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CONSUMPTION.
BY
HEJSTKY G. DAVIS, JVL I).
      NEW YORK:-
PRINTED BY C. A. ALVORD,
   15 YANDEWATER STREET.
       18fifl.
 
 
To  ^Jfrte+^^Zl........../aL.».........2a~^<e&-x>
        Dear Sir:—
  Accompanying this, you will find a paper prepared for a
work upon " Mechanical or Conservative Surgery," now in
the hands  of the printer.
  The facts there presented are of importance to any com-
munity.   It is for the purpose of engaging your influence
and co-operation in establishing  an  hospital for the treat-
ment  of those suffering from pulmonary consumption that
I address you.
  If, after an examination  of the article to which this note
refers, you are favorably impressed, have the kindness to
present  it  to your benevolent friends.  The success of va-
rious  institutions for ameliorating the  condition and the
sufferings of humanity, leads me to hope for your influence
in organizing a  charity which is very urgently demanded,
and which could not fail of being of the first importance in
this community.  The thousands that are  suffering from
this disease call imperiously upon the benevolent to aid in
every effort that promises them relief.
      Very respectfully yours,
              HENRY  G.  DAVIS,  M. D./
54 East Twenty-third St&eet^^
                        New Yobk!
.4 It" 
<                    v 
4^™%^
            PHTHISiITTOIMSNALIS.

   It is with some hesitation that Ave attempt giving our
views  of this disease.   This arises, not from any want of
confidence in the principles upon which we base the treat-
ment,  or in  the  results that follow; these  rest upon an
experience of many years, and are not to be readily shaken.
It is rather because we are  aware that any innovator in our
profession is looked upon Avith distrust; he is considered a
fit mark for all his brethren to bestow that class of feelings
upon of Avhich they are not lavish toward their friends.
He is exposed to all the  fault-findings of  all the fault-
finders in the profession.   An honest criticism, from a
seeker after truth, should be courted, and no  lover of truth
would object to it; it is, in  fact, for the accomplishment of
the same purpose sought by "the criticised; with such labor-
ers we would cheerfully co-operate.
   There is, perhaps, no disease which  claims its victims
from  our  households, in which the public are so ready to
catch at any course of treatment which promises success,
as in the one under consideration.   There  is  scarcely a
family, but has some member or some friend who is a  sub-
ject of painful solicitude on account of the premonitory
symptoms, or the actual access of this disease.   Yet,  if a
member of the profession advances  new opinions, particu-
larly if they  take a more favorable view of its amenability
to treatment, they are not only  discredited, but the author
is looked upon with suspicion, his motives are questioned,
and there is a lurking mistrust that it is but a bait to catch
those who are hoping against hope.
   On the other hand, a man may write  volumes upon the
subject, with the full  approbation  of the profession,  and
with  credit  to himself, provided his  efforts extend no
further than endeavors to illuminate the old, the venerable
path our fathers trod.  Why is this ?  Not because medical
men are of all men  the most obtuse, as well as the most
obstinate, or that they are not as desirous of curing this dis- 
4
  ease as the patient or his friends, but because they feel and
  are convinced that, when this disease  has once taken pos-
  session, it goes not out until the spark of life goes with it.
    The radical change which has been effected by our inves-
  tigations in the treatment of diseases of the joints—a class
  of cases that formerly ranked with  the profession next to
  phthisis, as to curability, also a similar change  in the treat-
  ment of deformities, as well as  other  affections that come
  within the province of surgery—necessarily impairs our con-
  fidence in the perfection of our science, and compels us to
  believe that much which is at present received as truth, will
  be found in the future, at least open  to criticism.  It is  one
  step in advance toward perceiving the necessity of seeking
  for more knowledge  upon a subject,  when we doubt  the
  present received opinions, and it is  a good mode  of in-
  vestigating any  disease, but particularly one within  the
  domain of surgery, to enter upon its study as  though this
  were the first case of the kind', without even a  reference to
  books or opinions.
    Let me not be understood as discarding or undervaluing
  the literature or the labors of our profession.  Far from it:
  we would  simply endeavor to make  every man  an inde-
  pendent thinker and investigator.  We would  also suggest
  that jevery man, after he has read all within his reach upon
  any disease, and  has thoroughly digested it, use this know-
  ledge to aid him in his investigations, not to decide his
  opinions.  There will necessarily be many things that we
  must  take  upon trust,  as no one can examine minutely
•  upon all points.
    We would  discourage the habit in  our profession of
  taking so much upon  trust.    Let  no  one  receive  the
  opinions of  others as decisive upon  phenomena that are
  before him, unless, after close examination, he is unable to
  form  an  opinion, or his conclusions  agree with those of
  others.  Every man should be able  to give  a reason for his
  opinions, rather  than an authority.
    Before entering upon the discussion of the subject, there
  are several considerations that should be thoroughly exam-
  ined. 
5
  It may at first appear incongruous to bring forward, in
a work devoted to " mechanical surgery," a subject Avhich
has  heretofore been  considered  exclusively Avithin  the
domain of physic; but we trust it  will be discovered in
the sequel that  this view is erroneous; that our  best and
most reliable resources for the cure of this disease  are to be
found under  the head of mechanical remedies.
