Consumption, bronchitis, asthma, catarrh, and clergyman's sore throat, successfully treated by medicated inhalations : comprising all the recent improvements in this mode of practice, with the remedies used

Front matter

YALE MEDICAL LIBRARY

HISTORICAL LIBRARY

COLLECTION OF

Preface

In presenting to the public the following treatise, I am fully aware that views of pathology, or treatment of disease, differing in any degree from those generally admitted and received by the great mass of the profession, are received by its members with hesitation and distrust.

And this is not a matter of surprise, when we reflect that new theories, or systems of practice, are almost every day being suggested and thrust upon the public, of which not one in a thousand proves to be of any real value.

Nor need we wonder that some are inclined to turn a deaf ear to improvements and discoveries in medical science, however beneficial their results may be to mankind. But so far from complaining of this, I am and ever have been among those who claim the right to investigate for myself every theory or principle in medicine, however "time honored" and long established; and adopt and give them my approval only so far as they are supported by sound philosophy and successful experience.

In the following pages I have presented briefly my views with regard to the phenomena and management of a class of diseases which are second to none in importance in the entire catalogue of human infirmities.

It is my design, as far as practicable, to divest the following work of all professional technicalities, to make it alike intelligible to the professional man and to the general reader. Let it be distinctlv understood, however, that we do not recommend self, or "domestic treatment."

No friend of humanity, I am persuaded, would advise the

10 PREFACE.

uninitiated to tamper with the treatment of a class of diseases which has for centuries past baffled the combined wisdom and skill of the wisest and best. It is not without some degree of diffidence that I lay before the public a work on this most important subject. For any defects or inaccuracies of style which may appear, I have but one apology to offer ; it has been prepared amid the pressure of constantly accumulating professional engagements. However, if my humble labors shall in any degree promote the advancement of medical science, or tend to prolong the life, or alleviate the sufferings, of one of my fellow-beings, I shall be amply repaid.

In taking this step, I am not unmindful of the position I occupy. We have old and long-established theories to contend with, deep-rooted prejudices, the trammels and fetters of schools, and also a host of physicians, whom, I presume, neither the power of persuasion, reason, nor argument, will convince. Claiming as I do to be actuated by motives of benevolence and philanthropy, I seek not the applause, nor do I fear the frowns, of any set of men, or cliques.

If this reform were a matter that related simply to our civil rights, it might be deemed of less consequence ; but the lives of our fellow-creatures are at stake. We see them laboring under diseases which are aggravated, and I regret to say, often rendered fatal, by improper treatment. In justification of my course, I appeal to the public, before whose stern, inflexible, and finally unerring tribunal it is unnecessary to plead the cause of truth, and useless to varnish error. Friends may flatter, and enemies may defame ; but the public at large do justice, because they are far removed from the sphere of personal feeling and influence.

Boston, April, 1857.

PREFACE

TO THE SECOND EDITION.

The author, iu issuing a new edition of his work, feels that his sincere acknowledgments are due to the gentlemen of the public press for the high eucomiums they have uuiformly bestowed upon its merits, and for their generous approval of the principles it advocates.

His acknowledgments are no less due to the numerous members of the medical profession, who have not only consulted him in practice, and in their own individual cases, but have referred many of their patients to his care.

It is also gratifying iu being able to state that, from many years of careful observation and experience, in a very extensive practice, devoted exclusively to the treatment of consumption and diseases of the air-passages, he is enabled to speak with increased confidence of the powers of medicated inhalations for the arrest and cure of this sadly fatal class of diseases.

Siuce the publication of the first edition, it is needless to add, that the author has had the most abundant opportunity for further testing the value of this mode of practice. His earliest convictions of the superior advantages of conveying remedies

12 PREFACE TO THE SECOND EDITION.

directly to the seat of the disease, by inhalation, have been strengthened at every step. His most sanguine expectations have been borne out by successful experience. And lie has seen it succeed in a vast number of cases where the oft-repeated and long-continued trials of the remedies ordinarily adopted have proved utterly inefficient. Believing the principles of inhalation to be of the first importance in the removal of one of the most terrible scourges that afflict mankind, the author desires to cast them forth as " bread upon the waters," in the hope of more happy and triumphant results.

