NIL

'7---
'V






ITS
NATURE, PREVE NTION,
AND
HOMffEOPATHJC TREATMENT,
(WITH ILLUSTRATIONS OF HOMCEOPATHIC PRACTICE.)
B3Y
WILLIAM H1-ITORTMAN, M.D., F.L.S.,
MEMBER OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, AUTHOR OF
"LECTURES ON THE PRINCIPLES AND PRACTICE OF HOMIEOPATHY,"1
FORMERLY RESIDENT SURGEON LIVERPOOL
110OACEOPATIIIC DISPENSARY.

PHIILA DELPHTIA:
WILLIAM RADDE, 635 ARCH STREET.
18019~



PRINTED BY KING & BAIRD, 607 SANBOM STREET.



PREFACE.

chemical tendencies-" galloping consumption." To
this part of our subject I would entreat earnest
public attention; and for it I would (from a long
experience of both old physic and new, bespeak
future homoeopathic, because natural and successful,
prevention. Tubercle, therefore, the proximate cause
of decline, consists essentially of a preventible process of deteriorated nutrition; and consequently,
how obvious is it that, with this key to the pathological meaning of the disease, this is the most
hopeful period for treatment; the critical time, in
which, by Homoeopathy, we may check, without
injury to the system, the destructive inroads of the
most fatal, incomparably the most deadly, of all the
numerous affections incident to the human frame.
Much might, I think, be done in domestic practice
towards the prevention of Consumption, as well as
for the improvement of the general health, by
expressly exercising the organs of respiration
according to the method herein suggested, through
which the chest may be alternately filled and emptied
of air-at least in part. Common usage, I am
aware, takes a diametrically opposite course, and
under the pretext of quiet, seeks to repress all direct
or voluntary exercise of this important function in
those having a tendency, hereditary or acquired, to
pulmonary disease. The average difference of the
vital capacity of lungs in health and in consumption
is 93 cubic inches-the healthy standard being 222
inches, and the consumptive 129. This enormous
disparity will serve to apprize the reader of the
1*



vi

PREFACE.

necessary constitutional disturbance from diminished
respiratory volume.  There are, I am confident,
several conditions in which tubercle may exist in
the lung, and yet be capable of complete removal
when treated homoeopathically-cases I have often
met with in very truth-in which the constitutional
and local disease entirely disappears, the signs and
symptoms vanish, and the patient's health is permanently restored; notwithstanding the peculiar and
somewhat singular characteristic of tubercle is its
appearance in successive deposits, yet, with the extension of homoeopathic knowledge, I believe such
desirable results may be achieved in each known
region of the earth where phthisis exists. The correct mode of proceeding should involve a due consideration of both the mental and physical constitution of the individual case-the particular origin of
the disease-the precise type and totality of the
reflected symptoms-and the condition of the vital
powers; a single well-chosen medicament is then
occasionally sufficient to restore the patient's health.
In comparing the symptoms, the adviser should
never omit reference to the mind and the emotions;
mind and body being intimately united and sympathetically diseased. Thus, supposing we have the
signs of a considerable cavity in one lung, with
hamoptysis, purulent expectoration, emaciation,
and a cough of some duration; if with these symptoms of decline, there was associated a very high
degree of mental irritability, I should prescribe
Bryonia; if, on the other hand, the patient were a



PREFACE.

vii

female, of mild disposition, and given to weep, the
last-mentioned remedy would be probably useless,
but Pulsatilla would be curative: and so on, almost
ad infinitum. The harmonic affinity to be exact,
demands moral likeness. The stage of growth is
eminently fatal in the phthisical habit; the nutritive
period of the young adult second in danger, and
middle life to age constitutes the third and least
dangerous. All statistics, I find, in every climate,
whether in Russia, in our West Indian Islands, in
Sweden and Norway, in the Anglo-Saxon countries,
Scotland, England, United States and Ireland, in
Australia, along the swamps of the Mississippi, in
our Canadian colonies, France and Italy; yes, even
in balmy Italy, the country to which doctors are in
the constant practice of exporting their patientsall tell the same tale; it remains, therefore, for
parents and guardians, and the people generally, to
learn a truthful lesson from a proper study of these
consecutive periods, this certain sequence of vital
processes in the natural history of man, and accordingly strive to maintain a wholesome nutrition, the
origin and cause of abiding health and strength; to
preserve in the greatest vigor this, the alone sustaining agent of the nervous system, ever remembering
that the truest and best tonic in nature is the pure
and healthy blood of the patient. In conclusion, I
beg the reader distinctly to understand, that in this
vade mecum, and in the accompanying illustrative
cases, I have neither attempted nor desired to
furnish an exact and unexceptionable picture of



viii
I  *0
Vill

PREFACE.

consumption, nor a full and complete description
of all its PHYSICAL characters, nor a detailed list of
the symptoms of each case, and the corresponding
positive effects of the remedies employed; on the
other hand, my sole aim has been to concisely
point out the true nature of a prevalent disease, by
a popular exposition of its pathology, with a view
to its more efficient prevention, and the successful
homceopathic method in treating it. Conformably
with the views epitomised in the ensuing pages, I
have for many years treated all my public and
private patients, and instructed clinically those who
came to the Homoeopathic Free Dispensary to study.
It is with the hope of inducing others afar off to
adopt (with the familiarity of " household words")
a rational and refined method of therapeutics, such
as Nature has herself revealed to us, and with equal
success, that I now wish this humble but sincere
offering to a good cause-God speed.
WILLIAM     HITCHMAN.

36 BRUNSWICK ROAD, LIVERPOOL,
January 1st, 159.



CONSUMPTION,
ITS NATURE, PREVENTION, AND HOM(EOPATHIC
TREATMENT.
(WITH ILLUSTRATIONS OF BOM(EOPATHIC PRACTICE.)
THE almost universal and fatal disease which is
popularly, but by no means erroneously, denominated
Consumption, owes its name to one leading, marked, and
invariable symptom-wasting of the tissues-a wasting
which is accompanied for the most part by the deposit
of a certain peculiar substance of low organization and
imperfect vitality in the structure of the pulmonary
parenchyma, or spongy substance of the lungs. In the
very threshold of the inquiry, I would fix the earnest
attention of the reader to the significant meaning of this
fearful word wasting; it not only constitutes the leading
feature of this truly English malady, but is its earliest
fatal symptom and most ominous character. Now, the
origin of this appalling disorder, the really consumptive
symptoms at the commencement of the disease, depend
not upon the state of the lungs, but upon the morbid condition of the nervous system, which has preceded and
produced it. The general features of the complaint-the
weak and quickened pulse, the languid aspect, the fre



2

CONSUMPTION.

quent perspirations-owe their origin entirely to the
phthisical habit of body, not to the tubercle (or small
round, pea-like body,) but to the waste of tissue, which,
when not removed from the system, or converted to
reparative uses by a healthful nervous power, is readily
deposited as an abnormal or foreign substance, which,
when once established, is recognizable by definite physical signs and symptoms, the earlier of which are due to
consolidation of respiratory organs, the latter to the
consecutive changes which that deposit undergoes; softening of the matter constituting a second stage of the
lung-affection; and its ultimate removal by disintegration and expectoration forms the third and natural
division of the disease.
It has long been a disputed question what is the
peculiar form or build of the numerous class of persons
who now become consumptive; but the experienced
medical eye can detect in the vast majority of instances
the following conformation of chest: it is long and
shallow, rather than wide and deep; its greatest deficiency is in the antero-posterior measurement, or in
depth. Its length is remarkable, and Rokitansky insists
that morbid conditions which force up the diaphragm
and shorten the thoracic space are antagonistic to consumption.   Such are abdominal tumours, cysts, and,
remarkably so, pregnancy. All forms of chest, however,
are, in my opinion, almost equally obnoxious to tubercle.
No conformation confers an absolute immunity from
decline; the most robust in aspect, and persons with the
largest chest-measurements, not unfrequently fall victims to its universal prevalence.  Nevertheless, there
exist certain conditions rarely combined with phthisissuch as skin diseases, hypernutrition or excessive nou



CONSUMPTION.

rishment of organs, new growths, external suppurating
scrofula, rickets, intermittent fever, cancer, emphysema,
pregnancy, and anaemia-at least with the first stage.
And here we may remark upon these antagonistic affections, and observe how completely tubercle appears to
monopolize the individual sufferer. How rarely does
one see any disease whatever combined with it I if it
be not some of those painful consecutive attacks indicating the deposit of the morbid matter in the peritoneum or serous membrane which lines the interior of
the abdomen, giving rise to peritonitis, in the intestines
causing ulceration and diarrhcea (abdominal phthisis),
or in the brain and its membranes, and in the larynx.
It is a striking fact, then, that consumption is a truly
systemic disease, exhibiting almost a preoccupation of
the entire organization, to the exclusion of other poisons.
Let us examine the practical facts as they stand in the
experience of physicians at the Brompton Hospital,
where 100 out-patients is the average attendance per
diem. Skin diseases of every class, we find, are extremely rare in phthisis. If there be an exception, it is
herpes, and that is very seldom seen. Rheumatism is
also very rare, and Rokitansky considers it antagonistic,
as absorbing the fibrin of the blood in its action on the
fibrous tissues, where plastic or formative deposits so
commonly result. The same of gout; it is rarely combined with phthisis. Hypertrophy of the heart-indeed,
hypernutrition of any organ-is not often combined with
tubercle.  Cancer may coexist with it, but even their
coincidence is far from common; nor are tumours commonly witnessed in these subjects, which is probably
explicable in a like manner-the fibrinous constituent of
the blood being taken up by their growth and nutrition.



4

CONSUMPTION.

External scrofulous enlargements of the neck or cervical
glands, proceeding to suppuration, are certainly not an
ordinary complication of tubercle in the lung. "It is
rare," says Dr. Pollock, "to meet with the scars of
scrofula in the glands of the neck in the cases presenting
themselves at the Metropolitan Institution for consumption and diseases of the chest."  This is a curious facta practical observation which occurred to me nearly
twenty years since as singular and suggestive; for
authors and practitioners are always accustomed to class
tubercle with scrofula, and to attribute its outward and
visible manifestation to precisely the same cause which
induces phthisis. It would seem that the glandular
swellings act in diverting the morbid action, the internal
psora from the deeper seated and more important vital
organs, or that the two affections are altogether dissimilar-at all events not due to the same constitutional
cause. Rickets-that is to say, in the developed subject,
or where growth has ceased-are certainly but seldom
associated with pulmonary tubercle. Deformed chests
are generally healthy, quoad the disease in question, or
emphysema-i. e., in other words, dilatation of the aircells and cardiac disease from congenital defect or
malformation are the derangements met with, but not
consumption.   Of lung-diseases proper, emphysema is
the one which seems almost antagonistic to phthisis;
and this is to be expected when we reflect on the atrophy
of the pulmonary tissue, and resulting diminution of
respiratory volume, which are the essential characteristics of the latter, constituting physical conditions
which are the exact converse of the distended cells of
emphysema,    Bloodlessness (anaemia), even in its extreme chlorotic stage, is not usually allied to tubercle



CONSUMPTION.

in the lung. The popular idea, I am aware, runs diametrically counter to this statement; their differences
are considerable. The symptoms of anaemia are, extreme pallor of the skin, the tongue, the mucous membranes, and the palpebral conjunctive; the veins are
small and purplish, the pulse is weak, compressible,
rapid and thready; there is dyspnoea on exertion, conijoined with palpitation, and generally a short, dry,
hacking cough. Faintness and occasional real syncope
indicate the imperfect supply of blood to the nervous
system, and cedema of the extremeties tells us of an
enfeebled capillary circulation. The physical or stethoscopic signs are a uniform and good percussion-note,
and a low respiratory murmur, over the aortic valves.
There is a soft murmur synchronous with the first
sound of the heart, and a venous murmur or whizzing is
audible in the neck. Such patients constantly come to
me as "consumptive;" but a differential diagnosis reveals
the true state of the case. There is, in the first place,
absence of rapid wasting; there is no hectic, and the
symptoms of weakness are unmistakably referable to the
impairment of nervous power, rather than to muscular
debility. The entire absence of the true physical signs
of consumption is, of course, strictly diagnostic; but it
is yet further remarkable that this soft murmur of
anemia in the aorta, and the whizzing in the veins, to
which I have adverted, are found exceptionably in
tubercle of the lung. The stage of phthisis which is
accompanied by symptoms of impoverishment of the
blood-a deficiency of the coloured globules, of its peculiar nutritive principle, in fact (for the principal constituent of the blood-globules is closely allied to albumen)
-is not to be confounded with pure idiopathic anaemia.
2



CONSUMPTION.

The phthisical condition referred to is more properly a
cacomomia-a state implying bad, depraved, poisoned
blood-and takes place only when the blood-contamination
has reached that stage which is only compatible with an
advanced period of the tubercular disease. The comparison here instituted has reference to the problematical
symptoms, the early stage of phthisis. The influence of
pregnancy in retarding consumption I have already
observed on, and deserves consideration. It is quite
true that it has such an influence, and the conservative
protection of life for an important physiological purpose
is obviously manifest in this provision. The patient far
advanced in consumption will outlive parturition, as a
rule; but the fatal event becomes rapidly accelerated
when this natural function is completed. Whence is
this?  Nature preserves a life for an ordained purpose;
a retardation merely of the consumptive stages is duly
effected.  The hyperfibrinated blood having another
office, one might assume, in foetal growth and nutrition,
ceases to deposit itself as a morbid agent; but that this
cause once removed, the fibrin again expends itself on
the destructive tubercle in the lung. Hence the frequent origin, perhaps, of phthisis after confinement, or
the more frequent impulse for evil which pre-existing
pulmonary or abdominal mischief so commonly receives.
These remarks necessarily lead one to consider the
many' theories which have been propounded from time
to time to account for the formation of tubercle. Undoubtedly the most prevalent idea of the present day
with regard to the nature of tubercle is that enunciated
by Rokitansky, who states that the tubercle-crasis is
beyond question a fibrin-crasis (fibrinosis); it is not this
in respect to quantity alone, but also in respect to



CONSUMPTION.

quality. Now, it is not my intention here to deal with
the arguments in favour of this view, which are derived
from chemical sources, but I will consider merely how far
this excess of fibrin in the blood accounts for the phenomena of consumption as we daily see it. A simple
excess of fibrin in the blood is common to many diseases,
and to pregnancy. Assuming its normal proportion in
health to be from two to three in 1000 parts, it is augmented by local inflammations to seven, nay, even to
thirteen, and in consumption to ten; it is increased in
pregnancy after the seventh month, but diminished in
the early stages.
FIBRIN.
In healthy blood, 2-3 in 1000 parts.
Augmented in                  Diminished in
Local Inflammation.           Fever (simple.)
Consumption.                  Typhus.
Later months of Pregnancy.    Apoplexy.
Rheumatism.                   Early months of Pregnancy.
The only point for us to remark here is, that tuberculosis, or the phthisical diathesis, augments the regular
proportion of fibrin, and that in the history of consumption in pregnancy a subsidence of the consumptive
symptoms concurs with the period of the minimum
quantity of fibrin in the blood, and an augmentation of
the phthisical malady immediately after delivery, when
the hyperfibrination of the blood, it is assumed, is at its
maximum.
Again: the proportion of fibrin in the circulation is
not lessened by bloodletting, but at least relatively
increased, an exhausted state of the system in these



8

CONSUMPTION.

circumstances resulting rather from a diminution of the
red globules than from any change in the fibrinous
element. Thus it would seem many diseases of exhaustion do not lessen the solid constituents of the blood,
but render it more innutritious and watery, by diminishing the healthful red globules. This altered condition,
no doubt, leads to morbid changes in the capillary circulation, by which the superabundance of fibrinous
material is separated and deposited as extraneous and
prejudicial matter. But Rokitansky's theory expresses
much more than this; he speaks not alone of the quantity,
but of the quality of the fibrin. It is sufficient for our
purpose merely to remark, that in its history consumption appears to furnish evidence that an augmentation of
fibrin in the blood is one probable source of the disease;
and this corroboration of an experimental fact is found
in the very destructive waste which results from defective assimilation, and that deficiency of the ultimate
nutritive processes by which blood is converted into
tissue-a mal-nutrition, in short, which leaves the circulating fluid overladen and oppressed with depraved
material, which lowers the vital tone of the general
system, and eventuates in the gratuitous formation of
plastic deposits, whose inherent tendency is to decay and
death. The various proofs which German physicians
bring to bear on this chemical theory are derived from
the fact that diseases which appropriate fibrin in their
growth are singularly antagonistic to tubercle, and that
tumours and the hypernutrition of organs generally are
but rarely coincident with consumption. Without any
theory, the practical fact remains for our remembrance,
that by whatever means we increase the nutrition of the
body, and thus elevate the health-giving vitality of



CONSUMPTION.

9

nervous power, or alter, it may be, the chemical qualities
of tubercle, in the same ratio we retard the advances of
phthisis, a constant sign of improvement being an increase
of weight, a diminution of fibrin, an augmentation of
the number of red globules, and other desirable changes,
evidencing a complete amelioration of the symptoms and
a remarkable strengthening of the vital powers of the
patient. Phthisis pulmonalis, then, when developed, is
owing to a deposit in the lungs of a peculiar product
called tubercle. Andrel describes it at its origin as a
pale yellow, opaque, small, round body, of various degrees
of consistence, in which no trace of organization or texture can be detected by the naked eye, although the
microscope shows various forms of cells, imperfectly
developed; so that this substance evidently consists of
unhealthy coagulable lymph, whose powers of organization are exceedingly imperfect. The prevailing opinion
among pathologists is, that the seat of tuberculous
matter is the areolar tissue of organs. It may, however,
be formed on secreting surfaces, as in the mucous
follicles of the intestines, on the surface of the pleura
and peritoneum, and likewise in false membranes or
other morbid products, and in the blood itself.    Sir
Robert Carswell regards the mucous surfaces as the
principal seat of tuberculous matter, and asserts, that in
whatever organ the formation of tubercular matter takes
place, the mucous system, if constituting a part of that
organ, is in general either the exclusive seat of this
morbid product, or is far more extensively affected with
it than any of the other systems or tissues of the same
organ. Andral considers the areolar tissue its chief
seat, but that it may occasionally occur on mucous and
serous surfaces.  Lombard supposes it to be wholly
2*



10

CONSUMPTION.

restricted to the areolar tissue. In confirmation of Sir
Robert Carswell's statement, he has shown it in the
lungs formed on the secreting surfaces, and collected
within the air-cells and bronchi, in the intestines, in the
isolated aggregated follicles or minute cavities in the
liver, in the biliary ducts, in the kidneys, in the infundibula, pelvis, and ureters, in the uterus, in the cavity of
that organ and Fallopian tubes, in the testicle, in the
tubuli seminiferi, epididymis, and  vas deferens-thus
showing it to be the result of processes deeply seated in
the system. The formation and subsequent diffusion of
tuberculous matter is also observed on the secreting
surface of serous membranes, particularly the pleura
and peritoneum, and in the numerous minute cavities of
the areolar or cellular tissue. The accumulation in the
lacteals and lymphatics, both before and after they
unite to form their respective glands, is frequently very
considerable. Tubercles in the lungs, in their earliest
stage, may present themselves in three forms.     1st.
The common cheesy tubercle, in yellowish friable masses,
in more or less rounded masses, or sometimes filling one
or more of the bronchial tubes. 2d. Miliary tubercles,
small granules, like millet-seed, bluish-white, and semitransparent, often found in great quantities. Some pathologists consider these as the earliest stage of the yellow,
cheesy tubercle; others, on the contrary, believe them
to be merely some of the air-vesicles, solidified by chronic
inflammation.   Certain it is, however, that they have
some relation to the regular, legitimate tubercle, as they
are found in the same patient and in the same parts of
the lung.   3d. Tubercular infiltration.  In this case
the morbid matter is uniformly diffused through a tissue,
and not agglomerated in masses. Tubercle, when depo



CONSUMPTION.

11

sited, may lie dormant for a length of time, without
exciting any obvious or particular symptoms. In very
rare and favourable cases their softer particles may be
absorbed, and nothing be left save the calcarea, or
phosphate and carbonate of lime they contained, which
may lie latent and quiet in the lung for a whole life.
But, in general, tubercle, after a time, acts as a foreign
body, excites inflammation and suppuration in the
neighbouring sound parts, and is ultimately expelled.
The first visible step is a softening, which depends probably on the exudation of serum or pus by the surrounding lung, or by the areolar tissue that may be entangled
in the unorganizable product. This increases till an
abscess forms, which is technically termed a vomica,
This vomica continues to enlarge till it bursts and discharges itself into an adjacent bronchial tube; and then,
in very exceptional cases, after the expulsion of the
tubercular matter and pus by expectoration, the cavity
may possibly contract, become smooth and cartilaginous
on its inner surface, and at last be obliterated-in a
word, the consumption be cured. More generally, however, fresh tubercle is deposited-more unorganizable
matter is eliminated from the blood in a fluid state: and
unless checked by the interposition of medical art, fresh
vomica~ form and unite, till the patient's lung is, as it
were, completely riddled with cavities, and he.dies from
sheer exhaustion, one or more of the bronchial tubes
opening into each vomica.
Tubercle generally occasions some degree of pleurisy
and consequent adhesion; this diminishes the frequency
of what nevertheless sometimes happens, viz., ulceration
of the pleura and escape of the matter from a vomica, and
of course of air into the pleural cavity, constituting a



CONSUMPTION.

