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Chapter 2

Cultural Heritage and History

This discussion focuses on the concepts of heritage, one’s intangible cultural heritage—

culture, ethnicity, religion, and socialization—acculturation, life trajectory, and cultural

phenomena that affect health beliefs and practices.

Learning Outcomes

1. Explain the links on the HERITAGECHAIN that contribute to heritage consistency—

culture, ethnicity, and religion.

2. Explain the links related to acculturation themes.

3. Discuss and give examples of cultural conflicts.

4. Explain the factors involved in the cultural phenomena affecting health and

healthcare.

Key Concepts

I. Introductory Questions

A. Classroom Activity

Discussion

1. Who are you? What is your intangible cultural heritage—cultural,

ethnic, and religious heritage?

2. What are images of the places and icons of your generation and culture?

3. How and where were you socialized to the roles and rules of your family

and community?
4. Who is the person next to you? What is this person’s cultural, ethnic, and

religious heritage?

1
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 Cultural Diversity in Health and Illness, Ninth Edition Instructor Resource Manual
Rachel E. Spector

5. How and where was this person socialized to the roles and rules of his or

her family and community?

II. Heritage Consistency

This chapter focuses on the background theory relating to “heritage”—a given person’s

intangible cultural heritage. Heritage is comprised of four facets—socialization, culture,

religion, and ethnicity—woven together in a given person’s heritage

A. Classroom Activities

Discussion

1. Instruct students to bring in something from their heritage—a photo, an

object, food, toy—that has sustained special meaning in their life

2. As each student develops an answer to the question Who are you? it

becomes self-evident that the heritage(s) in which they were raised play a

role in the answering of this question.

3. Develop the discussion to explore the parameters of their heritage(s).

Often, there are students who have parents from different heritages that are

woven together to build the family.

4. Encourage the students to explore norms from each of their heritages.

5. Focus on nutrition, manners, apparel, holidays, and so forth.

6. Assign the students to look up “Intangible Cultural Heritage” on

the Internet to broaden their understanding of the term and its

various applications.

7. There are 12 indicators of heritage. Discuss how each of these indicators

impact on the lives of each student.

2
Copyright © 2017 Pearson Education, Inc. All Rights Reserved.
 Cultural Diversity in Health and Illness, Ninth Edition
Instructor Resource Manual Rachel E. Spector

III. Acculturation Themes – Socialization, Acculturation, Assimilation

A. Classroom Activity

Use of the Heritage Assessment Tool

The students must answer the Heritage Assessment Tool (Appendix B, pp.276-

278) on themselves and/or a classmate, score them, then structure the discussion

around the answers.

1. Are the students mainly observing their family’s heritage?

2. Are they acculturated to the dominant culture?

3. Discuss the differences between acculturation and assimilation and

the impact of socialization.

4. Explore the differences between students who are heritage consistent

and those who are heritage inconsistent.

IV. Cultural Conflicts—Generational Differences, Generations in the United States,

Class, Language, Education, Literacy

A. Classroom

Activity Discussion

1. In most instances, the instructor is of a different generation than the

students—discuss life before devices and the Internet and other

technological changes that have impacted on daily life. When you were

the age of the students.

2. What were the social norms?

3. What were the social expectations?

4. Were they dependent on schools, religion, class, or family?

3
Copyright © 2017 Pearson Education, Inc. All Rights Reserved.
 Cultural Diversity in Health and Illness, Ninth Edition
Instructor Resource Manual Rachel E. Spector

B. Compare and contrast the answers—“today and yesterday”

C. Encourage students who are immigrants, or the children of immigrants to

share their experiences.

D. Discuss the impact of class, language, education, and literacy on daily life.

V. Cultural Phenomena Affecting Health

There are several factors that vary among people—biological, communication,

environmental control, social organization, space. And time orientation

A. Classroom Activity

Discussion

For each of the factors present illustrations and examples:

1. Biological: Present illustrations of different skin tones, body structure,

hair texture, and so forth.

2. Communication: Encourage the students to have non-

verbal conversations using facial expression and pantomime.

3. Environmental Control: Explore different dietary restrictions and have

students share dietary practices from their heritage

4. Social Organization: Know, understand, and explain the various religious

holidays that students from different heritages celebrate. (Review the

calendar in Appendix C, pp. 281-283)

5. Space: Discuss the principles of territoriality, and encourage students to

share the rules of territoriality in class

6. Time orientation: Stress the importance of conducting class in a timely

manner, and the different meanings of time cross-culturally.

4
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The Project Gutenberg eBook of An inaugural dissertation
on pulmonary consumption
This ebook is for the use of anyone anywhere in the United States and
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Title: An inaugural dissertation on pulmonary consumption

Author: Edward Delafield

Release date: August 17, 2022 [eBook #68772]

Language: English

Original publication: United States: John Forbes & co, 1816

Credits: 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.
A .

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
C . 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.”