ARMY MEDICAL LIBRARY WASHINGTON Founded 1836 /.AlMv.. Section. Number &£L^£.L 7- Fobm 113c, W. D.. S. G. O. (Revised June 13, 1936) 1U-9-H. * A TREATISE r HEALTH IIS AIDS AND HINDRANCES: CONTAINING AN EXPOSITION OF THE CAUSES AND CURE OF DISEASE, LAWS OF LIFE. AND NOTICING THE AFFECTIONS OF THE HEAD, THROAT, LUNGS, HEAET, LIVER, STOMACH, BOWELS, KIDNEYS, BLADDER, WOMB, SKIN, BONES, JOINTS, MUSCLES, ETC. BY SAMUEL SHELDON FITCH, A.M., M.D., AUTHOR OF "SIX LECTURES ON CONSUMPTION," AND FOUNDER OF A 8TSTEM OF PRACTICE BY WHICH PHTHISIS IS FOUND TO BE CURABLE BY MEDICAL ART. " The Most High has created the Medicines out of the earth, and he that Is wise will not abhor them."—Ecclesiasticus, xxxviii. 4 NEW YOEK: PUDNET AND RUSSELL, No. 79 JOHN-STEEET. 1857. F546>t /£.■/*, 7o Shoulder-braces................................................... 2~>7 Abdominal supporters............................................. 258 The benefits of these mechanical remedies stated by those who have used them.......................................................... 260 Letter from D. S. McAdie, of Scotland........................... 260 Letter from Mrs. E----H----, of Massachusetts.................. 263 Letter from L. T. Fales, of Illinois.............................. 264 Letter from Miss H----E. W----, of Vermont................... 265 Letter from Mr. Merritt Martin, of New York City................ 266 Letter from Mrs. Sylvanus Johnson, of Iowa..................... 266 Injurious remedies and hurtful treatment in consumption............. 266 Emetic tartar................................................. 270 Blood-letting—Iodine......................................... 271 Cod-liver oil................................................. 273 Emetics............... ...................................... 274 Sulphate of copper............................................ 275 CHAPTER XXV. VARIOUS FORMS OF CONSUMPTION, DESCRIBED BY THE PATIENTS THEMSELVES. Statement of a patient in true tubercular consumption................ 277 Case I.—Mr. Geo. D. Y---, of Ogdensburg, N. Y...............277 Statements illustrating how consumption is developed by simple cold... 280 Case II.—Mr. W. P----, of Livingston, 111..................... 280 Case III—Mr. J. W. P----, of Jacksonville, 111.................. 281 Case IV.—Mr. D. P. V----, of Lafayette, Ind.................... 281 Statement of cases in which consumption commenced with bronchitis... 282 Case V.—Mr. R. R. V----, of Ravenna, Ohio.................... 282 Case VI—Mrs. S. T----, of Manchester, N. H.................. 284 Statement of cases of consumption from salt-rheum and other humors, or skin diseases.................................................. 285 Case VII.—Mrs. E. A----, of Peterboro, N. Y................... 285 Case VIII—Mr. M. T----, of Corinna, Me...................... 286 Statement of complications of disorders from humor.................. 288 Case IX.—Mrs. E. A. P----, of Canton, N. Y.................... 288 Case X.—Mr. J. D----, of Bayham, C. W....................... 290 Case XI—Mr. A. McH----, of Cannonsburg, Mich.............. 291 Case XII—Mrs. M. D----, of Hayfield, Penn.................... 293 Statement of cases of congestive consumption, attended with bleeding, occurring in those predisposed to phthisis.......................... 294 Case XIII—Mr. A. N. P----, of Macon, Ga..................... 294 Case XIV.—Mr. J. Van N----, of Charleston, S. C............... 296 XU CONTENTS. PAGH Case XV.- Mr. H G----, of Hamilton, C. W................... 297 Case XVI—Mr. A. P----, of Sandy Creek, N. Y................ 298 Statement of a case of hepatic (liver) consumption.................... 299 Case XVII—Mr. H. G. C----, of Amherst, N. H................ 299 Statement of a case of consumption from mechanical injury............ 301 Case XVIII—Mr. R. H. P----, of Chaplin, Conn................ 301 Statement of cases of imposthumous consumption, or abscesses in the lungs.......................................................... 303 Case XIX.—Mr. H. H----, of Oberlin, Ohio..................... 303 Case XX.—Mrs. M. Van H----, of Floyd, N. Y................. 304 Statement of a case of congestive consumption, not attended with bleeding 305 Case XXI.—Mr. J. H. S----, of Peacham, Vt.................... 305 CHAPTER XXVI. CONSUMPTION CAN BE CURED. Testimony of those who have been the Subjects of Dr. Fitch's Treatment 307 Case XXII—Letter from W. H. Bangs, Esq., of Washington, D. C--- 308 Case XXIII.— Letter from John Gordon, Esq., of Ottawa, C. E....... 311 Case XXIV.—Letter from Dustin E. Kimbel, Esq., of Newark, Vt...... 312 Case XXV.—Letter from Mrs. Martha L. Bradeen, of Wilton, Vt...... 312 Case XXVI— Letter from Mrs. Ann A. Cole, of West Derby, Vt...... 314 Case XXVII—Letter from R. F. Nelles, of Gait, C. W............... 314 Case XXVIII—Letter from Mrs. D. L. Montanye, of Shandakin, N. Y. 315 Case XXIX.—Litter from Rev. II C. Longyear, Esq., of Phoenicia, N.Y. 316 Case XXX.—Letter from Mr. G. C. Ball, of Michigan City, Mich...... 317 Case XXXI—Letter from C. De Revere, Esq., of Tarrytown, N. Y___ 319 Case XXXII— Letter from Miss Jane Gray, of Brooklyn, N. Y........ 320 Case XXXIII—Letter from W. A. Hillyer, Esq., of New York City... 321 Case XXXIV.—Letter from Mrs. Annie P. Davis, of Berlin, Ohio...... 322 Case XXXV.—Letter from Mrs. Lucretia Louis, of Jeffersonville, Ind.. 323 Case XXXVI—Letter from Mr. Jno. Patten, of Medina, Ohio......... 324 Case XXXVII—Letter from Mr. Thomas Briggs, of Erin, C. W....... 326 Case XXXVIII—Letter from Rev. H. W. Baker, of York, Mich.....327 Case XXXIX.—Letter from Mrs. T. E. Cadwell, of Saratoga Co., N. Y. 328 Case XL.—Letter from A. H. Rock, of Winton, Iowa................. 329 CHAPTER XXVII. DISEASES OF THE HEART. Organic Diseases of the Heart....................................... 332 Enlargement of the heart.......................................... 332 Symptoms indicating enlargement of the heart....................... 333 Ossification of the heart........................................... 335 Fat about the heart............................................... 337 Thickening of the valves of the heart............................... 338 Rheumatism upon the heart........................................ 338 CONTENTS. XLU PAGE Causes of enlargement, ossification, and thickening................... 338 Curability of organic diseases of the heart............................ 339 Remedies for organic diseases of the heart............................340 Functional Diseases of the Heart.................................... 340 Influence of diseased lungs upon the heart........................... 340 Influence of deranged stomach upon the heart....................... 341 Effects of indigestion other than mechanical upon the heart........... 342 Curability of functional disorder of the heart......................... 344 Functional and Sympathetic Diseases of the Heart.................... 345 Palpitation of the heart............................................ 345 Palpitation from falling of the bowels............................... 346 Effects of derangement of the liver upon the heart.................... 346 Effects of costiveness upon the heart................................ 347 Influence of the spermatic organs upon the heart..................... 348 Angina Pectoris...................................................... 348 Causes of Angina Pectoris.......................................... 350 Treatment of angina pectoris....................................... 352 Diseases of the heart may be cured—with the testimony of those who have been cured................................................ 355 Case XLI—Letter from A. H. W. Vansiclen, Esq., of New York.. 356 Case XLII—Letter from Mrs. S. Lock, of Michigan.............. 357 Case XLIIL—Letter from Mrs. M. H. Valentine, of Brooklyn, N. Y. 358 Case XLIV.—Letter from Mrs. E. K. Clements, of Pennsylvania... 359 Case XLV.—Letter from Geo. S. Parker, Esq., of Illinois......... 359 CHAPTER XXVHI. DYSPEPSIA. Distinction between indigestion and dyspepsia........................ 360 Process of digestion explained...................................... 361 The remarkable history of Alexis St. Martin, as given by Dr. Wm. Beaumont...................................................... 363 Experiments with St. Martin by Dr. Beaumont...................... 369 Preliminary remarks of Dr. Beaumont............................... 370 Appearance of humor in the stomach............................... 377 Peristaltic motion of the stomach................................... 378 Varieties of Indigestion and Dyspepsia................................ 381 Indigestion from disorder of the stomach............................ 381 Indigestion from derangement of the liver........................... 384 Indigestion from derangement of the pancreas....................... 387 Indigestion from disease elsewhere than in the digestive organs........ 389 Induced by disease of the lungs................................. 389 Induced by disease of the heart................................. 390 Induced by uterine disease..................................... 390 Induced by spinal disease...................................... 391 Induced by over-stimulation of the brain........................ 392 XIV CONTENTS. PAGE Induced by acute disease, fevers, &c............................. 392 Induced by humor determining on the digestive organs........... 393 Medical treatment in indigestion................................... 394 Hygienic treatment in indigestion.................................. 394 Diet in dyspepsia................................................. 396 Beaumont's table showing the comparative digestibility of different ar- ticles of food................................................... 399 Obstruction of the gall-ducts by gall-stones.......................... 402 CHAPTER XXIX. SKIN DISEASES—FELON—CANCER—SCROFULA—GOITRE—RHEUMATISM —GOUT—UTERINE DISEASES—DISEASE OF THE OVARIES— WHAT IS INFLAMMATION? Skin Diseases........................................................ 404 Blotches, spots, pimples, &c., on the face.......................... 406 Erysipelas on the face............................................. 407 Skin disease affecting the lips...................................... 408 Skin disease in the scalp........................................... 409 Skin disease affecting the hands.................................... 410 Skin disease affecting the legs...................................... 410 Skin disease affecting the feet...................................... 411 Felons.............................................................. 411 Cancers.............................................................. 412 Causes of cancer.................................................. 413 Curability of cancer............................................... 413 Scrofula, or King's Evil............................................. 414 Treatment of scrofula.............................................. 415 Goitre, or Swelled Neck............................................. 416 Curability of goitre............................................... 417 Rheumatism.......................................................... 417 Causes of rheumatism............................................. 418 Curability of rheumatism.......................................... 419 Gout................................................................ 420 Not now a common disease......................................... 420 Causes and curability of gout....................................... 420 Uterine Diseases..................................................... 421 Leucorrhcea...................................................... 422 Inflammation of the uterus, acute and chronic....................... 423 Ulceration of the cervix uteri...................................... 423 Danger of mistaking other disorders for disease of the uteri............ 425 Causes of uterine disease........................................... 427 Curability of uterine disease........................................ 427 Disease of the Ovaries............................................... 428 On Inflammation..................................................... 429 CONTENTS. XV PAGE What is inflammation ?............................................ 429 Inflammation not a disease......................................... 431 All inflammation has a specific cause.. :............................ 431 Internal inflammation............................................. 432 Humor the great cause of both internal rmd external inflammation.....433 Art, not Nature, the great Physician................................ 437 What causes and what cures disease ?................................ 437 CHAPTER XXX. CATHARTICS. Nature and use of cathartic medicines............................... 451 How the different emunctories are relieved.......................... 453 Opening of the skin............................................... 453 Opening of the kidneys........... ............................... 454 On abstinence in place of cathartics................................. 454 The bowels the great emunctory.................................... 456 What the character and effect of cathartic medicines should be......... 458 Cathartics for affections of the head, catarrh, consumption, heart disease, dyspepsia and stomach complaints, liver complaints, bilious fever, fever and ague, derangement of the bowels, kidney complaints, female dis- orders, congestion, inflammation, scrofula, salt-rheum, all humors, sal- low complexion, pimples and spots on the face ; for cholera, common colds, influenza, after a surfeit, &c.......................... 458 to 477 Diet while using cathartics........................................ 477 Diet for children.................................................. 479 General remarks.................................................. 480 Examples showing the benefits of cathartics......................... 481 CHAPTER XXXI. THE LAWS OF LIFE, AND MEANS OF PROMOTING LONGEVITY. The great processes of animal life................................... 486 The process of nutrition........................................... 487 Conditions necessary to perfect nutrition............................. 489 The process of calorification........................................ 492 The process of excrementition...................................... 492 What is the natural limit of human life ?............................ 494 Examples of longevity............................................. 495 May longevity be promoted, and the vigor of youth extended into age, and how ?...................................................... 502 Suggestions on the mode of preserving health and attaining old age.....505 A purpose in life necessary to longevity.............................. 507 Vice tends to shorten life.......................................... 508 Virtue tends to lengthen life........................... .......... 509 xv* CONTENTS. CHAPTER XXXn. MEDICINE. Its mission................ ...................................... 511 Prejudice against medicine unfounded............................. 512 Vegetable, not mineral, medicines should be used.................... 512 Examples showing the value of true remedies........................ 514 Change of air and climate.......................................... 516 Two great classes of remedies...................................... 517 Poisons of the blood demand antidotes.............................. 518 Preventives of disease............................................. 519 Surgery and Medicine................................................ 519 Medical skeptics.................................................. 521 Conclusion....................................................... 522 INTRODUCTION. The late celebrated Dr. Rush, of Philadelphia, was once asked whether he believed the Profession of Medicine had been, on the whole, a benefit to the world. "Do you," he inquired in reply, " intend to include in ' the Profession,' old women and nurses ? If so, then I answer, yes; if not, doubtful." Says the French physician and author, Bichat, speaking of the " Science of Medicine:" " An incoherent assemblage of incoherent opinions, it is, perhaps, of all the physiological sciences, that which best shows the caprice of the human mind. What do I say ? It is not a science for a methodical mind. It is a shapeless assemblage of inaccurate ideas, of observa- tions often puerile, of deceptive remedies, and of formulas as fantas- tically conceived as they are tediously arranged." Said another French physician and professor, Magendie, in a recent lecture to his class of students in the city of Paris: " Gentlemen, Medicine is a great humbug! I know it is called a science: science, indeed—it is nothing like science! Doctors are mere empirics, when they are not charlatans. We are as ignorant as men can be. Who knows any thino; in the world about Medicine? * * * Who can tell me how to cure the headache ? or the gout ? or disease of the heart ? Nobody. ' Oh,' you tell me, ' doctors cure people!' I grant you, people are cured; but how are they cured ? Gentlemen, nature does a great deal; imagination does a good deal; doctors do... .devilish little.... when they don't do harm!" These are certainly neither complimentary nor hopeful views of Medicine. It may, however, be presumed, I think, that the men who spoke thus bitterly, did not intend that we should understand their caustic language in a strictly literal sense. They have evidently 2 XV111 INTRODUCTION. taken a little license with facts, in their ambition to give epigram- matic point and sharpness to their periods—to say striking things. And yet they do plainly intend to declare a great want of faith in Medicine, both as a science and as an art. And when it is remem- bered that these men are the " lights" and " guides" of the medical profession, confessedly standing at its head, the unsophisticated, non- professional reader at least may, we confess, very well be excused if he is somewhat astonished at the glimpse " behind the scenes" which they afford him. And it should be added that Rush, Bichat, and Magendie are not the only physicians who have fulminated such terrible criticisms upon Medicine; they are but the representatives of a large class who, either openly or to themselves, denounce while they practice it. Indeed, the medical infidelity to which these men honestly give expression, pervades to a most lamentable extent the whole profession. There are wide-spread skepticism, doubt, uncer- tainty, and embarrassment, with regard to the value of medical remedies and treatment in the cure of disease, prevailing extensively among physicians; and this skepticism is rapidly spreading among the people. It cannot remain confined to the profession. The ab- sence in the physician of heart-felt faith in medicine cannot long es- cape the notice of the patient, whatever attempts may be made to disguise it. The resolutions of medical conventions, the addresses of medical professors, the protestations issued through medical periodi- cals and books, or whatever other expedient may be resorted to, will do but little to sustain the waning confidence of the people in the benefits of Medicine, so long as those who administer it hesitate and doubt. It becomes, therefore, a most important subject of inquiry, whether Bichat is right in declaring that " Medicine is not a science for a methodical mind;" whether Magendie states the truth when he exclaims, "Medicine is a humbug;" and whether Rush had good ground for doubting whether the Profession of Medicine had, on the whole, been of benefit to the world. If they have herein really told us the truth, then it is still more important to inquire, whether this great failure of Medicine, for a failure it is, has resulted from an inevitable necessity, or from the fault of its professors ? I do not propose to enter at length upon a discussion of these questions—this would require more space than can be properly occu- pied here. But I will throw out a few suggestions, which may, per- INTRODUCTION. XIX haps, indicate to the desponding practitioner of Medicine the road of investigation wherein he will discover an escape from his skepticism, and to the invalid a ground of confidence in the " Healing Art." In doing so, it is proper to bring distinctly before our minds the great object of Medicine; and let me remark, that whether regarded as an art or as a science, it will not be denied by any one that to the physician, as such, this object is simply the prevention and cure of disease. Its aim is one of immediate practical utility and usefulness. In the circle of sciences there are those—that of music, for example —which, like the ornaments of our dress and the adornments of our dwellings, have for their purpose the gratification of our taste, or the polishing of our minds—they are among the embellishments of life. There are others which embrace in their design both ornament and use, contributing at once to our pleasures and our necessities. Astronomy, for instance, reveals to us the sublime wonders of the heavens, and we may study it, either, on the one hand, to unfold our minds, give breadth and compass to our intellects, and kindle our admiration and reverence for its Great Author; or, on the other, to enable us successfully to traverse the ocean with our ships, and map out the geography of our globe. Mcdichte, however, has only a practical value. There are, it is true, embraced in the range of study necessary to equip the physician for his duties, many subjects which are worthy of pursuit for themselves, or merely as mental accom- plishments. In this view anatomy, physiology, botany, chemistry, and many other sciences, are of high interest. But it is not with this view that the physician masters them; this is not the place they occupy in the comprehensive system of Medicine. Here their exclusive office is to subserve the practical end of preventing and curing the diseases to which our race is subject; aside from this, they have here no value. Now, if we turn to the history of Medicine as it is recorded for us, and notice the position in which we find it at the present time, I apprehend we shall be struck with the fact that, instead of its true design, as above stated, having been always kept steadily in view by our profession, it has been too much regarded as a science—a department of study and labor—having a value in and of itself—a dignity and importance of its own; not as a mere instrumentality to a practical end, and to be made at all times subordinate to that end, but rather as itself an end. From the earliest periods, when the XX INTRODUCTION. demons of disease were exorcised by jugglery and incantation in the temples of the Egyptian priesthood, down through all the schools and sects, the discoveries and improvements, the developments of science and the progress of learning, to our own day, we find the traces of an ambitious pretension in behalf of Medicine simply as a learned profession, laying claim to dignity and the homage of the world, rather because of the intellect, the learning, and the science by which it has been illustrated, than because of the actual good accomplished by it. To be sure, such an ambition is not in terms avowed. On the contrary, it is in terms frequently denied; and Medicine is even defined in our text-books as a science which has for its object the prevention and cure of disease. Still this ambition exists, lurking in our colleges and schools, and pervading to a great extent our ranks. To be convinced of it, we have but to call to mind any of the great masters in our profession, whose names the world recognizes as illus- trious. Upon what does their fame rest? Is it based upon the triumphs which they themselves are known to have achieved over disease ? Have these men towered above their contemporaries be- cause they have themselves been more successful in curing disease than all others ? What, in fact, do we know of the private practice of very many of them ? How often is even inquiry made as to what the result of that practice was, or whether they were themselves suc- cessful practitioners or not ? Is it not rather the fact that they have acquired their celebrity by some unusual exhibition of intellectual or scholastic accomplishment—by propounding a novel theory, by wri- ting an erudite book, by delivering brilliant lectures, by founding a new sect, or by some other remarkable achievement in the world of science or letters? It is true that there have been and are those who have become celebrated by their researches in anatomy and investigations in physiology—by their intimate knowledge of the human frame, its condition in health and its altered condition in dis- ease ; others, again, by making new and valuable discoveries, such as the circulation of the blood, and the prophylactic virtues of vaccina- tion—who have thus really been of great benefit to the world by directly promoting the prevention and cure of disease. Still, few of even this class of men are known to us as themselves excelling in the art of'healing; and how very small is the proportion of all our medical celebrities whose fame is founded upon their own personal success in the use of medical remedies! Is it not true, therefore, INTRODUCTION. XXI that even in the awarding of honors among us, science, as such, has a higher place in the scale of merit than skill and practical success ? —that we place the mere means and instrumentalities of Medicine before its great purpose and design ? Again, why is it that there is among us so jealous a watchfulness to guard what are called the honor and dignity of our profession ? Why is it felt to be a greater stain upon professional character to employ remedies which have been condemned, ex cathedra, as " em- pirical" or " quackish," even though life is saved by them, than to kill a patient by the blundering use of an " orthodox" medicine ? Why is it that Ave " cry havoc, and let slip the dogs of war" against every man who undertakes to cure the sick upon any other system than that denominated the " regular practice," however skilful and successful he may be—while at the same time we throw the shield of our professional influence over all who stand Avithin the pale of " regularity," however unskilful and unsuccessful ? Why is the " irregular" practitioner, when accused of harming his patient, con- demned without a hearing, and the " regular" physician, under like accusation, acquitted without a defence ? Why are the errors of the so-called " empiric" blazoned and magnified, A\rhile the errors, equally hurtful and disreputable, of the " rationalist" are apologized for and covered up? No one can successfully deny that these inquiries point to incon- trovertible facts: and, now, can these facts be explained upon the hy- pothesis of a controlling regard for human health and life ? Is it true that the scale of " dignity" in medicine is really graduated with a single reference to skill in preventing and curing disease—skill Avhich has been demonstrated by actual success? Is the most honor aAvarded to that physician who cures the greatest number of his patients and saves most lives, Avithout regard to the school or sect to Avhich he belongs or the system of treatment he employs ? In a word, is the exhibition by the physician of practical skill and capa- bility to cure the sick the only criterion of merit and honorable posi- tion in our profession—competent intellectual and moral qualities, of course, being assumed ? We all know that it is not. On the contrary, the man who presumes to present himself before the com- munity as a practitioner of Medicine, Avhatever may be his qualifica- tions or his skill, unless he confesses allegiance to the predominant, reigning school of Medicine, and shapes his course by the rules issued XXII INTRODUCTION. from it, he is at once by that school branded and persecuted, held up to public contempt, denounced as unworthy of public confidence, and unfit for " honorable" professional association. Until he " passes under its yoke," his claims or merits will not even be examined. However triumphant he may be in conquering disease, and however overwhelming may be the testimony presented that he is so, unless he bows to the authority of " science" as taught in this school, he is anathematized. This is not all: Avhen he has once submissively ta- ken his place in the ranks of the " regulars," he must never think of standing out of line with impunity. No deviation from the pre- scribed routine will be tolerated. If he tampers for a moment with forbidden remedies, or ventures upon a course of treatment not laid down in the chart of his school, he does so at the hazard of losing caste and position, and being " drummed out of camp." It is not difficult to perceive in these facts a source of hindrance to the progress of medical improvement, and the efficiency of medical practice. The circumstances adverted to fetter and cramp the ener- gies of the practitioner. The physician who feels it to be his first duty to uphold the " dignity of his profession," making the cure of disease in any degree subordinate, is necessarily embarrassed in his practice, and will inevitably meet with failure and disappointment. He cannot have that freedom in the choice and use of remedies so essential to success. His range of resources becomes circumscribed within the limits of certain arbitrary lines; and he dare not step over these lines, because he can do it only at the sacrifice of his " profes- sional standing." He may witness the repeated cure of diseases unmanageable in his hands; but if the remedies and the system of treatment by Avhich the cures have been effected are condemned by his "school," he must not adopt them—no, not even investigate them. It certainly cannot be denied, I think, that if " professional reputation," " honor," and " dignity," were made to rest upon ac- tual skill, usefulness, and success in the treatment of disease, and not «o much as they do upon an adherence to arbitrarily established doc- trines of " legitimacy," " orthodoxy," " regularity," etc., nor upon mere " scientific" acquirements, Medicine would be more progressive, more successful, and more useful, physicians would have more faith in its value, and the people more confidence in its efficiency. We should not then have to witness such mortifying confessions as those I have quoted from Bichat and Magendie. INTRODUCTION. xxm Another reason why Medicine has not yet been so far systema tized, and had imparted to it such a degree of certainty as to entitle it to be truly called a science, and why there is both among physi- cians and patients a Avant of faith in it, may, I apprehend, be found in the fact that those leading men in our profession who have been engaged in the work of constructing it into a science, have, almost without exception, each for himself, adopted as true some favorite idea, placing it in the centre of his system or theory, and then ex- cluding all other systems and theories as having no foundation avhat- ever in truth. Let any one study, without partisan bias, the history of Medicine, and he cannot fail to notice that for each of the various systems that have existed, or that now exist, its founder and adhe- rents have claimed that it embraces the whole truth, and that all others are entirely false; and he will at the same time, if he is an intelligent and scrutinizing student of this history, plainly discover that in each there is only a partial comprehension of the entire facts presented in the phenomena of disease and remedies—that in all, both error and truth are to be found. A glance at some of the prevailing theories will illustrate my meaning. Take, for instance, those of the two rival sects, knoAvn as the Rationalists, or Dogmatists, and the Empirics—sects that began to divide the medical world as long ago as the time when the school of Alexandria, in Egypt, first rose into estimation, some three hundred years before the Christian era, and have continued to divide it until the present day. On the side of the Rationalists, it has been con- tended that the observed effects of remedies, or therapeutical agents, constitute no proper guide in their administration; in other Avords, that because a remedy is known to have cured in one case, it is but little evidence that it will cure in another apparently similar; but that Ave should learn the structure and functions of the body, the nature and cause of disease—both the concealed and essential cause as Avell as that which is obvious—the changes produced by what are de- nominated "morbific" agents, and the modus operandi of remedies; and then from the premises thus established we should deduce our system of treatment, and make the application of our remedies. The Empirics, on the contrary, have held that the knowledge which the rationalist thus declares to be requisite is not to be attained; that it is impossible to acquire an insight into the essential nature or causes of disease ; that all that can be done is to observe the XXIV INTRODUCTION. outward phenomena of disease, and by experiment ascertain the effect which our remedies have under observed symptoms; then, if found to be favorable, to give the same remedies when similar symptoms again present themselves. These doctrines have, it is true, been modified somewhat since they were started, but still they have retained sufficient of their original character to trace a broad line of distinction between rationalism and empiricism to this day. Now it would seem that no sensible physician could fail to see that the truth lies between these extremes; and that both are partly true and partly false. It is certainly true that all our knowledge of the human frame, its structure, and condition both in disease and in health, as well as of the action and effects of remedies, must be de- rived from actual observation, and not from any species of reasoning; also that it is essential to observe all the external symptoms of dis- ease, and have reference to them in the exhibition of remedies. But it is equally true that the facts which Ave are enabled thus to learn from observation, are susceptible of being reduced to a methodical system ; and that very important general conclusions may be drawn from them to guide us in practice. Thus Ave reach what has been well termed a " rational empiricism," in which is the truth. Again, take the two theories known under the names Vitalism and Solidism on the one side, and Humoralism on the other. These also had an early origin, the former claiming Pythagoras and the latter Hippocrates for its author, and now, after the lapse of over tAA'o thousand years, are dividing the profession into riAral sects, who are as actively discussing their relative merits as though they were just started. In these sects Ave notice the same tendency I am pointing out, of considering facts too exclusively under one aspect, and bend- ing all observed phenomena to one favorite idea. Those who adhere to the vital theory, tell us that the orderly and harmonious discharge of the functions of the organic being is dependent upon the normal or natural condition of what is termed the vital principle, and that whenever this principle is disturbed or impaired, there is disorder and confusion ; therefore, that all disease is a result of some modifi- cation of vitality—that the only way in Avhich disease can be cured is by restoring the altered vitality to its natural condition,—medi- cines acting upon this vitality, and only upon it, Avhen they act at all. They direct us, therefore, to look for the cause of disease in the living principle, not in the material, visible being. They teach us INTRODUCTION. XXV also that all " morbific" agents, as they are termed—that is, all pri- mary causes of disease—act only upon the solids of the system through the vital principle. The humoralists, on the contrary, in- sist that the cause of disease resides in all cases in the fluids of the system, and that the altered condition of both the solids and the vital principle is related to disease as its effect, not its cause. To illustrate—here is a person who has the small-pox: says the vitalist, the " morbific" agent in this case, the specific virus or poison which has generated the disease, has acted primarily on the vitality of the system, deranging its orderly manifestations, and the conse- quent disorder has fallen directly upon the solids of the body, of which the various organs are composed, thus impairing their func- tions ; then that, as a consequence of impaired function in these organs, the fluids are deteriorated, and the phenomena of small-pox presented. On the other hand, the humoralist says the specific poison has been infused at once into the blood, and changed its nor- mal condition ; the blood is infected and poisoned, and being so poisoned, it becomes the medium of effecting a morbid change in the solids, and thus injuriously impressing the vital force. What is thus declared on the one side and the other to be true of small-pox, it is insisted, is the true explanation of all disease. And in con- formity with these diverse theories, the vitalists, on the one hand, address their remedies in all cases to the modification of the vital principle, and the humoralists, on the other, to the modification of the blood. Can an impartial investigator doubt that these theories are both partly true and partly erroneous ? Can any refinement of reasoning convince a candid mind, when the virus of small-pox is seen to be put into the blood by innoculation, and cutaneous eruption, pustulation and disease folloAV, that the blood is incapable of direct infection, and that the phenomena Ave witness are not the effect of this infection ? A man drinks largely of alcohol: Ave then open a vein, and find this a vent there, mingled with the blood, so copiously, it may be, that Ave can smell it, taste it, and set it on fire. Can we doubt that the blood is poisoned—that the "morbific" cause has here exerted its destruc- tive influence primarily on the "pabulum of life," and that as the hot and poisoned current rolls through the channels of circulation and is poured over the living tissues it becomes a source of the disease—the deadening of the sensibility, the palsying of the muscles, the imbe- XXVI INTRODUCTION. cility of the mind, and the depression of the vitality—which takes place? But there is just as little doubt that it is possible that the vital principle may be affected directly, and that then its disturbance may become a source of disease. There is certainly one class of causes which act thus. I refer to mental affections. An emotion of the mind will send the red blood to the cheek, or drive it back to the heart, leaving the face blanched and pale. So it will stop digestion, stimulate the salivary glands, elevate the pulse, throw the heart into violent pulsations, Avrinkle the skin, turn the hair gray, suspend the circulation, and even terminate life. Here, disturbance of the vital- ity evidently is the cause, not the effect, of the phenomena witnessed. It is possible, therefore, for disease to be engendered by the action of the vital principle on the material system, and for that principle to be reached in other Avays than through fluids and solids. I confess, however, that it is difficult to conceive how any material " morbific" agent can affect this vitality, except through its disturb- ing action upon the material system; or how any general effect can be produced upon this material system except through the fluids. But whether there are material agents that can or cannot act thus, is not important. It is evident that disease may originate from causes acting on either the fluids, the solids, or the vital principle; and that if the physician adopts any of the theories adverted to, believ- ing it to embrace the Avhole truth, and rejects all others, he will have only a partial view of the subject, and be led into embarrassing errors, both of philosophy and practice. I might refer to many other theories and systems, in Avhich the same features are apparent. The hydropathist has his theory, upon which water is the only proper remedial agent for all diseases; the "botanical physician" finds virtue only in vegetable medicines, and rejects absolutely all minerals, under whatever circumstances. One bleeds for every ailment; another never bleeds. One rejects all med- icines but cathartics; another as rigidly rejects all cathartics. One cures all diseases by electricity; another holds electricity to be Avorth- less in any case. And so on to the end of the chapter. But without noticing more particularly these various medical eccentricities, which I have noticed at all only to illustrate the peculiarity to which I have adverted, it must, I think, be clear, that this disposition to make a hobby of some favorite theory, and discard all others, stands very much in the way of erecting Medicine into such a science as will INTRODUCTION. XXV11 challenge the confidence of both physicians and their patients, and justify that confidence by a greater certainty of success. I shall not, of course, be understood as decrying the importance of true science, and the value of correct theories in Medicine. No man can be a safe and reliable physician, who has not an accurate knowl- edge of the human frame, in all its parts and all its functions, of all the phenomena of health and disease, as Avell as of the nature and action of remedies. The wider his range of information, and the larger his acquaintance with the whole circle of sciences, the better. So also the physician should be Avell established in " sound doctrine." He must not be a mere empiric; indeed he cannot be. It is impos- sible designedly to treat disease at all Avithout a theory. No physi- cian administers even a dose of castor-oil without having his theory of its action and of the disease he is prescribing for, upon which he determines that this remedy is the proper one. We must have our theories, and in framing them reason is called into requisition, to analyze, arrange, classify, and generalize our facts, and deduce our conclusions. The physician must in this respect be a rationalist. Indeed, Medicine presents a field in Avhich there is scope for the am- plest scholarship, the most scrutinizing observation, and the highest efforts of reason. The physician cannot know too much; and the ignorant pretender, AA'hether shielded by a diploma and having the prestige of " regularity" or not, who rashly tampers Avith life and health in the use of medical remedies, cannot be too severely con- demned or too carefully shunned. But Avhat Ave may and should demand is, that the true design of Medicine shall be kept constantly in view, and that all science and scholarship, all facts and theories, shall be subordinated to this design ; that they shall not be made the basis of a claim by the physician to honor and position, only so far as they are made subservient to the prevention and cure of disease. I may be permitted to advert to one other hindrance to the prog- ress of the "Art of Healing" and source of failure to the physician—it is the fostering of an unteachable spirit. There are feAv of us who are not willing to learn, if information comes to us from the right quarter. But there are many, very many, who turn proudly away from all sources of information that haAre not the sanction of some great name. They scorn to be taught by the humble and obscure. They seem to feel it to be a disgrace to confess that any but the learned can teach them. Such physicians may witness cures that are XXAT11 INTRODUCTION. really remarkable triumphs of Medicine, and that are entirely impos- sible to them; but if accomplished by the agency of some person who has not a general medical education, and has not secured a high position, they pass by such cures Avith contemptuous indifference, exhibit no desire to learn by what means they have been effected, or perhaps deny utterly the most thoroughly authenticated facts. For example, a patient of one of this class has a cancer, and applies to him for relief. He recommends that it be let entirely alone, to take its own course, and that the sufferer submit patiently to his fate, confessing that he can do nothing for it but to cut it out, and can do this only as a temporary check to the progress of the dreaded disease which he is sure must sooner or later destroy life. The pa- tient lets it alone as advised, until the dissolving tissues begin their purulent discharge, and the poisonous fangs of the disease are seen to be eating their way to a vital part. Just now there appears before him a man who tells him he can "cure cancer." He is, perhaps, a plain, unlettered person, making no pretension to medical skill, claiming no professional attainments or position. He cannot cure a fever nor set a broken leg, but he can cure a cancer. The physician curls his lip, and, denouncing " quackery," refuses even to see him. But as a forlorn hope, the poor patient permits him to apply his remedies and make a trial. Suppose he succeeds, the tumor being remoAred, the wound healed, and the patient restored to health. Now here is a plain, positive cure of a disease which the physician had pronounced incurable, and for which he kneAV no remedy. He may be infinitely the superior of the " quack" in every other respect, and capable of teaching him his alphabet in all other subjects; in the matter of curing cancer, however, the " quack" has most important information, Avhich the physician has not. What does common sense dictate that the physician should do ? Obviously, that he should seek out this " cancer doctor," and learn, if possible, Avhat is the agency by Avhich he conquers this disease. Then, having learned from him all he knows of the matter, apply to the subject the poAV- ers of his own better informed and more disciplined mind, and place cancer curing on a " scientific" basis. If, instead of this, he turns away in contempt of the " ignorant pretender," perhaps stoutly deny- ing the fact of cure altogether, does he not do himself and the cause of Medicine a real injury? Would he treat thus the announcement that cancer had been cured, if issuing from some high place in the INTRODUCTION. xxix profession? But is not a fact a fact, irrespective of the place where we find it ? There are valuable truths that have never yet been printed in books nor uttered from the professor's chair. It is the part of Avisdom to gather them up, appropriate them, systematize them, and use them; not to reject them, hoAvever humble the source whence they spring. I have put a strong case, but the point it illus- trates is the clearer because it is so. The principle has a Avide range; and I think I am not incorrect in saying, that the cause of Medicine loses much from pride and an unteachable spirit among physicians. The reader will not, of course, understand me as countenancing " quackery" and " ignorant pretension" in Medicine. On the con- trary, I am advocating the rescue of Medicine from such hands. But this cannot be done by preaching against and denouncing them. We can do it only by curing the diseases of the people, and thus con- vincing our patients that they are safest in our hands. If " quacks" cure Avhere Ave fail, the sick will go to them, and Ave cannot prevent it; and, let me ask, Avhy should avc, if they are more successful than we ? In truth, we have no right to complain for ourselves that the sick abandon us and resort to charlatans. We have always the first chance. No patient leaves his physician and goes outside of the " regular practice" for help, until his physician has tried and failed to cure him, or unless that physician's failure has been witnessed in some other similar case. The sick neArer dismiss their doctor with- out reluctance and regret. No class have a stronger hold upon the confidence and regard of those for Avhom they labor, than skilful and successful physicians. " Quacks" thrive upon our failures—Avhen they thrive at all. The Avay to put them doAvn is to cure our pa- tients ; and this is the only Avay. But if we would do so more cer- tainly and uniformly than "irregular" practitioners, Ave must not permit ourselves to be ignorant of any true curative remedies of which they are in possession. It is clearly the duty, as it is the true policy of the physician, to candidly investigate, as far as he can, all systems, theories, and rem- edies, while he should not permit himself to be the slave of any. He should thoroughly acquaint himself with every branch of science re- lated to medicine and surgery, and Avith all medicinal agencies and all modes of treatment that are proposed, in all quarters, for the cure of disease. Then, Avith a bold independence, he should fearlessly adopt and employ whatever his enlightened judgment determines is XXX INTRODUCTION. most certain to cure his patients, and preserve them in health; and do this, AvhateA-er school or sect, or man, or body of men, may con- demn or approve the course he pursues. If this were universally done. Ave should find less skepticism among physicians, and more confidence among the people. And here I may be permitted to add, Avhat the reader will, most probably, have inferred, that I am not myself embarrassed by any of the unbelief to which I have referred. I am no skeptic ; on the con- trary, I might more justly be charged with being an enthusiast in Medicine. I have certainly the most unbounded confidence in the curative poAver of medicinal remedies over the diseases which afflict our race. So, also, I am positive that the phenomena of animal life, of health, and of disease, Avith the principles which should guide us in the employment of hygienic and remedial agencies, may be syste- matized and comprehended in a scientific basis, so as to reduce the practice of Medicine to very much of the certainty Avhich belongs to Avhat are knoAvn as the exact sciences. This is not to say that all disease can, in all conditions, be cured. The human frame may, of course, be brought under the influence of destructive agencies, which must necessarily prove fatal to life, and against which no hu- man art or skill can avail. But it is to say that most of the diseases ordinarily considered incurable, are not so. There are few of our maladies for which there are not remedies; and we may obtain such a knowledge of these remedies, as well as of the causes of disease, and the manner in Avhich they act, as will give certainty, precision, and success to our practice. In the preparation of this volume, I have been guided by the prin- ciples which lie at the basis of the system of practice pursued by me, and which are indicated in the preceding pages. AcknoAvledging allegiance to no special school of Medicine, and permitting myself to be fettered by no arbitrary decrees of self-constituted professional censors, I have aimed in my practice to cure the sick by the most di- rect means within my power, not stopping to inquire whether the remedies employed Avere sanctioned or condemned by " medical au- thorities." The result of observations thus conducted, and of expe- rience thus acquired, I have endeavored faithfully to record. I have not, of course, disregarded the labors of those who have preceded me. To avoid becoming imitators, it is not necessary that we be ignorant of those held up as models. Availing myself of all possible INTRODUCTION. XXXI help, whether found in science, in the recorded experience and theo- ries of others, or in the daily events of life, I have endeavored to de- duce from all the simple truth, and to reach, by the most direct road, the great object of Medicine—the cure of disease and the preserva- tion of health. It will be observed that in this work I have given special promi- nence to the lungs—the diseases to which they are liable, and the treatment and remedies by which these diseases may be both avoided and cured. This I have done for several reasons, among which I may mention: (1.) The great mortality resulting from the various prevailing affections of tlie lungs.—Pulmonary consumption, as everybody knows, is the monster malady of Christendom. While it is more prevalent and fatal in some climates than others, it confines its rav- ages to none. It is circumscribed within no geographical limits, and no class or race escapes it. It sweeps to the grave at least one-sixth of all who die. A disease so wide-spread and so destructive of life, may very well claim a prominent position in a "Treatise upon Health, its Aids and Hindrances." Then, when we add to consump- tion the other affections to Avhich the respiratory organs are subject, asthma, bronchitis, inflammation, congestion, croup, etc., we see that they must have the first place in such a treatise. (2.) Tlie great importance of the lungs in the economy of animal life.—We all know that if our breath is stopped, even for a feAV sec- onds, we die; and yet few are aware how absolutely indispensable to robust, vigorous health it is that we have large, sound lungs. We have been taught that the office of these organs is to purify the blood and supply heat to the system; remove carbonic acid from it, and convey to it the oxygen of the air. But it has been generally overlooked that the most important office of the lungs is to supply, by means of the air inhaled, the force Avhich keeps the machinery of our bodies in motion. This is why we die so soon Avhen breathing is suspended. It is not simply because the carbon of the blood is not removed, nor because the heat of the system is abated; but for the reason that the supply of force, momentarily essential to every movement and function of the body, is withdrawn. Small, imper- fect lungs, and the consequent use of an inadequate amount of air, are liable to induce consumption. But this is not the only evil to be apprehended: though consumption is escaped, there is sure to XXX11 INTRODUCTION. be feebleness and disease of some kind. It is absolutely impossible to have vigor and strength and robust health, witli small or im- paired lungs. (3.) The great liability there is that the lungs will take on disease from disorders of the other organs.—There is scarcely an aberration from health occurring anywhere in the system that may not lay the foundation of disease in the lungs. Consumption is not an affection springing from one, and only one, specific cause. It may be said to be the great centre to which all other diseases tend. It may result as the sequela or consequence of almost any other disease to Avhich the human frame is subject. The lungs are in relation at once Avith all the internal mechanism of the body and the external world, con- stituting the great theatre of "exchange" between the tAvo, and liable therefore to hurtful influences from both. In this view also, then, they demand the first consideration in a treatise upon health. (4.) The prevailing belief that pulmonary consumption is incu- rable.