  It has been for some time a well-settled opinion, that a
low  state of the  vital  energies is  that condition  of  the
system most favorable for the development of tubercle.   It
is also an established fact, though one not so well known as
the  former,  that, other things  being  equal, an animal
digests  and  assimilates food  just  in proportion  to  the
Quantity  of  air he respires.  .If these propositions  are
admitted, then  it  follows  that if  we  have diminished
respiration, wi must have diminished assimilation, conse-
quently  a condition of the vital  powers favorable to the
development of tubercle.   Again, if a depressed state of
the powers of life favors the formation of tubercle, it fol-
lows that an  exalted state of vitality becomes a serious, if
not a fatal, obstacle to their development, and, if they  are
present, it not only prevents their degeneration, but actually
necessitates their absorption.
   From the foregoing conclusions, it is evident that much
of our  reliance  for  means of  counteracting or  curing
phthisis  must be upon a large  amount of air-cells or lung.
and, what is  of  equal importance, an  ability to use them.
Air-cells  are  of  no use in the animal economy unless they
perform their functions; if they are collapsed, or confined
in a cavity so small that only a fractional portion of them
can  be brought  into healthy exercise, then they are of no
more consideration for  the  function of respiration than so
much muscle.
   The Creator has given  us (and undoubtedly for a wise
purpose) two lungs; these he has subdivided into lobes ; an
injury of one  side of the  chest, a  punctured wound  for
instance, does not affect or impair the function of the other,
but life can be sustained with one lung only. We infer from
the fact  that one lung is separated from the other, that the 
6
 Almighty designed either lung to be of itself sufficient to
 support life under such accidental circumstances.  We see
 in other instances, where  organs are  double, that either
 can  perform all  the functions  usually  effected by both
 when acting together.  This is true of the eye, the ear, the
 brain, &c, &c.; therefore Ave  cannot avoid the conclusion
 that, with a well-developed chest, man has twice the volume
 of lungs necessary to support life.
   This is frequently demonstrated in  the case of punctured
 wounds of the chest, and, in some  instances, where the
 use of one lung has been destroyed by  disease.
   We  haATe mentioned,  as  a well-established  fact, that
 diminished vitality renders the system susceptible and pre-
 disposes to the development of tubercle; we would add that
 it also encourages and aids the ulcerative process.  If this
 proposition is granted, we must at the same time admit its
 converse.
   We  have also  stated  that, other things being equal,
 animals digest and assimilate  food in proportion to  their
 respiration.
   We have shown that the Creator has  given man, for spe-
 cial reasons, duplicate lungs, or double the amount of  air
 cells  necessary to  sustain life, provided the  cavities  or
 laboratories in which they do their work are of such ample
 dimensions  that they are not hindered or interrupted in
 accomplishing results equal to their full capacity.
   If these propositions are correct, we perceive no element
 in the foundation,  no reason to prevent  our asserting that
 we have a sure and broad oasis upon  which to build hopes
 of the curability of phthisis.
   It noAv remains  to  be  considered Avhether the  cavity of
 the chest can be enlarged  to the requisite dimensions; and
 if so, will the lungs be enlarged,  or the air-cells expanded
 or multiplied in proportion, or sufficiently so to fill it?
   In another place Ave have demonstrated how, and under
what  circumstances, the soft tissues can be elongated  to
any reasonable length ; therefore, if the  diminished size  of
the chest is dependent upon this cause, we have entirely
 within our control the means of remedying it. 
7
  As a general description, the chest may be said to be
the space enclosed by the ribs and  their coverings, the
sternum, and the diaphragm.  The  ribs unite with the
spinal column by an articular surface, a point from which
motion extends  through their whole length.   The first or
upper one stands nearly at a right angle Avith the »pine
and admits of but slight motion ; below this they gradually
increase in length, while at the same time they turn down-
ward more and more, bringing their sternal ends together
with that bone (to which a portion of them are directly
attached), near to the spinal  column, when  the  air is ex-
pelled from  the  lungs; at  the same time the diaphragm
which is attached to the margin of the lower ribs is thrust
up  by the  contents  of the  abdominal cavity, they being
compressed  by the contraction of the abdominal muscles.
  In  this condition we have the cavity of the chest reduced
to its smallest capacity, consequently most of the air is ex-
pelled from the lungs, leaving the air-cells  in a collapsed
state.  To enlarge the cavity of  the chest  and thereby
allow the air to  inflate the lungs, the muscles contract,
drawing upward the free end of the ribs (the other being
articulated  with  the spinal column), while  at the same
time  each rib rotates upon its ends,  forcing the sternum
farther from the spine, thus increasing the cavity inclosed
by  them.   During this  movement of the  ribs,  the  dia-
phragm contracts, bringing its fibers straight and increasing
the cavity yet more, by lowering its base.  This is, briefly,
the mechanical process by which a vacuum is produced in
the chest, the only entrance to which is through the trachea
and bronchea to* the lungs.   The lungs lying pendant in
this cavity, the air rushes in to fill the  vacuum, and inflates
them  to the  capacity of the chest.   All this is, in one sense,
simply a mechanical operation, similar to the production
of a vacuum in a pair of bellows or an air-pump.
  We have thus  explained respiration as  a mechanical
process, that the  reader may  the more readily  see  and
appreciate the necessity of a large  chest  (or cavity), in
order that an individual may respire a large amount of
air.   This cavity is as essential to. a  full inspiration as a 
                           8

large volume  of  lungs,  for  the latter  can accomplish
nothing  unless the cavity that contains them will admit
of their full expansion.
