COMPLIMENTS OF THE AUTHOR. 
THE TREATMENT 
OF 
CHRONIC TUBERCULAR CONSUMPTION. 
AND THE IMPORTANCE OF THE 
Recognition of Its Curability, and Early 
Diagnosis, and Prompt, Diligent 
Treatment, by Home Hygiene and 
Drugs. 
BY 
Q. Cincinnatus Smith, M.D., 
AUSTIN, TEXAS. 
Member of American Medical Association; 
Life Foundation Fellow Society Science, 
Letters and Art, London ; Life Fellow 
American Association for the Advance- 
ment of Science; Life Member California 
Academy of Science ; Active Member 
New York Medico-Legal Society, etc., 
etc. THE TREATMENT OF CHRONIC TUBERCULAR PUL- 
MONARY CONSUMPTION: AND THE IMPORTANCE 
OF THE RECOGNITION OF ITS CURABILITY, AND 
EARLY DIAGNOSIS, AND PROMPT DILIGENT 
TREATMENT, BY HOME HYGIENE AND DRUGS. 
Q. C. SMITH, M.D., AUSTIN, TEXAS. 
As we will limit our remarks to the form of Consumption 
above referred to, we will, in this paper, for brevity sake, simply 
call it Phthisis. 
That phthisis is a curable disease, and in a certain proportion 
of cases, even self-limited, there remains no doubt. The late 
Prof. Austin Flint, in some of his later writings, recorded, that he 
felt safe in saying, that at least ten percent of all cases of 
phthisis, were self-limited, and result either in spontaneous cure, 
or more or less permanent cessation of active progress, without 
the assistance of any form of treatment whatever. 
And further, that in a considerable proportion of these self- 
limited or spontaneously cured cases, there was more or less 
consolidation of a portion of the lung, and some cases spon- 
taneously recovered even after lung cavities were unmistakably 
detectable. Grancher, tells us, that: “ That which distinguishes 
the evolution and life history of tubercle from that of cancer, is 
the natural tendency of tubercle to become fibrous, and self- 
limited ; this transformation being due to the inherent nature 
and character of the tubercular lesion, and not to fortuitous 
circumstances or changes.” 
Louis, said : “ Few persons are born to necessarily die of 
phthisis.” 
The carefully kept records of the large private practice of 
Drs. Ephraim and John A. Cutter, show that they have cured, 
or more or less permanently arrested, and are still curing about 
thirty-five percent of the many cases of phthisis they have 
treated. And in quite a proportion of these cured or perma- 
nently arrested cases, the lungs had begun to break down and 
cavities form before treatment was undertaken. Prof. See has recently given his opinion, that a large percent 
of cases of phthisis are curable, provided proper treatment 
be instituted during the primary or apyretic stage of the 
disease. 
Prof. Jaccoud, recently said : “ To sum up what we have to 
state, would say, phthisis is curable in all its stages. This 
is the prolific idea which presides over the whole history of the 
disease, and which should unceasingly inspire and direct all 
medical action. The incurability proclaimed by Laennec and 
his immediate successors is disproved by pathological anatomy 
and clinical observation. None should therefore allow them- 
selves to be influenced by such condemnation. When the exist- 
ence of tubercle in the lung is recognized, it should not be 
inferred from that moment that he who has them is doomed to 
death in consequence of their presence. Should it be found 
that the tubercles soften and a cavern forms, it should not be 
believed on this account that all is lost.. For it has been shown 
that this is not the case, and the natural tendency which tubercle 
has to fibrous transformation, that is to recovery, should never 
be forgotten. For the curability of chronic tubercular pul- 
monary phthisis has now been established at every stage.” 
Prof. N. S. Davis says : “ In the earlier stages there is a 
reasonable chance for the patient’s more or less permanent 
recovery.” 
The late Prof. Brehmer,—whose clinical experience in the 
treatment of phthisis was immense,—recorded, in his latest writ- 
ings on the treatment of phthisis, that he was able to cure quite 
a large per cent, of the cases that came under his care during 
the latent or apyretic state of the disease, and even a consider- 
able per cent, of the cases that had progressed to still graver 
conditions before treatment was undertaken. 
Prof. Brehmer’s great work, recently issued, and that of Prof. 
Jaccoud, are the best now before the profession, on the treat- 
ment of phthisis 
Dr. J. F. Churchill, who has placed the world under immense 
and lasting obligation for his long lifetime persevering devotion 
to the study and investigation of the clinical aspects of tuber- 
culosis, and the discovery of its successful treatment by the 
hypophosphites and inhalent remedies, has put on record—what 
later observers have repeatedly verified,—that he was able to 
cure a large majority of cases of phthisis that came under his 
care during the earlier stages of the disease, and a considerable 
proportion after cavities had formed in one lung ; and even in a 
few cases of cavities in both lungs, he was able to more or less 
permanently arrest the disease. 
We deem further citation of authority in reference to the 
curability of phthisis, unnecessary : for indeed, all that we have stated on this point, and much more to the same effect, is within 
easy reach of every physician. 
DIAGNOSIS. 
Of the importance of an early correct diagnosis, it seems 
scarcely necessary to speak, as it is axiomatic, that correctness 
of diagnosis is not only the basis of therapeutic experience, 
but alone furnishes the true light directing intelligent treat- 
ment. And with peculiar force, in reference to this disease, does 
the principle apply, that imperfection of diagnosis, leads to an 
underestimate of the value of therapeutic agents. 
And the therapeutic nihilism, so superciliously affected by 
many of those of large pretentions, but shallow attainments in 
therapeutic knowledge and skill, is one of the greatest obstacles 
to the advancement of clinical medicine of our time. 
TREATMENT. 
Routinism is pre-eminently the bane of consumption therapeutics. 
The unfortunate patient’s precious months of golden avail- 
ability, are often criminally wasted by the dilly-dally do-nothing 
policy of his nominal medical attendant; the anxious patient often 
being pooh poohed out of the consultation room with only a 
perfunctory examination, or none at all, with the jocose assur- 
ance, that his lungs are perfectly sound. 
It being a well-known and undisputed fact, that the patholo- 
gical status necessary to constitute the disease or process known 
as chronic tubercular pulmonary consumption, vary greatly 
in different cases, hence it must follow, that the treatment, to 
be more or less successful, should be adapted to meet the several 
indications and conditions of each patient, and modified to suit 
the different stages and symptoms that may come to pass, or be 
manifest from time to time in any given case. 
