WFA Y47c 1850 fNOHVN 3NI3IQ3W dO AIVI9IT TVNOIIVN 3NI3IQ3W dO A IV I « I 1 TVNOI1V S f^K&{ NATIONAL LIBRAI I /S4\ AEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF M E D I C I r. /Vi VNOI1VN 3NI3IQ3W dO AIVISI1 TVNOIIVN 3NI3IQ3W JO AIVIBI1 TVNOI1M MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICI! AEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICI J J UJ VNOI1VN 3NI3I03W JO AIV8SI1 TVNOIIVN 3NI3IQ3W JO A II V I 9 I T TVNOI1* i I EDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICI* » - - v Jk. / a V -d»v VNOI1VN 3NI3I03W JO AIVIIIT TVNOIIVN 3NI3IQ3W JO AIVIII1 1VNOI1VI MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICIN 1VNO II V N 3NI3I03W JO AIVI9I1 TVNOIIVN 3NI3I03W JO AIVI9I1 TVNOI1V IEDICINE NATIONAL LIBRARY OF MEDI CINE N A T I O N A I I I B R A R Y O F M E D I C I r. for : jLor' V 1 \XiX/ i 1VNOUVN 3NI3I03W JO AIVI9IT TVNOIIVN 3NI3I03W JO AIVI9IT TVNOI1V yx f /\& "' >c^\ • /\-*f - \r/\ 'S X »• ■ —firx • i»&Vv , - ,~-&-fL I J\^h\ ' CONSUMPTION OF THE LUNGS, DECLINE: THE CAUSES, SYMPTOMS, AND RATIONAL TREATMENT. THE MEANS OF PREVENTION. T. H. YEOMAN, M.D. ^ BY A BOSTON PHY S.I C I A N. x^s^} ^;'^KV' BOSTON AND CAMBRIDGE: JAMES MUNROE AND COMPANY 18 5 0. ) Entered, according to Act of Congreas, in the year 1850, By James Munroe and Company, in the Clerk's Office of the District Court of the District of Massachusetts. WKIOHT AND HASTY, PRINTBRS, 3 WATER STREET. PREFACE. The nucleus of this small volume was a series of papers, published in 1847, in a London periodical of considerable circulation. Since that date, many applications have been made to the publisher and to the author for the articles in a collected form. In thus presenting his work to the public, the author ventures to add, that daily and extensive practice in the treatment of Consumption enables him to express earnestly, but not arrogantly, the confidence he reposes in, and the success which has attended, the rational treatment he advocates for the amelioration and prevention of this melancholy and pitiless disease. PREFACE BY THE AMERICAN EDITOR. The simplicity, good sense, and practical character of this little work have induced the publishers to issue an American edition. In regard to a disease which is so fatally interesting to a large portion of man- kind it is desirable that correct ideas should exist so far as the present condition of medical science can furnish them. Its insidious approach, the uncertainty of its earliest indications, its slow progress and fatal termination in so large a proportion of cases, renders it peculiarly open to the treacherous promises of Quackery, and renders people distrustful of the aid which science can afford. To give to the popular reader a knowledge of the true nature of the disease, a general idea of its his- tory, course, and terminations, of the habits of life which tend to de- velope or to check it, together with those remedies which on the whole have been found most useful to mitigate its symptoms, or to stay its progress, has been the aim of the author. And in this he has been most eminently successful. There are few evils in this world so inevitable that people will sit patiently down and await their approach without a struggle to avert them. When science says that it can do no more, or it is obvious that all its attempts fail, the sick man will turn to the first delusive hope which is presented to him, no matter under how absurd or offensive a shape it is presented. Of this trait in human nature, quackery avails l* PREFACE. itself, and is often the occasion of as great suffering as the disease, the more so that it is unnecessary. By leading the public to a cor- rect understanding of the disease they will be made to comprehend the difficulties with which the medical man has to contend to know how much and what kind of aid they are to expect, and to see that if they do not get the benefit which they hoped for from intelligent and educated men of the profession, it is not to be found in the specious pretensions of charlatanism. It will establish confidence in the opin- ions of medical men, and save many an unhappy sufferer from torment- ing himself or from being tormented by others with treatment which can never avail. Boston, November, 1850. CONSUMPTION. Consumption, Decline, or Phthisis, is the plague- spot of our climate ; amongst diseases it is the most frequent and the most fatal; it is the destroying an "el who claims a fourth of all who die. Does the individual exist who has not some special interest in every attempt to arrest its ravages ? Is there a family without anxiety, lest some loved Rela- tive or connection should fall a victim to its ruthless arm ? I have reason to believe that the nature of con- sumption is, at this day, but little understood by the non-professional public, who, it might be supposed, have an all-sufficient cause for obtaining every infor- mation concerning the disease : until within the last few years—until the immortal Laennec made his im- portant discoveries—it was imperfectly or incorrectly understood by the medical public. Cullen, the great nosolo^ist of the last generation, considered it as a sequel of haemoptysis (spitting of blood) ; and others, that it was a disease of inflammation, or a result of inflammation. The latter is the popular, but errone- 8 CONSUMPTION. ous, opinion at the present time ; I anticipate what I shall presently demonstrate, and say, that without the germ of the disease be already deposited in the lungs ; without the germ of the disease be inherent in the system; without the system be pre-disposed to the disease, inflammation after inflammation would never induce tib .cular consumption: in other words, in- flammation can never cause consumption in a healthy constitution. What is it, then, that renders hundreds of thou- sands of our fellow creatures of an" unhealthy consti- tution," as regards this disease ? It is scrofula, or, as it is termed in reference to phthisis, tubercle, or tuberculous disease. TUBERCLES. Tubercles are peculiar morbid or adventitious mat- ters, deposited in the substance of an organ, foreign to its normal or natural structure ; depending upon un- natural secretion, or imperfect nutrition; and termi- nating in the wasting or destruction of the organ. They exist not only in the lungs, but also in the glands of the mesentery, the mediastinum, the neck, and the groin ; and sometimes they are discovered in the heart, the liver, and the uterus ; in fact, in every part of the body that is capable of being affected by scrofula. It is upon the condition and progress of these tuber- cles that the different stages of consumption depend, TUBERCLES. 9 and by their advancement or arrest the symptoms are influenced and regulated. I shall, therefore, endeavor to describe, in the most simple language, the career of tubercles of that form in which they are more fre- quently found in the lungs, namely, miliary tubercles ; and in doing so I shall notice them as they exist at three different periods, or stages. In the first stage, these adventitious deposits are in the form of a small round body, similar to a millet seed, of a gray color, and nearly transparent; they are firm and gritty to the touch, but, if pressed be- tween the fingers, they crumble, or break down, like a morsel of dried mortar, or dried putty ; they are strongly adherent to the structure of the lungs, and are more commonly found in the cellular texture, or loose tissue which separates the bronchial, or air, cells from each other. In number they may range from four, or six, to twelve, to as many thousands ; I have made many examinations in which they were so profusely studded, that dividing the lung with a knife, gave the feeling of cutting through friable earthy mat- ter, rather than the soft, yielding structure of ordi- nary lung. According to Thenard's analysis, they consist pf Animal matter, principally fibrine and gelatine . . 98 . 15 Muriate of soda, phosphate of lime......1 . 85 Oxide of iron, a few traces. In the second stage, they have increased considera- bly in size, by additions to their external surface; and, 10 CONSUMPTION. as far as my own observations have gone, the fewer they are in number, the greater size are they capable of acquiring, so that sometimes they attain the size of an almond : their color also undergoes a change, and they now assume, especially at the centre, a yellow tint, which gradually spreads towards the whole cir- cumference. As they increase they become more closely approximated to each other, and, by successive growths or crops, which spring up between the inter- stices of the more matured tubercles, that part of the lung in which they are situated is studded with large, yellow, irregular-shaped masses, of a hard and firm character. The third stage is the period of softening. A tubercle never stops in the second stage ; it must ad- vance, it must soften, it must liquify; it becomes resolved into a thick yellow pus, not unlike cream, which sometimes contains more solid particles, similar to ripe cheese, or curd: when the whole is softened, it bursts into a neighboring bronchial tube ; it is expecto- rated by cough, and of course leaves a cavity in the lung, technically termed a tubercular excavation. Two, three, or more of these tubercles, contiguous to each other, may happen to ripen simultaneously, and run into each other; and thus, as their contents are ex- peotorated, a still larger cavity is formed, which is called a vomica. Nature will here sometimes make an effort to repair the destruction, or at least to arrest it, by an attempt to close and unite the opposite sides of the excavation by a cicatrix, or scar, and thus obliter- TUBERCLES. 