. NATIONAL LIBRARY OF MEDICINE Washington Founded 1836 U. S. Department of Health, Education, and Welfare Public Health Service 4 7 ^'J°S /&?<**&* OBSERVATIONS PHTHISIS PULMONALIS, AND THE USE OF THE DIGITALIS PURPUREA IN THE TREATMENT OF THAT DISEASE j PRACTICAL REMARKS ON THE USE OF THE TEPID BATH. by ISAAC RAND, m. d. a. a. et s. H. soc. A.ND PRESIDENT OF THE MASSACHUSETTS MEDICAL SOCIETY. had at the request of the massachusetts medical society, June 6, 1804. BOSTON : TRINTED AT THE REPERTORY OFFICE, 1804. AT a Meeting of the MASSACHUSETTS MEDICAL SO- CIETY, June 6, 1804. Voted— That Drs. Welsh, Bartlett and Spooner, be a committee t» wait on the President, and return him the thanks of the Society, for his Discourse, this day read, and request a copy for the Press. T. DANFORTH, Recording Sec'y. Boston, June 7, 1804. The Discourse read at the request of the Council of the Mas- sachusetts Medical Society, is respectfully submitted to your dis- posal. Tour humble Servant, ISAAC RAND. Drs. Welsh, Bartlett and Spooner. OBSERVATION'S ON PHTHISIS PULMONALIS, &c. lN O disease is more frequent or fatal than the Phthisis pulmonalis, the prevention and cure are among the desid- erata in our system of medecine. The occurrence of it in Cities and Country is obvious to every Physician : nearly one quarter of the bills of mortality is to be attributed to this disease : and it must be acknowledged to be almost invariably fatal under the usual modes of cure. And we cannot but deplore its ravages the more, as it destoys those who are in the prime of life, and not often past its meridian. This loss to the public\is elegantly expressed in the fu- neral oration of Pericles on the Athenian youth who per- ished in'the Samian expedition, that the' loss which the Commonwealth suffered by the destruction of the youth was like the loss, which the year would sustain by the de- struction of the Spring. To point out its latent and insidious, as well as the more obvious causes would require a volume, 4 When we consider the extent of the surface of thelungs, the organ primarily affected in this disease,* whose sur- face, the branchiae 1635 square inches, the vessicles 20,000 square inches, the whole surface of the lungs, make there- fore 21,635 square inches, or 150 square feet ; equal to ten times the surface of a man's body, which at a medium, is computed at fifteen square feet. As the whole blood of the animal incessantly passes through the lungs, by comparing the proportion, which the lungs bear to the whole body, we may make some estimate of the great difference of the velocity of the blood in each. f It appears, that 4. 34 pounds of blood pass through the heart in a minute, and in 36. 3 minutes, a quantity e- qual to a middle sized man, or 160 pounds of blood, will pass through the heart: then the same quantity must also pass in the same time through the lungs, since the left au- ricle and ventricle, are supplied from thence with blood to be circulated through every other part of the system. From whence it follows, that the velocity of the blood must be very much accelerated in the lungs. And wheu we reflect upon the very delicate structure of this organ, the number of vessels, the importance of its use, and the many accidents to which it is exposed, we shall be less surprized that so many, than that so few persons are the fatal victims of it. Among the remedies lately introduced, the digitalis purpurea is the most prominent. I therefore will give a concise history of it, and its modus operandi, with a case or two subjoined, with cautionary hints. * Hale's vegetable staticks, Vol. 1. page 238-39. t Hale's hsemastaticks Vol. 2. page 63, 4,5. 5 The digitalis purpurea of Linacus has been employed in medicine since the sixteenth Century ; and in some cases of phthisis pulmonalis with permanent success ; and has been celebrated as a certain remedy, and con- demned as a poison, from that period to the present time. * The first physicians who employed it, in pectoral complaints, are extravagant in their encomiums on it. Fuchsius in his h^4Ha plantarum, to whom we are indebted for its nam^vas the first that introduced it into medicine ; he speaks highbpof its utility in this disease. Gerard and Parkinson,^w&of'the most celebrated older botanists extol, it\s, ah*£xpec'torant; and Doctor With- ering has givej^manuseript note of Saunders, found in a copy of PgftWaWs verbal, which mentions consump- tions as infallibly cured b}r a decoction of fox glove leaves in water. Salmon in his family diet, says it is a specific^ in consumptions. But Ray, Boerhaave and Haller, assert its effects as generally deleterious. These discordant opinions may be accounted for,by considering that among the poor, where it was at first chiefly used, its incautious exhibition would naturally lead to this conclusion, that it was a poi- son ; but that when it was directed and its exhibition un_ der the eye of an intelligent and vigilant physician, its use was attended with the most surprising effects and cures. Doctor Withering, was the first, I believe, who men- tions its peculiarproperty as a diuretic\in dropsies ; pre- vious to that period, it was celebrated in epilepsy and scrophula as well as consumption. * Medical and Physical Journa', passim, voce digtialis purpurea. 