Consumption curable, and the manner in which nature ... : operates in effecting a healing process ... to which is added, a mode of treatment, by which the development of tubercles may be prevented

Front matter

(a

JL c^C^r ley a~ Jtns\>^_i.CKAsy /<P~y ' £

YALE MEDICAL LIBRARY

Appendix

Description of Plates .... 188

ERRATA.

Page 38, line 13 from bottom, lege, " on the exterior of the

the cyst." 186, line 3 from bottom, lege, "over the great cornu

of the thyroid cartilage."

TO THE FIRST EDITION.

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

Preface

deemed from the vyastes 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 ol 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 meclian'rcal process available to all.. That, which x PREFACE.

been as yet confused, is, I would hope, rendered fclear\ and I trust that modes \>{ treatment resultLrrg\p to this period from ^conjecture, and leadin^vbut\»<iJ)fteH.t6 con\rm^thd disea&Njhey were intended other exploded pity, or ou

TO THE SECOND EDITION.

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

PREFACE.

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 consistent, neither with reason nor 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 consumption was ill-understood, but that the pathology of most of the affections of the chest, had not received that investigation which they deserved. Yet none are more important, or indeed, taking their number into consideration, so much so ; seeing that the heart and lungs constitute the two

PREFACE.

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

PREFACE.

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 is consolatory to reflect, to employ the words of Laennec, that " Quelque dangereuses que soient les maladies de la poitrine, elles sont cependant plus souvent curables qu'aucune autre muladie interne grave."

'24, Ely-place.

September 22, 1834.

Introduction

I am induced, from my long connexion with the Infirmary for Asthma, Consumption, and other Diseases of the Chest, the only institution of the kind in this country, and as far as I have been able to ascertain, in Europe, to publish my opinions on the treatment of Pulmonary Consumption — a disease unfortunately too well known to the inhabitants of this clime, by its prevalence and fatality. Having been thus for nearly fourteen years placed in a situation which has given me unrivalled opportunities of seeing numerous cases of this disease I conceive it a duty I owe the public, through whose philanthropic aid the above charity has been long and liberally supported, to present them with the fruits of my labours, and unreservedly to state how far medical art is capable of arresting a disease to which nearly one-third of the adult population falls a sacrifice.

B ii INTRODUCTION.

The results which have hitherto attended the treatment of phthisis, have added but little to the reputation of the medical profession. I am fully satisfied, however, from the experience of years in treating this important malady as well as from the deductions of unremitting-pathological research, that it is in our power to adopt a line of practice more scientific, and successful, than that which has hitherto been employed.

Though great attention has been bestowed by several distinguished continental writers, especially by Laennec, Andral, and Louis, on the physical signs and morbid appearances of consumption, and notwithstanding cases have been minutely detailed by them in which nature has effected a cure, still they seem to me to have had little idea that we can do more than relieve indications purely symptomatic.

A modern writer on consumption in this country, the late Dr. Young of ^George's Hospital, who did not pay that attentionV* morbid anatomy, so commendable in our Gatnc neighbours, but whose opportunities of treating the disease were considerable, favours us with an opinion as to its curability, which is very discouraging. He says, " It is probable that without assistance, not one case in a thousand of the disease would recover ;

INTRODUCTION. iii

and with the utmost power of art, perhaps, not more than one in a hundred will be found curable." It is my intention, in the succeeding pages, briefly to shew that this statement is unfounded in fact ; and that medical treatment has, in not a few instances, tended to prevent, rather than advance recovery. I trust, too, I shall demonstrate, in the histories of some of my cases, that recovery has been owing, in a great measure, to the superven^ tion of some catarrhal disease occurring spontaneously through an apparently imprudent exposure to cold, after remedial agents had failed.