11 ate the seat of decay.* But can we expect that all will thus favorably terminate ? It is not one crop, or one generation of tubercles that we have to encounter; in the same lung we may have them, at the same time, in every stage; and as one ripens, so will the other advance. To make the progress of tubercle better understood, we will take an illustration Avhich is probably familiar to all, namely, the glands of the neck in a person o'' a scrofulous habit. We frequently see them, in children and young people, enlarged and projecting: by bad diet, by exposure to cold, and a thousand other causes which will arouse the dormant disease, they become red and tender; they increase in size, and are in- flamed ; presently they become softer, and fluctuate on pressure ; afterwards they point, the skin ulcerates, and ultimately they burst; they then discharge their contents, which is softened tuberculous matter, and as the constitution improves, they gradually heal with an irregular scar. We have all, perhaps, seen several of these glands similarly affected, either at the same time, or one rapidly succeeding to another, and we have then noticed that the inflammation and the pain is not confined to the immediate vicinity of the glands, but that the disturbance spreads around the whole neck * Sometimes a very considerable cavity is formed. The tubercular matter is discharged. The substance of the lungs for a line or more in thickness around the cavity becomes solidified. A false membrane lines the interior. The process of disintegration is arrested. And the individual although subject to occasional embarrassment, enjoys a tolerable degree of health through a long life. 12 CONSUMPTION. and to the neighboring parts. One after another, abscesses form and burst, until pus is dripping from innumerable points; at length the whole adventitious matter is discharged ; wide and deep openings are left, the edges of which are hard, thick, and indolent; nevertheless, as the health of the patient improves, so we may hope to close the wound, and in time it heals by a cicatrix. Here we have the progress of scrofu- lous tubercle in a part not essentially vital, from which we may trace the progress of tubercle in that vital organ, the lungs. A tubercle, like an egg or spawn in the animal kingdom, or a seed in the vegetable kingdom, possess- es within itself a principle of life, which requires only favoring circumstances to develope and mature. A congenial soil and atmosphere is to the grain of wheat discovered in the cerements of an Egyptian mummy, what " a cold," " a pleurisy," is to tubercle ; wanting this soil and this atmosphere, the grain would never vegetate ; wanting an exciting cause, the tubercle may remain undisturbed and unmolesting for years—for ever : without the seed, we could not have the plant— without tubercle, we cannot have consumption. Because an individual has a tuberculous nucleus in a gland of the neck, it does not follow, as an absolute and invariable consequence, that it will undergo the inflammation, the ripening and evacuation I have just described: by attention to the health, by counteract- ing every approach of disease, by removing every thing likely to prove an exciting cause, the germ of disease THE CAUSES OF CONSUMPTION. 13 in the neck may remain dormant for ever, or be en- tirely removed. So it is with consumption. But let other disease irritate the system, encourage and foster the development of the germ in the gland, add exci- ting causes to the latent cause, and the gland will en- large, will inflame, and go through the stages of soften- ing and discharging. So it is with consumption. We may successfully prevent that which we can seldom hope to cure. THE CAUSES OF CONSUMPTION. The causes of tubercular consumption come under two classes: first, the remote, or predisposing causes ; second, the exciting causes, or those which call the predisposition into action. Hereditary transmission is the chief remote cause. It is as certain that children inherit the diseases of their parents, as that they resemble them in feature and in character. In proportion to the development of the tuberculous disease in the father and mother, will be the disposition to the same affection in the off- spring. In some families we occasionally find the elder children healthy, whilst the younger are born with tuberculous disease already established, or with a pre- disposition to acquire it, in consequence of the tubercu- lous affection having become, in the progress of time, and by the action of exciting causes, developed and matured in the parent. Any disease and any circumstance which can dete- 2 14 CONSUMPTION. riorate the health of one or both parents, materially influences the health of the child yet unborn ; thus many persons acquire a predisposition to consumption from their parents, although the latter may attain an advanced age without evincing any symptoms of pul- monary disorder. Indigestion, some cutaneous affections, syphilis, anx- iety, grief and the depressing passions, intemperance or irregular mode of life in the mother, with insuffi- ciency of proper nourishment during pregnancy, are all capable of inducing a scrofulous habit, and, as a consequence, a predisposition to consumption: that which was bad general health in one generation, is frequently converted into tuberculous disease in the succeeding one. A peculiar formation of body, as distorted spine, narrow chest, and high shoulders, must also be consid- ered a remote cause ; and every pulmonary affection occurring in persons thus shaped, should always be looked upon with suspicion, even in the absence of hereditary predisposition, or more decided exciting cause. The question will probably occur to many—can a child, born of healthy parents, free from scrofulous taint—can he in after life become affected with tuber- culous disease ?—that is, can tubercle originate in him ? It can. By the combination of many circum- stances, which will be noticed under the head of ex- citing causes, a morbid state of the system is estab- lished, which induces and favors the deposit of tubercu- THE CAUSES OF CONSUMPTION. 15 lous matter ; and, by the continuance of these or other exciting causes, he may fall a victim to consumption, and be the first of his race who has suffered by the disease. If a child, born of robust, healthy parents, free from .all suspicion of disease, be insufficiently or improperly fed, or nursed by a woman whose milk is incapable of affording a sufficient quantity of nourish- ment, and if this child be confined in a dark, unwhole- some apartment, wallowing in dirt and uncleanness, tuberculous disease will, in all probability, be estab- lished: the abdomen will become large, hard, and tense, like a drum ; the limbs will emaciate, and the child waste and suffer from all the symptoms of mesen- teric disease : if the child live through infancy, in it the germ of tubercle is deposited ; it has acquired a scrofulous habit. This is only one of the many illus- trations which might be cited of tubercle being origi- nally generated. The peculiarities of frame and appearance which mark a scrofulous or tuberculous habit, although not constant, are yet so characteristic of a dormant liabili- ty to consumption, that the occurrence of what may be an exciting cause in individuals so constituted should be sedulously guarded against. The tuberculous dia- thesis is usually associated with a smooth, fair, and delicate skin; a rosy countenance; light-colored, or reddish, fine hair ; bright blue eyes ; long eye-lashes ; dilated pupils ; a thick upper-lip ; a narrow chest; a weak voice ; a slender form, with high shoulders; the fingers slender, but the knuckles and joints large and 16 CONSUMPTION. " clubbed;" the veins prominent; the teeth white and clear ; and, in general, there is great mental sen- sibility and constitutional irritability. It must be borne in mind that persons who are the very opposite to this description are not exempt from a predisposition which may be nursed into disease. Consumptive patients frequently have a dark complexion, and black hair. At the risk of being tedious, I will recapitulate. Tubercle is the seed of the disease ; it may be heredi- tary—it may be acquired ; an individual may possess undoubted signs of its existence—he may have the scrofulous diathesis strongly marked—he may have lost brothers and sisters, father and mother, by the disease, and yet he, by preventing the germination of this seed, may escape. It, therefore, behooves such an one to avoid the thousand circumstances which may act as a hot-bed in ripening this seed ; some of which I now proceed to notice. Exciting Causes.—Many exciting causes, when acting together in early youth, as improper diet, im- pure air, deficient exercise, insufficient clothing, and the absence of cleanliness, readily become a remote cause, capable of engendering the disease. Food which is not sufficiently nutritious, and food that is too rich and stimulating, are alike hurtful: the former does not furnish an adequate supply of nutriment to support the body in health and strength; the latter excites and irritates the digestive organs, and produces indiges- tion,—one of the most frequent and active agents in exciting consumption. the causes of consumption. 