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UNITED STATES OF AMERICA
FOUNDED 1836
WASHINGTON, D. C.
B19574
3789 
 
 
A N
INAUGURAL DISSERTATION
O N
PHTHISIS PULMONALIS;
SUBMITTED TO THE EXAMINATION
O F T H S
Rev. John Ewing, s. t. p. Provost,
THE
Trustees  and Medical Faculty
OF THE
UNIVERSITY OF PENNSYLVANIA ;

  ON *HE f^Eyrr-SEVENTU DAT OF MAY, 1802.
A
     For the Degree of   SsbWC.*'--
Doctor of MedicinNe^
By  CHARLES MEREDITH,
       OF PENNSYLfl
    PHILAD EL P HIA:
PRINTED BY ROBERT COCHRAN. 
T,
 
  Do&or Hugh Meredith,








            o »







 BUCKS COUNTY, PENNSYLVANU,







           THIS








DISSERTATION






             I 9






   Respectfully Inscribed,






          BY HIS





   Much obliged Son and Pupil,







                 The Author. 
 
iJriSrt
INTRODUCTION.
PULMONARY Consumption has been so frequently the sub-
jea of Medical investigation, that a mere repetition of what has
been already said may perhaps seem superfluous.

    But as the information respeaing this disease is diffused
through so many volumes, I  have judged it a matter of some
importance,  to  collea into the usual  limits of an  Inaugural
Dissertation, those ideas which appear to me the  most appro-
priate.
    I  shall likewise subjoin some remarks on the subjea which
my own experience may warrant.

    I  do not flatter myself that the  following sheets will contain
much new information,  or that 1 shall add considerably  to the
faas already established :  and as I here make acknowledgments
to the authors from whom my information has been derived, I
will indulge the hope, that particular references may  be  dis-
pensed with.
    In seleaing the subjea of Phthisis Pulmonalis, I am well a-
 yrare of the difficulties I have incurred, and  am conscious of my
 inability to do justice to a theme at once so complicated and im-
 portant:  but knowing the liberality of sentiment which  so pe-
 culiarly marks the charaaer  of the Gentlemen to whom  it is
 particularly submitted, I  feel an assurance, that the first essay of
 a juvenile mind, although wide of perfeaion,  cannot fail to
 meet with a flattering indulgence. 
 
A N
Inaugural  Dissertation, &c.
      X HAT difeafe, which is defcribed by medical
writers, as confiding of an ulcer in the fubftance of the
lungs, attended with an expectoration of purulent mat-
ter, and a hectic  fever,  has been called Phthifis Pul-
monalis.
      Although thefe  may  be  .generally  confidered
as diagnoftic fymptoms, and very certain criteria, by
which this may be diftinguimed from other  pulmonary
affections, yet the evidence which fupports the opinion
that Phthifis is fometimes  unattended with abfcefs of
the lungs, renders it probable that the fuppurative in-
flammation may take place, and pus be difcharged from
the lungs without any ulceration of their fubftance.

     Pulmonary Confumption generally makes its firffc
approaches in the  form of a fhort and dry cough, with
difficult and hurried refpiration, on the lead bodily ex-
ercife, the cough  is far more particularly to be obferv- 
                      (  8   )
$d on lying down; the patient becomes languid ahd is
much affected with laflitude from the mod trifling exer-
tions.  Thefe fymptoms are for the mod part fo flight,
as to be altogether unobferved, or little  regarded, by
the  patient  or  his friends.  If under thefe  circum-
ftances a catarrh fliould be fuperadded to the fymptoms
already mentioned, the cough becomes evidently worfe,
a difcharge firft of mucus,  and afterwards of purulent
matter takes place, refpifation  becomes more difficult,
and  emaciation and weaknefs  progrefs  very  rapidly*
About this  period the catamenia in women ceafe to
flow ; and from this circumftance they are often led to
entertain the mod fanguine hopes of a fpeedy cure, as it
is from the fuppreffion of this evacuation that they ima*
gine all  their  complaints  arife.  We do not always1
meet with much increafe of the frequency  or fulneft
of the pulfe  in the firft ftages  of Phthifis Pulmonalis,
but it becomes quick as the difeafe progrefles, and e-
Vening exacerbations  become  evident.  This  ftate of
the complaint  has obtained the name of Hectic.  A
pain in fome part of the thorax, mod commonly imme-
diately under the fternum,  is fometimes the firft indica-
tion of incipient Confumption ; the fenfation is  mod
troublefome  upon  a full infpiration, or upon the pa-
tient's lying down, fometimes it is confined to one fide,
renderiu  a recumbent pofition difagreeable and tire-
fome.