—Now, inasmuch as I know this to be a false doctrine, and being so, is most disastrous in its influence upon all efforts that are made to introduce a correct system of treatment for consumption and to establish public confidence in such a treatment, I have deemed it proper to devote considerable space to an exposition of the causes and nature of phthisis, and the remedial agencies found by me effect- ive in its cure; and also, by the presentation of undeniable facts, to refute the fatal doctrine of its incurability. (5.) The usefulness of the plan adopted.—If the foregoing remarks are correct, it is clear that in no Avay can we contribute more directly and efficiently to the prevention of the prevalent chronic diseases and the promotion of general health, than by directing special attention to the lungs. So far as correct information in regard to the true uses of the lungs, and the causes of the diseases to Avhich they are sub- ject, is diffused, and the mode by AA'hich they may be made large and strong, if healthy, and cured if diseased, is made known, most cer- tainly great practical good is accomplished. Not a little of the darkness AA'hich enveloped this a\ hole subject Avhen the first edition of my " Six Lectures" was issued, has been dissipated. Still, much of error in theory and mistaken practice remain. The truth cannot be exhibited too clearly nor too frequently. It is especiallv import- ant that it should be universally known that nearly every disease to which the human frame or any of its parts is liable, may lay the INTRODUCTION. XXX111 foundation of lung disease in some form. So, too, feeble or disor- dered lungs may and often do become the source of a vast brood of chronic maladies, that apparently have no connection Avith the lungs. Indeed, a person with a broad chest and large, sound lungs, habitu- ated to deep, copious breathing, and Avho never permits himself to breathe a stifled, vitiated air, can hardly be made sick, except by some great violence. He will resist completely all the ordinary morbific influences by which he may be surrounded; he may walk scathless through the pestilence, and stand unharmed in the midst of the most fatal contagions. We sometimes find men of this descrip- tion Avho seem to bear a charmed life. Their tenacity of life and health is wonderful. The secret is to be found in the perfect organ- ization and condition of their respiratory apparatus. They are sub- ject to the action of all the causes of disease to which other men are; but from the greater comparative size and perfection of this appa- ratus, they are endowed with a higher vitality and greater functional activity—they stand on a more elevated plane of animal life, and have such a power of resistance against any agent or influence which in- terferes with that life, that they are unharmed where thousands, with smaller and less perfect lungs, fall and die. Without enumerating other reasons for the plan adopted in pre- senting the subjects embraced in this treatise, I will say that I have reversed somewhat the order usually pursued in treating of the lungs themselves. I have first explained the method by which the condi- tion of the lungs may be ascertained. It is of the utmost importance that this should be more generally known and practised. One of the great reasons why consumption is so fatal, is because there is, in almost every case, positive and extensive disorganization of the lungs before the patient is aware that they are diseased at all. In its ear- lier stages, consumption is as curable as any other serious malady; and if when there is experienced any disturbance of the lungs, or of the general health, there should always be made at once an accurate examination of their condition, and the first traces of tuberculatum, or catarrh, or humor, or ulceration, or any other form of disease, should be, as they may be, detected, and then promptly treated, tens of thousands of precious lives might be saved that are now sa- crificed. I have thought it best, therefore, as I say, to place first before tlie reader the information necessary to enable him to knoAv at all times the condition in Avhich his lungs are; and I would rec- 3 XXXIV INTRODUCTION. ommend him not to pass over this portion of the book, thinking it of no consequence to him. After describing the best method of examining the condition of the lungs, and the external signs of disease that maybe presented, I have arranged, under separate heads, the various diseases themselves to which the organs of respiration are subject. Several varieties oi pulmonary consumption are noticed, to Avhich names are given indi- cating in each the origin or proximate cause of the affection. This plan has the advantage of bringing into vieAv the principal number of chronic diseases which afflict us, and at the same time establishing the fact that there are few that may not become the source of con- sumption of the lungs. The views presented on this subject are commended to the particular attention of the reader. Then follows a consideration of several of the prevalent chronic disorders by themselves, otherwise than as related to any pulmonary affection, with such reflections and suggestions as I have believed most adapt- ed to aid the sick in recovering, and those free from disease in pre- serving, that great treasure—health. In conclusion, I have only to add that it is my sincere desire that this treatise—Avhich I Avish Avas more perfect, and more adequately answered to the conception I have in my own mind of what such a work should be—may be useful to my fellow-men; that it may do something towards alleviating their diseases and sufferings, promo- ting their health and happiness, and prolonging their fives. While my own life and health continue, my seivices are at all times at their command, either to give such explanations as I may be able to give of any matter embraced in this book, where I have not made myself understood, and to aid the invalid by counsel and remedies; and, so far as it is in my power, to point out, to both the invalid Avho would escape from his suffering, and to him who rejoicing in the possession of vigor and strength Avould retain them, the pleasant road in which health and length of days may be found. HEALTH: ITS AIDS AND HINDRANCES. CHAPTER I. EXAMINATION OF THE CHEST. METHODS OF ASCERTAINING THE CONDITION OP THE LUNGS. As the lungs are the very citadel of animal life, through whose agency are derived the power, the vigor, the vitality of the whole body and all its parts, determining very much the state of the gen- eral health; and as disease of these organs is so common and so fatal, it is exceedingly important that the physician should possess some mode of ascertaining at any time, with the utmost possible cer- tainty, their true state; whether they are diseased or not; if dis- eased, what the precise nature of the disorder is,—its progress and the extent of its ravages; whether both lungs are affected, or only one; whether one or more of their lobes is diseased; the exact loca- tion of the disorder:—in a word, of ascertaining the true pathological condition of the lungs, throat, and air-passages. A knowledge of such a mode is also important to others besides physicians; as those who possess it are able to determine for themselves whether or not disease exists in the lungs of their friends, when it is suspected. If the correct manner of examining the chest were generally known, thousands might be saved who now die of consumption, which creeps stealthily upon its victim, and perhaps nearly destroys the lungs be- fore it is known to exist. The physician, it is true, may learn much concerning the condition of the lungs from the history of any. case presented to him, from the duration of the disease, the appearance of the patient, the pres- ence or absence of cough, bleeding, expectoration, &c.; and also 10 HEALTH : ITS AIDS AND HINDRANCES. from the manner of breathing, as the patient sits on his chair, or reclines on his couch,—whether or not it is difficult, short, or hur- ried. But although these circumstances are all very valuable in determining the condition of the lungs, and may thoroughly justify the inference, in many cases, that the lungs are diseased, yet they cannot absolutely establish the fact. The only mode of reaching certainty here, is by a careful examination of the chest itself, through the sounds given out by the lungs in breathing. I propose here to give some directions for making this examina- tion. They Avill be mainly addressed to young physicians, not yet acquainted Avith the'best mode of examining the chest, and also to the general reader. The physician qualified by experience to con- duct this examination, of course needs no instruction. Allow me to observe that the air, in passing into the lungs through the bronchial tubes and the smaller air-passages, to and from the air-cells, makes a peculiar sound; and this sound differs even in perfectly healthy subjects, according to their age. In the lungs of a child it differs from those of the man, and in the young and middle- aged from the aged. Now, the first step to take in arriving at a correct knowledge of Auscultation—as the examination of the lungs, by means of these sounds, is called—is to obtain a clear and perfect knowledge of the sounds emitted, in respiration, by healthy lungs. It is a common and almost universal error of those teaching medical treatment, or ibrming the medical mind, that they, in nearly all cases, commence at the point of disease, when they should begin at the point of health. No person can be truly and thoroughly prepared to inves- tigate disease, until he is perfectly acquainted with the phenomena of health in all its circumstances and conditions. From this stand- point alone can he see disease in its true nature, as a deviation from health. Almost all medical students are introduced to a study of the human system first, under abnormal conditions; not in the natural state, which is that of health, but in a diseased state, which is an unnatural one. The diseased chest, for instance, is examined before the true phenomena of the healthy chest is known- and while they see many varieties of disease, each differing hi appear- ance from the others, they all differ from health. As the first step, therefore, I would advise the student of medi- cine, or any person wishing to acquire the art of examining the HEALTH : ITS AIDS AND HINDRANCES. 11 chest, to learn the exact sounds produced from the lungs of healthy persons. Let the student and the young physician commence by examining the chests of healthy persons, both male and female, and of all ages; and let him do it repeatedly, until he has examined a great number. Let him be in the habit of examining the chests of all those who consult him for any disease, as far as the compla- cency of the patient will permit. He will find that even a few weeks' practice will give him a very clear perception of all the sounds pro- ceeding from healthy lungs, and thus he will be qualified to detect any deviation from health. Another cause of obscurity and want of success in practising aus- cultation, arises from the terms employed to designate unhealthy sounds. Laennec, the great French physician, who first discovered or noticed the sounds produced from diseased lungs, employed a set of terms to designate these sounds, derived from the French, Latin, and Greek languages, and they have been adopted by all subsequent English Avriters. I do not know of one English author who employs English words alone to designate these sounds; and while the foreign words fall pleasantly upon the ear of those familiar with the languages from which they are derived, they convey but little or no meaning to others. In the following description I shall avoid adopting for- eign terms, and give the best idea I can of these sounds through the medium of English words. MODES EMPLOYED TO ASCERTAIN THE CONDITION OP THE LUNGS BY THEIR SOUNDS. Physicians, in examining the chest, have adopted two methods to determine by sound the condition of the lungs. The first is called Percussion, and the second is called Auscultation. Percussion consists in pounding upon the chest, and noting the character of the sounds produced by the blows. It has been ex- tensively adopted, and is at this time practised by some eminent physicians both in Europe and in this country. For my own part, however, I look upon percussion as being a very uncertain method of determining the state of the lungs; for in many subjects the walls of the chest may be loaded with fat, or there may be a relaxed condition of the muscular coating of the chest. In these cases, percussion necessarily gives a dull sound, when the lungs be- 12 HEALTH : ITS AIDS AND HINDRANCES. neath may be perfectly free from disease. So, also, blows on the thick muscles of the back, on the scapuhe or shoulder-blades, and m the mammary regions of most females, give but dull sounds, independent of the condition of the lungs. Besides, there are various conditions of these organs, in Avhich extreme dulness of sound, on percussion, will be perceived, indicating disease of some kind, but in which it can- not be determined by this mode whether the lungs are tuberculated, hepatized, or highly congested, as in all these conditions they emit a dull sound when under percussion. Effusion and collections of pus may be present, and give dulness to the sounds of the chest, and yet percussion alone will not reveal these different states. This practice has, moreover, the objection that it is unpleasant, and sometimes even painful to the patient. It is but lately that I was consulted by a young gentleman recently from Europe, who had been examined by an eminent and world-renowned professor in Vienna, by whom the condition of the lungs is determined principally, if not entirely, by percussion. Mal- let in hand, he passes hours each day in examinations of the chest. But in this case he did not, so far as he declared it, reveal the true state of the patient's lungs by his percussion. I feel confident that, in very many instances, percussion alone will lead to very serious mistakes, even when employed by the most skilful, erudite, and experienced practitioners. Consequently, I never rely upon this mode of examining the chest. All the advantages it possesses are, with none of its objections, found in auscultation. I do not consider it worthy of any confidence compared with the latter mode of examination. If there are those whose experience and judg- ment lead them to recommend percussion as valuable and safe, their experience and judgment differ from my own. Auscultation.—This is a mode of determining the condition of the lungs by then sounds, directed immediately upon the ear. It is the true and proper mode of examining the chest, to obtain a clear, prac- tical, and correct knowledge of all the sounds produced in the chest during respiration, at every age of the patient. If, in the first place you accurately learn, by this mode of examination, the sounds made by the lungs when in health, then those indicating disease will be most promptly detected by the ear thus cultivated. Auscultation is practised in two modes; one is called immediate and the other mediate auscultation. The first is placing the ear di- HEALTH : ITS AIDS AND HINDRANCES. 13 rectly in contact with the chest itself; and the other is through the medium of an instrument intended to be a sort of ear-trumpet, and is called the stethoscope. This instrument was invented by Laennec, but has received a number of modifications since its invention. It has been very gener- ally and extensively used by physicians, and especially by those who are not acquainted with the sounds characteristic of either healthy or unhealthy lungs. It has been employed by thousands of physi- cians who have had no knowledge on the subject of what sounds they were to expect as indicating either health or disease. Indeed, some simple-minded physicians would seem to suppose that there is a property in the instrument itself—some mysterious power—by which it gives to the physician exact information of the true state of the lungs. But if it fails in this, there is one thing that it never fails to do, and that is to profoundly impress the patient and the beholder with the idea that this instrument Avill tell all about what is the matter with their lungs. If the physician, after applying this instru- ment to the chest, says that the lungs are diseased, it cannot for one moment be doubted that this pulmonary index has pointed out the malady as exactly as the hands of a clock indicate the hour of the day. For the purpose of impressing patients and their friends with the profound knowledge of the physician, the stethoscope has been employed in thousands and tens of thousands of cases, I have no doubt. The stethoscope may in some hands be convenient, and perhaps useful; but, for myself, I have always looked upon it, as ordinarily used, as embodying a great deal of quackery, as liable to lead to wrong conclusions, and as in no Avay enlarging or concentrating the sounds, so as to be in itself of any practical benefit. I consider that a good ear can never derive any assistance from an ear-trumpet in ex- ploring the lungs, and does not require or call for it. I therefore pre- fer to apply the ear itself directly to the walls of the chest; and in this view I am fully sustained by some of the best practitioners in Europe and in this country. Many of those who commenced practice with the use of the stethoscope, have long since laid it aside as useless and cumbersome. Their extensive practice, their experience and repu- tation, having given them celebrity and the confidence of the public, they have foimd themselves strong enough to discard all show and imposition of consequence derived from the use of this instrument. 14 HEALTH : ITS AIDS AND HINDRANCES, •They have found, too, that when the ear is applied directly to the chest, they are far less liable to be mistaken, and do not alarm the patient. Besides, the physician usually has his ears with him. He is not obliged, from any forgetfulness, therefore, to return home for his examining instrument, before his anxious patient can have his doubtful fate determined. MANNER OP EXAMINING THE CHEST. Placing the patient in a chair, uncover the chest in front, and lay it bare nearly to the nipples, and with slight covering over the other parts. Now ask the patient to inhale a long, full breath, so as slowly, fully, and deeply to fill and expand the whole lungs. Then let him exhale or breathe out the air, and fill the chest again in the same way. Two or three repetitions in this way will clearly inform you whether the chest rises fully and equally in all parts ; whether the Avails of the chest are flexible or rigid; whether there are any depressions in any part; and, if these depressions exist, whether they are slight or extensive. This will give you a clear idea of the state of the chest and lungs, as far as can be determined by the eye. Upon parts that are covered, you can place the hand, and notice if they rise equally, and are flexible and free. Should you observe that, in the exercise of breathing, one lung, or the walls covermg one lung, rises much more than the other ; or should you observe depressions, that portions of the ribs do not rise at all, and that the intercostal muscles and parts occupying the space be- tween the ribs, do not rise, then you have great reason to suspect disease at that spot. Or if you should notice a portion of the chest depressed, and the ribs almost immovable on inhaling the air ; and if, at the same time, you observe one circumscribed spot rise freely out of this extensive depression, you have great reason to suspect a large cavity there. At the same time you will notice whether the chest is emaciated, flat, small, thin, or stooping; Avhether the shoul- ders fall gracefully back from the chest, or whether they come for- ward, narrowing the chest in front. All these conditions the eye will readily embrace, and the inquiring mind will notice them as highly important in diagnosis of disease, and also in determining the probability of its cure; for we should remember that small lungs cannot bear disease to the extent that large lungs may. We can HEALTH : ITS AIDS AND HINDRANCES. 15 notice, also, all the advantages to the possessor from having a large, round, well-developed chest; and the disadvantages arising from tlu narrow, small, stooping, contracted chest. A few weeks of observa- tion aatII give to the medical student and inquirer the most exalted appreciation of a fine, noble bust, and fully confirm in his own mind what I have said in praise of its value. By what I have said, and by a thousand suggestions of his own, he will always be able to esti- mate these differences in the constitution and formation of the chest. Having completed the examination by the eye and touch, as above indicated, we are prepared to proceed to explore the lungs by auscul- tation. While the patient is still in the sitting posture, with the chest uncovered, apply the ear to the upper part of the right side of the chest in front, and follow the line of sound to the bottom of the lung. Then pass the ear over the left lung in the same way, noting carefully the normal and abnormal sounds, as indicating health or disease. Now request the patient to stand upon his feet, and, placing the ear near to the arm-pit, carry it down to the base of the lung in that region. Do this on both sides. Then place the ear upon the base of the throat, and notice the sound in the larynx and windpipe. Now apply the ear to the top of the posterior part of the chest—first on one side of the spine, then on the other, and follow the line of sound, by repeated observation, to the base of the lung along the back. This done, place the ear upon the shoulder- blades, and receive the sound directly through them. In a great many instances the sound comes clearly, and apparently unobstructed, through the scapula or shoulder-blade. During this examination have the patient breathe forcibly, cough, and utter vocal sounds, in order to thoroughly explore every part. In all cases, while examin- ing the front lobe of the left lung, apply the ear over the heart, and determine as nearly as possible its true condition by the sound made as the blood rushes in and out of it. The examination is now complete. The physician should make a record in all cases. SOUNDS REVEALED TO THE EAR, UPON ITS APPLICATION TO THE CHEST, BY RESPIRATION, WHEN THE LUNGS ARE IN A STATE OF HEALTH. It is exceedingly difficult to describe sounds by words. The notes of the octave may be perfectly familiar to the ear, and yet who can 16 health: its aids and hindrances. describe them, so as to be in any degree intelligible to those unac- quainted with musical sounds. I will, however, make the attempt to convey an idea of the peculiar sounds made by the lungs in respira- tion. But in doing so I must ask, in.advance, the utmost indul- gence, both of the professional and general reader; for probably almost any experienced person could as well describe these sounds as myself. SOUNDS EMITTED WHILE INHALING THE AIR INTO HEALTHY LUNGS. In lungs which are healthy, and have never been diseased, on in- spiration the air rushes into them in a full, round, unbroken volume —giving to the ear the impression of quantity, compression, and ex- pansion ; and the sound produced has very much the character of that made by air passing through the thick foliage of a tree, only softer, and of course reduced in quantity. It is a species of roar, but gentle and diminished, so that it can only be heard by placing the ear directly on the chest. It is a smooth bass sound—smoother and softer in females than males. It also differs very much in in- dividuals of both sexes. When the life and vitality of the chest are great, and the lungs are endowed with full strength, the sound be- comes much more bass, amounting almost to hoarseness; and if the lungs are very large and strong, while the chest is fragile and its walls thin, so bass or hoarse is the sound that we might almost sus- pect thickening of the internal membrane, unless other circum- stances were noted. The term murmur, ordinarily used, may be more graceful than that of roar/ but I think the latter word con- veys a more correct idea, and is more descriptive of the true sound than any other English word. This description gives as clear an idea of the sound made by healthy lungs in respiration, as I can convey by words. It possesses quantity, volume, force, and smoothness ; and it is uninterrupted, un- broken, and equal over the whole lungs. A fine life in the chest is indicated by the volume, quantity, and smoothness of this sound • and they will be increased or diminished, according to the increased or diminished size, vitality, and flexibility of the chest. In no state of disease whatever do the lungs present the same tone or volume of sound as when the whole system is in a state of health, notwith- standing the assertion of some hasty writers to the contrary. It health: its aids and hindrances. 17 should be remembered that what has here been said, refers to the sound made by inspiring the air. Allow me to remark, that all sounds from respiration, of whateA'er description, kind, or variety, and however different in intonation, arise from resistance of the partially collapsed lung to the ingress of air, and the friction of the air against the walls of the air-tubes and cells. On applying the ear to the chest, we perceive the air come rushing in. It rushes through the larynx, trachea, and bronchi, un- folding and expanding the lungs, until it fills the most minute air- cells, when the sound is a fine, smooth, gentle, and distinct roar. As I have before remarked, it is a bass, muffled tone, in the full-grown. healthy man. It is less so in females. In children the sound is full, distinct, and clear, owing to their activity and health, but less bass than in adults. In old age it is comparatively feeble and dull. Thus it differs in quantity, volume, and intensity, or strength, at different ages. When in health, the larynx, the trachea, the bronchial tubes, and air-cells, in all their ramifications and extremest points, are filled with a measure of unbroken sound. A few Aveeks of practice by the ear, will give to any investigating mind a clear, full, and familiar acquaintance Avith the sounds pro- duced by inspiring the air into healthy lungs, of Avhatever age or strength the subject may be. I would particularly advise the learner not to trust to any description; but to educate the ear to a clear per- ception of the healthy sounds, by exploring the chests of healthy persons, of both sexes and of all ages. SOUNDS PRODUCED BY EXPIRATION IN HEALTHY LUNGS. After the air has filled the lungs, and the inspiration is complete, it rests an instant, and then commences its return; and as it neces- sarily meets little resistance*, the sounds produced by its return are the same in character as those made by respiration, but vastly dimin- ished in quantity and force; so that in some persons the expiratory murmur is hardly heard at all. In this free expiration of the air, and the consequent absence of sound, is found important evidence that the lungs are in health. 2 18 HEALTH : ITS AIDS AND HINDRANCES. SOUNDS INDICATING DISEASE. I beg you to bear in mind that sound can never be produced un- less the air meets with resistance. There are several primitive sounds that take place in diseased lungs. One of these sounds, often recognized, may be counterfeited by throwing a little fine salt upon a blazing fire, by which a kind of crackling is produced, known to chemists under the term crepitation. It may be so fine as to indicate to the ear that it proceeds from a multitude of small points; or it may be coarser, and seem to pro- ceed from a broader base, and from fewer points. This sound, as I have said, is called crepitus, or crepitation. It is produced in the lungs by the bursting of minute air-bubbles in the air-cells and tubes. It occurs where there has been, from any cause, an increase of the secre- tion from the membrane lining these tubes and cells. When the air is brought into forcible contact with this secretion, the fluid is agi- tated, and bubbles are formed and exploded. The bubbles are ne- cessarily very minute; and the bursting of great numbers of them causes a crackling sound. This crepitation, or crackling, during respi- ration, indicates increased secretion in the lungs, but does not dis- ■elose its cause. There is a sound, frequently heard in diseased lungs, which may be imitated by sucking the tongue upon the roof of the mouth, and then withdrawing it suddenly, by which a humid clapping sound is produced, and this will be more or less extensive as the surface of the tongue is more or less extensively applied to the roof of the mouth. This sound I call clapping. Another sound, which is often heard, may be reproduced very nearly by rapidly beating thick fluid Avith a spoon, or bloAving into it so as to agitate it; or it is like thai? of gurgling in the throat. This is a true primitive sound, frequently heard in diseased lungs, and is called gurgling. There is a sound which comes under our notice in the lungs, that is similar in its character to air rushing into a closed, narrow- mouthed, empty vessel. It may be imitated by blowing air into a ATal or flask—bioAving it down upon one side of the aperture, and al- lowing it to rush out upon the opposite side. This is called the cavern- ous sound. In some cases this cavernous respiration, Avhich indicates HEALTH : ITS AIDS AND HINDRANCES. 19 the existence of a cavity in the lungs, becomes peculiarly clear and ringing. It occurs when the cavity is very large, with thin and elastic walls. This modification of the cavernous sound is termed by physi- cians amphoric respiration, derived from the Latin word amphora, signifying a flask, or hollow vessel. Another sound heard at times in diseased lungs, may be imitated by taking an ordinary oil-lamp, partly filled with oil, and shaking it gently. The oil will break from side to side in the lamp, and give you a very correct idea of this pulmonary sound. I take the hberty to call it the bottledfluid sound. There is still another set of sounds heard in diseased lungs, often noticed, that are in their character somewhat musical. These sounds are like the flute, the cooing of birds, or an exceedingly gentle screaming. They have various intonations, and differ in quantity, yet all have the same general characteristics, and all proceed from the same cause, and that is, obstructions in the air-tubes,—the lining membranes become thickened and roughened, and thus the passages partially closed; or a thick secretion takes place in them, adhering to the internal surface, and the air rushes through with a whistling sound. These sounds are dry, and convey no liquid impression to the ear. There is another class of sounds that are extremely analogous to the Avhistling, but which do not break into musical notes,—the obstructions that produce them not being so sharp, but are more extensive. They are humid in their character, and are called wheezing ; they indicate extensive thickening of the air-passages, ac- companied at the same time Avith more or less humid secretion. In the whistling sound it would seem that the air-pipe is entirely encircled with a sharp thickening. But in wheezing, the obstruction does not, to so great an extent, fill the air-pipe, and extends over a greater surface. The sound produced is not therefore that of shrill musical notes, but only a deep hoarseness, broken by the presence of a humid mucous secretion, in slight quantity, adherent to the sides of the tube. In the absence of these mucous secretions, this sound becomes deeply hoarse. When very much increased, we have a true wheezing sound, which is a grade of sound between hoarseness and gurgling. What is commonly called hoarseness, is another sound. This re- lates to the voice. It is of so frequent occurrence, and so familiar to 20 HEALTH : ITS AIDS AND HINDRANCES. all, that I need not describe it. It is a peculiar modification of the voice, caused in the larynx by a thickening of what is called the vocal chord, by whose vibrations, as the air passes over it, vocal sound is produced. When thus thickened and relaxed, this chord vibrates less freely, and makes, in consequence, a less pure and perfect sound. In the early stages of bronchitis and asthmatic phthisis, in asthma and catarrhal phthisis, the whistling and wheezing sounds pass up and down, along, and in the course of the air-pipes, to and from the throat, at the parts affected. But in tubercular consumption, during tuberculous softenings and in cases of abscesses, the sounds indica- ting disease often cross the chest, occupy a much wider space, and you can follow them across the chest. They exist over extensive surfaces, laterally in the chest, especially in the early stages of the disease, instead of extending down the lungs in narrow lines, as when the air-tubes only are affected. When the trachea or windpipe only is affected, of course the sound will be no wider than the tube itself. There is still another sound produced in the chest, which I have often noticed as occurring after bleeding, and sometimes before bleeding has taken place. It is a species of ticking or clicking, some- times distinctly audible to the patient, Avhen it is extremely annoy- ing. Hour after hour, like a death-watch, it sounds in his ear, pre- venting sleep and rest, and is in all respects disagreeable and wearying. Its seat is near the top of the lungs. I have noticed it oftener in the top of the right lung than the left. SOUNDS IN BRONCHITIS. The sounds in breathing which indicate this disease, are first simply a huskiness of the voice. Upon applying the ear to the chest, the sound seems thickened. As the disease advances, we find that the volume of air has lost its smoothness; that it is broken, as if passing over a roughened surface, producing more or less hoarseness, as the disease is more or less violent and extensive. The membrane lining the tube has become thickened, and the effect of this thicken- ing is to render these otherwise smooth surfaces, rough. In propor- tion to this roughness on the surface, will the impression of roughness or hoarseness be produced in the current of air passing over the sur- HEALTH : ITS AIDS AND HINDRANCES. 21 face. As the disease still advances, and the humid secretions in- crease, the obstructions in the air-passages, produced by the thicken- ing of the membrane and the secretions adhering to it, increase in quantity, there will then be produced a gurgling or rattling sound. This is noticed particularly in the bronchitis of children—in their Avinter coughs and colds. We observe in many of them large dis- charges of mucus from the nostrils; and when they cough, as the air forces its way through and across the deposits of mucus, and por- tions of the thickened mucous membrane on which the mucus has been secreted, this rattling sound is produced, which indicates genu- ine humid catarrh or bronchitis of the throat, air-passages, air-surfaces, &c. In other instances, the humid secretions will not take place, ex- cept to a small extent, and irregularly; and then we observe more or less of whistling, emitted from the affected part. Another sound occurs in bronchitis, which may be counterfeited by wetting the ball of the thumb, and passing it over a polished sur- face, under proper conditions, as the thumb is passed across a tam- bourine. The sound is sometimes very loud. In a great many instances in bronchitis, or skin disease upon the lungs, large quantities of matter, resembling pus, as well as mucus, are secreted, and that without the formation of ulcers. In many of these cases the air-surfaces adhere together; and the air, in making its Avay along the air-passage, will force them apart, producing a clapping noise, such as I have previously described as analogous to the sound produced by the tongue adhering to the roof of the mouth, and drawn suddenly from it. These are all the sounds that I noAV choose to notice as indicating bronchitis,—they are hoarseness, wheezing, gurgling, clapping, and whistling. When we observe one or all of these sounds, and notice at the same time that the chest rises well, that the lungs expand readily and fully, and that the expiration is easy and free, we may be cer- tain that it is a case of bronchitis. But we must never forget that this state of the disease may exist upon some portions of the lungs and air-passages, whilst other portions may be affected with another form of pulmonary disease. Hoarseness, the tambourine sound, Avheezing, and the whistling musical sound, in any part of the lungs or air-surfaces, are peculiar to bronchitis, and unfailingly indicate it in that particular spot; but 22 HEALTH : ITS AIDS AND HINDRANCES. gurgling and clapping are not peculiar to bronchitis. They occur also in other forms of disease. SOUNDS INDICATING ASTHMA. In the early stages of acute attacks of asthma, we notice intense hoarseness and shrill Avhistling, occupying almost the entire lungs in some subjects; less so in others, in proportion as the disease is more or less extensive. As the asthmatic paroxysm advances, and secretion commences, the hoarseness changes more or less—a humid whistling intervenes, and the shrill whistling sound subsides ; all the sounds become less dry, and, in many cases, a rattling is heard over the entire lungs. This diminishes and passes off as the secretion declines, as it gener- ally does at the close of the attack. In asthma, along with the sounds we have indicated, we observe, usually, that the chest is fully expanded, even unnaturally so in some cases. We also notice great shortness of breath, especially in exercise, which is increased on lying down, sometimes almost to suffocation; also the recurrence of paroxysms or exacerbations of short and difficult breathing. By these symptoms the disease is readily distinguished from bronchitis or permanent congestion of the lungs. The indications in asthma differ from those in bronchitis and ulcera- ted lungs, in that we hear no clapping sounds in the former, whilst in the latter the clapping sound frequently occurs, particularly in its advanced stages. Asthma, when it advances into asthmatic con- sumption, as it sometimes does, loses most of its asthmatic character- istics, and assumes nearly all the marks of true bronchial tubercular consumption. In cases where asthma has become permanently established, we generally notice hoarseness, wheezing, and whistling, more or less extensive, in proportion to the violence or extent of the disease. These sounds are usually more intense at night-fall than in early morning, in damp than in dry weather. We should, however, re- member that this asthma may be only partial—occupying one lobe of the lung, while the opposite lung, and even another lobe of the same lung, may be tuberculated or ulcerated. Hence the expan- sion of the chest may be general or partial, as the asthma is gen- eral or partial. In some subjects, life is so Ioav that expansion HEALTH : ITS AIDS AND HINDRANCES. 23 will be but slight even where the whole lungs become invaded by asthma. EMPHYSEMA OF THE LUNGS. Sometimes a number of air-cells become unnaturally expanded, and even break into each other. This state is called emphysema. In these cases the lungs are permanently expanded, and the murmur of air in the emphysematous lung is dull and feeble. It is here that per- cussion reveals full resonance, and, without auscultation, will indi- cate healthy lungs. Extensive emphysema of the lungs produces almost as great shortness of breath as takes place in asthma. This form of disease is strictly antagonistic to pulmonary consumption; emphysematous portions of the lungs resisting the process of tuber- culation. SOUNDS INDICATING PULMONARY TUBERCULAR CONSUMPTION. Tubercles generally occur in the least movable portions of the lungs, which are usually the front lobes, just below the clavicle, or collar-bone. The inactivity of the lung at this point is probably greater in the right than in the left lung, and tuberculation is more often observed to commence there than at any other part; at least, such has been my observation. I have stated, when speaking of the expiratory murmur, or the sound produced on exhaling the air from the lungs, that Avhere the lungs are free and healthy, we will observe very little sound, and sometimes none at all. But if obstructions occur in any part, the air, in passing out over these obstructions, will be partially interrupted, and sound produced. A loud expiratory murmur, with an apparent delay of the air in pass- ing out, unmistakably indicates obstruction, Avhich will almost al- Avays be found to be of a tuberculous character; so that the exam- iner who notices a feeble sound on inspiration, and a distinct expira- tory murmur, with more or less roughness of sound, approaching hoarseness, while at the same time the air, in passing out, is some- what delayed, is fully justified in announcing the presence of tuber- cles. If, united to this, you observe hoarseness on inspiration, you may infer that the tuberculous region is in a state of excitement, or that there is inflammation around the tuberculous deposits. 24 HEALTH : ITS AIDS AND HINDRANCES. SOUNDS PRODUCED BY TUBERCLES IN A STATE OF SOFTENING. As softenings commence in the tuberculous deposits, the air, upon entering the lungs and passing through this portion, besides the others we have noticed, Avill produce a clapping sound; the points of sound being finer or broader, as the extent of the softening is greater or less. In some cases you will find extensive portions of the lungs embraced in these softenings; and the air, in passing across these collapsed surfaces, and opening them, Avill seem to expose a large surface, and a clapping, squashy, humid sound is heard. This, taken in connection with the fact that the chest does not, upon in- spiration, rise much at this point, justifies us in concluding that the lung here is ulcerated, and its substance, in some degree, destroyed. In some cases Avhere much loss of substance has taken place, we shall notice points where no sound is heard, and sometimes a catching, interrupted sound, as the air seems to rush from one diseased sur- face to another, across an open cavity. If, with this sound, you observe that the ribs do not rise, you may be very certain that the lung is much wasted; that tuberculous softenings have taken place, and produced considerable destruction of the substance of the lungs themselves. SOUNDS INDICATING THE PRESENCE OF ACCUMULATED PUS IN LARGE CAVITIES. In connection with other symptoms which have been mentioned, you may, in some cases, catch the bottled fluid soimd; by AArhich I mean the sound I have described as counterfeited by the fluctua- tions, from side to side, of oil in a lamp. As the patient changes his position, or the air rushes in and out, the surface of any accumu- lated fluid, as pus, Avill be acted upon, and dashed from side to side, producing that peculiar sound to which I have referred, and clearly indicating cavities more or less filled Avith pus. SOUNDS INDICATING PULMONARY EXCAVATIONS NOT FILLED WITH PUS. The air, upon inspiration and expiration, as it enters and returns from a pulmonary excavation not filled with pus, will give a dry cav- HEALTH : ITS AIDS AND HINDRANCES. 25 ernous or amphoric sound, which I have described as counterfeited by blowing air into the open mouth of a vial. If, however, the cavity is partially filled, a clapping or gurgling soimd will also be observed. SOUNDS REVEALED BY AUSCULTATION IN INFLAMMATION OF THE LUNGS. ' In inflammation of the lungs, whether general or partial, on ex- amination Ave find diminished motion of the chest in breathing. This is not perceived, to any very considerable extent, in the first stage of the inflammation; but, as this disease progresses, and the lungs become filled Avith blood, it is noticed more. On applying the ear to the chest, there will be heard, over the points of inflammation, a fine crepitation, as of the bursting of numerous small air-bubbles. This sign is invariably found hi this disease. With it there will be heard often a kind of catching sound, as the air passes in and out of the lungs. At first, unless the inflammation is extensive, and the lungs are greatly engorged with blood, the respiratory murmur will be heard nearly as full and distinct as in health. But as the disease advances, and the lungs become what is termed hepatized, the sound diminishes, becomes more and more feeble and dull, and then at the hepatized points ceases to be heard at all, and gives place to a dis- tinct bronchial murmur, at first. But this latter, as the hepatization becomes more complete, is itself lost, and no sound is heard. If the disease does not become fatal, but subsides, as it does so, there is first heard a return of the crepitation, but of a coarser character, and more of a rattle. This increases for a time; and then, as the lungs are unloaded and become clear, it disappears. RESUME OF THE SUBJECT OF SOUND, AND THE MANNER OF EXPLO- RING THE LUNGS IN A STATE OF DISEASE. I have now summarily described the principal sounds and their indications of disease, as well as words will enable me to do so. I would remark further, that every possible form and complication of these sounds will be discovered in exploring many chests. But there are certain cardinal points that I have mentioned, which never fail us, and which indicate invariably the state of the lungs. Exter- nally, if Ave find portions of the chest depressed or flattened, and at 26 HEALTH : ITS AIDS AND HINDRANCES. those points the ribs rigid and immovable ; and if, on applying the ear to such parts, Ave observe obstructed expiration, a clapping, squeaking, gurgling, amphoric, and bottled-fluid sound, we may be certain of the presence of softened tubercles, or disorganized and ul- cerated lungs. In some instances the sounds are all dry; the patient has no cough, and very little, if any, air passes into certain portions of the lungs. There are cases where the lung has once been im- paired by disease or accident, and recovered so as to be healed. The diseased secretions are suspended, but the lungs have not recovered their expansibility and elasticity. Many of the air-cells, and perhaps the air-tubes, have become obliterated, and the lungs have lost more or less of their substance, but the process of tuberculatum has ceased. In conducting our examination of the lungs, we should notice not only the sounds discovered by auscultation, but also the general appearance of the chest—the play of the ribs—the fulness or the depressed state of the chest, whether general or partial. So also we should make ourselves fully acquainted with the past history of the case we may be examining, and carefully note and consider the present general condition, and constitutional symptoms. All these circum- stances should be taken into consideration ; for if the sounds are wholly relied upon, without regard to any other indications, we may be led into hurtful mistakes. The assistance of a competent teacher, who can point out the states of disease and health, as indicated both by auscultation and general symptoms, together with the opportunity of examining suit- able subjects, will of course greatly facilitate the acquiring of a cor- rect knowledge of the interesting phenomena presented in this branch of practice. Still, contmued practice and observation—a careful noting of the different sounds, collating the history of each case, and observing the subsequent progress and termination of the disease, Avill soon make almost any person, possessing a good ear and fair mental capacity, a master of all the prominent and useful facts revealed by auscultation. POSITION OF THE PATIENT, WITH DISEASED LUNGS, ON LYING DOWN-. As a general rule, the consumptive patient cannot lie upon the dis- eased side. On first lying down and turning upon the side affected coughing is immediately induced, which will in some subjects con- HEALTH : ITS AIDS AND HINDRANCES. 27 tinue until they turn to the opposite side. If the lungs are ulcerated, a considerable amount of matter will be expectorated during this coughing. After the diseased lung has been well cleared, by cough- ing, of the matter collected in it, the patient may he on the affected side for some time, without much inconvenience, if he lie perfectly quiet; but on moving he will immediately commence coughing again; and thus experience and necessity will teach him, that if he will avoid coughing, he must lie on the healthy side. Where both lungs are affected, he can, in some instances, only he upon his back; in others, he can he equally well on either side. In cases where water is extensively effused into the pleura of both lungs, as in dropsy in the chest, he cannot lie down at all; and this is also noticed in many asthmatics during the asthmatic paroxysms. But the history of the case, and auscultation, will very soon disclose whether water in the pleura, or asthma, be present. In some comparatively rare cases, the lungs will be loaded with a great amount of watery phlegm and pus, and the patient will be unable to lie down; or, on first doing so, especially, he will be taken with great shortness of breath, and with severe coughing; but after a while the lungs accommodate them- selves to the position, and he may sleep some hours uninterruptedly. I have seen it remarked by at least one writer on consumption, that where there is disease of the lungs, the patient can lie best on the affected side. But this, as a general rule, is a great mistake. Indeed, in many cases, he cannot lie on the affected side at all. I have, it is true, met with a few instances where this rule did not hold good—the invalid being able to he on one side apparently as well as on the other. But such instances are comparatively rare. They may be accounted for, when they do occur, by the fact, probably, that the healthy lung is in an irritable state, while there is at no time any very great amount of matter accumulated in the diseased lung. The rule that the patient lies best on the side of the sound lung is so uniform, that his disposition to lie on one or the other be- comes a fact of considerable importance, in connection with other symptoms, as indicating the location of the disease. IMPORTANCE OF AN ERECT FIGURE, AND A FULL, EXPANDED CHEST. Many persons, from extreme weakness at the pit of the stomach, or of the lungs themselves, are unable to stand erect, and imme- 28 HEALTH : ITS AIDS AND HINDRANCES. diately stoop upon rising. They imagine they feel better by stoop- ing and bending forward, Avhether standing or sitting. This habit, if indulged in, rapidly contracts the chest. It throws the shoulders forAvard, so that the chest has to bear their direct weight, and that of the arms, pressing it doAvnward and forAvard, of course contract- ing it, and preventing its full expansion. In the natural arrangement of the human frame, the weight of the shoulders and arms is made to fall backward, leaving the chest free, flexible, and capable of the fullest expansion. In the prevention of pulmonary consumption, there is no fact of more importance than that the chest should be erect, the lungs per- fectly inflated, and the weight of the shoulders made constantly to tend backwards, thus assisting the full and perfect expansion of the chest. This course will do very much towards forming good lungs, and continuing them in a healthy state. MECHANICAL REMEDIES TO PREVENT STOOPING. From remarking upon the great importance of keeping the chest erect, and the necessity of throwing the weight of the shoulders off from it, I am led to refer to the use of mechanical remedies to pre- vent stooping. These mechanical remedies are knoAvn under the name of shoulder- braces or trammels. The effect of a good shoulder-brace is to draw the shoidders doAvnward and backward, bringing the shoulder-blades flat upon the back of the chest and keeping them there, so as to take their weight off the chest, and thus to expand instead of con- tract it. Any person, however inclined to stoop, if under fifty years of age, can, by a determination of the will, and a proper use of shoulder- braces, do much towards remedying this bad habit, and producing a symmetrical chest. To me, I believe, belongs the credit, if any credit is due, of intro- ducing shoulder-braces as an assistant in the prevention and cure of pulmonary consumption. When I first commenced my lectures in this country, in 1842, shoulder-braces Avere almost entirely unknown. Very rude attempts had been made, and rude instruments devised for improving the figure of the chests of young persons at school; but I am not aware that they were employed, to any considerable HEALTH : ITS AIDS AND HINDRANCES. 