Consumption and its cure : being a popular and practical treatise ..

Front matter

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'Weseeyast University LIBRARY.

Accession No.

Preface

The evident desire which exists in the public mind to acquire information in every- department of human knowledge, is answered in a variety of ways by the publication of books explaining in simple language the principles of general science and the details of special subjects. But. comparatively httle has been done, as yet, with the view of imparting information on the nature, causes, and management of disease. There are several works on Domestic Medicine which aim at instructing the public how to treat diseases by specific prescriptions, described as being useful in particular kinds of ailment. More than this appears to me to be requisite. The description of a single malady, embracing its nature, causes, symptoms, and the best method of its treatment, as well as those means of prevention which are within our control, written so as to be intelligible to all classes of readers, ought to be acceptable and must be productive of benefit.

The vast interest, which attaches to the consideration of a disease so prevalent and so fatal as consumption, justifies every effort to render a knowledge of its essential nature available to the public.

Actuated by this impression and stimulated by the conviction that a strong desire for information does exist in the public mind, I have endeavoured to explain, in a brief narrative, all the facts of importance with regard to this disease, and to render my subject popular and intelligible to the general reader by excluding as far as practicable all technical language.

In describing the symptoms, causes, and treatment of lung disease, this fortunately can be done without wounding the sensibilities or unnecessarily awakening the alarm of the reader.

Few attempts have hitherto been made to accomplish all the objects that I propose to myself in writing this treatise, and those have been chiefly confined to the consideration of the benefits to be derived from residence in particular localities.

The high reputation of the numerous standard works on this subject is not alone sufficient to attract the attention of general readers, and hence much that is essentially valuable and absolutely necessary to their welfare remains unknown to them.

Next in importance to a clear knowledge of a disease, and the various causes which may produce it, is undoubtedly the qviestion of its proper treatment, and this is really the only point of vital interest to those who suffer from any form of lung disease. The change which has taken place, within the last few years, in the treatment of all diseases, has also unquestionably modified the practice with regard to those of the respiratory organs. I have therefore entered largely into the consideration of a system of treatment which has recently been much extended and improved, and the success resulting from which has been such as to warrant the highest expectations of its universal adoption, and ultimate benefit to mankind.

5, Bulstrode-street, ,

Introduction

Consumption— Explanation of the Term— Frequency and Mortality of — Relative Mortality from Bronchitis — Necessity for Early Detection — Methods of Examination— The Spirometer — Table of "Vital Capacity"— Breath-soundi— The Stethoscope— Percussion — The Laryngoscope — Objects of Diagnosis in Consumption — Erroneous Notion as to its Incurability — Question of Curability — Authorities— Failure of Past Treatment — Authorities on this Point -Review of the Old Treatment — Treatment by Inhalation — Errors of Earlier Advocates Explained — Opinion of Medical Profession on the Subject of — Basis of this Mode of Practice — Practical Conclusions as to the Action of Inhaled Remedies . . 9

Part I. Diseases Which Precede Or Accompany Consumption

The Mucous Membrane — Diseases Produced by Inflammation — Acute Catarrh — Symptoms of Influenza — Chronic Catarrh — Exciting Causes of — CEzena — Nature of — Treatment — The Straight and Curved SyriDges 32

Affections of the Throat, Tonsils, and Uvola.— Sore Throat — Symptoms of — Treatment — Inflammation and Enlargement of Tonsils — Symptoms and Treatment — Elongated Uvula and its Treatment 37

Acute and Chronic Laryngitis. — Acute Laryngitis — Symptoms of — Chronic Laryngitis or " Clergyman's Sore Throat" — Symptoms of — Causes of — Connection with Consumption — Treatment . . 42

Bronchitis — Definition of — Acute Bronchitis— Symptoms of — Treatment — Chronic Bronchitis or "Catarrh of the Lungs" — Symptoms of — Forms of— Moist— Dry — False Membranes in — Ulceration — Dilatation of Tubes — Treatment 46 vi CONTENTS.

