FOWLERS AND WELLS' Embracing X^r ALL THE MOST POPULAR WORKS h<^ ^ ON TUE SUBJECT: INCLUDING INTRODUCTION TO THE WATER-CURE ; HYDROPATHY, OR THE WATER-CURE ; EXPERIENCE IN THE WATER-CURE ; THE CHOLERA, AND BOWEL DI8KASES ; WATER AND VEGETABLE DIRT ; THE PARENTS' GUIDE ; TOBACCO : ITS NATURE AND EFFECTS ; CURIOSITIES OF COMMON WATER; WATER-CURE MANUAL ; WATER-CURE IN EVERY DISEASK ; WATER-CURE IN PREGNANCY ; HYDROPATHY FOR THE PEOPLHJ ERRORS IN THE WATER-CURE J WATER-CURE IN CONSUMPTION. IN SEVEN VOLUMES. VOL. VII. WATER-CURE IN CONSUMPTION; WATER-CU;&E IN PREGNANCY. C/2 ]-,} ■ " /■ - " . NEW t O R K : FOWLERS AND WELLS, PUBLISHERS, NO. 308 BROADWAY. SOt,r BY BOOKSELLERS GENERALLY CONSUMPTION: ITS PREVENTION AND CURE BY THE^ WATER TREATMENT. WITH ADVICE CONCERNING HEMORRHAGE FROM *THE LUNGS, COUGHS, COLDS. ASTHMA, BRONCHITIS, AND SORE THROAT. BY JOEL SHEW, M. D. RACTITIONER OF WATER-CURB. NEW YORK: FOWLERS AND WELLS, PUBLISHERS, » NO. 808 BROADWAY. Boston- ) j Philadelphia: 142 Washington St. f 1855. 1 No. 231 Arch Street WBF 7555" Entered, accoramg to Act ot Congress, in tne year 1849. BY FOWLERS AND WELLS, m the Jerk's Office of the District Court for the Southern District of New York. \ INTRODUCTION. In addition to what has been said concerning diet, as a means of prevention and cure of consumption, and its kin- dred diseases, in the work now presented to the public, the author wishes here to call more especial attention to the subject. The common belief among the civilized and enlightened nations of the earth, is, that man is, by nature, an omnivo- rous, or all-eating animal; that, in a state of pure nature, if such a state can be conceived of, he eats naturally, and with benefit, of flesh, fish, fowl, farinacea, fruits, and roots, according to his inclination, and the circumstances in which he is placed. The practice of the civilized world is in ac- cordance with its belief, with this exception, that in many parts, as, for example, France and Germany, the poorer portion of the population, which also constitutes by far the most numerous part, must of necessity subsist almost en- f j-ely on the vegetable productions of the earth. It may, indeed, be stated, that the manual labor of the world is done mainly on the strength gained from vegetable food. But this practice arises merely from the necessity of the case. The poor are not able to obtain animal food, be- cause of its scarcity, and higher price. If we look at man in the light of comparative anatomy, we find that his teeth do not at all resemble those of the omnivorous hog, or of any other omnivorous animal we can lind. True, he has what is called a canine tooth; but this is merely a transition from the double to the single teeth. and is possessed by other animals, which are well known to be herbivorous, equally with man. On the other hand, too, y INTRODUCTION. we find that the orang-outang, the animal which, in all re- spects of anatomical conformation, nearest resembles man, has the same number and order of teeth, and the jaw and teeth of which may be readily mistaken for those of the hu- man species. If we extend our observation to other organs of the body, we also find a striking resemblance between the orang-outang and man. The orang-outang, it is well known, is never, in a natural state, in any sense omnivorous. He eats only of the vegetable productions of the earth. The great objections to animal food, in a physiological point of view, are these : it causes too rapid circulation, and too great heat of the system ; it increases its tendency to inflammatory action, and thus renders it, at all times, more liable to the attacks of disease; it over-stimulates the pow- ers of life, and tends preternaturally to wear out the ener- gies of the living body, and thus to shorten man's days. It is common, I know, with manyHo recommend to feeble patients more stimulating and highly concentrated food. But this is done on the blind supposition that the enfee- bled stomach is able to digest such food. As well might we give a feeble horse a greater burden, and expect him to bear it, as to attempt to goad on the energies of the sys- tem, by giving it a greater than ordinary task to perform. The feebler the system, always the less able is it to digest food. In other words, the amount of food must always be graduated in proportion to the strength of the individual. The quantity of food, then, is a most important matter. In the treatment of the more active and later stages of con- sumption, we often see people partaking freely of the rich- est viands, under the supposition that the stomach is well enough off. So great is the disease going on in the lungs, the stomach cannot at all feel the mischiefs it is brought to endure. The law of the system i-s, that when a strono- dis- ease is at work in any one organ of the body, the other parts remain in a comparatively dormant state. But in all such cases, the weak and diseased organ receives the injury of the offending cause. Thus, in the case supposed, the abuses of the stomach are sent upon the lungs. Patients in an advanced state of pulmonary disease, will always find that if, in connection with other well-regulated INTRODUCTION. V and judicious means, they practice a good degree of absti- nence in food, their bad symptoms will uniformly become 1 mitigated; they will find that they have less feverishness, \ less debility and sweats, less diarrhoea, less cough and ex- I pectoration, and that they will enjoy better sleep at night. If free, regular, and continued exercise, in the open air, is to be regarded the great remedy of preventing consump- tion, in its earliest stages, I am convinced that abstinence, carried almost to the point of living on simple water, is the greatest of all known means for mitigating its symptoms, in its latter and more painful periods. I have known a case like the following: a woman about thirty years of age, with many of the most formidable symp- toms of deep-seated pulmonary consumption, such as severe cough, the raising of large quantities of very offensive ex- pectoration, wasting of the flesh, total loss of appetite, hec- tic, night sweats, extreme debility, cessation of the menses, etc., to become cured" in this simple way: she was kept for months nearly fasting; ocasionally as the appetite returned somewhat, a little mild nourishment was given her, but the appetite wsft never urged; at length she grew slightly bet- teY, and thus by going on little by little, as appetite return- ed, living yet all the time in a most abstemious manner, she, after many months, became well. Now in this case it must be considered, I think, that the prolonged fasting and abstemiousness broke up her disease. And it was ac- complished in this wise; under wasting, caused by lack of food, the tendency of the system is to throw off its morbid, diseased, and worn-out matter first. This is, indeed, the tendency of nature always, but to a much greater degree when prolonged fasting from all food is practiced. I have no doubt that consumption in numbers of cases, and other so-called incurable diseases, might in this way be eradi- cated. The hunger-cure, as it is called in Germany, acts on the principle just explained. " I am convinced by every day's experience," says Laennec, " that for one instance of mischief produced by too great abstinence in the conva- lescence from acute, and especially from inflammatory dis- eases, there are a thousand occasioned by the opposite extreme. And I would, therefore," he continues, " earnestly VI INTROPUCTION. request the young practitioner not to be seduced into tho too early exhibition of nutritive food to his convalescents, from fear of dangerous debility, or any other cause." On the other hand, it should be remembered, too, that there is such a thing as carrying fasting too far. A sick man may be starved as easily and as effectually as one that is well. The error is, however, almost aiways on the side of too great an amount of food. The subject of diet, being a most important one, not only as regards the prevention and cure of consumption, but of all diseases whatever, I earnestly recommend the reader to avail himself of such works as Dr. Lambe on Vegetable Diet, Dr. Alcott, and Mr. Graham's Science of Human Life. These works contain a vast deal of general and practical information, and such as will amply reward the reader, even if he do not become convinced of all the posi- tions laid down by these authors. In cases of colds in the chest and lungs, bronchitis, cough, and common sore throat, the treatment recommended by Priessnitz is both simple and efficacious. Mr. Henry C. Wright, whose case as cured at Graefenbei"g, is given in this volume, obtained of Priessnitz his advice to be followed in the attacks to which he had for years been liable. The questions and answers, as Mr. Wright gives them in his " Six Months at Graefenberg," are as follows : " Wright.—In case of severe cold on the lungs, attended with much cough and expectoration, what should be done ? " Priessnitz.—Rub the chest and throat with cold water, holding, at the same time, some water in the mouth. In cold climates, the wet bandage around the throat would be of service occasionally. In warm climates, washing and rubbing alone are better. " Wright.—In cases of inflammation and soreness of the throat, attended with hoarseness and difficulty in speaking? "Priessnitz.—Friction, washing, and the application of wet bandages. " Wright.—In cases of long attendance, and speaking at public meetings, in hot, close, crowded rooms, and then going out into the chilly night air ? INTRODUCTION. Vli "Priessnitz.—The rubbing-sheet, washing and rubbing the head and throat well, and the use of the foot-bath. " Wright.—When troubled with shooting pains across the chest, occasioned by long speaking at a time ? " Priessnitz.—Take rubbing-sheets, and' rub the throat and chest with water. In regard to friction, Mr. Wright judiciously remarks, " that it is worthy of special notice that Priessnitz never orders the rubbing to be done with brushes, flannels, or - linen towels. He never applies flannels and brushes to the skin for any purpose; linen is only used for wiping the sur- face dry, and, even in this process, the rubbing should be gentle. He wishes to have the skin kept as smooth and soft as possible; and hence his disuse of flannels next the skin, and of brushes and hard substances in rubbing. He recommends that the hand only should be used; and it is not possible to be long under his treatment, and to enjoy the delicious sensations resulting from a clear, smooth, soft skin, the almost invariable result of the cure, without being convinced of the correctness of his practice in this respect." The free use of the dripping-sheet (rubbing over the sheet, and not with it^for four or five minutes, until it becomes warm) is a most valuable remedy in colds and recent affec- tions of the throat and chest. It is the most mild of all general baths, and can be obtained in almost any circum- stances in which we may be placed. In cases of old and chronic affections of the throat, the water-treatment, together with suitable diet and exercise, long persevered in, will be found a most serviceable means, and, in fact, the only means that will in the end accomplish any thing in their cure. The fashionable practice of clip- ping the tonsils and palate, and applying a solution of nitrate of silver to the throat, will be found of very little benefit. In some cases, it may relieve the symptoms somewhat for the time; but in the end, all such treatment must prove worse than nothing. It does not at all go to the root of the difficulty. The only cure of a chronic throat affection is the complete renovation of the whole system. The throat too, be it remembered, as an important practical lesson, is, in such cases the very last part to become benefited. Vlll INTRDDLCTION. Clergymen, and all others, who are troubled with this most obstinate affection, are earnestly recommended to make them- selves acquainted with the water-treatment. In asthma, this same treatment will be found of most sig- nal benefit. It was long ago observed, by Mr. Wesley and other writers, that the cold bath was a. very efficacious remedy in this obstinate disease. A single cold bath will often relieve a person as by magic, when he is nearly suffo- cating from want of breath. In hooping-cough, the water processes are of great ser- vice. No treatment can at all compare with that by wet com- presses on the chest, the dripping-sheet, frictions with the wet hand, cold general baths, if the patient is not too weak, water drinking, and reasonable abstinence in food. Indeed, the same treatment we use for a common cold, will be strictly applicable in this affection. The author has not, in the following pages, spoken of percussion and auscultation, as means of ascertaining the state of the chest and lungs, in consumption. These are complex and difficult methods, and are moreover liable to mislead. They may serve to amuse the patient, and bring money to the physician; but as to their real worth, there is but little in them. We know that the most experienced often vary in their opinions of a given case; and if it were possible (which it is not) to learn by these means, in all cases, the true state of the parts concerned, it would not help us one iota in the treatment. The true and rational treatment of consumption must always be that which is graduated according to the patient's strength. Percussion and auscultation do not, in the least, aid us in ascertaining what the degree of strength is. It does not help us in any mode of treatment whatever. 11 JONTENTS. CHAPTER I. Consumption.—Meaning of the word.—Its derivation and implica- tion.—Signification of phthisis pulmonalis.—Dr. Hooper's seven va- rieties of consumption.—True meaning of the term at the present day.—Consumption a disease that belongs to all ages, and all classes of individuals.—It extends over a wide range of the earth's surface. —It is more to be feared than any other disease which afflicts the race.—Consumption is often, though not always, an hereditary dis- ease.—Persons of a particular conformation and habit of body more v liable than others to the disease. - 19-22 CHAPTER II. Females are, more than males, subject to consumption.—This is evidently not the natural order of things.—Reasons why males are less subject to pulmonary disease.—Opinion of Dr. Forbes.— Dr. Sweetser.—The Parisian hospitals.—Tables of mortality.— Scrofula also more common among females.—How are we to account for the fact that females are more subject to scrofulous disease?..........23-26 CHAPTER III. Periods of life at which consumption is most apt to occur.—Doctrine of the Greeks.—Tables of M. Louis; of Laennec ; of Dr. Alison; of Sussmilah; of M. Bayle, as quoted by M. Louis ; of Dr. Clark. 27-29 CHAPTER IV. Duration of consumption, and seasons of the year in which it is most prevalent.—It is generally a slow or chronic disease.—Testimony of M. Bayle and M. Louis.—Their tables, showing the duration of the disease.—This depends on a variety of circumstances.—Obser- vations of M. Louis and Dr. Clark.—Seasons of the year as affect- ing the duration of consumption.—Dr. Heberden's Bills of Mor- tality in the city of London, as quoted by Dr. Clark on this point.— City Inspector's Report of Deaths and Interments in the city of New York.—Comparative mortality of males and females at dif- ferent seasons of the year. ...... 30-34 xii CONTENTS. CHAPTER V. Mortality of consumption.—Imperfect nature ol statistical reports.— These are, however, sufficient for all practical purposes.—Number of deaths occurring, and at wh;it ages, in the city of New York.— Also, the number from each disease.—Conclusions drawn there- from.—Estimate of Dr. Sydenham of deaths by consumption in Great Britain.—Of Drs. Heberden, Young, and Woolcombe.— Great amount of consumption in Bristol, England.—Laennec's esti- mate concerning Paris.—Dr. Sweetser's estimate of consumption in the city of Boston.—Dr. Elliotson's statement concerning Europe.—Dr. Emerson's estimate in the American cities.—Mortal- ity among the English troops stationed in different parts of the world.—Conclusions drawn from the foregoing facts. - 35-40 CHAPTER VI. Anatomical description of the chest and lungs.—The thorax, or cheat. —The lungs.—Their situation, color, divisions, size, number of lobes.—Blood-vessels of the lungs.—Their structure and cover- ing.—The bronchial tubes.—The pulmonary artery.—The brachial arteries.—The lymphatics.—The nerves of the lungs.—The pleura;. —The mediastinum.—Professor Sweetser's ingenious description of the lungs..........41-55 CHAPTER VII. Phenomena of respiration further considered.—Its general principle explained.—Operation of the diaphragm.—The lungs and air-tubes are comparatively passive agents.—The lungs act like a pair of common bellows.—Great extent of surface in the air-colls of the lungs.—The exceeding great delicateness of this part.—The lungs are always nearly tilled with air.—An important practical point.— Atmosphere within the lungs is changed gradually.—Males inhale much more than females.—Probable amount of air inhaled in twenty-four hours.—Great importance of the function of respira- tion. .......... 56-62 CHAPTER VIII. Circulation of the blood.—The blood of two kinds.—The heart, arte- ries, and veins.—Action of the heart described.—The two rounds of circulation.—The arterial blood and the venous.—The never- ceasing action of the heart.—Amount of blood passing through the heart, and to the lungs, per hour.—Amount of air necessary to pu- rify it.—Practical deductions from the foregoing facts. - 63-68 CHAPTER IX. Tubercles, the foundation of true pulmonary consumption.—Meaning of the word tubercle.—Character of tubercles.—Tuberculous de- posits may occur in nearly every part of the body.—Tables show- CONTENTS. XUI ing their relative frequency in the different organs and parts,— Dr. Good's remarks on the subject.—Tubercles may probably remain many years in the system without endangering life.—They ordinarily increase in number and size, and have a greater tendency to inflame and mature as years advance.—Process of maturation.— Can tuberculous disease be cured 1—Opinions of various authors on the subject.—Animals often have tubercles.—How caused.— The milch cows of Paris.—Practical inferences from the foregoing facts...........69-79 CHAPTER X. The different forms of consumption.—That of infants and children.— In them the symptoms are usually more strongly marked than in adults.—There may also be great obscurity of the disease.—Cases in point.—Consumption of adults.—The latent form.—The chronic. —Acute, rapid, or quick consumption.—This may result from the latent form.—It is oftenest seen in young females.—No two cases of consumption in all respects alike. .... 80-89 CHAPTER XL Symptoms of consumption.—Hemorrhage from the lungs.—Bron- chitis.—Cough.—Hooping cough.—Spasmodic cough.—Nervous or hysterical cough.—Short, dry, or hacking cough.—Aphonic cough. —Stridulous, barking, wheezing, or whistling cough.—Loose cough.—Hoarse, loud, dry, forcible cough.—Asthmatic cough.— Cough sometimes occurs "in pregnancy.—Cough generally one of the earliest symptoms of consumption.—Dyspnoea, or difficult breathing.—The expectoration.—Dr. Cullen's rules for distinguish- ing dus.—Dr. Marshall Hall's observations on expectoration. 8 r - 90-100 CHAPTER XII. Symptoms of consumption continued.—Perspiration.—This occurs more particularly in the advanced stages of the disease.—Hectic fever.—Thirst.—This is not always present in consumption.—The pul8e_It is always accelerated in this disease.—Diarrhoea.—Ema- ciation.—Swelling of the limbs.—Aphthae, or sore mouth.—Pains in the chest.—The nails.—The hair.—Nervousness.—The intel- lect —Delirium.—Cessation of menstruation.—Pregnancy as affect- in" consumption.—Practical deductions to be drawn from the foregoing description of the symptoms of consumption. - 101-112 CHAPTER XIII. Causes of consumption.—The predisposing and the exciting causes of disease.—Hereditary predisposition.—Transmission of physiolo- gical and pathological qualities from parent to child.—Consump- tion not always hereditary-Ways in which it may be brought on in the system.—Intermarriage as affecting pulmonary consump XIV bi NTENTss. tion.—Relations should not intermarry.—Reasons why.—Is con- sumption a contagious disease'—Authorities quoted.—Relations of scrofula to consumption.—Important and instructive facts con- cerning the causes and the prevention of consumption. - 113-125 CHAPTER XIV. The causes of consumption continued.—Want of light.—Light as im portant to animal bodies as the vegetable.—Interesting and impor- tant facts in corroboration of this doctrine.—Consumption is found most among those who inhabit tho darkest places in cities.—Effects of insufficiency of food.—Excessive alimentation.—Its effects illus- trated by various facts.......126-133 CHAPTER XV. Causes of consumption continued.—Deficient exercise.—Its effects.— Excessive labor.—The latter a less frequent cause of disease than the former.—Over-exertion of the lungs in public speaking, singing, and playing on wind instruments.—A due degree of exercise of the vocal organs highly conducive to health.—Excessive mental labor.—Erroneous notions concerning the education of the young. —Clothing.—Females are most liable to suffer from improper dress.—Errors of mothers on this subject.—Want of cleanliness.— Spirituous drinks.—Spirit drinkers are very liable to consumption. 134-139 CHAPTER XVI. Causes of consumption continued —Mercury.—General effects of this drug.—It exerts a very deleterious influence upon those who are predisposed to consumption.—Abuse of medicines generally as a cause of tuberculous disease.—Drugs are used to great excess by the American people.—Tea and coffee.—These injure the general health, and may therefore aid in causing tuberculous disease.— Tobacco.—Its narcotic and poisonous effects on the living body.— Hard vater as a cause of disease.—Scrofula in Vermont.—Pure soft water far more healthful than that which is hard. - 140-146 CHAPTER XVII. Causes of consumption continued.—Suppression of habitual dis- charges.—The depressing passions.—Striking examples given by Laennec—Sexual abuse.—Haemorrhage from the lungs.—Inflam- mation of the lungs.—Bronchitis and sore throat.—Opinions of various writers on this subject.—Influenza.—Fevers.—Small-pox, scarletina, and measles.—Their influence in developing tubercular disease.—Indigestion........147-155 CHAPTER XVIII. The causes of consumption concluded.—The different occupations.— Tables of M. Benoiston made from observations in four of the CONTENTS. XV Parisian hospitals, namely, L'Hotel Dieu, La Charite, La Pitio, and L'Hospice Cochin.—Results in occupations which expose the lungs to the action of an atmosphere loaded with vegetable dust— Those which expose the lungs to the action of an atmosphere loaded with mineral particles.—Those which expose the lungs to the action of an atmosphere loaded with animal dust.—Occupations which expose the lungs to the action of an atmosphere loaded with hurtful vapors.—Those which expose the body, and particularly tile feet, to the action of damp.—Occupations in which the muscles of the chest and arms are subject to a constant and fatiguing exer- cise.—Those in which the muscles of the arms and chest are sub- jected to constant motion while the body is maintained in a bent position.—Recapitulation of the more prominent causes of con- sumption. ......... 156-164 CHAPTER XIX. Haemorrhage from the lungs.—This often exists as one of the earliest Bymptoms of tubercular consumption.—It is a symptom not always dangerous, but one that demands special attention. Females are most subject to it.—Opinions of Louis and Dr. Sweetser.—Age at which pulmonary haemorrhage most frequently occurs.—This affec- tion is not necessarily associated with a consumptive habit.—Na- ture of the affection.—Means of knowing it.—Bright red or arte- rial blood usually comes from the lungs, and dark or venous blood from the stomach.—Symptoms that immediately precede bleeding from the lungs.—Effects of pulmonary haemorrhage on the system. —Causes of this affection.—It appears sometimes to be a friendly disease.—Its treatment.—Injurious effects of fear.—Pulmonary haemorrhage should be treated on the same principles as an inflam- mation.—Dr. Elli->tson's method.—Bleeding and cold on the chest. —Blisters.—The general principles and the particulars of the treat- ment stated.—The true methods of avoiding a recurrence of this disease. --------- 165—177 CHAPTER XX. The treatment of consumption continued.—Cough.—Opium and anti- mony.—Washing the surface with pure water.—Fasting.—Evils of over-eating.—Saccharine matter.—Difficulty of respiration.—How treated.—The expectoration.—Diet and water-drinking as a means of modifying it.—Perspiration.—The great power of water to pre- vent the debilitating sweats of consumption.—Evils of feather beds in causing hectic night sweats.—Airing the bedclothes in the night, and exposing the surface of the body to the atmosphere a useful means.—Dr. Marshall Hall's remarks on sponging the surface with salt water.—The fresh is still better.—The hectic fever.—Means of modifying it.—The pulse.—Means of modifying it.—Exercise good, but should not be too violent.—Diarrhoea.—Palliative treat- ment to be used.—Pains of the chest.—Wet fomentations better than blisters.—Care to be exercised in making the wet applications XVj CONTENTS. —Debility in consumption.—How to modify it. —The true princi pies on which consumption is to be treated.—Remarks of Drs. Bit- ling and Elliotson.—Bathing and exercise the greatest of all known means for preventing this disease. .... 178-190 CHAPTER XXI. Treatment of consumption continued.—Sea-voyages.—Their advan- tages and disadvantages.—Erroneous notions concerning the effect of moisture in consumption and other diseases.—Consumptive patients generally improve at sea, notwithstanding the great amount of moisture in sea air.—A tendency to pulmonary haemorrhage ap- pears to constitute no objection to sea-voyages.—Testimony of Sir James Clark.—Experience of Dr. Andrew Combe as to the effects of sailing, in consumption.—Some of his opinions controverted.— Sea-sickness.—Its phenomena and effects.—It cannot of itself be supposed to cause any good.—Those who_ go to sea should select as large and well-ventilated a ship as possible.—Good effects of sail- ing much owing to the perpetual exercise to whichone is subject- ed.—Long-continued voyages the best.—Sea-sickness does not generally occur in bad cases of consumption.—Sailors are not much subject to this disease.—Atmospheric changes.—The milder seasons the best for most consumptives.—A change is of itself often benefi- cial. ........ - - 191-199 CHAPTER XXII. Treatment of consumption continued.—Effects of climate and fresn air.—Consumption far more common in Great Britain and the United States than in Russia.—Winter residences in relation to this disease.—Patients should be careful of going away from the com- forts of home.—Persons in this disease catch at every thing which promises the least hope.—The greater sensitiveness of the body to cold when extensive ulceration exists.—Cold both a tonic and a debilitant, according to circumstances.—It is, however, as a general thing, a tonic.—Moderate warmth appears to agree with a very feeble consumptive patient best.—In very advanced states of this disease life may doubtless be prolonged by going to a warmer cli- mate.—Personal observations of Sir James Clark.—Great mortality of consumption in Bristol, England.—Different localities compared. —Relative mortality of consumption in the larger cities of the United States.—Different estimates of authors.—Few, compara- tively, who wish to change their locality have sufficient pecuniary mean3 to,enable them to do so.—Most persons must, therefore, do the best they can at home.......200-207 CHAPTER XXm. Treatment of consumption continued.—Exercise.—Valuable remarks of Dr. Parish.—General effects of exercise on body and mind.— should be made a pleasure instead of a \ask.—It is best when per- CONTENTS. XVU formed in the open air, and not alane.—Exercise should be moder- ate when taken immediately after a meal.—The different modes of exercise.—Walking.—Walking over mountains.—Advantages of this practice.—It should be graduated according to the strength.— Riding on horseback.—This was in great repute anciently.—Syd- enham and Dr. Lambe.—It is one of the best possible modes.— Riding in carriages.—Swinging.—The good effect of this doubtful. —Dancing.—The use of dumb-bells.—Shuttlecock.—Graces.— Spinning wool.—Farming, gardening, woodsawing, chopping, and the more useful forms of exercise generally best.—Exercise of chil- dren.—Remarks of Dr. Clark. ..... 208-219 CHAPTER XXIV. The treatment of consumption continued.—Inhalation.—Meaning of the term.—Facts and principles on which the practice of inhalation is founded.—Advantages of this method.—III effects of confinement within doors.—When and to what extent is inhalation available?— Method of performing it.—Instruments, and directions for their use.—Playing on wind instruments as means of inhalation.—Public speaking and reading.—Their advantages in preventing pulmonary disease. ...------ 220--27 CHAPTER XXV. The treatment of consumption continued.—The processes of water- cure.—Water drinking.—Importance of water as an agent of life.— Effects of water taken internally, in fevers and other inflammatory diseases.—Rules to be observed.—The injection, or clyster.— Modes of using it.—The abreibung, or rubbing wet-sheet.—Its mildness and general applicability as a form of bath.—The towel- bath.—The sponge-bath.—The shower-bath.—Rules for its use.— General directions concerning baths.—Bath by affusion.—The plunge-bath.—How often should we bathe?—The half-bath.—The head-bath.—The nasal bath.—The mouth or oral bath.—The lem- tuch, or wet-sheet—Mode of applying it.—Wet compresses, ban- dages, and fomentations.—The cooling, the warming or stimulating, and the soothing wet compresses.—Their use in pains of the chest. 228-246 CHAPTER XXVI. Treatment of consumption.—Case of Miss Lydia Mott, of Albany.— Mr. Waterman Roberts, of Hartford, Ct—Mr. Jacob Campbell, ot New York.—Mr. John S. Sunderland, of Penn —Lyman Sherwood, ofla.—Mr. Henry C. Wright, of Philadelphia. - - 247-274 CHAPTER XXVII. Treatment of consumption concluded.—Animal sensibility as affected by heat and cold.—Interesting facts in relation to the power of habit.—Clothing natural to the human body.—Effscts ot flannel * xvni CONTENTS. worn next to the skin.—Objects of clothing.—Flannel useful unds? certain circumstances.—Soldiers, and coal heavers on board steam- ers.—Flannel a bad conductor of heat and cold.—Liability to error from habit.—Stockings.—What kinds are best.—Interesting facta. —Effects of cold bathing in enabling us to do with less clothing.— Spirit drinkers, although they have a warmer surface, suffer more with cold than water drinkers.—Rules in regard to clothing.— Tepid, cool, or cold bathing aids in making a change to lighter clothing.—Caution to the consumptive.—Dr. Combe controverted on the subject of wearing flannel.—The objections to flannel, and its advantages.—Bed clothing.—What it should be.—Evils of cotton comfortables. - - 275-286 19 CONSUMPTION. CHAPTER I. Consumption.—Meaning of the word.—Its derivation and applies tion.—Signification of Phthisis Pulmonalis.—Dr. Hooper's seven va- rieties of consumption.—True meaning of the term at the present day.—Consumption a disease that belongs to all ages, and all classes of individuals.—It extends over a wide range of the earth's surface. —It is more to be feared than any other disease which afflicts the race.—Consumption is often, though not always, an hereditary dis- ease.—Persons of a particular conformation and habit of body more liable than others to the disease. The word consumption—from consumere, to waste away—in its most extended signification, as applied to the living body, denotes that progressive emaciation which usually precedes death in the most of chronic diseases. The appellation is, however, more com- monly used to designate a scrofulous ulceration of the lungs. By consumption, as used in this country at the present day, is generally understood a wasting away of the substance of the lungs. Phthisis, from a Greek word signifying to consume, and pulmonalis (from pulmo, the lung) is the medical term for the same affection. Phthisis alone is often used ; pulmo- nalis being understood. Dr. Hooper, in his medical dictionary, makes-sevei varieties ot consumption: 20 coNjjCiMrrrox. 1. Phthisis incipicns, incipient consumption, with- out an expectoration of pus. 2. Phthisis humida, consumption with an expecto- ration of pus. 3. Phthisis scrophulosa, consumption from scrofu- lous tubercles of the lungs. 4. Phthisis hamoptoica, consumption from haemop- tysis, or haemorrhage from the lungs. 5. Phthisis exanthematica, consumption from exan- themata, or eruptive diseases. 6. Phthisis chlorotica, consumption from chlorosis of females. 7. Phthisis syphilitica, consumption from venerea] ulceration of the lungs. Phthisis signifies, as I have said, a wasting away, or a consuming of the body; but of late years the term has been restricted to that species of wasting which is caused by the presence of tubercular matter in the lungs. But it would be an error to suppose that the disease is restricted to the lungs in this case. The lung disease would indeed, of itself, be sufficient, in most cases, to destroy life; but its mortal tendency is aided and accelerated, in most instances, by diseases of a similar character situated in other organs. " The pulmonary consumption," as Dr. Latham justly ob- serves, "is no more than a fragment of "a great con- stitutional malady;" but that malady plays its part most conspicuously in the lungs. Consumption is a disease belonging to all classes of individuals. No age is exempt from its ravages. The unborn child has been found affected with it, and it is extremely common among the children of the ITS EXTENT. 2J poorer classes in large cities, as is proved by the re- cords of hospitals and other charitable institutions for the young. It invades the system also at the age when childhood is passing into adolescence, and not less frequently when the system is at the period of its greatest maturity and strength. From the fortieth to the fiftieth year it is frequent, and old age is by no means exempt from it. Even at the advanced period of one hundred years, persons have died of tubercu- lous pulmonary disease. " Consumption," in the language of an able writer —Professor Sweetser—" may be traced back to the earliest periods of medical history. Hippocrates, com- monly styled the father of medicine, who lived more than four hundred years before the Christian era, knew it, and has well described its melancholic course ; and though ages have rolled on with all their changes, this bane of human life still remains the same—has never abated in its fatality—never rested in its work of destruction. No condition, no period of human life, can claim immunity from its ravages. It respects not station, for it is a disease equally of the rich'and the poor. It attacks childhood in its weakness, youth in its bloom and elasticity, manhood in its power, and age in its decrepitude." Consumption is a disease which extends itself over a wide range of the earth's surface. In all northern Europe, in the United States, and in temperate cli- mates generally, this disease is more to be feared than any other which afflicts our race. In many instances we find that consumption is evi- dently an hereditary affection. The universal experi- 22 CONSUMPTION. ence of physicians proves that children of consump- tive parents are more subject to it than others are. It is true that we fortunately find exceptions to this rule ; but these exceptions are enough only to prove the general fact. " We sometimes find families," ob- serves Laennec, "in which only one or two of their members become consumptive in each generation ; on the other hand, we sometimes find large families of children destroyed by consumption, whose parents had showed no signs of the disease." Persons of a particular temperament or constitu- tion are the most subject to consumption. This par- ticular habit of the body, is distinguished by "the bril- liant whiteness of the skin, the bright red of the cheeks, the narrowness of the chest, the projecting or winged configuration of the shoulder-blades, and the slender- ness of the limbs and trunk, which is, at the same time, combined with a certain degree of adipose and lympha- tic stoutness." Aretseus, however, attributed this par- ticular constitution -rather to haemoptysical than con- sumptive subjects; but it is to be remarked, as Laen- nec observes, " that consumptive subjects of this con- figuration are more subject to haemoptysis (haemor- rhage from the lungs) than others.'^ It is to be ob- served also, that individuals of this 'particular consti- tution form only the smaller proportion of consumptive patients, and that this terrible malady frequently cuts off those who are the most robust, and have the best bodily configuration. OF MALES AND FEMALES. 23 CHAPTER II. Females are, more than males, subject to consumption.—This is evi- dently not the natural order of things.—Reasons why males are less subject to pulmonary disease.—Opinion of Dr. Forbes.—Dr. Sweetser.—The Parisian hospitals.—Tables of mortality.—Scrofula also more common among females.—How are we to account for the fact that females are more subject to scrofulous disease 1 When we examine the facts on an extended scale, it appears evident that women are decidedly more subject to consumption than males. It cannot, I think be supposed that the Creator, in infinite wisdom, anc in the beautiful fitness of things every where to be observed in nature, would have ordered such a re- sult. It is said, I know, that woman has naturally a greater delicateness of constitution, and that she is less able to bear up against the physical ills of life. But are we not rather to attribute this fact to the faulty methods of female life; as Dr. Forbes remarks, " to their most deleterious system of physical education, from the age of ten to puberty—to the wearing of stays, and the exposure of the upper part of the chest ?" May we not also take into this account the fact that in all nations, and in all periods of time, a very nearly equal number of each sex have been found to exist ? We cannot, I infer, suppose that the one sex was ori- ginally created with any greater natural predisposi- tion to this disease than the other. 24 CONSUMPTION. From the tables I have quoted in another part of this work—those of M. Benoiston de Chateauneuf— it appears that in Paris males are less subject to con- sumption than females. " The reports of the Paris hospitals," says Dr. Sweetser, " which are on a very extended scale, and made by the most scientific and accurate medical observers of France, unite in prov- ing a greater relative mortality from consumption in females than among males." Louis, whose observa- tions were perhaps as much extended as those of any one, states the proportion as seventy to ninety-two. Dr. Clark, of England, also exhibits tables, drawn from the medico-statistical reports of different coun- tries, but which show a result somewhat different from ihe statement of Louis, but yet in favor of males. M. Benoiston's tables, it will be seen by referring to them, give, as the results of four of the Parisian hos- pitals—the L'Hotel-Dieu, La Charite, La Pitie, and L'Hospice Cochin—during ten years, 4.77 per centum of deaths of females, while of males there died but 2.85 per centum. M. Louis, as quoted by Sir James Clark, found in his practice, that among females there were, during the first year, forty-two deaths to thirty of males. After this, the ratio of mortality as to time was the same in both sexes. Dr. Clark has given a table, gleaned from the re- cords of different cities, s'lowing a result somewhat different from the conclusions of some other writers. The table, taken in the aggregate, howevei, shows females to be the more subject to the disease. It )s as follows: SCROFULA. 25 Males. Females. Proportions. Hamburgh................____555 445 10 to 8.7 Rouen Hospital (in France).a... 55 44 10 to 8.6 Naples Hospital...............382 315 10 to 8.2 New York....................1584 1370 10 to 8.6 Geneva....................... 71 62 10 to 8.7 Berlin........................328 292 10 to 8.8 Sweden......................2088 1860 10 to 8.9 Ditto......................3054 3103 10 to 10.4 Berlin........................560 655 10 to 11.6 Blacks, New York............. 47 58 10 to 12.3 Paris.........................2219 2970 10 to 13.3 Ditto.........................3965 5579 10 to 14.3 Berlin, boys and girls...........363 567 10 to 15.6 Scrofula, which is also a kindred disease of con- sumption, appears to affect females more than males, in different parts of the world. Thus that peculiar swelling of the throat called bronchocele (goitre is the common name), which is supposed to be a scrofulous disease, is found to be more common with women than men. "It prevails," says Dr. Sweetser, " in some districts of our own country, as on certain parts of the Connecticut river, and on the borders of some of our northern lakes ; but is seen on a vastly more ex- tended scale among the Alps, and other mountainous ranges of Europe, as the Apennines and Pyrenees. In some situations among the Alps, goitre is so com- mon as to seem almost a local characteristic. But wherever I have had opportunities of observing the affection, I have remarked females to be its more fre- quent subjects." The same thing is seen, only prob- ably to a less extent, along the Sudates of Silesia, Austria, among which mountains the far-famed Wa- ter-Cure establishment, of Priessnitz is situated. <■> 26 CONSUMPTION'. If, then, it is true that females are more subject to consumption, and its kindred diseases, than males—a fact which cannot be doubted—how are we to assign a reason for this apparent anomaly in nature ? Are we to believe that the Almighty Disposer of all human events would thus create one half of the race with constitutions more subject to a malady so fearful as this? Who can believe it? I, for one, would much rather look carefully, reverently, into the ways of man's physical wrong-doing for a solution of this question—a question in which every member of soci- ety is interested. Is it said of females, as I have already hinted, that their native softness and delicacy of structure approx- imate them more nearly to that physical condition which tends strongly to scrofula and tubercular dis- ease? that this dainty organization of the female economy seems incompatible with that free energy of life which is needful to react against those vicissi- tudes of climate so operative in the generation of tubercles ? Are we not rather to say, that the habits of females generally, throughout the civilized world, are, and for centuries have been, such as are calculated, in no small degree, to waste, through successive generations, the inherent energies of the female frame? Thus the disease is augmented in both sexes, but most in those who transgress the laws of nature to the greatest extent. •ERIODS OF ^lFE. 27 CHAPTER III. Periods of life at which consumption is most apt to occur.—Doctrine of the Greeks.—Table of M. Louis; of Laennec ; of Dr. Alison ; of Sussmilah; of M. Bayle, as quoted by M. Louis; of Dr. Clark. It was a common doctrine among the Greek physi- cians that consumption rarely occurs before fifteen or after thirty-five years of age; and the opinion of most practitioners at the present day seems to be very much in accordance with this. I have remarked else- where that it may occur at any age, and even in the unborn child. Yet certain periods of life are more subject to it. Between the ages of eighteen and thirty-five the larger proportion of deaths occui but there are in this country at the present time a much larger proportion of deaths occurring after thirty or thirty-five years of age from consumption than is gen- erally supposed. A table of M. Louis showing the ages at which death occurs from consumption is as follows : « 20 " 30 " u ......39 " 30 » 40 ' li ......33 « 40 " 50 ' (i ......23 " 50 " 60 " u ......12 •♦ 60 " 70 " it ...... 5 ■28 CONSUMPTION. In a table of Laennec of 223 deaths from consump- tion, recorded by Bayle and Louis, there were— From 15 to 20 years of age,............21 deaths. " 20 " 30 » " ............62 " 30 " 40 " " ............56 " 40 " 50 " " ............44 " 50 " 60 » " ............27 " 60 " 70 " " ............13 Dr. Alison gives, as the result of practice in the New Town Dispensary, at Edinburgh, 55 deaths oc- curring during the two years, as follows : Before 15 years of age,................ 8 deaths. From ] 5 to 30 years of age,............13 " " 30 " 40 " " ............10 " After 40 " " ............24 " A table of Sussmilah, of Berlin, made in 1746, is as follows: Before 15 years of age,................251 deaths. From 15 to 30 years of age,............ 73 " " 30 » 40 » "............ 66 " Above 40 " "............230 " Louis has given, also, another table, on the au- thority of M. Bayle, as follows: From 15 to 20 years of age,............ 10 deaths. " 20 ' 30 " ' 40 " ' 50 « ' 60 " ' 70 " u .....23 ' " 30 <« ......33 » " 40 u ..... 21 ' " 50 It ___ 15 t " 'BO u Dr. Clark has collected two tables, from observa- tions made in different cities and countries, the general average of which goes to show that the greatest num. AGE.-!. 2D ber of deaths from consumption occurs between the ages of twenty and thirty. Next in proportion, be- tween thirty and forty, and next between forty and fifty. This remarkable agreement of all the places of observation warrants the conclusion, that after the fifteenth year of age fully one half of the deaths from consumption occur between the twentieth and fortieth, and that mortality is about at its maximum at thirt}'— and from that time gradually diminishes. 80 CONSUMPrlC V CHAPTER IV. Duration of consumption, and seasons of the year in which it is most prevalent.—It is generally a slow or chronic disease.—Testimony of M. Bayle and M. Louis.—Their tables, showing the duration ol the disease.—This depends on a variety of circumstances.—Obser- vations of M. Louis and Dr. Clark.—Season of the year as affect- ing the duration of consumption.—Dr. Heberden's Bills of Mor- tality in the city of London, as quoted by Dr. Clark on this point.—City Inspector's Report of Deaths and Interments in the city of New York.—Comparative mortality of males and females at different seasons of the year. Consumption, like all other diseases, varies much in regard to its progress. It is essentially a chronic disease; although in some cases persons die in a very short period after its invasion, and in which it takes on more the form of an acute disease. According to the tables of Bayle and Louis, from observations concerning 314 fatal cases, the average duration of the disease was twenty-three months. Counting from the time when consumption becomes fairly seated upon the system, the mean duration of cases may be stated at two years. This was Andral's conclusion. Many, of course, die in a much shorter period. The following are the tables of Louis and Bayle, referred to above: DURATION OF CONSUMPTION. 31 Louis. Bayle. Deaths within 3 months, 8 cases. 16 cases. Total .24 " from 3 to 6 u 25 tt 44 u n 69 " from 6 to 9 tl 25 it 44 ii ii 69 " from 9 to 12 11 12 it 20 ii ii 32 " from 12 to 15 It 12 it 21 it it 33 " from 15 to 18 It 3 i< 9 ii ii IS " from 18 to 24 u 10 u 18 u ii 28 " from 3 to 5 years, 14 ii 14 u ii 28 " from 5 to 10 tt 1 u 9 u ii 10 " from 10 to 40 u 4 114 ii 5 200 ii ii 9 314 It should be borne in mind that these tables are cal- culated from fatal cases, which occurred in hospital practice. The duration of consumption depends upon a va- riety of circumstances. The- constitution, the general health of the individual, the age, sex, occupation, season of the year, climate, and external circumstances, all have their influence. According to Louis—who is certainly very high authority on this subject—very acute cases are more frequent in early life; but Dr. Clark tells us that his own experience in this respect differs from that of Louis, for whose opinion he has great regard. " In the upper ranks of society," says Dr. Clark, "where patients have all the advantages that the best regimen, change of air, and medical treatment can afford, the medium duration of consumption is probably not much short of three years. Under other circumstances it is less." "And it is melancholical to reflect," says this estimable authority, " that curefc occur in so small a ratio, that in estimating the du- 32 CONSUMPTION. ration of this disease we cannot bring them into the calculation." Season of the year as affecting the duration of consumption.—That the duration of consumption is greatly influenced by the seasons, appears by the fol- lowing table, compiled by Dr. Clark, from the particu- lars given in Dr. Heberden's Bills of Mortality, which show the distribution of deaths from this disease, through the different months of the year, in the city of London. In January,............................. 4,363 deaths. In February,............................ 4,527 " In March,..............................4,634 " In April,...............................4,227 " In May,...............................4,043 " In June,............................... 3,604 " In July,................................ 3,242 " In August,.............................. 2,825 " In September,..........................2,994 " In October,............................. 3,521 " In November........................... 3,711 " In December,...........................4,516 " The result of this table accords with the common observation, that the disease proves more fatal in the cold months than in the warm According to the sea- sons, the aggregate number will stand thus : Winter months,........................ 13?4o6 deaths. Spring months,......................... 12 904 " Autumnal months,...................... \§ 226 " Summer months,..................... 9 678 " According to the City Inspector's Annual Report of the number of deaths and interments in the city of New York, during the different months of the yeai AFFECTED BY THE SEASONS, 33 1848, we find the number of deaths occurring from consumption as stated below : January..................................215 deaths. February,................................ 202 March,.................................. 182 " April,.................................... 160 " May,....................................147 " r June,.................................... 126 " July,.................................... I46 " 4 147 " August,.................................- A*' September,.............................. 121 October..................................156 " November,............................... *29 December,............................... 148 This table, it will be seen, shows a corresponding result of observations between the cities of London and New York. That the inclement seasons of the year are more productive of consumption than the mild would also appear from the fact that males, who are more than females exposed to the changes of temperature, storms, and the like influences, have a greater relative mortal- ity in cold seasons. This will appear from the follow- ing particulars, gleaned from the City Inspector's Re- port of deaths and interments in the city of New York, for the year as above: Tanuary ......116 males, and 99 females. February',".*.".".'-'.;.......... 105 « 99 « March,................... 91 " 91 " April,.................... 80 " 70 " Mav,....................- 80 " 6? ' ft-. .. GA II 34 CONSUMPTION. September,............... 59 males, and 62 females. October................... 77 " 79 November,................ 70 " 59 " December,................ 73 " 75 "* It should not, however, be inferred from this table, that because consumption is more prevalent in the city of New York in the cold seasons, it would neces- sarily be advantageous to remove to a warmer cli- mate. In the latter there are other influences than mere warmth to be taken into the account. We know that consumption is very rare, almost unknown in Northern Russia. We know, also, that in some warm climates it is very prevalent. But a temporary change from one place to another is doubtless often beneficial. M This table, showing that more males than females die of con- sumption in the city of New York, might at first appear to exhibit a result different from that which I have elsewhere stated, namely, that females are more subject than males to this disease. But it should be remembered that because of the more transient character of a considerable portion of the population of this city, and because of the fact that more of males than females are engaged in city pur- suits, we are to infer that there is always, necessarily, in this city, a greater number of the former than of the latter. Hence this result. ITS MORTALITY 35 CHAPTER V. Mortality of consumption.