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CONSUMPTION CURABLE 
 
 AND THE MANNER IN WHICH 
 
 NATURE AS WELL AS REMEDIAL ART 
 
 OPERATES IN EFFECTING 
 
 A HEALING PROCESS IN CASES OF CONSUMPTION; 
 
 EXPLAINED AND ILLUSTRATED BY 
 
 NUMEROUS REMARKABLE AND INTERESTING CASES : 
 
 TO WHICH IS ADDED 
 
 A MODE OF TREATMENT, 
 
 BY WHICH 
 
 THE DEVELOPMENT OF TUBERCLES MAY BE PREVENTED 
 IN PERSONS LIABLE THERETO, 
 
 FROM HEREDITARY PREDISPOSITION, OR A BAD STATE OF THE SYSTEM 
 INDUCED BY VARIOUS CAUSES. 
 
 “ Laguerison dans les cas de phthisie pulmonaire ou I’organe n’a pas 6te entierement 
 envahi, ne presente, ce me semble, aucun caractere d’impossibilite, ni sous le rapport de 
 la nature du mal, ni sous celui de I’organe affecte.” — Laennec, Nouv. Ed., tom. ii, p. 112. 
 
 BY 
 
 FRANCIS HOPKINS RAMADGE, M. D. 
 
 FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS, SENIOR PHYSICIAN TO THE INFIRMARY FOR 
 ASTHMA, CONSUMPTION, AND OTHER DISEASES OF THE CHEST, ETC., LONDON. 
 
 FIRST AMERICAN FROM THE THIRD LONDON EDITION. 
 
 WITH AN INTRODUCTION BY THE PUBLISHER, 
 
 •IN WHICH SEVERAL CASES ARE STATED WHERE THIS PRACTICE HAS PROVED SUCCESSFUL IK 
 THIS COUNTRY, WITH OTHER CORROBORATIVE TESTIMONY. 
 
 N E W-Y 0 R K : 
 
 PUBLISHED BY J. M. HOWE, 102 GRAND-STREET, 
 
 AND TO BE HAD ALSO OF 
 
 WILEY & PUTNAM, 161 BROADWAY. 
 
 1839 . 
 
O’ This Book, together with the Tube, may be had of J. M. Howe, Dentist, at 
 No. 102 Grand-street, New-York. Mr. Howe will, also, give directions as to the 
 use of the Tube, and any other information in his power connected with this subject. 
 All letters must be post paid. 
 
 
 “ Entered according to Act of Congress, in the year 1839, by J. M. Howe, in the 
 Clerk’s Office of the District Court of the Southern District of New-York*” 
 
Rm-c 
 
 INTRODUCTION. 
 
 y In presenting the work of Dr. Ramadge to the American public, it 
 it may be proper to give some explanation as to the circumstances 
 which have led to its publication. The following letter, which appeared 
 sS> in the Christian Advocate and Journal, of March 1, 1839, will throw 
 ^ some light upon the subject. 
 
 LETTER TO CONSUMPTIVES. 
 
 Messrs. Editors , — A two-fold object induces me to present the fol- 
 lowing for publication ; the one to proclaim the goodness of God in 
 his providential dealings with me in staying the hand of disease and 
 death, and the other the very novel instrumentality by which it has 
 been effected ; hoping, by the blessing of God, it may be a means of 
 saving some similarly afflicted. And without entering into any detail 
 of the general state of my health, I would remark that I took a cold 
 in December, 1837, after attempting to preach, which settled in my 
 throat, and finally terminated in chronic bronchitis ; and after having 
 had the best medical advice at home for about four months without 
 any benefit, but rapidly getting worse, so that my throat and lungs 
 were considerably affected, and my voice reduced to a whisper, every 
 change of weather affecting me much, I was informed by my medical 
 friends that I had nothing to expect from medicine, and that a sea 
 voyage and change of climate would be the only possible means of 
 alleviating my symptoms. In June last I sailed for Liverpool. The 
 result of the voyage was entire physical prostration ; but I still hoped 
 that change of climate would perform for me what the voyage had 
 not. For this purpose I travelled to some extent in England, and 
 consulted three of the most eminent physicians, who recommended 
 similar means to those of the physicians at home. These remedies 
 gave no relief, but together with the humidity and changeableness of 
 the climate and the fatigue of travelling, rather aggravated my di- 
 sease. I then went into France, hoping for the time being my symp- 
 toms would be alleviated ; but was again disappointed. And being 
 wearied out, and despairing of any relief from the ordinary means 
 used in such cases, I committed myself entirely to the Lord ; being in 
 much doubt whether my health would enable me to reach my home. 
 At Boulogne, on my return, I was obliged to consult another physi- 
 cian ; but to no purpose. And when I returned to London, I seemed 
 literally choking to death, and had to take to my room and bed. In 
 this condition I was providentially relieved by a work being put into 
 
 c 
 
4 
 
 INTRODUCTION. 
 
 my hands, entitled “ Consumption Curable,” by Dr. Ramadge, the se- 
 nior physician of the London Lung Hospital. After a cursory read- 
 ing of the book, I was led to consult the doctor, and was by him 
 encouraged to expect entire recovery. He directed as a principal 
 means — medicine being only auxiliary — a tube to breathe through. I 
 followed his advice, and experienced by its use, in the course of only 
 one or two days, very essential relief. It was the first thing I 
 had found to alleviate my symptoms in the least. It is now five 
 months since I began to use the tube, and my recovery has been gra- 
 dually progressing. On the first of January last, I resumed my labours as 
 chaplain of the City Hospital, from which I had been laid aside for 
 nearly one year ; and what is very remarkable, and speaks volumes 
 for the tube, though I arrived in the city in October last, with the 
 most unfavourable season before me, and have exposed myself to all 
 weathers, (storms not excepted,) and have twice taken severe colds 
 which settled in my bones, I have not once had any cold to settle on 
 my lungs or in the throat ; although previous to my using the tube, 
 the slightest unfavourable change affected me most seriously. 
 
 The tubes are made of different materials, and are five feet long^ 
 and half an inch in diameter, furnished with a mouth-piece, and piece 
 to contract the end to keep the air from rushing in and out too rapidly. 
 The instrument is to be used three times a day for the space of from 
 four to six months, discontinuing its use under certain symptoms. 
 
 I would further remark that Dr. Ramadge is a regularly educated 
 physician, and has been for nearly twenty years in the London Lung 
 Infirmary, and for several years past the senior physician. This is a 
 public institution, and has been established, if I mistake not, about 
 one hundred years, and is under the patronage of the nobility and 
 gentry of England. He assured me again and again that the use of 
 the tube would do more to prevent consumption, and restore those who 
 are consumptive, than any other means within his knowledge. 
 
 The doctor has written a very able work on the subject, explaining 
 the philosophy of his treatment, in which he shows the great benefit 
 arising from inhalation in preventing consumption, by enlarging the 
 volume of the lungs, and materially altering the shape of the chest ; 
 and also curing the disease in its incipient stages, and even after the 
 top of both lungs has been very considerably ulcerated. 
 
 So very limited is the knowledge of Dr. Ramadge’s work on the 
 treatment of throat complaints and consumption in this country, al- 
 though on the continent of Europe it has been translated into several 
 languages, and so invaluable, in my humble opinion — for I am quite 
 sure, under God, I owe my life to him — that I consider it an im- 
 perative duty I owe to my suffering fellow-men to call their atten- 
 tion to it. 
 
INTRODUCTION. 
 
 5 
 
 While in London I was several times at the Hospital, and conversed 
 with many of the patients, who all testified to the benefit of the tube ; 
 and since my return home I have recommended it to several, some of 
 whom have found very great benefit. I shall be happy to show the 
 tube, and also to furnish such other information as to the manner of 
 using it, together with some general information on the subject, at my 
 dwelling, No. 102 Grand-street, New-York. 
 
 JOHN M. HOWE. 
 
 The preceding letter was extensively copied in the city and 
 country papers, and was read with so much interest, being so novel 
 in its character, that many persons called on me soliciting further in- 
 formation, and many from abroad wrote to me ; as answering them 
 consumed much of my time, and subjected me to some expense, and 
 being desirous to spread the information, and to do it more effectually, 
 I abridged Hr. Ramadge’s work, and published a thousand copies ; and 
 although it is but six months since its publication, without the aid of 
 notices from the press, the whole are nearly disposed of. It now 
 appears necessary that another edition should be printed ; and so re- 
 peatedly has the work been called for by physicians and others, that 
 all doubt is now dispelled as to the publication of the complete work 
 being sustained. 
 
 As the principles of practice laid down in this work differ very ma- 
 terially from those of practitioners of our own country in chest dis- 
 eases, and as I have been successfully treated by the doctor, to whom, 
 under God, I am indebted for the prolonging of my life, (a debt of gra- 
 titude I can never repay,) for the benefit of others I deem it incum- 
 bent upon me to state a few facts corroborative of this practice, drawn 
 from my own case, and facts obtained from others. 
 
 For several years past I had suffered much from indigestion, which 
 deranged the whole system, and produced, finally, disease in the lungs. 
 Previous to sailing for England my symptoms were, the hectic fever, 
 night sweats, cold chills, a slight hacking cough, with some expecto- 
 ration 5 voice reduced to a whisper, and much emaciation of body. I 
 was labouring under most of these symptoms when I came under 
 .the care of Dr. R. I was informed that both my lungs were tuber- 
 culous, and had long considered my case utterly hopeless, unless God in- 
 terposed in some extraordinary way to save me. Almost the first 
 question that I proposed to Dr. R. was, with my mouth to his ear, in 
 a whisper, “ Doctor, can I yet live, or must I die?” He replied, “You 
 have come just in time to save your life ; you will recover.” “ Shall 
 I have my voice ? shall I be able to speak loud ? shall I be able to sing ? 
 shall I be able to preach ?” To all of which he answered, “ You will 
 certainly recover your voice so as to speak loud, to sing, and to preach.” 
 
6 
 
 INTRODUCTION. 
 
 “ How long, sir, will it probably be ere this takes place ?” He re- 
 plied, In four or six months you will call yourself quite well, and you 
 will attain a vigour you have not had for years.” I replied, “ Ah, 
 sir, I am afraid to rely upon you.” He answered, with warmth, “ I 
 would ensure it by my right arm, were it possible.” I then informed 
 him that I had made arrangements to leave England in twenty days, 
 and inquired, whether he wished me to tarry longer. He replied, “ You 
 may return by that time.’’ Upon subsequent interviews with him, I 
 made particular inquiries relative to my future place of residence, &c. 
 He directed me to pass the winter at home, and not to change for a 
 warmer climate, which I had previously purposed to do, and, instead 
 of confining myself to a warm room, or to the house, to expose my- 
 self to the weather every day, without regard to storms, as occasion 
 might require. Being somewhat skeptical as to the propriety of the 
 advice given, with the doctor’s permission and invitation, I visited 
 several times the lung infirmary,* to get what information I could 
 from persons under his care, — to many of whom I proposed the follow- 
 ing questions : “ What is the nature of your disease ?” “ Consump- 
 
 tion,’’ was the usual reply. “ Whose care have you been under pre- 
 vious to coming here for advice ?” Some answered one, and some, 
 another ; some named one or two hospitals. “ Did you get benefitted 
 “ No.” “ How long have you been here ?” They answered different 
 
 * It may be of importance to state, for the information of those who are unac. 
 quainted with the standing of Dr. Ramadge, and the institution with which he is 
 connected, that he is a regularly educated physician, and, for nearly twenty years 
 last past, has been physician to the London Lung Infirmary. Through the kind- 
 ness of a friend, I am enabled to give the following statement, copied from the 
 Royal Calendar, and Court and City Register, for England, Scotland, Ireland, and 
 the Colonies, for the year 1825. 
 
 “ Infirmary for Asthma, Consumption, and other Diseases of the Lungs, Union- 
 stjeet, Bishopsgate. 
 
 President, Duke of Sussex. 
 
 Vice Presidents, Marquis of Camden, Marquis of Cholmondeley, Earl of Darn- 
 ley, Earl of Crawford, Lord Calthorpe, Bishop of Salisbury, Benjamin Shaw, Esq., 
 Thomas C. Marsh, Esq., John Meyer, M. D. 
 
 Treasurer, William Heygate, Esq. 
 
 Consulting Physician, Isaac Buxton, M. D. 
 
 Physician, F. H. Ramadge, M. D. 
 
 Apothee and Surgeon, Mr. Hurkey. 
 
 Honorary Secretary, Samuel Amory, Esq. 
 
 Assistant Secretary and Collector, Mr. William Eddrup, White-chapel Road. 
 
 Housekeeper, Mrs. Elizabeth Fuller.” 
 
 From the above, it appears that Dr. R., as long ago as 1825, was physician to the 
 institution, and that the Infirmary was sustained by some of the most distinguished 
 men in the kingdom — and I am enabled to state, from my own personal knowledge, 
 that the institution is still sustained by individuals of the highest rank, and that 
 Dr. R. is now, and has been for several years past, the senior physician. 
 
INTRODUCTION. 
 
 7 
 
 lengths of time. “ Have you got benefit here?” “I have,” was the 
 usual reply. “ Under whose care are you in this place ?” “ Dr. Ra- 
 
 madge’s.” “Do you consider Dr. Ramadge a skilful physician?” 
 “ I do, most certainly.” One replied, “ Sir, you could not have your 
 life in safer hands.” 
 
 I also was favoured, upon more than one occasion, by being present 
 at the examination of some thirty, or perhaps fifty persons, who 
 applied for advice. One instance, which made a lasting impression 
 on my mind, was that of a young woman, of very interesting appearance, 
 dressed in deep mourning. After an examination of her chest and 
 symptoms she inquired his opinion. With great kindness, and sym- 
 pathy of feeling, he informed her, that all means would avail but little ,* 
 that in all human probability she would not recover. The silent tear 
 trickled down her face ; it seemed as though her only hope was cut off. 
 But, added he, you must use the means, and try. This frankness and 
 plainness of dealing inspired me with much confidence. How much 
 better, thought I, for a physician to be honest ; to deal plainly with 
 his patients. Why should a patient, labouring under a fatal disease, 
 be deceived upon a subject of so much importance. How much better 
 would it be to discover to him, with sympathy and kindness, his real situ- 
 ation, and thus afford him time to adjust his temporal affairs, and make 
 some preparation for his entrance upon the untried realities of another 
 world, than to keep him in suspense, or in the expectation of recovery, 
 until the last moments of life. 
 
 The home-bound voyage was much more comfortably made than 
 the outward one. I did not suffer the one-tenth part by sea-sickness, 
 owing, in part, to using the tube for a few minutes daily in the 
 cabin, which produced favourable results upon the stomach, &c., by 
 increasing the action of the diaphragm. 
 
 It is now a year since I first came under Dr. R.’s care, and I have 
 realized the benefit of his advice, and the fulfilment of his predictions. 
 My voice has returned so that I can sing, for a short time, at its highest 
 pitch, and speak loud in public for half an hour, without injury. My 
 digestion is better than it has been for years, so that I am enabled to 
 eat whatever is set before me, with the exception of hot breads, &c. 
 But what is of still greater importance is, that the shape of my chest 
 is very astonishingly improved and enlarged. About six years since 
 the measurement of my chest, close under the arms, was thirty-two 
 inches ; but, for five years following, there was a gradual diminution, 
 so that for three years previous to my getting the tube, my mea- 
 surement was thirty inches ; making a decrease in the size of two 
 inches. Since getting the tube I have increased in size two and a half 
 inches, making my measurement now thirty-two and a half inches. 
 But the alteration in the conformation of my chest is truly wonderful. 
 
8 
 
 INTRODUCTION. 
 
 The collar bones were very prominent, and the pit of the neck so 
 sunken, and the chest so drawn together, that I was afraid to see my- 
 self in the glass. Now my chest has recovered a rounder and plumper 
 appearance, and my neck has filled out, so that the conformation is 
 better than it has been for years ; and my whole system is generally 
 improved ; the principal cause of which I attribute to the instructions 
 received from Dr. R. 
 
 I would also remark, that previous to my getting the tube every change 
 of weather, even the slightest, affected me much, notwithstanding the 
 extra clothing put on, and care as to exposure ; but since using the 
 tube, I have taken off all extra clothing, without even wearing flan- 
 nels, except in the winter, exposing myself to all weathers every 
 day through the whole of the last winter ; and up to the present time, 
 (storms not excepted,) without once taking cold in my lungs. So 
 great has been the benefit received that I am encouraged to expect a 
 much greater strength of lungs than I have had for years, and perfect 
 recovery. 
 
 It has however been remarked by some, that my lungs never 
 could have been tuberculous, and that consumption could not have 
 been fairly seated, or I should not have recovered. This I grant 
 is the conclusion to which one must arrive from all the theories 
 and practice in common use. As to my lungs being diseased, 
 and of their being tuberculous, I could name several highly res- 
 pectable physicians of this city who would testify to the fact. 
 Previous to my going abroad four physicians, three of them of emi- 
 nence, informed me that my right lung was diseased, and that no me- 
 dical means could reach my case, and recommended me a voyage and 
 travelling. One of them, after my sailing, informed some of my friends 
 that I would never return. And when, in the good providence of God, 
 I had the first interview with Dr. Ramadge, after an examination he 
 informed me that both my lungs were tuberculous, but that I should 
 certainly recover. I wrote home to a friend that Dr. R. stated 
 that my lungs were tuberculous ; this friend informed one of 
 the physicians. He replied, “ I knew his lungs were tubercu- 
 lous previous to his leaving home.” And since my return, two 
 other distinguished physicians of this city, who had heard of my case, 
 called to see me, requesting an examination of my chest ; for, said 
 they, there is much that passes for consumption that is not. I grati- 
 fied them, and they pronounced both lungs tuberculed ; and one 
 remarked that the upper lobe of the right lung had passed to hepatiza- 
 tion. The other informed me that he had no more doubt of the diseased 
 state of the right lung than though he could see it. Besides the opi- 
 nions of physicians, my symptoms and appearance would justify the 
 belief that I was fair lyin consumption, and many of my friends were 
 
INTRODUCTION. 
 
 9 
 
 of the same opinion. Dr. Aider, the Wesleyan delegate to Canada, 
 now in this city, with whom I had the pleasure of a few short inter- 
 views in London and in Paris, informed me this day that he considered 
 me so much indisposed that he doubted whether I would survive the 
 home voyage. 
 
 I should not be thus particular on this point was I not fully aware 
 that some have asserted since my great improvement, that I never 
 had the disease. My own opinion is, but for the tube and Dr. R. as 
 the means, with the divine blessing, ere this the work of life had been 
 done, and I should have been taken to my rest. 
 
 But my own case is not a solitary one. I have the testimony of 
 persons of standing and of undoubted authority whom I have recom- 
 mended to use similar means. As an evidence of the great benefit of 
 inhalation, a respectable physician of this city informed me that one 
 of his patients had increased in size two inches and a half by the use 
 of the tube, in about two months, and that another of his patients 
 had received very great benefit ; he has recommended more than a 
 dozen to use it, some for the preventing and others for the cure of 
 disease. 
 
 Dr. Wm. H. Huggins, of West Hartland, Conn., writes me thus : 
 
 I have felt much interest in relation to the success of Dr. Ramadge’s 
 treatment in cases of phthisis pulmonalis, or pulmonary consumption, 
 — but fearful that this like other modes of treating that insidious dis- 
 ease might prove fruitless, I have delayed expressing my opinion until 
 confirmed by observation. I am ready to say, that the practice has 
 more than answered my expectations.” This gentleman has experi- 
 mented in six or seven cases. 
 
 John L. Sullivan, M. D., of New-Haven, after having perused 
 Dr. R’s. abridged work, wrote me thus, in a private letter : — “ Permit 
 me in thus commencing my acquaintance with you, and which I 
 shall hope to do personally when I first come to New- York, to con- 
 gratulate you on the good providence of God, who not only sent you 
 abroad in suffering to find the remedy, but made you the instrument 
 of the introduction into your country of the means of restoring many 
 to health. We and the public have much reason to be thankful to 
 the merciful and beneficent Disposer of events for this method. 
 
 “ The invention is philosophical and consistent. The discovery 
 was arrived at by the cautious gradations of observation and experi- 
 ment to establish its principles, and it claims no more than reason 
 warrants.” This gentleman has fully adopted Dr. R.’s practice of 
 inhalation in connection with his own, and has published a pamphlet 
 recommending it. 
 
 The Rev. H. G. L , of New-Haven, writes me thus : — “ It 
 
 gives me pleasure to say that my wife appears to be receiving much 
 
 2 
 
10 
 
 INTRODUCTION. 
 
 benefit from the use of your tube. I cannot but hope, if she improves 
 as she has done, she will soon be as well as formerly.” 
 
 The Rev. D. B. Randall, a member of the Methodist Episcopal 
 Annual Conference, in Maine, who had used the tube about six or 
 eight weeks, was so much benefited that he rose in the Conference, in 
 the presence of about two hundred ministers, to express his gratitude 
 to God, and to recommend it to others.* 
 
 The Rev. A. D. Merrill, of Providence, Rhode Island, has taken 
 so much interest in spreading the information that he has sent for a 
 dozen and half of the tubes. 
 
 The Rev. Ezra Withey, late of Maine, has written me a very in- 
 teresting account of the benefit he received from the use of the 
 tube, after having been afflicted with a pulmonary disease for two 
 years, during which time he had applied to various physicians of repu- 
 tation without any relief. He had been so afflicted by the changes 
 of the weather previous to using the tube, that he was obliged for 
 three months to confine himself within doors ; but even then he was 
 greatly affected. When so far relieved as to expose himself to the 
 air, he only ventured out during a few hours in the middle of the day • 
 but not a fortnight had elapsed from the time he got the tube till he 
 w’as enabled to go out mornings and evenings, in damp and rainy 
 weather as well as in the dry ; and ere he left the city I listened to 
 him twice from the sacred desk, preaching with much energy and 
 clearness of voice. He , soon returned to New-London, where he is 
 preaching the gospel ; and he writes me that some of his friends state 
 that his “ voice in singing is better than ever.” 
 
 The Rev. Mr. Garrett, of Lower Canada, writes me thus : — 
 
 NeW‘Yorlc, July 29, 1839. 
 
 Dear Sir, — Last June I arrived in this city from Hatley, Lower 
 Canada. For several months previous I was incapable of discharging 
 the ordinary duties of an itinerant ^ reacher, in consequence of a se- 
 vere cold I received during last winter, producing almost constant 
 pain in my chest, from right to left, great pain and difficulty in speak- 
 ing, together with frequent discharges of blood from my mouth. 
 
 I had been recommended by my medical friends to abstain in toto 
 from public speaking, and, if possible, to take a sea voyage. 
 
 In attending to these directions, I came from the province of Lower 
 Canada to this city, and, shortly after my arrival, was introduced to 
 you by the kindness of my friend, Mr. S. Dando. Having carefully 
 perused your pamphlet entitled “ Consumption Curable,” I determined 
 
 * He has since recommended it to others, and writes me that “ it has given 
 general satisfaction.” 
 
INTRODUCTION. 
 
 11 
 
 to procure a tube from you, and try its effects upon myself. I com- 
 menced by regularly breathing backward and forward, through the 
 tube, according to your directions, and, through divine mercy, have, 
 since then, been constantly increasing in inward strength ; so much 
 so, that yesterday I was enabled to comply with an invitation from 
 my excellent friend, the Rev. Mr. Trippet, Wesleyan minister of Se- 
 venth-street chapel, to officiate in his pulpit. I can now breathe 
 much deeper, and with less pain, than formerly. I have also had but 
 one return of blood-spitting since I commenced using the tube. I find, 
 after an exact measurement of my chest, that I have gained rather 
 more than three quarters of an inch. I still continue to use the tube, 
 and confidently hope that through the divine blessing I shall be fully 
 restored to my former health and strength. 
 
 You are (allow me to say) at perfect liberty to make any use of the 
 above simple and unvarnished statement of facts you think proper. 
 
 I am, dear sir, respectfully yours, &c., 
 
 RICHARD GARRETT. 
 
 The following testimony, from the pen of Rev. Mr. Sunderland, is 
 also very interesting : — 
 
 New- York, March 20, 1839. 
 
 Dear Sir, — It is now three months since, at your recommendation, 
 I commenced using the tube invented by Dr. Ramadge, for the cure 
 of pulmonary consumption. As you know, it is more than seven 
 years since I lost my voice from a severe bronchial affection, caused 
 by preaching when I had a bad cold. During this time I have used 
 every means in my power for a recovery ; and while my general health 
 for two years past has been very good, my voice had recovered 
 but very little strength ; (I mean, of course, strength sufficient to ena- 
 ble me to speak in public ;) till since I commenced using the tube. 
 And though I have used it only about eight weeks in all, yet I must 
 say that the tone of my voice has improved considerably more in this 
 time, I think, than during a number of years before. This is also the 
 opinion of my friends. And it seems to me that a slight acquaintance 
 with the anatomy and physiology of the human body must convince 
 any one that the system adopted by Dr. Ramadge is based upon the 
 immutable principles of philosophy and truth ; and the success which 
 has crowned his practice for a number of years puts the matter beyond 
 all reasonable doubt, that consumption, if attended to in time, can be 
 cured. LE ROY SUNDERLAND. 
 
 Mr. Sunderland has since informed me that he is well. 
 
12 
 
 INTRODUCTION. 
 
 From the Rev. T. J. Harris. 
 
 Having been afflicted for a number of years with a most inconve- 
 nient and distressing affection of the throat, it at length terminated 
 in the raising of blood. I was induced to procure of Mr. J. M. Howe 
 the tube recommended by Dr. Ramadge, and instructions for its use, 
 &:c., and have found it effectual in removing, in the course of a few 
 weeks, entirely the inflammation from my throat, and a most distress- 
 ing sense of pain and weakness of my lungs. Whereas formerly my 
 pulpit services were attended with great pain and suffering, I have 
 now for some time resumed them, with great comfort to myself, and 
 with little pain or difficulty of any kind, and am free to say, that no- 
 thing that I have ever tried has had the effect produced by the tube. 
 
 REV. T. J. HARRIS, 
 
 Pastor of 2d Mariners' Church, New- York, 
 
 From Rev. Mr. Sutton, of New- York. 
 
 Dear Sir, — I take much pleasure in informing you that since I 
 commenced the use of Dr. Ramadge’s inhaling tube my health has 
 slowly, yet constantly improved to the present time. When I obtained 
 the tube of you my health was very poor, as you will recollect, and my 
 difficulty in breathing was very great. This was attended with inflam- 
 mation of the left lung, and an almost unceasing pain in the left breast 
 and side. These symptoms, however, are being gradually overcome, 
 insomuch that I am strongly inclined to believe that, with the blessing 
 of a good Providence, a final restoration will yet take place. As to 
 the propriety of the tube in cases of bronchial and pulmonary affec- 
 tions I can have no doubt ; faith has been inspired in me by its phi- 
 losophy and its use. Furthermore, I have obtained the tube for several 
 intimate friends, to whom I recommended it, and who are now being 
 benefited by it. The increase in the size of my chest since I first 
 obtained the tube has been two inches. 
 
 I am most affectionately your brother, 
 New-York, Sept. 4, 1839. GEORGE D. SUTTON. 
 
 A lady of wealth and respectability, residing in Abingdon-square, 
 whose habit is decidedly consumptive, and who is confined to her house, 
 under the care of a respectable physician, has been using the tube by 
 his advice. When he obtained it for her he informed me that her 
 lungs were so much diseased, particularly one of them, which was ex- 
 tensively tuberculated, that he had no expectation that she could live 
 any length of time, being very much debilitated, with great weak- 
 ness of voice, &c. She has received very great benefit, so as to enjoy 
 comfortable health. In order to obtain some facts relative to her 
 
INTRODUCTION. 
 
 13 
 
 case I visited her while preparing this, and she informed me that her 
 chest has enlarged two or three inches since commencing the use of 
 the tube, that her voice is much strengthened, so that she can 
 converse with less weariness than formerly, and can indulge in sing- 
 ing a little, and that her general health is greatly improved. Her 
 improvement thus far affords the highest gratification to her friends. 
 
 A lady, in whose integrity and piety I have the utmost confidence, 
 informed me, a few days since, that as she was sailing down the Hud- 
 son, in one of our steamboats, an aged lady on board informed her 
 that her daughter had been raised from a very low consumptive state 
 by the use of the tube, to the agreeable disappointment of her phy- 
 sician and family. 
 
 From William H. Huggins^ M. Z>., of West Hartland, Conn., dated 
 
 Oct. 11, 1839. 
 
 I wish you to forward another tube, book, (fee., to Hartford, as soon 
 as Friday, the 18th, without fail. I herewith enclose the amount. I 
 have several patients under my care who are using the tube, and at 
 present seem to be benefited materially by it. Yours, &;c., 
 
 WILLIAM H. HUGGINS. 
 
 I have many interesting communications : one more shall suffice. 
 A lady from Owego writes me thus : — 
 
 “ Before I used the tube, at times I could not speak a loud word, 
 and it was very difficult for me to breathe ; but after using it about 
 three weeks, I was not again attacked with such extreme weakness of 
 voice and pressure for breath.” She adds, “ I am acquainted with two 
 ladies who are using your tubes, and have received great benefit from 
 them. One resides in Newburgh, and the other in Shawangunk.’’ 
 
 So increasingly numerous have been the cases of pulmonary con- 
 sumption, and so fatal the progress of the disease throughout a 
 large portion of our widely extended country, notwithstanding all the 
 efforts made to arrest it, that if more information can be thrown on 
 its treatment, it is due to the public that it should be communicated. 
 And while intelligent writers have shown, in various publications, the 
 importance of physical exercise in the open air, cleanliness, cheerful- 
 ness, and a strict regard to temperance in all things, I am led to 
 conclude, from my own experience and from observation, that too 
 little has been said or written upon the importance of proper breath- 
 ing, and its beneficial effects upon the whole system. 
 
 , The late Dr. Talmadge Sutherland, of this city, taught that one 
 
14 
 
 IXTRODUCTION. 
 
 of the principal causes of indigestion is improper breathing, which pro- 
 duces a total disarrangement of the abdominal viscera and the circula- 
 tion of the fluids, with a contraction of the muscles ; that the action of 
 the diaphragm becomes inadequate to perform its proper requirement, 
 producing indigestion, which, if not remedied, would eventually be fol- 
 lowed by pulmonary consumption ; and that the principal cause which 
 leads to improper breathing is, an anxious state of mind, produced by 
 disappointments, losses, or embarrassments, &c. This improper 
 breathing, such as sighing, or the like, he styled an upward breath- 
 ing. In treating his patients he particularly laboured to correct the 
 breathing. I owe my recovery from a low state of health, of full 
 three years’ standing, (in which I was entirely unfitted for business, 
 by indigestion,) to him, after having been medically treated by 
 some of the most eminent physicians of this city and elsewhere. 
 And to my certain knowledge he was also instrumental in recover- 
 ing many to health and usefulness who could get no benefit from 
 the usual medical treatment, and who had no prospect before them 
 but of dragging out a miserably useless existence. 
 
 ^The following facts will not be uninteresting. The testimony of a 
 gentleman with w^hom I travelled some distance in England is in point. 
 He informed me that three oil’ four years ago he had repeated attacks of 
 hemorrhage of the lungs, and that he cured himself by rising early in 
 the morning, and walking out on some hills adjacent, and taking deep 
 inspirations for an hour at a time. 
 
 The Rev. John Wesley states that he has known a deep con- 
 sumption to be cured by putting a sod of turf to the nostrils and taking 
 the scent of the earth. 
 
 I am indebted to Dr. North, of Saratoga, for the following fact : — 
 
 “ Dr. Dewees, of Philadelphia, recovered from frequent hemorr- 
 hages from the lungs, when young, by playing the flute, which prac- 
 tice he adopted with the express object of removing a threatened con- 
 sumption.” 
 
 The exercise in the lungs, by the use of wind instruments, beneficial 
 as it may have been in this solitary instance, is by no means to be 
 recommended, as it is a constant effort to expel from the body the air, 
 while little opportunity is offered to permit the person fully to inflate 
 the lungs by drawing a full and deep inspiration ; and although it pro- 
 duces exercise in the lungs, it is the opposite of the healthy and vigor- 
 ous exercise resulting from healthy breathing, or breathing through 
 the tube. 
 
 The Rev. John Hodgson, jr., of Middlesborough on Tees, En- 
 gland, gave me the following interesting account of a gentleman edu- 
 cated as a physician, who, on leaving his profession for the pulpit. 
 
INTRODUCTION. 
 
 15 
 
 after a few years was taken with a throat disease, with loss of voice, 
 and great debility of the chest. After being medically treated without 
 benefit, he was informed by the faculty that he would jeopard his life 
 by any further attempts at public speaking, and that it was necessary . 
 to abandon it entirely. He resumed his medical practice, and subse- 
 quently the thought occurred to him, that he had read in his youth of 
 the great importance of correct breathing, and of breathing through the 
 nostrils. He at once commenced this mode of breathing, taking deep 
 inspirations : after thus practising a few months he was perfectly 
 restored to health, and his voice was so strengthened, that for many 
 years he could with ease address the largest public assemblies in the 
 most spacious buildings. 
 
 The following remarks on the structure of the lungs, and the benefi- 
 cial effects of proper respiration, are from Combe’s Physiology, a work 
 of acknowledged merit, which is extensively before the public : — 
 
 “The substance of the lungs consists bronchial tubes, air-cells, blood- 
 vessels, nerves, and cellular membrane, or parenchyma. The first are 
 merely continuations and subdivisions of the windpipe, and serve to 
 convey the external air to the air-cells of the lungs. The air-cells 
 constitute the chief part of the pulmonary tissue, and are in one sense 
 the termination of the smaller branches of the bronchial tubes. When 
 fully distended, they are so numerous as in appearance to constitute 
 almost the whole lung. They are of various sizes, from the 20th to 
 the 100th of an inch in diameter, and are lined with an exceedingly 
 fine thin membrane, on which the minute capillary branches of the 
 pulmonary arteries and veins are copiously ramified ; and it is while 
 circulating in the small vessels of this membrane, and there exposed 
 to the air, that the blood undergoes the change from the venous to the 
 arterial state. So prodigiously numerous are these air-cells that the 
 aggregate extent of their lining membrane in man has been computed 
 to exceed a surface of 20,000 square inches. 
 
 “ It may be thought that the interposition of such a membrane must 
 have the effect of preventing any action of the air upon the hlood. 
 But, in addition to the proof to the contrary drawn from observation, 
 it has been ascertained by experiment that even the thick and firm 
 texture of the bladder is insufficient to prevent the occurrence of the 
 change ; venous blood confined in a bladder speedily becoming of a 
 florid red, like arterial blood. 
 
 “ The free and easy expansion of the chest is obviously indispensa- 
 ble to the full play and dilatation of the lungs ; whatever impedes it, 
 either in dress or in position, is prejudicial to health ; and, on the other 
 hand, whatever favours the free expansion of the chest equally promotes 
 the healthy fulfilment of the respiratory functions. Stays, corsets, and 
 tight waistbands, operate most injuriously, by compressing the tho* 
 racic cavity and impeding the due dilatation of the lungs ; and in many 
 instances they give rise to consumption. I have seen one case, in 
 which the liver was actually indented by the excessive pressure, and 
 long continued bad health and ultimately death were the results. In 
 allusion to this subject, MI. Thackrah mentions, that men can exhale. 
 
16 
 
 INTRODUCTION. 
 
 at one effort, from six to ten pints of air, whereas in women the ave. 
 rage is only from two to four pints. In ten females, free from disease, 
 whom he examined about the age of 18^, the quantity of air thrown 
 out averaged 3^ pints ; while, in young men of the same age, he found 
 it amount to six pints. Some allowance is to be made for natural 
 differences in the two sexes, but enough remains to show a great di- 
 minution of capacity, which can be ascribed to no other cause than 
 the use of stays. 
 
 “Judicious exercise of the lungs is one of the most efficacious means 
 which we can employ for promoting their development and warding 
 off their diseases. In this respect the organs of respiration closely 
 resemble the muscles and all other organized parts. They are made 
 to be used, and if they are left in habitual inactivity their strength and 
 health are unavoidably impaired. 
 
 “ When the chest is expanded by a full inspiration, the bowels are 
 pushed downward and forward to make way for the lungs ; when 
 the air is again expelled, and the cavity of the chest diminished, the 
 very muscles which effect this by pulling down the ribs contract 
 upon the bowels also, and push them upward and inward, as can be 
 plainly perceived by any one who attends to his own breathing. By 
 this contrivance, a gentle and constant impulse is given to the stomach 
 and bowels, which is of great importance to them in contributing to 
 digestion and in propelling their contents.” 
 
 He remarks further upon respiration and animal heat : — 
 
 “ The relation between the production of animal heat and the con- 
 dition of the respiratory functions, is the most direct and remarkable. 
 In general, other conditions being alike, heat is generated more or less 
 freely, in proportion to the size and vigour of the lungs ; and when 
 these are impaired, the production of heat is diminished. Hence many 
 persons with imperfectly developed lungs, and a predisposition to con- 
 sumption, complain habitually of coldness of the surface and feet ; 
 and many who were previously in good health become more and more 
 sensible to cold, in proportion as the approach of disease weakens the 
 functions of the lungs. I have noticed this increased sensibility to 
 cold as a precursor of chronic pulmonary disease, both in myself and 
 others, before any other very ostensible symptom had appeared, and 
 think I have seen its further progress arrested by the timely use of 
 proper means, where much greater difficulty would have been expe- 
 rienced had the warning not been attended to. 
 
 “ The generation of heat in the living system being so immediately 
 connected with the lungs, we find the temperature highest in those 
 animals who possess them in the greatest perfection, viz. birds. In 
 many species, the internal heat exceeds that of man by twenty or thirty 
 degrees; while that of man exceeds, to as great an extent, the heat 
 of such of the inferior animals as are remarkable for imperfect organs 
 of respiration.” 
 
 Beneficial, however, as is correct breathing, and necessary as it is to 
 the enjoyment of health, yet I well know that it is exceedingly diffi- 
 cult for a person in a low state of health to perform it so as to give a 
 healthy and vigorous exercise to the pulmonary muscles or digestive 
 
INTRODUCTION. 
 
 17 
 
 organs, without some contrivance to assist. I know of nothing so 
 well calculated to afford this exercise, expansion, and full develop- 
 ment of the lungs, as the tube ; a few months’ use of it by the invalid 
 will so call the chest into action as to enable him to breathe well with-' 
 out it. 
 
 The practice of Dr. Ramadge, however, is entirely new in this 
 country, and time must elapse ere it will be extensively known, adopt- 
 ed, or even fairly experimented on; but from the reception it has already 
 received from some physicians and other persons, I am encouraged to 
 hope that it may be brought into general use. 
 
 If the principles of practice laid down in this book be true, (and I 
 verily believe they are, if fairly adopted and practised,) how many a 
 pallid, cadaverous countenance might again be flushed with health ; 
 how many a feeble limb again nerved and strengthened ; and how 
 many a family made to rejoice that their stay and only hope in life 
 might yet be permitted to tarry with them ! 
 
 But even though it should not accomplish all that is asserted, yet 
 it still claims a fair and impartial trial ; for if it fail at last, it will do 
 no more, or accomplish no less, than all other means that have been 
 used in consumption for ages before it. But of this much I am cer- 
 tain, the means are so simple, and the exercise of inhaling so grateful 
 and soothing to the patient, affording him exercise and pastime, that 
 it will at least contribute to smooth his pathway to the tomb. But it 
 has been objected, by some physicians, that inhalation would be im- 
 proper in some stages of consumption. So says Dr. R., in his re- 
 marks on inhalation. 
 
 “ There are cases in which inhalation is contraindicated ; for in- 
 stance, in dilation, or hypertropha of the heart, severe mucus catarrh, 
 general emphysema of the lungs, pleuritic, or pneumonic inflamma- 
 tion, haemoptysis, or latent consumption, of long standing.” 
 
 It has been remarked by others that inhalation cannot effect a cure 
 in all cases. So says Dr. R., 
 
 “ No permanent benefit is to be expected from this remedy, when the 
 inferior lobes of the lungs contain cavities, or are studded with tuber- 
 cles ; yet, even in this unfavourable state I have known relief arise, 
 and surprising prolongation of life ensue, from its employment. I have 
 individuals under my care, at this moment, in whom one lung is 
 almost useless from extensive tuberculous disease, and with even well- 
 marked pectoriloquy on the top of the opposite lung ; still, from having 
 the rest of the lung on this side in a satisfactory state, and thus being 
 partially susceptible of the influence of inhalation, the progress of 
 consumption has been arrested ; and in more than one instance, the 
 relief afforded by inhaling has enabled the individual to attend to the 
 duties of his calling — of course no very onerous ones. Indeed, I shall 
 feel happy to introduce any of my readers, who may entertain a desire 
 to see such remarkable instances of inhalation, to these patients of 
 mine.” 
 
 S 
 
18 
 
 INTRODUCTION. 
 
 The doctor repeatedly assured me, that persons of narrow chests, or 
 whose system was in a bad state, or those who were hereditarily pre- 
 disposed to consumption, would entirely be prevented from falling into 
 it, if they would persist in the course of inhalation for about six months, 
 or longer ; it will however require some effort and perseverance, par- 
 ticularly in persons decidedly consumptive, who will occasionally be 
 discouraged by the return of the hectic fever, night sweats, and 
 shortness of breathing, and sometimes of soreness in the chest, all of 
 which are to be treated medicinally as directed. 
 
 The general use of the tube, however, I fear, notwithstanding the 
 clearness with which the doctor has pointed out the proper persons by 
 whom it should be used, and how and when it should be used and 
 when laid aside, and the medical course to be |)ursued in connection 
 with it, will be greatly hindered by its injudicious employment ; some 
 will use it when the lungs are in a state of inflammation, without 
 first reducing it, as directed, by local depletion, &;c., and some, when 
 labouring under great oppression of the chest, or shortness of breath- 
 ing ; it will be used by those whose lungs are asthmatic, and by others 
 who are afflicted with disease in the heart, &:c. Those, however, to 
 whom it is likely to be beneficial, will, by pursuing a course of inhala- 
 tion for months, experience a variety of sensations and changes of the 
 chest, (which at times will be sore, on account of the expansion and ex- 
 ercise,) and also a more free expectoration, upon the softening down of 
 the tuberculous matter. Without a proper knowledge of some of the 
 probable effects resulting from its use, one would hardly have patience 
 and perseverance to continue it ; but for the instructions received from 
 time to time from the doctor since my return, I should myself have 
 been in doubt. I am, however, sure, if used as directed, it will ac- 
 complish all that the doctor asserts. In conclusion, I would add, that 
 my only design in the republication of this work in this country is, to 
 spread information which I conceive to be invaluable, — information 
 which has prolonged my life and the lives of others ; humbly praying 
 that it may be a mean for the prevention of this dire disease, and 
 the restoration of the health of many. 
 
 I greatly regret my inadequacy to present this subject to the public 
 as it should be, and most sincerely wish it had fallen into abler hands ; 
 but, notwithstanding my insufficiency, I have no desire to shrink from 
 the task, most sincerely believing that I am acting in the order of 
 providence. 
 
PREFACE 
 
 TO THE FIRST EDITION. 
 
 Most men have some one darling wish, which forms the central 
 point to which all their ideas and feelings verge. My attention was 
 directed at my outset in the profession to that tremendous disease, 
 which, from its wasting effects on the human frame, too truly and 
 appropriately bears the name of consumption. I found those to whose 
 experience I looked to direct and guide me, themselves walking in 
 the dark. Books only displayed to me a mass of crude, ill-arranged, 
 unreasoned-upon facts, or the fanciful chimeras of medical visionaries. 
 I saw that those branches of knowledge which had been redeemed 
 from the wastes of empiricism, and brought within the pale of art, 
 had been indebted for this successful issue to the system of induction 
 which owns Bacon as its father. The assemblage of facts without 
 classification, and this last without careful investigation of specific 
 differences, might, and did, I perceived, pass for labour and observation, 
 but was certaihly not science. I felt mortified and degraded at the 
 utter inefficacy of medicine, and of medical art, in this the common- 
 est of diseases ; and I was soon convinced that the only means of res- 
 cuing my profession from this “darkness visible” was to make the 
 physician subordinate to the anatomist. I had yet a higher object in 
 view — that of mitigating human suffering. I have toiled to this end, 
 and what I felt to be my duty has been my reward. In no boastful 
 spirit do I speak, but in a thankful one. I have proved that there is 
 a cure for what has hitherto been deemed incurable ; and this, no 
 drug known but to its compounder, but a simple mechanical process 
 available to all. That which has been as yet confused, is, I would 
 hope, rendered clear : and I trust that modes of treatment resulting up 
 to this period from conjecture, and leading but too often to confirm 
 the disease they were intended to cure, will soon pass away with other 
 exploded practice, that now moves but our pity, or our disgust. 
 
