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A PRACTICAL THEORY 
 
 ^.AND TREATMENT OF 
 
 PULMONARY TUBERCULOSIS. 
 
 BYj 
 
 FRANK S. PARSONS, M. D M 
 
 PHILADELPHIA. 
 
A PRACTICAL THEORY AND 
 TREATMENT OF PULMON- 
 ARY TUBERCULOSIS. 
 
 r 
 
 BY FRANK S. PARSONS, M. D., U\^ 
 
 PHILADELPHIA, PA. 
 Editor of " The Times and Register." 
 
 U- 
 
 'V 
 
 published by 
 
 The Medical Publishing Co., 
 
 No. 718 Betz Building, Philadelphia, Pa. 
 
To those physicians whose interest in Pul- 
 monary Tuberculosis is paramount and those 
 sufferers of this dreaded disease, who desire 
 relief and encouragement, this little volume 
 is affectionately dedicated. 
 
 718 Betz Building, January 28th, 1895. 
 
 LC Control Number 
 
 tmp96 028683 
 
INTRODUCTORY. 
 
 Is pulmonary tuberculosis curable? 
 Undoubtedly! When? At any time 
 before destructive changes have ad- 
 vanced to a point beyond which the 
 organism is incapable of sustaining 
 life; or, before the primary cause of 
 such changes in retrograde metamor- 
 phosis has become lost in the sec- 
 ondary pathological processes, which 
 of themselves, would advance the or- 
 ganism toward ultimate dissolution. 
 Of course, the curability of any dis- 
 ease, in a measure, depends upon an 
 intimate knowledge of its causation 
 and a rectifying of disturbed rela- 
 tions, and, in this, the physician must 
 have the hearty co-operation of his 
 patient. The latter is not always an 
 easy matter to bring about in tu- 
 berculosis, for persons afflicted with 
 this disease are prone to disbelieve 
 the diagnosis of the physician, in the 
 forlorn hope that he may be mis- 
 
4 
 taken, or that it is quite impossible 
 for them to become the victims of so 
 dangerous a malady. 
 
 It is not niy idea, in presenting 
 this paper before the profession, to 
 add to the general confusion, which 
 now reigns, regarding tuberculosis; 
 nor to attempt to laud any new meth- 
 ods above others in vogue; but, I be- 
 lieve, a clearer light may be thrown 
 upon the etiology and treatment of 
 this disease, based upon the suc- 
 cesses and failures of the past, and 
 the recognition of the primative con- 
 dition which leads to the develop- 
 ment of pulmonary tubercles. 
 
 Of one thing I am quite confident, 
 that is, we may search and search in 
 vain for the antidote, or specific 
 medication in tuberculosis, unless we 
 get off the track of the microbe, and 
 develop the cause for the underlying 
 condition, upon which the develop- 
 ment of all bacteria must depend. 
 
 We should be thankful for the 
 
6 
 work of the bacteriologist; the re- 
 searches of this class of men have 
 taught us much, although the germ 
 has been the uppermost theme, and 
 its products of toxines and toxalbu- 
 mens, as the misty clouds which ob- 
 scure the light of underlying pa- 
 thology, have given us doubtful ideas 
 regarding the etiology of disease. 
 We have lost sight of the chemical 
 composition of man, and the fact that 
 disease is only a chemical decompo- 
 sition, in the universal furor after a 
 specific germ, the phenomena of 
 which may be observed in various 
 media, in and outside the body. We 
 have been scientifically brought face 
 to face with that ancient but burn- 
 ing question as to w 7 hich was first, 
 the chicken or the egg? We are con- 
 scientiously taught that no disease 
 can develop except from its germ, 
 and that no germ can develop except 
 from its disease. 
 
 In view of the many vaunted 
 methods of treatment in cases of pul- 
 
monary tuberculosis, some of which 
 have certain values, others of which 
 are worse than useless, we may well 
 look deeper into the underlying phe- 
 nomena of this disease, and ascer- 
 tain, if possible, the primative 
 causes, the earlier symptoms, and 
 base on them the more radical treat- 
 ment. 
 
 In the first place, it is to be borne 
 in mind that no two cases of pul- 
 monary tuberculosis should receive 
 identical treatment, solely because 
 they are tubercular cases. Personal 
 idiosyncrasies must be taken into ac- 
 count, modes and circumstances of 
 life, the stage of the disease, and a 
 thousand minor details, which the 
 well-informed physician considers 
 and governs his treatment according 
 
CONCERNING THE ETIOLOGY OF 
 TUBERCULOSIS. 
 
 The developments from the experi- 
 mental inoculation of animals with 
 cultured tubercle bacilli, during the 
 past decade, have gone so far that 
 the profession is now beginning to 
 see that there is yet considerable to 
 be learned concerning the causation 
 of tuberculosis. In fact, it has been 
 evident for some time that we have 
 allowed the bacillus craze to get be- 
 yond our better judgment. 
 
 It cannot be denied that the tu- 
 bercle bacillus plays an important 
 part in the phenomenal expression, 
 if not the etiology of tuberculosis, 
 but the facts are daily being brought 
 to light which tend to prove that the 
 bacillus alone, as a causative agent 
 in this disease, is as inefficient as a 
 grain of wheat is ungerminative 
 without sunlight, air and moisture. 
 
 When is considered the impunity 
 
8 
 with which colonies of tubercle ba- 
 cilli have been swallowed, we must 
 fall back on the certainty of a pre- 
 existing condition, which, when pres- 
 ent, offers favorable influence for the 
 development of the bacilli, and on 
 which the latter depend for support; 
 or, otherwise, that the bacteria are a 
 product of the disease, and causa- 
 tive only as they have the power of 
 reproducing themselves, and, when 
 in great numbers, of acting as for- 
 eign bodies. That tubercle bacilli 
 reproduce themselves is not doubted, 
 but this simple fact does not argue 
 anything, as it is no more than does 
 the animal kingdom in general. If 
 they produce toxalbumens, as is as- 
 serted, it may well be asked if any- 
 one knows what a toxalbumen is, 
 and the exact effect on the human 
 organism? This no one knows at 
 present, and it is not always appar- 
 ent that the term is more than a 
 cloak for ignorance, or to cover a 
 
9 
 theory that there must be some toxic 
 product from bacteria in the albu- 
 minous elements of the blood to 
 cause specific disease. For our pur- 
 pose, then, the tubercle bacillus, per 
 se, can act only as a foreign body. 
 
 If, before the appearance of tu- 
 bercle bacilli in this disease, there be 
 a condition upon which the causa- 
 tion depends (and there seems to be 
 no doubt that this is the case) a 
 short consideration of the anatomical 
 and physiological relations of the cir- 
 culation will, I believe, demonstrate 
 how such condition may arise, and 
 of what it must necessarily consist. 
 
 Hardly an autopsy is made with- 
 out it is seen that some time during 
 the life of the subject tubercles had 
 been present in the lung, or in other 
 tissues of the body, which tubercles 
 had resolved, or had been discharged. 
 We know that to obtain cicatricial 
 repair of lung tissue, a suppurative 
 process must have coexisted, and 
 
10 
 that suppuration never takes place 
 where there is not interference with, 
 or stasis of the circulation of a part 
 involved. In other words, there is a 
 loss of normal correlation between 
 the supply of arterial blood, carrying 
 oxygen and nutrition to the part, and 
 the venous blood, bearing away the 
 carbonic acid gas and waste tissue 
 elements. The waste is carried by 
 the circulation to the several organs 
 in the animal economy best calcu- 
 lated to excrete it, and the venous 
 blood becomes reoxidized in the 
 lungs, loosing its carbon dioxide. 
 
 Essentially, then, perfect tissue re- 
 pair is one with perfect circulation, 
 and, conversely, any stasis to the cir- 
 culation prevents perfect repair. Es- 
 pecially is, this true of either venous 
 or lymphatic stasis. 
 
 Any suppurative action must have 
 origin in an obstruction to circula- 
 tion in the part affected, and resolu- 
 tion occurring during any stage de- 
 
11 
 pends on the re-establishing of nor- 
 mal correlation in the entire circula- 
 tion of such diseased tissue. Abscess 
 formation is nature's way of ridding 
 tissues of abnormal waste when the 
 circulation is impeded. 
 