6 We are indebted to Dr. Darwin and Sir G. Baker for many ingenious and well conducted experiments in pul- monary consumptions, evincive of its singular effects in retarding, and partially suspending the motion of the heart and arteries. Previous to a detail of its effects in this disease, I will endeavour to give some idea of its modus operandi. Not- withstanding many physicians disdain all pretences to theory in medicine, and aver that they depend solely on facts, yet when they are requested to explain their opin- ion, they always shew that their practice is founded on some theory previously adopted. To theorise is to think> - and that physician who thinks or theorises the most close- ly, and reasons analogically on diseases, will, caeteris par- ibus, be the best physician. $ Many years since, * De Haen in his Ratio medendi* maintained, that the extremities of the arteries, in conse- quence of certain diseased actions, secreted pus. This opinion has been supported and proved by that accurate. and successful anatomist, John Hunter. Every physician may_discover the pus, by examining the discharge from the purulent ophthalmy, psorophthal- my of newborn infants, coryza, and in man)r cases of the pulmonary influenza, when no ulcers exist. The puru- lent discharge from either of these diseases, being mixed with distilled water and vitriolicX acid, by agitation they will form a homogeneous fluid. Then add caustic\ alkali to the mixture ; the acid having a greater affinity to the alkali tha|| to the pus, the pus will separate and by its greater gravity will subside in the fluid ; while the mucus, * Dr. De Haen Vol. 1. Chap, 2. ik Tims Gcnerationc. ■->'/«-*-.•/ ofc--*^ <.kins, in Welsh flannel; and when they took an airing, were wrapped in furs, so that any exercise produced an agreeable glow over the whole surface of the*body ; perpetual action continued and promoted Health. The ancients observed that the Gods sell all good things for Labour and Exercise. *Two Englishmen, and Brothers, resided in Holland ; one continued the dress and manners of the English, dis- daining to wear a flannel waistcoat, and braving the ele- ments with an open breast ; he fell an early victim to his predilection for English fashions at 30. The other confor- med to the Dutch mode of dress ; wore flannel waistcoat and drawers, by which he encountered the inclemency of the weather with impunity. He fished and hunted in the worst of weather, and was a stranger to colds and coughs, and enjoyed uninterrupted health till 57, when by accident he lost his life. The warm bath is well adapted to relieve many of the effects of colds and by invigorating the whole system to ward off the catarrhs to which the valetudinarian and those disposed to consumptions arc most incident. The practice of bathing was universally adopted among the Greeks and Romans. The institution was originally * Beddoes. C 19 the preservation of health,but as riches and luxury increa- sed in those nations, edifices of the most superb, sump- tuous and elegant nature were erected. In the baths of the Romans, there were five apartments. The tepida- rium, calidarium or laconicum, the solium, the baptisten- um or Piscina, and the frigidarium. The time will only admit of a few observations on the tepidariumand solium. It has been much agitated among the learned,whether, and how far,the writings of the ancient physicians contri- bute to our knowledge in the cure of diseases. Their use- fulness may be inferred from this single consideration. That the mechanism of the human body,always the same, a faithful history of diseases must necessarily be one of the surest guides to the proper application of remedies. And if the diagnosticks and prognosticks be of the great- est consequence in Phj^sick, and are only to be collected from long and accurate observation, then the histories of diseases by Hippocrates and others, who were so assiduous in their observations, so