 March, 1834. 
 
 PREFACE 
 
 TO THE SECOND EDITION. 
 
 “It is passing strange” that medical attention, in this country, 
 should have been so little directed to the pathological consideration of 
 consumption. Nor is it less so, that consumptive patients are expressly 
 excluded by the regulations from more than one of the metropolitan 
 hospitals. We are chiefly indebted to foreign writers for anatomical 
 investigations of the various diseases connected with the chest ; al- 
 though they have done but little toward developing any plan of treat- 
 ment, holding out decided hopes of success, in consumption. The 
 
20 
 
 PREFACE. 
 
 ill fortune which characterized the means usually pursued by the 
 profession, in consumptive cases, early struck my attention. My 
 medical brethren appeared, with respect to this disease, to be as rigid 
 fatalists as the Mohammedan ; and to resign themselves calmly to the 
 belief, that when once consumption appeared, human efforts could be 
 of no avail. Yet this apathetic resignation was neither consistent 
 with reason nor with sound philosophy. No man could feel more 
 deeply than myself that the issue is ever in the hands of the Omnipo- 
 tent ; but I could not bring myself to the conclusion, that, because 
 failure had hitherto attended human agency, to cure was therefore 
 impossible. I could not sit down like our oriental prototypes, with 
 the exclamation, “ Allah Akbar!” and do nothing. Such were my im- 
 pressions, and such my reasoning, twenty years ago. It appeared to 
 me, that not only the treatment of pulmonary consumption was ill 
 understood, but that the pathology of most of the affections of the 
 chest had not received that investigation which they deserved. Yet 
 none are more important, or indeed, taking their number into consi- 
 deration, so much so ; seeing that the heart and lungs constitute the 
 two main props of what, together with the brain, Bordeu felicitously 
 terms the tripod of life. For the time just mentioned, it has been one 
 of the chief objects of my professional labours to advance our know- 
 ledge of this interesting class of diseases. The vacancy which the 
 resignation of Dr. Buxton, (for several years physician to the London 
 Hospital,) left at the Infirmary for Diseases of the Chest, presenting 
 the only favourable opportunity London affords for seeing, in large 
 numbers, every variety of case connected with pulmonary and other 
 affections of the chest, was eagerly embraced by me. I was fortunate 
 enough to obtain the situation of physician to the Infirmary ; and trust 
 that the present work will prove that I have not misemployed the abund- 
 ant facilities it holds out for investigating the pathology of these diseases. 
 
 I feel a sincere pleasure in stating the reception which the first edi- 
 tion of “ Consumption Curable” has met with from the liberal portion 
 of my profession. The letters I have received, from intelligent prac- 
 titioners in every part of the United Kingdom, have gratified me in 
 more than a selfish point of view. They have proved to me that, 
 however interested motives may bias some, there is an active and hon- 
 ourable spirit abroad in the profession at large, which induces a frank 
 and manly openness to conviction. The owls, who shut their eyes to 
 the light of truth, because it would guide others through the “ palpable 
 obscure,” are likely soon to be left alone in their blindness. An amended 
 medical education will rectify all these things. 
 
 It will not be thought that I overrate the importance of the diseases 
 affecting the chest, when it is considered that scarcely any part of the 
 body can be indisposed without the chest’s participating. Yet it is 
 consolatory to reflect, to employ the words of Laennec, that ‘‘Quelque 
 dangereuses que soient les maladies de la poitrine elles sont cependant 
 plus sou vent curables qu’ aucune autre maladie interne grave.” 
 
 September, 1834 , 
 
PBEFACE. 
 
 21 
 
 PREFACE 
 
 TO THE THIRD EDITION. 
 
 In answering the demand for a new edition of the present work, it 
 is gratifying to state that I find my opinions are rapidly gaining ground 
 abroad, and steadily extending at home. To the German translators, 
 especially, of “ Consumption Curable,” for it has been honoured by 
 several distinct translations into that language, and to Dr. Hohnbaum, 
 in particular, I am much indebted. The prefacd of this justly cele- 
 brated individual is liberal and philosophic. Too thoroughly informed 
 in his art to deny the curability of phthisis, he was of too enlarged a 
 mind to refuse my system a fair trial merely on the score of its nov- 
 elty, and too high principled to withhold his testimony to its success. 
 In the Appendix will be found the cases with which he has enriched 
 his translation. 
 
 I may mention it as a proof of the earnestness of the foreign med- 
 ical press in the diffusion of our common art, that translations of my 
 work have been forwarded to me from the most opposite parts of the 
 continent. The last I have received is from the pen of Dr. Schmidt, 
 and was published at Pest, Hungary : it is a second edition of my 
 first edition. 
 
 In this country, likewise, I am proud and anxious to acknowledge, 
 that if I have encountered much prejudice, I have also met with great 
 liberality. The cases submitted to me by country practitioners would 
 alone be satisfactory evidence of the spread of sounder opinions on 
 the pathology and treatment of pulmonary consumption. But this 
 acknowledgment is not to be confined to the provinces. Were it not 
 for the fear of exposing them to ungenerous attacks and the vexations 
 of professional controversy, I might name several eminent physicians 
 of the metropolis who coincide with my views frankly and fairly; 
 others there are who quietly imitate my practice, and thus tacitly pay 
 it the best compliment ; while the numerous cases to which I am 
 called in by the general practitioner, warrant me in believing that I was 
 not too sanguine when I ventured to say in my first preface — “ I trust 
 that modes of treatment, resulting up to this period from conjecture, 
 and leading but too often to confirm the disease they were intended to 
 cure, will soon pass away with other exploded practice that now moves 
 but our pity, or our disgust.” 
 
 Still, as must ever be expected in the outset, there is no lack of op- 
 position to these views. Many refuse to examine their validity : many 
 examine, with a fixed determination not to be convinced. Others 
 again esteem themselves too much to credit the possibility of cure 
 where they have failed : it would be to deny their own talent, to con- 
 fess their own inferiority, in short — a bad compliment to self. Some 
 there may be — but this is hypothetical — who regard the increasing 
 reputation of another as so much subtracted from their own treasury. 
 With such, the abridging the duration of disease, and still more 
 the preventing its ingression, is to “ bring down the rate of usance 
 
22 
 
 PREFACE. 
 
 here to cure, above all to avert the need of cure, is not in their 
 “ bond.” 
 
 Since the publication of the present treatise, three works have is- 
 sued from the press on the same subject, or partly so. It would be 
 uncourteous to pass them over in silence ; and I am quite willing to 
 give them the “ honour due.” They differ in point of literary, and 
 are unequal as regards their medical merit ; but, in one respect, they 
 are on the same level. Their authors agree that they cannot cure 
 consumption, which is highly probable ; they likewise agree that it 
 cannot be cured, which is directly opposed to the highest authority on 
 the subject, and is the reverse of my own experience. To begin with 
 the work of Dr. James Clark. Since this gentleman passed the greater 
 part of his professional life (at least before I had the honour of being 
 one of his examiners at the college of physicians) among the Eng- 
 lish resident in Rome, his field of observation must, I presume, have 
 been rather limited. However, taking Laennec, Louis, and Andral 
 for his guides, he has produced a very neat compilation from their ad- 
 mirable volumes. His work is destitute of originality, to which, I 
 should suppose, its author hardly lays claim. The point on which he 
 insists most strongly is, that “ the constitutional origin of tubercles, 
 by far the most important part of the subject, has been neglected 
 and he would appear by the context to imagine that he was fixing at- 
 tention for the first time on an essential principle, since he adds, “ if 
 we succeed in giving a satisfactory exposition of this, the most im- 
 portant, but hitherto most neglected part of our subject, we may hope 
 to lay the foundation of a sounder pathology of tuberculous disease.’^ 
 Nothing can be more true ; but, without referring to the writers who 
 precede us both, had he bestowed a glance on my pages, he would have 
 seen the same doctrine strenuously insisted upon. To adduce one, out 
 of various passages of like tenour, I observe, “Many writers are 
 of opinion, that various thoracic diseases are a fruitful cause of con- 
 sumption ; but I am satisfied that this supposition is groundless. It is 
 merely owing to the loss of health entailed by them, that the develop- 
 ment of those accidental productions called tubercles takes place. To 
 enumerate the various causes of consumption would be endless ; for, 
 in fact, whatever is capable of impairing the constitution is liable to 
 produce a phthisical state. Surely the doctor’s “exposition” and 
 mine are convertible — alter et idem. 
 
 Would it not lead to too great a length, I should feel proud to bring 
 forward the coincidences which occur between Dr. Clark’s work and 
 mine, whenever he propounds any notion bearing the appearance of 
 novelty. Yet, by a strange predilection for the despairing side of the 
 question, he invariably declines following out such notions to their 
 practical results. He appears to labour under a morbid dread of the 
 curability of consumption ; although, in deference to Laennec, he is 
 constrained to admit those pathological facts on which I ground the 
 rationale of my practice. Thus he confesses, that “ although caverns 
 generally tend to increase in size, yet not infrequently when they occur 
 singly, and when no fresh depositions of tubercles take place, they 
 remain a long while stationary. In cases still more uncommon, they 
 gradually contract and become obliterated.’’ Again, “ in a very large 
 proportion of cases, it is only in the early stage we can hope to effect 
 
PHEFACE. 
 
 23 
 
 a cure.” There are some, then, that may be cured at a more advanced 
 stage 1 Euge ! the doctor after this may surely go a step further, 
 and exclaim with Laennec, “ Cure in cases of pulmonary phthisis, 
 in which complete disorganization of the lungs has not taken place, 
 ought not to be considered impossible, either as regards the nature 
 of the disease, or the organ affected.’’ It is singular that a medical 
 man should deny the curability of phthisis, after excepting “ the 
 small proportion of cases in which the tuberculous deposite is confined 
 within narrow limits.” If we believe this writer, consumption is not 
 curable — but there are exceptions, it seems. Truly there are ; and 
 had these cases of exception been thoroughly investigated, and the 
 process by which they were effected diligently traced, the instances 
 of failure would long since have taken their place, and have themselves 
 become the exceptions. I speak confidently on this head, as my ex- 
 perience warrants it. 
 
 The doctor, too, by some unhappy slip of memory, is at variance 
 with another writer, a coadjutor of his in the ‘‘ Cyclopaedia of Practi- 
 cal Medicine,” for whom he professes a profound deference. This 
 gentleman, Dr. Carswell, observes in his article on “ Tubercle,” 
 speaking of consumption, “ The important fact of the curability of 
 this disease has, in our opinion, been satisfactorily established by 
 Laennec.” And let me add, in the opinion of every one who has 
 read the immortal work of that great man — and understood it. Dr. 
 Clark, however, does not absolutely deny the possibility of curing the 
 disease, but “ damns with civil sneer.” Cases of cure do happen, 
 rare exceptions. Of course, rare enough with those who do not 
 know how to treat the disease. Rare and fortuitous, I grant, pre- 
 viously to the appearance of my publication. Yet, although his own 
 treatment may be productive of any thing but satisfactory results, 
 why not state with Laennec, that there is no valid reason, “ either as 
 regards the nature of the disease, or the organ affected,’’ why con- 
 sumption should not be cured ? Why so lachrymose, when his chief 
 authority holds out such hope 1 
 
 The above writer is “ followed to the field’’ by Dr. T, Davies ; the 
 motto to whose lectures on diseases of the chest might aptly be 
 “ ahandonate speranza voi cE entrate.'^ This work seems to be a 
 synopsis of that of Laennec ; and is inferior to Dr. Clark’s, inas- 
 much as it is chiefly borrowed from one authority, instead of from 
 three or four. But, on the favourite point. Dr. Davies has deviated 
 from his sworn guide still further than Dr. Clark. The one is re- 
 luctant to admit the curability of consumption, allowing, however, that 
 such an event does occasionally happen ; the other boldly proclaims, 
 in the teeth of his exemplar, that it is not curable. He speaks, I pre- 
 sume, from his own experience : he may have been uniformly unsuc- 
 cessful, and hence his claim to be so positive. Yet, incurable as he 
 may have found the disease, it is singular that after following La- 
 ennec with almost servile idolatry, he should arrive at directly oppo- 
 site conclusions. Laennec supposed, and truly, that he had not only 
 discovered a series of signs throwing the clearest light on the diag- 
 nosis of consumptive disease, but, that by establishing its pathology 
 on a broader and sounder basis, he had proved the possibility of cure, 
 and paved the way for important practical results. Dr. Davies, how- 
 ever, although he has lit his own rushlight, 
 
24 
 
 PBSFACS. 
 
 (“ And lights hia farthing candle at the sun”) 
 
 at the lamp of that great man, and painfully picks his steps by its as- 
 sistance, suddenly extinguishes it as he approaches his labours’ end^ 
 and jumps for safety into the slough of despond. “ Follow Laennec,” 
 he exclaims to his pupils, “ I can give you no better guide ; but do not 
 go straight to the mark with him and attempt to cure consumption ; 
 stop short and be warned by me, — for I have enjoyed a liberal allow- 
 ance of failure, — that it cannot be cured.’’ 
 
 Another of our medical illuminati. Dr. Latham, of St. Bartholo- 
 mew’s, has condescended to complete the triumvirate, and has just 
 published his version of Laennec, under the title of “ Lectures on Sub- 
 jects connected with Clinical Medicine.” After an introduction, in 
 which he informs us that surgery is more popular than medicine, 
 “ because it is easier,” he proceeds to treat of the signs afforded by 
 auscultation. These he divides into the moist and dry, and appears 
 to conceive that he has thus- made a novel and important distinction. 
 So in fact he would, did he not labour under the disadvantage of 
 having been anticipated by Laennec. As a specimen of the innocent 
 method in which he assumes the tone of a discoverer, I quote his con- 
 jectures as to ' the causes productive of the sign which is termed 
 sihilus. “ Sibilus may then, (in spasmodic asthma,) if ever, be truly 
 called a dry sound. But I am not sure that the sibilus directly re- 
 sults from the mere condition of dryness ; I doubt whether simple 
 dryness alone naturally would produce it. In consequence of its dry- 
 ness, the mucous membrane may lose its elasticity, and become, to a 
 certain degree, unyielding ; or it may undergo wrinklings,or puckerings, 
 at various spaces ; or its general tumefaction may produce a narrowing 
 of the smaller tubes, and thus present obstacles to the passage of air, 
 and impart to it new vibrations ; and hence the sibilus.” Let us see 
 what Laennec said touching the same sign some eighteen years be- 
 fore. According to this writer, that variety of the dry sibilous rhon- 
 chus which is “ more strictly sibilous, is probably occasioned by a 
 local contraction of the smaller bronchi, from thickening of their in- 
 ner membrane.” This short sentence is the key note on which Dr. 
 Latham rings the amplifications which he ushers in with the modest 
 “ I am not sure that,” “ I doubt whether,” until he arrives at Laennec 
 and the root of the matter with his “ it may undergo wrinklings, or 
 puckerings, at various spaces, or its general tumefaction may produce 
 a narrowing of the smaller tubes.” Proceeding to illustrate the said 
 sibilus still further, he describes the case of a little boy, in whose 
 chest a shrill sibilus had taken place of the natural respiratory mur- 
 mur, — “ Wherever you applied your ear to the chest, you might fancy 
 you heard the piping and screaming of a nest of unfledged birds.” 
 How delightfully this simile is brought in as a new and felicitous illus- 
 tration with the “ you might fancy and how poetically has he deco- 
 rated the dry, matter of fact, detail of Laennec, who writes — “ The 
 dry sibilous rhonchus is of very various character. Sometimes it is 
 like a prolonged whistle, flat or sharp, dull or loud ; sometimes it is 
 very momentary, and resembles the chirping of birds.” Truly, Dr. 
 Latham deserves credit for his ingenuity. It would be amusing 
 enough to show, page by page, how dexterously the Bartholomew pro- 
 
TREFACE. 
 
 25 
 
 fessor twists Laennec into a new shape. Sometimes he swells a 
 few words into a mass of well-rounded periods ; at others, he reverses 
 the process, and compresses, with crushing effect as to sense and infor- 
 mation, a series of nicely evolved deductions into a few disjointed 
 sentences. In fact, he lias put Laennec into his literary mill, ground 
 him down, and then leavened him with his own leaven, with that pe- 
 culiar skill in the process which might excite the envy of a “ book- 
 seller’s hack.” His art in appropriating good things is only to be 
 equalled by his aptitude to spoil them while in the act of “ conveying.’’ 
 
 Dr. Latham is equally guiltless with his comates of enlarging the 
 boundaries of science ; and is also equally anxious to announce his 
 want of success in the treatment of consumptive disease. He has 
 very whsely devoted a volume to show the marvels he can achieve by 
 means of auscultation, with what precision he can calculate the rava- 
 ges of the disease, and O ! the art of sinking, — how utterly unable 
 he is to cope with it. “ All the world,” he exclaims, “ is asking us 
 whether consumption be curable’’'’ (sic in original.) Indeed! It has 
 come to this, has it? I am personally obliged by the confession. 
 Dr. Latham has now only one more step to make, and he will dis- 
 cover some fine morning that consumption is curable. The pressure 
 from without will jog him and his brethren on. All the world asks 
 the question ! This coincides with my own opinion ; and I find peo- 
 ple come a long way to ask it. I have had individuals of this in- 
 quisitive turn of mind who have come from Sweden, from Russia, 
 from both the East and West Indies, and from other distant 
 quarters, to ask the aforesaid question, and they were satisfied wdth 
 my answer ; although I must think they would have repented their 
 trouble had I given them Dr. Latham’s. 
 
 Dr. Latham is much more elaborate than his non-curing coadjutors, 
 in displaying his disbelief of the curability of consumption. He rea- 
 sons ! at some length on this, to these gentlemen, all-important 
 point. So eager indeed are the trio to prove to their patients their 
 inability to cure consumption, that I verily believe they would willing- 
 ly contract the disease, were it possible, and die in order to support 
 their doctrine. They would be cheerful martyrs to their professional 
 faith, and perish honourably secundum arlem. 
 
 But to return to Dr. Latham’s reasoning. It is so exquisite a thing 
 of the kind, that I should do him injustice were I not to give it in 
 his own words. In examining by dissection the bodies of those 
 who die of pulmonary consumption we occasionally find the traces 
 of a vomica healed. But in those who have not died of any pulmo- 
 nary symptoms, (die of symptoms !) and who were never known 
 during their lives to have any symptoms apparently ; the same evi- 
 dences have been found after death of what was once a vomica. 
 This is a cure, or tantamount to a cure, but it was a consumption 
 which nobody knew to exist.” Proceeding then to the question which 
 he describes all the world to he asking, he rejoins, “ It is a mockery 
 to answer, ‘ Consumption is a curable disease ;’ because, forsooth, its 
 entire process from beginning to end — its formation, progress, cure — 
 may be secretly transacted within the body without our knowing, or 
 suspecting any thing about it.” This is superlative. I meet a person 
 whose face is seamed with the scars left by small pox, and because I 
 
 4 
 
26 
 
 PREFACE. 
 
 did not see him when labouring under the disease, 1 deny that he evez 
 had it. I am in company with another who has lost an eye, and be- 
 cause I did not witness the loss, I assert that it is in his head. A pa- 
 tient dies, as is supposed, of eruptive fever, for which he has been 
 treated, but dissection proves that pneumonia was the more immediate 
 cause of death ; still as the pneumonia was not discoverable during 
 life — ergo, says Dr. Latham, exist it did not. In short, according to 
 this writer’s newly invented logic, there can be no such thing as latent 
 disease because it is “ secretly transacted within the body,” and as be 
 ingenuously adds, “ without our knowing or suspecting any thing 
 about it” — a circumstance which an ordinary man would suppose 
 implied in the word secretly. 
 
 Should we be rash enough to affirm that Dr. Latham exists without 
 brains, because no traces of them are at present discernible ? Far 
 from us be such rigid logic — we will not test the doctor by his own 
 rule. 
 
 Did I leave the above quotations from Dr. Latham’s work as they 
 now stand, I should act, as Dr. Latham has done by the question at 
 issue, most disingenuously. I will quote his special pleading verbatim 
 et literatim, and give him all the benefit of it. By the abstract made 
 above, every word of whieh is his, although separated from the con- 
 text, I have been enabled to show the naked folly of his reasoning. 
 The context will render manifest either his disingenuousness, or, if writ- 
 ten in good faith, his ignorance. 
 
 “ Does consumption ever admit of cure ? If ever, it must surely 
 be when it occurs in the form which we are now considering, i. e. 
 in the form termed by Dr. Latham unmixed phthisis. Let us, there- 
 fore, now give a few moments to this interesting question. A vomica 
 certainly does admit of reparation so far as not to be a vomica any 
 longer, but not so far as to leave behind it no trace within the lungs. 
 It leaves behind it a scar — that is, the disease ceases in the part, but 
 the par tis not restored to the exact condition in which it was before 
 the disease began. In examining by dissection the bodies of those 
 who die of pulmonary consumption, among many existing vomic 2 e 
 we occasionally find the traces of a vomica healed. At the apex of 
 the lung we find an indentation, and descending from it, for half an 
 inch or an inch, a thick perpendicular line of tough ligamentous sub- 
 stance. Sometimes this substance, by being pulled asunder, is discov- 
 ered to contain the remains of a cavity, and sometimes not. But 
 what imports this reparation of a single vomica, if so many besides 
 still exist ? A reparation of a twentieth part of the existing disease 
 cannot be called a cure. But in those who have not died of any pul- 
 monary symptoms, and who were never known during their lives to 
 have had any symptoms apparently phthisical, the same evidences 
 have been found after death of what once was a vomica, but no ex- 
 isting vomica together with it. This is a cure, or tantamount to a 
 cure. It is as much a cure as when a single scrofulous cervical gland 
 goes on to suppuration, and heals with a scar. A single vomica, you 
 may say, is as much of the essence of consumption as a hundred ; 
 and if the morbid structure (no matter how small) in which the dis- 
 ease essentially consists be repaired, the disease is cured ; that is, the 
 consumption is cured. But it was a consumption nobody knew to 
 
PREFACE. 
 
 27 
 
 exist. Now all this may be very fine reasoning ; but it does not meet 
 the plain meaning of the inquiry, whether consumption be curable. 
 It is not proof enough to common sense of its being so, that a few 
 isolated vomicae, which gave no sign of their existence, should have 
 undergone reparation. All the world is asking us whether consump- 
 tion be curable? Indeed, all the world is interested in the question : 
 for there is hardly a family into which consumption, sooner or later, 
 does not enter : and when a man makes the inquiry (as it were) spec- 
 ulatively, or indifferently, he has most likely a real practical interest 
 in it at home. He says, ‘ Is consumption a curable disease?’ But 
 he would say, ‘ I have a wife or a child, a brother or a sister, who is 
 decidedly consumptive ; is there the least possible hope left me that 
 they can recover ?’ To the question proposed with such intent, it is a 
 mockery to answer, ‘ Consumption is a curable disease because, for- 
 sooth, its entire process from beginning to end — its formation, progress 
 cure — may be secretly transacted within the body without our know- 
 ing or suspecting any thing about it. If you ask me, as a physician, 
 whether I have ever had experience of a perfect and satisfactory re- 
 covery taking place, where there have been all the best known popular 
 symptoms, which, as far as they go, no physician could possibly say 
 were not those of phthisis? I answer, ‘ Often.’ But if you ask me 
 whether I have ever had experience of the like perfect and satisfactory 
 recovery where there were all these popular symptoms, and, withal, 
 the conditions proper to phthisis, ascertained by auscultatory signs to 
 exist beyond a doubt within the lungs ? I answer, ‘ Hitherto, never.’ 
 What shall we say then ? How shall we answer the popular question 
 in the popular sense, and still answer it truly? We cannot say that 
 consumption is curable ; but we can say, and truly, that there are 
 cases of imputed consumption which put on such an aspect of the 
 real disease, that they are with difficulty distinguished from it, yet 
 have not its essence. These are all within the possibility of cure,” 
 p. 254, et seq. The chain of reasoning, such as it is, in the above, is 
 substantially the same as in the abstract first given — its gist being the 
 consoling discovery that whatever we are ignorant of does not exist. 
 But there is this addition ; that traces of a healed vomica are said to 
 be found among existing vomicce in the bodies of those who die of 
 pulmonary consumption, but to exist in a solitary state when ocurring 
 in those who were never known during their lives to have had any 
 symptoms apparently phthisical. The interpretation designed by the 
 doctor to be put on this statement is, of course, that the vomica in the 
 one case belongs to real consumption, and in the other is accidental. 
 
 In Dr. Clark’s treatise, I find so apt an illustration of one probable 
 cause of Dr. Latham’s egregious errors, (and, indeed, of his own lim- 
 ited views,) that I am tempted to transcribe it. He observes, “ It often 
 happens that a patient, presenting all the indications of tuberculous 
 disease, is said, and believed to be, merely threatened with disease of 
 the lungs, or to have an affection of the trachea or bronchi ; and it is 
 commonly added that ‘ with care all will do well.’ This arises from 
 the habit of trusting to symptoms alone for a knowledge of disease, 
 neglecting pathological anatomy, by which the physician is enabled to 
 connect the external phenomena of disease with the morbid condition 
 of the organ.” 
 
28 
 
 PREFACE. 
 
 Even were the facts as Dr. Latham states, his inferences would be 
 supremely absurd ; but being utterly unsupported by the results of 
 dissection, they must be put forward either designedly or ignorantly. 
 To appeal to my own experience only would be to rebut assertion by 
 assertion. I shall therefore adduce proof of this accusation from the 
 pages of Laennec, Andral, and Louis. 
 
 Dr. Latham has indeed found it convenient to copy Laennec in all 
 save his conclusions, to which I shall presently draw his attention. 
 However, I shall first quote Laennec’s remarks on the cases he de- 
 scribes in his chapter on phthisis pulmonalis : for the cases them- 
 selves, I must refer the reader to his “ Traitd de V Auscultation Me- 
 diated’ He writes then as follows : “ In my opinion, the foregoing 
 cases prove that tubercles in the lungs are not in every case a neces- 
 sary and inevitable cause of death, and that after an ulcerous exca- 
 vation has been formed by their softening down, a cure may take 
 place in two ways : in one, by the conversion of the ulcer into a fis- 
 tula, lined, like all those which may exist without injuring the gene- 
 ral health, by a membrane analagous to the tissues of the healthy 
 body ; in the other, by means of a cicatrix, more or less complete, 
 and consisting of cellular, fibro-cartilaginous, or semi-cartilaginous 
 substance. The identity of the cavities recorded in the 19th, 20th, 
 21st, 22d, and 24th cases, leaves no doubt as to the similarity of their 
 origin, and their production by the softening of tubercles which had 
 occupied their place. The 19th case may be looked upon as a cure, 
 since no more tubercles existed in the lungs. The same may be said 
 of the 25th, since there was hut one small tubercle met with. The sub- 
 jects of the 20th, 21st, and 22d cases would undoubtedly have under- 
 gone relapses, since there were crude, or miliary tubercles in their 
 lungs which must have been subsequently developed ; although this 
 might have been protracted to a late period, and have still left the 
 hope of a long life. It has been truly remarked by Bayle that crude, 
 and in particular miliary tubercles, often exist for a series of years 
 without seriously affecting the health.” A little further on he writes, 
 
 “ Pulmonary fistulse and cicatrices are extremely common * * * * no 
 one can follow a six months’ course of pathological anatomy without 
 meeting with them.” (Vol. ii, pp. 98, 99, 100.) Will the learned 
 professor at Bartholomew’s step forward with his “ we occasionally 
 find,” and deny this — Latham versus Laennec ? 
 
 The doctor has indeed very coolly reversed the order of Laennec’s • 
 reasoning. He infers, as has been seen, that since cicatrizations are 
 found, at one time, combined with cavities and tuberculous deposites 
 in the lungs of those who have exhibited symptoms of phthisis, and, 
 at another, without these adjuncts in the lungs of those who are said 
 not to have betrayed such symptoms, the cicatrices in the last are 
 lusus naturcBf chance creations, “ delusions of the evil one.” Now 
 Laennec argues thus : “ Notwithstanding I have found tubercles, in 
 different stages of development, in most lungs that have presented 
 pulmonary fistulas or cicatrices, which would presume the certain, al- 
 though perhaps remote return of the disease ; yet, as in cases 19 and 
 25, I have likewise frequently met with the same marks of cure in 
 subjects who have been entirely free from tubercles in the lungs or 
 any other organ. In such cases it may, perhaps, be supposed that 
 tho cicatrices result from abscesses produced by inflammation of the 
 
PREFACE. 
 
 29 
 
 lungs, and not from tubercles. Such a supposition, however, would 
 be perfectly gratuitous. Whoever is in the habit of constant post-mor- 
 tem examinations, may trace day by day, as it were, the formation of the 
 semi- cartilaginous membrane on the surface of tuberculous cavities ; 
 but the production of a collection of pus, or of a true abscess in the 
 lungs by inflammation, although not an impossibility, is yet so rare 
 as to be utterly insufficient to account for so common an occurrence.” 
 (Vol. ii, pp. 104,105.) Dr. Latham andLaennec are thus at issue both 
 as to facts and as to inferences from those facts. It does not require 
 the technical knowledge of the practitioner to decide between them. 
 The common sense of the general reader may be safely intrusted 
 with the delivery of the verdict. 
 
 The conclusions drawn by Laennec from the experience of his vast 
 practice, from his pathological investigations, and from the extensive 
 field of observation laid open by his immortal discovery, are passed 
 over by Dr. Latham ; or rather, are flatly contradicted by the 
 ‘‘ learned Theban.’’ This, too, as in the case of Drs. Clark and 
 Davies, is the more astounding, as Laennec has furnished the staple 
 of his book. However, “ majora canamus^^ — Laennec thus sums up : 
 “ I here conclude what I had to say on the possibility of curing pul- 
 monary phthisis ; and trust the importance of the subject will excuse 
 the length of my observations. With regard to the facts I have 
 brought forward to prove its curability, I am convinced that every 
 attentive observer will frequently meet analagous ones by employing 
 the same means — mediate auscultation and dissection. My experience 
 makes me believe them to be extremely common. I met with the 
 cases I have adduced in the course of a few months ; I have since 
 seen many others in the same period ; and it appears to me much 
 more rational to refer this to their frequency than to my having by 
 chance fallen upon such a collection of cases that are naturally rare. 
 I have mentioned my having often observed similar appearances for- 
 merly, without paying much attention to them ; as in the natural 
 sciences, an object may be daily seen and yet remain unknown, un- 
 less our notice be particularly directed to it. A gardener is seldom 
 acquainted with a tenth part of the plants growing in the very ground 
 he cultivates ; and, to borrow a comparison from medical science it- 
 self, an anatomist may be utterly ignorant of the organic changes 
 which occur in the human body, notwithstanding he sees them every 
 day while tracing the blood-vessels, or the nervous filaments. From 
 my own experience I can affirm that a man in the daily habit of 
 opening dead bodies may nevertheless partly forget descriptive anato- 
 my. To conclude, the cure of consumption, when the lungs have not 
 been entirely disorganized, ought not, 1 think, to be considered at all 
 impossible, either as regards the nature of the disease, or of the organ 
 affected. Pulmonary tubercles are in no wise different from those 
 found in scrofulous glands ; the softening of which is, we know, often 
 followed by a cure. On the other hand, the destruction of a part of 
 the substance of the lungs is not necessarily mortal ; since even wounds 
 of this organ are frequently healed, notwithstanding their distressing 
 complication with the perforation of the walls of the chest, and the 
 admission of air into the pleura.” (Vol. ii, pp. 110, 111, 112.) 
 
 To illustrate the difference between the candid allowances made by 
 
30 
 
 PREFACE. 
 
 a man of genius, even when his experience has been contrary to the 
 existence of a reported fact, and the supercilious gainsayings ©f a 
 sciolist, I cannot do better than quote the following admission made 
 by Louis. He is closing his remarks on a case in which he had met 
 with an excavation of middle dimensions, lined by a false membrane 
 of moderate consistence, a quarter of a line in thickness, and lying 
 upon healthy pulmonary tissue : “ But may it not be asked, with some 
 show of probability, whether this excavation were really the product 
 of tubercles and if the patient had phthisiSf since no tubercles or gray 
 granulations existed in the lungs ; and there were no ulcerations in 
 the larynx, trachea, or intestines — alterations of such frequent occur- 
 rence in this affection ? To this I would reply, that the purulent 
 matter of the excavation was identical with that commonly found in 
 tuberculous cases ; that the false membrane had equally analagous 
 properties ; lastly, and the fact is a powerful one, a cervical gland 
 was evidently tuberculous : and, in the course of these researches, it 
 will be seen that I have never met with the tuberculization of lym- 
 phatic glands, except in the consumptive. * * * * To conclude what 
 I have to remark on the subject of tuberculous excavations, I may add, 
 that I have not met in a single instance with cavities, surrounded by 
 healthy pulmonary parenchyma, communicating with the bronchi, 
 and lined with a light gray, semi-cartilaginous, semi-opaque false 
 membrane, as tuberculous excavations of long standing are. M. La- 
 ennec, however, has found them in subjects who had presented the 
 symptoms of phthisis during life, for a longer or shorter time. Judg- 
 ing, too, from their structure, it would be difficult not to believe that 
 their formation was preceded by tuberculous softening. This fact, 
 indeed, receives confirmation from the foregoing case ; since, in this, 
 as well as in the other cases to which I allude, there was only a solitary 
 excavation ; the substance of the lungs was healthy ; and it may be 
 concluded that if the indiuidiial’s life had been prolonged for some 
 weeks, or months, the false membrane which lined the cavity would 
 have presented the above-mentioned characters.” 
 
 How different this from the animus, how widely different from the 
 reasoning powers of the man who writes, ‘‘ but it was a consumption 
 which nobody knew to exist.” How opposite the spirit of the patient 
 searcher after truth, and of the sophist who seeks to quibble it away. 
 Thus we have Dr. Latham versus Louis ! 
 
 Proceeding now to the author from whom Dr. Latham has taken 
 the best point in his argument, I will give him an answer, drawn from 
 the same source, to his “ consumption which nobody knew to exist.” 
 Andral then writes as follows : “Looking collectively at the facts now 
 cited, the result would seem that cavities of greater or less size, which 
 have at some period existed in the pulmonary parenchyma, may at 
 times perceptibly diminish, and even be completety obliterated. 
 Laennec has described excellently the progress of this obliteration ; 
 and this being a well- ascertained fact, the question may arise as to 
 whether they were tuberculous excavations. To this we may answer in 
 the affirmative.’^ (Andral, Clinique M^dicale.) The point which I 
 have just said Dr. Latham has conveyed from his author is founded 
 on the assumed fact that cicatrizations are generally observed existing 
 simultaneously with tuberculous deposites ; from which Andral infers 
 
PREFACE. 
 
 31 
 
 “ we must not confound the certain cure of a cavity with the cure 
 of the tuberculous aftection itself.” This is converted by Dr. Latham 
 into the similar, but exaggerated proposition — “ What imports this 
 reparation of a single vomica, if so many besides still exist % A repa- 
 ration of a twentieth part of the existing disease cannot be called a 
 cure.’’ Had he stopped at this conversion it would have been wise. 
 But he must improve it by his discovery, in the first place, that the 
 consumption in such cases is not known to exist ; and, in the second, 
 by his still greater discovery that whatever is unknown does not exist. 
 This, indeed, is the doctrine of the materialists ; and a sorry one it is. 
 
 Dr. Latham I have already answered. In reply to Andral’s more 
 feasible reasoning it is sufficient to observe, that if a single tubercle 
 may be cured, the same process may obliterate an indefinite number. 
 
 It may be urged that I have misunderstood or misrepresented Dr. 
 Latham’s argument ; that he does not deny the existence of consump- 
 tion in the cases in question, but our knowledge of its existence. 
 What then becomes of auscultation ? Or does he argue that because 
 a case is cured unknown to us, a cure, under similar circumstances of 
 affection, can never be effected with our knowledge, or by our guid- 
 ance ! I inquire of the learned professor by what means the science 
 of medicine has arrived at its present state. Is it by seeking in the 
 dead body for an explanation of what has been going on in the living ? 
 And if so, to what end is this investigation instituted ; to learn the 
 means of cure by what we see, or to reject the lesson oftered by na- 
 ture as an insult to art ? 
 
 I had previously shown that his facts were untenable. I have now, 
 I trust, proved that his arguments, understood in any sense, and with 
 every advantage of quibbling to boot, are equally groundless. How- 
 ever, he is, I dare say, correct in one particular — his want of success 
 in consumptive cases. 
 
 I have entered at this length into a consideration of the three writers 
 who have published since the first edition of my “ Consumption Cura- 
 ble,” not from any weight I attach to their authority, or from any 
 doubt of the validity of my own doctrines, but from a sense of duty. 
 They would contract; I would enlarge the boundaries of science. 
 Their opinions are at variance with the positive testimony of patho- 
 logical anatomy ; mine in accordance with it. They belie the art 
 they practise ; I give it all honour. They-refuse hope to the sufferer ; 
 I certainly would not awaken it in vain, but as certainly should deem 
 it criminal to crush it when its realization is countenanced by nature, 
 and effectuable by art. 
 
 It must be startling to the non-medical reader, at least, to be assured 
 that it is next to an impossibility to open a dozen bodies without meet- 
 ing with positive proof of the curability of consumption. Such, how 
 ever, is the fact. Yet here are three gentlemen, it will be urged, phy- 
 sicians of some standing and of decent repute, Drs. Clark, Davies, 
 and Latham, each of whom too is attached to some public institution, 
 who positively deny that this disease can be cured. Is it to be sup- 
 posed that if the proofs furnished by dissection be so common, they 
 have never met with them ? To this it may be answered, that there 
 are few, very few medical men who trouble themselves to open bodies, 
 and that not a tithe of these few rigorously examine them. I might 
 
32 
 
 PREFACE. 
 
 rest my case here, and the really scientific would fully understand me* 
 But to bring conviction home to the general reader, who might ima- 
 gine I was merely opposing theoretical opinions by theory of my own, 
 I shall bring forward the testimony of a gentleman, frequently eulo- 
 gized by Dr. Clark and late medical writers, who is, 1 imagine, as 
 eminent a pathologist as any in this country — no excessive praise by 
 the by — and who, though he has not added, that I am aware of, to our 
 stock of knowledge, has at least reported truly the appearances with 
 which his dissections have made him acquainted. Dr. Carswell, then, 
 writes as follows : — 
 
 “ The important fact of the curability of the disease has, in our opin- 
 ion, been satisfactorily established by Laennec. All the physical signs 
 of tubercular phthisis have been present, even those which indicate 
 THE EXISTENCE OF AN EXCAVATION, yet the disease has terminated fa- 
 vourably, and its perfect cure has been demonstrated by the presence of 
 a cicatrix in that portion of the lung in which the excavation had for- 
 merly existed. * * * * There must be few practical pathologists who 
 will not consider these anatomical facts as evidence that tuberculous 
 phthisis is a curable disease. No objection has been brought forward 
 calculated in the slightest degree to invalidate the conclusion to which 
 we have been led by the repeated observation of the changes we have 
 described, viz: that these changes are positive indices of the re- 
 moval of the material element of the disease, and also of the cure of 
 the lesions of structure to which it gives rise, even at an advanced 
 period of its progress. * * * * We cannot avoid repeating the factj 
 that pathological anatomy has, perhaps, never afforded more conclusive 
 evidence in proof of the curability of a disease than it has in that of 
 tubercular phthisis.^’ — Cyclopaedia of Practical Medicine, Art. Tuber- 
 cle, pp. 265, 266, 267. 
 
 In order to give the general reader a clue by which he may un- 
 ravel some of the workings of our medical press, I subjoin the follow- 
 ing anecdote. Dr. James Johnson, editor of the Medico-Chirurgical 
 Review, sent some few months since a medical work lately published 
 in Germany to Dr. Spillan, a contributor to the above periodical, beg- 
 ging him to furnish a review and analysis of its contents. Dr. Spil- 
 lan, of course, proceeded to his task, and at first conceived the work 
 to be full of promise for his purpose, but was perplexed to find, on 
 further reading, that the German physician advocated in the strongest 
 terms the views and plan of treatment laid down by Dr. Ramadge, of 
 London. For further illustration, the German reader was referred to 
 the translation of “Consumption Curable,” as to a publication well 
 known throughout Germany. This put the climax to Dr. Spillan’s 
 perplexity ; and it was quietly resolved that it would be the more pru- 
 dent plan to give no notice of the work. 
 
INTRODUCTION. 
 
 I AM induced, from my long connection with the In» 
 firmary for Asthma, Consumption, and other diseases of 
 the Chest, the only institution of the kind in this coun- 
 try, and, as far as I have been able to ascertain, in Eu- 
 rope, to publish my opinions on the treatment of pulmo- 
 nary consumption — a disease unfortunately too well 
 known to the inhabitants of this clime, by its prevalence 
 and fatality. Having been thus for above fifteen years 
 placed in a situation which has given me unrivalled op- 
 portunities of seeing numerous cases of this disease, I 
 conceive it a duty I owe the public, through whose 
 philanthropic aid the above charity has been long and 
 liberally supported, to present them with the fruits of 
 my labours, and unreservedly to state how far medical 
 art is capable of arresting a disease to which nearly one- 
 third of the adult population falls a sacrifice. 
 
 The results which have hitherto attended the treat- 
 ment of phthisis have added but little to the reputation 
 of the medical profession. I am fully satisfied, however, 
 from the experience of years in treating this import- 
 ant malady, as well as from the deductions of unremit- 
 ting pathological research, that it is in our power to adopt 
 a line of practice more scientific and successful than 
 any hitherto employed. 
 
 Though great attention has been bestowed by several 
 distinguished continental writers, especially by Laennec, 
 Andral, and Louis, on the physical signs and morbid ap- 
 pearances of consumption, and notwithstanding cases 
 have been minutely detailed by them in which nature 
 has effected a cure, still they seem to me to have had 
 little idea that we can do more than relieve indica- 
 tions purely symptomatic. 
 
 A modern writer on consumption in this country, the 
 late Dr. Young, of St. George’s Hospital, who did not 
 
34 
 
 INTRODUCTION. 
 
 pay that attention to morbid anatomy so commendable 
 in onr Gallic neighbours, but whose opportunities of treat- 
 ing the disease were considerable, favours us with an 
 opinion as to its curability, which is very discouraging. 
 He says, It is probable that without assistance not one 
 case in a thousand of the disease would recover ; and 
 with the utmost power of art, perhaps not more than 
 one in a hundred will be found curable.” It is my in- 
 tention, in the succeeding pages, briefly to show that 
 this statement is unfounded in fact ; and that med- 
 ical treatment has, in not a few instances, tended to pre- 
 vent rather than advance recovery. I trust, too, I shall 
 demonstrate, in the histories of some of my cases, that 
 recovery has been owing, in a great measure, to the su- 
 pervention of some catarrhal disease, occurring sponta- 
 neously, or which has been contracted, after the failure 
 of remedial agents, by an apparently imprudent expo- 
 sure to cold. 
 
 The reader will probably learn with surprise, that no 
 inconsiderable number of catarrhal and asthmatic dis- 
 orders are, indeed, the sequelae of the disease which 
 forms the subject of this work, more or less perfectly 
 cured. Had the learned doctor whose name I have re- 
 cently quoted been at the pains to investigate the pri- 
 mary symptoms of such disorders, he would have found, 
 in many instances, that they displayed all the common 
 symptoms of pulmonary consumption ; and had this 
 hospital physician been accustomed to the examination 
 of dead bodies, he would have discovered, in more than 
 one-fourth of the adult subjects examined after death, 
 cicatrizations indicative of cured consumption ; and oi;i 
 finding these appearances, had he inquired of some 
 near relative of the deceased, if the individuals, at any 
 period of their lives, had for a time expectorated blood 
 — had been troubled with indomitable cough, night- 
 sweats, diarrhoea, with emaciation of the body — or had 
 been regarded by their medical attendants as consump- 
 tive, his opinion as to the curability of phthisis would 
 probably have been more favourable. 
 
