Pulmonary consumption, successfully treated with naphtha

Preface

Among the various diseases which afflict and destroy the human race, there are none so unsparingly fatal, or fraught with such direful consequences as Pulmonary Consumption. No country on the surface of the earth is secure from its ravages, and although it more frequently developes itself in adults, at no period of life are cither sex exempt from its visitations. Hooping cough, scarlet fever, measles, and small-pox are still severe scourges ; although the latter disease has shown itself less frequently and with less violence since the value of vaccination, as a preventitive remedy, struck the mind of Jenner. The diseases enumerated, not even excepting small-pox when unchecked by vaccination, in the majority of cases, occur during infancy ; and frightful as arc the results, they fall far short in amount of misery with those of Consumption. This dreaded and dreadful malady steals upon mankind at that age when death is least expected, and when it is indeed painful to the living witness. It is unnecessary, however, to enter into detail, for there are, unfortunately, in the history of most families, too many afflicting instances of the loss of relatives and friends, in the prime of life, from Pulmonary Consumption.

PREFACE.

Although various and varied in their character were the works on Pulmonary Consumption before Laennec’s time, his vast discoveries, by means of auscultation, have spread over it a new light, and created another era in its history. And since Laennec wrote, the press has teemed with works on this and other affections of the chest, embodying his views, and extending his researches. But, extraordinary as it may appear, our means of cure seem to have diminished, in proportion as our knowledge of determining the character of Consumption has increased ; for at no period of its history has it been so fatal as since the discovery of the stethoscope. Nor is it difficult to comprehend how this apparently strange state of things was brought about. Prior to the discovery of the stethoscope, our means of ascertaining the nature of Consumption and other affections of the chest, such as chronic bronchitis and chronic pleurisy, were so confined and imperfect, that they were often taken for each other, which, in the case of actual Consumption, invariably led to the disease assuming its most formidable stage before being detected ; whilst the existence of chronic bronchitis and chronic pleurisy being mistaken for Consumption, led to the opinion that the hitherto fatal malady was curable, although there is good reason for believing that it was as untractable then as it has been since. This is not mere opinion, it has been reduced to absolute fact, which, of late, has been so evident, that a great and

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important change has been wrought in the minds of the medical profession; the vast majority believing it an incurable disease, whilst the small minority consider that cases do sometimes recover, where the constitutional powers are but little impaired ; and they are further supported by Laennec’s belief in the cicatrisation of tuberculous cavities, and by Carswell and others, who hold a similar doctrine. Whether these cicatrices are the remains of tuberculous cavities, or belong to some other disease, is a question which ought, for the honour of the medical profession, to have been settled long since. Dr. Hodgkin,* in his work on the Serous and Mucous Membranes, has drawn attention to the puckering of the lung as a consequence of common inflammation of the organ. This appearance bears, at times, no inconsiderable resemblance to the cicatrices attributed to tubercles, and I am strongly disposed to believe that many of the supposed cases of the latter description are really of the former character. For my own part it appears inconsistent with probability, that tuberculous abscess of the lung has ever been cured ; for, if it had, how is it that recoveries do not take place upon a repetition of the attested successful treatment ? From the vast amount of cases constantly occurring, no difficulty can possibly arise in confirming the fact. It may be

Lectures on the Morbid Anatomy of the Serous and Mucous Membranes, vol. n, part i. by T. Hodgkin, M.D., p. 9G— 101.

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a question whether it be humiliating to acknowledge our ignorance, but it is most undoubtedly absurd to bring forward a few unequivocal cases to prove the curability of Consumption, which is contradicted in millions of instances by those who have died from this affection, whilst under the care of the best informed medical men in Europe. Since medical men have familiarised themselves with the use of the stethoscope, and appreciated its value, recoveries from bronchitis and pleurisy are no longer registered as Pulmonary Consumption, and the mystery of its being more fatal now than formerly readily explained. It is gratifying to those who early inculcated the doctrine of auscultation, amid a host of opposition, to witness its increasing importance, and to see converts daily using the instrument who were once avowedly amongst its greatest opponents.

