&-.*-< 
 
 *9t 
 
 
 
 
 UNITED STATES OF AMERICA. 
 
ERRATA. 
 
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 15, Line 7, for "natura," read naturae. 
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 22, Line 8, for " loose," read lose. 
 22, Last line, for " is" read he. 
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CONSUMPTION 
 
 CURABLE, 
 
 PRACTICAL TREATISE 
 
 TO PROVE 
 
 CONSUMPTION 
 
 A MANAGEABIE DISEASE : 
 
 WITH CASES SUCCESSFULLY TREATED, UNDER A NEW MODE IN THIS 
 
 COUNTRY. 
 
 BY 
 
 ,^ * 
 
 J. ST RO>E, M. D 
 
 "Nature as well as art, operates to this end." 
 
 PHILADELPHIA: 
 
 CROLIUS & GLADDING, 
 
 No. 341 Market Street above Ninth. 
 
 J. G. AUNER, 
 
 No. 343 Market Street, above Ninth. 
 
 MDCCCXLI. 
 
Entered according to the Act of Congress, in the year 1841, by 
 J. S. ROSE, M. D., 
 in the Clerk's Office of the District Court in the Eastern District 
 of Pennsylvania. 
 
 
 PHILADELPHIA : 
 KING AND BAIRD, PRINTERS, 
 
 No. 9, George Street. 
 
PREFACE. 
 
 What I now offer is an unprejudiced theory, 
 confirmed by happy success in practice. And this 
 I think must ever be the most effectual method to 
 arrive at truth. 
 
 I am sensible of the force of prejudice, and also 
 the many difficulties attending an attempt to 
 eradicate long established errors, though supported 
 by men of fame. Yet I have ventured on the 
 task, and in obedience to duty and truth, have 
 pointed out many absurdities in practice, which 
 must appear evident to every candid and unpre- 
 judiced reader. 
 
 But it must be remembered by all, that in 
 pointing out the result of errors we do little, — if 
 we fail to amend them. This has been my chief 
 object ; and if writing what I must consider strictly 
 true, be not a breach of modesty, I am decidedly 
 
PREFACE. 
 
 of opinion, that this treatise will contribute more 
 to the welfare of my fellow creatures, than any 
 book I have seen or heard of on the subject of 
 consumption. 
 
 Where, I may ask, would surgery have looked 
 for its improvements, had not the gigantic minds 
 of Hunter, Bell, Home, Abernethy, Physic, 
 Dorsey, Lawrence, and Parrish, with a host of 
 others, among the departed, rendered clear the 
 supposed mysteries of nature's- operation in the 
 cure of disease, and by a well-timed application of 
 art, shortened and speedily removed the cause of 
 suffering ? 
 
 The discoveries of these great men are too well 
 known to need repetition here. 
 
 Happily there are those among us still who 
 possess the same zeal for research. Soon after 
 the great operations of M. Heurteloup, Leroy, and 
 Civiale, for the destruction of calculus in the 
 urinary bladder, we found many of our American 
 surgeons performing the same operation. The 
 success of Randolph, McClellan, Gibson and others, 
 is well known. 
 
PREFACE. 5 
 
 The division of tendons for the cure of deform- 
 ity, was looked upon — but a few years ago — 
 as an operation impossible ; but after Delpech had 
 cut the tendo-achillis, and cured club foot, the 
 division of tendons was soon considered not only 
 safe, but indispensable for the cure of deformity. 
 Dr. Mutter, of our City, is now almost daily 
 performing this operation with perfect success. 
 Dr. Togno, however, deserves, in my opinion, the 
 credit of introducing this operation to Phila- 
 delphians. 
 
 The daily papers of 1836 or 7 contained a hoax, 
 that was then considered as ridiculous as the great 
 moon story of New York. They asserted that 
 a Physician would spend the summer near the 
 springs at Saratoga, who could cure squinting. 
 In conversation with a medical man in our city, 
 with whom this matter was discussed, he ex- 
 claimed : This cannot be, " Till Birnam wood 
 remove to Dunsinane." 
 
 To continue the language of Shakspeare, we 
 
 may add, " And now the wood doth move/' for 
 
 this operation has been performed on more than 
 
 1# 
 
6 PREFACE. 
 
 four hundred persons by Dr. Grossman, with 
 perfect success, — not requiring for each case more 
 than from five to twenty seconds. 
 
 After all these facts, staring us full in the face, 
 I cannot imagine it will be found difficult to 
 believe, what has heretofore been considered 
 doubtful, the curable nature of consumption. 
 
INTRODUCTION. 
 
 It may appear somewhat curious to many of 
 my readers, when they find that in my first 
 attempt at authorship, 1 have selected a subject 
 that will doubtless be received by many as 
 fiction. The constant assertions of most, if not 
 all of the distinguished members in the medical 
 profession, as well as some of the most learned out 
 of it, has been " Consumption cannot be cured." 
 What ! cure Consumption ! take down the very 
 peg upon which the medical profession have 
 always hung their apology for failure, in the cure 
 of disease? Yes, even so! The lawyer twists 
 and turns in every way, when he is cast in a case 
 at the bar, to form some excuse to his client, and 
 finds a variety : such as, you did not tell me that 
 or this fact before ; or, you should have had the 
 other witness here, — or, the judge was partial — or, 
 perhaps he knew no better; and we must try to 
 have him removed from the bench, &c. &c., thus 
 
8 INTRODUCTION. 
 
 satisfying the client. But the physician declares, 
 that tubercles existed in the lungs, or abscess, or 
 bronchitis, or adhesions, or enlargement of some 
 important bloodvessel, or great disease of the 
 heart, or its enlargement, were sufficient to cause 
 death. I admit they are — but I shall show and 
 clearly prove to the unprejudiced reader, that 
 these diseases — although sufficient to cause death, 
 if erroneously treated, or left to themselves, or 
 sent to other regions, North, or even South, — can 
 be cured as easily as fever, inflammation, rheuma- 
 tism, dropsy, or any other of the vocabulary. 
 
 Members of the medical profession, — myself 
 among the number, — have too often been content 
 to follow the dictates of others, without the least 
 effort to mend their practice, or substitute a 
 better. 
 
 The cure of disease or the restoration of a 
 patient to health, does not always depend on this, 
 that, or the other nostrum, the swallowing of large 
 or small mixtures, or plastering the surface with 
 blisters, poultices, or suchlike things, or increasing 
 the violence of remedies in the sinking stages, 
 until the last lingering ray of hope is extinct. In 
 this state of things, the physician of judgment rests 
 on his oars, with his anxiety excited to its highest 
 
INTRODUCTION. 9 
 
 pitch, watching the operations of nature, and 
 viewing his patient and disease — as two animals 
 exhausted by combat. The one or the other must 
 now yield. That tranquil face, that composed 
 countenance, inspires a hope ; let no rude gossip, 
 now disturb the quiet of the becl-side, and all will 
 be well. 
 
 That smile which plays there great assurance gives, 
 He sleeps — disease is prostrate, and he lives. 
 
 But in this state of emergency, the friends 
 will be soliciting consultation ; yield to it by 
 all means — and if you are satisfied, from what 
 you have seen, that the case must terminate 
 favourably, make this statement to your medical 
 friend, and he will assist you in holding fast on 
 that confidence the family repose in you, which is 
 so very requisite for your success in the treatment 
 of all their diseases. In large cities, we possess 
 advantages that are never enjoyed by our medical 
 brethren in country practice. Here we cannot go 
 amiss, — the talent, experience, high-minded, and 
 honorable character of the medical profession, 
 invite consultation. But should consultation be 
 requested by partial strangers, and not be proposed 
 by the patient, or some deeply interested friend, or 
 
10 INTRODUCTION. 
 
 member of the family, resist it, or decline attend- 
 ance, unless you are decidedly at a loss how to 
 proceed in the case. 
 
 In consultation you may gain golden opinions, 
 you may find many, who possess by genius, what 
 others have obtained by hard and constant study. 
 Cnvier remarks, that it is the privilege of genius, 
 to see in its dreams, what the humbler race of men, 
 can ascertain by laborious vigils, and accumulated 
 researches alone. 
 
 And again, Professor Chapman observes: "as 
 well might we compare the mere fluttering of the 
 meanest and most grovelling bird, with the bold 
 and well sustained flight of Jove's own imperial 
 eagle, as the slow process of a vulgar intellect, by 
 which facts are collected or observed, with the 
 vigorous sallies of speculative genius, which seize 
 truth as it were by intuition, and reveal it in a 
 burst of light of celestial brightness." 
 
 Although the medical libraries of most men, 
 contain many volumes upon the cause, nature, and 
 treatment of Consumption, little has been done, to 
 put either the pathology or therapeutics of the 
 disease, on a satisfactory basis, — its treatment, 
 therefore, though variable, is by no means suc- 
 cessful ; to remedy this state of things, and place 
 
INTRODUCTION. 11 
 
 Consumption on the list of curable diseases, has 
 been my aim for many years, — and by this treatise 
 I shall give to the public at large, a list of cured 
 cases, with their history and nature, known only 
 heretofore in my private practice. I have delayed 
 this work for the purpose of establishing beyond a 
 possibility of doubt, the truth of what I now 
 assert, Consumption can be cured. 
 
 The mortification and degradation I feel, at the 
 utter inefficiency of our art, in this the most com- 
 mon of all diseases, is in itself sufficient stimulus 
 to the work I am now engaged in, — but I have a 
 higher object, that of mitigating human suffering, 
 — to this end I have labored for years, " and what 
 I conceived my duty, has been my reward." 
 
 The vast number of cases that die annually in 
 this and other countries through Consumptive 
 disease is a melancholy truism, although its extent, 
 familiar as it might appear, is very little known. 
 The common estimate gives one fourth of the 
 deaths, which annually occur as consequent on 
 Pulmonary Consumption. But it will be seen by 
 reference to our statistics that this is incorrect. 
 And that when we add to our estimate the many 
 diseases that emanate and finally terminate in 
 
12 INTRODUCTION. 
 
 Consumption, we shall find the number vastly 
 increased. 
 
 Though much attention has been bestowed on 
 this subject, by many distinguished European 
 authors, Laennec, Andral, Louis, and many others, 
 we find little certainty arrived at in the treatment 
 of Consumption, until Professor Ramadge, ot 
 London, declared to the world its curable nature. 
 When his work appeared I determined to stem the 
 current of public opinion on this side the Atlantic, 
 and prove what I have long asserted in private 
 practice, that the general treatment relied on in 
 this country is inefficient, and its result always 
 uncertain. Dr. Young, of St. George's Hospital, 
 says : " it is probable that without assistance, not 
 one case in a thousand of the disease would re- 
 cover ; and with the utmost power of art, perhaps 
 not more than one in a hundred will be found 
 curable." Now out of one hundred and twenty 
 seven cases treated by me in the last seven years, 
 sixty three were cured, seventeen died, (above 
 the age of fifty years) and forty seven were incur- 
 able from the extent of disease, having tubercles 
 on the coats of the bowels, and consequent diar- 
 rhoea. 
 
INTRODUCTION. 13 
 
 It is when this state of the bowels takes place, 
 that 1 consider the patient in a critical situation, — 
 and not when the cough, expectoration of blood, 
 or matter, or both, have alarmed the sick man or 
 his friends. These are only the symptoms of the 
 disease that we profess to cure, and should never 
 be looked upon as unfavorable ; add to these night- 
 sweats, a hectic flush, debility, and emaciation, 
 and you only have the disease in question, Con- 
 sumption. 
 
 Now whether this state be the result of a ne- 
 glected, or predisposed constitution, or a badly 
 treated pneumonia, or pleurisy, or any other 
 actively inflamed state of the lungs, where proper 
 depletion has been omitted the effect is the same, 
 abscess or softened tubercles, expectoration of pus, 
 sometimes streaked with blood, and hectic fever. 
 
 These are the symptoms belonging to that disease 
 authors have named phthisis puimonalis ; when it 
 occurs as a sequel of other diseases, especially 
 those above cited, 1 am decidedly of opinion that 
 the neglect of early, well timed, and proper de- 
 pletion, is in every instance the cause ; this fre- 
 quently happens from the delay of the patient 
 in calling his medical adviser. 
 
 1 cannot believe there are many medical men 
 
 2 
 
l4 INTRODUCTION. 
 
 among us, in the present enlightened state of our 
 science, unacquainted with the importance of the 
 bold and repeated use of the lancet, in the continued 
 form of fever which accompanies pneumonia, or 
 pleurisy. The time to lay down the lancet, will 
 be when the patient ceases to complain of pain, or 
 oppression, and can lay on either side with ease. 
 
 If, however, from timidity, or any other cause, 
 bloodletting should not have been timely and 
 freely used, the disease goes on unmolested, and 
 soon arrives at that point surgeons have designated 
 the third stage of inflammation, suppuration and 
 abscess.) The fever now assumes another form 
 from continued ; it intermits, and soon puts on the 
 hectic character. The abscess bursts, expectoration 
 of blood and matter follow, and the patient is said 
 to be in consumption. The same results from the 
 ripening, softening, and bursting of tubercles. 
 
 The constitution in which tubercles are most 
 frequently met with is marked by a scrofulous 
 idiosyncracy. The blood gives off its carbon 
 sparingly, in consequence of the delicate tissue, 
 lining the air cells, being loaded with a tenacious 
 mucus ; thereby preventing the free transmission 
 of the gases. Oxygen and nitrogen inward, and 
 carbonic acid outward. The blood in this case 
 
INTRODUCTION. 15 
 
 undergoes a change, from a healthy to a diseased 
 condition, its carbon is retained, and congestion is 
 the result. 
 
 In this state of things, if the venous system be 
 not relieved, by full and proper depletion, we shall 
 soon have mother nature (the vis medicatrix 
 natura,) acting for herself, and consequently a 
 ruptured blood vessel. 
 
 I see in looking over the thirty-sixth number of 
 the American Journal of Medical Sciences, for 
 August 1836, the experiments of Dr. Robert E. 
 Rogers, which must go far to prove the correctness 
 of the position 1 have advanced above. 
 
 I have taken the liberty of copying one of his 
 experiments. 
 
 "A small bladder, not long taken from a pig, 
 was filled with fresh venous blood, when it was 
 closed, and suspended by a thread from the cover 
 of a tall receiver, which fitted air tight. The 
 receiver, standing over mercury, was then filled 
 with oxygen, and in two hours the mercury in the 
 bottom of the receiver was considerably depressed. 
 Upon inspecting the contained air, a very sensible 
 quantity of oxygen had disappeared, but was 
 replaced by a still larger amount of carbonic acid, 
 
16 INTRODUCTION. 
 
 the excess of which explained the depression in 
 the mercury. 
 
 " This experiment was varied, by making trial of 
 other gases, as hydrogen, nitrogen, and bicarburet- 
 ted hydrogen ; and in every case with the develope- 
 ment of carbonic acid. 
 
 "In order to ascertain if, during this evolution of 
 carbonic acid and disappearance of the other gases, 
 any elevation of temperature ensues, an apparatus, 
 such as may be seen at page 297 of the August 
 number for 1836, of the American Journal of 
 Medical Sciences, was made use of. Using my 
 form of Sanctorio's thermometer, it was plunged 
 to the bottom in a bag consisting of membrane, 
 and full of blood, the bag being tightly secured at 
 the neck, and suspended in an atmosphere of 
 oxygen. In this instance the result was in a high 
 degree satisfactory. 
 
 " A considerably greater rise of temperature was 
 manifested, proceeding no doubt from the influ- 
 ence of the absorption of oxygen and the trans- 
 mission through the membrane of carbonic acid. 
 
 " Let us now recapitulate the leading facts de- 
 veloped in regard to the evolution of carbonic acid 
 from venous blood. 
 
INTRODUCTION. 17 
 
 " 1st. Exhaustion by means of the air pump has 
 no effect in evolving carbonic acid from venous 
 blood. 
 
 "2d. A temperature of 212° displaces no car- 
 bonic acid from venous blood. 
 
 " 3d. The carbonic acid on the other hand, is 
 absorbed by exposing it to venous blood. 
 
 " 4th. Exposing venous blood to oxygen, nitro- 
 gen, hydrogen, and nitrous oxide, though each of 
 these if we except hydrogen, is in part absorbed, 
 yet not a particle of carbonic acid is given off. 
 
 "5th. When, however, a portion of venous blood 
 is placed in a bag of some membrane, and the 
 whole immersed in an atmosphere of some gas, 
 oxygen, hydrogen, nitrogen or bicarburetted hy- 
 drogen, (others have not yet been tried,) then 
 carbonic acid is pretty freely evolved." 
 
 These experiments solve completely the problem 
 of respiration ; and I may add, clearly account for 
 loss of colour always met with in persons having 
 a slight catarrh. The extensive membrane of the 
 lungs being coated with mucus, prevents the 
 transmission of oxygen to the blood, and hence the 
 loss of colour. The inhalation of the vapour of 
 warm water to which a small portion of gum 
 ammoniac had been added, would always relieve 
 
 2* 
 
18 INTRODUCTION. 
 
 this state of things, without sickening the stomach 
 with nauseous mixtures of squills, antimony, 
 candies, lozenges, and such like things — the use 
 of which most frequently end in sending for a 
 physician. 
 
 But we will suppose this cold neglected for a 
 long time, until nature makes an effort to relieve 
 herself. She forces on the thickened mass of blood, 
 the heart and arteries labour, fever commences, 
 the fibrin becomes diseased, and consequently 
 deposits minute masses, the nucleus of tubercles. 
 The skin becomes permanently white, the con- 
 junctiva pearly, and the individual is prepared for 
 Consumption, unless some obstruction takes place 
 in the windpipe, or the tonsils enlarge, to prevent 
 the escape of the air, and swell the cells of the 
 bronchea, — breaking the adhesion of mucus, and 
 again exposing the membrane to the action of a 
 fresh portion (oxygen, nitrogen, &c.) of the atmos- 
 phere. In this case the individual gradually re- 
 turns to health. 
 
 But in the scrofulous habit, where tubercles 
 exist, they increase, and may be seen multiplying 
 on the sides of the neck, and under the scalp. I have 
 removed some hundreds of them in this situation, 
 and find them to contain the same cheese-like 
 
INTRODUCTION. 19 
 
 matter always met with in the lungs of those who 
 die of Tubercular Consumption. 
 
 A curious case of this kind occurred to me 
 about six years ago, which will go far in my 
 opinion, in support of my theory of Consump- 
 tion. , 
 
 This patient was the daughter of a lady who 
 had died of Tubercular Consumption under the 
 care of Dr. S. Jackson, the present professor of the 
 institutes of medicine in the University of Penn- 
 sylvania. I think I may say without the fear of 
 contradiction, that the practice he pursued in her 
 case prolonged her life, — she was above fifty-five 
 and died in her sixtieth year. She left daughters ; 
 one of these was soon after attacked with hae- 
 moptysis, which greatly alarmed her, and conse 
 quently produced the most unfavourable forebod- 
 ings in her mind ; Dr. S. Jackson was again called 
 and took charge of her health, her symptoms im- 
 proved for a time, but she died in about eighteen 
 months from her first attack. 
 
 Her younger sister was soon after attacked with 
 the same symptoms. She ruptured a small vessel 
 and spit blood freely, and determined at first to 
 let nature take her course. But her attacks were 
 frequent and debility alarmed her. Thus situated 
 
20 INTRODUCTION. 
 
 she applied to me in March, 1835, I found by per- 
 cussion and careful auscultation that the summit 
 of each lung was obstructed by tubercles ; several 
 existed on the sides of the neck, and more than 
 thirty under the scalp. I removed the most of 
 these tubercles wit^i the knife, and at once com- 
 menced the general treatment. 
 
 I gave her full assurance of a speedy convales- 
 cence, and the history of her case, under the head 
 of cases, will show how far I kept my promise. 
 
 There are few anatomists unprepared to admit 
 with me, that tubercles are most frequently, if not 
 always found in consumptive habits, in the ex- 
 treme summit of the lungs, where from the physi- 
 cal structure and consequent formation of the 
 chest, portions of the lungs thus situated, are denied 
 that free expansion in inhalation which other parts 
 enjoy. 
 
 Now this state of things can be prevented by 
 mechanical means, and this naturally compressed 
 part, be brought, to participate in the full and com- 
 plete inflation enjoyed by other portions of the 
 parenchyma, more favourably located for the pinv 
 poses of life, 
 
CAUSES OF CONSUMPTION 
 
 Hereditary predisposition has been consider- 
 ed by many authors as a cause of the most formi- 
 dable character, a cause that no treatment or care 
 can avert, and of which all who have unfortunately 
 inherited it, must feel the blighting influence. 
 
 The fallacy of this opinion I am fully prepared 
 to prove. Cases of this nature have been abun- 
 dant in my private practice. I shall detail several 
 of them through this work, and show how far the 
 physician may be able to remove the predisposi- 
 tion, and make good constitutions out of bad mate- 
 rials. 
 
 The constitution of man is framed by what it 
 feeds on. 
 
 The infant born to die of Consumption, if taken at 
 an early age from the parent, and far removed from 
 all her peculiarities, her milk, her careful housing 
 
22 CAUSES OF CONSUMPTION. 
 
 her exposed mode of dressing, her hot chambers, 
 &c. loses in an astonishing manner those constitu- 
 tional imperfections, which might otherwise (being 
 engrafted,) take root and flourish to its destruction. 
 I have seen many cases, I admit, where children 
 have been born perfectly healthy, and being 
 nursed by the mother for two or three months, 
 loose flesh, become marasmatic, dwindle and die. 
 But the same mother, having a second child, de- 
 termined upon my suggestion to employ a healthy 
 wet nurse, when the result was the reverse. 
 
 It happens occasionally, though rarely, that the 
 foetus in utero may have tubercles, and the greater 
 portion of the parenchyma rendered unfit for the 
 purposes of respiration. This seldom occurs, how- 
 ever, for great nature has so arranged the foetal 
 circulation, that the lungs are protected in a re- 
 markable manner from the deposit, which neces- 
 sarily precedes tubercles. I have frequently met 
 with tubercles in the placenta, but not often in 
 the lungs of the foetus. 
 
 Hereditary Consumption more frequently occurs 
 from a general constitutional contamination, de- 
 ranging the circulating mass of blood, and thereby 
 rendering the deposit of tuberculous matter certain, 
 pnless a complete change is made in the mode of 
 
CAUSES OF CONSUMPTION. 23 
 
 living. Let the infant be reared by a nurse in 
 constitution the opposite in every particular of its 
 mother, and the adult forsake all her habits of 
 former life when Consumption threatens invasion. 
 In vegetable life, you can so change the soii as 
 completely to arrest the growth, and finally de- 
 stroy the plant. So in Consumption, you may 
 alter the constitution of the infant to a degree 
 in which a consumptive diathesis cannot exist. 
 