 But circulation in the animal sys- 
 tem is a complex phenomenon, physi- 
 ologically of two kinds, afferent and 
 efferent ; anatomically of three kinds, 
 arterial, which is superabundantly 
 generous for nutrition; venous, 
 which is inadequate for the removal 
 of all the excess; lymphatic, which 
 supplements the office of the veins in 
 removing waste. A vigorously act- 
 ing lymphatic system precludes dan- 
 ger from tissue stasis in rapidly 
 wasting parts, while inactivity of the 
 system implies obstruction from sta- 
 sis. 
 
 This point was admirably illus- 
 trated by the eminent oral surgeon, 
 Dr. James E. Garretson, several 
 years back, in a paper read before 
 
12 
 the Pathological Society of Philadel- 
 phia, but which has never been pub- 
 lished to my knowledge. The illus- 
 tration draws attention to a circle, as 
 representing a part, or every part of 
 the human body, in the continuous 
 process of building and razing. Ma- 
 terial is brought to it. Eubbish is 
 to be taken away. Debris calls for 
 the work of the scavenger acting as 
 supernumerary to the removal of 
 rubbish. These bringers and takers 
 are the arteries, veins and lymphat- 
 ics. The first brings material ; brings 
 it in excess. The second carries 
 away the excess; carries away the 
 rubbish as well. The third cleans up 
 generally. 
 
 It is this third factor in the circu- 
 lation that most concerns us in the 
 etiology of tuberculosis, and a brief 
 consideration of the functions of the 
 lymphatic system will aid in the 
 clear understanding of their relation 
 to the causation of disease. 
 
13 
 
 First, inquiry as to the relation of 
 the lymphatics with the secretory 
 system of glands develops the fact 
 that both the conglobate and race- 
 mose varieties have identical offices 
 of excremental and recremental 
 signification. The lymphatic system, 
 therefore, must be one whose func- 
 tions imply the taking of material 
 from a relation with parts that do 
 not need it, and placing it in rela- 
 tion with parts that do ; i. e., the lym- 
 ph atics take care of excess of nutri- 
 tious elements and return them to 
 the general circulation. 
 
 We may logically distinguish the 
 lacteals and lymphatics as belonging 
 to different systems. It is true that 
 both characters of vessels hold pabu- 
 lum, a fact which does not argue 
 against the lymphatic as being a sys- 
 tem, the office of which is purely 
 emunctory; for the pabulum found 
 in these vessels, that is not excreta 
 in the strict sense, is so in signifi- 
 
14 
 cance, being an excess of nutritional 
 material which would speedily as- 
 sume the form of an irritant were it 
 not removed to a new situation; as 
 implied in its restoration to the gen- 
 eral circulation. 
 
 The lymphatic system, then, ex- 
 cluded from the lacteals, being ac- 
 cepted as primal emunctory organs, 
 it must follow that glands like the 
 pancreas, liver, kidneys, etc., must be 
 considered as secondary, or excre- 
 mental emunctories. 
 
 Bile, urine, perspiration and the 
 secretion of all the other excrementi- 
 tial glands (as physiological meaning 
 is given the word excrement) are phe- 
 nomena of the blood, and are de- 
 pendent on tissue metamorphoses. 
 Tissue metamorphoses ceasing, sec- 
 ondary secretion ceases also, and 
 death ensues. Tissue metamorphoses 
 ceases to be physiological in propor- 
 tion as the lymphatic system be- 
 comes pathological; that is, tissue 
 
15 
 
 metamorphoses is not an act in rela- 
 tion with racemose glands. 
 
 Reverting to our first corollary, 
 that perfect tissue repair is one with 
 perfect circulation, it is now seen 
 that perfect health is identical with 
 perfect excretory function, or, in 
 other words, with perfect elimina- 
 tion. 
 
 Again, considering our converse 
 proposition, we may now also see 
 how default in lymphatic action is 
 the starting point out of which may 
 arise many phenomena of disease. 
 
 The pathological phenomena of 
 tubercle, relating to the gray or 
 granular and the yellow or caseous 
 matter, is familiar to all; but what 
 is tubercle, and whence does it come? 
 
 It is to be argued that primarily 
 tubercle is a thing having no objec- 
 tive nature, in the sense that the 
 poison of a rattlesnake, introduced 
 through a bite to the system, is a 
 thing possessed of objectivity. 
 
16 
 Neither can it be similarly said of 
 the tubercle bacillus. Tubercle, if not 
 objective, must be a subjective condi- 
 tion, the subjective lying primarily 
 with a perversion of the lymphatic 
 system. 
 
 The acceptance of these last two 
 propositions brings us to another 
 corollary, viz., tuberculosis is not a 
 disease, but a symptom — a symptom 
 of lymphatic disturbance or stasis. 
 
 For the proving of the above prop- 
 osition let us consider scrofulosis, 
 struma and lymphoma. 
 
 I am aware that there are those 
 who refuse to believe scrofulosis to 
 be identical with tuberculosis, but 
 that they draw the line of demarka- 
 tion too finely, and that both terms 
 are synonymous with the same condi- 
 tion I trust we shall see hereafter. 
 
 Scrofulosis, all will agree, divides 
 its expression into two forms — surg- 
 ical and medical — or lymphoma and 
 struma. By the term lymphoma is 
 
17 
 meant a tumor of a lymphatic gland, 
 hypertrophied by reason of interfer- 
 ence with its efferent circulation. All 
 such tumors sooner or later express 
 interference with lymphatic circula- 
 tion by the effusion of lymph into the 
 surrounding tissues. A lymphoma is 
 scrofula localized. Struma implies 
 torpidity of the lymphatic circula- 
 tion at large, and is scrofula gener- 
 alized. 
 
 A scrofulous patient is full of ob- 
 structions. Abscess is nature's 
 method of clearing up such obstruc- 
 tions. The obstructions exist because 
 there is no capable lymphatic sys- 
 tem to remove them. Lymphatic ab- 
 scess is a symptom of struma. 
 
 Tubercle is first met with where 
 lymphoma or lymphangitis has alter- 
 ed the correlative relations of the 
 lymphatic system, and its meaning is 
 that obstruction exists. Tubercle is, 
 therefore, dependent on lymphatic 
 stasis, for without such we never get 
 
18 
 tubercle. Tubercle is a symptom of 
 tuberculosis. 
 
 It will now, I trust, become evi- 
 dent why scrofulosis and tuberculo- 
 sis are identical. They are both 
 symptoms of the same lymphatic con- 
 dition. 
 
 Eeference to the anatomy of the 
 lymphatic system, as this is of rela- 
 tion to the lungs, shows the former 
 to be delicate in character and much 
 exposed. Beginning with the ter- 
 minal radicals, the lymphatics ac- 
 company the blood vessels until ter- 
 minating in the bronchial glands at 
 the root of the lung ; the efferent ves- 
 sels from the latter traverse the 
 tracheal and esophageal glands be- 
 fore emptying themselves into the 
 general circulation. The bronchial 
 glands are in " state of change from 
 youth to old age, consequently are in 
 a state of susceptibility. Calcareous 
 degeneration is not uncommon in 
 them. Obstruction in a bronchial 
 
19 
 lymphatic implies obstruction in lung 
 metamorphoses. Here, then, we ar- 
 rive at the point of scrofulosis pro- 
 ductive of tubercle; whether the pro- 
 duction shall be caseous or miliary 
 may be assumed to depend on the 
 catalytic influences as excited on 
 epithelial or on alveolar structures, 
 or possibly on the state of the sys- 
 tem at large. 
 
 Pulmonary tuberculosis arising 
 from "taking cold 77 is primarily a 
 pure local affection. If too wide an 
 area of lymphatics are not involved 
 cure will come with suppuration, as 
 evidenced by the cicatricial repair 
 found in autopsies, before mentioned. 
 
 Struma, associated with general 
 lymphatic derangement, is phthisis 
 expending itself in the lung, and is 
 formidable in proportion to the de- 
 rangement. Struma, it will be re- 
 membered, is referred to as scrofula 
 generalized, in distinction from lym- 
 phoma, or scrofula localized, both 
 
20 
 being dependent on more or less 
 lymphatic stasis. 
 
 Recalling the pathology of chronic 
 inflammations in general, it will be 
 remembered that there exists a con- 
 tinued stagnation of lymph and 
 blood, as well as coagulation in their 
 vessels, and a condition of hyper- 
 plasia is first induced in the walls 
 of these vessels, and then in the im- 
 mediately surrounding parts. The 
 process being a continued one must 
 be gradual, for by a sudden and 
 complete stagnation we get active 
 or acute inflammation, and not 
 chronic. 
 
 What, then, is the cause of lym- 
 phatic stasis, leading to a condition 
 which may result in tuberculosis? 
 