To be brief and definite as possible, we will suggest an illus- 
trative case, such as more or less frequently occur, of a class 
of cases that are very often dismissed, by many reputable physi- 
cians, with a commonplace prescription (an opiate cough 
mixture perhaps) supposed to be sufficient to give relief from 
immediate suffering or inconvenience. 
An individual—especially those from fifteen to thirty years of 
age—consults us for perhaps a recent cold, cough or sore throat; 
for usually phthisically disposed persons take cold easily, be 
they ever so robust and apparently sound. A careful history of 
such a case may develop the probability, that perhaps phthisis, 4 
may be in its earlier stages, has been (and is) insidiously creep- 
ing upon the patient for at least several months. 
Therefore, if permitted, we make a careful physical examina- 
tion of the lungs and heart: and may be discover the peculiar signs 
that warrant us to suspect the presence of phthisis, though it 
may be in its early beginning. 
However, as it is* usually difficult, and often impossible, in 
this class of cases, to positively decide just what proportion of 
their observable signs are acute or recent, and what proportion 
chronic; hence we deem it proper to state plainly to such 
patients, the nature and import of their condition; prescribe to 
relieve the immediate demands of the case, and make special 
endeavor to impress the importance of a thorough re-examina- 
tion in the near future, and dismiss the patient with a favorable 
prognosis, provided our instructions are strictly complied 
with. 
’Tis often most difficult, or impossible, to bring this class of 
patients to realize the portentous importance of prompt diligent 
and decisive treatment in their case. For, may be with truth, 
they will tell us, that they have not been sick for years, always 
able to work more or less, never had haemoptisis, hectic fever, 
or night sweats, little or no habitual cough, pulse and circula- 
tion ordinarily good, appetite and digestion usually fairly good, 
and have lost little or no weight. 
Now many such patients, barring accidents and acute diseases, 
would live from two to five years, or possibly much longer, if 
left without treatment of any kind. Yet this is just the class of 
cases from which the great majority of recruits are constantly 
drawn to replenish the ever-rapidly thinning ranks of the vast 
host of irretrievable consumptives. 
Now is the golden opportunity with this class of patients; and 
if the physician make haste to utilize available therapeutic 
resources, such patients, with little loss of time from their ordin- 
ary employments, and at no great expense, can usually be, within 
a year or two, put in such condition that, with a reasonable 
degree of prudence, they may live out an ordinary lifetime, or 
ultimately die of other disease than phthisis. 
In this class of patients, the emunctories, especially the inter- 
nal excretal gateways, are usually sluggish and clogged with 
effete matters, the secretions and excretions have long been 
diminished and vitiated, hence the normal processes of metamor- 
phosis and disassimilation of the tissues and fluids of the body 
are more or less retarded; the gradually accumulated debris is 
too slowly eliminated, and its presence prevents the elabora- 
tion and appropriation of a good quality of new building up 
material. 
Chronic constipation, in more or less degree, usually exists,— the reverse obtains rarely,—and such persons do not usually as- 
similate well. 
These vitiated, and worn-out excretive products, resulting 
from normal, or perverted, tissue change, gradually accumulate 
wherever the economy least resists their presence, and they by 
degenerative changes, become or produce a slowly-acting leu- 
comanic or ptomainic poison, which gradually hampers and 
weakens the life-cell building power, until it becomes impossible 
for normal tissue-building material to be elaborated and utilized. 
Hence, while the assimilative and excretive organs move in 
this vicious circle, the strength of the patient cannot be per- 
manently built up, or his waning vitality restored: ply him as 
you may with so-called alcoholic stimulants, ferruginous tonics 
and cod liver oil. 
And thus, by this hypothesis, the correctness of which has 
been abundantly proved by clinical demonstration, we are 
enabled to push our research one link further back in the 
mysterious pathological chain of primordial causation, of at 
least a larger proportion of cases of chronic tubercular phthisis 
pulmonalis, than has heretofore been recorded for us. 
Jaccoud, in common with many other recent and earlier ob- 
servers, tell us, that the fons et origo of this disease, is organic 
constitutional debility. And upon this idea, as a basis for his 
remarkably successful treatment, he in his latest words, “ Pro- 
claims more earnestly than ever, that chronic tubercular phthisis 
pulmonalis, is curable, in a certain proportion of cases, in all its 
stages ; and that this encouraging idea presides over the whole 
history of the disease, and therefore the necessity, and proba- 
bility of utility of persevering well directed plan of active treat- 
ment.” 
And while our limited clinical experience, especially in recent 
years, strongly inclines us to indorse the hopeful views of Pro- 
fessor Jaccoud, See, Grancher, Brehmer, Churchill, Davis, Flint, 
and many others, as to the utility of timely well directed per- 
severing treatment of this disease; we think that the assigned 
predisposing causes or conditions—constitutional debility of Jac- 
coud ; Cutters vegetable spores in the blood ; the bacillus of Koch ; 
the want of phosphorus in the system of Churchill ; the mal- 
meteorologia of Storer, and many others—alleged as being the 
primary, principal or sole predisposing cause that must obtain 
or act, in order that the pathological phenomena recognized as 
constituting phthisis, may or must evolute, are inadequate to 
elucidate the leading manifestations that usually come to pass 
during the progress of this disease. 
Yet, a comprehensive understanding of each of these theories 
just referred to, will bring to the patient student much valuable 
light that no other window will let in. And when each and all of 6 
these theories, together with the hypothesis we have advanced, 
with a clear philosophic idea of the value and bearings of each, 
are considered as a comprehensive whole, we will be enabled, as 
cliniciens, to move one more sure step forward, in that most dif- 
ficult road, the obstacles of which have so often baffled the 
ablest efforts of the greatest physicians of all ages and coun- 
tries—the successful treatment of phthisis. 
These retained poison-producing waste or effete products re- 
ferred to act as an irritant, and tend to produce—and often do 
produce—a reactionary fever, usually called hectic, and which 
is the result of an effort of the conservative powers to rid the 
economy of such seriously disturbing poisonous materes morbi. 
This persistent, auto-ptomainic toxemia,producing hectic fever, 
the cool stage of which often results in night sweats : the latter 
phenomena being plainly an effort of the conservative powers 
to rid the system of this subtle poison. Hence, some phthisical 
patients, who are not extremely debilitated, feel better during 
the first few hours immediately following a profuse hectic sweat. 
