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ON CONSUMPTION
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RUDDOCK.

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ON CONSUMPTION,
AND
TUBERCULOSIS OF THE LUNGS:
THEIR DIAGNOSIS, CAUSES, AND PREVENTIVE
AND GENERAL TREATMENT.
By E. H. RUDDOCK, M.D.,
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL
COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY (LONDON AND
EDINBURGH); HONORARY PHYSICIAN TO THE READING AND
BERKSHIRE HOMEOPATHIC DISPENSARY, ETC.
"Dum spiro, spero.”
SECOND EDITION,
EMBODYING THE MODERN VIEWS ON THESE DISEASES WITH CASES TREATED
BY THE
AUTHOR.
LONDON:
HOMEOPATHIC PUBLISHING COMPANY,
2, FINSBURY CIRCUS, E.C.
1873.
PREFACE.
SINCE more than one-eighth of the entire mortality
in this country is due to Consumption, the acquisi-
tion of any knowledge that will augment our powers
of prevention or restoration must prove of the
highest value. Hence, the previous edition of 5,000
copies being exhausted, we have embraced the oppor-
tunity thus afforded, thoroughly to revise this work,
and herewith present the results of the most recent
investigations as to the causes, prevention, and cure
of that most fatal disease.
On the doctrinal points, about which considerable
differences of opinion exist in professional circles,
we lay no great stress; but we invite special atten-
tion to the chapters on the Causes of Consumption
(pp. 25-46), the Hygienic Measures (pp. 72-98),
and the Medical Treatment (pp. 98-108). Herein
we have shown how to avoid the causes which per-
petuate a disease that brings great and lasting
misery into the families it invades. We have great
confidence in the principles and practice enunciated,
and earnestly hope that the information we have
conveyed on the nature of an ever-prevalent disease,
with the view to its prevention and correct treat-
ment, will not be in vain.
2, Finsbury Circus, London,
July, 1873.
E. H. RUDDOCK.
:
CONTENTS.
I. INTRODUCTORY
II. THE ANATOMY OF THE LUNGS
III. PHYSIOLOGY OF THE LUNGS
IV. THE LUNGS IN DISEASE
V. VARIETIES OF CONSUMPTION
VI. PATHOLOGY OF CONSUMPTION
VII. ACUTE MILIARY TUBERCULOSIS
VIII. GENERAL CONSIDERATIONS
IX. CAUSES OF CONSUMPTION
•
a. Hereditary Predisposition
b. Impure Air
c. Unhealthy Occupations
d. Unsuitable or Insufficient Food
e. Depressing Emotions
f. Exciting Causes.
•
a. Nutritious Diet
b. Pure Air
c. Exercise
d. Bathing
e. Clothing
f. Healthy Residence
g. Change of Climate
•
•
X, SYMPTOMS OF CONSUMPTION,
XI. PHYSICAL SIGNS, AND THEIR DETECTION
XII. CURABILITY OF CONSUMPTION
XIII. HYGIENIC TREATMENT
?
९
*
•
XIV. MEDICINAL TREATMENT
XV. CASES TREATED BY THE AUTHOR
XVI. THE PROVIDENTIAL RESULTS OF PHTHISIS.
PAGE
5
6
12
13
16
21
•
•
22 23
23
24
25
26
35
38
41
42
44
46
59
69
72
2223
72
79
82
8888888
86
. 88
89
91
98
. 108
•
. 121
ON CONSUMPTION, AND TUBERCULOSIS
OF THE LUNGS.
I. Introductory.
Writer.
Object of the IN the following pages some practical
observations are offered on a subject in
which, unfortunately, most persons are deeply interested,
there being few families of which some member, near or
remote, has not fallen a victim to Consumption, or
Tuberculosis. The most powerful influences which tend
to engender and develop these maladies are pointed out,
so that, by avoiding the former, the accession of the
latter may be averted. These influences are of wide
extent, and associated, not only with our closest social
relationships, but with our habits as citizens of the
world.
Popular Style. As far as possible, technical phraseology
and mere hypothetical statements are omitted, preference
being given to points which have been amply confirmed
by extended observation, and which non-professional
readers may study with interest and profit. As it is
impossible, however, to avoid all technical expressions
without running the risk of obscurity or ambiguity, the
chief technicalities used are either explained parentheti-
cally in the text, or in the Index at the end of the
6
INTRODUCTORY.
treatise. The subject is especially adapted for popular
consideration, inasmuch as tubercular and consumptive
diseases spring from causes which only the public can
control. Nothing is so likely to raise the general
standard of health, and to lessen the yearly loss of life
from preventible causes, as a more general recognition
of those laws which regulate health, but of which the
great majority of persons are ignorant or unmindful.
It is true, legislation has done something in this direc-
tion, and may yet do more; but legislation must ever
be comparatively powerless to effect any substantial
abatement of the annual mortality until public hygiene
is more generally taught, and the great body of the people
come to recognise, in all its bearings, the intimate re-
lationship existing between a sound mind and a sound body,
and all surrounding agencies.
Before proceeding to the more practical portions
of our subject, a brief sketch of the anatomy of the
breathing organs may enable some of our readers better
to apprehend what is to follow.
II.-The Anatomy of the Lungs.
General Confor-
Lungs.
The lungs are vascular, spongy organs,
mation of the in which the blood is purified by at-
mospheric air, drawn into them by the
process of breathing. They are contained in the chest,
are two in number-a right and a left, one on
each side of the heart-and exactly fit the cavity
that encloses them. They are conical in form,
hung up, as it were, at the ends of the two main
lalith
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THE LUNGS.
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FIG. 1.
THE ORGANS OF RESPIRATION IN THEIR NATURAL POSITION
IN THE CHEST.
In the centre, beneath the chin, are the larynx and trachea, and on each side
the bloodvessels which carry the circulation through the brain. The lungs
are shown dark mottled, reating upon the diaphragm (represented by a dark
curved line), the summits rising just above each collar-bone. The position of
the heart is also shown by a dotted line, the gap in the left lang being for the
point of the heart.
8
ANATOMY OF THE LUNGS.
divisions of the windpipe, their apices projecting into
the neck above the collar-bones, and their bases resting
on the diaphragm, which is a transverse septum in the
body, and separates the lungs from the liver and
stomach. The illustrations, pages 7 and 9, will enable
the non-medical reader more fully to understand the
description we have given.
:
The rough anatomy of the lungs may be very fairly
studied by examining the whole breathing apparatus as
it may often be seen in a butcher's shop, under the
name of the "lights." If looked for carefully, there
may be seen close to the root or back part of the
tongue a little lid this is the epiglottis, or lid of the
larynx, and protects the vocal cords contained therein.
It is a real lid, and opens and shuts to let the air in and
out. But as air could get in and out without a lid, we
must here explain why the epiglottis exists. Just
behind it is the oesophagus or gullet, which is a
muscular canal leading from the mouth to the stomach.
Now when we swallow our food, it has to pass from the
back part of the throat to the gullet, and in so doing
it must go over the entrance to the air-passages-that
is, over the larynx. If there were no cover to this, the
food would fall into the air-passages and choke us. The
epiglottis, however, prevents such a serious mishap by
firmly closing on the top of the larynx, and allowing the
food to glide over it into the gullet. If examined, the
epiglottis will be found not unlike a little tongue, point-
ing backwards. It is somewhat hard, and very tough:
it may be seen at the root of a calf's tongue as it is
served at table. Next lift up the epiglottis, and look
down into the little box which it covers: this is the
THE LARYNX, ETC.
AU
larynx, containing the vocal organs. As it stands out in
the neck, the larynx has been called Adam's apple.
M
duks
NEPATOG
9

BONNINGAURI
FIG. 2.
THE LUNGS IN HEALTH.
Larynx, Trachea, Bronchi, and Lungs. The illustration shows the divisions
and subdivisions of the bronchi, and the cell-structure of the lung-substance.
Now look at the front of the larynx, and you see it is
continued downwards as a single tube, composed of
10
ANATOMY OF THE LUNGS.
little half-rings of cartilage, each being joined to the
next by ligamentous tissue: this tube, which proceeds.
downwards from the larynx, is called the windpipe or
the trachea. You can feel the larynx or Adam's apple
in your own neck, just below the chin in some persons
it is remarkably prominent. As you continue your in-
spection, you will find that the trachea divides into two
branches, called the bronchi,-one to the right, the right
bronchus ; and the other to the left, the left bronchus. At
the ends of the bronchi you see the lungs. If you take
hold of them and squeeze them in your hands, you will
find, if they are healthy, that they yield a little, and are
crisp, for they contain air. If you wish to prove this,
get a pair of bellows, put the mouthpiece through the
larynx into the trachea, fasten a bit of string tightly
round the trachea and mouthpiece, and if the lungs
are complete and unwounded you may inflate them.
Now you may observe that the right bronchus is
wider and shorter than the left one; and that each
lung is shaped something like a cone, having the
smaller end turned upwards, the base downwards, and
its inner side much flattened or hollowed. Observe
that the base is broad, concave, and of a semilunar
form. The outer surface is adapted to the ribs; the
inner is hollowed out to make room for the heart.
In our bodies, the apices of the lungs reach up into the
root of the neck, just above the inner ends of the collar-
bones. Hence you may have noticed that when a phy-
sician examines the lungs, he places his stethoscope
above, as well as below, those bones. Compare now the
right lung with the left, and you will see that fissures
appear to divide each of them into portions. These
THE PLEURÆ.
11
divisions are called lobes, and each lobe is composed of
lobules. The right lung is larger than the left (on
an average as eleven to ten), and it has three lobes.
These are called, respectively, the upper, middle, and
lower lobes. The left lung has but two lobes—an upper
and a lower one. The surface of the lungs is smooth and
polished, and covered by a thin membrane, termed the
pleura, which also lines the chest, and by its moist
nature allows of the free movement of the lungs as they
are alternately expanded and emptied by the acts of
breathing. Each lung has its own pleura. When one
of these pleuræ is inflamed we have the disease called
Pleurisy. Keeping in remembrance the names of the
parts, take a knife and slit up the larynx, trachea, and
bronchi, and observe that they are all lined with
mucous-membrane, a continuation of that which is
seen in the mouth and throat. Run your finger along
it, and you will find it smooth, and covered with a
slimy secretion called mucus: hence the name. Now
turn again to the bronchi, mark how each bronchus is
divided and subdivided, something like the branches of
a tree the larger branches are termed bronchia, the
smaller ones, stretching out all through the lungs, are
called bronchioles.
Now this process of subdivision goes
Microscopic
Anatomy of on until the bronchiolar branches have be-
the Lungs.
come exceedingly minute, and finally
terminate in microscopically minute cells, termed air-
cells, or alveoli. You will obtain a good idea of the
microscopic structure of the lungs by taking a large
bunch of small grapes, and imagining them-stems and
fruit-all hollow. Now call the principal stem the
12
PHYSIOLOGY OF THE LUNGS.
bronchus, the smaller branches the bronchia, the
smallest the bronchioles, and the grapes themselves the
air-cells, or alveoli. In this manner you have a fair
conception of the minute structure of the lungs.
III.-Physiology of the Lungs.
The air, entering at the mouth or nostrils, and travers-
ing the pharynx, passes into the larynx, the trachea, the
bronchi, the bronchia, the bronchioles, and finally
reaches the alveoli. It returns by the same channels.
The parts are termed collectively the air-passages.
Breathing-in is called inspiration. Breathing-out is
called expiration. Both these processes together con-
stitute respiration.
Why do we respire, or breathe? For this reason.
There is a certain gas in our atmosphere called oxygen,
without which we cannot live, and respiration is
the means of bringing the oxygen into communication
with the blood. If we breathe air containing too little
oxygen, serious embarrassment, or even fatal suffoca-
tion results. If the air-passages become choked up with
mucus, so that air cannot get in, we likewise suffocate
from the want of oxygen. When we eat, and laugh or talk
at the same time, the epiglottis is opened by the air,
and a bit of our food is apt to get into our larynx—“ it
goes the wrong way," as we generally express it. We
begin to cough violently to get the intruder out. This
coughing is nature's way of keeping these passages clear
for the air, so that we may get our oxygen, throw off
our carbonic acid, and not die of suffocation.
Further,
RESPIRATION.
13
there is a gas in our blood called carbonic acid, which
results from the vital process of combustion, by which
our high animal temperature is maintained. This
carbonic acid must be got rid of, or we are in danger of
being poisoned by it. Nature's way of getting rid of
this carbonic acid is (chiefly) by the lungs. We see,
therefore, that the inspired air takes in the oxygen,
without which we cannot live, and the expired air takes
out the carbonic acid, which would poison us if retained.
The fundamental idea of breathing is therefore simply
this, that between the lungs and the atmospheric air
there is a continual process of exchange going on the
blood has carbonic acid and wants oxygen, the atmo-
spheric air has oxygen and wants carbonic acid (for the
use of vegetables, whose food it is); and so a constant.
interchange takes place. We are continually reproducing
carbonic acid by our vital processes: yet we must expel
it, or death results. We are continually using up
oxygen in the organism, and we must have constantly
renewed supplies. Hence the necessity for uninterrupted
respiration, by which the interchange is effected, and to
effect which the lungs constitute a most admirable
apparatus. When a person has lost a part of his lungs
by Consumption, the remaining part must perform an
excess of work; and that is one reason why consumptive
patients breathe more rapidly than persons in sound
health.
IV. The Lungs in Disease.
During the last few years the doctrine has been for-
cibly established by the investigations of Niemeyer,
14
THE LUNGS IN DISEASE.
Dr. Andrew Clark, Virchow, and others, that inflam-
mation constitutes the most potent cause of every form
of Consumption.*
Pneumonia or
of the Lungs.
The intimate connection affirmed to
Inflammation exist between Pneumonia, and Phthisis
of the common form, renders it desirable
that the former disease should be explained. There
are three principal kinds of Pneumonia, viz., croup-
ous, catarrhal, and interstitial. When an inflamed
part of the lungs becomes choked up by congestion of
blood and effusion of proliferated cells, it loses its
spongy texture, and a bit of it, cut off and thrown
into water, sinks, whereas a piece of healthy lung
floats. This choked-up state is termed consolidation,
and the part has become inefficient for breathing; but
this consolidated part may be gradually restored to its
Caseous Meta- former permeable condition; or, on the
morphosis. other hand, it may undergo caseous meta-
morphosis. It is most important that this expression be
thoroughly comprehended. It indicates a degeneration.
of a solid part-of any part, not of tubercle alone-into
a cheesy mass which acts locally as if it were a foreign
body, and produces irritation, and which if dissolved
and absorbed into the blood becomes a violent poison.
Now when such consolidated pneumonic product is
present in an otherwise healthy person it undergoes
fatty degeneration, then liquefies, and is taken up by the
* It is due to the reader to state that some physicians still believe
that inflammation does not produce Phthisis, unless a special pre-
disposition to it exists; and, further, that in very many instances
tubercles are deposited, as the result of deteriorated health, without
any pre-existing inflammation.
CASEOUS DEGENERATION.
15
absorbents, and carried off to the blood, to be made use
of in some other part of the organism. In this
In this way the
solid part regains its normal permeability. When, on
the other hand, such product is present in a weak or
unhealthy person, it is apt to undergo caseous degenera-
tion, the caseous mass then irritates the neighbouring
parts, causes suppuration, and finds its way into the
air-passages, to be finally expectorated. Now if the
patient's health at this stage be improved as soon as
the cheesy mass has been completely ejected, the vacancy
may soon be replaced by connective tissue, and there
is so far an end of it. But if the patient remain in a
low state of health, notwithstanding that the mass finds
a way out, the destructive process spreads to other por-
tions of the lungs, and Consumption is set up.
There is no one special variety of Pneumonia which
sets up Phthisis; any form may leave a product which,
under unfavourable circumstances, is liable to be trans-
formed into a cheese-like substance, and finally to break
up into a cavity.
Caseous degeneration, however, is not necessary to
originate Consumption; a simple suppurative process.
may suffice. The pneumonic product may also calcify,
or result in fibrosis, or syphilitic gummata. If the
cheesy metamorphosis does take place, and the dis-
integrated matter enters the blood, then is developed a
Miliary Tuber- constitutional disease of a most deadly
culosis. nature, viz., Acute Miliary Tuberculosis
of a whole series of organs, including the lungs. This
is not, however, Consumption, but both diseases may
co-exist.
16
VARIETIES OF CONSUMPTION.
V. Varieties of Consumption.
Common Form. There are several kinds of Consumption.
Firstly, the common form, which results from the sup-
purative breaking up of an inflammatory product after
the caseous degeneration just described, and involving.
the surrounding lung-tissue. This is the most usual
kind, and may result from Pneumonia, Bronchitis, etc.
Secondly, we have Tubercular Phthisis, in which tubercles.
are formed in the mucous membrane lining the air-pas-
sages, and not in the substance of the lungs. These
tubercles are not capable of higher organization, but
quickly degenerate into a cheesy mass, as before de-
scribed, which irritates the contiguous tissue, excites
cough, suppurates, and involves the surrounding lung-
tissue, constituting Consumption.
The common form of Phthisis is what we mostly have
to deal with, and is Consumption par excellence. Tuber-
cular Phthisis is comparatively rare, and even more
grave than the ordinary form. Besides these, we have
hæmorrhagic, embolic, syphilitic, and fibroid Phthisis;
all more or less rare, and consequently not within the
scope of this treatise.
Preventibility
Common Form.
The most frequent cause of this form of
of the Phthisis is, according to some modern
authors, a neglected chronic Pneumonia,
or an acute Pneumonia, occurring either in a de-
bilitated subject, or under bad hygienic or other con-
ditions. The only essentials, therefore, for its prevention
are that the mal-nutrition of the debilitated subject
should be corrected, that the laws of health be obeyed,
and when an inflammatory process affects the lungs that
it should be properly treated until the consolidations
+
CURABILITY OF PHTHISIS.
17
have totally disappeared, and perfect health be restored.
Herein lies a great source of danger; a person takes a
prolonged and deep-reaching chill, and Inflammation
of the lungs results; he is treated until pain, fever, and
general malaise have disappeared; then, supposing that
the cure is complete, he pays no further attention to it
until the consolidated part has undergone caseous de-
generation, and broken its way into the bronchi, or
become absorbed, and Acute Miliary Tuberculosis be
developed.
Curability of
Of the curability of common Phthisis.
the there can be no doubt, provided it be
Common Form. taken in time, the proper remedies ad-
ministered, and hygienic conditions duly observed.
Preventibility of
Phthisis and We may safely affirm that precisely the
Scrofulosis. same condition of mal-nutrition under-
lies both these maladies, for though there is at first an
apparent hypertrophy of the glands in Scrofula, it is
no true hypertrophy of the normal organism, but
rather one of a low type, which finally results in a
consumption of the glands. They are twin sisters of
constitutional, hygienic, or nutritional misery.
If the state of nutrition be improved,
Tuberculosis. and the conditions necessary for the pro-
duction of caseous metamorphosis and the formation of
tubercle be obviated, then Tuberculosis cannot occur.
Its Curability. But we must candidly confess that
when tubercles have once been deposited in consequence
of caseous toxæmia, then medical science, as at present
developed, is comparatively powerless to effect a cure.
There is probably not one single indubitable case of this
veritable Tuberculosis which has been cured medicinally,
B
18
VARIETIES OF CONSUMPTION.
The Constitu-
of Phthisis.
or in which a spontaneous cure has resulted. However,
we do not despair even here. What we know not to-day
we may know to-morrow. It is not long since we held
erroneous views of the nature of Phthisis; indeed, it is
evident from a recent discussion (April, 1873), occu-
pying three meetings of the Pathological Society, that
nothing like a uniform conclusion has yet been arrived at
by the profession in general as to the nature of tubercle;
but we are nearer to a knowledge of its true nature now,
and therefore, we trust, nearer its cure and prevention.
The doctrine that Pulmonary Consump-
tional Origin tion is a purely constitutional disease,
the result of a specific morbid product,
from a peculiar inherent tendency or fault, has re-
cently been proved to be incorrect. We do not indeed
doubt that some persons-the weak and puny-are more
liable to Consumption than those who are strong and
well developed; but we also know that these same
debilitated persons are more liable to a host of other
complaints. Phthisis, then, is not a specific morbid
constitutional entity, as we, and with us all the highest
authorities in Europe, formerly taught; but it is a
peculiar state of mal-nutrition, with or without mal-
development of the chest and its contents, which
constitutes Phthisis. As such it is preventible, and, if
taken in time, curable. Herein lies the great advance
now made in this branch of medical science. Let us be
thankful that so much light has been thrown upon the
subject. It inspires us with hope for the future of our
noble calling. Having discarded the doctrine of a con-
stitutional taint,-a cachexia, a diathesis, a mysterious.
something lurking in the individual ego,—which Con-
ORIGIN OF PHTHISIS.
19
sumption formerly occupied in our minds, we now see
it in the clear light of mal-nutrition. It is constitutional,
it is systemic; the lung-disease is only a local manifesta-
tion of a general degenerate condition-an effect of
which mal-nutrition is the cause. In short, it is a con-
dition of defective health, which is preventible and curable.
The cause of Tubercular Consumption-depression of
the vital powers, leading to systemic disorder and the
course of the disease, marked by remissions of the dis-
tressing symptoms as the constitution improves-all
alike point to the systemic origin of the disease: the
common form of Phthisis may, however, begin and
continue throughout its whole course a purely local
disease of the lungs, and may result in a spontaneous
cure, or become fatal, as soon as there is not enough
healthy lung-tissue left for the proper aëration of the
blood ; or Tuberculosis may supervene from caseous
toxæmia, and hasten the fatal issue.
Evidences. Proofs of the constitutional nature of
Phthisis need only to be briefly stated. Any condition
of nutrition is necessarily constitutional; so also is mal-
nutrition, or Consumption. Yet very many of the
symptoms, formerly referred only to the diathesis, are
evidently the effects produced on the constitution by the
local lesions in the lungs, which have impeded the
functions of these organs.
A physical examination of the chest will generally
detect the presence of the common form of Phthisis :
but Tubercular Phthisis will escape detection if we rely
on the physical examination of the chest alone. Hæ-
moptysis is an effect of both these kinds of Phthisis.
When the blood is expectorated it cannot cause Con-
20
VARIETIES OF CONSUMPTION.
Elevated
sumption, but if hæmorrhage takes place into the lungs the
blood-clot may become a cause of Phthisis of any variety.
Heightened temperature of the patient
Temperature. also affords an important sign of the
nature of Phthisis. Dr. S. Ringer's observations,
made on patients in University College Hospital, are
very confirmatory of this point. He has been able to
detect a persistent elevation of the general temperature
of the body as the invariable accompaniment or pre-
cursor of the growth of tubercle in any organ. This
elevation he has found to exist for several weeks before
diminished weight, or other physical signs, indicating
Tubercular Phthisis of the lungs, could be appreciated.