 It is, indeed, strange that medical men have not no- 
 ticed the non-liability of the asthmatic individual to pul- 
 monary consumption; and that various species of ca- 
 tarrh are the instruments by which nature chiefly arrests 
 
INTRODUCTION. 
 
 35 
 
 that disease. It has been observed by me for years past, 
 and on many occasions I have particularly remarked to 
 my pupils, that asthmatics, (I mean those persons whose 
 lungs are emphysematous,) however long exposed to cir- 
 cumstances that favour the tubercular development in 
 the lungs, never become consumptive. Indeed, I have 
 long found, and it is a remarkable fact, that, whenever 
 the general health has been impaired by some ailment 
 of a chronic and even incurable nature, no phthisical 
 state supervenes, (which is unhappily in too many cases 
 the more immediate cause of death,) provided the individ- 
 ual have a voluminous and catarrhal state of the lungs. 
 
 From the numerous proofs dissection has afforded me 
 of the asthmatic state of the lungs in persons, who, 
 having recovered from consumption, have died from 
 some other cause, I am induced to recommend the early 
 employment of artificial means for the healing of ulcer- 
 ous phthisis. After the careful examination of at least 
 three thousand dead bodies, and after having had under 
 my care many thousand consumptive cases, my fixed 
 opinion is, that ulcers of the lungs are most effectually 
 cured, and a fresh formation of tubercles prevented, by 
 an expansion of the vesicular structure of the lungs ; 
 which, it will be seen hereafter, is, in many instances, 
 brought on by chronic catarrh. Before tuberculous ex- 
 cavations have taken place, and even after their exist- 
 ence has been ascertained by stethoscopic signs, there 
 is an absence, except toward the close of the disease, 
 of any catarrhal affection, or at least its continuance is 
 only of short duration. I know this statement of the 
 non-existence of a catarrhal state accompanying phthi- 
 sis is opposed to what appears in the excellent work of 
 M. Laennec ; but I am satisfied of its general correct- 
 ness, and that extended research will confirm my as- 
 sertions. 
 
 Independently of the extensive experience obtained 
 through my situation in the Infirmary for Diseases of 
 the Chest, I have enjoyed the advantages afforded by 
 no inconsiderable share of private practice, as well as a 
 wide field of inquiry opened to me for several years at 
 the Central Infirmary and Dispensary, an institution es- 
 tablished, and in a great degree upheld, at my own ex- 
 pense for all classes of diseases ; and where, from my 
 
36 
 
 INTRODUCTION. 
 
 being physician to the first mentioned charity, I had a 
 more numerous assemblage than is generally seen in 
 any institution of a similar kind of patients affected 
 with some disease or other of the chest. 
 
 It affords me pleasure to state, that my practice at 
 both institutions has been attended by numerous and 
 intelligent classes of pupils, who had opportunities, 
 equally with myself, of witnessing the recovery of many 
 consumptive persons, and of ascertaining that peculiar 
 condition of the lungs which I have already pointed 
 out as invariably occurring when a cure has been effected. 
 
GENERAL OBSERVATIONS ON CONSUMPTION. 
 
 The mortality which annually takes place in this 
 country through consumptive disease is a melancholy 
 truism, although its extent, familiar as it may appear, 
 is yet imperfectly known. The ordinary estimate, and 
 this as I shall subsequently prove far from an exag- 
 gerated one, gives one-fourth of the deaths yearly oc- 
 curring in this ever-varying climate as consequent 
 on pulmonary consumption alone. Dreadful as this 
 amount seems, yet since, in numerous instances, patients 
 who have laboured under chronic diseases, as dyspepsia, 
 cancer, severe diseases of the bones, joints, &c., or 
 any other affection by which the general system may 
 have been deteriorated, owe the immediate cause of 
 their death, not to these complaints, but to the super- 
 vention of consumption, it is evident that the propor- 
 tion of one-fourth is much lower than the truth. Again, 
 considering the frequency of cases in which asthmatic, 
 or catarrhal complaints arise in the first instance from 
 consumption, which, though arrested or finally cured, 
 occasions these very complaints as its consequences, I 
 may fairly assume that the startling proposition I have 
 laid down is corroborated by fact. To individuals 
 unaccustomed to extended pathological researches my 
 assertions will, at first sight, undoubtedly appear rash 
 and hypothetical. The pathologist, who is deserving 
 of the name, will either from his own experience be 
 ready to acquiesce in my views, or at least will can- 
 didly endeavour, by further inquiries, to verify conclusions 
 arrived at by the labours of years ; and this at a sacrifice 
 both of time and money, which none but the very few 
 who cultivate this branch of science with the zeal and 
 assiduity its importance deserves are prepared to estimate. 
 
 In addition to the reasons I have just given, to show 
 the inaccurate statement presented by the bills of mor- 
 tality, I could enumerate numerous instances in which 
 
38 OBSERVATIONS ON CONSUMPTION. 
 
 the real, as distinguished from the apparent causes of 
 the patient’s death, would offer conclusive testimony 
 to my position. Frequent are the cases in which an 
 individual will suddenly expire after violent expecto- 
 ration of blood, and his disease be attributed to a 
 ruptured blood-vessel, when indeed this hemorrhage 
 has been consequent solely on latent and unsuspected 
 phthisis. My readers must not misconceive me to 
 state, that every case of sudden death from spitting of 
 blood arises from the little-suspected presence of this 
 destroyer ; but that, in not a few instances, consump- 
 tion is indisputably the pre-existing cause. It were 
 easy to adduce further arguments corroborative of the 
 soundness of my conclusions ; but I have, I should 
 think, stated sufficient to induce conviction of their 
 reasonableness, if not of their entire validity. 
 
 The first questions to be considered are, to what the 
 frequency of this disease is owing, how it is produced, 
 and in what manner its ravages are unfortunately ex- 
 tended? The prevalence of consumption has long 
 been attributed to the proverbial variableness of our 
 climate ; but the mode by which this operates upon 
 the constitution has not been clearly explained. It 
 seems to me, however, that the action of the climate 
 on the system may be reduced to three distinct heads, 
 each equally common, and equally fatal : checked per- 
 spiration, retaining the superfluous humours, and thus 
 vitiating the fluids of the .body — constant fluctuations 
 of health, resulting from constant atmospheric changes 
 — and dejection of spirits, caused by mental troubles. 
 To these may be subjoined an unfortunate configura- 
 tion of the body, consisting in an undue narrowness of 
 the chest, especially in its upper part, less observable 
 in foreigners than among ourselves. It is not neces- 
 sary to dilate upon the process by which checked per- 
 spiration lays the foundation of this dreadful malady ; 
 since it must be evident to the tyro, that when those 
 humours which pass off insensibly in a healthy state 
 of the body are retained, and the natural functions 
 thus disturbed, disease more or less extensive will in- 
 evitably ensue. With respect to the second of these 
 heads, it may to the ordinary observer appear super- 
 fluous to insist upon the ill effects generated by con- 
 
OBSERVATIONS ON CONSUMPTION. 39 
 
 stant change of weather, in persons not only of delicate 
 but even of robust habits ; still, obvious as these effects 
 are, it is not quite so apparent in what they consist, or 
 rather how they are produced. Now, when we take 
 into consideration the peculiarly delicate conformation 
 of the lungs, and their immediate susceptibility of 
 every alteration in the atmosphere, we at once arrive 
 at a resolution of the question. It is essential, in or- 
 der to maintain a healthy action and proper configu- 
 ration of the chest, that our inspirations should be uni- 
 formly deep and full ; but, from the great inequality of 
 atmospheric pressure resulting from the constant fluctu- 
 ations of the weather, the depth and fulness of the inspi- 
 ration are exposed to frequent diminution; and that 
 play of the chest, which is as requisite to a healthy 
 state of the lungs as exercise to muscular development, 
 is consequently subject to repeated checks. Thus, 
 owing to the want of due excitement, or, more strictly 
 speaking, of proper exercise, the healthy functions of 
 the chest become deranged, its expansion restricted, its 
 action languid, and by degrees its shape alters ; so that, 
 instead of the bony compages of the chest being forced 
 boldly out in a somewhat semicircular form, and the 
 sternum pushed forward, the ribs fall in, drawing the 
 breast-bone backward to a position nearer the spinal 
 column than is the case in its natural movement. Now, 
 to bear out and verify the foregoing remarks, by show- 
 ing how^ requisite the expansible power of the chest is 
 to the healthy constitution of the lungs, I would state, 
 as an almost invariable law, that the commencement of 
 pulmonary consumption will be found to take place in 
 the superior lobes of the lungs, owing doubtless to the 
 small extension of the upper ribs as compared with the 
 more complete movement of the lower. Another sin- 
 gular instance, confirmatory of the novel view I am now 
 taking of the subject, is to be found in the exemption 
 of asthmatic patients from consumptive disorder. From 
 the peculiar nature of their complaint, gasping for 
 breath, and forced to respire frequently, their lungs are 
 ever fully exercised ; and the expansion of the chest, 
 which follows as a necessary consequence, preserves 
 the sufferer free from the attacks of this still more dread- 
 ful malady. To come to the third head — depression of 
 
40 OBSERVATIONS ON CONSUMPTION. 
 
 spirits, or mental anxiety — we shall meet with the 
 same cause still producing the same elfects. The un- 
 fortunate, who lives in the world as if he were not of it, 
 and to whom, whether his cares be the offspring of dis- 
 appointed ambition, hopeless love, or ruined circum- 
 stances, the world displays nothing but a cheerless 
 blank — the tenant of the sick chamber, whose distem- 
 per improper medical treatment has unduly prolonged, 
 or confirmed ; in hne, all who, from any cause, labour 
 under prostration of strength or general debility, are 
 prone to fall victims to the insatiable tyrant, consump- 
 tion, for reasons precisely similar — inability to take in- 
 spirations of depth sufficient to keep up the necessary 
 changes produced by the air on the venous circulation. 
 I have adverted to another cause, which in my opinion 
 contributes, at least in a degree, to render the inhabit- 
 ants of this country more peculiarly liable to phthisis — 
 a malformation of the chest, which, after repeated and 
 numerous examinations that I have been enabled to 
 make in considerable manufactories, where I had the 
 opportunity of comparing foreigners of different countries 
 with our own countrymen, would seem to be more preva- 
 lent in England than elsewhere. As a corrollary to the 
 above remark, I may note, that the children of consump- 
 tive parents generally inherit the narrowness of chest 
 and depression of the ribs which characterize the vic- 
 tims of this malady ; and that thus the range of its in- 
 fluence is indefinitely increased. 
 
 Following up the tenour of the preceding observations, 
 we shall find that the benefit usually derived from a 
 sea voyage, or change of air, is not so much due to the 
 removal from an impure to a purer atmosphere, per se, 
 as to the stimulating effects produced on the respiratory 
 organs, and the increased energy of the muscular pow- 
 ers of the chest, on which pulmonary dilatation is of 
 course consequent. Let us compare the muscular frame, 
 expanded chest, and robust health of the mariner, or of 
 the husbandman, with the emaciated figure, contracted 
 chest, and general want of vigour betrayed by the arti- 
 zan of manufacturing cities ; and, on attentive consider- 
 ation, we shall own that these differences are the con- 
 sequences of the superior expansion and activity of the 
 pulmonary apparatus enjoyed by the former. 
 
OBSERVATIONS ON CONSUMPTION. 41 
 
 I must now advert to a very remarkable circumstance, 
 upon the propriety of advancing which I have long 
 hesitated ; yet as it serves not merely to elucidate and 
 strengthen, but to prove the truth of the propositions 
 advanced above, and is a phenomenon as fatal in its 
 elfects as it is singular in a physiological point of view, 
 I should, after mature reflection, deem myself the slave 
 of a false and injurious shame were I to withhold it. 
 When we are the prey of other disorders, the desires 
 are deadened, and lie comparatively dormant ; but even 
 in the last stage of consumption the love of the sex 
 seems to increase with the decay of the strength, and 
 the disease, while it kills, is still propagated in the future 
 life of an unborn being. The same holds true, though 
 in a less degree, with respect to the gentler part of the 
 creation. 
 
 Among the many distressing cases which the medical 
 practitioner has to encounter, the premature and rapid 
 decline of the young of both sexes, more particularly of 
 the weaker, is without doubt the most painful. The 
 fragility of woman's constitution, as compared with that 
 of man, the delicacy of her frame, her retired and do- 
 mestic habits, and the sensitiveness of her mind, all 
 contribute to render her a mark at which consumption 
 too frequently aims his deadly darts. No sight is more 
 painfully interesting than that of a female, on the veiy 
 verge of womanhood, yielding unconsciously to the fatal 
 decree, and, like a drooping flower, nipped untimely in 
 the bud, graceful and lovely to the latest breath. Inde- 
 pendently of her greater liability to pulmonary disease 
 from delicacy of constitution, there exist other causes 
 which increase her susceptibility in a fearful manner. 
 The style of her dress— which, in compliance with the 
 fantastic usages of fashion, seems devised to alter the 
 free and graceful outlines traced by the hand of nature 
 into a wasp-like angularity, alike injurious to the tender 
 structure of her body and unpleasing to the eye of 
 taste — has been often pointed out as a pregnant source 
 of disease, and justly so. It has been already observed, 
 that a full and free dilatation of the chest is absolutely 
 necessary to preserve the lungs in a sound and healthy 
 state ; but how can a femalp, her cheat compressed by 
 an artificial support, the convexity of the ribs incapable 
 
 6 
 
42 
 
 CAUSES OF CONSUMPTION. 
 
 of being extended upward and outward, and the stern- 
 um consequently without the power of coming sufficient- 
 ly forward, enjoy this requisite expansion? She is 
 “ cribbed, confined,” and “ curtailed of nature’s fair pro- 
 portion” However, to counterbalance these incon- 
 veniences, it has fortunately happened, that owing to a 
 power she possesses of abdominal respiration, more de- 
 cided in her than in the male, the unnatural restraint 
 she has imposed upon herself is divested of some portion 
 of its ill effects. Still, so mischievous are the conse- 
 quences entailed upon woman by her adherence to this 
 baneful part of her costume, that in consumptive cases 
 there is this striking distinction between the sexes, that 
 the female thus deprives herself of the great, indeed the 
 sole chance of recovery, — a due expansion of the chest. 
 Thus the probability of spontaneous and permanent re- 
 covery, which is attended by an increase in the volume 
 of the lungs, is sensibly lessened to the female sufferer ; 
 and they who need most aid maybe said “ to take arms 
 against themselves.” 
 
 CAUSES OF CONSUMPTION. 
 
 A COLD, resulting either from imprudent exposure to 
 the air when the body has become heated, or from the 
 wearing of too light and insufficient clothing, is deemed 
 one of the most general and powerful causes of con- 
 sumption. Yet, in many instances, I am persuaded that 
 the real and efficient cause is to be found in the pre- 
 existence of latent tubercles in the lungs ; and when 
 these become softened by general indisposition, pro- 
 duced by the action of the cold, phthisis ensues. Fre- 
 quently, indeed, the irritation occasioned by latent tu- 
 berculous disease will determine a catarrh, and the 
 patient will be treated for this complaint without any 
 suspicion on the part of the medical attendant of the 
 real state of the case. Should the catarrh continue, 
 the consumptive disease masked by it will be effect- 
 ually cured : and if a cavity has been formed, this will 
 be obliterated by the increase that takes place in the 
 volume of the lungs. At other times tuberculous de- 
 
CAUSES OF CONSUMPTION. 
 
 43 
 
 posites will be found insulated, and rendered innoxious, 
 as I shall hereafter explain, by the secretion of black 
 pulmonary matter. I have verified these facts by nu- 
 merous autopsies, and it is very recently, that, open- 
 ing the body of an asthmatic individual who died at 
 the advanced age of seventy, I found distinct traces of 
 a former consumptive state, which, having been arrested 
 by the supervention of asthma, had existed unknown 
 to himself, his family, or his physician. Still, where a 
 hereditary tendency to consumption exists^ or the con- 
 stitution has been previously debilitated, taking cold is 
 most certainly a frequent exciting cause of pulmonary 
 phthisis. The transmission of this disease from parent 
 to child is a melancholy fact to which I have already 
 adverted. The generic marks of this sad heir-loom may 
 be traced in the sanguine yet delicate hue of the coun- 
 tenance, the unusual brightness of the eyes, the con- 
 fined and narrowed waist, ^ the sharp projection of the 
 scapulse or shoulder-blades, and the fragility of the bony 
 structure of the body, not unfrequently united with a 
 disposition to an unhealthy stoutness. In laying down 
 ' the causes of consumption, it becomes requisite to dis- 
 tinguish between those which are direct, and the far 
 greater class commonly confounded with them, but 
 which in point of fact are indirect. Among the latter 
 may be enumerated inflammation of the lungs, pleurisy, 
 contagious eruptive fever, repelled eruptions, badness and 
 deficiency of food, amenorrhoea, unhealthy localities, 
 affections of the abdominal viscera, (sometimes caused 
 by excessive drinking,) spitting of blood, constitutional 
 syphilis, and a long list of disorders, whose sole in- 
 fluence in producing consumption consists in the de- 
 bilitated state of the body they induce. I have said 
 that it is requisite to distinguish between the direct 
 and indirect causes of consumption, not that there 
 are any that can with propriety be termed direct, but 
 in order to impress thoroughly upon the mind the 
 grand truth, that phthisis is, for the most part, the se- 
 quence of debilitated bodily health alone. When the 
 general health becomes impaired, a total change takes 
 place in the fluids and secretions of the body, and there 
 is consequently an aberration of nutriment: on this, 
 the formation of tubercles soon follows. 
 
44 
 
 CAUSES OF CONSUMPTION. 
 
 Laennec gives an interesting account of the effect of 
 depressing passions in producing phthisis, in the case of 
 a religious association of females, all of whom became 
 consumptive from the ascetic spirit which regulated their 
 minds, rather than the austerity of their diet. Confine- 
 ment, most likely, contributed to this result. Since this 
 society was bound by no vow, Laennec persuaded the 
 members, as soon as consumption was clearly indicated 
 in each, to change to another place of abode, and he ex- 
 pressly declares that nearly all who took his advice re- 
 covered. The possibility of consumption’s being cured 
 is even yet denied by many practitioners, although the 
 light of truth is beginning to dawn upon them ; and yet 
 the above relation is a proof, that, some years previously 
 to the appearance of the present work, the greatest med- 
 ical authority on the disease had stated opinions similar 
 to mine. A parallel circumstance has occurred, in the 
 course of my practice, within the last two years. Two 
 young ladies were removed from a school in the neigh- 
 bourhood of London, in order to be put under my care 
 for consumption. I ascertained that ten or twelve of 
 their school-fellows had sunk under decline within the 
 preceding twelvemonth : and, on inquiry, I found that 
 the only exercise they were allowed, and this but sel- 
 dom, was the prim, formal walk, two by two ; which 
 pernicious and false decorum, it is to be hoped, will soon 
 be banished from these establishments. 
 
 To such an excess were the fantastical restrictions of 
 the school carried, that the poor girls were not allowed 
 to hold their heads erect, or maintain a proper carriage, 
 being told that so to do was a sign of pride. By this 
 enforced humility, conjoined with the radical error — 
 want of exercise — both my young patients not only 
 stooped, but, I am sorry to add, had contracted chests, 
 and lateral curvature of the spine. 
 
 I should mention the sequel of Laennec’s account, 
 in order to establish more fully the coincidence between 
 the circumstances, and to direct attention to the ill effects 
 of such absurd confinement. He proceeds to narrate, 
 that he witnessed, in the course of ten years, two or 
 three renewals of the religious society, by the admission 
 of new members to replace the loss of old ones ; and 
 that the only individuals attached to it, who withstood 
 
CAUSES OF CONSUMPTION. 
 
 45 
 
 its depressing influence, were the superior, the grate- 
 keeper, and the sisters who had charge of the kitchen, 
 the garden, and the infirmary. In addition to the exer- 
 cise given by these offices, the same individuals were 
 called upon, occasionally, to visit the city on the concerns 
 of the establishment. This narrative requires no comment. 
 
 Many writers are of opinion that various thoracic dis- 
 eases are fruitful causes of consumption ; but I am sat- 
 isfied that this supposition is groundless. It is merely 
 owing to the loss of health entailed by them that the 
 development of those accidental productions, called 
 tubercles, takes place. To enumerate the indirect causes 
 of consumption would be endless ; for, in fact, whatever 
 is capable of impairing the constitution is liable to 
 produce a phthisical state. Thus mental anxiety, or 
 any depressing passion long continued, as well as chronic 
 diseases of various kinds, engender a consumptive pre- 
 disposition. In this country the frequency and preva- 
 lence of this disease are attributed, in no small degree, 
 to the great and sudden vicissitudes of atmospheric 
 temperature, and the moist nature of our climate. These, 
 as I have already explained, operate powerfully in ef- 
 fecting changes in the human body, more or less calcu- 
 lated to affect the general health ; especially in those 
 who are naturally of a delicate make, and who inherit 
 a tendency to scrofula. Particular employments, in which 
 dusty particles and noxious fumes are inhaled, have long 
 been regarded as producing this disease ; but experience 
 has taught me that some catarrhal affection, and not 
 consumption, is what most frequently supervenes, and 
 that the former complaint is a preservative against the 
 latter. 
 
 The distinguished French writer I have lately quoted 
 denies that j^thisis 'pulmonalis is a frequent consequence 
 of pulmonary catarrh ; which opinion approximates to, 
 although it does not go so far as my own ; but it is 
 strange that so acute an observer, with all the facts be- 
 fore him — facts first promulgated by himself — should 
 have stopped short of the truth just as he was on the 
 point of reaching it. He clearly saw that catarrh was 
 not the cause of consumption, and affirms, “We recog- 
 nise a thousand instances of catarrh for one of phthisis.” 
 
46 
 
 CAUSES OF CONSUMPTION. 
 
 One step further would have led him to the discovery, 
 that catarrh was the remedy of nature for the cure of 
 phthisis. In the same paragraph he alludes to Brous- 
 sais, as supporting the once established, but I trust now 
 exploded, doctrine of ‘'phthisis pulmonalis being the 
 consequence of pulmonary catarrh.” Broussais, indeed, 
 had the temerity, or rather folly, to assert, that a pupil 
 of his used to bring on consumption — in fact, generate 
 tubercles in the lungs of a dog — by irritating the trachea 
 in some extraordinary manner, and thus producing ca- 
 tarrh. The contrary would happen. The catarrh would 
 prevent the appearance of consumption. But what will 
 not writers advance to support a favourite theory ! 
 
 Contagion has been considered in the southern parts 
 of Europe, especially in the Italian states, as a frequent 
 source by which large families of children have been 
 destroyed by consumption. For my own part, it has 
 never appeared to me to spread among individuals hav- 
 ing the same hereditary constitution, by any infectious 
 medium ; but by other circumstances operating upon an 
 inherent predisposition to tuberculous disease, which, as 
 I have already said, is indicated by a particular conform- 
 ation of the body ; such as a long neck, slender 
 trunk and extremities, contracted chest, high shoulders, 
 delicate and transparent complexion, weak voice, and 
 great sensibility. The same locality and the same man- 
 ner of living, no doubt, have often an influence in pro- 
 pagating it in certain families : and to this cause, and not 
 to contagion, we may attribute its remarkable fatality. 
 In my neighbourhood there are many Italian residents, 
 who, for the most part, live huddled together in small 
 and ill-ventilated rooms, and are apparently liable, from 
 their peculiar and not very nutritive diet, a neglect of 
 cleanliness, and misery and disappointment in every 
 shape, to have a consumptive constitution, yet I have 
 not been able to trace any case of the disease’s being 
 disseminated. Still, notwithstanding my firm belief that 
 consumption is not contagious, I would not be under- 
 stood to recommend neglect in separating consumptive 
 from healthy persons ; on the contrary, for the sake of 
 the personal comfort of the sufferer, and to forward the 
 chances of his recovery, I would have every precaution 
 taken that prudence can suggest, or kindness inspire. . 
 
THE SYMPTOMS OF 
 
 PULMONARY CONSUMPTION, 
 
 LOCAL AND SYMPATHETIC. 
 
 j 
 
 PHYSICAL SIGNS OF THE DISEASE. 
 
 It has long been acknowledged that the symptoms 
 on which practitioners generally rely in the incipient 
 stage as indicative of consumption are extremely va- 
 riable and uncertain. Its attack indeed is, in many 
 instances, so deceitful that before the patient is in the 
 least aware of his danger the case has become despe- 
 rate. Again, it seldom happens that pain, or any other 
 uneasy sensation, is felt in the part which is well known 
 to be the primary seat of the disorder, although it re- 
 sults from tubercles, disseminated at first in the sub- 
 stance of the upper part of one, or both lungs. At 
 other times we see cases in which its progress is latent 
 and altogether unheeded ; still a slight cough is gene- 
 rally the first symptom, and this is attributed to some 
 uneasiness in the throat, produced by a common cold. 
 After a time the cough increases, and from being either 
 hard or dry, is followed by the expectoration of a little 
 mucus, often devoid of colour, as in common catarrh. 
 This is succeeded by some degree of weight and slight 
 pain felt in the chest, along with difficulty of breath- 
 ing, general weakness, and an accelerated pulse, which 
 seldom ranges below 90 ; during the hot stage of the 
 hectic fever it is generally 120. A sense of chilliness 
 along the course of the spine, commonly experienced 
 toward noon, is the next symptom ; this is followed by 
 an augmented temperature of the body on the approach 
 of evening, and finally by perspirations, which usually 
 come on profusely after midnight, and greatly attenuate 
 the body. When spitting of blood occurs with the fore- 
 going symptoms, or when the matter expectorated be- 
 gins to assume the appearance of pus, we have strong 
 grounds to suspect the presence of pulmonary consump- 
 
48 SYMPTOMS OF PULMONARY CONSUMPTION. 
 
 tion. The occurrence of cough in any case, in which 
 the general health has been impaired, ought to be re- 
 garded with no small suspicion. Cases are not wanting 
 in which the disease manifests itself most irregularly. 
 F or instance, the usual characteristic symptoms are not 
 uncommonly preceded, for a short time, either by mesen- 
 teric enlargement, aphthae, severe diarrhoea, amenorrhoea, 
 or by an affection of the larynx, attended with a slight al- 
 teration of the voice. Though in the early stages there may 
 be some doubt as to the existence of phthisis, without the 
 aid of physical signs, there can be however little chance 
 of mistake in the advanced stages. As soon as hectic 
 fever is fully established, the wasting of the flesh be- 
 comes remarkable, and rapidly increases, if perspiration^ 
 diarrhoea, and expectoration have been abundant. To 
 me, who have been for so many years accustomed to 
 see this disease daily, the very look of the patient is in 
 most instances sufficient. 
 
 The nose and cheeks assume a striking prominency, 
 and the bluish paleness and emaciated appearance of 
 the face are remarkable, when contrasted with the 
 suffused, and, at other times, circumscribed flush, which 
 quickly goes and comes, together with a shining white or 
 pearl-blue appearance of the conjunctiva of the eyes ; 
 the shoulder-blades project, so as to be likened to wings, 
 while, at the same time, the chest is narrowed in its 
 lateral as well as transverse diameter, in consequence 
 of the increased convexity of the ribs, which has a great- 
 er inclination downward, and which thus likewise admits 
 of the nearer approach of the sternum toward the back. 
 On the upper and anterior part of the chest, the inter- 
 costal spaces appear widened and depressed, and the 
 belly is at the same time flat and retracted ; — the fingers 
 seem lengthened, and the joints of these, as of other 
 parts, are apparently enlarged ; incurvation of the nails 
 takes place, and where large tuberculous excavations 
 have long existed, an actual enlargement of the ends 
 of the fingers is observable ; the neck seems elongated 
 and impeded in its movements, and the angles of the 
 lips are drawn back, and produce a bitter smile. 
 
 Phthisis is not difficult to be recognised in that stage 
 in which the tuberculous mass, becoming softened, finds 
 an opening into some of the neighbouring bronchia, and 
 
SYMPTOMS OF PULMONARY CONSUMPTION. 49 
 
 finally leaves a cavity, whose existence is clearly indi- 
 cated by its characteristic symptom — pectoriloquy. 
 This peculiar phenomenon is generally first heard in the 
 upper portion of the right lung, when the tubercles which 
 first appear there are softened down ; and it may be 
 detected by applying the ear over the uppermost ribs, 
 or over the infra-spinal fossa of the shoulder-blade. 
 When the voice of the patient, on applying the ear, either 
 alone or armed with the stethoscope, to that part of the 
 chest corresponding with the supposed seat of an exca- 
 vation, is heard much louder than natural, and seems to 
 issue uninterruptedly from within, with a thrilling sound, 
 it constitutes what is termed a satisfactory pectoriloquy, 
 and is an indubitable sign of a tuberculous cavity ; the 
 contents of which we even hear not unfrequently by the 
 same method of diagnosis, agitated by the action of 
 coughing. Whenever the walls of an old, and nearly 
 emptied excavation, are dense and firm, a severe fit of 
 coughing gives to the ear a metallic resonance, or a 
 sound as of some empty glasses slightly shaken against 
 each other. If the excavations are numerous, and com- 
 municate one with another, the liquid matter within is 
 heard changing its situation every time the patient 
 breathes. 
 
 The plan I always pursue, and indeed a most ready 
 one, to distinguish consumption from pulmonary catarrh, 
 with which it is liable to be confounded, is to apply the 
 ear to the posterior part of the chest, about two or three 
 inches below the inferior angle of the scapula. Should 
 the respiration be almost natural, or slightly puerile 
 here, we may at once and early proclaim the case to be 
 phthisical, if the patient have a troublesome cough, 
 though he may present few of the other common symp- 
 toms belonging to a consumption. Except near the fatal 
 termination of the disease, when the great emaciation, 
 confirmed hectic fever, diarrhoea, and other bad symp- 
 toms manifest themselves, we have no physical sign of 
 any bronchial inflammation ; save in cases in which 
 some progress toward recovery has taken place. When 
 the sonorous rattle occurs before the lower lobes of the 
 lungs are affected with tubercles, it is to be considered 
 as a highly favourable symptom. In other cases, how- 
 ever violent and long the cough may be, auscultation 
 
 7 
 
50 SYMPTOMS OF PULMONARY CONSUMPTION. 
 
 gives US no signs of the catarrhal state which precedes 
 and follows complete recovery. Having daily opportu- 
 nities of seeing new consumptive cases, I readily come 
 to a conclusion, by the absence of catarrh, that they are 
 undoubtedly consumptive, without taking the trouble to 
 ascertain the state of the upper part of the chest ; for if 
 an individual coughs up blood, or rnuco-purulent matter, 
 is subject to chills, accessions of fever, and night sweats, 
 wastes away and complains of debility, and no catarrh 
 is heard in the inspirations, we may be perfectly satis- 
 fied that tuberculous cavities exist. When there is a 
 cough which is not influenced by remedies, and the 
 sympathetic signs of consumption and the auscultatic 
 results beneath the clavicles are somewhat unsatisfac- 
 tory, while the lower part of the chest has the murmur 
 of respiration almost natural, I should then, satisfied 
 with the experience derived from exploring the chests 
 of several thousand consumptive patients, unhesitatingly 
 pronounce the case to be genuine consumption. In nu- 
 merous instances, much to the surprise of my pupils, 
 and of those practitioners who have witnessed my prac- 
 tice, I have pronounced a patient to have tuberculous 
 disease in the superiour lobes, while he exhibited no 
 look indicative of such serious illness, but had merely 
 an annoying cough. This prompt decision after I have 
 ascertained by the ear the sanity of the respiratory mur- 
 mur, and absence of bronchial irritation in the inferior 
 part of the chest, has generally proved correct. In some 
 instances, obscure respiration in the upper part of the 
 chest, arising from tubercles and pulmonary induration ; 
 in others, a tuberculous cavity, affording the most per- 
 fect pectoriloquism, has been ascertained; and, on 
 closely questioning the patient, the symptoms he has 
 detailed have usually been corroborative of what might 
 be termed, if we were guided by the apparently unim- 
 paired state of health, latent phthisis. 
 
 It were easy to enter into a more full and minute de- 
 tail of the symptoms which characterize this complaint ; 
 but as my present object is to elucidate the preventive 
 and sanatory treatment to be observed, I deem it advis- 
 able to reserve many observations of a curious nature 
 connected with this branch of my subject. However, 
 should I have occasion to reprint this work, I may be 
 
MORBID APPEARANCES OF CONSUMPTION. 51 
 
 tempted to enlarge the present chapter, and publish many 
 interesting, and, as far as my knowledge extends, ori- 
 ginal facts. 
 
 I suffer this passage to remain as it stood in the for- 
 mer editions, as a renewed pledge to fulfil the promise 
 thus given. The call made upon me for a new im- 
 pression, as well as a pressure of literary and profes- 
 sional labour, prevents me from redeeming my word at 
 present ; but as I am now engaged in an extensive work 
 on the Diseases of the Chest,” I shall have an oppor- 
 tunity of pursuing the inquiry through all its ramifica- 
 tions. There is no branch of my subject on w^hich 
 more contradictory opinions have been emitted. Facts 
 themselves have been so differently described as to as- 
 sume the most opposite aspects. The founder of the 
 science of auscultative examination was induced not in- 
 frequently into error by over anxiety to complete his 
 system ; and too many of his followers have repeated 
 his oversights, or committed fresh mistakes from inac- 
 curate observation, and want of a proper field for its ex- 
 ercise. 
 
 MORBID APPEARANCES OF CONSUMPTION. 
 
 The most common morbid appearances met with in 
 the lungs are a peculiar species of accidental produc- 
 tion, known under the generic name of tubercles. These, 
 according to the different appearances they present, may 
 be distinguished into two primary forms — that of insu- 
 lated bodies, and that of interstitial infiltration or secretion. 
 In the former are classed miliary tubercles, so named 
 from their size, which usually corresponds with that of 
 a millet seed, although they are sometimes found much 
 larger. In their origin they are observed to be semi- 
 transparent, and of a grayish colour, sometimes nearly 
 colourless and transparent. On superficial inspection, 
 they are apparently orbicular, but, when more minutely 
 observed, occasional angularities and infractuosities are 
 visible. So closely are they interwoven with the fibre 
 of the lungs, that it is found impossible to separate them 
 without bringing away, at the same time, a part of the 
 former. They gradually approximate to, and unite with 
 
52 MORBID APPEARANCES OF CONSUMPTION. 
 
 each other, forming semi-cartilaginous groups or masses, 
 which in time acquire a light straw colour, and change 
 into a substance of the consistency of cheese. When 
 they thus spread and unite by intussusception, they form 
 what is technically denominated crude tubercles, or yel~ 
 low crude tubercles. Their progress to this state com- 
 mences with the appearance of yellow, opaque specks 
 occurring generally, but by no means uniformly, as has 
 been erroneously stated, in their centres. These tuber- 
 cles, increasing by degrees, either unite in the manner 
 described above, or remain, when thus converted into 
 the crude state, separate and isolated. A strong proof 
 of the soundness of the principle I am anxious to in- 
 culcate throughout this work, namely, that pulmonary 
 consumption is seldom met with in individuals of large 
 and expanded chests, will be found in the fact that these 
 nodules, or tubercles, almost invariably commence in 
 the upper portion of the lungs, which, by the very struc- 
 ture of the thorax, is their most confined part. From 
 the summit they spread downward, and in their single 
 formation will enlarge to the size of a hazel nut, although 
 rarely ; indeed, I consider it probable, that when they 
 apparently reach these dimensions they are not in point 
 of fact single, but an aggregation, so compacted as to 
 defy separation. 
 
 A second form of insulated bodies are the gramdar 
 tubercles, first pointed out by Bayle, who regarded them 
 as an accidental cartilaginous formation, different from 
 tubercles ; but without sufficient reason, since, on divid- 
 ing them, we find that they present the same colour and 
 opacity as the common tubercle, and their growth evi- 
 dently proceeds through the same stages : therefore, I 
 am of opinion that they are unquestionably the same. 
 The principal distinction between the two consists in 
 their external form. The granular tubercles are round- 
 ish or ovoid, of the size of a millet seed, which they 
 seldom exceed, and germinate singly in immense num- 
 bers over an entire lung, or its greater portion, so that 
 even where apparently blended, the granules are found, 
 on examination, to be entirely distinct. They differ 
 still further, by their being transparent and colourless. 
 Their induration and cartilaginous structure may arise, 
 it is not unreasonable to suppose, from their remaining 
 
' MORBID APPEARANCES OF CONSUMPTION. 53 
 
 during a long period without showing any disposition to 
 suppurate, which they are sometimes however found 
 to do. 
 
 I have stated, that one of the principal differences be- 
 tween the miliary and the granular tubercles consists in 
 the latter being colourless and transparent ; yet this is 
 not an invariable distinction, since they occur at times 
 of a grayish tint, and are not invariably diaphanous, 
 but in conjunction with this gray colour are also semi- 
 transparent, thus furnishing an additional proof of their 
 assimilation with the miliary tubercle. 
 
 The second form in which tuberculous matter exhib- 
 its itself in the lungs is that of interstitial infiltration ; 
 this, like the first, may be divided into two classes, one 
 of which may be denominated gray tuberculous infiltra- 
 tion, and the o\h.er jelly-like tuberculous infiltration. The 
 former is found, in this the second stage of the tubercu- 
 lar progress, infiltrated around tubercular cysts, and in- 
 corporated, if I may use the term, with the pulmonary 
 tissue. Occasionally it is met with in a separate deposite, 
 independent of the previous formation of miliary tuber- 
 cles, and forms large masses of a moist compact sub- 
 stance, impenetrable by the air. Its grayish hue is de- 
 rived from the secretion of black pulmonary matter in 
 minute particles. Softening gradually, in a manner 
 similar to the insulated tubercle, it passes into a state of 
 crudity, which is indicated by minute yellow and opaque 
 points, or specks. On making a section of this mass, 
 the matter contained in these minute specks oozes out, 
 and there remain small orifices similar to so many holes 
 left by the mark or prick of a pin. The jelly-like sub- 
 stance, termed the jelly-like tuberculous infiltration, is 
 discovered in the intervals of the miliary tubercles, and 
 is for the most part colourless, although occasionally it 
 is tinged with red. Gradually gaining greater consist- 
 ency, (says Laennec,) it becomes converted into yellow 
 tuberculous matter ; and this indeed, according to him, 
 at times so rapidly, that, on inspecting large masses of 
 the substance thus changed, we are often unable to find 
 any trace of its original state : but, according to my 
 own opinions, which have been based on observations 
 continued for a series of years, this view is altogether 
 erroneous, since the jelly-like infiltration is, I ^conceive. 
 
54 MORBID APPEARANCES OF CONSUMPTION. 
 
 the result of specific chronic inflammation. Nor does 
 this jelly-like infiltration, or, more correctly speaking, 
 secretion, ever become, as far as I am aware, converted 
 into yellow tuberculous matter. Again, the secretion, 
 of which we are now speaking, is precisely similar to 
 that morbid deposite frequently found beneath the serous 
 surface of the lungs, in cases of chronic pleurisy ; and 
 in chronic inflammation of the heart I have repeatedly 
 seen the same gelatinous matter, beneath the serous 
 investure of the auricles and that of the ventricles, with- 
 in the laminse of the pericardium, and underneath the 
 serous surface of parts within the abdominal cavity. 
 These facts are strong corroborations of my opinion as 
 to the specific chronic nature of this secretion ; but 
 when we find the presence of capillary vessels, extend- 
 ing themselves into this gelatinous matter, which minute 
 vessels are also traced in the jelly-like secretion of the 
 different parts above mentioned, I think my assertion 
 fully borne out. To extend my proofs still further, I 
 may observe, that, in some severe chronic diseases of 
 the joints, I have seen a like secretion on the exterior 
 surface of the sinovial capsule, extending itself to no 
 inconsiderable distance into the surrounding cellular 
 membrane. 
 
 The process by which both the insulated and diffused 
 tuberculous matter becomes softened into a fluid state 
 is similar. Generally, a number of small, yellow, opaque 
 specks make their appearance in the centre of several 
 coalesced tubercles, and in different parts of the dif- 
 fused tuberculous matter, until, by degrees, the whole of 
 the substance is converted into a uniform yellow mass, 
 which after an uncertain period becomes softened, and 
 is changed into thick and curdy pus. However, the 
 consistency of this pus is by no means invariably the 
 same, a portion assimilating to the secretion from an 
 ordinary sore, and being thin and watery. In expe- 
 diting this change in the tuberculous mass from hard 
 to soft, the secretion from the lining surface of the mem- 
 brane circumscribing it, I entertain no doubt, contributes 
 not a little. I find in a work published by M. Lombard 
 of Geneva that he supposes each portion of tuberculous 
 matter to act like a foreign body on the tissues with 
 which it is in contact, thus producing a secretion of pus 
 
MORBID APPEARANCES OF CONSUMPTION. 55 
 
 mechanically dividing* the tubercle into clots ; but I con- 
 ceive that this gentleman, though partially correct, at- 
 tributes too much to the action of this fluid, since we 
 find a particle, or particles of pus, contained within the 
 solitary tubercle, and evidently not in contact with any 
 tissue having the power of generating pus — nay, more, 
 we find deposites of pus in the large tuberculous masses, 
 in which the natural alveolar structure of the lungs is by 
 no means discernible. When a secretion of pus takes 
 place, and (partly established by a process of irritation) 
 to an amount sufficient to effect a solution of continuity, 
 an opening is made into some of the neighbouring bron- 
 chial tubes, or into some tubercular cavity, of previous 
 formation communicating with them. By this compound 
 process, according to the foregoing view, the elimina- 
 tion of tuberculous granules is effected. The interior 
 of such cavities, when of large extent, has columnar 
 bands extending across it ; these are formed of con- 
 densed pulmonary tissue, and they are sometimes coat- 
 ed with the tuberculous degeneracy ; it should be ob- 
 served, that none of the bronchial ramifications traverse 
 these excavations, and that the few vessels, occasionally 
 seen within the bands, are in almost every instance 
 obliterated. In the parietes of the large anfractuous 
 excavations of long standing, the blood-vessels are fre- 
 quently observed in a flattened state, and those that are 
 obliterated are covered by a thin, semi-cartilaginous 
 membrane : the bronchial ramifications, on the contra- 
 ry, with the exception of those necessary for the dis- 
 charge of sputa, though found obliterated, and invaria- 
 bly discovered to be cut off, yet would appear to have 
 been originally enveloped by the tuberculous matter, 
 and to have traversed the space it occupies. As soon 
 as these cavities have discharged their contents, they 
 become lined by a soft, thin, and nearly opaque morbid 
 membrane, or are merely invested by an exudation, 
 which is in some parts deficient, and varies in density. 
 At times, we meet with cases in which laminsB of a light 
 blue colour, and semi-cartilaginous nature, line these 
 excavations, interspersed here and there with, slight emi- 
 nences, and in intimate connection with the pulmonary 
 tissue, being continuous also with the lining membrane 
 of the bronchia. At others, the boundaries of the exca- 
 
56 MORBID APPEARANCES OF CONSUMPTION. 
 
 vations are found without either of the false membranes^ 
 and are formed by the natural texture of the lungs 
 merely condensed, or infiltrated with tubercular matter^ 
 In concluding my remarks on the formation of the tu- 
 berculous cavities, I must express my concurrence with 
 the view taken by M. Bayle, of the false membrane’s 
 secreting the pus which is expectorated, instead of its 
 being the product of the bronchial secretion. The 
 grounds on which I rest my opinion are these — in the 
 first place, that no bronchial alfection is perceptible until 
 the disease is drawing to a close, or unless nature at- 
 tempts to effect a cure by the supervention of catarrh ; 
 and, in the second place, that, on dissection, we do not 
 find these excavations frequently empty, as stated by 
 Laennec, but that they generally contain no inconsider- 
 able quantity of puriform matter, similar to the sputa 
 which had been ejected by the patient. 
 