This plausible and instructive—and we believe correct—hy- 
pothesis, is one of the chief corner stones upon which we predi- 
cate our system of curative treatment of early phthisis ; the past 
success of which has already given us much reason to hope for 
still greater success in future. 
And, as a rule, in any given case of early phthisis, if we are 
able to stop the auto-toxemia, the cause of the wasting hectic 
fever, its concomitant debilitating phenomena, will cease, and 
the patient will be enabled, by further judicious treatment (and 
some cases without further treatment) to make more or less per- 
manent improvement. And our experience leads us to believe, 
that this desirable result can be most surely and speedily pro- 
duced, in many cases, by the early eliminative and specific sys- 
tem of treatment which we advocate. 
The majority of physicians are very skeptical in regard to 
the curability of any form or stage of phthisis. And this wide 
spread skepticism is the more deplorable, because its tendency 
leads such physicians to shut their unwilling eyes to portentous 
manifestations, paralyzes their energies, diminishes their already 
too small confidence in the value of remedial agents, and they 
blindly endeavor to hope for the best, and thus supinely fritter 
away golden days of available opportunity, the criminal waste 
of which will make, in many cases, all the momentous differ- 
ence between a prolonged valuable and happy life, and an early 
sad lingering death. 
As before intimated, it is quite fashionable, with a certain 
class of physicians, especially those affecting superior intelli- 
gence and higher education, to profess to have little or no Jaith 
in the healing powers of drugs, even in other diseases than phthisis ; but with arrogant vehemence do many such scout the 
idea, that medicinal substances may be so administered to patients 
suffering from well defined pulmonary consumption, as to not 
only render temporary relief, but so as to be the principal means 
of causing a more or less permanent restoration of a fair de- 
gree of serviceable comfortable health. 
And only recently, an eminent medical teacher, published : 
“ It remains for phthisical subjects, then, to content themselves 
with caring for their health by means of the inhalation of rela- 
tively pure air, free from dust, by good, strengthening nourish- 
ment, and by strict attention to the hygiene of the body.” 
Of course, it would be a worse than useless waste of effort, to 
reason with this confirmed pessimistic class of therapeutic nihil- 
ists, who doggedly close, the shutters to the light of later ex- 
perience and progress, and declare the sun of increasing thera- 
peutic light and success does not shine. 
In the treatment of phthisis, in many cases, we should keep 
two somewhat distinct objects in view : 
First, The correction of the general perversion of the func- 
tions of the tissue building powers and processes ; and, 
Second, The palliative or curative treatment of the various 
local or special manifestations or complications,—such as cough, 
fever, sweats, pleuritic or other pain—acute, temporary or oth- 
erwise, as may come to pass during the progress of each indi- 
vidual case. 
In our efforts to relieve or cure the second class of manifes- 
tations, we should beware of over-active, perturbative or de- 
pletive treatment. 
But as before hinted, ’tis often the greatest difficulty en- 
countered, in our efforts to timely and successfully treat phthisis, 
is the inability of the patient and his friends, to appreciate the 
portentous gravity of his threatened condition, and to realize the 
urgent necessity for the immediate persistent and diligent use of 
whatever remedial agents deemed necessary. 
It seems difficult or impossible, for many such patients, to fully 
realize the momentous fact, that their chronic morbid constitu- 
tionality, wffiich usually has been years in developing, and in- 
deed is often inherited, cannot be eradicated or more or less 
permanently corrected, by the use of this or that remedy for a 
few days or weeks, or by a brief vacation from school or business. 
And we are sorry to say that this dangerous lulling skepti- 
cism is often encouraged, if not originated, by many reputable 
—but inconsiderate or uninformed—physicians. 
Hence it is, we see so few well devised and persistently ex- 
ecuted plans of timely constitutional treatment adopted, for 
either preventing or curing this obstinate disease. 
In the division or classification of remedial agents and meas- 8 
ures to be employed in the home treatment of phthisis, we 
would place first, hygiene ; second, foods ; and third, drugs. 
Of course, we refer to the treatment of those cases—the great 
majority—whose circumstances will not permit them to travel away 
from home, to secure the great advantages often to be derived 
from more or less prolonged judicious climatic treatment: which 
of itself, under favorable circumstances, with ample means, is often 
not only a most valuable auxiliary therapeutic resource, but the 
most powerful restorative agency or influence available. 
OF HOME HYGIENE. 
First. The patient should have, and regularly follow,—barring 
inclement weather and physical inability—some cheerful active 
out-door employment : even females should comply with this 
requirement as far as sex, strength and circumstances will 
allow. , 
For idleness consumeth the health as a devouring moth, and 
as a hungry leech it saps the strength and energies in the early 
morn, noontide and eve : and surely brings the wasting tor- 
tures of miserable introspective brooding gloom, that poisons 
the fountains of life, and often defies the restorative power of 
all healing agents and influences. 
This outdoor active exercise, is largely shorn of its remedial 
value, if performed as a slavish task or a dreaded penance. ’Tis 
best that it come as an incidental accompaniment to some 
specific more or less serviceable purpose earnestly carried out. 
The patient should be encouraged to resolutely take the world 
by the horns, and with determined spirit and energy bend its 
affairs to serve his laudable purposes. 
For many persons die prematurely, simply because they have 
nothing else of interest to do. 
And what is more: there is no bread so nutritious as that upon 
which open-air manual labor feeds, or viands so sweet as the 
trophies of the bronzed horny hand. 
Horseback riding, especially at a rapid pace, on an easy-going 
horse, is well known to be one of the best forms of exercise; 
and if circumstances permit, should, in many cases be preferred 
to heavier manual labor. 
But no form of labor or exercise, should be habitually taken 
to such an extent, as to cause the patient to be sore and wearied 
on rising the following morning : but the greatest amount that 
can be performed short of this sore-tired feeling, is not too 
much. Frequent short rests, through the day, preferably in the 
horizotal posture, and not over five to ten minutes at a time, 
are very beneficial. 
And we should not forget or neglect the great value of regu- lar, well-directed, home gymnastic exercises. This serves a 
most valuable purpose, that cannot be attained by any other 
means. And fortunately ’tis within the reach of all, even in the 
humblest circumstances : and is always available, even in the 
most inclement weather. 