29 extent, either in this country or in Europe, as a remedial agent, until I brought them into notice, and perfected several varieties of them. They were entirely unknown to the general mass of the people, and to almost all physicians. They are now manufactured in a great variety of styles, and of various grades of usefulness and elegance. In 1842, probably not twenty pair were manufactured a year in the United States: at this day the number manufactured and sold amounts to several hundred thousand annually. When properly made and adjusted to the size and condition of the patient, there is no remedy of so simple a character, capable of more unalloyed usefulness, or that so much improves the patient, without presenting a single drawback to its benefits. They never produce any injury. On first being worn, the patient may expe- rience a little inconvenience if they are drawn too tightly; but they maybe easily adjusted so as to avoid this inconvenience: habit will soon render their use agreeable, and the shoulders will gradually be brought back to their most perfect original symmetry. In young persons the collar-bone may be straightened, where it is bent and deformed, and restored to its natural position and shape; and the elevated, wing-like protruding of the interior edges of the shoulder- blades may be completely remedied; when beauty will take the place of deformity, and health be insured and reinstated Avhere it was endangered, or perhaps already impaired. The benefits of shoulder-braces to the human system are now so generally and thoroughly known, that neither physicians nor invalids often object to their being worn; but when they Avere first intro- duced, and their great benefits proclaimed, physicians Avere among the leading opponents to their use; a great many opposing them who had never seen the instrument, and who did not really know what they Avere opposing. They based their opposition, as they said, simply on the general principle, that God had made us right, and if we had needed shoulder-braces, he would have put them upon us; that for man to attempt to supply any thing to the human frame, was to charge God AAith having foolishly omitted, or perhaps over- looked, something essential to its perfection. These pious philoso- phers forgot that the collar-bones are shoulder-braces of the most perfect character ; and that did not vicious habits, and unhealthy em- ployments, stoop and distort the frame in spite of them, no artificial help Avould be needed. Reason is bestowed upon us that we may 30 HEALTH : ITS AIDS AND HINDRANCES. remedy the injuries Avhich accidents and injurious habits inflict upon the masterpiece of God's handiAvork—the human frame. I seldom treat disease of the lungs or heart, or any Aveakness of the chest or pit of the stomach, without advising the use of shoulder- braces, where it is practicable to wear them. They are not worn at night or in bed, but only during the hours of the day Avhen the pa- tient is walking, riding, laboring, &c, &c. Persons of every age, class, sex, and occupation, may wear them; excepting, of course, * children under three or four years of age. They assist very much to expand the lungs, to remove weakness from the chest, and to pre- vent the exercise of the arms and hands from straining and weaken- ing it, which will very often take place where the shoulder-braces are not worn, especially in delicate, weakly, and feeble people. To ladies and persons of sedentary habits, professional men and clerks, their benefits are inestimable. I would advise their universal use, in all cases of small chests and stooping shoulders. As I have said, I always use them in treating consumption. They are exceedingly valuable, whatever plan of treatment for restoring the health, strength, and symmetry of the chest, and preventing consumption, is adopted. CHAPTER H. PULMONARY CONSUMPTION—ITS VARIETIES. The disease commonly known under the term pulmonary con- sumption, consists in a destruction of the lungs, to a greater or less degree, by a peculiar process of disorganization. It is a disease which, when fully developed in the lungs, possesses certain peculiar features and characteristics that readily distinguish it from all others, and which unerringly indicate its existence. This fact has given rise to a popular notion, more or less entertained by the medical faculty also, that consumption always originates in the lungs, and has a spe- cific cause, operating only in these organs. This is a great error— a most disastrous error, blinding, in thousands of cases, both the physician and the invalid to the approach of the disease. While they are looking for it only in the lungs, and supposing that there is no danger so long as these organs show no signs of disorder, the enemy may be undermining the constitution through other organs, preparatory to seizing upon the lungs, and terminating life in true consumption. It is, therefore, a fact to which I desire to direct special attention, as being one of great importance, that pulmonary consumption may result from a great variety of causes. I wish to impress the truth, that there are many other affections—disorders of the general system, as well as of particular organs—which may either determine upon the lungs, or so affect the vital powers and fluids of the system, as to in- duce true pulmonary consumption. For example, long-continued dyspepsia may result eventually in consumption. The same is true of diarrhoea, constipation, liver complaint, some disorders peculiar to the female constitution, certain skin diseases, cancer, scrofulous tu- mors, &c.; and so of long-continued fevers, mechanical injuries, that prostrate greatly the strength of the system, occasioning a long con- finement in the house or in bed, &c. Perhaps the most familiar ex- 32 HEALTH : ITS AIDS AND HINDRANCES. ample of a distinct and independent disease, eventually causing destruction of the lungs under certain circumstances, is that of A COMMON COLD. This affection has, as Ave shall see, no necessary connection with ,the lungs; and yet how often does a simple cold end in consump- tion ! What is the disorder knoAvn as a common cold ? Confining my remarks to what is called a cold on the lungs, I reply, it is not, as many suppose, something inhaled into the lungs Avith the breath; nor is it the result of any direct action of cold upon the lungs them- selves. On the contrary, it is usually the effect of an influence ex- erted by cold upon the surface of the body; being nothing more nor less than the sudden checking of the perspiration, Avhich, in a state of health, is constantly passing through the skin. This perspiration consists of Avaste or worn-out matter, which is taken up from the blood by certain organs called sudorific glands, whose office is to eliminate this dead matter, and expel it through the pores of the skin. If it is retained, it becomes a source of disease—acting as an irritating, mischievous poison. In a healthy person it is constantly passing off, to the extent of three to four pounds every twenty-four hours, by what is called insensible perspiration, being in a state of vapor. It is only when it is poured out very rapidly, by increasing the heat of the body, that the perspiration becomes sensible, or ap- pears as a fluid in drops on the skin. This is termed sensible perspira- tion, or streating. The uninterrupted flow or expulsion of this dead matter is absolutely indispensable to health. The instant it is checked at any point, there is mischief done. One of the most common modes of checking it, is by suddenly chilling the skin, as the effect of cold on the skin is to close its pores, or those minute channels through Avhich the perspiration passes. Thus, when a person perspiring freely becomes rapidly chilled, and the perspiration is arrested, he is said to have " caught cold;" this dead matter has been retained, and thrown back into the blood, when it is either carried throughout the system, causing a general disturbance, or it determines on some organ, or set of organs, or to one point. Then it is said, the person " has cold in the head," or " a cold on the lungs," or that his cold has " settled" in the throat, the neck, the back, the joints, or elseAvhere. When this chilling of the surface is confined to a small space, the checked HEALTH : ITS AIDS AND HINDRANCES. 33 perspiration is apt to " settle" in the immediate vicinity of the place thus chilled, and to disturb, at first, but little the general system. Thus a person sitting with a " draft" blowing on the neck, will soon have a stiff neck or sore throat, with perhaps no other indication of having taken cold. When, hoAvever, the whole, or the greater part, of the surface is suddenly chilled, the general system usually suffers to a greater or less extent, and, at the same time, some one or more of the great vital organs is apt to receive, especially, the shock of the mischief caused by the suppressed perspiration. The lungs, of all these great organs, are most exposed to the attack; both because the blood, which is loaded with the retained poison, is all filtered, as it were, through them; and because it is one of the duties of the lungs, when the skin, or any other of the organs of excretion, fails in its appropriate work, at once to take upon themselves the labor, and render all the assistance in their power in cleansing the blood of im- purities. When, therefore, the pores of the skin are closed, the waste matter, not finding a Avay out, rushes to the lungs for escape. Then we have more or less congestion of these organs. The mem- Drane lining them becomes irritated and inflamed, by the presence of the poison, and strives to expel the enemy by pouring out an increased secretion, causing a cough and expectoration more or less profuse. This is what is termed a " cold on the lungs," which, as every one knows, may, unless arrested, end in "consumption," and destroy fife; especially Avhere there is a constitutional tendency to this dis- ease. I here repeat, therefore, what I have before remarked, that a " common cold" furnishes a familiar example of a distinct and independent disease, determining to the lungs, and resulting in consumption. But what is true of a " common cold," in the above respects, is equally true of a great variety of other disorders. Indeed, it is a fact that there is scarcely any form of disease, whether general or local, that may not become the source of pulmonary consumption. In the course of my practice, I have been able to trace affections of the lungs directly to many of these foreign sources; and it is my purpose, in the following pages, to give the result of my observations, not only in regard to the diseases Avhich seem to originate in the lungs themselves, but also those forms of pulmonary disorder Avhich are transferred to the lungs, or to which the lungs are subject, from disease elsewhere. In doing so, I shall take the hberty to designate 3 34 HEALTH : ITS AIDS AND HINDRANCES. the disease in the lungs, iu each case, by a term indicating its origin. Thus, when it has resulted from disorder of the stomach, I call it " dyspeptic pulmonary consumption;" when from disorder of the fiver, " hepatic (or liver) pulmonary consumption;" when from de- rangement of the bowels, "intestinal (or bowel) piUmonary consump- tion," &c. This, I think, will be found a convenient and appropri- ate nomenclature, as it will, in every instance, disclose the origin of the disease. Before, however, proceeding to the different varieties of consump- tion, I will here dispose of the subject of" hereditary consumption," as this can hardly be called a particular variety ; the hereditary pre- disposition influencing more or less all varieties. HEREDITARY CONSUMPTION. The offspring are reproductions of the parents, often in the mi- nutest particulars; and still more universally so in their general con- stitutional characteristics. In general, the children will inherit a predisposition to such diseases, as those to which their progenitors were subject, whether cancer, salt rheum, skin diseases, &c. Humors of every species, and particular weaknesses or particular strength, in any organ, or set of organs, are also transmittible; and hence the parents may communicate to their offspring weak lungs or strong lungs, large or small lungs. They will transmit strong appetites or weak appetites, large mental capacity or imbecility, deformities or malformations.' I have known a father, having a withered arm, re- ceive from his wife children with withered arms. If the parents are scrofulous, the children are liable to become so, and the development may follow at an earlier or later period of life. Indeed, sometimes parents are so depraved by a tuberculous disposition, that their children may almost be said to be born with consumption. And yet it seldom occurs that a child has any apparent hereditary disease at its birth; although I have known a child born with the ague and fever, derived of course from its mother, who, while bearing it, had been the subject of this disease. It is, I repeat, rarely, however, the case that children are born with any hereditary disease apparent upon them; consequently, a longer or shorter period may elapse before the disease shows itself, and this interval is one of what is called predisposition. HEALTH : ITS ADDS AND HINDRANCES. 35 This predisposition, which is a peculiar constitutional liability to the development of a disease, is far more easily cured and eradi- cated from the system than the disease itself. While those thus predisposed are of course more subject to disease, and though the disease, Avhen it occurs, makes more rapid progress, still it does not by any means necessarily follow that because the parent has had consumption, the child shall certainly have it too. If the causes that tend to develop the predisposition to the disease are removed, and proper means employed to eradicate it, the children of the most sickly parents may grow up perfectly free from consumption, and all development of hereditary disease. I am disposed, indeed, to think, that there is no disease to which we are liable, whose prevention is more perfectly under our control than tubercular consumption. If the child has inherited diminished vital powers from its parents, either generally or locally, either in the whole system or in any one particular organ—such as the brain, the lungs, the stomach, the heart, &c.—we shall find that by employing proper means to obvi- ate any difficulty or derangement of the individual organ, and at the same time by using proper measures to strengthen it, its heredi- tary or predisposed Aveakness may be entirely removed. It should be remembered, also, that the same cause which develops disease in a person predisposed to it, or eventually in a person not predisposed, where disturbing causes operate for a length of time, will finally produce the disease itself as effectually as if there had been an heredi- tary tendency. How often do we see persons whose parents were perfectly healthy, become the subjects of disease which their parents had escaped, and this from influences that did not act upon the parents! This we find illustrated in thousands of instances,—in children Avho, having left healthy situations and healthy occupations, and from necessity or choice adopted unhealthy occupations, pernicious habits, or unhealthy locations for residences, finally become subjects of disease. To this class belong especially healthy farmers' children, who have ex- changed their country residences, Avith the pure air and wholesome food of their homes, for confined residences and occupations in manu- factories,—or in cities where impure air, low living, constrained posi- tions at their labors, demoralizing habits, and depressing influences, grief, &c, will so reduce the vital energies and break down the pow- ers of life, that a predisposition to consumption is rapidly developed, 36 HEALTH : ITS AIDS AND HINDRANCES. and as fatally consummated as if the patient had been of unhealthy parents. Allow me to repeat, that a predisposition to disease, from any hereditary taint, is not the disease itself; nor does it necessarily de- velop the disease, which, on the contrary, may, by proper measures, be wholly eradicated from the system, leaving the person so predis- posed as perfectly free from any danger of finally incurring the dis- ease, as if there had never been any predisposition at all in the system. We are now prepared to notice the different varieties of consump- tion ; and I will first ask the reader's attention to that variety which is considered the most incurable, as it is the most common, and which seems to have, more than any other, its origin, as well as seat, alone in the lungs. TUBERCULAR CONSUMPTION. The term, tubercular consumption, is very frequently employed. It is seen in most medical books, and is heard from the lips of every physician, until it has become familiar to all; yet the disease it is in- tended to designate—simple, pure, and uncomplicated with any other affection of the lungs—is of comparatively rare occurrence. For in almost all cases of the disease called tubercular consumption, it is not purely so, but is complicated with other complaints,— such as bronchitis, pulmonary catarrh, &c. True tubercular consumption possesses peculiarities which distin- guish it from almost every other disease. We can trace the cause of most other disorders to some specific source,—to a poison in the blood, to a violence inflicted, to a loss of symmetry, or the derangement of some particular organ; but in pure tubercular consumption, the cause is to be looked for almost always hi a peculiar diminution of the vital powers; as a consequence of which, when protracted to a certain extent, the vital fluid—the blood—becomes degenerated, and a portion of it loses its capacity of being appropriated and built up into the system. This portion which thus fails to be vitalized, be- comes, as it were, foreign matter in the system, and generates dis- ease, unless it is expelled. It constitutes a vicious species of debris or waste matter, circulating sluggishly, and liable to be deposited in certain portions of the system, and in certain organs where the HEALTH : 1ST AIDS AND HINDRANCES. 37 blood-vessels through which it Aoavs are extremely minute, and the general circulation is carried forward with the least activity. Here this unvitalized part of the blood becomes separated from the portions which are purer, more lively, and endowed with more vitality; and, aggregating in masses, constitutes tumors of various kinds, scrofulous or otherwise, and very commonly what are called tubercles are formed. These tubercles are more liable to be deposited in the lungs than any- where else. This will be seen, if we consider for a moment the peculiar organization and office of the lungs. It will be recollected that the whole blood of the body passes through the lungs, to be exposed there to the action of atmospheric air, and thus to become arterialized or converted from venous into arterial blood, by which process it re- ceives the vital principle of the air, oxygen, and is thus prepared to carry life and vitality to all parts of the body. To accomplish this, it is, in the lungs, carried through an exquisitely delicate net-work of extremely minute blood-vessels; and, in its progress, any portions of it which are not homogeneous, or thoroughly united Avith the mass, or which are gross and heavy, as also any crude, undigested, or foreign matter which it may contain, are liable to be arrested, and fail to pass through. Where these portions are thus arrested and detained, the blood-vessels become of course choked up; other par- ticles of crude, unvitalized matter, in time, aggregate Avith the first deposits, and tubercles are established. In some cases these deposits Avill take place in small points, throughout a large portion of the lungs; in others we find them occupying one particular locality, Avhilst every other part of the lung presents a healthy appearance. At first, these points of deposition are usually very minute and slight. The manner in which the tu- bercles segregate may be likened, in some degree, to the effects of water when thrown upon red-hot iron: although thrown in a mass, it rapidly divides into little globules. Could these be congealed at the moment, they would be found to present an appearance similar to primitive tubercles in the lungs. In accordance with these vieAvs—namely, that tubercles are a true deposition from the blood—we shall find that, in those parts of the lungs where the circulation of this fluid is most active, tubercles will most rarely be seen; Avhile others, where it is less active, aa ill be found more liable to tuberculous deposits. This is a rule to which there are few, if any, exceptions in the phenomena 38 HEALTH : ITS AIDS AND HINDRANCES. of tuberculous formations. The lower portion of the lungs, where they are acted upon by the diaphragm beneath, and where the ribs are more elastic, rarely, in the first instance, show tuberculous deposits. But they will be found first in the upper portions of the lungs, beneath the collar-bones, and in front of the shoulder-blades, as Avell as in the posterior portions of the chest, where the ribs have the least movement, and where the circulation is comparatively passive. Hence it is that tuberculous deposits commence in the top of the lungs, or very apex. According to my experience, in at least five out of every six instances, they begin at the top of the right lung; for although it is the largest, and subject to the influence of the right arm, which is most frequently used, yet the position of the liver be- neath slightly impedes its movement when compared with the left ; and this difference, though small, causes the more frequent com- mencement of disease upon it. Should the causes which produce the first tuberculous deposit, continue in action, other deposits will naturally follow, until large masses of tubercles are formed, and the whole lung eventually is involved in the disease. Should, however, the vital poAvers of the system again, from any cause, regain the full standard of health, and a perfect circulation of the blood be re-estab- lished, the tuberculous deposits may be absorbed and removed from the lungs. There are individuals Avho deny that tubercles are ever absorbed and remoA'ed from the lungs. They assert that a child, born Avith tubercles in its lungs, Avill necessarily carry them with him through life. That this is not correct, may be inferred from the well-known fact that, in the case of tuberculous deposits in other parts of the system—as, for instance, scrofula in the neck—Ave find them removed by the use of appropriate remedies. The same process may take place in the lungs. It Avill not be denied, that the absorbents are capable of carrying off every part of the system, and do remove even the bones themselves. If they can remove bones, they can certainly remove tuberculous matter. I need not say that it is as ridiculous to deny the existence of absorbents in the lungs, as to deny that of tuberculous deposits themselves. But we are not left simply to infer, from analogy, that this process of absorption may take place in the lungs. I am confident I have witnessed the fact in my practice. HEALTH : ITS AIDS AND HINDRANCES. 39 SYMPTOMS OP TUBERCULAR CONSUMPTION. I would here remark, that all the different varieties of consump- tion which are described in this book, retain their original character- istics till a late stage ; but at the last, and near the close of life, they take the form of original, simple, and uncomplicated tubercular con- sumption. The remarks that I am about to make here, apply to tubercular consumption in its simple form, uncomplicated by any other disease. One of the earliest symptoms of tubercular consumption per- ceived by the patient, is debility, accompanied by disinclination to activity, loss of vigor, feeling of inability to perform accustomed duties, or to accomplish accustomed tasks; a slight shortening of the breath upon any exercise, as, for instance, ascending a stair, walking up-hill, attempting to run, or making any unusual exertion. This shortening of the breath increases more or less as tuberculous de- posits are more or less extensive in the lungs. Very soon a sense of tightness will be felt, as if the chest could not be expanded, with a desire to take long breaths, but an inability to do so. The breath seems cut off, and the air is expelled rapidly from the lungs; the breathing becomes habitually quicker. At length commences a slight, almost imperceptible cough,—so slight at first that the patient will not consent to call it a cough—only a shght hacking. Often a little over-exercise of the lungs will cause it, as laughing heartily, loud speaking, &c. It often occurs upon rising in the morning, or getting into bed at night, or on going from a warm to a cold room. This cough is frequently noticed by friends and companions long before the patient acknowledges it. A slight stooping of the chest will soon be observed, the breast becomes narrower, the shoulders ap- proach each other, and an observer is impressed by the fact that the individuars chest is becoming contracted. At a period more or less early, we find that a particular part of the chest, most usually on one lung, and at the very top, is immovable when a lono- breath is taken: it does not expand; and any patient may be satisfied of this by exposing the chest before a mirror, when, upon close observation, it will be seen that some part of the chest—gener- ally the upper part, just below the collar-bone—does not rise Avith the rest. When only one lung is affected, the difference is more 40 HEALTH : ITS AIDS AND HINDRANCES. marked, because we notice that the opposite side of the chest fully expands; and where the affection is considerable, we shall notice an absolute and marked depression in the ribs, on the affected side. There may be depressions in the chest from natural malformation, or from accidental causes, which have acted externally upon it. But such causes of deformity will usually be in the recollection of the patient. Thus, although depression in any part of the chest is not in itself proof that the lung is diseased there, yet if, upon taking a long breath, every other part of the chest rises and expands freely, and this part does not, we have very great reason to conclude that tubercles have been deposited, or that the lung has become wasted. This depression should not, therefore, be relied upon alone to de- termine the presence of tubercles. It is only a confirmatory symptom in the group of symptoms which are presented in this disease. It is here that the value of auscultation is shown; this will at once remove or confirm the suspicions which a depressed chest may have excited. The practised ear, applied to the chest, will detect the existence of tubercles, if they are present. As the disease progresses, the patient, at some period of the day, feels slight chilliness, and there is perceived a little blueness and coldness at the ends of the fingers. Frequently a creeping sensation down the spine, betAveen the shoulders, or in the small of the back, is felt; sometimes a sensation as if water was poured over the part; at other times as if cold air was rolling down it, although at the time fully and warmly clothed. The patient will be observed to approach the fire, and will not be so susceptible as others to the heat. This chilly sensation is usually followed by a slight fever, a little flushing of the cheek, accompanied by more or less headache, which soon passes off. A recurrence of the same symptoms will be remarked on each succeeding day. Towards evening the patient finds his voice a little husky; and on the occurrence of a damp day he feels the tight- ness in his chest increased, and the shortness of breath becomes greater; the chill is longer, and the fever more prolonged. He al- most instinctively dreads the night air, as it seems to increase his cough and aggravate all the other symptoms. Occasionally now he perceives that he perspires at night, or on lying down; but this he explains by supposing that the temperature of the room in which he reposes is higher. These symptoms, if unchecked, increase more or less rapidly, and with them mcreasing debility is experienced. Now HEALTH : ITS AIDS AND HINDRANCES. 41 commences a slight expectoration of frothy matter in the morning, and, in some instances, very slight spitting of blood. The appetite is generally still good, and no function of the system seems materially disturbed. He has little or no pain, and, judging by his own feelings, he would be as well as ever, if he could only regain his strength. He is disposed to attribute his weakness, his cough, his fever, and night- sweats to unfounded and adventitious causes. With the greatest pleasure he will hear favorable explanations made by sympathizing friends. Tubercular consumption, indeed, differs in this respect from all other diseases. The symptoms almost invariably flatter and de- ceive, and the explanations which the patient and his friends contin- ually make, are quite inconsistent with the reality. The tubercles now begin to soften—as it were to rot—in the lungs, being reduced to a cream-like matter, and are gradually discharged by expectora- tion. Sometimes, hoAvever, they suppurate, and are expectorated Avith hardly any change; as, Avith the sputa discharged by consump- tives, we often notice crude tubercles that have not softened at all. During the process of softening, the chills, the fever, the cough, and the night-sweats are all greatly aggraArated. Frequently the tuberculous mass is isolated, or exists in small quantities in a solitary spot. On its being discharged, the lung sometimes heals, leaving either a cavity lined by a membranous formation, or else a cicatrix or eschar. The patient now seems to improve—all the symptoms are moderated, the chills are less, the fever is less, the night-sweats disappear, the cough almost ceases, he rests better—and in all respects seems convalescent. In this con- dition he will continue, until another set of tubercles forms and begins to soften, when all the first symptoms will reappear, perhaps much aggravated. In some cases, however, the tuberculous deposits remain in one part of the lungs simply in a state of deposition; while in others they are undergoing the process of softening; and at the same time, in a third, healing is taking place where they have been discharged,—the process thus going on till the lung is totally de- stroyed. In some cases deposits of tubercles may soften only at long intervals, and the progress of consumption be very protracted. In others the processes of deposition and softening may go on together, and be continuous, when all the symptoms will be steadily and pro- gressively aggravated, and the patient rapidly and steadily decline. This of course would be influenced by the degree of predisposition 42 HEALTH : ITS AIDS AND HINDRANCES. existing in the case, and the strength of the destructive causes, what- ever they may be, acting upon the patient. It should be remem- bered that any thing whatever which tends to debilitate the patient, will increase the disease. In some cases of pure tubercular consump- tion, I have knoAvn the disease pass rapidly to a fatal termination without the intervention of any softenings Avhatever, and without any expectoration ; but such cases are extremely rare. I will men- tion one, on account of the peculiarly interesting circumstances at- tending it. Mrs. R., a resident of Brooklyn, N. Y., had a large scrofulous mass deposited under the right ear and down the neck. This increased to a remarkable size, so as to be an ungainly deformity. She had no hereditary predisposition to phthisis, but was of a delicate constitu- tion, and her natural delicacy of health had lately been increased by parturition. A few weeks after this event she had two or three chills. Her physician, a gentleman of some eminence of that city, gave her metallic tonics, iodine, iron, &c, for the tumor, and iodine was applied freely to it; but no effort was made to expand or im- prove the state of the lungs, or in any manner ascertain their condition. Soon now commenced one of the most curious processes with which we meet in the whole phenomena of disease. This large mass on the side of the neck began to disappear, and, pro- ceeding pari passu with its disappearance, occurred shortness of breathing, as well as a debility, which were imputed to nursing. Great joy was felt at the rapid diminution of the tumor. The child was weaned. Still there was no augmentation of strength. The lady remained confined to her house until April, and was not allowed to go out, from fear of aggravating a very slight cough. In April she went to the country, visited several watering-places, received the counsel and attendance of several prominent physicians, and, as she was perfectly easy in her circumstances, pecuniarily, every thing was done that affection or science could suggest. She frequently expressed a wish that I should be consulted, if any thing Avas the matter with her lungs ; but all her physicians assured her that her lungs were perfectly well. In the August following she Adsited her parents at New London, Conn.; there I saw her, and met in consultation her very intelligent attending physician, Dr. P. who had recently taken charge of her case. The curious process to which I have referred—the remarkable REMOVAL OF SCROFULOUS DEPOSITS TO THE LUNGS 43 phenomenon of the exhibition of a power in the system capable of removing a scrofulous mass of matter existing in one part of the body, and depositing it in another, was presented in this case; this tuberculous mass had been removed without any softening, and deposited in the bases of both lungs. The lady had been taught to suppress her cough. No physician had advised the expansion of the chest; the lower part of which, in consequence of lacing and the absence of all voluntary expansion, was far less active than the upper. Hence the deposits commenced in the bases of these organs. Slowly and gradually they filled up, from the bases to the tops, obliterating all the air-passages and cells, and rendering the lungs completely solid, like the mass on the side of the neck. When I first saw her in August, I examined her chest in company with Dr. P. More than tAvo-thirds of the lungs were filled Avith this tuberculous matter. She experienced but a slight cough, no pain, and little fever. Those not acquainted with such a case could not ac- count for her weakness and shortness of breath. Her mental powers were perfectly clear, but all the functions of physical life were reduced to their minimum of activity and vigor. She had a fair appetite, but could eat very little, because eating gave rise to great shortness of breath. While at rest, she felt as if she could walk and go out as well as ever; but on attempting to do so, debility and shortness of breath utterly prevented. Her case had become entirely hopeless; and, as to the cause, her intelligent physician and myself agreed that the course of treatment previously pursued, embracing the applica- tion of remedies to the scrofulous tumor on the neck, had driven the tubercular deposits to her lungs, inducing the terrible conse- quences which I have narrated. The progress of the disease was very anomalous in this most unique case. As water rises higher and higher in a receiving vessel, so these tubercular deposits continued advancing upwards until they filled the whole chest, and the patient was literally suffocated. No softening, no expectoration of matter had taken place during the entire progress of the disease. It was, both to her attending physician and myself, a most impres- sive warning against the impropriety of ever using external appli- cations to discuss or drive off tubercular deposits, without at the same time thoroughly securing the internal organs of the body, and particularly the lungs, against the great danger of these deposits being determined upon them. 44 TUBERCULAR CONSUMPTION. I have witnessed one other case similar to that of Mrs. R. It was that of a young lady whom I saw in Vermont in 1849. She came sixty miles to visit ine. Her chief symptoms were shortness of breath, great struggling in respiration, and much debility consequent upon it. Her lungs were nearly filled up ; the process commencing at the bases, and but a small portion remaining unaffected at the top of each. After ascertaining the true condition of her lungs, and de- termining in my own mind that her case was entirely hopeless, I was asked by an intelligent lady who passed through the room, whether this young woman had not worked in a cotton-mill. I told her that she had. " Well," replied the lady, " I thought so." I have seen several such cases in NeAV Hampshire, occurring in persons who have worked in the cotton-mills ; and they are, no doubt, caused by for- eign matter being carried doAvn to the bases of the lungs during in- spiration, and there accumulating until it arrests the action of a portion of these organs,—thus beconiing a nucleus for the secretion of tuberculous matter. PERSONS LIABLE TO TUBERCULOUS DEPOSITS IN THE LUNGS. Having noticed, in a cursory manner, some of the principal phe- nomena attending the deposition of tubercles in the lungs, and the progress of true tubercular consumption, I will add a few Avords to indicate the persons liable to these diseases; or those whom certain habits and conditions of life—in fact, all causes that tend to debili- tate and break doAvn the system—will more incline to tubercular consumption than others differently formed or constituted, or living under more healthful influences. It is neither correct nor just to designate any one class of people as highly predisposed to consumption ; because in every class we con- tinually find the victims of this disease. All that we can say is, that we meet more of a certain description of persons who have consump- tion, than we do of another. For example: the mulatto half-breed, and the various crosses between the colored and Avhite races, will be found much more liable to consumption than the pure-blooded negro or Indian, or the pure-blooded Caucasian; and, as a general rule, all the conspicuous crosses of the human family are much more apt to have tubercular consumption than the pure original stock. The half-breed Indian, when exposed to depressmg influences, is far TREATMENT OF TUBERCULAR CONSUMPTION. 45 more liable to pulmonary consumption than the pure Indian or the pure white. Passing over this mingled blood of distinct races of men, we find that in our own race, or the family to which we be- long, persons of sandy complexion, men Avdth sandy whiskers, blonde or red hair, who have a preponderance of the sanguineous tempera- ment, with a clear white skin—ofttimes with freckles—and soft blue eyes, have generally much less ability to sustain hardships and tax- ation of their vital energies, than those of the bilious or phlegmatic temperament. These persons are peculiarly liable to pulmonary consumption. Still, while this is so, no class whatever can be said to be exempt from the causes of this disease. Persons who are slender and tall, but more particularly the slender, whether tall or short, with flat chests, and lungs small in proportion to other parts of the system, are much more liable to consumption than those with full chests, and luugs relatively large. The phlegmatic temperament is more liable to consumption than the bilious; and, as a general rule, it may be remarked that persons of a bilious tem- perament and black hair,—brunettes, with thick skin, good appetites, good digestion, and an uneasy, restless habit, are less subject to consumption than any other class. TREATMENT OF TUBERCULAR CONSUMPTION. In describing the causes and origin of tubercular consumption, I have endeavored to explain that the deposited tubercles are pri- marily the result of debility and a low state of the constitution, induced by bad air, prolonged study, confinement to debilitating labors, long-continued sickness—or, finally, any cause that tends to break doAvn the powers of life, contract the chest, or arrest the circulation. With this vieAv of the disease, we are prepared to see that our plan of treatment should be one tending to expand the chest and restore it to perfect symmetry; to inflate the lungs, and thus more completely secure the perfect aeration of the blood; and then we should use such medicinal and hygienic remedies—constitutional and local—as will cleanse the blood of humors, cure all disorders in every part of the body, promote the absorption of tubercles, if they exist, heal ulcerations, remove bronchial inflammation and irri- tation, and restore the vital energies of the whole system, and each organ of it, to the highest degree of healthy activity. Free air, 46 TUBERCULAR CONSUMPTION. out-door exercise, change of location, travelling, pleasant and cheer- ful society, well-ventilated rooms, spending as much time as pos- sible in the country—in mountain districts and dry situations, avoiding damp, unhealthy locations, crowded rooms, ill-ventilated apartments, &c, all highly contribute towards restoring the patient to health. The inhaling tube—an instrument used to aid in forcibly inflating the lungs—should be freely employed to keep the chest ex- panded, and to promote a lively circidation of blood through the lungs. Long, full breaths should be taken in a pure, cool air; and cold bathing, salt-water bathing, or sponging the person in spirits, or spirits and water, should be resorted to. Some constitutions will be greatly benefited by the administration of alcoholic or fer- mented liquors, in small quantities, especially pure brandy, old Jamaica rum, London porter, &c. Every cause that tends to debili- tate the system, should be carefully removed and avoided. Me- chanical remedies, such as shoulder-braces and abdominal supporters, should, of course, be employed when needed, except in very young persons, by whom they cannot be worn. THE INFLUENCE OF POSTURE IN LUNG DISEASE. I shall here dispose of the subject of position, and its application to the treatment of pulmonary disease. In all cases of fever and inflammation, where it is desired to reduce the circulation in the system, or by rest to prevent excitement and exhaustion, the patient is allowed and requested to remain in bed. But in every form of lung disease, a recumbent posture should be avoided as far as practicable, and the hours in bed be as few as pos- sible ; lying in bed having a special tendency to arrest the circulation, and produce congestion of the lungs. In cases where there is pre- disposition to consumption, and the patient, from any cause, is in- clined to continue long a-bed, this habit should be renounced as soon as possible. Delicate ladies, inclined to pulmonary disease, or whose lungs are already affected, should not, if it can be avoided, remain in bed after parturition more than three days before they are bolstered up, or made to assume the sitting posture as much as practicable. They should, of course, be thoroughly bandaged and perfectly sup- ported, so that falling of the bowels and womb may be prevented. As early as their condition will permit, they should be invited to INFLUENCE OF POSTURE. 47 get up, and attempt walking. The chest should be bathed freely in alcoholic liquor, warm or cold, but generally tepid. In this way the usual bad consequences of confinement will be diminished or pre- vented. Lying long a-bed, or in any recumbent position, after par- turition and during the progress of most fevers, I have no doubt is a very powerful cause in producing pulmonary consumption. We often see this disease originate towards the close of a long-continued typhoid fever, and I have not the least doubt that in persons predis- posed, it may result, in a considerable degree, from this recumbent position. In conclusion, I would say, no person predisposed to pul- monary consumption, or already affected by it, should ever indulge in the habit of lying long a-bed, or in recumbent postures. On the contrary, the patient should sit up, walk about, ride, &c, as much as possible, and avoid lying down so far as practicable, save during the regular hours of sleep. CHAPTER HI. PULMONARY CONSUMPTION—ITS VARIETIES—Continued. BRONCHITIS AND BRONCHIAL CONSUMPTION. What is bronchitis ? By almost universal consent, bronchitis is understood to be a disease of the mucous membrane of the throat, the windpipe, and air-passages. It is mostly, however, considered to be confined to the throat. Physicians make several diseases of the air- passages, such as laryngitis, trachitis, bronchitis, &c, as the disease affects the larynx, the trachea, or the bronchi. I shall speak of these as one disease, under the name bronchitis, to meet the popular ac- ceptation of the term. I again ask, what is the nature of bronchitis ? and reply, it is a true skin disease, located on the membrane, which is in fact the skin, that lines the throat and air-passages. If this dis- ease were on the hands, face, or surface of the person elsewhere, it might be salt-rheum, tetter, acne, ringworm, &c, &c. Some of these diseases, as is known, discharge much watery matter. This is specially the case with salt-rheum. Others are dry, and do not form matter, but roughen and crack the skin, or form scales that drop off, and leave red, inflamed blotches, &c. The same phenomena occur in the various forms of bronchitis. In some cases Ave find profuse secre- tions, and patients expectorate large quantities of matter, which is sometimes thin and watery, and at others thick and tenacious. In other cases but little is raised; but a most distressing tightness and dryness, often with much itching and tickling, are experienced in the throat and Avindpipe, extending at times to the lungs. These, with other facts, indicate that this terrible complaint is in its nature a true skin disease. In every variety of consumption, bronchitis is almost always present, and forms a part of the wasting malady which finally tenninates in death. In some 35,000 cases of lung disease, for which I have been consulted, I do not think I have seen half-a-dozen in- BRONCHITIS, A SKIN DISEASE IN THE LUNGS. 49 stances of true consumption, in which there were no traces whatever of bronchitis. Bronchitis is, indeed, a most common complaint. Thousands of people have it more or less severely, usually in the cold or changeable weather of fall, winter, or spring—the disease subsiding of itself, in very many cases, in warm weather: following, in this respect, the laws of salt-rheum, and some other skin diseases, which are known to appear in their worst forms during the cold and changeable seasons of the year, and to disappear, perhaps, in summer. Sore throat, hoarse- ness, and cough, Avith expectoration, frequently subside in summer, and the patient believes himself well. Many medicines have the rep- utation of curing disease, when given at the commencement of the warm season, Avhich are found to fail at all other times; showing the cures to be the result of a change of season, from cold to warm, and not of medicine at all. The first material change in the weather, at the approach of autumn, exposes the sad mistake. After salt-rheum has existed for some length of time, we find that the recurrence of warm weather does not abate it. The same is true of bronchitis. After it has become thoroughly chronic, it will continue with but little, if any alleAriation, during the whole summer months, and often steadily pro- gress until bronchial consumption is fully established. As bronchitis, either in the throat or lungs, almost always accompanies true tuber- cular consumption, and, in its earlier stages, is better in warm than in cold Aveather, consumptives are very generally invited to visit a Avarm climate; and we have here an explanation of why it is that consumptive invalids for a time imagine themselves improved by going South. Their cough becomes less, they expectorate less, have less pain and tightness in the chest, &c, &c; but a sad experience usually proves that the great disease—the tuberculosis —the true consumption—goes on unchecked, and often as rapidly becomes fatal in a warm climate as in a cold one—sometimes even more rapidly. In some rare cases, certain skin diseases shoAv themselves only in hot Aveather; as, for instance, shingles, hives, ease is removed, the wasting of the system by them, the deteriora- tion of the general constitution, and the prostration of the general health aatII so reduce all the vital forces of the system, that tubercu- losis of the lungs will usually take place; and then, if timely aid is not secured, Ave may expect a fatal issue. There are hardly any diseases to Avhich the human system is subject, that require, for their successful treatment, more mature judgment or higher medical skill, than those under consideration. It is in these cases that the efforts of the skilful and experienced physician and surgeon, will often re- sult in the greatest medical triumphs. If the lungs have become dis- eased, operations for the cure of fistula, or amputations for the re- moval of limbs affected with white-swelling, must not even be 188 CONSUMPTION FROM SCROFULA. thought of until we have first relieved the lungs and placed them in a state of health; because, if the lungs are diseased, and, by a surgical operation, parts discharging great quantities of pus are removed, and the issues that have been long open are dried up, the Avhole cur- rent of purulent secretions will be thrown upon the lungs; and this, together with the shock to the system, caused by the operation it- self, will usually bring on a fatal termination in a very short time. I have witnessed many cases where surgical operations have been per- formed in the amputation of limbs, or the attempted cure of fistula by cutting, Avhen, at the same time, the kvngs were affected, and in all of them there has occurred a rapid increase of pulmonary symptoms, followed by the death of the patient far sooner than would have taken place had the diseased limbs been allowed to re- main untouched by the knife of the surgeon. This remark, however, does not apply to cases of dead bones, which may sometimes be re- moved Avithout exasperating any lung affection. But in all cases it is indispensable to fortify the lungs, so that in no contingency shall they become diseased. In 1847, a gentleman called on me from the neighborhood of Keene, N. II. His left elbow-joint was enormously SAvelled, and an abscess had formed from which were discharged great quantities of pus. The arm above the joint was emaciated apparently to the mere bone. He had at the same time a very bad cough, with purulent and bloody expectorations. He had received conflicting advice on the subject of his arm. The most experienced surgeons, such as Dr. T---- of Keene, advused to let it alone, as all experienced and judicious physicians Avould have done. I advised that the arm be not removed, and that no attempt be made to heal up this great issue until the lungs were cured. He followed my advice. I gave him such remedies as I thought best under the circumstances; ad- vising tonics, pure air, and pulmonary medicines. I strongly urged him to have no operation performed upon the arm. He returned to New Hampshire and recovered his health. His lungs were soon re- lieved, and I believe his arm got well. In all these cases, the cure must commence in the lungs and in the general constitution of the patient. His blood must be purified, degeneracy arrested, and its poi- sons removed, or a cure will not follow. But, by a course of treatment calculated to secure these ends, these diseases are generally curable. The late Dr. John A. Swett, in his work on chest diseases, gives INTERESTING CASES. 189 the following cases, which beautifully illustrate and prove what I have said in regard to pulmonary consumption, in a great variety of cases, beginning in a part of the system far from the lungs, and ending in the lungs themselves—terminating in true tubercular consumption. He says in his Treatises on Diseases of the Chest: " A medical gentleman died in this city during the past year, who had suffered for a long time with symptoms of disease of the urinary organs and of the rectum. This disease was found, after a post- mortem examination, to be a cancerous affection of these organs ; at the same time the lungs were found full of cancerous deposits. Yet neither the patient, nor the intelligent physician who attended the case, ever suspected any pulmonary disease." He gives another case equally striking :—" I remember the case of a young lady whom I attended many years ago, which made a great impres- sion on me. She was suffering from pain in the head and from chronic diarrhoea. She emaciated rapidly, had hectic fever, but never any symptoms of pulmonary disease : no cough or pain in the chest existed, and the respiration was easy and natural; yet after death the lungs were found full of tubercles beginning to soften." The first was a case of cancer consumption. The second a striking case of bowel and brain pulmonary consumption. There is perhaps no class of disorders having their seat in other parts of the system, that so severely threaten the lungs as the affec- tions I have adverted to in this chapter. When they occur, there is invariably great danger that disease Avill develop itself in the lungs in the natural course and progress of these affections. There is still greater danger that it Avill do so when any means are taken to " scatter" or suppress swelling, or heal abscesses, or indeed when any treatment is adopted calculated to subdue or dissipate any of the manifestations of humor, unless at the same time the most sedulous care and the most efficient measures are taken to guard the lungs against attack, and maintain them in the full and uninterrupted per- formance of their functions. These diseases should never be neg- lected. Besides being liable to develop disease in the lungs, they are most distressing and dangerous in any of the manifestations I have described. It is possible to treat them in such a manner as not to endanger the pulmonary organs, and at the same time arrest their destructive course, and rescue the patient from their delete- rious influences. 190 complications of consumption. I have now given a summary of the primitive forms of consump- tion, if I may be alloAved the expression, or a description of those diseases originating in the lungs themselves or in distant organs of the body, that finally terminate their course upon the lungs, each presenting in their origin distinctly marked characteristics, and so plainly differing from each other as to authorize a separate classifi- cation, and demand some different remedies in their treatment. Although at the very close of life, consumption seems the same disease in almost every person who dies of it—and many times an examination of the lungs themselves after death will hardly justify making so many distinctions in the disease called consumption—still, the original variety, the primary cause and the primary seat of the disease, and its peculiar influences upon the system, will mark and modify the whole course of the sickness almost to the very close of life. EVERY CASE OF CONSUMPTION AN INDIVIDUALITY. It should be borne in mind, that from the twenty-two varieties of consumption I have described, result almost an infinity of com- plications and combinations, so that it is extremely rare that you will ever see two cases of pulmonary consumption so nearly alike but that a close observation would detect differences. I remind you of this in order that you may recollect that every case of consumption is an individuality differing from every other in some particular, although agreeing with all others in general points of resemblance. This knowledge will lead you to avoid grouping together classes of pa- tients, and to investigate each case carefully in all its own peculiar features, overlooking not a single symptom by AA'hich a difference is established; prescribing in the first place all the remedies requi- ^ site for the general points of agreement between this and every other form of consumption; and then prescribing the particular remedy required to overcome the symptom or condition in Avhich the case in hand is peculiar. Thus every case will call for all your learning, your observation, your powers of analysis, and your pro- fessional acumen to determine its whole condition and the totality of its present and prospective lesions. This done, the same care, and the same regard to the individuality of the case, will influence you in selectmg the remedies necessary for its prevention and its final cure. COMPLICATIONS OP CONSUMPTION. 