17 Pure air, and plenty of it, is the basis of health: if impure in quality, it irritates the delicate structure of the lungs, and impedes respiration: when fresh air is insufficient in quantity, it is unable to assimilate the chyle, or nutritious element of food, during its circula- tion through the lungs. A prolific source of disease is found in the practice, too frequently unavoidable, of many persons sleeping in the same chamber; also in the confinement of many persons in small, ill-ventilated rooms, as we sometimes find in workhouses and schools, and too frequently in factories, where, as well as breath- ing a vitiated atmosphere, the body is restrained in one constant and unnatural position. A sedentary life in youth arrests the growth and proper development of the body ; in mature age, it im- pedes or disorders every function. Statistics clearly prove that the disease is more prevalent in cities and manufacturing towns than in the rural districts, where the population has plenty of exercise in the open air; and triat it is more prevalent amongst clerks, tailors, shoemakers, and watchmakers, than it is amongst sail- ors, carpenters, and others whose occupation is active. The want of exercise is an exciting cause of consump- tion, which is constantly overlooked or misapprehended even by the most anxious parents : under the dread of fatiguing a delicate child, they restrict hirn^or her to unnatural and unhealthy quietude ; and this incorrect idea is zealously carried out at fashionable, and too frequently finishing, boarding schools, where every movement is regulated by rule ; and the time that 18 CONSUMPTION. should be devoted to a skipping-rope or a foot-ball, is sacrificed to Berlin-wool, or the forcing system of some Dr. Blimber. Fathers should remember the words of Rousseau, who says, " Nature intended that children should be children before they were men. . I would as soon require a child to be five feet high, as to display judgment at ten." Mothers should learn that, " Beauty, like other flowers, needs exposure to the air and to the light of the sun." And both should remember that— " So wise so young, do ne'er live long." Clothing which is insufficient to keep the body at a proper warmth, must always favor disease, especially pulmonary disease ; in our climate, which is so liable to frequent and sudden vicissitudes of temperature, too much care cannot be given to the maintenance of a healthy and uniform warmth. The most injurious effect of cold on the respiratory organs is when it suddenly alternates with warmth. Fashion should be subservient to health; and, with some little care, the one would lose none of its attractions, and the other would attain continued ability for enjoyment. Nothing can be more hazardous than the too common practice, during the inclemency of winter, of women, who in the daytime * are clad m a Siberian costume of furs and shawls, ex- posing themselves at night in muslin or gauze, to the cold air of lobbies, passages, and damp pavements, im- mediately after being heated by exercise in a crowded THE CAUSES OF CONSUMPTION. 19 ball-room, or inhaling the warm atmosphere of a theatre. A constant cause of disease in females is " tight- lacing," by which the contents of the chest and abdo- men are compressed into a most unnaturally small compass. The corset is a most barbarous piece of armor, which cabins, cribs, ano^, confines the feminine proportions of women in an unnatural form, and, in the place of natural symmetry, exhibits artificial de- formity. Imagine the Venus de Medici reduced to a spider waist by a pair of stays ! Personal cleanliness is a duty we owe to ourselves and to those with whom we associate ; it is a means of preserving health within the reach of all, and its im- portance will be admitted when we consider that the skin is constantly producing perspiration and unctuous matters, which readily mix with the dust and fine par- ticles floating in the air, and which, if allowed to collect and remain on the surface of the body, form a coating that closes up the pores of the skin, prevents its healthy action, and gives to disease another ally. Intemperance in the use of spirituous and fermented liquors is one of the most prolific causes of consump- tion : when acting, as too frequently happens, in con- junction with bad, innutritions diet and insufficient clothing, whereby the body is excited and- stimulated, not strengthened and protected, habitual intemperance is capable of becoming a remote cause, or the origina- tor of tubercles, as well as the ever-ready agent to has'ten their development, should they already exist. 20 CONSUMPTION. The blanched, emaciated countenance of the dram- drinker faithfully corresponds with the diseased condi- tion of his internal organs ; and it may occur that an attack of that dreadful malady, delirium tremens, gives more decided evidence of the mischief and destruction effected on the nervous system. The dire effects of this debasing habit are not confined, unfortunately, to the drunkard himself; his progeny suffer, perhaps, in a still greater degree, and the frequency of tuberculous disease in the children of dissipated parents is a fact which can be confirmed by every physician of experi- ence. Surrounded by all the temptations to err which on every side allure the inexperience and indecision of youth, it cannot occasion surprise that— " Some begin life too soon,—like sailors thrown Upon a shore where common things look strange." Dear is the price hereafter to be paid for this pre- cocity ; imprudence or excess may be indulged in while strength and youth have the power to neutralize the immediate effects of folly ; but, when these are ex- hausted, and disease turns the balance, rapid is its onslaught, and, it may happen, decisive the victory. Change of temperature directly affects the respiratory organs, and conveys an exciting cause to the very seat of tubercle ; we, therefore, find consumption most gen- eral and most fatal in climates that are subject to sud- den alternations from heat to cold ; and Great Britain THE CAUSES OF CONSUMPTION. 21 ranks the first in this unenviable position. In those climates where the atmosphere is uniform, whether it be cold or hot, as in Russia and the Western Indies, con- sumption is comparatively rare; whilst in England it car- ries off about one-fourth of the inhabitants; in Paris, about one-fifth; and in Vienna, one-sixth. As well as by those rapid climatorial variations which are native to our soil, the disease is nurtured by our own careless- ness : this carelessness is directed rather to the effect than to the cause, for we constantly meet with persons who dread " catching cold," and use every precaution to avoid doing so, and yet they take no heed of the cold when it is " caught." The man who will not have his hair cut on an inclement day, lest he " take cold," will, nevertheless, allow a cold and a cough to distress him for weeks without adopting any effectual means of removing it. I do not remember having read a more forcible ad- monition on the necessity of attending to " a slight cold," than that written by the author of " The Diary of a late Physician." The value of the advice, and the vigor of the language, will be an adequate excuse for the extract:—" Let not those complain of being bitten by a reptile, which they have cherished to ma- turity in their own bosoms, when they might have crushed it in the egg. 'Now, if we call a slight cold ' the egg,' and pleurisy, inflammation of the lungs, asthma, consumption, the venomous reptile, the matter will be no more than correctly figured. There are many ways in which this ' egg' may be deposited and 22 CONSUMPTION. hatched. Going suddenly, slightly clad, from a heated to a cold atmosphere, especially if you can contrive to be in a state of perspiration—sitting or standing in a draught, however slight—it is the breath of death, reader, and laden with the vapors of the grave. Lying in damp beds, for there his cold arms shall embrace you; continuing in wet clothing, and neglecting wet feet; these, and a hundred others, are some of the ways in which you may slowly, imperceptibly, but surely, cherish the creature, that shall at last creep inextricably inwards, and lie coiled about your vitals. Once more, again,—again—I would say, attend to this, all ye who think it a small matter to neglect a SLIGHT COLD." Mental emotion and the passions, especially those which are depressing, exert a decided influence in arousing tubercles from their lair. The effect of men- tal affliction instantly overthrows the whole economy of the system ; an agonizing sense of oppression and tight- ness is experienced in the neighborhood of the heart and lungs, accompanied with a dreadful feeling of impending suffocation. If the sorrow be un-removed, if the heart be uncheered by hope, this disturbance continues, the health sinks under the oppression, and the mind falls into despondency. In the downfall of long cherished hopes ; in the bereavement of a loved parent or friend ; in disappointed ambition; in the reverse of fortune ; in slighted affection; in fact, by all that " maketh the heart sick "—affliction of mind is THE CAUSES OF CONSUMPTION. 