Blaikie’s and Lofving’s* small manuals, recently issued, give 
excellent practical teaching and valuable advice on the best 
modes and sanitary value of Home and School Gymnastics : and 
every Physician, and every School Teacher, and every phthisi- 
ually inclined patient or person, and all young persons living in 
cities, should procure one or both these small monographs, and 
heed their valuable teachings. 
In some cases of early phthisis, the fine dry crepitant rales, 
for which we so diligently seek — hoping we will not find them— 
and oftenest found at the apices of one or both lungs, may be 
made to disappear, in some cases more or less permanently, by 
the regular daily faithful intelligent use of respiratory gym- 
nastics, carried out in accordance with the instructions Prof. 
Lofving has laid down in his manual of gymnastics. Thus 
showing unmistakably the great value of this form of treatment. 
Home gymnastics serve an invaluable remedial purpose, that 
no other remedy, or form of exercise or treatment, can afford : 
and is of especial value as a preventive of phthisis, and also a 
remedy of great curative value in the earlier stages of that 
dreadful disease, and is always available. 
Nor should we forget or neglect vocal music, as a remedy of 
great value, in the prevention and early curative treatment of 
phthisis : for it furnishes a form of pulmonary strengthening 
exercise and gymnastics that cannot be supplied in any other 
way, or by any other means; and should be a part of the curric- 
ulum in all public and private schools. 
FOOD. 
In regard to what is proper food and feeding for phthisical 
patients or persons, we do not agree with the views so dogmat- 
ically laid down by some distinguished writers upon this sub- 
ject: who seem to think, that perfection of nourishing and per- 
manently building up phthisical patients, or phthisically inclined 
persons, consists in causing them to ingest the maximum 
amount possible of the richest concentrated nitrogenous and 
fatty foods—exclusive of other classes of foods—at regular 
stated periods every day. 
For we are quite sure, that the menu some such writers have 
specially formulated for this class of patients, would overtax the 
J. B. Lippincott Co., 1890, 60 c. digestive powers of even many sound robust persons in a short 
time. For the problem is plainly, not just how much con- 
densed rich, nitrogenious, fatty, or other strong food, we can 
induce these pattents to ingest, but what kinds, classes, and 
combinations of foods they can most easily and thoroughly 
assimilate, for more or less indefinitely prolonged periods of 
time. To do this to the best advantage, we must carefully study 
each individual case, with all available light, as an independent 
problem. For it is manifestly absurd to lay down cast-iron rules 
and rigid specifications, as to kind, class, and quality of foods, 
that every phthisical patient shall ingest within a given period 
of time. For physiological chemists have repeatecly demons- 
trated that a variety of food is necessary for even a fair degree 
of nutrition and continued health, in any given species of highly 
organized animals ; and man, being the highest, and inherently 
omniverous, naturally requires the greatest variety. 
Just here, we should not forget the important fact, of the indis- 
pensable value of certain fats, as not only being easily digested 
themselves, but their wonderful assisting power in aiding the 
digestion and assimilation of other classes of foods, notably 
starchy foods, and fresh herbaceous and leguminous vegetables. 
Physiological chemists tell us, that the assistance certain fats 
render the process of digestion is largely owing to their 
property of quick and ready combination with starchy foods 
and fresh herbaceous and leguminous vegetables, forming—by 
aid of the digestive juices—soluble albuminoid emulsions, which 
are the easiest forms of crude aliment from which the assimil- 
ative organs can draw supplies for new cell-building materials. 
Thus, to illustrate : See how much easier the old English 
dish, “ butter-bread,” is digested, than our American hot bis- 
cuits, or worse still if the butter be left out entirely. Again, 
see how much more easily the fresh raw, or cooked herbaceous 
salads are digested, if seasoned with a little toothsome gravy— 
especially that from well-cured bacon—than when eaten without 
such seasoning. 
Just here ’tis well to remember the powerful eliminative and 
health-restoring effects of good fresh herbaceous and legumin- 
ous vegetables, as so strikingly demonstrated in curing scorbu- 
tic sailors and soldiers. 
All are familiar with the phenomenal success of Prof. B. W. 
Dudley, who fed his surgical patients on turnip greens,—cooked 
with bacon,—plain corn bread and buttermilk. 
And this wonderful eliminative and health-restoring effect of 
fresh herbaceous vegetable diet, is most strikingly demonstrated 
every year, upon the Pacific coast Indians of Northern Califor- 
nia. 
These Indians are very subject to phthisis, and suffer most during the months that they are deprived of fresh herbaceous 
vegetables. But as soon as the fresh green wild salads (especially 
the wild clovers) become plentiful, these Indians consume large 
quantities of it,—eating a large portion of it raw—eating, for 
several weeks, little other food. During this herbaceous vege- 
table eating period, the improvement in the health of their sickly 
people is most remarkable, especially those suffering from 
phthisis 
Phthisical patients should ingest, at regular intervals, a liberal 
supply of good soft water; but never colder than good cistern 
water, and only moderate quantities at a time. This health-pro- 
ducing fluid is not only a veritable medicine for many diseased 
conditions, but, owing to its superlative solvent powers, it 
is at once the prime reducing agent, and also the vehicle by 
which the tissues are cleansed and rejuvenated, and built up. 
The ingestion of mineral waters, with few exceptions, is usu- 
ally injurious, rather than beneficial, to most consumptives, es- 
pecially drank freely, or for long periods of time. Hippocra- 
tes wrote a volume urging and explaining the remedial value 
of good water ; and physiological chemistry, and later clinical 
experience, have fully confirmed the correctness of his teach- 
ings. 
As an illustration of the bad effects of over-ingestion of too 
rich food, see the healthy robust young peasant mother, called 
to wet-nurse a rich man’s babe. Fresh from her rural cottage, 
with its plain food, fresh air, and plenty of physical exercise, 
her milk is of the best ; but so soon as she enters the palace of 
wealth, do her employers begin to cram her stomach with large 
rations of concentrated, rich foods, and drinks of ale, porter, 
and beer, causing her milk to soon become surcharged with 
nitrogenous matters, so that the nurslings are soon made 
sick. 
A knowledge of successful feeding, in health or disease, is 
necessarily largely empirical, both in general and special. 