191 THERE IS NO " SPECIFIC" FOR CONSUMPTION. It must be evident from what has been said in the preceding pages, that for the successful treatment of lung diseases, it is required that we exhibit far different remedies in some forms of consumption from what we do in others, if our practice is to be scientific, rational, and successful. If, however, we propose to treat lung disease on " spec- ulation," then we will employ one remedy for all forms of consump- tion, when, of course, failure and disappointment will cover us with contempt and shame; then we shall adopt some " cure-all," and, boasting of its "never-failing power to cure," prescribe it indiscrimi- nately in all cases, until repeated failure demonstrates its uselessness, and drives us to look out for some other " specific" to have its fashion and its day, and in turn to be thrown aside. Such a course, which is too common, tends to make the very name of physician, in connec- tion with the treatment of consumption, a term of distrust and re- proach. By carefully pursuing the history of the varieties of consumption that I have described, the intelligent reader and the intelligent physi- cian will most readily understand why no single remedy has ever yet been discovered that will prevent the commencement of pulmonary consumption, or cure it after it has once taken place. Hence the utter and total failure, in all times and in all circumstances, of the at- tempt to cure pulmonary consumption by one remedy. The disease itself is so diverse and so varied, its preceding causes are so multi- farious, the progress and changes made in the system and upon the lungs are so multiplied and conflicting, that it is truly impossible even to conceive of one medicine that shall alone cure pulmonary consumption. As well might we suppose that ice could be so modi- fied that it should at the same time heat our houses and congeal our creams, or cook our food and freeze it at the same moment, as to sup- pose that we can discover one remedy that singly and alone can restore the distorted chest to perfect symmetry, expand the lungs, restore the general strength, purify and enrich the blood, and diffuse health and life and vigor throughout the entire system. Such a single remedy has never been known, and seems in the nature of things to be even an impossibility. The terrible charlatanism and empiricism, Avhich have travelled the world over among high and low, has de- 192 COMPLICATIONS OF CONSUMPTION. rived its origin and its perpetuity from the great confusion that has prevailed upon the subject of consumption itself, more than any thing else,—a confusion Avhich I hope this treatise will serve in some measure to dispel, and so clear the noble science of medicine and the art of healing from most unmerited odium, incurred not from any want of efficiency or curative powers in medicine, nor from the impossibility of obtaining the mastery over nearly every case of pulmonary consumption in its commencement; when it will appear, if there is a failure to cure in any case not fatally delayed, that the failure is not a necessary one, but is due to a want of knowledge and want of skill in the practitioner who treats it,—knowledge and skill which are within the reach of all physicians who will consent to lay aside their preconceived notions and their prejudices, and be guided by the light of facts and true science. CONSUMPTION THE CITADEL OF QUACKERY. Consumption is the citadel of quackery. Make this disease un- derstood, and curable in the hands of all intelligent physicians— settle the principles concerning it, and the remedies required for its prevention and cure, and there is an end of quackery. Em- piricism will have so little left for its foundation and support, that it will not long exist in the hideous proportions that it now presents. But let the same confusion prevail in regard to consumption that has hitherto prevailed—the same capriciousness and want of success in the administration of remedies—and the quack, the empiric, and the regular physician will continue to be classed in the same cate- gory—the latter more respectable, but the former equally suc- cessful. CHAPTER XX. PULMONARY HEMORRHAGE, SHORTNESS OF BREATH, VARIETIES OF COUGH, AND EXPECTORATION. HEMORRHAGE. This is one of the great symptoms of pulmonary consumption, caused by an organic pulmonary lesion, and usually calling for prompt medical assistance. In all the varied horrors of consumption, in all the symptoms throughout its development, there is no one that excites more alarm in the patient, more overwhelming dread of present danger, or greater foreboding of future evil, than bleeding from the lungs and throat. Even Avhen slight, it excites the most intense alarm in the patient, and the most agonizing distress to his friends. There are various causes of pulmonary hemorrhage, as well as various periods when it is most apt to occur. So there are various states of the lungs inclining to pulmonary hemorrhage; and in many individuals we find, from peculiarities of temperament, a much greater disposition to bleeding than in others, although there are none Avithout exceptions. I have referred to pulmonary hemorrhage frequently before, but I here group the whole subject together, so that the physician and patient may have it all before them in one chapter, and, in case of emergency, find here a convenient reference for assistance and di- rection. Of the temperaments, the sanguine is doubtless most liable to pul- monary hemorrhage. Persons with red hair, sandy or red whiskers, light complexion, and thin skin, are much more liable to hemorrhage than those of bilious temperaments, with brunette complexions, dark hair, thick skin, black beard and AA-hiskers. The sanguine phlegmatic temperament is also very liable to hemorrhage, for in this tempera- ment life is loAvest and pulmonary circulation most feeble. It is in- dicated often by a plump habit, thick, rosy lips, etc. 13 194 PULMONARY HEMORRHAGE. The lungs may be placed in such condition as to lead or incline to hemorrhage, by the following causes:—and first, MECHANICAL INJURIES, Such as blows, falls, straining the chest by great mechanical efforts, as wrestling, running great distances, lifting heavy weights, long and loud speaking, orators holding on for some hours in their orations, clergymen preaching several sermons the same day with very much effort, will bring the lungs into a condition in which bleeding will take place. Sometimes the bleeding takes place immediately after the injury; in others, the catastrophe is put off for several hours or several days, when most unexpectedly, and even after the injurious occurrence is almost forgotten, the person may be seized with hemor- rhage. It may occur while walking or talking, while exercising or when at rest; but it very often occurs upon retiring to bed, or in the middle of the night, or towards morning. The patient upon : awakening feels something in his mouth ; he spits it out, or, rising, seeks a light, and finds that it is blood. In most cases the fever and alarm it excites are truly distressing, and it- must be a stout heart indeed that is not fearfully overcome by a first hemorrhage ifrom the lungs. HEMORRHAGE FROM PLETHORA AND CONGESTION. A condition of the lungs favorable to bleeding, may arise without any external injury whatever. Persons of indolent habits, students sitting long at desks, who have but little exercise, who indulge in full, free living, drinking much porter, ale, and malt liquors, and sometimes those who drink distilled liquors, whose bowels are slow, digestion tardy—food lying long in the stomach—when the circula- tion becomes slow, dull, and heavy; persons given to excesses and debauchery, or who are exposed to much heat or great cold; resi- dents of the city, and those who spend their time in large workshops, or in situations where the air is very close—will often be attacked with hemorrhage from the lungs without any previous admonition. This is strikingly the case where large numbers of persons sleep in one room in hot weather, where the air becomes exceedingly impure and highly rarefied. CAUSES OF PULMONARY HEMORRHAGE. 195 I was called, in the Avinter of 1853-4, to visit a young lady in New Jersey. She possessed a sanguine temperament, and was truly beau- tiful. There was not the least disposition to consumption in her family. The July previous, at a large boarding-school in New Jer- sey, she was compelled to sleep in a room with thirty other young ladies, most of them groAvn up. This room was in the attic of the house, which was divided into four compartments by board parti- tions, the partitions not extending to the ceiling: this room was wholly without ventilation. In this " black-hole" thirty young ladies, of the best families, were forced to sleep every night in the very hottest weather, without an open window or any thing whatever that could permit ventilation. As a consequence, she was taken with bleeding from the lungs. When I saw her, she was in very advanced consumption, and died in a few weeks. Another cause is found in TAKING COLD, And consequent suppression of the cutaneous perspiration and clo- sing of the emunctories of the system generally, from being excess- ively chilled, etc. The patient, after a period of short breathing, slight hacking cough, and cold upon the lungs and head, may be attacked with hemorrhage. The SOFTENING OF TUBERCLES, Is another cause of hemorrhage; sometimes the tuberculous de- posits may be near a large blood-vessel, and in the course of their softening may cut off this vessel so as to produce sudden, and some- times fatal, hemorrhage. In another class of cases, the lungs, one or both, may become collapsed from effusion of pus or water in the pleura. This state of collapse may become permanent; and the pa- tient, on returning to tolerable health, will be attacked with sudden and copious hemorrhage from the bursting of a blood-vessel, caused by the effort of the system to carry on the circulation and open the collapsed lung. 196 PULMONARY HEMORRHAGE. SUPPRESSED CATAMENIA, DRYING UP OF OLD ISSUES, ETC. Bleeding from the lungs, as a vicarious discharge, occasionally occurs. I have witnessed repeated instances in ladies, where the cata- menial function Avas suppressed, who, at the return of the period, would be attacked more or less with bleeding from the lungs, and this very frequently in very delicate subjects. The drying up of old issues, such as ulcers, sore legs, discharges from the ears, the sudden curing of long habitual piles, and especially bleeding-piles, will very frequently be followed by bleeding from the lungs. These are a few of the groups of causes that the physician will meet in the course of his practice. He should be perfectly aware of them all; and in individuals or families with whose constitutions he is acquainted—whom he knows to be predisposed to consumption— he should avoid and prevent, if possible, any thing that can place the lungs in a condition to bring on bleeding. BLEEDING FROM DEBILITY AND CONTRACTION OF THE CHEST. There is another class of persons inclined to pulmonary consump- tion, which I have not mentioned; and these are persons usually of sedentary habits, who have delicate organizations, are very effemi- nate, and Avho, by the habit of stooping and throwing the shoulders forward upon the chest, have greatly contracted it. They are usu- ally of slight, thin figure—chest relatively small, etc. If these per- sons are at all predisposed to consumption, they very readily bleed from the lungs when they are acted upon by any of the exciting causes I have before mentioned. REMEDIES FOR HEMORRHAGE FROM THE LUNGS. In some persons of very plethoric habits, with large chests and a vast quantity of blood in the system, hemorrhage from the lungs may be very soon arrested by free bleeding from the arm; and in such cases the physician is fully justified in recommending it; but in persons of more delicate constitutions, of slighter development, and especially where they have already lost much blood, bleeding from the arm is not justifiable, and should not be resorted to. In some CAUSES OF PULMONARY HEMORRHAGE--REMEDIES. 197 cases, one or two leeches, or more, may be applied to the chest or over the part apparently affected, and be of much benefit. Dry cupping is also found to be very useful, and can rarely ever do any harm to the patient. Every effort should be made to arouse and equalize the circulation, and procure activity throughout the whole capillary system; and if the feet are cold, which is often the case, they should be put in very warm water, and be kept there till the circulation is drawn fully to the extremities. Mustard-poultices may be put upon the chest or between the shoulders; and after taking the feet out of the water, mustard-drafts maybe put on the feet with much benefit. The patient may take at the same time as much as he pleases of common table-salt. This is one of the most valuable reme- dies known to us for the prompt arrest of hemorrhage from the lungs. It will almost always stop it. Saltpetre (nitrate of potash) is also very valuable. Almost any of the astringents may be given with good effect. Lead should be sparingly used. The diet should be low in robust persons for a considerable time ; but in the feeble and deli- cate the diet should be light, still it should be generous and highly nutritious. We should at the same time endeavor to remove all the causes that have induced or inclined to hemorrhage; the bowels should be kept perfectly free; a compress dipped in water, or salt and water, either hot or cold, may be applied to the chest, or so as to cover it either partially or wholly front and back, which should be changed two or three times a day, until all hemorrhage, and the effects of hemorrhage, have disappeared. In cases resulting from the suppression of bleeding-piles, the appli- cation of leeches to the parts may oftentimes have a prompt effect in stopping the bleeding from the lungs. Old issues should be re- established as much as possible, and suppressed catamenia should be restored. Although bleeding from the lungs is so alarming, I have found, in a vast many cases, that persons who bleed from the lungs quite as often recover from pulmonary disease as those who, in the same disease, never bleed at all. I need not add here that the patient should be kept quiet, that conversation should be avoided, and that in no way should the lungs be exercised much under some days after the bleeding. We should forbid the use of the inhaling-tube, or any mechanical inhalation whatever, until some time has elapsed, when these may be cautiously resumed. All persons inclined to pulmonary diseases, when they 198 SHORTNESS OF BREATH. commence expanding the chest by the use of the inhaling-tube, or by taking long breaths, should exercise great caution at first, so as not, by these attempts, to bring on hemorrhage. I need not recapitulate what I have before said, but will merely add, search for the causes, mark their results, avoid inducing any of them by your own prescriptions, and apply prompt remedies to pre- vent bleeding in all those persons where the causes exist that tend to induce bleeding. With a clear perception of the causes, and a careful knowledge of the circumstances of your patient, you may usually be able to foresee a coming hemorrhage, and avert it by timely remedies. SHORTNESS OF BREATH. I will say a few words upon the subject of short breathing, which I have alluded to several times already. I do not, however, propose to do more than refer to a few of the more prominent cases; for, to discuss the subject hi any thing like detail, it would be necessary to mention every disease I have described as connected with the chest, heart, lungs, etc. Shortness of breath almost always results from a bad circulation of the blood : there is some condition of the system in which the blood is prevented from passing promptly and perfectly through the lungs, and it is detained there. It thus accumulates in the lungs, fills them up, and lessens their capacity to receive air. The blood thus held in the lungs is not aerated, and distress is felt, as for want of air. There is of course a struggle for more breath, and violent pantings, or con- vulsive efforts at deep breathing, take place. This is the case when a A'ery bad cold has been taken. It is the case in inflammation of the lungs, and in pleurisy: the breath is short, because, by the inflamma- tion, the lungs are engorged with blood, and the pain prevents the free expansion of the chest, when tubercles are deposited in the lungs; then the breathing becomes short. In cases of water on the chest, short breathing is observed; when the stomach is greatly loaded, it produces short breathing, if there is any weakness of the lungs. In thickening of the air-passages, when it becomes consider- able, the lungs fill up, and short breathing is caused. Ossification of the heart, or water about that organ, will, on exercise, induce short, hurried, and catching breathing. In instances of water on the chest, DIFFERENT VARIETIES OF COUGH. 199 one of the very earliest symptoms is shortness of breathing. In true tubercular or congestive consumption, and many other forms, the first premonitory symptom is shortness of breath—the person finding that he has not his usual breath. When he exercises, he is soon weak and debilitated, and his breath is short; and many times he will in- cline to take long breaths, and strive ineffectually to expand the lungs; and frequently this effort is accompanied by continual gaping: all this shows that the blood does not circulate properly in the chest. Shortness of breath often arises from an accumulation of fat in and about the chest, in persons who are very fleshy and stout. The fat will accumulate about the heart, and prevent its action, and also about the walls of the chest, in such a manner as to impede their ac- tion ; the stomach will be greatly filled up, and the diaphragm, or floor of the chest, does not rise and fall freely, as it would in usual health. The excess of flesh thus often becomes an actual cause of disease. By referring to the various and separate diseases of the chest which I have mentioned, the reader will find shortness of breath con- nected with nearly all of them. OF THE DIFFERENT VARIETIES OF COUGH. Those who have the opportunity of extensively observing con- sumptive diseases, are often struck with the numerous varieties of cough—their peculiar phenomena, the time of their appearance, their duration, etc. There is one variety of cough which might be de- nominated a " clearing-up cough," which, in a vast many persons, is a mere hemming. On aAvaking in the morning, almost the first thing to do is to clear the throat. Perhaps they expectorate little or noth- ing—sometimes, perhaps, a small quantity of sticky phlegm; and a few forcible expirations of air from the lungs clear the throat of the mucus. Perhaps, in the process, the patient hacks once or twice; and may be, through the day, the throat becomes slightly filled up, and a little hoarseness, Avith a little hacking and hemming, takes place. This is often the case in old people, and very often the case Avith children who have a slight catarrh about the throat and lungs. Often the mucus seems to drop doAvn from the back part of the nostrils into the throat during sleep, and in the morning must be cleared away. 200 DIFFERENT VARIETIES OF COUGH. In persons not predisposed to consumption, this state of things is not very alarming, as it is found with many who have had it for a long lifetime. This is the catarrhal variety of bronchial cough. CONSUMPTIVE COUGH. The consumptive cough, if carefully and strictly noticed, presents many features which indicate to the experienced observer, almost at once, the variety of affections to which the patient is subject. True tuberculous cough, in its early stages, is usually very obscure—a slight hacking, which is brought on and increased by exercise, such as running, or going up stairs; the patient, after such exercise, finds himself short-breathed and panting, with a short hacking cough, which he cannot suppress. As the disease advances, this cough gradually increases until it becomes very annoying; rarely ever oc- curring, however, in the early stages, whilst the patient is at rest and perfectly quiet, or when asleep. Where this occurs in persons pre- disposed to consumption, it is usually when they find themselves in a Ioav state of health, when they are feeble and easily fatigued: they retire to bed at night fatigued, and feel as fatigued the next morning as when they retired at night—sleep does not appear to rest or re- fresh them. This is strikingly the case with delicate females and young persons of both sexes—those Avho work as clerks, teachers, sempstresses, sewing-women, etc. When these symptoms occur, ac- companied at times by slight pain about the chest, with intervals of entire freedom from pain, and slight expectoration as the cough in- creases, perhaps sometimes a little blood being mixed Avith the phlegm raised, and at others profuse discharges of blood taking place, they mark unmistakably the commencement of true consumption, particu- larly in those predisposed to it. The patient at this stage should not be neglected, nor the true condition of his case overlooked; but he should be treated promptly with a view to his immediate relief and ultimate cure. Sedentary employment should be exchanged for ac- tive exercise, city ah- for a country residence, and mechanical reme- dies should be employed—shoulder-braces to expand the chest, and a supporter to support and strengthen the back, shoulders, bowels, etc., should be employed; every cause of debility and disease should be removed, repelled eruption should be brought back to the surface, the blood purified and the strength renovated; and in this way, in CONSUMPTIVE AND CONGESTIVE COUGH. 201 the early stages of pulmonary consumption, a cure will very often promptly result, and the patient, by perseverance, may finally over- come the disposition to it, and live in health during a long life. After consumption is fully established, and ulceration of the lungs has taken place, we usually find the consumptive to rest tolerably well during the night; but as soon as he wakes, or begins to move, in the morning, the cough commences, and in many instances con- tinues more or less for from ten minutes to half an hour, or an hour, attended by expectoration of thick, heavy matter, sometimes of a saltish, sometimes a sweetish, and sometimes a nauseous character. Some of the matter usually sinks in water; it is in some cases the color of cream, in others it has a greenish color. Having cleared the lungs of this purulent matter, and the cavities of the lungs being thoroughly emptied of it, the patient will perhaps have but little more cough for the whole day—in some instances none at all—until he retires to bed at night, Avhen he will usually experience another fit of coughing. What he does cough up through the day is often a light, frothy, watery substance, with scarcely any hard or thick mat- ter mingled with it. In some instances the cough will be difficult and violent. This is especially the case where the throat is affected, or where some parts of the windpipe are in a state of inflammation or irritation, and then the fits of coughing may continue for hours. The patient may feel as if something was scratching at his throat— as if a pin, or something of the kind, stuck in the throat; sometimes it will appear to be on one side of the throat, sometimes on the other; and he will continue thus for a long time, unable to suppress the cough or remove the offending irritant by which it is produced. During this coughing, the patient Avill merely raise a watery matter— a frothy substance Avhich floats upon the surface of the dish. If any heavy or thick matter appears, it Avill be in only small specks or par- ticles, appearing occasionally among the frothy phlegm. CONGESTIVE COUGH. There is a class of persons, usually possessing large chests, and short, thick, fleshy necks, and Avhose throats appear to be exceed- ingly small: upon exercise—talking or lifting—such persons are al- most invariably induced to cough. They readily strangle from any thing passing " the wrong way" in the throat; and then they will 202 DIFFERENT VARIETIES OF COUGH. experience a violent fit of coughing, and the throat will appear sud- denly to swell and fill up. Such persons, on taking up a lucifer match and lighting it, if they inhale the sulphur, are thrown into a violent fit of coughing. If the atmosphere of the room where they are is filled, to any extent, with dust, they will be almost suffocated. This is often the case with asthmatics, who are thrown into a fit of short breathing and coughing by the presence of various kinds of dust, powder, etc. Hearty laughter will usually induce cough; so will full exercise of the voice, as loud talking, singing, etc., when the face AA'ill become flushed, and the veins of the neck swollen, etc. There are thousands in whom severe coughing will be brought on by any of these circumstances. At all times when these exciting causes are not present, they may be perfectly free from cough. This description of cough may result somewhat from a slight irritability in the throat or lungs, but most usually it is connected with a pleth- oric condition and a consequent congested state of the lungs. The circulation in the lungs is not as active as it should be. The diffi- culty may be easily removed. STRIDULOUS COUGH. There is another variety of cough which often occurs in persons who may be lean, and usually are, but who have an inflammation or humor about the windpipe and throat. The sound is a smooth one, like that of a trumpet—a whistling cough, or a kind of whooping, which is noticed in a far greater degree in whooping-cough. HUMID COUGH. There is one variety of cough which, to the uninitiated, would seem to indicate that there was a vast quantity of matter in the throat and lungs, as we seem to hear it gurgle when the patient coughs ; yet he never raises any thing, and this cough may continue on him for years. It is produced in parts of the mucous membrane of the larynx or throat, or some part of the lungs; and this valve- like swelling will flap backwards and forwards in the air-passages, and obstruct the air, so as to give a sound that indicates the presence of matter or mucus, when nothing of the kind is there. This kind of cough is mostly observed in young persons and children. I have ASTHMATIC, BRONCHIAL, AND WORM AND STOMACH COUGH. 203 known it to continue eight or ten years, producing a most painful impression upon the hearers and friends of the patient. This variety of cough is very soon cured, and in a great many persons never leads to consumption; in others, consumption may eventually take place, but may not be produced by this cough. It is, however, most dis- agreeable and annoying to the sufferer and his friends. ASTHMATIC COUGH. The asthmatic, in a great many cases, will cough very little, or none at all, except during the paroxysms of asthma and whilst the secretions following these paroxysms continue; and after the attack has lasted from three to ten days, the cough will go off entirely, and the patient will have none Avhatever until the recurrence of another attack. The cough is dry at first, but as the disease progresses it becomes humid, and at length is attended by copious expectora- tion. In some instances where the disease is severe, and has con- tinued a long time, the cough may become continuous, or occur daily more or less. COUGH IN BRONCHITIS AND PULMONARY CATARRH. Where the mucous membrane of the lungs is extensively and chronically affected, the cough is not confined to any time or period, day or night. Persons thus affected will cough whenever the lungs are filled up and cough is required to relieve them. They usually cough on awaking in the morning, and after clearing the lungs: they may cough more or less all day, and wake up many times in the night and cough, to clear the throat and lungs. They are usually observed to cough, or hem, or scrape the throat on first attempting to speak. WORM AND STOMACH COUGH. A short, hacking cough, occasioned by the irritation of worms, or irritating matter in the stomach, is very frequently observed; and this cough is sometimes exceedingly violent—fearfully so, as if the chest would burst to pieces. In this kind of cough there is never any expectoration. It may be distinguished fi-om congestive cough by the absence of all flushing 204 DIFFERENT VARIETIES OF COUGH. of the face, or SAvelling of the veins of the neck, or wheezing, or shortness of breath on exercise. From asthmatic cough it differs in this, that the subject of it does not cough much more at one time than another, and has no asthmatic paroxysms. By noticing these facts, and considering the other symptoms of worms or dyspepsia, it may be distinguished from any other kinds of cough. GENERAL REMARKS. I have thus cursorily glanced at these varieties of cough; but I never lay any great stress upon the cough as gi\Ting positive indications of the character of the disease from which it originates. The only certain mode of ascertaining the condition of the chest is by exami- nation, when, to the practised ear, unmistakable indications of healthy or diseased lungs and air-passages will at once be presented, and the cough traced directly home to its source. I Avould here remark, that cough is not a disease of itself, but a mere symptom or result of dis- ease, and always proceeds from some cause back of itself; and yet, when severe, it becomes a source of great injury to the patient, es- pecially when it is one. caused by irritation, and is not excited to expel matter from the Avindpipe, lungs, or any of the air-passages. It then becomes a source of injury and debility to the lungs, and, in congested lungs, may often bring on bleeding. It is most desirable, on this account, that a cough should be stilled and quieted, especially when it proceeds from irritation. It is ahvays a pleasant symptom when we find the cough retiring and the strength of the patient increasing. In the advanced stages of consumption, a very short time before death, after the patient has become greatly reduced and the lungs almost destroyed, his cough will often abate very much indeed—even stop altogether; and the mistake of inexperienced physicians and hoping friends will pronounce the patient much better; but the shortness of breath, prostration of strength, and inability to move or converse without immediate exhaustion, indicate unmistakably to the experienced observer that the patient is no better; but that, on the contrary, he is much worse, and that his sufferings will soon close in death. EXPECTORATION IN PULMONARY CONSUMPTION. 205 EXPECTORATION IN TRUE PULMONARY CONSUMPTION. In true pulmonary consumption, where the lungs become ulcerated, we usually notice three principal kinds of matter expectorated : one is the bluish, sticky, glairy, catarrhal mucus, which, on being taken up on a stick or a spoon, will extend out in long strings, sometimes to the extent of a loot or more, holding together by its gluey, sticky nature. This matter comes from that portion of the mucous membrane of the lungs or air-passages which is in a state of inflam- mation, and occupied by humor. The other is a kind of matter mixed more or less with that above described, which has in many cases the appearance of cream, of a whitish or greenish color, and of a sweet- ish, saltish, or nauseous taste, usually sinking to the bottom of the dish into which it is expectorated. It is found to consist of the pu- rulent result of ulceration, mingled with tuberculous matter in a greater or less degree dissolved. It is a great mistake, however, to suppose that it is necessary to have a cavity in the lungs in order to have pus present there; for the mucous membrane, in some states of inflammation, though it is neither broken or ulcerated, may pour out pus. This is the case in thousands of persons Avho have catarrh upon the lungs. There will at times be a secretion of true pus upon the surface of the mucous membrane in these cases. Of course, where there are ulcerous cavities, there will be secreted more of this cream-like, heavy matter, than when it proceeds from the inflamed mucous surface. I would remark, that frequently the discharge of this purulent matter is greatest in the morning, when on changing position in rising from bed there occurs a fit of coughing. The third variety of matter which consumptives often expectorate, usu- ally through the day, is a frothy, watery substance: there is hardly any thing of it but Avater. It is secreted in the mucous membrane of the lungs, which is in a state of irritation, and resembles greatly the water Avhich drops from the nose, when exposed to a cold, in persons inclined to catarrh. In some consumptives, it is very acrid and scalding to the throat, inducing great irritation and a burning sensation in the lungs and throat. In other cases it is not acrid, being scarcely more than simple water, as mild as the tears. 206 EXPECTORATION. EXPECTORATION THAT OFTEN PRECEDES TRUE PULMONARY CONSUMPTION. Persons troubled with catarrh about the throat or in the lungs, at- tended, as it often is in these cases, by annoying hemming and scraping of the throat, will frequently hnagine they feel a movement of something in the throat, as though a small mass of mucus were sticking there and moving up and down. This is most frequently felt in the morning immediately after rising from bed, when the pa- tient has usually a fit of coughing, accompanied by forcible but unavailing efforts to raise the phlegm. But it may occur at any time during the day, and in many instances many times a day. It seems to the person thus afflicted, that there is a considerable mass of matter in the throat, but that it is stuck fast—so firmly adherent that no efforts can dislodge it. After severe coughing and much effort, a small quantity of phlegm is raised to the mouth, and then there is another struggle to get rid of it, as it sticks pertinaciously to the tongue, the roof of the mouth, and the lips. When finally ejected, it is found to be a small mass—not usually in any case more than a small teaspoonful—in some cases of semi-transparent, sticky, tenacious matter, of a bluish-white color, and in others a thick, limpid fluid, like the white of an egg, as clear and transparent as isinglass. When persons are not predisposed to consumption, this expectora- tion is of but little consequence, and little danger is indicated by its presence; but if predisposed to consumption, this slight secretion may go on increasing until large quantities are expectorated, cough fully established, and consumption confirmed. I should never advise any one to allow its continuance, but to take measures to correct and remove its cause; for Avhatever the cause may be, the lungs and air- passages cannot be in a perfectly healthy state. There are no such vicious secretions whatever unless there is disease of some kind. The matter which is thrown out from healthy lungs, passes out in the form of vapor, along with the air we breathe, and does not obstruct any part of the air-passages. PECULIAR SUBSTANCES SOMETIMES EXPECTORATED. We frequently observe in the sputa expectorated by consumptives, pieces of hard matter; sometimes as hard as bone apparently, at PECULIAR SUBSTANCES SOMETIMES EXPECTORATED. 207 others about the consistency of hard cheese. Sometimes these par- ticles are very minute, and being mingled with the opake, creamy sputa, can hardly be distinguished; at others they are seen as large as grains of wheat, and even larger sometimes. These little particles of hard matter are raised and detected in the mouth almost or en- tirely free from phlegm or other sputa, when they are perhaps taken in the fingers and found to be small granules, round and smooth, appearing like bits of polished ivory, if very hard—and if softer, like pieces of white cheese that have been rolled smooth in the fingers. When this phenomenon occurs, it should give the alarm. These granulations are tubercles, more or less in a state of softening, which have become detached from their place of deposit in the lungs, and ejected. They indicate that the patient has the consumptive habit, or diathesis, as it is called—if not already in consumption. No time should be lost in taking measures to arrest the disease. In some instances we observe, in the matter expectorated fi-om the lungs, particles of a peculiar gritty substance, having all the appear- ance of, and which are in fact, chalky concretions. As I have before remarked, these chalk deposits in the lungs are most frequently found in those cases where there is, or has been, a rheumatic tendency in the system, and rheumatic consumption is developed. It is thought by some, and it may be true, that tubercles sometimes become con- verted into chalk, and are then detached, finding their way into the bronchi, and are thus expelled. If this is so, it is undoubtedly one of the modes by which consumption may be cured—the tuberculous deposits passing into this chalky state, instead of softening and breaking doAvn in a condition of ulceration. It sometimes, although very rarely, occurs, that living worms are developed in the lungs. I do not here refer to the more common occurrence of a peculiar formation in the pulmonary organs of what are known as hydatids, or vesicular worms. These are of a very low grade of animal life, hardly worthy the name, being as it were only a species of slightly animated cysts, or jelly-like bags. But the worms I allude to have a perfect organization, and a high degree of life. I have myself known only one case in which these worms made their appearance. They were expectorated with the sputa for a con- siderable time before the close of life, and were found in considerable numbers in the lungs after death. The case did not otherwise pre- sent any remarkable features, being true hereditary tubercular con- 208 EXPECTORATION. sumption, attended from its beginning to its close by the ordinary symptoms and circumstances. DOES MATTER EXPECTORATED FROM THE LUNGS, WHICH SINKS IN WATER, ALWAYS INDICATE THAT THE LUNGS ARE ULCERATED ? It is a common impression that any matter expectorated from the lungs by coughing, which sinks in water, must be of the na- ture of pus ; and then assuming that purulent discharges occur only where there is ulceration, and that none but the purulent discharges from the lungs are heavier than water, the conclusion is reached that such sputa ahvays indicate ulceration in the lungs. Now, both the premises and the conclusion are erroneous. It is not true that none but purulent discharges from the lungs have a greater density than Avater. We often find the purely mucous secretions denser ahd heavier than water. Even the mucus discharged from the nose will often quickly sink in water. This is frequently true also of the secretions that take place in pulmonary catarrh, particularly where the disease has been long established, and where the secretions lie for some time in the lungs, as they often do before they are expecto- rated. The simple fact, therefore, that matter thrown off from the lungs is heavier than water, unless there are present other symptoms pointing to tuberculation and ulceration, furnishes no ground for serious alarm. Still it is true that pus does sink in water, and that the product of ulceration in the lungs has generally this character. I will not, however, dwell any longer upon the subject of the mat- ter expectorated, or the varieties of cough ; neither of them afford conclusive proof of the presence of true consumption. When joined to other symptoms—such as fever, pain, prostration, short breath, night-sweats, raising blood, etc.—they may be safely set down as indicative that the patient is consumptive; but whatever may be their character when occurring in those who are in their usual strength, who do not suffer from short breathing, who experience no fever, no night-sweats, etc., and who are not predisposed in any man- ner to consumption, we may almost safely hope that the terrible dis- ease is not upon the lungs. At any rate, under these circumstances, the disease from which they originate is usually very promptly and readily curable. CHAPTER XXI. CONSUMPTION IN CHILDREN. True tubercular consumption and bronchial tubercular consump- tion are occasionally seen in children, and frequently those of the most tender age. They may be produced by any of the causes I have before mentioned as inclining or inducing pulmonary consump- tion. I once knew a child at the age of seven months, attacked by congestive consumption, commencing with bleeding from the lungs, produced by the sudden cure of salt-rheum upon the face, without at the same time opening the system and purifying the blood of its poisons. Hence it settled on the lungs, and true consumption super- vened, passing through all its stages, and the child died in its moth- er's arms, a victim to improper medical treatment. Measles, Avhooping-cough, and all this class of diseases, when im- perfectly treated, often leave their vestiges upon the lungs, and re- sult in true tubercular bronchial consumption. I have witnessed many of these cases ; but in some instances it will commence without apparently any special cause. The child may be in delicate health from any cause, and, by improper treatment, be thrown at once into pulmonary consumption. What I have said about improper medical treatment in adults, as often producing consumption, applies with ten- fold force to the condition of children. The exceeding delicacy of their tissues, the laxity of their fibres, the Avant of density in their muscles as evinced by the softness of the fleshy parts, and the very rapid emacia- tion to AA'hich they may be subjected, indicate to us most clearly that harsh medicines, severe treatment, and especially mineral medicines, should never be exhibited. Their nervous impressibility and sensibil- ity are also very great, and hence they are capable of the most acute anguish and suffering, from causes that would but little effect the adult. A blister upon the person of a child inflicts ten times the relative suffering that it would upon the adult. I must confess that in calling to mind the tortures to which I have seen children sub- 14 210 CONSUMPTION IN CHILDREN. jected by the use of harsh and cruel remedies, the sad remembrances fill me with sorrowful indignation. Could I influence physicians, I Avould implore them never to inflict upon a child any thing but the gentlest medicines. I cannot better illustrate this subject than by introducing a few cases within my recollection. Case First. During December, 1846, in this city, I was called upon by a very respectable medical man, Avho requested me to visit his only son, a fine little boy six years of age, avIio had been sick about three weeks. He had been attended by tAvo respectable physicians, who had pro- nounced his disease remittent fever. It had commenced very ob- scurely. He had drooped, lost his appetite, the eyes had become dull and almost expressionless, his flesh and strength had rapidly declined, and he had a slight hacking cough, with occasionally a chilly sensation folloAved by slight fever. The physician, pronouncing it re- mittent fever, had advised remedies consistent with such an hypoth- esis, as quinine, calomel, etc.; and these were persisted in for a long time, assisted by various medicines, fever powders, and others of that class. This treatment did not check the disease. The child's lungs might have been someAvhat tuberculated at the commencement of the treatment; if so, these remedies rapidly augmented the disease, and he grew worse and worse. When I Avas called to visit him, he was in the last stages of true tubercular consumption. I need not at- tempt to describe the sufferings of his parents, or dwell upon his early death. A different treatment, I have no doubt, would have saved his life. Mercury, in any form, is fatal to delicate children. Case Second. In the winter of 1850-51, I was called to Brooklyn to see a little girl of seven years of age—an only daughter. Her father, the master of a packet-ship, was at the time absent in Europe. She had been taken ill some weeks before Avith a slight cold—inclined to be feverish, with loss of appetite, etc., and a little obscure couo-h. The family physician was called in. He was a respectable, mid- dle-aged, old-school practitioner, of good standing among the first families of Brooklyn. After examining her case carefully, he pro- CASES STATED. 211 nounced it to be worms; and for their expulsion recommended the exhibition of a large dose of spirits of turpentine, beat up and disguised Avith the yolk of an egg. This horrible dose the moth- er gave her darling child. She had previously asked the physi- cian if it would do any harm. " Oh no," said he ; " anybody may take spirits of turpentine if it is only beat up with the yolk of eggs, to prevent its irritating effects." The consequences Avere Avhat might easily have been anticipated. The amount of tur- pentine given to the child, if applied to the throat and breast, Avould have blistered them all over; and although the internal surfaces were sheltered, in some degree, by mucous secretions, they failed to save them from the burning turpentine. The whole internal surfaces AA-ere literally burnt up—scorched as if a hot iron had been draAvn over them. Almost an utter suppression of urine also folloAved: the child scarcely passed a drop of water for whole weeks. The tongue, all but crisped, was scarcely larger than the little finger, and red as a piece of beef. The throat was so denuded of its mucous membrane and so contracted, that the voice became a mere squeaking treble, and the Avhole internal surface of the lungs Avas in the same condition. She had a dry hacking cough, but no expectoration. The air-passages Avere greatly shrunken, and the mucous membrane dried up. Throughout every part of the lungs, Avhistling and squeaking Avere heard as the air passed over the burnt surfaces. The boAvels were sIoav, and the Avhole surface of the body, with the limbs, hands, face, and feet, were dry and shrivelled—feel- ing like sand-paper to the touch. Such was the situation of this poor little sufferer Avhen I Avas called to see her. Could the physician have abandoned her after his first dose, Nature might possibly have relieved her; but harsh medicines were still given for her cough— squills and severe diuretics. These only served to perpetuate the cruel mischief that the turpentine had so dreadfully commenced. I apprehended that the cure of the child was impossible. Still I was anxious to preserve her life until her father's return. With the most soothing medicines and gentle demulcents, the blandest and gentlest diet, she slowly rallied, and the kidneys resumed in some degree their wonted office. She lived to see her father, but died in the July following of diseased lungs. 212 CONSUMPTION IN CHILDREN. Case Third. To illustrate this subject still farther, I will give another case, as stated to me in a letter written by the mother of the child referred to—a lady of intelligence, and belonging to one of the most distin- guished families in our country. I could not add any thing to the force of this sad narrative : " A---, near M---, Ky., June 25th, 1855. " Dr. S. S. Fitch : " Dear Sir,—Upon reading your Six Lectures on the uses of the lungs, I have determined to write to you respecting the condition of my little son. We reside in N---- in the winter, and return to K----y in the summer. My little son was taken with a slow fever the third day of last January in N----. Our family physician was called in, and administered medicine. He did not regard the dear little fellow as very sick; but his fever and loss of appetite continu- ing from day to day for two weeks, alarmed me, and Dr. S----was called in to consult with Dr. B----. He approved of his course of treatment (principally calomel and quinine), just calling it an obsti- nate lingering fever. On the 24th of January, he was taken with hemorrhage of the bowels. Dr. R----Avas then called in consulta- tion with Dr. B----and Dr. S----, and his life was despaired of for four days and nights, during AA'hich time the hemorrhage lasted. Then they pronounced it the fever typhoid. After checking the hemorrhage, they did not expect a return of the fever; but the fifth day it returned—the pulse 120 to the minute; still they examined his lungs and said they could discover no cause for the fever. They continued to endeavor to break the fever until the last of February; then they ceased trying. Very little of his strength had returned, and a slight clearing of his throat had commenced, Avhich gradually increased to a hacking cough. They told us we must take a sea- voyage : they could do nothing more for him. We sent for Dr. • 7T' the auscultator' to examine his lungs; and he told us if we wished the body of our child, never to take a sea-voyage-that his lungs were so far gone that he would not live but a few weeks (lie had not expectorated one particle at this time.) Neither Mr M----nor myself knew any thing of this disease, so we employed a homoeopathic physician one month. Still the child gradually o-rew CASES STATED. 213 worse, his fever as high, and his cough very hard and dry. We wished to change the air we were in, and it was too early to come to K----, so Ave went seventy miles in the Pine Woods, on the Jack- son railroad. We went out in March. The child was very feeble, and only weighed thirty-three pounds, and he is in his eighth year; he was not able to walk. Under the treatment of Dr. T----, the physician there, he greAV rather better. He commenced expectora- ting the 4th day we went out; and Dr. T----could not believe his lungs so seriously affected, but thought the disease Avas confined to the bronchial tubes. He relieved his throat, and he gained some three pounds in flesh, but his expectoration had changed from the white phlegm to yellow matter; his cough Avas no better, his nights became restless, and night-SAveats and chills commenced. We re- mained there six weeks, then I started to K----, not thinking my child AA'Ould live to reach L----; but during the trip up he suffered exceedingly. We were then applying a liniment and alcohol to his breast, and giving him cod-liver oil and whie. When we reached L----, Dr. R----and Dr. P----examined him, and told me there were cavities on his left lung, and the whole of it Avas thoroughly diseased, but that his right lung was sound, and that they could do nothing for him. He could not sleep at night, his respiration very hurried, his pulse 140 to the minute, some three or four chilly sensa- tions a day, an entire loss of appetite, most profuse night-sweats even Avhen he fell asleep in the day, cold feet and knees, and a most dread- ful cough, expectorating a large quantity of matter, and picking his nose constantly : that was the condition when Ave reached home, and feet very much swollen. So soon as I reached here, I asked our physician, Dr. R----, to alloAv me to put a bandage on our little son, wrung out of ice-water, but he said he Avas too Ioav to experiment Avith, and they all said I might look for his death any day. So I determined I Avould put it on Avithout his permission. I did so on the 15th of May, and he appeared to be better from the very day, and, until the last week, I had great hopes of his recovery. He has not had a night-sweat for some weeks. He noAV coughs very little, and expectorates none, and has not had a chill for some two weeks. He gained a little flesh and strength until the last week. He now complains of severe pain in the right side of his head. (He does not pick his nose as much as he did.) The glands of his throat around his ear on the outside are swollen, and he is much weaker than he 214 CONSUMPTION IN CHILDREN. Avas two Aveeks since. His fever is still the same, and very hot skin at times; but he now sleeps quietly all night, lying either on his right or left side, or back; his feet do not sAvell so much as they did. There is no hereditary consumption in our families. Our dear little son has never been robust, but never siekly—just had a delicate appearance, and has always been remarkable for his exceeding beauty, and regarded by every one as very precious. Were he now able for me to undertake the trip, I would not hesitate one moment about starting to place him under your care; but he suffers so much Avith his head, and appears to have lost so much strength in the last Aveek, that I fear to start. Since I have your lectures, I have procured one of your inhaling-tubes, but I cannot teach him to use it; still I try to make him draw long breaths as often as I can through the day, for his respiration is very hurried. I have just kept his chest and back covered Avith a wet linen cloth, wet three times a day with ice-water, for about six weeks. I have a cotton-cloth, lined with silk oil-cloth, to place over the wet linen one ; and I have still given the cod-liver oil and iron, and as much old brandy or whiskey as we could induce him to take:—that has been my treatment since reaching home. Previous to his being taken sick, he was generally bathed daily in cold water. We have but two children, Dr. Fitch (having lost one this winter, which I will ever feel was by the mismanagement of our physicians), so, if you are a father, you can readily understand our anxiety as parents respecting the recovery of our precious child. If you can venture to recommend at this distance a course of treatment, just have written directions sent me, and the medicine forwarded by mail or Adams' Express, and your bill with them, and the amount will be immediately inclosed to you. The fever noAV is the prin- cipal thing to combat with, and the pain in the head (which I fear is an inward rising); and so soon as he is able to bear the journey, if you think there is any ground for hope, we will carry him on to New York. If you will send any package to the office of I,----& W____, ^ °-----S- w- street, they will forward it immediately, for they are Kentuckians and old friends. Please answer me immediately, for I feel there is no time to be lost. He rides out twice every day that he is able to bear the fatigue. Mr. W----, who is in New York, can give you any information you desire with regard to the health of Mr. M----'s family and my own. Let me beg of you to give this letter your earliest attention. Most respectfully, J. L. M. CASES STATED. 