     In this  manner Phthifis ufually  progrefTes,  all its
fymptoms abating during  the  fummer feafon, and re- 
[   9   ]
turning with  renewed  violence  the  enfuing winter,
years frequently elapfing before its final termination in
health or in diffolution.
                          i
     The fever which attends Pulmonary Confumption,
and which is diftinguilhed from other  febrile affections
by the  appellation of  Hectic, appears,  according  to
Doctor  Cullen, in  the  form  of a remittent, with two
exacerbations occuring in the latter part of every day,
the fecond gradually  increafing till  after  midnight,
when  a  remiflion  takes place,  and becomes  more
evident  as the morning advances ; the exacerbations
are frequently attended with cold fhivering and a mor-
bid fenfibility to any coolnefs of the air: that which takes
place in the evening is always the moft considerable.

     Doctor  Heberden  defctibes  hectic fever, as  ap-
proaching nearer the form of genuine intermittent than
remittent fever.   I believe that it is fometimes marked
with regular accefiions of cold, heat and fweat, and pre-
ferves its uniformity through its whole courfe; yet, as
the Dodor obferves, in the moft perfeft Intermiffion,
the pulfe generally beats ten ftrokes in a minute more
than  exceeds the utmoft limits of a healthy one.   But
notwithftanding  this regularity  may be  fometimes
obferved, in a great majority of cafes, the acceflion of
the paroxifms preferves no uniformity,  fometimes keep-
ing off for ten or twelve days and at other times recur-
ring  very often on  the fame day-The patient is little
relieved by the coming on of the fweat, but is often as
                       B 
                     L   10  J
 anxious and redlefs  under it as during the chill  or
 heat;  when the fweat is over the fever will fometimes
 continue, and  in  middle  of the fever  the chill will
 return ;  this has been edeemed one of the mod certain
 indications of Hectic. The urine is high coloured, and
 exhibits a branny cloud, which feldom falls clofe to the
 bottom of the veffel. The third is not often confiderable,
 and the appetite for food little impaired ;  the mouth is
 for the mod part moid,  and the tongue and fauces are
 clean and fometimes prefent an appearance of inflamma-
 tion.   The face is  commonly pale, but during the exa-
 cerbations, a  circumfcribed  rednefs appears in each
 cheek.

     For fome time after the fever commences, the pa-
tient is codive,  but in its more advanced  d?ges,  a di-
arrhcea fupervenes, which continues at intervals during
the remainder of the difeafe.

    It has been remarked, that greater degrees of de-
bility and emaciation are confequent to this, than to any
other form of fever.  Delirium feldom attends Hectic ;
the fenfes and judgment commonly remain unimpaired,
and the mod fanguine hopes of recovery, leave the pa-
tient, but with life.  Towards the dole of the difeafe,
he becomes redlefs and difcontented, the mind and me-
mory feeming fometimes to {hare in the general debili-
ty of the body ; his voice faulters, a didrefling hiccough
and flight convulfions come on ; his peevilh complaints
fubfide, and he finks to death without a confcioufnefs
of pain or anxiety. 
                     [   »   ]
     I have thus endeavoured to give a defcription  of
Pulmonary confumption as it mod generally appears, but
the fliapes it aflumes are fo various, and its fymptoms of-
ten fo complicated, that the limits of an inaugural effay
do not permit me to trace it through its different forms.
It may not however be improper to obferve here, that it
not unfrequently alternates with fome other difeafes, the
mod  common of which are rheumatifm, gout and  di-
arrhoea ;  it has likewife been obferved to give place  to
Mania,  pains in  different parts of the body and cutane-
ous eruptions ;—but its progrefs appears to be arreded
in the mod remarkable degree by the date of the fydem,
which is induced by pregnancy ;  from this circumflance
Doctor  Beddoes has founded his very ingenious theory
of the difeafe ; afcribing it to an undue Oxygenation  of
the blood;—gedation in his opinion by diminiftiing the
capacity of  the thorax, and thereby leffening the pro-
portion of Oxygene decompofed in the lungs, mud ne-
ceffarily tend to fufpend the fymptoms of the difeafe till
delivery;  after which period we find the diforder pro-
greffes as before gedation.
     Phthifis Pulmonalis generally attacks perfons be-
tween the fifteenth  and thirty fifth years of life, but may
occafionally happen before, or after that period.—Thofe
who have grown fad, have clear fkins and delicate com-
plexions are the mod liable to pulmonary complaints.—
A narrownefs of the ched, and an elevation of the der-
num,  with a remarkable projection of the precedes of
the os facrum are evidences of a predifpofing conforma-
tion.  It has likewife been a general obfervadon, that  a 
[  12   ]
 whitenefs or tranfparency of the teeth, is a characterif-
 tic of Phthifical diathefis.  Doctor Simmons obferves
 that the greater number of thofe who are carried off by
 this difeafe, will be found never to have had a carious
 tooth.—I do not take upon me to determine, how far
 the doctor's affertion may be confident with the obfer-
 vation of others, but believe, that in this country at lead,
 indances to the contrary may be met with daily.