 We koow that an irritation acutely 
 expressed, as in the case of burns, 
 induces active inflammation. We 
 also know that irritation of a mild 
 degree, applied continuously, induces 
 chronic inflammation, as in the case 
 
21 
 of gastric catarrh from the alco- 
 holic habit. We have seen how ir- 
 ritation, increasing the flow of blood 
 to a part, tends to produce hyper- 
 trophy of that part ; yet, that so long 
 as the efferent vessels carry off the 
 additional waste there is no ten- 
 dency to ulceration or retrogade tis- 
 sue metamorphoses, other than that 
 induced by the contraction of new 
 tissue formation, and the secondary 
 cutting off the blood supply. But as 
 soon as the correlation between the 
 efferent and afferent vessels becomes 
 interfered with, and the waste pro- 
 ducts are left in the part, ulcerative 
 and suppurative changes take place. 
 (This is evidenced in malignant tu- 
 mors also.) 
 
 But, the question whether these 
 chronic inflammations are always 
 induced by irritations, and by what 
 such irritations are caused, is still 
 speculative. 
 
 Obviously, lymphatic stasis is the 
 
22 
 result of obstruction to lymphatic 
 circulation. Whether this obstruc- 
 tion exists in a coagulation induced 
 by foreign bodies, or by an interfer- 
 ence with the normal tone or healthy 
 condition of the arterial blood sup- 
 ply (probably due to a deficiency in 
 oxygen or an oxidizable element, or 
 an increase in the noxious gases of 
 the blood) and, hence, increasing the 
 amount of waste to be carried off 
 by the lymphatics, thus producing 
 sluggishness in their circulation, is, 
 of course, an open question. 
 
 One thing is certain — that is 
 the irritation, if such there be, 
 must be applied continuously to a 
 point where the lymphatic stasis is 
 complete enough to cause, of itself, 
 the remaining pathological tissue 
 changes in the disease. This must 
 occupy a considerable period of time, 
 and it is not apparent how a multi- 
 tude of bacilli, simply as foreign 
 bodies, can remain in any spot of the 
 
23 
 rapidly-moving blood current long 
 enough to irritate and thereby pro- 
 duce such coagulation, or stasis, in 
 an open lymphatic system of vessels. 
 Bacilli, entering the blood current, 
 must encounter difficulty of develop- 
 ment except when at rest, or the 
 oxygen is limited below the normal, 
 and any such rest of the blood cur- 
 rent would imply stasis somewhere 
 in the lymphatics. 
 
 It may be well to pause here to 
 consider the germ theory as relat- 
 ing to the production of tuberculo- 
 sis. 
 
 From all that has been demon- 
 strated on the living human organ- 
 ism, germs appear to belong to two 
 great classes: 
 
 First, those that are said to pro- 
 duce acute diseases. 
 
 Second, those that are said to pro- 
 duce chronic diseases. 
 
 This division, which is here drawn 
 for convenience, is apparently one 
 
24 
 of intensity of virulence, the former 
 being active and extremely poison- 
 ous, but easily destroyed, the lat- 
 ter being less active, but of greater 
 tenacity to life. The former may be 
 illustrated by the Klebs-Loeffler ba- 
 cillus of diphtheria, and the latter 
 by the Koch bacillus* of tuberculo- 
 sis. 
 
 It has been demonstrated that 
 these germs will reproduce them- 
 
 *(The products of bacilli, the toxalbu- 
 mens, toxines, etc., which are said to be 
 the ptomaines of disease, are duly con- 
 sidered in their connection with this 
 subject; but it is difficult for the writer 
 to understand how a poison, if such 
 exist to cause disease can be found 
 prior to the development of the bacillus, 
 which is said to be the father of the 
 poison; the poison certainly does not pro- 
 duce the bacillus; moreover, it is a pret- 
 ty well established fact that symptoms 
 of tuberculosis, or indications leading 
 thereto, are more or less advanced be^ 
 fore the appearance of the tubercle bacil- 
 lus is demonstrable, or enters into the 
 symptomatology.) 
 
25 
 selves in favorable media outside the 
 body, and, when injected into the 
 blood of susceptible animals, will — 
 what? — produce their specific dis- 
 ease? — no! — reproduce themselves. 
 
 If one examine the carcase of a 
 dead dog, or other animal, it will be 
 seen that the body is full of living 
 organisms, which, moreover, are not 
 all of the same kind. It is also of 
 common observation that these or- 
 ganisms are to be found occasion- 
 ally on living animals, including the 
 human species, who may be the sub- 
 jects of suppurative lesions. They 
 are found where decomposition is 
 going on in some form. They feed 
 on dead tissue and not on the living. 
 So it is with bacteria. They are to 
 be found in the waste products of 
 the body. They are not able to sub- 
 sist on healthy living tissues or cells, 
 as evidenced by their destruction in 
 them. Where suppuration and de- 
 cay exist there will be found the 
 
26 
 bacillus. If it is one of the virulent 
 kind found in diphtheria, it may in- 
 habit the waste products of every 
 throat irritated by a "cold," or every 
 open sore or wound it comes in con- 
 tact with, and may intensify the in- 
 flammatory action by its irritative 
 presence. It reproduces nothing but 
 its kind, and it seems probable that 
 the determining factor of its viru- 
 lence is the rapidity of its reproduc- 
 tion. The healthy throat is so rare, 
 especially in children, that the field 
 is ample for its generative powers. 
 The above is as true of other germs, 
 including the tubercle bacillus. They 
 reproduce themselves in favorable 
 media and atmospheric conditions, 
 and are destroyed by unfavorable 
 conditions. 
 
 The experiments conducted on 
 Guinea-pigs and rabbits with cultur- 
 ed tubercle bacilli, to show that 
 Koch's germ induces tuberculosis, do 
 not prove of much value, inasmuch 
 
27 
 
 as these animal- ery prom 
 
 •reular processes from any sort 
 of irritative interference with their 
 lymphatic circulation, and especially 
 
 so v ich irritation is app] 
 
 to a membrane, as the [ 
 
 toneum. 
 
 It must be rationally argued that 
 the favorable medium for one kind 
 of bacillus may not be identical with 
 that example: Ii 
 
 waste elements in t 1 serum 
 
 from eh . alti- 
 
 vation ground for th . .le bacil- 
 
 lus, it A arily imply 
 
 that the 
 
 ble field for the cultivation of the 
 Kiel and vice 
 
 versa. Hence, various forms of germs 
 may appear in different diseases, not 
 because the germs are specific, ex- 
 : as diagnostic phenomena, but 
 because they develop and multiply 
 in different media. It is not every 
 sore, or diphtheritic throat that 
 
28 
 gives evidence of a Klebs-Loeffier 
 bacillus, nor every healthy throat 
 that does not contain more or less of 
 them. 
 
 Without doubt, we imbibe, daily, 
 germs of many descriptions. We 
 breathe them in the air around us, 
 and swallow them in the food we eat 
 and the water we drink. So long as 
 our excrementitial organs and the 
 lymphatics are ill a healthy condi- 
 tion there can be no spot for germs 
 to congregate and multiply in the 
 blood. Most of them are destroyed 
 by oxygen, and none can germinate 
 in the blood current when oxygen is 
 in its normal quantity or in excess. 
 This is evidenced by the results upon 
 consumptives of living in ozonized 
 atmospheres and high altitudes. 
 Oxygen is the best sterilizer of 
 which we know. Germs, alive or 
 dead, will pass out with the waste 
 products of the body if not hindered, 
 by a stasis in some excrementitial 
 organ. 
 
29 
 
 Returning to our consideration of 
 lymphatic stasis, we may assume 
 that a cause for lymphatic obstruc- 
 tion may be found in an incompetent 
 excrementory organ, which theory is 
 perfectly in accord with the acknowl- 
 edgment of the lympathic organ of 
 tuberculosis. Such organ may be the 
 seat of congenital or acquired incom- 
 petency. 
 
 Congenital incompetency may be 
 due to a faulty intra-uterine nutri- 
 tion, tending to dwarf the organ and 
 limit its function; or such incompe- 
 tency may result from some one of 
 the many unknown causes common 
 to other congenital deformities. 
 
