On the successful treatment of consumptive disorders, and female complaints connected therewith; on scrofulous diseases; and on the management of delicate health by diet and regimen

Front matter

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Oi e~

Preface

the bed-side* have been wrought out by his own labor and self-communings* and although the modes of treatment proposed are different from the routine methods hitherto pursued* while they are also more successful — yet from his scanty opportunities of making himself acquainted with the professional literature of the day* he may not be able to deny that whatever apparent novelty there may be* must probably enter into the aggregate of received opinions* as it may (though insensibly to the writer) have sprung out of them. Sufficient for him will it be* if he can lay claim to no other merit than that of rightly combining or applying the thoughts of other persons* to the advancement of that science which has for its objects the preservation of life* and the alleviation of the pains and pangs “ which flesh is heir to.” Having passed his third professional decenniad — his rpirrjv oexolyit)olv — which* according to Numa and Plutarch* should entitle him to teach some of the duties of his profession ; and having been for many years engaged in the practice of medicine*

PREFACE, he has had considerable opportunities of observing disease. It has not been the least of his advantages that he has had to prescribe for, and to watch the phases of disease in hospitals, where his orders could not be contravened by the blunders of ignorance, nor by the wilfulness of temper; and where his plans could not be thwarted (as so often happens in private practice) by the opposing opinions of other practitioners, nor by the obtrusive officiousness and intermeddling of bustling relatives or friends.

He is glad to perceive that many medical officers of hospitals are now performing their duty to the public and the profession, by publishing occasional reports of their practice, which — like the votive tablets hung up in the temple when medicine was in its earliest infancy — will serve as guiding lights for the future. He is also not unwilling to give some little account of his stewardship conscious that, so far as his abilities and industry have permitted (little though they may be), he has endeavoured to do his best.

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IV

PREFACE.

In observing facts, as well as in reasoning on them, he has been desirous of avoiding what the Germans, in their copious and plastic language, describe in the one expressive word, einseitigkeit, or one-sidedness — a mode of viewing matters which is utterly destructive of inferential truth, and diametrically opposed to the only sound method of investigation, that by inductive reasoning ; and he is fully conscious of the necessity of bringing into play, during medical investigations, that Suvap'if avaXoTixrj, which will alone enable the physician to avoid error, and to arrive at truth.

In expounding his views, he has not been able to avoid making some conjectures on the proximate morbid conditions of phthisis — yet the writer’s practical suggestions are so independent of the proposed theory, that the treatment recommended may rest solely on the facts adduced ; he has, however, often appealed to, and quoted, better authority than his own.

He has long since put himself on his guard against plausible generalizations or

PREFACE.

V theories — lie has learned to distrust them — to investigate the pertinence or sufficiency of facts — and to repudiate the pleasing phantasms of the imagination in favour of dry, apparently barren, but substantial matters of fact — being quite aware that ce Experience is the crystallization of ten thousand arguments, while our only care in looking at it, rarely as we do so, is to prevent the torch we carry from discolouring it.” Still, a fact seems to acquire double confirmation when we know its cause ; and the philosophic practitioner will inevitably be led to reason on the causation of symptoms; else his practice, whatever his unreflecting experience might be, would be nearly worthless. In such a man, practice becomes the result of theory; and well may he reply to the empirical theoryderiding practitioner, who is also too conceited in general to apply to books, either contemporary or retrospective, that theory is nothing more than the conclusions of reason Irom numerous and accurately observed phenomena, and the deduction of the laws which connect causes with effects; and also

VI

PREFACE.

that he who rejects, unexamined and with derision, the theories of the philosopher who has been guided to his conclusions by the strict laws of induction, is an imbecile in intellect and a child in knowledge.

The hygienic precepts have been succinctly compiled from the numerous writers, British and foreign, who have published on hygienics. The author has only deviated from the general mass, in enlarging on the necessity of watching and profiting by the vibrations of that important balance of vitality, between the great internal organs and the extensive cutaneous capillary system, upon which so much depends ; and he has furthermore recommended special attention to the latter system and its various functions — particularly in relation to the use of iodine, as affording remedial means of superior efficacy in preventing those internal congestions which give rise to dangerous coughs and consumptive disorders; and in combating certain inflammations of the surface — of the eye, in particular.