183

nating dartings, with disposition to sigh, nocturnal
coughing, pain in the left side, resulting either in an inflammation of the pulmonary parenchyma or of the pleura.
Meanwhile, it may be laid down as an axiom, that a slow
and gradual loss of weight is far more serious than a
quick and irregular diminution of weight.
Whenever, therefore, a wasting of the tissues sets in,
and becomes either rapidly or insidiously progressive, it
is a symptom well calculated to excite the most serious
apprehensions and alarm. Frequently indeed it occurs
with very slight concomitant indications of deranged
health, and possibly it may prove even of temporary
duration, the frame recovering a perceptible although
spurious embonpoint, on some salutary change. The significant character of the emaciation of consumption
requires to be well considered; it takes its rise from the
morbid condition of the nervous system, and the defective
organization and nutrition of nerve-globules, cells, areolar
tissues, and of all those life-giving structures of which
nerve-globules form the natural basis. There is a consequent loss of correspondence, a want of balance, an
inharmonious equilibrium between the physiological
powers of healthy deposition and absorption. It indicates
that the system of the patient is becoming so decidedly
consumptive as to cease to be capable of sustaining the
healthy functions of life, and more especially the functions
of respiration and nutrition.
The atrophy of consumption is so important, both in
regard to diagnosis and treatment, that it is impossible to
be too vigilant in its detection-whenever its existence is
suspected, either in those who are hereditarily predisposed to the disease, or in individuals placed under cir.
cumstances in which a consumptive state of the system



14

CONSUMPTION.

is likely to be produced-nor too careful in assiduously
watching its progress. For these purposes direct medical
observations on the weight are absolutely necessary; no
vague notions on this point will serve any useful purpose.
Patients, and those of the consumptive temperament
especially, will frequently mistake the puffiness of the
face and spurious hypertrophy or enlargement of the
areolar tissue, which frequently conceals the true state
of the adipose and muscular systems, for a really good
condition of the general habit.  If we trust to their
representations, on the one hand, the emaciation may
proceed until tubercular aggregation in some important
vital organ occurs before we are aware of its existence,
and on the other hand, we can never fully appreciate the
results of homoeopathic treatment.
Nor is the determination of the absolute weight of the
patient important merely for the purpose of detecting
emaciation EARLY, and watching its progress as an
absolute sign or symptom of consumption; it is also
essential for the purpose of assisting in the due estimation
of the value of other symptoms. We shall find that the
respiratory powers are variously modified in consumption,
and furnish positive symptoms of the disease, but the
weight of the body exercises a direct influence over the
respiratory functions (and it is in the lungs, be it remembered, that the assimilation of the food is completed;)
and in this point of view it is essential to study the
weight of the patient, and to be aware of the vast import
of the absolute and relative weight, and of the great
variations of weight, to which the body is obnoxious.
In order accurately to determine the weight, and for the
purpose of detecting the first inroads of true consumptive emaciation and watching its progress, I have adopted



CONSUMPTION.

15

the use of Dr. Hutchinson's spirometer, and the French
scale or weighing machine, as occupying but little space,
and withal a most correct and valuable instrument. I
have employed the following Table with great advantage;
it is constructed from minute observations made on 2650
healthy males, at the middle period of life.
Exact stature.  Mean weight.  Weight increased by 7 per cent
ft.  in.     st.  lbs.  lbs.    st.  lbs.  lbs.
5    1       8   8 or 120       9   2 or 128
5    2       9   0... 126      9    9... 135
5    3       9   7... 133     10   2... 142
5    4       9 13... 139      10   9... 149
5    5      10   2... 142     10   12... 152
5    6      10   5... 145     11   1... 155
5    7      10   8... 148     11   4... 158
5    8      11   1... 155     11  12... 166
5    9      11   8... 162     12   5... 173
5   10      12   1... 169     12  13... 181
5   11      12   6... 174     13   4... 186
6    0      12 10... 178      13   8... 190
As a general rule, the weight of the body increases
with the height, but the absolute weight in relation to
the height varies considerably; nevertheless, it is within
the physiological range. The weight, therefore, is estimated in relation to the height, so that both height and
weight are taken and noted. The influence of excess of
weight, however, over the respiratory function is not felt
until the excess goes beyond seven per cent. of the mean;
therefore, to the mean which an individual ought to
weigh, seven per cent. must be added before we allow
for the corpulency as influencing the respiration.
By the spiromreter we ascertain the vital capacity of the
lungs and the respiratory movements, and more precisely



16

CONSUMPTION.

and easily detect slight deviations from the healthy state.
The difference in the quantity of air respectively drawn
in or thrown out of the lungs is as follows: 1. Residual
air, which is that air remaining in the lungs that cannot be expelled by the most violent effort. 2. Reserve
air, or that which remains in the lungs after a gentle
expiration, but which could be expelled by muscular
effort.  3. Breathing air, that which is required in
performing the ordinary inspiration and expiration.
4. Complemental air, that air which may be drawn into
the lungs by the most violent inspiration.  5. Vital
capacity, all the three latter combined, being the
greatest voluntary expiration following the greatest
inspiration. The quantity of air which can be expired
does not depend upon the girth of the thorax, but the
height of the individual, and this being known, the number of cubic inches he can expire in a healthy state may
be ascertained with accuracy; the application of this
principle, therefore, in the diagnosis of consumption is
most important. I have uniformly found that persons
who are the subjects of a decline expire a quantity of
air very much less than they ought to do if healthy. In
many cases the quantity of air expired when patients
were in health was exactly measured, and the experiments
beingrepeated some time after, they were found to expire
a great many inches less than on the first occasion; at
this time no disease whatever could be detected in the
lungs by experienced auscultators, albeit they died of
consumption some months afterwards, as proved beyond
doubt by post-mortem inspection.
The ordinary or natural weight of each individual may
differ from the above standard, both in excess and deficiency, but at all times deficiency of weight tends to show



CONSUMPTION.

17

deficient nutrition. The absolute loss of weight in consumption has been variously estimated. From various
experiments it would seem that the internal viscera for
the most part, do not participate in this emaciation. It
falls upon the organs of locomotion, probably the heart,
the areolar and fibrous tunics of the blood-vessels, and
the alimentary canal; but the liver, kidneys, spleen,
pancreas, and other organs, appear to maintain their
density and bulk.  According to statistical data, the
average sum of the weight of the entire viscera--the
brain, heart, lungs, liver, spleen, stomach, pancreas, kidneys, uterus, and appendages-after death from phthisis
pulmonalis, between 17 and 60 years of age, in males,
was 39"26 ounces above the normal standard, and in
females about 27"05 ounces; in these cases the average
of the weight of the lungs in males was increased 25'71
ounces, and in females 14"48 ounces. The heart both in
males and females was very slightly augmented in weight;
the liver, 5 63 ounces in males, and 7-32 ounces in females.
These experiments were made upon individuals who died
with local disease, and I may state that in the midst of
the general waste, as consumption, with local tuberculous
disease of the lungs, advances, a very large deposition of
fatty matter takes place in the liver, kidneys, and other
viscera. Enlargement of the liver is nearly a constant
occurrence, even before   the development of other
symptoms, certainly before any stethoscopic signs can
be perceived. 141 In consumptive patients compared
with that of an equal number free from the disease, the
loss of weight in relation to the height was more than
one-third of the whole body.      When consumption
pursues its onward course uninterruptedly, the loss of
weight before death is considerably more, but the sub3



18

CONSUMPTION.

jects of it are almost uniformly cut off by visceral disease
before it has attained its maximum; the average loss
may be estimated at forty-eight pounds. Lastly, emaciation is so commonly the earliest appreciable symptom of
disease in consumptive persons, it proceeds so progressively and regularly from the commencement to the termination, it is so little related to the extent of local
disease in the lungs or elsewhere, it is so directly related
to the morbid condition of the nervous system, that there
can, I think, be no question it is from the beginning to
the end symptomatic of the general disease.      Local
affections of the lungs, of the intestines, of the mesenteric
glands, or hectic fever, may precipitate it, but in instances
where consumption has pursued its fatal course in the
absence of the ordinary symptoms, without a sign of
hectic fever, and where the vital organs have been apparently little effected, emaciation has reached its utmost
limits before the death of the patient.
I shall now give the three stages of phthisis as ordinarily described. In the first stage the tubercle is developed, but not yet suppurated; in the second, small
ulcerations are formed; and in the third and last, we
have vast caverns excavating large portions of the pulmonary structure.
First stage.--The most prominent symptoms are those
of inflammatory irritation, cough, pain, and a quickness
of pulse, which in certain cases are preceded, but in the
greater majority followed, by an unaccountable emaciation
and weakness; the cough is almost always dry during the
first few weeks, unless where the tubercle has succeeded
to catarrh; it may occur in every variety, but it is most
commonly a slight, frequent, and irritating cough, referred by the patient to a tickling sensation in the



CONSUMPTION.

19

trachea. The expectoration, when occurring, is scanty,
and consisting of a thready, grayish, and nearly transparent mucus, occasionally dotted with blood; a slight
wheezing also sometimes accompanies the cough. With
these symptoms the patient frequently complains of pain,
which may be situated in any part of the right or left
side. In some instances it is only felt in the lower, while
in others it occupies the upper part of the chest, shooting
from the clavicle to the subscapular regions, and often
occupying the inferior angle of the shoulder-blade, when
it is often mistaken for rheumatism, or pain of hepatic
disease; it occurs with various intensities, is generally
remittent, and often relieved by Aconite, or slightly stimu
lating applications. This pain is commonly accompanied
by tenderness of the subclavicular region, and often with
that irritation of the muscular fibres which causes their
contraction on percussion; the respiration is slightly
hurried, and the first approaches of to-and-fro hectic can
be perceived.
Second stage.-This is characterized by the establishment of very decided symptoms: the emaciation and
debility increase, the pulse continues quick, the countenance becomes characteristic, the sweatings are much
more profuse, the cough looser, the expectoration becomes puriform, tubercular and bloody. The digestive
organs now begin to suffer seriously; incessant thirst,
loss of appetite, and abdominal pains torment the patient,
and the first indications of confirmed wasting and persistent diarrhoea appear; the patient feels that he can
lie much better on one side than on the other, and begins
to experience cutting pains in the opposite side of the
chest-a sure sign that his terrible destroyer has invaded
the remaining lung.



............

-V

20.-             costMPTrroN.
Third stage.-In this deplorable condition the patient
is not unfrequently apyrexial (without fever), and the
perspirations cease, particularly if the digestive system
remains tolerably healthy; the pulse may be slow, but
generally becoming accelerated some time before death,
emaciation proceeds to the last extremity; the voice is
sometimes wholly lost, at others hollow and melancholy;
the cough is loose, the respiration more facile, and expectoration easy; aphthe appear on the tongue and lips, and
spread over the cavity of the mouth; the limbs become
cold and clammy; the breath acquires a heavy odour, and
the appetite generally fails. Life may, however, even
under these circumstances, be protracted for a considerable time.   There are some other symptoms which
frequently attend the progress of consumption, and
which may be noticed in this place. Some writers lay
great stress upon the existence in phthisis of what is
termed the gingival margin. In the most decided cases
this margin is of a vermilion tint, inclined to lake, and
forming a marked contrast to the paleness of the rest of
the gums. It is usually confined to the region of the
incisors, but sometimes it extends along the whole line
of teeth, becoming narrower and fainter as it proceeds
backwards. Those patients in whom I have observed
the gingival margin have had other and more distinct
signs of consumption, so that I am satisfied of its existence in a very large proportion of cases. An incurvated state of the nails, with a rounded appearance of
the last joint of the fingers, is very often observed, and is,
I may say, generally regarded as a diagnostic sign of some
importance. The falling off of the hair is also a common
occurrence in phthisis. The appearance of the urine too
deserves some notice; it is very frequently turbid, foetid,



CONSUMPTION.

21

and throws down a copious sediment, while during the
early stages it is often covered with an iridescent pellicle.
The condition of the nervous system undergoes, and
consequently all other parts of the body, a considerable
change; the patient becomes, in a word, NERVOUS (and
that in itself implies volumes), both mentally and physically. One of the circumstances often remarked, even in
the early period of the disease, is this unusual degree of
morbid sensibility. The patient is exceedingly timid
and apprehensive of the slightest circumstance which can
increase his complaint; his hand shakes, and he becomes
peevish and irritable. These nervous symptoms generally keep pace with the increasing debility. The intellect for the most part, however, remains quite clear
till within a few days of dissolution, when slight delirium
occasionally supervenes. It has often been stated by
persons, who are more poets than physicians, that consumption of the lungs is a mild disease, by which the frail
sufferer is imperceptibly wasted away like a dying flower,
without pain or suffering. They must have witnessed more
of the disease in books than at the bedside, who state this
to be its general progress. The horrible sensations, produced by the incessant chills during the day, and by the
yet more distressing and death-like chills which follow
the perspirations in the night, the harassing cough and
expectoration, the pains of the chest and bowels, the
frequent dyspnoea and blood-spitting, the distressing
sense of sinking, all increasing as the strength is failing;
and more than these, even in a physical sense, the frightful bed-sores and that moral contention de l'esprit, that
inward struggle of the soul, which, whether avowed or
not-a struggle 'twixt hope and fear-is felt by the patient in the last stages, and make up an amount of
3*



CONSUMPTION.

25

and likely opinion of the health of the chest. Cough is,
undoubtedly, the first symptom which claims attention,
inasmuch as it is usually the earliest evidence of chestdisturbance, and ordinarily amongst the first circumstances which excite the attention of the patient or his
relatives. During the first weeks or months, it is, for
the most part, a slight dry cough, occurring chiefly in the
morning on the patient getting up, and on his making
any undue exertion during the day. In this state it is
scarcely noticed by the patient; it appears to him rather
to be a matter of no moment, to arise from some temporary irritation in the region of the larynx, and he
seldom suspects indeed that it can possibly have any
connexion with consumption of the lungs. Its continuance in this trifling degree for weeks or months, without
any expectoration, is also another circumstance in the
history of this cough which deserves attention.   By
degrees it occurs occasionally during the day, especially
after any exertion-such as running after an omnibus,
or upstairs quickly, speaking or reading aloud for some
time, laughing heartily, and the like. After a longer or
shorter time, this cough is attended with the expectoration of a transparent fluid-frothy-like saliva, which
appears at first to come from the fauces. In general,
this cough continues to increase in unison with the pulmonary disease; but in some cases of unmistakable
excavations of the lungs, it has remained insignificant
throughout. It is not sufficiently well known, indeed,
that the disease can exist, and even prove fatal, without
the slightest cough. The lungs of consumptive patients
have even been destroyed by suppuration, without their
ever having experienced the least degree of cough. As
the disease advances, however, it is commonly trouble



CONSUMPTION.

29

and which is dependent on functional derangement of
the uterus, may, in general, be distinguished from the
consumptive cough by the other symptoms with which
it is habitually associated, and by the facility with which
it yields to a mode of treatment (Ferrum mur.) which i,would have no effect in relieving the latter. It must,
however, be borne in mind that young females of a
consumptive constitution are the persons most obnoxious
to chlorosis; and on this account their cough must not
be treated lightly, nor an opinion hazarded without the
requisite circumspection.
Another form of nervous cough is often confounded
with the consumptive. The character of this cough,
the periods at which it occurs, its mode of attack and
ultimate disappearance-all differ from  those of the
consumptive cough. The nervous cough occurs at irregular times throughout the day, and whatever agitates
or affects the patient's mind is liable to induce it. It
has a singularly sharp, piercing sound, is repeated in
rapid succession at short intervals, and often continues
an hour almost without intermission. It is accompanied
with other indications of nervous irritability-such as
hysterical headaches, pains in the sides, neuralgias of
the face and spinal cord, the shoulder-blades, the back
and hips, and not unfrequently the very fingers' ends;
frequent shuddering, shivering, and jumping almost off
their seats; toothache, inability to walk, and the like.
In all its essential characters it differs from the phthisical,
and requires different treatment (Acid. nitricum).
In conclusion, all these coughs have their own peculiar
and significant characters, by which they may be readily
distinguished, when they are uncomplicated with each
other; but when such combinations exist, as they fre



32

CONSUMPTION.

to the expectoration of tubercular disease, viz., the
striated state of the expectorated mass, with a mixture
of whitish fragments in it, and the ash-coloured globular
masses which are observed in the more advanced stage of
the disease; this last is seldom or never met with unaccompanied with tubercular disease. Such are the various
changes in the character of the sputa or expectoration
which are generally observed in consumption.
Hcemoptysis, or blood-spitting, has been long regarded
as a frequent cause of phthisis, now, it is rarely, if ever,
a cause; it may be (doubtless it often is) rendered a
determining cause, by the debility which it induces, and
by the allopathic depletion adopted so injudiciously for
suppressing it; the effusion of blood into the pulmonary
tissue may become a source of irritation, and form the
nidus for the primary deposit of tubercle-in many cases
blood-spitting is the effect of the severity of the coughfits of coughing, in fact, which end in raising black blood,
with sharp tearing pains in every part of the chest, especially in the superior part of the RIGHT lung, with sense
of constriction and palpitation-singularly suggestive
of its specific analogue-one of the brightest ornaments
in the armamentarium of a philosophical physician,
Elaps Corallinus. The quantity of blood discharged
differs greatly: in some individuals not exceeding a
single mouthful, and in others amounting to a pint or
more. When it is slight it is confined to the mornings,
and when it proves fatal several pints may be all at once
discharged. This shows that the structure of the lungs
is extensively destroyed, and that the hmmorrhage arises
from an opening occurring in a large artery previously
implicated in the disease.  As a diagnostic symptom
blood-spitting is very important, because a very large



CONSUMPTION.

33

proportion of cases in which it has been found eventuate
in confirmed consumption.   Its occurrence, therefore,
either before or soon after the commencement of cough,
renders the presence of a decline exceedingly probable.
Inflammation.-Pneumonia is of such common or rather
universal occurrence, in consumptive persons, that it can
scarcely be regarded as one of the accidents of the
disease, unless, as it sometimes happens, it suddenly
makes progress from imprudent exposure, change of
temperature, or it may be without any assignable cause.
Under such circumstances its presence is indicated by
increased febrile excitement, pungent heat of skin, crepitation (stethoscopic), and the other symptoms which
ordinarily attend it; unless, however, it be quickly
arrested by the proper homoeopathic treatment, involving
Acon., Phos., Tart. Emet., and, possibly, Chelidonium for
the bronchitis; it quickly expedites the disorganization
of the lungs, and consequently the termination of the
disease in the ordinary manner. In some cases it has
been still more speedily fatal, where a large portion of
the lung, previously rendered impervious, blocked up,
so to speak, the remainder has been consolidated (and
consequently of no use,) by the pneumonic inflammation,
and death takes place, as a matter of course, from apncea,
that is, suffocation.
Pain of Chest.-Acute pain sometimes attends the
early stage of phthisis. This pain is frequently experienced in the upper parts of the chest and shoulders, and
in the arms; although it is scarcely noticed by the
patient, unless inquiry be made by the physician, being
generally attributed to rheumatism.   As the disease
advances the pain is yet more frequently, and I have
usually found it more severe on that side on which tuber4*



34

CONSUMPTION.

culous deposit existed to the greatest extent. I would
particularly notice also slight pains in the region of the
clavicles, because in a dubious case their presence would
tend to increase my suspicions of the presence of
consumption in its incipient stage, especially if other
symptoms were in unison with this view-such as the
consumptive cough-the oppression of breathing-pain
in the left side, and the like.  The pain in the chest
which attends catarrh, epidemic, or otherwise, is essentially different-in the catarrhal affection the pain is
located in the centre of the thorax, between the sternum
or breast-bone and the spine-it is chiefly felt whilst
coughing, and is rather a sense of soreness than of acute
pain.
The Pulse.-The state of the pulse in consumption
may also be distinctly considered, inasmuch as great
importance has always been attached to it. Like every
other symptom it varies remarkably, being modified by
both physiological and pathological conditions in each
individual patient, conditions which, perhaps, have no
direct connexion with the    lung-disease.  Generally
speaking, however, it may be correctly affirmed that the
pulse of the consumptive patient is frequent, especially
after the morbid condition of the chest is fairly established, and in doubtful and obscure cases a frequent
pulse, by which I mean one upwards of eighty in an
adult, would add very strongly to my suspicions of the
existence of consumption of the lungs. Before we form
any positive judgment as to the frequency of a man's
pulse, its natural state should be ascertained if possible,
for eighty pulsations of the radial artery in a minute
may be the natural number in one patient, and yet constitute a frequent pulse in another whose normal pulse



36

CONSUMPTION.

and intestinal irritation; these appear to have more
influence in exciting and modifying hectic fever, than
the tubercular deposit in the lungs, which frequently
exists for a long period, without being accompanied by
an appreciable degree of febrile disturbance. The first
symptom of fever, remarked by the patient, is a sensation of being very cold and chilly towards evening; this
sense of chilliness increases from time to time, as it continues to recur, amounting not unfrequently to a distinct
rigor or fit of shivering, it is then succeeded by heat of
skin during the night, the heat being particularly burning
in the hands and feet, which are for the most part
habitually cold in consumptive patients. After a time
morning perspirations are found to follow the hot stage;
and as the disease advances, these paroxysms of fever
become stronger and stronger, especially the hot stage,
and the heat is more generally diffused over the whole
cutaneous surface.
Perspiration.--Although this very prominent symptom forms a part of the febrile paroxysm, it is generally
so disproportionate to the cold and hot stage by which it
is preceded, and withal exercises so paramount an influence on the feelings of the sufferer and the course of
the malady, that it merits, with the others, a distinct and
particular consideration. The fever has generally continued a considerable time, and the disease is far advanced before the perspirations bec6me more than
LOCALLY copious.   In many cases they are out of all
proportion to the preceding fever; in exceptional cases
they are absent during the whole course of the disease.
The accurate French physician, M. Louis, found them
wanting, he states, in one tenth of his cases. According
to the clinical observations of this eminent authority,



CONSUMPTION.