     Women are more frequently affected with pulmo-
 nary confumption than men—they partake but in a fmall
 degree  of thofe  exercifes fo neceffary to the  health of
 the body.—Their delicate frames render them extreme-
 ly fufceptible of the action of exciting caufes; and their
 modes of drefs, by compreffing the thorax, and ob-
flructing a free refpiration,  neceffarily predifpofe them
to Phthifical complaints j hence we daily fee numbers
of the faired ornaments of human nature hurried to a
premature grave.

     It is generally believed that the Aborigines of our
country were nearly exempted  from this difeafe; how-
ever this may have been, it is certain, that fince the in-
troduction  of European intemperance amongd  them,
confumption has not been unfrequent;  the active em-
ployments of the Indians are very limited, and for the
mod part the calls  of hunger only can roufe them from
the date of inactivity attendant on the favage life • from
thefe circumftances, I think it not to be wondered at if
Phthifis pulmonalis fhould be found to be one of their
moft frequent  difeafes.   If any fituation in life can en- 
[  '3   ]
tirely preclude from pulmonary confumption, it is moft
probably that ftate of civilized fociety, in which the in-
duftrious and frugal peafant is barely fupported by an
unremitted induftry—a date equally removed from the
temptations of imported luxury, and the allurements of
favage indolence.—In confirmation of this idea I  am
happy in being able to bring forward the  tedimony of
Doctor Rufh, who obferves, when fpeaking of this dif-
eafe, that it is fcarcely known among the inhabitants of
our frontier fettlements.

     It has been an idea, held out by fome of the firft
medical characters, that confumption fometimes depends
on fpecific  contagion, and many indances have been ad-
duced where one perfon has communicated the difeafe
to another j but this theory is at bed hypothefis, and
even wants the character of probability ; I am of opini-
on that fuch cafes may be accounted for with more pro-
priety, on  lefs  exceptionable  grounds j—It cannot be
denied that an hereditary predifpofition often exids, by
which  more than  one perfon in  a family may be fub-
jefted  to Phthifis—add to this the date of debility in-
duced \m a condant attention to a patient languifhing
under  this difeafe, and  we will  not be furprifed that
fome indances of  the diforder fhould be  attributed to
contagion.
     It has been before obferved that an expeaoration
of purulent matter  is one of the charaaeridic fymptoms
of Pulmonary confumption; the mucus which is thrown
up  from the lungs in catarrh  frequently refembles this 
[  14   ]
 in a confiderable degree, and as it is of great impor-
 tance to be able to didinguifh one from the other, I mail
 fubjoin the methods commonly ufed for this purpofe.

      id,  Mucus and pus both acquire a greenilh colour
 fome time after they are formed, but it is more evident
 in the latter, than in the former.

      2nd, Mucus is vifcid and coherent, pus more fria-
 ble ; the former preferves its continuity when agitated
 in water, the latter is feparated into fmall  fragments
 under the fame circumftances.

     3rd, Pus when thrown on the floor fpreads over a
 confiderable furface, the  particles of mucus adhere more
 clofely together, and prefent a different appearance.

