Consumption

Preface

For many years my attention has been earnestly directed to the study of Pulmonary Disease ; first with my father, then as a pupil of the late J . R. Plancorn, an eminent surgeon in the north of London, who had an extensive practice in cases of Consumption ; afterwards in the Medical Schools and Hospitals of London (where I attended all the Courses of Lectures and Clinical Practice required of the Medical Student) ; and since that time in a practical sphere of observation, which has grown extensively year by year. It is now thirty years since I published the first ed.tion of my smaller pamphlet ; during that period it has passed through two hundred and forty editions, and nearly two hundred and fifty thousand copies have been issued to the world. My best energies have been devoted to the mitigation of human suffering, in grappling w.th this most aptly called “tremendous disease.” The success which has attended the treatment I advocate, especially when the case has come under my own observation, has been gratifying in the extreme, and, I trust, has evoked a thankful, not boasting, spirit. I certainly know of no other discovery in medical science from which the Consumptive patient may gather the faintest hope, and although his symptoms may be palliated by art, he has very rarely (I believe)

by any other means finally been cured.

In the period I have mentioned, it must be obvious to the reader there has been afforded me the scope for the most extensive pathological research. I have proved by many instances the truth of the theory that “Consumption is Curable,” with an application of proper means ; and I hope, by gradually diffused knowledge, that a just appreciation of these means and their principles of operation will so arise that, with God’s blessing, the benefits accruing therefrom may be extended into distant lands, as well as more widely in our own.

I have endeavoured, in re-writing and enlarging my former treatise, to make my observations throughout the book concise and clear to every reader, avoiding, as far as possible, technical terms and scientific phraseology. All patients in their first correspondence are invited to observe particularly the series of simple questions which are given for their guidance. I have subjoined, as far as space permitted, observations on some interesting cases, and selected letters from persons who have derived signal benefit after every other treatment had failed.

GEO. THOS. CONGREVE.

January i st, 1881.

Part I. The Subject Introduced

“ The flower in ripened bloom unmatched. Must fall the earliest prey ;

Though by no hand untimely snatched. The leaves must droop away ;

And yet it were a greater grief To watch it with’ring leaf by leaf,

Than see it plucked to-day.”

While Turkey has its plague, Africa its yellow fever, India its cholera and dysentery, England has its scourge too. It has been calculated that the deaths which annually ensue from disea ed lungs, throughout Great Britain, amount to one hundred and forty thousand ! upwards of ten thousand of which are in London alone, and this in spite of the elaborate investigations of the most profound pathologists all over the world.

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CONSUMPTION : WHAT IS I

Iiow many fond parents’ hopes have been 'Vis ted by this cruel malady, who can tt.» ? How many a lovely girl, just bursting into beauty, the object of a father’s delight and a mother’s tender care, has drooped away — withering like a flower, leaf by leaf — not plucked by untimely hand, but wasted by an influence unsuspected, because unseen ! There has been a bright flush on the cheek, boding no good, remarked only by the professional eye. There has been a languishing into outward loveliness, while there has been death and decay within. Unconscious of the danger of that slight cough and very trifling pain, they have allowed the foe to pursue his secret march until the mischief done is past all hope of remedy by common means.

And that idol of the mother’s heart, that child of hope, for whom, in the future, her imagination has pencilled out a brilliant destiny ; that only son, of high promise, too, and first in all earthly thought, alas ! too often, at the commencement of a bright career, have such anticipations been dispelled, and the golden dream been changed for a feeling of intense sympathy with her suffering child.

It is worthy of remark that persons cf a highly sensitive mind and fine intellect are frequently the subjects of this disease — a fact much to be regretted. How often has the spark of true genius been thus early quenched, and the expanding mind, panting for the living spring of the Beautiful, been hushed to its one long sleep ! Poor Kirke White, and many others, are examples of this.

I know not of any one thing more painful, in the annals of disease, than the premature and rapid decline of the young, especially when the mental powers remain unimpaired amidst bodily decay ; the more still when strong attachments have been formed, and the pangs of hopeless love contribute to the patient’s misery.