And since the optician has improved the microscope, and the microscopist has been unceasingly industrious ; a new field of inquiry has been placed before the man of science. Among the causes which led to that state of perfection to which the microscope has now been brought, none stand more prominent than the excellence and cheapness of those of our continental neighbours. This created a praiseworthy spirit of emulation at home, and called forth additional exertions from our machinists, who have at length constructed instruments which are at this moment unrivalled. By means of micros-

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copical investigations most of the demonstrative sciences connected with medical subjects have been more or less enriched. Indeed, to notice all the obligations which the physiologist and pathologist alone owe to the microscope would occupy more space than I can spare. But I cannot avoid stating that I am indebted to this invaluable instrument for the discovery of those spherical globules which I have found so constantly present in the expectoration of consumptive persons, and which I look forward to as a certain means of pointing out the disease in an earlier stage than has hitherto been the case.

It is to be deplored that the same routine of treating disease, particularly when it happens to he of a fatal nature, should be so perseveringly followed. Pulmonary Consumption has its cough, its diarrhoea, its perspirations, treated a thousand times over with the same well-known useless remedies. In this way its victims pass on to the grave, without any further effort being made to save them. Canine madness, cancer, and some other diseases, which at present belong to the class of incurable disorders, baffle the ingenuity of medical men, hut if an experimental hospital was established, liberally endowed, and the medical officers so well paid that private practice became a secondary consideration, or interdicted altogether, a more full and complete opportunity wrould be afforded for ascertaining the curability of these affections, than any of our nurne-

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rous institutions at present offer. From the very first moment I employed Naphtha in Pulmonary Consumption, up to the present time, it has been so successful in my hands, that I have no doubt it will be found upon careful and judicious use, to be little less than a specific in the earlier stages of the disease. This can scarcely be saying too much, when, in the more advanced stages, where some destruction of the lungs has ensued, recovery has most unquestionably been effected. It must, however, be understood that a favourable termination in this stage of the disease is by no means so certain as in those that precede it. These opinions are supported by numerous well-marked cases of recovery, with the names and addresses appended. It is, therefore, presumed that the evidence in favour of the Naphtha treatment will be found so strong, that he who has the least confidence in the powers of the Materia Medica, will consider this new remedy, at least, worthy a trial. To the cases recorded in this volume, several might have been added ; but as they would have been mere repetitions, from their similarity in symptoms and cure with some one or other of the cases, and thus have swelled the work without giving weight to the evidence, I have not thought it necessary to publish them.

J. Hastings, M.D.

14, Albemarle Street,

Piccadilly.

Chapter I. Causes Of Pulmonary Consumption

Whether tubercle be due to an unhealthy condition of the nutritive process, tending to the production of such a morbid condition of the blood as to dispose the organism to generate pulmonary consumption in preference to any other disease, is an opinion, which if admitted, of so vague and indefinite a character, that it throws little or no light on the obscurity of the subject. When we reflect on the varieties of disease which are attributed to impaired nutrition and digestion, we are at a loss to comprehend how these varied affections can be generated by a common cause. For notwithstanding the brilliant researches of Liebig and other philosophers, who have laboured in the field of animal and vegetable chemistry, the first step from health to disease is by no means well marked. It is said that the cause is modified according to the nature of the tissue or organ through which it operates, and that much is due to climate and season. But this, instead of obviating the difficulty, leaves us uninformed how the cause is altered or modified so as to create gout or

CAUSES OF pulmonary consumption at one time, and a skin affection at another.

By far the most common of the various incitements to the propagation of tubercle is the hereditary cause, which must, as a matter of course, precede any change in the nutritive process. Hence we are involved in a labyrinth of conjecture upon this subject, which some day or other may be unravelled, should our optical instruments ever reach that state of perfection which will enable us to see the molecular arrangement of matter both in its gaseous and fluid state while undergoing those changes necessary for the production of organised bodies.