      Befide the judgment to be formed from the above
 criteria, the  experiments of  Mr. Charles Darwin have
 thrown confiderable light on thefubjea, and  may be had
 recourfe to, where the nature  of the cafe admits of doubt.
 He obferved that fulphuric acid diffolves both mucus and
 pus, but moft readily the former, by adding water to  the
folution of mucus, this  is feparated and fwims on  the
furface, or is fufpended  by the liquor in fmalftakes ;
whereas if water be added to  a like folution of pus, this
falls to the bottom, or forms  an uniformly turbid liquor
by agitation.  Nitric acid diffolves both mucus and pus;
water added  to a folution of the latter, produces a pre-
cipitation, and the fluid above becomes clear and Preen •
while water  and  the folution  of mucus form a dirty
coloured fluid-  Alkaline lixivium diffolves mucus, and 
C   '5  ]
generally pus ; by the addition of water to their folution s
the latter will be precipitated, but the former will not.
Where alkaline lixivium does not diffolve pus, it  dill
didinguifties it from mucus, as it then prevents its diffu-
fion through water.

     The oxygenated muriate of  mercury coagulates
mucus but does not pus.

     Ladly, a purulent expeaoration may be known
from a mucus difcharge, by the former  being  attended
with hectic fever.

     I fliall in the next place proceed to date the caufes
on which pulmonary confumption  depends;  thefe are
remote, predifpofing, exciting and proximate.  What-
ever tends to impair  the drength of/thefydem, thereby
inducing a date of debility in the body in general, or in
the lungs in particular, fo as to render them more fu-
fceptible of the aaion of dimuli,may be judly enumer-
ated among the remote caufes of this difeafe.

     Hcemoptyfis, Pneumonia, Catarrh and Scrophula,
when  they induce a date of chronic debility,  are fre-
quently found among the remote caufes of Phthifis.  Me-
dical writers, have likewife defcribedit as an effea of local
injuries, particularly wounds of the lungs; it is faid to
arife alfo from the dud difcharged in certain manufac-
tories    In my opinion the lad mentioned circumdances
can operate as remote  caufes much lefs frequently than
has been generally fuppofed.   Wounds in the fubftance
of the lungs if they occur, in a healthy date of the fydem, 
[  .6   ]
 I believe are found to heal as certainly, and in as fhorr
 a period, as  injuries in  other parts of the body.   Mr.
 John Hunter, when fpeaking of confumption from this
 caufe, obferves that he never faw it produced by a wound
 of the Lungs.  Doaor Rufh, in his fecond volume of
 medical enquiries and obfervations, gives an indance,
 which mud fet afide every doubt on the fubjea.  Out
 of twenty-four foldiers,  who had been  admitted into
 Britifh Hofpitals, during the campaign of 1776 in the
 late  American war, with wounds in the Lungs, twenty
 three of them recovered perfeaiy.

     The floating particles of dud, by  which  millers
 are fubjeaedto a cough,  I believe never produce Phthi-
 fis unlefs there has been  a predifpofition, or fome unfa-
 vourable concomitant circumdances.

   Heat fuddenly fucceeding cold, violent exercife, and
 ftimulatingpaflions,are frequently remote caufes of con-
 fumption ; thefe may either bring on a ftate of indirea
 debility, or, by inducing  a preternatural determination
 to the lungs, may excite haemorrhage, and thereby cre-
 ate a weak part.

     To thefe  caufes may be added, a fedentary life, and
 the fuppreflion of any cuftomary evacuation.

     It may not perhaps  appear foreign to our fubjea,
to enquire,under what circumftances Hcemoptyfis,Pneu-
monia and Catarrh, are followed by confumption of the
lungs ?  Whenever Hcemoptyfis occurs  as a fymptom
of a general difeafe, which has occafioned a confiderable 
L  '7   J
degree of debility, a phthifis pulmonalis may be dreaded
as its confequence j the fame may be expeaed,  when
from the magnitude of the injury,  and the  irritation
given to the Bronchial veffels, a cough is induced which
it long  continued, mud neceffarily bring on a date of
general or pulmonary debility.  In this fituation of the
fydem, Hcemoptyfis is moft commonly followed by ab-
fcefs in the lungs.   But when the debility  induced is
temporary, and capable of being removed by cordial di-
et or tonic medicines, all the fymptoms of difeafe difap-
pear, upon the redoration of the fydem to its accuftom-
ed vigour.