Boston, March, 1866.

Introduction

If there is one class of diseases more than another which preeminently claims the attention of medical men, and the public generally, it is that melancholy train of diseases popularly known as consumption, and those relating to the air passages of the lung*.

These diseases have become so common, and hare hitherto proved so universally fatal, that scarcely a " domestic hearth can lie found that has not lost by them the dearest one of all." The young, the beautiful, and the good, have alike been its victims.

It spares neither age nor sex, but extends its ravages to every climate, from the frozen North to the sunny South.

And can there be nothing done to stay this increasing tide of death, which is sweeping like a sirocco over our country, leaving blighted hopes, sadness, and woe in its melancholy tread?

This is truly a question of momentous importance, involving, as it does, the lives of thousands of our fellow-beings annually. From the most reliable statistics we find that consumption has increased at the rate of five per cent, over and above the increase in population. To combat this disease, the most opposite modes of treatment have from time to time been recommended ; yet the treatment thus far, as one has very truly remarked, " has only been equivalent to death." While the world is teeming with new discoveries, and the arts and sciences are advancing with rapid strides, it can hardly be said of Medicine that she has kept pace

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in their onward march of improvement. Sir James Clark remarks on this point, " We have no reason to believe that the physicians of the present clay are more successful than were their predecessors twenty centuries ago."

And to no class of diseases does this remark apply with such peculiar force as to those of the respiratory organs. A deep and abiding conviction is-every where beginning to be felt in the public mind, that the usual modes of practice have no power in arresting the progress of this fearful malady. Such has been the universal fatality attending it, and so often have the fondly cherished hopes of friends been doomed to disappointment, that the poor consumptive, at the first intimation of his disease, is ready to yield himself up to despair. No art of medicine, no power, it was thought, could drive out or grapple with this giant foe of human life, when once he had fairly gained possession of the lungs. The great majority of physicians have been so long in the habit of regarding this disease as incurable, that little else than a mere palliation of symptoms has been attempted. The remedy has been administered by the stomach, while the festering, corroding ulcers in the lungs have been left to pass through their destructive changes undisturbed. I fully concur in the opinion of an eminent writer on this subject, when he says, " I am persuaded that no essential progress has been or can be made in the cure of consumption until the disease is treated upon different principles from what it hitherto has been." Unfortunately for the advancement of medical science, a spirit of illiberality, in too many instances, is allowed to mingle with the discussion of medical topics, and which serves to retard the progress and attainment of truth. We find in the days of Hippocrates, the father of medicine, as well as in our own, that medical truths were of slow development ; and we cannot but be struck with wonder and surprise, when we reflect that after the commencement of human dissections by Democritus, two thousand years should have elapsed before the important discovery of the true circulation of the blood was made known to the world.

Such was the ignoble spirit of envy and jealousy, even in that remote period of antiquity, that the illustrious Harvey, whose splendid discovery of the circulation, though demonstrated in the most convincing and satisfactory manner, was nevertheless denounced by his contemporaries as a charlatan, and his name calumniated.

He had the satisfaction, however, of living to see the clamors of ignorance and superstition silenced, every argument against him completely refuted, and his new theory of the circulation universally established. In a profession like ours, whose object is to alleviate human suffering, to gently soothe the dying pillow, and smooth the passage to the tomb, it is but fair to presume that its members will hail as an invaluable boon any remedial means, or system of treatment, calculated to avert the fatality or diminish the frequency of this class of diseases.