 A supposed predisposition is not an unfrequent 
 cause of Strumus Consumption. When the indi- 
 vidual who may be the subject of disease of the 
 lungs, has contracted severe pneumonic inflamma- 
 tion, it frequently happens that they rely on lozen- 
 ges, cough mixtures, plasters, pediluvium, or some 
 hocus-pocus for some days before sending for a 
 physician, or when they do send for a physician, 
 they may select one who considers active remedies 
 dangerous in such constitutions, and the inflam- 
 mation is allowed to pass through the several 
 stages, until suppuration and abscess are the re- 
 sult. 
 
 I attended a family in this city some years ago, 
 who had (under the care of their former physi- 
 cian) lost three infant children, one at the age of 
 ten months, the second at seventeen months, and 
 
24 CAUSES OF CONSUMPTION. 
 
 the third at three years. They were all nursed by 
 the mother for nine months, and carefully fed from 
 that time, principally on farinaceous articles, until 
 teething was completed. The third, living some- 
 what longer than the others, was allowed some 
 animal food. 
 
 At the expiration of the third year she had a 
 severe attack of croup, from which she recovered 
 with the usual treatment ; one week after her 
 recovery she was taken out, and contracted (ac- 
 cording to the account I had of her case) a slight 
 cold, she coughed frequently, with occasional crying 
 spells after each attack of coughing ; in the course 
 of a few days some fever was evident, and the 
 family physician was called to prescribe for her. 
 He gave her an expectorant, mixture of squills, 
 paregoric, and spirits of nitre, and directed her 
 bowels to be kept open with senna. The little 
 sufferer improved but slightly, sometimes fretful 
 and uneasy, and now and then amused for a short 
 period with her toys. 
 
 This milk and water treatment was persevered 
 in until the inflammation, fever, and cough became 
 continual; the patient was now pronounced, like 
 the former children, in a rapid decline. 
 
 The mother having heard that I had asserted 
 
CAUSES OF CONSUMPTION. 25 
 
 Consumption was curable, determined I should be 
 sent for; this was done, and I saw the child eight 
 hours before its demise, nature had relieved herself 
 by effusion and the patient soon expired. 
 
 I requested permission to examine the body; 
 this was granted, and I proceeded to the autopsy 
 twelve hours after death. 
 
 The brain was found in a healthy state ; the 
 stomach distended with flatus ; the bowels in the 
 same condition, except the excretories on their 
 surface, which were much congested. The blood- 
 vessels of the liver, larger than natural. The heart 
 in a perfectly natural state, with rather more fluid 
 in the pericardium, than is generally met with at 
 the age of this subject. The cavity of the chest 
 was next examined. The pleura exhibited much 
 inflammation, with many points of adhesion. The 
 exterior surface of the lungs was thickly beset with 
 small hydatics, and more than three ounces of 
 serum was found in the cavity of the pleura. The 
 parenchyma was not yet exposed to view. I hesi- 
 tated a moment at this stage of the examination — 
 until my friend (the family physician) asked why 
 I did not proceed. You are aware, Doctor, said 
 I, upon my next incision depends my professional 
 reputation. I have told you already, that this 
 
 3 
 
26 CAUSES OP CONSUMPTION. 
 
 child had no tubercles — now if they should exist ? 
 Then, said the doctor, I shall say nothing about 
 your opinion. No, said I, if they do proclaim me 
 ignorant, but if they do not, believe no more in 
 the necessity of children dying of consumption, 
 who have the misfortune to have been born of pa- 
 rents said to be predisposed to that disease. 
 
 The parenchyma was now cut into, and that 
 state of things only found, which is always met 
 with after death from pneumonia. No tubercles 
 existed. 
 
 In the course of two years the lady had another 
 child, which is now well and very healthy, although 
 it has passed through two or three severe attacks 
 of pneumonic inflammation, where the lancet was 
 not spared. 
 
 From what I have already said, it must appear 
 evident, that I consider inflammation of the lungs 
 erroneously treated — a very frequent cause of ab- 
 scess and consequent consumption, from the simple 
 fact, that when remedies are not properly directed 
 or judiciously administered, (the result being un- 
 certain,) the lungs become engorged with venous 
 blood, their mucous membranes transmit little or no 
 oxygen, and abscess, or tubercles, are the result. 
 
 The causes of consumption are either abscess or 
 
CAUSES OF CONSUMPTION. 21 
 
 tubercles, produced by a depraved state of the 
 blood, which may be occasioned by a long spell 
 of moist or rainy weather, in which the atmosphere 
 becomes too light to expand the air-cells of the 
 lungs ; by a debilitated constitution, brought about 
 in various ways, either by poor living or weak 
 digestion, or by many constitutional diseases ob- 
 structing the free circulation of the arterial blood. 
 
 Dyspepsy, diseases of the liver, of the spleen, 
 mesenteric glands, or of the heart, may all be cited 
 among the causes of consumption. But as we 
 consider all these diseases manageable, they can- 
 not be called formidable causes. 
 
 Jlmenorrhoza and dysmenorrhea are decidedly 
 more so, and therefore, call for our prompt atten- 
 tion. 
 
 As these causes occur long before the thoracic 
 derangement can be produced by them, they conse- 
 quently should not be admitted by the judicious 
 practitioner, but removed before consumption can 
 be produced. 
 
28 
 
 OF AUXILIARY 
 
 CAUSES OF CONSUMPTION. 
 
 Tight lacing has been hinted at by many writers 
 of high repute, as a cause of not unfrequent oc- 
 currence. By this abominable practice, most fre- 
 quently met with in large cities, thousands are 
 annually sent to a premature grave. Nature is 
 cramped, confined and shaped to suit the taste or 
 style of some mantua maker or other, until the 
 respiration which should be performed by the pec- 
 toral muscles, is compelled to be abdominal, un- 
 less fashion varies, and the lacing puts these 
 muscles also in a quiescent state. In that case, 
 free respiration will be found to exist only in the 
 upper portion of the chest. 
 
 In the prevalence of short waists or high skirts 
 in the dress of the ladies, when death occurs from 
 consumption, it will be found that tubercles occupy 
 the upper portion of the parenchyma ; and 
 when the fashion alters to long waists, the lower 
 portion of the lungs will be their seat. 
 
CAUSES OF CONSUMPTION. 29 
 
 Now these facts speak volumes for the theory I 
 have advanced in this work, on the subject of vo- 
 luminous lungs — a theory upon which my practice 
 is based, and supported by every day's experience. 
 
 This practice of lacing not unfrequently binds 
 the longitudinal muscles of the back also, in such 
 a manner, that one side or the other must give 
 way, and lateral curviture of the spine be the ine- 
 vitable consequence. The lung of the affected 
 side becomes compressed, a free passage of air is 
 prevented from penetrating its cells, and conse- 
 quently tubercles must follow. 
 
 My success in the treatment of the so-called 
 spine affections, is too well established in this city, 
 to admit of these notions being called theoretical. 
 
 Mothers, if you value the lives of your fair 
 daughters attend to these matters, for although 
 the brain may escape uninjured, the spine and 
 lungs never can. Remove all obstacles that may 
 tend to impede that useful and beautiful phenome- 
 na of nature, respiration, and my word for it, the 
 number of victims to the sad destroyer consump- 
 tion, will daily diminish among that fair portion 
 of creation for which man only lives to cherish and 
 protect. 
 
 Wet and cold feet are very frequently produc* 
 
 3* 
 
30 CAUSES OF CONSUMPTION. 
 
 tive of lung affections. There are few ladies in 
 our city attentive to this matter, their feet and 
 ankles are thinly clad, and consequently cold, 
 while their bodies are well protected, and their 
 neck and shoulders loaded with furs. The conse- 
 quence is, a continual moisture of the neck and 
 chest, and great liability to inflammation of the 
 lungs, from a sudden check of this unnatural de- 
 gree of perspiration. 
 
 I have always recommended my patients to 
 harden this portion of the body, (if I may be al- 
 lowed the expression) by bathing the bust and 
 neck night and morning in cold salt water, and in- 
 stead of wearing as much clothing on this part as 
 can be borne, to wear as little as they can be com- 
 fortable with, keeping the feet and lower limbs 
 well protected with thick shoes and stockings 
 during the fall, winter and spring months. 
 
 During the coldest of winter weather, a thick 
 double veil should be worn, and instead of running 
 directly to the fire when you enter your dwelling, 
 retire to your chamber to make the change from 
 an out to an in-door dress; or if your chamber 
 should be heated, let the change be made in the 
 hall or some part of the building not supplied by 
 hot air. Remain there ten or fifteen minutes, to 
 
CAUSES OF CONSUMPTION. 31 
 
 enable the Jungs to bear the difference of tempera- 
 ture, without feeling that sensation of oppression 
 which few individuals are unacquainted with, who 
 pass a winter in a cold climate. 
 
 The present mode of heating most of our dwel- 
 lings and public places by furnaces, greatly in- 
 creases the risk we encounter of inflammation of 
 the throat and lungs, by a sudden transition from 
 cold to heat. 
 
 Indifference to these hints may not produce 
 tubercular consumption, but it will lay the founda- 
 tion of a more unmanageable disease, bronchitis. 
 
 It is from heated churches and offices that our 
 ministers of the gospel suffer so much from bron- 
 chitis, and not from preaching, — as has been 
 imagined by many. Churches are now generally 
 warmed by furnaces, the air therefore is hot before 
 the congregation enter it, the number respiring this 
 heated and consequently impure atmosphere, soon 
 increase its temperature, while they exhaust its 
 oxygen. You now see many individuals, before 
 the service is half over, throwing off their cloaks 
 or shawls, fanning and fidgeting, reminding us of 
 animals under the receiver of an air pump partly 
 exhausted. Some friend now opens a window or 
 door and admits a current of cold, which relieves 
 
32 CAUSES OF CONSUMPTION, 
 
 in a measure the general mass, but endangers those 
 who may be seated near its entrance, from the 
 previous highly excited state of the surface. But 
 the preacher encounters still more danger, his 
 situation is ten or twelve feet above the congrega- 
 tion. Heat being disposed to ascend, he is 
 surrounded by an atmosphere many degrees 
 higher in temperature than that in which his 
 hearers exist Here, if he escapes asphyxia, he 
 cannot expose himself many months without 
 bronchitis. 
 
 If this state of things was produced by public 
 speaking, how is it, let me ask, that our auctioneers, 
 our sea captains, or our lawyers, are not more 
 frequently the subjects; their lungs are as often 
 called upon to perform perhaps a more arduous 
 and longer continued duty — but our court or auc- 
 tion rooms, are not often crowded, and if they are, 
 the mass of people are continually going in and 
 out, and consequently, admitting fresh air with 
 every fan of the door. 
 
 Churches are, on the contrary, kept warm or 
 hot, and the doors closed, unless some one being 
 overcome, is led out for fresh air, relieving those 
 who may be located near the opening. 
 
 This accident by no means benefits the pastor, 
 
CAUSES OF CONSUMPTION. 33 
 
 his situation is fixed for two hours at least, and if 
 he be not positively exhausted, and faint, he is 
 allowed to breathe the fresh atmosphere, only after 
 the lining membrane of the air tubes of his lungs, 
 have by this continued excess of heat been pre- 
 pared to -put on inflammation. 
 
 But the sea captain or his healthful crew, breathe 
 no atmosphere like this. The air they respire, is 
 warmed by the sun's genial ray; their home, walled 
 by the horizon, and roofed by the blue vault of 
 heaven. In their constitutions, you seldom meet 
 with bronchitis, or consumption, and their voices, 
 like trumpets, are heard afar. 
 
 This state of things, always met with in the sea 
 faring man, I own is sufficient to induce all who 
 are threatened with Consumption, to try the ocean 
 wave. And if this is done before it becomes too 
 late for exercise, I have little doubt that many, who 
 could participate in the duties of the sailor, might 
 be much benefited by a sea voyage. 
 
 I would by no means, however, recommend a 
 sea voyage, to the individual who is expectorating 
 pus freely, or may have hectic fever. To over- 
 come this, a careful and well directed home treat- 
 ment is indispensable, the privations on board of 
 ship are too great to obtain the attention and care 
 
34 CAUSES OP CONSUMPTION. 
 
 required. And it generally happens that the voy- 
 age to sea, is the last remedy recommended, and 
 consequently produces no beneficial result. 
 
 The reason must be obvious; the debilitated 
 individual is perhaps unable to leave the cabin, 
 and the air of this, is little better (if at all,) than 
 that of their own chamber, with less of home 
 comforts. 
 
 Or if their strength should enable them to be 
 on deck, they are prevented either from want of 
 inclination, or from the directions of their physi- 
 cian, from participating in those healthy exercises 
 of the sailor, upon which the benefit of a sea voyage 
 depends. He is pulling and hauling continually — 
 frequently making full and deep inhalations, and 
 often for moments holding his breath, to enable 
 him to concentrate all his power for the accom- 
 plishment of some difficult task, consequently fully 
 inflating the parenchyma, and thereby rendering 
 himself exempt from obstructions in its circulation 
 producing Consumption. 
 
 Nor is the mariner the subject of bronchitis, 
 his throat and neck is continually exposed to all 
 the vicissitudes of the atmosphere, and like his face 
 and hands, will always be found florid and 
 healthy, no debility of the cuticular circulation 
 
CAUSES OF CONSUMPTION. 35 
 
 will here exist, to invite disease, and consequently 
 he escapes most if not all the throat affections. 
 
 To see physicians at this time of vast improve- 
 ment in medical science, recommending thick 
 stocks, boas, pieces of flannel, and the wearing 
 long beards, as a protection from disease, excites 
 in me a smile ; when all should be done to harden 
 and accustom those parts to exposure. 
 
 The mariner or common labourer on shore, is 
 unacquainted with bronchitis or chronic inflamma- 
 tion of the throat. They wear no stocks or pads 
 about their necks, on the contrary, you will 
 generally find them with this part exposed, and 
 like their faces, a lively circulation through the 
 skin, giving that florid hue, the true criterion of 
 health. 
 
 Consumption is never met with in the savage, 
 whose mode of life causes him to encounter the 
 most severe weather, half clad. He sleeps on the 
 ground, frequently with nothing under him but 
 his blanket, and escapes taking cold, (as it is 
 called,) because his skin is hardened to his mode 
 of life. 
 
 Many who travel among the Indians, without 
 reflecting on their manner of living, attribute the 
 
36 CAUSES OF CONSUMPTION. 
 
 good health they enjoy to their knowledge of the 
 medical virtues of the roots, leaves, and bark, of 
 the forest trees. This is not the case, however, 
 for although some of the best of our botanic medi- 
 cines are found in the far west, the Indian gathers 
 them not for his own use, but for trafiic. His con- 
 stitution requires little or no remedial art, in most 
 of his diseases nature operates for herself; in catarrh 
 some little obstruction may take place in the bron- 
 chial tubes, but the volume of his lnngs is only 
 increased. His shoulders are not tied down with 
 straps to keep up his pantaloons, secured from 
 raising by being fastened beneath his shoes : his 
 lungs are allowed full play, and consequently their 
 circulation not being obstructed in any manner by 
 his clothing, he soon finds himself free from all his 
 thoracic or throat affection. 
 
 Not so however in civilized life, here we find 
 broad suspenders on the clavicle, and strong leather 
 straps to keep the pants from raising up, fixed 
 under the boot, with frequently large stiff plasters 
 over the breast and back, tied down by a tight net 
 shirt, tight vest, and not unfrequently a large stiff 
 stock reaching the chin, and thus a full inflation 
 of the parenchyma is most effectually prevented. 
 
CAUSES OF CONSUMPTION. 37 
 
 Can any one be surprised at the production of 
 disease under these circumstances ? Ask nature 
 — the result must be obstructed respiration, ob- 
 structed circulation, inflammation, adhesions, tuber- 
 cles, abscess and death. 
 
SYMPTOMS OF CONSUMPTION. 
 
 It has long been acknowledged by the most 
 learned in the medical profession, that the symptoms 
 of phthisis pulmonalis are so variable and uncer- 
 tain, the disease may be irremediably fixed, before 
 the individual or physician has the most remote con- 
 ception of its nature ; and the first intimation the 
 invalid may have of his situation, perhaps will be 
 a ruptured vessel and consequent hsemoptoe. Since 
 the introduction of the stethoscope, most if not all 
 the members of the medical profession, have be- 
 come more enlightened on the subject of diseases 
 of the lungs; and if applied to early in their 
 course, can in general foretell what must certainly 
 happen. 
 
 The credit of introducing this instrument to 
 Americans belongs to Professor Jackson, of our 
 city, whose indefatigable zeal for improvement, 
 
40 SYMPTOMS OP CONSUMPTION. 
 
 has done more for the art of discrimination in 
 diseases of the chest, than any other physician on 
 this side the Atlantic. 
 
 Had his practice proved as certain as his know- 
 ledge of the nature of Consumption, little would 
 have remained for others to accomplish. His suc- 
 cess has been much greater, however, than that of 
 any of his predecessors, and his head deservedly 
 crowned with laurels. 
 
 Hippocrates had no doubt made use of auscul- 
 tation, as is proved by reference to his writings : 
 " you shall know by this that the chest contains 
 water and not pus, if in applying the ear during 
 a certain time on the side, you perceive a noise 
 like that of boiling vinegar." Auscultation, there- 
 fore, is not a recent discovery, but its application 
 has been much improved by some of the French 
 physicians. " Render to Caesar, that which is Cae- 
 sar's." 
 
 The general external signs of Consumption, few 
 accustomed to observation can mistake; a de- 
 jected expression, sharp features, shining eye, con- 
 tracted chest, thick and projecting lips, and not 
 unfrequently a slight anterior curvature of the 
 spine. 
 
 As the disease advances, we find a slight cough, 
 
SYMPTOMS OF CONSUMPTION. 41 
 
 hectic blush at some period in the day, but gene- 
 rally for the most part a very pale smoke, or lead 
 color of the skin, with a livid, or vermilion lip, a 
 red dry tongue, evening chills, followed by fever, 
 terminating in night sweats, and free morning 
 expectoration. These continue for a longer or 
 shorter period, until finally, (without proper treat- 
 ment) the individual succumbs. 
 
 Cough is by no means an unequivocal symptom 
 of phthisis ; this maybe produced from congestion 
 of the liver, crudities in the primse vise, foreign 
 substances, smoke, dust, certain gasses or fumes, 
 or from elongation of the uvula, these may all 
 occur without the least disturbance of the healthy 
 action of the parenchyma. The removal of such 
 causes soon puts an end to the cough, without 
 disturbing the stomach with nauseous mixtures of 
 syrups or candies. I witnessed a few years ago 
 a remarkable case of this kind occurring in the 
 family of a respectable merchant of New Orleans. 
 His youngest daughter was taken during the 
 winter season, (while in Philadelphia,) with severe 
 cynanche-tonsilaris or inflammatory sore throat ; 
 this continued for some weeks, although her physi- 
 cian used, (as he supposed) very proper and ener- 
 getic treatment. The child improved after being 
 
 4# 
 
42 SYMPTOMS OF CONSUMPTION. 
 
 for some time confined to her chamber, and at the 
 expiration of two months was allowed as much 
 fresh air as she could get by being well bundled 
 up and put into a close carriage ; her health im- 
 proved a little by this slight change from her 
 heated chamber, but not sufficiently to satisfy her 
 parents ; another physician was consulted, and 
 they determined the patient should go home to 
 New Orleans. When she arrived there, the best 
 medical advice the place afforded, was obtained ; 
 the child was now considered in a rapid decline ; 
 her cough was incessant, she was bled, cupped, 
 leeched, blistered, and well dosed, for several 
 months, but still the stubborn cough kept on. 
 The anxious parents watched every dose of medi- 
 cine, every blister, every change of expression, to 
 see some improvement, but alas none appeared. 
 At length they determined, that if their daughter 
 lived until the sailing of the next packet, they 
 would take her back to Philadelphia, and consult 
 Dr. Physic; this was done, and the doctor soon 
 discovered the whole cause of her suffering ; 
 great elongation of the uvula. Dr. Physic removed 
 this cause by one stroke of the scissors, and all the 
 alarming symptoms of Consumption vanished. 
 How much distress and unnecessary pain would 
 
SYMPTOMS OF CONSUMPTION. 43 
 
 this little sufferer have escaped, had auscultation 
 or percussion, been used by her first physicians ; 
 her lungs had nothing to do with the cough, which 
 circumstance would have been at once discovered 
 by the stethoscope. Well might this patient ex- 
 claim, "throw physic to the dogs, I'll none of it," 
 and how often is our materia medica taxed to per- 
 form, that which belongs to the better judgment of 
 the physician. 
 
 I have heard of senna and salts being given 
 every other day for a period of six months, to cure 
 a pain in the lower part of the abdomen, when this 
 was produced by irritable uterus, and the symp- 
 toms much aggravated by the course, all yielding as 
 soon as proper remedies were used ; and yet both 
 these articles are valuable in their proper place. 
 But to return to my subject. Haemoptysis has 
 been looked upon by many as a cause of Consump- 
 tion, and this opinion appears to have gained 
 ground so rapidly that few are prepared to believe 
 their physician when he declares its existence 
 should not alarm the individual who may be at- 
 tacked with spitting of blood. The confidence 
 must be great indeed if his assertion has the effect 
 of allaying all their fears; now, although hae- 
 moptoe may cause great alarm, and occasionally be 
 
44 SYMPTOMS OP CONSUMPTION. 
 
 an unfavourable symptom, this is by no means 
 always the case. It may occur in a slight catarrh, 
 from local plethora of some minute vessel of the 
 lining membrane of the bronchia, and be of no 
 more importance than bleeding from the nose, in 
 consequence of fullness of some of the small ves- 
 sels of the Schneiderian membrane. In most 
 cases, we may consider spitting blood a favoura- 
 ble sympton, often relieving an unpleasant weight 
 or fulness in the breast, and frequently terminating 
 the most alarming diseases, as pleurisies, peripneu- 
 monies, fevers, &c. &c. 
 
 The history of one of our most, respectable 
 members of society, the late Joseph Watson, 
 former mayor of this city, may not be generally 
 known to many of our readers ; I therefore, take 
 the liberty of introducing an account of a portion 
 of his life, to prove that haemoptysis should not 
 always be looked upon as an alarming symptom. 
 
 About the year 1810, Mr. Watson was employ- 
 ed in the counting-house of my father-in-law, 
 (Chandler Price, Esq.) who became much alarmed 
 for his safety, in consequence of his having a con- 
 tinual cough, free expectoration mixed with blood, 
 and frequently attacks of hsemoptoe ; debility and 
 emaciation soon took place, and in less than six 
 
SYMPTOMS OF CONSUMPTION. 45 
 
 months Watson was called a walking skeleton. 
 Dr. Physic was consulted in his case, and finding 
 that he was determined to try riding on horseback, 
 gave him the best directions he could follow under 
 the circumstances : he was to make short stages, 
 to be well protected from the weather, to eat 
 sparingly, to keep the bowels open daily with a 
 mild pill of rhubarb and aloes, and never to sleep 
 in a strange bed unless the sheets and blankets 
 had been well dried the day previous. 
 