No cause, the hereditary excepted, to which the majority of my recorded cases are attributable, is more prominent in engendering pulmonary consumption than the application of cold to the surface of the body. The lady of fashion, who, lightly clad and in a state of perspiration, passes from the heated ball-room through cold passages into the open air to her carriage, is not less likely to fall a victim to the disease through her imprudence, than those of the poorer class who are unable to procure sufficient clothing to protect themselves during the inclement season. Disease arising from these sources is of daily occurrence, and numerous are the victims to consumption from the effect of damp clothes and beds. Climate and other local causes, such as bleak situations, arc as much the predisposing

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causes, as depressing passions, general debaucheries, and all circumstances which prostrate the mind and lower the vital actions, are the fruitful sources of pulmonary consumption.

Continued fever has been, by some observers, ranked among the occasional causes of the disease, and I have now under my care a young man scarcely recovered from intermittent fever, who is labouring under a well-marked attack. Previous to the appearance of the fever he enjoyed excellent health, and a tendency to consumption has not shewn itself in his family. His spleen and liver are now considerably enlarged.

Women are unquestionably more liable to pulmonary consumption than men ; for out of nine thousand five hundred and forty-two deaths which occurred at Paris, five thousand five hundred and forty-two were women. This difference has been very properly attributed to a feebleness of constitution, which often arises from tightly lacing the chest, and other defects in the training. Exposure of the chest is regarded by some practitioners as an additional exciting cause.

That pulmonary consumption is hereditary there can be no doubt, from the abundant evidence at our disposal. Children who have lost both parents from consumption are more liable to this affection than those deprived of but one; while the family of consumptive parents frequently enjoy excellent health, and are even strong rather than weak in the chest. On the

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CAUSES OF other hand whole families are swept off, the parents remaining healthy.

The contagious nature of pulmonary consumption is a question of great importance, and no opportunity should be neglected, no circumstance be left unnoticed, which will tend to solve the problem. The contagious nature of scarlet fever, of small-pox, and of measles is not doubted, although but little is known of the laws of transmission from one person to another. Among my recorded cases, there is the history of two married women, under thirty years of age, restored to health ; the one having been for a considerable period in attendance upon her consumptive husband, previous to which she was in good health, her family being as healthy as herself; the other having been nurse during six months to her sister-in-law, and, as in the former case, previously healthy, and even robust in person, neither wos there in her family, as far as I could learn, a consumptive taint.

Andral has repeatedly noticed similar facts, and I would, therefore, earnestly recommend those w'ho are engaged as nurses in consumptive diseases, whether they are husbands, waves, sisters, brothers, or servants, not to sleep in the same bed with the patient, or to remain even within the distance of twTo or three feet longer than is absolutely necessary, particularly if they are under thirty years of age. Relatives, from that affection inherent in man, will often be induced to disregard this caution ; nevertheless, it is a duty the

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medical man owes to society, to strongly insist upon the adoption of those means which he believes have a tendency to prolong, or shorten the duration of life.

According to Andral,(l) Langston Parker, (2) and others, that which has been termed strumous dyspepsia, or dyspeptic phthisis, frequently ushers in the more well marked symptoms of pulmonary consumption ; but as this malady is not always co-existent with dyspepsia, the question arises if it be anything more than a complication similar to those of the heart and liver, with which it is often associated. From numerous statistical records, it has been satisfactorily proved, that persons employed as dry grinders, clerks, and tailors, arc liable to suffer from pulmonary consumption, as well as those engaged in cutting through sandstone, in order to recover a lost vein of coal ; whilst butchers, poulterers and tallow chandlers, are remarkably exempt from its visitations.

(2) The Stomach in its Morbid State, by Langston Parker, 183S, p. 232.