As a member of the medical profession, whose office it has been to ward off " death strokes " for many years, and having witnessed with deep and painful anxiety the unsuccessful results of the ordinary modes of applying the remedy in the treatment of consumption, I feel that it is only in accordance with the common dictates of humanity that I should give to the public my views, and the results of my experience, in the treatment of this class of human maladies, knowing, as I do from daily experience in my own practice, the incalculable benefits of medicated inhalations in throat and lung affections. It is a fearful truth, and one which cannot be too deeply impressed upon the mind of the

consumptive invalid, that the practice hitherto adopted in these 9 diseases has not only failed in arresting the fatal symptoms, and performing a cure, but in the great majority of cases has caused the disease to run a more rapid course to a fatal termination.

His choice of treatment, therefore, must be to him a matter of infinite importance. But says one. Shall we reject the use of medicines by the stomach altogether ? I answer, No ; the careful and judicious administration of remedies by the stomach, with a view to improve and regulate the various functions of the system, must ever be regarded as valuable auxiliaries in the treatment by inhalation, and should by no means be disregarded. But what I contend for is, the direct application of the remedy to the seat of the disease. This is what is meant by inhalation in the treatment of consumption.

In asserting the curability of this disease, I am supported by the highest medical authority. Laennec, the greatest pathologist of modern times, says, " From a multitude of facts, I am convinced that in some cases the disease is curable, even in the latter stages ; that is, after the softening of the tubercles and the formation of ulcerous excavations have taken place." And he further adds, that " the cure of consumption, when the lungs are not completely disorganized, ought not to be looked upon as at all impossible, in reference either to the nature of the disease or the organ affected." I might allude to the names of many others whose testimony is equally strong in support of this opinion. In a very large city and country practice, I have employed this treatment in many hundreds of cases, from a simple catarrh in the head to bronchitis, asthma, and consumption, with the most gratifying and satisfactory results. And in the more advanced stages of disease, where there was no possibility of effecting a cure, the treatment has universally afforded great comfort and relief.

It is sometimes urged as an objection to this method of practice, that the ancients employed it centuries ago, and laid it aside as useless. That this mode of treatment was employed even as early as in the days of Hippocrates, is admitted ; and many since that day have from time to time resorted to it, and there is reason to believe, not without advantage. If they have failed of success, it has been because their treatment was empirical, the remedies being administered without regard to the pathology of the disease, or the indications to be fulfilled. I make no pretensions to actual novelty ; we have the same views, we follow the same intentions, of our medical fathers ; the only difference consisting in the simplification and improvement of the old modes of exhibition, and the adoption of many new and important remedies, which the modern discoveries of pharmaceutical chemistry have brought into use.

The eyes of the world are at this moment anxiously turned to this system as the only one from which there can be any possible ground of hope ; and from the evidence already before us, I feel warranted in coming to the conclusion, that the day is not far distant when consumption and its kindred diseases, now regarded with such universal dread, will be ranked among our most curable diseases, and when it will be considered an act of stupidity and fally to treat diseases of the lungs in any other way.

MEDICATED INHALATION

IN CONSUMPTION AND DISEASES OF THE AIR PASSAGES.

Chapter I. Physiology Of The Respiratory Organs

Before entering upon the consideration of the diseases of the throat and lungs, I shall call the attention of the reader briefly to the anatomy and physiology of the lungs.

The lungs consist of two porous, conical bodies, of a dark purple hue, composed of an infinite number of air cells, and situated within the natural cavities or walls of the chest, which they completely fill. They are divided into separate lobes ; the right side has three lobes, while the left has only two.

Physiologists have computed each lung to contain 1,744,000,000 air cells.

Lieberkuhn, a celebrated German anatomist, represents them as composing a surface equal to 20,000 square feet. Now, each air oell of the lungs communicates with the pipes or bronchial tubes, from which

22 PHYSIOLOGY OP THE RESPIRATORY ORGANS.

it is filled with air at each inspiration, and empties itself at each expiration of the breath.

These cells may be compared to a cluster of grapes, and the air pipes, or bronchi, to the stems on which the grapes hang.