After a certain time, however, caseous infiltration be-
came apparent by physical signs in the upper portion of
the lungs. The writer has repeatedly verified these ob-
servations in cases under his own treatment, and his
prognosis has been modified in accordance with the
strength of the evidence thus furnished. But in the
common form a careful examination will discover the
condensation of lung-tissue, or a cavity in the organ,
or some other physical change there.
Post-mortem
Post-mortem examinations of fatal cases
Examinations. prove that Tubercular Phthisis is not a
mere disease of the lungs, and afford evidence that these
organs only furnish a specially suitable nidus for tuber-
cular exudations; for, at the same time, various other
organs of the body exhibit proof of the action of this
destructive agent. In short, scarcely any organ escapes,
and at last the patient succumbs not to one, but to
many local affections.
PATHOLOGY OF CONSUMPTION.
21
VI.-Pathology of Consumption.
The Common In many instances it is the already-
Form. described termination of Pneumonia
in caseous infiltration that constitutes the morbid
starting-point. In Bronchitis, too, when the air-
cells of a lobule, or of a lobe, become filled with
morbid secretions, and are thus rendered impermeable
to air, caseous infiltration, irritation, suppuration,
breaking-up of the consolidated part into the bronchi,
and expulsion of the débris-all these processes may
follow, and destroy the lung-tissue. Later on, Tuber-
culosis may be superadded.
Tubercular
In this species of Phthisis the destruc-
Phthisis. tion of the lung is caused by the break-
ing down of Tubercles, and by the secondary Pneumonia
or Bronchitis, which follows on the Tuberculosis. (The
tubercle generally first develops in the mucous-membrane
of the bronchi, as was first demonstrated by Virchow.)
Even in the trachea and larger bronchial tubes we often
find extensive granular patches, consisting of innumer-
able miliary tubercles, or ulcers with the characteristic
marks (according to Rokitansky) of primary or secondary
tuberculous ulceration. In addition to this, however, in
the finer bronchi, besides the evidences of purulent
catarrh, we find small whitish or yellowish nodules, and,
upon examination of a well-prepared section under the
microscope, we can satisfy ourselves that the develop-
ment of the tubercle has spread from the bronchus to
its lateral and terminal alveoli (Niemeger). The pneu-
monic process by which the tuberculosis is attended
in this tubercular form is much less extensive, as a rule,
22
PATHOLOGY OF CONSUMPTION.
than the process which accompanies that kind of Con-
sumption which is solely due to chronic Pneumonia, or
than the process on which secondary Tuberculosis super-
venes, at a late period, when induration and destruction
take place,—a circumstance of some importance in the
diagnosis of Tubercular Consumption.
Tubercles. We will here add a few remarks on the
tubercle itself. Tubercles are of two varieties, the grey
and the yellow: the former is semi-transparent and
somewhat firm; the latter of a dull-yellow colour, and
of a cheesy consistency. The yellow has in it far
greater elements of danger; softening takes place.
earlier, and it has a greater tendency to aggregate in
masses. Frequently the two varieties are mixed, but as
cases advance towards a fatal termination, the yellow
appears to gain the ascendency. Many pathologists are
of opinion that the grey is a previous form of the
yellow, into which it passes after the lapse of an uncertain
time. Tubercles are usually deposited slowly and pain-
lessly, during some period of defective health; and after
remaining latent for an indefinite time, they waste, if
the general health improves; or soften and cause
abscesses and other destructive changes, if the health
deteriorates.
Course
The practical conclusions of Lænnec,
of Tubercles. Clark, Bennett, Pollock, and other care-
ful observers are, that if the further growth of tubercle
can be arrested, those already existing may diminish in
size, become absorbed, and the lung-tissue cicatrize; or
they may remain dormant, without exciting any symp-
toms, after undergoing a process called cretification, in
which the animal portion is absorbed, the earthy only
1
7
7
COURSE OF TUBERCLES.
23
remaining. Frequently, however, from Indigestion,
defective hygienic conditions, Bronchitis, or other causes,
tubercles undergo a succession of changes: they
become soft, first in the centre, that part being the
oldest and farthest removed from living influences; then,
like foreign bodies, they excite inflammation, suppura-
tion, and ulceration in the neighbouring lung-tissue;
the products being usually coughed up, and so expelled.
The groups often continue to enlarge by fresh deposits
till several groups communicate together, and form an
abscess, or in medical language, a vomica (see Plate III.,
p. 62); this bursts, and discharges its contents into an
adjacent bronchial tube, and the matter is conveyed into
the windpipe, and thence to the mouth, to be evacuated.
Unlike Cancer, tubercle contains within itself no elements
of growth, and is only capable of extension by fresh ex-
udations of the morbid materials. Unless the disease be
arrested by remedial measures, other abscesses form and
unite, till the lung-substance is so diminished in volume,
and its continuity so completely destroyed, as to be incom-
patible with life, and the patient dies from exhaustion.
In other cases, as before explained, as the result of
treatment, and good hygienic conditions, the tubercular
matter, with the inflammatory products it excited, are
removed by expectoration or absorption, the tissues
around the cavity contract and obliterate it, the general
health is restored, and so the disease is cured.
VII.-Acute Miliary Tuberculosis.
Strictly speaking, this disease is not Consumption at
all, but it so often steps in, in the later stages, that we
24
PATHOLOGY OF CONSUMPTION.
cannot well pass it by. It is not to be confounded with
Galloping Consumption; it depends upon an eruption
of tubercles in the lungs as well as in most other organs,
and is accompanied by the symptoms of an acute
disease. In the great majority of cases, the disease
is seen in persons whose lungs and other organs
contain old caseous deposits. This fact, and the cir-
cumstance that the symptoms and course of acute
Miliary Tuberculosis bear a strong resemblance to those
of the acute infectious diseases, would make it appear
highly probable that the malady arose from infection of
the blood by the caseous deposits. True it is that it
now and again occurs apparently unpreceded by any
such caseous product, but this does not contradict the
hypothesis, as an infection from person to person is
quite possible.
VIII.-General Considerations.
Since Phthisis may arise from pneu-
monic, bronchitic, embolic, hæmorrhagic,
syphilitic, and other products, having
their origin in the lungs, it must be obvious that any
and every pulmonary affection should be regarded as
important, and detected early, with a view to proper
treatment.
Importance
of Lung
Affections.
The Phthisical There is a peculiar build of the chest
Habit. and other parts of the body which ex-
perience has stamped as belonging to the consumptive.
No necessary connection, however, exists between this
habit of body and Consumption,- that is to say, a
person of phthisical habit will not inevitably die of
PHTHISICAL HABIT AND DIATHESIS.
25
Consumption. But with a narrow chest we have feebly
developed lungs, and experience tells us that a feeble
part of the body is more subject to disease than a strong
one, and, being thus subject, may easily give way to it.
In fact, it is a well-known law that a strong organ can
resist more strain than a weak one. It is only right to
add that a person not of phthisical habit may, neverthe-
less, die of Consumption.
Phthisical
The phthisical habit is simply mal-
Diathesis. development, and the phthisical diathesis
is simply mal-nutrition, the former resulting from the
latter. Phthisis does not necessarily go on from one
generation to another, until the whole consumptive races
be no more, from sheer want of vitality; the condition
may be ameliorated in the parents, after which they may
beget relatively sound offspring, and in one or two gene-
rations the phthisical tendency may be eradicated. On
the other hand, parents usually of robust health may,
when debilitated, beget children having a decidedly
phthisical propensity. The phthisical diathesis is there-
fore not an immortal entity, always reproducing itself;
but it is simply a condition of mal-nutrition, often of
untraceable origin.
IX.-Causes of Consumption.
Necessity for
studying
This is a most important Section of our
subject, for in it will be suggested points
Causes. of a highly practical bearing; and to no
department could popular study be more profitably
directed. Happily, we now know something of the
direction in which we should look, and, consequently,
26
CAUSES OF CONSUMPTION.
in which we should work, in order to trace out the
causes of Consumption. The more general diffusion of
the knowledge thus acquired is sure to be attended with
a great reduction in the mortality of Phthisis. Just
as Dysentery, Ague, Leprosy, and other diseases have
declined in their intensity and fatality since their causes
have been better understood, so a correct appreciation of
the causes, and the various conditions which favour the
development of Consumption, will wonderfully diminish
it, and the health, happiness, and longevity of the com-
munity be correspondingly increased.
There are two kinds of Causes to be con-
Predisposing
and Exciting sidered, those which predispose to, and
Causes. those which excite, Phthisis. The former
of these is coeval with birth; and when this hereditary
influence is very intense, as when both parents are
affected, there is great danger of the disease being
brought into activity in the offspring. A person, however,
may have even a strong predisposition to Consumption,
and yet not fall a victim to it, if he can, under favour-
able circumstances, steer clear of those exciting causes
which determine its accession.
a. Hereditary Predisposition.
By this is meant the transmission, from parents to
children, of a liability to the disease; this is undoubtedly
a common and fruitful predisposing cause of the malady.
The potency of this influence may be inferred from the
fact that, in its absence, thousands pass
through the most adverse circumstances
Influence. with exemption, and even reach a consi-
derably advanced stage of life. Yet such as are capable
Power of
Hereditary
•
い
​HEREDITARY INFLUENCE.
27
of resisting lung-diseases are often laid low by others from
which the consumptive may be free. In one person a cold
may produce Pneumonia resulting in Phthisis, while in
another a similar cold may produce Acute Rheumatism
resulting in Heart-disease; and again, a third may,
although exposed to similar circumstances, not take cold
at all. A person of phthisical habit begets a child
who remains healthy all his life, but the latter has a
child that dies of Consumption. Does this prove that
the parent transmitted the disease to the child?
Certainly not; for privation, excess, errors in habits of
life, sedentary occupations, the pernicious influence of
certain trades, grief, anxiety, unkind treatment from
parents and friends, and other wasters of vital power,
will suffice to induce Consumption in many individuals.
But it is also true that if to any or all of these con-
ditions there be superadded a strongly marked hereditary
tendency, very few indeed escape the disease. Consump-
tion, as we have seen, is curable, and may be generated
de novo. It is not a morbific entity, skipping over one
generation, and then pouncing upon another quite inde-
pendent of circumstances, but, on the other hand, it is
most certain that consumptive parents are, cæteris pari-
bus, more likely to have consumptive children than
healthy parents: "like begets like."
Moral and Phy-
Now it is often with a sad and puzzled
sical Analogies. state of mind that we contemplate the
transmission of the infirmities and errors of those who
preceded us in the ancestral line. We know, however, that
such inflictions are in accordance with other inexplicable
facts observed in the moral government of the world and
also with the teachings of divine revelation. The lessons
28
CAUSES OF CONSUMPTION.
which the physician gathers in the consulting-room and
at the bedside have their counterparts in the inscrutable
permission of the origin of moral evil, and in the
penalty exacted for transgression even "from the third
and fourth generations." "Nor can the fact be disputed,
though appreciable with difficulty, that the natural and
special dispositions of the individual descend to him in
a certain measure from his origin, and that parents
transmit to their children such and such moral propen-
sities, just as they do such and such physical tempera-
ment, or such and such features. Hereditary trans-
mission enters into the moral as well as into the
physical order of the world" (Guizot). Disease may be
transmitted through any person in whom, through a
combination of favourable circumstances, it never be-
came developed into actual mischief. Individuals
placed, as it were, on the chain of inherited disease, may
personally escape its influence by avoiding the other
agents which concentrate and precipitate any special
disorder. They are not, however, the less transmitters
of peculiar constitutions, if they be not individually
sufferers. The electric current on the wire passes on its
errand, and leaves no trace of its transit" (Pollock).
True; yet when passing, its presence at any point of
the wire may be demonstrated. So where Phthisis is
transmitted, its presence may be equally proved by the
operation of exciting causes.
CC
Consumption The consumptive should not marry until
and Marriage. they have been restored to health and
strength. Indeed, weakly or sickly persons generally
should not marry, for marriage involves a further drain
upon the system already too weak to bear efficiently the
r
CONSUMPTION AND MARRIAGE.
29
burdens of life. Confronted with this impressive truth,
based on no mere theoretical grounds, but on practical
observations a hundred times verified, we cannot but
pause to gather a most obvious lesson, although we may
refer to it again in a following Section. The lesson is
plainly expressed, that individuals having consumptive,
or any other transmissible disease, should on no account
marry until they have thoroughly recovered their health;
and not at all if the disease had so far advanced as to
destroy a considerable portion of the lung-substance.
Attention to this fundamental point forms the very
foundation on which rests all our hope of diminishing the
mortality from this potent and wide-spread cause of
weakness and premature death. If the phthisical young
man marry before being restored to health this con-
dition often becomes a fresh cause of debility, and he
will almost certainly become the father of feeble or
tainted children, who often, after a few months or years
of suffering, die, and the parent is surrounded with
responsibilities and anxieties which press heavily on his
weak frame. If the young woman marry, she probably
becomes a mother, for marriage in about five cases.
out of six is followed by pregnancy, and while she
thus exposes herself to the perils of childbirth, greatly
heightened in such a disease, she indelibly imprints.
her infirmity on her offspring. With regard to the
transmission of Phthisis, it has been noted that the
probability in favour of the disease being transmitted
from male to male, or female to female, is two-thirds
greater than the probability that it will be transmitted
from one sex to the other, that is, a consumptive father
is more likely to transmit his disease to his sons, and
30
CAUSES OF CONSUMPTION.
a mother to her daughters than vice versa. The ob-
servant medical practitioner, who can trace effects to
their causes, can alone gauge the suffering and bitter
disappointment which result from such marriages, and
should be oftener consulted before marriages are formed
or arranged. Institutions for the reception and special
treatment of the disease may be reared in the most
congenial climates; our Materia Medica may continue
to receive large accessions of the most valuable drugs ;
our already multitudinous appliances for the relief and
comfort of those affected may be indefinitely increased;
but unless the great fountain, whence nearly all the
evil flows, be itself purified, the disease can receive
but the most insignificant palliation.
We hope we shall be excused for dwelling
on this point; but we are strongly im-
pressed with the belief that its vast practi-
cal importance has never received that general considera-
tion which it deserves. The question of the marriage of
unsuitable persons is either altogether disregarded, or is
viewed from a too narrow standpoint, as though it only
concerned the welfare of the individuals forming the
alliance. Our duty, however, as protectors of the public
health, imposes on us the responsibility of enforcing the
neglected truth, that the health, and consequently the
happiness and material greatness, of future generations
are influenced by such marriages. As before remarked,
no one but a physician can fully appreciate this evil, or
accurately trace its workings in society. Consumptive
parents become the propagators and transmitters of a
grave constitutional disorder, and with it misery, pain,
and often poverty. This subject is therefore both
Vital Import-
ance of the
Subject.
་
CAUTIONS RESPECTING MARRIAGE.
31
humane and economic, and should enter into the
consideration of persons contemplating marriage, as
one of paramount importance. In cases of doubt, a
physician should be consulted, and all the information he
requires should be fully placed before him, so that he
may arrive at correct conclusions. Frequently, indeed,
he is consulted, but generally only when the misguided
step has been taken, and the evil is past remedy. Great
responsibility attaches to parents and guardians; they
should not countenance unions which, though they may
appear to favour commercial interests, or give solidity to
family greatness, or cement family properties, can only
result in the perpetuation of a disease which dims the
brightest domestic hopes, and multiplies and strengthens
a malady that prematurely sweeps away more than
an eighth part of the human race.
Cautions re-
specting
Should a consumptive young man fully
regain his health, and decide to marry,
Marriage. the only hope of his having vigorous
children lies in his allying himself to a female of sound
health, descended from a healthy stock, and reared in the
country. To ensure further exemption from Consump-
tion in his children, they should live in the country,
and be brought up under those hygienic conditions
which we have pointed out in this Manual (Section XIII).
Still greater precaution is necessary in the case of
females. After recovery from Consumption, they should
wait sufficiently to be certain that recovery is permanent;
for pregnancy, from which we have shown the con-
sumptive are not exempt-labour, and nursing are serious
drains on such constitutions, and are almost certain to
rekindle the disease if not thoroughly cured. Even
K
32
CAUSES OF CONSUMPTION.
after marriage, if consumptive symptoms reappear, the
process of child-bearing should cease. It may seem hard.
to separate a husband and wife, but it is far harder that
they should beget children, with the certainty that their
offspring will inherit the mother's disease, and possibly
be the agents of introducing it to other families.
Society has its rights as well as individuals. Liberty
should not be used as a covert for license.
Evils of Con-
As intimately connected with this sub-
sanguineous ject, we will here refer to the influence
Marriages. of the intermarriage of persons of near
consanguinity. Hereditary tendency to Phthisis is by no
other means so intensified and so certainly precipitated
on the next generation. The evils of the marriage of
persons of the same blood are not confined to families
having a consumptive predisposition. For the offspring
of such marriages are generally feeble. Constitutional
weaknesses or defects, in themselves, perhaps, of no grave
importance, are confirmed by intermarriage, and may
readily become developed into actual disease. Should
any hereditary weakness, derived from a common
ancestry, affect both parents, it is almost certain to be
intensified in their children. Whereas the union of per-
sons of different families, nationalities, or constitutions,
if exempt from positive taint of disease, is likely to modify
any peculiarity possessed by one parent only. These
remarks apply with double force to the disease under
consideration. The marriage of near relations, whose
families possess a consumptive cachexia, is sure to lead to
a concentration of the disease in the progeny, and to lay
the foundation of some of the most destructive maladies
to which the human frame is liable. Even this expresses
CONTAGIOUSNESS OF PHTHISIS.
33
but half the truth. A convergence of ancestral liability
to nearly any disease, by intermarriage, is an almost
certain method of insuring tubercular disease in its most
active form, even where no such tendency previously
existed. On the other hand, persons having a slight
hereditary liability to Consumption, but with no actual
disease, forming judicious marriages with persons of
healthy blood, may lead to such an admixture and dilu-
tion of the peculiar element which exists on one parental
side, as shall, in process of time, render it altogether
inoperative.
Contagiousness This is a point of great practical im-
of Phthisis. portance, and one deserving general con-
sideration. We believe there are but few observing
practitioners who will deny that Consumption is, in
a limited sense, contagious, for cases cited in proof are
by no means rare-a phthisical husband conveying the
disease to his wife, and vice versa. It is true, Sir Thomas
Watson states that he does not believe Phthisis to be
contagious; but then he adds, "Nevertheless I should,
for obvious reasons, dissuade the occupation of the same
bed, or even of the same sleeping apartment, by two
persons, one of whom was known to labour under Pul-
monary Consumption." On this important subject
Dr. Fuller writes "Though the non-infectious character of
Phthisis be admitted, it behoves the physician to warn
the patient's friends of the dangers incident to long-
continued attendance on him, especially if the disease be
in an advanced stage. It would be the height of
imprudence for a healthy person, and especially if young,
and of a scrofulous diathesis, to sleep in the same bed, or
even in the same apartment, with a consumptive patient;
C
34
CAUSES OF CONSUMPTION.
for although the malady might not be communicated
directly from one to the other,.
the surround-
ings and the air would be calculated to predispose him
to the disease." It is precisely in this respect that
we consider the disease contagious. We can call to mind
repeated instances of a surviving husband or wife suc-
cumbing to the malady which carried off the deceased
partner too quickly to allow of a reasonable doubt that, in
some way or other, Consumption may be conveyed by
long breathing an atmosphere charged and poisoned by
the products of ulcerating lung-surfaces. "During the
course of Pulmonary Tuberculosis," said Bouillaud, in
the French Academy of Medicine, "when pus or other
septic products are formed in parts which are accessible to
the atmosphere, Phthisis, like so many other affections
in which purulent foci happen, becomes indirectly a
cause of septic infection."
The practical outcome of these remarks is, that
relatives and attendants should not eat nor drink habi-
tually nor sleep in the sick-room of a consumptive person ;
and during the whole time, by means of an open door,
window, or other aperture, ventilation should be uninter-
ruptedly going on. If sitting up with one, food should
be taken, in another room, about every fourth hour
during the night.
Other Aspects. While it is undoubtedly of primary im-
portance that consumptive persons should refrain from
marriage until their medical advisers have declared
them fit for such a relation, yet, though every phthisical
person in the world should die without offspring, we
should not thus get rid of Phthisis. It is being con-
tinually reproduced by neglect of the laws which govern
POPULAR INSTRUCTION.
35
health. A neglected inflammatory process of the lungs,
coupled with a certain amount of debility and bad
hygiene, is all that is requisite for the generation of
Phthisis, the subject of which would again transmit a
phthisical tendency to his offspring. Until the masses.
of the population are instructed in the fundamental laws
of health; until their children are taught something of
the structure of the lungs and their physiology; until
they know what air is, what breathing is, why bad
air is bad; until these things are accomplished, Phthisis
will continue to stalk through the land as heretofore.
We look to our School-Boards for help; but even they
will not accomplish much unless our School Managers
take a proper view of the subject. May the day soon
dawn when it shall be considered the characteristic of
gentlemen, and of ladies, that they know something of
"the house they live in." May our influential men
come to see that it might possibly be as useful and
quite as interesting to the young citizen to know how
wonderfully and beautifully he is made, as it is to know
this or that Greek root, the height of Mont Blanc, or
the signs of the Zodiac.
b. Impure Air.
We now proceed to consider other influences which
act as causes of Consumption by enfeebling the
nutritive functions. Probably the first in importance
is that of breathing an unrenewed atmosphere. Nothing
is more prone to deterioration than pure air, for every
breath we breathe subtracts from it a portion of the
oxygen it possesses, and imparts to it carbonic acid; but
36
CAUSES OF CONSUMPTION.
this process can only go on when the air is confined
around the breather in a badly-ventilated room, and is
entirely obviated when he respires in the great air-ocean
out-of-doors. Moreover, besides the changes in the
proportion of its oxygen and carbonic acid, respired
air is vitiated by animal effluvia given off from the
lungs of each person by whom it has been inhaled.
The want of pure air consequent on the imperfect
ventilation of sitting and sleeping rooms is a frequent
and potent cause of tubercular disease, as indeed might
be inferred from the physiological evidence of the ex-
treme importance of a due aëration of the blood.
Defective Persons breathing, for a considerable
Ventilation. period, air which has been rendered im-
pure by respiration, soon become pale, partially lose their
appetite, and gradually decline in strength and spirits.
Defective aëration of the blood leads to imperfect nutri-
tion of the tissues, the general tone of the system sinks,
and it can offer but a feeble resistance to morbific agencies.
Of special diseases, Consumption is now known to be
frequently induced by the constant breathing of air
vitiated not only by respiration, but by the organic
vapours and particles arising from the extensive surface
of the skin. Evidences of this are very numerous. That
this has been the chief cause of Phthisis among soldiers
In Barracks, is proved by the well-known fact that with
very different duties, and altered diet and circumstances,
a great amount of Phthisis has prevailed in the most
varied stations of the army, and in the most beautiful
climates in Gibraltar, Malta, Ionia, Jamaica, Trinidad,
Bermuda, etc.: in all these places the only common
condition was the vitiated atmosphere which our barrack
DEFECTIVE VENTILATION.