—Imperfect nature of statistical reports.— These are, however, sufficient for all practical purposes.—Number of deaths occurring, and at what ages, in the city of New York.— Also, the number from each disease.—Conclusions drawn there- from.—Estimate of Dr. Sydenham of deaths by consumption in Great Britain.—Of Drs. Heberden, Young, and Woolcombe.— Great amount of consumption in Bristol, England.—Laennec's esti- mate concerning Paris.—Dr. Sweetser's estimate of consumption in the city of Boston.—Dr. EHiotson's statement concerning Europe.—Dr. Emerson's estimate in the American cities.—Mortal- ity among the English troops stationed in different parte of the ^orld.—Conclusions drawn from the foregoing facts. In order that some definite idea may be gained re- specting the fearfulness of the disease under consider- ation, I will present the reader with some items of statistical information, which, however, it must be ad- mitted are always to a greater or less degree inaccu- rate, and not from any want of honesty in those who make such reports, but from the great difficulties which always necessarily belong to calculations of the kind. Still, such calculations are sufficiently ac- curate to enable us to arrive at an approximation of the truth. According to the New York City Inspector's An- nual Report of 1848, the deaths during the year pre- vious were as follows: 36 CONSUMPTION. Whole number of deaths,.....................15,788 Of children under 5 years of age,.............. 7,373 " " between 5 and 10 years of age,..... 571 Of those between 10 and 20 " " ----, e46 « it » 20 "30 " " ---- 1>947 tt it n 30 »40 " " ____ 1,833 it ti tt 40 "50 " " ____ 1,279 u u n 50 " 60 " " ____ 746 « u n 60 "70 " " ____ 580 « « »t 70 "80 " " ____ 389 « " " 80 " 90 " " ____ 153 » " " 90 " 100 " " ____ 35 Above 100 " '* ____ 3 The principal diseases of the mortality of this year, and the number of deaths from each, are stated as below : Typhus and typhoid fever,.....................1,396 Apoplexy,................................... 446 Cholera infantum,............................ 692 Convulsions,.................................1,023 Debility,.................................... 515 Dropsy of the head,........................... 559 Croup,...................................... 274 Erysipelas,.................................. 162 Measles,.................................... 275 Scarlet fever,................................ 142 Old age,..................................... 180 Delirium tremens,............................ 137 Small pox,................................... 53 Whooping cough,............................. 86 Cholera morbus,.............................. 44 Inflammation of the lungs,..................... iaj*, Consumption,................................ 1 926 Thus we see, according tc this Report, thart of the diseases of this metropolis, much the largest number ITS MORTALITY. 37 of deaths occurred from consumption. And if we deduct the number of deaths that occurred in persons under twenty years of age, before which death very seldom occurs from this disease, and at the same time bear in mind the fact that probably a considerable number of those reported as dying from " debility," actually died from pulmonary consumption, we are led to the conclusion, that of all adults dying in the city of New York, more than one fourth is from this dire disease. It must, however, be admitted that medical reports, as made at the present day, are, in the aggregate, always, to a greater or less extent, in- correct. But we may safely infer from those of the city of New York, that, year by year, when no great epidemic, like the cholera, prevails, about one fourth of all deaths occurring after puberty are from pul- monary consumption. The ratio of deaths by consumption in the city of New York during this year (1848), in proportion to the whole number of deaths, is a little less than one in eight, a result somewhat different from what has been arrived at in the statistics of other cities of the Union, and of the same city in other years. According to Dr. Sydenham, two thirds of those who died of chronic disease in Great Britain, fell vic- tims to consumption. The estimates of Drs. Heber- den, Young, and Woolcombe show us that an ave- rage of about one in four of the deaths which happen in Great Britain are from this disease. It is said to be a curious fact, that in Bristol, Eng- land, there is the greatest relative amount of mor- tality from consumption, and among its native inhab- 38 CONSUMPTION. itants, too, of any place yet compared with it; al- though this town is in the southern part of the coun- try, and is a great and popular resort for consump- tive patients from other parts. This fact does not, certainly, speak very well for the judgment of those who send them thither. " Laennec states," says Dr. Sweetser, "that in Paris, and the great cities in the interior of France, the proportion of deaths from consumption is well known to be one in four or five." In the city of Boston, according to Dr. Sweetser, " the average number of deaths by consumption, as compared with other diseases, may be about one in four or five. In New York, the proportion will vary but little from this. In Philadelphia, it may be about one in five." Dr. Elliotson quotes Dr. Thomas Young (author of a Practical and Historical Treatise on Consump- tive Diseases, whom the former regards as good authority, he having referred to every work written on the subject previously to his own), as asserting that one fourth of the inhabitants of Europe die oi consumption. Dr. Emerson, of Philadelphia, states the relative number of deaths by consumption in the larger cities of the United States as being, in proportion to the whole mortality, as follows : In New York,............................. 1 in 5.23 " Boston,................................. i ti 5.54 " Baltimore,.............................. 1 u q^I *' Philadelphia,...........,................ 1 tt 6.38 ITS MORTALITY. 39 The number of deaths, in proportion to the whole population, in the different cities, according to this author's estimate, are: In New York............................. 1 in 39.36 " Baltimore,.............................. 1 " 39.17' " Boston,...............................1 " 44.93 " Philadelphia,.......................■.....1 " 47.86 A table, showing the proportion of deaths from all diseases, and also from consumption among English troops as stationed at different parts of the world, has been given by Dr. Clark, from which the following is an abstract. The basis of reckoning is one thousand men. The numbers show the proportion of deaths from all diseases, and how many from consumption per thousand in one year : Where stationed. AH diseases. Consumpt East Indies and New South Wales,......... 57.5 1.1 Cape of Good Hope,...................... 14.5 1.6 Western Coast of Africa,.............:____144.5 1.7 Mauritius,.............................. 28.2 3.2 West Indies (Europeans),................. 80.3 4.9 West Indies (Negroes),................... 26.6 13.7 Bermudas,.............................. 12.4 2.3 Canadas and Nova Scotia,................. 12.2 3.4 Malta.................................. 14.7 2.6 Gibraltar,............................... 13.1 2.4 Ionian Islands,........................... 26.6 2.1 Malta, Portugal, Gibraltar, and Ionian Islands,. 24.2 1.6 City of London, 1820 to 1830,............. 19 6.2 From this table it appears that the average of about one in ten of deaths of English troops is from consump- tion. It is however, to be remembered hat military 40 CONSUMPTION. men are chosen from among the most healthy and hardy of the inhabitants, and that, too, from males, who are on the whole least subject to this disease. We have no registry of deaths in this country, ajs in Great Britain, except in the larger cities. It is, therefore, impossible for us to tell whether con- sumption is moie prevalent, according to the whole number of deaths, in the city or country. Probably, there is more of it in proportion to the number of inhabitants in the former than in the latter. From the foregoing facts, it appears that in the most enlightened parts of the world, from one fourth to one eighth of all deaths are caused by that greatest bane of human life, tubercular consumption. It is a most insidious malady, coming upon us like a thief in the night, so stealthily, indeed, that in most instances, neither the patient nor his friends, and often not even his physician, are aware of the true nature of the case, until it is absolutely too late to attempt any thing more than mere palliation of the disease. ANATOMY DF THE LUNGS. 41 CHAPTER VI. Anatomical description of the chest and lungs.—The thorax, or chest. —The lungs.—Their situation, color, divisions, size, number of lobes.—Blood-vessels of the lungs.—Their structure and cover- ing.—The bronchial tubes.—The pulmonary artery.—The brachial arteries.—The lymphatics.—The nerves of the lungs.—The pleurae. —The mediastinum.—Professor Sweetser's ingenious description of the lungs. Having given a general view of some of the leading features of pulmonary consumption, I now proceed to describe the anatomy and physiology of the parts more immediately concerned. This will aid in giv- ing a clearer idea of the true nature of the disease, its causes and symptoms, and of the most suitable means for its prevention and cure. The thorax, or chest.—The thorax, or chest, is that cavity situated at the upper part of the trunk of the body. It is conical in its shape, with its base below, and apex above. It is bounded as follows : in front by the sternum or breast bone, the sixth superior costal cartilages, the ribs, and intercostal muscles ; on the sides by the ribs and intercostal muscles; and be- hind by the same structure, and by the spinal column, as low down as the upper border of the last rib. Above, it is bounded by the thoracic fasciae, or cov- erings, and the first ribs, and below by the diaphragm. This latter, which may be termed the floor of the chest, does not lie either horizontally or flat, as may be seen by cut No. 2, but rises into the cavity of the 42 consumption. chest, presenting a considerable convexity above, and a corresponding concavity below. This is its position in a relaxed state; but when it contracts, it becomes partially flattened, so that the space above it is increased. In the diaphragm, there are apertures through which the oesophagus, larger blood-vessels, and certain nerves pass. No. 1, View of the Ch»st. B, b, the breast bone. R, R, the ribs. C, C, cartilages connecting the ribs with the breast bone. C, b, the collar bone. S S. •**, ■pine. S, b, the shoulder blade. RESPIRATION 43 No. 2. Sections of the Chest and Abdomen, Showing more particularly the diaphragm. D, D, diaphragm. M, M, M, muscles of the abdomen. In the first view, the diaphragm appears as in its relaxed condition; in the second, in its contracted state. As this is drawn inward, at the same time expanding the chest, the diaphragm descends. When the air is forced outward, the diaphragm ascends. ' The mechanism of respiration is beautifully illus- trated by Dr. Griscom, of this city (New York), in his most valuable and instructive tracts for the people, entitled, "Uses and Abuses of Air," works which should be in the possession of every family in the land.* Figure No. 4, page 45, represents the model by which the illustration is made. * The Uses and Abuses of air: showing its influence in sustaining life, and producing disease ; with remarks on the ventilation of houses, and the best methods of securing a pure and wholesome atmosphere inside of dwellings, churches, court rooms, workshops, and building! of all kinds. J. S. Redfield, New York. 44 consumption. No. 3. Front view of the chest and diaphragm ; the latter relaxed. The front half of the ribs being cut away, the interior of the chest is ex- posed. C, c, C, c, represent the cavity of the chest empty. D, D, D, D, the diaphragm, rising high in the centre, and descending very low at the sides and behind. The white space/ at its upper part, is its tendinous portion. A, A, the abdomen. Anatomical description of the lungs, and other* parts within the chest.—The trunk of the human body, which contains all its great and more im- portant organs, except the brain, may be compared to a house two stories high. In the lower story, there are the stomach, liver, spleen, pancreas, bowels, kidneys, bladder, womb, etc. In the upper story, there are the lungs, or lights, heart, and large blood- vessels. The partition, or diaphragm, between these, or the floor, as we may say, of the upper story, as we have seen, crosses at the lower ribs. I cannot RESPIRATION. 45 No. 4. C, C, hg. <*, is a bell-shaped glass, to represent the chest. In the mouth of the glass is inserted, very tightly, a cork, T, representing the trachea, having a hole lengthwise through it. To the lower end of the cork is attached a small bladder, L, representing a lung. The lower opening of the bell is closed by a piece of sheet gum elastic, D, which fits air-tight. This answers for the diaphragm. No communication can exist between the cavity of the bell and the oxternal air, except through the hole in the cork ; and any air entering through that hole can only go into the bladder. It is evident, also, that when the diaphragm is pushed into the cavity of the glass, as at D, the bladder will be flaccid and void of air; but when the dia- phragm is drawn down in the situation of the dotted curve, a partial vacuum in the glass will be the consequence, which can only be sup- plied with air through the cork, whereby the bladder will expand to its full extent, shown by the dotted circle; and when the diaphragm is pushed up again, the air will be forced out from the bladder. do better in giving my readers a description of the contents of the chest, than to quote the words of Dr. Erasmus Wilson, a very succinct and accurate wri- ter on anatomy. " The lungs are two conical organs, situated one on 46 consumption. each side of the chest, embracing the heart, and sepa- rated from each other by a membranous partition, the mediastinum. On the external or thoracic side they are convex, and correspond with the form of the cavity ot the chest; internally they are concave, to receive the convexity of the heart. Superiorly they terminate in a tapering cone, which extends above the level of the first rib, and inferiorly they are broad and concave, and rest upon the convex surface of the dia- phragm. Their posterior border is round and broad, the anterior sharp, and marked by one or two deep fissures, and the interior, which surrounds the base, is also sharp. " The color of the lungs is pinkish gray, mottled, and variously marked with black. The surface is figured with irregular polygonal outlines, which repre- sent the lobules of the organ, and the area of each of these polygonal spaces is crossed by lighter lines. "Each lung is divided into two lobes by a long and deep fissure, which extends from the posterior surface of the upper part of the organ, downward and forward, to near the anterior angle of its base. " In the right lung, the upper lobe is subdivided by a second fissure, which extends obliquely forward from the middle of the preceding to the anterior border of the organ, and marks off a small triangular lobe. " The right lung is larger than the left, in conse- quence of the inclination of the heart to the left side. It is also shorter, from the great convexity of the liver, which presses the diaphragm upward upon the right side of the chest, considerably above the level of the left. It has three lobes. THE HEART AND LUNGS. » No. 5. View of the Heart and Lungs. 1. The right ventricle ; the vessels to the right of the figure are the middle coronary artery and veins ; and those to its left, the anterior coronary artery and veins. 2. The left ventricle. 3. The right auricle. 4. The left auricle. 5. The pulmonary artery. 6. Tha right pulmonary artery. 7. The left pulmonary artery. 8. The re- mains of the ductus arteriosus. 9. The arch of the aorta. 10. The superior vena cava. 11. The right arteria innominata, and in front of it, the vena innominata. 12. The right subclavian vein, and behind it, its corresponding artery. 13. The right common carotid artery and vein. 14. The left vena innominata. 15. The left carotid artery and vein. 16. The left subclavian vein and artery. 17. The trachea. 18. The right bronchus. 19. The left bronchus. 20, 20. The pul- monary veins; 18,20, form the root of the right lung ; and 7,19,20, the root of the left. 21. The superior lobe of the right lung. 22. Its middle lobe. 23. Its interior lobe. 24. The superior lobe of the left lung. 25. Its inferior lobe. "The left lung is smaller, has but two lobes, but is longer than the right. 2337�5 48 CONriUMP. iON. " Each lung is retained in its place by its roots, which is formed by the pulmonary artery, pulmonary veins, and bronchial tubes, together with the bronchial ves- sels and pulmonary plexuses of nerves. The large vessels of the root of each lung are arranged in a similar order from before, backward, on both sides, viz., Pulmonary veins, Pulmonary artery, Bronchus. "From above downward, on the right side, this order is exactly reversed; but on the left side the bronchus has to stoop beneath the arch of the aorta, which alters its position in the vessels. They are thus disposed on the two sides : Right. Left Bronchus, Artery, Artery, ---- Bronchus, Veins. Veins. " Structure of the lungs.-—The lungs are composed of the ramifications of the bronchial tubes which ter. minate in bronchial cells (air cells), of the ramifica- tions of the pulmonary artery and veins, bronchial arteries and veins, lymphatics, and nerves, the whole of these structures being held together by cellular tis- sue, which constitutes the parenchyma. The paren- chyma of the lungs, when examined on the surface or by means of a section, is seen to consist of small poly- gonal divisions, or lobules, which are connected to each other by an interlobular cellular tissue. These lobules again consist of smaller lobules, and the latter are formed by a cluster of air cells, in the parietes of which the capillaries of the pulmonary artery and pul- THE LUNGS. 49 No. 6. Relative Position of the Lungs in the Bodt. The letters R L and L L mark the right and left lungs, with the heart H lying between them, but chiefly on the left side. V is not a very accurate representation of the large blood-vessels going to the head, neck, and superior extremities. Liv. is the liver, lying in the abdomen, or belly, and separated from the chest by the arched fleshy partition, D D, called the diajkhragm, or midriff. The stomach ap- pears on the other side, marked Stm., but both it and the liver are re- moved a little from their natural situation. G is the gall-bladder. I I I are the various parts of the intestinal canal, through "which the food is passed on its way from the stomach, by means of what is called the peristaltic or vermicular motion of the bowels, one circle of fibres narrowing after another, so as to propel its contents slowly but steadily, and resembling in some degree, the condition of a worm. 3 50 CONSUMPTION. monary veins are distributed. * * * The walls of the air cells are so imperfect, that all L'»e cells of any lobule communicate freely with others, while the contagious lobules are separated by the parenchyma. Dr» Horner's dissections exhibit this in a beautiful manner. See Horner's Special Anatomy, 3d edi- tion.—G. " The Bronchial tubes.—The two bronchi proceed from the bifurcation of the trachea to their corre- sponding lungs. The right takes its course nearly at right angle with the trachea, and enters the upper part of the right lung, while the left, longer and smaller than the right, passes obliquely beneath the arch of the aorta, and enters the lung at about the middle of its root. Upon entering the lungs they divide into two branches, and each of these divides and subdivides dichotomously to their ultimate termination in small dilated sacs, the bronchial or pulmonary cells. " The fibro-cartilaginous rings which are observed in the trachea become incomplete and irregular in shape in the bronchi, and in the smaller bronchial tubes are lost altogether At the termination of these tubes the fibrous and muscular coats become extremely thin, and are probably continued upon the lining mu- cous membrane of the air cells. " The pulmonary artery, conveying the dark and impure venous blood to the lungs, terminates in capil- lary vessels, which form a minute network upon the parietes of the bronchial cells, and then converge to form the pulmonary veins, by which the arterial blood, purified by its passage through me capillaries, is re- turned to the left auricle of the heart. THE LUNGS. 51 No. 7. The letter a represents the trachea or wind pipe; b, its bifurcation or division into the two bronchial tubes ; e, e, e, the minute ramifica- tion of the bronchi; and c, c, e, the right lung with its three lobes, the loft having but two, to give room for the heart. " The Bronchial arteries, branches of the thoracic aorta, ramify upon the bronchial tubes and in the tis- sue of the lungs, and supply them with nutrition, while the venous blood is returned by the bronchial veins to the vena azygos. " The Lymphatics, commencing upon the surface and in the substance of the lungs, terminate in the bronchial glands. These glands, very numerous, and 52 CONSUMPTION. often of large size, are placed at the roots of the lungs, around the bronchi, and at the bifurcation of the trachea. In early life they resemble lymphatic glands in other situations; but in old age, and often in the adult, they are quite black, and filled with carbonace- ous matter, and occasionally with calcareous deposits. " The Nerves are derived from the pneumogastric and sympathetic. They form two plexuses—the an- terior pulmonary plexus, situated upon the front of the root of the lungs, and composed chiefly of filaments from the great cardiac plexus; and posterior pulmo- nary plexus, on the posterior aspect of the root of the lungs, composed principally of branches from the pneumogastric. The branches from these plexuses follow the course of the bronchial tubes, and are dis- tributed to the bronchial cells. " Pleurae.—Each lung is inclosed, and its structure maintained, by a serous membrane—the pleura, which invests it as far as the root, and is thence reflected upon the parietes of the chest. That portion of the mem- brane which is in relation with the lung is called pleura pulmonalis, and that in contact with the pari- etes pleura costalis. The reflected portion, besides forming the internal lining to the ribs and intercostal muscles, also covers the diaphragm and the thoracic surface of the vessels at the root of the neck. "The pleura must be dissected from off the root of the lung, to see the vessels by which it is formed and the pulmonary plexuses. "Mediastinum.—The approximation of the two re- flected pleurae in the middle line of the thorax forms a septum which divides the chest into the two pulmo- THE MEDIASTINUM. 53 nary cavities. This is the mediastinum. The two pleurae are not, however, in contact with each other at the middle line in the formation of the mediastinum, but leave a space between them, which contains all the viscera of the chest, with the exception of the lungs. The mediastinum is divided into the anterior, middle, and posterior. " The Anterior Mediastinum is a triangular space, bounded in front by the sternum, and on each side by the pleura. It contains a quantity of loose cellular tissue, in which are found some lymphatic glands and vessels passing upward from the liver, the remains of the thymus gland, the origin of the sterno-hyoid, ster- no-thyroid, and triangularis sterni-muscles, and the internal mammary vessels of the left side. " The Middle Mediastinum contains the heart, in- closed in its pericardium, the ascending aorta, the superior vena cava, the bifurcation of the trachea, the pulmonary arteries, veins, and the phrenic nerves. " The Posterior Mediastinum is bounded behind by the vertebral column, in front by the pericardium, and on each side by the pleura. It contains the descend- ing aorta, the greater and .lesser azygos veins, and superior intercostal vein, the thoracic duct; +,he oeso- phagus and pneumogastric nerves, and tne great splanchnic nerves." A very able and lucid writer, Professor Sweetser, of this city, ingeniously describes the lungs as being reared up in the following manner: " An elastic air-tube, called the trachea or wind- pipe, opens into the superior portion of the throat-— and consequently communicates with the mouth and 54 CONSUMPTION. posterior part of the nostrils—by a curious mechan- ism, in which the voice is mostly formed, called the larynx. This tube passes down the neck, enters the chest and then forks into two divisions, called bronchia or bronchi, from a Greek word meaning the throat, one going to each lung. They then subdivide, and go on ramifying again and again, becoming smaller and smaller, and less and less elastic, until they ultimately terminate in the minute vesicles or air-cells, to which I have before alluded. These air-cells, with the air- tubes conducting to them, may be viewed as the framework of the lungs, and constitute the greater proportion of their substance. The cells, too, always contain more or less air; it is to them that these or- gans owe their light and spongy character. " The union of these little vesicles is effected through the medium of a fine membrane, denominated cellular, which, though so abundant in many other structures of the body, is here very small in quantity. Every where upon these cells, minute vessels are ramifying, to carry to them blood to be acted upon by the vital air they are continually receiving, and to convey it back again in its course to the heart, after having un- dergone its mysterious aerial change. " It appears to have been a grand principle of na- ture, in building up the beautiful and important organs of respiration, to provide that the greatest possible quantity of blood should be brought under the influ- ence of the greatest possible amount of air. The number of the air-cells exceed all accurate calcula- tion. They have been estimated in man at between one and two millions, and as presenting a surface of BIK3PIBATI0N. r»5 fifteen hundred square feet. They exercise, too, as may readily be conceived, the most important agency in the breathing function, since it is during the pas- sage of the blood over their delicate coats that the essential vital influence is wrought upon this fluid." M CONSUMPTION. CHAPTER VI. Phenomena of respiration further considered.—Its genera principle explained.—Operation of the diaphragm.—The lungs and air-tubes are comparatively passive agents.—The lungs act like a pair of common bellows.—Great extent of surface in the air-cells of the lungs.—The exceeding great delicateness of this part.—The lungs are always nearly filled with air.—An important practical point.— Atmosphere within the lungs is changed gradually.—Males inhale much more than females.—Probable amount of air inhaled in twenty-four hours.—Great importance of the function of respiration. Having spoken of the anatomical structure of the lungs and the adjacent parts, we are prepared to con- sider, in the next place, the physiology of respiration, and its effects on life. The general principle of the operation of respiration is this: " The lungs are suspended in a cavity that is completely closed, being bounded above and around by the bony framework of the chest, the interspaces of which are filled up by the muscles and membranes, and being entirely cut off from the abdomen below by the diaphragm. Under ordinary circumstances, the lungs completely fill the cavity, their external surface, covered by the pleura, being every where in contact with the pleural lining of the chest. But the capacity of the thoracic cavity is susceptible of being greatly altered by the movements of the ribs, and by the ac- RESPIRATION. 57 tions of the diaphragm and abdominal muscles. When it is diminished, the lungs are compressed, and a por- tion of the air contained in them is expelled through the trachea. On the other hand, when it is increased, the elasticity of the air within the lungs causes them immediately to dilate so as to fill the vacuum that would otherwise exist in the thoracic cavity; and a rush of air takes place down the air-tubes and into the remotest air-cells, to equalize the density of the air they include (which has been rarefied by the dilatation of the containing cavities) with that of the surround- ing atmosphere." But the diaphragm performs the most important part in the act of inspiration. " The contraction of this muscle (see the anatomical description) changes its upper surface from the high arch that it forms, when relaxed and pushed upward by the viscera (such as the stomach, liver, spleen, bowels, etc.), to a much more level state, though it never approaches very closely to a plane, being somewhat convex even when the fullest inspiration has been taken. When thus drawn down, it presses upon the abdominal viscera, and causes them to project forward, which they are allowed to do by the relaxation of the abdominal mus- cles. In tranquil breathing, this action is alone nearly sufficient to produce the requisite enlargement of the thoracic cavity, the position of the ribs being very little altered. In the expiratory movement, the dia- phragm is altogether passive; for being in a state of relaxation it is forced upward by the abdominal viscera, which are pressed inward by the contraction of the abdominal muscles. These last, therefore, are the 3* 58 CONSUMPTION. main instruments of the expiratory movement, dimin- ishing the cavity of the chest by lifting its floor at the same time they draw its bony framework into a nar- rower compass." The lungs, and air-tubes conducting to them, are almost entirely passive instruments in the function of respiration. True, the contraction of the lungs when over-distended, and their dilation after extreme press- ure, may be partly due to the elasticity of their struc- ture. A moderately distended state of the lungs is that condition which seems most natural. But the fullest expansion, and the most complete contraction Df which they are capable, are accomplished only by a voluntary or forcible effort. The operation of the lungs in respiration may be compared to the action of the common bellows. When the sides of the chest are separated, and the diaphragm depressed, a vacuum takes place within this thoracic cavity, and by the pressure of the at- mosphere from without, the air is made to rush through the bronchial tubes into the innumerable cavities or air-cells of the lungs. This alternate expansion and contraction of the chest and lungs go on incessantly, whether we sleep or whether we are awake, from the first moment of our existence to the very last. The lungs are not simple hollow organs, like many others of the human body, but are composed of a sponge-like mass of cellular tissue. The trachea, or wind-pipe, as it enters the chest, is divided, as we have seen, into two branches, called bronchia?. These pass one to each lung, and as they advance are divided and subdivided to an unlimited and inconceivable ex- STRUCTURE OF THE LUNGS. 59 tent, terminating in the myriads of air-cells, somewhat in the same manner as the twigs of the trees termi- nate in leaves. It has been calculated that the num- ber of air-cells, grouped around the extremity of each tube, is little less than 18,000, and that the total num- ber in the lungs amount to six hundred millions. Ac- cording to this estimate, and even admitting that it is much above the truth, it is evident that the amount of surface exposed to the atmosphere by the walls of these minute air-cells, must be many times greater than that of the exterior of the body. When we look at facts of this kind—facts, too, which cannot be at all adequately estimated or comprehended by the finite mind—we have an evidence truly, that man is most fearfully and wonderfully made. The delicateness of the internal surface of the lungs will appear evident, when we consider their lightness or trifling weight. Notwithstanding this great amount of surface, thirty times that of the whole surface of the body, as some have reckoned, the lungs, in the largest individuals, weigh at most, only a few pounds. The lining membrane is so delicately and finely con- structed, that it readily allows of the transmission of air through it, while the blood is retained in the ap- propriate vessels for that purpose. The lungs also contain a large quantity of air. Their external surface is at all times in contact with the internal surface of the chest. The chest is formed, in a great measure, of unyielding bones and ligaments; so that it cannot change much in size after it is fully formed. Consequently, from the pressure of the at- mosphere from without, the lungs must contain at all 60 CONSUMPTION. times a considerable portion of atmospheric air- enough, in short, to fill the vacuum which would oth- erwise be formed. It is interesting here to observe an important practical point in the function of respiration. It is easy, by well-regulated exercise, to educate the voluntary muscles of the system to almost any desira- ble extent. Such exercise, properly conducted, and persevered in for a sufficient length of time, must ne- cessarily result in a greater development, size, and strength of whatever muscle is thus exercised. We know that a blacksmith strengthens his arm by the proper use of the part. The muscles of the lower ex- tremities of sedentary persons, are very readily made larger and firmer by properly conducted pedestrian exercises. So, too, that important part of the system, the chest, one upon the development of which health so much depends, can be enlarged and invigorated to a truly wonderful extent. The atmosphere contained within the lungs is never changed suddenly, as some might suppose. The lungs never empty themselves at any one time. A small portion only, comparatively, is received at each in- spiration, and at each expiration a corresponding por- tion is thrown off. An ordinary inspiration is reck- oned at from one to two pints, while the average capacity of the lungs, when the chest is fully expanded, is estimated at about twelve pints. There would thus be left in the lungs, after an ordinary expiration, the remaining ten or eleven pints of air, which serve to keep the air-cells continually distended. Public sing- ers and speakers, and such as habitually use their lungs to a greater than ordinary degree, especially if RESPIRATION. 6] this be practiced in the open air, it is ascertained may take in at a single inspiration from five to seven pints at a time. By this wonderful power of adaptation, which these delicate structures possess, some very in- teresting and remarkable effects in vocal and instru- mental music may be performed. There appears to be a great difference between the capacity of the lungs for air, between males and fe- males. Thus Mr. Thackrah (as quoted by Dr. Combe) mentions that men can exhale, at one effort, from six to ten pints of air; whereas, in women the average is only from two to four pints. In ten fe- males, about eighteen and-a-half years of age, belong- ing to a flax-mill, and who were laboring under no disease, Mr. Thackrah found the average to be only three and one-half pints, while in young men of the same age, it amounted to six pints. Thus it appears that physiologists vary in their es- timates as to the amount of air inhaled and exhaled at each respiration. It is difficult to arrive at the ex- act truth in matters of this kind, nor is this strictly necessary for practical purposes. At the rate of from one to two pints at each inspi- ration, an almost incredible amount of air is received into the lungs every twenty-four hours. The average number of respirations is about eighteen per minute. Consequently, the number for one hour is one thou- sand and eighty; in twenty-four hours, twenty-five thousand nine hundred and twenty. Allowing eigh- teen pints of air—the lowest estimate—to be inhaled every minute, there would be upward of fifty hogs- heads inhaled each twenty-four hours. The largeness 62 CONSUMPTION. of this amount must serve to impress every one with the importance of paying particular attention to the quality of this life-giving fluid, which is daily and hourly received into these delicate structures of the system, and on the proper state of which life and health so much depend. Must it not be always an important consideration whether this air be pure or impure ? in other words, whether good or bad? We may subsist for days, and even weeks, without food and drink, but if respiration be cut short for three minutes only, death is the inevi- table result. CIRCULATION OF RLOOD 03 CHAPTER VII. Circulation of the blood.—The blood of two kinds.—The heart, arte- ries, and veins.—Action of the heart described.—The two rounds of circulation.—The arterial blood and the venous.—The never- ceasing action of the heart.—Amount of blood passing through the heart, and to the lungs, per hour.—Amount of air necessary to pu- rify it.—Practical deductions from the foregoing facts. The nature and importance of the function of respi- ration will become still more apparent by considering, in this connection, the circulation of the blood. The blood, which circulates every where throughout the living body, is of two kinds: the one dark, impure, venous blood; the other red, pure, or arterialized blood. The latter, alone, is capable of supporting life. The heart—with its accompaniments, the arteries and veins—is the great organ by which the circulation of the blood is effected. It is a muscular organ, hav- ing somewhat the shape of an inverted cone, lying in the lower part of the thoracic cavity, between the two folds of the pleura, which form the central partition of the chest. (See cut No. 8.) It lies partly on the middle line, and partly on the left side of the chest. Strictly speaking, it is a-double organ, with two cor- responding halves. Each half is also divided into an upper and lower cavity, the upper being called auri- cles, and the lower ventricles. The right auricle re- ceives the dark blood coming in the veins from all 64 COIW-U'MPT.ON. No. 8. The Heart. a, the left ventricle; b, the right ventricle: c, e,f, the aorta, the great artery that goes off from the left ventricle; g, k, i, the arteries that are sent from the arch of the aorta; h, the pulmonary artery, that goes from the right ventricle to the lungs ; I, I, branches of the pulmonary artery, going to the two sides of the lungs; m, m, the pul- monary veins, which bring the blood back from the lungs to the left side of the heart; n, the right auricle ; o, the ascending vena cava; q, the descending; these two meet, and by their union form the right auricle; p, the veins from the liver, spleen, and bowels; s, the left coronary artery, one of the arteries which nourish the heart. parts 01 the body. From this it is sent through a valve into the right ventricle; from the right ventricle the blood is sent through a vessel which divides itself into two branches, one of which goes to each lung. These are called pulmonary arteries, although they THE CIRCULATION. 65 No. 9. Relative Position and Mode of Communica- tion BETWEEN THE CAVITIES OP THE HEART. Two large veins, V, V—one descending from the head and up- per extremities, the other ascending from the lower extremities, abdomen, and other parts—receive all the impure blood from the body, and unite together near the right auricle (R, A). They pour their joint currents into that chamber, and distend it. When filled, it contracts upon its contents, and forces tho fluid into the right ventricle (R, V). This, when filled, contracts, and drives the blood into the pulmonary artery (P. a), which carries it all to the two lungs, dividing it between them, through appropriate branches, and distrib- uting it, iu minute particles, over the.surface of the pulmonary air. cells. Its color is yet of a dark purple; but immediately, as it is dis- tributed through the lungs, and is acted upon by the air in the cells, its color changes, and becomes a bright vermilion, or scarlet. This change having been effected, it is again collected from the lungs by means of another set of blood-vessels, called pulmonary veins (P, v.) which convey it away from the lungs, and carry it back to the heart, where, the vessels from each lung uniting, it is emptied into the left auricle (L, A). From this it is thrown into the left ventricle (L, V). From this cavity arises the main artery of the body, the aorta (A) ; and through this great tube the purified blood is sent, to be distri- buted all over the body, visiting every fibre and atom for their sus- tenance and growth. 66 CONSUMPTION. carry dark or venous blood. " In the innumerable branches of this artery, expanding themselves through- out the substance of the lungs, the dark blood is sub- jected to the contact of the air inhaled in breathing; and a change in the composition, both of the blood and the inhaled air, takes place, in consequence of which the former is found to have reassumed its florid or arterial hue, and to have regained its power of sup- porting life." The blood then enters the myriads of minute venous ramifications, which gradually coalesce into larger branches, and at last terminate in four large trunks, two from each lung, and empty them- selves into the left auricle, from which the blood is thrown into the left ventricle, and from this through the great aorta, which divides itself again into myri- ads of arteries, greater and smaller, through which the purified or arterial blood is distributed to every part of the body, however minute. Thus, it will be seen, there are in the living body two distinct circulations, each carried on by its own system of vessels. First, the impure blood comes from every part of the body to the right side of the heart. It is sent thence to the lungs to be purified. It returns to the left side of the heart, and is sent from thence throughout the whole body for the mainte- nance of life. Neither the crude blood, which is formed from the food in the living laboratory, nor the dark ve- nous blood, can afford any nourishment to the living body until having been subjected to the purifying in- fluence of the atmosphere in the lungs. Venous blood in the aiteries is indeed positively poisonous. The heart, as every one knows, acts by pulsations. It is CIRCULATION AND RESPIRATION. 67 composed of an involuntary muscle, as we say. It goes on both by night and by day, both when we sleep and when we wake, throughout our whole life. It is an organ over which we have no direct or volun- tary control. It is a beautiful phenomenon of nature that the pul- sations of the heart, and the movements of the chest and lungs, harmonize with each other, or have a rela- tion which in health is always maintained. The of- fice of respiration is to induce a constant supply of pure air into the lungs, by which the blood becomes arterialized or purified. There is an average of four pulsations of the heart to one respiration. The average number of respirations is about eighteen per minute. In infancy it is more, about twenty-five per minute. In old age it is less, about sixteen per minute ; but at whatever age, the relation between the respirations of the lungs, and the pulsations of the heart, remain the same. When there are seventy-two pulsations of the heart per minute, as may be ascertained by the pulse at the wrist, there are one fourth as many respirations, namely, eighteen in the same period of time. The amount of blood sent to the lungs at each pul- sation of the heart, in an adult individual of average weight, may be reckoned at about two ounces. Ac- cording to this estimate, then, more than twenty-five hogsheads of blood are sent through the heart, and to the lungs, every day of the individual's life, and to purify this blood, more than twice the amount of air must be inhaled ! When, therefore, we consider the important rela- 68 CONSUMPTION. tions that exist between respiration and circulation, and the most intimate dependence of life at all times on these functions, numerous practical inferences are suggested to the mind. Thus it will be apparent, that the quality of the air breathed must be ever an im- portant consideration in regard to health. So, too, the quality of the blood which is to be changed con- stantly by the wonderful, nay, mysterious, action of the air upon it! What food shall we eat ? What air shall we breathe ? What exercise, mental and phys- ical, shall we take? These are important questions, and such as concern every individual, in proportion as health is the best of all earthly gifts. These con- siderations will be entered into more in detail in another part of the work. 69 TUBERCLES. CHAPTER VIII. Tubercles, the foundation of true pulmonary consumption.—Meaning of the word tubercle.—Character of tubercles.—Tuberculous de- posits may occur in nearly every part of the body.—Tables showing their relative frequency in the different organs and parts.—Dr. Good's remarks on the subject.—Tubercles may probably remain many years in the system without endangering life.—They ordi- narily increase in number and size, and have a greater tendency to inflame and maturate as years advance.—Process of matura- tion.—Can tuberculous disease be cured ?—Opinions of various authors on the subject.—Animals often have tubercles.—How caused.—The milch cows of Paris.—Practical inferences from the foregoing facts. Tubercle being considered the foundation or germ of true consumption, this abnormal structure or condition of the living parts will now be considered. The word tubercle is derived from the Latin term, tuberculum, which signifies an excrescence, tumor, or swelling of some part of the living body. In patholo- gical anatomy, the term is applied to a diseased pro- duct, or species of degeneration, which is composed of " an opaque matter, of a pale yellow color," resembling cheese in its color and consistence. They vary much in size, from that of a pin-head up to the size of an orange. When, however, they have become large, it is supposed that many must have coalesced or come too-ether. They are probably always small at first, but as they grow larger, many become amalgamated into one. They are at first, perhaps, always more 70 CONSUMPTION. grayish and semi-transparent than opaque and yellow. It is when they have increased in size and number, and when many have grown into one, that they take on this latter character. " When tubercles are few," says Dr. Elliotson, " they seldom exceed the size of an almond each, but the masses produced by their aggregation, may be very large." The whole of a lobe of the lung may become converted into a solid tubercular mass, and it is said, indeed, that a whole lung has, in certain cases, become thus affected. Tubercles may occur in almost any part of the body. Indeed no part, with the exception of the bones and the external skin, may be said to be wholly exempt from a liability to them. According to a table quoted by Sir James Clark, the result of fifty careful post-mortem examinations of children, made with the view of determining the relative frequency of tubercles in different organs, was a# follows: Bronchial glands (glands of the wind-pipe),___49 times. Lungs....................................38 " Cervical glands (glands of the neck),..........26 " Mesenteric glands (in the abdomen),.........25 " Spleen,................................... 20 " Pleura (lining membrane of the chest),........17 «« Liver,................................... 14 u Small intestines,...........................12 » Peritoneum (surrounding membrane of the in- testines),............................. 9 " Large intestines,........................_ Q <• Brain,.................................... 5 tt Cerebellum,.............................. 3 u Membranes of the brain,.................... 3 « TUBERCLES. 71 Pericardium (covering membrane of the heart), 0 times. Kidneys,................................. 2 " Stomach,................................. 1 " Pancreas,................................. 1 " Vortebrae, radius, tibia (bones of the spine, fore- arm, and leg),......................... 1 " A table of Louis, showing the relative frequency of tubercles in the different organs, referring to persons above the age of fifteen who died of consumption, is is follows : Tubercles in the small intestines,. " " large,. mesenteric glands,. cervical,......... lumber glands,___ spleen,.......... prostate,......... ovaries,.......... kidneys,......... case in 3 9 « 4 » 10 » 12 " 14 » 13 » 20 " 40 These persons having all died of consumptions, had, of course, tubercles in the lungs, as well as in the other organs mentioned. Dr. Good gives similar testimony to the above in regard to tubercles. He observes : " There is not an organ of the body but is capable, as well in its substance as its parenchyma (covering), of producing tubercles of some kind or other ; and occasionally of almost every kind at the same time; for Bonet, Boerhaave and De Haen, as well as innumerable writers in oui own day, have given striking examples of clusters of cystic tubers, or enlarged tubercles, of every diversity of size, existing bcth in the abdomen and in the thorax 72 CONSUMPTION. (chest), formed in the interior of their respective vis. cera, or issuing from the surface of their serous mem- branes, some of which are filled with a limpid fluid, others with a gelatinous, a mucous, or a puriform, and others again with a cheesy, pulpy, or steatomatous mass." It is supposed, although it cannot be proved posi- tively, that tubercles may remain many years in an uninflamed or quiescent state ; and this must depend much upon the general habits of the individual. Bad habits, bad air, bad food, and bad influences generally, develop them often to a fearful extent. Ordinarily, when tubercles have been once formed. they go on augmenting in size more or less rapidly, according to the habits of the individual, the climate in which he lives, and all the varying influences which go to operate on the health, until they are converted at last into a fluid mass, resembling common pus. This may be said to resemble unstrained whey, and is sometimes stained with blood, or a black matter formed in the lungs. As this stage of maturation or softening goes on, the fluid mass finds its way into the air pas- sages, and is expelled from the lungs day by day, by expectoration, leaving an ulcerous excavation or cav- ern, as some call it, in the lungs. In some cases this process of ulceration appears to remain nearly station- ary for an indefinite time, until at last the individual sinks under it. Is tuberculous disease curable? It has been re- garded by many that tuberculous diseases of the lungs are never cured. These morbid productions are found in the youngest children, even in the unborn TUBERCLES. 