A treatise on consumption; embracing an inquiry into the influence exerted upon it by journeys, voyages and change of climate. With directions for the consumptive visiting the south of Europe, and remarks upon its climate. Adapted for general readers

Front matter

«tfs?»*lKtr>

SC-

YALE MEDICAL LIBRARY

Chapter IV

Physical Characters indicating a Predisposition to Consumption — Relative Prevalence of the Disease in the two Sexes — Periods of Life during which it is most Prevalent, . . . . . . .35

Physical signs, ...... ib.

Relative prevalence of consumption in males and females, 41 Periods of life during which it is most usually developed, 44

CHAPTER V. Hemoptysis, or Pulmonary Hemorrhage, . 46

Predisposition, ...... ib.

IV CONTENTS.

Relative prevalence in the two sexes, . . .51

Ages in which in it most commonly occurs, . . . ib.

Pathology, or nature of the disease, . . ■ >'>.

Danger of the disease, . . . • • "*

Treatment, ....-• ' u -

Chapter X

Causes of Consumption continued — Those which act indirectly, or on the General System, . . 106 Climate, ... . . . . ib

Insufficient clothing, and undue exposure, . . 107

CONTENTS. V

Impure atmosphere, . . . . .112

Want of exercise, . . . . . .114

Intemperance, . . . . . .115

Suppression of habitual discharges, .... 116

Unnatural excesses of youth, .... ib.

Abuse of mercury and other active medicines, . . ib.

Excessive mental labor, .... 119

The depressing passions, , 122

CHAPTER XT.

Causes of Consumption continued — Those which act more directly on the lungs, ..... 125

Mechanical and chemical causes, . . . ib.

Unnatural confinement of the chest by dress, . . 133

Extraordinary exertions of the lungs in public speaking, playing on wind instruments, &c. . . .136

Chapter XII

Causes or Consumption concluded — The Influence exercised by other Diseases in the Production of Tubercles in the Lungs, ..... 140

Hemoptysis, or hemorrhage from the lungs, . . ib.

Lung fever, or common inflammation of the lungs, . 141

Pulmonary catarrh, or cold on the lungs, . . 142

Dyspepsia, or chronic indigestion, ... 144

Continued, remittent and intermittent fevers, . . 147

Scarlet fever, ...... ib.

Measles, . . . . . . . ib.

CHAPTER XIII. Treatment of Consumption, .... 150

Irritation on the surface of the body, . . . 151

VI CONTENTS.

CHAPTER XIV. Treatment op Consumption continued, . . 163

Exercise and fresh air, . . . . . ib.

Walking 167

Riding on horseback, ...... 168

Riding in a carriage, and swinging, . . . 169

Inhalation of vapors or volatile substances, and gases, . 170

Chapter XV

Sea voyages, . . . . . . . ib.

Remarks on sea sickness, . . . . 178

Chapter XVI

Treatment of Consumption continued. — Change of Cli mate, .......

General remarks on the influence of change of climate, ib-

Character of the climate to be selected, . . . 191

Period of consumption when change of climate may be advisable, ....... 194

Introduction

I am not ignorant of the objections urged against the introduction of medical works to the public generally ; and well know the hazard of countenancing the popular employment of active medicinal agents. The disposition among mankind is already too strong to tamper with our art, to trifle with the well-being of the animal constitution, and needs be repressed rather than encouraged. But a brief statement of the design and plan of the present volume, it is believed, will exempt it from the objections usually raised against works of this character.

In the first place, I shall give a brief and general history of consumption, and the climates in which it is most prevalent, its relative mortality, &c. Next, I shall introduce a general view of the lungs and their functions. Then the pathology or nature of the disease will be considered. The physical characters indicating a tendency to consumption. Its relative prevalence in the two sexes, and the 2

10 INTRODUCTION.

ages during which it is most frequent. Then a concise account will be given of hemoptysis, or bleeding from the lungs. Next, the causes of consumption, and their means of prevention, so far as known, will be examined. The history of the symptoms will next follow. Then an account of the diet and regimen best adapted to the premonitory and declared state of the malady. And lastly, I shall particularly consider the influence exercised by sea voyages and change of climate on the disease, and the period and circumstances in which these means will be likely to exert a beneficial agency, and shall give some necessary directions in regard to them.