The reader will probably learn with some degree of surprise, that no inconsiderable number of catarrhal and asthmatical disorders, are, indeed, the sequelae of the disease, which forms the subject of this work, more or less perfectly cured. Had the learned Doctor, whose name I have recently quoted, been at the pains' to investigate the primary symptoms of such disorders, he would have found, in many instances,Ahat they displayed all the common symptoms of pulmonary consumption ; and had this hospital physician been accustomed to the examination of dead bodies, he would have discovered, in more than one-fourth of the adult subjects examined after death, cicatrizations indicative

of cured consumption ; and on rinding these ap-

b 2 iv INTRODUCTION.

pearances, had he enquired of some near relative of the deceased if the individuals, at any period of their lives, had for a time expectorated blood — had been troubled with indomitable cough, night sweats, diarrhoea, with emaciation of the body — or had been regarded by their medical attendants as consumptive, he would probably have arrived at a more favourable conclusion.

It is, indeed, strange that medical men have not noticed the non-liability of the asthmatic individual to pulmonary consumption ; and that various species of catarrh are the instruments by which nature chiefly arrests that disease. It has been observed by me for years past, and on many occasions I have particularly remarked to my pupils, that asthmatics (I mean those persons whose lungs are emphysematous), however long exposed to circumstances that favour the tubercular development in the lungs, never become consumptive. Indeed I have long found, and it is a remarkable fact, that whenever the general health has been impaired by some ailment of a chronic and even incurable nature, provided the individual have a voluminous and catarrhal state of the lungs, no phthisical state supervenes, which is unhappily in too many cases the more immediate cause of death, the foregoing pathological condition not existing.

introduction.

From having long observed the asthmatic state o£ the lungs, which is frequently witnessed on the dissection of persons, who, having recovered from consumption, have died from some other cause, I am induced to recommend artificial means to be early employed for the healing of ulcerous phthisis After the careful examination of at least three thou sand dead bodies, and after having had under m} care many thousand consumptive cases, my fixed opinion is, that ulcers of the lungs are most effectually cured, and a fresh formation of tubercles prevented, by an expansion of the vesicular structure of the lungs ; which it will be seen hereafter is, in many instances, brought on by chronic catarrh. Before tuberculous excavations have taken place, and even after their existence is ascertained by stethoscopic signs, there is an absence, except towards the close of the disease, of any catarrhal affection, or at least its continuance is only of short duration. I know this statement of the non-existence of a catarrhal state accompanying phthisis, is opposed to what appears in the excellent work of M. Laennec ; but I am satisfied of its general correctness, and that extended research will confirm my assertions.

Independently of the extensive experience obtained through my situation in the Infirmary for vi INTRODUCTION.

Diseases of the Cliest, I have enjoyed the advantages afforded by no inconsiderable share of private practice, as well as a wide field of inquiry opened to me for several years, at the Central Infirmary and Dispensary, an institution established, and in a great degree upheld, at my own expense, for all classes of diseases ; and where, from my being physician to the first mentioned charity, I had a more numerous assemblage than is generally seen in any institution of a similar kind, of patients affected with some disease or other of the chest.

It affords me pleasure to state, that my practice at both institutions has been attended by numerous and intelligent classes of pupils, who had opportunities, equally with myself, of witnessing the recovery of many consumptive persons, and of ascertaining that peculiar condition of the lungs, which I have already pointed out as invariably occurring when a cure has been effected.

GENERAL OBSERVATIONS

ON 1

CONSUMPTION^

Chap. I

The mortality which annually takes place in this country through consumptive disease is a melancholy truism, although its extent, familiar as it may appear, is yet imperfectly known. The ordinary estimate, and this as I shall subsequently prove far from an exaggerated one, gives one-fourth of the deaths yearly occurring in this ever-varying climate, as consequent on pulmonary consumption alone. Dreadful as this amount seems, yet since numerous instances exist of patients labouring under chronic diseases, as dyspepsia, cancer, severe diseases of the bones, joints, &c, or any other affections by which the general system may have been deteriorated, who owe the immediate cause of their death, not to these complaints, but to the supervention of consumption, it is evident that the proportion of one-fourth is indeed lower than the truth. Again, considering the frequency of cases in which asthmatic, or catarrhal, complaints arise in the first instance from consumption, which, though arrested or finally cured, occasions these very complaints as its consequences, I may fairly assume that the startling proposition I have laid down is corroborated by fact. To individuals, unaccustomed to extended pathological researches, my assertions will, at first sight, undoubtedly appear rash and hypothetical. The pathologist, who is deserving of the name, will either from his own experience be ready to acquiesce in my views, or at least will candidly endeavour, by further inquiries, to verify conclusions arrived at by the labours of years ; and this at a sacrifice both of time and money, which none but the very few who cultivate this branch of science with the zeal and assiduity its importance deserves, are prepared to estimate.