The bronchial tubes are formed at the lower part of the neck by the division of the trachea, or windpipe, into two principal branches, which take the name of the right and left bronchi ; and these again subdivide, the right into three, the left into two, corresponding with the number of lobes in each lung, which they severally supply ; these again divide and ramify into almost an infinite number of smaller branches to every part of the lungs, and terminating each in a small sac formed by a continuation of the lining membrane of the air tubes, called the air cells.

The lungs may very properly be considered the great laboratory of the system — the place where the blood is purified and rendered fit for the circulation. They also serve as one of the principal waste gates of the body, through which the impurities and worn-out particles of the body are expelled. To illustrate this, all the blood in the human body passes through the lungs once in about four minutes, and is distributed over millions of air cells by means of small vessels, forming a perfect network over the inner surface of each cell.

The coats of these vessels conveying the blood are so extremely delicate that the air in the air cells can

PHYSIOLOGY OF THE RESPIRATORY ORGANS. Z'6

pass through them and mingle with all the blood in the body in the short space of about four minutes.

The heart throbs, and every vessel is filled with blood. We breathe, and every air cell is filled with air ; and thus, by a beautiful law of the human mechanism, this momentary union is sufficient to remove the carbon from the dark or venous blood, from which it is expelled in the form of carbonic acid gas, and by which it is converted into red or arterial blood.

From the above remarks it will be observed, that the lungs perform several very important duties. The same chemical changes which purify the blood, and impart life and energy to the system, also serve to generate and maintain the natural heat or warmth of the body.

The act of respiration, or breathing, is only a simple process of combustion, similar to that observed in an ordinary fire, or the burning of a candle or lamp.

In animal life you will observe that the breath and food are the actual fuel of the system ; the lungs the furnace where the fire is kindled ; and the arteries which carry the red blood serve as pipes, through and by which the heat and nutriment is conveyed to every part of the body ; while the veins, which carry the dark blood, gather up the worn-out particles and impurities of the system, (which are the product of combustion,) to be expelled at the lungs.

When we reflect that the lungs are in every part filled with air cells, countless in number, and composing an absorbing surface of 20,000 square feet, and that these

24 PHYSIOLOGY OP THE RESPIRATORY ORGANS.

cells are constantly filled with fresh supplies of air -at every inspiration of breath, and that this air is absorbed through the delicate coats of the vessels into the blood, and carried by means of the circulation through the entire system, what can be more rational, more simple and efficacious, than the treatment of consumption by inhalation ?

Since, in the same manner we breathe common air, we can inhale or breathe a medicated vapor, the atmospheric air, passing through the inhaler, becomes loaded or mixed with the vapor, and is conveyed directly into the lungs, filling every air cell and sac. The active properties of the remedies employed are thus brought to bear at once tipon the seat of the disease — the inflamed mucous membrane and the ulcers in the lungs — without the unpleasant and disagreeable effects of the action of drugs xipon the stomach.

Chapter II. Chronic Catarrh

This is a disease which has hitherto been very much neglected by medical writers. It has generally been regarded as trifling and unimportant ; yet, in reality, it almost invariably lays the foundation for the most difficult and dangerous maladies. As a " constant dropping of water will wear away a stone," so must the acrid, offensive matter, collecting and dropping from the head into the throat, when continued for a length of time, destroy the integrity of tbe mucous membrane coming in contact with it.

Too much attention cannot be given to this important fact. A common cold may pass off in a few days without much disturbance of the general health ; but too often, alas ! when neglected, and left to itself, it tends slowly but surely to a fatal termination. The symptoms of catarrh are so generally known as scarcely to need a description. They are most commonly marked by a dull, deep-seated pain in the forehead and temples ; a sense of dryness and burning heat in the nostrils ; frequent sneezing and weeping of the eyes, accompanied with more or less fever, alternating with chills.