I shall purposely omit the consideration of active medicines, which may be demanded in the confirmed state of the disease, being convinced that these can only be rightly and safely employed under the immediate direction of a medical attendant.

The special designs of the present work, are to make known the causes of, and best means of preventing the fatal malady under consideration ; that those unfortunate individuals, especially, who bear in their physical organization its indications, or those who are their guardians in early life, may be apprised of their danger, and thus induced to a seasonable resort to those preventive measures

INTRODUCTION. 11

which have been found most effective in raising the energies of the system, and repressing its diseased tendencies. That the premonitory or threatening signs of the disease may also awaken an early solicitude, and incite to a timely application for medical aid. And to communicate some little information on the question relating to sea voyages and warm climates in consumption, which is often so momentous to the sick, and so embarrassing to friends.

Technical terms will be avoided, as far as possible, in the ensuing volume, so that it may readily be comprehended by all who feel an interest in its subject.

I am not aware that any work precisely of the character designated is now before the public ; and whether such a one is wanted, and if so, whether the present will answer such want, the public must decide. I cannot, however, but indulge the hope that I may be able to impart some instruction to that numerous and unhappy class of individuals, who seem marked for the victims of consumption, which may tend either to prevent its development, repress it in the beginning of its course, or, if no more, smooth the destined passage to the grave.

TREATISE ON CONSUMPTION.

Chapter I. General Remarks On The Disease The Situations Where

IT IS MOST PREVALENT ITS RELATIVE MORTALITY.

Consumption* may be traced back to the earliest periods of medical history. Hippocrates, commonly styled the father of medicine, and who lived more than four hundred years before the Christian era, knew it, and has well described its melancholy course ; and though ages have rolled on with all their changes, this bane of human life still remains the same — has never abated in its fatality — never rested from its work of destruction. No condition, no period of human life, can claim immunity from its ravages. It respects not station, for it is a disease equally of the rich and the poor. It attacks childhood in its weakness, youth in its bloom and elasticity, manhood in its power, and age in its decrepitude.

It has a range over a wide extent of latitude ; visiting people dwelling in different climes, and of

* Phthisis, Phthisis pulmonalis, Consumption and Pulmonary Consumption, when U6ed in the following pages, will express one and the same disease.

14 WHERE MOST PREVALENT.

the most dissimilar manners and habits of life. But it is especially active in what are denominated temperate climates — more even than under the intense cold of extreme northern latitudes. It should be borne in mind, however, that the degree of latitude which would be temperate in Europe, would be very cold in America. Paris enjoys a temperate climate, and yet it is two degrees farther north than Quebec.

The disease prevails, more or less, throughout Europe ; and has its victims even under the bright skies of Italy, and of the islands and southern borders of the Mediterranean. It exists in the island of Madeira, once so celebrated as a residence for the consumptive, as well as in other islands of the Atlantic; and even those between the tropics are not wholly exempt from it. Its ravages in the more northern part of America are but too familiar to my readers.

High northern latitudes, as already remarked, where the cold is intense and uniform for a large portion of the year, seem less favorable to the prevalence of consumption, than those which are more temperate. In Russia, for example, the relative proportion of deaths from it, is considerably less than in England or France, and the result of various inquiries has satisfied me that it prevails less in Lower Canada than in the Northern, or even Middle States. Laennec has asserted that its frequency diminishes among the inhabitants of high mountainous coun-

WHERE MOST PREVALENT. 15

tries, particularly the Alps, whose winters are long and severe.

Several causes may be influential in giving this greater immunity from consumption to the dwellers in the severe climes of the north.

The character of both their soil and climate necessarily calls forth active and laborious habits of life, which increase all the physical energies, and consequently the ability to resist disease. The effect, too, of uniform and severe cold, especially when associated with bodily activity, is to elevate and strengthen the vital actions. It is the sudden and great vicissitudes of the winters and springs of temperate climates, against which the inhabitants cannot always be guarded, that are so harmful to the lungs, and in short to the whole economy. The animal body has within itself a power of adaptation to almost any atmospheric condition, if constant, or if the variations are so gradual as to allow time to rally its reacting principle.