37
system everywhere produced. Of late years there has
been a most decided decline in phthisical cases in these
stations, while the only circumstance which has notably
changed in the time has been the condition of the
respired air. Two Austrian prisons, in which the diet
and mode of life were essentially the same, offer the
following contrast:-In the prison of Leopoldstadt, at
Vienna, which was very badly ventilated, 54 per 1,000
died from Phthisis-there being no fewer than 42 cases
of Acute Miliary Tuberculosis. In the well-ventilated
House of Correction, in the same city, only 7.9 per 1,000
died of Phthisis. The deaths from Phthisis in the royal
navy have been remarkably different in different ships,
and excess of lung-disease has been clearly traced to
contamination of the air.
In Schools. In a school at Norwood, containing 600
boys, Scrofula was extremely prevalent, and great mor-
tality occurred, which was supposed to be due to
deficient or unwholesome food. The diet was investi-
gated, and found to be good, but the ventilation of the
rooms and dormitories was very imperfect.
This was
corrected, and the disease rapidly disappeared.
Both among landsmen and seamen working in con-
fined rooms, but otherwise very differently situated,
an excess of acute lung-diseases prevails. The only con-
dition common to both classes is the impurity of the
atmosphere. The popular notion that Consumption and
Bronchitis are caused by persons passing from hot rooms
to the external air is probably somewhat incorrect; the
main cause is the devitalizing influence of the impure
air in the confined rooms. The reports of the Registrar-
General show that the deaths from this cause among the
38
CAUSES OF CONSUMPTION.
inhabitants of towns are twenty-five per cent. greater
than in the country districts, notwithstanding the fact
that the dietary and general comforts of the former are
often greater than those of the latter.
"If in expiring," writes Dr. Mac Cormack, "we threw
into the atmosphere Carbon or visible smoke, instead of
invisible carbonic acid, we should really appreciate the
noxious character of pre-breathed air-that is, air that
has been already breathed by other human beings or
animals, and which besides being minus the due proportion
of oxygen, the pabulum of life, is loaded with the products
of animal decay."* This writer considers Pulmonary
Consumption to be almost wholly due to the respiration
of pre-breathed air in close unventilated rooms; and
although we have brought forward other factors as
tending towards the same result, this is probably the
most frequent and potent of them all.
Among the
Nor is the application of these state-
Lower Animals. ments restricted to man. Observations
made on the health and habits of the inferior animals
confirm the great fact that an insufficient supply of pure
air is a fertile cause of tubercular disease in them.
c. Unhealthy Occupations.
Unhealthy occupations occupy a prominent place
among the predisposing causes of Phthisis and other
diseases of the lungs. Many of the industrial occupa-
tions of this country are carried on, to a greater or less
degree, at the expense of the health of those engaged in
Consumption from pre-breathed air.
3
ឥ
UNHEALTHY OCCUPATIONS.
39
them. Occupations, however, are only
Why certain
Occupations injurious to health incidentally, and the
are Unhealthy. chief circumstances which render them
so are mostly preventible, and are, briefly, the follow-
ing-Deficiency of sunlight and pure air, the inhalation
of mechanical or poisonous substances, too great pro-
longation of the hours of work, a bad posture of the body
during labour, and the intemperance, and consequent
poverty, of those engaged in them.
Dust. Phthisis has been observed to occur in
workmen who breathe air loaded with particles of dust,
as bakers, needle-grinders, stone-masons, quarrymen,
cotton-carders, workers in porcelain, makers of mat-
tresses, furriers, coal-miners, and others. Dust is un-
doubtedly a most destructive agent, and a fruitful cause
of Consumption among those whose occupation compels
them to inhale it.
V
The sedentary occupations, such as are carried on by
milliners, book-keepers, tailors, shoemakers, and many
others, are often most unfavourable to health, not alone
from the effect of crowding without sufficient access of
air, but from the effects of a sitting and stooping posture
combined, thus offering a mechanical hindrance to the
free access of air to the lungs, limiting the expansion of
the bony walls of the chest, and preventing perfect
aëration of the blood. It must be obvious that what-
ever diminishes the amount of air which enters the air-
tubes to the same extent restricts respiratory changes,
interferes with the renovation of the vital fluid, and
tends to induce those secondary disorders which favour
the development of tubercle. To a limited extent the
hurtful consequences of such postures may be avoided
40
CAUSES OF CONSUMPTION.
by occasionally changing to a standing position when at
work, and by taking out-door exercise during the hours
of relaxation. Plenty of healthful recreation in the open-
air is the best corrective of the injurious consequences
of sedentary employments.
pations
In- and Out- From accurate statistics it has been
door Occu- shown that Consumption is five times as
contrasted. frequent in persons occupied within doors.
as in those following open-air pursuits. In the mining
districts of Cornwall and Devonshire, among the most.
healthy portions of Great Britain, about one-half of the
entire number of the miners deprived of fresh air and
light, die of Phthisis. Tailors, shoemakers, printers,
and needlewomen are found to form about one-sixth of
the whole number of consumptive patients. Clerks also
figure conspicuously; carpenters form about one-twen-
tieth part; but gardeners, hawkers, and policemen, who
are constantly exposed to weather vicissitudes, present
only about one-fiftieth part. The general testimony
of accurate observers in London, Paris, Vienna, Ham-
burgh, etc., confirms the correctness of these observa-
tions. The subject has another important practical
aspect, namely, that patients in Consumption who have
followed out-of-door occupations recover or improve.
more often under medical treatment than those em-
ployed in-doors. Dr. Walsh has shown that improve-
ment in hospital cases was effected in about fourteen
per cent. more persons following open-air occupations
than in those who followed confined trades.
Cold a Cause. This seems a fitting place to observe
that Consumption often originates in severe cold. Cold,
or catarrh, consists of slight or intense inflammation of
"
41
A
the lining membrane of the nose and windpipe; and
accurate observation shows that consumptive patients
are more liable to cold than others, and when it is
contracted, they cannot throw it off so easily.
catarrhal cold in itself is quite insufficient to produce
the disease, except it be neglected; when it may go on
to caseous infiltration and consumption: cold can also
act as an exciting cause in persons already predis-
posed. Notwithstanding that consumptive patients.
easily take cold, they often bear exposure to cold air
with striking immunity when the air is pure and dry;
but when they do take cold it affects the weakest organs,
namely, the lungs.
INFLUENCE OF FOOD.
d. Unsuitable or Insufficient Food.
A deficient supply or an improper quality of food
may serve as an exciting cause of Struma and Tubercle,
although probably to a less extent than causes already
pointed out. It has frequently happened that Struma
and Phthisis have prevailed amongst the inmates of cer-
tain establishments, and that such diseases have quickly
disappeared on the introduction of an abundant,
nourishing diet.
The influence of an insufficient diet in the production
of Consumption was strikingly shown in a case that lately
came under the author's care. An artisan, a Scotch-
man, earning good wages, consulted me having all the
symptoms and signs of early tubercular disease. He
came of healthy parents, and no member of his family
had ever been seriously ill. I had some difficulty in
42
CAUSES OF CONSUMPTION.
arriving at the true cause of the disease, and had to
question him most minutely. The result was I found
he had been depriving himself of a sufficient amount of
nutritious food, from foolish ideas of economy. His
plan was to have his week's supply of mutton well
boiled-down, and to make the soup thus obtained serve
him for about one-third of the week, and for the re-
maining portion of the week to eat the tasteless and
worthless mutton, supposing that it yet retained all its
nutritive juices. The patient made fair progress under
treatment and improved diet, but I soon lost him, as he
had a decided objection to pay a physician's fees, his
ambition being, by long hours of work, and hard living,
rapidly to amass a purse of gold, and return to his
northern home.
Hand-feeding
The influence of hand-feeding of infants,
of Infants. as too generally practised, is certainly
very considerable in the production of the consumptive
cachexia. The blood and the tissues derive nourish-
ment from the food administered; and Nature furnishes
milk as best adapted for children till the period of den-
tition. A healthy mother should, therefore, always
nurse her own children; when the mother's condition
does not permit of this being done, a healthy wet-nurse
should, if possible, be obtained. For further remarks
on this subject, see under "Diet of Children," pp. 72-4.
e. Depressing Emotions.
The influence of mental anxiety also ranks pro-
minently as a predisposing cause of Consumption. The
gradual decay of one member of a family who has
HOPE AND DESPAIR.
nursed another through the complaint, has so often oc-
curred as to give weight to the belief that Consumption
is infectious. Instances of very rapid cases of Con--
sumption have come under our notice, in which, through
the indiscretion of friends or the medical attendant, the
Influence of fatal character of the malady has been so
Despair and emphatically stated, that the patients,
having abandoned all hope, and sur-
rendered themselves to death, have rapidly perished.
Hope.
С،
43
Among the predisposing causes of Phthisis," writes Lænnec,
"I know of none more certain than the depressing passions, especially
when they are profound and long-indulged. I had under mine own
eyes," he states, "for ten years, a most striking example of the in-
fluence of melancholy in the production of Phthisis. There existed
in Paris for that space of time a nunnery, remarkable for the
severity of its rules. The alimentary regimen of
the nuns, although extremely severe, was still not
beyond the bounds of nature; but the spirit of
the rules of the nunnery, directing the mind to the most terrible
rather than to the consoling truths of religion, as well as compelling
the inmates to resign themselves in everything to the will of the
abbess, produced effects as sad as unexpected. These effects were
the same in all. At the end of two months' sojourn in this house
the Menses became suppressed, and in a month or two afterwards
symptoms of Phthisis appeared. As the nuns had not been allowed
to take the usual vows, I entreated that they would leave the house;
and all who followed this advice recovered. But during the ten
years I was physician to this establishment the members were re-
newed twice or thrice, with the exception of the superior, the
tourière (portress who attends at the gate), the sisters who had the
care of the garden, of the kitchen, and of the infirmary, or of such
as had more frequent intercourse with the city, and consequently
greater distraction. The rest died of Phthisis.
Asceticism
and Phthisis.
Mark well the concluding sentence in the above quota-
tion, the rest died of Phthisis. This is proof positive
that Consumption can be generated de novo. Here the
mode of life of these poor nuns must have been some-
thing more than a predisposing cause to Phthisis.
Surely they could not all have been originally phthisical.
44
CAUSES OF CONSUMPTION.
f. Exciting Causes.
Some of the circumstances which tend to call into
activity or produce the consumptive diathesis may here
be enumerated. The diseases or errors mentioned would
not, perhaps, of themselves originate Tubercle without
an intermediate inflammatory process; their influence
is rather in the direction of lowering the vitality, or
causing the germination of those seeds of disease which
have either been transmitted from parents, or acquired
through the long working of the predisposing causes
already referred to. Acute diseases-Fevers, Hooping-
cough, Pneumonia, and especially Measles-may excite
congestion, which, acting in conjunction with in-
herited or acquired tendency, may determine a growth
of tubercles. Prolonged Bronchitis, chronic Abscesses,
severe Indigestion, interfering with the nutrition of the
body, these and other devitalizing diseases, with or with-
out a pre-existing contamination of the blood, are suffi-
cient to lead to the commencement of active organic
disease. The periods of gestation, childbirth, and of
nursing, are eminently favourable to the development of
systemic mischief. It is thought that the course of
Phthisis is often arrested during pregnancy; but if so,
it advances with greater rapidity afterwards. The
hæmorrhage which often complicates labour in women
of feeble frame is highly prejudicial. Imprudent and
unusual exertions, such as the tremendous respiratory
efforts called forth by a University boat-race, or the long
marches and steep ascents of a student or literary man
during a hurried Alpine excursion; the sitting up, till the
early hours of morning, of the anxious and jaded gover-
7
¡
!
CASE OF A COMEDIAN.
45
ness, in order to enjoy converse with books and absent
friends; the excitement and effects of badly-ventilated
ball-rooms, operating on the insufficiently-clad lady,-
all these, and many other unwise proceedings, are either
voluntarily endured, or through the hard necessities of
life enforced, and the seeds of a dire disease, hitherto
absent or dormant, germinate and produce their fatal
fruit. The following case will be read with interest :
"Thomas B., aged 32, comedian; no predisposition; presented
February, 1857. A spare, low-sized, intelligent man, chest well
developed, arms muscular; was accustomed to gymnastic exercise
in the circus (as clown) till nine months ago, when he lost his voice,
and with it his engagement at Astley's. Ill for five years, with
cough and frequent hæmoptysis, and a certain amount of dyspnoea on
exertion, which, however did not prevent his extraordinary exertions
before the public. Has no present fever; digestion good, appetite
excellent; leads a strictly temperate life. Dulness, cavernous blowing,
pertoriloquy well marked and circumscribed, left sub-clavian region.
Ordered oil, etc. May.-Voice as strong as it ever was; has re-
sumed his occupation as clown, can sing, but by my advice avoids
the more violent exercises of the circus (as somersaults). In October
went to the north of England, and fulfilled many engagements.
In
August, 1858, I was telegraphed that he was seized with profuse
hæmoptysis on the stage at H I directed the treatment, and
he resumed his occupation within a month. In May, 1859, this well-
walled cavity gave way, and a coarse crepitant sound was evident over
the whole left front, while dry blowing respiratory sounds were heard
at the right apex. Yet, in spite of many warnings, he persisted in
his professional exertions, only greatly moderating the muscular
exercises, and confining himself to the jesting department. In
August be was so weak that he fainted more than once; but at the
end of the month he again accepted a provincial engagement. In
the summer of 1860 he had much improved, and still acted and sung.
The expectoration had much increased, and diarrhoea at intervals re-
duced his strength. Yet, with a full knowledge of his danger, he
continued at his occupation. Finally, in 1862, his weakness became
extreme; and although in nightly attendance at a theatre in the
north, he was so ill as to be scarcely able to stand. Alarmed, at
length, by repeated faintings, he hurried up to London by train, and
died in my presence two hours after his arrival.
"I cannot forbear from dwelling on the heroic fortitude of this
remarkable man, and can testify to his self-denial and its object. He
had a wife and aged mother much dependent on his exertions. I
46
CAUSES OF CONSUMPTION.
have witnessed his performances at Her Majesty's Theatre when
few would have credited the physical weakness against which he
struggled" (Pollock).
Difficulties
tiation.
Although we have endeavoured to dis-
of Differen- criminate between predisposing and exciting
causes, it must be borne in mind that this
part of our subject offers very great difficulties. We
can but very rarely demonstratively affirm that a given
cause was absolutely exciting, or simply predisposing;
for it is more than probable that one and the same cause
may in one person be truly exciting, and in another
predisposing.
X.-The Symptoms of Consumption.
The early symptoms, which are often obscure, may
arise at any period of life from infancy to old age, but
more frequently from the eighteenth to the twenty-
second year;
or speaking more widely, from the
eighteenth to the thirty-third year. The chief symp-
toms are-progressive emaciation, impaired diges-
tion, short or difficult breathing, more or less cough,
rapid pulse, hæmoptysis, and as the disease ad-
vances, Hectic fever, Diarrhoea, and Aphthæ. As
additional evidence, the gums should be examined to see
if there is a red line next the teeth, and the nails, to
observe if they are curved downwards at their ends
(filbert nails), for both these are common in Phthisis.
We must observe, however, that the latter supposed
symptom of Phthisis is now believed to be simply one
of emaciation, having no value whatever as a diagnostic
mark of tubercles, but occurs more or less in emaciation
from any cause. The shape of the nails, it will be found
WASTING AN EARLY SYMPTOM.
47
by observation, varies with the state of bodily nutrition.
The disappearance of the tissues from under the nail
deprives it of its natural support. It must hence-
forth rest almost immediately upon the bone as upon a
model, and is obliged to follow the direction of its surface.
This surface being rounded at the top, the nail takes a
direction downwards. But if a patient regain flesh,
the nails duly recover their normal shape.
Wasting an Progressive emaciation, in the absence
Early Symptom. of any other known cause, is one of the
earliest and most important symptoms of Consumption.
Except during well-marked intermissions, it generally
proceeds uniformly from the commencement to the ter-
mination; and it extends to nearly every tissue of the
body the adipose, the muscular, and the bony; even
the skin and the intestines become thinner. It
evidently bears a closer connection to the constitutional
than to the local diseases; and though liable to be
increased by extensive disease of the lungs, of the
intestines, and of the mesenteric glands, and by Hectic
fever, still in the absence of these conditions, in their
ordinary intense form, wasting goes on to the fatal ter-
mination, the patient sustaining a total loss of from
one-third to half his entire weight. Slow and gradual
emaciation" the grain-by-grain decay"-is far more
indicative of Phthisis than a rapid or irregular dim-
inution of weight.
Emaciation is more marked, and also more dangerous,
in individuals who have been previously stout. To
gather correct and full information from wasting of the
bodily tissues, frequent observations, extending over a
considerable length of time, are necessary, as the
48
SYMPTOMS OF CONSUMPTION.
atrophy progresses insidiously and almost imperceptibly.
As it is this continuously progressive emaciation which
it is so important to detect, it becomes necessary to
have the means of accurately weighing our patients.
And by this means a physician is also able to judge of
the proportion of the weight of a patient to his height,
to his age, and to his breathing, and other functions.
In advanced stages of the disease
Wasting. emaciation progresses in a peculiar
manner, the patient losing perhaps three pounds in one
week, and gaining two pounds or more in the next; and
this alternation of gain and loss goes on for many weeks
or months, but generally leaving a balance against the
patient (Aitken.)
Irregular
From a statement previously made, it
Wasting with-
out Apparent will be perceived that the value of this
Cause. symptom is contingent on its being un-
connected with any temporary cause, such as acute
disease, variation in diet, occupation, season of the year,
and the like. But whenever a person becomes progres-
sively thinner, without any apparent cause, even though
it be unaccompanied with cough or expectoration, and
especially if it be conjoined with any of the other
symptoms pointed out, the best medical advice should
be at once obtained and adopted.
Indigestion. Disorders of the digestive tract are pro-
minent and serious symptoms, and are computed to occur
The
in at least three-fifths of all cases of Phthisis.
indigestion, even in the worst cases, may only manifest
itself by a capricious appetite, with special aversion to fat
meat, pain in the epigastrium, and vomiting after cough-
ing. But it is probable that no growth of tubercles.
-
+
INDIGESTION.
49
ever takes place except during a period of imperfect.
nourishment of the system, from loss of power in the
digestive apparatus; and that the exemption of in-
dividual members of consumptive families from the
disease is due mainly to the perfection of digestion and
nutrition. Even when Consumption does occur, the
restoration of the digestive and assimilative functions is
invariably attended by great prolongation of life.
Homœopathy holds out the most rational hope of cure,
and its value is often strikingly manifested by the aid
which its remedies afford to the digestive viscera; and,
by correcting the mal-assimilation of food, it often arrests
a further growth of tubercles, while those which pre-
viously existed remain latent and harmless. Power
given in this direction is always beneficial, and often
successful. On the other hand, a persistent irritability
of the lining membrane of the digestive canal, with
vomiting and diarrhoea, are symptoms so grave, even in
cases in which the pulmonary affection is but limited, as
to justify extreme anxiety. Simple innutrition from
defective digestion or assimilation is one of the first
links in the chain of processes by which Consumption
destroys life, for the organs may be so disordered as
virtually to lead to the same result as an inadequate
supply of food, by depriving the blood of its necessary
nutrient pabulum.
Gastric The gastric or stomach symptoms most
Symptoms. commonly present are,-furred, red, and
often dry tongue, loss of appetite, dislike of fat meat,
thirst, nausea, vomiting, irritability of the bowels,
and, in rare cases, severe Gastralgia. The association
of these symptoms with Hectic implies great danger.
D
?
Tw
50
SYMPTOMS OF CONSUMPTION.
{
Vomiting may arise from irritation, causing the food
to be rejected soon after it has been swallowed;
or it may result from coughing-the straining of the
diaphragm and the abdominal muscles emptying the
stomach of its contents mechanically. The tongue,
furred in the earlier stages, afterwards becomes red,
preternaturally clean, and smooth. The evacuations
sometimes become more abundant than in health, from
inability to appropriate the accustomed quantity of
nutriment prepared by the stomach. In the last stage, the
eruption of Thrush covers the mouth, and is a striking
effect of the failure of vital power; this vesicular
eruption being now known to be dependent on a mi-
croscopic vegetable growth on the mucous-surface.
Diarrhoea does not usually occur in the early stages of
Phthisis, and when it does is often amenable to our
remedies. But its persistence in spite of well-directed
measures, even in the absence of very extensive lung-
complication, leads to a rapidly fatal termination.
Dyspnoea Undue shortness of breath is a common
although not an invariable symptom, and may be thus
explained. The act of breathing is partly under the
control of the will, and partly involuntary, and should be
performed without any effort. When, however, the cells
of the lungs are pressed upon by a mass of tubercle, the
cause of the dyspnoea becomes obvious. The easy pas-
sage of air into and out of the air-cells is often further
prevented by a secretion of mucus in the bronchial tubes.
An extensive growth of tubercle in the lungs gives rise
to very great distress in breathing: this symptom
becomes, therefore, a sign of the extent of the deposit.
This is confirmed by the use of the spirometer (described
7
DIFFICULTY OF BREATHING.
51
on a previous page), which shows the reduction of the
capacity of the lungs for air to be greater in extensive
and diffused tubercle than when the growth is scanty
and limited to one lung.
In Phthisis the capacity of the lungs is diminished,
and enough air is not inspired to aërate the blood, sent
there by the quickened action of the heart.
The chief cause, therefore, of the shortness of breath,
arises from disproportion between the rapidity of the
heart's action, by which blood is sent to the lungs, and
that of breathing. The heart acts quicker during and
after exertion that it may the better supply the muscles;
and as the right and left hearts act together, sufficient
air is not taken-in to aërate the blood sent to the lungs
by the heart; and then the blood, not being properly
acted on, stagnates in the pulmonary capillaries, and all
the feelings and effects of dyspnœa arise.
The number of respirations in healthy, tranquil
breathing is from 14 to 18 per minute, and they bear a
remarkable proportion to the pulsations of the heart,
that is, one complete respiration to about every five beats
of the heart. In Phthisis, the number of respirations is
from 24 to 28, the number increasing as the disease pro-
gresses. Inspiration is generally short, limited, and
speedily checked, causing uneasiness, or inducing cough,
and is quickly succeeded by expiration. The patient
complains of want-of-breath; exercise, especially going
up-hill, or up-stairs, or walking fast, exhausts him, and
he often requires to rest. Such lowered respiratory
power tends of itself to induce accumulations of mucus
in the air-cells, and to excite inflammatory action.
Everything which impedes the complete and regular
52
SYMPTOMS OF CONSUMPTION.
performance of the respiratory acts has a prejudicial
effect upon the lungs. Life not only depends on breath-
ing, but the energy and vigour of life are in a great
measure ruled by the capacity and the free play of the
breathing organs (Sibson). The circulation through the
lungs is the measure of the whole circulation; just as the
strength of all constructions, and of all machinery, is
measured by that of its weakest point.