 With these directions our friend set off for New 
 Orleans on horseback, I believe in the latter part of 
 the summer of 1811. The first day he reached Old 
 Chester, fifteen miles, on the second of his journey 
 he had some spitting of blood, but made out to get 
 as far as Wilmington, where he remained two days 
 in consequence of bad weather. The eighth day 
 he arrived at Washington, where he again spit up 
 some blood after a violent spell of coughing. He 
 persevered on his journey, making short stages, 
 and finally reached New Orleans after travelling 
 twelve weeks, much improved in his appearance, 
 strength, and spirits. 
 
 He had no return of haemoptoe after he left 
 Washington, and his cough gradually subsided, 
 being entirely free from it, in about six weeks 
 
46 SYMPTOMS OF CONSUMPTION. 
 
 after leaving his home in Philadelphia. Early 
 in the summer of 1812, he returned home by- 
 sea in fine health, and much improved in flesh; 
 he continued to increase in size gradually for some 
 years until his weight became the only cause of 
 complaint, having no return of his old disease 
 since leaving Washington in the last of September 
 1811. He died of hydrothorax in 1841, at the 
 age of sixty years. 
 
 The general healthy appearance of Mr. Watson 
 must be familiar to most of our citizens. Had he 
 remained at home and continued the sedentary 
 employment of book-keeping, he would no doubt 
 
 have died in the course of two or three years from 
 the supervening of phthisis. Many cases of this 
 kind have occurred, where from neglect of exer- 
 cise, digestion, and full inflation, hsemoptoe has run 
 on, and Consumption been the result. This may 
 always be prevented, and the individual who 
 neglects his constitution under these circumstances 
 pays dearly for his folly. 
 
 Various nostrums, candies, lozenges, etc., de- 
 serve notice under this head of auxiliary causes of 
 Consumption. 
 
 Most if not all the popular compounds for cough 
 contain opium in some form or other ; they conse- 
 
SYMPTOMS OF CONSUMPTION. 47 
 
 quently relieve one of the symptoms of lung affec- 
 tions, while they increase in most cases the cause 
 of many others, by producing constipation and 
 consequent derangement of the liver. Few per- 
 sons apply to physicians until they have swallowed 
 all the quackery within their reach, and their 
 bowels locked up ; this is certainly the case in this 
 country, and prevails to a much greater extent in 
 England. There is so much truth in these asser- 
 tions, that the great Abernethy, (whose talent and 
 extensive medical acquirement I shall always hold 
 in the highest respect,) suspected the liver as the 
 primary seat of Consumption, and consequently 
 prescribed blue pill with some purgative, to be 
 continued daily for months if there was no amend- 
 ment. He no doubt found most of his cases with 
 a previous confined state of the bowels; had mer- 
 cury been omitted, however, and this great surgeon 
 of Europe illumined by the same ray that lights 
 the mind of Ramadge to the secret operations of 
 nature's work in lung diseases, he would have 
 removed the mischief done by nostrums, with 
 milder means, and perhaps explored the chest. 
 
 Professor Chapman in one of his clinical lectures 
 at the old Philadelphia Almshouse in 1818, speak- 
 ing of Consumption observed to his class, " as 
 
48 SYMPTOMS OF CONSUMPTION. 
 
 well might the physician shoot a bullet through 
 the heart of his patient in tubercular consumption, 
 as administer mercury in any form." I think I 
 may truly say, I have seen abundant proof of the 
 truth of this assertion, in a practice of twenty 
 years. 
 
 The working class of our fellow beings are for 
 the most part free from the impositions practised 
 upon the human family by forged certificates of 
 wonderful cures, for they have no means to sup- 
 port quackery ; their simple catarrhs are not often 
 interrupted, and consequently the chylopoetic 
 viscera is undisturbed by these narcotic mixtures ; 
 the bowels are free, and the mucous membrane 
 soon pours out the offending cause, while the 
 moderate contraction of the trachea always met 
 with in catarrh oppresses the breathing, producing 
 a voluminous state of the Jungs, the circulation 
 thereby freely maintaining a healthy action 
 throughout the whole body. 
 
 There is no limit to the credulity of man, the 
 most learned can be brought to believe, that, which 
 sober reflection would condemn as false, until ma- 
 turer reason claims control. 
 
STRUCTURE OF THE LUNGS. 
 
 The different opinions which have been enter- 
 tained by many anatomists in relation to the 
 structure of the lungs, it may not be improper to 
 mention, before entering upon the treatment of 
 their diseases. It was imagined by Malpighi 
 that the lining membrane of the bronchia divided 
 to form air cells, like a sponge. But the experi- 
 ments of Helvetius went to prove that the air cells 
 were formed by a simple cellular tissue enveloping 
 the various blood vessels of the lungs. The greater 
 number of anatomists, Haller among the rest, have 
 adopted the opinion of Helvetius. If we inject 
 the blood vessels of a fresh young subject with 
 wax, and at the same time fully inflate the air 
 cells through the trachea, we can by careful in- 
 cision, fully satisfy ourselves of the correctness of 
 the views of Riesseissen, who proved the lungs to 
 
 5 
 
50 STRUCTURE OF THE LUNGS. 
 
 be formed by air cells and blood vessels, the 
 former terminating in a kind of cul-de-sac. 
 
 This natural structure of the lungs, while it so 
 admirably adapts them for the office they perform 
 in the support of animal life, renders them suscep- 
 tible to many diseases, in a variable climate like 
 ours. But as most of those diseases have been 
 already mentioned, I shall now confine myself 
 entirely to a description of the morbid condition 
 met with after death from Consumption. 
 
 Upon dissection of those who die of Consump- 
 tion, we generally find that morbid state of the 
 lungs which unfits them for the duties they are 
 destined to perform for the purposes of life. Por- 
 tions of the parenchyma will be found absorbed 
 or changed into abscess, or its substance occupied 
 by tubercles; or large adhesions may exist, or the 
 greater portion of the lungs may be completely 
 solidified or hepatized ; or great effusion may be 
 dicovered in the cavity of the pleura, and the 
 parenchyma so compressed, that respiration cannot 
 be longer performed and death the inevitable re- 
 sult. Or the surface of the air cells may put on a 
 high state of inflammation, (acute bronchitis) and 
 consequently be rendered unfit to perform the 
 function nature has ordained for these parts, by 
 
STRUCTURE OF THE LUNGS. 51 
 
 pouring out an abundant, thick and adhesive 
 mucus, and thus effectually preventing the trans- 
 mission of the gasses in respiration. The blood re- 
 ceives no oxygen, its carbon is retained, and sent 
 back to the heart, which soon becomes enfeebled, 
 its action is consequently rendered weak and rapid, 
 the pulse will increase in frequency while it grows 
 weaker, the skin becomes livid or blue, and the 
 individual is said to be suffocating. I consider 
 patients thus situated in immediate danger, and 
 believe there is no remedy but the lancet. I have 
 seen hundreds of children thus situated restored 
 by frequent and free depletion. In this state of 
 things, the case will generally be called hopeless, 
 but if the physician is experienced, and will bleed 
 boldly, even to an extent that would be prejudicial 
 under other circumstances, or in other diseases, he 
 may produce some slight effusion from this lining 
 membrane of the bronchia, washing away the 
 tenacious mucus which block up its surface, and a 
 free expectoration will frequently follow. 
 
 Perhaps this page may meet the eye of my old 
 
 and much esteemed friend G. S , Esq., one of 
 
 our most respectable merchants ; should this hap- 
 pen, he will no doubt remember the situation of 
 his little daughter Sarah, whose case was very 
 
52 STRUCTURE OF THE LUNGS. 
 
 similar to that above described ; free bleeding was 
 repeated seven times, producing syncope after each 
 operation, she soon recovered without general 
 dropsy as was predicted by some of her friends. 
 
 I am of opinion that the lancet seldom if ever 
 produces dropsy, but much more frequently pre- 
 vents Consumption. 
 
 
PROPHYLACTIC TREATMENT 
 
 O F 
 
 CONSUMPTION. 
 
 One of the most powerful agents in preventing 
 Consumption, is exercise ; and I may add, one of 
 the best additions we can make to the use of inter- 
 nal remedies, for its cure. Of the different kinds 
 of exercise, perhaps running, and riding, are the 
 best. We seldom or ever see Consumption as an 
 original disease, in the young pupils of our com- 
 mon schools ; there is no limit to the playfulness of 
 boyhood; the respiration is frequent and deep, a 
 large volume of air is admitted, favouring a healthy 
 development of the whole parenchyma, while with 
 the increased action of the heart and arteries, 
 rapid decarbonization of the blood is the conse- 
 quence, and health is less liable to interruption. 
 From this constant and free supply of oxygen the 
 
54 PROPHYLACTIC TREATMENT 
 
 animal heat is increased, the action of the heart 
 becomes more vigorous, and all the glandular 
 secretions carried on with greater energy. 
 
 Sydenham was generally in the habit of recom- 
 mending riding as an exercise of much value as a 
 prophylactic, and perhaps it will be found that 
 riding, may produce all the benefit of walking or 
 running without the fatigue ; I have already given 
 an instance of the great advantages arising from 
 horse back exercise under another head, and its 
 value is too well established to require repetition 
 here. I shall, therefore, pass on to gymnastics, as 
 a mode of exercise, particularly in the winter 
 season, best calculated to assist the physician in 
 restoring his patient to health, whose sedentary 
 habits may demand something of this nature, or 
 whose debility may prevent him from leaving his 
 chamber. The most proper machinery for this 
 purpose will be a pair of ladders ten feet high, set 
 six or eight feet apart at bottom and firmly secured 
 at top, and so braced that there shall be no risk of 
 falling ; a pair of horizontal bars six or eight feet 
 long supported on two stands, in such a manner 
 that the individual exercising, may walk between 
 them, and by placing his hands upon the bars, 
 raise his body, by the action of the pectoral, and 
 
OF CONSUMPTION. 55 
 
 other muscles, until the feet swing clear of the 
 floor. This exercise, will generally be found to 
 produce a glow, and give rise to a free circulation 
 throughout the limbs ; I have often been called 
 to visit patients, who were unable to raise the hand 
 to the head, in consequence of great debility of the 
 muscles, and after daily trial for two weeks, could 
 perform many feats upon the ladder above de- 
 scribed, raising the whole weight of the body from 
 the floor to the great astonishment of all their 
 friends. Strong ropes may be secured at opposite 
 points, on the wall, to bear the weight of one or 
 more persons at the same time ; upon these ropes 
 so fixed, individuals may perform all the evolutions 
 of a sailor, and in a short time obtain strength and 
 a consequent free circulation in muscles, that might 
 otherwise soon become comparatively useless. 
 A remarkable case of this kind occurred in my 
 
 practice in the fall of 1837. N. P , a young 
 
 man, about twenty two years of age, was taken 
 with pneumonia, from which he recovered under 
 the use of the usual remedies ; — but the muscular 
 power of his limbs remained so feeble, that he 
 despaired of ever being able to leave his room : 
 tonics and friction, with the most stimulating lini- 
 ments, had no effect. Under these circumstances 
 
56 PROPHYLACTIC TREATMENT 
 
 I determined to try the efficacy of exercise on the 
 voluntary muscles, and at the same time recom- 
 mended full and deep inhalation, and a consequent 
 full expansion of the parenchyma ; a double ladder 
 twelve feet high was made for his use, and at the 
 expiration of three weeks 1 found him suspending 
 his body from the top rounds by his hands, although 
 at first unable to raise them above a level with his 
 shoulders : he soon recovered his usual health, 
 which he still continues to enjoy. 
 
 The ancients no doubt were fully acquainted 
 with the advantages derived from gymnastics; and 
 consequently recommended these exercises to be 
 particularly practised by those who might be des- 
 tined to take an active part in their wars ; this they 
 considered necessary, to produce that muscular 
 strength required in the field of battle. War was 
 a laborious occupation from the weight of the 
 armour used by the ancients, and strength must be 
 acquired by exertion, and supported by constant 
 exercise. The gymnastic games were consequently 
 connected with their religion, and victory in them 
 was politically rendered an object of the highest 
 importance. 
 
 " Palmaque nobilis 
 
 Terrarum dominos evehit ad deos." 
 
OF CONSUMPTION. 57 
 
 The gymnastic art had attained no considerable 
 degree of perfection in the time of Homer, as we 
 find from the description of the games at the fu- 
 neral of Patroclus. Gymnastics were introduced, 
 however, into medicine only about the time of 
 Hippocrates, or perhaps a little before his era by 
 Herodicus, his father. The gymnastics of the 
 warriors were too violent for the diseased, or even 
 for the preservation of health in those not naturally 
 strong ; and Hippocrates, in his work on regimen, 
 speaks of exercise in general, of walking, of races 
 on foot or horseback, leaping, wrestling, the cory- 
 cus, or exercising the suspended ball, with the 
 usual additions of unctions, frictions, and rolling 
 in the sand practised in those days. Boxing, the 
 pancratia, hoplomachia, running, quoits, the exer- 
 cise of the ball, hoop, and javelin, required too 
 great exertion to be admitted into the medical de- 
 partment ; though walking, vociferation, recitation, 
 and holding the breath, seem to have been among 
 the medicinal exercises; — and by this holding the 
 breath, we must conclude the ancients had some 
 knowledge of the advantage arising from full in- 
 flation of the parenchyma. Hoffman mentions 
 fifty-five kinds of medicinal exercises, which I 
 shall not enumerate ; Dr. Carmichael Smyth recom- 
 
58 PROPHYLACTIC TREATMENT 
 
 mends swinging as one of the best modes of exer- 
 cising ; he devoted a treatise entirely to this subject, 
 in which he brought forward many proofs of its 
 superior utility. I unhesitatingly recommend all 
 the different modes, leaving their choice to the 
 judgment of the physician ; but as the double 
 ladder, the horizontal poles, the festooned rope, 
 swinging weights in the hands, horseback riding, 
 walking, running, and inflating the lungs, have 
 done all for my patients that I could expect or they 
 desire, I shall most certainly adhere in the gene- 
 rality of cases to their use. 
 
 I have known sterility entirely cured by atten- 
 tion to some of these modes of exercise, thereby 
 removing the debility of the nerves, which is in 
 many cases the sole cause. 
 
 The peculiar delicacy of constitution often met 
 with in young married ladies, preventing their ever 
 becoming mothers, arises most frequently from their 
 sedentary habits. By constant attention to proper 
 exercise and a mild local treatment, I have known 
 many blest with the full enjoyment of all their 
 wishes, when neglect of these matters would fre- 
 quently end in bad health, the forerunner of Con- 
 sumption. If we would wish to preserve good 
 health in females we should attend to the harmo- 
 
OP CONSUMPTION. 59 
 
 nious action of all the functions. To accomplish 
 this end exercise is a powerful agent. 
 
 If we extend our observation to the inferior 
 animals, and observe the difference between the 
 tame and wild deer, we shall be struck with the 
 importance of exercise. I have found in the course 
 of my inquiries, (and this has no doubt occurred 
 to others,) that tubercles are never met with in the 
 lungs of the wild deer, while they frequently exist 
 in the lungs of the same animal, domesticated. 
 
 Perhaps this cannot be better exemplified than 
 by way of contrast, — swine, proverbially the most 
 indolent of all animals, are the most subject to the 
 tuberculous disease ; hence the derivation of the 
 word scrofula, from the latin scrofa, a swine ; and 
 Consumption and scrofula are often the same, both 
 resulting from tubercles. 
 
 I have introduced these facts as an argument in 
 support of the importance of exercise — if that 
 healthful prophylactic is properly attended to, I 
 shall be fully repaid for all the trouble I have been 
 at. I have thus far set before the reader, disease and 
 a preventive; not life and death, these are the 
 dispensations of a higher power. 
 
TREATMENT OF CONSUMPTION. 
 
 If from neglect or improper treatment of any of 
 the acute diseases already cited, or from a scrofu- 
 lous constitution, Consumption should take place, 
 our first effort should be directed to the cure of 
 hectic fever. When this is completely accomplished 
 we may proceed to the removal of its causes. 
 
 It is this fever in Consumption that debilitates 
 the patient, and not the expectoration, as has been 
 imagined by many : we often find large ulcers on 
 the limbs, called constitutional, discharging a great 
 quantity of pus, and yet no hectic fever or debility 
 is produced. The scrofulous habit is the most sub- 
 ject to hectic. 
 
 For the purpose of removing this form of fever, 
 I have employed moderate anti-phlogistic means, 
 with the most decided benefit in the majority of 
 cases. Ramadge (it will be found by reference to 
 
 6 
 
62 TREATMENT OF CONSUMPTION. 
 
 his work,; directs for this purpose the application 
 of a few leeches to the chest, I must differ from 
 him a little, but only in locality. I have always 
 found three or four ounces of blood taken from the 
 back, immediately opposite the fourth or fifth dor- 
 sal-vertebrae, either with leeches or cups, decidedly 
 more efficacious. A few applications of this nature 
 
 with the daily use of a compound pill 
 
 will soon lessen or re- 
 
 move hectic paroxysm, and prepare the patient for 
 a course of inhalation. Weakness is seldom com- 
 plained of, from this careful mode of depletion, 
 while the relief is certain. Blood-letting in Con- 
 sumption should never be carried to an extent that 
 may cause reaction, unless it is used for this pur- 
 pose solely, as in the case of indolent ulcer ; if 
 practised under other circumstances, the fever in- 
 stead of being relieved will be much increased. 
 There are those no doubt in the medical profession, 
 who have observed a sluggish ulcer discharging 
 matter and remaining in the same state for months, 
 immediately put on the healing or adhesive pro- 
 cess, after some slight hemorrhage has taken place. 
 Many surgeons have recommended the application 
 of a few cups or leeches for this purpose ; and we 
 frequently find the consumptive patient improve 
 
TREATMENT OF CONSUMPTION. 63 
 
 after a slight discharge of blood from the lungs. 
 Perhaps this apparent relief met with by all ob- 
 servers, may have led many to the conclusion, that 
 a removal of bleeding hemorrhoids was always 
 dangerous to the consumptive individual. My 
 opinion is, however, that this conclusion is erro- 
 neous, and that it would in all cases be better for 
 the physician to keep, if possible, depletion under 
 his immediate controul, carefully watching every 
 change in the system and being always governed 
 by circumstances. 
 
 Slight haemoptoe there is decidedly less risk, in 
 leaving to nature ; this only occurs when idiopathic 
 plethora requires depletion. 
 
 When by this local depletion, the hectic parox- 
 ysm is subdued, we must in the next place try to 
 discover by attentive examination, the state of the 
 constitution ; and find whether the ulcers or 
 vomica, are indolent, inflammatory, or irritable : 
 upon their nature, will depend the treatment. If 
 indolent, and the patient complains of no pain or 
 suffering, when coughing or upon full and deep 
 inspiration, I would direct for the purpose of pro- 
 ducing new action, — the inhalation of a mixture of 
 such gasses as I have invariably found useful for 
 the production of this healthy change; a brisk purge 
 
64 TREATMENT OF CONSUMPTION. 
 
 of sulphur, super-tart-pot, jalap and iodine, should 
 follow the use of the gasses, and the general me- 
 chanical inhalation should commence, with a full 
 and generous diet ; by these means I should expect to 
 prepare the cavity for reunion and approximation. 
 But should I find the abscess, of a painful charac- 
 ter, the expectoration ichorous, and the inflamma- 
 tion of the tongue and throat very considerable, I 
 should rely on local depletion for a few days, or 
 until these symptoms abated. This will soon 
 happen and the patient be prepared for restorative 
 treatment. In the irritable kind of abscess, local 
 depletion should be less in quantity and frequency ; 
 a very slight sedative course combined with a mild 
 diet, and a careful alterative treatment, [not mer- 
 curial,) by adding a small portion of the nitro 
 muriate of gold, to the pill I have already men- 
 tioned. 
 
 The use of blisters, so frequently directed in 
 Consumption, is always, in my opinion of doubtful 
 utility; and in the constitution subject to this irri- 
 table kind of inflammation, producing the irritable 
 vomica, will tend more to increase than diminish 
 the disease. I have known the cough aggravated, 
 the appetite destroyed, the secretions all deranged, 
 and the patient suffer much strangury, by the ap- 
 
TREATMENT OF CONSUMPTION. 65 
 
 plication of blisters, and yet they were continued 
 until the vital powers were sinking under their 
 influence. 
 
 Plasters of all kinds should be prohibited, when 
 the individual is labouring under Consumption ; 
 if applied about the chest they tend to impede 
 respiration, by preventing full play of the ribs and 
 sternum, and if used on other parts of the body 
 they can have no other influence, but to increase 
 the irritable state. 
 
 Plasters of burgundy pitch were much used 
 during the summer of 1832, as a preventive of 
 cholera ; many wore these plasters who escaped 
 the disease, and they attributed this good fortune 
 to their use. Faith in plasters was unshaken until 
 the disease broke out in the Arch street prison, and 
 it was found that many died with the plasters on 
 their stomachs. 
 
 1 have always prohibited the use of plasters or 
 the chest, and for this reason, that their composi- 
 tion cannot possess virtues that shall counter- 
 balance the great inconvenience the lungs suffer 
 from a want of full inflation, which plasters worn 
 over the ribs or breast invariably tend to prevent. 
 
 The first and most important point in the treat- 
 ment of Consumption, is to get rid of fever ; while 
 
 6# 
 
66 TREATMENT OF CONSUMPTION. 
 
 that state of the body exists called fever, we cannot 
 expect the healing process to go on ; it will always 
 be found, that ulcers on the surface and conse- 
 quently open to inspection, will change from the 
 healing process to the opposite during fever. In 
 this way we can account for the suspension of 
 discharge from the lungs of the consumptive pa- 
 tient during the fever of hectic, and the free ex- 
 pectoration, when the diaphoresis (the third stage 
 of the paroxysm) is completely established. 
 
 When we have completely removed hectic fever, 
 we will find the remaining treatment easily man- 
 aged, by the kind of depletion I have already 
 hinted at, by free ventilation and a well regulated 
 temperature, by proper clothing, allowing in all 
 cases, deep and full inflation, by a kind of diet 
 that shall nourish without stimulating, and by re- 
 moving all the causes that may tend to produce 
 irritability of disposition. 
 
 When the bowels are obstinately constipated, 
 they should be corrected by medicines that produce 
 the effect, while at the same time they tend to 
 alter that state of the blood which gives rise to the 
 deposit of tuberculous matter. This has long been 
 a desideratum devoutly to be wished ; perhaps it 
 may be found in gymnastics and the use of my 
 
TREATMENT OF CONSUMPTION. 67 
 
 prophylactic compound. I have always recom- 
 mended the use of this compound for some weeks, 
 after pneumonia or any of those diseases which 
 might leave that state of the fluids, so frequently 
 productive of obstruction and consequent tuber- 
 cles, and in the majority of cases, I have had the 
 gratification of seeing my patients return to per- 
 fect health, leaving (of disease,) no trace behind. 
 Whatever others may think of my remedies, I 
 shall always praise the bridge that carries me safe 
 over. 
 
