Chapter II: Part 2

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”