73 infant, and from this up to the octogenarian, and how much older we do not know. But that tubercles can never be cured is not yet proved. The world gener- ally has poor notions of what it is possible to do by a combination of good general circumstances, in the curing of these worst forms of disease. If we take a number of dirty children—those of the lowest and most unhealthy and miserable class in any of our great cities, and remove them to a good air, keep them clean, give them good food, and, in short, bring them up in accordance with the principles of physiological science, we find that most of them will get along remarkably well, better than children ordinarily do whose parents are in good circumstances. Such things have been done over and over again. I visited two years since the Hamburgh Redemp- tion Institute, as it is called in this country, an insti- tution in which has been received for some twenty years the most miserable of the children of the city of Hamburgh ; and the worthy founder of this char- ity informed me that they were never sick. It is situated a few miles in the country, in a very pleasant healthy place. Every thing in regard to sleeping, eating, drinking, occupation, amusements, etc., is car- ried on with the utmost regularity. Good food is fur- nished, but of the plainest kinds. I asked if the chil- dren had any tea, coffee; beer, or like drinks; I was an swered by the worthy pastor, " No, they have only wa- ter-gruel or milk. We regard this much more health- ful, and it is not too much to say that our children never become sick." So much for temperance, regularity, healthful employment of mind and body, and the in- 4 74 CONSUMPTION. fluence of a rational religion dail) carried out, and this too among the most dirty, miserable, degraded, and most badly born children of the city of Hamburgh, in Germany. Taking a hint from this pattern insti- tution, what might not people accomplish with all the health, prosperity and abundance of these United States ? People ought no more to become sick than drunk. The following extract from Dr. Dunglison, of Phila- delphia, will give the reader an idea of the prevailing opinions, concerning this subject, among medical men. " It has been a prevalent opinion, that when once a cavern has formed in the lungs, it is incapable of cicatrization ; and Dr. Chapman, of Philadelphia, has pronounced the opposite opinion to be an illusion. One of the most distinguished of modern pathologists, M. Louis, has affirmed that, in the numerous dissec- tions which he has made, he has never met with a single example. His negative experience has, how- ever, been controverted by the positive observation of others. The author has met with several instances, in which this change was unequivocally accomplish- ed ; and the details of the case of an eminent medical practitioner in this city, Dr. Parrish, have been pub- lished, in whose lungs there were marked evidences of cicatrization. This probability occurred after he had long suffered under symptoms of phthisis, and ex- posed himself to a regimen as will be mentioned here- after. M. Boudet affirmed, before the Academic Royale des Sciences, of Paris, that, in 197 cases taken indiscriminately, he found ten examples of cavern completely cicatrized, without any trace of recent tu. TUBERCLES. 75 bercles; and eight examples of complete, or partial cure of cavern, coinciding with recent tubercles ; and he concludes, that recovery is possible at any period of pulmonary consumption. His researches would seem to show, that tubercles of the lungs are common when no suspicion is entertained of their 3xistence. Of the 197 persons who died in the hospitals of vari- ous diseases, or were killed suddenly by accidents, he detected tubercles in the lungs of one—a child under two years of age; from this age, to that of fifteen, tu- bercles were present in three fourths of the cases; and in those between fifteen and seventy-six, no fewer than six sevenths of the bodies exhibited the tubercu- lar deposits in the lungs. These results are explained by M. Boudet, by the facility with which tubercles undergo a change in their intimate constitution, by which they become not incompatible with a state of health. These modes of cure, according to him, con- sist of sequestration, induration, absorption, and elimi- nation, which supervene spontaneously. Observers are every day discovering appearances, or dissec- tions, which can only be referred to the existence of tubercular deposits at a former period. Of seventy- three bodies examined by Dr. H. Bennett, between November, 1844, and April, 1845, he found pucker- ings, or concretions, in twenty-eight; in twelve of these, indurations alone existed ; and in sixteen, cal- careous concretions were also present. In 100 bodies examined by M. Rogee, at La Salpetriere, these lesions were discovered in fifty-one, or more than one half. M. Boudet also states, that of 135 bodies examined by him, he found them in 116, or in 76 CONSUMPTION. about four fifths of the whole number. Dr. Hughes arrives at the startling conclusion, from his own ob- servations, and those of MM. Rogee and Boudet, that the spontaneous cure of tubercle has occurred in from one third to one half of all who die after forty. ' So deeply rooted, however,' he adds, ' is the opin- ion of the necessarily fatal nature of this disease, that, simply because recovery has taken place in cer- tain cases, medical men have rather mistrusted their own diagnosis,' than ventured to oppose a dogma of universal belief." v Dr. Cullen, who was a practitioner of great celeb- rity and experience in the last century, regarded that the prospect for recovery in consumption is for the most part unfavorable; and that of those affected with it, the greater number die. " But there are always," says he, " many of them who recover entirely, after having been in very unpromising circumstances." He published the following aphorisms as the result of his observations: " 1. A consumption arising from pulmonary haemor- rhage is more frequently recovered than when arising from tubercles. " 2. A pulmonary haemorrhage not only is not al- ways followed by a consumption, but even when fol- lowed by an ulceration, this latter is sometimes at- tended with little of hectic, and frequently admits of being soon healed. Even when the haemorrhage and ulceration have appeared to be repeated, there are in- stances of persons recovering entirely, after several such repetitions. " 3. A consumption arising from a suppuration in TUBERCLES. 77 consequence of inflammation ofcthe lungs, is that which most rarely occurs in this climate (Ireland); and a consumption does not always follow such suppuration, when the abscess formed soon breaks and discharges a laudable (healthy) pus. But if the abscess continue long shut up, and till after a considerable degree of hectic has been formed, a consumption is then pro- duced, equally dangerous as that from other causes. " 4. A consumption from tubercles has, I think, been recovered ; but it is of all others the most dangerous; and when arising from an hereditary taint, is almost v certainly fatal. " 5. The danger of a consumption, from whatever cause it may have arisen, is most certainly to be judged of by the degree to which the hectic and its consequences have arrived. From a certain degree of emaciation, debility, profuse sweating, and diarrhoea no person recovers. " 6. A mania coming on, has been found to remove all the symptoms, and sometimes has entirely cured the disease ; but, in other cases, upon the going off of the mania the consumption has recurred, and proved fatal. " 7. Pregnancy has often retarded the progress of consumption ; but commonly it is only till after de- livery, when the symptoms of the disease return with violence, and soon prove fatal." Various authors have given accounts of cases in which it was found after death that there were cica- trizations or scars in the substance of the pulmonary tissue, proving to a most positive demonstration that ulceration had at some period existed. Every medi- 78 CONSUMPTION. cal man, too, who has had a few years' experience in treating the disease, must have found cases in which all the more prominent symptoms existed, and in which the individuals have recovered, even contrary to his most sanguine expectations. Considering, then, how alarming the ravages of consumption are becoming in the United States, and at the same time the pernicious nature of the physio- logical and hygienic habits of the community gener- ally, may we not confidently hope that by the pro- mulgation of correct principles of health much may yet be done in staying the course of this most fearful disease. Beyond a doubt many might be saved who, under the existing modes of hygiene and medical treatment, now sink prematurely with tubercular dis- ease. These considerations will be entered upon in another part of the work. Unhealthy animals also are subject to tubercles.— The morbid productions of which we have been speaking, are not peculiar Jo the human species. In menageries, where animals are kept in a state which is certainly very far removed from being the natural one, the animals are often affected with a cough, and the other symptoms of pulmonary consumption. Their lungs, too, are often found after death to have become ulcerous, and are filled with tubercles. The monkey family, it is said, too, when removed from their climate to colder regions, and are at the same time kept in a confined and unnatural state, frequently die of tuber- cular disease. The lungs of the domestic animals, as the horse, ox, cow, sheep, hog, rabbit, and other of the mammalia, are also frequently tc be found tuberculous. TUBERCLES. 79 It is said a dog, however, is rarely affected with them. Tubercles have also been found in the bodies of do- mestic birds, as the turkey, fowl, etc. According to M. Andral, most of the animals in which tubercles are found to exist, are either transported from a hot to a cold climate, where they nre deprived of their liberty and exercise, as in the .nstance of monkeys and par- rots ; or else confined in damp situations, without the light of the sun, and almost without air, as cows, pigs, and house rabbits ; or exposed to constant alternations of heat and cold, or to constrained and violent exer- cise, as in the case of the horse. " All the milch cows in Paris, and no doubt else- where," says Sir James Clark, "become tuberculous after a certain period of confinement. I have been informed that for some time after the disease has com- menced, the quantity of milk obtained is greater than before, and that their flesh is more esteemed by the unsuspecting epicure than that of the healthy animal. A circumstance of the same kind is mentioned by Aristotle, who observed tubercles in the pig, the ox, and the ass; in regard to strumous pigs, he says that when the disease (grandines) exists in a slight degree, the flesh is sweeter." When we thus learn how easily tubercles may be generated in animals by taking them out of their own climate, and by placing them in unnatural and un- healthful conditions, how deep and lasting should the impression be made upon our minds, that disease is, as a general fact, a thing of man's own begetting; that the race is, as a whole, accountable for the diseases with which it is afflicted! * 80 CONSUMPTION. CHAPTER X. The different forms of consumption —That of infants and children.— In them the symptoms are usually . nore strongly marked than in adults.—There may also be great obscurity of the disease.—Cases in point.—Consumption of adults.—The latent form.—The chronic. —Acute, rapid, or quick consumption.—This may result from the latent form.—It is oftenest seen in young females.—No two cases of consumption in all respects alike. Consumption of infants and children.—Formerly, more than latterly, tuberculous disease was supposed to be an infrequent cause of death in infancy and childhood. But since pathological anatomy has been studied With greater care, infants and children have been found to be much more subject to scrofulous dis- ease than was formerly imagined. Dr. Guersent, of Paris, one of the physicians to the Hospital des Enfans Malades—an institution appropriated to the treatment of patients between the ages of one and sixteen years —states, as the result of his observations, that five sixths of those who died in that establishment are more or less tuberculous. The symptoms of consumption in cases of children are less strongly marked than in adults; and it is to this fact that we must attribute the former belief, that tuberculous disease can rarely happen in infants. The hectic fever, in children, is less perfectly formed than in adults. The perspirations are less -opious, and 'the cough is of a different character, OF INFANTS AND CHILDREN. 81 and much less prominent than that which accompanies consumption in persons of mature age. The cough occurs frequently in paroxysms, resembling those of pertussis, or hooping-cough. In many cases, especially in young children, there is little or no expectoration, unless, perhaps, at a late period of the disease; the matter, too, is probably often swallowed, so that we have no visible signs whatever of its existence. It will be seen from the description, that the consumption of infants and children must sometimes be very diffi- cult of detection; but Sir James Clark regards that this will not usually be the case if we attend to the other symptoms. He observes: " The tuberculous aspect of the child, the rapid pulse and breathing, the frequent cough, and the gradually increasing emacia- tion commonly afford sufficient evidence of its nature. Consumption in children is often preceded or accom- panied by considerable derangement of the digestive organs: the abdomen is tumid, the bowels are irregu- lar, at one time constipated, and affected by diarrhoea at another; the evacuations in either case are gene- rally of a pale, unnatural color. This deranged state of the functions of the abdominal viscera has led to the belief that the mesenteric glands are the chief seat of tuberculous disease; whereas, in reality, the bronchial glands and lungs are most commonly affect- ed. It is true that the mesenteric glands become tuberculous more frequently in infancy and childhood than at a later period of life, but by no means so gene- rally, nor to such an extent, as is supposed." But there must every now and then cases occur, I think, in which it will be very difficult, nay, impossible to 4* 82 CONSUMPTION. ascertain whether real consumption exists. While, on the one hand, cases occur which pass for consumption, there yet being no real disease of the lungs, the cough being only a symptom of other and fatal disease, there are, on the other, cases where the lungs are deeply and fatally diseased, and yet, at the same time, none of the plain, characteristic, and decided symptoms of the disease, such as are usually found, appear. Every practitioner who has had some years of experience in these matters, and who has watched studiously the manifestations of pulmonary disease, must have en- countered cases in which he has found himself greatly mistaken in the opinions he has formed of the indi- vidual case. Thus, he will at one time believe that he can cure a case without difficulty, but on trial it grows worse and worse, till at last the patient passes into a rapid emaciation and death. But in other cases, which unfortunately happen far less often, he will believe that the individual must inevitably sink, and yet, after some months, or, perhaps, years, he is surprised to learn that his patient has recovered. I repeat, every one who has had any considerable experience in the treatment of pulmonary diseases, must acknowledge frankly to himself that he has been not unfrequently thus misled in his opinions. There are many cases of the kind in the records of medicine. The late and talented Dr. Dewees, of Philadelphia, whose great experience as well as his candor, and his true love of the profession, make his opinions valuable on the subject, gives, in his Practice of Physic, pub- lished in Philadelphia the following cases. He observes: DR. DEWEES' GASES. 83 " Drs Physic, Otto, and myself attended a young lady of Liis city, and in the course of the disease which destroyed her, there was not a single symptom that betrayed there was the slightest mischief working in the lungs ; there was neither cough, difficulty of breath- ing, hectic fever, nor purulent expectoration, which Pinel makes constitute phthisis; there was marasmus, but it was not excessive. On opening the body, the lungs alone were found diseased. In another instance, Dr. Chapman and myself attended a boy, eight or nine years old, whose disease appeared to be located in the abdomen—in this part he appeared to suffer excruciating agony, which powerful doses of laudanum would scarcely abate; and this continued to the last moment of his existence. Indeed, we may look upon Bayle's 38th and 39 th cases, as being cases without the pathognomonic signs of phthisis. " On opening the body, none of the abdominal vis- cera were at all diseased; the lungs alone were the seat of the disorder. They contained very large quan- tities of the most offensive pus I ever remember to have encountered; yet in this case there was not a solitary symptom to direct attention to the chest. Bayle has, therefore, said correctly, that the artificial ' character of phthisis is not applicable to all its de- grees, or to all cases, and that the " essential" would not be sufficient to know it by during life.' In fact, we have no pathognomonic symptoms of phthisis— the knife alone reveals its existence with absolute cer- tainty. * * We might, with much safety, include stethoscope; but this instrument is so little under- stood in this country, and employed so rarely, that we 84 CONSUMPTION. hardly dare at this time consider it as a discriminat- ing means, though it is absolutely one of great cer- tainty." It is but just to the public, to those for whom I write, that I should make known these difficulties— these uncertainties of the healing art. People have too often a blind confidence in physicians, and would appear to suppose them to know far more than it is possible for mortal mind to comprehend. There is a habit, too, among medical men—by far too common— of putting on an air of knowledge and wisdom and infallibility which they never possessed, and which indeed none can ever possess. As a consequence of such medical habits, the profession become narrow and bigoted in intellect, and the people have in the end less confidence in them than would be the case if they passed for what they are worth, and no more. In this, as in all other things, the old maxim of honesty holds good. Consumption of adults.—Writers speak of a num- ber of varieties of consumption in grown persons, such as the latent, the slow or chronic, and the acute, rapid or quick consumption. The peculiarities of each of these I will briefly enumerate. Latent consumption.—Of 112 cases recorded by M. Louis, eight were latent, a smaller proportion, Dr. Crark is inclined to believe, than generally occurs from the history of these cases, and on attentive and minute examination of the lungs after death, not only of the lungs but of all the other organs. M. Louis entertained no doubt of the existence of tubercles dur- ing a period, varying from six months to two years in THE CHRONIC FORM. < 85 different cases, previous to their presence being indi- cated by coughing and the most common local symp- toms. Dr. Clark ^is also of opinion—indeed, he says that he has obtained satisfactory evidence, that in some cases tuberculous disease tiad commenced in the lungs from one to two years, or longer, before it was properly attended to, ov its nature understood. Middle life is supposed to be most liable to this va- riety of consumption, but no age is probably exempt from it. In this variety of the disease, the tuberculous pro- duct may exist evidently for a considerable time, longer or shorter, and to a considerable extent, with- out occasioning any of those more common and promi- nent symptoms of consumption which we ordinarily see, such as cough, expectoration, or haemorrhage, yet it goes on as surely, although not so rapidly, effecting its work of destruction as if these symptoms existed. In some of these cases there may be observed a hectic feverishness, night sweats, wasting of the flesh, diarrhoea, etc., without any local indications of the pulmonary disease. In other cases, the malady is more insidious in its nature, and each of the constitutional and local symp- toms are either not present, or in a degree so slight as to be very difficult to determine. At length the individual passes suddenly into a very rapid consump- tion, that soon destroys his life. The chronic form.—The symptoms of chronic con- sumption are often obscure, especially in its earlier stages ; yet they are more prominent and easily dis- tinguished than in the so-called latent form. All / 86 CONSUMPTION. cases of consumption are in some sense chronic, but the term is used to designate such as are more slow in their progress, and liable to interruption from other causes. This form 01 the disease may continue for several years in its course, subject, however, to con- siderable pauses and variations. M. Louis has given cases often, twelve, fourteen, and twenty years' dura- tion ; and it has been known to have lasted even forty years. Older persons, more than younger, are subject to chronic consumption. It is quite apt to occur even after the fortieth year. The individual gradually finds himself growing languid, and less capable of exertion than formerly. He has now and then a slight cough, but it is, however, scarcely sufficient to attract atten- tion. He may have little or no feverishness, and the appetite, on the whole, may be very good. At times, again, the disease assumes a more serious aspect. In the more inelement seasons of the year, he perhaps takes a cold in the head, which results in cough ol considerable severity, sometimes, indeed, very severe, and which is attended by fever and copious expecto- ration. These attacks may appear often to threaten life seriously, and yet the individual recovers from them, and thus goes on from year to year with little appa- rent advancement of the disease. Such patients are often subject to dyspepsy, and sometimes to diarrhoea ; hence both the patient and his friends are apt to attri- bute his complaint to a fault of the stomach and di- gestive organs. Such patients grow pale and thin; and although they may eat heartily generally, and the appetite be remarkably good, they do not get flesh. THE ACUTE FORM. 87 Indeed, the more they eat the less flesh they appear to have. They may be able to transact their ordinary avocations, whether physical or mental, but with less alacrity than usual. They are short winded, as horsemen say, and can bear but little fatigue, especi- ally in ascending hills or mountains. They are, how- ever, compelled to be scrupulously mindful of their health, and are not unfrequently ranked among that unhappy class of individuals who are supposed to be more indolent than sick. They are valetudinarians— neither on the sick list, nor are they by any means well " The aggravations and pauses in chronic con- sumption are more or less frequent and distinct in dif- ferent cases; the former being far more common in the cold, the latter in the summer, months. Hence the sufferer will often appear to be fast approaching the goal of his being; his fate is even pronounced, when, unexpectedly to all, the threatening symptoms abate, his health rapidly grows better, and thus, for the time being, he disproves the prediction both of physician and friends." This form of consumption may at any time run in- to the acute; and I think it will be found generally to end in what may be termed the acute attack, or, per- haps, more correctly, the acute exacerbation of the disease. Acute, rapid, or quick consumption.—The dura- tion of consumption is more commonly from nine to thirty months ; but, in what is popularly termed quick consumption, the disease frequently runs its course in two or three months, and occasionally less. Persons have died often in a single month from the 68 CONSUMPTION. disease. This form of tuberculous pulmonary affec- tion, has been aptly termed " galloping" consump- tion. The disease is more apt to take on this rapid form when developed by some other disease, as a fe- ver, small-pox, scarletina, measles, and the like. A common inflammation of the lungs, where tubercles have been supposed to exist, not unfrequently ends in acute consumption. The inflammation, it is supposed, serves to bring into action the tuberculous disease. Acute consumption is evidently often only the re- sult of the latent form ; and exposure to cold, inflam- mation of the lungs, over-exertion, an attack of ca- tarrh, or haemorrhage from the lungs, serves to develop the malady, which, although unperceived, has been for a long time performing its silent work. In such cases, we may suppose, that when the tuberculous de- posit is thus brought into vigorous action, or, in other words, an active state of disease, consumption pro- ceeds in its course with the most fearful rapidity. This form of consumption is most frequent in young persons, particularly young females, and oftener with those who inherit the scrofulous or tuberculous habit. It happens more commonly in the earlier periods of puberty, and especially with those in whom the men- strual function becomes deranged. " Such individu- als seem as frail as the leaves of autumn, and fall al- most as readily. They are often peacefully sinking into the arms of death before their danger is even sus- pected." In the varieties of pulmonary consumption, we have— 1. That which affects infants and children, an ob- ITS VARIETIES. 89 scure form of the disease, and one which it i$ some- times impossible to detect. In adults, we observe three varieties: 1. That which is latent, or unperceived, and which is often very difficult, and sometimes impossible to de- termine. 2. The chronic variety, in which the symptoms aie more marked and distinct in character, and which may pass into the acute attack, or be merged into one. 3. The acu-te variety, which happens oftenest in young persons, especially young females, runs its course frequently with great rapidity, causing death in one, two, or three months; but which may also precede or follow the latent and chronic varieties of the disease. Thus I have spoken briefly of the different varieties or forms of pulmonary consumption. It must be man- ifest, however, that we can find no two cases which are, in all particulars, exactly alike; often, too, one form of the disease blends with another. Latent consumption may become active, and the chronic va- riety may suddenly become acute. On the other hand, too, the acute variety may pass off and turn into the chronic or latent; and then this again sud- denly into the rapid or acute. The distinction made, may, however, aid somewhat toward the gaining a knowledge of the disease 90 CONSUMPTION CHAPTER XL Symptoms of consumption.—Haemorrhage from the lungs.—Bron- chitis.—Cough.—Hooping cough.—Spasmodic cough.—Nervous or hysterical cough.—Short, dry, or hacking cough.—Aphonic cough. —Stridulous, barking, wheezing, or whistling cough.—Loose cough.—Hoarse, loud, dry, forcible cough—Asthmatic cough.— Cough sometimes occurs in pregnancy.—Cough generally one of earliest symptoms of consumption.—Dyspnoea, or difficult breathing.—The expectoration.—Dr. Cullen's rules for distinguish- ing pus.—Dr. Marshall Hall's observations on expectoration. Haemoptysis or haemorrhage from the lungs.—Pul- monary haemorrhage is a frequent symptom attending consumption, although not always present. I regard it as being, in the majority of cases where it occurs, a symptom of less importance and less danger than is generally supposed. - It, however, always indicates a wrong state of things in the general health, and, as such, merits, in every case, careful consideration. In some cases it is one of the most'fatal of all affections of the pulmonary organs. The subject being connected with a great variety of circumstances, I have devoted a separate chapter to the consideration of its nature, causes, and effects, and the means of prevention and treatment to be employed. To these the reader is referred to another part of the work. Bronchitis.—Bronchitis, or inflammation of the bronchial tubes often comes as a prelude to this dis- V VARIETIES Of COUUH. 91 ea ;e. it s indeed to be reckoned as one of its exciting ca ises, a though we have no positive proof that actual tubercles are ever thus brought into existence. But this affection, as well also as chronic sore throat, will be more fully considered in another place. Cough.—This is a spasmodic action, more or less violent, of the parts composing the throat and the lungs and chest; a full inspiration of air is taken into the lungs, then the glottis is closed pretty firmly, and in inspiration the air forced suddenly out, and with it frequently mucous or other matters which had irri- tated the air passages. Cough is generally, though not always, one of the normal efforts of nature to expel from the throat and lungs, more especially the latter, things which ought not to be there. Cough is a symptom belonging to a variety of com- plaints ; it attends a slight inflammation of the mucous membrane, or the throat and air passages, as when we have a cold as we say. It attends also inflamma- tions of the lungs, bronchitis, chronic and acute, pleu- risy, and diseases of the heart; it may also be merely spasmodic or nervous, as happens not unfrequently in hysteria; but it is a symptom belonging more espe- cially to pulmonary consumption. It is to be regarded, as before remarked, as a healthful symptom; or, in other words, it is a normal effort of nature, when it is not purely nervous, to expel some offending substance from the throat and lungs ; although some old and feeble persons laboring under chronic bronchitis, with profuse secretions from the mucous membrane, have not strength to cough the phlegm up, and so die, suffo- cated in the effort. 0 92 CONSUMPTION. Hooping-cough is not easily mistaken by those who have ever heard it. Spasmodic cough occurs in adults. It comes by turns, and is violent, " tearing persons in pieces," like hooping-cough. It often arises evidently from sym- pathy with derangement of the stomach and digestive organs. It may, perhaps, also be united with a cer- tain degree of inflammation of the air passages, but if so, it is not at all proportionate to the latter, being much greater than what ordinarily occurs. The Nervous or hysterical cough is a verys ingular affection, and has often misled patients and their friends, and even the medical attendant, to think that it was a matter indicative of positive consumption. It happens oftenest in cases of young women who have not good general health. We see such persons cough- ing day after day, month after month, and year after year, and yet they grow no worse. They complain that every time they take in air they cough. It is loud, harsh, dry, more like a bark than a cough; sometimes it is more incessant; at other times it occurs in par- oxysms which is doubtless often more annoying to hear than to suffer. I need hardly add, that in order to cure this cough we have only to remedy the affection which gives rise to it; and it should be particularly remembered, although often a comparatively trifling affair in the beginning, it is liable to end in affections of the throat and wind-pipe, and not unfrequently.brings on consumption, and so destroys the patient. The short, dry, hacking cough occurs often in the incipient stages of consumption. It may also be caused by an elongated palate, by irritation of the fauces and VARIETIES OF COUUH. 93 throat, by febrile affection, ana sometimes in persons who appear to be in no appreciable way diseased. The aphonic cough, signifying that which is feeble or whispering, depends on the same causes which pro- duce aphonia, or loss of voice. In the vocal functions, it occurs in severe and extensive ulcerations of the throat, and in extreme debility arising from whatevei cause. A stridulous, barking, wheezing, or whistling cough is such as occurs in that very dangerous affection, the croup. It occurs also sometimes at the beginning of catarrh and measles. It is seldom witnessed in pa- tients above twelve or thirteen years of age. A loose cough is such as occurs in the advanced stages of colds. In consumption, in the latter stages of lung-fever, and sometimes in old age, it is caused, as its name expresses, by the presence of a loose fluid, such as mucous, purulent mucous, or pus. In colds, it is a favorable symptom. The hoarse, loud, dry, forcible cough is such as ex- ists in the early stages of pulmonary colds, and does not appear to be caused by the presence of foreign matter in the throat or lungs. The asthmatic cough is that which occurs in asth- ma, and is to be considered as of the spasmodic kind. The amphoric, or hollow cough has a deep reverbe- rating sound, and is caused by large quantities of fluid matter coming from extensive cavities in the substance of the lungs. If is a striking symptom of the more ad- vanced stages of pulmonary consumption. Pregnancy is sometimes attended with cough, which may come in severe paroxysms, or, in other words, a 94 CONSUMPTION. spasmodic cough. In other cases, it may be almost constant, and what is called short and teasing. This cough may be dry, or a tough viscid fluid may be ex- pectorated. If it is not cured by attention to the general health, it is extremely apt to bring on abor- tion. This cough, although it generally ceases sud- denly after delivery, may be brought back] again by carelessness, and the taking of cold. In such cases, if a predisposition to consumption exists, the disease may then be very easily excited. Cough is generally, though not always, one of the earliest indications of pulmonary consumption, and is consequently the first symptom which excites the at- tention of the patient and his relatives. During the first weeks or months, and in some cases years, it may be slight, occurring mainly in the morning. It ap- pears often to arise simply from irritation in the re- gion of the throat, hence it does not excite alarm. I would by no means frighten people at every little symp- tom of cough they may experience. I would not have them become nervous, and imagine that because they have a cough they must necessarily pass into con- sumption ; but at the same time, I would have every one remember that coughing is never a symptom of health. A person who coughs is not entirely well; and consequently no pains should be spared to arrest, if possible, this symptom; and here I am constrained to remark that in no one thing is it more important to begin in season. As Poor Richard says, " a stitch in time saves nine," and if this principle is an important one in the common affairs of life, how much more so in matters of health ' DYSPNOEA. 95 When this early cough has continued for a time, longer or shorter, according to the case, the individual finds that after any particular exertion, such as run- ning up stairs, speaking, reading, singing, or laughing for some time, he becomes more troubled with the cough, and the expectoratioL increases. As a gene- ral rule, these symptoms increase exactly in the same proportion as the disease. Cases, however, may oc- cur in which the cough is very slight through the whole period of consumption, and in a few rare cases it has been known to appear only a few days before death. Even where tuberculous excavations of the lungs exist to a considerable extent, the cough may often be absent altogether in the disease. " It is not sufficiently known," says Portal, "that consumption may exist without the slightest cough. The lungs of consumptive patients have often been destroyed by suppuration (the formation of pus), without their hav- ing experienced the least degree of cough." Various writers have mentioned cases of this kind. Dyspnoea, or difficulty of breathing.—This may arise from a variety of causes, such as feebleness of the heart, nervous debility, and a deranged state of the general health. It is not to be much relied on as an indication of consumption. Dyspnoea is, however, more frequently present in this disease than is gene- rally believed. There is almost always more or less of it in consumption ; but it occurs also in a variety of other complaints. On the whole, this symptom al- ways demands attention. It is unattended with pain, is slow and gradual in its increase, and so may be lit- tle noticed for a considerable time at first. Asthma, 96 CONSUMPTION. which is necessarily attended with dyspnoea, is sup- posed often to cure consumption, or, in other words, if a person is attacked with the former disease he does not sink with the latter. Expectoration.—Both patients and physicians have Deen in the habit of looking a good deal to the matter thrown off from the lungs in pulmonary disease. The matter expectorated, however, is not so sure a guide as has been often supposed. The quantity of mat- ter thrown off is by no means so sure an indica- tion of the real degree to which the disease has mani- fested itself in any particular case. It may be very small, while at the same time the lungs are crowded with tubercles, many of which are already in a state of ulceration. It may, on the other hand, be quite ex- tensive, often large, when in fact the disease has made but little progress. Formerly it was imagined—and the opinion is yet prevalent, to a considerable extent, even among practitioners of medicine—that if real pus, or purulent matter, such as sinks in water, be thrown off, the case must necessarily be one of tuberculous consumption; but it is now well known that such is not the fact. Genuine pus is often secreted from the mucous membrane of the air passages at the end of an attack of simple bronchitis, and also of a common cold. Still, I regard that the throwing off of heavy purulent matter, and such as has an offensive odor, is generally to be looked upon as an unfavorable symptom. It denotes, evidently, a depraved state of the general health. Whether the test be one of consumption or otherwise, it is a better symptom for the matter expec- torated to float upon the top of water rather than sink. EXPECTORATION. 91 It is often a matter of interest, both to the patient and the physician, to be able to ascertain whether pus does actually exist in a given case. Dr. Cullen has given the following excellent rules in his " First Lines of the Practice of Physic," Dublin edition, 1784, vol. ii. p. 224: "1. From the color of the matter; as mucous is naturally transparent, and pus always opaque. When mucous becomes opaque, as it sometimes does, it be- comes white, yellow, or greenish; but the last-men- tioned color is hardly ever sc remarkable in mucous as in pus. " 2. From the consistence; as mucous is more vis- cid and coherent, and pus less so, and may be said to be more friable. When mucous is thrown into water, it is not readily diffused, but remains united in uni- form and circular masses; but pus, in the same cir- cumstances, though not readily diffused, does not re- main uniformly united, and by a little agitation is broken into ragged fragments. " 3. From the odor; which is seldom perceived in mucous, but frequently in pus. It has been proposed to try the odor of the matter expectorated by throw- ing it upon live coals; but in such a trial, both mu- cous and pus give out a disagreeable smell, and it is not easy to distinguish between them. "4. From the specific gravity compared with wa- ter; and, indeed, it is usual for the mucous of the lungs to swim on the surface of water, and for pus to sink in it. But in this we may sometimes be deceived, as pus which has entangled a great deal of air may swim, and mucous that is free from air may sink. 5 98 CONSUMPTION. " 5. From the mixture which is discernible in the matter brought up; for if a yellow or greenish matter appears, surrounded with a quantity of transparent or less opaque and less colored matter, the more strongly colored matter may be generally considered as pus; as it is not easy to understand how one portion of the mucous of the lungs can be very considerably changed while the rest of it is very little so, or remains in its ordinary state. " 6. From the admixture of certain substances with the matter thrown out from the lungs. To this pur- pose we are informed, by the experiments of the late Mr. Charles Darwin: " That the vitriolic acid dissolves both mucous and pus, but more readily the former; that, if water be added to such a solution of mucous, this is separated, and either swims on the surface, or, divided into flocculi, is suspended in the liquor; whereas, when water is added to a like solution of pus, this falls to the bottom, or by agitation is diffused so as to exhibit a uniformly turbid liquor; that a solution of the caustic fixed alkali, after some time, dis- solves mucous, and generally pus; and if water be added to such solutions the pus is precipitated, but the mucous is not. From such experiments it is supposed that pus and mucous may be certainly distinguished from each other. " 7. From the expectorations being attended with a hectic fever. A catarrh, or expectoration of mucous, is often attended with fever, but never, so far as I have observed, with such a fever as I am presently to describe as a hectic. This, in my opinion, is the most certain mark of a purulent state in some part of EXPECTORATION. 99 the body ; and if others have thought differently, I am persuaded that it has been owing to this, that, presum- ing upon the mortal nature of a confirmed or purulent pthisis, they have considered every case in which a recovery has happened as a catarrh only; but that they may have been mistaken in this, I have shown elsewhere." Dr. Marshall Hall has given very clear and concise explanations of the different characters of expectora- tion, as witnessed in different diseases, and which are the following: "In a state of health, the natural saliva and mucous are transparent and colorless, and they generally re- main so in the incipient stages of pulmonary diseases. " When the sputa consists of mucous, which is thick, whitish, and opaque, during common pulmonary ca- tarrh, it indicates a subsidence of the inflammation. It is sometimes yellowish or greenish, when the dis- ease is prolonged. " When the spittle is of a rusty red color, viscid, heaped in small masses, and adherent to the vessel into which it is discharged, the disease is pneumonia. It is also sometimes brown or yellowish in this disease. " When liquid blood, of a fresh, florid, and frothy appearance, is thrown off by an expiratory effort in any considerable quantity, the case is one of haemop- tysis. It shows, in most cases, the existence of tuber- cles in the lungs, but may take place under the influ- ence of other causes, such as catamenial irregularities, aneurism of ^ae aorta, and external accidents. Pul- monary haemorrhage, when slight, probably proceeds from exhalation from the mucous membrane; when 100 CONSUMPTION. more serious, from the vesicular texture, and in rare cases from the rupture or division of a blood-vessel. "When pus is expectorated, the disease may be bronchitis, pneumonia, or phthisis. The characteristic sputum, often seen in advanced phthisis, has received the French name pelatanne, which has been rendered in English by the word nummulated. It appears in roundish masses, with shred-like edges, floating in a clear, transparent liquid. The taste is often sweetish, and the smell nauseous. But it is in some cases ex- tremely difficult to distinguish the pus of phthisis from that of chronic catarrh. " When chalky or calcareous concretions are coughed up, they mostly indicate tubercules or phthisis, usually in a more chronic form. Tuberculous matter is some- times coughed up in the same disease. When the spit- tle is extremely foetid, and accompanied with a putrid odor of the breath, the disease is gangrene of the lungs. " The expectoration of young children cannot be examined, from the circumstance that the substances raised are immediately swallowed by them. "The act of expectoration fails to take place when there is a want of sufficient sensibility in the mucous membrane, or the diseased part, to excite coughing. This happens in the lethargic and the moribund, giv- ing rise to the well-known rattling sound in the throat, so often heard in these cases. For the same reason expectoration is suspended during sleep, and takes place in increased quantity on waking. Some pa- tients voluntarily avoid expectoration as long as pos- sible, on account of pain or fatigue attending the ex- ertion of coughing," ITS SYMPTOMS 101 CHAPTER XII. Symptoms of consumption continued.—Perspiraticai.—This occurs more particularly in the advanced stages of the disease.—Hectic fever.—Thirst.—This is not always present in consumption.—The pulse.—It is always accelerated in this disease.—Diarrhoea.—Ema- ciation.—Swelling of the limbs.—Aphthae, or sore mouth.—Pains in the chest.—The nails.—The hair.—Nervousness.—The intel- lect.—Delirium.—Cessation of menstruation.—Pregnancy as affect- ing consumption.—Practical deductions to be drawn from the fore- going description of the symptoms of consumption. Perspiration.—Perspiration, or sweating, is a prom- inent symptom of consumption in its latter stages; and is one of so much importance, that it deserves special consideration. It occurs generally, though not in all cases. According to Louis, it occurs in nine tenths of those who die of phthisis. Perspiration in consumption occurs chiefly in the night-time; but in the more advanced stages of the disease, it may occur whenever the patient sleeps. It comes on most toward morning. Especially if the patient takes a late or second sleep, remaining in the same bed, he will be liable to suffer from profuse sweating. Although perspiration occurs generally in the ad- vanced stages of pulmonary consumption, it is occa- sionally seen in its more early periods. But it is then much less in quantity, and is often so little that the patient scarcely takes any notice of it. 102 CONSUMPTION. Perspiration, hectic fever, frequent pulse, and ema- ciations are sometimes the only symptoms of pulmo- nary disease. Whenever we meet with tl ese symp- toms in a scrofulous or tuberculous constitution, it will be well for us to examine carefully as to whether pulmonary consumption does not already exist. Any state of the system in which there is great debility, may be attended with copious night sweats, and this when tuberculous consumption does not exist. Thus, in the earlier periods of nursing, a mother of delicate constitution may experience sweats. We see the same in many fevers, and in a variety of diseases; but in general there will be no great difficulty in ascer- taining whether the perspiration be caused by real consumption. If arising from other causes, it is not so persistent; it sooner leaves the patient. I shall explain elsewhere the method of mitigating, and in most cases curing the night sweats, which are so trou- blesome and debilitating in pulmonary consumption. Hectic fever.—This we may consider as the cause of the symptom which I have just been considering, namely, perspiration. It comes on slowly and insid- iously at first, and is often, for a considerable time, so slight as not to elicit the patient's attention. A prac- ticed observer will, however, have no difficulty in de- tecting it. It may be ascertained by the pulse, even in its earliest stages, as well as by some slight augmen- tation of the color of the cheeks. The respiration also becomes somewhat more hurried and difficult. It varies much in degree, in different stages of me dis- ease, in the same individual, and also in different cases. Some have very little of it, while others are THIRST .--PULSE 103 very much troubled with i . It is perhaps liable to more variation than any other prominent symptom in this disease As in all other attacks of feverishness, the patient often experiences sensations of chilliness. These are more common in the evenings. As the disease progresses, the intensity of these sensations in- creases, and amounts, in some cases, to almost an ague. This is succeeded by heat of the skin during the night; especially is it attended with ncrease of heat and dryness in the feet and hands. Sometimes, too, there will be an exacerbation of the hectic in the earlier part of the day, as toward noon. After a time, longer or shorter, according to the case, the paroxysms of febrile excitement become stronger, and the heat more generally diffused over the surface. Thirst.—This symptom is usually experienced to a greater or less extent in consumption. Feverishness in this, as in all other diseases, must necessarily, I suppose, cause more or less thirst. The fever of con- sumption does not, as a general fact, rise at any time to a very great extent, it being chronic in its charac- ter ; and hence thirst does not exist in a very great degree. I think thirst will seldom be found wholly absent, in cases of consumption. Dr. Clark has seldom seen it so, although Louis tells us he found it wanting in one fourth of his cases. Pulse.—When we are called to examine a case in which consumption is suspected, if we find the pulse considerably more frequei.t than natural, and that there are no other reasons by which to account for this phenomenon, we have reason to believe that pul- monary mischief has already commenced its insidious 104 CONSUMPTION. work. On the other har 1, if we find the pulse habit- ually at a normal stanuard- -that is, from sixty to eighty pulsations in a minute, which includes the aver- age of that of adults—we are to consider it as a fa- vorable omen; still there are persons of tuberculous consumption, who have habitually a slow, languid cir- culation, and which in some cases continues so until the patient is perhaps far gone in the disease; but these cases are only exceptions to the general rule. In estimating the pulse in any given case, it is desira- ble, if possible, to know what has been the frequency or number of beats per minute when the individual was in health. The pulse varies considerably in dif- ferent persons. While that of one may range from sixty to sixty-five a minute, that of another may aver- age from seventy to seventy-five, or even eighty ; con- sequently, what might be natural in one case, and no increase upon the healthy standard, would be a de- cided augmentation in another. It will be found, I think, that persons of a scrofulous and tuberculous tendency have, as a rule, a more rapid circulation, and consequently a quicker habit of pulse than those who are not so disposed. Diarrhoea.—This symptom does not generally occur as a distinct mark of consumption until the disease is far advanced ; in some cases it occurs a few days only before death, and sometimes, though rarely, it is en- tirely wanting. In one eighth of Louis' cases, he found diarrhoea commenced with the disease and con- tinued till death;,in the majority, it occurred in the latter stages; in others, during the last days of life only; and in four among 112 cases it never appeared. DIARRHOEA. 105 Diarrhoea is to be considered one of the most im- portant of the symptoms of consumption; and which often, if not generally, exercises as great an influence over its progress as the expectoration does. The wasting of the flesh, the debility, and the rapidity of the disease, are generally proportionate to the severity of the diarrhoea. This symptom often proves one of the most distress- ing with which the poor patient is afflicted in this disease. It is attended frequently with severe pains before, and a deadly sensation of sinking immediately after, each evacuation. The cough and expectoration appear sometimes to be diminished by the frequency and quantity of these discharges. And pains of the chest are likewise some- times rendered less; but, on the other hand, the ex- treme debility, the extreme sensation of sinking and exhaustion which are experienced, more than coun- terbalance. It is a remarkable fact in consumption, that in persons who have been long subject to constipation, the bowels become exceedingly regular, and apparently healthy in their action, after consumption has become to a certain degree developed. " The fact that the wasting and loss of strength in consumption correspond with the number and fre- quency of evacuations," Dr. Clark observes, " suggests a wholesome and not unnecessary caution concerning the employment of active purgatives, even in the early- stages of consumption, and of mild aperients in large doses as the disease advances, since they reduce the strength, and may bring on diarrhoea before it would 5* 106 CONSUMPTION. otherwise have occurred. I have seen," continues this writer, "a tablespoonful of castor-oil throw a con- sumptive patient into an alarming state of debility." As a symptom indicative of consumption, diarrhoea is of no importance, inasmuch as it does not occui until after the disease has made considerable progress. Emaciation.