 The painful inflammatory ulcer often met with 
 in Consumption, requires a treatment somewhat 
 different from that demanded for the indolent 
 ulcer; although the symptoms may appear the 
 same, they will be found to differ widely, upon 
 minute inspection. 
 
 The patient can most frequently place his finger 
 over that part of the lung in which this kind of 
 ulcer exists ; the expectoration is generally viscid, 
 scanty and dark. This species of ulcer or excava- 
 tion, like the preceding, is produced by the sup- 
 purating and bursting of tubercles, forming an 
 open abscess, but unlike the preceding is con- 
 tinually inflamed producing a cough almost con- 
 stant, harrassing the patient day and night. 
 
68 TREATMENT OP CONSUMPTION. 
 
 In the treatment of this form of diseased lung, 
 we must be guided by the situation in which we 
 find the venous system ; should we find much 
 plethora generally existing, we must direct one, 
 two, or three small bleedings from the arm, with 
 moderate evacuations from the bowels daily, pro- 
 duced by small doses of rochelle salts, with the 
 continued use of the prophylactic mixture, for the 
 purpose of arresting the new formation of tubercles 
 in other portions of the parenchyma. After the 
 venous system is relieved, Or if this should not 
 require general depletion, we may remove the 
 inflammatory disposition of the vomica, by the 
 application of six, eight, or ten leeches to the spine, 
 directly over the fifth dorsal vertebra, attending to 
 the healthy action of the bowels daily, and the 
 continued use of the prophylactic. 
 
 When from the absence of pain and a change 
 in the expectoration, we are led to believe the 
 inflammatory condition is removed, we may com- 
 mence the appproximation of the sides of the 
 cavity, by careful inflation. The patient should 
 now begin, by inhaling five minutes at each time, 
 morning, noon, and evening, gradually increasing 
 the time until he can use the tube half an hour at 
 each period. This should be continued for three 
 
TREATMENT OP CONSUMPTION. 69 
 
 or four days and then lessen the time, by revers- 
 ing the process that was practised in the increase. 
 As printed directions will be found accompanying 
 each inhaling tube, it is deemed unnecessary to 
 describe minutely the mode of using them, in this 
 part of the work. 
 
 I would here remark, that the instrument I have 
 been in the habit of using for the last seven years, 
 is in many respects different from the kind I now 
 recommend, though the principle is the same. I 
 used formerly a long tube with a calibre, a line and 
 a half, and in some cases two lines in diameter; 
 my patients were directed to breathe in and out 
 through these tubes morning and evening, as long 
 as they could, without feeling oppressed; in the 
 majority of cases the result was remarkable. In 
 all cases, the preparatory treatment I have just 
 described, was premised. 
 
 The first intimation of the utility of this mode 
 of procedure occurred to me in 1824, while en- 
 gaged in forming a bulbous extremity to a glass 
 tube for the purpose of experiment; 1 was at the 
 time indisposed from slight catarrh, from which I 
 suffered some oppression. After blowing several 
 bulbs which required full and deep inhalation, I 
 found my lungs much relieved, the escape of air 
 
70 TREATMENT OF CONSUMPTION, 
 
 was prevented by my mouth being closed upon the 
 cool end of the glass tube, the air cells of my lungs 
 were distended until portions of the tenacious 
 mucus was loosened and expectorated, perhaps 
 assisted by the stimulus imparted to the respiratory 
 organs by this exercise of the lungs ; the relief was 
 very remarkable, and I determined to substitute a 
 glass tube of small calibre in the treatment of a 
 case of Consumption, then under my care, for a 
 mudge inhaler in use at that time. The improve- 
 ment was soon evident, and I now determined 
 upon the general use of such an instrument. 
 
 I cannot recur to this circumstance, without a 
 lively recollection of the advantages derived from 
 the intimate and friendly intercourse I have long 
 enjoyed with the Professor of chemistry in the 
 University of Pennsylvania; in whose "laboratory 
 the most obtuse mind, cannot long exist without 
 receiving some useful impression, from the multi- 
 plicity of apparatus, or the great brilliancy of ex- 
 periments, seldom failing in the hands of a pro- 
 fessor, saturated with chemical knowledge ; here 
 we find the operations of the whole universe, con- 
 densed to suit the limited vision of man ; to this 
 great teacher of chemical science, I owe the origin 
 of all my remedies for the cure of the lion of 
 
TREATMENT OF CONSUMPTION. 71 
 
 diseases, Consumption. The blowing of glass 
 bulbs, the compounding, and decomposing of 
 chemical material, the effect of certain gasses upon 
 the respiratory organs, are all the result of experi- 
 ment here performed, and always encouraged by 
 that great benefactor Professor Hare. 
 
 That he may long enjoy the reputation he now 
 possesses as a public lecturer and private citizen is 
 the most ardent wish of one who cannot flatter. 
 
 Strange to tell this practice prevented my 
 being consulted in many cases of lung disease. 
 When proposed by such of my friends as were 
 acquainted with my practice, the reply was in 
 many cases— he only uses glass tubes, pills, and 
 mixtures; time has removed many prejudices that 
 existed years ago, and I in common with many of 
 my old class mates, have passed the period of 
 probation, which every one engaged in the medi- 
 cal profession must experience, and instead of not 
 having patients to occupy my time, I may say now, 
 I have too little time for my patients. 
 
 Objections are always made to consultation 
 with junior members in the profession, who fre- 
 quently possess remedies the result of well tested 
 experiment, which should always take the place of 
 
72 TREATMENT OP CONSUMPTION. 
 
 useless compounds, the result only, of old establish- 
 ed nosological rule, right or wrong. 
 
 As soon as I find my patient prepared for the 
 use of the tube, I direct a good generous diet ; and 
 if great debility should exist, 1 add a small portion 
 of wine, with daily exercise in the open air unless 
 forbid by great weakness or the state of the 
 weather. 
 
 The chamber or sleeping room, should be large 
 and the ceiling lofty ; no curtains should be used 
 round the bed, and the fire, if any is required, 
 should certainly be made of wood ; the bed clothes 
 should be sufficient, but not heavy ; the bed should 
 be a hair mattrass. \ 
 
 In the treatment of the irritable ulcer sometimes 
 met with in Consumption, one or two small leech- 
 ings from the back will be found sufficient, or if any 
 no great benefit can result from their repetition in 
 this form of the disease ; one or two applications 
 of eight or ten leeches will suffice to prepare the 
 lungs for inflation ; but should oppression or cough- 
 ing be produced, the tube must be omitted until 
 this is removed by a few days use of the sedative 
 emulsion, and the daily external application of the 
 irritative liniment, or in mild cases the daily use of 
 
TREATMENT OF CONSUMPTION. 73 
 
 strong salt water, beginning with it tepid, and di- 
 minishing the temperature as the part shall become 
 accustomed to its use. 
 
 The fauces will generally be found inflamed ; if 
 so, the part thus effected should be touched daily, 
 or oftener if required, with a wash composed of 
 nitro muriate of gold and rose water. This will 
 soon be found to lessen or remove the inflamed 
 state of the fauces, and in a few days the patient 
 will be ready for inflation, without much inconve- 
 nience. In this form of disease, I would particu- 
 larly recommend the removal of all unnecessary 
 clothing about the neck or shoulders, and by 
 cautious steps to accustom this part to all the 
 changes of our climate. This can be done by 
 daily diminishing the amount of clothing, until as 
 little is worn as the neck can be kept comfortable 
 with, and by using for a long time, night and 
 morning, friction with a coarse towel, saturated 
 with strong coarse salt water. 
 
 The clothing of the body should be sufficient, 
 but not too heavy ; the chest should never be con- 
 fined in any way by the garments ; the lower limbs, 
 and particularly the ankles and feet should never 
 be allowed to feel cold. 
 
 When we succeed in establishing a healthy 
 
 7 
 
74 TREATMENT OF CONSUMPTION. 
 
 action of the surface of the body, we will soon 
 find the same communicated to the lining mem- 
 brane of the throat and lungs ; and yet we find 
 many physicians using large plasters or prescribing 
 them for their patients, with adhesive additions, to 
 be worn on the chest, oppressing respiration, and 
 debilitating the skin. These are worse than use- 
 less, unless they are small and composed of material 
 that may be absorbed constituting an endermic 
 treatment, and having some decided beneficial 
 effect on the existing disease. I have sometimes 
 used iodine in this way for some of the glandular 
 diseases with great effect. 
 
 This brings me to the consideration of bron- 
 chitis and its treatment. 
 
 By the term bronchitis, we are to understand an 
 inflammation of the lining membrane of the bron- 
 chial tubes ; but we frequently find the individual 
 said to have bronchitis, complaining only of the 
 trachea or larynx, which should be called laryn- 
 gitis when it occupies the part of the throat at the 
 root of the tongue. Trachitis when the inflam- 
 mation exists between this part and the top of the 
 breast bone, and bronchitis when confined to that 
 portion of the wind tube, which branches at about 
 this point, or immediately opposite the third dorsal 
 
TREATMENT OF CONSUMPTION. 75 
 
 vertebra, and ramifies very minutely through the 
 whole substance of the lungs. This tube through 
 its whole extent, is kept distended by cartilaginous 
 rings ; indeed it appears to be entirely formed by 
 a series of these rings, joined together by liga- 
 ments. Nosology can be of little importance, 
 particularly in diseases of this tube ; it can be of 
 little moment to the practitioner or his patient to 
 discover the particular locality of an inflammation 
 known by them to exist only in one organ. Disease 
 generally commences at a small point, and spreads 
 frequently throughout the whole extent of an 
 organ, altering in no manner its character, although 
 increased in degree ; the treatment being the same 
 with a corresponding increase in potency, will 
 always be found producing the same benefit. I 
 have repeatedly cured, what was called bronchitis, 
 by the application of a small portion of a weak 
 solution of the nitro muriate of gold to the fauces, 
 and strong salt water to the neck daily ; and again 
 I have found cases requiring repeated bleeding or 
 leeching, dieting, housing, and the artificial pro- 
 duction of urticaria. Yet this was the same dis- 
 ease, though in not the same degree. 
 
 This inflammation of the windpipe or its 
 branches is sometimes neglected until small ab- 
 
76 TREATMENT OF CONSUMPTION. 
 
 scesses are produced on its surface, these burst 
 forming open ulcers, and sometimes the ulceration 
 penetrates to the cartilaginous rings; when this 
 happens it must be obvious that the case will be 
 chronic, and require a treatment of the most per- 
 severing kind, this cartilaginous inflammation 
 should be looked upon as of the same nature as 
 inflamed cartilage in the other parts of the body. 
 We should avoid exposure to a damp or very cold 
 atmosphere, and if compelled to leave our dwelling 
 from the nature of our business, the cold or damp 
 air should be prevented from having direct contact 
 with the inflamed bronchia, by holding a handker- 
 chief loosely over the mouth and nose. Apart- 
 ments heated by furnaces should be carefully 
 avoided by individuals affected with any form of 
 bronchitis. 
 
 The best constitutional treatment in this chronic 
 form of bronchitis, will be such as. has been found 
 useful, when inflammation of cartilages existing 
 in other parts of the body demand attention, with 
 the exception of all debilitating remedies. 
 
 The inhalation of resinous fumes, the applica- 
 tion of moxa to the upper part of the chest and 
 sternum, the internal use of sarsaparilla, and the 
 alterative prophylactic pill. Attention should also 
 
TREATMENT OP CONSUMPTION. 77 
 
 be particularly paid to the dress in this form of 
 disease, the feet should never be cold or damp, and 
 any undue moisture should not be excited by too 
 much clothing about the neck or chest; an over 
 coat should never be worn in the house, as fre- 
 quently happens to professional men, making short 
 calls ; nor should the individual ever sit with his 
 back to the fire ; these rules may be considered of 
 little importance, but experience will prove their 
 utility. 
 
 Gestation frequently arrests Consumption, and 
 if the treatment was always properly attended to 
 after parturition, the physician could in the ma- 
 jority of cases carry out this prophylactic of nature, 
 and restore to health, the individual whose good 
 fortune it has been, to be so blest. 
 
 We frequently find Consumption arrested during 
 gestation ; and in our post mortem examinations 
 we see in the lungs of females who die of Con- 
 sumption, after having many children, large cica- 
 trices extending several inches in many cases, in a 
 direction crossing the thorax, which proves the 
 previous existence of abscess ; and from the ex- 
 pectoration and cough diminishing as gestation 
 goes on, it is but reasonable to conclude, that the 
 
 >7* 
 
78 TREATMENT OF CONSUMPTION. 
 
 pressure of the gravid uterus produced this gradual 
 approximation and consequent reunion. 
 
 Now it has always appeared to me a matter of 
 great importance, for ladies under such circum- 
 stances, to select an accoucheur whose time was not 
 so entirely taken up in his profession, that he is 
 compelled to neglect the after treatment of his pa- 
 tient; health more frequently depends on this than 
 the public are generally aware of; if the abdominal 
 compress or bandage used after delivery, be not 
 properly managed, the consumptive individual 
 soon feels her old symptoms returning ; and per- 
 haps in a very few days will find her strength 
 rapidly declining, her cough renewed, her^expecto- 
 ration, her night sweats, her hectic flush, resuming 
 their former unwelcome regularity. Perhaps under 
 these circumstances, she will be directed to nurse 
 her infant, and an extra drain is thus added, has- 
 tening her destruction, while her infant and her 
 cough makes sleep a stranger to her eyelids, 
 and the new being is poisoned by what it feeds 
 on. 
 
 Can this be prevented ? Certainly. Nature 
 points out the way, her works are simple. 
 The married female is for the most part more 
 
TREATMENT OF CONSUMPTION. 79 
 
 exempt from Consumption. And if this should 
 take place, her hope of cure should be greater than 
 in single life. The common functions are for the 
 most part more regularly performed, and if she 
 should become a mother, (being threatened with 
 Consumption,) the certainty of cure is increased. 
 After parturition the bandage should be broad and 
 made to fit the person perfectly ; it should be ap- 
 plied by her physician, and examined daily ; it 
 should cover the abdomen completely, and be so 
 constructed, that there shall be no slipping up ; we 
 should endeavour to bring the stomach and bowels 
 as firmly in contact with the under surface of the 
 liver and diaphragm, as they were before delivery; 
 thus continuing the support the lungs may have 
 had from the uterus. We should also dry up the 
 milk as soon as possible, and keep the chamber 
 cool and airy, not without fire, but this should de- 
 cidedly be of wood in an open chimney ; a hori- 
 zontal posture should be enjoined and a generous 
 diet allowed. The child should be nursed by a 
 healthy female, and the use of prophylactics and 
 inhaling at once commenced. As soon as practi- 
 cable after the third week, she should ride out 
 daily, with prudence in her dress. By this care 
 
80 TREATMENT OF CONSUMPTION. 
 
 the mother will frequently escape debility and its 
 consequence, and the infant become robust, which 
 could not have happened without this mode of 
 practice. 
 
CASES OF CONSUMPTION. 
 
 CASE I. 
 
 J. B. S , aged forty two years, applied to 
 
 me in December, 1833, for the relief of a severe 
 neuralgic pain of the heart, attended with much 
 palpitation, and constant cough. He stated that 
 he had been directed by his physician to observe 
 perfect rest, to eat no animal food, and to take of 
 lugal solution five drops night and morning. 
 
 His symptoms (for which he supposed he was 
 using the best remedy,) increased, and he became 
 alarmed for his own safety; after persevering for 
 several months without relief I was consulted. 
 
 I found upon examination of the chest, that the 
 summit of the left lung was the seat of an abscess, 
 occasioned no doubt by a severe inflammation of 
 
82 CASES OF CONSUMPTION. 
 
 that part which he stated had existed a few weeks 
 before the palpitation of the heart commenced. 
 
 I assured him at once that the heart was free 
 from disease, although its motion was somewhat 
 out of order, and commenced a different treat- 
 ment. 
 
 I directed one of my prophylactic pills to be 
 taken nightly, and the application often leeches to 
 the spine immediately over the fifth dorsal verte- 
 bra, and a ride of half a mile in an open carriage 
 in the morning of every fine day ; on the fourth 
 day of this treatment, my patient called at my 
 office some little improved in spirits, with rather 
 less frequency of pulse. The expectoration was 
 still very great, but the cough less frequent ; the 
 pills had improved the state of his digestion, and 
 the uneasy feeling he had complained of for many 
 months, was in a great measure removed. I di- 
 rected the left side of the thorax to be bathed 
 night and morning with the irritative liniment, and 
 the pills to be continued. On the twelfth day of 
 my treatment he called again to say the soreness 
 had all left him ; upon applying my ear over the 
 upper portion of the left lung, I found distinct pec- 
 toriloquism; I now furnished him with a small 
 glass tube, directing him to breathe through it as 
 
CASES OP CONSUMPTION. S3 
 
 long as he could at one period, without being 
 oppressed, to continue the pills and liniment, and 
 to call in a few days again. 
 
 On the following day he left the city, and re- 
 mained at his brother's residence, in Delaware, for 
 two months ; at the expiration of this time he 
 returned, when the change for the better, prevented 
 my immediately recognising my patient. 
 
 He stated that the cough had left him gradually, 
 his expectoration was gone, and that he was now 
 able to leave for the west — which had been his 
 determination a year previous, had not his heart 
 affection prevented it. (Still harping on the old 
 palpitation.) Two years after I received a letter 
 
 from J. B. S , informing me his health was 
 
 never better, and that he had married and trans- 
 ferred his heart affection. 
 
 CASE II. 
 
 A young lady, the daughter of a very respecta- 
 ble grocer in this city, who had for many months 
 suffered from weak digestion, and consequent 
 debility, for which she had taken various remedies 
 
84 CASES OF CONSUMPTION. 
 
 without permanent benefit, became consumptive ; 
 after many proofs from various symptoms, of the 
 existence of phthisis, I was called to visit her in 
 consultation with her uncle, her attending physi- 
 cian, who gave it as his opinion that she could not 
 survive six weeks ; and observed that I had been 
 called to satisfy her brother. I replied, as I was 
 then in the house, perhaps he was already satisfied, 
 and that I conceived the next step of importance, 
 was to examine the case. I found the patient 
 much emaciated, with some cough and night 
 sweats. And upon applying my ear to the chest, 
 discovered the existence of a small cavity at the 
 summit of the right lung, while I also detected a 
 dry crepitous rattle, with bubbles manifested by 
 auscultation, the certain proof of emphysema. 
 This state arose from a spasmodic affection of the 
 throat, which the patient had been subject to for 
 more than a year. There existed much oppres- 
 sion and upon being informed that this symptom 
 had come on suddenly after a distinct sound in the 
 chest, resembling the tearing of parchment, I con- 
 cluded in my own mind, that a rupture of some of 
 the air cells had taken place, and that in time cica- 
 trization would happen through the consequent 
 dilitation of the parenchyma. I, therefore, sup- 
 
CASES OF CONSUMPTION. 85 
 
 posed a favorable prognostic existed, and of course 
 differed in opinion from the attending physician. 
 I supplied this patient with a large quantity of 
 prophylactic pills, one of which I directed to be 
 taken morning, noon, and night; from the exist- 
 ence of spasms in the throat, preventing free respi- 
 ration, 1 concluded there was little use for an 
 inhaling tube. And I am happy to add, that this 
 young lady now enjoys perfect health. 
 
 CASE III. 
 
 Mrs. M. W , aged forty two years, applied 
 
 to me in 1834, in consequence of a continued 
 hacking cough, which had been existing for four 
 months, notwithstanding the use of all the known 
 remedies, or cough mixtures : upon examination 
 of the chest by percussion, I at once discovered 
 the right lung was perfectly useless to her, and that 
 its greater portion was occupied by an abscess. 
 Believing surgery might afford some relief, 1 pro- 
 posed a consultation with my friend Dr. J. Ran- 
 dolph, which was acceded to ; the doctor made the 
 same examination, and agreed with me at once in 
 
 8 
 
86 CASES OF CONSUMPTION. 
 
 opinion. The patient was very desirous that some- 
 thing should be done to relieve her breathing, and 
 was willing and anxious to have an operation 
 performed ; there being great emaciation and very- 
 great debility, we concluded to support her 
 strength with a portion of rich soup and malt 
 liquor daily ; this she took freely for three or four 
 weeks, and recovered some strength, the bowels 
 keeping tolerably regular for some time ; this did 
 not continue long, however, and at the expiration 
 of about four weeks from our first visit, obstinate 
 constipation took place, and all purgative medi- 
 cine swallowed produced no operation. The use 
 of a teribinthinate injection had a better effect. A 
 large tumor was now distinctly felt immediately 
 under the right false ribs, and in a few days this 
 became very prominent, yielding fluctuation by 
 percussion. She now repeated to me her desire 
 for an operation, and begged me to puncture this 
 large gathering, (as she called it.) I promised this 
 should be done, and on the following day, request- 
 ed my friend Dr. G. S. Morton to be present at the 
 operation. 
 
 Dr. Morton examined the tumor and we jointly 
 concluded, that an operation was not only safe, 
 but justifiable. 
 
CASES OF CONSUMPTION. 87 
 
 After providing bandages, compresses, etc., I 
 proceeded by making a small incision through the 
 skin immediately over the most prominent point 
 of the tumor, and then changing my scalpel for a 
 small trocar, I gently pressed this instrument 
 through the muscles and into the enlarged liver, 
 the seat of the abscess ; upon withdrawing the 
 trocar and leaving the canula, (with which this 
 instrument is generally sheathed,) thin unhealthy 
 pus flowed freely through it. This continued until 
 six quarts had been discharged without any signs 
 of syncope being produced. I should not mention 
 this large quantity, had not Dr. Morton been pre- 
 sent who can vouch for the authenticity. 
 
 The respiration and general unfavorable symp- 
 toms continued to improve, the cough completely 
 leaving her for three weeks. At the expiration 
 of this time, the oppression and cough returned, 
 and she sunk rapidly, living one month after the 
 operation, from which no ultimate benefit could be 
 promised, although demanded for relief. 
 
 Autopsy, assisted by my friend Dr. Morton, 
 twelve hours after death: the right lung as had 
 been anticipated, was nearly destroyed by ulcera- 
 tion, except a small portion which was found 
 shrunk up under the right clavicle, while the cavity 
 
 -;■ 
 
88 CASES OF CONSUMPTION. 
 
 of the pleura of the right side was filled with the 
 same kind of matter which had been discharged 
 by the operation a month previous. The heart 
 was found to be perfectly natural, although this 
 patient had suffered much from palpitation ; the 
 left lung appeared healthy with the excep- 
 tion of its upper lobe which was hepatized, the 
 cavity of the pleura of this side contained about 
 four ounces of serum. The right lobe of the liver 
 was found greatly distended, and upon being 
 punctured, discharged as much thin matter or pus 
 as would make up, (with the quantity found in the 
 chest,) the same amount discharged at the time of 
 the operation; the liver was only a sack contain- 
 ing this fluid, its walls not thicker than four lines, 
 its upper portion adhering to the diaphragm and 
 opening into the right pleural sack, by a sinus ; 
 accounting for the great relief the patient had ex- 
 perienced in her breathing after the operation. 
 