 The stage of my subject at which I have now arrived 
 leads me to the consideration of encysted tubercles . Al- 
 though seldom met with, except in the bronchial glands, 
 yet, in at least a dozen instances, I have found these 
 tubercles surrounded previously to softening by an ac- 
 cidental membranous formation, and sometimes by con- 
 densed pulmonary tissue. Still, seldom as this occurs. 
 Nature, ever prone to discover and apply a remedy to 
 her own infirmities, has benignantly provided that the 
 black deposite, caused by the tuberculous irritation, shall 
 answer every purpose of a cyst. It has often happened 
 to me to have had opportunities of examining patients 
 of my own, who, after having recovered from consump- 
 tion, and enjoyed a good state of health for years, have 
 expired of diseases not referable to the pulmonary or- 
 gans. In many of these instances, in which ulcers of 
 the lungs have been transformed into semi-cartilaginous 
 fistulee, or in which perfect cellular cicatrization has 
 taken place, I have remarked, that such nodules of tu- 
 bercles as then existed have become enveloped by 
 black pulmonary matter, which by isolating them, and 
 rendering them innoxious, has evidently produced the 
 same beneficial effects as would have resulted from the 
 encysted state. Indeed, I have reason to believe, from 
 inquiring into the history of the cases of many persons, 
 who in their youth bad laboured under consumption, 
 
MORBID APPEARANCES OF CONSUMPTION. 57 
 
 from which they afterward recovered, and on whose 
 demise I have been called in to examine the body, that 
 latent nodules, in the state described above, have exist- 
 ed upward of thirty years. Again, in individuals in 
 whom consumption has been arrested by the spontane- 
 ous occurrence of chronic catarrh, or by treatment 
 adapted to render the disease chronic, similar nodules 
 similarly situated, together with wrinkled depressions 
 on the exterior surface of the lungs, signs of internal 
 cicatrices, are of no infrequent occurrence. Without 
 intending to enter too far into the debateablei ground of 
 hypothesis, I yet feel induced to observe that I regard 
 tubercular deposition as a specific vitiated secretion, 
 arising from an aberration of nutrition. In confirmation 
 of this opinion, I have strong grounds for believing that 
 tubercles of very recent date, and not arrived at a state 
 of crudity, undergo absorption, and that upon this re- 
 storation from incipient phthisis soon follows. Thus I 
 have indicated two modes by which recovery from 
 phthisis occurs ; the one is the reabsorption of tubercles 
 in their early state, and the other is their insulation, even 
 in a state of crudity, by black pulmonary matter. I 
 now approach what I consider the most interesting por- 
 tion of my subject connected with the morbid anatomy 
 of phthisis, the mode of union and cicatrization of ulcer- 
 ous excavations, which seems by no means understood. 
 Whenever nature operates a cure, there is an extension 
 of irritation from the lining of the cavity into the neigh- 
 bouring bronchial tubes ; and the consequence of this 
 is, supposing there exist one or more cavities, in the 
 summit of the right lung for example, (since the right is 
 the one generally first attacked,) an emphysematous 
 state of the vesicular structure of that portion of the 
 lung, through imprisonment of the air in the act of ex- 
 piration. Hence, through enlargement of the aerial 
 cells, and consequent voluminous state of the pulmonary 
 tissue, the pressure is so constantly exerted from with- 
 out inward on the exterior of the cyst, that in time an 
 apposition of the parietes of the cavities takes place, 
 and the ulcerous excavation becomes healed by the first 
 intention. If the healing occurs early, and the cavity 
 is not of old date, cellular cicatrization is the conse- 
 quence ; but if no pulmonary catarrh supervenes until 
 
58 MORBID APPEARANCES OF CONSUMPTION. 
 
 after phthisis has existed for a length of time, the cica- 
 trizations are commonly formed of fibro-cartilaginons 
 lamellee, or there is left an imperfect cicatrix with semi- 
 cartilaginous fistula. Whenever vesicular emphysema 
 exists, recent tubercles are rarely seen ; hence it hap- 
 pens that fresh crops of tubercles have no disposition to 
 appear in the cicatrized summit of the newly healed 
 lung ; but if, after recovery has taken place through 
 this change, any circumstance should arise to injure the 
 patient’s health, the summit of the other lung, not being 
 emphysematous, may be the seat of a fresh formation 
 of tubercles ; and the fresh successive crops of tuber- 
 cles may even appear beneath the emphysematous por- 
 tion of the summit of the right lung, as well as in other 
 parts. In the progress of the disease, when unchecked, 
 these crops proceed downward by progressive stages. 
 No sooner has a cavity been formed in the summit of 
 either lung, than, after an indefinite period, a succeed- 
 ing eruption appears lower down, so that the appear- 
 ances, presented on dissection, show the inroads of the 
 disorder from its direst ravages down to its latest attacks. 
 Thus, an anfractuous cavity is generally found in the 
 summit, surrounded by tubercles in an advanced state 
 of crudity ; somewhat lower down are smaller cavities 
 containing portions of undissolved tuberculous matter, 
 and around them small nodules assuming the yellow 
 appearance ; beneath these the crude miliary tubercles 
 are apparent, having their centres already occupied with 
 yellow points ; and lastly, the transparent miliary tuber- 
 cles, which form the first morbid tuberculous appear- 
 ance in pulmonary consumption, occupy the inferior 
 portion of the lower lobes of the lungs. I ought here 
 to mention that, if, after tubercles are deposited, or a 
 cavity is formed in the summit of the lung, general vesi- 
 cular emphysema arises in consequence of catarrhal af- 
 fection, or of irritation spreading through the ramifica- 
 tions of the bronchi from the seat of the disease, there 
 will be no disposition to the formation of tubercles. 
 This strange and singular exception may be probably 
 the result of the extraordinary exercise of the pulmo- 
 nary apparatus, caused by the frequency of respiration 
 inseparable from catarrh or asthma. Most truly does 
 Laennec observe, what my own extended experience 
 
MORBID APPEARANCES OF CONSUMPTION. 59 
 
 confirms, that tubercles are less frequently met with in 
 the muscles of voluntary motion than elsewhere ; and 
 in this we find a strong confirmation, given by the hand 
 of nature herself, of the value of artificial means to in- 
 crease the action of the lungs, and thus arrest any new 
 development of tuberculous eruptions. 
 
 Before I conclude my observations on the morbid ap- 
 pearances, I deem it necessary to notice the organic 
 changes which accompany phthisis, many of which are 
 entirely dependant on the particular treatment to which 
 the patient may be subjected. The intestines, more es- 
 pecially the small, are, next to the lungs, the most liable 
 to tuberculous degeneration, leading to the ulcerous state, 
 which in its turn keeps up profuse and wasting purga- 
 tion. This troublesome condition may, in many instan- 
 ces, be avoided by a plan of treatment which the read- 
 er will find laid down in another part of this work. — 
 More than one-fourth in a hundred adult subjects, ac- 
 cording to Dr. Lombard, had tubercles in the intestines ; 
 but I have found, that, under judicious management, this 
 proportion may be considerably decreased. Being de- 
 sirous, however, to see how far phthisical patients were 
 liable to this intestinal affection, I found that, out of the 
 same number of adult subjects who came under my 
 notice, less than a sixth part had intestinal tubercles : 
 
 4 yet, though such was the result of my inquiry with 
 respect to these particular cases, I cannot but allow that 
 the relative proportion, as stated by M. Lombard, is, 
 generally speaking, correct. Next, in order of frequency, 
 as subject to the tuberculous state, are the mesenteric, 
 bronchial, and the cervical ganglions ; the viscus most 
 liable to be affected after the intestines is the spleen ; 
 then the kidneys, and, less rarely, the liver. A wide 
 difference, however, in the proportions above estimated, 
 and in the liability of the several parts to tubercles, ac- 
 cording to the order I have just set down, is met with 
 in young, as compared with adult subjects. Thus intes- 
 tinal tubercles are more rare in the former than in the 
 latter, but the mesenteric, as well as the bronchial gan- 
 glions, are much more frequently the seat of this disease 
 in children than adults : and the result of repeated ex- 
 aminations has proved to me, that the presence of tu- 
 bercles is oftener detected in the nervous centres of chil- 
 
60 MORBID APPEARANCES OF CONSUMPTION. 
 
 dren than in those of adults. Were I to follow the bias 
 of my inclination, I should willingly extend my re- 
 marks on this interesting branch of my subject still 
 further ; but the plan of the present work precludes me 
 from entering upon a more detailed notice. I am thus 
 necessarily restricted to brevity, in my observations on 
 the principal lesions which accompany phthisis pulmo- 
 nalis. 
 
 It is with no small degree of surprise, that I perceive 
 it stated by a French physician of eminence, M. Louis, 
 that peripneumony and pleurisy were found by him to 
 occur in so small a proportion as one-tenth of the cases ; 
 whereas I am fully persuaded that, in the last stage of 
 consumption, not less than one-fourth, nor should I ex- 
 aggerate by stating the proportion as greater, display, 
 on dissection, one or both of these diseases. Another 
 strange error into which a medical writer of the same 
 country, M. Andral, has fallen, is his supposition that 
 peripneumony is common in the early stages of the dis- 
 ease, the contrary being decidedly the fact. I admit 
 that partial peripneumonies, around the nodules of tuber- 
 cles, are not uncommon ; but the cases are rare indeed 
 in which the disease occupies the lower lobes of the 
 lungs, the usual seats of inflammation. Were phthisi- 
 cal patients so frequently affected with pulmonary in- 
 flammation as M. Andral describes, the duration of con- 
 sumption would be wonderfully shortened. One dis- 
 eased state or other of the mucous membrane of the 
 trachea, of the larynx, and of the epiglottis, occurs in 
 the same ratio as pneumonia ; but these affections are 
 of infrequent occurrence until phthisis has made con- 
 siderable progress. Fortunate indeed would it be for 
 consumptive patients to be early attacked with inflam- 
 mation of some part of the great air passage, since, in 
 such case, the progress of their disease would be effect- 
 ually checked. I would here particularly draw atten- 
 tion to an important circumstance, which, if left unex- 
 plained, might appear subversive of the very principles 
 and practice I would inculcate throughout this work. It 
 may reasonably be inquired, if inflammation of the air 
 passage, in one part or other, oppose so completely the 
 progress of consumptive disease, how does it happen, 
 that in numberless cases we find the first symptoms of 
 
MORBID APPEARANCES OF CONSUMPTION. 61 
 
 phthisis exhibited by the patient to consist in loss of 
 voice, hoarseness, and, in short, all the apparent evi- 
 dences of laryngeal affection, and yet the pulmonary 
 disorder receive no visible relief ? Now auscultative 
 experience has clearly demonstrated to me that, in cases 
 of this kind, latent tubercular disease invariably exists 
 in the lungs previously to this aphonia ; and that this 
 very loss of voice, and accompanying hoarseness, are 
 the results of a thickening and ulceration of the mucous 
 membrane of the ventricles, and vocal chords of the 
 larynx alone, which, however, do not present an obstruc- 
 tion to the expiration so as to excite the action of the 
 lungs, in the decided manner effected by catarrhal, or 
 asthmatic complaints. There exists, indeed, an essential 
 difference in the character and effects of this distressing 
 aphonia, and of catarrhal disorder. However, notwith- 
 standing all the various symptoms of phthisis proceed 
 uninterruptedly, in patients so afflicted ; yet, through a 
 subacute irritation in the ventricles of the larynx, at 
 last producing a swelling of the surrounding mucous 
 tissue, so as to encroach sufficiently on the area of the 
 windpipe to cause a slight obstruction to the expiratory 
 process, consumptive subjects of this class live at least 
 twice as long as the generality of those whose disease 
 is not accompanied by such laryngeal affection. 
 
 The stomach, liver, spleen, and pancreas deviate not 
 infrequently from a healthy state. In consequence 
 of remarking the hardness, enlargement, and other struct- 
 ural alteration in the liver, the late Mr. Abernethy, to 
 whom the department of surgery owes so much, was 
 induced to believe that consumption frequently origina- 
 ted in a diseased state of this organ. From this erro- 
 neous view, a mode of treatment was pursued by him, 
 calculated rather to aggravate than lessen phthisical symp- 
 toms. By too great a reliance on the effects of mercu- 
 ry, he unfortunately hastened the catastrophe which he 
 sought to avert ; and gave the sanction of his high au- 
 thority to a practice, which, for several reasons, could 
 not be attended with other than pernicious effects. It 
 is evident that he never reflected upon the causes to 
 which this morbid condition of the liver is to be ascribed. 
 
 In consumption, the great venous trunks are always 
 congested in a greater or less degree. The cold stages 
 
62 MORBID APPEARANCES OF CONSUMPTION. 
 
 of the hectic paroxyms, the tuberculous indurations, the 
 partial pleurisies, peripneumonies, and the contraction of 
 the chest which are constantly diminishing the capacity 
 of the lungs, retard the circulation from the right side 
 of the heart through the lungs ; hence a gorged state 
 of the venae cavae, and congestion of the liver, the in- 
 separable consequences of the preternatural plenitude 
 of the inferior cava, which receives the blood of this 
 the largest gland in the system. The anatomist, being 
 aware that the vena portae carries the residual blood of 
 the already specified organs through the liver, will read- 
 ily account for the frequent occurrence of the morbid 
 appearances that are observable after death in these 
 various parts ; since the derangement of the liver will, 
 it need hardly be said, exercise an injurious influence 
 on the stomach, spleen, pancreas, and the intestinal 
 tube : nay, it is by no means uncommon to meet with 
 the symptoms of subacute inflammation of these parts 
 during life. The frequency, extent, and complication, 
 however, of these lesions on dissection, are chiefly de- 
 pendant on the treatment that has been pursued. Should 
 depletion have been neglected, these morbid affections 
 will necessarily be considerable ; but should the contra- 
 ry course have been judiciously resorted to, they will 
 be proportionably rarer. I may mention, by way of 
 corollary to these remarks, that serous effusions take 
 place as a sequence of neglect in recurring to due deple- 
 tion, and also, in many instances, as the result of debil- 
 ity, and are the proximate cause of death. These may 
 occur to a quintuple extent ; for example — in the brain, 
 the pericardium, the cellular membrane of the lungs, 
 the pleural sacs, and the peritonial cavity. From repeat- 
 ed observations made by me, and which have never yet 
 been subject to a single exception, I may lay it down as 
 almost an invariable rule, that an oedematous state of the 
 feet is an index of some internal effusion. Indeed, 
 whenever I observe, after death, and before dissection, 
 that the extremities are swollen, I feel convinced that 
 the presence of effusion will be one of the results of 
 the examination. As one of the complications of phthi- 
 sis, I may here mention a disposition to fistula, which 
 Bordeu states to be of common occurrence ; but accord- 
 ing to my calculation, I estimate that the proportion 
 
MORBID APPEARANCES OF CONSUMPTION. 63 
 
 does not exceed one in five hundred cases. Yet anal 
 abscesses are far from being infrequent: on examina- 
 tion, however, they will be found not to deserve the 
 name of true fistulse. Calcareous deposites are occa- 
 sionally found loose, in some large cavities of the lungs ; 
 and I entertain no doubt from having seen them in 
 imperfect cicatrizations, that they have escaped into 
 these excavations, owing to the destruction of their con- 
 taining cicatrice by ulceration. The general formation 
 of these deposites, which are chiefly composed of phos- 
 phate of lime, and of traces of animal matter, is not a 
 little curious. When the process of healing is imper- 
 fectly performed, and the constitution of the individual 
 is possibly inclined to a chalky diathesis, a calcareous 
 secretion is substituted for the cicatrization that remains 
 to be finished, and a cure of the part is thus completed : 
 and l am satisfied that, in such of the bronchial glands 
 as contain similar concretions, they supply the room of 
 tuberculous matter, which it is by no means improbable 
 is partly removed by absorption. 
 
 Mr. Abernethy has remarked in the heart, which is 
 generally free from disease, with the exception of slight 
 dilatation of the right ventrical, that the foramina ihehesii 
 are frequently enlarged. However, I have never yet 
 met with any appearances to verify his assertion. 
 
 There remain many observations which I would gladly 
 make public, on the morbid appearances observable in 
 consumption, a department of inquiry to which I have 
 devoted my entire professional life ; for instance, empy- 
 ema, resulting from the escape of tuberculous matter 
 into the cavity of the chest, pneumo-thorax, gangrene, 
 &c. : but, as I have already stated, the circumscribed 
 limits and peculiar nature of my work preclude me 
 from indulging my wishes on this my favourite theme. 
 On a future occasion, however, it is not improbable that 
 I may have to olfer a distinct treatise on this interesting 
 subject. 
 
 This opportunity will be presented in the w^ork on 
 “ Diseases of the Chest,” to which I have already al- 
 luded, and which I am now actively engaged in prepar- 
 ing. 
 
PROPHYLACTIC TREATMENT, 
 
 BY WHICH THE DEVELOPMENT OP TUBERCLES IN THE LUNGS MAY* 
 
 BE PREVENTED IN PERSONS LIABLE THERETO FROM HEREDITARY 
 
 PREDISPOSITION, OR A CACHECTIC STATE OF THE SYSTEM. 
 
 Early in my practice, when consulted by patients of 
 an hereditary predisposition to consumption, it was usual 
 with me to recommend a generous invigorating mode 
 of living, and daily exercise in the open air, with a 
 caution to avoid every thing calculated to impair the 
 general health. If, too, it were in the patient’s power 
 to avail himself frequently of change of air and scene, 
 I generally found it productive of considerable benefit, 
 both in a physical and mental point of view. The ad- 
 vantages derivable from short excursions, or, still bet- 
 ter, voyages by sea, always invited my recommendation 
 when circumstances rendered them available. Impreg- 
 nated as the sea breezes are with saline particles, they 
 act, I conceive, as stimulants of the lungs to deeper and 
 more frequent inspiration, and thus forward the enlarge- 
 ment of the chest, a point to which I have more than 
 once adverted, in the course of this work, as of primary 
 importance. They may also be regarded as possessed 
 of a tonic power, bracing and invigorating the surface 
 of the body, and, by continuous sympathy, exerting a 
 beneficial influence on the viscera, especially those con- 
 nected with the digestive functions. Another strong in- 
 ducement to recommend a sea voyage, in the case of 
 persons labouring under incipient consumption, is the 
 probability of the patient’s having his chest expanded in 
 the manner described above, and thus increasing the 
 chances of his contracting some variety of catarrh — 
 hence bidding defiance to phthisis. With reference to 
 a generous mode of living, it is obvious that the tenden- 
 cy to weakness, exhibited by individuals of consump- 
 tive constitution, calls for a method of treatment calcu- 
 lated to counteract the commencing symptoms. Par- 
 ticular rules and limitations, with respect to the dietetic 
 management, will be specified under the head of diet. 
 As to change of residence, a singular instance of its 
 
TREATMENT OF CONSUMPTION* 
 
 65 
 
 preventive effects occurred some years ago in the family 
 of a near relative of mine, formerly colonel of a dis- 
 tinguished cavalry regiment, who, after the afflicting loss 
 of two grown-up daughters and a son, removed with his 
 remaining children to Tours. Here he resided for five 
 years ; at the expiration of which period, returning to 
 his native country, and to the neighbourhood of the 
 place in which the disease had first manifested itself in 
 the children he had lost, he had the affliction of wit- 
 nessing the premature deaths of three other members 
 of his family within the short period of two years. 
 
 Celsus says, that the worst air for the patient is that 
 which has given rise to the disease ; to which we may 
 add, that to consumptive families the worst locality is 
 that in which the disease has first betrayed itself. 
 
 While preparing these sheets for the press, I have 
 met with a very striking exemplification of the value of 
 distant removal, in families consumptively inclined, to 
 those members whose circumstances have called from 
 their native land. Out of a family, consisting at one 
 period of eleven individuals, seven remaining here have 
 fallen victims to consumption ; while two, who, as I 
 have been given to understand, displayed the same 
 phthisical constitution as these, having removed to some 
 of our distant settlements, have enjoyed an excellent 
 state of health for many years, and have continued 
 free from any pectoral complaint. 
 
 Of the different kinds of exercise, I would particu- 
 larize running and riding as the most calculated to for- 
 ward the purposes of prevention ; indeed, as the best 
 general prophylactics. After a quick and brisk run, 
 the respiration becomes frequent and deep, and the 
 panting that ensues by exercising the muscles of the 
 chest, favours a healthy development of that part, and 
 enlarges the volume of the lungs. It has been my 
 universal practice to recommend a constant attention to 
 this healthy exercise, in those schools I have been in 
 the habit of attending, and to advise the preceptors to 
 promote it by every inducement within their power; 
 and I have never been disappointed in the results ex- 
 perienced. Nor are its happy effects confined to the 
 mere expansion of the chest ; by the greater portion of 
 air thus brought into contact with the venous system 
 
 9 
 
66 
 
 TREATMENT OF CONSUMPTION. 
 
 the blood becomes more effectually decarbonized, the 
 animal heat increased, the action of the heart more vig- 
 orous, and the multifarious secretions are carried on 
 with greater energy. 
 
 Riding, which stood so high in Sydenham’s estima- 
 tion, is an exercise of no mean value, for the self-same 
 reasons, with this advantage, that it yields all the good 
 effects of the former, unattended with its fatigue. To 
 those, however, in whom consumption has decidedly 
 appeared, the benefit deriveable from this mode of exer- 
 cise, may, perhaps, be enhanced by the tendency to au 
 upward motion imparted to the lungs, thus disposing to 
 apposition the diseased surfaces in the upper region of 
 the chest. Dr. Carmichael Smyth has advocated the 
 utility of swinging as an exercise, and has devoted a 
 treatise to its supposed merits. This, although he does 
 not explain its mode of operation, undoubtedly acts in a 
 manner similar to the foregoing, and, notwithstanding 
 I have never recommended it, it may not be unworthy 
 of trial as a prophylactic. A strong proof of the advan-' 
 tages of exercise may not unwarrantably be sought for 
 in the probable exemption of man, in a savage state, 
 from the ravages of this disease. Although various dis- 
 orders are mentioned by travellers as having fallen un- 
 der their observation, I do not remember, in the course 
 of my reading, to have met with any notice of consump- 
 tion, recorded by those who have mingled with the 
 savage tribes of either the old or the new world ; at 
 least, among the more active races of uncivilized man. 
 Indeed, it would be wonderful were the case otherwise. 
 Dependant for their subsistence on incessant vigilance 
 and vigorous exertion ; constantly engaged in the toils 
 of the chace, or animated to activity by the animosities 
 ever subsisting between neighbouring tribes, however 
 they may lapse occasionally into habits of sloth and in- 
 dolence, their life from the cradle to the grave must, 
 generally speaking, be calculated to call forth and per- 
 fect every bodily energy. Free from the restraints 
 which are the unavoidable consequence of a state of 
 superior intelligence, — neither confined to the manufac- 
 tory, nor chained down to the desk of the counting-house, 
 untrammelled by dress, and uncramped by the various 
 devices to which either fashion, or the force of habit. 
 
TREATMENT OF CONSUMPTION. 
 
 67 
 
 renders us subservient despite the dictates of reason, — 
 the savage possesses at least the uncontrolled use of 
 his limbs ; and the symmetry usually observed in him 
 is perhaps the best index of the health he enjoys. If, 
 too, we extend our course of reasoning to the inferior 
 race of animals, and observe the differences existing 
 between them in their wild and domestic condition, we 
 shall find a singular analogy between them and man. 
 To go no further than the harmless creature, the rabbit, 
 I have found, in the course of my researches in com- 
 parative anatomy, that this animal frequently dies of 
 consumption, in its tame state ; but I never met with an 
 instance of the kind in the wild rabbit. Perhaps the 
 benefit of exercise cannot be better exemplified than by 
 way of contrast. Swine, proverbially the most indolent 
 of animals, are also the most subject to tuberculous dis- 
 ease ; hence the derivation of the word scrofula from 
 the Latin scrofa, a swine ; and consumption and scrof- 
 ula are identically the same, both resulting from the 
 presence of tubercles. To pursue the analogy, another 
 strong instance of the force and good effects of exercise 
 is observable in the race-horse, the hunter, and indeed 
 in all of this class that are subject to frequent and active 
 exertion. These seldom or ever, I believe, are found to 
 have tubercles in the lungs, so long as they are kept 
 constantly employed. Many illustrations of this nature 
 might be adduced, but sufficient has been said to enable 
 the reader to extend this comparative inquiry, and to 
 confirm the high value which I set on the effects of ju- 
 dicious and well-regulated exercise. In additional con- 
 firmation of my reliance on mechanical modes of exer- 
 cise, as prophylactics, I proceed to relate a few out of 
 numerous cases of the kind I find recorded in my note- 
 book. 
 
 Case 1. — Some few years back I was called in to see 
 the eldest son of a family of rank, a boy of twelve years 
 of age, who, when I first saw him, was in the last stage 
 of consumption, to which a younger member of the same 
 family, whose case I had the opportunity of witnessing, 
 had previously fallen a victim. As was expected, the 
 case terminated fatally ; and on examining the body, 
 independently of the diseased state of the lungs which 
 usually occurs in consumption, the serous surfaces of 
 
68 
 
 TREATMENT OF CONSUMPTION. 
 
 the chest, as well as of the abdomen, were studded with 
 innumerable tubercles. Some of these, seated in the 
 peritoneum investing the intestinal tube, were of large 
 size, and in a state of crudity ; and I traced two minute 
 openings in the ileum, (formed, I have reason to believe, 
 by softened tuberculous matter,) through which liquid 
 foecal contents were diffused within the abdominal cav- 
 ity. This part, during life, was of ascitical magnitude, 
 and fluctuated on percussion, but was almost devoid of 
 pain. He had vomited on two or three occasions con- 
 siderable quantities of liquid matter, emitting a foecal 
 odour, and similar in appearance to what I afterward 
 found deposited in the peritoneal sac ; and subsequent 
 to each vomiting, a perceptible reduction in the magni- 
 tude of the abdomen took place. This circumstance 
 would induce me to suppose, judging from the peculiar 
 smell and appearance of the ejected fluid, that a portion 
 had been returned from the abdominal cavity into the 
 intestinal canal, whence, by inverted action, it reached 
 the stomach to be discharged by vomiting. The same 
 appearances, in regard to extensive tuberculous deposite, 
 with the exception of the intestinal perforation, were, 
 I was given to understand, presented in the body of the 
 younger brother, whose death, I have already mentioned, 
 preceded that of his elder. From the delicate health 
 of the remaining members of the family, two especially, 
 joined to the foregoing signs of highly-charged scrofu- 
 lous habit, it was apprehended by their nearest relatives 
 that the disease would successively pervade the whole 
 family. One, however, I felt assured, from her having 
 had for two years a pulmonary catarrh, would be ex- 
 empt from the dreaded visitation. Following up the 
 plan which I had ever found so eminently serviceable, 
 I immediately recommended them to commence a course 
 of inhalation. For this purpose, I ordered that tubes, 
 of diameters varying with the respective ages of the 
 patients, should be prepared, through which they were 
 directed to respire twice a day ; and the time for this 
 process was gradually extended, until it occupied half an 
 hour morning and evening. By pursuing this plan of 
 treatment their chests gradually enlarged, their health 
 became surprisingly amended, and a regularity of bow- 
 els, without the aid of medicine, was soon established. 
 
TREATMENT OF CONSUMPTION. 69 
 
 It may here be advisable to explain in what manner 
 the simple process of inhalation, while it expands the 
 pulmonary apparatus, at the same time regulates the 
 most important of the visceral functions. The mere ex- 
 pansion of the lungs in the first instance tends indirectly 
 to remove congestion of the liver, and also of the sto- 
 mach, spleen, pancreas, and intestinal canal, all depend- 
 ant on the more free circulation of the blood in the for- 
 mer. The biliary as well as the great salivary secre- 
 tion is hereby promoted to a healthy activity. Such 
 morbid irritability of the mucous membrane of the sto- 
 mach, as may be present, productive of indigestion, is 
 removed; the chyliferous absorption belonging to the 
 small intestines, so indispensable to life, is actively car- 
 ried on ; and the injurious retention of excrementitious 
 matter, in the larger intestines, is obviated by increased 
 mucous moisture, and accelerated peristaltic motion. 
 It were easy, did I deem it essential, to point out at 
 length the beneficial effects produced on other secre- 
 tions, and to explain the mode by which inhalation acts 
 upon that of the kidneys ; but sufficient has been stated 
 to enable the medical man to draw his own deductions 
 in these particulars. To bring the history of this fam- 
 ily case to a close, I have the pleasure of saying, that 
 a perfect restoration has attended my endeavours, and 
 that at this moment these, my former patients, are en- 
 joying all the blessings of health. 
 
 Case 2. — A young gentleman was brought to my 
 house, by the secretary of an incorporated literary in- 
 stitution in Lincoln’s Inn Fields, labouring, his friends 
 feared, under incipient consumption. His conformation 
 evidently predisposed him to phthisis ; and his chest in 
 particular was singularly narrow^ and slightly deformed. 
 I laid down the plan which I conceived it would be most 
 advisable for him to follow, and pointed out the necessity 
 of strict adherence to my directions. Inhalation, of 
 course, formed a prominent feature in the treatment to 
 be observed. It so happened, that I had only this soli- 
 tary opportunity of prescribing for him, although I could 
 have wished to see him from time to time, since 
 there are circumstances which occasionally render it 
 expedient to suspend inhalation for a short period, and 
 to have recourse to local and^ other treatment. Not- 
 
70 
 
 TREATMENT OF CONSUMPTION. 
 
 withstanding the w^ant of this opportunity might be con- 
 sidered unfavourable, it so occurred, to my great satis- 
 faction, that meeting the gentleman who had introduced 
 the youth, about eighteen months subsequent to his con- 
 sulting me, and of course inquiring into the state of his 
 health, I found that he, having punctually adhered to 
 my instructions, had not only overcome all his consump- 
 tive symptoms and been restored to robust health, but 
 that his chest, formerly so flat and confined, had altered 
 in shape, was considerably enlarged, and was, to use 
 the expression of his friend, perfect symmetry. 
 
 Case 3. — Two young ladies, of adult age, vrere 
 brought to towm by their mother in the middle of the 
 year 1832, for the purpose of taking my advice. Four 
 of her children had, she stated, been attacked by con- 
 sumption, within a short period of time, and had fallen 
 a prey to it. Both, when I first visited them, had a 
 short hacking cough, with undefined pain in the chest. 
 In the eldest, who was in her nineteenth year, the mur- 
 mur of respiration was imperfect in the top of the right 
 lung ; percussion also, on the centre of the clavicle of 
 the same side, yielded a flat sound. My impression from 
 these signs was, that a tuberculous deposite had already 
 taken place. Bronchophonism was distinctly heard by 
 the naked ear ; and it was plain, from the absence of 
 any variety of pectoriloquy, that no softening of the 
 mass, so as to form a cavity, had occurred. With re- 
 spect to the other sister — since the sound of her respi- 
 ration was natural, and no bronchial affection whatever 
 was indicated, yet as she had occasional cough, and 
 had had, as I was informed, slight hsemoptysis — I con- 
 ceived that a few solitary tubercles might possibly exist 
 in her lungs, irritating the pulmonary tissue like the thorn 
 of Van Helmont. These symptoms considered, I com- 
 menced with local blood-letting, and the exhibition of nitre 
 in doses of a scruple, &c. ; after which, my chief reli- 
 ance was on inhalation. They persevered in a course of 
 this for some months, inhaling, according to my custo- 
 mary directions, twice a day, varying the diameter of 
 the tubes employed, since occasionally pain arose from 
 the expansive process being too powerful. Indeed, the 
 liability to pulmonary engorgement, from using tubes of 
 too small a diameter, points out the necessity for the 
 
TREATMENT OF CONSUMPTION. ' " 71 
 
 constant superintendence of the practitioner, skilled in 
 the auscultative exploration of the chest. ' One circum- 
 stance, perhaps, should not be passed over, as exhibit- 
 ing an additional proof of the good effects of inhalation 
 on the general health. The periodical uterine secretion 
 of the elder of these young ladies having been sup- 
 pressed for some months, she recovered in the course 
 of a few weeks the usual feminine habit, which subse- 
 quently continued underanged. Nothing of further mo- 
 ment occurred in the course of these cases. Continuing 
 gradually to improve, the younger became perfectly re- 
 stored to health ; and the elder, although the respiration 
 in the upper lobe of the right lung is not so perfect as I 
 could desire, still, from the general expansion which 
 the pulmonary tissue underwent in all other parts, and 
 the probability that in time black pulmonary secretion 
 will form around the existing nodules, so as to isolate 
 them in the manner I have fully described in the chap- 
 ter on morbid appearances, I consider as entirely free 
 from all danger of any new formation of tuberculous 
 matter. 
 
 The value of exercise, in checking and removing 
 symptoms of incipient phthisis, is, in my opinion, so 
 great, that I am induced to dwell at some length upon 
 this part of my subject. Those musicians whose pro- 
 fession it is to play upon wind instruments are in general 
 supposed to be peculiarly subject to pulmonary com- 
 plaints ; perhaps not inaccurately so : yet, I am not 
 aw'are that any detailed or circumstantial explanation 
 has been given of the mode through which injurious 
 effects arise from the use of such instruments. Who- 
 ever will take the trouble to watch attentively a player 
 on the flute, or clarionet, &c., will find, that although 
 the performer seemingly inspires and expires frequently 
 and fully, yet that, in point of fact, he often makes sev- 
 eral consecutive expirations to one inspiration. Thus 
 his breathing, so far from being advantageous, and so 
 far from 'developing the lungs, as I have previously de- 
 clared well-regulated mechanical exercise will ever do, 
 is indeed so irregular and furtive, that it produces effects 
 entirely the reverse, narrowing the chest, and confining 
 the volume of the lungs : indeed, it favours that dimin- 
 ished size of the respiratory apparatus which engenders 
 
72 TREATMENT OF CONSUMPTION. 
 
 a tendency to consumption. What I may not inaptly 
 term a wholesale case occurred some years ago, illus- 
 trative of the foregoing remarks. The leader of an itin- 
 erant band of musicians applied to me in behalf of him- 
 self and followers, to know what method they should 
 pursue to avert the threatening appearances, which they 
 considered would ultimately lead to confirmed pulmo- 
 nary affection. I advised, that after their musical en- 
 tertainment for the time being was concluded, they 
 should always take a long and quick run, or else carry 
 walking sticks, perforated longitudinally, through which 
 they might respire, and thus compensate their previous 
 irregularity in breathing. Ludicrous as the idea may 
 appear, of a set of men scampering off, after an exhi- 
 bition of their scientific powers, these poor fellows had 
 the good sense to perceive the advantage of pursuing 
 my advice ; and I have subsequently learned that they 
 have experienced its happy influence. It has been my 
 uniform practice indeed, in similar instances, to recom- 
 mend a similar proceeding, and the benefit has, I trust, 
 been widely diffused. Before proceeding further in this 
 chapter, it may not be irrelevant to notice, that protracted 
 indisposition, whether arising from mental or bodily 
 causes, is productive of diminution of ,the chest ; the 
 general debility causing local muscular weakness, and 
 this being more particularly the case in the muscles of 
 inspiration. The lungs, thus compressed, are of course 
 favourable to the development of tubercles ; as well 
 as to pleurisies, which, according to a great authority, 
 M. Laennec, are the cause of permanent contraction of 
 the chest in consumption. But it should be borne in 
 mind, that this writer is utterly mistaken when he as- 
 serts that the endeavours of nature to cure phthisis ori- 
 ginate the same phenomenon. 
 
 The truth is, the contrary is the fact ; since, on ex- 
 amination of the lungs of persons who have recovered 
 from consumption, we almost invariably find their lungs 
 voluminous, and their chests of increased capacity. — 
 When individuals labour under chronic or incurable 
 diseases of any kind, whether medical or surgical, and 
 the constitution is much impaired by the continuance of 
 ill health, consumption is peculiarly prone to manifest 
 itself : but should they have been subject for any length 
 
TREA.TMENT OF CONSUMPTION. 73 
 
 of time to catarrhal, asthmatic, or cardiacal affections, I 
 have long- observed that they enjoy a complete immuni- 
 ty from tuberculous attacks, and hence cannot become 
 consumptive. Therefore, in imitation of my own prac- 
 tice, I would earnestly recommend the physician, as 
 well as surgeon, to exercise the chest by means of in- 
 halation; and the result would be to ward off any 
 secondary complaint, such as consumption, which so 
 commonly supervenes to shorten lives that otherwise 
 might have been indefinitely prolonged. To strengthen 
 my assertions respecting the beneficial results arising 
 from the manifestations of catarrh, in persons suffering 
 from incurable complaints, I could give from my case-book, 
 and indeed from memory as well, innumerable cases 
 confirmatory of my views : but a few will suffice to 
 show that I do not exaggerate its happy influence. 
 
 Case 4. — Sarah Jackson, aged forty-eight, applied 
 four years ago to the Infirmary for Asthma, Consump- 
 tion, &c., in consequence of consumptive symptoms ; 
 such as hectic fever, frequent pulse, violent cough, with 
 copious puriform and sometimes sanguineous expectora- 
 tion, profuse nocturnal perspirations, and, as might be 
 expected, great emaciation and debility. Her habit had 
 long been feeble : this had been in the first place in- 
 duced by a cancerous affection of the womb, destruct- 
 ive of the cervix and a portion of its body, and which 
 had produced malignant ulceration of the upper part 
 of the vagina, accompanied with racking pain, fetid 
 sanies, and other exhausting discharges attendant on 
 schirrous uterine disease. It was not till she had been 
 an out-patient at the infirmary for some time that I was 
 made acquainted with the above alarming cancerous 
 state. This of course appeared a fearful complication 
 of disease, and, in fact, made me regard the case as 
 almost hopeless. However, by means of small local 
 bleedings, at times from the chest, and occasionally 
 from the neighbourhood of the uterus, together with the 
 exhibition of saline medicines, conjoined with tartar 
 emetic in small quantity,, and aluminous and other in- 
 jections for the womb, I succeeded in entirely removing 
 her constitutional disorder, and in greatly mitigating, the 
 disease of the chest, as well as that of the uterus. Now, 
 whether it was owing to her own imprudence, in im- 
 
 10 
 
74 TREATMENT OF CONSUMPTION. 
 
 properly using the injections too cold, or from incautious 
 exposure to the weather during the prevalence of east- 
 erly winds, a severe bronchial affection took place, in 
 which was well marked sonorous and sibilant rattle. — 
 Excepting mucilaginous and demulcent drinks, with 
 small doses of nitre, she had very little medicine ad- 
 ministered to her. Indeed, I hailed this adscititious 
 complaint, notwithstanding her much embarrassed breath- 
 ing and distressing cough, as the most fortunate circum- 
 stance that could have befallen her ; and was therefore 
 inclined to let nature work, carefully watching every 
 indication, and desirous to assist rather than to inter- 
 fere with her operations. It is superfluous to enter into 
 all the minutise of this patient’s treatment ; suffice it to 
 say, that a permanent catarrh was established, thus at 
 once arresting the progress of consumption, and daily 
 adding to her security from all danger of relapse. Nor 
 was this the sole advantage resulting from the super- 
 vention of a bronchial complaint. By the improvement 
 which the patient’s general health experienced, from 
 the successful termination given to the consumptive 
 symptoms, the uterine malady has increased but little, 
 which, aggravated by the supervening phthisis, would, 
 without the ingression of the last of this ternary com- 
 plication, most probably have long since proved fataL 
 Thus, in this instance, as well as in many others of no 
 dissimilar nature, which it were easy to adduce, we have 
 proof corroborative of the fact, that the supervening 
 catarrh, occurring spontaneously, will not only give a 
 favourable turn to the course of consumption, but be 
 instrumental in delaying the advance of an incurable 
 disease. So well defined is this case, and so strong a 
 proof does it afford of the efficacy of the practical treat- 
 ment which it is my chief object to point out, that I 
 deem it necessary to demonstrate beyond doubt the 
 consumptive condition of this patient ; and I therefore 
 am anxious to add, that my opinion was not grounded 
 merely upon the common symptoms of phthisis, but 
 upon the more certain indices affi)rded by physical phe- 
 nomena. This female, whose employment is that of a 
 nurse, has, I understand, communicated her improved 
 health to Mn White, surgeon to the Westminister Hos- 
 pital, and also to Dr. Borett, a Polish physician, and 
 
TREATMENT OF CONSUMPTION. 
 
 75 
 
 others, who, in conjunction with myself, carefully ascer- 
 tained the nature of her pectoral as well as uterine dis- 
 orders, and can bear testimony to the order in which 
 they occurred. 
 
 Case 5. — Mr. C. W., from the neighbourhood of 
 Rumford, applied to me in February, 1828, for a com- 
 plaint of the chest. He had been for some months ex- 
 pectorating muco-purulent matter in considerable quan- 
 tities ; through this, as well as profuse perspirations, 
 and an occasional febrile state, he had become exces- 
 sively debilitated and attenuated. After pursuing my 
 advice for a short time, he lost his more formidable symp- 
 toms ; and there were merely left slight cough, and an 
 oppressive wheezing, which, at times, would compel 
 him to leave his bed about two hours after midnight 
 Though he considered himself well for nearly five 
 years after this, I have nevertheless grounds for belief, 
 as this was a cured consumptive case, and as he exhib- 
 ited slight symptoms of emphysema, that his lungs must 
 have been more or less affected throughout this space 
 of time with some bronchial irritation, though he had 
 but little cough. Being called in to this gentleman 
 about three years ago, as apprehensions w'ere enter- 
 tained, from certain pulmonary indications, of his re- 
 lapsing into the state from w^hich I had formerly relieved 
 him, I ascertained by the ear that a bronchial affection 
 had been established, which, from my recollection of 
 the peculiarities of his ailments, and my having regard- 
 ed his case as one of cured consumption, I felt satisfied, 
 previous to auscultation, would prove to be the fact. 
 Pointing out this condition of his patient to that most 
 intelligent practitioner, Mr. Sewell, I assured him that 
 he need not have contemplated a recurrence of con- 
 sumption, though such might not unreasonably be ap- 
 prehended from a malignant schirrous affection, which 
 had made its appearance a year previously, and had 
 committed extensive ravages on the rectum, perineum, 
 and adjoining parts, for which the most celebrated sur- 
 gical advice was taken. From the ill health induced 
 by the foregoing destructive malady, the chances of his 
 having consumption were considerably augmented ; but 
 owing to the protection afforded by chronic catarrh, as 
 I have often reiterated, the patient is placed beyond the 
 
76 TREATMENT OF CONSUMPTION. 
 
 reach of that most common and fatal of human dis- 
 eases — pulmonary consumption. 
 
 Case 6. — However Anti-Malthusian the doctrine 
 may be, yet as it is in accordance with the law, and 
 may likewise be regarded as a special dispensation of 
 nature, I do not scruple to advance it as my opinion, 
 that many cases of threatened, or indeed actual con- 
 sumption, in the female, may be warded off by a timely 
 compliance with the first benignant ordination given to 
 our first parents — marriage. In order fully to explain 
 how the benefit arises, and in what manner the bless- 
 ings of matrimony, — for such I believe, despite the late 
 talented professor just alluded to, they are still called, 
 — operate, I shall cite one from a variety of similar ca- 
 ses. Mrs. E. S., aged thirty-eight, made application to 
 me, in the winter of 1827, for a painful state of the 
 chest, with oppressed breathing and severe cough, with 
 expectoration of blood, mixed with frothy, yellow matter. 
 She likewise complained of profuse perspiration^, fol- 
 lowed by emaciation and extreme debility. Among 
 other physical signs, pectoriloquism was distinctly heard 
 by the naked ear underneath the second and third ribs 
 of the right side. When she first came to me she laboured 
 under much depression and anxiety wfith respect to her 
 state, not only from her having lost two sisters by the 
 same disease, but from her husband’s having inadvert- 
 ently communicated to her the opinion of a respectable 
 medical practitioner of Great Ormond street, who, to 
 use her own words, had unreservedly stated to him, 
 ‘Hhat no power on earth could save her life.” My opin- 
 ion at first was also of an unfavourable kind. The ex- 
 perience of a few days, however, since the most distress- 
 ing symptoms of the case yielded to remedial treatment, 
 induced me to entertain hopes. These hopes became 
 certainty when I discovered that she was in a state of 
 pregnancy, for I had long noticed that the constantly 
 increasing magnitude of the womb exerts a powerful 
 influence in suspending, and still further in curing tu- 
 bercular phthisis. This circumstance is not brought 
 forward as any novelty to the profession, but simply as 
 affording an opportunity of explaining the process by 
 which the gravid uterus accomplishes so favourable an 
 end. The hitherto received opinion is, that a diversion 
 
TREATMENT OF CONSUMPTION. 
 