 Acquired incompetency must de- 
 pend on faulty nutrition after birth ; 
 this, without doubt, is due to a lower 
 degree of oxidation in the cellular 
 elements of the blood. Whether such 
 lowering of oxidizing power be in 
 consequence of a deficiency of oxi- 
 dizing agents, according to Church- 
 
30 
 ill's theory, or the outcome of loss in 
 the available oxygen to vitalize the 
 tissues, the result is the same ; i. e., 
 sluggishness of the efferent circula- 
 tion by overcharging the lym- 
 phatics and veins with waste tissue 
 elements, the ultimate backing up 
 of waste products in the capillaries 
 of the affected part, and, finally, 
 stasis resulting in inflammation, 
 which will be acute or chronic as the 
 completeness of the obstruction be 
 accomplished suddenly or gradually. 
 It is on complete oxidation that 
 the healthy cellular life of the ani- 
 mal depends. Deoxidation means 
 death. Life is opposed to death, and 
 nature is continually striving to pre- 
 serve the former by ridding herself 
 of the latter. As soon as an animal 
 cell is deoxidized it becomes devital- 
 ized and is crowded out of its rela- 
 tions with living cells. If it can pass 
 out through the excrementory chan- 
 nels, as nature intended it should, 
 
31 
 no harm will result, even if many 
 bacteria are feasting on the defunct 
 cell. If it cannot pass out, but is 
 held by stasis or obstruction in rela- 
 tion with living cells of the part, 
 we soon have a collection of such 
 dead material causing irritation to 
 the nerve elements* of surrounding 
 tissue, and inflammatory results. 
 
 Deoxidation or other alterations 
 in the chemical equilibrium of the 
 normal human organism may be 
 
 *I incline to the opinion that we have, 
 first, a stasis of waste elements; sec- 
 ond, a nerve cell paralysis due to the 
 stasis; third, increased blood supply to 
 the part as a result of the paralysis 
 and which, owing to the existing ob 
 struction, brings about the phenomenon- 
 inflammation. Phagocytosis may be 
 easily explained, inasmuch as a leuco 
 cyte, if it does not contain enough oxy- 
 gen to vitalize it, becomes pus, and, 
 hence, waste; if there is oxygen 
 enough in the cell bacteria may be 
 destroyed; otherwise, as a waste cell 
 it may become the prey of the microbe. 
 
32 
 brought about in many ways. It 
 would be interesting, in this connec- 
 tion, to note what the different ef- 
 fects are from atmospheric changes 
 upon the chemistry of the blood. 
 Different localities and seasons must 
 have noxious chemical elements, 
 which are detrimental to certain hu- 
 man organisms whose excrementitial 
 powers are below the normal. There 
 is no reason to suppose that chemi- 
 cal elements act differently than 
 their natures, which are known spe- 
 cifically in the laboratory, determine 
 that they must. Why, then, cannot 
 gases in the air act chemically on 
 the gases of the blood to produce dis- 
 ease, and this irrespective of any 
 germ? 
 
 It seems nonsensical to assume 
 that a micrococcus alone should hare 
 the power of limiting a disease like 
 pneumonia to a solitary lobe of a 
 lung. If microbes play a primary 
 part in the etiology of disease 
 
33 
 through the medium of the blood, 
 why do they not occasion uniform 
 inflammations in the various organs 
 or parts of the body and not con- 
 fine themselves to specific spots, as 
 they are said to do in pneumonia or 
 diphtheria? Blood serum, if it is a 
 developing medium anywhere, must 
 be so throughout the entire body. 
 
 It is a fact that in phthisis, or 
 tuberculosis, the venous blood is 
 brighter than normal. This gives 
 evidence that the oxygen imbibed 
 by the red blood-corpuscles, in the 
 lungs, is not properly oxidized in 
 the tissues, and passes over through 
 the capillaries in a free state. This 
 fact would imply that there was a 
 deficiency in an oxidizing element. 
 We know that the blood contains 
 phosphorus in an oxidizable form, 
 and that oxygen has a great chemi- 
 cal affinity for phosphorus; hence, it 
 is not out of reason to infer that in 
 the condition known as tuberculosis 
 
84 
 there is a deficiency in oxidizable 
 phosphorus. This fact is proven by 
 the supplying to the blood of a 
 phthisical person an oxidizable form 
 of phosphorus, when it will be seen 
 that the venous blood assumes its 
 naturally darkened hue. 
 
 We know that every effort, men- 
 tal or physical, oxidizes this element 
 in the organism into phospate, a 
 waste product, and that there is also 
 direct connection between the ex- 
 cretion of the phosphates and the 
 waste of nervous element. The abun- 
 dance of means for causing an ex- 
 cess of oxidizable phosphorus to be- 
 come a waste product in the shape 
 of the phosphates gives ample op- 
 portunity for a condition of devital- 
 ization. This element may not be 
 the only chemical agent in tubercu- 
 losis, but that it is a very important 
 one is evidenced by the results of ' 
 treatment along this line. 
 
 The question whether pulmonary 
 
35 
 tuberculosis may be communicated 
 by contagion, or infection, does not 
 rest with the proving that a specific 
 germ is found in this disease, for we 
 know that unless a favorable me- 
 dium is presented such germ will 
 not develop, and that to obtain this 
 medium there must be a condition 
 to be recognized as pathological. If 
 an element of infection exist in any 
 locality, and we take for a criterion 
 the fact that ozonized atmospheres 
 are exempt from tuberculous cases 
 developing in them, then it holds 
 that there must be a proportionate 
 deficiency in oxygen in those locali- 
 ties in which tuberculosis is develop- 
 ed. Ozonized atmospheres are both 
 beneficial to the oxidation of the 
 blood and the destroying of micro- 
 organisms. Living in localities 
 where there is a tendency to defi- 
 cient oxidation of the tissues will, as 
 a consequence, tend to increase 
 waste elements; which, if there be 
 
36 
 an incapacitated lymphatic system 
 to carry such waste away from situ- 
 ations where they will do harm (as 
 might follow a pneumonia, laryn- 
 gitis, or other acute inflammation of 
 the respiratory tract), may cause the 
 starting point of tuberculosis. 
 Bacilli may be communicated if 
 there is found favorable lodging for 
 their development. 
 
 The conclusions regarding the eti- 
 ology of pulmonary tuberculosis 
 which the writer has endeavored to 
 show may be summed as follows : 
 
 That pulmonary tuberculosis is 
 due, primarily, to a lymphatic stasis. 
 
 That such lymphatic stasis may be 
 congenital, or acquired, as a result 
 of incompetency of excrementory 
 function. That incompetency of ex- 
 crementory function may be develop- 
 ed from acute diseases, especially of 
 the respiratory organs, or from grad- 
 ually increasing stasis of waste ma- 
 terial due to overtaxation of excre- 
 
37 
 mentory organs (where such, can be 
 overtaxed), by deoxidation of the tis- 
 sues. 
 
 That the tubercle bacillus is to be 
 regarded as a development, existing 
 simply because favorable media are 
 presented, in the lymphatic stasis, 
 for its cultivation. The develop- 
 ment is often some length of time 
 after the stasis is apparent, and in 
 some favorable cases may not de- 
 velop at all. Bacilli may exert in- 
 fluence on the disease as foreign 
 bodies, similar to other foreign or 
 waste elements; but are not, pri- 
 marily, causative. They form excel- 
 lent symptoms of tuberculosis if they 
 develop early enough, but the mere 
 removal of them will not cure the 
 disease, unless such removal implies 
 restored excrementitial function and 
 perfect lymphatic circulation and 
 elimination. 
 
 That tuberculosis implies the 
 atrophy of the pancreatic gland in 
 
38 
 the majority of cases, but that the 
 dislike of fats by phthisical persons, 
 or those having a consumptive ten- 
 dency, is the only symptom we can 
 depend upon to show that in the 
 pancreas may lie the origin of this 
 disease. 
 
 CONCERNING THE EARLY SYMP- 
 TOMS OF PULMONARY TU- 
 BERCULOSIS. 
 
 The ordinary symptoms of tuber- 
 culosis of the lungs are so familiar 
 to physicians at large as not to need 
 consideration in a paper of this char- 
 acter. There is, however, one symp- 
 tom that presents and accompanies 
 all others, and which, strange to 
 say, has been entirely overlooked, so 
 far as the writer knows, until at- 
 tention wa« directed to it by Pro- 
 fessor Garretson, in his clinical lec- 
 tures. This refers to a dislike of 
 fats by people having the phthisical 
 
39 
 tendency. Observation will show 
 that fat-eaters are almost entirely 
 exempt from the disease we now con- 
 sider; while, on the other hand, the 
 information that the appetite and 
 stomach of a patient refuse fats is to 
 be accepted as diagnostic of the con- 
 dition established, or of dangerous 
 and formidable tendency to it. 
 