Cough. Cough is a prominent, often distressing
symptom of Phthisis. In the early stage it is dry, short,
and irritative, and most troublesome in the morning, or
after exertion; it is unattended with expectoration, or is
simply to clear the throat, and may continue for mouths
without aggravation or the supervention of any other
symptom. It is due to reflex action, the tubercles in the
air-cells irritating the nerves distributed to the lungs.
In the second or more advanced stage cough recurs
during the day, and especially after slight exertion, and
is caused by the necessity for getting rid of secretions,
and then may be regarded as a conservative effort to
clear the tubes of the morbid deposit, the inflammatory
products and disintegrated lung-tissue, which then begin
to accumulate. The recognition of this different
variety of cough is necessary in order to prescribe for
its cure or relief, as remedies suited to one condition are
inadmissible in the other. The mere existence of a
cough alone by no means proves that Consumption is
present, as it may arise from diseases of other organs
than the lungs, as from enlarged tonsils, elongated
uvula, indigestion, a nervous habit, and other causes;
neither does the absence of cough prove the non-
existence of the disease. This symptom is, then, only
P
EXPECTORATION.
53
indicative of Phthisis when connected with that general
disorder of the constitution which is characteristic of
the disease.
Expectoration. As stated in the preceding para-
graph, this is absent in the early stages of Consump-
tion; for the cough being chiefly due to irritation,
is dry, and has its seat in the upper part of the throat. As
the disease advances, however, it is attended with the
expectoration of a whitish adhesive matter, chiefly from
the bronchial tubes, and most abundant in the morning.
With further progress it becomes thicker, often contains
ropy or glairy mucus, probably discoloured with streaks.
of blood. When tubercles rapidly soften, the expectora-
tion becomes abundant, of a purulent character, and is
discharged with blood; and in the end is usually in the
form of yellow masses. In these stages there is disin-
tegration of considerable and irregular portions of
tubercle, with the adjacent lung structures; the expecto-
ration, therefore, is made up of tubercular matter, fluids
from the pulmonary vessels, and lung-tissue. The last
furnishes a good diagnostic sign, and can often be recog-
nised long before destruction of the organ has sufficiently
advanced to yield conclusive general symptoms, or signs.
that can be detected by the stethoscope. The sputa of
true Phthisis contains fragments of elastic tissue, the
presence of which proves that the lung-substance is
breaking up. For the detection of this the microscope.
is indispensable, as it exists in such minute quantities.
that it is only when considerably magnified that the fibre
can be discovered. Examination of the sputa is of
special service in cases in which Consumption follows or
is associated with inflammatory affections of the air-
54
SYMPTOMS OF CONSUMPTION.
passages, as it often enables us at once to decide the
diagnosis.
→
Hemoptysis. Spitting or coughing-up of blood in a
majority of cases takes place; and although, as a
symptom of Consumption, it has a grave import, it often
betokens a prolonged variety of the disease; within
certain limits it produces an immediate salutary effect,
by relieving the cough and breathing, moderating the
pulse and fever, and enabling the patient, previously
unable to do so, to lie down and sleep. But an attack of
Hæmoptysis occurring without any injury or obvious
cause, is an unfavourable omen. It indicates a morbid
friability of the terminal branches of the bronchial
arteries supplying the mucous membrane,and is generally
associated with a tendency to inflammatory affections of
the pulmonary tissue. Hæmoptysis often gives the first
intimation to the patient of the real nature of his
malady; and its occurrence either before or soon after the
commencement of a cough always renders Consumption
probable, especially if the patient has received no injury
of the chest, and has no disease of the heart, or of the
uterine system. The amount of blood discharged is
sometimes very small in the early stage, merely streak-
ing the sputa, or tasted as salt in the mouth; or there
may be a few teaspoonfuls, due to extreme congestion
of the pulmonary vessels from inflammatory action
set up by tubercles; but in the latter stage there is
sometimes so copious and sudden an effusion, from the
opening of some large vessel in a vomica by ulceration
and rupture, that the patient dies suffocated; this, how-
ever, is comparatively rare, because the vessels become
plugged with coagula before the ulceration opens them.
THE PULSE-HECTIC.
55
Distinguished, of course, from sputa, merely tinged from
spongy and easily bleeding gums, the discharge of blood
by expectoration is almost always indicative of organic
disease of some portion of the chest. But when Hæ-
moptysis occurs without previous cough, dyspnoea, or
other sign of lung disease, it does not always indicate
Consumption. When it does so, other symptoms are
generally superadded.
The Pulse. A persistent rapidity of the pulse, ranging
from 90 to 120, or higher, is an invariable symptom of
active Phthisis. It is especially liable to become accele-
rated towards evening, and, as the disease advances, be-
comes more rapid, and also feebler. "The nervous
system has the heart for its gnomon or dial of the
clock; and extreme rapidity of the heart's action, while
it has a most grave import in acute disease, is also an
accurate measure of the failure of nervous power in
chronic affections. The acceleration of the pulse during
a febrile attack is not here alluded to, but a uniform
high range of pulse, deficient in force, which, although
it vary in number, is never below a high rate. It is
rarely under 100, and may run up from this to 140, or
till it is impossible to be reckoned; and there is no
more disastrous symptom. In various chronic affec-
tions the muscular walls of the heart are thinned and
softened; but unless this has taken place, the action of
the heart during remissions of the symptoms falls to a
more healthy average, and the pulse acquires fulness"
(Pollock).
Hectic Fever.
Hectic is often an early and very charac-
teristic symptom, and its coincidence with those already
mentioned clenches our diagnosis of Consumption. It
56
SYMPTOMS OF CONSUMPTION.
:
is a remittent fever. The febrile access most fre-
quently occurs towards evening, with dry heat of the
skin, chills, and flushing of the face-on each cheek-bone
a circumscribed spot appearing, in strong contrast
with the surrounding pallor. This is especially noticed
after any exertion, or even after food there is also
burning heat of the palms of the hands and soles of the
feet, and extreme restlessness. Towards morning the
remission occurs, the patient falls asleep, and wakes
bathed in perspiration. The pulse is small and weak;
uniformly too high, but greatly accelerated towards
evening, reaching 120 or many more beats in a minute,
“the beat being performed with a jerk, as if the result
of irritation upon a weakened heart": the heart, in fact,
shares in the general waste of tissue. The bowels are
relaxed, especially in advanced stages of the disease, the
diarrhoea aggravates the effects of the sweating, and
consequently increases the exhaustion; the tongue is
furred white or brown in the centre, but unnaturally
red around the tip and edges, and immediately preced-
ing the final break-up, is covered with the eruption of
Thrush. The urine deposits the red brick-dust or pink
sediment, consisting of the urates of soda and ammonia;
the skin is clammy, except during the evening exacerba-
tion, when it is burning hot; the hair falls off; œdema
of the feet and ankles sets in; the complexion is clear,
the eyes are bright and sparkling, and there is most
marked emaciation, especially as death approaches. The
mind usually remains bright, often vigorous, and so
hopeful, that even amidst this general material wreck
the patient dreads not the future, and thinks he “would
be well but for his cough;" towards the end, however,
P
.
DURATION OF PHTHISIS.
57
suffocative dyspnoea may render the death-struggle
painful, or, which is more frequent, slight delirium occurs,
from circulation of venous blood in the brain, or a de-
posit of tubercles in its membranes, and the weary and
exhausted sufferer sinks to rest.
Duration. It would be difficult to state, even ap-
proximately, the duration of Phthisis, as there are
different varieties, and also causes, of the disease which
influence its course. Tubercle arising from severe Con-
tinued Fever, Pneumonia, and especially Measles, or
other acute disease in the young, runs a far more rapid
course, with implication of several organs at an early stage,
than the same disease in or after the middle period of
life. A deposit of tubercles in one constitution may be
tolerated for years without exciting any serious disorder;
while in another a like deposit may give rise to the
most violent irritation. Tubercular matter appears in
some cases only tardily to pass through its destructive
changes, slightly involving the surrounding tissues, and
remaining almost as an inert substance; in other cases
the process of softening, the implication of other struc-
tures, and the systemic destructiveness proceed most
rapidly. Intermissions alter the duration. The disease
sometimes becomes latent, and there is for the time
marked general improvement, with increase of strength,
till fresh irritation is set up, and all the constitutional
symptoms become aggravated. Again, the influence.
of the digestive organs is very considerable. An irri-
table mucous membrane, indicated by loss of appetite,
nausea, vomiting, furred tongue, diarrhoea, etc., will
hurry the tubercular deposit through its stages; while a
healthy digestive apparatus may prolong the stages, or
58
SYMPTOMS OF CONSUMPTION.
arrest the disease, indefinitely. Other circumstances
must also be considered-age, amount of hereditary
influence, hæmoptysis, fever, etc. Lastly, the type
of disease transmitted greatly influences the duration.
Every practitioner experienced in the disease knows that
the acute or chronic form of the malady which prevailed
in the older branches of a family is commonly shared
by its successive members.
Absence or We must, however, bear in mind that
Ambiguity of under certain circumstances any and all
Symptoms. the ordinary symptoms may be absent,
even when Phthisis is far advanced. Likewise it is to
be remembered that many of the symptoms so charac
teristic of the disease may exist without Phthisis being
present. Especially should it be remembered that there
is no single sign or symptom by which Pulmonary
Phthisis can be clearly and safely determined. Here it
is the physician's province to differentiate, and to judge
by the general symptoms and signs present.
Summary. Such is a brief description of the symp-
toms and course of this destructive malady. Some of
the symptoms are more prominently marked in one case
than in another, and are intensified as the end draws
near. Exhaustion and emaciation, from impairment of
the digestive functions, become confirmed and persistent
symptoms. Increased susceptibility renders the patient
liable to frequent attacks of Bronchitis, and even Pneu-
monia; dyspnoea becomes very distressing, so that the
patient is unable to make any active exertion, or even to
read aloud a short paragraph without pausing; the
sputa is more purulent, and pus is often expectorated
pure, in roundish masses that remain distinct in the
}
ADVANCED SYMPTOMS.
59
vessel into which they are spat. Other organs become
implicated, as the lymphatic system. The intestinal is
especially susceptible: a deposit of tubercle takes place
similar to that in the lungs, which afterwards bursts
into the intestines, and leaves an ulcer; the entire
alimentary canal is affected, the diarrhoea is aggravated;
and the appetite completely fails. The respiratory
mucous-membrane may also be ulcerated, producing
huskiness, and even loss of voice, but more frequently
the former, from the thickening and increase in vascu-
larity which it undergoes; and, frequently, deposit of
tubercles, and consequent ulceration, occur in even the
larynx itself. The skin covering the parts on which the
patient lies is apt to become sore and inflamed, and even
to perish, from the pressure of the attenuated body.
Aphthe of the mouth, pharynx, etc., or oedema of the feet,
ankles, and even legs, ensue, and the long and weary
struggle is at last terminated by the gentle and happy
approach of death. It is therefore but seldom that the
local affection in the lungs is the sole cause of the fatal
result.
XI.-Physical Signs and the Methods of their
Detection.*
Value of Signs. Notwithstanding the comparative con-
clusiveness of symptoms, a physician does not rely on
them alone, but calls in the aid of other evidence; for,
* Physical Signs are those evidences of disease which we discover
by our senses, in contradistinction to symptoms which are gathered
from the complaints or statements of the patient. They depend
upon some change in the organs of the body,—an alteration of their
physical condition.
60
SIGNS OF PHTHISIS.
in consequence of the frequent obscurity that surrounds
symptoms, or of the possibility that they admit of
explanation by causes distinct from Phthisis, a physical
examination becomes necessary to remove all uncertainty,
and, if conducted with care, and aided by the study of
natural science, the diagnosis of this disease may be ren-
dered almost as clear as if the morbid processes beneath
the chest-walls were exposed to view. Thus a skilled
observer is not merely able to determine that the lung
is implicated, but also the particular portion, and, to a
great extent, the actual progress the disease has made.
The value of such evidence is obvious; it often enables
us to determine whether certain remedies are likely to be
available; whether travel and change of climate are
hopeful for cure; and so to avoid that distressing prac-
tical error of sending the patient to die in a distant land.
A physical examination of the chest is conducted by
different methods, the chief of which we will now refer to.
Inspection. The first is Inspection or ocular examina-
tion of the external form, size, and movements of the
chest, for which purpose the patient must be naked to
the waist, or only clothed with a single thin covering.
To serve any really useful purpose, the chest must be
fully and leisurely seen; indeed, unless it
can be
thorough, a physical examination had better be
omitted, and the general symptoms alone trusted to.
An uneducated eye might not be able to detect any-
thing abnormal in the chest of a consumptive patient,
unless the evidence were very strongly expressed. A
physician, however, would recognise at a glance flatten-
ing of the chest over the part affected, from shrinking of
the lung-substance; also that the part thus affected does
PERCUSSION, ETC.
61
not permit the same amount of respiratory movement as
on the healthy side. The clavicles (collar-bones) become
very prominent from shrinking of the lung-substance
in those regions. When the growth of tubercles is
chiefly in the upper portion of the lungs, it will be ob-
served that the patient breathes chiefly by the lower
portion of the chest, the parts just below the collar-bones
becoming nearly immovable.
Mensuration. Mensuration is simply an aid to inspection,
for determining by measurement the comparative volume
of the two sides of the chest, and also the degree of
expansion and retraction during breathing.
Percussion. Percussion is striking with the fingers,
first on one side, and then on a corresponding part of the
other side of the chest, to ascertain the relative degree.
of resonance (reverberation of sound) or dulness.
It is
well known that a barrel containing only air yields a clear,
resonant sound when struck; but that if filled with
water or with any solid body, a dull sound will be pro-
duced. A drum gives a resonant sound in perfection.
In like manner a well-developed chest, with air freely
permeating the air-cells of the lungs, gives a full clear
note when percussion is practised; but when the cells
are filled with tubercular deposit, the clear sound is im-
paired; the tone is heavy and dull, like that elicited by
percussing solid flesh, as of the thigh. The amount of
dulness varies in different cases, according as the air-
cells are partially or completely filled with tubercle. The
absence of dulness does not always prove the absence of
tubercle, as the deposit may be embedded below the sur-
face, and a portion of healthy lung intervene between
the diseased part and the walls of the chest, and a clear
62
SIGNS OF PHTHISIS.
W
but not a full sound be heard. The dullest sound arises
when there is a large quantity of fluid in the pleural
cavity. Information from percussion will be much in-
creased, and its value as an aid to a correct opinion
rendered much more certain, if it be practised during
inspiration, and then during expiration. In the latter

D
B
Ca......
E
A
PLATE III. THE LUNGS IN PHTHISIS.
The
apex of left lung (B) is shown in the stage of consolidation; the large
white patches indicate tubercles in the stage of softening (A). Below the
latter, as at B, the black dots show tubercles in the first stage. C represents
a cavity or vomica, resulting from destruction of lung-tissue; D enlarged
bronchi, and E the trachea.
stages of the disease, when cavities exist, the resonance
or dulness will depend on the actual condition which is
then present; for if the cavity is filled with purulent
AUSCULTATION.
63
matter there will be dulness; but if empty and super-
ficial there will be resonance.
Auscultation. On listening over a healthy lung we may
hear, as the patient breathes, certain sounds produced by
the air rushing from the windpipe into the bronchial
tubes and air-cells; these sounds are called "the vesicu-
lar murmur," and have been compared to the breeze
among the leaves, or to the cooing of doves. If, however,
the air-cells become obstructed with tubercular matter,
the natural sounds will be modified or changed; they
are chiefly-feeble or harsh breathing, jerking inspira-
tion, and prolonged expiration. There will also arise an
increased clearness of the sound of the patient's voice as
heard through the affected lung, from the solidity of the
tubercles rendering it a better conductor of sound. If
these phenomena are persistent, and restricted to one
side of the chest, they indicate tubercle. Persistent
coarseness of breathing, with small bubbling râles and
sonorous sibilant rhonchi-signs of Bronchitis-earliest
marked in the supra-scapular, and supra- and infra-cla-
vicular regions, inaudible below the second intercostal
space, and limited to one lung, certainly justifies the
suspicion of Consumption.
Although the investigation of internal disease by the
sense of hearing is based upon an extremely simple
theory, and affords decisive means for detecting disease,
the acquisition of the art is by no means equally easy;
indeed, much skill and practice, both in healthy and
diseased persons, is necessary to arrive at truthful
conclusions.
Stethoscopy. The stethoscope is simply an instrument
for conducting the sounds of the chest to the ear of the
64
SIGNS OF PHTHISIS.
physician, and is chiefly used to avoid the necessity of
placing the ear directly upon the chest of the patient,
and when the sounds to be listened to are limited to a
small and definite region. Frequently, however, the
best way to hear the sounds within the chest is to apply
the ear in immediate contact with it; but when it is
desirable to localize the sounds the stethoscope may be
used.
Thermometry. We must not omit to notice the aid which
the thermometer affords. The proper application of the
clinical thermometer yields most valuable diagnostic in-
formation when the ordinary symptoms and signs are
ill-defined, or when their true cause may be doubtful;
especially in the early stages, when treatment is likely
to be most effective. The importance of the aid of the
thermometer in this case will be recognised by the fact
that, during the deposit of tubercle in the lungs, the tem-
perature of the patient is heightened from 98° Fahr., the
normal temperature, to 101° 104°; the abnormal
temperature, rising in proportion to the rapidity of the
turbercular deposit. Heightened temperature may often.
be detected by the thermometer for several weeks before
reduced weight, or any local sign, indicates the undoubted
existence of tubercles. Hence the temperature not
only affords us certain information as to the existence of
Phthisis, but the degree of elevation enables us to esti
mate the extent of the disease, and also the rapidity with
which it advances.
Spirometry. One other method adopted in our prac-
tice, especially in early and obscure cases, may now be
described. The principle of the spirometer is very
simple, and if an intelligent regard be paid to the height,
SPIROMETRY-HEIGHT.
65
weight, and age of the individual examined by the in-
strument, most valuable and reliable information may be
obtained. The spirometer consists of a cylinder, sus-
pended and balanced by means of cords and weights in a
reservoir of water, to which a graduated scale is attached.
The patient, having taken a full inspiration, forces the
air from his lungs through a tube, so that the cylinder
ascends, and indicates by the scale affixed the amount of
air passed into it. It will be found that the number of
cubic inches of air thus expelled from the lungs of a
person in health, after a full inspiration, is subject to so
little variation, that the vital or healthy capacity of the
lungs for air may be considered as a constant quantity.
This capacity, however, depends upon four circumstances,
-height, age, weight, and the state of the health; and
these must be taken into account before any inference
can be deduced from the registered number of cubic
inches of air expired by an individual.
1
Height. Height is an important element in the
regulation of vital capacity, so that with few exceptions
we are able to determine the height of an individual in
health, by the number of cubic inches of air he is capable
of expiring. We stay not now to offer any explanation of
the curious connection that exists between height and
vital capacity. Indeed, we have none to offer. But it
is a singular fact that the vital capacity has a strict re-
lationship to height, and yet that the height is mainly
regulated by the length of the legs, and scarcely at all
by the length of the body. Dr. Hutchinson, to whose
able
paper, communicated to the Medical and Chirurgi-
cal Society, we are greatly indebted, found by numerous
examinations of persons, both before and after death,
E
66
SIGNS OF CONSUMPTION.
that the circumference, breadth, and depth of the chest
bore no necessary relation to height.
Weight. Weight forms another element in the
calculation; and the standard weight of a person of a
given height has been determined by Dr. Hutchinson,
who obtained the weights of 2,648 men at the middle
period of life. The annexed table contains reliable
information, and may be consulted with advantage.
TABLE OF HEIGHT, WEIGHT, AND VITAL CAPACITY.
Height.
5
LO LO LO LO
123 TLO ∞
Ft. ins. Ft. ins. Stns. lbs.
5 0 to 5 1 8
5
2
9
5 2 5
5 3
4
* * * * * *
""
39
5 4 9
5
5 10
5 5 5
6 10
5 6
5
710
5
7
5
8 11
5
8 5 9 11
""
5 9 5 10 12
5 10 5 11 12
""
""
5 11 6 0 12
""
*
12
""
Weight.
lbs.
8 or 120
0 126
7
13
2
4
8
1
8
1
6
10
""
""
""
19
15
در
""
""
""
""
"9
Vital Capacity.
In
In Consumption.
Health. 1st Stage. 2nd Stage. Last Stage.
Cub. ins.
174
182
133
190
139
198
142
206
145 214
148
222
155 230
162 238
169 246
174
254
178 262
Cub.ins.
117
122
127
133
138
143
149
154
159
165
170
176
Cub. ins.
99
102
108
113
117
122
127
131
136
140
145
149
Cub. ins.
82
86
89
93
97
100
104
108
112
116
119
123
This table reads as follows:-An adult male of middle age,
5 ft. 7 in, to 5 ft. 8 in. in height, should weigh, in his clothes, about
11 st. 1 lb., and possess a vital capacity of 230: in the first stage of
Consumption the vital capacity is reduced to 154; in the second
stage to 131; and in the last to 108.
As might be expected, the breathing power is at its
maximum during that period of adult life when the
general functions are most vigorous, viz., from thirty to
thirty-five. After this period they fall gradually, at the
rate of, approximately, 1 cubic inches a year.
2
VITAL CAPACITY.
67
It will be manifest that if it is possible to determine,
à priori, the standard vital capacity for all heights,
weights, and ages, the spirometer enables us to decide
upon the normal or abnormal condition of the respiratory
organs of any persons tested by it. Hutchinson's extra-
ordinary number of experiments gives us the standard
of health in question, and its application in cases of Con-
sumption becomes easy and conclusive, and is especially
valuable during the premonitory stage. Every physician
must occasionally find himself in difficulty, when called.
upon to give an opinion on a case, when the local signs
are few or obscure, and the constitutional symptoms are
too vague to enable him to fix with certainty on the real
nature of the complaint, notwithstanding the strong sus-
picions he may entertain. In such cases the spirometer
affords most valuable aid, and gives an almost certain
test of the actual state of the lungs. Not only so-and
this is nearly as valuable-it enables us to remove the
anxieties of persons respecting themselves or their
friends when we find the vital capacity normal. As an
interesting illustration of the correctness of the informa-
tion afforded by the spirometer, we may cite the case of
Freeman, the well-known American giant, who was at
one time an out-patient of the London Hospital. Pre-
viously to this period he had been examined by Dr.
Hutchinson, who found the following to be his measure-
ments-height, 7 ft.; weight, 19 st. 5lbs.; circumference
of chest, 47 inches; vital capacity, 434 cubic inches.