Is there a human being without some special interest in every endeavour to stay the ravages of the destroyer ? Is there any family without some apprehension that some one dear to them

T ?— THE CAUSES TRACED.

may be smitten down by the ruthless invader of many a happy home ?

I have sometimes thought that the amelioration of the woes of mankind is one of the noblest ends to which science can minister. Be it my lot to soothe, in some humble measure, the sufferings of my fellow-creatures, and in the testimony of an approving conscience I shall consider myself amply repaid.

CONSUMPTION— WHAT IS IT?

•‘Progressive truth, the patient force of thought Investigation calm, whose silent powers Command the world.”

Within the memory of many living the nature of Consumption was very imperfectly known. Cullen, the great nosologist of a past generation, described it as a sequel of haemoptysis (spitting of blood), yet there were then, as now, many cases of Consumption terminating fatally in which that symptom had never appeared. (In an average number of cases there will be one in five where no spitting of blood occurs at all). Others considered it a disease of inflammation, or the result of inflammatory condition ; hence they resorted to bleeding. It was not until the immortal Laennec, inventor of the stethoscope, made known his discoveries that the true nature of the disease was understood. It has been proved beyond all doubt that inflammation will not of itself produce Consumption in a previously sound constitution.

The true nature of Consumption is scrofula affecting the lungs. Scrofula is a hydra-headed foe, assuming a hundred different forms, affecting any or every organ of the body, especially the organs of digestion, the lungs, or the brain. When the lungs are the seat of mischief, it assumes the form we call Tubercular Consumption, or Phthisis.

THE CAUSES TRACED.

“Prevention is better than cure.”

I. — THE PREDISPOSING CAUSE.

Consumption, like most other maladies, has its predisposing cause. In

THE CAUSES TRACED.

all its victims there has been an aptitude or fitness for the complaint, and this may be either constitutional or acquired.

It has been said in the previous chapter that Consumption is simply scrofula affecting the lungs. Perhaps it may be remarked, with greater propriety, that scrofula is the aptitude or predisposing cause.

Defective action in the absorbent - system is the characteristic of scrofula. This may be constitutional from birth,

; transmitted from generation to gene- : ration ; or it may be acquired through any influence of a debilitating kind. It is well known that defective action .exists in Consumption of the lungs, .and in every victim of that disease -some general traces of scrofula may be : found. We may, therefore, assume . that in all cases a scrofulous condition, constitutional or acquired, is the pre- . disposing cause.

This condition is frequently marked 1 by external appearances; by a long : neck, prominent shoulders, and a nar-

■ row chest ; by a fine, clear skin, fair i hair, delicate rosy complexion, large

veins, and thickness of the upper lip. It is also indicated by a weak voice and great mental sensibility. Note, however, that persons whose descripi tion is the very opposite of this are not i exempt from that condition which may i be nursed into disease. I have frequently known persons with broad .chest, dark complexion and hair, in .consequence of some predisposing dei bilitating influence, fall a prey to this disease.

2. — THE IMMEDIATE CAUSE.

The immediate or exciting causes of ' Consumption are many. They may be divided into three classes or kinds : —

I. Certain previous diseases— neglected colds, inflammation, dyspepsia,

' syphilis, small-pox, and measles. But i .t, must be observed that none of these ' vwll produce Tubercular Consumption, t. except in a subject already tainted with s scrofula.

II. Mental emotions — grief, disapi pointed love, jealousy, anxiety, or ae-

■ spair ; ambition, intense application to study, or too ardent pursuit of literarv fame.

III. Debilitating excesses— too frequent indulgence in the luxuries of the table, and the irregularities of fashionable life —

“ Oh, shame ! oh, pity ! nipt with pale quadrille,

And midnight cares, the bloom of Albion dies

sedentary occupations, long business hours, late watching, the abuse of intoxicating drinks, unchecked diarrhoea, excessive venery, the whites, immoderate discharge of the monthly evacuations, or too long-continued suckling of weakly women.

All these may be considered as immediate causes, producing the disease ; the constitution being more or less prepared to receive it by the predisposing influence.