Part II. The Symptoms Of Consumption

Threatened Consumption. — Suspicion of Hereditary Tendency — When to be Apprehended — Lassitude— The Complexion— Temperature of Body— The Cough .51

Incipient Consumption. — Persistence of Cough — The Expectoration and its Character — Haemoptysis or Blood-spitting — Difficult Breathing — The Pulse — Form of Chest— Auscultation — Percuse ; n — Pain — Hectic Fever — Night-sweating — Wasting — Functional Irregularities — Value of these Symptoms .... 50

Confirmed Consumption. — The Cough— The Expectoration — The Haemorrhage — Hectic Fever — Wasting — Diarrhcoa — Other Complications and Peculiarities — Frequency of the Disease at Various Periods of Life — Infantile Consumption — Mortality from . . 63

Part III. The Nature Of Consumption

Changes which Tubercles undergo— First, Second, and Third Stages — Formation of Cavities — Absorption of — The Function of Respiration and its Purposes — Composition of the Atmosphere— Philosophy of Respiration — Consumption of Oxygen — Exhalation of Carbonic Acid — Effects of the Diminution of Pure Air — Usual Seat of Tubercle— Different Views on Composition of — Rational Theory as to its Production — Authorities on this Subject- Chemical Composition of Tubercle 67

Part IV. On The Causes Of Consumption

Influence of Inheritance — Arguments against Inheritance — Influence of Defective Organisation — Importance of the Physical Training of Children — Influence of Local Irritation — Diseases of the Throat and Air-Passages leading to Consumption — Authorities on this Point — How these Causes Act — Trades and Occupations an Exciting Cause — The Effects of Impure Air, Close Confinement, and Want of Exercise — How these Causes Operate — The Respiration of Atmosphere containing Irritating Particles- Statistics on this Subject — Means of Obviating this Cause

General Argument 73

CONTENTS. Vii

Part V. The Treatment Of Consumption

Division of the Subject.

Preventive Treatment. — Period of Commencing — Danger of Delay

— Evila to be Avoided — Hygienic Discipline .... 96

Curative Treatment. — Means hitherto Used — Local and General Treatment— Local Treatment easily Accomplished— Methods of Administration — Forms of Inhalation — Description of Instruments — The Inhaler— The Atomizer — The Fnmigator— The PaBtille — The Gas Chamber 99

Palliative Treatment. — The Cough — The Pain — The Fever — The Night-Sweating — The Blood- Spitting — The Diarrhoea — The Dyspepsia 116

Hygienic Treatment. — Ventilation — Influence of Climate — Diet —

Clothing — Exercise — Bathing . 122

ILLUSTRATIVE CASES.

A case of Incipient Consumption, accompanied by obstinate Chronic

Catarrh and enlarged Tonsils 141

A case of Acute Consumption 142

A case of Chronic Consumption 143

A case of Chronic Consumption 144

A case of Chronic Consumption complicated with obstinate Bronchitis 145 A case of Chronic Consumption of several years' standing, simulating

Asthma 145

A case of Incipient Asthma 146

A case of Spasmodic Asthma 147

A case of Spasmodic Asthma, accompanied by periodic attacks of

Acnto Bronchitis 147

A case of Spasmodic Asthma, occurring in a Rheumatic patient . 148

A case of Chronic Bronchitis 149

A case of Chronic Bronchitis, accompanied by Chronic Laryngitis . 149

A case of Constitutional ffizena ....... 150

A case of severe Scrofulous CEzena, threatening destruction of the

nasal bones 150

INTRODUCTION.

The term "Consumption" was originally applied to manydiseases situated in different organs, and having no symptom in common except the wasting or emaciation of the body. This use of the term led to very great confusion among writers, and it was found necessary to designate the variety of consumption which they intend to describe. But as the study of pathological anatomy became general, it was discovered that disease of the lungs was more frequently the cause of chronic decay of the body than all the others combined, and hence arose that restriction of the name to tubercular affections of the lungs only ; and this acceptation of the term is the one which I intend to keep in view in the following pages.