 The health of this patient had been declining 
 for many years from leucorrhea ; this circumstance 
 led me to examine particularly the state of the 
 uterus; and from the situation in which I found 
 this organ, I concluded our general remedies for 
 that disease must frequently be very inefficient ; I 
 determined from this hint to change the practice 
 
CASES OF CONSUMPTION. S9 
 
 somewhat, and my success in the treatment of 
 uterine diseases since that period will always pre- 
 vent my regretting a desertion from the old plan 
 of treatment generally pursued. 
 
 CASE IV. 
 
 Proving the injurious effect of inflammation 
 and vesication about the chest, by blisters or 
 plasters. 
 
 Miss E. S , aged 17 years, in the spring of 
 
 1835, after long exposure to a cold and damp 
 easterly wind by riding in an open carriage, was 
 taken with a chill which proved to be the com- 
 mencement of pneumonia. Medical aid was soon 
 called and a proper treatment at once directed ; 
 she was bleed freely, and as often repeated as the 
 nature of the case required. Evacuants were used 
 freely and properly, and a speedy convalescence 
 was brought about. 
 
 Some days after her physician left her, she com- 
 plained of a slight pain in the right side, for the 
 relief of which her parent administered a large 
 
 8* 
 
90 CASES OP CONSUMPTION. 
 
 dose of calomel, which operated slightly, and was 
 not followed by any other medicine ; the following 
 day, she had some fever and a return of her cough ; 
 the breast was rubbed with a stimulating liniment, 
 and a blister applied. The consequent inflamma- 
 tion of the cuticle and general soreness produced, 
 prevented full motion of the chest, and the patient 
 soon complained of much oppression in breathing. 
 This created some alarm, and her physician was 
 again called in, who imbibing some of the 
 views of the patient, directed a large plaster of 
 burgundy pitch, sprinkled with Spanish flies, to be 
 applied to the back and shoulders. This effectually 
 prevented all healthy respiration or full inflation, 
 and the best selected internal treatment was conse- 
 quently of no avail ; the lungs were supposed to be 
 diseased, and I was called in consultation. I could 
 not explore the chest on my first visit, in conse- 
 quence of the very great inflammation and sore- 
 ness of the whole surface of this part occasioned 
 by the blisters, liniments, plasters, &c, &c. But 
 finding the bowels still slow, with a slight degree 
 of ptyalism, I directed one of my pills to be given 
 morning, noon, and night, (the composition of 
 which I made known to the attending physician,) 
 with ten grains of nitrate of potash as often, ah 
 
CASES OF CONSUMPTION. 91 
 
 the plasters to be removed, and the chest bathed 
 frequently with a little cool brandy. The applica- 
 tion of brandy to surfaces inflamed in this way, 
 or by blisters alone, is perhaps one of the most 
 soothing and comforting we can direct. 
 
 The nitre, the prophylactic pill, the removal of 
 all external irritants, had a most charming effect. 
 On my next visit, the lively countenance, the 
 cheerful expression, the desire to be questioned, 
 that she might answer for herself, told all that I 
 could wish to hear. 
 
 Her fever had left her, the skin felt naturally 
 moist, the tongue looking much more like health, 
 the eye lively, and the irritable state of the throat 
 much subdued. The peristaltic action of the 
 bowels improved, and so much improvement in 
 the state of the skin over the thorax, that I was 
 now able to examine the state of the lungs by per- 
 cussion, auscultation, &c. 
 
 I found immediately under the left clavicle, the 
 respiratory murmur could not be heard ; this part 
 gave a dull sound on percussion, and the difficulty 
 of breathing was much increased by laying upon 
 the left side. As there was some pain produced 
 by a deep inspiration in this part, I directed ten 
 leeches to be applied to the back in a small com- 
 
92 CASES OF CONSUMPTION. 
 
 pass over the fifth dorsal vertebra, and the pills to 
 be continued. On my next visit I found very 
 little uneasiness or pain in any part of the chest, 
 by full inflation, and less inconvenience produced 
 by change of position. I now furnished a small 
 glass tube for inhaling, with the general directions 
 in manuscript, ordering at the same time a con- 
 tinuation of the pills morning and evening, and a 
 moderate diet of small portions of venison, (one 
 ounce,) and one cracker, morning, noon, and night, 
 with one wineglass of good ale after the mid-day 
 meal ; the daily use of dumb bells, and a brisk 
 walk up and down the chamber several times 
 through the day. With these directions and a 
 promise on her part to continue them faithfully, 1 
 left my patient under the care of her attending phy- 
 sician. 
 
 At the expiration of six weeks, she called at my 
 house in a carriage to report her health; there 
 was now distinct respiratory murmur heard in 
 every part of the chest, and I agreed with her in 
 opinion, that further treatment was unnecessary. 
 
 This young lady still continues to enjoy unin- 
 terrupted health, without the least appearance of 
 ever having had lung affection. 
 
CASES OF CONSUMPTION. 93 
 
 CASE V. 
 
 Case of recovery after the formation of tubercles, 
 in a constitution of a hereditary predisposi- 
 tion. 
 
 In March, 1835, I was consulted by Miss M. 
 
 R , aged twenty two, for a painful affection of 
 
 the chest, attended with considerable cough and 
 expectoration of blood, mixed with frothing yellow 
 matter. She stated that she had lost her mother 
 and sister with the same disease, and believed she 
 herself was going rapidly ; upon exploring the 
 chest I found the summit of each lung was ob- 
 structed by tubercles, several existed on the sides 
 of the neck, and many under the scalp ; she expe- 
 rienced much inconvenience from these small 
 tumours, when her bonnet pressed them ; I pro- 
 posed their removal which she acceded to, and 
 commenced a general treatment : I directed her to 
 leave the city, to use daily a pair of heavy dumb- 
 bells, to make full inspirations frequently through 
 the day, to swing by the hands from the lower 
 
94 CASES OF CONSUMPTION. 
 
 limbs of peach or apple trees, (which I knew she 
 would find on the farm she had chosen for her 
 location.) I provided her with an alterative mix- 
 ture and a large box of prophylactic pills, she con- 
 tinued at the farm, and most of the day, (in fine 
 weather,) in the orchard swinging upon some of 
 the horizontal limbs. The expectoration grad- 
 ually diminished, her strength returned, her chest 
 and hips expanded, she became robust, and still 
 enjoys good health; her chest in August, 1841, 
 when I last examined it, showed no marks of dis- 
 ease. I then for the first time since I had made 
 it, observed that I had kept my promise, and that 
 with common prudence she might enjoy a long 
 life. 
 
 I had left one of the small tumors on the head, 
 for the purpose of seeing whether the internal use 
 of medicine could produce its absorption ; upon 
 searching for it after she returned to the city, I 
 could discover no trace of this tubercle. 
 
 Note. — This case was to be the third victim in one family, see 
 introduction, page 19. 
 
GASES OF CONSUMPTION. 95 
 
 
 CASE VI. 
 
 Consumption in its very advanced stage cured 
 by the supervention of another disease. 
 
 Mrs. S. W , aged thirty nine, applied to me 
 
 in May, 1835, for advice in her case. She stated 
 that for eighteen months previous, her health had 
 been declining, with continued cough, much ex- 
 pectoration of bloody matter, and hectic fever. 
 She had been for six months under the care of 
 two very able physicians, whose treatment cor- 
 responded with that of others under the same cir- 
 cumstances : as she had received no benefit from 
 medicine, and as dropsy had taken place, which in 
 her opinion, was to end her suffering, she gave up 
 ail hopes of recovery ; but as her cough and ex- 
 pectoration had diminished, while her strength had 
 increased, and her chills, fever, and night sweats 
 had completely left her, she consulted me for the 
 cure of her dropsy. This I observed might be ac- 
 complished, but, that in my opinion she owed her 
 recovery from cough to this disease. This opinion 
 
96 OASES OP CONSUMPTION. 
 
 I formed from the fact of there being no edema, 
 which led me to conclude the dropsy was encysted, 
 while the abdomen was as large as is generally 
 met with in the last months of gestation. I had 
 no doubt that the relief from her pectoral affection 
 was owing entirely to the support the diaphragm 
 and lungs received from the existence of this dis- 
 ease. 
 
 I, therefore, advised her to continue without 
 medicine, and to let me know immediately, if any 
 of her old symptoms of cough or expectoration 
 should take place. In October, 1835, 1 was again 
 called to visit this patient, when she requested that 
 I would do something for her dropsy, as she had 
 no return of cough or spitting, and thought that 
 dropsy had done all it could for her, and that now 
 she would like to do without it if possible. Having 
 some suspicion of large hydatids in the uterus, I 
 proposed an examination per vaginum, and soon 
 discovered that the views I had of her case were 
 well founded. The uterus was as large as we 
 generally meet with at the ninth month of gesta- 
 tion ; I proposed the introduction of a common 
 sound, through the os uteri, which was acceded to, 
 and by making a few rotatory movements, broke 
 the sack containing the fluid, and in a few mo- 
 
CASES OF CONSUMPTION. 97 
 
 ments my patient was relieved from ail her distress 
 from dropsy. I directed her to lie with her head 
 and shoulders low, and to keep constantly applied 
 round the lower part of the abdomen, a broad 
 bandage moderately tight ; my object was to sup- 
 port the diaphragm as much as possible. She soon 
 recovered without the use of any medicine, and 
 now continues in perfect health. 
 
 CASE VII. 
 
 A. W , aged thirty two, consulted me in 
 
 November, 1836, for the relief of a troublesome 
 cough, with scanty expectoration of matter streak- 
 ed with blood, which had existed for several 
 months. He had been frequently leeched on the 
 throat, and as often blistered. He had also inhaled 
 iodine for a long time by the advice of his physi- 
 cian, and had tried a short sea voyage without 
 relief. Upon exploring the chest, I found the 
 parenchyma healthy throughout. He complained 
 when exposed to the atmosphere of heated rooms, 
 of a deep seated pain and sore feeling at the upper 
 part of the sternum, (or breast bone,) which was 
 
 9 
 
9S CASES OF CONSUMPTION. 
 
 much increased by inhaling a very cold air, but 
 was greatly lessened when the weather was tem- 
 perate. He had avoided all stimulating drinks, 
 and animal food, dressed warm, and particularly 
 protected the chest and neck. This 1 directed he 
 should remove as soon as possible, and bathe the 
 part night and morning with cold salt water, I 
 supplied him with my solution of gold, and ordered 
 him to touch the fauces with a soft camel's hair 
 pencil, moistened with this solution night and 
 morning. To commence the daily use of the Lisbon 
 diet drink, and one of the compound prophylac- 
 tic pills to be taken nightly. At the expiration of 
 
 one week A. W called at my office much 
 
 improved, his expectoration had diminished very 
 considerably, his soreness of throat nearly gone. 
 He continued to mend from this time, and after 
 this treatment lasted two months he considered 
 remedies unnecessary. This patient continues to 
 enjoy perfect health. 
 
CASES OF CONSUMPTION. 99 
 
 CASE VIII. 
 
 Case of incipient tubercular consumption cured, 
 
 Miss E. D , aged twenty four, canre from 
 
 the state of Maryland to consult me, in the month 
 of September, 1S40, she complained of great sore- 
 ness of the throat with enlarged tonsils, and con- 
 tinued cough, except a few hours after the use of 
 a cough mixture, which always produced sleep. 
 
 The upper lobe of the right lung yielded a dull 
 sound upon percussion, and she complained of a 
 deep seated soreness when pressure was made on 
 the ribs over this part. Her cough was very con- 
 stant, but without expectoration ; her pulse fre- 
 quent and tense, the tongue coated except near the 
 end. which was of a deep red, her cheeks occupied 
 by a hectic blush, lips thick and protruding. In 
 fact all the marks of incipient tubercular consump- 
 tion, commencing in a constitution loaded with 
 scrofula. ( The indications in this case were plain ; 
 to soften and cause absorption of the tubercles, to 
 remove the hectic, and change the diseased action 
 
100 CASES OF CONSUMPTION. 
 
 into healthy. Laennec it would appear by refer- 
 ence to his work on diseases of the chest, places 
 little confidence in remedies said to possess the 
 power of softening tubercles ; I am by no means 
 astonished at this. By a perusal of his writings, 
 it will clearly be seen that this " great author," 
 like many of his predecessors, introduces to the 
 reader a variety of remedies, the utility of which 
 in his mind is doubtful ; without attempting to ac- 
 count for their failure, or proposing a better means 
 of cure. 
 
 He classes under the head of empirical reme- 
 dies, mercurial salivation, emetics, (which have 
 been highly recommended by many distinguished 
 practitioners in imitation of a sea voyage ;) why 
 they should select the most unpleasant part of a 
 sea-voyage, has I must acknowledge, always ap- 
 peared strange to me : and from what I have 
 already said in relation to the advantages of a sea- 
 voyage, it must appear evident that I place little 
 reliance on the mere effect produced on the 
 stomach. Laennec also places under the head of 
 empirical means, charcoal, mushrooms, red cab- 
 bage, wolf's bane, crabs, oysters, frogs, vipers, 
 electricity, opium, cicuta, cinchona, hydrocyanic 
 acid, the seeds of the phellandrium, aquaticum, 
 
CASES OF CONSUMPTION. 101 
 
 &c, &c. How the opinions of Laennec have 
 been received by those practitioners who have 
 relied on opium, cicuta, hydrocyanic acid, mer- 
 cury, &c, I know not. — But to return to my 
 subject ; I directed this patient to use all the out 
 door exercise practicable, to throw off corsets and 
 all restrictions to a free motion of the muscles of 
 the body or limbs, to have a double ladder erected 
 in the chamber, and a single large sized rope sus- 
 pended from the top round ; on this ladder she was 
 to perform all the evolutions and calisthenics in 
 her power, to climb the rope to the top by the use 
 of the hands and arms alone, to use dumb-bells 
 twenty minutes night and morning, and ride or 
 walk out whenever the weather would permit ; 
 1 directed as medicine the daily use of my prophy- 
 lactic compounds, and every evening ten grains of 
 the nitrate of potash. 
 
 To rub the upper portion of the right side of 
 the chest with an ointment of iodine nightly, and 
 use the inhaling tube every four hours, for twenty 
 five minutes at each time. I prohibited all animal 
 food, except wild meats, and these were to be used 
 but once in twenty four hours. With a continua- 
 tion of these directions, I visited my patient every 
 three or four days, perceiving improvement at 
 
102 CASES OF CONSUMPTION. 
 
 every visit. Much change in the skin, and whole 
 expression, was soon remarked by all her friends ; 
 the thickness of the lips began to diminish, the 
 hectic left the cheek, the tongue lost its morning 
 dryness, the stoop and disposition to approximate 
 the shoulders was soon changed to an erect and 
 broad expansion of the chest, and at the expiration 
 of four months she left the city in good health. I 
 frequently see the relatives of this patient, and 
 learn from them the pleasing fact that she still en- 
 joys most excellent health. 
 
 CASE IX. 
 
 Case of inflamed ulcer in the lungs cured by 
 leeching, prophylactic pills, and inhaling. 
 
 S. M , aged thirty three, called on me in 
 
 February, 1837, with bloody expectoration, mid- 
 day chills, evening fever, and nocturnal perspira- 
 tion ; much emaciated, considerable cough, and 
 great loss of strength, most sensibly felt early in 
 the day from the constant perspiration of the 
 night. I directed fifteen leeches to be applied over 
 
CASES OF CONSUMPTION. 103 
 
 the fifth dorsal vertebra, and a pill to be taken 
 nightly, composed of teraxicum cicutae and nitro 
 muriate of gold. At the end of one week he called 
 at my office free from pain or soreness in any part 
 of the chest, and upon exploration with the stetho- 
 scope, I could distinctly perceive the existence of 
 a cavity near the summit of the right lung with 
 clear pectoriloquism ; the corresponding portion 
 of the left lung yielded a dull sound by percussion, 
 while the respiratory murmur was very dull and 
 indistinct. The night sweats still continuing, with- 
 out perceptible chill, or much fever preceding. 
 Having frequently met with cases that v/ere re- 
 lieved of this unpleasant symptom by a remedy 
 often used in the practice of my late and highly 
 esteemed friend Dr. Joseph Parish, whose medical 
 career was noted for success, I determined upon 
 its trial in this case. I therefore directed the 
 whole surface to be sponged every night with 
 a strong solution of alum in hot water, to which 
 had been added a small portion of brandy ; or- 
 dering at the same time the regular use of my 
 prophylactic pills, and a full inflation of the lungs 
 through the inhaling tube, which I had provided 
 for this patient, made of glass two feet in length, 
 having a calibre one and a half lines in diameter. 
 
104 CASES OF CONSUMPTION. 
 
 The soreness originally complained of never re- 
 turned sufficiently to demand a second leeching— 
 the expectoration diminished gradually, the bath- 
 ing or sponging was used for two weeks, when 
 the night sweats had completely subsided. The 
 prophylactic pills were used for three months, and 
 the inhalation continued at intervals for two ; at 
 the expiration of this time the lungs became 
 voluminous, the pectoriloquism was no longer 
 heard at the summit of the right lung, while 
 in the left the respiratory murmur was now 
 distinct : October, 1841, continues to enjoy good 
 health. 
 
 Flattered by my success, I determined to test my 
 genius, if any I possessed, to the construction of 
 better inhaling tubes ; these I subsequently con- 
 trived of various material ; of gum elastic stomach 
 tubes, of large catheters, of lead, and of wood. They 
 answered my purpose tolerably well, until a friend 
 of mine returned from a visit to Europe, who 
 supplied me with breathing tubes from the maker 
 employed by the celebrated Dr. Ramadge. In 
 many respects these tubes are superior to any I 
 have ever used, and I have had a large supply 
 constructed by a mechanic in this city for general 
 use. There is one great advantage in having a 
 
CASES OP CONSUMPTION. 105 
 
 maker at hand, the length of tubes may be in- 
 creased or diminished, while the calibre can be 
 made to suit the peculiar state of the lungs, or age 
 of the patient ; much attention to this point is 
 required when tubes are used. 
 
 CASE X. 
 
 In February, 1839, I was called to visit the 
 daughter of a respectable merchant of New York, 
 whose health had been declining for more than 
 eighteen months ; she complained of constant pain 
 about the middle lobe of the right lung, with pal- 
 pitation of the heart, and much oppression in 
 breathing : she had been confined to the house for 
 more than six months, by the advice of her former 
 physician, but not to her bed. She had taken 
 many mixtures for her cough, which was very 
 troublesome, but without relief. She complained 
 of some soreness upon pressure being applied to 
 the fifth, sixth, and seventh dorsal vertebrae : this 
 led her parents to believe the cough and emacia- 
 tion was occasioned by a disease of her spine, for 
 which I was consulted. Upon examination of the 
 
106 CASES OF CONSUMPTION. 
 
 spine I could not percieve any derangement in its 
 column, but had no doubt that the state of the 
 lungs communicated through the nervous system, 
 their increased sensibility to this part. The locality 
 of pain is deceptive, and often will mislead a 
 superficial observer ; we have often seen cases of 
 severe hemiplegia, treated with blisters, setons, 
 emetics, narcotics, &c, without relief, at once 
 cured by the extraction of a decayed tooth, which 
 had not attracted the attention of the patient or 
 perhaps occasioned the least uneasiness. Upon 
 exploring the chest, the cause of this soreness of 
 the spine was soon discovered; there existed about 
 the middle of the right lung a space of about six 
 inches in circumference occupied by tubercles, a 
 circumstance sufficient in my opinion, to account 
 for the derangement of the motion of the heart, 
 as well as the existence of all the other unfavorable 
 symptoms. There were several small moveable 
 tumors in the direction of the absorbents on the 
 right side of the neck, which the patient stated, 
 had existed for more than twelve months ; the skin 
 was always dry and the temperature above the 
 natural standard of health. 
 
 I commenced the treatment, by causing all the 
 articles of dress (corsets, tight frock bodies, &c.,) 
 
CASES OF CONSUMPTION. 107 
 
 to be removed, and to use no garment that could 
 in the least impede a full inflation of the chest, or 
 prevent the arms from being raised perpendicularly 
 above the head ; I had fifteen large leeches ap- 
 plied to the portion of the spine complained of, and 
 directed one of the prophylactic pills to be taken 
 morning, noon, and night ; to rid the system more 
 perfectly of all the scrofulous tendency, I directed 
 at the same time twenty drops of my solution of 
 bromine every four hours, and a bath daily of salt 
 water at a temperature of eighty degrees Fahren- 
 heit. This treatment was continued for one week 
 with decided improvement, and at the expiration 
 of that time, finding less cough and pain in the 
 chest, I added to the remedies the use of the in- 
 haling tube, a double ladder, dumb-bells, &c. 
 
 In about six weeks from the commencement of 
 the treatment, the small tumor on the neck sub- 
 sided, the pain left the breast and back completely, 
 the respiratory murmur was distinctly heard 
 throughout the chest, and the patient now took 
 daily exercise on horseback. She continued under 
 my care for three months longer, when she return- 
 ed to her native city in perfect health, I frequently 
 hear from this patient who continues to be active 
 and well. 
 
108 
 
 NOTE. 
 
 I might go on with my history and treatment of 
 cases, but my time is too much occupied at pre- 
 sent in practice, to allow sufficient leisure to put 
 them in form for publication. I shall therefore 
 keep the manuscript account of each case of Con- 
 sumption always in my note book, which will be 
 found upon my office table, with the name and 
 residence of most of my patients. 
 
 I shall now pass on to the consideration of some 
 of the most important derangements of the vital 
 functions. 
 
DISEASES OF THE HEART. 
 
 The healthy action of this organ is frequently 
 disturbed by other diseases, while its deranged 
 motion constitutes only one of their symptoms ; 
 the practitioner being misled often prescribes 
 remedies under these circumstances that can have 
 no influence on the real seat of disease ; this is 
 consequently allowed to go on unmolested, and 
 the palpitation or irregular action of the heart 
 which was originally symptomatic, becomes idio- 
 pathic, and consequently in most cases unman- 
 ageable. Diseases of the lungs, liver, stomach, 
 bowels, spine, and nervous system, may be classed 
 among the causes of heart affections; while the 
 passions, such as love, grief, envy, and despair, 
 should not be overlooked. 
 