clear and exact in their descrip- tions, must be allowed to contain a valuable treasure of medical knowledge. They have been verified by subse- quent Physicians and quoted as authorities. Opinionum commenta delet dies, naturae judicia confirmat. Cicero. Celsus is the only Roman Physician, whose work de Re medica, survived the destruction of the barbarous ages. He lived in the first Century of the Chr. ^Era in the reign of Augustus. It has been disputed whether Celsus was a practitioner of Physick, or only to complete a liberal edu- cation, acquired all that was then known in Physick and Surgery. We must suppose from his very particular direc- tions, in most cases, that he Mas a regular Practitioner of Physick and Surgery. His Surgery is preferable to his Physick. 19 Among the ancients, to whom the individual, was of so much importance to the publick, bathing was as frequent as washing among us ; every person in easy circumstances bathed once every day j many in affluent circumstances, 5 or 6 times in a day. The prohibition of Bathing was among the severe mor- tifications to which certain priests in Greece, were bound by the rigid rules of their order.— The use of the bath came from the East into Greece, and thence into Italy, and the north of Europe. The baths were esteemed of so much importance to the health of the people ; that Princes and magistrates procured them for the use of the publick. In the life of Augustus, it is mentioned, that Maecenas was the first that established the warm bath at Rome. The Roman Emperours erect- ed superb publick baths, assigned revenues to support them, appointed Slaves, Servi balnearii, who heated the baths ; others kept the clothes of those who bathed, a third rubbed them with oil : and all were under the in- spection of certain officers, who had the charge of the baths. In many of the reigns there was no sort of con- straint on account of rank or quality, all sorts of persons and sexes were admitted gratis to the baths, which the Emperors maintained at their own expense ; a largess which they gave the people on occasion of any publick rejoicing, called balneum gratuitum. Often the masters of the World bathed indiscriminate- ly with their Subjects. Titys admitted the common peo- ple to bath with him in the thermae he had built; and Spar. tian relates that the Emperor Adrian, bathing in a croud of people, discovered an old Soldier, rubbing his back a- 20 V i » ■ gainst the Wall. Adrian who knew him, by having seen him in the service, asked him the reason of it. It is, repli- ed the old man, because I have no servant. TheEmperour immediately gave him Slaves, and a revenue sufficient to support them. Seneca, in his 86th Epistle, shews us of how great importance the Romans esteemed the tepid baths, in the time of the republick, where he, observes, " what pleasure there would be in going into the baths, which a person knew to be tempered by the hand of Ca- to in his Edileship, or Fabius Maximus or one of the Corn- elii, for this function, the most noble Ediles performed, of inspecting those places, frequented by the people, and re- quiring cleanliness, and a salutary temperature : not such as has lately been brought into use, in which the heat is so violent, that one would imagine a Slave convicted of some crime, were condemned to that punishment." That the warm bath was considered both, by theGreeks as well as Romans, as corroborant, is evinced by a dia- logue from Aristophanes in which one of'the Characters says "I think none of the sons of the Gods ever exceed- ed Hercules in bodily and mental force" upon which the other asks " where didst thou ever see a cold bath dedi- cated to Hercules ?" It is impossible to ascribe such an absurdity to the ingenious and consistent people of an- tiquity, as to make them consecrate to the God of strength, what they held to be so very debilitating as we do. They therefore must have esteemed the warm bath in- vigorating to the system, and from their constant use of it, must have been competent judges of it. They did not consider its frequent use as tending to enervate the body; they meant it in a moral, not a physical sense. Celsus, as I mentioned, must have considered the trpid bathinvigo- 21 rating, it is evident from this passage. The valeludina- narian imbecillis homo ; iturus in balneum, vitare debet, ne ante frigus aliquod experiatur, ubi in balneum venit, paulisper resistere, experique num tempora adstringun- tur, et an sudor aliquis oriatur : illud si incidit, hoc non secutum est, inutile eo die balneum est: perunguendus est is leniter, et referendus ; vitandutnque