—This is to be considered as an im- portant symptom of this disease. If there is no evident cause for it other than tuberculous disease, and if it is accompanied by rapid pulse, loss of strength, and frequency of breathing, there is always reason to be lieve that tuberculous disease of the lungs already exists. In some cases, the derangement of the digestive organs, which is always present to a greater or less extent in consumption, is often regarded as the princi- pal cause of the wasting of flesh ; in these cases, let persons do what they will to maintain the digestive organs in a healthy condition, and eat as freely and liberally as they may of the best and most nourishing food, the wasting yet goes on, and in spite of all that can be done. In persons about the middle period of life, as from forty to fifty, Dr. Clark regards emacia- tion as one of the earliest symptoms of consumption, even where there was no frequency of pulse, no cough, no marked dyspnoea, nor any other symptom to draw attention to the state of the lungs. Emaciation, it will be understood, may occur from a variety of causes, so that it would be unwise for every person who may become debilitated and lose flesh to imagine at once that he has necessarily con- sumption. Still, where there is an hereditary predispo- PAINS IN THE CHEST. 107 sition to this disease, a manifest wasting of the flesh should always be looked upon with suspicion. Swelling of the limbs.—This symptom may be caused by any thing which materially debilitates the system. When it happens in a curable disease, as it sometimes does, as after an attack of fever, cholera, dysentery, etc., it is curable, provided the original malady be so; but when it happens in consumption, it is in general to be considered as a sure prognostic that the disease is approaching to its fatal termination. It is supposed to be an invariable attendant in the last stages of this disease. Aphthae, or sore mouth.—Generally a week or two before death, and as one of the last in the long cata- logue of maladies which afflict the consumptive pa- tient, the mouth becomes sore. Small, roundish, pearl- color vesicles appear upon the lips, within the mouth and throat, and extend probably into the intestinal canal. These are apt to slough or throw off matter to a greater or less extent as death approaches. Some- times this symptom is productive of little inconve- nience, but oftener it causes great irritation and ten- derness of the mouth and throat, and proves a source of no inconsiderable suffering. We cannot, of course, expect much from remedial means in this complaint. Pain in the chest.—Pains are not unfrequently experienced in the thoracic cavity. In pleurisy, chro- nic and acute, we have them, especially severe in the latter; so in rheumatism of the chest, in a common cold, too, where there is no danger whatever of tuber- culous consumption, persons experience pain or cough- ing. A :ute pain rarely attends the early stages of 108 CONSUMPT: ox. pulmonary phthisis; as the disease advances, it be- comes generally a more prominent symptom, and some suffer a good deal with it. It is most severe on the side most affected. Pain experienced in the upper part of the chest and shoulders is sometimes indicative of the coming on of pulmonary disease, although the symptom may be so slight as not to elicit any particu- lar attention to the patient. Indeed, often he will not mention it at all unless his attention were called to it. Such a pain may easily be confounded with rheuma- tism. Indeed, this early pain appears more like that of rheumatism than any thing else; and in many cases the most experienced observers will not be able to determine positively to which class it belongs. In either case, however, the indications of treatment would be the same, that is to fortify and invigorate the general health. The nails.—In the latter stages of consumption we observe—oftenest in the cases of females, I think—an incurvated state of the nails. There is, at the same time, a rounded appearance of the last joint of the fingers. The ends of the fingers also appear to be larger than is natural. The hair.—Owing to general debility, the wasting of the constitution, and consequent impoverishing of the skin, on the health of which the good condition of the hair so much depends, this latter not unfrequently falls off in the later stages of pulmonary disease. Nervousness.—The patient not unfrequently be- comes nervous, peevish, and irritable, even in the early stages of the malady. As the disease advances, irri- tability of temper and feelings, and timidity, increases. CESSATION OF MENSTRUATION. 109 The intellect.—It is a singular circumstance that the mind usually remains clear until the very last of this fearful disease. We find, too, that patients are ever ready to catch at straws; and we can seldom convince them of their danger. Where we have rea- son to suspect consumption, I regard it as one of the worst possible signs if the patient has no fear whatever of the disease. He thinks that he has only a little cold, which he will soon be able to throw off. He con- verses about his business, and prospects in life, as if he were absolutely certain of getting well; and this delusion goes on, in many cases, until the very last. On the other hand, if we find a feeble person who is continually imagining that he has the disease, and that he is certain soon to die of it, we have reason to sus- pect that he has only hypochondria, arising from a bad state of the general health. Delirium.—If the feverishness runs high, or is not properly managed by remedial means, delirium some- times comes on near the last. Cessation of menstruation.—Cessation of this func- tion in females is one of the common accompaniments of consumption. Let it be remembered, however, that suppression of the menses may arise from a vari- ety of causes other than pulmonary disease. Those females who are undergoing a vigorous course of wa- ter-treatment, not unfrequently experience cessation of this function for months, and even a whole year or more, and at the same time are steadily improving in their general health. So, too, pregnancy may arrest menstruation, or the simply taking of a cold. But if a person has had for a length of time cough, the raising 110 CONSUMPTION. of purulent matter from the lungs, sweating at night; and the other accompaniments of consumption, and then with all these, if menstruat;on ceases, it is to be regarded a most unfavorable omen. Pregnancy as affecting consumption.—It is an un- fortunate thing for a consumptive mother to bring forth young; and it is a remarkable fact that females inclined to consumption are apt to be very prolific. Not unfrequently pregnancy occurs even in the ad- vanced stages of pulmonary disease. It is apparently arrested in its course for the time. Possibly, in some cases, pregnancy, with its concomitant circumstances, may effect either a partial or a total cure of the dis- ease ; but I think it must far oftener happen that it only hastens on to a more rapid and fearful termina- tion the awful disease. » Some of the more important of the practical de- ductions to be drawn from the foregoing description of the symptoms of pulmonary consumption are the following : 1. That pulmonary haemorrhage, although some- times a fatal symptom, is in general not so alarming an occurrence as is generally supposed ; but that it always indicates a wrong state of things in the gene- ral health, and, as a consequence, demands special care and attention. 2. That bronchitis, or inflammation, whether acute* or chronic, of the mucous membranes of the bronchial tubes, and also common sore throat, are frequent fore- runners of a tuberculous disease. 3. That a cough is not necessarily an alarming symptom, but is one, lowever which should always PRACTICAL DEDUCTIONS. Ill be regarded with suspicion, especially by those who are born of consumptive parents, or in whom there is a strong predisposition to pulmonary disease. 4. That we are not to regard purulent matter as being indicative necessarily of incurable disease ; yet the expectoration of such matter is always to be looked upon as being a more unfavorable symptom than if mucous and light frothy expectoration be thrown off'. 5. That dyspnoea, or difficult breathing, although a frequent symptom of pulmonary consumption, is also frequently to be observed in other maladies. 6. That pure asthma and pulmonary consumption do not, as a rule, go together ; that an attack of the latter appears sometimes to cure the former. 7. That night sweats, although they occur in any condition of the system, attended with great debility, are always to be looked upon with caution, in regard to pulmonary disease. 8. That hectic fever, although slight in some cases, is one of the most common symptoms of this disease. 9. That thirst is not usually a prominent symptom. 10. That diarrhoea, emaciation, swelling of the limbs, and extreme soreness of the mouth and throat are to be looked upon as very unfavorable omens. 11. That pains in the chest, appearing at first to be only slight, and of a rheumatic nature, but afterward increasing in severity as the disease advances, gene- rally attend this disease. 12. That extreme debility is one of its most promi- nent symptoms. 13. That the individual generally becomes very nervous, feverish, and irr'.abie 112 CONSUMPTION. 14. That the intellect usually remains clear. 15. That delirium comes on a little before death in some cases, especially if the fever be not properly treated. 16. That suppression of the menstrual function is a frequent symptom of females toward the fatal close of the disease. 17. That the cessation of the menses may also at- tend a variety of circumstances where no pulmonary disease is present. 18. That pregnancy and nursing appear, in gene- ral, to check consumption for the time, and in some cases to cure it altogether; but that, as a general fact, these circumstances tend only to hasten the final ter- mination of the disease. PREDISPOSING AND EXCITING CAUSES. 113 CHAPTER XIII. Causes of consumption.—The predisposing and the exciting causes of disease.—Hereditary predisposition.—Transmission of physiolo- gical and pathological qualities from parent to child.—Consump- tion not always hereditary.—Ways in which it may be brought on in the system.—Intermarriage as affecting pulmonary consumption. —Relations should not intermarry.—Reasons why.—Is consump- tion a contagious disease ?—Authorities quoted.—Relation of scro- fula to consumption.—Important and instructive facts concerning the causes and the prevention of consumption. The causes of consumption, as of most other diseases, are of two classes, the predisposing and the exciting. Predisposing causes are such as tend to bring about a certain state of things in the system, in which it is more liable, under certain circumstances, to take on a particular form of disease. Exciting causes are such as occasion a develop- ment of any certain disease to which the system has already been predisposed. Thus, a person of consump- tive habits may be exposed to severe wet and cold, by which consumption is brought on. Wet and cold are here the exciting causes. If several persons were subjected to a long and severe exposure to cold; one might experience, as a consequence, inflammation of the lungs; another, pleurisy; another, inflammation of the bowels ; another, gout; another, rheumatism ; another, erysipelas; another, a general fever; and still another might escape unharmed. The character of the disease, in each of these cases, would be in ac- I 4 CONSUMPTION. cordance with the predisposition existing in each in- dividual case. Hereditary predisposition.—It is a familiar fact to all, that children always inherit, to a greater or less degree, the looks, conformation, and general constitu- tion of their parents. It will be found, I think, a gen- eral rule, that daughters resemble the male parent most, both in appearance and general constitution, and sons the female parent. If this be true—and I think facts of observation warrant me in asserting it— a daughter has more to fear from consumption if the disease existed on the father's side, than if on the mother's ; and the son the contrary. But if the dis- ease be farther back, as among the grandparents, the daughter has more to fear if the disease have been on the grandmother's side, and the contrary of the son. I know of no author who has put forth these views, but I think, notwithstanding, that they will be found to be in accordance with the facts. Professor Sweetser, in his work on consumption (page 96), gives a striking instance in proof of the transmission of certain qualities from parent to child. He observes: " An interesting fact was related to me, a few years since, by Professor Zerah Colburn, the gentleman who was so extensively known, in early life, for his extra- ordinary powers of calculation. One of his parents (his father) had a supernumerary finger and toe on each hand and foot, which malformation he inherited, being born with six fingers on his upper, and six toes on his lower extremities. Some of his brothers dis- mayed the same peculiarity, others not. The extra HEREDITARY PREDISPOSITION. 115 fingers were cut off in ii fancy. The lady whom he married was a distant connection of his own, and inher- ited exactly the same malformation. She had born him three children, two of whom were twins, and all with a supernumerary finger and toe on each band and on each foot. Desirous of learning some more particulars in regard to this peculiarity, and especially whether it would continue to be transmitted to his off- spring, I recently addressed a communication on the subject to Professor Colburn, to which he kindly re- plied, acquainting me with the following additional and interesting facts, which I will give in his own lan- guage : ' I do not know at what period this peculiarity was imported into this country. It came, I believe, from Scotland, in the name of Kendall. From the Kendalls it came into the family of Green, by mar- riage. My grandfather married a Green, and thus it got into our family. How many, if any, of my un- cles had this mark, I know not. My father had it on each hand and foot; of his children, one brother and myself have it complete. One other brother has one odd finger ; he has two children, twins, and both com- pletely furnished with odd fingers and toes. The other brothers and sisters have it not, either themselves or in their children. My wife is great-granddaughter of my grandfather ; her mother has one finger and one toe extra. This fact accounts for her being born with the full complement of supernumerary fingers and toes; they were cut off at her birth, by the attending physician. Since I saw you I have been favored with another daughter, with like accoutrements, and have net any doubt bu:, even though I had as many 116 CONSUMPTION. as Gideon of old, by my present wife, they would all show alike in this respect, and be, like my four daugh- ters now, six fingered and six toed. The descend- ants of Kendall generally have this distinction, or can tell of some kinsman who has.' " The world is full of examples showing the effects which peculiar qualities or predispositions of parents may entail upon their offspring. Consumption not always hereditary.—It is to be observed that consumption, although often an heredi- tary disease, is not always so. The new-born child is sometimes affected with tubercles, even where no taint of the sort can be traced in the family. Laennec observed that "numerous families are at times de- stroyed by the disease, whose parents were never affected by it." Cases have been known in which the parents have both died at a very advanced age, but previously having buried a large family of chil- dren, all of whom died of consumption. Laennec has mentioned an instance in which the father and mother died upward of eighty years of age, and of acute maladies, after having seen fourteen children, born healthy, and without any indications of a predisposi- tion to consumption, successively carried off by it, between the ages of fifteen and thirty-five. Dr. Clark also informs us, that instances have come under his observation, " where whole families have fallen victims to tuberculous consumption, while the parents themselves enjoyed good health, to an ad- vanced age, and were unable to trace the existence of the disease in their families, for generations back." How are we to account for facts like these ?—Con- NOT ALWAYS HEREDITARY. 117 sumption had a beginning somewhere. This origi- nated, doubtless, in consequence of man's physical tran^-ession. We cannot believe that the wise and benevolent Creator would bring upon man so dreadful a disease, through causes which are not, as a general principle, under his control. True, a child may in- herit the disease from its parents, and so be unable to ward it off; still, its parents or its parents' parents were accountable for the disease ; so that we have, in this matter of hereditary predisposition, an illustration of the principle that " the iniquities of the fathers are visited upon their children unto the third and fourth generation." Should we observe carefully, I have no doubt we might trace, in our great and unhealthy cities, many cases of consumption, where the more healthy parents, who were born and reared up in the more healthy country, had no tendency whatever to the disease. A multitude of causes may operate, a considerable time, upon both parents, which will bring on the disease, where no predisposition to it has ex- isted. A depraved state of the general health in the mother, before and during pregnancy, does often un- questionably exercise a very deleterious influence up- on the new being whose life is so intimately connected with her own; and by this means, we have every reason to believe, tubercles are sometimes formed. There is an important consideration—one which should be deeply pondered, and for which we should be ever thankful to the Author of our being, that inas- much as man, by his physical wrong-doing, brings upon himself so terrible a malady as consumption, so 118 CONSUMPTION. may he, by a correct course of physical management, ward off the disease; in other words, as the tendency of nature is ever downward, under bad influences, so, on the other hand, is her tendency ever upward, un- der the operation of good influences. Intermarriage as affecting consumption.—"Mem- bers of families," says Dr. Clark, " already predisposed to tuberculous disease, should at least endeavor to avoid matrimonial alliance with others in the same condition; but above all they should avoid the too common practice of intermarrying with their own immediate relatives—a practice at once a fertile source of scrofula, and a sure mode of deteriorating the intellectual and physical powers, and eventually the means of extinguishing a degenerated race." It has always been found injurious among the infe- rior animals to allow those which are in any way dis- eased to breed in-and-in, as the term is. So well ap- prised of this fact are breeders of animals, that they are in the habit of introducing frequent crosses among their flocks. If man is so careful in rearing his horses, oxen, sheep, and swine, how much more so should he be in the propagation of his own species. i The remark, that it is a sign of bad luck to marry a relative, has long since grown into a proverb, and, as is true with most other popular proverbs, it is based in wisdom drawn from observation. It was long since observed that, in unions between blood-relations, the various imperfections existing in families, and their morbid predispositions, are exceedingly liable to be perpetuated; and in consequence of the impulse re- ceived from both of the parents, are greatly aggra- INTERMARRIAGE. 119 vated in the offspring. The degeneracy of many royal families might be cited in proof of this doctrine. Burton says, " I think it has been ordered by God's special providence, that, in all ages, there should be, once in six hundred years, a transmigration of nations, to amend and purify their blood, as we alter seed upon our land;" and Sir Humphrey Davy remarks, "You saw, in the decline of the Roman empire, a people enfeebled by luxury, worn out by excess, over- run by rude warriors ; you saw the giants of the North and East mixing with the pigmies of the South aM West. An empire was destroyed, but the seeds of moral and physical improvement in the new race were sown ; the new population, resulting from the alliances of the men of the North with the women of the South, was more vigorous, more full of physical power, and more capable of intellectual exertion than their ap- parently ill-suited progenitors; and the moral effects are final causes of the migration of races, the plans of conquest and ambition which have led to revolutions and changes of kingdoms, designed by man for such different objects, have been the same in their ultimate results^—that of improving by mixture the different families of men. An Alaric, or an Attila, who marched with legions of barbarians for some gross view of plunder or ambition, is an instrument of divine power to effect a purpose of which he is wholly unconscious— he is carrying a strong race to improve a weak one, and giving energy to a debilitated population; and the deserts he makes in his passage will become, in another age, cultivated fields; and the solitude he produces will be succeeded by a powerful and healthy 120 CONSUMPTION. population. The results of these events, in the moral and political world, may be compared to those pro- duced in the vegetable kingdom by the storms and heavy gales so usual at the vernal equinox, the time of the formation ot the seed; the pollen or farina of one flower is thrown upon the pistil of another, and the' crossing of varieties of plants, so essential to the vegetable world, produced." If persons of consumptive tendency marry at all, the opposite party should by all means be as free as possible from all predisposition to this complaint; and the healthier and more hardy in other respects the better. That the Mosaic law relating to marriage of relatives was founded in wisdom, facts abundantly prove. Is consumption a contagious disease?—It may be, and probably is true, that all severe and dangerous diseases have a tendency, greater or less, to produce their kind. It is well known that hysteria, epilepsy, St. Vitus' dance, and catalepsy may be communica- ted by sympathy. The same also might, probably with truth, be said of cholera, and various other dis- eases. But that consumption is contagious, or that it is transmitted directly from one person to another, in any proper acceptation of the term contagious, cannot, I think, be proved. If we take into consideration the great frequency of consumption and other pulmonary complaints confounded with it, we need not be at a loss to account for the seeming transmission of it from one individual to another, if one fourth, one fifth, or even one sixth part of the population die of consump tion. RELATION OF SCROFULA. 121 Many cases will necessarily cccur, however, where one individual will seem to take it from another. But we see husbands nurse their wives, and wives their husbands, parents their children, and children their parents, and yet the survivors do not seem to fall into consumption immediately afterward, unless there has been beforehand a strong predisposition to it. If the husband or his wife dies of this disease, it will, I think, very seldom be found that the other party falls a vic- tim to the disease, unless it has existed beforehand in the system. In Languedoc, Spain, and Portugal consumption : believed to be contagious, and, in accordance with this idea, the clothes of patients who have died of the disease are there burned by the civil authorities. " Morgagni was so frightened at the contagiousness of this disease," says Dr. EUiotson, " that he never opened the body of a person who died of it." Dr. Morton, an English author, considers it contagious. But with very few exceptions, from the time of Hip- pocrates down, consumption has been considered a non-contagious disease. Relation of scrofula to consumption.—Scrofula and consumption are reckoned by most writers as having an intimate relation. It has, indeed, been maintained that true tubercular consumption is necessarily a scrofulous disease. The term scrofula, however, is not well defined; but what is generally termed scrofula is to be regarded as being, in many cases, co-existent with, or an exciting cause of, consumption. Scrofula affects persons most who have fair hair and complexion, fine clear skin, and a predominance of 6 122 CONSLMPTION. the sanguine temperament, such precisely as are most liable to pulmonary disease. Any thing, then, which tends to the production of scrofula, we may consider as being equally productive of tubercular consumption. "Consumption," says Dr. Griscom, "is very often, if not always, a. symptom of a disease which assumes different forms, and is known by the generic term SCROFULA." Bad air as a cause of consumption and scrofula.— M. Baudelocque, a celebrated French writer, who has made the causes of scrofula a subject of careful investigation, and whose opinions have been exten- sively adopted by the best physicians in Europe and the United States, makes the following remarks con- cerning the causes of this disease : " Invariably it will be found, on examination, that a truly scrofulous disease is caused by a vitiated air, and it is not always necessary that there should have been a prolonged stay in such an atmosphere. Often a few hours each day is sufficient, and it is thus they may live in the most healthy country, pass the greater part of the day in the open air, and yet become scrofu- lous, because of sleeping in a confined place, where the air has not been renewed. This is the case with many shepherds. It is usual to attribute scrofula, in their case, to exposure to storms and atmospheric changes, and to humidity. But attention has not been paid to the circumstance that they pass the night in a confined hut, which they transport from place to place, and which guarantees them against humidity; this hut has only a small door, which is closed when they enter, and remains closed also during BAD AIR. 123 the day ; six or eight hours passed daily in a vitiated air, and which no draught ever removes, is the true cause of their disease. I have spoken of the bad habit of Bleeping with the head under the clothes, and the insa- lubrity of the classes where a number of children are assembled together. The repetition of these circum- stances is often sufficient cause of scrofula, although they may last but for a few hours a day." M. Baudelocque cites, in confirmation of his views, the following striking example : " At three leagues from Amiens lies the village of Oresmeaux; it is situated in a vast plain, open on every side, and elevated more than a hundred feet above the neighboring valleys. About sixty years ago most of the houses were built of clay, and had no win- dows ; they were lighted by one or two panes of glass fixed in the wall; none of the floors, sometimes many feet below the level of the street, were paved. The ceilings were low ; the greater part of the inhabitants were engaged in weaving. A few noles in the wall, and which were closed at will by means of a plank, scarcely permitted the light and air to penetrate into the workshop. Humidity was thought necessary to keep the threads fresh. Nearly all the inhabitants were seized with scrofula, and many families, continually ravaged by that malady, became extinct; their last members, as they write me, died rotten with scrofula. A fire destroyed nearly one third of the village ; the houses were rebuilt in a more salubrious manner, and by degrees scrofula became less common, and disap peared from that part. Twenty years later, anothei third of the village was consumed ; the same ameliora 124 CONSUMPTION. tion in building produced alike effect as to scrofula. The disease is now confined to the inhabitants of the older houses, which retain the same causes ot insalubrity." Dr. Guy, of England, in his examination before the health commissioners, affirms, that the deficient ven- tilation or foul air is more productive of consumption than all other causes put together. The results of his inquiries, respecting the causes of this disease, were— " 1. Consumption is relatively more frequent in per- sons working in doors thai: those employed out of doors. " 2. In those employments within doors, it is most frequent with men using little exertion. " 3. It makes its attacks earlier where it is of most frequent occurrence. "4. It is very common in the intemperate, and in those exposed to the inhalation of dust. " 5. It is more frequent in men than women, at least in the city of London." According to Dr. Guy, of the three classes of men, gentlemen (including professional men), tradesmen (storekeepers), and artisans (including laborers of eve- ry class), the cases of consumption stand as the num- bers 16, 28, and 30. " From this it follows," says Dr. Griscom, " that the tradesmen of London (and they are pretty similarlv circumstanced in New York, and the other cities of this country), are nearly twice as liable to consumption as the gentry. This great mortality, Dr. Guy mainly attributes to the confinement, during so many hours of every day in ill-ventilated shops. In large cities, the tradesmen and shopmen suffer occasionally from the way in which they are lodged or housed. They give BAD VENTILATION. 125 up to their business all the space they can command. and let the upper part of their houses to lodgers, liv- ng themselves in small back rooms, connected with their stores, which rooms are no larger or better ven- tilated than those of the poor. This leads to much sickness among them. ' It is,' continues Dr. Guy, ' only within a few days that a London tradesman gave me this account of himself: He had been origi- nally a workman, and, having saved a little money, opened a small store in a back street. For some years he slept in a small, close back room, behind his shop, and during the whole time was subject to frequent at- tacks of cold, with affection of the chest. These at- tacks were often so severe as to require medical advice and attendance, for weeks together. He has since moved into an open, airy situation, with ample accom- modation for himself and family, and he is not only rarely subject to colds, but these, when they do occur, are readily cured by the most simple means. He states that he saves, in this way, a large sum previ- ously expended on medicine.'" It is well known that farmers, who are exposed almost constantly to the invigorating effects of air, light, and exercise, seldom die of consumption. "Were I to select two circumstances," says Sir James Clark, " which influence the health, especially during the growth of the body, more than any others, and concerning which the public, generally at present most ignorant of them, ought to be well informed, they would be the proper adaptation of food to difference of constitution, and the constant supply of pure air for respiration 126 CONSUMPTION CHAPTER XIV. The causes of consumption continued.—Want of light.—Light as im- portant to animal bodies as the vegetable.—Interesting and impor- tant facts in corroboration of this doctrine.—Consumption is found most among those who inhabit the darkest places of cities.—Effects of insufficiency of food.—Excessive alimentation.—Its effects illus- trated by various facts. Want of light.—As light is one of the most impor- tant agents in the growth and well-being of the vege table'productions of the earth, so, also, it is not less important in the animal. If tadpoles be nourished with proper food, and at the same time be exposed to a constantly renewed contact of water, so that their respiration may be fully carried on, while they remain in their fish-like condition, and at the same time be deprived entirely of light, their growth continues, but their metamorphosis into the condition of air-breath- ing animals is arrested, and they remain in the con- dition of a large tadpole. So the rapidity with which water-flies, and other insects of pools, undergo their transformation, is found to be much influenced by the amount of light to which they are exposed. If equal numbers of the eggs of the silkworm be preserved in a dark room, and exposed to common daylight, a much larger number of them are hatched from the latter than the former. It has been observed, too, that a remarkable free- WANT OF LIGHT. 127 dom from deformity is to be found among those na- tions that weai but little clothing, thus leaving the system more exposed to the influence of air and light; while on the other hand, those who are much confined within doors, or are born and brought up in cellars, mines, narrow and dark streets, and like places, de- formity is much oftener found. " It has been stated by Sir A. Wylie, who was long . at the head of the medical staff in the Russian army," says Dr. Carpenter, "that the cures of disease, on the dark side of an extensive barrack at St. Petersburgh, have been uniformly, for many years, in the propor- tion of three to one, to those on the side exposed to strong light. And in one of the London hospitals, with a long range of frontage looking nearly due north and south, it has been observed that a residence in the south wards is much more conducive to the welfare of the patient, than in those on the north side of the building." In accordance with these facts, we find that con- sumption goes most among the inhabitants of the dark parts of the cities. It is to be observed, too, that fe- males, who are less exposed to light, because of their remaining more in-door than males, are also more subject to consumption. By referring to the tables of M. Benoiston de Chateauneuf, quoted in another part of this work, it will be seen that rag-pickers, stone- quarriers, stone-cutters, and carpenters, all of whom are much exposed to the influence of light, have a low average of mortality from consumption. As I have remarked elsewhere, it is well known that farmers, and all such persDns as are exposed almost constantly 128 CONSUMPTION. to the open air, vigorous exercise, and light, are of all persons the most free from consumption. Insufficiency of food.—In the old country, a want of proper food often becomes a cause of consumption. Among the poor of the European cities, where con- sumption is so exceedingly prevalent, meagreness of diet is to be considered as one of the most prolific among the many causes of the disease; but in our own country, an insufficient supply of food cannot properly be reckoned among the causes of consump- tion, although such cases may now and then happen. Even in our almshouses, which are peopled mainly by the offscouring of almost all nations, there is far more harm from excess, than from a restricted supply of nourishment. Excess in food.—This has not generally been reck- oned as among the causes of consumption; but inas- much as excessive alimentation may become a cause of a great variety of diseases, so also, we have every reason to believe, it may become a cause of consump- tion. That able writer, Sir James Clark, well re- marks, on this subject, that " proper food (as well as improper), when taken in excess, or of too exciting a quality, may also induce tuberculous cachexia in youth—a circumstance which is not sufficiently at- tended to, I may say not generally understood, even by medical men; nevertheless, I hold it to be a fre- quent cause of scrofula. Imperfect digestion and ex- citement of the digestive organs, in the one case, and inadequate supply of nourishment in the other, lead ultimately to a similar state of disease; the form and general character which it assumes may differ, but in EXCESS OF FOOD. 129 both cases the result may be the same. The adapta- tion of food, in quantity and quality, to the age of the individual, as well as to the powers of the digestive organs, is too little considered, and the evil conse- quences of this neglect are often evinced in the chil- dren of the wealthy classes, who are frequently al- lowed an unrestricted use of the most exciting kinds of animal food, than which there cannot be a greater error. By a too stimulating diet at this early age, the digestive organs become over-excited ; the biliary and other secretions, connected with digestion, are dimin- ished ; congestion of the abdominal circulation ensues ; and the skin, sympathizing with the irritation of the internal surface, becomes dry and harsh; and cuta- neous eruptions, or copious perspiration, are common consequences. The ultimate effect is often tubercu- lous disease, which is generally attributed to imperfect nourishment; and on this erroneous view, steel and other tonics, and stimulants, are often prescribed, by which the evil is increased. So all-pervading are the errors concerning the effects of excessive alimentation, and of too great con- centration in food, in our country generally, I will proceed to remark at some length on these evils. It is a well-ascertained law of the animal economy, that food, to be healthy, must contain a considerable portion of matter that is wholly indigestible and innu- tritious. Thus, Magendie, the physiologist, found that dogs, fed upon sugar, gum arabic, butter, olive-oil, and some other articles of rich or concentrated nature, each given to the animals separately, with pure water, they verv soon lost their appetites, began to droop 6* 30 CONSUMPTION. became emaciated, were attacked with ulcers, and died, invariably, within the space of four or five weeks. Fed upon superfine flour-bread and water, they lived uniformly about seven weeks, varying only a day or two. When fed upon coarse or military bread, such as contained either the whole or a considerable por- tion of the bran, the dogs thrived perfectly well, and were found in no respect to suffer. The same truth has often been illustrated on shipboard, at sea. In many cases, where the hay and straw have been swept overboard, it has been found that the animals, in a few days, famished, unless some innutritious sub- stance, as the shavings of wood, was mixed with the grain given them. The animals have been observed to gnaw at the spars and timbers, or whatever wood they could lay hold of; and thus the idea was sug- gested, that the grain alone was of too rich a nature for their sustenance. The same principle holds good in reference to the health of the human body; and, as a general fact. food, in civilized life, is of too concentrated a quality. This is particularly true in those parts of the world where an abundance can be had; in other words, in the more civilized and enlightened parts of the world. A host of diseases, both acute and chronic, are either caused or greatly aggravated by concentration in food. Indigestion, with its immense train of evils, constipation, loss of flesh, corpulency, nervous and general debility, torpor, and sluggishness of the gene- ral system are the principal roots of all diseases in the human family; and these are among the difficul- ties caused by too great richness in food Children EXCESSIVE ALIMENTATION. 131 are often injured in this way. Mothers, in their kind- ness, think nothing too good for their little ones. In many parts of our country, the infant at the breast is taught to suck at its piece of pork, or other fat meat. Sugar, sugar-candy, sweetened milk, superfine bread, and rich pastries are all given for the same reason, by mothers and nurses, in their mistaken kindness. Children reared in this way can never be healthy for any considerable length of time, are generally very puny and weak, and often die within two or three years of birth. Scrofulous and other ulcers are fre- quently thus caused, and so also those derangements of the stomach and bowels, which so often, in spite of the best remedial means, sweep these little sufferers from their earthly existence; and this at the very time when their growing minds begin to gladden the parent's heart. There is great and prevailing error upon this subject, and happy are those parents who take it upon themselves to gain wisdom in the most important matter of food. Sedentary and studious persons, and especially young ladies at seminaries and boarding-schools, suffer much from the effects of superfine bread, and other forms of concentrated food. Constipation, which is always attended with unpleasant results, is very com- mon among this class of persons; one of the greatest causes of that state of health being too great richness in food. The effects of superfine flour were strikingly illus- trated in the case of a crew of seamen belonging to Providence, R. I. The narrative was quoted from Graham's Science of Human Life, and is as follows: 132 CONSUMPTION. " Captain Benjamin Dexter, of the sh'p Isis, belong- ing to Providence, R. I., arrived from China in Decem- ber, 1804. He had been about 190 days on the pas- sage. The sea bread, which had . onstituted the prin- cipal article of food for his hands, was made of the best of superfine flour. He had not been long at sea before the men began to complain of languor, loss of appetite, and debility. These difficulties increased during the whole voyage, and several of the men died on the passage from debility and inanition. The ship was obliged to come to anchor about thirty miles below Providence; and such was the debility of the hands on board, that they were not able to get the ship under way again; and the owners were under the necessity of sending men down from the city of Providence to work her up. When she arrived, the owners asked Captain Dexter what was the cause of the sickness of his men, to which he answered, " The bread is too good." Cases of similar kind have elsewhere been known to occur. Sailors, the world over, are generally fur- nished with brown sea bread, much to the advantage of this useful class of men, did they but know it; and their health is proverbially good while they are away from the temptations upon land. These hardy, weather-beaten men are subjected to many healthful influences other than the use of coarse bread, but, on the whole, their dietetic and other hygienic habits need greatly to be improved; still, compared with the mass of mankind, they are remarkably healthy. Every one who is aware of the importance of a certain degree of '.nnutritiousness in food, must lament EXCESSIVE ALIMENTATION. 133 ma*7 of the so-called improvements of modern times. Who can think of the good dishes our New England mothers used to prepare, homely and plain, as the fas- tidious would now consider them to be, and not desire earnestly that such days of simplicity might again re- turn to us ? As things are, if a person travels from home, or visits among friends, almost every dish that is set before him is of a form so concentrated as to be positively injurious. At the best hotels and boarding- houses, upon the floating palaces that glide upon our waters, and in our splendid ships that traverse the seas, the evil we speak of is generally prevalent. Now, in view of all these pernicious practices- practices, too, which are so common in our country at the present day—who does not see that the increase of that most fearful of all maladies which have ever afflicted the human race, is owing in great part to excess in quantity, and in too great richness of food. When the world has long enough quailed under the strong hand of disease, may we not hope that a better state of things will exist? that the race will again return to nature, and thus become free ? J 34 CONSUMPTION. CHAPTER XV. Causes of consumption continued.—Deficient exercise.—Its effects.— Excessive labor.—The latter a less frequent cause of disease than the former.—Over-exertion of the lungs in public speaking, singing and playing on wind instruments.—A due degree of exercise of the vocal organs highly conducive to health.—Excessive mental labor. —Erroneous notions concerning the education of the young.— Clothing.—Females are most liable to suffer from improper dress.— Errors of mothers on thi3 subject.—Want of cleanliness.—Spiritu- ous drinks.—Spirit drinkers are very liable to consumption. Deficient exercise.—According to all well-ascertained facts, it is found that those who are engaged in laborious occupations, are, as a general rule, the least liable to consumption. Farmers are proverbially free from the disease. Sailors, also, seldom experience it. According to the tables of M. Benoiston de Chateau- neuf, drawn from observation in four of the largest Parisian hospitals, it will be seen that those who are engaged in the most laborious occupations, such as blacksmiths, locksmiths, stone-sawyers, stone-cutters, stone-quarriers, carpenters, masons, and laborers were the most free from consumption. On the other hand, such as were subject to in-door occupations, and especially those in which a part of the system was mainly exercised, such as jewelers, tailors, shoe- makers, polishers, embroiderers, seamstresses, glove- makers, etc., the proportion of deaths by consumption was very large. If a due supply of proper food and pure air is OVER-EXERTION OF , UNGS. 135 necessary to the growth and well-being of the human body, habitual exercise in the open air is not less so. "Without exercise," says Sir James Clark, "we have abundant proof that there cannot be sound health, more particularly in early life." Excessive labor.—This, too, may become a cause of consumption. Doubtless, among farmers of many parts of our country, the youth are in the habit of work- ing too hard. Excessive labor, particularly at an early age, exhausts and debilitates the system, and checks the full growth and development of the body; especially when this labor is carried on in confined apartments, and in impure air, are its effects more decided. But a deficiency of physical labor, far oftener than too much, is a cause of disease. Over-exertion of the lungs in public speaking, sing- ing, and playing on wind instruments, etc.—A due degree of exercise of the organs of speech, the lungs, and other parts concerned in the vocal functions, is highly conducive to health. Such exercise calls the muscles of respiration into free action, thus aiding to produce a full expansion and development of the chest and lungs. But as any other part of the system may be injured by excessive exercise, so also the lungs. Violent efforts in playing on wind instruments, and in public speaking, and especially if these efforts are periodical, and at considerable intervals, are, without great care, necessarily prejudicial to those who are predisposed to pulmonary disease. But reading aloud, from day to day, and frequent public speaking, when not carried to excess, are excellent means for invigorat- ing the lungs. It is particularly necessary here to 136 CONSUMPTION. understand how to distinguish between the use and abuse of a valuable means. Excessive mental labor.—Too much exertion of mind, as well as of body, is not unfrequently produc- tive of harm to the constitution. Excessive mental labor operates injuriously in two ways. First, the sensorial power of the system becomes exhausted by too long application to study and books. And sec- ondly, the body becomes debilitated by the want of exercise in manual occupations. The notions of many are altogether wrong, as re- gards education of the young. Weakly boys, parents suppose, may be sent to school and prepared for a pro- fession. The weakly may become, too, a teacher, a ?lergyman, or a lawyer, or a merchant's clerk, it is supposed, while the stronger ones are kept at, home upon the farm. Now this is all wrong. The profes- sions of divinity, law, and medicine are all harder upon the constitution than the occupation of farming, or other active out-door employments. Therefore it is that the stronger should enter these professions, and not the weaker. And the professional man should remember that he can accomplish more with his brain, if he will do daily a certain amount of physical work. The elder Rev. Dr. Beecher was, we are told, in the habit daily of sawing wood for exercise; and he holds that such exercise was indispensable, in order to success in the ministerial avocation. Clothing.—The subject of clothing has become cer- tainly a very common one ; but yet there is, I appre- hend, little danger of overdoing the subject. So long as people will continue to dress improperly, so long CLOTHING. 137 should there be those who raise their voice against the practice. Ladies, more especially, are liable to suffer from er- roneous practices in regard to clothing. Generally, too great an amount is worn; then to attend a thea- tre, a ball, or party, or wedding, a great change is made. Their stockings and delicate shoes are all of a sud- den changed for less substantial ones. The same general change is made in the dress. Who does not know that by these improper changes cold is often taken that lasts for weeks and months, and in not a few instances becomes the foundation of in- curable disease, ending, in some instances, very soon in death. Mothers are greatly at fault in this matter. Great changes in regard to dress should never be made sud- denly, even with persons in health. So impressed with the importance of this rule was one great physician, that he laid down as a maxim that all who wear flan- nels should, in the warmest of the summer, throw it off one day and resume it the next. Now I repeat again, there is generally far too much clothing worn; but all changes, to a less amount, should be made in connection with cool or cold bathing; and always gradual, if it may be. Many a cold is received, when, if at the making the change the cold bathing, followed by exercise, had been practiced, the individual would have been safe. The practice of wearing dresses low at the neck is often prejudicial to health. About the waist there is worn a half a dozen or more thicknesses, while low about the neck there are none at all. At another 138 CONSUMPTION. time, perhaps, the same person will have the neck warmly clad. These changes are not good, as a gene- ral thing, and persons have often received injury by making them. The skin is truly a breathing organ; hence cloth- ing should never be so tight as to prevent the ex- posure of air to the surface. As a general fact, the more loose and flowing clothing is, the better for health. Want of cleanliness.—Among the most filthy and degraded people of large towns and cities, we al- ways find the most consumption and kindred dis- eases ; hence we must set down uncleanliness as one among many of the prolific causes of consump- tion. Spirituous drinks.—Spirit drinkers are often af- fected with a cough. This is particularly troublesome when Jie first rises in the morning. Any thing which injures the general health, as all forms of spirituous drinks do, and especially any thing that excites a cough, is very liable to become a cause of pulmonary disease. " While this pernicious habit," says Sir James Clark, " is one of the most powerful means of debasing the morals of the people, and of extinguishing the best feelings of human nature, it is no less fatal in destroying the physical constitution. There is good reason to believe that the abuse of spirituous liquors among the lower classes in England, is productive of consumption, and other tuberculous diseases, to an ex- tent far beyond what is generally imagined. The bland, cadaverous aspect of the spirit drinker bespeaks the condition of his internal organs. The tale of his moral SPIRITUOUS DRINKS. 139 and physical degradation is indelibly written on his countenance. The evil, unfortunately, does not rest with himself by destroying his own health, but entails on his unhappy offsp:ing the disposition to tubercu- lous disease." HO CONSUMPTION. CHAPTER XVI. Causes of consumption continued.—Mercury.—General effects arfthis drug,—it exerts a very deleterious influence upon those who are predisposed to consumption.—Abuse of medicines generally as a cause of tuberculous disease.—Drugs are used to great excess by the American people.—Tea and coffee.—These injure the general health, and may therefore aid in causing tuberculous disease.— Tobacco.—Its narcotic and poisonous effects on the living body.— Hard water as a cause of disease.—Scrofula in Vermont.—Pure soft water far more healthful than that which is hard. Mercury.—Dr. Clark observes that mercury, when used so as to affect the system, has been very gener- ally considered as capable of inducing tuberculous disease. " I am inclined," says he, " to believe this; and therefore consider that in persons of a delicate or strumous constitution, its use requires the greatest caution and circumspection." If mercury is capable of producing dropsy, as is stated by Sir Astley Cooper, or enlargement of most of the glands of the body, as according to Dieterick, or sloughing and ulceration of the gums and throat, as according to Sir Astley Cooper and many others, or mercurial leprosy, as is stated by Moriarty, or mercurial fevers and saliva- tion, as is stated by numerous authorities, or mercu- rial tremors, or palsy, as according to Dr. Christison, or mercurial wasting of the bowels, as has been often observed, or a rotting and decaying of the bones, a fact well known to medical men—I say, if mercury MERCURY. 