 Idiopathic affections of the heart, are in my 
 opinion of rare occurrence, comparatively speak- 
 
 10 
 
110 DISEASES OF THE HEART. 
 
 ing; they are generally unmanageable, and the 
 individual thus afflicted, drags out a miserable life. 
 Post-mortem examinations frequently betray the 
 existence of diseases of other organs with decided 
 marks of having preceded the heart affection. 
 Any obstruction in glands, will often produce 
 derangement of the circulation, and consequently, 
 great alteration in the heart's action ; these glan- 
 dular diseases frequently owe their origin to some 
 derangement in the respiratory apparatus, by 
 which the blood not being perfectly changed from 
 venous to arterial, is unfit for the purposes of 
 health ; in this state it is returned to the heart, and 
 sent by the route of the circulation to supply the 
 different glands of the body. Its unfitness for this 
 purpose soon produces glandular disease, and 
 congestion of the venous system becomes the result. 
 Derangement of the organs of digestion soon fol- 
 lows, debility with all its consequences takes place, 
 and the heart is condemned unheard, or like the 
 innocent victim of justice, not listened to by those 
 who nominally preside as judges. The physician 
 may feel the pulse and perhaps look at the tongue, 
 but ridicules the use of the stethoscope, and con- 
 sequently is ignorant of the state of things exist- 
 ing at the fountain of life. 
 
DISEASES OF THE HEART. Ill 
 
 < 
 
 We frequently find congestion in the venous 
 system producing derangement of the digestive 
 organs, which not being relieved by medicine 
 alone, soon yields to its use when assisted by free 
 depletion. 
 
 Those physicians, who are accustomed to think 
 for themselves, and to apply to nature as the great 
 and only unerring teacher, are aware of the fre- 
 quency of such congestions, and their cause. The 
 injected state of the capillary vessels of the stomach, 
 and intestines, must be productive of important 
 derangements of the action of these organs. It is 
 essential, therefore, to restore them to healthy ac- 
 tivity by general or local bleeding ; and shonld 
 this not suffice to bring them back to their natural 
 functions, tonics may then be administered to cor- 
 rect any debility that may be left. 
 
 Corvisart mentions, among the various morbid 
 appearances observed by him in those who died 
 in consequence of disease of the heart, the high 
 vascularity of the stomach. To such extent does 
 this at times proceed, that, as he correctly states, 
 the stomach will be nearly filled with sanguineous 
 clots of a deep red colour, extending also through- 
 out the small intestines. I am induced to dwell 
 upon this phenomenon, with which indeed my 
 
112 DISEASES OF THE HEART. 
 
 pathological inquiries have long made me familiar, 
 principally from its singular importance in forensic 
 medicine ; although it is of no slight moment on 
 other accounts. 
 
 " Dr. Ramadge gives an account of a very 
 interesting trial occurring some years ago ; the 
 parties in which were the Rock Insurance 
 Office, and the executors of a respectable banker. 
 His death had been sudden ; and on opening his 
 body appearances were presented, which induced 
 the suspicion that the deceased had made away 
 with himself. More than one hospital surgeon of 
 eminence gave it as his opinion, that the individual 
 in question had taken poison. Their authority 
 would, in fact, have influenced the Jury, had not a 
 young medical practitioner, a former pupil of mine, 
 decided the point at issue, by counter-evidence. 
 It was, indeed, evident to the pathologist, from the 
 detail of the circumstances, that the deceased had 
 laboured under some obstruction to the circulation, 
 whence arose the congested state, and discharge 
 of blood, which had misled the other medical 
 witnesses. 
 
 Now the phenomenon, which I have just no- 
 ticed, may be presented after death from another 
 cause, which, however, produces precisely the 
 
DISEASES OP THE HEART. 113 
 
 same results as cardiac disease, namely, inflam- 
 mation of the lungs. As an instance of this fact, 
 I may adduce the 'post mortem examination of his 
 late Majesty ; and I recommend the considerations 
 I shall have to make on this subject, to the especial 
 notice of our honoured President, Sir Henry 
 Halford. If I am wrong, he will correct me ; and 
 he cannot have a more graceful, or loyal opportu- 
 nity, of making public those pathological inquiries 
 to which doubtless his life has been unremittingly 
 devoted. 
 
 From the report made after death, to which was 
 appended the name of that truly eminent surgeon, 
 Sir Astley Cooper, it would appear that this gen- 
 tleman referred the phenomena, presented on dis- 
 section, to disease of the heart. 
 
 This opinion is undoubtedly correct. Disease 
 of the heart did produce some aberrations from 
 healthy structure therein noticed. But, through 
 tenderness, I presume, for his Majesty's more 
 immediate medical attendants, he omitted to men- 
 tion, that the aggravated symptoms of this disease, 
 which, as he truly observed, " had existed for 
 many years/' were secondary, not primary causes, 
 of such morbid phenomena. Accordingly, the 
 President, knowing that Sir Astley's name is " a 
 
 10* 
 
\ 
 
 1 14 DISEASES OF THE HEART. 
 
 tower of strength," gave out afterwards that 
 cardiac disease was the ".fons malorum" Yet, 
 such being his opinion, it is extraordinary that he 
 should not have remonstrated against his Majesty's 
 frequent drives in Windsor forest, in the severest 
 weather, previously to increased indisposition con- 
 fining him to his apartment. He must, of course, 
 have been aware of the pre-existence of his cardiac 
 complaint ; since although the President, I believe, 
 does not employ auscultation, a careful exploration 
 of their patient's chest, must doubtless have been 
 made by one, or other, of the remaining medical 
 attendants. Still I do not find, from his diagnosis, 
 (so far as this is to be gleaned from the bulletins) 
 that he had any suspicion of an affection of this 
 organ, previously to death. The said bulletins 
 were indeed most " ambiguous givings out ;" and 
 were characterized, at the time, by Mr. Brougham, 
 (the late Chancellor,) in rather severe terms. I 
 forget the particular expressions of which he made 
 use, but their tenor was, that so deceptive and 
 unmeaning were those official documents, he 
 defied any man to lay his hand upon a single 
 passage from which the prospect of the event, 
 deplored by the whole nation, could have been 
 gained 
 
DISEASES OF THE HEART. 115 
 
 Supposing, however, that he did entertain the 
 belief of his Majesty's labouring under some 
 affection of the heart, I am totally at a loss to 
 account for his apathy in permitting those repeated 
 airings, of which the newspapers made at the time 
 consant mention. 
 
 It is a fact, that on the sudden setting in of cold 
 weather, numbers of elderly persons suddenly 
 succumb to the manifestation of disease of the 
 heart. This has long been observed in those 
 establishments (at least I have noticed it) in which 
 the aged are congregated together, as at our noble 
 institutions, Greenwich and Chelsea hospitals. 
 The reason is very apparent. Cold at once con- 
 stringes the cutaneous capillaries, and thus operat- 
 ing on the deep seated vessels occasions a conges- 
 tion which the heart, called upon to exert fresh 
 activity at a period when time, or disease, has 
 enfeebled this vital organ, is unable to overcome. 
 To use a technical illustration, an additional 
 leverage is exerted, and the spring snaps. 
 
 Against the above account it may be objected, 
 that dissection furnished evidence of cardiac lesion. 
 The vascularity of the stomach, as I have already 
 remarked, is no proof of the existence of disease 
 of the heart ; but what did exist had, doubtless, 
 
116 DISEASES OP THE HEART. 
 
 been called into activity by the unsuspected in- 
 flammation of the lungs. 
 
 In fine, as no diagnosis was recorded, it is pre- 
 sumable that no diagnosis was made, at least none 
 that had careful exploration of the chest, by 
 auscultation and percussion, as its basis. The 
 evils, resulting from such omission, may be con- 
 jectured from the preceding remarks. 
 
 By way of corollary to the above, and as an 
 example of how confined the knowledge of pa- 
 thology is, or else of its difficult acquisition, I may 
 mention that about two years previously to the 
 demise of his Majesty, 1 had had some prepara- 
 tions made, at a considerable expense, faithfully 
 imitating the stomachs of persons who had died 
 of the consequences of cardiac disease. These 
 preparations were shewn by the modeller to some 
 of the most eminent in the profession, and in one 
 case, to a gentleman who, he stated, was preparing 
 to publish a work on the morbid appearances of 
 the stomach in individuals destroyed by poison. 
 They all pronounced the subjects, from whom the 
 preparations were modelled, to have lost their 
 lives by poison, or some acrid substance taken into 
 the stomach. 
 
 In the report of the autopsy, on the body of his 
 
DISEASES OF THE HEART. 117 
 
 Majesty, it is stated that the immediate cause of 
 his death was the rupture of a biood-vessel in his 
 stomach. To this I can give no credence. The 
 effusion was, I make no doubt, poured forth 
 from the muco-villous coat of the stomach. It is 
 generally supposed that the vasa brevia supply a 
 channel for sanguineous congestions by the com- 
 munication they furnish with the splenic end of 
 the stomach ; but in addition to this passage, I 
 believe the vascular pores of this organ itself must 
 facilitate the escape of effusion. This, however, 
 is contrary to the opinion of Corvisart, who sup- 
 poses that the liver unloads itself of its accumulated 
 blood, through the intervention of the hepatic 
 arteries and veins, and the pori biliarii, into the 
 hepatic duct, and that the fluid conveyed by this 
 means into the beginning of the duodenum, may, 
 in part, flow back into the stomach. Now, fre- 
 quently as I have examined the hepatic duct, both 
 before and since my acquaintance with Corvisart's 
 work, I have never been able to detect the pre- 
 sence of any sanguineous collection there. 
 
 The course of the disorder which terminated 
 his Majesty's life seems to me briefly this ; and I 
 ground my opinions on the few hints to be gleaned 
 from the President's bulletins, and the details of 
 
US DISEASES OF THE HEART. 
 
 the examination after death. Cold, I conceive, 
 induced inflammation of the lungs, which was 
 latent, but could have been readily discovered by 
 an experienced auscultator. The absence of cough, 
 till within a few days preceding his demise, by 
 no means invalidates the above supposition, as 
 experience has fully shown me; and the difficulty 
 of breathing, so often mentioned in the bulletins, 
 tends to confirm it. 
 
 Consecutive hydrothorax first occurred in the 
 left side of the chest (between two and three 
 quarts of water were found after death) and the 
 compression of the lungs, produced by this effu- 
 sion, might in some degree, mask to the inexpe- 
 rienced, the auscultative signs of pneumonia. Had 
 bleeding been seasonably employed, effusion could 
 not have well occurred ; and, as a proof of the 
 inestimable value of auscultation, I must beg espe- 
 cial attention to the fact that venesection, critically 
 applied, might not only have prevented the depo- 
 sition of water in the chest, but had it been again 
 resorted to at fitting periods, it would have obviated 
 the sanguineous effusion from the stomach. This 
 latter, indeed, arose from the general venous con- 
 gestion brought on by the compression of the lungs 
 just noticed. 
 
DISEASES OF THE HEART. 119 
 
 In the outset of this digression, I have taken 
 the liberty of calling Sir Henry's attention to it. 
 Although, conjecturing from the <<■ aniles fabel- 
 las," or short essays he has published on medical 
 subjects, I am fearful that these are details which 
 possess little attraction for him. In' one of his 
 prolusions, at the conversazioni if I mistake not 
 held at the College of Physicians, he speaks of 
 individuals' having suffered from palsy of the 
 kidneys. This is so extraordinary, that one would 
 suppose the curiosity of the learned President 
 would have led him to examine these organs, in 
 order to satisfy himself whether, or not, they had 
 undergone any change of structure. Doubtless he 
 knew, without examination, the morbid condition, 
 as well as functional derangement, of these poor 
 palsied kidneys. It would, however, have been 
 kind in him, to have stated them for the benefit of 
 individuals less favoured by nature. 
 
 Before dilating further on the President's mul- 
 tifarious endowments, it behoves me to apologize 
 for having, although I trust in no irreverent spirit, 
 invoked the names of royalty; yet, I am but 
 following, although at immeasurable distance, 
 " non passibus xquis" the steps of the President 
 himself. It is his delight, and 1 humbly hope the 
 
120 DISEASES OF THE HEART. 
 
 delight of his auditory likewise, to dwell upon the 
 " last, long, lingering" scenes of royalty. Seldom 
 does one of those evening parties occur, at which 
 science, tea, and coffee, hold divided empire, but 
 he favours his hearers with an account of the 
 patience and resignation of those illustrious per- 
 sonages, who have died under his hands. 
 
 How far the interests of medicine may be ad- 
 vanced by these reunions, at which the courtly 
 President delivers his popular harangues, it be- 
 comes not me to decide. Judging from what have 
 already appeared in print, I should conclude that 
 I am no very serious loser by my absence from 
 these high solemnities. I cannot, indeed, conceive 
 how any scientific advantages can possibly accrue 
 from meetings, at which are assembled " throned 
 dominations, princedoms, virtues, powers," at 
 which, in short, a number of individuals profound- 
 ly ignorant of medicine, in company with those 
 who by virtue of their diplomas do, I should con- 
 jecture, know something of the matter, congregate 
 to listen to some popular essay on the gout, 
 insanity, &c, or observations on the charms of a 
 death-bed under the auspices of Sir H. Halford. 
 Such meetings may tend to introduce some half- 
 dozen sucking favorites of the Galenical Sultan's 
 
DISEASES OF THE HEART. 121 
 
 to promising patients, and gratify personal vanity 
 at the same time. The non-professional hearer 
 will take oratorical common-places for the dicta of 
 an Hippocrates, and the initiated will be wiser 
 than to gainsay his e^a st-tepospta. 
 
 But seriously speaking, is this a state of things 
 which can, or ought to exist ? Was the college of 
 Physicians founded for no higher purpose, than to 
 furnish forth an evening's entertainment? Pro- 
 perly directed, it might become the central point 
 around which the real talent of the kingdom might 
 be collected. Bestowing countenance, and pro- 
 tection, on the young and zealous, and made the 
 depository of every fresh accession of knowledge 
 gained by the experienced, it might rise higher 
 than personal views, and by enlarging the sphere 
 of science, lessen the ills of humanity. But to 
 effect this, or any thing approximating to it, the 
 high places, with the images of Baal, must be 
 overthrown. Wealth, and fortuitous success, must 
 no longer give a patent right to the office of 
 President. Fair, and open competition, should 
 here, as on the continent, give the highest seat to 
 the worthiest. The man, who has at his disposal 
 the most valuable situations in the reach of the 
 
 11 
 
122 DISEASES OF THE HEART. 
 
 profession, should have medical knowledge no 
 less than integrity to direct his choice. 
 
 I fairly own that when I regard the men, pre- 
 eminent in skill, and therefore, therefore alone, 
 pre-eminent in rank, who adorn the profession 
 abroad, I feel not a little ashamed of the figure we 
 make at home. The estimability of private cha- 
 racter cannot compensate for the want of distin- 
 guished professional reputation, in the nominal 
 head of the medical schools of this country. 
 Surely the ephemeral sheets, published by Sir 
 Henry, could not, by his most obliged partizan, 
 be compared, without a blush, with the masterly 
 productions — translations of which form the rich- 
 est part of our medical libraries. Did I know 
 one offering laid on the shrine of science by the 
 President, I would willingly give him the credit 
 due. I attack not the man, but the system, 
 which imposes the man upon us. When I am 
 informed of any one discovery, in either the 
 theory, or the practice of medicine, first com- 
 municated to the world by Sir Henry, I will pro- 
 claim him — a better man than many of his prede- 
 cessors in the chair. Yet let me not be too pre- 
 cipitate in my judgment. His present publication 
 
DISEASES OF THE HEART. 123 
 
 may be merely the forerunner of some great 
 posthumous work, which may call forth our re- 
 grets when its author is no more. The boon 
 denied us now may be vouchsafed to posterity ; 
 and future generations may hail, with reverence, 
 that name by which at present 
 
 Devisor vero plus laudatore movetur. 
 
 9 >9 
 
 1 am unacquainted with any member of the 
 medical profession on this side of the Atlantic, who 
 betrays in practice so much ignorance of sympto- 
 matology or pathological anatomy. Had William 
 the Fourth been surrounded by men devoted to 
 medical acquirement, and possessed of less desire 
 to relate the death-bed resignation of some patient 
 of rank, perhaps he might have still enjoyed his 
 rides in Windsor Park. 
 
 The treatment of the disease which closed the 
 life of President Harrison, was severely criticised 
 by some member of the medical profession in New 
 York, and perhaps justly. In Philadelphia we 
 were informed that the President was ill with in- 
 flammation of the lungs, but we had no account 
 of his being bled freely ; every niail brought us 
 the sad tidings of his disease progressing from bad 
 to worse, until finallv his demise was announced. 
 
124 DISEASES OF THE HEART. 
 
 There is a fact long established in practice with 
 regard to blood-letting, that persons advanced in 
 life bear bleeding better than acute inflammation ; 
 and it will generally be found, that acute inflam- 
 matory attacks will often yield more readily in 
 advanced than early life ; one or two free bleed- 
 ings will generally put an end to all danger from 
 inflammation, and completely prepare the system 
 for internal remedies, which may be indicated by 
 derangement of any of the functions. After free 
 blood-letting in old persons we should re-establish 
 the healthy action of the constitution by the use of 
 the mildest means. We should select articles of 
 medicine that would fully accomplish what we 
 desire to perform without debilitating the patient, 
 or causing the least irritation. We should never 
 rely on antimonials to remove inflammation ; the 
 tone of the stomach should be assiduously guarded. 
 In most cases the bowels may be acted upon by 
 enemas alone, or assisted by food that will have 
 the same tendency. It has been remarked by 
 others, and often witnessed by myself, that anti- 
 monials frequently reduce the patient but not the 
 disease. Where blood-letting has been early and 
 judiciously practised, there will be no necessity for 
 
DISEASES OF THE HEART. 125 
 
 antimonials ; and when the lancet has been with- 
 held nauseating doses can be of no avail. 
 
 I have met with many physicians, who having 
 lost patients with acute disease attended with some 
 irregularity of pulse, concluded that no treatment 
 could have resulted otherwise, in consequence of 
 the existence of some latent affection of the heart. 
 I have known certificates given, " died of diseased 
 heart J' when the subject had enjoyed a long life of 
 uninterrupted health free from irregularity of the 
 heart's action, until the commencement of the 
 disease that had proved fatal. I do not wish to be 
 understood to say, that diseases of the heart never 
 occur ; but I do say, in my opinion they are de- 
 cidedly more apt to be symptomatic, than idio- 
 pathic. 
 
 I have attended a lady in this city for the last 
 fifteen years, who from derangement of the liver, 
 has frequent attacks of dysenteric discharges from 
 the bowels, and while this disease lasts, which is 
 generally from two to three weeks, her heart beats 
 with great irregularity, her pulse consequently in- 
 termits, she has frequent syncope — and this state 
 of things exists as long as the bowels continue 
 deranged: but when remedies triumph over dis- 
 ease, and this disordered state of the bowels is 
 
 11* 
 
126 DISEASES OF THE HEART. 
 
 completely subdued, I find the fountain of the cir- 
 culation moving on with the same healthy regu- 
 larity, that had existed previous to the attack. 
 
 I have at this time a young lady under my care 
 whose heart (according to the opinion of her former 
 physician) was so diseased, that nothing could be 
 done for her relief. When she became my patient, 
 I gave her case all the attention it demanded ; 
 I examined the lungs, the heart, the stomach, the 
 spine, &c, and gave a written opinion to her 
 friends sealed up, with this remark, that I would 
 not pass judgment upon the discrimination of her 
 former physician, until some one of our city prac- 
 titioners had seen the case. The selection was 
 left to the family, and Dr. S. Jackson was their 
 choice, who frankly stated, after auscultation, per- 
 cussion, &c, that the heart was free from disease, 
 and in his opinion, its regularity could be esta- 
 blished, by attention to the spine, the nervous 
 system, and the bowels. This statement corres- 
 ponding with my written opinion, the seal was 
 broken and the family perfectly satisfied. The 
 treatment for spinal irritation commenced and the 
 improvement progresses daily. 
 
 I consider diseases of the heart extremely rare, 
 while inflammation of its covering, (the pericar- 
 
DISEASES OP THE HEART. 127 
 
 dium) more frequently occurs. This disease is of 
 the same nature as inflammation of the pleura, 
 though often more violent ; blood-letting should be 
 boldly performed, and the general antiphlogistic 
 plan of treatment rigidly practised. This kind of 
 inflammation often terminates by effusion, the 
 fluid in the cavity of the pericardium is thus in- 
 creased in quantity, the heart labors, its action 
 becomes irregular, its vibrations yield a dull sound 
 upon applying the stethoscope, the pulse grows 
 weak and intermits, while the individual is said to 
 have disease of the heart: under these circum- 
 stances, if we direct a spare diet, daily exercise, 
 and a compound of squills, digitalis, and elaterium, 
 in small doses, the symptoms will soon change for 
 the better, until finally the patient declares himself 
 free from disease. 
 
 The heart itself is sometimes diseased in its 
 organic structure ; the labors of Lancici, Morgagni, 
 and Senac, threw much light on this subject : and 
 many late writers have added useful information 
 to this branch of medical science. The present 
 mode of discriminating by auscultation, ensures a 
 more perfect knowledge of cardiac diseases, than 
 the ancients practised: but the inexperienced ear 
 will frequently hear sounds produced by healthy 
 
128 DISEASES OP THE HEART. 
 
 vibrations that are often mistaken for disease. 
 Corvisart made many discoveries in diseases of the 
 heart, but they were for the most part confined to 
 organic lesions : he probably made use of mediate 
 auscultation ; or perhaps, his cases frequently ter- 
 minated fatally, and lesions were discovered by 
 autopsy. It was asserted by Vieussens at an early 
 period in the last century, and soon afterwards by 
 Thebesius, a German Professor, that there were a 
 number of small orifices in the texture of the 
 heart which opened into the different cavities on 
 both sides of it. The assertion of a fact so difficult 
 to reconcile with the general principles of the cir- 
 culation, was received with great hesitation : and 
 although it was confirmed by some very respecta- 
 ble anatomists of the last century, it was denied 
 by others. The subject was brought forward by 
 Mr. Abernethy, (see London Philosophical Trans- 
 actions for 1 798, Part I.; who states, that he has 
 often passed a coarse wax injection from the 
 proper arteries and veins of the heart into all the 
 cavities of that organ, and particularly into the 
 left ventricle. But it was only in subjects with 
 diseased lungs that this was practicable. 
 
 The existence of this communication between 
 the coronary vessels and the great cavities of the 
 
DISEASES OF THE HEART. 12.9 
 
 heart seems therefore to be proved. The easy 
 demonstration in such subjects is ingeniously re- 
 ferred by Abernethy to the obstruction of the 
 circulation in the lungs : and he regards the com- 
 munication as a provision, enabling the coronary 
 vessels to unload themselves, when the coronary 
 vein cannot discharge freely into the right auricle. 
 
 I have met with but few cases of chronic disease 
 of the lungs, where there was not more or less 
 disturbance of the heart; a frequent and often 
 irregular pulse is a common attendant on chronic 
 pulmonary disease, even at a period in the day 
 while fever is absent. When masses of tubercles 
 exist in the lungs, or large abscesses, or tumors, 
 causing obstruction in their circulation, we always 
 find an irregular pulse : and by removing these 
 causes we soon discover improvement in the con- 
 dition of the circulation. 
 