omnimodo fri- gus, et abstinentia utendum. At si temporibus integrisi primum ibi, deinde alibi, sudor incipit, fovendumos aqua calida, turn in solio desidendum est : arque ibi quoque videndum, num sub primo contactu aquae calidae summa cutis inhorrescat, quod vix tamen fieri potest, si pribra recte accesserunt: ccrtum autem id signum inutile bal- neumest. Theancientsspent some hours in the tepid bath, they were therefore accommodated with a seat, Solium ; therefore Celsus says,tum in Solio desidendum est, he is to to sit in the bath at his ease. And Suetonius,in the life of Augustus, mentions the Epigrams which that Prince com- posed in the tepid baths. The elder Pliny, while in the bath, had his Secretary at hand, to make extracts of what appeared worthy of remark. * The English antiquarians adduce many instances, in history, of the great predilection of their ancestors to bath- ing ; many of their nobility had warm baths in their own houses j and there were publick baths,to which those who could not afford these means of health, repaired. That a custom so congenial with the increasing disposition to luxury and refinement should have fallen into disuse, would afford matter of great surprise, if the cessation of Leprosy, and the introduction of lues venerea, at these periods, did not solve it. The moderns as well as the * Strutt, quoted by Beddoes. 22 ancients bathed, promiscuously, in one large bath, and in the same fluid. The dread of receiving the lues ven- erea, by absorption, deterred many from its use ; and the decrease of Leprosy finally extinguished the de- sire of that indulgence. The modern separate baths and clean water for each person obviate these objections. I know of no place except in Russia where they now pro- miscuously bathe.* With the revival of learning in the 15th century, the Sovereign called in the aid of the priest, and con- verted bathing into a religious rite, and persuaded the people they could wash away their sins, and obtain ab- solution. Such baths were denominated baths for the soul, balnea animaria, et refrigeria animae. I might add, that the use of Shoes and Stockings and linen Shirts, has rendered that of the bath much less necessary to clean- liness among us, than among the ancients, who knew nothing of the pleasures of clean linen, which we now es- teem essential tocomfortand convenience. Linen was such a luxury among the ancients, that the master of the feast furnished no napkins to his guestsj and each brought his own : this custom which cannot but shock us, continu- ed after the reign of Augustus. Martial says Hermo- genes, who frequented the best company, used to filch the guests' napkins, and when for fear of his Hawk's talons, they brought none to the feast, Hermogenes con- trived to purloin the table cloth. Martial, in a couplet, transmits him to immortal infamy. Attulerat rnappam nemo dum furta timentur, Mantile e mensa surripit Hermogenes. Perhaps the disuse of the bath may, in some measure, be attributed to the fashions of medicine. We have all * Cox's travels in Russia. 23 of us been witnesses to the various changes that have been introduced into the practice of physick, depending not so much upon reason as Hypothesis, which is anoth- er word for fashion. Medical hypothesis and false anal- ogies from the writings of Physicians, have caused that to be avoided upon principle, although a false one, the use of which might not in every case be so necessary as it anciently was ; and because the promiscuous use of it had sometimes been injurious. We shall be less surpris- ed that the people in general, have neglected the bath> however salutary in its effects : when Physicians them- selves are but just emerging from the false analogies of their predecessors, and some of them reverting to unbias- sed observation. Physicians and Philosophers reasoning from false analogies have been induced to think, that the warm bath almost universally debilitates,and that the cold bath strengthens, in the same proportion that it recedes from warm. They have reasoned from the effects of heat upon inanimate substances, and have drawn conclusions from substances that have no affinity with each other; and because cold contracts and hardens inanimate bodies, and heat dilates, elongates and weakens them, therefore heat and cold must operate in a similar manner upon animals. The mechanical Physician,being so absorbed in consider- ing man, as an hydraulick machine, subject to the same laws, that he forgets the animating principle; and in his reasoning upon the animal functions, does not introduce the vital and sensitive