He would willingly have chosen some other term than that of delicate health, to

PREFACE.

Vll designate the state of body described in the following j:>ages — and to which state he has endeavoured to assign a pathological existence— but none other equally applicable presented itself; for he submits that a person may be in delicate health, and in a state readily to be influenced by the causes of disease, without being a decided invalid.

He has insisted upon a timely resort to practical measures ; and he wishes he could flatter himself with a hope that his representations may in some quarters prove effectual. Urgent recommendations on this head from a medical man might seem to originate from interested motives ; yet his interest would consist in the very opposite course — for doctors, if early applied to, would have less to do than if they were never consulted until disease had had time to take root; and besides, the objection, at best but a sordid one, is amply overruled by the greater probability of preventing loss of life. In consumptive disorders, nothing is more common than a total neglect of the hacking dry cough which so commonly attends them ;

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PREFACE.

and it is referred to a passing cold, or to any other source than the real dangerous one, until great risk of life is at length incurred. Many a head-ache has been lightly called a sick or bilious head-ache, and exercise, &c. ordered, which depended on diseased heart, and required different means of cure. Another person shall complain of pains in feet and legs, which shall be referred to slight stomach derangement- — yet insidious and mortal disease shall be going on in the brain. So again shall similar pains be ascribed to rheumatism — yet shall they depend on gastric inflammation, which, if unchecked, would take away life. Costiveness will often be tampered with, by the most drastic medicines, which ultimately turns out to depend on a mechanical obstruction, requiring very different measures for its removal. In fine, many instances might be enumerated, which are repeatedly occurring to the medical man, all tending to show the danger of neglecting the first and earliest symptoms of disease, however slight they may appear to be.

PREFACE.

IX

It may seem to sound like a truism to say that to secure good healthy the blood must be duly decarbonized; but the writer does not think this subject has been sufficiently enlarged upon in practice — and when viewed in connexion with the skin, its capillary system and its depuratory functions hardly at all noticed.

With a view to his restricted limits, he has purposely given as few illustrative cases as possible, and he has put the surnames of the patients in initials for certain local reasons; but all those who recovered are still alive, are in good health, and for the most part readily to be referred to. He has endeavoured clearly to define, as far as the pen will allow, the various states of constitution, or periods of disease, which require each its own peculiar mode of treatment; but the practical man need not be told that there are fine shades of difference in temperament and morbid signs, which serve to guide the experienced practitioner, yet which cannot be pourtrayed on paper.

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PREFACE.

In conclusion, he will allege that his objects have been, to impress upon the minds of those predisposed to consumption, the benefit to be derived from early treatment; and to combat, by cases successfully treated in his own practice, the erroneous notion which is so generally prevalent, of the inevitable fatality of all cases of this disease— while he has endeavoured to guide the invalid, by pointing out the most eligible regimen aof diet and of life5’ — to prevent loss of life in the young female at her most critical periods, when nature requires close watching, and occasionally much assistance, (and here he thinks he has been practically successful) — to treat scrofula at less cost to the constitution than hitherto — finally, to show parents how they may avoid exciting disease in their offspring, and how they may best preserve in them “ a face blooming with health, the glad promise of many years.” To the sound and legitimate critic, who enters rather into the spirit than the letter of his author, the writer need not address any remarks deprecatory of severity; but

PREFACE.

XI from others he would ask, for a gracious overlooking of whatever errors may be detected in style or diction, on the grounds that this opusculum , aiming solely at practical improvement, consists of little more than a series of extracts from his case-book, with the remarks noted down at the time, (truly may he say current e calamo ,) — and that he has been less occupied about the syllables than the sense — with the counters of knowledge, than with knowledge itself.

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Contents

ON CONSUMPTION.

CHAPTER I. PAGi

General Remarks. — Pathogenetic state, called deR&ite health — three stages of tubercular disease — value of early treatment — strumous and phthisical conformation— short account of tubercles 1

Chapter II

Pathogeny. — Organic nerves in fault — circulation of blood sluggish — altered condition of blood — causes — atmospheric air as a cause — its purity, temperature, and hygrometric state— atmospheric electricity a probable agent in epidemics and other diseases — asphyxial cholera — changes of the air by respiration — chemical difference between arterial and venous blood — ultimate elements of animal matter — superfluous carbon in the blood poisonous — country air for sickly children — ■ London climate insalubrious — influence of light on vegetable and animal bodies — caution in recommending change of climate — ventilation, natural and artificial— necessity of attending to the circulation in the cutaneous capillaries — meteorological summary of England — barometrical pressure of the atmosphere —

Dr. Prout, heavy air, and cholera 10

XIV

CONTENTS.