We should adapt the feeding to the patient—not the reverse, as 
some would-be oracles command. 
As to the diet list—presuming the patient to be in a condition 
warranting the hope of cure, or more or less permanent improve- 
ment—we usually direct, that the patient take little or no coffee 
or tea, no tobacco in any form, no alcoholic liquors in any form 
(unless prescribed)—as they, even in moderate quantities, dimin- 
ish the power to assimilate fats—no rich pastries, sweet cakes, 
or sugared compounds. 
Plain dishes, toothsomely prepared, are preferable to rich 
compounds. 
Phthisical patients should take three good regular meals 
every day ; a liberal part of at least one of which should be good fresh butcher meat—beef or mutton, or other fresh and 
easily digested meat—prepared to suit the taste and digestion. 
Good well cured bacon, may be taken once or twice a week—best 
lightly boiled or raw—as a change. 
A good hearty breakfast, a moderate dinner, and a light supper. 
The foods should be varied from day today, as much as circum- 
stances will allow, but not many kinds of food at any one meal. 
Choice ripe fruits, cooked or raw, are valuable foods in this 
as in most other diseases, but should be taken as a part of the 
regular meals; not promiscuously through the day, especially 
in the afternoon. 
All are familiar with the notable success of the “grape cure ” 
of phthisis, during which the patient, for several weeks, takes 
little other food than fresh, ripe, sweet grapes, which are 
very rich in fruit sugar ; yet, if of proper variety, well ripe and 
fresh, rarely disagree, though several pounds of them be eaten 
daily for long periods of time, provided they be taken only at 
regular meal times—three times a day—and the patient exercise 
freely in the open air. Just here ’tis instructive to observe, that 
those grapes found beneficial to phthisical patients, are not only 
rich in fruit-sugar, but also strongly charged with astringenc)\ 
especially in their skins. Here we get a clew as to the best com- 
bination of tannic and pyrogallic acids, sometimes found so 
beneficial in the treatment of phthisis. 
Fresh herbaceous and leguminous vegetables, properly cooked 
and seasoned to suit the taste, are also a valuable class of foods. 
Some herbaceous vegetables—as tender white cabbage, blanched 
celery, cresses, etc.—digest more easily, and are more nutritious 
and generally beneficial, when eaten raw; and these form a 
valuable class of foods for consumptives. 
Eggs do not usually agree well with phthisical patients, unless 
eaten raw or slightly cooked. Choice milk —fresh rich sweet 
milk, or butter milk—and gooo fresh butter, with good light 
wheat, Graham, rye or oat bread, or good plain corn bread, are 
foods of indispensable value, which every phthisical patient 
should have. 
To recapitulate: No food should be eaten that the patient does 
not digest comfortably. The form-s and kinds of food should be 
varied frequently ; for, “ Variety is truly the spice of life.” 
But only two or three kinds of food should be taken at any 
one meal. 
Food should be taken at regular intervals, eaten slowly, and 
thoroughly masticated. To this end the teeth should be kept in 
good condition. 
The circumstances of mealtime should be made as pleasant 
and cheerful as possible. When the appetite is sharp the patient 
should not eat quite as much as he wants. SLEEP. 
“ Nature’s sweet restorer. 
A favorite theme of inspiration for the bards of all ages in 
everv land : 
All peoples have craved thy solace 
S:nce earth from chaos woke. 
As all know, the nervous system is divided, both as to organs 
and functions, into two grand divisions. And while these two 
divisions interfunctionate more or less in unison, as mutually 
assisting and complementing each other’s duties, yet each 
division has its specific, and somewhat exclusive work to 
perform. 
The cerebro-spinal system runs the machine during wakeful 
hours; while the sympathetic system is mainly engaged, during 
wakeful hours, in cleansing and lubricating the bearings, and 
otherwise preserving the machine from unnecessary injury dur- 
ing its outwardly active periods. And the cerebro-spinal system 
is not only the great executor of outward or productive labor, 
during wakeful hours, but is also the great consumer of organic 
force and new force-producing materials of the body. 
On the other hand, the sympathetic system does its beautiful 
and indispensable work, which is mainly eliminative, renova- 
tive, reparative, and constructive, mostly during sleeping 
hours. 
During sleep, the old worn-out effete products, the result of the 
previous day’s activity and kata'bolic change, must be gathered 
from all the organs and tissues of the body, and conveyed out 
of the system; and new force-storing and reparative material, 
the result of anabolic change and elaboration, must be carried 
to all parts and organs of the economy, ready for the follow- 
ing day’s outward activity. 
So we see the indispensable necessity of a regular and plen- 
tiful supply of comfortable sleep. And eminent physiological 
investigators, have proven, in this connection, two great broad 
propositions, both of which are of momentous importance, just 
here : 
First. That sleep, during the dark hours, is more recuperative 
and generally beneficial, than during the light hours. 
Second. That too much sleep, is injurious to the genera well 
being of an individual—sick or well—especially to those whose 
respiratory capacity is diminished below normal. 
Hence ’tis equally important that phthisical patients rise 
early as that they go to bed early; and here clinical observation 
substantiates physiological experiments. And Prof. Draper’s careful and repeated experiments conclu- 
sively show—what accords with common observation—that the 
excess of oxygen taken into the system during too prolonged sleep, 
does not serve any good purpose, unless there be in the body an 
excess of material the oxidation of which would either furnish 
increased force and vitality, or render such excess of oxidizable 
material less noxious or more easily removable from the econ- 
omy. 
And that too rapid or too great an oxidation in the body—as 
in the case of too much sleep—leads to physical feebleness and 
sluggish mentality, instead of increased power and vivacity—as 
is popularly believed. 
The sleeping rooms of phthisical patients should be the larg- 
est and best ventilated of their homes ; and the air thereof 
should not only be kept fresh and pure, but should also be kept 
at a comfortable equable temperature day and flight, by the aid of 
artificial heat if necessary ; an open fire place or grate being 
greatly preferable to a stove. 
But such patients—nor no other person—should sleep in a 
current of air, however hot the weather, for such exposure not 
only frequently results in serious or fatal acute attacks, but is 
often the first perceptible beginning of phthisis. 
No other person should sleep in the same room with phthisi- 
cal patients. 
If there be tendency to cold feet, they should be vigorously 
rubbed with coarse cloth or brush, in pleasantly cool water 
every night, then made very dry and warm before going to bed, 
and kept warm all night. 