Where such preparatory influence has been great, or, in other words, where there has been a decided scrofulous tendency, and tubercles have existed in the lungs without occasioning inconvenience (probably for years), a very trivial circumstance has caused their suppuration and hurried, on the disease — none more frequently than inflammatory catarrh, or even a slight cold.

It is by such process that damp clothing, damp beds, or moist and damp air have done more than the raging pestilence to populate the grave.

3- — THE COMBINATION OF CAUSES.

The history of this terrible disease may be summed up in a few words r scrofula, hereditary or acquired, affects the lungs in the form of tubercle — the deposit of tubercle may be the siow work of years, or may occur very rapidly as certain things tend to favour it. Thus in process of time the seed is sown. A thousand circumstances by causing the seed to germinate become exciting causes : these must be studiously avoided.

In the course of my long experience, many patients with strong hereditary tendency to Consumption have come to me at the first approach of danger. The scrofulous condition of the system has been strongly marked ; they have

B 2

SUSCEPTIBILITY, lost father or mother, brothers and sisters, by this fell disease, and yet, by careful treatment preventing the germination of the seed, they have escaped.

SUSCEPTIBILITY.

** His care were ill bestowed

Who would, with warm effeminacy, nurse The thriving oak.”

Breathe not the chaos of eternal smoke,

It is not air ;

That from a thousand lungs reeks back to thine.

—The lungs a' hor

To drink the dun fuliginous abyss.”

There is a peculiar susceptibility for this j disease, not natural, but acquired, often | arising from certain sometimes unavoidable circumstances of life.

Among these may be named — the want of nutritious food proportioned to the bodily waste, impure air and sedentary occupations, extreme delicacy of liabit produced by the early want of proper physical education, tight-lacing, continuing long in a stooping posture, and any other circumstances which tend to mall or m the chest —

“ And rob the fine machinery of its play also every employment which produces mechanical irritation of the lungs, such as that of millers, weavers, grinders of metals, masons, 'dressers of flax or wool, &c. ; and, lastly, severe mental emotions, or passions of the mind.

The want of early physical education is a crying evil. I have known many children of the affluent brought up like greenhouse plants, vegetating only in the confined space and atmosphere of the nursery, habituated almost exclusively to the monotonous motion of a carriage for an airing, and seldom taking any other exercise in the open air. No wonder they are susceptible to colds and coughs. No wonder that a pale and sickly countenance, and other evidences of constitutional debility, are manifest from an early age. No wonder that, so educated, they become peculiarly susceptible of diseases of the lungs.

The theory of contagion may be worth our notice here. The question has often been put to me by anxious relatives : “ Do you think Consumption is catching? is it safe to keep in the same room and sleep in the same bed ?” To this I answer: “It is decidedly

unsafe to occupy the same bed as a Consumptive patient ; the vitality of the healthy person is reduced, with no real benefit to the invalid. Nor is it wise to continue long shut up in the sick chamber, breathing constantly air that is saturated with purulent secretions of advanced phthisis ; frequent change is necessary, and due ventilation of the apartment should be secured. But there is no contagion in the disease, although physicians of old almost all believed in it — the idea has been exploded. And when, as now and then is the case, some devoted relative who has nursed some dear one to the last, in turn becomes a sacrifice —sister after sister, for example — there has been the latent, unsuspected, predisposing cause ; and constant anxiety, the wondrous sympathy of mind with body, and of body with mind, with the want of pure air and sufficient exercise, have rendered her an easy prey.

Severe mental emotions exert a most decided influence, through the agency of the nervous system, upon the corporeal vital power. The first effect of pungent sorrow is felt in the region of the lungs. There is a sense of tightness and depression, and fear of impending suffocation. If the sorrow be unremoved the functions of the chest become permanently impaired, and such a state of ill-health is engendered as renders the subject an easy prey to this fell disease. The loss of a beloved parent or child, the heart-breaking separation from the happy associations of home, exile from the land of birth, unrequited affection, the hopeless end of long-cherished hopes and lofty ambitions ; to these, and many othet mental ills, may be attributed acquired susceptibility.

The want of sufficient exercise is another circumstance unfavourable to bodily health. To young ladies, confined in seminaries and large schools, exercise is of vast importance. They are deprived of the maternal watchful-

FOREBODINGS . OF DANGER.

ness their years of developing womanhood require. The want of exercise is frequently the cause of uterine obstructions, and other functional irregularities : constitutional debility is induced, rendering them particularly . liable to this disease.