Chapter III

c PAGE.

secretions and Excretions.- — Carbon-removing organs, the lungs, liver, kidnies, and skin — a quadruple connexion between them — also a vicarious action — diminished respiration under high temperatures, and accumulation of carbon — the skin, its functions — baths, local, medicated, or simple, recommended — public gratuitous baths 54

Chapter IV

Exercise. — The amount of exertion — tight lacings, &c.

— the new-born infant — mortality of children not unavoidable— effects of muscular exercise — musculo-cardiac function — muscular action a good hygeiometer — straining of joints, &c. to be avoided — different kinds of exercise — early rising — John Wesley — exercise neglected — good effects of proper muscular exercise, of percussion, champooing, &c. even on the bed-ridden— illustration of effects of exercise — various kinds of exercise, and its adaptation to circumstances 65

Chapter V

Diet. — To be adapted to circumstances — much to be done by diet, in cure of disease — life, longevity, and happiness — the average duration of life— temperance and exercise — adaptation of stomach, as to quantity and quality— nitrogen, at times to be dispensed with, to a certain extent — the food of various nations — great muscular exertions, on a light diet— nutritive matter in eight pints of ale — animals, and gradual change of diet — the consequent available powers of nutrition in the vegetable kingdom — temperance, abstinence, and hunger-cur — anecdote of Dr. Jas. Gregory, secundus — disadvantages of repletion — indigestion— consump-

CONTENTS.

XV

PAGE.

iion of meat, per individual, in several countries — degrees of digestibility of various articles of food — a table of diet — meats, poultry, game, jellies, soups, fish, milk, butter, cheese, grain, herbs, roots, fruits, seeds — infusory drinks, as tea, coffee, chocolate, cocoa — condiments, how dyspeptics should take sugar — vinous and spirituous drinks, Sherry, Madeira,

Port, Champagne, Burgundy, Claret, Hock, and German wines ; brandy, rum, gin, and malt liquors — regulations as to meals — drinking at and after meals, 81

Chapter VI

Sleep and Rest. — Necessity of rest to the organism — ventilation, &c. of bed-rooms 124

Chapter VII

The Intellect. — Conditions for healthy action of brain — indolence, mental or physical, reprobated — children’s intellects usually overtasked — self-education in very early years — rapid development of organism, early fatal — Barettier and Hermogenes — necessity of caution — practical system of early education — Montaigne— alternation of work and play — extracts from Bishop Berkeley and Sir E. Bulwer — pernicious effects of over-study 127

Chapter VIII

Symptoms of Phthisis. — System of hardening by exposure not adapted to delicate children — consumption mistaken for liver disease — signs of unsoftened tubercles — the venous congestion of delicate health different from the active sanguineous or inflammatory congestion around the tubercles — different treatment required — modes of attacks various , * 139

XVI

CONTENTS.

Chapter IX. Page

Diagnosis. — Necessity of an early diagnosis — catarrhus siccus and phthisis — hepatic and nervous coughs — ague — senile bronchitis — dilated bronchi — hysterial hoemoptysis 161

Chapter X

Treatment. — Early assistance requisite — system of minute precaution — principles of treatment — prevention— modern system of excessive blood-letting deprecated— signs of re-action from loss of blood likely to mislead — the proximate condition of blood-vessels often mistaken in comatose states — rules for blood-letting— periodicity of nature, as seen in fever — carbonate of soda in typhus fever — indications of treatment in phthisis — absorption of tubercles not improbable — carbonate of soda — mercurials — emetics — change of climate, and the oral respirator — low diet and lowering treatment highly prejudicial in venous congestion, but necessary in the active sanguineous or sub-inflammatory congestion — cases of the first stage — stoppage of menstruation remedied — chlorosis and amenorrhoea — treatment of these states — emetics, &c.