Thick soft cotton stockings will usually keep the feet warm 
better than woolen. The body underwear, for all the year 
round, should be made of soft wooL or silk, thick or thin, to 
suit the season ; and shirts should be made with long bodies and 
long sleeves, and to fit snugly round the neck : but the clothing 
should never be so close-fitting as to interfere with free full 
easy respiration, locomotion or circulation. 
The bedding should be sunned and aired at least twice a week. 
Once or twice a week, in a close, pleasant room, the patient’s 
whole person should be thoroughly and vigorously rubbed and 
cleansed with a brush or coarse cloth, wet in weak warm soap 
suds; each region being rubbed thoroughly dry and covered 
before another is bared, exposing as little of the person at a 
time as possible. The ordinary modes of bathing or washing 
the body usually do more harm than good ; haemoptysis and 
other injurious results being often produced by such exposure 
and chilling of the surface. 
A weak, continuous galvanic current, applied mobile over the 
body for half an hour, followed by a brisk dry brush shampoo massage, just before going to bed, will produce much comfort and 
some real benefit in many cases, especially if the patient be ner- 
vous and suffers from insomnolency. 
DRUGS. 
In the language of the latest writings of the late Professor 
Austin Flint, in reference to this topic, we would say : ‘‘All 
remedies which improve appetite, digestion, assimilation and 
nutrition are in greater or less degree useful.” 
But, upon this subject, there are two points, both of which we 
deem of great importance, that stand out prominently in the 
writings—especially his latest, of this learned physician : 
ist. His ideas of drug therapeutics, were seriously hampered 
by a theory—the bacillus theory—that even the latest lights 
do not enable us to successfully apply in the clinical cura- 
tive treatment of this or other diseases. 
2d. He failed to recognize the idea of the significant impor- 
tance of the elimination from the system of the leucomanic 
or ptomainic poisons, generated by the perverted processes 
of disassimilation of the tissues of the body, and by the 
imperfect, or failure, of assimilation of ingesta, regardless 
of its kind, quality or quantity. 
(Just here, it would be instructive to note, that theories and 
theorists, have done far more to hinder than help the advance- 
ment of clinical medicine.) 
For it is well known, that even the normal katabolic changes 
and processes that daily occur, even in the bodies of the healthi- 
est individuals, and when they take the best foods, produce a 
sufficient quantity of leucomanic poisons to seriously jeopar- 
dize the health, if not endanger the life, of the individual, were 
these autogenic poisonous products not eliminated, at least to a 
greater or less degree, by the various emunctories. 
And so we find that in the treatment of all chronic constitu- 
tional diseases, we must direct our curative efforts to elimina- 
tion of those autogenic katabolic toxic materials, if we would 
secure any great degree of permanent improvement to the 
patient. 
And, fortunately, there are various means and methods by 
which the so-called vis medicatrix naturce may be impressed or 
assisted, in greater or less degree, in this eliminative, conserva- 
tive process or action. 
Just here, it will be profitable for us to remember that thehver 
is the chief of this class of conservative agents ; for, with sleep- 
less vigilance it stands at the great gateway of chylopoietic nu- 
trition, and by virtue of its sui generis metamorphosing powers, 
it seizes upon poisonous substances passing the round of the circulation—especially leucomanic, ptomainic, and other organic 
poisons—and if the toxic substances be not overwhelming in 
quantity or quality, it neutralizes them, in whole or in part, and 
the innocuous—or may be useful—product is allowed to pass 
on to fulfill its predestined purpose in the nutritive or repara- 
tive economy. 
In some cases, especially if the toxic substance be inorganic, 
the liver holds such poisons under arrest, stored up in its lym- 
phatic cellular substance for an indefinite more or less pro- 
longed period of time; and in some cases relatively large 
quantities will thus accumulate before steatosis progresses to 
such a degree as to render longer effective functionation im ■ 
possible. 
Hence, medicinal substances, especially inorganic medicines, 
e.g.t mercury, arsenic, phosphorus, iron, etc., should not be 
administered continuously for long periods of time, but exchanged 
for vegetable remedies, or, better, all remedies be remitted 
from time to time. 
So here we discover one of the great secrets of the why and 
how we may benefit our phthisical patients by the judicious use 
of drugs that increase hepatic functionation. And we also readily 
sec how our syphlographers are enabled to increase the red blood 
corpuscles, and improve the blood-plasma by the use of minute 
doses of mercurials, in the treatment of constitutional syphilis. 
And, again, we see how our remedies in the treatment of 
phthisis, especially if inorganic, as mercurials, phosphorus, 
arsenic, etc., may become—and sometimes do—-poisons, if admin- 
istered in too large doses, or continuously for too long periods. 
The therapeutic indications being plainly to administer reme- 
dies, especially of this class, in small non-perturbating doses, 
and with, or just after meals, that the medicinal substance may 
be digested with the food-mass, and pass into the long round 
of chylopoietic nutritive circulation, thus becoming albuminoids, 
the form in which they may be most quickly and thoroughly 
appropriated by the assimilating organs and forces, and thereby 
render the greatest possible service toward renovating and 
building up the various tissues of the body. 
And in this connection, we should refer to alcohol\ as it is 
regarded by many, even of those of eminence, as one of the 
remedies in the treatment cf phthisis. 
Alcohol, being a narcotic sedative, and an anaesthetic, and 
strongly tending to retard reparative physiological tissue 
change, and by its paralyzing effects upon the excretive forces 
and organs, prevents the normal physiological disintegration 
and elimination of effete products, thereby directly tending both 
to cause tubercular deposits in the lungs, and at the same time 
to cripple the emunctory organs : hence its ingestion in any quantity or combination, could not result otherwise than injuri- 
ously to phthisical patients—unless possibly, as an ancesthetic in 
some cases that were already hopelessly near the grave. 
We speak thus strongly and positively, not upon mere theory 
or hypothesis, nor as following or opposing the bias of tradi- 
tional influences or teachings. 
But as the result of many years’ close observation, and clin- 
ical experience : therefore we know whereof we speak. And it 
is scarcely necessary to state, that the foregoing opinion, coin- 
cides with the latest and best authority, as touching this subject. 