Two years subsequently to this period he was taken ill;
and although complaining of some dyspnoea, no trace
could be found at the time of the deposit of tuber-
cular matter in his lungs. "An examination by the
-
68
SIGNS OF CONSUMPTION.
spirometer, however, showed that his vital capacity had
sunk to 344 cubic inches. In a year from that time he had
fallen a victim to Consumption." This case fully in-
dicates the value of the spirometer; and we have come to
the conclusion, as the result of many observations, that
a very small amount of tubercular growth in the lungs is
sufficient to produce a great diminution in the natural
elasticity of the organs, and a corresponding reduction
in the vital capacity. It can scarcely be necessary to add
that the spirometer aids, but does not supersede the
usual methods of investigation, and is chiefly valuable
when other data are insufficient or obscure. But "when
the vital capacity is large, it is more than probable that
no considerable disease of the lung can exist. So, too,
when it is decidedly below par, we may infer that there
are tubercles, provided the deficiency cannot be accounted
for by debility and other conditions or diseases calcu-
lated to impair the respiratory movements, and the con-
clusion may be even received as highly probable, not-
withstanding the absence of the usual physical signs,
since there are, certainly, occasional cases in which dis-
seminated tubercles are not positively revealed, either by
auscultation or percussion" (Dr Pepper).
The Pre-tuber- Some physicians affirm, and we think
cular State. correctly, that in most cases there may
be detected some signs and symptoms which indicate the
existence of Phthisis before the actual growth of tubercle.
This is termed the pre-tubercular state, the physical signs
of which are, according to Markham, "the slightest sub-
clavicular dull percussion-sound, with lessened vesicular
murmur, less forcible and deep inspiration, and flatten-
ing of the apex of the lungs." These signs, however,
*
.
CURABILITY OF CONSUMPTION.
69
are not distinctly marked, and can only be considered
conclusive when there co-exists the general cachectic
condition already described. The general symptoms
must confirm the physical signs. The temperature of
the body, it is believed, affords the most reliable ground
for early diagnosis, long before any physical sign is
present, and when the symptoms are insufficient to make
such a diagnosis certain. We have such cases frequently
under our care, and under early treatment they generally
terminate favourably.
XII.—Curability of Consumption.
As may be inferred from preceding observations, we
are now, happily, able to take the affirmative side of the
question as to the curability of many forms of this
disease. The testimony of numerous competent ob-
servers proves that if the further growth of tubercles can
be arrested, those already present may be absorbed or
shrink, and the portion of lung close up; or they may
be converted into a cretaceous (chalky) mass, and remain
quiescent, so as to be tolerated; or they may be ulti-
mately expectorated. The lesions of the lungs occurring
in early life often heal, although they may subsequently,
perhaps not till advanced life, recur and prove fatal.
The destructive and ulcerative process rarely goes on
uniformly, the symptoms remitting and the patient
appearing comparatively well. Even in the worst speci-
mens investigated many cicatrices and proofs of efforts
to heal may be detected. Fatal results, however, may
ensue from the cicatrices becoming the seat of further
induration, softening, and cavities, and consequently
70
CURABILITY OF CONSUMPTION.
further encroachment on the lung-tissue. The vital
lesson therefore to be gathered from pathology is the
necessity of correcting the conditions which lead to a
further occurrence of tubercle. Post-mortem examina-
Post-mortem tions furnish conclusive evidence, in the
Evidence. frequent occurrence of cicatrices in the
upper portion of the lungs, that tubercular growths are
either absorbed or thrown-off, and so the disease is
practically cured. Many individuals, no doubt, are the
subjects of modified attacks of Phthisis which they
survive, and from which they completely recover. Many
Testimony illustrations have occurred within our own
of Experience. experience, a few of which are briefly
given in this treatise. In many cases, of which other
physicians had made the diagnosis, we have witnessed
all the evidences of tubercle arrested, and the symptoms.
entirely removed. "In such instances, after wasting,
febrile access, cough, spitting of blood, expectoration,
and the presence of physical signs indicating a solid
deposit in the apex of one of the lungs, the systemic
disturbance subsides, the patient regains flesh and
strength, and all chest symptoms cease" (Pollock).
The most practical scientific physicians are agreed that
it is a disease specially likely to arise during the period
of growth; that under proper treatment it ceases for a
time, years may "elapse before there is any renewal of
the symptoms; and that, were full advantage taken of
the intervening period to correct the constitutional
cachexia, the cure might prove complete" (Carswell).
Opportunities The remarkable feature of remissions
afforded by before referred to, which characterize the
course of Consumption, may be regarded
Remissions.
HOPEFUL VIEWS.
71
as efforts of the system to recover losses sustained, and
to eliminate, by increased secretions, morbid materials
from the blood. Neither should we overlook the oppor-
tunity which such pauses "offer in practice for an
attempt, which is almost always successful, to assist in
the reparative processes.
These are the golden.
moments, and if from some mistaken theory we overlook
them, or through fears of inflammation should persist.
in a low regimen and the use of depressing drugs, we
are counteracting the attempts to rebuild and repair,
towards which the vital system is labouring with all its
powers. It has been shown that the intermission-period
is hopeful for resistance, for repair, and for cure; and it
has been sought to establish that Nature herself indicates,
by the cessation of morbid processes, and increased
nutritive energy during these pauses, that the resistance
of the system can be effectually aided by judicious
assistance, if it be afforded at the right time and in the
proper direction" (Pollock).
From the foregoing statements it must not be inferred
that we do not sufficiently recognise the great danger
and fatal character of the disease. We do regard it as
dangerous to a high degree; the meaning we intend to
convey is that, although in the majority of cases the
efforts of the physician to bring about a cure are in the
end unsuccessful, still recovery does take place in many
instances, sometimes in very unpromising ones; and in
most, not only may sufferings be greatly mitigated, but
life-useful life-considerably prolonged.
72
HYGIENIC TREATMENT
XIII-Hygienic Treatment.
From what has been advanced on the nature, symptoms,
and causes of Consumption, it will be evident that the
treatment must be of a comprehensive character, in-
cluding the following aims :-(1) To prevent the disease,
as in the case of the children of consumptive parents;
(2) to correct defective nutrition, which leads to tuber-
cular deposit; (3) to arrest the progress of active
Consumption; (4) to prevent fresh deposits, by building
up the health in the intervals of apparent recovery;
(5) to moderate the hectic and lessen the sufferings of
advanced and hopeless cases.
The chief indications for treatment are, therefore, to
improve faulty nutrition, promote the formation of
healthy blood, and thus to anticipate altogether the
growth of tubercles, or to repair the constitutional
health that further deposit of tubercles may be prevented,
and that what has already occurred may be rendered
harmless. These ends are to be obtained by hygienic.
means and by specific Homoeopathic treatment. To the
former we will first and chiefly direct attention, and
afterwards, briefly, to the latter.
a. Nutritious Diet.
Diet of Infants
The diet of the children of consumptive
and Children. parents is a point of the highest import-
ance, and should engage attention from the earliest
period of life. If the mother be delicate and predisposed
to Consumption, a wet-nurse of a thoroughly healthy
constitution should, if possible, be provided. If a
DIET OF CHILDREN.
73
The Best
consumptive mother nurse her infant, she is in danger of
bringing into activity the tubercular disease in herself;
while the child is but imperfectly nourished, and derives,
with the supply of milk, an additional element of danger
to that which it inherited from birth. The infant should
be restricted to healthy breast-milk for the first five or
six months, after which slight additions of farinaceous
food may be allowed once or twice daily, and the child
weaned at nine months. If a wet-nurse cannot be
obtained, the nourishment should bear the closest possible
resemblance to the mother's milk. The
Artificial Food. best substitute, and one which we have
known successful in numerous instances, is cow's milk
assimilated to human by the addition of water and
Sugar-of-Milk, for the milk of the cow contains more oil
(cream), but less sugar than that of woman.
It is pre-
pared for use as follows:-" Dissolve one ounce of the
Sugar-of-Milk in three quarters of a pint of boiling water.
Mix when wanted with an equal quantity of fresh cow's
milk, and let the infant be fed with this preparation
from the feeding bottle in the usual way. Always wash
the bottle after feeding, and put the teat into cold water,
letting it remain until wanted again."
In carrying out the above directions it is necessary to
use cow's milk of good quality, and always to administer
the food freshly mixed, and at a uniform temperature,
namely, that of breast-milk, and for the first month
not oftener than every two hours and a half during
the day, and every four hours during the night. On no
account should the babe be allowed to sleep with the
tube of the bottle in his mouth, to suck as often and
as long as he likes.
74
HYGIENIC TREATMENT.
About the eighth or ninth month, when the teeth
usually begin to appear, a gradual change of diet is
necessary. This should consist chiefly of farinaceous
preparations, the best of which is, according to our
experience, Neave's Farinaceous Food; afterwards sop
made with bread without alum, bread-and-milk, light
puddings, oatmeal porridge, and a little mutton-broth,
beef-tea, or bread soaked in a little gravy as it escapes
when cutting up a joint of meat. Feeding with a spoon,
by favouring admixture of saliva with the starchy par-
ticles, will probably insure a more perfect digestion of
the food. Till the teeth appear, however, all prepara-
tions of animal food should be avoided. After weaning
great care should be taken, and every kind of food avoided
that causes irritation or diarrhoea. Children should be
fed regularly, be taught to masticate thoroughly, and
not allowed to take too active exercise immediately after
meals.* Even thus early, should there be any symptoms
of mal-nutrition, a small dose (ten to fifteen drops) of
cod-liver oil may be given with very beneficial effects.
Diet of Adults. For older persons, the diet should be
digestible, nourishing, and sufficiently varied and abun-
dant to meet the requirements of each case.
As a
general rule it should include animal food once or twice.
a day; wholesome kinds of fish, especially those varieties
which are richest in Phosphorus; good home-made
bread, not less than one day old; puddings of arrowroot,
rice, sago, tapioca, etc., taken, if preferred, with stewed
fruit; various kinds of green vegetables, and mealy
For fuller details the reader is referred to the Author's work on
the "Treatment of Infants and Children," Chap. III.-Examples of
Dietary for Children of Different Ages.
DIET OF ADULTS.
75
potatoes, oatmeal and milk; good milk is a fundamental
article; raw eggs, swallowed whole, or beaten up with
a little cold milk are strongly recommended; but fresh
pork, sausages, veal, fish not having scales, pastry, and
all articles that give rise to irritability of the stomach,
nausea, heartburn, eructations, or any other symptoms
of indigestion, should be avoided. If the patient is bene-
fited by its use, a moderate allowance of beer or wine.
Two or three glasses of Carlowitz, Burgundy, Claret,
or Hock, diluted with water, may in some cases be
given with good results.
The importance of selecting digestible food exclusively
is evident from the fact that tubercles do not arise except
during a period of imperfect nourishment of the body.
By whatever means the nutrition of the body is increased,
in the same ratio the advance of Consumption is pre-
vented or retarded; an important sign of improvement
being an increase in the patient's weight. The system
is invulnerable to Consumption so long as it is well
nourished by a healthy digestive apparatus.
"It is clear, therefore," writes Dr. Chambers, "that it is the
tendency to tubercle, and not the existing tubercle, which we have
to fear and to guard against; and that for the successful treatment
of Consumption we must withdraw our minds from the morbid
anatomy of the locality to the fatal propensity of the constitution. I
know you are disposed to turn first to the lungs. But if we inquire
into the histories of those who have lived long with vomica
(abscesses) or tubercles, they are by no means found to have taken
special care of their chests-they have not coddled or lived indoors,
in even temperatures, hanging their lives on to their thermometers
for fear of coughs; they have gone on with their professions or
business or work; they have not 'laid a knife to their throat,' but
have eaten and drunk like other people, and have enjoyed the gratifi-
cation of their appetites. A patient of mine, over fifty, with copious
pyoptysis (spitting of purulent matter) and condensed lungs (of pro-
bably a tubercular nature) from his youth, has kept hounds, broken
his bones like other Nimrods, contested county elections, sat in Pai-
76
HYGIENIC TREATMENT.
liament, enjoyed his champagne and other good things, but never
allows any doctoring of his chest.
"Leave the respiratory organs alone, and direct your thoughts to
the organs of nutrition-the stomach and bowels, which will receive
with thankfulness, and return with interest, any care you bestow
upon them. It is truly by aid of the digestive viscera alone that
Consumption can be curable. Medicines addressed to other parts
may be indirectly useful sometimes, but they more commonly im-
pede the recovery; whereas aid judiciously given in this quarter is
always beneficial, and usually successful. Your aim should be to
get the greatest possible amount of albuminous food fully digested
and applied to the purpose of the renewal of the body, at the same
time that the renewing agencies are brought to their highest state of
efficiency. In this way a healthy cell-renewal takes the place of
that morbid, imperfect cell-renewal which appears in the shape
of tubercular matter."-Lectures chiefly Clinical.
Fat. Fatty matter, in quantities as large as it
can be assimilated, has been strongly recommended.
The late Sir James Simpson some time since remarked
the healthy appearance and freedom from Scrofula and
Consumption of the operatives of woollen factories, conse-
quent on the oil which in the course of their daily labour is
freely applied to the skin. It was also seen that the
work-people improved in appearance when engaged in
the more oily processes, and often lost flesh and strength
Oil by Inunction. after leaving them. So impressed was
Dr. Simpson with the value of oil in the prevention of
Consumption that he laid down rules for its application
by inunction. He recommended a bland, inodorous
olive-oil to be applied warm to the whole cutaneous
surface, with a considerable amount of friction, which
renders absorption greater.
Cod-liver oil* is the substance which has
Cod-Oil.
* Cod-liver oil is perhaps most palatable when made up in bread.
Two tablespoonfuls of oil to half a pound of dough (with an extra
pinch of salt) make a small loaf almost tasteless, and which can be
elished even when a small quantity of the crude oil excites nausea.
COD-LIVER OIL.
77
been found most beneficial. It may be considered as an
item of food, and its power in checking emaciation and
improving the healthy tone of the muscular structures
is too well known to require commendation now. At
Brompton Hospital more than six hundred gallons are
consumed every year. Perhaps some of its usefulness
depends on the Iodine and Phosphorus contained in the
oil, which thus forms a natural compound of food and
medicine. It may be advantageously given in scrofulous
affections, troublesome cough, etc., especially if occur-
ring in a family in which Consumption has been fatal.
The discriminate use of this agent nourishes the body,
gives firmness to the pulse, checks the expectoration and
night-sweats, and diminishes the cough. It should not,
however, be alone relied on, but used only as an adjunct
to such remedies as Calc., Phos., Stann., Lyc., Zinc, etc.
-
Cautions Two cautions are necessary to be observed:
respecting Oil. —(1) It should not be given during the
persistence of febrile symptoms,-hæmoptysis, congestion,
or any active form of the disease. It is not till there
are evidences of a pause in the disease, the decline of
the pulse, and the cessation of the Hectic, that oil can
be of any value. The sphere of cod-liver oil is to remove
exhaustion and raise the general tone. This is best ac-
complished when active morbid processes and local irrita-
tion have subsided, for then the system is in a condition
to appropriate a considerable amount of nourishment.
The common error is to administer it when, active in-
flammation or irritation being present, it cannot be
tolerated, but tends to produce gastric disorder.
It may
also then accelerate emaciation by supplying the elements
of combustion. Such remedies as Aconitum, Bryonia,
78
HYGIENIC TREATMENT.
•
and Phosphorus would then be more appropriate. (2)
It should never be given in such large doses as to
excite nausea or eructations. At first a teaspoonful,
or in the case of children ten or fifteen drops, may
be given twice a day, and the dose gradually increased
to a dessert-spoonful, if it seems necessary. The ap-
pearance of any unchanged oil in the evacuations is evi-
dence that more is given than can be digested, and
the quantity should be reduced till none can be detected.
Too large doses of oil, or other kinds of fat, may have
a considerable share in the production of fatty degener-
ation of the liver, a condition found in the post-mortem
room to exist in a large number of cases.
The best time to administer the oil is with, or directly
after, food. If there be any difficulty in retaining the
oil we prescribe it at bed-time, just as the patient
lies down to sleep. But when there exists an insuper-
able repugnance to the internal use of the oil, enemata
containing it may be tried; or it may be introduced
into the system by inunction, or by applying lint
saturated with it, to the chest, sides, or between the
shoulders.
"become
"The effects of cod-liver oil," writes Dr. Chambers,
less and less a marvel the more we know of physiology. The
instinctive desire shown by all nations for an oleaginous diet, and
their association of substances of this nature with proverbial ideas
of happiness in all ages, show the value of a certain amount of it
to man's comfort. The butter and honey' of the prophets, used
as a phrase for royal food, and the constant reference in the Bible
to oil as a luxury (though it could have been no rarity in a land of
'oil-olive')—these are sufficient to prove its estimation among the
Hebrews. The Hindoo labourer, when he devours his gallon of
rice for a meal, will spend all the pice he can get on the clarified
butter of the country; and as good as ghee!' is his expression of
unqualified admiration. It was a mistake in Baron Liebig to state
that oily foods are disgustful to natives of hot climates. All races
COD-LIVER OIL.
79
of men require them and seek after them; and the taste of the
Esquimaux, so often quoted, depends mainly on the abundant
supply of the article which the sea places at his disposal, coupled
with a scantiness of other provisions. Throughout mankind there
is an instinctive appreciation of the importance of this aliment,
independent of accidental differences of nation and locality. It
seems felt to be, as science really shows that it is, a necessary
material to prevent waste of the tissues, and the desire for it becomes
synonymous with a desire for augmented life.
To find the easiest assimilated oil, and to prepare the digestion
for the absorption of oil, are the main problems in the cure of Con-
sumption."—The Indigestions.
Besides cod-liver oil, there are other animal fats and
oils which, if they can be taken and assimilated, are
certain to be followed with good results: such as rich
milk, cream, butter, home-fed fat bacon, glycerine, and
other substances rich in fatty matter. We mention
these varieties so that in the event of a change being
desired, one may be substituted for another, as circum-
stances indicate. Cream is often of great value; to
prevent its oppressing the stomach, a teaspoonful of
French brandy, or better, a teaspoonful of cold, strong
black tea may be mixed with it. Cream is, however,
probably inferior to cod-liver oil, and has not the same
anti-tubercular effect, for the Iodine which is present in
the former is absent from the latter.
b. Pure Air.
One of the most vital elements of tonic treatment
exists in fresh air; on the other hand, everything which
impedes the free and perfect removal of respired air
favours the development of tubercle. The children of
consumptive parents should be exposed daily to out-of-
door air soon after birth, in suitable weather. The pure
air of the country, or of the parks which are now,
80
HYGIENIC TREATMENT.
happily, provided for the inhabitants of most large.
towns, should be selected. Carbonic-acid gas, and effete
Ventilation. animal effluvia, the product of breathing,
are most inimical to healthy life, and provision should
be made for their uninterrupted removal from houses,
and especially from sleeping-rooms. Inasmuch as about
one-third of human life is passed in bed rooms, airy,
well-ventilated sleeping apartments should be ranked with
the most important requirements of life, both in health and
disease. The sleeping-room should afford a space of
about a thousand cubic feet for each person (that is, ten
feet each way); and one room should on no account
perform the double office of sitting-room and bed room.
:
To render air sufficiently pure for breathing, it must
be continually changing, and this involves the following
conditions (1) The air entering an apartment must
itself be pure, that is, without admixture with effluvia.
(2) It should travel at such a moderate speed that it does
not cause the sensation of draught. (3) It should be
diffused equally through the room. (4) Expired air
should be uninterruptedly removed, that there may be
no danger of breathing it over again. (5) Expired air
naturally passes upwards; it should therefore be dis-
charged above. (6) The means by which these ends
may be attained are, natural ventilation-diffusion of
gases, the action of winds, and unequal weights of air
-and artificial ventilation-permitting free communica-
tions between the atmosphere without and the atmosphere
within.*
*
For an elaborate statement of these points, with excellent sug-
gestions for their practical application, the reader is referred to
Parke's "Practical Hygiene."
VENTILATION.
81
The possible evils to be guarded against in carrying
out the ventilation of bedrooms are currents of air playing
on the face of the occupants; there should be an uninter-
rupted but imperceptible movement of the air. In nearly
every case, draughts may be obviated by placing the bed in
a suitable situation, or by a single curtain on the side of
the bed next the door or window. During windy or
foggy weather, the apertures directly communicating
with the external air may be closed.
A very important requisite in obtaining good ventila-
tion is by the simple arrangement for windows to open
both at the top and bottom. It may appear unnecessary
to offer such a suggestion, but there are yet so many
windows which do not open at the top that we venture
to offer it here. Glass louvres, which admit of being
more or less closed, placed in one of the panes, are a very
useful contrivance. The use of them, with a door or
window in an opposite side of the room, secures a certain
amount of ventilation, by the removal of vitiated air,
and the introduction of pure. It is of great importance.
that the size of the apertures for the inlet or outlet of
air should admit of variation, so as to adapt them to the
difference of the internal and external temperatures.
Mr. Rawlinson advises a slit an inch wide in the top
of the door of bedrooms, or still better, in the wall
above it, so as to form a communication between the air
of the room and that of the staircase and passages.
In severe weather, when the invalid cannot bear the
free access of fresh air from without, the generation of
fresh oxygen in the apartment will be highly beneficial.
This may be easily accomplished by placing near the
bed a vessel containing permanganate of potash, either
F
82
HYGIENIC TREATMENT.
in the crystal, or as Condy's fluid, to which two or three
drops of sulphuric acid are from time to time added.
c. Exercise.
The unrestrained exercise of the muscles and lungs in
pure out-of-door air is of high importance, both as a
preventive and curative measure; experience has largely
proved that this is the most efficient means of benefiting
the prospective or actual subject of Phthisis: the air,
however, should be dry, as on a sandy or gravelly soil,
and the situation elevated. In such a climate,
"The more fully the lungs are judiciously used, the more is their
capacity nursed; and, conversely, the less they are used and
expanded, the more useless are they likely to become, if not
absolutely diseased. Under a judicious system of training, an
undeveloped man, even although he may be feeble, narrow-chested,
and sickly, may yet become active, full-chested, and healthy. It is
therefore within the power of the medical adviser to direct the
physical training of young persons, so that the apparently sickly
and the short-winded may in time be developed into the wiry and
active young man, long in wind, sound in body, and lithe of limb;
a result which, however, can only be attained by judicious feeding,
careful exercise throughout the whole period of development, and
by the gradual nursing of the breathing powers" (Aitken).
Swinging the If possible, exercise should be so taken as
Arms. to bring all the muscles into moderate and
agreeable action, and with the body in an erect posture.
Walking exercise secures these conditions to a certain
extent; but in walking the arms should be allowed to
swing freely, as this brings into play the pectoral and
intercostal muscles, the muscles by which the function.
of breathing is performed, and so tends to enlarge and
strengthen the chest-walls and their contents. This
suggestion is chiefly intended for females, who usually
+
7
OUT-OF-DOOR EXERCISE.