215 Case Fourth. " Middletown, N. J., September 20, 1855. "Dr. S. S. Fitch: " Dear Sir,—I have long wished to have you give to the world an account of the sickness of my child, and her almost miraculous cure by the use of your remedies. In August, 1850, my little girl, Rachel Cooper, aged five years, was taken with whooping-cough. This continued on her until winter, and all the following winter she had a bad cough. In March she took a violent cold, followed by inflam- mation of her lungs, with fever, a dreadful cough, etc., raising a great deal of thick, heavy matter. She became emaciated to the last de- gree ; nothing left of her scarcely but her skin and bones. She had dreadful cold sweats ; so that wherever I laid her, she would leave the j »rint of her form in water, so profuse were the sweats. Her left lung or ribs did not move at all; little appetite; a mere, almost translucent skeleton. The doctors who attended, said a recovery was hopeless—utterly hopeless. For eight weeks she slowly sunk to the very verge of the grave. I then applied to you, received your remedies, and faithfully used them, and with the fullest success. By their means, and no other, was she restored to perfect health; and she is now perfectly Avell, and well-grown for her age. Your reme- dies served not only to cure her and raise her up to health and strength, but to remove all traces of disease from her system. " Mrs. Cooper." Case Fifth. In February, 1850, a lady of Brooklyn called to consult me about her little daughter, nine years of age. She, in common with thou- sands of children, was the subject of a winter cough, apparently humid, but still with no expectoration of any consequence. Daily, in all weather, she attended school. Her cough increased somewhat, and the family physician Avas called in. He advised that the child should be kept from school, be confined entirely within doors, and not even alloAved to go in the yard to play, or take any fresh air whatever. Previously she had gone out as much as she pleased, but Avas warmly clothed. Besides being confined Avithin doors, she had cough medicines prepared for her, and was dieted very rigidly. 21G CONSUMPTION IN CHILDREN. These cough medicines were usually of a reducing character—such as squills, antimony, opium, etc. Under this treatment her strength rapidly failed, and her cough greatly increased. Another physician Avas called in to counsel with the first; and after a few Aveeks they both pronounced the case one of true tuber- cular consumption, adding that she would not recover. The second physician called a feAv days aftei-Avard at the house of the little pa- tient's aunt, and, being questioned, said that the child could not live, that medicine Avas entirely unavailing in her case, that it was no use at all to doctor her. The aunt called immediately to see the mother, and told her all that the doctor had said, concluding Avith the question, " What are you going to do about it ?" " What can I do about it ?" said the mother. " There is one thing that I will do : I will call on Dr. S. S. Fitch, of Broadway, N. Y." The father at this time was perfectly inconsolable. He looked upon his little daughter as already dead. The mother did not despair, but retained her fortitude and resolution to do what could be done to save her child. She called on me and stated the case; and I prepared such remedies as I thought the emergency required. I also directed that the child should be kept from school, and bathed every day in tepid Avater ; that generous nour- ishing diet, suitable for children, should be adopted ; that each morn- ing a small bowl of sago gruel should be given, well sweetened Avith loaf-sugar; a little dry toast was also recommended; but I counselled that coffee should be avoided; and for her dinners and suppers I advised her usual food. She was also enjoined to resume her sporting and playing in the yard in all agreeable Aveather, and to go out with her mother riding and shopping whenever she pleased. In a very short time the mother brought the child to see me. Her recovery was very rapid; and in two months a healthier and more rosy-cheeked little girl could hardly be found in Brooklyn. Case Sixth. In the winter of 1851, a gentleman and lady called upon me. He was a young German importer, and a very highly intelligent man. They were both young; and on his arms, supported by a pillow, rested his only child, sixteen months old, and as beautiful a boy as any I CASES STATED. 217 ever saw. Yet he Avas apparently in the last hours of life—his face had the blue, pallid hue of the dead. Languidly he opened his eyes, but had hardly strength to speak or groan. In utter despair they had brought him to me, having been told that I never visited the sick out of my house, which, however, was not correct. This child had suffered from a bad cold and inflammation of its lungs ; and the treatment had been of the common order—nausea- ting, reducing, and prostrating. I could give little or no hope of relief; but at once prepared medicine for the occasion, and told the father that he might return it next day, as in all probability his little son would then not be living. I heard nothing more of them for fourteen days, when the father returned, saying that his little boy was almost entirely well; that the medicine I gave him caused him soon to revive; that his cough was greatly relieved, his strength and appetite restored, and that they rejoiced in his recovered health. He is still alive—a fine and beautiful child—and in excel- lent health. Some time afterwards, upon the father going to Europe, he com- mitted his wife and child to my care, as their medical adviser. The memory of this beautiful boy and his recovery, fill me with a pleas- ure that I cannot express. It is a great mistake to suppose that consumptive children cannot be made the subjects of successful medical treatment. Medicines can be prepared as appropriate to all the phases of the disease of children, as to those of adults. No medicine should ever be given to adults that cannot be prepared so as to be perfectly suitable for chil- dren also; and no medicine should be given to a child that is not perfectly adapted to its condition and its strength. Severe, harsh doses of medicine should never be exhibited to anybody, much less to children. I have had the satisfaction of treating great numbers of children for coughs, colds, dyspepsia, and almost all the ills that infant " flesh is heir to;" and yet in my oAvn practice I have never lost but one child, where I was the first physician called. Great numbers of chil- dren have been brought to my house, or I have been called to see them, Avhen they Avere apparently dying of consumption—their chests loaded with phlegm, their strength prostrated, their appetite gone, and all the forces of life receding; and yet, in nearly every instance, 218 COUGHS OF CHILDREN. I have resuscitated them, and brought them back to the enjoyment of health, by God's blessing. The diseases and sicknesses of children are very seldom at first or- ganic, and they very readily yield to suitable remedies. But if harsh, unsuitable medicines are given, and improper measures adopted by the parents or physicians, woe! to the unfortunate child. In this city and elsewhere, I consider that the deaths of at least ninety out of every hundred children are entirely avoidable, and might be obvi- ated by proper remedies at the proper time; that often the cause of death has been improper management or the exhibition of improper food and medicine. COUGHS OF CHILDREN. Great numbers of children, in the changeable and cold weather of autumn, Avinter, and spring, are liable to take cold and discharge large quantities of mucus from the nostrils. Where these discharges are free, it has passed into a proverb that the children are likely to be healthy. In many other cases, such colds affect the throat, lungs, and windpipe. The cough sounds very humid, and one would ex- pect that the child would raise great quantities of mucus, when in fact scarcely any at all is raised. But the cough continues some- times all AA-inter. This most unquestionably is a humor upon the lungs—a skin disease affecting the nostrils, lungs, and air-passages. Sometimes upon the occasion of colds, the cough becomes very aggravating. In most cases it leaves on the appearance of spring, and returns more or less during the following winter; yet with proper care it will disappear altogether after a few seasons. I have, how- ever, known such a cough to continue in one person until the age of sixteen ; but it generally ceases at a much earlier period—usually from the age of three to eight. Now, in any children afflicted by this description of cough, nothing is easier than to produce pulmo- nary consumption: it is only necessary to place them under those exciting causes which I have dwelt so much upon as leading to pul- monary disease; especially to call in a physician who gives harsh drugs, and particularly mercurials, or any of the medicines which dry up the secretion of the lungs; of these, quinine is the chief,—iron also, and all iodine preparations are included, and so is any thing that reduces the child's strength unduly. If children are sent to TREATMENT OF COUGHS IN CHILDREN. 219 school, severe studies forced upon them, and subjected long to con- finement in heated rooms, have blisters applied to the chest, and the accustomed food AA'ithheld, in nearly every case true consumption will rapidly supervene. PROPER TREATMENT OP CHILDREN ON THE OCCURRENCE OF COLDS, OR DURING A HABITUAL WINTER COUGH. It is said that medicine has made some progress within the last hundred years. And this indeed is true; but I very much doubt whether there has been much improvement in the treatment of chil- dren's coughs, whilst an enormous amount of injury has been accom- plished. The domestic practice now in vogue for children, was at one period the universal practice of physicians; and the idea of giving harsh medicines—mercurials, Peruvian bark, quinine, or shutting them up to prevent their out-door exercise, or withholding their accustomed food, Avould have been looked upon as unspeakably ridiculous and improper. My advise in such cases is to give the children mild de- mulcents, such as flaxseed-tea, hoarhound candy, and any of the sim- ple syrups prepared from colt's-foot, hoarhound, elecampane, com- frey, etc.; boiling the herbs to obtain the strength, then SAveetening it well Avith sugar, and allowing the child to drink as much as in- clined. Molasses and castor-oil are an admirable remedy. One table- spoonful of castor-oil to a half-pint of molasses, Avell mixed together, may be taken at pleasure—a teaspoonful ten times a day if desired, but not to move the bowels too much. The chest may be rubbed over Avith a little goose-grease,—the nose, as well as the forehead over the eyes, may be subjected at bedtime to a similar treatment when the nostrils are much obstructed. The child may be sponged over every day in tepid salt and water, of a temperature not so cold by any means as to chill it; and the room should be Avarm, so that the young patient may not be in any danger of receiving cold. If general bathing is not adopted—and by this I mean ablu- tions—the throat and top of the chest should be bathed freely in tepid, coolish, or cold water every day. The child may go out in pleasant weather; but if it is intensely cold, stormy, or windy, the little sufferer is better Avithin doors. The sleeping-room and apart- ment should always be perfectly comfortable, so that if the bed- 220 TREATMENT OF COUGHS IN CHILDREN. clothes are throAvn off accidentally, chill may not follow and cold ensue. By means of this care and treatment, the most delicate child, Avith the most tender lungs, may be gradually conducted to health and hardihood. Whilst young, children's powers of endurance are naturally small, and nothing should be imposed upon them by Avhich they can be injured. As their years advance, they should have more exposure. During the hot Aveather, a residence in the country, espe- cially in cool, mountainous regions, will be found highly salutary. Those Avhose lungs are not unduly delicate, will derive benefit from a feAv weeks at the seashore. Carriage-riding is most excel- lent for children. Delicate children should never ba^ sent early to school. Nothing can be more injurious than this. I have some- times looked upon the conduct of parents in this matter as truly astonishing. It is but a few Aveeks ago since a lady called on me with her only daughter, a most delicate child of twelve years. Her mother had just discovered that her offspring's heart Avas diseased. Yet she had kept the child regularly and constantly at school from the age of five years*—summer and winter. Her constitution was, of course, noAV entirely broken and prostrated. To send children early to school, and confine them several hours there, is in itself a severe task, irrespective of study; but when un- due study is superadded, the effect upon city and delicate village children, and the children of delicate parents, as well as indeed all children, may, as a general rule, be considered as tending to impair the mind, enervate the constitution, and enfeeble the health. CHAPTER XXn. CROUP—QUINSY SORE THROAT—ACUTE PLEURISY. CROUP. It does not enter into the plan of this work to discuss acute dis- eases of the lungs, chest, or air-passages, yet I cannot forbear noticing one or two, for the benefit of both the physician and the general reader, especially as these diseases are so perfectly curable, and yet, when neglected, are so rapidly fatal. At the head of these stands croup. The subjects of this disease are usually children, from infants to those of seven or eight years of age. It is rarely observed after the age of twelve. Fleshy children, with short necks, full chests, and plump figures, and especially chil- dren Avhose parents are consumptive, scrofulous, or asthmatic, are extremely liable to attacks of croup. I have known many families where nearly all the children have died with croup. It seems in many cases peculiarly fatal. It arises from taking cold, and is most apt to occur in the Avet and changeable periods of the year. City children going to the country, where they are exposed to cold air or Avet, will often become subjects of croup. It is most apt to occur in damp, Avet weather, during the prevalence of easterly Avinds. At these periods, and especially in spring, children are apt to be tempted into the gardens or fields, Avhile the sun shines mildly upon them, and the young blossoms are putting forth, and the tender grass is spread- ing its green mantle over the earth ;—the yoimg child, going forth full of life to enjoy these exquisite pleasures of sense, is often struck by the cold damp Avind, and its chest seems pierced as with daggers. This is particularly the case Avhen not protected by a full amount of clothing. The apparent Avarmth of the day will often induce care- lessness in respect to dress. In many cases, children whose health has been carefully preserved a Avhole Avinter in warm pleasant rooms, will be taken into the street 222 CROUP. on some pleasant vernal day, and there be overtaken by cold winds or sudden changes of Aveather, and be immediately attacked Avith this disease. Sometimes, in later spring, they will visit the fields, and there sit doAvn upon the damp ground, unconscious of the enemy that lurks beneath. In fact, every description of exposure to changes, particularly from heat to cold, without suitable protection, may be folloAAed by attacks of croup. SEAT OF THE DISEASE. The seat of this disease is the throat and windpipe, about the vocal organs, and finally extending through all the air-passages to the lungs themselves. It commences with hoarseness, is folloAved by a shrill musical cough, as though the child Avere coughing through a brass-tube, great difficulty of breathing, speaking almost impossible, and shortness of breath; the face becomes flushed, the eyes almost bloodshot, an expression of great anxiety upon the face, the feet are cold, and the skin at first apt to be so. These symptoms, in a great many cases, rapidly augment and increase. Often, in a very few minutes, the child will be almost suffocated, and, if able to explain, he sometimes will say that his throat is full of cobAvebs and strings, and that he cannot breathe on account of them. The internal lining membrane of the larynx or windpipe, and covering of the vocal or- gans, is rapidly thickened, so as to close up the throat in a most alarming manner. The conservative poAvers of nature are promptly brought in requisition to relieve the engorgement of the mucous membrane I have before mentioned, by secretions of matter; but the secretions at first are almost dry, and the matter is exuded in a mem- braneous form, so as to line the windpipe and air-passages, which is frequently coughed up in the form of hollow tubes; or pieces of this secretion will come off apparently in the form or mould of the trachea and larynx. In these cases there is exuded from the inflamed membrane lining the throat, a fibrinous fluid, which immediately hardens into what has the appearance of organized membrane, which adheres more or less firmly to the sides of the air-tubes. This exudation takes place rap- idly, and, unless prevented or arrested, very quickly often fills up the windpipe, and sometimes the larger bronchi, and the patient dies from mere suffocation. When the disease has proceeded so far as to the SEAT OF THE DISEASE. 223 formation of this membrane, it is exceedingly dangerous, and most obstinate to cure. But if prompt and efficient measures are resorted to before this stage is reached, it is not very difficult to arrest the disease and prevent the formation of the membrane. I am aware that, in many cases, this croup comes on suddenly, and that before the parent knows there is danger, the child is struggling in its grasp. But if the child subject to the croup is closely watched, as it always should be, there will almost always be some indication of the approach of the disease in time to ward off the fatal attack. There will be cough, more or less, a little soreness of the throat, or some symptom of cold or disturbance. When any sign, even the slightest, makes its appearance, the alarm should be instantly taken, and the most energetic means instantly adopted to ward off the attack from the throat. Evren after there are distinct symptoms that the mem- brane of the throat is inflamed, if proper treatment is immediately employed, the formation of the membrane may be prevented, as the engorged mucous surfaces may be relieved without forcing out this membraneous exudation. Having never lost a patient in my life by croup Avhen called in season, I fully believe that the fatal cases so often occurring are the result of neglect or improper treatment, and very frequently of both. The physician is often called too late, and the treatment is often inefficient Avhen he is called. All parents, guar- dians, and nurses, having under their care croupy children, should be thoroughly masters of the treatment of this disease. This is more especially necessary, as often a short delay may be fatal. The time required to send even a short distance, may be the period when relief could be immediately administered with perfect success, if the parents or nurses are acquainted with the nature of the disease, the remedies required, and their proper employment. Croup is very apt to take place in the night; and those having under their care croupy children, should always have the remedies prepared, so as to be brought into use upon the first symptoms of the disease; and in this way the most violent attacks may often be relieved in half an hour, and entirely cured in one day. To illustrate what I have to say, I will give one case, and the man- ner of its treatment. The subject was a little boy about six years of age, who Avas subject to a winter cough, and was liable, upon any exposure, to attacks of croup. At four o'clock in the morning, the father arose and observed that his little boy, sleeping in the same 224 CROUP. room, was indisposed. On awakening him, it was found that he could not speak—that he was almost suffocated, so rapidly had been the closing of his throat. It Avas a case for immediate relief or immediate death. The course pursued a\ as as follows : His throat Avas immediately gargled Avith a little catnip-tea, so as partially to clear it, and externally it was thoroughly rubbed with a liniment—made of goose-oil, and hartshorn or aqua ammonia—so as to produce irritation and redness upon the surface. Whilst this was doing, a poultice was prepared from flaxseed-meal, goose-oil, and a very little aqua ammonia or hartshorn, and applied hot to the throat, extending to both ears under the chin, and down the whole throat to the chest, covering it, and tightly bound on. A simple dose of castor-oil was given at the same time, drafts of this flaxseed poultice were applied to the feet, and the child Avas laid doAvn and covered up warmly in bed. The whole of this Avas but the work of a feAV minutes, as every thing was in readiness for such an attack. In tAArenty minutes the child was relieved, and at nine o'clock of the same morning he ate breakfast with the other children, and was only confined to his bedroom during the next twenty-four hours. A simple plaster of Burgundy-pitch, sprinkled over with a little powdered camphor and gum-guaiac, was placed between his shoul- ders, and worn there for a number of days. A perfect cure suc- ceeded, without leaving any unpleasant traces upon the lungs or air- passages. Had this child been neglected even for one hour, his life would havre been in imminent danger. There is nothing which calls forth my sympathies more than to hear of the death of children by croup, when I know the disease is so perfectly curable. Croupy children, during the changeable seasons of the year, should wear a plaster of Burgundy-pitch betAveen the shoulders. It may be four inches long and two inches wide. On such a plaster, a few grains of camphor—say five grains—three grains of opium, and five grains of powdered gum-guaiac, all in fine poAvder, may be sprinkled evenly over it before it is applied to the child's back. This plaster cannot by any possibility do any harm, and to croupy children it is almost a perfect life-preserver. In some cases it may be rather too stimulating, and the camphor and guaiac may be omitted. It most usually will produce a little itching and slight redness; but not so as TREATMENT OF CROUP. 225 to break the skin in any way, and will prove a constant source of protection to the croupy lungs and air-passages. A great many other remedies may be used. My pulmonary lini- ment is almost a perfect curative, freely rubbed on the throat and top of the chest. A little Scotch snuff sprinkled on a tallowed- rag, and laid over the throat and top of the chest, is excellent. My cough medicines are also very useful, given hot so as to cause vomit- ing. The course I mentioned as taken with the little boy, is the true and very best one. Cold-water bandages and hot-Avater bandages to the throat and chest have often been successfully employed. In cases where flaxseed-meal cannot be obtained, bread, Indian- meal, or carrot poultices may be applied, hot, to the chest and throat, having mixed AA-ith them a little goose-oil or lamp-oil, and aqua am- monia. Oftentimes a plaster with a little Scotch snuff will relieve the patient. PoAvdered slippery-elm bark makes an excellent poul- tice in these cases. An eminent physician in Philadelphia, Dr. Nathaniel Chapman— long and Avell known there, and I might say everywhere—used to advise putting a cigar in a tumbler of Avater, and, after a few mo- ments, commencing by giving the patient a teaspoonful at a time, until sickness and vomiting were produced. He also advised unfold- ing the cigar, and spreading the wet leaf upon the upper part of the chest. A little syrup of ipecac, lobelia, or bloodroot, given so as to excite vomiting, will very often promptly relieve the child. Whatever is done, should be done quickly and boldly, yet for my part I prefer the poultices I have indicated. External applications, and giving the child castor-oil, oftentimes a tablespoonful of cod-liver oil or common fish-oil, will at once relieve the patient; but the child should neA er be abandoned or given up, even if the disease has con- tinued hours, or even days, for by proper and judicious management croup may be cured at almost any stage. Drafts upon the feet are truly invaluable, and should never be omitted. Children should not be exhausted by excessive vomiting, purging, or blistering. Simple irritation is far better than blistering. The room should be kept warm, and cold damp air should be most carefully avoided. The diet should be simple sago or tapioca gruel. Let me add, that I hope every parent, guardian, or physician, who reads this article, may remember it, and adopt its directions 15 22G QUINSY SORE THROAT. whenever called for. I will close the subject by giving one more instance, for the benefit of those Avhose faith in the curability of croup needs strengthening. Some years ago a gentleman of Portsmouth, N. H., went to the post-office about eleven o'clock in the morning, and remarked to the clerk in the office that nothing but the importance of the letter could have induced him to have left his house, as his little son was dying with the croup, and that two physicians had given him up, saying that he could not live longer than till four o'clock of that day. The clerk immediately gave him a bottle of my pulmonary liniment, such as I apply to the chest in all cases of pain or oppression of the lungs or air-passages. He said to him: " Take this bottle of lini- ment, carry it home, place the little boy on your knee before the fire, and rub this freely on his throat until he is relieved." The father did as the clerk directed, and at four o'clock of that same day the little boy, instead of being dead, was playing around the room. I would particularly advise the use of this pulmonary liniment as most valuable and reliable for the relief of croup. The formula for it will be found in the second volume of this work. QUINSY SORE THROAT. This is a disease to which many consumptive people, as Avell as others, are liable, especially in early life. Many persons in early life are subjects of quinsy, who in after life become the subjects of con- sumptive diseases. Quinsy sore throat is most apt to attack persons between the ages of sixteen and twenty-five ; it more rarely occurs after the age of thirty, and rarely before the age of twelve. It arises from nearly the same causes as croup—from exposure to cold, sup- pressed perspiration, etc. And its proper treatment is, in many re- spects, very similar: counter-irritants, hot poultices to the throat, and castor-oil, promptly administered, will usually rapidly relieve the disease. Putting the feet in hot water is a most admirable rem- edy in pleurisy, in croup, and in quinsy;—the water may be made stimulating by the addition of mustard or pepper, and the feet may be continued in it for a half an hour—repeatedly adding hot water until the feet and legs are excessively heated and perspiration induced over the whole body. Hot boiled potatoes, mashed, put in a bag PI.KURISY. 227 and placed around the throat in cases of quinsy, is a most efficient remedy. This may be applied at bed-time, and will keep the parts hot and perspiring all night. Very often, under this treatment, where the attacks are not very severe, the patient will find himself entirely well in the course of twelve or twenty-four hours. In quinsy, after the disease is arrested, the neck, throat, and top of the chest should be bathed thoroughly in cold or tepid water every day. By this means the habit or liability to quinsy will soon disappear. PLEURISY. In a former part of this book I have spoken of chronic pleurisy and pleuritic consumption, but now I propose to say a few words on acute pleurisy and its treatment. This disease is most apt to occur in persons of delicate constitu- tions and those who have weak chests. Many asthmatics, and even persons in consumption, when exposed to cold east winds or currents of air, after being in a perspiration, will be suddenly attacked with acute pain in the side—most usually in the right side, but often in the left. You will remember that the pleura is a membrane that lines the inside of the ribs and the outside of the lungs. The first symptom of this disease is an acute pain, which rapidly spreads over the side and usually along the ends of the short ribs, extending upwards to the arm-pits, to the shoulder-blades, and to the back of the side af- fected. On attempting a full long breath, the patient finds it im- possible from the excessive pain it produces—it seems suddenly cut off by the sharpness of this pain—the expansion of the chest being impossible. Fever soon ensues, the pulse becomes excited, a short hacking cough takes place, but is rendered almost impossible from the excruciating pain it causes. The lung of that side soon becomes affected, and, as the disease advances, an effusion of water or serum will take place into the pleura of the affected side, and the lung itself will become involved. The extensive inflammation may finally, and often does in many subjects, induce pneumonia, followed by collapse and death. Now, this disease is perfectly curable in its early stages; only a very few hours will suffice to cure almost any case of pleurisy, if the treatment be prompt and in season. 228 PLEURISY. TREATMENT OF ACUTE PLEURISY. In persons perfectly robust and of full habit, especially if the dis- ease has only continued for some hours, bleeding from the arm may be allowed to the extent of eight or ten ounces; but in aged or deli- cate persons, general blood-letting should be avoided—in place of which three or four leeches may be applied to the affected part, and often with much benefit. Wet or dry cupping may be used, and in a vast many cases blood-letting need not be employed at all—it being unnecessary. My treatment in this disease is very simple. I direct the part affected to be rubbed with a little liniment, and I know of none equal to my pulmonary liniment; it is the most valuable com- pound I have ever known in the treatment of acute pleurisy. In the absence of this, hartshorn and sweet oil, or a strong tincture of red pepper mixed with laudanum—say a wineglassful of laudanum and half a pint of the strong decoction of red pepper. It may be ap- plied hot to the side, and over this cloths dipped in hot water may be laid, and repeatedly changed, until the pain is subdued. In a great many cases, mustard-poultices applied to the part until the skin is reddened, but not blistered, and then followed by the ap- plication of cloths dipped in hot water, will be found to be all that is necessary to break up the pain. The patient should at the same time take castor-oil, or rhubarb and magnesia, or some active physic, which will soon move the bowels, and in this way relieve the system. Very little other medicine will be required. If there is much cough, the patient may take tincture of ipecac, bloodroot, or lobelia, or my pulmonary expectorant, until some nausea, and even slight vom- iting, are produced. The feet and legs should be kept in very hot water thirty minutes. The diet should be unirritating and very light until the disease is broken up. This practice, commenced early in the disease and persevered in, will usually relieve the patient in the course of a few hours. Poultices of powdered slippery-elm, flax- seed, or Indian-meal, or any other convenient material, may be ap- plied to the side, mixed with a little hartshorn or laudanum. Some- times hot boiled potatoes may be wrapped in a bag and applied to the side with great benefit; or a bag of hot oats, moistened with water or vinegar. These various remedies, one or all, or any that may be convenient, will usually be found perfectly effectual. They TREATMENT OF PLEURISY. 229 do not contemplate the reduction of the patient's strength; and in all probability he will soon be about his usual occupation, without experiencing much prostration or being much enfeebled by the attack. After the pleurisy has ceased and the patient resumes his usual health, he should constantly expand his lungs, so that no contraction of the chest may result from the attack. On the subsidence of the acute symptoms, the side should be bathed daily in cold water, and the remedies continued till every vestige of the disease be removed. Shoulder-braces may be worn for a time with much benefit, until the whole side is restored to perfect health, strength, and symmetry. From half-cured and neglected pleurisy, result a great many cases of pulmonary consumption. CHAPTER XXIII. ON THE TREATMENT OF INVALIDS—HYGIENIC, MECHANICAL, AND MEDICINAL. ON THE SEPARATION OF CONSUMPTIVES--VENTILATION AND CLEAN- LINESS--CONSUMPTION MAY BE PROPAGATED--WHOOPING-COUGH DANGEROUS. Persons who are in consumption, or who are inclined to pulmo- nary disease, should be discouraged from any very intimate associa- tion wuth other persons. If closely in relation with other consump- tives, there will be a mutual aggravation of the condition of each; if with the healthy, the latter will be liable to suffer to a greater or less extent from the contact. Consumption cannot, to be sure, be said to be contagious, in the strict sense of that word. Still, the poi- sonous emanations from diseased lungs, borne out on the breath of the consumptive, and probably the unhealthy exhalations from the person, if constantly received into the lungs of a healthy person for a length of time, may and will corrupt the blood, and in some cases incline to pulmonary disease. Many times I have seen con- sumption propagated in this way. While it is thus evident that it is hazardous for the healthy to take the breath, and be much in contact with the persons of those in consumption, still greater hazard of such association between two consumptives is still more evident; where each contributes to pollute the air about them, and where each com- municates to the other the poison generated in their diseased lungs and bodies. The consumptive should always therefore sleep alone in a Avell-ventilated room; and, if it can be avoided, should not in- habit even the same house with another consumptive. He should never allow the air in his own room, either night or day, to become " close" or " stifled," or loaded with the exhalations of even his own breath. For these reasons I have always resisted, most strenuously, the suggestion, frequently made by my friends, in regard to establishing VENTILATION AND CLEANLINESS. 231 a " Consumption Hospital." Such an institution would be no real charity to the invalid. The mere gathering together under one roof of a company of persons with diseased lungs, would inevitably place them in circumstances Avhere the obstacles in the way of cure would be increased, whatever increased facilities for medical treatment and attendance might be afforded. I think the true path of charity to- Avards consumptives lies in the direction of spreading knowledge among the people in regard to the true nature of consumption, the proper treatment, both medical and hygienic, to be adopted, the ne- cessity that exists for cleanliness, exercise out-doors, free ventilation in-doors, and aiming to render invalids as comfortable as possible in the bosoms of their own families, or among their friends, as far removed as may be from other invalids, and surrounded by those AA'ho will give them the best care they can have. But I do not pro- pose to discuss at length here the policy of " Consumption Hospi- tals," a matter which is just now being pressed upon the attention of the public. I leave the subject to the consideration of the wise and good. What I have said above should not render the friends of the con- sumptive fearful to bestow all needed care and attention to their sick. I would not influence the mother, although she may be in del- icate health herself, to desert the bedside of her consumptive child, nor counsel the son or daughter to neglect the parent struggling in the grasp of this disease. The sick-room of a sister or brother or friend should not, need not, be shunned. But still I would wish to impress the thought that precautions ought to be taken by those at- tending consumptive invalids, against receiving from them the seeds of a similar disease. The most perfect cleanliness in the room, the bedding, the clothes, and all the appointments of the invalid, should be constantly observed; particularly the vessel used to receive the expectoration should be frequently purified; and there should be the freest ventilation, and fullest enjoyment of the light and sunshine. The attendant should never sleep with the patient, nor in the same room, if it can be avoided, but should have a separate apartment; should go out into the open air daily, and practice taking long full breaths, if necessary using the inhaling-tube ; should bathe the whole person every day, and should live on a good nourishing diet. If these precautions are observed there is little danger. Let me re- peat, for it is important: throw open and air the room of the inva- 232 TREATMENT OF INVALIDS. lid at least twice a day ; lead the invalid himself daily into the open air, and there encourage him to inhale long deep breaths, to wash out his lungs, if I may use the expression, with the pure wholesome air. Have him bathe daily; if he have night-sweats, the clothes Avet by their perspiration should be daily changed and cleansed. In all these respects the treatment should be as careful as if he had the typhus fever. CONSUMPTIVES SHOULD AVOID THE WHOOPING-COUGH. Persons predisposed to consumption should most cautiously avoid localities where there is whooping-cough ; otherwise it may become to them a fatal pestilence. Even though he may have had the Avhooping-cough previously, the consumptive will feel the influence of the poison peculiar to this contagious disease. More or less irritation will usually be caused in the throat and down the air-passages into the lungs, giving rise to a cough, obstinate and distressing in its character, and which will frequently sink the person rapidly in true pulmonary consumption. All Avho have weak or irritable lungs, even though they may not be aware that they are predisposed to consumption, should avoid being much with or taking the breath of those who have the whooping-cough. EXERCISE. It cannot be denied that active exercise in the open air, patiently persevered in, is one of the most valuable means known to us of in- vigorating the system, and preserving its life and health. Young children should be early taught to exercise, vigorously, out-doors. In fact, such exercise should be practised by all persons at every period of life. Walking is at the command of any and everybody whose health is not too far destroyed, and the use of Avhose limbs is retained. It is very true that persons may suffer such a reduced state of health that they cannot walk, and it is also true that per- sons very feeble and debilitated may do better to ride than to walk; but moderate exercise, in some way, especially in the open air, drawing long, full breaths, expanding the lungs, and spreading the chest, will be found of vast benefit to the most delicate. Exercise most When you feel best, and best enjoy it. I have known delicate EXERCISE. 233 persons to be dragged out of bed at an early hour of the morning, and with an empty stomach ride or walk miles ; of course they came home sick. Now this does not do ; it is not the proper mode. A person should not attempt to take long walks at unseasonable hours, or with an empty stomach, feeling hungry, and exhausted before he starts ; neither should he continue the exercise to a point of great fatigue. It is beautiful to see how children and youth are benefited by ex- ercise—out-door exercise, whether for an object or purpose, or for amusement: the more they exercise and move about, the more health they enjoy; the exercise of course being proportioned to their strength. I prefer for very feeble persons carriage exercise to all other. They should ride in an open carriage. Horseback exercise is also very well; but the person should not be exposed too much to a burning sun, to rain, or to hard wind. They should avoid riding on a very hard-going horse, especially if very delicate. It is preposter- ous to put a feeble woman, with a weak back perhaps, on a hard- going horse ; such riding is sufficient of itself to produce the very disease it is intended to relieve. In some cases, where the lungs are broken or badly ulcerated, riding on a very hard-going horse will injure them, and sometimes produce bleeding. The exercise should always be in proportion to the strength of the individual. Invalids, and persons who are deli- cate and young, may commence Avith moderate exercise, and contin- ually increase it, until they can perform hard, manual labor for a whole entire day. Working on a farm, moderate garden labor, is a most valuable mode of exercise, even for delicate persons. In- deed, there is no labor superior to that of the management of a small garden, breaking up the soil, tilling it, tending flowers, culti- vating plants, pruning fruit-trees, etc., etc. Horticultural or pomo- logical labors are beautiful for the invalid, and develop strength in the delicate. A good constitution may thus be formed, after some years of ef- fort, upon a very poor foundation, and good and well-established health gradually be introduced in a frame once sickly. For young men, all the old-fashioned sports, such as pitching quoits, playing ball, cricket playing, bowling at " nine-pins," cannot be too much encouraged. Boat roAA'ing is not so well, as it is calcu- lated to strain the chest very much. I have known bad bleeding 231 TREATMENT OF THE INVALID. fi-om the lungs to folloAv efforts at rowing in several cases. Where much effort is about to be made with the chest, such as handling a fast-going or a hard-bitted horse, or rowing a boat, the patient will derive much benefit from the shoulder-braces, which tie back, and prevent the weight of the shoulders being dragged on to the chest. I need not say any thing more on the subject, but merely to again repeat that going out daily in the open air—the pure, cool air—in all seasons of the year, should be adopted by every person as far as possible, unless it storms excessively, or there is an exceeding high wind, or it is keenly cold; in which case, the patient may Avalk in the house, in an open hall, etc., or out-houses, where he finds it con- venient. He will find it extremely beneficial, and it should not be omitted. CHANGE OF AIR AND PLACE FOR THE CONSUMPTIVE--THE BEST CLI- MATE--SEA VOYAGES--GOING TO EUROPE, ETC. I am often consulted by invalids on the subject of a change of air, and as to where they should go. I need not, however, here speak of the importance of such a change, as it is universally known that it often proves in itself a great remedy ; but merely point out what I consider some of the principles by which invalids should be gov- erned in seeking this change, and to notice some of the best loca- tions to which to resort, and also the errors entertained upon this subject. For the consumptive there is no period of the year in which a visit to the sea-shore in this country, north of Virginia, is safe, ex- cept during the last half of July to the first half of August. At that period there is generally about four weeks that the Avind blows from the land, or very gently from the sea ; and during this period the consumptive sometimes derives great benefit from a visit to the sea-shore. On the Gulf of Mexico, however, and the sea-coast north of it, as far as North Carolina, for several months in the year the air is warm, agreeable, and salubrious, and very beneficial, in many instances, to consumptives. At the North, it is limited, as I have said, to about four weeks; and through the entire autumn, winter, and spring, until late in July, the sea-air is too strong and too cold, and the winds too piercing for weak or diseased lungs. Consump- tive invalids are very apt to bleed from the lungs if they visit the CHANGE OF AIR AND PLACE. sea-shore, and remain there long during those seasons; their cough will become greatly aggravated, the expectoration either much in- creased or almost repressed, so that the breathing will become ex- ceedingly short and difficult. It is far better for the consumptive not to reside near the sea-shore at those seasons of the year; but if he is obliged to do so by circumstances beyond his control, then on the occurrence of the cold northeasterly storms, which frequently prevail, he should keep himself very carefully housed, avoid expo- sure to them, and obtain artificial warmth, if necessary, so as not to suffer from chill and cold—not so housed, however, as to deprive himself of fresh air and free ventilation. In the interior of the country the consumptive may almost always find retreats as beneficial as can be found anywhere on the seaboard. In fact, there is no great choice of place, except to avoid, as a gen- eral rule, all large bodies of water during the cold and windy seasons. One of the worst places to any invalid, however, is where the dis- ease originated,- and any change of air he may adopt will be almost always for his benefit: he can hardly leave home, in fact, without advantage. The rooms which he has long occupied often become thoroughly poisonous for him; circumstances which escape his no- tice, and hidden causes, which no scrutiny can detect, will often operate to the extreme injury of the patient, but which are all often obviated by a removal from the patient's accustomed locality. The finest country I have ever known for consumptives, in this northern climate, is along the shores of the Hudson River, commen- cing ten or fifteen miles above New York, and extending through the highlands on both sides of the river. It is for the consumptive the most healthy district of country I have eA'er known in any part of the world. I have seen patients recover when residing on the shores of the Hudson River, who, I believe, could not have been cured in any other locality known to me. The purity of the water, and the air on the dry lands on the shores of this river, certainly afford retreats for a temporary residence for the invalid and the con- sumptive that are not, I am confident, sufficiently appreciated. A warm climate, in some rare cases, benefits the invalid; but by the large majority of patients little or no permanent benefit is de- rived from visiting the South, and the disease usually terminates quite as soon as if they remained at home—in some instances even sooner. It is in the Middle States of this Union—the State of New 230 TREATMENT OF INVALIDS. Jersey, eastern Pennsylvania, the southeastern part of New York, the northern part of Virginia, Kentucky, Ohio, and Tennessee—that he finds the most favorable climate. Patients from either North or South often find a few months' residence in pleasant situations in the localities I have indicated, to be most beneficial; and here, by the aid of proper remedies, even desperate cases will often recover. A change from the Eastern to the Western States, and on to new territory, if the high lands are selected, is beneficial. Some parts of California furnish a beautiful climate for the consumptive and asthmatic, while other portions of it are extremely unfriendly. San Francisco itself—to many a very healthy place—is exceedingly insa- lubrious to the consumptive and asthmatic; and for a young and neAv State, California furnishes more cases of pulmonary consump- tion than any country I know, although this may probably arise from the fact that many consumptives go there from the old States in hopes that the change Avill restore them to health. The northern shores of Lake Superior afford a favorable climate for the invalid ; and the same may be said, in fact, of all the western and southwest- ern country that is free from malarial influences. The mountains and high parts of Tennessee and Virginia in summer, and the lower lands in winter, furnish many delightful spots. The consumptive requires first a change of air, and in effecting it, if he secures a dry atmosphere, rather cool, and free from malaria, the change will usually promote his recovery. A warm climate for any length of time is too enervating and prostrating; and in the high latitudes, such as many parts of Canada, the climate is too cold and harsh; and still, in some instances, a residence in portions of Canada East, where the patient's rooms are kept artificially warmed through the winter, and the temperature kept steady, will be as favorable to delicate persons as in any other location. In most parts of the Southern States it is too damp in winter and too hot in summer—the climate is too variable and changeable. Some locali- ties will be found very beneficial to some patients and not to others; so that frequently consumptives have to change their location sev- eral times before they find one that is congenial, and that suits them. Many physicians are in the habit of sending their patients to sea in the months of April, May, or June. Very frequently do they call on me for advice about going to the Banks of Newfoundland, to the Gulf of St. Lawrence, or some other place on our coast. I have DIET. 237 known many consumptives visit these places, and I do not recollect an instance where the patient has been benefited ; as a general thing, they have been injured. Damp, cold, chilly winds, heavy fogs, and the neighborhood of icebergs, must necessarily be bad for the del- icate consumptive. If a sea-voyage is resolved on, the best course is to take a voyage at once to Europe. Indeed, a voyage to Eu- rope, and particularly a residence for a time in Ireland, Scotland, England, France, or Germany, is often very beneficial, and I fre- quently recommend it to the consumptive. Indeed, I have witnessed most happy effects in patients who adopt my remedies, and travel in Europe for a longer or shorter period. The air far out to sea is often better for the consumptive than near the land. And still long sea-voyages are usually injurious to the consumptive, but short voyages, as from this country to Europe in the steamships, and fast, well-appointed, sailing packets, where the invalid may have all his wants supplied, are often highly beneficial and not often injurious. The same remarks apply to voyages of European invalids to this country, and a residence here, which often nearly cures the asth- matic, and usually helps the consumptive. DIET. As I have again and again referred to the matter of food, I shall be excused if I do not speak of it noAV at any great length. My omitting to do so, should not, hoAvever, be considered as indicating that the subject is not one of much importance. I have observed before that it is far better to use cathartic medi- cines to cleanse the boAvels from food, acids, bile, and excrementi- tious matter, than to attempt to do this Avholly by dieting. There are a great many persons who undertake to starve themselves into health, or to live upon one kind of food ; but the experiment is usu- ally productive of no good, and is a source often of much inconve- nience, indeed of positive injury, to the patient. Noav the food which we eat should carry with it all those constit- uents of the blood which the system requires for its continued sus- tenance, growth, and strength. It should never be taken in such quantities as to o\rerload the stomach, or oppress the system, nor at such short intervals that the stomach is deprived of its necessary rest before repeating the task of digesting. There are great differ- 23 S TREATMENT OF THE INVALID. ences of opinion upon the number of daily meals, and also upon the length of time that should elapse between each meal. Nearly all the races of men, especially all the laboring and industrious ones, agree in taking their food three times a day: at an early hour in the morning, at midday, and at evening, allowing intervals of about five hours between each meal. This is probably about the correct rule, as it agrees with the ordinary experience of mankind. The fullest meals should be those of breakfast and dinner; the supper should be lighter and less in quantity. Dinner should never be taken later than five hours before bedtime, and in all cases the supper should be very light. Most persons make the dinner the princi- pal meal of the day, which is usually eight or ten hours before bedtime. In this matter of food and diet, experience is certainly a good teacher, and its counsel should never be lost sight of or forgotten in establishing our plan of living. Children, in proportion to the tenderness of age, require food much oftener than adults. This peculiarity of theirs should be un- derstood, so that when craving food they should be gratified—not of course to the extent of surfeiting or overloading the stomach, which is always dangerous. In our reflections upon diet, we should remember that the human system is constantly suffering Avaste, which must be continually sup- plied by the food, which, as I have already remarked, should con- tain all the different elements or constituents that the system re- quires, and in their necessary proportion and in fidl quantity. An adaptation of the food to the climate in Avhich we five, the diversity of the seasons, and the nature of our occupations, must not be over- looked. The inhabitant of Siberia, Labrador, and the Arctic regions, re- quires that kind of food which contains a large supply of carbon to develop heat in the system, such as is found in the oil and fat of an- imals. Hence the Esquimaux, Laplander, and Greenlander, delight in blubber, train-oil, fish-oil, etc. They cannot subsist upon vegetables, particularly in the AA-inter season, and they live chiefly or almost en- tirely upon fat meat; while in the tropical regions we find the natives subsisting almost entirely upon rice, vegetables, and fruits. Inhab- itants of the polar regions delight in and eagerly desire alcoholic spirits ; but the tropical inhabitants, left to their own tastes, employ DIET. 239 vegetable infusions, such as coffee and cocoa, as beverages with then- daily diet, which are for them sufficient stimulus. The waste of the system depends of course upon the amount of labor performed—the amount of power expended ; consequently the laboring man requires much larger quantities of food than the idle man. In every point of observation, we must bear in mind the waste of the system, the condition of health, the power of digestion, etc. Of course these remarks which I have made upon food apply to per- sons in health; those in sickness must be governed by entirely differ- ent rules, such as their medical attendants may suggest. General experience in all the different parts of the world, among all the dif- ferent tribes and families of men, teaches that the healthy appetite is a correct guide; that is, the appetite not coerced, or made un- natural by circumstances. The intelligent man or woman learns at an early period to determine the amount of food which his or her system requires, its quality, its quantity, and the times most proper for taking it. This observation they extend to their children and those under their care, and in this way no doubt arrive at conclu- sions as correct as can be formed upon this subject. One of the first rules to be considered in regard to our food is moderation, and as a general principle a mixed diet is best, consist- ing of meat and vegetables, well cooked, and fruits in all their vari- eties and modes of preparation ; not all at once, but rather sparing- ly, proportioned to the strength and waste of the system. It is a well-knoAvn truth that all persons who have attained great age, have been, at least for all the latter years of their lives, noted for the sim- plicity of their diet, and often for their abstemiousness, while a long- lived glutton was probably never known. I do not recollect in any of my readings to have ever met a case of a gluttonous man who had attained to any thing like the old age which we witness in the abstemious and the temperate. As regards the details of diet, and the food necessary for indi- vidual constitutions, I would not for a moment attempt to state any set rules. The general every-day practice of sensible, common-sense people is doubtless the true one in every country. The fleshy, stout person should avoid all such food as conduces to obesity, or that will make fat. Such a person will find that game, venison, wild land-foAvls, lean beef, and mutton, are the most appro- priate, so far as the animal portion of his food is concerned. A 240 TREATMENT OF INVALIDS. lean, spare person may indulge in oily food if his stomach per- mits it. The dyspeptic should study the nature and peculiarities of his own constitution, and take only that food which agrees best with him, and should never break off suddenly long-continued habits of diet, which experience has proved to be salutary, no matter who may advise it. I would urge all and every class, as a general thing, to be quite natural in the selection of their food, and to eat enough without overloading their stomachs, or rendering themselves uncom- fortable by quantity or quality. BATHING. For several years past the subject of bathing has received con- siderable practical attention from physicians, from invalids, and the community at large. Much has been learned from this experience, and some benefit has been derived. In my " Six Lectures" upon Pulmonary Diseases, I urged, very strenuously, the advantages to be derived from cold bathing. My opinions have not changed upon the subject since the publication of that work. Still I am free to confess that I believe there are many delicate persons Avho are wholly unable to sustain the shock of cold baths in very cold weather. A system debilitated by disease is over- come by this treatment, especially delicate ladies and young children. From extensive correspondence and from long observation, I am convinced that a majority of invalids and patients lose faith in the importance of very free bathing in cold weather, from having re- ceived no decided benefit from it, or fi-om being injured more or less by it. Yet I know many, and even invalids, avIio continue cold bathing in the freest manner throughout all seasons of the year, and declare themselves greatly benefited by doing so. The general conclusions of individuals, derived from experience and from circum- stances, age, health, strength, etc., must not be ignored. We must take the human constitution, not as we Avould have it, but as it is, and remember that as there are no conditions or states of any two individuals precisely the same in all particulars, so there are no rules that will apply to all without exceptions. Whilst cold bathing is useful to many people, it is injurious to some, and quite unnecessary to others. All persons should keep the body clean, and should use ablutions sufficient to accomplish that object; but it may not be BATHING. 