 Palpitations of the heart frequently exist without 
 any organic affection ; its violent commotion is 
 often a source of great annoyance to the patient, 
 and may frequently be heard some distance from 
 the individual laboring under this symptom. I 
 have at this time a patient under care, whose 
 heart, in the beginning of her indisposition could 
 be heard pulsating ten feet from the bed side ; 
 
130 DISEASES OP THE HEART. 
 
 this violent action subsided under the use of an 
 infusion of digitalis, and a powder composed of 
 oxide of bismuth, rhubarb and ipecac, which 
 was continued for three months, occasionally 
 omitting the digitalis. Dyspepsia was in this case 
 the sole cause, which yielding to the above medi- 
 cine and a well regulated diet, the palpitation was 
 soon removed and. the patient returned to ordinary 
 health. 
 
 Certain positions of the body, obstructing the 
 free circulation in various parts, will often occasion 
 derangement of the heart's action ; and if not at- 
 tended to may often lay the foundation of disease. 
 Clerks in banks and counting-houses are frequently 
 subject to these disorders from leaning over, or 
 upon their writing desks : and children in many of 
 our seminaries, frequently have curvature of the 
 spine and deformity of the chest, produced in the 
 same way. The desks upon which they rest their 
 arms, should be nearly on a level with their shoul- 
 ders, and their seats should always be supplied 
 with high backs, upon which they should be 
 directed to lean back, when occupied with 
 study. No term in the day should exceed two 
 and a half or three hours; and large seminaries 
 should always be provided with one large room 
 
DISEASES OF TfflE HEART. 131 
 
 as a place for exercise, where the pupil can be free 
 from restraint, and jumping ropes, horizontal 
 bars, dumb-bells, &c, should be kept for their use. 
 In this way we might hope to avoid many diseases, 
 and improve the rising generation. The heat of 
 this apartment should be less than that of the 
 school-room, the temperature of which should 
 never exceed sixty-five degrees Fahrenheit. In 
 mild weather the open air would be preferable for 
 exercise. For a minute description of heart dis- 
 eases, I refer the reader to the works of Laennec. 
 I would remark in conclusion of this chapter, 
 that individuals laboring under chronic disease of 
 the heart, or enlargement, are much benefited by 
 attention to a spare diet, and in all cases by avoid- 
 ing excitement of the mind. Abstemiousness in 
 food, rigid renunciation of stimulating liquors, 
 and above ail, peace of mind are indispensable to 
 ensure recovery in all the affections of the heart. 
 It is in the treatment of these diseases that the 
 physician must add to the routine of his art, the 
 higher offices of the philosopher and Christian. 
 Without a knowledge of the world, and the work- 
 ings of the human bosom he will be often incom- 
 petent to counsel ; without that faith, which alone 
 " makes wise unto salvation" he will be unable to 
 
132 DISEASES OF THE HEART. 
 
 soothe, strengthen, and console ; and he who has 
 not those qualifications which enable him to be- 
 come the moral teacher and the friend, may in the 
 majority of these diseases, as well " throw physic 
 to the dogs" as prescribe for the body when it is 
 the vassal of the mind. 
 
 
ASTHMA. 
 
 This term, though indefinite, still continues to 
 be employed by the scientific as well as the uned- 
 ucated ; though asthma not unfrequently exists 
 under the name of phthisic, a term often used in 
 some parts of the country. " Difficulter respirare," 
 is perhaps as significant a name as we can give 
 asthma under its varied forms. A name can be of 
 little importance to an individual suffocating with 
 asthma, and yet a name will frequently relieve a 
 patient or destroy the peace of a whole family. 
 
 Among nosological writers names have pro- 
 duced much confusion, and as a necessary conse- 
 quence have led to a similar result in practice. 
 What one nosologist considers a cause, another 
 describes as an effect ; and medicines highly ex- 
 tolled by one physician, are often decried by 
 another. 
 
 12 
 
1 34 ASTHMA. 
 
 Attempts have been made by writers from the 
 earliest history of medicine to distinguish asthma 
 from other diseases of the chest, and this end was 
 supposed to be attained, by terming a slight diffi- 
 culty of breathing dyspnoea, and laborious respi- 
 ration asthma. The moderns recognise two pri- 
 mary species — the spasmodic and the humoral. 
 
 The parenchyma of the lungs is seldom if ever 
 affected by the disease, while the mucous mem- 
 brane will invariably be found to be its seat, having 
 its remote cause in the digestive organs primarily, 
 disordering the nervous system, and through this 
 connection, affecting the lining membrane of the 
 bronchial tubes. In this way the system is con- 
 tinually predisposed to attacks, and when exciting 
 causes occur, such as wet feet, exposure to a damp 
 and cold wind, or a location in a low and marshy 
 section of country, the disease will be produced. 
 Or derangement of the nervous system, pro- 
 ceeding from other causes may produce asthma, 
 independent of disordered digestion. A remarkable 
 case of this kind occurred to me in 1837. A 
 gentleman in Pittsburg, having received a severe 
 blow upon the back, near the sixth dorsal vertebra, 
 from the falling of a brick while passing under a 
 scaffold erected in front of a new building, was 
 
ASTHMA. 135 
 
 immediately seized with great difficulty of breath- 
 ing, strongly resembling spasmodic asthma. His 
 physician pursued the best treatment for his relief, 
 which was soon obtained ; he was bled freely, 
 and repeatedly leeched on the contused part of 
 the back ; purgatives and anti-spasmodics were 
 used with a mild diet : under this treatment the 
 patient soon recovered. 
 
 At the expiration of six weeks from the acci 
 dent, his breathing became oppressed, and now 
 assumed the decided character of asthma, which 
 yielded to the application of forty leeches to the 
 spine, and large doses of gum foetid. His third 
 attack was as punctual, as to time, as the second 
 had been, six weeks having again elapsed : this 
 third attack occurred while on a visit to our city, 
 and I was called to visit him during the paroxysm. 
 He gave me the above history of his case, and 
 declared his digestion had never been out of order 
 in the least. Upon examination of the spine I 
 was at once convinced of the fact, that the shock 
 received by the sympathetic nerves, had been 
 sufficient to occasion all the inconvenience from 
 asthma which this patient suffered ; and as he had 
 been repeatedly leeched, I presumed all the benefit 
 that could be obtained from this remedy the 
 
136 ASTHMA. 
 
 patient had experienced. I, therefore, applied 
 moxa about three inches above and below the 
 tender spot on the back, and slight galvanic shocks, 
 and eight drops of Fowler's solution to be taken 
 night and morning. This attack subsided in half 
 an hour after the application of the moxa and 
 galvanism, when the patient observed that he had 
 found the right thing at last. These sores were 
 kept open with Savin ointment, and the solution 
 continued with galvanism for twelve days. He 
 returned home in the third week after my treat- 
 ment commenced, and has had but one slight 
 attack since that time ; this occurred at the expi- 
 ration of the first six weeks from his visit to our 
 city. After a lapse of five months he suffered the 
 sores to heal. 
 
 Asthma in my opinion is originally spasmodic ; 
 becoming humoral either from being connected 
 with some latent inflammation, or from long con- 
 tinued habit. There is doubtless a third species, 
 namely from gout, which will generally be found 
 to be hereditary. This we should try to fix in 
 some part less necessary for the functions of life. 
 
 Sauvage has employed the word suspirium, 
 used by Celsus and Seneca, as a general term to 
 designate asthma. Independently of this authority, 
 
ASTHMA. 137 
 
 it has perhaps a claim to admission into the medical 
 vocabulary from being identified with the person 
 of Virgil ; and this moreover, through the pleasant 
 observation of Augustus, who alluding to the 
 asthma of the epic poet, and the weak eyes of 
 Horace, when seated between them at the table, 
 observed that he was "inter suspiria et lachrymas," 
 (between sighs and tears.) 
 
 The treatment I have found most beneficial, has 
 been that which was required for the correction of 
 disorders which may be its cause. Derangement 
 of the liver, of the uterus, of the bowels, stomach, 
 spine or brain, with injuries of the bony walls of 
 the chest, predispose to, while irregularity in 
 sleeping, eating, clothing, and weather excite the 
 disease. These causes can all be removed by 
 proper medical treatment, and great care on the 
 part of the patient. 
 
 The dyspnoea requires, during an attack, some 
 relief, which will always be obtained by taking 
 small doses of the tincture of lobelia and ether, and 
 inhaling a mixture of oxygen and etherial va- 
 pour. 
 
 My practice in asthma has invariably been, to 
 remove the predisposing cause of the disease ; when 
 
 12* 
 
138 ASTHMA. 
 
 this is accomplished, 1 have generally found its 
 exciting causes were harmless. 
 
 I shall conclude the subject of asthma, by intro- 
 ducing some of Dr. Ramadge's remarks, taken 
 from his able work on that disease. 
 
 "In its uncomplicated state Asthma, as has 
 been observed, is of very rare occurrence. Since, 
 too, it seldom or ever proves fatal, the pathology 
 of this, the spasmodic form, is altogether conjec- 
 tural. Many physicians, indeed, deny the exist- 
 ence of a purely nervous species. The correct- 
 ness of this opinion will be examined hereafter. 
 At present, we shall assume the reality of such a 
 disease, and proceed to detail its ordinary symp- 
 toms. 
 
 The peculiarity of this form consists in the 
 suddenness of its attack, so that no warning would 
 appear to be given. Its ordinary fore-runners, 
 when "note of preparation" is sounded, are 
 mental anxiety, extraordinary exertion of any 
 kind, sudden changes in the weather, disagree- 
 ment of food, and, in short, whatever operates 
 mediately, or immediately, upon the nerves. 
 Thus, it is apparent, that the proximate cause of 
 the spasmodic asthma, must, with that of most 
 
ASTHMA. 139 
 
 nervous disorders, remain unknown, until we can 
 resolve that mysterious connection betwixt the 
 mind and body, which, it seems probable, will 
 ever baffle alike the physiologist and the philoso- 
 pher. 
 
 The symptoms, with which the attack com- 
 mences, are a sense of general oppression, more 
 particularly in the head and chest. The eyes are 
 affected much in the same manner as in common 
 cold ; and there is a feeling of weight and fulness 
 about the pit of the stomach. The patient is heavy 
 and languid ; disinclined to exertion, drowsy, and 
 apt to fall into disturbed and uneasy slumber. In 
 some cases, a day or two preceding the attack, the 
 patient is sensible, a short time after dinner, of a 
 feeling of weight and over-fullness in the region of 
 the epigastrium, and the stomach is swollen and 
 distended with wind. From the disturbance given 
 to the digestive functions, the eructations are 
 usually acid or insipid. Floyer observes, that he 
 noticed in himself the spasmodic state of the lungs 
 to be so much the more supportable in proportion 
 to the spasm of the intestinal canal, marked by 
 the gaseous distension, extending itself to the 
 lower bowel. 
 
 As the respiration becomes more difficult the 
 
140 ASTHMA. 
 
 pain at the chest increases, and the constriction is 
 at last so intense as to be compared by the sufferer, 
 to what might be supposed to arise from cords 
 bound tightly around it. Jt heaves and dilates as 
 if striving to burst these imaginary bonds, and is 
 again compressed, as it were, by their violent re- 
 action. The stupor and heaviness, at first felt in 
 the head, are not unfrequently replaced, as the 
 attack approaches its height, by severe headach. 
 Slight fever is occasionally present with its usual 
 concomitants of thirst and restlessness ; as are also 
 dryness, corrugation and pallor of the skin. Cough, 
 of a strictly convulsive nature, seldom at first 
 accompanied by expectoration, comes on, and 
 harasses the patient by its frequency and violence. 
 It appears to the patient as if his lungs were 
 pushed to the top of the thorax; a number of 
 muscles, and indeed the whole muscular apparatus 
 is exerted in aid of the muscles of inspiration, and 
 sometimes with such efforts that convulsions, and 
 even epileptic symptoms, are the result. 
 
 A deadly paleness now overspreads the coun- 
 tenance ; the extremities turn cold, and the wheez- 
 ing, which accompanies each expiration, is audible 
 at the distance of several yards. The sufferer 
 literally gasps for breath ; the blood vessels of the 
 
ASTHMA. 141 
 
 eyes become swollen and turgid by the violence of 
 the cough ; and the eyes seem ready to start from 
 their sockets. To speak, at this stage of the 
 paroxysm, is impossible, or if effected, the effort is 
 agony. Even to make a sign with the hand is a 
 distressing exertion ; and to add to this complica- 
 tion of agony, the most even-tempered will at this 
 crisis become fretful and peevish ; and a gesture 
 misinterpreted calls forth a manifestation of pas- 
 sion, and with it an aggravation of every distress- 
 ing symptom. It not unfrequently happens that 
 the mind participates in the highly-wrought excite- 
 ment of the body, and adds a train of imaginary 
 terrors to the real tortures which rack the patient's 
 frame. A thousand ills, conjured up by the 
 morbid state of the mental faculties, not only 
 harass the patient in themselves, but by their re- 
 action super-add to the extremity of his suffering. 
 Of course, it will be understood that all these 
 symptoms are not always present; but some or 
 other of them form the general characteristics of 
 Nervous Asthma. 
 
 In the generality of instances, the attack com- 
 mences towards evening, and after retiring early 
 to bed from the lethargy, which I have mentioned 
 as one of the primary phenomena, the patient is 
 
142 ASTHMA. 
 
 suddenly awakened in a few hours by a feeling of 
 strangulation, and finds that the fit has seized him 
 with all its violence. Occasionally, however, the 
 asthmatic will, after awakening, lie in a half- 
 dreamy, half-conscious state, sensible in some sort 
 of the approach of the attack, and yet indisposed 
 to rouse up and strive to ward it off by having 
 recourse to preventives. When fully awake, he 
 finds an oppression of the chest, weighing him 
 down like an incubus, and is constrained to sit up, 
 or to quit his bed at once, if, as he imagines, he 
 would escape suffocation. One of the most ordi- 
 nary symptoms of this disease is an unusual flow 
 of urine of a pale colour ; but at the termination 
 of the attack it becomes high coloured, and de- 
 posits a sediment. In fits of short duration, on 
 the contrary, such a limpid state of urine is seldom 
 observed ; and the most inconvenient symptom is 
 that of flatulency. A few hours generally bring 
 such fits to the close, and relief is first indicated 
 by the expectoration becoming copious. A dispo- 
 sition to sweat, and irregularity of pulse, are like- 
 wise concomitants of these short attacks ; which 
 are free from the proneness to sleep before noticed. 
 Frequently, these attacks are repeated at intervals 
 of one or two days, or more, for some period. In 
 
ASTHMA. 143 
 
 such cases the pause, or intermission, between each 
 attack, consists of an abatement of the more 
 violent symptoms, rather than a cure. The patient 
 will, from the delightful contrast presented by 
 present ease to his recent suffering, feel light of 
 heart, and imagine his restoration to health per- 
 fect; but a nice observer can easily detect in- 
 completeness and general irregularity of respira- 
 tion. 
 
 It deserves notice, that the violence of the 
 symptoms increases, instead of diminishing, at 
 each successive paroxysm, until the attack has 
 run half its course ; and that after this the remis- 
 sions are longer, and more perfect, until the 
 termination of the fit. When the nervous habit 
 is once established, that is to say, when at some 
 determinate period, or periods of the year, the 
 fits recur, whether in winter or summer, or more 
 frequently, the intervals elapsing between them 
 are not times of complete health. Many indices 
 present themselves to the physician of some disor- 
 dered state, still existent in the asthmatic. Aretaeus 
 expressly says, " in morbi cessationibus licet ipsi 
 non decumbentes obambulent, secum tamen illius 
 signam ciecumferunt ;" and indeed, in many 
 instances, the countenance, gait, and manner of 
 
144 ASTHMA. 
 
 the patient, indicate but too truly the disease under 
 which he labours. Without however going the 
 length of the ancient, but most accurate observer, 
 just quoted, it is certain that some functional 
 derangement, or some confirmed local disease may 
 generally, if not invariably, be traced in the asth- 
 matic. In cases of mal -conformation of the chest 
 there is an obvious cause ; but in the absence of 
 every other easily discerned symptom a shortness 
 of breath, made evident by the slightest extra 
 exertion, will prove the asthmatic diathesis. Few, 
 however, who suffer from this disease, are affected 
 in precisely a similar manner. The symptoms 
 are as various, as the causes are usually stated to 
 be ; and the variations in the duration, and recur- 
 rence of the fits, are equally as anomalous. In 
 some, the nervous habit assumes a regular charac- 
 ter, and its periodic return are duly' anticipated 
 by the patient. In the great majority of cases, 
 however, much uncertainty prevails on these 
 points. 
 
 Independent of the constitutional habit, there 
 are a variety of secondary causes, which have 
 more or less influence in retarding, or accelerating 
 the attacks. For instance, if summer be the 
 period of suffering, (and this is the more frequent 
 
ASTHMA. 145 
 
 form in the purely nervous asthma,) excessive heat 
 may bring on the commencing fit as early as the 
 end of May ; but if the weather be cool, it may 
 keep off till the close of June, or beginning of 
 July. In winter again, the early setting in of the 
 frost, or as the case may be, a continuation of a 
 close, foggy state of the atmosphere, will exert a 
 marked influence on the early or late appearance 
 of the disease, when it co-exists with catarrh. 
 The most violent and frequent attacks occur soon 
 after the summer solstice. 
 
 On the abatement of the paroxysm, when it has 
 been severe and of long duration, a sense of sore- 
 ness, arising from the straining and unwonted 
 exertion of the respiratory muscles, is usually left 
 for some hours subsequently. Both during the 
 attack, and after its violence is abated, there is a 
 painful feeling of fulness, and of undue distension, 
 in the region of the two solid, floating viscera of 
 the abdomen, the liver and the spleen. This state, 
 as well as flatulence, and headach which I have 
 mentioned as symptoms, and attendants, of asthma, 
 are, in a certain degree, owing to venous conges- 
 tion. The flatulence, which medical writers gene- 
 rally put down as a precursory symptom of asthma, 
 is not, I have long remarked, apparent, until a 
 
 13 
 
146 ASTHMA. 
 
 succession of fits has established the dyspeptic 
 habit in the patient ; which is the result of the 
 obstruction to the circulation of the blood in the 
 chylipoietic viscera, arising indirectly from the 
 congested or compressed condition of the lungs. 
 To enter more minutely into the causes leading to 
 this mechanical hyperemia. In all varieties of 
 asthma lesions of circulation may be traced ; and 
 to place the subject in a more distinct light, I shall 
 quote a passage from my Treatise on Consumption, 
 explanatory of the happy effects resulting from 
 free respiration, in order by this contrast to give 
 a clearer view of its contrary. 
 
 < The mere expansion of the lungs in the first 
 instance, tends indirectly to remove congestion of 
 the liver, and also of the stomach, spleen, pancreas, 
 and intestinal canal, all dependent on the more 
 free circulation of the blood in the former. The 
 biliary, as well as the great salivary secretion, is 
 hereby promoted to a healthy activity. Such 
 morbid irritability of the mucous membrane of the 
 stomach as may be present, productive of indiges- 
 tion, is removed; the chyliferous absorption be- 
 longing to the small intestines, so indispensable to 
 life, is actively carried on, and the injurious reten- 
 tion of excrementitious matter in the large intes- 
 
ASTHMA. 147 
 
 tines, is obviated by increased mucous moisture, 
 and accelerated peristaltic motion.' 
 
 I now proceed to the contrast ; and do not know 
 that I can explain the mechanical hyperemia 
 existing in asthma better than by the following 
 passage from the same work : — 
 
 ' The blood of the right ventricle of the heart not 
 finding a ready passage through the lungs, afflicted 
 as above-mentioned, causes a preternatural quan- 
 tity of the same fluid in the adjoining auricle, and 
 especially in the two great veins opening into it. 
 The consequences of this state are head-ache, 
 owing to the interruption of the free return of 
 blood from the head; pulmonary engorgement, 
 through the difficulty the bronchial veins expe- 
 rience in transmitting their blood, by either its 
 direct or circuitous course, into the vena azygos; 
 and serious derangement, or actual disease, of the 
 most important viscera of the abdomen. The 
 superior cava, preternaturally full of blood, will, 
 by retarding that fluid in the jugular veins, pro- 
 duce pain in the head ; and, by a similar»interrup- 
 tion to the circulation of the vena azygos, besides 
 interfering with the free return of the blood into 
 the bronchial veins, it will, in some degree, impair 
 the activity of the kidneys ; the due return of the 
 
148 ASTHMA. 
 
 effete blood of which organs depends on the 
 freedom with which it is conveyed from the vena 
 azygos into the vena cava superior.' — P. 80. New 
 Edition. 
 
 Pursuing this train of observation it will not, I 
 think, be unphilosophical to suggest that the great 
 debility accompanying asthma may originate, in 
 some degree, from the want of a due supply of 
 blood to the left side of the heart, and its arterial 
 system. 
 
 Having thus presented the ordinary symptoms 
 of the disease, it remains to ascertain the state of 
 the respiration afforded by means of auscultation. 
 No disease presents more anomalies in its auscul- 
 tative diagnosis than asthma. This partly arises 
 from the longer, or shorter period, during which 
 the patient has been asthmatic, and is partly owing 
 to other causes of a pathological nature. It has 
 been stated that the inspiration yields little or no 
 sound ; but in most cases of nervous asthma 
 examined by me, I have detected the presence of 
 a more *than ordinary mucous secretion in the 
 trachea, more or less audible. Spasm of the 
 posterior membrane of the trachea, as well as of 
 the membrane of its cartilaginous rings, is, I am 
 inclined to think, a general accompaniment of this 
 
ASTHMA. 149 
 
 species of the disease ; and this is pointed out not 
 less by the impediment presented to the action of 
 swallowing than by the peculiar manner in which 
 the breath is, as it were, sucked in. The posture, 
 too, in which the patient ordinarily sits, with his 
 head inclined forward, favours this belief: and 
 would seem to show that the spasmodic contrac- 
 tion of the connecting membrane of the rings of 
 the trachea, in some degree, induced this position. 
 That the lungs do not receive their due proportion 
 of air, is conclusively proved by the want of 
 natural clearness in the inspiration. 
 