83
hold the arms quite still; while a man in walking a
mile swings his arms some 2,000 times without inducing
fatigue. Riding on horseback has the advantage of
permitting the patient to breathe a large amount of
fresh air, while the exercise does not occasion great
difficulty of breathing. Except when a cold north-
easterly wind is blowing, children should take open-air
exercise every day, as in running, trundling a hoop, or
using other out-of-door toys. Frost, and even a moderate
amount of damp, need not stand in the way, if the child
is taught to move briskly, and a healthy circulation is
kept up in the hands and feet. On the other hand,
confinement in close rooms, and too little open-air exer-
cise, leads to the worst results in children predisposed.
The exercise of the muscles of the
Rowing, Gymnas-
tic Exercises, etc.
upper extremity and of the chest is
very desirable. Rowing, if practised within moderate
bounds, is useful in raising the tone of the muscles of
these parts. Gymnastic exercises, gradually increased,
involving muscular movements of the upper half of the
body, rapidly improve both the respiratory and digestive
functions. When the weather forbids out-of-door
recreation, dumb-bells, or some of the well-contrived
apparatus for arm and back exercise, should be daily
used in the house with open windows, or in a covered
playground with a dry floor. Muscular and respiratory
changes will thus be promoted, and the digestive pro-
cesses strengthened. There is one form of exercise as a
preventive of Consumption, first described by Dr. Long,
which we have prescribed for many years with excellent
results in suitable cases. We will call it the cross-bar
swing.
84
HYGIENIC TREATMENT.
The Cross-bar
Swing.
By this we mean hanging by the hands
from a horizontal bar or piece of wood,
about three feet long, to the centre of which one end
of a rope or chain is affixed, the other end being
fastened to a beam, or the branch of a tree. (See
the illustration.) The gymnast should grasp this cross-bar,

V
which should hang from six to nine inches above the
head, with the hands two or three feet apart, and swing
very moderately at first-perhaps only bear the weight
if very weak and gradually increase, as the muscles
gain strength from the exercise, until it may be freely
used several times daily, various movements of the legs
7
EXERCISE-CAUTIONS.
85
being combined with this exercise. The arms being
chiefly connected with the body by a muscular attachment
to the ribs, the effect of this exercise is to elevate the ribs
and enlarge the chest; and, as nature allows no vacuum,
the lungs expand to fill the cavity, increasing the volume
of air—the natural renovator of the blood,—and pre-
venting congestion and the deposit of tubercles. By
this exercise the measure of the chest may be increased
from two to four inches within a few months, and with good
results. It is, however, only as a preventive, or during
the absence of active symptoms, that we recommend
this exercise. Let those who desire long life cultivate a
well-formed, capacious chest. The student, the clerk,
the merchant, the sedentary, the young of both sexes,
should have a cross-bar upon which to exercise daily;
if this were done by the rising generation, in a dress.
allowing the free and full development of the body,
tens of thousands might be saved from Consumption.
In recommending exercise it is necessary
to remark that it should not be excessive, or too long-
continued, but regulated by individual fitness. Exercises
unsuited to the frame, or continued beyond the power
of the heart and lungs, will only result in overtasked
powers and exhausted energies.* The rationale of this
is obvious; Phthisis being a disease of debility, if the
Cautions.
A man
A painful instance of the neglect of this precaution is recorded
by Mr. McLaren, in his "System of Physical Education."
boasted to him some time ago that he and his son-the father a
strong hardy man, the son a lanky and loose-grown lad of thirteen
years-had just walked from London to Oxford in one day-a
distance of nearly sixty miles. Before the year was out they made
another journey together, a short one this time; the son carried
before, the father, broken-hearted, following. The boy had never
recovered from the exhaustion to that day.
86
HYGIENIC TREATMENT.
vital power is expended too lavishly in exercise, sufficient
is not left for healthy digestion; food is then imperfectly
assimilated, nutrition is at fault, and the disease
advances. Consumptive patients should indeed be much
in the open air, but at the same time avoid any but the
gentlest exercise; such patients lack endurance, and if
exercise be carried too far, digestion will inevitably.
suffer, and the nutritive processes be inadequate to
repair the wasted tissues. On this account horseback
exercise, which gives the largest amount of fresh-air,.
with the minimum expenditure of muscular force, is
strongly recommended. Excessive work of the brain
must be strictly avoided, and an interest taken in natural
objects and operations, such as those of the garden, the
farm, the hill-side, and the river.
d. Bathing.
Bathing the entire surface of the body daily is a most
useful habit. The great vascularity of the skin, its large
daily secretions, and its breathing-power in aid of the
lungs, testify how corrective the healthy play of its
functions must be in cases of threatened mischief to the
internal organs. Perhaps there is no one other hygienic
habit commensurate in value to the cold bath, both as a
preventive and corrector of the consumptive cachexia.
It improves the functional activity of the body generally,
by increasing the capillary circulation of the skin, and
so fortifies the system that persons extremely liable to
take cold can in time endure severe changes of tem-
perature with impunity. This is a point of great
W
COLD BATHING.
87
For persons
advantage to a consumptive patient.
unaccustomed to it, the water should be tepid first, but
gradually reduced to cold. The most healthy plan for
children is to plunge them rapidly into water; this
obviates the exposure consequent on sponging, and
insures a quick and complete reaction. Adults who can-
not command full bathing facilities may sponge the chest.
both in front and behind quickly, or rub the whole surface
of the skin first with a wet sheet and then with a dry one ;
this can generally be borne and enjoyed, and where it is
followed by a general glow is a most valuable aid in
promoting capillary circulation. The use of sheets is
preferable to sponging, as by completely covering the
body they prevent loss of heat by radiation. Under all
circumstances, vigorous friction with a dry bath-sheet or
large towel should immediately follow the bath, as
reaction is thus rendered more complete. Cold bathing
must be regarded as injurious if, notwithstanding
vigorous friction, the surface remains cold, numb, blue,
or pale. In such a case, tepid or warm baths should be
used at first, and cold water only adopted when good
reaction follows.
Sea-Bathing. Except in confirmed and hopeless cases of
Phthisis, sea-bathing is generally advantageous. The
best season of the year is from July to October; and the
best time of the day is perhaps about two hours after
breakfast. The object sought is to produce vigorous
reaction; and to secure it the nervous and circulating
systems should be in some degree of excitement, and
there should be a slight augmentation of the tempera-
ture of the skin, although it should not be in a state of
perspiration. But on no account should the patient
C
88
HYGIENIC TREATMENT.
bathe when exhausted by fatigue, or when the body is
cooling after muscular effort; nor should he remain in
the water more than a few moments at first. If the
bather be strong, he may plunge into the open sea early
in the morning before breakfast, not only without injury
but with decided advantage; but the forenoon is the
most appropriate time for a weak child or delicate
patient, as then the air has become warm, and the
system has been invigorated by nourishment.
Sea-Salt. Patients who are unable to secure sea-
bathing may enjoy, to a limited extent, its advantages
by adding a solution of sea-salt to the water of the bath.
Sea-salt is the residuum of evaporated sea-water; and if
it be added in proper quantity to a bath, so that the
mineral ingredient approximates to that contained in
sea-water, it will be very much more efficacious than a
simple fresh-water bath, in consequence of the stimu-
lating action of the water upon the skin imparted by the
saline matter which it holds in solution. The addition
of salt obviates the chill which fresh-water sometimes
gives. It will often be found that consumptive patients,
with feeble circulation and cold hands and feet, are
much benefited by a salt-water bath, who could not
bear the shock of fresh water. For inland residents,
Sea-salt is an excellent substitute for sea-water bathing;
in its absence a handful of bay-salt, or even of common
salt, may be used.
e. Clothing.
This should be sufficiently warm to maintain in
vigour the cutaneous circulation; the extremities
especially should be kept warm, to obviate congestion in
1
FLANNEL-RESIDENCE.
89
:
the chest or abdomen. Flannel should be worn both in
summer and winter in the former it neutralizes any
variation of temperature, and prevents sudden cooling
by evaporation of the perspiration; in the latter it
prevents loss of the vital warmth of the body. In
winter, the addition of a chamois leather vest may be
advantageously worn over the flannel. The notion that
delicate children may be hardened by habitually
exposing them to atmospheric changes, when but im-
perfectly clad, is erroneous in all cases; and in the
instance of children of tuberculous predisposition, often
leads to the worst results. It is in the spring that our
climate is so treacherous, and this season especially
requires careful attention to clothing. But flannel
should not be worn next to the skin, as it is thus likely
to cause unnatural action, and it should not be worn at
night. The habit of sleeping in flannel is highly
objectionable, and is subversive of the very object for
which it is recommended. (See Vade Mecum, p. 49,
5th Ed.)
f. Healthy Residence.
A person predisposed to tubercular disease should, if
possible, reside in the conntry, and select a house on a
gentle slope and gravelly soil, with a southerly or
westerly aspect; the bedrooms especially should look
in one of these directions. If the house is not upon a
slope, the drainage must be artificial. The house should
not be too closely surrounded by trees, or in immediate
proximity to thick woods, for they both attract and
retain moisture, while they exclude much of the valuable
influence of sunlight, and thus render the climate damp
90
HYGIENIC TREATMENT.
and cold. At the same time the sight of green hedges,
shrubs, and isolated trees has a beneficial tendency. If
compelled to live in a town, the house should face a
park, square, or other open place, or at least a wide
street, with a favourable aspect. Some who read these
pages may be compelled to live where their occupations,
families, or means determine, being unable to adopt the
hints we have given. Nevertheless, even such may be
benefited by the suggestions, for although they cannot
secure perfection in a residence, they may aim at an
approximation towards it. Most young persons, how-
ever, notwithstanding their limited means, may abandon
a town-life to find work or service in the country. Fre-
quently this is the only way of escape, and there are few
who have not friends to aid them to make the necessary
change. This may involve the acceptance of lower
wages, or an humbler position, but should on no account
deter them from abandoning the bad air of a city
workshop or sleeping-room, which constitutes one of the
chief predisposing causes of the disease.
The choice of a dry soil and climate has a vital bearing
on our subject. In the report of the Medical Officer of
the Privy Council for 1866, a dry soil and climate is
suggested as a means for the diminution of Consumption.
It is there stated that in improved towns, where the soil
has been dried by the laying of main sewers, it has led
to the reduction, more or less considerable, of Consump-
tion; in the case of some towns to nearly fifty per cent.
Writing on the importance of a dry soil for the resi-
dence of consumptive patients, Dr. Buchanan expresses
himself in the following terms:-
SOIL CLIMATE.
91
"It seems probable that the central fact is, that the soil upon
which people live may be seriously good or bad for Consumption.
Populations living on flat retentive soils, or on low-lying water-
logged plains die of Consumption far more than others who live on
elevated, pervious and dry soils. It is questionable whether for any
other influence comprehended under the term "climate," so strong
a connexion with the disease has been proved to exist, as its con-
nexion with qualities of soil. And if this be true as a cause of
Consumption, we need not hesitate to believe that a dry soil will
influence the progress of the actually present disease. But, indeed,
we shall only be following the indications of long experience if we
advise the choice of places elevated on a sandy or chalk soil, rather
than of localities that lie low, whether on shore or inland. I know
well what strong opinions are expressed in favour of sea-air, but the
evidence has never been sufficiently sifted of the influence of sea-air,
apart from the other influences that make up climate in the places that
are favourite resorts for consumptive patients."-Lancet, Feb. 1, 1868.
Elevated situations are also to be preferred. By the
rarefaction of the air in elevated situations the patient.
is obliged to breathe more fully and deeply than in low-
lying localities, and in this manner the lungs are
expanded and stimulated to healthy development.
J. Change of Climate.
It is scarcely possible to over-estimate the importance
of a change of climate in the treatment of Consumption.
It combines in one prescription a multitude of remedies.
for the whole constitution,-air, water, food, light, tem-
perature, elevation, natural scenery, and diversified
occupation. With a suitable change of climate, a
patient is often at once enabled, instead of occupying
two or three rooms on one floor to breathe a uniform
temperature, to range at pleasure in the great air-ocean,
to bask in the sun, in light and free apparel, and to
enjoy a degree of warmth which shall keep the skin
active, and so relieve the lungs and other organs of a
portion of their work of depuration. The choice of a
92
HYGIENIC TREATMENT.
Wide Mean-
suitable climate is a point of great practical importance,
and requires a considerable knowledge of natural science.
The term climate has a wide meaning,
ing of Climate. it comprises many and varied influences
connected with the nature and elevation of the soil; the
temperature, moisture, and density of the air; and the
character-chemical and microscopical-and quantity of
the water. As these are highly complex subjects, it is
not possible to determine their separate effects except
approximately. In addition to the points referred to
under "Healthy Residence," the following should be
specially taken into account. The climate should be
sufficiently mild and equable to permit a large portion of
the patient's time to be passed in the open air. The
summer residence should be in a northern and brac-
ing region; but the winter in a southern and warmer,
so as to favour the almost constant breathing of out-
of-door air. To the consumptive, whose very life is air,
this is a most vital point, and includes nearly every-
thing that need be said here on climate.
Out-of-door
Life.
I
Dr. James Blake, of California, adopted
the plan of making his consumptive pa-
tients live in the open air; in the summer months he
made them sleep out without any tent; the result was
an astonishing improvement in digestion and blood-
making. The resistance to any ill effects from cold and
wet are described as marvellous.
"In choosing a home for your consumptive patient, do not mind
the average height of the thermometer, or its variation; do not
trouble yourself about the mean rainfall: do not be scientific at all,
but find out from somebody's journal how many days were fine
enough to go out forenoon and afternoon; that is the test you require,
and by that you may be confidently guided."-Chambers.
93
"In the true Alpine region, Tubercular Consumption is almost
absent, and strangers arriving there suffering with it are often cured.
Still, even there, especially in the lower heights, women suffer greatly
in consequence of setting at defiance the principle we have so much
insisted on. The women employed in making embroidery congregate
all day in small, ill-ventilated, low rooms, where they are often
obliged to be in a constrained posture. Their food is poor in quality.
Scrofula is very common. The men, who live an open-air life, are
exempt. There, in the very place where strangers are getting well
of Phthisis, the natives die from it, another proof that we must
look to local conditions and social habits for the great causes of
Phthisis. It would seem even probable that, after all, it is not indeed
elevation and rarefaction of air, but simply plenty of fresh air and
exercise which cures Phthisis."-Parkes.
OPEN-AIR-A VOYAGE.
There is no unconditional curative power possessed by
any climate, and those who have returned from distant
health-resorts with renewed health and vigour are in-
debted for the favourable change mainly to their passing
twice or thrice more time in the open air than they had
previously done at home.
A Sea-Voyage. The entire change of climate we have
just recommended involves a voyage, which in itself,
under favourable conditions, often wonderfully renews
the constitution. Persons troubled with cough, and
other symptoms of a phthisical character, often find a
voyage, if undertaken before the development of advanced
active symptoms, of signal benefit, or permanently res-
torative. The continuous moving through pure fresh air,
free from dust, and rich in ozone, iodine, etc.; the
novelty and grandeur of the scenes; the rest without com-
plete inactivity; and the sharpened appetite which soon
follows the walk upon deck, tend to render the voyage
both charming and invigorating. The amusement to
be obtained from exercise, games, books, music, and the
pleasant interchange of thoughts, entirely divest a sea
voyage of monotony. A voyage, however, to insure
94
HYGIENIC TREATMENT.
good results must be taken under favourable circum-
stances; for if a patient suffers from prolonged sea-
sickness, has to spend a large portion of the time in a
confined and imperfectly ventilated space, and cannot
command every necessary comfort and adjunct, a long
voyage would only tend to deteriorate the health of
the invalid, and jeopardize the prospect of recovery.
Further, sea-air, if to a great extent preventive of
pulmonary disease, should only be confided in as an
adjunct to medical treatment in the cure of the disorder,
and even then only when it is undertaken before the
health is much impaired.
The Colonies.
Entire change of climate is a subject of
special interest to the inhabitants of this country, as our
extensive colonial dependencies, and the comparative ease
with which they can be now reached, place the advantages
of a suitable climate within the reach of most persons. It
is a subject that specially concerns families whose members
have given evidence of a marked proclivity to Consump-
tion; they should consider whether, to consolidate their
family interests, and render them healthy and long-lived,
they had not better turn their early attention to some of
those fairest portions of the globe which are included in
the vast outspread of our colonial empire, in which to
seek that immunity from Consumption which they cannot
insure in the mother country. Foremost among the ad-
vantages which such a change would confer is the choice
of an active out-of-door occupation in the bush, among
cattle, trees, and corn, and in a dry climate, in exchange,
perhaps, for the vitiated air of a crowded workshop, or
the sedentary life of a counting-room. Even individuals
in whom actual disease has shown itself may often be
AUSTRALIAN CLIMATE.
Contra-indica-
tions
of Change.
95
benefited by change to a suitable climate, by obviating
congestion and irritation, which the sudden and extreme
changes of this climate frequently occasion.
The Climate
The climate of Australia * has been
of Victoria. recommended for the permanent residence
of the consumptive, and it offers no doubt some points.
of favourable contrast with the long-esteemed resorts of
Southern Europe, which, however grateful they may be
in winter, are unsuitable in summer. It is, however,
only in the early stage of Consumption, or if possible.
in the pre-tubercular condition, when the patient can
"rough it" in the Victorian bush, and live chiefly an
active out-of-door existence, that such a change of climate.
is advisable. It cannot be too emphatically stated that
the chief advantage of an Australian climate is, that
it enables a patient to take open-air exercise at all
seasons of the year. But in the last stages of Con-
sumption, when the strength is so far reduced as to
prevent exertion, and when Hectic and its concomitants
confine the sufferer to his bed, it will be evident that
little benefit can result from change of climate.
Patients should not, therefore, on any account be
sent away from home and friends without a reasonable
expectation that the case admits of benefit by such
change, as it has too often happened that patients have
left home merely to die. The chief point which contra-
indicates change of climate is the pre-
sence of active disease, as shown by a
persistently quick pulse, and a tempe-
rature above 100° Fahr. The importance of these
* A recent report states the death-rate from Consumption and
other lung-diseases to be less than half that of England.
96
HYGIENIC TREATMENT.
indications lies in their being continuous, and not when
due to merely temporary and passing causes.
Further, facts have recently been adduced which prove
that Phthisis prevails very extensively in Australia,
especially in Melbourne, and elsewhere among those
following occupations liable to be so affected, and that
in rapidity of course, and in fatality, it rivals the same
disease at home. Not only does the disease exist there,
but there is ground to believe the cases are not all
imported. Benefit may be derived from a favourable
voyage, and good new hygienic surroundings, but Mel-
bourne does not offer to the consumptive patient a
certain cure. Still, although not infallibly curative, an
out-of-door life in the pure air, and under the clear sky,
with a favourable temperature and the absence of
humidity, is certainly likely to benefit a youth, without
ties, in the incipient stage of Phthisis, who leaves our
shores to rough it in Australia.
New Zealand. The climate of New Zealand is, in some
respects, a more desirable one than that of Australia for
a consumptive patient. The Australian summer is
excessively, and often injuriously hot; New Zealand is
cooler, while offering summer weather during our winter
months.
The Climate
Egypt is now much recommended for
of Egypt. the consumptive, on account of the dry-
ness as well as moderate warmth of the climate ;
dryness of air prevailing even on the Nile. Those who
can command such a remedy, improve their prospects of
recovery, or at least prolong their lives, by migrating to
this climate in the winter.
Madras.
At the time of writing, Madras is
VARIOUS HEALTH-RESORTS.
Ap
recommended, by an eminent member of our profession,
as a highly advantageous winter residence. It com-
mands, especially, four essential elements for the
restoration of health,-warmth, without any fatiguing
effort to maintain the animal heat; air, in unstinted
measure, for the patient almost lives out-of-doors, or in
spacious rooms, in which there is a moving mass of
delicious air; food, in the most liberal supplies; and
amusement, for he must be dull indeed who does not
find something to excite his curiosity every hour.*
97
When removal to very distant countries is impracti-
cable or undesirable; and even Nice, Cannes, Mentone,
San Remo, Malaga, Cadiz, Madeira, Algiers, or other
European health-resorts, are beyond reach, Hastings,
Clifton, Bournemouth, Ascot, Dartmoor, Torquay,
Ventnor, Guernsey, and Queenstown (Ireland), are places
in our own Islands to which patients may be sent with
the prospect of excellent results.†
Ascot. Among our inland health-resorts, the locality
of Ascot is perhaps one of the healthiest in England,
often far superior to foreign places, the reaching of
which is both exhausting and expensive, and proving
frequently unavailing in the end. The whole neigh-
bourhood, including Sunningdale, Sunninghill, Bagshot,
and Ascot, stands pre-eminent in soil and in natural
drainage, while the air is specially advantageous to
persons of a consumptive cachexia. The late Sir James
Clark, who occupied the royal residence in Bagshot
* See "Notes on Madras as a Winter Residence," in the Medical
Times and Gazette, June, 1873, et seq.
+ Useful information respecting the various health-resorts in the
British Islands is contained in the first and second volumes of the
Homeopathic World.
G
98
MEDICINAL TREATMENT.
Park, said it was the most salubrious district in England.
Pine trees stud the locality, emitting at evening a
delicious fragrance, which is believed to be as restorative
as it is pleasant. Bournemouth possesses also this
advantage, probably to a greater extent, being sur-
rounded with pine woods.
Dartmoor.
Another not less favourable, but per-
haps more neglected place, both for children and adults.
suffering from incipient Consumption and its attendant
debility, is that extensive tract of country in Devonshire
known as Dartmoor. The fine moorland air in some cases
acts like a charm, and invalids going there with weak
lungs and lost breathing-power, return home after a few
months' residence apparently in perfect health.*
XIV.-Medicinal Treatment.
Difficulties of
Although our rich Materia Medica fur-
Treatment. nishes medicinal agents applicable to every
form and stage of Consumption-preventive, remedial,
and palliative-yet, when we come to prescribe for the
actual treatment of the disease, we find our task a most
difficult one, as a multitudinous and varied class of
remedies are required to meet the different manifesta-
tions of the malady as met with in practice. Just as no
two human faces are exactly alike, so no two cases of
Consumption ever present, from their early manifestation
to their full and fatal development, precisely the same
symptoms. Consumptive patients are to be dealt with,
therefore, according to their most special conditions.
* See Homœopathic World, vol. vi., p. 141-2.
MEDICINES AND HYGIENE.
99
The perfection of the treatment of Phthisis, as, indeed, of
disease in general, lies in its adaptation to individual
cases. The stock whence the patient has sprung, the
circumstances of his early life, his education and general
habits, the influences of soil and climate, the diseases he
may have passed through, the tendency to disease of the
body generally, and of organs and tissues in particular,
-these are but illustrations of the points that have to
be brought, as it were, into the focus of thought before
a course of treatment can be prudently decided upon.
We need, therefore, scarcely add that the knowledge
and experience of a physician are pre-eminently neces-
sary, and that every case of suspected disease should be
confided to the care of a professional Homoeopath.
