGEONS OF THE NEW-YORK HOSPITAL, - - THIS DISSERTATION - - IS DEDICATED, - - AS A TESTIMONY OF GRATITUDE - - FOR THE MANY VALUABLE PRACTICAL LESSONS - - RECEIVED FROM HIM - - BY HIS FRIEND AND PUPIL, - - EDWARD DELAFIELD. - - - - -INTRODUCTION. - - -The attention of Physicians has for several years past been excited -to the consideration of that inveterate enemy of the human race, the -CONSUMPTION. Several works have been published, new remedies proposed, -and the practice of former physicians revived with modifications -and amendments, in the treatment of this disease. At one period, -Consumption had been so long considered without the reach of remedies, -that it had almost ceased to excite the enquiries of the learned in -medicine. Fortunately, however, the spirit of enquiry has revived; and -it is believed that the treatment of this dreadful malady has been so -far improved, that many are rescued from its grasp, and the sufferings -of those who are still its victims, are materially mitigated. -Notwithstanding, it appears that in this city the mortality from -Consumption has increased rapidly of late years. Formerly, its climate -was considered remarkably salubrious, and diseases of the lungs were -rare. Lieutenant Governor Colden, in a series of remarks on the climate -and diseases of New-York, made seventy years ago, has the following -observations: “The air of the country being almost always clear, and -its spring strong, we have few consumptions or diseases of the lungs. -People inclined to be consumptive in England, are often perfectly cured -by our fine air; but if there be ulcers formed, they die. The climate -grows every day better, as the country is cleared of the woods; and -more healthy, as all the people that have lived long here testify. This -has even been sensible to me, though I have lived but about twelve -years in this country; I therefore doubt not but it will in time, -become one of the most agreeable and healthy climates on the face of -the earth.”[1] - -These anticipations have not been realized; but, on the contrary, -Consumption has become the prevailing disease of our city. The causes -of this increase of the disease are numerous. We are told by Dr. -Rush, that it is unknown among the Indians of North America; that it -is scarcely known by those citizens of the United States who live in -the first stage of civilized life, and are generally called the first -settlers; that it is less common in country places than in cities, and -increases in both, with intemperance and sedentary modes of life; that -ship and house-carpenters, smiths, and all those artificers, whose -business requires great exertion of strength in the open air, in all -seasons of the year, are less subject to this disease than men who -work under cover, and at occupations which do not require the constant -action of their lungs. By applying these facts to the situation of -this city, the causes which have produced the increased mortality from -consumption, become evident. - -1. The growth of the city, and consequent state of the atmosphere, most -distant from that of the pure air of the country. - -2. The increase of all those causes which have enervated the bodies of -men, and rendered them more susceptible to the influence of a variable -climate. Among these are, augmentation of wealth, and consequently, -luxury; increased dissipation, with its accompaniment, imprudence in -dress; and extension of manufactures, affording greater opportunity for -sedentary employments, and exposure to an insalubrious atmosphere. In -general, the causes are, all those circumstances which tend to remove -man farthest from that situation, in which the body is possessed of -the greatest vigour, and of course, least subject to disease, that of -the savage. In proportion as the city has enlarged, these causes have -continued to increase, and probably still will do so. But in Great -Britain, they appear already to have attained their acme, and as a -consequence of the improvements in medicine, the causes not increasing, -the disease is on the decline.[2] - -The following statement will show the proportion, which the number of -those who die from consumption, bears to the whole number of deaths, in -this city, during the last twelve years. - -In 1804, 499 persons died from Consumption, and were to the whole -number of deaths, 2125 as 1 to 4.25. - - In 1805 462 2352 1 5.09 - 1806 354 2225 1 6.28 - 1807 464 2312 1 4.94 - 1808 429 2014 1 4.69 - 1809 413 2108 1 5.1 - 1810 569 2158 1 3.79 - 1811 595 2524 1 4.24 - 1812 669 2553 1 3.81 - 1813 562 2229 1 3.96 - 1814 618 2507 1 4.04 - 1815 572 1974 1 3.8 - -From this statement it appears, that the number of deaths from -Consumption has gradually increased. The average proportion during the -period mentioned, is as 1 to 4.36. Nearly one fourth of all those who -die in this city are destroyed by this fatal disease. - -These facts prove indeed that the power of medicine has little control -over so destructive a malady. But it should not therefore paralyse our -exertions. From what has been done already, in improving our knowledge -of its nature and treatment, a hope may be indulged that consumption -may one day, like many other maladies formerly deemed incurable, be -placed no longer among that number. - - - - -INAUGURAL DISSERTATION - -ON - -PULMONARY CONSUMPTION. - - -The term Phthisis, or Consumption, in its broadest sense, is applied -to all those diseases, in which the system sinks under a gradual -waste of the powers of life. These diseases may be divided into two -great classes--1. That form of Consumption in which the lungs are -unaffected.--2. Phthisis Pulmonalis, properly so called, where the -lungs are the seat of the disease. - -Under the first class are included, - -1. Atrophia, or Consumption from want of nourishment, or excessive -evacuations, but without hectic fever; excluding all those forms of -disease produced by immoderate evacuations, in which the lungs become -affected. - -2. Tabes, accompanied with hectic fever, frequently attended with -disease of the mesenteric glands, and produced most commonly by -scrophula. - -The second class, Phthisis Pulmonalis, to the consideration of which -this essay will be more immediately confined, may be also subdivided -into, - -1. Primary, where the lungs are the original seat of the disease, and -as a consequence, the general system becomes affected. - -2. Secondary, where the system being first reduced by any debilitating -cause, the lungs become secondarily affected, as a symptom of the -general disease. - -These two forms of Consumption, although somewhat similar in their -symptoms, yet proceed from opposite causes, and require opposite -treatment. The one is a disease of pure inflammation; the other of -unmixed debility. In the one, an active antiphlogistic treatment is -necessary; in the other, the system requires all the support, which -tonics and good nourishment can afford. - -Phthisis Pulmonalis is thus defined by Dr. Cullen, “_Corporis -emaciatio et debilitas, cum tussi, febre hectica, et expectoratione -purulenta_.” This definition is peculiarly incorrect, because it leads -us to neglect, the first stage of the disease; if the symptoms of an -Incipient Phthisis were stated to us, and we were asked, what was the -disease, from this definition we would be perfectly at a loss for an -answer. Except the cough, none of the symptoms there stated are to be -found in the first stage of Consumption. And yet that is as truly a -part of it, and of as much importance to the practitioner, as the last -stage, which alone is included in Cullen’s definition.[3] - -Agreeably to this definition, in his view of Phthisis Pulmonalis, Dr. -Cullen makes ulceration of the lungs and hectic fever essential to its -existence, and seems rather to consider the preceding symptoms a cause -of this ulceration and fever, than as constituting an integrant part of -the disease. - -Nor is the place assigned by him to Phthisis Pulmonalis, in his -Nosological Arrangement, more correct than his definition of it. He -places it in the order Hæmorrhagiæ, and considers it merely as a -consequence of Hæmoptysis. Even if it were always excited by hæmorrhage -from the lungs, it would be improperly thus placed; but as that, even -by Dr. Cullen, is considered merely as one among many exciting causes, -the arrangement is altogether inadmissible. But if it be admitted, -according to the view which will be hereafter taken of Hæmoptysis in -this treatise, that it is rather a symptom than a cause of Consumption, -the propriety of another arrangement will be evident. Accordingly -Phthisis Pulmonalis is placed by Dr. Hosack, as one of the Phlegmasiæ. -This disposition appears to be the most proper that has hitherto been -suggested, and as such I shall adopt it. But before we can ascertain -the character and treatment of any diseases, it is necessary minutely -to examine their causes and symptoms. - -Primary Phthisis Pulmonalis first claims our attention. Its -predisposing causes may be mostly arranged into five classes, as they -depend on organization, age, sex, occupation and climate. - -Organization predisposes to Consumption, by mal-conformation of the -chest, which may be either natural or accidental; and an hereditary -internal structure not depending on the external form of the thorax. -For it is observed, that in some instances, those who have every -part of the external configuration, such as is generally attributed -to persons predisposed to Consumption, yet shall be free from this -disease; while on the other hand, some whose chests are externally -perfectly well formed, have been subject to catarrhal and inflammatory -complaints of the lungs, terminating in Phthisis. The form of chest -peculiar to many Phthisical patients, “is occasioned by the sternal -or breast-bone being pressed too much in upon the substance of the -lungs: thus the clavicles and shoulder-blades are thrust out of their -proper position, and made to assume, in some measure, the form of -wings, to which indeed they have been with propriety compared, just -raised from the body and about to expand for flight. By this internal -direction of the sternum, the full expansion and proper sweep of the -ribs is likewise prevented, and an unnatural curvature or prominence is -occasioned on either side of the breast, with a corresponding central -depression.”[4] This is the peculiar form to which the term narrow -chest is generally applied. A flattened or any other unnatural figure -of the chest may produce the same injury. - -The thorax may become accidentally malformed from any violence done to -it, particularly during infancy. A frequent source of it is the mode of -fashionable dress adopted by females. The corset, to which I allude, -when worn only with moderate firmness, and by those not otherwise -predisposed to Phthisis, serves but to add elegance and beauty to the -female figure; but when applied with the object of converting into a -delicate and slender waist, one naturally otherwise, it cannot but do -injury. By immoderate pressure, it converts a well formed chest into -the deformed and narrow one, or at least an approximation to it, which -has just been described. In our own city and time, too many fatal -examples of the deleterious effects of this fashion have occurred, to -permit us to retain any doubts on the subject. - -The internal constitution of the body predisposing to Phthisis, -independent of external form, has been generally attributed to -scrophula. English authors are particularly fond of making Consumption -another form of that Protæan disease. We are much disinclined to concur -in this opinion from the fact, that the mass of those who labour under -the disease in question, and cases too, which, after death show that -tuberculated state of the lungs, generally ascribed to scrophula, -evince no other of the numerous symptoms of that disorder. The -supposition that tubercles were scrophulous, probably originated from -the opinion that they are diseased glands; an idea now sufficiently -exploded. This hereditary predisposition we know to exist, but of its -mode of action we are totally ignorant. In this city there are many -melancholy examples of whole families successively falling victims to -Consumption, and sufficiently proving its hereditary nature. But an -hereditary predisposition does not necessarily produce Consumption. It -is not uncommon for parents who inherit this taint, to remain free from -disease of the lungs, by the pursuit of laborious occupations. Nor is -it more uncommon that the children of these very parents, whose active -industry had preserved their lives, and amassed them wealth, should -by being enabled to indulge in ease and luxury, fall victims to an -inherited Consumption. - -So the females of a family are sometimes all consumptive, while the -males are free from pulmonary disease, in consequence of the more -sedentary mode of life of the former. - -Although no period of life, from infancy to old age, is exempt from -Consumption, but all are liable to its attack, yet at a particular age, -it is observed to appear more frequently than at any other. This period -commences about, or soon after the age of puberty, and terminates at -thirty-six; the period at which inflammatory diseases most generally -occur. - -Sex also gives a predisposition to Consumption. Females are more -frequently affected by it than males. This may be attributed to -their greater delicacy of constitution, and nervous temperament. -Their comparatively sedentary habits of life add to this peculiar -constitution. But improper compliance with the requisitions of fashion -and taste constitutes not a small part of the greater susceptibility -of females to Phthisis. Independent of the use of corsets, the small -quantity of clothing frequently worn by them, under circumstances when -it is most necessary, is a fruitful source of mischief to their health. -In the coldest of our winter nights, will these fair devotees of -fashion issue from rooms, heated to a degree never experienced in our -hottest weather, into the chilling air of midnight, with less clothing -than they use at noon, when the sun exerts his greatest power. The next -day brings with it “a violent cold,” and this cold is too frequently -the foundation of the Consumption which destroys them. - -Occupation in life is another source of the ravages of this disease. -Particular occupations subject those engaged in them to the respiration -of air impregnated with foreign materials, irritating the lungs, either -by their chemical or mechanical action. Substances acting mechanically -upon the lungs, are inhaled by stone-cutters, millers, hair-dressers, -bolters, coal-heavers, scythe-grinders, persons engaged in pointing -needles, chimney-sweepers, dressers of flax and feathers, spinners -in wool, and others employed in similar occupations. Chemical agents -are taken into the lungs by manufacturers of acids, and all other -volatile corroding substances. These materials constantly acting upon -the lungs, produce irritation and slight inflammation, terminating -in Phthisis. The operation of any of these causes is favoured when -the occupation requires a stooping or other awkward posture of the -body to be maintained. This cause may act independently of the former -also, and hence, students, and clerks writing at their desks, taylors, -shoemakers, &c. are liable to this disease. To the same causes are -frequently added, a sedentary life, and confinement in hot rooms; -hence “a surgeon of London whose opportunities of observation are very -extensive, relates of the gilders of that city, who work in heated -rooms, that six out of seven are said to die consumptive in their -apprenticeship.” Sedentary habits of life, accompanied with hard -study, and too intense application of mind, predispose literary men to -Consumption. Loud public speaking, blowing on wind instruments, glass -blowing and other circumstances requiring a laborious and continued -action of the lungs, produce the same effect. Any one of these causes -may frequently exist without injury, but their combined action seldom -fails to produce pulmonary disease. - -Climate was enumerated under the predisposing causes of Phthisis. That -of our own latitude affords an example. Its variableness, increased -by contiguity to the ocean, together with the prevalence of the moist -and chilling north-east winds, is probably the agent which produces -this effect. The climate of Great Britain is not less unfavourable -to health, from similar causes, with the addition of its greater -moisture; for it is observed that cold combined with moisture is -peculiarly dangerous to the consumptive. On the other hand, inland -countries, not exposed to the moist winds from the ocean, are free -from this disease. Hence, the inhabitants of Russia and other parts of -the north of Europe, notwithstanding the severity of their climate, -are very little affected by Consumption. The habits of the people, -probably assist in producing this immunity from pulmonary disease. -Sir John Sinclair, in a communication to Dr. Reid, attributes it in -a great measure to the employment of furs, cloaks and other modes of -clothing, which preserve an uniformity of warmth throughout the body; -to the great care taken by all classes of people to preserve their feet -from cold and damp; to the different modes of communicating heat to -their apartments; and to the constant use of the vapour bath. Similar -observations were made by Dr. Cogan, who in a letter to Dr. Beddoes, -remarks that the people of Holland are exempt in a great degree -from this disease, so prevalent among the English, and ascribes the -difference to the contrast observable between the two countries, in the -construction of their habitations, and in the peculiarities of dress. - -Debility from the want of accustomed stimuli, is mentioned by Dr. -Hosack as another cause of consumption, and he instances those confined -in the State Prison. The want of accustomed air and exercise, the -deprivation of the use of spirituous liquors and good diet, to which -the prisoners had been accustomed before their confinement, was -observed by him to have produced this disease. - -Depressing passions of the mind, and a consequent too free use of -spirituous liquors have also been noticed by authors among the -predisposing causes of Consumption. - -The last of these causes which I shall notice, is the disposition -of the system to form calculous deposits in the lungs, generally in -consequence of a plethoric habit. Phthisis from this cause however is -rare; of nine hundred patients examined by Bayle, only four were of -this description. - -These various causes having either separately or conjointly predisposed -the body to Phthisis, are most frequently excited into action by a -common catarrh; which becomes the more active by frequent repetition. -The danger arising from catarrh is not a little increased by the -popular mode of treating it: stimulating spirituous drinks, and a vast -variety of remedies of the same class are the usual prescriptions. -Almost every body has an infallible remedy for a cold; some of -them innocent, but many injurious. The common prejudice in favour -of “feeding a cold” increases the mischief, and unfortunately, the -disease not generally affecting the system sufficiently to destroy -the appetite, as in many other maladies, nature does not prevent -the practice. Abstinence, cooling acidulous drinks, with perhaps a -gentle saline cathartic, are the safest and most effectual remedies in -curing a common catarrh, when of its usual slight form. At the same -time, inhaling warm air, by means of Mudge’s apparatus, is a valuable -and grateful auxiliary to this treatment. Catarrh is so common and -generally so easily cured without any consequent ill effects, that it -is too apt to be neglected. Many a patient, labouring under incipient -Phthisis, has been supposed to be affected by merely a “trifling -cold,” and the only opportunity for curing the disease has been lost. -“The evil becomes irremediable before it calls either the attention -of the parents, the friends, or even the physician, who has not been -familiarly conversant with the fatal consequences of this disease.”[5] - -Pneumonia is not unfrequently an exciting cause of Phthisis. Like -catarrh, its frequent repetition is more dangerous than a single -attack. Pneumonia may indeed act merely as a predisposing cause of -Consumption, by leaving the lungs in a debilitated and irritable -condition, favourable to the production of that disease; but it is -an exciting cause, when in consequence of inflammation of the lungs, -suppuration follows, and vomica or empyema is the consequence. This -shews the close analogy between Phthisis Pulmonalis and ordinary -Pneumonia. In the first, the inflammation being seated in the cellular -and comparatively insensible portion of the lungs, is slow and -gradual, and the consequent suppuration forms in the same manner; -while in Pneumonia, the membranous as well as cellular portion of the -lungs being involved in the disease, the inflammation is rapid and -violent, and must soon terminate in either resolution or suppuration. -Hence Phthisis Pulmonalis was appropriately called by Dr. Rush a -“_Pneumonicula_.” No word could more accurately describe the nature -of the disease. That acute observer has drawn an excellent parallel -between the two diseases, and concludes with observing, “In short the -pneumony and Consumption are alike in so many particulars, that they -appear to resemble shadows of the same substance. They differ only as -the protracted shadow of the evening does from that of the noon-day -sun.” It is remarked, however, that all cases of Pneumonia terminating -in suppuration are not necessarily fatal. If a predisposition to -Phthisis do not exist, or the constitution be not too much debilitated, -a vomica may burst and be discharged, and the patient recover. - -A third exciting cause of Phthisis, is the suppression of accustomed -evacuations. These evacuations are the menses, the lochiae, the -discharges in Leucorrhæa, and from ulcers, fistulæ and issues. -Retention of the menses producing Chlorosis, being a consequence -of debility, does not excite primary Phthisis Pulmonalis, but the -secondary form of the disease. Suppression of the menses, however, not -unfrequently excites a Consumption, bearing all the characters and -requiring the treatment of primary Phthisis. The plethora, consequent -on the cessation of the menses, has often the same effect. - -Asthma, by the constant irritation to which it subjects the lungs, -becomes an exciting cause of Consumption. - -Several eruptive diseases, as Scarlatina, Small-Pox and measles, often -produce the same disease. - -Morton also enumerates stone in the kidneys and bladder, gout and -rheumatism, as causes of Consumption. - -By the same author, contagion is supposed to communicate this disease. -Morgagni, Van Swieten, Home and Heberden all hold this opinion. And -Morgagni relates that Valsalva, who was predisposed to Consumption, was -so satisfied of its contagious nature, that he constantly avoided being -present at the dissection of the lungs of persons who had died of that -disorder. - -Dr. Rush maintains the same doctrine, and relates that the late Dr. -Beardsley of Connecticut, informed him that he had known several black -slaves affected by a Consumption, which had previously swept away -several of the white members of the family to which they belonged. -In these slaves no suspicion was entertained of the most distant -relationship to the persons from whom they had contracted the disease: -nor had grief nor fatigue, been supposed to have had the least share -in debilitating their bodies. The force of so much authority with -the evidence adduced, constrains us to admit the communicability -of Consumption by contagion. But if this agent has any effect, its -action must be extremely limited, and extend no farther than to those -previously predisposed to the disease. For daily examples without -number occur of the constant attendants upon those labouring under -Phthisis remaining perfectly free from that malady. - -Violence done to the lungs by blows or other injuries of the chest, has -in some instances, excited Consumption.