cause. Professor Cullen asserts, and justly, that cold below 62° is sedative and debilitat- ing. However,those who from speculation never use the te- pid bath from an apprehension of its debilitating effects, will, when uniform experience convinces them of its cor- roborating power, I hope,change their opinion. Tissot, in his Essay on diseases of literary and sedentary people, 24 and diseases of people of fashion, says, " That, toper- sons afflictedwith nervous debilitating diseases, the warm or tepid bath, used fasting, is of the greatest utility," and adds, " I have seen three patients, of this class, in a con- firmed hectick, whose situation seemed desperate, yet were perfectly cured by this remedy." Would time admit, I should adduce a cloud of evi- dence,in support of the corroborating effects of the warm bath, from the writings of Beddoes, Darwin, March- ard and Franks, who directed the warm bath to weakly, nervous persons, such as, instead of recovering their health, as they actually did, ought to be dissolved all to- gether, if the warmth given to the waters had a relaxing effect. The Author of Zoonomia says, the use of the warm bath, from 96° to 98°for half an hour, daily, for three or four months, he has known of great service to weak peo- ple, and is perhaps the least noxious of all unnatural Stimuli. And when Dr. Franklin wras in England, ma- ny years since, he recommended to him the use of the tepid bath, twice a week, to prevent the too rapid access of old age, of which he then thought he felt the approach. We know the Dr. continued the use of it till his death, which would have been preserved many years, had not the cruel disease, the stone, destroyed him. Nothing can more forcibly impress the mind with the invigorat- ing powers of the tepid bath, than its effects on persons labouring under the disease Pelagra, which is exceeding- ly frequent among the peasantry of Lombardy. This debility cannot be more certainly removed by any means than by the use cf the tepid bath. The debility is so 25 great, that many patients are obliged to be carried, al- though the bath is not above forty paces from the Ward. Many who can walk are yet so weak, that they cannot get into the bath without help. The appearance of these people, in going in and coming out, is truly miserable. If they were not supported by the attendants, they would stagger like drunken persons. In the space of four, or at most, six weeks, which is the usual course of bathing, they are commonly so much restored, by the use of the warm bath, as to return to their friends and ordinary employments.* In fine, the warm bath from 94° to 98° by diffusing the circulations, and removing partial pres- sure, prevents spasms, relieves the chronickRheumatism, and most erratick pains : and by cleansing the pores, and determining the circulations to the surface of the body, promotes the secretion of that fine fluid, that gives deli- cate softness and smoothness to the skin, which heighten the charms of youth and beauty ; and by its invigorat- ing effects retards the rigidity of the fibres, and the coal- escence of the capillary vessels, the harbingers of old * Marcard's med. and chirure, Journal, FINIS. 26 MASSACHUSETTS MEDICAL SOCIETY. At a Statute Meeting of the Fellows cfthis Society, held yune the 6tk, 1804, the following Gentlemen were elected Counsellors for the year en' suing: Viz— SUFFOLK. Isaac Rand, John Jeffries, Charles Jarvis, Lemuel Hayward, Thomas Kast, John Warren, William Eustis, Thomas Welsh, Aa- ron Dexter, Joseph Whipple, William Spooner, John Fleet, Thomas Danforth, David Townsend, Isaac Rand, 3d. ESSEX. Edward A. Holyoke, Micajah Sawyer, Joshua Fisher, Thomas Kitteridge, Benjamin L. Oliver. MIDDLESEX. Josiah Bartlett, John Brooks, Isaac Hurd, Oliver Prescott, juit. William Gammage. HAMPSHIRE. Ebenezer Hunt, Henry Wells, Chauncey Brewer. MAINE. Daniel Coney, Nathaniel Coffin, Shirley Erving, Ammi R. Mitch* ell. BRISTOL, PLYMOUTH and BARNSTABLE. William Baylies.---James Thatcher, Gad Hitchcock____Sam- uel Savage. WORCESTER, BERKSHIRE and NORFOLK. Israel Atherton, Oliver Fisk, D. Frink, sen.----Erastus Sargent- Timothy Childs.----Cotton Tufts, Amos Holbrook, John Bartlett. • At a Meeting of the Council the succeeding Day agreeably to Stat- ute, the following Gentlemen were elected Officers : Viz ■ JOHN WARREN, President. JOSHUA FISHER, Vice President. THOMAS DANFORTH, Recording Secretary. JOSEPH WHIPPLE, Corresponding Secretary. ' THOMAS KHAST, Treasurer. LEMUEL HAYWARD, THOMAS WELSH, AARON DEXTER, JOSIAH BARTLETT, and ' JOSEPH WHIPPLE. THOMAS DANFORTH, Recording Secretary. 704998