In addition to the reasons I have just given, to show the inaccurate statement presented by the bills of mortality, I could enumerate numerous instances in which the real as distinguished from the apparent causes of the patient's death, would oft'er conclusive testimony to my position. Frequent are the cases in which an individual will suddenly expire after a violent expectoration of* blood, and his decease be attributed to a ruptured blood-vessel, when indeed this hemorrhage has been consequent solely on latent and unsuspected phthisis. My readers must not misconceive me to state, that every case of sudden death from spitting of blood arises from the little suspected presence of this destroyer ; but that, in not a few instances, consumption is indisputably the pre-existing cause. It were easy to adduce further statements corroborative of the soundness of my conclusions ; but I have, I should think, stated sufficient to induce conviction of their reasonableness, if not of their entire validity.

The first questions to be considered are, to what the frequency of this disease is owing, how it is produced, and in what manner its ravages are unfortunately extended. The prevalence of consumption has longbeen attributed to the proverbial variableness of our climate ; but the mode by which this operates upon the constitution has not been clearly explained. It seems to me, however, that the action of the climate on the system may be reduced to three distinct heads, each equally common, and equally fatal : checked perspiration, retaining the superfluous humours, and thus vitiating the fluids of the body — constant fluctuations of health, resulting from constant atmospheric changes

—and dejection of spirits, caused by mental troubles. To these may be subjoined an unfortunate configuration of the body, consisting in an undue narrowness of the chest, especially in its upper part, less observable in foreigners than among ourselves. It is not necessary to dilate upon the process by which checked perspiration lays the foundation of this dreadful malady j since it must be evident to the tyro, that when those humours which pass oft' insensibly in a healthy state of the body are retained, and the natural functions thus disturbed, disease more or less extensive will inevitably ensue. With respect to the second of these heads, it may to the ordinary observer appear superfluous to insist upon the ill effects generated by constant change of weather, in persons not only of delicate but even of robust habits; still, obvious as these effects are, it is not quite so apparent in what they consist, or rather how they are produced. Now, when we take into consideration the peculiarly delicate conformation of the lungs, and their immediate susceptibility of every alteration in the atmosphere, we at once arrive at a resolution of the question. It is essential, in order to maintain a healthy action and proper configuration of the chest, that our inspirations should be uniformly deep and full ; but, from the great inequality of atmospheric pressure resulting from the constant fluctuations of the weather, the depth and fulness of the inspiration are exposed to frequent diminution ; and that play of the chest which is as requisite to a healthy state of the lungs as exercise to muscular development, is consequently subject to repeated checks.

Thus, owing to the want of due excitement, or, more strictly speaking, of proper exercise, the healthy functions of the chest become deranged, its expansion is restricted, its action languid, and by degrees its shape alters ; so that, instead of the bony compages of the chest being forced boldly out in a somewhat semicircular form, and the sternum pushed forward, the ribs fall in, drawing the breast- bone backward to a position nearer the spinal column than is the case in its natural movement. Now, to bear out and verify the foregoing remarks, by showing how requisite the expansible power of the chest is to the healthy constitution of the lungs, I would state, as almost an invariable law, that the commencement of pulmonary consumption will be found to take place in the superior lobes of the lungs, owing doubtless to the small extension of the upper ribs as compared with the more complete movement of the lower. Another singular instance, confirmatory of the novel view I am now taking of the subject, is to be found in the exemption of asthmatic patients from consumptive disorder. From the peculiar nature of their complaint, gasping for breath, and forced to respire frequently, their lungs are ever fully exercised ; and the expansion of the chest, which follows as a necessary consequence, preserves the sufferer free from the attacks of this still more dreadful malady. To come to the third head, — depression of spirits, or mental anxiety, — we shall meet with the same cause still producing the same effects.