141 may cause all these evils, which it does, with a host of others, too numerous to mention, we may easily believe in the existence of the mercurial wasting, de- scribed by Travers as known " by irritable circulation, extreme pallor and emaciation, and acute and rapid hectic, and an almost invariable termination in pul- monary consumption." According to experiments, made in France by Cou- veelhier, on dogs, in which crude mercury was in- jected into the lungs through the air-tubes, and into the cellular textures of other organs, tubercles, with a globule of mercury in their centre, was the result. "In the year 1810,"says Dr. Sweetser, " a large quan- tity of quicksilver was taken from the wreck of a Spanish vessel, on board the English ship Triumph, of seventy- four guns, and the boxes principally stowed in the bread-room. Many of the bladders, in which it was confined—owing to the heat of the weather, and to having been wetted during their removal—soon rot- ted, and several tons of the mercury were diffused through the ship, mixing with the bread, and more or less with the other provisions. The consequence was, that very many of the officers and crew experi- enced severe salivations, and other deleterious effects, from the mercury that was taken into their systems, two dying from its influence ; and that nearly all the live stock, as well as cats, mice, a dog, and even a canary bird, died. "But how did it affect the lungs? The account informs us that the mercury was very deleterious to those having any tendency to pulmonic affections; that three men, who had previously manifested no in- 142 CONSUMPTION. disposition, died of pulmonary consumption ; and that one man, who had before suffered from lung-fever, but was entirely cured, and another, who had had no pul- monic complaint before, were left behind, at Gibraltar, with confirmed phthisis." Abuse of medicines generally.—If mercury is known to produce such disastrous results on the constitution, we may readily suppose that other powerful drugs may do the same. Iodine, an article much used at the present day, is a substance which, when taken for a continuance, pervades the whole system, and is no doubt often a prominent cause in the development of consumption. Those people who are the most sickly, we find, as a general fact, are most in the habit of taking medicines; and those who take the most medi- cines are most liable to consumption. If we are any where to regard the maxim of Hoffman, " avoid physic and physicians if you value health," it is in reference to tubercular consumption. If the American people are more energetic than all other nations in money-making and general handi- craft ; and if they are, on the whole, more independent than any other people, so, also, are they more perse- vering in the use of the thousand-and-one nostrums and quack medicines of the day. It was well said, a few years since, by in eloquent lawyer in the legis- lature of the State of New York, sarcastically it is true, " that with all our keen-sightedness, adroitness, skill and ingenuity in all we undertake, we are, per- haps, the most easily humbugged nation in the world. In nothing is this alacrity to be deceived more fully manifested than in the never-ending, still-beginning, FEA AND COFFEE. 143 doctor-still, and still-destroying patent medicines. Perhaps one fourth of the advertising patronage of the country newspapers consists in puffing patent medi- cines, and this great tariff is levied on credulity af- flicted with disease. If there were truth in the adver- tisements of a single paper, attested by the learned, the wise, and the pious, there is not a disease to which poor humanity is heir, but what is susceptible of speedy relief and ultimate care." Who does not know that there are, all over our States, multitudes of consumptive persons who are every day reading those infamous advertisements, which are every where put forth in this country of more newspapers than the whole world besides, and catching at the promises of the infernal quack-venders like a drowning man catching at a straw ? I have just been consulted by an elderly lady of a rich family in the city of New York, who acknowledges that she has for years been watching the papers, and has tried every thing in which the advertisers have promised relief. Evidently, consumption of the lungs will soon number her days, and this, too, although she was not hereditarily predisposed to it. Tea and coffee.—-If tea and coffee are sufficient, as facts abundantly prove, to cause, in their worst forms, tremulousness, hysteria, hypochondriasis, depression of spirits, sick headache, palpitation of the heart, pale- ness and sallowness of complexion, and decay of the teeth, we may safely infer—nay, more, we know posi- tively, that these articles are to be reckoned among the many causes of consumption. It was well said by old Dr. Baynard, "In no one thing do people exhibit 144 CONSUMPTION. more ignorance than in the rearing of that noble creature, man." Tobacco.—Tobacco, or Nicotiana Tabacum, belongs to the same natural order as Atropa Belladonna, and which is commonly known by the name of deadly night-shade, and the Datura Stramonium, or thorn- apple, both of which are among the most powerful and deadly of the acro-narcotic poisons. Hence we may infer that the constant use of this article must be capable of producing powerful effects on the living >ody. " From the habitual use of tobacco, in either of its forms—of snuff, cud, or cigar," says Professor Mussey, " the following symptoms may arise : a sense of weakness, sinking or pain at the pit of the stomach, dizziness or pain in the head, occasional dullness or temporary loss of sight, paleness and sallowness of the countenance, and sometimes swelling of the feet, enfeebled state of the voluntary muscles manifesting itself sometimes by tremulousness, weakness, squeak- ing, a hoarseness of the voice, rarely a loss of voice, disturbed sleep, starting from early slumbers with a sense of suffocation, or feeling of alarm, incubus or nightmare, epileptic or convulsive fits, confusion or weakness of the mental faculties, peevishness and irri- tability of temper, instability of purpose, seasons of great depressions of the spirits, long fits of unbroken melancholy and despondency, and, in some cases, entire and permanent mental derangement." "To- bacco," says Dr. Woodward, " is a powerful narcotic agent, and its use is very deleterious to the nervous system, producing tremors, vertigo, faintness, palpita- tion of the heart, derangement of the stomach, and HARD WATER. 145 other serious diseases. Judging from such authority, we may readily believe the statement of the great Dr. Rush, that he once lost a young man, seventeen years of age, of a pulmonary consumption, whose disorder was brought on by the intemperate use of cigars. Hard water.—Hard water, which is generally abundant in the vicinity of mountains, is supposed to be productive of bronchocele (a peculiar tumor or swelling on the outside of the throat), which is to be regarded as a scrofulous disease. If this supposition is true, we may readily suppose that consumption, a kindred disease to scrofula—a scrofulous disease al- ways, as some would have it—may also be caused in many cases by the use of hard water. Evidently this may be reckoned among one of the causes of con- sumption. There appears to be a great amount of scrofula in the state of Vermont; and although this section of country is celebrated for its purity of air and exemption from marshes and malarious emanations, yet there appears to be a vast deal of scrofula and consumption in this state. There are now and then to be found springs of remarkable purity, but still the greater proportion of the springs, streams, and rivulets, which are to be found in such abundance in the Green Mountain country, are generally, so far as I have observed, very hard. All experience proves that the constant use of hard water in connection with other bad habits, is decidedly pernicious to the constitution. Hence there is reason to believe, as some physicians have done, that the use of water holding in solution large quan- tities of salts, such as lime, soda, etc., is to be regarded 7 146 JONSUMITION. often as a cause of scrofula, tubercles, and consump- tion. But some may here ask, if hard water is so deleterious to the constitution, why should it have been placed almost every where apparently for the use of man. To this I answer; first, an abundance of water falls from the clouds upon every man's house; and which, by the exercise of a little ingenuity, may be easily retained for use. Secondly, if we live upon the natural food of man, the farinacea and fruits, and avoid flesh meats and stimulants of whatever kind, thirst is seldom experienced at all. Living in this way, many persons have passed weeks, months, and some even years, without drinking or thirst. Evi- dently, however, water is man's natural drink, and if he exercises a moderate degree of ingenuity, there can be no excuse for his using water which is hard. DEPRESSING .'A3SIONS. 147 CHAPTER XVII. Causes of consumption continued.—Suppression of habitual discharges. —The depressing passions.—Striking examples given by Laennec. —Sexual abuses.—Haemorrhage from the lungs.—Inflammation of the lungs.—Bronchitis and sore throat.—Opinions of various writers on this subject.—Influenza.—Fevers.—Small-pox, scarletina, and measles.—Their influence in developing tubercular disease.—Indi- gestion. Suppression of habitual discharges.—A sudden sup- pression of the menstrual discharge, as by taking cold, has been known to develop latent consumption. Doubtless, too, this might, in connection with bad habits generally, become a prominent cause of bring- ing on the disease, even where a predisposition to it did not before exist. A sudden check of perspiration from exposure to cofd, the checking of long-established cutaneous eruptions by stimulating washes, ointments, etc., and the healing up of old ulcers and fistulous openings may also develop this disease. These things act as a cause of consumption, more particularly where there is a predisposition to it. The depressing passions.—" Mental depression," says Sir James Clark, "holds a very conspicuous place among those circumstances which diminish the powers of the system generally; and it often proves one of the most effectual determining causes of con- sumption. Disappointment of long-cherished hopes, slighted affections, loss of dearer relations, and re- verses of fortune," continues this able writer, " often 148 CONSUMPTION. exert a powerful influence on persons predisposed to consumption, more particularly in the female sex." Who is not familiar with the melancholy examples of consumption following close on the death of some near relative, some bosom friend, or disappointed and unrequited love? Laennec records a striking example of the effect of the depressing passions, which example was ten years under his immediate observation. The account, as translated by Professor Sweetser, is as follows : " There existed, during the time mentioned, at Paris, a recent religious community of women, who, on ac- count of the extreme severity of their regulations, had obtained only a conditional toleration from the eccle- siastical authority. Their diet, though austere, yet did not exceed what the powers of nature could endure. But the rigor of their religious rules was productive of effects both melancholy and surprising. Their attention was not only habitually fixed on the most terrible truths of religion, but they were tried by all kinds of opposi- tion to induce them, as soon as possible, to renounce entirely their own proper will. At the end of one or two months, the catamenia (menses) were suppressed ; and in one or two months more, phthisis was evident. They not being bound by vows, I urged them, on the first manifestation of the symptom of the malady, to quit the establishment; and almost all who followed the advice were cured, though many of them had al- ready exhibited evident signs of phthisis. During the ten years that I was physician to this household, I saw it renewed two or three times by the successive loss of all its members, with the exception of a very small SEXUAL ABUSES. 149 number, composed principally of the superior, the grate-keeper, and the sisters who had the care of the garden, the kitchen, and the infirmary; and it is worthy of remark that these persons were those who had the most frequent distractions from their religious austerities, and that they frequently went out into the city on duties connected with the establishment." It will, of course, be readily understood, that in all cases of this kind there are other causes besides that of mental depression merely, such as want of exercise, deficient ventilation, improper food, and the like, all of which aid in the production of the disease. Sexual abuses.—If solitary vice, that one of the greatest of human curses, is sufficient, as is testified bj Dr. Woodward, to cause idiocy, the most deplorable of all the forms of insanity, oftener than all other causes put together; if it is sufficient to cause an amount of depression of spirits, melancholy, dissatis- faction with life, and a waste of the strength of both body and mind to a most deplorable extent, as is often witnessed, we may well understand that this unseemly practice may often become a cause of consumption ; nay, such must inevitably be the result. So, too, con- nubial excesses often develop this disease, as may be inferred tiom the fact that we often see the newly- married pass rapidly into hopeless decline. " I have seen many young men die of phthisis," says Dr. El- liotson, " a twelvemonth after their marriage, although they have shown no signs of it before.'' Many a young man, too, in great cities—those hot-beds of pollution and of vice—has often, by a ca- reer of licentiousness, been brought early to the con- 150 CONSUMPTION. sumplive's grave. If a young man contrac most loathsome of all diseases, which arises froi tious habits, and if then, superadded to this, he is generally the case, a course of medical treatment, by which the system is saturated with mercury, iodine, and like medicines, he may be very thankful if he does not pass into a rapid consumption, or some other de- cline equally fatal. But whatever may be the result, he will find to a demonstration, which he will not soon forget, that, " The way of the transgressor is hard." Haemorrhage from the lungs.—People are generally much alarmed at raising blood. It is often difficult, and many times impossible, to tell from whence the blood comes; nor does this make any great difference. Bleeding from the stomach indicates quite as bad a state of things as bleeding from the lungs. But I am satisfied that pulmonary haemorrhage, or the spitting up of blood, is, in many instances, by no means so unfavorable an omen as is generally supposed. I have known, in my practice, many who have bled from the lungs, and have yet afterward recovered health. I have been myself surprised, over and again, to see with what facility persons have, by proper treatment, outgrown difficulties of this kind. Yet it should be remembered that a bleeding from these important or- gans always indicates a wrong state of things, not only in them, but in the system generally ; and that, there- fore, no pains should be spared in doing all in our power to regain health, to fortify and invigorate the general system. Inflammation of the lungs.—That inflammation of the lungs often precedes the development of consump- BRONCHITIS and sore throat. 151 tion, and that such inflammation may result in ulcera- tion of these parts (which, although it is not really consumption, according to the modern acceptation of the term, but may yet cause death), is plainly true; but that such inflammation produces tubercles, there is no proof. But this has been the common doctrine among medical men. Inflammation of the lungs rarely affects both sides of the chest at a time, while con- sumption generally affects both lungs. Males are more subject to pulmonary inflammation, while fe- males are more subject to consumption. But although tuberculous matter is never the result of inflammation, it should be remembered that tuber- culous subjects are more liable to inflammation than others. Hence, all persons who are predisposed to consumption, and such especially as those in whom we have reason to suspect that tubercles already exist, cannot be too careful in avoiding all causes of pulmonic inflammations. Such inflammation never fails to increase the mischief in those who are already laboring under tuberculous disease, and often serves to convert that which was before latent, and might in all probability have been kept in check for many years, into an active state of disease. Inflammation pro- motes the softening, or maturation, of tubercles, and thus hastens on their fearful work. Bronchitis and sore throat.—Irritation and inflam- mation of the mucous membrane of the larynx, pha^ rynx, and adjacent parts, or, in other words, the throa- and trachea, or wind-pipe and bronchise (divisions of the trachea passing into the lungs), is supposed to be often the cause of tubercular consumption. Probably no 152 , CONSUMPTION. affection whatever so commonly precedes it as throat and bronchial irritation. The pulmonary mucous membrane of tuberculous persons, is certainly very susceptible to the impressions of cold, moisture, vicis- situdes of temperature, mechanical irritants conveyed into the air passages during respiration, and all those causes generally, which, in the nature of things, tend to produce irritation and inflammation of the part. Tubercles, too, often prove a source of bronchial mu- cous irritation, long before their presence can be de- tected by other symptoms. Repeated attacks of throat and bronchial inflammation, or the long-con- tinued application of mechanical irritants to the mu- cous membrane of the air passages, it should be re- membered, are very apt to prove exciting causes of consumption, especially when a constitutional predis- position to it exists. Dr. Cullen regarded that consumption is liable to follow catarrh, or cold of the throat and lungs, only in constitutions already predisposed to it. " The be- ginning of consumption," he says, "so often resembles a catarrh, that the former might have been mistaken for the latter." Besides, to increase the fallacy, it often happens that the application of cold, which is the most frequent cause of catarrh, is also frequently the exciting cause of the cough which proves the be- ginning of consumption. Louis, the celebrated French writer on pulmonary diseases, considers that the influence of pulmonary catarrh, in the production of consumption, is no bet ter demonstrated than that of lung-fever, or inflam mation of the lungs; and he affirms that females, who, INFLUENZA. 153 according to his observation, are more exposed to consumption than males, are less subject to pulmonary catarrh, or colds. Andral holds, that if inflammation of the lining or mucous membranes, or the air passages, be followed by the production of pulmonary tubercles, it is necessary to admit a predisposition to them. In view of this subject, then, it should be remarked that persons who are subject to the taking of cold in the throat and lungs, ought not to be alarmed at every trifling occurrence of the kind; although it is always better that such attacks should, as far as possible, be prevented. It should likewise always be remembered that in cases where a predisposition to pulmonary con- sumption is known to exist, a comparatively trifling cold may become a cause of exciting into action a fa- tal onset of the disease. At the same time, let no one blame himself when he knows he has been careful, and has avoided all possible causes of taking a cold, and yet finds such symptoms coming upon him ; for con- sumption may be unavoidable in his case, and its be- ginning, in spite of all human means, must often be pre- cisely like what appears the taking of an ordinary cold. Influenza.—This disease, especially when epidemic, appears to sometimes hurry on to a final termination cases of chronic consumption. Those who have long la- bored under coughs, and other symptoms of pulmonary disease, have been frequently observed to die during this epidemic Influenza may doubtless aid tubercular in- flammatory action, and the softening or maturation of tubercles in the lungs; but that it can directly cause them, we have no reason to believe. The same prin- 7* 154 CONSUMPTION. ciple holds g->od here, as in inflammation of the lungs, bronchitis, and the like. It is not believed that any of these are sufficient, however, of themselves, to pro- duce tubercles, although they may produce ulcera- tions of the lungs, and such as may lead to a's fatal a termination as if tubercles existed. Fevers.—Fevers, of whatever kind, whether contin- ued, remittent, intermittent, bilious, or typhus, appear, generally, to hasten on the fearful work of consumption, where a strong predisposition, to it exists, and in cases of inflammation of the lungs and air passages generally. We have no proof, however, that fever is a direct cause of tuberculous consumption. It only operates by call- ing into action tubercles which already exist, or a tu- berculous disposition of the individual. The eruptive fevers, as small-pox, scarletina, and measles, appear often to develop this disease. Hence, 1 may remark, too great care cannot be paid to the proper treatment of this disease. The barbarous modes of stimulating such patients, keeping them in heated rooms, and under feather beds, in these diseases— modes which have been practiced to so great extent, for the last two centuries, cannot be too strongly deprecated. Doubtless many a patient has been thrown into consumption by these means, and in which, if they had been treated by the cooling plan, which may be emphatically styled " nature's method," the terrible malady would have been, for a time at least, kept off. Indigestion.—This has, by many, been regarded as one among the multiform causes of consumption. It would, doubtless, be difficult, if not impossible, to INDIGESTION. 155 prove that tubercles are ever caused by indigestion. But we know that bad food, bad air, and bad influ- ences generally, are sufficient to generate tuberculous disease. As bad food, then, causes indigestion, we must regard this latter as bearing an important relation to tubercular consumption. 156 CONSUMPTION. CHAPTER XVIII. The causes of consumption concluded.—The different occupations.— Tables of M. Benoiston, made from observation in four of the Pari- sian hospitals, namely, L'Hotel Dieu, La Charite, La Pitie. and L'Hospice Cochin.—Results in occupations which expose the lungs to the action of an atmosphere loaded with vegetable dust.—Those which expose the lungs to the action of an atmosphere loaded with mineral particles.—Those which expose the lungs to the action of an atmosphere loaded with animal dust.—Occupations which ex- pose the lungs to the action of an atmosphere loaded with hurtful vapors.—Those which expose the body, and particularly the feet, to the action of damp.—Occupations in which the muscles of the chest and arms are subject to a constaut and fatiguing exercise.— Those in which the muscles of the arms and chest are subjected to constant motion while the body is maintained in a bent position.— Recapitulation of the more prominent causes of consumption. Occupation as a cause of consumption.—We have but few well-arranged tables in medical literature that are calculated to give light on the important subject of the effect of different occupations in causing con- sumption. The most valuable ones which I have any where seen are those of M. Benoiston de Chateauneuf, drawn from observations in four of the Parisian hos- pitals, namely, L'Hotel Dieu, La Chaiite, La Pitie, and L'Hospice Cochin, during ten years, namely, from 1817 to 1827. For these tables I am indebted to a very accurate and able work—the Journal of Health, Philadelphia, 1832, page 91. The tables are as follows: TABLES OF M. BENOISTON. 157 1. " Occupations which expose the lungs to the action of an atmosphere loaded with vegetable dust: Males. Deaths. Proport'n, "Starch-makers,............. 98 1 1.02 Bakers,....................2,702 56 2.07 Coalmen,.................. 375 14 3.73 Forts de la Halle,........... 246 6 2.43 Rag-pickers,............... 590 5 0.84 Workers in cotton,.......... 319 6 1.88 Spinners,.................. 594 14 2.35 Females. Deaths. Proport'n. "Rag-pickers,............... 237 4 1.68 Workers in cotton,.......... 882 24 2.72 Thread winders,............ 263 9 3.42 Spinners,..................1,173 19 1.61 " Total number of males admitted of this class, 4924, of whom 102 died of consumption, or 2.07 per cent. " Total number of females admitted of this class, 2555, of whom fifty-six died of consumption, or 2.19 per cent." That rag-pickers should exhibit so low a degree of mortality as in the above table is certainly suprising, and if we are to judge from the results of these obser- vations concerning the effects of " factory life," as it is called in this country, it is by no means so un- healthful as many suppose it to be. 2. " Occupations which expose the lungs to the ac- tion of an atmosphere loaded with mineral particles : Males. Deaths. Proport'n. " Stone-quarriers,............ 887 13 1-46 Masons and laborers,........ 4,071 (J0 2,22 Stone-cutters,.............. 162 2 1-25 Plasterers,................. 158 4 2.53 Lapidaries,___ ........... 551 5 0.90 158 CONSUMPTION. "Total number of this class admitted, 5829, all males, of whom 114 died of consumption, 1.95 per cent." According to this table, stone-cutters, with the ex ception of lapidaries (dealers in precious stones), were the least subject to consumption. It has been sup- posed by many that this occupation is necessarily one of the most injurious of all to the lungs. The con- tact with dust and fine particles of stone to which the laborer is constantly subjected, has been regarded as very detrimental to the health of the lungs. Stone- quarriers als^ come, to a certain extent, under this head; that is, they too are much exposed to the d»'4 and dust arising from the cutting and blasting ol stones, and yet their proportion of deaths is very small. Comparing this table with the last, we find the per cenlage of deaths a little less in the latter. In con- nection, it is to be observed, that the occupations of the last are more out-door and active in their nature than the former. 3. " Occupations which expose the lungs to the ac- tion of an atmosphere loaded with animal dust: " Brush-makers, ..______ Carders of wool and hair, Hatters,.............. Feather workers,....... " Brush-makers,........, Carders of wool and hair, Hatters,............... Feather workers,...... Males. Deaths. Proport'n. 283 10 3.53 129 4 3.10 983 47 4.78 39 3 7.69 Femalea. 103 Deaths. 8 Proport'n. 7.76 451 11 2.43 130 1 0.55 61 7 11.47 TABLES OF M. BENOISTON. 159 " Total number of males admitted of this class, 1434, of whom sixty-four died of consumption, or 4.46 per cent. " Total number of females admitted of this class, 795, of whom twenty-seven died of consumption, or 3.39 per cent." Comparing this last table with the next preceding, it would seem that in-door workers have a poorer chance in reference to consumption than such as are engaged in active out-door pursuits. The per centage of deaths among females according to this table is less than that of males, which is sup- posed to be different from the general rule. 4. " Occupations which expose the lungs to the action of an atmosphere loaded with hurtful vapors : Males. Deaths. Proport'n, "Gilders,....................... 545 29 5.32 Painters and ornamenters,....... 2,160 47 2.17 Fumigators,................... 389 13 3.34 Females. Deaths. Proport'n. "Gilders,....................... 285 16 5.61 " Total number of males admitted of this class, 3094, of whom eighty-nine died of consumption, or 2.87 per cent. " Total number of females admitted of this class, 285, of whom sixteen died of consumption, or 5.61 per cent." According to this table, painters and ornamenters have a much better chance, in regard to consump- tion, than many of those of the other occupations. 160 CONSUMPTION. 5. " Occupations which expose the body, andparticu- larly the feet, to the action of damp : Males. Deaths. Proporfn. "Bleachers,.................. 218 4 1.83 Females. Deaths. Proport'n. "Bleachers,..................2,775 125 4.50." It is to be observed, in reference to this table, that males, who geneially dress their feet and lower ex- tremities with greater care, or more perfectly than females, have a much lower proportion of deaths in those occupations where these parts are much ex- posed to cold and damp. These results afford, I con- ceive, an important practical lesson on this point. 6. " Occupations in which the muscles of the chest and arms ar/e subjected to a constant and fatiguing exercise : Males. "Weavers,................... 935 Gauze-makers,............. 251 Carpenters,................ 286 Joiners,....................1,716 Blacksmiths, etc.,........... 214 Locksmiths,................ 668 Water-carriers,............. 373 Stone-sawyers, etc.,......... 702 Females. "Weavers,.................. 163 Gauze-makers,.........____ 253 "Total number of males admitted of this class, 5127, of whom 109 died of consumption, or 2.12 per cent. " Total number of females admitted of this class, 416, of whom eleven died of consumption, or 2.64 per cent." Deaths. 20 Proport'n. 2.13 8 3.18 4 1.49 53 3.08 2 0.93 5 9 0,74 2.41 8 1.13 Deaths. 3 Proport'n. 1.84 8 3.16 TABLES OF M. BENOISTON. 161 We see, in reference to this table, that carpenters have a much lower average of deaths from consump- tion than joiners. The latter do the in-door work of buildings, the former the out-door work, which is cer- tainly, in many respects, the more healthy occupation of the two. It is remarkable, too, that blacksmiths and locksmiths, the trades of both of which are very laborious, while at the same time both classes are sub- ject much to dirt, dust, iron filings, and the like, have yet a very low average cf deaths from this disease. Stone-sawyers, too, who work, for the most part, out doors, and are yet much subject to particles of dust from the stone, have a very low average. This table, on the whole, speaks well for hard and fatiguing labor, in the open air and light. 7. " Occupations in which the muscles of the chest and arms are subjected to constant motion, while the body is maintained in a bent position: Males. Deaths. Proporfn. Scriveners,.............. ... 908 43 46 4.73 ... 715 6.43 ... 1,048 49 4.67 Shoemakers,............ ... 1,818 78 4.29 Fringe and lace-makers, .. ... 426 20 4.69 ... 244 15 6.14 Polishers,............... ... 270 12 4.44 Females. Deaths. Proport'n. 39 4 13.33 ... 1,069 49 4.58 Fringe and lace-makers,__ ... 534 25 4.68 ... 548 21 3.83 ... 397 22 5.54 ... 593 51 8.60 ... 5,392 296 5.48 162 CONSUMPTION. 1 Flower-makers,.. Bone-lace makers, Glove-makers,__ Menders,....... "Total number of males admitted of this class, 5429, of whom 263 died of consumption, or 4.84 per cent. " Total number of females admitted of this class, 10,129, of whom 574 died of consumption, or 5.66 per cent. " Total number of males of all the foregoing classes admitted, 26,055, of whom 745 died of consumption, or 2.85 per cent. "Total number of females 16,955; deaths 809, or 4.77 per cent. " Total number of individuals, of both sexes, 43,010, among whom the deaths by consumption were 1554. " Proportion of deaths by consumption to whole number of patients who were admitted, 3.61 per cent." We see, according to the last table of M. Benoiston, the injurious effects of those occupations which con- fine persons within doors, and for the most part in a bent and sitting posture. The averages, among all these occupations, it will be seen, are higher than those of most others. Habitual stooping of the body is, be- yond doubt, one of the greatest of all causes of con- sumption. It must be admitted that all such tables as the above, even when drawn up by the most careful and accu- rate observers, are liable to more or less imperfections. It is only by observing a considerable number of them Females. Deaths. Proport n. 357 31 8.68 258 16 6.20 402 26 6.46 540 33 6.11 CAUSES OF CONSUMPTION. 163 that we can arrive at an approximation of truth. But all such tables are, on the whole, very valuable and interesting. " There are certain occupations," says Dr. Clark, " which are generally considered unfavorable to the occurrence of consumption : those of seamen, butch- ers, and tanners hold the first rank. Various reasons have been adduced to account for this exemption. I nave no doubt that it is chiefly attributable to the free and regular exercise in the open air which they enjoy." To conclude, then, on the causes of consumption, as shown in the foregoing chapters, the more promi- nent may be stated as the following: 1. Hereditary predisposition. 2. Impure air. 3. Want of light. 4. Insufficient food. 5. Excess of food. 6. Deficient bodily exercise. 7. Excessive labor. 8. Over-exertion of the lungs. 9. Excessive mental labor. 10. Improper clothing. 11. Want of cleanliness. 12. Spirituous drinks. 13. Mercury. 14. Abuse of medicines generally. 15. Tobacco. 16. Tea and coffee. 17. Hard water. 18. Suppression of the natural discharges. 164 CONSUMPTION. 19. The depressing passions. 20. Sexual abuses. 21. Haemorrhage from the lungs. 22. Inflammation of the lungs. 23. Bronchitis and sore throat. 24. Influenza. 25. Fevers. 26. Dyspepsy. And lastly, all causes, and ah occupations which lend to deteriorate the general health HEMORRHAGE FROM THE LUNGS. 165 CHAPTER XIX. Haemorrhage from the lungs.—This often exists as one of the earliest symptoms of tubercular consumption.—It is a symptom not always dangerous, but one that demands special attention. Females are most subject to it.—Opinions of Louis and Dr. Sweetser.—Age at which pulmonary haemorrhage most frequently occurs.—This affec- tion is not necessarily associated with a consumptive habit.—Na- ture of the affection.—Means of knowing it.—Bright red or arte- rial blood usually comes from the lungs, and dark or venous blood from the stomach.—Symptoms that immediately precede bleeding from the lungs.—Effects of pulmonary haemorrhage on the system. —Causes of this affection.—It appears sometimes to be a friendly disease.—Its treatment.—Injurious effects of fear.—Pulmonary haemorrhage should be treated on the same principles as an inflam- mation.—Dr. Elliotson's method.—Bleeding and cold on the chest. —Blisters.—The general principles and the particulars of the treat- ment stated.—The true methods of avoiding a recurrence of this disease. As haemorrhage from the lungs is often associated with consumption, and in many cases exists as one of its earliest symptoms, it will be proper to enter some- what into detail concerning it. I have remarked else- where that persons are generally much alarmed at symptoms of this kind, and more so, often, than there is any need of. I have also remarked, that in many instances persons have, by proper treatment, out- grown these difficulties. Still, however, it must be confessed that pulmonary haemorrhage ought always to be looked upon as a serious matter, and one that demands special attention on the part, both of the pa- tient and the physician. 166 CONSUMPTION. Females mors subject than males to pulmonary haemorrhage.—The observations of various writers go to prove that this affection is more common among females than males. According to Louis, the propor- tion is as three to two. Professor Sweetser is of the opinion, also, that the observations of medical men in this country, in relation to pulmonary haemor- rhage, would lead to like results with those of the French physicians. Haemorrhage from the stomach is doubtless much more frequent also in women than men. Age at which it occurs.—Pulmonary hasmoirhage will be found to occur oftenest at that period of life when the system is most liable to consumption. Thus it will seldom be observed before fourteen or fifteen years of age, or, in other words, before puberty, and seldom after forty. Between eighteen and thirty-five, may be stated as the period in which persons are most liable to this affection. It occurs oftenest at that pe- riod during which the chest expands, and we spread, as is said. " The first part of life," says Dr. Elliot- son, " is disposed to haemorrhage from the nostrils; the second, to haemoi rhage from the lungs; and the third, to haemorrhage from the abdomen." Not necessarily associated with a consumptive habit. —We not unfrequently see persons who have been liable to considerable spitting of blood, and without anv apparent injury to health, during many years of their life. Dr. Heberden gives an account of a woman at seventy, in good condition, who, for fifty years, had never been free from this symptom above two years together. Pulmonary haemorrhage may happen in NATURE OF HAEMORRHAGE. 167 persons in whom there are no reasons for suspecting tubercles, and who appear to be, in no respect, of a consumptive habit. Nature of the affection. —The bleeding is supposed to proceed oftenest from the air passages, or from the air-cells of the lungs. Probably the popular notion that haemorrhage from the lungs is owing to the rup- ture of a blood-vessel, seldom holds true. Such, it'is true, may sometimes be the case, as in the advanced stages of consumption, when there has been great de- struction of the substance of the lungs. But in the greater number of cases the haemorrhage arises simply from the affusion of blood from the mucous membrane within the lungs. This haemorrhage being often, then, simply an affusion or oozing of blood from the mucous membrane, and not from a ruptured blood-vessel, we may readily understand why it is that we so often succeed in curing it. Signs by which it is known.—The principal diffi- culty is to distinguish between it and bleeding from the stomach. The latter may be more commonly known by the discharges, consisting of black blood. The blood is either discharged from the veins of the stomach, or it lies in the stomach so long after it es- capes from the vessels, that it acquires a venous hue. From the one cause or from the other, blood, when discharged upward from the stomach, is generally black ; and has, also, generally lain there long enough to be coagulated—it is in clots, larger or smaller. Frequently, too, it passes through the pylorus, and is seen in the discharges from the bowels. Besides that, it frequently comes up with the food, and other content* 168 CONSUMPTION. of the stomach ; and, when it does not, still it comes up with sickness and nausea, if not with downright vomiting. We know that people may have a dis- charge from the stomach without vomiting some- times a quantity of fluid comes to the mouth, and even portions of food, without any retching ; and so it is with the blood. Occasionally, however, it comes up with decided vomiting. There is frequently a great uneasiness about the praecordia, and a fullness about the liver and stomach. These symptoms are absent in haemorrhage from the lungs. The blood, here, is florid ; and instead of being mixed with food, it is frothy, and is necessarily mixed with air, in con- sequence of the parts from which it comes containing always a large quantity of it. These parts will not allow it to stay so long as in the stomach ; and it gene- rally comes up as soon as it is poured into the pas- sages, and it is therefore seldom coagulated. Occa- sionally, however, there is a little coagulum; for it will sometimes lie sufficiently long to become solid and black, before it comes up. In addition to this, we have pectoral symptoms in haemorrhage from the lungs; instead of nausea and vomiting, there is a " stitch in the side, a little cough, and a tickling in the throat. On listening to the chest, when the blood is in the air passages, we hear sibilous and sonorous rattles." The signs immediately preceding the flow of blood, may be distinct and stiongly marked, or scarcely ap- preciable. Sometimes it may happen without any premonition, but, as a general fact, there may be no- ticed some febrile excitement, and especially signs of CiUANTITY OF BLOOD EMITTED. 169 preternatural determination of blood to the lungs. Among the more threatening symptoms, there is sense of weight, weight and oppression about the chest, and more, or less embarrassment of breathing, especially if any* effort be made. There is, also, a sense of heat within the chest, particularly in the breast bone. Lassitude, paleness, and coldness of the skin, shiver- ing and coldness of the extremities, all of which are sometimes felt, indicate that the blood is pressing inward too much upon the lungs. The patient ex- periences, often, an unusual desire for fresh air, im- mediately preceding the attack. And some persons, subject to pulmonary haemorrhage, have had warning of a tendency to an attack, by their being obliged, con- trary to their usual custom, to sleep with a window open, otherwise breathing would become distressing, and sleep disturbed. Quantity of blood emitted.—Sometimes the dis- charges may hardly be said to consist of blood at all, the common mucous of the air passages being merely tinged with it. These symptoms may continue for several days, or even weeks, and then cease; or they may be followed by a considerable gush of pure blood. Often the haemorrhage seems at once to relieve the over-loaded vessels and then ceases, to return again at longer or shorter intervals; or, as happens in some cases, disappears forever* The haemorrhage will be found varying from seve- ral mouthfuls to a teacup full; but it is difficult in many cases to determine the precise amount. There is often so much alarm at the moment, that persons are very apt to over-state the quantity. Bright blood, 8 170 CONSUMPTION. it should be remembered, makes a gieat show. It always appears more than it really is. Effects on the system.—The effects of pulmonary haemorrhage are often trifling; and it not unfrequent- ly, as before remarked, brings relief to the system. At other times, the individual is able very soon, almost at once, to go about his ordinary avocation. At other times the system becomes much prostrated, so that the patient may be an invalid for weeks. At other times, in the advanced stages of consumption, it may be the means of quickly closing the death-scene. Causes.—This disease sometimes occurs when we can scarcely attribute it to any particular cause; and sometimes in the presence of great strength of general system, and apparently good health. Cold, and vari- able conditions of the atmosphere, may act as an ex' citing cause. Diminution of atmospheric pressure, as on the ascent of very elevated mountains, is said to have caused it. Irritating substances breathed into the lungs, intemperance in the use of spirituous liquors, excess of food, and whatever occasions ple- thora of the system, violent exercise of the body, and especially over-exertion of the lungs, as in playing on instruments, or in long-continued reading and speak- ing, fear, and all strong mental emotions, may cause * Broussais relates an instance where a lady, sitting • the grass, felt a living frog /all into her bosom from me claws of a bird of prey, and was instantly seized with so copious a bleeding from the lungs that she survived but a few minutes. Long-continued and excessive laughing has also been known to cause it A. fall, or a blow upon the chest, may also bring on pul- TREATMENT. 171 monary haemorrhage. A sudden suppression of per- spiration, checking of cutaneous eruptions, and of any habitual discharge whatever, may also bring on this affection. Sometimes friendly to the system.—We know that bleeding from the nose not unfrequently cures head- ache and oppression of the brain. We know, too, that bleeding from the bowels in fevers, and some other diseases, appears sometimes to be nature's method of effecting a cure. So, also, we may con- clude that bleeding from the lungs is, in some in- stances at least, a natural effort of the system. De- spite of the fright it generally causes, it often relieves oppression and embarrassment in the lungs, apd doubt- less does the individual decided good. Treatment.—I have said that many persons recover from bleeding at the lungs, even from severe attacks. Dr. EUiotson tells us, that he has known many per- sons who had expectorated blood fifteen or twenty years before he wrote on the subject, and who were at the time well. I can myself call to mind a number of persons who have had pulmonary haemorrhage over and over again, so much so at times, as to prostrate the system very much; and although this happened a number of years since, those persons are now com- paratively well; better, perhaps, than ever before in their lives, and more hardy and enduring than peo- ple generally are. These facts should give us cour- age in the treatment of this affection, and, at the same time, teach individuals subject to it the important les- son that they should not become alarmed and fright- ened almost out of their senses at every little oozing 172 CONSUMPTION. of blood from these parts; and yet I would not have this advice construed into an excuse for carelessness in regard to the means and necessity of observing all good rules of health, so that the individual may, as far as possible, avoid al such attacks. The treatment of the slighter forms of pulmonary haemorrhage, is to be comprehended by a reference to all those rules and habits generally, the observance of which tend to fortify and invigorate the general health; and I shall here but repeat, that I assert that people generally are far more frightened than there is any occasion for, in attacks of this kind; yet at the same time all who have haemorrhage from the lungs, however slight, should spare no pains, however great, in order to establish a permanent state of general health. When an individual has lost this best of all earthly blessings, and is made to quail under the in- fluence of an incurable disorder, what would he not give if he could again be made well ? All the wealth of the city of New York, the wealth of the Indies, yea, more, the wealth of the whole world combined, would be as nothing in the balance when compared with that most important matter, the restoration of health. May I not hope, then, that some at least will heed my admonition. In the alarming cases of this disorder, prompt and decided measures are often necessary. Such attacks, too, often come on suddenly, so that even perhaps at the most critical time the presence of the physician cannot be had. Hence the necessity for people to learn how to do for themselves. It should be remembered that wherever there is haemorrhage—no matter in what part of the living BLEEDING. 173 system—too much heat exists; hence all judicious physicians treat haemorrhage on the principle of in- flammation, singular as the practice may appear. I will here remark, that as much as I deprecate bleed- ing, as a general thing, I have no doubt persons have often been saved in haemorrhage, by the artificial ab- straction of blood ; but I maintain that there is yet a better means, one which is more effectual in bringing about the desired object, and at the same time leaves the blood, " in which is the life thereof," w?thin the system, so that recovery may be much more speedy in the end. " Bleed in the arm freely," says Dr. EUiotson, " and set the patient upright, and keep him so, in order to make him feel as faint as possible ;" and then adds, with his good sense, " it is safe to apply ice to the front of the chest; and this, I think, should always be done. There can be no impropriety in it. As soon as we have bled, until ice can be procured, we should throw cold water on the chest, and endeavor to pro- duce a contraction of the end of the vessel—in the same way as we proceed in the case of the womb. But generally the bleeding soon stops; for a patient seldom dies of pulmonary haemorrhage at the time. Bleeding at the arm, throwing open the windows and doors, and taking the clothes off the chest, answers very well. The patient should not be allowed to move. He should be made easy and comfortable; but he should not be allowed to move, or speak. 1 have often made persons persevere, for a fortnight together, after dangerous haemorrhage, making them write for whatever was wanted. It is proper to starve 174 CONSUMPTION, the patient; to give him nothing but plain water, milk and water, lemonade, or things of that description; and it is surprising how patients, in this disease, bear cold." This quotation gives, in short terms, the sum and substance of the orthodox treatment in this disease— a treatment, too, which is conducted on physiological principles, although the means of the treatment are not always such as I would agree with. Acetate of lead, the extract of tannin, or tannic acid, and a great variety of other remedies, are some- times also resorted to, in this affection. Dr. Rush had a favorite remedy, which he used to check the bleed- ing, and which may now, in this country, be consid- ered a popular remedy—namely, common salt, taken in a dose of a teaspoonful, every few hours, till the haemorrhage abates. This article, although so com- mon and so much used, is a powerful drug, when taken in such quantities. I should be unwilling to take it myself; but it is doubtless as good as any other of the drug remedies that are given with the view of arresting the flow of blood. Blisters on the chest have been resorted to, and I am not prepared to say that these do not often do good. Dr. EUiotson regards them as good in the lat- ter part of the treatment; but the application of cold by means of ice, he regards as being better. But I should myself prefer cold wet cloths even to ice. I think ice is, in general, too severe a measure ; that is, more severe than is necessary. By the use of cold wet cloths, we may abstract the same amount of heat from the part, by continuing the application a little TREATMENT ;F HEMORRHAGE. 175 longer, often rubbing it, and thus not do so great vio- lence to the system. I have reason to believe that, in all cases where ice is used, as upon the scalp, chest, and whatever part, the cold cloths are better; and we can always get cold well-water, but not so with ice. There is a tendency with practitioners generally, I think, and also with the people, to desire a remedy that is more powerful than is natural, or necessary; and thus, by overdoing a good thing, I am confident, harm is sometimes done. The coldness of the extremities and surface, often experienced in severe haemorrhage from the lungs, symptoms which show that the blood is pressing in- ward too much upon the affected part, teaches us to resort to means which will tend to bring the blood back again more toward the surface and extreme parts of the system. And one of the best possible means for accomplishing this, probably the best, is to wash the surface smartly with the palms of the wet hand. Wet friction upon the skin is certainly a very admi- rable means of exciting cutaneous circulation; at the same time, it refreshes the general system, cools the circulation, and supports the patient's strength. It is well, I am convinced, in these cases—especi- ally when the feet are cold, to put them into warm water; at the same time the washing over of the gene- ral surface may be followed up. The parts of the treatment, then, in severe haemor- rhage from the lungs, may be stated like the follow- ing: 1. To make cold applications to the chest by means of cloths wet in cold water, or by pounded ice or snow 176 CONSUMPTION. in their season, so as effectually to cool the mass of the circulation; 2. To practice wet friction over the general system; 3. To take frequently small quantities of water in- ternally, and even pieces of ice, where this is desired; 4. To cool the back of the head, the neck and spine, generally; and, 5. To keep the feet in warm water, and make other warm applications to them when necessary. After the haemorrhage has been arrested by the means of thus effectually cooling the blood and regu- lating the circulation, the general principles of good nursing, such as apply in all serious diseases, it will be understood, are to be observed. And here I will remark, that quite as much depends upon how the nursing is performed, as upon what the medical adviser does. I will remark, also, that Dr. EUiotson of London —as high authority as can be quoted in the old-school practice, tells us—and he has had great experience in these things, that it is surprising how patients in this disease bear cold. " I know not a single instance of a person suffering inflammation of the chest from all this exposure," he remarks, "notwithstanding that in other circumstances he would, in all probability, have suf- fered severely." Thus, I think, it will appear plain that any individual of good understanding, provided the patient have con- fidence in simple means, may safely and efficiently treat this often serious malady. If I were myself at- tacked by this formidable affection, I should most cer- tainly resort to the means I have here described—in short, to the cool or cold water plan, by far in prefer- COLD APPLICATIONS. 