37

the stage of consumption at which the very copious perspirations occurred corresponded with that at which the
diarrhoea made its appearance.  These two symptoms
have commonly been considered supplementary of each
other, the one diminishing as the other increased; but it
is NOT the common rule, both in general proceeding for
the most part quite uninfluenced by each other, at least
this is the belief of the pathologist Louis, who has paid
particular attention to this reputed reciprocal influence
of two phthisical symptoms, and he could never find that
such reciprocal influence existed. The perspirations
occur chiefly in the morning, more especially if the
invalid happens to fall asleep after having once awoke.
As the disease advances they come on whenever the
patient falls asleep; during the early stages they are
confined to the head and chest, but by degrees they
extend over the whole surface. I have myself observed
them almost exclusively restricted to the anterior surface of the chest. The copious perspirations of the comsumptive patient present a remarkable instance of extensive and long-continued derangement of the functions
of the skin without any appreciable alteration of structure; but the excreted fluid no doubt possesses characters widely different from those of healthy perspiration;
although occurring in a somewhat advanced stage of
phthisis, perspiration occasionally attends its very early
and incipient periods. It is seldom copious, however,
unless it be LOCALLY SO, at the commencement, and the
patient, unless interrogated on the subject, takes but
little cognizance of it. It not unfrequently happens
that after having continued for some considerable time
it altogether ceases, and again recurs without our being
able to assign any definite reason for this singular de



40

CONSUMPTION.

in young ladies gifted with high intellectual endowments,
and the most refined accomplishments, whose eyes flashing with unnatural, well-nigh celestial brilliancy, are not
regarded as indications of a ruthless disease, but as
personal charms to be sung in verse or celebrated with
perhaps grateful flattery.   True, alas l as the poet
singsConsumption's cheek ne'er looks more pure
And lovely, than when past all cure;
And yet that bloom, so fresh, so still,
Has lent its fleeting aid to kill,
And speaks to those who watch its hue
Of sickness, death, and suffering too;
Though who just viewing aught so fair,
Could ever dream that death was there!
Day by day the energies decline, the body grows
weaker, the eye more brilliant, but the aspect blanched,
the lip attenuates and   trembles, the form   once so
graceful and elastic is bent and bowed, needing the
support of a trusty arm, and a loved friend to mark a
mournful spectacle, the stealthy and insidious advance
of a resistless doom.  The cases of phthisis in which
emaciation takes place to a large extent before any
decided symptoms of pulmonary disease set in, are met
with most frequently in men rather advanced in life, and
in whom consumption has been induced by drink, and
its satellite, an irregular mode of living, (or rather of
dying), which impairs the divers functions employed in
nutrition and assimilation, prior to the manifestation of
tuberculous deposit in the structure of the lungs. In
these men the wasting begins early, and is owing, no
doubt, to the disease in the lungs, impeding the process
of assimilation, or in  other words, termination of



42

CONSUMPTION.

swelling and puffing in phthisis different from what is
remarked in other chronic diseases, except that it is an
invariable attendant, at least in an experience of fifteen
years I have never once found it wanting in the earlier
or later periods of decline, Although usually confined
to the lower extremities, and seldom extending higher
than the legs, it is sometimes observed in the upper
extremities, and the face is frequently cedematous in the
mornings, during the progress of the disease. (Edema of
the lungs, moreover, sometimes supervenes; and in other
cases an oedematous state of the glottis, or aperture
of the larynx. CEdoma is a symptom and sure prognostic
that the day of departure draweth nigh, in very truth,
is at hand.
Aphtha.--An aphthous state of the mouth, tongue, and
fauces: what is called Thrush, consisting of numerous
white vesicles or blisters, terminating in white sloughs,
is commonly the last in the long, dark catalogue of
symptoms which affect the poor consumptive patient.
It occurs generally a week or fortnight before death, and
varies greatly in degree, being sometimes productive of
but little inconvenience,, and at others attended with
frightful irritation, and ulceration of the mouth, so much
so as to prove a source of intense suffering to the patient.
The approach of aphtha, marked by a very red shining
appearance of the tongue, mouth, and fauces, the former
of which is also not unfrequently chapped, cracked, or
fissured, should be promptly met by its efficient antidote,
a few consecutive doses of Elaps corallinus.
Physical Signs.-These may be divided into two
classes; first, those of the earlier stages, which betoken
the presence of tubercles; secondly, those of the later
stages which show the existence of vomicce, besides which



CONSUMPTION.

43

there are in the last stage of certain cases the signs of
pneumothorax. When a portion of lung is solidified by
the deposit of tubercle, the corresponding part of the
chest will be dull on percussion.  Vesicular breathing
will be inaudible; and in place of this natural, healthy
and proper respiratory murmur, denoting that the lungs
are permeable to air, a whiffling sound, called bronchial
respiration, arising from the passage of air through the
bronchial tubes will be heard, if any such tube is enclosed
in the solidified portion of lung. Before, however, the
portion of lung is so filled with tubercle as to render its
vesicles quite impervious, there are heard a feebleness
and roughness in the respiratory murmur, and the sound
of expiration is prolonged; the voice will be conveyed
with unusual loudness through the solidified lung, so as
to impart the sensation we call bronchophony. But withal
auscultation, or the use of the stethoscope, is far from an
infallible means of judging of the existence of tubercles
in their earliest stage of incubation, so to speak, and
moreover, numerous tubercles either still in a state of
crudity, or already softened may possibly exist, these
tubercles may give rise to all the symptoms of consumption, in the second, and even in the third stage, and
yet the sound yielded on percussing the parietes or walls
of the thorax may not have undergone any appreciable
morbid alteration.  This perfect sonorousness of the
chest in phthisical patients, is always observed when the
pulmonary parenchyma has retained its healthy state
around the tubercles. Increased sonorousness may exist
under three circumstances: Firstly, when there exists
a large tuberculous cavity, into which the air enters by
one or two bronchi which open into it, and the parietes
of which secrete but a little liquid, so that the cavity



44

CONSUMPTION.

contains more air than pus: Secondly, where a partial
emphysema has been produced: Thirdly, when a pneumothorax occurs as the result of the opening of a tubercular
cavity into the pleura; this occurrence is generally manifested by the sudden accession of an acute pleurisy.
When tubercular induration in the upper parts of the
lung is considerable, it has the effect of conducting the
sounds of the heart with great distinctness, to the upper
regions of the chest.
Indications of Vomicce.-First, supposing the vomica
to be half-filled with liquid, and to communicate freely
with the air-tubes, there will naturally be heard on every
entrance and exit of air a gurgling sound, like the bursting
of very large bubbles. The same may also arise from
dilatation of the bronchi, but these morbid conditions,
and especially the last, are, strictly speaking, rare.  If
the vomica is empty of liquid, there will be heard a class
of sounds, called cavernous respiration, consisting of
certain variable sounds indicating the passing of air into
and out of a cavity, if the vomica be but partially full of
liquid, the latter may be heard to splash when the patient
coughs. The particular resonance of the voice which
constitutes pectoriloquy, is another sign of a vomica.
When a cavity of moderate size, and regular form, empty,
or nearly so, is in free communication with a large bronchial tube, and is very near the surface of the lung, in
contact with the thoracic parietes, or walls of the chest,
or when the intervening structure is rendered a good
conductor by condensation, the voice is transmitted in
the most perfect and unmodified manner, and seems to
be produced in that spot of the chest, seemingly distinct
from the oral voice. This is perfect pectoriloquy. If
heard with the stethoscope, the sound of the voice seems



CONSUMPTION.

45

to come through the tube, and enters the observer's ear,
louder than that which coming from the patient's mouth,
strikes the other ear, but the utterance is never so distinct. When heard to this degree in parts where there is
naturally little or no resonance of the voice, it proves
beyond doubt the existence of a cavity communicating
with the bronchi.   But immense cavities may exist
without there being pectoriloquy; thus, then, this phenomenon, when it does take place, indicates the presence
of a tuberculous cavity; but, per contra, we must not
conclude from its not occurring that there are no vomicce.
The nature and quantity of the fluid contained in the
cavity, the manner in which the bronchi open into it
and the extent of induration around it, considerably
modify the pectoriloquy. We should bear in mind that
without there being any trace of tuberculous excavation,
and but merely a considerable induration of the pulmonary parenchyma existing, the voice may possibly
present a peculiar resonance, which approximates more
or less to perfect pectoriloquy, it is then, according to
Laennec bronchophony. These phenomena of auricular
exploration being separated merely by refined shades of
diagnostic nicety, it is not difficult to conceive how
readily they may be confounded by an inexperienced or
uninitiated investigator. By imperfect pectoriloquy is
meant that form, in which the voice does not seem to
enter the stethoscope, but only to resound at the end.
This sound cannot be relied upon when heard in the
sternal half of the infraclavian and mammary regions,
the axilla, and interscapular spaces. There is yet another class of sounds to be spoken of. I said before, that
the pleura sometimes ulcerates, so that a communication
is formed between a vomica, and the pleural cavity. In
5*



46

CONSUMPTION.

consequence of this aperture, air passes at each inspiration
into the pleural cavity, whilst the lung collapses, and
more or less liquid will also escape from the vomicae.
The spot where this perforation occurs, is generally
opposite to the angle of the third or fourth rib. A
patient of mine afflicted with this desperate disease, a
child eight years old, became the subject of pneumothorax, with abundant fetid purulent effusion in the left
pleura. She was menaced with impending suffocation,
and I evacuated the fluid by a puncture with a trocar
between the ribs. I find I am supported in this proceeding by Dr. Heyfelder, of Erlangen (and no higher
authority need be cited), who operated on six patients
with complete success. I also agree entirely with him
that when homoeopathic treatment has made us doubt
whether the fluid will be absorbed, the sooner the operation is performed the better. The little patient soon
lost her hectic fever, pain and dyspnoea, with the symptoms
of effusion, and gradually but steadily regained health
and strength, art assisting nature by the medicinal interposition of Arnica, Bryonia, and Elaps corallinus; the
left lung was ultimately inflated, the orifice in the pleura
closed, and the child cured. The amphoric resonance in
this case may be exactly imitated by applying a child's
india-rubber ball to the ear and gently striking it.
The indication of this fearful state of things will be:
1st, great clearness on percussion; 2d, complete absence
of respiratory murmur; 3d, a peculiar resonance of the
voice, breathing and cough, called by the French amphoric
resonance. This is a sound of metallic character, and
greatly resembles that produced by speaking or coughing
over an empty barrel or copper boiler, or perhaps more
intelligibly still by blowing into an empty decanter.



CONSUMPTION.

47

4th, there is occasionally a tinkling sound of a metallic
character, produced by the fall of a drop of liquid from
the upper to the lower part of the cavity. Now these
four sounds, all indicating as they do the existence of a
large cavity containing air and liquid, and communicating
with the trachea, are generally caused by pneumo-thorax,
as I have before said. But they may also, though rarely,
be caused by the presence of a very large vomica. In
this case they will only be heard in the upper part of the
chest, and instead of great clearness we shall find extreme
dulness on percussion.
The Sputum.-There is no invariable or constant
relation, as I have already detailed, between the appearances of the expectorated matter and the exact state
of the lung. The sputa of consumptive persons may
consist, then, of catarrhal mucus, of the matter of
tubercles more or less softened, and occasionally of pus,
secreted by tuberculous excavations, which are completely empty, or nummulary, a term applied to the sputa
in phthisis, when they flatten at the bottom of the vessel
like a piece of money (nummus). In many people it is not
at all characteristic, indeed, it may be mucous merely while
large holes exist in the lung, or purulent from bronchial
irritation as in drunkards.  Sir John Forbes observes,
" In the earliest stage of the disease, the cough is either
quite dry, or attended by a mere watery, or slightly
viscid, frothy, and colourless fluid; this, on the approach
of the second stage, gradually changes into an opaque,
greenish, thicker fluid, intermixed with small lines or
fine streaks of a yellow color. At this period also the
sputa are intermixed with small specks of a dead white
or slightly yellow color, varying from the size of a pin's
head to that of a grain of rice, and which have been



48

CONSUMPTION.

compared by Bayle to this grain when boiled. These
have been noticed by many writers from Hippocrates
downwards.    After the complete evacuation of the
tubercles, the expectoration puts on various forms of
purulency, but frequently assumes one particular character, which has always appeared to be pathognomonic
of or peculiar to phthisis, although the more accurate and
extensive observation of modern pathologists has proved
the same to exist occasionally in simple catarrh. The
expectoration to which I allude consists of a series of
globular masses, of a whitish-yellow color, with a rugged
woolly surface, and somewhat like little rolled balls of
cotton or wool. These commonly, but not always, sink
in water. This kind of expectoration has appeared to
me most common in young subjects, of a strongly marked
strumous habit, and in whom the disease was hereditary.
At other times, in the cases in which these globular
masses are observed, and also in those in which they have
not appeared, the expectoration puts on the common characters of the pus of an abscess, constituting an uniform,
smooth, coherent, or diffluent mass, of a greenish or
rather grayish hue, with an occasional tinge of red (from
intermixed blood), and sometimes more or less foetid."
Dr. Stokes, of Dublin, considers the expectoration, in
which the globular ragged masses here described are
expelled, more peculiarly associated with a decline than
any other. He says, "I do not recollect a single case
in which I observed this sputum that did not turn out to
be consumption."
To recapitulate, the first evidence of that diseased condition of the nervous system which precedes the deposit of
tuberculous matter in the pulmonary tissue, and which
requires for the restoration of the assimilative functions,



CONSUMPTION.

49

Zinc, Nux vom. and Arg. nit., is shown by the following
symptoms: the patient has dyspepsia, with a depressed
state of nervous energy, the result, probably, of the wear
and tear of both mind and body. There is much irritability present, an excited pulse, loss of appetite, sleeplessness, a tongue white and coated on the surface, and
red at the margin and tip, with a dry, hot, imperspirable
skin; still it is not hypochondriasis, but irritability with
depression-a kind of erethism, so to speak, in fact, of
the nerve-globules, like that exhibited after great losses
of blood (or money). The patient's mind is given up,
in short, to some morbid influence, whether real or
imaginary (it is, at all events, real to him); added to
these are deposits of earthy phosphates in the urine, which
is fretid, and more or less marasmus; a painful sense of
tremulousness, with an anxious expression of countenance, great prostration, and in some men all the phenomena of delirium tremens.
Prevention of Consumption.-The causes of phthisis
are principally referable to two distinct heads-the remote and the exciting, or those which excite and induce
the constitutional predisposition, and those which determine the local deposition of tuberculous matter after
such predisposition is established. The one class of
causes operates by modifying the whole system; the
other by determining, in a nervous system so modified
the particular morbid action of which tuberculous matter
is the product. Until this grand distinction between the
causes of the constitutional and local disease is fully understood and appreciated, and acted on by the publie, we
shall, I fear, make but little progress in the prevention of
consumption. I believe that this disease may be induced in
any class of animals by those circumstances which produce



50

CONSUMPTION.

it in the human subject, being equally influenced by the
same causes. Tubercles have been found in many orders
of the mammalia, carnivorous and herbivorous, in birds,
and in insects. The morbid appearances presented on
examination of animals bear a striking analogy to those
observed in man. The lungs, the mucous membrane of
the intestines, the liver, and the mesenteric glands, are
the organs most frequently affected.   The principal
causes which induce consumption are hereditary transmission, improper diet, both as regards quantity and
quality, deficiency of pure air, exercise, clothing and
cleanliness, excessive labor and affections of the mind.
When the person is little exposed to the exciting causes,
the constitutional predisposition may be long present
without any local affection of the chest, while continued
exposure to exciting causes may determine the local disease, when the morbid state of the nervous system exists in
a slight degree. We have examples of the former among
the wealthy classes of society, where we see the consumptive cachexia prevail for a length of time without
the full development of tubercles, because the person is
little exposed to the usual exciting causes, and even
sedulously eschews them; and we meet with numerous
instances of the latter amongst the poor, when engaged
in occupations, in the exercise of which the lungs are
peculiarly exposed to irritation, by which a diseased state
of the bronchial membrane, and ultimately tuberculous
deposits are produced. Of this number are the numerous
classes of mechanics and artisans, who breathe for many
hours every day an atmosphere charged with fine particles of sand, metal, dust, and the like. But the most
striking examples of consumption which may be adduced,
as the consequence of pulmonary irritation, occur in



CONSUMPTION.

51

persons who are at the same time exposed to some of the
most powerful causes of tubercular cachexia, such as
sedentary occupations, carried on in a confined and
deteriorated atmosphere, and too often also to excessive
indulgence in the abuse of alcoholic drinks, so that they
are exposed to the causes of the constitutional and local
malady at the same time. There are also other causes
which may determine consumption of the lungs; to this
class may possibly be assigned contagion; certain it is
that  allopathic  bloodlettings, bronchitis, pneumonia,
hooping-cough, eruptive  fevers, such  as smallpox,
measles, and scarlatina, prove not unfrequently its determining causes. There is also what is called pneumonic
phthisis, in which the excavation of the lung is brought
about by the softening of those parts of the organ which
had been the subject of inflammatory consolidation, called
by some scrofulous pneumonia. There is again another
form, made up as it were of chronic bronchitis, with profuse puriform expectoration. These affections are to be
met with, firstly, in those who have inherited no tendency to consumption, but whose nervous systems have
been impaired by exposure, illness, or irregularities, or by
repeated attacks of some of the diseases I have mentioned.
In persons of strumous constitutions, secondly, but who
have escaped the dangers of phthisis in early life, but in
whom the tendency again manifests itself, though in this
altered shape, when their strength has become impaired
by age. These forms of disease of the chest constitute,
in fact, the consumption or decay of impaired and brokendown constitutions, and of advanced life.
Having thus briefly stated my views respecting the
nature, symptoms, and causes of what may almost be
regarded as the English disease, so lamentably prevalent



52

CONSUMPTION.

is it among us-few families, indeed, are there but
mourn over a place made vacant by this fell-destroyerit is necessary to enter upon some further details on the
momentous subject of prevention. I shall, however, endeavour more particularly to restrict my observations to
a condensation of some excellent hygienic directions by
Sir James Clark, Dr. Mason Good, Dr. Beddoes, and
modern judicious writers on the sources of health and
diseases in communities, respecting the principal circumstances which require the attention of the parent or
guardian who may be called upon for guidance and instruction on this most important subject.
The first question that suggests itself under the head
of prevention regards hereditary transmission, and involves the consideration of two distinct objects: the first
being to check the transmission of consumption from the
parent to the offspring; the second, to prevent the
disease in children born with the constitutional predisposition to it.
1. Prevention as regards parents.-It is not at all
necessary that parents should be the subjects of consumptive disease in order to transmit the consumptive
constitution to their children. The general impression
that scrofulous parents only have tuberculous children
is an egregious error that cannot be too generally
corrected.  It must be remembered that a deranged
state of the health from depressed nervous power in the
parent, from many different causes, will render the
offspring predisposed to the disease before us. Every
member of the community, by observing what is daily
passing before his eyes, may see numerous proofs of the
truth of this statement; he will find that when the male
or female parent is unhealthy, the male or female child



CONSUMPTION.