SYMPTOMS OF

Chapter II. Symptoms Of Pulmonary Consumption

In the early deposition of tubercles in the lungs, where they are scattered and few in number, it is very difficult to detect them ; notwithstanding they offer a sufficient obstacle to inspiration and expiration, as to produce slight cough, which often precedes the more doubtful signs of pulmonary' consumption ; this state continues in some persons, without apparently making a step in advance, for a considerable but indefinite period, where the disposition for the development of the disease is feeble, and all exciting causes avoided. At this time, prolonged expiration is a symptom often present, which has attracted but little attention in this country, although it has been long recognised by continental observers. As there are so few symptoms in the early stage of pulmonary consumption to point out its existence, this cannot fail to be regarded as one of great value. When tubercles are deposited in the more central parts of the lungs, the circumference remaining uncontaminated, they are detected with great difficulty, and frequently

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altogether escape notice. Mr. Henderson during our sojourn in Paris in 1 840 and 1 84 1, as a means of detecting these deep seated tubercles, as well as those deposited in cases of early pulmonary consumption, was accustomed to percuss either the anterior, or posterior walls of the chest, and then apply his ear to the opposite side, with the expectation that the sound would be so modified by the dense structure of the tubercles, as to enable him to decide on their existence. This ingenious plan was abandoned by Mr. Henderson in consequence of its failure in producing those practical results which he expected. Dr. Williams, (3) however, who has recently called the attention of the public to this method, may be more successful.

Authors from an early period have recognised a class of symptoms, which have been grouped under one head and called by Sir James Clark, (4) tubercular cachexy, as indicative of an early stage of pulmonary consumption. As this condition neither precedes or exists at any time in some cases, it would appear to be attributable to complication. It is known, that patients far advanced in disease often seek relief for the first time, without being previously aware of their

(3) Medical Gazette, p. 404, December 16th, 1842.

(4) The Influence of Climate, &c., hy Sir James Clark, M.D. Seoond edition, p. 320.

SYMPTOMS OF danger, although upon close interrogation many of the signs of this* cachectic state were present.

Some individuals from deficiency of moral courage blind themselves to their own condition, by refusing their consent to the well marked symptoms of the disease; while others in complaining are subjects of ridicule from their blooming cheeks and other signs of health, and thus the disease progresses to an advanced stage before seeking medical aid. Probably most cases of pulmonary consumption, prior to the deposition of tubercles, are preceded by some more or less general deterioration in the system due to a vitiated state of the blood, and as this is the great fountain of supply whence the body draws its support, it is not difficult to understand how it deranges all the functions, and paves the way to fatal diseases. Nevertheless cases, as I have shown, now and then occur, where cachectic symptoms are altogether wanting. This may arise from a kind of purification the blood undergoes through depositing its poisonous tubercles in the lungs so immediately after their formation in the blood or elsewhere, that no constitutional derangement or tubercular cachexy is manifested in the system.

Tubercular cachexy is often ingrafted in persons with chests below the ordinary size, at the same time the skin is thin and transparent and of a dirty hue, the eyes are light blue, or dark brown, dull and

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glassy, and the countenance sallow and faded, the hair is light brown, or black, the joints large, and the finger nails disposed to bend round the pulp of the fingers. The tongue is white and furred at the base, the appetite is variable, the bowels alternate between constipation and diarrhaea, or are wholly constipated. Flatulence and pain exists at the pit of the stomach after meals, which in females is accompanied with palpitation and faintings. Menstruation is irregular in time, quantity, and quality, head-ache is present, the feet cold, the action of the heart feeble, and the pulse below the natural standard, (5) the muscles of voluntary motion are softer than usual, and there is great disinclination to exertion, and the temper is unusually variable and irritable.

Tubercles first show themselves in the superior portion of the lungs, and the left lung is said first to be attacked. Their existence is characterised at this early stage by dry cough, or cough and expectoration of a semi-transparent white mucus, which varies in quantity and frothiness. Sometimes the expectoration is blackish, owing to the inhalation of carbonaceous matter existing in the atmosphere of crowded cities; the cough is often harassing, and muscular effort is mostly attended by impeded respiration, particularly

SYMPTOMS OF on ascending a hill, or a staircase. At this period, the disease may generally be recognised by its physical signs. On percussing the walls of the chest, a dull sound is at one time perceived over both sub and supra clavicular and scapular regions, at another only one side, which most frequently proves to be the left.