   But this is not all—there  is another consideration of
equal importance.   A  man may possess a large chest,
naturally,  taking  its  external  dimensions,  and  yet be
able to  inhale but  a small quantity of air.  His  chest
resembles a large  pair of bellows, with  the  handles  con-
fined so as to permit them  to open  but  a short distance.
It must  be remembered that  the amount of air respired
depends upon the vacuum produced at each inspiration, so
that it is evident, we may possess a large chest and yet not
be able  to  inhale as much air as a person  with a chest
smaller, yet admitting of free expansion.  This fact should
not be lost sight of, as it accounts  for some persons suc-
cumbing to phthisis who  are  said originally to have pos-
sessed large chests.
   A large  chest, from long disuse  of its fxdl power of  •
expansion, may he so confined by  a shortening of  its liga-
ments, muscles,  and other soft tissues^ that  it cannot be
expanded to any thing near  its full extent.
   This  is in accordance with a  law we have elsewhere
explained; it will be seen  by this,  that  a man, who by
nature is furnished Avith a large respiratory apparatus, can,
by only a partial use of it, gradually bring it down to the
smallest compass, a point even below that of a small chest
which can be fully expanded.  This is  another and impor-
tant element to be taken into consideration in the treat-
ment of  phthisis.  We  must possess relatively not only a
large chest and a large volume of lungs, but they should
be kept in a condition in which they can be expanded to
their fullest capacity.
  From what has been said, it is evident that the best and
most effectual method of enlarging the chest, and  thereby
the lungs, becomes a consideration of the  highest impor-'
tance.  The processes that  have been recommended for
this purpose are innumerable, and as varied as their in-
ventors.  The principle upon which we  propose to effect
it was published in the American Medical Monthly, March, 
9
1858, and is based upon the physiological  and anatomical
conditions involved in the  act of respiration.   It will  be
remembered  that  respiration is an  involuntary act;  it is
performed  and governed by nerves  and muscles that are
without our control;  an animal cannot destroy his life  by
simply refraining from breathing, however strong his will
or determined his resolution; there  comes a time beyond
which he cannot prevent the act of respiration, whatever
may be his efforts to the contrary;  therefore we say that
it is without  his control.
  We caution the reader to  keep this fact in mind, for it
has a decided bearing in devising plans for enlarging the
chest and  increasing the volume of lungs.  It is evident
that, if respiration be an involuntary act, we must, in what-
ever we do, conform to the laws that govern it; our volun-
tary efforts to increase the  amount  of air  respired should
conform to the laws that  govern the involuntary act, or
there comes a strife, a clashing of effort, between the  two;
but the latter is sure to be victorious, and, like most victors
it suffers more or less exhaustion by the struggle.  To test
this, let any one force himself to breathe at  a different order
of time from what is natural for him at the  time of the
experiment—no matter whether it is faster or slower than
is the standard for him.  He will find, after a few respira-
tions, that the process is not an harmonious one ; that there
is a conflict of effort, and this conflict exhausts him.  As
we are aiming, in our treatment of this disease, to increase
the vital powers, we  should avoid any process by which
the individual is prostrated ; although he may have taken
in more air than usual, and although he has been successful
in increasing the respiration, he has  done it at the expense
of  a loss of vitality,  rather than  a gain.  The  plan  of
drawing a full  inspiration, retaining it, and by its rarifica-
tion expanding the air-cells, is not only open to the objec-
tion that it interferes and exhausts, but the person is, as it
were, without the  benefit of air during the time the  air is
retained in the lungs beyond the usual time of an involuntary
respiration, as  air will take up but such a proportion of
carbon, however long it may be retained.  The breathing 
10
through a  tube, where the aperture is smaller than  the
orifice of  the larynx, thereby  obliging  the person to
make an extra muscular  effort, has the same objection.
Inhaling through a tube, in which  the inspiration is free,
but where  the expiration is obstructed by a valve, is sup-
posed to enlarge the lungs, by forcing the air into every
air-cell by  the violent efforts in compressing the chest to
expel the air.  By these plans, the  air is retained beyond
its capacity for effecting any healthful change in the blood;
beside, it interferes with the natural time for inspiring and
expiring, which interference, we have shown, fatigues and
exhausts.
  Passing by many other plans of this character, for de-
veloping the chest, all of which are open to the same objec-
tions, we come to what are termed gymnastic exercises, for
this purpose.  Before entering upon an examination of these,
we will review, so far as is necessary to elucidate our plan,
the anatomy of the muscles, &c, connected with the act of
respiration  in these exercises.   All the muscles that go to
the arm  are muscles  that are brought-more  or less into
use during voluntary  respiration;  they arise from  the
ribs or parts adjacent, and, when used in voluntary respira-
tion, contract from the shoulder, this being held by  muscles
that pass from it to the neck.   The  clavicle, like  a sweep,
holds the head of the humerus away from the chest, while
the cervical muscles draw it upward.  In this position the
muscles going to the arm  contract, and draw the  ribs up-
ward, as in  the act of involuntary inspiration.   When
the shoulder is the fixed point during the contraction of
these muscles, the chest is free, and can be  enlarged to the
full extent  the ligaments will admit.