23 a constant " worm i' th' bud," that preys on the health, and accelerates the progress of consumption. A frequent exciting cause of phthisis in young per- sons may be traced to a deep and settled despondency, consequent on a separation from the happy scenes and associations of home. This has been termed home sickness—" the piercing anguish hid in gentle heart;" —(the heimwehr of the Germans, the maladie du pays of the French). Whenever the sufferer from such a cause be of frail or delicate constitution, the danger will be greatly enhanced. Intense application to study, which involves loss of sensorial power and exhaustion of the nervous system, together with sedentary habits, imperfect digestion, and constipation, is another mode in which the mental powers affect the health. One, from among the many victims of consumption hastened to an untimely end by severe mental application, was Kirke White—he who, whilst in the grasp of the destroyer, sang,— " Gently, most gently, on thy victim's head, Consumption, lay thine hand I Let me decay Like the expiring lamp." Rapid growth is, in many instances, the harbinger of this disease, as it is always attended by debility in consequence of inadequate nutrition: the progress of development in the frame being more rapid than the elimination of the required nourishment, the body grows without being matured, almost without being perfected. Richerand relates a case of this kind that 24 CONSUMPTION. terminated fatally, the individual having grown more than an English foot in a year. Several occupations which produce mechanical irri- tation of the lungs, greatly quicken the development of tubercles : this mechanical irritation is excited by in- haling an atmosphere loaded with minute particles of dust or powders, as happens to sawyers, millers, starch- makers, flax-dressers, weavers, feather-dressers, and artizans similarly engaged. These employments, how- ever, are harmless when compared with others in which the dust is of a deleterious nature, as it is in the manu- facture of cutlery and the grinding of metals. The mortality amongst needle, edge-tool, and gun-barrel grinders, is excessive ; and Dr. Johnstone, of Worces- ter, informs us that the former seldom live to be forty. Mr. Thackerah gives a similar account of the early fatality of such employments in Sheffield, where the disease, so induced, is known amongst grinders by the name of " pointers' cough," or " grinders' rot." Sedentary employments, and confinement in a par- ticular position, are most injurious to those who have any predisposition to the disease : literary men, law- yers, artists, clerks, watchmakers, jewelers, tailors, shoemakers, and others similarly engaged, add more than their proportionate quota to the lists of mortality from consumption. Public speakers, clergymen, read- ers, singers, performers on wind instruments, and oth- ers who strain or over exert the vocal organs, are also liable to pulmonary disease. Some avocations appear to enjoy considerable im- THE CAUSES OF CONSUMPTION. 25 munity from consumption ; butchers, in particular, are seldom consumptive, and the disease is rarely found in soap-boilers, glue-makers, fishermen, and fishwives. Many diseases, especially those which affect the pul- monary organs, have a peculiar tendency to excite consumption: catarrh, bronchitis, and inflammation of the lungs, frequently give an impulse to the more seri- ous and fatal malady. Fever, when occurring in a person of tuberculous constitution, acts in like manner. The eruptive fevers, ^Bjoaeasles, small-pox, scarlet fever, frequently induSSne subsequent disorder of the system, and in many instances that disorder is phthisis. Nervous debility, produced by irregularity and excess ; indigestion, which implies deficient nutri- tion and constant irritation of the whole body, are never-failing causes ; worms, or any thing capable of exciting habitual irritation in any part of the alimen- tary canal, readily induce a sympathetic action in the lungs. The tendency of syphilis to produce consump- tion has been noticed by almost every writer, from the time of Bennet (1654). The remedy—the specific— for the syphilitic poison—mercury, when used so as to affect the system, possesses the same dangerous prop- erty, and in persons of a delicate or scrofulous consti- tution its employment demands the greatest caution and circumspection. Certain profuse discharges, as long continued diarrhoea, diabetes, menorrhagia, fluor albus, bleeding piles, &c, may, with sufficient reason, be included amongst the exciting causes. The imprudent practice of young and delicate moth- 3 26 CONSUMPTION. ers suckling their children, as some do, for twelve or fourteen—nay, some eighteen months, or two years, is most reprehensible, and dangerous, alike to themselves and to their offspring. It must not be supposed that these exciting causes act injuriously in every case, or that one alone is al- ways sufficient to foster the disease ; but we may be assured that whatever tends to debilitate the constitu- tion, whatever interferes with the proper nutrition of the frame, and whatevef^B Ksses the vital powers, will always accelerate unjl B? the production of tu- berculous disease. The opinion at one time prevailed that consumption was contagious ; but the experience of modern physi- cians goes far to prove that it cannot be so propagated; it is, nevertheless, highly imprudent for a healthy per- son to occupy the same bed, or to sleep in the same chamber, with a consumptive patient. THE INFLUENCE OF AGE ON CONSUMPTION. Pulmonary consumption is a disease of all ages ; yet how frequently is the poignancy of its attack tempered by the season of its visitation. It is not the infant— the child to whom life and its endearments, its ties of affection, its dreams of honorable ambition, are yet unknown or unappreciated ; it is not the decrepit man who is steadily advancing to that bourne to which the course of time leads us all, who is satiated alike with THE INFLUENCE OF AGE ON CONSUMPTION. 27 the cares and the troubles, the joys and the delights of life,—but it is youth bursting into manhood,—it is man in the perfection of his strength, in the zenith of his intellect, in the enjoyment of love, honor, and fame, on whom it lays its fatal grasp. For its victims, how frequently does it claim those to whom existence dis- plays the brightest future of usefulness and happiness —the young, the beautiful, the intellectual! how fre- quently do they hold life on its frailest tenure ! The youth entering the busy world ; the girl gushing into the loveliness, the tenderness of woman; the husband striving to maintain an infant family ; the wife cheer- ing, encouraging and directing his efforts ; the toiler who has just surmounted the difficulty of obtaining a maintenance ; the aspirant within the reach of the pin- nacle of his ambition : these,—these are the victims of consumption. In the chamber of the rich, surrounded by all the comforts and luxuries that wealth can procure, that refinement can suggest, that medical skill can direct— in the damp, dark chamber of poverty, where the re- quirements of sickness are unknown, where the neces- saries of life are stinted, consumption steadily and surely pursues its way, and desolation of heart, of home, of hope, follows in its path. The period of life at which phthisis is most frequent, has been a subject of inquiry since the earliest times. The Greek physicians held it a common doctrine that it rarely occurred before fifteen, or after thirty-five, and the results of recent investigations differ but little 28 CONSUMPTION. from this statement. Dr. Woolcombe, however, of Plymouth, has published a table of seventy-five deaths, ten of which took place before the age of fifteen, six- teen between fifteen and thirty, and forty-nine above the age of thirty. Dr. Alison, of Edinburgh, states that fifty-five deaths occurred in the practice of the New-town Dispensary in two years ; eight of which occurred before fifteen years of age, thirteen between fifteen and thirty, and thirty-four after the age of thirty. The most satisfactory information is obtained from the investigations of M. Louis, who gives the following table of one hundred and twenty-three cases: Age. Deaths, From 15 to 20......11 " 20 to 30......39 " 30 to 40......33 Age. Deaths. From 40 to 50......23 " 50 to 60......12 " 60 to 70......5 I have now before me a list of sixty-four cases which were under treatment in January, 1847, and I find that, From 12 years of age to 20, there were under treatment 14 " 20.....30..........24 " 30.....40..........12 " 40.....50..........10 " 50.....60..........4 In this number (sixty-four) three deaths occurred dur- ing the month, at the ages of twenty-three, twenty-five, and thirty-six. On reviewing all the tables, we may come to the conclusion that the development of consumption gener- THE SYMPTOMS OF CONSUMPTION. 