[6] - -Foreign bodies conveyed accidentally into the lungs has produced the -same effect. Morton relates a curious case where three nails had passed -into a person’s trachea and destroyed him, by inducing Consumption. - -Bayle also enumerates a form of Phthisis, which he calls cancerous, -arising in patients in whom the cancerous disposition has become -constitutional. It is, however, extremely rare; only three cases having -occurred to him among the 900 whom he had examined. - -Hæmoptysis and tubercles are mentioned by most authors as exciting -causes of Consumption, and remain to be examined. So frequently did Dr. -Cullen consider Hæmoptysis the cause of Phthisis, that he placed the -latter disease in his Nosology, merely as a consequence of the former. -The impropriety of this arrangement has been already touched upon. - -On this subject, I would suggest the following facts. Hæmoptysis -occurring in persons not predisposed to Consumption, except the -quantity of blood lost be so great as to produce it by mere debility, -very frequently may be easily cured without danger of any consequent -disease. Indeed not only in such cases consumption is not induced by -it, but that disease has actually been prevented, by the occurrence of -hæmorrhage from the lungs, relieving that inflammation, which the inert -physician, by withholding the lancet, would have suffered to destroy -his patient. Dr. Rush relates two cases of inflammatory Consumption -attended by a hæmorrhage of a quart of blood from the lungs, in which -the patient recovered; and ascribes their recovery entirely to the -loss of blood. Wounds and other injuries of the lungs frequently heal, -when no predisposition to Phthisis exists, as easily as in other parts -of the body. Of this fact also Dr. Rush affords an example. A British -officer informed him, a few days after the battle of Brandywine, in -September 1777, that the surgeon general of the royal army had assured -him, that out of twenty four soldiers admitted into the hospitals, -during the campaign of 1776, with wounds of their lungs, twenty-three -recovered. These facts prove sufficiently that the constant motion of -the lungs does not prevent the healing process taking place in them as -easily as in other parts of the body. - -In most instances, the spitting of blood which is supposed to have -produced the Consumption, has occurred a considerable period before -the Phthisical symptoms appeared. During this interval perhaps the -patient was perfectly well. Can it be supposed, that the inflammation -necessary to form an ulcer, and the process of ulceration itself, could -so long be going on unperceived, without producing any irritation of -the lungs? Is it not more probable, that the Hæmoptysis was recovered -from, and that the same cause which produced it, at length produced the -Consumption? - -Hæmoptysis, then, I would consider, as very seldom, perhaps, never, -being the cause of Consumption; but in all those cases in which it -is assigned as the cause, merely a symptom of the incipient stage of -the disease. The symptoms accompanying hæmorrhage from the lungs, are -no other than those of incipient Phthisis. They are thus accurately -described by Dr. Reid. “When subsequent to a sense of weight and -oppression in the breast, which scarcely amounts to a feeling of pain, -together with cough, difficult respiration, and general lassitude, a -quantity of blood is suddenly, and in a convulsive manner, discharged -from the mouth, there can remain small doubt respecting the part from -which it proceeds. If the discharged blood be of a florid colour, and -together with the above symptoms, a saltish taste be perceived in the -mouth, and the patient become sensible of a degree of irritation in -the upper part of the trachea, the nature of the affection is rendered -altogether unequivocal.” Every symptom here enumerated, occurs in the -early periods of Consumption. - -Nor have we any better reason for believing tubercles to be an exciting -cause of Phthisis. These appearances are indeed very frequently found -in dissections of the lungs of those who have died of Consumption. -Of the nine hundred patients examined by Bayle, 624 had tuberculated -lungs. Tubercles were formerly considered as indurated glands, and -generally attributed to a scrophulous constitution; but we are assured -by Baillie, in his morbid Anatomy, “that there is no glandular -structure in the cellular connecting membrane of the lungs; and on -the inside of the branches of the trachea, where there are follicles, -tubercles have never been seen.” These tubercles are roundish bodies, -of a firm consistence, and frequently a cartilaginous structure, but -often containing decidedly purulent matter. By the union of several -of them, vomicæ are formed, which are only larger tubercles. May not -the formation of these bodies be sufficiently accounted for by the -preceding inflammation, and they be considered therefore a consequence, -rather than a cause of Consumption? Dr. Rush insists that tubercles are -the effects, and not the cause of pulmonary Consumption; and remarks as -a farther evidence of this opinion, that similar tumours are suddenly -formed on the intestines by dysentery, and on the omentum by a yellow -fever. He refers to cases of the former in the dissections of Sir John -Pringle, and one of the latter mentioned by Dr. Mackittrick, in his -inaugural dissertation on the yellow fever, published in Edinburgh, -in the year 1776. Dr. Hosack, in his Lectures on the Theory and -Practice of Physic, advocates the same doctrine, and enforces it, by -remarking, that similar tubercles are formed in the parenchyma of -the brain, the liver, and the kidneys, in which no small glands have -yet been detected, and where, as in the lungs, there is nothing but -cellular membrane and vessels. It is his opinion, that it is an union -of a number of these cells in a state of congestion that constitutes -tubercles or vomicæ--that in some instances they heal, the matter is -absorbed, and they remain in a scirrhous state, the patient becoming -perfectly restored to health; and hence the remark of Dr. Simmons, -that tubercles may exist without Phthisis. - -These are all the principal predisposing and exciting causes of -Phthisis Pulmonalis. Some few others are mentioned by authors, but they -are of either very doubtful agency, or too rare to deserve notice. - -The disease having been excited into action, produces a succession -of symptoms which are now to be detailed. Its attack is frequently -extremely insidious and slow; at other times, well marked and rapid in -its progress. It is to this insidious and gradual mode of attack, that -Consumption owes much of its fatal character. Before the unfortunate -patient suspects himself to be seriously indisposed, it but too -frequently happens, that his fate is sealed, and death is inevitable. -This arrives in part from the resemblance that Incipient Phthisis -bears to a long continued catarrh. It frequently is only marked in -its earliest periods by a slight, dry, hacking cough, trivial during -the day, increased at evening, and most troublesome at night; a sense -of weight about the breast, and some little difficulty of breathing, -increased on taking any unusual exercise, or ascending a height; the -pulse is slightly accelerated, and sometimes only so after taking food: -occasionally, burning hands and feet, and a slight flush in the cheek -are the only symptoms of fever. These symptoms may be so slight as -hardly to attract the patient’s notice; at other times they are more -severe and distressing. Frequently, on any little unusual exercise, -the cough is increased, the patient feels a pain in the side, and -expectorates a frothy mucus, and blood is discharged from the lungs. -This, perhaps, is the first symptom which excites the alarm of the -patient. Expectoration of blood is generally preceded by a saltish -taste in the mouth, and a sense of irritation at the upper part of the -trachea. It is known to come from the lungs and not the stomach, by its -frothy appearance and admixture with mucus, while that from the stomach -is generally dark coloured and mixed with the food; and by being -brought up by coughing and not vomiting. The blood coming from the -stomach too, is generally in larger quantity than that from the lungs. - -In addition to these symptoms, the patient is often affected by an -increased sensibility of the lungs, observable on any exposure to -cold, change of dress, or going from a warm to a cool apartment. -There is a sense of soreness in the lungs attended with a sensation -of stricture about the chest. Pain is felt in the side or breast, and -the patient lies with difficulty on the side affected. The pain is -frequently lancinating, and shooting through the breast, sometimes in -the direction of the mediastinum, at others, confined to one side. - -As the disease advances, the symptoms of fever become more marked. The -tongue is dry, attended with thirst, loss of appetite, nausea, and -occasional vomiting, and a desire for acids. The secretions generally -are checked. Perspiration is diminished, and the skin is hot and dry. -The urine is at first diminished in quantity, and high coloured. The -menses, in females, are either suppressed or very irregular. The -bowels are frequently costive. The patient passes restless nights, -and is prevented sleeping by a tormenting cough, or if he sleeps, is -troubled with dreams. In consequence of indigestion, pain is felt in -the situation of the stomach, attended with flatulence. The patient -begins to have a pallid countenance, and emaciation gradually takes -place. - -These symptoms may continue a length of time, gradually debilitating -the patient. But the expectoration which at first was frothy, in -small quantity, and coughed up with difficulty and pain, increases, -and gradually passing through all the stages between mucus and pus, -at length becomes decidedly purulent. A new train of symptoms follow. -Hectic fever makes its appearance, commencing with irregular cold and -shivering fits, returning frequently during the day. It soon, however, -assumes a decided character, and has two marked exacerbations, the -one at noon, the other at night. These exacerbations begin with a -sense of coldness, succeeded by heat, and at night terminating in -profuse perspiration. During the chill and hot fit, the cough, pain, -and dyspnœa are aggravated, but relieved by the sweating. The pulse -before the paroxysm is accelerated and weak, during its continuance -quick and strong, but abates as the perspiration flows. The countenance -is generally pale, but during the exacerbation is marked by a -circumscribed crimson flush, which occurs mostly at noon, but may be -produced by taking food or any other cause of excitement. The profuse -sweats do not occur after the exacerbation at noon, but in the morning, -while the patient is warm in bed, with the system relaxed by sleep. -The perspiration is principally confined to the superior parts of the -body, as the neck, breast, and about the shoulders. The tongue is often -very clean during hectic fever, but sometimes furred. The bowels are -generally torpid, alternating with diarrhœa. - -The disease continuing to advance, the cough and dyspnæa increase, and -the hectic symptoms become more marked and violent. Emaciation rapidly -goes on, the face looks sharp and haggard, and the absorption of fat -makes the eyes appear remarkably large and prominent. At the same time, -the teeth appear unusually white and beautiful. The appetite becomes -extremely irregular, the pulse more accelerated and diminished in -strength. The mind is extremely vacillating, at one time depressed, at -another, elated with hopes of recovery. Profuse diarrhœas, alternated -with obstinate torpor of the bowels, exhaust the patient; the eyes -assume a ghastly and pearly whiteness; the mouth becomes filled with -apthous eruptions; sometimes hiccup ensues; the patient’s mind becoming -more and more disturbed, delirium comes on, which soon terminates in -death. - -An assemblage of some or all these symptoms, constitutes Phthisis -Pulmonalis, differing however very materially in number, degree and -violence in different patients. They are variously modified by a number -of attending circumstances, which require some attention. - -Many authors declare, that an expectoration of pus does not always -attend this disease. The matter may be confined in a vomica, and the -patient die with the symptoms of Phthisis before it bursts. Nor does a -purulent expectoration necessarily indicate the existence of an ulcer -in the lungs. The matter may be poured out from the secreting surfaces -of the lungs without ulceration, precisely as it comes from the adnata -of the eye after opthalmia, or the urethra in gonorrhœa, where no -ulcer is suspected. In the New-York hospital, dissections of numerous -patients who have died of Phthisis, sufficiently prove the fact in -question. - -Nor does pain in the side or breast, always accompany this disease. Dr. -Reid remarks that many cases have occurred in his practice, where no -pain in any part of the chest has been observed during the whole course -of the disorder. “I have witnessed,” says Dr. Heberden, “many deaths -from genuine pulmonary consumption, where dissection has demonstrated -an entire destruction of the substance of the lungs, and where through -the whole course of the disease, neither expectoration of blood, -difficulty of breathing, nor pain in the side had been present.” On -the other hand, pain in the side may occur merely as a consequence of -the debilitated or irregular action of the muscles, as in walking, and -should not be mistaken for a symptom of Consumption. - -In the course of the disease, dropsical effusions, constituting -Ascites, Hydrothorax and Anasarca, are not unusual, as in other -diseases where great debility is produced. - -In the advanced periods of Consumption, diarrhœa constitutes a -prominent and troublesome symptom. This is sometimes produced by any -cause which checks the profuse sweats; while on the other hand, if the -diarrhœa be checked, the cough and dyspnœa, which perhaps had been -relieved by it, frequently return with redoubled violence. Under these -circumstances, the condition of the patient is hopeless indeed. - -The approach of summer frequently mitigates the sufferings of the -consumptive, and gives them hopes of returning health; but when winter -returns, these hopes are blasted; the patient sinks again into his -former condition, and most generally is cut off during the cold season. - -The symptoms of Phthisis are frequently suspended or mitigated by any -cause producing a new determination in the system. The most prominent -of these causes is pregnancy. It almost invariably happens that -the symptoms of Consumption are relieved by the occurrence of this -event; but after parturition the disease returns with all its former -violence. The occurrence of mania has produced the same effect, and -has even entirely cured the disease; but generally, when the mania is -removed, the symptoms of Consumption return. An attack of rheumatism -has frequently relieved phthisical complaints. Dr. Rush refers to three -clinical patients in the hospital of Pennsylvania to exemplify this -observation. In the same manner gout is observed to alternate with -Consumption, and during its paroxysms, the complaint of the lungs is -relieved. Frequent cases are related, in works on this subject, of -eruptions on the skin alternating with Phthisis Pulmonalis. - -Long continued ulcers, or fistulæ in ano not unfrequently relieve -pulmonic complaints in phthisical patients; while the healing of these -ulcers or fistulæ reproduces the disease with tenfold violence. - -A farther circumstance worthy of remark in this disease is, the -willingness with which the patient suffers himself to be flattered with -hopes of recovery. Notwithstanding he sees daily victims of Consumption -falling around him; notwithstanding the perfect assurance he has of the -small number of those who recover from it; to the last his hopes are -not abandoned. Although depressed at night by the evening exacerbation -of hectic fever; in the morning, from his comparatively comfortable -situation, his hopes revive. Happy is it for these miserable sufferers -that they do not despair. In a disease whose progress is frequently so -slow, and whose event is but too often so sure, fortunate it is, that a -solace remains to cheer the unhappy patient. - -The duration of Consumption is extremely various; from a few weeks to -fifty years have patients laboured under it. In Bayle’s statement of -the duration of the disease in two hundred cases in which the patients -were destroyed by it, it was between two months and two years in 168 -cases, four were less than two months, and 28 remained more than two -years. - -From the detail of symptoms which has just been given, it is evident, -that there are two distinct stages of Phthisis Pulmonalis, each -characterised by peculiar symptoms, and requiring peculiar treatment. -The first, incipient, or acute stage as it is variously termed -by authors, is the stage of inflammation, and terminates as soon -as purulent expectoration and hectic fever commence. The second, -confirmed, or chronic stage commences where the first terminates, and -ends most generally in death. We would not however assert, that these -stages can always be accurately distinguished, and a line drawn between -them. On the contrary, hectic fever may occur early in the disease, -before any expectoration of pus takes place, and inflammatory symptoms -frequently attend its advanced stage. In general, the distinction can -be made, and must necessarily guide the prudent physician. - -Having taken a view of the causes and symptoms of Phthisis Pulmonalis, -we are now prepared to investigate the proximate cause of the disease. -From the nature and extent of these symptoms, it appears evidently a -disease of the whole system, and not confined merely to the lungs. -The proximate cause, as taught by Dr. Hosack, in his lectures, is, an -inflammation of the lungs, terminating either in a purulent secretion, -or ulceration in their substance. This opinion is much strengthened by -the analogy before remarked between Phthisis Pulmonalis and Pneumonia. -It is a little singular that Dr. Rush, notwithstanding he had remarked -this close analogy, and although he speaks of inflammatory fever as a -part of the disease, and prescribes blood-letting in its treatment, -should yet have made debility its proximate cause. This is only one -instance among many, of physicians arriving at precisely the same -modes of treatment by directly opposite routes. If that theory of -inflammation be admitted, which makes debility its cause, so far it -is also the proximate cause of Phthisis Pulmonalis. In the secondary -species of Phthisis, hereafter to be considered, debility may be fairly -ranked as the proximate cause, and the indications of cure correctly -drawn from it. But in the primary disease under consideration, if we -were to found our indications on this basis, and thence deduce the -propriety of exhibiting powerful tonics in the first stage of the -disease, when brought to the test of practice, its error would soon -become sufficiently glaring. - -Various other causes have been successively treated of by authors, -but to shew their inconsistency and absurdity, it is only necessary -to observe that, “the existence of an acid or an alkali, of chemical -acrimony, or mechanical changes in the blood, of corroding volatile -particles, and even of animalcula in the lungs, have been vaguely -conjectured to be the cause of pulmonary ulcer and hectic fever.[7]” - -Assuming then, inflammation of the lungs, and consequent ulceration -of their substance as the proximate cause of Phthisis Pulmonalis, we -naturally deduce the following indications in the treatment of the -disease. - -1. To endeavour to relieve the inflammation of the lungs, and promote -its resolution. - -2. If, notwithstanding all our efforts, suppuration takes place, to -give sufficient support and tone to the system to enable the ulcers to -heal. - -In fulfilling these indications, our first object is to remove the -remote causes, where it is possible. If the patient’s occupation is -one of those which predisposes to Consumption, unless it be abandoned, -or at least so modified as to correct the objectionable parts of it, -we cannot hope to cure the disease. If the disease arise from the -suppression of an accustomed evacuation, our utmost endeavours must -be made to restore it. Should suppression of the menses be the cause, -means calculated to produce their return must be resorted to. If an -ulcer or fistula has healed up, they must be re-opened, or issues -established in more convenient situations. In short, the rule is plain -and simple. Remove the remote causes, wherever it is practicable. - -Among the remedies which are necessary to fulfil the first indication, -the most prominent is Blood-letting. This remedy has been strongly -advocated by many of the most distinguished authors who have written -on Consumption; and its propriety admitted by all under certain -circumstances. Probably, most of the injurious effects attributed -to it, may be accounted for by a proper distinction not having -been made between Primary and Secondary Phthisis Pulmonalis. When -bleeding has been practised in the secondary form of the disease, -it has been generally injurious, and hence an odium has been cast -upon its employment in any circumstances. In the same manner, it -has done mischief, when used too late in Primary Phthisis, and thus -another groundless argument furnished against the remedy. But the -indiscriminate use of blood-letting is not here contended for. Its -judicious and cautious use, when inflammatory action is evident, alone -is intended to be advocated. On the other hand, too timid practice -may induce us to withhold the lancet when it is necessary; and we -may thus do as much injury by losing the proper time for action, as -we would have done by pushing the remedy too far. It is difficult to -fix the period beyond which it is improper to bleed in Consumption. -Dr. Hosack insists that as long as there is any pain or soreness on -taking a full inspiration, the lancet is necessary. This rule is not -applicable to practice; for if we adopt it, we may bleed the patient -until he dies. Until that moment will the pain in some instances -continue. It is not unfrequent, after the patient has been exhausted -by colliquative sweats, and profuse diarrhœa, for pain in the breast -to recur at intervals, a few days before death: and what practitioner, -under such circumstances, would feel himself justified in using the -lancet? But this rule is incorrect in another point of view. In some -cases, it will prevent our using this valuable remedy, when it is -necessary. On the authority of Dr. Reid, it is asserted, that pain -is not always present in Phthisis Pulmonalis; and may not occur -during the whole course of the disease. A reference has been already -made to Dr. Heberden to prove the same fact. On this subject it is -impossible to fix any precise rule. The strength and habit of the -patient, the urgency of the symptoms, and state of the pulse, must all -be recollected and adverted to in making up our judgment as to the -propriety of the remedy. In general, perhaps we may say, that after the -formation of matter is perfectly ascertained, it is improper to bleed. -This, however, is not without exceptions. Cases sometimes occur, after -this period, in which the symptoms of high inflammatory action arise, -and where the lancet is indicated. It is now generally admitted that -the buffy appearance of the blood is by no means an infallible evidence -of the necessity of the repetition of blood-letting. Nor is its cupped -form a better proof of the existence of inflammation. Many writers have -observed, that the buffy coat appears in the blood drawn in Consumption -at the latest periods of the disease. A remarkable and decided case of -Enteritis, occurred during the last winter, in the New-York Hospital, -in which very large and repeated bleedings were made use of, with -the good effect of curing the patient: and yet, neither buff nor the -cuplike form appeared in the smallest degree in the blood drawn. This -case alone is sufficient to prove, how equivocal are these appearances -of the blood, as tests of inflammation. Nevertheless, the judicious -practitioner will not fail to observe these circumstances, and as they -so frequently accompany inflammation, will consider them, when attended -with other evidences, as properly influencing his judgment on the -propriety of bleeding. - -If the abstraction of blood from the system generally is useful, no -less so is it when drawn from the part itself, by the application -of cupping-glasses, and the scarificator to the chest. This mode of -obtaining blood is peculiarly useful in those frequent cases, where the -patient is too much debilitated to bear the loss of much blood, but the -existence of inflammatory action makes its abstraction necessary. - -Emetics are a powerful remedy in the treatment of Phthisis. They not -only promote expectoration, and relieve the distressing cough in the -first stage of the disease, but by their general relaxing effects -upon the system, are useful in reducing inflammatory action. The use -of this remedy, however, should not in general be commenced until -blood-letting has been premised; otherwise in plethoric habits, full -vomiting might induce hæmoptysis. Practitioners have differed very -much in the choice of emetics proper in this disease. The antimonial -preparations and ipecacuanha, as acting more generally upon the system -in reducing excitement, and from their good effects in other febrile -diseases, appear to be the most proper. But in the last stage of -Consumption, where our object is to relieve the pulmonary symptoms, -without debilitating the patient, the sulphates of zinc and copper are -preferable. - -Emetics are not only useful when exhibited for the purpose of full -vomiting, but medicines of the same class given as diaphorectics are -also proper. With this view the various preparations of antimony are in -use. Small doses of the Antimonial powder combined with calomel have -been found, perhaps, one of the best sudorifics that can be employed, -and as such are frequently useful in Phthisis. No medicine is superior -to this combination in reducing inflammatory action; and it frequently -has a better effect by proving both emetic and purgative. - -As a sudorific, warm bathing may be very useful, and is an agreeable -remedy in the inflammatory stage of Phthisis. As the warm bath is -useful in relaxing the surface of the body generally; in a similar -manner inhaling warm air, by means of Mudge’s apparatus, relaxes the -inflamed membrane of the bronchiæ, and acts as a fomentation there, -with the same good effect as is produced by warmth and moisture upon -any other inflamed surface of the body. This remedy gives great relief -in the cough and hoarseness so distressing in Phthisis Pulmonalis. - -With the same view of counteracting inflammation, cathartics may be -prescribed. As in other febrile diseases, so in Phthisis, the bowels -are frequently torpid, and require the frequent use of aperient -medicines. Saline and mercurial cathartics, possessing the greatest -power in diminishing excitement, are perhaps the most proper in this -disease. But as it is an object not to induce too much debility, the -use of drastic purgatives should be avoided as much as possible, and be -confined to the earliest periods of the disease. During its advanced -stage, the bowels should be kept open by mild