It is a disease with which, unhappily, we are too familiar in this country : there are few who have not to mourn the loss of some relation or friend taken from them, it may be, in early life, or after a period of association which had strengthened the ties of feeling existing between them. It spares no age or condition of life, finding its victims equally amidst those who are more exposed to its assaults, and those who are able to surround themselves with the best precautionary means of warding off its attacks.

It has heretofore defied all efforts to arrest its progress and avert its fatality. It unquestionably extends itself in all communities coincident with the spread of civilisation. The adoption of artificial modes of life would seem to render the constitution more prone to its inroads, while the increase of population, and the too frequent intermarriage of persons with contaminated constitutions, afford it abundant material for its ravages. The importance of the subject, therefore, can scarcely be overrated.

The frequency of its occurrence is established by the most partial glance at the recorded statistics of its mortality. It has been computed from these records that upwards of 71,000 persons die annually from this disease, which would be about 1 in every 300 of the entire population; and Sir James Clark, in his work on pulmonary consumption, says — " It has been calculated by the late Dr. Young, Dr. Woolcombe, and others, from the best data which the bills of mortality afford, that in Great Britain and Ireland consumption causes a fourth part of the deaths that occur from disease."

It is true that there are other forms of disease assailing the lungs which are very frequent and very fatal, and many of these have been undoubtedly frequently mistaken for consumption ; but even admitting this, we still find that none of them are comparable to this disease in fatality.

Within a few years, owing to a more exact compliance with the true principles of mortuary registration, a considerable proportion of deaths, which were formerly recorded under the head of phthisis, are now placed under that of bronchitis; the result of which is that the mortality from the latter disease has been made to appear numerically greater than that from consumption.

Whether this be an error of computation, or is due to the fact that the whole mortality from acute and chronic bronchitis is classified under the single head, or whether the improvements in science have enabled physicians to discriminate more completely between the chronic form of bronchitis and true tubercular consumption, is a subject open to discussion.

Experience has taught us that in all diseases in which the respiratory organs are implicated, especially in chronic cases of long standing, there is always a manifest tendency to ultimate destruction of the lung tissue, accompanied by depreciation of the vital powers, more or less rapid according to the extent of the lungs involved. This connection it is which has led to the conclusion arrived at by many writers, that they must be to a great extent regarded in the light of cause and effect. I am free to admit that a difference of opinion does exist on this point, but inasmuch as the same may be said with regard to many other pathological questions, it should not deter us from accepting it as true, particularly when we are able to point out what appear to be good reasons for the opinion — these reasons being founded on facts which are within the observation of every one who is familiar with these diseases.

If this view of the close relation existing between them be correct, then there can be do question that such a result would obtain more readily when there already existed any constitutional tendency to tubercular disease of the lungs. That catarrh, bronchitis, and some forms of asthma are the frequent precursors of phthisis is generally admitted j the reasons for which these may be regarded as causes of this disease will be found fully discussed in the section on the "Causes of Consumption."

When true consumption exists as the primary disease, the occurrence of any of those just alluded to will, of course, greatly aggravate the condition of the patient; increase the difficulty to be encountered in the treatment; and hasten the progress of the disease. Under such circumstances their removal becomes a necessity ; and it is fortunate that the local method of treatment advocated in this treatise is equally applicable to these different maladies.

When consumption is apprehended, without the preceding occurrence of any of these diseases, it becomes a matter of the greatest importance that its existence should be detected as early as possible.

The improvements, which have been introduced for examination of suspected cases, have placed within our reach various appliances and methods of procedure. In order to avail himself successfully of these means, the eye and the ear of the physician must be early educated in their use.

Among the examinations which are necessary I would first allude to inspection of the general form of the body, particularly of the chest, with relation to its size, mobility of its walls, position of the collar-bones, shoulders and ribs, these being essential points ; and the facility of distinguishing any departure from the natural appearance of this region must depend upon the practised eye of the observer. The regularity with which the act of breathing is performed, and the difference, if any, which exists between the action of both sides of the chest, must be carefully noted. The accordance between the respiration and the frequency of the pulse will also demand close attention.

The complexion and expression of the countenance, and the presence or absence of any of those indications which are known to denote certain constitutional conditions, must not be lost sight of. These are the points which demand that faculty of observation which education of the eye alone can give.