In cold countries, moreover, every thing is ordered with special reference to the effectual protection against the severity of the climate. The little period of warmth and sunshine is passed mainly in preparation for the long and dreary winter which is to ensue. The inhabitants defend their bodies by thick clothing, and the furs of animals ; and their houses are so constructed as most securely to shelter against the cold, and by means of stoves are constantly maintained at a high temperature, so that the amount of suffering endured, may really be no

16 WHERE MOST PREVALENT.

more, and perhaps in many instances it is less, than among the people of more temperate climates, who guard themselves less cautiously against the occasional rigors of their uncertain winters.

The natives of cold latitudes — or such is in correspondence with my own observations — accustom themselves to warmer clothing, even in a like temperature, than those who dwell under milder skies. A Canadian will often be seen dressed in his winter clothing, his throat and breast protected by a large shawl, in a temperature in which an inhabitant of our Middle States — of New York or Philadelphia, for example — would hardly put on an additional garment, and the front of his chest would, very likely, be guarded only by a thin linen shirt.

Furthermore, the air during the cold of northern winters is drier, and consequently conducts off the animal heat less rapidly than the more moist winter atmosphere of temperate climes. It is also sharper and more exciting, and more certainly ensures reaction of the extreme vessels of the surface of the body. Every one knows how red the face and hands become, when exposed to a dry and keen winter air, and how rarely colds succeed to such exposure; and, on the contrary, how pale and chilled is the surface, under the influence of a cool and damp atmosphere, and how frequently colds and pulmonary affections are the consequence. We are driven, too, to more brisk action in a dry, sharp air, to excite the circulation and overcome the painful sense of cold on the surface, than when under

RELATIVE MORTALITY. 17

the depressing influence of a damp and chilly atmosphere, which seems to impel all the blood to the interior of the body. Who does not experience better health and spirits, and a stronger disposition to action, on a clear, cold December's day, than when acted upon by our chilling easterly winds of spring ?

As society advances in refinement and luxury, the causes of consumption become multiplied, and the disease is consequently more prevalent than among people whose minds are more calm, and whose habits more primitive and simple.

Various computations have been made of the relative sum of mortality from consumption in various countries and climates of the earth. But on this subject we can only expect an approximation to accuracy. The science of medical statistics is far from being advanced in any country ; and in our own, especially, it has been attended to but very little. Our bills of mortality not being ordinarily kept by those competent to the task, are apt to be loose and inaccurate, and the names of different diseases are frequently confounded with each other. Any data, therefore, from this source, are too uncertain for accurate philosophical deductions. It should be observed, too, that the term consumption is employed by many in a sense too vague and extended, being allowed to embrace, not only affections of the lungs very different in their nature, but sometimes even diseases of other parts, under which the individual gradually wastes away and dies ; whereas — 3

18 RELATIVE MORTALITY.

as I shall soon show — it ought to be limited to one peculiar affection of the organs of respiration.

Dr Sydenham said that two thirds of those who died of chronic diseases, in Great Britain, fell victims to consumption. The estimates of Drs Heberden, Young and Woolcombe, show us that an average of about one in four of the deaths which happen in Great Britain, are from the disease I am describing. It is a curious fact that in Bristol there is the greatest relative amount of mortality from consumption — and among its native inhabitants — of any place yet compared with it ; although this town is in the southern part of England, and is a great resort for consumptive individuals.

Laennec states that in Paris, and the great cities in the interior of France, the proportion of deaths from consumption is well known to be one in four or five.

In the United States of America, the ratio of deaths from the disease will of course vary according to latitude — being greatest in the Northern and Middle States. In Boston, the average of deaths by it, compared with other diseases, may be about one in from four to five. In New York, the proportion will probably vary but little from this. In Philadelphia, it may be about one in five. And as we advance south, hepatic diseases and fevers increase, and consumption gradually diminishes.

Chapter II. General View Of The Lungs And Their Functions

As the disease under consideration has its location in the lungs, and as some of my readers may be unacquainted with human physiology, I trust it will not be deemed irrelevant if I introduce here a very general and concise account of these organs and their function.