And just here, en passant, permit us to say, that the problem, 
of general and special therapeutic application, as to what hour 
of the day, in reference to meal-time, etc., is the best time to ad- 
minister medicines, is a question of vital importance—but too 
much neglected—and well worthy of the profound attention of 
every physician. But it remains to the knowledge, judgment, 
and sagacity of the physician, to select the most appropriate 
means and methods, and to properly direct their use and appli- 
cation, in order to obtain the greatest possible curative results 
in any given case. For, indeed, herein lies the supreme con- 
summation of therapeutic skill, and which has been truly termed, 
the poetry of medicine. 
When we consider the many medicinal substances that have 
been found more or less useful in the treatment of phthisis, in its 
several stages and different types, and in individuals of dis- 
similar constitutionality temperament, age etc., the bare men- 
tion of their names might bewilder us, if we do not keep well 
before our minds some definite idea of their real or supposed 
modus operandi. 
Probably the most numerous class of remedies referred to, 
are treated of in works of materia medica, under the general title 
of vegetable alteratives. The most palpable manifestations of 
the remedial value of this class of medicines, are to be observed 
either upon the cutaneous surface, or the respiratory and gas- 
trointestinal mucous membranes, or more directly upon the 
adenoid tissues of the body. 
Another notable characteristic and valuable therapeutic prop- 
erty of vegetable alteratives, is, that they do not accumulate in 
the system, and thereby become poisons rather than medi- 
cines, as mineral alteratives are prone to do, especially if admin- 
istered continuously for long periods of time, even in small 
medicinal doses. 
Another important therapeutic peculiarity of vegetable alter- 
atives, is their tendency to gradually lose their medicinal effect, 
if administered continuously for long periods of time ; hence 
more or less frequent change of them is necessary to obtain 
their best remedial effects. To be both brief and specific, we will simply name some of 
the drug-remedies we have found most useful in the general or 
special treatment of phthisis. 
Beginning with the vegetable alteratives, we would note: 
Extracts, or active principles, of ipecac, wahoo, burdock and 
yellow dock root, stillingia, wafer ash, phylocoa, leptandrin, 
lupulin, collinsonia, chionanthus, sarsaparilla, golden seal, 
inulain, asclepias tuberosa, gelsemium, sanguinaria, senega, 
tag-alder ergot, nux vomica, buchu, red and black pepper, 
cubebs, and aloes. 
The mineral acids—muriatic, nitric, and phosphoric—we find 
most useful for internal use; and lactic acid, in form of spray, 
for laryngeal phthisis. The balsamic remedies, as several of 
the refined turpentines: as oleum templinum,oleum pini sylves- 
tris, light oil eucalyptus, oil cinnamon, oil cloves, sweet gum, 
oil camphor, oil sassafras, menthol, balsam Peru, oil sandal- 
wood, and others of the same class. These oils and balsams are 
used, some for inhalation, some by the stomach, and some by 
both modes of administration, and are an invaluable class of 
remedies in the treatment of phthisis. Assafoetida, in pill com- 
bination, and soluble balsam tolu, in fluid combination, are both 
useful remedies, in this disease. 
Of the specific remedies, we would note, as most important, 
the alkaline hypophosphites, especially that of soda, as being most 
frequently applicable. 
But to secure good results from the use of the hypophos- 
phites, it is of indispensable importance, that they be of pure 
quality, and be given judiciously. 
For several years, we have given the hypophosphites (in 
syrups), manufactured by R. W. Gardner, of New York, and 
believe them to be the best made in the United States, and equal 
to those manufactured by Swann, of Paris. 
The dose of the hypophosphites, as directed in the U. S. Dis- 
pensatory, is much too large, and will more frequently prove in- 
jurious than beneficial. To adults, we usually administer the 
syrups of the hypophosphites (but never mix them,) teaspoonful 
(about two and one half grains) three times a day, just before 
meals. 
Arsenic and the hypophosphites, should not be administered 
simultaneously: but vegetable alteratives, tonics, and laxatives— 
as indicated—should always be administered simultaneously 
with either or both. 
The syrup of hydriodic acid, is often a useful remedy, especi- 
ally in dry, asthmatic or feverish cases: whether the fever be 
purely hectic, or a more or less malarial complication. Just 
here, we should state: that the febrile exacerbations—which are 
often followed by profuse sweats—from which phthisical pa- tients often suffer, are in many cases aggravated and prolonged 
by the administration of quinine: regardless of the fact, that 
these febrile exacerbations may or may not be complicated with 
more or less malarial poisoning. 
In slow, dry asthmatic cases, where there is no fever, the 
hypophosphite of potassium, will often render valuable service; 
but its effects should be closely watched, for when given long 
or in too large doses, its pathological tendency is to cause a 
deliquescence of the tissues. 
A small proportion of cases, especially babes and small chil- 
dren, and those with strong tendency to more or less rapid break- 
ing down of the lungs, may be benefited by the judicious use 
of hypophosphite lime. 
Bromide of arsenic, and mercurials—the cyanide, bichloride, 
and biniodide, of mercury, we most frequently use—all in very 
small doses, and intermitted from time to time, are valuable rem- 
edies in some cases. 
Guaiacol, one to three drops, t. i. d., just after meals, in pleas- 
ant emulsion, is an invaluable remedy; and in cases of strong 
tendency to fever, will supersede the hypophosphites until the 
fever is subdued. 
Myrtol, is also an invaluable inhalent remedy. A diligent, 
judicious, and persistent use of inhalent remedies, will usually 
not only preclude the necessity of cough mixtures—one of the 
greatest curses of pulmonary sufferers—but will, in many cases, 
also produce great generally beneficial results, that could not 
so well be secured by any other means. The inhalation of 
dilute aqueous spray of wine of ipecac, is also a valuable cough 
remedy. 
In dry asthmatic, or eczematous cases of early phthisis, bi- 
sulphite soda, given in small doses in dilute solution, for several 
weeks, is often a valuable remedy. 
If night sweats give trouble, oxide zinc with sulphate hydra- 
stis, will usually soon stop them, though the timely and judici- 
ous use of vegetable alteratives and inhalent remedies, will 
usually prevent or cure night sweats. 
As a rule, with rare exceptions, the hypophosphites should 
never be administered when there is fever, or the tongue foul or 
unnaturally red ; nor given conti?iuously for longer than one or 
two weeks. 
Nor should the different hypophosphites ever be mixed, in any case, 
as they are therapeutically incompatible. 