Subsequently, in the progress of the disease, an increased discharge of a clear watery fluid takes place from the nostrils, which irritates the parts over which it passes ; becoming, however, less in quantity, thicker, and assuming a yellowish appearance, as the affection subsides. These are the usual symptoms attendant upon a " common catarrh,'''' or " cold in the head." But the tendency of this disease is to pass downwards, involving the soft palate, fauces, tonsils, and uvula ; and then it takes the name of sore throat.

These symptoms, when properly treated, usually subside in a few days ; but if neglected, and the disease is allowed to pass on unmolested, it sooner or later assumes a chronic form, and then it is called " chronic catarrh." This stage of the disease may be regarded as the result of a neglected cold, or leaving a cold to take care of itself.

Persons have not unfrequently suffered months from this most disagreeable affection ; yea, years, without understanding the cause of the difficulty.

This form of the disease is characterized by several different stages, each having its own peculiar symptoms.

First, we usually have a discharge of a yellow or straw-colored mucus, which accumulates in the posterior nares, above and behind the soft palate, dropping down into the throat, and producing almost a constant and irrepressible desire to hawk and spit, with a view to remove the matter.

In the second stage we find the secretions dry and hard,

CHRONIC CATAERH. 27

in the form of dry crusts or scabs, which very much obstruct the nasal passages, and which are often very difficult of removal. In this form of the disease the sense of smell and hearing are often very much impaired ; and where the disease has existed for a great length of time, the patient not unfrequently becomes quite deaf. Indeed, one of the most common causes of deafness may be found in chronic catarrh. In the third and last form of the disease, we have a muco-purulent discharge, generally of an offensive odor, and, being the result of ulceration of the mucous membrane, is almost invariably attended with loss of taste and smell : and in some instances the ulcerative process has extended so far as to produce caries of the bones of the nose, when it is attended with a dark, fetid discharge. A case of this character is at the time of writing under my care. Persons of a scrofulous diathesis are always more liable to this form of the disease than any other.

Individuals suffering from this affection are extremely liable to take cold on the slightest exposure, or on any sudden change of temperature.

This disease, as I have before remarked, is rarely confined to the head alone. From the constant irritation which is kept up by the dropping of matter into the throat, the patient sooner or later experiences a degree of hoarseness, with a tickling sensation in the part, and a frequent desire to cough. Thus, in the progress of the disease, we see it constantly assuming a more serious character — from the slight catarrh to the seated bronchitis, from bronchitis to the first speck or deposit of tubercular matter in the lungs ; and, from this deposit to the filling up of the entire lung with matter, burrowing among the delicate air cells, until the whole lung becomes a hopeless mass of disorganization.

That this disease is so fatal in its tendency, and productive of such unhappy consequences, no one will be surprised to learn, if he will but reflect, that every breath of air that is inhaled into the system by those suffering from chronic catarrh, must pass over an unhealthy and diseased membrane ; and the air, in passing over these putrid and ulcerated surfaces, must necessarily imbibe the most noxious and deadly properties ; and in this manner every breath of air taken into the lungs is converted into a poisonous agent of death.

Chronic catarrh, in a very large proportion of cases, may be regarded as the foundation and forming stage of pulmonary consumption, and other diseases affecting the air passages of the lungs. Too much importance cannot be attached to the early removal of this most unpleasant and disagreeable affection.

TREATMENT.

Until recently nothing has been done by the profession to obviate this offensive and dangerous disease. The treatment, if any adopted, has not even deserved the name. The consequence has been, that multitudes of empirics, ignorant of the anatomical structure of the parts as they were of the pathology of the disease, have undertaken its cure ; and, hy their wonderful pretensions and extravagant promises, thousands have been attracted to them for relief. Unfortunately their last state has generally been worse than the first.