There are also many thousand victims from among the poor, whose abject poverty deprives them of nutritious food, who are crowded together in large cities and precluded the enjoyment of proper air and exercise.

Look at the captivity of twelve, or fourteen, often sixteen, sometimes eightteen hours ! How many hollow cheeks,

. and ghastly features, and sunken eyes are to be found in the wretched hovels of our manufacturing towns ! Look at the poor needlewomen of this vast ; Metropolis. How many have pined away * their short lives in penury and want, patiently submitted to their lot, endured their slavery without murmuring—

“ Then dropt into the grave, unpitied and unknown.”

I will venture to say that, on stethoscopic examination, one-half of these poor creatures would be found with their lungs diseased.

FOREBODINGS OF DANGER.

“ Forewarned, forearmed.”

Let every person of scrofulous habit or enfeebled constitution be on the watch for the insidious foe.

The symptoms which indicate the existence of Consumption in its earliest stage are variable and uncertain. So deceitful are they, in many instances, that the case may import great danger before the patient is aware ; especially when, as it sometimes happens, no great inconvenience is occasioned.

A slight cough excites no attention ; it is regarded as arising from a simple cold, and passed unheeded. Whereas it is generally the earliest footstep of the destroyer, and, however slight, should be looked upon by every person of impaired health and delicate habit with apprehension, and suppressed without delay.

Very frequently the cough is for some lime little more than a dry hack, mostly observed in the morning. By and bye it occurs also during the day ; should this steal upon a person who is otherwise in apparent health, without the accessory of a cold, it should excite suspicion, and no time should be lost in submitting to stethoscopic examination.

The cough is sometimes followed by a slight haemoptysis, or spitting of blood. The patient is a little paler, somewhat languid, and easily fatigued. Still, as the appetite is not impaired, nor the breathing seriously affected, the cough and spitting, which begin to attract a little notice, occasion no alarm.

(Let it be observed that I speak here of the majority of cases, but not of all ; as, in some instances, the symptoms are so prominent as to strike the sad conviction ol the most careless observer.)

After a time the cough becomes more frequent, particularly at night or m the morning, and is accompanied by a trifling expectoration of clear frothy saliva, such as is usually observed in a common cold or catarrh. The pulse becomes a little hurried after meals and towards evening, at which time a slight chilliness or shivering is felt, followed by increased heat of the skin, particularly the palms of the hands and soles of the feet ; succeeded towards morning by moisture or perspiration, from which the patient rises relaxed and enfeebled.

Such are the usual symptoms of the first stage. They are not always all present. They vary, too, in the order of development and their intensity. Age, mode of living, and individual peculiarities account for this.

One of the least reliable symptoms, but frequently occurring in the early as well as the later stages of Consumption, is pain in the chest. It must, however, be regarded with suspicion if accompanied by any of the signs before named. It may vary much in intensity. It may be acute or dull ; with some, a sense of oppression ; in others, a soreness or sense of burning. It may be over an affected part, or it may be elsewhere. It may be fixed or wandering.

THE SAD REALITY — ALL DOUBTS CONFIRMED.

This maybe explained by the fact that whatever pain is felt is not in the structure of the lung, but in the lining membrane, or in the walls of the chest, and is mostly of a sympathetic character. Nothing is more common than for patients to imagine that the place where the pain is felt must be the seat of the disease. There may be much pain, and yet no actual disease, and, vice versa , considerable amount of disease without any pain. Let patients remember that pain of itself is no indication of mischief. It may be neuralgic ; it may be muscular ; the settlement of this point, however, is not of great importance, as the liniments which 1 prescribe, hereafter named, will be applicable in either case.

There is mostly some obscurity in the early period of the disease ; so much so that its existence can only be told, with anything like certainty, by those long practised in auscultation, or stethoscopic examination. The tubercles are not sufficiently advanced in size or number to cause much change in the breathing 'sounds perceptible to the inexperienced ear.