 77 
 
 of morbid action from the lungs takes place, through 
 the necessary afflux of sanguineous fluid to the womb 
 and its embryo, thus arresting disease ; but I conceive 
 that this mode of accounting for the cures effected is 
 utterly vague and unsatisfactory. In such cases, the 
 suspension of existing disease in the lungs, and indeed 
 the permanent removal of the constitutional symptoms 
 of phthisis, are no doubt effected by the encroachment 
 made on the chest from below upward by the pressure 
 beneath the diaphragm, which has the effect of bringing 
 in apposition the inferior and superior surfaces of the 
 pulmonary cavities, so as to unite them. This view of 
 mine is borne out hy Xhe post mortem appearances which 
 I have witnessed in those who had recovered from con- 
 sumption while in a pregnant state. In not a few ex- 
 aminations of this kind, I have noticed that the inter- 
 nal cicatrizations of the healed lungs were transverse 
 or horizontal, thus proving that the progressive pressure 
 upward, in the direction of the diseased summit, had 
 been the sole cause of that union to which the disease 
 has, in a great measure, owed its cure. This mode of 
 explaining the cure appears to me much less hypothet- 
 ical than the generally received doctrine, since it is based 
 on proofs derived equally from anatomical and patholo- 
 gical research ; yet I do not wholly dissent from the 
 customary view of the subject, the cure being indisput- 
 ably, in many instances, consequent on the determina- 
 tion of blood to the uterus, thus diminishing to a certain 
 extent a local disease, and allowing, by this diminution, 
 the supervention of subacute bronchial irritation. This 
 last accident is, in no slight degree, perhaps, favoured 
 by the horizontal enlargement of the lungs, especially 
 of the lower lobes. Though instances of recovery, 
 attendant on pregnancy supervening to consumption, are 
 numerous, yet as cases notwithstanding happen in 
 which a cure has not been effected, I think it essential 
 to indicate one or two reasons for such occurrence. 
 
 First, we cannot be surprised, when pregnancy takes 
 place in an advanced stage of the disease, at not meet- 
 ing with the usual effects, and a second reason that 
 may be assigned for death following what might other- 
 wise be regarded as a case of cured consumption, may 
 be found in the absence of chronic catarrh ; or in the 
 
78 TREATMENT OF CONSUMPTION. 
 
 production of a fresh crop of tubercles by ill health, 
 after cicatrization has taken place. Having thus pur- 
 posely digressed, in order to explain my views of the 
 sanatory influence of pregnancy, I hasten to the con- 
 clusion of the present case. Since Mrs. E. S. first be- 
 came my patient she has had four children, now alive ; 
 and with the exception of a discharge of blood and 
 muco-purulent matter, that continued for a week, about 
 five years ago, possibly expectorated from some imper- 
 fectly healed cavity of long date, she has had no recur- 
 rence of her former formidable complaint. During the 
 last two years she has been free from cough ; and, with 
 the exception of slight catarrh, for a time attended with 
 abundant pituitous discharge, she is in the enjoyment 
 of better health than she has been in for the last ten 
 years. At present I consider her as perfectly secured 
 against a relapse into her former state, for two reasons 
 — the partial cicatrizations which evidently took place 
 during pregnancy, and the existence of emphysematous, 
 and voluminous lungs — the first discoverable by respi- 
 ration denoting that state, and the second being its cer- 
 tain consequence. It cannot, I think, be wondered at, 
 that having repeatedly witnessed the fortunate results 
 arising from the pregnant state, I should have some 
 years ago ventured to suggest to the unmarried con- 
 sumptive female the propriety or necessity of matrimo- 
 ny where from the circumstance of existing reciprocal 
 attachment such an engagement could be happily en- 
 tered into. 
 
 I have previously mentioned that asthmatic, catarrhal, 
 and cardiacal individuals are exempt from all danger of 
 pulmonary consumption; and to these I may subjoin 
 persons affected wdth diseases of the convulsive kind, 
 such as hysteria, epilepsy, or, in truth, all in which a pro- 
 longed, forcible retention of the breath is frequently 
 seen. This circumstance, in patients of this description, 
 must be accounted for in the manner already explained, 
 when dwelling upon the benefits arising from the me- 
 chanical extensibility of the air cells by inhalation. 
 
 Before bringing these remarks on the prophylactic 
 treatment of phthisis to a close, there remain a few 
 general observations, which spring as much, or nearly 
 so, from experience in my own person, as from my at- 
 
TREATMENT OF CONSUMPTION. 79 
 
 tention to the cases of others. In the foregoing portion 
 of my work, I have advised a generous mode of living, 
 as among the preventives of this disease ; and in pe- 
 culiar circumstances I would even recommend the use 
 — of course the cautious use — of wine, sound home- 
 brewed malt liquors, and occasionally of other stimulants. 
 I now allude to a failure of health, the forerunner of 
 consumptive attack, induced by trouble of mind, to which 
 I lament to say mimbers fall lingering victims. It has 
 been my misfortune to witness, in the course of my 
 practice, but too many instances of the maladies engen- 
 dered by ‘‘ a mind diseased.” Well has the poet of na- 
 ture remarked this, among his aggregate of human 
 ills, when he mentions ‘‘ the law’s delay,” than which I 
 know not a greater destroyer of peace of mind, and 
 with it, of the body’s health. We are accustomed to 
 look back with horror on the proceedings recorded by 
 historians as having taken place in that iniquitous court 
 which went under the name of the Star Chamber : how 
 then, judging by analogy, will our posterity execrate 
 the records left them of the practice of the Court of 
 Chancery ! They will there read a piteous tale of just- 
 ice withheld, — of hope, the brightest boon of heaven, 
 extended and protracted, until to look forward is to ex- 
 claim, with Lear, ‘‘ O ! that way madness lies.” The 
 ghastly train of diseases, consumption, cancer, and 
 other fell destroyers of the human race, which I have 
 seen brought on the wretched victims of the procrasti- 
 nation, until recently the characteristic of this court, 
 leads me, in common with the general voice, to reflect 
 with gratitude on the change that has been effected by 
 the wise energy of one master spirit. Had the reforms, 
 introduced by him, been adopted even a few years 
 sooner, how many a fair fabric of human happiness 
 would have been spared that now lies dismantled and 
 overthrown ! To return from this digression. On oc- 
 casions when the mind is kept constantly on the rack, 
 I consider it not unadvisable to allow a comparative 
 freedom in point of living ; but I must add a caution, 
 with respect to patients of the weaker sex, to whom this 
 freedom, limited as I have stated it should be, must be 
 still more sparingly granted. The difference in strength, 
 both mental and physical, calls for strict attention to 
 this distinc‘tion. 
 
TREATMENT OF CONSUMPTION. 
 
 There are but two modes by which we can hope to 
 cure this disease : the one is by rendering it chronic, 
 and the other by artificially enlarging tliose portions of 
 the lungs which are pervious to air. In the first we 
 endeavour to effect an absence of constitutional disorder; 
 but, after this change is effected, there may still remain 
 for an indefinite period one or more cavities uncicatrized, 
 with lining membrane, partly semi-cartilaginous, or of 
 such condensed and insensible structure as to be 
 productive of little inconvenience, if we except occasional 
 cough and some haemorrhage, which last occurs at long 
 intervals, and rarely to a great extent. In the second, 
 there is produced what is invariably seen when nature 
 or art has effected a cure — an enlargement of the 
 vesicular structure of the lungs, and subsequently a 
 gradual healing of the tuberculous excavations. 
 
 It has always been my great aim to put an end, as 
 early as possible, to the symptoms of hectic fever. This 
 I have successfully accomplished, in many instances, by 
 employing moderate anti-phlogistic means ; among 
 which, I may first mention general and local blood-let- 
 ting. It is astonishing how great is the relief afforded 
 by even six or eight leeches, applied to the chest while 
 the patient is labouring under the hectic paroxysm. It 
 was early my practice to bleed two or three times from 
 the arm, as we thus interrupt the noon-day chills, even- 
 ing fever, and the nightly perspirations : and when the 
 abstraction of blood by the lancet is employed early, 
 (acute inflammation being absent,) and in a quantity 
 rarely exceeding five or six ounces at a time, weakness 
 is seldom complained of ; on the contrary, the greatest 
 relief is experienced. The weight and erratic pains of 
 the chest, distressing cough, shortness of breath, and 
 irritability of the stomach, are greatly lessened. It has 
 long appeared to me that the necessity for the abstrac- 
 tion of blood has not been judiciously considered ; other- 
 wise, I should not be consulted by so many consumptive 
 
TREATMENT OF CONSUMPTION. 8l 
 
 individuals, in whom the disease has gone on unpalliated 
 by any sanguineous depletion. 
 
 This consideration becomes the more important when 
 we reflect how liable to produce a certain degree of 
 venous congestion are the chilly fits, which are of daily 
 occurrence, as well as tubercular deposites and engorge- 
 ments in the lungs themselves, the bulk of which is 
 gradually undergoing a diminution by the contraction of 
 the chest. The blood of the right ventricle of the heart 
 not finding a ready passage through the lungs, afflicted 
 as above mentioned, causes a preternatural quantity of 
 the same fluid in the adjoining auricle, and especially in 
 the tw’o great veins opening into it. The consequences 
 of this state are head-ache, owing to interruption of the 
 free return of blood from the head ; pulmonary engorge- 
 ment, through the difficulty the bronchial veins experi- 
 ence in transmitting their blood, ‘by either its direct or 
 circuitous course, into the vena azygos ; and serious de- 
 rangement, or actual disease, of the most important vis- 
 cera of the abdomen. The superior cava, prenaturally 
 full of blood, will, by retarding that fluid in the jugular 
 veins, produce pain in the head ; and, by a similar inter- 
 ruption to the circulation of the vena azygos, besides in- 
 terfering with the free return of the blood into the bron- 
 chial veins, it will in some degree impair the activity of 
 the kidneys ; the due return of the effete blood of which 
 organs depends on the freedom with which it is con- 
 veyed from the vena azygos into the vena cava superior. 
 
 The moderate abstraction of blood, occasionally, pre- 
 vents that congestion in the floating viscera of the ab- 
 domen which gives rise to diarrhoea, irritability of the 
 stomach, and effusion from the serous membrane invest- 
 ing them, which at times occurs. It has, indeed, an 
 excellent effect in securing freedom to the hepatic cir- 
 culation ; and thus all the parts, whose venous circula- 
 tion passes through the liver by the vena portae, are long 
 preserved in a state of integrity. Besides the great ex- 
 emption from diarrhoea which this practice affords, the 
 colliquative perspirations likewise are either greatly 
 lessened, or for no inconsiderable period wholly removed. 
 Where the disease is not of such long duration as to be 
 attended by much emaciation and debility, I would 
 advise general blood-letting, to the extent of four or six 
 
 11 
 
82 TREATMENT OF CONSUMPTION. 
 
 ounces, to be performed three or four times during the 
 presence of hectic fever ; allowing, of course, the patient 
 being better, a reasonable time to elapse before he be 
 again subjected to this operation. In consumption, par- 
 ticularly in its early stage, I find patients generally say 
 they are strengthened, rather than weakened, when four 
 or five ounces of blood are taken at intervals of a few 
 days. After the constitutional fever has been in this 
 manner interrupted, if it seems shortly after disposed to 
 return, we may again ward it off by applying six or 
 eight leeches on the summit of the chest just beneath 
 the clavicles. In my opinion, they are best applied on 
 the upper part of the chest, since it is there that the 
 tubercular affection first commences. By thus alterna- 
 ting the general and local bleedings, we husband the 
 patient’s strength, while at the same time we mitigate 
 the most distressing symptoms of his disorder. Cases 
 are at times met with, in which the lancet may be used 
 with some degree of freedom. For example: when 
 signs of pleuritic or pneumonic inflammation are pre- 
 sent, and when hsemoptical discharges are attended with 
 much oppression, pain, and heat in the chest. I have 
 not seen it noticed, that, in the absence of acute inflam- 
 mation, the blood taken from the arm of consumptive 
 persons is peculiar in its crassamentum ; it is never 
 cupped, and its upper surface has a somewhat greenish, 
 semi-transparent, gelatinous appearance, with yellow 
 filaments here and there interspersed. This extraordi- 
 nary and characteristic state of the blood has been for 
 years noticed by the attentive apothecary, so long at- 
 tached to the Infirmary for Diseases of the Chest. It 
 is indicative of an actual and inappreciable change in 
 the circulatory fluid. * When the muscular parts and 
 integuments about the chest are greatly attenuated, lo- 
 cal bleedings are best accomplished by leeches, rather 
 than cupping — the tediousness of the former may be 
 obviated by picking them off when they are tolerably 
 full. Instead of fomenting the bites as is customary, 
 which practice exposes the patient unnecessarily to cold, 
 I advise some lint or old linen to be immediately ap- 
 plied, and not removed for at least half an hour ; by this 
 means, the blood absorbed acts as a fomentation to en- 
 courage a sufficient effusion. 
 
TREATMENT OF CONSUMPTION. SZ 
 
 I have ascertained, by auscultative examination, that 
 when sanguineous sputa make their appearance in chro- 
 nic or latent phthisis, they not unfrequently result from 
 inflammation of the lower lobe of one or both lungs, 
 causing an unusual degree of congestion in parts re- 
 maining unhealed ; my advice is, therefore, that a care- 
 ful exploration of the chest be made, both by the ear and 
 percussion, in all cases, however unequivocal be the 
 common symptoms of inflammation of the substance of 
 the lungs. When we have fully satisfied ourselves that 
 the spitting of blood is not the result of any primary 
 change in the vessels coasting tuberculous excavations 
 in the summit of the lungs, but that it is owing almost 
 wholly to some engorgement, or sympathy with portions 
 of the lung beneath in a state of actual inflammation, it 
 will be found that an effective abstraction of blood, to 
 the amount of fourteen or sixteen ounces, will assist in 
 bringing the patient in a short time to his wonted state 
 of health. Should this be insufficient, the bleeding may 
 be advantageously repeated after a couple of days. 
 But it must be premised that any active treatment of this 
 kind employed without discrimination, particularly when 
 much tuberculous disease is disseminated through the 
 lungs, and has formed numerous cavities which have 
 seriously and manifestly impaired the general health, 
 would in most cases be productive of the greatest evil, 
 and possibly soon give rise to oedema of the lungs, or 
 some other watery effusion elsewhere. Few consump- 
 tive cases terminate fatally, without being preceded by 
 some dropsical state of the lungs. This generally oc- 
 curs when the feet and legs begin to swell, and is a 
 period too when leeches even are rarely admissible. 
 
 I shall now close my observations on bleeding with 
 mentioning that blood drawn from the arm, in any in- 
 flammatory affection of the chest co-existing with 
 phthisis, appears with a cupped and buffy coat, and not 
 with the peculiar appearance already noticed by me as 
 attending the latter disease in its unmasked state. Not 
 unfrequently the close of existence in the consumptive 
 individual, already reduced to the lowest condition of 
 weakness and emaciation, is preceded by some pneu- 
 monic and pleuritic affection which admits of no perma- 
 nent relief by blood-letting. 
 
84 TREATMENT OF CONSUMPTION. 
 
 Inhalation. — I am well aware that many objections 
 may be started to this practice from prejudice, or ineffi- 
 cient observation. Strange to say, the principle on 
 which this mode of treatment operates beneficially ap- 
 pears to me quite unknown to medical men. It is sup- 
 posed, that the inspiration of medicated vapours has in 
 many instances proved useful by allaying cough, and by 
 producing some healthy and unexplained change in dis- 
 eased parts of the lungs, as well as on such adventitious 
 surfaces as are formed after the softening, or discharge, 
 of tuberculous matter : but the permanent advantages 
 which inhaling is capable of affording are for several 
 reasons unsuspected by the generality of practitioners. 
 First, because the period during which persons are di- 
 rected to inhale is generally too short to produce either 
 a catarrhal or an enlarged state of the lungs, one of 
 which conditions is absolutely necessary in order to sus- 
 pend, or cure consumption : and, secondly, the appara- 
 tuses employed lor this purpose are not constructed 
 scientifically, so as to facilitate those physical changes 
 which it is desirable the chest should undergo. Proper 
 inhalers ought to be so arranged as to offer some slight 
 impediment to free expiration ; which can be effected by 
 having the vessels which are to contain the materials, 
 to be inhaled large enough to hold about two quarts 
 of liquid, and with covers perforated by two apertures ; 
 one of very small size, serving as an air-vent, the other 
 furnished with a flexible or straight tube of narrow 
 diameter, and at least five feet long. For the end of 
 the tube destined to be received between the lips, we 
 may have mouth-pieces formed of ivory or bone, each 
 of them having an aperture of a different size. The 
 length of the tube will save the patient’s countenance 
 from being heated by too close an approximation to the 
 body of the apparatus, when filled with warm water ; 
 besides, it contributes, together with the small air-vent, 
 to retard the free egress of air from the lungs, which I 
 shall presently show constitutes, in no small degree, the 
 great virtue of inhalation. 
 
 An extraordinary, but most undeserved reputation is 
 bestowed on various substances, mechanically received 
 into the lungs in a state of vapour. Among these I may 
 mention tar, iodine, chlorine, hemlock, turpentine, and 
 
TREATMENT OF CONSUMPTION. 85 
 
 many other articles of a stimulating, or sedative nature. 
 I attach little or no importance to any of them. If be- 
 nefit is derived, it is, in almost every instance, in conse- 
 quence of some such effects as the following : — Pulmo- 
 nary expansion, to a degree sufficient to exert an influ- 
 ence in bringing into contact the surfaces of those early 
 cavities which are almost invariably formed in the 
 summit of the lungs ; — pulmonary catarrh, or its com- 
 mon consequence, a vesicular emphysema, in both of 
 which the lungs acquire an unusual magnitude ; in the 
 latter more especially. 
 
 Neither perfect recovery, nor indeed exemption from 
 the danger of relapse into a consumptive state, is found 
 to occur, except in very rare instances, unless the pul- 
 monary organs become naturally, or artificially, volu- 
 minous ; which not infrequently happens by the 
 supervention of some catarrhal state of the larynx, 
 trachea, or bronchial tubes. It is a most fortunate 
 circumstance for some affection of this kind to occur 
 early, as it never fails permanently to arrest this most 
 fatal disorder. When the lower lobes of the lunors are 
 
 O 
 
 entirely free from tuberculous matter, (which is often 
 indisputably the case for a considerable period, unless 
 there be strong hereditary predisposition,) and though 
 there exist, at the same time, cavities in the superior 
 part of one or both lungs, clearly indicated by perfect 
 pectoriloquism, there is almost a never- failing hope of re- 
 covery to be entertained, provided an emphysematous 
 sound can be heard. In fact, I never knew a consump- 
 tive person who did not lose all his formidable symptoms 
 and regain health, when an emphysematous, or a semi- 
 asthmatic change had early taken place ; and, likewise, I 
 never knew an individual to become consumptive who 
 was subject to chronic catarrh, or to any species of 
 asthma. It is from long consideration of these facts, 
 that I interfere but little with any catarrhal inflamma- 
 tion which may show itself in the midst of consumptive 
 symptoms, for I well know that it will gradually super- 
 sede all these. 
 
 I may here remark, that cavities in the upper part of 
 the chest are never healed, unless the pulmonary tissue 
 be expanded in their neighbourhood, or in the other 
 lobes of the lungs. In such case, I have repeatedly 
 
86 TREATMENT OF CONSUMPTION. 
 
 listened to some bronchial inflammation which has 
 fortunelj taken place near to those cysts which are 
 left when tuberculous matter has been removed by ab- 
 sorption or expectoration. I have been truly gratified 
 to hear the well-marked pectoriloquy gradually become 
 less distinct, till, together with the constitutional symp- 
 toms of phthisis, it has been at last entirely lost, and 
 nothing has remained but the dry rale of enlarged air- 
 cells, slight catarrh, and a little absence of respiratory 
 murmur in the place before occupied by tubercles. 
 
 Should there be catarrh in the superior bronchial tubes, 
 of a duration sufficiently long only to heal ulcerations 
 and cure the patient, he may be again attacked by con- 
 sumption, months or years afterward, if there be any 
 cause assisting to impair the general health ; but never 
 can this relapse happen, if the bronchial tubes be sub- 
 acutely inflamed for a period sufficient to produce chro- 
 nic dyspnoea, or habitual asthma, more or less severe. 
 Half of those which are commonly regarded as cases 
 of catarrhal asthma originate in consumptive disease 
 whose progress has been arrested by the supervention 
 of that affection ; but in which neither fresh crops of 
 tubercles, nor hectic fever, are to be apprehended. Any 
 individual indeed having asthma, from whatever cause, 
 is as perfectly exempt from consumption as he who had 
 been consumptive, but has afterward had his disease 
 merged into asthma. In a word, it may be confidently 
 affirmed, that no asthmatic person need ever fear be- 
 coming consumptive. 
 
 In order to promote expansion of the aerial tissue of 
 the lungs, it is my usual practice, in the absence of ca- 
 tarrh, and when congestion in the chest and the symp- 
 toms of hectic fever have been diminished by small 
 general bleedings, repeated at proper intervals, or by 
 the application of leeches over the second and third ribs 
 anteriorly, to advise inhalation as soon as possible. 
 There are few cases of incipient consumption but what 
 will be rapidly improved by this treatment, steadily 
 pursued. The disease being thus checked, the same 
 changes will follow which are attendant on catarrh. The 
 nodules of unripe tubercles will become innoxious in 
 consequence of being surrounded by black secretion, or 
 what has been call^ black pulmonary matter ; and 
 
TREATMENT OF CONSUiMPTION. 
 
 87 
 
 small cavities, already formed, will have their surfaces 
 soon brought in contact, so as to heal by what surgeons 
 term the first intention. It is, we must own, preferable 
 to effect pulmonary expansion by sure artificial means, 
 rather than to depend upon the uncertain production of 
 catarrh. And there is another point gained, inasmuch 
 as recovery takes place unaccompanied by the cough, or 
 difficulty of breathing, generally attendant on those 
 cures which nature herself now and then accomplishes, 
 by introducing this less fatal, yet distressing complaint. 
 Inhaling, performed two or three times daily, for half 
 an hour each time, will in the space of a few weeks 
 work a wonderful change on the chest ; externally the 
 muscles concerned in respiration will be manifestly en- 
 larged, and the bony compages of the chest, both before 
 and laterly, visibly increased ; while, at the same time, 
 the natural respiratory murmur will be heard internally 
 far more distinct than ever. Such has been the increase 
 of size which the chest, in young persons especially, 
 has undergone through the exercise of inhalation, that 
 I have known individuals, after inhaling little more than 
 a month, require their waistcoats to be let out. It is in 
 fact incredible to one who has never been at the pains 
 to measure the chest, or examine its shape, what an en- 
 largement it acquires by the simple action of breathing 
 for the time above stated, backward and forward, 
 through a narrrow tube of a few feet in length. I have 
 several times found, on measurement of the chest, that 
 its circumference has increased, within the first month 
 after inhaling, to the extent of an inch. I here speak 
 of patients not arrived at adult age. Though I attach 
 but little virtue to the substances that are inhaled, still, 
 as we find patients prefer receiving into their lungs some- 
 thing having sensible properties to pure atmospheric air, 
 I recommend a handful of hops, either, a little vinegar, or 
 a table-spoonful of spirits of turpentine, to be added to 
 the warm water in the inhaler. Every impediment to 
 the free action of the ribs is to be guarded against by 
 loosening whatever, in the way of dress, is at all likely 
 to confine them ; and it would be advisable too for the 
 patient, if strength allows, to inhale at times in a stand- 
 ing position, as the diaphragm will then descend more 
 easily and deeply, and of course allow the lungs more 
 room to expand. 
 
88 TREATMENT OF CONSUMPTION. 
 
 There are cases in which inhalation is contra- 
 indicated; for instance, in dilatation, or hypertrophy 
 of the heart, severe mucous catarrh, general emphy- 
 sema of the lungs, pleuratic or pneumonic inflamma- 
 tion, haemoptysis, or latent consumption of long stand- 
 ing. 
 
 It is to be discontinued, at least for a time, should 
 there arise distressing headache, or much internal tho- 
 racic soreness. When it agrees well, it can be safely 
 and most beneficially used for six months, or even long- 
 er. By this time, besides a removal of every consump- 
 tive symptom, a permanent enlargement of the chest 
 will have taken place, proving a perfect safeguard 
 against the recurrence of any future attack. 
 
 No permanent benefit is to be expected from this re- 
 medy, when the inferior lobes of the lungs contain 
 cavities, or are studded with tubercles : yet, even in this 
 unfavourable state, I have known relief arise, and sur- 
 prising prolongation of life ensue, from its employment. 
 I have individuals under my care, at this moment, in 
 whom one lung is almost useless from extensive tuber- 
 culous disease, and with even well-marked pectoriloquy 
 on the top of the opposite lung ; still, from having the 
 rest of the lung on this side in a satisfactory state, and 
 thus being partially susceptible of the influence of inha- 
 lation, the progress of consumption has been arrested ; 
 and, in more than one instance, the relief afforded by 
 inhaling has enabled the individual to attend to the 
 duties of his calling — of course, no very onerous ones. 
 Indeed, I shall feel happy to introduce any of my 
 readers, who may entertain a desire to see such remarka- 
 ble instances of the virtues of inhalation, to these patients 
 of mine. 
 
 I must direct especial attention to the circumstance, 
 that restoration, by means of inhaling, is only to be 
 looked for when the cavities are confined to the sum- 
 mit of one, or of each lung. When they extend into the 
 lower lobes, relief, as I have just shown, will often be 
 given, but it would be unreasonable to expect perfect 
 recovery. The experience of the medical world, from 
 the days of Hippocrates down to our own time, has 
 proved, that medicine is utterly powerless over the ex- 
 cavations formed in the lungs by tubercular phthisis. It 
 
TREATMENT OF CONSUMPTION. 
 
 89 
 
 cannot bring into contact, and unite the opposite surfaces 
 of the cavities : it cannot enlarge the pulmonary tissue ; 
 — mechanical agency will. I have never known inha- 
 lation fail, when resorted to in the incipient stage of con- 
 sumption ; and am firmly of opinion, that when pursued 
 under the eye of a skilful practitioner, who knows how 
 to apply according to circumstances the other inferior 
 but still accessary powers of art, it never will. 
 
 As tubercles are rarely formed in the muscles of 
 voluntary motion, we have hence reason to believe that 
 the same additional exercise of the pulmonary organs, 
 by more frequent expansions and contractions, will act 
 as a preventive. 
 
 Before I was aware how materially the lungs can be 
 enlarged by simply respiring through a long tube, of 
 small diameter, I was induced some years ago to try 
 various means for producing pulmonary catarrh, or some 
 corresponding affection, in the great air passage vulgarly 
 called the windpipe ; knowing well what an excellent 
 agent such an affection is for expanding the chest, re- 
 moving speedily well-marked symptoms of consumption, 
 and, in a word, destroving: altogether the tuberculous 
 tendency. For this purpose, as in the heat of summer 
 and the early part of autumn we rarely meet with cases 
 attended with a catarrhal complaint, one of my expedi- 
 ents was to oblige the patient to breathe twice or thrice 
 a day atmospheric air, made cold by artificial means. In 
 more than one case I succeeded in producing a catarrh, 
 which led to the recovery of the consumptive patient. I 
 have, on several occasions, dismissed those in-patients of 
 the Infirmary for Diseases of the Chest, — the wards of 
 which are heated in winter so as to imitate a moderate 
 summer temperature, — whose consumptive state seemed 
 to be but little relieved: but owing to their going at once 
 from the warm atmosphere to their own abodes, where 
 perhaps some of them were badly secured against cold, 
 or indeed owing perhaps to their imprudent and 
 thoughtless exposure to the open air, they have caught a 
 severe cold of a catarrhal nature ; and this, I can assure 
 the reader, has alone effected a cure in some who have 
 had tuberculous excavations of ancient, as well as recent 
 date. I subjoin a case, in which will be seen the value 
 
 12 
 
90 
 
 TREATMENT OF CONSUMPTION. 
 
 of a catarrhal affection in removing, or affording perfect 
 security against consumption. 
 
 Case 7. — A young man, a cutler by trade, having lost 
 three brothers by consumption, came to my house in the 
 summer of 1827, seeking to be relieved from symptoms 
 similar to those which he had observed in them during 
 their illness. He stated that the first indication of his 
 complaint appeared after he had had a severe attack of 
 rheumatism, which was with difficulty removed, and 
 which left him much debilitated. When I first saw^ him, 
 he computed that his cough, which was soon followed 
 by a discharge of blood from the chest, had existed four 
 months. He stated, too, that he had early placed 
 himself under medical advice ; but that, in spite of 
 various medicines administered for his cough, the spitting 
 of blood, periodic fever, profuse perspirations at night,, 
 and occasional diarrhoea, in short, all the unfavourable 
 symptoms seemed daily to increase. The moment I 
 saw him, his countenance bespoke the nature of his 
 malady ; and a few questions put to him soon confirmed 
 my supposition, that he had all the common symptoms 
 of consumption. On exploration of the chest by the 
 naked ear, and by the stethoscope^ I ascertained the 
 existence of a cavity in the summit of the right lungy 
 which afforded, when he spoke, a perfect pectoriloquy, 
 and there was a gurgling when he coughed. The 
 respiratory sound was indistinct on the left side,- 
 anteriorly, beneath the clavicle and over the second 
 and third ribs : in all other parts the chest seemed 
 healthy, save a state of respiration approaching the 
 puerile, which was heard in the lower lobes. In order 
 to subdue the constitutional fever and painful cough, I 
 directed some blood to be taken from the arm ; and this 
 not affording the expected relief, several leeches were 
 applied a few hours after to the anterior and upper part 
 of the chest ; and scruple doses of nitre, with a quarter 
 of a grain of tartar emetic, and a drachm and a half 
 of syrup of poppies were taken in an ounce of some 
 demulcent vehicle, at intervals of four or six hours 
 during the day. This compound acted freely on the 
 kidneys, and, together with pills taken at bed-time, 
 containing extract of lettuce, ipecacuanha, and precipi-- 
 tated sulphuret of antimony, gave, in the course of four 
 
TREATMENT OF CONSUMPTION. 91 
 
 or five days, great relief to his pectoral disorder. Though 
 I succeeded two or three times, by means of leeches 
 again and again applied, and medicine varied to meet 
 new symptoms as they appeared, in regaining for him 
 what, comparatively speaking, he considered a return 
 of tolerable health ; still, with a view to effect a perfect 
 cure, it occurred to me, that as my patient w^as a man 
 of no small ingenuity, I might possibly get him to make 
 a steel instrument shaped like a collar, deep behind, 
 and so contrived, while it produced no inconvenience 
 on the neck laterally, as to make a gentle pressure on 
 the small part of the trachea, immediately above the 
 sternum, and betw^een the sterno-cleido mastoid muscles. 
 This new agent w^as soon ready for use, and was worn 
 at intervals for the space of tw^o months. In front, a 
 small piece of dry sponge was placed between the 
 converging points of this imperfect collar and the wind- 
 pipe ; most happily for the patient, the pressure on the ^ 
 wind-pipe caused a slight mucous inflammation wdthin 
 it, and this was succeeded throughout the lungs by 
 bronchial irritation, with a slight wheezing denoting an 
 enlargement of the air vesicles. None of these symp- 
 toms were interfered with ; and they continued for some 
 months, after every apprehension of consumption was 
 removed. It was really wonderful how much he increased 
 in flesh, and to what bodily vigour he arrived, especially 
 when the catarrhal complaint had established itself in 
 the neighbourhood of the tuberculous disease in the 
 superior lobes. At the expiration of a fortnight from 
 this time a loud mucous rattle began to appear near 
 to the seat of the pectoriloquy in the top of the right 
 lung; all trace of a cavity was nearly lost, and the 
 respiration there became daily more audible. The 
 same improvement took place in the respiration of the 
 upper portion of the other lung, which, I have already 
 mentioned, seemed to be diseased. With the exception 
 of periodic shortness of breathing, sometimes preceding 
 and at other times following fits of coughing, the patient 
 might be said, were he judged only from his looks and 
 his feelings, to be perfectly well. After tracheal rattle 
 had been distinctly heard in the larynx for a month, and 
 appeared to be extending itself along the trachea to the 
 larger bronchial tubes, he was directed to discontinue 
 
92 TREATMENT OF CONSUMPTION. 
 
 altogether the further use of that simple apparatus, the 
 steel collar. On one occasion only was it necessary to 
 moderate, by the application of leeches, the mucous 
 excitement of the lunj^s, when it ran so hiorh as to cause 
 suffocative breathing, incessant cough, superabundant 
 expectoration, and general febrile disorder. With the 
 exception of five grains of compound ipecacuanha 
 powder, and double that quantity of extract of hops, 
 made into pills to be taken at bed-time, and the occasional 
 use of a mild aperient, there was little else done for the 
 supervening catarrh ; for I felt exceedingly reluctant to 
 interfere much, well knowing the value of the new 
 disorder, and that it would long prove a successful 
 antagonist to any future as well as present liability of 
 sinking under consumption. In the month of August, 
 1830, which was three years from the time he became 
 my patient, I had an opportunity of seeing him in the 
 enjoyment of excellent health ; if I except a little asth- 
 matic respiration, which I detected by the naked ear, 
 whenever he made a forcible expiration. The expira- 
 tions were of an emphysematous character, in the upper 
 part of the chest, both before and behind ; the air, in 
 fact, was heard escaping from the enlarged air cells with 
 a prolonged murmur in which' dry cracklings were 
 audible, perhaps arising from some air cells being united 
 into one. Having ascertained what I have just described, 
 and how much the shape of the chest had been altered, 
 which, from being narrow in its antero-posterior diameter 
 and flat, was become cylindrical and enlarged, I assured 
 him that he never would relapse into his former con- 
 sumptive state ; and that with some care bn his part, 
 in attending to the directions which I gave him, his 
 present asthmatic symptoms would have little effect in 
 abbreviating the duration of his life. 
 
 This case is highly instructive. It is one by which 
 mechanical aid produced in the midst of summer such a 
 degree of general catarrhal affection of the air passages 
 of the lungs, that complete recovery took place. Nor 
 was this all ; for, through the emphysematous state of 
 the lungs, a perfect security existed against any liability 
 hereafter to tuberculous productions. In a word, he 
 escaped all danger of pulmonary consumption. 
 
 It may not be uninteresting to mention the particular 
 
TREATMENT OF CONSUMPTION. 93 
 
 circumstance which led me to imagine and adopt the 
 above invention. A gentleman of the name of Willis, 
 who a few years ago resided in the neighbourhood of 
 Kennington, and was under my care, happened to have 
 a small oblong tumour in front of the neck, with its in- 
 ferior portion lying between the sternum and the trachea, 
 from which resulted a slight obstruction to his respira- 
 tion. This tumour, which had existed for some years, 
 had induced a perfectly asthmatic state. By preventing 
 free expiration, and likewise by exciting a slight contin- 
 uous inflammation of the mucous membrane from the 
 point of pressure into the numerous ramifications of the 
 bronchi, the air had become imprisoned within the air 
 cells, and in this manner was produced a general em- 
 physematous state of the lungs. Besides the difficulty 
 of breathing, usually attendant on this condition of the 
 pulmonary organs, the obstruction from the tumour na- 
 turally caused him to breathe with a loud, wheezing, 
 and somewhat croupy sound. Observing this, I con- 
 cluded that if a slight mechanical resistance to the free 
 egress of air from the lungs could be produced, so as to 
 impart the prophylactic benefits of the asthmatic state, 
 without the distressing and aggravated accompaniments 
 noticed in the case just described, it would be a reme- 
 dial agent of no small efficacy. “ On this hint I spake 
 and, seconded by the ingenious contrivance of the arti- 
 zan whose case I have particularized, I was fortunate 
 enouorh to bring- the contrivance to bear, and to find that 
 I had not miscalculated its advantages. I have entered 
 into this detail, as it serves, by analogy, to throw addi- 
 tional light on the position I have advanced respecting 
 the non-liability of the asthmatic or catarrhal patient 
 to phthisis although, from the superior benefits to be 
 
 * Circumstances, in two instances, corroborative of the above change 
 from a consumptive to an asthmatic state, have occurred within my 
 
 own observation. Major of the U. S. armv, called on me a few 
 
 months since, to obtain information respecting Dr. Ram.adge’s views, 
 &c., and to ascertain whether the tube would be advisable in his case; 
 he stated that he had been sent home three different times to die, sup- 
 posing he was in the last stage of consumption, but that he again re- 
 vived. Being in some doubt, from his symptoms, as to the nature of his 
 disease, although he was a spare-made man, and much reduced in flesh, 
 with a cough, difficulty of breathing, &;c., I advised him to go to Dr. 
 
 W , of this city, and ascertain the nature of his disease — he did 
 
 so, and returned to inform me that the doctor stated that his disease had 
 
94 
 
 TREATMENT OF CONSUMPTION. 
 
 obtained by a duly extended course of inhalation, and 
 having satisfied my curiosity by the experiment, I have ne- 
 ver since employed the preceding mechanical contrivance. 
 
 Havincj noticed the effects arising from a small tumour 
 on the neck of my patient, Mr. Willis, I may observe, 
 that that enlargement of the thyroid gland technically 
 called bronchocele, but more familiarly known by the 
 name of Derbyshire neck, induces, when considerable, 
 similar symptoms and results by the pressure it occasions 
 on the trachea. Nor are the consequences of aggrava- 
 ted hysteria to be overlooked in this place ; since a fre- 
 quent communication of spasm to the posterior membrane 
 of the trachea, will, by imparting to the person so affect- 
 ed a slight asthmatic tendency, and thus enlarging the 
 volume of the lungs, preserve the female from all lia- 
 bility to pulmonary consumption. 
 
 A positive proof of the advantage accruing to the con- 
 sumptive patient through mechanical development of 
 the lungs, is to be inferred from the general immunity 
 from phthisis enjoyed by those families in which a well- 
 formed chest is common to all the members. I may 
 cite as, what the lawyers call, a case in point, the nu- 
 merous offspring of the venerable George the Third, 
 himself the model of a manly form. Heaven knows, 
 nature must have done more for them than medicine. 
 
 A negative proof of the benefits of inhalation, and a 
 positive one of the inefiicacy of medicine, has unfortu- 
 nately occurred, of late years, in the family of a noble 
 lord, to whose illustrious kinsman this country is indebted 
 for one of the greatest boons ever conferred upon it by 
 
 been originally tubercular consumption, but that it was changed to an 
 asthmatic state, and advised him to dispense with the use of the tube. 
 Dr. W subsequently informed me that the above instance con- 
 
 firmed him in the correctness of Dr. Ramadge’s principles, that con- 
 sumption was arrested by a change of the nature of the disease in the 
 
 lungs. The other instance is that of a Miss B , since deceased, 
 
 who came to me from with an introductory line from the Rev. 
 
 Mr. Abbot : her case was one of so difficult a nature, her symptoms 
 
 being so complicated, that I directed her to Dr. W , to ascertain 
 
 the nature of her disease. Her whole appearance denoted ponsumption, 
 yet she had lingered so long with cough, difficulty of breathing, &c., 
 that it was a matter of astonishment that she did not die. She re- 
 turned to inform me that her disease was asthmatic. From the account 
 she gave of the former state of her health and symptoms, there was 
 no doubt left in my mind that she would have died years ago but for 
 the intervention of asthma. J. M. H. 
 
TREATMENT OF CONSUMPTION. 
 
 95 
 
 legislation. It is impossible to look upon the frank, artless, 
 but pensive features of the lovely boy whose lineaments 
 are recorded by the imperishable pencil of Lawrence, 
 and not to regret that medicine could elfect nothing. 
 
 How lonof will it be before this truth will lead the 
 scientific to adopt its fellow-truth, — that, so surely as 
 medicine alone will ever fail, the mechanical means I 
 have pointed out will succeed ? 
 
 While preparing this edition for the press, I have 
 met with two very singular cases, confirmatory of my 
 view's ; the one in Hippocrates, and the other in a curious 
 treatise, entitled “ Phthisiologia,” written by Dr. Rich- 
 ard Morton, a man of considerable eminence in our early 
 English medical school. I term them singular, inas- 
 much as written at two such distant periods, they present 
 accounts which elucidate and strengthen my opinions 
 as strongly as any case taken from my own memoranda. 
 The father of medicine relates that the daughter of 
 Agasias, when a girl, laboured under tubercular con- 
 sumption ; that, becoming pregnant after marriage, she 
 expectorated an unusual quantity of puriform matter ; 
 and that, subsequently to this, she became asthmatic. 
 Here the process of cure, as laid down by me in the 
 preceding pages, is distinctly traced. I have already 
 noticed the advantages of pregnancy in consumption ; 
 and have proved, what the above early record so sur- 
 prisingly confirms, that if asthma supervene on con- 
 sumption, the latter is cured. 
 
 The case I am now about to quote bears witness to 
 the solidity of my practice no less triumphantly than 
 the former. I quote Dr. Morton’s own words : — ‘‘ My 
 only son, before he was eight years old, while I was out 
 of town, was taken with a most severe bloody flux, by 
 which he seemed to be brought into a consumption, even 
 to a marasmus, before I returned : but after the bloody 
 flux was plainly overcome by the diligent use of all sorts 
 of convenient remedies, and his body, with respect to 
 his stools, was reduced to its natural state, there still 
 remained a hectical heat, a dryness of his skin, a quick 
 pulse, with other signs of a hectical heat. Moreover, 
 his appetite failed him very much ; a dry cough came 
 upon him, and a thickness of hearing, with a dulness 
 of his brain : but yet with the choice of a wdiolesome 
 
96 
 
 TREATMENT OF CONSUMPTION. 
 
 air, the use of a milk diet, and afterward of the Peru" 
 vian bark, and of a plentiful nourishment, which afforded 
 a good juice, he recovered a good colour, and his flesh, 
 within the space of three or four months, without any 
 other inconvenience, but only that he has been ever since 
 very subject to an asthmatical cough upon the least occasion'’’ 
 
 My remaining observations on the treatment of con- 
 sumption will be brief, for two reasons, first, since I have 
 fully detailed the two most important branches of the cu- 
 rative process ; and, secondly, because the general uses of 
 medicine are to palliate, or, by inducing a chronic state, 
 to favour the supervention of catarrh. Again, by remov- 
 ing the constitutional symptoms, the local affection may 
 terminate in an insensible excavation, hardly interfering 
 with the general health. 
 
 Among the innumerable medicaments that have been^ 
 and are still tried, I shall specify a few, the advantages 
 of which are capable of proof, not depending on the 
 caprice of fashion — there being a fashion even in me- 
 dicine — or upon any imaginary virtues. Our dispen- 
 satories are full of such drugs, and so unfortunately is 
 practice ; yet the number applicable under any form to 
 phthisis, is of a limited extent. 
 
 Cathartics. — Recourse must be had to purgatives 
 very sparingly, in the commencement of consumptive 
 symptoms, as the general health is usually deranged. 
 From an erroneous view of the causes of consumption, 
 great mischief has arisen in the employment of aperi- 
 ent medicines ; and this injudicious treatment has been 
 propagated by the sanction of names of no mean 
 authority. Instead of increasing debility by the exhibi- 
 tion of cathartics, it is infinitely preferable to remove 
 congestion by the moderate abstraction of blood, as pre- 
 viously noticed. Great caution should be observed, as 
 to the kind of medicine employed for purgative purposes. 
 Saline aperients ought in general to be avoided, from 
 the debility they induce by carrying off the serum of the 
 blood, and by too rapidly accelerating the passage of 
 the chyliferous matter, before due absorption takes place. 
 It should be borne in mind, that a relaxed state of the 
 bowels is a very frequent accompaniment of consump- 
 tion ; and that any undue administration of laxative 
 medicines will, in most cases, superinduce abdominal 
 
TREATMENT OF CONSUMPTION. 97 
 
 grlpings and diarrhoBa, events which cannot be too 
 sedulously guarded against. In the inflammatory com- 
 plication of phthisis, a powder composed of from ten to 
 fifteen grains of jalap, combined with two or three 
 grains of calomel, may be administered as an auxiliary 
 to venous depletion. Indigestion is of no uncommon 
 occurrence in consumptive complaints, yet, as it usually 
 arises from vascularity, and morbid sensibility of the 
 stomach and of the intestines, the most rational method 
 of proceeding is to equalize the circulation by moderate 
 venesection. Occasionally, a few leeches, applied to 
 the pit of the stomach will be equally successful in re- 
 moving dyspepsia. As an ordinary laxative, a few 
 grains of dried subcarbonate of soda, calcined magnesia, 
 and rhubarb, taken in some liquid vehicle, will be found 
 highly useful. 
 