53

is so likewise, and that the latter often shows evident
and unmistakable signs of the consumptive or tuberculous
constitution when the former has no symptoms of it.
The children of parents who have suffered long from
dyspepsia and other complaints-gout, rheumatism, cutaneous affections, or any form of disease, in fact, which
has influenced the general system-are very frequently
the subjects of nervous and tuberculous disease, or of
such nervous derangements, at least, as dispose to what
is called tuberculous cachexia. When both parents are
thus implicated, this result eventuates with almost invariable certainty.  What is to be done?  There are
three grand rules to be observed: first, to lessen nervous
irritability, and thereby diminish the liability to inflammation in the respiratory organs; to support the general
health and strength is the second golden rule; and,
thirdly, to combat all untoward symptoms as they arise
by their appropriate dynamic antidotes-counter-agents,
it may be counter-poisons-it must be, to prove radically
beneficial-medicines which operate in the healthy
organization such morbid changes as correspond with
the symptoms or signs of existing disease.  In order to
prevent effectually the extension of tuberculous disease.
it is essential that we should, in the first place, direct our
attention to the health of the parents. Were they convinced that the health of their children depended upon
their own, a beneficial effect might be produced among
the more thoughtful and reflecting portion of mankind,
and especially among families of a consumptive diathesis.
If more consideration were bestowed on matrimonial
alliances, and a more healthy and natural mode of living
were adopted by persons in that social position which
gives them the power of regulating their mode of living
6



54:

CONSUMPTION.

according to their own choice, the predisposition which
is so often entailed on their offspring might be checked,
nay, even extinguished, in their family in the course of
a few generations. In the present state of society, the
converse of this commonly obtains; and from the utter
disregard of the precautions to which I have adverted,
the third generation terminates the race. The children
of dyspeptic persons generally become the subjects of
dyspepsia in a greater degree and at an earlier period
than their parents; and if they marry into families of a
delicate strumous constitution, their offspring become
nervously debilitated and tuberculous, and die of consumption in early youth, or even in childhood. Innumerable examples might be adduced of this truly
melancholy fact, but it is consolatory to know that it is
likewise an evil which may be in some measure obviated
or removed. This complete annihilation of families may
be prevented, I believe, by judicious-I hesitate not to
say more judicious and less commercial-intermarriages
with healthy persons. Families already predisposed to
consumption should, at least, endeavour to avoid matrimonial alliance with others in the same, or possibly in a
worse condition; but, above all, they should emphatically
eschew the too common practice of intermarrying among
their own immediate relations-a practice which is at
once a fertile source of scrofula, a sure method of
deteriorating the intellectual and physical powers, and
eventually the means of extinguishing altogether the
diseased and degenerated race. There can be no question
that intermarriages among the collateral branches of the
same family tend more than anything else to fix and
multiply and aggravate hereditary predisposition; and
hence nothing can be more wise, on physical as well as



CONSUMPTION.

55

on moral grounds, that the salutary restraints which
divine and human laws have concurred in devising
against marriages between relations. It would also be
well if all persons who contemplate marriage were
seriously aware of the necessity of scrupulously attending to their state of health previously to and after the
adoption of this important change-this momentous and
eventful step in the brief span of life. The dyspeptic
and nervous should have recourse to those homoeopathic
means which are best calculated to restore the normal
functions of his digestive organs; the gouty invalid
should renounce the well-known causes of his disorder,
chronic alcoholism renounced by the omission of spirituous liquors; and all those who are afflicted with
organic disease, more especially with consumption, should
pause ere they enter into a permanent contract, which,
according to organic laws, can only entail disease and
unhappiness on all concerned. The medical practitioner
alone sees, or at least comprehends, the full extent of
physical misery originating in marriages of this description; nevertheless, every candid and well-informed mind
can appreciate the justness of these remarks, although
perceiving, at the same time, the appalling difficulty of
adequately enforcing them on the practical consideration
of the public at large. I am quite well aware that the
masses of mankind are far too apathetic and reckless to
attend to or carry out any precautionary measures on
the subject, even though perfectly conscious of their
truth and satisfied of their necessity. Still, there is a
small proportion, a " fit audience, though few," on whom
I feel persuaded these medical notes and reflections may
not be wholly thrown away. It must never be forgotten,
however, that this is not merely a question of expediency,



566

CONSUMPTION.

having reference only to private feelings and social happiness, but one of vast public importance, involving, at
the same time, the well-being of society and the moral
as well as the physical condition of nations. There are
certain rules of management and conduct which it is
absolutely necessary for every prudent mother to pursue
during pregnancy or utero-gestation.   Far too little
regard is paid by ladies to their health during this most
important period of their lives, and they are, in general,
little aware indeed of the paramont influence of their
own health upon that of their children. From the
commencement of pregnancy every female, especially if
she is delicate or belongs to a consumptive family, should
regard her health with more than ordinary solicitude;
she should take daily exercise in the open air suited to
her strength, and when circumstances permit, it would
tend to her advantage if she passed a large portion of the
period of utero-gestation in the country.
It has often been asserted that females, during the
state of pregnancy, require a fuller diet than that to
which they have been previously accustomed. This is a
great error, as a general rule; increase of diet is neither
necessary nor beneficial; on the contrary, it is often
expedient to reduce the usual quantity of food, especially
in the advanced months-a period during which stimulants of all kinds are generally hurtful. There is an
increased activity in the system of the pregnant woman,
which, so far from requiring any additional increase from
art, more frequently renders it necessary and proper to
diminish the amount of stimulants in common or habitual use. Crowded assemblies, hot, close rooms, public
spectacles, balls, operas, and theatrical exhibitions of all
kinds-in short, everything calculated to excite very strong



CONSUMPTION.

57

feelings, to depress the mind, or excite the passionsought to be sedulously avoided.
There are numerous other circumstances regarding
the health and deportment of females during pregnancy,
which do not strictly come within the province of this
small work; these it will be the pleasing duty of some
good homoeopathic Samaritan to point out and enforce.
He should, however, seriously and particularly impress
upon the attention of the young mother that the health
of her infant depends upon her own, and that from the
commencement of pregnancy she is in duty bound to
consider herself eminently responsible for the future
health and happiness of her offspring. One of the political " Quarterlies" some time since assured its readers
that nothing in the way of sanitary improvement or the
prevention of disease was to be looked for from the
medical profession; their interests were so clearly involved in the continuance of a low standard of public
health. And how far, I would ask, has the medical
profession justified this despicable slander, debasing even
the very sordid soul that made it?    It has created
sanitary science; it has gone forth, like a modern Hercules, to slay the hydra-headed causes of disease, preaching
preventive doctrines, demonstrating  preventive principles, and founding journals to disseminate hygienic
truth. Pioneers in the practical toil, its members have
not shrunken from jeopardizing life-nay, have not unfrequently met even death-at least they have refuted the
poor scribe in the " Quarterly."  To whom is the world
indebted for the knowledge of the influence exercised on
the physiology of nations by Government and political
institutions, public morals, ratio of population to area
inhabited, colonization, climate, physical geography,
6*



60

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its achievements in modern times exceed those in the
past, owing to the larger experience upon which it has
wrought. The startling point has differed. He proceeds
to say: "As to the social utilitarian advancement, that we
have left the ancients far, far behind in the race, can
scarcely, it would seem, be questioned." We are told it
is true, by a man (Dr. Knox), whose genius and whose
rugged, unfettered modes of thought I sincerely admire,
that "in Cicero's time the island of Rhodes presented a
civilization which no part of Great Britain can at this
present day pretend to."  What, can this be true of a
period when the great emperor himself, Augustus, who
ruled the world, had, as Gibbon expresses the facts,
(thereby symbolizing the civilization of the time), "neither
a shirt to his back, nor a window to his home." We are
told, too, by the Scottish physiologist that " monumental
records, artistic remains, architectural designs, and utilitarian plans, prove beyond all question that the ancient
races of men were at least equal, if not superior, to the
modern."
But let us take a choice specimen of those ancient
races. Let the reader place himself on the site of those
ruined monuments-probably the most interesting architectural remains in the world-amid the ruin of the
material glories of that mysterious people whose origin
and course no one knows, nor perchance shall knowthe ancient inhabitants of central America; or produce
that singular mixture of Medean, Grecian, Egyptian,
Phoenician, and special civilization. Restore those palaces
of Palenque even to their remotest detail; give them
back their gigantic stairs; fashion once more into perfect
shape their imposing fagades and their massive turrets;
redecorate their walls with those sculptured hieroglyphics,



CONSUMPTION.

61

the remains of which prove an artistic power far beyond
the ordinary Egyptian; deck out the surface in that
bright coloration of old days, which harmonized with
the glittering plumages and brilliant Flora around; erect
a throne that in material splendour shall dazzle the
eyes; place upon it a monarch gentle as Montezumaone that scarce knoweth guile; repeople those walls and
corridors with greedy placemen and servile retainers;do all this by fancy and cozenage, and still the civilization you reproduce falls as immeasurably below that of
the Europe of to-day as did the soft Aztec himself, with
his social angle of about forty-five, below the energetic
Saxon and the brilliant Celt of the nineteenth century.
How small and insignificant seem all these antique
strivings after utilitarian civilization when we institute
a comparison with the achievements of to-day, when we
see the Anglo-Saxon conquering time, space, and disease,
by his application of natural laws, that were as powerful
before the Deluge as they are now, as ready then to obey
his will, had man known how to command them, as they
at this moment prove!    Look at the Anglo-Saxon
throwing the Grand Trunk Railway Tubular Bridge,
two miles long, across the St. Lawrence, and compare
him in engineering resources with nations to whom the
construction of the arch was unknown. See him bid
thought travel in material fashion, through air, under
oceans, with the velocity of lightning, and compare him
with men whose highest notion of speed is signified by
relays of running footman, lithe of limb and strong of
wind.
But a truce to this digression.  Truth, sought from a
medical point of view, lies between the two extreme
dogmas I have set forth; progress has been going



62

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forward, farther advancement is obtainable, and the
generous enthusiasm of Condorcet approaches more
nearly to the reality of nature than the cold disenchantment of Knox. And by what means may that advancement, the health of the people, the prevention of
consumption, be best promoted and accelerated? By
the extension of homoeopathy, by improved popular education, and by sanitary science.  Even in our own
favored land there are relics of feudalism that still
impair the health, and thwart the mental emancipation
of the masses. In homceopathic and hygienic education
lies the best protection against consumption; highest
amongst all powers in ameliorating the physical condition of mankind rank these, best teaching the masses
to secure the mens sana in corpore sano. Homceopathic
and hygienic education will most invulnerably arm man
for his incessant conflict with those numerous extrinsic
influences which tend to injure and destroy him. A
large share of the gravest, acute disease, that which cuts
down our population at the period of life when it is most
useful to the state, is of man's own production, and as
assuredly preventible by sanitary measures-consumption
par excellence-as is chronic alcoholism by the eschewing
of alcoholic drinks.  If all the modern triumphs of
Saxon and Celtic civilization and medical reform float
not even in thought before us; if their memory be not
constantly present; if their indifference to them, as the
donors of blessings innumerable, physical and moral; it
is that we are too familiar with them, too unchangingly
living under their continuous and benign influence.
Time may remedy "tortive and errant" justice, but, in
our day, it will be enough to be encouraged by the consciousness of having contributed more than our oppo



46

CONSUMPTION.

say that more than five sixths perish under the present
egregious system of mismanagement.
In proceeding to develop more fully the measures
which I deem essential in the accomplishment of this
desirable object, I am well aware that some of my recommendations may, unfortunately, be beyond the means
of the public at large; but, nevertheless, I feel called
upon to state them without regard to individual exceptions, inasmuch as they are, in my experience, the most
effectual means of preventing consumption, when circumstances admit of their steady and uniform application.
In order to render my observations more practical, I
shall apply them to the different stages or periods of
life. This will, no doubt, give rise to occasional repetitions; but these are altogether unavoidable in treating
of a prevalent disease the causes and symptoms of which
vary so much at different ages.
Prevention of the disease in infants.-During the
growth and development of the body, all those measures
which are known to contribute to the general health
must be regularly and persistently adopted, in order to
prevent the full development of tuberculous disease in
an infant born with the predisposition to consumption.
The rules for governing the health of psoric or strumous
infants, are nearly the same as for others, but they
require to be more rigidly enforced and more strictly
attended to. Unless the child of consumptive parents
be reared with the greatest possible attention to every
circumstance which can contribute to nervous power, he
has no chance of reaching maturity without the deposit
of tuberculous matter in the head, chest or abdomen.
If hereditary tendency to phthisis exists, it is of great
importance to anticipate the pulmonary era, and introduce



CONSUMPTION.

earnestly recommend the suckling and the homoeopathic
treatment to be continued for this length of time, with
a view to enable the child to pass over the difficult and
dangerous process of dentition   or "teething" with
greater safety. Indeed, the consumptive infant should
not be weaned till the first set of teeth have appeared;
he should have little or no food in general but the nurse's
milk till he is six months old at least, and for some time
after this it should be of the very lightest character and
quality, and constitute but a small proportion of his
nutriment.  It is almost unnecessary for me to say,
perhaps, that the selection of a nurse for a tuberculous
infant deserves especial attention. She should be young,
healthy, vigorous, free from all suspicion of a consumptive diathesis or a scrofulous constitution, clear of all
cutaneous eruptions or diseases of the skin. This last
point I hold to be a sine qua non, for many and obvious
reasons, and her child should not be older than that
which she is required to nurse. She should take daily
exercise in the open air; her regimen should not differ
much from that to which she has been accustomed, and
any change which is made in it should be gradual. It
is a common and erroneous opinion that women, when
nursing, require to be much more highly fed than at
other times; in short, that they should be eating and
drinking from morning till night, and in the night. A
good nurse does not need this, and a bad one will not be
the better for it. The quantity which many nurses eat
and drink, the indolent life which they too often lead
and the large amount of sleep, or stupor, as the case may
be, which they indulge in, have the infallible effect of
deranging. their digestive organs, and not unfrequently
induce an undesirable state of febrile excitement, and a



68

CONSUMPTION.

premature or profuse return of the catamenial or monthly
secretion.
Nursery treatment.-No other kind of milk should be
given to an infant in addition to the milk of the mother
or wet nurse. The less rocking the better; when asleep
to be laid upon its right side. The best food is "Lemann's
Biscuit Powder," soaked for twelve hours in cold spring
water, then boiled for half an hour, not simmered, or it
will turn sour. Very little sugar to be added to the
food, and then only at the time when given. Sweets of
every kind are generally injurious, producing acidity,
flatulence, and indigestion, "inward fits," sores in the
mouth, much puking and crying from griping pains in
the bowels, bending and straining the body backwards,
followed by disordered secretions. An infant will take
even tasteless medicines better, and all the more readily,
if made lukewarm in a cup placed in hot water, adding a
very little sugar of milk when given. The warm bath, at
ninety-four degrees of heat-not less-for ten minutes, is a
valuable domestic remedy in many cases of habitual constipation; and when used every other night is also an
excellent means of relieving many other attacks of habitual sickness, by exciting and restoring a healthy
action in the vessels of the skin. In a very large class
of cases of chronic disease, usually known under the
name of "indigestion," the practice of hydropathy is
well deserving of trial; in many chronic nervous affections and general debility, preceding the deposit of tuberculous matter of consumption, I should anticipate great
benefit from  the "cold water system."    In chronic
diarrhoea, acute fevers, with or without an eruption on
the skin, dysentery, prolapsus, and the like, the wet
sheet, the cold bath, and the sitz-bath, have frequently



CONSUMPTION.

69

proved an effectual practice.   On the other hand,
"soothing syrup," whether American or English, sedatives and anodynes, all and singular, are most prejudicial
and destructive. They stop the secretions. A very small
dose of laudanum given to an infant is amply sufficient
not only to stop the cough, but to produce coma or insensibility, and death. When an infant is weaned it is
of the utmost importance that it be fed with the milk of
one cow, and one only (a milch cow), mixed with
"Lemann's Biscuit Powder," prepared as before directed
and very little sugar. Boiled bread pudding forms a
light and nutritious dinner, made with stale bread, hot
milk, an egg, and very little sugar. When an infant is
well and twelve months of age, bread and milk should be
given every night and morning, stale bread toasted
soaked in a little hot water, and then the milk of one
cow added cold. Solid meat is not generally required
until an infant is fifteen months of age, and then to be
given sparingly, and cut exceedingly fine. Roasted mutton, or broiled mutton chop (without fat), is the best
meat; next to that, tender, lean beef or lamb; then fowl,
which is better than chicken; no pork or veal, no pastry,
no cheese-the less butter the better. An infant should
not be put upon its feet too soon, especially while
teething or indisposed. Avoid overfeeding at all times,
more particularly, however, during teething. It is very
likely indeed to eventuate or end in indigestion and disordered secretions, the common primary causes of fits or
convulsions, various eruptive complaints and inflammatory affections of the head or throat, the chest or bowels.
There should, lastly, be no crude drugs in the nurseryno calomel or jalap, senna tea or James's Powder-no
paregoric or chalk mixture-no salts or magnesia-no
7*



72

CONSUMPTION.

and the state of our fickle and variable weather. A
delicate infant born late in the autumn will not generally derive advantage from being carried into the open
air in this country till the succeeding spring; and if the
rooms in which the baby is kept are large and lofty,
often changed and well-ventilated, he will not suffer in
any way from the confinement, while he will in all
probability escape catarrhal affections, hooping-cough,
measles, bronchites, pneumonia, scarlatina, and smallpox,
which are so often the consequences of the frequent and
injudicious exposure of infants to a cold and humid
atmosphere, and at the same time the fertile source of
consumption of the lungs.
Residence.--It is almost unnecessary to say that when
an infant can be suckled in a healthy situation in the
country it is cceteris paribus, far preferable to town;
but the choice of situation requires so much judgment,
and is withal so little regarded, that I shall offer no
apology or trust to be excused for offering a few remarks
on the hygienic rules by which it should be regulated.
There is no one circumstance connected with health,
concerning which the general public is in my opinion so
ill informed, as the requisites of a healthy residence, both
as regards the local position and the internal construction.  In this island we have chiefly to guard
against incessant humidity, on which account our houses
should not be built near water, especially when stagnant,
and still less near marshes. Large trees, which are both
an ornament and an advantage at some distance from a
house, become injurious when so near as to overshadow
it, or prevent the air from circulating freely around it
and through its various apartments. The atmosphere
of a building overhung with trees or surrounded by a



CONSUMPTION.