Hence, how important it appears to attend to every cough, to check the progress of every common cold. It may, or it may not, be the shadow of the approaching destroyer ; and as it is difficult in many cases positively to detect the presence of the disease in its early stage, let every possible precaution be taken, and the treatment hereafter recommended be used. Prevention is better than cure. And it is easier to expel the foe on his first approach, than when he has gained the citadel and usurped his destructive reign in the constitution.

Yet, let us remember that there is an over-ruling Providence not to be lightly esteemed. Our lives are in the hands of One —

“ Too wise to err, too good to be unkind.”

But He has given us means, and it is our duty to use those means. It is our bounden duty; and that person is highly culpable, is almost an infidel, who neglects to do so to the utmost of his power.

THE SAD REALITY— ALL DOUBTS CONFIRMED.

“ While wilful you, and fatally secure.

Expect to-morrow’s more auspicious sun,

The growing pest, whose infancy was weak. And easy vanquished, with triumphant sway O’erpowers your life. For want of timely care,

Millions have died from medicable wounds.”

It is uncertain how long a time the patient may continue in the first stage of Consumption. It may be a few days, as many weeks as months, or in some cases years. He may acquire renewed strength to combat the exhausting effects of the disease. The development may be retarded, but, alas ! the mischief lurks within — the cause is unremoved.

In the second stage of phthisis the nature of the malady is evident, if doubtful before. The cough becomes more frequent, and if violent will occasion vomiting, but is seldom attended with any acute pain. Hoarseness is not unusual. The pulse is hurried. The breathing becomes more difficult and permanently oppressed.

In the first stage of Consumption there is seldom an apparent loss of flesh, but now there will be some visible decrease ; and this, although the appetite may not be impaired, and the diet may be abundant and good.

(Diverging for a moment here, let it be observed that, in children, many of the symptoms of adult cases may not be present ; there is reason to believe that a vast number pine away and die with the true cause unknown. They are said to die of Marasmus, or wasting disease; whereas, what is termed the wasting disease is simply the effect of tubercular deposit in the lungs. There is cough, but no spitting, for all that should be forced up is swallowed ; there is little or no hectic — the one formidable symptom is the slow but progressive wasting away. These cases generally afford a fair chance of recovery (humanly speaking), by proper means. I allude more particularly to those between four and ten years old.)

The expectoration now changes its character. It is no longer a clear frothy

THE SAD REALITY — ALL DOUBTS CONFIRMED.

mucus, and slight in quantity ; but copious, less frothy, less clear, somewhat opaque, thick, in colour of a pale yellow, with sometimes a greenish tint, sometimes streaked with dull yellow lines, frequently tinged with blood. Indeed, an occasional spitting of blood is a frequent symptom, not perhaps to an alarming extent. The expectoration is generally devoid of smell, but in some instances it emits a faint, disagreeable odour. It is heavier than water, and, if it does not mix with it, will sink to the bottom — not always at first ; it may float for a time, in consequence of containing minute bubbles of air.

This change in the character of the expectoration arises from the softening or liquefaction of the tubercles, or morbid deposits existing in the lungs, when the purulent matter is expectorated by cough. In a future chapter, I shall treat more particularly of the nature of tubercles and the anatomical aspect of the disease.

At this period Hectic Fever, more or less, always prevails. It is caused by the absorption of some portion of the purulent matter into the circulation. As soon as the tubercles liquefy, and pus is formed, it manifests itself in all its fearful symptoms.

Hectic Fever is remittent, and has two accessions in 24 hours ; one in the day, and the other in the evening or : night. That in the day is uncertain, and differs both in the time and severity of the attack. That in the evening and night is most severe, and is always regular. It commences with chilliness and shivering, a cold feeling in the back and down the spine, and an acute sense of the least cold air. After some time, the hot stage succeeds, the pulse is 1200, the skin dry, the face is flushed and burning. The patient continues in this state several hours, and towards the morning the fever goes off in profuse perspiration — so profuse, in some instances, that it rolls from the body in a stream, and the bed-linen is soaked in moisture.

Excessive debility now ensues, and ' the patient becomes unequal to bodily exertion. No symptom tends so much 1 to reduce the strength and emaciate the body as the night sweats of hectic fever.

