Consumption curable; and the manner in which nature as well as remedial art operates in effecting a healing process in cases of consumption; explained and illustrated by numerous remarkable and interesting cases ..

Front matter

YALE MEDICAL LIBRARY

HISTORICAL LIBRARY

COLLECTION OF

Preface

TO THE-F1RST EDITION.

Most men have some one darling wish, which forms the central point to which all their ideas and feelings verge. My attention was directed at my outset in the profession to that tremendous disease, which, from its wasting effects on the human frame, too truly and appropriately bears the name of Consumption. I found those to whose experience I looked to direct and guide me, themselves walking in the dark. Books only displayed to me a mass of crude, ill-arranged, unreasoned-upon facts, or the fanciful chimeras of medical visionaries. : I saw that those branches of knowledge which had been redeemed from the

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wastes of empiricism, and brought within the pale of art, had been indebted for this successful issue to the system of induction which owns Bacon as its father. The assemblage of facts without classification, and this last without careful investigation of specific differences, might, and did, I perceived, pass for labour and observation, but was certainly not science. I felt mortified and degraded at the utter inefficacy of medicine, and of medical art, in this the commonest of diseases ; and I was soon convinced that the only means of rescuing my profession from this " darkness visible" was to make the physician subordinate to the anatomist. I had yet a higher object in view — that of mitigating human suffering. I have toiled to this end, and what I felt to be my duty has been my reward. In no boastful spirit do I speak, but in a thankful one. I have proved that there is a cure for what has hitherto been deemed incurable ; and this, no drug known but to its compounder, but a simple mechanical process available to all. That which has been as

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yet confused, is, I would hope, rendered clear : and I trust that modes of treatment resulting up to this period from conjecture, and leading but too often to confirm the disease they were intended to cure, will soon pass away with other exploded practice, that now moves but our pity,

or our disgust.

March, 1834.

PREFACE

TO THE SECOND EDITION.

"It is passing strange" that medical attention, in this country, should have been so little directed to the pathological consideration of Consumption. Nor is it less so, that consumptive patients are expressly excluded by the regulations, from more than one of the metropolitan hospitals. We are chiefly indebted to foreign writers for anatomical investigations of the various diseases connected

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with the chest ; although they have done but little towards developing any plan of treatment, holding out decided hopes of success, in Consumption. The ill fortune which characterized the means usually pursued by the profession, in consumptive cases, early struck my attention. My medical brethren appeared, with respect to this disease, to be as rigid fatalists as the Mahommedan ; and to resign themselves calmly to the belief, that when once Consumption appeared, human efforts could be of no avail. Yet this apathetic resignation was neither consistent with reason, nor with sound philosophy. No man could feel more deeply than myself that the issue is ever in the hands of the Omnipotent ; but I could not bring myself to the conclusion, that, because failure had hitherto attended human agency, to cure was therefore impossible. I could not sit down like our Oriental prototypes, with the exclamation, "Allah Akbar," and do nothing. Such were my impressions, and such my reasoning, twenty years ago. It appeared to me, that not only the treatment of Pulmonary

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Consumption was ill-understood, but that the pathology of most of t'he affections of the chest, had not received that investigation which they deserved. Yet none are more important, or indeed, taking their number into consideration, so much so ; seeing that the heart and lungs constitute the two main props of what, together with the brain, Bordeu felicitously terms the tripod of life. For the time just mentioned, it has been one of the chief objects of my professional labours to advance our knowledge of this interesting class of diseases. The vacancy which the resignation of Dr. Buxton (for several years Physician to the London Hospi-

*

tal,) left at the Infirmary for Diseasesof theChest, presenting the only favourable opportunity London affords for seeing, in large numbers, every variety of case connected with pulmonary and other affections of the chest, was eagerly embraced by me. I was fortunate enough to obtain the situation of Physician to the Infirmary; and trust that the present work will prove I have not misemployed the abundant facilities it holds out,

PREFACE.

for investigating the pathology of these diseases.

I feel a sincere pleasure in stating the reception which the first edition of " Consumption Curable" has met with, from the liberal portion of my profession. The letters I have received, from intelligent practitioners in every part of the United Kingdom, have gratified me in more than a selfish point of view. They have proved to me that, however interested motives may bias some, there is an active and honourable spirit abroad in the profession at large, which induces a frank and manly openness to conviction. The owls, who shut their eyes to the light of truth, because it would guide others through the " palpable obscure," are likely soon to be left alone in their blindness. An amended medical education will rectify all these things.

It will not be thought that I overrate the importance of the diseases affecting the chest, when it is considered that scarcely any part of the body can be indisposed without the chest's participating. Yet it isconsolatory to reflect* to employ the words

September, 1834.