 The universality of this dislike and 
 refusal of fats by the destined vic- 
 tims of phthisis commands for the 
 peculiarity the first place in a con- 
 sideration of symptoms. 
 
 To what is to be referred the dis- 
 like and refusal? 
 
 It is a deduction by Dr. Garretson 
 that the pancreas is at fault in all 
 such persons; and that with this 
 gland is not unlikely to be found the 
 origin of all those cases of gradually 
 developing consumption which con- 
 stitutes the large majority. The 
 writer has fully satisfied himself, out 
 of sufficient data, that too much im- 
 
40 
 portance cannot be made of this 
 symptom; for, with its early recog- 
 nition, before destructive changes 
 have taken place, we have our great- 
 est hopes for successful treatment. 
 
 The symptom indicates that there 
 is either faulty secretion from the 
 pancreas, whose function is to fur- 
 nish a chemical product for the 
 emulsification of fats; or a chemical 
 inferiority of the secretion, by reason 
 of impaired nutrition; otherwise an 
 inability on the part of the lacteals 
 to properly absorb the emulsion. 
 
 The first could easily exist in a 
 congenital abnormality of the pan- 
 creas. The last would exist in in- 
 testinal catarrh. 
 
 Another important early symptom, 
 though not pathognomonic, but sug- 
 gestive, lies in the abnormal weak- 
 ness generally observed in consump- 
 tives. This languor is undoubtedly 
 due to the deficiency in oxidizable 
 phosphorus and the increase in 
 
41 
 waste phosphates, dependent on 
 retrograde tissue metamorphoses. 
 It is in this manner that the vitaliza- 
 tion of the tissues is impaired, and 
 weakness is a symptomatic result. 
 Too often this symptom is passed 
 over by the physician as an indica- 
 tion of "malaria." 
 
 Limited lung and chest expansion, 
 while not essentially an early symp- 
 tom of phthisis, when it exists is 
 very suggestive, and demands thera- 
 peutic attention. 
 
 Another of the early symptoms, 
 which has important bearing on the 
 therapy of tuberculosis, is chronic 
 gastric catarrh. More strictly class- 
 ified, it is a complication, as it is to 
 be regarded as a result of the general 
 systemic disturbance rather than a 
 tubercular lesion of the stomach. 
 
 Other physical signs of phthisis 
 are of great importance. Mention 
 of some of them may not be out of 
 place. The signs belonging to the 
 
42 
 incipient stage are slight dullness 
 on percussion, broncho-vesicular res- 
 piration, or a weakened respiratory 
 murmur, more or less frequency in 
 respiration, some increase in the 
 vocal resonance, increased bronchial 
 whisper occasional subcrepitant 
 rales, pleuretic friction murmur, and 
 abnormal transmission of the heart 
 sounds. Most of these signs are lim- 
 ited to the summit of the chest on 
 one side. As the case advances the 
 physical signs are intensified and 
 augmented. Pectoriloquy may be 
 present before and after the forma- 
 tion of cavities. In the former in- 
 stance the transmission of speech is 
 by solidified lung; in the latter, it 
 occurs through a cavity. Cavernous 
 sounds accompany the formation of 
 cavities only. 
 
 Hemoptysis is likely to happen 
 early in the disease, in the majority 
 of cases; and, if before cavity forma- 
 tion, it is to be regarded as indica- 
 
43 
 tive of congestion and rupture of 
 the smaller bronchial vessels. After 
 cavities have formed, bleeding may 
 originate from their walls. Occa- 
 sionally, in the latter instance, a 
 large vessel may be opened, causing 
 fatal hemorrhage. 
 
 If the larynx be involved, huski- 
 ness or hoarseness of voice exists. 
 Occasionally the voice may be lost 
 entirely for a space of time. 
 
 Kise in temperature is an early 
 sign, and one apt to be attributed 
 to malarial disease on account of 
 its - * intermittent quality. 
 
 Anemia and pallor of counte- 
 nance are more or less marked from 
 the beginning as a result of impover- 
 ished blood. 
 
 Tuberculous peritonitis may occur 
 as an acute or chronic affection, and 
 is to be regarded as symptomatic 
 of the pulmonary type only in regard 
 to the tendency it exhibits toward 
 subsequent involvement of the lym- 
 
44 
 phatic system in the lung. A pecu- 
 liar consequenc of treatment is 
 the curability of tuberculous peri- 
 tonitis by laparotomy. This has 
 lately been attributed to the en- 
 trance of the staphylococcus through 
 the atmospheric air, and the claim 
 made that the toxalbumen from 
 this micro-organism is antagonistic 
 to the tubercle bacillus. If this 
 were true, we would have no pul- 
 monary tuberculosis; for we are 
 breathing into our lungs, daily, sta- 
 phylococci enough to generate toxal- 
 bumens for a nation; and, if there 
 is any such antagonistic action on 
 tuberculous products in the peri- 
 toneum, why not in the lung? The 
 effect of atmospheric air on the 
 serous membrane of the peritoneum 
 seems to have the effect of restor- 
 ing eliminatiye function of the ef- 
 ferent vessels; a thing it does not 
 establish in the lung. 
 Microscopically, a third blood-cor- 
 
45 
 puscle has said to have been demon- 
 strated, which is attributed by some 
 to be one of the causative factors of 
 this disease. It is doubtful if this 
 corpuscle be more than an altered 
 leucocyte; possibly occurring as 
 waste : but not at all causative. It 
 remains to be proven whether it be 
 symptomatic or not. 
 
 The venous blood of phthisical per- 
 sons is brighter than normal, unless 
 they are undergoing treatment by 
 hypophosphites. 
 
 THE MORTALITY OF TUBERCU- 
 LOSIS. 
 
 Evidence is given that the mortal 
 ity from this disease is no greater 
 at the present day than it was hun- 
 dreds of years ago. A recent ar- 
 ticle was published in an exchange, 
 which I regret having mislaid, show- 
 ing that, in Jewish history, years 
 
46 
 before the Christian era, consump- 
 tion was as rampant as now. This 
 w T ould tend to refute the idea that 
 tuberculosis is at present on the in- 
 crease, and at the same time indi- 
 cate that we possess no better ther- 
 apy for this affection now than did 
 the ancients. 
 
 The Medical Record published 
 some time since an article showing 
 the different occupations predispos- 
 ing to tuberculosis, and I can do no 
 better than to quote the article 
 here. 
 
 "The greatest number of deaths 
 from phthisis occur in workers ex- 
 posed to irritating substances in the 
 respired air. In Switzerland 10 out 
 of 100 stone cutters die from phthis- 
 is. In England of 1000 deaths occur- 
 ring in these workers, 340 were from 
 phthisis. Tuberculosis makes cruel 
 onslaught likewise in those indivi- 
 duals who habitually occupy a bent 
 posture at their occupations, and in 
 
47 
 
 those who live sedentary and intel- 
 lectual lives. Of 1000 deaths in 
 Italy among students and seminar- 
 ians 450 died of phthisis — that is, 
 nearly one-half. In England, of a 
 similar number of deaths in prin- 
 ters, 430 died of phthisis.'' 
 
 "On the other hand, statistics 
 show that it was quite exceptional 
 for this disease to be the cause of 
 death of those who live in open air. 
 Switzerland, of 1000 deaths occur- 
 ring in outdoor laborers and farm- 
 ers, not more than one or two die 
 from phthisis. A similar number of 
 deaths in Italy among shepherds and 
 farmers shows only from 44 to 45 
 deaths." 
 
 "In France the sanitary statistics 
 gathered from 662 towns show that 
 the more the poulation is conglom 
 erated, so in proportion are the in- 
 habitants gravely infected with tub 
 erculosis." 
 
48 
 
 TREATMENT. 
 
 The recognition of lymphatic stasis 
 as the primal cause of tuberculosis 
 explains the failure to successfully 
 combat the disease with antiseptics. 
 Germs will develop in a favorable 
 medium, and it is impossible to ren- 
 der the medium unfavorable in tu- 
 berculosis without removal of the 
 cause of its presence : i. e., lymphatic 
 stasis. We know the effects of urea 
 on the human system when it is re- 
 tained in the blood by obstruction in 
 a diseased kidney. Why, then, 
 should the same not hold true in 
 relation to waste elements from 
 other parts of the body? Eelief and 
 cure coming by restoration of elimi- 
 native function are proportioned by 
 the completeness of the latter. Micro- 
 organisms depart when the medium 
 in which they thrive is eliminated. 
 The only way to sterilize the germ- 
 ground of tuberculosis is by remov- 
 
ing the waste: i. e., increase oxygen 
 and the function of oxidation by add- 
 ing elements to the blood which 
 have a natural affinity for oxygen in 
 the organization of healthy tissue. 
 In accomplishing this the actual 
 waste elements are lessened, giving 
 the excreting organs less work to do, 
 thereby allowing nature a chance to 
 absorb excess and repair damage. 
 