  We have  said,  that  during this process  of muscular
action, the  ribs are at liberty, and can be acted upon to
enlarge the cavity of the chest; but suppose a man attempts
to raise fifty pounds in each hand above his head, can he do
it and leave his ribs free, or will he be compelled, in order
to make the effort, to draw  in his  breath and  retain  it,
thereby giving his ribs a support from the air inside, while
the muscles of involuntary respiration hold them firmly in 
11
 this  position ?  Let any one who is  in doubt test it by
 making the experiment.  What is true in  this act  is true,
 in a degree,  of every other, where these muscles act upon
 the arm, moving it in any direction.   In all such motions,
 the chest is more or less firmly fixed.  When  they  are
 slight, requiring but a small amount  of muscular  power,
 they may be effected without any perceptible confinement;
 but always Avhen the effort comes in any degree  near  the
 whole muscular power, the chest  must be  fixed, as  a point
 from Avhich these muscles can act.   We see  the effect of
 this fixing of the chest,  in a man who attempts to expend
 his entire strength in lifting a heavy body, by the deepened
 color of the face,  caused by holding his breath.  The man
 splitting wood often holds his breath until he has expended
 his effort, when, in consequence of having  retained  the air
 in the lungs beyond the regular time allotted by the invol-
 untary nerves and muscles, he expels it suddenly, and not
 unfrequently audibly.
   All the muscles that go  to the arm have  two sets of
 nerves of motion.  When the arm is to be moved, the chest
 is held motionless, while the muscles contract, drawing the
 arm toward the body.   The chest is the fixed  point from
 which the muscle  contracts, but when these  muscles are
 called upon to contract in  the opposite direction, then the
 shoulder is the fixed point, and the chest is left free to  be
 moved by the muscles,
   We have endeavored, by repeating this two-fold  action
 of these muscles and the condition of the  parts to  which
 they are attached during each of these  processes, to fix it
 in the mind of the reader, that he may not lose sight of it
 when we come to use these facts  in showing  the true  or
 philosophical method of developing the chest.
  We are now prepared to make the inquiry, how can the
chest be enlarged by any of those  exercises,  where the arm
moves as it does in practicing with the dumb-bells, the club,
or in rowing, pulling up weights, &c, etc., movements  in
which the chest is  more or less firmly fixed, and therefore
cannot be enlarged while so held.   An effort, to be effectual
in enlarging the chest, must take  place when its walls are 
12
unrestrained, when the power exerted will be expended
upon it, while it is not trammeled by the contractions of
any muscles that counteract its enlargement.  This can be
effected whenever  we make the hands the fixed point, and
draw  the body toward them; the same effect upon the
chest takes place also when the body is simply suspended
by the arms.
  In these positions, the weight  of the body is suspended
by the pectoral muscles,, these  acting upon the ribs, as in
voluntary  inspiration, drawing them up  to  the fullest
extent  their ligaments and other soft tissues will admit, and
this without  the fatigue or exhaustion  consequent upon
voluntary inspirations.   A particular consideration in this
process is, that it  does not interfere in any Avay with the
natural involuntary respiration ; this goes on, as usual,
without that interruption in time, or sense of fatigue expe-
rienced when the  chest is expanded by a voluntary effort.
By this process there is just as much  more air enters  and
escapes from  the lungs than during ordinary respiration, as
the cavity of the  chest will hold when  enlarged  by the
entire  weight of the body.  The only expenditure  of nerve
or muscular force  is through the hands, in holding upon
the bar.   To give  some idea of the increase in  the amount
of air  respired under this process, we will give the experi-
ments of a committee appointed by the British Association,
of London, to report upon the  best method of restoring
asphyxiated persons.  In this report, made in 1862, the plan
fs called Dr. Sylvester's, but it is the same mode of expand-
ing the  chest  we published  in the American  Medical
Monthly, of this city, in March, 1858, and reprinted in a
pamphlet form, it will  be  observed, over four years before
this report.  Dr. Sanderson, another  member of the com-
mittee, constructed  an  instrument  for measuring the
amount of air entering the lungs during their experiments
upon the daad subject.  By Dr. M. Hall's  " ready method,"
the quantity  of air moved  in and out of the lungs rarely
reached  nine cubic  inches, and never  exceeded fifteen ;
whereas,  by  the plan  we proposed  in March. 1858, pub-
lished in the  American Medical Monthly, of this city, viz., 
13
by making use of the arms to expand the chest, the quan-
tity reached  as high as fifty cubic inches, five and a half
times as much as by Marshall Hall's plan.  We think the
most  skeptical must be convinced that this  was a large
amount of air to introduce into the lungs of a dead sub-
ject by any process at  all simulating natural respiration,
and at the same time it must be evident, if this same force
is applied to the living  subject, and does  not  interfere in
any way with the ordinary involuntary respiration, it must
increase, to a very great extent, the amount of air respired
—a  difference, in  most cases,  as great as between that
during disease and that quantity sufficient for the enjoy-
ment of the most perfect health.
  We have  introduced  the results of this experiment to
show the effect of  this  mode of acting upon the chest to
enlarge it.   It is  as though every fiber of muscle was a
fine thread attached to the ribs through their length,  and
the draft upon them made in the direction and in the manner
best calculated to bring them  upward  and outward, as in
the  act of inspiration, thus enlarging the eavity of  the
chest  to the' extent that the weight of the body would,
were it suspended over  a pulley to these threads (muscular
fibers).  It should  be remembered that this is in addition
to the ordinary respiration; the  function of involuntary
respiration goes on the same as though the ribs were not
raised by this great weight.  As we have shown, this non-
interference  Avith  the  natural inspiration  is one of the
essential requisites to any plan for developing  the lungs,
and that any other mode fatigues and exhausts the system.