73

thick shrubbery is in a state of constant humidity,
except in the very dry weather, and the health of the
infants rarely fails to suffer. The natural moisture of
the country, arising from the humid state of the soil and
vegetation, is greatly increased by such an injudicious
mode of planting; an artificial atmosphere is thus
created, which renders a situation of this kind much less
healthy than the more open and airy parts of such huge
and Babylonian towns as Liverpool and Manchester. It
is not generally known how limited may be the range of
a damp, unhealthy atmosphere: a low, damp situation,
surrounded by trees, is capable of inducing tuberculous
disease in an infant; whereas a dry and rising ground,
only a hundred yards distant, would afford a choice and
healthy site for his residence. The dryness of the air in
large towns, which is the consequence of good drainage
and an artificial soil, is at once the safeguard of the inhabitants and a compensation in some measure for the want
of that unimpeded circulation and renewal of pure air
which the hills and dales of the country alone affords.
Prevention of the disease in childhood.-During the
period of childhood, the same unremitting attention is
necessary to the circumstances just mentioned under
the head of infancy. The important process of teething
being fairly passed, the food of the child ought to be
regulated chiefly by the state of the digestive organs.
In proportion to the delicacy of the digestive organs of
the child, the diet will, in general, require to be very
mild. When he thrives upon farinaceous food, milk, and
light broths, no stronger or more substantial diet need
be used during the first two years of life. When he looks
healthy-that is to say, when he has a good supply of
red globules in his face, and some nice firm, mottled arms,



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and grows, and his bowels are regular (for this is one
of the surest indications that he is well, and that the
food is suited to the digestive organs)-we have the best
proof that the diet agrees with him. When, on the
other hand, the child appears heated and flushed towards
evening, is fretful and cross, drinks greedily and more
than is usual in children of the same age, and when his
bowels do not act regularly, no, not even with Nux, we
may now be reassured that there is something wrongwrong in the regimen employed. There is no greater
error in the management of children than that of giving
them animal diet very early in life.  To feed an infant
with animal food, before it has teeth proper for masticating it, shows a total disregard to the plainest indications of nature in withholding such teeth till the system
requires their assistance in masticating solid food.
Before that period, milk, farinaceous food, and broth,
afford that kind of sustenance which is best suited to the
digestive organs, and to the nourishment of the system.
The method of grating and pounding meat as a substitute for chewing may be well suited to the toothless
octogenarian, whose stomach has had plenty of experience
and is capable of digesting it; but the stomach of the
young child will take offence, it is not yet adapted to
the digestion of such food, and will infallibly be disordered by it. When the child has the means of masticating, a little animal food may be allowed; but, at first,
it should be of the lightest quality, and given on alternate
days only; and even then its effects should be watched,
for all changes in the regimen of children should be
sufficiently gradual. The frequent origin of scrofulous
disease in defective nourishment has led to the opposite
extreme, and children who are disposed to tuberculous



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75

disease are too often subjected to a system of overfeeding
which actually induces the disease it was intended to
prevent.  By persevering in the use of an overstimulating diet, the digestive organs become irritated, and
the various secretions immediately connected with digestion are diminished, especially the biliary secretionat least the sensible qualities of the bile enable us to
observe it best.  Constipation of the bowels soon follows,
congestion of the hepatic and abdominal veins succeeds,
and is followed by the train of consequences which have
already been detailed. It would be well, I think, if the
advocates of the system of high feeding children would
bear in mind this salutary adage-" Corpora impura quo
plus nutries, eo magis lcedis."
Exercise-When the child has acquired sufficient
strength to take active exercise, he can scarcely be too
much in the open air. The more he is habituated to
this, the more capable will he hereafter become of bearing the incessant vicissitudes of this climate. If children
are allowed to amuse themselves at pleasure, they will
generally take that kind and degree of pleasurable
exercise which is best calculated to promote the growth
and development of the body, When they are too feeble
to take sufficient exercise on foot, riding on a donkey or
quiet pony forms the best substitute. This kind of exercise is at all times, indeed, of infinite service to delicate
consumptive children; it amuses the mind and exercises
the muscles of the whole body, and yet in so gentle a
manner as to induce little or no fatigue. Young girls
should be allowed-nay, even encouraged-to take the
same kind of exercise; it is almost chiefly and entirely
the unrestrained freedom of active play that renders
boys so much less subject to formidable curvatures of



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the spine and other orthopcedic deformities than girls, a
vast proportion of whom, I find, are more or less physically misshappen, in consequence, possibly of a defective
supply of phosphate of lime, but principally, it is believed, of the unnatural and painful restraint which is
imposel upon them in their exercise and dress.
The clothing ofyoungpersons predisposed to consumption requires, or rather peremptorily demands, the most
scrupulous care and attention, and, of course, must be
well regulated and appropriately adapted to the peculiar
requirements of the season.  The winter clothing should
be early resumed and late laid aside. It is in spring
and autumn that the vicissitudes of our climate are
greatest, and congestive and inflammatory affections
demanding Acon., Tartarus, and Dig. most common.
This is peculiarly the case in the spring, which is also
the season when local glandular affections and scrofulous
abscesses are most liable to occur in the constitutions of
young persons predisposed to them. When young persons are known to be hereditarily disposed to phthisis,
they should be taught to avoid every imaginable source
of irritation in the chest, for a bad cold or pleurisy is
exceedingly apt to bring consumption after it. A warm
and dry sheltered residence, exercise in the open air,
especially on horseback, and a steady, uniform good diet,
calculated to keep up their strength without producing
feverishness, are very important to be remembered. A
prolonged course of Ferrum mur. and Allarton's steel
biscuits I have often known of considerable service.  A
young person in apparent health-perhaps at school, or
a " Ladies' college," or laboring propably under a slight
cold-is attacked with sudden and copious blood-spitting,
or hemoptysis, as it is termed, accompanied with con



CONSUMPTION.

79

in a minute-thirteen cubic inches of air being the quantity usually inspired at each time; expiration taking place
alternately with the preceding act, the quantity of air
usually expired being the same as that which is inspired.
The object of breathing is to finish digestion-to free the
system of carbon and hydrogen, which accumulate in the
system and become noxious in the extreme-for its removal we inhale air which contains oxygen in sufficient
quantity to form a combination with the carbon and the
hydrogen, which is then exhaled in the form of carbonic
-acid and water. In this process, however, is contained
another exquisite provision, which imparts life, health,
and motion to the entire system-the generation of
animal heat-and a principal cause of the circulation of
the nutritive fluid derived from the food-respiration
and circulation are thus united. It is in the lungs that
the assimilation of chyle is completed, and when the
respiration is inadequately or imperfectly performed, or
a sufficient supply of oxygen is wanting, perfect digestion
and assimilation are prevented. However well chosen the
food, however apparently nutritious, however minute the
attention paid to clothing, or cookery, or cleanlinesswith whatever care temperature, exercise, sleep, or
waking be regulated-if children are so circumstanced
that fresh air is insufficiently renewed, they will become
thin, debilitated, from depressed nervous power, tuberculous deposit will take place most likely in the brain,
or its membranes, the tubercles being deposited in the
arachnoid, or on the cerebral surface of the pia mater.
The symptoms of this complication, which I may observe, en passant, is remarkably frequent, generally commence with weight across the forehead, which gradually
increases to most intense pain over the whole of the



80

CONSUMPTION.

cranium, often attended with considerable stupor, but
seldom with violent or active delirium, the patient will
perhaps look you most steadily in the face whilst speaking, and then deliberately turn away his head without the
slightest expression of displeasure. Tubercular meningitis-for that is the disease when it supervenes under
these circumstances-is generally fatal in a few days. At
no period of youth, therefore, should education be pushed
to gain a gewgaw, or trifling bubble, called " The Prize."
The mind must not be stretched or worked beyond its
powers. The welfare of the pupil demands the observance
of this rule on the part of the professor or teacher, as
well as the parents, more especially when the child belongs to that class of consumptive children whose intellects are preternaturally precocious and acute. Unfortunately, however, these are generally the pupils
selected by the master (or mistress) of the "establishment" to do credit to his capabilities of teaching; every
means are taken to foster and encourage this premature
manifestation of mind, and to stimulate the child to
renewed exertions, and thus health and life is not unfrequently sacrificed at a period of brilliant promise,
when the hopes of friends are buoyed up by the fallacious
expectation of a harvest which a more rational, not to
say physiological or natural, system of education might
have realised. In some cases, however, the mischief
resulting from this cause does not make its appearance
at this early age; I have met with many distressing examples of young men who, after years of close application
at a public school or gymnasium, had entered upon their
studies at the university with the same unabated zeal,
but were soon compelled, by the sudden failure of their
health, to abandon their literary pursuits and the pros



CONSUMPTION.

81

pects which they had in view. " The more I have seen
of the prevailing system of management in schools,"
writes Sir James Clark, "the more have I been persuaded that no subject more deserves the attention of
parents and guardians than the education of consumptive
children." However laudable, therefore, may be the
desire of individuals to see the minds of their offspring
highly cultivated and enlightened, it should receive a
wholesome check in the knowledge that this object can
only be attained by the sacrifice of health, and too often
by the acquirement of consumption. The time, perhaps,
is not far distant when homzeopathy will reign supreme;
then parents and teachers will discover that the best
method of cultivating the understanding provides, at the
same time, most genially and effectively for robustness of
physical constitution, and that the means of securing
both parts of the comprehensive prayer of the satirist"Ut sit mens sana in corpore sano," are identical.
The consequences which I have just noticed as arising
from the erroneous system of education in the schools
for boys prevail in a greater degree, and are productive
of more injury, in female boarding-schools. If the plans
pursued at many of these establishments for young ladies
with which I am acquainted were intended to injure the
health of the pupils, they could not be better contrived
to effect that purpose. The prevailing system of female
education is indeed fraught with most pernicious consequences; at a period of life when the development of
the physical constitution demands the most judicious
management, young ladies are sent to school in which
no other object appears to claim consideration than the
amount, in kind, of mental acquisition, or rather the
variety of fashionable accomplishments, with which they
8*



82

CONSUMPTION.

can be crammed. At an early hour in the morning, the
pupil is set down at the piano, the drawing table, or
some other table, where she remains in a constrained
position, often in a very cold room, till the whole frame,
and more especially the lower extremities, become
chilled-the brief relaxation, during the short space of
time allowed for meals and the formal walk, are altogether insufficient to restore the natural warmth of the
system, and it often happens that girls are allowed to
retire to their room at bedtime, with their feet so chilled
as frequently to prevent sleep for hours. Those who are
acquainted with the internal economy of the boardingschools for young ladies of this country, will allow that
this is no exaggerated picture of many of them. A delicate
girl, persistently submitted to such a regimen for a lengthened period, cannot escape consumption. While schoolboys have the advantage of a play-ground, or enjoy their
recreation at pleasure in the open fields, the unfortunate
inmates of a ladies' boarding school are only permitted to
walk along the footpaths, in pairs, in the stiffest and most
monotonous formality, resembling a funeral procession,
and wanting nothing to funereal melancholy but sables
and the hearse. The consequence is, that the muscles,
of the upper extremity and those which are chiefly
concerned in the support of the trunk, are rarely called
into operation; they do not acquire strength as the body
increases in stature; they remain weak and unequal to
the task of supporting the trunk in the erect posture. A
curved state of the spine is the consequence; and this,
by altering the portion and form of the chest, renders
the respiratory movements imperfect, the capacity of the
chest is diminished; and the lungs are consequently liable
to congestion-hence the blood-spitting or haemoptysis,



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83

and the diseases which are its consequences. While the
natural form of the girl's body is thus destroyed, the
derangement of the general health is manifested by the
paleness of the countenance, the dry and coarse appearance of the skin, costive bowels, and cold extremities;
in short, all the requisites for the production of consumption may be found in a large proportion of ladies'
boarding schools, where the system I have briefly described is regularly pursued. There are, I know, many
honorable exceptions to this system of boarding school
education, and the number would no doubt be very
considerably augmented if the conductors of such schools
were duly aware of half the physical misery they inflict
on the young ladies committed to their charge. In the
establishments to which I have adverted, as being conducted on more enlightened and philosophical hygienic
principles-the cultivation of the mind and the acquirement of the various fashionable accomplishments, are
the successful though not the sole objects of pursuit; the
health of the girls, both mental and physical, moral and
religious, forms, as it ought, the first and paramount
consideration. The time devoted to study by the present
system should be greatly abridged, and that allowed for
exercise augmented in proportion. The situation and
construction of the school should be free from all the
objections which I have already pointed out; and the
physical exercises should be such as to call into action
every muscle of the body in succession. The clothing
during the winter must be warm, and every means should
be adopted to guard against coldness of the lower extremities. The pupils should not be allowed to sit so long
as too induce this state, nor to go to bed with chilled
feet. Were I to select any one circumstance more



84

CONSUMPTION.

injurious than another to the health of young ladies, it
would be cold extremities-the consequence of want of
active exercise, and the prevailing and most pernicious
habit of wearing thin shoes while in the house. A good
warm bath should form a necessary appendage to every
boarding school, and every girl should enjoy the benefit of
occasionally conjoiningit with her habitual practice of cold
sponging. A large and commodious, lofty, well-ventilated
room, should be set apart for the express purpose of
Kinesipathic exercises, when the weather, as frequently
happens, is so inclement as to prevent it in the open air.
I believe that the Kinesipathic system of gymnastics is
quite as indispensable in the schools for girls as it is in
those for boys; and although they need not be carried
so far as in the latter, they should be sufficiently varied
to give the freest possible exercise to the trunk and
arms, so as to expand the chest well, and strengthen the
back. If the girl has any tendency to curvature of the
spine those exercises, which are employed to cure this
deformity, should constitute a part of the daily gymnastics. To the room devoted to these physical exercises
the younger girls should be allowed to retire for a short
time during the usual hours of school, and amuse themselves right heartily at their own discretion and pleasure.
This latter recreation I consider of the utmost importance; it must, nevertheless, be understood, that no exercise is to be considered a substitute for that which is
enjoyed in the open air; and for this reason, every female
boarding school ought to have a proper playground, where
the pupils, one and all, may choose their own amusements,
and play without restraint. It is almost superfluous for
me to observe, that tight lacing and all tight dressing, is
utterly incompatible with the extent and variety of phy



86

CONSUMPTION.

will) take a comprehensive retrospect of the nature and
causes of THE ENGLISH DISEASE, the claim of this important subject to their best attention will be fully
apparent, and in seriously urging it on the community at
large, I would remind them of the fact, that the most
important object of physical education in this country is
unquestionably to guard against all possible tendency to
consumption, and that it is only through their exertions
that the desired improvements can be duly effected. Its
advent will realize the expectations of thousands-its
procrastination mar the happiness of millions. Before I
conclude these medical notes and reflections on the
physical education of our consumptive youth, I would
advert, however briefly, to the great and paramount importance of the choice of a profession or business. There
may be some advantages, as our great moralist contends,
in fixing a young person, from the first dawn of thought,
in a determination to some particular future condition of
life, but I consider that it is far more essential that the
parent or guardian should pause in selecting a business
or profession for his son, or ward, before he has fully
ascertained that his health and physical capacity are
sufficient to sustain the duties inseparable from it. So
little is this now considered, that the most unhappy
results are very frequently produced by the ill-judged
selection of businesses or professions, without any regard
to the stern requirements of organic laws or the avoidance
of consumption.
Prevention of the disease in youth.-The period of life
which extends from youth to adult age, from about the
eighteenth year to the twenty-fifth in young men, and
the sixteenth to the twenty-second in young women, is
one of vast importance as regards persons predisposed to



CONSUMPTION.

89

bined with these, warm bathing, alternated with cold sponging or frequent cold ablution, friction of the surface, exercise
in the open air, and, above all, on horseback, with a dry
residence in an open and airy part of town, or a healthy
part of the country, will often, in a few months, and
generally much sooner, produce the most beneficial
effects. There is one particular kind of exercise, however,
which has never been sufficiently attended to in the prevention of consumption, but which deserves special
commendation in this place; I mean the exercise of the
respiratory organs themselves, and of all the muscles
employed in the vital process of respiration; the great
object of this exercise is to adequately expand the chest,
and ensure the full physiological action of the lungs.
Dr. Autenrieth, of Erlangen, was the first eminent
"lung-doctor," who recommended the wholesome practice of improving the narrow and contracted chest of our
consumptive youth, by deep and frequent inspirations
of complemental air.     He advised all his patients
to place their hands upon some firm solid support, and
to exercise themselves by taking repeated deep inspirations, but cautioned them against carrying this so far
as to produce pain. I am in the habit of recommending
the full expansion of the chest in a manner, (adopted by
Sir James Clark, and other distinguished practitioners,)
somewhat different from that of Autenrieth.  I desire
the young person while standing to throw his arms and
shoulders well back, and while in this position to inhale
as much complemental air, as he can, slowly, and repeat
this physical exercise at short intervals several times in
succession; of course when this can be done in the dry
open air, it is so much the more desirable, a double
advantage being thus obtained from the salutary practice.
9



90

CONSUMPTION.

Some exercise of this peculiar kind should be adopted
daily by all young persons, more especially by those
whose chests are narrow or deformed, and should be
slowly and gradually increased.  Boat-rowing, quoits,
battledoor and shuttlecock, sword-fencing, the use of
dumbbells, and similar modes of exercising the arms,
even polishing tables and the like, will all be eminently
useful in attaining the important end we have in view,
but they should in no wise be carried so far as to induce
or maintain fatigue and    uneasiness.  If regularly
employed by young persons, under this necessary restriction, they would not merely expand the chest, but
would tend to remove that disproportionate development
of their upper and lower extremities, which one so frequently observes in youth.   By thus exercising the
upper extremities, and the muscles of the trunk, and
inflating the lungs to their full extent, the chest and
pulmonary organs will acquire their due proportions. I
also consider these exercises particularly indispensable
to persons engaged in occupations which require a bent
or stooping posture, and especially to the countless host
of clerks and book keepers, as well as tailors and shoemakers, and many other mechanics, whose constrained
position seldom  allows the superior parts of the lungs,
which are usually most affected in incipient consumption,
to be fully and adequately expanded.  Reading aloud
and public recitation will, moreover, when prudently
employed, be useful in strengthening the pulmonary and
digestive organs, and in giving tone and power to the
voice.  The clear and distinct enunciation, which is
acquired only by long practice, is seldom found associated with pulmonary disease; and I am therefore strongly
inclined to commend the practice of recitation and



CONSUMPTION.

91

elocution at schools. It would, I submit, be difficult to
cite the example of any great orator who died of pulmonary disease, while a vast number might be adduced
whose health was radically improved and their life
prolonged by the beneficial effects of this exercise.
Cicero was consumptive in early life, or at least strongly
predisposed to  phthisis, and  Cuvier attributed his
exemption from pulmonary disease, to which he was
expected to fall a sacrifice, to the increased strength
which his lungs ultimately acquired in the discharge of
his duties as a public lecturer. Many of the modes of
exercising the pulmonary organs which I have described
will be equally useful to young females, although they
will not of course require to be carried to the same
extent.  I consider the very ancient and well-known
game of battledoor and shuttlecock one of the best
physical exercises which can be adopted by them within
doors. Although I so highly approve of every judicious
means of exercise, I would at the same time strongly
condemn those which require excessive bodily exertion,
such as climbing lofty precipices, and the like, and which
have  not unfrequently been recommended      for the
prevention of consumption.    These violent measures
undoubtedly exercise the lungs, but they at the same
time excite the impulsive action of the heart, and render
it liable to be oppressed by the blood being suddenly
forced upon it by the inordinate muscular exertion. I
consider all such violent exertion fraught with imminent
danger; indeed, I am acquainted with many instances of
severe hemoptysis from running, jumping, lifting heavy
weights, and such-like asinine recreation, and have met
with several cases of diseased heart in young persons,
evidently originating in forcible, foolish, long continued



CONSUMPTION.

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or tissue principally affected, and of the general system
on the individual case. But the symptoms, doubtless
constitute the chief source of the distinction. The form
and violence of the symptoms, the particular order in
which they appear, the particular manner in which they
are conjoined, offer additional means of discerning the
true nature of the case.. But it must be acknowledged
that it is to the study of the materia medica pura that
we are principally indebted for the recent progress, and
indeed for almost all that is real and solid in medical
science. The progress of medicine as a science-might I
not say as an abstract science?-may be considered as
greatly dependent on that of our knowledge of materia
medica pura; but the advancement of physic, as a practical art, is naturally linked with our knowledge of the
history, symptoms, and the effects of remedies upon the
healthy organization, with the diagnosis or distinction of
disease in each suffering individual. The sources of
diagnosis may be arranged. in the following manner:
I. The history. II. The changes of function or symptoms. III. The effects of remedies. IV. The morbid
anatomy or changes of structure.
I. The history of consumption comprisesI. The causes which are1. Constitution,
2. External.
II. The course which is1. Acute (galloping).
2. Chronic.
3. Insidious.
4. Sudden (haemorrhagic)
9*



CONSUMPTION,

97

as are not engaged in the process of assimilation.  The
latter are (or rather is) consumption, whether it be
called disease of the lungs, and affection of the chest,
chronic bronchitis with waste of tissue, marasmus,
mesenteric disease, chronic peritonitis, chronic pleuritis;
it involves some disease of the organs of supply, which
implicates the nerve-globules, and leads infallibly to the
formation and deposit of tuberculous matter somewhere.
A third inquiry is into the state of the pulse. Increased
frequency of the pulse shows nervous irritability, and is
the customary attendant or herald of the insidious forms
of phthisis, whilst it is not observed in the less serious,cases of chronic dyspepsia. Other questions are-What
is the seat of pain or discomfort?  Where is your uneasiness? What functions of your body are disordered,
deranged, or perverted?    What is the general aspect,of the patient? What the general character and course
of the symptoms?   The dawn of consumption is marked
by a delicate and often waxy paleness, alternated with
transient gentle flushing, slight lividity of the prolabia
or membrane which invests the lips on exposure to cold,,an appearance of indisposition and languor, frequently
motion of the nostrils from respiration, and frequently a,quivering of the chin and lips when speaking to you. Its
progress is denoted by persistent emaciation, in addition
[to an aggravated state of the other morbid appearances
adverted to.   In phthisis pulmonalis the posture is
various; frequently, however, one particular position is
chosen and preserved-pain, cough, dyspnoea, and oppression being induced in any other; this is on the side
most diseased; pleuritic pain is mostly there, early in
the disease, and cavities in its later stages. In pneumonia
the patient almost invariably assumes and retains the



CONSUMPTION.