laxatives and enemata, -which tend least to debilitate the patient. - -Blisters, Setons and Issues relieve the inflammation of the lungs, and -produce a new determination to the surface with the happiest effects. -Most writers agree in recommending repeated blisters to the chest, as -an useful remedy, and with reason. But it is to be regretted that they -have been suffered to usurp the place of a more powerful remedy of the -same class, viz. Issues. If we may judge from the effect of ulcers and -fistulæ, which palliate all the symptoms of confirmed Phthisis, while -they continue, but whose healing restores the disease, it would appear -that the establishment of similar drains, in the form of issues, ought -to have a good effect. In caries of the spine, and disease of the hip -joint, where the inflammation in the cellular structure of the bones -seems to be very analogous to that in the cells of the lungs, issues -are used with the greatest benefit. In these cases, they are uniformly -preferred to repeated blistering, and experience has sanctioned the -preference. Issues are preferable to blisters by their constant and -uniform action, whereas the latter remedy has its effect continually -interrupted by healing up and requiring renewal. In general, blisters -appear to be more useful in acute diseases, which may soon be subdued: -but in Phthisis Pulmonalis, which continues so long, and whose progress -is so slow, issues appear to be the better remedy. Dr. Mudge was so -well convinced of their efficacy, that he assures us, he cured himself -of an Incipient Consumption, by a large issue between the shoulders. -Beddoes also recommends them, and relates several cases, in which -they were used with the best effect. But if this remedy be tried, it -should not be done timidly, and with the fear of giving pain; when -used at all, issues should be large and effectual, not only sufficient -to contain a single pea, but at least a dozen. This is not the only -remedy which has fallen into disrepute by a trifling and inefficient -mode of employing it. But as blisters are preferred by many of the most -judicious practitioners, their use may easily and with advantage be -combined with that of issues. While a large issue is kept open between -the shoulders, successive blisters may be applied to the chest. Many -patients, perhaps, would not submit to so severe a mode of treatment; -but it is only by such active and efficient practice, that we can hope -to cure this formidable malady. - -It is only in the first stage of Consumption that much benefit is to -be expected from this class of remedies, or at all events, before the -patient is much debilitated. In its latest periods, they would tend -rather to add to the debility already induced by the disease. At any -time, however, when the patient is not too much reduced, they may be -prescribed with advantage. - -Mercury, given until it produce salivation has frequently cured -Phthisis Pulmonalis. It is used with greatest advantage in its first -stage, but after the inflammatory action has been in some measure -reduced, by means of blood-letting, and the other remedies proposed. -Before these evacuations have been premised, it would tend rather to -increase the inflammation; while in the advanced stage it would add too -much to the debility of the patient. It generally succeeds only when -it affects the mouth, and therefore to secure this effect and prevent -its running off by the bowels, it should be combined with opium. But -the best form of exhibiting mercury, is one much in use with my worthy -friend and preceptor, Dr. Borrowe. Calomel, combined with small doses -of antimonial powder, given morning and evening, until it affect the -mouth, is the form proposed. In this way it may be given at an earlier -period of the disease, than would otherwise be proper, by the constant -determination to the skin kept up by the antimonial powder, obviating -the tendency which mercury has to increase inflammatory action. At the -same time it serves to keep the bowels open, and makes almost every -other medicine unnecessary. On the other hand, if it acts too much -on the bowels, it may be usefully combined with opium, which adds to -its diaphoretic effect. The good effects of this mode of exhibiting -mercury, is strikingly illustrated by the result of the following case, -which occurred in the practice of Dr. Borrowe within a few months past. - -“Miss ------, aged about 14 years, had been for six months past, -afflicted with some cough, pain in the chest and difficulty of -breathing. She was affected with loss of appetite, emaciation and -profuse sweats at night. Her pulses were frequent; she had the peculiar -pearl-like appearance of the adnata; frequent attacks of diarrhœa, and -an expectoration much resembling pus. She was attacked with chills -about the middle of the day, followed by considerable excitement, -aversion to motion and drowsiness; succeeded by great prostration of -strength; palpitation and hurried breathing on ascending a height or -engaging in any considerable bodily exertion; attended with a livid -appearance of the lips, evidencing a difficulty in the passage of blood -through the lungs. - -It was determined to put her upon the use of Calomel and Pulv: Jacob: -which were given in small doses every night and morning; a blistering -plaister was also applied to the chest, and kept in an irritable -state for a considerable length of time. The diet was ordered to be -soft, mild and nutritious. The mercury and antimonial medicine were -occasionally omitted when they acted more on the bowels than the skin, -or occasional anodynes were administered to restrain their action on -the alimentary canal. - -Some weeks elapsed before the mercury produced any effect upon the -salivary glands, which was one of the objects aimed at. As soon as the -mouth became sensibly affected, the symptoms were generally mitigated. -A temporary suspension of the use of the remedies became necessary, in -consequence of the considerable effect produced by the mercury. When -the soreness of the mouth abated, small and less frequent doses of the -calomel were given so as to keep up a tenderness of the gums several -weeks longer. The affection of the chest became now entirely relieved, -and it was thought advisable to suspend the use of the mercurial -treatment, the effects of which were suffered to pass off, rather than -be relieved or cured. - -From this time no medicines were employed, except a small quantity of -a weak infusion of colombo as a tonic. Long before the patient’s mouth -enabled her to eat, her appetite became craving. She was indulged in -eating moderately of such food as she had a particular desire for; -and she soon was enabled to take exercise without inconvenience. She -did not now complain of any pain in the chest, the cough left her, -the bowels became regular, there was no recurrence of night sweats, -she began to gain flesh, the countenance assumed the healthy aspect, -and the peevishness under which she had long laboured was effectually -cured. She now slept well, and gradually returning to her former -habits, is at the end of five months after discontinuing her remedies, -in perfect health.” - -Digitalis is a remedy in Phthisis, which has excited much acrimonious -controversy among practitioners of medicine. As always happens in -these contests, it has been praised too highly by one party, and -condemned too severely by the other. When first introduced, it seemed -to promise the complete eradication of Consumption: and it almost -appeared that digitalis was as specific in the cure of that disease, -as mercury, in syphilis. Dr. Magennis of the Royal Navy Hospital -at Plymouth, England, published a paper, containing an account of -seventy-two cases of incipient or confirmed Consumption, in seamen and -marines, treated with digitalis. Of these, twenty-five with ulcerated -lungs recovered; and fifteen from the stage previous to ulceration. -Thirteen of the seventy-two in an early stage of ulceration were -discharged, greatly relieved; and nine in the previous stage. In ten -cases, the medicine failed; but in some of these it gave considerable -relief. Beddoes assures us, that three cases out of five of tubercular -consumption, in his practice, had recovered under the use of digitalis. -Kinglake insists that one in three cases of the tubercular stage of -Consumption, may be cured by this medicine. Dr. Currie informs us, -that digitalis may be used with safety and success in cases where the -lancet can no longer be employed. These results in the practice of men, -distinguished in their profession, although they may be somewhat warped -by prejudice, are extremely flattering, and prove at least that the -medicine has some power. But like all other new remedies, digitalis has -been rated too highly by those who first used it. Delighted that they -had discovered a medicine, which, in some cases would cure a disease, -which they had been accustomed to look upon as totally incurable, these -physicians have suffered themselves to attend too exclusively to its -successful results, and to neglect cases in which it has failed. Other -practitioners, on reading their exaggerated statements, have tried the -remedy, but finding themselves frequently disappointed, have gone into -the other extreme and condemned it entirely. Their representations -are to be admitted with as much qualification as those of their -opponents, and the judicious physician will not suffer himself to be -exclusively guided by either. That in certain cases, digitalis will -cure Consumption, cannot be doubted; but we have also to regret, that -it very frequently fails. It was prescribed in the New-York Hospital, -under the direction of Dr. Hamersley, during the last winter, in six -cases which I have witnessed, of evident and well marked Phthisis. Of -these, two patients were perfectly cured; one has nearly recovered, and -is only retained in the Hospital for a slight cough, which is yielding; -a fourth was discharged at his own request, but evidently relieved; the -fifth commenced the use of digitalis, at a very advanced period of the -disease, and soon died; in the last it failed entirely, and appeared -rather to have done injury. - -Having ascertained that digitalis does sometimes succeed in curing -Phthisis Pulmonalis, it remains to discover what are the cases in -which we may exhibit it with success. For this purpose it would be -desirable to ascertain the _modus operandi_ of the medicine. Here -writers have differed as widely as in their account of its success -in practice. One author determines it to act by diminishing the force -and frequency of the circulation, and reducing inflammatory action; a -second attributes its salutary effect to its operation on the kidneys; -while a third believes it no longer to be of advantage, when it -increases the discharge by urine, excites nausea, vomiting, purging -or any undue excitement, but attributes its beneficial effects to its -stimulant efficiency, in invigorating the arterial and muscular energy -of the system: and a fourth insists that by promoting the action of -the absorbents it cures Consumption. These conflicting and opposite -opinions constrain us to admit, that farther enquiry is necessary, -before we can rest satisfied as to the mode in which digitalis acts. -It must be confessed that this medicine is extremely uncertain in -its operation. Its most evident effect, and that most insisted on, -of reducing the frequency of the pulse, is by no means certain; and -indeed, it is the opinion of Dr. Beddoes, that the force and strength -of the pulse are increased by it. In the N. Y. Hospital I have -witnessed frequent cases in which its continued exhibition produced no -effect in reducing either the force or frequency of the pulse; and in -some instances no effect at all seemed to be produced by it. A case -occurred in that institution in October last, in which a patient, by -his own carelessness took six drachms of Tinct: Digitalis with no -evident injury. In examining the effect of this medicine on the pulse, -it is necessary to recollect the remark of Beddoes, that it is very -different in the recumbent and erect posture; the pulse frequently -being found to be reduced in frequency and irregular in the former, -but recovering its frequency and regularity in the latter situation. -From the same author we learn, that if this remedy do not produce any -good effect within three weeks, we can expect no advantage from it at -all. It is generally admitted that digitalis will succeed only in the -first stage of Phthisis Pulmonalis; in the last or ulcerated stage of -that malady, it will not save our patient, but we are apprehensive, -will rather hasten his dissolution. As it is acknowledged to be an -uncertain medicine, we should not place our whole dependence upon it, -nor suffer it to take the place of blood-letting and the rest of the -antiphlogistic treatment before recommended: it should be used rather -as an auxiliary than a principal remedy. From its uncertainty of -operation it requires a cautious exhibition. The dose for an adult is -from ten to fifteen drops of the saturated tincture, three times a day, -and gradually increased until some effect is produced. - -The use of factitious airs in Consumption is now very much abandoned. -No essential benefit has ultimately appeared to be derived from them; -although in the first instance, they produced some apparently good -effect. - -Of much more advantage is a sea-voyage and a mild climate. The benefit -evidently derived from sea-voyages has been attributed to various -causes. The nausea and vomiting from sea-sickness, the uniform motion -and gentle regular exercise produced by sailing, and the uniformity -and mildness of the atmosphere of the ocean, so evident at a distance -from the land, probably all combine in producing these happy results. -We can hardly suppose, however, with Dr. Mudge, that the exhalations -from the tar and pitch about the ship, taken into the lungs in -respiration, have any agency in the effect produced. But whatever be -the cause, it is not at all unfrequent for consumptive patients to -experience immediate relief after having been a few days at sea. A -sea-voyage to produce permanent benefit, should be long continued, and -what is of still more importance, terminate in a mild climate. Every -winter, instances occur in this city, of consumptive patients being -restored to health by a voyage to the south of France, or some other -country of similar temperature. The climate most grateful to these -patients is one whose temperature is uniform, not subject to any sudden -variations, and where the atmosphere is dry and pure. The island of -Madeira possesses all these requisites. The part of it best adapted to -the purpose in question is thus described by Dr. Adams, a physician of -that island, in a letter to his friend in London:-- - -“The valley of Funchall is defended by immense hills from every wind -but the south, where it is open to the sea-breeze; this preserves a -temperature so even, as is unknown in any other part of the world. Our -winters may be compared to your summers in every thing but the length -of days, and those sudden changes from heat to cold, to which you are -subject. The thermometer with us is often steady within doors, or -varies scarcely a degree for weeks together. During winter its whole -range is from 58 to 65; and in summer, from 70 to 75, rarely amounting -to 80; the heat being always tempered by a breeze in proportion to the -force of the sun. The dryness of our atmosphere is not less remarkable.” - -If this description be correct, Madeira has a climate possessing every -requisite to make it most favourable to phthisical patients. The -southern parts of the United States are frequently resorted to, also, -by the consumptive with great benefit. I have had the satisfaction -of seeing a young friend return from Charleston, a short time since, -perfectly restored to health, who, during the last autumn, was attacked -with repeated hæmoptysis and other symptoms of Incipient Phthisis. - -It is to be regretted, that change of climate, a remedy of so much -advantage in the early stage of Consumption, should so often be -postponed, until no possibility of recovery remains. It is too often -the fate of such patients, to leave their homes in quest of health, -merely to find a foreign grave; resorting to that remedy which should -have been first, as the last effort of despair. To this cause alone, -may we attribute its frequent inefficiency, and unfortunately the same -cause has contributed too much to bring the remedy into disrepute. - -Where from any circumstances, change of climate is impracticable, it -may to some extent be imitated, by confining the patient to apartments -whose temperature is kept constant and uniform. This has been tried and -with some success; and is probably, the remedy of the same class, next -in power, but much inferior to a warm climate. Beddoes made use of it -in several cases with relief to his patients, but it has not yet been -sufficiently tested to establish its character as a remedy in Phthisis -Pulmonalis. - -Besides the use of the remedies which have been enumerated, with the -view of effecting a radical cure of this disease, there are some -symptoms occurring in its first stage, which require immediate relief. -Hæmoptysis sometimes comes on in such a manner as to be very alarming -to the patient. Blood-letting in large quantities, and repeated in -proportion to the strength and habit of the patient and violence of -the symptoms, is then absolutely necessary. Unless the plethora, which -is oppressing the system, and exciting the hæmorrhage from the lungs, -be relieved by general blood-letting, blood will not cease to pour -out from that viscus. At the same time the free exhibition of saline -cathartics, a blister to the chest, a rigidly abstemious diet and a -strict adherence to the antiphlogistic regimen must accompany this -treatment. Peruvian Bark, Chalybeates and Elixir of Vitriol so often -used, in active hæmorrhage during the inflammatory stage of Consumption -cannot but be injurious. They increase the force of the circulation and -consequently the disposition to hæmorrhage. In the same symptom arising -from an opposite cause, they may be prescribed with advantage. Common -salt, administered dry in the manner directed by Dr. Rush, has been -found by experience to be very useful in abating hæmorrhage from either -cause; but it should not be depended on alone, nor suffered to take the -place of the treatment just detailed. - -If possible, we should anticipate the occurrence of hæmoptysis with -our remedies, and thus prevent the formation of a habit of spitting -blood, which when once established, is difficult to destroy. The usual -precursors of this symptom are, a saltish taste in the mouth, a sense -of irritation at the upper part of the trachea, and some oppression -and difficulty of breathing. At this time, before the hæmorrhage has -commenced, blood-letting and the rest of the remedies mentioned above -should be actively exhibited. “_Venienti occurrite morbo._” - -A distressing cough at this period also requires the attention of -the physician. From its occurrence more particularly at night, it -disturbs the rest and adds much to the sufferings of the patient. It -should be alleviated by Opiates, accompanied with any of the mild -demulcent remedies, generally denominated Pectorals. Mudge’s Apparatus -for inhaling the steam of warm water, may also be used with relief, -especially on going to bed. - -When all inflammation is gone and the second stage of Consumption has -decidedly formed, a different mode of treatment becomes necessary. -Little indeed is now to be hoped for from any treatment, as a radical -cure; but our patient is not to be abandoned; if he cannot be cured, -his sufferings may be materially mitigated, and he may be directed to -avoid such things as may increase his malady. Nor should we entirely -despair of performing a radical cure; for solitary cases are related by -many authors of consumptive patients being cured in every stage of the -disease. Many of these cases, perhaps, have been mistaken for Phthisis -Pulmonalis; but of some of them we cannot doubt. The authority from -which they come is too high to permit us to hesitate. - -The remedies last mentioned in the treatment of the first stage of -Consumption may yet be proper, and although with not so great a -prospect of success, should still be tried. These are a sea-voyage, -change of climate, and confinement to apartments whose temperature -is regulated. But all the debilitating remedies before recommended, -are now to be avoided. The lancet in general is improper, although -in some few instances, the occurrence of acute inflammation at this -period, still requires its cautious use. Drastic Cathartics should not -be used; the bowels if torpid must be kept open by gentle laxatives -and Enemata. Antimonial and other debilitating Emetics should not -now be exhibited, but the Vitriol Emetics may still be prescribed -with advantage. The Sulphate of Zinc given in such doses as to excite -occasional vomiting, is frequently very useful, and especially where -much irritation is present. It was introduced and strongly recommended -by Dr. Mosely in his Treatise on Tropical Diseases &c. His Vitriolic -solution[8] is certainly an useful remedy in relieving dyspnœa and -promoting expectoration. Instead of debilitating as antimonials do, he -assures us, that its emetic effects are instantaneous, not harassing -the patient, but always leaving the stomach strongly invigorated. Mr. -Warburton, the present House Physician of the New-York Hospital, has -assured me, that he has frequently prescribed it in that Institution -with evident benefit. With similar intentions, Dr. Senter, in the -Medical and Chirurgical Review, published in 1793, recommends the -sulphate of copper. - -At this time blisters will be preferable to either setons or issues, -as they relieve the local symptoms without producing a constant -debilitating discharge. Indeed they should be used in such a manner, -as to produce as little discharge as possible. With this view, they -should not be kept open by stimulating dressings, but be healed up, and -occasionally renewed. With the same intention, stimulating plaisters -may be applied to the chest with advantage, and in general are -preferable to blisters. - -To support the patient’s strength, as was proposed in the second -indication, tonics are necessary. Of these some of the simple bitters -are preferable, as columbo, gentian, boneset, chamomile, &c. But -we should be careful not to exhibit them during the paroxysms of -hectic fever, but during its intervals. Peruvian bark has not been -found admissible. It produces a sense of stricture and oppression of -breathing, adds to the cough, makes the pulse quick and hard, and -hæmoptysis is not unfrequently the consequence of its exhibition. -Dr. Fothergill dwells particularly on the abuse of this medicine in -Consumption. - -As stimulating and bitter medicines, the Polygala Seneka and -Aristolochia Serpentaria have been recommended in this stage of -Phthisis Pulmonalis. - -The stimulating balsams and gums are also proper in this stage. They -have been highly recommended by Morton; and myrrh in particular is -prescribed with great confidence by Simmons. They are objected to by -Fothergill, on the ground, that by their stimulating properties, they -increase the inflammation of the lungs. His objection appears well -founded, while symptoms of acute inflammation still exist; but after -they have subsided, the cough and other distressing symptoms of the -last stage of Phthisis, may be much alleviated by these medicines. By -their stimulating effects upon the whole system, also, they may be -useful at a time when the patient is sinking under great debility. - -As stimulating applications are frequently found necessary and useful -to indolent ulcers on the surface of the body, it naturally occurred -that similar applications might be made with advantage to ulcers of -the lungs. With this view, the steam of tar water, and the vapour of -sulphuric æther inhaled in respiration, have been used in the treatment -of Consumption.