  Exercise during phthisis has been objected to by some
 authors, from a fear of exciting the  action of  the  heart,
and that, through this increased frequency, the lungs would
become congested, and  the  liability to  hemorrhage in-
creased.   By  this plan of ours, the whole  process is
changed.  In the first place, the action of the heart is not
materially accelerated; in the next place, the  volume of
lungs is very much enlarged to receive the blood, so  that
probably the pressure  upon them is less  than when not
under the extension.   Again, the action  of  the heart is 
14
rendered  easier,  inasmuch as the  blood,  as  well  as air,
rushes into the lungs to fill the vacuum.
  Instead, therefore, of its predisposing  to.hemorrhage, it
actually prevents it.  We see by this that not only the
respiration is benefited by this process, but the circulation
is made easier.  It acts to increase  the vigor of the heart,
as a tonic whose primary effect is upon the circulation, or
rather, it renders the labor of the heart less by diminishing
the resistance.
  The effect of this  mode of expanding the chest  is Avell
illustrated by those subject  to  asthma.  Most of those
habitually subject to it have discovered  that  if they lean
the head forward, resting  it upon the hands on the  back
of  a chair,  leaving  the chest suspended by the pectoral
muscles, they can breathe much easier, and obtain, in this
position, refreshing sleep.  This  relief is due  entirely to
the enlargement of  the chest, by its weight hanging sus-
pended by the pectoral muscles.   If the position is changed,
the respiration is impeded.  It should be distinctly under-
stood that this process of enlarging the chest by suspension
from the arms calls for but a small  outlay of nerve force ;
there are  contractions only of the muscles of the hand, in
holding on to the bar; beyond this, the weight of the body
hangs upon the ligaments and muscles; even the contraction
of the muscles of the hand we have often in a measure ob-
viated, in  persons that were very weak, by securing a band
or handkerchief around the bar as close as the hand can be
forced  through it; this  comes down upon the wrist;  then
the hand is placed upon the bar as before, yet without the
effort to hold as when without the band around the wrist,
the latter  sustaining  most of the weight.
  It will be perceived that this  plan gives the patient the
benefit of full, free, and deep inspirations, Avith but a slight
increase of nerve power, or exhaustion from the process ;
and the exercises can be continued for a number of minutes
in succession, and then a short respite.  There is a larger
amount of air taken into the lungs at each inspiration than
can possibly be done by the  ordinary  effort  of voluntary
inspiration. 
15
  If the patient feels equal to the task, the voluntary effort
can be  superadded.   This can be  done occasionally, but
we should not advise its frequent repetition, particularly in
the case of feeble subjects.  It will scarcely  be necessary
to remind the reader that the air is forced into this vacuum
by the weight of the atmosphere, which is computed to be
fifteen pounds to the square inch, a force sufficient to open
every permeable air cell to its full capacity.   The  imme-
diate effect of this plan of increasing the amount of respi-
ratory poAver is, that the individual takes from  one  to two
hundred per cent,  more air into the lungs without any in-
terruption  of the frequency, and  without any sense  of
fatigue, except in the arms; and this more a feeling of ex-
treme extension of the soft parts, than that of exhaustion.
Were the only advantage derived, that from an increased
respiration for one-half or even one-quarter of  the time, it
would be invaluable to a person dying, in consequence of
the respiration being diminished below  the  necessities of
the system.   But this is but a part of the benefit, and that
of a temporary character.
  This process should be continued until the chest  has
become permanently enlarged, and the lungs have  devel-
oped  until they fill  this  capacious cavity.   This is done
on the  principle we have elsewhere explained, viz.:  that
the soft tissues elongate by the addition of new material,
when they  are  retained  in a tense state.  This condition
stimulates the  nutrient  vessels, and the growth is much
more rapid than would be supposed.  Again, this exercise
increases the power of the muscles of respiration.   We stated
in the commencement of this article that the power of di-
gesting food and assimilating  it was in proportion  to the
quantity of  air respired,  other things being equal.  Can
we  expect a patient to increase the quantity of food taken,
one or two hundred per cent., the proportion we have given
as the ratio of increase in the  respiration, by this process %
And can we expect them to increase in flesh and strength
accordingly ?  We  hesitate giving the results we have seen,
because they are too startling  to be believed by the  profes-
sion or public, with their present views of the incurability 
16
 of this disease.  We have known a lady, feeble from dis-
 ease of the lungs, gain ten pounds in weight in two Aveeks •
 and this was not a mere evanescent gain,  but it continued
 until she had increased in weight  twenty-eight pounds.
 This improvement was not confined to an increase of flesh
 merely; the muscular power, and the vitality of the  whole
 system, was increased in proportion.   This is not the result
 in a single case only, but is a general law.   The result fol-
 lows as certainly as the result follows any other law  of the
 animal economy.  We can rely upon it with as much con-
 fidence, and with as little fear of disappointment.
  The profession will not mistake us.  They will not sup-
 pose that, when the mesenteric glands are diseased so as to
 cut off all reception of nourishment from the  alimentary
 canal, we expect, by increasing the respiration,  the patient
 will gain flesh.  We stated that, other things being equal,
 this result would follow.