In accordance with the title of this
subordinate to book, we have endeavoured to give a
clear view of the conditions under which
Consumption and Tuberculosis of the Lungs are most
likely to appear, and of the preventive and general
measures to be adopted in order to their correction. It
must be distinctly stated that, if these measures are
neglected at the proper time, they cannot be atoned for
by any subsequent medical treatment, however skilfully
applied; hence the remedies mentioned in this chapter,
though of great utility for the correction of disordered.
functions, especially digestive and assimilative, should
only be regarded as secondary to the early and continued.
observance of the hygienic rules we have pointed out in
these pages.
Medicines
Hygiene.
Incurable
Still, in keeping with the motto we have.
Cases may be placed on the title page, hopefulness
must be encouraged. The fear is that.
mentioned.
100
MEDICINAL TREATMENT.
in unmistakably clear cases of incurable disease, the
practitioner and friends should be so appalled by the
amount of structural change that has taken place as to
overlook those favourable results which good treatment
may yet effect. It should never be forgotten that in
many instances considerable organic mischief may be
arrested, and urgent symptoms so modified as to com-
port with the exercise for many years of various useful
functions, and with a tolerable share of real enjoyment:
cases of this nature are always under our care, and we
have given brief details, further on, of examples
in point. Although we have no overweening confidence
in medicines, our experience justifies us in stating that
there are few if any conditions of the disease in which
the application of well-chosen remedies is not capable of
rendering most valuable aid, or at least of acting as
handmaids to hygienic and climatic influences. Instead,
then, of being disheartened by the extent of lung-
mischief which has been detected, earnest and well-
directed efforts should be made to correct the digestion,
and improve such other functions as are still within the
range of our remedial resources.
Epitome of Treatment.
1. Tubercular Cachexia. — Calc.-Iod., Ferr., Ars.,
Phos., Sulph.
2. Indigestion.-Lyc., Puls., Nux Vom., Hydras.,
Calc., Merc., Kali Bich., Ant.-Crud., Carbo Veg.
Mud14
3. Active Symptoms.-Ars.-Iod., Ars., Phos., Hyos.,
7
EPITOME OF TREATMENT.
101
Acon., Bell., Ipec., Ferr., Soda Arsen., and the Warm
Bath (See pp. 107-8).
4. Cough, etc. Bell., Hyos. (nightly dry cough);
Bry. (with stitching pains in the side); Phos., Stannum
(with profuse expectoration and night-sweats); Dros.
Ipec. (paroxysmal cough); Kali Carb. (cough from
irritation of the throat); Kali Bich. (with tough
stringy, adhesive mucus). In most cases, the frequency
and violence of coughing may be considerably controlled
by voluntary efforts made by the patient.
5. Hæmoptysis. -Mill., Ham.-V., Ipec., Dros., Arn.,
Ferr., Calc.-Iod.
Ga
6. Dyspnea. Ars., Ant.-Tart., Ars.-Iod., Ipec.
Rubbing the chest with cod-liver oil, or glycerine; also,
the chest compress often relieves difficult breathing.
7. Hectic Fever, Night-sweats, Diarrhoea, etc. --
Phos.-Ac., China, Sulph-ac., Hep.-S., Samb., Ars. Spong.
Also the Warm Bath. Night perspirations are dimi-
nished by sponging with warm vinegar and water, and
by improvement of the cutaneous functions generally.
Smearing the skin with clarified suet at bedtime is also
useful.
8. Various Symptoms. Kreas. (sympathetic vo-
miting); Acon. (congestive and febrile symptoms); Merc.
(yellowness, depression, and other liver symptoms); Kali
Bich. (yellowish, stringy expectoration). As a general
tonic, and to relieve various local discomforts, hard rub-
bing the skin, and the manipulations of the shampooer
are often strikingly effective.
The Accessory and Palliative treatment of advanced
and hopeless cases is not described here, as it did not
come strictly within the scope of this treatise. Appro-
102
MEDICINAL TREATMENT.
priate directions on Nursing are given in the author's
"Vade Mecum.”
LEADING INDICATIONS.-Calcarea Carbonica.- This
noble remedy is well adapted to those constitutions in
which the digestion or assimilation of food is imperfect,
not resulting in the formation of good blood and healthy
tissues; there is an impoverished appearance, notwith-
standing that a fair, or even a large supply of good
food is taken. Other indications are--a want of firm-
ness of the bones, slow or difficult dentition, scrofu-
lous swellings, extreme sensitiveness to cold and damp,
cough, easily induced fatigue, acid eructations, relaxed
bowels, gradual wasting, and, in females, too frequent
and profuse periods. It is specially adapted to children
and females, to those who have previously exhibited
scrofulous symptoms, and to the pre-tubercular condition
generally.
Calcarea Phos.-The sphere of this remedy is nearly
the same as that of Calc.-Carb.; it corrects the assimila-
tive functions, and most forms of mal-nutrition from
imperfect cell-growth. It is especially valuable for
patients who have grown too rapidly, or suffered from
exhausting discharges, excessive menstruation, prolonged
nursing, the bad effects of town life, worry, or any other
causes of debility.
Phosphorus.-Incipient Consumption, when the lungs.
are frequently and easily affected, as from a slight cold,
with a short, dry cough, pain or soreness of the chest,
shortness of breath, tendency to diarrhoea or perspira-
tion, and general feebleness of constitution. This remedy
should also be prescribed in confirmed cases, especially in
delicate girls, troubled with frequent moist cough and
INDICATIONS FOR REMEDIES.
103
greenish expectoration, from an abscess in the lungs ;
excessive shortness of breath, diarrhoea, sweats, and ema-
ciation; pain and tenderness of the chest, poor appetite,
and small, quick pulse.
Arsenicum.-Tight feeling of the chest, as if bound
round, greatly oppressed breathing, aggravated on lying
down; chilliness in the chest, or soreness and burning
from coughing; constant thirst; exhausting diarrhœa ;
rapid emaciation; depression of spirits. Ars. is valu-
able in all stages of the disease, especially in the last.
Arsenicum Iod.-Broncho-Phthisis, with shortness of
breath, dry, irritable cough, with muco-purulent or
stringy expectoration, and other symptoms and signs of
tubercles. If given before softening has commenced,
excellent results may be anticipated.
Arsenite of Soda.—Severe cough and profuse expecto-
ration; hectic fever; night-sweats; diarrhoea. Even
when auscultation detects abscesses in the lungs, the
disease may sometimes be controlled by this remedy.
Spongia.-Loose, splashy cough, with fluid, greyish-
green, fœtid expectoration; bitter taste; hectic; cold
extremities.
M
Laurocerasus.—Irregular pulse, sweats, and emacia-
tion; hoarseness, thick bloody mucus, poor appetite.
Iodium. This remedy is adapted to that condition of
the system in which swelling, or atrophy of the glands,
and general emaciation, are prominent symptoms. A
chronic diarrhoea, premonitory of Consumption of the
bowels, is also an indication for Iodium.
Merc.-Iod. and Silicia are suitable adjuncts to Iod. in
many cases.
Ferr.-Iod.-Valuable in the anæmic, impoverished,
104
MEDICINAL TREATMENT.
FO
and cachectic conditions so common in Tuberculosis,
arising from imperfect assimilation of food.
Sulphur.-Phthisis, with chronic inflammation of the
lungs.
Nux Vomica.-This is a prime remedy for Indigestion
with the following symptoms :-flatulence, heartburn,
acid eructations, and constipation or irregular action of
the bowels. It is specially indicated in persons of dark
complexion, sallow skin, of sedentary habits, or who
suffer from much mental fatigue or anxiety.
Pulsatilla.—This drug is adapted to that form of
Indigestion in which fat, an important constituent of a
mixed diet, is distasteful, and is not taken without more
or less derangement of the mucous membranes. But
except that Puls. is generally more suitable to light-
complexioned persons, and where there is a tendency to
diarrhea rather than to constipation from gastric dis-
turbance, the indications are much the same as for
Nux V. For obstinate acid eructations, not cured by
Nux V. or Puls., with a debilitating relaxation of the
bowels, Calc.-Carb. should be had recourse to.
Lycopodium.-Acidity, intestinal flatulence, obstinate
constipation, and other symptoms of chronic indigestion.
It is chiefly adapted to old-standing cases, and when the
symptoms are not active; it is also said to be more use-
ful in young men than in young women. (See Phos.)
Emaciation, poor appetite, pain in the lungs, hacking
cough, Hectic, and profuse night-sweats are also indica-
tions.
Mercurius.-Faulty action of the liver, with yellow-
ness of the skin and white-of-the-eyes, mental depression,
loss of appetite, purulent expectoration, etc.
:
!
INDICATIONS FOR REMEDIES.
105
Hepar Sulph.-Scrofulous patients in the early stage.
Hoarse, rough, or weak voice; hollow cough, with ex-
pectoration of mucus, sometimes of blood; dyspnoea,
especially on lying-down; night-sweats; pain after the
least food; clay-coloured or greenish evacuations.
Aconitum.-This is a prominent remedy in Con-
sumption, and its administration during any course of
the disease, when febrile symptoms recur, is attended
with the best results. It is especially valuable in re-
moving congestion, and modifying inflammatory and
febrile action. Physicians of the old-school were for-
merly accustomed, and in many cases are so still, to use
depletory measures-leeches, blisters, cupping-glasses,
low diet, fever-dranghts, and exclusion from fresh air-
to diminish local congestion; but, thanks to Homoeo-
pathy, in Aconite we have a remedy which answers this
purpose better than the lancet or the leech, without
the consequent loss of strength. No inconsiderable
portion of the fatality of Phthisis in former days was
due to the lowering methods of treatment adopted,-
methods calculated to hasten the fatality rather than to
arrest a disease, the main element of which is one of
lowered vitality.
Belladonna.-Cough, with expectoration of bright-red
blood; spasmodic, often violent cough, worse at night;
frequent congestion of the head, with alternate redness
and paleness of the face.
Hyoscyamus.-Night-cough, especially when the cough
commences, or is aggravated, on lying-down.
Bryonia.-Tearing dry cough, as if the chest or the
head would burst by the effort; stitching pains in the
sides, catching the breath.
106
MEDICINAL TREATMENT.
Ferrum.-Anæmia, hæmoptysis, diarrhoea, cedema
of the lower extremities, emaciation. Ferr. is required
in most cases for the constitutional condition. Admin-
istered in large and long-continued doses, Iron has
been known to bring on hæmoptysis; hence in small
doses it is homoeopathic to the condition.
Ipecacuanha-Spasmodic cough, with accumulation.
of mucus in the chest, causing a sensation of weight,
often vomiting of mucus, and sometimes of blood.
Administration
of the remedies.
In this disease, as in others, the fre-
quency of the doses must be regulated
by the acute or chronic nature of the symptoms. In
administering one or more of the above remedies as
modifiers of the constitutional tendency, a dose may be
given once or twice daily, and continued for ten or four-
teen days. After one or two days' pause, Sulph. may be
administered, morning and night, for a few days, after
which the course may be repeated; or if the symptoms
point to it, another remedy may be chosen. When the
symptoms come on rapidly, or are severe, the doses may
be given every three or four hours, or even at shorter
intervals, till improvement takes place, when they should
be administered less frequently.
Inhalation.
Medicines by In concluding this part of our subject,
we will notice a mode of medication
which often proves extremely useful, especially for ad-
ministering such remedies as Iodine, Kreasote, Aconite,
Bryonia, Hyoscyamus, Belladonna, Ipecacuanha, etc. In
certain forms of the disease, especially in those chiefly
involving the throat and large bronchial tubes, or in
cases of irritative or convulsive cough, or with fœtid
expectoration, the method of inhalation is very effective.
INHALATION-WARM-BATH.
107
It is done very simply, and often more effectively and
with less effort, without, than with a special inhaler.
All that is required is a jug of hot water, over which the
mouth may be held, and a towel so arranged that it
covers the face below the eyes and surrounds the top of
the jug, and so confines the vapour. A few drops of the
drug to be inhaled being added to the hot water, the
medicine finds ready access to the air-passages through
both the mouth and the nose. This may be practised
for five or ten minutes at bed-time, and if necessary,
and the patient has not to be exposed to cold air during
the day, it may be repeated once, twice, or oftener in
the day. A portion of the drug thus administered
reaches the lungs and enters the general circulation;
but the chief action of the medicated vapour is on the
throat and bronchial mucous surface. Inhalation can,
however, be only a subordinate method of treatment in
a great constitutional disease like Consumption. A well-
chosen Homoeopathie remedy, administered in the usual
way, just as certainly reaches the seat of the disease as
anything inhaled can do, and at the same time tends to
correct the constitutional error on which the local
symptoms depend. Apart from this method of applying
various remedies to the respiratory passages, the simple
vapour of hot water is of great utility; it soothes the
inflamed mucous membrane, and assists in detaching
mucus from the air-passages.
The use of the Warm Bath, two or
three degrees below the temperature of
the patient, for twenty or thirty
minutes, and the temperature uniformly maintained by
occasional additions of hot water, has an extremely
The Warm Bath
in Consump-
tion.
108
CASES TREATED.
beneficial effect in controlling the active symptoms of
Consumption, as well as of Pneumonia, Pleurisy, etc.
The cough subsides, the expectoration is facilitated, the
pulse moderated, and the high temperature reduced.
Beyond these immediate results, after three or four baths,
or even earlier, sleep is improved, diarrhoea lessened,
and early-morning perspirations diminished.
For con-
sumptive patients a warm bath as above described is
not recommended to be given oftener than every second
day; it should be administered at bed-time, or when
the patient has not to be again exposed to chilling
influences; and the duration of each bath should be
regulated by the strength of the patient.*
XV.-Cases Treated by the Author.
These cases, which might have been multiplied to fill
a volume, are taken partly from private and partly from
dispensary practice; they are not published as present-
ing any remarkable results from treatment, but simply
as illustrations of the method of dealing with this
frequently-recurring disease. The mere outlines are
given, and symptoms rather than signs are noted, our
space being limited. In fact, the idea of inserting
cases at all was but an afterthought, and when the
pages intended to be occupied were already filled.
* In a case under our care at the time of writing, the warm-bath
proved strikingly and promptly beneficial. On the morning follow-
ing the first bath the patient was able to rise before breakfast,
although she had not done so for some time previously. All the
distressing symptoms have been ameliorated.
CASES TREATED.
109
We have omitted cases in which the disease was so
hopelessly advanced as to confine the patients to their
rooms, our object being rather to record such as were
yet within the reach of cure, or of prolonged ameliora-
tion.
Case No. 1.—Phthisis, with Hamoptysis.—Subsidence of
Active Symptoms.
J. T., æt. 21.—This patient, of dark complexion,
lymphatic temperament, and looking much older than
his years, first consulted me May 11th, 1871. The
signs and symptoms of Consumption were strongly
expressed. Emaciation was excessive, the patient
having lost two stones in the twelve months preceding
his coming under my care. There was copious, thick,
muco-purulent expectoration; and after any exertion he
spat up red blood in considerable quantities. Cough and
dyspnoea were very troublesome, and entirely prevented
him from following his occupation, that of a cutter of
fishermen's clothes, which necessitated his having to
breathe a great deal of cotton dust. The chest walls
under the clavicles were much sunken, and their
mobility greatly diminished. The percussion note was
dull, with feeble inspiration and prolonged expiration.
Treatment. The chief remedies prescribed were-
Dros., Phos., and Calc.-Phos. They were continued, with
some interruptions, to the end of the year, and with
such good results that I recommended the resumption.
of his employment, if practicable, with a sea-coast resi-
dence. The only place which presented itself in which
he could obtain occupation at his own handicraft was
Yarmouth, to which town he went at the end of 1871,
❤
110
CASES TREATED.
and there he has continued to follow his employment to
the present (June, 1873), with scarcely any loss of work
during the whole of the time.
Besides the remedies above mentioned, Bry., Merc.,
Acon., China, Ign., and Mill. were now and then given
for intercurrent symptoms. Millefolium was especially
valuable for the recurring hæmoptysis. An attack
occurred in May of the present year, and was quickly
arrested by it.
This patient has been most grateful for restoration to
comparative health, and consequent ability to resume.
his work and means of subsistence, which his previous.
physician had given him no ground to hope for. The
climate chosen was not the best for a residence through
the whole year; for Yarmouth is much exposed during
the spring months to cold east winds, which often tell
disastrously on the consumptive. In spite of this draw-
back, and somewhat long hours of employment-8.30
a.m. to 8 p.m.—he feels quite equal to his duties, and
states in a letter, June 12, 1873, "I do not know any-
thing that ails me now, unless it is that I am excessively
liable to take cold." Colds tell very injuriously upon
his health, aggravating his cough, and sometimes bring-
ing on hæmorrhage. I recommended him to cultivate his
beard, to acquire the habit of breathing by the nose,
and to take a cold shower, or sponge-bath daily.
Case 2.-First Stage of Phthisis.- Speedy Results.
Anna W., æt. 30.-Came under treatment Nov. 14,
1871. She suffered from a distressing, frequently-
recurring cough, aggravated on lying down, and in the
T
CASES TREATED.
111
night. Great dyspnoea; often spat blood; and could
not lie on the right side. She also complained of loss
of appetite, sickness after food, and other symptoms of
Indigestion.
Under a course of Dros, with an occasional dose of
Ipec., or Hyos., she made rapid progress, lost her cough,
regained her appetite, and discontinued treatment,
considering herself cured, in rather less than two
months.
The treatment of this case differs from the last,
inasmuch as little or no change in the hygienic.
surroundings of the patient were practicable. The bene-
ficial results recorded were therefore clearly due to the
remedies administered.
Could the advantages of a dry climate, a sheltered
house, and other favourable hygienic conditions have
been superadded to the medical treatment, the tubercles
present could no doubt have been reduced to so latent a
state that she might almost literally have been said to
be cured, and years added to her span of life.
The same observations apply to the following case,
and to others recorded in these pages.
५
Case 3.-Phthisis, complicated with Pleurisy.
J. B., æt. 32. Nov. 29, 1871.-Has been gradually
getting thinner, being now eight stones nine pounds.
Pulse small, 80, and the hands and feet cold and purple.
He has copious night-sweats, pain in the right shoulder
and side, which is aggravated by deep breathing. There
is dulness extending for an inch under the right clavicle,
and moist mucous râles can be heard in the same region.
112
CASES TREATED.
There is also impaired mobility of the chest. He had,
too, very unfavourable antecedents, his father dying of
Phthisis at about his present age.
R Bry. 1x gtt. iij. ter in die.
Dec. 4.-Less pain in breathing, but otherwise the
same. R Phos. 3× gtt. iij. ter in die.
Dec. 13.-Much better, both locally and generally.
Compressible pulse. Repeat.
Dec. 22.-Coughs on lying down.
R Hyos. 1x gtt. iij. ter in die.
An accurately-fitting chest compress to be worn.
Dec. 29.-Compress does much good. Cough bad in
the evening, and on stooping or moving quickly.
R Bry. 1x gtt. iij. ter in die.
Jan. 10, 1872.-Suffers from a severe hacking cough
day and night, the result of a catarrh.
R Dros. 1× gtt. iij. ter in die.
Jan. 17.-Catching pains in the right side on cough-
ing or deep breathing. R Bry. 1x gtt. iij. ter in die.
Jan. 31.-Pain continues in spite of the remedy.
R Acon. 1× gtt. iij. ter in die.
Feb. 12.-Pain quickly relieved after commencing the
last medicine. R Phos. 3x gtt. iij. ter in die,
1
CASES TREATED.
113
March 25.-Better every way. Has gained about
three pounds in weight, and considers himself cured.
The physical signs have correspondingly improved; the
area of dulness has considerably diminished, mucous
râles can scarcely be detected, and the breathing capacity
of the lungs has greatly increased. Continue Phos.
Considering the severity of the weather during the
time he was under treatment, and the occasional aggra-
vation of his symptoms by colds, the progress he made
was most satisfactory.
The patient's medical history, however, is very dis-
couraging, and the manner in which that information
was given to me showed that he also felt it to be so.
Phthisis is more or less hereditary. Insurance offices
are justified in considering that they incur increased
risk when they become responsible for the lives of the
children of the consumptive. This risk is greatly in-
creased in the descendants born of parents suffering at
the time from the symptoms of Phthisis. The duty,
therefore, we have attempted to enforce in the preceding
pages, that consumptive persons should not marry till
they are fully restored to health, although it cannot be
enforced by legal penalties, should tell with all the force
of a moral obligation.
Case 4.-Phthisis (early stage).— Recovery.
T. A.-This patient came under my care Sept. 21,
1871. Up to within a few weeks of consulting me his
health had been fairly good, but there was a family
history of Consumption. He was pale and thin, his
height 5 ft. 6 in., and his weight 8 st. 10 lbs. He now
H
114
CASES TREATED.
complained of hoarse cough, with spitting of blood, and
copious purulent sputa. The appetite was poor, the
circulation accelerated but feeble, the pulse being 104
in the minute; the hands and feet were cold, and he
was troubled with early-morning perspirations.
B Phos. 3x.
Phos.-Ac. (dilute).
A dose four times daily, on alternate days.
Oct. 9.-Cough much relieved, expectoration easier,
and no more hæmorrhage. Repeat.
Oct. 26.-General health much better; again spat a
little blood. B Ferrum and Phos. on alternate days.
Nov. 8.-Much better. Repeat.
Nov. 15.-Continues better, except being troubled
with diarrhoea, chiefly after tea. B Phos.-Ac.
Nov. 26. Still improving. Appetite good; takes
his food with zest, and enjoys everything more than he
did. The diarrhoea previously mentioned no longer
exists. Complains of pain in right lung, and expecto-
rates dark-coloured thick phlegm.
B Phos. and Hep.-Sulph., a dose every alternate
four hours.
Dec. 13.-Better. Pulse now 88. Enjoys his food,
and has gained two pounds in weight. B Phos. and
Ferr.
Under the use of these remedies the patient was so
much better and stronger that, after Feb. 14, 1872, he
discontinued treatment, and, just as the second edition of
į
CASES TREATED.
115
this treatise was preparing for publication (June, 1873)
two of his sisters came under treatment, who informed
me that T. A. continued to enjoy good health.
Case 5.-Incipient Phthisis.-Restoration.
W. L., Eltham, æt. 21.-This patient first consulted
me on December 30, 1870. He was pale, anxious, and
depressed. He was also very liable to take cold. He
complained of severe dyspnoea after any exertion,
troublesome cough, especially on rising, with thick,
gluey, ropy sputa; pains in the left side of chest, and
rapid loss of strength and flesh. Present weight, 11
stone 2 lb. The respiratory murmur was feebler in
the left infra-clavicular region, the chest-wall of this
part was also much depressed, and there was but
imperfect movement of the chest-walls generally.
R Kali Bich. 3× 3j.
Phos. 2x 3j.
The remedies to be taken in alternation, three drops.
every four hours.
January 7, 1871. The patient reported himself
much better; the expectoration was easier and greatly
diminished; the spirits and appetite had also much
improved. The patient now complained of pain in the
arms, legs, etc.