The unfortunate who lives in the world as if he were not of it, and to whom, whether his cares be the offspring of disappointed ambition, hopeless love, or ruined circumstances, the world displays nothing but a cheerless blank — the tenant of the sick chamber, whose distemper improper medical treatment has unduly prolonged, or confirmed; in fine, all, who from any cause labour under prostration of strength or general debility, are prone to fall victims to the insatiable tyrant, consumption, for reasons precisely similar — inability to take inspirations of depth sufficient to keep up the necessary changes produced by the air on the venous circulation. I have adverted to another cause, which in my opinion contributes, at least in a degree, to render the inhabitants of this country more peculiarly liable to phthisis — a malformation of the chest, which, after repeated and numerous examinations that, I have been enabled to make in considerable manufactories, where I had the opportunity of comparing foreigners of different countries with our own countrymen, would seem to be more prevalent in England than elsewhere. As a corollary to the above remark, I may note, that the children of consumptive parents generally inherit the narrowness of chest, and depression of the ribs, which characterize the victims of this malady ; and that thus the range of its influence is indefinitely increased. I musl now advert to a very remarkable circumstance, upon the propriety of advancing which I have long hesitated ; yet as it serves not merely to elucidate and strengthen, but to prove the truth of the propositions advanced above, and is a phenomenon as fatal in its effects as if is singular in a physiological point, of view, I should, after mature reflection, deem myself the slave of a false and injurious shame were I to withhold it.

When we are the prey of other disorders, the desires are deadened, and lie comparatively dormant ; but even in the last *tage of consumption the love of the sex seems to increase witli the decay of the strength, and the disease, while it kills, is still propagated in the future life of an unborn being. The same holds tme, though in a less degree, with respect to the gentler part of the creation . Following up the tenor of the preceding observations, we shall find that the benefit usually derived from a sea voyage, or change of air, is not so much due to the removal from an impure to a purer atmosphere, per se, but to the stimulating effects produced on the respiratory organs, and the increased energy of the muscular powers of the chest, on which pulmonary dilatation is of course consequent. Let us compare the muscular frame, expanded chest, and robust health of the mariner, or of the husbandman, with the emaciated figure, contracted chest, and general want of vigour betrayed by the artizan of manufacturing cities ; and, on attentive consideration, we shall own that these differences are the consequences of the superior expansion and activity of the pulmonary apparatus enjoyed by the former. Among the many distressing cases which the medical practitioner has to encounter, the premature and rapid decline of the young of both sexes, more particularly of the weaker, is without doubt the most painful. The fragility of woman's constitution, as compared with that, of man, the delicacy of her frame, her retired and domestic habits, and the sensitiveness of her mind, all contribute to

CENERAL OBSERVATIONS ON CONSUMPTION. 9

render her a mark at which consumption frequently aims his deadly darts. No sight is more painfully interesting than that of a female, on the very verge of womanhood, yielding unconsciously to the fatal decree, and, like a drooping flower nipped untimely in the bud, graceful and lovely to the latest breath. Independently of their greater liability to pulmonary disease from delicacy of constitution, there exist other causes which increase their susceptibility in a fearful manner. The style of their dress, — which, in compliance with the fantastic usages of fashion, seems devised to alter the free and graceful outlines, traced by the hand of Nature, into a wasp-like angularity, alike injurious to the tender structure of their body and unpleasing to the eye of taste, — has been often pointed out as a pregnant source of disease, and justly so. It has been already observed, that a full and free dilatation of the chest is absolutely necessary to preserve the lungs in a sound and healthy state; but. how can a female, her chest, compressed by an artificial support, the convexity of the ribs incapable of being extended upwards and outwards, and the sternum consequently without the power of coming sufficiently forward, enjoy this requisite expansion 1 She i< " cribb'd, confin'd," and " curtailed of Nature's fair proportion." However, to counterbalance these inconveniences, it has fortunately happened, that owing to a power they possess of abdominal respiration, more decided in them than in the male, the unnatural restraint they have imposed upon themselves is divested of some portion of its ill effects. Still, so mischievous are the consequences entailed upon woman by her adherence to this baneful part of her costume, that in consumptive cases there is this striking distinction between the sexes, that the female thus deprives herself of the great, indeed the sole chance of recovery, — a due expansion of the chest. Thus the probability of spontaneous and permanent recovery, which is attended by an increase in the volume of the lungs, is sensibly lessened to the female sufferer ; and they who want most aid may be said "to take arms against themselves."