 As most patients come to us in a 
 more or less advanced stage of tu- 
 berculosis, generally after lesions 
 have developed which are demonstra- 
 ble by physical examination, we have 
 lost the most promising of the peri- 
 ods for inaugurating successful treat- 
 ment. If, however, the case has not 
 advanced to a point where the le- 
 sions which are present may not of 
 themselves prove destructive to life, 
 there is always hope that, with 
 proper care and treatment, recovery 
 may ensue. 
 
 In a paper like the present it is 
 
50 
 difficult to map out the proper treat- 
 ment for all cases of phthisis. If 
 there is a disease in the category of 
 chronic affections which in its treat- 
 ment requires wisdom, skill and 
 judgment, that disease is pulmonary 
 tuberculosis. 
 
 The first thing to do is to study 
 the individual case. Temperament, 
 environment and the circumstances 
 of a patient have much to do with 
 success in treatment. If a different 
 climate is required and the financial 
 means to carry out such requirement 
 is lacking, the chances are so much 
 less in a patient's favor. (This is not 
 saying that every patient needs 
 change of abode.) 
 
 In nearly every case, no matter at 
 what stage of the disease, it is hope- 
 less to attempt medication without 
 first preparing the stomach and in- 
 testines to favor absorption of the 
 remedies used. These organs, where 
 phthisis is present, are usually in a 
 
51 
 state of chronic catarrhal inflamma- 
 tion, with more or less thickening of 
 the mucous membrane, thereby ren- 
 dering digestion and absorption in- 
 efficient. 
 
 To begin with, it is found of ad- 
 vantage to insert a stomach tube 
 and thoroughly wash out that organ, 
 teaching the patient the art of per- 
 forming the feat himself. The solu- 
 tion used for this lavage should be 
 a one to 16 dilution of Marchand's 
 hydrozone in warm water. I prefer 
 the hydrozone to the peroxide of hy- 
 drogen, because it is double the 
 strength of the latter * and is more 
 constant in its therapeutic qualities. 
 The solution should be allowed to 
 remain for a few minutes in - the 
 stomach and then be syphoned out 
 through the tube. 
 
 Peroxide of hydrogen or hydrozone 
 acts in two ways on the mucous 
 
 * See "Times and Register," Decem- 
 ber 15, 1894. 
 
52 
 membrane of a stomach chronically 
 inflamed. First, it clears the sur- 
 face of excess of mucus, combining 
 with the pus to form carbon diox- 
 ide and nascent oxygen (both gases 
 and easily removed through the 
 tube); second, the oxygen of the 
 preparation acts directly and favor- 
 ably in stimulating the mucous mem- 
 brane and underlying glands, there- 
 by favoring the circulation of blood 
 and the performance of function. 
 The good results of lavage of the 
 stomach will be apparent in a short 
 time by an increasing appetite, with 
 better assimilation of food. 
 
 Second to this method, for the 
 treatment of catarrh of the stomach 
 in tuberculosis, is internal adminis- 
 tration of hydrozone before meals. A 
 dilution of one part hydrozone to 32 
 of water may be employed in this 
 manner; a glassful of the mixture tak- 
 en half an hour before meals. If the 
 dilution is too strong the gas gene- 
 
53 
 rated will be distressing to the pa- 
 tient. Glycozone (c. p. glycerine 
 treated to 15 times its own volume 
 of ozone) may be used together with 
 the hydrozone as a curative agent. 
 
 The building up of the body by nu- 
 tritious and well-assimilated food is 
 a primal necessity in treating tuber- 
 culosis. The disease being one of 
 impaired nutrition, it is obvious that 
 waste of the body must be reduced 
 to the minimum, in order to prevent 
 further lymphatic stasis from excess 
 of excreta. 
 
 On the other hand, the production 
 of tissue-forming elements in the 
 blood must be encouraged. Oxygen 
 is not only to be carried into the tis- 
 sues, but utilized there. Oxidation 
 is essential to cell ife. 
 
 The foods necessary to the forma- 
 tion of tissue may be classified as 
 natural and chemical, or therapeuti- 
 cal (all being essentially chemical). 
 
 By the term natural food is here 
 
54 
 
 intended such articles of diet as, by 
 process of digestion, are converted 
 into pabulum from the ordinary ta- 
 ble supplies.in contra-distinction from 
 chemical food medicinally employed. 
 
 To the former class belong animal 
 and vegetable foods and oil; to the 
 latter the hypophosphites. iron, lime 
 and soda. 
 
 Discussion of diet and phthisis has 
 been elaborated in so many mono- 
 graphs on the subject of feeding that 
 only such articles will be mentioned 
 here as pertain to the therapy of the 
 disease. 
 
 A nitrogenous diet is essential, but 
 care must be taken not to over- 
 supply it, for the reason that a too 
 highly nitrog^nized diet i animal food] 
 throws upon the system excess of 
 eliminative work. All nitrogenous 
 matter, which is in excess of that di- 
 rectly applied to growth and recon- 
 struction of the body, undergoes a 
 process of retrograde metamorphosis, 
 
55 
 
 taxing the excrenientitial organs, and 
 cannot fail to do harm. Where ex- 
 ercise and free circulation can be 
 maintained nitrogenous elements are 
 best borne. 
 
 It devolves upon the physician to 
 point out suitable foods to be taken, 
 but it depends upon the system of 
 his patient whether his recommenda- 
 tions can be carried out. It is not 
 good to force any rigid dietetic regu- 
 lations, founded upon the number of 
 grains of carbon and nitrogen neces- 
 sary to support life, as may be done 
 in health. 
 
 If we consider force production, re- 
 sulting from different articles of 
 food, it will show that fats, especially 
 cod liver oil and olive oil, lead the list 
 in value. The inability of phthisical 
 persons to eat fat is a serious draw- 
 back to its use as a therapeutic food. 
 Where chronic impairment of power 
 exists in the digestive organs it is 
 not always wise to force an article 
 
56 
 
 of food against the appetite and de- 
 sires of the patient. Fatty foods 
 pass the stomach to undergo emulsi- 
 fication, or preparation for absorp- 
 tion, in the small intestines. When 
 fats are fresh, and not taken in ex- 
 cess, they may pass on without giv- 
 ing any sign of nausea or sickness of 
 the stomach. It is important, there- 
 fore, that small doses of oil be given 
 in this disease to begin with, and an 
 increase be made gradually. Olive 
 oil is often better borne by the stom- 
 ach than cod liver oil. Petroleum 
 oils also have value. The stomach 
 and intestines, being in a catarrhal 
 state, are not calculated to assimi- 
 late fats for proper absorption by 
 the lacteals, when given in excess, 
 or even the ordinary dose, often in- 
 crease the waste to be eliminated 
 by their production of volatile fatty 
 acids and excite derangement. 
 
 Having first treated the stomach in 
 the way suggested, we are prepared 
 
57 
 to apply fats with greater hopes of 
 beneficial results. Regarding the 
 various emulsions of cod liver oil and 
 other oily preparations on the mar- 
 ket, it may be said that all pre-einul- 
 sified fats have preference to the 
 crude oils, providing they contain 
 enough of the fatty elements for tis- 
 sue building. Oil treated with hy- 
 drogen makes an excellent prepara- 
 tion of value in certain cases. 
 
 Next to oil in the dietetic manage- 
 ment of tuberculosis is beef. What 
 is necessary in the administration of 
 beef elements to a consumptive is 
 not to get the greatest amount into 
 him, but to have what he does take 
 advantageous to him. Over-charg- 
 ing the blood with tissue-forming ele- 
 ments means overcrowding the elimi- 
 nitive organs, and these are to be 
 freed from an excess of pabulum, as 
 we shall see when speaking of med- 
 icinal therapy. It is not necessary 
 to discuss here the different values 
 
58 
 of beef preparations in detail; but 
 one method of application of this 
 food may be mentioned, because it 
 is found of more worth than the ordi- 
 nary market products. I refer to 
 blood taken from living animals. This 
 food, representing the elementary vi- 
 talizing fluid, is an ideal tissue-build- 
 er. In disease we must consider the 
 chemical alterations dependent apon 
 an existing malady, and govern our 
 therapy accordingly. Healthy living 
 blood cells can supply to a wasted 
 part, in union with oxygen, recon- 
 structive material. Such food to be 
 palatable must be perfectly kept, and 
 adapted for internal use. The best 
 preparation of this kind is repre- 
 sented by bovinine, which is simply 
 beef blood, drawn from the living ani- 
 mal and hermetically sealed, acting 
 quite as beneficially as transfusion, 
 and with less danger. Beef extracts 
 have certain values, but are not in 
 the same category with the above. 
 