At this stage of Consumption the countenance and figure become highly characteristic of the disease. The cheeks are alternately pale, and of a brilliant hectic flush. The nose becomes thin. The eyes are bright though sunken, and speak more than their wonted intelligence, and the white part assumes a pearly hue. The tongue is of a deep red colour, and the throat is often covered with small white specks or ulcers, similar to the thrush. The cheeks are hollow. The hair falls off. The nails are curved. The spine projects. The shoulder blades stand out. In fact, every part of the body bears witness to the general decay.

It is now that by means of the stethoscope, and sometimes simply by the ear applied to the patient’s chest, positive and decisive evidence may be obtained of the mischief within. There is an increased density in the structure of the affected lung; and in that part where a large tubercle or cluster of tubercles exist, the breathing, scarcely audible in health, becomes more distinct, and the voice is heard more loud ; while percussion of that part elicits a duller sound, the reason being that the solid substance of the tubercle is a better medium for the conveyance of sound than the elastic sponge-like structure of healthy lung. These alterations in the natural sound, with few exceptions, take place from the upper to the lower part of- the chest. Sometimes there is fluid in the cavities of the lungs, not expectorated so fast as formed. The air passing through this produces a gurgling noise — the gargmiliement of the French. The space in which ali these changes are observed is at first limited, but daily increases until the lung appears to be more or less affected through its entire extent.

It is possible, as will be hereafter shown, even now, to rrest the further progress of the diseaoe, by regulating the general health, strengthening the system, assisting the absorbent vessels to cafry off and expel the morbid deposit from the lungs, and healing, by CURATIVE PROCESS, TH ULCERATED

THIi LAST STAGE— PATHOLOGY AMD ANATOMICAL APPEARANCES.

PARTS OR CAVITIES OF THE LUNGS, which are formed by the suppuration of tubercle. And it is a favourable circumstance that, amidst the bodily wreck, the mental faculties remain unimpaired. Hope still clings to and sustains the mind, and the spirits are seldom much depressed on account of the disease. These circumstances, which, at an earlier period, are too likely to induce neglect, are now of favourable influence. I cannot too strongly urge upon the patient at this time a° steady, hopeful perseverance with the means I shall hereafter point out.

THE LAST STAGE, OR CLOSING SCENE

“ Gently, most gently, on thy victim’s head, Consumption, lay thine hand. Let me decay Like the expiring lamp.”

In the last stage of Consumption the expectoration becomes profuse, frequently making half-a-pint in a few hours. It is thick, heavy, purulent, and of a faint sickly smell, sometimes offensive ; in colour varying from a dirty cream colour to a yellowish green, mixed with glairy mucus, and occasionally streaked with blood. The cough becomes unceasing ; the hectic fever is more violent. In fact, all the symptoms of the second stage prevail in a more intense degree.

.diarrhoea is often present to a debilitating extent. The patient is reduced by the continued evacuation to the lowest ebb, in addition to which the appetite is bad, there is a loathing of food, and that which is partaken is productive of pain and uneasiness.

Dropsical swellings of the feet and ancles are common in the last stage of Consumption. Sometimes the whole legs are anasarcous, in which case the night -sweats and diarrhoea usually cease.

At the “closing scene,” the physical power is gone, the body is reduced to a skeleton, while the mental faculties to the very last are acute and capable of severe application to study — not unfrequently does it happen that every distressing symptom ceases, and the patient is left in a state of tranquillity and peace. The lines at the commencement of this section, by poor Kirke White (himself a ‘’victim”) are an illustration of this. Life passes away sometimes

“ Like the expiring lamp ! ”

I shall be prepared to show that that hope which seldom forsakes the sufferer to the last, WITH THE USE OF EFFICIENT MEANS, IS NOT UNFOUNDED. I shall bring forward certain cases in which the lungs were ulcerated extensively, and high medical authority declared them hopeless, and yet the patients were completely restored to accustomed health and strength; and with such evidence, and the use of the same means, and the eye directed to the great Disposer of all human affairs, who works through human agencies, NONE SHOULD GIVE UP ANY CASE IN DESPAIR !