For the detection of those which are technically termed the physical signs, the employment of certain instruments is necessary. In order to determine any departure from the natural

INTRODUCTION.

standard of respiration, an instrument called a Spirometer is employed. This instrument was perfected by Mr. Hutchinson, and the observations which he conducted by its means have thrown much light upon the physiology of respiration, and resulted in the establishment of what is technically termed the ' vital capacity,' based upon the phenomena of inspiration and expiration. These phenomena are found to bear a close relation to the height of the body.

The following table has been constructed as the result of experimental researches by numerous observers : —

Table of the Vital Capacity in Relation to Height.

Height

Regular Progression.

From Observation.

Height

Regnlar Progression.

From Observation.

Ft. in. Ft. in.

Cubic inches.

Cubic inches.

Ft in. Ft in.

Cubic inches.

Cubic inches.

From this table it will be perceived that there should be a regular increase of eight cubic inches of air for every inch of stature. But as the result of many thousand observations, a variation from this regular progression has been noticed, this variation probably depending upon differences of conformation and muscular development.

It is obvious, therefore, that whenever any great difference exists between this natural standard and the actual power of respiration in those under examination, not to be accounted for by malformation, muscular debility, or any similar causes, we are justified in suspecting the existence of some obstruction to the function, situated within the lungs.

The measurement of the dimensions of the chest is a subject of much interest, and materially aids the physician in detecting those defects which may indicate the existence of a want of proper development, in itself an exciting cause of the disease.

The external dimensions differ in individuals, and this must be apparent to every one. From an interesting table prepared by a careful observer from a large number of admeasurements (the calculations being made from three classes, according to weight in relation to height), it appears that every increasing inch of stature causes the smallest chest to increase on an average nearly four-eighths of an inch ; the medium size rather more ; and the largest size five-eighths.

Mr. Hutchinson found a regular arithmetical progression in the circumference of the chest in relation to the weight of the body. It would seem that the chest increases exactly one inch for every ten pounds increase of weight ; this, however, is without reference to height, which cannot be well omitted from such calculations, as the height always influences the weight of the body.

The following relational proportions of admeasurement have been established by another observer : — Twice the breadth of the shoulders equals the circumference of the chest. Four times the distance between the nipples is equal to the circumference. It must be remembered, however, that this distance is relatively less in women than in men. Four times the depth of the chest is equal to its circumference ; so that the depth of the chest and the distance between the nipples is, or oucht to be, equal. At the height of 5ft. 9in. the depth of the chest varies from 7^ to 12^ inches.

These admeasurements indicate, it must be understood, the proportions of a well-formed chest in a full-grown, healthy person. Any departure from these proportions may lead to the suspicion of some fault within that cavity; the external conformation of the chest being modified by a variety of circumstances, such as age, sex, and the influence of occupation and disease. All these points must be taken into consideration in the examination of each individual case.

It is a popular belief that there is a close relation betv/een the volume of the lungs and the vigour of the constitution, but this is erroneous ; nor does the amount of air which can be respired bear anything like an exact relation to the size of the cavity of the chest. A small chest may in some persons admit of a deeper inspiration than a large one in others. This difference would seem in a great measure to depend upon the mobility of its walls, precisely in the same way as the volume of the blast from a pair of bellows is more dependent upon their movability than on their absolute size.

In the act of healthy respiration, when we apply the ear to any portion of the chest, three sounds, produced by the breathing, may be perceived ; those which are occasioned by inspiration and expiration, and that which is caused by the passage of the air through the cells of the lungs.

A perfect knowledge of the character of all these sounds, in the healthy state, is indispensable to the physician who seeks to discover the existence of disease within the lungs, or to determine its probable nature. From the instrument called a Stethoscope he derives material aid; for by it the sounds are intensified and made more distinct. This instrument is a simple tube made of some hard material, and adapted at one end to fit smoothly on the chest of the patient, and at the other to cover the ear of the listener. There is also another form of this instrument by which the physician is able to employ both ears at the same time, which possesses great advantage over the single tube.