177 ence to that of any other; and this, not because I have advocated it, and recommended it to others here- tofore, but simply because I believe it to be the best. I hope to have no other hobby than that of the most earnest love for truth. 376 CONSUMPTION*. CHAPTER XX. The treatment of consumption continued.—Cough.—Opium and anti- mony.—Washing the surface with pure water.—Fasting.—Evils of over-eating.—Saccharine matter.—Difficulty of respiration.—How treated.—The expectoration.—Diet and water-drinking as a means of modifying it.—Perspiration.—The great power of water to pre vent the debilitating sweats of consumption.—Evils of feather beds in causing hectic night sweats.—Airing the bedclothes in the night, and exposing the surface of the body to the atmosphere a useful means.—Dr. Marshall Hall's remarks on sponging the surface with salt water.—The fresh is still better.—The hectic fever.—Means of modifying it.—The pulse.—Means of modifying it.—Exercise good, but should not be too violent.—Diarrhoea.—Palliative treat- ment to be used.—Pains of the chest.—Wet fomentations better than blisters.—Care to be exercised in making the wet applications. —Debility in consumption.—How to modify it.—The true princi- ples on which consumption is to be treated.—Remarks of Drs. Bil- ling and EUiotson.—Bathing and exercise the greatest of all known means for preventing this disease. Cough.—This being a troublesome symptom, a great variety of remedial means have, from time immemo- rial, been resorted to with the hope of benefiting it. Our newspapers are filled with advertisements of cough mixtures, cough candy, and the like. Opium will often relieve a cough, although it does not always produce this effect. Whatever good it may do, in preventing this symptom, is accomplished only by its power of lessening the general vitality of the system. It must necessarily do harm in the end. SACCHARINE MATTER. 179 Antimony, in some of its preparations, combined either with or without opium, is also much used in coughs. This is also a most pernicious drug. One of the best palliative means for cough, when consumption has not proceeded to a great extent, is to make the body naked, and wash the surface with pure water, especially the throat and chest. Even wash- ing the feet will often relieve a troublesome cough. Walking or riding in the open air is also good. Omit- ting a meal, especially at night, will many times make a material difference in this symptom. The sipping frequently of pure soft water, when a cough is trou- blesome, is also a most excellent means. There is more or less feverishness in the blood always, when troublesome coughing occurs, and hence it is that washing the surface, and drinking water, that is, cool- ing the mass of the circulation somewhat, is good in these cases. Over-eating, it should be remembered, always ag- gravates a cough. In some cases of bronchitis, and perhaps in the early stages of consumption, where cough is troublesome at night, so as to keep the pa- tient awake, a little honey, or other saccharine mat- ter, taken into the stomach, appears to do good. I know that, in my own person, I nave at times had a very troublesome cough, which would keep me awake for hours sometimes in the night; and I found that by taking a small piece of sugar into the mouth, the lungs became soothed and quiet, so that I very soon fell asleep. Now the way in which this remedy oper- ates is by mere sympathy. The saccharine substance passes into the stomach ; iv>. doing so, however, it comes 180 CONSUMPTION. in contact with the epiglottis, and so, by sympathy operates upon the wind-pipe, where the irritation ex- ists. We know that getting a piece of sugar, or any other substance, " the wrong way," would only make us cough the harder. But I recommend, in this mat- ter, that patients be very careful how they indulge in sweets, with the hope of relieving cough. Saccharine matter is always hard of digestion, and is necessarily very apt to derange the stomach. It is possible that it does good in some instances, as I have mentioned, by procuring sleep, when one would otherwise be kept awake; but great care is necessary to be observed, or more harm than good will be the result of this practice. The difficulty of breathing, which often attends lung complaints, may be greatly modified and relieved by the washings and wet hand frictions, such as I have recommended for cough. Here, too, we must be careful in diet, and also in regard to pure air. The same general rules which apply in cough, apply also to this symptom. The expectoration may be greatly modified in its character by diet, and especially by the drinking of pure soft water. If the food is simple and unstimu- lating, the expectoration will be less. Perspiration.—The power of water to promote the strength of the living tissue, is nowhere more strikingly exemplified than in the treatment of hectic night sweats. With every thing besides well managed, it would seem that these debilitating night sweats can be effectually checked, to the very last. Often have I known persons, who have sweltered for weeks and BED CLOTHING. 181 months, nightly, with perspiration, in whom it was checked altogether by the simple effect of cold water, and wet frictions upon the surface. Nor would I have the water applied very cold ; only of such tem- perature as the patient can bear, that is, can get com- fortably warm after. In proportion as these night sweats are checked by water, is the strength sup- ported, the health made more comfortable in every respect, and, to all appearance, life materially pro- longed. These washings may be practiced two or three times daily, with the view of invigorating the surface. Pure fresh water—the purer and softer the better—should be used. Feather beds often do a great deal of harm in caus- ing night sweats. Perhaps it would be impossible for all persons, when they become much emaciated, so that the bones almost protrude through the skin, to lie upon hard beds. I would not say that those poor sufferers should never lie upon feather beds. I would gladly do any thing, if it were not positively and decidedly prejudicial, to promote the comfort, in any degree, however small, of those suffering patients; but I would advise that great care be taken in regard to the bedding. Avoid feathers, both for the bed and pillow, as far as possible. * Have the bed clothing well aired, and the cleaner the better. The patient, too, should have the coolest and most airy room in the house. The bed should be placed as near the middle of it as may be; never have the head away in the corner of the room, for in that situation the air must be breathed over more than in the former. Would that all consumptive patients 182 CONSUMPTION. might be placed in comfortable and independent cir- cumstances, in all that pertains to this life. Getting up in the night-time and airing the bed, and walking about in the air of the room, if not too cold, will help to prevent the night perspirations. Going to a fresh bed will also often check them. Sponging the surface with salt water.—Dr. Mar- shal Hall speaks strongly in favor of sponging the surface with a solution consisting of one ounce of common salt dissolved in one pint of water. With this the patient is to sponge the whole surface, using it as he recommends, warm in winter, tepid in spring and autumn, and cold in summer. But what tem- perature is meant by the terms " warm," " tepid," and " cold ?" This is an important matter which does not appear. As for the salt, it had better be omitted, because it injures the skin. If water is taken warm, that is about the temperature of the blood, it is very liable to debilitate the system, and to give the patient a cold. I regard that it is better to take it a little cooler. Dr. Marshall Hall is correct, however, when he recommends the repetition of the morning spong- ing "as the most effectual remedy for the colli- quative perspirations of tuberculous patients in the night, or early part of the morning." Let the patient, if he can, remove to another bed after this sponging, and he will be more apt to pass the remainder of an otherwise wearisome night in refreshing sleep. Changing the night clothes and sheets is also service- able. So trifling a matter, as going from one bed to another, changing the clothes, or even getting up and airing the bed, at the same time exposing the surface HECTIC FEVER. 183 of the body to the atmosphere for a few minutes, will often help much to keep back this perspiration, and thus aid in procuring good sleep. But the washing the surface when it is warm, two or three times in the twenty-four hours, with water cool and yet not too cold, that is, not so cold as to shock or over-chill the system, is, as before remarked, the great and sovereign remedy for preventing, the night sweats of consumption, as well also as that of all other debilitating diseases. But this effect is pro- duced by the tonic or strengthening effect of cold water and friction upoh the skin. Not only is the skin strengthened by this practice, but the whole sys- tem. Sleep, too, is thus made better; and this aids also in keeping up the general strength. Thus one good influence aids another. Hectic fever.—Nature teaches us, most unequivo- cally, as to what is the greatest as well as the most abundant of all febrifuges. All other remedies than pure water and fresh air dwindle into comparative insignificance when compared with water. As soon ns the consumptive patient begins to feel the heat coming into the feet and hands, let him at once com- mence washing these parts. He need not take the water extremely cold, but washing freely the face, hands, and arms often accomplishes wonders in keep- ing down this symptom. Heat, it should be remembered, takes away the strength rapidly. It is heat, too, that causes delirium in fevers; and if this is properly attended to by the cooling plan, I think that symptom can never occur in this disease. In prooorti9n a? the heat is kept 184 CONSUMPTION. down, the strength will be supported, and the mind rendered more clear. Perseverance in this method also aids in keeping off debilitating sweats. Sweating comes on in proportion to the amount of feverishness, as a general thing ; hence to remedy the one is equiva- lent to preventing the other. The pulse.—This is always more or less acceler- ated'and feeble in consumption. It varies in differ ent individuals and at different periods of the disease. It varies also during each day, rising in proportion to the general feverishness, and most toward night, as a general thing. After consumption has fairly com- menced, the pulse may be said to range from ninety to a hundred beats per minute, and upward. It is small and feeble, and such as indicates great debility of the system. The cooling treatment has a great influence in regu- lating the velocity of the circulation. Any thing which tends to prevent the feverishness, acts in bring- ing the pulse to a more natural standard. But in order to remedy this symptom fully and permanently, the system must be capable of being so invigorated as to prevent all general and unnatural debility. So long as the system remains enfeebled, the pulse is liable to become too quick. Exercise is an invaluable means in consumption ; but if this be too great, the heart is made to beat too quick, and the general circulation is accelerated. It is important, therefore, that consumptive persons should not exercise too much ; and one of the methods of knowing how to graduate the exercise, is by ob- serving the frequency of the pulse. OVER-HEATED ROOMS. 185 Over-heated rooms always exercise a pernicious in- fluence on the circulation. It is common for con- sumptive patients to be kept in rooms that are much warmed. An individual remaining constantly in heated air cannot at all judge properly by his feelings as to what temperature is best suited to his case. Indeed, the more the air is heated above a certain standard, the more the patient suffers from cold, and, as a consequence, the more fire is desired. A few weeks since, being in the state of Vermont, I was taken to see a young man far gone in consumption, who was yet, however, able to sit up, and even to ride out. It was on Sunday, when the family were at home, and they were all seated in a room heated by a stove. As I entered it, the air appeared most oppressively hot, and could not have been less than 809 Fahr., I think, when at the same time the weather was decidedly cool. The young man complained of great debility, and his pulse had risen (it was in the afternoon) to 110 beats per minute. I directed the door to be opened a little way, and after sitting about half an hour, and when the air had become a good deal cooled, I again examined the pulse. It had fallen ten beats per minute; and this was solely attributable to the change made by opening the door. Imagine that this young man had gone on from day to day in thus ac- celerating the velocity of the heart's action by the over-heated air of his room. We can readily imagine how much faster his life would have been worn out. The thirst is not generally a troublesome symptom in pulmonary disease. It occurs, however, not un- frequently to some extent. The principles of treating 186 CONSUMPTION. it in whatever disease are the same. The free use of fruits, as a part of the regular meals, aids much in keeping off both feverishness and thirst. The diarrhoea occurs generally in proportion to the debility present; frence any thing which tends to a betterment of the health and strength, will aid in keeping off this symptom. It arises in consequence of ulceration of the bowels ; hence a radical cure can seldom be effected. I would have persons distinguish, however, that during the progress of consumption, they may very easily, at times, have other forms of diarrhoea than that which attends its latter stages, so that they should not become alarmed at every little attack of the kind they may experience. As a palliative means to be used in the fatal diar- rhoea which occurs toward the last of consumption, pretty copious injections of lukewarm or tepid water into the bowels, will be found a most excellent means. It serves to soothe the patient, and at the same time supports his strength. Have a good instrument, and resort to the internal rinsing at every time when the bowels act unnaturally. Use it either just before, or after, or both. Be the diarrhoea of whatever kind, this is a most excellent remedy. Pains in the chest.—Shall we put on blisters or make sores with an ointment of tartar emetic, or some other escharotic, for pains in the chest ? Such will certainly relieve them; but I think the application of mustard would be a preferable means to any of these and safer, certainly. All of these means, I firmly believe, do almost al- ways more harm than good in the end, especially the COLD APPLICATIONS. 187 former articles; besides, I believe there is a more effectual way than either of these, and that is, the application of wet compresses over the part where the pain exists, and over the whole chest, if necessary. We wring wet towels tolerably dry out of cold water, lay these upon the chest, over these dry flannels, or other materials enough to insure a tolerable degree of warmth. Some have worn wet jackets over the whole chest—one, two, or three thicknesses, and then dry ones enough to insure the proper degree of warmth In hot climates and hot seasons any where, these ap- plications are liable to become almost immediately too warm, and so to debilitate the system. At such times, the frequent washings of the chest with the wet hand will be found preferable. This may be done repeatedly during the day. Any one who is timid in regard to these applications—and all should be careful in their use—can commence with a simple application, a single napkin, or the like, at first; place it over the most painful part, and watch its effects; and if it does well, a larger application may be made, and so on to any extent desired. If there is already extensive ulceration, these appli- cations must be made cautiously. The system must not be too much chilled in such cases, if so, harm will be done. With a little exercise, the patient's feelings will be a sufficient guide in this matter. Let him remember, however, if his case be a bad one, that when there is so much prejudice as now exists in the world against the use of cold water, and so much io-norance of its effects, if he wear the wet cloths, and is perfectly sensible that they do him good, and if 188 CONSUMI TION. he yet is doomed to get worse, in consequence of the incurability of his case, there will not be wanting those among his friends who will be ready enough to tell him that these water applications have caused his death. With the great and all-pervading igno- rance that exists concerning the use of this safest of all nature's remedies, people would a great deal rather be bled, blistered, poisoned by calomel, and a hundred other vile drugs which were never designed by God for the human system at all, than to use that pure element which is of all others incomparably the best, and which was designed for man's universal use. Debility may be much prevented by frequent ablu- tions in tepid, cool, or cold water, according to the patient's strength. If a person is far gone with con- sumption, I would certainly not use the coldest water; I would, however, in all cases, use it somewhat cool. It is most surprising to-witness to what an extent the patient's strength may be supported in this way. Pursuing this plan, many are brought to believe that they are certain to obtain a cure, so great is the bene- fit experienced. After having been very weak, and quite confined to the house, they became able to walk miles, and bear it well; and this improvement may continue for months. Still, however, it must be ac- knowledged that, in many cases, the patient must, in the end, sink; yet it is a great comfort to keep him as well as may be; and if life is desirable at all, under such circumstances—and the instinct of natur teaches us the duty of fighting disease to the ve last—it is a great satisfaction to keep him able to 1 about in the open air as long as possible. WATER-TREATMENT. 189 " One thing of which I am convinced," says Dr. Billing, of London, the very able author of a work entitled "First Principles of Medicine," "is, that the true principle of treating consumption is to support the patient's strength to the utmost. I am satisfied," says this author, "that the want of exercise induces a languor which makes consumptive patients wear out faster than if permitted to ride or walk, according to their strength, in the open air." Dr. Billing further observes, that " some years ago, a gentleman, of the name of Stewart, adopted the ra- tional mode of treatment, with which he had consider- able success ; but because he could not work miracles, his plan was unjustly depreciated. His method was entirely tonic, and especially the cautious use of cold and tepid ablutions of the skin, a modification of cold bathing—a remedy which is found so uniformly bene- ficial in promoting the resolution (cure) of scrofulous tumors." Dr. EUiotson also strongly recommends bathing in this disease. "I saw a young gentleman," he observes, "whose brother died of phthisis. He expectorated blood at the same time as his brother; and they ap- peared equally disposed to the disease. In one it run on very fast, and he died. The survivor was spitting blood continually, and the pupil of his eye was large. I prevailed upon him to begin the use of the shower- bath, and he has done so all the winter. The result is that he has lost his cough, spits no more blood, and is now a strong young man. No doubt, if he take care of himself, and commit no excess of any descrip- tion, he will go on well. I do not know of any means 190 CONSUMPTION. so powerful, in hardening the body, as the cold shower-bath." There is no magic, I will remark, as to the particu- lar form of bathing. Any good ablution—the drip- ping-sheet, as it is called in our hydropathic works, the affusion of water, the washing of the body in a wash-tub, or merely by wet towels and the wet hand— all of these are good modes. The shower-bath, it is to be remarked, is one of the most severe of all; hence great care should be exercised in its use. Preventing debility, then, we find to be the most affectual mode of treatment, in pulmonary consump- tion ; and for this object bathing, in connection with proper exercise, is the most effectual known means. SKA-VOYAGES. 191 CHAPTER XXI. Treatment of consumption continued.—Sea-voyages.—Their advan- tages and disadvantages.—Erroneous notions concerning the effect of moisture in consumption aud other diseases.—Consumptive patients generally improve at sea, notwithstanding the great amount of moisture in sea air.—A tendency to pulmonary haemorrhage ap- pears to constitute no objection to sea-voyages.—Testimony of Sir James Clark.—Experience of Dr. Andrew Combe as to the effects of sailing, in consumption.—Some of his opinions controverted.— Sea-sickness.—Its phenomena and effects.—It cannot of itself be supposed to cause any good.—Those who go to sea should select as large and well-ventilated a ship as possible.—Good effects of sail- in" much owing to the perpetual exercise to which one is subject- ed.—Long-continued voyages the best.—Sea-sickness does not generally occur in bad cases of consumption.—Sailors are not much subject to this disease.—Atmospheric changes.—The milder seasons the best for most consumptives.—A change is of itself often benefi- cial. Sea-voyages in consumption.—Concerning the advan- tages and disadvantages of sea-voyages in consump- tion, there have been differences of opinion among writers on this disease. A sea-voyage, in the tem- perate and warmer latitudes, has certainly many ad- vantages, as well also as disadvantages, when com pared with journeying, or remaining on land. The disadvantages are length of time that the patient is necessarily confined to the close, impure, and debili- tating atmosphere ot the sleeping places, the want of good vegetables and fruits, and fresh food generally; a longing for the society of friends ; and a too great 192 CONSUMPTION. sameness in the daily circumstances. But all of these evils, it is held by many, are more than compensated by the favorable circumstances which attend a trip at sea. Moisture has been often regarded as being espe- cially pernicious in all consumptive cases, and doubt- less many physicians, who have sent consumptive patients to sea, with the expectation of their being benefited, have not been aware of the fact that, on every part of the ocean, even in the driest seasons, the atmosphere is exceedingly humid. Heavy dews fall almost before the sun sets. Moisture penetrates almost every thing, even to the innermost parts of the ship's lading. Musical instruments, such as the vio- lin, violincello, guitar, etc., which have resisted the air well on shore, become so permeated by moisture, that they swell, and are not unfrequently rent asunder thereby. Fruits and vegetables, also, decay very soon ; and that all this happens in consequence of the moisture, and not from the effects of sea air, as some might suppose, is proved by the fact that sea air is ex- ceedingly pure, and pure air is the same every where, either on the mid-ocean, on the highest mountain- tops, or in the valleys. Notwithstanding the great amount of humidity to which seafaring consumptive patients are exposed, we find that they generally grow better, and this, not- withstanding the unfavorable circumstances of the seafaring life. Colds, too, are very seldom taken at sea ; and it is notorious among seamen that, if a per- son has a bad cold on land, just before sailing, he is likely very soon to get :id of it, after going to sea. SEA-VOYAGES. 193 It is proper, however, to remark, in this connection, that the changes of temperature on the ocean are generally much less sudden than on land. The cli- mate is always more equable at sea than in the same latitudes on shore. A tendency to haemorrhage from the lungs would be reckoned, by some, as forming an objection to a sea-voyage. Reasoning beforehand, it might be sup- posed that the retching and vomiting to which the seafaring are often exposed, would have a tendency to bring on the difficulty in question. But such is not the fact, and it may, I think, be set down as a safe rule of practice, that going to sea is one of the best possible means that can be resorted to in this state of the system. Any thing that will improve the general health—and going to sea generally accomplishes this object—will aid in preventing the haemorrhagic ten- dency alluded to. Dr. Clark tells us that Dr. Peebles of Edinburgh, Scotland, whose long residence at Leg- horn gave him a favorable opportunity of observing the effects of sea-voyages on consumptive patients sent from England to Pisa, met with many examples where haemorrhage had existed. And this, Dr. Clark tells us, was also the case in most of the examples which came under his own observation. The circum- stance of the patient being subject to pulmonary haemorrhage, in the early stages of the disease more especially, is not, therefore, to be considered as afford- ing any objections to a sea-voyage. Sailing, and riding on horseback, the two remedies which have, perhaps, the oldest and most general repu- tion in treatment of consumption, Dr. Combe regards 9 194 CONSUMPTION. as owing much of their influence to their exciting the cutaneous function, and equalizing the circulation. He tells us that he himself " became ill in the month of January, 1820, and soon presented many of the symp- toms of pulmonary consumption. In spite of the best advice, he continued losing ground till the month of July, when he went by sea to London, on his way to the south of France; but, finding himself unable for the journey, he was obliged to return from London, also by sea. Being extremely liable to sea-sickness, he was squeamish or sick during the whole j>f both voyages, so much so as to be in a state of gentle per spiration for a great part of the time. After this he became sensible, for the first time, of a slight improve- ment in his health and strength, and of a diminution of febrile excitement. Some weeks afterward, he em- barked for the Mediterranean, and encountered a suc- cession of storms for the first four weeks, two of which were spent, in the month of November, in the Bay of Biscay, in a very heavy sea. For more than three weeks he was generally very sick, and always in a state of nausea ; and during the whole time, although his head was repeatedly partially wetted by salt water, and the weather cold, the flow of blood toward the skin was so powerful as to keep it generally warm, al- ways moist, and often wet with perspiration, forced out by retching and nausea. The result was, that on en- tering the Mediterranean at the end of the month, and there meeting fine weather, he found himself, though still more reduced in flesh, and very weak, in every other respect decidedly improved ; and on his arrival in Italy, at the end of seven weeks, recovery fairly SEA-VOVAGES. 195 commenced, after about ten months' illness; and, by great care, it went m with little interruption till the summer of 1821, when he returned home." I do not, however, agree, in all respects, with Dr. Combe, in his explanation of the good effects of sea- sickness in consumption. Sea-sickness is one of the most horrible and unnatural feelings to which the hu- man body is ever subject. I do not believe that it does any good to pass long weeks, and even months, as is sometimes the case, with all the horrors of this malady. It cannot certainly do one any good to be almost constantly disturbed in sleep, and to pass many nights in succession, either almost without any repose, or with the most unrefreshing sleep imaginable. The atter horribleness of sea-sickness cannot be conceived of only by those who have experienced it. I cannot, therefore, believe that all this retching and vomiting, soreness of the abdominal muscles, headache, and un- utterable depression of the spirits, can cause any good whatever ; but, on the contrary, I believe that the prolonged fasting, in connection with the constant ex- ercise caused by the motion of the ship, which persons are thus compelled to undergo, is the true source of the great benefit which is often derived at the time of being sea-sick. Persons who go to sea fur consumption, as indeed from any object whatever, cannot be too careful in selecting as airy a ship as possible, and the best ven- tilated rooms. Most of the sleeping places in sailing- vessels, even in this day of improvements, are horrible places in which to spend the long and often dreary nightsvat sea. I have envied even the second-cabin 196 CONSUMPTION. passengers, who were sometimes put in rooms poorly enough furnished, where their windows were left open a greater part of the time. Comparing this with the close and unventilated state-room, furnished no matter how expensively, the occupants of the former have been in a paradise compared with the latter. A great source of the benefit to be derived from a sea-voyage, doubtless, is the perpetual muscular exer- cise to which one is subjected in a ship at sea. We are constantly in motion. We can neither walk, stand, sit, or even lie down in our berths, without be- ing subject to much muscular motion. The import- ance of this source of benefit, has, I think, been often overlooked. I am informed by intelligent sea-captains, that long voyages, as to the East Indies and to China and back, do much more good than simply going to Great Bri tain or France. The time, they say, is too short in which to effect any considerable good in confirmed cases of pulmonary disease ; and that it is only by a long voyage that any great and permanent good is to be expected. It is to be remarked, however, that although most, if not all, consumptive persons who go to sea, appear, for the time to be benefited, the relief is often only tem- porary. Many persons with this disease do not become sea-sick at all, and if sea-sickness be an advantage, which it doubtless is, because of the fasting which it compels persons to undergo, if for no other reason, many must lose the advantages that would otherwise thus be gained. I think it will be found, that in bad cases of consumption, as also bad cases in diseases of ATMOSPHERIC CHANGES. 197 whatever kind, sea-sickness rarely, if ever occurs. If this is known to be correct, we may regard sea-sick- ness as a sort of test whether a consumptive invalid may be materially benefited or not. It is plainly true, I think, the most unhealthy persons are, as a rule, the least liable to be affected by sea-sickness. I would admit, however, that the diet and general regimen of the individual have much to do in causing sea-sickness. Sailors not often subject to the disease—Sailors ap- pear very seldom to have consumption. I admit that they are not a long-lived people, and many of their habits are sufficiently bad to account for these cir- cumstances, but their comparative freedom from con- sumption is a remarkable fact. This I attribute in part to their springing from parents of hardy consti- tutions, and such as have from necessity lived upon simple fare and in simple habits of life. But their immunity from this disease is still more to be attri- buted to their constant exercise, more especially with the arms and chest, thereby bringing the lungs into active play. This too, it is to be remarked, is carried on wholly in the open air. Atmospheric changes.—Sudden changes of weather, from warm to cold and damp, appear always to affect consumptive invalids unfavorably. We find often that persons who can get along very well during the milder months of the year, experience great difficulty as the season of sudden changes approaches. A more equable temperature of the ocean, doubtless contri- butes in a high degree to the advantages of voyaging. Persons experiencing much difficulty of respiration when on land or at the seaside, will often be very 198 CONSUMPTION, sensibly relieved by sailing only so far from the shore as to be beyond the immediate influences of the land breezes. The temperature at sea when beyond sound- ings, is in a great measure regulated by the mass of water, the range of temperature of which is very limited. Hence there is an exemption from the in- fluence of those sudden and great vicissitudes of heat and cold so common to our own climate, and which appear to be extremely prejudicial, in all descriptions of pulmonary disease. Consumptive invalids coming from the country to the city of New York appear for the time generally to be benefited by the change. Indeed, I have seen no exceptions to the rule; and I presume the same would be true of all large cities which are surrounded by a country of such changeable climate as that of New York. The air of the city in the cool and colder months—and it is this season to which I refer—is milder and more equable by night and by day than the country about. The inhabitants are shielded from the winds by the buildings, and the many fires serve in some measure to moderate the atmosphere. I have known persons who were in the habit of coming down the Hudson river from Albany frequently during each year, who could always bear well with the city air, but on going to Brooklyn heights, where the atmo- sphere is remarkably fresh and bracing, the cough to which they were predisposed was certain to grow worse; and so manifest were these symptoms, they have refrained from remaining over-night in Brook- lyn, although they had relatives residing there who had a right to their company. This refers, it will be CHANGE OF LATITUDE. 199 understood, to the cool and cold seasons of the year only. I would not be understood, however, as recommend- ing, as a general thing, a residence in the city either for consumptive or any other cases. I regard all large cities as being tht great ulcerous, plague spots of the earth ; so unhealthy, indeed, that were not their population constantly fed by an influx of new-comers from the country, they would in time literally die out of disease. There is more consumption too, we have every reason to believe, in cities than in the country. But all this does not militate against the fact which I have mentioned in regard to the transient ameliora- tion of consumptive symptoms by persons passing, in the cool and cold seasons, from the latter to the former. A change from one latitude to another appears of itself often to be sufficient to cause a mitigation in the symptoms of this disease. This, indeed, appears to be true in some cases where the change is from a good to a bad atmosphere—from a healthy to an unhealthy location. And this apparent improvement—which can be reckoned upon only for a short time—must be owing in great part to the effects upon the mind. The more a person thinks of his cough, the more it is likely to continue; and on the contrary, when he goes among new scenes and new objects, his mind being taken fron himself, the cough abates. 200 CONSUMPTION. CHAPTER XXII. Treatment of consumption continued.—Effects of climate- ard fresh air.—Consumption far more common in Great Britain and the United States than in Russia.—Winter residences in relation to this disease.—Patients should be careful of going away from the com- forts of home.—Persons in this disease catch at every thing which promises the least hope.—The greater sensitiveness of the body to cold when extensive ulceration exists.—Cold both a tonic and a debilitant, according to circumstances.—It is, however, as a general thing, a tonic—Moderate warmth appears to agree with a very feeble consumptive patient best.—In very advanced states of this disease life may doubtless be prolonged by going to a warmer cli- mate.—Personal observations of Sir James Clark.—Great mortality of consumption in Bristol, England.—Different localities compared. —Relative mortality of consumption in the larger cities of the United States.—Different estimates of authors.—Few, compara- tively, who wish to change their locality have sufficient pecuniary means to enable them to do so.—Most persons must, therefore, do the best they can at home. All authorities agree that consumption is incom- parably more common in Great Britain and in the United States than in the more severe climate of Russia. " The lungs suffer rarely among the Rus- sians," says Sir James Clark, " except in public schools, and among those who adopt the European dress and fashions." I have already observed that a change from one latitude, or from one place to another, is, of itself, often beneficial in the disease we are now considering. But that there is much error in the WINTER RESIDENCES. 201 world in regard to the influence of air in consump- tion, is, I think, very evident. A brief consideration of this important subject will now be entered into. Winter residences.—It appears to be a prevalent idea, both with the people and the profession, that going from colder climates to warmer, during the winter season, is beneficial in consumption ; and facts seem to warrant this conclusion. But 'n advanced stages of the disease, when tubercular disease of the lungs has become fully established, it must be admit- ted, humiliating to the profession though it may be, that no real benefit is to be expected from a change of climate, or indeed from any circumstance in which the individual may be placed. It should be a serious question with every consumptive person, who pro- poses going away from the comforts of home, on a long journey, among strangers, whether he may not receive more harm than good. Not even money is capable of buying those attentions which a sick man often needs; and for this reason, doubtless, many a one has been injured, rather than benefited, by chang- ing his residence to a warmer climate, which, under more favorable circumstances, would have been of some benefit, and in some cases might prove effec- tual. Let, then, those who are far gone with this dreadful disease, resolve upon remaining under the watchful care of friends, and amid the comforts of home. It is, I am aware, peculiarly characteristic of this disease, that patients cling to every thing which seems to afford the slightest ray of hope. Indeed, it is often, perhaps generally, very difficult, until almost the very 9* 202 CONSUMPTION. last moment of life, to convince a -eally consumptive person that he is in any danger from the delusive disease. Well may it be said of this affection, " a dying man catches at a straw." " The medical ad- viser," says Dr. Clark, " when he reflects upon the accidents to which such a patient is liable, should surely hesitate, ere he condemns him to the additional evil of expatriation; and his motives for hesitation will be increased, when he considers how often the unfortunate patient sinks under the disease before the place of destination is reached ; v~ at best arrived there in a worse condition than when he lived in his own country, and doomed shortly to add another name to the long and melancholy list of his countrymen, who have sought, with pain and suffering,a distant country, only to find in it a grave." It will be found a rule, I think, to which there can be few exceptions, that where extensive ulceration has taken place in the system, and from whatever cause, there is a much greater sensitiveness to cold. If this observation be correct, it is an important con- sideration, in each individual case, whether or not the ulcerative process has actually commenced. If it has not, and yet there is a great predisposition to it, the winter of the Canadas, northern United States, and Great Britain, would doubtless, in many instances, be better than a warmer climate. Cold, it should be re- membered, is a tonic to the living system—a perma- nent tonic; unlike medical tonics, which by use be- come unavoidably, in the end, debilitants. True, cold may be so severe as to debilitate; but this is the abuse, and not the ase of the remedy. In accordance BENEFITS OF A WARM CLIMATE. 203 with this, we find in at least some cases, where a strong predisposition to pulmonary consumption exists, and where many of the symptoms are already present, persons are benefited by being more exposed to cold air. On the other hand, where ulceration has already commenced, and especially ii U have gone to a con- siderable extent, a warm, genial, sunny climate ap- pears to agree best with the invalid. A comfortable temperature is doubtless the best, as well as the most agreeable, where the pathological condition of which I am speaking exists. In certain cases, which are not too far advanced, life may doubtless be preserved, for many years, by a con- stant residence in a mild climate, and by carefully avoid- ing, at the same time, all imprudence in diet and general regimen, and by adopting that course of hygienic man- agement throughout, which is best calculated to pre- serve the blood in a mild and uninflammatory state. Dr. Clark tells us that, during his residence abroad, he met with several invalids laboring under this chronic form of disease, who passed their winters in Italy, with infinitely more comfort and enjoyment of life than in England. And I myself have had a number of pa- tients, who have had, to say the least, a strong pre- disposition to consumption evidently existing, who assure me that when they have left our northern coun- try, to go to such parts as the Gulf of Mexico, some portions of Florida, the Carolinas, and Virginia, they have got through the winter better and more com- fortably in every respect than could have been done at the north. But I apprehend that, after all, the imagination has a good deal to do with many of these 204 CONSUMPTION. cases ; and besides, human beings are not willing to go to a considerable expense without wishing to believe that they have beei. compensated therefor. I am not sufficiently acquainted with this subject to give an opinion as to what locality is best calculated for winter residence for the consumptive; but this much I may safely affirm, that the location, wherevei it be selected, should be of dry, sandy soil, with pure soft water for drink. Such locations, I am told, are to be found at different points on the Gulf of Mexico, between Mobile and New Orleans, and also in various parts of Mississippi. An idea that some have ad- vanced, namely, that aguish districts form a good residence for the consumptive, is erroneous. Always, the purer the air and the better the water—that is, the purer and softer—the better the locality, not only for the consumptive, but all other individuals, provided the temperature be such as to do no violence to the system. In regard to purity of water, it may be ob- served that, in the region of Bristol, England, one of the mildest and best, as far as the temperature is con- cerned, the water is exceedingly bad; and here, as I have elsewhere observed, there is greater mortality from consumption, and that too among native inhab- itants, than of any other locality of which we have a record. The climate which Dr. Clark considers of all others the best suited to consumptive patients generally, is that of Madeira. According to meteorological obser- vations, comparing the climate of this island with that of the more favorable situations on the continent of Europe, it appears that the winter temperature is con- RELATIVE MORTALITY IN U. S. CITIES. 205 siderably higher and more equable, and the summei heat much more moderate, than at any of these places. Consequently Madeira has this advantage over many other places—that the patients may reside there during the whole year, which would be an object, in many cases, for a residence. But a single winter in any lo- cality, however favorable, cannot be expected to bring about any very great benefit. The two places, which, from the character of their climate, approach most nearly to Madeira, are, according to Dr. Clark, Te- nerifte and the Azores. The climate of the latter, in particular, is said to be remarkably mild and equable. That of Bermudas is changeable, and holds out more disadvantage to the consumptive invalid. " The sum- mer climate of the whole shores and islands of the Mediterranean," this author remarks, " is unsuited to consumptive invalids, and indeed is known by experi- ence to be so pernicious to them, that sailors and sol- diers attacked with the disease in the Mediterranean fleet, and garrisons of Malta, etc., are sent to England on the approach of summer." As regards the number of deaths in the four largest cities of the United States—New York, Philadelphia, Baltimore, and Boston, the average annual proportion of the general mortality was, according to the estimate of Dr. Emerson, of Philadelphia, made a few years since, as follows : New York, one in 39.36 ; in Phila.- delphia, one in 47.86 ; in Boston, one in 44.93 ; in Baltimore, one in 39.17; and that the average of the mortality from consumption alone, to the general mortality, was, in New York, one in 5.23; in Phila- delphia, one in 6.38 ; in Boston, one in 5.54; in Bal- 206 CONSUMPTION. timore, one in 6.21. According to Dr. Hay ward, of Boston, the deaths from consumption, in proportion to the whole number, as shown by an estimate made for ten years, from 1831 to 1841 inclusive, the deaths in Boston, from consumption, were one in 7.587; in Philadelphia, one in 7.482 ; and in New York, one in 5.952. Thus, it appears, authorities differ somewhat in their estimates, and, indeed when we compare all statistical writers that have made estimates in rela- tion to these cities, it is very difficult to ascertain which is most subject to consumption. It is evident, however, that Boston is by no means so unfavora- ble a locality as many have supposed. We may, in- deed, I think, safely conclude that the chance is as good in that city as either of the others mentioned. Dr. Chapman, of Philadelphia, who is regarded as high authority, considers the native population of that city as being nearly exempt from this disease. " Com- paring Philadelphia with New York, Newport, and Boston," he remarks, " equally remote from the sea and the mountains, it comparatively escapes the au- stere winds of the one, and the cold blasts of the other, maintaining a more regular and moderate temperature than the latitude of its position would seem to warrant. That our bills of mortality exhibit a number of deaths from this disease, cannot be denied, but most of these are negroes and foreigners—and it must also be known that all chronic pectoral affections are reported, with little discrimination, under the title of consumption. It is at least a fact," continues Dr. Chapman, "that in the whole circle of my acquaintance, wide and intimate as it is, there is hardly a native family who has the VVA.NT OF PECUNIARY MEANS. 207 consumptive taint, or who for year's has lost a mem- ber by this disease." But, on the other hand, Dr. Dunglison, who is equally good authority, says, " that such, certainly, has not been the result of his experi- ence, except in the Philadelphia Hospital, where, for obvious reasons, the proportion of foreigners is large." In private practice, the great number of consumptive cases that have fallen under his notice, has occurred among the " native population." Moreover, the ne- groes—who fall victims to it in great numbers—are natives, in as large a proportion, perhaps, as the whites who inhabit Philadelphia. It should, however, be remarked, as an important consideration in reference to consumptive individuals changing their locality, that there are few, compara- tively, who can avail themselves of whatever advan- tages might thus be gained. Even in our northern United States, the population of which is, on the whole, far more independent in pecuniary matters than that of any other country on the face of the globe, very few indeed have the means that would en- able them to journey for months a long way from home. It becomes, then, a serious consideration with the majority of consumptive invalids as to what they can best do, under the circumstar 'jes, at their own nomes. 208 CONSUMPTION. CHAPTER XXIII. Treatment of consumption continued.—Exercise.—Valuable remarks of Dr. Parish.—General effects of exercise on body and mind.—It should be made a pleasure instead of a task.—It is best when per formed in the open air, and not alone.—Exercise should be moder ate when taken immediately after a meal.—The different modes of exercise.—Walking.—Walking over mountains.—Advantages of this practice.—It should be graduated according to the strength.— Riding on horseback.—This was in great repute anciently.—Syd- enham and Dr. Lambe.—It is one of the best possible modes.— Riding in carriages.—Swinging.—The good effect of this doubtful. —Dancing.—The use of dumb-bells.—Shuttlecock.—Graces.— Spinning wool.—Farming, gardening, woodsawing, chopping, and the more useful forms of exercise generally best.—Exercise of chil- dren.—Remarks of Dr. Clark. In the North American Medical and Surgical Jour- nal (1830), there is an article by Dr. Parish, from which the following is an extract, the doctrines of which are far in advance of the profession generally, even at the present time. The extract is as follows : " Vigorous exercise, and a free exposure to the air, are by far the most efficient remedies in pulmonary consumption. It is not, however, that kind of exercise usually prescribed for invalids—an occasional walk or ride in pleasant weather, with strict confinement in the intervals—from which much good is to be expect- ed. Daily and long-continued riding on horseback, or in carriages over rough roads, is, perhaps, the best mode of exercise; but where this cannot be com- manded, unremitting exertion of almost any kind in HEALTHFULNESS OF F.XERCIS3. 209 the open air, amounting even to labor, will be found highly beneficial. Nor should the weather be scru- pulously studied. Though I would not advise a con- sumptive patient to expose himself recklessly to the severest inclemencies of the weather, I would never- theless warn him against allowing the dread of taking cold to confine him on every occasion when the tem- perature ma)r be low, or skies overcast. " I may be told that the patient is often too feeble to bear exertion ; but, except in the last stage, where every remedy must prove unavailing, I believe there are few who cannot use exercise without doors; and it sometimes happens that they who are exceedingly debilitated find, upon making the trial, that their strength is increased by the effort, and that the more they exert themselves, the better able they are to sup- port the exertion." We read in the sacred volume that it is necessary for man " to eat bread in the sweat of his brow." By this we are to understand that physical exercise is implied. How beautiful is this provision of nature; that the very means which we are to put forth for acquiring an honest maintenance on the earth, is also calculated to promote both healthfulness of body and peace and happiness and contentment of mind. This is a lesson which a selfish, diseased, and suffering hu- manity has yet to learn. " Were I to mention the remedy," says Dr. Sweet- ser, " which promised most in the onset of consump- tion, I should say, daily, gentle, and protracted exer- cise in a mild and equable atmosphere. * * * Though exercise in the open air," continues this able writer 210 CONSUMPTION. " may not be expected to cure confirmed phthisis, yet, if judiciously pursued from day to day, the strength will hold out better, the individual will be rendered more comfortable, will retain more sources of en- joyment, and his existence will probably be longer protracted than it would have been under confine- ment." Exercise, to cause its best effects should not be per- formed solitarily. Man is a social being. We read of its having been said, " It is not good for man to be alone." The mind during exercise should be as much as possible pleasantly engaged. Exercise to do its greatest good must be made a pleasure instead of a task. Those who are interested in botany, mine- ralogy, and other branches of natural sciences, and have the means and leisure at their command, can- not fail of finding pleasant objects of pursuit. Jour- neying through pleasant portions of the country, or to foreign countries, where " sight-seeing" can be enjoy- ed to the fullest extent, has a most excellent influence on those who have strength, and can avail themselves of such advantages. Would that all poor patients— a class too, which forms the great majority of cases— could have these blessings. To cause its best effects, exercise should be moder- ately and continuously as the patient can bear. Too much and too violent exercise is certain to debilitate the consumptive patient, and so does inevitable harm. Persons are far too apt to do too much one day, and then remain idle the next. Moderate and habitual exercise should be the rule. As to the best times for exercise, the early part of MANNER OF EXERCISE. 