59 
 
 A new product has recently been 
 brought to the attention of the pro- 
 fession from Germany. It is a con- 
 centrated alburnose, consisting of the 
 active nourishing elements of meat, 
 called somatose. It is said to con- 
 tain eight times the strength of beef 
 and to be readily digested, an import- 
 ant point in the treatment of all 
 wasting diseases. 
 
 Milk is an article of diet which in- 
 cludes the fats without taxing the 
 digestive powers. It is commonly 
 best borne by being boiled. The ad- 
 dition of soda water (aerated water) 
 will make it more palatable to those 
 phthisical persons who do not like 
 milk. Hot milk is an excellent rem- 
 edy in paroxysms of coughing, espe- 
 cially during the night, with scanty 
 or thickened expectoration met in 
 the later stages of this disease. In 
 this connection are to be considered 
 the various milk preparations as be- 
 ing of more or less value. 
 
60 
 
 Where there is much fever in pul- 
 monary tuberculosis the carbohy- 
 drates are the foods to be most de- 
 pended upon; they do not call for 
 the excessive eliminative work of the 
 nitrogenous compounds, and are eas- 
 ily assimilated by the digestive or- 
 gans. 
 
 Chemical foods being here con- 
 sidered, those elements which are 
 necessary to replace the inorganic in- 
 gredients of the blood may be repre- 
 sented by the hypophosphites, iron, 
 lime and soda. 
 
 We have seen why the venous 
 blood of a phthisical person is bright- 
 er than normal, inasmuch as there is 
 a loss of oxidizing element (i. e., oxi- 
 dizable phosphorus) and a carrying 
 over of oxygen in the free state 
 through the capillaries; hence it is 
 necessary to supply this loss to the 
 blood. This subject has been so 
 thoroughly demonstrated by Dr. 
 Churchill, of Paris, in his treatise 
 
61 
 on the hypophosphites in phthisis, 
 and so well elaborated by R. W. 
 Gardner, of New York, that it 
 seems unnecessary to enter into de- 
 tail on this treatment. A few points 
 may be well quoted here, however, 
 for the purpose of cautioning the pro- 
 fession against the misuse of Dr. 
 Churchiirs ideas. First, "the hypo- 
 phosphites of soda, lime and quinia 
 are the only ones indicated in phthis- 
 is." Second, "the hypophosphite must 
 be chemically pure and uncombined." 
 Third, "the hypophosphite should 
 only be in the form of a syrup, be- 
 cause this is the only vehicle which 
 will protect it from oxidation in the 
 air." Fourth, "soda is indicated in 
 the incipient stage and lime in the 
 second and third stages, with ex- 
 ceptions." Lime reduces expectora- 
 tion; soda favors it. Judgment in 
 using both is necessary. Fifth, "hy- 
 pophosphites should not be given 
 with any other remedy." Sixth, 
 
62 
 seven grains in 24 hours is given 
 as the maximum dose in phthisis. 
 Seventh, "plethora must be avoided, 
 for it tends to hemorrhage, and, 
 hence, cod liver oil, iron and stimu- 
 lants, when used, should only fol- 
 low the discontinuance of the hypo- 
 phosphites." Eighth, "complications 
 requiring treatment indicate a dis- 
 continuance of the hypophosphites 
 while such treatment is being given." 
 Iron in phthisis is necessary occa- 
 sionally. The anemia of this dis- 
 ease being dependent, however, on 
 a different cause from those condi- 
 tions which bring about anemia 
 through faculty correlation of the 
 constituents of the red blood corpus- 
 cle, as seen in chlorosis", the results 
 from iron treatment in phthisis are 
 often disappointing. 
 
63 
 
 CLIMATE. 
 
 Ozone is an indispensable aid to 
 the successful treament of pulmon- 
 ary tuberculosis. Cities, which have 
 been cleared of all forest growth are 
 not the ideal locations for the con- 
 sumptive to dwell in. Vegetation, in 
 healthy and luxurient growth, ab- 
 sorbs the carbon dioxide and gives 
 out oxygen. Other elements also en- 
 ter into the question of climate for 
 consumptives, such as dryness of the 
 air, altitude and drainage. 
 
 Without entering into a discussion 
 of this subject it may here be stated 
 that the only way to test a given lo- 
 cation recommended a phthisical 
 person to reside in, is for such an one 
 to try the various localities, if prac- 
 ticable, and make a permanent abode 
 in the one which agrees best with his 
 individual constitution. Colorado, as 
 
64 
 
 a health resort for consumptives, is 
 no place for a victim of the third 
 stage of the disease. Fibroid phthisis 
 and bronchial irritation, on the other 
 hand, do not contraindicate resi- 
 dence there. Except in excessively 
 high altitudes the liability to hemor- 
 rhage is not greater than in other 
 localities. 
 
 North Carolina is fast coming to 
 the front as a health resort for the 
 tuberculous, and properly, too. The 
 region in and around Southern Pines 
 presents all the advantages of cli- 
 matic regularity desirable in any 
 stage of the disease. The soil is 
 sandy, the air dry, an invigorating 
 feeling exists from the ozonized at- 
 mosphere, and, being situated in the 
 midst of the pine districts of North 
 Carolina, there is every element con- 
 ducive to health in the locality. 
 
 Southern California has long been 
 one of the most famous health re- 
 sorts in America. Its balmy atmos- 
 
6o 
 
 phere, absence of dampness and equ- 
 able temperature make it a very de- 
 sirable place in which to reside. 
 Other localities might be mentioned, 
 but of these the writer has personal 
 knowledge. 
 
 The application of oxygen inhala- 
 tions, while of some value in the 
 treatment of phthisis, is by no means 
 as satisfactory as the residence in 
 ozonized atmospheres — the probable 
 reason of this being that oxygen 
 given by inhalation through an ap- 
 paratus cannot be constantly applied, 
 and the good that results, for a few 
 hours after this mode of administra- 
 tion has been employed, is more than 
 counterbalanced by the necessity of 
 breathing the normal atmospheric 
 air of the locality of residence. In 
 other words, the oxygen is not ap- 
 plied a sufficient length of time to 
 do more than temporary good. Could 
 a room be so arranged to furnish the 
 patient a continuous ozonized atmos- 
 
66 
 
 phere the results of the cabnet meth- 
 od of treatment might be improved. 
 
 HYGIENE AND EXERCISE. 
 
 Important as are proper diet and 
 air for consumptives, no less so are 
 regulated exercise and hygiene. It 
 is a well-known fact that the more a 
 phthisical person can live out of 
 doors the better are his chances for 
 recovery. Protectiveclothing should 
 always be worn next the skin. A 
 daily plunge bath in cool water fol- 
 lowed by invigorating friction of the 
 skin with a coarse towel conduces 
 to free action of the sweat glands 
 and assists active elimination. 
 
 Moderate dumb-bell exercise, or 
 with chest weights, assists in estab- 
 lishing freer circulation. Fatigue 
 should not be encouraged in the per- 
 formance of these duties, but the pa- 
 tient is to be instructed to stop short 
 
67 
 of weariness. Lung development 
 should be practiced by drawing in 
 air through a quill until the lungs 
 are fully inflated, then allowing the 
 air to be as gradually expired. 
 
 An important hygienic point in 
 the treatment of tuberculous cases 
 is proper clothing. A great number 
 of consumptives think they must 
 clad themselves heavily, especially 
 about the chest, and, with this unfor- 
 tunate idea, they generally wear two 
 or three undershirts of wool, in ad- 
 dition to a chest protector. The re- 
 sult is that the skin of the chest is 
 kept in an unnecessary state of ex- 
 cessive perspiration, which renders 
 an individual the more susceptible to 
 contract numerous "eolds." The 
 whole body should be evenly and 
 warmly clad; silk and wool flannel 
 to be preferred next the skin. Sev- 
 erity of weather to an extent de- 
 manding excessive weight of cloth- 
 
68 
 ing indicates that a patient should 
 seek a warmer clime for a residence. 
 