Anatomical description. — The lungs or lights, in company with the heart and large blood-vessels, to which they form an important appendage, are inclosed in a distinct cavity, familiarly known as the thorax, or chest. It is formed by the sternum or breast-bone, the ribs and their muscles, the spine, and at the inferior part by a large flat muscle, called the diaphragm or midriff, which forms a sort of floor for the thoracic cavity, and separates it from that of the abdomen, immediately below, and which contains the stomach, liver, intestines, &c. — organs immediately subservient to the functions of digestion and assimilation. The great organs, therefore, of respiration and circulation, have no direct connexion with those of digestion, and the functions immediately associated with it.

There are two lungs, a right and a left, separated by a vertical, membranous partition, passing from

20 THE LUNGS,

the sternum to the back-bone, and dividing the chest into two nearly equal cavities. The right lung is a little larger than the left, possessing three lobes, while the latter has but two.

The form of the lungs is conical, their base resting, as it were, on the diaphragm, and their apex in contact with the most elevated part of the thorax. They are remarkably light and spongy ; their texture is extremely delicate ; and so compressible are they that, though in their natural condition completely filling the chest, they are capable of being so reduced as to occupy only a space of two or three square inches.

They are composed essentially of elastic air-tubes, very delicate membranous air-cells, blood-vessels, and are externally invested by a strong, shining membrane, which is reflected from them over the interior of the thorax, forming for it a complete lining; it is called the pleura, and is the membrane which is inflamed in the disease termed pleurisy.

In the natural condition of the lungs, their external surface, or investing pleura, is in contact with, but does not adhere to, the pleura lining the thorax ; yet, as slight inflammation readily occasions such adhesion, it very commonly exists to a greater or less extent ; but unless extensive, does not seem materially to impede respiration.

I may describe the lungs as reared up in the following manner. An elastic air-tube, called the trachea or windpipe, opens into the superior portion of the throat — and consequently communicates

AND THEIR FUNCTION. 21

with the mouth and posterior part of the nostrils — by a curious mechanism, in which the voice is mostly formed, called the larynx. This tube passes down the neck, enters the chest, and then forks into two divisions called bronchia or bronchi, from a Greek word meaning the throat, one going to each lung. They then subdivide, and go on ramifying again and again, becoming smaller and smaller, and less and less elastic, until they ultimately terminate in the minute vesicles or air-cells to which I have before alluded. These air-cells, with the air-tubes conducting to them, may be viewed as the frame work of the lungs, and constitute the greater proportion of their substance. The cells, too, always containing more or less air, it is to them that these organs owe their light and spongy character.

The union of these little vesicles is effected through the medium of a fine membrane denominated cellular, which, though so abundant in many other structures of the body, is here very small in quantity. Every where upon these cells, minute vessels are ramifying, to carry to them blood to be acted upon by the vital air they are continually receiving, and to convey it back again in its course to the heart, after having undergone its mysterious aerial change.

It appears to have been a grand principle of nature in building up the beautiful and important organs of respiration, to provide that the greatest possible quantity of blood should be brought under the influence of the greatest possible amount of air.

22 THE LUNGS,

The number of the air-cells exceeds all accurate calculation. They have been estimated in man at between one and two hundred millions, and as presenting a surface of fifteen hundred square feet. They exercise, too, as may readily be conceived, the most important agency in the breathing function, since it is during the passage of the blood over their delicate coats that the essential vital influence is wrought upon this fluid.

Physiology of the function of respiration. — The diaphragm, in its relaxed and natural state, ascends upward into the chest in the form of an arch. When respiration is to be effected, its centre, which is tendinous, is drawn down by the contraction of the flat muscle attached to, and encircling it, and the whole midriff is thus brought into the form of a plane, and the cavity of the thorax consequently becomes enlarged. The ribs, likewise, which form almost the entire walls of the chest, hanging in their natural state, obliquely to the spine, or from above downward, are elevated by the contraction of their muscles, augmenting still more the capacity of the thorax. The lungs, and air -tubes conducting to them, are but passive agents in the function. Bearing in mind now, that the air is an elastic fluid, ever tending to an equilibrium, and that more or less of it is always contained within the air-cells, it will easily be conceived that as the thoracic cavity enlarges, this residuary air must expand to avoid the vacuum which would otherwise take place between the exterior surface of the lungs and the in-

AND THEIR FUNCTION. 23

terior surface of the thorax ; and the next and necessary consequence is, that the denser air from without must rush into the mouth or nostrils, one or both, and through the windpipe into the lungs, to restore the balance between it and the rarefied air within. It is literally a mechanical action, on the principle of suction, and may be nearly imitated by closing the valve of the common bellows, and drawing air through its nose by enlarging its cavity.