211 the day, when the system is most vigorous, and after the sun has risen high enough to dispel the cold and damps of evening, is to be regarded as on the whole the best. At sea, we need not fear so much from dampness, but on land the temperature between day and night varies much more. For this reason, it is necessary for consumptives to be careful of night air on land. Exposure to the hot sun in the hot wea- ther should also be avoided. If exercise be taken immediately after eating, it should "be of a very mild kind. Gentle exercise al- ways promotes digestion. It must be remembered, too, that what may be moderate exercise for one, may be far too great and fatiguing for another. Each should carefully judge for himself, and the exercise should always be graduated according to the habits and powers of the individual, and to his present con- dition of health. Of the different forms and modes of physical exer- cise, it is proper that something should be said, and I must here remark, that the tendency with many ap- pears to be the seeking of that which is complex, and not easily understood, rather than the simple and na- tural modes. People are too apt to confide in dumb- bells, gymnastic academies, ten-pin alleys, and the like —things good enough in their proper place—to the neglect of walking in the open air, tilling the ground, woodsawing spinning, weaving, washing, bread-mak- ing, and things of a similar nature. Honest labor with the body is not at all genteel at the present day. " The sluggard will not plough by reason of the cold ; he shall, therefore, beg in harvest and have nothing." 212 CONSUMPTION. This principle holds as good in regard to bodily health as elsewhere. Walking.—This is said to be the most independent means of exercise, and it is certainly one of the best. Walking is pre-eminently a natural means of locomo- tion. It brings a large number of muscles into play, and at the same time, when practiced out of doors, as is usu- ally the case, gives us the additional advantage of fresh air and light. These, as I have elsewhere said, are very important agencies in the restoration and pres- ervation of health. Walking shakes off sleep in the morning; it increases the appetite, and aids digestion ; it gives vigor and elasticity to the body, and cheerful- ness and .contentment to the mind. Walking over mountains, for those who are able to endure such an exercise, is one of the best possible means of giving strength to the lungs, and the system generally. The air is pure, and in consequence of the exertion required, a large amount is necessarily inhaled. Long journeys, performed on foot, have, also, been found most valuable to consumptive patients, who are not too far gone in the disease. Dr. Combe remarks, "I was myself sensible of advantage from this kind of exercise during a Highland excursion. The necessity of frequent and deep inspirations, and the stimulus thus given to the general pulmonary cir- culation, had an obvious effect in increasing the capa- city of the lungs, and the power of bearing exertion without fatigue. Even when I was wearied, the fa- tigue went off much sooner than after a walk of equal length on a level road, and was unattended with the languor which generally accompanied the latter. In EXERCISE ON HORSEBACK. 213 fact, the most agreeable feeling which I experienced during the whole time was while resting after under- going, in the ascent of a hill, a degree of exertion sufficient to accelerate the breathing, and bring out a considerable quantity of perspiration. A lightness and activity of mind, and freedom about the chest, which I never felt to the same extent at any other time, followed such excursions, and made the fatigue comparatively light." Walking, like all other modes of exercise, should be timed and regulated carefully in accordance with the patient's strength. It is no doubt true, that many, both among the sick and the well, avoid this exercise as much as they can, more from want of moral energy and will, than from lack of bodily power. Still, it must be admitted that walking may be overdone; the con- sumptive may, by doing too much, aggravate all of the unfavorable symptoms in his case. Good judg- ment and common sense, joined to experience, are the best guides in this matter. Riding on horseback.—Sydenham, one of the earlier English physicians, looked upon horseback exercise as a particularly efficacious remedy in pulmonary complaints. In reference to the treatment of cough and consumption, he observes : " But the best remedy hitherto discovered in this case, is riding sufficiently long journeys on horseback, provided this exercise be long continued ; observing that the middle-aged must persist in it much longer than children or young per- sons. For, in reality, the Peruvian bark is not more certainly curative of an intermittent fever, than riding is of a consumption at this time of life." And else- 214 CONSUMPTION. where he says: " But the principal assistant in the cure of this disease, is riding on horseback every day ; insomuch that whoever has recourse to this exercke, in order to his cure, need not be tied down to observe any rules in point of diet, nor be debarred any kind of solid or liquid aliment, as the cure depends wholly upon exercise." The older physicians, however, drew no very nice distinctions between simple coughs—which may arise from various ailments other than pulmonary—and consumption itself. Hence we must make some al- lowance in their estimate of this exercise. Still, it is an invaluable means, and should, when at all practi- cable, be resorted to by the consumptive. This method has a number of advantages over walking; it can be persevered in longer at a time, without fatigue, to those who are accustomed to it; it gives a more general or successive exercise to the body, and at the same time it does not over-tax the lungs; the patient has a more rapid passage through the air, and is for a longer time exposed to its influ- ence, in connection, also, with that of light. Dr. Andrew Combe relates his experience of the good effects of horseback riding, in connection with other means. He says : " To carry on what was so well begun (namely, by a sea-voyage to the Mediter- ranean), riding on horseback in the country was re- sorted to, and that exercise was found to excite the skin so beneficially as to keep it always pleasantly warm, and generally bedewed with moisture, even to the extremities of the toes ; and in proportion to this effect was the advantage derived from it in relieving EXERCISE ON HORSEBACK. 215 the chest, increasing the strength, and improving the appetite. A second winter was spent in the south with equal benefit; and in the summer of 1822, riding was resumed at home, and the health continued to improve. The excitement given to the skin by riding was sufficient to keep the feet warm, and to prevent even considerable changes of temperature from being felt, and rain was not more regarded, although special attention was of course paid to taking off damp or wet clothes the moment the ride was at an end. Strength increased so much under this plan, combined with sponging, friction, and other means, that it was pei- severed in through the very severe winter of 1822-3, with the best effects. For nine years thereafter the health continued good, under the usual exposure of professional life; but in 1831 it again gave way, and pulmonary symptoms of a suspicious character once more made their appearance. The same system was pursued, and the same results have again followed the invigoration of the cutaneous functions, and of the general health, by a sea-voyage, horseback exercise, and the regular use of the bath. These have proved beneficial in proportion to their influence in keeping up warmth and moisture of the surface and extremities." Dr. Combe, it will be remembered, finally sank with consumption in the year 1848, and although his disease could not be considered as ever wholly cured, still the benefit he derived from the means he so judiciously adopted, well rewarded him for the efforts put forth. And had his health not been thus improved, he could, in all probability, never have written those able and invaluable works which he afterward did. 2i6 CONSUMPTION. Riding in carriages.—When the lungs are weak, and the individual has not the strength to enable him to walk with advantage, riding in a carriage may of- ten be rendered a beneficial exercise. " It calls into more equal play all the muscles of the body, and, at the same time, engages the mind in the management of the animal, and exhilarates by the free contact of the air and more rapid change of scene. Even at a walking pace, a gentle but universal and constant action of the muscles is required to preserve the seat, and adapt the rider's position to the movements of the horse; and this kind of muscular action is extremely favorable to the proper and equal circulation of the blood through the extreme vessels, and to the preven- tion of its undue accumulation in the central organs. The gentleness of the action admits of its being kept up without accelerating respiration, and enables a delicate person to reap the combined advantages of the open air and proper exercise, for a much longer period than would otherwise be possible." Swinging.—This, as an exercise in consumption, has had a certain degree of reputation with some. It is, in some respects, like sailing. I consider this of doubtful benefit. It is apt, I think, to injure the brain. Dancing has been reckoned on, by some, as a means of invigorating the muscular system. It is not, however, often resorted to as a mere means of exercise. It is generally practiced too long at a time, and not often enough, to be productive of any con- siderable good. Waiving the question of morality, I do not consider this mode of exercise nearly as good as many others. It has the disadvantage of being BENEFITS OF EXERCISE. 217 performed within doors, generally in close and con- fined air, and at late hours of the night. The rooms, too, are almost necessarily dusty—a circumstance which must always operate, to a certain extent, against the well-being of the lungs. Practiced in the daytime, out of doors, as is common in France, danc- ing may certainly be made an invigorating exercise. Dumb-bells, when not too heavy, and not too vio- lently used, are serviceable, as an in-door exercise, for strengthening the arms and chest. Persons gen- erally practice this exercise too violently, and not long enough at a time. Dumb-bells " do harm occa- sionally from their weight, being disproportioned to the weak frames which use them ; in which case they pull down the shoulders, by mere dint of dragging." In resorting to this, as in all other in-door exercises, the windows and doors should always, when practica- ble, be thrown open. Shuttlecock is an exercise that calls into play the muscles of the chest, trunk, and arms more especially, and is therefore good for those predisposed to consumption. If females will persevere, and learn to play with the left hand, as well as with the right, they will find it an excellent mode of preventing spi- nal curvature, and thus of invigorating not only the whole spinal column, but the system generally. The play of graces is similar to that of shuttlecock, and is also well adapted for expanding the chest, and giving tone and vigor more especially to the upper parts of the system. Both of these exercises are very useful, if practiced in the open air. Spinning wool, at the common hand-wheel, is one 10 218 CONSUMPTION of the best possible exercises for females. It not only gives free movement to all the muscles of the arms, chest, and trunk, but amounts also to a large share of exercise of the whole body. Chopping and sawing wood, are, for those who are sufficiently strong to endure such exercises, invaluable means of warding off consumption. It must be ad- mitted that exercise, which is performed merely for exercise, is never so satisfying to the mind as that which is of itself intrinsically useful. All modes which are resorted to merely as exercise, become soon tedious to the mind, and individuals are not willing to pursue them. Tilling the soil, gardening, fruit-raising, and most of the forms of manual industry, are far prefer- able, as a general fact, to the more artificial modes of exercise. I would not, however, lose sight of the fact, that man is by nature a social being, and needs at times recreation of the body, as well as of the mind. Exercise of children.—As a means of preventing scrofula and consumption in children, Dr. Clark gives us the following excellent advice : " When the child has acquired sufficient strength to take active exercise, he can scarcely be too much in the open air; the more he is accustomed to it, the more capable will he be of bearing the vicissitudes of the climate. If children are allowed to amuse themselves at pleasure, they will generally take that kind and degree of exer- cise which is best calculated to promote the growth and development of the body. When they are too feeble to take sufficient exercise on foot, riding on a donkey or pony forms the best substitute; this kind of exercise is at all times of infinite service to delicate BENEKTS OF EXERCISE. 219 children; it amuses the mind, and exercises the mus- cles of the whole body, and in so gentle a manner as to induce little fatigue. Young girls should be al- lowed and even encouraged to take the same kinds of exercise as boys ; u is chiefly the unrestrained free- dom of active play that renders them so much less subject to curvatures of the spine and other deformi- ties than girls—a large proportion of whom are more or less misshapen, in consequence of the unnatural restraint which is imposed upon them by their dress and imperfect exercise." 220 CONSUMPTION. CHAPTER XXIV The treatment of consumption continued.—Inhalation.—Meaning of the term.—Facts and principles on which the practice of inhalation is founded.—Advantages of this method.—111 effects of confinement within doors.—When and to what extent is inhalation available?— Method of performing it.—Instruments, and directions for their use.—Playing on wind instruments as means of inhalation.—Public speaking and reading.—Their advantages in preventing pulmonary disease. By " inhalation" is meant a method of exercising the chest and lungs, through means of drawing in a more than usual quantity of air, which is again expelled slowly and with an effort of the muscles concerned in the respiratory function. Thus, if we take a com- mon goose-quill, each end of the hollow part of which is cut off so that it forms a tube, and hold this, with some degree of compression, in the mouth, and breathe through it, either inwardly or outwardly, or both, we in a measure, and in proportion as we exert ourselves, give an artificial exercise to the chest and lungs. This principle has, in different ways, been taken advantage of by practitioners of the healing art, to give tone, vigor, and greater volume to the parts of the living body concerned in the respiratory process. The facts on which this mode of practice is based, are the following: It is a matter of observation that those classes of persons who are. by their occupation INHALATION. 221 or modes of life, compelled most to exert these mus- cles and parts about the chest—such persons, for in Stance, as the various out-door workers noticed in the tables of M. Benoiston, concerning the Parisian hos- pitals, in another part of this work—are the most free from consumption. Singers, and public speakers, too, by reason of their exercise, often gain great power and volume of the chest and lungs. Men, also, who play much on wind instruments, tell us that, instead of being weak-chested, as when they commenced, they have grown vigorous and strong under the exer- cise, the general health, at the same time, becoming much improved. In accordance with these physiological facts and principles, inhalation has been instituted. " An extraordinary, but most undeserved reputa- tion," says Dr. Ramadge, "is bestowed on various substances, mechanically received into the lungs, in a state of vapor. Among these I may mention tar, iodine, chlorine, hemlock, turpentine, and many other articles of a stimulating or sedative nature. I attach little or no importance to any of them. If benefit is derived, it is, in almost every instance, in consequence of some such effects as the following. pulmonary expansion, to a degree sufficient to exerl an influence in bringing into contact the surfaces of those early cavities which are most invariably formed in the summit of the lungs ; pulmonary catarrh, or ts common consequence, as vesicular emphysema (infla- tion), in both of which the lungs acquire an unusual magnitude ; in the latter more especially." This quo- tation gives an explanation of th,■* benefits that are to be 222 CONSUMPTION. derived, mechanically, from the method which we are now considering. But there is another advantage gained by inhala» tion, and a very important one in the cure of con- sumption. The air breathed may well be compared to food in the living body. Food gives us blood, but air is necessary in order to make that blood pure. Air may be said to be food to the blood. If the lungs breathe but little air, the blood must of necessity be but poorly purified. If that air be impure also, the blood, evidently, cannot be so perfectly formed. The good condition of the blood depends much, therefore, upon the quantity and quality of the air we breathe. If an individual be confined in a close and badly ventilated room, so that his lungs become enfeebled by want of the proper stimulus of pure air and exer- cise, we find that soon the whole frame becomes weak. There are, it is true, a variety of causes concerned in bringing about this result; but one of the most efficient among them all is the lack of good air for the daily and constant purification of the blood in the lungs. When, and to what extent is inhalation available ? If extensive cavities have already been formed in the pulmonary tissue, we cannot, unfortunately, in the great majority of cases, look for any permanent im- provement, whatever may be the means employed. Still, in these unfavorable cases, surprising relief will often be afforded by inhalation in connection with other suitable treatment, and life may in many in- stances be thus materially prolonged. Such persons should begin the practice with caution, since whatever INHALATION. 223 tends to over-exercise the lungs under such circum- stances will only tend to hasten on more rapidly the fatal work. Players on wind instruments, singers, and public speakers have often brought on fatal haemor- rhage from the lungs by an excessive effort in these exercises. But any individual may, if he will but observe carefully, be enabled to go on safely in this matter. If inhalation over-fatigues the system, or ii it excites much coughing and expectoration, or any other unpleasant symptoms, let him desist for a time; at least, let the efforts be made milder. Thus by be- ginning carefully, doing each succeeding day a little more than on the preceding, a great deal of good may be accomplished in most cases. Inhalation performed two or three times daily, and half an hour or an hour at each time, has been found in a few weeks to work a wonderful change for the bet- ter in the chest. " Externally, the muscles concerned in respiration become manifestly enlarged," says Dr. Ramadge, " and the bony compages of the chest, both before and laterally, visibly increased; while at the same time, the natural respiratory murmur will be heard internally far more distinct than ever. Such has been the increase of size which the chest, in young persons especially, has undergone through the exer- cise of inhalation, that I have known individuals, after inhaling little more than a month, require their waistcoats to be let out. It is a fact incredible to one who has never been at the pains to measure the chest, or examine its shape," continues this author, "what an enlargement it acquires by the simple action of breathing for the time above stated (a half hour 224 CONSUMPTION. two or three times daily) backward and forward through a narrow tube of a few feet in length." It is said that on measurement of the chest, its circumfer- ence may be increased within the first month of in- haling to the extent of a whole inch. Means by which inhalation is accomplished.—A method which has been adopted by some in inhalation, and one which has been particularly recommended by Dr. Ramadge, of London, is to make use of a tube of rather small calibre, several feet in length. The patient. breathes both inward and outward through this appa- ratus, and in so doing necessarily gives exercise to all the parts concerned in respiration. Another method is to have a small tube of silver, wood, or some other material, with a calibre of from an eighth to a six- teenth of an inch, and about three inches in length. At the outer extremity of this tube a valve is arranged so as to allow the free passage of air inward to the lungs, but which partially closes as the air is expelled. Thus the lungs are kept inflated a longer time than would ordinarily be the case in the act of expiration. This, then, amounts to an artificial exercise of the parts, and resembles very nearly the action of the respira- tory organs of an individual playing on a wind instru- ment. I do not however see any particular advan- tage in the tube containing a valve over the simple form or even a common goose-quill. We need ex- ercise in drawing in air as well as in forcing it out. These breathing tubes have been sold at a very great price, compared with their cost. If a practi- tioner holds forth that he will give advice gratis, but must sell twenty-five or fifty dollars' worth of appara- INHALATION. 225 tus and drugs before he can do any thing, it does not look very well, certainly, as to point of honesty. It would be a better mode—and one too which would succeed better in the end—if he should sell his articles at a fair valuation, and at the same time have pay for his professional services direct. But there are all manner of means by which dishonest men cheat the community, and in no one thing is this carried on more effectually, or more successfully, than in matters of treating the sick. I have myself designed a form of breathing tube which I consider much more convenient, and better fitted to the purpose intended, than any I have yet seen. It is made of silver, and will be furnished at a price not to exceed $1 50. At the same time I must tell my readers that I consider a common goose-quill, with its ends cut off, quite as good as any other tube. But if the silver is an object, and if an individual con- siders that he will persevere more with the use of that which is costly, he can easily obtain tubes at from 81 50 to $5 00, as he may choose. On the other hand, if he prefers to go upon Poor Richard's plan, that " a penny saved is as good as two earned," he may carry in his pocket the common goose-quill, and if he will but persevere, may succeed just as well as with the more costly apparatus. In conclusion, on the subject of the breathing tube, I would remark, that patients should not reckon too much on its advantages. Nor should they neglect bodily exercise, or any of the other well-known means of regaining lost health. Above all, they should not n6e it to excess. It should be looked upon as one of 10* 226 CONSUMPTION. the various means by which life may be p?olonged and rendered more comfortable—a means which has an abuse as well as use. Playing on wind instruments.—Those who are predisposed to weakness of the chest and lungs, will do well, if they will but commence in season, to select some wind instrument of music to practice on, as a means of invigorating the parts mentioned. The flute is one of the best of musical instruments, and is, moreover, one that is easy to learn. As a general thing, however, those instruments which require the mouth to be closed in the act of blowing them, are best. The clarionet, the bugle, and French horn are instruments of this class. When the blowing is per- formed with the mouth closed, as is the case in the use of those instruments, the lungs are more inflated, and the exercise greater, than in the use of the flute. But it should be particularly remembered, that these exercises may be misused; persons have been killed by them—that is, by practicing too violently, by doing too much at a time, or by adopting them at a time when the lungs were too weak to bear the exertion. A little care, and the exercise of good common sense, however, will generally be sufficient guides in all such exercises. Public speaking and reading aloud.—It is said that the celebrated Cuvier was in the habit of ascribing his own exemption from consumption to this practice. At the time of his appointment to a professorship, it was believed that he must necessarily fall a victim to this a. sease. The habitual exercise of lecturing grad- ually strengthened his lungs, and improved his general PUBLIC SPEAKING. 227 health so much, that he was never after threatened with any serious pulmonary disease. Mr. O. S. Fowler, the able and well-known lecturer on Phre- nology, tells us that there is no doubt but that, if he had not commenced soeaking in public, and giving phrenological examinations in private, he would long ago have died of consumption. " I find," he remarks, " its habitual practice, if not indispensable in order to arrest the progress of this consumptive tendency, at least highly beneficial to health, and a powerful strengthener of the lungs." A medical lecturer of London gives us the following testimony : " We know ourselves, from personal experience, that often, when preparing to go to a lecture, a languor has crept upon us, inducing an unwillingness to exert ourselves. We have gone—the lecture has commenced—the mind was called into action—a perspiration broke forth on the brow—the circulation was equalized—and, at the conclusion of the lecture, the languor was gone." Hence, also, this writer recommends "reading to one's family in the evening, as an excellent practice, and one tending much to sweeten social life." Public speaking may, however, like every other good exercise, be carried to excess. Clergymen, who are often in the habit of speaking two or three times on a Sunday, and then little or none at all during the week, and who, at the same time, use but little physi- cal exercise of any kind, are often injured by it. Sore throat, bronchitis, weak chest and lungs, and even consumption "'.'.self, are thus sometimes evidently brought on. 228 CONSUMPTION. CHAPTER XXV. The treatment of consumption continued.—The processes of water cure.—Water drinking.—Importance of water as an agent of life.— Effects of water taken internally, in fevers and other inflammatory diseases.—Rules to be observed.—The injection, or clyster.— Modes of using it.—The abreibung, or rubbing wet-sheet.—Its mildness and general applicability as a form of bath.—The towel- bath.—The sponge-bath.—The shower-bath.—Rules for its use.— General directions concerning baths.—Bath by affusion.—The plunge-bath.—How often should we bathe ?—The half-bath.—The head-bath.—The nasal bath.—The mouth or oral bath.—The lein- tuch, or wet-sheet.—Mode of applying it.—Wet compresses, ban- dages, and fomentations.—The cooling, the warming or stimulating, and the soothing wet compresses.—Their use in pains of the chest. The processes of what is popularly termed the "wa- ter-cure," being eminently valuable as a means, both of prevention and cure of consumption, according to the nature of the case in which they are applied, I have deemed it advisable, in this work, to enter some- what into detail concerning them. And I here re-af- firm what I have elsewhere inculcated, that this treat- ment, which includes, in its detail, water, air, exercise, diet, and clothing, is the best of all known methods in this most formidable malady of which I am writing. Those who desire to peruse a more detailed account of these processes, are referred to the " Water-Cure Manual," written by the author of this volume. Drinking of water.—The human body, as a whole, by weight, consists of about 80 parts in the 100, of DRINKING OF WATER. 229 water. Even its drier portions, as bone, muscle, car- tilage, ligament, and nerve, contain a large proportion of this fluid. The blood has about 90 parts in the 100, and the brain nearly the same proportion. With- out the presence of water in the living body, food would not become digested in the stomach ; no chyme would be elaborated, to supply the chyle, or chyle to form the blood. Respiration, circulation, secretion, nutrition, perspiration, elimination, neither of these could take place in the human system without the presence of a large proportion of water. The living body may be compared to a perpetual furnace, which has a tendency, constantly, by evapor- ation, to become dry. If food and water are, in every form, withheld, the individual grows parched and fe- verish. In a few days, delirium supervenes, and, in about three weeks, he dies. But if water be taken according to the demands of thirst, no fever or delirium ensues, and life goes on more than twice as long as when both food and drink are withheld.* These facts * In the " Transactions of the Albany Institute," for 1830, Dr. McNaughton relates the case of a man, named Reuben Kelsey, who lived on water alone for fifty-three days. " For the first six weeks, he walked out every day, and sometimes spent a great part of the day in the woods. His walk was steady and firm; and his friends even re- marked, that his step had an unusual elasticity. He shaved himself, until about a week before his death, and was able to sit up in bed till the last day." Kelsey was twenty-seven years of age at the time of his death, and, during his fasting, evidently under the influence of delusion. At the beginning of his course, he assigned as his reason for so doing, that he would be furnished with an appetite when it was the will of the Almighty he should eat. Barn-yard fowls, kept from food and drink, do not survive the uinth day. If water is allowed them, they reach the twentieth day. 230 CONSUMPTION. show us, most conclusively, the great value of watei as a drink. It is not, however, proper to speak of water as a nutriment. True, it is immediately concerned in most or all of the transformations constantly going on in the system; but that water is ever decomposed, or chemically changed, in the .iving animal, has not been proved; nor have we reason to believe that such is ever the case. Water, besides being the best of all drinks, is, as an internal remedy, the greatest of all medicinal sub- stances. We can scarcely give a lecture, enter a neighborhood, or even a family, and introduce the sub- ject of water, but that we are at once told of remark- able instances of cure, which the narrator has known to take place, through the drinking of water. The patient was very sick; learned physicians de- clared, " For his life, he must not touch cold water." Every thing fails ; the man grows worse—is given up; and, in the long, dark night, to give some small relief from his raging thirst, water is administered. The friends tremble for his safety ; but he appears to grow better, and more is given. Sleep and perspiration ensue. The patient lives—" in spite of cold water," shall any one say ? Or, perhaps, in his delirium, he has broken over all bonds, and quaffed, suddenly and deep, of the fluid which, above all earthly things, he craved; or, by stealth, hire, or threat, he accom- plishes his object. Who ever knew a patient in high, These experiments can be easily tried; but, as the principle is well established, no possible gcod wouU resujt; and none but the most heartless barbarian would repeat tt 3m. RULES FOR DRINKING WATER. 231 burning fever (not induced by over-exertion) killed by cold water ? Many have been saved ; but more, alas ! incomparably more, have been lost for the want of its use. These facts all go to show the importance of water, both as a curative and prophylactic agent, in pulmo- nary consumption. Only pure soft water is to be used. By this means, the cough and feverishness may be often modified, to a truly wonderful extent. Rules for drinking water.—A very good rule for the healthy, and such as have active exercise, is to drink, except in fatigue and exhaustion, as thirst de- mands. Patients may have the general direction to take at such times, as when the stomach is empty, as much as can be conveniently borne, which will gene- rally be from six to twelve half-pint tumblers in the whole day. Feeble persons must not go on very rap- idly at first. If they have been accustomed, a long ,ime, to hot drinks, they should, on commencing, make small beginnings, gradually training the stomach in the new way. Wonders may thus be accomplished, if the patient can have system and perseverance enough to proceed. The better statement for invalids, perhaps, is, " ex- ercise as much as may be without causing too great fatigue; by this means, the system becomes invigo- rated and warmed; more fluid is thrown off, more is needed, and more relished; so exercise and drink as much as you conveniently can." Patients in the later stages of consumption will al- ways find themselves much the better if they will omit the suprer, and take only pure soft water instead 232 CONSUMPTION. By this means the cough and feverishness may be often modified to a truly wonderful extent. The injection, or clyster.—This very important part of the water-treatment is as old as the healing art itself, but in the endless complications of the reme- dial means of modern times, almost any irritating or disgusting fluid, other than pure water, is preferred. A variety of instruments for administering injections are now manufactured, varying in price from four to five dollars. The cheaper kinds, if well made and used with some degree of dexterity, answer a good purpose. Every person should have access to one; no lady's toilet is complete without it. Contrary to the common notion, a person, by the exercise of a little skill, can easily use this remedy without assistance. It is in no wise painful, but decidedly agreeable, and affords, in a variety of complaints, speedy and efficient relief. Thousands suffer incalculably from constipa- tion, year after year, when the use of this simple means would give the greatest relief and thousands more are in the daily and constant habit of swallowing cathartic and aperient drugs, Brandreth's pills, castor oil, magnesia, blue pill, mercury, and so through the long chapter, that irritate and poison the delicate coats of the stomach, and exert their pernicious influence throughout the numberless lanes and alleys of the system, destroying the healthy tone of the tissues, de- ranging the nerves, and thus causing a state of things incomparably worse than the disease itself, and ren- dering even that more and more persistent. Most persons may and should use this remedy cold. A beginning may be made with the water slightly THE INJECTION, OR CLYSTER. 233 warmed. In obstinate cases, lukewarm water effects the object quicker and with greater certainty than cold. It may be repeated again and again, in as great quantity as is desired. Some prefer the clyster before breakfast; others immediately after; the former, I be- lieve, on the whole, to be the best. A good mode, too, is to take a small injection, a tumbler full, more or less, that is retained permanently without a move- ment before morning. This is very soothing to the nervous system, aids in procuring sound sleep, and by its absorption, in the coats of the bowels, dilutes acrid matters therein, tonifying and strengthening likewise those parts, and aiding materially in bringing about natural movements ; but invaluable and efficient as is this remedy, let no one persist in those habits of diet, such as tea and coffee drinking, the use of heating and stimulating condiments, greasy and concentrated forms of food, etc., that tend so certainly to constipation and irregularity of the bowels. In all forms of looseness of the bowels, as diarrhoea, dysentery, cholera morbus, cholera infantum, and the like, this remedy is most excellent. In many a sudden attack, injections, sufficiently persevered in, will suf- fice quickly to correct the attack, and this when, in the ordinary treatment, a course of powerful drugging would be deemed indispensable, that would result per- haps in death. This statement will cause sneering, I know, but it is no fancy sketch. The. thoroughly washing out, so to say, the lower bowels; by which also the peristaltic or downward action of the whole alimentary canal is promoted, and by the absorption or transudation of water, its contents are moistened 234 CONSUMPTION. and diluted, and the whole of the abdominal circula- tion completely suffused, by that blandest and most soothing of all fluids, pure water. I say all this is suf- ficient to effect, in all such cases, a great amount of good ; and whoever understands well the sympathies and tendencies of these parts of the human system, will at once perceive the truth of that I affirm. So, also, in constipation and obstructions of the bowels, when no powerful cathartics that any one dare ven- ture to exhibit, can be made to act, this simple remedy is effectual in bringing about the desirable object. In any of these cases, if there is debility, and espe- cially if it be great, whether the patient be young or old, the water should be used of a moderate tempera- ture—not above that of the' blood (98<* F.), nor very much below that point. Even if there is high inflam- mation and much heat in the bowels, water at 90 or 95°, persevered in, will readily bring down the tem- perature of the parts to a natural state, as may be de- termined by placing the hand upon the abdomen. The patient's feelings of comfort as to warmth or cold are a good guide. With these precautions as to tem- perature, etc., the injections may be repeated for an hour, or even hours upon the stretch. The abreibung, or rubbing wet-sheet.—This is one of the mildest and most convenient forms of a bath. A large linen sheet, of coarse material, is wrung out in cold water, and, while dripping, one or more assist- ants immediately aid in rubbing over the whole sur- face. This is continued, briskly, three, five, or more minutes, until the skin becomes reddened, and the sur- face in a glow. The system is then made dry with THE RUBBING WET-SHEET. 235 towels, or a dry sheet. Frictions with the dry hand are dso very useful. If the patient is feverish, much friction is not required—the sheet is repeated often. In determination of blood to the head, the lower ex- tremities being generally cold, the rubbing-sheet tends to restore an equilibrium of the circulation. The rubbing wet-sheet, in principle, is easily administered to patients in such a state of health as to render it necessary for them to remain in bed. The person lays upon a blanket that may be afterward removed; a portion of the system is rubbed, first with wet towels, followed with the dry. This part is then covered, and the other extremities disposed of in the same way. The water should be moderated according to the strength of the patient. All who are able to walk about, to insure warmth, should take the water cold. If a person is very much fatigued, and covered with perspiration, he must be careful how he meddles with the cold bath. But if the fatigue has not gone too far, although there is perspiration, the rubbing wet- sheet is one of the most soothing, and, at the same time, invigorating modes that can possibly be found. Such as have become exhausted from public speak- ing, strong mental efforts, watchings, and the like, are greatly benefited by the rubbing wet-sheet. If at any time the surface is cool, dry frictions or exercise are to be practiced, to. induce warmth, before it in used. If a person from debility fails of becoming warm, he is well wrapped in dry blankets a half houi or more, and when sufficiently comfortable the rub bing-sheet is again given, to promote the strength. Frictions, with the dry, warm hands of assistants, are 236 CONSUMPTION. always good in these cases, to help to insure warmth. If a person finds himself remaining cold in the lein- tuch, he should omit that, until the use of the abrei- bung, exercises, etc., enables him to get warm. The tonic effect of the rubbing-sheet is most serviceable in night perspiration and debilitating sweats. The towel-bath.—By means of wet towels we may take almost any where a good bath. With a single quart of water we can do this, even in a room car- peted ever so nice, without spilling a single drop. The towel-bath may seem a small matter; but we find none, but the most lazy, who, once accustomed, are willing to relinquish its use. Small matters oft re- peated and long continued accomplish much. A little medicine is taken day by day, and, at length, health fails, and death is the result. Tea, coffee, tobacco, wine, etc., are used in very small quantities, and the teeth become dark, and decay; the head aches, the hand trembles, and the spirits fail. So good influ- ences, however small, in the end accomplish great results. Sponge-bath.—Some like to stand in a tub, and use a large sponge out of which the water is pressed, and made to pass upon the head, neck, and shoulders, and other parts. We may pour water from a cup, basin, or pitcher, if we choose. There appears no particular advantage in the sponges — the water is what we need. The shower-bath.—This is often wrongly used. As physicians are becoming generally more impressed with the importance of water, they not unfrequently say to a patient, "Take the shower-bath." The THE SHOWER-BATH. 237 patient, a lady, perhaps, is very weak. Medicine enough to make her so, quite likely has been given, and a good bill run up. Last of all, the order comes, " Take the shower-bath;" about as philosophic a pre- scription as to say to a person in severe constipa- tion, and not at all acquainted with the doses of medi- cine, " Take Croton oil." Of this most powerful of all purgatives, every one would, of course, take too much. Within a few years, since baths are getting to be the fashion, I have known a number of persons materially injured in consequence of this loose kind of advice. A great many patients are too weak to take the cold shower-bath. Milder means must be used. The shower-bath should never be taken upon the head. Some can bear it; but, in all cases, it is better to wash the part. The head should never be beaten by water, or any thing else. Most men have an idea that taking it upon the head is necessary, to prevent rushing of blood to the part. Cooling the head is, of course, good for this, and, if the bath has but little force, the head is, in many instances, benefited. But it may be beneficially acted upon indirectly, as by the foot-bath, which is excellent to relieve headache. The hip-bath is easily managed, so as to cause the same effect. So, also, the shower-bath, upon any or all parts of the body, but the head, may be made to cause the same result. Now the blood at the feet is cooled, and now it has arrived at the head. The blood is rapidly coursing through the aystem; and thus, by cooling it, we very soon affect the most dis- tant part. If the person has strength enough, and does not 238 CONSUMPTION. take the shower-bath upon the head, he will find no difficulty in its use. It is a very valuable and con- venient mode; and many persons have, by this sim- ple means, been most wonderfully restored. And yet some water-practitioners are so prejudiced, that, if a patient commences telling them the benefit he has derived from its use, they at once fall into a rage. It is easy, in these cases, to see where the shoe pinches: they have committed themselves beforehand, and been talking of what they know but little about. If I have, myself, taken some hundreds of the shower- bath, and prescribed it to hundreds of others (as I have), I ought to know more concerning its effects than those who have seldom or never attempted its use. I do not say that a shower-bath is the best that can be; but I contend, that, properly managed, it is a most excellent mode. The pouring of water, or the small stream, of the same quantity and force of the shower, I hold is, in most cases, the best. I go, as I always have done, for avoiding the shock, although this is generally advocated as being the principal good of the bath. The pouring, and the small stream, much less than the shower, produce this result. General directions concerning baths.—Persons who are under the necessity of commencing the use of water, without the advice of a physician (and most persons in chronic disease, with the most perfect safety, may), should begin very cautiously. It is so easy, at any time, to increase, that there is no need of hurry in the matter. " Haste makes waste." Be- gin by merely washing the surface once, daily. If you are very weak and sensitive, use the water at D.RECTICNS CONCERN ;NG BATHS. 239 70° F., or even 80°, and, if it is at 90°, it is yet cool- ing—cold water, in effect, and very mild in degree. It is easy, then, to lower the temperature, day by day, as you find you can bear. Rub the skin thoroughly, to excite activity in this part. The warmer it be- comes, and the better the circulation, the more grate- ful is water, and the better the effect accomplished. Very soon one can commence taking the shower, small stream, or douche, upon a part. Take it, first, upon a single limb, or two, next upon all the limbs, then upon a part of the body, and, finally, upon the whole, except the head. In this way, any one, who is able to walk about, may gradually and safely ac- custom himself to the shower, or small douche bath. Most persons are apt to wish to proceed too rapidly, and, in so-doing, fail of bringing about the best results. If disease has been a long time accumulating, as is almost always true, time must be given for nature to do her work. We may aid her in her efforts, but to force her is impossible. Many invalids, of course, have strength to proceed nuch more rapidly than I have indicated for those who are very weak. But, I repeat, those who practice upon themselves should proceed cautiously and, as it were, feel their way. If one bath per day is found useful, soon a second may be ventured upon, and, finally, a third, or even a fourth. Weak persons go fishing voyages, and, in many cases, soon become able to remain much in the water, the whole day, and half of the night. If a cri- sis appears, we may know nature is doing her work. The treatment must then be moderated according to the degree of the critical action present. 240 CONSUMPTION. Bath by affusion.—A person may stand in a wash- tub or any convenient place, and by means of a pitcher, cup, or hand-basin, pour water upon the neck and shoulders, and thus take a very excellent bath. This simple way will indeed be found, as a general thing, better than the portable shower-baths. These are very apt to get out of order, although some of them are very good. Fifty years ago, Dr. Currie, of England, performed wonders by the affusion of cold and tepid water, grad- uated in temperature according to the strength of the constitution. In all the varieties of fever he adopted the mode; so in small-pox, measles, scarlet- ina, as well as in convulsive diseases and in insanity. It is now acknowledged by the highest authority in that country, that Dr. Currie's mode was attended with greater success than any other previously known. Plunge-bath.—In sea, river, and lake, as well as by artificial means, bathing and general ablutions have been practiced from time immemorial; as a matter of luxury, religious observance, purification, prevention, and cure of disease, bathing has been resorted to in every period of the world. So efficacious has this simple means proved in the healing of the sick, that not a little superstition has been mingled with it. Springs and wells have often been supposed to pos- sess some mysterious power, and have, therefore, been named after some patron saint. The world has loved mystery and marvelousness, has ever been wander- ing from simplicity and truth. How often should we bathe ?—There appears to be as good reason for the daily cleansing of the whole THE HALF-BATH. 241 surface as of the hands and face. I have before writ- ten, every sick person, in whatever condition, or how- ever weak, should have the whole body rubbed over, with wet cloths, sponges, etc., at least once each day. In some cases, great caution will be required, in order that the bath be performed safely. Let those who have lain for days upon a sick bed, without any ablu- tion, as is usually the case in the ordinary modes of medical practice, try, when the body is warm, the rubbing it, part by part, over the whole surface, fol- lowing, briskly, with dry cloths, and then covering it warmly, according to the feelings of comfort, and they will find it a most effectual tonic, as well as an appli- cation productive of the greatest comfort. Physi- cians, generally, have yet many simple lessons of this kind to learn. Let every individual, then, old and young, male and female, sick or well, have a daily bath; and, in case of indisposition, of whatever kind, let there be more, instead of less attention, given to this practice. The half-bath.—This may be used as one of the mildest of water processes, or as one of the most pow- erful. An ordinary bathing-tub is a very good appa- ratus for the purpose. A good-sized washing-tub will answer very well, if there is nothing else at hand. The water is generally quite shallow in this bath— from three to six inches. Priessnitz's half-baths are made of wood, four to five feet long, about two and a half feet wide, and twenty inches deep. This simple contrivance is one of his most powerful means—that by which some of his highest triumphs are achieved. The water is generally used of moderate temperature: n 242 CONSUMPTION. as 60° to 70° F., and when long continued, is changed, as it becomes warm from the heat of the body. Head-bath.—From time immemorial, cooling and other applications to the head have been much de- pended upon in that violent and dangerous disease, phrenitis, or inflammation of the brain. When all other means had failed, certain obstinate affections of the head have been known to give way by a constant stream, or affusion of cold water, upon the part. In headaches, convulsions, delirium tremens, the delirium of fever; in epilepsy, rheumatism of the head, dis- eases of the eyes, ear-ache, deafness, loss of smell and taste; and in epistaxis, or nose-bleed, this highly en- ergetic remedy is brought to bear. In taking the head-bath, the person lies at length upon a rug or mattress, with perhaps a pillow under the shoulders. A broad, shallow basin, or bowl of some kind, is used. The back and sides of the head are, in succession, placed in the water. It may be taken for five minutes to a half hour, or even more, according to the case. The whole head should be well rubbed and dried, if there is no inflammation to combat. Those who are under the necessity of going to ex- cess in literary labors, or have much mental effort to put forth, will find great benefit from affusions upon the head, and the head-bath. Not unfrequently a troublesome headache will at once give way, by merely washing with cold water the part in which the pain exists. The nasal bath.—Ir catarrh, colds in the head, and THE SITZ, OR HIP-BATH. 243 in diseases of the nasal passages, the sniffing of water up the nostrils is to be performed. The water should be drawn back and ejected by the mouth, to obtain the best effects. This is a little disagreeable at first; but one soon becomes accustomed to it. The mouth, or oral bath.