29 ally happens between the ages of eighteen and thirty- five. THE SYMPTOMS OF CONSUMPTION. The progress of consumption is dependent on the progress of the tuberculous deposit in the lungs; therefore, in describing the symptoms, I shall endeavor to place them in relation with the physical signs, or those which may be deduced from the employment of the stethoscope—sounding the chest, as it is popularly termed—and thus connect the external and observable symptoms with those changes and alterations which, we are taught by morbid anatomy, are going on in the structure of the lungs. With this view I shall consider the symptoms under three stages, corresponding with the three periods of tubercles already described : thus, the first stage cor- responds with tubercles in their crude state ; the second stage, with that of " ripening ;" and the third and last stage corresponds with the period when they have softened, are coughed up, and cavities or excava- tions are formed in the lungs. THE FIRST STAGE. It sometimes happens that the local and functional symptoms are so obscure or doubtful, that the existence of consumption in the first stage of the disease cannot be detected with certainty; in fact, they may give so 3* 30 CONSUMPTION. little uneasiness or anxiety to the patient, that he may be unconscious of any great departure from his ordi- nary health until the disease is far advanced, and the case has become desperate. In other instances, the symptoms are so prominent and so characteristic as to attract the attention of the most careless observer. The symptoms and signs are materially modified by the age, strength, habits, and peculiarities of the indi- vidual : some may be altogether absent, others may be irregular, and all may vary in the degree of intensity. Although the symptoms in the first stage are usually obscure, and it is difficult to detect the real nature of the disease, we should always suspect the presence of consumption when we know there is hereditary predis- position ; when we find a cough continue for some length of time, inducing increasing debility and emaci- ation ; and especially when the invalid bears the ap- pearance of a scrofulous constitution. The commencement of consumption is slow and insidi- ous ; there is seldom any pain in the part most affected to direct the attention of the patient to his malady. After some slight exposure to cold, or other exciting cause, he feels an uneasiness at the back part of the throat, which induces a hard and dry cough : without being very troublesome the cough continues, and is soon accompanied by a trifling expectoration of frothy mucus, without color and without consistence, as in common catarrh. Presently the cough becomes more frequent and more decided, particularly in the morning on getting up, and at night soon after retiring to bed. THE SYMPTOMS OF CONSUMPTION. 31 The expectoration is now transparent, but more tena- cious, almost ropy ; any little exertion during the day, as walking fast, or going up stairs, is sufficient to bring on a fit of coughing, and with it quickness of breathing, attended with some degree of oppression at the chest. The patient soon becomes sensible of unusual languor; he is readily fatigued, and finds his strength unequal to his customary labor or exercise ; he breathes with some difficulty, and his respirations are shorter and quicker than usual ; if he take a deep inspiration he is conscious of uneasiness, scarcely a pain, immediately beneath the collar bone, and this more frequently is felt on the right side. The local disease now begins to implicate the general health; and, as the pulmonary symptoms advance, which they now do more rapidly than heretofore, the whole frame sympathizes with the chest affection. The pulse becomes quicker than natural, especially towards even- ing ; the body is frequently chilled with a sudden rigor, or shivering, which is followed by increased heat of the skin, particularly at the palms of the hands and the soles of the feet, which, towards night, are hot, harsh, and dry. After midnight, the feverish heat is suc- ceeded by a moisture ; and, towards morning, the body is bathed in a profuse perspiration: the sleep is oc- casionally disturbed by a sharp attack of coughing, and the patient arises in the morning, relaxed and enfee- bled. The appearance of the invalid soon attracts the atten- tion of his friends ; the countenance loses its healthy, 32 CONSUMPTION. rosy bloom, and at one time is pale and anxious, and again suddenly flushed with a blush of red ; the eyes sparkle with unusual brilliancy ; the hair grows long and damp; the body diminishes in bulk, and begins gradually to waste ; the flesh loses its natural firm- ness, and is soft and loose; the spirits are dejected ; the appetite precarious, and he is indolent, languid, and easily fatigued. The patient may continue for a considerable length of time in the state just described; he may gain re- newed strength to combat the exhausting effects of his disease ; the further development of tubercles may be retarded by judicious remedial measures ; the growth of this, the first crop, may be arrested, and he may be restored to such a share of health as to remove the alarm of his connections. But, alas! " the snake is scotched, not killed." By some accession of cold, the symptoms again return ; again they may be subdued ; and, thus battling with disease, life may be prolonged for years after the known and certain existence of that which at one time or other may prove fatal. Dr. Latham relates that he knew one patient in this state twelve—and another, twenty years.* * Frequently early in the disease, almost always towards the close, the tubercular affection involves the larynx, or organ of voice. The voice is more or less affected, sometimes entirely lost. When it occurs early, before the symptoms of affection of the lungs are distinctly de- clared, it often occasions a delusive hope that this is all, and the atten- tion is entirely turned in this direction. A distinction here is important. If the symptoms are owing to a simple inflammatory affection, although they may be obstinate in their resistance, they are eventually very THE SYMPTOMS OF CONSUMPTION. 33 In other instances—rapid decline—the disease is not so controllable ;, it assumes the mastery at the on- set, maintains it, and conquers. Before detailing the physical signs, it may not be irrelevant to give a short account of the stethoscope, an instrument which is as essential to the physician as is the compass to the navigator. The stethoscope was invented in the year 1816 by Laennec, a French physician. It is generally made of cedar wood, of a cylindrical form, about ten inches long, about an inch broad, having a cylindrical perfora- tion throughout its whole length, an expansion or cup at one end, and a flat surface at the other ; in effect, it is a wooden tube. Its use is to convey the sound emitted in the chest to the ear, and enable us to prac- tice mediate auscultation—that, is, listening to the sounds and movements of the heart, lungs, &c. We all know that when a person has a cold, and the bron- chial tubes are loaded with mucus, the air rushing through them gives rise to a wheezing in the chest, or a rattle in the throat; and if we apply the ear to the side of a person, we may hear the heart beat. It was left to Laennec to notice, and to turn to practical ac- count, the indications thus afforded of the actual state sure to yield to treatment. If they are owing to tubercle, they almost as certainly go on to a fatal termination. These two classes of the affection usually go with the public, improperly, under the name of bronchitis, and are often uselessly very harshly treated, when a careful and intelligent observation of the symptoms would show that the affec- tion of the larynx is only one feature of a much more grave disease elsewhere. 34 CONSUMPTION. of the working machinery of our internal organs. At the time of his discovery he was physician to the Necker Hospital, in Paris, and in its wards he insti- tuted a series of observations and experiments, first to ascertain the regular and healthy sounds which were elicited in natural, vigorous respiration and inspiration, and afterwards those alterations and changes which were caused by disease. The result of his experiments was, to use his own words, " a set of new signs of diseases of the chest, for the most part simple, promi- nent, and certain, and calculated, perhaps, to render the diagnosis of these diseases as positive and circum- stantial as that of many affections which come within the immediate reach of the hand or instruments of the surgeon." One of the first physicians who introduced the ste- thoscope into England, was my late respected teacher, Dr. Thomas Davies, who was the friend and pupil of Laennec during the time he was perfecting his dis- covery. Dr. Davies, on his return from Paris, where he paid much attention to the nature and treatment of pulmonary and heart affections, opened a class at his own private residence, which was attended by many practitioners in the metropolis, and from that period the value of the stethoscope has neither been doubted nor neglected. The Physical Signs are obscure when the tubercles are small in size and few in number, and scattered throughout the substance of the lungs ; when, how- ever, many are accumulated together, and we apply THE SYMPTOMS OF CONSUMPTION. 