. — menstrual clots to be distinguished from the coagula of uterine haemorrhage — stage of softening of the tubercles — remedies and systems of cure numerous — inhalation — strength to be spared as nfuch as possible — repeated counter-irritation — the checking of the exhausting perspirations — diarrhoea of phthisis — death often, from exhaustion of the vital principle, and not from the extent of organic alteration — nitro-muriatic acid lotion — hoemoptysis — aconite — ipecacuan — cases of softened tubercles 168

CONTENTS.

XVli

ON SCROFULA.

Chapter IV

Treatment. — Hygienics to be attended to — chorea in the strumous — mercurials — iodine — quinine — case of chorea — of crusta laetea — local application of tincture of iodine recommended in strumous ophthalmia, enlarged glands, tumours of the mammae, wounds, abscesses, mortification — gargles of solution of iodine in ulcerated sore throats, &c., with cases 283

Conclusion 318

Necessity originated medicine — experience perfected it; and that which at first was rude and uninformed, became endowed with skill and science by the progress of time, and by the continual accession of experimental observations, one casting light on another, and made under the moderating influence of superintending judgment.

Free Translation.

CORRIGENDA, &c.

Page 30, after line 12, add Another more recent author thus writes.

44, line 1, instead of “maintain,” read maintains.

65, line 7 from the bottom, instead of “ exercitum,” read exercitium. 109, line 4, after “ sugar,” add 2. Coffee.

147, line 4 from the bottom, instead of “evaporated,” read evacuated. 228, line 2 from the bottom, instead of “ vomicae,” read vomica.

254, last line, instead of “ 3j-” read 5j.

255, line I, instead of “ Acid. Sulphas.” read Acid Sulphuric, and after

“m. v.” add Infus. Rosar.

288, line 18, instead of “Garg. Iodind.” read Garg. Iodin.

ON CONSUMPTION tyc. §c.

Chapter I. General Remarks

The absorbing interest with which every medical practitioner of kindly feeling and of long experience must have watched the insidious approach or the withering progress of Tubercular Consumption^ affords an ample apology for any attempt made to diminish its mortality. Under such feelings,, and with such motives^ the writer^ on whose way of life the shadows now sensibly lengthen^ has ventured to submit to the attention of his professional brethren, observations which he

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ClIAr. I.

trusts may lead, under Divine Providence, to the prevention of this perilous disease, in many instances, and to the more successful treatment of it, in others.

He has also had in view a state of constitution, which demands at the hands of the medical practitioner much judicious attention; for, although it may not terminate in Pulmonary Consumption, yet it places all persons endowed with it in constant danger of incurring disease, either functional or organic, of some perhaps vital part. All such persons may be considered as standing on the brink of a precipice, over which, causes, usually of trifling influence on the human animal economy, may suffice to cast them. He alludes to a state which he has denominated delicate health — in which term he includes tuberculous cachexia, as one of its conditions or results. To remove this state, or to prevent the danger constantly impending, are desiderata of the utmost importance to human life ; and the following observations have been written, no less with 4 view to these objects, than to the provention and treatment of phthisis pulmonalis. The pathological and pathogenetic peculiarities of this state will be hereafter detailed.

It would be an inexcusable waste of the reader’s time, if the writer were to offer any observations on the propriety and necessity of preventing actual disease, when possible — the propriety and paramount necessity are admitted, orally ; but how far from their being practically attended to, the records of disease sufficiently prove; for it is demonstrable that a large proportion of such maladies have originated in a neglect of some of the laws of sound physiology. If the anvil of the human frame, in some individuals, will not safely bear the strokes which the ordinary course of events must cast upon it, it is the duty of the medical practitioner to attempt to strengthen it ; or else he ought to direct, how’ such blows may be either more safely borne, or altogether avoided.

Having had opportunities of acquiring considerable experience of his own, and as Baglivi writes, “cuncta preesertim regente ac moderante rationis lumine,” he has endeavoured.