     Pneumonia has been feldomthe remote caufe of pul-
monary confumption, except in thofe cafes in which the
cure has been left in the hands of nature, and fufficient
evacuation has not been reforted to—Nature endeavour-
ing to relieve herfelf of the violent fymptoms of the for-
mer difeafe, produces a vomica or an  effufion on the
lungs ;  thereby changing an acute into a chronic affec-
tion.   From this circumdance Dr. Rufh has with much
propriety, called Pneumony an acute confumption, and
confumption a chronic pneumony.

     As the debility attending  thefe cafes is generally
iranfient, and differs widely from that habitual predif-
pofition already mentioned ; we find fewer indances of
mortality in Phthifis Pulmonalis from  this than from
any other caufe.  A nourilhing diet, frelh  air,  and a
return to cudomary exercifes,  very  frequently redore
the patient to perfea health.
                       C 
[   >8   J
     It has been fuppofed, that the mucus thrown from
 the lungs in catarrh, is fometimes gradually converted
 into pus,thereby forming a genuine Phthifis pulmonalis,
 this I can eafily conceive to be poflible, for although Ca-
 tarrh is for the mod part a mild difeafe, yet when it has
 been of long duration, and by condant irritation has in-
 duced a date of general debility, a fuppurative inflamma-
 tion of the lungs and Bronchia may take place, and pur-
 ulent matter be difcharged.   That this fuppurative  in-
 flammation does aaually take place, in the lungs, I infer
 from many well atteded cafes, where upon diffeaion, no
 abfcefs  nor ulceration were obferved in their  fubdance,
 although large quantities of matter, evidently purulent,
 had been expeaorated.

     We frequently meet with cafes  of catarrh, which
 have continued  for  many  years without  producing
 Phthifis pulmonalis, more efpeciallyinperfons who pur-
 fue aaive and invigorating occupations,  it is therefore
 probable that it feldom operates as a caufe of Pulmona-
 ry confumption, and in thofe cafes in which it does, it is
only when joined  with a confumptive  diathefis, or has
 occafioned a confiderable degree  of general debility.

   From what has been faid refpeaing the remote caufes
of this  difeafe, it is evident that they tend to  produce a
ftate of the fydem, liable to morbid excitement on the
application of dimulus ; this date has been called debil-
ity, and is the  predifpofing cause of difeafe.   Stimulus
aaing on this diminifhed energy, is the exciting caufe.
Any of the remote caufes enumerated may induce this 
                     [  '9   ]
complaint; and whether it be heat, fatigue or intemper-
ance, they all aa in the fame manner.

     Various theories have been offered of the Proximate
caufe of Pulmonary confumption, fome of which, after
mifleading  the medical world for centuries, have been
laid  afide, as inconfident with the late improvements in
Phyfiological fcience;  others, after  obtaining a  fhort
lived popularity from their ingenuity, have fallen into
neglea for want of faas or probability.

     I am of opinion that the lead objeaionable theory
is, that a moibid excitement in the  blood veffels  gene-
rally, and in thofe of the lungs in particular, forms that
ftate of fever, which has been didinguiflied, by the name
of pulmonary.

     In a difeafe by which fo many of the human race
are daily carried off, it will not be furprifing that  num-
berlefs  remedies have been  propofed to arrest its pro-
grefs; but the almoft  undiminimed  number of its vic-
tims, dill bears a fad  teftimony  of the fuccefs of our
prefcriptions ;—thofe  indances which have yielded  to
medicines, are for the mod part fuch as arife from  pneu-
monia, or depend on occafional or tranfient debility ;
but  in thofe cafes which arife from  hereditary or habi-
tual predifpofition, our endeavours have been generally
fruitlefs.
      I apprehend that a great caufe of our ineffi-
ciency in the  cure of phthifis, may depend  on the ve-
ry gradual manner in which its approaches  are made ; 
[  *°   ]
 they are for the mod fo flow that the patient,  feldom
 complains till the difeafe is incurable.   Indeed he is so
 invariably  poffeffed with an idea of the favourable ter-
 mination of his  diforder, that throughout its whole
 courfe he is willing to indulge  the mod  flattering ex-
 peaation, and too often negkas the only poflible means
 of recovery.  If ever providence had damped a necef-
 fary fatality on the charaaer of any difeafe which afflias
 our  fpecies, it had mod probably been on pulmonary
 confumption, wherein he kindly permits the lingring
 viaim dill  to hope, and indulges him with the pleafing
 delufion of returning health till  the lated  period of his
 exiftence.