35 the ear to the chest whilst the patient is speaking, we shall find, at that particular part where they are situ- ated, that the voice resounds in an unnatural manner, because the solid substance of the tubercles is a better medium for the conveyance of sound than the elastic structure of healthy lung. Wherever, therefore, the patient's voice can be most distinctly heard, there may we suspect the presence of tubercles. We may also detect an inequality in the sound of the respiration. At one part of the lung it may be soft and easy ; at another part, where tubercles offer an obstruction, it will be found irregular and interrupted. By observing the motions of the chest during inspiration, we may sometimes discover one side more fully expanded than the other ; and, when this happens, we may suspect the existence of tubercles on that side which is the more contracted. THE SECOND STAGE. The symptoms now cannot be mistaken; Avhatcver was doubtful in the first stage, is confirmed into a sad reality. The cough, which before was only occasional, is now frequent and distressing ; the expectoration is no longer a scanty, clear, frothy mucus, but is copious, and as- sumes a purulent, or muco-purulent character, which presents, on examination at different periods, some or all of the following appearances :—It is opaque, thick, and of a pale yellow color ; sometimes it has a greenish 36 CONSUMPTION. tint, and at others, it is dark, almost black: a portion may acquire a greater, even hard consistence, and be surrounded by a watery or whey-like mucus; it may be tinged with blood, or contain small specs or streaks of blood; small solid particles, or shreds, resembling curd, of a dead white, or straw color, varying in size, from a pin's head to a grain of rice, may be noticed floating or sustained, either in a cream-like, or a trans- parent fluid; sometimes the softened tubercles are coughed up in flakes. The expectoration, in some cases, is devoid of smell; in others, it has a faint foetid odour ; it is of greater specific gravity than water, and, when deposited in a vessel containing that fluid, mixes with it, or sinks to the bottom. The cough, although constantly tormenting the pa- tient, is seldom attended with any acute pain, except when there is some slight degree of inflammation of the pleura (the investing membrane of the lungs, and the lining membrane of the chest), or when old adhesions of the two pleurce—the result of former inflammation— interfere with the natural expansion of the lungs. Pain, almost of rheumatic character—indeed, it is sometimes referred to rheumatism alone—is frequently experi- enced around the shoulders, between the shoulder-blades, and at one or both sides ; occasionally, there is diffi- culty in lying in bed on one or the other side, without some pain and uneasiness. In general, the amount of pain endured during the progress of the disease, bears no proportion to the extent of mischief going on in the lungs. THE SYMPTOMS OF CONSUMPTION. 37 The difficulty of breathing, which in the first stage was temporary, is now, in the majority of cases, con- stant. This may be readily accounted for by the increased size and increasing number of the tubercles having encroached upon, and blocked up, the air cells, and thus diminished that surface of the lungs by which the act of breathing is performed. In some instances, the patient complains of very little annoyance in respi- ration, and when tranquil he breathes with ease and freedom; nevertheless, any considerable or long-con- tinued exertion cannot be borne without much tightness and oppression of the chest, and mounting an ascent always aggravates the dyspnoea. Hectic Fever.—When the expectoration is puru- lent, and presents the characters I have just described, that condition of the system which is designated hectic fever, always prevails ; at the very commencement of consumption this fever slowly and insidiously affects the health and strength, but it is seldom that it manifests itself in all its fearful symptoms until the tubercles be- gin to liquify and pus is formed. Hectic fever is of a remittent type, and is said to have two accessions in the twenty-four hours ; one in the middle of the day, and the other towards evening; with the exception of the evening exacerbation, which is always regular, the periodicity of its return is uncer- tain ; sometimes it is absent altogether during the day, and sometimes the patient is never free for any length of time from its sudden invasion; but these repeated 38 CONSUMPTION. attacks are never so severe as that which exhausts the patient in the evening and night. The access of the fever commences with chills and shuddering, and a sense of "creeping" in different parts of the body; the back, especially down the course of the spine, although hot to the touch, feels cold to the patient, and he is acutely sensible of the slightest breath of cold air. After a time, varying from half-an- hour to two or three hours, the hot stage succeeds, and the patient is then burnt up with fever—he is restless, and overpowered with lassitude ; the pulse is seldom less than 100—more frequently 120 ; the skin is hot and dry, and the face is flushed and burning. This stage lasts several hours, and towards morning termi- nates in perspiration. The ordinary acceptation of the word " perspiration," is quite inadequate to express the amount of the night sweats ; the body is not bedewed, or damp, but wet; perspiration, like drops of water, oozes from the pores of the skin, and in some instances rolls from the body almost in a stream, so that towards morning, the per- sonal clothing and bed-linen are completely saturated with moisture. The chest in particular is subject to this excessive perspiration; and in cases where the disease presents itself without any aggravated symp- toms, the patient constantly complains of awaking with his breast and shoulders damp and moist. Of all the signs diagnostic of consumption, not one is so constant, or so confirmatory of the disease, as these night sweats. When hectic fever is established, the pulse increases THE SYMPTOMS OF CONSUMPTION. 39 in rapidity, and beats from 100 to 120 or 130 ; the heart palpitates violently, and is easily excited by trifling causes ; the respiration is hurried ; the cough is "hacking" and exhausting; the body loses flesh, and wastes or melts away ; the flesh that remains is soft and flabby, and the skin loses every appearance of health. The debility is great, and the lassitude so in- creases that the patient is quite unequal to any bodily exertion. The sleep is invariably disturbed by repeated paroxysms of cough, induced by the loaded state of the air-passages ; and the least change of position, as turn- ing from one side to the other, is sufficient to cause a recurrence of the attack. The appetite is fickle ; some- times it remains good to the last, but more frequently there is perfect loathing of food, which occasionally produces nausea and vomiting: thirst is seldom troublesome or excessive, even during the feverish state. The tongue often preserves a healthy appear- ance for some time, but afterwards it becomes dry, of a deep red color, and at its edges and tip is frequently covered with small ulcers, resembling particles of cur- dled milk : this aphthous state of the tongue may extend to the throat, and cause numerous small sores, which distress the patient, and render swallowing pain- ful. At the commencement, the bowels are usually constipated ; after a time they become irregular, being relaxed for several days, and again costive : when, as may happen towards the close of the disease, the mu- cous membrane of the bowels is irritated, or even ulcer- ated, diarrhoea is frequently present, and greatly assists 40 CONSUMPTION. to reduce still lower the remaining strength of the pa- tient. The urine is generally high-colored, inconstant in quantity, and deposits a bran-like sediment. Haemoptysis, or spitting of blood, generally becomes an alarming symptom at this stage of the disease, and by presenting to the patient visible evidence of the ex- istence of internal mischief, frequently arouses the first suspicion in his mind that he bears within him the germ of a fearful complaint. The ordinary phrase, rupture of a blood-vessel, is not always a correct one; when a blood-vessel is " rup- tured"—I am speaking now without reference to external violence—it is usually caused by a morbid distension of the blood-vessels and increased impetus of the blood, and is technically termed an active hemor- rhage. Active hemorrhage more frequently occurs in those vessels which are the least protected and sup- ported by integuments, or by surrounding muscular or ligamentous substance ; thus the minute vessels which supply the Schneiderian membrane of the nostrils are, in some persons, liable to be ruptured by any trifling exertion, as sneezing, or by a slight blow. Active bleeding of the lungs is usually accompanied by symp- toms denoting determination of blood to that organ, or by actual inflammation, rather than by those symptoms of diminished action which we usually find in this stage of the disease. When the whole system is debilitated, as it is in con- sumption, the blood-vessels are of course in a weakened condition ; their coats become lax, they lose their natu- THE SYMPTOMS OF CONSUMPTION. 