  Dr. M'Cormac, of Belfast, Ireland, in his work on Con-
 sumption, says  "tuberculous  scrofulous  deposits,  then,
whether in the offspring of scrofulous consumptive parents,
 or the offspring of persons free from scrofulous, tuberculous
 disease, are alike; and in every case, owing to the  insuf-
ficient, imperfect performance of the respiratory function,
 the carbon is retained—in other words, it is not  discharged
 or sufficiently discharged from the blood in the lungs, and,
 finding  no adequate outlet by the liver, skin, or other pos-
 sible emunctories, being neither burnt oft*  in  the  lungs,
nor expended in the tissues, is deposited, mainly as a hydro-
 carbon,  in the lungs and other organs, under the form of
 the bodies known by the designation of tubercles."
  He attributes this imperfect decarbonization of the blood
 to the impurity of the air we breathe in our places of busi-
 ness and pleasure, but more particularly  in our ill-venti-
 lated sleeping apartments.
  It is undoubtedly true that much impure air  is respired,
 and that the  consequences  are  as deleterious  as he sup-
 poses ; consequently the subject deserves our highest con-
 sideration as a matter of hygiene.  Yet  we  cannot  think
that all would  escape phthisis, even  should they  never 
17
breathe impure air, granting that Dr. M'Cormac's views
of the cause are correct.
  The  habits and employments of a large  proportion of
the community are  such, that they require but a small
amount of air to supply the wants of their system: the
student, the accountant, the vast majority of females, par-
ticularly those eonfined to the needle, persons of sedentary
habits, or those  afflicted with ennui, require but a small
amount of air to supply the needs of the system under such
circumstances;  their respiration  is slight, the  chest  is
seldom if ever expanded to its full capacity; it is limited,
day  after  day  and  month  after month, to  this  semi-
developed state,  and the consequence  is, that the  chest
follows that law of the animal economy which limits the
nourishment of a part to its uses.   If a ligament, ordinarily
three inches in  length, be limited to a space between its
origin  and insertion of two inches, it will not be reproduced,
in the  ordinary  process of nourishment, to any greater
length  than the duty it has to  perform demands.   The
thorax is no exception to this law; if the ribs remain con-
fined for months to a motion of half  their capacity, the
muscles and ligaments conform to this altered condition ;
the result is, the chest cannot be  expanded to the extent
designed, but only to that within the limits to which it has
been confined.   As we have before stated, the lungs  con-
form to the cavity in which they are located, or in  other
words, they conform to the amount of labor they are called
upon to perform.  When the thorax has long remained in
this contracted state, one in which there is just sufficient
volume of lungs to support life, while -ho increased demand
is made upon them beyond ordinary respiration,  the indi-
vidual may enjoy good health, but limited to this scale of
labor;  under these conditions, should he be  exposed to im-
pure air, or should any difficulty with the lungsoccur, then
the system must suffer just in proportion as the lungs fail of
performing their office.  It would immediately be below the
point of sustaining itself, and must, of necessity, sink underit.
   The full development of the  chest,  by the means we
have proposed, provides against such contingencies.
   If the capacity of the thorax has been increased to that
          2 
18
extent that it contains a volume of lungs capable of per-
forming double  the  service ordinarily required of them,
then the extra quantity  of air inhaled will be sufficient,
when the individual is placed in an impure atmosphere, to
furnish an amount of oxygen equal to the demands  of the
system; while in the other case, with a Arolume of lungs
barely sufficient  to supply  the wants  of the system when
only a pure air is breathed, if placed in an unfavorable
atmosphere, the  body must necessarily  yield  under the
deleterious influences of imperfectly aerated blood.   Large
lungs can be partially inflated and thus perform a small
amount of labor, but a  contracted  chest  and a limited
quantity of lungs cannot supply the  place of the former,
when called upon  for increased service by the demands of
the system.  There is, however, an effort made to accom-
plish, this by increasing the frequency of the  respiration,
as the capacity of the lungs diminishes.
  This view of respiration deserves and demands from the
profession a more careful consideration than it has hereto-
fore received.
  Without a large chest and a corresponding volume of
lungs, all our medication in phthisis will be but palliative;
but when we, by proper training, develop in our youth the
full capacity of the respiratory apparatus, then the system
will be in a condition to respond, and Ave may anticipate
with confidence the most happy results whenever medica-
tion becomes necessary.
   As we  stated at the commencement of this chapter, a
diminished vitality favors  tubercular development, there-
fore this  condition should immediately receive the atten-
tion of the physician.  Medicines that increase the appetite
and the power to assimilate food are to be administered; but
there will be found no drug to equal, for this purpose, the
 exercise we have been recommending.   Avoid in phthisis
 all that class of articles termed expectorants; they not only
 increase the secretions, but they diminish the appetite.
   The nit. argente, in combination with some extract, par-
 ticularly  the  ext. nux  vom., will be found  to  diminish
 the secretion, increase the  appetite, and, if night sweats are
 present, this preparation will check  them.  It is not un- 
19
frequently the case that persons with hectic fever will not
tolerate tonics.   If, however, they are conjoined with some
form of opium, they will not disturb the system.   Let me
advise the practitioner to make  the cough a secondary
consideration.  In so far as possible, treat the local disease
of the lungs as though the same state of parts were upon
the surface of the body.  Who would ever suggest the
giving of expectorants in the case of an ill-conditioned ulcer
upon  the surface ?  Put the system  in the best possible
condition to  counteract  this destructive tendency, and it
will be found that the lungs will be amenable to the same
law that governs superficial ulceration.  When the chest
is fully developed, if a sufficient amount of air-cells remain
healthyj and the power of assimilation is at a healthy stand-
ard, then the  ulceration of  the  lungs—like any super-
ficial  ulceration—will heal.  There is no greater  difficulty
in healing a cavity in the lungs than one in  a  muscle, or
in any other part, except that chronic diseases of the lungs
occur in vitiated conditions of the system.  Therefore, if
we would heal  a cavity in the  lungs, we must bring the
system to a healthy standard, and, as has before been stated,
our chief dependence is upon  developing the chest, and
thereby  the  amount  of  healthy air-cells.  This  increases
the power of assimilation, so that it is only the minor dif-
ficulties that we have to attend to, after the patient is put
upon  a system of exercise.