PREF A CE

TO THE THIRD EDITION.

In answering the demand for a new edition of the present work, it is gratifying to state that I find my opinions are rapidly gaining ground abroad, and steadily extending at home. To the German translators, especially, of "Consumption Curable," for it has been honoured by several distinct translations into that language, and to Dr. Hohnbaum, in particular, I am much indebted. The preface of this justly celebrated individual is liberal and philosophic. Too thoroughly informed in his art to deny the curability of Phthisis, he was of too enlarged a mind to refuse my system a fair trial, merely on the score of its

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novelty, and too high principled to withhold his testimony to its success. In the Appendix will be found the cases with which he has enriched his translation.

I may mention it as a proof of the earnestness of the foreign medical press in the diffusion of our common art, that translations of my work have been forwarded to me from the most opposite parts of the continent. The last I have received is from the pen of Dr. Schmidt, and was published at Pesth, Hungary: it is a second edition of my first edition.

In this country, likewise, I am proud and anxious to acknowledge, that if I have encountered much prejudice, I have also met with great liberality. The cases submitted to me by country practitioners, would alone be satisfactory evidence of the spread of sounder opinions on the pathology and treatment of Pulmonary Consumption. But this acknowledgement is not to be confined to the provinces. Were it not for the fear of exposing them to ungenerous attacks and the vexations of

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professional controversy, I might name several eminent physicians of the metropolis, who coincide with my views frankly and fairly ; others there are, who quietly imitate my practice, and thus tacitly pay it the best compliment ; whilst the numerous cases to which I am called in by the general practitioner, warrant me in believing that I was not too sanguine when I ventured to say in my first preface— "I trust that modes of treatment resulting up to this period from conjecture, and leading but too often to confirm the disease they were intended to cure, will soon pass away with other exploded practice that now moves but our pity, or our disgust.''

Still, as must ever be expected in the outset, there is no lack of opposition to these views. Many refuse to examine their validity : many examine, with a fixed determination not to be convinced. Others again esteem themselves too much, to credit the possibility of cure where they have failed : it would be to deny their own talent, to confess their inferiority, in short— a bad

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compliment to self. Some there may be— but this is hypothetical,— who regard the increasing reputation of another as so much subtracted from their own treasury. With such, the abridging the duration of disease, and still more the preventing its ingression is to "bringdown the rate of usance here r" to cure, above all to avert the need of cure is not in their " bond."

Since the publication of the present treatise, three works have issued from the press on the same subject, or partly so. It would be uncourteous to pass them over in silence ; and I am quite willing to give them the " honour due." They differ in point of literary, and are unequal as regards their medical merit ; but, in one respect, they are on the same level. Their authors agree that they cannot cure Consumption, which is highly probable ; they likewise agree that it cannot be cured, which is directly opposed to the highest authority on the subject, and is the reverse of my own experience. To begin with the work of Dr. James Clark. Since this gentle-

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man passed the greater part of his professional life, (at least before I had the honour of being one of his Examiners at the College of Physicians) among the English resident in Rome, his field of observation must, I presume, have been rather limited. However, taking Laennec, Louis, and Andral for his guides, he has produced a very neat compilation from their admirable volumes. His work is destitute of originality ; to which, I should suppose, its author hardly lays claim. The point on which he insists most strongly is, that "the constitutional origin of tubercles, by far the most important part of the subject, has been neglected ; "and he would appear by the context to imagine that he was fixing attention for the first time on an essential principle, since he adds " if we succeed in giving a satisfactory exposition of this, the most important, but hitherto most neglected part of our subject, we may hope to lay the foundation of a sounder pathology of tuberculous disease." Nothing can be more true; but, without referring to the writers who precede us both,

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had he bestowed a glance on my pages, he would have seen the same doctrine strenuously insisted upon. To adduce one, out of various passages of like tenour, I observe p. 21, "Many writers are of opinion, that various thoracic diseases are a fruitful cause of Consumption ; but I am satisfied that this supposition is groundless. It is merely owing to the loss of health entailed by them, that the development of those accidental productions, called tubercles, takes place. To enumerate the various causes of Consumption would be endless ; for, in fact, whatever is capable of impairing the constitution is liable to produce a phthisical state." Surely, the Doctor's "exposition" and mine are convertible— alter et idem.