241 necessary for all to bathe daily in cold water in cold weather, or in- deed in any weather. Laboring people generally, and those whose lives are spent out- doors, travellers upon our western plains, miners, gold-diggers in California, wood-choppers, farmers, etc., fishermen, sailors, mari- ners,—all these seldom bathe, and do not seem to require it; but in our cities, and in all locations where mankind are crowded together, where luxurious habits are indulged in; sedentary persons, those whose occupations confine them to a sitting posture, as in close, illy ventilated rooms, attendants upon the sick, residents in hospitals; those who Avork amid much dust and dirt, or are exposed to the fumes of mineral and chemical substances, carbonaceous fumes, the exhalations of animal or vegetable substances in a state of decom- position ; young children, and finally all those who lead an easy, sed- entary, or luxurious life, especially fleshy and stout persons;—all these will especially derive great benefit by observing the most thorough rules of cleanliness—bathing frequently in AArarm or cold water, soap and Avater, etc. This may be practised at the discre- tion of the individual, yet in these cases it is usually best to bathe daily. I much prefer simple ablutions to immersions in water. It must be remembered that the general effect of cold Avater is to invigorate the system, and increase the energy and activity of the vital forces; whilst warm Avater, if long continued, -will have an op- posite effect, enervating the system and rendering it more suscepti- ble to the influence of cold, and to injuries from sudden changes of weather. All persons croAvded together in close apartments should bathe frequently. Emigrants on emigrant ships ought to bathe daily in sea-Avater. In these situations the Avell-instructed captains and intelligent passengers will co-operate Avith each other in observing perfect cleanliness of person, thus dissipating the foul air Avhich rapidly generates in croAvded cabins, often developing some of the most fatal forms of disease to which the human system is liable. I recommend to invalids and delicate persons, when contemplating daily bathing, to commence with warm or tepid water, in the form of ablution, and in a Avann room, where no cur- rent of air can strike upon the person, for this Avill almost ahvays cause a cold in the delicate, and sometimes even in those Avho have the strongest and most robust constitutions. If the skin is cold and inactive, it is avcII to employ friction before bathing, by rubbing the 16 242 TREATMENT OF INVALIDS. surface of the body with the hand, a coarse napkin, brush, or glove for the purpose, so as to arouse the circulation. Then the tepid Avater may be used, and if you please adding a little of any of the alcoholic liquors, or alcohol itself, rubbing the body thoroughly after each ablution, to excite a gloAv of heat. This may be practised daily, gradually reducing the temperature of the water until cold water can be employed at all seasons of the year. Nervous persons, and those debilitated by care, watching, and general anxiety, or from sickness, will usually derive great benefit from bathing; still they must suit their own constitutions, and if they suspect that it injures them they should discard its use. Sea- bathing, in the very warm seasons of the year, is very agreeable and healthy for most persons, especially those of strong consti- tutions. In cases of pulmonary consumption, colds, catarrh, bronchitis, king's evil, chronic rheumatism, etc., I usually advise thorough bathing, and it is generally attended Avith beneficial results. FeAv are the rules connected with the human system that are Avithout exceptions ; and by the judicious, intelligent, and humane, these ex- ceptions are as much to be respected as the rules themselves. Let every person carefully observe his own experience, and when he has fully decided what is beneficial for him, cling unwaveringly to it, and never lose its benefits upon himself, nor be forced to make new experiments to confirm that which is already sufficiently estab- lished. Hot baths, and especially hot foot-baths, are extremely beneficial in cases of recent colds, in chills produced by colds, in congestion of the brain or lungs, or sudden attacks of rheumatism. In diseases of the heart, in asthma, particularly in persons of full, fleshy chests and obstructed circulation, I Avould urge the patient never to go under Avater, but be content Avith simple ablutions over the whole person, as I have before advised. To all consumptives, and those troubled with or liable to short breathing, I would say, never immerse yourselves in water, as I have known it to prove fatal. THE WET-SHEET IN AGUE AND FEATER. I have known attacks of ague and fever entirely broken up by the use of the wet-sheet. In these cases the patient is to be completely SWEATING--DRESS, CLOTHING, ETC. 243 wrapped in a cold wet-sheet, and placed in a warm bed immediately after the commencement of the cold stage of the disease. Full and free perspiration, even violent sweating, will take place in a very few minutes: the chill will be broken up, and the hot stage of the dis- ease will not be developed at all. After perspiring one or tAvo hours, the patient can be gradually cooled off, and finally sponged over freely with cold water, wiped dry, and resume his clothing, hardly realizing that he has been sick at all. Two or three repeti- tions of this treatment will often break up the ague and fever entirely, without any other assistance whatever. This treatment has this re- markable advantage, that no unpleasant effects are produced upon either the head, stomach, or liver, Avhich is so frequently the case Avhen quinine, calomel, and remedies of that class are much used. I think this form of applying water for attacks of ague and fever is most highly deserving of our attention, and not only in chills and fever, but in the early stages of all febrile diseases. In measles and scarlet fever, when the eruptions do not fully appear, the employ- ment of the wet-sheet for a short time will usually bring them out in the most desirable manner. SWEATING. Sweating the patient for recent colds, croup, congestion of the lungs, inflammation of the lungs in its commencement, is most ad- mirable. Perhaps the best are rum or alcohol sweats. Place the patient on an open-seated chair; put under it a saucer with alcohol or rum in it, and set it on fire ; cover the patient all over Avith blan- kets, so far kept from the person as to alloAv the vapor to pass all around the naked person, limbs, etc. In a very few minutes a vio- lent perspiration will take place. Keep this up for some time—say ten to thirty minutes ; wipe dry, get into a Avarm bed, and perspire some hours. Usually this will throw off almost any recent attack of cold, inflammation, pleurisy, lung fever, rheumatism, etc. These sweats are most excellent. Many other forms of sweating are used, and often with much success. DRESS, CLOTHING, ETC. I will detain the reader but a moment upon this matter. I am only required to notice its effects and its relation to health. Clothing 244 TREATMENT OF THE INVALID. is required first to protect the system from the vicissitudes of the weather, AA'hich is the only object that concerns this subject. In our artificial life much more is required to be Avorn than in savage life. The true laAv is, that, under all circumstances, the body should be kept comfortable, being neither smothered by a superabundance of clothing, frozen or chilled by its scantiness, nor cramped by its fit- ting too closely to the form. A person may bathe himself in Avater as cold as ice can make it if he has the hardihood to do so, but which I by no means would ad- vise or recommend; still, after he has wiped himself dry, it is neces- sary that his clothing should be warm and comfortable, for although many persons can bear a sudden change of temperature, such as a sudden plunge into ice-water, yet no one can bear being continually chilled by the cold from insufficient clothing Avithout injury. In the cold winters of our northern climate, it is well for deli- cate persons to wear flannels or woollens ; and when they go out they should put on a sufficiency of over-clothing to protect them from being suddenly chilled; yet this should not be carried to such an extent as to induce undue effeminacy, or too great sensitiveness to cold air. Children and old persons require much more clothing than those of middle age, when the strength and vitality of the system is great- est. The degree of cold or heat which one can endure is very much a matter of habit; but when once a habit is established, and partic- ularly Avhen it has been long continued, it must not be suddenly broken off. Changes in dress, especially from a greater to a less amount, should always be made gradually. The winter clothing should not be thrown off too soon in the spring : persons should Avait until the warm Aveather is fully established before they throw aside wholly their winter garments. The feet should always be kept warm and dry as far as possible. A good old-fashioned rule is, " Keep the head cool, the feet warm, and the boAvels free," in which there is much wisdom. With these suggestions, I leave the whole subject of clothing and dress to the judgment of the intelligent reader. Let him, in the ex- ercise of good sense, adapt his dress to his own constitution and his necessities. SLEEPING-ROOMS, ETC.—CHEERFULNESS. 245 BEDS, SLEEPING-ROOMS, ETC. I will detain the reader Avith only a very few words upon this sub- ject. Luxurious down-beds and warm rooms are particularly apt to induce effeminacy and reduction of the vital energies of the system. On the other hand, hard beds, scanty covering, and cold rooms are apt also to reduce the system, and they are most injurious to inva- lids and delicate people, and especially to young children. The true medium is found betAveen very cold rooms and very warm ones— the condition of the beds and the age of the persons being fully considered. The very hardy and robust do not require any artificial heat in their rooms, whilst the feeble and delicate may require it. Individuals and families must study this subject for themselves, remembering that persons of every age and every state of health require to be comfortable during the hours of sleep. If they can sleep warmly without the aid of artificial heat in their rooms, it is better that they should do so, and if they cannot, on account of di- minished vitality, they should have their sleeping apartments artifi- cially warmed. Good hair mattresses make excellent beds. In sum- mer straw husks in mattresses are useful. From long experience, I feel confident that open fireplaces or open grates are to be preferred in warming a house. Stoves come next, and air heated by furnaces last of all. It is certainly unhealthy to live in a house warmed by heated air. I could say much more on this subject, but would only warn all persons to avoid houses warmed by heated air. CHEERFULNESS. I hardly knoAV of any thing that has a more depressing influence upon the health than Ioav spirits, gloomy forebodings, viewing every thing upon the dark side. It will reduce the vitality of the strongest person, and is in every respect injurious. All religious teachings that lead the mind to entertain great fear for the future, or great remorse in view of the past, are apt to be very pernicious to the health of those influenced thereby. I would urge every one, Avho Avould have health and long life, to ban- ish, as far as possible, all depressing thoughts from the mind, and to cultivate cheerfulness and hope. Despondency of all kinds works 246 TREATMENT OF THE INA'ALID. directly against the health, while cheerfulness aud hope operate for it. For this reason I always recommend such amusements as are not too exciting, and not demoralizing in their tendency. Dancing is one of the most delightful and elegant exercises for mhabitants of cities, crowded towns, and villages, who do not en- joy much exercise and Avho have not the means of extensive recrea- tions. I would recommend its being early taught to children, and its forming a part of their school education. Laborers in Avorkshops, male and female scholars at boarding-schools, students at theological seminaries and colleges, &c, should be urged to practise dancing every day. Almost every form of exercise will be found more or less agreeable and healthy. Each individual must be his own guide on this sub- ject. Let him receive the best advice that can be obtained, and make the amount of exercise and time of taking it such as suit his taste best; and above all things avoid every species of sloth, idle- ness, melancholy, and irreligion. SELF-DENIAL NECESSARY TO INVALIDS. One of the earliest lessons that the invalid should learn is that of self-denial. Whatever he suspects may injure him, or whatever from experience he has discovered to be pernicious to his constitution and health, he should carefully and rigidly avoid. If he has discovered that coffee, alcoholic liquors, condiments, any indulgences, either in the quality, quantity, or time of taking his food, to be injurious, he should most sedulously avoid them. If he discovers that night-watching, late hours, or any irregularity in any of his habits, are productive of mischief and injurious to his system, or if he has observed them to have such effects upon others whose conditions and circumstances are like his OAvn, he should avoid them. He will soon find that habit will make Avhat is right quite as pleas- ant to him as to indulge in that which is injurious. Mothers should strenuously urge upon their children the habit of self-denial. Vast numbers of children die annually because unin- structed in the practice of this virtue. Thousands of these lose their lives, bring on relapse of disease from which they were recovering, or render a curable disease fatal, from imprudence in then diet, from exposure, or indulgences. Although the path of duty may be NEVER TELL AN INVALID THAT HE LOOKS SICK. 247 clearly pointed out and urgently recommended, yet wanting the habit of self-denial they do not follow it, but their lives are sacri- ficed by wandering from it, and allowing a slight temporary gratifi- cation to lead them to throw away health and life, when, had they denied themselves, they might have lived on to the full term of human life. NEVER TELL AN INVALID THAT HE LOOKS SICK. I have been sometimes greatly astonished at the treatment inva- lids receive from their attendants and relatives, and often from their nearest friends. Some of these practise the fault I shall mention through ignorance, some from mistaken kindness, some from bad manners, some from sheer malignity, and others from a desire to excite the fears of the patient, by which to secure the use of certain remedies for his recovery. The practice to which I refer is that of telling the sick and nervous that they look ill, and upon any signs of amendment checking and depressing their hopes by questioning or denying the correctness of their belief that they are better or improving in health. I once knew a mother whose son had been attacked by bleeding at the lungs, but whose case I did not by any means consider des- perate. He had very fair hopes of recovery, but his mother insist- ed from the very first that he must die ; that she had never knoAvn any one in his state to recover: her great anxiety was to get him prepared for another world; every effort towards mitigating his symptoms, prolonging his life, or producing a cure, she insisted were entirely useless. On coming down from his room in the morning, his mother would say— " James, how do you do this morning ?" " Why, mother," he would say, " I feel considerable better. I rested AA'ell last night; I coughed less, and I feel stronger." " Oh, James," she would say, shaking her head, " don't deceive yourself. If you could only see how you look, you would not say you were better. No, James, you are not better at all." And this course she persisted in, till finally her distracted son fled into the streets a raving maniac, and eventually died insane, his death 248 TREATMENT OF THE INVALID. occurring apparently from affection of the brain rather than the lungs. I have witnessed the effects of this treatment towards invalids in many cases, on persons meeting their friends in the street, seeing them in their morning calls and at evening parties. A feAv evenings since I met a small circle of individuals at the house of a friend. During the latter part of the e\rening a young lady came in, Avho, after being seated and receiving the compliments and gratillations of her friends upon her good looks, etc., and all inquiries for her health having ceased, commenced reminding each individual that he or she " must be ill;" one looked " much paler than when she last saAv him ;" another Avas " much Avorn out—she must be indisposed ;" and in this Avay she made the circle of the company, giving a stab to each, and inflicting a pang of distress that would be sure to last during the whole evening. In this case she appeared to knoAv no better, though she moved in what is called the " first circles." I would most earnestly beg all persons never to tell another, in health or in sickness, that he or she looks ill. It is very rarely of any benefit, and in nine hundred and ninety-nine cases out of a thou- sand inflicts pain, and produces mental anxiety and more or less pros- tration of the nervous system; and, if often repeated, may produce very mischievous consequences. I once knew a gentleman, fifty- eight years of age, who was somewhat indisposed, but not much so, who called at a house upon some business, and there encountered a strange, eccentric creature, a brick-mason, who was at the time building a chimney. With his shirt-sleeves turned up, the trowel in one hand and a brick in the other, he turned to the gentleman, and said— " How do you do, Mr. Hastings ?" " Well, Mr. Goodrich, I am pretty well, though not entirely so." He had ridden that morning several miles on horseback. " Well," said Goodrich, " do you go directly home : your time is short; you won't live three days." Whereupon the gentleman re- turned home, and being nervous, he was overcome by fear, took to his bed, and died in the three days set for him. This case excited a panic in the neighborhood, and the mason tried to frighten some other people to death ; but, although he greatly alarmed them, still fortunately he produced no other death. NEVER TELL AN INVALID THAT HE LOOKS SICK. 249 Every person should remember that it is an act of flagrant ill- breeding, besides being extremely injurious and unkind, to tell any person that he looks ill. It is better and wiser to say soothing words and to encourage hopes, which we may be sure are agree- able to those in health and most precious to the sick, for they are always received with feelings of joy and thankfulness. CHAPTER XXIV. SPECIAL REMEDIES IN PULMONARY DISEASE, MEDICINAL AND ME- CHANICAL—INJURIOUS REMEDIES AND TREATMENT, ETC. COUNTER-IRRITATION. Counter-irritation, in the treatment of disease, is oftentimes of immense service. For example: in cases of pain, congestion, or deep-seated humor, by exciting irritation on the surface, above or in the neighborhood of the diseased part, we shall be able to draw the humor or inflammation to the surface, and thereby relieve the suffer- ing organ beneath. In cases of pain in the side, breast, joints, etc., sore throat, conges- tion of the brain, pain in the bowels, in the spine, in hip diseases, in chronic rheumatism, etc., counter-irritation, in some form or other, has been at all times more or less extensively employed by all classes of physicians. This counter-irritation is employed in the shape of blisters for causing large sores or issues, or for simply reddening the skin. I will ask permission here to mention a few of these, with my vieAvs upon them and the propriety of their use. In the first place, I will mention the ordinary SPANISH-FLY BLISTER. This is used extensively by a vast many physicians—sometimes with benefit, but, to my certain knowledge, oftentimes with injury. Blistering by this agent will too often prostrate the delicate, increas- ing their nervousness and depriving them of sleep. Indeed, in many subjects who are very susceptible, and where there is fever, it pro- duces temporary delirium, which is imputed to the fever, but is oftener the result of the fly-blister. I never use it at all, and would most earnestly discourage its em- MUSTARD-POULTICES--EMETIC TARTAR--CROTON OIL. 251 ployment in all reduced subjects and all delicate persons, and never apply it to highly nervous or sensitive parts. I have knoAvn fly- blisters applied to the abdomen and continued there until the patient was throAvn into convulsions from the agony and suffering they pro- duced. There may be instances where a fly-blister, in the absence of any thing better, may be applied for a short time; but it should in no case be used upon excitable or nervous persons: above all, never on infants or young children. MUSTARD POULTICES. Mustard poultices may be applied to any part of the body for a short period of time, simply to redden the skin, with good effect. If continued for a length of time, they produce the most distressing blisters and soreness on the parts where applied. They are often serviceable in cases of colds, sore throats, pain in the side, or sudden accession of pain anywhere, if continued simply long enough to red- den the surface without producing blistering; and this they will do in from ten minutes to one hour's time, according to the strength of their composition and the susceptibility of the patient. EMETIC TARTAR. This terrible mineral I utterly and totally repudiate in every form. I have seen the most distressing effects produced by it, and very rarely, if ever, any benefit whatever. I never use it, and would most unhesitatingly beg physicians and patients to avoid its use as an ex- ternal application in any form. CROTON OTL. Croton oil, rubbed upon the surface of the body as a rubefacient, will not blister, but will bring out great numbers of little pimples, producing only a heat and an itching, and, when judiciously em- ployed, is often very useful. There are very few objections to its employment in this manner. It acts without making the patient nervous or prostrating his strength. 252 MEDICINAL AND MECHANICAL REMEDIES. LINIMENTS. Nearly all pain of every description may be greatly relieved, if not permanently removed, by the employment of a suitable liniment, which may be so prepared as to produce a slight irritation upon the surface, and also to produce a medicinal effect upon the diseased part independent of the irritating action ; extending at the same time its influence deeply through the pained part, neutralizing the poison or humor that may give rise to the pain, and relieving the suffering. All invalids subject to pain in the side, chest, spine, joints, or else- where, will find vast benefit from a proper liniment, which they should ahvays have at command, so as to be immediately applied in case of an attack of pain, or Avhen pains recur, and in this Avay they may entirely do aAvay with the habit of pain. In the second part of this work will be found formulas of such liniments as I have found, from personal experience and long-continued use, to be most eminently beneficial. The one designated as " Pul- monary Liniment," which I employ and prescribe in all suitable cases, I consider one of the most useful agents in removing pain of any kind that I have ever known. In croup, in chronic rheuma- tism, in acute or chronic pleurisy, Avhen rubbed OA'er the chest upon sudden occasions of colds, cough, bronchitis, in swelling of the face from toothache, SAvelling or softness of the joints from rheumatism, and in almost every possible form of congestion, I have found this liniment superior to any other with which I am acquainted—hardly ever disappointing myself or my patient when judiciously employed. PLASTERS. In cases of pain in the small of the back, or about the hip-joints, betAveen the shoulders, and in sciatic rheumatism, etc., I have known plasters to act very well. These may be prepared with Burgundy- pitch, with the addition of a slight irritant, opium, camphor, and gum- guaiac in equal parts. These, melted and intimately mixed together and spread upon soft leather, make a fine plaster, Avhich may be ap- plied to almost any painful part, where the skin is whole, Avith bene- fit. I do not much approve of large plasters applied to the Avhole chest, as they prevent its expansion, and are sometimes very injurious PLASTERS FOR CHILDREN. 253 from this cause. The plaster I have mentioned is excellent in cases of cough and pain in the side ; but if you wish to apply it externally to the chest, it should be cut up in small pieces and applied in this way, so that it will allow the chest to expand in respiration without torturing the skin upon which it is spread. Still I prefer to bathe the chest in cold water, and apply a suitable liniment every day, which aatII usually remove pain much more readily and effectually than the use of any plaster. plasters for children. In cases of croup, bad colds, inflammation of the lungs, whooping- cough, etc., in children, I would most earnestly recommend to nurses or parents the application of a plaster, made of Burgundy-pitch, up and down the spine, between the shoulders. It may be made two or three inches wide and from four to six inches long, or extending from the back of the neck down to the small of the back. After the pitch is spread upon the leather, there may be sprinkled over it two or three grains of powdered opium, mixed with five or six grains of camphor. In a very short time after the application of this plaster, the child will usually be rescued from danger. It will bring the in- flammation to the surface, with very slight irritation and with great relief to the chest. This, I think, is far better than to apply the plaster over the breast, because it does not prevent the expansion of the chest, which must certainly result, to a greater or less degree, if applied over the front of the chest. Plasters I never apply to the chests of children, nor do I think it advisable in any case in front, but apply them betAveen the shoulders. For laboring people, and those greatly exposed to cold and damp, who are often subject to rheumatic attacks, and for any person in circumstances Avhere the affected parts require warmth and protec- tion as well as medication, such a plaster AA'ill be found to be very useful; and much more to these classes than to those in easy circum- stances, and who are subject to less exposure. To such people, as well as others, I would recommend the use of a good liniment and bathing in cold AA'ater. These measures will be much more agreeable and satisfactory to them. Blisters should never be applied where they produce so much pain and irritation as to prevent sleep and dis- turb the nervous system. 254 MEDICINAL and mechanical remedies. fomentations. By this term is meant the application of hot poultices, or warm or hot water, to any painful part, or a part in a state of congestion. The poultice or water may be mixed with herbs, or simply applied on a wet cloth. The application may, indeed, be made either hot or cold; for if applied cold in a case where there is sufficient vigor to secure a complete reaction, in a very feAV minutes it will become sufficiently warm to produce free sweating from the part to which it is applied. A cloth worn upon the chest is oftentimes of great benefit, and may be continually applied for months if the state of the chest requires it, and it is not disagreeable. I have known great benefit derived in acute attacks of pain from the application of a small bag of hops, wet in hot water, and continued for several days and nights, as the case may have required. Bags of oats, wet in hot water, are also found to be excellent, and will often contribute very much to the allevia- tion and cure of pain, whether acute or chronic. BLOOD-LETTING. Twenty-five years ago, and for a long period previously, blood- letting Avas most extensively employed in almost every disease, but particularly in attacks of inflammation, rheumatism, pleurisy, palsy, and indeed for almost every ill that flesh is heir to. I once knew a man to lose seven wine quarts of blood in the course of two weeks. In this case an experienced physician, AA'ho possessed a little common sense, was called in to counsel with the medical at- tendant—an individual not greatly experienced, but greatly self- sufficient, who asked the physician why the patient jerked about and kicked around the bed as he did. " Why," replied the older physi- cian, " have you ever seen an ox die after his throat Avas cut ? and do you not recollect that just before death he makes great strug- gles ?" " Yes." " Well, that is the condition of your patient." The younger physician proposed to give him small doses of calo- mel ; the older physician advised large doses of musk, but said that nothing would save his life, as his blood Avas nearly all drawn out of his body. This proved true, for the unfortunate patient soon ex- pired. THE INHALING-TUBE. 255 As a general thing, blood-letting should be sparingly resorted to, especially in all delicate, nervous, and sedentary people. The robust may sometimes suffer a moderate loss of blood without any incon- venience, and not unfrequently with decided benefit; still I very rarely employ blood-letting in my practice, as I seldom meet a case that I cannot relieve much more satisfactorily by other treatment. In some rare cases, I recommend the use of leeches and topical bleeding, but scarcely ever advise general blood-letting, or find it necessary to do so, except in acute attacks in very robust persons. THE INHALING-TUBE. I have several times already alluded to the very great importance of securing a large chest and fully expanded lungs, if we would hope either for the prevention or cure of consumption; in fact, if we ex- pect to escape from the effects of disease of any character to Avhich Ave may be exposed or liable. But this subject cannot be too often pressed upon the attention of the reader; and I would here refer to it again, and, in connection with it, recommend the use of the in- haling'-tube. Whenever there is weakness of the lungs from whatever cause, or any tendency to disease there, there is always a disposition on the part of the invalid to " favor" the lungs, to stoop the shoulders, con- tract the chest, and take short breaths. This usually takes place unconsciously. But in some instances, patients have an impression that the less motion there is in the lungs the more hkely they are to get well. They therefore purposely breathe as little as possible. This is, of course, all wrong. The lungs were designed for action. Motion is their natural state, and instead of disease being cured or prevented, it is almost sure to be induced if the full, free play of the lungs is in any degree impeded. Besides, all the vigor and vital force in the system is derived from the air received through the lungs. When the chest becomes contracted, the lungs folded up or compressed, and the breathing short, less vital air is received into the system than is demanded. Of course the whole system then suffers; the strength declines, the flesh wastes, the blood becomes impure, the digestion is impaired, the nerves are weakened, and above all, the lungs themselves suffer from the mischievous influences of this deprivation of air. When, on the contrary, the lungs are 256 MEDICINAL AND MECHANICAL REMEDIES. kept expanded, Avhen the figure is erect, the chest large, and the breathing deep and full, then the blood is perfectly aerated, every organ is imbued Avith vigor, the great processes of life go on regu- larly, the digestion and nutrition are healthfully carried forward, the nerves are strong, a fine life pervades the lungs, and the whole sys- tem is maintained in a state of health. When the importance of large lungs and deep breathing is prop- erly understood, most persons may do much tOAvards securing them by voluntary efforts at full respiration—by forcibly taking long, deep breaths, holding the air an instant in the lungs, and then letting it sloAA'ly escape. This should be done many times a day, and continued until the lungs are fully expanded, and the habit of full, deep breathing is established. There are many, however, who cannot well forcibly inflate the lungs thus without some artificial assistance; and all are aided by it, if properly contrived. For this reason the inhaling-tube—originated by Dr. Ramage, an English physician, and improved by myself—is of the greatest service in expanding the con- tracted chest and lungs, in arresting disease Avhere it has already in- vaded the lungs, and in preventing diseased lungs in those inclined to consumption. In the treatment of consumption it is all but indis- pensable. Where there are deposits of tubercles, or where there is ulceration, there is almost invariably established a habit of slight breathing—the breath being short and feeble. To break this habit up, and furnish the lungs Avith a constant, full supply of pure air, an effort is requisite, which will not be made unless there is some aid given. This aid the inhaling-tube furnishes. It is a convenient little silver instrument, so contrived that the air passes freely through it into the lungs on inspiration; and then, by the closing of a valve, it passes out less readily, requiring some force to expel it. This forci- ble expiration of air presses it deeply into the lungs—it penetrates every portion of them, unfolding those portions that have become collapsed or folded up, forcing open those tubes and cells that are closed by the secretions that have taken place, contributing to cleanse out the sores and ulcers, aiding the expectoration of the mucus, pressing together the walls of the cavities that may exist, promoting the absorption of tuberculous matter, preventing the further deposit of tubercles by quickening the circulation of the blood and purifying it, and by cleansing the surface and thinning the Avails of all the air- tubes and cells. It is designed to be used three or four times a day, SHOULDER-BRACES. 257 from five to thirty minutes at a time, and with more or less force__ from little more than a natural breath to nearly all the force the pa- tient can exert—according to his condition and strength. There have been instances in which persons, most undeniably in true con- sumption, have been restored to health by the simple use of this tube, Avith bathing and exercise in the open air. While it is thus valuable as a means of curing, it is not less so as a means of preventing consumption. I wish I could impress upon every person in Christendom, aa-1io is inclined to consumption—who has weak lungs, or who belongs to a consumptive family, the im- portance of forcibly expanding the lungs by the use of an inhaling- tube, and induce them thus to adopt its use, and continue it through life. I am persuaded that if I could do this, we might hold a day of jubilee, that the day of redemption from this monster scourge had dawned. It is not alone in diseases of the lungs that the inhaling-tube is valuable. There are thousands of persons who suffer from nervous- ness, lassitude, feebleness, decline, dyspepsia, deranged liver, head- ache, costiveness, palpitation of the heart, or some other annoying ailment, Avhose troubles grow out of an insufficient supply of air: they may be sedentary people, who exercise but little, and therefore breathe but little ; or they may have acquired contracted chests and diminished lungs. Now, all such people would find great relief most promptly by the use of the inhaling-tube. SHOULDER-BRACES. It is hardly necessary for me to recommend the use of shoulder- braces, or point out their advantages. They have noAV come so much into use, and their value in all cases Avhere there is a disposi- tion to stoop is so obvious, and has been so completely demonstrated, that the stupid prejudice which they encountered Avhen I first advo- cated their employment in my public lectures ten or tAvelve years ago, has Avell-nigh disappeared. It is true that a feAv antediluvian "conservatives,''' both in the profession and out, may yet condemn their use on the ground that '■'•nature furnishes the best shoulder- braces," or some other equally rational; but their senseless objections are little heeded. This is both gratifying and encouraging. Shoulder- braces should, of course, be so constructed as to be efficient in hold- 17 258 MEDICINAL AND MECHANICAL REAIEDIES. ing the shoulders back from resting doAvn on the chest, while at the same time they may be worn Avith ease, and cause no annoyance. When this is done, they are most unquestionably valuable instru- ments. All persons who have any tendency to stoop, or to throw the shoulders forAvard, and by this means contract the chest—thus diminishing the capacity of the lungs and impeding the action of the heart,—those who suffer pain in the chest, in the shoulders, sides, or back, under the shoulder-blades, or between the shoulders, will find vast benefit in wearing Avell-constructed shoulder-braces. Those who sit much—clerks, bookkeepers, office lawyers, secretaries, clergymen while writing their sermons, students, whether at school or in their OAvn study-rooms, women Avho sew much—in fact, all whose occupa- tions may lead them to stoop, if in the slightest degree inclined to do so, should by all means wear braces. In the treatment of almost every form of pulmonary disease, and especially in tubercular consumption, we can rarely dispense with their use. Here there is in every case a tendency to a contraction of the chest and a stooping of the shoulders, and however the patient may be admonished to struggle against it, he will not resist the tendency Avithout some artificial assistance. He must put on shoulder-braces. These, if made and worn right, will correct the habit of stooping, and, in connection with the inhaling-tube, aid him very much in securing an expanded chest, and thereby a restoration to health. ABDOMINAL SUPPORTERS. In my remarks upon the causes of pulmonary consumption, I ob- served that falling of the bowels, by the relaxation of the abdominal belts or muscles, is a frequent cause of weak lungs, short breath, and a sinking, exhausted feeling at the pit of the stomach, which may occur in all debilitated persons—at all ages and in both sexes. In a great many of these persons there is Aveakness in the loins, and in the lumbar region or small of the back, accompanied often Avith pain in the back when walking or riding, and every jolting motion be- comes difficult or impossible. This is especially the case with ladies who are delicate and who experience falling of the womb. In many cases after parturition, the abdominal belts do not resume their nat- ural firmness and tenseness, but become relaxed, and hence result ABDOMINAL SUPPORTERS. 259 prolapsus uteri and falling of the bowels. If in this condition the female is in any manner predisposed to consumption, the lungs are extremely apt to become affected. Hence it is that women who are consumptive often experience, immediately after confinement, a great increase of their consumptive symptoms—shortness of breath being frequently a prominent symptom; and this is owing to extreme relaxation of the abdominal belts or muscles, Avhich relaxation is the occasion of the falling of the boAvels, and the consequent removal of the support from beneath the diaphragm or floor of the lungs. To remedy this as far as practicable, I recommend full support to the boAvels and small of the back by the use of a suitably-adjusted ab- dominal supporter. The supporter which I employ has a large pad in front, connected by elastic steel-springs to pads resting on each side of the spine at the small of the back, and so adapted as to fully support the bowels and loins. I need not enter into a detailed de- scription of abdominal supporters, as they are hoav manufactured in vast numbers, and in great varieties of form and workmanship. This instrument, when properly adjusted and perfect in its action, becomes of incalculable benefit to the patient, and to all delicate persons, aa'Iiether male or female. I do not employ it in cases of children's diseases, for they generally seem to get along very Avell without it; but in almost all other debilitated persons I advise its use, as I find very few cases Avhere it may not be used successfully, and Avhere its use is not urgently demanded. In cases of weakness or loss of voice, for public speakers, teachers, and others Avho must talk a great deal, the abdominal supporter is invaluable. In the course of my practice I have known many Avho have been confined to their beds for months and unable to walk, from falling of the boAvels, soon restored to usefulness and active health by the use of a well-adjusted abdominal supporter. Sometimes the first application of an abdominal supporter may create or develop very considerable tenderness, soreness, or heat in the abdomen. In these cases the use of the instrument should not be neglected altogether, but it may be laid aside occasionally for a feAv hours; its use should be persevered in, and gradually the soreness and heat Avill be overcome. The patient may at first be unable to Avear it more than one or tAvo hours each day, and it may be neces- sary to wear it over several articles of dress, to decrease its direct 260 MEDICINAL AND MECHANICAL REMEDIES. pressure. Bathing the abdomen at intervals each day Avith salt and water or some alcoholic liquors, or wearing a wet compress upon the bowels every night, and perhaps rubbing some liniment upon them, will usually, in a short period of time, remove in those parts all ten- derness occasioned by the use of the supporter. When these objec- tions to the abdominal supporter are overcome, the patient will gen- erally acknowledge its inestimable value—he finds it a perfect life- preserver, and sometimes he can find no words to express his appre- ciation of its merits. My abdominal supporter, by its lightness, elasticity, and perfect adaptation to the patient, has secured for itself extensive favor ; and through the sIoav workings of individual experience, the medical fac- ulty—cautious of novelties—have finally acknowledged its benefits; and now it is widely and extensively known, and its merits very generally appreciated. Much credit is due to all my co-laborers in the Avork of introducing and perfecting abdominal supporters, because they are truly invaluable to the feeble and sick. THE BENEFITS OF THE ABOVE MECHANICAL REMEDIES STATED BY THOSE WHO HAVE USED THEM. Facts are of course worth more than theories and assumptions. No one is so competent a judge of the real value of either a medici- nal or mechanical remedy, as the person who employs it in his OAvn case, and experiences himself the benefit of it. I am therefore in- duced to subjoin a few letters written to me by those who have used my supporter, braces, and tube, and who speak of them from their own experience. If their testimony shall influence other sufferers to find relief in their use, my object will have been obtained. Better from Bev. D. S. McAdie. " Falkirk, Scotland, August 22d, 1855. "Dr. S. S. Fitch, M. D., New York : " Dear Sir,—I feel cause to reproach myself in that I have not be- fore this time written to you. When I called upon you about the close of last September, I was on a tour for my health, having, with the consent of my medical advisers, undertaken a voyage across the Atlantic in the hope that a sea-voyage might alleviate or check the letter from rev. d. s. m'adie. 261 progress of the pulmonary disease under which I had, for about six- teen months previously, been suffering. "I arrived in Canada after a sail of six weeks, somewhat improved in general health, but still feeling the disease in my chest much the same as it was when I left Scotland. In Upper Canada I heard of you, and of several parties there in the case of whom your treatment had proved successful in restoring them to health after they seemed to be hopelessly gone in consumption. A gentleman Avith whom I got acquainted there, and who had used some of your mechanical appliances, spoke highly of them, and recommended them as likely to be useful in my case. At Coburg I procured the shoulder-braces from your agent there, and also your Lectures on the Nature, Treat- ment, and Cure of Consumption. I had not the braces on more than a very few days when I began to experience their beneficial ten- dency. " The perusal of your lectures affbrded me some hope of res- toration, if not to perfect health, to such a measure of it as that I might again be able to do something for my oAvn support—that is, if I followed the directions prescribed. Previously I had little ex- pectation of recovering, as I regarded myself, and was regarded by my friends, as far gone in consumption. The simple, yet convincing, because most reasonable manner, in which you treated the whole subject, and the probability AA'hich you showed there Avas of curing, in ordinary circumstances, diseased lungs, made me think that per- haps my case Avas not hopeless, and encouraged me to use Avith greater energy than I had done all likely means of recovery. Hav- ing, as I have stated, experienced great benefit from the use of the braces, I procured your abdominal supporter in Toronto, and found it, too, admirably adapted for the purposes intended. I then resolved upon endeavoring to see you personally. With this intention I went to NeAv York. My intervieAv with you there Avas one of the most agreeable things I experienced in America. Your kind, sympa- thizing manner, and the encouragement you afforded me to hope for a cure, tended to cheer me much, as it considerably dispelled that sadness and depression of spirits AA'hich are almost unavoidably at- tendant on apparently hopelessly-broken health. " Shortly after I saAv you I returned again to Canada, and thence soon after to Scotland, where I arrived on the 1st of November, 1854. I commenced the use of your medicine, and your other appliances, 262 MEDICINAL and mechanical remedies. immediately after seeing you. But as I was for some time then moving from place to place, I was able only very partially, on some occasions, to folloAv your recommendations. I, however, soon began to experience the beneficial effects of even a partial trial. The medi- cine from which it appears to me I derived most benefit, were the Cathartic Pills, the Cherry Pulmoniac, and the Universal Tonic. I have also had considerable relief by the use of the Pulmonary Lini- ment AA'hen troubled with a sore throat. But the mechanical appli- ances recommended by you have been, if possible, of more use to me than the medicines.. I have already said that I had the braces and supporter before seeing you. I do not know that I have ever de- rived more benefit from any one thing of the kind, than I have from the braces. For several years past, I had been feeling a tendency to stoop considerably Avhen walking. This had partly been caused by studying much, and sitting in a bad position Avhen so doing, and partly by the disease in the chest. When I commenced the use of the braces, I felt as if it was impossible for me to wear them; for on attempting to stand erect, I felt severe pain in the breast, and as if something would break there. But by persevering, and gradually tightening them as I could bear it, the disagreeable sensation in the breast almost entirely subsided,, and altogether the breast became very much stronger. When I arrived in Scotland, at the time I have stated, I was much better in health than when I left it; but the alteration in my appearance> which chiefly struck my friends and acquaintances, was my upright gait.. They could not understand how I had got over the stooping. On learning that it was by means of braces, not a few applied to me to ascertain if I could get some- thing similar for them. But I have not been able to learn that there is any thing similar on sale in this country. By the means of the brace, I can now stand or walk as erectly as any one. So great, indeed, Avas the change produced upon me, that on my arrival home I had to get my coats altered to suit the form of the back, etc. I wish I had a quantity of the braces, for the supply of many who re- quire and desire them. " The supporter I find extremely useful also. Without it I feel I cannot take a long full breath, but with it I breathe freely. I wear it and the braces constantly, and indeed would not feel comfortable Avere I to want either. It appears to me that the supporter must be of incalculable benefit to all Avho have weak chests—that is, if they LETTERS FROM PATIENTS. 263 use it. To delicate females it must be, I should think, exceedingly useful. "I have used the inhaling-tube you so kindly gave me, almost daily, and have found it of great benefit. It ahvays gives relief to the chest, and makes the breathing more easy. Through the use of it and the braces, my chest is, I know, much broader and fuller than it was this time last year. I consider the inhaling-tube an excellent little instrument for the purpose intended, and wish that it and the other articles I have referred to were known and for sale in this country. " I may mention, in conclusion, that on arriving in Glasgow from America, though my health was improved, I did not consider it pru- dent to return to my former employment there—viz., that of city missionary, but to endeavor to obtain some situation in the country, and Avhere I would not require to speak much. I very soon got no- tice that a governor was required for this institution (work-house). On application I received the appointment, and have discharged all the duties since December 1st, 1854. My health during that time has not been what may be called robust, but on the whole I have been comparatively well. We had a very severe winter here—the most so that has been experienced for many years; but during the Avhole of it I was never a whole day at a time unfitted for duty through illness. I have a little cough still, occasionally, in the morn- ings, and a sensation in the right lung as if all were not quite sound; but on the whole I enjoy pretty good health—much better, indeed, than once I ever expected to have. " With best wishes for your welfare, " I am, dear sir, ever yours gratefully, " David S. McAdie, " Falkirk, North Britain." Letter from Mrs. F---H---- "Warwick, Franklin Co., Mass., September 19, 1854. " Dear Dr. Fitch : " Sir,—Doubtless you have been led to anticipate from the place at Avhich this letter is dated, that I have changed my location—and so I have. Before I had used your remedies a fortnight, I Avas able to be conveyed from Princeton to Wanvick, a distance of about 264 MEDICINAL AND MECHANICAL REMEDIES. thirty miles, in an easy carriage, by travelling but a short distance in a day. Had I had sufficient notice previous to starting that I was to return home, I should have consulted you as to the propriety of undertaking such a journey in my present state of health, but I had not; and I Avas so anxious to return home that I would risk my life, almost, in attempting to reach it; but no evil results from this journey, but rather good. I think it has been highly beneficial to my health. I feel much better than I did AA'hen I left P----: there Ave re many circumstances connected Avith my staying there, opposed to my recovery. And noAV I am at home !