  This exercise is not to be a pastime—an  occasional re-
creation—a matter of amusement; but a labor, into which
all the energies are thrown—labor and effort, such as a man
makes when his life is in immediate danger.  It should not
be  relinquished when a little  weary;  but  the  energies
should be goaded to the last extremity.  This applies more
particularly to feeble  persons, when.they  first commence
the exercise;  as they advance, it becomes  easier.   The
more  feeble the patient, the more urgent the need  of the
advantages to be derived from  it.   The practitioner must
enjoin it upon  the friends to encourage the patient by
every means in their power to make the effort.  We often
find the mistaken kindness  of friends a greater obstacle to
overcome than the indisposition of the patient.  The latter 
20
generally experiences so much relief to the breathing while
exercising, that they are disposed to  renew it frequently *,
while the friends are apt to think they " should rest  more,
that it is too laborious," &c.  It is best to be governed by
the clock—so many minutes to rest, and so  many minutes
to exercise.   At first, if the patient is feeble, place him in
a warm room, under the swing, on a high chair, so as to
save, as much as possible, the labor of rising.  As he im-
proves, remove the swing to a cold room,—even in winter;
but the patient must not be idle  a moment, and should leave
for a warm room as soon as he is through exercising.
   The more feeble and exhausted the patient is by the
disease, the more urgent the necessity for effort.  He is in
the  condition of the man in the water—exhausted, yet
able, by words of encouragement, to hold out a little longer
until relief is  afforded!   The moments are as precious and
as pregnant with life or death in the one case  as in  the
other.   If the patient feels an  appetite for  food between
the hours of the regular meals,  it may be gratified; but
the palate should not be mistaken for the appetite, neither
should it be indulged at the expense of the  regular meals.
Patients are not unfrequently fed upon  dainties,  thereby
excluding substantial food.  In no  case should food be
allowed between meals, or dainties, such as fruit, &c, &c,
be furnished, if it detracts from  the appetite at the regular
periods for taking food.   These periods should  be punctu-
ally  observed, for  the reason that the gastric and  other
fluids will be secreted  at such times from habit, if the
period is preserved with regularity.
   It is not well to compel a patient always  to  eat a par-
ticular article of food, because certain articles are supposed
to contain a larger amount of nutriment  than others.   An
adult patient can eat whatever  the appetite craves, or he
feels will relish.  It is the appetite that is to be consulted,
and is to be the judge, and not the palate. A little wine with
the food often promotes digestion.
  The inquiry naturally arises, how much time  should be
spent in exercising ? or rather  it should  be, what propor
tion of the time should be occupied  in exercising ?   This
will depend,  at first,  upon  the strength of the  patient. 
21
The more feeble, of course the less time he can  exercise.
At first, for a fewr days, he may only be able to hold on to
the bar for one or two minutes; but it can be  renewed
again in five or ten minutes.  This time can be gradually
increased, and the interval proportionately shortened.
  Hitherto we have spoken of the treatment as applicable
only to confirmed phthisis.  It is always better to prevent
than to cure a disease, and in no instance  is this more
manifest than in the one under consideration. Every family
has, to a certain extent, within its power to guard against,
not only this, but all those diseases arising from diminished
vitality.   Every child  should  be made to exercise on this
principle, viz. :  making the  hands the fixed point, sus-
pending the body from  them;  under all circumstances
leaving the weight hanging upon the pectoral and other
muscles attached to the arm and scapula.  In this position,
the weight  of the body must  necessarily expand the chest
to the fullest extent its ligaments will permit, while at the
same time the ribs are not restrained by any of the muscles,
but are at liberty and  can be drawn  up,  as in the act of
voluntary respiration.  The  parts to  be affected by this
exercise can be so, much more rapidly in the young subject
than in the middle-aged, inasmuch as the growth is much
more rapid in youth.  Yet age is not a fatal barrier to the
good  effects of the treatment.
  The question may very naturally be asked, What pro-
portion of the ordinary cases  of phthisis we should expect
to cure or benefit by this mode of treatment ?
   The answer to this inquiry  depends upon the same con-
siderations that govern the results, when my mode of treat-
ment is adopted in joint-diseases.
   It was  formerly more general than at present;  but even
now  there are many in the profession who say that our
plan of treating joint-diseases is only applicable to  the last
stages, after a considerable amount of destruction has been
effected ;  or who will assert that, if the patient is not cured
by the process in a given number of months, he never will
be  cured  by it, &c,  &c.  All this interferes with  a result
that otherwise would  be attained.  We  say, if a  patient
with the  ordinary diseases of  joints is from the commence- 
22
ment treated by our plan of u continued elastic extension,"
he should recover with a good joint, provided the treatment
is continued,  together  with other appropriate remedies.
When this mode of treatment becomes appreciated by the
profession at its full value,  this result will follow.
  In like manner, when the treatment of phthisis we here
propose commences with the disease, and  is pursued unin-
terruptedly, we have every reason to expect that every case
Avill recover.  When the treatment is i sed as a prophylac-
tic, every case will be prevented.