Would it not lead to too great a length, I should feel proud to bring forward the coincidences which occur between Dr. Clark's work and mine, whenever he propounds any notion bearing the appearance of novelty. Yet, by a strange predilection for the despairing side of the

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question, he . invariably declines following out such notions to their practical results. He appears to labour under a morbid dread of the curability of Consumption ; although, in deference to Laennec, he is constrained to admit those pathological facts on which I ground the rationale of my practice. Thus he confesses, that "although caverns generally tend to increase in size, yet not infrequently when they occur singly, and when no fresh depositions of tubercles take place, they remain a long while stationary. In cases still more uncommon, they gradually contract and become obliterated." — Again, " in a very large proportion of cases, it is only in the early stage we can hope to effect a cure.' ' There are some then, that may be cured at a more advanced stage % Euge ! the Doctor after this may surely go a step further, and exclaim with Laennec— "cure in cases of Pulmonary Phthisis, in which complete disorganization of the lungs has not taken place, ought not to be considered impossible either as regards the nature of the disease, or the organ

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affected." It is singular that a medical man should deny the curability of Phthisis, after excepting "the small proportion of cases in which the tuberculous deposit is confined within narrow limits." If we believe this writer, Consumption is not curable— but there are exceptions it seems. Truly there are ; and had these cases of exception been thoroughly investigated, and the process by which they were effected diligently traced, the instances of failure would long since have taken their place, and have themselves become the exceptions. I speak confidently on this head, as my experience warrants it.

The Doctor too, by some unhappy slip of memory, is at variance with another writer, a coadjutor of his in the " Cyclopaedia of Practical Medicine," for whom he professes a profound deference. This gentleman, Dr. Carswell, observes in his article on "Tubercle," speaking of Consumption, " the important fact of the curability of this disease has, in our opinion, been satisfactorily established by Laennec." And let me add

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in the opinion of every one who has read the immortal work of that great man— and understood it. Dr. Clark, however, does not absolutely deny the possibility of curing the disease, but "damns with civil sneer." Cases of cure do happen— rare exceptions. Of course— rare enough with those who do not know how to treat the disease. Rare and fortuitous, I grant, previously to the appearance of my publication. Yet, although his own treatment may be productive of anything but satisfactory results, why not state with Laennec, that there is no valid reason, " either as regards the nature of the disease, or the organ affected," why Consumption should not be cured'? Why so lachrymose, when his chief authority holds out such hope %

The above writer is " followed to the field" by Dr. T. Davies; the motto to whose Lectures on Diseases of the Chest might aptly be " abandonnate speranzavoi cK 'entrate." This work seems to be a synopsis of that of Laennec ; and is inferior to Dr. Clark's, inasmuch as it is chiefly borrowed

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from one authority, instead of from three or four. But, on the one favorite point, Dr. Davies has deviated from his sworn guide still further than Dr. Clark. The one is reluctant to admit the curability of Consumption, allowing, however, that such an event does occasionally happen ; the other boldly proclaims, in the teeth of his exemplar, that it is not curable. He speaks, I presume, from his own experience : he may have been uniformly unsuccessful, and hence his claim to be so positive. Yet, incurable as he may have found the disease, it is singular that after following Laennec with almost servile idolatry, he should arrive at directly opposite conclusions. Laennec supposed, and truly, that he had not only discovered a series of signs throwing the clearest light on the diagnosis of Consumptive disease, but, that by establishing its pathology on a broader and sounder basis, he had proved the possibility of cure and paved the way for important practical results. Dr. Davies, however, although he has lit his own rushlight,

(" And lights his farthing candle at the sun")

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at the lamp of that great man, and painfully picks his steps by its assistance, suddenly extinguishes it as he approaches his labours' end, and jumps for safety into the Slough of Despond. ' Follow Laennec,' he exclaims to his pupils, ' I can give you no better guide ; but do not go straight to the mark with him and attempt to cure Consumption ; stop short and be warned by me,— for I have enjoyed a liberal'allowance of failure, — that it cannot be cured.'

Another of our medical illuminati, Dr. Latham, of St. Bartholomew's, has condescended to complete the triumvirate, and has just published his version of Laennec, under the title of "Lectures on Subjects connected with Clinical Medicine." After an introduction, in which he informs us that surgery is more popular than medicine, " because it is easier," he proceeds to treat of the signs afforded by auscultation. These he divides into the moist and dry, and appears to conceive, that he has thus made a novel and important distinction. So in fact he would, did he not labour under the