Ordinary expiration is almost a passive act ; it is a restoration of the active agents of respiration to their natural or relaxed condition, and depends in a great measure on their physical properties, especially the elasticity of their cartilages. Hence it is the last act of the dying, and they are said to expire.

In placid breathing, as in healthy young children when at rest, there is but slight, if any motion of the ribs, the diaphragm alone acting. Hence we see how ordinary respiration may be maintained when the thorax is so confined by dress that all motion of the ribs must cease. If, however, under such restraint, extraordinary physical exertions, or strong moral emotions increase the demand for air, and consequently for extended and rapid motions of the ribs, a sense of suffocation is immediately experienced, and fainting and even death may ensue, unless free play is speedily given to the ribs, by taking away the mechanical obstruction which impedes their motions. Thus it is that we often loosen our garments when under the influence of severe

24 THE LUNGS,

exercise or strong passion, and that persons afflicted with diseases of the heart or lungs, or any which much affect the respiration, suffer great distress from the influence of a tight dress, or any cause which restrains the thoracic motions.

From the increased ossific depositions in the advance of life, the ribs become less movable, which is probably one reason why old persons are apt to breathe with embarrassment on exercise.

It may be readily understood, too, how the habit of exercise, calling for increased motions of the ribs, may tend to maintain, and even augment their facility of action, and may thus add to the vigor of respiration, as well as of all the other important functions of the body.

Habitual tranquillity of respiration, with strong capabilities in reserve for extraordinary exertions, indicate, on a general principle, health and bodily vigor. Broad shoulders and a well developed chest have ever been associated with physical strength ; and in all the masterpieces of sculpture, a large thorax and great muscular development are united. Wide shoulders and narrow hips constitute the beau ideal of the manly form, in which we admire the indications of strength ; but in woman, whom we love for her delicacy, weakness, and dependence on our own power, the contrary conformation is witnessed, and is most pleasing to us.

The inferior animals, in like manner, display strength and activity in proportion to the relative size of their respiratory organs. Birds are endowed

AND THEIR FUNCTION. 25

with a remarkably extensive breathing apparatus, and their astonishing physical power is amply evinced by their rapid and long continued flights.

That light, elastic, invisible fluid, called the atmosphere, which encompasses our globe, is the essential agent by which the vital change is wrought in the blood during its passage through the lungs. It is composed of twenty or twenty-one parts or volumes of oxygen, and seventy-nine or eighty of azote or nitrogen ; which relative proportion holds constant, whether the air analyzed be taken from the deep valley, or the lofty mountain — from the foul lazar-house, or the open fields of the country. Unhealthy or impure air, then, owes its character not, as was formerly imagined, to a deficiency of its oxygen, or a change of relation between its constituent elements, but to noxious effluvia or gases, which may be derived from various sources.

The atmosphere on the surface of the earth is, I believe, never found entirely pure — that is, comprising only oxygen and azote. It has always combined with it a minute though variable quantity of carbonic acid or fixed air ; also watery vapor, varying in amount in different locations and under different circumstances. The aroma of plants and their flowers, and the numerous gases and volatile particles given off during respiration, and the decay of animal and vegetable substances, are in like manner often blended with it. Some of these are necessary, as a certain amount of water in solution ; and those pleasing odors exhaled from many families 4

26 THE LUNGS,

of the vegetable kingdom, beside the enjoyment they impart, may exercise a healthful influence on our constitutions. Others, however, as the subtile effluvia and gases arising from decomposing organized matter, are extremely pernicious to human life, and are probably a source of many of the maladies from which we suffer.

The air, too, differs in the interior and on the sea-coast, in towns and in the country. It is denser and contains more impurities in valleys than on hills. It is likewise unquestionably affected, though insensibly, by the character of the soil ; which influence, however, can only be inferred from effects on the human constitution. The night air is less wholesome than that of the day.