—dear, dear spot!—and though humble, there is no place like it. " I am using your remedies faithfully and perseveringly, according to directions, and think they are having a happy effect. " Your supporter I prize Aery highly—think it was the principal instrument in enabling me to return home, for without it I verily be- lieve I should haAe fallen to pieces. I could not wear it all the time at first, but now experience no other feeling but comfort and sup- port ; and although I cannot walk around much yet, I suppose it is because my Avhole system is debilitated, rather than because the supporter does not have the right effect. The inhaling-tube I am using daily; it does not fatigue me but very little to use it; often wish I could use it longer than directed. Would any injury result if I should? ***** " Truly yours, "Mrs. E. H---." Letter from L. T. Fales. " Griggsville, Essex Co., III., September 10, 1856. " Dr. S. S. Fitch : " Dear Sir,—It has occurred to me recently, that it is due to you that I should make some acknowledgment of the very great benefit I have derived from the use of your remedies, and particularly your abdominal supporter. Some twenty years ago I sustained an injury from riding a hard-trotting horse. I was not very sensible of it at the time, but in the course of a few months my health failed me; I had great weakness at the pit of the stomach ; I lost my strength very much; my food did not seem to nourish the system. I became very much emaciated. I consulted a number of the best physicians LETTERS FROM PATIENTS. 265 in Washington, D. C, where I then resided, but I received no help from them; in fact, they could not determine what my disease Avas. They did not attribute my illness to the injury from horseback-riding. I continued to grow worse until 1847, Avhen I had about given up hope of being better. I then consulted you. You at once laid your finger on the source of the difficulty. My violent horseback-riding had injured and relaxed the abdominal muscles, and caused a falling of the boAvels. From this cause all my difficulties proceeded. You prescribed for me, and gave me a supporter, together Avith some medicines. The effect was wonderful and immediate. I at once improved. The faintness, pain, Aveakness of the stomach, Avere re- lieved ; the costiveness and diarrhoea I had suffered, severely by turns, were subdued; my strength and flesh came back, and I have enjoyed eight years of fair health. I am quite confident that but for your help I could not have lived long after the time I applied to you. I have always felt most grateful for what you did for me. " Respectfully yours, "L. T. Faxes." Letter from Miss H----F. W----. "Mt. Holly, Vt., January 1st, 1855. " Dr. S. S. Fitch : " Dear Sir,—I have taken my pen to inform you of the benefit I received from your shoulder-braces, supporters, and medicines. " I Avas quite Ioav before I received your medicines, and was not able to do any thing. I could not sew but a feAv minutes before it Avould seem as though I could not take another stitch, there was so much pain through my lungs to my shoulder-blades, and the back of my neck. I received your remedies on Thursday evening. I put on your shoulder-braces, and after a little while I felt quite relieved, and Avent to seAving, and was not as tired at night as I was in the morn- ing. I wore them about three months, and do not haAre to wear them any more. I was troubled very much with weakness across my kidneys. I put on your abdominal supporter: within three days I was Avell as ever. I think it is the best thing a lady can wear, if she is troubled with any female weakness. " Yours truly, " Miss H---E. W---." 266 INJURIOUS REMEDIES AND HURTFUL TREATMENT Letter from Mr. Merritt Martin. "New York, March 4, 1856. " Dr. S. S. Fitch : " Dear Sir,—Some years ago I found myself an invalid, and scarcely knew hoAv or why. I had a constant sense of faintness and weakness, a sinking, and as you have in your Lectures well expressed it, dis- tressing, all-gone feeling at the stomach. Standing or walking about wearied me excessively. I had a tired, dragging feeling about the chest and shoulders. These difficulties rendered me unfit for busi- ness or labor, and my life miserable. In this condition I was induced to get one of your abdominal supporters. I Avas relieved as soon as I put it on. I have Avorn it constantly since, and would not be Avith- out it for its weight in gold. Why do not more who need just this instrument for falling of the bowels, Avear it ? I desire to thank you for the very great relief and benefit I have derived from it. " Yours respectfully, "Merritt Martin, 731 Eighth-av., N.Y." Letter from 3Irs. Sylvanus Johnson. "Iowa City, Iowa, July 14th, 1855. "Dr. S. S. Fitch: " Dear Sir,—I have worn the supporter almost constantly for five years, and would not be without it. I presume it has done more for me than medicine. I supposed at the time I wrote that con- sumption was rapidly approaching, if not already seated, and cannot but feel very grateful to a kind Providence that you have been the means of restoring me to so comfortable a state of health. " Mrs. Sylvanus Johnson." INJURIOUS REMEDIES AND HURTFUL TREATMENT IN CONSUMPTION. In the disease called consumption, which almost universally has a double character, being both bronchial and tubercular, two de- structive agencies are acting upon the patient, and in opposite direc- tions ; so that in most instances the ordinary treatment will be found to hasten the disease; and the case that would permit the continu- THE old treatment a failure. 267 ance of life two or three years without any medical treatment what- ever, is often brought to a fatal termination in the same number of months. Many judicious medical men, therefore, after repeated at- tempts to cure consumption, and observing the prostrating effects of almost all medical remedies, and their fatal results, finally arrive at the conclusion that it is better to let the patient alone and leave him to pursue his own instincts for relief, rather than to prescribe their medicines; and in this they are perfectly correct and truly humane. The general directions for the treatment of consumption as laid doAvn in books, are found to hasten rather than retard the disease, Avhich is OAAdng to the confusion that prevails upon the subject of the disease itself, and the attempt to cure two distinct diseases, pre- vailing upon the same organ at the same time, by a single remedy; and hence, in the treatment of pulmonary consumption throughout the entire history of medicine, we find a constant succession of sin- gle remedies suddenly springing into popularity, becoming fashion- able for a time, and universally applied, and that Avith little dis- crimination, and then abandoned as useless. The history of these remedies exhibits a series of most unhappy failures—fatal to the sick and derogatory to the profession—yet, of remedies for a time lauded to the very skies as perfectly re- liable, thoroughly curative, and applicable to every case: these fail- ures finally giving birth to a universal dogma, which has been that pulmonary consumption is incurable, and that, consequently, the failure of any treatment designed for its cure leaves no stain upon the escutcheon of any physician, whether eminent or obscure— whether he be the highest professor in the highest school, or the loAvest empiric in the lowest grade of quackery. It has been always orthodox in the most accredited schools of medicine, to em- ploy any remedy that has been the prevailing fashion, however ridic- ulous or absurd. The treatment, thus changeable, and thus worth- less in all its changes, has been continued until thousands of men, revolting at the results, and declaring that no treatment can be more unsuccessful, are prepared to turn their eyes away from the pro- fession, to almost any source that promises relief. I Avill recall to the memory of the reader a very few of those in- fallUde and fashionable remedies. Their history is a most instructive one, not only in its bearing upon consumption, but also in its appli- 268 INJURIOUS REMEDIES AND HURTFUL TREATMENT. cation to all other diseases; for it is a thoroughly established fact, that Avithout a clear perception of Avhat the disease is and what its complications are, the application of remedies must necessarily be empirical—must be quackery—an experiment, Avithout previous suc- cess to warrant its employment or justify its continuance, and with- out any true analytical knoAvledge of the disease to explain its failure, or from its failure to construct any plausible theory or any successful practice that would lead to a cure. From the employment of a remedy adopted upon a false theory and in the darkest ignorance, no light of course can arise. The effect must be only to discourage the physician, and to make him eager for some new remedy; and, gen- erally, any remedy that for the moment seems to mitigate any one symptom, will be seized upon as a curative for the disease itself. I will mention a feAV of these. First, the preparations of mercury have, at different times within the last seventy years, been employed by various physicians—the most humble and the most eminent—in the attempt to cure con- sumption ; Avhile, hoAvever, it has never risen to the dignity of a uni- versality, it has been used by different physicians during this whole period, down to the year 1857. Within ten days of the time I am noAV Avriting, a lady called on me, laboring under bronchial tubercu- lar consumption, Avho, in the latter part of the past winter, was saliva- ted for six entire Aveeks, under the prescription of one of the oldest and most eminent physicians in NeAV York; and yet no man living or dead ever Avitnessed any success from such practice, any assistance to the sick, or any credit to the physician. Its effects are, on the contrary, most wonderfully to accelerate the progress of the disease. Diseased lungs once thoroughly mercurialized, are nearly deprived of all hope of cure. Woe to the unhappy patient with weak lungs, Avho has his system saturated Avith mercury! Mercury, taken into the system, becomes often a direct cause of tuberculous deposits, by weakening all the powers of life. The par- ticles of mercury in the lungs themselves arrest the circulation and become a direct nucleus for tuberculous deposits, and tubercles already formed rapidly soften. Indeed, mercurials are among the most pow- erful agents for producing consumption, for extending its develop- ment, and hastening its fatal termination, of any and all of the mad remedies admitted or employed by the medical faculty. The next that I would mention is foxglove (digitalis). Forty FOXGLOVE—PRUSSIC ACID. 269 years ago this remedy enjoyed a high reputation. Its praise echoed through Great Britain and through this country; and one learned writer and celebrated physician declared that he wanted nothing more—that foxglove, used at any time and persevered in, was as certain to cure consumption as Peruvian bark and its preparations were to cure ague and fever. It was fashionable during many years for physicians to prescribe foxglove; and it Avas quite amusing to observe the complacency and self-gratulation enjoyed by them when descanting upon the virtues of this remedy. I should think that foxglove must have been employed with con- siderable ardor and much assumed confidence for at least twenty years ; Avhen, finally, its use, and almost its remembrance, disap- peared. It retains its place in the materia medica only as a simple narcotic and sedative, remarkable for its powers of depressing the vitality of the system and lowering the pulse. So little did physi- cians knoAV of the nature of pulmonary consumption, that they employed this remedy for many years because it had the simple property of reducing the pulse, and lessening in a small degree the action of the heart: just as if increased arterial excitement was the cause of this disease. FolloAving up this idea, other similar agents were sought for; as poor foxglove, falling from its universal popularity, had become truly dis- tasteful to all patients and friends of patients. Then 2^'ussic acid Avas introduced ; and this, from its powers of depressing vitality—of re- ducing the pulse—was thought to promise the most curative results. It is true that timid physicians rather shrunk from employing a remedy a feAv drops of AA'hich might occasion instant death; but the bolder spirits cried out, " Dilute it! dilute it! and it may be given Avith the safety of milk." It is true that the point of dilution was not agreed upon soon enough to prevrent the sacrifice of a feAv valuable lives. The late Dr. John Eberly, author of " Eberly's Therapeutics," so well and widely known in this country, who in his day was certainly one of the best educated practitioners of medicine in America, told me that he received a small quantity of prussic acid directly from Berzelius himself, and, acting under the most careful directions (as it Avas so expensive, he did not try it upon any poor person), he gave it to one of his most respectable female patients in Philadelphia. So quieting was the effect, that she died in twelve hours. 270 injurious remedies and hurtful treatment. I need not say that prussic acid is now never spoken of in any quarter as a curative agent in consumption. It finds a place, how- ever, in some mixtures, but as a mere palliative. EMETIC TARTAR. Having some properties in common both with foxglove and prussic acid, has been long employed because it so readily reduces the pulse and so thoroughly prostrates animal life. It is tenfold more ener- getic as a sedative than foxglove, and without any of the poisonous properties of prussic acid. Its power of depressing life and reducing the vital forces of the system, is equal to any effect desired by the physician who wishes the vitality of his patient placed on the rule of reduction descending. But its effects in lung disease are cer- tainly most appalling; and if given to the consumptive after the de- position of tubercles, or after softenings have commenced, it will hurry him out of the Avorld much faster than consumption itself. By its direct effect in reducing vitality, it has been, as it is to this day, one of the most destructive agents ever employed by physicians in hastening pulmonary consumption to a fatal termination. It Avas very considerably employed for a great many years, and is even now used by some physicians. Whilst foxglove and prussic acid Avere never thought of for external application, emetic tartar—a mineral in its origin, a chemical salt in its composition, and a terrible caustic in its constitution—was employed to eat up the patient. Dr. Joseph Clapp, considered a most respectable and intelligent physician—a resident in the south part of Philadelphia, Avhere he enjoyed a large practice—told me that to him belonged the honor of having first employed emetic tartar AA'ith lard, in the form of an unguent or an ointment; of such strength—I might say of such commensurate strength—that when he applied it to the chest, and kept it on about tAA'enty-four hours, he Avas able to remove from half an ounce to an ounce of living flesh from the breast of the patient. He declared that its effects were truly remarkable, yet he did not intimate that he had ever seen a person cured by it. The use of this remedy as a caustic, more or less severe, has been continued up to the present. Emetic tartar is exceeded by scarcely any thing in its power of producing intense suffering. It attacks flesh, skin, muscles, bone—all give way before this devas- BLO OD-LETTING--IODINE. 271 tator. I have seen the breast-bone cut entirely through to the cavity of the chest by it. Woe to the unhappy wretch who is the victim of this practice! Terrible distress results from its application—the strength is rapidly prostrated, all power of healing in the lungs is utterly removed, and the poor patient, hopeless and helpless, sinks into his grave. I never remember to have witnessed an instance where any one in consumption received any benefit from the appli- cation of emetic tartar to the chest. It has been applied in tens of thousands of cases in the last thirty years. Dr. Clapp's idea was, that you could hardly make too great a sore on the outside of the chest, if a sore already existed inside of it. I need not say that I have never employed or advised its use, externally or internally, in consumption, save very slightly in some rare cases, and in very minute doses. The next great remedy that I will mention, following immediately after foxglove and prussic acid, and used also with them, but more particularly AAdth foxglove, is blood-letting. This, indeed, arose al- most to the dignity of a universality. It had its origin in some essays on consumption, written by Dr. Gallup, a celebrated physician resi- ding in Vermont. The practice of blood-letting in consumption, following his sugges- tions and teachings, became nearly universal in this country. The quantity drawn out from, was frequently only limited by the quantity in, the body. I personally knew one man who was bled twenty times in nineteen days. During the intervals of bleeding, there was made a free use of foxglove. Probably nothing could have horrified his attending physician more than the suggestion of a tonic, or in any way sustaining the vital functions. The physician seemed not aware that his patient had any vital functions; he appeared to have only the single idea that the poor wretch had blood, and that from blood proceeded inflammation and consumption : therefore it should be all draAvn out as fast as possible. This practice so rapidly cleared off the consumptive sick-list, that it Avas pretty soon abandoned, although it is still practised more or less by a few physicians. In some rare cases, blood-letting may be admitted to the extent of a feAv ounces, yet I seldom ever employ it at all. Lodine.—This mineral, considered one of the greatest, if not the greatest, gifts of chemistry to medicine, on its first discovery was 272 INJURIOUS REMEDIES AND HURTFUL TREATMENT. lauded to the very echo as an agent capable of curing every form of scrofula and nearly every possible form of skin disease. It was supposed to be very useful in pulmonary consumption. It Avas used and exhibited in almost every variety and mode—in the form of pills, plasters, tinctures, lotions, vapors, etc. I have no doubt that iodine, in some forms of scrofula, is an excellent remedy; but in my hands it has nevrer been successful as a curative in any disease AA'hatever when exhibited alone and Avithout auxiliaries, which were good in themselves, therefore leaving in doubt the amount of benefit derived from the iodine ; but in combination Avith other remedies I sometimes exhibit it in minute doses. It has the effect of producing pain and stricture in the chest; and this it is apt to do, unless given in very minute doses. This effect is produced in every form of combination if used in large quantities ; if inhaled into the lungs in the form of a vapor, it will produce pain there and tightness, much of a rheumatic character. In fact, I have rarely seen much benefit derived from the use of iodine in any form of consumption or in throat disease. Its application to scrofulous swelling should be conducted with the greatest possible care, so as to prevent these swellings from being driven to the internal organs; or, in other Avords, to prevent their striking in. I have, in a great many in- stances, witnessed deplorable results from this practice. When scrofulous swellings or lumps come upon the neck or any part of the body, Ave may be positively assured that this is an effort of nature to deposit out of harm's way the superabundant tubercu- lous material existing in the blood. If we attempt to disperse these deposits Avithout elevating the general health and guarding all the great internal organs of the body and opening all the emunc- tories, these deposits \A'ill almost certainly be transferred to the in- ternal organs, where they may produce a vast amount of mischief. In combination with potash, iodine has been much exhibited, and is still; but in many cases where this combination has been used, I have thought that potash alone acted better, and that Avithout any of the bad effects that may be produced by iodine. It is doubtless true that, in many cases, iodine may be profitably used for a short time for a specific purpose—it is no doubt a stimulant and excitant of the syst em; in some cases by these properties alone it may be useful. In cases of old sores and running scrofula, it is no doubt extremely useful; but I again repeat, that as a remedy in bron- COD-LIVER OIL. 273 chitis or in any form of consumption, I havre rarely found it so useful as to depend upon it altogether, without the addition and as- sistance of every auxiliary with which I am acquainted. But com- bined or uncombined, if its use is pushed to much extent, its effect is to excite pain in the lungs and walls of the chest, often continuing for a long time, and becoming difficult to eradicate. If depended on to cure consumption, it Avill prove a failure ; and, in fact, the same remark may be made of the whole list of mineral agents. Passing out of the mineral region, we next find ourselves embarked upon a sea of oil. Not oil and oleaginous substances in general, but one oil only—cod-liver oil. This remedy has been employed in Germany for a great number of years. There they have not been very particular, as they have employed any description of fish-oil, whale-oil, etc. Train-oil and lamp-oil have been exhibited for a long period of time, not only in Germany but nearly in all the north of Europe, where it has enjoyed a very pleasant repu- tation, particularly in domestic practice, in the treatment of colds, coughs, etc. About sixteen years ago it began to be talked of in England and whispered in this country; yet great professors here received it with expressions of unmitigated contempt and disgust. Dr. Nathaniel Chapman, the old and able professor of the theory and practice of medicine in the University of Pennsylvania, at Phila- delphia, could not really find Avords to express his contempt for this new aspirant to favor. He applied his whole powers of Avit, sarcasm, and ridicule, with Avhich he was largely endowed, to combating the idea of ever introducing such a disgusting article into public use. However, it slowly made progress; and because the utter failure of every thing else excused any experiment with any new substance, cod-liver oil very unctuously made its way upAvard to the dignity of a widely-spread universality. About the year 1851, its comet assent may be said to have cul- minated ; Avhen nearly every consumptive in the civilized world was invited to partake of its thoroughly curative virtues and its sure-curing benefits. It was everyAvfiere adopted, and every thing else Avas rejected. It Avas in truth the reigning goddess of the day; and not to have been orthodox upon cod-liver oil, Avas to show sur- passing ionorance in the progress of medicine. Professors lauded it, and physicians even'Avhere prescribed it; at the same time re- 18 274 INJURIOUS REMEDIES AND HURTFUL TREATMENT. ferring to other remedies as being quite unnecessary Avhen they had such a potential agent at their command. A medical friend of mine, at that time visiting the lung hospital at Brampton, near London, found over seventy persons in consumption, of different ages and sexes; every one of Avhom, Avithout the least discrimination, Avas taking cod-liver oil, and nothing else. One physician in this country, at that time writing to me, and a well-educated man too, said that if I would throw away my medicines, he Avould inform me of a remedy which he had dis- covered, and AA'hich would cure every case of pulmonary consump- tion : and that Avas cod-liver oil. I informed him by return of mail, that I had tried and tested it in lung disease, even when its employ- ment was considered derogatory to me as a physician—that I had perceived some benefits to arise from its use, but a cure I had never known effected by it. It is now rapidly sinking in the public estimation, and, as a cura- tive agent, AA'ill no doubt fall into greater disregard than its merits deserve; for there are conditions and circumstances of the lungs and of the patient, AA'hen cod-liver oil becomes a useful agent. To some it is a tonic, a deobstruent, an alterative, and, when judiciously given, care being taken that the lungs supply air enough to vitalize it, it is useful in bestowing fat upon the attenuated. EMETICS. Forty years ago the treatment of nearly every disease, and almost every variety of indisposition, Avould commence with an emetic. This practice, then entirely universal, is continued more or less down to this day. The Thompsonians exaggerate its importance, and sometimes vomit their patients two or three days together; and in some cases thereby produce death. This very exaggeration has, perhaps, tended to do away in some measure with the system of vomiting among sensible physicians. The " old-school" physicians usually employed tartar emetic—espe- cially the advocates of " heroic practice;" Avhilst those more humane and considerate towards their patients, employ ipecac. Many an old man or woman, upon becoming a little indisposed, and suspect- ing an accession of fever, has received a prompt quietus from a dose EMETICS. 275 of tartar emetic. I recollect several such instances, Avhere old, feeble persons have been sent to their long home by one or two hours' vomiting, and the prostrating effects of emetic tartar. At one time, emetics of sulphate of copper were greatly in vogue ; and invalids, especially consumptives, would be vomited in a mild manner every day by its use. This practice has now entirely disap- peared, or is pursued very little, so far as I know. Lobelia and ipe- cacuanha are still more or less employed; but the use of emetics is, at this time, far less general than I have ever known it, and I be- lieve is fast being discarded entirely. Their merit, as a general thing, is certainly questionable and doubtful. There are, of course, some peculiar circumstances in which an emetic is called for; as, for example, where some poisonous or other- Avise deleterious thing has been swallowed, or where the person has endangered his life by surfeiting. It may also sometimes be the case, that the stomach is loaded with bile or vicious secretions to such an extent that an emetic will be useful in ejecting it. I prefer, however, in these cases, relying on cathartics. But if vomiting is resorted to, a simple warm-water emetic, or warm water with a very little mustard in it, is all that is required—is just as efficient as a harsh dose of emetic tartar or ipecac, and it is followed by no inju- rious consequences. In lung disease, for which emetics have been unaccountably used, this treatment is most absurd and pernicious. They prostrate the strength, weaken the stomach, and sometimes cause bleeding at the lungs by vomiting, and can do no possible good. I, of course, entirely discard the use of emetics in lung affec- tions ; and I do not call to mind any chronic affection in which I believe they can be of any benefit. CHAPTER XXV. VARIOUS FORMS OF CONSUMPTION, DESCRIBED BY THE PATIENTS THEMSELVES. There are some persons who read the descriptions of disease which they find in books, with the impression that the writers draw upon their imagination for their facts ;—that such cases of disease as they describe, with the various symptoms stated, do not really ex- ist ; or if they do, that they cannot be so minutely known to the physician. If, indeed, the description is of a disorder with which the reader is himself affected, he usually finds that his condition,— with all his " pains and aches," his sufferings and annoyances,—is accurately stated, perhaps better than he could state it himself. But when the case is one of which he has had no experience, he is apt to think that it is " made up," to match the writer's theory or the system of treatment he thinks proper to employ for its cure. Now, that some writers may not thus substitute fancy for facts derived from actual observation, I will not vouch; but that I have not done so in Avhat I have said of diseases of the lungs, I desire to convince my readers by presenting them with extracts from letters written to me by my patients themselves, when applying for advice and treat- ment. It has only occurred to me to do so, since the manuscript of this Avork was put into the hands of the printer; and I have not time therefore to select from the mauy thousands of letters I have on file those Avhich would be best adapted of any I have to show the various phases, forms, and symptoms of consumption. The letters copied in the following pages, I draw from my files almost at random; and yet, if I am not mistaken, the reader, par- ticularly if he is an invalid, will be interested to find that the views of consumption given in this book are very completely corroborated by these letters. I permit the writers to tell their own stories in their own simple way—often quite informal, and always inartificial, AN INVALID'S STATEMENT OF HIS CASE. 277 but usually very expressive. I desire also that the invalid, as he reads these statements, may be encouraged to hope for relief, when he sees that others, who have been afflicted as he is, have been re- stored to health. STATEMENTS SHOWING THE VARIOUS STEPS OF PROGRESS IN THE DE- VELOPMENT OF TRUE TUBERCULAR CONSUMPTION. Case I. Mr. Geo. D. Y-----, of Ogdensburg, N. Y., writes me, Octo- ber, 1856 : " Dr. S. S. Fitch—Sir : For nearly four years I have been taking doctors' advice and drugs, without receiving any benefit. About three months ago I quit taking any thing, for I thought there was no use tor- menting myself with swallowing trash any longer. But in the Tribune the other day I read certificates of cures, of cases apparently worse than mine, and I thought that, as a last resort, I would write to you, state my case, and ascertain whether you thought I could be cured. In 1852 my health began to decline ; felt weak; my legs felt as if they could not support my body. Then I had a bad cough also, and sick- ness and oppression of stomach. In the fall I improAred sufficiently to work that winter and the next summer : took nothing but a little cod-liver oil. In the fall of 1853 began to grow Aveak again ; cough set in; and after New Year kept my bed and room the rest of the winter. Spit a few mouthful s of clear blood, also bloody matter; had a sore throat and SAvelled tonsils; had no regular physician; took syrups of different roots, and bathed every day with a wash of spirits of ammonia and Avhiskey. In the spring my health improved; AA'orked during the month of July. Over-exertion brought my cough back. Was advised to go to Texas ; stayed there two Avinters and one summer; took no medicine; had the chills and fever for six months; came back this spring a good deal worse. Heard of W. G----'s remedy ; tried it, and found it a failure. " I AA-ill now give you a sketch of my symptoms. I am twenty-six years old ; a carpenter by trade ; have ahvays lived in Ogdensburg; except a weakness of stomach, health very good; never had a cough in my life before this attack; five feet ten inches in height, and twenty inches across the shoulders ; thirty-two and a half inches around the chest, twenty-nine around the waist—thirty-one and a half when my 278 VARIOUS FORMS OF CONSUMPTION, lungs are fully expanded. Never was very fleshy ; Aveighed AA'hen well one hundred and fifty-five pounds—now weigh one hundred and thirty-two pounds. Always walk very erect; do yet, except Avhen tired ; have brown hair and whiskers, blue eyes; father died of what was called consumption, at the age of fifty ; do not know what dis- ease my mother died of; both of my parents' families very healthy. Breath short at times ; no skin disease except a little scaly rough- ness on the face at times. Have a good deal of headache; some pain in the left side in my chest; also at the lower edge of my ribs above the hips ; heavy, oppressed feeling back part of the neck be- tAveen the shoulders and at the collar-bones. Have sore throat, SAvelled tonsils at times ; heat and dryness in the throat; voice weak; hurts me doAvn to the pit of the stomach to speak loud. When I take a cold it settles in my head or throat. Have had a cough more or less for four years ; for the last year coughed all the time, and spit up nearly half a pint of matter per day, of a dirty-white color; does not sink in water. I have no more cough than is necessary to raise the corrupt matter that gathers in my chest; were that checked, my cough AA'ould leave I think. I cough and raise most at night. Nearly tAvo years ago I spit up about a pint of blood ; it seemed to come from the midriff, at the lower edge of the left ribs; have been tender there, and short of breath at times ever since; have raised bloody matter several times since—a few mouthfuls at a time. I lie on my right side and back ; when I lie on my left side there is a rat- tling or Avheezing sound, seeming to come from under the collar- bone on my left side; sometimes it makes me cough when I breathe full. My left side rises more than the other; I do not know why it is so, as I never had much pain or bad feeling in my right side. I have had Aery little chills or fever for the last six months. Never had a regular night-sweat, but in warm weather my head would sweat so that the hair would be as Avet as though dipped in water. I go out every day; can walk a couple of miles in the course of the day. At times, after walking a short distance, the matter in my chest seems to rise up to the upper part near my throat, and I have to stop and cough until I raise it, or I would choke. I am also troubled with an all-gone feeling at the top of the chest, pit of the stomach, and across the bowels—feel it most when walking. When I get excited, or when I have a severe fit of coughing, my heart will beat very hard, and sometimes, without any apparent cause, will DESCRIBED BY THE PATIENTS THEMSELVES. 279 beat so hard as to shake my whole person. Am rather nervous ; have oppression at the stomach a good deal; not particularly after meals have sickness at the stomach a good deal. When I have a bad cold in my head, I raise a clear stringy matter; when any of that lodges in my throat, it always makes me vomit after eating, for I have a coughing spell after every meal—sometimes after eating pretty Avell. When I awake in the morning, the matter that I raise is thin, of a white color, and of a nasty taste, and I vomit it up, mixed with yelloAV bile, which is very bitter. My bowels are regular at present, but are generally costive; appetite variable; heartburn al- most every night; coffee, or any thing burnt, taken into the stomach, gives me the heartburn. My back feels rather weak at times—about the middle—some heat there, and in my head; feet do not trouble me; no bloating; some wind in the stomach at times; no pain in the limbs; no rheumatism; no deformity; no wounds. Had the chills and fever in Texas for six months; took two or three doses of calo- mel at that time,—no more that I know of. I think that I am rather bilious. My complexion—a yellowish cast all summer—but is gen- erally clear. Have not taken any thing for the bilious disorders. I am not married. I cannot read or talk loud without coughing. I can Avalk as fast as men generally do for a short distance; the least exertion makes me cough. I have done no work in three years; have used up all the property I had made, principally in travelling for my health; am dependent on my relative, and that to me is more bitter than my sickness. I have now answered about all your ques- tions to invalids ; and wish that if you think that there is a reasona- ble chance for me to regain my health, that you let me know as soon as convenient, and also your most favorable terms for such of your remedies as I may need. If you think that I cannot be cured, tell me so plainly. I have looked Death too long in the face to be much alarmed at his approach. I have one of your books, and from read- ing it I am convinced that something like your supporter was what I needed long ago. I have shoulder-braces, but they irritate and tire the shoulders so that I cannot wear them." Here are presented the usual phenomena of hereditary phthisis— a steady, gradual, but insidious development of the disease, spite of all palliative remedies, and somewhat accelerated no doubt by chills and fever and by exposure. { 280 VARIOUS FORMS OF CONSUMPTION, CASES ILLUSTRATING HOW CONSUMPTION IS DEVELOPED, BY SIMPLE COLDS, IN THOSE PREDISPOSED TO IT. Case II. Mr. W. P----, of Livingston, 111., Avrote me in August, 1856, for advice and treatment. It will be seen that he had been the greater part of his life a robust man, until his taking a violent cold in April preceding the date of his letter. But he belonged to a consumptive family ; his father died of hemorrhage of the lungs, and his mother of asthma or heart disease. The poisonous taint lurked in his blood, unsuspected by him, until a neglected cold determined it upon the lungs, and consumption Avas developed. He says: " I Avas born and reared in the southern part of Pennsylvania, and came to the state of Illinois about eighteen months ago. My occu- pation is that of a tinner. My figure is short and rather broad—or- dinary flesh—have usually been quite straight, but since I have been sick have become rather stooping : dark complexion, hair, and eyes. My family is somewhat predisposed to consumption. My mother died with the asthma or heart disease at the age of seventy ; and my father died at the age of seventy-six, of hemorrhage or bleeding at the lungs. I have usually had good health until last April, AA'hen I Avas once out over night exposed to the damp night-air, and caught a severe cold. I did not get rid of it, and a cough soon set in, with chills and fever, soreness of the bones, etc.; and for six Aveeks I had hard night-sweats, which were very debilitating, and I lost in the time some eighteen pounds of flesh. I succeeded in breaking these sweats, and noAV feel someAvhat better, but far from well. I have still a dry hacking cough, and find I have little strength or endu- rance ; a few hours' work fatigues me, so that I am obliged to lie doAvn, and I have a soreness directly on the breast-bone and a little way above the stomach; also a pain or soreness in my side. I am nervous, sometimes sick at the stomach, and have the blind piles. I have taken calomel, quinine, and iron-rust at various times, but have now quit taking medicine altogether." It will be noticed how evidently this cold, which, in a person of a pure constitution, would have passed off without material injury, developed the latent tendency to disease in the lungs, and ended in consumption; for undoubtedly this man had at the time of DESCRIBED BY THE PATIENTS THEMSELVES. 281 writing tuberculous deposits in his lungs—a condition Avhich would have terminated fatally but for the right kind of treatment efficiently employed. Case III. The folloAving case presents similar features. Mr. J. W. P----, of Jacksonville, 111., wrote, in August, 1856 : " Dr. S. S. Fitch—Sir : Having heard of your successful treatment of lung disease, I thought I would write you in relation to my OAvn case. About Christmas I caught a severe cold, from which I have never re- covered. A cough at once set in, for AA'hich I used a cough-mixture, Avhich palliated it someAvhat, but did not cure it. Since'that time I have employed several physicians and taken a great deal of medicine; and among other things have tried the inhaling of medicine under Dr. H---- of St. Louis, but from Avhich I derived no benefit, but rather grew worse all the time. I have now quit all medicine. My father's mother, and some of her brothers and sisters, died of con- sumption, and have, until within a few years, been troubled with asthma and short breathing. My cough is now very bad, and I raise a great deal of yellow matter. My throat is sore, with swelled ton- sils, and voice lost, so that I have not for two months spoken above a AA'hisper. I have fever every day, and sometimes night-sweats. My limbs are swelled and painful, appetite capricious, boAvels irregu- lar, with bleeding piles. I have a rather delicate constitution, am lean and slender, and have a contracted chest; twenty-one years old, fair complexion, and blue eyes." Here the hereditary predisposition to consumption, passing over one generation, fastened upon the next in the person of this young man, and remaining latent until excited by the cold, then suddenly developed, and rapidly progressed to an advanced stage, spite of all the useless treatment he had. Had proper measures been employed, instead of a simple palliative in the shape of the " cough-mixture" he speaks of, the development of the disease might have been at once checked, and the young man's ordinary health restored. Case IV. Mr. D. P. V----, Esq., attorney, Lafayette, Ind., writes: " Having seen your ' Medical Exponent,' and having also been urged by a Mr. B. of this city (one of your old patients) to consult 282 VARIOUS FORMS OF CONSUMPTION, you in regard to my health, I have concluded to do so. About six weeks since I took a violent cold, which settled on my lungs. Since then I have coughed a great deal, and raised a good deal of matter, which sometimes has a yelloAV, mattery appearance, and at others it is light-colored, and somewhat curd. I am considerably hoarse, and have catarrh badly. I discharge almost incredible quantities from my nose every day, and my face on either side frequently becomes sore. I frequently get sore also in the regions of the tonsils, Avhich have been affected more or less for a number of years. I raise more in the morning, immediately on getting up, than at any other time. I have some fever at times, but no night-sweats. I am greatly de- bilitated, though still able to be about. My constitution is delicate, and three years ago I had a hard fit of sickness, and have not been in good health since. My father and mother were usually healthy people, but my father's sister died of consumption. Permit me to add, that several years since I read your ' Six Lectures,' and know that I have derived great benefit from their teaching, and Avould have received more had I been more attentive to them." In this case there was only a slight tendency to consumption; still that tendency, slight as it was, was developed into active disease by a cold, which, most unfortunately for the patient, was neglected and allowed to remain on the lungs, until he applied to me. CASES IN WHICH CONSUMPTION COMMENCED WITH BRONCHITIS. Case V. Mr. B. B. V-----, of Ravenna, Ohio, wrote me, September, 1856 : " Dr. S. S. Fitch :—Dear Sir: Having labored under a difficulty of the lungs for some time, I have concluded to send you a descrip- tion of my case as near as I can, intending to give you a pretty good insight into my situation ; and if you think there is any pros- pect of doing me good, to put myself under your treatment. My occupation is civil engineering, my age thirty-three years, height five feet ten inches, weight when well about one hundred and forty-five pounds—it is now about fifteen pounds less—complexion dark, hair very dark and curly. The lung complaint has prevailed in my father's family, but not in my mother's. " About twelve years ago I took a bad cold, and it settled in the DESCRIBED BY THE PATIENTS THEMSELVES. 283 tonsils of the right side; they became very sore. I had pains in my breast and back, and I became debilitated. I Avas then engaged in the study of a profession. I quit that and engaged in the engineering business. My pains left, throat got well, and my health became very good. During the winter of 1852, I took a cold, and it ap- peared to settle in my throat at the upper edge of the breast-bone. The irritation was very great, causing almost instant coughing. This lasted for some weeks, and then yielded to simple treatment. The next Avinter I Avas taken the same way, but found relief in a short time by the use of mild remedies. From that time up to the first of June, 1855, I had a sort of influenza, which left me with a bad cough. The seat of disease appearing to be in the depression of the throat at the upper edge of the breast-bone. The irritation was such as to cause almost incessant coughing night and day. My spittle was frothy, with the exception of a few mouthfuls on rising in the morning. The constant and hard coughing caused soreness in my breast; appetite failed, strength left me, and my breathing became quick and difficult. I tried various remedies; among others, in- haling from a prescription by my family physician. This gave me some relief at first, but finally ceased to be of any benefit. This was in the month of July. September 1st, 1855, I coughed very fre- quently, but not so hard as previously; Avas almost free from sore- ness in my chest, breathing about the same, general health poor. At this time I put myself under the treatment of Dr. W---- of Cleveland, homoeopathy. I tried his medicine for some six weeks; thought I was benefited in my general health, but could see no change in my disease. I quit that practice, and about the first of November commenced to use stimulants freely, sometimes brandy, but mostly ale, bathing with warm Avater and spirits, and using no medicine except some simple thing to allay the irritation at night: this I would use perhaps three or four times during the night. I had night-sweats. I used sage-tea. Under this treatment, to a con- siderable extent regained my health. I engaged in my usual occu- pation. Had no chills or night-sweats, and could endure the cold as Avell as at any time in my life. My breathing became free and easy, so that, aside from the cough, I have for the last ten months enjoyed excellent health, until within about four Aveeks of the present time, when my breathing became bad. But my disease remained about the same, except that during the day I did not cough quite so often; 284 VARIOUS FORMS OF CONSUMPTION, and at night I rested well, sometimes coughing three or four times, at others none. " This brings me to my situation at present. My breathing is someAvhat hurried and difficult. I have never used any braces for support, and I am almost as free from stooping as I ever Avas. My voice remains clear and firm as formerly. Appetite good, and find no injury from the free use of all Avholesome food. I rest pretty well at night: sleep mostly on my back ; lying on my side induces coughing, especially the right side, but not so much but that I fre- quently fall asleep lying on my side. My strength has failed to some extent, but I can ride or walk about most of the day. I never lie down except an hour or so about noon. I have night-sweats, not very copious—sAveating mostly on my back. Have been troubled of late with pain in the small of my back. The great difficulty appears to be in my right lung, near the upper part. During the space of twenty-four hours, I raise about a gill, one-half of AA'hich will be frothy, the other a dirty yellow mucus that floats in water, except sometimes a mouthful or so when rising from bed in the morning. In the early history of my disease I used Dr. II----'s inhaling medi- cine, but found no relief—rather injury, and through the advice of a friend I tried J----'s Expectorant. This Avas only about five weeks ago. I took half a bottle and then quit it: it produced too lax a state of the bowels, and brought on night-sweats. At present I am using no medicine except a powder given by my physician for the night-sweats, and syrup of morphine—about the proportion of one grain per day. I am using at present Port Avine as a stimulant." Case VI. Mrs. S. T-----, of Manchester, N. H., wrote, June, 1856 : " Dr. S. S. Fitch—Kind Sir : As a lady friend of mine, and once a patient of yours, presented me Avith a copy of your lectures, I have been highly interested the past week in perusing them. With the advice of my friend I write asking your kind advice. I am quite hoarse; have thought perhaps my left lung was somewhat diseased. Have consulted several physicians; they all say my lungs are not diseased, or no local disease. My throat is sore by spells, seems to extend up to my left ear; have been hoarse since two years last October. Am not subject to cough even when I have a cold. Took DESCRIBED BY THE PATIENTS THEMSELVES. 285 cold two weeks ago; coughed last week some, raised some thick yellow phlegm, but lungs feel rather sore when I cough or hack. Been short-breathed for nearly two years ; on my left lung scarcely ever get a long breath on that side; at times I think my lung is swollen, a weakness at the bottom part of my lung, or Avhat some physicians say is right over my heart. At times I feel a weakness, a sort of soreness, when I move my left arm, and arm feels weak down as far as my elbow. I have plenty of blood, and it seems to cir- culate well, so Dr. D----, an old physician, tells me, but yet I am hoarse and short-breathed. I am thirty years of age, of medium height, have blue eyes, hair not very light nor dark, rather slim. I sometimes feel as though I wanted to let my shoulders fall forward to rest; am subject to the sick-headache." CASES IN WHICH CONSUMPTION RESULTS FROM SALT-RHEUM AND OTHER HUMORS, OR SKIN DISEASE. Case VII. Mrs. F. A----, of Peterboro, N. Y., wrote me, Aug. 10, 1856 : " Dr. S. S. Fitch—Dear Sir : In consequence of the delicate state of my health, I am induced to consult you, hoping that you will, by the Divine Providence, be able to afford me relief. I was born and brought up in the north of Scotland; was married at the age of sev- enteen, and am now tAventy-seven. I am of slender figure, rather tall, chest flat and inclined to stoop, dark hair and eyes, fair com- plexion, and am subject to asthma. I am troubled with short breathing, headache, pain in the chest, neck, spine, shoulders, back, stomach, boAvels, sides, and limbs. I have soreness of the throat, weak voice, and hoarseness ; have had a cough for three years, and raise a great deal of tough phlegm, and sometimes vomit up frothy phlegm mixed Avith yellow matter. I cough most mornings and evenings. I have fever and night-SAveats, also palpitation of the heart, sour stomach, distress and pressure at the stomach, nausea, often to vomiting wind, with a sinking, exhausted, all-gone feeling at the top of the chest and pit of the stomach, appetite capricious, bow- els costive, blind piles, weak back, gravel, cold feet, and am easily exhausted. I ought to mention that I have always been subject to the salt-rheum. Sometimes this is out badly on my hands, and then again it AA'ill disappear. When it is out I feel much better othenvise. 286 VARIOUS FORMS OF CONSUMPTION, But Avhen it disappears from the hands, my cough is worse, I expec- torate a great deal, and all my symptoms are greatly aggravated." Here is a distressing catalogue of ills, all having their origin in this poisonous humor, which, when developed on the surface, is called salt-rheum. In a little time longer it would have terminated in true consumption of the lungs, as it has for three years been fastened there already. It is perfectly clear that this case could not have been cured Avithout removing the humor. Case VIII. Mrs. M. T----, of Corinna, Me., wrote me, May, 1856 : " Dr. S. S. Fitch—Dear Sir : Having seen one of your books of Six Lectures, and hoping that you may be able to give me relief, I desire to state my case and ask your advice. I was born and brought up on a farm in a new settlement. When I Avas between eight and tAvelve years of age, my mother said one day as she had company, and speaking of the health of her children—myself being the third— ' Martha is well enough—nothing ever ails her.' I Avas then short, thick, and straight, and lived with my mother till I was thirteen years of age. My parents were poor, and I began to work out for my clothes. When fourteen I worked tAvo miles from home through the summer, and walked home and back again. I fre- quently got my feet and legs poisoned in the woods the same sum- mer, so that they were a raw sore from the toes to the knee-joint. I Avashed them in new rum, and took a SAvallow at the same time to keep it from my stomach, and it disappeared. Father says that that summer I began to groAV round-shouldered. The next summer I worked in the same neighborhood, and walked home as often. I worked hard thf ough the Aveek, and walked to meeting and home on the Sabbath, making a walk of five miles. The next spring I was sixteen ; my stomach Aveak and my health poor. I overworked my- self the next summer, and had the liver complaint in the fall. I then took calomel and blue-pills, after which my health revived; but I Avas troubled Avith a cough, if I took a little cold, until I was married and had children. I married in my nineteenth year. I am now thirty-six years old, and have had six feeble, sickly children. They are not healthy till they are weaned and get their teeth; then they DESCRIBED BY THE PATIENTS THEMSELVES. 