Chap. I

wherever he could, to avoid telling again “the twice-told tale,” by copying out the experience of others — what he has to relate may be received as inferences from what he has himself seen ; and he trusts he may be allowed to say, not by way of boast, but by way of guarantee, that, as an observer, both his previous education, and a mind not unobservant, have fitted him for a faithful and accurate scrutiny into the facts which have come before him; but should it happen, that any striking coincidences with other writers be here or there detected, without acknowledgment, he begs to disavow any intention of pirating the observations of his predecessors, or of setting up a claim to priority or originality — satisfied alone, if good be done, whether that good is effected by himself or not ; and contented, if the record of his individual experience should accomplish no more than a confirmation of the conclusions of those who have preceded him, in their efforts to prevent the formation of disease, or to cure it when formed.

GENERAL REMARKS.

The pleasure he has felt in witnessing his increased success, since he has adopted the mode here recommended, of treating this disease, and of strengthening the invalid, has been “its own exceeding great reward” — and if his experience shall be corroborated by that of others of his fellow-labourers in the profession — and if it should effect a more frequent prevention, or a greater curtailment of mortality in this complaint, he will gladly deem any other consideration as altogether a secondary matter.

In a practical point of view, it will be sufficient to treat of this disease, and its prevention, as it exists — in a state of predisposition, or of latent tubercular deposits — in the stage when the tubercles assume an active state — when they have softened — and in the cases of mixed or complicated phthisis.

The first is the most important period; for although, we cannot consider the disease to have already commenced, yet must we view all persons so situated as in the greatest danger, and as requiring quite as much attention and even professional care, as in the f)

chap. 1.

latter stages. It is here, that well directed efforts will avail much, in preventing the dread onset of symptoms : and the assertion may be hazarded, that tubercles may be prevented, for many years, from breaking out into irritative action, with all its intractable consequences, if those whose good fortune places them above the necessity of providing for the day that is passing over their heads, would attend strictly to the means of safety herein described.

What are the signs of general health or of a predisposition to phthisis ?

We shall find the consumptive and scrofulous constitution to he commonly associated with a fair complexion — light hair — a tumid upper lip — a delicately fair skin, with the veins large and prominent — the head large — the intellect, in many cases very precocious, and mind highly sensitive — the body sensible to chills — neck long — the chest narrow — and perhaps the stomach tumid — the feet almost invariably cold — dyspnsea on exertion, at times attended with palpitation — diminished muscular power, showing itself in a weakness of knees and ancles — a pulse easily accelerated — appetite capricious, not unoften voracious, yet digestion is not well performed ; and on any particular ingesta disagreeing, an irritation of the gastroenteric mucous membrane is often set up, which is removed, only by a febrile diarrhoea of several days5 continuance.

In some cases there are, a dark complexion and sallow skin, with a defective condition of its functions ; mental dullness and sluggishness of the body.

The eye affords almost unerring indications to the experienced practitioner, in the blueish or pearly state of the conjunctiva ; the dilated pupil ; and the long fringed eyelash; the intensely white (as if bloodless) forehead; the pinkish, or else livid eyelids; which are corroborated by the peculiarity of the whole physiognomy, recognisable without difficulty, by any one who is conversant with it.

W ith these physiological characters are often conjoined, redness of the eyelids — a tendency to lachrymation, and to inflamma-

CHAP. I.

tion of the conjunctiva, (the latter of very intractable nature) — paleness and puffiness of the face — flabbiness and unhealthy look of the skin — tendency to chilblains or to being frostbitten — the conglobate glands, in various parts of the body, enlarging apparently without exciting cause ; and such persons, if attacked by defluxions from nose, or ear, or by cutaneous defoedations (to which they are especially prone), will have much difficulty in getting rid of them ; whilst the ordinary diseases of childhood, bronchitis, measles, scarlet fever, whooping-cough, &c. are sources of the most imminent danger — requiring from the medical attendant the most prompt attention, the utmost decision, and the exercise of the profoundest judgment.

A low degree of vitality seems to prevail in this state of, what is not unaptly called, delicate health, or scrofulous diathesis; in consequence of which, predisposition to disease is augmented, exciting causes are endowed with power, and disease itself is less successfully borne.

GENERAL REMARKS.

Tubercles are usually deposited in a rounded form, of magnitude varying from that of a millet-seed or pin^s head to a much larger size — that of an orange ; they are yellow, opake, friable, without organization, are found scattered about singly or in masses, and are deposited, according to some authorities, in a solid form from the first, — according to others, in a fluid shape, but soon solidifying.