41 ral patency, and, without being ruptured or their con- tinuity interfered with, they allow the red particles of blood to e.nule and become effused. This is termed passive hemorrhage, and is the cause of spitting of blood that we have now to encounter. This degree of hemorrhage will continue without any marked increase of the other pulmonary symptoms, or the invasion of new ones: the expectoration is dotted with small par- ticles of congealed blood, and occasionally streaked with a delicate film of a bright red color; sometimes pure blood is coughed up, or discharged without an effort, and the quantity may vary from a drop to a tea- spoonful, and from that to a much larger quantity ; but it seldom escapes in a stream, as it will do in active hemorrhage. As the disease advances, the bleeding may arise from active and passive hemorrhage, inasmuch as the branches of some arteries may be ruptured by the sof- tening of the tubercles; and the weakened coats of others may allow the constant oozing or weeping of blood. The periodical indisposition in females is either irregular, deficient, or altogether absent; and this deviation from custom, is often erroneously considered as the cause of all the debility, languor, and wasting, instead of the effect of the pulmonary disease. The appearance of a patient advanced to this stage of decline is so characteristic of the disease, that to those who have experience in its treatment, the coun- tenance and figure depict, almost describe in detail, 42 CONSUMPTION. every symptom. The account given by Aretseus so faithfully portrays this appearance, that I cannot do better than borrow a sentence from the elegant trans- lation of the late Dr. Young. " The nose becomes thin, especially at its point; the cheek bones project— the skin covering them is pale during the day, in the evening it is flushed in circumscribed patches of a brilliant red color—(hectic blush) ; the white part of the eye shines, and is of a light pearly hue ; the eyes are large and bright, although somewhat sunk in their orbits; the cheeks are hollowed ; the lips retracted, presenting often the appearance of a melancholy smile ; the teeth increase in transparency ; the whole body is shriveled ; the spine projects, instead of sinking, from the decay of the muscles ; the shoulder-blades stand out like the wings of a bird ; the fingers are shrunk, except at the joints, which are prominent; the nails are curved ; and the hairs gradually fall from the head." During this wreck of health, the mental faculties continue perfect, and are often endowed with increased intelligence ; the temper may be occasionally irritable, but the spirits are seldom oppressed on account of the malady. Hope, a strong hope of ultimate recovery, constantly and wonderfully sustains the patient; he will admit he has " a cough which may be serious ;" but " when warm weather comes he will be better." How often have I heard a girl, who could scarcely utter the word—" Wonder why mamma was fretting ?" THE SYMPTOMS OF CONSUMPTION. 43 —unconscious that the danger which surrounded her- self was the sole cause of a mother's sorrow. The duration of the second stage of consumption is variable : in some cases a few weeks may be sufficient to place the patient beyond hope ; and he is then, in familiar language, said to be in a " galloping consump- tion ;" while others may continue for months, or even years, without any aggravation of the symptoms, or much increase of the disease taking place. By main- ■ taining the general health, and supporting the strength, we may arrest the further development of more recent tubercles, and those which have already advanced to " softening," may be reduced to a chronic state ; or— but we must confess the instances are rare—the seat of softened tubercle may become obliterated by a cura- tive process, which unites the sides of the cavity. When, however, spitting of blood, diarrhoea, and night sweats, reduce and waste the patient, the result is rapid, although the disorganization of the lungs may have ceased. The jJujsica! signs now indicate more clearly the change and enlargement which the tubercles have un- dergone, and, by a careful examination of the chest, we may gain positive evidence of the internal mischief. The sound of the voice, wherever an enlarged tubercle, or a mass of tubercles exist, is louder than elsewhere, and gives rise to the stcthoscopic sound, termed bron- chophony : bronchophony, however, by itself, should not be considered a certain diagnostic of tubercle, unless conjoined with a dull sound on percussing the part sus- 44 CONSUMPTION. pec ted with the points of the fingers. On applying the stethoscope, we sometimes hear a distinct crepitation or crackling, and occasionally, at the upper pars of the lung, we hear a still louder sound, like a gurgling. The sounds are at first more distinctly heard at the upper part of the chest, and gradually proceed down- wards ; they are often more decided on one side than the other, according to the extent of tuberculous de- posit in the lungs. THE THIRD STAGE. This stage of consumption coincides with the com- plete softening of the tubercles, when the liquified tu- berculous matter bursts into the bronchial tubes, is then gradually expectorated, and the seat of the abscess converted into an excavation or cavity. The symptoms described as characteristic of the second stage, now prevail in~ greater intensity; the cough is scarcely absent for any length of time, but tears and racks the breast, sides, and back, with sharp, lancinating pains, and leaves the patient, after each paroxysm, faint and exhausted : during the night the cough is unceasing, and drives off that natural and blessed restorative—sleep. At the commencement of a paroxysm, the cough is " hollow," but as the expec- toration becomes loosened, it gives a gurgling or rolling sound, which gently subsides almost to a murmur. The expectoration is profuse, occasionally amounting to a pint in a few hours : it consists of a heavy, purulent THE SYMPTOMS OF CONSUMPTION. 45 discharge, in consistence equal to cream, and in color varying from pale yellow to green, or bluish-black or brown ; it contains small lumps of a curd-like substance, and is sometimes freely mixed with fresh florid blood ; at others, the blood is in minute congealed clots or threads ; the odor is generally faint and sickly, in some cases foetid and offensive. The expectoration may be so copious in quantity, and the strength of the patient so prostrated, as to deprive him of ability to eject or cough up the accumulated matters, and thus suffocation may be threatened. I remember a case that occurred at the London-hospital, during the time I was dresser, in which death was instantaneous from these causes. Spitting of blood does not happen so frequently in this, as in the earlier stages of the disease ; the tuber- culous matter, in its softened state, appears to throw aside the larger blood vessels, and in examinations we sometimes find them flattened, and occasionally oblit- erated ; but, except in their most minute ramifications, seldom ruptured. The breathing is oppressive and difficult; the dyspnoea does not come on in occasional or spasmodic attacks, but is constantly laborious, in consequence of the imperfect inflation of the lungs—perhaps I should say, of what remains of the lungs : the least exertion, or change of position, aggravates the oppression, and the sufferer obtains breath by a succession of gasps, rather than by natural respiration. The hectic fever ravages the frame with undimin- 46 CONSUMPTION. ished violence ; the chills are frequent; the succeeding heat produces an exhausting faintness, and the perspi- rations during the day, as well as the night sweats, are abundant. Diarrhoea is generally present, and the copious evacuations which are constantly occurring, reduce the strength of the patient to the lowest possible ebb, and constantly cause an overpowering sensation of faintness and sinking. The appetite is bad ; and it is only by the most savory, delicate, and not always the most proper food, that the patient can be tempted to eat. Whatever is eaten readily causes uneasiness and disturbance in the stomach; sometimes it is quickly rejected ; but, if retained, it creates so much irritation as to produce pain and nausea. Flatulence, and vio- lent eructations of acid, unpleasant wind, constantly harass the patient, and occasion a " rising in the throat," which appears to threaten suffocation. The pulse maintains its unnatural rapidity, and is seldom less than 110 ; the surface of the body is always hot to the touch, and the palms of the hands and the soles of the feet are burning. The throat and mouth are generally sore from numerous small aphthous ulcers, and in some cases the larynx is ulcerated : when this occurs, it renders the cough still more frequent and painfully distressing. I have, in several instances, noticed the formation of small abscesses, either in the rectum, or in the immediate neighborhood of the lower gut, during the last stage of consumption ; indeed, the whole mucous membranes appear to approach closely to ulceration, if they are not absolutely ulcerated. THE SYMPTOMS OF CONSUMPTION. 47 Towards evening the feet and ankles become swollen, tumid, ;-. NOTICES. 105 " There is no assumption or quackery in this little Volume—it is just such a work as might be anticipated from an intelligent and experienced physician. The suggestions and recommendations of Dr. Yeoman are extremely valuable, and may be unhesitatingly and advantageously adopted by all who are interested in the health and well-being of the rising generation."