 Out-of-door life is essential for the 
 welfare of phthisical persons. The 
 sudden changes in temperature ex- 
 perienced by those who live in our 
 northern districts, caused not only by 
 storms, but by the relation between 
 in-door and out-of-door heat, imply 
 additional dangers to the contrac- 
 tion of "colds." For this reason, if 
 for no other, should the consumptive 
 live in warm climates where he can 
 remain in the open air as much as 
 possible. 
 
 Sea voyages are useful in a propor- 
 tion of cases. The exposure and out- 
 of-door life, necessarily led in a 
 long sea trip, are very beneficial. 
 
69 
 
 MEDICATION. 
 
 Elimination is tlie first principle to 
 consider in the medicinal treatment 
 of phthisis, and this relates with the 
 extent of pathological changes which 
 have taken place in a given case. It 
 is essential that an obstruction, 
 wherever it is, be removed. Elimina- 
 tion does not necessarily imply that 
 associate excrementory organs must 
 be called into excessive activity in 
 order that the system may be reliev- 
 ed of stagnant waste. The chances 
 are that good results from this prac- 
 tice will be wanting. Elimination 
 must come gradually by judicious 
 employment, from time to time, of 
 agents which will promote absorp- 
 tion of the pathological agent ob- 
 structing. Nutritious elements caus- 
 ing obstruction by becoming excess 
 of waste must be avoided. On the 
 
70 
 
 other hand, oxidation and organiza- 
 tion of new tissue should be encour- 
 aged. Cure of tuberculous deposits 
 will come by suppuration and absorp- 
 tion, and for this reason we need al- 
 teratives, because such pathological 
 changes exist. 
 
 To a large degree cure can be ac- 
 complished by dietetic and climatic 
 treatment tending to advance nutri- 
 tion. 
 
 One of the most satisfactory meth- 
 ods of elimination and alteration 
 which have been given the profession 
 in late years bearing on this dis- 
 ease is a formula advocated by Dr. 
 Barclay, of Pittsburg, and consisting 
 of the bromide of gold and arsenic. 
 Arsenic is a well-known alterative in 
 phthisis and highly efficient as a tis- 
 sue builder. The late Dr. E. A. Wood 
 presented the therapeutic value of 
 this formula, in all wasting diseases, 
 two years back, in a paper before 
 a Western medical association, the 
 
71 
 
 subject of which was so thoroughly 
 circulated about the country that its 
 quotation here is unnecessary. Prac- 
 tical experience with this formula 
 bears out all the claims made for 
 it. It is not to be considered as a 
 specific for tuberculosis, in any sense 
 of the word, but that it is an active 
 eliminator and alterator there can 
 be no doubt in the minds of those 
 who have used it. 
 
 Iodine has long been established 
 as useful in the treatment of tuber- 
 culous conditions. The syrup of hy- 
 driodic acid, as prepared by R. W. 
 Gardner, gives the most service- 
 able form for internal administra- 
 tion, as it is less irritating to the 
 stomach. Locally iodine may be ap- 
 plied to the lung area by inhalation 
 with ether. Dr. Garretson advocates 
 a few drops of the compound tincture 
 of iodine in equal portion of sulphuric 
 ether, to be held in the palm of the 
 hand and placed close to the nose, 
 
72 
 when the vapor of the ether inspired 
 will carry the iodine to all accessible 
 portions of the lung. 
 
 Other alteratives may be employed 
 with benefit when indicated. 
 
 Symptomatic medication for pul- 
 monary tuberculosis, as with most 
 chronic ailments, is directed to a 
 variety of complications which arise 
 during the course of the disease. For 
 the indications in which it is neces- 
 sary to employ symptomatic medica- 
 tion the physician is to be governed 
 by the individual case in hand. As a 
 rule, the least medication employed 
 is best, attention being directed to 
 nutritional and climatic treatment. 
 
 Catarrh of the stomach has been 
 mentioned and its treatment indica- 
 ted. Catarrh of the nasel passages 
 may be efficiently combated by a 
 diluted hydrozone spray or Carl Sell- 
 er's formula. In acute exacerbations 
 of this affection I have seen good 
 
73 
 temporary results from the employ- 
 ment of the following formula: 
 
 R. Cocaine hydrochlor. grains vi 
 
 Bismuth subcarb. drachms, ss 
 Talc. drachms, iss 
 
 M. thoroughly. 
 
 Sig. Snuff every four hours. 
 
 In chronic catarrh a mild astrin- 
 gent powder or boric acid may be 
 added to the above. Atomization of 
 medications apply to the topical 
 treatment of nasal catarrh. Mr. 
 Marchand has invented an efficient 
 instrument with an attachment for 
 applying ozone, made from glycerine 
 and peroticle of hydrogen. 
 
 Anorexia, dependent on a catarrh- 
 al state of the stomach or the gen- 
 eral debility of phthisis, is not to be 
 taken as an indication that food is 
 not required. This state is often 
 overcome by treatment of the stom- 
 ach, combined with small but fre- 
 quent feedings. Such agents as pro- 
 
74 
 mote digestion, papoid, pepsin, pan- 
 creatin and one of the dilute mineral 
 acids, aid the assimilation of food in 
 this condition and indirectly promote 
 appetite. Gaseous eructations call 
 for the employment of bismuth in ad- 
 dition to the above. 
 
 Attacks of pleuritic pain require 
 sinapisms to the chest wall and mor- 
 phia. When the latter is used less 
 discomfort will be experienced after- 
 ward if atropia is combined. 
 
 Fever, unless excessive, rarely re- 
 quires treatment. The employment 
 of phenacetin often prevents active 
 fever and quiets the nervous system 
 beside. 
 
 Night-sweats, when excessive, tax 
 the patience of the physician, and it 
 will be found that no drug can be re- 
 lied upon to prevent this disagree- 
 able phenomenon in every case. 
 Among those holding an efficient po- 
 sition are ergot, atropia, aromatic 
 sulphuric acid and agaric. 
 
75 
 
 Cough does not call for active 
 treatment. Occasionally, when hard 
 and dry, quieting preparations may 
 be necessary. Nauseating expecto- 
 rants should not be given. Paregoric 
 and the preparations of ammonia are 
 sometimes beneficial. When cough 
 is accompanied with abundant ex- 
 pectoration I have seen good results 
 from the smoking of pure cubebs; 
 the smoke being drawn well into the 
 lungs. Even ladies soon become ac- 
 customed to the use of this remedy. 
 
 Bronchial hemorrhage requires ac- 
 tive treatment. When due to a con- 
 gestive state, remedies applicable to 
 the lessening of blood pressue are in- 
 dicated. If due to ulceration contrac- 
 tion of the lumen of blood-vessels 
 should be encouraged. During the 
 hemorrhage common salt in large 
 doses is generally efficient. Ergot, 
 or ergotin, hypodermically adminis- 
 tered, acetate of lead or tannic acid 
 are recommended. Temporary liga- 
 
76 
 tion of a limb is often useful in con- 
 trolling hemorrhage. This should 
 only be employed during the pres- 
 ence of the physician. 
 
 Symptomatic medication, in this 
 article, has only been outlined. The 
 circumstances of the patient and the 
 peculiarity of this disease require 
 that the physician be one whose 
 sound judgment and educated sense 
 is equal to the task of meeting any 
 symptomatic indication with the 
 most efficient remedy at his com- 
 mand. The most hopeless cases to 
 treat are among the poor, where pov- 
 erty deprives the victim of phthisis 
 of the necessaries for even palliative 
 treatment. 
 
 The primal thought must be di- 
 rected to the restoration of perfect 
 elimination, especially in the locali- 
 ties obstructed. For this reason the 
 consideration of antiseptic medica- 
 tion has been omitted, the author 
 recognizing the fact that very little 
 
77 
 good has been accomplished through 
 this plan of treatment. Certain drugs 
 of the antiseptic class have seemed 
 beneficial at times, especially to ap- 
 petite and digestion. Their action 
 may in some degree be attributed to 
 stimulation of elimination. 
 
 In cannot confidently be expected 
 that any specific will ever be found 
 for the cure of this disease. Phthisis 
 arises from a combination of condi- 
 tions which require a combination 
 of therapeutical measures to eradi- 
 cate. Good sanitation and cleanli- 
 ness are essential for health among 
 the well, and much more important 
 are these virtues among the sick. 
 
PUBLISHED BY 
 
 The Medical Publishing Co., 
 
 718 Betz Building, 
 
 PHILADELPHIA. 
 
 1895. 
 
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