[9] With the same restrictions as are necessary with -the stimulating gums and balsams, these remedies may be beneficial. It -is not probable, however, that any permanent relief can be derived from -them; they can only mitigate symptoms. - -To check the profuse sweats, which occur at this period, and add -materially to the debility of the patient, the elixir of vitriol is an -useful medicine. As a general tonic it acts beneficially also upon the -whole system. - -With the view of quietting the cough and procuring rest at night, -opiates are necessary; and fortunate are we that we have in our -possession, a remedy, which although it will not permanently cure the -disease, palliates the symptoms, at least for a time; and makes more -smooth the path to death. It is true that opium produces some ill -effects. It debilitates the stomach, and injures the appetite; but when -the symptoms are urgent, it cannot for these reasons be dispensed with. -By lulling pain, and giving rest to the watchful patient, it more than -counterbalances these disadvantages. The humulus lupulus or common -hops, does not possess the objectionable properties of opium, but with -its anodyne combines some tonic powers, and promises to be an excellent -substitute for that medicine. - -The large and frequent use of syrups in the form of expectorant -mixtures and linctuses, to alleviate cough, is very injurious. They -cloy the appetite, destroy the tone of the stomach, and prevent the -taking of nutritious aliment, which is now so necessary; and frequently -without producing any material relief of the symptom for which they are -prescribed. - -The use of opiates is necessary also, to check the profuse diarrhœas, -which now alternate with costiveness, and reduce the already -debilitated patient. With the same view, the chalk mixture may be used -with advantage, and the astringent medicines, Kino and Catechu, with -others of the same class. - -It is not unfrequent for hæmoptysis to occur at this period, as well -as in the earlier stages of Consumption. Sometimes it is the effect of -some temporary excitement, and may be relieved by the loss of a few -ounces of blood. But frequently this evacuation cannot be borne; and -the hæmorrhage proceeds rather from debility in the vessels of the -lungs, than any increased force of the circulation. We must then trust -to astringents--muriate of soda, sulphuric acid, and alum. - -We come now to speak of the diet and regimen of patients labouring -under Phthisis Pulmonalis; a subject no less important than the -remedies to be exhibited. In the first stage, the diet should be -perfectly simple, and such as will least tend to increase the -inflammatory action of the system. For this purpose nothing is better -than milk. So sensible have physicians, at all times, been of its -propriety, that in many cases, they have trusted the cure entirely -to a milk diet. It is highly spoken of by almost every author who -has written on this subject, and with reason. It is light, easily -digested, and does not produce any excitement. Many have preferred -Asses’ to Cows’ milk, but it does not appear that there is any material -difference, which should influence our choice. The former is thinner -and less nutritious, and perhaps, to very delicate stomachs, may -be more acceptable; but in general, the latter is as useful. Milk, -however, is very offensive to some stomachs, and not so easily digested -as other food; in such cases it must necessarily be prohibited. - -As a general rule, with regard to diet, in this stage, animal food is -improper, and the patient should be confined to the use of vegetables. -Fresh sub-acid fruits are proper; and, indeed, of so much importance -have they been considered, that Hoffman mentions a case of confirmed -phthisis, cured by confining the patient to the use of fruits, and -particularly strawberries. Mucilaginous and diluent drinks, as those -formed from barley, sago and flaxseed are also useful. Among these -may be classed, the Lichen Islandicus, which has gained with some the -reputation of curing Consumption. Weak is the foundation for hope of -those who depend on it. As an article of diet, from its mucilaginous -property, it is useful; and in the last stage, from its possessing -slightly better and tonic virtues, it is also proper; but as a -remedy for phthisis it is altogether inert. Nor are its tonic powers -sufficiently great, to render it injurious in the early stage of the -disease. - -The dress of the patient should also be regulated by the Physician. He -should be clothed in flannel, and this frequently changed. A constant -determination is thus kept up to the surface, and to some extent, -diverted from the chest. At the same time, all exposure to cold, -moisture, or sudden alternations of temperature must be studiously -avoided. As in many cases, they lay the foundation for consumption, so -after it has commenced, their repetition aggravates it. - -Mental distress and consequent despondence, impedes the cure of -those who otherwise might recover, and should be obviated as much as -possible. Happily, patients labouring under Phthisis, generally with -difficulty, resign hopes of recovery, and despondence from that source -does not often depress them. But mental anxiety, produced by other -causes, is very injurious. It should be relieved, as much as possible, -by pleasant amusements, a journey, a sea-voyage or any other method -most suited to the particular circumstances of the patient. - -In the second stage of Consumption, the diet of the patient must be -altered, as well as the medical treatment. The most nutritious articles -of food are then to be chosen, and such as are at the same time the -most easily digested. It is well ascertained that the older meats, -as beef and mutton, possess these properties in a higher degree than -veal or lamb; and generally, the brown more than white meats. With the -same view, wild fowl and game generally, form nutritious articles of -diet, proper for consumptive patients. Eggs combine a large quantity -of nourishment in a small compass, and may be freely used. They should -be taken either quite raw, or boiled a very few minutes. When boiled -hard, they form one of the most indigestible and offensive substances, -to the delicate stomach, that are used in diet. The various culinary -preparations, of which eggs form a principal part, are for the same -reasons proper. Jellies also contain a great quantity of nutritious -matter, and are very acceptable to patients, who, as in Consumption, -have little appetite. Oysters and some other of the testacea, are also -extremely nutritious. Isinglass boiled in milk is frequently in use, -and with advantage, in these cases. Of the vegetable nourishments, -those should be chosen which are most nutritious and abounding in -mucilage, as rice, sago, arrowroot and Tapioca. Chocolate, when -prepared in such a manner as to be free from oily matter, is a very -pleasant article of diet. - -The drinks of the patient should also be stimulating and nutritious. -Malt liquors combine both these properties with some tonic virtues, -which they obtain from the bitter of the hops infused in them, and -therefore constitute the best drink for consumptive patients. Wine, -also, may be used moderately with advantage, but requires some caution; -and should be immediately abandoned, if any undue excitement be -produced by it. - -In this, as in every other stage of Consumption, while the patient has -sufficient strength, exercise is necessary to the recovery of health. -Of so much importance is exercise, that in many cases, it has alone -cured this disease. Dr. Rush relates many such cases, and particularly, -three instances of persons in confirmed consumptions, perfectly cured -by the hardships of a military life. Of so much consequence was it -in the eyes of Sydenham, that he pronounced riding on horseback, as -certain a cure for consumptions, as bark for an intermittent fever. -Indeed, all writers on this disease join in recommending it, not only -as a part of the regimen, but as a principal remedy in the treatment. -The mode of exercise to be chosen, should depend entirely on the -situation of the patient, at the time. While much pain and soreness -subsist, denoting the presence of active inflammation, the most gentle -exercise only should be used: at that time riding in a carriage or -on horseback, would be as improper as for a patient labouring under -pleurisy. The swing, so highly recommended by Dr. Carmichael Smyth, is -the least fatiguing, and most gentle mode that can be adopted. It may -be serviceable, too, when the patient is too much debilitated to bear -other more fatiguing exercise. But I would, by no means, adopt the -opinion of Carmichael Smyth, that the swing, in itself, and unassisted -by other remedies, will cure Consumption. Experience has proved the -contrary; and has taught us that it is only useful as an article -of regimen, while the patient is under the influence of other more -powerful remedies. When there is sufficient strength to bear it, and -not too much excitement, riding in an easy carriage is the next mode of -gestation which may be used. But when the patient is enabled to ride -on horseback, we have more to expect from it, than any other species -of exercise. To attain the greatest benefit from it, it should be made -use of regularly and constantly; not during the cold air of early -morning, nor the dews of the evening, but rather during the day, after -the sun exerts some influence. A long journey on horseback affords the -most useful method of obtaining all the advantages that can be derived -from exercise. It is then made constant and regular; and the amusement -afforded by travelling serves to divert the patient’s mind from his -own feelings, and adds to its beneficial effects. - -Secondary Phthisis Pulmonalis remains yet to be treated of. Under -this order, should be included every form of Consumption, in which -the system has become debilitated by any cause, and the lungs in -consequence become affected. I would exclude from it that form of the -disease occurring after measles, scarlatina, and some other eruptive -diseases, which I would consider as primary Phthisis Pulmonalis; -because, in those cases, the lungs do not become affected merely in -consequence of debility, but these diseases seem rather to act as -exciting causes, in constitutions already predisposed to Consumption; -while in secondary Phthisis, the affection of the lungs is only one -symptom of the general disease, which is wasting the body. Nor would -the treatment, which will be advocated in the latter form, be proper -in the cases alluded to. They require that, which should be used in -the first species of Phthisis, and which has already been detailed. -The reason, why the lungs become affected in consequence of debility -induced by particular causes, I would not attempt to explain. It is -one of those laws of the constitution, not better understood, than why -particular parts are successively affected in consequence of syphilis, -or that the breasts and lower extremities are more liable to disease -than other parts, except the uterus, in females after parturition. Many -laws of this kind exist in the human constitution, of whose effects, we -are every day made sensible, but of the cause of which we are totally -ignorant. - -One of the most frequent causes of Secondary Phthisis, is Chlorosis, -that disease which occurs in young females, in consequence of Retention -of the menses. The constitution not having sufficient vigour to produce -this evacuation at the proper period, if any predisposition to Phthisis -exist, a determination takes place to the lungs, producing Phthisical -disease. This case is not analogous to Consumption produced by -Suppression of the menses, after they have been once established; for -in that instance the suppression is not generally induced by debility, -but by cold, or some other cause, not acting merely by weakening the -patient; and it produces active inflammation of the lungs. But in the -case before us, the affection of the lungs is merely a symptom of the -want of vigour in the constitution, which shews itself in retention -of the menses. Accordingly, in the treatment of this disease, our -attention must not be directed primarily to the affection of the lungs, -but to the state of the system, the cause of that affection. - -Profuse evacuations, of any kind, may be the cause of Secondary -Phthisis. Hæmorrhages from the Nose, Lungs, Stomach, Kidneys and wounds -are all mentioned by Morton, as having induced Pulmonary disease. Mr. -Hey, in his work on Surgery, observes, that he has seen a great many -cases of pulmonary Consumption, the consequence of debility, induced -by violent hæmorrhages, and in persons who had no apparent tendency to -Consumption. In the same manner, loss of blood from Hæmorrhoids and -in Menorrhagia, may act as causes. Debilitating evacuations, by means -of Diarrhœa, Diabetes, Salivation, and Sweating, have had the same -effect. But the most frequent causes of this class are, immoderate -discharges by fluor albus, and too long suckling by delicate woman -of robust children. They are particularly mentioned by Morton and -Fothergill, and have been adverted to by most authors, who have written -since. - -Chronic Catarrh, terminating in Phthisis, may be ranked also in this -class. The profuse and long continued discharge from the membrane -lining the trachea and bronchiæ, is the debilitating agent in that case. - -Long continued Fevers, and particularly Intermittent fevers, not -unfrequently leave behind them, a state of debility, sufficient to -induce Consumption. - -In the New-York Hospital, frequent instances occur of Consumption -induced by intemperance in the use of ardent spirits. This habit -destroys the tone of the stomach, which becomes primarily affected, and -in consequence the whole system becomes debilitated, terminating in -disease of the Lungs. - -Secondary Consumption has also been induced by some other preceeding -diseases, such as Scurvy and Syphilis, and requires the attention of -the Physician, to the primary disease rather than to the affection of -the Lungs. - -In the treatment of Pulmonary Consumption, arising from any of these or -analogous causes, our attention is first called to the removal of the -primary source of the disease. If it be Chlorosis, remedies, calculated -to cure that malady, must be prescribed. If profuse evacuations are the -cause, all the means in our power, must be employed in restraining -those evacuations. If the disease has been induced by the long -continued suckling of a vigorous child, by a delicate mother, another -nurse must be provided, or the child must be weaned. If Scurvy or -Syphilis have produced it, the proper remedies for those disorders must -be employed. - -Our next object is to remove the debility, the cause of the pulmonary -symptoms. For this purpose, Tonics are indicated, and at their head -stands the Peruvian Bark. In the other species of Phthisis, this -medicine has been much abused, but in the present one, its use is -sanctioned by experience. In the cases proceeding from Leucorrhœa, -and long suckling, it is highly recommended by Dr. Fothergill; but he -cautions us against persevering in its use, longer than while it is -doing good; and remarks, that if the breathing become more oppressed, -the cough dry, the pulse more quick and hard, and especially, if slight -transitory pains or stitches about the thorax, are more frequently -complained of, a perseverance in the use of the bark will increase -the disease. If, in consequence of this increase of symptoms, we -are obliged to desist in the use of the Bark, other Tonics must be -substituted. The combination of bitter and tonic medicines in the -Infus: Amar: of the dispensatories may be then usefully prescribed. -Columbo, which is sometimes an ingredient in that formula, is -particularly recommended by Dr. Thomas Percival, as not possessing any -of the injurious properties of bark. - -The Elixir of Vitriol is also an excellent tonic, and may be usefully -given at the same time with the remedies just proposed. But it -requires to be administered with the same cautious hand as the bark, -and to be discontinued, if the symptoms appear to be at all aggravated -by its use. In general, no ill effects arise from it, but if the -determination to the chest be so great, as to produce much inflammatory -action, it may do injury. Independent of its tonic powers, it will be -serviceable in checking any disposition, which may exist, to profuse -sweating. - -Iron, in its various officinal preparations, is also a good remedy, -in this form of phthisis. Although, highly dangerous in the primary -disease, there is now little danger of increasing the inflammation, -which in that form, made it improper. Mineral chalybeate waters, will -in this instance, be useful, not only by the journey to them, and the -amusement derived at watering places, but may be drank with advantage -by the patient. - -In addition to these remedies, the diet and regimen should be such as -is most invigorating to the constitution. A nutritious diet and the -moderate use of wine will be proper; and country air and exercise with -the same rules as were mentioned in the treatment of primary phthisis, -are very important circumstances in the cure of the secondary form. -A long journey, a sea-voyage and change of climate are also equally -proper. - - * * * * * - -The prominent feature and primary object of this essay has been, to -establish the distinction between primary and secondary Phthisis -Pulmonalis. Although, perhaps, the minute parts of the arrangement may -not have been distributed, in every instance, with perfect accuracy, I -feel confident that the general plan is correct. Farther observation -and experience will probably suggest a more accurate disposition of the -varieties of Phthisis, under the two orders which I have proposed. - -Probably from the want of the distinction between primary and -secondary Phthisis, may be explained the various and contradictory -practice, proposed by physicians of deserved eminence. A more -frequent opportunity of observing one or the other form of the -disease, has determined with each, his mode of treatment: and hence -in diseases bearing the same name, we may see blood-letting and a -rigid antiphlogistic regimen adopted by one party, and bark, iron, and -a nutritious diet by another. Any error which may arise from these -contradictions, may be corrected by the distinction, which has been -proposed. - -It has also been my object, to call the attention of the practitioner, -to the earliest symptoms and first dawnings of Consumption. Were they -not so much neglected by the physician, as well as the patient, our -bills of mortality would not continue to present so frightful a picture -of the ravages of this disease; while, on the other hand, a prompt -attention to these incipient symptoms, and the interference of an -active practice, would afford a reasonable prospect of saving many from -Consumption, who are now its victims. - - -FOOTNOTES: - -[1] Amer. Med. and Phil. Reg. Vol. I. - -[2] Dr. Lettsom observes, that Consumption is decreasing in Great -Britain. - - _Med. and Phil. Reg._ - - -[3] The following judicious remarks on this subject are made by Bayle, -in his “Recherches sur la Phthisie Pulmonaire, D’après la notion que -j’ai donnée de la Phthisie Pulmonaire, on voit que je dois regarder -comme Phthisiques des individus qui n’ont ni fièvre, ni maigreur, ni -expectoration purulente: il suffit que les poumons soient affectés -d’une lésion qui tend à les désorganiser et à les ulcérer. On ne doit -pas regarder cette lésion une simple cause de la Phthisie, mais comme -le premier temps de cette maladie, puisque la Phthisie est cette lésion -même dont la continuation et le developement successif amènent la -mort. Il seroit donc bien peu raisonnable de vouloir attendre, pour -reconnoitre la Phthisie Pulmonaire, qu’elle fut constamment parvenue à -son dernier degré qui est le moment où ses symptômes pathognomoniques -sont bien marqués.” - -[4] Dr. Reid. - -[5] Dr. Hosack. - -[6] Dr. Lind states, that out of 360 patients whom he attended between -July 1, 1758, and July 1, 1760, in consumption, the disease was brought -on one fourth of them by falls, bruises and strains, received a year or -two before it made its appearance. - -[7] Dr. Reid. - -[8] - - ℞ Vitriol: alb: Ʒ iij - Alum: rup: Ʒ j - Coccinnel: pulv: griij - Aq: ferveut: ℔j. Misce in mortareo marmoreo. Solutio - a fæculantia vel residendo expurgetur, vel per chartam bibulam - fittretur. Dos. ℥ss.-- - - -[9] Dr. Borrowe formerly had a patient labouring under Consumption, a -manufacturer of tin ware, who was uniformly relieved of his phthisical -symptoms when engaged in soldering tin, a process in which a great deal -of resin is used, and constantly inhaled in respiration. - - - - -ERRATA. - - - Page 10 Note, for _d’après_ read _D’après_. - 22, line 25, for _which like the inert physician_, - read _which the inert physician_. - 25, line 13, for _dysentary_, read _dysentery_. - - - - -Transcriber’s Notes - -The errata have been fixed. - -Punctuation errors and omissions have been fixed. - -Page 10: “peculiary incorrect” changed to “peculiarly incorrect” - -Page 40: “very analagous” changed to “very analogous” - -Page 54: “frequenty prescribed” changed to “frequently prescribed” - -Page 60: “acceptible to patients” changed to “acceptable to patients” - -*** END OF THE PROJECT GUTENBERG EBOOK AN INAUGURAL DISSERTATION ON -PULMONARY CONSUMPTION *** - -Updated editions will replace the previous one--the old editions will -be renamed. - -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the -United States without permission and without paying copyright -royalties. 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You may copy it, give it away or re-use it under the terms -of the Project Gutenberg License included with this eBook or online -at <a href="https://www.gutenberg.org">www.gutenberg.org</a>. If you -are not located in the United States, you will have to check the laws of the -country where you are located before using this eBook. -</div> - -<p style='display:block; margin-top:1em; margin-bottom:1em; margin-left:2em; text-indent:-2em'>Title: An inaugural dissertation on pulmonary consumption</p> -<p style='display:block; margin-top:1em; margin-bottom:0; margin-left:2em; text-indent:-2em'>Author: Edward Delafield</p> -<p style='display:block; text-indent:0; margin:1em 0'>Release Date: August 16, 2022 [eBook #68772]</p> -<p style='display:block; text-indent:0; margin:1em 0'>Language: English</p> - <p style='display:block; margin-top:1em; margin-bottom:0; margin-left:2em; text-indent:-2em; text-align:left'>Produced by: Sonya Schermann and the Online Distributed Proofreading Team at https://www.pgdp.net (This file was produced from images generously made available by The Internet Archive)</p> -<div style='margin-top:2em; margin-bottom:4em'>*** START OF THE PROJECT GUTENBERG EBOOK AN INAUGURAL DISSERTATION ON PULMONARY CONSUMPTION ***</div> - - -<h1><span class="small">AN</span><br /> -<br /> -Inaugural Dissertation<br /> -<br /> -<span class="small">ON</span><br /> -<br /> -<span class="big">PULMONARY CONSUMPTION.</span></h1> - -<p class="center p2 big">BY EDWARD DELAFIELD, A. B.</p> - -<p class="center p2 bb bt small">——For want of timely care,<br /> -Millions have died of medicable wounds.    <span class="smcap">Armstrong.</span></p> - -<p class="center p4"><span class="big"><i>NEW-YORK</i>:</span><br /> -PRINTED BY JOHN FORBES & <abbr title="company">CO.</abbr><br /> -78 WALL-STREET.</p> -<hr class="r5" /> -<p class="center"> -1816. -</p> - -<hr class="x-ebookmaker-drop chap" /> -<div class="chapter"> - - -<p class="center"> -<span class="small">TO</span><br /> -<br /> -<span class="big">SAMUEL BORROWE, M. D.</span><br /> -<br /> -<span class="small">ONE OF THE SURGEONS OF THE NEW-YORK HOSPITAL,</span><br /> -<br /> -THIS DISSERTATION<br /> -<br /> -<span class="small">IS DEDICATED,<br /> -<br /> -AS A TESTIMONY OF GRATITUDE<br /> -<br /> -FOR THE MANY VALUABLE PRACTICAL LESSONS<br /> -<br /> -RECEIVED FROM HIM<br /> -<br /> -BY HIS FRIEND AND PUPIL,</span><br /> -<br /> -<span class="big">EDWARD DELAFIELD.</span><br /> -</p></div> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_v">[Pg v]</span></p> - -<h2 class="nobreak" id="INTRODUCTION">INTRODUCTION.</h2> -</div> -<hr class="r5" /> - -<p>The attention of Physicians has for several years past been excited -to the consideration of that inveterate enemy of the human race, -the <span class="smcap">Consumption</span>. Several works have been published, new -remedies proposed, and the practice of former physicians revived with -modifications and amendments, in the treatment of this disease. At -one period, Consumption had been so long considered without the reach -of remedies, that it had almost ceased to excite the enquiries of the -learned in medicine. Fortunately, however, the spirit of enquiry has -revived; and it is believed that the treatment of this dreadful malady -has been so far improved, that many are rescued from its grasp, and -the sufferings of those who are still its victims, are materially -mitigated. Notwithstanding, it appears that in this city the mortality -from Consumption has increased rapidly of late years. Formerly, its -climate was considered remarkably salubrious, and diseases of the -lungs were rare. Lieutenant Governor Colden, in a series of remarks on -the climate and diseases of New-York, made seventy years ago, has the -following observations: “The air of the country being almost always -clear, and its spring strong, we have few consumptions or diseases of -the lungs. People inclined to be consumptive in England, are often -perfectly cured by our fine air; but if there be ulcers formed, they -die. The climate grows every day<span class="pagenum" id="Page_vi">[Pg vi]</span> better, as the country is cleared of -the woods; and more healthy, as all the people that have lived long -here testify. This has even been sensible to me, though I have lived -but about twelve years in this country; I therefore doubt not but it -will in time, become one of the most agreeable and healthy climates on -the face of the earth.”<a id="FNanchor_1" href="#Footnote_1" class="fnanchor">[1]</a></p> - -<p>These anticipations have not been realized; but, on the contrary, -Consumption has become the prevailing disease of our city. The causes -of this increase of the disease are numerous. We are told by <abbr title="doctor">Dr.</abbr> -Rush, that it is unknown among the Indians of North America; that it -is scarcely known by those citizens of the United States who live in -the first stage of civilized life, and are generally called the first -settlers; that it is less common in country places than in cities, and -increases in both, with intemperance and sedentary modes of life; that -ship and house-carpenters, smiths, and all those artificers, whose -business requires great exertion of strength in the open air, in all -seasons of the year, are less subject to this disease than men who -work under cover, and at occupations which do not require the constant -action of their lungs. By applying these facts to the situation of -this city, the causes which have produced the increased mortality from -consumption, become evident.</p> - -<p>1. The growth of the city, and consequent state of the atmosphere, most -distant from that of the pure air of the country.