 Much variation exists in the auscultative signs, 
 from the structural difference in the lungs occa- 
 sioned by the habitual recurrence, or otherwise, of 
 the disease. Thus, as Laennec has observed, the 
 respiration is, in many instances, almost perfectly 
 puerile ; although I do not conceive his explana- 
 tion of this phenomenon to be satisfactory. I feel 
 convinced, from repeated observations, that por- 
 tions of pulmonary tissue are at times subject to 
 spasm, and that to antagonize the contraction, the 
 other portions assume an extraordinary power of 
 expansibility. Repeatedly have 1 heard that part 
 which at first yielded a clear sound become less 
 
 13* 
 
150 ASTHMA. 
 
 distinct, and the parts previously in a state of 
 spasm, give out in their turn a puerile respiration. 
 It has appeared to me that the portion influenced 
 by spasm must by its contraction have the air 
 contained within it forced out ; and whilst the 
 other parts were receiving the air inspired, I have, 
 unless my ear, well-accustomed to such minutiae, 
 deceives me, heard the counter stream from the 
 spasm, or spasms of the pulmonary tissue, escape. 
 This phenomenon must not be confounded with 
 that of interlobular emphysema of the lungs, 
 noticed by Laennec, as being of rare occurrence, 
 and the peculiar sound observable in which he 
 denominates the friction of ascent and descent. 
 The latter occurs but rarely in asthmatic patients ; 
 whilst the former is met with early in the disease. 
 The sound in this phenomenon, which I believe is 
 now noticed for the first time, is less audible than 
 the dry crepitous bubbling rattle which is the 
 characteristic of interlobular emphysema. 
 
 The character of the sound in asthmatic cases 
 varies from a variety of circumstances. Thus the 
 "rale sonore" the sonorous rattle, so far from 
 presenting one uniform character, is divided into 
 several sounds perfectly distinct from each other. 
 
ASTHMA. 151 
 
 At times, it resembles the sighing of the wind 
 through the trees ; at others, that of air violently- 
 forced through a tube, as is the case with the 
 bellows of a forge ; and in others again, it acquires 
 a sharper sound, something betwixt a hiss and a 
 whistle. The sound is occasionally broken into a 
 kind of gurgling noise, like that made by a small 
 brook; and, in some instances, like that produced 
 by rubbing the finger over paper of a coarse 
 texture, and uneven surface. This difference of 
 sound depends, in great measure, on the state of 
 the mucous membrane of the trachea ; and is also 
 modified by the spasm or spasms of the bronchi, 
 as well as their membranous terminations, and on 
 the quickness with which the inspiration is made. 
 Where the paroxysm has been very severe, and 
 the patient exhibits much debility, as well as 
 when the attack occurs late in life, a subcrepitous 
 watery rale is sometimes heard, the diagnostic sign 
 of oedema of the lungs. To hear the respiratory 
 process in this, as well as in most other diseases, 
 and more particularly to discern the sound made 
 by the expulsion of air consequent on spasm, an 
 eligible method is to place the ear over the apex 
 of the lungs, or over the fine edges of this organ 
 approaching the sternum. 
 
152 ASTHMA. 
 
 Another peculiarity, attendant on this disease, 
 will be perceived by auscultation; which is the 
 irregularity and unevenness of the heart's action, 
 occasioned by the effort it makes to overcome the 
 opposing spasm of the respiratory apparatus. 
 Percussion, in patients who suffer from permanent 
 emphysema, produced by a long continuance of 
 the disease, yields a sound clearer than natural ; 
 but in recent cases, I have not observed this to 
 happen. Much has been written concerning the 
 immobility of the chest in asthma ; but this is only 
 observable after a long series of attacks, and when 
 the disorder has become habitual. From the over- 
 exertion of the ribs, caused by excessive and re- 
 peated anhelation, their cartilaginous extremities 
 undergo ossification ; and I have known this to 
 happen before the age of puberty, the patient 
 having been affected from childhood. When the 
 disease dates from an early age, this precocious 
 change of structure from cartilage to bone prevents 
 that enlargement of the chest, usually seen in asth- 
 matics; but the chest partakes of the generally 
 rounded form characteristic of the disease, and 
 which arises in part from the antagonism offered 
 by the muscles of inspiration to the contraction of 
 the lungs. However, this tendency to ossify is 
 
 
ASTHMA. 153 
 
 not so marked in the nervous, as in other species 
 of asthma. 
 
 This truly singular and terrible disease, " mor- 
 bus maxime terribilis" as Willis terms it, is "not 
 unfrequentiy hereditary; and this, with its fluctu- 
 ating nature in some, and regular recurrence at 
 stated periods in others, forms another marked 
 feature in asthma. When we meet with cases in 
 which the fits return invariably every month, as 
 they often do at the catamenial period, or at the 
 expiration of a certain number of months, or, as 
 we have it on the authority of Heberden, after 
 every seven years, the regularity of the occurrence 
 coupled with similar phenomena in other disorders, 
 would induce a belief that there were certain laws 
 of nature, independent of the " seasons' difference" 
 common "to mute and to material things," to which 
 the health of man is periodically subservient. 
 
 One extraordinary instance of this singular 
 uniformity came under my knowledge in the 
 person of a lady, a patient of mine, who, for 
 eleven or twelve months, had alternate monthly 
 
 attacks of epiiepsy, and of asthma, and this with 
 the greatest regularity : a strong proof, I may 
 observe, of the purely nervous character of the 
 disease. 
 
154 ASTHMA. 
 
 Bonnet relates, in his " Sepulchretum Ana- 
 tomicum," that he had met with a case of asthma 
 alternating with dysuria; and we find in the 
 "Ephemerides des Curienx de Ja Nature," an 
 account of an asthma which attacked the patient 
 the moment he had composed himself to sleep. 
 
 Among my own patients, I have lately had a 
 singular example of the mind's forming the essen- 
 tial circumstance of 'the disease. A female of the 
 upper class of domestics, who was attacked with 
 asthma, on her removing to the country, after 
 having lived three years in London in the same 
 situation, without any manifestation of her com- 
 plaint, was seized, on her return, with a fresh 
 paroxysm, just as she had obtained a new situa- 
 tion. Every thing had been arranged to her 
 satisfaction, and she was on the point of setting 
 off, (it being abroad,) when the poor creature's 
 hopes were destroyed by this untimely attack. 
 Ever since, the same result attends her, when 
 placed in the same circumstances ; and no sooner 
 does she obtain a situation, and prepare to repair 
 to it, than on the very day, and almost the very 
 moment she is about to enter her new abode, her 
 complaint incapacitates her from embracing the 
 opportunity. 
 
ASTHMA. 155 
 
 Among other cases recorded by Heberden, in 
 addition to the one before alluded to, he states 
 that he has known some patients to remain free 
 from asthma (after having suffered under it 
 several 3^ears) for the space of thirty years ; and 
 he mentions that one person used to suffer from 
 violent paroxysms for a single day, which would 
 then cease, and after an indefinite period recur for 
 the same brief space, endangering life from their 
 excessive severity. 
 
 I have quoted these instances from Heberden, 
 as I probably shall do from others, rather with a 
 view of showing that I have not neglected the 
 writings of those whom, as a member of the 
 College of Physicians, I am bound to reverence, 
 than for any high opinion of their science. A 
 note-book like Heberden's proves his attention 
 to appearances, but throws no light on causes. 
 However, like the cabinet of the virtuoso, the 
 curiosities the possessor cannot explain, others 
 may. I allude to the species of writing, not to 
 Heberden. His fame was well-earned — for he 
 wrote in Latin. 
 
 The primary, or proximate cause of the purely 
 spasmodic asthma is unknown; but from many 
 reasons, that may be grounded on the facts I am 
 
156 ASTHMA. 
 
 about to state, the inference will be that this 
 species of the disorder positively depends on some 
 alteration of the condition of the nervous in- 
 fluence. The suddenness of the attack, the 
 irritable temperament of the patient, the sympathy 
 betwixt the mind and body peculiarly observable 
 in this form, its periodic recurrence, its hereditary 
 character, and, above all, the non-existence in the 
 few instances in which it has been possible 
 to make pathological observations, of any percepti- 
 ble organic lesion, however minute, all tend to 
 the same point. 
 
 Nothing can be more various than the origin 
 of this disease, as far as it can be traced. Almost 
 every variety, however, is complicated with cold. 
 Whether it depend chiefly on an affection of the 
 trachea, or the numerous ramifications of the 
 bronchi, or a peculiar state of the nerves, each or 
 every of these influential and additional causes, is, 
 for the most part, dependent on, or rather is com- 
 plicated with cold. Hoffman observes, " Quern- 
 admodum frigis, omnibus nervosis partibus 
 infensum est : ita ?naxime pectori deprehendltur 
 inimicissimum. Quamplures mihi cogniti sunt 
 casus ubi ex eo solo liberalius admisso tusses, 
 asthmata spasmodica, et cardialgix atrocissimas 
 
ASTHMA. 157 
 
 propullarunt." Again, he says, " Si quid ex 
 causis occasionalibus est quod asthma convulsi- 
 um inducer e potest, certe est externum frigus, 
 hostis ille nervoso generi inimicissimus." 
 
 Without, however, recurring to authorities, a 
 very little experience will prove that the more 
 ordinary apparent cause is cold. To say posi- 
 tively what is, or is not the cause, I cannot pre- 
 tend to do.; and until we are acquainted with the 
 proximate origin of epilepsy and hydrophobia, I 
 firmly believe this " crux medicorum" will not 
 be removed. Some injury done to the nerves of 
 the chest, by cold or other means, would seem to 
 be its most general exciting cause; but in this 
 there is nothing positive. One of the best defined, 
 and most exquisitely determined cases, that ever 
 came under my knowledge, was in the person of 
 a noble lady, wife of an officer of high rank, to 
 whose immediate ancestor we are indebted for a 
 large accession to our Indian territories. Convul- 
 sive asthma first seized her after an attack of 
 whooping cough, and I never witnessed the disease 
 of a more purely convulsive, or a more distressing 
 nature. In this lady there occurred a disturbed 
 state of the mucous membrane of the trachea,with 
 a decided catarrhal tendency, but the same symp- 
 
 14 
 
] 58 ASTHMA. 
 
 toms may be noticed in other individuals without 
 the manifestation of any asthmatic disorder. 
 
 Although the pneumo-gastric nerve sends out 
 many filaments or branches to the lungs, in no 
 other species of asthma does it appear so peculiarly 
 excited as in the nervous. From various cases 
 which have passed under my observation, this 
 may, I think, be satisfactorily accounted for from 
 some peculiar disposition of the nerves. 
 
 A gentleman, a patient of mine, from making 
 the common galvanic experiment with a piece of 
 zinc and of copper in his mouth, was seized with 
 tic douloureux, and became an intense sufferer 
 from it. He would pass the edge of his nail along 
 his upper lip several times, as a sort of test, or 
 criterion, of his state ; when, if the liability to fits 
 for the time being had ceased, no effect would 
 ensue: but, if otherwise, no sooner was a certain 
 minute point touched than he was thrown into the 
 most acute agony. Coupling this with facts of a 
 similar nature, such as lock-jaw from a trivial 
 wound, we shall have the purely nervous nature 
 of the disease rendered highly probable ; and it 
 may, perhaps, be accounted for from an unusual 
 distribution of the nervous filaments, as in the case 
 of tic douloureux above-mentioned. I would refer 
 
ASTHMA. 159 
 
 the obvious nervous influence to a sentient ex- 
 tremity of the nerve's being seated somewhat 
 nearer than usual to the cuticular surface. The 
 laws of sympathetic association of muscular con- 
 traction, will thus solve many phenomena of the 
 disease. Although I certainly am inclined to think 
 that some functional disorder, or morbid sympathy, 
 of the nerves of the chest is the more immediate 
 cause of true asthma ; yet reasoning from analogy, 
 it is far from improbable that its origin may some- 
 times be considerably removed from the seat of the 
 disorder. Some years ago I was called to see a 
 female who was suffering severely from tic dou- 
 loureux. It was not until my second visit that I 
 discovered she had lost a leg, which had been re- 
 placed by one of cork. Inquiring into the history 
 of her case, I found that in order to wear the arti- 
 ficial one with the better regard to appearance, she 
 compressed the stump of the amputated limb so 
 forcibly, in inserting it into the false leg, as to con- 
 strict the nerves in a very prejudicial manner. At 
 least, conceiving this to be the case, 1 ordered her 
 immediately to discontinue the use of it; and 
 found, from the relief subsequently experienced by 
 her, that my conjecture was right. 
 
 Here was an evident proof of the intimate con- 
 
160 ASTHMA. 
 
 nexion existing between the nervous extremities, 
 or rather, as this required no additional proof, of 
 the effect injury in one place might communicate 
 to a more distant locality. 
 
 I may here mention that having understood from 
 the domestic physician of a gallant nobleman, re- 
 presentative of his monarch in a sister kingdom, 
 and who had lost a limb in the service of his coun- 
 try, that he had become subject to attacks of the 
 same distressing complaint, I related the above 
 case to Dr. M., and had the satisfaction of intro- 
 ducing him to my patient. Whether the hint was 
 acted upon, I cannot say ; but from a communi- 
 cation I received, with the thanks of his noble 
 employer, I should trust that it had proved ser- 
 viceable. 
 
 A writer, who appears to have used much in- 
 dustry in collecting materials for his work on 
 Asthma, Dr. Bree, is of opinion that the spasm of 
 the chest is an effort of nature to relieve the suf- 
 ferer. Had he trusted to experience rather than 
 the dogmas of others, and inclined to fact rather 
 than theory, he would have seen reason to retract 
 this doctrine. Some time ago I enquired of him 
 if he had ever employed auscultation ; but he told 
 me a defective state of hearing precluded him from 
 
ASTHMA. 161 
 
 its use. Otherwise the ear would have convinced 
 him, that he had embraced an erroneous view of 
 the subject. But, independently of this, we find 
 that in the humoural asthma, in which the effusion 
 of serum is considerable, the spasms are trifling ; 
 whilst in the nervous, at the commencement of 
 which there is almost always a total absence of 
 serous effusion, and its presence but slightly indi- 
 cated at the end, that the spasmodic convulsion is 
 of the most violent nature. 
 
 Following the observations of Dr. Whytt, who 
 truly remarks, that the contractions of the abdo- 
 minal muscles, and diaphragm, in pregnancy, 
 tenesmus, and stranguary, are marked with a wise 
 intention, he quotes from the same writer, with 
 great satisfaction, the following indisputable error, 
 where he asserts that < the increased motion of the 
 organs of respiration in the fit of an asthma are 
 the efforts of nature to free the body of something 
 hurtful.' 
 
 By a parallel reasoning, it might be asserted 
 that the lethal convulsion of the pharynx, conse- 
 quent on a bite of the hand, for example, by a 
 rabid animal, or the itching of the nose indicative 
 of the presence of worms, were the efforts of 
 nature to relieve the patient. 
 
 14* 
 
162 ASTHMA 
 
 Because instances of mercy and wisdom are 
 visible in many apparent disturbances of the 
 human frame, it is an abuse of reason to conclude, 
 that no alteration in the animal economy can take 
 place unless to effect a relative good. Palsy might, 
 on such inferences, be deemed a blessing ; and the 
 spasmodic rigidity accompanying tetanus the 
 means of relief. A little reflection will show, that 
 the inordinate muscular action in asthma is radi- 
 cally injurious. It lays the foundation for an 
 emphysematous state of lungs, which, although a 
 blessing to an individual of a consumptive diathe- 
 sis, is in other cases any thing but enviable. Thus 
 frequent attacks of convulsive asthma generally 
 end by rendering the disease chronic, and will even 
 lead progressively, in some cases, from pulmonary 
 or vesicular, to interlobular emphysema, and so 
 induce the numerous train of ills which are com- 
 plicated with asthma in its last and worst stage. 
 
 It is perhaps necessary again to observe that 
 nervous, or convulsive asthma, strictly so called, 
 depends on some cause, or causes, hitherto un- 
 known ; and that whenever the cause is definite, 
 the disorder is a variety, and not a pure asthma. 
 Thus in some individuals subject to attacks of 
 gout, which have been suddenly arrested, or have 
 
ASTHMA. 163 
 
 ceased for an indeterminate period, a difficulty of 
 breathing has taken place, accompanied by spasm, 
 which may, or may not arise from the non- 
 appearance of the usual fit ; but in either case, it 
 is the pure form of the disease, since we know not 
 in what manner the suppression of the gout can 
 influence the chest. Stimulation, or sympathy, is 
 another exciting cause, as it likewise is in hysteria, 
 and chorea ; and apprehension of an attack, the 
 mere nervous dread of its recurrence, will not 
 infrequently bring it on. The purely nervous 
 nature of the disease is still further elucidated, by 
 the paroxysms of asthma being often excited by 
 powerful, and penetrating odours, such as those of 
 ipecacuanha, the tuberose root, and other scents 
 which are known to affect some individuals in a 
 very violent manner. 
 
 A medical gentleman of my acquaintance was 
 subject to sudden attacks of asthma, but how 
 produced he was long unable to ascertain. At 
 length it occurred to him that he was invariably 
 seized after sleeping in a particular bed, which 
 had been presented to him by the captain of a 
 ship in the Baltic trade. The feathers, from some 
 process in drying, most probably emitted a pecu- 
 liar smell, and to this he was led to ascribe the 
 
164 ASTHMA. 
 
 origin of his atacks ; since on no other occasions 
 did he ever suffer from them. 
 
 Here is an exciting cause, to all appearance ; 
 but the modus operandi of the odour on the 
 nerves is so unknown to us, that we cannot ven- 
 ture to term it a proximate one. 
 
 Ferrus, in his ingenious article on Asthma, 
 inserted in the " Dictionnaire de Medecine," has 
 given a case of what he terms idiopathic, or 
 essential asthma, which at the same time that it is 
 instructive, is not a little characteristic of la grande 
 nation. The patriotic feelings of the soldier, mad- 
 dened at the sight of " foreign troops at the gates 
 of the capital," furnish a Jittle touch of the senti- 
 mental in the true Gallic vein. The case is as 
 follows : — 
 
 6 A young officer, full of talent and honour, 
 grievously wounded in the last campaigns, but at 
 the time in good health, returned in 1814, with 
 his family to Paris, still occupied by the allied 
 troops. He experienced so "great a shock on per- 
 ceiving foreign soldiery at the gates of the capital, 
 that he was immediately seized with a sense of 
 uneasiness, and his respiration became difficult. 
 This state became worse, and he had that very 
 night a violent fit of asthma. The following 
 
ASTHMA. 165 
 
 nights he was equally distressed ; and the inten 
 sity of the symptoms did not decrease until fifteen 
 days after the first attack. M. Corvisart was con- 
 sulted ; and he perceived no certain index of 
 organic lesion. The condition of the invalid was 
 but little benefited by the most enlightened advice, 
 or the most affectionate nursing. He repaired to 
 the south of France for the winter, and entirely 
 regained his health. 
 
 'In 1815, the paroxysms of asthma recurred on 
 his experiencing griefs, but with longer intervals, 
 during which his health was good. He was 
 seized, in 1820, with severe intermittent fever of 
 an ordinate character. In the course of a journey 
 which he took during his convalescence, he was 
 again attacked by an asthmatic fit, after taking a 
 warm bath, and subsequently stopping some hours 
 in a place of public entertainment. The expecto- 
 ration, which did not come on till the morning of 
 the following day, consisted of sanguineous secre- 
 tion, and in great quantity. No change in the 
 state of the circulation was observable. The in- 
 valid continued his journey, had a recurrence of 
 the attack for four or five following nights, and 
 recovered without even fc observing a strict regimen. 
 During the last ten months, his health has been 
 
166 ASTHMA. 
 
 good, he has devoted himself to numerous active 
 exercises, and experiences no difficulty of breath- 
 ing, except when mounting a stair-case too 
 quickly.' 
 
 I cannot conclude this part of my subject better, 
 than by quoting the words of Delens. 
 
 * Enfin, il faut le dire, dans quelques cas 
 toutes les recherc/ies des anatomistes ont ite 
 infructueuses, et V on n 9 a pu rapporter la ma- 
 ladie qu' a une perversion de V influenee tier- 
 veuse, dernier retranchement ou il faut bien 
 nous rtfugiee en pareil cas pour ne pas etre 
 oblige' d' admettre, comme nos predScesseurs, des 
 maladies essentielles ? des maladies sans matiere, 
 bien qu' a vrai dire, notre explication ne soitpas 
 beauceup plus satisfaisunte que V espece d 9 ob- 
 scurite dont Us cherchaient a couvrir leur igno- 
 rance,'' " 
 
 I would remark that the general treatment di- 
 rected by most physicians for asthma is confined 
 to the period of attack; this often gives much re- 
 lief, but as remedies are not continued during the 
 time of intermission, the disease returns at stated 
 intervals with all its horrors. A disease so purely 
 intermittent in its nature, can only be eradicated 
 by a careful continuation of remedies during the 
 
ASTHMA. 167 
 
 intermission, which shall tend to alter the state of 
 the system to a degree, that must certainly prevent 
 its recurrence. 
 
 The chylipoietic viscera should be particularly 
 attended to during the intermission, by the re- 
 moval of crudities of the prima via, by regulating 
 the diet, and the use of such medicines as may 
 tend to keep up a healthy peristaltic action of the 
 bowels, and the alterative pill of nitro muriate of 
 gold. During the attack the treatment should be 
 entirely directed to the nervous system; galvanism 
 — a never-failing remedy in the treatment of pure 
 neuralgia — should alone be relied on during the fit 
 of asthma. 
 
 This has always been my practice, and the 
 success attending it prevents my seeking a better. 
 
RECAPITULATION. 
 
 In the treatment of consumption, many reme- 
 dies that are worse than useless, are still recom- 
 mended by some physicians, such as the removal of 
 tonsils, the use of blisters — sometimes perpetual,— 
 emetics, cathartics, expectorants, demulcents, nar- 
 cotics, alterative mercurials, astringents, tonics, 
 balsams, inhaling iodine, sea voyages, southern 
 climate, &c, &c. But as I have used all these, 
 and witnessed their full trial in the hands of others, 
 I conceive myself fully prepared to pass judgment, 
 and declare them utterly inefficient. 
 
 Exercise of the body and lungs, by inhalation, 
 by gymnastics, or by the common pursuit of busi- 
 ness, (where this is sufficient,) regulation in diet 
 and digestion, attention to the healthy action of the 
 skin, and all the secretions, by the daily use of re- 
 medies I shall style prophylactics, will soon ac- 
 complish what the patient may look for in vain 
 from the use of medicines already tried and justly 
 condemned 
 
170 RECAPITULATION. 
 
 These prophylactic compounds will be constant- 
 ly kept, by some of our most respectable druggists, 
 accompanied with full directions. 
 
 In conclusion I would remark that in the fore- 
 going very brief sketch of the pathology and treat- 
 ment of a disease hitherto considered as admitting 
 of little more than palliative remedies, I aim at no 
 literary fame. The harassing engagements of a 
 laborious profession leave but little leisure or in- 
 clination to cultivate the graces of composition. 
 My object will be fully accomplished if by the 
 labour, anxiety, and intense application of many 
 of the best years of my life I have succeeded in dis- 
 arming of its terrors one of the most formidable 
 diseases to which flesh is heir; and of infusing into 
 the hearts of despondent and weeping relations 
 the cordial — hope. Justice must cede to me the 
 merit of having contributed largely to effect this 
 important and most desirable consummation; and I 
 fully acquit myself of the charge of arrogance or 
 presumption, when I assert my ability to control 
 and cure a large majority of the cases of clearly 
 developed pulmonary Consumption. 
 
 finis. 
 
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