CAUSES OF

CONSUMPTION

Chap. II

Cold, resulting either from imprudent exposure to the air when the body has become heated, or from the wearing- of too light and insufficient clothing, is deemed one of the most general and powerful causes of consumption. Yet, in many instances, I am persuaded that the real and efficient cause is to be found in the pre-existence of latent tubercles in the lungs ; and when these become softened by general indisposition, produced by the action of the cold, phthisis ensues. Still, the influence of cold is considerable, and where an hereditary tendency to consumption exists, or the constitution has been previously debilitated, it most certainly induces pulmonary disease. The transmission of this disease from parent to child, is a melancholy fact to which I have already adverted. The generic marks of this sad heir-loom may he traced in the sanguine yet delicate hue of the countenance, the unusual brightness of the eyes, the confined and narrowed waist, the sharp projection of the scapulte or shoulder-blades, and the fragility of the bony structure of the body, not unfrequently united with a disposition to an unhealthy stoutness. In laying down the causes of consumption, it becomes requisite to distinguish betwixt those which are direct, and the far greater class commonly confounded with them, but which in point of fact are indirect. Amongst the latter, may be enumerated inflammation of the lungs, pleurisy, contagious eruptive fevers, repelled eruptions, badness, and deficiency of food, amenorrhoea, unhealthy localities, affections of the abdominal viscera (sometimes caused by excessive drinking), spitting of blood, constitutional syphilis, and a long list of disorders, whose sole influence in producing consumption consists in the debilitated state of body they induce. I have said that it is requisite to distinguish betwixt the direct, and indirect causes of consumption, not that there are any that can with propriety be termed direct, but in order to impress thoroughly upon the mind the grand truth that phthisis is the sequence of debilitated bodily health alone. When the general health becomes impaired, a total change takes place in the fluids and secretions of the body, and there is consequently an aberration of nutriment : on this, the formation of tubercles soon follows.

Laennec gives an interesting account of the effect of depressing passions in producing phthisis, in the case of a religious association of females, all of whom became consumptive from the ascetic spirit which regulated their minds, rather than the austerity of their diet. Confinement, most likely, contributed to this result. Since this society was bound by no vow, Laennec persuaded the members, as soon as consumption was clearly indicated in each, to change to another place of abode, and he expressly declares that nearly all who took his advice recovered. The possibility of consumption's being cured is even yet denied by many practitioners, although the light of truth is beginning to dawn upon them ; and yet the alx>ve relation i« a proof, that, some years previous to the appearance of the present work, the greatest medical authority on the disease had stated opinions similar to mine. A parallel circumstance has occurred, in the course of my

practice, within the last six months. Two young ladies

c 2 were removed from a school in the neighbourhood of London, in order to be put under my care for consumption. I ascertained that ten or twelve of their school-fellows had sunk under decline, within the twelvemonth preceding; and, on enquiry, I found that the only exercise they were allowed, and this but seldom, was the prim, formal walk, two by two, which pernicious and false decorum, it is to be hoped, will soon be banished from these establishments. I should mention the sequel of Laennec's account, in order to establish more fully the coincidence between the circumstances, and to direct attention to the ill effects of such absurd confinement. He proceeds to narrate, that he witnessed, in the course of ten years, two or three renewals of the religious society, by the admission of new members to replace the loss of the old ones ; and that the only individuals attached to it, who withstood its depressing influence, were the superior, the gratekeeper, and the sisters who had charge of the kitchen, the garden, and the infirmary. In addition to the exercise given by these offices, the same individuals were called upon, occasionally, to visit the city on the concerns of the establishment. This narrative requires no comment.

To such an excess were the fantastical restrictions of the school above-mentioned carried, that the poor girls were not even allowed to hold their heads erect, or maintain a proper carriage, being told that so to do was a sign of pride. By this enforced humility, conjoined with the radical error— want of exercise— both my young patients not only stooped, but, I am sorry to add, had contracted chests, and lateral curvature of the spine.