</p> - -<p>2. The increase of all those causes which have enervated the bodies of -men, and rendered them more susceptible to the influence of a variable -climate. Among these are, augmentation of wealth, and consequently, -luxury; increased dissipation, with its accompaniment, imprudence<span class="pagenum" id="Page_vii">[Pg vii]</span> in -dress; and extension of manufactures, affording greater opportunity for -sedentary employments, and exposure to an insalubrious atmosphere. In -general, the causes are, all those circumstances which tend to remove -man farthest from that situation, in which the body is possessed of -the greatest vigour, and of course, least subject to disease, that of -the savage. In proportion as the city has enlarged, these causes have -continued to increase, and probably still will do so. But in Great -Britain, they appear already to have attained their acme, and as a -consequence of the improvements in medicine, the causes not increasing, -the disease is on the decline.<a id="FNanchor_2" href="#Footnote_2" class="fnanchor">[2]</a></p> - -<p>The following statement will show the proportion, which the number of -those who die from consumption, bears to the whole number of deaths, in -this city, during the last twelve years.</p> - -<p>In 1804, 499 persons died from Consumption, and were to the whole -number of deaths, 2125 as 1 to 4.25.</p> - -<table class="autotable"> -<tr> -<td class="tdr"> - In 1805</td><td class="tdr">462</td><td class="tdr">2352</td><td class="tdr">1</td><td class="tdr">5.09</td></tr> -<tr> -<td class="tdr">1806</td><td class="tdr">354</td><td class="tdr">2225</td><td class="tdr">1</td><td class="tdr">6.28</td></tr> -<tr> -<td class="tdr">1807</td><td class="tdr">464</td><td class="tdr">2312</td><td class="tdr">1</td><td class="tdr">4.94</td></tr> -<tr> -<td class="tdr">1808</td><td class="tdr">429</td><td class="tdr">2014</td><td class="tdr">1</td><td class="tdr">4.69</td></tr> -<tr> -<td class="tdr">1809</td><td class="tdr">413</td><td class="tdr">2108</td><td class="tdr">1</td><td class="tdr">5.1</td></tr> -<tr> -<td class="tdr">1810</td><td class="tdr">569</td><td class="tdr">2158</td><td class="tdr">1</td><td class="tdr">3.79</td></tr> -<tr> -<td class="tdr">1811</td><td class="tdr">595</td><td class="tdr">2524</td><td class="tdr">1</td><td class="tdr">4.24</td></tr> -<tr> -<td class="tdr">1812</td><td class="tdr">669</td><td class="tdr">2553</td><td class="tdr">1</td><td class="tdr">3.81</td></tr> -<tr> -<td class="tdr">1813</td><td class="tdr">562</td><td class="tdr">2229</td><td class="tdr">1</td><td class="tdr">3.96</td></tr> -<tr> -<td class="tdr">1814</td><td class="tdr">618</td><td class="tdr">2507</td><td class="tdr">1</td><td class="tdr">4.04</td></tr> -<tr> -<td class="tdr">1815</td><td class="tdr">572</td><td class="tdr">1974</td><td class="tdr">1</td><td class="tdr">3.8</td></tr> -</table><p> -<span class="pagenum" id="Page_viii">[Pg viii]</span></p> -<p>From this statement it appears, that the number of deaths from -Consumption has gradually increased. The average proportion during the -period mentioned, is as 1 to 4.36. Nearly one fourth of all those who -die in this city are destroyed by this fatal disease.</p> - -<p>These facts prove indeed that the power of medicine has little control -over so destructive a malady. But it should not therefore paralyse our -exertions. From what has been done already, in improving our knowledge -of its nature and treatment, a hope may be indulged that consumption -may one day, like many other maladies formerly deemed incurable, be -placed no longer among that number.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_9">[Pg 9]</span></p> - -<h2 class="nobreak" id="INAUGURAL_DISSERTATION">INAUGURAL DISSERTATION<br /><br /><span class="small">ON</span><br /><br /><span class="big">PULMONARY CONSUMPTION.</span></h2> -</div> - -<hr class="r5" /> - - -<p>The term Phthisis, or Consumption, in its broadest sense, is applied -to all those diseases, in which the system sinks under a gradual -waste of the powers of life. These diseases may be divided into two -great classes—1. That form of Consumption in which the lungs are -unaffected.—2. Phthisis Pulmonalis, properly so called, where the -lungs are the seat of the disease.</p> - -<p>Under the first class are included,</p> - -<p>1. Atrophia, or Consumption from want of nourishment, or excessive -evacuations, but without hectic fever; excluding all those forms of -disease produced by immoderate evacuations, in which the lungs become -affected.</p> - -<p>2. Tabes, accompanied with hectic fever, frequently attended with -disease of the mesenteric glands, and produced most commonly by -scrophula.</p> - -<p>The second class, Phthisis Pulmonalis, to the consideration<span class="pagenum" id="Page_10">[Pg 10]</span> of which -this essay will be more immediately confined, may be also subdivided -into,</p> - -<p>1. Primary, where the lungs are the original seat of the disease, and -as a consequence, the general system becomes affected.</p> - -<p>2. Secondary, where the system being first reduced by any debilitating -cause, the lungs become secondarily affected, as a symptom of the -general disease.</p> - -<p>These two forms of Consumption, although somewhat similar in their -symptoms, yet proceed from opposite causes, and require opposite -treatment. The one is a disease of pure inflammation; the other of -unmixed debility. In the one, an active antiphlogistic treatment is -necessary; in the other, the system requires all the support, which -tonics and good nourishment can afford.</p> - -<p>Phthisis Pulmonalis is thus defined by <abbr title="doctor">Dr.</abbr> Cullen, “<i lang="la" xml:lang="la">Corporis -emaciatio et debilitas, cum tussi, febre hectica, et expectoratione -purulenta</i>.” This definition is peculiarly incorrect, because it -leads us to neglect, the first stage of the disease; if the symptoms of -an Incipient Phthisis were stated to us, and we were asked, what was -the disease, from this definition we would be perfectly at a loss for -an answer. Except the cough, none of the symptoms there stated are to -be found in the first stage of Consumption. And yet that is as truly a -part of it, and of as much importance to the practitioner, as the last -stage, which alone is included in Cullen’s definition.<a id="FNanchor_3" href="#Footnote_3" class="fnanchor">[3]</a></p> - -<p><span class="pagenum" id="Page_11">[Pg 11]</span></p> - -<p>Agreeably to this definition, in his view of Phthisis Pulmonalis, <abbr title="doctor">Dr.</abbr> -Cullen makes ulceration of the lungs and hectic fever essential to its -existence, and seems rather to consider the preceding symptoms a cause -of this ulceration and fever, than as constituting an integrant part of -the disease.</p> - -<p>Nor is the place assigned by him to Phthisis Pulmonalis, in his -Nosological Arrangement, more correct than his definition of it. He -places it in the order Hæmorrhagiæ, and considers it merely as a -consequence of Hæmoptysis. Even if it were always excited by hæmorrhage -from the lungs, it would be improperly thus placed; but as that, even -by <abbr title="doctor">Dr.</abbr> Cullen, is considered merely as one among many exciting causes, -the arrangement is altogether inadmissible. But if it be admitted, -according to the view which will be hereafter taken of Hæmoptysis in -this treatise, that it is rather a symptom than a cause of Consumption, -the propriety of another arrangement will be evident. Accordingly -Phthisis Pulmonalis is placed by <abbr title="doctor">Dr.</abbr> Hosack, as one of the Phlegmasiæ. -This disposition appears to be the most proper that has hitherto been -suggested, and as such I shall adopt it. But before we<span class="pagenum" id="Page_12">[Pg 12]</span> can ascertain -the character and treatment of any diseases, it is necessary minutely -to examine their causes and symptoms.</p> - -<p>Primary Phthisis Pulmonalis first claims our attention. Its -predisposing causes may be mostly arranged into five classes, as they -depend on organization, age, sex, occupation and climate.</p> - -<p>Organization predisposes to Consumption, by mal-conformation of the -chest, which may be either natural or accidental; and an hereditary -internal structure not depending on the external form of the thorax. -For it is observed, that in some instances, those who have every -part of the external configuration, such as is generally attributed -to persons predisposed to Consumption, yet shall be free from this -disease; while on the other hand, some whose chests are externally -perfectly well formed, have been subject to catarrhal and inflammatory -complaints of the lungs, terminating in Phthisis. The form of chest -peculiar to many Phthisical patients, “is occasioned by the sternal -or breast-bone being pressed too much in upon the substance of the -lungs: thus the clavicles and shoulder-blades are thrust out of their -proper position, and made to assume, in some measure, the form of -wings, to which indeed they have been with propriety compared, just -raised from the body and about to expand for flight. By this internal -direction of the sternum, the full expansion and proper sweep of the -ribs is likewise prevented, and an unnatural curvature or prominence is -occasioned on either side of the breast, with a corresponding central -depression.”<span class="pagenum" id="Page_13">[Pg 13]</span><a id="FNanchor_4" href="#Footnote_4" class="fnanchor">[4]</a> This is the peculiar form to which the term narrow -chest is generally applied. A flattened or any other unnatural figure -of the chest may produce the same injury.</p> - -<p>The thorax may become accidentally malformed from any violence done to -it, particularly during infancy. A frequent source of it is the mode of -fashionable dress adopted by females. The corset, to which I allude, -when worn only with moderate firmness, and by those not otherwise -predisposed to Phthisis, serves but to add elegance and beauty to the -female figure; but when applied with the object of converting into a -delicate and slender waist, one naturally otherwise, it cannot but do -injury. By immoderate pressure, it converts a well formed chest into -the deformed and narrow one, or at least an approximation to it, which -has just been described. In our own city and time, too many fatal -examples of the deleterious effects of this fashion have occurred, to -permit us to retain any doubts on the subject.</p> - -<p>The internal constitution of the body predisposing to Phthisis, -independent of external form, has been generally attributed to -scrophula. English authors are particularly fond of making Consumption -another form of that Protæan disease. We are much disinclined to concur -in this opinion from the fact, that the mass of those who labour under -the disease in question, and cases too, which, after<span class="pagenum" id="Page_14">[Pg 14]</span> death show that -tuberculated state of the lungs, generally ascribed to scrophula, -evince no other of the numerous symptoms of that disorder. The -supposition that tubercles were scrophulous, probably originated from -the opinion that they are diseased glands; an idea now sufficiently -exploded. This hereditary predisposition we know to exist, but of its -mode of action we are totally ignorant. In this city there are many -melancholy examples of whole families successively falling victims to -Consumption, and sufficiently proving its hereditary nature. But an -hereditary predisposition does not necessarily produce Consumption. It -is not uncommon for parents who inherit this taint, to remain free from -disease of the lungs, by the pursuit of laborious occupations. Nor is -it more uncommon that the children of these very parents, whose active -industry had preserved their lives, and amassed them wealth, should -by being enabled to indulge in ease and luxury, fall victims to an -inherited Consumption.</p> - -<p>So the females of a family are sometimes all consumptive, while the -males are free from pulmonary disease, in consequence of the more -sedentary mode of life of the former.</p> - -<p>Although no period of life, from infancy to old age, is exempt from -Consumption, but all are liable to its attack, yet at a particular age, -it is observed to appear more frequently than at any other. This period -commences about, or soon after the age of puberty, and terminates at -thirty-six; the period at which inflammatory diseases most generally -occur.</p> - -<p><span class="pagenum" id="Page_15">[Pg 15]</span></p> - -<p>Sex also gives a predisposition to Consumption. Females are more -frequently affected by it than males. This may be attributed to -their greater delicacy of constitution, and nervous temperament. -Their comparatively sedentary habits of life add to this peculiar -constitution. But improper compliance with the requisitions of fashion -and taste constitutes not a small part of the greater susceptibility -of females to Phthisis. Independent of the use of corsets, the small -quantity of clothing frequently worn by them, under circumstances when -it is most necessary, is a fruitful source of mischief to their health. -In the coldest of our winter nights, will these fair devotees of -fashion issue from rooms, heated to a degree never experienced in our -hottest weather, into the chilling air of midnight, with less clothing -than they use at noon, when the sun exerts his greatest power. The next -day brings with it “a violent cold,” and this cold is too frequently -the foundation of the Consumption which destroys them.</p> - -<p>Occupation in life is another source of the ravages of this disease. -Particular occupations subject those engaged in them to the respiration -of air impregnated with foreign materials, irritating the lungs, either -by their chemical or mechanical action. Substances acting mechanically -upon the lungs, are inhaled by stone-cutters, millers, hair-dressers, -bolters, coal-heavers, scythe-grinders, persons engaged in pointing -needles, chimney-sweepers, dressers of flax and feathers, spinners -in wool, and others employed in similar occupations. Chemical agents -are taken into the lungs by manufacturers of acids, and all other -volatile<span class="pagenum" id="Page_16">[Pg 16]</span> corroding substances. These materials constantly acting upon -the lungs, produce irritation and slight inflammation, terminating -in Phthisis. The operation of any of these causes is favoured when -the occupation requires a stooping or other awkward posture of the -body to be maintained. This cause may act independently of the former -also, and hence, students, and clerks writing at their desks, taylors, -shoemakers, &c. are liable to this disease. To the same causes are -frequently added, a sedentary life, and confinement in hot rooms; -hence “a surgeon of London whose opportunities of observation are very -extensive, relates of the gilders of that city, who work in heated -rooms, that six out of seven are said to die consumptive in their -apprenticeship.” Sedentary habits of life, accompanied with hard -study, and too intense application of mind, predispose literary men to -Consumption. Loud public speaking, blowing on wind instruments, glass -blowing and other circumstances requiring a laborious and continued -action of the lungs, produce the same effect. Any one of these causes -may frequently exist without injury, but their combined action seldom -fails to produce pulmonary disease.</p> - -<p>Climate was enumerated under the predisposing causes of Phthisis. That -of our own latitude affords an example. Its variableness, increased -by contiguity to the ocean, together with the prevalence of the moist -and chilling north-east winds, is probably the agent which produces -this effect. The climate of Great Britain is not less unfavourable -to health, from similar causes, with the addition<span class="pagenum" id="Page_17">[Pg 17]</span> of its greater -moisture; for it is observed that cold combined with moisture is -peculiarly dangerous to the consumptive. On the other hand, inland -countries, not exposed to the moist winds from the ocean, are free -from this disease. Hence, the inhabitants of Russia and other parts of -the north of Europe, notwithstanding the severity of their climate, -are very little affected by Consumption. The habits of the people, -probably assist in producing this immunity from pulmonary disease. -Sir John Sinclair, in a communication to <abbr title="doctor">Dr.</abbr> Reid, attributes it in -a great measure to the employment of furs, cloaks and other modes of -clothing, which preserve an uniformity of warmth throughout the body; -to the great care taken by all classes of people to preserve their feet -from cold and damp; to the different modes of communicating heat to -their apartments; and to the constant use of the vapour bath. Similar -observations were made by <abbr title="doctor">Dr.</abbr> Cogan, who in a letter to <abbr title="doctor">Dr.</abbr> Beddoes, -remarks that the people of Holland are exempt in a great degree -from this disease, so prevalent among the English, and ascribes the -difference to the contrast observable between the two countries, in the -construction of their habitations, and in the peculiarities of dress.</p> - -<p>Debility from the want of accustomed stimuli, is mentioned by <abbr title="doctor">Dr.</abbr> -Hosack as another cause of consumption, and he instances those confined -in the State Prison. The want of accustomed air and exercise, the -deprivation of the use of spirituous liquors and good diet, to which -the<span class="pagenum" id="Page_18">[Pg 18]</span> prisoners had been accustomed before their confinement, was -observed by him to have produced this disease.</p> - -<p>Depressing passions of the mind, and a consequent too free use of -spirituous liquors have also been noticed by authors among the -predisposing causes of Consumption.</p> - -<p>The last of these causes which I shall notice, is the disposition -of the system to form calculous deposits in the lungs, generally in -consequence of a plethoric habit. Phthisis from this cause however is -rare; of nine hundred patients examined by Bayle, only four were of -this description.</p> - -<p>These various causes having either separately or conjointly predisposed -the body to Phthisis, are most frequently excited into action by a -common catarrh; which becomes the more active by frequent repetition. -The danger arising from catarrh is not a little increased by the -popular mode of treating it: stimulating spirituous drinks, and a vast -variety of remedies of the same class are the usual prescriptions. -Almost every body has an infallible remedy for a cold; some of -them innocent, but many injurious. The common prejudice in favour -of “feeding a cold” increases the mischief, and unfortunately, the -disease not generally affecting the system sufficiently to destroy -the appetite, as in many other maladies, nature does not prevent -the practice. Abstinence, cooling acidulous drinks, with perhaps a -gentle saline cathartic, are the safest and most effectual remedies in -curing a common catarrh, when of its usual slight form. At the same -time, inhaling warm air, by means of Mudge’s apparatus, is a valuable -and grateful auxiliary to this treatment. Catarrh<span class="pagenum" id="Page_19">[Pg 19]</span> is so common and -generally so easily cured without any consequent ill effects, that it -is too apt to be neglected. Many a patient, labouring under incipient -Phthisis, has been supposed to be affected by merely a “trifling -cold,” and the only opportunity for curing the disease has been lost. -“The evil becomes irremediable before it calls either the attention -of the parents, the friends, or even the physician, who has not been -familiarly conversant with the fatal consequences of this disease.”<a id="FNanchor_5" href="#Footnote_5" class="fnanchor">[5]</a></p> - -<p>Pneumonia is not unfrequently an exciting cause of Phthisis. Like -catarrh, its frequent repetition is more dangerous than a single -attack. Pneumonia may indeed act merely as a predisposing cause of -Consumption, by leaving the lungs in a debilitated and irritable -condition, favourable to the production of that disease; but it is -an exciting cause, when in consequence of inflammation of the lungs, -suppuration follows, and vomica or empyema is the consequence. This -shews the close analogy between Phthisis Pulmonalis and ordinary -Pneumonia. In the first, the inflammation being seated in the cellular -and comparatively insensible portion of the lungs, is slow and -gradual, and the consequent suppuration forms in the same manner; -while in Pneumonia, the membranous as well as cellular portion of the -lungs being involved in the disease, the inflammation is rapid and -violent, and must soon terminate in either resolution or suppuration. -Hence Phthisis Pulmonalis was appropriately called by <abbr title="doctor">Dr.</abbr> Rush a -“<i>Pneumonicula</i>.” No word could more accurately<span class="pagenum" id="Page_20">[Pg 20]</span> describe the -nature of the disease. That acute observer has drawn an excellent -parallel between the two diseases, and concludes with observing, “In -short the pneumony and Consumption are alike in so many particulars, -that they appear to resemble shadows of the same substance. They -differ only as the protracted shadow of the evening does from that -of the noon-day sun.” It is remarked, however, that all cases of -Pneumonia terminating in suppuration are not necessarily fatal. If a -predisposition to Phthisis do not exist, or the constitution be not too -much debilitated, a vomica may burst and be discharged, and the patient -recover.</p> - -<p>A third exciting cause of Phthisis, is the suppression of accustomed -evacuations. These evacuations are the menses, the lochiae, the -discharges in Leucorrhæa, and from ulcers, fistulæ and issues. -Retention of the menses producing Chlorosis, being a consequence -of debility, does not excite primary Phthisis Pulmonalis, but the -secondary form of the disease. Suppression of the menses, however, not -unfrequently excites a Consumption, bearing all the characters and -requiring the treatment of primary Phthisis. The plethora, consequent -on the cessation of the menses, has often the same effect.</p> - -<p>Asthma, by the constant irritation to which it subjects the lungs, -becomes an exciting cause of Consumption.</p> - -<p>Several eruptive diseases, as Scarlatina, Small-Pox and measles, often -produce the same disease.</p> - -<p>Morton also enumerates stone in the kidneys and bladder, gout and -rheumatism, as causes of Consumption.</p> - -<p><span class="pagenum" id="Page_21">[Pg 21]</span></p> - -<p>By the same author, contagion is supposed to communicate this disease. -Morgagni, Van Swieten, Home and Heberden all hold this opinion. And -Morgagni relates that Valsalva, who was predisposed to Consumption, was -so satisfied of its contagious nature, that he constantly avoided being -present at the dissection of the lungs of persons who had died of that -disorder.</p> - -<p><abbr title="doctor">Dr.</abbr> Rush maintains the same doctrine, and relates that the late <abbr title="doctor">Dr.</abbr> -Beardsley of Connecticut, informed him that he had known several black -slaves affected by a Consumption, which had previously swept away -several of the white members of the family to which they belonged. -In these slaves no suspicion was entertained of the most distant -relationship to the persons from whom they had contracted the disease: -nor had grief nor fatigue, been supposed to have had the least share -in debilitating their bodies. The force of so much authority with -the evidence adduced, constrains us to admit the communicability -of Consumption by contagion. But if this agent has any effect, its -action must be extremely limited, and extend no farther than to those -previously predisposed to the disease. For daily examples without -number occur of the constant attendants upon those labouring under -Phthisis remaining perfectly free from that malady.</p> - -<p>Violence done to the lungs by blows or other injuries of the chest, has -in some instances, excited Consumption.<a id="FNanchor_6" href="#Footnote_6" class="fnanchor">[6]</a></p> - -<p><span class="pagenum" id="Page_22">[Pg 22]</span></p> - -<p>Foreign bodies conveyed accidentally into the lungs has produced the -same effect. Morton relates a curious case where three nails had passed -into a person’s trachea and destroyed him, by inducing Consumption.</p> - -<p>Bayle also enumerates a form of Phthisis, which he calls cancerous, -arising in patients in whom the cancerous disposition has become -constitutional. It is, however, extremely rare; only three cases having -occurred to him among the 900 whom he had examined.</p> - -<p>Hæmoptysis and tubercles are mentioned by most authors as exciting -causes of Consumption, and remain to be examined. So frequently did <abbr title="doctor">Dr.</abbr> -Cullen consider Hæmoptysis the cause of Phthisis, that he placed the -latter disease in his Nosology, merely as a consequence of the former. -The impropriety of this arrangement has been already touched upon.</p> - -<p>On this subject, I would suggest the following facts. Hæmoptysis -occurring in persons not predisposed to Consumption, except the -quantity of blood lost be so great as to produce it by mere debility, -very frequently may be easily cured without danger of any consequent -disease. Indeed not only in such cases consumption is not induced by -it, but that disease has actually been prevented, by the occurrence of -hæmorrhage from the lungs, relieving that inflammation, which the inert -physician, by withholding the lancet, would have suffered to destroy -his<span class="pagenum" id="Page_23">[Pg 23]</span> patient. <abbr title="doctor">Dr.</abbr> Rush relates two cases of inflammatory Consumption -attended by a hæmorrhage of a quart of blood from the lungs, in which -the patient recovered; and ascribes their recovery entirely to the -loss of blood. Wounds and other injuries of the lungs frequently heal, -when no predisposition to Phthisis exists, as easily as in other parts -of the body. Of this fact also <abbr title="doctor">Dr.