 Since I am on the subject of dyspepsia, I cannot help 
 adverting to the strange tissue of absurdities gravely 
 put forth by a Dr. James Johnson in a treatise on Indi- 
 gestion. So far as I can make out the meaning of a series 
 of passages, which contain a number of scientific words, 
 serving only to show a remarkable ignorance of morbid 
 anatomy, this person seeks to establish a distinction be- 
 tween the symptoms of phthisis, when it “ supervenes on 
 derangement of the liver and digestive organs and 
 when it commences originally in the chest.” What 
 he would have his reader understand by this word 
 ‘^originally” is somewhat difficult to make out. I never 
 before heard of pulmonic affection commencing in 
 any other part than the lungs. Does he wish to have 
 it inferred that consumption at times originates in the 
 stomach, or the head, or the feet ? Again, it is by no 
 means clear what he intends to convey by pulmonic 
 affection supervening on “derangement of the liver,” 
 &c. If the literal interpretation of these words be taken, 
 he states what is by no means the fact. Phthisis super- 
 venes on impaired general health, and this may be 
 occasioned by dyspeptic ailments ; but to say that it 
 supervenes on dyspepsia, is nonsense. But when he 
 begins to draw his distinctions, he sinks deeper into 
 “ confusion worse confounded.” He talks of phthisis 
 advancing in consequence of “ a previously tuberculated 
 state of the lungs.” As Parson Evans says, “ These be 
 
 18 
 
98 
 
 TREATMENT OF CONSUMPTION. 
 
 phrases and tropes, look you.” Advancing ! — If phthisis 
 be not established, and too surely established, when the 
 lungs are tuberculated, then “ there’s nothing serious in 
 mortality.” We shall hear next, that when an indi- 
 vidual has got a wooden leg, he is in a fair way of losing 
 his fleshy one. Perhaps Doctor Johnson makes use 
 here of the figure Hysteron, Anglice, “ putting the cart 
 before the horse.” He then, pursuing his nice dis- 
 tinctions, winds up his medical budget by stating it as*a 
 pathological fact, that “phthisis, of the common and 
 fatal kind, will soon be developed” — after what ? — “after 
 hepatization of the parenchymatous tissue of the lungs.” 
 Better and better still ! In plain English, the doctor ex- 
 pressly affirms, that, instead of consumption inducing 
 hepatization — for this is the natural order — the latter^ 
 which every anatomist knows is the consequence, will 
 be the cause of the former. The attempt to unravel 
 still further this Gordian knot of technical terms, which, 
 like Mrs. Malaprop’s, are “ so ingeniously misapplied,” 
 would be waste of time : nor should I have thought it 
 worth while to have taken this slight notice, but for 
 the parade of superior knowledge, the “ flourish of drums 
 and trumpets,” with which this nautical surgeon ushers 
 in his dicta. They may suit the cockpit, but not the 
 temple of science. 
 
 Another individual. Dr. .W Philip, who has likewise 
 written on Indigestion, with more, although not much,, 
 success, has stated that the pulmonic affection is merely 
 sympathetic ; and again, that the sympathetic produces 
 actual disease in the lungs, indicated by some degree of 
 inflammation in the bronchia, &c. Now, had his expe- 
 rience been at all of an extended nature, or his obser- 
 vation been keenly applied to even limited opportunities, 
 he could hardly, one would imagine, have failed of per- 
 ceiving that such a disease as dyspeptic phthisis does 
 not exist. Indigestion is a very common disorder ; but 
 the dyspeptic patient never becomes consumptive, until 
 his general health has been seriously impaired by the 
 derangement of the digestive functions. Dyspepsia, it 
 may be as well for him to know, often follows pulmonic 
 affections, but is never their proximate cause. Were 
 Dr. P. in the habit of employing auscultative exploration 
 of the chest, he would discover that the presence of 
 
TREATMENT OF CONSUMPTION. 99 
 
 blood in the expectoration is not, as he seems to imagine, 
 the forerunner of tubercles ; but that, in three-fourths 
 of the cases, it arises from the existence of cavities al- 
 ready formed by the softening down of tubercles. As 
 to inflammation of the bronchia occurring at the time he 
 speaks of, if it does, it is of a very fugacious description 
 indeed. 
 
 The singular opportunities I have enjoyed for observ- 
 ing every variety of disease connected with the chest, 
 have led me to entertain views not a little at variance 
 with those of this writer. Ten years ago I had 
 the opportunity of seeing a hundred patients, at the 
 Infirmary alone, in a single day ; and since that time 
 my field for observation has been very considerable: 
 yet I have never found the daily use of mercury, as 
 advocated by Dr. P., of advantage, even in a solitary 
 instance. I have had, on the contrary, patients who 
 have been under his care, and who have derived no 
 benefit whatever from his undue estimate of the virtues 
 of this mineral. It is by no means improbable, judging 
 from his opinions as expressed by himself, and from his 
 non-employment of auscultation, that he has been mis- 
 taken in the nature of those cases which have yielded 
 to his treatment ; that he has supposed them to have 
 been connected with phthisis, when no such complication 
 had existed. 
 
 Emetics. — At one period emetics were held in no 
 slight repute ; and much useless torture, or I should 
 rather say injurious pain, was the consequence to the 
 consumptive sufferer. It has always been a principal 
 object with me to avoid every thing calculated to distress 
 or annoy without imparting benefits equivalent to the 
 uneasiness undergone. That this is not the case with 
 the administration of emetics is proved convincingly by 
 the fact that when vomiting is brought on in a natural 
 way by violent coughing, the patient experiences no 
 relief Whatever faith medical men may be inclined to 
 place in the remedial powers of emetics, I have none ; 
 although I candidly confess, that I am in the daily habit 
 of prescribing small doses of the tartarized antimony, 
 and of ipecacuanha ; yet in so minute a degree that they 
 are within the limit of actual nausea. 
 
100 TREATMENT OF CONSUMPTION. 
 
 SuDORiFics. — Twenty or thirty years ago it was the 
 general practice, in all diseases, to determine to the 
 surface of the body ; and some practitioners, enamoured 
 of the wisdom of their youthful days, still adhere to it. 
 Great injury undoubtedly resulted from this indiscri- 
 minate course, and more particularly would this be the 
 case in phthisical complaints. Although employed with 
 the view of diverting morbid action from the lungs to 
 the surface of the shin, yet the consequence of the 
 stimulus thus imparted is not unfrequently increase of 
 hectic fever, terminating in pulmonary engorgement, or 
 other visceral excitement. 
 
 No relief indeed is afforded by sudorifics ; on the 
 contrary, wdien perspirations occur spontaneously, they 
 are found sensibly to reduce the patient’s strength. In 
 the hot stage of hectic fever, I endeavour to reduce the 
 tenseness and aridity of the cuticular surface, by having 
 the hands and upper part of the body sponged with 
 tepid water and vinegar ; and I order this to be continued 
 until a reduction of temperature takes place. The same 
 treatment is to be pursued on every return of the hectic 
 paroxysm. It being of infinite importance to preserve 
 an equable temperature of the body, I uniformly attempt 
 the removal of whatever state is unduly predominant : 
 therefore, in the cold stage, I direct the immersion of 
 the feet in warm water, and advise the patient to take 
 some warm beverage, as tea, &c. ; and when perspiration 
 is profuse, I lessen it by administering either an infusion 
 of columba or of camomile, in preference to the acidu- 
 lated infusion of roses, in such general, but, in my 
 opinion, injudicious use. Except in the very last stage 
 of the disease, the application of leeches to the chest, 
 in periodically recurring perspiration, will be found far 
 superior to any tonic whatever. 
 
 Expectorants. — The use of this class of medicines 
 seems founded on no valid reasons ; nor are the benefits 
 produced very visible or satisfactory. Could they stimu- 
 late the mucous 'membrane of the lungs to a catarrhal 
 state, they would be beneficial indeed : colchicum, I 
 have reason to believe, occasionally operates in this 
 manner : but its effects are uncertain. 
 
 In many consumptive cases there exists a superabund- 
 ance of expectoration ; and, consequently, in these all 
 
TREATMENT OF CONSUMPTION. 101 
 
 f 
 
 expectorants are supererogatory. Above all, that anxie- 
 ty which is frequently displayed to avert, or palliate 
 cough, is unnecessary, since it often occurs that to this 
 an emphysematous state of the lungs is owing ; which 
 protective is thus lost, by the injudicious attempt to allay 
 the cough. The chief good resulting from expectorants 
 is not owing to any specific action exerted, in particular, 
 on the pulmonary organs : but rather, as is the case 
 with ipecacuanha and tartar emetic, it is due to a variety 
 of influences. Thus the former of these medicines 
 seems to act as an astringent where expectoration is 
 superabundant ; and, generally speaking, both these 
 substances, in addition to their value as expectorants, 
 aid all the secretions. Other expectorants, as squill, 
 ammoniacum, myrrh, &c., are to be cautiously employed 
 when phthisis is accompanied by hectic fever; but ipe- 
 cacuanha, and preparations of antimony, possess the great 
 advantage of being of safe administration during every 
 stage. Mercurial agents exert a powerful influence in 
 promoting expectoration, as they likewise do on every 
 other secretion ; and this property has led to most 
 injurious consequences. Some years ago, I had oppor- 
 tunities of seeing, in the practice of a deceased physician 
 at the London Hospital, a woful example of the evils 
 arising from the exhibition of mercury in cases of phthisis. 
 The facility given to expectoration seemed to delight this 
 practitioner ; but it was so rapidly increased, and accom- 
 panied by such extreme perspirations, wasting away, 
 and diarrhoea, that the patients soon went into what is 
 vulgarly, but not inappropriately denominated — gallop- 
 ing consumption. 
 
 Narcotics and Demulcents. — The latter, as reme- 
 dies, are out of the question ; but, as palliatives, are 
 highly serviceable. Being mostly of a nutritious nature, 
 they tend to keep up the patient’s strength, wLile they 
 soothe the irritability of the chest. The former are 
 occasionally useful, but they are liable to great abuse. 
 Given wdth a view to promote sleep at night, much nicety 
 is required in their regulation. When the hectic state 
 and excitement obstructive of sleep have been removed, 
 recourse may for one night be had to an opiate ; but 
 should it be repeated on the succeeding evening, it too 
 often happens that its effect will be lost. Digitalis and 
 
102 TREATMENT OF CONSUMPTION. 
 
 hvdrocyanic acid have both been extolled as of infinite 
 efficacy ; but they are undeserving of the high reputation 
 bestowed upon them. Dr. Ferriar imagined, that by 
 combining the former with myrrh and sulphate of iron, 
 he increased its utility in consumptive disease ; yet, how 
 its union with two stimulants could be productive of 
 benefit, I do not exactly see. As to hydrocyanic acid, I 
 concur with Iiaennec in regarding it, although it may 
 sometimes relieve cough and dyspnoea, as of far inferior 
 value to many preparations of opium. In particular 
 idi'v^syncrasies, in which opium under any form is found 
 to disagree, the extract of hyoscyamus, and the feebler 
 narcotics, as extract of lettuce or hops, will singly, or 
 combined, lull cough and afford rest. I should regard 
 it unfair were I not to state, that Battley’s Liquor Opii 
 Sedativus is the preparation I in general prefer. I may 
 here note, that the pharmacopoeia of this country exhibits 
 an unsatisfactory catalogue of opiates. It is to be hoped 
 that these, with other omissions, will shortly be rectified. 
 The expected admission of the numerous and intelligent 
 physicians termed licentiates, to the privileges due to 
 their learning and science, will indisputably operate a 
 most beneficial change and form a new era in medicine. 
 
 Astringents and Tonics. — The first of these are 
 employed for a threefold purpose — to check discharges 
 of blood from the lungs, to restrain colliquative perspi- 
 rations, and also diarrhoea. Sulphuric acid, with infusion 
 of roses, has acquired much notoriety as an astringent ; 
 but I seldom employ it, since I find its use not unfre- 
 quently followed by distressing tension of the chest. 
 Although, I own, it may be advantageous for a time, yet 
 its continuance is apt to exercise an effect the reverse 
 of what is intended. It seems to me in such cases to 
 increase rather than diminish haemoptysis. The acetate 
 of lead in small doses, combined with opium, is far 
 superior not only to the acid but to every other astringent. 
 All danger of its producing an unpleasant action upon 
 the bowels, apprehended by some, may be obviated by 
 occasionally intermitting it, and regulating the evacua- 
 tions. I have already pointed out the most salutary 
 mode of checking perspiration, by the application of 
 leeches to the chest, and it remains for me to notice the 
 best remedial agents for diarrhoea. These are chalk, 
 
TREATMENT OF CONSUMPTION. 
 
 103 
 
 kino, catechu, pomegranate bark, and Armenian bole. — 
 Chalk, with a few minims of Battley’s ])reparation of 
 opium, administered in barley water, gruel, &c., will be 
 found to equal in efficacy more compound admixtures. 
 Of tonics, the simplest are the best. Bark I rarely, or 
 ever prescribe ; but under particular circumstances in- 
 fusion of columba, of camomile, or occasionally of cas- 
 carilla, may for a short period be not disadvantageously 
 employed. While the Brunonian theory was held as the 
 guide of practice, preparations of iron were in high re- 
 pute : and one of these, the antihectic mixture of Dr. 
 Griffith, so termed it would seem like “ lucus o. non lu- 
 cendo^' from its possessing properties the reverse of its 
 name, is still, I am sorry to say, in estimation with some 
 practitioners. The use of such medicines, in a com- 
 plaint that calls for every effort to abate and moderate 
 excitement, cannot be too highly reprobated. 
 
 It is not a little curious, that the only medical work 
 which has I believe, issued from the University of Oxford 
 for the last century and a half, should have been wTitten 
 to divulge the virtues of an insignificant astringent. Dr. 
 Bourne, the Aldrichian Professor of the Practice of Phy- 
 sic, published in the year 1805 an octavo volume, wholly 
 dedicated to the recommendation of the uva iirsi, or 
 whortleberry, as a specific in phthisis pulmonalis. The 
 poor gentleman even apologizes in his preface for having 
 delayed divulging this astounding discovery to the world 
 so soon as he might have done. I honour his sense of 
 humanity, but cannot help being amused at the simpli- 
 city of the professor. The little good he did effect was 
 obviously due to the medicines combined with the afore- 
 said whortleberry. As for any pathological views, they 
 were out of the question. He does not even enter into 
 any consistent rationale of his own practice. However, 
 he did manage to write a book, and. attempt in his small 
 way to promote science : which is more than many of 
 his brother professors have done. The medical w^orld 
 should not be severe upon them, seeing that, from their 
 situation as heads of the art, they have enough to do in 
 conferring degrees, without the additional trouble of ac- 
 quiring knowledge. What can be expected from a place 
 Avhere there is no regular school of anatomy ; and no 
 lectures on half the useful branches of medical science ? 
 
104 TREATMENT OF CONSUMPTION. 
 
 Indeed professors in all places, in this country, seem to 
 be alike ; — witness the elder Duncan’s anomalous treatise 
 on the same complaint. Both appear to have been ex- 
 empt from the sin of having ever opened a human body. 
 May the reign of such teachers be quickly at an end ! 
 To think, too, of the last having been forty years a 
 medical lecturer at Edinburgh, and of having written 
 fifty volumes, — such is his own boast : it is to be hoped, 
 at least, that he never published them. 
 
 Balsams. — I hold it totally unworthy time or paper 
 to waste many words on this very futile description of 
 medicine, at least as applied in consumptive cases. It 
 was supposed in the days of Dr. Morton, and of Van 
 Swueten as well, that balsams exerted a vulnerary power : 
 butto use such medicines at present, or to suppose that any 
 medicine w'hatever can heal ulcers of the lungs, betrays an 
 extraordinary ignorance of the peculiar nature of phthisis. 
 There can be no other possible method of healing them 
 than by bringing their surfaces in apposition, since, unlike 
 other ulcers, they never granulate. 
 
 Blisters. — When expectoration is superabundant, 
 or an oedematous state of the lungs is supervening, these 
 may be applied with success ; and when abstraction of 
 blood generally, as well as locally fails in removing fixed 
 pain of the chest, I find them very useful. In gfeneral, 
 however, they are too indiscriminately employed ; since 
 their use at an improper period tends to bring on, and 
 accelerate, the hot stages of hectic paroxysms. Thus 
 they superinduce a continued febrile state, not unfre- 
 quently terminating in some variety of thoracic inflam- 
 mation. One fact, peculiar to the application of epis- 
 pastics in consumptive cases, seems almost unknown to 
 the medical profession. I have never known a patient 
 suffer from gangrene through their use, although such 
 cases are of no uncommon occurrence in other disorders. 
 How^ little susceptible individuals labouring under phthisis 
 are to mortification, has been noticed by that great au- 
 thority, Laennec ; he explicitly states, that even protract- 
 ed confinement is inapt to produce gangrenous eschars, 
 and the whole course of my experience corroborates his 
 assertion. 
 
 Diet. — This should ever be varied according to the 
 digestive powers of the patient. Van Swietenhas given 
 
TREATMENT OF CONSUMPTION. 105 
 
 a homely, but very sensible, illustration of what ought 
 to form the general guide in all dietetic advice. He 
 compares the physician, who pronounces such or such 
 food to be wholesome without reference to the state of 
 the patient, to the sailor who shouts out that the wind 
 is fair without considering to what port the vessel is 
 bound. As a general rule, the system of overfeeding, 
 or, to use a common phrase, of keeping up the strength 
 of the consumptive individual, cannot be too strongly 
 deprecated. It is, indeed, strange to find any one so 
 imbecile as to recommend in a disease in which, even 
 under the most judicious treatment, febrile action will 
 be of almost daily occurrence, a course of diet suitable 
 only to the healthy and vigorous : yet, in the absence 
 of gastric irritation, and on the abatement of hectic 
 fever, the food may be of a nutritive and invigorating de- 
 scription. This caution, however, is to be borne in mind, 
 that whatever is followed by increased heat of body 
 should be abstained from. The best index of food's 
 agreeing with a patient, is the absence after meals of 
 constitutional disturbance. Except during the presence 
 of inflammation and of haemoptysis, I am in the habit of 
 allowing the moderate use of meat once a day, wuth an egg 
 occasionally at breakfast or by way of lunch, according 
 to the patient’s fancy ; nutritive broths, taken lukewarm ; 
 (indeed, except the patient feels chilly, whatever liquid 
 is drunk should be of very moderate temperature ;) and, 
 as to a milk diet, so commonly ordered, I reject it alto- 
 gether. It excites expectoration in an unusual degree, 
 without however leading to a catarrhal state. When 
 consumption is decidedly manifested, wine is for the 
 most part inadmissible. A small glass of ale at dinner 
 may at times be permitted ; and occasionally at night, 
 with the view of inducing sleep. 
 
 I subjoin a few leading observations on the common' 
 articles of diet. To begin with fish, an important item 
 in the cuisine of the invalid. It forms a moderately nu- 
 tritious food ; and is so far of advantageous use, that it 
 does not stimulate the body and raise the pulse in the 
 same degree as flesh. The chief considerations in 
 selecting fish for the patient, are, in the first place, its 
 exemption from oiliness and viscidity ; in the second, its 
 firmness of texture ; and, lastly, the colour of its muscle, 
 
 14 
 
106 TREATMENT OF CONSUMPTION. 
 
 which should be a clear white. Such being the most 
 desirable qualities, haddock, whiting, sole, cod, and tur- 
 bot, all, in different degrees, answer to these requisites. 
 The whiting and haddock are the easiest of digestion, — 
 the cod, perhaps, the least so of all. Salmon is too 
 heating, and too oily, to be indulged in. 
 
 As to shell- fish, the claws of crabs, lobsters, and craw- 
 fish, are usually palatable, and agree well with the pa- 
 tient. Nor are shrimps and prawns to be forbidden: of 
 course, they should not be indulged in to any extent ; 
 but, in moderation, they may be safely eaten. Indeed, 
 I have often observed, that the petty delay and trouble 
 that there is in iinshelling this tiny fry seem to excite 
 the salivary glands, and, by supplying the food in small 
 quantities and in slow succession, to stimulate the secre- 
 tion of the gastric juice. In cases, too, of extreme de- 
 bility, the preparation and process of the repast serve to 
 interest and amuse a mind weakened by long indisposi- 
 tion. Oysters I generally leave to the discretion of the 
 patient. If there is any desire expressed for them, I 
 see no reasons for their refusal ; but I have observed 
 that patients, whose expectoration is heavy, generally 
 turn from them with loathing. I do not deny, that 
 many of these articles are commonly and justly consider- 
 ed as indigestible ; but this can only hold good when they 
 are taken in any quantity. When their use is moderated 
 by prudence, I have never found them more liable to 
 disagree than the ordinary edibles of the table. I may 
 mention, that I had a patient, a very frequent article of 
 whose food was turtle. He took it, of course, dressed 
 in a less stimulating manner than the usual form. 
 
 So much does the agreement or disagreement of food 
 depend upon the constitution and habit, that, in laying 
 down dietetic rules, we must always bear in mind the 
 old axiom, Quid nocet alien, alteri juvat^ I have 
 found it a very ordinary custom among my poorer pa- 
 tients to indulge in eels, when first permitted after illness 
 to take any thing of a more solid nature than gruels, 
 &c. Judging, a 'priori, one would conclude from their 
 oleaginous nature, that they would prove a most indi- 
 gestible article of diet : yet nothing can be more com- 
 mon than for them to be chosen by the lower orders, 
 
TREATMENT OF CONSUMPTION. 107 
 
 on these occasions, as a delicacy ; and nothing can be 
 more certain than that they agree. 
 
 So long as hectic fever, or any febrile symptoms con- 
 tinue to any extent, the living of consumptive individuals 
 should indisputably be low ; but otherwise a generous 
 diet, in the absence of fever, so far from being depre- 
 cated, may be safely left to the option of the patient. 
 Mutton is the lightest, most digestible, and most nutri- 
 tious meat for the invalid ; and broiling one of the most 
 advisable modes of cookery : at the same time that few 
 things are more palatable, nothing can be more whole- 
 some than a mutton chop. Beef is of a denser fibre, re- 
 quires a longer space to perfect its chymification, and is 
 consequently less easy of digestion. Although it is 
 equally as nutritious as mutton to the healthy, it can 
 harldy be pronounced to be so to the invalid, since it 
 requires a tone and vigour in the digestive organs which 
 the latter seldom possesses. Veal and pork are the 
 meats which follow next in the order of digestion. I 
 need scarcely enter my Jveto against eating much of 
 the fat, whether of mutton or any other meat ; for the 
 delicate state of the stomach in illness will, in general, 
 cause a repugnance to it. 
 
 The meat should always be plainly cooked ; and, 
 when it does not contravene all the laws of cookery, I 
 would say, let it be roasted : next to this, broiling is the 
 most wholesome form. Spallanzani has demonstrated 
 satisfactorily, that meat should be neither over nor under 
 done ; and since he has established this point by numer- 
 ous well-conducted experiments, the general order to the 
 cook, on this head, should be to observe the ''juste mi- 
 lieur A few words, as to the reasons of the preference 
 given to roasting over the other modes of cookery, may 
 not be unacceptable to the patient. The loss in roast- 
 ing arises from the diminution of the fat, which is melted 
 out, and the evaporation of the water ; in boiling, the 
 loss is caused chiefly by the solution of the gelatine and 
 osrnazone ; therefore, the nutritious matter, as the gela- 
 tine, is considerably lessened in boiled meat, but re- 
 mains condensed in roasted. Its superiority over broil- 
 ing consists in its retaining, from its size — we are of 
 course supposing that a joint is put down — more of the 
 juices of the meat. Broiling, from the quickness with 
 
108 TREATMENT OF CONSUMPTION. 
 
 which the outside of the meat is hardened, suffers it to 
 retain a much greater portion of its juices than boiling 
 or baking ; but even the celerity with which a chop or 
 steak is thus cooked, cannot enable it to compete, in this 
 respect, with the advantage roasting possesses from the 
 size of the portion usually submitted in this mode to 
 the action of the fire. Baking, from its peculiar process 
 not only prevents the evaporation of the oils of the meat, 
 but renders them additionally indigestible by presenting 
 them in an empyreumatic form. On the whole, how- 
 ever, I prefer it to boiling. Before quitting the subject 
 of meats, I may mention that venison or hare will prove 
 a very nutritious food to those whose stomach is debili- 
 tated. They are easily digested ; but, as they furnish a 
 quantity of highly stimulating chyle, they must be avoid- 
 ed by those whose state of body requires the absence 
 of all stimuli. 
 
 As to the bird kind, the wild are more digestible, but 
 at the same time more stimulating, than the domes- 
 ticated ; and the darker the colour, and the greater the 
 proportion of fibrin, the more stimulant the chyle pro- 
 duced. There is this advantage presented by the bird 
 kind, that they all differ in flavour from each other, and 
 are consequently well adapted to tempt the invalid. 
 The appetite, in ill health, is often in abeyance — not so 
 much from weakness of the digestive functions as from 
 the want of a little management in varying the food. 
 Persuasion is no less requisite inleadingthe animal than 
 in conciliating the rational powers. An argument, pleas- 
 ingly addressed to the palate, is often no less conducive to 
 bodily than — when directed to the judgment — it is to the 
 mental health. Nothing is to be deemed trivial which 
 can soothe; nothing should be neglected which may, 
 with due limitation, contribute to invigorate the sufferer. 
 
 Climate. — It has been seen from the preceding pages 
 how much I am at variance with the common opinions 
 entertained of phthisis, and to none am I more diametri- 
 cally opposed than to those which respect climate. So 
 far from sending a consumptive patient to the south of 
 France or Italy, I should, if change be requisite, deem 
 the climate of St. Petersburgh a thousand times more 
 beneficial. In the latter case he has a chance of con- 
 tracting catarrh, and of thus staying consumption : in 
 
TREATMENT OF CONSUMPTION. 109 
 
 the former, any catarrhal state which might exist would 
 assuredly be fatally removed. When I hear of con- 
 sumptive individuals being recommended to try the 
 genial climes, as they are absurdly termed in these in- 
 stances, of Lisbon, Madeira, or other sunny lands ; and 
 when I reflect on the evidence given by medical statistics 
 of their deadly influence on phthisis, I long to suggest 
 the fitting answer to such advisers, — ''Me vestigia terrent 
 omnia adversum s'pectantia, 7iulla retrorsura'' My ex- 
 perience on this point is full and explicit ; and I could 
 substantiate it, were it requisite, at the close of a treatise 
 the scope of which has been to prove the true nature of 
 this little understood malady, by numerous cases. Two, 
 however, which have come to my knowledge since the 
 publication of the last edition of this work, are on 
 several accounts so interesting, that I am unwilling to 
 withhold them. The first of these, which I extract 
 from the letter of an eminent solicitor in the west of 
 England, who had occasion to consult me, bears ample 
 and irresistible evidence to the soundness of my conclu- 
 sions. It comes with the full weight of authority, for it 
 is a true tale told by the most unexceptionable witness. 
 The writer commences by stating that the death of three 
 sisters, a brother, and his mother, of consumption, had 
 naturally induced some anxiety on his part, and led him 
 to consult me for symptoms it is here unnecessary to 
 detail. He then proceeds as follows : “ I am unacquaint- 
 ed with medical science, but I presume that what you 
 call ‘ a permanent catarrh,’ I vulgarly designate a con- 
 stitutional cough, — if this be so, my own father affords 
 a striking illustration of the correctness of your views. 
 He, when young, was considered very consumptive, 
 and to use his own words was ‘ sent home from abroad 
 twice to die among his friends,’ the foreign doctors pro- 
 nouncing his case to be incurable decline. The first 
 time he rallied, probably in consequence of the voyage, 
 &c., but relapsed after his return to Italy, where he was 
 when first attacked—^^ further corroboration of your 
 opinions.) Business then called him to Newfoundland, 
 where he was exposed to the severest weather. He 
 returned to England, apparently without a chance of 
 living many weeks ; he, however, soon exhibited indi- 
 cations of amendment, and although a strong cough and 
 
110 
 
 TREATMENT OF CONSUMPTION. 
 
 expectoration continued and never left him for sixty 
 years, he attained the age of 84, and never from the 
 establishment of his catarrh (if such it was) knew a 
 day’s illness of consequence, with the exception of occa- 
 sional attacks of the gout. There are other circum- 
 stances,” the writer continues, “which I have not space 
 to mention. My eldest sister has escaped hitherto, and 
 she has a similar cough, and has had it for years -^ * * * * * 
 the other members of my family who have died in de- 
 cline had no such constitutional cough.” The above is 
 surely, to use the language of Shakspeare, “confirma- 
 tion strong as proof of holy writ.” The other case to 
 which I have alluded is not equally valuable in point of 
 conclusive testimony with the preceding, yet is far from 
 foreign to the purpose. It is, indeed, rather curious, 
 that as I had originally instanced the climate of St. Pe- 
 tersburgh as preferable to more southern latitudes, 
 selecting it by chance as the representative of cold climes 
 in general, the following should have been sent me as a 
 piece of gratifying news by a lady of high rank, a patient 
 of mine : — “ I have now before me a confirmation of your 
 views of the beneficial effects of a cold climate in pul- 
 monary cases, in a letter from Mr. Canning, (the pre- 
 mier s son,) who has spent the last winter in St. Peters- 
 burgh, though many of his friends, in consequence of his 
 extreme delicacy and liability to attacks on the chest, 
 dreaded the effects of that climate, and urged him to 
 visit the south of Europe in preference. He says, ‘ I 
 have never felt so well, or been so free from cough and 
 every ailment as since I have been in Russia.’” 
 
 The author of the article on “ Climate” in the “ Cyclo- 
 paedia of Practical Medicine,” a work based on a foreign 
 prototype, but far inferior in original views, has obtruded 
 some crude notions on the subject, which, being calcu- 
 lated to mislead the young practitioner, I shall briefly 
 notice. He writes as follows : — “ The great desideratum 
 in this country is to find a mild climate and sheltered 
 residence for our pulmonary and other delicate invalids 
 during the winter and spring” — and then proceeds to 
 specify the various advantages of our different watering- 
 places. Now it is lamentable to find in a work of so 
 much pretension, a writer, who, at this time of day, is 
 so obtuse as to advocate opinions which have become 
 
TREATMENT OF CONSUMPTION. Ill 
 
 the opprohria of the science. If, instead of repeating 
 platitudes which have been handed down from father to 
 son, he had taken the trouble to repair to some of the 
 spots whose salubrity he vaunts, and examiue the tomb- 
 stones in their respective burying grounds, he would 
 have discovered from the excessive proportion of deaths 
 occuringin the spring of life, particularly among females, 
 that consumption here, if anywhere, “shadowed the 
 portals of the tomb.'’ As a friend once observed to me, 
 a walk in Clifton church yard read a finer homily on the 
 vanity of life than any sermon which he knew. He 
 mentions, to prove the beneficial effects of the climate 
 of Madeira, 'that out of fifty-two patients who went 
 thither in a given number of years, twenty-three re- 
 covered ; which, if it proves anything, v/ould indisputa- 
 bly establish — were the cases accurately reported — the 
 efficacy of a sea voyage, since those who died suc- 
 cumbed for the most part, it would seem, from too prolong- 
 ed a stay on the island. The truth is, this person is con- 
 tented with writing in the usual vague manner on the 
 efficacy of a warm climate, without condescending to 
 explain how warmth can heal up a cavity in the lungs, 
 as if indeed there were a charm in the phrase — warm 
 climate. I have had numerous patients who have re- 
 turned from these lands of “ the myrtle and vine” with 
 excavations in the pulmonary organs, but never knew a 
 solitary instance in which a cure has been the result, 
 except by the fortunate supervention of a catarrh or 
 bronchial affection. Facts are the best, and most stub- 
 born arguments. 
 
 So decided am I on this head, that I never admit into 
 the infirmary a phthisical patient with recent catarrh, 
 because its wards are heated in winter time so as to re- 
 semble a moderate summer temperature. The cases 
 of consumption that come under my notice in summer 
 are nearly double the number of those I see in winter. The 
 reason is evident : — the augmented temperature of the 
 weather increases the intensity of two of the most im- 
 portant stages of the hectic paroxysm — the hot and the 
 sweating. To subdue these then becomes peculiarly 
 difficult : how likely they are to be aggravated by going 
 abroad, any well-constructed thermometrical table will 
 tell. Again, if the disease be latent, removal to a 
 
112 
 
 TREATMENT OF CONSUMPTION. 
 
 warm climate is the most probable means of making the 
 case one of manifest phthisis. In uniformity with these 
 opinions, I feel no anxiety respecting consumptive 
 patients being kept scrupulously within doors. When- 
 ever the weather permits, they should be allowed to take 
 an airing daily; but be by no means suffered to remain 
 so long as to be sensible of chillness or cold. 
 
 From every inquiry I have made with respect to the 
 influence of climate, I conceive that, all things duly con- 
 sidered, the patient cannot have a more suitable residence 
 in winter than in some of the spacious, well-ventilated 
 streets of our own metropolis. Another consideration — 
 a great one to the invalid — is that of comfort, a word 
 indigenous among ourselves. Many of those who had 
 been led by blind guides to roam abroad in a vain search 
 after that health which, under judicious treatment, they 
 might have preserved here, have assured me, to use the 
 language of Sterne, that they had done better to “have 
 remained dry shod at home and I am convinced that 
 the greater number thus sent on a useless errand make 
 — when hundreds of miles from their own comfortable 
 fireside — the reflection that occurred to honest Touch- 
 stone ; — “ Ay, now am I in Arden— the more fool I ; 
 when I was at home I was in a better place.” 
 
APPENDIX. 
 
 CASE I. 
 
 SUPPOSED CONSUMPTION CURED BY PARACENTESIS. 
 
 Exuperius V. Parker, aged 32, of the merchant 
 service, but formerly a petty officer in the royal navy, 
 was admitted into the Infirmary for Diseases of the Chest 
 in November, 1831. He was at this time suffering under 
 frequent and painful cough, attended with expectoration 
 of opaque yellow sputa, singularly fetid, and so abundant 
 in its discharge as to amount, in the course of the day, 
 to three quarts ; it was occasionally tinged with blood. 
 Along with violent pain in the inferior part of the left 
 side, his respiration was obstructed and difficult ; and 
 his sleep was unrefreshing and broken by constant 
 suffering, and accessions of high fever on the approach 
 of night. He likewise laboured under profuse perspira- 
 tions, was excessively emaciated, and his complexion of 
 a sickly yellow hue. It appeared, on inquiring the 
 causes which had led to this state, that while on his 
 passage, in 1829, from Kingston to Morant Bay, in Ja- 
 maica, he had been frequently drenched to the skin, and 
 that he had suffered his clothes to be dried on him by 
 the heat of the sun. In consequence of this, as he 
 supposed, he was seized with the yellow fever, and, on 
 a relapse occurring after his return to Kingston, he was 
 admitted into the hospital. The fever was so violent 
 as to produce delirium, during which he repeatedly rose 
 from his bed to commit suicide, and beino- then under a 
 course of mercury, he concluded that he must, in these 
 paroxysms, have caught cold ; since, when convalescent, 
 he experienced severe pains in the left breast, accompa- 
 nied by violent cough. The latter continued unabated ; 
 and on his return to England he consulted a medical 
 man at Limehouse, after a violent seizure, in which he 
 
 15 
 
114 
 
 APPENDIX, 
 
 experienced a sense of strangulation, followed by a 
 copious discharge of matter. Being regarded by this 
 gentleman as in the last stage of consumption, he was 
 induced to apply to the infirmary. Here he derived 
 such relief, notwithstanding the existence of a large 
 abscess, occupying the inferior lobe of the left lung, 
 which I detected on the first examination of the chest, 
 that I recommended him to go to sea again. I was 
 induced to give this advice from having met with two or 
 three similar cases, in which the abscess had remained 
 stationary for some years. He again made a voyage to 
 the West Indies : on his return from which to this country 
 it was that he presented himself to me, affected with 
 the formidable symptoms I have detailed at the com- 
 mencement of the case. 
 
 Having satisfied myself by auscultation with the naked 
 ear (which I invariably prefer to the stethoscope) of the 
 extent of the disease, and after various topical applications, 
 combined with constitutional treatment, had failed to 
 mitigate the intense pain in his side or to relieve the 
 suffocative respiration, I determined to introduce a 
 small trochar into an intercostal space immediately over 
 the seat of the abscess. I had resolved to perform this 
 operation when I was first called in to this patient, two 
 years previous to the period of which I am now speak- 
 ing, had no improvement taken place ; but finding his 
 health so amended on the very day I had fixed for the 
 paracentesis thoracis, as to preclude its necessity, I 
 deemed it expedient to trust to time and palliative treat- 
 ment. The result proved I had not judged incorrectly. 
 But to return to the operation. Having observed a 
 slight tumefaction about two inches beneath the left 
 nipple, I directed Mr. Herring, in the presence of Mr. 
 Hudson, navy surgeon, to open it ; having first carefully 
 ascertained that the pressure of the accumulated matter 
 had occasioned a sensible inclination of the heart toward 
 the right side. From the intensely acute pain felt in 
 this spot by the patient, for which the abstraction of 
 blood afforded no relief, it appeared to me that nature 
 was on the point of endeavouring to work a cure by 
 gangrene of the pleura ; and that by fixing on this as 
 the spot of election, a ready escape would be given to 
 the contents of the pulmonary abscess. After the divi- 
 
APPENDIX. 
 
 115 
 
 sion of the integuments by the lancet, the same instru- 
 ment was used to open the intercostal space ; and no 
 sooner was this effected than a quantity of air issued 
 from the orifice with a hissing noise, followed by a 
 discharge of opaque yellow matter similar to his expec- 
 toration, wdth the exception of its containing particles 
 of a friable substance. The opening thus made con- 
 tinued to discharge matter, mixed with air, for the space 
 of ten days, with surprising mitigation of his previous 
 suffering. Having about this period imprudently sat for 
 a considerable time in an unaired apartment, he was 
 seized with so violent an inflammation of the bowels 
 as to demand vigorous and decided antiphlogistic treat- 
 ment. This attack produced a sudden and entire sus- 
 pension of the thoracic secretion ; but on the abatement 
 of the inflammatory symptoms, his convalescence was 
 slowly though permanently effected. It should be 
 mentioned, that on examining his chest, I ascertained 
 that the portion of the lung which had previously been 
 the seat of matter and air, and from which a clear 
 gurgling sound as well as pectoriloquism emanated, 
 began almost immediately after the operation to be 
 occupied by the dilated pulmonary tissue ; a process 
 indicated by respiratory murmur. Before the operation, 
 and indeed for three years previously, the respiration of 
 the whole of the right lung, and of the upper portion 
 of the left, as far as a line drawn horizontally from the 
 outside of the nipple of the left breast to the spine, had 
 been distinct and somewhat puerile. In the inferior 
 part of the left side of the chest, pectoriloquism was 
 clearly marked ; and nearly the whole of the low^er 
 lobe of the left lung was, as far as I could judge, the 
 seat of an immense abscess, from wdiich he could 
 discharge matter at will, even to the amount of a tea- 
 cup full. At times, during the action of coughing, I 
 could perceive the intercostal spaces over the vomica 
 apparently distended. Mensuration of the chest gave 
 no perceptible difference between the capacity of the 
 two sides ; but that enlargement of the ends of the 
 fingers, especially of the thumbs, which I have already 
 noticed as indicative of the existence of large excavations, 
 was in this case particularly observable. On his reco- 
 very, this unnatural tumefaction entirely subsided. I 
 
116 
 
 APPENDIX. 
 
 have been thus minute in detailing this case, from my 
 conviction of its rarity and importance. It was, as has 
 been seen, a case of pulmonary abscess which had ex- 
 isted for three years, resulting from the combined effects 
 of yellow fever and severe cold, and terminating in 
 pneumonia. During the greater part of this time I 
 was called upon to observe, and consequently felt a 
 strong interest in its progress. As I had early intimated 
 to my pupils my judgment on this case, and was sanguine 
 in my belief of the patient’s recovery, I derived great 
 satisfaction from having the precision of my diagnosis 
 verified. 
 
 CASE II. 
 
 CONSUMPTION CURED BY PARACENTESIS. 
 
 David Scott, aged seventeen, admitted as an in- 
 patient of the Infirmary, November, 1827, had been in- 
 disposed eleven years ; his illness originated in his 
 having taken arsenic by mistake. For several years 
 previous to my seeing him, he had been afflicted with 
 cough, and other symptoms of consumption. On enter- 
 ing the infirmary he showed none of the usual signs of 
 emaciation in his person, but there was an unhealthy 
 fulness and flushing in his face ; he expectorated abun- 
 dantly viscid frothy sputa, of a greenish colour, and 
 semi-opaque. This matter, amounting to about one 
 quart daily, was of an odour so intolerably offensive as 
 to require the almost instant removal of the vessel which 
 received it, in order to spare the feelings of the patients 
 of the same ward. Conceiving that a well-regulated 
 atmosphere, such as that of the Infirmary, (which is 
 kept of a uniform temperature by means of German 
 stoves,) would, conjoined with sedatives, lessen the co- 
 piousness of the discharge, I deemed it advisable to try 
 their influence for a time. After a month’s sojourn in 
 the Infirmary, and the failure of remedial agents, finding 
 his feet oedematous and considerable dyspnoea present, 
 and that there was, in fact, a decided change for the 
 w’orse, I resolved to have recourse to an operation. His 
 condition, at this period, was as follow^s. On the right 
 side anteriorly, from the clavicle to the fourth rib, there 
 
APPENDIX. 
 
 117 
 
 was a strong gurgling rattle, indicating the passage of 
 air through cavities containing matter. The character 
 of the sound induced the belief that the fluid was in 
 immediate contact with the walls of the chest. Pecto- 
 riloquism was well-marked, posteriorly, as well as ante- 
 riorly ; his respiration cavernous, but there was an en- 
 tire absence of the souffle voile (the veiled puff.) Hence 
 I became certain, that the surface of the lung adhered 
 firmly to the costal pleura. Percussion on the same 
 side, as well as the naked ear, showed that some portion 
 of the inferior lobe of the lung, a little below the exca- 
 vations, still admitted the passage of air. On the left 
 side the chest sounded well, and the respiration was 
 distinctly audible over the whole of it, except below the 
 clavicle, where I at once detected imperfect pectorilo- 
 quism. The operation was performed with a small tro- 
 char, in the presence of Mr. Herring, the apothecary, 
 and of more than twenty of my pupils, by a surgeon, a 
 fellow-lecturer of mine. The place of election was in 
 the intercostal space, a little anterior to the digitations 
 of the greater serratus muscle. It was my desire that 
 the puncture should have been made between the third 
 and fourth ribs ; however, it so happened that the instru- 
 ment was introduced between the fourth and fifth, upon 
 which there immediately issued a quantity of air, with a 
 hissing noise, without any discharge of matter. The 
 point of the trochar, indeed, exhibited traces of pus, and 
 although it had been fairly introduced, yet the place of 
 election was too low to suffer the escape of the matter. 
 Observing that the patient was lapsing into syncope du- 
 ring the rushing out of the air, I stopped its farther 
 escape by placing my finger over the orifice, until this 
 could be properly secured by bandages. On his re- 
 covering from this disposition to faint, and scarcely com- 
 plaining of pain, I explored his chest with my naked 
 ear, and in the region of the spot operated upon, I dis- 
 tinguished a dry, crepitous rattle, accompanied by a con- 
 tinued sound as of a rent, or as of something being torn 
 within the chest. This particular noise lasted, and even 
 increased, for some days. Subsequent to the operation, 
 he slept well, with the aid of a composing draught ; his 
 expectoration, as well as the oedema of his legs, gradu- 
 ally diminished, and for a short period he exhibited 
 
118 
 
 APPENDIX. 
 
 every sign of returning health. However, confinement 
 to the house appearing to operate injuriously, it was re- 
 solved he should return to his place of abode in the 
 country, a short distance from town. Here I saw him 
 two or three times, and at first he displayed symptoms of 
 amendment; but subsequently his breathing became 
 troublesome, in consequence of an emphysematous state 
 of his left lung, and of the other’s being from cicatriza- 
 tion of its several cavities, and from compression also, 
 impermeable to air. So great was this compression pro- 
 ceeding from contraction of the chest, that he became 
 what is termed pigeon-breasted. As a consequence 
 of the hepatized state of the one lung, w^hich occurred 
 a few months afterward, the circulatory functions were 
 disturbed, and venous congestion gave rise to general 
 dropsy. I recommended abstraction of blood to equal- 
 ize the circulation, diuretics, and other hydropical re- 
 medies, but fruitlessly, he having been, I apprehend, 
 prejudiced against my advice by some neighbouring 
 practitioner. After much suffering he succumbed to this 
 complication of disease, about eleven months from the 
 time of his leaving the Infirmary. I was sent for to ex- 
 amine the body, which I did about twenty-four hours 
 after decease. Notwithstanding the deformity which 
 the chest had undergone, there was no perceptible con- 
 traction of the affected side, which, subsequent to the 
 operation, had yielded the fleshy sound on percussion. 
 The right lung was one-fourth less than the left, and ad- 
 hered intimately to the costal pleura by well-organized 
 cellular tissue, and likewise to the middle mediastinum, 
 which, with the heart, was forced considerably into the 
 right side of the chest, by enlargement of the left lung. 
 This lung was altogether emphysematous, remained un- 
 collapsed, and occupied the entire cavity of the left side 
 of the chest. The anterior edge was rounded, and dis- 
 played vesicles wdiich were of great size, owing to the 
 union of several air-cells into one. The summit of the 
 lung adhered to the chest, developing in its centre the 
 indurated trace of cicatrization ; and it presented several 
 nodules of tubercles, surrounded by a copious deposite of 
 black pulmonary matter. In the cavity of the pleura, 
 there were above two pints of reddish serosity. On 
 making a longitudinal section of the right lung, its inte- 
 
APPENDIX. 
 