When one side is found to yield this dull sound, an increased sonoriety may be detected over the other, the murmur of inspiration will then be augmented in intensity, or, in other words, it will be puerile ; whilst on the opposite side it will be diminished or feeble, and will have a peculiar harsh or rough character. In more advanced cases, dulness from percussion will be common over all the superior portion of the chest, and the respiratory murmur, at parts, will sometimes be absent or replaced by a dry crackling rdle ; over other spaces it will be loud and rough. Inspiration wall now and then be performed by jerks; expiration will frequently be loud and prolonged, which is occasionally a symptom amongst the earliest noticed. The sounds of the heart will be now very distinct over the dull spaces, from the condensation which has taken place in the lungs ; and which, from their having acquired a greater density through the deposit of tubercles, become in consequence better conductors of sound. As the cough, expectoration, difficulty of breathing, hectic fever, and debility increase, depressions in the walls of the chest become

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manifest, varying in extent and situation according to the part and portion of the lungs which become collapsed, independent of any wasting of the muscles, cellular tissue, or skin; in consequence of which the movements of the chest are diminished, and its measurements altered. Eventually the tubercles form themselves in such masses, that they exclude the atmosphere from the air cells and the minute bronchi in their immediate neighbourhood, which is probably owing to mechanical pressure, and thus the admission of air beyond the larger branches is prevented. Then tubular breathing is developed, the respiratory murmur disappears, and the voice is heard at the distal end of the stethescope, or, in other words, bronchophony is present. Sometimes the tubular murmur is blended with the dry crackling rdle and sibilant and sonorous rattles.

When hardened tubercle has softened and discharged its contents, a clear sound is sometimes the result of percussion, and a cavernous or blowing murmur is heard over the spaces it had occupied ; the voice traverses the whole length of the stethescope, and speaks as it were into the ear. This pectoriloquy is more or less evident the nearer or farther the excavation is from the central part of the lungs. The countenance assumes a leaden hue, and the system is often harassed with colliquative diarrhsea and perspirations, and towards the close of the disease obstinate costiveness often ensues. The character of the expecto-

20 SYMPTOMS OF PULMONARY CONSUMPTION.

ration, at first thin, viscid, and colourless, then opake, greenish yellow, and of a thicker nature, has now become of a creamy consistence, containing within it small bodies of a dense character, combined with a little frothy secretion, and occasionally stained and streaked with blood ; and globules of tubercle, as well as a cryptogamic plant, are readily detected by the microscope. After the discharge of a large tubercular mass, improvement not unfrequently takes place, which only lasts until another crude portion is ripened ; and in this way, step by step, the patient sinks.

Sometimes, but less frequently than is generally believed, the early symptoms of pulmonary consumption are ushered in by spitting blood, which returns at uncertain intervals ; the ordinary train of symptoms then follow, and the disease runs its usual course.

Chapter III. Complicated Forms Of Pulmonary Consumption

If pulmonary consumption is defined to be a deposition of tubercles in the lungs, then all those diseased states accompanying it, as well as those arising from tubercular deposit in other organs, must he considered to he complications of consumption. Taking then this view of the subject, that species of dyspepsia called strumous must certainly belong to the complications, instead of being itself a stage of pulmonary consumption. For sometimes the disease runs its course unaccompanied with dyspepsia, and dyspepsia is a very common affection in persons uncontaminated with pulmonary consumption. Hence we may conclude that its strumous character depends on the accidental circumstance of its being engrafted on a consumptive constitution. It might, moreover, a priori, be expected that dyspepsia would exist during an attack of consumption, from the enfeebled state of the organisation then present, combined with irregular appetite.

Under the head of complications, are fatty degc-

COMPLICATED FORMS OF negation of the liver, and diseases of the heart. The symptoms of the former are so obscure as to afford little indication of its existence ; while both functional and structural diseases of the heart are to be detected in their earliest stages. Both are found co-existing with consumption, but in this country the former less frequently occurs. Functional disease of the heart is often conjoined with dyspepsia, and is probably due to reflex-action. It manifests itself by palpitation, faintness, irregularity of pulse, difficulty of breathing, and on the application of the ear or stethoscope over the left ventricle by a bruit. Structural disease of the heart is more commonly met with in an after stage of consumption, such as dilatation, with sometimes hypertrophy and valvular disease.