     Until  the  late improvements in  medical fcience,
this difeafe  was  looked upon as local;  phyficians pre-
poffeffed with this idea, have in vain fearched the mate-
ria medica for a fpecific,  which  may invariably prove a
remedy to  the  affeaion  of the  lungs;  experience has
proved the futility of the refearch, and more accurate
 obfervation evinced, that Tubercles and pulmonary ab-
 fcefs are fymptomsof a general difeafe, and only to be cu-
 red by thofe remedies, which eradicate the general af-
feaion of the fydem.

     As confumption of  the lungs always depends on
 debility as its predifpofing caufe, our firft objea  fhould
 be either to remove the  debility, or to determine the
 aaion of exciting  caufes, to parts of the  body lefs effen^
 tial to life,  than the lungs. 
[  *•   ]
     The preventive remedies  principally to be relied
on, are wholefome exercifes, a dry fituation, the cold
bath, peruvian bark, and cordial diet.  If thefe are at-
tended  to, and duly adminidered  during the forming
ftage of pulmonary  confumption *, it may, 1 believe be
very frequently protraaed, to  that  period  of life, in
which  the  fyftem is lefs  fubjeaed  to indirea debility,
and the difeafes which induce  phthifis lefs frequently
 cccur.

     When the complaint has been negleaed in its form-
ing ftage, although there may fometimes be a compli-
cation  of fymptoms, yet the inflamatory diathefis is gen-
 erally  fo prevalent, that the ufual remedies for increaf-
ed aaion of the arterial fyftem are plainly indicated.—
Thefe are blood-letting, nitre, degitalis, vomits, dry air
and a vegetable diet j  blifters and mercury may alfo be
enumerated here.

     The hard pulfe and laborious  refpiration which at-
tend the inflamatory ftate of this difeafe, evidently prove
the propriety, and even neceflity of blood-letting,—To
 render this remedy effectual, it fhould be frequently re-
forted  to, and the quantity taken at each time, fhould be
regulated  according to the violence of the difeafe and
the conftitution of the  patient.  I have had frequent op-
 portunities of feeing blood-letting ufed with furprifing
advantage, and we have  many well atteded indances of
perfons predifpofed to confumption who by occafional
 recourfe to this remedy, on the appearance of any in-
 flamatory  fymptoms, have attained to old age without 
                     [  M   ]
 any ferious pulmonary affeaions.—The refpeaable tef-
 timony of Dr. Mead, adds not a little to the charaaer of
 our remedy, and the caufes of Phthifis cured by accident-
 al hcemorrhage are fatisfaaory proofs of its efficacy—If
 advantage has been gained by thofe precarious difcharg-
 es from the  erring hand of nature, how much more
 may not be  expeaed where the evacuation is appor-
 tioned to the condition of the patient, by the difcern-
 ment of a phyfician.

    Although Nitre has been one of the mod commonly
 prefcribed remedies, I am inclined to believe  its ufe in
 Phthifical complaints fhould be more limited than has
 been hitherto imagined, when combined with fome of
 the mercurial or antimonial preparations  it may be ad-
 minidered in  fmall dofes with very great advantage, but
 the difagreeable effeas arifing from its ufe, on the Sto-
 mach and Bowels, often render a continued exhibition
 of larger quantities impraaicable.

    The Digitalis Purpurea  or Foxglove, has of  late
 excited a confiderable fhare of the public  attention, as
 a remedy in pulmonary confumption; its general opera-
 tion on the vafcular fydem, and the hidory of cafes in
which it has been ufed with advantage, confirm me in
the opinion, that it can only be prefcribed with a prof-
 pea of fuccefs in the inflamatory dage of this com-
plaint.   The  cafes detailed by  Doaor Moore, which
occurred in the Philadelphia Alms-houfe, and in which
digitalis was  exhibited with fo much advantage, were
evidently inflamatory. 
                    [   *3  ]
     Dr. Withering, in his treatife on this  plant, com-
plains of its want of efficacy  in Phthifis Pulmonalis; I
am of opinion that his want of fuccefs may in fome mea-
fure have depended on the advanced dage of the difeafe,
for the cafes he has recorded, were evidently too far ad-
vanced to admit of the  antiphlogidic mode of treat-
ment.   It may be eafily fuppofed that the medicine fo
far from proving a remedy, may be of ferious injury af-
ter the difeafe  has paffed its inflamatory date.