 119 
 
 rior, which was flaccid, somewhat fleshy, and of a mar- 
 bled blue and brown colour, presented cellular lines 
 running in different directions, being the remains of ob- 
 literated excavations ; but there was not the slightest 
 vestige of tuberculous formation. The pericardium con- 
 tained about a tea-cup full of serum, and the apex of the 
 left ventricle was unusually prolonged ; a considerable 
 quantity of fluid existed in the -peritoneal cavity; the 
 chylopoietic viscera were much congested ; the kidneys 
 were of remarkable magnitude, and their cortical sub- 
 stance underwent fatty degeneracy. 
 
 From a general view of the case I feel satisfied that 
 this patient might have lived some years, had he submit- 
 ted to the treatment I proposed to him on his change for 
 the worse. 
 
 CASE III. 
 
 CONSUMPTION, IN ITS VERY ADVANCED STAGE, SINGULARLY ARRESTED. 
 
 W., clerk in a counting house in the city, aged 
 
 25, — for whom my advice was solicited by Dr. Tuke, 
 the humane and talented proprietor of Sidney House, 
 Homerton, the best-regulated private establishment for 
 the insane I have ever visited, — when first seen by me, 
 had been for some months affected with cough, and ex- 
 pectoration of thick, yellow sputa. He was extremely 
 pallid, and much emaciated, perspired profusely at night, 
 and had occasionally been subject to heemoptysis. It 
 appeared that he had recently lost a brother by the same 
 complaint: this circumstance, as was natural, seemed to 
 prey upon his mind, and depress his spirits ; and to so 
 low a condition was he reduced, that he was given over 
 by a respectable surgeon-apothecary who had attended 
 him. I detected distinct pectoriloquism on the anterior 
 and upper part of both sides of the chest ; and this phe- 
 nomenon, together with a strong gurgling sound, most 
 audible in the left side, was clearly perceptible, over the 
 whole space, from the top of the shoulders to the third 
 rib. From partial indistinctness of the respiratory mur- 
 mur, without the rale of pneumonia in the lower part of 
 the right side, I apprehended that nodules of tubercles 
 were disseminated throughout its lung. I ordered the 
 
120 
 
 APPENDIX. 
 
 application of leeches to his chest, with a view to lessen 
 perspiration, and remove congestion and morbid sensi- 
 bility of the chest : and having described to him the 
 species of apparatus for inhalation I wished him to use, 
 he procured for himself a tube of half an inch in diame- 
 ter, and furnished with a stop-cock, by turning which 
 he was enabled to increase, or diminish, the resistance 
 to the egress of air from the chest. With very little 
 medicine, and that merely to regulate his stomach and 
 bowels, a striking amendment was soon visible, through 
 the beneficial effects of the above mechanical exercise. 
 His progress to recovery being now rapid and decided, 
 I recommended him to repair to the country for a short 
 time, and to continue the plan from which he had 
 already derived such benefit. After some weeks’ resi- 
 dence, he returned to town well enough to resume his 
 employment, and exhibited every appearance of health. 
 He had gained flesh in a surprising degree, his muscles 
 were firm and developed, his cough and expectoration 
 had almost left him, and he was — comparatively speak- 
 ing — a vigorous man. The only time I saw him after 
 his return, I examined his chest, and the result was, on 
 the whole, satisfactory. Pectoriloquism, indeed, could 
 still be detected in both sides of the chest ; but in the 
 right it was imperfect: in the left, however, it was 
 extensively manifested, though in a less degree than 
 before, and had a metallic sound. From this last cir- 
 cumstance, I inferred that the lining membrane was 
 acquiring a semi-cartilaginous structure, which I have 
 found in many individuals will remain insensible, and be 
 productive of but trifling inconvenience for a series of 
 years. It unfortunately happened, that at no long pe- 
 riod after his convalescence, he was attacked with pleu- 
 risy, probably from neglecting himself ; and although he 
 survived this latter affection, as I was given to under- 
 stand, for two months, yet not applying for advice, he 
 ultimately sunk beneath its effects. 
 
APPENDIX. 
 
 121 
 
 CASE IV. 
 
 pulmonary excavation, discharging its contents by an 
 
 OPENING MADE IN THE RIGHT SIDE OF THE NECK. 
 
 In 1822, a child, nearly two years old, whose father 
 was an out-door patient of the Infirmary, was brought 
 for my advice, labouring under cough, as well as a rare 
 disease, known under the name of pemphigus, which 
 commenced behind the right ear, with the eruption of 
 vesicles, about the size of almonds ; and these succes- 
 sively extended themselves some way down the back 
 and the same side of the neck, discharging acrimonious 
 yellow serum, and forming deep pits in the skin. This 
 almost intractable disease yielded, at last, to varied 
 treatment, and the application of an ointment composed 
 of the scrofularia nodosa. The part that had been af- 
 fected with the disease healed up like a burned surface, 
 but with several depressions. The delicacy brought on 
 by this disorder, terminated in tubercular formations in 
 the summit of the right lung, which finally softened and 
 made a way for themselves by forcing a passage under 
 the clavicle — the matter approaching the middle of the 
 neck, in the direction of the cicatrized integuments. 
 Observing that every time the child coughed a puffing 
 up of this part took place, and that there was air within 
 it, I directed Mr. Sturkey, the intelligent surgeon-apo- 
 thecary of the establishment at that time, to make an 
 opening here, when there immediately issued a consi- 
 derable quantity of air and matter, with great relief to 
 the little sufferer. This discharge ceased after some 
 days : but in consequence of the extreme debility, in- 
 duced by two diseases occurring in a short space of 
 time, the child, originally of delicate constitution, did 
 not survive beyond two weeks. Its death, indeed, was 
 absolutely owing to a complete prostration of vital 
 power, not to be restored either by nourishing diet, or 
 tonic remedies. On examination there were several tu- 
 bercles in both lungs, but the surfaces of the large 
 cavity were found to be in apposition, and in more than 
 one point slightly adherent ; affording a proof, evi- 
 denced likewise by the voluminous state of the Iimcfs, 
 
 16 
 
122 
 
 APPENDIX. 
 
 that had the child lived, it would have triumphed over 
 every consumptive tendency. I must not omit to men- 
 tion, that the mesenteric glands were so enlarged, as to 
 present a decided obstruction to proper nutrition of the 
 body. 
 
 CASE V. 
 
 CONSUMPTION CURED BY PARACENTESIS. 
 
 Mr. G. S., aged 30, residing in Norfolk-street, Strand, 
 having experienced several severe losses in trade, fell 
 into a declining state, which ultimately led to confirmed 
 consumptive symptoms. It appeared that about three 
 years previous to my attending him he had laboured 
 under phthisis, from which it would seem that he reco- 
 vered ; and his recovery took place, as I have reason to 
 believe, from the occurrence of bronchial affection, which 
 after a time deserted him. However, meeting with new 
 calamities, he relapsed into his former phthisical condi- 
 tion. At the time he first sought my advice, every sign 
 indicated that his malady had made considerable progress. 
 From the history of his case, I concluded that a se- 
 condary eruption of tubercles must have taken place at 
 least eighteen months before ; and that the softening of a 
 tuberculous mass of large size had led to the formation 
 of a vomica. At times he was sensible of fullness in 
 the upper region of the left side of the chest, as if produced 
 by accumulation of matter in the cavity, unable to find an 
 exit ; and he would suddenly be relieved by expectorating' 
 a quantity of purulent secretion, sufficient to fill a small 
 tea-cup. He could himself distinguish the agitation of 
 the fluid in his chest, when he coughed. On examina- 
 tion with the ear, extensive pectoriloquism was audible, 
 extending from beneath the clavicle to below the third rib, 
 and I distinctly recognized the gurgling of the fluid 
 over the whole of the upper part of the left side of the 
 chest. I succeeded in removing for a time, in a great 
 measure, well-marked hectic fever, and the abundant ex- 
 pectoration was somewhat lessened. The fluctuations 
 from amendment to relapse were frequent ; and, among 
 other remedial measures I advised him to go to the 
 north of England by sea, conceiving that he might 
 
APPENDIX. 
 
 123 
 
 derive benefit from the bracing qualities of the air. Re- 
 maining there a brief period, he returned to London but 
 slightly improved in health. Convinced that medicine 
 could only afiford temporary relief, and being satisfied 
 that his right lung, with the exception of old cicatriza- 
 tion, was sound, and that the inferior lobe of the left 
 lung was in a very satisfactory state, I ventured to pro- 
 pose an operation to him. In spite of the ridicule thrown 
 upon the proposal by a medical acquaintance of his, he 
 reposed such entire confidence in me that he unhesi- 
 tatingly agreed to it. Indeed, no accident ever attended 
 the operation as performed by me, except in a case of 
 empyema, occurring in my early practice ; the particu- 
 lars of which extraordinary case I unreservedly stated to 
 a medical society in this city. Laennec gives an 
 instance not dissimilar from that which happened to me, 
 since both arose from an unnatural position, in my case 
 an unheard-of one, of an important viscus. 
 
 Attended by one of my pupils, I operated with entire 
 success. The trochar was introduced by me between 
 the second and third ribs, in a line nearly perpendicular 
 with the left nipple : very little matter escaped, as I had 
 expected ; for my chief object in performing this opera- 
 tion was to ensure the emission of the air, and thus effect 
 a diminution of the cavity by the expansion of the inferior 
 lobe of the left lung. I kept the punctured place open 
 for about ten days by the introduction of a small piece 
 of catgut, properly secured externally ; when, finding 
 that the cavity became so contracted, through the en- 
 croachment made on it by general pulmonary expansion, 
 as to preclude all further escape of air, I withdrew it. 
 About this time, a catarrhal affection of the inferior lobe 
 of the punctured side supervened ; and I could tell by 
 the ear, that the pulmonary tissue in the summit of the 
 same side was undergoing expansion. In less than two 
 months my patient was able to go out, and had com- 
 pletely lost all his phthisical symptoms. In less than 
 two years after the operation he was in the enjoyment 
 of excellent health, the only drawback being the exist- 
 ence of catarrh, to which he more immediately owes his 
 recovery. 
 
124 
 
 APPENDIX. 
 
 CASE VI. 
 
 CONSUMPTION CURED BY SUDDENLY SUPERVENING EMPHYSEMA. 
 
 A YOUNG lady, daughter of a highly respectable trades- 
 man in Little Britain, (London,) long subject to a nervous 
 disorder for which various advice had been taken with- 
 out permanent effect, became consumptive. Her decline 
 was, in my opinion, brought on by an ill regulated use 
 of medicine. After long manifestation of the various 
 symptoms of phthisis, it was proposed to me to meet in 
 consultation a physician belonging to one of the metro- 
 politan hospitals. The view of the case taken by this 
 gentleman was so unfavourable, he unhesitatingly gave 
 it as his opinion to her parents — that she could not sur- 
 vive six weeks. Careful exploration, however, of the 
 summit of the left lung, where I suspected the presence 
 of a cavity, convinced me of the probable error of his 
 conclusion. This belief, on my part, originated in de- 
 tecting decided indications of emphysema from a dry 
 crepitous rattle, with large bubbles, manifested by 
 auscultation. This emphysematous state, I conceive, 
 arose from a spasmodic attack of the throat, so violent 
 as almost to produce suffocation. From this circum- 
 stance, combined with the suddenness of the emphysema, 
 I inferred that a rupture of several air-cells had taken 
 place, and that in time cicatrization would be effected 
 through the consequent pulmonary dilatation. Nor did 
 my conjecture prove erroneous ; since, thought five years 
 have elapsed from the period of which I am speaking, I 
 am most happy to state, that this young lady is not only 
 living, but is in the enjoyment of excellent health. 
 
 CASE VII. 
 
 CONSUMPTION CURED BY NEGLECT. 
 
 A SILVERSMITH, when in good health and circum- 
 stances, and nearly fifty years of age, was exposed to 
 one of the most terrible of all paternal inflictions — the 
 misconduct and subsequent legal punishment of his son. 
 
APPENDIX. 
 
 125 
 
 The young man, having formed dissolute connections, 
 had been persuaded to pass a forged note ; and, on the 
 fact being proved against him, v^as sentenced to trans- 
 portation. The disgrace thus brought on their hitherto 
 unimpeachable family, operated so powerfully on the 
 feelings both of the father, and of a daughter just enter- 
 ing into life, that their distress and agony of mind at 
 last entirely undermined their health. The debility thus 
 induced terminated in each of them in consumption. 
 After a few months’ illness the daughter died ; and the 
 father, after extreme suffering, both of body and mind, 
 having apparently reached the verge of the grave, and 
 being indeed so utterly reckless of life, which he regarded 
 only as a burden, as to neglect not only recourse to 
 medical advice, but even common care of himself, yet 
 recovered, and survived for many years. It was fully 
 seventeen years subsequent to this seemingly miraculous 
 recovery, that I attended him on the occasion of his 
 being seized with an apoplectic fit, resulting, as I after- 
 ward had reason to believe, from valvular disease of 
 the heart. During his convalescence from this attack, 
 he was unfeelingly taunted by some brute in human 
 shape with his son’s disgrace ; and so wounded and 
 humiliated did he feel by this unworthy allusion, and so 
 deeply did it sink into his mind, that I entertain no doubt 
 it accelerated his death. It was during my attendance 
 on him, that learning from his wife his previous con- 
 sumptive state and recovery, and perceiving that he 
 laboured under a bronchial affection of long standing, 
 I at once attributed the return to health w^hich she re- 
 garded as so strange, to the ingression of catarrh on 
 phthisis. The 'post-mortem examination verified my 
 conclusions ; it presented well defined cicatrizations, 
 especially on the summit of the right lung ; nodules of 
 tubercles, yellow and opaque in the centre, and rendered 
 inert by the secretion of black pulmonary matter in the 
 surrounding tissue ; and the lungs were exceedingly 
 voluminous. I will venture one observation on the case, 
 and although it may appear harsh, regard for truth and 
 the advancement of medical science compel me to make 
 it; namely, that had this person when reduced to a 
 phthisical state recurred to medical advice, the probability 
 is, that the bronchial affection, which was his safeguard, 
 
126 
 
 APPENDIX. 
 
 would have been interfered with, its value being unknown 
 to the profession, and his life, consequently, shortened 
 for years. 
 
 CASE VIII. 
 
 CONSUMPTION SPONTANEOUSLY CURED. 
 
 Miss M , about twenty-three years of age, a lady 
 
 of great personal attractions and highly cultivated mind, 
 consulted me in the summer of 1826 , for symptoms of 
 confirmed consumption ; for which she had already en- 
 joyed the benefit of Mr. Howship’s advice. It was ar- 
 ranged that I should visit her in conjunction with this 
 talented surgeon ; and we continued to attend her for 
 several weeks. In all the cases I have witnessed, I 
 never met with such distressing, racking, and perpetual 
 cough. We tried every method of relief we could pos- 
 sibly devise, and administered sedatives of every des- 
 cription, but without effect. Her disorder, instead of 
 receiving mitigation, evidently increased ; and not only 
 were the fears of her friends awakened, but we ourselves 
 began to despond. At this crisis, through the importu- 
 nity of some near connections, her mother was persuaded 
 to try the advice of an individual, who, although I am 
 not aware that he had received a regular medical educa- 
 tion, enjoyed some notoriety. On receiving a delicate 
 intimation to this effect, and being of course inclined to 
 humour the natural anxiety of a parent, we agreed that 
 it might not be totally infra dignitatem of us, the more 
 legalized authorities, to hear what this person might 
 suggest, although a formal consultation was out of the 
 question. To do him justice, we found his opinions 
 sensible, and much to the purpose ; but he considered 
 the condition of the patient as so hopeless that he declined 
 interfering with the case. Yet, notwithstanding these 
 grave prognostics, the young lady, to our great satisfac- 
 tion, soon after this began to exhibit signs of amendment. 
 Her health was gradually restored, and continues, I be- * 
 lieve, unimpaired up to the present time. From my 
 further experience, and from cases which have subse- 
 quently come under my notice, I entertain no doubt that 
 the cough I have already alluded to, and which was of 
 
APPENDIX. 
 
 127 
 
 a convulsive character like that of the whooping-cough, 
 must have produced a rupture of the air cells, which 
 caused infiltration of air within their partitions. This 
 variety of emphysema, similarly to the vesicular, renders, 
 while it lasts, the lungs voluminous ; and when happen- 
 ing in the neighbourhood of the diseased summit of the 
 lung, would naturally bring the surfaces of any excava- 
 tion into contact. Indeed, although from my reluctance 
 to put the patient to inconvenience by examining the 
 chest in the latter part of her illness, I could not posi- 
 tively affirm the existence of emphysema, still all my 
 reflections on the case lead me to the belief, that she is 
 in no small degree indebted for her cure to a cough, 
 which in general would be considered highly injurious, 
 and in fact appeared so to me at the time. 
 
 CASE IX. 
 
 REMARKABLE INFLUENCE OF THE PROTECTIVE POWER OF A 
 BRONCHIAL AFFECTION. 
 
 I OFFER this case as one instance out of many, equally 
 as decisive which I could adduce, of the value of catarrh 
 in preventing pulmonary consumption. An eminent 
 publisher of Paternoster-row, all of whose brothers and 
 sisters have been the prey of consumption, is himself 
 subject to asthma, induced by a catarrhal affection of 
 the chest contracted in childhood. The gentleman to 
 whom I allude is at present about fifty years of age, of 
 a ruddy, healthy complexion, expanded chest, and ex- 
 cepting occasional inconvenience experienced from the 
 above constitutional complaint, he enjoys life in every 
 respect. It is but fair then to infer that since, out of a 
 numerous family, he is the sole member who has escaped 
 phthisis, this singular exemption has been owing to 
 what might to a superficial observer appear an infliction, 
 but which is really in this instance a providential dis- 
 pensation ; namely, catarrhal asthma. 
 
 Being thus naturally led to the subject, I take the 
 opportunity of explaining a very remarkable phenome- 
 non, exhibited in the offspring of consumptive and asth- 
 matic individuals. That consumption is hereditary, I 
 
128 
 
 APPENDIX. 
 
 have already noticed ; but an additional confirmation 
 not only of this fact, but of the truth of the opinions I 
 have given on the preventive nature of catarrh, may be 
 found in the circumstance often noted by me, — that when 
 a consumptive individual becomes asthmatic, the children 
 born prior to the supervention of asthma exhibit a 
 phthisical diathesis, while those who are born subse- 
 quently are entirely free from any consumptive tendency. 
 Exceptions may undoubtedly be met with, the result of 
 some strong exciting cause ; but, generally speaking, the 
 rule will be found to hold good : the exception, indeed, 
 will substantiate the rule, from the resistance, in such 
 cases, offered by nature to the inroads of consump- 
 tion. 
 
 CASE X. 
 
 COMPLICATION OF DISEASE ENDING IN PHTHISIS. 
 
 C. L., aged 50, the matron of a medical institution, 
 and who consequently had the best advice within her 
 reach, and was visited by several eminent medical men, 
 was for some months subject to distressing uneasiness 
 and irritability of stomach, which prevented the due re- 
 tention of food. It being supposed that she laboured 
 under a cancerous affection of this organ, various palli- 
 ative expedients were resorted to. Her health, however, 
 declined, and she became subject to frequent cough 
 from which she had hitherto been free, — to shortness of 
 breath, purulent expectoration, much emaciation, hectic 
 fever, and night sweats. After great suffering for a 
 lengthened period, she sank under this seemingly 
 double affection of the stomach and chest. On exami- 
 nation, however, of the body, the cause of this train of 
 disease was discovered to be a polypus of the womb, 
 which had considerably enlarged it, and had undoubtedly 
 excited that morbid sensibility of the stomach which, de- 
 ranging the general health, induced phthisis. The only 
 remarkable appearances presented by the stomach, 
 were several small opaque glands in the mucous surface, 
 near the pylorus. The lungs were excavated, and tuber- 
 culous ; and, exhibited marks of inflammation in various 
 places. I have introduced this case to prove the just- 
 
appendix. 
 
 12^ 
 
 Mess of the views 1 have taken in the preceding portion 
 of this work, with respect to the fatal supervention of 
 phthisis on general debility, when unchecked by catarrh, 
 or mechanical expansion of the chest. Had inhalation 
 been early employed, the disease would have been at 
 once arrested ; and the patient might have lived until 
 the appearance of the polypus through the external 
 opening of the womb would have attracted notice, w hen 
 means might have been adopted for its removal. 
 
 I have by me numerous cases in which consumption 
 has fatally supervened on diseases both of a curable and 
 incurable kind ; but their description could only confirm 
 what I have already, I trust, established. 
 
 CASE XL 
 
 THE PROTECTING INFLl/ENCE OF CATARRH, SUPERVENING ON CON« 
 SUMPTION, EXEMPLIFIED. 
 
 Mrs. Hawkes, the wife of a gentleman attached to 
 the Bank of England, who had been under the care of a 
 retired lecturer on midwifery at our largest hospital, 
 without relief of her consumptive symptoms, applied to 
 me about twelve years ago. She suffered from hectic 
 fever, spitting of blood, and, in short, exhibited all the 
 well-known symptoms of phthisis. At this time, my 
 view^s of treatment of consumption were not matured. 
 However, I succeeded in rendering her disease chronic : 
 and soon after this change was effected, a bronchial af- 
 fection supervened. Until the pulmonary cavity was 
 perfectly healed, she was liable at long intervals to 
 sanguineous expectoration ; and her health consequently 
 exhibited occasional fluctuation. During one of these 
 temporary relapses, she consented, in order to oblige a 
 friend whose importunities were unceasing, although at 
 the same time her confidence in me continued unshaken, 
 to apply to Dr. Mat on, the late physician to their royal 
 highnesses, the duchess of Kent and the princess Vic- 
 toria. Like other physicians of the same standing, he 
 possessed no very accurate knowledge of the modern 
 improvements in the art, and, from the defective educa- 
 tion which prevailed when he commenced his studies, 
 had probably never turned his attention to pathological 
 
 17 
 
130 
 
 APPENDIX. 
 
 researches. At least, 1 cannot otherwise account for his 
 mistaken views of the present case. I do not intend re- 
 flecting on Dr. Maton in particular, more especially as 
 he is now no more. He was quite equal to any of the 
 practitioners of his day, and having had the honour to 
 prescribe for two successive queens, was known, like 
 most of those who have enjoyed similar posts, by his 
 preferment chiefly. The duties of the station, doubtless, 
 preclude the possessors from making contributions to 
 medical science, or, at least, from extending their fame 
 to foreign countries : a rather singular exception, in- 
 deed, to what occurs elsewhere, since we find that 
 abroad those medical men who hold similar posts are 
 the most distinguished by their professional attainments. 
 To return to the case. Dr. Maton gave it as his opinion 
 that recovery was impossible. This was accordingly 
 reported by my patient to me, with apologies for the ap- 
 parent want of confidence in my skill. I soon reasoned 
 her out of her fears, and carefully putting by the pre- 
 scription, she proceeded in better spirits from my assu- 
 rances to order mine to be made up. The usual results, 
 attendant upon catarrh in pulmonary consumption, were 
 not belied in her case. She is at this moment ever 
 ready to join in the laugh with me at her former trepi- 
 dation ; and is one, out of hundreds of instances that 
 have passed under my observation, of the cures effected 
 by the interposition of nature herself. 
 
 CASE XII. 
 
 CONSUMPTION CURED NOTWITHSTANDING EXPOSURE TO COLD AND 
 NEGLECT OF MEDICINE. 
 
 Mr. D , aged 24, had so materially impaired his 
 
 constitution throuo^h irreofular habits as to fall in conse- 
 quence into a decline. He of course availed himself of 
 the benefit of medical advice, which produced no very 
 visible amelioration of his state of health. Being natu- 
 rally of active habits, he grew impatient of the confine- 
 ment to which he was subjected, and, tempted by the 
 return of spring, he suddenly deserted his heated apart- 
 ment, and determined, since he concluded he must die, 
 
APPENDIX. 
 
 131 
 
 to die in the manner most agreeable to himself. Accord- 
 ingly he betook himself to his favourite sport of fishing. 
 This was in the month of March, a period at which 
 easterly winds are most prevalent. The worst conse- 
 quence of this apparently rash exposure was, that after 
 a time he caught a cold, which, as it would appear, was 
 confined to the trachea. His respiration was sensibly 
 affected, and he laboured under a distressing fulness of 
 the chest. He had continued subject to this affection, with 
 an apparent increase of the violence of his disorder ; but 
 he still rejected all care and medicine, and persevered 
 in going out. After some period, he began to exhibit 
 signs of amendment ; he gradually lost his emaciated 
 appearance, and acquired flesh and bodily vigour ; but 
 w^as much annoyed of wheezirig of the chest, and loud 
 rattle in the throat. He had remained in this state for some 
 months, when he applied to me. On examination of the 
 chest, and hearing a detail of his complaints, not only 
 from himself, but from the gentleman under whose care 
 he had perviously been, I at once perceived that he was 
 indebted for his recovery from consumption to this ca- 
 tarrhal state of the trachea. I may here observe, that re- 
 coveries of this kind are more frequent among the lower 
 than the other classes of the community ; owing, doubt- 
 less, to what may at first appear a misfortune, but is to 
 the consumptive patient, in numerous instances, a bless- 
 ing — exposure to cold ! 
 
 CASE XIII. 
 
 CASE OF CONSUMPTION, EXEMPLIFYING THE GREAT VALUE OF 
 INHALATION. 
 
 A GENTLEMAN, aged fifty, whose house of business 
 is in Hatton-garden, began to exhibit decided symptoms 
 of consumption about three years ago. Originally of 
 delicate constitution, and inclined by his make to 
 phthisical disorder, his health was undermined by 
 family afflictions. Within a very brief period he lost 
 his wife and two grown-up daughters ; the two latter 
 through the same destructive complaint, which, super- 
 vening on the decay of health occasioned by grief for . 
 
132 
 
 APPENDIX 
 
 their loss, has since endangered his own life. At the 
 time I was called in he exhibited the physical signs, as 
 w^ell as constitutional symptoms of the disease. He had 
 inflammation of the inferior and middle lobe of the right 
 lung, and expectorated no inconsiderable quantity of 
 blood. This circumstance, indeed, is no infrequent con- 
 comitant of the above inflammatory state, when it coex- 
 ists with tuberculous excavations of the lungs. He had 
 been under the care of two able practitioners, his 
 brother-in-law, Mr. Wallace, and Mr. Christie, a surgeon 
 in the neighbourhood of his country residence. Both 
 these gentlemen considered their patient in a most 
 alarming state ; and on seeing him, I fully shared their 
 apprehensions. The first consideration wus to subdue 
 the inflammatory state ; and for this purpose blood 
 was taken from the arm, and medicines were likewise 
 exhibited to further the end proposed. The pneumonia 
 continuing, it became necessary to repeat the general 
 abstraction of blood, and to follow this up by the appli- 
 cation of leeches near the seat of the inflammatory 
 action. By these depletory measures, the pneumonic 
 disease lost its more violent symptoms ; but, after dis- 
 playing a temporary amendment, the active determina- 
 tion of blood to the chest recurred with its former 
 severity. At this juncture, his brother-in-law, Mr. 
 Wallace, who watched the case with great anxiety, 
 considered himself fully justified in bleeding him in my 
 absence, and that to some extent. Leeches were also 
 repeated, and medicines given, whose chief action was 
 determined to the kidneys. Under this plan of treat- 
 ment, he gradually got rid of the formidable pneumonic 
 complication, and it remained to counteract the phthisic- 
 al disease alone ; which, after a time, began to exhibit 
 graver and more pressing symptoms. In fact, the 
 patient was at this period in so lamentable a condition, 
 and so utterly hopeless of recovery— being rendered ad- 
 ditionally uneasy by the discharges of blood again 
 appearing— that he arranged his affairs, and made every 
 preparation which a conscientious man deems it im- 
 perative to do, when looking forward to the awful 
 summons. Having first reduced the spitting of blood, 
 and removed some of the more formidable external 
 symptoms connected with phthisis, I pressed the neces- 
 
APPENDIX. 
 
 133 
 
 sity of recurring to inhalation. The practice was novel 
 to the other medical gentlemen, but I pointed out its 
 rationale, and illustrated my opinions by the convincing 
 support of cases. They yielded to my arguments, in- 
 asmuch as their reason was convinced ; yet so unwill- 
 ingly, that they could not enlist their hopes on my side. 
 The utmost they at first expected was palliation ; but 
 they could not bring themselves, as they have since 
 owned to me, to believe that inhalation could effect the 
 healing of internal ulcers, and prevent the fresh forma- 
 tion of tubercles. The trial was however made ; and 
 its result up to the present date has been attended with 
 marked success. In less than two months from the 
 period of the patient’s commencing to inhale, his chest 
 was so much enlarged as to render it necessary for him 
 to have his waistcoats let out ; and his general health 
 was proportionably amended. It is now two years and 
 a half since he began this process, and for the last two 
 he has been enabled to attend constantly to his business in 
 town. He inhaled for many months twice a day, except 
 at such times as slight spitting of blood, arising from the 
 cavities not being yet entirely closed, has called for an 
 interruption. This is a circumstance, which, although 
 it is apt to occasion alarm in the patient, is to be ex- 
 pected in many instances, so long as the excavation 
 remains. I have already adverted in case xi. to a 
 similar instance of sanguineous expectoration, which 
 likewise proved perfectly innocuous. The cure was in 
 the case of this lady complete ; and in that now^ under 
 consideration, I am happy to be able to say, ''finis 
 corona t opus'" 
 
 CASE XV. 
 
 ANOTHER CASE CORROBORATIVE OF THE EFFICACY OF INHALATION, 
 WRITTEN BY THE FATHER OF THE PATIENT. 
 
 Dinah Marks, of the Jewish persuasion, aged nine- 
 teen, was suddenly seized with spitting of blood, in the 
 beginning of September, 1833. On application to a 
 medical gentleman, he treated the case as of no import- 
 ance, but prescribed for her ; and she continued under 
 his care, without experiencing any relief, until the end 
 of December. She was seized at this juncture with 
 
134 
 
 APPENDIX. 
 
 sanguineous expectoration, similarly to the first attack ; 
 and this was followed by a violent cough. Nocturnal 
 sweats ensued, accompanied by loss of appetite, dejec- 
 tion of spirits, and other common symptoms of decline. 
 She drooped visibly ; and her appearance awakened all the 
 fears of her mother and myself. At this critical period, I 
 made the acquaintance of a person who had been in- 
 debted to you for restoration from a state even more 
 alarming than my daughter’s ; and I immediately sought 
 the benefit of your advice for her. The state of weak- 
 ness to which she had been reduced, and consequent 
 inability to inhale, prevented her from deriving, or, rather 
 perhaps, from exhibiting outwardly, much immediate 
 benefit from your prescriptions ; and she remained ap- 
 parently in a very precarious condition. The spitting 
 of blood came on again in the beginning of March ; and, 
 on its removal by your treatment, you advised her at 
 once to commence inhaling. From this moment her 
 progress to convalescence has been rapid. With her 
 amended health her spirits also have revived. She has 
 been enabled to resume her business ; and no doubt can 
 possibly be entertained of her ultimate recovery. Her 
 mother and myself” — 
 
 I cut short the thanks of the worthy couple, as they 
 have nothinof to do with the understanding of the case. 
 Since the above was written, the amendment of my 
 youthful patient has been still more decisive. 
 
 CASE XVI. 
 
 CASE OF A MEDICAL GENTLEMAN WHO HAS RECOVERED BY INHALATION. 
 
 Mr. Clements, aged twenty-five, member of the 
 Royal College of Surgeons, did me the honour to solicit 
 my advice more than two years ago. I found that he 
 laboured under well-marked symptoms of consumption. 
 Since, however, they presented no peculiar features, it 
 is unnecessary to recapitulate the long list of consti- 
 tutional and physical phenomena which have been so 
 often described in the preceding pages as concomitants 
 of the disease : suffice it to say, that I have enjoyed the 
 satisfaction of seeing him recover ; and that he chiefly 
 owes his restored health to inhalation. 
 
APPENDIX. 
 
 135 
 
 CASE XVII. 
 
 PROTECTING INFLUENCE OF PARTIAL EMPHYSEMA, EXEMPLIFIED IN 
 THE LONG LIFE OF A CONSUMPTIVE PATIENT. 
 
 Martha Henderson, of Cherry Garden street, Ber- 
 mondsey, first came under my care about thirteen years 
 ago. She was at that time fifteen years of age. It 
 appeared that phthisical symptoms first supervened after 
 an attack of the small pox, which had seized her naturally 
 the year preceding. The ill health engendered by this, 
 it is probable, gave rise to the formation of tubercles in 
 the lungs. She exhibited no signs of consumption in 
 her person. Her countenance was florid, not flushed ; 
 and the emaciation usually witnessed in consumptive 
 patients was not observable. The hectic symptoms 
 were very irregular and undefined, recurring at uncertain 
 intervals, and those far distant. She was subject to 
 cough and shortness of breath, influenced by changes 
 of weather ; but the most remarkable symptom was the 
 quantity and fetor of her expectoration. It resembled 
 the matter discharged by a phlegmonous abscess, and 
 she could bring it up at will. She imagined from the 
 peculiar sensation she felt there, that it proceeded from 
 the right side of the chest ; and, in point of fact, a great 
 sympathy was discernible between the external and in- 
 ternal parts on this side. A swelling, and induration of, 
 the mamma, invariably took place whenever the matter 
 collected to any great extent within. I have alluded to 
 the fetid odour of the expectorated matter ; it was of so 
 rank and sickening a nature, that her parents, although 
 she was their favourite child, needed every excitement 
 that a sense of parental duty could give to enable them 
 to live with her. It is no exaggeration to say that it 
 contaminated the whole house, and was perceptible as 
 soon as the street door was opened. I have seen my 
 own pupils ready to vomit at the disgust it occasioned, 
 and have, used as I am to such scenes, been affected by 
 it myself When I first examined her, she exhibited 
 the following symptoms : — The sound of respiration 
 was barely audible over the right side of the chest, with 
 
136 
 
 APPENDIX, 
 
 the exception of a space, about two inches square, be- 
 tween the clavicle and the third rib, where a loud gur- 
 gling rattle was heard, caused bj the intromission of 
 air into a cavity containing a quantity of puriforni sputa. 
 A mucous and sometimes sibilous sound was occasion- 
 ally heard in some of the bronchial tubes in the inferior 
 region of the same lung. The opposite side of the 
 chest gave out an asthmatic wheezing, from the clavicle 
 downward, as far as the fourth rib. The inferior part 
 of the same side, both before and behind, yielded a dull 
 sound on percussion ; and the respiration was nearly 
 inaudible over the same region. When she spoke, I 
 could discover on the same side distinct pectoriloquism 
 in the midst of this imperfect respiration. After exami- 
 nation I recorded the following diagnosis : — “ Large 
 excavation in the superior lobe of the right lung, con- 
 taining a quantity of liquid matter ; the rest of the 
 lung on the same side tuberculated ; cavity in the 
 midrlle of the inferior lobe of the left lung, the remain- 
 der of the lobe in a state similar to the opposite ; the 
 upper lobe of the same lung emphysematous through- 
 out.” 
 
 I augured, no long period after this, that she was likely 
 to live many years ; feeling assured that the asthmatic 
 condition of the one lobe of the lung would counter- 
 balance the defects, alarming as they were, of the rest 
 of the pulmonary apparatus. I caused her to attend on 
 several occasions, when lecturing on diseases of the 
 chest, to point out the phenomenon of a person’s existing 
 so long under such ravages from consumptive disease. 
 She was seen several times at the Central Infirmary, as 
 well as the Infirmary for Diseases of the Chest ; was 
 well known to the two apothecaries of those establish- 
 ments ; and must have come under the notice of above 
 one hundred professional individuals. I was not aware 
 for some short time after her first attendance on me of 
 the value of that emphysematous state, which I now 
 recognise as the preserver of her life for so long a pe- 
 riod. Hers was at first considered by me as a remarka- 
 ble case, from the circumstance of her displaying most 
 of the external signs of health in spite of her really 
 distressing condition. Of late years, however, I have 
 learned to estimate properly this strong corroboration of 
 
APPENDIX. 137 
 
 the truth of those views, whichl have at last systematized, 
 and reduced to proof. 
 
 A singular peculiarity, connected with the history of 
 the patient, is, that from the age of fifteen to twenty- 
 two her personal appearance exhibited no change. She 
 displayed the same girlish look throughout these years ; 
 and it w^as not indeed until she had turned her twenty- 
 second year that she underwent the catemenial crisis. 
 After this, it was astonishing how quickly she acquired 
 the aspect and proportions of womanhood. She was 
 an occasional patient of mine, as I have already stated, 
 for the space of ten years ; appplying to me from time 
 to time whenever she was in London. In the course 
 of these years she experienced several severe inflamma- 
 tory attacks. The immediate cause of her death was, 
 in fact, a violent pleurisy, which seized her when on a 
 visit to some friends about forty miles from town. She 
 endured this as long as she could hold up, without taking 
 any medical advice ; and at last hastened home, and 
 sent for me. But she had delayed till too late. Her 
 tongue was thickly covered with aphthae, her lips livid, 
 her respiration so impeded as to prevent her from lying 
 down, and accompanied with extreme pain in the side : 
 her extremities were cold, and she had occasional hic- 
 cough. I saw that she was beyond the reach of medical 
 aid ; and the poor girl expired within thirty hours after 
 reaching home. 
 
 Dissection thirty-six hours after death . — The right 
 lung was adherent throughout, by ancient attachments, 
 to those parts with which (though without adhesion) it is 
 naturally in contact. The summit w^as indented, indu- 
 rated, and covered, or capped, as it were, by a fibro-car- 
 tilaginous mass. Highly condensed cellular substance, 
 of irregular thickness, and about an inch and a half in 
 length, extended itself into the lung, and gave off several 
 bonds, of the same structure, which ran in nearly a 
 horizontal direction, and gradually lost themselves in 
 the cellular membrane of the viscus. The structure 
 just described was probably formed from the cicatriza- 
 tion of ancient vomicse. In the same summit there was 
 a number of tubercles, in different stages, several of 
 them surrounded by black pulmonary matter. There 
 was a large cavity, nearly opposite the third and fourth 
 
 18 
 
138 
 
 APPENDIX, 
 
 intercostal spaces, containing a calcareous secretion of 
 the size of a peach stone ; and instead of being lined by 
 semi-cartilaginous membrane, its lining was composed 
 of laminae of the colour and consistence of old yellow 
 wax. The rest of the lung contained a multitude of gray- 
 ish tubercles, of unusually hrm consistence, and of 
 various sizes : on cutting it, a quantity of frothy serum 
 flowed out. The upper lobe of the left lung completely 
 filled the cavity of the chest on that side ; and when 
 handled, imparted a sensation different from the natural 
 crepitation, and somewhat similar to that caused by the 
 displacement of some elastic fluid. Its surface exhibited 
 several transparent vesicles, some of the size of an 
 almond, evidently dilated air-cells. The dilatation of 
 the cells over the rest of this lung was likewise remark- 
 able. On making a longitudinal section of this lobe, a 
 slight trace of cellular cicatrix was perceptible ; and two 
 of the bronchial tubes were considerably dilated from 
 their cartilaginous termination. The mucous membrane 
 of all the tubes, without appearing highly vascular, was 
 considerably thickened, and contained much yellow 
 opaque matter. The inferior lobe, on the same side, on 
 its anterior and lateral surface, w^as adherent through 
 the medium of a false membrane a quarter of an inch 
 in thickness, containing beneath it a gelatinous sub- 
 stance, transparent and almost colourless. There \vas 
 a large cavity with tubercles, similar to those presented 
 in the superior lobe of the opposite lung, but not so 
 numerous ; and marks of inflammation were exhibited in 
 various places. The above cavity, which occupied the 
 centre of the lobe, and communicated by a large open- 
 ing with another of less size, had a membranous lining 
 exactly resembling in structure that which I have 
 described as appearing in the excavation of the right 
 side. 
 
 I entertain no doubt that there existed originally a 
 cavity in the summit of the left lung, along w'ith tuber- 
 cles in a state of semi-transparency ; the latter of which 
 had been absorbed, and the former healed by the first 
 intention. 
 
appendix. 
 
 139 
 
 CASE XVIII. 
 
 CONSUMPTION WARDED OFF BY THE PRE-EXISTENCE OF ASTHMA, 
 WHICH HAD LASTED UPWARD OF TWENTY YEARS IN A FEMALE 
 WHO SUBSEQUENTLY DIED THROUGH CANCER IN THE WOMB. 
 
 Mr. Morgan, a general practitioner of Great New- 
 port street, has, on various occasions, invited me to ac- 
 company him to post mortem examinations. I have had 
 the pleasure of pointing out to him, in some of these as- 
 sociated labours, the cicatrices of cured consumption ari- 
 sing from enlargement of the volume of the lungs. In the 
 case now under consideration, extensive cancerous dis- 
 ease had destroyed a great portion of the uterus and the 
 bladder; had produced considerable induration of the 
 rectum, as well as obturation of the external iliac, with 
 a portion of the adjoining hypogastric vein on the right 
 side ; and had affected the whole of the right leg and 
 thigh in a manner similar to what is witnessed in 
 'phlegmasia dolens. Notwithstanding the ill health in- 
 duced by the continuance of cancer of the womb, with the 
 deplorable accompaniments just detailed, as well as ex- 
 hausting discharges for upward of two years, no symp- 
 tom of consumption appeared ; but the patient, at last, 
 succumbed under general effusion, the result of protract- 
 ed debility. On opening the body, I pointed out to Mr. 
 Morgan the asthmatic state of the lungs, (with cicatrices 
 on their summits,) which had acted as a preservative 
 against the ingress of that phthisical condition which, 
 without this state, would in such a case have indisputably 
 supervened. I have had opportunities of showing similar 
 cases to several respectable practitioners, and, among 
 others, to my worthy friend, Dr. Helsham. My chief 
 inducement for mentioning this case, is to impress upon 
 the medical world the high advantage of recurring, in all 
 instances of debility occasioned by long continued 
 chronic ailment, to mechanical means for preventing the 
 sure inroads of consumption, the consequence of such 
 state. Mr. Carmichael of Dublin has indeed affirmed in 
 the second edition of his excellent Avork on cancer, that he 
 never examined the body of a patient who died with 
 
140 
 
 APPENDIX. 
 
 any variety of that disease without finding the lungs 
 tuberculated. This, in the first instance, strongly cor- 
 roborates the correctness of rny opinion, that consump- 
 tion is a very common result of ill health produced by 
 any ailments of long continuance ; and, in the second, 
 it shows by negative testimony the value of those 
 means which will prevent such supervention. I have 
 no doubt that this gentleman, in the prosecution of his 
 pathological studies, will meet with cases in which the 
 utility of catarrhal and asthmatic affections in anticipa- 
 ting or arresting phthisis will be w^ell marked : and I 
 feel pleasure in adding, that from his high character, 
 and zeal for the true interests of his profession, he will, 
 in such case, I am confident, be forward to acknowledge 
 the accuracy of these observations, already verified by 
 me in numerous examinations after death. 
 