They may remain in a latent state for a variable period — even for many years — or on the application of exciting causes, they may begin to soften and assume a caseiform state — congestion of the surrounding vessels and texture takes place — a creamy pus-like matter is formed, which, seeking an outlet, makes a way for itself, through the surrounding pulmonary parenchyma, just as the matter of an abscess works its way to, and through, the skin ; — some of the ramifications of the bronchia become implicated, and through their open orifices the tuberculous matter, mixed up with the surrounding secretions, is expectorated.

CIIAP. I.

Should further tuberculous deposition be prevented^ and the disease be successfully treated; disturbance ceases in the pulmonary organ; and the patient is restored to a comfortable enjoyment of health.

Tuberculous matter may be deposited in three distinct forms, viz. that of grey semitransparent granulations — of caseous or crude tubercle — and that of tuberculous infiltration ; but as it does not consist with the writer’s views to reprint from the various excellent summaries of our knowledge of tubercles, to be found both in French and English authors, he will refer for further information to those valuable monograms — more particularly to the work on Consumption, written by Mons. Louis, which is a splendid instance of great acuteness — profound judgment — and untiring, well-directed labour.

Chapter II. Pathogeny

The peculiarities of a constitution, such as that above described, seem to consist in a less energetic condition, or vitiated functional exercise of the organic nerves, manifested in a too delicately organised skin, without — and a tendency to sluggish action or congestion of the circulating fluids, within.

There can now be litttle doubt, “ that the Tubercular Diathesis is in direct proportion to the development of this peculiar constitution,” and that the deposition of tubercles is in persons, hereditarily predisposed, much favoured by, and in others, mainly dependant on, a deviation from healthy innervation, producing a morbid alteration, together with a remora of, or as some say, a congestion of the blood in certain organs — which remora or congestion leads directly to the formation or localization of tuberculous matter.

CHAP. IT.

The matrix of this matter, according to Dr. Todd, consists of albumen or of coagulable lymph, imperfectly organizable — and the morbid alteration in the blood probably consists in an undue superabundance of carbon in it — for we must recollect that albumen contains nearly fifty-three per cent, of carbon.

As another consequence of this state of the nerves, an imperfect assimilation of the nutritive matter, received into the economy takes place — this is a powerful auxiliary in occasioning, or augmenting the mischief — and with this imperfect assimilation is combined defective secretion or elimination from the system of effete and useless matter.

“To sum up all,” says Andral, “it appears to me, that in the present state of the science, tubercle must be considered as the result of a modification or perversion of secretion, which is often attended or preceded by an active sanguineous congestion. These congestions arise out of, and are caused by, an impaired organic nervous power.”

PATHOGENY.

This diminished power of the organic nerves is, with sole probability, the proximate cause of the phenomena observable in this disease ; and accounts at once for the various pathological conditions — namely, the defect or failure in the capillary system, cutaneous and pulmonic — the perversion or suppression of certain secretions — the diminished decarbonization of the blood in the lungs and elsewhere — -and the sluggishness of the circulation in the cutaneous, hepatic, and pulmonic vessels.

This sluggishness of the circulation most naturally occurs where the lungs are the least moveable during respiration, namely, in the upper lobes; and as in addition, we know, that in inspiration much less air is inspired than the lungs are capable of receiving— some say not more than a tenth part of what would be necessary for that purpose — it is not difficult to discover the reasons why imperfect decarbonization, and consequent deposition, takes place in the upper lobes, rather than in any other part of the lungs. That this state of the organic

Chap. II

nerves may lie congenital, we know — just as any other tendency to weakness or disease may be hereditarily derived — but while we know, that even in that case, much may be done to avert danger, wre also are certain that, in the majority of instances, the neglect of physiological or hygienic rules, has been the sole agent in building up this destructive predisposition to disease.

The organization, and capillary system of the skin, depend for their healthy tone on the same system of nerves ; and the capillaries are, at times, so very delicate, that the vessels shall give way on the slightest pressure ; — a little friction, or even the gentle pressure of taking hold of an arm, will in such constitutions be often followed by lines or marks of extravasated blood, in shape corresponding with the parts pressed upon.