</abbr> Rush affords an example. A British -officer informed him, a few days after the battle of Brandywine, in -September 1777, that the surgeon general of the royal army had assured -him, that out of twenty four soldiers admitted into the hospitals, -during the campaign of 1776, with wounds of their lungs, twenty-three -recovered. These facts prove sufficiently that the constant motion of -the lungs does not prevent the healing process taking place in them as -easily as in other parts of the body.</p> - -<p>In most instances, the spitting of blood which is supposed to have -produced the Consumption, has occurred a considerable period before -the Phthisical symptoms appeared. During this interval perhaps the -patient was perfectly well. Can it be supposed, that the inflammation -necessary to form an ulcer, and the process of ulceration itself, could -so long be going on unperceived, without producing any irritation of -the lungs? Is it not more probable, that the Hæmoptysis was recovered -from, and that the same cause which produced it, at length produced the -Consumption?</p> - -<p>Hæmoptysis, then, I would consider, as very seldom, perhaps, never, -being the cause of Consumption; but in<span class="pagenum" id="Page_24">[Pg 24]</span> all those cases in which it -is assigned as the cause, merely a symptom of the incipient stage of -the disease. The symptoms accompanying hæmorrhage from the lungs, are -no other than those of incipient Phthisis. They are thus accurately -described by <abbr title="doctor">Dr.</abbr> Reid. “When subsequent to a sense of weight and -oppression in the breast, which scarcely amounts to a feeling of pain, -together with cough, difficult respiration, and general lassitude, a -quantity of blood is suddenly, and in a convulsive manner, discharged -from the mouth, there can remain small doubt respecting the part from -which it proceeds. If the discharged blood be of a florid colour, and -together with the above symptoms, a saltish taste be perceived in the -mouth, and the patient become sensible of a degree of irritation in -the upper part of the trachea, the nature of the affection is rendered -altogether unequivocal.” Every symptom here enumerated, occurs in the -early periods of Consumption.</p> - -<p>Nor have we any better reason for believing tubercles to be an exciting -cause of Phthisis. These appearances are indeed very frequently found -in dissections of the lungs of those who have died of Consumption. -Of the nine hundred patients examined by Bayle, 624 had tuberculated -lungs. Tubercles were formerly considered as indurated glands, and -generally attributed to a scrophulous constitution; but we are assured -by Baillie, in his morbid Anatomy, “that there is no glandular -structure in the cellular connecting membrane of the lungs; and on -the inside of the branches of the trachea, where there are follicles, -tubercles<span class="pagenum" id="Page_25">[Pg 25]</span> have never been seen.” These tubercles are roundish bodies, -of a firm consistence, and frequently a cartilaginous structure, but -often containing decidedly purulent matter. By the union of several -of them, vomicæ are formed, which are only larger tubercles. May not -the formation of these bodies be sufficiently accounted for by the -preceding inflammation, and they be considered therefore a consequence, -rather than a cause of Consumption? <abbr title="doctor">Dr.</abbr> Rush insists that tubercles are -the effects, and not the cause of pulmonary Consumption; and remarks as -a farther evidence of this opinion, that similar tumours are suddenly -formed on the intestines by dysentery, and on the omentum by a yellow -fever. He refers to cases of the former in the dissections of Sir John -Pringle, and one of the latter mentioned by <abbr title="doctor">Dr.</abbr> Mackittrick, in his -inaugural dissertation on the yellow fever, published in Edinburgh, -in the year 1776. <abbr title="doctor">Dr.</abbr> Hosack, in his Lectures on the Theory and -Practice of Physic, advocates the same doctrine, and enforces it, by -remarking, that similar tubercles are formed in the parenchyma of -the brain, the liver, and the kidneys, in which no small glands have -yet been detected, and where, as in the lungs, there is nothing but -cellular membrane and vessels. It is his opinion, that it is an union -of a number of these cells in a state of congestion that constitutes -tubercles or vomicæ—that in some instances they heal, the matter is -absorbed, and they remain in a scirrhous state, the patient becoming -perfectly restored to health;<span class="pagenum" id="Page_26">[Pg 26]</span> and hence the remark of <abbr title="doctor">Dr.</abbr> Simmons, -that tubercles may exist without Phthisis.</p> - -<p>These are all the principal predisposing and exciting causes of -Phthisis Pulmonalis. Some few others are mentioned by authors, but they -are of either very doubtful agency, or too rare to deserve notice.</p> - -<p>The disease having been excited into action, produces a succession -of symptoms which are now to be detailed. Its attack is frequently -extremely insidious and slow; at other times, well marked and rapid in -its progress. It is to this insidious and gradual mode of attack, that -Consumption owes much of its fatal character. Before the unfortunate -patient suspects himself to be seriously indisposed, it but too -frequently happens, that his fate is sealed, and death is inevitable. -This arrives in part from the resemblance that Incipient Phthisis -bears to a long continued catarrh. It frequently is only marked in -its earliest periods by a slight, dry, hacking cough, trivial during -the day, increased at evening, and most troublesome at night; a sense -of weight about the breast, and some little difficulty of breathing, -increased on taking any unusual exercise, or ascending a height; the -pulse is slightly accelerated, and sometimes only so after taking food: -occasionally, burning hands and feet, and a slight flush in the cheek -are the only symptoms of fever. These symptoms may be so slight as -hardly to attract the patient’s notice; at other times they are more -severe and distressing. Frequently, on any little unusual exercise, -the cough is increased, the patient feels a pain in<span class="pagenum" id="Page_27">[Pg 27]</span> the side, and -expectorates a frothy mucus, and blood is discharged from the lungs. -This, perhaps, is the first symptom which excites the alarm of the -patient. Expectoration of blood is generally preceded by a saltish -taste in the mouth, and a sense of irritation at the upper part of the -trachea. It is known to come from the lungs and not the stomach, by its -frothy appearance and admixture with mucus, while that from the stomach -is generally dark coloured and mixed with the food; and by being -brought up by coughing and not vomiting. The blood coming from the -stomach too, is generally in larger quantity than that from the lungs.</p> - -<p>In addition to these symptoms, the patient is often affected by an -increased sensibility of the lungs, observable on any exposure to -cold, change of dress, or going from a warm to a cool apartment. -There is a sense of soreness in the lungs attended with a sensation -of stricture about the chest. Pain is felt in the side or breast, and -the patient lies with difficulty on the side affected. The pain is -frequently lancinating, and shooting through the breast, sometimes in -the direction of the mediastinum, at others, confined to one side.</p> - -<p>As the disease advances, the symptoms of fever become more marked. The -tongue is dry, attended with thirst, loss of appetite, nausea, and -occasional vomiting, and a desire for acids. The secretions generally -are checked. Perspiration is diminished, and the skin is hot and dry. -The urine is at first diminished in quantity, and high coloured. The -menses, in females, are either<span class="pagenum" id="Page_28">[Pg 28]</span> suppressed or very irregular. The -bowels are frequently costive. The patient passes restless nights, -and is prevented sleeping by a tormenting cough, or if he sleeps, is -troubled with dreams. In consequence of indigestion, pain is felt in -the situation of the stomach, attended with flatulence. The patient -begins to have a pallid countenance, and emaciation gradually takes -place.</p> - -<p>These symptoms may continue a length of time, gradually debilitating -the patient. But the expectoration which at first was frothy, in -small quantity, and coughed up with difficulty and pain, increases, -and gradually passing through all the stages between mucus and pus, -at length becomes decidedly purulent. A new train of symptoms follow. -Hectic fever makes its appearance, commencing with irregular cold and -shivering fits, returning frequently during the day. It soon, however, -assumes a decided character, and has two marked exacerbations, the -one at noon, the other at night. These exacerbations begin with a -sense of coldness, succeeded by heat, and at night terminating in -profuse perspiration. During the chill and hot fit, the cough, pain, -and dyspnœa are aggravated, but relieved by the sweating. The pulse -before the paroxysm is accelerated and weak, during its continuance -quick and strong, but abates as the perspiration flows. The countenance -is generally pale, but during the exacerbation is marked by a -circumscribed crimson flush, which occurs mostly at noon, but may be -produced by taking food or any other cause<span class="pagenum" id="Page_29">[Pg 29]</span> of excitement. The profuse -sweats do not occur after the exacerbation at noon, but in the morning, -while the patient is warm in bed, with the system relaxed by sleep. -The perspiration is principally confined to the superior parts of the -body, as the neck, breast, and about the shoulders. The tongue is often -very clean during hectic fever, but sometimes furred. The bowels are -generally torpid, alternating with diarrhœa.</p> - -<p>The disease continuing to advance, the cough and dyspnæa increase, and -the hectic symptoms become more marked and violent. Emaciation rapidly -goes on, the face looks sharp and haggard, and the absorption of fat -makes the eyes appear remarkably large and prominent. At the same time, -the teeth appear unusually white and beautiful. The appetite becomes -extremely irregular, the pulse more accelerated and diminished in -strength. The mind is extremely vacillating, at one time depressed, at -another, elated with hopes of recovery. Profuse diarrhœas, alternated -with obstinate torpor of the bowels, exhaust the patient; the eyes -assume a ghastly and pearly whiteness; the mouth becomes filled with -apthous eruptions; sometimes hiccup ensues; the patient’s mind becoming -more and more disturbed, delirium comes on, which soon terminates in -death.</p> - -<p>An assemblage of some or all these symptoms, constitutes Phthisis -Pulmonalis, differing however very materially in number, degree and -violence in different patients. They are variously modified by a number -of attending circumstances, which require some attention.</p> - -<p><span class="pagenum" id="Page_30">[Pg 30]</span></p> - -<p>Many authors declare, that an expectoration of pus does not always -attend this disease. The matter may be confined in a vomica, and the -patient die with the symptoms of Phthisis before it bursts. Nor does a -purulent expectoration necessarily indicate the existence of an ulcer -in the lungs. The matter may be poured out from the secreting surfaces -of the lungs without ulceration, precisely as it comes from the adnata -of the eye after opthalmia, or the urethra in gonorrhœa, where no -ulcer is suspected. In the New-York hospital, dissections of numerous -patients who have died of Phthisis, sufficiently prove the fact in -question.</p> - -<p>Nor does pain in the side or breast, always accompany this disease. <abbr title="doctor">Dr.</abbr> -Reid remarks that many cases have occurred in his practice, where no -pain in any part of the chest has been observed during the whole course -of the disorder. “I have witnessed,” says <abbr title="doctor">Dr.</abbr> Heberden, “many deaths -from genuine pulmonary consumption, where dissection has demonstrated -an entire destruction of the substance of the lungs, and where through -the whole course of the disease, neither expectoration of blood, -difficulty of breathing, nor pain in the side had been present.” On -the other hand, pain in the side may occur merely as a consequence of -the debilitated or irregular action of the muscles, as in walking, and -should not be mistaken for a symptom of Consumption.</p> - -<p>In the course of the disease, dropsical effusions, constituting -Ascites, Hydrothorax and Anasarca, are not<span class="pagenum" id="Page_31">[Pg 31]</span> unusual, as in other -diseases where great debility is produced.</p> - -<p>In the advanced periods of Consumption, diarrhœa constitutes a -prominent and troublesome symptom. This is sometimes produced by any -cause which checks the profuse sweats; while on the other hand, if the -diarrhœa be checked, the cough and dyspnœa, which perhaps had been -relieved by it, frequently return with redoubled violence. Under these -circumstances, the condition of the patient is hopeless indeed.</p> - -<p>The approach of summer frequently mitigates the sufferings of the -consumptive, and gives them hopes of returning health; but when winter -returns, these hopes are blasted; the patient sinks again into his -former condition, and most generally is cut off during the cold season.</p> - -<p>The symptoms of Phthisis are frequently suspended or mitigated by any -cause producing a new determination in the system. The most prominent -of these causes is pregnancy. It almost invariably happens that -the symptoms of Consumption are relieved by the occurrence of this -event; but after parturition the disease returns with all its former -violence. The occurrence of mania has produced the same effect, and -has even entirely cured the disease; but generally, when the mania is -removed, the symptoms of Consumption return. An attack of rheumatism -has frequently relieved phthisical complaints. <abbr title="doctor">Dr.</abbr> Rush refers to three -clinical patients in the hospital of Pennsylvania to exemplify this -observation. In the same<span class="pagenum" id="Page_32">[Pg 32]</span> manner gout is observed to alternate with -Consumption, and during its paroxysms, the complaint of the lungs is -relieved. Frequent cases are related, in works on this subject, of -eruptions on the skin alternating with Phthisis Pulmonalis.</p> - -<p>Long continued ulcers, or fistulæ in ano not unfrequently relieve -pulmonic complaints in phthisical patients; while the healing of these -ulcers or fistulæ reproduces the disease with tenfold violence.</p> - -<p>A farther circumstance worthy of remark in this disease is, the -willingness with which the patient suffers himself to be flattered with -hopes of recovery. Notwithstanding he sees daily victims of Consumption -falling around him; notwithstanding the perfect assurance he has of the -small number of those who recover from it; to the last his hopes are -not abandoned. Although depressed at night by the evening exacerbation -of hectic fever; in the morning, from his comparatively comfortable -situation, his hopes revive. Happy is it for these miserable sufferers -that they do not despair. In a disease whose progress is frequently so -slow, and whose event is but too often so sure, fortunate it is, that a -solace remains to cheer the unhappy patient.</p> - -<p>The duration of Consumption is extremely various; from a few weeks to -fifty years have patients laboured under it. In Bayle’s statement of -the duration of the disease in two hundred cases in which the patients -were destroyed by it, it was between two months and two years<span class="pagenum" id="Page_33">[Pg 33]</span> in 168 -cases, four were less than two months, and 28 remained more than two -years.</p> - -<p>From the detail of symptoms which has just been given, it is evident, -that there are two distinct stages of Phthisis Pulmonalis, each -characterised by peculiar symptoms, and requiring peculiar treatment. -The first, incipient, or acute stage as it is variously termed -by authors, is the stage of inflammation, and terminates as soon -as purulent expectoration and hectic fever commence. The second, -confirmed, or chronic stage commences where the first terminates, and -ends most generally in death. We would not however assert, that these -stages can always be accurately distinguished, and a line drawn between -them. On the contrary, hectic fever may occur early in the disease, -before any expectoration of pus takes place, and inflammatory symptoms -frequently attend its advanced stage. In general, the distinction can -be made, and must necessarily guide the prudent physician.</p> - -<p>Having taken a view of the causes and symptoms of Phthisis Pulmonalis, -we are now prepared to investigate the proximate cause of the disease. -From the nature and extent of these symptoms, it appears evidently a -disease of the whole system, and not confined merely to the lungs. -The proximate cause, as taught by <abbr title="doctor">Dr.</abbr> Hosack, in his lectures, is, an -inflammation of the lungs, terminating either in a purulent secretion, -or ulceration in their substance. This opinion is much strengthened by -the analogy before remarked between<span class="pagenum" id="Page_34">[Pg 34]</span> Phthisis Pulmonalis and Pneumonia. -It is a little singular that <abbr title="doctor">Dr.</abbr> Rush, notwithstanding he had remarked -this close analogy, and although he speaks of inflammatory fever as a -part of the disease, and prescribes blood-letting in its treatment, -should yet have made debility its proximate cause. This is only one -instance among many, of physicians arriving at precisely the same -modes of treatment by directly opposite routes. If that theory of -inflammation be admitted, which makes debility its cause, so far it -is also the proximate cause of Phthisis Pulmonalis. In the secondary -species of Phthisis, hereafter to be considered, debility may be fairly -ranked as the proximate cause, and the indications of cure correctly -drawn from it. But in the primary disease under consideration, if we -were to found our indications on this basis, and thence deduce the -propriety of exhibiting powerful tonics in the first stage of the -disease, when brought to the test of practice, its error would soon -become sufficiently glaring.</p> - -<p>Various other causes have been successively treated of by authors, -but to shew their inconsistency and absurdity, it is only necessary -to observe that, “the existence of an acid or an alkali, of chemical -acrimony, or mechanical changes in the blood, of corroding volatile -particles, and even of animalcula in the lungs, have been vaguely -conjectured to be the cause of pulmonary ulcer and hectic fever.<a id="FNanchor_7" href="#Footnote_7" class="fnanchor">[7]</a>”</p> - -<p><span class="pagenum" id="Page_35">[Pg 35]</span></p> - -<p>Assuming then, inflammation of the lungs, and consequent ulceration -of their substance as the proximate cause of Phthisis Pulmonalis, we -naturally deduce the following indications in the treatment of the -disease.</p> - -<p>1. To endeavour to relieve the inflammation of the lungs, and promote -its resolution.</p> - -<p>2. If, notwithstanding all our efforts, suppuration takes place, to -give sufficient support and tone to the system to enable the ulcers to -heal.</p> - -<p>In fulfilling these indications, our first object is to remove the -remote causes, where it is possible. If the patient’s occupation is -one of those which predisposes to Consumption, unless it be abandoned, -or at least so modified as to correct the objectionable parts of it, -we cannot hope to cure the disease. If the disease arise from the -suppression of an accustomed evacuation, our utmost endeavours must -be made to restore it. Should suppression of the menses be the cause, -means calculated to produce their return must be resorted to. If an -ulcer or fistula has healed up, they must be re-opened, or issues -established in more convenient situations. In short, the rule is plain -and simple. Remove the remote causes, wherever it is practicable.</p> - -<p>Among the remedies which are necessary to fulfil the first indication, -the most prominent is Blood-letting. This remedy has been strongly -advocated by many of the most distinguished authors who have written -on Consumption; and its propriety admitted by all under certain -circumstances. Probably, most of the injurious<span class="pagenum" id="Page_36">[Pg 36]</span> effects attributed -to it, may be accounted for by a proper distinction not having -been made between Primary and Secondary Phthisis Pulmonalis. When -bleeding has been practised in the secondary form of the disease, -it has been generally injurious, and hence an odium has been cast -upon its employment in any circumstances. In the same manner, it -has done mischief, when used too late in Primary Phthisis, and thus -another groundless argument furnished against the remedy. But the -indiscriminate use of blood-letting is not here contended for. Its -judicious and cautious use, when inflammatory action is evident, alone -is intended to be advocated. On the other hand, too timid practice -may induce us to withhold the lancet when it is necessary; and we -may thus do as much injury by losing the proper time for action, as -we would have done by pushing the remedy too far. It is difficult to -fix the period beyond which it is improper to bleed in Consumption. -<abbr title="doctor">Dr.</abbr> Hosack insists that as long as there is any pain or soreness on -taking a full inspiration, the lancet is necessary. This rule is not -applicable to practice; for if we adopt it, we may bleed the patient -until he dies. Until that moment will the pain in some instances -continue. It is not unfrequent, after the patient has been exhausted -by colliquative sweats, and profuse diarrhœa, for pain in the breast -to recur at intervals, a few days before death: and what practitioner, -under such circumstances, would feel himself justified in using the -lancet? But this rule is incorrect in another point of view. In some -cases, it will<span class="pagenum" id="Page_37">[Pg 37]</span> prevent our using this valuable remedy, when it is -necessary. On the authority of <abbr title="doctor">Dr.</abbr> Reid, it is asserted, that pain -is not always present in Phthisis Pulmonalis; and may not occur -during the whole course of the disease. A reference has been already -made to <abbr title="doctor">Dr.</abbr> Heberden to prove the same fact. On this subject it is -impossible to fix any precise rule. The strength and habit of the -patient, the urgency of the symptoms, and state of the pulse, must all -be recollected and adverted to in making up our judgment as to the -propriety of the remedy. In general, perhaps we may say, that after the -formation of matter is perfectly ascertained, it is improper to bleed. -This, however, is not without exceptions. Cases sometimes occur, after -this period, in which the symptoms of high inflammatory action arise, -and where the lancet is indicated. It is now generally admitted that -the buffy appearance of the blood is by no means an infallible evidence -of the necessity of the repetition of blood-letting. Nor is its cupped -form a better proof of the existence of inflammation. Many writers have -observed, that the buffy coat appears in the blood drawn in Consumption -at the latest periods of the disease. A remarkable and decided case of -Enteritis, occurred during the last winter, in the New-York Hospital, -in which very large and repeated bleedings were made use of, with -the good effect of curing the patient: and yet, neither buff nor the -cuplike form appeared in the smallest degree in the blood drawn. This -case alone is sufficient to prove, how equivocal are these appearances -of the blood, as<span class="pagenum" id="Page_38">[Pg 38]</span> tests of inflammation. Nevertheless, the judicious -practitioner will not fail to observe these circumstances, and as they -so frequently accompany inflammation, will consider them, when attended -with other evidences, as properly influencing his judgment on the -propriety of bleeding.</p> - -<p>If the abstraction of blood from the system generally is useful, no -less so is it when drawn from the part itself, by the application -of cupping-glasses, and the scarificator to the chest. This mode of -obtaining blood is peculiarly useful in those frequent cases, where the -patient is too much debilitated to bear the loss of much blood, but the -existence of inflammatory action makes its abstraction necessary.</p> - -<p>Emetics are a powerful remedy in the treatment of Phthisis. They not -only promote expectoration, and relieve the distressing cough in the -first stage of the disease, but by their general relaxing effects -upon the system, are useful in reducing inflammatory action. The use -of this remedy, however, should not in general be commenced until -blood-letting has been premised; otherwise in plethoric habits, full -vomiting might induce hæmoptysis. Practitioners have differed very -much in the choice of emetics proper in this disease. The antimonial -preparations and ipecacuanha, as acting more generally upon the system -in reducing excitement, and from their good effects in other febrile -diseases, appear to be the most proper. But in the last stage of -Consumption, where our object is to relieve the pulmonary<span class="pagenum" id="Page_39">[Pg 39]</span> symptoms, -without debilitating the patient, the sulphates of zinc and copper are -preferable.</p> - -<p>Emetics are not only useful when exhibited for the purpose of full -vomiting, but medicines of the same class given as diaphorectics are -also proper. With this view the various preparations of antimony are in -use. Small doses of the Antimonial powder combined with calomel have -been found, perhaps, one of the best sudorifics that can be employed, -and as such are frequently useful in Phthisis. No medicine is superior -to this combination in reducing inflammatory action; and it frequently -has a better effect by proving both emetic and purgative.