R Phos. 2x.
Sulph. .
A dose thrice daily of the former for three days, and
next of the latter; afterwards, the course to be repeated.
The patient remained under treatment till May 11,
when he had gained five pounds in weight, could stand
a heavy day's work- being a wheelwright - without
116
CASES TREATED.
fatigue, and had little or no cough, except occasionally
on rising in the morning.
This patient permanently regained his health; for
although he has been under treatment for a disease con-
tracted since, he soon recovered, and remains well to
the present time (July, 1873).
Case 6.-Incipient Phthisis.—Recovery.
J. J. H., æt. 17.-Nov. 17, 1871. Formerly had
Bronchitis and Pleurisy. Complains of defective eye-
sight, so that he cannot read for half-an-hour con-
tinuously. Teeth much decayed, tongue foul on rising ;
hands and feet cold; pulse irregular, 88; temperature,
100°; feeble respiratory murmur, and depressed infra-
clavicular regions. The patient, being apprenticed to
an ironmonger in Hertfordshire was confined to the
shop for about twelve hours daily. The skin, lips, and
mucous membrane had a bloodless appearance from
deprivation of sufficient air and sunlight.
R Phos. 3x. A dose thrice daily.
Ferr.-Red. A dose twice daily after meals.
The former to be taken for three days, and next the
latter for three days; afterwards the course to be re-
peated. Liq.- Ferr.-Perchlor., as a paint, was also pre-
scribed for an ingrowing toe-nail.
I recommended the patient to abandon his present
occupation, and return to the home and pursuits of his
father, a farmer in Ireland. My advice was carried out
with as little delay as possible, and the patient continued
the treatment by correspondence for a short time, and
rapidly regained health Phos., Phos.-Ac., and Ferr.
were the chief remedies prescribed, and they acted very
CASES TREATED.
117
satisfactorily. The Ferr.-Perchlor., painted on the in-
growing toe-nail, also gave rapid relief.
This case illustrates the injuriousness of occupations
carried on within-doors, especially to persons not
possessing great physical resistance. At the same time
it confirms the more pleasant view previously stated,
namely, that patients with consumptive symptoms more
frequently recover or improve under medical treatment
when they can pursue out-of-door occupations. Risk may
be incurred during active symptoms by exposing con-
sumptive patients to chill and damp air, but they will
not steer clear of catarrhs by excessive confinement
to warm rooms, and they inevitably suffer injury by
breathing vitiated air. No doubt there is more danger
in confinement to the house than in going freely into the
open air.
Case 7.—Early Tubercular Stage.-Rapid Recovery.
M. A. S., æt. 21.-Complained (Nov. 26, 1871) of
severe cutting pains under the collar-bones; great
dyspnoea on taking exertion, especially going up-stairs or
up-hill; night perspirations; and excessive general loss
of flesh, so that her dresses had to be taken in. The
pulse was small and quick; she often suffered from pal-
pitation, and her temperature was abnormally high.
Phos. and Phos.-Ac. were the chief remedies given, and
in little more than a month she had so far regained
her strength and flesh, and had so entirely lost all the
symptoms complained of, that she felt no further treat-
ment was necessary.
Case 8.-Phthisis, with Hamoptysis.
G. N., æt. 32, Nov. 1871.-Complained of bad cough,
118
CASES TREATED.
great dyspnoea, occasional spitting of blood, and
abundant expectoration of thick and blood-streaked
sputa. He was also losing flesh, and had early-morning
perspirations, and other symptoms of Hectic.
Phos. and Ars. were the remedies administered, and
in a few weeks all the symptoms were wonderfully
mitigated. He had also cod-liver oil, and now and then
a few doses of Hyos., when the cough was troublesome
at night. In a few weeks more the patient lost all his
distressing symptoms, and regained such a measure of
health that he could follow his employment fully and
uninterruptedly.
Case 9.-First Stage of Consumption.-Complete subsi-
dence of the Symptoms.
M. J., æt. 22.-This patient consulted me Feb. 7,
1872. Her medical history was very discouraging, her
mother having died of Consumption many years ago.
She complained of severe cough, with copious muco-
purulent expectoration, and distressing want of breath.
She was also very bloodless, her lips, tongue, and inside
of eyelids being unnaturally pale.
This patient was under treatment for four months, and
was so greatly improved in every respect that she con-
sidered herself cured; and consequently discontinued
treatment. Ferr., Ars., Phos., Ferr.-Iod., and Puls.,
constituted the medical part of the treatment.
Case 10.-Pre-Tubercular Condition.-Complete Recovery.
F. M., æt. 31, a draper, much in doors, breathing an
atmosphere inimical to health, complained of a hoarse,
almost inaudible voice, rapid loss of flesh, perspirations.
CASES TREATED.
119
in the early morning, was soon fatigued, and was
physically and mentally depressed. The respiratory
murmur was lessened, the percussion sounds somewhat
dull, with slight flattening of the chest below the
clavicles. There were also the symptoms of Indigestion
which characterize the antecedent phthisical state,—fail-
ing appetite, furred tongue, distention after dinner, pain
in right side, irregular action of the bowels, etc.
The patient made a good recovery under a course of
Merc., Nux V., Podoph., Phos., and Sulph. The last
remedy was given for a crop of blind boils which troubled
the patient towards the end of the treatment. The diet-
ary was made conformable to the plan already sketched
(pp. 74-5). Gardening, horseback exercise,* and other
open-air pursuits were also recommended. The patient
was under observation from Jan. 4th to April 9th, 1873,
and I have been informed within a few days, by a patient
from the same town, that he continues in good health.
Case 11.-Phthisis, with Haemoptysis.
G. H., a young man of 20 (May, 1869), stated that he has
had a harassing cough, with a variable amount of expecto-
ration, since he was sixteen years old, and at the time of
coming under my care presented the following symptoms
and signs-Indigestion with flatulence and distressing
irritability of the mucous-membrane of the intestinal
canal; extreme weakness; small pulse, 112 per minute;
night-sweats; cough with expectoration containing
blood; painful breathing, and great dyspnoea on making
* Sydenham says, daily riding on horseback is all in all; and
that if this is done, the rules of diet may be neglected, and the
patient need deprive himself of no sort of meat or drink.
}
120
CASES TREATED.
any exertion. There was considerable dulness over the
apex of the right lung, prolonged expiratory sound, flat-
tening of the chest-walls, and other signs.
Phos. 2x thrice daily, and a teaspoonful of Cod-liver
oil, twice daily, were prescribed. In four days he
reported himself" rather better." Ferrum Iod. 2 X was
now prescribed, a dose thrice daily. He next stated
himself to be altogether stronger and better, the cough
was less frequent and troublesome, and the pain on
breathing diminished, though the sputa still showed
streaks of blood. The progress was constant under this
remedy; in one week he felt much stronger; in fourteen
days he was freed from the cough and its accompanying
symptoms, and in a month considered himself so well
that he discontinued treatment. Nearly three years
have now elapsed, and the patient has not again pre-
sented himself at the Dispensary, as he most probably
would have done had there been any relapse.
Case 12.-Phthisical Cough, with Diarrhea.
S. W., a girl eleven years old.-On March 1st, 1869, she
complained of cough, causing pain between the shoul-
ders, worst in bed at night; there was no expectoration,
but the breathing was short; she was getting thinner,
and had a cadaverous appearance. Digestion was im-
paired, the tongue coated, the papillæ of which pro-
jected through a whitish fur, giving the tongue a pale
strawberry-like appearance; she was thirsty, and the
bowels were relaxed. Phosphorus was given in the 3rd
dec. dil., thrice daily.
Two days afterwards she reported herself better of the
pains in the chest. Repeat Phos. 3 × .
7
:
RESULTS OF PHTHISIS.
121
Five days later, "still better;" bowels relaxed only
three times a day. Continue same remedy.
A fortnight subsequently she appeared much im-
proved; her general condition being comparatively firm,
and her face wearing a more cheerful and healthy, aspect.
A week afterwards she took cold, and had a sharp
attack of Diarrhoea, with "pricking pains," etc., for
which Arsenicum 3x was prescribed.
Nine days afterwards she reported herself "quite well,"
and remained so for a year afterwards, during which
time she was under observation. Since then I have lost
sight of her.
This patient's history, symptoms, and physical signs,
all alike pointed to Phthisis, and if the condition de-
scribed above had not been promptly corrected, she would
no doubt have succumbed to the disease ere this.
XVI.-The Providential Results of Phthisis.
A few words on one point, often lost sight of in
the consideration of this disease, may not be out of
place here.
It has been abundantly proved that an exudation
of tubercle is evidence of vital decay; the mission,
then, if we may so express it, of Phthisis is, the
eradication of worn-out constitutions to prevent the
perpetuation of enfeebled or diseased
the Weak. generations. In a philosophic sense,
says Dr. Bennett, Tuberculosis is not an inexpli-
cable scourge of the human race, but one of the
means by which Providence weeds it of worn-out
Weeding-out
122
PROVIDENTIAL RESULTS.
organizations, incapable of perpetuating healthy off-
spring. The diseased parent begets diseased children,
who, being incapable of continuing the race in its
integrity, die off like plants that perish before they
blossom and seed, and the earth remains the heirloom
of the strong. Were the sickly members of the com-
munity to have the power of continuing their race, it
would rapidly deteriorate. It is well known that those
who marry too young or too old, or are diseased, have
children who die of Tubercular Meningitis, of Scrofula,
or Pulmonary Consumption; whilst even those who
have healthy youthful parents may wear-out their
organic powers in the struggle of life, and succumb
to accidental Phthisis. Mr. Darwin has shown by
his researches that the struggle for life pervades
animated nature. In the undomes-
ticated animal kingdom the sickly
and the aged die from want of power to secure their
existence, or are exterminated by their natural enemies,
so that the young and vigorous alone survive to per-
petuate their races. The destruction of birds of prey is
supposed to have engendered disease among the game,
in this way. It is well known by naturalists that birds
of prey always attack those birds in a covey which rise
last, and are weakest, and all wild animals destroy those
which are the victims of accident or disease, even of
their own species; thus the perpetuation of a deteriorated
and enfeebled race is obviated. With man, however, it
is different; his intellect enables him to accumulate for
the future, to preserve his own existence in old age, and
to provide for his sickly progeny. But the laws of
Providence correct the operations of the human intellect,
Illustrations
in the Animal
Kingdom.
CONCLUSION.
123
and the race is weeded of its exhausted organizations by
the instrumentality of disease and death.
The all-pervading law to which we have referred
presses heavily, indeed, on individuals who have to be
thus prematurely weeded; but individual interests have
always to be merged in the general good; and although
the operation of the law may appear harsh to the few, it
is really an evidence of the existence of that guardian-
ship which, as a shield, our beneficent Creator has
thrown over the human family. The action of the law
has been likened to hurricanes which inflict great indi-
vidual suffering, but at the same time contribute to the
fruitfulness and perpetuity of the human race.
Conclusion. And here we bring to a close our con-
tribution to a better knowledge of the laws of this
disease. Of its shortcomings no one can be more
conscious than the writer. But we have done our best,
and believe it will not be unproductive of good results.
The principles enunciated as to the causes of Consump-
tion and the preventive measures are, we believe, in
harmony with the teachings of true physiological science,
and with the experience of the most intelligent and
observant physicians of the present day. Should the
suggestions be widely acted upon, this scourge of our
race may be prevented in countless instances, and man's
earthly life lightened and lengthened; and even where
the existence of Consumption shall be manifested by
unmistakable signs, the disease may be, in many cases,
so largely arrested, and for so long a time, that it may
virtually be said to be cured.
124
INDEX.
ABSCESS of the lungs, 23, 53, 62, 103
Active disease, 95
Acute Miliary Tuberculosis, 15, 17, 23,
37
Adipose tissue (adeps, fat. The tissue
which encloses the fat), 47
Advice respecting marriage, 28
Advice to those nursing consumptive
patients, 34
Aeration, 19, 36, 39, 51
Air, use of, in breathing, 12; impure,
35-38. 94; open, 86 92; pure, 39
Alveoli (microscopic air-cells of the
lungs), 11, 21
Anæmia (deficiency in the quality and
colour of the blood), 106
Anatomy of the lungs, 6-12
Aphtho (Thrush), 46, 50, 59, 65
Apices (summits), 8
Arms, swinging the, 82-3
Artificial food for infants, 73
Asceticism and consumption, 43
Ascot, climate of, 97
Assimilation (the conversion of food
into the substance of the body), 49, 86,
102
Atrophy (wasting of the body or a part),
48, 103
Auscultation (ausculto, to listen; to
examine the chest by the application
of the ear), 63:
Bathing, 86-88; sea, 87
Baths, warm, in lung diseases, 108
Bournemouth as a health-resort, 97, 98
Bronchi (Bpoyxos, the wind-pipe. The
two trunk branches of the windpipe),
9, 10, 17, 21
Bronchioles (the minute branches of
the bronchi), 11, 12
Cachexia (kakij, bad; étis, habit: a
faulty condition of the system), 18,
42, 86, 97, 100
a
Cachexia, Tubercular, 100
Calcify (calx, lime; fio, to make:
change due to the deposit of lime or
chalk), 15,
Capillaries (hair-like tubes), 51
Cartilage (gristle; smooth, elastic tis-
sue, softer than bone), 10
Caseous infiltration (the exudation of
cheesy matter into the lungs), 21, 41
Caseous metamorphosis (a change of
deposit to a cheesy substance), 14,
17
Caseous toxæmia (blood-poisoning by
caseous matter entering the circula-
tion), 19
Causes of Consumption, 25-46; cold,
40; depressing emotions, 42; exciting,
44; hereditary predisposition, 26; im-
pure air, 35; insufficient food, 41; un-
healthy occupations, 38; necessity of
studying, 25
Cause, wasting without apparent, 48
Cautions as to bathing, 88; exercise,
85; marriage, 31, 113
Chest developed by cross-bar swing, 85
Clavicles (collar-bones), 61, III
Climate of Ascot, 97; Australia, 95;
Bournemouth, 97; Dartmoor, 98;
Egypt, 96; Madras, 96; New Zealand,
96; Victoria, 95; change of, 91–98;
wide meaning of the word, 91; a dry
one preferable, 90
Clothing, 88, 89
Cod-liver oil, 76
Cold a cause of phthisis, 40
Colonies, 94, 95
Congestion (excessive fulness or stag-
nation of the small blood-vessels), 77,
88, 105
Condy's fluid, 82
Consanguineous (related by blood), 32
Consumption and Asceticism, 43; cases
of, 108-123; causes of, 25-46; con-
tagiousness of, 33; common form of,
16, 21; curability of, 17, 69-71;
duration of, 57-8; hygienic treat-
ment of, 72-98; incipient, 115, 116;
medicinal treatment of, 98, 108; pa-
thology of, 21-23; preventibility of,
16; providential results of, 121;
symptoms of, 46-59; tubercu'ar, 21;
of the glands (scrofula), 17; varieties
of, 16
Cough, 52, 101; remedies for, 101
Cretification (creta, chalk; fio, to be-
come. The transformation of tubercle
into earthy substance), 22
cross-bar swing, 84
Depletory (depleo, to empty. Reducing
the amount of blood in the system),
105
INDEX.
Depuration (depuro, to cleanse. Cleans
ing), 92.
Diagnosis (diarvois, distinguishing.
The art of distinguishing a disease
by the symptoms present), 54, 60
Diaphragm (diappayμa, a partition-
wall. The transverse muscle which
divides the chest from the abdomen),
7, 50
Diarrhoea, 46, 49, 50, 59, 101, 103. 121
Diathesis (constitutional tendency to
disease, as the scrofulous diathesis),
19
Diet, 2-9, 72-6
Differentiation, difficulties of, 46
Dumb-bells, 83
Dust, a cause of consumption, 39
Dyspnoea (bus, with difficulty; πvew, to
breathe difficult breathing), 45, 50,
58, 101, III, 103, 109
Effluvia (odour, or vapour, -as from
decaying animal or vegetable matter),
36, 80
Emaciation (emacio, to make lean
Wasting with debility), 46, 48, 58,
77, 103, 109
Embolic (due to minute particles of a
blood-clot which are arrested in the
capillaries), 16
Emotions, depressing, 42
Enemata (injections), 78
Epigastrium, 48
Epitome of treatment, 100-1
Evidence, post-mortem 70
Exercise, 60, 82-86; cautions, 85
Expectoration (ex pectore, from the
chest spitting-up), 48, 53, 103, 109
Experience, testimony of, 70
Fat, 49, 76, 104
Fibroid (having a coarse resemblance to
fibres), 16
Filbert nails, 46
Flannel, use of, 89
Foci points or atoms from which disease
may spread), 34
Focus (point of greatest intensity), 99
Food, the best artificial, 73; unsuitable
or insufficient, 41-2
Gastralgia (pain in the stomach), 49
Gastric symptoms, 49
General conformation of the lungs, 6-11
Gestation and Consumption, 44
Giant, the American, 67
Granulations (small, grain-like points
on the surface of a wound or ulcer,
the product of organized lymph),
Gummata (soft tumours or tubercles
containing gummy matter,, 15
Hæmoptysis (uiua, blood; TUOIS, a
125
spitting. Expectoration of blood.)
19, 45, 46, 77, 101, 105, 110, 117, 119,
Hæmorrhage (a discharge of blood), 20,
44, IIO
Hand-feeding of infants, 42
Hands and feet, heat of, 56
Healthy residence, 89-91
Hectic fever (a remittent fever, marked
by daily paroxyms), 46, 49, 55, 77,
101, 103
Height, weight, and vital capacity, 66
Hereditary influence, 26, 30, 113; pre-
disposition, 26–35
Horseback exercise, 119
Hygienic (relating to the preservation
of health), 72, 96, 99, 111
treatment, 72-98
Hypertrophy (vπep, in excess, TρON;
nutrition. Enlargement of a part
from excessive nutrition), 17
Indigestion, 48, 100
Inflammation of the lungs, 14
Infra-clavicular (underneath the collar-
bones), 115
Inhalation, 106-7
Inspection of the chest, 60
Intercostal (lying between the ribs), 82
Larynx (the upper part of the windpipe,
modified to contain the organs of
voice), 7, 9.
Laws of Health, 6
Lesions (lado, to hurt. Any morbid
change or injury), 19, 69
Life, out-of-door, 92
Liver, fatty degeneration of, 78
Lungs, anatomy of the, 6-12; Micro-
scopic, 11-12; inflammation of, 14,
21; general conformation of, 6—11;
physiology of, 12, 13; as influenced
by disease, 13; use of the, 12, 13;
Lymphatic, 49, 109
Marriage, cautions as to, 31, 113; and
consumption, 26, 28; consanguine-
ous, 32
Medicinal treatment, 98-108
Mensuration (measurement), 52
Miliary tuberculosis, 15, 37
Morbific (causing death), 36
Mucous membranes (surfaces which
secrete mucus), 11, 21, 50, 51
Mucus (fluid secreted by the mucous
membrane), 11, 12, 59, 107
Nidus (a nest), 20
Night-sweats, 101, 104, 112
Occupations, in and out-door contrasted,
40; unhealthy, 38
Edema (oidéo, to swell. A dropsical
swelling), 56, 59, 106
126
INDEX.
Out-of-door life, 92, 97
Ozone (concentrated oxygen), 93
Pabulum (food), 33, 49
Palliative (giving temporary relief), 98
Pathology(rutos disease; Xoyos. speech.
That branch of medicine which treats
of the nature, causes, and symptoms
of disease, 21
The
Pectoral (of the breast), 83
Percussion (percutio, to strike.
method of ascertaining the condition
of subjacent parts by the nature of the
sounds elicited by striking over the
part), 53
Pharynx, 59
Phthisical habit, 24, 27; diathesis, 25;
cough with diarrhoea, 120
Phthisis (from gow, to waste away).
See Consumption
Physical examination, value of, 60
Physical signs, and the methods of their
detection), 59-69
Physiology of the lungs, 12-15
Pleuræ (the serous membranes that
invest the lungs, and line the inside
of the chest), II
Pleurisy (inflammation of the mem-
brane lining the lungs and chest
walls), 11, III
Pneumonia, 14, 21
Post-mortem examination (the opening
and examination of the body after
death), 20
Pre-tubercular state, 118
Prognosis (determining beforehand the
course of a disease), 20
Proliferation (the process of the genera-
tion of new and similar elements), 14
Pulse, the, 55, 77
Pus (matter), 58
Râle (a rhonchus, or rattle), 111, 113
Residence, healthy, 89-91
Respiration, 12
Rhunchi, 63
Riding, 83, 119
Rowing, gymnastic exercises, etc., 83
Scrofula, 37, 93
Scrofula and Phthisis, 17
Sea-salt, 88
Septic (causing putrefaction), 34
Septum sepes, a hedge. A wall or
division separating two cavities), 8
Sibulant rhonchi (sibilo, I hiss. A hissing
or whistling sound), 63
Signs, physical, and the manner of
their detection, 59-69
1
Soil, influence of, on health, gr
Spirometry, 64
Sputa (matter spat up`, 115, 120
Stethoscope (an instrument invented by
Laennec for listening to the sounds
of the chest), 10, 53
Struggle for life, 122
Struma (scrofula). 41
Summary of symptoms, 64
Supra-scapular (above the shoulder-
blades), 63
Swing, the cross-bar, 84
Sweating, 65
Swinging the arms, 82-3.
Symptoms of Consumption, 46, 59
Table of height, weight, and vital
capacity, 66
Temperature, 55, 100; elevated, 20
Testimony of experience, 70
Thermometry
(an instrument
measure the heat of the body), 64
Thrush, 46, 50, 65
Tongue in Phthisis, 65
Tonsils, 52
to
Toxemia (Toikóv, a poison, aipa, blood.
Blood poison. 19
Trachea (trachus, rough.
The wind-
pipe or common air-passage of both
lungs. So termed on account of the
inequalities of its cartilages), 9
Treatment, epitome of, 100; difficulties
of, 98; hygienic. 72-98; medicinal,
98-108
Tubercles, 21, 22, 46, 52, 55, 64; course
of, 22-3
Tubercular Phthisis, 19, 21
Tuberculosis, acute, 17, 19, 21; 15, 17,
23, 37 pathology of, 23; preventi-
bility of, 17
Uvula, 52
Vascular vas, vessel. Relating to or
abounding in blood-vessels), 80
Venous (pertaining to the veins), 57
Ventilation. 34, 45, 81; defective, 36-
38; in schools, 37; among animals,
Viscera (internal organs), 49, 76
Vital capacity, 65-68
Vomica (vomo, to vomit.
the lungs), 23,54,63
38
An abscess in
Walking, 82
Warmth, 89, 97
Wasting, 47, 102; irregular, 48; with-
out apparent cause, 48
Weak, weeding out the, 121
Weight, table of height, and vital
capacity, 66
J. AND W. RIDER, PRINTERS, LONDON.
1
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