That these affections are not of more frequent occurrence is a matter of astonishment, when the opposition the blood meets with in traversing the lungs is taken into consideration. Where the disorganisation of these organs has proceeded to a great length, regurgitation takes place in the right ventricle, and great muscular effort is necessary to drive the blood onwards, which accumulates in its cavity from the right auricle and pulmonary artery. The effect of this morbid state more or less influences all the cavities of the heart ; the right auricle is unable to propel its contents without unusual efforts, in consequence of the almost constant fulness of the right ventricle ;

Chapter IV. Pathological Condition Of Pulmonary Consumption

Tubercles, when examined under the field of the microscope, appear to be composed of globules, differing only from those found in pus by their form being less perfectly round, and by their having sometimes a sort of undefined, ragged edge, and, when placed in water, being found to undergo no change for a considerable time ; whereas pus globules, when put in water, are soon altered in appearance. Such was the opinion Gruby, the celebrated microscopist of Vienna, expressed to me in Paris in 1841. Since I have been investigating the microscopical character of tubercle, the expectoration of a considerable number of persons suffering from pulmonary consumption have met with my most careful attention. This has led me to observe, what as far as I am aware has hitherto been unnoticed, another description of globule, of a spherical form, variable in size, but inferior to that of a pus globule ; its appearance is that of a small milk or oil globule, and as far as I have been able to distinguish contains neither granules or nuclei. These globules, in

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PATHOLOGICAL CONDITION OP the perfect state, may be seen by submitting to the field of the microscope a comminuted portion of hardened tubercle ; the greater part, however, of the mass will be found composed of irregularly shaped bodies, which is attributable, in my opinion, to compression; and that if allowed further to dcvelope themselves or ripen they would assume the spheroidal form. Should these globules be identified with tubercle, it will be possible to determine the character of consumption at a very early stage.

The Cryptogamic plant, first, I believe, observed by Dr. John Hughes Bennet, and recorded in the Transactions of the Royal Society of Edinburgh, I have invariably found present in the expectoration of consumptive persons, and if peculiar to this disease, is highly important. In order to ascertain whether this minute plant was generated in the lungs, I cut through a hard tubercular mass, and immediately placed the central portion under the field of the microscope, when several fine specimens were perceptible.

I have not had an opportunity of searching for the globules I have mentioned in the blood of consumptive patients, as 1 rarely employ blood-letting either local or general. That tubercles exist in the blood before they are deposited in the solids may be inferred from the fact, that upon examination after death almost every organ of the body is found more or less covered and infiltrated with them ; a condition which it is difficult to

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understand, except upon the supposition that the disease previously existed in the blood. A careful examination of the blood of consumptive patients is highly necessary in order to confirm, if possible, the opinion of Liebig, that there is in this disease a deficiency of blood globules, or, as he calls them, “ oxygen carriers.”

Of the phenomena of pulmonary consumption, the systematic deposit of tubercles in the superior part of the lungs is the most extraordinary. Whether they arc held in solution by the blood, and precipitated within the lungs, after the carbonic acid gas and water has been given oft’ which previously held them in solution, is a problem not easily solved. Again, whether the changes which ensue reciprocally in the blood and air contained \\ ithin the lungs are earned on to a greater extent in the upper lobes than in the middle or lower, and in this way become more liable to disease, is also a difficult question to answer.

Tubercles have been described and named, according to their size, seat, colour, and consistence, as if they were ah initio different; whilst there is good reason for believing that they have a common origin. As far as the naked eye can discern, their first appearance is of a transparent grey colour, and of the size of a millet seed. These appear to augment in size, until they are sometimes met with as large as a walnut,

PATHOLOGICAL CONDITION OF when they are found to be of a cheesy friable consistence, and unless the colour is altered by an accidental circumstance, is then of a yellowish opakc white.