</p> - -<p>As a sudorific, warm bathing may be very useful, and is an agreeable -remedy in the inflammatory stage of Phthisis. As the warm bath is -useful in relaxing the surface of the body generally; in a similar -manner inhaling warm air, by means of Mudge’s apparatus, relaxes the -inflamed membrane of the bronchiæ, and acts as a fomentation there, -with the same good effect as is produced by warmth and moisture upon -any other inflamed surface of the body. This remedy gives great relief -in the cough and hoarseness so distressing in Phthisis Pulmonalis.</p> - -<p>With the same view of counteracting inflammation, cathartics may be -prescribed. As in other febrile diseases, so in Phthisis, the bowels -are frequently torpid, and require the frequent use of aperient -medicines. Saline and mercurial cathartics, possessing the greatest<span class="pagenum" id="Page_40">[Pg 40]</span> -power in diminishing excitement, are perhaps the most proper in this -disease. But as it is an object not to induce too much debility, the -use of drastic purgatives should be avoided as much as possible, and be -confined to the earliest periods of the disease. During its advanced -stage, the bowels should be kept open by mild laxatives and enemata, -which tend least to debilitate the patient.</p> - -<p>Blisters, Setons and Issues relieve the inflammation of the lungs, and -produce a new determination to the surface with the happiest effects. -Most writers agree in recommending repeated blisters to the chest, as -an useful remedy, and with reason. But it is to be regretted that they -have been suffered to usurp the place of a more powerful remedy of the -same class, viz. Issues. If we may judge from the effect of ulcers and -fistulæ, which palliate all the symptoms of confirmed Phthisis, while -they continue, but whose healing restores the disease, it would appear -that the establishment of similar drains, in the form of issues, ought -to have a good effect. In caries of the spine, and disease of the hip -joint, where the inflammation in the cellular structure of the bones -seems to be very analogous to that in the cells of the lungs, issues -are used with the greatest benefit. In these cases, they are uniformly -preferred to repeated blistering, and experience has sanctioned the -preference. Issues are preferable to blisters by their constant and -uniform action, whereas the latter remedy has its effect continually -interrupted by healing up and requiring renewal.<span class="pagenum" id="Page_41">[Pg 41]</span> In general, blisters -appear to be more useful in acute diseases, which may soon be subdued: -but in Phthisis Pulmonalis, which continues so long, and whose progress -is so slow, issues appear to be the better remedy. <abbr title="doctor">Dr.</abbr> Mudge was so -well convinced of their efficacy, that he assures us, he cured himself -of an Incipient Consumption, by a large issue between the shoulders. -Beddoes also recommends them, and relates several cases, in which -they were used with the best effect. But if this remedy be tried, it -should not be done timidly, and with the fear of giving pain; when -used at all, issues should be large and effectual, not only sufficient -to contain a single pea, but at least a dozen. This is not the only -remedy which has fallen into disrepute by a trifling and inefficient -mode of employing it. But as blisters are preferred by many of the most -judicious practitioners, their use may easily and with advantage be -combined with that of issues. While a large issue is kept open between -the shoulders, successive blisters may be applied to the chest. Many -patients, perhaps, would not submit to so severe a mode of treatment; -but it is only by such active and efficient practice, that we can hope -to cure this formidable malady.</p> - -<p>It is only in the first stage of Consumption that much benefit is to -be expected from this class of remedies, or at all events, before the -patient is much debilitated. In its latest periods, they would tend -rather to add to the debility already induced by the disease. At<span class="pagenum" id="Page_42">[Pg 42]</span> any -time, however, when the patient is not too much reduced, they may be -prescribed with advantage.</p> - -<p>Mercury, given until it produce salivation has frequently cured -Phthisis Pulmonalis. It is used with greatest advantage in its first -stage, but after the inflammatory action has been in some measure -reduced, by means of blood-letting, and the other remedies proposed. -Before these evacuations have been premised, it would tend rather to -increase the inflammation; while in the advanced stage it would add too -much to the debility of the patient. It generally succeeds only when -it affects the mouth, and therefore to secure this effect and prevent -its running off by the bowels, it should be combined with opium. But -the best form of exhibiting mercury, is one much in use with my worthy -friend and preceptor, <abbr title="doctor">Dr.</abbr> Borrowe. Calomel, combined with small doses -of antimonial powder, given morning and evening, until it affect the -mouth, is the form proposed. In this way it may be given at an earlier -period of the disease, than would otherwise be proper, by the constant -determination to the skin kept up by the antimonial powder, obviating -the tendency which mercury has to increase inflammatory action. At the -same time it serves to keep the bowels open, and makes almost every -other medicine unnecessary. On the other hand, if it acts too much -on the bowels, it may be usefully combined with opium, which adds to -its diaphoretic effect. The good effects of this mode of exhibiting -mercury, is strikingly illustrated by the result of the following case, -which occurred in<span class="pagenum" id="Page_43">[Pg 43]</span> the practice of <abbr title="doctor">Dr.</abbr> Borrowe within a few months past.</p> - -<p>“Miss ———, aged about 14 years, had been for six months past, -afflicted with some cough, pain in the chest and difficulty of -breathing. She was affected with loss of appetite, emaciation and -profuse sweats at night. Her pulses were frequent; she had the peculiar -pearl-like appearance of the adnata; frequent attacks of diarrhœa, and -an expectoration much resembling pus. She was attacked with chills -about the middle of the day, followed by considerable excitement, -aversion to motion and drowsiness; succeeded by great prostration of -strength; palpitation and hurried breathing on ascending a height or -engaging in any considerable bodily exertion; attended with a livid -appearance of the lips, evidencing a difficulty in the passage of blood -through the lungs.</p> - -<p>It was determined to put her upon the use of Calomel and Pulv: Jacob: -which were given in small doses every night and morning; a blistering -plaister was also applied to the chest, and kept in an irritable -state for a considerable length of time. The diet was ordered to be -soft, mild and nutritious. The mercury and antimonial medicine were -occasionally omitted when they acted more on the bowels than the skin, -or occasional anodynes were administered to restrain their action on -the alimentary canal.</p> - -<p>Some weeks elapsed before the mercury produced any effect upon the -salivary glands, which was one of the objects<span class="pagenum" id="Page_44">[Pg 44]</span> aimed at. As soon as the -mouth became sensibly affected, the symptoms were generally mitigated. -A temporary suspension of the use of the remedies became necessary, in -consequence of the considerable effect produced by the mercury. When -the soreness of the mouth abated, small and less frequent doses of the -calomel were given so as to keep up a tenderness of the gums several -weeks longer. The affection of the chest became now entirely relieved, -and it was thought advisable to suspend the use of the mercurial -treatment, the effects of which were suffered to pass off, rather than -be relieved or cured.</p> - -<p>From this time no medicines were employed, except a small quantity of -a weak infusion of colombo as a tonic. Long before the patient’s mouth -enabled her to eat, her appetite became craving. She was indulged in -eating moderately of such food as she had a particular desire for; -and she soon was enabled to take exercise without inconvenience. She -did not now complain of any pain in the chest, the cough left her, -the bowels became regular, there was no recurrence of night sweats, -she began to gain flesh, the countenance assumed the healthy aspect, -and the peevishness under which she had long laboured was effectually -cured. She now slept well, and gradually returning to her former -habits, is at the end of five months after discontinuing her remedies, -in perfect health.”</p> - -<p>Digitalis is a remedy in Phthisis, which has excited much acrimonious -controversy among practitioners of<span class="pagenum" id="Page_45">[Pg 45]</span> medicine. As always happens in -these contests, it has been praised too highly by one party, and -condemned too severely by the other. When first introduced, it seemed -to promise the complete eradication of Consumption: and it almost -appeared that digitalis was as specific in the cure of that disease, -as mercury, in syphilis. <abbr title="doctor">Dr.</abbr> Magennis of the Royal Navy Hospital -at Plymouth, England, published a paper, containing an account of -seventy-two cases of incipient or confirmed Consumption, in seamen and -marines, treated with digitalis. Of these, twenty-five with ulcerated -lungs recovered; and fifteen from the stage previous to ulceration. -Thirteen of the seventy-two in an early stage of ulceration were -discharged, greatly relieved; and nine in the previous stage. In ten -cases, the medicine failed; but in some of these it gave considerable -relief. Beddoes assures us, that three cases out of five of tubercular -consumption, in his practice, had recovered under the use of digitalis. -Kinglake insists that one in three cases of the tubercular stage of -Consumption, may be cured by this medicine. <abbr title="doctor">Dr.</abbr> Currie informs us, -that digitalis may be used with safety and success in cases where the -lancet can no longer be employed. These results in the practice of men, -distinguished in their profession, although they may be somewhat warped -by prejudice, are extremely flattering, and prove at least that the -medicine has some power. But like all other new remedies, digitalis has -been rated too highly by those who first used it. Delighted that they -had discovered a medicine, which, in some cases would cure a<span class="pagenum" id="Page_46">[Pg 46]</span> disease, -which they had been accustomed to look upon as totally incurable, these -physicians have suffered themselves to attend too exclusively to its -successful results, and to neglect cases in which it has failed. Other -practitioners, on reading their exaggerated statements, have tried the -remedy, but finding themselves frequently disappointed, have gone into -the other extreme and condemned it entirely. Their representations -are to be admitted with as much qualification as those of their -opponents, and the judicious physician will not suffer himself to be -exclusively guided by either. That in certain cases, digitalis will -cure Consumption, cannot be doubted; but we have also to regret, that -it very frequently fails. It was prescribed in the New-York Hospital, -under the direction of <abbr title="doctor">Dr.</abbr> Hamersley, during the last winter, in six -cases which I have witnessed, of evident and well marked Phthisis. Of -these, two patients were perfectly cured; one has nearly recovered, and -is only retained in the Hospital for a slight cough, which is yielding; -a fourth was discharged at his own request, but evidently relieved; the -fifth commenced the use of digitalis, at a very advanced period of the -disease, and soon died; in the last it failed entirely, and appeared -rather to have done injury.</p> - -<p>Having ascertained that digitalis does sometimes succeed in curing -Phthisis Pulmonalis, it remains to discover what are the cases in -which we may exhibit it with success. For this purpose it would be -desirable to ascertain the <i lang="la" xml:lang="la">modus operandi</i> of the medicine. Here -writers have differed<span class="pagenum" id="Page_47">[Pg 47]</span> as widely as in their account of its success -in practice. One author determines it to act by diminishing the force -and frequency of the circulation, and reducing inflammatory action; a -second attributes its salutary effect to its operation on the kidneys; -while a third believes it no longer to be of advantage, when it -increases the discharge by urine, excites nausea, vomiting, purging -or any undue excitement, but attributes its beneficial effects to its -stimulant efficiency, in invigorating the arterial and muscular energy -of the system: and a fourth insists that by promoting the action of -the absorbents it cures Consumption. These conflicting and opposite -opinions constrain us to admit, that farther enquiry is necessary, -before we can rest satisfied as to the mode in which digitalis acts. -It must be confessed that this medicine is extremely uncertain in -its operation. Its most evident effect, and that most insisted on, -of reducing the frequency of the pulse, is by no means certain; and -indeed, it is the opinion of <abbr title="doctor">Dr.</abbr> Beddoes, that the force and strength -of the pulse are increased by it. In the N. Y. Hospital I have -witnessed frequent cases in which its continued exhibition produced no -effect in reducing either the force or frequency of the pulse; and in -some instances no effect at all seemed to be produced by it. A case -occurred in that institution in October last, in which a patient, by -his own carelessness took six drachms of Tinct: Digitalis with no -evident injury. In examining the effect of this medicine on the pulse, -it is necessary to recollect the remark of Beddoes, that it is very -different in the recumbent and erect posture;<span class="pagenum" id="Page_48">[Pg 48]</span> the pulse frequently -being found to be reduced in frequency and irregular in the former, -but recovering its frequency and regularity in the latter situation. -From the same author we learn, that if this remedy do not produce any -good effect within three weeks, we can expect no advantage from it at -all. It is generally admitted that digitalis will succeed only in the -first stage of Phthisis Pulmonalis; in the last or ulcerated stage of -that malady, it will not save our patient, but we are apprehensive, -will rather hasten his dissolution. As it is acknowledged to be an -uncertain medicine, we should not place our whole dependence upon it, -nor suffer it to take the place of blood-letting and the rest of the -antiphlogistic treatment before recommended: it should be used rather -as an auxiliary than a principal remedy. From its uncertainty of -operation it requires a cautious exhibition. The dose for an adult is -from ten to fifteen drops of the saturated tincture, three times a day, -and gradually increased until some effect is produced.</p> - -<p>The use of factitious airs in Consumption is now very much abandoned. -No essential benefit has ultimately appeared to be derived from them; -although in the first instance, they produced some apparently good -effect.</p> - -<p>Of much more advantage is a sea-voyage and a mild climate. The benefit -evidently derived from sea-voyages has been attributed to various -causes. The nausea and vomiting from sea-sickness, the uniform motion -and gentle regular exercise produced by sailing, and the uniformity<span class="pagenum" id="Page_49">[Pg 49]</span> -and mildness of the atmosphere of the ocean, so evident at a distance -from the land, probably all combine in producing these happy results. -We can hardly suppose, however, with <abbr title="doctor">Dr.</abbr> Mudge, that the exhalations -from the tar and pitch about the ship, taken into the lungs in -respiration, have any agency in the effect produced. But whatever be -the cause, it is not at all unfrequent for consumptive patients to -experience immediate relief after having been a few days at sea. A -sea-voyage to produce permanent benefit, should be long continued, and -what is of still more importance, terminate in a mild climate. Every -winter, instances occur in this city, of consumptive patients being -restored to health by a voyage to the south of France, or some other -country of similar temperature. The climate most grateful to these -patients is one whose temperature is uniform, not subject to any sudden -variations, and where the atmosphere is dry and pure. The island of -Madeira possesses all these requisites. The part of it best adapted to -the purpose in question is thus described by <abbr title="doctor">Dr.</abbr> Adams, a physician of -that island, in a letter to his friend in London:—</p> - -<p>“The valley of Funchall is defended by immense hills from every wind -but the south, where it is open to the sea-breeze; this preserves a -temperature so even, as is unknown in any other part of the world. Our -winters may be compared to your summers in every thing but the length -of days, and those sudden changes from heat to cold, to which you are -subject. The thermometer<span class="pagenum" id="Page_50">[Pg 50]</span> with us is often steady within doors, or -varies scarcely a degree for weeks together. During winter its whole -range is from 58 to 65; and in summer, from 70 to 75, rarely amounting -to 80; the heat being always tempered by a breeze in proportion to the -force of the sun. The dryness of our atmosphere is not less remarkable.”</p> - -<p>If this description be correct, Madeira has a climate possessing every -requisite to make it most favourable to phthisical patients. The -southern parts of the United States are frequently resorted to, also, -by the consumptive with great benefit. I have had the satisfaction -of seeing a young friend return from Charleston, a short time since, -perfectly restored to health, who, during the last autumn, was attacked -with repeated hæmoptysis and other symptoms of Incipient Phthisis.</p> - -<p>It is to be regretted, that change of climate, a remedy of so much -advantage in the early stage of Consumption, should so often be -postponed, until no possibility of recovery remains. It is too often -the fate of such patients, to leave their homes in quest of health, -merely to find a foreign grave; resorting to that remedy which should -have been first, as the last effort of despair. To this cause alone, -may we attribute its frequent inefficiency, and unfortunately the same -cause has contributed too much to bring the remedy into disrepute.</p> - -<p>Where from any circumstances, change of climate is impracticable, it -may to some extent be imitated, by confining the patient to apartments -whose temperature is kept constant and uniform. This has been tried and -with some<span class="pagenum" id="Page_51">[Pg 51]</span> success; and is probably, the remedy of the same class, next -in power, but much inferior to a warm climate. Beddoes made use of it -in several cases with relief to his patients, but it has not yet been -sufficiently tested to establish its character as a remedy in Phthisis -Pulmonalis.</p> - -<p>Besides the use of the remedies which have been enumerated, with the -view of effecting a radical cure of this disease, there are some -symptoms occurring in its first stage, which require immediate relief. -Hæmoptysis sometimes comes on in such a manner as to be very alarming -to the patient. Blood-letting in large quantities, and repeated in -proportion to the strength and habit of the patient and violence of -the symptoms, is then absolutely necessary. Unless the plethora, which -is oppressing the system, and exciting the hæmorrhage from the lungs, -be relieved by general blood-letting, blood will not cease to pour -out from that viscus. At the same time the free exhibition of saline -cathartics, a blister to the chest, a rigidly abstemious diet and a -strict adherence to the antiphlogistic regimen must accompany this -treatment. Peruvian Bark, Chalybeates and Elixir of Vitriol so often -used, in active hæmorrhage during the inflammatory stage of Consumption -cannot but be injurious. They increase the force of the circulation and -consequently the disposition to hæmorrhage. In the same symptom arising -from an opposite cause, they may be prescribed with advantage. Common -salt, administered dry in the manner directed by <abbr title="doctor">Dr.</abbr> Rush,<span class="pagenum" id="Page_52">[Pg 52]</span> has been -found by experience to be very useful in abating hæmorrhage from either -cause; but it should not be depended on alone, nor suffered to take the -place of the treatment just detailed.</p> - -<p>If possible, we should anticipate the occurrence of hæmoptysis with -our remedies, and thus prevent the formation of a habit of spitting -blood, which when once established, is difficult to destroy. The usual -precursors of this symptom are, a saltish taste in the mouth, a sense -of irritation at the upper part of the trachea, and some oppression -and difficulty of breathing. At this time, before the hæmorrhage has -commenced, blood-letting and the rest of the remedies mentioned above -should be actively exhibited. “<i lang="la" xml:lang="la">Venienti occurrite morbo.</i>”</p> - -<p>A distressing cough at this period also requires the attention of -the physician. From its occurrence more particularly at night, it -disturbs the rest and adds much to the sufferings of the patient. It -should be alleviated by Opiates, accompanied with any of the mild -demulcent remedies, generally denominated Pectorals. Mudge’s Apparatus -for inhaling the steam of warm water, may also be used with relief, -especially on going to bed.</p> - -<p>When all inflammation is gone and the second stage of Consumption has -decidedly formed, a different mode of treatment becomes necessary. -Little indeed is now to be hoped for from any treatment, as a radical -cure; but our patient is not to be abandoned; if he cannot be cured, -his sufferings may be materially mitigated, and he may be directed to -avoid such things as may increase his malady.<span class="pagenum" id="Page_53">[Pg 53]</span> Nor should we entirely -despair of performing a radical cure; for solitary cases are related by -many authors of consumptive patients being cured in every stage of the -disease. Many of these cases, perhaps, have been mistaken for Phthisis -Pulmonalis; but of some of them we cannot doubt. The authority from -which they come is too high to permit us to hesitate.</p> - -<p>The remedies last mentioned in the treatment of the first stage of -Consumption may yet be proper, and although with not so great a -prospect of success, should still be tried. These are a sea-voyage, -change of climate, and confinement to apartments whose temperature -is regulated. But all the debilitating remedies before recommended, -are now to be avoided. The lancet in general is improper, although -in some few instances, the occurrence of acute inflammation at this -period, still requires its cautious use. Drastic Cathartics should not -be used; the bowels if torpid must be kept open by gentle laxatives -and Enemata. Antimonial and other debilitating Emetics should not -now be exhibited, but the Vitriol Emetics may still be prescribed -with advantage. The Sulphate of Zinc given in such doses as to excite -occasional vomiting, is frequently very useful, and especially where -much irritation is present. It was introduced and strongly recommended -by <abbr title="doctor">Dr.</abbr> Mosely in his Treatise on Tropical Diseases &c. His Vitriolic -solution<a id="FNanchor_8" href="#Footnote_8" class="fnanchor">[8]</a> is certainly an useful remedy in relieving dyspnœa<span class="pagenum" id="Page_54">[Pg 54]</span> and -promoting expectoration. Instead of debilitating as antimonials do, he -assures us, that its emetic effects are instantaneous, not harassing -the patient, but always leaving the stomach strongly invigorated. <abbr title="mister">Mr.</abbr> -Warburton, the present House Physician of the New-York Hospital, has -assured me, that he has frequently prescribed it in that Institution -with evident benefit. With similar intentions, <abbr title="doctor">Dr.</abbr> Senter, in the -Medical and Chirurgical Review, published in 1793, recommends the -sulphate of copper.</p> - -<p>At this time blisters will be preferable to either setons or issues, -as they relieve the local symptoms without producing a constant -debilitating discharge. Indeed they should be used in such a manner, -as to produce as little discharge as possible. With this view, they -should not be kept open by stimulating dressings, but be healed up, and -occasionally renewed. With the same intention, stimulating plaisters -may be applied to the chest with advantage, and in general are -preferable to blisters.</p> - -<p>To support the patient’s strength, as was proposed in the second -indication, tonics are necessary. Of these some of the simple bitters -are preferable, as columbo, gentian, boneset, chamomile, &c. But -we should be careful not to exhibit them during the paroxysms of -hectic fever, but during its intervals. Peruvian bark has not been -found admissible. It produces a sense of stricture and oppression of -breathing, adds to the cough, makes the pulse quick and hard, and -hæmoptysis is not unfrequently the consequence of its exhibition. -<abbr title="doctor">Dr.</abbr><span class="pagenum" id="Page_55">[Pg 55]</span> Fothergill dwells particularly on the abuse of this medicine in -Consumption.</p> - -<p>As stimulating and bitter medicines, the Polygala Seneka and -Aristolochia Serpentaria have been recommended in this stage of -Phthisis Pulmonalis.