     Notwithdanding the ill  fuccefs of Dr. Withering's
prefcriptions, foxglove is edeemed a fpecific in Phthifis
pulmonalis by the common people in fome parts of En-
gland, and it is not  improbable that it  may have been
a valuable medicine even in their hands, for as  in this
ftate of the  difeafe the fymptoms are moft  didrefllng;
fo the patient would have a much greater inducement to
call for releif, than when the more 'flattering,  but not
lefs mortal, typhus date comes on.
     I have  had feveral opportunities of feeing this me-
dicine adminidered  in  pulmonary  cafes,   the benefit
which refulted from its ufe in fome of thefe, convinces
me that it may be often fubdituted with advantage for
the remedies in common ufe.   Although  in the only
cafe wherein a cure was  performed,  blood-letting was
alfo  had recourfe to ; I am neve^rthelefs of opinion  that
digitalis was of eminent fervice,  for I do not recollea
fuch fpeedy and perfea fuccefs from blood-letting alone.
I fliall briefly date the cafe I allude to.
     Mr. J. H. Etat. 30 in confequence of an ill cured
Pneumony, in April 1801, was feized with fymptoms of 
t  "-4   ]
 Phthifis Pulmonalis, he complained of an acute pain un-
 der his dernum, a troubiefome cough, and great difficul-
 ty of breathing,'his cheeks were flufhed, chills and fever
 recurring  in  the afternoon.   He was much affliaed
 with night  fweats, and an  expeaoration  of purulent
 matter ; although his pulfe was fuller than that which
 generally denotes heaic, there could  be no doubt of his
 difeafe being a genuine Phthifis.   Under thefe circum-
 ftances  blood-letting was  prefcribed,  and  about 40
 ounces were taken in the fpace of four days.  This e-
 vacuation was attended  with evident  advantage, and
 although the difeafe dill appeared to continue, the more
 didrefling fymptoms were much alleviated.

     The pain of the thorax was lefs  fevere, and the
 cough and  expeaoration  evidently diminifhed;  his
 pulfe, although its fullnefs and frequency were fome-
 what  abated, dill indicated a confiderable  degree  of
 morbid  excitement ; it may  not be  amifs to obferve,
 that the chills, which before recurred after ftated inter-
 vals, no  longer obferved  regular  periods of acceffion..
 The patient having  now learned from fome of his
 officious neighbours, that his difeafe was confumption,
 and  confequently beyond the reach of human (kill; and
 that blood-letting was a very fafhionable mode of ter-
 minating the complaints of incurables, would be per-
 fuaded by no arguments, to permit more  blood to be
 taken.  It was therefore thought proper to try the effeas
of digitalis,  this was given in the form  of pills ; three
grains a day were at lird exhibited, and the dofes were
 gradually increafed, till  he took fix grains in a day, be- 
[ -»5   ]
 yond which he did not go.   After he had been on the
 ufe of this medicine  about  a week, he began to feel  a
 confiderable alleviation  of his complaints, and  in  a
 fhort time was able to ride on horfe back with eafe and
 pleafure, when either through excefs of fatigue, or by
 taking cold, his difeafe returned  as feverely as before.'
 The pain in his thorax was fo violent, that he no longer
 objeaed to bloodletting \ he was accordingly bled three
 or four times, and again  hadrecourfeto digitalis as be^
 fore ;  his  pulmonary fymptoms foon vanifhed, and he
 has finee followed the  ufual bufinefs of a farmer, I be-
 lieve, in perfea health.   Except an epidpaftic, laid on
 his bread, and the occafional ufe of Opiates, this patient
 ufed no other  means for the recovery of his health than
 thofe before mentioned.

     Although in this, and  fome other cafes of the fame
 nature, our medicine feems to have been given with ad-
 vantage ;  it muff be  confeffed that in by far the greateft
 proportion of pulmonary affeaions, no real advantage
 has refulted from its ufe  ; but a remedy, which has &
 ven in a few indances, arreded the progrefs of fo mor-
tal a difeafe, certainly deferves attention, and this  more
particularly, as it is probable that  many indances of its
failure have depended on its exhibition in dates of the
fydem, which have forbidden an  antiphrogiftic mode
 of treatment.