—For inflammation in the gums, mouth, throat, and palate; in slimy secretions from the throat, stomach ; in toothache, catarrh, colds, and chronic hoarseness, garglings, and baths for the mouth, are of great service. Pauley, a merchant of Vienna, has been thought singular for his zeal in re- commending this bath. Clergymen and others, who suffer hoarseness by much speaking, will find that holding very cold water in the mouth, until it begins to grow warm, and then ejecting it, and by frequently repeating the process, much benefit will be obtained. Falling or elongation of the palate, in which it is now so much of a professional hobby to clip off the part, the gargling sufficiently with cold water'will be found a never-failing remedy. Coughs and tightness in the chest may often be essentially relieved by this bath. In mucous secretions from the threat and stomach, by ejecting the water a number of times, it will sur- prise those who have not witnessed the remedy, to see the amount of slimy secretion thrown off. The sitz, or hip-bath.—Convenient tubs, wooden or metallic, are constructed for this bath; but an ordi- nary wash-tub answers very well. The article should be large enough to admit the motion of the arms in rubbing the abdomen, sides, and hips, first with one hand, and then the other. Water enough is used gen- erally to come pretty well up the abdomen. The 244 CONSUMPTION. more movement and friction, while in the bath, the better. It is more convenient if the tub be elevated two or three inches from the floor. Some undress completely, and place a blanket or sheet over the up- per part of the body; but oftener the parts only of the person, to be exposed to the water, are uncovered. In a variety of ailments, this bath is highly valuable. It may be made one of the most powerful of all of the hydropathic modes. Like all other powerful ap- plications, it should be made only after digestion is nearly or quite gone through with. As a tonic to the stomach, liver, bowels, womb, spine, etc , this bath is highly useful. In constipation, and other irregularities, it is famous. Those of seden- tary habits will find its use of rare service. It may be taken for five, ten, or more minutes, according to the demands of the case. The leintuch, or wet-sheet.—The usual mode of ap- plying the wet-sheet is thus: a number of woolen blankets are spread evenly upon a bed or a mattress; a sheet, of cotton or linen material (linen is the more cooling), is spread smoothly upon the blankets; the patient then lays at length upon the sheet. This is lapped over from Jde to side, and made to cover the whole surface; the blankets, one by one, are, in like manner, adjusted, drawn tightly, and well tucked un- der each side. Large pins, or tapes, may be used, to secure these coverings. The blankets should be we)? arranged about the neck and feet, to prevent evap- oration and too great chilliness. A down or feather bed is sometimes put over the whole, and tucked un- der, the more effectually to retain the warmth. If THE L1ENTUCH, OR WET-SHEET. 245 there is a tendency to coldness of the feet, these may be left covered with the blankets only. Faithful rub- bing them with the hand, is a good mode. Working and rubbing them one against the other, is service- able ; and, rather than allow these parts to remain a tong time cold, as is sometimes done, it would be bet- ter to place moderately warm bricks, or, better, bot- tles of warm water, etc., to them; and the same may be said of any part of the system. Some fear warm applications, in water-cure, seeming to believe that every thing must be of a cold, chilling kind. The fact is, warm applications, though seldom needed, are, under certain conditions, as natural, as scientific, as the cold, under other conditions. Still, it is always better, as far as possible, to cause the body to create its own warmth. The wet-sheet is now used, by Priessnitz, only as a cooling means. It may be called a convenient mode of applying a cold bath. His practice is, to allow patients to remain in it only for about twenty minutes at a time. • Some form of bath should be given, after the wet- sheet, not that it is absolutely required in all instances, to be safe, but, on the whole, it is more beneficial so to do. The surface now needs cleansing, and the in- vigorating effect of cold water. If a person is weak, and not able to sit up, the water should be used tepid, as at 70° or 75° F. Piecemeal, with wet towels, the body is to be rubbed, until dry ; and it is better to ob- tain a comfortable glow. A half-bath may be takeni or a shower, plunge, or spout-bath, as the case may be. As in all other applications, those who have nol 246 CONSUMPTION. the advice of an experienced physician, should begin with the milder modes, and then proceed gradually to the stronger, as they ascertain, by experiment, what they can bear. Wet compress bandages and fomentations.—These perform precisely the same office upon a part of the system, as the wet-sheet upon the whole. Cooling wet comj>resses are such as are changed or re-wet frequently, until the necessary amount of cool- ness is obtained. These are applicable to any part. Warming, or stimulating, wet compresses are, in their secondary effects, the opposite or the cooling. Covered, and left upon the part a sufficient length of time, the surface becomes warm, and even warmer than is natural, in consequence of the retained heat They are therefore said to be warming, or stimulating. Soothing wet compresses.—A distinction may be made between the cooling and the warming. Such as give no decided sensation of either coolness or warmth, may be said to be soothing in effect. Under the head of "pains in the chest," I have else- where all uded to the good effects of compresses on the affected part. I have thus given a short description of the princi- pal modes of using water, both as a remedial agent and a preventive of disease. I advise most strongly, that all who are in any way predisposed to pulmonary consumption, resort to these processes, according to the means they have at hand, and the necessities of the case. l.'ASE OF MISS LYDIA MOTT 247 CHAPTER XXVI. Treatment of consumption.—Case of Miss Lydia Mott, of Albany.— Mr. Waterman Roberts, of Hartford, Ct.—Mr. Jacob Campbell, of New York.—Mr. John S. Sunderland, of Penn.—Lyman Sherwood, of la.—Mr. Henry C. Wright, of Philadelphia. Having entered, in the preceding chapter, into an account of the processes of the water-cure, so called, I now propose to give a number of cases in illustra- tion of the effects of this treatment in consumption, and its kindred complaints. Case of Miss Lydia Mott—In the Water-Cure Journal of Dec. 15th, 1845, I published the following case of this young lady. " About the first of October last, my friend, Sidney Howard Gay, of this city, called to confer with me concerning the case of Miss Lydia Mott, of Albany, given up by her physicians, as he was informed, in a hopeless state of consumption. I said to him in sub- stance, as I always do in reference to this disease, that water-treatment is altogether more powerful to save than any other known mode, and that in case a cure is necessarily impossible, the treatment, incom- parably more than other, will prolong life and render the sufferings less. " In two or three days after this conversation with Mr. Gay, I received a letter from the sister of Miss Mott, asking my opinion of her case. The sister in- formed me that the physicians declared her case to be 248 CONSUMPTION. one of tubercular consumption, and that they despair- ed of medicines reaching her case. She said, further- more, ' for the week past we have tried the wet-sheet and bandages during the day, with no other result but an apparent suspension of the disease.' " In one week from this time, I had the pleasure of seeing both the sister and patient at my house in New York. I had advised her to continue the treatment which appeared to be doing so much good, and that as soon as possible, for a change of air, it would be one of the best things she could do to make a journey down to the city. They remained two or three days, Miss Lydia feeling decidedly better from the journey, and having obtained my directions for future treat- ment, returned home to Albany. "Concerning the true nature of her disease, there may be some doubt. I am myself not fully satisfied what it was. Up to the time of her commencing water-treatment, she had been under the judicious care of Drs. Ward and Paine, of Albany, and Dr. Bryan, of Troy, as counsel. I have not yet had the satisfaction of conferring with either Dr. Ward or Paine. I met with Dr. Bryan, who told me that when he saw the patient, she had, without any mistake, hepatization, as it is called (hardening), of the right lung. As to his opinion concerning ulceration, I do not recollect. He considered her case a very dan- gerous one, and he should watch the progress of the disease under the water-treatment with much interest. Drs. Ward and Paine, as I am informed, declared that there was actual ulceration of the lung. Not having seen the patient until she had considerably CASE OF MISS LYDIA MOTT. 249 recovered, I cannot give any positive opinion of nay own. There could not have been any mistake as to the hardening of the lung; and this alone is dangerous enough without ulceration, which did probably exist. If ulceration did exist, it was caused either by the inflammation and breaking down of tubercles, or it was the result of inflammation of the substance of the lung, causing hardening, and the hardening resulting in ulceration. This, however, seldom takes place, although it sometimes does. The ulceration is by far ofienercaused by the inflammation of tubercles, than by inflammation resulting in hepatization or harden- ing of the part. Whatever was the state of the lung, I am confident there was likewise severe rheumatic pains in the chest, which amounted to a good deal of suffering. . "It is proper here to state more of the history ot this case. Miss Mott is a person of very active habits, and during the last spring took a severe cold which settled upon the lungs. This caused a serious illness at the time, and which continued to trouble her very considerably during the whole summer. She did not, as she usually has done, spend a part of the hot sea- son in the country air, but remained actively engaged during the whole of the past hot summer.- About the first of September she took again a very severe cold, settling, as before, upon the lungs, and resulting ia the dangerous illness described above. " Beginning now again at the time when she re- turned home from visiting New York, she continued to use water nearly two weeks longer, at which time I was at Albany, and called according to promise, to 11* 250 CONSUMPTION. see her. Before commencing at all the use of water, Drs. Ward and Paine very candidly said, that not- withstanding they considered the case now entirely hopeless, they would be glad if water-treatment could be fairly tested, but that themselves, not having given the subject sufficient attentiorf, could take no responsibility in iis use. In making this statement, these gentlemen exhibited a degree of candor which we too seldom find. How many physicians are there yet of our country who have at all seen the applica- tion of the wet-sheet, and yet very generally they assume to know as much about it as if they had ad- ministered it as often as they have doses of calomel. This is not as it should be ; and if they do not choose thoroughly and impartially to investigate the new mode, patients will practice upon themselves, as in such case they should. But to return to the treat- ment in this case. " The wet-sheet, as has been said, was used each day. It was wrung from water that was rather mild of temperature, and applied according to the usual mode. It produced a soothing and relieving effect, and was followed by an ablution in water of a moder- ate temperature. Four well wrung wet towels were arranged about the chest, to meet at the side, making two thicknesses of wet linen upon every part of the chest. Over these towels still another moist bandage was placed, and over the whole an abundance of flan- nels, to retain the warmth. These were worn at first, I believe, only during the day. It would have been still better to have continued them at night also. The effect of the sheet, the ablutions, ami the bandages in CASE CF MISS LYDIA MOTT. 251 removing pain, preventing general fever, cough, and night sweats, was indeed wonderful. She improved astonishingly in strength, and, as before said, was able to journey to New York in two weeks. " During a part of the following two weeks, she is now of the opinion, that she used too much of cold applications; or thai, as the general feverishness of the system, and particularly of the chest, was at this time considerably removed, the same applications as before made were not now well borne. The system did not, as before, react sufficiently against the cold. During the most of this second two weeks, the patient thinks she rather lost ground than otherwise. "In four weeks she came again to the city to re- main with us, to undergo a more thorough treatment than could be conveniently carried on at home; be- sides, she felt that she needed special advice, as new symptoms might arise. The right lung was at this time still very weak. I should have said, that on first seeing her, that is, two weeks from the commence- ment of water-treatment, the hardening of the right lung had given away considerably, so that the air penetrated some distance downward. At the end of the four weeks there was still much pain through the chest, particularly the right side, and extending to the right shoulder, and under the right shoulder-blade. The right arm could only be used with great diffi- cultv. In the most comfortable situation it could be placed, two or three days were required to a finish a single letter. The treatment by the wet-sheet once daily, and ablutions and bandages, were kept up. In two or three diys she was able to bear a mild shower 252 CONSUMPTION. bath, and in two or three days moie a small douche This proved very strengthening, and was powerful in removing pain. At Albany she could scarcely go in the open air at all. The mild air of this city agreed much better, and she was, day by day, able to take more exercise in the open air, and in less than two weeks she could walk at one time some miles with- out inconvenience, and with benefit. After a few of the first days she took two shower or douche baths daily, besides the one following the wet-sheet, in all three general baths daily. "After remaining nearly three weeks, she thought, as a matter of experiment, feeling now so much im- proved, she would make some friends a visit on Long Island. She remained about one week, continuing the daily use of water, and returned still more im- proved. She could now undergo as much exertion as she had been able to do for years, and has now (Nov. 26th) returned to Albany, after having used water in all about eight weeks, to remain, 1 hope, in the enjoyment of good health. With the good care she will now observe, there is reason to believe that no recurrence of the disease will take place. Still, it must be remembered, the chest is contracted and weak, and that this will be the part most likely to give way first. " Food, it should be mentioned, was taken very sparingly. During the first two weeks, it consisted almost entirely of grapes. During the second two weeks, friends had urged that flesh meat should be taken to promote strength; as her health was, if it had been said, to promote pain, inflammation, "ough- CA3E OF MISS LYDIA MOTT. 253 ing, expectoration, and weakness, the fact would have been stated. While with us, she partook of farina- ceous food, as coarse bread, milk, toast, buckwheat cakes, potatoes, squashes, turnips, stewed fruit, etc., using of animal food only what little was contained in the preparations in which milk was used. No but- ter, or food in any way prepared with butter, was taken. Salt was almost entirely abstained from. We care not what physiologists tell us from theory about the necessity of salt. We go for facts. Salt, like other medicines and medicinal stimulants, we choose to abstain from. Miss Mott partook of food but twice a day, and on the whole, the regulation of diet had no small share of effect in her remarkable cure. " She is now able to endure nearly or quite as much exertion in the open air as she ever has been, and more than most ladies in good health. Time will determine how permanent her cure may be. " It should have been mentioned that, while upon Long Island, Miss Mott, feeling quite strong, thought she would try the experiment of discontinuing the bandages upon the chest. She found, in less than one day, that she could not yet do without them. A sen- sation of sinking and weakness in the chest was ex- perienced. It will be best, for a time at least, that the bandages be continued, both night and day, as they have been." In 1817, I remarked on this case as follows : " Miss Mott remains yet very well. It should be remembered that, in all these cases of hO-called cure of consumption, the lungs remain the weakest part of *. the system; and that such persons are, perhaps, of 254 CONSUMPTION. all others, the most subject to colds. In every chronic disease of important organs, the best possible cure that can be effected, yet leaves the part that has been affected in a condition susceptible to the disease. This remark applies particularly to diseases of the lungs; and those who may have the fortune to be- come cured of such disease, should remember that the greatest care and perseverance will be required, in order to enable them to keep tolerably free from colds and fresh attacks ; and that, in the end, they must, in all probability, sink with that fearful disease, consump- tion of the lungs. " Since making the above remarks on Miss Mott's case, she writes (March 4th, 1847): You will be grati- fied to learn that my health is good, although I still perceive a little difficulty in my chest. I have not had any colds this winter. They have been very prevalent with us." Up to the present summer (1849), this patient re- mains well. There is every reason to believe that, with her very simple and industrious habits, and by the exercise of good judgment, which she possesses in an eminent degree, she will yet live to a good old age. Case of Mr. Waterman Roberts, of Hartford, Conn.—This case of Mr. Roberts was published in the " Water-Cure Manual," first, in the spring of 1847. It was given as follows : "It is due Mr. Roberts to state, that he is only willing that his name appear in public, because of his belief that some one, in the condition he has been, may be similarly benefited as himself I give Mr. Roberts' own account: CASE OF MR. WATERMAN ROBERTS. 255 "I am now forty-five years of age. My habits of life have been decidedly active. My health, until about five years ago, was usually good. My grand- parents were long-lived. My father died at the age of forty-seven ; my mother at fifty-seven, of consump- tion. One of my brothers, younger than myself, died a few years ago, at about forty, decidedly of the same disease. My mother had the disease some eight years ; my brother about three years. " Five years ago last November, I was attacked with the lung-fever. For a while before that time, my health had not been as good as usual; but I still kept about. For this attack, I was bled, according to the usual modes in such cases, freely. The band- age became disarranged in the evening of the same day, soon after the bleeding was practiced. I awoke, and found my arm in a puddle of blood, as it were. I immediately undertook to rise from my bed, but fell in the attempt, and fainted. The loss of blood made me exceedingly weak; but I appeared to be, in a measure, free from the fever. However, at the end of about two days, my lung-fever returned with in- creased violence, and I became delirious. Various means were resorted to; and after some days I began to mend, so as to be about the house a part of the time. I was, however, very weak, and highly sus- ceptible to cold; and could not undertake business until late in the spring. I never again became so strono* as before, until after I resorted to the use of water. An obstinate cough followed this attack, and was verv bad. I raised, first and last, a good deal of matter, apparent'v from my 'ung* Food, also, disa- 256 CONSUMPTION. greed with me; and I lost much flesh. About two years after my attack, I became much reduced, and had frequent night sweats. "About this time (Feb. 1844), I was advised, by my physician, to take a voyage to the West Indies. I sailed to St. Domingo, and was absent some three months. The voyage appeared to be of benefit, dur- ing my absence. My cough was less, the raising less ; and I became a little stronger. But, on returning to Hartford, my difficulties soon returned; yet not so formidably, until cold weather again set in. Warm weather appeared then to agree with me best. " In December of the same year, I became much debilitated and discouraged. By the advice of some of my friends, one in particular, I was led to examine the water system ; and, as you will recollect, called upon you for advice. You left it optional with me whether to go home and be treated, or to return to you. The first I concluded to do. I was very thin, and susceptible to cold. You advised me to begin cautiously, with tepid bathing, and a good deal of fric- tion. The wet jacket upon the chest, to be covered with flannel, I was to commence at once. After a few days I was to commence showering with cool water, immediately after the tepid bath. My health was such that I frequently took colds. You recommended that, at such times, I should lay awhile in the dry blankets, to cause warmth, and that I might the bet- ter endure the baths. Occasionally, I sweated in the blanket; and perhaps, in a few instances, became weakened thereby. " For a time, I bathed twice daily. The cool towel- CASE OF MR. WATERMAN ROBERTS. 257 bath at evening acted most beneficially in arresting the night sweats. The wet application worn over the chest night and day, changed three 01 four times in the twenty-four hours, seemed to allay irritation in the lungs, and to prevent the cough. The effect was very soothing, as well as warming. After some weeks, I at times left off the wet jacket for a day, and was surprised to find that the surface was warmer where the wet cloth had been than elsewhere. Still I felt the need of it for its tonic and soothing effect. You directed me to have no more fire in my sleeping room, and to have it well aired by day. I was also to exer- cise in the open air daily, and to be out as much as I could possibly bear. It was better for me, you said, to go out even when it was stormy and inclement, than hover over the fire in a hot room. I asked if I had not better take some syrup or medicine for my cough. These I had taken by the quart. You said, • Nonsense; the cough will take care of itself, as your strength becomes improved.' " I was to partake only of plain, coarse food—brown bread especially ; the less meat the better. The coarse bread has been my 'staff of life.' Until I be- came strong, I used plain flesh meat, and but once a day. I left off tea and coffee, drank only soft water. My appetite had been by turns very poor, but now increased wonderfully. Digestion also improved much. From that time to the present, now two years and two months, I have, with some little drawbacks, been growing firmer in health and strength. For the past eight months, I seem to have been able to accom- plish as much, and undergo as great bodily fatigue, as 258 CONSUMPTION. for the same space at any time within the last ten years. " I feel yet that the lungs are the weakest part; and I sometimes take colds; but I have each time suc- ceeded in throwing them off by renewed treatment, the blanket, baths, wet jackets, injections, etc. The tepid bath, taken usually at from 70 to 75° F., fol- lowed by a slight shower, cold, has seemed to be, of all baths, the most beneficial. For the past seven or eight months, I have, as a rule, used the water cold. I have good reaction, and the cooler the air now, the more am I invigorated. Differently from before, I now enjoy the cold weather decidedly the best. " And now, after having followed the water-treat- ment for more than two years, although my lungs are not yet free from weakness, and I am liable to serious pullbacks, yet I feel grateful to God, that I have re- ceived such wonderful benefit. And I do herein add my testimony, that I have unwavering confidence in the water-cure." I have heard a number of times from Mr. Roberts, since the above account of his case was published. He has continued, on the whole, very well, so far as I have learned, and I am confident he is still in good health (Nov., 1849) ; otherwise, I may conclude, I would have heard to the contrary. Case of Mr. Jacob Campbell, of New York.—Mr.' Campbell's case was also published in the Water-Cure Manual, in 1847. "The case of this gentlemen is certainly, all things considered, a very remarkable one. Mr. Campbell is a resident of this city, engaged (principally at the desk) CASE OF MR. JACOB CAMPBELL. 259 at tn ; bank in the Bowery. He is of very fair, deli- cate complexion, blue eyes, and auburn hair, a most perfect subject for consumption. The disease is also hereditary in the family, on the father's side. His father's brothers died of it, and he has lost already a brother and sister by consumption. " Mr. C. is now thirty-one years of age. About one year ago, the present time (15th March, 1847), he called to consult me. He had had a pain, at times severe, in the left lung, for two years. For eighteen months he had raised blood, but not in large quantity. He expectorated a good deal, apparently from the lungs. This exhausted him very much; he was in- deed so debilitated that it was with difficulty he could go to and from his place of business, or attend to his labors at the desk. He took colds often, and at the most trifling exposures. He had suffered also a good deal from constipation, and appetite was poor. " Mr. Campbell could not at the time come to my house, nor could he leave his business. Accordingly, he was under the necessity of doing what he might at home. I directed him to commence bathing, once a day for three or four at first, and then twice per day, with wearing the wet jacket about the chest, to ob- serve strictly the rules of diet, and gradually to go more and more in the open air. There was an immediate amendment in all of his symptoms, and he pursued the reo-ular course for months, continuing business, however, all along. He grew stronger and stronger, and the appetite improved; the wet jacket removed all pain from the chest, the expectoration grew less and less, and the spitting of blood entirely ceased. 260 CONSUMPTION. Mr. C. now says how he has been as strong all winter as he ever was in his life. Appetite perfectly good for the plainest food, and the bowels regular. The expectoration is not all gone, but he says there is not now more in a whole month than formerly in one day. " Whether there were actually tubercles that had gone to suppuration or not, it is impossible to say. Mr. C.'s former physician, a man of respectability and experience, declared that tubercles did certainly exist. The result of the treatment has been entirely beyond my most sanguine-expectations. It is to be observed, however, that Mr. Campbell persevered in the treatment with a diligence that deserves great credit. " It seems, then, that this was a case in which the patient fled to the water-treatment, just in time to save life. No one acquainted with that dire disease, could believe that Mr. Campbell would long hold out as things were going. Generally, consumptive pa- tients come to us after all other means have failed, and then it is too late, only they can be invigorated somewhat, and kept incomparably more comfortable (if we may use that term), than by any other known means. There is probably a point at which, if water- treatment were commenced, almost every one could be saved. But after the disease has become deep- seated, we must tell our patients frankly that in all probability they must sink." Since the foregoing account was published I have often seen or heard from this patient, and he has re- mained well to the present time (Nov., 1849). CASE OF MR. JOHN S. SUNDERLAND. 261 Case of Mr. John S. Sunderland.—The case of this young man, with the accompanying adviCe, was pub- lished in the Water-Cure Journal of Sept., 1848. It is as follows: "John S. Sunderland, a young man of NewtoD, Bucks County, Pa., writes us respecting his case the following particulars. He had been much subject to croup when young, and for years had shortness of breath and difficulty of breathing. In the winter of 1845, he took a severe cold, and had also been subject to these attacks previously. He took colds upon colds until 1846, when he had become so weak from con- stant cough that he was obliged to lie by for some weeks When he exercised or made some exertion, he raised bloody, frothy matter ; the cough was very bad at night. He was subject frequently also to the nose-bleed. In June, 1847, he had an attack of fever. After this left him he had chills two months. For a sore spot in one of the lungs he was ten times blis- tered by a physician of Philadelphia. He also had a pretty good share of self-dosing in the way of syrups, cough mixtures of the nostrum kinds, etc. Finally, he became so low last winter that he was obliged to keep to the house, and was not able to go up stairs at all. He says he could sleep only in a sitting posture, and often not a half hour in the whole night; raised much hard phlegm; appetite sometimes very good, and at others none at all; had severe turns of nose-bleed, some of which lasted four and five hours at a time. 'I must say I got tired of taking medicine,' he says, 'for on counting up the number of bottles of the dif- ferent kinds I have taken, I find they exceed fifty, be- 262 CONSUMPTION. sides the other medicines from the physicians. By chance I heard of water-cure about two months ago. A young man told me that he had received great ben- efit from the treatment, and he advised me to purchase a copy of your Water-Cure Manual. I immediately obtained one, and thereupon commenced bathing. I was so weak that I could only take a towel-bath at first, and that only with assistance. I regulated my diet according to your directions, and have found great benefit by so doing. I use water as my constant drink; boiled apples and brown bread, pot-cheese, thick sour milk, and boiled rice and potatoes. I have, however, used a little boiled lean meat about once a week. I use no butter or any thing but what is re- commended. My appetite, which was before so changeable, has now become so good that I relish well the coarse bread. " ' I have now been two months bathing. Three weeks ago I commenced with the entire bath, in a large wash-tub. With this I make out very well. At first I used the water a little lukewarm, but gradually I have become able to bear it right out of the pump. After bathing, I dress and take a glass of water, and then walk in the open air. I eat my breakfast with an appetite like other people. I can go up stairs now to sleep without coughing, and can rest without be- ing propped up. My cough is a good deal better than it was, but is not entirely gone. I can walk farther than I could for a year. I feel no more trouble of palpitation at the heart, which, before I commenced bathing, troubled me. I have had no trouble of bleed- ing at the nose since I commenced bathing. I feel REMARKS. 263 much stronger and better in ever/ respect. I forgot to mention that I was catching cold at every change of weather before I commenced the water, but since that I have scarcely taken any.' " Remarks.—The above case is attested by Thomas Janney of the above, and further advice is asked for. Whether the young man can be cured or not is very doubtful. He has been asthmatic, but there is still greater trouble in the lungs, as would appear from the raising of blood and thick phlegm. He ought not to bathe at all in water as cold as that from the pump. Let it stand a while in the sun, and use only soft wa- ter, if it is possible to obtain it. If he continues to bear it well, he may plunge into water of rain or river- water temperature once a day, in the morning—not more. He may take the rubbing wet-sheet (rub over the sheet, not with it, as is generally done), forenoons and afternoons—not oftener. Three or four foot- baths per day a few minutes each, water not too cold, and walking after each will be useful. These may be taken soon after meals, and on going to rest. Wash- ing the neck and chest with the wet hand a number of times a day, will also be serviceable; but the wet bandages about these parts few are competent to manage properly during hot weather. An ingenious person may use them advantageously mornings and evenings, but they are almost invariably allowed to become too warm, and then weakness is the inevitable result. Persons of this class almost always do too much with water. They should do little by little, and keep doing, and especially should they observe the rules of exercise and diet. 264 CONSUMPTK i. " Exercise.—This too is apt to be made too violent. Do little and often, and proceed as you can bear. Horseback riding is probably the best of all forms of exercise for those who have weak lungs. Riding in a carriage is good. Walking also should not be neg- lected, and if a person has not the means of riding, let him walk and undertake lighter forms of out-door work. Persons have been astonishingly benefited by taking long journeys on foot, going a little way daily, and then increasing the distance as they can bear. Some have been thus cured who could scarcely walk in the commencement of their experiment. The tonic and invigorating effect of the fresh open air, and the light, when not too powerful, is poorly understood. Remember out-door exercise and work constitute the best part of water-treatment, so called, in chronic dis- ease. " Diet.—Our readers already pretty well understand our notions on diet. We hold that the same kinds of food and drink which are best for the vigorous, ath letic, and healthy, are best also for the most feeble, only we must graduate the quantity according to the patient's amount of exercise and strength. There are all sorts of notions about diet, both in and out of the profession ; that one kind of food is good only for one person, and another kind for another; in short, that what is one man's meat is another's poison. Is not good brown bread in liberal quantity good for a ploughman ? So if a half pound of it is good for him, a half ounce, less or more, is good for the sickest man if he need nourishment at all. If a teaspoonful, less or more, of Indian or wheat meal water-gruel is good REMARKS. 265 for a fever patient of a morning, who begins to need nourishment, so is a bowlful good for a ploughman or any other man to go to meeting upon. There is no truth in the old saying, that what is one man's meat is another's poison. " Any kind, quality, or form of food which is good for one man is good for all men, and under all cir- cumstances, provided they need food at all. Waiving the question of animal food, or rather admitting for the moment its necessity, milk, we contend, is the best form. Sour or loppered is certainly one of the best forms in which it can be used. The German and Dutch people in some parts of this country have seemed to do remarkably well with buttermilk and buttermilk porridge a little sweetened, with other food. All these things, however, must be taken in modera- tion. Consumptive persons, more than all others, are apt to take too much food. It has been a common saying that nothing disagrees with their stomachs, be- cause they generally feel no trouble in that part. But the mischief, however, is visited in all its intensity upon the poor lungs. So in other diseases, the weakest and diseased parts receive the injury most. " New milk, as warm and fresh as possible from the cow, has been much recommended by some good judges in this disease. From some experiments in lung diseases we think well of it. But no one should make any great sudden change. Some people who have thought they could not eat milk, find that soon, by help of the water-treatment, they can go at once to sreat excess, acting as if they thought the more of a crood thing they could get down their throats the 8 12 266 CONSUMPTION. better. It would seem as if no class of persons thought and reasoned so little for themselves as patients in chronic disease; and no schoolmaster ever had one tenth part of the trouble that the physician of a water establishment has if he takes at all to heart the busi- ness in which he is engaged. Consumptive patients, above all others, should be careful in the use of water. If people ever learn to have a tenth part of the confi- dence in water, air, exercise, and diet, that they have in the ten thousand nostrums that are hawked about by saint and sinner every where, then we may begin to indulge a hope that the great scourge of our country, consumption, will begin to wane away. Now it is on the increase." I have never heard from this young man since an- swering his letter. Case of Mr. Lyman Sherwood.—In the summer of 1848, I received the following letter, from a very worthy relative in the west: " Hamilton, Steuben Co., Ind., } May 12th, 1848. ] " Dear Nephew : I wrote you last summer, and ob- tained some books on the water-cure, which, I think, have been of so much benefit to myself and family, that I have concluded to write again, and request you to send me the ' Water-Cure for Ladies.' " When I wrote you last summer, I was impelled by the strongest motives. Your cousin Betsey had been from home, attending the Lagrange Institute; and the young lady with whom she roomed had a brother, about three-and-twenty, between whom and my only child there appeared to be the strongest attachment. JASE OF MR. \YM\N S:iE:iWOOD. 267 His parents were from New York state—a very re- spectable family, and members of the Presbyterian church. We 'could not object to the young man; but we were pained to find his health very poor, with many symptoms of consumption. He had tried apoth- ecary medicine till he became discouraged. He came to our house the first of June, last year, then under the care of a German root-doctor; but his health seemed failing. He had not done a day's work for three months, nor been able, at any one time, to sit up all day. I put your 'Cold-Water Journals'into his hand, and urged him to leave off drinking tea and coffee (he being immoderately fond of the latter), and adopt the use of cold water. When he read of some one getting out of bed and plunging into a cold bath, he said he would not do it for one hundred dollars. I then told him I had, for three months, practiced cold bathing in the morning, and that, instead of killing me, it had nearly cured me of the rheumatism. He returned home, a distance of twenty-five miles; dis- continued the use of tea and coffee; and the next morning stripped, and plunged into a creek, near his father's house ; rubbed dry with a towel; and returned to the house. His parents were very much alarmed, thinking he would surely kill himself. But, in one week, he was able to commence work moderately, His health continued to improve; and he became anxious to be married. " Accordingly, your cousin was married to Lyman Sherwood, August 11th, 1847. He then came to our house to reside; and I persuaded him to use the wet bandage to sleeo in nights, and in the morning to wash 268 CONSUMPTION. himself in cold water, having no other chance of bathing. His health continued to improve, and his cough to abate ; and he gained in flesh remarkably, until February, when there seemed a general disease of the lungs to affect the whole population; and there have been many deaths. " Since that time, he has been much worse. We have procured a shower-bath. He wears the bandage nights; takes the bath in the morning; and then tries to labor through the day. He has almost constant pain in the stomach ; coughs a great deal, and raises much. The matter is not tough, like that of a person with a cold, but seems almost rotten. He has con- siderable fever nights. "I am very much afraid he is past help; and yet, if you can form any opinion from what I have writ- ten, and think there is any help for him, write us; and if you advise it, he will come at once to your es- tablishment, if he can be persuaded so to do. I do not think he is fully aware of his danger. " If you can possibly find time to answer this long letter, which you must pardon on account of my anxiety for my son, you will much oblige, etc. " Yours, with respect, Delana Beecher." At the time of receiving the above letter, I wrote a somewhat discouraging answer, believing that the young man could not live. 1 remarked, in my reply : " The case is one which shows well the tonic effects of bathing. We can easily make consumptive per- sons, who can walk about think they are going to CASE OF MR. HENRY C WRIGHT. 269 get well; so powerful are the effects of water, when properly used. This young man's life has, no doubt, been prolonged by bathing. He may have bathed in water too cold, or too much. But, on the whole, he has been much benefited. Persons with lung diseases should, of all others, be the most careful; and they are perhaps, of all others, most apt to go to extremes. It is singular, too, that they seldom appear aware of their danger until the very last." Judging from the description of Mr. Sherwood's case, at the time, I did not believe it possible for him to live. I am informed, however, now, in the autumn of 1849, that he has become well; sufficiently so, at least, to enable him to attend to business. Case of Mr. Henry C. Wright.—This gentlemen, of the city of Philadelphia, went to Graefenberg, in Germany, in the year of 1844. The following account was published by him in a very able and interesting work, entitled " Six Months at Graefenberg," which was issued in London, in 1845. Mr. Wright still remains well in 1849. His account is as follows: " My lungs, I was assured by my medical advisers, were ulcerated, and my organs of speech and respira- tion diseased; my chest, which was formerly very full and prominent, had fallen in. My breathing, once deep and strong, was difficult and painful; my sleep, never very sound, much more disturbed than usual. I had a dry and sometimes painful cough for more than a year; a short walk made me perspire, and I was sub- ject to night perspiration. I was conscious of great weakness compared with my former strength ; and my constitution, originally exceedingly vigorous, had re- 270 CONSUMPTION. ceived a shock from which I never expected to recover. I am forty-six years of age, and such has been the soundness of my constitution and my general health, that I was never confined to the house by sick- ness one day in my life. I had never been bled or blistered, had never swallowed an emetic or a particle of calomel, nor indeed ten shillings' worth of medicine of any kind. Cold water had been my only drink for fifteen years; no alcoholic liquors, fermented or dis- tilled, no tea, no chocolate, no warm drink of any kind had passed my lips during that time; and I had been exposed to the extremes of heat and cold, from 100° above to 10c below zero (Fahr.), by night and by day, by land and by sea. But continued public speaking during the last twelve years, in the United States, and in England and Scot- land, in connection with Sabbath schools, and for the promotion of teetotalism, anti-slavery, and peace, had at length affected my lungs, and caused a general prostration of my physical nature. For three years past I had worn flannel next my skin in summer and winter, thinking that I could not live without it. I had usually worn cotton, worsted, silk, or fur mufflers round my neck, to keep as far as possible all cold, fresh air from my throat, chest, and lungs. I had used every precaution to keep the pure air from the surface of my body, supposing that health and comfort are promoted by keeping the skin as much as possible from the direct action of the air. As I had for years been accustomed to bathe and wash myself in cold water every morning, both winter and summer, I had no fear of its effects when applied as soon as I left my CASE OF MS. UENRY C. WRIGHT. 271 bed in the morning; yet I was afraid to let the cold air circulate freely about me, not reflecting that if my body could with benefit receive cold water on its surface, cold air could not injure it. " I commenced the water-cure at Graefenberg, under the direction of Priessnitz, on the 12th of last January. The weather was exceedingly cold, the thermometer (Fahr.) nearly at zero. All my flannels were laid aside; my silk, cotton, worsted, and fur mufflers were thrown off. I was ordered two leintuchs (wet-sheets) daily, one at five in the morning, the other at five in the evening, with a cold bath after each. At first, for about week, I took the abgeshrecktebad (tepid shallow bath) instead of the cold bath, after the lein- tuch. At eleven a.m., I had a sitz-bath (sitting bath) for fifteen minutes. I wore the umschlag (a damp bandage covered by a dry one) round my body, and changed it four times a day. Every morning before breakfast, be the weather ever so inclement, I walked four, six, or sometimes eight miles, having previously drank six or eight tumblers of cold water. I also took a walk after the sitz-bath and evening lein- tuch, to excite re-action. This treatment lasted for three months. I afterward took the douche or water- fall bath once a day, and instead of the evening lein- tuch and cold bath, two abreibungs (wet-sheet baths) at intervals of an hour. " From the first I found the cure exceedingly stimu- lating. The various external and internal applica- tions of cold water, the out-door exercise, and pure air, which in my walks I allowed to circulate about my neck, throat, and chest as much as possible, had, 272 CONSUMPTION. during the first three months, a most invigorating effect. A lash appeared upon my neck, chest, and shoulders, and around my body under the umschlag, and was rather annoying from the burning and itch- ing which it occasioned. My cough ceased ; I had a voracious appetite; I found that my breathing grew deeper, stronger, and easier, and that 1 could climb the mountains more rapidly, and with less panting. "But a painful change was at hand. About the 1st of April all my joints, and especially my knees, began to grow stiff, sore, and weak; walking became painful, and after sitting for a few moments I found it difficult to straighten my knees. I became gloomy and disheartened; but was assured by those about me that these were favorable symptoms, being evidences that the cure was taking effect. The whole surface of my body, even my hands and face, became very sensitive to the touch of cold water. It seemed as if my nerves were laid bare. I had a perfect horror of cold water, a kind of hydrophobia. As the spring advanced, and the weather grew milder but damper, the cure became more intolerable. 1 found the damp weather of April and May far worse than the cold of January and February. I became afflicted with acute and throbbing pain in my teeth, jaws, and face, for which I was directed to rub the back of my head, and my neck and face with my hands, wet in cold water. I was also ordered to rub my knees frequently in the same way. This was the crisis, and for some weeks I was as miserable as the most enthusiastic admirer of the water-cure could desire. Indeed, I was often* congratulated on my misery, which was CASE OF MR. HENRY C. WRIGHT. 273 regarded as the prelude to a speedy cure. At the close of April, I had boils on my arms, hands, fingers, and chin, and nearly all over my body. They sup- purated and discharged; and during the month of May they all healed, and none have since appeared. I have continued the application of cold water exter- nally and internally, with free exercise in the open air. Since I left off the water as a cure, I take it as a luxury. I feel that all disease is removed from my lungs; my chest has recovered its natural fullness, and my breathing its usual ease and freedom; my cough is entirely gone, and my voice is as strong and deep- toned as ever it was. I think great violence must be done to my lungs before disease can again fasten upon them. What I may yet enjoy of health and physical comfort, I owe, under Providence, to the water-cure, and to the kind friends who, against my will, almost compelled me to go there. During my experience of the cure, nothing surprised me more than the perfect safety with which I cast away my comfortable warm flannels and mufflers. A terrible cold upon my lungs and an increase of cough were the least that I ex- pected ; but I was agreeably disappointed. In my walks, for three months, I had no hat or cap on my head, no handkerchief around my neck, not even my shirt collar buttoned. My clothes have often been completely drenched with snow and rain, and my hair filled with snow ; but I have not had the slightest cold upon my lungs, nor any which a leintuch or one night's rest has not cured. My only remedy has been to take an abreibung and put on dry clothes on re- turning to my room to take off my wet clothes. This 12* 274 CONSUMPTION. simple process has not only saved me from taking cold, but also from the effects of over-exertion. "After my experience at Graefenberg, I shall never again have any fear of colds, influenza, or fevers, how- ever violent, if I have but the means of applying the water-cure. It is impossible to fear these diseases, after seeing the most malignant fevers so easily and speedily subdued by a remedy that leaves no sting be- hind. I went to Graefenberg resolved to submit im- plicitly to Priessnitz's directions. I did so, and was restored to health. I am certain that my long absti- nence from all alcoholic and warm drinks, and my disuse of tobacco in all its modes, and of medical drugs, have been powerful aids to my recovery. If any one will make cold water his only beverage, and abstain entirely from the use of medicine, he will find the water-cure sufficient to cure any disease that may assail him, if it be not absolutely incurable, and if he be determined to persevere in whatever process may be requisite for his recovery. But whoever expects to find health by the water-cure while wrapped up in flan- nels, and lounging on easy chairs and on sofas, in a warm, air-tight room, without personal exertion and ac- tivity, will certainly be disappointed ; ♦ >r perseverance and exercise in the pure fresh air is m essential en- ment of the cure." TEMPERATURE OI \TMOSPHERE. 275 CHAPTER XXVII. Treatment of consumption concluded.—Animal sensibility as affected by heat and cold.—Interesting facts in relation to the power of habit.—Clothing natural to the human body.—Effects of flannel worn next to the skin.—Objects of clothing.—Flannel useful under certain circumstances.—Soldiers, and coal heavers on board steam- ers.—Flannel a bad conductor of heat and cold.—Liability to error from habit.—Stockings.—What kinds are best.—Interesting facts. —Effects of cold bathing in enabling us to do with less clothing.— Spirit drinkers, although they have a warmer surface, suffer more with cold than water drinkers.—Rules in regard to clothing.— Tepid, cool, or cold bathing aids in making a change to lighter clothing.—Caution to the consumptive.—Dr. Combe controverted on the subject of wearing flannel.—The objections to flannel, and its advantages.—Bed clothing.—What it should be.—Evils of cotton comfortables. Animal sensibility, as affected by heat, cold, and vi- cissitudes of temperature, is one of the most curious, interesting, and at the same time difficult of all physio- logical subjects. As in physics, so in physiology, heat and cold are relative terms. What is warm and com- fortable to the feelings at one time, may be cold and uncomfortable at another; and one person, or one part of a person may be of comfortable temperature, while another, in the same atmosphere, or under the same degree of temperature in surrounding bodies, may experience very different sensations. The following is an interesting experiment: Tem- perature of atmosphere 55° F., body of comfortable warmth ; took three basins of water at 60,70, and 80° 276 CONSUMPTION. F.; placed one ha