—Mtrrning Herald. " There is so much good sense, scientific knowledge, and useful in formation in this little volume, that we gladly assist in giving it pub licity. Dr. Yeoman discountenances all empirical modes of treatment, at the same time that he suggests some safe and beneficial rules for the cure or amelioration of the disease. The remarks on the healthy disci- pline of home, show that the author is a sound social philosopher as well as an experienced physician."—The Britannia. " This compendious little treatise is marked by much good sense, careful observation, and specific views as to the nature of the terrible disease of which it treats. The subject is treated ill a popular form: and the volume should be consulted by every one who is interested in this disease: and who is not, in this its favorite region ?"— Court Journal. " Let us entreat particular attention to this little work, whose merits are in inverse proportion to its magnitude. It bears evidence of great common sense and absence of learned affectation and jobbery."—Lady's Newspaper. " We most cordially recommend the work to the heads of families, and to the medical profession."—Bells Weekly Messenger. " This little work, from the pen of a gentleman who has made pul- monary complaints his special study, and who has acquired a well-de- served celebrity by his mode of treating these terrible afflictions, will be found a valuable addition to the medical library. Written unosten- tatiously, and in a style which is earnest, though completely unaffected, it may be studied with advantage by the general as well as the profes- sional reader."— Weekly Dispatch. " This may truly be called a work for all classes; for consumption is the disease of all classes who breathe our humid and variable atmos- phere The large proportion of deaths arising from this cause gives an almost universal interest to the subject; and we have never seen it treated with greater simplicity or practical sense than it is in the pages of Dr Yeoman's unpretending little volume. There is no quackery, no learned mystery, no affectation of originality in it; but a plain exposi- tion of the causes, symptoms, and rational treatment of the complaint, 106 NOTICES. with the means most likely to be effectual in preventing it; all set forth with the clearness of a man who wishes to be understood, and the earn- estness of a man who desires to be useful. We know that in all dis- eases a timely application of the remedy is more than half the battle, And the aphorism which teaches that' prevention is better than cure, applies with peculiar force to the case of consumption, which, if once established, rarely, if ever, gives way, even to the most skillful treat- ment and the most sedulous care. Let all, therefore, as well those who have no reason to apprehend the existence of the seeds of the malady in themselves or their children, as those who have, read Dr. Yeoman's book, they cannot fail to obtain much salutary advice with reference to the regulation of their diet and the preservation of their health."—Liverpool Courier. " We much approve of Dr. Yeoman's work on consumption, it is a straightforward, practically-written book, prepared for the public with great research and attention, and we are sure that, if generally perused, it would avert many dangerous consequences in complaints leading to consumption. We have understood that Dr. Yeoman has been highly successful in many cases of early consumption, and we prize his ef- forts."—Blackwood's Lady's Magazine. " The chapter on the ' Prevention of Consumption,' is excellent. It is, in fact, a safe guide to acquire health. To the anxious parent, it will prove a sympathizing, friendly counselor; to the youthful, it will be a monitor to direct them to health and vigor. We cordially recom- mend the work to all our readers, and cannot but express our opinion that Dr. Yeoman has done the ' state some service' by its publica- tion."—Preston Chronicle. " The prescriptions are given in English ; and the medical phrases are almost entirely left out. The chapter upon the ' Prevention of Con- sumption,' and the paragraphs treating of the necessity of sufficient and well-regulated exercise, a proper attention to personal cleanliness and clothing, are particularly apt and good."—Leicester Journal. " We can with sincerity state we never before read a work on the causes, symptoms, and rational treatment, with the means of prevention of consumption so satisfactory, and not its least recommendation is the entire absence of medical technicalities. The style in which it is written is easy and pleasing, and without exciting the mind of the reader, even if he is, or thinks he is, of a consumptive habit, it gives him many use- ful and valuable hints. We would recommend its perusal to the heads of families."—Hampshire Guardian. NOTICES. 107 " This is really an admirable little work on a subject, alas, too con- genial to our climate. We speak conscientiously when we say that we can heartily and strenuously recommend the work as plain, practical, and rational—utterly devoid of mystification, without a trace of empi- ricism. The causes of disease are distinctly pointed out; the symptoms so vividly delineated that he who runs may read them; and the best treatment clearly and concisely unfolded. To consumptive patients and consumptive families this little volume is a treasure; and how many such patients and families there are in England, let the Registrar- General and the Bills of Mortality bear witness."— Cambridge Advertiser. " This is a very well-written treatise on that horrible plague-spot of our climate, consumption. The advice given is excellent—the treat- ment rational, and there is good encouragement held out that by a judicious use of the remedies prescribed, life may be much lengthened, even in bad cases, though the disorder itself may not be eradicated."— Hampshire Advertiser. " In the production of this little work, Dr. Yeoman has conferred a boon on society : without overloading his pages with those technicalities which would render it unintelligible to the non-professional reader, he places the insidious malady on which he treats in a plain, tangible form before us, and enables the most unacquainted with medic* 1 matters, to become familiar with its causes, its symptoms, and lucidly exhibits its remedy. This work we would recommend to the attention of our readers."— Waterford Mail. " This book will be found specially useful to those who wish to avoid the common disease of consumption. Besides being scientifically written, it is popularly written, and will be extensively circulated."- Glasgow Examiner. " This is a sensible and unpretending little brochure. The symptoms, the progress, and treatment of the disease, are ably and familiarly de- scribed, and the prescriptions given are expressed in plain English, an improvement we hope some day to find universally adopted.-'-Z-ancos- ter Gazette. ..______his treatment is of the safe kind. The volume is popular and plainly*written."—Spectator. « There is much to be learned from Dr. Yeoman's work that must be of service to the afli.ctcd and their fri^r.V2>ftu-UOtpt-H^dm-d. VALUABLE BOOKS! JAMES MUNROE AND COMPANY, PUBLISH THE FOLLOWING : NOTES ON CUBA*—Containing an Account of its Discovery and Early History, a Description of the Face of the Country, its Population, Resources, and Wealth ; its Institutions, and the Manners and Customs of its Inhabitants, with Directions to Travelers visiting the Island. By a Physician. One vol., 12mo., 360 pp., cloth. $1.00. " A well-written, carefully-printed, and instructive book, by a physi- cian. No invalid who seeks the blissful climate of Cuba should leave home without this best of all guides and counselors. We are delighted with the valuable contribution which he has made to history, as well as with the intelligence and good judgment he evinces as a physician."— Boston Medical Journal. WYMAN ON VENTILATION__A Practical Treatise on Ventilation. By Morrell Wyman, M. D. 82 Cuts. 12mo. 436 pp. " This will be found a very useful book on a subject intimately con- nected with comfort and health."—Examiner. THE SICK CHAMBER,—A Manual for Nurses. 18mo. Cloth. 25c. " A small but sensible and useful treatise, which might be fittingly entitled the Sick Room Manual. It is a brief outline of the necessary cares and precautions which the chamber of an invalid requires, but which even quick-sighted affection does not always divine."—Atlas. " It is not a medical treatise, but a practical instruction-book for the performance of the common offices of a sick-chamber."— Courant. PARKMAN'S OFFERING OF SYMPATHY.—Offering of Sympa- thy to the Afflicted; especially to Parents bereaved of their Children. Being a Collection from Manuscripts never before published. With an Appendix of Extracts. Third Edition. 18mo. Cloth. 63c. " Though small, it is rich in comfort and instruction."—Miscellany. " It has carried comfort to many a heart. We wish it well on its errand of peace."—Christian Examiner. CONSOLATIO,—or Comfort for the Afflicted, tWth a Pre- face and Notes, by the Rev. P. H. Greenleaf, M. A. One vol. 16mo. pp. 264. 63 cents. CATARRH, INFLUENZA, BRONCHITIS, and ASTHMA ;- their Causes, Symptoms, and Rational Treatment. By. Dr. Yeoman. 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