The object of this method of examination is to detect those departures from the natural sounds which are known to indicate the presence of disease, as well as to recognise the special character of those sounds which accompany its various forms.

It requires a nice, acute ear, well educated for the purpose, to distinguish slight departures from the healthy pulmonary sounds, just as a practised eye is necessary to mark the deviation from the proper configuration and relative proportions of the chest, and the character and extent of its movements as influenced by disease ; and, indeed, with the best natural endowments this knowledge cannot be attained without the experience, which only years of practice on a large number of cases will confer. Every one ought to be examined regularly at stated periods during the year, and perhaps there are no seasons better suited for this than the broken weather of autumn and spring. Those who know themselves to be exposed to the chances of pulmonary disease, cannot be too jealous in the watch they keep over the earliest perceptible signs of its approach.

In addition to the use of the stethoscope for distinguishing the value of the signs of disease, as denoted by changes in the character of the respiration, we employ percussion to ascertain whether there be present in the lung any of those structural alterations produced by the deposit of foreign matter.

Percussion is best performed by placing the fingers of one hand firmly on the surface of the chest, and tapping them with those of the other hand gently, but with such force as to produce resonance through the cavity. There are various modifications of instruments employed for the purpose called " pleximeters," but none of these equal the fingers in practical utility.

On striking the healthy chest in this manner a clear sound is easily produced ; should there be, however, present within the cavity of the chest any products the results of disease, this sound will be altered in character according to the density of the deposited matter, its nearness to or distance from the surface ; a dullness is produced which will be circumscribed or diffused according to the extent of this deposit. This change of sound guides the physician in determining upon the position, extent, and probable nature of these deposits. There is also a peculiar but well-marked sound given out by striking the chest over the region of a cavity.

This mode of investigation becomes an invaluable aid in determining the existence of disease within the chest, and frequently forms a safe guide in the earliest period of tuberculous disease.

For the examination of the condition of the mucous membrane lining those passages which are accessible to sight, a small instrument made of highly-polished metal which acts as a reflector for condensing and throwing the light into them is employed ; and for the exploration of the larynx and windpipe an elaborate but highly-interesting apparatus called the " Laryngoscope" has been lately invented.

With this little instrument the more remote parts can be easily examined, and the existence of diseased conditions detected, which were formerly merely a matter of surmise and uncertainty.

The advantage which medical science has gained in recent

B years from the facilities offered by these several modes of investigation admits of no doubt. We can no longer be said to grope in the dark with regard to these diseases. We can measure the extent and determine the nature of the mischief which has been done to so vital an organ as the lung, and all who negltct to avail themselves of these means fall short of their duty to their patients, while those who object to their use deprive themselves of the benefits which are to be derived from their proper and judicious employment.

The great object to be attained in seeking to discover the nature of any disease is to enable the physician so to regulate his treatment as to promote its cure, and this, after all, is the only matter of any real interest and importance to those who are the victims of consumption.

We can hardly be surprised that with a knowledge of the large mortality resulting from this disease, the idea of its incurability should have obtained possession of the popular mind, and should have influenced, to a great extent, even the opinions of medical men. Some people are so thoroughly convinced of the impossibility of curing it that they condemn all efforts to accomplish this desirable result, and even stigmatise them as empirical.

The question of curability is one which has engaged the mind of the profession for a long period of time, and the conviction has been growing stronger every day that, with improved knowledge as to the true nature and source of the disease, and the confidence engendered in the minds of consumptives by this fact, we shall be able to adapt the treatment to the requirements of each ca3e at an earlier period, and on a more scientific and rational basis, than has hitherto been done.

It would be easy to show that the curability of consumption is a portion of the professional creed of many distinguished physicians.

The following extracts will be sufficient to illustrate this : —

Laennec, one of the most profound investigators of this disease, records his opinion in the following words : — " Recovery in cases of consumption, where the organ has not been wholly invaded, seems to me to present no character of impossibility, either as regards the nature of the disease or that of the organ affected."