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disadvantage of having been anticipated by Laennec. As a specimen of the innocent method in which he assumes the tone of a discoverer, I quote his conjectures as to the causes productive of the sign which is termed sibilus. " Sibilus may then, (in spasmodic asthma,) if ever, be truly called a dry sound. But lam not sure that the sibilus directly results from the mere condition of dryness ; I doubt whether simple dryness alone would naturally produce it. Inconsequence of its dryness the mucous membrane may lose its elasticity, and become to a certain degree unyielding ; or it may undergo wrinklings, or puckerings, at various spaces; or its general tumefaction may produce a narrowing of the smaller tubes, and thus present obstacles to the passage of air, and impart to it new vibrations ; and hence the sibilus." Let us see what Laennec said touching the same sign some eighteen years before. According to this writer, that variety of the dry sibilous rhonchus which is " more strictly sibilous, is probably occasioned by a local contraction of the smaller

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bronchi, from thickening of their inner membrane." This short sentence is the key note on which Dr. Latham rings the amplifications, which he ushers in with the modest "I am not sure that," "I doubt whether," until he arrives at Laennec and the root of the matter with his " it may undergo wrinklings, or puckerings, at various spaces, or its general tumefaction may produce a narrowing of the smaller tubes." Proceeding to illustrate the said sibilus still further, he describes the case of a little boy, in whose chest a shrill sibilus had taken place of the natural respiratory murmur, — " wherever you applied your ear to the chest, you might fancy you heard the piping and screaming of a nest of unfledged birds." How delightfully this simile is brought in as a new and felicitous illustration with the "you might fancy:" and how poetically has he decorated the dry, matter of fact, detail of Laennec, who writes—" the dry sibilous rhonchus is of very various character. Sometimes it is like a prolonged whistle, flat or sharp, dull or loud ; sometimes it is very mo-

PREFACE. XXV mentary, and resembles the chirping of birds." Truly, Dr. Latham deserves credit for his ingenuity. It would be amusing enough to show, page by page, how dexterously the Baitholomew professor twists Laennec into a new shape. Sometimes he swells a few words into a mass of well-rounded periods ; at others, he reverses the process, and compresses, with crushing effect as to sense and information, a series of nicely evolved deductions into a few disjointed sentences. In fact, he has put Laennec into his literary mill, ground him down, and then leavened him with his own leaven, with that peculiar skill in the process which might excite the envy of a "bookseller's hack." His art in appropriating good things, is only to be equalled by his aptitude to spoil them while in the act of " conveying."

Dr. Latham is equally guiltless with his comates, of enlarging the boundaries of science ; and is also equally anxious to announce his want of success in the treatment of Consumptive disease. He has very wisely devoted a volume to

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shew the marvels he can achieve by means of auscultation, with what precision he can calculate the ravages of the disease, and oh ! the art of sinking,— how utterly unable he is to cope with it. "All the world," he exclaims, "is asking us whether Consumption be curable" {sic in original.) Indeed ! It has come to this, has it 1 I am personally obliged by the confession. Dr. Latham has now only one more step to make, and he will discover some fine morning that Consumption is Curable. The pressure from without will jog him and his brethren on. All the world asks the question ! This coincides with my own opinion ; and I find people come a long way to ask it. I have had individuals of this inquisitive turn of mind, who have come from Sweden, from Russia, from both the East and West Indies, and from other distant quarters, to ask the aforesaid question, and, they were satisfied with my answer; although I must think they would have repented their trouble had I given them Dr. Latham's. Dr. Latham is much more elaborate than his

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non-curing coadjutors, in displaying his disbelief of the curability of Consumption. He reasons ! at some length on this, to these gentlemen, all important point. So eager indeed are the trio to prove to their patients their inability to cure Consumption, that I verily believe they would willingly ^contract the disease, were it possible, and die in order to support their doctrine. They would be cheerful martyrs to their professional faith, and perish honorably secundum artem.

But to return to Dr. Latham's reasoning. It is so exquisite a thing of the kind, that I should do him injustice, were I not to give it in his own words. "In examining by dissection the bodies of those who die of Pulmonary Consumption we occasionally find the traces of a vomica healed. But in those who have not died of any pulmonary symptoms, (die of symptoms!) and who were never known during their lives to have any symptoms apparently ; the same evidences have been found after death of what was once a vomica. This is a cure, or tantamount to a cure, but it

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was a Consumption which nobody knew to exist." Proceeding then to the question which he describes all the world to be asking, he rejoins " it is a mockery to answer 'Consumption is a curable disease ;' because, forsooth, its entire process from beginning to end— its formation, progress, cure, may be secretly transacted within the body without our knowing, or suspecting anything about it." This is superlative. I meet a person whose face is seamed with the scars left by small pox, and because I did not see him when labouring under the disease, I deny that he ever had it. I am in company with another who has lost an eye, and because I did not witness the loss, I assert that it is in his head. A patient dies, as is supposed, of eruptive fever, for which he has been treated, but dissection proves that pneumonia was the more immediate cause of death ; still as the pneumonia was not discoverable during life— ergo, says Dr. Latham, exist it did not. In short, according to this writer's newly invented logic, there can be no such thing as latent disease because it is "se-

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cretly transacted within the body," and as he ingenuously adds, " without our knowing or suspecting anything about it"— a circumstance which an ordinary man would suppose implied in the word secretly.