99

strated in the most irrefragable manner that tubercles
may degenerate and become abortive with extreme frequency; particularly is this the case too if nature be not
thwarted by allopathic, but assisted by homceopathic
treatment. Again, it has been argued that after all,
practically speaking, phthisis pulmonalis does not mean
the existence of a few isolated tubercles scattered here
and there through the lung, and that what is really meant
is that advanced stage in which the lung is affected with
ulceration, and in which the bodily powers are so much
lowered that perfect recovery never takes place. But
even here, again, a careful examination of the records of
medicine will show that many of these very advanced
cases have recovered, and recovered too under all the
disadvantages of the practice of the old school. Laennec, Andral, Cruveilhier, Kingston, Pressat, Rogee,
Boudet, and others, have published cases of unmistakable
consumption, where all the functional symptoms and
physical signs I have detailed as appertaining to the
disease, even in its most advanced stage, were present,
and yet where the individual not only recovered from the
disease, but survived the allopathic treatment in addition;
not only lived, but lived many years after the suppuration
of the lungs had healed; ultimately they died of some
other disorder; and on dissection of their bodies, large
cicatrices, or scars left after the healing of the ulcers,
have been found in the lungs. I will here subjoin a few
particulars of a very interesting case, which exhibited a
remarkable cicatrix in the lung:
John Keith, set 50, a teacher of languages, was admitted into the Royal Infirmary, February 8th, 1844, in
a state of profound coma, and died an hour afterwards.
On examination, the membranes of the brain, at the base,



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he died in the manner previously described. This case
points out most clearly the following important facts:
1st. That at the age of 22 or 23 the patient had a tubercular ulcer in the right lung, the size of which must have
been very considerable, when the contracted cicatrix
alone was three inches long. 2d. That tubercular exudations existed in the apex of the left lung. It is
therefore only reasonable and proper to believe that the
statement made by his friend at the examination was
strictly correct, namely, that he laboured under all the
symptoms of advanced     consumption.   It is shown,
thirdly, that after receiving the appointment of a parish
schoolmaster, after changing his residence and occupation,
while his social condition was greatly improved, these
phthisical symptoms wholly disappeared.     We may
consequently infer that it was about this period when
the cavity on the right side healed and cicatrized, whilst
the tubercular exudations on the left side were converted
into cretaceous masses, and thus rendered null and void,
or, in a word, abortive. It proves to demonstration,
lastly, that when, at a more advanced age, he again fell
into bad circumstances, and even became a drunkard,
tubercular exudations did not return, but that delirium
tremens did, with simple exudation on the membranes of
the brain, of which he died. I am enabled to refer to
many similar cases, which, although living and enjoying
unexceptionable good health at the present time, I am
satisfied have undergone a permanent recovery, and were
signally benefited by homoeopathic treatment in the
accidents, as they are termed, of phthisis, viz., pneumonia,
pleurisy, haemoptysis, and the like. Not only am I
deeply convinced of the fact in question, but at the same
time I know that in the practice of homceopathy is to
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CONSUMPTION.

to be found an unanswerable amount of evidence as to the
curability of even the worst cases of consumption. So
deeply rooted, indeed, has been the opinion of the necessarily fatal nature of this disease, that the generality of
practitioners have concluded that because consumptive
cases recovered, ergo, the disease was not consumption;
that is, they have rather distrusted their own diagnosis,
than ventured to oppose a dogma of general, if not universal belief. But although the stern facts of the curability of phthisis pulmonalis by homceopathy, even in its
most advanced stage, can now no longer be denied by
rational beings, it has been argued that this is entirely
owing to the unaided operations of nature, and that the
" lung-doctor" can lay no claim whatever to the result.
To these sage heroes I answer, that if it be true, according
to Hoffman, that " medicus naturse minister non magister
est," or, in one's own vernacular, that a physician is not
the master, but the servant of nature, it follows logically,
as a matter of course, that by carefully observing the
operations of nature, learning her law of cure, imitating
it as closely as possible, avoiding what she points out to
be injurious, and furnishing what she evidently requires,
that we may at length arrive at rational and natural
indications of cure. Both the principles and practice of
homceopathy, tested  by science, furnish  irrefragable
evidence that we have in a great measure attained this
desirable end.
-General Treatment.-Personal experience, reading,
reflection on a vast number of facts, and the analysis of
clinical observations, have for many years impressed me
with the deep conviction that there exists one truthful
comprehensive principle of medical treatment, a perfect
NOMOS, or central therapeutical law in the universe of



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since the deluge; as ready was it, and as powerful, when
properly commanded, Hippocrates assures us, in his dayhundreds of years anterior to the Christian era-as ready
then to obey his will, as it at this present moment proves
to us. I regard homoeopathy, then, in its absolute, fundamental, deathless principle, as the sublime and veritable
exponent of a true and philosophical natural relationship, subsisting between the pathogenetic effects of each
medicinal substance upon the healthy organization, and
its beneficial or curative influence upon the sick, when
those morbid phenomena arise from idiopathic, or other
causes. When this kindred connexion is made manifest
by the reflected light of signs or symptoms, in organs or
their functions, the mere dose or quantity, to be administered is altogether secondary-comparatively, in fact,
insignificant; it may be a grain, or a drop, diluted or
undiluted, a pilule, or a globule; yea, verily, pointed at
as it is, all besmeared with odious epithets, repudiated
as heretical, shunned as fanatical, assailed as contemptible and quackish withal, the atomic dose yet
reposes, in its deep philosophy and healing power, as an
invulnerable target, at which the scaramouch in vain
launches his scurrilous and scathless anathemas; it is
even yet the brilliant and dazzling sun-like torch, to
which the jack-puddings and gnat family rush for sport,
to their inevitable destruction.
Much   has of late been said and written about
"legitimate" medicine. I do not know what it means,
but I should like to say a word or two anent rational
and physiological medicine  Observation and experiment
are, I take it, the foundation of our knowledge of facts in
physic as in other sciences. Reflection complements the
inductive process; but it must be, if conformable to the



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injury than is imagined, and although they may possibly
give a feeling of temporary support to the system, they
will not fail to confirm the functional derangement which
it should be our first object to remove. The general
cure of consumption is then directed to be ensured, or
brought about by the various eminent allopathic authorities-in this wise: "The general remedies," says Sir
James Clark and a host of others, "consist of bloodletting, general and local, emetics, digitalis, iodine, iron,
climate, cod liver, and other animal and vegetable oils,
counter-irritation, blisters, tartar-emetic, ointment, (parodied by St. John Long), setons and issues, and inhalations." Digitalis is a medicine concerning the virtues
of which allopathic writers differ as perplexingly as they
usually do on all drugs; some assert that it is possessed
of powers beyond all others; a second class consider it
to have very little efficacy; while a still larger proportion condemn it as absolutely pernicious.
In my bibliographical researches on the subject of
consumption, I have collected a vast number of clinical
facts concerning digitalis, which have been published in
France, Germany, America, and other countries; and I
find, that the remedy in question has been unwittingly
administered in strict conformity to the indications of
homoeopathy in no less than 155 cases, embracing all
stages of the disease; that of this number 87 were perfectly cured, 35 greatly improved, and 33 not then cured;
and this is the medicine, be it remembered, that was, in
abject ignorance of any sound principle on which to
prescribe it, ignominiously struck from the list of therapeutical agents by the London College of Physiciansthe same doubts and apprehensions of its safety existing
then concerning digitalis in consumption, as exist now



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ll

although it is quite clear that we are not yet acquainted
with the peculiar circumstances under which it may be
employed with advantage." The "peculiar circumstances"
are a hard stile-a set of steps to get over to another
inclosure, lit up by the sunshine of truth; a sharp point
of the sundial which casts a shadow, "yet" too dazzling
to be appreciated I Watcher of the sciences I watchman
of old physic 1 what of the hour? He knows not of the
break of day!!!
The general treatment of consumption has usually been
considered either as prophylactic, or palliative merely; the
former applying chiefly to those cases in which, from
family predisposition, or other causes, the disease may
be apprehended, the latter to those in which there is
satisfactory evidence of its existence, this distinction
being based upon the absurd assumption that when the
disease is once established, its removal is a thing
altogether beyond the reach of art, even of homceopathy.
The question as to whether we are to regard the treatment of incipient consumption as curative, or prophylatic, is not of very great practical value, though it is not
without its influence upon our views of the principles
according to which, the management of the disease is to
be conducted. Since, if, according to the opinions I
have expressed, there must be a nervous lesion antecedent
to the disposition of tubercles by the blood, we have at
this preliminary period a disease to treat by Phosphorus,
Acid. nitricum, and Zinc--in      conformity to the
indications I have given (anon)-and one, from which
there are rational grounds for believing thousands have
already recovered; and whether that recovery be regarded
as spontaneous, or as the result of medical art, it cannot
well be supposed that such would have taken place



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under other than favorable circumstances, both external,
internal, and collateral, and therefore the reasonable
method of proceeding must be to endeavor to ascertain
those circumstances, and as far as practicable to imitate
them, and the same argument holds good of the less freequent instances of cure or recovery in the more advanced
stages or periods, the cure of consumption by homoeopathy
being a result neither opposed to professional experience
nor to any known laws of pathology. When success does
not attend our efforts to relieve, we should diligently
search out the obstacle. What is it? Does it arise from
an error in diagnosis? Does the patient attend to his
regimen? Is it from the non-homceopathicity of the
remedy? or is it in consequence of chronic psoric miasma?
or it is owing to the insusceptibility of the ego to that
particular dose? For instance, formerly, at Liverpool, the
intermittent fevers had such symptoms that Arsenicum was
the indicated remedy. That is not so now. I prescribe
at present China three times daily; for a few tertian,as it is
called, in which the intermission continues for forty-eight
hours, the paroxysm commencing at noon and usually
remaining until twelve hours, Ipec. alternately with
Nux. The present fevers are catenating and protracted,
that is, they give rise to various chest-symptoms, and
the intermissions are inordinately short and imperfect.
What can homoeopathy accomplish in averting the
onward death-march of phthisis?
In briefly answering this solemn question, I shall
relate actual cases from my own experience and that of
others, and afterwards suggest farther indications for the
remedies employed in this disease, a malady so common,
and withal so appallingly fatal under ordinary treatment,
and which in its multiform relations to us, in its deeply



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seated and constantly operating causes, and in that enormous fatality, opens such a large page of exhaustless
interest, that in considering only a portion of its topics
one enters on fields of research interminable, in which
the most ardent inquirer may find a study for years.
CASES.
CASE I. - A laborer, aged 38 years, of a strong,
powerful constitution, and hmemosthenic temperament,
who had frequently suffered from "itch" and was habitually intemperate, had for many years been afflicted with
a cough, expectorating mucus and pus, without its preventing him from attending to his usual work. In March,
he very suddenly experienced violent pains in the right
side of the chest and liver. The pain extended over the
whole right hypochondrium and region of the liver, and
as far back as below the right scapula; it comes in
paroxysms or fits and starts, and is acute and lancinating,
when the patient breathes or coughs. The chronic cough
and expectoration are worse, tongue very much coated,
shortness of breath, no appetite, constipation, and fever.
Acon., Bry., and Nux. removed the pulmonary inflammation and fever completely in five days. But the cough
and expectoration of pus had become imminent. He
coughed up large lumps each time, felt and looked
extremely debilitated, and perspired most profusely
during the night. The chest was covered with an eruption of pustules that was painful. The prognosis was, of
course, unfavorable; the only symptom per contra, was
the pustular eruption; I gave him Sulphur       on
April 2d.   Upon this, the eruption came out very
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CONSUMPTION.

abundantly, covering nearly the whole of the body, head,
chest, abdomen, and extremities, upper and lower, and
both cough and expectoration became aggravated, until
the 13th of April. I became anxious and somewhat
alarmed for his safety, and accordingly prescribed, Calcarea. Immediately afterwards, the whole system began
to rally and improve, without any primitive effects of the
medicine. The eruption, night sweats, cough, and purulent expectoration gradually disappeared. In May, the
patient returned to his ordinary work, and has remained
quite well, which is more than a year since.
CASE II.--A child, aged 4 years, of hybrid-hoemosthenic temperament, who had been afflicted for a couple
of years with pneumonic phthisis, or scrofulous pneumonia, accompanied by constant night cough, rattling
in the throat and chest, with great prostration of
strength, being in an almost complete state of atrophy,
was entirely cured in a few days by one dose of Belladonna. Singularly enough, the cure of the consumption
in this little scrofulous patient was succeeded by a
swelling of the salivary glands.
CASE III.-I have before spoken of the pneumonic
variety of consumption, in which the excavation of the
lung is induced by the softening of those parts of the
pulmonary tissue which had been the seat of inflammation and consolidation. The following is an illustration. A clergyman, aged 38 years, of a decidedly
phthisical diathesis, of the hybrid hoemosthenic temperament, was seized, in consequence of exposure to wet and
cold, and great professional exertions in the pulpit, with
a severe rheumatic peripneumony, which at first appeared
of moderate extent only, but gradually grew worse,
and ultimately assumed a very dangerous acme The



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treatment had recourse to in the first instance was
conformable to the customary allopathic routine, involving calomel, opium, and salines. Depletion was, at
first, considered uncalled for, but as the acute lancinating
pains in the chest and pleuritic stitches declined to yield,
or give way, either to internal remedies, or outward
applications, leeches were finally applied, and, after a
short time, another layer was repeated. After the last
application of leeches, however, the physician, who had
thus far been very assidious in his attention to the
case, left him, fully impressed with the utter hopelessness
of it. I was hastily sent for in the night, and urgently
requested to attend. Yet, on examination, I could but
endorse the sentiments of my predecessor; I could make
no  more favorable prognosis than he, because the
formidable state of things-double pleurisy, with effusion, pneumonia supervening upon tuberculous deposit,
with the physical signs of a cavity, flattening, diminished
resonance and mobility, tubular breathing, and so on
-denoted the greatest danger. Exhausted to the last
degree, the patient lay there, corpse-like and perfectly
motionless, occasionally motioning with his tremulous
and emaciated hand, cold, marble-like and singularly
contracted (I attach great importance to the hand as a
diagnostic mark) on the suffering side of the chest, with
a very painful, anxious, hippocratic expression in his
features.  Pulse uncountable, small, trembling in the
balance, intermittent, scarcely perceptible. Breathing so
weak, that on placing the flat hand on the chest I could
with difficulty perceive any dilatation of the lungs. Upon
reviewing the case, and the morbid treatment he had received, I gave Aconite In half an hour, or so, afterwards
the chest began to expand, the breathing became longer



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Sulphur, but which yielded magically, as it were, to a few
doses of Sepia. This lady became quite convalescent and
made a perfect recovery; her catamenia returned, and
kept their due periodicity; she now enjoys good health,
has regained her florid appearance, flesh and strength,
and performs the onerous duties of her large household
with facility and pleasure. The peculiar obstinacy and
difficulty, combined with insusceptibility to remedial
influences, exhibited in this case, was caused by her
having habituated herself to the abuse of mercury, opium,
and bark, which have a strong tendency to develop and
maintain tubercular consumption.
CASE V.-A gentleman, aged 37, who had been "very
poorly " for a couple of years, complained of many chestdifficulties, which were much expedited on their adverse
career by his well-marked and predominant phthisicahabit, hybrid-haemosthenic temperament, and hereditary
predisposition to consumption. He had been many times
under allopathic treatment,and had undergone the destructive art of " rapid mercurialization " employed in such
cases, a practice of curing till they die which I regret to
observe is advocated by not a few British physicians, who
have obtained the style and title of eminent "lung-doctors '
in our country. On the 13th of March he was visited, and
found pale, emaciated, the breathing short and puerile,
coughing frequently, now dry, then again accompanied
with greenish, yellow, sweetish, expectoration, especially
morning and evening; diminished reasonance, tubular
breathing and flattening, with physical signs of disease in
the corresponding part of the chest on the other side,
referable to the pleura. Sharp pains in the head, probably from tuberculous deposit--these chiefly in the
forehead, with strong knitting of the eyebrows-worst



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between the cartilages of the second and fourth ribs.
The homoeopathic treatment, strictly, was continued
during the winter, and her improvement was steady,
firm and progressive. In the following February, during
the prevalence of epidemic fever, she was seized with
cold shivering, vomiting and purging, and sank with
rapidity on the third day of the typhoid attack. The
autopsy showed to demonstration that the consumption
had been cured. The whole of the superior lobe of the
right lung was occupied by a cavity, now reduced to the
size of a small walnut, lined by a distinct membrane, and
surrounded by condensed walls. It contained old tuberculous deposits in the lower lobe, but was permeable to
air.  The left lung was puckered at its apex, and
throughout its substance were points of old tuberculous
deposit, but there was not the slightest possible appearance whatever, in either the right lung or the left, of any
recently deposited tubercle. There was no appreciable
disease of any other organ-the consumption was cured
-but her powers of life had been suddenly crushed by
the poison of fever.
We are called doctors, that is, teachers, because we
profess to teach how to avoid certain causes of sickness,
which are found not only to be dis-eases-want of easebut are known, moreover, to destroy life. How shall we
remedy consumption?-better still, how shall we all do
our individual part in preventing it? for I am a much
greater believer in the power and efficacy of individual
reform, whether hygienic or otherwise, than of corporate
reform. To strike at the root, then, let us fall back
upon first principles. As regards the strictly preventive
or prophylactic treatment of phthisis, it consists in
measures calculated to prevent the full and complete
12



126

CONSUMPTION.

transition from nerve-derangement to the secretion of
tubercle and its deposit by the blood in the parenchyma
of organs essential to life; and where the tuberculous
diathesis exists, to obviate all circumstances tending to
promote chest-irritation, excitement, or even undue
activity of the respiratory organs; and where such irritation has arisen, to endeavour to subdue it as speedily as
possible, without having recourse to allopathic measures,
as by thus lowering the reparative powers we should
infallibly favour the general tendency to nerve-derangement and tuberculous deposit. As to the first of these
indications, namely, the preventing the full development
of the consumptive diathesis, precautions should be
most strictly enjoined for the avoidance of all those
circumstances under our individual control which have
been already pointed out as favouring it, and the proper
use of such hygienic and homoeopathic means as may be
reasonably expected to have a converse tendency. It
becomes a matter of great moment to parents, guardians,
schoolmasters, teachers, and others, in the physical
management of young persons, in whom a tendency to
consumption may be apprehended, to use every possible
precaution to obviate determination of blood to the
lungs, as well as undue excitement of the respiratory
organs.  In the first place, the obvious and ordinary
rules of diet, clothing, air, and exercise-which are, however, but too habitually ignored, cannot be too assiduously
followed; though as regards diet, it must, of course, be
nutritious but non-stimulating, in moderate quantities
and at reasonable intervals, so as to avoid the extremes
of exhaustion and repletion, and prevent undue afflux to
the digestive organs, and consequent languid circulation
in the extremities.  Determination to the lungs must



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be guarded against by a careful attention to the temperature and circulation of the surface. Uniform clothing
is an important means to this end; and it must be used
in subserviency to the principal of preventing the sudden
abstraction of animal heat, but not employed to such an
extent as to diminish the activity of those vital functions
upon which the evolution of this caloric depends. Light
woollen clothing should be employed in some form for
the whole of the body below the clavicles, and where
there is a tendency to irritation about the larynx
(evinced by hoarseness and sore throat), a constant
habit of cold sponging the neck should be at once
acquired, and a thin layer of woollen gauze may be worn
round tlhe throat. Where a uniform system of underclothing is adhered to, there will be no occasion whatever
for oppressing the body with a huge load of outer garments.   The same remarks apply to night covering,
though it will not generally be desirable that the patient
should sleep in flannel. The night dress should be calico,
and if there is much coldness of the feet woollen socks
may be worn.
Before quitting the subject of clothing, I must not
omit to again advert to the mischiefs which may and do
arise from severe undue pressure and constraint.  The
apices or upper extremities, are the particular parts of
the lungs first attacked, and therefore, whatever causes
increased activity of that part in either lung promotes
consumption, and this cannot be done more effectually
than by compressing the lower lobes, or divisions of these
organs, by tight-lacing  stays or waist-bands.   The
questions of air and exercise, in the former of which, for
the sake of brevity, I include climate, are at this period
particularly important.  In the case of any young person



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sciousness. In this State of the brain, or celebral organ, the
pupils are uniformly contracted, and there are occasionally incoherence of speech and forgetfulness.
The characteristic peculiarities of Acid. nit. are: drawing pains
in all the limbs-worse at night in the shin-bones and in bed;
cramp-like stiffness of the back, as though the patient had been
in a draught; aching in the knee-joints, which crack and are
painful, as if dislocated; sick feeling in the whole body, with
chilliness and sensitiveness to cold; vascular excitement, or
seething of the blood, and languor with lassitude. A slight
exertion will cause palpitation and partial perspirations. The
patient is always taking cold and having pains in the back;
short, but severe headaches, when the weather changes; excessive thinness and emaciation, especially of the arms; feeling
of faintness, trembling, weariness, and heaviness; tired almost to
death after doing nothing, the limbs feeling paralysed, with a
general want of energy, both of mind and body.
Most of the symptoms of Phos. appear early in the morning.
The patient feels better in the open air; great depression of
spirits.; loathes existence; anxious and irritable; inclined to
start and be apprehensive; frightened, in fact, at his own shadow,
or a "will o' the wisp;" restless at night, and perpetually
dreaming frightful nonsense. There is almost an habitual sense
of oppression at the chest, and pain in the small of the back;
pain in the larynx, with scraping and hoarseness; itching of the
skin when undressed; giddiness in the morning after profuse
sweats; falling off of the hair, with progressive emaciation and
debility.
Of course it is of the highest importance to prevent
any inflammation of the lungs or their appendage, but
where such does occur, it must be treated upon the
natural    principles   I have    already laid   down; the
individual case must be duly studied and investigated,
but, in general, pneumonia may be effectually combated
by Aeon., Phos., and Tartarus, as I have already
explained, and any more trifling irritation, as catarrh, or
13*



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slight bronchitis, by light diet and Bry., Chelid., Lycop,
or Ipecac.
The symptoms of bronchial disturbance which more particularly point to Chel., are-dull and heavy deep-seated pain in the
whole right side of the chest and right shoulder, without much
cough, but with very embarrassed respiration. This pain, which
is at times accompanied with dull beatings in the chest, does not
allow the patient to take a long breath; it is not perceptibly
aggravated by the motion of the arm; the pain is particularly
felt in the axilla, and under the shoulder blade; a sort of numbness of the muscles in the region of the liver, and in the whole
right side of the neck, face, and head; apprehension of threatening pneumonia, great anxiety depicted in the countenance,
constant desire to be stirring and moving, or changing and
adjusting the bed-clothes.
Lycop. will almost invariably afford signal relief when there is
fluent coryza, with cough and hoarseness; stuffing of the nostrils;
formication or ant-like crawling in the windpipe at night; dry
cough in the morning; cough after drinking; cough which affects
the chest; a loose cough with spitting of purulent matter, like
confirmed consumption; short breathing of children; constant
oppression with suffocation on doing the least work; painful
stitches in the left part of the chest, with bruised feeling; beating
of the heart in bed; herpetic spots on the neck and chest; pain
in the loins in bed; stitches in the back after stooping; dragging
in the shoulder blades; stiffness of the nape of the neck; boring
pains in the arms; twitchings in the arms during sleep; dry
skin, and the patient always complains of having lost all strength
in the arms, and having cold feet; moreover, when the cough
is troublesome and materially worse at night, and attended with
thirst, quickness of pulse, subsequent tendency to moist skin,
expectoration grayish, saltish, or yellowish, with oppression
about the bronchial tubes, this medicine is strikingly indicated.
When the symptoms, general and local, indicate an increased determination to the lungs, a few doses of Elaps
or Dig. may be given, or, possibly, dry cupping from
under the clavicles may be of temporary service.'