Sir James Clark, another eminent authority, tells us — " That pulmonary consumption admits of a cure is no longer a matter of doubt ; it has been clearly demonstrated by the researches of Laennec and other modern pathologists."

Professor Carswell, probably the greatest pathologist England ever produced, observes — "Pathological anatomy has, perhaps, never afforded more conclusive evidence in proof of the curability of a disease, than it has in that of tubercular consumption. . . . The destruction of a part of the substance of the lungs is by no means necessarily mortal."

Dr. Hughes Bennet, Professor of Medicine in the University of Edinburgh, thus speaks on this point : — "The fact of the recovery from phthisis pulmonalis, even in its most advanced stage, can no longer be denied."

Dr. Swett, an American writer of great authority in his country, remarks — "Another important question presents itself. Is consumption a curable disease? The general impression in the medical profession is, that a patient with consumption is doomed to death. ... I have known a number of patients during the last fifteen years who have had the evidences of consumption, and sometimes in an advanced stage, who finally recovered, and are now in the enjoyment of good health."

Dr. J. Henry Bennet, in a paper on the treatment of pulmonary consumption, also records his testimony in favour of the curability of the disease as follows : — " The fact to which I have to testify is, that pulmonary consumption is a curable disease — indeed, in its early stages a very curable disease — under proper treatment."

And Dr. Cotton, whose experience in this disease is unquestionable, says — " The possibility of tubercle becoming absorbed has been much questioned ; but I have witnessed so many instances in which recovery was complete, and all evidence of pulmonary disease was entirely dissipated, after every general and physical symptom of tubercular deposition had been most unmistakably manifested, that I cannot for a moment doubt its occurrence — less often, it is true, than we could desire, but sufficiently frequent to encourage a hope, and to lead to a steady perse veranco in those measures which are likely to promote it.''

In reflecting on this subject the question naturally suggests itself, Why should consumption be incurable ? That it has defied the therapeutic means hitherto employed is no reason why it should for ever remain beyond the reach of our curative efforts. As the revelations of science have made us better acquainted with the nature of this disease, surely the application of those principles which a more extended knowledge of it, of the properties of remedies, and, above all, of a different method of administering them, will make our efforts more successful in the future.

It cannot be denied that much of the want of faith in the power of medicines to cure this disease arises from the failure which has hitherto attended their administration solely by the stomach. This failure has been acknowledged by authorities competent, from their great experience and abundant opportunities of observation, to form a correct judgment on this very important point.

Sir James Clark, whose opinions I have already freely referred to, says — " The total inefficacy of all means hitherto adopted for diminishing the frequency or reducing the mortality of this class of disease, is of itself sufficient incitement to us to seek for some other method of remedying the evil."

Dr. Davies, Consulting Physician to the Infirmary for Asthma and Consumption, remarks in his lectures — " I now arrive at the least satisfactory part of this subject, I mean the treatment of consumption ; for I am convinced that art has done little more than palliate this disease."

And Sir Alexander Crichton, a leading authoricy in his day, observes — " That pulmonary consumption cannot be cured by medicines which act through the medium of the stomach, the whole history of our art proves to ua."

A greater number of authorities on this subject might easily have been selected, but I think I have quoted sufficient to establish the point ; it may not, however, be unadvisable, in. commenting upon this failure, to review to some extent what the general features of treatment heretofore pur.-iued have been.

Under the erroneous impression that consumption was the result of inflammation of the structure of the lung, blood-letting was proposed and largely employed, but was ultimately given up; partly in consequence of disappointment at the results obtained, and partly in accordance with the general abandonment of this method of treatment.

The administration of emetics was also carried to a very great extent, and obtained a considerable amount of favour with most practitioners, under the impression that the digestive functions e were chiefly at fault, and that by the use of these medioiues expectoration would be favoured, and the lungs would thus be thoroughly relieved. Another of the older remedies relied upon was mercury, given in some of its various preparations. This at length fell into disfavour, and came to be regarded with great distrust, even to the extent of supposing it to be capabl of producing the disease. Few, however, now employ this medicine to produce salivation, as was formerly done ; while a large majority of physicians condemn its use in consumption altogether as being extremely prejudicial.