     I am not prepared to determine on the advantage
derived from the adminidration  of vomits  in this difv
eafe, having feldom feen them ufed, but from their gen- 
                     [   26  ]

eral operation,  fuppofe they may be fafely fubdituted
to fome of the above remedies, where thefe are objeaed
to;—I am the more difpofedto think highly of emetics,
as they have received a high charaaer from the very
ingenious Dr. Reid.

   Dry air is next to be confidered : befide the benefi-
cial effeas of this as a preventive of  Pulmonary difeafes,
it is  proper to  mention it as an antiphlogidic remedy.
In that aaive date of the pulfe, which attends catarrh,
and which in a moid atmofphere is indicative of inci-
pient  Phthifis, a change to  a dry fituation almod cer-
tainly effeas a cure.
     A family who lived in a dove-room, which had a
direa communication with a large fpring of water imme^
diately below it, was affeaed with pertuflis during the
lad winter j  one of the family died fome time fince of
pulmonary confumption, two others who  had evident-
ly fymptoms of incipient Phthifis, were fpeedily cured'
by a change of their habitation.

     The  effeas of cold and dry air in reducing the fre-
quency  of the pulfe, evince the propriety of its being
ufed in the inflnmmatory date of this difeafe.

     A vegetable and mild diet, as it tends to leffen the
aaion of the arterial fydem, certainly ought to be called
in aid of the above mentioned remedies.
    It has been a  common praaice to prefcribe bliders
in the latter dages only, of confumption, under a mida-
ken idea that they injure the patient by increafing the
inflammatory diathefis j but 
["  27   >
time be lefTened by depleting remedies, I am confident
that it is in the firft ftage only we can expea much per-
manent relief from their application, although they may
at any time be ufed as palliatives.

     Mercury has of late attraaed confiderable notice as
a remedy in phthifical cafes, the depletion it gives the
fyftem when it excites a falivation is certainly produce
tive of beneficial effeas ; and the new and powerful ac-
tion it induces,  feems well  calculated  to counteraa the,
morbid excitement of the lungs.
     It now  remains  to fay fomething concerning the
remedies for the more advanced dage of pulmonary
confumption, or what prof'effor Rufh has, with much
propriety, called the  typhus date.                   *

   The gums and Balfam, formerly the principal medi-
cines given in this difeafe,  have been  found ferviceable
only when the reduced date of  the fyftem requires fti-
mulating remedies.

     Wine, peruvian  bark, and the cold bath ; although
they have been  much condemned, are  found not only
perfeaiy  innocent, but of great advantage, where there
is a total abfence of inflammatory diathefis.

     Cordial and  ftimulating diet,  given without wait-
ing for the calls of appetite, by keeping up a gentle fti-
mulus, may fometimes prevent the diarrhoea which fo
frequently forms the  clofing fcene of this diforder.

     Air,in which there is a diminiihed quantity of Oxy-
gene, has been  propofed; and Dr. Withering found the 
C  2*   J
 refpiration of carbonic acid gas of infinite advantage to1
 fome of his patients—but the effeas of this prefcription
 have been fo various, in the hands of different medical
 gentlemen, that I am not competent to decide on its
 medical virtues—but from what has been faid of its ufe,
 I am inclined to believe it will be found moft fervicea-
 ble in the typhus ftate of confumption.
     Although opiates may be ufed with advantage in
 every ftate of the difeafe, yet as the benefit derived from
 them, is always lefs in proportion  to the aaion of the
 arteral fyftem, I  have thought  moft proper to mention
 them here ; independent of the advantage derived from
 the abatement of the cough and dyfpnea, we may calcu-
 late highly on the ftimulating qualities of opium.
     The remedies above mentioned have in fome cafes'
 proved beneficial, but in many others they are at beft
 but palliatives—Long  continued  exercife has been"
 propofed as a radical cure ; but we find the patient fo
 averfe to the fatigue he mud neceffarily undergo, that it
 is feldom reforted to.  This is the  more to be lament-
 ed, as we have yet no  fuccedaneum for thofe aaive and
 invigorating purfuits, which alone feem adequate to re-
move  that great degree of chronic debility on whicfc
pulmonary confumption depends.
FINIS, 
Me A. Hist.
  xno 
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