We usually give the syrup of the hypophosphite soda, tea- 
spoonful three times a day, just before meals, for one or two 
weeks, then leave it off for one week, then—if not contra-indi- 
cated—resume its use, thus using it for two weeks out of every 
three weeks, for several months if no contra-indication inter venes—then alternate with some other remedy. In many cases, 
especially in non-febrile early phthisis, this invaluable remedy 
may be thus used ; with proper intermissions and precautions, 
and in connection with vegetable alteratives and tonics, and 
other indicated remedies, for many months, or even for several 
years, with most beneficial results. 
The syrup of lactophosphate lime, is often a valuable ap- 
petizing building up tonic remedy, especially for babes, young- 
children and for advanced cases. 
We have prescribed (and taken several gallons) large quanti- 
ties of cod liver oil, plain and in various combinations, and of 
the best quality the markets of the world afforded, and in ac- 
cordance with directions from the most distinguished authori- 
ties, but usually with discouraging results ; hence, rarely pre- 
scribed it during the last few years. Professors Williams, father 
and son, of Brompton Hospital, have treated about 15,000 cases 
of consumption, mainly with cod liver oil, as the constitutional 
remedy, resulting in a mortality of about 99 per cent. 
The malt extracts, if not too sweet, or charged with too much 
alcohol—as most all of them are—act well in some cases, as an 
appetizer and aid to digestion : large tablespoonful in half a 
glass of water, three times a day, with meals. Hoff's and Wyeth’s 
malt extracts, are the best we have tried : but even these would 
be more valuable, and more frequently applicable, if they con- 
tained no alcohol. 
In the curative treatment of phthisis, the bowels should be 
caused to move in a free, natural, comfortable manner, at least 
once every twenty-four hours ; and during acute or feverish ex- 
acerbations it is usual ly best that the bowels move twice in twenty- 
four hours. 
But in no case should drastic purgatives be used, or free pur- 
gation be induced. 
During acute exacerbations, which are usually attended with 
circumscribed dry pleurisy, pain in upper chest, and fever, even 
in the earliest stages of phthisis, the patient should be kept 
quietlyin bed; feet andlimbs kept very warm, free—Croton oil— 
counter-irritation over the chest, and such other general or spe- 
cial remedies administered or applied as may be necessary, until 
all acute pain and inflammatory symptoms are relieved. 
By a judicious use of vegetable alteratives, laxatives and 
tonics, proper food and exercise, we are usually able to keep 
the bowels in good condition without purgatives. 
We usually give two to four vegetable alteratives, with one or 
two vegetable tonics, in coated pill form, simultaneously with 
some of the balsamic remedies, by inhalation or otherwise, and 
such special remedy as may be indicated. 
But we make it a cardinal point that our medicines must be given in small, non-perturbative doses, made pleasant to take, 
and never to disturb the stomach or hinder digestion ; and very 
rarely administer any remedy oftener than three times a day. 
Just here it may be well to note, that the chinchova salts are rarely 
beneficial in the treatment of any stage of phthisis, or any of 
its complications ; but they often produce injury, even in mod- 
erate doses, by increasing the tendency to nervousness, hectic 
fever and night-sweats. 
The compound sulphur lozenges, serve a valuable purpose, as 
a cholagogue laxative in some cases, and may be (in hepatic de- 
rangements independent, of phthisis) given for several weeks or 
months, one to three lozenges three times a day. The following 
formula is a good one : 
1$ Pure Sulphur, gr. 5. 
Pure Cream of Tartar, gr. 2. 
Ext. Ipecac., gr. 1-100. 
Ext Capsicum, gr. 1-500. 
Arsenious Acid, gr. t-iooo. 
Bisulphite Calcium, gr. 1-8. 
M. ft. lozenge. 
Messrs. John Wyeth & Brother, manufacture them for us, 
by compression, and they are stable, elegant and pleasant to 
take. 
Cases that are attended with hemoptysis in the early stages, 
especially if the bleedings are not large, are usually the most 
easily cured. For such cases, the extracts of ipecac, ergot, with 
sulphate hydrastis, extract viburnum prunifolium, and pyro- 
gallic acid, given for long periods of time, are of special value. 
For the immediate arrest of hemoptysis, give large doses of 
ipecac, well diluted. 
Should the phthisical patient suffer with fistula in ano, it 
should be cured soon as possible : as the emunctorial capacity 
of fistula—if indeed they ever exercise any such powers—are 
far more than counterbalanced by the injury they do the victim, 
as a source of pain and irritation ; to say nothing of the far 
more serious danger incurred, of steatosis or amyloid degene- 
ration of the kidneys, or metastatic hepatic abscess. While all 
must allow, that such means as the ulcerating surface of a 
fistulous tract—or any other ulcerating surface, regardless of 
its extent or locality—is a miserable lame (and often dangerous) 
way or means, to say the least of it, of eliminating peccant 
humors from the system, or purifying the fluids and tissues of 
the body. 
Owing to their occupation, prostitutes are specially liable to 
hemoptysis, and some of them bleed from the lungs more or 
less.frequently for several years or longer without developing phthisis, or any apparent serious decline of health; and the 
first attack of hemoptysis, in other persons than prostitutes, 
often occurs during sexual intercourse, regardless of sex. 
To recapitulate briefly, we would say: 
That it is well established that chronic tubercular pulmonary 
consumption is, in a considerable proportion of cases, a curable 
disease : provided, proper treatment is undertaken and pertistent- 
ly, diligently and judiciously carried out, from the date that the 
earliest diagnosis of the disease can be made, (and in some cases, 
much later) until the disease is cured, which will usually re- 
quire from one to three years, and in some cases longer. 
That this treatment can often be carried out to successful 
issue without the patient making distant journeys, or expensive 
sojourns at this or that health resort, provided his home climate, 
employment, and environment be not specially unfavorable. 
That a recognition of the correctness of the hypothesis we have 
advanced, as to one of the great predisposing causes of chronic 
tubercular pulmonary phthisis, brings us one link nearer to the 
primordial origin of at least many—if not most—cases of this 
disease, which, therefore, indicates a plan of treatment most 
likely to be successful. 
Lastly: clinical experience and observation has confirmed the 
correctness of our herein expressed views in reference to the 
prognosis and treatment of this disease. 
Austin, Texas, October 1890.