Should we be rash enough to affirm that Dr. Latham exists without brains, because no traces of them are at present discernible 1 Far from us be such rigid logic— we will not test the Doctor by his own rule.

Did I leave the above quotations from Dr. Latham's work as they now stand, I should act, as Dr. Latham has done by the question at issue, most disingenuously. I will quote his special pleading verbatim et literatim, and give him all the benefit of it. By the abstract made above, every word of which is his— although separated from the context, I have been enabled to shew the naked folly of his reasoning. The context will render manifest either his disingenuousness, or, if written in good faith, his ignorance.

" Does Consumption ever admit of cure'? If

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ever, it must surely be when it occurs in the form which we are now considering.— (i. e. in the form termed by Dr. Latham unmixed phthisis)— het us, therefore, now give a few moments to this interesting question. A vomica certainly does admit of reparation so far as not to be a vomica any longer, but not so far as to leave behind it no trace within the lungs. It leaves behind it a scar— that is, the disease ceases in the part, but the part is not restored to the exact condition in which it was before the disease began. In examining by dissection the bodies of those who die of Pulmonary Consumption, among many existing Vomicae we occasionally find the traces of a Vomica healed. At the apex of the lung we find an indentation, and descending from it, for half an inch or an inch, a thick perpendicular line of tough ligamentous substance. Sometimes this substance, by being pulled asunder, is discovered to contain the remains of a cavity, and sometimes not. But what imports this reparation of a single Vomica, if so many besides still exist % A reparation of a

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twentieth part of the existing disease cannot be called a cure. But in those who have not died of any pulmonary symptoms, and who were never known during their lives to have had any symptoms apparently phthisical, the same evidences have been found after death of what once was a Vomica, but no existing Vomica together with it. This is a cure, or tantamount to a cure. It is as much a cure as when a single scrofulous cervical gland goes on to suppuration, and heals with a scar. A single Vomica, you may say, is as much of the essence of Consumption as a hundred ; and if the morbid structure (no matter how small) in which the disease essentially consists be repaired, the disease is cured ; that is, the Consumption is cured. But it was a Consumption nobody knew to exist. Now all this may be very fine reasoning ; but it does not meet the plain meaning of the inquiry, whether Consumption be curable. It is not proof enough to common sense of its being so, that a few isolated Vomicae, which gave no sign of their existence,

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should have undergone reparation. All the world is asking us whether Consumption be curable ?• Indeed, all the world is interested in the question : for there is hardly a family into which Consumption, sooner or later, does not enter : and when a man makes the inquiry (as it were) speculatively, or indifferently, he has most likely a real practical interest in it at home. He says, 'Is Consumption a curable disease V But he would say, ' I have awife or a child, a brother or asister, who is decidedly consumptive ; is there the least possible hope left me that they can recover V To the question proposed with such intent, it is a mockery to answer ' Consumption is a curable disease' ; because, forsooth, its entire process from beginning to end— its formation, progress, curemay be secretly transacted within the body without our knowing or suspecting anything about it. If you ask me, as a Physician, whether I have ever had experience of a perfect and satisfactory recovery taking place, where there have been all the best known popular symptoms, which (as far

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as they go, no Physician could possibly say were not those of Phthisis % I answer, 'Often.' Bat if you ask me whether I have ever had experience of the like perfect and satisfactory recovery where there were all these popular symptoms, and, withal, the conditions proper to Phthisis, ascertained by auscultatory signs to exist beyond a doubt within the lungs % I answer, ' Hitherto, never.' What shall we say then % How shall we answer the popular question in the popular sense, and still answer it truly % We cannot say that Consumption is curable ; but we can say, and truly, that there are cases of imputed Consumption which put on such an aspect of the real disease, that they are with difficulty distinguished from it, yet have not its essence. These are all within the possibility of cure." p. 254, et seq. The chain of reasoning, such as it is, in the above, is substantially the same as in the abstract first given— its gist being the consoling discovery that whatever we are ignorant of does not exist. But there is this addition; that traces of a healed vomica are said

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to be found among existing vomicae in the bodies of those who die of Pulmonary Consumption, but to exist in a solitary state when occurring in those who were never known during their lives to have had any symptoms apparently phthisical. The interpretation designed by the Doctor to be put on this statement is, of course, that the vomica in the one case belongs to real Consumption, and in the other is accidental.