  This may excite incredulity in the minds of most readers.
It is but a few years since the results in the treatment of
joint-diseases,  now known to be attainable, Avere looked
upon in the same light.
  If the reader will follow  the train  of reasoning  with
which we commenced this subject, we cannot see how  he
can fail to be convinced.
  We stated  that tubercular deposit was the result  of
diminished vitality (this term is used in its broadest sense);
that, other things being equal, persons digested  and assimi-
lated food in proportion to  their respiration ;  that the
Creator had given us (when the chest was developed to its
fullest capacity) double the  amount  of lung  or air-cells
necessary to support life; that the capacity of the chest
can be increased by exercise, and  that the  lungs  will en-
large correspondingly.   If these statements be true, how
can we  avoid  the  conclusion  that phthisis is  as much,
if not more, decidedly within our control than most other
diseases ?
   It is easy to give cases that corroborate any  theory, and
this has  made the profession very skeptical in regard to
new remedies or new theories.  We  can say we have as
strong testimony, drawn from our OAvn experience in the
treatment  of the disease, that phthisis is  curable, as  we
have  of  the  efficacy of our  treatment in diseases of the
 joints.  We have one  fact capable of being investigated,
that to our mind proves more than any array  of  cases, as
the diagnosis in them might be erroneous, however honest.
the examiner; but it would be incredible to assert that a
practitioner in general practice, in the center of New Eng- 
23-
land, where phthisis is so common, should not have had  a
case of phthisis in thirteen years.  Yet we can prove from the
records of the town and from living witnesses that for thir-
teen years we had not one case of phthisis, commencing and
terminating fatally, in the families upon which we attended,
  It is obvious to  our mind why this disease has been so
irremediable.   In  every case  of phthisis the causes have
been operating for months, perhaps years, that  eventually
culminate  in confirmed phthisis.    This is the  ordinary
course.   Sometimes it follows lung fever  or  some acute
disease, when this produces the effect suddenly.  The cause,
we  say,  has  been operating for months,  that  brings  the
person at last under the care of the physician.  On exami-
nation, he  finds not only tubercle, but tubercle softened,
or perhaps cavities.  Now, if the patient is cured of all the
disease that now exists, what does  it do for  the condition
that existed before the tubercular  development ?  Does it
remove the cause that brought the  patient  into that state
in which he required  treatment ?
  In ascites,  we can remove the fluid;  but  does that  save
the patient ?  Certainly not.   We  must go  back of these
results /  they but follow as a sequence of causes that have
long been in operation.  In cases  of phthisis, it  is gene-
rally a deficiency of useful air-cells ; and unless we bring
into use a sufficient number of these to fully .perform  this
function, so requisite to health, we  shall gain  but a tem-
porary advantage by medication.   By restoring a  full
supply of air-cells, we not  only  restore  this function, but
we increase the power of assimilation in the same propor-
tion.  By this we gain a double advantage.   The patient
should be encouraged by every means  within  our power
consistent with truth; yet if the case is to be speedily fatal,
the  fact should not be withheld  from  him.   Do not be
anxious to get your patient out to " take the  air," or to
"ride out to make him feel better."   The exercise  pro-
posed is worth more than all things else. The most ready
way of arranging the apparatus for exercising is to make
a triangle,  one of whose sides will  be formed by a wooden
bar of convenient size for the hands of the patient,  and
3£ or 4 feet long; the  rope that forms the other two sides of 
•24
the triangle to be secured at each  end of the bar, and
fastened to the ceiling  by its middle.  We have found a
hook made from ^-inch iron, with a coarse screAv cut upon
its shank, the  most convenient; this can be put in the tim-
ber overhead  without  marring  the  wall, and it  is not so
liable to be drawn out  as one that is driven into the wood
like a nail.  The higher the walls, the longer will be the
rope;  consequently the swing will admit of freer motion,
allowing a more general exercise to the body, as well as a
greater variety to the action of the muscles.   This may be
advantageous to one who has acquired considerable muscu-
lar strength; but at first, simple suspension from the bar
is all  that is  desirable.  It should never be lost sight of,
however, that the primary object is to enlarge the chest.
and not  to develop all of the muscles of the  body.   It is
generally sufficient for a man that he  possess a well-de-
veloped chest; other portions of the body will follow, as
his business or pleasure may demand.
  It is an absolute waste of time and material for the man
who labors exclusively  with  his  brain, to  spend not  only
his time, but a portion of his nutriment, in developing large
muscles; as all the nourishment that goes for this purpose
is%so much lost to the  brain.  A large chest enables the
literary man  to digest  and assimilate  a  good supply of
food; and as his  pursuits do not require a large arm or
leg, to cultivate them is to waste his  nutriment upon parts
that are subordinate in his vocation ; Avhile the brain—the
portion of the system with which he labors—is deprived of
just so much nutriment  as he expends upon  the muscles.
This  will be  understood as applying  to  the full use, in
either case, of all the nutriment supplied  the system.
  The views advanced in this chapter have been accumu-
lating for thirty years,  and the application of the  princi-
ples has  neiu-r faihd  of producing  results  more  or less
favorable.   Therefore we consider them based on  a sure
foundation.   It is difficult to make views that are mechani-
cal  in their application fully understood by the profession;
we  therefore entreat them to make full trial  of our plans
before they discard them—-even though the why and where-
fore may not be thoroughly  understood. 
 
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