 CASE XIX. 
 
 CURE OF HEREDITARY CO^"SUMPTION. 
 
 Mr. S , a gentleman of middle age, attached to 
 
 one of the government dock-yards, applied to me more 
 than twelve months ago, after having been under the 
 care of a physician in large practice in the west end of 
 the town. He presented all the usual symptoms of con- 
 sumptive disease, and had a cavity in the summit of his 
 right lung, where was well-marked pectoriloquy. He 
 was considerably emaciated, expectorated abundantly 
 matter streaked with blood, was harassed by incessant 
 cough, and perspired profusely. His cough, which had 
 made its appearance simultaneously with the first symp- 
 toms of illness, had constantly remained unrelieved. 
 Having ascertained by auscultation that the entire of the 
 left lung, and the lower part of the right, from the third 
 rib downward, were perfectly healthy, I felt no doubt, 
 notwithstanding his reduced state and the time he had 
 been seriously ill, which was five or six months, that 
 there were firm grounds for hope. In conformity with 
 my usual plan, I advised the application of leeches, in 
 order to lessen the hectic symptoms, and mitigate the 
 
APPENDIX. 
 
 141 
 
 violence of the cough : they were applied at times be- 
 neath the clavicle, at others between the right scapula 
 and the spine. The medicines ordered were chiefly 
 diuretic and sedative. After the leeches had been em- 
 ployed a few times, and the hectic symptoms reduced, I 
 recommended him to begin inhaling, which he accord- 
 ingly commenced at the rate of 'eight or ten minutes, 
 three times a day, and extended the period by a minute 
 daily till he reached the term of half an hour. After 
 continuino* at this increased rate for a short time, he 
 complained of a feeling of soreness in his chest, possibly 
 created by it, and I advised him to lessen his term of 
 inhaling in the same manner as he had increased it, by 
 a minute each time, until he gradually dropped down to 
 the ten minutes with which he had original! v begun. I 
 may observe that this course of alternate increase and 
 decrease is often advised by me, with the best results. 
 In about four months after consulting me he had become 
 quite an altered man. During this time his health had 
 occasionally fluctuated, the hectic and other unfavourable 
 symptoms recurring : being, however, always promptly 
 met, they produced only slight interruptions to the steady 
 course of his amendment. These alternations, indeed, 
 must generally be expected ; and the occasional returns 
 of hectic fever are sometimes owing, I conceive, to the 
 softening of tubercles which have reached, or are nearly 
 arrived at a state of maturity when the patient'^iSm- 
 mences inhaling, and Vv^hich, forcing their way into some 
 of the bronchial branches, produce an irritation with 
 which the constitution sympathizes. 
 
 It is now a year since I first prescribed for this patient. 
 On last exploring his chest, I could not discover the 
 slightest sign indicative of the presence of the cavity I 
 have spoken of above : there was a slight indistinctness 
 of the respiratory murmur perceptible in the summit of 
 the right lung, but no remains whatever of pectorilo- 
 quism. 
 
 The above is a case of hereditary consumption ; and 
 several of this patient’s brothers and sisters have fallen 
 victims to the disease. He is now actually in the enjoy- 
 ment of better health than he remembers his ever pos- 
 sessing ; and is perfectly competent to the active dis- 
 charge of business. 
 
142 
 
 APPENDIX. 
 
 I may conveniently place under the same head seve- 
 ral other cases of the cure of hereditary consumption ; 
 and I adduce them as so many proofs that the possibility 
 of the cure of consumption in this, its worst form, does 
 not depend upon an isolated, or fortuitous instance, but 
 has been effected in various patients of both sexes and of 
 different ages. I do not propose entering into any par- 
 ticular detail of the progress of the complaint in the re- 
 spective cases, but shall cite them as facts that may easily 
 be ascertained by any of my readers. 
 
 A young gentleman, grandson of a late celebrated 
 financier and member of parliament, whose theory of 
 rent is w^ell known to the political economist, was 
 brought to consult me about a year and a half since. 
 His family were in the greatest alarm respecting him, as 
 a sister of his had died not long before, who had pre- 
 sented symptoms precisely similar to those he was then 
 labouring under. Such was their alarm, and their ner- 
 vous apprehension of having his fears excited, that they 
 begged me, if possible, to examine his chest in an appa- 
 rently unconscious manner, as if going through a mere 
 matter of form, so as to avoid awakening suspicion in his 
 mind of his real state. This» youth, who is now about 
 eighteen years of age, is quite well. 
 
 Miss G , whose father is a fashionable ladies’ shoe- 
 
 maker in Soho-square, had been deprived of her mother 
 by consumptive disease, and had likewise lost a brother 
 and a sister by the same scourge, all three within the two 
 years previous to her consulting me. When she applied 
 to me, this young lady was in a most enfeebled state, and 
 could hardly walk a dozen yards. Passing over other 
 symptoms, it is sufficient to say that I ascertained the 
 existence of a cavity in the summit of the right lung. 
 Miss G. is, at the time I now write, in the enjoyment of 
 excellent health. 
 
 Mr. M., a gentleman well known in one of our large 
 manufacturing districts, came to town to consult me, 
 about a year ago. His case had been pronounced despe- 
 rate by tile most eminent medical man of the city in which 
 he resides ; and indeed, there was a cavity in his left lung 
 so extensive as almost to preclude hope. He w^as daily 
 visited by me for about two months, and remained in 
 town until the constitutional symptoms were removed. 
 
APPENDIX. 
 
 143 
 
 Returning to the country, he continued a regular course 
 of inhalation. Five months afterward he revisited Lon- 
 don, and I begged him to have the kindness to call on 
 Dr. Waller, lecturer on midwifery, who had then a deep 
 interest in whatever related to consumptive disease, in 
 order to let him hear the history and examine into the 
 state of the case. The cavity was not then entirely 
 healed up ; but its size had been reduced by one half, 
 and Mr. M. was so far restored as to be able to attend to 
 the business of his factory. My last accounts from him 
 are of the most favourable nature. 
 
 This gentleman, I must state, has lost a mother and 
 sister through consumption. 
 
 Some short time since Messrs. Maw, the celebrated 
 surgical instrument makers, put a domestic of theirs under 
 my care who was labouring under far advanced phthisis. 
 I received the subjoined letter from them the other day, 
 in which her present state of health is satisfactorily 
 alluded to. 
 
 ‘‘ The bearer of this, W. B , a young man 
 
 in our employ, seems much in the same state as the fe- 
 male servant of ours whom you kindly attended a few 
 months since, and who, we have the pleasure to inform 
 you, is now enjoying a good state of health. As he is 
 not able to pay for medical advice, we enclose a fee, and 
 shall feel obliged by your kind attention to him. 
 
 “We remain your obedient servants, 
 
 “ J. & S. Maw. 
 
 “11 Aldersgate-street, May 25, 1836.” 
 
 CASE XX. 
 
 CONSUMPTIVE DISEASE SUPERVENING ON DYSPEPSIA. 
 
 Mr. C , a highly respectable tradesman, resident 
 
 at Brighton, naturally of delicate constitution, fell into a 
 most distressing state of health through long protracted 
 dyspeptic disease. The consequences of this debilitated 
 
144 
 
 APPENDIX. 
 
 condition manifested themselves in the expectoration of 
 muco purulent matter, often streaked with blood ; in 
 harassing cough ; in night sweats ; in gradual and almost 
 complete prostration of bodily strength ; and in fine — 
 in confirmed consumption. To so alarming a state was 
 he reduced that the prayers of the congregation had been 
 publicly requested in his behalf in the church which he 
 attended. When he had himself conveyed to town to 
 consult me, he was, as may be supposed from the above 
 account, apparently a complete wreck. On exploring the 
 state of his chest, I ascertained the existence of a well- 
 marked cavity in the summit of the right lung ; in that 
 of the left the respiratory murmur was highly obscure. 
 It is unnecessary to detail the varying symptoms that pre- 
 sented themselves, and the treatment by wdiich they 
 were met; as this w^ould be a mere recapitulation of 
 much that has gone before. During the time that he 
 remained in town under my care he suffered several 
 temporary relapses from the softening down of the tuber- 
 culous deposites previously formed, and underwent all the 
 fluctuations common to the most trying symptoms of 
 consumptive disease. These constitutional symptoms had, 
 of course, to be treated as they arose, at times by anti- 
 phlogistics, at others by sedatives, and occasionally by 
 tonics. At the proper juncture he commenced inhala- 
 tion ; and here I must again insist upon a point to which 
 I have several times adverted in the course of this 
 work, that although inhalation is of vital consequence in 
 the cure of phthisis, yet it is likewise essential that the 
 constantly changing constitutional symptoms be treated 
 as they occur by the proper remedial measures. Hence 
 the necessity for the watchful superintendence of the 
 physician skilled in all the minutise of consumptive dis- 
 ease, to counteract the ingression of every unfavourable 
 symptom, to take advantage of every circumstance cal- 
 culated to forward recovery, and to regulate the treat- 
 ment, medical and dietetic, according to the emergency. 
 
 No case that ever came under my care has afforded 
 more satisfactory proof of the remedial powders of inhala- 
 tion, combined with proper constitutional treatment, than 
 the present. The patient was naturally delicate, had 
 had his health so impaired by indigestion as to pass into 
 
APPENDIX. 
 
 14o 
 
 a phthisical state, which, becoming confirmed, had 
 brought him to the brink of the grave, and — he is now 
 well. Conscientiously can I affirm, and I do it from no 
 impulse of vanity, (for there is too much yet to be learn- 
 ed for any right-thinking physician to feel vain,) that 
 death must have been the result under any other system 
 than mine. 
 
 CASE XXI. 
 
 IXEFFICACY OF REMOVAL TO A WARM CLIMATE. 
 
 Mr. a., a deputy alderman of one of the city wards, 
 was recommended to consult me, in the spring of 1835, 
 by Alderman Harmer. He had but lately returned from 
 Italy, whither he had been recommended to repair for 
 the benefit of his health by his former medical adviser, 
 who was an assistant physician to one of our London 
 hospitals. This advice had been given after the ascer- 
 taining the existence of a cavity in the summit of the 
 right lung, and the presence of a very slight catarrh. It 
 was well meant, but was attended by the usual nuga- 
 tory or worse than nugatory results, since during a resi- 
 dence of some months his complaint got worse rather 
 than better. Singularly enough, he first heard my name 
 mentioned abroad, and the recommendation he there 
 received to apply to me was supported, as I have 
 just stated, on his return to England, by Alderman Har- 
 mer. On exploring his chest, I found the cavity above 
 mentioned still existing, and that the summit of his left 
 lung likewise was in an unsatisfactory state. His ca- 
 tarrh had yielded to the influence of a warm climate, 
 and the interposition of nature in his behalf had thus 
 been entirely superseded. His deterioration had of 
 course been sensible to himself, but he was not a little 
 surprised to be told that the only safeguard, artificial 
 means excepted, which he could possess against the in- 
 roads of consumption, was the catarrh on whose removal 
 he had congratulated himself It recurred not long after 
 his return ; but since, as I have already had occasion to 
 observe, the expansion of the pulmonary tissue necessary 
 to heal up a cavity is much more agreeably and equally 
 
 19 
 
146 
 
 APPENDIX. 
 
 effected by inhalation, I of course would not trust to the 
 dilatory results of a catarrhal cure, and ordered immedi- 
 ate recourse to the above mechanical process. The 
 constitutional symptoms have presented the usual varia- 
 tions in the course of this gentleman’s attendance, and 
 some time back, finding himself much better, he was 
 tempted to comply with a call upon him for a song at 
 some civic festival, and a hemorrhage was the result. 
 About three months ago he had an attack of what now 
 goes under the appellation of influenza, and I seized the 
 opportunity of once more examining his chest. The 
 cavity had nearly disappeared, and the state of the rest 
 of the thorax was in the highest degree satisfactory. 
 This favourable result was for the most part owing to 
 his steady perseverance in inhalation ; since, with this 
 exception, he has been a very careless patient, negligent 
 of himself, and seldom letting me see him ; a circum- 
 stance originating, perhaps, in his acquaintance with a 
 clergyman who cured himself by the use of this means 
 alone. However, this is an unsafe example, since con- 
 stitutional symptoms will often arise to call for the im- 
 mediate, though temporary, suspension of inhalation. 
 
 I may here observe that notwithstanding the super- 
 vention of catarrh on phthisis is the mode by which 
 nature endeavours, and often does effect a cure, still it 
 is so far imperfect in its operation, inasmuch as it substi- 
 tutes for the consumptive state a difficulty of breathing 
 which often terminates in confirmed asthma. Hence the 
 superiority of inhalation, which both acts more efliciently 
 and entails no troublesome consequence. Hence too, 
 although catarrh have set in so as to afford the benefit 
 of its protection to a consumptive patient, I at once 
 order recurrence to inhalation, not onlv for the beneficial 
 agency it exerts in phthisis itself, but as a means of 
 curing the catarrh. Its influence over the last is partly 
 owing to the completeness it gives to the expirations. In 
 catarrh the air is imprisoned, as it were, in the air-cells, 
 and embarrassed breathing is the result. Inhalation here 
 steps in as an auxiliary, and not only renders the expi- 
 rations more perfect, but contributes in other respects to 
 the removal of the catarrh. 
 
 Another benefit of inhalation, and this is a physical 
 fact no less novel than important, is the security it affords 
 
APPENDIX, 
 
 147 
 
 against the ingression of pleurisies, so frequent, accord- 
 ing to the testimony of Laennec, in the consumptive. 
 The same exemption from pleurisy is observable in the 
 asthmatic. 
 
 Again, if from any cause there exist empyema, or a 
 collection of matter, in one side of the chest, (even for 
 months,) a state in which the lung of this side is com- 
 pressed, the lung of the other side undergoes increased 
 expansion. Now the lung thus expanded, if previously 
 healthy, never becomes the seat of tuberculous deposite. 
 I have verified this in several instances ; and this is a 
 strong collateral proof of the inestimable value of inha- 
 lation. 
 
 To return to the “ inefficacy of removal to a warm 
 climate.” I have never known a cavity healed by a 
 residence in a southern clime, though I have known 
 many a consumptive case fatally confirmed by it. Three 
 times did an officer in the army to my knowledge try a 
 residence in Madeira : the voyages certainly did him tem- 
 porary good, but he ultimately returned with the deadly 
 enemy in his bosom — the cavity — as distinctly marked 
 as ever. 
 
 To the above cases, which bear a slight proportion 
 indeed to the number I have at this moment lying on the 
 table before me, detailed as well by the thankful patients 
 themselves as minuted by me, I append two letters from 
 medical gentlemen illustrative of the happy results of 
 pulmonary expansion. The first of these stands in need 
 of no other explanation than my observing that the 
 writer has omitted, that, on exploration of the chest, the 
 physical signs of consumption were distinctly marked. 
 Mr. Graves, the brother-in-law of my patient, who en- 
 joys an extensive practice in the east end of the town, 
 and has been long accustomed to auscultative examina- 
 tion, fully concurred with me in the opinion I expressed 
 of the existence of cavities and entered into my views 
 as to the plan of treatment I had laid down. 
 
 “Dear Sir, 
 
 “ In compliance with your request, I beg to give 
 you the following statement relative to my health : — 
 
 “ In the winter of 1832 I was troubled with a cough, 
 after which my health continued indifferent, and in the 
 
APPENDIX. 
 
 148 
 
 month of May last I had a violent attack of pain in mj 
 chest, for which a blister was applied and medicine 
 taken, apparently with great effect ; but in about eight 
 days the pain returned with increased severity. After 
 being twice bled copiously from the arm, and the local 
 application of leeches and a blister, the pain was allayed 
 so as to allow of free respiration. I was now, of course, 
 extremely weak. In about four weeks the pain again 
 returned in my chest. Leeches and blisters were re- 
 peatedly applied, without effecting its removal, and al- 
 though the general state of my health was of course 
 attended to, my strength of body soon so much decreased 
 that it was thought I should not recover. Under these 
 circumstances, I applied to yourself in July, and am 
 happy to say that under your skilful treatment I soon 
 began to amend, and that for the last two or three months 
 I have entirely left off taking medicine, being now stout- 
 er and stronger than before the commencement of my 
 illness in 1832. I have been for some time without any 
 cough. 
 
 “Hoping these particulars may be useful to you, be- 
 lieve me to be, dear sir, 
 
 “Your much obliged, humble servant, 
 
 “Charles Rose. 
 
 “24 Beaumont-square, Feb. 5, 1834.” 
 
 It affords me much pleasure to state that this gentle- 
 man is in the enjoyment of excellent health. 
 
 The following is from a gentleman of the name of 
 Langley, a general practitioner, and, as will be seen, a 
 former patient of mine : — 
 
 “ Dear Sir, 
 
 “ The bearer appears to me to have incipient 
 phthisis, and has been suffering from an indomitable 
 cough, with dyspnoea and nocturnal perspirations. I 
 have taken blood from him, used counter-irritants very 
 freely, and attempted to abate the pulmonary irritation 
 by sedatives, combined with ipecacuanha and nitre. His 
 ill state of health has reduced him so much in circum- 
 stances that he approaches you as a gratuitous patient 
 
APPENDIX. 
 
 149 
 
 Any suggestion you may be kind enough to advise shall 
 be strictly attended to. Under your direction I have 
 myself recovered my health, and 'svith many thanks for 
 your kindness, I remain, dear sir, 
 
 Very faithfully yours, 
 
 “John Langley. 
 
 “ 36 Tottenham-street, Fitzroy-square.” 
 
 It has so happened, that 'within the last three years 
 I have had several cases of consumption in medical 
 men, under my care, and in nearly every instance the 
 result has proved satisfactory. 
 
 I subjoin to the above testimonies to the value of in- 
 halation the following letter from a professional friend 
 of mine, whose abilities need no encomium from me, 
 and who is very generally known among his brethren 
 from the circumstance of his having been secretary to 
 the Medical Society of St. Bartholomew’s Hospital some 
 years since. The gratification I experienced in receiving 
 so powerful a corroboration of my opinions from so 
 excellent a judge was enhanced by its having been 
 entirely unexpected. Several years had elapsed since, 
 through business, and the every day cares of life, our 
 correspondence had ceased. To have it renewed was 
 in itself a pleasure, which was doubled by the manner 
 of the renewal. I shall not apologize for inserting re- 
 marks so favourable to myself. The writer is too inde- 
 pendent to have written any other than his conscientious 
 opinion ; and I have not the false pride which would 
 conceal praise when praise is honourable. His residence 
 on a part of the coast to which consumptive patients 
 are frequently sent has given Mr. Bowden peculiar op- 
 portunities of studying the nature of phthisis. I feel 
 that he is well qualified to pronounce a judgment on 
 any mode of treating the disease which may be pro- 
 pounded, and am grateful for the manly liberality with 
 which he has come forward. There are many reasons 
 for the opposition to my views which, I know, exist 
 among many of my medical brethren : disinclination to 
 unlearn is, perhaps, among the chief Were it the only 
 one, I should not step out of the way to notice it. I 
 should be well contented to undergo what Harvey, Syden- 
 
150 
 
 APPENDIX. 
 
 ham, and J enner have undergone before me. The thought 
 of the future would indemnify me for any temporary 
 annoyance, and I should anchor my hopes upon the 
 indisputable axiom, Magna est veritas et prcevalehit — 
 but unworthier motives have been at work. I was one 
 of the first, if not the first, to point out the deficiencies 
 of the medical education of the day ; and had my sug- 
 gestions been attended to, many M. D.’s might have 
 been spared the pain of their confessions before the 
 medical committee lately sitting at Westminister. 
 
 **Dawlish, Devon.j June 20th, 1834. 
 
 “My Dear Doctor, 
 
 “ I have just purchased and read your book on 
 consumption with much gratification. I perfectly coin- 
 cide with your views, in every particular, and am sat- 
 isfied of their accuracy. It is, perhaps, paying myself 
 a compliment at the expense of my professional breth- 
 ren to say, that I have, ever since I had the pleasure of 
 knowing your sentiments, differed from them as much 
 as you do. With regard to their treatment of that plague- 
 spot in the English constitution — consumption — it has 
 ever appeared to me founded on false principles, or 
 dictated by the hereditary prejudices of our profession : 
 of you they are particularly jealous, and would gladly 
 rob you of your dearly earned knowledge and fame. I 
 call it dearly earned, for I remember the many unpleasant 
 situations we have been placed in, among the haunts 
 of London disease and misery, particularly in the pur- 
 lieus of Saffron hill. I must say honestly, and without 
 flattery, that I never knew one of your profession who 
 laboured so zealously, and constantly, as you did in 
 post mortem examinations ; or who was so thoroughly 
 conversant with morbid appearances, and their anatom- 
 ical detail and minutise. i have myself experienced the 
 accuracy of your observations in the persons of several 
 of my own patients ; and so nearly have our ideas coin- 
 cided that I have been in the habit of making my patients 
 inhale through an (Esophagus tube, to oblige them to 
 inspire deeply. I am quite certain I have cured two 
 cases of tubercular phthisis by your means. 
 
 “Very sincerely and truly yours, 
 
 “R. B. Bowden.” 
 
APPENDIX. 
 
 151 
 
 It is about twelve months ago that Mr. Ward, a gen- 
 tleman practising in the vicinity of London, took my 
 advice for consumptive disease, at the suggestion of Dr. 
 James Blundell. I detected a well-marked excavation 
 in the summit of the right lung, and was informed by 
 him that he had had several attacks of hemoptysis. 
 Without entering into any details, which indeed would 
 present no novelty either respecting symptoms, or my 
 usual practice, I at once give the satisfactory result, 
 which is — restoration to health. I shall conclude these 
 instances of cure among my medical brethren by ad- 
 ducing the name of Mr. Paine, son of the ingenious 
 inventor of the illuminated dials now becoming common 
 in our churches, who consulted me about three years 
 since, and has been enabled to resume his profession, 
 which he had then abandoned as beyond his failing 
 strength. 
 
 CASES GIVEN BY DR. HOHNBAUM IN THE PREFACE TO HIS 
 TRANSLATION OF ‘‘ CONSUMPTION CURABLE.” 
 
 Case 1. A female, 36 years of age, of weak and 
 sickly constitution, skin white and of delicate texture, 
 neck long and slender, chest confined, complexion very 
 pale, habitual stoop, had suffered in childhood from scro- 
 fula, the glands of the neck having frequently suppurated. 
 Her father is living, but has laboured from a boy under 
 disease of the chest, and has often appeared to be sink- 
 ing into a decline. Some years after her marriage, she 
 lost all the outward signs of scrofula, but became subject 
 to an occasional dry cough, which would disappear after 
 a time. In 1833, anxiety, occasioned by the illness of 
 her only child, brought on a return of this cough, which, 
 however, did not leave her as usual, but seemed to in- 
 crease constantly, and awakened much apprehension. 
 The patient was greatly dejected at this, despaired of re- 
 covery, lost sleep and appetite, fell away in flesh, and 
 
152 
 
 APPENDIX. 
 
 complained of such extreme weakness as to be hardly 
 able to leave her bed. The coughing continued to in- 
 crease, and was particularly harassing in the evening, 
 during the night, and on awaking. At first there was 
 no expectoration ; but afterward she brought up a little 
 phlegm the first thing in the morning. The cough was 
 accompanied by pain in the chest, and occasional 
 twitches ; her breathing was short, especially when going 
 up stairs, and was considerably affected by every bodily 
 exertion, however slight. The pulse gave no indications 
 of actual fever ; but the patient complained of frequent 
 shiverings, with burning hands, and morning perspira- 
 tions. Her whole appearance answered to the commence- 
 ment of phthisis scrofulosa. 
 
 Having continued in this precarious condition for a 
 year, reckoning from the first manifestation of the 
 cough ; having been under the care of two physicians, 
 without deriving any benefit ; and having tried a variety 
 of medicines to no purpose, I recommended the system 
 of inhaling, advocated by Doctor Rarnadge. Following 
 exactly the rules laid down in his work, I ordered her to 
 inhale the vapour from an infusion of hops in vinegar 
 twice a day, for a quarter of an hour each time. This 
 period was subsequently extended to half an hour. 
 
 The patient had scarcely tried this method for a 
 week, to the exclusion of all others, when her sleep be- 
 came sounder, and her cough seemed less frequent. In 
 the course of another week it was perceptibly less so ; 
 and the expectoration had diminished. Her respiration 
 gradually became more free and deep, she gained flesh 
 and strength, the perspirations left her, her appetite re- 
 turned, she recovered her serenity of mind, and, in short, 
 rapidly approached a state of convalescence. 
 
 At the present time, she has used inhalation con- 
 stantly for three months ; the expectoration has entirely 
 ceased; the cough too has almost left her, being so 
 slight as to be scarcely deserving of notice. The patient 
 has returned to her household duties, and, in favourable 
 weather, walks daily in the open air ; in fact, with the 
 exception of a little weakness and irritability, which, 
 however, were always peculiar to her, she is in perfect 
 health. Still, for security’s sake, I have advised her to 
 continue inhaling. 
 
API^ENDIX. 
 
 153 - 
 
 Case IL A female, 21 years of age, healthy from 
 childhood, but of consumptive make — that is, neck long, 
 chest narrow and compressed, skin white and delicate, 
 with rosy transparent cheeks, and light brown hair, eye- 
 brows, and eye-lashes — contracted, about fifteen months 
 since, a dry, obstinate cough ; in all probability, while 
 heated by excessive dancing. It was accompanied by a 
 pain in the chest ; but was entirely disregarded by her, 
 until she began to expectorate, at times, about half a cup 
 full of bright red, frothy blood. This sanguineous ex- 
 pectoration was removed by appropriate medicine ; and, 
 in the course of the following summer, the cough, like- 
 wise, was partially subdued. 
 
 I was called in to see her, in the autumn of this year, 
 aggravation of the above symptoms having taken place, 
 and found her in the following condition : her rosy com- 
 plexion gone ; pallid, much emaciated, strength greatly 
 impaired ; chest contracted and sinking in, respiration 
 quick and short, a rattle during each inspiration, particu- 
 larly marked in the right lung, where a cavernous sound 
 was yielded on percussion ; a sense of pain in the same 
 spot with occasional twitchings over the chest ; frequent 
 cough, partly dry, and in part accompanied by a yel- 
 lowish green expectoration, which, in the course of the 
 four and twenty hours, might have filled a good sized 
 cup. Her appetite was small, sleep short and interrupt- 
 ed by frequent cough, pulse quick ; toward morning she 
 fell into profuse perspirations, and fits of shivering at 
 noon, and toward evening there came on a dry, burning 
 heat, with hot hands, flushing of one cheek in particular, 
 and extreme thirst ; there was oedema of both feet, and 
 menstruation had ceased for three months. 
 
 Under these circumstances, I ordered eight leeches to 
 be applied to the right side of the chest : but no relief 
 being afforded to the painful sensations there, I had six 
 ounces of blood taken from the right arm a few days 
 after. At the same time, the patient commenced in- 
 haling, taking no medicine, but observing a suitable 
 regimen. The progress of the patient soon convinced 
 me of the good effect of this method ; and she herself 
 was much cheered by her sleep being sounder and less 
 broken by coughing. This amendment continued unin- 
 terruptedly, so that in the space of six weeks the cough 
 
 20 
 
154 
 
 APPENDIX. 
 
 and expectoration had decreased to such an extent that 
 the latter amounted in the four and twenty hours to no 
 more than about half a table-spoonful. At the same 
 time, the pain in the chest had disappeared, the rattle 
 spoken of above was no longer audible, the perspira- 
 tions, shiverings, and swelling of the feet had left her, 
 her appetite had returned ; and what with the refreshing 
 nature of her sleep, the increase of her strength, and the 
 amendment in her respiration, the patient was so much 
 recovered as to be able to take half an hours walk every 
 day in the open air. Still the sensation of heat toward 
 evening, the flushing of the one cheek, the* frequent 
 pulse, and the fact of the patient’s not increasing visibly 
 in bulk, overcast the prospect of perfect recovery. 
 
 After these favourable symptoms had lasted about a 
 week, the patient was persuaded to take a ride with a 
 friend when it blew a cold east wind. The consequence 
 was that in the evening of this day she was sensible of 
 cold in the head, hoarseness, pain in the throat, and in- 
 creased cough. Relying on the happy results which 
 Dr. Ramadge has observed to attend the supervention 
 of catarrh, I ordered the inhalation to be discontinued, 
 and patiently awaited the issue. But I was soon con- 
 scious of the disappointment of my hopes ; for notwith- 
 standing the patient got rid in a few days of the cold in 
 the head, the hoarseness, and the pain in the throat, yet 
 the earlier symptom of pain in the chest returned with 
 more than its former violence. She now also felt a 
 pain in the left side, in the neighbourhood of the fourth 
 rib ; her respiration grew shorter, her cough became 
 worse, the expectoration increased to its first amount, 
 the nightly perspirations returned, the feet swelled, and 
 altogether her state of health was worse than it had 
 been when I first saw her. 
 
 I now recurred to the inhalation ; and again the re- 
 sults were so favourable that the cough and expectora- 
 tion decreased, but not to the degree that had taken place 
 previously to the relapse. 
 
 The unfavourable symptoms before described again 
 made their appearance, and the patient soon afterward 
 died in a violent fit of suffocation. 
 
 Although it is doubtful whether inhalation would have 
 effected a cure in this case, in which pulmonary con- 
 
APPENDIX. 
 
 155 
 
 sumption had already made such considerable progress, 
 I can scarcely doubt that it would have proved success- 
 ful had it been adopted at an earlier stage. The patient 
 ■was loud in her praise of its beneficial effects, and I have 
 no reason to dissent from her, as I am firmly persuaded 
 that I should not have affected more, but most probably 
 much less with other remedies. 
 
 It was discovered by dissection that the immediate 
 cause of death was rather effusion within the cavity of 
 the chest than extensive suppuration. 
 
 There is one point in the above case which requires 
 notice. Dr. Hohnbaum was correct in his general prin- 
 ciple when he concluded that the ingression of catarrh 
 on phthisis was a favourable symptom, but wrong in its 
 application to this particular instance. The disease 
 was so far advanced that he should not have intermitted 
 the inhalation, and trusted, as he did, to the beneficial 
 influence of the catarrh solely. Indeed, as I have 
 already observed, the process of inhalation will not only 
 effect thoroughly what nature, by means of catarrh, too 
 often brings about imperfectly, but will obviate the 
 emphysematous state which is entailed by the catarrh. 
 
 The following letter has this moment reached me. 
 It is in every way too gratifying for rne to hesitate to 
 publish it. By so doing I shall best fulfil the writer’s 
 intention, and shall be enabled to prove to the most 
 skeptical the positive powers of inhalation. The 
 hypercritical may refuse to admit assertions as to the 
 changes which pass inside the chest, but can hardly 
 withhold credence from those proved by measurement 
 to take place outside. 
 
 Tenby, 26th Oct. 1834. 
 
 Dear Sir, 
 
 I trust you will be pleased to hear of the suc- 
 cess of a course of six months’ inhalation in my case. 
 
 In order to bring to your recollection the circumstances 
 under which I waited upon you for advice, I beg to re- 
 fer you to your note book, in v/hich, if I recollect aright, 
 
156 
 
 APPENDIX. 
 
 you will find the 29th of last March specified as the 
 date of my first visit. But as you may have kept no 
 memorandum, I may remind you that mine was a case 
 of sinking in of the sternum so as to press on the right 
 ventricle of the heart ; you likewise described the arch 
 as being under compression, and the ribs fixed. The 
 attendant symptoms I need not detail. 
 
 I commenced inhaling on the 30th of March. You 
 directed me to inhale three times a day ; but being under 
 great suffering at night when I assumed a reclining pos- 
 ture, I thought it desirable to inhale four times daily, 
 which I followed up for the first four months. Finding 
 myself greatly relieved at the expiration of this period, 
 I have inhaled for the last two months only three times 
 a day. It was not until the 22nd of April that I could 
 manage to inhale continuously half an hour at a time ; 
 and on that day my girth was taken immediately under 
 the nipples of the breast by Mr. Shaw, our medical at- 
 tendant. 
 
 May 22d, Increase the 1st month, five-eighths of an inch. 
 June 22d, 
 
 July 22d, 
 
 Aug. 22d, 
 
 Sept. 22d, 
 
 Oct. 22, 
 
 Whole increase, two and a half inches. 
 
 a 
 
 2d “ 
 
 three-eighths 
 
 i( 
 
 3d “ 
 
 one-half 
 
 a 
 
 4th “ 
 
 three-eighths 
 
 u 
 
 5th “ 
 
 one-fourth 
 
 u 
 
 6 th “ 
 
 three-eighths 
 
 In the first measurement my girth was two feet ten 
 and a half inches. 
 
 October 22d it was three feet and one inch. 
 
 In June I took six inspirations and six expirations 
 per minute while inhaling. In August I took only five 
 inspirations and five expirations during the same time. 
 This month I have taken only five inspirations and four 
 expirations or the reverse — showing, I presume, the in- 
 creased volume of the lungs. 
 
 This increase is, I think, great at my time of life, as 
 I am forty-six years of age. The benefit I have derived 
 is necessarily very great. My ribs, judging from the 
 heaving of my breast when I breathe, have, I should 
 conclude, come into tolerable play. My lungs are 
 amazingly strengthened : I can now sing at the very 
 
APPENDIX. 
 
 157 
 
 top of my voice, but not long together. I sleep in gen- 
 eral well, but I am not able to lie on my left side. The 
 sinking of the sternum, however, remains exactly the 
 same, and occasionally my pulse intermits — generally 
 whenever I stoop to do any thing. Nevertheless, I can 
 walk at a great rate without inconvenience, and do walk 
 from three to five miles every day. I have gained con- 
 siderable fiesh, and my appetite is always good. 
 
 I do not hesitate to say that I think inhaling has done 
 me more good than all the Uue pills I ever took for 
 bilious attacks. 
 
 If this communication will tend to illustrate any point 
 of practice, you are quite at liberty to use my name and 
 reference. 
 
 I am happy also to inform you that Mr. Shaw has 
 made a cure of consumption in this neighbourhood by 
 following your system. I visited the individual when 
 he was thought to be in a dying state, and he is now 
 about pursuing his usual avocations. 
 
 I remain, dear Sir, 
 
 Your obliged, 
 
 J. Greaves. 
 
 The following statement is copied from the Royal Kalender, and 
 Court and City Register for England, Scotland, Ireland, and the 
 Colonies, for the Year 1839. 
 
 Infirmary for Asthma^ Consumption, and other Diseases of the Lungs, 
 10 Artillery-street, Bishopsgate, 
 
 President, Duke of Sussex. 
 
 Vice Presidents, Marquis Camden, Marquis of Hertfrod, 
 Marquis of Anglesey, Earl of Ripon, Lord Calthorpe, 
 Lord Ellenborough. 
 
 Treasurer, 
 
 Physicians, F. H. Ramadge, M. D., Thos. Davies, M. D. 
 Apothecary, Mr. William Herring. 
 
 Honorary Sec., Samuel Amory, Esq. 
 
 Assist. Sec. and Collector, Mr. Wm. Eddrup, 51 Houndsditch. 
 Matron, Mrs. Jane Hine. 
 
The following explanations of some of the medical terms 
 
 EMPLOYED IN THIS WORK MAY BE OF USE TO THE GENERAL READER. 
 
 Abscess, — A cavity containing purulent matter produced by suppuration. 
 
 Aorta, — The great artery of the body which arises from the left ven- 
 tricle of the heart, forms a curvature in the chest, and descends into 
 the abdomen. 
 
 Anfractuous, — Winding, full of windings and turnings. 
 
 Aphony, — A loss of voice, 
 
 Amenorrhcea, — Suppression of the menses. 
 
 Arteries, — Vessels originating from the heart. By their means the 
 blood is carried to every part of tbe body for nutrition, &c. The 
 action of the arteries, called the pulse, corresponds to that of the 
 heart. 
 
 Arterial, — Belonging to the arteries. 
 
 Auricles, — Those portions of the heart that receive the blood from the 
 veins. 
 
 Autopsis, — An examination after death, post mortem. 
 
 Aspera arteria, — The trachea, or windpipe. 
 
 Astringent, — Binding, contracting, opposed to laxative. 
 
 Auscultation, — A method of distinguishing diseases, particularly in the 
 thorax, by observing the sounds in the part, generally by means of a 
 tube applied to the surface. 
 
 Bronchii, — The ramifications of the trachea. 
 
 Bronchial, — Belonging to the bronchia, or ramifications of the wind- 
 pipe in the lungs. 
 
 Calcareous, — Containing lime. 
 
 Cava , — Hollow. 
 
 Catarrh, — A deduction of mucus from the membranes of the nose, 
 fauces, and bronchiae • 
 
 Cervix, — Neck. 
 
 Cartilage, — Gristle, a smooth, solid, elastic substance, softer than bone. 
 
 Colliquative, — Wasting, indicating a morbid discharge of animal fiuids. 
 
 Cellular, — Consisting of cells, or containing cells. 
 
 Cicatrize , — To heal or be healed, to skin over by a scar. 
 
 Coalesce , — To grow together, to unite, as separate bodies. 
 
 Collapse , — A falling, sinking, a low and feeble condition. 
 
 Congestion , — A collection of fluids in an animal body, an accumulation 
 of blood in a part. 
 
 Conjunctiva, — The exterior covering of the eye, and inner parts of 
 the eyelids. 
 
 Cuticle, — The scarf skin. 
 
 Clavicula, — The clavicle, or collar bone. 
 
 Clavicles , — The collar bones. 
 
 Dyspnoea, — Difficulty of breathing. 
 
 Demulcent, — Softening, mollifying, mucilaginous. 
 
 Depletion, — The act of diminishing the quantity of blood, usually by 
 the lancet. 
 
 Diaphragm, — The muscular partition between the chest and abdomen. 
 
 Dilatation, — The act of expanding, expansion. 
 
EXPLANATION OF MEDICAL TERMS. 159 
 
 Diagnostic, — The sign or symptom by which a disease is known or 
 distinguished from others. 
 
 Effusions, — Fluids generally colourless secreted into cavities where 
 they do not belong. 
 
 Eliminations, — Animal products thrown off or expelled from the system. 
 
 Emphysema, — A distention of cells in any part of the body, particu- 
 larly the lungs, by air or gas. 
 
 Epispastics, — Blisters. 
 
 Encysted, — Enclosed in a body, bladder or vesicle. 
 
 Eschar ^ — ^The crust or scab occasioned by burns or caustic applica- 
 tions. 
 
 Febrile^ — Feverish. 
 
 Fibre , — A fine slender body or thread which is a constituent part of 
 muscles. 
 
 Fistula, — A deep narrow ulcer. 
 
 Gland,— A soft body formed by the union of a great number of vessels 
 for the production of the various animal secretions. 
 
 Granule, — A grain, a small particle. 
 
 Generic, — Pertaining to a genus or kind. 
 
 Gelatinous, — Resembling jelly. 
 
 Gangrene, — The first stage of mortification. 
 
 Hemoptesis, — A spitting of blood. 
 
 Hepatization, — A consolidation, as when the lungs assume a consoli. 
 dated form like liver. 
 
 Hypertrophy, — A morbid increase in the size and weight of any organ, 
 as the heart. 
 
 Induration, — The act of hardening. 
 
 Interstitial, — Implying spaces between the constituent parts of any 
 organ. 
 
 Infiltration , — A passing of liquids into portions of the body where they 
 do not belong. 
 
 Lamina, — Scales or plates. It is used to express the foliated structure 
 of bones or other organs. 
 
 Lamellar, — Disposed in thin plates or scales. 
 
 Larynx, — The upper part of the windpipe. 
 
 Laryngeal , — Pertaining to the larynx. 
 
 Lobe, — A part or division of the lungs. 
 
 Lymphatics, — Vessels which convey only colourless fluids, as lymph. 
 
 Marasmus , — A wasting of flesh without fever, or apparent disease, a 
 kind of consumption. 
 
 Membrane, — A thin expansion very much resembling the skin in its 
 structure and appearance, and constituting the inner lining of the 
 lungs, stomach, bowels, &.c. 
 
 Mucous membrane, — The membrane lining the alimentary canal, 
 lungs, dec. 
 
 Morbid, — D isea sed . 
 
 Mucilage, — A solution of gum. 
 
 Mucilaginous, — Pertaining to mucilage. 
 
 Nodule , — A little knot or lump. 
 
 Narcotics, — Drugs causing stupour, stupefaction. 
 
 (Edematous , — Puffy, retaining the impression of the fingers. 
 
 Pancreas, — A gland of the body situated between the bottom of the 
 stomach and the spine. 
 
160 
 
 EXPLANATION OF MEDICAL TERMS. 
 
 Pathology^ — That part of medicine which explains the nature of dis- 
 eases, causes, and symptoms. 
 
 Parietes, — The fleshy walls that enclose a cavity. 
 
 Paroxysm^ — A temporary increase or aggravation of disease. 
 
 Parenchymatous^ — Pertaining to the solid parts of glands as distin- 
 guished from the superficial or membranous coverings. 
 
 Pericardium^ — A membrane surrounding the heart. 
 
 Pectoriloquism^ — TJie act of transmitting articulate sounds through 
 the walls of . tlie'^hest. 
 
 Phthisis, — Disfe'dse of the lungs occasioned by tubercles, pulmonary 
 consumption.,* • v 
 
 Pleura, — A thin mumbrane that covers the inside of the thorax. 
 
 Pleurisy, — Ah inflammation of the pleura. 
 
 Peripneumony,—An inflammation of the lungs. 
 
 Pneumonic, — Pertaining to the lungs, pulmonic. 
 
 Post mortem, — After death. 
 
 Prophylactic, — Preventive, defending from disease. 
 
 Pus, — White or yellowish matter generated in ulcers and wounds in 
 the process of healing. 
 
 Secretions, — The act of producing from the blood substances different 
 from the blood itself, or from any of its constituents. 
 
 Spleen, — A soft grand ular organ in the left and upper part of the ab- 
 domen. 
 
 Sputa, — Things ejected or spit from the mouth. 
 
 Subacute, — Of a grade of action below the highest or most acute 
 point. 
 
 Suppuration, — The morbid action by which pus is deposited in inflam- 
 matory tumours. 
 
 Supervening, — Coming in an additional way. 
 
 Sudorijics, Diaphoretics , — Medicines causing sweat, exciting perspi- 
 ration. 
 
 Stethoscope^ — A tubular instrument for distinguishing diseases of the 
 chest by sounds. 
 
 Thyroid, — A cartilage of the larynx, the pomum Adami, or Adam’s 
 apple in the throat. It is larger in men than in women. 
 
 Tonics, — Medicines used for increasing the strength or the tone of the 
 animal system. 
 
 Tissue, — A particular arrangement of nervous or muscular fibres in 
 the organs. 
 
 Thorax, — The chest, that part of the body situated between the neck 
 and the abdomen, containing the lungs, heart, pleura, &;c. 
 
 Trachea, — The windpipe. 
 
 Vesicle, — A little bladder or a portion of the cuticle separated from 
 the skin and filled with some humour. 
 
 Ventricle, — A small cavity in an animal body. 
 
 Vena porta, — The large vein that conveys the blood from the abdo- 
 minal viscera to the heart. 
 
 Vena azygos, — A solitary vein in the right cavity of the thorax. 
 
 Viscera, — Internal organs, as the liver, stomach, kidneys, lungs, 
 heart, &c. 
 
 Viscera abdominal, — The glands and hollow organs of the abdomen. 
 
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