287 are better. The most of them had a very bad humor when they nursed. It has almost worn my life out to take care of them—they have been sick so much of the time, day and night. The oldest is fifteen, the youngest two years old. " I have enjoyed better health when I have nursed than at other times. I am always weak, especially after confinement, and never able to sit up all day for three or four weeks. My back is weak, and I am weak all over. Seven years ago my nursing-babe had the canker- rash ; my breasts became cankered; I could not heal them up, but weaned my babe. The next babe I had was a terrible source of trouble for six months; my breasts were a raw sore the whole of that time, and my child crying day and night. I tried every thing I heard of to heal them, but to no purpose, until I took iodine to physic my blood, and applied nitrate of silver to my breasts, which healed them up immediately; but in taking the iodine I took too much, and it weakened me very much; but the weakness seemed to settle in my back, and it has never been strong since. I have not been able to go to church but four or five times for three years. Tavo years ago my last babe was born, and since that time I have remained weaker than before. One year ago this spring my babe had the canker-rash, throat distemper, and fever. The care of him about finished me. The babe being weaned, dried my milk, and I became dizzy-headed, weak and sore across the lower part of my bowels. I could not sit up more than half of the time; could do no kind of work but it hurt the boAvels where affected. I could not sleep nights. If I rode or walked out days to take the air, my back ached hard. When I awoke in the morning, I could not bear to have the children walk on the floor, or jar my chair or bed, on ac- count of this tenderness; still I had no bearing-doAvn pain—only a heated, burning tenderness. I took syrup of iron to bring abo.ut reo-nlarity, and commenced flowing after six weeks, and flowed till I could not rise up in my bed without fainting. I began to sit up after tAvo Aveeks. I tried to Avash a few clothes about three months ago in a cold day, after I had been unwell seven days; I was weak, and it strained the lower part of my bowels. I took a bad cold, and it set- tled on the back of my neck, and downward under my right shoul- der-blade. I packed my shoulders in cold water two nights, Avhich took out the soreness, but left me with a dry, hacking cough, some- where about my throat; it seems to me that it does not go more 288 VARIOUS FORMS OF CONSUMPTION, than tAvo or three inches beloAv the holloAv of my neck. I do not cough much ; sometimes a little once a day, AA'hen I am tired or after eating sometimes. When I rise up to dress in the morning, I do not raise any thing—it is nothing but a dry hack. I do not breathe en- tirely clear sometimes after I eat; if I eat milk it makes me cough a little, but I cannot tell where it originates. I am very weak and low, and if I Avork half of the time I have to lie in bed the other half. I have no pain in any part of the body—only a Aveakness in my back. My stomach used to be very Aveak, and my mouth and gums often very cankery ; Avind often in my stomach to distress me ; but I think my stomach is better than it used to be, or I am so weak beloAv I do not feel it so much. The humor I had in my breast Avas called the scrofula by an experienced physician. My victuals set well on my stomach if I eat that AA'hich is very light. I am lean and bend for- ward ; dark-broAvn hair and dark skin. One of my sisters lingered with consumption, and died after ten months ; another with the hec- tic, and another has been an invalid for ten years." COMPLICATION OF DISORDERS FROM HUMOR. Case IX. In the following statement the reader will find clear evidence that humor or poison in the blood may give rise to the most annoying, even distressing and protracted disorders of the vital organs, and tend eventually to develop true consumption. It is made by— Mrs. F. A. P----, of Canton, St. Lawrence Co., N. Y. She wrote me, August, 1856 : " Dr. S. S. Fitch—Dear Sir : Your Medical Exponent I have pe- rused, and have come to the conclusion that I would consult you by letter, giving you a detail of my case. I have been for the last three years troubled with a deranged stomach, spitting up of food after eating, sour stomach. At times I would seem to be better, and then again as bad or worse than ever. Until sixteen months since I was prostrated on a sick-bed. My symptoms were palpitation of the heart; at times my heart would cease to beat, and then commence Avith a bound ; at times a sense of suffocation, and could not at times lie doAvn, but sit bolstered up in bed; coated tongue, loss of appe- tite, with a great deal of distress and soreness at the stomach, and DESCRIBED BY THE PATIENTS THEMSELVES. 289 costiveness. I employed an apothecary physician five months ; during that time I seemed to gain but little. At times I would be a little better, and then worse again. My physician, I suppose, became dis- couraged—his visits not so frequent—until at length he ceased visit- ing me. This was in August, 1855. I was at that time able to sit up a great part of the time, and to ride some. I then obtained a syrup of a root-doctor, which relieved some of my complaints. I had before for months been obliged to use a syringe daily to obtain an evacuation of the bowels, as my physician dared not give me physic, it so prostrated me. By this means my bowels became quite regular, but still there remained weakness in my left side, with a dull pain in the region of the heart. I had dyspepsia in its worst form, and could not eat the coarsest food without great distress; every thing taken into the stomach—even a drink of cold water— would sour; and in this condition I remained, feeble and nervous, through the fore part of the winter of 1855 and 1856. I think about January I became so debilitated that I pretty much gave up all hopes of recovery. I, however, began to gain a little, continued to gain slowly through the spring, and have been able to oversee my house- work, and do some light work up to the present time. About tAvo weeks since I was taken with a most distressing cough, with sore- ness of the lungs. I had pre\iously taken no cold that I Avas aware of. This cough did not abate much for about ten days ; during this time I was attacked suddenly Avith a violent itching, and in the course of a feAv hours it broke out in blotches from the size of a pin's head to that of a dollar, completely coArering the surface. While this lasted, AA'hich Avas about four days, my stomach and side felt better than they had for months. I never experienced any thing of the kind before, and I did not knoAv that I had any humor in my blood. This humor has now all disappeared, and my cough does not trouble me much, except a slight hacking occasionally. For a few days mv old symptoms have been growing Avorse. Having told you Avhat they have been, I will noAV endeavor to tell you, as plainly as possi- ble, what they now are. " To-day, Avhenever I attempt to draw a long breath, it causes a sharp pain in the region of the heart, extending to my shoulder and collar-bone, with a AAreakness in my left arm. Going up-stairs, or much exercise any way, takes away my strength and breath very much ; any sudden emotion Avill set the heart fluttering rapidly. At 19 290 VARIOUS FORMS OF CONSUMPTION, times there is a sudden sensation of an indescribable rotary motion of the heart, as though it turned over. I often awake at night with a sense of suffocation, Avhich causes me to start up suddenly and gasp for breath. I have been Avholly unable to obtain any rest on my left side for the past year. At times a dull, heavy pain in the heart or thereabouts, or more generally a Aveak feeling prevails in my left side, so that Avhen I breathe deep, I often place my hand to my side to support it. Any food, however coarse or adapted to the dyspeptic, or Avhether partaken of in large or small quantities, sours and causes much distress. My appetite is quite good at present—sometimes none at all. I have also a weak back, Avith an occasional sensation of heat across the back and hips; often a severe pain in the head, Avith dots or webs before the sight. I suffer somewhat from the piles. Some days I labor a little. I do not generally lie in bed any more than a well person. I am exceedingly nervous and easily disturbed. And now I have great faith that you can afford the wished-for relief." This case is curable in every particular. ASTHMA INDUCED BY THE DRIVING IN OF A SCROFULOUS HUMOR. Case X. The patient describes his case here—which is one of severe and protracted asthma—without suspecting the true origin of the dis- ease. Incidentally, however, he discloses it, and we see it to be a humor, which first made its appearance in the form of a swelling under the arm. The case is that of Mr. J. D----, of Bayham, C. W. He wrote me, December, 1856: " Dr. S. S. Fitch—Dear Sir: I have been trying to see one of your books, to guide me in giving a proper description of the disease with which I am troubled. Not, hoAvever, seeing your book, I hope the folloAving will be satisfactory. It is as I feel. " I am now about twenty-three years of age. About eight years ago I had a large swelling under my right arm, which continued for about two weeks, and then went aAvay again of its own accord. But I had severe headache, with giddiness; also pain in my right side for about tAvo years after the swelling left me. Then I was taken doAvn with the bilious fever for three months. During six weeks of that DESCRIBED BY THE PATIENTS THEMSELVES. 291 time I was so low that I could not help myself, being so very weak. All the trouble, I thought, was in my right side. The pain Avas very severe there, and I could not lie on any other part of my body but on my right side, AA'here the pain Avas. This makes tAvo years and three months. For one year aftenvards I continued in a lingering state, still a pain in my side, with giddiness and headache. Then commenced the asthma, the first of Avdfich was a stiffness in my right shoulder, with severe pain Avhen I attempted to move my arm. It lasted about a week, shifting from the shoulder to the back of the neck; then left me for a week, came back upon me again for an- other week in the same manner, and then left me altogether. But the asthma continued, with pain in the side, less or more ever since. " When the asthma commenced, about four years and nine months ago, I had it about one Aveek in every month, and it has continued increasing ever since until noAV, which is evrery week ; and the week I have the asthma there are generally three or four nights I cannot lay doAvn in bed. When I cough it seems as if my lungs Avere clo- sing up my windpipe and choking me altogether. " I have tried a number of the best local doctors around me. I generally found their medicine do me good for tAvo or three Aveeks at the first; after that I thought they made me worse, and had to stop taking their medicine. I am a temperate man; but the only or best thing I found to do me any present good, when the asthma Avas bad, Avas a glass of strong brandy. I also use tobacco by smo- king it; I think it helps me. I have tried to give it up altogether, but I found I could not, on account of the asthma being worse when I did not use it." Case XI. Mr. A. McH-----, of Cannonsburgh, Mich., wrote me, Feb. 1857 : " Dr. Fitch—Dear Sir : I wish to get your advice on my disease. I have confidence that your remedies with your advice will cure me. Six years a«-o I Avas affected with salt-rheum on my hands, and in a year it disappeared ; then I felt a pain in the right side, under the last short-rib. On drawing a long breath and when Avalking fast, I can hear a wheezing in the right lung, which seems to run doAvn as Ioav as the diaphragm, and often I feel a tickling low down in the rio-ht side. When I wralk very fast, and draw a deeper breath than usual, the tickling produces a hacking cough; and by a great effort 292 VARIOUS FORMS OF CONSUMPTION, I raise little clots of yellow and greenish-looking matter. Much A\-heezing; and if I walk fast enough to produce a perspiration, my skin feels prickly. After eating and at night I feel very feverish ; at night I am often restless and full of fever; head feels full of blood, with a ringing in my right ear. Often I lay and turn from side to side, and get no sleep all night; and when I rise in the morn- ing I feel all gone, worn out, bad taste in my mouth, a dull, heavy feeling in my head, Avith no inclination to stir out of the house; and before I rise it seems impossible for me ever to get out of my bed again, so avoiti out are the poAvers of the body for the want of a good refreshing sleep, which seems to pull me down the most. After I go out and work a while, I generally feel a little better, and I sit down and eat a hearty breakfast. My appetite is always good, but the food sometimes sours on my stomach ; I am costive by spells, when I feel worse ; I often have a headache, with dull, drowsy feel- ing. When I ride horseback, the jolting causes a pain in the right side, under the short-ribs and up midAvay of the chest, with a sort of dragging-down, as though something was tearing loose, and then the pain is so severe that I can hardly draw a breath. Often I feel no ambition, and no inclination to do any thing; feel as though I wanted to be alone, to sit and think, and I have a great dread. I often wake from a restless sleep in a great fright, and it takes me some time to get righted and find where I am, and that it is all right with me. When I gape the pain catches me under the short-ribs, and it seems as though I could not draw a deep, full breath. I get a breath down as far as the short-rib, and there the pain stops me, and it can go no further doAvn. Five years ago I had the chill-fever, and since then I have never felt well. At that time I felt a ringing in my head, Avith noAv and then a spell of ague. I find my constitu- tion failing. I can yet do the work on my farm ; but I often feel as though I overdid myself, and then I feel a severe pain between my shoulders. I am five feet eight inches high ; thirty-tAvo inches round the Avaist, two inches above the hips ; dark complexion ; dark hair ; I am twenty-three years old. My mother was affected Avith salt- rheum, and died of pulmonary consumption at sixty years of age; my father is well—no disease with him; he has a family of ten chil- dren, some affected with humors and some healthy ; one sister died of consumption. I have a straight form ; chest not very full, but not deformed ; have no cough, and I think no consumptive symptoms; DESCRIBED BY THE PATIENTS THEMSELVES. 293 sometimes I have spells of strangling, choking, and fainting feelings (they are the Avorst in the summer), and I feel as though I could not get a breath, and when I Avake up I feel scared, as though I Avas going to die. I have a lonesome feeling, and wish to have some one to speak to, and tell me Avhat has happened, etc. I often have bad dreams, and Avake in a great fright. I have had bad teeth for years ; some of the back teeth are full of scurvy, and one side is so bad that I cannot make use of it. I have been married one year; no family. Please Avrite to me soon." Here is presented a complication of disorders, for which no doubt the liver is to a considerable extent responsible. But many are to be attributed to, and all are aggravated by, the salt-rheum poison, which has been repelled from the surface, and fastened on the inter- nal organs. Case XII. Mrs. M. D----, of Hayfield, Penn., wrote me, January, 1857 : " Dr. S. S. Fitch—Sir : I have read your ' Guide to Health,' and have made up my mind to address you by letter, trusting to your generosity for counsel and perhaps medicine. My name is Margaret D----; fifty-four years old ; residence, Crawford county, Pa.; have been in the habit of seAving; family consumptive ; born and brought up in the northern part of York State ; lost my husband three years ago ; always had delicate nerves; very fleshy; height five feet seven inches; size around the Avaist, twenty-eight inches; dark-brown hair; complexion light; have suffered much from salt-rheum, but it has entirely disappeared ; tAvo years since I had a cough and night-sweats all AAdnter ; last winter I had the neuralgia; a lightning pain under my left breast and left shoulder, which prostrated my nervous sys- tem very much ; last spring it left me, and a distressing cough came in its place, AA'ith general debility, same pain in the chest, pain over the eves, in the cheek-bone, and ears. This cough is not like any other that I ever saAV. I do not cough through the day ; but when I lie down at night a dry, hard cough begins and continues for some time, and after a flnv minutes a clear, tough phlegm rises in my throat and comes up without much effort. I then rest till near morning, when I cough again. I Avork all day; go out when the Aveather is fine ; I have a pretty good appetite, and have gained in flesh since last September. I have not taken apothecary medicine 204 VARIOUS FORMS OF CONSUMPTION, for a number of years ; I generally prepare my own cleansing syrups —made of roots ; bowels regular ; heart beats too hard sometimes; a little excitement appears to do me good, but too much is bad ; sense of smelling imnaired." INSTANCES OF CONGESTIVE CONSUMPTION, ATTENDED WITH BLEED- ING, OCCURRING IN THOSE PREDISPOSED TO PHTHISIS. Case XIII. The following case presents many interesting features. The pa- tient has detailed the history of his complaint minutely and intelli- gently. On carefully examining it, it will be observed how the various circumstances and influences to which he was subjected, all tended to kindle the latent consumptive tendency in his constitution into active disease. It is particularly mteresting to notice Iioav quickly the lungs were thrown into a congested condition, and bleed- ing induced by mechanical causes ; also how clearly it appears that the blood and fluids of the system are the seat of this something, called a tendency ov predisposition to consumption. The benefit of my recommendations will be seen. The case is that of Mr. A. N. P----, of Macon, Ga. He wrote me May 20th, 1856: " I noAV hasten to lay before you my case, as near as possible. In the first place, I believe that consumption is partially hereditary on my father's side. I do not know that my mother's family were ever subject to it at all. My age is thirty-two last April. I am by oc- cupation a mechanical engineer—residence as above. I was born and lived in the State of Maine until I was about nine years of age ; then removed a short distance into New Hampshire ; lived in the New England States until I was twenty-one years old, and then came South. I had the whooping-cough at seven or eight years of age, and have ahvays had a cough since, but never suffered any pain from it, unless it Avas by too much exposure to cold, etc. There was usually a free expectoration with the cough, Avhich remains nearly the same yet. About nine years ago I discovered the mucus to be colored Avith blood, and felt uneasy about it; but I took some dilu- ted acid a few times, and had no more trouble at that time. I was married soon after. The next year, in assisting to raise a pump out of a well, I lifted pretty hard, and a little after—say five minutes—I DESCRIBED BY THE PATIENTS THEMSELVES. 295 commenced spitting large quantities of fresh frothy blood, but did not experience any further inconvenience from it than a temporary prostration. About a year and a half afterwards, being as rugged as I had ever been in my life, I started over land to California, and Avas exposed a great deal ; I lived on the hardest kind of fare, but never Avas heartier in my life. I started to come home by Panama, but oAving to shortness of supplies, the ship put into a small place in Central America, and thirty of us crossed over, and came out at Be- lize, British Honduras. Before I could get away from there, I was taken AA'ith the bilious fever, and was near dying ; but it pleased God to raise me up, sufficient at least for me to take passage for New York, AA'here we arrived about the 20th of June, 1851. When I got to New York I had a seated case of fever and ague, which last- ed until frost, and which debilitated me considerably ; but my health Avas tolerably good from that time until a year ago last January, at which time I Avas much exposed to cold damp air and wind, when I commenced spitting the bloody mucus, and also having pain in my side, soreness, etc. I became uneasy, and quit my job and went home; but Avas still unable to get rid of the soreness in one of my sides—I believe it Avas the left. My physician told me that it was a slight case of pneumonia. I did not get rid of the soreness until I used some Croton oil liniment. This took aAvay the soreness ; but I still had night-SAveats, and expectorated copiously, sometimes of the bloody hue. " I went on in this way from March until September. Some few times I raised a little fresh blood during this time, but it could gen- erallv be traced to over-exertion. I Avas also troubled Avith sour stomach, heartburn, etc. But in September a kind gentleman placed in mv hands your first edition of ' Six Lectures;' and as soon as I reached home I commenced bathing my chest in salt and water, using tlie friction, etc. Since that time I have raised but little bloody mucus and if it occurs at all it is generally when from some cause I neglected the bath, etc., for a day or tAvo. I have very little, if anv niwht-sAvcats noAV; and, by avoiding the more laborious parts, have been able to attend to business ever since I commenced the bathino-. I was not disabled entirely before, but the bath certainly was, and still is, a great help to me. " There was a little circumstance occurred after I had bathed a month or tAvo, which I Avas particularly anxious to lay before you. 296 VARIOUS FORMS OF CONSUMPTION. There appeared first a lump or swelling under my left ear, and some- thing inside seemed to become swollen, Avhich I thought might be the tonsil; meantime the left ear Avas quite sore, and had some itch- ing sensations; and after a week or two the ear commenced dis- charging matter, and has continued ever since. I have never con- sulted a physician about it, but rather concluded that it Avas catarrh, and that it might help my lungs. There are also quite copious dis- charges from the nose, and frequently are quite bloody." Case XIV. Mr. J. Van N-----, of Charleston, S. C, wrote me, July, 1856 : " Dr. S. S. Fitch—Dear Sir: My friend P----(who has been using your remedies for consumption) met me on the 4th inst., and strongly advised me to read your book of ' Lectures,' at the same time offering to loan it to me. I accepted his kind offer, and have carefully read it through, and the result is, I have determined to call on you as soon as I get to Ncav York, which will be near the 1 st of August. That you may the more readily understand my case, I will give you a feAv particulars. " I was born in New York State, and came to Charleston in the Avinter of 1850. Previous to coming here, I was of a most robust, hearty constitution; never a pain or an ache—in fact, never kneAV any but Avell days. My weight Avas one hundred and fifty pounds. My second summer here I began to lose my color and flesh, and oc- casionally was suddenly seized with a tickling sensation in my throat, causing me to cough, and what I raised was blood. I thought noth- ing of it, for being a hearty eater I supposed it came from my stom- ach, particularly as I felt no soreness after it. These slight hemor- rhages continued, at intervals of three months or more, until July, 1853, when after very severe exertion I raised perhaps a gill of pure blood. The physician pronounced it to be from the lungs; but still I had no cough or other symptoms of consumption, therefore took no medicines. In June, 1855, I was seized with a hemorrhage Avhile feeling perfectly well, and raised in two days nearly three quarts of blood, besides nearly strangling to death, for my mouth could not dis- charge it fast enough, it poured out of my nose. My physician said ' my lungs were too large for my body, and contained too much blood for the wants of the system,' hence the necessity, I suppose, of a waste- DESCRIBED BY THE PATIENTS THEMSELVES. 297 pump. I bled, and he purged and blistered, and I was soon reduced very much. Now for four weeks I Avas confined to my room; the first time it had reduced me. In March, 1856, I had another at- tack, Avhich in spite of medicine and blisters continued Avithout ces- sation twenty-three days; the discharges groAving less the last ten days, until it (the lung) gradually healed up. Noav, for the first time, I had a cough, and raised a little every day. The 5th of this month I was again seized, but not having the time to spare to purge and blister, and having read a little in your book, I treated my own case, and stopped the bleeding, Avithout an ugly blister all over my breast ' to draw the inflammation out.' " My father Avas first attacked, when about thirty-five years old, with a pain in his side and spitting of blood, and in a few months died. My only sister died with consumption and dropsy combined in her twenty-seventh year. My mother is a strong, healthy woman, and bids fair to live long. I am twenty-eight years of age, five feet six inches high, black hair, hazel eyes, etc. Independent of my lungs, I enjoy perfect freedom from pain. I have every morning a tickling sensation in my throat, causing me to cough ; cannot expec- torate freely, but feel a tightness across my chest; when I expecto- rate ever so little I am relieved ; Avhat I raise is very yellow, and tastes like the yolk of an egg. My sleep is sweet and refreshing; my appetite poor; weight now one hundred and ten. I don't know the meaning of dyspepsia practically; all I have to do is to eat Avhat I can and forget it; bowels regular ; occasionally a slight touch of piles ; sometimes a touch of rheumatism. I am married, but unfor- tunately let my wife go to New York last week. Can't read aloud or sino- without coughing. Circumstances not to be mentioned; to say the least, they oblige me to work hard and take active exercise. Teeth very good, but most of them false. All other particulars given when I get to New York. If you can cure me, my friends in Charles- ton wili consider it a pretty fair transaction." Case XV. Mr. H. G----, of Hamilton, C. W., wrote me, November, 1856: " Dr. S. S. Fitch—Sir : To-day I accidentally came across one of your late Almanacs, and after reading a portion of it on ' Consump-- tion' I have concluded to send for your remedies. I will state my 298 VARIOUS FORMS OF CONSUMPTION, case. About twelve years ago I Avas attacked Avith inflammation on the lungs, from which I partially recovered. About two years after I had another attack, from which I also partially recovered; and from that time, up to the last three years, I was occasionally sick for two or three days at a time, but not seriously so. For about three years past I have enjoyed very good health ; but now, and for a short time past, I feel as though there Avas something wrong Avith my lungs, and am satisfied that unless I can check or prevent it go- ing further, it must end in consumption. My symptoms are, short- ness of breathing, wheezing in the chest, unable to draw a long breath witliout considerable exertion, contraction of the chest, and a little soreness at the bottom of the lungs, just at the edge of the short-ribs, a slight spitting of blood occasionally, but no bleeding from the lungs, nor any cough Avhatever. These are the principal symptoms. I of course do not knoAV Avhat remedies to apply for, but leave that Avith you, supposing you can tell Avhat I want from my symptoms given you." Case XVI. Mr. A. P----, of Sandy Creek, N. Y., wrote me, Oct. 1856 : " Dr. S. S. Fitch—Dear Sir : On the recommendation of some of your patients I Avrite you for advice in regard to my health. My business is blacksmithing, and I have worked at it for thirty years. Two years ago about this time I was shoeing horses, and worked very hard. When I got so tired I could not work any longer, I would take a drink of brandy and work on the strength of that until that was gone, and then repeat it again ; perhaps from three to four drinks a day for some five weeks. One day I commenced bleeding at the lungs. I probably bled a pint, and the blood clotted in my lung. I commenced coughing, and running down until I became a complete skeleton. I tried all the physicians in this vicinity, but to no purpose ; they all gave me up. I would discharge from the lungs more than a quart of blood a day. This clotted blood Avould come from my lung in large black chunks; it Avould scent the room so that the people could not stay in it. This lasted nearly tAvo weeks, and then it was not quite so offensive. After the clotted blood got out, there Avas an abscess formed on the left lung. I became so bad that the neighbors were called in, expecting every five minutes would be the last; but the next morning I began to recover, and in the DESCRIBED BY THE PATIENTS THEMSELVES. 299 course of four months my lung, to all appearance, became sound. I began to flesh up, until I got my usual weight, although I have not had my strength since, though I have been able to work at farming most of the time. This was two years ago. This summer my right lung became affected ; it lasted very near all summer. Noav it ap- pears well, and the left commenced bleeding two months ago. It discharges some three times a day. I have a spell of coughing in the night, and raise considerable : it lasts from half an hour to an hour, and then I will be quite comfortable. I sAveat some nights; through the day I haAvk.and raise more or less. I am now in a busi- ness that agrees with me as well as any thing; as I am out riding most part of the time and in all sorts of weather, but I am careful to keep my feet dry, and also myself. I feel better to' be stirring out in the open air than I do to be in the house. I am forty-six years old, have always worked hard, and the neighbors say I have too much ambition. One of your patients says my lungs are similar to what his were. He calls himself a new man, and I know he had an abscess in one of his lungs; I don't see but he now breathes as natural as any one. On my mother's side they are consumptive. I have quite a full chest yet, but I can see it falls in some. " My brother-in-laAv has been using your medicine for a year or more. He thinks he is recovering his health; he has stuck to it faithfully for a year; is now able to work, which he has not done in two years before; he has worked two months quite hard, and is still improving." CASE OF HEPATIC (LIVER) CONSUMPTION. Case XVII. The following case has evidently been obscure to the physicians who have prescribed for it. The primary seat of the difficulty is the liver. The patient indulged his appetite too much, and the liver in consequence became weakened and congested, dyspepsia was in- duced, and the Avhole system suffered. This occurring in a consti- tution AA'here there was a scrofulous disposition, disease begun to be actively developed in the lungs, which would, unless arrested, have ended in consumption. The case is that of Mr. H. G. C----, of Amherst, N. H. He wrote me, Feb. 1857 : " Dr. S. S. Fitch—Dear Sir: I wish to address you in regard to 300 VARIOUS FORMS OF CONSUMPTION, my health, in compliance with the suggestions contained in recent advertisements of yours, published in the New York Weekly Trib- une. My name is Henry G. C----; I am a twin ; age, twenty years and eight months; occupation, farming. My address is Amherst, Hillsboro' county, N. H. I was born and have always lived in this place. My father's family were scrofulous ; several died of consump- tion—in some cases attended Avith throat disease; in some the disease seemed to be rapid, like consumption of the blood, without much cough. I am of rather slender make; my hair and whiskers are dark-brown ; eyes, dark-blue ; complexion, rather dark ; height, five feet eight inches; girth just above the hips, twenty-seven inches— below the arms, three feet. I raise a little loose, yellow phlegm. I am apt to have a roughness and irritability of the throat; cannot use the vocal organs much, at times, Avithout fatigue. I have never considered myself as humory ; my mother is much troubled by ery- sipelas humor in her loAver limbs. I Avas told by a physician last autumn that I had an inward humor. I have sometimes had some slight pimples on the face ; my skin on the body is rough—ahvays Avas, I believe. I have been subject to ' a running at the nose' almost all the time, ever since my remembrance. My digestion has been usually good; have been active, and have been a great eater, though not intending to be gluttonous. I have not felt able to labor hard since the latter part of last September. My appetite has been gen- erally good since then ; I have been apt to over-eat, and have not exer«ised much at times after eating a very full meal. I have some- times felt a feeling of oppressive fulness; sometimes a dull, heavy pain across the small of the back. I have been called bilious by doc- tors ; I am inclined to be costive, and think that I should suffer con- siderably from this cause, if I did not adopt a plain, coarse, and chiefly vegetable diet. I have been troubled, at intervals, since the summer of 1853, Avith a grinding and disagreeable pain in the right side, just above the hips : it is often brought on and aggravated by such Avork as hoeing, digging potatoes, mowing, pitching, cutting down trees, or any side-trying labor. Since feeling it, my mind and spirits have been much affected ; I have been troubled with great depression, melancholy, and confusion, and sometimes I have almost trembled for my sanity. Every thing looks gloomy—I feel no cour- age. I did not medicate much for these difficulties till last spring, Avhen I got to be nearly sick. I Avent to a homoeopathic practitioner, DESCRIBED BY THE PATIENTS THEMSELVES. 301 who relieved me, but they recurred about the first of last October, since which time I have used various remedies, but without much permanent benefit. I have taken homoeopathic drops and powders, one week each ; also two quarts of humor syrup, a few doses of liver, anti-bilious, and nervous pills, and two bottles of oxygenated bitters. I have practised some bathing the whole body in cold wa- ter mornings, and have sometimes worn a wet cloth on my sides at night. I have not taken much of any other medicine during my life. At present the pain is not confined to the right side; it changes to the left side of my back—it rarely or never aches at both sides at once. Sometimes I have pain across the small of the back. I used to be much troubled with backache when doing stooping work. I am able to walk a mile or two without injury when I feel best; but my strength is much reduced. My blood seems to be poor ; I feel the cold sensibly; my feet are inclined to be cold ; I feel much bet- ter some days than others ; at times I feel disinclined to make the least physical exertion ; I generally sleep pretty well—am sometimes very sleepy in the evenings. I believe I have stated my symptoms with sufficient particularity. I would like to know your opinion as to the name and nature of my ailment." CASE OF CONSUMPTION FROM MECHANICAL INJURY. Case XVIII. Mr. B. H. P----, of Chaplin, Conn., writes me June, 1856 : " Samuel S. Fitch, A. M., M. D.—Dear Sir: As my health is very bad, and I have some fears of the lungs being affected, by the ad- vice of Mr. J. G. P----, a gentleman Avho has been under your treatment, I take the liberty to give you a fair statement of my case as I am and have been for some time. I am now in a store most of the time ; have sold at auction until I could not speak ; then stopped for a time ; sold some last winter and spring. I think this has hurt me. Some four years ago I Avas throAvn some distance from the cars against the rocks, in the State of Pennsylvania, and I think I have not recovered fi-om the hurt; I struck on my right shoulder. I dis- charged a considerable blood at the time from my nose and mouth, and Avhen I had a passage of the bowels blood Avould attend it. This kept me down for some time. I got some better of that. When I Avas able to do any thing again, I found that I was troubled Avith 302 VARIOUS FORMS OF CONSUMPTION, sharp pains and a hard cough, and sometimes spit some blood. The pain Avould be sometimes on one side and then on the other, Avith a dull pain betAveen the shoulders. At the present time my throat is very sore, am quite hoarse, have a very hard cough, and raise a great quantity of yehW, frothy matter Avhen I get through cough- ing. I am very weak ; if I lift any Aveight, it gives me much pain. As quick exercise puts me out of breath, I feel, as Ave term it, lazy all the time. I have taken some medicine ; the great celebrated Dr. B----, formerly of New York, prescribed for me ; also Dr. B----, Dr. O----, and Dr. K----, of Willimantic. Dr. O---- has been my family physician for several years, but I have taken his medicine with but little effect. I am now under Dr. K----'s treatment. " Mr. P----placed your books in my hands this morning, and I find in your small pamphlet, headed 'Throat Affections,' Avhat I think hits my case the nearest of any thing that I have seen. My constitution is broken doAvn—it was good ; I never had much out- door exercise ; chest, medium size ; very stout, not fleshy ; measure thirty-seven inches around the waist, thirty-two inches above the hips; my complexion is light; hair and whiskers neither light nor dark ; eyes, blue. Our family are subject to the consumption ; my grandfather on my mother's side died with it at the age of thirty- four. There were ten children in our family—five dead and five living ; tAvo brothers and one sister died with the consumption. "Dr. 0---- is a botanic physician, and very popular. He has spoken of you to me several times, but I thought that I should get well if I took care of myself. There is one thing I omitted to men- tion ; that is, when I choke up nights, before waking, I have horri- ble dreams; I sometimes think that some one is choking me to death. My height is six feet ; weight, one hundred and fifty pounds; large frame." Here is a strong hereditary tendency to consumption, and in the ordinary course of events, the disease would sooner or later, no doubt, have been developed, unless measures had been taken to pre- vent it. But it is plain that the injury received from being throAvn from the cars had much to do with accelerating the disease. Had this not occurred, many more years of comfortable health might have been enjoyed. DESCRIBED BY THE PATIENTS THEMSELVES. 303 CASES OF POSTHUMOUS CONSUMPTION—OR ABSCESSES IN THE LUNGS. Case XIX. Mr. FT. H-----, of Oberiin, Ohio, writes me February, 1857 : " Dr. S. S. Fitch—Dear Sir : I would embrace the opportunity you so kindly offer of consulting you in regard to using your medi- cines. I have just commenced using your Anti-bilious Mixture, Pul- monary Balsam, and the Pulmonary Liniment, and think that I have already received some benefit from them. But I presume that I ought to have other remedies, and if you will answer this soon, and state what I shall use and hoAv, I shall be greatly obliged. I will give you, as near as I can, an idea of my condition. I am tAventy- eight years of age ; reside in Oberiin, Ohio ; was born and lived till ten years of age in Connecticut, since then in northern Ohio ; no case of consumption in our family as far as I know; all generally robust and healthy. I have previously enjoyed good health. About the middle of last April I was taken down with what my physician called bilious pneumonia, which kept me-in bed five weeks. During this time Avhat he called a perennial abscess, or imperfect fistula (it being open only externally), broke out, discharging a good deal for some time, but seemed gradually to heal from the bottom, the dis- charges gradually diminishing up to the present time. It now dis- charges but little, and it seems to be of but little depth. I had some cough the latter part of last winter and early part of spring. While I Avas sick I did not cough much, but on getting up, the cough re- turned, dry and hacking, though after a while I sometimes raised a little blood. I spent the summer and part of the fall in Connecticut, and regained my strength and flesh in part only. During the fall and winter I have coughed considerable, raising some mucus, and sometimes a little blood mixed with it, but have noticed no blood for near two months past: the mucus is now of a yellowish shade, sometimes bordering upon green. I have had but little pain in the chest; sometimes a lameness in the sides—right side more than the left, and frequently changing from right to left, or fi-om either to the back or right shoulder. I have had considerable pain across the back in the region of the kidneys (urine of red color). I feel it more particularly Avhen frightened, or excited from any cause ; feel at such times a kind of general ' goneness,' with violent beating of 304 VARIOUS FORMS OF CONSUMPTION, the heart, and my heart seems at times to have a kind of a labored, double beating. I have had considerable sickness at stomach, with sourness or acidity, vomiting often, unless very careful what and Iioav much I cat; appetite generally good. In summer, was part of the time quite costive, but more recently bowels most of the time quite loose. I do not have much pain—some days a little, but not gener- ally unless I overload my stomach. My strength is pretty fair yet; I could Avalk four or five miles without being much tired, if I took it ' cool,' but running up a flight of stairs would put me out of breath someAvhat. I have no night-SAveats, and have not had, Avith the ex- ception that when I Avas sick last spring and about two months ago, I had tAvo or three shakes of the ague then for a few nights, and sweat some." Case XX. Mrs. Sarah M. Van V----, of Floyd, N. Y., wrote me April, 1856 : " Dr. Fitch—Dear Sir : I have a brother that was taken about four Aveeks ago with inflammation on his lungs; the inflammation ran about five days. During that time he had a dry, hacking cough, accompanied at times with an acute pain in the lower part of his right lung. This cough continued about two weeks ; then suddenly he commenced raising a yellow, creamy sort of matter. The physi- cian said that an ulcer had broken on the right lung. When taken sick he Avas from home; he remained about three Aveeks, and then returned. He had no appetite, and Avas reduced almost to the weak- ness of an infant. We called in another physician, Avho ordered a change of treatment. It is one AAreek to-day since he commenced taking this medicine ; he has noAV a good appetite, sits up through the day, and the cough has nearly subsided, and to all appearances is doing well; but after reading your Lectures we feel anxious for your advice. Accordingly Ave -will answer your questions. He is nineteen, in his tAventieth year; has always Avorked on a farm until the last five months—in this time has been studying dentistry. Du- ring this time he has had a stock of cattle to take charge of, Avhich has given him out-door exercise night and morning. He Avas born and brought up at Trenton, Oneida county; is of rather delicate constitution ; height, five feet eight inches ; he is slender ; is rather lean ; stoops a little ; chest rather contracted ; measures above his hips tAvo feet five inches ; hair, dark-broAvn; eyes, dark-blue; com- DESCRIBED BY THE PATIENTS THEMSELVES. 305 plexion, clear; has a slight headache in the morning; has catarrh m his head ; his ribs rise equally when breathing ; through his sick- ness has had night-sweats ; no fever ; walks in the yard every pleas- ant day; appetite good; bowels regular; never sick since a child until now ; has taken three portions of calomel in this sickness ; his voice is good, but if he talks a long time it creates a tickling in his throat; he coughs most at night; circumstances, works for a living." CASE OF CONGESTUVE CONSUMPTION. Case XXI. Mr. J. H. S----of Peacham, Vt., wrote me, February, 1857 " Dr. S. S. Fitch—Dear Sir : Having for some time been familiar with your name as that of a physician successful in treating diseases of the lungs, I have concluded to apply to you for advice, thinking to procure medicines from your agent in this place. I give you a description of my case. My father and mother are not consump- tive, but both are troubled with catarrh. I Avas born and brought up here; am married ; straight, slim, and lean; strong constitution; auburn hair ; rather light and freckled complexion. Whether I have asthma, I cannot tell, but leave it to you to say ; have had trouble in breathing, at times, for three years, more especially in cold weather, and after exercising in the open air. I have consulted several doc- tors : one told me it was a slight congestion ; another, that it was weakness of the pectoral muscles; another, that it Avas bronchitis, together with inflammation of the throat and pharynx, and he ap- plied nitrate of silver, with the laryngial syringe, but without effect, as far as difficult breathing was concerned, although it removed a hoarseness, to which I had been subject. I have inflammation and I believe conjestion of the pharynx ; am troubled a little with dys- pepsia when I eat too much ; am at times a little costive ; my appe- tite is good. My chief trouble seems to be to get my breath. I have sometimes slight pains in different parts of my lungs, as much under the breast-bone as anywhere, and they always ache when I have difficulty in breathing. I breathe more freely in the morning than in the after part of the day; Croton oil relieves it for a few days onlv. I do not breathe very short—believe it is only eighteen times in a minute ; but my lungs feel as if they were filled up. For two veai's I have bathed in cold Avater nearly every morning, and 20 306 various forms of consumption. for a few weeks I have worn a cloth wet in salt and water during the night. My general health is very good this winter, much better than for the past two years. I have gained ten pounds Avithin three months, and now Aveigh one hundred and thirty pounds." Here is congestion of the lungs, not severe, but which would in time, unless relieved, induce tuberculation of the lungs. There is also a catarrhal humor about the throat. With these few selections from the mass of letters written me by invalids, I must close this chapter, as I could not copy from them at greater length without swelling this volume beyond the limits I have designed. In the extracts given, the reader will find many of the diseases I have mentioned in former pages very clearly described by the patients themselves. CHAPTER XXVI. CONSUMPTION CAN BE CURED. TESTIMONY OF THOSE WHO HAVE BEEN THE SUBJECTS OF DR. FITCH'S TREATMENT. After having read in the foregoing pages a description of what consumption is—its causes, varieties, symptoms, and complications, with a general view of my mode of treating it—the invalid will per- haps read with interest some additional evidence that, by the treat- ment I recommend and employ, this dreaded disease may really be cured. Such evidence I propose to give in this chapter, in the testi- mony of those who have themselves been the subjects of this treatment. I ask the reader to give the following letters a candid and careful pe- rusal. If he will do so, he will, I think, certainly conclude that the persons who wrote them, if they tell the truth, had true pulmonary consumption. That they have been cured, they are living wit- nesses. If any doubt is entertained as to the authenticity of these letters, I beg that the writers may be addressed and inquiry made of them. Their names and places of residence are given in full, so that it will require only the trouble of Avriting a line (inclosing a postage stamp) and depositing it in the mail, to satisfy the skeptical as to whether the letters are genuine. If they are, and the writers have stated only the simple facts, as I know they have, their testimony is of the utmost importance. It settles the vexed question as to the curability of consumption; it does more, it points the consumptive invalid to the system of treatment in which relief may be found. I am aAvare that testimonials of cures, given by restored invalids, are often regarded Avith suspicion ; and I am sorry to say that there is not unfrequently good ground for suspicion. It is not a difficult thino- to manufacture such testimony, and it is too often done; so often, indeed, that no person should rely upon published letters of 308 CONSUMPTION CAN BE CURED. " wonderful cures" without investigating their sources and learning for themselves AA'hether or not they are genuine and truthful. But while the sick should guard themselves against imposition in this matter, they should not be so unAvise as to reject all testimony presented by those who assert they have been cured of dangerous diseases. A single fact outAveighs a thousand falsehoods, and we should not throw away the genuine because there are counterfeits. The part of wis- dom is to investigate and ascertain for ourselves the truth. Let me add, that the letters here published were received in the course of a regular correspondence between my patients and myself; but the evidence they contain of the efficiency of the treatment em- ployed is not less valuable on that account. They are of course only a few of the many hundreds of similar ones I have received. I state these facts because I am really desirous that the invalids who shall read this book may be convinced that consumption, as well as the other diseases I have described, can be cured; believing that if I can spread this conviction, I shall contribute much towards alle- viating suffering and saving valuable lives. I again commend the folioAving letters to the careful attention of the reader. Case XXII.—Letter from W. H. Bangs, Esq., of Washington, D. C. "Bank of the Metropolis, Washington, D. C, | December 10, 1856 J "Dr. S. S. Fitch, New York: " My dear Sir,—I hasten to comply with the promise made to you some weeks since, to give you a detailed statement of my case prior to placing myself under your care, Avith the effect produced upon me subsequently by your course of treatment. This I do the more readily in the hope that some one or more of my felloAv-beings who may have been so unfortunate as to make shipwreck of their health, may see in this a beacon light of hope, to cheer, and perchance to rescue them from their perilous condition. " In March, 1853, after a severe attack of bilious fever, which was followed by a general prostration of my system, I contracted a cold, which, settling upon my lungs, produced the most alarming symp- toms of consumption—such as spitting of blood, profuse night-sweats, and a hacking, troublesome cough. My friends were exceedingly anxious that every available means of relief should be resorted to, LETTER FROM WM. H. BANGS, ESQ. 309 and accordingly nothing was left undone which thoughtful care and solicitous kindness could accomplish, aided by professional skill. Under all these appliances my health, as the spring opened, became better, and I buoyed myself up with the hope that, as the summer advanced, I should become quite strong again. This hope remained with me until the latter part of the summer, when, by an unfortunate accident, I was subjected to a severe hemorrhage of the lungs, which prostrated me even more than I had been when first attacked. From this time up to the period when I placed myself under your care, I led a miserable existence—at times sorely perplexed and dispirited, ready to yield to the approach of despair—and then again tempo- rarily relieved, only to find myself again deceived and disappointed in the various means which I resorted to for relief. Among the remedies which claimed my attention, none seemed to offer so great advantages as the popular theory of ' inhalation.' I procured books on the subject, and after entirely perusing them I became convinced that this was the only true method of administering for pulmonary diseases. Alas! this was the greatest humbug of them all. Upon submitting myself to the charge of the great apostle of inhalation in your city, I Avas forced to the conclusion, after time and money were both wasted, that however good the system might be in theory, it was certainly villainous in its practice. Finding that it did me more harm than good, I gave it up, determining never to be in- duced again to experiment in any new doctrine which promises to cure every one by the same course of treatment, no matter how dis- similar their cases might be. Some months after the downfall of in- halation as a specialty, I came across your ' Six Lectures to Con- sumptives,' and became deeply interested in them, for I thought the arguments there used displayed more sound common sense than I had ever seen before on that subject. The reading of the work kin- dled anew the flames of hope which had almost died within me, and I determined to write to you, and, if encouraged, to submit my case to you. In the month of March or April of this year I Avrote to you, and received an encouraging reply. I then resolved to place myself under your care; and not being able to visit you at that time, wrote you a detailed statement of the symptoms of my case, in an- swer to Avhich you sent me a box of your medicines, together with a shoulder-brace and supporter, and an inhaling-tube for the purpose of expanding the lungs and filling them Avith air. Accompanying 310 CONSUMPTION CAN BE CURED. these was a letter containing directions for my guidance in the use of the medicines. From the time I commenced the use of these remedies, I commenced to gain flesh, and to feel as I had not done for years. The shoulder-brace and supporter I found every thing you indicated to me they Avould be. Prior to their use, after a day's writing I would feel so exhausted and Aveak as to unfit me totally for any kind of out-door service. After using them I ascertained that I could perform the same amount of Avriting with one-half the fatigue and exhaustion which formerly accompanied me from my place of business. I have noAV been seven months under your care, and can assure you that during that time my health has been gradually but steadily improving, and I am now in better health, can endure more fatigue, take more exercise, and enjoy life generally, better than I have been permitted to be or to do for many years. I know that, with a sys- tem which has been so completely enfeebled and prostrated as mine has been, great care and caution -will always be necessary auxiliaries to good health ; but with the use of your remedies, both medicinal and mechanical, and a perfect trust in that good and ever kind Providence AA'hich has thus far blessed the use of them to my good, I can look forAvard to the future, if not with positive hope, at least with cheerfulness and contentment. I would not, on any account, be without your shoulder-brace and abdominal supporter and your med- icines. I continue to use them, although there is no actual necessity for my doing so. But I shall use them until ordered by you to desist. " There are many points I might touch on which would more clearly elucidate my case ; but I fear I have already tired you, and I will bring my letter to a close, merely adding, that if this commu- nication should reach the eye of any one in doubt on this important subject, and he will address me a fine to that effect, it will at all times be a pleasure to me to endea\Tor to satisfy such an one with regard to the correctness of the foregoing. " Leaving you the permission to use this letter, or any part of it, in any way Avhich may subserve your purposes, " I am, my dear sir, " Very truly yours, " Wm. Howell Bangs." LETTER FROM JOHN GORDON, ESQ. 311 Case XXIII.—Letter from John Gordon, Esq., of Ottawa, C. F. ut\