</p> - -<p>The stimulating balsams and gums are also proper in this stage. They -have been highly recommended by Morton; and myrrh in particular is -prescribed with great confidence by Simmons. They are objected to by -Fothergill, on the ground, that by their stimulating properties, they -increase the inflammation of the lungs. His objection appears well -founded, while symptoms of acute inflammation still exist; but after -they have subsided, the cough and other distressing symptoms of the -last stage of Phthisis, may be much alleviated by these medicines. By -their stimulating effects upon the whole system, also, they may be -useful at a time when the patient is sinking under great debility.</p> - -<p>As stimulating applications are frequently found necessary and useful -to indolent ulcers on the surface of the body, it naturally occurred -that similar applications might be made with advantage to ulcers of -the lungs. With this view, the steam of tar water, and the vapour of -sulphuric æther inhaled in respiration, have been used in the treatment -of Consumption.<a id="FNanchor_9" href="#Footnote_9" class="fnanchor">[9]</a> With the same restrictions<span class="pagenum" id="Page_56">[Pg 56]</span> as are necessary with -the stimulating gums and balsams, these remedies may be beneficial. It -is not probable, however, that any permanent relief can be derived from -them; they can only mitigate symptoms.</p> - -<p>To check the profuse sweats, which occur at this period, and add -materially to the debility of the patient, the elixir of vitriol is an -useful medicine. As a general tonic it acts beneficially also upon the -whole system.</p> - -<p>With the view of quietting the cough and procuring rest at night, -opiates are necessary; and fortunate are we that we have in our -possession, a remedy, which although it will not permanently cure the -disease, palliates the symptoms, at least for a time; and makes more -smooth the path to death. It is true that opium produces some ill -effects. It debilitates the stomach, and injures the appetite; but when -the symptoms are urgent, it cannot for these reasons be dispensed with. -By lulling pain, and giving rest to the watchful patient, it more than -counterbalances these disadvantages. The humulus lupulus or common -hops, does not possess the objectionable properties of opium, but with -its anodyne combines some tonic powers, and promises to be an excellent -substitute for that medicine.</p> - -<p>The large and frequent use of syrups in the form of expectorant -mixtures and linctuses, to alleviate cough, is very injurious. They -cloy the appetite, destroy the tone of the stomach, and prevent the -taking of nutritious aliment, which is now so necessary; and frequently -without producing any material relief of the symptom for which they are -prescribed.</p> - -<p><span class="pagenum" id="Page_57">[Pg 57]</span></p> - -<p>The use of opiates is necessary also, to check the profuse diarrhœas, -which now alternate with costiveness, and reduce the already -debilitated patient. With the same view, the chalk mixture may be used -with advantage, and the astringent medicines, Kino and Catechu, with -others of the same class.</p> - -<p>It is not unfrequent for hæmoptysis to occur at this period, as well -as in the earlier stages of Consumption. Sometimes it is the effect of -some temporary excitement, and may be relieved by the loss of a few -ounces of blood. But frequently this evacuation cannot be borne; and -the hæmorrhage proceeds rather from debility in the vessels of the -lungs, than any increased force of the circulation. We must then trust -to astringents—muriate of soda, sulphuric acid, and alum.</p> - -<p>We come now to speak of the diet and regimen of patients labouring -under Phthisis Pulmonalis; a subject no less important than the -remedies to be exhibited. In the first stage, the diet should be -perfectly simple, and such as will least tend to increase the -inflammatory action of the system. For this purpose nothing is better -than milk. So sensible have physicians, at all times, been of its -propriety, that in many cases, they have trusted the cure entirely -to a milk diet. It is highly spoken of by almost every author who -has written on this subject, and with reason. It is light, easily -digested, and does not produce any excitement. Many have preferred -Asses’ to Cows’ milk, but it does not appear that there is any material -difference, which should influence our choice. The<span class="pagenum" id="Page_58">[Pg 58]</span> former is thinner -and less nutritious, and perhaps, to very delicate stomachs, may -be more acceptable; but in general, the latter is as useful. Milk, -however, is very offensive to some stomachs, and not so easily digested -as other food; in such cases it must necessarily be prohibited.</p> - -<p>As a general rule, with regard to diet, in this stage, animal food is -improper, and the patient should be confined to the use of vegetables. -Fresh sub-acid fruits are proper; and, indeed, of so much importance -have they been considered, that Hoffman mentions a case of confirmed -phthisis, cured by confining the patient to the use of fruits, and -particularly strawberries. Mucilaginous and diluent drinks, as those -formed from barley, sago and flaxseed are also useful. Among these -may be classed, the Lichen Islandicus, which has gained with some the -reputation of curing Consumption. Weak is the foundation for hope of -those who depend on it. As an article of diet, from its mucilaginous -property, it is useful; and in the last stage, from its possessing -slightly better and tonic virtues, it is also proper; but as a -remedy for phthisis it is altogether inert. Nor are its tonic powers -sufficiently great, to render it injurious in the early stage of the -disease.</p> - -<p>The dress of the patient should also be regulated by the Physician. He -should be clothed in flannel, and this frequently changed. A constant -determination is thus kept up to the surface, and to some extent, -diverted from the chest. At the same time, all exposure to cold,<span class="pagenum" id="Page_59">[Pg 59]</span> -moisture, or sudden alternations of temperature must be studiously -avoided. As in many cases, they lay the foundation for consumption, so -after it has commenced, their repetition aggravates it.</p> - -<p>Mental distress and consequent despondence, impedes the cure of -those who otherwise might recover, and should be obviated as much as -possible. Happily, patients labouring under Phthisis, generally with -difficulty, resign hopes of recovery, and despondence from that source -does not often depress them. But mental anxiety, produced by other -causes, is very injurious. It should be relieved, as much as possible, -by pleasant amusements, a journey, a sea-voyage or any other method -most suited to the particular circumstances of the patient.</p> - -<p>In the second stage of Consumption, the diet of the patient must be -altered, as well as the medical treatment. The most nutritious articles -of food are then to be chosen, and such as are at the same time the -most easily digested. It is well ascertained that the older meats, -as beef and mutton, possess these properties in a higher degree than -veal or lamb; and generally, the brown more than white meats. With the -same view, wild fowl and game generally, form nutritious articles of -diet, proper for consumptive patients. Eggs combine a large quantity -of nourishment in a small compass, and may be freely used. They should -be taken either quite raw, or boiled a very few minutes. When boiled -hard, they form one of the most indigestible and offensive substances, -to the delicate stomach, that are used in diet. The various culinary -preparations, of which eggs form a principal part, are for the same -reasons<span class="pagenum" id="Page_60">[Pg 60]</span> proper. Jellies also contain a great quantity of nutritious -matter, and are very acceptable to patients, who, as in Consumption, -have little appetite. Oysters and some other of the testacea, are also -extremely nutritious. Isinglass boiled in milk is frequently in use, -and with advantage, in these cases. Of the vegetable nourishments, -those should be chosen which are most nutritious and abounding in -mucilage, as rice, sago, arrowroot and Tapioca. Chocolate, when -prepared in such a manner as to be free from oily matter, is a very -pleasant article of diet.</p> - -<p>The drinks of the patient should also be stimulating and nutritious. -Malt liquors combine both these properties with some tonic virtues, -which they obtain from the bitter of the hops infused in them, and -therefore constitute the best drink for consumptive patients. Wine, -also, may be used moderately with advantage, but requires some caution; -and should be immediately abandoned, if any undue excitement be -produced by it.</p> - -<p>In this, as in every other stage of Consumption, while the patient has -sufficient strength, exercise is necessary to the recovery of health. -Of so much importance is exercise, that in many cases, it has alone -cured this disease. <abbr title="doctor">Dr.</abbr> Rush relates many such cases, and particularly, -three instances of persons in confirmed consumptions, perfectly cured -by the hardships of a military life. Of so much consequence was it -in the eyes of Sydenham, that he pronounced riding on horseback, as -certain a cure for consumptions, as bark for an intermittent fever. -Indeed, all writers on this disease join in recommending it, not only<span class="pagenum" id="Page_61">[Pg 61]</span> -as a part of the regimen, but as a principal remedy in the treatment. -The mode of exercise to be chosen, should depend entirely on the -situation of the patient, at the time. While much pain and soreness -subsist, denoting the presence of active inflammation, the most gentle -exercise only should be used: at that time riding in a carriage or -on horseback, would be as improper as for a patient labouring under -pleurisy. The swing, so highly recommended by <abbr title="doctor">Dr.</abbr> Carmichael Smyth, is -the least fatiguing, and most gentle mode that can be adopted. It may -be serviceable, too, when the patient is too much debilitated to bear -other more fatiguing exercise. But I would, by no means, adopt the -opinion of Carmichael Smyth, that the swing, in itself, and unassisted -by other remedies, will cure Consumption. Experience has proved the -contrary; and has taught us that it is only useful as an article -of regimen, while the patient is under the influence of other more -powerful remedies. When there is sufficient strength to bear it, and -not too much excitement, riding in an easy carriage is the next mode of -gestation which may be used. But when the patient is enabled to ride -on horseback, we have more to expect from it, than any other species -of exercise. To attain the greatest benefit from it, it should be made -use of regularly and constantly; not during the cold air of early -morning, nor the dews of the evening, but rather during the day, after -the sun exerts some influence. A long journey on horseback affords the -most useful method of obtaining all the advantages that can be derived -from exercise. It is then made constant and regular; and the amusement -afforded<span class="pagenum" id="Page_62">[Pg 62]</span> by travelling serves to divert the patient’s mind from his -own feelings, and adds to its beneficial effects.</p> - -<p>Secondary Phthisis Pulmonalis remains yet to be treated of. Under -this order, should be included every form of Consumption, in which -the system has become debilitated by any cause, and the lungs in -consequence become affected. I would exclude from it that form of the -disease occurring after measles, scarlatina, and some other eruptive -diseases, which I would consider as primary Phthisis Pulmonalis; -because, in those cases, the lungs do not become affected merely in -consequence of debility, but these diseases seem rather to act as -exciting causes, in constitutions already predisposed to Consumption; -while in secondary Phthisis, the affection of the lungs is only one -symptom of the general disease, which is wasting the body. Nor would -the treatment, which will be advocated in the latter form, be proper -in the cases alluded to. They require that, which should be used in -the first species of Phthisis, and which has already been detailed. -The reason, why the lungs become affected in consequence of debility -induced by particular causes, I would not attempt to explain. It is -one of those laws of the constitution, not better understood, than why -particular parts are successively affected in consequence of syphilis, -or that the breasts and lower extremities are more liable to disease -than other parts, except the uterus, in females after parturition. Many -laws of this kind exist in the human constitution, of whose effects, we -are every day made sensible, but of the cause of which we are totally -ignorant.</p> - -<p><span class="pagenum" id="Page_63">[Pg 63]</span></p> - -<p>One of the most frequent causes of Secondary Phthisis, is Chlorosis, -that disease which occurs in young females, in consequence of Retention -of the menses. The constitution not having sufficient vigour to produce -this evacuation at the proper period, if any predisposition to Phthisis -exist, a determination takes place to the lungs, producing Phthisical -disease. This case is not analogous to Consumption produced by -Suppression of the menses, after they have been once established; for -in that instance the suppression is not generally induced by debility, -but by cold, or some other cause, not acting merely by weakening the -patient; and it produces active inflammation of the lungs. But in the -case before us, the affection of the lungs is merely a symptom of the -want of vigour in the constitution, which shews itself in retention -of the menses. Accordingly, in the treatment of this disease, our -attention must not be directed primarily to the affection of the lungs, -but to the state of the system, the cause of that affection.</p> - -<p>Profuse evacuations, of any kind, may be the cause of Secondary -Phthisis. Hæmorrhages from the Nose, Lungs, Stomach, Kidneys and wounds -are all mentioned by Morton, as having induced Pulmonary disease. <abbr title="mister">Mr.</abbr> -Hey, in his work on Surgery, observes, that he has seen a great many -cases of pulmonary Consumption, the consequence of debility, induced -by violent hæmorrhages, and in persons who had no apparent tendency to -Consumption. In the same manner, loss of blood from Hæmorrhoids and -in Menorrhagia, may act as causes. Debilitating evacuations, by means -of Diarrhœa, Diabetes, Salivation, and Sweating,<span class="pagenum" id="Page_64">[Pg 64]</span> have had the same -effect. But the most frequent causes of this class are, immoderate -discharges by fluor albus, and too long suckling by delicate woman -of robust children. They are particularly mentioned by Morton and -Fothergill, and have been adverted to by most authors, who have written -since.</p> - -<p>Chronic Catarrh, terminating in Phthisis, may be ranked also in this -class. The profuse and long continued discharge from the membrane -lining the trachea and bronchiæ, is the debilitating agent in that case.</p> - -<p>Long continued Fevers, and particularly Intermittent fevers, not -unfrequently leave behind them, a state of debility, sufficient to -induce Consumption.</p> - -<p>In the New-York Hospital, frequent instances occur of Consumption -induced by intemperance in the use of ardent spirits. This habit -destroys the tone of the stomach, which becomes primarily affected, and -in consequence the whole system becomes debilitated, terminating in -disease of the Lungs.</p> - -<p>Secondary Consumption has also been induced by some other preceeding -diseases, such as Scurvy and Syphilis, and requires the attention of -the Physician, to the primary disease rather than to the affection of -the Lungs.</p> - -<p>In the treatment of Pulmonary Consumption, arising from any of these or -analogous causes, our attention is first called to the removal of the -primary source of the disease. If it be Chlorosis, remedies, calculated -to cure that malady, must be prescribed. If profuse evacuations are the -cause, all the means in our power, must be employed in restraining<span class="pagenum" id="Page_65">[Pg 65]</span> -those evacuations. If the disease has been induced by the long -continued suckling of a vigorous child, by a delicate mother, another -nurse must be provided, or the child must be weaned. If Scurvy or -Syphilis have produced it, the proper remedies for those disorders must -be employed.</p> - -<p>Our next object is to remove the debility, the cause of the pulmonary -symptoms. For this purpose, Tonics are indicated, and at their head -stands the Peruvian Bark. In the other species of Phthisis, this -medicine has been much abused, but in the present one, its use is -sanctioned by experience. In the cases proceeding from Leucorrhœa, -and long suckling, it is highly recommended by <abbr title="doctor">Dr.</abbr> Fothergill; but he -cautions us against persevering in its use, longer than while it is -doing good; and remarks, that if the breathing become more oppressed, -the cough dry, the pulse more quick and hard, and especially, if slight -transitory pains or stitches about the thorax, are more frequently -complained of, a perseverance in the use of the bark will increase -the disease. If, in consequence of this increase of symptoms, we -are obliged to desist in the use of the Bark, other Tonics must be -substituted. The combination of bitter and tonic medicines in the -Infus: Amar: of the dispensatories may be then usefully prescribed. -Columbo, which is sometimes an ingredient in that formula, is -particularly recommended by <abbr title="doctor">Dr.</abbr> Thomas Percival, as not possessing any -of the injurious properties of bark.</p> - -<p>The Elixir of Vitriol is also an excellent tonic, and may be usefully -given at the same time with the remedies just<span class="pagenum" id="Page_66">[Pg 66]</span> proposed. But it -requires to be administered with the same cautious hand as the bark, -and to be discontinued, if the symptoms appear to be at all aggravated -by its use. In general, no ill effects arise from it, but if the -determination to the chest be so great, as to produce much inflammatory -action, it may do injury. Independent of its tonic powers, it will be -serviceable in checking any disposition, which may exist, to profuse -sweating.</p> - -<p>Iron, in its various officinal preparations, is also a good remedy, -in this form of phthisis. Although, highly dangerous in the primary -disease, there is now little danger of increasing the inflammation, -which in that form, made it improper. Mineral chalybeate waters, will -in this instance, be useful, not only by the journey to them, and the -amusement derived at watering places, but may be drank with advantage -by the patient.</p> - -<p>In addition to these remedies, the diet and regimen should be such as -is most invigorating to the constitution. A nutritious diet and the -moderate use of wine will be proper; and country air and exercise with -the same rules as were mentioned in the treatment of primary phthisis, -are very important circumstances in the cure of the secondary form. -A long journey, a sea-voyage and change of climate are also equally -proper.</p> - -<hr class="tb" /> - -<p>The prominent feature and primary object of this essay has been, to -establish the distinction between primary<span class="pagenum" id="Page_67">[Pg 67]</span> and secondary Phthisis -Pulmonalis. Although, perhaps, the minute parts of the arrangement may -not have been distributed, in every instance, with perfect accuracy, I -feel confident that the general plan is correct. Farther observation -and experience will probably suggest a more accurate disposition of the -varieties of Phthisis, under the two orders which I have proposed.</p> - -<p>Probably from the want of the distinction between primary and -secondary Phthisis, may be explained the various and contradictory -practice, proposed by physicians of deserved eminence. A more -frequent opportunity of observing one or the other form of the -disease, has determined with each, his mode of treatment: and hence -in diseases bearing the same name, we may see blood-letting and a -rigid antiphlogistic regimen adopted by one party, and bark, iron, and -a nutritious diet by another. Any error which may arise from these -contradictions, may be corrected by the distinction, which has been -proposed.</p> - -<p>It has also been my object, to call the attention of the practitioner, -to the earliest symptoms and first dawnings of Consumption. Were they -not so much neglected by the physician, as well as the patient, our -bills of mortality would not continue to present so frightful a picture -of the ravages of this disease; while, on the other hand, a prompt -attention to these incipient symptoms, and the interference of an -active practice, would afford a reasonable prospect of saving many from -Consumption, who are now its victims.</p> - - -<div class="footnotes"><h3>FOOTNOTES:</h3> - -<div class="footnote"> - -<p><a id="Footnote_1" href="#FNanchor_1" class="label">[1]</a> <abbr title="American">Amer.</abbr> <abbr title="medical">Med.</abbr> and Phil. Reg. Vol. I.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_2" href="#FNanchor_2" class="label">[2]</a> <abbr title="doctor">Dr.</abbr> Lettsom observes, that Consumption is decreasing in -Great Britain.</p> - -<p><i><abbr title="medical">Med.</abbr> and Phil. Reg.</i><br /> -</p> - - -</div> - -<div class="footnote"> - -<p><a id="Footnote_3" href="#FNanchor_3" class="label">[3]</a> The following judicious remarks on this subject are made -by Bayle, in his <span xml:lang="fr" lang="fr">“Recherches sur la Phthisie Pulmonaire, D’après la -notion que j’ai donnée de la Phthisie Pulmonaire, on voit que je dois -regarder comme Phthisiques des individus qui n’ont ni fièvre, ni -maigreur, ni expectoration purulente: il suffit que les poumons soient -affectés d’une lésion qui tend à les désorganiser et à les ulcérer. On -ne doit pas regarder cette lésion une simple cause de la Phthisie, mais -comme le premier temps de cette maladie, puisque la Phthisie est cette -lésion même dont la continuation et le developement successif amènent -la mort. Il seroit donc bien peu raisonnable de vouloir attendre, pour -reconnoitre la Phthisie Pulmonaire, qu’elle fut constamment parvenue à -son dernier degré qui est le moment où ses symptômes pathognomoniques -sont bien marqués.”</span></p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_4" href="#FNanchor_4" class="label">[4]</a> <abbr title="doctor">Dr.</abbr> Reid.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_5" href="#FNanchor_5" class="label">[5]</a> <abbr title="doctor">Dr.</abbr> Hosack.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_6" href="#FNanchor_6" class="label">[6]</a> <abbr title="doctor">Dr.</abbr> Lind states, that out of 360 patients whom he attended -between July 1, 1758, and July 1, 1760, in consumption, the disease was -brought on one fourth of them by falls, bruises and strains, received a -year or two before it made its appearance.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_7" href="#FNanchor_7" class="label">[7]</a> <abbr title="doctor">Dr.</abbr> Reid.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_8" href="#FNanchor_8" class="label">[8]</a></p> - -<table class="autotable"> -<tr><td>℞ -</td><td>Vitriol: alb: Ʒ iij</td></tr> -<tr><td></td><td>Alum: rup: Ʒ j</td></tr> -<tr><td></td><td> Coccinnel: pulv: griij</td></tr> -<tr><td></td><td>Aq: ferveut: ℔j. Misce in mortareo marmoreo. Solutio a fæculantia vel residendo expurgetur, vel per chartam bibulam fittretur. Dos. ℥ss.— -</td></tr></table> - - -</div> - -<div class="footnote"> - -<p><a id="Footnote_9" href="#FNanchor_9" class="label">[9]</a> <abbr title="doctor">Dr.</abbr> Borrowe formerly had a patient labouring under -Consumption, a manufacturer of tin ware, who was uniformly relieved -of his phthisical symptoms when engaged in soldering tin, a process -in which a great deal of resin is used, and constantly inhaled in -respiration.</p> - -</div> -</div> - - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<h2 class="nobreak" id="ERRATA">ERRATA.</h2> -</div> - - -<ul class="index"> -<li class="ifrst"><a href="#Page_10">Page 10</a> Note, for <i lang="fr" xml:lang="fr">d’après</i> read <i lang="fr" xml:lang="fr">D’après</i>.</li> -<li class="ifrst">         <a href="#Page_22">22</a>, line 25, for <i>which like the inert physician</i>, read <i>which the inert physician</i>.</li> -<li class="ifrst">         <a href="#Page_25">25</a>, line 13, for <i>dysentary</i>, read <i>dysentery</i>.</li> -</ul> - - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter transnote"> -<h2 class="nobreak" id="Transcribers_Notes">Transcriber’s Notes</h2> - - -<p>The errata have been fixed.</p> - -<p>Punctuation errors and omissions have been fixed.</p> - -<p><a href="#Page_10">Page 10</a>: “peculiary incorrect” changed to “peculiarly incorrect”</p> - -<p><a href="#Page_40">Page 40</a>: “very analagous” changed to “very analogous”</p> - -<p><a href="#Page_54">Page 54</a>: “frequenty prescribed” changed to “frequently prescribed”</p> - -<p><a href="#Page_60">Page 60</a>: “acceptible to patients” changed to “acceptable to patients”</p> - -</div> -<div style='display:block; margin-top:4em'>*** END OF THE PROJECT GUTENBERG EBOOK AN INAUGURAL DISSERTATION ON PULMONARY CONSUMPTION ***</div> -<div style='text-align:left'> - -<div style='display:block; margin:1em 0'> -Updated editions will replace the previous one—the old editions will -be renamed. -</div> - -<div style='display:block; margin:1em 0'> -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the United -States without permission and without paying copyright -royalties. 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