The fact is well known that diseases are often materially benefitted by simple changes of air, independent too of any remarkable discrepance of temperature. Analytic chemistry, however, is not yet sufficiently advanced to acquaint us with those various modifications of the atmosphere which so essentially influence the human body, both in its healthy and morbid states.

The precise nature of the agency exercised by the air on the blood is not understood. The function of respiration appears to exist on the borders of chemistry and vitality, and is more or less influenced by the laws of each.

The air that is expired is discovered to have experienced a material alteration in its chemical composition. A portion of its oxygen has disap-

AND THEIR FUNCTION. 27

peared, its carbonic acid is increased, and the sum of its azote remains about the same. And by continuing to breathe the same air, nearly all the oxygen will vanish, the carbonic acid will be still further augmented, while the amount of nitrogen is but slightly altered.

It was long believed that oxygen was actually absorbed into the blood, and that by such union the vivifying powers of this fluid were renewed. This theory not being found tenable, another was substituted — viz. that the oxygen, instead of being retained in the blood, merely united with and carried off its impurities, thus restoring its necessary integrity. The deleterious agent acquired during the circulation, was supposed to be carbon ; and the oxygen of the atmosphere having a strong affinity for this principle, was thought to combine with it chemically, forming the expired carbonic acid. Other theories have also been advanced on the subject, yet none satisfactorily account for all the phenomena of respiration.

The oxygen of the atmosphere is proved to be the essential principle through whose instrumentality the life-giving power of the blood is restored ; and not unlikely, it may act by uniting with and conveying away something, which, if retained, would prove fatal to the animal economy. It is not improbable, moreover, that a portion of it may actually be absorbed ; and some experiments have gone to show that a minute quantity of azote disappears during respiration.

Oxygen, though so essential to vital existence, is too stimulating to be breathed in its unmixed state, and would soon destroy life were it not, as in the atmosphere, largely diluted with nitrogen. No other combination of it, except what nature has prepared for us, is capable of supporting vitality for any considerable time.

It has been estimated that an adult will consume about forty-five thousand cubic inches of oxygen in a day ; but it is plain the amount must be greatly influenced by circumstances, as diet, exercise, moral feelings, &c. The more ample the chest, and active the circulation, the larger will be the quantity consumed ; and other things being equal, the greater will be the bodily vigor.

Chapter III

BRIEF VIEW OP THE PATHOLOGY OP CONSUMPTION, OR THE DIS- EASED CHANGE WHICH TAKES PLACE IN THE LUNGS.

Since the publication of Laennec's philosophical work on the chest, in 1819, the term phthisis pulmonalis, or consumption, has been very properly restricted to a condition of the lungs in which there exist certain morbid productions, soon to be described, denominated tubercles. Previous to this period, a wider latitude was given to the disease, it being allowed to comprehend several affections of the lungs, distinct in their nature, varying in their degree of fatality, and requiring different forms of management ; the obvious tendency of which was to retard the philosophic knowledge of the complaint, and consequently lead to error, both in prediction and treatment.

An individual, for example, may be afflicted for months or years with a chronic cough and expectoration, ultimately, however, subsiding and leaving him in health. Or it may continue, with remissions perhaps, through life; the subject dying of some other disease. Or, lastly, it may result in emaciation, hectic fever, night sweats, with many other of the symptoms of consumption, and ultimately terminate in death, and yet not be this disease, but chronic inflammation of the mucous or lining membrane of the air-tubes, known by the various names of chronic bronchitis, chronic pulmonary catarrh, and cold on the lungs. The intemperate in the use of spirituous liquors, and old men, are often its subjects, though it is not confined to such. It is aggravated by cold, damp weather, by irritating substances inhaled into the lungs, and by all undue excitements. It not unfrequently yields, even when it has been of long duration, to the influence of sea voyages, journeys, and mild climates; and hence may constitute many of those cases reported as declared consumption, which have recovered under the use of such means. The most careful examination on the part of the physician is often demanded to distinguish it from genuine consumption, and the diseases may in some instances be confounded even by the most experienced and judicious in our profession.