In a recent number of Braithwaite's Retrospect we find the following method, adopted by an English physician, of some prominence in his profession, for the application of local remedies to the nasal passages. We regard this as a step in the right direction. " By means of the application of this principle to the treatment of diseases of the nose," he says, '• it is possible easily and frequently to wash the nasal cavity, to disinfect and deodorize it, to remove the sordes which so easily accumulate in it, and to apply to its surface a great number of beneficial medicinal substances, so as to prevent acute affections from extending, and to incline them towards a speedy recovery ; to stop hemorrhages, to allay irritations, and to subdue in a remarkable manner chronic affections of the Schneiderian membrane, so as to reestablish a perfectly healthy surface, and normal condition of the organs of smell."

The apparatus he employs is thus described : —

" A rod of iron or brass, thirty inches in length, is

fastened upright into a heavily loaded foot, so as to form

a firm stand. On this rod slides a nut, which can be

fixed at any height by means of a screw, and carries an arm and ring, in which is cemented a high, cylindrical glass vessel, of a capacity of from one to two pints. The glass vessel is open above, and its cavity contracts within the ring in which it is fastened, and here passes into a small-bore muzzle, to which a suitably sized, flexible India-rubber tube, thirty-six to forty inches in length, is fastened. To the other end of the rubber tube a stop-cock is fixed ; upon this a little cup-shaped collar, and upon this the cylindrical, perforated nozzle of gutta percha, or of prepared India rubber. If now the glass vessel is filled with fluid, and the little stop-cock immediately underneath the nozzle is opened, the fluid will escape at the fine openings of the nozzle ; and if the nozzle accurately fits the nostril, and the fluid is allowed to flow, it will enter and fill the cavity of the nose. All the air in the India rubber is now replaced by fluid, the escape of' the air upward being facilitated by gentle manipulation. The glass vessel is fixed and raised in the position which will give the desired pressure. The nozzle previously selected as of proper size, and connected with the apparatus, and filled as described, is now inserted into one of the nostrils, while the patient is told to breathe exclusively through the mouth, and to abstain from swallowing. The little stop-cock being now opened, a continuous and rapid stream is seen to flow from the opposite nostril. The reason of its flowing from the opposite nostril is simply owing to the fact that when one side of the nasal cavity is entirely filled with a

CHKONIC CATARRH. 81

fluid, while the patient breathes exclusively through the mouth, the soft palate completely closes the passage, and does not permit the fluid to pass into the pharynx, while the fluid easily passes around the posterior edge of the septum narium into the other cavity — a physiologial fact first discovered by Professor Weber, of Leipzig."

There is still another apparatus, invented by Dr. Lewin, of Berlin ; but as its action and general principles are the same as that above described, I shall not enter upon a particular description of it.

Having carefully examined and tested this mode of application, I can see no advantage in it over the anterior and posterior nasal showering syringes now in use. I have successfully employed these syringes in my own practice for a long time, and I can say, with entire confidence, that every indication is answered, every object gained, in the use of the nasal showering syringe, that can be derived from the use of more complicated machinery. The syringe is also more convenient, portable, easily cleansed, and always free from any unpleasant odor. The plan of treatment usually adopted in my practice is, to shower the nostrils several times during the day, with suitable applications, rendering them disinfecting, alterative, soot/ting; or astring-ent, as the case may require. These applications are neither attended with pain, or inconvenience ; a child will readily submit to them. In this manner the hardened and depraved secretions are thrown otf, the mucous surfaces are cleansed from all impurity, and a healthy action is at once established in the parts. Superadded to this, the patient is required to inhale a medicated vapor three or four times a day, varied according to the age, symptoms, and character of the disease, and under some circumstances a resort to constitutional measures has been necessary to complete the cure.

Chapter III. Follicular Inflammation— Sore Throat

The mucous membrane of the throat and air passages are abundantly supplied with small glandular bodies, which, in a healthy condition, are constantly pouring out from their delicate mouths a bland, transparent fluid, for the purpose of lubricating and shielding the lining membranes which invest them. This membrane, being constantly exposed to the atmosphere, as it is, in the act of breathing, must soon become hard, dry, and unyielding, and inadequate to its various offices but for this wise and beneficent arrangement.