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Elaps is to be preferred when there is a feeling of a heavy load
upon the breathing function; spitting of dark-black blood, with
constriction and stitches in the right lung; dull aching in right
side of the thorax; worse when moving, with rush of blood to
the chest and throat; painful pulling and lancinating in the right
lung. When the chest symptoms appear to be aggravated by
warmth, such as a warm roomDig. is reflected. There is also present slow and deeper
breathing, with throbbing, as of something alive, in the right
side of the chest; spasmodic asthma for many days; strong
tumultous heavings of the heart; again the heart palpitates;
anon, the beats can with difficulty be felt; slow pulse; expectoration streaked with blood, with spasmodic coughing; anxious
sadness, owing to pains at the heart; bluish lips, with bloating
and paleness of the face.
Blisters must never be applied, nor yet tartaric-emetic
ointment; a far better temporary expedient than either
of them, is the application to the chest of a warm aromatic plaster of frankincense, or Burgundy pitch, or
friction  with  warm   camphorated oil.    Plasters are
usually employed with the view of exciting the action of
the cutaneous vessels, and in a very inactive state of the
skin, accompanied with an irritable condition of the
bronchial membrane, I think them of considerable use,
and accordingly do not hesitate to prescribe and recommend them; they will also often afford much relief in
severe local pains, when there is little probability of
getting rid of their exciting cause; they are yet farther
effectual in protecting the chest from cold. I apply them
by preference between the scapulma or shoulder blades,
because they are less inconvenient in that situation and,
moreover, leave the chest, anteriorly, clear for other
useful applications, such as cold sponging and friction.
The pulse in this stage of the disease is generally very
rapid, and it is important in some measure to control the



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CONSUMPTION.

tumultuous heart's action; for this purpose, Acon., Bell.,
or Dig., will sometimes be most useful, and the lower
attenuations are the best form for the exhibition of them
in these circumstances.     Where there is much       active
irritation of the lungs or bronchia, the Dig. may be advantageously alternated with Chininum Sulph., as there is
at the same time much general debility and exhaustion;*
or Zinc. will be found a most useful medicine, and this
more especially in those numerous cases where the skin
is generally moist; and another most useful medicine will
still be found in Phos., alternately, perhaps, with Sulphur.
If there be much emaciation, cod-liver oil will be of
service, but otherwise it is rarely so in this stage of consumption.    It is not unfrequently at this period that
hmmoptysis occurs, and when it does so, it must be
treated with Acon., Arnica., Ipecac., and Elaps.
Aconitum will have the preference when the slightest attempt
at clearing the throat brings up blood; when the patient feels a
* The characteristic indications for Chininum Sulph. arepressure, lancinations, cutting, throbbing, tension, burning,
pressing asunder, lacerating, drawing, darting sensations. In
alternation with Dig. in those forms of adynamic pulmonary
phthisis with constant profuse purulent discharges; loss of
strength; evening hectic fever, and night sweats. In short, it
must never be forgotten that he who achieves the greatest success
in the treatment of disease has the greatest knowledge of the
materia medica, and ever before him this great truth-that consumption and its complications can only be cured or relieved by
drugs that are capable of exciting derangements in the healthy
organism, the totality of whose symptoms corresponds to the
totality of the phenomena that characterise the natural disturbance. Hence arises the absolute necessity of a constant reference
and study of the pathogenetic effects and clinical indications
which belong to each individual case.



CONSUMPTION.

145

sensation of ebullition in the chest, the latter seeming full, with
a burning feeling; palpitation of the heart; agitation; uneasiness;
is worse when lying down; with an anxious, pale, countenance;
and when the blood comes by gushes, and in large quantities at
a time. Ipecac. may follow Acon., if the latter, which is the
homoeopathic lancet, has checked the hmemorrhage, but there
is remaining a constant taste of blood, with a short cough, discharge of phlegm, mixed with blood, nausea and weakness.
Arnica and Elaps will almost always do good in this alarming
incident, but they are positively required when the blood is very
black and coagulated, and raised easily; accompanied by asthma;
shooting pains and burning contraction in the chest; palpitation
of the heart; pains in the right side; great heat over the body,
with weakness and faintness; and when the blood is raised with
slight cough, is bright red, frothy, mixed with small coagulated
clots of serosity and mucus, accompanied with tickling and
gurgling under the sternum or breast-bone; coughing produces
dreadful shooting pains in the head, with vertigo; and all the
ribs and interior parts of the chest feel as if bruised or lacerated.
They may be taken with advantage every half hour, or less, in
alternate doses, when the symptoms are severe and imminent.
At the same time it must be borne in mind that when
not very great, blood-spitting may be regarded rather as
a bad and formidable symptom, than as, in itself, a cause
of mischief, since it is far from impossible that it may
give some relief to oppressed organs by diminishing the
hypermemia or excessive fulness of blood which occasions
it. It is never desirable or expedient, under any circumstances, to take blood from the arm, or locally by cupping
or leeches, but dry cupping under the clavicles is sometimes admissible; and where it is obvious that one lung is
much more affected than the other, that side may be
selected. If the pulse be very quick, Aconite and Dig.
may be again had recourse to, and should the bleeding
be of such an amount as to become of itself a source of



116

CONSUMPTION.

alarming weakness, threatening death from exhaustion, a
few drops of Spirit of Turpentine may be given and repeated with yelk of egg, and cold applied to the surface
of the chest. The latter, however, is a remedy to be used
with the greatest caution, as there is too much reason to
fear that by the application of ice to the chest, and the
neglect of cautions to prevent the patient remaining wet
with ice-cold water, congestion, pneumonia, and speedy
death may be the consequences of over-much zeal in
checking hbemoptysis in this manner.    When ice is
applied it should be carefully tied up in a bladder, and
its effects upon the general temperature of the surface
carefully watched.  There is good and well-founded
reason for believing that in many cases of this description, tending  strongly  to tuberculization, and
softening of the lungs, the disease has been arrested by
measures such as I have been recommending, and that,
too, in cases where a removal from this country has not
been practicable.
The treatment of the next two stages, those, namely,
of tuberculization and softening, must be essentially the
same, if, indeed, these stages can be often separated,
but the object, in either case is, to allay irritation, and
maintain the vital powers of the system, simultaneously,
and to treat any of the accidents, or complications of the
malady, which may now be expected to present themselves, as they arise.  It will be of great moment to
allow the lungs as great a degree of repose as is consistent with the maintenance of general health, and
particularly to preclude all those circumstances which
might be expected to call upon them for any sudden, or
hurried augmentation of action. This is mainly to be
effected by a uniformly warm temperature. At the same



CONSUMPTION.

147

time, however, in the absence of all the accidents above
adverted to, one must never loose sight of the principle of
maintaining to the utmost, the healthy nutrition of the
patient. The selection, where it is practicable, of such a
climate as will allow of his, or her, passing some time in
the open air, or even taking moderate out-door exercise,
without incurring any considerable change of temperature, or, in fact, of at any time breathing an atmosphere
below 660 Fahr., is a most important means to this end;
nevertheless, where the disease is at all far advanced, or
likely to be very rapid in its progress to dissolution, a
removal to a warmer climate, as the Cape, or Madeira,
must not be entertained-certainly not attempted, or
encouraged, without an express intimation to the friends
of the patient of the extreme doubtfulness of his living
to come back, and therefore one of the genial places in
this country will often be preferred. Even in England,
for many months in the year, it will be quite possible to
obtain fresh air without any violation of the above conditions; and when the external temperature is not below
600. artificial doctoring of rooms should be dispensed
with, and the windows freely opened to the breeze. The
diet should be nutritious, but non-stimulating-mutton,
or white fish, or game, being allowed once, and when
there is much debility, twice in the day. The cases that
are likely to be cured by the stimulating plan of treatment, by beef-steaks and porter, bear so small a proportion to the many that will be injured by it, that I do not
consider it deserving of farther notice in this place.
Many more patients have been preserved by the early
adoption of milk and vegetable diet, with homceopathic
treatment in the country; and there are, I know,
numerous instances in which this regime, hygienic and



CONSUMPTION.

151

sleep; screaming, or moaning, starts wake the patient when
falling asleep, frightful dreams, terrifying and anxious; in the
morning languid and unrefreshed.
Lauroc. is adapted to a soporous condition between sleeping
and waking; sleeplessness, from sad, confused, and frightful
dreams; frequent yawning, without drowsiness; irresistible
drowsiness like sopor, but cannot sleep; excessive languor, with
chilliness and shuddering.
Lamium answers well when there exists a chilliness over the
whole body; heat of the cheeks, with cold hands; sleeplessness
in the early part of the night, from vivid, anxious dreams;
sadness, restlessness, and anguish.
Acon. must be administered when there is nightly delirium.
The patient almost always lies on the back, with a hand under
the occiput, and dreams with a sort of clairvoyance; continued
tossing, as if the patient were in great agony-this is pathognomonic
of aconite-startings in sleep, with nightmare; desires to sleep
after dinner or whilst walking; frequent yawning and stretching;
sometimes rapid respiration.
Con. is indicated by great drowsiness in the evening and
falling asleep late after midnight, and is then sleepless afterwards,
owing to a number of intimidating dreams; weeping and
muttering during sleep, but somnolence in the day.
Phos. is to be prescribed when there is frequent waking in the
night with chilliness, and sometimes from feeling too hot; tossing about, with moaning; feels ill in the morning from not
having slept enough; spasms of the chest; great languor of the
limbs; morning drowsiness, with inclination to vomit and continual eructation; feels paralysed and bruised in the morning,
with frequent yawning, and stupifying slumber in the day-time.
Nux vom. may be given effectually when there is irresistible
drowsiness after meals; excessive drowsiness in the day-time, as
if the head felt stupified; light sleep at night, with frequent
waking; violent starting on going to sleep; frightful visions;
after sleeping is uneasy, with anxious moaning, followed by
diarrhoea, languor, drowsiness, chilliness, dulness of the head,
and, after rising in the morning, some refreshing sleep.
Puls. is most useful when sleep is prevented by ideas rushing



152

CONSUMPTION.

and crowding upon the mind; frequent waking from light sleep;
liability to start; restless tossing about, with intolerable dry
burning heat, jerking of the limbs; yawning and drowsiness in
the day-time; feverish with anxious fancies day and night;
crying out of sleep; full of dreams, with nightmare and distortion of the mouth.
One of the greatest errors committed in the treatment
of consumption, is, in my humble judgment, a too early,
too frequent, and much too habitual use of opium in
large doses. I have often obtained the full effects of an
opiate from four or five drops of the tincture of Coffea,
without, of course, any subsequent inconvenience; indeed, it is always desirable to avoid narcotics of every
ordinary kind, because, as the disease advances, it is
absolutely necessary to be ever increasing the quantity
and varying the preparation; whereas, after all, homoeopathy becomes, even in the last stages, the chief solace of
the patient amidst his multiplied sufferings.  The tincture of Acon., or Bell., in alternation with Coff., Puls,
or Conium, will often be effectual medicines, or either of
the others, (in short, any in the materia medica) that
may, perchance, happen at the time to be most indicated.
If all fail, Morphia may be employed; but when all fail,
there must be " something rotten in the state of Denmark;" for I may, in solemn, sober, and sincerely
truthful earnestness, reassure the reader of this fact-that
homoeopathy has generally succeeded even when allopathy
has signally failed. If Morphia be given, the solution of
the hydrochlorate is the least injurious, and the dose for
an adult may be three drops to ten; for a child it is
dangerous and unsafe-out of the question. In truth,
it is a sorry species of medical art that forces a factitious
stupefaction over the eyelids of a poor sufferer, and in



154

CONSUMPTION.

the same homoeopathic measures must be pursued as
heretofore, and as an adjuvant to the medicine most
indicated, the  cod-liver  oil will  usually be   found
serviceable.  A  nutritious but non-stimulating system
of diet must yet be pursued, though where there is protracted exhaustion the moderate use of sound unsophisticated wine or malt liquor (if such things ARE ex
nubibus) may be allowed     When there is any increase
of cough or expectoration, the Chelid., Conium, Ipec., or
Tartarus emeticus, according to circumstances, may be
again had recourse to, the last of which medicines in the
first trituration will ordinarily, at this crisis, accomplish
much good. When the cough is kept up (and it frequently is) by an accumulation of mucus in the bronchi
and low inflammatory action, possibly, in the parenchyma
of the lungs, and the patient has much nausea and
accumulation of mucus with rattling, a dose or two
of Tart. emet. will often    afford  great and   almost
immediate relief, and save the patient hours of harassing
cough and a restless night.    It is in this stage that
the night sweats are most troublesome, and against
them there is no remedy superior to Zinc., China, or
Acid. nitric, consecutively, or Hyos. in    alternation;
the last is to be preferred if there be grasping at flocks,
moaning, sleeplessness, with anxiety, or starting from
sleep.
Acid, Nitric, is indicated when there is a sense of great debility
and weariness in the lower limbs the whole preceding afternoon,
as after a long journey on foot, with sick feeling, dread of movement, drowsiness, chilliness, and very sickly appearance, a peculiar debility with rigidity in the calves, feels weary, feeble, even
hungry, yet could not eat; debilitated even to tremulousness,
with fear and apprehension; sensations as if the body, sometimes
the whole frame, but especially the face and head, expanded, as



156

CONSUMPTION.

Arsenicum, where there is much thirst, restlessness, heat
of skin, or hectic flushing, and the bowels are irritable,
may be administered in small doses, and a little Acon.
for the fever, or Hepar for shortness of breath, given at
night, or alternately, night and    morning.     However
decidedly active may be the inflammation, no leeches
must, under any pretext, be applied or any quantity
(large or small) of blood be removed by cupping.
Hlemoptysis, when it occurs, must be treated in the
manner I have already recommended.
Sickness or vomiting is often, though not always, a distressing incident in consumption; it is generally, however,
the effect of some abdominal complication, such as tuberculous disease of the glands about Glisson's capsule or
mesentery; it may be frequently counteracted with good
effect by Ipecac., Antimon., Crud., Tartarus, Elaps, Arsenicum, Nux or Cocc.* to which may be added, if neces* In this complaint the probable causes ought to be taken into
due consideration, and the remedies selected accordingly. Not
unfrequently the feeling of sickness disappears of itself after
vomiting, therefore it may be sometimes proper, in cases of indigestion, to promote it moderately by giving tepid water, or coffee
without milk. When the tongue is much coated, white or yellow,
Ant. C. is best to be given; or, when the tongue is clean, Ipec.
Sometimes vomiting, or sickness and nausea are caused by improper aliment, by overloading the stomach, or by taking cold;
then, Nux V. will be serviceable. When connected with headache
and giddiness, caused by riding in a railway train, or a carriage,
or on a steamboat, Cocc. will be appropriate. Vomiting from
weakness of the stomach occurring after every meal, is often cured
by Ars. and Tart. Stib., given alternately, with an occasional
dose of Nux. Elaps will be beneficial when the stomach is so
weak that only very little food can be taken at a time, and the
least sense of repletion causes vomiting with spasms, cutting
pains in the bowels, or giddiness with diarrhoea, weakness of the
limbs even to fainting.



CONSUMPTION.

157

sary, effervescing draughts of soda-water, seltzer-water,
given in small quantities at a time; or where there
is much irritability of the mucous membrane, as manifested by redness of the      tongue, by restricting   the
patient for a time, at least, to the use of milk and limewater in the proportion of a dessert-spoonful or so of the
latter, to a tumbler of the former, and giving also at bedtime if unrelieved a small dose of Bell. applying at the
same time a plaster of Bell. to the pit of the stomach or
epigastrium.
Diarrhoea is another very troublesome symptom, and
in particular towards the termination of phthisis, it
occurs, however, not uncommonly, as we have seen, in
the more early stages, when it is, in all probability,
excited  by allopathic   medicines, or   other   irritating
matters in the alimentary canal; under which circumstances, Rheum, Chamomilla, Acid. sulphur., Arsenicum, will be appropriate and useful selections.
Rheum is indicated by sour, thin, slimy, fermented diarrhoea,
that namely, so common with children when they cry from pain
and anguish in the bowels, are very uneasy, and draw up their
legs.
Chamom. is appropriate also as well as for grown-up persons
particularly, when the evacuations are green, watery, hot and
offensive, with bitter taste in the mouth, bitter eructations, bilious
vomiting, fulness of the pit of the stomach, griping and headache.
Acid. sulph. is to be given for diarrhoea, which is so acrid as to
occasion soreness in the bowels, and the parts around the anus,
or to produce cutaneous eruptions like millet-seeds, frequently
accompanied by great emaciation, or in young persons by a hard,
distented abdomen, when every fresh indiscretion, or exposure
to its exciting causes, renews the relaxation of the bowels. It is
also serviceable after the failure of other remedies.



160

CONSUMPTION.

bowels augmented by pressure, scanty urine, and most distressing tenesmus, or bearing down.
Merc. corr. is one of the chief medicines in obstinate diarrhoea
or dysentery, when attended by much straining and colicky
pains; where, in the beginning, a large quantity of bile is discharged, and afterwards blood and mucus. If there is improvement after the first dose, which does not continue, repeat the
medicine; if it gives no relief, refer to the other remedies, particularly to arsenicum.
Bry. often answers well in diarrhoea arising from drinking cold
water, or from taking cold, or from eating more than can be
digested; likewise when purging sets in immediately after meals,
or when it is produced by mental irritation, if Chain. fails.
But when the diarrhoea continues obstinate, under
these circumstances, stimulants and allopathic astringents only aggravate and increase it; while a mild diet,
consisting chiefly of farinaceous food, such as the best
rice, arrow-root, and sago, soups, milk, and light animal
food, diminish it, and even prolong the patient's life.
The diarrhoea depends upon diseased bowels, and internal
ulcerations forbid the absurd and injurious practice of
loading them with huge quantities of chalk mixture, kino,
logwood, catechu, and stimulating aromatics, and emphntically bespeak a mild regimen, and soothing homoeopathic
medicines. Ipecac. in the form of two grains of the fresh
powdered root combined with half a pint of gum-water,
and administered in doses of a dessert-spoonful after
every loose evacuation, forms a very useful medicine, both
in diarrhoea and other symptoms of consumption to which
it is homoeopathic, such as blood-spitting, vomiting, difficult breathing, bronchitis, catarrh, coughs and colds, and
the like.  I may observe, in conclusion of this subject,
that a lavement of starch and opium frequently suspends
the diarrhoea in intractable cases for a considerable time,



CONSUMPTION.

161

and occasionally produces sleep more effectually than any
other remedy.  Pain and tenderness in the abdomen,
with lancinations as of knives, arise from tuberculous
peritonitis, or, as it is more commonly called, abdominal
phthisis, it may occur at any period, though it is sometimes itself the elder of the two diseases, and sets in as
follows:
The appetite of the young person becomes capricious;
there will often be an unwillingness to take food, alternating with an almo st insatiable craving, erroneously
attributed to worms, the complexion becomes doughy,
though the cheeks may possibly retain their color for
some time. He or she, as the case may be, then begins
to lose flesh and emaciate-the abdomen becomes swollen
like a tub-there will be flushings of heat towards night,
generally speaking, when there will be a bright, welldefined flush upon one cheek. The bowels are mostly
irregular, the motions sometimes dry and friable, at
others very relaxed, and almost always pale. The urine
is loaded with lithates, or pink deposits, and a stain of
purpurine at the bottom of the chamber; previously to
this, however, I may say that there will have been some
headaches, bad colds and swelled glands-marks of the
tuberculous diathesis. On inspecting the tongue, it will
be found covered with a creamy coating, through which
the elongated red papulme will conspicuously protrude
themselves; the breath will be observed sour and offensive; if these incipient signs of consumption be not
arrested by the proper homoeopathic treatment, the emaciation will increase, the abdomen enlarge, and effusion
take place into the peritoneal cavity; frequent attacks of
diarrhoea, pus, or blood, or both, being present in the
evacuations; hectic increases, and the young person is no
15



162

CONSUMPTION.

more, having sunk from exhaustion-such is abdominal
phthisis.
The treatment, to be effective, must be prompt and
skilful, and the diet singularly appropriate; milk, beeftea, the gravy of roast meat, or meat itself carefully
cooked, with    light farinaceous articles.    The counteracting medicinal agents will be found in Zinc., Phosphorus, Kali. Hydriod., Acid. Nitric., and Sulphur.
Sulphur is indicated when the bowels are irregular, generally
costive, but occasionally relaxed and irritable. The child has a
nasty, dry, hacking, troublesome, spasmodic sort of cough; remains feverish and drowsy towards evening, but generally seems
very well in the morning; the appetite is variable; the pulse
ranges from 100 to 140, and the tongue is loaded. There is
great languor and depression of the vital powers, and extreme
irritation of the bronchial membrane. Sometimes this stage of
incubation presents all the outward and visible marks of phthisis,
wearying, fatiguing cough, profuse purulent expectoration (which
in childhood is swallowed,) wasting and night-sweats; but yet
it is curable by dynamised Sulph. There will probably be considerable solidification of the upper lobes of one or both lungs,
but no pectoriloquy possibly, or signs indicating a cavity or
vomica.
Next to Sulphur we have Acid. nitric, which is characterised by
symptoms of a disturbed mucous membrane, and deranged digestion, such as canine hunger and voraciousness alternating with
entire loss of appetite, sour alliaceous or garlic-like smell from
the mouth, flatulence, worms, colic, cramps and spasms, alternate
costiveness and diarrhoea, with slimy, greenish, stir-about stools,
slimy, turbid, and milky urine. The skin is almost always full
of sore places; it feels cold and harsh; albeit, there is in some instances a very peculiar satan-like condition of the skin, which
betokens a serious abdominal complication, viz.: fatty degeneration of the liver; the pulse is sluggish, anon very hasty. Nosebleed is very frequent; the teeth and bones cease growing, but
scarcely ever cease aching; the muscles are flabby, weak and



164

CONSUMPTION.

ing, tickling irritation in the larynx, quick, anxious, laborious
respiration, with raucedo, or hoarseness, slight occasional abdominal pains, often scarcely noticeable, but at the same time, most
insidious, dangerous, and fatal in their ultimate result. They
are augmented by pressure; fulness and tension of the belly,
particularly a deep-seated tightness as if the integument and muscles glided over the too tightly stretched and thickened peritoneum or serous membrane, which lines the interior of the
abdomen; coughing and deep breathing are painful, and there is
feverishness with emaciation.
Zinc. is indicated by coryza, coughing followed by nausea,
tendency to perspire night and day; the bowels feel, and literally
are, glued together, flushings of heat, motions dry, hard, and
friable, intense nervous anguish, and mental depression, uneasiness about the stomach, abdominal pains, particularly increased
after meals, sense of constriction in the lower part of the neck,
dyspepsia, eructation with metallic taste, vomiting of food, or
purging of mucus, streaked with blood, or pus; skin dry, pulse
accelerated, tongue loaded with yellowish or whitish fur, red at
tip and edges, and dotted with red patches, collapsed face, pewter-like, distended abdomen, hypochondriacal spirits, in short,
the hatching of a decline and fall.
Not unfrequently, however, in this case also, one drop
of the juice of Conium, or of the lower attenuations of
Bell., together with the application of a plaster of the
latter or a few doses of Arnica, possibly, and the employment of an arnicated poultice (made by immersing a linen
rag in arnica-lotion, and covering it with oiled silk to prevent evaporation), or a poppy fomentation and the common linseed-meal, will, in general, realise our wishes and
expectations eminently well. The juice of Conium, which
I employ, is prepared in the following manner: Take of
fresh hemlock leaves any quantity-express the juice in
a tincture press, set it aside for forty-eight hours, pour
off the clear supernatant liquor from the fecula and



CONSUMPTION.

165

chlorophylle, which it has deposited; and lastly, add to
it a fifth part by measure of rectified spirit. This preparation I can strongly recommend (having employed it for
twenty years) in all instances in which it is homoeopathic;
it will, moreover, keep admirably well for a couple of
years, and is really a most useful medicine in consumption-its uniform strength (in a material sense), as well
as the facility with which we can increase or diminish
the dose, according to the susceptibility, or otherwise, of
the individual patient, give it, according to my observation and experience, a decided advantage over many
other preparations, or the extract, or powder, of the fruit,
or leaves.  The best time for gathering the leaves is
when the plant is in full flower, and previous to submitting them to expression, the stalks should be carefully
picked out and rejected, the leafy part alone being used.
It must not, however, be supposed that because I speak
favorably of the juice of Conium (as I would, indeed, of
the Spirit of Camphor), that I do not approve of the
higher attenuations; on the contrary, in the matter of
dose I am thoroughly eclectic, and my prescriptions range
almost daily from the matrix or mother tincture, as it is
called, to a pilule or globule, of the third or sixth dilution;
and I may truly affirm, that I have as much well-grounded
confidence in the sterling efficacy of either of the latter
as of the former, and vice versa, when appropriately indicated by existing circumstances. What, we have now
inquired, can homceopathy accomplish against pulmonary
phthisis, or rather what has she already accomplished?
According to unbiassed and faithful observations, she has
accomplished a vast amount of unmixed good, and does
not shrink from close comparison with her unfriendly
sister, because in numerous instances, where the latter
15*



166

CONSUMPTION.

was worse than powerless, and acknowledged to be so by
her own disciples, the former restored the patients to
health-nay, perfect health. Homoeopathy, therefore,
has just (and according to the new " Medical Act,")
legitimate, lawful claims to that due respect and consideration which is now conceded to it-as to a "great
fact."
I will next enumerate the various medicines which
have performed cures, or, if preferred, expedited natural
recoveries, in cases of consumption, and in how many
each was successful when homceopathically indicated
in individual cases, placed on the records of our literature.

Times.
Arsenicum.............. 22
Bell......................... 23
Bry........................ 35
Cale..................... 48
Con....................... 67
Carb. v.................. 22
Chin.......................   26
Dig.......................... 87
Dulc........................ 21
Dros...................... 21
Ferrum................. 25
Hyos.......................  37
Kali carb..................   46
Lycop..................      32
Laurocer.................. 11
Ledum p................ 13
Mere...................... 21

Times.

Nux vom..................
Nitric acid...............
Petrol.....................
Puls........................
Plumb....................
Phos........................
Phos. ac..................
P lat........................
Sepia..................
Silicia......................
Stram....................
Samb......................
Sulph....................
Stannum................
Staphys................
Zinc...................

12
31
49
25
17
66
32
27
17
11
36
12
53
26
12
76



CONSUMPTION.

167

It is now well known to the profession that an increase of weight is a pretty constant sign of improvement in consumptive cases, treated with Oil.  It occurred in 70 per cent. of the patients at the Brompton
Hospital for Diseases of the Chest, while in 21 per
cent. there was loss of weight, and 9 remained stationary
out of the 100.   Oil adds to nutrition. Here then
we have facts proving the utility of oils as nutritive
agents, but do they exert any farther influence?  There
can be little doubt that they do, and it is by no
means improbable that by adding an oily ingredient
to the low organization of tubercle, the vitality of the
latter is possibly augmented.  I may remark, moreover, that painstaking experiments have been made
upon healthy animals which proved the fattening properties of cod-liver oil, to the extent of thousands of
instances.  These experiments are of considerable importance but, as I take it, even cod-liver oil is beneficial in consumption, because it is an oil, indeed, in
process of time. I make no doubt, that the whole
matter will resolve itself into a question of cookery,
rather than pharmacy, and that it will be quite sufficient
to enjoin upon one's patients, in these circumstances,
the wholesome necessity of taking an unusual supply
of good fat Gloucestershire bacon and butter; certain
it is, that I already know of numerous cases, which
warrant this expectation and belief. But a still more
important effect of oily matters, even homoeopathic
cocoa, on the human blood, has been observed, for under
their protracted use, the fibrin, that is, the tuberculous
element of consumption in the blood, diminishes, and
the healthful red globules increase, as may be seen by
the following table:



168

CONSUMPTION.

RED GLOBULES IN HUMAN BLOOD.
Increased by              Diminished by
Plethora,               CONSUMPTION,
Iron,                      Bloodletting,
Cod Liver oil,             Anemmia,
Cocoa,                     Scrofula,
Train oil,                 Diabetes,
Neatsfoot,                 Cachexia,
Linseed, Almond,           Abstinence.
or Olive oil.
Amongst other homoeopathic remedies, iron exerts a
very powerful influence on the blood, augmenting the
number of red globules from forty to ninety, as in
Andral's experiments.  But it exerts no influence on
the tuberculous element of consumption in the blood,
the fibrine, and is therefore less valuable than oily
ingredients. Other medicines of constitutional action
find their place in the great variety of cases we are
called on to treat, and amongst these may be mentioned
alkalies, to the extent of small doses of Lime water,
and Liquor potassce, or solution of potash. Opium and
other sedatives have also a systemic action; and it is
well, perhaps, to remember, that in allaying severe
coughs, its mode of operation is entirely two-fold;
firstly exerting an influence on the nervous irritability
of the bronchial membrane, and secondarily diminishing
the requirements of the blood for respiration. It may
be very fairly questioned, again, whether galic acid and
oxide of zinc, which rapidly diminish sweating in some
persons, do not act much rather through the nervous



CONSUMPTION.

171

gather from every quarter; and suffer not the alleged incurability of consumption to pass unimpugned. Hitherto
has this error (perniciously promulgated by influence and
authority) been left well-nigh undisturbed, paralysing
the best energies and exertions to cure by classing the
disease in the category of utter hopelessness and despair.
Cheerfully resorting to every practice which science and
observation commend as sound and salutary, let them
not forget that from age to age the great spirits of the
world, the ardent and deathless followers of truth,
whether in science or in ethics, have uniformly been
the calumniated few, but press onward to the achievement of other and yet more ennobling triumphs-well
knowing that there shall be but one true art of healing,
as there is but one Hope, one Faith, one Life, and one
great Physician. Let us be grateful for that knowledge
which Providence has already vouchsafed to shed over
our path, the great principle, which, like a stone thrown
into a lake, is spreading its ripples throughout the earth;
and ever earnest in our endeavour for what light or help,
patient, industrious, honest observation of nature may
hereafter bring; till pure and unmixed TRUTH itself,
clothed in her own spotless and unsullied chastity,
shall have descended amongst us in all the glory of its
divine lineage, and won the homage of our hearts, as
its irresistible and heaven-born birthright.



APPENDIX.

1;7

simply. They are useful cough drinks, and allay the
tickling which excites cough in catarrh and consumption,
and are also useful in diarrhoea and dysentery; they
are, of course, merely palliatives, having no healing power
to cure; the proper homoeopathic medicine must accomplish that desirable end. The dose of mucilage may be
a small spoonful, or more, frequently repeated, as it is
quite nutritious.
Nitric lemonade.
Take of Acidum nitricum, twelve drops; pure water,
one pint; refined sugar and honey, according to taste.
I have prescribed this remedy with singular success as
a common domestic beverage in sickness from chest
diseases, consumption, hooping-cough, asthma chronic,
bronchitis, cutaneous affections, and hoemorrhage from
the bowels. According to Hahnemann, it has been used
by him with great efficacy in "fetid smell, fetid urine,
constant coldness, cold feet, and night sweats. I can
fully confirm this statement of its value also-in fact it
is homoopathic and that is sufficient. The dose may vary
according to age, from a tea-spoonful to a wine-glass two
or three times a day.
Cold lotion.
Take hydrochlorate of ammonia, one drachm (in common vernacular Sal ammoniac); water, half a pint;
spirits of wine, two table-spoonfuls. Mix.
This cooling application may be advantageously employed in headache, to abate the pain and heat of inflammation of the brain or its membranes, arising from
tuberculous deposit or other causes.

16*



178

APPENDIX.

Honey of borax.
Take of Biborate of soda, powdered, a drachm; clarified best honey, an ounce. Mix them.
This is a useful, cooling, detergent application in the
sore mouth and tongue of phthisis-aphthous affections,
as they are called. Dissolved in water, it forms an
excellent wash for allaying the pain attending allopathic
salivations, or rapid mercurialization in phthisis.
Decoction of poppy.
For a poppy fomentation take of the capsules of the
white poppy, or "poppy heads," four ounces; water,
four pints. Boil for a quarter of an hour, and strain.
In making this decoction the seeds should not be rejected, because they contain a considerable portion of
bland oil, which added to the mucilage and sedative principle of the capsule increases the emolient or soothing
quality of the decoction. It is a very useful fomentation
in persistent local pains or swellings, and in the excoriations produced by the acrid discharge of bed-sores, and
those common to infancy and childhood.
Decoction of barley.
Take of pearl barley, two ounces; water, five pints;
first wash away any extraneous substances that may
adhere to the barley; then having poured on it half a
pint of water, boil for a few minutes. This water being
thrown away, let the remainder be added boiling, then
boil down to two pints, and strain. In habitual constipation, or protracted torpidity of the bowels, add to these
two pints, two ounces of sliced figs; half an ounce of
sliced liquorice root: two ounces of best raisins (stoned);



APPENDIX.

179

water, a pint; and boil down to two pints, then strain.
The preparation of barley-water is generally intrusted to
nurses, charwomen, and servants, who know nothing and
care less than that (if possible) about the domestic
management of a sick chamber; but the lady of the
household ought not, I conceive, to be unacquainted
with the best manner of making it, as her directions may
not unfrequently be necessary.  It is an elegant and
useful demulcent in cases of hectic fever, consumption generally, and in strangury, given as a drink ad
libitum.
CONCLUSION.
From a careful study of the symptoms, causes, morbid anatomy and histiology, or microscopical examination
of the nature of consumption, I may venture to reassure
the reader of this irresistible conclusion, that it is primarily a disease of the nervous system. A derangement,
par excellence, of the nerve-globules; the fons et origo
of nervous power causing-firstly, indigestion, and consequent mal-assimilation of the food, and impoverishment
of the blood, accompanied with an excess of acidity in
the alimentary canal (temporarily mitigated by dropdoses of Kali purum or solution of potass in milk);
secondly, local exudations which present the abnormal
and unhealthy characters called tubercle; and thirdly,
owing to the successive formation and softening of these,
and the ulcerations which follow in the pulmonary and
abdominal tissues, those destructive results denominated
respectively thoracic and  abdominal phthisis.   Enlightened observation and extensive experience will, I



180

APPENDIX.

believe, soon show, also, to the public at large, that
homoeopathic treatment which removes this nerve-derangement and mal-assimilation of food, checks farther
tubercular exudations, diminishing at the same time the
cough, expectoration and emaciation, while those which
previously existed become altogether abortive (as already
attested by numerous drawings in my possession taken
from nature in cases of death from other causes); and
that not unfrequently extensive excavations in the pulmonary tissue may, owing to like circumstances, heal up
and permanently cicatrize. Since my adoption of modern
therapeutics, I have witnessed this notable amelioration
in numerous instances, in cases, too, where allopathy was
not only useless but positively hurtful, and was discontinued accordingly from sheer necessity; one patient, in
particular, having been ordered by her physician-a wellknown baronet--" to amuse herself," to take a "nourishing diet" with tonics, and go at once into a foreign
country (Provence); and I am far from astonished, since
she laboured under all the physical signs of advanced
consumption, with the addition of profuse fetid bronchial
catarrh, weakness of sight (amaurosis), an ulcer in the
nose, with cancer of the nostrils, discharging an intolerably offensive, purulent, bloody matter, which, with the
other symptoms, gradually, yet slowly and surely, yielded
to the genial and harmonic influence of Glanderine and
Farcine, alternately administered. And our opponents
may depend upon it that if pain and human woe continue
to be relieved by homoeopathy, the emancipated sufferers
will continue to persist in preferring homoeopathic, if
"heretical," ease to allopathic, if "orthodox," anguish.
In the words of Goethe" DIETH HE WHO STANDETH STILL.



INDEX.

AcAcIA mucilage..........................176
Air......................................... 71
Allopathic preventives..................107
Almond emulsion........................176
Andral, M............................  9
Aphtha................................. 42
Appendix.................................173
Appetite.....................................161
Atrophy....................................... 13
Autenreith, Dr........................... 89
Auxiliaries, household...................173
BARLEY decoction..........................178
Bathing of children....................... 70
"  in consumption................  130
Beddoes, Dr..................................110
Blisters..................................143
Blood globules.............................167
S  spitting.........................32, 145
Bowels, ulceration of...................158
Breathing, difficulty of............... 30
Brompton hospital........................    3
Bronchitis.................134, 141
CARSWELL, Sir Robert....................     9
Case of John Keith...................... 99
Cases.....................................113, 122
Cataplasm    of mustard..................174
powder for....................174
Chest, form   of the.........................  2
S  inflammation of............... 33
"  pain in.............................. 33
Clark, Sir James.........39, 109, 111, 112
Climate...........................128, 139, 140
Clinical frcts................................113
Clothing................................... 76
Cod-liver oil.................................167
Cold lotion..................................177
Commencement of consumption......            1
Complications............................155
Concluding observations................179
Constipation................................132
Consumption cured and post-mortem................125
6         origin of............       1
"         prevention of........... 49
Consumptive cough....................... 25
Cough.......................................  29
S consumptive....................... 25
"    gastric............................... 27
S stomach.............................. 27
Curability of consumption............. 92

DzcocTIoN of barley.....................178
"      of poppy.......................178
Detection of consumptimn............... 92
Diagnosis of consumption............... 92
Diarrhoea...........................38, 157-160
Diet in consumption.....................147
wigculty of breathing.................. 30
MoFtos.... #....................125................. 103, 104
S g..........................121, 122
S s of chil s.................. 70
Dyspnoea..................... 30
EARLY stage of phthisis................. 22
Education................................   78
Emaciation............................39, 144
Exercise.............................. 75
"     of the chest.......................  v
Expansion of the lungs..................128
Expectoration........................... 30
FEVER, hectic................................ 35
Fibrin........................................  7
Form   of the chest.........................  2
Fistula...............................139
GENERAL treatment......................102
HIEMoPTYSI................................. 32
Hectic fever................................ 35
IHeyfelder, Dr.............................. 46
Homoeopathy...............................103
Honey of borax..........................178
INCTPIENT consumption.................. 23
Indigestion................................ 28
Inflammation............................. 33
S    of the lungs............. 23
Infusion of linseed.......................173
Inhalations.........................175, 179
KINESIPATHY................................. 84
LAST stage.................................158
Legitimate medicine......................104
Lemonade, nitric...........................181
Linseed, infusion of....................173
Lotion, cold................................182
Louis, M..................................... 39
MARRIAGES, improper................... 53
Med icines for consumption............166